HomeMy WebLinkAbout020-1479-12-000 (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: 605004
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:
Jeff Wright TOWN OF HUDSON 020-1479-12-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
JeA--1 36.29.19.3033
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURE 7 CAPACITY STATION BS HI FS ELEV.
r S
Septic / q
G~ t ti wok.-ser / Z so Benchmark 2.5 16 i~~
OMIN -1 -j AL, I ` Alt. BM
Aeration 7 Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL ent to it Intake ROAD Dt Inlet
eJ
41 AA
Septic ga 2-1 1 _ Dt Bottom
Dosing Header/Man.
Aeration Dist. Pipe
Holding Bot. System
.O
PUMP/SIPHON INFORMATION Final Grade 3• / ".7
Manufacturer Demand St Cover g ! C
GPM Z ,3 ! 7
Model Number
le I--
a 1SJ /d . (o
Tift Friction Loss System He H Ft
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 /C
~V e p ' \
SETBACK SYSTEM TO V P/L BLDG d WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION
Type Of System: CHAMBER OR
~il~{~('i ~Q 60 / 166_ UNIT Mod~W eJ~l~ ber:~ 44
DISTRIBUTION SYSTEM 4-/ ZZ_
Header/Manifold Distribution x 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 177eeded/Soddecl xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
NNIZ2 No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2.-
Location: 605 SCHWALEN DR~ 4/~~9A_ L/•O_
/
1.) Alt BM Description = 40
2.) Bldg sewer length oWle ' W4 f4
- amount of cover = , • 7 G~Jf~ /aa
Plan revision Required? U Yes No y
Use other side for additional information.
SBD-6710 (R.3/97) Date Insepcto ignatur Cert. No.
oUw s a
Y Y ~
~ D County
D Safe and Buildings Division
C ~
201 W. Washington Ave., P.O. Box 7962
~j Madison, W1 53707-7162 Sanitary Permit Number (to be Ened in by Co.)
41 La1Q U ,
-t. Croix cSatj ermit Applicatio State ber
in I is be> submission` of this form to the appropriate governmental unit A-
i0t`t° ova sanitary permit Note: 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 )
oses in accordance with the - Pte Law, s. 15-04(l )(m), Stars. /~1 n y
I. A lication Information -Please Print t All Information 11J 1V_L{I~ ,K,t, 'M\^
Property Owner's Name
Parcel #
00Z r -
Property Owner's Mailing 0 o Address
Property Location
pty, S Govt Lot
Zi
f~ ~ f p Code Phone Number z- /
/r31, j %y Y Section b
e ire
II. Type of Building (check all that apply) Lot # T Ec (!WT
` amity Dwelling - Number of Bedrooms Subdivision Name
El Blocky t
PubIic/Commercial -Describe Use
❑ City of
State aed - Describe U CSM Number ❑ Village of f
Z,6 wn
-z z of
z-Z--+--
III. Type of Permit: (Cbeck ly one ox on line A. Complete line B if applicable)
A. ~~7ew System
acement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B• ❑ Permit Renewal ❑ Permit Revision
El Change of Plumber 11 Permit Transfer to New List Previous Perm itNumber and Date Issued
Before Expiration Owner
TV. T of POWTS System/Com onenUDevice: (Check all that a l y rt a
Non-Pressurized In-Ground ❑ Pressurized 1n-6round ❑ At-Grade
❑ Mound > 24 in. of suitable soil ❑ Mound <?4 in. of suitable soil
E3 Holding Tank Other ispersal Component (explain) g 5
❑ Pretr atment Device (explain)
V. Dis rsal/Trea ent Area Information:
rgn Flow (gpd) Design Soil Application r
dsf) Dispersal Area Required f) Dispersal Area Proposed (sf) Elevat» '
VL Tank Info C ac'
~ in Total # of Manufacturer
Gallons Gallons Units u
New Tanks Existing Tanks Z o J
o a~ s m m
Seppc or Holding Tank / M. Dosing Chamber
VII. Responsibifity Statement- the undersigned, me responsibility for installation of the PORTS shown on the attached plans.
Plulber's Name (Print) 's Signature
s _ MP(1v1PRS Number Business Phone Numb
Plumber's Address (Street, city, state, Zip ) L Lj
unty/De artment Use Only t/
pProved Permit Fee Date sued Issuing. t Signature
Reason for Denial
~i~ZIIS
IX Condi o rov easo qr approval
ep "p ark, e. LIE- ~n5 3 Q~ tr
u` _ a cell ,USt dll be ~_ic s ! tna int r'$S 1/l
.is per :;gar3gemen'. pl n P:o,ioed by plumber. 2 t L
2. All se!ba, k rec4.ir en,~ rnust c t ;rt it.e : IJ r7 f q 7 ~~'f r
as per 4ppknbl cod ! , rri ra:~„ J 1~'
Attacb to compiac plans for the system and submit to the County only oa paper pot Less e 8 r2 z I aches in size
1 /
~ `J $ b Ga~-
SBD-6398 (R. 11/11)
System PLOT PLAN
PROJECT Jeff Wriaht ADDRESS 605 Schwalen Drive Hudson Wi 54016
SE 1/4 SW 1/45 36 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX
SYSTEM ELEVATION 90.0/90.1 7' below grade 5/13/18 4
DATE BEDROOM
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44
BENCHMARK V.R.P. Top of ST manhole ASSUME ELEVATIO 99.5' ilter PolyLok 525
❑ BOREHOLE O WELL *H.R.P. same as benchmark
Scale = 1/4" = 10'
Schwalen Drive
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
QVent
>6" Quick4 Standard
of Cover Leaching Chamber 12 with 20.0 ft2 of Area
5.6ft^2/pair of end caps
4' Long
Grade at System Elevation
34"
Vent B-2
Vents
Failed system
B-3
2-3'X 90' Cells
4 with >spacing
Bedroom
House
30' B.M.*
10'
10' -1
10'
_ 104'
52
167'
172' 24' 40' Property Li e
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 5/13/18
Owner:Jeff Wright
Location: SE1/4 SW1/4 S 36 T29N,R19W 605 Schwalen Drive Hudson
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross 4"ction
4-6. Maintanance anc4!Contingency Plan
7. Existing Septic Torm
Signature
License number #'226900
System PLOT PLAN
PROJECT Jeff Wriaht ADDRESS 605 Schwalen Drive Hudson Wi 54016
SE 1/4 SW 1/4s 36 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX
SYSTEM ELEVATION 90.0/90.1 7' below grade 5/13/18 BEDROOM 4
DATE
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44
BENCHMARK V.R.P. Top of ST manhole ASSUME ELEVATIO 99.5° filter PolyLok 525
❑ BOREHOLE O WELL *H.R.P. same as benchmark
v Scale = 1/4" = 10'
Schwalen Drive
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
Vent
>6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
4' Long 1 5.6ft^2/pair of end caps
Grade at System Elevation
34
Vent B-2
Vents
Failed system
•
B-3
2-3' X 90' Cells
4 with >3' spacing
Bedroom
House
30' B.M.*
10'
10' -1
10'
104'
52'
167'
172' 24' 40' Property Li e
Cross Section of Infiltrator Quick 4 L
eachin9 Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
5.6ft^2 pair of end plates To be >1, above grade
/ Finish grade elevation
Typical Installation 97.5'
Len /
Grade Vent
r 3'
4 Septic Tank
5' Lo5' 5Grade at System Elevation
36Grade at System Elevation
Spacing 5'
2-3' X 90' Cells
Same on other end Observation tubeNent
At end of cell
A
B
22 chambers per cell
System elevations:
A_90.0'
B_90.1'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
PILE INFORMATION SYSTEM SPECIFICATIONS
Owner ,
J r`; Septic Tank Capacity S r al ❑ NA
Permit #
Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms _ ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units &NA Pump Tank Capacity
al ~JA
j Estimated flow (average)(] aUda Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) al/day Pump Manufacturer NA
Soil Application Rate aUda JftZ Pump Model NA
Standard Influent/Effluent Quality Monthly average" Pretreatment Unit O NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD$) 120 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other.
Pretreated Effluent Quality Monthly average Di persal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODs) 530 mg/-
9n- -Ground (gravity) 11 In-Ground (pressurized
Total Suspended Solids (TSS) 530 mg/L ;4Nk ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other:
iMaximum Effluent Particle Size l6 in dia. El NA Other.
❑ NA
Other: Other:
NA ❑ NA
"Values typical for domestic wastewater and septic tank effluent. Other ❑ NA
IAINTENANCE SCHEDULE
Service Event Service Frequency
(Inspect condition of tank(s) At least once every: Q month(s)
Z~ ears (Maximum 3 years) ❑ NA
(Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA
(Inspect dispersal cell(s) At least once eve ❑ month(s)
ry. ~ ear(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: l` ~year(s)s) ❑ NA
Inspect pump, pump controls & alarm At least once every: ❑ y ar(s)s) ❑ NA
=lush laterals and pressure test At least once every: 0 ,meoanth s) ❑ NA
ether.
At least once every: ❑ month(s) ❑ NA
❑ year(s)
~Dther.
[I NA
MAINTENANCE INSTRUCTIONS
:,Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
(Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must
!include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of
immbined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be
visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.
'T'he 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 (J) or more of the tank volume, the entire contents of
I:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
Ill other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
land any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals t Ot
may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thO
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.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will ble
discharged to the dispersal cel(s) 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 cells. 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 performance and prolong the life of the POWT$_
anfiblotics; 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; sari tary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is propertyy
and safely abandoned in compliance with chapter 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 property 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.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compCont
replacement system:
0 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systeM.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by requiried
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the nged
for a new soil and site evaluation to establish a sortable replacement area. Replacement systems must comply with the rule;/ in
effect at that time.
0 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologK a
holding tank may be installed as a last resort to replace the failed POWTTS.
*!h! site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sal and site evaluation
must be performed to late a suitable replacement arse. if no replacement area is available a holding tank may be installed as
a last resort to replace the failed POWTS.
E3 Mound and at-grade soil absorption systems may be reconstructed in plane following removal of the biomat at the infitrajive
surface. Reconstructions of such systems must comply with the rules in effect at that time.
<NYARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NIOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAN UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
/
POWTS INSTALLER POWTS MAINTAINER
Name / , Name /
Phone
SEPTAGE SERVICING OPERATOR LIMPER LOCAL REGULATO AUTHORITY
Name - Name
Phone Phone '7f
This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(t) and 383..54(1), (2) & (3), Wisconsin Administrative Code.
ST. cROZx COUnTy cERTIFI4TIO ZONING OFFICE
FOR UTILIZAT.IoN G AN EXZg,rr MENT
~'1 t i. s i s t O NG SEPTIC TANK
certi f17 Pat I have
l g they inspected the
~ti septic k presen
et.,t.Y
, ~t- -
res i
the ~ upon n a//~--wCe' 1 o `1,ca t e <j
tank and baffles to beinspection own c;f
, certifY that I
functioning Properly. in good have
Condition, and it appears ~O
time serviced: he
ced:
c7
1_t i d flow J
back occur from
yes ~ _Nabsorption
system?
APProximate volume o (If no, skip next line}.
~ r length o f time :
tacity: 1.2 ~y gallons
m.in«t:~s
Prefab Concrete
'on' Steel
~ (If known) Other-
0
IICjC f rZ,
known) rT~
(s, .Z V
ure}
(Name } lease
-
('itle) _ ? print
0l c..7>
(License Number)
l it to be
Statutes) or completed by lice
code) Licensed Disposer S(NR
Plub 145.o6, WisconsiWisconsin n
Administrative
?'lumber (appZyin9 for sanitar
Y permit) certification:
Cri acceptxn
condition J the above
r I certif statement
conform to the y that the tank tot st of g septic; t,,,,
opening qui merits of ILHR 83, s~ MY knowledge w.iJ..1
Name ~ r outlet baff e Adm. Code (except h' for.
5 atu - b/~/
MP/MFRS <-2 /-7
ST. CROIX COUNY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer.
Mailing Address 6>
Property Address
(Verification required from Planning & Zoning Department for new construction-)
City/State Paxcel Identification Nur-iber
LEGAL DESCRIPTION
Property Locations. E
5 w 4 ,Sec. _ T ~N RI W, Town of Subdivision
Lot
Certilfie # 1 v~
d Survey Map # r---
Volume
Page
# -
Warranty Deed # P-1
- Vo [tune _ Page #
Spec house YeS U Lot lint-•. identifiable yes no
SYSTEM 1VIAINTENANCE AND OWNER CERTII,ICATION
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, ii '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 §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zon ing Department a certification form,
owner and by a toaster plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site ed by the
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 113 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 Commerce 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 ye expiration date.
1/we certify that all statements on this orm are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of warr ty deed recorded in Register of Deel;ls Office.
Number be
IT1S
T
(S)
DATE
Y tion that is misrepresented may result Y in the sanitary permit being .re,voked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register- of Deeds Office and a co
reference is made in of the
the warranty deed. PY certified survey map if
(REV. 08/05)
2.20 Acrea.
Sys $ 95,890 SQ. FT. - 65,
F
n
eyJt~~4, dy $I~(0`~lS~t-~~,L / c9~ < yo~ !f
_a
HWL=1039,00 1
p,
rb~ lot
'~iO 24139' ?
208.38' 3909' 172.39' 217A9'
69°2734- 685.48 .~pF P.9',"Oyg.
- - TDn- -_---a-._--- - - /r ~pQt<pt~ W
N89°2T34'W 330.00' d . 0
20650;_ I 1n4.N 13, w V
T TOP OF REBAA ~ _ ~ ♦ m
tv ' I ELEVATION = 1038.38 '
't .........T
5 2.49 Acres
p~ s>j 106,608 SQ. FT. e W
SEENOTEA Z
r 30 33' 33' • GF F LBO=IG48.00 J
97,797 SQ. Fr.'r1y~'G9F~iF p`~1+ $ 2
[ I W L80=1043.504y~'1T 1n n N
r N85°5837'W 222.75 g Q
_ 200,47
14 3 26}
2.13 Acme Q - DRAINAGE N89°53'02'W 160.00' 15.03 b S65`5637.E 03.35 a2
RACMEl51STEV(E4Xt , 4 Q x-
m EASEMENT) ~
92,827 SQ. FT. Z _s 200 .d "
180=,x43.04 J J W - - / N OUTLOTI 5r55637E209.47 30'WIDE
SAN jp ° 39937' -
i 5 a - - - - _ - b}d MEND
% _
S 3 f_ C u°j 0.60 Acres m ~..'"`OA (NARY HIGH 0 MA no
U 8 26,199 SO.FT.I WATE E
A A{Ar
.,._15, I of OPKINAL s.STEM iWX I IQ7
. 30 i4 20' , w~ s>s~rSB,E
fizz
89°53'02'E 2
S87°45'01'EF796T' 6~'8' 'I 2AO3 67A2'_._ DRAINAGE EASEMENT
DRAINAGE 76°Zg
Acres HWL-1044,00
T Ni
87,128 SO. Fr. -
i EASEMENT 48A4' '
- ~ ~ ~ L80=1048.00 SIS°2gr56'F m
o ~ rM1 I r
CRAINAGE EASEMENT
WETLAND
i -i DELINEATION -
N89'50'231 456.12`
_ EDGE S
I - _ 62448' - 158.65' l~ WATER
20 CPANAGEEASEMENT 487,68, M o
110.87 45,83 43. '
E I- El b SOUTH LINE OF THE SW1/4 N895023"E 1316.60' DRAINAGE EASEMEN m N02 Si/4 CORNER N89'33'25"E
-------------------------------------------i~1L SECTION36 1328.80'
N89°5C'23'E 1316.56`
T- SHAPED TURNABOUT IS
LOCATED AT THE END OF I 1 NOTE:
SCHWALEN DRIVE CONTAINED OUTLOT 2 PLATTED FOR THE LOCATION
OF THE COMMON SEPTIC SYSTEM FOR
WITHIN THE REMOVED AT TIME WAY OF AND LOTS 6, 7, 8, 9, 10 611. OWNERS OF SAID LANDS INUNDATED
WILL BE RE MOYEO AT NATURALLY OCCURRING
ROAD EXTENSION. LOTS SHALL HAVE COMMON AND EQUAL NAVIGABLE WATER ARE
OWNERSHIP IN SAID OUTLOT 2. SUBJECT TO THE WISCO
• PUBLIC TRUST DOCTRINI
THE COMMON SEPTIC SYSTEM IS .1 5\~
DESIGNED FOR 24 BEDROOMS` i
LIMITING EACH LOT (6THRU 11)
TO A 4 BEDROOM HOUSE I'A
i
xt:;n DepartmeMof Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
-jr and Building Division
INSPECTION REPORT Sanitary Permit
506343 ` 0
GENERAL INFOIRMATION (ATTACH TO PERMIT) State Plan ID N .
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] r/
Permit Holder's Name: City Village X Township Parcel Tax No: t
Bast, Kernon Hudson, Town of
CST BM Elev: Insp. BM Elev: BM Description: / Section/Town/Range/Map No: - 1
1"96.6 O .8~ ('d .~A . ✓4l/ as , 36.29.19.
TANK INFORMATION ELEVATION DA VA
TYPE MANUFACTURER CAPACITY STATION BS HI FS
Septic Benchmark 3.7
03 / a
Dosing VJ (J~ OI. DIL / Alt. BM 'tv+ a&-r I''~.~ ~i • L- -7~
T73 v ~ C ~
Aeration Bldg. Sewer
Holding St/Ht Inlet
.Z./
e7l
TANK SETBACK INFORMATION SvHt ou~ue_t_
TANK TO gL WELL BLDG. Vent to Air Intake ROAD Dt Inlet Q
l
Septic Dt Bottom #f
Dosing Header/Man. I
Aeration /imp Dist. P'
Holding Bot. Sy /
Final Gra
PUMP/SIPHON INFORMATION J I It -26A .6 9-5
Manufacturer DePMand St G ovrZ /r f- 0 S S
Model Number
` TDH Lift Friction Loss Head TDH Ft 9 0
nakV
O (7~ Sac LL
.
j Forcemain Length Dia. Dist to Well 4 7lln
~ CG
SOIL ABSORPTION SYSTEM
BEDfTRENCH Width TT gth f o. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia th 2
DIMENSIONS t 'ii
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHING Manuf I L~
INFORMATION CHAMBER OR /
Typ~A System: t < Model Number:
D IBUTIOI/NJSvnYYSTEM >w Uj
Headeri nifo Distribution , x Hole Size x Hole Spacing ent to 'r Intakg~ _ -AXA :Pipe(s) `X) '
IF
Length Dia Length O v Oa/ Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of T Seeded/Sodded rMulched
Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: l Lt f 2 / O Inspection #2: 1 1
Location: 605 Schwalen Drive Hudson, WI 54016 (SE 1/4 SW 1/4 36 T29N R19W) Cottonwood South 07 Lot 12 ~ Parcel No:-36.29.19-
4
1.) Alt BM Description = I DP 4 Z lltl~tJt 7 /
- _ n^ L
2.) Bldg sewer length h
amount of cover= ( 'T (i,f" Y~/~,~4~~~ ~ri~►1 t~j►0"''
i Plan revision Required? slrj Yes No
Use other side for additional information. i
Date Insepoor's oignaturee
SBD-6710(R.3197)
RECEIVED
t
cotnmerce.wi.gov 1 arxt B ridings Dtwslon X
2b1 'ashingto Ave.> b0, Sion
7162
fl S /N J! S S . CROIX CO NTi on. 1 53707-7162 S Mr ermit Number (tu be Filled in by Co.}
Department of COMM4 ZONING
State Transaction Number
Sanitary Permit App ication p
In accordance with s. Cumm 83 21(2), Wis. Adm. Code, submission of this form to the sppropt7ate govefnmental A
unit is required prior to obtaining a sanitary permit. Noce: Application forms for state-owned POWTS are ProjeclAddr (ifdiffaentthan mailingruidreas)
submitted to the Department of Commerce. Personal information you provide may be used for secondary
w see in accordance with the Privacy Law, s 15.040)(m), Slats.
1 Applicution information - Please Print All Information tv
Ps vet M
I+ropeny Owner's Navin
Property Owner's Mailing Address ropeny LOCati
City, State Zip Code Phone Number S 1~ Y.. Section b
(circle o
SU1V W~ 7yd 7 ~9_N: R~.ISO WW
II. Type of Building (check all that apply) Lot p
Subdivision Name
t I or2 Family Dwelling - Numl+eror 'eddro/orns
Block q Cp CL 4~1 W C L~~ 1~ 4~ S O t
i Public/Commercial - Describe Use v
Q city of` - j
CSM Number Cl Village of
Q Stale Owner! - Descrilx Use A
is'rown of C"C ,3
a
ill. Type of Permit: (Check only one box on line A. Complete lute 8 if applicable)
A. ew System D Replacement System L~ Treatmeet/Holding rusk Replaoamant Only Q Other Modificstrorm to Existmr. Systan (expbin)
List Previous Permit Number and Ike
B. 0 Permit Renewal Permit Revision 1) Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner (~l7
IV. Type of POWTS Svstem oneit t/Deviee: (Check all that sm~j
Non-Pressurized In Ground ❑ Pressurized In-Ground At-Grade C o nd > 24 i t. o(suitable soil ou e24 of stab soli
❑ Hoidmg Tank ❑ Other Dispersal Component (explain) a+tm -
i V. Dis eraal/1'reatment Area Information: u r C
Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal A ystem Elevation
V1. Tank Info Capacity in Total N of Manufacturer
2v
Gallons Gallons Units a t'
New Tanks ExistutsTanks 4 o y y i
Septic or Holdiag Tank L Qf L Y V
Dosing Chamber w -
VII. Responsibility Statement- 1, the undersigned, assume responsibility for htstallat a of the P S sb wit on the at lied plane. _
Plumber's Name (Print) Plurber's Signature P, PRS Number Business Phone Number
i Cs/►Md
he J.-
Number's Address (Street, City. State. Zip Code)
VIII. unt /De armrest Use Only
Silp
Perot fee ` ` Date is red lssuml Agent 'nature
proved ❑ Disapproved
d Owner Given Reason for Denial
IX. Conditions of AltprovaUReuons for D rn roost
S A/Iaef to sanp`l` Plans to.' fhc system nhtalt tot r County eMy a+papcr not thin a rn x 1 I indw iq sisc
U ytit.C c~G /3/-3/0.7 q 4zt ~ ~-4-,
SBD-6398 (R. 01/07) Valid thm 01109
L
I Vi
087
#2
sconsin SOIL EVALUATION REPORT
Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of _ 3
Division of Safety and Buildings Steel's Soil Service
Attach complete site plan on not less than 8% x 11 inches in size. Plan must County
P paper St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and -
percent slope, scale or dimensions, north arrow, and location and distance to nearest road Parcel I.D. r-N Pending
Please print all information. Revietfk Date 1
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15 04 (1) (m)). J
Property Owner Property Location
Bast, Kemon Govt. Lot na SE1/4, SW114, 36, T29N, R19W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSNV
400 S. Second St. 12 na Cottonwood Ridge South
City State Zip Code Phone Number City Village Town Nearest Road
Hudson WI 54016 715-386-0217 Hudson Cty Rd N
New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 _GPD
Replacement Public or commercial - Describe: na
Parent material outwash plains and pitted outwash Flood plain elevation, if applicable na ft.
General comments Conventional system, system elevation 91.40ft Trenches spaced and depth to code 7.00ft below grade. Or
and recommendations. system depth to be determined acording to depth of sand at the time of installation.
Boring # Ground surface elev. 98.40 ft. Depth to limiting factor 130 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
1 0-44 10yr3/1 fill material Sil na na Cs lvf .0 .0
2 44-58 10yr4/4 none sicl 2msbk mfr Cs na .4 .6
3 58-68 7.5yr4/4 none SI 2msbk mfr CS na .6 1.0
' - - _ - -
4 68-88 7.5yr4/4 none grcos osg mvfr CS na .7 1.6
5 88-130 7.5yr4/6 none ms osg ml na na 7 1.6
.I F2 ] Boring # Ground surface elev. 98.40 _ ft. Depth to limiting factor 130 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G_PD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. EH#1 Etf#2
I
1 0-67 10yr3/1 fill material sit na na CS lvf .0 - .0
2 67-74 10yr4/4 none Sid 2msbk mfr CS na .4 .6
3 74-87 7.5yr4/4 none grcos osg mvfr CS na .7 1.6
4 87-130 7.5yr4/6 none ms osg ml na na 7 1.6
* Effluent #1 = BOD 5> 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L
CST Name (Please Print) - Signature: _ CST Number
David J. Steel 248956
Address Steel's Soil Service Data Evaluation Conducted Telephone Number
1699 150th St New Richmond, WI 54017 11/29/2007 715-760-0347
Snn-eslc iR ovaa
r -
°rope,ty Owner Bast, Kennon Parcel ID # pending Page 2 of 3
a Boring # Ground surface elev. _98.10-_ ft. Depth to limiting factor
130in. Soil Application Rate
Horizon Depth Dominant Color ! Redox Description Texture Structure (Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr Sz Sh. ER#1 Eff#z
1 0-42 10yr3/1 fill material sil na na cs ivf .0 .0
2 42-48 10yr4/4 none slcl 2msbk mfr cs na .4 .6
3 48-63 7.5y r4/4 none sl~ 2msbk mfr cs na 6 1.0
4 63-82 7.5y
r4/4 none grcos osg mvfr cs na .7 1.6
-
5 82-130, 7.5yr4/6 one ms osg ml_ na na 7 1.6
❑ Boring # Grounds rf c elev. ft. Depth to limiting factor in. Soil Application Rate'
Horizon Depth Dominant Color Re o escriplion T lure Structure Consistence Boundary Roots _ _GPD/fl'
in. Munsell Q . S ont. Color Gr. Sz. Sh. Eff#1 Eff#2
❑ Boring # Ground surface elev. ft. Depth to limiting factor _ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure (Consistence! Boundary Roots I GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 I `Erf#2
I
i
' Effluent #1 = BOD5> 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 'I' I'Y 608-264-8777.
SLL is Soil Sernce
sao-enn la rvro[p
i
STEEL'S SOIL SERVICE 3 of 3
David J. Steel Kernon Bast 1699 150th St.
CST-POWTSM SE1/4,SW1r4,S34,T329,R19W New Richmond, W1 54017
Ne. 41248956 To«m of Hudson, St. Croix Co. Direct 715-760-0347
Cottonwood Ridge South Lot 12 Fax 715-246-0318
Legend 1\
I"-40'
♦ = Benchmark Ele. 100.00 11
Top of 3/4" PVC pipe
• = Alt Benchmark El 100.00 ft
Top of 3!4" PVC pipe
z-- - % - j ❑ Borings
Boring Elevations
~;7 B1 = 98.40 ft
B2 = 98.40 ft i Y
B3 = 98.10 ft
B4 0.00 ft
t 61 V,
VU
,L ~t7
h
1
4~,P5Yy s
ti
f ~ 01 r
1115 ~
z' g
4