HomeMy WebLinkAbout020-1121-20-000Wisconsin Department of Commerce
Safety and Building Division
GENERAL INFORMATION
Personal information you provide may be used for
Ashley Fall
TANK INFORMATION
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
[Privacy Law, s.15.04 Glum lj
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMPISIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
TDH
lift
Friction Loss
System Head
TDH Ft
Forcemain
Length
Dia.
Dist to Well
SOIL ABSORPTION SYSTEM
TOWN OF HUDSON
ELEVATION DATA
County St. Croix
Sanitary Permit No:
633388
Slate Plan ID No:
Parcel Tax No
020-1121-20-000
Section/TownlRangelMap No
17.29.19.529
STATION
BS
HI
FS
ELEV
Benchmark
Alt BM
Bldg. Sewer
SUHt Inlet
SUHt Outlet
DI Inlet
Dt Bottom
Header/Man
Dist Pipe
Bot. System
Final Grade
St Cover
BED/TRENCH
DIMENSIONS
Width
Length
No Of Trenches
PIT DIMENSIONS
No. O(Pds
Inside Dia
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
P/L
BLDG
WELL
LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
Manufacturer
Type Of System
Model Number
DISTRIBUTION SYSTEM
Header/Manifold
ID,stnbut,on
x Hole Size
x Hole Spacing
Vent to Air Intake
Pipets)
Length Dia
Length Dia Spacing
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx Mulched
Bech Trench Center
Bed/Trench Edges
Topsoil
L] Yes [:: No
1:1 Ves , No
COMMENTS: (Include code discrepenaes, persons present, etc)
Location: 362 BROOKWOOD DR
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Regwred9 L] Yes I No
Use other side for additional information_
Date
SBD-6710 (R.3197)
Inspection #1:
Insepctofs Signature
Inspection #2.
Cert. No
7HEnETWED;n-09 2021 5T. e-wXJUN "{Nu ' r,El„St Croix Countyommunity Developme0t -
Sanitary Permit :Application
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II. Iypc of Huddling (check all 11hal apply)
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\. OtelatnAll,f,drc' /QImeat Are a information: t.t,1x
IA•f I}�i, 11, (A' V I$,n;ll tioll Appl auon Raic .pdsn Ur.p. r>a �c, R I„ rrJ Iv) Duty tl 1 ca Pro
7so o,Y arts 1, roa 9z so Qa.ao
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\ 1.'tank Into
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\ II Hrnlnandlry Statement I, tbG urrdeltpaed, uaurAe res nvblli, !or lasbtla,Arn nf,he i'/l1t I )hone oa the AuuhGd p1aY — - _ -
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\111*(uum)/1mcn,l me Onl, , _ "—' ---- ------ ---- __
._. .- _
ATEM Cl 1yppnnec— —� pr`m r `wl
oc,
1 .-•f. tffiF(1ti641A
isSQ12 4 tast s�t�rcAanmauaeo,ed -- - —
as per management plan provided by plumb( ! ' ` av
2. All setback requirements must be maintain// 1/ �G
as per applicable code/ordinances. \'ft.4'W11CI-/ i14�7/ Pftvl,
o'� �ysk,� �'►tkin,k.,q,a1e,�
t YL(cor, r,
\r1acM1 to eomple. pions f.I the y>I r Y11J eYhrMt to tM C omo rml) un payer a aea t� a t t 11 hoe ,n.,
S��//xls��i� s��c� rals�f �� a�✓� Qs��
4RIkhi9R IR M'la) L06GG
Plot Plat
F
P40PERIY OWNER: A,- M � 'FALL
i.e le alDesaintion: LM 26_ MbUT BRA V.}60Ds ME`%W OF nje SEVq
1"74 It, Tzanl, klgvJF TOWn of t VV-50A, sr. c-VDIX Counrc�f
l t5co>u�,nl. Oza-IIZi-zp-off 362 BpoKwoob bRIVC
i ho p
41COPY
E ,T
F
D
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a �
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�V1CO PY
.I F}
FdA OUTLET
4�
Z
3
P
0
i location:
�C.0
Page a. of �/
1" — 40 FT.
(except where noted)
Q = baahoe pit
North
a
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I "Jal-
ig
285 COUNTY
RIVER FALLS
800-828-3723
715-426-6466
6/8/2021
To: Comm
Re: Ashley Fall 362 Brookwood Dr, Town of Hudson, Replacement Sanitary Permit
Application
Please expedite the permit application process: the current drain field system meets the
criteria for failing as per W 1145.245(4)(d)
Thanks Mike
Michael Rode%vald
MPRS 931384
Pg1of4
Pg2of4
Pg3of4
Pg4of4
Attachments:
In -Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
Version 2.0, SBD-10705-P (N 01101, R 10112)
--
PAGE 1 OF 4
Index & Cover Sheet
Plot Plan
Dispersal Area Cross -Section & Plan View
Management Plan
Enclosures: __
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name I Description
Owner Name(s): ,. 45�HL&y FAu- Phone:
Owner Address: — Z _�BpjCW DbD lip_L _- Zip: SIPOIip
Project Address: l
Govt. Lot: — /V&_ 114 of Sb 114, Sertion_ 17 _, T_ Z_TN-R_�_E ❑ or W
Township: _�wzAf _— County: __ 5T CP41 _ _
Project Parcel ID#: _020— I iZ1-20- VoD
Designer Information
Designer Name: A1Q uPp� , --` Phone: �1S- L124, _-1775
� �l
Designer Address: gEgg7 K6RA u6 ' 64. L2J Zip: 05Y.F36
E-mail: /16��iS%tY�PSIAl1�� BGff/DD 7— le.
License Number: I1-1517•00 : �•` >- ,,,
Remarks: '
WII:sEX TANK kJl �DLY�oK S2S H U P f k9A^' 5^.
Signature: Date: ,tom-1�1-g�1
OPQIRI 9 W. required an arch m millrA cupY
Plot Plan
Page. of y
PROPERTY OWNER: F-ALL-
Legal Description: Loi Zo InLt BwwK Wams, N)cy'i aF THE SE/y}
su- )'74 ($, TZ40, kjgW 1 TOW, OF tjtkV A, fit. LMlx eOkA
W lsCON,�I>J . 02P- i l2l-Zp-UOD� 36Z BRODK W OAD DR�V6
1" = 40 FT.
(except where noted)
= Wahoe pit
I. W A OR&S
North
1 !�
Y 9• j _
i
1
�Rc;cHa 1►
FOk t y,7 ET �.
r
S)
D
f ��Y
10, u.
Site location:
I�rf I
IN -GROUND GRAVITY DISPERSAL AREA
Stepped Elevation Trenches with EZ1203HP Bundles
3-ft Trench `down -sizing credit)
G.mtegib I -I{
SAIL COYEH
T
lL'
r,�pa. t_ —
vr�am
Highest Trench
Imo 12
!typ—')
�XLYtII�:
Septic Tanks) NMLA.'Iftnrer
I&--:D NuFFcu-TT
f}DD
3Zm WIF.55
Septic Tank(s) Volunw(,):
)Z50.9a'
3m gal Oat
rY ,
TYPICAL TRENCH
CROSS SECTION VIEW
(No Scale)
System Elevations= qz•2 it, `1Z.0D :;
t_
Fffuent POtrr Marwfacturar
PDLY L0 K
Effluent f We, Model k $�
Lowest Trench (as applicable)
TYPI CAL TRENCH (she, loc:ahun of ,nk:t ) outlet pipe cnmil on plan wow.)
B
PLAN VIEW 4" g t _111.:1mop� nha:l lr. lr 1"A',
(No Scale) Perforated Lateral observation Pipe
- (typical) ItYP�cal) (ryPlral)
B - /(D ft
(typmn
INSTALL PER TRENCH'
;p-ft bundles @ 50 fY FlSAjunit = 550 ft'
+ -' 5-ft bundles (Ci) 25 ft' EISA/unit = -' W
----------------- --- --
= 1'mposed EISA pertrench = 550 ft'
Provide minimum3ft
separation between tranches.
O3SERVATION PIPF OFTAIL
(ho Fwo l
ft
sun Gep oocsw I
+nor hoa f, x+otl,�a
a`P PVC
Tolw C,3w
r,por oq.• m i=r^.r.ar
..I I fill
�Il rfdtY.ve rllll,r,rv,; J.d.ie
:4)1IT-10 x t-
ri
M✓r:rru'q Ik�.ad:
�—�" J�)
rlohdtlan
�A = 3.0 ft
_ (typirap
IfD71.Y3� s %3G-4-?/MirE2'121`�P Bundle
c
203 pR Z2 UNITS firm 6y Inritrato. Syslens inc )
27. "tts A it tall pursuant to manuf.act,mrs ln,ttd(A S
7-W
(2) 3,x
Required Infiitrabon Area 43ft-
Distribution Method,
x Z trenches = Proposed Total EISA = to 100 fY / PALIFO ..D
D
G� CA
m
w
n
33.02 183.9 cm ]
— 20.71 [52.6cmI
y4" (10.16 cm) BALL HOUSING
TRAVEL FILTER CARTRIDGE MATERIAL -POLYPROPYLENE
y p r-- 5.7 114.7 cm] F- MATERIAL - FILLED POLYPROPYLENE
- A
6.5' (16.51cm) SEALED BALL
MATERIAL - HDPE
POLYLOK PL- 525 - 625 CUTAWAY
BALL PUSH ROD SECTION A A�������
FACTORY INSTALLED �!
MATERIAL - FILLED POLYPROPYLENE
4" AND 6" FACTORY — OPTIONAL BUSHING
INTALLED PIPE OUTLET (FOR 4" THIN WALL PIPE)
MATERIAL - PVC PART NO. 30142-R
OR OPTIONAL FLOAT SWITCH —
(FOR 110 MM. PIPE)
PART NO. 30142-EUR
0
4" CAST-A-E-
FILTER 0
r-4 -2'---1
INLET
I
3" r
TANKS ARE MANUFACTURED TO MEET OR EXCEED
CAST -A -SEAL
OUTLET
N
J
U
W320-MR
TANK SPECIFICATIONS
DIMENSIONS:
WALL' 3"
BOTTOM: 3"
COVER: 4"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
HEIGHT: 58"
LENGTH: 4'-2"
WIDTH: 4'-2"
BELOW INLET: 46 1/2"
LIQUID LEVEL: 43"
WEIGHT: 3,880 LBS.
INLET AND OUTLET:
4" CAST -A -SEAL BOOT OR EQUAL GASKET
INLET AND OUTLET BAFFLE AND FILTER:
WISCONSIN, SEE DETAIL #10
(OTHER STATES SEE CHART)
-
w
N
3
m
ffi
o
o
o
o
E
$
�
W
LIQUID CAPACITY: 8.00 GAL/IN
W n
LOADING DESIGN: 8'-0" UNSATURATED SOIL
co �z �
L0
TANK CAN BE USED AS:
C
SEPTIC / HOLDING / PUMP OR SIPHON
CA o
aCN
COVER: MIX DESIGN #8 (NO FIBER)
rNj
TANK: MIX DESIGN #10 (STRUCTURAL FIBER)
W �
of
CUSTOMIZED TANKS:
C
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
W
3
D
Z
Z
¢
I
O
M
m
U
REVIEWED BY
REVIEW DATE
3
a
cn
DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY:
SHEET NO
APPROVAL DATE:
/
PRODUCTS NEEDED BY:
/
OF
ST. CROIX COUNTY ZONING OFFICE
i
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
SH LE A LL.
This is to certify that I have inspected the existing septic and/or dose tank
presently ;serving the following residence:
(Street address ) 367— g4kw OD
located
at: _Ale _?/4, SC `/<, Se tionn 418 , Town_ N, Range�_W,
Town of ` �1f , 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 receht date of inspection or service
Did flow back occur from absorption system? Yes_ NoL_
(if no, ski next line.)
Approxirlate volume or length of time: gallons minutes
Tank Capbcity: I ?M
Construction: Prefab Concrete_ Steel _ Other
Manufacturer (if known): 5XA W
Age of Talnk (if known : 10 - a7 - 81
Permit nuinbeXif kny�+vn) 161 S�f
Signature)
PLWN� . ?
(Title)
i
(Date)
M IICI; gomwA t.D
(Print Name)
_ g3138y
(License Number) ?PH'/MPRS
Form to bh completed by licensed plumber (Dept of Safety and Professional
Services dhapter 305 and s. 145.06. Wisconsin Statutes) or licensed disposer
(NR 113 'Wisconsin Administrative Code)
Rev. 2/2012
i
i
i
PAGE 4 OF 4
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 Maintalner in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operating Limits:
Design Flow = 754) gpd; BOD, 5 220 mgL4; TSS _< 150 mgL"; FOG <_ 30 mgL-'
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 (Le., pumps, valves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (Le., 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., winng, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Slats. 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 filters) shall be inspected every 3 years and shall be deaned 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:
MIKE RODEWALD
Phone:
Local government unit: ST. CROIX COUNTY COMMUNITY DEVELOPMENT Phone:
Local government unit address: COURTHOUSE, HUDSON, WI
715-425-6200
715-386-4680
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.
Continnencv 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 predetermined area of suitable soils.
System Abandonment
It use of this POWT5 is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
um
ClioI�IN"I'Y SANITARY SYSTEM Fll°#`
Office
OWNERSHIPIADDRESS FORMcrwftd
y
wnity Development Department will utilize this information to provide the property owner with
Cation regarding ('Ioperation and maintenance of your new or replacement sanitary system! This
Cation will be prdvided as part of our ongoing efforts to protect public health, your well, groundwater,
e water, property values, and county resources. Once approved, this completed form and educational
ration will be sent to you by email. If you would like to view your issued sanitary permit online, you can
by using the PLQpr[y Has Scanned weblink.
OWNER/BUYER INFORMATION
AS}ILE� �7A Ly - ----
ng Address 36Z ultr7r/K Vi)ObrA ,Dp-lVE
State/Zip UDSoN) Lent Szi01 to
e Number (required) �%/S' 339- nn9016
I Address (required)3 �� LEA rGinl l" V1 r lI�% CO+�
II Identification Number OZD- I zl -ZO - 000
I on the property tax pill)
NEW SYSTEM: LEGAL DESCRIPTION
arty Location N1a 1/4, —C 1A , Sec. 17 T AIN RAW, Town of 14V-D'
ivision Plat: 7N9-A.-r EN co AVV4 Lot # 4-yo.
fled Survey Map, #- I Volume_q/r . Page # Alfl
anty Deed # IO% L i 3 (before 2006)Volume -716 Page # �19L
Der of bedrooms, s Spec house O yesidno Lot lines identifiable yes O no
Property Address
(Venflcation of P4wadd
(Staff Initials) (Date)
USE ONLY
required from Commumty Development Department for new construction)
form Mutt be subrititted with all Private Onsite Water Treatment System (POWTS) applications.
ue 'System: Include Wo this form a recorded warranty deed from the Register of Deeds Qfce and a copy df lhi* certified
;u ey map if reference is made in the warranty deed.
Community Development Department - Land Use Division
-115 886 468Q St. Ciolx cuunty Government Center 71S :?45-42S0('ax
P L B 67 State and County
Permit Application
for Private Domestic Sewage Systems
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required
State Plan I D -
�
State Permit# z
County Perini
County
A OWNER OF ''PROPERTY Madmg Add,", S�QQjZ
cksa� Gia del v R� I R:< 23R Sf f�J4ierr�r w
e LOCATION Section T�N, Rj- _16- rvl- ii Lot at Gty
Subdivismn NNam(eJ, 1, nearest road, lake m landmadl Blk# �1 Village
•Oct f` PMdC lc'a1sLOK N_ Township
C TYPE OF OCCUPANCY `Commerwal 'Industrial 'Other (specify) Variance
Single family V/ Duple. No of BedroomsA� No of Persons__
D SEPTIC TANK CAPACITY Z Total y.Ilci No of ta,ks
HOLDING TANK CAPACITY NNIA- Total gallons No of ta,ks
Prefab concrete Poured -in -Place Steel Rberglass Other (specify)New Installation Replacement
Lift Pump Tank or Siphon Chamber _�ATotal gallons Prefab concrete —Poured in Place_Other(Speafy)_
E EFFLUE yT DISPOSAL SYSTEM Percolation Rate !S/1:% Total Absorb Area sq ft.
New ✓ Replacement Alternate (Specify)
Seepage Trench No. of Lineal Ft.—Width—Depth—Tile�♦depth (top) No of Trenches
Seepage Bad Length 6 Z.
y Width 'Y � Depth_((L—Tda depth (top)�N No. of Lice,
Seepage Pit: side 3
diameter Llquid Depth No. of Seepage Pits
Percent slope of land �� ��s Distance from critical slope
WATER SUPPLY Private li Joint LL Commumty IJ Municipal'� _
Owners name as listed on EH 115 if other than present owner
I, the undersigned, do hereby tends that the information I have reported is in accord with Saunun H6220,
Wisconsin Adminntratrve Code and that I haae sized the effluent disposal system from the EH 115 prepared
by the Certified Soil TesterrI,
NAME C.ST u $j e327 and other information
obtmned from � lewrse+ibwlder 1.
Plumber's Signature .',..� 'dp'MPRSW#Phone >=7!i -$(n5i •1a 9'�a
Plumber's Addre IA
PLAN VIEW Provide sketch below of system (include duection of slope and all distances in accord with H62 20. Well loca
per, shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate
SQF �^(-fi4c4e.c� f �.1
Do ac Not Write In Spe Below OR COUNTY AND STATE DEPARTMENT SEW •� p p
Date of Applma bon Feesr�P id: State > d'y C only Date
Permit Issued/Rgadnd,4date) `%-.�-d� Issuing Agent Nam I-✓- �t---
Inspection Yes�No _ State Valid# Data R.e'd
1 county Iwhite copy) 3 owner (green copy) Dt VISION OF HEALTH, PO, BOX 309, MADISON, WI 53701
'.tate (pink copy) 4 plumber (canary copy) Revised Date 7/1/78
"(,B L 7 - n 1 AS BUILT SANITARY SYSTEM REPORT
OWNER r. TOWNSHIP }�,,,n S,Las SEC. �2 T2k1-R//
ADDRESS 'L.. �d ,.; ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION r .* �V II
.-� y r. /Yv+F' Mtjc LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
BENCHMARK: (Permanent reference Point) Describe:
X. fOL, [-
Elevation of vertical reference point:&w Q:j�_•_ovkr Slope at site ,�J c
SEPTIC TANK: Manufacturer:,_�",Q Ui -,✓ ;�,�.t Liquid Capacity:
Number of rings on cover : ; yt,/ Tankk manhole cover elevation:
Tank Inlet Elevation: O ,, Tank nnrlar
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set or a cyc a gallons; total capacity o
distribution lines gallon: size of pump head,
gallon per minute ; horsepower r—b and name of pump
and model number --
Type of warning Tevice
IOL.DING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Typpe of warning device
SEEPAGE PIT SIZE: Number of pits feet diameter
feet liquid depth— seepage pit in e� pipe -elevation
bottom of seepage pit a evation feet.
SEEPAGE BED SIZE: number Of lines rc w t a_t,• length_aLtile depth
SEEPAGE 'FRENCH: width_'-Tlength
PERCOLATION RATE ___9nrK_WQUIRED AREA AS BUILT
INSPECTOR-//O t!J
DATED PLUMBER ON -JOB,
LICENSE NUMBER
I
//u"/
RLPOR7 Of /NSVLCTION - INVIVIOUAL SIWAbt SVSILM�
NIII14
St�ate Sk,ptAc/44r7
/_),����fi�+de«J�—S f. 1 n✓ c� r • u u u I
� l't't, UYI //f tut Mt_S4ub di V4e 4 Un
/x---"'-- qurrurte NumbeA U6 fumpUAtmente _ _�
7
,nl: WCY rI L _ / Buitdeng_�e_y _12% etopjr%
H.cyhwateA 7 tZ[t Gl we
.'IfAMBlR
_ -- gaCZane
1f :No TANK
_---gattone
.•m. We I'Y
If, yhwa Iv
Pump Manujactu4eA
Numbers o6 Compaatmente
AtaAm Sgetvni
--- buitdtng---
I n ("1 " h _
`rt q 1 II UI_MLN_S_I ON_S�, 2-
7C ••(, !Wench � �� (�t
each tJne _ ZC'6t
i
I.oern rinve L" 6t
I�� 6
1' IN t
r/ ,
u
I Ali' KI It ('IIDIJ
tSu,Xd, n,y
Mudee NumbrA
12$ eYnpe
.�- 121 eXope__--,
Reyu,avd anea_.. _ '�' C,
Depth u6 Anvk beYuw f,Yr � (� rn
Veto (1, u6 'Loch uven hY,•
Vep(h uA t,.Yv bveow yna.ly ,J�h
SXnpe U6 t1tenv{I
lypv op CUVeA: Papers n n(ruw
Gaavvf aAnond pits
Ucpth betow InYvf
DATL _ _✓
DATL
115 R•v 9, 8
.EH
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
n�
P.O. BOX 309, MADISON, WISCONSIN 53701
r'jjII
>` RECC IVC[U \✓�•
JUL :?'/leas
�=�
�ppt
LOCATION ��`L,2`/., Srrti.n�,T_(N,RaE-•Ie.I W, Township or Mm,c,pality
ZONING )A7
Lot No_�, Block No. j / 1 °
ILL
County
u Iwsion eme
Owner's/Buyers Nam//e: o• o �S
•� _
Madmg Address C/o G is 1nI "1� l•{ - ��ri (a-. ?' A;i
TYPE OF OCCUPANCY. Residence ✓ No. of BedroomsCOMMERCIAL
EFFLUENT DISPOSAL SYSTEM NEW _Z_ R EPLACEM ENT ALTERNATE SYSTEM
OTHER
DATES OBSERVATIONS MADE: SOILBORINGS. PERCOLATION TESTS
SOIL MAP SHEET ,
ne- NAME OF SOIL MAP UNIT``r+..+r:�
PGtl CTIrIN TFSTS
TEST
DEPTH
CHARACTER OF SOIL
HOURS
WATER IN
TESTTIME
DROP IN WATER LEVEL, INCHE
NUM-
INCHES
THICKNESS IN INCHES
SINCE HOLE
HOLE AFTE
INTERVAL
RATE
PERIOD t
PERIODS
PERIODS
BER
1STWETTEO
SWELLING
IN MINUTES
NINON
P_ Z
M
-
3
a
i7
P-
"i
. r
.f,1k
'ice
-
P-
P-
v-
RCRI Rl1RINP TFSTS
TEST
NUMBER
TOTAL DEPTH
INCHES
DEPTH TO GROUNDWATER, INCHES
CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE, MOTTLING AND DEPTH TO BEDROCK
IF OBSERVED IN INCHES
OBSERVED
ESTIMATED HIGHEST
B- /
ia0 •'
/12 q r
> t; f..,
�" YrK u �- 2C
e-
a
—H,
B-
- - -•• _ 11-111 —r.. r. a nuns ana swiatue set areas I Indicate on the plan the Iota Ion rrd square feet of suitable areas.
I ndlcate number of square feet of absorption area needed for building type and occupancy �'= c %' .Indicate scale or distances.
Give horizontal and vertical reference Minn. Indicate slope.
b'/oil
kC.
g, ~ / r'
El
gz -'lo/'
fs.,
63 = /o3'
cc-
G.l
P, =lens
Et,
Py = ,dL
Et.
C rr�
4;/•K
S PtP
rr.4 .
n : z
,L
...t./ .4 12•' �t( ll
Z3.
25•
I, the undersigend, hereby certify that the soil tests reported on this form Were made by me in accord With the procedures and methods
specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my
knowledge and belief.
Name (or in Jc:lu. _ - ' t ' j77_
Address !" W b 1 Y R W
Name of installer if known
r
CST Signaare(
Copy A — Local Authority "y. - 7Th
_ T, �v
tensional Services
SO EPORT Page I of 4
J U N 09 2021 In accordance with SIPS 383, Vfti Aar. Code
d1 cor�1p � ig(1,papar less than 512 x 11 inches in size, Plan must county ST. CROIX
I dude, bBf-n tb horizontal reference point (Brit), direction and Parcel I D 020 - 1 121 - 20 - 000
r rth an", and location and distance to clearest road
Please print all irr/ormaUon- Reviewed by Date p
Personal edo'instW you pruvde nay be used for secondary purposes (Pnvacy Law, s 15,04 (1) (m))
Property Owner Property LocaWn
ASHLEY FALL Govt. Lot --- NE 1/4 SE 114 S 17 T 29 N R 19 E (or)
Property Owner's Mading Address Lot # Bbdc # Subtl. Name a CSM#
362 BROOKWOOD DRIVE 26 — TROUT BROOK WOODS
City State Zp Code Phone Number iry E]Vftge ElTown Nearest Road
HUDSON, WI 1 54016 I ) BROOKWOOD DRIVE
New Construction Use Residential / Number of bedrooms 5 Code denied design flow rate 750 GPD
0 Replacement Public or commercial - Describe.
Parent material SANDY Flood Plain elevation if applicable ZVV-
PP A)v4 ft.
Germs counts CONVENTIONAL IN -GROUND TRENCHES — 0.7 LOADING RATE — UPGRADING TO A 5 BEDROOM
and recornmendations" AND MOVING LOCATION OF REPLACEMENT AREA. NEW TEST REQUIRED AS PREVIOUS TEST
WAS 115 REPORT.
Pit Ground surface elev 9445 R Depth to limiting factor 100 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/W
•ER#1
'Efi#2
1
0-9
7.5YR2 52
--
Is
Osg
dl
cs
3vf-co
07
1.6
2
9-32
7.5YR3/4
-
grly s
Osg
dt
gs
2vf-co
0.7
l 6
3
32-100
7.5YR4r4
--
s
Osg
ml
--
—
0.1
1.6
some cobs
2] 13odf19 # Boring 96.45 108
El Pit Ground surface elev. R. Depth to limiting factor in
Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsed
Redox Descriptor
Qu.5z Cont Color
Texture
Structure
Gr SZ Sh
Consistence
Boundary
Roots
I
GPD/ff
-Eff#1
'Efl#2
1
04
7.5YR2.5r2
--
Is
Osg
III
cs
2vf-m
0.7
1.6
2
4-51
7.5YR3/4
--
s
Osg
dl
gw
Ivf-m
0.7
1.6
3
51-108
7.5YR4/4
--
s
Osg
ml
--
_
0.7
L6
horizon 2 has
some A frig. 1-5%; some gr/
cobs
It 01 = ULM > 3U < Z2U rng/L and TSS 130 < 150 nlgti • Effluent #2 = SOD < 30 mgrL and TSS < 30 nxyrL
CST Name (Please Print) S CST Number
MARY 10 HUPPERT(Hollister's Soil Testing & Design) GL_ _(�llf 224832
Address Date Evalu Conduded Telephone Number
28497 King Arthur's Court, Danbury, WI 54830 05 - 112021 715-42& 1775
5111> 8330 (R07113)
A. -.
Property Owner FALL, Ashley Parcel ID#
Boring
3 Boring _ r_...,��Aciir rpelnv 9325 ft
020 - 1121 - 20 - 000 Page 2 of 4
102 � '
Depth to limiting factor lo cnilRRaate1
Horizon
Depth
in
Dominant Color
Munsell
Redox Description
Qu Sz. Cont Color
Texture
Structure
Gr Sz Sh
Consistence
Boundary
Roots 1
GPD1ff
'Eff#1
'Etf#2
1
0-4
7.SYR2.5/2
—
Is
Osg
dl
cs
2vf-m
0.7
1.6
2
4-28
7.5YR3/4
s
Os
dl
gs
2vf-co
0.7
16
3
28-102
7.SYR4/4
__
s
Osg
ml
--
--
0.7
1.6
some gr/cobs
Z •5'
z'
❑ Boring # U Boring
Pft Ground surface elev. ft. Depth to knits g factor in
SoA Application Rate
Horizon
Depth
in
Dominant Color
Munsell
Redox Descrli
Qu Sz. Cant Color
Texture
Structure
Gr Sz Sh
Corrsuatence
Boundary
Roots
GPD/ff
"Eff#i
I 'Eff#2
❑ Boring # Boring
Pit Ground surface elev. ft Depth to limiting factor in.
Honzon
Depth
n
Dominant Color
Munsell
Redox Description
Qu Sz Cent Color
Texture
Structure
Gr Sz. Sh
Consistence
Boundary
Roots
JViI 11�'anOn M=
GPOM
'Ef #1
'Eff#2
Effluent 91 = BOD, > 30 < 220 rng/L and TSS �30 < 150 rrg/L
$BW bO(ROJ/I1�
' Effluent #2 = BW, < 30 nriglL and TSS < 30 mgA
S . c..f`01 %( COUNTY
NO. 633388
STATE SANITARY PERMIT
DK�k��8/et�gd a-0PREVIOUS l57
OWNER
PLUMBER /%ILIC.#
TOWN OF IjvdSoh
SEC,T Zq N, R /1_E/ t�
AND/OR LOT ZCo BLOCK
Trftw &Wk kb SUBDIVISION
THIS PERMIT EXPIRES
POS
ZONF x
CHAPTER 145.135 (2) WISCONSIN 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.
,RIZED ISSUING OFFICER - DATE
Z0Z3 UNLESS RENEWED
V
RE THAT DATE
AIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (RI 1/20)