Loading...
HomeMy WebLinkAbout030-2161-20-000 (3)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 1s 04 (1)(m)] Permit Holder's Name City Village Township Jeffrey ot Christine Gibson ;ST BM Elev Insp BM Elev IBM Description TANK INFORMATION TOWN OF SAINT JOSEPH TYPE MANUF TURER �e-�iw1e •\%r CAPACITY Septic Ic66141— Dosing U^ Aerati oldi TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Au Intake ROAD Septic Dosing 7 �� &V% Aera ' Holdi PUMP/SIPHON INFORMATION "amL ai Manufacturer �`6 emarld GPM op Model Number 1ZLIL TDH ILift - FncY01;s ` _r Syste H� T , Forcemain Lfjlp ` Dia. �q Dist to wel_ try ci�.r�_.-nr�.�ruartn�n�■�r� r ELEVATION DATA STATION BS HI FS ELEV Benchmark r�G BM Bldg. Sewer / r` SUHt Inlet MN SUHt Outlet FYN 7 . Dt Inlet Dt Bottom 6- Header/Man. Dist. Pipe /'• ` Bot. System Final Grade Cover C16-65 av16 Lip 6 BED/TRENCH DIMENSIONS Width A Len th� s No. PIT DIMENSIONS No Of us v Insi quid Depth `xJ SETBACK SYSTEM TO P/L jBLDG WELL 1 LAKE/STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR UNIT Typj 011pystarn 7 0' Model Number. r11PTPf 1f111T1I'\.1 �ii.��. Header/Man�dd ' � 10istribution N Pipeis)length x Hob Size 1a a Hole Sp 11 Vent to irdDt/ka \ Dia' Length Dia Spacing Depth Over / a Depth Over - -.._ _... --- Depth of --._..._ _...,_ . fir ioc Seeded/Soddennc Mulched Bed /Tra Cent N Bed/Trench Edges Topsoil, I - as r No No wo Wyes 'mm�1ry1 ,: (Include code discra:p cies, persons present. el .) I.nnssppeectition #1: ` �1 (11I s,) Inspection #2:P C�oFcatWWlon: �/1 141ST AAA���ItAS�/►lltC.a M - [ n p/�23 1 ) Alt BM Description S, 2.)Bldg �Jsewer length = y`Z I I� �Y�7L e17t�/�ln ' V�Y amount of cover = 7��1%5(j'1\ Cps07� ,/ a Plan revision Requi ed? Yes DT No /1j I ' Use other side for additional information. 1—_ _ { SOD-6710 (R.M97) Date Insepdor's Signature Con No. ■■■■■■■■■■■■■■■■■■■■■■■�i■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■aaaaaaaaaaaaaaaaaaaaaal'■is��;•••■aaaaaaaaaaaa���!�aaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii�..�����=_�/�aaaa■■��aaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaraaaaaaaaaaaaaaaaaaaaaaaaaaaaalaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaa�aaaaaaaaaaaaaaaaaaaaaaaaaaaaaiwaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaalaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa\.iiiiiiiiiiiiiiiiiiiiii■ ■aaaaaaaaaaaaaaaaaaaaaa■Iaaaaa■■■■����aa��aaaaaaaaaaaaafallaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaa:�!��__o..��u�..�����i■■/!Ci�a■Iaaaaaaaaaaaaaaaaaaaaa■ ■iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii\�ilaaaaaraaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaal�aaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa�laaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■■1.■■aaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa�i�ll llaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaSZraaalllaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaaaaaaaaaaaaaaaaa■■IIC+■aaaaa\ai'::Gu:C:�aaaaa��\Rl iiiiiiiiiiiiiiiiiiiiiii■ ■iiiiiiiiiiiiiiiiiiiiiiiiii■IG ar�ii7�iiiiii►�iiiii��NJu7iiiiiiiiiiiiiiiiiiiiiii■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaa7aaaaaaaaaaaaaaa■■a�n►1 fJl�\'J ■\iiiiiiiiiiiiiiiiiiiiiii■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaai\a\aaaaar7l\■■I\i■�aaaa►\aaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaAaaa■v:aliiiii�:u�i lS.u■aa►Ci■iiiiiiiiiiiiiiiiiiiiii■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa�Vaaaaa/ii7..■aaaaR9aaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaa■aaaaGiaaaaaaG%■aaa/Ciaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■■aaR�aaa�\►%aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaaaaaa:G:ii�a�ai:!!Si■■aaaaa�a6iaaaaaiaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaaaaaliaaaaaaaaaaai'■IYaaaaaa/��aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■iiiiiiiiiiiiilliiiiiiiiiiiiilli.i�Glaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaflaaaaaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaaa■■Ilaaaaaaaaaaaaall■■aaaaaa■1r^■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■iiiiiiiiiiii■Ilaaaaaaaaaaaa■L'��!■�aa�9ai�7■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■iiiiiiiiiiii■Ilaaaaaaaaaaaaaaaaaaiaaaaa/.■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaailaaaaaaaaaaaaaaaoaaa7aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaallaaaaaaa■il�ii��......\■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■iiiiiiiiiiii■I�aaaaaaaaall■■aaaaaaallaaaaaFl\aall■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■iiiiiiiiiiii■7aaaaaaaaallaaaaaaaaallaaaaa■+lid,■Ilaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaw\.riilliiiiiiiiilliiii►�r �Iallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaa■t'aiaaallaaaaaaaaallaa■■Illl�aaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaa■uii■aaraaaaallaaaaaaaaalla■n.\�aaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaaaall■■aaaaaaaallaaaaaaaaall■■I.■Jaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaa�i��■■aaaaaaaallaaaaaaaaa�i■■Jaaaaa■■Ilaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaa:l■■aaaaaaaaallaaaaaaaaaiaa■■■■■■■■Ilaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaa��faa�!!!!!aa■A'■iiiiiiiii■���������Jaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaa:=faaaaaaaaaaaitfaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaL�a■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■iiiiiiiii�:; 7aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■iiiiiiiiil�•�aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaia!aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaa[�aaaaaaaaaaalaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■iiiiiiiiiiiiiiiiiiiiiit'■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■iiiiiiiiiiiiiiiia:===iiaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaraaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaal\aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaallaaaaaaaaaaaaaaalaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaallaaaaaaaaaaaaaaalaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaallaaaaaaaaaaaaaaali■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaallaaaaaaaaaaaaaaa�l■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaaaaaaa■■It■■aaaaaaaaaaaaall■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaa►:G:■aaaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaaaaaaaaaaaaal■■aaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaa�aaaaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaiaaaaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaa■■aaaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaaaaaaaaaaaa�l■■aaaaaaaaaai'■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaaaaaaaaaaaa<=====••••====■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaaaaaaaaaaaaa�aa■�aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaaaaaaaa..■■i.ii.■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaalaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaaaaaaaraaaaaaa■■i�aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaallaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaallaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaallaaaaaaaaallaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaallaaaaaaaaa\laaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaallaaaaaaaaaiaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaaaaaaaiaaaaaaaa■■�\aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaaaaaaaaaaaaa�!===Jaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaC�aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■aaaaaaaaaaaaaaaLCi■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa■ h.1. e� �rJ -a�aa 3. _ a •l�s'= JUL 2 8 2 22M.a Madison 4822 s� oswry s,n*„rPernik Number cw I� �a:lbyc P.O_ Box 7162 St. L'Oix t_ou ty Madison, WI53707-7162 71 `7 pI1C10 i ShleTraoomomNrlmbv"f In wemtirlce wile SPS 3E311(2Z Wis Adm. I , is m 1 m Code. erhanisiom of Otis farm to the appsapriste / t' ' ✓ ©7 � II 7C O ` L °�tl1O1/ + Y D Note• Application forms fix anmeo VAMUtled b Project Address (if dffaent lhrn mu7ug ad tle Messes of SafaY ad �srorrl Swrees- Pavord mftmaeon you pswide may be ud 1br aecorhdery 1w aoomdm= with the Pri Law, s. 15.0t(1 xm). SotR L _pplileadow Lfir>♦atlee — Tleeae T. Ae r i AEQ:-Wf d CH1?-v'-toc l7'-iESOQ Prtrpetty Owma's Mar76hg Ads J?I ,�II �T fl"i3E city Ss ate Z' Cade Phone Nnanbc t)bULTO ii : �''v'1 "11D 1 IL Type of 13am (eieek a/ tart apply) La Y car 2 Family Dwelling- Number ofBedrooms __ 20 YE�"wXommemial - Describe Use Block Y �Stau Owned - Dmibe Use III. Type of rowy YSIM EL E)Wdimg Tank C ORtmewal Before Tarok Infmrtim System or "RsplaaasnC' sew Ober Modification to Em" Sysscm (mosim) 1n-Grohad (oarveraiarl) ❑Rev let n of Plumber Area Ara lc and Task Iefenuthm: n Application Rate(gpd/sf) yne�rad^Arm^ Rvelem Capacity in Total slam Y of units V- Reap..eilift Saissawl.1. dw P1 Nuae i'Print) JF, F F � X_ 5 fax is k f )l,ZES�IZ Wl ':�. 2- to New —zi6)-zo- Gout Lot 5E � SetUuh Z ORL+I A US 0 r S7` C R r ilisp of O4N1 of �� b 6e A. Cbo& are box w Kee A Ceaplda lira C Addmmrl Premmm e t l)rit (esplem) Individual Site Devi Type (ex0 m) r t !hrTb Prt� opowd (>� System EkvaaFr tuner —1. a .f the POWM Merun ea dw afte i d plea Buanes Phase Number Z73ZyZ 1 —115- 47/ -3`I5? a14w 9 rSYSTErM ed O Permit Fa Iswxd Isw Ages Siphaum �rltvwsewvfor Denial �'�� �� Z O ZZ e R: S Y�1� ►t /�J 4h ULF/ L Pmµ ll / 1. Septic tank, effluent filter and ✓.►^{rJ /pI`r�7r 7f(y/ A n kt �d (�%/`��v r { y� / dispersal cell must be servi /m i n � / /S/ ) ��Q / 1� as per management plan provided by pin�' 1 °�` f� �r'~� S rr r r 7 {hh�CC T J--t /-C 2. All setback requirements must be maintained-1 yY f v1 e4eL — / as per applicable code/ordinances. �^ n Aweb rIar •r raa-�-'�6L�1. r'+Aem re wbdt r rY Cwb a� MR oft Im bar I N x 11 Yrar IN aie 0 / ErP-K�( + C F-Or/W; G113So1J LOT 8 0Rci(f\ROS or 5T C z01 `I' 5w,14 5F")W 5 ZW Tad iJ Iv- Zo w ST-DSE�fLW 7ASP 1-371 Ceo(X CTY �APRS ZyZ AL of u WARRVI SP5�1 D F 1 •C N \ -EIT1iE2 Fgit E �7' El. )Df? T1 SDIL �ti21l.�(a ,4 �AePGE 1. )ZM)860 TAMV, T i v blsnUop, AREA � I 8N\ O July 27, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-07-27 Plan Review: PWTS-072201700-C JEFFERY V FOX PO Box 565 Dresser WI 54009 SITE: Jeffrey Gibson 271 141 st St. Town of ST. JOSEPH St. Croix County Total Amount: $250.00 DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http:l/ds ps.vn.govlprogra ms/i nd ustry-services www.Wsconsin.gov Tony Evers - Governor Dawn Crlm - Secretary CondNbna/ty APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES D ION OF TRY SERVICES SEE CORRESPOND CE FOR: Description: Four Bedroom Mound System 1 Sloped Site Mound Component Manual — Ver. 2.1 (May 2022-2027), Pressure Distribution Component Manual — Ver. 2.1 (May 2022-2027); 600 GPD, 20 inches to limiting factor from original grade, Maintenance required, Effluent filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1 /4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, /� ae' P�O�rGG POWTS Plan Reviewer — Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: Katie.PetzelCobwisconsin.gov Cell: 608-574-1189 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Jeffrey & Christine Gibson Owner's Name Owner's Address: 271 141 st Ave Houlton WI 54082 Legal Description. SW 1/4 SE1/4 S24 T30N R20W Township: St. Joesph County: St. Croix Subdivision Name: Orchards of St. Croix Lot Number: 20 Block Number: Parcel I.D. Number: 030-2161-20-000 Plan Transaction No.: Page 1 Index and title Conditionally Page 2 Data entry APPROVED DEPT. OF SAFETY AND PROFESSIONAL Page 3 9 s Mound drawings 9 SERVICES Page 4 Lateral and dose tank DIV SION OF I TRY SERVICES Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications SEE CORRESPOND CE Designer: Jeff Fox License Number: Date: 07/15/22 Phone Number: Signatu� MPRS 223242 715-491-3458 Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01, R. 11/12), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-107WP (N. 01/01, R. 10/12) Version 7.0 (R. 11/12) Page 1 of 7 Mound and Pressure Distribution Component Design Design Worksheet (P o• C) Site Information Residential or Commercial Design Estimated Wastewater Flow (gpd) Peaking Factor (e.g. 1.5 = 150%) Design Flow (gpd) Site Slope (%) Contour Line Elevation (ft) Depth to Limiting Factor (in) In -situ Soil Application Rate (gpd/ft2) r 400.00 1.50 600.00 13.30 100.00 20.00 0.40 Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ftz) 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information (C of F) e Center or End Manifold 4.00 Lateral Spacing (ft) 2 Number of Laterals 0.156 Orifice Diameter (in) 2.37 Estimated Orifice Spacing (ft) _ r 2.00 Forcemain Mamater (in) 110.001 Forcemain Length (ft)\ 92.00 Pump Tank Elevation (tt) 4.55 System Head (ft) x 1.3 8.93 Vertical Lift (ft) 2./ti notion Loss 0.00 In -line Filter Loss (ft) 16.231 Total Dynamic Head (ft) �I teral Diameter Selection in. dig. options choice f r 1 0.75 70 1.00 1.25 1.50 x x 2.00 x 3.00 x Treatment Tank Information 1200.001 Septic Tank Capacity (gal) Wieser I Manufacturer Note: Sand fill (D) calculations assume a Table 383-"-3 in -situ soil treatment for fecal coldorm of <= 38 inches. 8.00 Cell Width (ft) Are the laterals the highest I in the distribution network? Enter Y or N If N above, enter the elevation ft of the highest point. 9.38 ft2/orifice Does the forcemain drain back? Enter Y or N .94 Forcemain Drainback (gal) .41 ff 5x Void Volume (gal) .35 Minimum Dose Volymw (qal) I 5-t.461 system Demand (gpm) Manifold Diameter Selection in. dia. options choice 1.25 x 1.50 x x 2.00 3.00 Gallons/Inch Calculator (optional) Total Tank Capacity (gal) Total Working Liquid Depth (in) galfin (enter result in cell B49) Dose Tank Information Effluent Filter Information✓ 800.001 Dose Tank Capacity (gal) Ilifetime Filter Manufacturer 22.001 Dose Tank Volume (gal/in) 1 8 Filter Model Number Wa I Manufacturer Project: Jeffrey & Christine Gibson Page 2 of 7 Mound Plan and Cross Section Views L Mound Component Dimensions A 8.00 ft E 2q9:5 in B 75. F in D 6.0 in G ft 600.00 (ft) Dispersal Cell Area 8.00 (gpd/ft) Linear Loading Rate H ft I ft J 5463 ft K 10.97 It L 96.94 ft W 32.04 ft 1981.07 (ft) Basal Area Available 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.13 (ft) - 0 G H /il/l/lllllll/l/ /ll///I/llll/I I F pig � 101.83 (ft) Lateral 101.33 ft) - i — Invert Di sal II Elevation D 100.00 (ft) Contour Elevation 13.3 % Site Slope Geotextile Fabric Cover Shading Key a DispersCell See lateral details on 10 _ Topsoil Cap 3 1.5 ft Page 4 for number, size, 2 lllllll/ Subsoil Ca ~ 7al '�{) and spacing of laterals. ASTM C33 Sand v �" �—Laterals are ced from t elyhe Tilled Layer c N 0.5 ftral F disstiribution celrs © Aggregate + o centerUne in the A distribution cell (Axe). Project: Jeffrey & Christine Gibson Page 3 of 7 End Connection Lateral Layout Diagram Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral Flow Rate System Flow Rate016.23 Total Dynamic Head 2 Orifice Diameter in — Orifice Spacing (X) ft Orifices per Lateral ft Orifice Density m Manifold Length Manifold Diameter ft Forcemain Velocity 1.50 73.47 4.00 17.23 4.46 Dose Tank Information Electrical as per NEC 300 and 10 SPS 316.300 WAC Tank component is property vented Weiser Capacityl 800.00 Volume 1 22.00 Dimension Inches Gallons A 19.58 430.85 B 2.00 44.00 C 3.88 85.35 D 10.90 239.80 Total 36.36 800.00 Manufacturer Gallons gal/inch A q B C D Disconnect 3" Bedding under tank. Alarm Manuatacturer lRhombus Alarm Model Number MJ Plugger Pump Manufacturer lZoeller Pump Model Number 1bn151 Pump Must Deliver 34.46 gpm at 16.23 It TDH Project: Jeffrey & Christine Gibson 156 in 2.37 ft 9.38 ft2/orifice 4.00 ft 1.50 in Locking cover with warning label and locking device and sealed watertight -T 4 in. min. 1 Alternate outlet location Forcemain diameter 2 in. Weep hole or anti - siphon device d Pump off elevation (ft) 92.91 Dose tank elevation (ft) 92.00 Note: Switches containing mercury may not be used in this system Page 4 of 7 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 We. Adm. Code, and shall maintained in accordance with its' component manuals (SBD-10691-P (N.01/01, R. 11112), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01101, R. 10/124 and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33. Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shed be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to faiure must be replaced. Exposed access openings greater than 8-itches in diameter shall be secured by an effective locking device to prevent accidental or uneu #homed entry into a lank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48. Stab. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shell be cleaned as necessary to ensue proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tans Mint may sough off the filter when removed from Its enclosure. If the filer is equipped with an alarm, the filter shall be serviced A the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm The septic lank shall have M contents removed when the volume of sludge and scum in the tarts exceeds 1 r3 the liquid volume of the 1". M the contents of the tank are riot removed at the time of a triennial assessment, mai tenance personnel shall advise the owner of when the nett servioe needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, it such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. AN switches, alarms, and pumps shall be tested to verify proper operation. tf an effluent fitter is installed wlthit the tank A shall be inspected and serviced as necessary. Mwatd and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mounds perimeter, and the mound shah be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (odw than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather irstaiations (October -February) dictate that the mound be heavily mulched as protection from freezing. Influent quality nib the mound system may not exceed 220 mg& BODs, 150 mg/L TSS, and 30 rng/L FOG for septic tank effluent or 30 mglL BODs, 30 mg/L TSS, 10 mgA. FOG, and 104cfkW100 mL for sty treated effluent. ptAient flow may not exceed maximum design flow specified in the permit for this installation. The pressure distrbu Lion system is provided with a fYshing point at the end of each lateral, and A is recommended that each lateral be fleshed of accumulated adds at least once every 18 months. When a pressure test is performed A should be compared to the initial test when the system was installed to determine If orifice clogging has occurred and A orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shell be checked for effluent ponding. Pondng levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent montorig. Contingency Plan h the septic tank or any of its components become defective the tank or component shah be repaired or replaced to keep the system in proper operating condmon. 11 the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shah be Immediately repaired or replaced with a component of the same or equal performance. If the mood component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in r& present location by increasing basal area A toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of tins plan for the name and telephone number of your local POW TS regulator and service provider. Pratrutmant Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection urns are attached as separate docxrnerts and are considered pan of the overall management plan for this system. / J£f't`iJ q 4 NKt5 mr- Gm35otJ L o-r 8 O tZC mom n F 5T C izol vj- sw'M 5F')y S zN T36 rS l2 zo vJ sT Zbslr--F-W 7WS? -3-T ceorx GTY tAfRS C-V gN � H►�� ; � P�EtxNNlAR1� F�A�. r?F E I TMsR FLx >G ks-v sl- : )to N tf 5D I L r%?MNo 8F'o 'ems �ff i 6A IZtWB60 TANK � i ► v DoY Dl�`tu2x AREA is' kLai H1oe11i�D _� f 8 N\ FLOW '� omm own r 164' 1 FLLTER OR BAFFLE TOP VIEW SCALE: 1/4' . V 510E VIEW SCALE: 1/4' - 1 OPTIONAL MANHOLE ACCESS WLP1200/800-MR TANK SPECIFlCA110NS DIMENSIONS: WALL: 3' BOTTOM: 3' COVER: 6' MANHOLE: 24' I.D. HEIGHT: 53" O.D. LENGTH: 154" O.D. WIDTH: 96" O.D. BELOW INLET: 41' O.D. LIQUID LEVEL: 36" W£ICHT: BOTTOM 12,DD0 LOS COVER 8,170 LBS INLET AND OUTLET: 4" BORE NTH STOP FOR OUIK-TITS, FERNCO GASKET, CAST -A -SEAL 8007 OR EOUAL INLET AND OUTLET BAFFLE AND FILTER: SEE DETAIL #10 UQLAO CAPACITY: 33.45 GAL/IN (SEPTIC) 22.Z4 GAL/IN (RUMP) LOADING DESIDN: 8'-0' UNSATURATED SQL CUSTOMIZED TANKS. TANKS CAN BE CUSTOMIZED CONTACT WIESER CONCRETE W3716 US K1 0. YA"N ROCK, M !p�750 800- 325-8456 MODEL WLP12DO/800-MR SEPTIC/SEPTIC, SEPTIC/PUTAP OR SEPTIC/SIPHON I'11.E: MPIi00 800-P r. 7 r _ Zo%yam Di Y SOIL EVALUATION REPORT 7epa1mtw d Sate'y a•rd Pr Suor•x Sary w i 4 :+'.a::•t:`Sa'elylrrBld�•v}c th 85 W s Adm Code 01675 Page 1 d 3 Geo Teo Soil t3 Srta Eva uabcn. LLC ti•y _... inaccordance vn .,CmIr r - Ceunry Attach eo,rrpb:r site ;Ian o-i paper not leas Han ti'ri r 11 Inches n sirs olan muse $1. C+rOIs include, but no: lim tee to vert ca and horuento releranca poh: (OM) If reatlon artl -- ----- --- -- Parcel 10 perwr slope. scab or dmensinns north arrow. and wcatph and Cr7tance to rearesl road Li(i - ZCOa'O Please print all information. Reviewed By Do* Pe•aorul n'c•rwLwn you picric. •rey be reed for seconcary pvpcses ,Pnvacv Law a 1: C4 111(mlt /1 A�G // 3 - 1`/T Pwarry C)wnw Property Location HARTMAN HOMES Gout Lo' SW114. SE1/4 S24. T30N. R20W Lot a 8 oex a 5ubd Name cr CSMP -- rlrope•ty Owners NaJ'rg Address 744 RYAN DRIVE 9102 20 NA ORCHARDS OF ST. CROIX --- _ _ City Slab Z p Code Poona Numbe• - --- Cly t Vdlapa , - Town Nsansst RaW HUDSON WI 54016 715.377-1555 St Jose:3h -) 1 141ST AVENJE 4aw Construes ar Jse ResldenW ; Nuwbar of badroCms 4 Code derived ces pre flaw rate 600 UPL; Reciscemov. Pubsz orcommercwl Dersrr-be NA Parerd enatanr LOESS OVE TII L, .'cod pram abvabcn. it appleCOWS NA 6 General commenh Repiros a Ntd fa mpu d oorhporeM UpsVI;*j MJga of dlbelbt.iim ces b be 1r 81111ed along dM Ragge0 IOMW gum and .ecorrmerldstro Is ento,rr. Mumum basal SLR e 0 4 ;er it) Mamrium 21`4 M Slope at wed motour Wlu:. GIIA G - ,c z E ,vim R !Stir *A1C4W,- (IOnng e : 9onnp Ground 100.00 ta: 26 in _ ae surface ele+ R Depth IC rm,t■iy w Spa Appsralien RSM tloita<on Depth Dort rant Color RWox Description 1 Tealure Structr a Constusimcal Boundary Roots, WON 'EIR1 'EIMi in Munsel Qj S2 Cont. Color Gr SZ Sn I 1 0.6 LOYR 3/2 Sll — - — 2 6-26 10YR 4/3 SL - - 3 26-30 LOYR 4/6 C2D 7_SYR 1,6 ":SL - -- - 7.5YR 3i4 i � �B01ega Pr; Ground s.r•race eiev WOO ft Depth to wn vig factor 20 in. 13od A okMon Rrs Horizon Depth Dominant Gobi Redox Doacripl On Texture Slruduts ConsistenceBoundary Root taPDrq' in Murree'I Zo, Sr Cord Color Gr. SL 31, fern 'Ea¢ 1 0 7 ! LOYR 3/2 SIL 2 7.20 10YR 4/3 SL C2D 7.SYR 4/6 3 2O.25 10YR 4/6 7.5M 5/4 FSL EMuerm e1 = BGC. N 30 a 220 nW, and TSS >30 -c 15.0 wg& ' EHltrerlt e2 = 800e s 331rpyL anV TSS _30 my'. CST Nora (Plane Prim) Spnature. Number William J. Bergh ,/r 227819 ----- Addis Goo Tech So I S Six Evaroahon. LLC - DaN & TeNpaone Nvnba 11091 301h Avenue Ch,ppew7 rsas W, 5472i; 1 715 57743838 Propimry Cyr MAR I MAN HOMES _ Parcel ID e _-_--_-- °age 2 of 3 Ocurg a ng + • Pit Ground surface e'er. 100A0 Ft De" to limit rg !actor 23 in AW"Iion Rate HW=n Depth Dowmiattt Cofer Reoox Descriction I Texture SOucture Boundary Roots GPO_ t' In. M.rnse'I Qu Sit Cort tlulv Gr Sz Sot Emt 'EI1 2 1 D / IOYR 212 none sil I 1 f sbk mvfr gs I 2m 0.4 0.6 J{ 2 I 7-I3 1 IOYR 413 I none 511 1 m sbk mff ps if 0.4 0.6 3 23-40 10YR 4/4 c2d z.SYR 41b sd 1 m abk mfi if 0.2 0.3 Swing _ Bo•rnq Boring e17 PI Ground s.raace wev 8. Depth to rt-trng factor r AcpkcN on R Horizon Depth Deen rd cob• Redox Desoipba Texture svucb" catstssenda timm" Root GPW ,n munsel Qu. Sz. Cant Color dr I Gr Sz. Sh i -Eir.1 r '9tt12 Fojent e1 - nmb> X < 220 "& and TSS >30 � 150 mgr_ ' Eff tent e2 - SOD, < 30 mgt avid TSS <30 mqt The mparunent orSaret% aril Prufrs.iwaJ Scrrictx i� an equal th+purtunity xmia pm%ida &W anpk»et. If you WVJ assistarwr to arc.-v� wn izr< rw nrrd m.tlrr.d in an al%matr foncat. costuct the dcpartmr.it at ldlR-?!A.:1 S 1 or M' throw Relay. .nn+• r t..• a ' i , , two ran Sor a Sat :vw o% U1 X ' § /J|q ~' ST CRO NTY SANITARY SYSTEM OfficFilets: i OWNERSHIP/ADDRESS FORM Create 212021Use y Created 2/2a2t 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 Jeffrey & Christine Gibson Mailing Address 271 141st Avenue City/State/Zip Houlton, WI 54082 Phone Number (required' 952-200-9652, 952-201-2260 Email Address(required)jeffagibson7@gmail.com; christinesgibson7@gmail.com Parcel Identification Number 030-2161-20-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SW '/4 , SE 1/4 , Sec. 24 T 30 N R 20 W, Town of Saint Joseph Subdivision Plat: Orchards of St. Croix Lot # 20 . Certified Survey Map # Volume . Page # Warranty Deed # (before 2006)Volume . Page # Number of bedrooms 4 Spec house 13 yes ■ no Lot lines identifiable ■ yes O no New Property Address kl-- (Aeff [ Initi OFFICE USE ONLY 4I s- A'X (Verific *on of new address required from Community Z&/W ZZ (Date) for new construction.) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 71 S-245-4250 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.aov o. �I • 144 -n 0 m Ila z N CHRISTINE & JEFF > GIBSON RESIDENCE K) dam= 744 Ryan DrWo, Suss 102. HUftM, M 54016 715,3771565 <�- OUTLOT 1 ------ -+� `� PARK° % C S 65,495 SQ FT. r i.s04ACRES STOMWATER POW G 132,sio sq, Er. � 3.042 ACRES \ ' t b \ s ' / pp�, 1 3j6.OT / � 1 / 0 \ / / I �` �wt}. L.B.O.0917.0 mat-1,o�y., ors 4 SOIL EVALUATION REPORT #1875 Department of Safety and Professional Services Page 1 of 3 Division of Safety and Buildings d ith C e5 W Adm Code Geo Tech Soil & Site Evaluation, LLC in actor ante w omm , is. 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 Information. Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.04 (1) (m)). County St. Croix Parcel I.D. v30—Zl�o ' ZO—do0 Reviewed By Date GI`,qIG 3 ,v / Property Owner HARTMAN HOMES Property Location Govt. Lot SW1/4, SE1/4, S24, T30N, R20W Property Owner's Mailing Address { 744 RYAN DRIVE #102 Lot # 20 Block # NA Subd. Name or CSM# ORCHARDS OF ST. CROIX City State Zip Code Phone Number HUDSON I WI 1 54016 1 715-377-1555 City ❑ Village ® Town Nearest Road St.Joseph '1I 141STAVENUE ® New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: NA Parent material LOESS OVE TIL�'LLg _ _ Flood plain elevation, if applicable NA ft. General comments Requires a �6 sand fill mound component. Upsloped edge of distribution cell to be installed along the flagged 1 00.00'ground and recommendations: contour. Maximum basal SLR = 0.4 (eff #1). Maximum 21% design slope at flagged Contour. 1V114- Q RRG icif AMNlr REIC6116' R /SS"AWCC. ❑ ® Boring -� lj tDr MW CA t- C4-F, Cj" t k— Boring # ❑ Pit Ground surface elev. 100.00 ft. Depth to limiting factor 26 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' 'EfM -12002 1 0-6 10YR 3/2 SIL - - - 2 6-26 10YR 4/3 SL - - - - 3 26-30 10YR 4/6 C2D 7.5YR 4/6 7.5YR 3/4 FSL - - - — Boring # Z Boring l,] Pit Ground surface elev. 96.00 ft. Depth to limiting factor 20 in. Soil Application Rate Horizon Depth in. I Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/W •Ef#1 'EB#2 1 0-7 10YR 3/2 SIL - — 2 7-20 10YR 4/3 SIL - 3 20-25 10YR 4/6 C21) 7.5YR 4/6 7.5YR 5/4 FSL — — Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 <30 mg/L an TSS <30 mg/L CST Name (Please Print) Signature: CST Number William J. Bergh 227819 Address Geo Tech Soil & Site Evaluation, LLC Oate v ati n Con Telephone Number 11091 30th Avenue Chippewa Falls, WI 54729 /1/ 5 715-577-6838D SeJ170(R 1 U]0 Property Owner HARTMAN HOMES Parcel ID # Page 2 of 3 3 ❑ Boring Boring # Pit Ground surface elev. 100.00 ft. Depth to limiting factor 23 in. ® Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Re 'Eff#t •Eff#2 1 0-7 10YR 2/2 none SO 1 f sbk mvfr gs 2m 0.4 0.6 2 7-23 10YR 4/3 none SO 1 m sbk mfr gs if 0.4 0.6 3 23-40 10YR 4/4 c2d 7.5YR 4/6 7.5YR 3/4 sd 1 m abk mfi - if 0.2 0.3 ❑ Boring Boring # ph 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 Gr. Sz. Sh. Consistence Boundary Roots GPD/W -ER#i I T1102 ❑ Boring Boring # 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 Gr. Sz. Sh. Consistence Boundary Roots GPD/W 8081 •Eff#2 Effluent 01 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg& and TSS < 30 mg/L The Department of Safety and Professional Servicese is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBn-937oTw (R I i n I) Goo Tech SuM s Sae Evsk atkn, LLC N W E S SCALE 0 30 60 MOSS SHOWN OTHOWA ) WILLIAM J. BERGH WISCONSIN CERTIFIED SOIL TESTER DESIGNER OF ENGINEERING SYSTEMS CUSTOMER ID 227819 BUILDING SEWER MUST COMPLY A. WITH SPS 382.30 WAC (11KC) A. LOCATION OF WELL MUST COMPLY CO WITH WDNR CHS. NR 811 8 812 H BENCHMARK ELEVATION =100Z - BASE OF EITHER FENCEPOST e LOCATION OF SOIL BORING(S) LOCATION OF SOIL PIT(S) * NO APPARENT SPS 383.43 SETBACKS ® DESCRIBED LOCATION OF LOT LINE ® LOCATION OF RIGHT-OF-WAY 19 CENTERLINE OF DESCRIBED ROAD THE INFORMATION CONTAINED WITHIN THE ATTACHED SOIL REPORT M NOT TO BE USED TO DETERIINE THE SURABLITY AND OR DEPTH OF ANY PROPOSED FOUNDATIONS. THIS POW75 COMPONENTS NOT DESIGNED TO RECEIVE THE ADDMONAL WATER GENERATED FROM ANY WATER TREATMENT DEVICES I .. WfV N � A j' MQN1 l_ V J /(1 I .... �N to tit ~ Q� Nl CL , s IWO aw �1 =m l M, ���► �`•.,s,Lm 3m c l� 900 / 4 UNPLATTED LANDS — o ^ J/ /ZONED AG-RES" USE: AGRIC 7ED & BERGETTA ANDERSON 910 ` ` \ 135915TH ST HOULTON, Wl S4M2 ; l 1006 16199V0 :eooa LOT 1 u6Wgrt. wm 5 // , ,/ MNL 1M• PART OF / ! / ar R/ice LOT 1 C.S.M _VDL 1 PG 187 VG. 9. LN; I —:,lT2_STF1 STREET / � .on or, .u.sos"obmucnob M"u7s.tl eeoumro giO.s.N f1e[TroM rtammumPm WYI.ION INbIf CIBMfi G1'JI BIV1MMfOWl1D INIPD:Nt N1tl.NOSIY[r.11YD1411Yr0 O.N-M. MW1Mm191P1N1PI MI Mi."glyT 111p11eIDf llYp. ip (pIR1Y.Tp. mIBRIMMM u.rraNec.rowTeu uoonaanubM nM.TMmWNn NN.bWnbr.4 eYOtl t0414WMMIOfroItl MMOW6M®ro mtlfNeleebM.DrbYllb. rm16N11nn 0MM.ONO WOnYr4rl pY .e.L rr evN nub mev. MOMroetlan emsL g1011.tl noueo ro.NNMeOiWn .IT[ .m rw.a[.tlen.Nvma.. woservlsp ne.Y1I�M 1Wl.NYf AsrM.6TWIp.LT M M MT.11CYr 6 m161R1Y116 Lppllr wrN rN nM eMcbrm omra..eeaan eNotl b UGMn6Y0YN1YYnM.L f.M1Y[nbn (ObiYR1b.DO6Ol"iTgp110Mt � H; • ; �1 nq LA�II s s k s ` LOT 19 , n", LM.m uo.eoe COUNTY PLAT OF ORCHARDS OF ST. CROIX LOCATED IN THE SW2/4 OF THE SEL/4 • nl AND PART OF THE NW1/4 OF THE SE1/4 OF SECTION 24, T30N, R20W, LOT 16 TOWN OF ST. JOSEPH. ST. CROIX CDUNTY, WISCONSIN. t f.06 `5 _ ! PREPARED FOR: �.' L su.n.M awo.sYu.YUN.NIru / L LO Nx7 s.v...n..Y 'F1 iCt S )N lnM pw'I FG[ F' .ic r�Aab. wssma ei! y� S _ nsu sn.isu YO ji / PREPARED RY: Y F V �/ ¢YRrYa1RR5 +I$E // - Mm mesabW.sson.m F C] $lsi Fy � Nufh wfm. r� � mu NL,mr nsu: r•.r 1 �•. �I � nM..N'w.v Y.Yea i 1 ` � Fi 41 sY�s w'w�armea LOT 17 °�3` o .� 2 .uaa�a�r,crie I N� �Y TI ..�OPYP.IYtlN V NM.A.Y.OA �iatir 4 LOT 18 ______ „� rM uL7on n. � m•n.m N.YYra��wsears. rme."tl ,r9,1 .asn..ar..r"w..Na nm I ana.u. n.rtr YwYa JI Nars rYLv V / LOTH L07]I LOT 10 or WOODLAND HILLS �\ I' 7 •� I IAT 7llls qN M m6.NRlee P.�YtllNtl tl.lOeebrorre u.en+rA�N fYtl,Y AY e�'NeG W M r.^r^ba..^YMa WMYNGURIO Nl M..1LRYLLIOUrlb6 a,0�u.�vrru.� rq.p POe M mNrr.croY". rr.n bfre Y r�isow.iN^Ys.snr wUN+e..l.Yn sNNNPONm 7Y nNe NYO Ya IY .Y, S r, ti i. se.e.w MIPr.., V AY.N�IMI.l YI'1ai�d0YT.N�.Y wi.a Rai AY...ifNY1L0M,N �N.sY+YNr M..a..a.�NerL r.rur C..Y rYbWYP M..O..ai.a.pPWYr Ns.Ormwa+ew nN.vwtla.aan.N va.me NYOL.ruYra wcroY.YosNa Naas.nsYv memu.naN.Yar.. N..v v�uasu.a..Yrsr+.rsvM.ra..xr. awseLNvwurrw._wrvow�ma�L OIaa.M _ +aOW=�r.�er Y�..�.= IIa,�IOY�A•Y] I jl I a! IaaroYs¢rb xrnw u 77FY, emw enM [Yn emenR b mm Hamm-vn ewmora rmm ♦� iol.•l cols ww7•+ oonNtlrt. is' Pau u .Y,." acNn� oFml M. W.NrIN.. M.N .... N1re SHEET 1 OF 4 SHEETS WERV" AREA PER LOT AREA n rows 00'ewwllPew • 2tt6 SF t eeaawanwf roroonama wwir ••c Real • 4,797 BF t •~we A •win w� TOW -7,W BF! a�•rfvdlwallglOARTwn � •1 LOT AREA TRT11tl 300 FT OF OWM • ].`/ w Ott AC. t 1171,50T SF t) ` MW2W# M AREA WnM 70D FT OF C*fm • /' �^ TOTALtiERVg116 PER LOT • / \ LEGEND 7.4831132.510. 5^00-ERYKM AREA ___.--''/ e \ TOTAL WERVpVS WRMR 500 F7 OF Ol1FRA• j \ \ �r •m�e g 7.M51171,50T • 5.7% tAPERV1OUS AREA / \ -\ �••Cr N•R •Ilw•�Iw OOIyYr RE6IXRFD RAM OAROa AREA mrowwrr.wrrm 7,465 X 0.075. 552 6� / / — wer•nor Al 1w17 tAW•tr•r bmbm en reRriwtl ww • /rsbnw d e0D SF Yr eb i \ a -prat KG LU �rl� \ \ slaar rr0l urNf•e0elw � S LLZ , .' nora..am (I uij Q C• r �� / \ l 0 aawmv�wfwnr LU IS" 05 .A �--- .' i 1, nr.,. F Z� Y r �� w�• ` � � \\ .�. woaeearrwn � 5L ``j \ y oir orow•wweNwrwea �= Uf i V11 \ .•r � I�SB � '6. 0a•RwLTfiM l,�'11, MyW19111Np r iy I C 91'%X ROMItl ) yL i r J 929W / 1iMMYY!!D !t F LOT 20.E Msu �a Fr. ., ,aa Ao1eB FS �Rpr ` � r ) ��•i.wT r� y, t SfTEPLAN Q) �3[ 2 . CID STAT SANIT R =Z:tte2TI OWNER PLUMBERZI�F f V X TOWN OF I STiME LIc.# 2232'F'L SEC,T_N, R Zp -�-40 AND/OR LOT 2,6 BLOCK OP sr. L' RG/X SUBDIVISION NO., 644767 PERMIT NO. CHAPTER 145.135 (2TWISCONSIN 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. (I) 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. G�AA AU RIZ D ISSUING OFFICER — DATE 724 11 wA 2.2. S PERMIT EXPIRES Zvi UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FAQM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 11/20� �' L �� 06 2ot? -� cR > W 4ps �W4