HomeMy WebLinkAbout040-1306-28-000 (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.15.04 (1)(m)j.
ermit Holder's Name: City Village Township
David A. & Wanda M. Shafer TOWN OF TROY
ST BM Elev: Insp. BM Elev: BM Description:
AN K !NI-UKMATIUN
TYPE MANUFACTURER CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
.
ModelTmber
I Z
TDH
KJ
ic ion L ss
L
tem H d IT
ISV
H Ft
Forcemain
Length
Dia.
Dis to Well
JUIL AbbUKV I IUN SY5 I tM
ELEVATION DATA
County:
St. Croix
Sanitary Permit No:
645405
State Plan ID No:
Parcel Tax No
040-1306-28-000
Section/Town/Range/Map No:
08.28.19.1855
Benchmark
vim
NIIIIIIIIIIIIIIIIIII�
=1
nm
St/Ht Inlet
mm
IOWA
I
Dt Inlet
�V 'A
"IF
lBot. System
I/ 11 /- / 1A-- IA.. -_
BED/TRENCH
DIMENSIONS
Width
'31
Length
(/(O /_/ I
No. Of Trenches
PIT DIMENSIONS
No. Of Pis
Inside DiWp"
Liquid ffepth
SETBACK
INFORMATION
SYSTEM TO
P/L
JBLDG
WELL Kei�fE/STREAM
LEACHING
CHAMBER OSystem:,
UNIT
Manitfactwer,
Type Of Sy
I
V 30'
23�
/ 01
Number:
LJ10 1 MI0U I IUIV J T J I tIVI
Header/Manifold
Distrib utjon
x Hole Size
x Hole g
to ntake
Pipe(s)
Length Dia
Length Dia Sp
SOIL COVER x Pressure Svstems Only YY Mnunril Or At-rrnrin Svctnmc Only
Depth
e ter 1
Depth Over
Bed/Trench Edges
xx De t f
Topsoil
xx d/Sodded
u No
xx Mulc -
`_ Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: {.� Inspection #2: p
Location: 429 JORDYN LN Vakl-(will ►� to v" '�.�Vn +d (�
st a�A 0� �x
►� U tstr S{/S
1.) Alt BM Description = � (9yV�'�OIN r -1 U
• l •
2.) Bldg sewer length = •��� DV,cJ �A.;l�� ( r�llit�5
V 7~ �l• { QNS f
-amount of cover�Vu �
Plan revision Required? Yes )( No y /
Use other side for additional information.
SBD-6710 (R.3/97) Date ctor's Signature Cert. No.
S n ._ I -% _)-7'7
County
MI � u
Safety and Buildings Division
201 W. Washington Ave.. P.O. Box 7162
St. Croix
Sanitary Permit Number to be filled in b
( Y Co.)
�' p,UG 3 0 2022
Madison, WI 53707-7162
ssan, 0"o it Application 61
:appro
State Transaction Number
In accordance with P83! I m. Code, submission of the form t riate governmental unit'
Na
�AICJUired prior to aintng a sanitary permit. Note: Application forms for state-owned POWTS are submitted to
project Address (if differehap mailing address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04 1 m Stats.
Same
I. Application Information — Please Print All Information
Property Owner's Name
Parcel #
David & Wanda Shafer
040-1306-28-000
Property Owner's Mailing Address
Pro Location t a�
J CJ
429 Jord n Ln.
Govt. Lot
NE '/4, SE '/4, Section 08.
CM . State
Phone Number
54016
(circle one)
Hudson, WI
(715) 983-5350
T 28 N; R 19 W
II. Type of Building (check all that apply)
Lot #
® 1 or 2 Family Dwelling — Number of Bedrooms 3
28
Subdivision Name
❑ Public/Cornmercial — Describe Use
Sunset View
Block #
Na
❑ City of
❑ State Owned — Describe Use
❑ Village of
CSM Number
Z.0v.,*
Na
® Town of Troy
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A.
❑ New System
y
®Re Replacement System
p y
❑ Treatment/Holding Tank Replacement Only
❑ Other Modification to Existing System (explain)
B.
El Permit Renewal
Before Expiration
El Permit Revision
El Change of Plumber
❑ Permit Transfer to New
List Previous Permit Number and Date Issued
S747 lb3:� 3
Owner
.2/ ,?-V`3
IV. Type of POWTS System/Component/Device: (Check all that apply)(2—) '?
® on -Pressurized In -Group ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (exp ❑ Pretreatment Device (explain)
V. Dispersal/Treatident Area Information: filtrator " -4" standard Plu,,vfeaching chambe
Dcsign Flo\ti (gpd
Design Soil Application R gpdsf)
Dispersal Area e e s
Dispersal Area Pr d (sf)
System Elevation
450.0 Gpd
0.7 Gpd/Sq. Ft.
642.85 sq. ft.
654.40 sq. ft.
93.50'
VI. Tank Info
Capacity in
Gallons
Total
Gallons
# of
apufacture
�� 1 0
o
-
Units
i
0
New Tanks
Existing Tanks
o
W
a U
C7
ci.
Septic or Holding Tank
1,000
1,000
1
Wieser Concrete
X
Dosing Chamber
VI1. Responsibility Statement- 1, the under si ed, as me responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
nature
MP/MPRS Number
Business Phone Number
James K. Thompson
=ig
MPRS 30021
715 248-7767
Plumber's Address (Street, City, State, Zip Cod
340 Paulson Lake Lane, Osceola, WI 54020
VIII. County/De artment Use Only
Permit Fee Issued
Approved ❑ D' pprove to Issuing Agent Signature
1$525—
❑ O iven Re for Denial
IX. Conditions Appro 3
SYSTEM OWNER: r 7r'rN' T
1. Septic tank, effluent filter and 4vP% �er
dispersal cell must be serviced / maintain
as per management plan provided by plumber, 5 S lM yvlgltyl p�jZqn� F�1�
10 •
J
�,. ... av wmp.c.r pans wr uie sy tem anu sunmit to me i.ounn onry on paper not less man a 1/2 x i i inches in sue
as per applicable code/or inances (
SF3D b398 (R. 1 L l l)
4
ST. CROIX COUNTY ZONING OFFI
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC
R-CE-HEIO i
S E P 2 0 2022
ANVO)roix County
Community Development
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) 497 Jordyn Ln., Hudson, WI 54016 located
at: NE 1/4, SE 1/4, Section 08 , Town 28 N, Range 19 W,
Town of Troy , 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 6/22/22 4
Did flow back occur from absorption system?
(if no, skip next line.)
Approximate volume or length of time:
Tank Capacity: 1,000 gallon
Construction: Prefab Concrete X Steel _
Manufacturer (if known): Huffcutt Concrete
Yes No X
A e of Tank (if known): 9 years, installed May 10, 2013
ermit umber (if known) 561037
censed Plumber S igna ure)
MPRS
(Title)
August 29, 2022
(Date)
gallons
Other
James K. Thompson
(Print Name)
MPRS #30021
minutes
(License Number) MP/MPRS
4
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
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Conventional POWTS Index & Title Sheet
Project Name: Shafer 3 Bedroom Replacement Conventional POWTS
Owners Name: David & Wanda Shafer - Buyer: Geoff Schatz
Owner's address: 429 Jordyn Ln., Hudson, WI. 54016
Site address: Same
Project Location:
Subdivision: lot 28, Plat of Sunset View
Legal Description: NE I /4 SE 1 /4, Sec. 08, T.28N., R. 19 W., Tn. of Troy, St. Croix Co., WI.
Parcel ID #: 040-1306-28-000
Page 1
Index and Title Sheet
Page 2
Site Plan
Page 3
Dispersal Cell Sizing Calculations
Page 4
Dispersal Cell Cross Section
Page 5
Infiltrator "Q-4" Chamber Specifications
Page 6
Conventional POWTS Management Plan
Page 7
Existing Septic Tank Certification
Page 8
Sanitary System Ownership & Address Form
Page 9
Parcel Map
page 10
Warranty Deed
Attached: Soil Evaluation Report
Mater Plumber Restric ed Service: Jim Th2p�Esoq, DSPS Credential #30021
Signature:
Date:Oe__�.ZO Z z
Page 1 Of 10
Design pursuant to In -Ground Soil Absorption Component Manual for POWTS, version 2.1 SBD-10705-P (N.01/01)
L
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trl— eten ho% &JW. ASSu,,Kcd
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Shafer 3 Bedroom Dispersal Cell Sizing Calculations
1. (3 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 450.00 Qpd design
2. Infiltrative capacity of native soil = 0.7gpd/sq. ft.
3. Absorption area required: 642.86 K. ft.
4. Absorption area as proposed: 654.40 sa. ft. (32 chambers + 2 pair end caps)
Infiltrator "Quick 4" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end caps = 7.20 sq.ft, EISA/pair
642.86 sq. ft.- (7.2 x 2)/20.00 = 31.72 chambers required
Number of trenches: 2_A 16 chambers per trench (32 chambers total)
Trench width: 2.83'
Trench length: 67.00'
Trench spacing: 9.00' on center
Total system area w/ 6' trench spacing: 12'x 67'
Pg. 3 of 10
b
IN -GROUND DOSED -GRAVITY DISPERSAL AREA
Stepped Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down -sizing credit)
SOIL COVER
Highest Trench
System Elevations = 93.50 ft; 9 3.5 0
TYPICAL TRENCH
CROSS SECTION VIEW
(No Scale)
. u
I'• 34" a
(typical) a
e
Lowest Trench (as applicable)
ft; ft; I ft;
Quick4 Standard-W
w/ End Cap (Show location of inlet / outlet pipe connection on plan view.)
(typical)
_71— — — — — — —
B = 67 ft —
(typical)
INSTALL PER TRENCH:
16_ Quick4 Std-W @ 20 ft2 EISA/chamber = 320.00 ft2
+ = Pairs of end caps @ 6 ft2 EISA/pair = 7.20 ft2
Provide minimum 3 ft
separation between trenches.
ft
Observation Pipe
(typical)
Install per manufacturers
/ instructions.
TYPICAL TRENCH
PLAN VIEW
(No Scale)
I A= 3.Oft
(typical)
_I
Quick4 Standard-W Chamber
(typical)
(mfd by Infiltrator Systems, Inc.)
Install pursuant to manufacturer's instructions.
= Proposed EISA per trench =
327.20
ft2
Required Infiltration Area =
642.86
ft2
x
2
trenches
= Proposed Total EISA =
654.40
ft2
Distribution Method. -
branched manifold
Quick4 Plus'"' Series
Quick4 Plus Standard Chamber
2Z 12'
34"
Quick4 Plus All -in -One 12 Endcap
PRESSURIZED PIPE DRILL
ATIONS
33'�
FRONT VIEW
Quick4 Plus All -in -One Periscope
3
INFILTRATORS,
water technologies
QUICK4 PLUS
'"' •ONE PERISCOPE
50
4 Business Park Road
P.O. Box 768
Old Saybrook, CT 06475
860-577-7000 • Fax 860-577-7001
1-800-221-4436
www.infiltratorwater.com
48"
EFFECTIVE LENGTH
8" INVERT
SIDE VIEW
INFILTRATOR WATER TECHNOLOGIES, LLC ("INFILTRATOR")
Infiltrator Water Technologies, LLC STANDARD LIMITED Drainfield WARRANTY
(a) The structural integrity of each chamber, endcap, EZflow expanded polystyrene and/or other
accessory manufactured by Infiltrator ("Units"), when installed and operated in a leachfield of an
onsite septic system in accordance with Infiltrator's instructions, is warranted to the original pur-
chaser ("Holder") against defective materials and workmanship for one year from the date that the
septic permit is issued for the septic system containing the Units; provided, however, that if a septic
permit is not required by applicable law, the warranty period will begin upon the date that installa-
tion of the septic system commences. To exercise its warranty rights, Holder must notify Infiltrator
in w, iting at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) days of
the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be
covered by this Limited Warranty. Infitrator's liability specifically excludes the cost of removal and/
or installation of the Units.
(b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE
ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS, INCLUDING NO IMPLIED
WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE
(c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone
other than Infiltrator. The Limited Warranty does not extend to incidental, consequential, special or
indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of
production and profits, labor and materials, overhead costs, or other losses or expenses incurred by
the Holder or any third party. Specifically excluded from Limited Warranty coverage are damage to
the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units;
the Units being subjected to vehicle traffic or other conditions which are not permitted by the instal-
lation instructions; failure to maintain the minimum ground covers set forth in the installation instruc-
tions; the placement of improper materials into the system containing the Units; failure of the Units
or the septic system due to improper siting or improper sizing, excessive water usage, improper
grease disposal, or improper operation; or any other event not caused by Infiltrator. This Limited
Warranty shall be void if the Holder fails to comply with all of the terms set forth in this Limited
Warranty. Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder,
the Units, or any third party resulting from installation or shipment, or from any product liability
claims of Holder or any third party. For this Limited Warranty to apply, the Units must be installed in
accordance with all site conditions required by state and local codes; all other applicable laws; and
Infiltrator's installation instructions.
(d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No
warranty applies to any party other than the original Holder. The above represents the Standard _
Limited Warranty offered by Infiltrator. A limited number of states and counties have different war-
ranty requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in
Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, and
should carefully read that warranty prior to the purchase of Units.
U.S. Patents: 4,759,661: 5,017,041; 5,156.488; 5,336.017:5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5.839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending.
Infiltrator, Equalizer, Quick4, and SideWinder are registered trademarks of Infiltrator Water Technologies. Infiltrator is a registered trademark in France. Infiltrator Water Technologies is a registered trademark in Mexico.
Contour, MicroLeaching, PolyTuff, ChamberSpacer, MultiPort, PosiLock, QuickCut. QuickPlay, SnapLock and StraightLock are trademarks of Infiltrator Water Technologies.
PolyLok is a trademark of PolyLok, Inc. TUF-TITE is a registered trademark of TUF-TiTE, INC. Ultra -Rib is a trademark of IPEX Inc.
2016 Infiltrator Water Technologies, LLC. All rights reserved. Printed in U.S.A. PLUS05 0816
10
Conventional Septic System Management Plan
Pursuant to SPS 383.54, Wis. Adm. Code
General
The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained
in accordance with component manual SBD-10705-P (N.01 /01). All local and/or state rules 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 Thompson at (715) 248-7767 or the Polk County Zoning Department at
(715) 485-9279.
Septic Tank
Septic tank servicing mechanics comply with SPS 383.54(1)(e). Septic tank to be located within 150' of service pad, with
bottom of tank to be < 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be
assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in
the tank exceed 1/3 the liquid volume of the tank. The contents 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, Stats. If the contents of the tank are
not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be
needed to maintain less than 1/3 scum and sludge accumulation in the tank. 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 filter is equipped with an alarm, the filter shall be
serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water
tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of
service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater
than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank.
No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank
abandonment shall be in accordance with Comm83.33, 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 required. 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 area above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for
vegetative maintenance) over the system is to be avoided. Soil compaction mqy hinder aeration of the infiltrative surface
within and above the system and will promote frost penetration during cold weather months. Cold weather installations
(October -March) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BOD5, 150 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 ponding. Ponding levels shall be reported to the
owner. Levels above 8 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If any POWTS component becomes defective, the component shall be repaired or replaced to keep the system in proper
operating condition. Excessive ponding within the dispersal cell will be eliminated by alternating the diversion valve
between dispersal cells to bring the system into proper operating condition. If alternating cells does not result in a properly
operating system, a new dispersal cell will be installed.
Pg. 6 of 10
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) 497 Jordyn Ln., Hudson, Wl 54016 located
at: NE 1/4, SE 1/4, Section 08 , Town 28 N. Range 19 W,
Town of Troy , 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 6/22/22
Did flow back occur from absorption system?
(if no, skip next line.)
Approximate volume or length of time:
Tank Capacity: 1,000 gallon
Construction: Prefab Concrete X Steel _
Manufacturer (if known): Huffcutt Concrete
PAgeTank (if known): 9 years, installed May 10, 2013
mber (if k 561037
J- I/5.,,,�James K. Thompson
Plumber ignature) (Print Name)
MPRS MPRS #30021
(Title) (License Number) MP/MPRS
August 29, 2022
(Date)
Yes No X
gallons
Other
minutes
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
P3. 70 le/ o'
SANITARY SYSTEM File #:
ST. �RC3 � ,IJ,IVTY Office Use Onl
OWNERSHIP/ADDRESS FORM Created212021
ji,nmunity 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
OWNER/BUYER INFORMATION
David & Wanda Shafer
Mailing Address 429 Jordyn Ln.
City/State/Zip
Hudson, WI 54016
Phone Number (required) (715) 983-5350
Email Address (required) dshafer11 @Hotmail.Com
Parcel Identification Number 040-1306-28-000
(found on the property tax bill)
NEW SYSTEM; LEGAL DESCRIPTION
Property Location NE 1/4 SE 1/4 , Sec. 08 , T 28 N R 19 W, Town of Troy
Subdivision Plat: Sunset View
Certified Survey Map # Na
Warranty Deed # 975305
Number of bedrooms 3
New Property Address I:! )(1��/'
(Staff Initials)
, Lot # 28
Volume Na , Page # Na
(before 2006)Volume Na , Page # Na
Spec house 0 yes E no Lot lines identifiable E yes 0 no
OFFICE USE ONLY
(Verification of njw address required from Community Development Department for new construction.)
(Date)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified
survey map if reference is made in the warranty deed.
Community Development Department — Land Use Division
715-386-4680 St. Croix County Government Center
cdd@sccwi.ciov 1101 Carmichael Road, Hudson, WI 54016
715-245-4250 Fax
www.sccwpi. ao v
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in Department of Commerce PRIVATE SEWAGE SYSTEM
nd Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you Drovide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]-
ermit Holder's Name: City Village X Township
Shafer, David & Wanda Troy, Town of
ST BM Elev: Insp. BM Elev: BM Description:
40 - /00 --D ok
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
�► ����"���
DD Q
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
ELL
BLDG.
Venom Air Intake
ROAD
Septic
v i
/
2,(!5,
Z -(—
Dosing
rt SG%S
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Model Number /
TDH
Forcemain ILe1fQth IDia. IDsst. to
ad
Demand
GPM
H Ft
tLtVA 1 IUN UA I A
County:
St. Croix
Sanitary Permit No:
561037 0
State Plan ID No:
Parcel Tax No:
040-1306-28-000
Section/Town/Range/Map No.
08,28.19.1855
STATION
BS
HI
FS
ELEV.
Benchmark
5:3
/a 57--3
lob -b
Alt.
0 � f� Z
ie-w
Bldg.erAD le�.
7 7 ` 3
7
St/Ht nl
St/Ht utle
Dt Inlet
Dt Bottom
Header/Man.
O
- V
9� 3
Dist. i e
q. ,
Q `,
� f
Bot. System
Fi de
St er * � �
3. S�
-7
ornn A mQrwoTtnK1 QVQTFtU -e 01I
BED/TRENCH
Width Length No. Of Trenches
PIT DIMENSIONS
No. Of Pits
Inside Dia. Liquid Depth
DIMENSIONS
/„ 112-
�-
SETBACK
SYSTEM TO CY P/ BLDG EL
LAKE/STREAM
LEACHING
Manuf re :
INFORMATION
CHAMBER OR
UNIT
Ty Of System:
•� f
�vA
171'
Model Number:
yso
o
, f
Dt5TRIBUTION SYSTEM sl Q T S 2 C4" L4hO- _ .��
eader aannifold �j
Distribution r
Ix Hole Size
x Hole Spacing
nt Air Intake
� I/
[Length
Pipe(s) / - V Q'
Spacing p
G i
f'l
�L Dia
Len th Dia
c^11 rr%%1Cn r.— �- -&--- ^-I .... IU.. —4 flr A1-r:r=r1a CvCYPmq t)r11v L4^,74FI
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx M Ic d
Bedlrrench Center
Bed/Trench Edges /
Topsoils
es &,f No
Yes [�] No
COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: -4> 1 Inspection #2: I I
Location: 429 Jordyn Lane Hudson, WI 54016 (NE 114 SE 1/4 8 T28N R19W) Sunset View Lot 28 Parcel No: 08.28.19.1855
1.) Alt BM Description = P�0'�r *5�
r �
2.) Bldg sewer length = Z� 2,Qt�t-�21�- SKs7 Lll
- Ct An
amount of cover — //
>3� 3b n S�� "al �=
//
Plan revision Required? ® Yes No —
Cert
Use other side for additional information.
Date Insepctor's Sig ture No.
SBD-6710 (R.3/97)
PLOT PLAN
PROJECT David Shafer ADDRESS 429 Jordvn Lane Hudson Wi 54016
NE 1 /4 SE 1 /4S 8 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 3/18/13 BEDROOM 3
CONVENTIONAL XXX IN -GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
IL BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL * H. R. P . Same as Benchmark
All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 97.3/97.2' 4.7 below qrade
of tank, piping shall be Schedule 40.
Jordyn Lane
Vent
>6„ Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
4' Long 12"
5.6ft^2/pair of end caps
• 34" Grade at System Elevation
Pro 3
Property Line Bedrpom
Houle
15'
Please note: 'onal boring is going to be
ST be done to o - r system elevation
20'
B-2
i
{ Well is to meet all
setbacks required by
75' Sf WDNR
Itk3"
3-3' X 66' Cells wit 3 s in
2% SLope
B-1
Scale i 1" = 40'
40' 01) unless therwise
noted
Property Line
�a� a a a� y
Wisconsin Depa onal ervices Page 1 of 3 um
Division of Ind ,
2p22 S(7IL EVALU ION REPORT
3 PSG nth St. Croix
In acc dance with SPS 385, Wis. Adm. Code County
Attach complete site Ian on paper�q�N_- o 9\ 1 inches in size. Plan must include,
but not limited to: verti al and iri al e point (BM), direction and percent slope, Parcel I.D.
scale or dimensions, n rth@ ovation and distance to nearest road. 040-1306-28-000 Ref#2694
Please print all information. Rev ed by 419)
Personal information you provide may be used for secondary ur oses Priva Law, s. 15.04 1 m . 2
Property Owner Property Location
David & Wanda Shafer Govt. Lot NE % SE % S 8 T 28 N R 19 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
429 Jord n Ln. 28 Na Plat of Sunset View
City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
Hudson WI 54016 _ (512) 983-5350 Troy
❑ New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
® Replacement ❑ Public or o eraaI - Describe:
Parent material Glacial Outwash 7TYC._ /` Flood Plan elevation if applicable na ft.
General comments and recommendations: Site suitable for in -ground POWTS with 0.7 gpd/sq/ft. design loading rate. Recommended system infiltrative
surface elevation to be 93.50'. 4
1 Boring # ❑ Boring
L-J El Pit
Ground surface elev. 99.47 ft.
Depth to limiting factor >122 in.
Snil Annhnntinn Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
none
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
*Eff#1
*Eff#2
1
0-14
1Oyr2/1
sil
2fgr
dsh
cs
2vf,f
0.6
0.8
2
14-26
1 Oy4/4
none
sl
2fsbk
dsh
cs
1 vf,f
0.6
1.0
3
26-35
1Oyr4/4
none
sl
2f&msbk
dh
gs
1vf
0.6
1.0
4
35-42
7.5yr4/6
none
Is
Osg
dl
cw
-
0.7
1.6
5
42-66
1Oyr5/4
none
s
Osg
dl
-
-
07
1.6
6
66-199
1 Oyr4/4
none
gr s
Osg
cl
-
-
0.7
1.6
L
I
I _.. - ____
I 0� q316�_
I
I
I
I
❑ Boring
� I.��10_7 L •
2
Boring#
❑ Pit
400.42
Ground
surface elev.
ft.
Depth to limiting
factor >128 in.
Soil Application Rate
Horizon Depth
Dominant Color
Redox Description
Texture
Structure
Consistence
Boundary Roots
GPD/Ft2
In.
Munsell
Qu. Az. Cont. Color
Gr. Sz. Sh.
*Eff#1 *Eff#2
1
0-12
1Oyr3/2
none
sil fill
Na
dsh
gi
3vf,f
0.0
0.0
2
12-22
1 Oyr4/4
none
none
sl fill
Na
dh
cw
1 of
0.0
0.0
3
22-32
1 Oyr4/4
gr sl
gr Is
2msbk
Osg
dh
dl
cw
gw
1 of
-
0.6
0.7
1.0
1.6
4
32-40
7.5yr4/6
none
none
5
40-71
1 Oyr4/6
gr s
Osg
dl
cs
-
0.7
1.6
6
]_ZL12.0
1 Oyr5/4
none
gr s
0 sg
dl
-
-
0.7
1.6
* Fffluent *1 = Ron > 3n S ??n mn/I airs TSS > '4 5 15(l mn/I ,1 F=%iPnt #9 = RCN) > sn 5 99n mn/I anri TSS > 3n S 15n mn/I
CST Name (Please Print)
ignatu
CST Number
James K. Thompson
30021
Address
ate Evaluation Conducted
Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020-5413
August 16, 2022
715 248-7767
q 3.
5 SBD-8330 (R04/15)
3 Boring #
E Boring
❑ Pit Ground surface elev. 100.26 ft. Depth to limiting factor >127 in.
Cnil Annlirnfinn Pn+=
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
*Eff#1
*Eff#2
1
0-10
10y3/2
none
sl
2fgr
dsh
cw
2vf,f
0.6
1.0
2
10-28
10yr4/4
none
sil
2msbk
dsh
cw
1 vf,f
0.6
0.8
3
28-33
10yr4/4
none
sl
1 msbk
mfr
cs
-
0.4
0.7
4
33-39
7.5yr4/6
none
Is
Osg
dl
cs
-
0.7
1.6
5
39-75
10yr4/6
rrone
gr s
Osg
dl
cs
-
0.7
1.6
6
75-1
10yr5/4
none
gr s
Osg
Odl
-
-
0.7
1.6
v - I
Boring # ❑Boring ' � � 7'
u El Pit Ground surface elev. ft.
Depth to limiting factor in.
Snil Annlirntinn Rata
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
*Eff#1
*Eff#2
Boring #
❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Snil Annlinnfinn Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
*Eff#1
*Eff#2
* Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 < 150 mg/L * Effluent #2 = BOD, > 30 <_ 220 mg/L and TSS > 305 150 mg/L
4
L.
rcicScd w�rta�d:�p.Cc,/!.
EXts��S d.s p.vs.�lc� r/.
-two �enc,Jes ct i 3 jr 66'
' Sfrke'tC& C>;-t+C
be ;.714laa
y4r,ZK1-41Ce USf 6y,'Osfa// e--1
o,-" (Yi Jft3%cr7 aa/J/e
�oroirn �n�
■ 61
9yt1,
64e" Top OF scpfic.
�a,.2'r►� hok ��'. �ss�cnttd
FS�+' g►-a flee- a s.T, o, 14e6
■ 6o% e ilzl&a 6'ool14Or6
♦ EXis�� �rac� ek�a�'a,-,
cikS�a14!�,-
9,Tolo/y.1 art.
11ud4cn, c.J/. Syo/!o
,,!�Of ,;Z8, ,/a/_ of.5�.,rc�
/'I El'�lSff�, Sic u� � �BiI•►
troy,
lac/ 09o-/306-28-0,50
6&; l / o va c re's
re s;ds,-�cc
0
G�e1/ Scl v. ,ljt
Ae boil*
re5tdcrncE.,
P. 3 �-s
IG C10 11 couNTv NO. 645405
STATE SANITARY PERMIT
OWNER
PLUMBER�w*AeSlt't
PREVIOUS 00 Sao
LIC,v# 30eL I
TOWN OF 01
SEC Si ,T 29 N, R I
A,ND/OR LOTBLOCK
T
SUBDIVISION
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.
A RI ED ISSUING OFFICER -DATE
S PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE
POST IN PLAIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (R11/20)
State Bar of Wisconsin Form 1-2003
WARRANTY DEED
Document Number d Document Name
THIS DEED, made between & L Land Development. Inc., a Wisconsin
Cnrnoratenn _
("Grantor." whether one or more),
and David A. Shafer and Wands M. Shafer
("Grantee," whether one or more) -
Grantor, for a valuable consideration, conveys to Grantee the following described real
estate, together with the rents, profits, fixtures and other appurtenant interests, in
St. Croix County, State of Wisconsin ("Property") (if'more space is
needed, please attach addendum):
Lot 28, Plat of Sunset View Development in the Town of Troy,
St Croix County, Wisconsin.
8 Tx44114076 7
975305
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
03/20/2013 2:34 PM
EXEMPT*: NA
REC FEE: 30.00
TRANS FEE: 140.40
PAGES: 1
Recording Area
Name and Return address
River Valley Abstract & Title
1200 Hosrford St. Suite 201
Hudson WI 54016
File: 9899469-
040-1306-28-000
Parcel Identification Number (PM)
Dated this —day of March, 2013. This is not homestead property
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fec simple and free and clear of encumbrances except:
Easements, restrictions and rights -of -way of record, irany.
B & L Land Development, Inc., a Wisconsin
Corporation ,
1 (SEAL) (SEAL)
e_T. Weatherholt, President/Treasurer •
(SFAI.) (SEAL)
• = UTHENTICATION ACKNOWLEDGMENT
,Stgnat<e(S)s" STATE Of KENTUCKY )
ly .
. t •2futhentit:4fec�.bn ; ) ss.
. r JEFFERSON COUNTY )
Personally came before me on thiaAy of Mercb, 2013 ,
TITLE: MEMBER STATE BAR OF WISCONSIN the above -named Lyle T. Weatherholt,
(If' not, 1!residenjareacurer '
authorized by Wis. Star. § 706.06) to me known to be the person(s) who executed the foregoing
instrument and ackno a ed the same.
PHIS INSTRUMENT DRAFTED BY: — `��--
Doug Berg
— CLAYTON
1200 Hosford St. Suite 201 Hudson W154016 Notar ub ic, State o Ke cky j
My ommission (is permanent) (expires: 10
(Signatures maybe authenticated or acknowledged. Both are mot necessary.)
NUFF.: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO TIIIS FORM SHOULD BE CLEARLY IDENT IFIED.
WARRANTY DEED ® 2003 STA'I E BAR OF WISCONSIN FORM NO. 1-2003
• Type name below signatures
1 of 1
�9. /dore/o