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HomeMy WebLinkAbout020-1002-50-020 (3) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (p~Sbzl GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID Nc: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Permit f leWiNt;: City Village Township Parcel Tax No* i Y TOWN OF 6Z'0-100Z-:56- CST BM Elev: Insp. BM/Elev: BM Description:✓ ~ Section/Towri/Range/Map No: 9av d TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , 1 B chmark Y. SZ Lje t/l Zad ✓ (4 a/ 7 Dosing o `oa T&-) Alt. BM /d 3- f d W- Bldg. Sewer Holding St/Ht inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 14 Dt Bottom Dosing H ader/Man. a ! Y Aeration Dist. Pipe Holding Bot. System O ! "'I PUMPlSIPHON INFORMATION Final Grade G -1 mo -np Manufacturer &0 De andy St Cover J GPM Model Number A411 AK 1,17.7' Z ,la C/ TDH Lift Friction Lom,5 System H@apl~ TDV, t 77 ~P Forcemain Len th Dia.Z I Dist to Well SOIL ABSORPTIOI`j SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dial Liquid Depth DIMENSIONS jtj 3 ?b 1 7- ff4e,411ii, SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. ~1 1 INFORMATION CHAMBER OR y 6a Type f System Io + 'Z' In UNIT Model W 6,t .0j cle- -4 So I ~JG DISTRIBUTION SYSTEM L. Z z Header/Manild Distribution x Hole Size x Hole Spacing Vent to Air intake ' Length~_ Dia Pip Lee(sth) Dia Sparing_ I - 14 SOIL COVER ( x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over Txx De pth of Seeded/Sodded Mulched Bedrrench Center Bed/Trench Edges psoil~ Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: j i _ r JQ C~. lit 1.) Alt BM Description V 2.) Bldg sewer length - amount of cover 4 Plan revision Required? ❑ Yes >~No Use other side for additional information. (0 cuuu/ff~~~/ Date Insepctor' nature Cert. No. SBD-6710 (R.3/97) 20- bduoy St Yxm Diva m County 1440 E Was~gton Ave , C' Ol y 3 0 2018 P.O. Box 7162 5xwsry Perron Number (to be filled in by Co.) Croix County n,5370?-7162 JO~O~ ani dry Permit Application sb~aTsaact;atN,mber In woordence with SPS 3&321(21 Wis. Adm. Code, wbmissi m of dAs form to the approprisa goverrow=w unit A/A is required prior to obeaauag a smeary permit Note: Application forma for stasa.owaed POWYS m submitted to Project Address (if diMrcuK than owtl; * s&kw) the Dcwtmc% of SaJtty and PM&SPO q Services. Pemantil itihmubm you provide may be used for sectariwy OgMmin atxatdmCe vib die ftrvaq Irv s. I S. 3 m Stets j~ krda I. AppHaWoz Ia n - Please Print Ail b&rwtbn J Pemy roperty Omia•s Name ~ parod f I 1 M 59PZGy .b. W 41 D ZD "I DOZ-St7-- 0-:?D 44AUJI Property Owwter's Mailing Addmas Property Location C q, 15. . 5 TT---W 5140 / f; C& UAN!r:, _ city, state Zi Cade Phone Numbs Govt. W p section Q7 HuUS~~V LV-T- -4 circle TqN; R1!_E-& fZ ype of Baiidiag (eDtcit ali 1th:i appty} , J Let Y I or 2 Family Dwelling - Number of Lf Subdivision Name $Zock El Pubh,-Comnerciat - D..,i a tlsc 0 city at ❑ state - Dube Use CSM Number D V alaoe of -114,0 Z 'S~ ~.Z+ZZ 23 -firg$ .~Ta,~a€ ff ctt lV IIL Type of P-wk: (Cimck ealy me s an Ohm A. C wplete Use B if appKmble) A. 0 New System Rrptaaenxs t system 0 Treetmeowiok 4 Tack Rnplao®Mst okay Q Odw Modifxwtion to Fxrshng SysCaa (explain) B. D Permit Reasewai D Permit Rc"Sion 0 QwWof Mun-,bc D Permit Tn%vn*r m New List Pfmots Permit Nuaba wA Date Fsm ate EqisaCOn Owner 5-150q5 q- J-4-o q IV. T of POWIN S M beck al3 an Pr~+nizea bt coo mct CI Ae-zmedb-Qnund D AW ade 0 M0UDd> 24 m of =bole sail 0 round < as ia. err all ` Q Holding Tack Other Componu t (explain) 0 Nwmbwm DeYite v. Aare Iaforntation: Design Flow _.r t 7F e DOW 3°d ©i m Ram( -W Am g t4) Di~wmg Ant Fraaas,ea sysamr F~evatbn -d& D ~~?15- 'gyp? • ~I3. 3~~ VI. Taak fate cap" in TOW l of ~ Gallons New Tails Taks t.allceta Units ~jnr /~1 U o 0 rzota t 5 . V(t_ w. 1....aa- +w ..»...F My Aw o n..t ue rOw7a n.ws errs tee aepeaei Pi- Plumber's Name (Psis}) Pf s -tat hiM- Number gum Ph. Number Plumber's Added (Street, City, State. `Lip coda) ~ _ Z y 10 -S E. G'H IPPLaUA 5-7, . MD 0 t7` ;t` vin. corm rtmeal Use 2 7 only Fee Dane Reason for Dmis1 C& 6 l $ Wertriii cell must A 4L" L%" ! jt. 4 n g Of PK Y+a Sgernent plEn pxr4ded by pluiflbe . 2. Aktid*rkt Ak6*w4m tnu W,raertsi .vj I* portlppif M9 cadet 1 ~:rdnnmss. Aam* IV ~ PIM tar as a2Ngw ad 0whow w tie oai7 OR paler sae leas Nrra a H z t r isdea is tie SFAD-6348 (it 09t14) Plot Plon ~ Page z o f A' Property Owner { I"= 4Dft Legal Description {except w re note ST Ctntr 1kASCQ SIAJ. ate-1002--fD--020 North ~s~vrv• \ -r 3o a " t.0 3' x~o' b2 m t{rZA-r7-&&Y L_AA19 PAGE 1 OF 5 In-Ground Dosed-Gravity Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10705-P (N.01101, R. 10/12) Pg 1 of 5 Index & Cover Sheet Pg 2 of 5 Plot Plan Pg 3 of 5 Dispersal Area Cross-Section & Plan View Pg 4 of 5 Pump Tank Specifications (oN FJCF~ Pg 5 of 5 Management Plan (vN Fla) Attachments: Enclosur Pump Curve ou Fl POWTS Application for Review Pump Specs ov >=1t~ Soil Evaluation Report & Site Map Fitter Specs Art Tank Specs r' Infiltrator Specs Project Name / Description ~ 5 A An-A a c F -I LC-) Owner Name(s)• 1Z9E56rE L\~_KM 6ek , Wt ITS Phone: - Owner Address: 3110 Kt2s~`fTt-~ LAk ` zip: Project Address: C SA And Govt. Lot: 1/4 of Sv) 114, Section a'J , T Zq_N-R_g ]or Wfi~ Township: ilubsmj County: 5'. CX0 Project Parcel [D#:. 020-1002---5-0-02-D Designer Information Designer Name: Mary ,Ira Huppert Phone: 715 _426 -1775 Designer Address: 28497 King Arthur's Court, Danbury, Wl Zip: 54830 E-mail: hollisterdesign @outloolccom , 4it ytt~~rYy~t,: 1859-007 License Number: MARY JO Remarks: Huppeff DIM a 1 =.RIVER FALLS ! Pill . 9y ~~1GNt'~'` / iq'4if~~,{ntr~m+a~cdSignature: ©ate: S =zs = ~o~~' .4,,Wm tog" on eeh sub d copy. 55XF PAGE 3 OF 5 LU W c I- cn .S~ T U_2 E ol 0 ~v C L n Sub Q 7 ^ 0 vi Z Z W a W 0 r cn Z, ~d C. , a_w Q ~ ~ ~ I I ~ tl d~ i~ Q W CL 0 ~ o I I o it a ~n ` i I O 4 cn -0 I C b r O Q I I Z Q M .6.0 x 1 w o ~ a > Q t I t(}W I I v w V 'S ( I Z o n 3 N Q I W LU w, O 11 fl Q. N o I Q 5 f7 m } cn Z r1l tf3 + I Plot Plan Page Z o, f4" ProperFty Owner Roe&E WHr~ l"=4Qft Legal Description,, {except w re nntert7 Tot 5NI/~f~>,'f zqj, is tutu, 1-bWAI OF -H W>SIW 4 r ~i pit :S aMtj( MIMTY set~as~u. 'Q.Q-1002--5D-020 North ~_~ssUM~~ (00.00 ` ~~,~vdG //.l~~ o 41 If'Ll 3+iC4Gj T1c~ryCN~ T~uYth1_ ~2~JUC#£~ rb2 CSt GRW gr C I DIVISION OF INDUSTRY SERVICES artrt:T~ PO BOX 7162 MADISON WI 53707-7162 ContactThrough Relay http:Udsps.w.gov;programstindustry-ssrvicns 1 y'., ~ $ /,wI www.Nnscansin.gov Scott walker, Governor hrsio~? i i Dave ROSS, Secretary May 08, 2015 eus'r ID No. 1316956 DAVID LLi.NTL GOVT AFFAIRS DFIrT INFILTRATOR SYSTEMS INC 4 BUSINESS PARK RD PO BOX 768 OLD SAYBROOK CT 06475 Identificalion Nuinbca Tzatrsaction ID No. 2534224 Site ID No. Please refer to both identification nutr4wrc, Re: Description: LEACHING CHAMBER e with the agency. l Manufacturer: INFILTRATOR SYSTEMS INC. above, in all cvrres orSde ru Product Name: QUICK4 PLUS STANDARD, QUICK4 PLUS STANDARD LOW PROFILE (LP) LEACHING CHAMBERS AND END CAPS (trans. id 2534224) Model Number(s): QUICK4 PLUS STANDARD (INCLUDING QUICK4 PLUS ALL-IN-ONE 12 ENDCAP WITH TOP.. END, OR SIDE PIPE INLET CONNECTIONS USED SINGLY OR IN PAIRS AT ENDS OF CHAMBER LINE, OR AS A MID-CHAMBER LINE CONNECTOR) AND QUICK4 PLUS STANDARD LOW PROFILE (LP), (INCLUDING QUICK4 PLUS 8 ENDCAP WITH END PIPE INLET CONNECTION USED SINGLY OR IN PAIRS AT ENDS OF LINE; AND QUICK4 PLUS ALL-tWONE 8 ENDCAP WITH TOP, END, OR SIDE PIPE INLET CONNECTIONS USED SINGLY OR IN PAIRS AT ENDS OF CHAMBER LINE, OR AS MID-CHAMBER LINE CONNECTOR) QUICK 4 PLUS STANDARD, DIMENSIONS; 53.0 IN L. X 34.0 IN. W X 12.0 IN H; MAX. DEPTH OF BURY= 8 ft. [EISA for chambers with or without fabric = 20.0 sq. ft./chamber, EISA for Quick4 Plus All-in-One 12 Endcap installed at the ends of a chamber row = 2.6 sq. ft./end cap, EISA for Quick4 Plus Alt-in-One 12 Endcap installed in-line within a chamber row = 3.6 sq. ft./end cap; Laying length of chamber = 4.0 ft., LayirKj length of Quick4 Plus Ail-in-One 12 Endcap installed at the end of a chamber row = 1.5 ft., Laying length of Quick4 Plus All-in-One 12 Endcap installed in-fine within a chamber row - 0.9 ft., QUICK4 Plus Standard Open Bottom area = 9.72 sq, ft./chamber, Quick4 Plus All-in-One 12 Endcap installed at the end of a chamber row Open Bottom area = 3.1 sq. R./end crap, Quick4 Plus Alt-in-One 12 Endcap installed in-line within a chamber row Open Bottom area 2.2 sq. 01.1end cap; SEE ALSO ATTACHMENTS). QUICK 4 PLUS STANDARD LOW PROFILE (LP), DiMENStONS: 62.0 IN L. X 34.0 IN. W X 8.0 IN H; MAX. DEPTH OF BURY- 8 ft. [EISA for chambers with or without fabric = 20.0 sq. ft./chamber; EISA for Quick4 Pius Alf-in-One 8 Enclcap installed at the end of a chamber row = 2.3 sq- ft.lend cap; EISA for Quick4 Plus All-in-One 8 Endcap Installed in-fine within a chamber row = 2.0 sq. ft./end cap; EISA for Quick4 Plus 8 Endcap installed at the end of a chamber row = 0.7 sq. ft./end cap; Laying length of chambers = 4.0 ft.; Laying length of Quick4 Plus Ali-in-One 8 Endcap installed at the end of a chamber row = 1.1 ft.; Laying length of Quick4 Plus All-in-One 8 Endcap installed in-line within a chamber row = 0.9 ft.; Laying length of Quick4 Plus 8 Endcap installed at the end of a chamber row = 0.4 ft.; Quick4 Plus Standard Low Profile Open Bottom area = 9.77 sq. ft./chamber; Quick4 Pius All-in-One 8 Endcap installed at the end of a chamber row Open Bottom area = 1.4 sq- ftJend cap; Quick 4 Plus AlHn-One 8 Endcap installed In fine within a chamber row Open Bottom Area = 1.2 sq. It./end cap; Quick 4 Plus 8 Endcap installed at the end of a chamber row Open Bottom Area = 07.4 sq. ft./end cap SEE ALSO ATTACHMENTS] Product Fite No: 20150111 2534224 DAVID LENTZ Nee 2 5fw-()15 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of May 2024. This approval supersedes the approval issued on 11/11/2014 under product file number 20120137. This approval is contingent upon compliance with the following stipulation(s): • This product must be installed in accordance with the manufacturer's printed instructions, product approval, and plan approval. If there is a conflict between the manufacturer's instructions and the product approval and/or plan approval, the product approval and/or plan approval will take precedence. • When this product is installed in a dispersal cell that is sized based on the EISA rating stated in the regarding block of the product approval letter, this product must receive wastewater having a SOb5 value less than or equal to 220 mgll_, a TSS value less than or equal to 150 mg/L and a FUG value less than or equal to 30 rttg/L on a monthly average, • When this product is installed in a distribution cell that is sized based on the EISA rating stated in the regarding block of the product approval letter, this product must be installed in individual excavations that create a row of chambers that are horizontally separated from other rows in other excavations by at least 3 feet. The 3-foot measurement is measured between the closest outside edges of the leaching chambors. • When this product is installed in a distribution cell that is sized based on the EISA rating stated in the regarding Mock of the product approval letter, the distribution cell design must allow at least six inches of ponding in the chambers without backflow of wastewater into the drainpipe that discharges into the chambers. • When this product is installed in a distribution cell that is sized based on the EISA rating stated in the regarding block of the product approval letter, this product must be installed in a distribution system. which has the top of the distribution cell at or below original grade. • When this product is installed with geotextile fabric on the sides of this product in a distribution cell that is sized based on the LISA rating stated in the regarding block of the product approval letter, the EISA ! rating with fabric must be used to size the system. • When this product is installed next to each other in a distribution cell that is NOT sized based on the EISA rating stated in the regarding block of the product approval letter, the effluent distribution area is equal to the length times the width of the chambered area. The use of geolextile fabric in this type of installation is optional. • When this product is installed with geotextile fabric on the sides of this product in a distribution cell that is sized based on the EISA rating stated in the regarding block of the product approval letter, the geotextile fabric must meet all of the following specifications: Geotextile shall be non-woven Weight shall be 0.35 oz/sq yd to 1.5 oz/sq yd Apparent openiN size (AOS) shall be 20-30 U,S. Sieve (ASTM D-4751). • For mound designs, see the manufacturer's propriety mound component manual for this product line. • For mound designs, see the manufacturer's propriety mound component manual for this product line. DAVIT UN771, Nge 3 5N20t5 253422ft The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincoroly, Glen Jones, M.S. POWTS Product Reviewer phone: (608) 267-5265 fax: (608) 267-9723 email: gien.jones@>wi.gov The DSPS is committed to service excellence. Visit our survey at: www.surveymonkey.com/s/dspsiscustomersafisfacton i l i i ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address "v-;~ r~ (Verification required from Planning &Zoning Department for new construction.) k City/State tA) - Parcel Identification Number L (,,r f 2 ~ - CDC LEGAL DESCRIPTION Property Location,_S y4 , _S~ Sec, r % r r T 1N R V4 ~ , Town of 1 I tr nli Subdivision Plat: , Lot # Certified Survey Map # , Volume Page # Warranty Deed # (before 2007)Volume . Page Spec house Dyes 01o Lot lines identifiable ❑yesEl 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. I/we, 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 is form are true to the best of my/our knowledge. I.'we am/are the owner(s) of the property described above, by virtue of a rranty deed recorded in Register of Deeds Office. Number of bedrooms SI 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 tl~ following residence: (Street address) located at: '/4, fL ~ 1/4, Section own _N, Range W, Town off , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. i' Most recent date of inspection or service ! Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: C, FC C Construction: Prefab Concrete Steel Other Manufacturer (if known):,( Age of Tank (if known): Permit number (if known) (Licensed Plumber/ gnature) (Print Name) t-1 C 3-7 (Title) (License Number) MP/MFRS (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Wisconsin Department of Safety and Professional Services Division of Industry Services SOIL EVALUATION REPORT Page I of 2 in accordance with SPS 383, VVrs. Adm. Code COY ST. CRt7IX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizonU reference point (BM), direction and Parcel ID. 020 - 1002 - 50 - 020 percent slope, scale or dimensions, north arrow, anti location arxi distance to nearest road. Please print all infixrtlatfon. Reviewed Date Personal intimation you provide may be used for sccondwy purposes (Privacy law. 9.15.04 (f) (rn)). G el Property Owrver Property Location ROBBIE D. & KMBERLY D. WHrlE Govt. Lot S1: 1/4 SW 14 07 T 29 N R 19 E (rx)W Property Owner's Mating Address Lot # Block # Subd. Name or CStir1# 340 Krattlcy Lane 2 23-5598 City State 7rp Code Phone Number [I Village own Nearest Road Hudson WT 54016 ( ) Krattley Lane N. Construction Use; Roside,ntiai / Numaw of bedrooms 4 Code delved design flow rate 600 GPD Replacement Pubin or commercial - Describe: _ Parent material sandy Fk)eed Plain elevation if applicable NA ft- General comoieft Conventional In-ground trenches 0.7 loading rate and recommondatiorrs: Boring conducted to verify soil conditions for replacement area. 4 ( Boling # El Boring L_J Pit Ground surface elev. 97.30 fL Depth to Hm&V factor 90 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture StMxAure Consistence Boundary Roots GPDHf in. Munsell Qu. Si. Cont. Color Gr. Sr- SK 'Eff#1 'Eff#2 1 0-10 I0YR3/3 - sl 2fshk mvfr - 0.6 1.0 2 10-30 10YR4/4 sil 2fabk mfr - 0.6 0.8 3 30-90 t4YR4/6 s Osg ml 0.7 1.6 1l lid F_9 Boring # Boring (;j Pit Grtxrrrti surfatxs elev. ft. Depth to limiting factor in. Sal ication Rate Horizon Depth Dominant Cat Redox Description Texture Structure Consistence Boundary Roots GPDAF in. Munseli Qu. Sz- Cant Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 < 224 mgtL and TSS >30 < 150 rrugrl 'Effluent #2 = 80D < 30 mA and TSS < 30 nx g/L CST Name (b=lear a Pint) Sig CST Number MARY JO HUPPERTI Hollister's Soil Testing&Design) -74832 Address Date Evalua ' Conducted Tekephorw Number 28497 King Arthur's Court, Danbury, W1 54830 05 - 11, 2018 715-426-1775 S13"330 (R07A 3) Plot Plum Page z oft Property Owner `K, iE Q~1 KA B F.,6. , . WHIE' I40ft Legal Descriptions (except where noted) pic- 6q14 s ~C 07, r lj Aj t) "GiaArZq..k' rq 7-D u, N unson, - pit 1(,, Wx-S 00Q AJ. C) ZQ-1602- -s50 0ZO North 31'0 KR 77t }t va~r~ 3r 3 1RCKE5 (00W ~.TvPor ~X►s'CtN ~ v \ q7.~a _ -a! T. f F rT $2 ~ test kn~+Tr~~y t,.hNF i I f _ WisconsinfdepartmentofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515048 0 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 X Township Parcel Tax No: Johnson Land Develo ment LLC Hudson, Town of 020-1002-50-020 CST BM Elev: Insp. BM Elew BM Description: Section/Town/Range/Map No: ~oZ•S 07.29.19.5A20 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER Aj CAPACITY STATION BS Fp FS ELEV. <j4 o!d! /.06 Septic , T-, 6 Benchmark • ems- ' JZm -r a F S. 35 107• I z)Z . 5 Dosing Al. B C. !0 860 t Go 75 /As. j '03.4 { pet.len Pd La k. SZ Bldg. Sewer 7.77 b . 17• Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic o 76 .1~ 56 / k Dt Bottom /Z • 0 75 05 Dosing 76 A* 3 14 3d Header/Man. 4 •7 Aeration Dist. Pipe t~ G , $•7 9 S ~ Holding Bot. System 1-7 `I • PUMP/SIPHON INFORMATION Final Grade ~•3 03. Manufacturer C J S GPM Demand St Cover a s f b3 Model Number , ■ L~ TDH Lift Friction oss System Hep(I JTDH,f yt Forcemain Lengtht Dia. 11 Dist. to well 7 2 SOIL ABSORPTION SYSTEM BEDITRENCH Width Length, No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 H 4-90 2 !ay SETBACK SYSTEM TO WLO~JA P/L BLDG WELL LAKEISTREAM LEACHING Manufacturer: INFORMATION Zy JJ CHAMBER OR UNIT Model Number: • T~D/t ste d Md~ ~5 ~T AM v • crfc DISTRIBUTION SYSTEM v $ & ZZ a 15 Header/Manifold, 11 7Distribution x Hole Size x Hde Spacing Vent to Air Intake Length ~u Dia ` Dia ` Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only s. Depth Over Depth Over xx Depth of 1XX SeededlSodded r Mulched Bed/Trench Center Bed/Trench Edges Topsoil q . p j~ a No ryes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: (0/ ! / O ( Inspection #2: Location: 340 Krattley Lane H dson, WI 54016 (SE 1/4 SW 1/4 7 T29N R19W) NA Lot 2 Parcel No: 07.29.19.5A20 1.) Alt BM Description = F~ I COJ~' G~,~,q •t.~ S a 2.) Bldg sewer length =33 I e L 4~ v - amount of cover = It Y n r -q -I Plan revision Required? Yes No I _ ZL t Use other side for additional information. L `s' , _ ~J J Date Insep rs Sig a Cart No. SBD-6710 (R.3197) outkatstael.tirl.yov Safety mid Building Division county 201 W. Washington Ave., P.O. Box 71162 scons, n Madison, WI 53707-7162 ga y p pp ~ be filled as by Co.) - 5/ QzPF Sanitary Permit Application State Trmsacdmt Nainim in accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of" form to the app oprisse govermaawl unit is required prior to obtaining a sanitary permit. Note: Application forma for awls-owned POVM are Pmject Address (ifdiffamt than nailing ) submitted to the Department of Comnx=. Personal information you provide may be used for AJI purposes in awordow with the Pd Law 15. 1 m StMs. * Q I. A a fi for ratios - Pleme Priat All Information ! ~.J Property Owner''ys-Nafne ~pluvclf ~0 CT a,- U t le ~LI J Property Owner's Mailing Address E-"' ',c : ve /Qej" RECEIV 1 SA-Zo Ckr&LM coy, state zipcode PhmteNumbr APR 13 ZD 9 r y~ t l y, f Lc S yGl N; R I j3 E Qi~ IL Type of Building (eba& A dot apply) p~ L'o ST CROI)(COUN Ta 01 or 2 Family Dwelling - Number of st,a NNING 8 ZONING Nsrne ❑ FublidC'onarxrcisl - Describe Use Block I City of ❑ State Owned - D.O. Use CSM Number ❑ VNtage of V ~ ~~.Q.>:j r-✓ k Z ` „„,~pG ©Town of III. Type of Permit: (Cheek oniy one ba N ise A. Complete We B if apPiabk) A. New 3ystern Replacement Treapnas/fiokNng Tank Replacement Qniy tNher Moditicadrm b Existing 9yatem (explain) Sys- B, Permit Pamir Revision Clangs of Pemu Trwfa b List Pcevio n Pamir NOS and Daft lamed Rem wsi Before Plumber Nets Oatna I on IV. of POW" t/Daviee• cYeek ass that NEW Non-Pressurized [,o, ,w Presatrized )n43rurtnd At-Grade Mound ? 24 in. of suitable soil Mound < 24 in. Of anisble sell ❑ Folding Tank Other Disposal ' ponrrt (explain) Preueamndm Device (-11111JR) i , V. Vfrea tAraHtfesantlon: d- I design Flow (gpd) Design Soil Application epe ial AORe WAW (sf) Dispersal Atea (a~ s mm ElevationLC Vl. Task Info Capacity in Total A of ~Mrawfaetura Maoerial Gallons New Tanks Sxis fag Tacks (lallons U°ns ! o /U Septic or bolding Teak .2 5 d Dosing C3reber ~d ~l4 ~G s'c r VII. Raptsmilb" Statemwt- L she radessipasd, asearae tsr Uslatlallan of 14 POWT$ alt she a1 "law, Plumber's Name (Prior) Pluatter's Si lMPRS Nmumber Basirress Phom 1!hober PhmdW& Address (Street, City, State. Zip Code) V)31 Coss t Use XApproved Pamir rune Date -.DanielforDisapprwal / 3, 137✓tt f kJ~C~o ~(oJ~ ^J 1. septic tank, effluent filter and dispersal cell must all be servtcaa / maintained as per mepagemertt plan p wAdod by plumber. r' 2. M sa11backtaqukMhants rrtw( be ms0ttaWod ( tiro Auaelt w estapkte plans tt<Ae slats mul wis'M so As C"" a+s nr Mss subs dm a us:1 r t.elrss r aloe SBD.6398 (R. 01/07) Valid thru 01/09 SEPTIC TANK & ,PUMP CHAM IQN AND SPECIFICATIONS i „ WEATHERPROOF 4" CI VENT PIPE 12 MIN. ASQu-9 Q ? 25' FROM N40R, WINDOW OR JUNCTION WITH BOX CONDUIT APPROVED MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK B FINISHED GRADE WARNING LABEL 4" CI RISA .._.4„ MIN. 18" IN. 6++ MAX. INLET ~WATER TIGHT SEALS raAS TIGHT + vAPPRAVED SEAL JOINTS WITH 'IPROVED ALM APPROVED PIPE ON 3' ONTO 'IPE 3' SOLID SOIL )NTO SOLID i OFF RISER EX I7 ;OIL PUMP OFF ELEV. _T, PERMITTED ONI I F TANK MANUFACTURER HAS APPROVAL 3" APPROVED BF,,?R CONCRETE PAD SEPTIC / DOSE AQ$ES PER DAY : TANK MANUFACTURER: TANK SIZES: SEPTIC --1-f~,~5 - ~0 GAL. AQ V?tE pINCLUDING LpWBACK~GAL. DOSEs GAL FACTTIZO; A = _ INCHES = y ~GAI ALARM MANUFACTURER: lri, gM „ MODEL NUMBER: DL.Y - B = 2 INCHES = 4l GA: SWITCH TYPE : ryNtAg •,r C 0 INCHES = J-_6 PUMP MANUFACTURER : MODEL NUMBER: F'l D INCHES =^GA SWITCH TYPE : +M+a ~ c R REQUIRED DISCHARGE RATE yO GPM IPMP 9 ABM WIRING AS PER ILHR 16.23 k FEET VERTICAL DIFFERENCE BETWEEN PUMP 'orr ~Z~1!j"~JBUTION PIPE, • IQ- FEET 2.5 + MINIMUM NETWORK SUPPLY PRESSURE , + 'I. FEET + FEET FOItCEMAIN XOI'T.•QQ . p,G'TON FACTOR,,, FED AI, t (GAMIC HEAD = ~ - -75 D;AMETEK INTERNAL DIMENSIONS OF PUMP TANK: ~JRVUH WIDTH a I Cr,4L peR I Lx Aft NUld~~ : DATE: SIGNED: RECEIVED AUG L 8 2Uu8 Wisconsin Department of Comme ~of Division ofSafety andBulkkvs ST.CROIXcout§QIL AL T EPORT 'Page ii, FF W.S. Attach complete site plan on paper County not less than B 1/2 x 11 inches in size. Plan m ' include, but not limited to: vertical and horizontal reference point (BM). direclion and Parcel I.D. Percent slope. scale or dimensions, north arrow. and location and distance to nearest road. Please print all Intormadon. Re by Personet iMam"- You.Mvids mey be used tot secondary purposes (Privacy Law. s. 15.04 (1) (m))• Gbh n~ - c G Property Owner Property Location /I - !a aLp Govt Lot J 1!4 4 i,s1/4 S T N R E (or rs~fdailing Ate. Q~ ^ L~ # Block # Subd. Nano L!1 V G 2-, city ZJp Cade Qu l1 ❑ C ❑ me own Nearest Road Gomh'- on use. esidential / Nu nlW of bedrooms Code derived design flow rate GPD ❑ Replaosrnent Public or canxn I - Describe: _ Parent material Flood Plasm elevation if applicable- - Genwall and nconwriendallona: y'aela y ~~ti,Le~ I , System Typoe~ i/~.► System Elevation 19 ~s. R #~~Q! Borlm i'~ 1PIt Ground a+face ' tL Depth to Ila tiny factor in. Sol Rate Florixon Depth DwMw*Color Redox Description Texture Strucfixe Consistence Boundary Roots PD/(F in. Manses Qu. Sz- Cont. Color Gr. Sz. Sh. -Eff#1 '01102 ~V)W All i I 6o. M-1 C] BodrV ~Kf It Ground au►tece 9 Depth to ornd ft factor in. sw Rate Florhm Depth Dominant Cokxi Redox Description Texture Structure Consistence Boundary Roots GPD/IF in Manses Qu. Sz Cori Color Gr. Sz. Sh. 'Efi#1' 'Eff#2 0 - 31,_ / / I I EftmM #1 - BOD > 30 < 220 mylL and TSS >W j ' Effluent #2 BOD IM mWL and TSS 30 rnglL CST Horne (Please P" CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401~1 0Y ~1., 715-246-4516 Z, Property Owner Parcel ID # Page f e # Boring AM Ground surface elev. ft Depth to I' AMV factor -PtRD~._ in. w Rate Horizon Depth Dominant Redox Desorption TexWM Sbucture Cormwmm Boundary Roots GFUM in. Munsd flu. Sz. Copt Color Gr. Sz. Sh. •E01 •Etf#2 16 6:12 luxl'r~& )I ❑ Borkv # ❑ Borirv ❑ Pit Ground surface elev. It. Depth to fiffAV factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF in. Munsell Ou. Sz. Court. Color Gr. Sz. Sh. 'Etf#1 F-1 B°r"rg # 0 ❑ Pswim it Ground surface elev. n Depth to Wnhbrg factor it San Rate, Horizon 'leptit D.arrinart Color Redox Description- Texture Struc4se Consistence Boundary Roots GPOIN A Munsd flu. Sz. Cont. Color Gr. Sz. Sh. •E 1 • EtArarrt #1 = BOD, > 30 220 mgiL and TSS >30 =150 mpiL ' Ettknent #2 ■ BW, 30 nVL and TSS = 30 MWL 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 die department at 608-266-3151 or TTY 608-2648777. sso-wo pr.wol ' - Soil Test Plot Plakir Project Name Johnson Land Development ShAddress 484 E. Cove Rd. Hudson Wi 4016 Lot 2 Subdivision Date 8/20/08 SE 1/4 S W 1/4S 7 T29 N/R19 W Township Hudson Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 1 oo ft. Top of 1 /2" pipe System Elevation 95.5/95.4 *HRpSameasBenchmark Alternate Benchmark Top of Steel Fence Post @ 102.5' A IVVI (.6 A, 5 w~ ry ~ Scale is 1" = 40' ° unless otherwise noted 283' Property Line 35' L-2 G1Q o 47A k B-1 5 40 ' .M. Krattley Lane It B.M. ~C~ /off - -