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HomeMy WebLinkAbout020-1395-18-000 (2),Nisconsin Department of Commerce PRIVATE SEWAGE SYSTEM bt. uroix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 624840 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 Township Parcel Tax No: John & Barbara Moksnes I TOWN OF HUDSON 020-1395-18-000 CST BM Elev: Insp. BM Elev: IBM Description: S �nh L0p-e(ir Sectionrrown/Range/Map No: 25.29.19.2412 b �l."c TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic �1L{S I.11{ r Z'SC7 Dosing Aeration r;S�-� Zee -fie J TANK SETBACK INFORMATION M®Mm® ••, ® M_-- MAW=.wAM MEWSWAMAIWAMARE ®"==�= PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model N jimb r TDH L Ftion L ss Syst Head T Ft Forcem Le 'a. Di t ell STATION BS HI FS ELEV. Benchmark o3 1o3. 10 I .47 Alt. BV `VL 7.Q' A q `. ! Q { J lv 7 Bldg. Sewer St/Ht Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. A , ` �'T p,Z DD q` 2S (J Dist. Pipe Bot. System /S u , l q�.ZS K •Z5 Final Grade St Cover Ugly e. Te l 95. 6 9' SOIL ABSORPTION SYSTEM `7 -,1— `7 C Z F/z>" S BED,TRENCH DIMENSIONS Width ♦ Len � t No. Of Trenches Z Net.J PIT DIMENSIONS No. Of Pits Liquid Depth SETBACK INFORMATION SYSTEM TO P/L V BLDG IWELL LAKE/STREAM I LEACHING CHAMBER OR UNIT Manufacture Ty a Of S tem: 7on6�c4".V„& f 9 f 96 93' �� Model Numbe z PtlowS DISTRIBUTION SYSTEM Header/Manifold 7 I Y 71 Distribution Pipets) 11-eni x Hole Size x Hole Spacing Vent to Air Intake Length Dia Die Spacing SOIL COVER x Pressure Systems Only xx Mound Or AtGrade Systems Only Depth Over Bedrrrench Center �r L jam/ Depth Over ` Bed/Trench Edges IZ t xx Depth of Topsail 1xx Seeded/Sodded xx Mulched No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Inspection #2: Location: 837 PRAIRIE MEADOWS DR 1.) Alt BM Description =Qvi, 2.) Bldg sewer length = p V -amount of cover = X S ` Plan revision Required? Yes No �7^ j Use other side for additional information 1(J 2-5 (�(/ /. � _ �'_ 4� ,BD-6710 (R.3/97) Date Insepctofs Sign re Can. No. Industry Services County 'a,� s'OlU — St.Croix Division 1400 E Washington Ave Sanitary Permit Number (to be filled n by Co.) P.O. Box 7162 02 2Q2Q Madison, WI 53707-7162 / 2r C Pe 0 transact0 * R,e it Application Stater ion Number In accordance w SPS 39:2�VAh W v ode, submission of this Ii inn to the rnlol unit is required prior o nary permit Note: Application forms far stateowned POWTS arc submr d to 'Project Address (if different than mailing address) the Department o cry and Professional Services. Personal information you provide may be used for secondary Purposes in accordance with the Privacy Law, s. 15. I m Stars. 837 Prairie Meadows Drive I. Application la formation - Please Print All Information Property Owner's Nerve Parcel a John & Barbara Moksnes 020-1395-19-000 Property Owner's Mailing Address Property Location 837 Prairie Meadows Drive Govi. Lot NE'/. NW Y., Section 25 City, State Zip Code Phone Numlx:T Hudson, WI 54025 `L 1 rck one) ZT(Zl T29N R19Eme) / 11 T ype of Building (cheek all that apply) ® �_ Lot a 1 or 2 Family Dwelling- Number of Bedrooms 18 Subdivision Name ❑ Public/Commercial -Describe Use Scenic Hills Block a ❑ City of ❑ Stare Owned - Describe Use ❑ Village of CSM Number ® Town of Hudson Ill. TvDe of Permit: Cheek—onlyWheek-only one box on It.. A. i-q—tillete line B ifs livable A. ❑ New System lacement System ❑ Trcelmem/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous n Number and Date Issued Before Expiration Plumber Owner 430157 C+14T- hAM of POWTS S stem/Com nent/Device: Check all that apply) on -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Dcvioe (explain) V. Dis erselffrestment Area Information: �( Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed (56 trsyslcm FJevation 600 Rate(gpilvi 857 900 93.72 07 VI. Tank Info Capacity in Ga11a Total a of d IGallons � u New TalesExisting Tanks Gallons Units anufaaurcr k Septic or Folding Tads 1250 1250 1 Wieser Concrete Dosing Chamber VIL Responsibility Statement- 1, the undersigned, assume responsibility for issiallados of the POWPS shows on the Ott" hod ace. Plumber's Name (Print) Plum Business Phone Number John Schmitt 223760 715-760.0486 Plumber's Address (Street. City, State, Zip Code) i 586 Valley View Trail, Somerset, WI 54025 Core /De artment Use Only ,hVV,111L 131 Approved ❑ Disappmvey Permit Fee LT/DA patg1S u9d / g Agent Si urc Reason or Denial S �,GGC-Z_ D IX. Conditions of Aptimyst/ltessons for Disapproval 3� {oar YSTEMOWNER: k+. -+-� oFSYS in 1. Septic tank, effluent filter and %� e� S *W F6 `( dispersal cell must gserviced / maintained YPl.� erd as per management plan provided by plumber. duys4r . as per applicable code16ffffi1xdP1Fk3i"rrs ta'm rorlme,ysi , eoc-Atms caamr�or n e - �� , m.a s t sty„ �,�„s`� LF�',[�� 6) S „a►wi tit �uri� S 0 t P Otxr; lywrWr fJJ�Q_r� (n� �r,+py {� uo S.�q(ai.�, �L -ipL w�`CI..... Oda �l �'Lt eA.m..%AmA-. DrAlioutgQ ai-rek NJIJ--6 Aav PeFF; F iota _ SYSTEM PLOT PLAN Moksnes 4 Bedroom Septic System Design Flow: 600GPD Prolacl Address: 637 PreMe Msadues Drke Attach design flow calculations for commercial plena: BM7 Symbol: A BM Elevation: 101.4T Pipe Materials! ASTM Standard BM Description: Septic tank cover Tables 354.303 a 38430.5 BM2 Symbol: Q BM Elevation: 95.32' 4"SCH 40 PVC p4m ASTM- 026M BM Dees OW: Septk: leek outltl Slope Gradient of Tested Area: 14%) 9034 4' PVC pipe ASTM-03030 Well Symbol (If applicable) Notes: See Plat Map for complete map HV.L=938 96 / / T2i 97, go / 98 / i 1W — a — -- 99 Ddveway / 4% BMt Garage / Well E>oadr .� Existing 1250 Bm 4 eedraortr HOOu septic tank w! Zabel A-100 filter , T1-3'x87.5' Infdbator Standard trench El.- 93.72 T2 - TA7.5' InRtratcr Standard trench E1.= 93.72 T3 - 3'k90' EZ Flow trench EI = 93.72 T4. 3k90' FZ Flow trench EI = 93.72 i r.1LAAr N Scale: 1" = 69 0 60 80 120 151 RNV Prelde Meadows Drtw e a '-10y CONVENTIONAL COMPONENT DESIGN ,,_.._ INDEX AND TITLE PAGE Project Name: Moksnes 4 Bedroom Replacement Drain Field Owners Name: John & Barbara Moksnes Owner's Address 837 Prairie Meadows Drive Hudson, WI 54025 Legal Description: NEl/4, NW1/4, S25, T29N, R19W Township Hudson County: St. Croix Subdivision Name: Scenic Hills Lot Number: 18 Block Number Parcel I.D. Number 020-1395-18-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Effluent Filter Information Page 5 Valve Information Page 6 System Sizing & Cross Section Page 7 EZ Flow Information Page 8 Management and contingency plan Page 9 Septic Tank Maintenance Agreement Page 10 Existing Tank Certification Page 11 Warranty Deed Page 12 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 5/31/2020 Phone Number: 715-760-0486 Signature: In -Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) SYSTEM PLOT PLAN Moksnes 4 Bedroom Septic System Proect Address 837 PraHe hilwwd n Draw BM7 Symbol: A BM Elewtion: tot 4T BM Description: SepOc tank cover BM2 Symba: Q BM Elevabon: 9532' BM Desuipbon, Sepilotank outlet Slope Gradient of Team Area' (4%) Well Symbol (9 applicable) Notes See Plat Map for complete map HW1=938 Del Flow. 800 GPO Attach dowgn flow r Iaflons for oommefaal pima Pipe Motorola / ASTM Standard Tables 384 30-3 a 384 30.5 4" SCH 40 PVC pipe ASTM- D2%5 3039 4" PVC ppa I ASTM-0. 4% 99 I Existing 1250 gale 100 sepbc tank w/ Zabel A-100 rdw �\ _ ` 97 Vats —98 ■ B2 _ - 99 Driveway BMi Garage well E)dsbng� 4 Bedroom House Tt - 3'x87.5' IMINrator Standard trench EI = 93 72 T2 - 3'x87.5' Infitrator StandardbenchEL= 93 72 T3 - 3'x90' EZ Flow bench El - 93.72 T4 - 3'x90' EZ Flow trench El - 93.72 ! MCAAr- I: r®N 1 .r go 120 RAN Praline Meadows Ddva 2 IL tsimm 4" CAST -A -SEAL OUTLET 0 TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS W1250-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2" BOTTOM: SEPTIC 3' HOLDING 5" (ADD 1300 LB.) COVER: 4" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 72 1/4" O.D. LENGTH: 104" O.D. WIDTH: 86' O.D. BELOW INLET: 53' O.D. LIQUID LEVEL' 47" WEIGHT: 7,220 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. 26.81 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,340 GALLONS LOADING DESIGN: 8' 0" UNSATURATED SOIL TANK CAN BE USED AS. SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN j8 NO FIBER) TANK: MIX DESIGN #10 STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE IIDRAFORGAPPROVALTEDII APPROVED BY• _ APPROVAL DATE: PRODUCTS NEEDED BY: W x W v UU- C 0 w 00 2 I < �A � N M W� I W�0 �oF 1 PAGE 2 or2 The interval for servicing septic tanks is set by state and local code. Throughout the United States, there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel filter, which does not increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped. However, our filter is virtually self-cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged particles to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFilter@ alarm, you will be notified by an alarm when the filter needs servicing. Step 1: Locate the outlet of the septic tank and remove the tank cover. Step 4: While holding the cartridge over the access opening, rinse off the cartridge with fresh water, being careful to rinse all septage material back into the tank. Step 2: Remove the tank cover and pump the tank if necessary to prevent any solids from escaping to the the drain field when the filter is removed. Step 5: Insert the filter cartridge back in the case, making sure the filter cartridge is properly aligned and completely inserted in the case. Replace the septic tank cover. Step 2: Firmly pull the filter handle and slide the cartridge out of the rase. 0 Residential Applications Certified to ANSI/NSF Standard 46 Copyright 2014, Polylak, Inc Affrights reserved Proomf(s) covered by one or more U.S. and/or Intemabonal patents. Other U.S. and Imemadonel patents may be Pendmg. 1-877-765-9565 / www.polylok.com Home About site Map Order Info Videos Literature Contact Drip Systems Treatment Comrots Products Downloads Design Guldance The Bull Run Valve'" is designed to split flows to septic fields or systems. In addition to the advantages of longer life and easier installation it is the most public health safe alternating device available for wastewater disposal applications. The use has absolutely no contact with wastewater due to the valve's leak -proof and external operating characteristics. The change over from one drainage field to another can be accomplished in less than a minute by simply turning the valve without digging or contact with wastewater. d I rs Iln DESCRIPR O4 BRV4 BULL RUN VALVE 4" BRV8ULK BULL RUN VALVE & KEY ONLY BRVCIRISER BULL RUN VALVE RISER W/ CAST COVER BRVKEY28 BULL RUN VALVE KEY 28" BRVKEY36 BULL RUN VALVE KEY 36" BRVKEY48 BULL RUN VALVE KEY 48" I 1r4. RSM CAP ALNPTM MMR TUBE Ir OUTPORr MTB%TIOFIr ACOMa W VALVE DMEM ON FANDLE C N Parr The Bull Run Valve is available in 4" sch 40 pvc and is suitable wherever septic disposal systems are used - in commercial, industrial, and residential applications. OPERATING THE VALVE The direction control handle should be rotated periodically to direct effluent to one or the other of two septic fields. After removing the screw cap at the top of the riser tube, the valve handle can be turned with the valve key furnished. BULL RUN VALVE Complete Valve Kit Contains 1. Bull Run Valve body 2. 28" Valve Key 3. Riser Cap Adapter 4. Watertight Access Cap BRVCIRISER - 4" ADJUSTABLE TO 28" HIGH IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) I Geotextile Cover 99 SOIL COVER ` re Y mkt. trench INI depth t (typical) System Elevation = 93.72 ft. (typical) min. 12' (Ndral) Septic Tank(s) Manufacturer Wieser Concrete Septic Tank(s) Vdume(s): 1250 gal gal gal gal Effluent Filter Manufacturer Zabel Effluent Filter Model #: A•100 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Provide minimum 3 ft separation between trenches. TYPICAL TRENCH (Show location of inlet / outlet pipe connection on plan view.) PLAN VIEW Gbse ato pipe shell be n is sled (No Scale) are at protan batlwen two oms. Perforated Lateral Observation Pipe (typical) (typical) r- B = 90 ft (mean INSTALL PER TRENCH: 9 10-ft bundles @ 50 If EISA/unit = 450 ftl + 0 5-ft bundles @ 25 ff EISA/unit = 0 ft' OBSERVATION PIPE DETAIL No Scale) Sr -Type or ---- slip cap (loose) 4'9 PVC Ppe -- Top of tape to tarmnale at or above fna"d grace (4) 114;IK X e' Slob 9U apart Anchenng Davra 10 ft (typical) �A=3.0 ft (typical) f Bundle (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturees instructions. = Proposed EISA per trench = 450 ft' Required Infiltration Area = 857 ft' x 2 trenches = Proposed Total EISA = 900 ft' Finrshed Grade (mulched & waned) Topsoil Cover (min 1 foot) Infiarebon Sudam Distribution Method: branched manifold m w O .RESET. Installation Instructions for EZflow Systems in Wisconsin Wisconsin Department of Commerce, Safety and Buildings Division, has reviewed the specifications and/or plans for this product and determined it to be in compliance with chapters Comm 82 through 84, Wisconsin Admin. Code, and Chapters 145 and 160, Wisconsin Statutes. All sites must meet the Sk & Soil Conditions & Locations & Isolation distances as noted in local regulations. The approved products are 1203H (3-12" bundles with pipe in center bundle in 5' or 10' lengths) and 1203HP (3-12" bundies with pipe in each bundle in 5' or 10' lengths. A single pipe bundle contains a four inch perforated pipe sur- rounded by EPS aggregate and is held together with poly- ehtylene netting. A single aggregate bundle contains aggregate only and is held together with polyethylene netting. Materials and Equipment Needed • EZflow Bundles • EZflow Geotextile Fabric • EZflow Internal Pipe Couplers • Pipe for Header and Inlet • Backhoe/Excavator Installation Instructions The instructions for installation of EZflow products are given below. This product must be installed in accordance with state rules defined in chapters Comm 82 through 84, Wisconsin Ad- ministrative Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design manual. 1. After the local health department has determined sizing, configuration, and layout for the EZflow systems, stake or mark with paint the location of trenches and lines. Be careful to set correct tank, invert pipe, header line or dis- tribution box and trench bottom elevations before instal- lation of pipe bundles. 2. Remove plastic EZflow shipping bags prior to placing bundles in the trench(es). Remove any plastic bags in the trench before system is covered. 3. This product must have geoextle fabric that meets re- quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed directly on top of the product and extending down along the sides of the product to a pant at least six inches from the bottom of product. 4. When installed in a trench, the trench should be dug to a width of 36 inches. This not only saves labor in excava- tion, but also provides better load -bearing capacity after backfilling is complete. EZf owm by INFILTRATOR 5. The Absorption area (SF) necessary for a given site shall be sized based on maximum daily sewage flow (GPD) and the Permeability for the site. If certain criteria is met, the EISA sizing can be used in Wisconsin, resulting in a 40% smaller drainfield. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- lar site. The top or center -most bundles containing pipe are joined end to end with an intemal pipe coupler. Any additional aggregate only bundles that may be required, should be butted against the other aggregate -only bun- dles and do not require any type of connection. The top of each GEO cylinder contains a filter fabric pre - manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer shall make sure the the GEO is posibioned upward and is in contact with the fabric contained in the adjacent cylin- der before backfilling. 8. The EZflow Drainfield Systems should be Installed in a level trench in all directions (both across and along the trench bottom) and should follow the contour of the ground surface elevation (uniform depth), with all continuous adjoining 10-foot cylindrical bundles placed end to end, with central bundle distribution pipe interconnected, without any dams, stepdowns or other water stops. 9. The trench top shall be graded such that water will not pond. Backfill should be seeded or sodded immediately after completion to reduce erosion. 10. EZflow EPS bundles are flexible and can fit in curved trenches as may be necessary to avoid trees, boulders, or other obstacles. 11. EPS aggregate is lighter than water, therefore, it might be expected that natural buoyancy forces would tend to cause EZflow assemblies to float out of ground when ponding occurs. Field experience has shown, however, that this is not a problem when systems have a minimum of 6' of soil cover as recommended by manufacturer. 1203H-GEO Geotextile r Material PAGE 4OF4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. 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), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 2 gpd; BODE 5 220 nrl TSS <-150 mgL'; FOGS 30 mgL' Inspection Checklist INSPECT EVERY 3 YEARS o type of use c. age of system nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e.. pumps, valves, switches, floats, etc.) " 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) c, 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 (113) 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 fllter(s) 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, Wisc. Admin. Code. ST. CROIX COUNTV Si:PT1C •i-ANK AL�IVTF.N:1\CC :1GR1:C"+il��'T AND OWNERSHIP C1:RT11-1C ATION FORNI ONnct Burn John & Barbara Moksnes i\ aihnL Address 837 Prairie Meadows Drive, Hudson, WI 54017 Propcity Ackb%:,. 837 Prairie Meadows Drive t,nli-.attnn leyuaad Inall l'IJrr1 W;c \ / nuly lkl•JIln. at till ,,.n .,riG uua hani Clt> Slaty Hudson, W1 PdlI�cl 020-1395-18-000 LEGAL DESCRIPTION' Pl„pialy LUr.•rltlUn NE NV' , r S%%. 25 T 29 ` R 19 fill .. T,,,, It I)] Hudson Suhdi%istun Mul. Scenic Hills Lot �! 18 Certified Survn Map 4 Volume Tad l Harraety Deed A 32 3 tbclilli :CNI?lVoillint Page = Slit lwetK11c-, -Ilo Illy iul,el tl,a Jatl I I:.JIufG"A It, c ..: N 'Ul ,alai. ,,t tel:1 .uuld I ,jilt tIt II, tHrauJtul: IJI Ia I It i1AWL NJ,Ii I'r.l r Irld mt.-n.ln... IM, i+i. ,,I' If us till a lg'hd t11: + I)Ilk tmlk c.:I., Ihica tt.e, kit „> Ma 11 a n: eJeJ. I,y J lu:nxJ punth:r. N hil wu put IUI,- tits >-% lWtn sill Jlteat the iulalltal D( fit, ,c PUt IJtll. J, J tl:Jllllctll ,Lqf: Indio. 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J, ,:t i:, the 1):PJt1111er111.11J:a1'..fill I'• !. .,;.n;Ji \gaha`, JIIJ 11K DellJlttrt:rlt ill \atWJ: Raaaaul a. ,. \IJte of t1 »,Huai. t UlIIi:Jliatl Qal;fle that wut +epu, ,t *I:u.�u- 11,.1. ni.:.11il,an.1 lewd ha .onglialad and teltatiel In tha NI Man ♦ :j,IVF trulrr .•.. .n,+, of fill W.,, I'll a tp:. ..ir.-ai ridn I M.r :erti" dial ill stJtuu,nt, on dlr, 1elu,.o, flu,: it- ill, !•a,l o� alt out Ao "ied .. 1 M: jilt All. the t--%imf,^ of the I'Iaperty dcsalihcd Jl+vaa. by .tnu: o.' J NJ:innt.N d:cd I,uw.,ki w K:t-ntaf .,I D:o.• tI:ti.,: mber of bedrooms 4 1GNATURL OF APPLICAKTISI DATE. `A ilt UjUnjualwa II&A :, 7tl:,la In esdlitid Ina% ti,ull Ill the �Jrttl Jl % lxt:lu: K%lu. 1 c,ala,d h, the pl.nuuflg k /.awny D:-pallmcm "' lrl:itule •wdh dn, Jl`I`LaJl t: fI J I::trl Jed It J/l Jfli% Jeed ti:I:l 1I11: Reyl,tel ill Ihed, 1):Ilae JW J.Vp. ,'tali Celtltled ,YIt,.1 llup It let: kIt,I. I, IIIJde its Ilt: It JtIJar, J,cd Will. 9442) 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) 837 Prairie Meadows Drivr at: NE i/4, NW /a, Section 25 Town of Hudson located Town 29 N, Range 19 W, 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 Did flow back occur from absorption system? Yes_ No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1250 Construction: Prefab Concrete x Steel Other Manufacturer (if known): Weser Concrete Age of Tank (if known): 10/1i2003 Permit number (if known) 430157 John Schmitt (L' ensed Plumber Signature) (Print Name) MPRS 223760 (Title) 6-ay,OQV (Date) (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 SCENIC HILLS LOCATED IN TBS NI114 OF ME NFI/4, Ndf/4 OF TBS MI/4, SSI/4 OF TBS M 14, PART OF TBS M14 OF THE NF1/4, PARF OF FBI M1/4 OF THE SF114 AND IN TRR N81/4 OF TNS SURVEYOR: NS71/4. ALL IN SSCTLON DO, MR, RISF, TOW OF RODSON, Sr MIT COMM. IJSCOMLX, °O10'e� �wR�nxe rb - PREPARED FI o � cax,v,oaw g3g3�inG 1 _._�:�?O� i meP*aR C9PubRT RlD rurartn� ,. 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If you need assistance to access services or need material in an alternate format, please contact the depamnem at 608-266-3151 or TIY 608-264-8777, sau.uw( a W) PAGE 3 OF_ NAME LOT# I d LEGAL DESCRIPTIoni c 'Iyu'/ S s-T7a N R ri E (oo sy SCALE: I"= yO BM l ELEVATION /pp. d K N BM 1 DESCRIPTION ion o L ! i � a+c- /LPL -� t" BM 2 ELEVATIONIcl.o6 2-5 SEG BM 2 DESCRIPTION_ k4_e� P l p t SYSTEM ELEVATION 95.9 0 ALTERNATE ELEVATION 9s 20 CONTOUR ELEVATION_4Yov, 99 00, /6d a t I 0. Ll• s.t 0a34 � - zs' A - bit _l B-L 3 I I I 1 I L58 70 28' � • 229 70 - - - . - 252.08' C -- -T � ' N&M05TE 889.38' — — Prairle Meadows Drive — - SW50'53'W 889.35 938.0 i } y.,4f .............. ................. 18 11 Q FT 2.727 ACRES 64 iH.W _ �1 17 140,111 SOFT 3.2 17 ACRES 4e1� r5 y7 1 rj 19 111.175 SQ FT 2.552 ACRES H.W.L.- 1 i 932.00 i i i 80.95 250.00' 239.29' N8W50'S39