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Home My WebLink About020-1376-70-000 (4)Wisconsin 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)] Permit Holder's Name: city Village Township HEATHER LEE LANDE TOWN OF HUDSON CST BM Elev: InsInsp, BIA Elleeey BM D riptio : V TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic , Dosing ` Aeration Holding PUMP/SIPHON INFORMATION dN rvL anl' Li,/ Manufacturer errand GP( Model Number TDH L Friction Liss System Head T H Ft Forcemain Length Dia. Dist. to Well -- r SOIL ABSORPTION SYSTEM L•d� I .0 :. -WMA BED/TRENCH DIMENSIONS Width r Len th � � No�3reneheS 2 PIT DIMENSIONS No. Of Pits Insid is iq i Depth SETBACK INFORMATION SYSTEM TO PIL BEDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Type Of System: �% 61 Al J t a 1 Mo DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake I Pipe(s) I Length Dia Length Dia Spacing SOIL COVER v Pressures Svstamc Clnlv vv Mnund Or Atlrada Sustums Only Depth Over ' ( Bed/Trench Center / �� Depth Over ,, Bed/Trench Edges �% I. xx Depth f Topsoil xx Seeded/So d _ ul e YJ / o ]Yes^; No COMMENTS: (Include code discrepancies, persons present, etc.) Location: 942 FRASER LN 1.) Alt BM Description = p 2.) Bldg sewer length - amount of cover = Inspection #1: Inspection #2: flilk Plan Yes till on Use otherlside foruadditional information._I �1((_ k ! ! No i l ` Date sepctor's Signature Cen. No. 22 flog-, tCounty --EE Industry Services Division p ix as JUN 2 8 2022 1400 E Washington Ave P S P.O. Box 7162 Sanitary Permit Number (tu be filled in by Co.) Y. St, Croix County Madiso 53707-7162 �D 7 ani ary Applie State Transaction Number In accordance with SPS 383.2112), Wis. Adm. Code, suhmissinn of This forth to the emmental unit is required prior to obtaining a sanitary permit. Not Application forms for state-owned PO submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may he used for wcundary 2urposes in accordance with the Privacy Law, s. IS.u4 1 tin . stats. 942 Fraser Lane I. Application Information - Please Print All Information Property Owner's Name Parcal a (,(r+tt� LeeLftoE 4 C'1-t*&L�S J 020-1376.70.000 Property Owners Mailing Address Property Location 942 Fraser Lane Govt. Lot NW'/4,SW'G, Section 14 City! State Hudson, WI Zip Code Phone Number 54016 t 'rcleone) T29N R19Eor 11. Type of Building (check all that apply) / J Lnt tt ® 1 or 2 Family Dwelling - Number of Bedrooms 70 Subdivision Name ❑ PuhliclCommercial - Describe Use Sweet Grass Farm Block N [I City of ❑ State Owned — Describe Use X ❑ Village of ® CSM Number E Town of Hudson III. Type of Permit: Check only ri�ft box on line A. Complete line B if applicable) A. ❑ New System ® Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber (honer 'l�J R q05_`.7 4 IV. Type of Pil S stem/Coin onent/Device: (Check all that a 1 Non-P ssur¢e n-Uroun At -Grade ❑ Mound> 24 in ot'swtable sad ❑ Mound <24 in. of'suitable sod Lj Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaUTreatment Area Information: p aft?' u.*AA Design Flow (go) Design Soil Application Dispersal Area Required (sfl Dispersal Area Proposed Isf) Svstem Elevation 600 Rate(gpdst) 858 900 84 50', 83.30' 0.7 VI. Tank Info Capacity in Gallons r Total Gallons tY of l!n1L5 manufacturer w r, New Tanks Existing T:mks I l a U ✓- M O a Septic or Holding Tank 1200 1200 1 Wieser Concrete ❑ Dosing Chamber 800 800 1 Wieser Concrete 71 Vll. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the PORTS shown on the attached plans. Plumber's Name (Print) PI er' . i lure fMP/MPRS Number Business Phone Number John Schmitt Z? L 41:1C, 41 223760_ 715.760-0486 Plumber's Address (Street. City, State, Zip Code) 586 Valley View Trail, Somerset, WI 54025 Vlll. CountylDepartment Use Only Approved ❑ D' rove Permit Fee ' a e I sued Issu• g Agent Si re ❑ We on for Denial S SZ r ZOO_ ��j,Sttadji t Approva 1 3)QQ"�p,,�pp 1. Septle tank, effluent Alter and/ dispersal cell must be aetyleAd ! malntalnad as per management plan provided by plumber. -I, a �� S as per ap 1i�AAA ete plans for the system and suba* t, the ours only oqeper not to A IpdU.NOL 5) ('char ntiuc�-p ry u�AQ. s SYSTEM PLOT PLAN Project Name: Josephson 4 Bedroom Design Flow: 600 gallons/day Attach design flow calculations for ' V Project Address: 942 Fraser Lane commercial plans: BM1 Symbol: & BM Elevation: 84.55' Pipe Materials / ASTM Standard BM Description: Top or Dose Tank manhole cover Tables 364.30-3 & 384.30-5 Scale: 1" = 60' � 8M2 Symbol: Q BM Elevation: 84.25' 0 60 90 120 4" SCH 40 PVC AST 02665 BM Description: Patio Door Sille 4" SCH 3034 PVC ASTM D3034 15, Slope Gradient of Tested Area: (14%) Well Symbol (If applicable) Notes: See CSM for complete Map • I GO Property ine T1-3'x90' EZ Flow trench El. = 84.50' T2-3'x90' EZ Flow trench El. = 83.30' go� —' �'' Existing Chambers full of sand. 68� To be abandoned 86' T2 ' B�— c 14% Slope Existing 4 Driveway m J m Bedroom m BM1 House arag BM2 Detached o Existing WLP12001800-MR Garage o Septic/Dose Tank C) Existing Property Line Well GGP� Page 2 CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Josephson 4 Bedroom Replacement Drain Field Owners Name: Charles & Heather Josephson Owner's Address 942 Fraser Lane Hudson, WI 54016 Legal Description: NW1/4, SWl/4, S14, T29N, R19W Township Hudson County: St. Croix Subdivision Name: Sweet Grass Farm Lot Number: 70 Block Number Parcel I.D. Number 020-1376-70-000 Plan Transaction No. Designer Date: Signatur Page 1 Index and title Page 2 Plot Plan Page 3 Septic & Dose Tank Specifications Page 4 Existing Tank certification Page 5 Effluent Filter Information Page 6 Dose Tank Cross Section Page 7 Pump Curve & Specifications 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 e: John Schmitt Licnese Number: MPRS 223760 6/26/2022 I/ Phone Number: 715-760-0486 In -Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 SYSTEM PLOT PLAN Project Name: Josephson 4 Bedroom Design Flow: 500 gallona/day Attach design How calculations for N Project Address: 942 Fraser Lane commercial plans: BM1 Symbol: A BM Elevation: 64.55' Pipe Materials / ASTM Standard BM Description: Top of Dose Tank manhole cover Tables 384.303 8 384.30-5 Scale: 1 ° = 60' BM2 Symbol L BM Elevation: 84.25' 0 60 90 120 4" SCH 40 PVC ASTM D2ee5 BM Description:Patio Door Silk 4" SCH 3034 PVC ASTM D3034 15' Slope Gradient of Tested Area: (14%) Well Symbol (if applicable) Notes: See CSM for complete Map Property Line T1-3'x90' EZ Flow trench El. = 84.50' T2-3'x90' EZ Flow trench El. = 83.30' 9Q\ Existing Chambers full of sand. 6' \ To be abandoned 85, T2 8 c m 14% Slope Existing 4 Driveway N Bedroom m BM1 House arag LL --- 8102 Detached oExisting WLP1200/800-MR Garage o- Septic/Dose Tank O Existing well Property Line Page 2 53" AS y REQUIRED DA 41" Z 8' r m C UP 5" ~ Z 4" CAS C J-6 m0AO�o�D r m 3" n Mr>A mm At�II - -TaiIIII'I�1III1 I D - ` _ O .�-UP 36" rr-- --- -- ------ ro 1�- 4" CPLR j 4" CPLR v I I II II it II m I if it c m 'll 1 I 1 II 11 m l II I' z'D------- fir_='= __ A — V n UP 7" z 0 4" CAS o a I 39" rm D rn a r O -1r0 -4 r r Z Z p z'4 'A2' A z p ot�n� ,- QrnozEED 00> I� i d> C) 0 m�p"z >Z =oo 0 'js�j� 2 H X; o z O >0 A 2 O to p 1< f OC: T � Z Dot GG Z oW C y I �l- p.1 •A Oa 7R 20 ymm co c D �O�p0 >fn 2 CO NW m-1 Dm A W y - a g p D m m z '� c�i D w W ^ o °° r pp m o U% N a g Tl 5 s $ In 4- C:)z o 6" OH * 0 xz c 0C) � g po � m 0 m m A .n CD D �Dmi Z -q 00D ^ZiO N tim nO m D o D O o D ►3-I .. > Z Z7 r r^ A Ln Ln v i LlWLP1200-800—MR SCALE' I/4' a 7'-0" REV. DATE M'EBER CCDCAETE DRAWN BY: WCPSEPnC MANUAL W3716 US HWY 10, MAIDEN ROCK, N 54750 GATE' 00/DD/00 POST-POURI 800-325-8456 FILE wIp1200-800-mr 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)942 Fraser Lane located at: NW '/4, SW 1/4, Section 14 , Town 29 N, Range 19 W, Town of Hudson , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes Nox (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1200/800 Construction: Prefab Concrete x Steel Manufacturer (if known): wfeser Age of Tank (if known): 9127/2005 ,--„- -„ Permit number (if known) 405136 John Schmitt (4ensed Plumber Signature) (Print Name) MPRS (Title) 7-13 ZZ (Date) 223760 Other (License Number) MP/MPRS Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145,06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Page 4 PAGE 2 of 2 The interval for servicing septic tanks is set by state and local code. Throughout the United States, there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel filter, which does not increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped. However, our filter is virtually self-cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged particles to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFilter0 alarm, you will be notified by an alarm when the filter needs servicing. Step 1: Locate the outlet of the septic tank and remove the tank cover. Step 4: While holding the cartridge over the access opening, rinse off the cartridge with fresh water, being careful to rinse all septage material back into the lank. Step 2: Remove the tank cover and pump the tank if necessary to prevent any solids from escaping to the the drain field when the filter is removed. Step S: Insert the filter cartridge back in the case, making sure the filter cartridge is properly aligned and completely inserted in the case. Replace the septic tank cover. Step 2: Firmly pull the filter handle and slide the cartridge out of the case. (a Residential Applications Certified toANSVNSF Standard 46 Copyright 2014, Polylok, Inc. All lights raaervad Pfodpct(a) eov►rid by mre or more U S and/or tntoma0onal patanle. Other U.S. and tntRnanonatpaNnts may ba pandlnp Page 5 PAGE 5OF6 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) A°(A \Inns Gin.. IMPORTANT: N vent cap Anchor tank(s) as necessary pursuant to SPS 383.43(8)(g) Finished Grade CAPACITIES @ 22.24 gal/in Depth (in) Volume (gal) A 18 400.32 B 2.0 44.48 [C] 5 111.20 D 11 244.64 *Pump Tank Liquid Level = 36 in Force Main Diameter = 2 in Force Main Length = 110ft ry Force Main Void Volume = 17.93 gal Electccal must comply wth BPS 316 and NEC 300 Extend manhole user as necessa HO�e A I� A'snr B l�—On I t�l Pump ON c 3" Approved Bedding Malarial BarwalP Tank [ C] Total Dose Volume TDV = 127.93 gal/dose (5X total lateral void volume <TDV <0.2X design flow) + (force main drainback volume) MIN. PUMP DISCHARGE RATE = 20 gpm ..I �Approved Joints wlh Approved! Pipe 3 ft onto Solid Ground (typical) PUMP -OFF ELEVATION = 77.77 ft INSIDE BOTTOM ELEVATION = 76•85 ft Vertical Head = 7.23 ft + Min. Supply Head = 0 ft + FM Friction Loss = 1.012 ft + Fitting Loss' = 0 ft '(min. supply head x 0.3) — = TOTAL DYNAMIC HEAD = 8•24 ft PUMP TANK: SEPTIC TANK(S): Volume = 800 gal Total Volume = 1200 gal Manufacturer: Wieser Concrete Manufacturer(s): Wieser Concrete Pump Manufacturer: Gould Install approved effluent filter at the septic tank outlet Pump Model EP05 (See attached DUMP ddfve.) immediately upstream of the fpump tank Inlet. Controls/Alarm Manufacturer: Existing Filter Manufacturer: Zabel Controls/Alarm Model: Existing I Filter Model: A-100 Float switches containing mercury are prohibited. rage o Wastewater METERS FEET 10 9 30 8 / Q 25 W V_ 6 20 Q Z 5 C1 15 J 4 I.. O ~ 3 2 5 0 0 1 0 2 4 6 8 10 12 m3/h CAPACITY MODEL INFORMATION Omer Minimum Float Cord Discharge Minimum Minimum Minimum Maximum Shipping Number HP Vohs Amps Circuit Phase Swkch length Connection On Level Off Level Basin Solids Weight Breaker Style Diameter Size Ibs.kg EP0411F 115 12 20 Plug No Switch20' Manual Manual 2019.1 EP0411AC Piggyback / 12" 6" 21 / 9.5 .4 1 Wide -Angle Ul 15" YA" EP0412 230 6 10 Plug No Switch 10' Manual Manual 20/9.1 EP0412F Plug 1 No Switch 20' Manual Manual 20 / 9.1 EP0511 F 115 13 20 Plug / No Switch Manual Manual 22110 EP0511AC Piggyback / 12" 6" 23 / 10A .5 Wide -Angle EPD512F 230 "5 10 PlugNo Switch Manual Manual 22110 PAGE 3 Page 7 N I o (D Va' C) -C w C Vf i 0 .0 F-- Ll > Z L11 D MO LL V Q- I Q) Z U-15 LDm ;= J fi2} $E r E W O a a 02 0 8 W O CL N N M r I m P l ... "so 00 — uJ 63 C - c E N O L w to T I I O N U .s o m n > a, W E > co PAGE 3 UP 5 v a g i t 8 c C i ro U J a � a711 0 E O a I I I I' y W .'b' CM CD r I I a I y G C Page 8 Installation Instructions for EZ#0u, Systems in Wisconsin Wisconsin Department of Commerce, Saiet) and Buildings Division, has reviewed the specifications and/or plans for this product and determined it to be in compliance with chapters Comm 82 through 84, Wisconsin Admin. Code, and Chapters 145 and 160, Wisconsin Statutes. All sites must meet the Site & Soil Conditions & Locations & Isolation distances as noted in local regulations. The approved products are 1203H (3-12' bundles with pipe in center bundle in 5' or 10' lengths) and 1203HF (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 is held together with poly- ehtylene netting. A single aggregate bundle contains aggregate only and is held together with polyethylene 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 of EZfiow products are given below. This product must be installed In accordance with state rules defined in chapters Comm 82 through 84, Wisconsin Ad- ministrative Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design manual. 1. After the local health department has determined sizing, - configuration, and layout for the EZfiow systems, stake or mark with paint the location of trenches and lines. Be : careful to set correct tank, invert pipe, header line or dis- tribution box and trench bottom elevations before instal- : lation of pipe bundles. : 2. Remove plastic EZflow shipping bags prior to placing : bundles in the trench(es). Remove any plastic bags in the trench before system is covered. 3. This product must have geotextile fabric that meets re- quirements of s. Comm 64.30 (6) (9), Wis. Adm. Code, installed directly on top 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, the trench should be dug to a width of 36 inches. Tiis not only saves labor in excava- tion, but also provides better load -bearing capacity after backfilling is complete. : EZf,ozv7U by INFILTRATOR 5. The Absorption area (SF) necessary for a given site shall be sized based on maximum daily sewage flow (GPD) and the Permeability for the site. If certain criteria is met, the EISA sizing can be used in Wisconsin, resulting in a 40% smaller drainf eld. 6. Place EZfiow oundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- lar 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 bur- dles and do not require any type of connection. 7. The top of each GED cylinder contains a filter fabric pre - manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer snail make sure the the GEO is positioned upward and Is in contact with the fabric contained in the adjacent cylin- der before backfiUing. 8. The EZflow Drainfield Systems should be installed in a level trench in all directions (both across and along the trench bottom) 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 central bundle distribution pipe interconnected, without any dams, stepdowns or other water sops. 9. The trenrh top shall oe graded such that water will not pond. Backfill should be seeded or sodded Immediately after completion to reduce erosion. 10. EZfiow 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 EZfiow assemblies to float out of ground when ponding occurs. Field experience 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 Gentextile. i Material Page 9 In -ground Dosed -Gravity Management Plan IMPORTANT: PAGE 4 OF 4 The owner of this in -ground dosed -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 = • 111 gpd; BOD3 5 220 nrl TSS <-150 nrl FOG 5 30 mgL" Inspection Checklist INSPECT EVERY 3 YEARS c type of use o age of system c nuisance factors (i.e. odors, user complaints, etc.) c mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e.. leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) e extent of ponding in distribution cell prior to dosing c dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) 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 tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin, Code. Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: John Schmitt Phone: 715-760-0486 Local government unit: St. Croix County Community Development Phone: 715-386-4680 Local government unit address: 1101 Carmichael Road, Hudson, WI ZIP: 54025 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 ST Cuo,l LJNTY SANITARY SYSTEM File #: nly OWNERSHIP/ADDRESS FORM Creaed ce n0 7 Community Development Department will utilize this Information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Charles & Heather Josephson Mailing Address 942 Fraser Lane City/state/Zip Hudson, WI 54016 Phone Number (required)715-642-1729 Email Address (recuired)CJOsephson@Q Outlook.com Parcel Identification Number 020-1376-70-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location NW '/4 , SW 1/4 , Sec. 14 T 29 N R 19 W, Town of Hudson Subdivision Plat: Sweet Grass Farm Lot # 70 Certified Survey Map # NSA Volume . Page # Warranty Deed # 984884 (before 2006)Volume Page # Number of bedrooms 4 Spec house 0 yes ■ no Lot lines identifiable ■ yes 0 no OFFICE USE ONLY New Property Address (Verification of ew address required from Community Development Department for new construction.) (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Regrster 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 r s wi rw_ 1101 Carmichael Road, Hudson, WI 54016 svww'�s.4wfggy Page 11 SWEET GRASS FARM LOOATED IN THE/WI/4 OF THENWI/4, INTHE 6KV4 OF THE NWIµ, IN THEW 4OF THE Dwt/4,11,,0,TH[NEI/4 OF THE EWI/4. IN THE 6Wl%4 OP TN8 EWIµ AND PART OPTHE MIµ OF THE OWI14 OF SECTION 14 AND PANT OF THE NW I �4 OF THE NWI /4 AND PAIR OR THE NEI ra OF THE NW/µ OP SECTION 23, ALL IN TEEN, HIEW, TOWN OF HVOEON, ET. CROIX COUNTY, WISCONSIN- I uttc»u .ivSL' IC h 1L:.. w.ft- . ....... n,.. I 1 I I i __ _ 0 '•' n w _.. .. •_ NM9111F lYl SRS.� fi HOAR—yT-�«. - I i I 6 I LOT 78 ( LOTS c I� 9 ' I E O LOT 44 ' '� I LOT n7 LOT 77 T 47 ° � . Y•.,.... ;.� ++ LOT 48 IvnFI ,a ly an ::M'b p i LOp76 Q a LOT LOT�49 p It .n a«a Z LOT 75 • ^«.,«,O C` Y ! i ' �Y•wpYD �r1 �� FI, I LOT 42 «., a LOT So y LOT 74 LOT 41 r LOI 51 �w ` LOT 73 ..:Y:. i LOT 40 iJd iwn I i r «6. � I LOT 52 Y i LOT>p LOT 39 'a,a- •o-•«,Y.0 �x Y.r..�,r LOT 53 4 LOT 71iV LOT 38'" - 4' f L7f 54 i$ dQN LOT 37 E r - _ I DuroLw yy� •/a.YY S. �,HxM 1 s 1 • � M F . I Y • \ »« .•. d I _ _ VA>T'l, rJuf ^Pf ��, 1.dY .a, r .. ... WTCX LA'F P£L - _. ,.rx. «�w n.Rn e4..e.>•ro. RICHYIDO. E11,0L1T i L_!_a_N_D SXCR(J DF f " - ....,n., rmx-•se•n: . .rx. wr.+•rer.».,.tr•vY. JANEf F. STOUT ti8a AWATKMTR L I • iYy!»rv+_Nw,a 4r'm. M.rt.S1•• O ,xtr,n rtY»^i.,�r<�� .,n•wv�^ »S4 M1., r«.. v.. m.m.�.,«. ' I ,aunrrsr -Vry •• �. / r .a r n •.wv o- �•-.. x+ 'M� � CCAIG IN FEET f' . 1 W' too ENEET T OF E sH[ETe Page 13 CCC�Lh OMD Is f .4 s>�ety 2 8 Z02ZSOIL�EVALUATION @EfORT ` = s in scco nce with Comm 85, Wis. Adm. Code P nal r� jx counc� I CsT�vd4 - l37 $2212 Page 1 of 4 SchmlR Soil Testing, Inc. un [)eve ARaeh aanplete ails pet het x 1 ir�hes In sirs. Plan must Indude, but not Moiled to: vertical and horizontal referenoo point (BM), drectlon and peroenl Naps, scale or dimensl ns, north arrow, and location and distance to nearest road. Please print all /rrformnHon. Personal lnbmwWn YOU P VVWe may Ce used hx seoontlary WPoaW (Pm' W taw, A. 15.04 (1) (m)). County St. Cron Parcel I.D. 020-1376-70-OW a to =4AA&AA �. Property Owner Josephson, Chattels IS Heather Property Location Govt. Lot NW1/4, SW1/4, S14, T291N, R19W Property Owner's Melling Address 942 Fraser Lane Lot 0 70 Block a Subd. Name or CSW Sheet Grass Farm City State Zip Cade Phone Number Hudson WI 1 54018 1 715-642-1729 U City Lj Village 7 Town Nearest Road Hudson I Fraser Lane j Now CanWuclion lice: E] Residential / Number of bedrooms 4 Code derived design Row rate SIX) GPD Replacement ❑ Public or commercial - Describe: Parent material Outwash (Surkt►ardt-Satire Complex) Flood plain elevation, i1 applicable NA R. General comments Replacement area is suitable for a conventional system with a 0.7 gpolKft rate. Ponilie system eievelion for the replaosmenl and recommendations: is 84.W (high trench), 83.30'. Scope of area Is 14%. / t 1 ❑ Boring Cs� Boring ae I`] Ph Ground surface etev. 88.52 R. Depth to limiting factor 98+ in. Still —Application Rate Horton Depth in. Dominant Color Munseli RedoxDescription Ou. SL Cont. Color Texture G. Consists Boundary Roots GPDfle •Eml1 E1M2 1 0-9 10yr3/3 none si 72mgr mvfr as ivr 0.6 1.0 2 9-17 10yr3/3 none si mfr gW 1vf 0.4 0.7 3 17-25 10yr4/4 none grst 2rnsbk mvfr gW 1vf 0.6 1.0 4 25-48 10yr5/6 none grcos Osg ml Cs - - 0.7 1.6 5 48-98 10yr6/4 none s 0s9 ml — 0.7 1.6 .2.q Z,1-j 2•V' . 6 `{ Boring 0 p BoringFil Ground surface elev. 88.52 R. Depth to smtii factor 96+ in. n9 Still Application Rate Horton Depth In. Dominant Color Murrell Redox Description Qu. Sr- Cont. Color Texture Structure Cortsiste Gr. Sz. Sh. Boundary Roots GPDMF •Emal 'EM2 1 012 10yr3/3 none sl 2mgr ! mvfr as 1vf 0.6 1.0 2 12-26 10yr3/3 none sl 2msbk mfr gW 1vf 0.6 1.0 3 26-41 10yr5/6 —none Is 059 ml a 0.7 1.6 4 41-96 10yr6/4 none 5 059 ml — 0.7 1.6 Effluent 01 = ODD? 30 4 220 mg/L and TSS >30 4 150 mg/L ' Effluent #2 = BOO c 30 mg/L and TSS s 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt- .. 227429 Addre» Schmitt Soll Testing, Inc. T Date Evaluation Conducted Telephone Number 160 72nd St New Rkhmond, Mrl 54017 6/22R022 715-7M1978 seoarfeamnm � X� Property Owner Josephson, Charles & Heather Parcel ID # 020-1376-70-000 Page 2 of 4 F Bow # n Boring P8 Ground surface elev. $5.87 ft. Depth to Ilmlting factor 98+ In. Soin Applcation Rate Horizon Depth In. Dominant Color Mutlsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' •En#1 -EBs2 1 0-10 10yr3/3 none si 2mgr mvfr as 1Vf 0.6 1.0 2 10-23 10yr3/4 none $i 2msbk mfr gw 1vf 0.6 1.0 3 23-36 10yr4/4 none grsl 2msbk mfr gw 1vf 0.6 1.0 4 36-53 10yr5/6 none 91's 099 ml CS -- 0.7 1.6 5 53-98 10yr6/4 none s Osg I ml -- — — — 0.7 1.6 Bing # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth In. Dominant Color Munseil Redox Descripton Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' -EM -HH#2 ❑ Boring # ❑ Boring 0Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rat Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDMP -Erf#1 *002 Effluent 01 z BODS> 30 S 220 mglL and TSS >30 � 150 mg& ' Effluent #2 = SODS < 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 serried or need material in an alternate forme[, please contact the department at 601-266-3151 or TTY 609.764-8777, sso "O pLmroot semxe Fatl TO", Inc _^T Y U ?f c U � 1 � 1 e '.IS L 1 n V ^W8 u, T N U N N N O N U co � w a < c� �n 3 - J u o - n - _ - ti C C CD II `tea g 'rnry t� m� wm= wyv m E a Z 1 es = cn p rn i~ =m o IN- 1 1 1 N N m QD p 1 00� L Q7p m cq aim O a)m iff) LL N 1 I m h cl N � 1 N. 06 C N ��"- / 0m land LONE N O _ 'd, O / nr cO cO E �LL cnNr Lv C �03�o i:. I Iand Iw ENO mho o mm U Urn= ��cnZE- ��` ,,Ro Cn N b1oCabed- Ap c Wisconsin Department of Commerce County Safety end Building Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: 405136 0 GENERAL INFORMATION r (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may tile used for secondary purposes [Privacy Law, s.15.04 (1)(m) Permit Holder's Name: Clry Village X Township Parcel Tax No: Koe ke, Jim Hudson Township 020-1376-70-000 TANK INFORMATION M Pr ERAMMME A 7 AN /� TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing �^ 7 Aeration Holding PUMP/SIPHON INFORMATION Manufacturer emand orlGPM�' —Ao //UU Model Number rpO l' TDH Lift 3•q Friction Losses System a TD Ft 2 , A a3 Forcemain Len / Dia. Z h Dist. o Well F.IellW_1:1.I•]:1ilU7:E.tiE.Y1=1d�L�1LY1/— ELEVATION DATA Benchmark Oil•Final rig Grade —. 1110.N WAVE l _ BED/TRENCH Width Length i No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BL G W LAKE/STREAM EAC NO Manuta r INFORMATION CHAMBE R I T Of System: 36' Model Number: 5�m 1�]Ec11:71:1111[a]�l.ti1.91 d, �9Wj ldiLlow-w-wFMM lHeaderiMaililaW Distribution / Pipe(s) x Hole Size x Hole Spacing f Vent to Air Intake ' Length_ Dia Length Dla Spacing ern✓Q- SOIL COVER x Prnsaura R.0i,m a Only xY Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mukhed BedlTrench Center Birrench Edges Topsoil -- u Yes ['. No [] Yes t. No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection Inspacdon #2:__L/Z'3lQ( Location: 942 Fraser Lane lHudson, -�WI 54016 (NW 114 SW 1/4 15 T29N R19W) Sweet GrassFarm Lot 70 Parcel No: 15.29.19.2331PQ 1.) Alt BM Description 2.) Bldg sewer length =� / -amount of cover=� �i , /J / n,,,_�c,� Plan revi ' fired? No'w,'t Use other side for additional information. SBD- Date Insepctors Signs re J }�-. ..- f a1lS(�e I , U O"Ot' Z'hI ch'wl l n Safety and Buildings Division County , CA"O—t Visconsin 201 W. Washington Ave., . . ox 7162 .ST Madison, WI'B37 - 71 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608)266 I51 %��s �3 Sanitary Permit Appligah State Plan I.D. Number In accord with Comm 83.21. Wis. Adm. Code, personal inform on you provide dress (ifdiffereot thm nailing address) maybe used for secondary purposes Privacy Law, sl . 1X1t�'? L' 71,�4 1. Application Information - Please Print All Information Gy(�-I-�, ' UL L Proper y Owner's Name Cc o arcel # La[ # Block # Property Owner's Mailing Add r Property Locationn �,.� p /�/¢ / p 5/7� Z/ r '�� `�_ V ' . PW %. wr/, Section L� City, Sate Zip Code Phone Number �✓/�{.��`^AV 53- OO d b;� T _-L'=-J 1; R-ZfE H. Type of Building (check all that apply) Subdivision Name CSM Number Kr 1 or 2 Family Dwelling- Number of Bedroom ❑ Public/Commercial- Describe Use ❑City_❑V iQggc �7' wnship of ❑ Sate Owned - Describe Use III. Type of Permit: (Check only one box on line A. Complete line B if applicable) '/O O A. ,ANew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. El Permit Renewal it Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Fxpiratfon Plumber Owner 7 / � (o/ a `- 05- -7 (v � .7 IV. Type of POWTS System: Check all that apply) .( Non -Pressurized tat -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Weiland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Fitter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter AlleachingChamber ❑ Drip Line ❑ Gmvel-less Pipe ❑ Other(explain) V. Dis rsaVTreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sQ System Elevatiens-5— / / f 8S7 9b y� = 84,B- Vl. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons ofunits Concrete Constructed Glass New Eaisting Tanks Tanks Septic M Holding Tank llJJft O� AercNe Trearnxat Unin Dosing Chamber VIL Responsibility Statement- 1, the undersigned, assume responsibility for lation of the POWTS shown on the attached Firms. M ber's Name (Print) Plum r Sig e M PRS Number Business Phone Number t? aa3s? 7�s-�6g Plumber's Address (Street, City, St_ e, Zi Code)' 0 , Vlll. Goigotv/Detriartment Use Only ApprovedFLUD1011mer isapproved Sanitary Permit Fee (i udes Groundwater Surcharge Fee)/ Dat Issued ISaaln gent Si nature (No S d Given Reason for Denial fQ / b IX. Conditions of Approval/Reasons for Disapproval ,, .� mot' L3/os"�?7 off n:a- Attach earaplete place (to the County poly) for the rys,trm an paper sot lass, nun St/2 a 11 unbes is nu SBD-6398 (R. 01/03) Ya- /U -�D0 e I3%t - Iao T�° PC N N It Nt 0 0 M H H w a d z d o a a IT, y w w � '� • a e b o� o d •.�.�=� i d y Y � p •8 'O a 0. �� d H W o 0.� d ,,'� a a�aF� y aei• ..0 �. se s��wN •� � 8 �z �z E.�� M w y L y C C O •�. = T•^� ^ h a. A C a y G 7 w d p o d 7 M. O~ y O .. o� va ama�eo•4 L O H e8 d U a� y v p ai ,O +A 0. C O y N T •.. H H m H C U pp N p 3 w 9 h O a N P4 7 �D CA O d CA