HomeMy WebLinkAbout020-1128-10-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix
Safety and Building Division
INSPECTION REPORT sanitary Permit No:
(ATTACH TO PERMIT) 624806
GENERAL INFORMATION State Plan ID No:
Personal information you provide may he used for secondary purposes (Privacy Law, s.15.04 (1)(m)]
Permit Holder's Name City Village Township Parcel Tax No:
JOHN & KRISIT NOSER I TOWN OF HUDSON 020-1128-10-000
CST BM Elev: Insp. BM Elev: 4( BM..D��scriplion: ^ SeclionRown/Range/Map No:
%Dc7 /op O� (muc"4a kfi;-C,t fM, 17.29.19.596
TANK INFORMATION /<;n-5 = '.;k- 5-T4 ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
\
Oo
)r01jV�
2 ^)
Aeration
V0,
0
I
TANK SETBACK INFORMATION
�4
r •
r �
M,-.=_�=
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model I um er
TDH
i
riction ss
System ead
T H t
Force in
Length
Dia.
D I. to well
SOIL ABSORPTION SYSTEM 77—4' 7J_ CIA ttPA%w [
DIMENSIONS I 2 t
INFORMATION
DISTRIBUTION SYSTEM
STATION
BS
HI
FS
ELEV.
Benchmark
L J
lbb
Alt. BM
4.3
95.8 6
Bldg. Sewer
SUHt Inlet yOF
SVHt Outlet
4
Y
D nlet
D ott
Header/Man.
�`�(
1
Dis Pipe
Bot. System
�n ��{
f3 OO
Final Grade
/
St Cover\s
CHAMBER OR
UNIT
Header/Manifold
Dist' ution
x Hol
x Hole Spacing
ant to Intake
Q, (}rlt
—` �
Pipe )
Length Dia
Lengt Spacing
SOIL COVER x Pressure Svstems Only x Mound Or At -Grade Svstems Only
Depth Over / t
BedrTrench Center (.� �. 5,.�
Depth Over t1
Bedr-rench Edges '� I J-
xx Depth of
To soil
1xx SeededlSodded
Mulch
0 No
Yes No
0 0
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection 41: Inspection #2:
Location: 476 PARK LN ` l rt nl S rt v\ ,�A�i p k
1.) Alt BM Description = VC v iA�1 V 'I 1V '1 L C.r`U
2.) Bldg sewer length = 3o.ty1 G - �'7f
-amount of cover= 1 1.,�,t„j b Li&-
Plan revision
Use other(side foruadditional Information. No
SBD-6710 R.M7) `_�
Date Insepc s nature J Cert. No.
D SAu-2ozo- �:
o"""TMrvr4
`;- MAY 0 8 202
Industry Services Division
1400 E Washington Ave
Count `
+a
R
P.O. Box 7162
Sao' Permit Number (to be filled in by Co.)
Coun ty
I f adison, WI 53707-7162
/� D
•s spW
trA.,
�.1
Sanitary erne Application
State�T�ryaannsacuon Number
In accordance with SPS 3832](2), Wis. Adm. Code, submission of thi3 form to tie a unit
1" 1
is required prior to obtaining a 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 Services. Personal information you provide may be used for secondary
purposes in accordance with the Privacylaw, s. 15. 1 m Stata,
/''�
�} 1 _ �� ` I ^ n
�•'� C-4 Lck
1. Application Information Please
- Print All Information
—
Property Own 's Name
nN NG54 ti
Parcel #
rilst rz
ono-IIAt-It -�oo
Pro
g Address
Property Location
1Owner's
to A W' LpN-P
{ -
Govt. Lot
����( —���
_lY ^ %.. IV W Y., Section
City
jI,
State
ZipCode
Phone N
rl
c
W D 0� (.
t-
S y 0 1 Y
Q (circle erne)
T A9 N; R _ E or W
II. Type of Building (check all that apply)
111 2 Family Dwelling
lot #
15
Subdivision
tor -Number of ins
Name
'
L
? F. v 1 4&k
Bbck #
❑ Public/Commercial - Describe Use WUH—❑
City of
❑ State Owned - Descri-be Use
❑ Village of
CSM Number
qq
a—OkS'f14g1TT1DeS Cl:L�S W 22 tZ2
IV1'$
❑Town of NWDS00
cal. Type of Permit•.
Rae A. Complete Bne B if applicable)
A.
❑ Ncw S ere ys[
eplacement System
❑ TrratmrnNBolding Tack Replacement Only
❑ Other Modification to Existing System (explain)
B.
❑ Permit Renewal
❑Permit Revision
❑ Change of PW fl.
❑ Permit Transfer to New
LiSt Previous P 't Number and Date Issued
Before Expiration
Owriff
5 1 978
o
emlCo nent/Device: Check a0 that apply)
at -Pressurized Io-Groin ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
Other Dispersal Component (explain) ❑ Pretreatment Device (explain) i
V. Dispersalfrreatromt Area Information: r
Design Flow (v- Design Soil A IicationJZ>Qe(gpdsf)
Dispersal Area R "red (sf)
Dispersal Area Proposed (st)
S Elevation
G ()( .�
B5n.IY
M 010.4
3-M ole-
VL Tank Info
Capacity in
otal
# of
Manufacturer
Gallons
Gallons
Units
I f
2
$
u
t3
New Tanks Existing Tads
336 Wni)
(ni Po 1 l 0 IL
,A.
I(
�U
L
6i
Septic or Holding Tank
p
3a D
�n
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DoStegCbambv
VIL Responsibility Statement- I, the a mum respo ity for untallatba of the POWTS shown oe the attached plans.
Plumber's N �oU e�
Imn� ignatu
sera 9 (Y
11S' g7bdU
Plumber's Address (Street, City, State, Zip Code) \
bib
1A w �k
Vlll. Coact /D trtmen se Only
ved ❑ v Permit Fee Date Issued Issuing Ag gut
i
"van z'`I ..
Reason for Denial �`�"• 1
DL Conditions of Approval/Resso ss for Disapproval
SYSTEM
,.�,..,e._
1.5ePlctank efllue;M fitt�eranJdde
dispersal rell must
aspen management PlM Pnust hedr�iaipinainad ludm
Y�rtY It ti�ulrrmu+ w,thf/� VA Pr Win
2. AI! setbxk r¢QUMeme
able (Oda/erMMnCMS.
al
A�
Avaean eeaspan pass ran ra, syatean and.aholifto therpmay any a< 00t ks than sini1t habet 11 Stan ` /
a d flAd co 4-sv- 1',1ispecb'A-f-e.?vt4@'emsfrI7,i
SBD-6398 (R. 09/14)
A ::ro hN ,�- vi) STtl
N o pk
'-116 pPK� Lpnt�
'S b st-e m'r v -, cl 100
13w1\ Raw V b{v-
y
Culsl'�Nq Ser�'��c,
�� TnNI� loJ�ny1,o_j
T
ga r w a-3x rfgNcl is
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TD�A, WA\, 9ultj Lek 5;t5
PAOz L ANC
Project Name:
CONVE i 1ONAL COMPOWNT DESrN
Residenta) Application
MDEX AM TITLE PAGE
MOKI
owners Name:
0hKv--rs Add e$: y 1 L �A n�L I pkc
Legal Desuiptbn:
Townships
County:
Subdivision Name
Lot Numtor 5
t•`ffiW ID Numtser.
POA i
indict altd we
Page 2
Plat Plan
PW 3
SYS%Mn SERI. & C. USS-56aWn 1
Page 4
Fir Sptss `
P2ffe 5
MaffMWM= IninmiaAM
Pam 6
marmmnertt r'In-n
Page 7
SL Croix Otg Stfc Tank Wv.qjE� ForM
Page 8
Wam" Deed
page a
CShlt or Piet
Ate: Sw7 Test a Hmr&a Pkris
Destir;ii-er ) irez Nucor. o2a�Z 90
Date- S 0� u r'hona Nufrher 7f� 3810— qQA
Signature
Uesignetl Wrtsva.-'r to me 3uH Mxa,'?tnn CorsVnient wia:cra� tar POWlrS W-rsim 2g Sat17GM&p M Q7N1).
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Map
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1063
Nf
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fig,
Crew . ►OO. O "5 PAo
3A0 50)1 oy SA,t, <
Tp�-k, wYN Poly Lek 9;S
PAkk LAYJe
Soil Abs2o�
�-- - 94 (b
d' sctt2� 40 � j 1 Feiel trs¢e
PVC Vent Pi 1
6l o Vew, Cup
Vent Or Obsei-vWon Pipe
u
3
I
dnart'ura> r.Ariv Wdet
E1SA igaing Z sG ;, per chamber 3ois Aapfr� lion Pa e . gpt3lso iT
00 gpdDesigrFbws .% Sa;rappricetiory:aie EisA=_43_chafnham
i rows 0! ✓rhzzte egci;.
Page of
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oil
ST. CROIX COUNTY
SEPTIC TANK MA ArCENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
0w1rerBuyer 11ro N I 1N 0
Mailing Address
Property Address
(Verification required from Planning & Zoning Department for new construction)
City/State a xkb" N W' 1 Parcel Identification Number a 6 ( I -a ' 0 U 0
LEGAL DESCRIPTION
Property Location N W Y< , N W 14, Sec. ( I , T °� N RA_LW, Town of
Subdivision Plat PPrkk V )-QI) V'Mts Lot# l J.
Certified Survey Map # , Volume , Page #
Warranty Deed #
Spec house D ym)lzo
(before 2007)Volurne , Page #
Lot lines identifiable yes D 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 mairiteneince
responsibilities are specified in ¢Comm. 8352(1) and in Chapter 12 - St Croix Comu 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
wastew ner disposal system is in proper operating condition and/or (2) after inspecbon and pumping (f necessary), the septic tank is
less than 1/3 full of sludge
Uwe, the undersigned have read the above requirements and ague to maintain the private sewage disposal system with the
standards set forth, herei , asset by the Department of Commerce and the DgmvaeM of Natural Rmurc s. State of Wisconsin.
Certification stating tbat yotr septic system has beta maiarabed must be completed and murned to the St. C1au County Planning &
Zoning Department within 30 days of the three year expiration data
Uwe ce+tfy flux all statements on this 1prm are true to the best of my/our knowledge. I/we aware the owner(s) of the
property described above, by vnnrc of a ty deed recorded in Register of Dregs Office.
Number oPtedroop
/7 AGkb
41"GNA OF APPLICANT(S) DATE
"*Any infitrnution that is misrepresented may resit in the sanitary permit being revoked by the Planning & Zoning Dena tment
Include with this aP licatio,n a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warram y deed.
(REV. 09M7)
Page _ of _
drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over
all system components. Compaction ofsnow over the dispersal unit may cause it to fieeze up.
INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or
certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, or Septage Servicing Operator (per the attached
Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware,
identify any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or ponding of effluent to the
ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings
greater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks.
When the combination of sludge and scum in any tank exceeds one-third (1 /3) or more of the tank volume, the entire contents of the
tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Ch. NR It 3, Wisconsin Admin. Code.
Specific servicing mechanics must be provided if vertical is >15 feet or if horizontal is >150 feet and instructions to be provided below.
The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids accordingto manufacturer's specifications. Solids
washed from the filter shall be retained in the tank Filter cleaning may be necessary at more frequent intervals than stated in the
maintenance schedule to keepthe system operating.
Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS,
There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the
system are corrected to prevent back-up of sewage into the dwelling or surfacing.
ABANDONMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that
the system is properly and safely abandoned in compliance with Ch. SPS 383.33, Wisconsin Admin. 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 properly 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 other 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 compliant replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soi I absorption system. The
replacement area should be protected from disturbance and compaction and should not be mfiinged upon by required setbacks
from existing and proposed structure, lot lines and wells. Failure to protect the replacement area renders it unusable. Replacement
systems must comply with the rules in effect at the time of replacement.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area Upon failure of the POWTS a soil and site evaluation must
be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last
resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effectat that time.
WARNINGI!!! SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT
OXYGEN. DO NOT ENTER A SEPTIC, PUMP, OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH
MAYRESULT. RESCUE OFA PERSON FROM THE INTERIOR OFATANK MAYBE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS:
POWTS INSTALLER POWTS MAINTAINER
Name: 1'f� -(,� -� Name:
. -
ph(me' Phone:
SEPTAGE SERVICING OPERATOR (Pumper)
Name: Mb Im. s
Phone: J'l 'C'O
LOCAL REGULATORY AUTHORITY
. ( it A)Xe:
te:
3 b `' 4
0:44h
Page of _
POWTS OWNER'S MANUAL AND MANAGEMENT PLAN
FU..E INFORMATION
DESIGN PARAMETERS
Number of Bedrooms (100 m)
Number of Commercial Units
Estimated flow (average)
6gal/day
Design flow (DWF) = estimated x 1.5
gal/day
Soil Application Rate
" gal/da /tF
Influent/Effluent Quality (O NA)
Monthly Average
Fats. Oil & Grease (FOG)
5 30 mg/L
Biochemical Oxygen Demand (BODs)
:5 220 mg/L
Total Suspended Solids (TSS)
< 150 mg/L
Pretreated Effluent Quality (O NA)
Monthly Average
Biochemical Oxygen Demand (BODs)
<_ 30 mg/L
Total Suspended Solids (TSS)
<_ 30 mg/L
Fecal Coliform (geometric mean)
5 10 cf i/100ml,
Maximum Effluent Particle Size
1/8 inch diameter
SYSTEM SPECIFICATIONS
Septic Tank Capacity
gal O N
Septic Tartk Manufacturer
O N
Effluent Filter Manufacturer
O N
Effluent Filter Model
S liq
O N
Pump Tank Capacity
gal N
Pump Tank Manufacturer
N
Pump Manufacturer
N
Pump Model
CJ N
Pretreatment Unit (O NA)
O Sand/Gravel Filter
O PeatFilter
O Mechanical Aeration
O Wetland
O Disinfection
O Other:
Manufacturer.
Model:
Soil Absorption Component (O NA)
-Wln-ground (gravity)
O In-ground(pressurized)
O At -grade
O Mound
Cl Drip -line
O Other.
Vertical Distance TankBottom to Service Pad:
ft
Horizontal Distance Tank(s) to Service Pad:
It
Dhpenal Unit M19JMoM Number:
Ctlenhtlen:
Soil Dispersal End Cap (Dispersal Unit EISA)
DWF — Application Rate = Area Reouired - EI A or (Trench Width)
oD r 9 = Ssg ao ) _
O "Design ofPressme Distribution Networks for Septic Tank -Soil Absorption Systems" Publication 9.6 (SSWMP Manual)
O "ICC Flowtech Mound Component Manual" Version 1.2
O "EZ Flow Mound Component Manual" Version 8/20/2007
O SBD -10854-P (R. 1/1 2)"At-Grade Component Manual Using Pressure Distribution" Version 2.0
.jdSBD-10705-P (N.01/01) "In Ground Soil Absorption Component Manual" Version 2.0
O SBD - 10691-P (N.0I/01) "Mound Component Manual" Version 2.0
O SBD - 10657-P (R.6/99) "Drip -line Effluent Disposal Component Manual"
O SBD-10706-P (N.01101) "Pressure Distribution Component Manual" Version 2.0
MAINTENANCE MONITORING SCHEDULE - MAINTENANCE AND MANAGEMENT
NA
Service Event
I Service .
Puninfinspectcell a clean filter
At least once everr. O 13 months
O 3 ycars
O Other.
Inspect pump & pump controls, alarm, pretreatment unit
At least once every. O months
O 3 years
O NA
Flush and pressure test laterals
At least once : O months
O 3 years
O NA
START UP AND OPERATION: For new construction, prior to using the POWTS check treatment tank(s) for the presence of painting
products or other chemicals that may mrpede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have
the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall notaeenr when soil conditions arc frazea
at the infiltrative surface.
The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and
quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water -saving appliances and
fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units,
other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not
include laundry waste, showers, dishwater, etc.
This system is designed to handle domestic strength wastewater; however, the disposal of food based greases, oils, vegetable/fruit peels,
seeds, bones, and food solids, such as those produced by a garbage disposal should be minimised Toilet tissue is the only paper that should
be discharged into the system. Other non -biodegradable items, such as baby wipes, tampons, sanitary napkins condoms, cigarette butts,
dental floss, and cotton swabs, should not enter the system. Chemicals, such as petroleum products, paint, disinfectants, pesticides,
antibiotics, solvents, etc., should not be flushed into the system because they can seriously damage your POWTS and contaminate your
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING -SEPTIC TANK
This is to certify that I have inspected the septic tank presently se ing
the �hN y kxis i I�lcyey' residence located at:
Sec. �T o�9 -N, Rjj_W, Town of WUDSok
St. oix
County, Wisconsin. Upon inspection, I certify that I have found the tan and
baffles to be in good co`nL it'on, and it appears to be_funetioning prope ly.
Last time serviced (� afi �i U
Did flow back occur from absorption system? Yes No"\ (if no,' skip
line.
Approximate volume oz, length of time: gallons
Oinutea
Capacity: o
Construction: Pref b Concrete Steel Other
Manufacturer (if known): W1i�
Age of Tank (if known):
Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes)
licensed disposer MR. 113 Wisconsin Administrative Code)
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank conditic
certify that the tank, to the best of my knowledge, will conform to
requirements of ILHR 83, Wis. Adm. Code (except for inspection opening
outlet baffle).
Name -JlM IJO Awu Signature
MPJMPRS
or
I'
irt� i Huv
T29N,Rl9W TOWN OF HUDSON
-1 "00
e
Yr,
•• 0
u
1.42 ACRES
cD
0
rn
N
UNPLATTED LANDS OWNED BY STATE OF W
N 89° 13' 09'E - 3228.10'
200.00' 200.00'
1366.52'
WE
07-16�
0
(D M
v
0
Y-,
1.37 ACRES
-7�
1.38 ACRES
200.00'
S 8 9 013' 09" W
P0
N
rM
0 14
0
0
0
ro 1. 38 ACRES
s •• me
200.00'
LANE '
N 8 9° 13' 09'E
2 20.00'
400.00'
1.53 ACRES
Zn
100. C
..� ... r.��•u.♦ J\VJY\• 1W1V1\l
.^.BIER j ♦ , / /' , TOWNSHIP_Jdj SEC.17 T_; 9' N. R / `% W
.0. ADDe-..;S , ST. CROIX COUNTY, WISCONSIN
'BDIVISION /LOTLOT SIZE
PLAN VIEW
Distances 6 dimensions to meet requirements of H62.20
AF SYSTFM
A
ENCHES NO. of width length area
) no. of line width ! length 5 :, area 1,46
dept to top of P.Ipp
>REGATE! E., i
a RATES , AREA REQUIRED 1,/6 — AREA AS BUILT
;claimer: The inspection of this system by St. Croix County does not imply complete
ipliance 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 SYSTEM.
DATED - �`(�' / PLUMBER ON
LICENSE NU
XrPOP,T OF I11SPECTI01.1- 111DIJIDUAL SLZ,!AGE DISPOSAL SYSTEM
..,. r
T&I-INSHIP
SRDTIC TA'1K
Sanitary Permit
State Septic_
/ 0'74/
t, Croix County
Size i[ V Q _ gallons. 'lumber of Compartments
Distance From: well
ft.
Building I ft.
Highwater ft.
DISPOSA7.
SYS':;:4 -X—Tile Field or
Distance
106
From: Tell ft.
Building 30 ft.
FII9�tl
'� i:iphwater WA ft.
12% or greater slope=ffi.
Wetlands ft
Seepae Pit(s)
0
12or greater slope t
Wetlands 1V4W f
Total lengt o lines -UQ16 ft. Number of lines Z. Length of
each line _$Lg( ft. Distance between lines �YLft. Width of the
trench / .Aft. Total absorption area `sq. ft. Dept:
of rock below tile in. Depth of rock over tile Z, in. Cover
over.rock, . Depth of tile below grade aq-in. Slope of
trench in per 100 ft. Depth to Bedrock ft. Depth to
ground water A. &44- ft.
PIT°
Number of pits Outside d r. ft, Depth below inlet
ft. Gravel around pit: L.:ye `no. .Total absorption area
sq. ft.
Square feet of seepage trench bottom area required
:square feet of a nit /re� required
Inspected e ,f"°" Title:
Approved Date 197_
cn
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
.'
LOCATION: L
kf '/,, tvu_'b, Section , 1Y-1 N, R A,E (orj P Township or Municipality j) 22)
_
Lot No. __/.) Block No ---------- .- �f3+�_-1Y/rrG.Spf E `ngTE 5, _County
_ A t ubdlvision Name
Owner's Name:
Mailing Address:-_ `Yi 1M_-i�.,6.-iY�_(3LrJ_LL�?�I ���- 1--t-"•.....__ �"_1_�
TYPE OF OCCUPANCY: Residence __Z� _ _ No. of Bedrooms . _ Other
EFFLUENT DISPOSAL SYSTEM: NEW ; _ AD ITGION REPLACEMENT.—
DATES OBSERVATIONS MADE: �SL�O/�IL BORINGS—_.
O __-PERCOLATION TESTS _ — ---
SOIL MAP SHEET- _ --�U hTft
SOIL TYPE....-- �. J;P- ------ —
PERCOLATION TESTS
TEST
I NUM-
BUR
UEP H
INCHES
CHARACTER OF SOIL
THICKNESS IN INCHES
HOURS
SINCE HOLE
1ST WETTED
WATER IN
HOLE AFTER
SWELLING
TEST TIME
INTERVAL
IN MINUTES
DROP IN WATER LEVEL, INCHES
RATE
MINIIN
PERIOD 1
PERIOD 2
PERIOD 3
P 1�
L
__-
i
P
/
`+
`
it If
l
`L
P
SOIL BORING TESTS
TEST
TOTAL DEPTH
DEPTH TO GROUNDWATER, INCHES
CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER
INCHES
(DEPTH TO BEDROCK IF 08SERVEDI
OBSERVED -----!ESTIMATED
HIGHEST
-
___
....._.._
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r !
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-
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- i }max �'SGl� �. � - J i. L . •�. _
PLAN VIEW (Locate Percolationtests,soil bore holes and suitable soil areas.)
Indicate on the plan the location. and square feet ofJ�uitlabfe areas Indicate number of square feet of absorption area
needed for building type and occupancy. =21u- 0 - s-3�---_.--.--_----__..____..-._ Indicate scale
or distances. Give horizontal and vertical reference points. I Icate slope.
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PLB67
State and County
Permit Application
for Private Domestic Sewage Systems
"DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required
A. OWNER OF PROPERTY
State Plan I.D. At
Mailing Address:
State Permit
County Perm
County --
Section
BLO TION 4'T R� _ E foil t•�F• C �1 Lj2oail'u
. �%Y< �' /_!7_, t# �, _City
u ivision Name, nearer. ma , lake or landmark Blk#___„_-.—.._ Village___
Township
C. TYPE OF OCCUPANCY: Commercial_ 'Industrial_____ Other (specify) _ 'Variance_
Single family !� Duplex No. of Bedrooms_ 3 No. of Persons .�
D. TYPE OF APPLIANCES- Dishwasher AYES _ NO Food Waste Grinder —_ YES O # of Bathrooms
Automatic Washer �ES Other (specify)
E SEPTIC TANK CAPACITY Total gallons No. of tanks
'Holding tank capacity Total gallons No of tanks_,.._.
New Installation L--"'. _._ Addition Replacement Prefab Concrete ice_.
'Poured in Place Steel _ Other Ispe yl r
F EFFLUEY DISPOSAL SYSTEM Percolation Rate 1P`�.'7} _Total Absorb Area sq. ft.
New Addition Replacement 'Fill System
Seepage Trench: No. Lin. Feet Width DepthTile Depth _. No. of Trenches
Seepage Bed. Length Width / � " Depth Lt" He Depth 54 _ _ No. of Lines
/� / z
Seepage Pit. Inside diameter _Liquid Depth__ Tile Size 'tri Q
Percent slope of land _ a Distance from critical siope_�
1, the undersigned, do hereby certify that
the information
I have reported is in accord
with Section H62.20,
Wisconsin Administrative Code, and that I
have sized the
effluent disposal system from
the EH-115 prepared
;Sogister
NAME
by the Certjnatij
C.S.T. #_/rV �t
and
other information
ohtamed fro
Plumber's Sre
(owner/builder).
MP/MPRSW#-/_._I__.Phone
Plumber's
PLAN VIEW: Provide sketch below oif
system (include
direction of slope and all distances in accord with
H62.20, including well).
lecr
G�C�C�L�OMC D
1Msconsin Department of Safety and Professional Services
Division of Industry Services MAY 2 0 2020
SOI EVALUATION REPORT
St. Croix County
3 In accordancewit6®RBr8B61 v!lltrprr� L021
Attach complete site p on paper no ess than 8 1/2 x 11 inches in sae. Plan must include,
b
but not limited to: vertical and horizontal reference point (BM), direction and percent slope, I.D.
scale or dimensions, north arrow, and location and distance to nearest road. 28-1
Please print all information. t
GS7--2DOO -10 I
Page 1 of 3
Ref #2570
Property Owner I Property Location I - r - i/ ❑ Ll
John & Kristi Noser Govt. Lot NW '% NW '% S 17 T 29 N R 19 E (or) W
Property Owner's Mailing Address Lot # I Block # I Subd. Name or CSM#
City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
Hudson WI - _ 154016 1 (715) 760.2550 1 1 Hudson I McCutcheon Ln.
❑ New Construction Use: ® Residential Number of bedrooms 3 Code derived design flow rate 450 GPD
®Replacement ❑ Public or commercial - Describe: _
Parent material __Glacialoutwash Flood Plan elevation if applicable Na ft.
General comments and recommendations: Site suitable for in -ground POWfS with 0.7 gpd/sq. ft. loading rate. Recommended infiltrative surface elevations to
be 93.00'
7❑ Boring # ❑ Boring
® Pit Ground surface elev. 99.71 ft.
Depth to limiting factor >129 in.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ftz
•Ef#1
'Eff#2
1
0-10
10yr313
none
sit
2fgr
mvfr
cs
2vf,f
0.6
0.8
2
10-20
10yr4/4
none
sic]
2fsbk
mfr
a
1vff
0.4
0.6
3
20-28
10yr4/6
none
sit
lmsbk
mvfr
gw
-
0.2
0.3
4
28-40
7.5yr4/6
none
/Is
Osg
ml
cw
0.7
1.6
5
1 40-53
10yr4/6
none
s
Osg
ml
aw
0.7
1.6
6 _
63-61
7.5yr4/6
none
I
tmsbk
mvfr
aw
0.4
0.7
7
61-129
10yr4B
none \
grs
Osg
ml
-
-
0.7
1.6
2 goring # ® Boring �r_�fy1 r
❑ Pit Ground surface elev. 98.33 ft.
Depth to limiting factor >119 in.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Az. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ftz
-Etf#1
•01192
1
0-10
10yr3/3
none
sit
2fgr
mvfr
Cs
2vff
0.6
0.8
2
10-27
10yr4/6
none
sicl
lfsbk
mfr
Cs
1vf,f
0.2
0.3
3
27-34
7.5yr4/6
none 01
gr al
1msbk
mvfr
M
-
0.4
0.7
4
34-41
7.5yr4/6
none 90
Is
Osg
ml
aw
0.7
1.8
5
41-49
10yr4/6
none
sl
1msbk
mvfr
aw
0.4
0.7
6
4957
7.5yr4/6
none
gr Is
Osg
ml
cs
-
0.7
1.6
7
•
57-119
Ff '..nf Ala
10yr416
nf1r1 > vn
none
s
Osg
mill
-
0.7
1.6
CST Name (Please Print)
S ature
CST Number
James K. Thompson
30021
Address
D valuation Conducted V
Telephone Number
340 Paulson Lake Lane Osceola, WI 540205413
April 22 2020
15 248-7767
q V . 33 - y� JdU-t333� (RU4/15)
-
• 3❑ Boring # ❑ Boring
® Pit Ground surface elev. 96.36 fL
Depth to limiting factor .>110" in.
Soil Application Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ftz
•Eff#1
•01#2
1
0.10
10y13/3
none
all
2fgr
mvfr
ce
2vf,f
0.6
0.8
2
10-20
10yr4/4
none
Sid
lfsbk
mfr
cw
1vf,f
0.2
0.3
3
20-32
7.5yr4/4
none
sl
lmsbk
mfr
cw
lvff
0.4
0.7
4
3242
7.5yr4/6
none
gr Is
Osg
ml
w
-
0.7
1.6
5
42-W
10yr4/6
f1f 7.5yr4/6
sicl
lmsbk
mvrr
aw
-
0.2
0.3
6
50-57
7.5yr4/6
none
grIs
On
ml
gs
-
0.7
1.6
7
57-110
10yr4/6
none
s
Osg
ml
-
0.7
1.6
❑ Boring # ❑ Boring U%
❑ Pk Ground surface elev.
ft.
Depth to limiting factor _ in.
Soil Application Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ftl
"Eff#1
"Efr#2
❑ Boring # ❑ Boring —
❑ Pit Ground surface elev. ft.
Depth to limiting factor in.
Soil Ambrarinn Rare
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ftz
'Eff#1
•Eff#2
Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 < 150 mg/L " Effluent #2 = BOD, > 30 <- 220 mg/L and TSS > 30 s 150 mg/L
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