HomeMy WebLinkAbout020-1485-13-000 (2)
rn, •nsu ur1„nn,-r, ur :r- -r PRIVATE SEWAGE SYSTEM V'v 1, St. CfOIX
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INSPECTION REPORT Sani:a'vPerm! Nc
605080
GENERAL INFORMATION fATTACI I T 0 PRIAIT' State Plan ID Ne,
.1e ,onal aft"'Iaio -I .,.1u rfn' In- may he r.vd rcr s!-;nncm'y p..ip'asn~~ IPrvany I aAN s.15 C4 ii IIm;Q
1crn' t iJlner's Naure Cir'i \41'a4c' Ic'-sh* Parcel 'a. NO.
Kernon Bast TOWN OF HUDSON 020-1485-13-000
.:91 Uri t ev I-se. BM I RL` 0-s.^ript ~n n'~,icmTo,vn+Runpa'n,tap No
99 Gs 21.29.19.3088
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Seph:: r Tn 7 Benchmark ct d
eAe f' t ! F; l 1. / Z00 i
Dos ng G ,,-f I A t Dr°' 12 AT
icfl. s
0
Awat en n0 1OiG Bldg Sevier ei!!) •ejs
Holding Y iLHI Inlet ! T
9l•('0
3
SUHt octet
TANK SETBACK INFORMATION
TANK It) 1"L 'V'ILLBLDG •i>r rr A. r Irizhc ROAD D! Into:
Septic - 46 Ut 6::Ilan
J~2 may, L
Dosing /J 166 q6 Header'totan 41O 9S.
Aeraltcr Dist. F pe Flo 941. 4
Holdnxl Dot. Systern q, J
O 9 1 •
PUMPISIPHON INFORMATION FinalGrade
~ • ~
Manufa-tu-ei
GPM ndX St Cover
1 e,
rAodel Numoei lJN /1.a / L~ Lw✓
TDH LiR F-iclicn Loss :;yslem Ile TDH 1 ~r:
ai37 r
Forcemain Lengt) O r D;: z ! Dr.. bheil 165
SOIL ABSORPTION SYSTEM 171 x 416 - /oo :
BED,TRENCH :'Jidtn Lcre;t^ No O` Tienjws PIT DIMENSIONS Ne Cl i'OS h>;;~ne uia I iewr. Depth
DIMENSIONS 9a 7--k .
SFIBACK SYSTEM TO P!L BLDG hJELL IAKE+STREAM LEACHING N1avAof'I. ^ r
INFORMATION d ,t CHAMBER OR Y rte` 1
I'iFr A ,'t'in C~ 9a 9~ / DO ~ UNIT !.Me„I NU t?r ~ S><
`r 1 D ' 1 V • w.
DISTRIBUTION SYSTEM Z2 4-"Z v'
Hcvor-.1ar fii` 111: -I hutIm 11 Wife Size fl-c '•:e^.t :e Aii Intake
11_u•1yIF Dia Lc .i l•_~ C.a~-~ nq
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
0U:.A'1 OV, If I)'-l- t), r' De ]I". of •:'.a Secer~Jan9n-d . I& OeC
H-n!Tr-ncl'Cen:c' L P Bcd11,, 1,l )wl for°;A ~~xes N, ` YeS Nc
COMMENTS: flnch:de code discrepenaes, oersons preser.l etcA Inspeclton #1 Inspection #2
Location: L)WOOLDBERRV R
I Alt BM Description
2.;, Bldg sewer length = ~O
- amount of cove,
7 V' O t~ AS(JC.. ~y~
P'an revision Requ reds !Yes II No I4 I9
use other side for additional uifmnlalion. T . I tri °1`~
Date Ir'se J,r'S Si atu'u Cert NG.
SI:D 6I`a,;R 3 1'3'1
PUMP PERFORMANCE CURVE
PUMP PERFORMANCE CURVE SUMP, ' EFFLUENT MODELS
3iV V2" & 3;4° SOLIDS PASSING CAPACITY
1 [r it-. v 14 1 fj a l ' T T~' y y ti p-
lot cn '-'2s t~
x -T,
-
TO.
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PUMP PERFORMANCE CURVE
- - SEWAGE MODELS
- 2" SOLIDS PASSING CAPACITY
- A AVT ~ 1 23v I ol;
lapc'lyn: 7II~ =:!eLer "J. v;l rin'1`. re:+,cniCU.
Safety and Buildings Division
201 W. Washington Ave P.O. Dox 7162
Madison. WI 53707-710L 1111 °`tn°ll Tkmbv (o° be filled in GY Cn-)
_ _ ~ (~b5o8a
Sanitaryeama#_Application Sum Ttmsan;oa rte be
I In atxmdamx with SPS 30142). Wiz. Adm. Code, submission of 4imm to A-
c; squired prior to obtaining a sanitary penntt Note' aDPr S al ante
- m oon tino forms for slateo ed POW,$ are submitted in project Address (if different Ikon truil-g address)
the Depavnmt of Sefay and Rofeaimal Bevies- Psmd io5sur>aipr Ynu prmld ide may he t6ed fm secppdary,
sesmaccordaarawish
ati Iaw-z.t5.(MHI)(m r~
L Application inform ation on-Ptease Priat_AH_tn_ t ab
mpe:rry (hxmts's Name ~ ~ - PamrJ A
PmPerty Owner's r.~taiia~ Adarzcs -
'0o0
~ (J L •/U jz ~ ail PmPoTY,.,ne00a a a r9. 3~~gp
GM Code i'Phone Number GM [.M
X/ Q (circle one)
FL Type of Balding (check all that apply) T N. R _ H of W
T7 I 2 Family Dwelling- Mb. of Bedrtroeet _ I Subdivision Tdm e ` -I-
drCp a, 13lorks Q,Q A V Pl
❑Publid(7. mmtrcml-Dtacnbc Usr,
❑ CSty of
❑SUM:Owned-DraeibeUseCSMNumbcr - ❑VBlaeeof
t I.A.J ~~/Z- faG ~Tuwn of__ or
~,>J
M. Type of Permit: (Cbeclt only o e boz on line A. Complete line B if applicable) - -
A. cW System C1 Replacement System ❑ Trea rnettMolding Tack Rel,lacm cot Only ❑ Otko Mndiftration to Existing System (nylai,)
B- ❑ Perma Renewal I~- Permit Revisigt ❑CBP.o -ofPlu Previous Peru Number and Dale Issued
of POW mber CJPermitTrsnsfe to New lid
Bef ne 6>.yiratiw, Owter
'I'S hYstem/Cam CY,J~[
poamUDevicc (deck ell that apDlr)
L;~Nun-£rtssunzed kr•(rtduul ❑ [yasariml,n{'mund ❑ M-C"dr. L) Mound > 7.4 in of suitable soil Cl Mamd 124 ir. of mnablc soil G L j S
)-J ifoidin-tank C1 Omn Di:pvsai Component (captain)_-_-___ Retreatrcern Ikvix
V. Dis rsnvfreatm Area Ia -
Design Flaw (gpd) f., -
ign Soil Applir orr Rate( fl Uizpena) A. Itequi.l (zt) Dispersal At"
Pc+sa 1'mpntcd System Eievaaon
~11 C"
i VL Tank IaFo
Y~ ~p°p1)'to Total of Manufactmer
1 ti..r l'mdz - CWlons _ Gallons limos ~ o o
Exactas Tara u U
~ _ ~~j °o Pty to
l
gept or Hotdina Tao4 - r _ _ - d IO .7G a u o~ ty, :n
tot V IL Rnsponsiblity Statement- L the undersivgmed, assume . -
rsspoasibiGty for utshGNloa of rbe POWfS ffitnvs on the atlaehed pleas
Plumticr Nerve (Fein) ~P1 'SS
J F.. 1<( ~iVv ~b M~J/MPIRS Numidr Buziaxs l'ttone Ntmrbe
II Punt 'S d{ (Sttee (My taloe, 7ip CwWc--
_ 11_11 frllll J~ w ~ ~ Tl U ~ ~ ~ ~ l 1 1,
VIf[. COUa /De ar6nent pselpo
ppmved Per/in~i[QFe --Date n-d Issu, SwAadre
tam Reason far hit s " ro 4 -0 • (7 / S
A. Cond teems fnr Ijisa n q - • / 1 -
1_ . es lNM rat PProval 7~ i,turl I X1.0 ~O nG4J
uispers~, crtlm r?ust uat dll be sarIars J F~
as per marsgernen' plan nro,iae i by pjunuer. IK4b~ - f _ rte.
2. AN e. * regU".t ems muut iv r. it t ; t4/ r
as pN eppxrb! C')dIa j zrri dioe.>- I A. , e✓\ .
noon m.mPw~ vlags far We sysr® zwMait b the Camry ig w man a of z I I ferh. it,
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CONVS?- i!Oj,\ir1L COPulf''ONE:NT DFSfGR
Residential Applicatian
INOFX AND TITLE PP;(zE
ojrc[ Name: k KN N~ b
-
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c' u,ty S`r z~
~ctllvi ion IV2rre C P ilk
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Page 3 S rem Sr;.c & Cross 9~c idn
Pe3ge 4 Rite-, ppHG4 -
`ge 5 _ tii&irttenlrice -7----
Pam, 6 - _ '-ns4enS P?an
Page i St_Crni ;,e-~S~Tank_vkntena:;; for, 1•:
Page 8 Vian enty (deed
Val 9 CSrw; rr* P'z_ _ _
A a' : Soil Test & I-Iewse p-,,41
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Mal vs,-)t Cap
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- gPd Design Flow < r 80i) .-Application Rate
EfSA = 1 3 Chambers
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Technical Specifications
PL-525 EFFLUENT FILTER (COMMERCIAL)
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MAIMk PaYPRCYYLLNE -
AND
OWNERSHIP CERTIFICATION FORM
ownerlBuyer kum) 5- W/
. M ling, Address %fb 14 6MLL Iwo W:r _9W,
'ooetty Address ' 554 WrcoWy DA*I -
!4aificazim _egtired from Plapaing & Zoning Department for ittw on.)
Parcel Iden i$wtion Nrmm= (n0' ~ 5' r3"Gnd
:'in^State OSt1rJ ! 4
LEGAL DESCREMON
?roperty LDcanon 4 , W ;Sec. 2I , T ~IqN R-2-W, Town of
~'FAoQJPtt _ Lot- e3
SaL~w•ision
Certified Survey Map Volume Page
Warraaty Deed Volume Page # _
San house V" ® Lot luxe identifiable ® se-
I
SYSZMM MAi`t'fEP kNCE AND OWINFR R~1YpN
,,roper use and maiotema-e of your aptic system mold tesah in i¢ memsrrle ,`Intro to MdleAnb%VUu put into
MaMMUMXe coussts of ptmsping out ie septa tank eveiY three yeas or sooner, if taeded, by, }icensed ptarrper•
he system can affcd the fund on of the sepric tank as a treat- shge ID the waste Otv[ter maintertatKr
in §Cor= 83.52(1) and m Chv= 12 - St. DnbX Ctximty Samt8ty Ordir e
responsibilities are specified
T'= uroreny- o~, graees to subrmi-m S_ wrour County Phmiag a` Zoning Deparuu=ot a cer,caIIOp fors s:¢red by the
lu-R> . restricted Pltmi!>Q or a licensed gu:o7, er m'+fY'aB that (1) the onsrW
owner and a/ a master Plumixz, joamoY v. cortdition ar~'oa (2) eRa irss)>Gbon and Fuvipm5 (if nxessary'). the sera. r-rk is
..aaev~a~er disposal system n in vrom overa;I.9
less than 1/3 fall of sludge.
i/we, the radenugned have read the above mquir=eFuSi and aFee to maruaia the pm-ate sewar dVWJ- of Wrmtscov th Irf
s=xbrds set forth. herein. as set by the Dcoartratnt of Cots and the Department of Mauaal Resances:
system has been unnIMmed 91St be completcd and retied to the St Croix County Plannmp X
Zonmg s tating than your septrc omhg Dcga"mrt~ ""-ibun'0 days of the ibrez,yeaz expiration date-
I/v c eertiy that a I I satements on fora are Tr to the bat of mytiour knowledge- live am4are dre ok.ter~s; of'er
property described abvv of a i dt ed recorded it. Reps!ts of Dix & MCC.
Number of
07; oS 1 S
~ DATE
JRE OF APPLIC_-'i_NT(S)
`
+:s any ~fotmatio I iis tmsre~eseated may result m the samury pecan beM revoked by toe Planning & 7onmg Deparmen
- - of the certified sur.-ey IMP 1'
in-lode with this application a r-x~orded waIIaiiy deed fi~m the ReVsbm of L)eeas Ofr-c and a copy
reference is made m the warranty deed.
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Wisconsin Department of commerce SOIL EVALUATION REPORT Page _ of
Diosion of Safety and Buildings - in acco danca with Comm 85. VTls. Adm. Coda Cr p n,y I y
Attach complete site plan air paper not less than 8 1i2 x 11 Inches in size. Plan must - `
include• but not limited to ved wi and honzonta' reference point (Wr dlredl:n and Parcel 1 O. d /3 - G~0
percent slope. scale or dimans~ons• north arrow, and location and distance In nearest fdaA. Date
Please print all information. Reviewed by
Personal inrorri yw yrrvde may oe vied for secwW ary pvryoaes (Privacy Lew. a 15 w I t i Imli
Properly (honer Property Location
Govl.Lot ) 174 174 S C I T~_ 1 N R E Ion W
Properly Owrlees mailing Address ,n I,ot Block # SILd Name rx CSMq / /
City ,l State Zip - he Phone Number I ❑ Cdy ❑ Villagt Town Nearest Road 559_ t.Jl" eJt
construction Use Resldendal I Number of bedrooms code derved design flow rate GPD
❑Reyammerl ❑ Public ar commercial - Descnbe'
Parent material Flood plain elevation if applicable ~iL _lO~E X It
Ger enj oomments
and recorlvnendafions' -
/
S-'Stem Sy1Crt tiC:'atiOP I__ r J.
&EA/r tEL oZD-/o -6/D
❑ Binding
Boni C
1 ~ # r D / it Depth to limiting factor _ in
1 ® pit Gratin surlace elev. RRwtsGPD,,W
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary inMunsell Ou. Sz. ContColor GrSzSh. 0 o U 34 _ C
l >
I
1
❑ Boring r,
N.
FZ pit Groundsudaceelev, # 2tt. Depth to limiting factor _ LS
a . IJ - Sou I~ation Rale
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bouhaary Roots GPD#f
in. Munsell Ou. Sz. ConL Color Gr Sz. Sh_ 'Eff#1 'Ef1#2
I
It
' Effluent #1 = BOD. > 30 < 220 mdL and TSS > ,!5 "-Effluent #2 = BOO. < 30 mgJL and TSS < 30 mcyl
r -
CST Name (Please Print) Signature CST Number
Rird Plumbing, Inc. Shaun Bird / 226900
Dale Evatuabon Con',uvvid retephunv Number
Anrress
L1432 120th St, New Richmond, W 017 715.246-4516
` f -
I
i3
Property Owict - Parcel 09
Boring d /
Pit Ground sur!a.x elev. L-` Depth to emdrtg arxrx in. gw: lirancn _H_a_tu
Horizon Depth Dominant Color Hedox C sarpl Texhue Structure Cons+slwrCe Boundary Roots
n. j . - 'EffdG' PU!f
'E62
Munseli Oe 51 Cox CNor Gr. SzSh
❑
Boring A Bong
pit Ground sudaw Ce.•6. Depth to limiting lava in ~cp/~ ,irah:n Rate
Horizon Depth Dominant Gobi Reoox Descriptor ler.!ure Structure Consistunce; Boundary Roots GPD!lf
in. Munse.1 Ou. Sz Cont. Color Gr. Sz Sh 'Effdt ! TfI02
r
I
' Bonrg A Bcnng p,t Ground surface elev. ft Depth to limiting factor _ in
U ❑ Soil Iration Rate
Honzon IoPth Domrnanf Color Redox Descapnon Texture Structure Consistence Boundary Roots GPD/IF
n Mun_sell Ou Sz Cont. Color Gr. Sz. Sh. 'EBd: 'EffA2
i
I
' E"Wear d' = SOD, > 30 < 220 ug•L and TSS >30 < 150 mg.'L ' Effluent 42 = SOD, < 30 U10- and TSS < 30 r g'L
the Deparzmem of Commerce is an equal opportunity service provider and entploycr. If you need assistance to access services or
need material in are alternate format. please contact the department at 608-266.3151 or'1-fY 609-264-8177.
Soil Test Plot Plan
Project Name Kernon Bast Shaun B
Address 948 LaBarge Road
Hudson Wi 54016
('STM ?26900
Lot Subdivision Date V15/15
S W 1/4 NE 1/4S 21 T 29 N/R 19 W Township Hudson
Boring 0 Well PL Property Line County ST. CROIX
Bbl or VRP Assume Elevation 100 ft. Survey Iron/top of 3/4" pvc pipe
System Elevation TBD *HRpSame as Benchmark
Scale is j" = 40'
unless otherwise
noted
Mustang Drive
B-3
2< Slope
2 [3 I
45 4
20
99'
B2
90'
579' Property fine
B.M." 300'