HomeMy WebLinkAbout030-1025-50-000 (3)Wisconsin Department of Commerce
Safety and Building Division
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
T PERMIT
GENERAL INFORMATION (ATTACH 0 )
Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name I City Village Township
TANGEN
5N
TANK INFORMATION
TOWN OF SAINT JOSEPH
TYPE
MANUFACTURER
3
CAPACITY
Septic
Dosing
Aeration
v
TANK SETBACK INFORMATION
®
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®®®
•
M®=
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®M._�.-
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1-,r-_-
mm=m�=
PUMP/SIPHON INFORMATION
Manufacturer
Demand
PM
Model Num
er
TOH
Lift
Frilion I ss
Syst Hea
TDH Ft
Forcemain
Length
Dia. VDist.
to W
DATA
STATION
BS
HI
FS
ELEV.
Benchmark
o.66rro
1O5
Alt. BM
Bldg. Sewer
SVHt Inlet
I • G.
I . OC
, 144.
f .J
/'3
SUHt outlet
r75
. 9
Dt Inlet
Dt Bottom
Header/Man.
4. 9
13,75
Dist. Pipe
Bot. System
WIT-1
W.JD
B.'!
Z.Z
Final Grade
3.5
f-i, �s
St Cove r �� r
Z.9 3
Q7, 7
5}" 0-4
r
G.14714.I6
SOIL ABSORPTION SYSTEM ) L, 4 11. t Plzr- r UJ4 -j--q
BEDITRENCH
Wdth( ,
Length�r
No. Of Trenches
PIT DIIl IONS
No.Of -
Depth
DIMENSIONS
66
z-
SETBACK
SYSTEM TO
P/L
LDG
IWELL
LAKE/STREAM
LEACHING
Manufactu
INFORMATION
Type Of System :
ONiFCs17'ti'-11
1
5 )
��}7!�
✓ I 1
l bo
CHAMBER OR
UNIT
Jew
Model Number.
DISTRIBUTION SYSTEM
Header/Manifold t,
Distribution
x Hole Size
x Hole Spacing
Vent to Air Intake
Pipets)
Length Dia ////
Length Dia Spacing
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over
Bed/Trench Center
L/ I
Depth Over
Bed/Trench Edges
t
7 17f 1
xx Depth of
Topsoil
xz Seeded/Soddetl
O Yes
No
] Yes
Na
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:
Location: 1128 TROUT BROOK RD Lb j"5 tf G k,1l
1.) Alt BM Description = F11
2.) Bldg sewer length = T+ 1y qq
-amount of cover = - - ,- ' 1:)
Plan revision Required? 0 Yes �r//�}°/l No
Use other side for additional information. ! �_
Date
SBD-6710 (R 3/97)
Inspection #2:
s, .6 ',ddeJ V KJV phi it
a3dcd 40 Ek19 , Y" AaIN DL
J I i)3S
Insepcta s tignature Cart- No.
D vkvt"2 (5;4tj —zw— (16--)
alyR•'tT'ray�
\�
APR 27 2020
Industry Services Division
County
st.Cmix
Satirist Permit Number (to be filled in by Co.)
1400 E Washington Ave
P.O. Box 7162
St. Croix Count y
Developm
nt
Madison, WI 53707-71
/_
tP
Community
Sanitary Permit Application
Stale Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to
the Deparhrtett of Safety and Professional Services. Personal mfmmatikm you provide maybe used fur w"dary
Project Address (if different than mailing address)
purposesin accordertee with the Privacy Law s. 15.04 1 Xmj. Stets.
It 28 Trout Brook Road
►. Application Information - Please Print All Information
Property Owners Name
Pend a
Daniel & Mclissa Tmgen
030-1025-50-OW
Property Owner's Mailing Address
Property Location
1129 Trout Brook Road
Govt. Lot
NE'/., SE %., Section 6
City. State
Zip Code
Phone Number
Hod". WI
54016
(dick one)
T29N ; R19EorW 063679
If. Type of Building (cheek all that apply)
Lot a
Subdivision Name
®I or2 FamilyDwelling-Numberol'Bedrooms
2
NA
Block a
® Public/Commercial - Describe Use
❑ City
❑ State Owxted - Describe Use
❑Village of
SMNu tkl�t ?
r
® Town of St. Joseph
Ill.
Type of Permit: CYeGirsuily one box on line A. Complete Yoe B if applicable)
A.
❑ New System
® lacemem System
❑ Trcatmcnt/tIolding Tank Replacemcnt Only
❑ (Aber Modification to Existing System (explain)
B
❑ Permit Renewal
❑ Permit Revision
❑ Change of
❑Permit Trassfrr to New
List_Prievious Permit d Date Issue
Before Expiration
Plumber
Owner
OQO,V ! 9
of POWTS S stem/Com nenVDevice: Check all thatapply)
® Pressurized In -Ground ❑ Pressurized In -Ground ❑ AI -Grade ❑ Mound > 24 in. ofsui d- 24 in. of bleA011
Holding Tank ❑Wier Dispersal Component (explain) treatment Device (ex JEN #,+L
rdoi
V. Disperudiffrestment Area laformation:
CA"
Design Flow (gpd)
Design Soil Applicatillin Dispersal Area Required ssn Arce Purposed (sn SysFlevaunri ✓
450
Rate(gpdsn 750 780 92.85'.91.85'
.,
0.6 7,
V1. Tank Info
Capacity in
vo o
Gallon
Total
Gallcros
a of
Units
Mate
yyy
g
!o
see Tanks
Exishn Tanks
R
t naui' w►I
M c7
G
Septic or Holding Tank
1000
1000
2000
2
Wieser Concrete
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume rcspoesibilit) for Installation of the POIyTS shown on the arniched plans.
Plumber's Name (Print)
Plu i ure
MP/MPRS Number
Business Phone Number
John Schmitt
T f/
223760
715.760-0456
Plumber's Address (Street. City, State. Zip Code)
586 Valley View Trail. Somerset, Wl 54025
Vill. County/Department at my
Ig Approved ❑ U
Perm rcc
Dam Issu
Is i Ageru Signature
ter Given awn forDenial
S t
4
IX. Conditions of Approval/Reasons for Disapproval E f✓ ` —� Ca.,....t.tAe_ '
3
SYSTEM OWNER:
n(�{t1[� t vl tr
Sei
1. S u t
1. Septic tank, effluent filter and qJ jj� „��*o`• C \ e�
dispersal cell must be serviced !maintained
by � 0,
�G�1��wf�4C
as per management plan provided plumber.
_..... ..........,.. ...y,........,,
o cam e p as art a s�srem enA�Ph tit Cuunb only ure patmr nM re. (wan a I ip_I I inchn in sire `
as per applicable c e or manes. S ' P1 _...p 8- 4p' greYt f �+'i�"e't ✓"la�'1
SBD-6398 (R03/14) _ / �'�a proyaa t! dWY`Qr'
IAtf rWO- (66t
SYSTEM PLOT PLAN
Tangen 3 Bedroom Septic System
Project Address: 11287rrou18rook Road
BMf Symbol: A BM Elevation: t00.00'
BM Description: Top of vent pipe on wasting drain field
BW Symbol: Q BM Elevation: 101.27'
BM Description: Bdckwindow sill on Norm East basement vdnd
Slope Gradient of Tested Area: (7%)
Well Symbol (if applicable)
Notes:
Design flow: 450 GPD
Attach design flow calculations for
commercial plans:
Pipe Materials 1 ASTM Standard
Tables 384.363 S 384.30-5
4- SCH 40 PVC pipe ASTM- D2885
4" 3034 PVC pqe ASTA4 D3034 4
W
_ r
r r rr
Z%
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Tangen 3 Bedroom Replacement Septic system
Owners Name: Daniel & Melissa Tangen
Owner's Address 1128 Trout Brook Road
Hudson, WI54025
Legal Description: NE1/4, SE3/4, S6, T29N, R19W
Township St. Joseph
County: St. Croix
Subdivision Name: NA
Lot Number: 2 Block Number
Parcel I.D. Number 030-1025-50-000
Plan Transaction No.
Page 1
Index and title
Page 2
Plot Plan
Page 3
Septic Tank Specifications
Page 4
Effluent Filter Information
Page 5
System Sizing & Cross Section
Page 6
Management and contingency plan
Page 7
Septic Tank Maintenance Agreement
Page 8
Existing Tank Certification
Page 9
Warranty Deed
Page 10
CSM or Plat
Attachment 1
Soil Evaluation Report
Designer: John Schmitt Licnese Number: MPRS 223760
Date: 4/27/2020 Phone Number: 715-760-0486
Signature: y77
GSF In -ground Component Manual IN. 2019) based on the In -Ground Soil Absorption Component
Manual Version 2.0 SBD-10705-P IN. 01/01)
Page 1
SYSTEM PLOT PLAN
Tangen 3 Bedroom Septic System
Project Addrass. 1128 Trout Brook Road
BM1 Symbol:A BM Elevation: 100.00'
BM Description: Top of vent pipe on mosting drain fnk
BM2 Symbol: Q BM Elevation: 101.27'
BM Description: Brick window sill on Norm East beaamerd window
Slope Gradient of Tasted Area: (7%)
Well Symbol (if applicable)
Notes:
Design HOW: 450 GPD
Attach design flow calculabons for
commercial plans:
Pipe Materials / ASTM Standard
Tables 384.30-3 6 384.30-5
4' SCH 40 PVC pipe AST02DIMS4' 3034 PVC pipe AM- STM-D3034
Scale: 1" = W
0 50 75 100
2.
d
A
PI
u
a
�n
i0
M
SIDE VIEW
4- CAST -A -SEAL
OUTLET
n
�.J
PUMP PAD
(TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
WLP1000—MR
TANK SPECIFICATIONS
DIMENSIONS:
WALL- 2 1/2'
BOTTOM: SEPTIC 3"
COVER: 4"
MANHOLE: 24' I.D. PRECAST CONCRETE RISER
HEIGHT. FLAT COVER 53 1/4' O.D.
LENGTH: 104" O.D.
WIDTH: 86" O.D.
BELOW INLET: 42' O.D.
LIQUID LEVEL 36'
WEIGHT: 6,790 LBS.
INLET AND OUTLET:
4" CAST -A -SEAL BOOT OR EQUAL
GASKET, CAST -A -SEAL BOOT OR EQUAL
INLET AND OUTLET BAFFLE AND FILTER:
WISCONSIN, SEE DETAIL #10
(OTHER STATES SEE CHART)
LIQUID CAPACITY: 27.83 GAL/IN
HOLDING TANK:
OUTLET HOLE PLUGGED
ACTUAL CAPACITY: 1,085 GALLONS
LOADING DESIGN: 8' 0' UNSATURATED SOIL
TANK CAN BE USED AS:
SEPTIC/ HOLDING/ PUMP OR SIPHON
COVER: MIX DESIGN /8 (NO FIBER)
TANK: MIX DESIGN #10 (STRUCTURAL FIBER)
CUSTOMIZED TANKS:
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
FOR APPROVAL
APPROVED BY:
APPROVAL DATE:
PRODUCTS NEEDED BY:
a
z z
z
U
IL
ti
�OF 1
:I
PaMR AW.
P
Inc
Wz1@w,Wubwefe.rl0dld5 and Pcped Mc
PL-525 Effluent Filter
PL-525 Filter
The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has
525 linear feet of 1/16" filtration slots. Like the Polylok PL 122, the Polylok PL-525 has an automatic shut-off ball
installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off
the system so the effluent won't leave the tank
Features:
• Rated for 10,000 GPD (gallons per day).
• 525 linear feet of 1 /16" filtration.
• Accepts 4" and 6" SCHD 40 pipe.
• Built in gas deflector.
• Automatic shut-off ball when filter is removed.
• Alarm accessibility.
• Accepts PVC extension handle.
PL-525 Installation:
Ideal for residential and commercial waste flows up to
10,000 gallons per day (GPD).
1. Locate the outlet of the septic tank
2. Remove the tank cover and pump tank if necessary.
3. Glue the filter housing to the 4" or 6" outlet pipe. If
the filter is not centered under the access opening use a
Polylok Extend & Lok or piece of pipe to center filter.
4. Insert the PL-525 filter into its housing.
5. Replace and secure the septic tank cover.
PL-525 Maintenance:
The PL-525 Effluent Filters will operate efficiently for
several years under normal conditions before requiring
cleaning. It is recommended that the filter be cleaned
every time the tank is pumped, or at least every three
years. If the installed filter contains an optional alarm,
the owner will be notified by an alarm when the filter
needs servicing. Servicing should be done by a certified
septic tank pumper or installer.
1. Locate the outlet of the septic tank
2. Remove tank cover and pump tank if necessary.
3. Do not use plumbing when filter is removed.
4. Pull PL-525 cartridge out of the housing.
5. Hose off filter over the septic tank. Make sure all
solids fall back into septic tank.
6. Insert the filter cartridge back into the housing making
sure the filter is properly aligned and completely inserted.
7. Replace and secure septic tank cover.
3/16" Filtration Slots
Alarm SwiKh
10,000 GPD (Option)
<� Accepts 1" PVC
t t Extension Handle
Rated for
10,000 GPD
525 Linear Ft.
of 1/16"
Filtration Slots
Accepts 4" & 6" _
SCHD 40 pipe
to
VOW Certified
NSFlASI Standard 46
Outdoor Smarttilter Alarm
Polylok, Zabel & Best fitters accept
the SmartFilterS switch and alarm.
Gas DeOcrmr
Automatic
Shut.(Nf Ball
Extend & Lok^
Easily installs
into existing tarns.
Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Too Free: 877.765.9565 Fax: 203.284.8514 www.poWok.com
Page 4
e0go Eljen GSF System WI Design Program
Dee:
25 Apr-20 ❑lent Name Daniel Tangen
Site Address:
1128 Trout Brook Road, Hudson, Wi 54016
Designer:
John Schmitt
Note: This warkshrer Is prodded to asrin the planner In sidnp in, number.1 Egrn GSFModules reealredtor a The cakufedens Mir in are r+Pfafnrd/areaN
oonsw- The Fveeess aI raeawmll design Is based on the Flannen Lputs aM cunsldreallons outside o7Mis wurksheet.
System Stang (Total Number of Eton GSF Nodules Restudied)
Design sobs; sued lbneTrenb
1.1 Site Characteristics:
Total Number of Bedrooms
3
DDF per Bedroom (Daily Design Flow per Bedroom)
150 gpd
EB4entgl Appgtaupnliate gdma
DDF (Daily Design Flow)
450 still
Equivalent ElRue t Q Appgution Is",
Apphration Rate
0.6 gaWta
Required Basal Area (DDF+Appacan nAnte)
250.0 fts
Unit Used (Usual B431
043
Unh Install Width
6 h
Squee Footage r Net
24 h'junk
1.2 Module Quantity Analvsi4:
Minlmun Number of EI)en GSF Modules Required
IRequired Basal Area' Square Footage per Unit or Bedrooms(S for 843s
or 6 fa A42); whichever, Is veafer)
32 units
Atrlount of Eljen GSF Modules Used
Must be greater than or equal to Minimum Number of Ellen GSF Modules
Required
32 elite
13 Trench Desfan:
Number of Trench Rows
2 Rows
Trench Width
6 ft
Trench Length
65 h
Units per Row
16
Total Square Footylnt
780 R:
r
3h
I
6
65
MIN 12"
CLEAN FILL
12" SPECIFIED SAND
NMWE FILL
\\\ N\\\�\`
u
3 R
Page 5
In -ground Gravity Management Plan
IMPORTANT:
PAGE 4 OF 4
The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, VYsc. Admin Code. Pursuant to SPS 383,52 (2). Wisc. Admin Code, this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wsc. Admin. Code.
Maximum Dispersal Area Operating Limits:
Design Flow = 450 gpd; BODE <- 220 mgL"; TSS <-150 mgL-'; FOG <- 30 mgL"
Inspection Checklist INSPECT EVERY 3 YEARS
type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes)
o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.)
o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin Code.
o Effluent filterfs) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company Schmitt & Sons Excavating, Inc.
Phone: 715-760-0486
Local government unit St. Croix County Community Developement Phone: 715-386-4680
Local government unit address: 1101 Carmichael Road, Hudson
ZIP: 54016
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc- Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Contingency Plan
In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be
abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, VYsc. Admin. Code.
Page 6
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIPCERTIFICATION FORM
OWnertBuyer Daniel Tangen, Melissa Bolin
Mailing Address
Property Address
1128 Trout Brook Road, Hudson WI 54016
1128 Trout Brook Road
(Verification required from Planning & Zoning Department for new construction.)
Hudson WI 030-1025-50-000
City/State ' Parcel Identification Number _
LEGAL. DESCRIPTION
Property Location NE t'/. SE t;,, Sec. _6 T 29 N R 19_W. Town, of St. Joseph r�
Subdivision Plat: Lot # 2
Certified Survey Map # ____ - 3571 �3 3 , Volume 3 Page # (e& l-
Warranty Deed # So`f `I l Z (bei'ore 2007)Voluni � 03 _, Page et fO 1
Spec houu 1]yesdur
lot lines identifiable 8 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 lank every three years or sooner, if needed. by a licensed pumper. What you put into
the system can affect the function of the septic lank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(I) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agues to submit to St. Croix County Planning & Zoning Department a certification form. signed by the
owner and by a master plumber, joumcyman plumber, restricted plumber or a heeosed pumper verifying dial (1) the on -site
waslcwalcr disposal system is in proper operaling coalition and, or (2) after inspection and pumping (ifnecessary). the septic tank is
less than 11 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, asset by the Department of Sa Icty And Professional Services and the Department of Natural Resources.
Stale of Wisconsin. Certification slating that your septic sysdcm has been maintained must he completed and returned to the St. Croix
County Planning & Zoning Depanmcm within 30 days of the three year expiration date.
I we certify that all statements on ihts foam arc true to the best of my our knowledge- I we amrare the owner(s) of -the
property described above, by virtue of a warranty deed recorded in Register of feeds Oil let.
Number of bedrooms
/SIGNATURE OF AP ICE} L CA S)
y zZ '2�0
DATE
***Any reformation that is misrepresented may result in the sanitary permit being revoked by the Planning & 'Zoning Mparlment. ***
Include with this application a recorded warranty deed from the Register of Deeds Ottice and a copy of the certified survey map if
reference is made in the warram� deed.
(REV. 04/121
Page 7
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) 1128 Trout Brook Road located
at: NE r/4 SE 1/4, Section 6 Town 29 N, Range 19 W,
Town of St. Joseph 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.
Most recent date of inspection or service - Z 0
Did flow back occur from absorption system? Yes_ No
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: loon
Construction: Prefab Concrete Steel Other
Manufacturer (if known): Weser Concrete
Age of Tank (if known): 42 Years
.Permit number (if known) teoa9
John Schmitt
( ensed Plumber Signature) (Print Name)
MPRS
(Title)
(Date)
223760
(License Number) MP/MPRS
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
Page 8
• AS BUILT SANITARY SYSTEM REPORT
'ER. Tn�i GC% / % , TO'•TNSHIP� SEC. TO' R�W
0. ADDRESS U ^ w is , ST. CROIX COUNTY, WISCONSIN.
'3DIVISION , LOT LOT SIZE
PLAN VIEW
-Distances 6 dimensions to meet requirements of H62.20
SNOW EVERYTHING WITHIN 100 FEET OF
,TIC TANK(S)�_ MFGR. W 2 (S a f2 CONCRETE X STEEL
NO. of rings on cover Depth DRY WELL
'NCHES N0. of width length_ area
J nQ._of linewidth length 2 area
dep to top of pi a
,REGATE
:X RATE 2, AREA REQUIRED AREA AS BUILT 12,4 S
:claimer: The inspection of this system by St. Croix County does not imply complete /
.pliance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
tem operation. However, if failure is noted the County will make every effort to
-ermine cause of failure.
ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEH.
DATED—] G / ` J PLMJBER ON JOB
LICENSE NUMBER
,i .
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
State Septic/ O
NAME , - M-rVc,, /C' � Township L ° ' : St. Ckoi//z �Co�ugnty
f LocatioK�t o6,4, Section:p 12/N,R�j W
SEPTIC TANK T
Size�9 9 gallons. Numm/bert o4 Compartments
Distance Faom: Well 6t. 121 oa gteater. elope-) S"-`6t
Building 3';.;'6t. Wetlands
DISPOSAL SYSTEM Highwater it.
Distance Faom: Well 6t. 12t on gneatea etope_�Z. 6t.
Building :'1f 6t. Wettanda Ft.
Highwaten 6t.
FIELD DIMENSIONS:
Width o6 tAench 6t. Depth o6 sock below the --in.
Length o6 each tine _it. Depth o6 rock over tite f in.
l>
/ Number o6 tinesDepth o6 tite below gtiade.v".) in.
Totat Length o6 tines At. Stope o6 taench in pen 100 6t.
Distance between tines , bt. Depth to bedrtock 6t.
r
r. Totat absoa.btion aaea /-,.) 6t2 Depth to gaoundwater 6t.
Required area At
PIT DIMENSIONS:
Numbed o6 pits j GAavet around pits -yes -no
Outside diametek 6tl Depth below intet 6t.
Totat absonbtion &Kea 6t .
Area aequiaed it
INSPECTED B,1C--� TITLE
APPROVED ,SATE 197�.
REJECTED ,DATE 197
WERCEWE
AP%As7 2020
Pro
ant of SOIL EVALUATION REPORT
and
11 as;oroance v,rtr. Lamm 65 `hSs Alm erode
Services
(c vxl t vie
#2031
Page 1 of 4
l ^mat So➢ Testing Inc
St. Crol% lowi�y
Courtly
oreBWiBlkbPrd'atl�,Mited: paper not less than % 11 in
Plan must
St ClOI%
--i u tic rmned to venioaf and hor,zonlal reference point (BM3
re point MI
direction and
percent slope scale or dimensions, north arrow and location and distance
to nearest road
Parcel i Cl
030-102550-000
Please print all information.
e vrer;By Dale
Persocat mPormano^ yoc p-. oiie -a, " used for se a^oa''• C.rr..;<s : o.:.. a:, Lax s "1 na 11 :: m:.
S/aL z0
T
Property Owner
Property Location
Tangen Daniel D 8 Bolin, Melissa A
Gov! Lol NE V4 SE 1i4. S6, T29N. RIM''
Property Owners Madmg Address_
LCI a Bock k Subo Name o' CSMV
112E Trout Brook Rd
2 0565-CSM 03-0655 030 78
City State Zip Code Phone Number
oily Village 7c vn Nearest Road
Hudson 54016 715760-1776
St.Joseph Trout Brook Rd
New Construction Use Residential I Number of bedrooms 3 Code derived design Flow rate 450 GPC
Replacement Public or commercial - Describe
Parent matena: Glacial till Jewett Silt Loam
=boa plain elevation If apo'cabie NA If
Genera comments Areas sunaoie . - ^: e•.• n -=„e.. _:.. r,'r. t : ? gCd spfr rare Resit+= < :ur _ F.ae - - r re:daxrnerl area
recommendations ie Q2 bs
(and
/ T 7
Boring 0 Boring
95.80 it
Pa Grcund sorface eiev
Depth to in*ng factor 84 - Sor v ication Pare
Horizon Depth Domimarl Color Reddy Description Texture
Structure Consistence Boundary Roots GPD:h`
ir, blunse,l Qu r' ::;nt : ov
Gr Sz Sh 'Etic' prx,
1 0-5 10yr3i3 none sit
2mgr mvfr as 2m,2vf 0.6 0.8
2 5-22 10yr4,4 iron sr
2msbk mfr g,v 2vf 0.6 0-8
3 22-26 7.Syr4!4 none st
Imsbk mfr qw, tvf 0.4 0.7
4 26-84 5yr4/4 none sl
Om mfr -••-- 0.2 0.6
2 Borrg X Boring
45.00
�L''eptn 'o factor :
RI Ground surface eiev It
tm,bng 35r in Soil Application Rate;
Honzon Depth Dominant Color Redox Description Texture
Structure Consistence Boundary Roots Gp".
In Munseli Ou Sz Cent dolor
G` Sz Sh •ENar •Eea2
1 0-7 10yr313 none sit
2mgr mvfr as 2,4 0.6 8
2 7-25 10yr4/4 none sit
2msbk mtr err 2vf 0.6 0.8
3 25-30 7.5yndlM none sl
1msbk mfr qw Iv'f 0.4 0.7
4 30-85 5yr4!4 none s!
� mfr — 0.6
E4�?'285� 91•� 1
'Effluent a1 = 600_, 30 s 220 mg t and TSS > 3C < 150 MO =2 = BOD, s 30 mg,L and -55 < 30 mgiL
CST Name ;Please Print% Signature 7 �1 , ,. CST Number
Thomas J Schmitt—�.�''•- ;/tea- 227429
Address Schmitt Son Testing Inc d' Dale Evaluation Conaucted Telephone Number
159572nd St New Richmond VYI5401% 3i31,2020 715760-1978
7
utAR
�`*Z'
Property Owner Tangen, Daniel D_B Bolin, Melissa_ Parcel ID# ,030_1025-50-000Page . 2-_. of _ 4_
7 Boring a
Boring
limiting
Pit Ground surface elev.
-92.50
-
- ft Depth to factor
- 85+
in.
jSoil Application Rate
Horizon Depth
Dominant Color
Redox Description
Texture
Structure
Consistence Boundary
Roots
GPD/ft'
in.
Mansell
Qu. Sz. Cant Color
Gr. Sz. Sh
_ _
'Eea1 'Eex2
1
0-9
10yr3/3
none
sit
2mgr
Pri
as
2f2vf
0.6 0.8
2
9-23
30yr4/4
none
sit
2msbk
mfr
gw
if,2vf
0.6 0.8
3
23-29
7.5yr414
none
sl
Imsbk
mfr
gw
lvf
0.4 0.7
4
29-82
5yr4/4
none
st
Om
mfr
----
------
0.2 0.6
4
Boring
Boring #
Pit Ground surface elev _ _
97.40
ft. Depth to limiting factor
-
-- 89+
in.
Soil Application Rate
odzon Depth
Dominant Color
Redox Description
Texture
Structure
Consistence Boundary
Roots
G_ PDPo'
in.
Munsell
Qu. Sz Cont. Color
Gr Sz. Sh
'Val 'Ert02
1
0.8
10yr3/3
none
sil
2mgr
mvfr
as
2ri
0.6 0.8
2
8-23
10yr4/4
none
sil
2msbk
mfr
gw
2vf
0.6 0.8
3
23-28
7.Syr4/4
none
sl
Imsbk
mfr
gw
Ivf
0.4 0.7
4
28-89
5yr4/4
none
sl
Om
mfr
----
------
0.2 0.6
Boring #
Boring
factor
Pot Ground surface elev. _—___—
ft Depth to
limiting
m
Soil Application Rate
Horizon Depth
Dominant Color
Redox Description
Texture
Structure
Consistence Boundary
Roots
_ _ GPDRN
in.
Munsetl
Qu. Sz Cant Color
Gr. Sz. Sh
'Eea1 'Eex2
Effluentill = SOD,> 30 <_ 220 mgiL and TSS >30 <-150 mgfl. Effluent #2 = SOD, c 30 mglL and TSS - 30 rrtgrL
The Department of Commerce is an equal opportunity xn icc pros ider and cir er. rf%ou need assistance io acccss sen ices or
need material in an alternate tixmat. pleas contact the depannlent at 608466.315 t or TT S h084h4-R'".
SHD.Y:p �Rr nI, $allrbn Sol Test'v, 1%.
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SHOP/POLE SHLU •\.�.�,�•�•
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it
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Conducted for DanwJ Tangen S Melissa BolinConducted by. Thomas J Sch"WI
1128 rmul Blook NFU a
Hutson. WI 54016 CST 227429
PID: 030-1-25-50-000 3-31-2020
588 94'
Lot 2 CSM 31665
588,94'
St. Joseph Township
M 1Q!�.00' Top of vent pipe on existing drain field
BM 2 0127' Brick window sill on North East basement window
St Croix County, WI
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