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Home My WebLink About020-1395-07-000 (3)Wisconsin Department of Commerce Safety and Budding Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT ATTACH TO PERMIT GENERAL INFORMATION ( ) Personal information you provide may be used for secondary purposes [Privacy Law, s.15 04 (1)(m)] Permit Holders Name City Village Township Jason & Tammy Meyer I TOWN OF HUDSON CST BM Elev. I Insp SM Elev. BM Description t3. 5-2,S3 J a -C— 2 " PVL = 6ST-9i TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic W 1 Ell ,n` Dosing r Aeration Holding TANK SETBACK INFORMATION ■. MEll IME_E�11- W_=--_M- PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift ricticn Loss System Head TDH Ft Forcemain Length a. Dist l SOIL .ABSORPTION SYSTEM STATION BS HI FS ELEV. Benchma Z. 9.51 �I'i• A.BM �! Bldg. Sewer 8.31 / o s }Y SUHt Inlet v'? 0 .321 SUHt Outlet A .26' Dt Inlet Dt Bottom Header/Man. Dist. Pipe L._', ;t ry �2,8s D r. 20 r Bot. System Final Grade sde 9r�D 1 o .r� St Cover RENC DI Width t Lengthh 55 No of Tteniches (i t J PIT DIMENSIONS No Of Pits Inside Die Liquid Depth SETBACK INFORMATION SYSTEM TO I P/L BLDG IWELL LAKE/STREAM I LEACHING CHAMBER OR UNIT Manuf re = Type Of System �J�` Z1l 7 l ,� OD 07, Made tuber DISTRIBUTION SYSTEM 4" r"(- y HeaderlMa^ndold N istrihution x Hole Sze x Hole Spacing Vent to Air Intake Length Di pe(s Length Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No MMEN S: IncIudef,ode iscrepenciE+s, perso sp�esent, etc.) Inspection#1. S�l�l?Mr Inspection#2' aAI �o ;D axe.e t J 1 catlan: 834 PRAIRIE MEADOWS DR 1.) Alt BM Description = g-M&V40k � J 2.) Bldg sewer length = I . IB -amountofoover=� It�jOr�C.BV� S� 37� ❑ rvw.�Mo1eNc a i v+esQ e' looked PI n revision Required? Yes Use other side for additional informal Da In Actors Signature Cart No CAAl.:s111— Intl Industry Services Division County St Croix $ 1400 E Washington Ave ,D P " S 21 2�1 P O. Box 7162 Sanitary Permit Number (to he tilled in by Co. ) APR 19 Madison, WI 707-7162 jr I� 3 3,3 a SanitarY,t Applicatio o Statc I runsachon Number In accordance wnh'SP" 3,M,21(21.Wm-Adm Code. submission of this form to the appropri e a) unit Is required prior to dbtaming a sarI permit. Note. Application forms for state-owned POWTS are submnte Pro)ect Address (if different than mat ing address) the Department of Safety and Professional Servlces Personal information you provide may he used for secondary 2W20ses m acaodance with the Pnvacv Law, s I5 04(I Hm) Stars 834 Prairie Meadows Drive L Application Information - Please Print All Information Propertv Owner's Name Jason & Tammy Meyer (Acwsson Structure Parcel H / Septic .System) 020-Uq5-07-000 ✓ Property Owner's Matting Address Property Location Prxme Meadows Drne, Z�. (•j. Z, l� Gavi. Lot NE''/., NW',; Section 25 Clt}, State Zip Code Plante Number I Judson. WI 53017 (y�rck one) T 29 N R 19 E oiCSt� IL Type of Building (check all that apply) I'q'•C.. Lot a E I of 2 Family Dwelling -Numktu.e48ndrn , _ Subdrvuion Name ❑ PublidC'ommercial- Describe Use _ Scenic Hills Blo"P ❑ Cox of / ❑ State Maned - Lesdnbe Lc ❑ Village of ✓/ CSM Number E'lownof Hudson Ill. Type of Permit: Check only one box on line A. Complete line B if applicable) New SystemReplacement System ❑ l rcatmcnL'I Dolduig Tank Replacement (kilt' ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued J4O Permit Renewal ❑ Pemut Revision ❑ Change of ❑ Perion Transter in New efore Bapirmlon Plumber Owner IV. Type of POWTS S stem/Coin onent'Device. Check all that a I Non -Pressurized In-Groun ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in ofsunable soil ❑ Mound < 24 m o(suimhlc wd Hnidmg Tank 011ie, Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersalfri-catment .Area Information: r,-en Design Flow (gpol Dewgn Soil Applwau Dupersal Area Rcqu red 0 )Ispersal .Arta Pro d nin System filevation / 150 Raleigpds0 214 1 W 20' ✓ 07 V1. Tank Info Capacity In (e k SZJr Gallons Total a nil pl� Manufacturer `ev. lanky I:<isnnr tanks Gallons !:nits _ Ccv a V e u a Septic or Holding Tank 320 320 I Wieser Concrete Z ❑ 0 ❑ Dosing Chamber VIE Responsibility Statement -I, the undersigned, assume responsibility for installation of the POWTS shown an the attached plans. Plumber's Name Frmn PluulR:I'S igi Ic MPMPRS Number Busu¢s+ Phone Number John Schmitt 223760 11i-760-0486 Plumber's Address (Strcet, On State, Zip Code) 586 Valley View "J rail. Somerset- R 154025 VIII. County/Department Use Only ij�y�(��Approved ❑ Disapproved Permit Fee Die ssued -7 a 7 / Issuing Agent Sign JYSTr�EI C Given Reason for Dental S Li1r. 0�o` L 1� �HFvnnenr IX. ,.Oh drtQ'bt'A'pproUiWei4l�ts for Disapproval 3 Gj,ypr{ 1�Z P t.J yytti$�.06) f✓t 0'7 �(3 spersa cell dust be serviced / maintained / �5 as per management plan provided by plumber.d {Sc� 2 All setback regUiremenls must be maintained 7 j4L<rxuH-r LcptGe N^vSf rucwl �" � � a� per appllc�.r� ccdeisrJu.,r:`s S P%vwrber Slxall Youi 5 sie� r>1ac�nne(Hae Attach to co plete plans for the sxxte afd au m t to the ( noon, nob an a r rim Im than a tQ x 11 inches in size )f/UB[(� 4 D-1634R 11CD1J�14 � �nclq 'C/ 4) Sl GS > Z J! °/6 7'Ytf tr Ef se kt.,Ce T�. �t S J J�Pd/�/cam d SYSTEM PLOT PLAN Meyer Accessory Building Septic Systen Design Flow i50GPD- Attach design flow calculations for ��jj� Project Address: 634 Praha M88dow9 Onva commercial plans: SM1 Symbol. & BM Elevation. fOOW Pipe Materials I ASTM Standard BM Descdpbon: Top of 1" Steel lot mmer marker Tables 354.30-3 8 384.30-5 0 Scale: 1" = 50' 50 75 100 BM2 Symbol. A BM Elevation. 113.53' 4" SCH 4o PVC pipe ASTM- D2885 BM Description: Top of 2" PVC pipe 4' 3a34 PVC pipe ASTA4-D3034 Slope Gradient of Tested Area (23%) 12.5 Well Symbol (if applicable) Notes. See Plat map for complete lot existing septic system serving the house Drainage Easement / •'° 101' 103' orvii 105' 107' k3�By: x50' FZ Flow trench L. 100 BM2 23% Slope �Q V� F a Q a ed Existing 40-MR 4W320-MR Bedroomc tank House RAN CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Meyer Accessory Building Septic System Owners Name: Jason & Tammy Meyers Owner's Address 834 Prairie Meadows Drive Hudson, WI54025 Legal Description: NE1/4, NWl/4, S25, T29N, R19W Township Hudson County: St. Croix Subdivision Name: Scenic Hills Lot Number: 7 Block Number Parcel I.D. Number 020-1395-07-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Effluent Filter Information Page S System Sizing & Cross Section Page 6 EZ Flow Information Page 7 Management and contingency plan Page 8 Sanitary System Ownership/ Address Form Page 9 Accessory Structure Affidavit Page 10 Warranty Deed Page 11 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Date: 4/19/2021 Signature: Licnese Number: MPRS 223760 Phone Number: 715-760-0486 In -Ground Soil Absorption Component Manual Version 2.0 5BD-10705-P (N. 01/01) Page 1 SYSTEM PLOT PLAN Meyer Accessory Building Septic Systery Design Flaw 150 GPD , Attach design flow calculations for '��'jJ� Protect Address 834 Prairie Meadows Dnve commercial plans BM1 Symbol AL BM Elevation ROW Pipe Materials / ASTM Standard Scale: t" = 50' BM Description; Top of 1" Steel lot comer marker � Tables 384 30-3 8 384 30-5 p 50 75 100 BM2 Symbol 0 BM Elevation 113 53' it 4' SCH 40 PVC woe AS'M- D2685 BM DescriptionTop of 2" PVC pipe 4' 3034 PVG pipe AS'M-D3034 Slope Gradient of Tested Area (23 e) 12 5' Well Symbol (if applicable) Notes See Plat map for complete lot 101' 1 C3 ww i 07 low 00 BM2 Yl R 1k Prairie Meadows Drive RNV W320—MR TANK SPECIFICATIONS a 2 , DIMENSIONS: �^ WALL: 3" n BOTTOM: 3" COVER: 4" MANHOLE: 24" I.D. PRECAST CONCRETE RISER `a 4, 2•— HEIGHT: 58" LENGTH: 4'-2" STA-SEgL A- (-,AT- tea" rgSi A -SEAL WIDTH: 4'-2" BELOW INLET: 46 1/2" ' - LIQUID LEVEL: 43" 'c F---------I, WEIGHT: 3,880 LEI& _ INLET AND OUTLET: a # E 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER:LL_ J� 1 -- 'a1 WISCONSIN. SEE DETAIL #10 s' (OTHER STATES SEE CHART) W 9 FILTFR OR BAFFLE LIQUID CAPACITY: 8.00 GAL/IN ~ v W" C TOP VIEW LOADING DESIGN: 8'-0" UNSATURATED SOIL L' c TANK CAN BE USED AS: z co SEPTIC / HOLDING / PUMP OR SIPHON v wa _ Ln COVER: MIX DESIGN 08 (NO FIBER) n TANK. MIX DESIGN p10 (STRUCTURAL FIBER) W o U a CUSTOMIZED TANKS: 3 m = FOR CUSTOM TANKS CONTACT WIESER CONCRETE LU INLET T OUTLE I 6 Q REVIEWED BY n o ;-, RENEW DATE 3 a w N SIDEVIEW DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET NO. APPROVAL DATE: PRODUCTS NEEDED BY: """- - OF I I Z JUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS POLYAONOwX P1 -;2; 1 ftlut'Ill i iItel Pl -323 1 illvr 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 l/16" filtration slots. Like the Polylok PLA22, 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 featutcv • 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=i'; Ir.�tall,ttttn. 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. IT It n n, ea �,.,. '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. l; i6"" Filtr•rtitrr= =+Ints� ;� Alarm switch 10,000 GPD - • jOpf'°"'`l Accepts V & k' t=E> SCHD Jo p,pe 0 < '— Accepts 1" PVC tensmn Handle Rated 1°r 1n,000GI'D SZ Linear Ft of 1; 16' Fdtrahor Slnh NSFAN 51 Standard 46 < —_ � Gas Deflector Automatic Shut -Off Ball n. 'I i .,I. i, I.,I ifn ,.I.. P°Ivtok, Zabel & Best filters accept Frilly installs the SmartRlleF> swatch and alarm into existing tanks Polylok. Inc. 3 Fairfield Blvd, Wallingford, CT 06492 Toll Free 877.765 9565 Fax: 203.284,8514 www.polylok.com Page 4 IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) I comexfile Cesar SOIL COVER —D 2 min. !remit depth t t (typical) System Elevation 100.2C = ft. (typical) min 12' ('ypioll Septic Tank(s) Manufacturer Wieser Concrete Septic Tank(s) Volume(s) 320 gal gal gal gal Effluent Filter Manufacturer Polvlok Effluent Filter Model ll 525 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Provide minimum 3 ft separation between trenches. TYPICAL TRENCH (Show locabon of inlet i outlet pipe connection on plan v ew ) PLAN VIEW 4" 0 obee.eoon plve>,faii oe isma«i (No Scale) xP'con between unm. Perforated Lateral Observation Pipe (typical) (typical) — ------———————-?�——————— — — — — —— B = 50 ft (typical) INSTALL PER TRENCH 5 10-ft bundles @ 50 t EISA/unit = 250 + 0 5-ft hundles @ 25 if FISA/unit = 0 OBSERVATION PIPE DETAIL (No sc,le) Suew-Type oI"-- Flowed Gad. "IMP tioo(malUatl B wfe l 4, PVC Pipe1; Topso9 Cover Iop of PVC to teenin, ('run 1fmn et or eeuve liroshed y i4: 1 ,y--L j•• T e• 9bt9 open Anchonny pe�rc 10 ft (typical) �A=3.0 It (typical) EZ1203H Bundle (typical) (mfd by Infiltrator Systems, Inc ) ft Install pursuant to manufacturers mstructims. ft' = Proposed EISA per trench = 250 W Required Infiltration Area = 214 x 1 trenches = Proposed Total EISA = 250 RESET Infillralon S da. m W O n ft` Distribution Method: W branched manifold 0 Installation Instructions for EZflow Systems in Wisconsin Wisconsin Department of Commerce, Safety and Buildings Division, has reviewed the specifications ano/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 Site & Soil Conditions & Locations & Isola-ior distances as noted .r local regulations. The approved products are 1203H (3-12" bundles with pipe m center bundle in 5' or 10' lengtks) and 1203HP (3-' 2" bundles with pipe in each oundle in 5' or 10' lengths, A single pipe bundle contains a four inch perforated pipe a,r- rounded by EPS aggregate and Is held together with poly- ehtylene netting. A single aggregate bundle contains aggregate only and is meld together with polyethylene netting. Materials and Equipment Needed • EZflow Bundles • EZflow Geotextile Fabric • EZflow Internal Pipe Couplers • Pipe fg, Header and inlet • Backhce/Excavator Installation Instructions The instructions for installation of EZflow products are given below. This produc- must re installed in acro,cance with state rules defined in chapters Comm 82 through 84, `/vlscwnsin Ad- ministrative Code, and Chapters 145 and 160, Wisconsin Srat- utes, as well as the local health department's current design manual. 1. After the local heath department has determined sizing, configuration, and layout for the EZflow systems, stake or mark with pant ;he 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 gectextile fabnc brat meets re- quirements o` s. Comm 84.30 (6) (g), Ws. Arm. Code, installed directly on top of the product and extending down along the sides of the product to a point 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,owTM 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 FISA sizing ran be used in Wsconsin, resulting in a 40% sT,alle, drainfield. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for fine particu- lar site. -he top or center -most bundles containing pipe are toned end to end with an nterral pipe coupler. Ary adddiona' aggregate only bundles that may be required, should ire butted against the other aggregwe-only, bun- dles and do not require any type of connect, on, The top of each GEO cylinder contains a filter fabric p-e- marufactured in between the netting and aggregate The fabric is inserted to prevent sod intuson. The tnstaler shall make sure the the GEO is positiioned upward and is in contact wth the fabric contained in the adjacent cylin- der before backfd6ng, 8. The EZflow Drairfield 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 certral bundle distribution nice interconnected, without any dams, stepdowns or other water stops 9. The Irench top shall be graded such that water will not pone. Backfill should be seeded or sodded immediately after completion to reduce erosicn. 10. EZflow FPS bundles are flexible and can fit n curved trenches as may be necessary to avoid trees, boulders, or other obstacles. 11.EPS aggregatc is lighter then water, aerefore, it might be expected that natural buoyarcy forces would tend to cause EZflow assemblies to float out of ground when pending occurs. Field experience has shown, however, that this is not a problem when systems have a minimum o' 6" of soil cover as recommended by manufacturer. 1203H-GEO r;P f, 'toe matcral Page 6 In -ground Gravity Management Plan IMPORTANT: PAGE 4OF4 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 = 150 gpd; BOD5 5 220 nri TSS 5150 mgL-t; FOGS 30 nri Inspection Checklist INSPECT EVERY 3 YEARS o 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.i o material fatigue (i.e., leaks, breaks, corrosion, etc.) , 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.) 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) • 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 oe pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tanks) exceeds one-third (113) the liquid volume of the tanks) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent fllterts) 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. Page 7 S r. CROI u v rY SANITARY SYSTEM File#: Office Use Only OWNERSHIPIADDRESS FORM Created 212027 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system) This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources Once approved, this completed form and educational information will be sent to you by email. If you would Ike to view your Issued sanitary permit online, you can do so by using the Froperty_�Iles_Scarred webllnk. OWNER/BUYER INFORMATION Owner/Buyer Jason & Tammy Meyer Mailing Address 834 Prairie Meadows Drive City/State/Zip Hudson, WI 54016 Phone Number (regwred) 715-781-3102 Email Address (required) Jason.meyer@qualitysignsolutions.com Parcel Identification Number 020-1395-07-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location NE 1/4 , NW /, , Sec. 25 T 29 N R 199 W, Town of Hudson Subdivision Plat: Scenic Hills , Lot # 7 . Certified Survey Map # Warranty Deed # 1017161 Number of bedrooms 150GPD Page # (before 2006)Volume Page # Spec house O yes ■ no Lot lines identifiable ■ yes 0 no OFFICE USE ONLY New Property Address 93 � Pit nt C AA;te mx,,s D/A (Verification of new address required from Community Development Department for new construction ) 27 2I (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is mode in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax crlc)n ccwrgov 1101 Carmichael Road, Hudson, WI 54016 v✓wwsccwi nQv Page 9 j St. Croix Countr Accessnrp Structure Affidavit Jason Meyer R Tannny Meyer being dulv'wom . states, under oath, that Het she Is the legal owner of the following parcel of land located in St. Croix Couw: . \l,isconsin. recorded in DOCn111eat NUntbeltO17161 St, Croix C \font\ Register of Deeds Off ice. being duly described as follows', Lot ?. Scenic I lilts. Town of Hudson. St. ('rou Count' w <,, d, ,, 1„,, S•me xnd Itc[urn \fort'. Par..l \und,n I PI\ I As owner of the above described propert, I acknos' Icdge that the Private Onsite W nme.'atcr I-reatment S'slem IfOWW'I Sl hen lees an accessory btlilding on this lot and is sized for a design flow of I2U gpd. I his accessory building ntay not he used as a second residence on this parcel. I also acknowledge that I w ill disclose this information and stipulation to am lunlre parne,, intereatrd in purcha,a,,_ ihi< properly'. \ I)mcJ thie 1 7 da, rl a x %t 1IIENIR It I10\ SIPNnurcl+ authcnucawd thn da+ ul IIILC h11'.SI HPR S; All-A:1i2 Or W'ISUI�SI`. 111 not authorwd m ; 106 Pb Ws Sale 1 hh 1111 KLIMI\I WNOR\t 11-D 0 .John Schmitt (Stgnxntm> nm) he amhenncntd nr ackno»Iedged ti,dimcm)t ncctt nn 1 v V 01 wIS( '(1NSI, I ♦L ( ryjr 1 �.., n,, t 11cnonalh ..,ale h,Inrt to 11 da, � t he n.mm.l h+mc knr.v, w Ir, lhepcnnm.l .,N, 11—It cd tilt Irnlp'nnc,n Mnn.nt and a.6no„Icdet;I>t w 1c Sulam NMI,. Stnic,•I w t'wl .. Mh (tnunp...... n pcnnanult 11'mq..�!Jle c'P't.Hmn Ja'c D ar Page 9 SCENIC HILLS LOCATED IN THE NEI/A OF THE NWi/4. NEF/I OP TEE NEI/l. SE1/4 0£ THE NEI/l, PART OF THE SW(/4 OF THE NIT'/A, PART OF THE N➢I/A OF THE SEI/4 AND IN THE NEI/4 OF THE SSUR vOP T,T lv SII/A, ALL IN SECTION PS, TYBN. RIGIT, TOWN OF HUDSON, SL CROR COONTT. WISCONSIN. �imin �aw�e - PRREPnRRD FOR R p �'CR6TD11II� cu]!'ASs Oi'jD' iluaw�nrrn` wxm�••w • � :¢s:-iTcm� maxet'ms uuvs i__._......__. ______� 1AT5 i .90. ➢HI ^.. Q,itap 4SY1T I I urn i i -- IMl .-NxYVYxO'N IYdV � SECH �Jt� arm rcii j [f ill . kk to ! lip I xx at zz 27 ze ^fie\ A om e ._ m >a.snie • — ; w. .6 _ m ,I SEE SHEET 4 SNEfT20F s SREFt9 Page 11 11 � 1� ; h 1 � � "� `�.' � -mac �� _ . 1 r oL��SEV C s r—�d/— Depa t O LUATION REPORT 0� rSafe d _ = Professions Service�PR 05' 02 rdan with Comm 85, WI . . Page 1 of 5 Schmid Soil Testing, Inc. �. Attach complete site Ian on r not3ls£Y®e WAxA Inches size Plan must County P P P Pe V St. Croix include, but not limited to ve I®edIM6r3 a ® rnt BM), direction and - -- Parcel I.D percent slope, scale or dimensl distance to nearest road 020-1395-07-OW Please print all information. Revie ed By Date Personal mrormason you provide may be used for secondary purposes (Privacy Law, s 15.04 (1) (m)) Property Owner Property Location Meyer, Jason & Tammy Govt. Lot NE1/4, NW1/4, S25, T29N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 834 Prairie Meadows Drive 7 Scenic Hills _ _ City Stale Zip Code Phone Number I__1 City ---'Village ' Town Nearest Road Hudson WI. 54016, 715-781-3102 Hudson Prairie Meadows Drive New Construction Use: I- Residential / Number of bedrooms 1 Code derived design flow rate 150 GPD . Replacement Public or commercial - Describe Bathroom in garage for rivate use Parent material _Outwash (Burkhardt-Sattre Complex) Flood plain elevation, if applicable NA ft. General comments Area is suitable for a conventional system with a 0.7 gpd/sgft rate. Possible system elevation for area is 1002. Slope of area is and recommendations 23%. zoNE x # F 1-1Boring Bo 104.78 IPitGround surface elev. 1 Pit ft. Depth to limiting factor _100+ in. Soil Application Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consisten Boundary Roots GPD/ t' •Ef#f1 _ _ 'EfhC2 j in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh.' 1 0-10 10yr3/3 none 10yr4/4 none sl 2mgr mvfr as 2m,2vf 0.6 1.0 2 10-27 grsl I 2msbk mfr gw lvf 0.6 1.0 3 27-42 10yr4/4 10yr6/4 none sl 2fsbk I none grs I 0s9 ml Cs lvf 0.6 1.0 4 42-100 ml ---- -- 0.7 1.6 -- 5'�. Boring # i Boring F21104.78 factor 100+ Pit Ground surface elev. —ft. Depth to limiting in Soil Application Rate Horizon Depth Dominant Color Redox Description I Texture Structure ConsistencIlBoundary Roots GPD/ t'_ 'ER#1 -Efl#z in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-14 10yr3/3 none 51 2mgr mvfr as 2m,2vf 0.6 1.0 2 14-27 10yr4/4 none grs] 2msbk - mfr gw - 1f,lvf 0.6 1.0 _ 3 27-42 10yr4/4 none — -- sl 2msbk ml Cs -t 2vf 0.6 1.0 4 42-500 10yr6/4 none grs 0sg ml ---- 0.7 1.6 - - -- - A /00. -- _ - ' Effluent #1 = GOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD5 < 30 mg1L and T5S < 30 mg/L CST Name (Please Print) Signature CST Number Thomas J. Schmitt �� 227429 -- Address Schmitt Soil Testing, Inc Dale Evaluation Conducted Telephone Number 1595 72rid St. New Richmond, WI 54017 3/31/2021 715-760-1978 SBU8330 kx07Nai Property Owner Meyer, Jason & Tammy __ _ Parcel ID # 020-1395-07-000 Page 2 of 5 Boring 3 Boring # Pit Ground surface elev. 102.28 fl. Depth to limiting factor 100+ in. - _ Soil Application Rate Horizon Depth Dominant Color Redox Description i in. Munsell Qu. Sz. Cont. Color Texture Structure ,Consistence Gr. Sz W Boundary Roots GPDAP •Eff#t •Eff#2 1 0-13 10yr3/3 none sl 2mgr mvfr as 0.6 1.0 2 13-30 10yr4/4 none grsl 2msbk mfr gw 0.6 1.0 3 30-41 10yr4/4 none sl 2msbk mvfr cs F2f,2vf 0.6 1.0 4 41-100 10yr6/4 none grs j 059 ml 0.7 1.6 1 Boring Boning # -_ 1 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Descnphon Qu. Sz Conl. Color Texture Structure Gr. Sz Sh Consistence Boundary Roots GPDM' 'Eton •EfAr2 — I � Boring Boring # _, PH Ground surface elev. ___-_ fl. Depth to limiting factor in Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Texture Qu. Sz Cont. Color Structure Gr. Sz Sh. Consistence BouMary Roots GPDM' •Emit •EB#2 i i • Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS <30 mg& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608.266-315l or TTY 608-264.8777. SBD-83301R 07/007 Strn tt SON Tesiti>g. Im. St Croix County, WI Conducted for: Jason & Tammy Meyer 834 Prairie Meadows Drive Hudson, WI 54016 PID: 020-1395-07-000 Lot 7 Scenic Hills NE1/4 NW1/4 S25 T29N R19M Town of Hudson Conducted By: 421.48' Thomas J. Schmitt CST 2274 3-31-2021 •\ 23% SL,JD1 ' I DRAINAGE ' EASEMENT Jf ft p 1ouj � ;I 1 �• 105, HOUSE LOT 7 WELL 0 EBM 1 E5 [23' 32 4' 2 BM 1 100.0' Top of 1" steel lot corner marker BM 2 113.53' Top of 2" PVC Pipe co fD Legend Other Counties Lakes and Rivers Rivers and! Streams m, 'a—rv.,M Intlos ates US Highways State Highways County Highways Local Roads Rustic Roads Rana Road Right of Way Ill— a— v„:.w,iaow Railroads Conveyance Division Simultaneous Conveyance rand sl—1 w is wm'suar,.wK ill =60' Nl { 0 20 40 60ft DISCLAIMERS This map is not guanuined to be accurate, correct, current, or complete and conclusions drawn are the responsibibty of the user. 4 42021 Resource Limit ng Mao Page 4 of 5 - iSIV i' 1 � 4 ti' r:T �v B2 II s .v x 'l i x g C)Qf[ Mips rscccdd.maps arcgis ccm,apps+webappvie'wer:index htrr17id=893Ked22946484fb78237a6d2c721det 1 c �� =vc, St Croix County, WI Legend • K iy OImi, Counnas �I A •., Lakes and Rnnas .40 Y I• Rivers and Streams I •�'�tS ; t 5 I • rw'•r".' ti •b e r A :C* t r V � �A,. }�f �• US Highways � • t * •�i ! fit �. • State Highways • Cwnty Highways • ,•I N �R{ • ,ram ? ♦ y■ Lowl Roads Rustic Rcads Ramps r •+ . • �. .. Road Right of way d -*a, •-, Radroada fAl a y s Y SnrManeous Conveyance � Y ryv saq..neo N 1 0 zoo 400 600ft DISCLAIMER'. This map is not guaranteed to he accurate, m ct. woad, m complete and com*.i ns drawn are the rasponsiNity of the Ace5se�/ S�rie-lure &flv�n, S�.6rt;X couNTv NO. 633330 STATE SANITARY PERMIT Qymk��, PrarP rhao6ws a, OWNER �YAsay% d- Ttrw�.i PLUMBER 7d�n �,�.,q; LIC.#_ZZ3740 TOWN OF i4lu„ SEC-2 5 ,TAN, R_Lj E AND/OR LOT BLOCK SUBDIVISION ZIOOtiS: CHAPTER 145.135 (2) IN SCONSEN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and maybe renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: if you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ISSUING OFFICER — DATE of UNLESS RENEWED AIN VIEW !Z I THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20) . �R� fy • , bAoi� a >I.i '•a' P70 ° ire* 4 � a r a 6• • Y T'� � ;i• � � �^•!R •'. sir j.�... .. .. .. � _ ... _ _ �•� a � IL OW k e A,, -_I I 'y1 •>.'_ •.� _. ,c-w i . A 7 .� .. ..