HomeMy WebLinkAbout020-1055-60-200 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix
Safety and Budding Division
INSPECTION REPORT Sanitary Permit Nc
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No 644755
Personal information you provide may be used for secondary purposes [Privacy Law. s 15.04 (1)(m)I
Permit Holders Name. City Village Township Parcel Tax No
Gary A. & Kelly J. Frank TOWN OF HUDSON 1 020-1055-60-200
CST BM Elev Insp. BM Elev: SM Description: Section/Town/Range/Map No
21.29.19.206A-20
TANK INFORMATION ELEVATION DATA
TYPE
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Mo el Number
TDH
Litt
Friction L as
rim Head
TDH Ft
Force in
Length
a
Dist to Well
SOIL ABSORPTION SYSTEM
arm
�nW�
' L L.! a-1 / h L .._c
BEOf RENCH
Width
Lenyth
1
No Of Tren es
PIT DIMENSIONS
No Of Pits
Inside Dia
Liquid Depth
DIMENSIONS
V,
(mil
6
SETBACK
SYSTEM TO
P/L
BLDG
WELL
LAKElSTREAM
LEACHING
M ct
INFORMATION
CHAMBERUNIT OR
V
Ty Of Syatem.
ens 'Ic I
�I
7 �(J
w
I N m r
DISTRIBUTION SYSTEM
HeaderrMandold Y
t
Length Die
DistnDutron
Pipe(s)
Length Die Sp mg
ize
x Hole Spacing
Venl to Air Intake
SOIL COVER If Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Depth Over
I of
SeededrSodded
Bedrrrench Center
Bed/Trench Edges
pso--
�xxDepth
Yes No
s No
COMMENTS: (Include code discrepencies. persons present. etc.) Inspection #1:
Location: 521 PRAIRIE LN
1.) All BM Description '" eeee
2.) Bldg sewer length = V,V (s�l/I
- amount of cover = l
Plan revision Required? :] Yes X1' No
Use other side for additional information.
Date Inaepdor's Signature
SBD-6710 (R.3/97)
Inspection #2.
/ sl D�6
Cen No
`� SGI �� I�W� I ��
�� � S�rcC�� � i YY1. i � bo ��� �a bhoo f �%u �
Ali -� , ���� �,,,�,t.�-�st� l��-o���-�d rah -taw
C- ',rgasum. JWW 4
SID
�
201 W. Waehirgton Ave.. P.O. Banc 7182
ldy
SL CrtoyP
smitary Permit Number (to be 1Lled in by Co.)
u
Madison, Wl 53707-7le2
�5 't Application
Soft TremactionNumber
1n a000rdaeoe aim ' Cok s�ssioa of tiia tom totbappwNa
is requeed prior b • amaay permit Noes Appliatioo bans for atdo-owaed PO b
Abr9wooday
pry Addrea fd ditferml thm o>di* addrrss)
me Department of Satiety nod Proteaooad Swioes. Peraood otoraatioo you prandle msy be
wanom o accordenoe with the priyaw taut S. 15,04(txml Stec.
some
L Appliladilow Wwwatiem — Fbm hint AN lafarmatiea
property owner's Name
Pace) f
Gary & Kelly Frank
020-1055-60-200
properly Owner's Mailog Adbew
Pmpaty Locubw
521 Prairie Ln.
Gout. Lot
NESW y, setae 21 .
City, Stele
zip Code
Pbone Number
154016
(airck oae)
Hudson, WI
715 573-5262
T 29 N; R_ 9 W
II. Type of BaBdiaq (eberk all dud apply)
Ld M
Name
® 1 or 2 Family Dwetlioa-Number of Bedtoaroa 4
03
Bbctr
CSM VoL 14 3796
❑ poblir�Cammertaal-Desmbe Use
Na
❑ city of
❑ State Owned- Deaeribe Use
❑ Vow of
CSM Number
617461
® Town of Hudson
UL Type of Permit: (Cheek ano gate Nil M line A plete iiae B if applicable)
A-
❑ New Sys*® 1
® Replammmt Syreum
❑ Trdtm Wl-liddmg Tank RMIlaoameal Oaty
❑ Omer Modification to B01009 Syaeem (cep M)
B.
❑ Pero k Rmwwal
Before 6 iadm
❑ Per Rerwoa
❑ Clump of Plumber
❑ Pkw i Trader b New
owner
"ea Frew, Pamos Number and Date lead
3G3 go� %*Z000
IV. Type of POW TS SyahmKLmpoom&Dmim (Cieek a9 fiat apply)
® NW-Pramriaed W.Gmmd ❑ Prummnd W4mmd ❑ AL -Grade ❑ Momd >> 24 m. of micabia =a ❑ Momd <24 o. of sa0able sod
E]Hd dmg Tmk ❑ Omer t Mend eoa000rw ( r ' ❑ Preseatmra< nevis ( )
V.
Area 6brn&dm 44)q0lbr Qu' 4 SW dad Pia chambers & 2 oak cad I ok PL-525 elHuCId Slur
Damp Sal Appricabon D opend Area Rogmmd (at) Dapa Nd Ara Sya*am Hnatroa
0.7 GpolSq. Ft. 847.15 sq. ft. 890.40 sq. 3 _ 102.00'
Design Flow (gpd)
600.00 Gpd
VL Tank We
Cwacity
O inOTo
UeOf
JJJJ,
U
Nat Tab
13aumt Tmlo.
q
3006cr9alaaaTmIk
Do=gChm*w
Fftw canister V1,250
1,250
2
RriraerCmcrele
X
V L RapeftGO86ateaet- 1,14 mr IwrtdaWa of tie POtP18 aMwa a lie wearied
Plmrbds Name (Prot)
MPlMPItS Nmtber
Berens Phoa Number
Jim Botmieesta'
MPRS 222904
715 760-0117
Plmober's Addlems (SWK Cry, Stet, Zip Code)
� WN � N Aubfo)4 Wj 5
UP-
vID net Ua
P(Approsed
Permit Fee
S
nom I
AllWd
ODrsppro+ed brDmid
JL,7r
;?o7;7—el
IX. C "Hoeaa 1 3) }a LC �SYSTEM OWNER: a a( irete� ina. P��
1. Septic tank, effluent filter and I o
dispersal cell must be serviced / maintained �� Q-�y^`�h4TQ�s�►^L� l�1
as per management plan provided by plumbal. MCWA -
i
as per applicablecodAf0lSiRJ41�5'w'�•',s.��aaaw��.�a—...---------.
SBD-6398 (IL 11/11)
—f— . I
<441f c 7-r.
- Y
-7=7
Pi
•
Conventional Replacement Conventional POWTS Index.& Title Sheet
Project Name: Frank 4 Bedroom Conventional POWTS
Owners Nance: Gary & KellyFrank
Owner's address: 521 Prairie Li., Hudson, WI 54016
Site address: Same
Project Location:
Subdivisi0o: lot 03, CSM #317461, Vol. 14, Pg, 3796
Legal Description: NEU4 SWIM, Sec. 21, T29N., R. 19W., Tn. of Hudson, St. Croat Co., WL
Parcel ID M 020-1055-60-200
Page I Index and Title Shoes
Page 2 Site Plan
Page 3 Dispersal Cell Siting Calculations
Page 4 Dispersal Cell Cross Section
Page 5 1nflhrator "Q-4" Chamber Specifications
Page 6 Conventional POWTS Maoagemmt Plan
Page 7 Filter Camister Cross Section
Page 8 Effluent Filter Specifications
Page 9 Sanitary System Ownership & Address Form
page 10 Certified Survey Map
page I I Warranty Deed
Attached: Soil Evaluation Report
Maur Phnaber Restricted Service: Jim Boumeester, DSPS Credential #222904
Signature: Date: ilia 48
Page 1 0f 11
DOWPposaao, ro hi-<k and sou AM=pli= CanpomM M=W for POVnS vasm 2.1 sou.10705-PIr1.01roq
&&MCA mme: Tr �.4E mac•
awl.
5ei�trb/ra{bn/ptf by
/,Lc dam, rJ/. s3/cyi
3M,,
�}�rs�cddiar ��G�J.
+ +*% liapia:.eAWay c�.:.bws; ro
cp
a t .
Iio. 2J• _
®I
I' ,2 ofR
IN -GROUND DOSED -GRAVITY DISPERSAL AREA
Stepped Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down -sizing credit)
nri. +r
SOIL COVER tvaon TYPICAL TRENCH
+r CROSS SECTION VIEW
°'` . twoh (No Scale)
Provide minimum 3 R
Highest Trench Lowest Trench (as applicable) separation between trenches.
System Elevations m 102.0 ft; 102.0 ft; ft: ___ ftft
Qulck4 Stenda"
wl End Cap (Show location of Inlet 1 outlet pipe connection on plan view.)
(bpi)
----�--------- ----
-��---------�f----
ow �"
WON pw MKubowNft
87 R ---►I
(� Quldc4 Sta
INSTALL PER TRENCH:
2 Rulok4 Std-W 0 20 fP EI8Ndwnber ■ 440-00 M
+ Pairs of end caps a 0.1NEIIWpalr • 5.2, 0 „ fN
■ Proposed ElSA per trench ■ 44_6.20 fe
TYPICAL TRENCH
PLAN VIEW
(No Sole)
JA ■13tY�
ndard-W Ohsmbsr
(bp1�
(mtd by N"in►sr rm., rW)
holdp"wdbuwm^ m%bouaOofo.
Required lrtllitradon Area ■857.16 it' Distribution Method:
x 2 trenches = Proposed Total EISA = 880.40 fta branched manifold
Frank 4 Bedroom Residential Dispersal Cell Sizing[ Calculations
1. (400 gallons estimated ftowx 1 S design factor) = 600.00 God design Bow
2. Infiltrative capacity of native soil = 0.7 =&so. ft.
3. Absorption area mired: $57.15 sa. ft.
4. Absorption area as proposed: MAO sa. ft. (44 chambers + 2 pair end caps]
Infiltrator "Quick 4" — 20.00 sq ft. EISA per chamber, Infiltrator "Quick 4" end raps — 520 sq.ft, EISA/paic
957.15 sq. R+(2 pair mdcaps)(520) = $46.75 sq. R
846.75 sq. ftl20.00 — 42.34 chembes requited
Number of trenches: 2 A 22 chambers per trench (44 chambers total)
Trench width:
Trench length:
Teach spacing:
Total system area w/ 6' Umch spacing:
2.83'
87.00'
9.00' on center.
12.00'x 87.00'
Pg.3ofII
�3
N
O w
b J
53
f t
jo
Conventional Septic System Management Phu
Pursuant to SPS 393.54, Wk Adm. Code
Gmend
The conventional septic system shall be operated in accordance with SPS 382-384 %rm Adm. Code, and shall be maintained
in accordance with component manual SBD-10705-P (N.01/01). All local and/or state Hiles pertaining to system
maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system
should be directed to the installing plumber, Jim Boumeester at (715) 760-0117 or the St. Croix County Zoning Department
at (715) 386-4680.
Septic Tank
Septic tank servicing mechanics comply with SPS 38354(l)(e). Septic tarok to be located withih 150' of service pad, with
bottom of tank to be515' below service pad elevation. The operating condition of the septic tank and outlet filter shall be
assessed at least once every two years by impecdon. The septic tank canI shall be removed when the sludge and scup an
the tank exceed 1/3 the liquid volume of the task. The tomcats of the septic tank shall be disposed of in accordance with NR
113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Suds. • If the its of the tank are
not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of wbm service will be
needed to maintain less than 1 /3 scum and sludge accumulation in the tamer. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank
that may slough off the filter when removed from its enclosure. if the filteris equipped with an alarm, the filter shall be
serviced if the aderm is activated Septic tank manholes risers access risers, and covers should be inspected for water
tightness and soundoess. Access openings used for service and assessment shall be sealed watertight upon the completion of
service. Any opening deemed unsound, defective, or subject to Wine: most be replaced Exposed access openings greater
than 8 inches in diameter shall be secured by an effective kxkmg device to prevent aaatideatal or unauthorized entry into the tank.
No individual should ever enter the septic tank as dangerous gases may be present that could cause deafly. Septic tank
abandonment shall be in accordance with Comm8333, Wis. Adm. Code when the tank is no longer used as a POWTS
component The addition of biological or chemical additives to enhance septic tank performance is generally not regdnnd. If
such products are used, they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings
Division.
Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption system. The aura above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of &net protection. Traffic (other than for
vegetative maintenance) over the system is to be avoided Soil compaction may hinder aeration of the infiltrative surface
within and above the system and will promote frost peneteatim during cold weather months. Cold weather brstallations
(October -March) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BOD5, I50 MG/L TSS, and 30 mg/L FOG. Influent flow may not
exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent pond ng. Pordmg Levels shall be reported to the
owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system In proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil
absorption cell to bring the system into proper operating condition.
Pg. 6 of 11
FILTER
DETAIL 13
CANISTER DETAIL
WARNING LABEL
LIFTING HOOKS
APPROXIMATE LOCATION
SEE DETAILS , 1-2-3
CONCRETE SEALANTS TYP.
4-
/
OR EQUAL FOR ALL JOINTS
—�
(SEE DETAIL 5)
TOP
VIEW
i
�
o
W
STEEL CHAIN
ZINC TED
PAD LOCK SEE DETAILS, 1-2-3
N
N
�
00
CAST -A -SEAL
—T-
I�
CAST IN RISER
SEE DETAIL a
FILTER
4' CAST -A -SEAL
N
CAST IN RISER
c
O
O
m
0
n
Z
r
OD
s
24„
�
F�
SIDE
VIEW
SHEET NO.
�1
V'KMIOL
zBW
F 1,-525 Filter
PL-525 Effluent Filter
The PLr525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters m its class. It has
5251inear feet of 1/16" filtration slots. LAU the Polylok P1,122, the Polylok PLr525 has an automatic shut-off ball
installed with every filter. When the filter is removed for cleaning, the ban will float up and temporarily shut off
the system so the effluent wcn't leave the tank. i e
Features:
• Rated for 10,000 GPD (gallons per day).
• 525 linear feet of 1/160 filtration.
• Accepts 4" and 6" SCHD 40 pipe.
• Built in gas deflector.
• Automatic shut-off ball when filter is removed.
• Alarm amessibility.
• Accepts PVC extension handle.
FL-525 Installation:
Ideal for residential and commercial waste flows up to
10,000 gallons per day (GPD).
1. 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 C outlet pipe. If
the filter is not cantered under the access opening use a
Polylok Extend & Lok or piece of pipe bD center filter.
4. Insert the PLr525 filter into its housing.
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 recomaraded 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 filter
needs servidng. 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. Pill PL.525 cartridge out of the housing.
5. Hose off filter over the septic tank. Make sure all
solids fall bark into septic tank
6. Insert the filter tartridge back into the housing making
sure die filler is pmperdy aligned and complekdy its rted.
7. Replace and secure septic tank cover.
1A6" Filtration Sh
Accepts 4- & 6-
SCHD 40 pipe
NSF
R�
Osfdoor SoatMterO Alarm
Poiylots, 7abd & Beet f lbas accept
the SmcftUerO swikh and alarm
Accepts 1- PVC
Exie lion Hindle
Rated for
10,000 GPD
525 Linear Ft.
oft/16-
Ftltration Skis
Cor„MW to
IMf/ANtrt stanMr 46
Ges Defieftf
Automatic
shut-off eau
Extend & Lakm
FAsiiy kotalls
veto extra teaks.
Polylok, Loa 3 Fairfield Blvd. VVapingfmA Cr 06492 'ibdl Free: Wn.765.9565 Fare 203284.8.514 www.polylok.00m
P 8'ofit
ST, Ca, SANITARY SYSTEM File If
OWNERSHIP/ADDRESS FORM C'xeff W�'�r
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 Gary & Kelly Frank
Mailing Address 521 Prairie Ln.
City/State/Zip Hudson, WI 54016
Phone Number (required) (715) 377-1322
Email Address (required) GKFrank@gmail.Com
Parcel Identification Number 020-1055-60-200
(found on the property tax bile
Property Location NE ,/4 , SW % , Sec. 21J T 29 N R 19 W, Town of Hudson
Subdivision Plat: Na Lot # 03
Certified Survey Map # (o I q-`+(v 1 Volume 1 . Page #�� ?T9(°
Warranty Deed # 628596 (before 2006)Volume . Page #
Number of bedrooms 4 Spec house 0 yes ■ no Lot lines identifiable ■ yes O no
New Property Address N4A
(Venfication of new address required from Community Development Department for new construction.)
(StaA Initials) (Date)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications
New System: Include with this fort a recorded warranty deed from the Register of Deeds Office and a copy of the certified
survey map if reference is mode in the warranty deed,
Community Development Department — Land Use Division
715-386-4680 St Croix County Goverment Center
cdd0sccwi aov 1101 Carmichael Road, Hudson, N 54016
715-245-4250 Fax
www.sccwLgov
pa.90Fli
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 rest ence:
(Street address) GpwM y ),h jtbwl( located
at: 1�'/a, .$L. '/a, Section _�, own_aL_N, Range 14 W,
Town of jlyb5 e>J , 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 J U as
Did flow back occur from absorption system? Yes No'
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity:
Construction: Prefab Conifete � Steel Other
Manufacturer (if known): TAX
Age of Tank (if known): a 0
t num r (if known)
Ts 1' ►ti �,'6v
(Licebs 4 Peumber Signature) (Print Name)
MM
(Title)
;;0' �' �1 pb-�a
(Date)
aaa 9()y
(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
WisconsirlDeparlmerdof C:ornmerce PRIVATE SEWAGE SYSTEM
Safety and Buildings Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personai information You Drovice may be used for secondary purposes fPdvacv Lew. 9.15.04 /1llmll_
Permit Holder's Name:
City 0 Village Town of,
Miller, Sam
I Hudson Township
CST BM Elev.:
Insp. BM Elev.:
BM Description:
v6
S
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
D
Aeration
Ho '
TANK SETBACK INFORMATION
TANKTO
P/L
WELL
BLDG.
vent to
Air Intake
ROAD
Septic
��/
Z�r
3 /
NA
DosingNA
Aeratio
N
Holding
PUMP / SIPHON INFORMATION
macill.laclurer emand
Model Number
TDH Friction S tem TDH
Forc4main Length Dia. Dis .
SOIL ABSORPTION SYSTEM ( L
FI FVATION DATA
County:
St. Croix
Sanitary Permit No.:
363864
State Pan ID No.:
Parcel TaxNo.:
020-1055-60-200
STATION
BS I
HI
FS
ELEV.
Benchmark
U
( 9D
o
Alt. BM
/ 2
Bldg- Sewer
f S
Ht Inlet
/
/ Ht Outlet
�• j2
/o . 3 -P
ottom
Header / Man.
Dist. Pipe
fit
2
sot. System
(&
/' • Ys
�0� y!_
Final Grade
�^ 2
St cover
d
r
BED /
Width
Length No. Of Trenches
PIT
No. Of Pits
Inside Dia.
liquid Depth
/
r
ls-5
SYSTEM TO
P/ L I
I
BLDG
WELL
LAKE /STREA
Man" ur r:
SETBACK
A
YPe Or
3 f
S `J
3
Modelm r:
INFORMATION
OR UNIT
System:
DISTRIBUTION SYSTEM
Hea /Mani o Distribution Pipes x Hoe Size x Hole Spacing Vent To Air Intake
Length �L Dia Length Dia Spacing7
SOIL COVER is Pressure Systems Only xx Mound Or t-Grade Systems Only
Depth Over
Depth Over
xx Depth Of
xx Seeded/Sodded
I
xx Mulched
I
Bed ?Trench Center
Bed/Trench Edges
Topsoil
1] Yes ❑ No
❑ Yes p No
COMMENTS: (Include code discrepancies, persons present, etc.) InsKction #1: S / 1 1/ o0 lnsoection rrl: / /
Location: 521 Prairie Lane, Hudrn, WI 54016 (NE 1/4 SW 1/4 21 T29N R19W) - 21.29.19.206A20 -Lot 3
1.) Alt BM Description =-Jrp s
2.) Bldg sewer length = Z 1•
-amount of cover = > ;'
3) �� t.YIt j t-ih4q
Plan revision required? ❑ Yes l% No
Use other side for additional informlition.
SBO-5710 (R.31871 Dot Inspector's Sign Cen No
Safely and Buildings Division
Visconsin SANITARY PERM A,TION 201 W. Washington Avenue
P O Box 7162
Department of Commerce In accord wah . Adm. Coax .PvZ Madison, WI 53707-7162
• Attach complete plans (to the county copy only) for ter not. County
County
than 81/2 x 11 inches in size. c— _
• See reverse side for instructions for completing thi licatio `�QQQ L I
�._
State Sanitary Permit Number
Personal information you provide may be used for secondary purpo
(Privacy Law, s. 15.0411) (m)1. 5 /
El Chess it revis on to previous appacalxx
State Plan Review Transaction Number
�f 0)
1. APPLICATION F ATI N - LE INT
Pro ertyowner ame
6
� LLIF
so
anon
u;11'4 Z T 2, 2, N, R E (qfW
er
P party Owner's Mailing Address
O 2t /
Lot Number
Block Num bar
a
City, State Zip Code
llvjDDN W f is 5M /
Phone Number
dy(0) z7l0
Subdivision Name or CSM Number
Oe S CS 143 1
: (check one) ❑ State Owned �[
° t. I yy
Nearest Road
Public 1 or 2 Famil Dwelling- No. of bedrooms T
Town oFifuoso N
T/?fil (2 E /.a NE111
01111 nut tor. ... . .
— ---• .••..-..,,,y .ryc . yuurr�, �nrca au Snas apply) m aa rvaniocr Sa!
1 ❑ Apartment / Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on IineA. Check box online B, if applicable)
A) 1. bd S stem New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an
_ ___ Tank Only Existin System Existin S tem
Y--Y------------------------Y---------------------------------�- ----
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressunzed Distribution Pressurized Distribution Experimental Other
1 1 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank
12 Seepage Trench 1,�JtCFI 22 ❑ In -Ground Pressure / i 42 ❑ Pit Privy
13 Seepage Pit 0 IKF/L T2 ArC& .2)(3 , !S 43 ❑ Vault Privy
14❑System-In-Fill 3lt$ SQ;-T S10Ew/Al0SfL C gAeii3_a 5 7.K-7drg".
!III asra�nn�a.a.
1. Gallons Per Day
2. Absor . Area
3. Absorp. Area
4. Loading Rate
S. Perc. Rate
6. System Elev.
7. Final Grade
�Q
R�us�(sq. ft.)
Proposed (sq. ft.)
(Gals/�ay/sq. ft.)
(Min./inch)
Elevation
'�
'�`
r Q (ts feet
Feet
VII. TANK
Capacity
INFORMATION
in gallons
New Existin
Total
Gallons
# of
TanksConcrete
Manufacturer's Name
Prefab.
Site
con-
Steel
Fiber-
Plastic
Exper
Apo.
T nk
T k
strutted
glass
septic Tank r Holding Tank
L
WF SF
Lift PUMP Tank hi hon Chamber
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of
the onsite sewage system shown
on the attached plans.
Plumber's Name: (Print)
�ArKL- rv___1_`___D__N_EL_ �-_
Plumber Signature: oSta
r
MPIMPRSWNo.:
Business Phone Number:
r� - .. _
Zz o371
3�6-k69Z
❑ Disapproved S nitary Permit Fee (WK$wd iGruuna.amr Re- ssue Issuing Agent Signature (No Stamps)
�IAPproved ❑ Owner Given Initial Swchor¢ree)
Adverse Determination C-2c -$-
X. CONDITIONeS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398(R.12199) DISTal1U11011 0rlp6nlioCo njj.orr.apyTo. SalolyaWildinq.Diviuon.D.vnw.M.1to,
/3 M. LoT *1 E/-: -
STArwe CopcH TRAIL --�
ATDw OF iRou pi PE
F_ I . = /00 • o0 '
/N
I Z50 6AL. ST
SUM 1111��rr(L
RA1c1ER ESTFi E S [aT'° 3
52! Pe-A/R1F- LANE.
TA za - 1psss40-OOC
�f-8EU rtoo� �ytitQ�
Jj.TR A-14 9 E g 3 X -7
r i -1NFl[ TRk7*0 4. cN�4�►�Er�S
FAcM TRtNcN
ay-ToTA4-
I ROUSE 0 WELL
11 �8XS0, i.
G.d2A
�'SP[tij VE
DR1VE. WAY
Ll
UYroarsin'txpartinentdconxneroe SOIL AND SITE EVALUATION
r Dwlmo of Saiely and &Akw in accord with Comm 83.05, Wis. Adm. Code
Attach monde s4e plan on pepv not laws then BW x 11 lrchas in aim Plan must
ncYde, but nol bn4ed to werbcal and horlam teller. point (9", direction ad
pelcrlt slope, scale or dirnem ms, Faith anew, and location and dlofanos to nearest road.
APPLICANT INFORMATION - PIMn printapNNOmrstlim.
PeraarY kft.,*aon you prodde may be used for aecadaryl pxpoess (Rher*M'. a. 15.04 (1)' m)).
property Owner Prop"
Pape 1 d 3
A-C.H.SseAllift lwrti�s
St. Croix
Pral IA.i
part of 020-1055.604M
Millar. Sian God Lci - 1 NE IN SWIM S 21 T 29 N.R 19 W
tOwne/aMeMeAd*m
Box 151 1 • ST
Subd. NwwcrCSMf
CNy Stale zip Ca— d - Hudson W1 54016 71 Y/ 0®Yawn I lleraal
Trd
New cbon USe: ! ` H�i tiaI d 4 Addition to exldng building
Repiacement
`,
r commardd-M�
Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpdV 9 hatch, WdW
Action area required 857 bed, if 75 te%h. ft' Maximum design loading rate .7 bed, Wff .8 torch, ch, gpdr
Recommended in9tralla surlace elevatlon(s) 8 (as lobs b slle plan banclmrerk)
Additional design 1 she considerations '� " htgh qp", ma=m
Parentmalarial Glacaloutwash Flood swialion, 8 NA ft
S=jUitaWfor syslen Conventional Maud In -Ground Pressure AT -Grade Sydemnl7 Holding Tank
U=Umilabie for system[-: S' U pal S F- U I S U g S l 1 U [IS 23 U 1 J S sl U
Do* to
11111111011
Nctlor
>1210
2
Ground
slow
106.>se
Depth b
Iimibng
111d or
>11r
Depth Winlilant Color
in. m nsei
Mottles
Qu. S?-Cont. ColorHorb"
Shftre
Texhxe I Gr. Sz Sh.
Rods
BoundaryRaab
GPQAC
Trench
1
0-I1
10yr3/2
Now
sl
2msbk
ds
cs
car
Its
2f
OS 0.6
2
I1-23
I0y►4/3
- None
si
Is
2m2L dsh
038 dl
2f
if
OA i 0.5
0.7 0.8
3
28-36
10yr5/4
None
4
36-73
10yr5/4
None
s
Os8 dl
038 d]
gs
if
-
0.7 0.8
0.7 0.8
5
79-121
10yr6/4
None
s
lot LOR
--
Ran Wks.' - - --
1
0-8
10yr32
None
al
2msbk
ds
a
2f
OS 0.6
2
3-18
10yr4/3
Now
at
2msbk
058
dsh
car
2f
OS 0.6
3
18-24
I0yr5/4
Name
Nave
Is
- dl
Sw
If
0.7 0.8
4
22-81
10yrS/4
s
088
dl
ea
1f
0.7 0.8
5
81-119
10yr6/4
Nate
s
028
dl
-
-
0.7 8
63r.yo ,y
_ %'
Y
Name (Please Print)
James R. Tbo
kE11-111'T7fr1'7T':�e
715 249-7767
Oab --CST Number Rd#
11/5/99 3602 1127
SOIL DESCRIPTION REPORT = Page? of 3
♦rr C'l)CW Frd"M6�
PROParrr'DWNEk NOW Sm
PARCEL LDJ PM of0]0.105566-000
3
(iro+s+d
Bier
108.3fi A
DOA 10
limiting
factor
>119'
4
Omund
ow
10516R
DMb b
kofUp
bx
MW
5
Ground
elev
105.93 R
Depth to
limiting
Factor
>108'
Dep/1
Horizon in.
Deni+adCdor
Mu+eel
Moon
Qo- &- Cad. Color
Structure
Gr. Sz Sh.
Bou ry
,OM
Roots _ GP _
Bed Trench
i
0.8
10yr3f2
None
sl
2msbk
ds
cs
2f OS 0.6
2
9-22
10yr4/3
Nate
$1
2msbk
dsh
a
2f
OS Ob
3
22-30
10yr5/4
NOW
Is
Osg
dl
Yw
if
0.7 0.8
4
30-92
10yr3/4
Now
s
Osg
dl
gs
If
0.7 0.8
5
82-119
10yW4
NOW
s
055
dl
-
-
0.7 0.8
rlemarKs:
1
0-10
10yr3/2
None
sl
al
2mabk do
2! i deb
cs
cs
2f
2f
0.5 0.6
2
10-20
I O, r
None
None
3
20-26
10yr5/4
Is
Osg
dl
gw
If
0.7 0.8
4
26.75
1OyrS/4
None
s
Osg
dl
gs
1f
0.7 0.8
5
75-104
1Oyr6/4
Nate
s
Oag
dl
-
-
0.7 0.8
1
0-9
IOyr4/2
NOW
si
2fa
ds
cs 2f
0.5 0.6
2
9.36
10yr3/2
Now
a0
2msbk
dsh
ca 2f
0.5 0.6
3
36-41
10yr1/2
Now
sl
2msbk
dsh
mr
if
OS ! 0.6
4
41-91
10yr3/4
Now
a
2msbk
dh
gs
if
0.7 0.8
S
91-108
7.Syr4/4
Now
adcgr.
Dag
dl
gs
-
0.7 0.8
HemarKs:
6 Toga oii/on�p�oe a�
IL cQ 'icrn ¢/ o F Ice-2 - E/,eV
%op of iron
/oti . /4ssc-mtd eb ar. = IcV cD'
/cl-'z I Id,3
P;,6
• ale✓aeon
/oCa1�CAf piyb,o.
Okarner.
, a Miller
N�dst�c, cj/.
syaG
/013 W,&-o/osla c5q,
44CAY6wyy, see. x/
T.zV Q. /qu�>, r,of
75?f -
p1.3QF3
`�
Division ofI � a1 /vimVQri -�c Pagel of
2� vzz SOIL EVALU TION REPORT P�'
�UN In once with SPS 385, Wit. Adm. Code County
Attach complete s e plan opWfldt ant QSt. Croix
�1 x 11 inches in sae. Plan must include, not limited to: rtical or 'P(�zpf3tisy point (BM), direction and percent slope, Parcel I.D.
scale or dimension , n location and distance to nearest road. 020-1055-60-200 Ref #2686
Planes print all Information. RevWMied by Date
Property Owner Property Location❑
Gary 8 Kelly Frank Govt. Lot NE % SW % S 21 T 29 N R 19 E (or) W
Property Owner's Mailing Address Lot 0 Block ar Subd. Name or CSMS
521 Prairie Ln. 03 Na CSM Vol 14. P . 3796
CIA' State Zip Code Phone Number ❑ city ❑ )(illage ® Town Nearest Road
❑ Ne Construction Use: ® Residential /Number of bedrooms 4 Cade derived design flow rate §W GPD
® Replacement ❑ Public or cave rcal — Describe: _
Parent material Glacial OulwaSh / ///O� Flood Plan elevation if applicable no ft.
General comments and recommendations: Soil Evaluation completed to verify depth of suitable soil to accommodate replacement dipsersal cell. Soil is
suitable for in -ground dispersal cell to a depth Of 100.17 with a soil application rate of 0.7 gpd/sq. ft.
Boring # ® Boring
❑ Pit
Ground surface elev. 107.12 ft. Depth to limiting factor >120" in.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
StGr. clz. ro
Consistence
Boundary
Roots
sou Application Rate
GPD/Ft'
•Effk1
•Eff#2
1
0-9
1Oyr3/3
none
sl
2fgr
dsh
cs
2vf,f
0.6
1.0
2
9-29
1Oyr4/4
none
sl
2msbk
n*
cs
1vf
0.6
1.0
3
29-31
7.5yr4/6
none
Is
Osg
ml
cs
0.7
1.6
4
31-120
10yr4/6
none
grs
Osg
ml
gs
0.7
1.6
�• -1
g
❑ Boring 0
❑ Boring
❑ Pg Ground surface elev. _ ft. Depth to limiting factor _ in.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
Soo Application Rate
GPD/Ft2
'EffaK1
•Eff82
'EMijant ele
nn ,%n<<9,3n
.....n
--- '---'- �-
CST Name (Please Print)
C lualll OC -DVV
f-W SLLU land r$5>3os 15o
ignat
CST Number
James K. Thompson
—
30021
Address
ate Evaluation Conducted
Telephone Number
340 Paulson Lake Lane Osceola WI 54020-5413
June 20 2022
1715 248 7767
4 a6U-o33u (KU4/15)
6
co'
E/id. • /d0. ca;
49-x,-5&. 5' rs'rztr d-
drs p•r2 er.// %^sto
'Af
4
l
Sei/ar�/t�e%bnPii° by
T7.«npson Ir/eS/!!•
• So:/ t ✓a Au tr 0" bori
byT1n«rf•n Wu/AZ.
lot
CdeyeA-Z
S.i/ i/itirie
A4 d6o", u1 /. SSrCYG
Cotn3 C3M✓o/. /i; 370
OAF`f 3�s! Sca. Z4 T. s9d:
,P /7rJ•, T.Of NG.dsen,
st. Cr&A dr., u)/.
/Cie/ d o3CJ-,oSf (oo-.UV
�clns 1. s/i3 acres.
a
I
o�
1
-t
"
�'r'i t su•h G
i
I
'l
/
03 IT
I
�,v�
/� bf
ncl, .r � Tope •��'ow.da� •rr.
glad • No. 2Zo
/ iJ LI
.f
/•1fI:
EXSii„q
•t--cX+'Itinq t.x11
l- --
.r..d
1liirc/
EX.SEin /�Sa e0,
W,tf• Conar t
1
54/6-e- 60-" ' CAW.
t - --
Qi tpaFen4#/at•,o4'jd'
L
F, ,20P2
oak couNnr
NOa 644755
STATE SANITARY PERMIT
PREVIOUS NO. 343Sb
OWNER tagRY hW INK
PLUMBE - w�
TOWN OF
SEC9T
AND/OR LOT
to
R
BLOCK
SUBDIVISION
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 ■
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.
"10%,d 1h, Aw A O ZED ISSUING OFFICER - DATE Z
PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE
POST IN PLAIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (R11/20)