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Home My WebLink About020-1305-00-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) 633386 state Plan ID No Personal information you provide may be used for secondary purposes IPnvacy Law, s 15 0411)(mll Permit Holder's Name City Village Township Parcel Tax No, David Saltness TOWN OF HUDSON 020-1305-00-000 CST BM Elev Insp. BM Elev BM Description !l Section/TownlRange/Map No TANK INFORMATION TANK SETBACK INFORMATION TANK TO P/L WELL BLDG Vent to Air Intake ROAD Septic I Dosing Aeration Holding PUMPISIPHON INFORMATION Manufacturer GPM Model umber I TDH L Fnc on Loss System ead TDH Ft Forcenri Lengt Dia. Dist to SOIL ABSORPTION SYSTEM DATA STATION BS HI FS ELEV Benchmark 'p7- Alt BM 1 Sf I .SZ I �• St/Ht Inlet SUHt Outlet !� 7 Inlet Dt BQ4Ly Header/Man 6.� Dist Pipe 7 T. 7.35 4S.e Bat System To 7 _, Final Grade St Cover 98' • j P BED/TRENCH Width n� Length _ �t No Of Trenches PIT DIMENSIONS No Of Pas DIMENSIONS 5✓j Iifr' IB] DISTRIBUTION 1 2 CHAMBER OR 7 SD UNIT Header�Mamfold Distribution x Hole Size x Hole Spacing Vent to Air Intake Lengtn$ Dia Length Dia Spacing J V IL 1. V V CK s PrA.111r. Svctnmc nnly — M..—el nir er-r—A- Depth Over Berl Center Iy /I'' / 1 l �� i� Depth Over Bed/Trench Edges 1 t xx D pth of Tops I xx Seeded6odded I Yes '— No ra Mulched �� Yes No COMMENTS: (Include code discrepencies, persons present. etc ) Inspection #1. Inspection #2 Location: 1076 BUCK RIDGE -- jn_ I _ 1) Alt BM Description = 6#,A �41rL0✓<J v{l+t/�7 1 ` 'S Y v l• 2.) Bldg sewer length - amount of cover Plan other Regwredv Yes n d � i Use other side for additional information _ __ _ SBD-6710 (R 3197) Date ores Cert No ��o\ * fiW',)(a(-167 1400 E Washington Ave Saaday Pemtr(to il Nambbe Win by Co.) P.O. WI 537W Madi7162 eat & 333 Flp x�ppA ermit Application m aomtdavx w th srs Aaa cede to bt®m dths f® m the ml nit �— s regoecd Poor m a saadary P®iL Naga AP4fie+® kzm for am submitted to toe DTwtmm of Sd*y ad Prokm d Serves Pesmal ot®fim ym poside may be used forsesmday Proja t Ad&= Cif GIN thn maling addrxw) ` ?,Lh E f. Property0aav'a NNW h S �nK sl �►�s i( Plods Qaa- l3o s�c�b 0 0 Prapaty Owads Mad* Add�e Q � j 6 \A Ptapexylamrm ice) ya SaetimL 9VT�s7 �• Zip #odc �`N��Xr.14 „ �V UN W 1 c I, " " T�_It R��E*"w .. EL Type ofBdWmg (tdtak aN &d apply) Lot Tr I m2 Family Dwdhng-Nora of Bedrooms S16dvitimNaate 1 }� uNe KjQ S c )b� p��tlW Blacks ❑ Pu6tio(.aoaaaaat - Desctrbe Use ❑ Chyof ❑State O.Ad-Desrstbe Use ❑Vmwof CSM Number ❑ Toam of tAb1 n a UL Type of PtraiC (Credkaall box o Noe A. Cammtlete Erse R Rappliork) A" ❑Nm Sym= syse— ❑T-4cmit Tact RAdi—cat Ody ❑omv11[adddotim bFaYeg Systrm(espleer) IL ❑P®itReraantl ❑P®RRcRtim ❑(humCofPhtmber ❑Pcomi6Tnadab New List Fori s Pl=t Numhermi Daac Esod Before FiPmem Owner 2-33 `¢o S s/! ! 94S IV- 7 Of POWs$ CbOCk au fret almPlyl ulr-ra®L-Caoaod ❑P❑At-0Me ❑Momd>244datahiesol 11M®d<24 o. dommahie aul ❑ linllimg Tea [loom Dep®1 CmOoteat ( ; V. teaddt Analdarras�ac �' `'4 [+ �J 4 (W) D� � Ali°` - Dial AA!m Rid M �►Am 1¢i �• a I l VL Tut Lade Cgmc ty io TOW 9 d MaooGrJroclV fa1Rm9 COII06T t�8 1 CAN1Syl1-�bNk,'� O ' � C tg s s o 'p _3 tx.r� i3el�raa� C4N111f12 W)71t�v� Lt, � SeaCeaBo-6 Twk — I oka W)t ur D siaq Cbmba VILReVOWRAN►SbAMCUt- asthe atedmidpsaa Pan' e '1�3% Pkw46A Pbaia's Adam (SaaR an: Suo ,Tip Cade) , U� IU w N u sulr W S' Von I use 0043 Apposed Ate ❑ Rnsm Heald = SZa� ZoL! SYSTEM OWN 3) r 1. Septic tank, effluent filter and - O-P n_ O Ors "' �� dispersal cell must b»�cRd I maintained µme` � gCOtle" d,bL6t.t�CO` C.O� as per management plan provided by plumber. t�r� be 2. All setback requirements must maintained S Kx $ tH0.14e-I�/tC2s1tp,Xt Ct) as Per OW"I'v:c ..v..c ,�. yapL (�, taeay�aaat aai�ab waHrat`aiax 11 laAtarattls ��,, rr -Plo-� MAP I IA M-e.: D pv t o st i t, S5 LOCK 1ION : Lot 13 sysfi-gym l✓I�Y = ga.so CaN�J�-tn wa�� R`la�� S�eC,lbl �dd (ICppY NN �m poumt{s-6, UIC_hiPR5 aaa9at Kam- - Top 0� wb)�04 pour. lev: 10b,33 > 1E �,�CppY i�j tia'raTL+.d58m V88az ahwi ft Iy -�hQ-. WSO V aftd Eiw- wjo.tea WE- Y ecwd eftd Za`d ia53,4 qoo-4o-SQ� All %V,*N N , (%113 0 'kS. �AJv Nil �Loi jsau�ws a N(IG a5va -ZLt CAR/ u.mmia� NIDi93CI -(N3Wi C0n IVNO N3AW O -pict RAP Nia m-e : TJpv'iv Sp f tmess LOCF(fl0. �pNNR Lot 13 I)SO RAll - S��b1 na. 3,1M voumtesk CICAPRS aaa90y ,u �ervc�nm� = TOP o� W)AI OMj DoUK nos u d �Iev = 10b.33 3 awe\\ , ; �'lb ft } (`%cvaBt PiPl VeM Or Oase'�mr n Pipe 4aso� I cr, b_ is n2� rdY3e7 aac� A@��tjfhEde, -ft drbal"09water'supply_ ViiLt2iri a:eyntar candy aoa.t_ _ _ Paaa — of � _. -- aLYWAM , Cbrinpecoon orsaow, overtbe dispersal unit may cau5c it to fi=zc tip. INSPECTIONS & NLADMENANCE: Inspection shall be made by an individual carrying one of the following licenses or uertilications. Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, or Septage Servicing Operator (per the attached cche—w- l_ Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, Wenah nun grits or rears, measure the volume of combined sludge and scam and check farm backup or ponding of eRlaeat to the ground surfim and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater thmm g inches in diameter shall be seated with effective locking devices to prevent accidental or n®rnhariad carry the tanks. When the combination of sludge and sane in any tank exceeds one-third (1/3) or nonce of the tank vohurne, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Ch_ NR 113, Wisconsin Admix Code. Specific servicing mechanics must be provided if vertical is >15 feud or if horimatal is >M feet and instructions to be provided below. The outlet filter(s) shall be inspected and cleaned to removeany accumulated solids according to maaubacunees specifications Solids washed from the filter shall be retained in the tank Fiber cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service P OWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corMnd to prevent back -op of sewage into the dwelling or surfacing. ABANDONMENT: Wben the POINTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is Frnpedy and safely abandoned in compliance with Ch. SPS 39333. Wisconsin Admen. Code: • All piping to tanla and pier shall be disconnected and the abandoned pipe openings sealed • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or then covers removed and the void space filled with soil, gavel, or other inert solid material. CONTINGENCY PLAN: If the POINTS fails and cannot be repaired the following menvn.c have been, or mug be taken, to provide a code compliant replacement system: A suitable reparea has been evaluated and may be utilized for the location of a replacement sot I absorption system_ The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, la lanes and wells. Failure to protect the replacement area readers it unusable. Replacement systems mast fly with the roles in effect at the time of replacement ❑ A suitable replacement area is not available due to setback and/or soil limitations. Suring advances in POINTS technology a holding tank may be installed as a last resort to replace the failed POINTS. ❑ The site has not been evaluated to identify a suitable replacement area Upon failure of the POINTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the fatted POINTS. 0 Mound and at -grade soil absmption systems may be teconsitncted in place following removal of the brat at the infiltrative surface. Reconstructions ofsuch systems must comply with the rules ineffectat that time. WAR?W*r=! SEPTIC, PUMP, AND MUM TREATMENT TANKS MAY CONTIAN LETBAL GASSES ANDOOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP, OR OTD.ER TREATMENT TANK UNDER ANY CIRCUMSTANCES, DEATH MAYRESULT. RESCUE OFAPERSON FROM THEUNTERIOR OFATANKMAYBEDIMCULT OR 114P06SUILE. POINTS INSTALLER POINTS MAINTAINER Name: d [�Phitne-=_ Phone SEPTAGE SZRVKMfG OrIWATOR Name: P Q V- Phone: J it U del LOCAL REGULATORY AUTHORITY Name: (t066 N) IV Pbo=-.' Page _ of POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FUX INFORMATION ounce Pv 7 a NHS f Permit # DESIGN PARakfE1ERS Number of Bedrooms (100 gpolbedromn Number ofC mmcacW Units Estimated flow (average) 30IJ galtday Design flow (DWF) = estimated x 1.5 0gal/day Soil Application Rate day(f? InfluenUEtBuett Quality (Q NA) MosithlyAverage Fats. Oil & Grease (FOG) 5 30 mg/L Biechcrucal Oxygen Dui (BODs) - 220 mg/i Total Sum Solids (1SS) S 150 mglL Pretreated Effluent Quality (Cl NA) Monthly Average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (M) <_30mgjL Feral Coliform (geometric mesa) < 10 cfu/100ml, Matdmum Effluent Particle Size 1/8 inch diameter SYSTEM SPECIFICATIONS Septic Tank Capacity 0 c O gal El N Septic TankManubcturer ( K ON Effluent: Filter Man�actu er e (3 N Efi']uent FilteaMadel O N PUMPT1111kcapa"tYN Pump Tank Manufacturer N PManufacturer Pump PumpModel NA Pretreatment Unit (13 NA) 13 Sand/Gravel Filter Q PeatFilter O Mechanical Aeration O Wetland i3 Disinfection 13 Other. Manufacturer:_ ModeL Soil Absorption Component (rI NA) Ill ln-ground (gravity) ❑ (pressuozcd) Cl At -grade CI Mound Q Drip -lien (1 Other. Verticali3istaaceTankBotto®toServicePad: R I�orizontatDisfanceTaWs)toServWAPad: It Dispersal Unk MfglModel Number: ei NA Caleudatw= Soil Dispersal End Cap (Dispersal Unit EISA) DWF _ Application Rate = Area Required - F1SA = or (Trench Width) _ # Units or Total Lrncdt of Tttaoh(s) `fib L.4 3 � = D b - 3__kLl = L � - 3x ( 4) D "D=ga of Pressure Distribution Networks for Septic Tank-Sor7 Absorption Systems" Publication 9.6 (SSWMP Mamml) O "ICC Flowtech Mound Component Manual' Version 1-2 O "tZ Flow Mound Component Manual" Version M(V2007 O SBD-10954-P(ltUt2) "At -Dade Component Mamral UsingPressure Distribution" Version 2.0 13 SBD-10705-P (KOI/01) "In Ground Soil Absorption CompottntManuual- Vetsonzo O SOD -1069I-P (N.OI/Ol) "Mound Component Manual" Version 2-0 Cl SBD - 10657-P (It-6/99) "Ih'ip-line Effluent Disposal Component Manual- 13 SBD-10706-P (N.01101) -Pressure Distribution Component Manual" Version 20 O other R(wiNTi'Nw 1JP`L` alAxr'r'AQrahC: Cf`itTi rlrir.r% _ MAIN-FRNANC`F. AND MANAGEMENT Service Frequency- s dew lilts i At least owe 13 months O 3 years O Oche: de mnttds, alarm.luetraOtmat ®it I At least once _ 13 months 17 3 yews O NA Flush and press= test laterals At ieaat once ev . O mouths 03years ❑ NA START UP AND OPEPATION: For new construction, prior to using the POWTS check treatment tank(s) for the presence of pambug products or othtc ebe®cals that may impede the treatneat process andlor damage the dispersal cell(a)_ If high concentrations are ducted have the contems of the ranks) removed by a septage see icmmg operator prior to use. System AartupshaRaetoccsQ wbea sal eat ate fr>$es at the mlShative s dace. The property owner is responsible for the operation and maintenance of the POWTS and submission of tegrmed repom the quantity and quality of the wastewater steam wi0 aiiee t the performance and longevity of your POWTS. The urstallatim of water -saving appliances and fixtures along with Prompt repair of leaf induces the wastewater volume. Also the firm or waste from water softeners, irm removal wits, other clear water treatment devices and foundation drams should be discharged to the ground surface whenever possible. Nat= this does not include laundry waste, mowers, dishwater, eau. This system is designed to handle domestic strength wastewater however the disposal of food based greases, oils, vegetable/fruit peels, seeds, bones, and food solids, such as those produced by a garbage disposal shouklbeminimi>pd Toilet tissue is the Only paper that should be discharged into the system Other notOmdegradable items, such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and carton swabs, should out ewer tic system_ Chemicals, such as petroleum pmducres, palm, dmuftc.'tanM pesticides, anubickcs, sohvents, etc., shooldnot be flushed into the system bmamthey can seriously damage your POWTS amp c ontammatevour ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I- have inspected the septic tank presently se ing the Du�(Y% Shl� NPS residence located at: SE W, N� tix %, Sec_ T; 7 N, RA_W,Town of (ip3 St_ County, Wisconsin. Upon inspection, I certify that I have found the tannd baffles to be in good cond*tipn. and it appears to be functioning prope ly. Last time serviced ��TTIIIIII Ila Did flow back occur from absorption system? Yes No_j (if no, skip line_ Approximate volume or length of time: gallons Capacity: Construction: P fab Concrete Steel Manufacturer (if nown): Wig L Age of Tank (if known): n. �a k (Signat ) (Name) Please F (Title) (License Number) (Date) 1 Other )+�bt# int minutes Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) licensed disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank conditic certify that the tank, to the best of my knowledge, will conform to requirements of ILHR 83, Wis. Adm_ Code 7(t for inspection opening outlet baffle`). Name ��j m �5DUmlj1bA(, Signature MPJMPRS aaa9 0y or I es Im Vi OW gig m M r WisconsinDeper6rrerdofSafety and PrOlesswralServloes page 1of _ Dnvsiahof industry Senvices SOIL EVALUATION REPORT In accordance with SPS 385, Wls. Adm, Code Attach complete Site plan on SL Croix paper not leas 61arh 8 1/2 x 11 inches in sae. Plan must khdnda, but not united to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D- scale or dimensions, north arrow, and location and distance to nearest mad. 020-1305-00-000 14 Please print all inforrrna6on. Reviewed by I ate Personal Information you PvAde may be used fa' Low, & 15. t m . Pn>�rtY Owrher Property Location Davd SaWtess Got. Lot SE % NE Y. S 11 T 29 N R 19 E (or) W Properly Owner's Mailing Address Lot # -.— Block # Subd. Name or CSp 1076 Buck Ridge 1 13 1 Na I Term" RKW Special Addition Cty State Zip Code Phone Number ❑ Cty ❑ Vrtage ®Town - - Special Nearest Road ❑New Construction Use. ❑Resideratat/Ntnhberofbacrooms 3 Code derived design flow rAq!M GPD ® Replacement - ❑ Public or commercial — Describe: _ Parent Mdedd Glacial Out wash Flood Plan elevation If applicable 01L . General comments and necoirnmendatiors: Site suitable for In -ground POWfS with 0.7 fipdfsqm design flog rate. Sydern efirrative surface wation to maintain gravity flow -- 92.50'. instalation of a Pump chamber and shallower dispersal cat should be corsklered to facilitate a shallower system ir Nation. Boning # ❑ Boring �' Pit Ground surface elev. 97.95 R Depth to finbrng factor i 6" an. Horizon Depth _ In. Dominant Colo Mursatl R�ior Description Qu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consislenoe Boundary Roots sw -yPlYW +rate 1 0-9 t0yr3l2 nos sit fill 21gr mvfr aw 2vffin 0.0 0.0 2 9-18 10yr4/4 none silk fe tfebk/Oag ... f1h.I cxv 1vffm 0.0 0.0 3 18 86 10yr5/4 nortrte grs Osg nil cS - 0.7 1.6 4 66-116 10yr6)4 rune grs Osg dl - 0.7 1.6 I Boring # ❑ Boring ® Pt Ground surface elev. 100.08 fit Depth to uniting fordo > 31" M. Horizon Depth In. Dominant Color Munsoll Redox Desaiptbn Qu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roos sot Gi n Rate PD/F12 -il#1 -011112 1 415 10yh3/3 none sit 21gr nrAr act 2vf,1m GA 0.8 2 15-22 10yr4/4 nos sl lmsbk mvh aw lvf,fm 0.4 0.7 3 22-29 10yr4/4 none Is Mg nil ON lvf 0.7 1.6 4 29-M 10yr&4- none grs 099 rM cs - 0.7 1 1.6 5 68-131 10yr6/4 - none grs ()Sg nit 0.7 1 1.6 CST Nam (Phase Print) ,,,VrIxK-OVY �.IYa LLV L81q IAJ>dUS 10U DST Number 'lei K. Thompson 30021 Address Date Evaluation Cond Telephone Number 340 Paulson Lake Lam Oscola-WI 5402Q5413 April 22 2(121 1 248.7767 JW3tlP30 {Fi04/15) UBorings ❑ Boring ® Pit Ground surface elev. es.62 it Depth to Writing factor > 121 in. Horizon • Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consisteme Boundary Roots V,... (JPD1W W 'Ef191; -Efin 1 0-19 10yr2/1 none all 21gr Mir cw 2vff 0.6 0.8 2 19-24 10yw none sl 1malik mrr oar 2vff 0.4 0.7 3 2434 10yrW4 none Is OSg ml ON - 0.7 1.8 4 34-65 10yr416 none grs 059 ml gs 0.7 1.6 5 65-121 10yr8/4 none gr a On nd - - 0.7 1.6 ❑ erg ❑ Boring ❑ Pit Ground surface elev. _ R Depth to lira ftrg factor In. Fs;i—Apsikafion Rate Horizon Depth Dominant Color Redox Description Texture Structure nsi Costence Boundary Roots In. Munsell Qu. Az. Cont Color Gr. Sz Sh. ❑ Boring S ❑ Bwng ❑ Pit Ground surface alev. _ fL Depth to IaT7 factor .. m — - Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Gr. Sr Sh. Consistence Boundary Roots• 'EtfEt' ,EII i ' Efllmrpnt S1 = BOD, > 305 220 nWL and TSS > 30 s 150 mgrL • Effluent #2 = BOD, > 30 s 220 mg/L and TSS > 30 9 150 ng/L • S.Yerd,,.�,, . L�✓;d ass �yC � �rsafrcd ASP. PeNtL gra✓ti r ad"skry / \„ ��Nil eemer � pa6a E'kK� 9Rls,' ! i l goer - __� - _ ��»te.�'Sy"S�i►.i i�sa(o1�i�ie+ ST. CR VJ""NTY SANITARY SYSTEM F' �h, OWNERSHIP/ADDRESS FORM �z�t 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. OWNER/BUYER INFORMATION Owner/Buyer Mailing Addre City/State/Zip Phone Number (required) q I J - - 3 63 O Email Address (required)Dw s 01�r cg 5 Q 9 M))i Parcel Identification Number (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location5t 1/4 ,1J 1/4 ,Sec.1 1, T 11 N R l W, Town of P L4 D3 Z 4 Subdivision Plat KNG.1 Vlk% I�Olpl p Lot # Certified Survey Map # Volume Page # WanantyU", vD S1a l 9 Deedd # � 2. (before 2006)Volume .Page # Number of bedrooms 7_ Spec house 0 yes 15 no Lot lines identifiable Byes 0 no New Property Address (Staff Initials) OFFICE USE ONLY 504,41 e liw S 4-� (Verification of new add required from L6MML (Date) Development Depammem 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 cdd0sccwi.aov 1101 Carmichael Road, Hudson, WI 54016 wwwsccwi.aov ACTION II ........� S-1N89 25'46'E 340.00' —' 2d LEGEN( 341.65' 68 00 Q UNINU FOUND FOUND • I" IRON O I// QO ° PER LINE LOT 11 LOT 12 ��h NOTE V AC. N co2.51 —12' WIDE //J / y 2.53 AC. 3 109,52=SO.FT Q 110,286 SOFT. �ry ................. 50' RDA PONDING ELEVATIC LOT 3 3 C.S.1/l . IQ `low \ 8 PG.283- U) I84, 613 60. FT. u � ; 1 _ ' EXISTING \• 66 °a`�o DEDi D '7 ore W TANNEY- ° rHE 3 " ee-� 6 \� 5 21 LANE- we IC \ .� '•.� — S>8^l2•OO.,E 330.4r�` zz \\��\ �J $ o J *48'00 0•W LOT 14 O^J 2.85 AC. a 123,933 SO.FT. i PLAT LOCATI a � LOT15 v J' SECTION C I I T29N, R19W 2.95 AC. O >'E 128,376 SOFT. .y� I WNEIA 1 / NI/4 — \ —I 1 I I M� 903 awry � \\ 5 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER SAP) 171 /6LFcL_ ADDRESS_/30K #zgz #aDSOIV SUBDIVISION / CSM#'r,4N WFV 'Z/D&E LOT # 13 SECTION I Z T Z`( N-R (y Town of fFJDSo1J ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N -M, -r0P pt I„ IoT P/P4 AT NW ceRNE•2 E/= /vO,vv Sc?GE %yi'=/o WVE wAy WELL -� 17.�, , Noon£ INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form_ Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: lot' aF I" T/-PL AT NU) Col-CaRAWA— yo-f ALTERNATE BM: 7-OP ap L400,$.F ruuND*Al 161N EPTIC T / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: OjE�tSFI- Liquid Capacity: (oUU 6AL.. Setback from: Well '88� House 16 Other I7' fo JE [oeNE2 1400Sf Pump: Manufacturer Float seperatio Alarm Width: S Model# Gallons/cycle: SOIL ABSORPTION SYSTEM Size i Length (o D Number of trenches 2_ Distance & Direction to nearest prop. line:_ �/S To Ells/ Lo% Ll rr Setback from: well: /30 House44 7_Other 7z' 7'0 57-- ELEVATIONS NI A Nhgo6E 7.3 5/ ; 9`.7/ Building Sewer ST Inlet. 9-3L-9y 3 ST outlet9,8'8 =9`117 PC inlet — PC bottom -- Pump Off — af Header/Manifold /Z•38 Bottom of system /3-71- Z=/yob , Existing Grade /O,06 Final grade 0 "96 DATE OF INSTALLATION: PLUMBER ON JOB:j LICENSE NUMBER: /�f-Q3r'D INSPECTOR: 3/93:jt Wrswnsin Department of Industry, Labor and Human Relations Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) PgrrryiiHo)S is Nag;- E. ❑ City 0 village R Town of: CS11�tT11118MLLELLIeEvR: JA[1 Insp. BM Elev.: BM Description:udann $ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing — Aeration Holding TANK SETBACK INFORMATION TANKTO P/L -WELL BLDG. Ventto Air Intake ROAD Septic >�J 77 5�' �/� NA Dosing NA Aeration Holding PUMP / SIPHON INFORMATION Many Dema M del Number GP TDH Lift Fr' on S stem TDH Ft Head Forcem Length Dia. Dist Towel SOIL ABSORPTION SYSTEM ELEVATION DATA OCounty Nr ST. CROIX Sanitary Permit No State Plan o Parcel Tax No.: STATION BS HI FS ELEV. Benchmark 0 14 (t ), ,/%, JG Bldg. Sewer eo t�r St//If Inlet 9,91 , yyr St/ F,KOutlet G99271 Dt Inlet / Dt Bottom Headers �� /,/ ' Dist. Pipe r3.s o" 38 943 .G9� Bot. System Final Grade /a7 .�� n. �Ou<i y / 1 • // 6,7a 1 BEDITRENCH Width Length I No. Of Trenches PIT No Of Pits Inside d Depth DIMENSIONS DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHI W Manufacturer: INFORMATION CH400BER eR UNIT TypeO �_,7A - 64+ i 47 >Iev Model Number: System: /1 ,+- DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) . „ z x Hole Sae x Hole Spacing ntake Length Dia Length � Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade S s Only Depth Over 1 Depth Over , xx Depth Of xx Seeded/So xx Mulched '/ Eli/Trench Center 35�-7`-� ,/ Bpi./Trench Edges �y Topsoil ❑ Yes ❑ No ❑Yes No COMMENTS: (Include code discrepancies, persons present, etc.) L/O�CATION: HudQson./12�./29.-/19W, SW, NW, Lot 13, Buck Ridge_Aoad n /Cie" -, 'T �OkC/9�.,-•>/Ca1 (ti-%.-C'✓3'iGJ�� jr,��rai�<��, Plan revision required? ❑Yes [q No Use other side for additional information SBD-6710 (R 05y91) Date Inspector's Signat re Cent No 2',/ SAM MILLEvL /OiG BUCL RID(.E TANNy R I OGE GoT#/3 • &M. Tod of /' /toffy oNWE4T "T- 4///E hT col-pE-ygc m�N Ff. n iou.00' Sy,TeM 1:1 "/=9s.ov '+z g0.0o '11 LoT i S v zY Ne- D 'P Le ell / RoN 110 cz Z may, , � \ rA.M, c4-N oNwE T[OTUNE �J\ AT Cc(pE-�A� E/.= /00.00' Cot -DE- SNc $cJc.IG 0,1066 F4L 98.5I' Wisconsin Department of Safety and Professwnal Services ' Division of Industry Services i'� SOIL EVALUATION REPORT r�Y Q 4 ZQ21 In accordance with SPS 385, Wis Adm Code Attach complete site plan o4� er not less than 8 112 x 11 inches in size Plan must mck de, but not limited to vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions. north arrow, and location and distence to nearest road Please print all information. l/0 Page 1 of 3 County St Croix Parcel I D 020-1305-00-000 Ref#2614 Reyiewed by pate , Personal irltormation you provide may be used for secondary purposes Pnva Law, s. 15. 1 m ' " 60A Property Owner Property Location ❑ David Saltness Govt Lot SE Y. NE %. S 11 T 29 N R 19 E (or) W Property Owner's Mailing Address Lot # I Block # I Subd Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Hudson I VIA 1 54016 1 (71 51 386-3038 I I Hudsnn I Tnnnev Ridge ❑ New Construction Use ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ® Replacement ❑ Public or commercial — Describe. Parent material Glacial Outwash Flood Plan elevation if applicable na ft- General comments and recommendations Site suitable for In -ground POWTS with 0 7 gpd/sq/ft design loading rate System infiltrative surface elevation to maintain gravity flow = 92.50' Instalation of a pump chamber and shallower dispersal cell should be considered to facilitate a shalloweJ�ystem iry L�tlallation j� Boring # ❑ Boring ® Pa Ground surface elev. 97 96 ft Depth to limrting factor> 116" in Soil Application Rate r-- Horizon Depth In Dominant Color Munsell Redox Description Qu Az. Cont Color Texture Structure Gr Sz. Sh Consistence Boundary Roots GPD/Ft' •Eff#1 'Eff#2 1 0-9 1 Oyr3/2 none sit fill 2fgr mvfr aw 2vf,fm 0.0 00 2 9-18 10yr4/4 none sills fill 1fsbk/Osg mfr/ml cw tvf,fm 0.0 00 3 4 18-66 66-116 10yr5/4 10yr6/4 none none gr s gr s Osg Osg ml dill cs - - - 07 07 1.6 1 6 r-- — I I nnrv�— I I I 2❑ Boring # Boring ® Prt Ground surface elev. 100 08 If Depth to limiting factor >131" in cna A-1-1 n Pnf- Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az Cont Color Texture Structure Gr Sz Sh Consistence Boundary Roots GPD/ 'Eff#1 'Eff 11 1 0-15 10yr3/3 none sil 2fgr mvfr cs 2vf,fm 0.6 0 8 2 15-22 10yr4/4 none sl lmsbk mvfr Cw 1vf,fm 04 0.7 3 22-29 10yr4/4 none Is Osg ml Cw 1vf 0.7 1.6 4 29-68 10yr5/4 none gr s Osg ml cs - 0.7 1 6 5 68-131 10yr6/4 none gr s Osg ml - - 0.7 1.6 r— �I - tmueni si = BUD, > JU s zzu /L a d I bb > W <_ 15 YZ /L muent #2 = BOD, > 30 5 220 /L and TSS > 30 5150 m CST Name (Please Print) gna re CST Number James K Thompson s 30021 Address Date Evaluation Conductet Telephone Number 340 Paulson Lake Lane. Osceola. WI 54020-5413 Annl 22 2021 r7151 248-7767 3 Boring # El Boring ®Pd Ground surface elev 98 82 ft Depth to limiting factor > 121 In I Soil Annlratinn Rate Horizon Depth In Dominant Color Munsell Redox Description Qu. Az Cont Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPD/Ft' *Eff#1 *Eff#2 1 0-19 10y2/1 none sit 2fgr mvfr rw 2vf,f 0.6 0.8 2 19-24 1 Oyr3/3 none sl I msbk mfr av 2vf,f 04 07 3 24-34 1Oyr5/4 none Is Osg ml tw - 0.7 1.6 4 3465 1 Oyr4/6 none gr s Osg ml gs - 07 1.6 5 65-121 10yr6/4 none gr s Osg ml - - 07 1.6 i IF7 Boring # I � /' ❑ Boring ❑ Pit Ground surface elev ft Depth to limiting factor �n Sal Aol ohcatlon Rate�� Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPD/Ft' *Efl#1 *Eff#2 r-- I Boring # ❑ Boring .� ❑ Pit Ground surface elev. _ ft Depth to limiting factor in Snd Annliratinn Rafe Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az Cont Color Texture Structure Gr. Sz. Sh Consistence Boundary Roots GPD/Ft' *E1f#1 *Eff#2 I i Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L * Effluent #2 = BOO, > 30 5 220 mg/L and TSS > 305 150 ❑g/L d'yiss4/Cc!/. g /'a ✓e./ c�N✓ew 6' be c• ntc.C-cd b0-- t4 elv:lkni 36e014-CO • Assewe / Ss✓ e✓a/aa,/tcn�t ♦ E,1!isk7 yr,we eta : 'Pest w`�4iY ,c6v, l /0764kce'j�e. /_ot/cf �fTawihyy��c � �� i/ YD/lkdsA� 36.em;x co, cJ/, eOeJ. o`o1e-��S-�-cm s �/e. eernereF�vnc/ a Ekv.. 99.9Z,' �PgFcac4ta47-d�.ev / ..3W3 � W&Ceote4' Svd't+m+ ,p�.QOa caurvm NO, 633386 STATE SANITARY PERMIT OWNER I& 5*=Tuess PLUMBER)10. C OIIM E6 TOWN OF * SEC_ It 2 N, R AND/OR LOT I Z PREVIO ac.# 2Z2o+ BLOCK, �COO.�u SUBDIVISION NO. z3340r ENE is MAPTER 145.135 ) 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 willbe based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. ffistory: 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. A ZED ISSUING OFFICER - DATE Y V(�44Cy j MW PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)