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020-1395-59-000 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safely and Building Division ji -iS 3 1 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 City Village Township JON & ALLYSON LOEWE TOWN OF HUDSON CST BM Elev In BM Elev BM Descn ion �ku�cc— TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic y G � �J Aeration Holding TANK SETBACK INFORMATION TANK TO PIL WELL BLDG. Vent to Air Intake ROAD Septic Ian Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model umbe TU7 Li Fric n Loss System ead DH Ft F &main Le gth Die Dist to Well SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV. Benchmark • n / 1p D O �• 1 AIL BM Bldg. Sewer V. St/Ht Inlet C. Tl StlHt inlet ktS� (, , o I DD. a� Duletal W M. Dt Bottom "�s�go s •yz Dist. Pipe (o • V 5 r Z-7 Ent. System `t•-S T -63 Final Grade y 11-87 St Cover 11)4-1D CAP),S BEDrrRENCH DIMENSIONS Width t Length 1 1 f CJ/ / No Of Trepches PIT DIMEN IONS No Of Pits Inside Dia. Li SETBACK INFORMATION SYSTEM TO T eOfS stef1n „� hr 0,1i / P5 !L A BLZDG YO l WELL �5a LAKEISTREAM I LEACHING CHAMBEROR UNIT Manufacturer. e L Model Number. gzR DISTRIBUTION SYSTEM Header! a}4101 th Len Ih) J is Dislnbubon t a /1' / Pipe(at .Y Length I / Dia Spacing ( x Hole Sze x Hole Spacng Ve to fir Intake c v�� SOIL COVER _R — 3. 5 • x Pressure Systems Only xx Mound Or At -Grade Systems Only y-C Fopm vver umpul Uvei xa vepm of 1a oeeusurouuueu Bedrrrench Center _ Z Bedr-rench Edges , 1N Topsoil-�__T_--Tzr-�-No COMMENTS: (Include code discreoencies. Demons present, etc) Inspection #1. Inspection #2 Location: 757 HIGHLANDER CTC 1.)AIt BM Description =0 (e Vyk 2 ) Bldg sewer length = X;s�� - amount of cover = l Plan revision Requiredo ] Yes No Use other side for additional mforn ati n. lY SBD-6710 (R 3lg7) �g-41tjj-' oh VrI`*� PkJ. Su0+11 -eNJ A �+ �J �Jl J oh � 45 fte /14ti . 18 Z► � Date Insepctors Signatur e f�skv- e/110119��'1, 1��3�5 Gen No 0 County - Industry Services Division SI.Croix p _ S P MAY 25 2021 1400 E Washington Ave P.O. Box 7162 Sanitary Permit r(tobe l in Co.) $ St. Croix County Madison, 37 7162� 3 3 S N - • Community Developmen Sanitary Permit Application--- State Transaction Number In accordance with SPS 383.21(2), Wis Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note Application forms for state-owned PowEs are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services Personal information you pro. ide may be used for secondary 757 Highlander Court purposes inaccordance with the Privacy Law, s. 15 04 I (m). Slats. 1. Application Information - Please Print All Information Property Owner's Name Parcel q f Jon & Ally'son Loewe 020-1395-59-000 Property (Tuner's Mailing Address Property Location 757 Highlander Court Govt. Lot SE'/., NW 'G, Section 25 City, State Zip Code Phone Number Hudson, WI 54016 (circle one) T 29N R19 Eor� 11. Type of Building (check all that apply) I or 4 Subdivision Name ® 1 or 2 Family Dwelling - Number of Bedrooms �_ 59 Scenic Hills Block 4 ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use ❑ Village of CSM Number ® Town of Hudson III. Type of Permit: Check only one box on line A. Complete line B if applicable) A ❑ New System Replacement ystem ❑ Treatment/Holding "tank Replacement Only ❑ Other Modificarmn to Existing System (explain) B ❑ Permit Renewal ❑ Permit Revision ❑ Change or ❑ Permit Transfer to New List Previous Persil Numbeerand Issued Before Expiration Plumber Owner IV. Type of POWTS S stem/Corn onent/Device: Check all that apply) Non -Pressurized I -Ground ❑ Pressurized In -Ground ❑ At{Grade ❑ Mound > 24 in. of suitable 1 El <24 in. of suitable sod Lj Holding Tank Other ispt�:Com nent(explaw ❑ Pretreatment Device (cx lam) r V. Dispersal/Treatment Area Informatio : 2 Design Flow (gpd) Design Soil Application Dispersal Area Required (if) Dispersal'Pmipow(WMISysemllcvation P 600 Rate(gpdsf) 375 410 97 4', 96.75' 16 VI. Tank Info Capacity in ^ �� /I = Gallons Total 71 of r\ a v V 15 New Twixs '. ExTanks rung Gallons Units (.r�.Mario G/`•l� c i Septic or Holding Tank 1250 1250 1 Wieser Concrete ® ❑ El El 0 Dosing Chamber ❑ ❑ VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) re MP/M Number MP/MP Business Phone Number John Schmitt / 715-760-0486 Plumber's Address (Street. City, State, Zip Code) 586 Valley View Trail, Somerset, W154025 Vlll. County/Department Use Only XAppmved ❑ Disapprove Permit Fee IP/1yp• Is ed Is m Agent Signatiy 10 /) ❑ Ivan n for Dental $ �27 r Ip/ •� �Z-' 1�1 . �Fn ../V�� "�t'^'` IX. Conditions A rova asa t SYSTEM OWNE p3�g ,I ce t 'is (C9{ GA �Qt ��Gx 1. Septic tank, effluent Alter and I dispersal cell must be serviced / maintained as per management plan provided by plumber 9 All QPthArk requirements must be maintained as per (� I late plans for the system a su to th County only on paper apt less man 8 i 11 inches ie siae 6) C llL`^J`-tom applicable code""__, F dug �CJt+;.7G'f1^�G�� QS�� Project Name: Owners Name: Owner's Address Legal Description: Township County: CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Loewe 4 bedroom EIJen Septic Ststem Jon & Allyson Loewe 757 Highlander Court Hudson, WI 54016 SE1/4, NW1/4, S25, T29N, R19W Hudson St. Croix Subdivision Name: Scenic Hills Lot Number: 59 Block Number Parcel I.D. Number 020-1395-59-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Existing Tank Certification Page 5 Effluent Filter Information Page 6 Bull Run Valve Diagram Page 7 System Sizing & Cross Section Page 8 Management and contingency plan Page 9 Sanitary System Ownership/Address Form Page 10 Warranty Deed Page 11 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 5/25/2021 Phone Number: 715-760-0486 Signature: Jl In -Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 SYSTEM PLOT PLAN Loewe 4 Bedroom Septic System Project Addre 57 Highlander Court BM7 Symbo BM Elevation 104 11 BM Description Top of septic lank manhole cover BM2 Symbol Q BM Elevation BM Description Slope Gradient of Tested Area (8%) Well Symbol (if applicable) Dnveway Design Flow 600 GPD Attach design Flow calculations for commercial plans Pipe Materials I ASTM Standard Tables 384 30-3 & 384 30-5 4' SCH 40 PVC pipe ASTM- 02665 4.3034 PVC pipe ASTM-03034 Existing 1250 gallon Septic Tank wl Zabel A-100 ExsImg Ell Driveway Garage I ' ( / Existing 4 T5 T4 I Bedroom / T2 • Bonngs by Schmaker House �— T3 1 0 , I ■ Bonng by Schmitt 100' T1 I I I T1-3'x62.5' BwdMusar trench El =98 42' T2-3'x62 5' Biad ffuser trench El =98 25' T3-3'x62 5' Boddfuser trench EI =98 04' T4-5'x41' EI1en Sand Filter module El =974' T5-5'x4l' Egen Sand Filter module El =96 75' Scale: 1" = 60' 60 90 Gamge 15, ,w-oszLM 3llj 9Sb8-SZ�-008 \ .8nOd-1SOd LdOM:AG 31V0 OSL4S N1 'NOOtl N3OIVY1 'OL AMH Sn 9LLEM IVONVVV OLLd3S w 4InOd-38 MV?JO 313H000D d1tl0 'A38 .0-,L31V05 ����'� aw—OSZtM \ LLJ U —^ W Z -� z J fl: C) H Q U w m 0 m w > x m 0 (L) J cn p a w D� Q z a to a N V) IL w J �m r r 0. m U_ m k LA < p li < o <Wh4 ` 0 can = moo' O U w o acxi wA Z a zN 0 w W HO i� N W a m ft�w 0 (n\ N m 0 0 �Q w w Q o� c �� J motwil o D� I QZ z a. a c -�. M� �w r wn a `< JWJJ LJLJl a Y \. N ^ al N WrW WJW �V F rQ �a Z 00 W nM• V'o7.I J> 7¢ 7 F ]CO< O W x pw r Z W n Z n O F O N N Q Z x U W m\ X p p N Q Z N O O r �F 3 p 2 Z a Z O W Q ~ W Q p Q U x N U NQ OOQ W W p W OwC7 QU aV) p SOU = U W I.�I.�� 00 3 m U� x J� m � 3 � C W� Ov 0 0 4 Q Z to S Z N w J Q O Z J 2 OJ Fa- OU H U J Q W to .I Q I w OS fn � a o � U SV� p w �ll .e don a w a � s Q // � ♦� I I I N _N It � W Il I U 0 J 11 I m u wa n � Z I „[9S I .,F p III `1c dY 11 j U Sty .b N wi S do w n J w I z D a „Z-,L Z a3alnO3a f < SIV " 49 w U K < N ZY 6 r ozoo 2 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) 757 Highlander Court located at: SE 1/4, NW /4, Section 25 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 & — ( -7' °�, ( 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 Manufacturer (if known): Wieser Concrete Age of Tank (if known): 12/22/2003 Permit number (if known) 430619 John Schmitt (Lie Iled Plumber Signature) (Print Name) MPRS (Title) G / �-0), I (Date) 223760 Other (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 +� y vNNW a1 Z Page 4 PAGE 2 or 2 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 cartrdge out of the rase. 0 Residential Applications Certified to ANSIINSF Standard 46 Copynght 2014, Polylok, Inc All nghts reserved Product(s) covered by one or more U S an&nr Intemabonal patents Other U S and Inlemal,onal patents may be pending 1-877-765-9565 / www.polylok.com pace 5 av T71 Home r About F Site Map f Order Info Videos & Literature contact Drip Systems Treatment Controls Products Downloads Design Guidance , 4M 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 No. I Valve `l Positioned Dn No. 1 during Odd Years Septic Tank No 2 ITEM DESCRIPTION BRV4 BULL RUN VALVE 4' BRVBULK 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" 2 irs RISER CAP ADAPTER RISER TLM3E 4" OUr PORT NATER-TIGER ACCESS CAP VALVE DIRECTION HANDLE V OUr PORT 4' 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 Pave 6 eyen Eljen GSF System Wl Design Program Date. 25- Ma, -21 Qient Name: Jon & Allyson i newe Site Address 757 Highlander Court, 4udson, W154016 Designer: John Schmrtt Note This wortshee is provided to assort the Nearer in sold, Me number ofEVlrn GSF Modo/n ewphredforo svecificproject.The<nlndatmns herein are eaplarnedfor each output The success of the overall design rs based on the Nor rnputs and mnsiderohons outsde of this worksheer System String (Total Number of Ellen GSF Modules Required) Design Notes and Cammenta 1.1 Site Characteristics: Total Number of Bedrooms 4 DDF per Bedroom (Daily Design Flow per Bedroom) 150 go Effluent al Application Rate 0.7 gal/ftt DDF (Daily Design Flow) 600 gpd Equivalent Effluent a2 Application 1.6 gal/fta Application Rate 16 g*,ft' " Required Basal Area (DDF + Application Rate) 375.0 ft' Unit Used ( Usually 943) B43 Unit Install Width 5 ft Square Footage per Unit 20 W/unit 1.2 Module Quantity Analysis: Minimum Number of Ellen GSF Modules ReMR )Required Basal Area - Square Footage pe20 Or 6 for A42), whichever is gteaterl units Amount of Ellen GSF Modules Used Must be greater than m equal to Mwimum Regared 0 units 1.31r ench Design Number of Trench Rawl2 Rows Trench Width 5 ft Trench Length 1 ft Units per flow 10 Total Square Footprint 410 ha I 3-ft I 5 41 MIN 12" CLEAN FILL �]E:f =1 12" SPECIFIED SAND NATIVE FILL �1' 3ft —J Iz raJ Pavia 7 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 = .11 gpd; BODS 5 220 mgL"; TSS 5150 mgL"'; FOG 5 30 mgL" Inspection Checklist INSPECT EVERY 3 YEARS c 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.) o 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) c neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing c 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) 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. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) 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 filter(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. PAUP R File At. S-r C�. UNT-Y SANITARY SYSTEM Office Use Only OWNERSHIP/ADDRESS FORM crporee�rzozr 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 Jon & Allyson Loewe Mailing Address 757 Highlander Court City/State/Zip Hudson, WI 54016 Phone Number (required) 612-382-1770 Email Address (required) Jcloewe@gmail.com Parcel Identification Number 020-1395-59-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SE ,�4 NW 1/4 Sec. 25 T 29 N R 19 W, Town of Hudson Subdivision Plat: Scenic Hills Certified Survey Map # Warranty Deed # 1070352 Number of bedrooms 4 New Property Address (Verification of (Staff Initials) (Date) _, Volume Page # Lot # 59 (before 2006)Volume — Page # r--- Spec house 0 yes ■ no Lot lines identifiable ■ yes 0 no OFFICE USE ONLY address required from Community Development Department for new construction.) 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 in the warranty deed Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd(o)sccwigov 1101 Carmichael Road, Hudson, WI 54016 wwwsccwi.gov Paaa q U SCENIC DILLS (OCATFD f1V f8F TFS SD'I/i DI 7FMF lN/el 1MFNNTBel/OP TFF NFI/, PAFf' OP SURVEYOR:I/OPPF OFFn'/4,Ff/I,14 0F';s1N I St1/4IN ECTION 25, TEDN, JUDY, 701N OP FUDSON, ST. CSOIF COUNTY, WISCONSIN. p�iu csw.nxc SEE SHEET Z 61 u 1 Lui. !T { 6E I I I { 1 I .oas I I I 1 I I � I ; I �l I I !lam a0 I Y/.1/A -I I 72 I i a 1 1 I l p � ss 1 ii}!I1 i mm I I I I W I i •• I I 1 /'I I � N,1Q1 ia,llf]ii arorvn ,i 1 .. ......... I 919pR Yn a 47 <a9pR Etn1OE5 b R3lfltfa Ci5Qi4 u JBYpR }'l.W ei ivmpr xi ss aa�. He: Roe:,s �vw PREPARED FOR: cmvzw.s...c Imruwlu.wewpx u, vw.awmv N 4110pR � eauon a 11 Wclu 1 @p Y T it h 3� B�a�T IiAWJOF>E EET6 Department of SOIL EVALUATION REPORT #2107 S P S Safety and in accordance with Comm 85 Ws Adm Code Page 1- of 2 Professional Services Schmitt Soil Testing. Inc Attach complete site plan on paper not less than BY> x 11 caches insize Plan must County St Croix include but not limited to vertical and horizontal reference point IBM( direction antl - - - percent slope scale or dimensions. north arrow and location and distance to nearest road Parcel I D _ _ 020_-1395-59-000 Please print all information. PV wed F Date Persona: mformai�on you Prov de may be osatl tc seccnoary ParW"ses iPnvacy Law s 1504 r imp . , q. Jam. 4/1 Property Owner Property Location Loewe- Jon & Allyson Govt Lot SEt/4 NW114, S25. T29N, R19W Property Owner's Mailing Address Lot # Block # Subd Name or CSM# 757 Highlander Ct _ 59 Scenic Hills City State Zip Code Phone Number City Vilage Town Nearest Road Hudson WI 54016 Hudson Highlander Ct New Construction Use Residential; Number of bedrooms 4 _ Code derived design flow rate 600 GPD Replacement Public or commercial - Describe Parent material Outwash( Burkhardt-Sattre Complex) -_. Flood plain elevation if applicable - NA ft General comments P , =-er, a - ._ , _ ... a':°? gc-J -1 ra!e pc5sib•e so stem � .. -r f�� the replacement area and recommendations - -- _ 2 l 4 Borino # Boring u Pit Ground surface elev 100.75 it Depth to imaing factor 90 in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD+ft' in Mansell Ou Sz Cont Color Gr Sz Sh •ER#. 'E"2 1 0-12 10yr3/3 none sit 2mgr mvfr as 2vf 06 08 2 12-27 10yr4,/4 none sit 2msbk mfr aw lvf 0.6 0.8 3 27-38 10yr4/4 none SI 2msbk mfr Cs lvf 0.6 1.0 4 38-90 10yr6/4 none arS 05a ml ---- ------ 0.7 1.6 — a+— `(L) I CW �6 t e f Effluent #1 = BOD-> 30 < 220 mgrL and TSS 130 a 150 mgrL - Effluent #2 = SOD, < So mg/L and TSS < 30 mg,L CST Name (Please Print) - Signature CST Number Thomas J Schmitt i,yl - 227429 Address Schmitt Soil Testing Inc Date Evaluation Conducted Telephone Number 1595 72nd St New Richmond WI 54017 5/20/2021 715-760-1979 St Croix County, WI Legend Lakes and Rivers Rivers and Sthi u.m Interrelates US Highways State Highways County Highways Local Roads Rustic Roads RamDe ETACHED 10 GARAGE Road Right of Way 10 em uo,a a..— , B3 v.�an now 0% SLOPE HOUSE Railroads IBf HIGHLANDER CT BM 104.11'Top of aeptic tank manhole cover B4100.10' N 0 20 40 60ft DISCLAIMER: This map Is not guaranteed to be accurab, .,act, current, or ..plate and W nciuslons drawn are the m lacnslbairy of the ..at oszvn e x w Wwwodn Deporynna of Cammerm MWolon of Safely and B *Wo SOIL EVALUATION REPORT pap--Lot-3— Mitch oortyiob are pen an paper not bee than 81rz x 1 �pa Ian that `� C r, La OZD_f3gS` S — k duids. bhs not frhiiW our vaNcal and horirorhbl •AsdfeO andPAMM pwmds)oM swim ardhwwWm rooM snow. aoats rum. Plan pnw ON ` n Dab h*aeamel tnbm,�aon yhw parNehh,gN maOrlx pwpor (Pilrr{ey��. 76.Dh(i) m11 � 2 O P.Wey0wrw - - -SO K -- ,Y z , ��� sr • -? _ Lay SE N R E(od RopertyCwtetSMatyh0AdM= My Lot f SL&LNamarCOW G ZO S�il S lD r"1 i abo _zip coft_NQAv ❑Mtge (Town Nest Raw ® New Cwmbt"m Llse: ® RwtlehY r Nunher of bo*wma 3 _ `{ pods derMd dadpr bw rob ppp ❑rbpemmard ❑ Pubkormrmrerdel-Desabe: Pago lam bi Ookra-s b. now pismawdmif armMe ,(/Ml R Grwal amrrwnr f S1t GIG110.f•b /� — /A�•9 U� Q,f /03, andrawl arrerhdaamw S, Z,h ❑ Bwkv © BorkvS ® Pft Gmurmi leasalev. 03 ?O fL Depth b bnMV farJor l f G yr, Sot Applonfim Rab Norm Depth I DvNnrtl RWaoc Dsea"m Tw&n gemM tm Carsbrnm Baxdry Roo` -am mm In. Murgat QLL Sz Cunt Cobh Gr. St WL f O-IZ I/ r31z — Is I 2r,--c k ,Cr ( Iv 5 � Z I Z- Zq )r 441 -- s I 2rrfbk rn51 C) u 9 8".91 , a Saire # Cl auto 9 Pit CMmd wftm w m. /aZ. 5`c) fL Depth to b t Q lector / /D IM Sol Rab tlarlamhkD Donirhrtrl Redox DasaOtorr T"" Satrmae CorhaYbrhm BdiMry Root GPLYt? In. Mhawat pu. St Cant Color Or. Sz Sh '9Y1 'fdta2 I 1, 3 Z 4r cS Ivy 1 ylq — y'I + c_ /tom -- mS G S m I 1.2 Cw�..14 'Etydd�lcaDD a30«0mo&wdTMS*Qj15onVL •EMd@M 92-M 130 nVL aid TSS <3011pIL CST Name (Pbaae p" CST Me i m —AolawsGi zs3 Lo b� a'e Dab EvWuWJm Cmdided Tabph" timber ]�/6,8 7/S —217- fapany OORW af- K� t 1 parcel wa. L of 3 © �Iw �I �I 'EftardiM-WD,>30_<Mff g&&VTW>30<t60mWL * art-",j30M&snd T85jWnV, The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or rued material in an alternate fertna . please contact the department at 608-266-3151 or TT.Y 60&264-IrM. saelna (XWMj l PAGE 3 OF 3 NAME r LOT#5 9 LEGAL DESCRIPTION S E V. Aw,'.S 25 T z4 ,N.R III E Carr® CCAT.F- P� Zit BM 1 ELEVATION /OUy BM I DESCRUMON_&p a .0 1 ` p vc pipe ✓ BM 2 ELEVATION 9 8'. yS BM 2 DESCRIPTION ±v p o j ( ., Prc p_pe ✓ SYSTEM ELEVATION 44• S o ALTERNATE ELEVATION 44. Sc> CONTOUR ELEVATION ro z.O, �o3. a , (oY• c 5 jyo0j4.'`, L 15 5 g kb 'Z- G^' o y� too-'�' b _ 1 2S I i 5, S ^' —co -p I I'gA Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety ano'BulldhgyMslon INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes IPrNacy Lew. aASG4 (1)(m)). l,,,a,,.,. St. Croix I I 430619 0 I 020-1395-59-000 o-o • o O %h fj/G Y u a r, , /(• P/, 25.29.19.2453 TYPE MANUFACTURER CAPACITY Septic r /l Dosing (i)) Aeration Holding TANK SETBACK INFORMATION III ./ "M -MI PUMP/SIPHON INFORMATION Manufacturer GPM Model Number TOH Lift Fdctlon Los tem Head TDH Ft Forcemain to Dia. Dist. to We SOIL ABSORPTIC A ion,rd / 0 / 1 0 DATA STATION BS HI FS ELEV. AIL BM �� fq a / 2 s 9Y 11.3/ Bldg. S- 5 /o/. / Spit Inlet /0 I oa• 3 ? st/tlt ounet S.21 DI Inlet �- Dt Bottom Header/Man. -7l Dist. Pipe 1 I I z / I21 •6.9 q 9- �z Bot S tey, I�'� (� I 3 9 Final Grade j21 8/ s 3 Z y g. D 3t Cover r/ 7, (5 /o •// h &-eN ri NL Qj�C.Qlt/ 4v4 ITr 4e///// /it(�fY�/�13 /BAN i���l..n <i,/ r NS NCHONS Width I Length o gTmMpeg PIT OIMEN S No Of Pns IneWe Die Lpuid Depm DIM Z.S I SETBACK SYSTEM TO P BLDG WELL LAKE/STREAM LEACHING n or INFORMATION CHAMBER OR b e T SYate<n I _ 13S ' I ! Number. UNR UI, I hi I IVN SYSTEM r?A+ n' L I n 7 .,,,,,.,.. ------7 a nuie.. • Mrs.Paang rvr m,we Laroml� oia L{ " ,a�vut: f.2•S n c....„,,,, fs !- SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only [Depth Oder I Depth over xx Depm of n Seeded/Sodded zx Mukhed BeNfrendl Center J} Bed?rer� Edges Topsoil Yes IV No ,,; Yes 'i, No - COMMENTS: (Include Q$ eisaepe.cin. persons p went. etc.) Inspection #I: -�5- Inspection #2: 1 !_ Location: 757 Highlander Court Hudson, WI 54016 (SE 11 /4,NW 114 25lT2299NN,,R,19W) Scenyic H�lli�s Lo159 Pe csl No: 25,29.19.2453 1.) Alt BM Descdphon =T o�'i�y/7'L�J (��� (""/.ILY �YJ ' - L r �S l[GGCG'G1 7/1/D /q1 Wl xt 6 Gk4a=G�'�_ , 2.) Bldg sewer length = 13 {c(1L• -(�J�d c'/,r4,yz , -amount of cover=��„+ wot�et� Y Cr 11 YYh�y`R.n.Ky—sl %`2��'•�""l�'�'� ,_y,, Plan revision Required? rw Yes o Use other side for additional Information. L __ JI _-____ ___i— SBD6710(R3M7) Date InsepctdeSigpetu�rep��� _ r /C1M/No G ✓ �%1 �Y�:G�� � ¢[.1�/U'�i%(-(Lt.!( Ly( �6EQ��R�T� d Satetv and F)uwldings Division Covey 201 W. Washington Ave., F.0 Dox 7082 ST. CROIX yuwsr Pennit NunAw(mbe filled in by Co.) IQ/�/1��,� Madi.m, WI 53707 7092 (608)261f546 Department of Commerce Sanitary Permit Applieati n REG In wowswith Conoco 23.21. Wig Adm Crair. paraad rdanaaoon prowdr nnrm) Ad&m (it dBcnra dan aatiaig Warm) A p be uaod la wo odcy purpoaa Ynrsy liw, st -lM(1 m) 1 S 2U� DECL 7 HIGHLANDER C-r- _ L Appecstim laferawatioa-Pkw PrW All larwainUuo GpQ1x COON gT. pFFIG _ Fnyuty()aarars Nang: __- _.__ PAN l.otM Sg llbdcg_ CARRIAGE HOMES, INC. .m Ffupaly Owrwv's Mailing AdiYoa 12415 - 55TH ST. NO. SE y, NW v5 sea wa 25 Crty, state Tip Code Phme Numba LAKE ELMO, MN 55D42 nmlz me) T 29 x; R191�Ig IL Type of Balkh% (check all that apply) 14 I or 2 Faraly DmB*-NI®ha ofFla3oma BDRMS PER SUBMITTED HOUSE PL Sulxl on Name t:SS/Ntamia U thddiucuvasanual-13x ke car SCENIC HILLS Llcity lvaaw lkovmhip of HUDSON ❑ Stak pwnd _ n onbc iiae _ - - � - - - Ia TYI» or P.rawlr: (Cw.ek mnLy ago bm w aMs AA eewpino a.. 3e if appBe.b c) o Ld -ado.. 2 New Sy"- (1 Replamrad Syaem Q Pamn geviaun ❑ Tmono&floZ%TnlL Roplaraaraad Ordy J1 txFra Mudifin0w+to Eio#ing Svaam I PaM Kaewat U Paaai Traiaa m New lia q^'iona Fe on Number and Dana hmM 4Hkcf,w Eapua4m =Fkuvbff Owaa of POWTS ' m: Check all tlna a Nan-)7mw=d 60ru and Li Muaw_ 24 in ofsWW* sail LI Maad 124 in ofaanble soil ❑ .,u-o a& ✓J si4k Pao Sew Files I� caaluaed wpland ❑ Prawreiaed lo1)ra+r,ad Ll )Idde g'feic ❑ Pm Hher n Awab.-rnalnwa Lkif ❑ Raa rwint g Sand Fiks �l RcrernLwiap Syndmie Media FAN LI I 1133rp line faaw9•las Ppa ❑ Ulba i,011an1 V.taseat Ara lnfotaaat' ran es w io Defuser chambers ea. trench total chambe Zabel Al Do fitt DOM soil AMb ation Rmol�a) Dbgrasl K-Fi od(In D"onai A—"-W (er) �- .7 857 1050 98.91 cw-*yTaalNurdxrMan =Ut faamc Aefab sit eel Fbea cw Cenaele Comuuclod Gliva.New ExTm Turksx 1250E 1 WIESER X �e^2 c`s.nlW V¢Rp ibgi Stavni t-I,ak iaare a>ransa r.aw N�r)pWt9 abaaaw Me albeYed Plweeber's Naeea (Prbn) /MPRS Numbw M inw. Pt. Numb" TODD FEATHER3TONE 242514 715-381-1704 Plurrdra'a Adhea (Street, CM. SiAq . U,dc) - _ P.O. BOX 467 HUDSON, WI ---- VUL Coon fOe a Uw Only'--- PApp ,O L, Diarippovd SardaryPerron Fer (rnnrJudw (iraudwala Dde Laud I Si)e>otlrm (No ) p Fa) ❑ Ownas Ums, Ream for Ikoi l 2 JV r- - u tX. CbotBfanns of ApproraVKaasaw for Ihsapprmal -- SYSTEM OWNER: 3) gyp t1 saL® 1 Septic tank, effluent filter arW dlspt3rs� illl must all be serviced ! mAnhMrad � � �ittga,A2)tbJ 1 as per mpnagement plan provided by plumber. �' I (r �. I- 2. All setback requirements must be maintained T " i a"^�- as per applicable code/ordinances Attach wglae Pl_ (416e Cranaly gay) ter tie a7aea w ppr aaalm Iaw inR a ai fabo Y der 1 r i t o w kY- 0 of I� o % �� CL i � r �� u/ D n1 / CO o � ( 94(jim"Or 15?*W • CkO ( COUNTY NO. ) 633394 STATE SANITARY PERMIT OWNER PLUMBER30 NN TOWN OF SEC 9T� AND/OR LOT s IN WE t" TLIC.# 22 w BLOCK �~ SUBDIVISION s NO. i(30(0l CIIAPTER 145.135 M?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 may be 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. (t) The sanitary permit Is transferable. History: 1977 c. 169; 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. UED ISSUING OFFICER - DATE Z/ M EH PERXPIRES UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20)