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HomeMy WebLinkAbout020-1036-40-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building 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)] Gary A. Pacolt TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic IcIfs looU Dosing Ae F P I Hol TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic t I Dosing Aeration Holding PUMP/SIPHON INFORMATION Ma ufacturer p6mand PM Mod INumber TDH Lift Friction Loss Sy em Head I TDH Ft Force ain ength Dia. U Dist. to well SOIL ABSORPTION SYSTEM WED 11(ICSU I1UN JTJ I tM TOWN OF HUDSON TION DATA County: St. Croix Sanitary Permit No: 641949 State Plan ID No: Parcel Tax No: 020-1036-40-000 Section/Town/Range/Map No: 18.29.19.157A1 STATION BS HI FS ELEV. Benchmark I �D I /00 Alt. BM (p Bldg. Sewer St/Ht Inlet St/Ht Outlet (� t Inlet D Bo om Header/Man. Dist. Pipe Bot. System Final Grade X'Cover T7. (a jr 0.60jr 9 HI Header/Manifold t Distri ution Pipes Hole Size x Ho crng Vent to Air Intake Length Dia Length Spacing SOIL COVER sure Systems Only xx Mound Or At -Grade Systems Only Depth Over /f Bed/Trench Center t/'/-� Depth Over M Bed/Trench Edges -7 xx De th of To eded/Sodded xx Mulched E yes , es No _'A v COMMENTS: (Include code discrepencies, persons present, etc.),y �Inspection ^#1: n/n Inspection #2: Location: No Address Available .ypA10 Vve'v 06 lob l I►��Q 0Y ) 1.) Alt BM Description = 4'( wv-f Y P{(1 v 2.)Bldg sewer length =�1 y��y���"�r{V� -amount of cover =7 jQ'N �Y ( f, in Plan revision Required? ❑Yes } No ✓ I(tr n� f - Use other side for additional information. Date e!/6/ct/� ns or's Signature Cert. No. 3! SY 1. I 2. �rrx•t"•sryr, Industry Services Division County , -VT st r'3 1 e) 'to't2 4822 Madison Yards Way 1 i7 i ( JC. Sanitary Permit Number (to be filled in by Co.) -Yip APR Madison, WI 53705 P.O. Box 7162 Croix County 707& 62 men,Madison, to State Transaction Number °m rotary Permit Applicatio In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the a governmental unit Project Address (if different than mailing address) 7 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Department Safety Professional Services. Personal information you provide may be used for secondary the of and purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. y�,r l� 1. Application Information - Please Print All Information Prpppny Owner's Name Iv- f / Parcel # � PTerly Qwner's Mailing ddres Property Location �j) ft '1 JI Govt. Lot 1Section Ci , Star Zip Cood%e� i Phone N'ujmbler� (/.�, T 1 N R I 1 E o Lot # Type of Building (check all that ply) ' Subdivision Name or 2 Family Dwelling - Number of edrooms ///'�":::111 $ � 6 ��► Block # ❑Pttblic/Commercial - Describe Use l ❑Ciryof DtateOwned- Describe Use illageof CSMNumber�pC; V lo�� own of 111. Type of POWTS Permit: (Check either "New" or "Replacement" and other app able on fine A. Check one box on line B. Complete tine C if app1f le. A. ew System ❑Replacement System 00ther Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) B. []Holding'.rank n-Ground 04t-Grade Mound Individual Site Design Other Type (explain) enti n C. ❑ Renewal Before [:]Revision Change of Plumber Transfer to New Owner Number and Date Issued List Previous PeE t Expiration t f beIgW IV. DispersallTreatment Area and Tank Information: Design Flow (gpd) LA Design Sol[ P�plication Rate(gpd/sf) 6 ' persal Area Required (so DisQers rea Pr sed (sf) S stem Eleyati n Capacity in Total # of Manufacturdro Tank Information Gallons Gallons Units ('; I •r L �.�( ;; A u c '8 U New Tanks Existing Tanks cC v in :n w V a Septic or Holding Tank Dosing Chamber O O V. Responsibility Statement- I, the undersigned, assume respo for nstallationof the POWTS shown on the attached plans. ` Plu b ',Name (Print) Plumber's Si MP/MPFj,S Number 2ZZ I�f Busing ss Phone Number _ �r ICI I Plum Address (Street, City, State, Code) VL CountylDepartment Use Only - - - Approved ❑ Di oved Permit Fee_ $ mLL Date Issued I s ' g Agent Signat e ❑ Owner rven Reason esyal J Conditions of pprova easens fen Rica} tsual 3� & i-S E 5 €M omm )i iptic tarok, f14IttaRt filIeF ong ! maintained II persal cell must t serviced e M^�e2 1 management plan provided by plumber. S P� per d setback requirements must be maintained 1 per applicable code/ordinances. SBD-6398 (R. 03/21) Attach to complete plans nor the system ano suomt to the County only un papc+ nm ,c» .,,a„ � "I .... ,-- ... System PLOT PLAN PROJECT Gary Pacolt ADDRESS 944 Wert Road NW 1/4 NE 114S 18 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 92.9/92.6 '1 P 4/2/22 BEDROOM 3 DATE 'jIdow CONVENTIONAL xxx CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 LIFT TANK SIZE DOSE TANK SIZE HOIWNG TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. , t SSUME ELEVATION 100' Filter Lifetime Filter REHOLE O . same as benchmar ® Vent Vent 0 >6„ Quick4 Standard Leaching Chamber Scale = 1 /4" = 10' of Cover with 20.0 ft2 of Area 6.6ft^2/pair of end caps 4' Long 12 34" Grade at System Elevation Existing Garage B.M.' Pro 3 10' Bedroom ST House 70' 1 8' 15 97' 3 10' 10' ents ►1 4% Slope B-1 2-3'X 66' cells with >3' spacing go 00P� Drive Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 04/02/22 Owner: Gary Pacolt Location: NW1/4 NE1/4 S 18 T29 N,R 19W Casperson Dr Hudson Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintance and Conti cy Plan 7. Filter Cross Section Signature License number # 6900 System PLOT PLAN PROJECT Gary Pacolt ADDRESS 944 Wert Road NW 1/4 NE 1/4S 18 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 92.9/92.6 H r DATE 4/2/22 BEDROOM 3 CONVENTIONAL XXXCONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. it SSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL" *H.R same as benchmari QVent >6» Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 6.6ft^2/pair of end caps 4' Long 12" Grade at System Elevation 34" Existing Garage B.M.` Pro 3 10' Bedroom ST House 70' Scale = 1 /4" = 10' WW K 1 2-3'X 66' cells with >3' spacing 30 Vents 10' R AO 96' -2 14% Slope B-1 10' Drive Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 6.6ft^2 pair of end plates Typical Installation Vent Grade ----------------------- _�/30/34 Septic Tank 3 5' Long; V, 5' � /5 3 6 " Grade at System Elevation Spacing 5' System elevations: A 92.9' B 92.6' To be >1' above grade Finish grade elevation 96.9' ,Vent 1 " at System Elevation 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell 0 1 0 0 48 4 0e SECTION A -A �A POWTS OWNER'S MANUAL. & MANAGEMENT PLAN Page _cf— FILE INFORMATION Owner Permit #/ ! DESIGN PARAMETERS Number of Bedrooms O NA Number of Public Facility Units T�NA j Estimated flow (average) ravda I Design flow (peak), (Estimated x 1.5) allda Soil Application Rate aUda /flz Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODr,) s220 mg/L 0 NA Total Suspended Solids (TSS) <150 mg/L !Pretreated Effluent Quality Monthly average i Biochemical Oxygen Demand (BODe) s30 mg/L Total Suspended Solids (TSS) <_30 mg/L �%NA Fecal Coliform (geometric mean) 5104 cfu/1 o0ml iMaximum Effluent Particle Size in dia. ❑ NA Other L.1 ❑ NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity 10Dal ❑ NA Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer A 6, ❑ NA Effluent Filter Model ❑ NA 'Pump Tank Capacity al )�NA Pump Tank Manufacturer 0NA Pump Manufacturer NA Pump Model ONA Pretreatment Unit A ❑ Sarrd/Gravel Filter ❑ Peat Filter I-J Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other. Dispersal Cell(s) ❑ NA )�In-Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line ❑ Other: Other: ❑ NA Other: ❑ NA Other ❑ NA Service Event Service Frequency inspect condition of tank(s) At least once every:ear(s) months) (Maximum 3 years) 094fPump ❑ NA out contents of tank(s) When combined sludge and scum equals one-third (36) of tank volume ❑ NA Inspect dispersal call(s) At least once every: year(s) months) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ` t �months) jyear(s) ❑ NA ! nspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) NNA l9ush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) ISI NA ether. every: At least once eve__ ❑ month(s) ❑ year(s) NA ether: _ _ �_i ❑ NA ..J MAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Maalur (Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must linclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be 'visually inspected to check the effluent levels in the observation pipes and to cheek for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing conditloar and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-thhd (%) or more of the tank volume, the entire contents of !:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin ;Administrative Code. (Ali other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of 512 months, shall be performed h,t a certified POWTS Maintainer. A service report shall be provided to the local regulatory autho0t ,vithirt It 'I' days of cornpletion of any service event. Page _. of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals the:t may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thr= tanks) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will by discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluenit. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area withln 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTG: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting producils; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits 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 their covers removed and the void space filled with sail, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code comphilint replacement system: LA suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requii,ed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules/ in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologv a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluat on 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 failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiitraiive surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK' UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name L1 Phone POWTS MAINTAINER Nama Phone SEPTAGE SERVICING OPERATOR PUMPER RY AUTHORITY Name Phone �? ( —11�) __? . This document was drafted in compliance with chapter SPS 3a3.22(2xbX%d),L(f) and 393,54(1), (2) & (3), Wisconsin Administrative Code. Parcel #: 020-1036-40-000 Valid as of 04/14/2022 10:05 AM Alt. Parcel #: 18.29.19.157A1 Owner and Mailing Address: GARY A PACOLT 944 WERT DR HUDSON WI54016 Districts: Dist# Description 1611 SC H DIST OF HUDSON 1700 NORTHWOOD TECH Abbreviated Acres: 2.210 Description: SEC 18 T29N R19W NW NE LOT 1 OF CSM V 4/1047 TOWN OF HUDSON ST. CROIX COUNTY, WISCONSIN Co-Owner(s): Physical Property Address(es): Information Not Available Parcel History: Date Doc # Vol/Page Type 11/30/2017 1058019 / WD 09/22/2014 1001871 / WD 11/09/2012 967135 / EZ-U 02/21/2006 818927 / EZ-U more... Plat Tract (S-T-R 402/4 1601/4 GL) Block/Condo Bldg * 1047-CSM 04-1047 020-81 18-29N-19W NW NE LOT 01 2021 Valuations: Values Last Changed on 09/25/2018 Class and Description Acres Land Improvement Total Gl-RESIDENTIAL 2,210 73,400.00 13,900.00 87,300.00 Totals for 2021 General Property 2.2101 73,400.001 13,900.001 87,300.00 Woodland 1 0.0001 0.001 0.001 0.00 Totals for 2020 General Prooertv 1 2.2101 73.400.001 13.900.001 87.300.00 2021 Taxes Bill # Fair Market Value: Assessment Ratio: 17384 99,800.00 0.8745 Amt Due Amt Paid Balance Net Tax 1,198.82 599.41 599.41 Special Assessments 0.00 0.00 0.00 Special Charges 0.00 0.00 0.00 Delinquent Charges 0.00 0.00 0.00 Private Forest Crop 0.00 0.00 0.00 Woodland Tax 0.00 0.00 0.00 Managed Forest Land 0.00 0.00 0.00 Prop Tax Interest 0.00 0.00 Spec Tax Interest 0.00 0.00 Prop Tax Penalty 0.00 0.00 Spec Tax Penalty 0.00 0.00 Other Charges 0.00 0.00 0.00 TOTAL 1,198.82 599.41 599.41 Interest Calculated For 0411412022 Installments End Date Total 1 01/31/2022 599.41 2 07/31/2022 1 599.41 Net Mill Rate Gross Tax School Credit Total First Dollar Credit Lottery Credit Net Tax 0.014585302 1,433.56 160.26 1,273.30 74.48 0 Claims 0.00 1,198.82 Payment (Posted Payments) Date Receipt # Type Amount Note 12/17/2021 104291 T 1 599.411 PACOLT CK #1010 CD Key Payment Type: A - Adjustment, R - Redemption, T - Tax * - Primary mow. a . File #: ST. CRa C�NTY. SANITARY SYSTEM Office Use Only OWNERSHIPIADDRESS FORM Created212021 I 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 o f our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once apiroved, this completed form and educational information will be sent to you by email. I Owner/Buyer \7G0 Mailing Address `( "I " I W PFlyl 2 City/State/Zip Phone Number (required) l b1 IIED ` 1"IJ 0 Email Address (reouired) Parcel Identification Number V LU l l J :_-) lD 1 V' (found on the property tax bill) Property Location NA w 1/4 , 1/4 , See. T VN RA' Subdivision Plat: Certified Survey Map # Town of Lot # I Volume- _� Page # I Q � i Warranty Deed # (before 2006)Volume Page # Number of bedrooms Spec house 0 ye no Lot lines identifiable yes O no New PropertyAddress3t07 - / (Verification of r:ew address required from Commuriity 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. is Community Development Department- Land Use Division 715-386-4680 St Croix County Government, Center 715-245-4250 Fax cdd Dsccwi.00v 110;1.Carmichael Road, Hudson, WI 54016 www.scckaov ro"'Mf- MMFf6T/L Sl�T • '4 i 1512 SO. FT. 780 M FT. 1512 Sa FT. LOWER LEVEL GARAGE MAIN LEVEL 313 OESIGN LLC S.{S1•{la�at Sa.a,{at NOTILEI I ELEVATIONS I Al al BRACED WALL UNE PANEL DETAILS �Ircaoa.�.. aeewcraYutawas» MAIL�pM� MW l aIII V P��Y tler YO CSI6PLY Gv[.10�00[NOYRSi cwlwearw.r"v aaacmawu uma�cnwa..�na.ulwa vrem�aoo�nou a i IMML al �% 1/a'�1bLEVE 4a lZ al 40 � G3�C�C��dC�D �-ao aa- ©yS YJtsoonsnDepatment a^,R 13 ZOZZ Cii1. EVALUATION REPORT Page—o+— Dik^six of Safetyand B ir, aC.'Di oancE w : ornrr E5. 11,'is Adm. .rode St. Croix County 1. Court, ' Attach compiete site pl n -d 1 pGfl. y thaLm9MIfIt" inches ir. size. Pian rust %Jl X l n include, buot iirited n :reference point !EM., direction and t Pa oz I percent siope, scale or dimensions, north arrow, and iocation and distance tc nearest road. a () -- �� j (� ^ l Please print all informatior:. Re "ewes by Date / ?arsons. ,Mormsrior yo,; provide m2) t� usec fa sewoa n, pj.Tm r fPnv&cy Law': e. 15.06. :.'. j (m);. , f/ �Z ZI f Prope,-.: �,-Nvrer//.,7G ^ i Pr'operh'LoCatio.^ ^ v l r / /a O / j Go d. Lot/1� S 1, a q. /Jy1, O T ( R E� i Property Owne's Maili: . ddress 11/�� t Lot # Bi= # Subc. frame or .SW - I l State Zip Code Phone hlumbe r j City ` V oe Town tr�^ 10"Nearest Road j /&&,gef:r�G��. I New Construction .:se�&.Residentla / Number o` bedroors J Cade dewed design flow rate 7 JCJ pD L Replacement Li �Fu�bl�ii- or r mme,c4 - Desv be ---. ----- parent material i9 if71 c�11 l�^� / I low Plain eievation h applicable A.1 1,4— ft Genera: cornirneints l J (o r i eQs m41 /°� and reCortendatio s: !! /^` Q-Vstern Type Co sTy 2 tom, ,r r System Elevation 7 0�' [ / �' 4 o Boring # U Bong I� Pit Ground surface elev,?-:-5 ft. Depth to limiting `actor �`�— in. Soil Application Rate Hordw Depth in. DomirtantColor Munseff Redox Description Qu. Sz. Cont. Coior 1 Texture ! Stricture I Gr. Sz. Sh. Consistence Boundary! Roots I GPOM *SW I •Eff#2 z , z ' , f .----- c� 1 �� , 3 'u-Inn l fnl y, � �i S O sr, m i t/✓.I 4 1 A, i 1 .3 •8 1 ==Fj 1 1 1 1 1 Boriry Pit Ground surface elev. / J it Depth to Writing factor Ann in. - A ate;,.n,,,, Rya Qu. Sz. Cont Color Effluent #t = BOU. > 30 < 220 mWL a Kf T55 >30 5 ' Effluent Xe = 5UU, < 3u mgrL ana i ao < su MWL CST Name (Please Print) nature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address -3 Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 540 /-Z-Z, 715-246-4516 Property Owner _ Parcel ID # Eng # [❑7� Boring pit Ground surface elev. ft. Depth to limiting factor Z rn_ in. Page of . nA Ar"vnt. R�ee �R M /W MVI�l ��I�WSZM®WU ❑ Boring Al ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Aaolicetion Rate Qu. Sz. Cont. Color Boring El Boring # Ground surface elev, ft. Depth to limiting factor ❑ Pit in. Sol Apdication Rate Effluent #1 = BOD, > 30 � 220 mglL and TSS >30 1150 rrg& . Effluent #2 = BODs 130 mglL and TSS 130 m9l 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. SBD69730(R-&W) '�i Property Owner _ Boring # [❑77II Boring ILh pit Parcel ID # Ground surface elev. . ft. Depth to limiting factor zn in. Page of _ c..a EMMMM M �% �� ��i�7diT:I1(►7����� MWIN ElBoring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Aoolication Rate FROMMO TOM! Redox Description ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Sod Annlication Rate Effluent #1 = BOD, > 30 < 220 mgrL and TSS >30 < 150 mglL • Effluent #2 = BODS < 30 mg1L and TSS < 30 mg1L 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. Soil Test Plot Project Name Gary Pacolt Address 944 Wert Road Hudson Wi 54016 Lot 1 Subdivision -------- ird iTM #226900 3/21 /22 N W 1/4 NE 1/4S 18 T 29 N/1319 W Township Hudson Boring Q Well PL Property Line County ST. CROIX /'C-"k2M or VRP Assume Elevation 100 ft. Bottom of garage siding System Elevation 92.9/92.6 -� *HRPSame as Benchmark 3 �edraa�� l Of COUNTY NO. 641949 STAT04#�E SANITARY PRMIT n T 36i GsP:R�N dR.^.^ OWNER 1W7 PLUMBE PERMIT EXPIRES rnr, v iv/r3 SUBDIVISION ISSUING OFFICER NO. CHAPTER 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. (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. - DATE UNLESS RENEWED BEFO POST IN PLAIN VIEW 2OLZ THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)