HomeMy WebLinkAbout020-1121-20-000 (3)51,3
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Crop(
Safety and Building Division
INSPECTION REPORT Sanitary Permit No.
(ATTACH TO PERMIT) 633388
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes IPnvacy Law, s 15 04 (1)(m)I
Permit Holders Name City Village Township Parcel Tax No.
Ashley Fall I TOWN OF HUDSON 020-1121-20-000
CST BM Elev Insp BM El ev BM Description 'J � Seclion/Town/RangelMap No
pp T TAM 17.29.19.529
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
t S
f Z5b
1
r >^ Zfr �; yti
3 w
rtt
Pa lam 51-5
Holding
TANK SETBACK INFORMATION L1x — d %'Ihs 4
TANK TO
I
WELL
BLDG.
Ventto Arintake
ROAD
3�e
i Z5
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model Nu ber
TDH
Li
iction L s
S stem He
T Ft
Forcem n
Lengt
Dist
st to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width r J Length
DIMENSIONS / ID r
TION
STATION
BS
HI
FS
ELEV
Benchmark
I r 3
Avl f
/OCD
Alt . b -�, ,, � Co
3, 7
7 7, 3�
BldJdg Sewer
s)
( YI
SUHt Inlet
x
SUM Outlet
H6 ti t ✓1
. QJ
�1 �7. Z
-/.„
2-3
HEaderlytAn.
I
Q. 4 )
92 • 7 z-
Dist. Pipe
sz t, , ; >7 ry
z
.7
2 "5
Bot. System
TZIo,)o
(
/ , !, Z
/.
Final Grade
, Qj
'K 33
Sion, -/4tn
3, 74
17. 3cl
ll Z—
_._._... ._ ...fy,cY _�.,.. .. ��- -. ...-,...... .... - ..._ __.___�_
INFORMATION CHAMBER OR h 1 :�R
Type Of System r UNIT Model Number
tout a �IOJ �Z ocJ
DISTRIBUTION SYSTEM I. (?ir,Y
HeaderWanifold r
' y
Length�Dia
Distribution
Pipets)
x Hole Size
Ix Hole Spacing
ant to Fur Intake
Z F /�-ii
Length Dia Spacing
SOIL COVER x Pressure Svstems Only x Mound Or At -Grade Svstems Only
Depth Over
BedlTrench Center I .r �'®`
Depth Over
BedlTrench Edges � I Z N
xx Depth of
Topsoil
xx SeetletllSodtletl
-
- Mulched
0 No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1
Inspection #2
Location: 362 BROOKWOOD DR
�i' —Jev, oh u..,�1, e,,r)
1.) Alt BM Description = 320 TM✓1 L- (Oyyr. `'
2.) Bldg sewer length = }/vv V
-amount of cover = Vfy 1,7j']k°) r K D�kr VArIoN.� �Q /N.
Siiv% ii ox.�,
Plan revision Rfor ad do _Yes l No ?7 2 I �-
Use other side for additional infonnati U! !i I
SBD-6710 (R 3/97) Date Insepctoes Signature Can. No
hfj
(91 M _,;z -A
UN L JUN 09 2021 ,p, A,c 5T CAV)(
't c
(x County Ik i
St Cro 2
Community Development
"Bill
Sanitary Permit Application
;X,.' 1; -, j N I , AJ,Ii ( ,i!, ,a,, t III ji-, III 1 111
...... ... .. 1.1, "ol, vppl",,.I,,, 11PA IN iie IMI IT,
a oil fn -�pplw it irli- atm Please E not Ml fitformation
j A F
362 1jlpOr 0 -tug
hw
H lvpc of lluililinglefleck all that
N'trilc
mm" 77-STUT.
'apennit: (Chmkvnl�iB"lm%o,i (opipletelineB f, applicable)
- - - --- --- -- * R� — --
'�c,, S�Swm pi Cill $ISLCIII I LJ i"Itour Xlk kqfl,,,<Inent (III oowf Llalus .m'. III I 'II lu,pm ic"',
11. TPer"m Rmm,i Fj Po""t Re, "i" 'I pImm, Poma "unlivi �l Dxe [,,I
1 ( fw, Iwol PI,m:Tvr Pv, ... I
1-15'7/ 1`7- st-
III. �FN� "S S S Z: - p: twits
-Ssqicrq(Cc�n"I/Dnicr; lj�
—6 JLlpund 2 : IT' Ol 'IT IILpIL III
DI,,1 d F LT-FK
I'llent trey information , 3 x acl,
r>e,,,.,I Sul A,,5,-iT1.WR
VL L),stvr,,I Arcs Vwx 7 Slqe, I 1%,"I ,,I
��.Tlrltlt
&7 t
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1�11J.11�1
l,' L
3
L-------
------ -- -- _A
JLI�-"fl�)nmhilfty 1,witinmt- 1, the uptimgo'd ee ume rnOft"Lilidly.f for f,fi, 1"h""
.0 he tuscled plan
fun ,
'N" Im
,do
CTq- 5LSLLS, W-7 S `4 F) ,
P4 IT
Aeh"h I. romnlerc 14., F., the t 0,.t I the t .1, •iet P. IW..e, "irm Aij,ji he, I,.
5?SAkf,,
al Description: Lp, �11
i
,',CoPY
rfilCO PY-
location:
Plot Plan
)as. NEA OF TI-C-
VV$DAI, Sr.OEDIA C
BRZODKwooD DR,'
ti
Z
4
v_
y D�
Page a of 7
1" = 40 FT.
(except where noted)
L� = &Iddloe pit
I.CM -A CRGS
h North
o � a
0.
(0RaIaLET
,�
EXCAVATING
285 COUNTY ROAD SS
RIVER FALLS, WI 54022
800-828-3723
715-425-6200
715-425-8458 FAX
6/8/2021
REC OVE
JUN 09 2021
St Croix County
To: Community Development Community Developr
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 WI 145.245(4)(d)
Thanks Mike
Michael Rodewald
MPRS 931384
PAGE 1 OF 4
In -Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
Version 2.0, SBD-10705-P (N.01/01, R 10112)
Pg 1 of 4
Index & Cover Sheet
Pg 2 of 4
Plot Plan
Pg 3 of 4
Dispersal Area Cross -Section & Plan View
Pg 4 of 4
Management Plan
Attachments: j Enclosures:
rWW lotbs_PAemWW_K POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name I Description
Owner Name(s): __A5�HL&y FA u- _ Phone:
Owner Address:Z gRppic, �� .I_ It l_-r__ L --Zip: 5`POlip
Project Address: �6LAE _)__-__-_--__
Govt. Lot: - Ni _114 of 5E 1/4, Section 17 T_�N-R�__E0or W K
Township: _�t_ J� ___ County: _ ST CKDIX
Project Parcel ID #: __PZD_(i21-,g.._p0O
Designer Information
Designer Name: _-MA-a -JDTPhone: 71S- 412J- 1775
Designer Address:
LL 9Jq7 JNGS C%jw_t�t Zip:8 —
E-mail: i1d��157G�PSIAi1t� BGff DD pM rt,!!'- :r"r,
License Number: ---If-9?-0
Remarks: --- v
l ThNK po Ly, HtjrS25 Pd 1,
i'
`-' D ifin3
mil/ A
Signature: Date:
. at," n
rrtlinal 5,gOAWd on erhGvlfls, „rilttd wo,
Plot Plan
PROPERTY OWNER: stiLky AL_ -
L l Descri ton: L-oi 2b I nUT 'BW MK W mzs
� p , . Iyr;yy ar- Tt1E � Y
S 0- I"7 4 19, 1-29n1, iZ JqW , TMof HLW5DA , -r. CTOiX L'okKW
�l1lsC'ONJii�. O2a-iizi-zp—rjpa �3bZ BRoaKWoaD DRIVE
O + J,/
0
a
I
i
'r�.V.
G RR cfi D
FOR
Site location:
a,
2L 4 D 17
7
Page,. of 7
I" — 40 FT.
(except where noted)
Q = backhoe pit
twat-
IN -GROUND GRAVITY DISPERSAL AREA
Stepped Elevation Trenches with EZ1203HP Bundles
3-ft Trench (down -sizing credit)
i Y _A — --
min 12"
Gcwtr AiL I - (LYP�call
Gom —
_tiiLCObLit -�- - -
17 J
nvn Irenrh — —
a.�pn'
TYPICAL TRENCH
CROSS SECTION VIEW
(No Scale)
Septic Tanks) MannLxturer
�Xl^1TI/,ln; IZ.� NtaFFCUTT
�}pD 32t) WrESS
Sepfi Tank(:i)Vo0.mw(e):
�ZJr'o gal 320 qal gal ,r.1i
F1Puent Filter Minutarturar
Pay r-o K
E@lumtl bite, Modal #
HighestTrench --- --- -- -- -- Lowest Trench (as applicable)
System Elevatlons = qz.,9 ft, 61Z•co t, Y, (t;
TYPI CAL TRENCH istw.v location e! Inge,) 0LA10t pipe connoction on plan view)
PLAN VIEW 4" 0 F'"n lh4lI, .telbtl
A��„�ao�. t.nw.�,� me a-w. /Q ft
(ND Scale) Perf� ated Lateral observa;inn Pipe
-- (typical)
--- —_-- -----ter---- -------_--_ — =--
Provide muumum3ft
separation between tranches.
0,3SERVATION PIPE GEi AIL
ft
Spp Cei, O.wse� ,���.+ rmurv,e .; ralu
aV rvc Pry ----I -:
I np,�f o,,, 1, w•..",
.,l.,zuv f,,,";ymae
A = 3.0 ft
1- (typical)
F- ---- -- --- — ,z
(typical)
INSTALL PER TRENCH
10-ft bundles a, 50ft' EISA)unit= f'
+ 5-ft bundles @ 25 ff EISA/unit
-- -_---- Proposed EISA per trench 55D fl:
CLILR- Iol. REQuI
7� 91� Ii '— EZ1203H Bundle
IID71.Y3� 3of%-,ELSi/Mcr ,. (typical)
ZI 43 OR Z2 tmms prdrl by Infiltrator Systecla, lit, 1
tU rTS Xs
ZZ Install pursuant to niar.ufar.turerelnstcrc [ions
730
(2)3'X /!ol 7RENc9iE5
3
�m.itl oa s seo,lea,
i-I irae,.,
Required Infiltration Area= liv1L.`Ift' Distribution Method.
x Z trenches = Proposed Total EISA = t. I00 t'
AAA+n tpoL.D
D 4-1
G) CA
m
W
0
- A
A
6.5" (16.51cm) SEALED BALL
MATERIAL - HOPE
4" (10.16 cm) BALL
TRAVEL
5.7 14 7 cm I
'A0
POLYLOK PL- 525 - 625 CUTAWAY
33 02 ; 83.9 cm:
20.71 :52.6 cm]
HOUSING
FILTER CARTRIDGE MATERIAL -POLYPROPYLENE
MATERIAL - FILLED POLYPROPYLENE
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
c-1
W320—MR
TANK SPECIFICATIONSD o
o a
a I
DIMENSIONS: o
WALL: 3" a a
BOTTOM: 3"
COVER: 4"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER <
HEIGHT: 58"
4 -2 LENGTH: 4'-2"
4" CAST -A -SEAL WIDTH: 4'-2" 4" CAST -A -SEAL BELOW INLET: 46 1/2"
LIQUID LEVEL: 43"
rr-- ----�� WEIGHT: 3,880 LBS.
III _ I1
. d o
II ii INLET AND OUTLET:
4" CAST -A -SEAL BOOT OR EQUAL GASKET 'm o
a
li INLET AND OUTLET BAFFLE AND FILTER: Q w
JI LL =_--- --_- e24^ WISCONSIN, SEE DETAIL #10 m
(OTHER STATES SEE CHART) W N
FILTER OR BAFFLE LIQUID CAPACITY: 8.00 GAL/IN W `m
TOP VIEW LOADING DESIGN: 8'-0" UNSATURATED SOIL
Ln
TANK CAN BE USED AS: C "t
SEPTIC / HOLDING / PUMP OR SIPHON v w I
o�
N
COVER: MIX DESIGN #8 (NO FIBER)
o TANK: MIX DESIGN #10 (STRUCTURAL FIBER) W of
a CUSTOMIZED TANKS: Y� i co
FOR CUSTOM TANKS CONTACT WIESER CONCRETE W
INLET _ OUTLET 3
e
3" 0 Z
IF- - T4J 0 �
REVIEWED BY n c�
REVIEW DATE 3 a
w
SIDE VIEW DRAWINGS SUBMITTED N
FOR APPROVAL
APPROVED BY: SHEET NO
APPROVAL DATE:
OF
PRODUCTS NEEDED BY:
UFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS /
ST. CROIX COUNTY ZONING OFFICE:
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
I .4SH Lty rA LL_..
This is to pertify that'I have inspected the existing septic and/or dose tank
presently perving the following residence
(Street address) 3(oZ �iZtm W ODA �tLVB located
at: �_ y/<, 5C V Se tionn b18 , Town �l N, Range�_W,
Town of 1 50N 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 /ZF124
Did flow back occur from absorption system? Yes_ NO
(if no, ski next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: 1 7-'Sn
Construction: Prefab Concrete_ Steel Other
Manufacturer (if known): ISXA 1/J
Age of Tank (if known): 10 z7 - 81
Permit nuf nbe if kn/vn) I to /,-rl
Signature)
PLw�nW
(Title)
I
(Date)
>' V l I K9- lz-1-A t b
(Print Name)
_ g3138y
(License Number) IvHI/MPRS
Form to bi completed by licensed plumber (Dept of Safety and Professional
Services dhapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer
(NR 113 *isconsin Administrative Code)
Rev. 2I2012
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 Maintalner in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operating Limits:
Design Flow= gpd; BODs 5 220 mgC; TSS <_ 150 mgL"; FOG 530 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 (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)
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., wining, 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 W is.
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 ordnance 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:
MIKE RODEWALD
Phone: 715-425-6200
Local government unit ST. CROIX COUNTY COMMUNITY DEVELOPMENT Phone:
Local government unit address: COURTHOUSE, HUDSON, WI
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.
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 he
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.
4JN-l'Y SANITARY SYSTEM File #*
office OWNERSHIP/ADDRESS FORM &MtY
Co munity Development Department will utilize this information to provide the property owner with
inf rmation regarding operation and maintenance of your new or replacement sanitary system! This
inf rmation 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
info rmation will be sent to you by email. If you would like to view your issued sanitary permit online, you can
do1'o by using the Property Files Scanned weblink.
OWNER/BUYER INFORMATION
�7A L V
ng Address 3(02 t]"K VXnD �I21UE
State/Zip RiAusoN I lNs 5zf of
ieNumber (required)/n�1O�Q
I Address (required) 3 1 1fie ri t&t lam' (m& com
d Identification Number 02D— 1 I Z1 — Z0 — o00
I on the property tax 0111)
NEW SYSTEM: LEGAL DESCRIPTION
Location NE t/a , SE Ya , Sec. !7 T -AI N R Ig,W: Town of 14 VJ,-SWJ
Plat:
Lot # ZL.
I Survey Map # Nk Volume_(, Page # nl8_,
Y Dead # 107 413 (before 2006)Volume %/ 5 Page # y9L
of bedrooms 15� Spec house O yesAE(no Lot lines identifiable yes O no
Property Address
C � (5 r r 4
(venfication of e w add /
(Staff Initials)
(Date)
USE ONLY
required from Community De eiopmem Department for new construction.)
form Must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
i System: Include with this forma recorded warranty deed from the Register of Deeds Once and a copy d% the' cifrh fed
u ey map if reference is, made in the warranty deed.
Community Dovelooment Department — Land Use Division
l;)i 3ti6-4fiti0 St, ODlx County <invematerit Center 715 245-4156 ray
P L g 67 State and County
Permr[ Application
for Private Domestic Sewage Systems
'DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan LD #
A. OWNER OF PROPERTY
Mailing Address
State Per, 1 #
County Pe rm
County
55OBe
B LOCATION NF'.$F -., Section Z& T e�N, R_Lq__ .� W Lot# _4942-Clty
Subdivision Namne, nearest road, lake Or landmark Blk# Village
/Ulfu 7� Proa� Lf ba�S �t`esfl "Oef pa`ae Township
Single family ✓ Duplex No, of
of Persons
D. SEPTIC TANK CAPACITY Jz Total gallons No of tanks /
HOLD I NG TANK CAPACITY. IA- Total gallons No, of tanks
Prefab concrete Poured -In -Place Steel Fiberglass Other (spec-fy)
New Installation Ii Replacement
Lift Pump Tank or Siphon Chamber_-1 Total gallons Prefab concrete- Poured -in-Place_Other(Specify)_
E EFFLUEfyT DISPOSAL SYSTEM Percolation Rate f ( Total Amcub Area sq.ft.
New ✓ Replacement Alternate (Specify)
Seepage Trench' No of Lineal Ft. Width Depth Tile depth (top) No. of Trenches_
Seepage Bed -Length M ( Width L�/�♦
-I � Depth depth (top)-31E�.N No. of Liner t
Seepage GhA Inside ter Liouid Depth No. of Seepage Pit -
Percent s
Percent slope of land- 10 Distance from critical slope
WATER SUPPLY: Private S: Joint El Community L Municipal Li
Owners name as hsted on EH 115 if other than present owner
I, the undersigned, or, hereby certdy that the information I have reported is in accord ,,th Section H62 20,
Wisconsin Adm inis.rative Code, and Chet I have need the ffluent (1spotal system Irom the EH 115 prepared
by the Certified Sod Tester/1,
NAME J4ks,c„ S,a Kc�c si.� CST # .j,}"' 0327 and other mformaton
obtained tram � fenweh.hu dden
Plumber's Signature JiW MPRSW# Phone #7/5—57e3i•f9'�S
Plumber's Address2`�
PLAN VIEW Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion 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.
Do Not Write in Space Below OR COUNTY AND STATE DE ARTMENT SE ONLY ``�� pO
Date of Application FeesnP iI State C unty Date �/7-1�' A/
Permit Issued/Rarrrdd(date) `%-. Z-d� Issuing Agent Name - _ f�f / % �11
Inspection Ves�No _ State Valid# Date Redd
1. county Iwhrte copy) 3 owner (green copy) DIVISION OF HEALTH, P.O BOX 309, MADISON, WI 53701
-rate (pink copy) 4 plumber (canary copyl Revised Date 7/1/78
L
(9(b c7 - n ' AyS/ BUILT SANITARY SYSTEM REPORT
OWNER r TOWNSHIP -�, ,� �SEC.�T?N-R//jW
ADDRESS ,.- ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION• -, - j j �,f { _ LOT �(( LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
BENCHMARK- (Permanent reference Point) Desc ibe:
L 16L
Elevation of vertical reference point:/A. ,. _w Er Slope at site., S
SEPTIC TANK: Manufacturer::�^Q p; �; ::r "� Liquid Capacity: /f} !J
Number of rings on cover yla '�a�n -manhole cover elevation: hk;i
Tank Inlet Elevation: J-i. ?.. Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer:
Number of gallons
Number of gal. pump set
or a cyc a gallons, total capacity o
distribution lines
gallon: si—z-eoT pump head,
gallon per minute
horsepower ran name of pump
and model number
Type of warning ev ce
11OLDING TANK: Manufacturer
Number of gallons
Elevation of manhole cover
Type of warning device
SEEPAGE PIT SIZE:
ts eet iameter
Number o pie�
feet liquid dep CFI
seepage pit in e-elevation
pip
bottom of seepage pit a
evat on feet.
SEEPAGE BED SIZE: number of
��
lines r� width <r,• lenat gth-aile depth
SEEPAGE TRENCH: width_
length
PERCOLATION RATE -AKLA
REQUIRED AREA AS BUILT
INSPECTORg. A
DATED ':; jq / PLUMBER ON B -�
LICENSE NUMBER _
0
�Yui t
VLVORr Of INSPLCTION INVII IV VAI SI wAGL SVS ILn�
\uru fl,/ul I'I'9e1 1���/
vct+un04( M -SubdivtOtun - ----
/X-�Z)-yu 4't onA NumbeA o6 compaAlm¢n to __
wets_ tr liuitdtny/94-12% dtupe_�
NiyhwatcA�L-ttN-f-C-�j
1 IIA481-R
__ yaUonA_ Pump A1anu6actuaeA
41. IANA
1 _9attana
weft
11"'hwaleA
Nodet Numbeh
NµmbeA nA C,,mpantmentd _ _
AtaAm Slletvnl
— buttdany-- I?% de"Pe-__
1 Av n cl, --
We tl' A16f Nua tdAna
if yhwa (v''
„II ULNLNSIONS/{ _
r2t ALope
7Z _
A lAeneh___
_.At
Reyu.c lied
anea__
_ ��CI nr
,IA each tone
_ .%t.At
De.plh
,A
Aock
below ntv
,.A I'lrled
J_
Vep(1,
o6
puck
oven fl to
06
tined%Zi
At
Depth
nA
tety
below ,1
1 f.ul'
1'l ned "
64
Neopy
u6
t"eny{I
`�rrl. pry llhl ,j!
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91J8
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION Lt-'G,�SEY.,Section /> q
l�L,TS N, fi1L E{erj W, Townsb.p or Municipality
Lot No_ , Block No. J. �. y' l�JZc<f .` County
� ivision ame �
Owner's/Buyers Name/: �2 ��C.S,t,�� �N � � i
Mailing Address-Cz (^/' ) / �� /.L - � / (a "!' sy.
TYPE OF OCCUPANCY Revdence No of Bedrooms COMMERCIAL
RErF1VFO
JUL "I1t 1981
ZONING
EFFLUENT DISPOSAL SYSTEM NEW lv_� REPLACEMENT ALTERNATESYSTEM // OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS .�Z`/ �'__e- PERCOLATION TESTS 1�L-4/1!4!
SOIL MAP SHEET ea♦e- C7 NAME OF SOIL MAP UNIT Cawslr .; f
PFRCEN ATION TFSTS
TEST
NUM
BER
DEPTH
INCHES
CHARACTER Or
THICKNESS IN INCHES
HOURS
SINCE HOLE
1 ST WETTED
WATER IN
HOLE AFTE
SWELLING
TEST TIME
INTERVAL
IN MINUTES
DROP IN WATER LEVEL, INCHE
RATE
MIN/IN
PERIOD
I PERIODI
PERIOD
5
3
? z
1 2
/.
P-
P-
P-
Srnt Rr1RIND TFSTS
TEST
NUMBER
TOTAL DEPTH
INCHES
DEPTH TO GROUNDWATER, INCHES
CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE, MOTTLING AND DEPTH TO BEDROCK
OF OBSERVED IN INCHES
OBSERVED
ESTIMATED HIGHEST
S
B-
B-
-
•... �.,.,..o H� wiovvii Ara u, sou bore noses an, suitable sod areas.) Indicate on the plan the Iota ion rid square feet of suitable areas
Indicate number of square fees of absorption area needed for building type and occupancy — b'� c -% Indicate scale or distances.
Gwe horizontal and vertical reference points. Indicate slope.
y'/�:/D0'
_
kZ.
L�a
/ s /
�Lr
B, "= l03
c(,
i
a {+•c i^
off I +12ar
•
$H� r'A,�rf r ris tL Nc � .
wc\ 74� 'T
k
cu
-ire
S /L
sr
C, /Y .ti.
/7d•.-e
'rand y !2"
177/6/
2R.
I, the undersigend, hereby certify that the soil tests reported o , 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
f
Name of installer if known _Ii_s ..-.. r
Copy A —Local Authority
CST Slgnalure U Q. lzt-
C_
fl�l h71 fessional Services
p �C LJ
SO EPORT Page I of 4
n IN 09 2021
o�plgteO gp,,paper n lesa than 8 12 x / 1 inches m size Plan must
$ horizontal reference point (SM), direction and
61"gun.nh am", and location and distance to nearest road
Please print all IMMOlntaVOn.
Personal information you pronde may be used for secondary pure es (Pnvacy Law, s 15 04 (1) (m))
County ST. CROFX
Parcel I.D 020 - 1121 - 20 - 000
Revlo-wed by Date
Property Owner
ASHLEY FALL
Property Location
Govt Lot --- NE 114 SE 1!4 S 17 T 29 N R 19 E (ora
Property Owners Mailing Address
362 BROOKWOOD DRIVE
Lot #
26
Block #
1 —
&bd. Name m CSW
TROUT BROOK WOODS
city State Zip Code Phone Number
HUDSON, I µ7 1 54016 1 ( I
LjCrty 0 village • own Nearest Road
BROOKWOOD DRIVE
❑ New Construction useE] Residential / Number of bedrooms 5 Code denved design flow rate 750 GPD
SReplacement Public or commercial - Describe
Parent material SANDY Flood Plain elevation If applicable ZOA4 Ail fl
Germs O0mments CONVENTIONAL IN -GROUND TRENCHES — 0.7 LOADING RATE. — UPGRADING TO A 5 BEDROOM
and recarmlendabow AND MOVING LOCATION OF REPLACEMENT AREA. NEW TEST REQUIRED AS PREVIOUS TEST
WAS 115 REPORT.
6mrwer--} .4crrK5
0 B«,ng# ElBoring
11 Pit Ground surface elev 94.45 it Depth to limiting factor 100m
Soil licetnn Rate
Horizon
Depth
n-
Dominant Color
Munseit
Redox DescrPhon
Qu. Sz Caryl Cokx
Texture
Structure
Gr. Sz. Sh
Consistence
Boundary
Roots
GPDIT
'Eff#1
•ER#2
1
0-9
7.5YR2.5/2
--
Is
Osg
dl
cs
3vf-co
0,7
1.6
2
9-32
7.5YR3/4
-
grly s
Osg
dl
gs
2vf-co
0.7
1.6
3
32-100
7.5YR4/4
--
s
Osg
ml
__
--
0.7
1.6
some cobs
2] Boring # E] Boring 96-45 108
pit Ground surface elev ft. Depth to lim ling factor in
Soil Application Rate
Horizon
Depth
In
Dominant Color
Munse l
Redox Description
Qu Sz Cunt Color
Texture
Structure
Gr, Sz. Sh
Consistence
Boundary
Roots
I
GPDM
'Eff*1
I 'EfW2
1
O-4
7.5YR2.5/2
--
is
Osg
ill
cs
2vf-m
0.7
1.6
2
4-51
7.5YR3/4
--
s
Osg
di
gw
Ivf-m
0.7
1.6
3
51-108
7.5YR4/4
--
s
Osg
ml
--
_
0.7
1.6
horizon 2 has I
some A fmg. 1-5%; Nome gr/
cobs
ti Z S'low
• Effluent #1 = BOD, > 30 < 22D mKA and TSS >30 < 150 mgI • Effluent #2 = BOD < 30 nV% and TSS < 30 nglL
CST Name (Please Print) S CST Number
MARY JO HUPPERT(Hollister's Soil Testing & Design) 224832
Address Date Evalu o Conducted Telephone Number
28497 King Arthur's Court, Danbury. W I 54830 05 - 12, 2021 715-426-1775
SBD-8330 (R07113)
Property Owner FALL, Ashley Parcel ID #
I I Boring# 11771 Borng ......,.ee�e., 93.25 it
020 - 1121 - 20 - 000
102
Depth to knifing factor
Page 2 of 4
Cm A.
I_ i
tioraon
L-i
Depth
in
Yn
Dominant Color
Munsell
Redox Description
Qu Sz Com Color
Texture
Structure
Gr Sz Sh
Consistence
Boundary
Roots
GPD/ffEfl#2
-E
l
0-4
7.5YR2.5/2
--
Is
Osg
di
cs
2vf-m
0.7
1.6
2
4-28
7 5YR3/4
s
Osg
dl
gs
2vfco
0.7
1.6
3
28-102
7.5YR4/4
--
s
Osg
ml
--
—
0 7
1.6
Somc gr/cobs
Boring # H Boringpft Ground surface elev fl Depth to lirtuurg factor in
SoA A Marion Rate
Horizon
Depth
in.
Donxnant Color
Munsell
Redox DescWtim
Qu. Sz. Cont- Color
Texture
Structure
Gr. Sz. Sh
Consistence
Boundary
Roots
GPDRf
'Eff#1
I 'EB#2
Boring
Boring # Pit Ground surface elev. ft Depth to IunNng factor in
Horton
Depth
in
Dominant Color
Munsell
Redox Description
Qu Sz Cont Color
Texture
Structure
Gr. Sz. Sh
Consistence
Boundary
Roots
Halt
GPDRF
'Eff#1
•Efl#2
Effluent #1 = BOD, > 30 < 220 "A and TSS >30 < 150 mgrL
$6D1]30 (AOJ/13 �
Effluent #2 = BOO, - 30 rngA- and TSS < 30 ng/L
Ref
54. Croi}C COUNTYNp, 633388
STATE SANIARY PERMIT
367Z a*k,W a*
Drf��� PREVIOUS NO. /67
ENE X
OWNER I+gh [N /A l
PLUMBER /ht;kto &eW4J LIC.#
TOWN OF /;vokb"
SEC _/�7 ,T 2q N, R_�E/ t�
AND/OR LOT 7 C& BLOCK
THIS PERMIT EXPIRES
0
SUBDIVISION
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.
(0 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
UNLESS RENEWED
RE THAT DATE
AIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (R11/20)