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HomeMy WebLinkAbout020-1055-20-001 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 600222 GENERAL INFORMATION (ATTACH TO PERMIT) 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: ZANE & TRACY jOHNSON TOWN OF HUDSON 020-1055-20 CST BM Elev: Insp. BM Elev: BM DescripyiQn: Section/Town/Range/Map No: 2- GS`~ 21.29.19.203A TANK INFORMATION ELEVATION DATA TYPE MANUFACTUR R CAPACITY STATION BS HI FS ELEV. S Septic r ~ IJ Benchmark IP~7 Dosing Alt. BM POLI-t 10 k_ 57 3• Aeration Bldg. Sewer 7.65 9V, 55 Holding SUHt Inlet 44. 111, P5 S TANK SETBACK INFORMATION T• ?(O 17. '94 TO L WELL BLDG. Vent to it Intake ROAD Dt Inlet 'P Septic Dt Bottom Dosing Header/Man. %•a %-94. Aeration Dist. Pipe S, •9 Holding Bot. System C • Final Grade • 7 PUMP/SIPHON INFORMATION ffi .5• Manufacturer D emand St Cover c• / J8 ~ /0?- GPM Model Number TDH Lift Friction Loss System Hea - 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 T /CMG SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufact r: I~Z INFORMATION -7 1 .Q. CHAMBER OR J Type Of Systemr` A)UNIT Model Num er: Wffs 1- 5, DISTRIBUTION SYSTEM 4-/ d ral\ Head er/Manifold1 1#1 Distribution IX Hole Size ix Hole Spacing Vent to A Intake / Pipe(s) Length 1 ~ Dia Length ` Dia `Spacing ~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over 1xx Depth of xx Seeded/Sodded r Mulched Bed/Trench Center IV Ajig Bed/Trench Edges ~ Topsoil C"']~ No] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: r Inspection #2: Location: 526 CTY RDA C111-A6 4- n t -/fin ~GVU.~ Grsn ~r~ 1.) Alt BM Description 2.) Bldg sewer length = ~L 1+6tJ , \ - amount of cover = / / (1 7 3 o v\. Plan revision Required? [_1 Yes >CNo Use other side for additional information. [ Date Insepctor's gnature Cert. No. SBD-6710 (R.3/97) //~6 CCiEIVED SAN - ~?e 17 - Cotnny G Safety and Buildings Division L C. x 201 W. Washington Ave_, P.O. Box 7162 San4 G ~ f Madison, M 53707 7162 itary Permit Number (to be filled in by Co.) NOV -OMMUNVT ermzt A.pplaGa O stateTransactionN 1191ber In accordance with SPS 38321(3), Wis. Adm. Code, submission of thi ell unit is required prior to obtaining a sanitary permit, n=ote: Application forms for state-owned POWTS are submitted to project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary n purposes in accordance with the Prrvacy Law, s. 15.44{1 (m . Slats. 0/) 4`~'F- L Application Information -Please-Print All Information Property Owner's Name Parcel Fu D c T; b G ~J tr1 had d J~ 0 J J' Property Owners Mailing Address f` A Property Location Imo,` Govt. Lot Ci State Zip Code Phone Number r a '/s Section f circle one) YL 'Type of Building (check all that apply) Lo T a 1 N; R -1 it E or w l~I or 2 Family Dwelling- Number of Bedrooms ! Subdivision'Name Block it ❑ Public/Commercial - Desenbe Use ❑ City of ❑ State Owned`-Describe Use CSM Number ❑ tr,114F of t , 'Town of _ r lA17 IYI. 't'ype of Permit: (Check only a box on line A. Complete line B if applicable) A. _N~Vcw System ❑Relacement S P ystem D Treatment/Holding. Tank Replacement Only ❑ Otlzcr 1%4odification in Existing System (explain) B ❑ Permit Renewal ermit Revision 0 Chauge of Plumber ❑ Permit Transfer to New List Previous Permit Number and Dare Issued Before Expiration Owner ~ Q, L FV. Type of POWTS System/Coatponent/Devire: (Check alt that apply) r I ❑ Non-Pressurized In-Ground Q Pressurized In.Ground ❑ At-Grade ❑ Mound > 24 in, of suitable soil ❑ Mound <24 in_ o£svrtable s i J • r ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (eaTtIain) V. Dis rsallTreatment Area Information: Decrgn Flow (gpd) Design Soil Application Rate(ggds) Dispersal Area Required {st) Dispersal Arr a Pro ased (st) S Elevation 47 U ank Ti►fo Capacity in Total V of Mimafacwrer \ Gallons Gallons Units L o o l Neu& As Existing Tanks a, U ~ u, zn w b !1, Septic or Holding Tani Dosing Chamber iq F_ I_VJL Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans Plumber's Name (Print) P1 cr ignatur IviP/MPI2S Nimbus Business Phone Number Is 6117 Plumber's Address (Street, City. State, Zip Codc) I oun /De artme llse Out Appmved Permit Fee Date ed Issuing Si ❑ Owner Grv on for Denial S A • 7 , C~ 1~. Cord easans for Disapproval 1 t'ark Etflttittie tr►te• F+,[fif 61Sp2r :Sri cell must all be snih s ! r; nt ec as per management plan pro tided by plum, 2. "A I ielbp reWire inen,,s m1jut,iw r'.&r.tt*.jrE as pet Fiktlbli cads / t.rdt~tlhr ?s. F.~aeh sn enmpicfc plans Far @le yysrnm and sabmit ra ttrC Conner nnrv an paper not tom, Man A jr_ I I 11Mhei in s'ue SBD-6393 (R_ 11/11) , M.-41P W ~4 H I I-) C.l,plw K r SI Y~ op-R 'CO i . wl c so) O Or L6 a7 ~ ~A KN 1 ~ c i i Oki v~ W E&, Co Ct~ 78 -s+ r SO 0*4Mqo~ i SO( t =kPJ I I i t: f _ Si.EI!:01(t!(? +.?D ~ ~frt2 ~y'ig~E' PVC vent Pipe NO, Vs-'11 Cap ~ I_era4hirt~~ / ~ ChaaMber f " ~ ii - SyjStCEY, i E~!+tatit~ri !R Fa AL $oil tic tl dL 1 i caach~ts Trt~ch 4 iE IF' Wmuw"" `o 4°Deis. Trench ~ yeatl~s VI'M Or ObSefvaVon Pip-? k M4EaE.ss`'aett.;rZ's And Model ~~lb f h E=ESA Rating ae; chamber SoEi-Al3piicatif)rt Rate • .1 + Soli ' AapEica 1 Qn #'.ate G~3 F►SA dap _ _ libers 0 fC3~irS o~, C,~t?tY1~fS ~~~~3. Pave _ of i i ~f ^s1CIC?nt?~i Al)la'l1Gritlr`'f ; 1 !"EX AND TJTL.E PACE Ploje Ct !Name: _ A -Fl2 PCL,1 Owner's Na, mfg: Owner's Addees-,,~: Legal Deseriptio,.: T mnshil:~ Count : +ubdfvisinn Narnra~ _ Lc3t Number: 1 F'r~rcnl in I dLax-~kh l title Pa d 2 Plot plan Page 3 a7L III Si f y& Cross-;ecid an PP-ge R _ Filter Specs ''ale ~ ~~ain'ten;~n'c•P Insrrrrrtia~k-~rZ _ I ian Pa,c7e 7 C;3ix L , tip Tank I~t~i`ititea't~~cw Fc~rt`Y Pane Warranty pea4l 'JG 9 - CSAP rsr Plat h~~t hr tip : Sefft Tali & H u plaa,:s ()Esl~ilei~l-~'ILrfr~'F+r; ' C Lici~ll,te Numb-ar: ~v Pl1c~rE Nurt~izer rucx~3 Sir~n2~ure Oc-.;irJred {aursuanf kn ;he ; ;_;ar 5cl 1bs~;fara, rl! i i on Ror.en; f~ian;:,a! fn; PC1VnS ~lersinn 2.l) Sf~D-.9D'7fa:5-> '?kt.Qtlo'!} Page 7 J1 I r C, YT - ~c 1-1- ~ 3 7 " Wisconsin D Saf t rofessional Service A ~ ~ Page 1 of 3 Division of In i ~ - r~ DAT60A5MVRFNM 'ORT NOV U 1 Z U 1 i In accordance with SPS 385, Wis. Adm. Code County ' Attach pleteSTp r Cf~M St. Croix com ss than 8 1/2 x 11 inches in size. Plan must include, but not limiillqpp~e nce point (BM), direction and percent slope, Parcel I.D. scale or dimensions, n..o••ft arro I and distance to nearest road. 020 10 20 000 Ref #2491 Please print all information. Revi ed by Date / / Personal information you provide may be used for seconds purposes Privac Law, s. 15.04 1 m . Property Owner Property Location ❑ Lorraine Jacobs - Zane Johnson Govt. Lot NW '/4 NW S 1 T 2 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # Sub Name or CSM# 526 Co. Rd. A 01 na Vol. 28, P g. 6388 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Hudson WI 54016 ( ) Hudson Dail ® New Construction Use: ® Residential/ Number of bedrooms 3 Code derived design flow rate 450 GPD 7 ❑ 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. loading rate. Recommended infiltrative surface elev. to be 96.75'. 1 I Boring # ❑ Boring ® Pit Ground surface elev. 101.18 ft. Depth to limiting factor >102" 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 0-5 1Oyr3/2 none I 2fgr mvfr cw 1fmc 0.6 0.8 2 5-10 10yr3/6 none sil 2fsbk mvfr cw 2fmc 0.6 0.8 3 10-20 10yr4/6 none sil 2msbk mfr cw 2fmc 0.6 0.8 4 20-29 10yr4/6 none sil 2msbk dh aw 1vf,fm 0.6 0.8 5 29-40 10yr4/6 none (grrOs%) Osg dl gw 1vf 0.7 1.6 6 40-102 10yr5/6 none s Osg dl - 0.7 1.6 E Boring # ❑ Boring r ~b ® Pit Gr d surf ac el v. 101.20' ft. Depth to limiting factor >104" 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 0-11 10yr2/1 none I 2fgr mvfr cs 2fmc 0.6 0.8 2 11-22 10yr4/4 none sit 2fsbk mvfr cw 2fmc 0.6 0.8 3 22-44 10yr4/6 none sil 2fmbk dh cw 2fm1c 0.6 0.8 4 44-49 10yr4/6 none gr Is Osg dl cw 1vf,f 0.7 1.6 5 49-65 10yr4/6 none gr s Osg dl gw 0.7 1.6 6 65-104 10yr5/6 none s Osg dl - 0.7 1.6 * Effluent #1 = BOD, > 30:5 220 m /L a d TSS > 30:5 150 rigglL uent #2 = BOD, > 30!5 220 m /L and TSS > 30:5 150 m /L _ CST Name (Please Print) nature CST Number 1 .Ag James K. Thompson 4pi'4 e14 30021 Address Bate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020-5413 October 10, 2017 (715) 248-7767 SBD-8330 (R04/15) 33] Boring # ❑ Boring ® Pit Ground surface elev. 98.26 ft. Depth to limiting factor >98" 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 0-9 10yr3/2 none I 2fgr mvfr cw 1fm 0.6 0.8 2 9-13 10yr4/4 none sil 2fsbk mvfr cw 1vf,fm 0.6 0.8 3 13-48 10yr4/6 none sil 2msbk dh aw 1vf 0.6 0.8 4 48-53 10yr4/6 none gr Is Osg di cw - 0.7 1.6 5 53-98 1Oyr5/6 none s Osg dl 0.7 1.6 J El Boring # F-1 Boring t ❑ 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 ❑ 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 Effluent #1 = BOD, > 30<_ 220 mg/L and TSS > 30:5 150 mg/L ` Effluent #2 = BOD, > 30 220 mg/L and TSS > 30 150 mg/L f A EXiSt~%nC' prx.dl ¢kv! 5 ca/a • / r~~ ~ Co. ed. Lor-~a:ne ~acobs~ Z/ CSM ✓o? 26~, Pay. L388, % 0.'0. aE.ClbIxel)-o- O 1044 t'ow-/0557 zo-op/ s 3 a Y i 0 E,r;s~.,S u~► h be gbanda,ed. 0 b ¢nc~ Mar!(: To of /Yy` 3 ~I Sc~. t!o P.i; C . /aPt. d gr ' ,4SSawted a ftd. =~af1.~.' f s a b . c N ~ Sys£~.~ Arcs '83 / ~ i BZ yB.o'e.Nfeci 343 l -7 1 '9 q~•I' _ Safety and Buildings Division S fi, C~• (y E~w~~~/~ 201 W. Washington Ave_, P.O. Box 7162 SanV ,I ttarS Permit Number (to be filled in by Co.) Madison, WI 53707-7162 ZzZ- PerMit A Y*nI7 State Transaction Number In accordance wi 7![~Ee, submiss Wsog W~P - +mit is required pAguatmermit. Note: Application 8 g (rt "Yo l to oject Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may ;ary u oses in accordance with the Privacy, Law, s. 15.04(1 (m), Stats. { A L A lication Information -Please Print Ail Information Property Owner's Name Parcel 4 ANA K C, NEON 5Z6../A S$ Z-6 - Property Owner's Mai " Address S Property Location I0 ~x ~ C7 City, Sm Zip Code Phone Number ■O{i'!t Lot Rkktfs 0 W ~Y`l ~ ~1 6 ) ~ %a Section (circle one) II Type of Building (check all that apply) Lot n T N; R E or W ❑ I or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block 1. ❑ Public/Commercial - Describe Use ✓ ~ 2's ❑ City of State Owned - wilt, 97` CSM Number 3 ❑ villa`ne of 4 -4 -7 -K Town of JAU pf iJN rc, III. Type of Permit (Check only one box on line A. Complete line ppiicable) 5KL A. Jew System Q Replacement System D TreatmenttHotd' Tan Replacement Only ❑ Other Modification to Existing System (explain) R. El Permit Renewal ❑ Permit Revision L-1 Change of PI Permit Transfer to New List Previous Permit Number and Date Issued f Before Expiration Owner TV. Type of POWTS S stem/Coat oven vice: Cltec a I .90 NNon-Pressurized In-Ground ❑ Pressurized nun oY, do L1 Mound 24 in. ofsuitable soil ❑ Mound <24 in_ of suitable soil El I. v mg Tank O er Dispersal Component ( El Pretreatment Device (explain)/~~ V_ Dis rsalfrrea eat Area Information: 1 Design Flow (gpd) Design Soil Ap cation Rate( Dispersal Area Required (si) Dispersal Area Proposed ( System Elevafiwon a0 Isoo VL Tank Info Capacity in Total 4 of Manufacturer Gallons Gallons Units a g ° I Ne« Tama Existing Tans n c0 i= V 5 ~ °i 7 p., ua rn tz. C7 A., j Septic or Holding Tani; ` vs-enr Dosing Chamber VII. Responsibility Statement- I, the undersIgn some responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI bee' igna a MP/MP RliNumber Bu4siness Phone Number ~ Warn, ~,I o~ad , 0 Plumber' Address (Stmt ity. State. Zi Cod) 3W No~bN W A A VLFI. Gun /De nrtment D E}nf Ppmved Permit FFee Date Is ed Issuing Signature $ #Of'~ ~d ~7 van Reason for enial IX. Cond Disapproval t en. I t~ , '0 6 3 I tityper <S,i cell -.,just all be 5if fc.?s ! roE rota etc' as per i Aragement plen pro t00 by plumber. r , 2. 'AD sclback reCtell'r mAn1S rml,akve ma.nt,,u;frl b Q I P~ Wlimbis c4 d,! / zrdinancsi. 9 Attach to «,mplctc plans for the system and submit to the County only on papernot fen than 8 in x 11 inches in Sire SBD-6398 (R_ I1/11) • ~A h1E ~ ~ e J ~ ~ F'v .S Gig 1 A OR* is4tr 1`4 Cr. t7 e _ t ~ G ' t 1 h Z, o CONVENTIONAL 'OMPONENT DESIGN ResidetltRl AjYt~lic.,afj~r INDEX A.l`O TITLE PACE Project Name: Owner's owner's /address: 50 I eclat Description.- rownshii; bSL~ county: S~'', c:.1c-c►~_______ Subdivision game: Lot Nun'rae'r: P;rrcel FD Number: 1 lrrc~~~'~Cie1 title Pale 2 Pint Plan Page 3 ,'7 enti Guinn & Cros-s- ~ ; Page 5 kliairlb narrc'P infrarrnati x~ Pa4'e 5 farss9:rEn•~i~t P7~ n I Pa ,3 r St. t_,_~ix C ~~ti nk ilt___ r first nerYcw Fc~r~h Page t3 ly 9 _ N@rranty De-eci PL 9 _ C1~1 rr Plet hrrrir~h~r;: Se R TM Hziua-p i~T~aa;'s De,rgrier/C''~~rber: Date: Lien p Ntjmb.pr: ~ Q Pl,crc NhAnnber A6 Signature? ko th4--Ild Doti /1bso;niio n Compo,~ent Lf~r~va! rnr POWtC 5/ersinn 2.D SI3[7--TD'71J.n N.01/7i}. FligE: T f e a+~ 5(1 P-j 1~ 0*4U L 19~.y W~ r P';~ ~ ~ dC~J O .0 /Jbs~ f Idpll ~o O Absorat n ft's j~m Pw vent Pepe i Final Grate Witt) Vent Cap H ChaMber C.. i~ 7S r lq lilt --ft 3 . - s f~r~~ ~~~~~tic~r► S\s, am %flea Leaching (mch E 4" Vent OF abse;vation Pipe Trench 2 Trench ;3 Ulsbckifer And Model FtSA ~atine+. ° Per chamber Sc~r! AP~Rica#is~rt Pete ! - - C- ,qp~d Design Flow, - pdfsq fi Soft APPlica#ion Pat,- EISA ~ 7,S _ CfiaYrtlh3tS . rotas 4~ Ch RfY be FS e Q c F'ae of pa-if+jT $ ea AN•AGS'MENT MAC ppn -°fi - Gl Ir-antri.€ a Sl> gsi lta i ~ r- q Permi~ ~,eptjtD Tank Mantk%=mr ~ t GsRQ. • 1 Rtlar nd,rn Urar Pc Li,~ ct 1A citiM PMRAMMIS n PA ~ 1:~lwen~ ~l4sr Maz~;9t S NM. ber a` p, ,a ( M NA >~t MA ! ititA primp Tpnk Capa 4ty ik 11L F tt~er G,i r u iiG i eoi? t i^.ftz i o N~ r'UTYI[J ~,~EiC'~V'`•.'~'it#73It'><"~-(ruT nn ;N G~trrwe aicrv~ [avara} i -i~ti h1 i F A~J-A ;~Ci n ~ ~ ~ifail l !.ESF.S'~ i`fh$11t.lyEt w3r~', ~Y r ~16L47 i }t 's~S2tIi7~ i ( MA ©ii A gsfi a ~c~I7 ° - a°aw d Pump mmas! NA ~ rMortiei~ auEYS~~"' s Pr~-2~iltlc":7: Liflii: 5tsndra'd ls,-,Rjw it iu'enl.a ~s. C1 ltdf auai k ~i 81 Q Flaw ~t'2C ^a~8, all sr Cry t.i! rTl ~icrCham'ii~61 t3>~},~f311 ~srlMnd t~~iss} ~~[3 mr~li- p NA ( ®Mrr2~! 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(~3} or # • ba In allerAur and 43spwd. ef in WdarEae milth ahepter CSR 1 S , Garr`amts of tlTa yank shen ire rwraved bY~ s e ,._pw4 ga ^ irt9 Tlp $r ig$3tYf$i1~ iti~isresndin drnjnfa'CCaen+a CCCiE, o=4,,sr stsi S s. l ctct in i i t4 rtvk litrilt ~ i~ ,he servicing rei a;itwar~ ~ilta~, r~acYl~rirrat ar Fr'~u~=~ ~ ~~~`l 15 tar;:s, and any serul~s'~B eit iR~arVai,~ ~1~ rtirsnzi?s~$tall ~+~i; r~ 3n(1)Y,^, Li icy.~at+ 55;'Ei? X? ~r~'VS~flGS 4D 'S:i"i8 i'-768t Cffi~j J~