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Home My WebLink About020-1032-80-000Wisconsin 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)] Nord TANK INFORf#ATION TYPE TURER LSi APACITY Septic W lEs�(L ILW Dos' Aer Holdi TANK -SETBACK INFORMATION PUMP/SIPHON INFORMATION Manufacturer -- Demand GPM Model Num r TDH LiftcT oss System Head TD Ft Forcemain gth Dist. to Well SOILASSORPTION SYSTEM 13 7 JO 6a R TOWN OF HUD C� JC. Car,' x ELEVATION DATA N STATION BS HI FS ELEV. Benchmark 8 Aft. BM Bldg. Sewer �•'O 4/-al (tP Gyp St/HtInlet / 7 St/Ht Outlet / Dt Inlet Dt Bottom Header/Man. Dist. Pipe(- T. V4 9 Bot. System ! • 3 q . D ? / Final Grade //• (� ni/ b' St Cover A 3 •►o 00. M 2.Ro (OX90 I I Lv.ta e ENCH DIM idth r Length ! No. Of Trenches PR DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WE L LAKE/STREAM LEACHING CHAMBER OR UNIT Manul r I l T Of Syste rIr O i I \ ( Modej be;jDtF/ DISTRIBUTION SYSTEM (W: R•o.w`F- / Header/ManifoW Distribution x Hole Size x Hole Spacing Vent to Air Intake p / Length Dia Length Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over r« Depth of xx SeededlSodded roc Mulched BedrTrenrh Center 113ed/Trench Edges Topsoil 1__1 yes L 1 No 0 Yes Q No y�/C��C�n:958TR (include code dis a ncies, persons present, etc.) Inspecr # 9114 11��0 Z� Inspection #2: Cr LUT BROOK Dc !! '' �``__��yyI ! l 1�+G(X a 1.) All SM Description = Z, 0, f t►rti ' ^�'J� molt � • S �C K��. 2.) Bldg sewer length = 22 f 3 • SD Mom, ( te•di �%• 3 ant of coves % '"7y� C � M �Sf ia. Gt�d. Plan revision Re fired? ; Yes No O Z Z - of r side dd onal i foQaation — se s na Cart. No. df.04- �r n SN 1. 2. Industry Services Division County "y 4822 Madison Yards Way St. Croix r�•=r �= 3 202�, �UL Madison. WI 53705 Sanitary Permit Number (to be filled in by Co-) i P.O. Box5 County 707 -7 Madison W13707 -7 lopik Comm ermit Application State Transaction Number memta'unit In accordance wi . 3g3 21(2), Wis. Adm. Code, submission of this form to the appropAIS�r�s'uhrnjltodto required prior to obtaining a sanitary permit. Note Application forms for slatcowne d Projoct Address (if different than mailing address) the Department or Safety and Professional Services Personal information you provide may be used for secondary purposes to accordance with the Privacy I aw, s 15 04(1)tm ). Stats. S2V14 e 1. Application Information - Please Print All Information Property Owner's Name Yarcel ft Fredrice Nord / Glenn Hause p 9W, tarr1.j(, T,eu 020-1032-80-000 Property Owner's Mailing Address Property Location 958 Trout Brook Road Govi lot City. Stale Zip Code Phone Number Hudson Wi. 154016 612-849-0573 SW , NW Section 17 .1. 29 N R 19 F, or W 11. Type of Building (cheek all that apply) Lot p OI m 2 Family Dwelling - Number of Bedrooms 3 —� Subdivision Name �ttbhcJCommeretal Describe l lsc QJ{J 441C Mock N licIty of -� dlageof 'tale (Tuned - Describe Use CSM Number E t/ Drown of Hudson III. Type of POWTS Permit: (Ghee ither "Newt" or "Replacement" mod other applicable on line A. Check one box on line B. Complete list C if ap ble A. [::]New System ✓ eplacement Syste ❑Other Modification to Existing System (explain) Additional Pretreatment Unit (explain) ) & Diolding Tank v/ In-(imund El4t-Grade Mound Individual Site Design Other Type (explain) P ) P C. ❑ Renewal Before E]Rcvision -hange of Plumber 1:11'ransfer to New (honer List Previous Pcmmtt Number and Date Issued I:xptralton IV. - Dispersallrremtment Area and Tank Information: ( X ( D"rCAW Design flow (gpd) Design Soil Application Rau(gpolst) I isperml Area Required (sl) Dispersal Area Proposed (sf) System Elevation 450 .7 642.85 669_ 413rp 94.75 Capacity in 'Total H of Manufitclurcr 'Tank Information Gallons Gallons hints D ((� �� ['� PO�(11[� 52.5_ o T u etv N'Tanks F.xistmg Tanks IIJJ o s 2 y y 5 a ir cn zg v u. septic o Ifofding Tan► 1000 Poly-Lok 525 1000 Wieser Dosing Chamber I M == PR V. Responsibility Statement- 1, the onderiiii assame rillsponsibillilly for lasts oo of the S shown om the attached plans. Plumber's Name (Print) Plumhc ggauuc MP/MPRS Number Business Phone Number Keith Knudtson 8443 651470-1737 Plumber's Address (Street, City, State. Ztp 927 150th Street, Roberts,Wi. 54023 VI. CountylDepartment Ilse Only �,Approvcd ❑ Dlsap rorov�/� Paine Ice Date Issued Issuing Agent Signature ❑t<en mural Reason or Conditions fApprova TEM OWN optic tank, effluent filter and ispersal cell must be serviced ! malNelned s per management plan provided by plumber. II setback requirements must be maintained 4) � x Y�,� rNp. iii ,Q W�rwj:zh� s per applicable code/ordinances. " f Aflaca m complete plans for the system and submit to the County soh oo aprr not [ IR a 1 I etches in sae SBD-6398 (R. 0321) Page 3 of 3 OCOPY 0 so 40 G-PWO Boole (FeeU 1 +nax - 40 & 443' P/L Top of Tank Cleanout = 100.55' Proposed Tank Grade = 99.02' Bldg. @ Home = 96.63' Grade @ Dry Well = 98.62' Dry Well S.E. = 93.62' BM — Bottom of Sidng S.E. House Corner * HRP = Same ASSUMED ELEV. — 100.00' ' = Backhoe Pit Hite Plan For. Frederice Nord Parcel in SWIM - NW IM Sec.17 T29N-R19W Town of Hudson - St Croix County 1.70 Acre Panel Brushy Slope P/L 98.00' 13% I s as 99.00'� Site is open yard `l3o�£2f Three Bedroom t 2 Home B D Garage Home E T l 6 B k1 Ay greU Existing Septic Tank Proposed Septic Tank /ODOgae L / Mt FN# / TroutBr Brook Rd CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Nord Sewer Owners Name: Fredrice Nord Owner's Address: 958 Trout Brook Road Hudson Wi.54016 Legal Description: SW 1 /4N W 1 /4 S 17 T29N R 19 W Township: Hudson County: St. Croix Subdivision Name: Lot Number. Parcel ID Number 020-1032-80-000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross -Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Page 7 Page 8 Page 9 Management Plan St. Croix Cty Septic Tank Maintenance Form Warranty Deed CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber. Keith Knudtson License Number: 648443 Date: 06/13/2022 Ph o Number (651)470-1737 Signature Designed pursuant to the In -Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 Page 3 of 3 0 20 40 cr.pe+e Basic (het) i Imb s 40 R Proposed Cell GE Elevation Data B# I = 99.08' B#2 = 99.09' B#3 = 98.00' Top of Tank Clcanout = 100.55' Proposed Tank Grade = 99.02' Bldg. @ Home = -- 96.63' Grade @ Dry Well = 98.62' Dry Well S.E. = 93.62' BM — Bottom of Sidng S.E. House Corner * MP=Same iite Plan For: Frederice Nord Parcel in SWIM - NW1/4 Sec.17 T29N-R19W Town of Hudson - St. Croix County 443' 1.70 Acre Parcel P/L Brushy Slope AE 98.00' 13% 98.50' , B n-t 99.00: Site is open yard. `l3o�f2i Three Bedroom , 2 Home B D Garage EL • a1 �7' WExisting Septic Tan��B Proposed Septic Tank AP PrVPos FN# 958 Trout Brook Rd ASSUMED ELEV. - 100.00' = Backhoe Pit SOIL ABSORPTION SYSTEM DETAIL 1 GRAVELLESS LEACHING UNIT Page_ot Project Name: No. of Cells Per Cell ft Cell width /3 Total No of n Cell Length f.Sj� sq it EISA Per Cell /y fr ft Cell Spacing sq it Total EISA Manufecbmer Model Lavine Lenath EJSA Ratlna InWator EZ120311-5ft 5.0' 25.0 Ez1203H-1Dn 10.0r 50.0 Gravelless Leaching Unit Manufacturer: �� T' 4Q fpf Gravelless Leaching Unit Model: EZ /AL p j ,yc_ AQ i Typical Cross Section Finished Grade Observation Pipe with approved cap or vent f. . .:,. Soil BacKII 3& in �Geotextile Fabric it Infiltrative Surface it 12 in L)L _ n Umiting Factor 4-0—in $lofted and Anchored Vent/ Observation Pipe with Cap .................-..:...::.. ....... ........ .......... was ... was ....... ...., Plumber/Designer Signature: Ucense lk Date: POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ' of 2 FILE INFORMATION Owner ' Permit # DESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units D1�A Estimated flow leverage) g Z�' al/day Design flow (peakl, (Estimated x 1.5) —,q al/day Soil Application Rate al/day/ft2 Standard influent/Effluent Quality Monthly average` Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD6) 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODb) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ❑ NA Fecal Conform (geometric mean) 510' cfu/100ml Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity Ij DQ al ❑ NA Septic Tank Manufacturer jv p ❑ NA Effluent Flier Manufacturer 70,0 Z _ Lto NA Effluent Flier Model ❑ NA Pump Tank Capacity al R<A Pump Tank Manufacturer &NA Pump Manufacturer 3-NA Pump Model L A Pretreatment Unit JO NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other: Dispersal Collis) ❑ NA Pli -Ground (gravity) ❑ In -Ground Ipressurizedl ❑ 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: ❑ month(s) (Maximum 3 ear(s) years) ❑ NA Pump out contents of tanks) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cellls) At least once every: ❑ rrryryoon151 this) (Maximum 3 years) B—year ❑ NA Clean effluent filter At least once every: 9rp onthls) ❑ NA B'year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) �A Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) W'NA Other: At least once every: ❑ month(s) ❑ year(s) .,/. v�� Other: $NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include 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 check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page _21 of I, - 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 that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) 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 be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. 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 within 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 POWTS: 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 products; 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 properly 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 soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ❑ A 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 required 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 technology a holding tank may be installed as a last resort to replace the failed POWTS. e alua ' o mg tank be' e ar Fff2DNl$ifga �Q �� CO(VS7RLl�7lD ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative 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 POVIITS INSTALLER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) Name dtKi - Phone _ POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Name Phone —7lS— 3O Cp— i'o This document was drafted in compliance with chapter Comm 63.22(2)(bl(1)(d)&(f) and B3.54fl), (2) & (3), Wisconsin Administrative Code. Wkonsin ^r+per Ment d Safely and Protessialal Services Mision of Industry Services SOIL EVALUATION REPORT f In accordance with SPS 385, Wis. Adm. Code CY 03324 Page 1 _of _3 - Keith Stoner CST Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must 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. Please print all imbrmatlon. Personal inMrmation you provide may be used for secondary purposes (Privacy law, s 15.04 (1) (m)). County St. Crobr - Parcel I.D. 020-0132430.000 Reviewed By Data Property Owner Fredrice Hord Property Owners Malting Address — - 958 Trout Brook Rd City State Zip Code Phone Number Hudson WI 1 54016 1 Property Location lr'1 Govt. Lot SWIM, NW1/4, S17, T29N, R19W Lot i Bbck t Subd. Name or CSW ( _] Cky F ( Village N Town Nearest Road Hudson i Same ( ,( New Construction Use: (9 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement (_� Public or commercial - Describe: _ Parent material Set OUMMaSh __ __ _ Flood plain elevation, if applicable NA ft. General comments Propose one 3 x 134' dispersal cell centered over the approximate 98.75' contour with a system elevation = 94.76. and recommendations: oBoring . Boring Oft Ground surface elev. 99.08 ft. Depth to limiting factor >94 kt. Soil Application Reba Horizon Dapth In. Dominant Color MurtseH Redox Description Ou. Sz. Cont. Color Texture Structure Consists Gr. Sz. Sh. Bourdery Roots GPDMI 'EM1 •EIR2 1 0-6 7.5YR2.5/2 Is lfgr mvfr a 3f-m 0.7 1.6 2 6-21 7.5YR3/4 _ - is 099 mt gs 3f-o 0.7 1.6 3 21-30 7.5YR4/4 -- - - Is - -- 0s9 - - ml gs 2f-m 0.7 1.6 4 30-39 5YR4/4 - gr Osg ml gs 2f-m 0.7 1.6 5 39-94 7.5YR5/4 --- srs5 -- 099 ml - 0.7 1.6 ❑ Boring f ( ] B01in9 Oft Ground surface--- - ace elev. 99.09 ft. Depth to limiting factor >106 __in- Soil Application Reba Horizon I Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Consistence Gr. Sz. Sh. Boundary Roots GPDMi2 _ •EfMt •Efl/2 1 0-6 7.5YR2.5/2 — --- - I Is lfgr 099 mvfr a 3f-m 0.7 1.6 2 6-24 7.5YR3/4 -- Is ml gs 3f-m 0.7 1.6 3 24-34 7.5YR4/4 Is srs 099 --099 -- m1 gs 2f-Co 0.7 1.6 4 34-106 7.5YR5/4 ml 2f-m 0.7 1.6 Fllluent #1 = BOD s> 30 < 220 mg/L and TSS >30 < 150 mg/L Ftftrlem aF2 = BODS c :tu mgrL NO 1455 S au MWL CST Name (Please Print) Signature: CST Number Keith Stoner — ! fj7AF 224059 - Address Keith Stoner CST jj Date Evaluation Conducted Telephone Number 23220 Wood Creek Rd Siren, WI 54872 6/7/2018 715-566-0900 seo-awncarin> Property owner Fredf'foe Nord _ Parcel ID / 020-0132-80-000 _ Pape 2 of 3 _ 3 u Boring Boring N Pit Ground surface elev. _ 98.00 ,. ft. Depth to limiting farmer >97 In. ISO ApplWW Rate Horizon Depth In. Dominant Color Munsall Redoz Description Qu. Sz. Cont. Color Tarlhtra Structure Constance Gr. Sz. Sh Boundary Roots GPDW •EW 'EfW2 1 0-3 7.5YR2.5/2 7.5YR3/4 - - Is lfgr rrfvfr is 3f-m 0.7 1.6 2 3-6 Is Osg ml 95 3f-o 0.7 1.6 3 6.12 7.5YR4/4 - gr Is Os9 Will CIS 3IF-w 0.7 1.6 4 12-27 7.5YR4/4 7.5YR5/4 - S Osg rrd ml 9S - 21F-m - 0.7 0.7 1.6 1.6 5 27-97 Sits Osg Borng s I BOf V [� Pill Ground surface elev. -ft. Depth to limiting factor _ In. SoN Application Rate Horizon Depth in. Dominant Color Radox Description Munsell Qu. Sz. Cont. Color Texture Structure Consistence Gr. Sz. Sh. Boundary Rook GPDAV •Effft •Erra2 Boring Boring 8 ' Pit Ground surface elev. . _._ _ -. ft. Depth to limiting factor _ in Sofl Application Rele Horizon Depth Dominant Color in. Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 1 GPDXP 'E1fat 'Hw2 / � Y �"�'�� c o�� Ufa 5/ �i17/8 • EffueM 01 - BODS> 30 < 220 mg/L and TSS >30 <150 rng/L • Effluent 02 - BODS < 30 ng/L and TSS - 30 mpll Property Owner Fredrke Nord pa" ID # 020-0132-OD-000 Page _?__of 3 - 3] Boring #r Boring ® Pit Ground surface elev. 98.00 ft. Depth to limiting factor >97 in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDAP 'Ettst 'Efra2 1 0.3 7.5YR2.5/2 - Is lfgr mvfr Cs 3f-m 0.7 1.6 2 3-6 7.5YR3/4 - Is Osg M gS 3f-o 0.7 1.6 3 6-12 7.5YR4/4 - gr Is Osg m< gs 3f m 0.7 1.6 4 12-27 7.5YR4/4 - S OSg a gS 2f-m 0.7 1-6 5 27-97 7.5YR5/4 - srs Osg ml - - 0.7 1.6 Boring Boring ❑ Ph Ground surface elev. _ ft. Depth to limiting factor in. Sol Appilcatlon Rate Horizon Depth in. Dominant Color Munsell Redox Desorption Qu. Sz Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDAI' M'EfW2 D Boring Boring D P t Ground surface elev. ft. Depth to limiting factor In, Sory Application Rate Horezon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. ConsWenca Boundary Roots GPD/W 'Effat 'E11a2 417110 • Moo tl a t30D5> 30 <_ 22o mg& and TSS >30 � 150 mg& ' Effmant #2 = BODS -S 30 mglL and TSS <_30 mg& B r Page 3 of 3 0 20 40 c+.pldc em. t>•aerl I Ineb - 40 t! Proposed Cell GE Elevation Data B# 1 = 99.08' B#2 99.09' B#3 _ 98.00' Top of Tank Cleanout _ 100.55' Proposed Tank Grade = 99.02' Bldg. @ Home = -- 96.63' Grade @ Dry Well = 98.62' Dry Well S.E. = 9.1,62' BM — Bottom of Sidng S.E. Noose Corner * EMP—Same ASSUMED ELEV. — 100.00' = Backhoe Pit 443F P/L Soil Test Site Plan For: Frederice Nord Parcel in SW1/4 - NWI/4 Sec. 17 T29N-R19W Town of Hudson - St. Croix County 1.70 Acre Parcel P/L Brushy Slope 98.00' 13% 98•SO /99.00'1'�a Site is open yard Three Bedroom Home • wEL # B n Garage OO sat Dry Well 0 Existing Septic Tank Proposed Septic Tarot June 7th,2018 Keith E. Stoner CST# 224059 ST. Clto NTY SANITARY SYSTEM File #: Office Use Only r®" OWNERSHIP/ADDRESS FORM umaftd21202, Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. OWNER/BUYER INFORMATION Owner/Buyer Mailing Addrf City/State/Zip Lb-KJ so n 1i C t i 1 54 0 1(c / Phone Number (required) G1 J S54Cii—0 S/dos 2-&SS ,(o390 Email Address (required) ran( ciQ�JZ� �ff�a CD m Parcel Identification Number (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SvJ 1/4 ,/J W 1/4 , Seca T ftN R/ 9 W, Town of !)SD►� Subdivision Plat: (We - ,Certified Survey Map # v — Volume . Page # Try' Wa entyJ y Deed # �-(before 2006)Volume . Page # Number of bedrooms New Property Address (Staff Initials) Lot # Spec house O yes O no Lot lines identifiable O yes E3 no OFFICE USE ONLY (Venfiration of new addrep6ecquired from Community Development Department for new construction.) (Date) This form must be submitted with all Private Onsite Water Treatment System (POINTS) 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 cdd(a)sccwi.00v 1101 Carmichael Road, Hudson, WI 54016 www.sccwioov YMeoateYt ' ' $ 0 201$ SOIL T ,UN in accordance with SPS W5, Wis. Adm. Code C5-r -do 13-lac #=4 Page 1 of 3 Keith Stoner CST r oU�tY Attach plete sdel,IluV han 8'r4 x 11 inches in size. Plan must Ctwrtty St. Croix include, not lir�i(gt¢(q: horizontal reference point (BM), direction and percent mansions, north arrow, and location and distance to nearest road. Parcel I.D. 0-000 Please print all inforinformation.02032 ' Re By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �J -41- V==�L at 1/ / Property Owner Property Location 1`11 Fredrioe Nord Govt. Lot SW1/4, 1/4, S17, T29N, R19W Property Owners Mailing Address Lot # Block # Subd. Na or GSM/ 958 Trout Brook Rd City Stalls Zip Code Phone Number City ' Village N Tam Nearest Road Hudson I WI 1 54016 1 Hudson Same ❑ New Constriction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ]C Replacement Public or commercial - Describe: Parent material Sandy Outmsh Flood plain elevation, if applicable NA ft. General comments Propose one 3 x 134' dispersal cell centered over the approximate 98.75' contour with a system elevation = 94.75'. and recommendations: Boring # Boring Ground 99.08 Pit surface elev. _ ft. Depth to limiting factor >94 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Co Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -EM1 '011112 1 0.6 7.5YR2.5/2 Is lfgr mvfr ml a gs 3f-co 3f-oo 0.7 0.7 1.6 1.6 2 6-21 7.5YR3/4 Is NEI 3 21-30 7.5YR4/4 - Is Osg ml gs 2f-co 0.7 1.6 4 30-39 5YR4/4 - gr s OSg mI gs 2f-m 0.7 1.6 5 39-94 7.5YR5/4 - srs row ml - - 0.7 1.6 r T Q Z Boring # Boring Ground 99.09 Soil Applicatlort Rate Pit surface elev. ft. Depth to limiting factor > 106 1n. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPW in. Munsell Qu. Sz. Cont. Color Gr Sz Sh 'EfM IMI 1 0-6 7.5YR2.5/2 Is ifgr mvfr cs 3f-m 0.7 1.6 2 6-24 7.5YR3/4 Is 099 ml gs 3f-co 0.7 1.6 3 24-34 7.5YR4/4 Is 059 ml gs 2f-ao 0.7 1.6 4 3+106 7.5YR5/4 - srs Ogg ml 2f-M 0.7 1.6 I Z IS • Eft UNA #1 - BODe 30 < 220 miYL and TSS >30 < 150 mgA. qffiuwd #2 = BOO <_30 rite/_ and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Keith Stoner ho 224059 Address Keith Stoner CST Date Evaluation Conducted Telephone Number 23220 Wood Creek Rd Siren, WI 54872 6/72018 7155-566-0900 seo-uw(Rmm) Property owner Fredi ice Nord Parcel ID f 020-0132-SD-000 Paps 2 d 3 Boring • Boring Pit Ground surface elev. 98.00 ft. Depth to limiting factor >97 in, Soil Application Rate Horizon Depth Dominant Color in. Munsell Redox Description Qu. Sz. Cont. Color Texture Stntduro Gr. Sz. Sh. Consistence Boundary Rods GPDW �Ettri 'EM2 1 0-3 7.SYR2.5/2 - Is lfgr mvfr a 3f-m 0.7 1.6 2 3-6 7.5YR3/4 - Is Osg Mil gs 3f-ao 0.7 1.6 3 6-12 7.5YR4/4 - grIs Ogg ml gs 3f-oo 0.7 1.6 4 12-27 7.5YR4/4 - s Osg ffd gs 2f-m 0.7 1.6 5 27-97 7.5YR5/4 - srs Osg ml - 0.7 1.6 lr Boring [� Boring I Pit Ground surface elev. —_ _— ft. Depth to limiting factor in. --- Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Consistence Boundary I Roots Gr. Sz. Sh GPDAt' 'E1f/1 'Ef X2 Boring Boring * Pit Ground surface elev. ft. Depth to limiting factor in. — Soil Application Rate Horizon Depth Dominant Color Redox Description in. Munsell Qu. Sz. Cont. Color Texture Structure Consistence', Boundary I Gr Sz. Sh. Rods GPDNe 'ERl1 1082 Effluent #1 - BOD5> 30 < 220 mg& and TSS >30 < 150 mgA- OhW* �l7 /8 Effluent •2 = BOD5 < 30 mgl- and TSS <30 mg& I 4 Page 3 of 3 0 20 40 omphlc Scala (►ant) t loch - 40 R 443' P/L Proposed Cell CT Elevation Data B# 1 = 99.08' B#2 — 99.09' B#3 = 98.00' Top of Tank Cleanout = 100.55' Proposed Tank Grade = 99.02' Bldg. n Home = - 96.63' Grade @ Dry Well - 98.62' Dry Well S.E. = 93.62' OK. BM- Bottom of Sidng S.E. House Corner _ HRP — Same — Soil Test Site Plan For: Frederice Nord Parcel in SWIM - NW1/4 Sec. 17 T29N-R19W Town of Hudson - St. Croix County 1.70 Acre Parcel 99.0041-e�2 Site is open yard. Garage Three 1 Home Brushy Slope 13% 'B #3 00 \ B 2 D OO B # I H/Y Well Existing Septic Tank Proposed Septic Tank FN# 958 Trout Brook Rd P/L ASSUMED ELEV. - 100.00' June 7th, 2018 1 = Bacithoe Pit F71!Ceith E. Stoner CST# 224059 CROIX.COUN-ry No. 644745 STATE SANITARY PERMIT OWNER PLUMBER TOWN OF PREVIOJd� i togN#3 SEC_,T 27 N, R__W AND/OR LOT i BLOCK � iano AUZ& SUBDIVISION NO. CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit (b) The approval of the sanitary permit is based on regulations In force on the date of approval. (c) The sanitary permit Is valid and may be renewed for a specified period. (d) Changed regulations will not Impair the validity of a sanitary permit (e) Renewal of the sanitary permit will be based on regulations In force at the time renewal is sought, and that changed regulations may impede renewal. (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. WAA AUHRIZED ISSUING OFFICER - DATE ' 9 AVZ PERMIT EXPIRES 70Z#UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)