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Home My WebLink About020-1150-20-000 (2)Wisconsin Department of Commerce County. PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) 633393 State Plan ID No' Personal information you provide may be used for secondary purposes [Privacy Law, s 15.04 (1)(m)] Permit Holders Name City Village Township Parcel Tax No JEFFREY & PAMELA RYBERG TOWN OF HUDSON 020-1150-20-000 CST BM Elev Ins p BM Elev BM D��ption y� SecticnrTown/RangelMap No O r C K i S�r O✓ r 33.29.19.810 TANK INFORMATION ELEVATION DATA TYPE MANUFACT ,n9s CAPACITY Septic = "mayy (000 4v,w ,t- Holding TANK SETBACK INFORMATION TANK TO P!4 WELL BLDG Vent to Air Intake ROAD Septic l.,� ' (( r Lj 0, U Dosing Aeration Holding PUMP/SIPHON INFORMATION Ft STATION BS HI FS ELEV Benchmark q ! /To /i 09 /0- 147 Alt. BM Bldg Sewer �Xt ` SUHt Inlet A,pr-vj St/HI Outlet -6 ' O, 3 /aO_ 3 6 Dt Inlet Va 1vo II,J-7 19- 7 Ot Bottom Her7.1 6G i n n. P I'll.. Z- Dist Pipe (r '�'{ IT. 9'Z Bet. System' 13 ` 7, 5 Final Grade Iv. Sq /ov. 5 St Cover ' Z �' ..►- f5 4 1 � i In � BED/TRENCH DIMENSIONS Width x Length r o Ot Tr;° aches /L MIL^) PIT DIMENSIONS No Of Pits Inside Dia L uid Depth SETBACK INFORMATION SYSTEM TO ',2y. PIL BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer' Type OfNystem � t p� l `� x -- Model Number19 Ulb I KIIJU I IUN SYS I tM y" /air G,. 4.l i I;d r. Header/Maa mmfold r r 1 Dislnbution f r �� r 11) 1 x Hol Size x Hole Spacing Vent to Air Intake Length Dia ` LengtPlth Length Dia Spacing �i.X'aYI / JUIL GUVtK x Pressure Systems Only xx Mound Or At.Grada Svsfnmc Only ' /, Depth Over ` Bed/Trench Center 2 Depth Over ` r Bed(rrench Edges �'Z xx Depth of Topsoil xx Seeded/Sodded xx Mulched Yes _ No — i� Yes L No COMMENTS: (Include code discrepencies, persons present, etc.) Location: 625 COUNTRYSIDE LNN 1.) Alt BM Description = TD 2.) Bldg sewer length = �,- - amount of cover = !X 1 )1r ✓ 5 Plan revision Required? ❑ Yes I No Use other side for additional informati IQ SBD-6710 (R.3/97) Date Inspection #1: Inspection #2 —Vtil a� jJer}l� e. JS - 12 x� Sr�11J vn�%2r F� ev-% . Insepctors SigMature r D County Services Division SLCrotx S MAY 2 5 2�2 0 E Washington Ave S :Industry P.Q. Box 7162 Bonita y Pe nit Number (to lx filled n by CoJP St Croix County Community son, WI 53707-7162 II 11 -p(J� Developmen /v ( 7 (o Sanitary Permit Applications State Transaction Number In accordance with SPS 383 2] (2), W is Adm. Code, submission of this form o,uniumurat unit 6 33 37 3 is required prior to obtaining a sanitary permit. Note Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) purposes in accordance with the Privacy Lax s. 15 (A(I AAft Slats 625 Countryside Lane 1. Application Information — Please Print All Information C�6J Property Owner's Name Parcel # Jeffrey a Pamela Ryberg 0320-1150-20-000 Property Owner's Mailing Address Pmpertv Location 625 Countryside Lane Govt, Lot City, State Zip Code Phone Number SE 'A, NE 'A, Section 33 Hudson, WI 54016 (circle one) T 29N R19Eor® 11. Type of Building (check all that apply) Lot # Subdivision Name ®Ior2 Family Dwelling— Number of Bedrooms 3 24 Countryside Village Block # ❑ Public/Commercial — Describe Use ❑ City or ❑ State Owned — Describe Use ❑Village of CSM Numbrr-- ® Town of Hudson 1[I. Type of Permit: Check only one box on line A. Complete line B if applicable) A. ❑ New System ® Replacement System ❑ Treatment/Holdmg Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ElPermit Revision ❑ Change of ElPermit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 64846, 4/12/1985 IV.Type of POWTS S stem/Com onentlDev ice: Check all that apply) (� QC - s =mil [ ❑ Pressurvcd In-0mund ❑ At-0r de F1 Mourad > 24 n1,1 AbIP ❑ Mound < 24 in of suitable soil El Holding Trial, El Other Dispersal Component (explain) Pretreatment Device (explain) EIJrn I V. Dis ersaUTreatment Area Information: 7 ek.M Design Flow (gpd) Design Soil Applicatio Dispersal Area Required (sf) ispetsal Area Pro sed (sf) System Elevation 450 Rate(gpdsf) 28 125643 330 / 9700 16 V1. Tank Info Capacity in Gallons p Total Gallons # of UnitsManufacturer O U W New Tanks ExistingE Tanks = J m „ �; L �, (✓ N L Septic or Holding Tank 1000 1000 1000 2 Wieser Concrete/ Weeks C.P. Dosing Chamber ❑ V ill. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's r MP/MPRS Number Business Phone Number Jahn Schmitt 16 223760 715-760-0486 Plumber's Address (Street City, State, Zip Code) 586 Valley View Trail, Somerset, WI 54025 V_ill.Count /De artmentUseOnl IXI Approved I ❑ D ` Fermi F c Ijat Is ed 1 w Agc,,nt Sip�r T ❑ Owner iven Ke n for Denial $ ,�,--� IX. ConditioWN pprova RresertsforHisepproOAl 3)6 e0 ti �,.,Q�� w,u.a,s�-� `ly pit xx.9y�1 dy DM E GG,' - 1 1. u LN YSTEMOWN /Gt 1 LLA -(jq Np �r t P�fJ6� Sr 1 Septic tank, effluent filter ®tad -DJ � - / lo...•�[ A dispersal cell must be 5erv�/ maintained 31 t plan provided by plumber. ) �tTtr�6.rt - a o � as per management vt^� setbackAll requirementsmust be maintained as r pplieable c plans for the system and suboo to the County only on paper of inn 6 ins 11 in es in size �-4�7lcr— c t •per � e(l sir"C��p'` l'u` � SYSTEM PLOT PLAN Ryberg 3 Bedroom Septic System Project Address 625 Countryside Lane BM1 Symbo BM Elevation: 100.00' BM Description: Top of southern most phone ped at SW lot comer SM2 Symbol: Q BM Elevation: 104.90' BM Description, Top of existing drain field vent cover Slope Gradient of Tested Area. (a%) Well Symbol (d applicable) Notes: See CSM for complete lot T1- 5'x33' ELJEN trench El =97.00 T2- 5'x33' ELJEN trench EI =96.50' B1 C� 18'x36' Rock & Pipe Bed Design Flow 450GPD Attach design flow calculations for commercial plans: Pipe Materials / ASTM Standard Tables 384.30-3 & 384.30-5 4" SCH 40 PVC pipe ASTM- D2665 4" 3034 PVC pipe ASTM-133034 'M M /Proposed Existing 1000ga1 WLP1000-MR Septic Tank Septic Tank w/ Polylok 525 Existing 3 Bedro( House Garage N Scale: 1" = 40' 0 40 60 80 'AJGL"3 tAh-� o t Existing Well t Driveway inn, 1ng, Ana, Property Line 10' fcCppY CONVENTIONAL COMPONENT DESIGN Reside n:ial Application INDEX AND TITLE PAGE Project Name: Ryberg 3 Bedroom Septic System Owners Name: Jeffrey & Pamela Ryberg Owner's Address 625 Countryside Lane Hudson, WI54016 Legal Description: SE1/4, NE1/4, S33, T29N, R19W Township Hudson County: St. Croix Subdivision Name: Countryside Village. Lot Number: 24 Block Number Parcel I.D. Number 020-1150-20-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Existing Tank Certification Page 4 Proposed Septic Tank Specification 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: 5/24/2021 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 Ryberg 3 Bedroom Septic System Project Address: 625 Countryside Lane BM7 Symbo BM Elevation 100.00' BM Description Top of southem most phone pod at SW lot corner BM2 Symbol Q BM Elevation: 104 90' BM Description Top of existing dram field vent cover Slope Gradient of Tested Area. (8%) Well Symbol (If applicable) Notes See CSM for complete lot T1- 5'x33' ELJEN trench EI.=97.00' T2- 5'x33' ELJEN trench EI.=96.50' 18'x36' Rock & Pipe Bed Design Flow. 450 GPD Attach design flow calculations for commercial plans. Pipe Materials 1 ASTM Standard Tables 384.30-3 & 384.30-5 4" SCH 40 PVC pipe ASTM- D26s5 4" 3034 PVC pipe ASTM-D3034 Existing 1000gal Wr 1V 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) 625 Countryside Lane located at: SE 1/4 NE 1/4, Section 33 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 2 ' Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000 Construction: Prefab Concrete X Steel Manufacturer (if known): Weeks Concrete Products Age of Tank (if known): 4/12/1985 Permit number (if known) 64646 ;fA:e John Schmitt (Lic sed Plumber Signature) (Print Name) MPRS (Title) (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 Page 3 4" CAST - a 1-1 WLP1000-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2' 4" CAST -A -SEAL BOTTOM: 3' COVER: 5' MANHOLE: 24' I.D. PRECAST CONCRETE RISER HEIGHT: 53 1/4' LENGTH: 8'-8' WIDTH: 7'-2' BELOW INLET: 42' LIQUID LEVEL: 36' WEIGHT: 6,790 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) LIQUID CAPACITY: 27.83 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,085 GALLONS LOADING DESIGN: 8'-0' UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON OUTLET N k Till, � h PUMP PAD COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: Lii 1 OF / I PAL �� Inc Innevatwm,rt Precast 0." oj Zabel& &&tent" P,o&cu A F6not -c PL-525 Filter PL-525 Effluent Filter 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 Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will Float up and temporarily shut off the system so the effluent won't leave the tank. Features: • 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 Inslallation: 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. 11I -525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2 Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace and secure septic tank cover. 1/16" Filtration Slots Alarm Switch y (Optional) f Accepts 1" PVC tension Handle Rated for 10,000 GPD 525 Linear Ft. of 1/16" Filtration Slots Accepts 4" & 6" r�� SCHD 40 pipe 0 ®Certified d NSFlA e, Standard 46 r AW ( luld oor�uwrildtrr 41ann Polvlok, Zabel & Best filters accept the SmartFilter® switch and alarm Gas Deflector Automatic Shut -Off Ball [,tend & 1 aW'' Easily installs into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com Page 5 r ? Home Abou[ Site Map Order Info Videos & Literature Contact Drip Systems Treatment Controls Products Downloads Design Guidance *1, O b ( 'WATER -TIGHT ACCESS CAP RISER CAP ADAPTER RISER TUBE VALVE DIRECTI ON HANDLE 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 Valve Positioned on No I during Odd Years ITEM BRV4 BRVBULK BRVCIRISER BRVKEY28 BRVKEY36 BRVKEY48 Tank Tank DESCRIPTION BULL RUN VALVE 4" BULL RUN VALVE & KEY ONLY BULL RUN VALVE RISER W/ CAST COVER BULL RUN VALVE KEY 28" BULL RUN VALVE KEY 36" BULL RUN VALVE KEY 48" Valve Positioned on No 2 during Even Years 4' OUT PORT C OLTr PORT T 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 Pace 6 eljen Eljen GSF System WI Design Program Date 21 V, 'I ❑rent Name is%4ey & I a•rels RyOerF Site Address: 625 Counrlyside Lahr. itud.on Wi 54016 Designer, labn Sc hmT Note. Thn worksheet a promded he assist he Planner rn vvnq the number of fpen Gsf Modules re4urmd for p,peelpa pro)rt The mkWin,cne here In are ,knotedfor rah output. The success of the overall design is Cased an the Phhinen Inputs andron,deratrons oW de of this warlaheet. System Sizing (Total Number of Ellen GSF Modules Required) Design Notes and Comments I 1 Site Characteristics Total Number of Bedrooms 3 ODE per Bedroom (Daily Design Flow per Bedroom) 150 gpd Effluent #1 Application Rare 0.7 gal/ft' DDF (Daily Design Flow] 450 gpd Equryalent Effluent a2 Application 1.6 gal/ft' Application Rate 1.6 gal/ft' 1/ Required Basal Area (DDF <Apphaoon Ratel 2813 ft' Unit Used I Usually B43) 843 Unit Install Width 5 ft Square Footage per Unit 20 ft°/unit 1.2 Module Quantity Analysis: Minimum Number of Ellen GSF Modules Required IPegwrE'. Reset A...„ - iau'err Fsr u4Vsr =n, or bcdr_m4',5 or 6lor A421_ wh¢hever is greater) ]5 units Amount of Ellen GSF Modules Used 4'uvL,-grrate,ite=arP,,! Mnimum Number, p•n 0.gpuu2d 16 units 1.3 Trench Desiii Number of Trench Rows 2 Rows Trench Width 5 ft Trench Length 33 ft Units per Row 8 Total Square Footprint 330 ft° F aft 5 33 MIN 12" CLEAN FILL L 12" SPECIFIED SAND L 5 0 NATIVE FILL 3 ft -- AST'' 33 S Page 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 = 450 gpd; BOD5 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) 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.) 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 (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 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. Pace 8 B43 Eljen Geotextile Sand Filter The Eljen GSF (Geotextile Sand Filter) is an alternative onsite septic leachfield system. Each GSF Module is made up of geotextile fabric and a plastic core material that work together to provide vertical surface area and oxygen transfer. The GSF System applies secondary treated effluent to the soil, increasing the soil's long-term acceptance rate. A Specified Sand layer provides additional filtration, and prevents saturated conditions. INSTALLATION Installation shall comply with the latest installation instructions published by Eljen Corporation and abide by local regulations. Eljen Modules are installed along their 4-foot lengths on a base of stabilized Specified Sand, with the painted stripe facing up. A 4-perfor- ated pipe is centered on top of the Modules, and is secured with supplied metal clamps (one per Module). Cover fabric is supplied by Eljen and substitutions are not allowed. Specified Sand is placed along both sides of the Module, and at the beginning and end of each row once the cover fabric is in place. For more specifications and detailed installation instructions consult the appropriate Design and Installation Manual. elen CORPORATION Innovative Onsite Products and Solutions Since 1970 Tel:800-444-1359 • Fax:860-610-0427 Email: info@eljen.com www.eljen.com moo• • � •• • •-• •• a-.•. • • �PER SPEg9 E1JSMD - - - - — W, J PERDESIC3J - EXAMPLE INSTALLATION Patented 02019 Ellen Corporation 1933A-05/19 STr. CRo UNI'Y SANITARY SYSTEM File ce Office Use Only OWNERSHIP/ADDRESS FORM Created 2RO21 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 Jeffrey & Pamela Ryberg Mailing Address 625 Countryside Lane City/State/zip Hudson, WI 54016 Phone Number (required) Pam 715-441-2170, Jeff 715-441-4144 Email Address (required) pkryberg@hotmail.com Parcel Identification Number 020-1150-20-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SE ,Z4 NE 1j14 Sec 33 T 29 N R19 W, Town of Hudson Cubdivision Plat:/ �n �> 3 Warranty Deed # 400730 Number of bedrooms 3 VI Lot # 24 . Volume"�. Page #— (before 2006)Volume 708 Page 4499 Spec house O yes ■ no Lot lines identifiable ■ yes O no OFFICE USE ONLY New Property Address I v 1, 1 (Verification of new address required from Community Development Department for new construction.) (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center cdd(o)sccwi gov 1101 Carmichael Road, Hudson, WI 54016 715-245-4250 Fax www sccwl. aov Page 9 COUNTRYSIDE VILLAGE 4 — cv 9 .47 LOCATED I12 AND THE SW 1/4 OF SECTION 34 T29N, R19W "'tom A', . TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN 1 FE101E1FJ1 St9ttEY 119P LER�]EC SVR(E[ ANP. rFRrJf1EP SK - .NS' YDWME Z. MSC 49B_ } xn I 4 Y9LNL ]. Pl�PE 24A Z I Z _�Y91YME 1. E9PE fi92 xOb.'O¢`[ 'numb® A.W. Ia1100'1 J_ _ x.Bq .4.1 wr.. >eo Be rwm a,u ;� y ---ye.- t.0 ne xt°.B jasi - IF. 4 p _ gArca R It:ate t . rw'.rnea .' to �x ¢.. -3 xIecxr> - ue=� E �, .Ba15vme ,•-'�� •.oay xia.� u w�A_ i+oJp_ F St SATS IF P01A n s Bh xso aka[ 's• /m •i' max° ea �{ / zlz�raea ell ,AKKs ^ eN.rrsa it e $ +� zi ,0." 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I. u`rervorB mBcn omm ml. zom om or zlmt.lz.8 mm _.3 J IR�N IMyY 1. eRM�x I�/LiXGt McO�N EN„SNFt RIN. IS ]e-., U T. .19)9 xx.. 0.b �'xq ¢AL FACT w Department of SOIL EVALUATION REPORT #2105 S' - Safety and in accordance with Comm 85, Wis Adm. Code Page 1 of 4 ch s < Professional Services Schmitt Soil Testing, Inc. Attach 'com complete site Ian on paper not less than 87> x 11 Inches in size Plan must P P P Pe County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and - --- ---- -- - percent slope, scale or dimensions, north arrow, and location and distance to nearest road Parcel I.D. 020-115a20-0oo Please print all information. R v By Date Personal information you provide may be used for secondary purposes (Privacy Law, s 15 04 (1) (m)) K 6/n lam' Property Owner Property Location Ryberg, Jeffrey & Pamela Govt. Lot SE V4, NE7/4, S33, T29N, R19W Property Owner's Mailing Address Lol # Block IIISubd. Name or CSM# 625 Countryside Lane 24 Countryside Village City State Zip Code Phone Number City_ Village Town Nearest Road Hudson WI 54016 1 Hudson I Countryside Lane _ New Construction Use _ Residential I Number of bedrooms _ 3 Code derived design flow rate 450 GPD _ ;Replacement Public or commercial - Describe Parent material Outwash Sand- --- - -. _- - Flood plain elevation, if applicable NA It General comments Replacement area is suitable for a conventional system with a 0.7 gpd/sgft rate. System to be installed along the contour at least 2 and recommendationsfeel deep. Slope of area is 8%. y Boring Boring g # ' 98.20' factor 96t—_ .Pit Ground surface elev- -. R Depth to limiting in. ISoil Application Rate Horizon Depth '... Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW •- •Efl#2 in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. 1 0-12 1 r3/3 none 51 2mgr I mvfr as 2m,2f 0.6 1.0 2 12-18 10yr4/6 none Is lcsti mvfr gw lvf 0.7 1.6 3 18-96 10yr5/6 none s Osg ml --- ------ 0.7 1.6 - Boring a Boring If Pit Ground surface elev. 101.30 ft. Depth to limning factor 96+ in Soil Application Rate Horizon Depth Dominant Color Redox Description 1 Texture Structure Consistence Boundary Roots GPD/R' 'Eff#1 _ •Etf#2 in Munsell Ou Sz Cont. Color Gr. Sz Sh 1 0-5 10yr3/3 none sl 2mgr mvfr as 2m,2f 0.6 1.0 Is Osg ml �Osg gw 1Vf 0.7 1.6 2 5-37 1 10yr4/4 none 3 37-96 i 10yr5/6 none s ml T - 0.7 1.6 Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 � 30 mg/L and 155 < JO mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc Date Evaluation Conducted Telephone Number 1595 72nd St New Richmond, WI 54017 5/13/2021 715-760-1978 SBD-8330 fR 0700) PropertyOwner Rytoerj Jeffrey & Pamela Parcel ID# 020-1150-20-000 Page 2 of 4. Boring 3 Boring # Pit Ground surface elev 10000 It Depth to limiting factor 96+ in. - - — Soil Application Rate Horizon Depth Dominant Color in Munsell Redox Description Qu Sz Cont. Color Texture Structure (Consistence Gr. Sz. Sh Boundary j Roots GPD/ft'_ •ER#t •ER#2 1 2 0-10 3Oyr3/3 10-18 10yr4_/6 none none I none sl Is 2mgr mvfr icsbk I ri Osg ml 05g ml as 2m,2f 0.6 1.0 gw cs 2m,2f 0.7 1.6 3 - - 4 18-41 1Oyr5/4 Is ------ 0.7 6 41-96 1Oyr5/6 none s -- ----- 0.7 1.6 Bonng ❑ Boring # Pit Ground surface elev. It Depth to limiting factor in Soil Application Rate Horizon Depth Dominant Color in Munsell Redox Description Go Sz. Cont. Color Texture Structure Gr Sz Sh Consistence) Boundary Roots GPD/ft_' •Efl#1 •Efl#2 I j Boring Boring # -- Pd Ground surface elev It Depth to limiting factor in - Soil Application Rafe Horizon Depth ''... Dominant Color Redox Description in Munsell Du Sz Cont. Color Texture Structure Consistence, Boundary Roots GPD/W Gr Sz. Sh. 'Efff •Efen2 I i -_ • Effluent #i = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L 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,i*rY 608-264-8777. SBU-8330 iR 07 W .SdiiiiiII Sai Tea V' DX. St Croix County, WI Conducted for Conducted By: Legend � Jeff & Pam R ber Y 9 Thomas J.Schmitt/ lakesalMRrvers a1 625 Countryside Lane Rners Hudson, WI 54016 and so-eams m _ n CST 227429 Lot 24 Countryside Village rY 9 5-13-2021 PID' 020-1150-20-000 »•w SE1/4 NE1/4 S33 T29N R19W messes Town of Hudson US Highways SWIl Hqg ao 100-00' Top County Highways of southern most phone pedestal at South West Lot corner BM 2 04.90' Top of existing drainfield vent cover I owl Raaw Rustic Roads Ramps Road Right of Way 271.25' •e,�•••m nv e n Raltoads \ Corneyence Drv,..n \ EXISTING WEEKS •\ 1000 GAL TANK �, 2 35' \ 1EX 7IN 15, •••8%SLOPE •\••'• HOUSE ' PROPOSED REPLACEME •• ' \ AREA B3 O wELL N � 1 \ 1"=40' i BM 1 I • 0 20 40 60R DISCLAIMER Thu maP m not guaranteed m be 409.44' accuote cwrect, w"nt. a wn elete and mn ..ns d,e are tlta responsibility of the user. aurn.sysu St Croix County, WI Legend Lakes and Rivers Rivers and Streams Inlerstetea US Highways State Higaways County Hgeways Local Roads Rustic Roads Ramps Road Right of Way R,uloeds Conveyenu Denson Aenal Plglo(2020)1Colorl 0 50 100 150R DISCLAIMER, Thla map is not guaranteed to N accurate correct, cu.t, or co ate and conduvona drawn are Me mapdas OIYIy of the uaer 1 4 Form - SPT C - 1 AS BUILT SANITARY SYSTEM REPORT OWNER tt TOWNSHIP �j/ ( - SEC. T_'l N-R__LJ_W ADDRESS 1\ ��, _ ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEN Distances and dimensions to meet requirements of H 63 SHOW EVERYTHINC WITHIN 100 FEET OF SYSTEM J v I` INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used i— Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: I�•' Liquid Capacity: `) Numbar of rings used: ( Tank manhole cover elevation; Inv, S / Tank Inlet Elevation: w �,� Tank Outlet Elevation: JN Numbs of 6:et from nearesc Road: Fron [,O SideO Rear,O I.. ) feet i From warest propertyline Franc,O Side O Rear,O j feet ( Numb,r of feet from: yell ! fbuilding: 1' (Include this infurmatloo of tlw ,ibuve plot Plan)( 2 reference dimensions to septic tank) = REVERSE SIDE PUMP CIIAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: ^ Number of feet from nearest property line: Front, O Side, OR ear,f 1 Ft._ Number of feet from well: ��/// Number of feet from building: (Include distances on plot plan). SOLL ABSORBTION SYSTEM Bed: Trench:_ Width: Length:_. Number of Lines: I Area Built: ai Fill depth to top of pipe: Numher of feet from nearest property line: Front, O Side, O Rear,O Pt .� Number of feet from well: Number of feet from building: r (Include utSLances on 1110L 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 O been used on any of the above soil absorbtion sytems^: (Check one). 110LDTNG TANK 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: Dated' �_ L i Inspector: _ Plumber on job: License Number: 1/Bh:m} DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS P.O. BOX 7369 MADISQN, WI 53707 INSPECTION REPORT FOR PRIVATE SEWAGE SYSTEMS )=CONVENTIONAL IALTERNATIVE -1 Holding Tank 1.1 In -Ground Pressure I Mound SAFETY & BUILDINGS DIVISION BUREAU OF PLUMBING v.�. Pl.n I D NumNr. w ..,.a•IM1 AG NAME OF PERMIT HCLOEH A0011E5501 PERMIT Nnl 0ER IYSPE_IION DAr r Ryberg, Jeff R. R. 1, Box 424, Hudson, WI /i S BENCH MARK 1 Pn... IT ...II DESCRi BE II L uftNENT FEIN IL., NEFP ELEV CST HEI PI ELEV SE NE, Section 33, T29N—R19W, Town of Hudson,Lot#24, Countryside Vill. —T. NemiT Vlirnun vdbsw m c �.� s..un a-�.I v„m Richard Hopkins 1059 St. Croix 64846 SEPTIC TANK/HOLDING TANK' • i t tf 1 MPNJF«iVHFF �{I..J� IIGVIU C>A.IATv IAM1K IlaLt1 EL[V 14NY. nV ILFT ELkY WARNING LABEL LOCKING COV FH • PRDVIDED PROVIDED VES L-No -YES rNO eeocmc ,.EVT OIA � rE-n n.., .I r.A!ER °��"`�1' NUMBER OF ROAD rHnrurtr _ nE�-, 1 w= .L� evl, uiv-� vENr ro fR sx Alu Ip1EJ . --{ -I LLVES � _ FEET FROM � 1 ._NO _.YES ._.NO NEAREST % L ,. DOSING CHAMBER' MAIMJ'ACl.illlH BE;1111M1t. Ar:. ll. .. E.N:1)cl >H11V 111HI.N MnYV1 A. TC111 •. AANYIYG Lle II LOCKING COVEN PRU JIOEO VROVIDG _ L. VES 1�NO F�YES I_. NO —YES "NO - GALLONS PER CYCLE. P,nv .:.D;.:.YTN-Ls oPERA!lov:.E NUMBER OF '.Pnl•, .:i_. (DIFFERENCE BETWEEN FEET FROM '` H IVLEI PUMP ON AND OFF) _:YES I�NO NEAREST—). I )In•+.•rn AI1Hine Ael,.1<-.. v.:. SOILABSORPTION SYSTEM,Check thestill moistllreat the depth of plowing or excavatlun. (It soil can be rolled mto a wire, construction shall cease untd FORCE the soil Is dly enough to continue] MAIN CONVENTIONAL SYSTEM: BED /TRENCH P IP. DIMENSIONS 5 jl_ PIT JIPrn (.RAYFL DFVr� EILIIDfI'tH i l<r. . l I�r V Pi DISTR PIPE MATENIaI \rl ') 11 NUMBER OF VN7VE ry w[�l NIIILJINIa YEN( rU fpE$H flflTYPlv[5 ABII'.�ll)Y!N EILx1�ll lr \lr (!.D VIVfS LINF AIH INLET ` !! FEET FROM MOUND SYSTEM: , �s, Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope mound systems to make certain that It ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand TIONS MEASURED. C YES ENO ILCOVER 't rvnE -__ .:..,::..•.. .....I,,..: .:.,E.,,:_.— _YES ._NO C'VES 1LNO I:Irnl nvEo- 1111\IHxEL I:LVp.'PILN V-.tn.uxHll� Llrnl�n r.M1l yL — _ SCUnfn \frnf0 MOLcnFI: LI NTFN I'VIII'� _1VES ..NO __IVES [---'NO LVES LINO BED/TRENCH DIMENSIONS ELEVATION AP DISTRIBUTION INFORMATION Sketch System an Reverse Side. L\ Retain In county file for audit. 01 LHR SEC) 6710 IR. 01182) NO. �•CRovcCOUNTY _ 633393 STATE SANITARY PERMIT OWNER PLUMBE TOWN OF SECT N, AND/OR LOT 2 PREVIOUS NO. C.# 1MLIA—x"—VV OCK 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 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. (I) 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. U ZED ISSUING OFFICER -DATE %r /GV� PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)