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020-1180-20-000 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Budding Division 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 Holdefs Name City Village Township Kim Pilarski I TOWN OF HUDSON CST BM EIe�O • O Insp BM (19i9.Elev , BM Description I C -roe*F S.T, 04SA . TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 2 lg Selz 2.D Aera ' ` Lap ✓> Hol TANK SETBACK INFORMATION PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift ion Loss System Head H Ft Forcemaln Length Dist to Well SOIL APSORPTION SYSTEM TION DATA STATION BS HI FS ELEV. Benchmark S.(o oS� t If c0 A Alt. BM Bldg. Sewer SNHt Inlet ` r Si Outlet Dt Inlet Dt Bottom Header/Man, (. _ Dist Pipe `•D Bot System 3t 6 r Final Grade g ♦ N �\ TJif St ever # z 6 •►'D g . 2 \w1 . l5 p Si Z 04V Otf M2$ 4s;3�r REN Width I Length Of Trenches PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth DI NS 9A e- INt SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufac urer INFORMATION CHAMBER OR UNIT T e Of Syste 31 I b , / Model Ne4r O DISTRIBUTION SYSTEM HeaderlManifpld 1 Lengt Dia N Distribution R Length Dia Spacing x Hole Size Ix Hole Spacing Vent to An Intake SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedr-rench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No (,.� Yes ❑ Nc COMMENTS: (Include code discrepancies, persons present, etc) Inspection #1. // /toZ 1 Inspection #2 — — Location: 770 LARSEN LN ��xr 1.)Alt BM Descnptlon =� 2- W A-& `0.-Ga'V- 2.) Bldg sewer length = �1 1 -amount of cover = \ Apnt, 66 to COVE _� �o A p kIl __.1/ J Plan revision Requlredv ❑ Yes /�1��/ty, No 4xAe othejf,side for add}n�lonal informs 1[ On. � WCt� ��we t \N to?�,cePc_t'orfs 5ignalu o� R��� � Cen No i Industry Services Division Sl CRIIX _ $ - 6 'Z021 �. 1400 E Washington Ave Number be filled PS PUG P O Box 716SurfeSurfersPermit (to in by Co 1 Madison,3707-7162 vJJ� CrotxCOun<Ym out �° ry Permit App catiOLfLa0, Stele Tr sactionNnnhber In accordance with S S ?H3 21(2). W is Adm. Code, submission of ihr tom, to Oic appm I unit 1 is required prior to obtaining a sontmn permit 'vole Application forms for smteawned POWTS are so m led to the Department of S&RIN and Professional Services Personal ulfunnatam you provide may be used for,scocndary +rojeet Address oddifferem than trading address) puilicees in accordance with the Privacy Law, s L 04 I1(m). Suits 770 Larsen Lanc I. Application Information- Please Print All Information Property Owner s Name ptr ccl p / ✓ Kim Pilarski 020-1180-20-F100 Properiv Owner s Mating Address PmpenN Locate 770 Larsen Lane p il Z I, R �� 3'Z C� 1 1 J Gorr. Lot SW 'A NE'/., Section 28 City, State Zip Code i Phone Number 1ludsnn, WI 54016 circle one] T29N R19Eorr [I. Type of Building (check all that apply) � Lolu ® I or family Dwelling - 'xiimher nl Bednxtms j 31 Subdivision Name ❑ Public/Commercial Descnbc Use _ _ C'cdar Hills ills Estates 11 Blua.k K ❑ Crn of ❑ Village ❑ State Owned - Descnhe Lse CSblNumber n zo 1, or ® Townof Hudson I11. Typeof Permit: Check on one bo on line A. Coro fete line B if applicable) A ❑ New Svstem ® Replace it System ❑ Treatment/Holding 1 ank Replacement Only ❑ Other Modirication to Existing System (explain) B. ❑ Perot Renewal ❑ Permit Revision ❑ Chan ge nl ❑Perron Tmnsler to New 1 in PTC1'111115 Pennd Number � d D e Issued Before Expiration Plumber Owner (�t,i it VU U/ fiD IV. Tv e of POWTS S\stern/Corn onenvDevlce: Check all that a Iv 'von-Pressurned In -Ground Pressur¢cd in-oround ❑ At-0,adc ❑ Mound > 24 in of suitable sod ❑ Mound <24 in of suitable sin[ Lj Holding 1 ark Other Dispersal Component (explain) ❑ Pretreatment Desice (explain) 1 V. Dis ersal/Treatmen rea Information: Design Flow (gpd) Design S,ul Application Dispersal Area Req d (st) I Dispersal Area sell is 0 Svstem Elevation 450 Rale(gpds0 900 9W 9J 60' 05 VA. rank Info Capacity Oullon (inllons )ylok o( lolal A of Manufacturer ' A `o 0 9 t5 New IanAa Granny iairka Gallons Units v _ Septic or Holding Tank 320 1000 1120 2 Reeks. Wieser Concrete ®� ❑ ❑ ❑ ❑ Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume resprmsihilit_v four installation of the POWTS shown on the attached plans Plumber s Name (Print) Plumbcr, I Si arc R1P/61PRb Number Business Phone .Number John Schmitt ! l l j/Cis 223760 715-7604986 ['lumber's Address (Street. CIIN, Stale, Zip Code) 586 Valley View Irail. Somerset- WI 54025 Count /De artment Use Only Approved I ❑ Disapproved Perm Tee 1) tte s ed Issuing Agent Signature ❑ Owner6nen Reason Cot Oemnl S 0c:> rsj f ` { CA IX. Cpn{ii rov I/Reasons for Dise royal / pp u,n {- If'L15T PYOVI 5 ;. '��(nar and lop d:."if jIrtg iftit t l� ) ld llfort�l.keagnenlPonp(oidedbyelnlvem p lwr L-pBltu M4- L"- !'t]r11("c) A . COde/WAnMKYa. .Qy L l.fiq)c . 1. Attach to mmple,e nlam four the system and sunryry i is the f'iw�`n�tr� lv, rn page, art Iesa than fl iQ I I ni hea i cue SBD-6398 (R03/14) c e a SYSTEM PLOT PLAN Pilarski 3 Bedroom Replacement POWTS Pm)ea Address. 720 Leven Lane BMt Symbol Ak BM FJerallon. 100.00' BMDeschpinn. Top al lnapecdon pipe or acr-rig sapec lank 71142 Symbol A BM Blevebcm 95.70' BMDeicnplon Existing septic lank oabet Slaps Grediem of Tested Area (2W) Well Symbol (d applicable) Design. Flow' 45C GPO Attach design Ibw calculations fc, commercial plena Pipe Malenals / ASTM Standard Tables 384.W 3 6 3M 30-5 4"SCH4UFVCp:ps ASTM-D2Be5 4-3 P pl, I ASTM-OWU Exteting Wall P,,Pefly Lim Ewsbng 3 Bedro Garage Existing 1000 Sill Tank Proposed W320-MR Septic Tank wl Polylok 525 \ �� \\ Dnwway \ � � ■86 \ \ ` \ Existing 1B'x3B' 92 Rock 8 Pipe bed \ . 81 \ \ �i 83�^ T1- 3k90' EZ Flow Trench El =93.60' T2- 3'x90' EZ Flow Trench El=93 60' Shad `x�e t<Y plops CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Filarski 3 bedroom Septic System Owners Name: Kim Pilarkski Owner's Address 770 Larsen Lane Hudson, WI S4016 Legal Description: SW 1/4, NE1/4, 528, T29N, R19W Township Hudson County: St. Croix Subdivision Name: Cedar Hill Estates II Lot Number: 31 Block Number Parcel LID, Number 020-1180-20-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Existing Septic Tank Specifications Page 4 Existing Tank Certifications Page S Proposed Tank specifications Page 6 Effluent Filter Information Page 7 Bull Run Valve Diagram Page 8 System Sizing & Cross Section Page 9 EZ Flow Information Page 10 Management and contingency plan Page 11 Sanitary System Ownership/Address Form Page 12 Warranty Deed Page 13 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date 8/4/2021 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 Pllarsui 3 Bedroom Replacement POWTS Pr el Addmes 770 Lsrse, 1.11 BMI Symbol A aM Elevation 100 W' BM Descnpbon iop of In,paai.n pipe i, exuunp iiii lanw 131,42 Symbol ji 6M Elevation 95 TO BM Desonpbon Existing sepl¢ lank oueat Slope Gradient of Teslad Area (26) Well Symbol (i' apple abk) Demgr Flow 45C GPD AY,ach design row oalwlalans for corposi. pan. Pipe Materiels I ASTM StendeN Tables 3N 30-3 b 3N 30.5 <33U Pil pi Le Eel .1 . 90 120 Zt eM1Y Una P1Op E64re �y\ \Existing 16'x36' 92 Rock & Plpe bed19<\ Existing load Gal_��T�_— ■BS m Septic Tank /r — �_ --\ e t � u--- Valve �� PProposedW320-MR 9� QSii Tenk w' Polylok \ u 525 100, T 1 3'x90' EZ Flow Trench El == `3 60' T2- 3'x90' EZ Flow Trench El =S360' Shed Pro,ya \�t,e commerce.wl.gov, isconsin Department of Commerce February 16, 2010 WEEKS CONCRETE PRODUCTS RAY WEEKS 1832 215TH STREET NEW RICHMOND WI 54017 SAFETY AND BUILDINGS DIVISION Plumbinq Product Review P 0 Box 2658 Madison, Wisconsin 53701-2658 TTY: Contact Through Relay Jim Doyle, Governor Richard J. Lelnenkugel, Secretary Re Description SEWAGE TANKS. CONCRETE Manufacturer: WEEKS CONCRETE PRODUCTS Product Name: SEPTIC, HOLDING, OR PUMP Model Number(s): 1000 (49 IN. L.L , 21.76 GAL IN. 84 IN MAX. DEPTH OF BURY 511 G.P D. WHEN USED AS A SEPTIC TANK BASED ON A 3 YR SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER:. TANK DIMENSIONS = 84 IN, L X IN. W X 49 IN. H ) Product File No: 20100040 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters Comm 82 through 84, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of JUNE 2015. This approval is contingent upon compliance with the following stipulation(s): • This tank must be designed to withstand the pressures to which it will be subjected. • The manufacturer must keep at the manufacturing plant a set of plans and specifications 'bearing the department's stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the department. • When this product receives wastewater from dwellings and is used as a septic tanK, it will produce an effluent quality with a maximum monthly average value for BOD5 of greater than 30 mg,'L and less than or equal to 220 mg/L TSS, or greater than 30 mg/L or less than or equal to 150 mgIL TSS, and F.O.G. of less than 30 mg/L • Approval is issued for this product as being equivalent to a floor outlet water closet when the fixture drain is installed in the vertical pos tion. The design meets the intent of s. Comm 82.32 (5) (c) and 84 20 (5) in), Wis. Adm. Code, which requires water closets to discharge through a minimum diameter 3" drain pipe or fitting and the bowl to conform to ANSI Standard At 12.19.2M. The intent of the code is met since this product provides the same functional performance as water closets that meet ANSI Standard At 12.19.2M. • BEDDING: Bedding material shall be used to provide a uniform bearing surface. A min. of 4-inch base of sand or granular bed on top of a form and uniform base is recommended. The tank should not bear on rocks. Sites with high ground water tables should have specially designed bedding. Soils should be compacted under the tank. This approval supersedes the approval issued on 4121 r2005 under product file number 20050106. This approval letter shall be incorporated with your previously approved plans and/or specifications approved under product file number 2005D106. As of May 15, 2008, a copy of a successful water tightness test report for this product must be AVAILABLE FOR INSPECTION AT THE MANUFACTURER'S PLANT prior to this product being used as a POWTS holding or treatment tank In Wisconsin. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincerely, Jean M. MacCubbin, CST Engineering Consultant --Plumbing Product Reviewer Commerce; Safety 8 Buildings Div.; PO Box 2658; 201 W Washington Ave.: Madison WI 53703.2658 Phone. 606-266-0955, Fax. 608-283-7456, E-mail. Jean,MacCubbin@wisconsin.gov SBO-10564-E (N 10�97) File Re( 10004003 DOC Page 3 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)770 Larsen Lane located at: sw ;, NE i<, Section 28 Town 29 ti, Range19 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 9' 1 - ;1 ( Did flow back occur from absorption system? (if no, skip next line.) Approximate volume or length of time: Tank Capacity: 1000 Construction: Prefab Concrete x Steel Manufacturer (if known): weeks Age of Tank (if known): 9/26/1988 Permit number (if known) 112794 John Schmitt (Li nsed Plu ber Signature) (Print Name) MPRS (Title) (Date) 223760 Yes Nox gallons Other minutes (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 4 4" CASF-A-SEAL n C �I I i II TF-P CH E3AEF.F.- 4 -, . r 1 r4" PAST -A -SEAL � In I TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM I W32O-MR TANK SPECIFICATIONS DIMENSIONS: WALL 3" BOTTOM 3' COVER: 4" MANHOLE: 24' I.D. PRECAST CONCRETE RISER HEIGHT: 58' LENGTH: 4'-2" WIDTH: 4'-2" 'r BELOW INLET: 46 1/2" - LIQUID LEVEL: 43" -� WEIGHT: 3,880 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER. WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) �) 0 Ev i a W LIQUID CAPACITY: 8.DO GAL/IN H " C LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: O '� a SEPTIC / HOLDING / PUMP OR SIPHON p E COVER: MIX DESIGN i 8 (NO FIBER) TANK MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE 3 J Q� �Q I 0 � REVIEWED BY REVIEW DATE ; a w i DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: i Of PRODUCES NEEDED BY: / � i I , 1 --� 1 iltlit•111 FIItt,I I'l ; diet 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 Polvlok PL-122, the Polvlok PL-S25 has an automatic shut-off ball installed with every filter. When the filter rc removed for cleaning, the ball will tloat op and temporaNhe shut off the system so the effluent won't leave the tank. 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. !'l ir, I! it Ideal for residential and commercial waste Flows up to 10,000 gallons per day (GPD), l 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 Polvlok Extend & Lok or piece of pipe to center filter 4. Insert the PL-525 filter into its hou_,mg 5 Replace and secure the septic tank cover 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 filler 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 filters property aligned and completely inserted. 7 Replace and secure septic tank cover r I,— Alarm S,,inh 10,000 GPD (Optional) M .Accepts 1" PVC Extension Handle Accepts 1" SC HD 40 pipe Ratmi tur 10,000 GPD 525 Linear Ft oft/16" Fdtratu,n slot Gerlified to NSF ANSI Stantl and 4ti Gas Ddle<tor Aulonahc Sh,nt if Ban Pnhdok, Zabel fa Bot filter, a rapt Ea,dv n,tall, the SnwrlFdter,e LLehand a lean into eaiehng tanks Pulylok, Inc. 3 Fairfield Blvd Wallingford, C-F 06492 Toll Free- 877 765 956i Fax 201 284 8514 www pulylok com Page 6 y �G Home F About Site Map Order Info Videos S Literature Contact I Drip Systems Treatment Controls Products Downloads Deson Guidance The Bull Run Valve T" 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 F C Valve Positioned on tlo 2 during Septic lank EvenYeais ITEM DESCRIPTION BRV4 BULL RUN VALVE 4" BRVBULK BULL RUN VALVE 6 KEY ONLY BRVCIRISER BULL RUN VALVE RISER Av CAST COVER BRVKEY28 BULL RUN VALVE KEY 28" BRVKEY36 BULL RUN VALVE KEY 36" BRVKEY49 BULL RUN VALVE KEY 48" ir t RISER CAP ADAPTER RISER TUBE C OUT PORT I(, � 1( WATER -TIGHT ACCESS CAP VALVE DIRECTI ON FW VD LE 4" OUT 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 Page 7 IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) I Glwtextile Corer 99 SOIL COVER {{{ 2" 1 min trenM IF depth t typrcaq System Elevation/ 93.60 ft (typical) I min 12" (typcal) Septic Tanks) Manufacturer Weeks=ieser Concrete Septic Tank(s) Volumets) 1000 gal 320 gal gal gal Effluent Filter Manufacturer Polvlok Effluent Filter Moeel #525 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Provide minimum 3 ft separation between trenches. TYPICAL TRENCH (Show location of Inlet I outlet pipe connection on plan view.) PLAN VIEW Orr 0 fih5PM1dtlon piper shell he InSbiled (No Scale) Perforated Lateral at,urmon eel.een b ums Observation Pipe (typical) (typical) ---------�f----- -- B = 90 ft (typical) INSTALL PER TRENCH m 9 10-ft bundles @ 50 fr FISA/unit = 450 ft' iA + 0 5-ft bundles @ 25 ft EISA/unit = 0 ft' OBSERVATION PIPE DETAIL (No Scale) ScreaP"d FlnlshaA Grade 160 Cap iio°"e1 IT,,had & seeded) 4"0 PVC Pipe iop�il Corer Iop of mire to laminate (min 1 fooll al or almae finished grade ,41 1/A'-t r` A ii' SMs t4 �e apa�TA AnJronng Device j� r+ 'utraw /Y s�ne� 10 ft �A=30 ft (typical) EZ1203H Bundle (typical) (mfd by Infiltrator Systems, no ) Install pursuant to manufacturers instnlctaxts - Proposed FISA per trench = 450 ftt Required Infiltration Area = 900 ft' x 2 trenches = Proposed Total EISA = 900 ft' RESET Distribution Method: branched manifold El Installation Instructions for EZf ow Systems in Wisconsin Wsconsin Department of Commerce, Safety and Buildings Division, has renewed the specifications ari pans for this p,odudt and determined it to be in compliance with chapters Comm 82 through 84, Wisconsin Admin. Code, and Chapters 145 and 160, Wiscols:n Statutes. All sites must meet the Site & 5oil CQndiflion & Locations & Isclatcr distances as noted in local regulations. The approved products are 1203H (3-12' bundles with pipe in center bundle in 5' or 10lengths) and 1203HP (3-12' bundles with pipe in each bundle in 5' or 10' lengths. A single pipe bundle contains a four inch perforated pipe sur- rounded by EPS aggregate and ,s held together with poll ehtylene netting. A single aggregate bundle contains aggregate only and is held together with poryethylene netting. Materials and Equipment Needed • EZflow Bundles • EZflow Geotextile Fabric • EZflow Internal Pipe Couplers • Pipe for Header and Inlet • Backhoe/Excavator Installation Instructions The instructions for installation o` EZflow omducts are given below. This product must be installed in accorda-ce with state rules defined in chapters Comm 82 through 84, Wrconsin Ad- ministrative Code, and Chapters 145 and 160, Wisconsin Stal- utes, as well as the vocal health department's current ce>ign manual. 1. After the local health department has determined sizing, configuration, and layout for the EZflow systems, stake or mark with paint the location of trenches and Imes. Be careful to set correct tank, invert pipe, header line or dis- tribution box and tench bottom e'evatcriF before instal- lation of pipe bundles. 2. Remove plastic EZflow shipping bags prior to olacing bindles in the tench(es). Remove any patio tags in the trench before system is covered 3. This product must have geotextile fabric that meets re- quirements of s. Comm 84,30 (6) (9), Ws. Adm. Code, installed directly on too of the product and extending down along the sides of the product to a point at least six inches from the bottom of product. 4. When installed in a trench, t'ne trench should be oud to a widtn of 36 inches. This not only saves labor in e.cava- don, but also provides better load -bearing capacity after backfrhng 's complete. EZf ,oRw 5. The Absorption area (SF) necessary for a giver site shall be sized based on maximum daily sewage flow (GPD) and the Permeability for the site. If certain criteria is met, the : E19A siring can br' used in Wisconsin, resulting in a 400i smaller dranfold. 6. Place EZflow oundle(s) in the EZflow configuration ap- proved by system design permit specified for the pa,6cu- Jar site. The top or center -most bundles containing pipe are joined end to end with an internal pipe coupler. Any additional aggregate only bundles that may be required, should be butted against the other aggregate -only bun - dies and do not require any type of connection. The top of each GEO cylr^der contains a filter fabnc pre - manufactured in between the netting and aggregate. The fabric s inserted to prevent soil intrusion. The installer "all make sure the the GEC is positioned upward and is in contact with the fabric contained in the adjacent cylin- der before bacxhlling. 8. The EZflow Drainfield Systems shcuid be installed in a level trench in air directions (both across and along the trench bvttum) and should follow the contour of the ground surface elevation (uniform depth), with all continuous adjoining 10-foot cylindrical bundles placed end to end with :ertral bundle distribution pipe interconnected. without any darns, stepdowrs or other water stops, 9. The trench top shall be graced such that water wtl not pond. Backf ll should be seeded or sodded immediately after completion to reduce erosion. 10. EZflow EPS bundles are flexible and can fit in curved trenches as may be necessary to avoid trees, boulders, or other obstacles. 11.EPS aggregate is lighter than water, therefore, it might be expected that natural buoyancy forces would tend to cause EZflow asembles to -oat out of ground when founding occurs. Field expenen_e has shown, however. that this is not a problem when systems have a minimum of 6" of soil cover as recommended by manufacturer. 1203H-GEO ^--',rtde Material Page 9 In -ground Gravity Management Plan IMPORTANT: PAGE 4 OF 4 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; BOD, 5 220 mgL"; TSS 5 150 mgL"'; FOG <_ 30 mgL" Inspection Checklist INSPECT EVERY 3 YEARS type of use o age of system nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i e., pumps, valves, switches, floats, etc.) f, material fatigue (i a., leaks, breaks, corrosion, etc.) solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) neglect or improper use (i.e., exceeding design capacities. prohibited activities, etc,) extent of pending in distribution cell prior to dosing dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) electrical components - if applicable (i e., wiring, connections, switches, controls, timers, alarms, etc.) distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) 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 tanks) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin, Code. Effluent fliterls) 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. Page 10 S-I. CR0IX -(-)UN-I Y SANITARY SYSTEM File #: OWNERSHIP/ADDRESS FORM ��eeZf2021 y 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 lire to view your Issued sanitary permit online, you can do so by using the Fror_erty files Scawie(1 webllnk. OWNER/BUYER INFORMATION Owner/Buyer Kim Pllarski Mailing Address 770 Larsen Lane City/State/Zip Hudson, WI 54016 Phone Number (reau,red)715-377-3033 Email Address(reciuired)kimpilarskil9@gmail.com Parcel Identification Number 020-1180-20-000 (found on the property tax bile NEW SYSTEM: LEGAL DESCRIPTION Property Location SW 1/a , NE 14, Sec 28 T 29 N R 19 W, Town of Subdivision Plat: Cedar Hill Estates li Certified Survey Map # 425605 Warranty Deed At 937198 - Number of bedrooms 3 New Property Address Hudson Volume 5 Lot # 31 Page # 39 (before 2006)Volume Page # Spec house ❑ yes ■ no Lot lines identifiable ■ yes ❑ no OFFICE USE ONLY (verification of new a+ress 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 715-245-4250 Fax Cr Ug'-irr Ni 3_n. v 1101 Carmichael Road, Hudson, WI S4016 w�t w Sccw-iJnv Page 11 e Form -ST C- 104 AS BUILT SANITARY SYSTEM REPORT OWNER h '�i rLe e!/ TOWNSHIP �M 11 e,,,/ SEC. � T aLN-R Zp W P. r ADDRESS r TNCIQ i��/0 / ST. CROIX COUNTY, WISCONSIN 1"-d46aX-� SUBDIVISION efrjar Ff //9 LOT 4 ( LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM l k INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used �"' A 9 //'/41 //,-r Elevation of vertical reference point: Af A1�_< Proposed slope at site: /s r SEPTIC TANK: Manufacturer: iquid Capacity: / eo d Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: - Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side o Rear, ® feet From nearest property line : Front, 0 Side,©Rear,O �_ £-- Number of feet from: well 1t0•W<6dilding: /� (Include this information of the above plot plan)( 2 reference dimensions to SEE REVERSE SIR' r PUMP CHAMBER AW^t 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, O Rear, O Ft._ Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: Width: /f� Length: 9 ,,' Number of Lines: 3 Area Built: LS Fill depth to top of pipe: 4/,r%^ 43&67'cj 0 "� /sue Number of feet from nearest property line: Front, ��O��SS"ide�,, ® Rear,®Bt.,� Number of feet from well: JL� a,�,eo� Number of feet from building: (Include distances on plot plan). 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 absorbtfon sytems? (Check one). HOLDING 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:y /y/��j-��{/��� Inspector: V V e rr""" ": Dated: Plumber on job: License Number: DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR ' LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS P.O. BOX 79,A9 .MAPISON, WI 53707 S(V;,NE;,S28,T29N-R19w MCONVENTIONAL ❑ALTERNATIVE 'n Town ob Hudson ❑ Holding Tank ❑ InGroundPressure ❑ Mound I-o.t 31 Ceda/L HiUFA Estate SAFETY & BUILDINGS DIVISION BUREAU OF PLUMBING � J NAME OF PERMIT HOLDER 4DORESS OF PERMIT HOLDER INSPECTION DATE Witham Hawtea Box 1901 Hudson, W1 54016 �p-(�-g� I() MARK IPermanem W"I.—pomp DESCRIBE IF OIIFERENT FROM Pury PER PT ELEV CSL REI PT ELEv 7BFJiCH A. —of lame Mv,MPRsw Nn cav„lV 9mu11 HII—I Number wiU,i.am SchurnahevL 63&2 St. Choix 112194 SEPTIC TANK/HOLDING TANK: MANUFAC UR LIOUm C4PPCIiY i4NN IN_EI rIEV iANN OUTLET ELEJ WAflNING LABEL PROVnOEO LOCKINGCOVER PROVIOF QOU JJ�� O0o� 6, ��— YES [:]NO ❑YES NO BEDDING vIHT OIA II vEnT MITI Iur,r, WPrFI• Al 4NM1' NUMBEROF Re Ly. / PHOPERTr -ELL BJP_1N VE TO FRESH M1INE�/ J PIA PIR INLET / { OYES NO r' LT DYES NO NEARESTOM 1___ Ov DYES ENO 1 11 ❑_YES ❑NO ❑YES ❑NO GALLONS PER CYCLE PUMPAN CONTH L PERATIONAL NUMBER OF NnPENry Lo,E wt LE eoaDl N•, VENTLE FRESH (DIFFERENCE BETWEEN FEET FROM 41R INLET PUMP ON AND OFF) YE LNO NEAREST—?• SOIL ABSORPTION SYSTEM. Check the soil molstu e t t e de or of p D Ing FORCE ur: �rn rAar IEX M41111141 Amu MARNINI, or excavation, (If soil can be rolled into a were, con t c on shall cease Lnul the soil Is dry enough to continue I MAIN CONVENTIONAL SYSTEM: 'EE CH W IDiv ( LtNGiX ( n r•NEN nrv.•. L r.b d. 5 r ^:f• --_ - PIT Insre Im: �Prti LOW DEPr/ _ DiMENS_ ENSIOIONS' I / Rd"I OE I X FILL DEPLN IN5'N Pllf UISTr PIPE DISTR PIPE MATERIAL I)IC NUMBER OF - PHOPE NTv 1VEL BUILDING VFNT TO FRFSN BELOW Aaovaov Ea In LI l Ef� EN, AlLI P� FEET FROM .- EInEi 1 ! 7 AIR INLE �' v` '7 �� �_ NEAREST _ Mound site plowed perpendicular to slope and furrows thrown upslope. 1 I , Sketch System oIn Reverse Side. DILHR SBD 6710 (R. 01/82) Check the texture of the fill material for mound systems to make certain that it meets the criteria for medium sand u�ao DE 11-,1 RI LIW IP PROVIDE A DIAGRAM OFSYSTEM ON REVERSE SIDE. SHOW ELEVA- TIONS MEASURED, LINE a. sl L Retain in county file for audit. X TITf F Zoning Admini.a#iLaton LEI `L (� u SANITARY PERMIT APPLICATION O'�• couN 0 U •� In ILHR 83.05, Wis. Adm. Code �� accord with STATE % �T(�RxP71T # .UMM/BER —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN 17.DD..NN 8'f. x 11 inches In size. —See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PETITION IIC�II FOR VARIANCE ❑ YES 9 NO PROPERTY OWNER PROPERTY LOCATION G%' % A19 %, S &tF- T2 f, N, R If E (or PROPERTY OWNER'S MAILING ADDRESS LOTNUMBER BLOCKNUMBER SUBDIVISIONNAME G rn a a 111114 A101. s 3 — Y qe hnT-r' CITY. STATE ZIP CODE PHONE NUMBER L.J CITY NEAREST ROAD, LAKE OR LANDMARK VILLAGE 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2, 3 or 4, if applicable) 1. a. L Iew b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. gConventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) d 1. a. -See a e Bed b. ❑ See a e Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feel): PROPOSED (Square Feel). Feet I�private ❑ Joint ❑ Public VI. TANK INFORMATION CAPACITY in al Ions Total Gallons #of Tanks Manufacturer's Name Prefab. oncrete Site Con- Steel Fiber- glass Plastic Exper. App New xisiin Tanks Tanks strutted Septic Tank or Holdinn Tank Lift Pump Tank/Siphon Chamber VIL RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system sho on the attached plans. Plumber's Name (Print): Plumber's (No Stamps) IMPRSW No.: Business Phone Number: sSSignature, �� PlumkV Address (Street Ciry, ata, Zip Code): Name of Designer: dsc- CJZs o ito Vlll. SOIL TEST INFORMATION Certified Soil Tester (CST), Name CST# v CST's AD SS Miraity, State, ip Code) Phone Number: IX. COUNTYIDEPARTMENT USE ONLY ®Approved Disapproved I ❑ OwnerGivenOptenitiel Sanjtary Permit Fee ,$20 rv` �}rC er eFee� I Groundwate)ISr C� ee -�40— I 'ng Agent Signature (No Stamps) AdverseDeterminahon �J X. COMM ENTS/REAS�O,N,S FOR DISAPPROVAL: T SBD-6398 Iformerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber 0� 1) ant of ss = Saf and AUG "' 209bIL /_ in accor Professio al Servtct t es�rn x County Z #2166 �with LU Comm 85, Wis. Adm Code ' Page 1 of 5 Schmitt Soil Testing, Inc. snit Developmem y Coun County Attach• complete site plan o ] z inches in size Plan must 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 10 02a1180-20-000 Please print all information. Personal Revi By / Dale rG / information you provbe may be used for secondary purposes (Privacy Law, s 15 04 (1) (m)) ( ' n -! Property Owner Property Location Pilarski, Kim M. Govl Lot SW1/4, NE1/4, S28, T29N, R19W Properly Owner's Mailing Address Lot # 81ock # Subd Name or CSM# 770 Larsen Lane 31 Cedar Hills Estates 11 -- City [ :Village i:_'; Town Nearest Road City State Zip Code Phone Number Hudson WI 54016, Hudson Larsen Lane New Construction Use: I, Residential / Number of bedrooms 3 _ _ Code derived design flow rate 450 GPD _ Replacement Public or commercial - Describe Parent material Outwash( Burkhardt-Sattre Complex) _ Flood plain elevation, if applicable NA ft. General comments Replacement area is suitable for a conventional system with a 0.5 gpd/sgft rate. Possible system elevation for replacement area is and recommendations. 93.60'. Slope of area is 2%. 1 Boring Boring # '_ -- Pit Ground surface elem _98.67 -ft, Depth to limiting tailor 100+ in ISoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPDttt' •E5#t •Efflr2 in Munsell Cu. Sz. Cont Color Gr Sz Sh. 1 0-8 10yr3/3 none sl 2mgr mvfr as 2vf 0.6 1.0 — - — 2 8-48 10yr4/6 none j sl lmsbk mfr as 1vf 0.4 0.7 3 t411100 10yr614 none fs Osg ml ---- ------ 0.5 1.0 i Sy ' fG n2Boring# -;Boring Pit Ground surface elev 99.37 ft. Depth to limiting factor 110+ in Soil Application Rale nzon Depth '�, Dominant Color Redox Description Texture Structure ConsistenceBoundary' Roots GPD/fl' •EB#1 •E##2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 1 0-6 10yr3/3 none sl 2mgr mvfr as ivf 0.6 1.0 2 6-18 7.5yr5/6 none Is lcsbk mvfr gw lvf 0.7 1.6 3 18-53 10yr6/4 none s Osg ml as ------ 0.7 1.6 4 53-84 10yr6/4 - none fs Osg ml as — 0.5 1.0 5 84-110 10yr6/4 none s Osg ml ----- 0.7 1.6 ' Effluent #1 = B0U5> 30 < 220 M91L and T55 >30 < 150 mg/L - • Effluent 02 = BOD5 < 30 mg/L and 1SS < W 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 7122/2021 715-760-1978 SBPU30(1 071W) Property Owner Pilarski, Kim M. Parcel ID # 020-1180-20-000 Page 2 of 5 T 1 Boring3 Boring # [� Pit Ground surface elev. 98.42 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz Cont Color Texture . Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/B' 'Eff#1 'Ea#z 1 0-8 1Oyr3/3 none sl 2mgr mfr as 2vf 0.6 1.0 2 8-19 30yr3/2 none sil 2fsbk mfr gw 2vf 0.6 0.8 3 19-46 1Oyr4/4 none sil 2msbk mfr gw Ivf 0.6 0.8 4 46-100 1Oyr5/6 none Ifs OSg ml ---- ------ 0.5 1.0 157, 4 [, Boring Boring # Pit Ground surface elev. 93.97 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft° -Eft#i 'EM#z 1 0-8 1Oyr3/2 FILL sil 2mgr mvfr j as 2vf 0.6 0.8 2 8-57 1Oyr4/6 FILL sl 2msbk mfr as ------ 0.6 1.0 3 57-84 1Oyr3/3 m2d 1.5yr6/6 7.5yr6/2 sil Osg mfr -- ------ 0.5 1.0 =F=I � AREA HAS BEEN FILLED, ORIGINAL TOPSOIL AT 57- 5 Boring Boring # Pit Ground surface elev 94.32 ft. Depth to limiting factor 108+ in .� Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh Consistence Boundary Roots GPD/W 'EB#1 'EIr#2 1 0-7 1Oyr3/3 FILL sil 2mgr I mvfr as lvf 0.6 0.8 2 7-30 10yr4/4 FILL grsl 2fsbk mvfr gw lvf 0.6 1.0 3 30-39 7.5yr4/6 none grsl 2msbk Mil as ------ 0.6 1.0 4 39-53 7.5yr5/6 none sl lmsbk mfr as ------ 0.4 0.7 5 53-66 1Oyr6/4 none fs 05g ml as ------ 0.5 1.0 6 66-108 1Oyr6/4 none S Osg ml ---- ------ 0.7 1.6 Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 <150 mg/L ' Effluent #2 = BOD5 < 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 TTY 608-264-8777. SBD-8330 (R OWW) Sch0dtt Sod TesUN, Im. Property Owner Pilarskl,-Kim M. Parcel ID# 020-1180-20-000 Page _ 3 of 5 r Boring Boring # - — _ 1 PR Ground surface elev. _ 91.72 ft. Depth to limiting factor 0 on. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Texture Structure Ou. Sz. Cont Color Gr. Sz. Sh Consistence; Boundary Roots GPD/ft _ _ •Eff#1 -Eff*2 1 0-7 10yr3/3 FILL sil 2mgr mfr as 2vf 0.6 0.8 2 7-48 10yr4/4 FILL grsl 2fsbk mfr as 0.6 1.0 3 48+ 10yr4/3 -- 7 5yr6/2 m2d 7.5yr6/6 — -- sid lmsbk mfr 717 0.2 0.3 -- AREA NAS BEEN FILLED, ORIGINAL TOPSOIL AT 48- Boring Boring # `- I Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appliceton Rate Horizon Depth Dominant Color Redox Description in Munsell Ou Sz. Cent Color Texture Structure Consistence Gr. Sz Sh BoundaryRoots �_ GPD/ft' _ 'Eff#1 'Eft#2 ; i ! Boring ❑ Boring # iL 111 pit Ground surface elev. __- _ .__ H. Depth to lima ing factor- in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Texture Structure Ou. Sz. Cont Color Gr. Sz Sh. Consistence Boundary Roots GPDM2 'ER#t •Eff#2 Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <-150 mglL • Effluent #2 = BODS q 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 TTY 608-264-8777, ssu833o (R 07 W) SdmNtt Sod Testing, Inc. Conducted for: Kim M Pilarski Conducted By: 770 Larsen Lane Hudson, WI 54016 Thomas J. Schmitt PID: 020-1180-20-000 / Lot 31 Cedar Hills Estates II CST 227429 SW1/4 NE1/4 S28 T29N R19W 7-22-2021 t Town of Hudson /� /9k' p wt-t_L 94' RNV B4 96' \ B6 HOUSE 0' B1 \. BM BM 1 100'•�• B.� •�.�.\ B5 50, \• 5 _ _ ' SLOPE•\•�69' B3 •\ 51 3T 5' 85, \ - \• 40' 18, 56' SHED 1"=60' 2"s. Pj BM 1 100.00' Top of inspection pipe on existing Weeks 100 gallon tank BM 2 95.70' top of septic tank outlet pipe St Croix County, WI Legend O ar Counties Lakes and Rivers Rners and Streams — Inuiroates US Hghways Stale H,ghways County Hgy,ways Loat Roads Rushc Roads Ramps Road Rght of Way aref v.r.,.e aav Raumads Conveyance Drva,on IN i 0 20 40 60n DISCLAIMER This map is not guaranteed to he accurate, oorted, a,rrent, or complete and condusuns drawn are the respons,blRy of the I.,., n a no 1 � Of i St Croix County, WI Legend OMer Counties Lakes and R.e Rivers and! Streams e...Y 1 Ioterstates US Hghwa a State Hghways County Hgiways Loral Road. Rosbc Roads Ramps Road Rght of Way rmme arm w„ Ravoads I 0 100 200 3COft DISCLAIMER. Th,s map is nol guaranteed to be a¢urate, coma. Comm or complete and concWsrons drawn are the responsiblity of Me user (Le,p 14CL%if. v�v�� couNTr / NO. 633881 STATE SANITARY PERMIT 7 70 (OXUh l-v► �'� L PREVIOUS NO. 117w97 OWNER k;Al R I qrc, ki PLUMBER -'ph < TOWN OF SEC ZQ ,T N, AND/OR LOT 3 / 0 LIC.# ZZ 3 n U BLOCK — SUBDIVISION Zo 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. let Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ISSUING OFFICER - DATE Z/ THIS PERMIT EXPIRES g ZO Z4ZSUNLESS RENEWED BE/0R11 THAT DATE POS15 IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499(RI 1/20)