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Home My WebLink About020-1476-01-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law s 15 04 (1((m)] Permit Holders Name I City Village Township Bayliss, LLC - Condo Unit 502A TOWN OF HUDSON CST BM Elev Ilnsp BM Elev IBM Descnnhnn 11 TANK INFORMATION TYPE MANUFACTURER� CAPACITY Septic Basing W;Gk.I- `l.5ff 3Zv KNc n. d 1 lU zs Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG Vent to Air Intake ROAD Septic zO Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GP Model N r7 TDH L Fric n Lass Sy em Head TDH Ft Forcem in ed9th Di Dist to wel SVIL ABSVRPTION SYSTEM B TION DATA STATION BS HI FS ELEV Benchmark 2.-r7 /vZ$ IDO Alt BM Bldg Sewer SVHt Inlet �xS h St/HI Outlet�5- L'XY5 � '7 of Bottom710 1 tt ✓L r— p Q ys cJ qy r Header/Man Dis e y /.r Bot System f6- rade St Cover -4 /a.i.- BEDfrRENCH DIMENSIONS Worth , Length r No Of Trench PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manurr��gqCurer{, o I�t2. r� d' 1) 2. Type OF System / ` 50 > CO �— Model Number DISTRIBUTION SYSTEM Headerily ld fl UU 1v/1 / Distribution • tr Pipe(s) G � x Hole Size I , .J- x Hole Spannp G r! Vent to Air Intake F_�Z F��"'� Length Dia Length Cis Spacing 2 SOIL COVER : Prassuhn Svstams nnly c,r Mn e❑ nr et-[lodn Q..'— nnly Depth Over Bed/Trench Center -- / 1 Depth Over Bed/Trench Edges 7 jl xx Depth of Topsoil xx SeededrSdded xx Mulched es No IJ Yes No COMMENTS: (Include code discrepancies. persons present, etc.) Inspection #1. Inspecton #2 Location: 502A PRAIRIE LN 1 /� 1 ) Aft BM Description = �ir La, H Wof 64Se 2 ) Bldg sewer length = I - amount of cover = Plan revision Requiredv L I Yes / No Use other side for additional information Date SBD-6710 (R 3197) Insers pctoSignature 1"M � _1 Cert No SY 1.; County " - - - 11 Industry Services Division st.cmrx 0 $ I �_. - _- 1400 E Washington Ave P S P.0 Box 7162 Sannaq� Permit Notches -(to be filled in by Cu 1 APR 13 2 21 j Madison, WI 53707-7162 333 I i Sang ary,P nit A ])cation Stale Transaction Number `W ^ l cqC In accordance with SP.S 383 21(_brWila,rttMiy 'his Comm h) the Z4c rental unit u required poor to obtaimn an' pertntcetion forms for stateoumed PO y'C0 PrnJect Address Id different than marling address) the Depanment of Safety and Professional Services Personal utfonnabon you provide mas. be used for second air u es in accordance with the Privacy Law. s 15 04 On Slats 502A ['mine Lane 1. Application Information - Please Print All Information Property Owner's Name Parcel H Bayliss, LLC 020-1476-01-000 Property Owner's Mailing Address Pmpeny Location P 0 Box 32 Gout Lot SW 'i.. NW V. Section 21 oh. State lip Code Phone Number New Richmond, W'I 54017 1$$Ircle ones T 29 N R 19 1 oi-V Il. Type of Building (check all that apply) l Litt A Subdivision Name ® I or F=61% Dwelling - Numberof Bedoamms 35 Jacobs Landing, 1i AdditionElPubadCummercml Bln,k B - Desuibc Use ❑ Oty of ❑ State Owned - Describe Ilse ❑ village of CSMNu beatbei rr ® T9vsnof Hudson Ill. Typt of Permit: Check onl one box on line A. Complete line B if applicable) A ❑ New System ® Replacement System ❑ I reatmenVHolduig fmsk Replacement Only ❑ Other Modifcabon to I xislmg System (explain) 9 ❑ Pernut Renewal ❑ Permit Revision ❑ Change or ❑ Permit I ranster to New List PtCV109a Permit Number and Date Issued Before F_xpuation Plumber O%ncr 135399, 1120/1989 IV. T e of POWTS System/Component)Device: (Check all that apply) Z V -' yySS_ - No-Pmssunzed In -Ground ❑ Pressurized In-Oruund ❑ At-Oradc ❑ Mound = 24 in ofsuoahle soil ❑ Mound 24 in of suitable sail Holding Tank other Dispersal Component Iexplam) ❑ Pretreatment Device (explain) %JpG ?r 1� r / V. Dis ersalfTreatment Area Information: tu. Design Flow (gpd) Design Soil Application Dispersal Area Required (st) ✓ Dispersal Area Proposed (sD System ldcnanon 450 Rale(gpdsp 643 650 926(l' /reG+l. 3\ 07 (.J / VI. Tank Info Caracas in p .. Gallons Po� �� s►L I buts Manufacturer Sc, fu Link, V xisunp Tanks Cationso Units I Septic or Holding Tank 320 Toff 1320 2 \4 ieser Con erete Dosing Chamber 1 ❑ _ ] R 1 a VII. Responsibility Statement- 1, the undersigned. assume responsibility for installation of the PORTS shown on the attached filans Plumber's Name (Pnntl Plumber's Signature - - MPMPRS Number Business Phone Number John Schmitt `" - 223 i60 715-760-(986 Plumber's Address (Stme4 Cry. State. Zip Code) ; 586 Valley View Trail. Somerset W 154025 Vill. County/Department Lse Only Approved ❑ vod 1n'en Pertnn ee DL,at Isss7su ! I gAgRiu Sign u D I ❑ 'on list Dennl $ � �� ZnZ� M `� IX. ConlihWp Approv I/Roaee111 Io F-Biteppr00al �/� TEMO M bo$Q� lrtt �n eptic tank, effluent er and 0. tspersal cell must be serwced I maintained C.d'nSL IQ� -_ �_ __ 0_ - by -b i � f +eoic— `-s s per management plan provided plumber. n - — S be mantained 41 Pthackre wrements must e oX � as er applicable codelovotiAdn6vin piece pleas for the ... tam and satins it to the( ounty'O6iti on paper ibt less th 8 1�1 i(11 inch in �) P15�.�, `�� P�wµf�er-fo a i.'( 1U698( 3/141 fi r, `'' A sN � �p as �a� �p C C�*�k- d p e yn 5-)gkLI ru" v d�of "fesfi"asptie Ss ,'�^ ^�aQio v�5f1H� PG'wh� SYSTEM PLOT PLAN Bayliss LLC 3 Bedroom Septic System Purled Address502A Frame Lane BM1 Symbol. - BM Elavadon 10000' By Description Bosom of send or house BM2 Symbol A BM Elevalon. 99 55' BM Description Concrete alrcondltbner base Slope Gradient of Tested Area 0%) Well Symbol (If epploable) Nolen. See Plat map for complete lot See next page for complete plot map Opel L� 1 � too, I 1 , I , I 1 % Slope Tt- 5'x 65' Rock d Pipe Bad EI = 92 60' T2. ll 55' Rook 3 Pipe Bed IJ = 9260 Z BM1 OnItA ooa O Existing Well Design Flow 550GPo Anal design flow reWallons V oommerc al plans. Pipe Materials /ASTM Standard Tables 364 30.3 & 384 31t,5 4' SCH a0 PVC pipe I ASTM- D2665 4^}o]4 PVC Dine ASTM-D3034 4.2729 PM oloe I ASTML2729 100 Existing iB'z36'rock & pipe bed Jg %LL" r_lt^'1� V mpased VJ320-MR 99' sapoc tank w/ � Polylok 525 / \ Ewsbng 1 WOgal / septa lank 1 BM2 f I I v Gm n Ewsbng f [� 3 Bedroo unite % , Scale: 1" = 60' 0 60 90 120 ZZZA 152 Prairie Lane R/W IC CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Bayliss LLC 3 Bedroom Replacement Septic System Owners Name: Bayliss LLC Owner's Address P.O. Box 32 New Richmond, WI 54017 Legal Description: SW1/4, NW1/4, S21, T29N, R19W Township Hudson County: St. Croix Subdivision Name: Jacob Landing 3rd Addition Lot Number: 35 Block Number Parcel I,D. Number 020-1476-01-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Existing Tank Specifications Page 4 Septic Tank Specifications Page 5 Effluent Filter Information Page 6 Valve diagram Page 7 System Sizing & Cross Section Page 8 Management and contingency plan Page 9 Existing Tank Certification Page 10 Sanitary System Ownership/Address Form Page 11 Warranty Deed Page 12 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 4/9/2021 Phone Number: 715-760-0486 Signature: In -Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 SYSTEM PLOT PLAN Bayliss LLC 3 Bedroom Septic System Project sorriness 502A Paine lane BM1 Symbol. BM Bever on 10000' BM Descophon B."., of ad., on lwuae 111142 Symbol L BM Elevation 99 55' BM Description Concrete air conditioner base Slape Greoiem of Tested M a (1%) Well Symbol (d applicable) Notes See Plat map for complete lot See next page for complete plot map Desl Ptow 551GPG Attach design flow oal[ulaaons for commerclsl Means Pipe Matenels ( ASTM Standard Tables 384 30-3 d 311e 30-5 a" SCH 40 PVC pipe ASTN- 0295° T3- PVC p�oe ASTM-DJ03a a' 2720 Parr moa I ASTM-02729 �� .1 I I I I VZOM ®"% �w-ooa�dM 3iu 9S4B—SZf-008 \ anod-lscd oo/ooioo 31va oscvs N 'NDGa N301VH 'oL eMH Sri 9iLCM iyf1NVW OI1d35 na ,dAG WYNO an318SI0U B353Im-ai 3.C—.L a/L 3,v�s w 28W-0001d-W w O z W J o hi Q O w m w f 1 C 00 O " N K o o F- Z L R d m U Q m 4 N a .. w O LVw a o aan¢ N N O w a 8� o o Of j a Z 3 pZ.� o Q N IM w W m fJ^ O 4\ O Y W W 3 LL o a J N aim aci id Fad Iwo N aQ 00 �9 cziz8 W a n Sa o0 OS V Z CO �� oQ Dz'a' y a wx woW a Z Z NIJ _Nz o I ONN a ZSU N m\ Q ZONm 2 F L�J ..; o�'y-1 Z a 20 W a ~WQ m 21 U� ix N� W 3 m0mzmV1�lJJ�0� z< � Y In �Y 3 J J < ZZ 0 O z N EsZ z x ~ OU — U a lil N N Y U O t SVJ --� w I f � o - w s W I U Q I. ..f N iIl .a dy it Qas U X � I r I N � ~s t cin g � a I z 03211f103d {£s SV 2 a U w � a N Y H Page 3 d A A 4 CAST -A -SEAL 4" CAST -A -SEAL I I I I ` I L_� FILFER OR BAFFLE �o a� v INLET _ OU TI FT I I I� v 3 e TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS W320-M R TANK SPECIFICATIONS 0 a DIMENSIONS: rc WALL: 3' a BOTTOM: 3' COVER: 4' MANHOLE: 24' I.D. PRECAST CONCRETE RISER a HEIGHT. 58' LENGTH: 4'-2' WIDTH: 4'-2- BELOW INLET: 46 1/2" LIQUID LEVEL: 43' o WEIGHT: 3,880 LBS. INLET AND OUTLET: Y U 3 4" CAST -A -SEAL BOOT OR EQUAL GASKETS m INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL 010 (OTHER STATES SEE CHART) W LIQUID CAPACITY 8.00 GAL/IN W v. C LOADING DESIGN: 8'-0' UNSATURATED SOIL TANK CAN BE USED AS: C w SEPTIC / HOLDING / PUMP OR SIPHON G7 I c � COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) W � of CUSTOMIZED TANKS: S FOR CUSTOM TANKS CONTACT WIESER CONCRETE LU ,- � c 3 J 4 mZ < I O M U REVIEWED BY REVIEW DATE 3 a w DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET NO APPROVAL DATE: j PRODUCTS NEEDED BY: / PF-525 Fffluetnt Filter PL-3: 5 I iftei 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 Polvlok PL-122, the Polvlok 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. I ea(ures. • 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 lrsfal lotion_ 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 PI: 525 VYlaintrnnncz: 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 property aligned and completely inserted 7. Replace and secure septic tank cover. lllh"' 1 iliration 10,000 GPD Accepts 4" & SC HD 40 pipe I/� i-r- Alarm Switch t.w (Optional) -cep is 1" PVC tension Handle Rated for 10,000 GPD 525 Linear Ft. of 1/16, Filtration Slots Certified to 10 NSVANSI Standard 46 ti Gaa Deflector Automatic is Shut -Off ball .,1d.:>.... .. Polvlok. Zsbxl & Hest filter' accept the SmaztFiltenfJ switch and alarm 1, na,« Fasily wialis vrto exmhng tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingfoici T 00492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com Page 5 Home About site Map Order Info Videos &literature Contact Drip Systems Treatment Controls Products Downloads Design Guidance I , m e,l f I I've 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, Field Field No I No.2 Valve Positioned on No. 1 during Odd Years Septic Tank Field F-Li w Field (� Valve Positioned on No 2 during Septic Even Years Tank ITEM DESCRIPTION BRV4 BULL RUN VALVE 4" BRVBULK BULL RUN VALVE 8 KEY ONLY BRVCIRISER BULL RUN VALVE RISER W/ CAST COVER BRVKEY2B BULL RUN VALVE KEY 28" BRVKEY36 BULL RUN VALVE KEY 36" BRVKEY48 BULL RUN VALVE KEY 48" RISER CAP ADAPTER RISER TUBE 4' OUT PORT NATER-TIGHT ACCESS GAP VALVE DIRECTION HANDLE C OUT PORT C IN PORT 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 Page 6 a IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Washed Aggregate 1 4- 0 Geot xtge Perforated Lateral gorover (typical)� SOIL COVER 2" 1 mn irenrli depth (typist TYPICAL TRENCH CROSS SECTION VIEW (No Scale) TYPICAL TRENCH System Elevation/ 92.60 ft (typical) ent Filter Model tt min 12- (typical) Septic Tank(&) Manufacturer - Wieser Concrete, Wieser Concrete Septic Tanks) Volumes) 1000 gal 320 gal gal Effluent Filter Manufacturer Effluent Filter Model # 525 0 5' TO 2 5• WASHED AGGREGATE (min 6 0' beneath distnblltiOn pipe - - -min 20' over distribution pipe and ' covered with approved synthetic fabnc) Provide minimum 3 ft separation between trenches. (Show location of inlet / outlet pipe connection on plan view.) OBSERVATION PIPE DETAIL (W Scapl Slip Cap (looua) 4-0 PVC frfn — Top of pipe to lenninate at or above fiashed grade (4) l/4'-1/2" X 6- Sipls Cg W road Anrhonrg IMnrn PLAN VIEW 4° q (ND Scale) Perforated Lateral (typical) Observation Pipe 6.5 ft (center lateral in trench) (Np(typical)l� T — — — — — — — — — — — — — — — — — - - —----------- — — — — — — — — ----- L------ ------------/------------------ J i B= 65 ft -1 (Nroral) Required Infiltration Area = 643 ft2 Proposed Total Infiltration Area = 325 ft' per trench x trenches = 650 Fig — Finished Grade (midrh.dA avehen —Iwo icover (mn 1 fwp infdtra0on Sudaod A= 5 ft 1 (typical) Distribution Method: branched manifold Ij BaJ 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, 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 = 450 gpd; BOD5 5 220 mgL-'; TSS 5 150 mgL-'; FOGS 30 rri 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.) 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.) c distribution lateral or lateral odfice 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 tanks) shall be pumped by a certified septage servicing operator licensed under s. 281.48 W is. 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. c Effluent filterts) 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 8 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) 502A Prairie Lane located at: sw /4, NW 1/4, Section 21 Town 29 N, Range 19 W, Town of Hudson 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 ' (— 3 0 -a Did flow back occur from absorption system? (if no, skip next line.) Approximate volume or length of time: Tank Capacity: 1000 Construction: Prefab Concrete x Steel Manufacturer (if known): Wieser concrete Age of Tank (if known): 1 v2a1989 Pcrmit number (if known) 135399 John Schmitt (Li used Plumber Signature) (Print Name) MPRS (Title) s- (o - 21 (Date) 223760 Yes No gallons Other minutes (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 9 File #: S-r. CKR0I- = L1N-I-Y SANITARY SYSTEM Office Use Only OWNERSHIP/ADDRESS 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 like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Bayliss LLC Mailing Address F.O.BOX 32 City/State/Zip New Richmond, WI 54017 Phone Number (required) 651-329-9934 Email Address (required) Applegateinc@frontiernet.net Parcel Identification Number 020-1476-01-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SW '/, , NW Vs , Sec 21 T 29 N R 19 W, Town of Hudson Subdivision Plat. Jacobs Landing 3rd Addition Lot # 35 Certified Survey Map # 842675 Volume 2 Page # 30 Warranty Deed # 996870 (before 2006)Volume Page # Number of bedrooms 3 Spec house O yes ■ no Lot lines identifiable ■ yes O no New Property Address OFFICE USE ONLY (Verification Y' rle)A/address reqwred from Community Development Department for new construction) (Staff ImUals) (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 made to the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center ccid t sccwl ao,v 1101 Carmichael Road, Hudson, WI 54016 715-245-4250Fax u"WW scrw, r V Page 10 SC)IL EVALUATION REPO!-' an - New, RICI19iond s4,-j 17 I 1. i Fnrery Cw^e 5cri 55 _�i -i ;Y > t r.: - - - - - Ll ------------ -- -- ----------- - —tzz--z fv i tep DSaffn d SOIL EVALUATION REPO �! a 06 20#cordan with Comm 85, Wis Adm t, ProfessioServit>LR �sr�a)-64b #2092 Page 1 of 4 Sdhmilt Soil Testing, Inc Attach complete site plan on aper nMsssrMdn�81#i Sl IP`t in a m size. Plan must County St. Croix include, but not limited to. ve icaippflaaptl3lse� (BM), direction and direction - percent slope, scale or dime n and location and distance nearest road. Parcel I.D. 020-1476-01-000sw Please print all information. — Wkwek BY D(81t Personal information you provide may be used for secondary purposes (Privacy Lew, s 15 04 (1) (m)). 2 l 23 (f�Z Property Owner Property Location Bayliss LLC (502A Prairie Lane) Govt Lot SW1/4, NW1/4, S21, T29N, R19 Property Owner's Mailing Address Lot # j Block # Subd. Name or CSM# PO Box 32 35 Jacobs Landing 1 City - Village ` Town Nearest Road C ty State Zip Code Phone Number New Richmond WI 54017 i 651-230-0762 Hudson I 502A Prairie Lane New Construction Use Residential / Number of bedrooms _ 3 Code derived design flow rate 4.5_0 GPD Replacement _-, Public or commercial - Describe. Parent material Outwash Plain (Pillot Series) 1� Flood plain elevation, if applicable NA ft. General comments Replacement area is suitable for a conventional system with a o.7 gpolsgft Possible system elevation for replacement area is and recommendations92,60'. Slope of area is 1%, �DNE 17 Bonng # Boring 99.53 Pit Ground surface elev. ft. Depth to limiting factor _ 125+ in. Soil Application Rate Horizon Depth , Dominant Color Redox Description I Texture Structure Consisten Boundary Roots GPD/_f l •Eff#1 •Efl#2 in. Munsell Ou Sz. Cont Color Gr. Sz. Sh. 1 0-11 10yr3/3 none none none none sit sil sl 2mgr mvFr as 2m,2f 0.6 0.8 2 11-27 10yr4/4 2msbk mfr 9w lvf 0.6 0.8 3 27-35 10yr4/6 2msbk mfr Cw 1vf 0.6 1.0 4 3 10yr6/4 grs Osg ml --- 0.7 1.6 i •{- Q2.6t7 �'IV�II`i•► � l ❑ Boring If Boring Ground 99.53 factor 125+ Pit surface elev. ft Depth to limning in Soil AWlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtt_t'_ 'EB#t •Eff#2 in. Munsell Ou Sz. Cont Color Gr. Sz. Sh. 1 0-10 10yr3/3 none sit 2mgr mvfr as 2m,2f 0.6 0.8 2 SO18 10yr3/4 none sit 2msbk mfr gw lvf 0.6 0.8 �— 3 18 24 10yr4/4 none sl 2msbk mfr gw 1vf 0.6 1.0 4 24-33 10yr4/4 none sl 2msbk mfr gw — -- 0.6 1.0 5 33-125 10yr6/4 none s Osg ml —_ ------ 0.7 1.6 g3.16 n °t.l • Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD5 S30 mg1L and TSS <30 mgA- CST Name (Please Print) Signature' - CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Dale Evaluation Conducted Telephone Number 1595 72nd St New Richmond, WI 54017 3/22/2021 715-760-1978 SB"3301R 07M) Property Owner Bayliss LLC (502A Prairie Lane) parcel ID # 020-1476-01-000sw Page 2 of 4 3] Boring # - Boring Pit Ground surface elev. 99.53 ft. Depth to limiting factor 125+ in. Soil Application Rate Horizon Depth In. Dominant Color j Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roofs GPD/ft' •Eff#t •E0*2 1 0-7 10yr3/3 none sit 2mgr mvfr as 2m,2f 0.6 0.8 2 7-20 10yr4/4 none sit 2msbk mfr gw 2f,lvf 0.6 0.8 3 20-281 10yr4/6 none sl 2msbk mfr gw lvf 0.6 1.0 4 28-125 ; 10yr6/4 none S Ogg MI — ------ 0.7 1.6 �� Ib Il°►.Ib [_ Boring Boring # — Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft` Will 'Eff#2 ❑ Boring Boring # � Pit Ground surface elev. ft. Depth to limiting factor in. �_, Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu Sz. Cont. Color Texture Structure Gr. Sz. Sh. ;Consistence Boundary Roots GPD/ft' 'Eff#t •EfW i I ` Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mgfL 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 608-266-3151 or TTY 608-264-8777. SBD,8330 (x.OWN) Schmitt Soil Tesang, I K Page 3a4 / !! - > o « o / � ] E -n \ 9 Z / - air-0=Ln zzE $2) :3 (A> #aoo 02; p ® \) y% &z�7 0 r \\\]/\$ =\\)\E 0i7 } \] t _ =§Oe$; 2 j 2C§ I 2 ! (0 ° ■ e >ecc z w 2 i 0 00 \% \ (\\ \ 6@3 \ �-- {)\ % } m \ (( ° ; (()CL m \\° / �/ /l;,�=! to §` - |i. !!�!i#! [ x |$7!` \/ ! |�|I/ 0 \ \ /}2 ~ «�| = 0 § I ; �aeR ; R w♦c( a� � 1 4 elkn T .1 ♦ e Z � sjr 4 T.♦r..._r. _ >i ..... i r F +"a 'ts cn n m P 8 8 a A A a A A a r m p G ¢ x a N z C— N d a E m (Q 7 C 1 x 0 C G Y u 0 E u a m c N m n O � m i m LL m n m co a c E w E O O W m c d m K �i c m w 0 E U m Y m a 6 t Fotm -STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER SaM TOWNSHIP SEC. T �N-R I W a1.2�.19,137,8 ADDRESS Rot V Z8 ST. CROIX COUNTY ,OWI CONSIN u,_.lt n W1: SYvlo 55 CA�S1P SµDI(o SUBDIVISION sc LOT W LOT SIZE r4 7 A«+ S PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S-6s 1,,jjn5 /-ot*35 D.�Ple.x 35w a5E Sys+-�61- u t_ 1 • I I � I;4 3 , 95 � � W f � Wall Da�r�w.y fb B.M.T<p of NS? �PED.A+ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point usedT f-{Vj$1? P A S W <qvocr Elevation of vertical reference point: IOO.PY Proposed slope at site: 2 0 IVE SEPTIC TANK: Manufacturer: ILa j,� Liquid Capacity: I000<5,o-1 Number of rings used: -7— Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front ,(;7%Side,O Rear, O �. feet From nearest property line Front,o Side Rear,O —IQ 5-feet Number of feet from: well 15 building: 'L� (Include this information of the above plot plan)( Z reference dimensions to septic tank) SEE REVERSE SIDE ifl�rr�.�T PUMP CHAMBER ��fj r Manufacturer: Z/T Liquid Capacity: 1,mp Model: Pump/Siphon Manufacturer: Elevation of inlet: Pump off switch elevation: Bottom of tank elevation: Gallons per cycle: Pump Size Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Slde, O Rear,O Pt.__ Number of feet from Number of feet from building (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: /nQ Trench: Width:T�j' Length: -�_._ Number of Lines: Area Built:k/ Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, Opt._ Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT ,/% [� Size: / // Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK ��! ;pµ Manufacturer: /�/ // Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt._ Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: f Dated: Plumber on job: �✓,y-�/� License Number: /t4 / ; % 3 Z 3/84:mj