HomeMy WebLinkAbout020-1454-00-096 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name:
Brent & Kore Nielson
City Village Township
TOWN OF HUDSON
CST BM Elev:
Insp. BM Elev:
BM Description:
TANK INFORMATION
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
"` 4
n
yyryU94 III
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Demand
GPM
TDH I Ft I
ELEVATION DATA
County: St. Croix
Sanitary Permit No:
651301
State Plan ID No:
Parcel Tax No:
020-1454-00-096
Section/Town/Range/Map No:
36.29.19.2911
STATION
BS
HI
FS
ELEV.
Benchmark
�
Alt. BM
Bldg. Sewer
St/Ht Inlet
St/Ht Outlet
00C "al
Dt Inlet
Dt Bottom
Header/Man.
Dist. Pipe
Bot. System
16.1
Final Grade
St Cover
a&NrA.. ,�
7
oak
g.�,s
BED/TRENCH
DIMENSIONS
Width
,
Length
6N
No. Of Trenches
I ?
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid Depth
I
SETBACK
INFORMATION
SYSTEM TO
P/L S
BLDG
WELL
LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
Man re : ,
Ty Of System:
Mocrrft 1tuber:
DISTRIBUTION SYSTEM - `
Header/Manifold
Distribution
Size
x Hol
Vent to Air Intake
Pipe(s)
61
Length °r Dia °n
Length Dia
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over
Bed/Trench Center6
Depth Over
Bed/Trench Edges
xx Depth o
Tops
eded/Sodded
xx Mulched
.
❑ Yes ❑ No
[:]*Ns ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 681 MARY JO CT
1.) Alt BM Description =
CX
2.) Bldg sewer length = �S
- amount of cover =
Plan revision Required? ❑ Yes [ No
Use other side for additional information. /1.:400000
l
SBD-6710 (R.3/97) Date n epctor's Signature Cert. No.
OU1 V U1 V 1�d"LJI I lill
I E W LISI Vy L
4822 Madison Yards Way Z)
P Madison, W1 53705 Sanitary Perrinit Number (to be filled In by Co-)
13.0. Box 7161
2023 Madison, W1 53707L7,1621 I 3
Saniftary Permit hication 1 "14; "1 \Xiiiiiii State Transaction Number
()Verl
I ii accordance wifli SPS 383.2 1 l(2), its.. Adni. Cok submission or this forrili to lire appropria overnniental tinit
XTSaTe
iS rCqUired 1)[ior to ohitziiiiing a SM) I tL"Ll-Y permit. Notc- A ppill icition forms for state-owned PO sUbimitted icy Pro-jecl Address (if different than mailing address)
trhe Deparwicilt ofSzjil`e-tv ind PFo1_QNllli1o11a1 Sergi" ice,�. Pcr' oria[ infoi,wation you pirolvide may be tised for secondary
purposes in accord',M)CC W1111 thic Earl va:y L.Law, �, 15.04(1)(,ii1), Stall.
I. Application Information - Please Print All Information
Properly Owiler's Napic Parcel N
!Tope Ow ne r's M a I I I i i A d d iress, Property Location
,Gut- Lot
CX,Mate Z1) code Phone NUniher
. Stt1cd
U.,
//
4
4 Section
0
H. ype of i;uilding (check all that apply) Lot iff N fl� Lj6r V
0/
2 Fam ily CorrellNumber Bedrooms Tu d- I v i is i o n 'N i i i i
of
or Ilk
ng -
Block ff
4A A
ublic/Conimericial - Describe Use
y of
C ity
State OmAied - Describe Use CSM Number Elvill age or A Ii
Towl) of 74 11,
I I I . 'Fy pe u t' 110%VVS Perin i t: (Cheek either "New" or Rep ia cem en t" and other sp p I i ca tale on line A - Ch cc k o n e box on I i n le 13. Co in plete I j 11 e
-11) 1) 1 i Ca 1) 1 ed)
A
ElNc�� Sy.�dcni
�ecrilcill Systcal
Elo( ger` Modification to Exisits Systeni
D dd itionnl Pretreatment Unit (t,\
B.
E114o I di ng -rank
hi -Ground
E�t-trade
D ound
Individual Site Design
(Convcntiolial)
C.
Renewal Before
E] Rev i sio ii
hange Of PILlinber
ransC'er to New Owner
List Previous Perm It Nuil� d
Expiration
001
Nil lil "it
IN`.. Dig por, salo"Treatment At -ea and Tank Information: 2 �')C cro
±!Eyj4a
Design Flow (gpd)
Design Soil Application Rtae(gpdisf) Dot Recl u i re d (s 0
D'i�_pcmal Area, Proposed (SO
Sstem F.levatioll
00
Capacity ill
Manufacturer
,
Tank Information
Gallons
Gal long
U n I I S
�j
U
1A
Nniks Exislikig Tiwks
U
I X
=
LZ
FZ
Septic or Holding Tank
I i i g C I m i n ber
Responsibility Statmient- 1, the undersigned su e responsibility for installation of the 110WTS shown on (lie attached plans.
JK
'Utg(
Plumber's Narne (P-6111.) P er's Signature N I P/M f R S N u inber Businc!sNu i fir r
Plumber's Address (Street, City, Staste y Ll 0
l�
L2
:2 ?,
V1, County/Department Use Only
Approved
d
rd
Pic riI it FV
n
Date Issued
Issuing Agent Signature
ZO=wyner Given 1 or L
53 s�
0/12 lZC�2,�
T q Lit
Conditions of ApprovaUROasonis I'll Dl�tIppr-oval -7> ) -
( � -Q
SYSTEM OWNER: r t � p� c�R.�. +�e.q � � i
I. Sepfic tank, effluent filer and dispersal cell IL
must be serviced I maintained as per � �� I
-%
management plan provided by plumber. Ot- pejA OCQ r
2. All setback requirements must be maintained
as per applicable cede/ordinances.
N
A11.1j,11 to (")JI111101v plmrs for 01L. "It'm mid �iihriill In ill f `jltuith- nrdv oil Impk-r- Aril Ivs. H1.511 "1 1 :2 111t-11i.-S Ln ,i]ZV
I A,
LSN,,stcm FLOT PLAN
PROJECT Brent Nielsen 1)1,) 1� i: s s 681 Mary Jo Ct. Hudson W1, 5,4016
SW I / 4 NW 1/4s 36 rr 2 9 N/It 19 W TOWN Hudson COUNTY T. CROIX
SYSTEM ELEVAJA()N 91-8/91.7 6' to grade 10/5/23 " 1) 11 4
I DATE .11ROOM
COMA T"INITIONIA1, >= CONVENTIONAL LIFT HOLDING TANK
1260 gallons LIFT TANK SIZE DOSE TANK SIZE
N4 0 U N 1) SEPTIC TANK SIZI. 1
1101,I)ING TANK SIZE i () k i) iN, .7 ABSORPTION AREA 891 # of chambers44
hl,{.NCIIMARK Top of 3/4" pipe ASSU. F
ME ELEVATION 100' Filter Lit"etinic Filter
BOREI-101-,E (.!� WELL *I.I.R.P. same as ben chm-,ark
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
sbird@frontiemet.net
10/5/23
Subject: Septic Failure at 681 Mary Jo Court
To whom it may concern:
The septic at the above property has failed. The drainfield is completely full of water and
the septic system just backed up into the house this morning. The family is going to get by
by pumping the septic tank and drainfield. A new system is needed asap.
Sincerely,
Shaun Bird MPRS #226900
715-781-0653 if you have any questio
P"11%
uover Page
Shaun Bird
Bird Plumbing Inc,
1432 120th St.
New Richmond W 54017
715-246-4516
IMM
Owner: Brent Nielsen
Location SW1/4 NW1/4 S 36 T29 N,R 19W 681 Mary Jo Ct. Hudson
Ulsed: hi -ground absorbfion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3, Chamber Cross Secfior
4-6. Makiti
Signature
L'icense ni
LSN,,stcm FLOT PLAN
PROJECT Brent Nielsen 1)1,) 1� i: s s 681 Mary Jo Ct. Hudson W1, 5,4016
SW I / 4 NW 1/4s 36 rr 2 9 N/It 19 W TOWN Hudson COUNTY T. CROIX
SYSTEM ELEVAJA()N 91-8/91.7 6' to grade 10/5/23 " 1) 11 4
I DATE .11ROOM
COMA T"INITIONIA1, >= CONVENTIONAL LIFT HOLDING TANK
1260 gallons LIFT TANK SIZE DOSE TANK SIZE
N4 0 U N 1) SEPTIC TANK SIZI. 1
1101,I)ING TANK SIZE i () k i) iN, .7 ABSORPTION AREA 891 # of chambers44
hl,{.NCIIMARK Top of 3/4" pipe ASSU. F
ME ELEVATION 100' Filter Lit"etinic Filter
BOREI-101-,E (.!� WELL *I.I.R.P. same as ben chm-,ark
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
6.6ftA 2 pair of end plates
Typical Installation
Vent At/ Grade
�r
411
,&130/34 Septic Tank
5' Long
3611 Grade at System Elevation
Spacing 5'
System elevations:
A 91.8'
E3 91.7'
To be > 1 ' above grade
Finish grade elevation
97.8'
Vent
OF
5' Lon 1 y
g Grade at System Elevation
2-3' X 90' Cells
Same on other end Observation tubeNent
At end of cell
A
B
22 chambers per cell
I POWTS OWNERPage 'S MANUAL & MANAGEME14T PLAN --�Of
FILE IN FORMATION
chwner
P D rrm it If
erTnft
DESIGN PAPAMF-TERS
Number of Bedrooms
11 NA
, lu;
Number of Commercial Units
Estimated flow (average)
—��ZL—PaVday
Design flow (peak), (Estimated x 1-5)
6�e��6 9aVday.
Soil Application Rate
�al/di ay 2
InfluentfEffiucnt uali
Monthly average*
Fats, Oil & Grease (FOG)
�0 mg1L
Bicr6hernical oxygen Demand (BODE)
:!220 mg/L
Total Suspended Solids JSS)
:0oL
Pretreated Effluent Quality �)KINA
Monthly average"
Biochemical oxygen Demand (BoDs)
�0 mg/L
Total Suspended Solids (TSS)
30 mg/L
Fecal Coliform, (geometric mean)
:510" cfu/ 1 00M I
Maximum Effluent Particle Size
Y inch diameter
MAINTENANCE SCHEDULE
Service Event
SYSTEM SPECIFICATIONS
septic Tank Capacity
CO3 NA
Siep�c Tank Manufacturer
Z4,01010
Lal
0 NA
C3
Effluent Filter Manufacturer
C1 NA
Effluent Filter Model
FA
a NA
Pump Tank Capacity
gal NA
pump T,--ink Manufacturer
NA
purnp Manufacturer
NA
pump Model
NA,
—4NA
Pretreatment Unit
[I Sand/Gr-avel Filter
L1 Peat Filter
[,I Merhaniaal Aeration
0 gand
D Disinfecton
U Other -
Manufacturer
Dispersal Cell(s)
. I In -ground (gravity)
C1 In -ground (pressurized)
0 At -grade
0 Mound
LEI Cori dine
EJ Other.
Vatues ical for domPstic (non -corime rdal) wastowater and
:sepoc tank efflueni..
Values typi,cal for pretreated wastawatcr.
Service Frequency
Inspect condition of tank(s)
At least onc-e every
'> D
1-N —
(Maximum 3 yrs.) —
Pump out contents of tank(s)
When combined sludge
-,ind scum equals One-third (Y,) of tank volume
Inspect dispersal cell(s)
At least once every
D months �ar�s)
(Maximum 3 yrs-)
Clean effluent filter
At least once every
7 0 rn o n t h s-/--110, y e a r (5)
—
Inspect pump, pump cO ntrols & aiarm
At least once every
0 months 0 year(s)
El NA
Flush latflirals and pressure test
At least once every
[I months ri year(s)
El NA
At least once every
Lj monttis [J year(s)
Cl NA
der.
At least once every
0 Months 0 year(s)
C1 NA
MAINTENANCE INSTRUCTIONS made by an Individual carrying one of the following licenses or
Inspect.ions of tanks and dispersal :Its !>-ha.11 be any missing or broken
certfficaUons, Master pjumt>er- Master Plumber Restricted Sewer, POWTS ln:spector, POWTS Maintainer, Septage
Safvicing Operator. Tank inspections must include a visual inspection of the tank(s) to I
dea ti hardware, Ident.ify any cracks or leaks, measure the volume of oornbined sludge and s6,um and to check for any back up
or n-ding of effluent, on the ground surface. The dispersal cells) shall visually inspected to check the effluent levels
I d surface. The ponding of effluent on the
in the observation pipes and to check fora . n ' y poncfing of effluent on the round latory authority.
ground surface may indicate a failing conditi(-)ii and requires the immediate notjfication of the local regu th
When the coal pined -ICCUmulation of sludgf, .md scum in any t,,r-)nk (�quajs one-third (�J) or moCe of the tank volume. e
enure contents of the tank shall be rernovml �)y a Septage Sfrvicing Operator and disposud of in accordance with ch. NR
1131 Wisconsin Administern tive COdc-
[It components, and --'fly
The servicing of effluent filters, rnechs-,inical or pressurized POWTS components, fret rent ImL
other maintenance or monitoring at Aefvals of 12 months or less shall be performed by a cettfiead POWTS Maintainer-
pletion of -einy sefvicO evcnt-
rov (Ic- ulatory autho iet within 10 dzlys of c om
A servicd repod shall be p I d to the- louz3! req
- U -jUkj'j0N -
P AND ()pL
'S check treatment tarik(s) fof the presence of painting products Of other
1, c) Ir c I cv -, c ��-i s tru c ( i o n, to u c-; e, o f 0 1 e P ( YvV I
I t m,
treatment promss andlor damage t,he dispersal cell(s), If high concentrations are
th a -w r,),
remo-t jhc tc-iflk(red by a septage servicing operator prior to use.
s)
Page of
0
START UP AND OPERATION cbeck treatment tank(s) for the presence of painting PrOdUM or other chemicals thir-it
ructon, pdor to use Of the PoWTS the contents of thf-11
Fof new constj - and/or damage the &SPeTsEll WKS), If high concentmtions are detected have
may impede the treatment Pmmss I
tank(s) removed by a sere servlc4ng operator prior to use -
System start up shall not oGcur when soil condibons are frozen at the infillmfive surface. tored the excess wastewate, YAI bp
er levels. When power Is res
Duftnq power dwsges pump tanks may fill at�ove normal highwat in thf) backup or surface discharge of effluent.
discharged to the dlsperSBI oell(s) in one large dose, overloadling the oell(s) and MaY result 4e
ge SerAcing oper*o, prior to restodng power tO tl7h
To avoid this sft;j6on have the contents of the purnp tank removed by a Septa ormal levels
0 assist *n manually operating the pimps to rest0re n
effluent pump or contact a plumber or POVVTS MaIntainer 1, t, the area withIn
wfthin the pump tank. Vehides oVer tanks and disperoal oells. Do not drive or park over, or otherwise disturb or compar
Do not drWe or park r at-gra
nd ode soil 8bS0rPt0,n ar6s-
15 feet dawn slope Of an Y m ouM
may improve the performance and prolong the iffe of the POV�(T-'-3
Reduction or ellminabon of the following from the StO Wawater stream ers; denapers; tal f�oss; di&sinfectantsl tat; fcundafion dr�itn
,ondoms; cOWn mabs: degreas edications; 0'1: painting producIA,
antibiotics; baby wpes; agarette butts; r rease; 'herbicides, meat sc-raps-o
er- fruit and vegetable peelitngs; gasoline-, g
(sump pump) Wat I nd, water softener brine.
poisficIdes; sanitary napkins; taMPOMF R to insure that the system is proPetlY
ABANDONMENT ng steps shWl be takell
When the POWTS fails and/or is perrnanent�y taken out of seNice the fbliovvi
and safety abandoned In c*mpliance Mh chapter Comm 83,33, Wisconsin Administrdve Code'
• All piping to tank's and pits shall be disconnected and the abandoned pipe openings sealed. Operator.
ed and properly disposed of by a SiBI)t8ge Servicing
• The contents of all tanks and pits shall be rem ov the void space filled with Will,
• After pumping, all tanks and pits shall be excavated and removed or their 00vem removed and
gravel or another inert solid M,ate6a.l.
CONTINGENCY PLAN a have been, or must be taken , to provide a code ccMP140
If the pOWTS falls and iaarnot be repaired the follavving measures
replacement system' locaUon of a replaceMent soil absorption sYst0m.
m
0, A sultable reptaceent area �as been evaluated and may be dlized for the
action and should not be "nf *nged upon by reqijltd
should be proteded from disturbance and compa I n
The replacement area rotal the replacOment area witl result in the nElPed
setbacks from existing and proposed structureq lot lines and wells. Failure tap Z in
+table replacement area. Replaoement systems must Comply Wfth the rule�
for a new soil and site evalustiOn to establish a Sul
effect at that time. sell limftations. asITIng advances in POVVTS technologlw a
0 A suftable replaoement area is not available due to setbwA and/or so
holding tank may 1 installed 85 a last resort to replact the failed POVVTS. PoVvTS a scil and she evalUa401'
evaluated to idenfify a suitable replacement SM. Upon failure of the 9
The site has not been 1,e a hoWing tank may be installed x
must be pefformed to locate a suitable replacement arta. if no replacement am Is Ewa
a last resort to replace the failed POAS . oval of the biomat at the infiltraliv(
0 Mound and at -grade solt absorption systems may be remnstructed in pl.ace folloWng re
surface. Reconstructions of such syslems must comply with the rules in effect at that Ume.
-t<WARN1NG>> ANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN, DO NO'
SEPTIC, pump AND OTHER T RSAT MENT TMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF 0
ENTER A SEPTIC, puAT IMP OR OTHER TRE
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE
ADDITIONAL COMM-ENT S
e7
pOWTS MAINTAINER
POWTS INSTALLER
;NIame
Name
Phone
Phone
LOCAL REGULATORY AUTHORITY
Ef�&TOR �,FUMPERJ
SEPTAGE SERVICING Of
Nanne Z 0
'qnl a
FName 4-7
..V
Phone
P
Phor, e
in Administrative CAS
S 383.22 0) i u'� 0; n d 8 3.54 (1), (2) & (3), Vftj�= s
T f� i�, &cu m e rat was d rafted I comp,iance w c,-3 Pt�-- I
-!Mae File
ST. CIZ01 NTY SANITARY SYSTEM °�azla�ffitily
OWNERSHIP/ADDRESS FORM e
Community Development Department will utilize this information to provide the property owner with
information regard'ing operation end maintenance of your new or replacement sanitary system! This
inforiration will be provicled as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, a r d county rescurces. Once rapproved, 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
Rio so by USitIg the Pr % Files -Scanned weblink.
OW1101' BUyer Z�
Mailing Address
city/state/zip
Phone Number (requlred)L,�L,
Email Address (required) A��242
Parcel Identification Number
(found on the property tax bill)
0 'TER INFORMATION
WM01 0 04 M041
v
NEW SYSTEM; LEGAL DESCRIPTION
—.4//' -04 X 1 --1//
P r o p e r t o c a t i o n- 4:1'�%4 Sec' ' TZ?
N
Tfien of
7
Subdivision Plat: Lot#
Certified Survey Map Volume Page#
Warranty Deed # I (before 00 )" olurn a Page#
N w i- be r of b ed roo ,-n s e-011 Spec house 0 yes Lot lines identifiabl es 0 no
OFFICE USE ONLY
Nevi Property Address
(Veri f icat on of new address required from Community Uevebp n, e rit Depci t-t me n t for new construction)
(STA initials) (Date)
This form trust be submitted with all Piet vote nsite Water Treatment S Lem (POWTS) applicotions,
YS
N e w 5 yst e m - include with th is farm a re c o rde J w (i rro -o i t,� creed fro tx� the Register of Deeds Office ors d a copy of the cef- t
sunray map if referen ce is rr. ci de in tiro warranty deed.
C c. iTinunity Development Department - Lanc,] Ue Division
715-386-4680 St. Croix Cotirity Government Center 715-245-4250 Fax
c1-1 110 1 Ca rn)� c ha e I Road, H u d sonr WI S 4 0 16 WtKW4�( cw j.
DOCUMENT NO. I STATE BAR OF WISCONSIN FORM 1-2003
WARRANTY DEED
THIS DEED, made between Daniel R. Boe and April D. Boe husband and
wife("Grantor" whether one or more) conveys and warrants to Brent A. Nielsen
and Kore L. Nielsen, husband and wife as survivorship marital property
("Grantee", whether one or more), the following described real estate in ST
CROIX County, State of Wisconsin:
Lot 9 Cottonwood' 2nd Addition, St. Croix County, Wisconsin.
*County Plat of
**Ridge
Illilllllllilll � II I
8335458
Tx:4277942
1020581
BETH PABST
REGISTER OF DEEDS
ST, CROIX CO., WI
10J28J2015 2:23 PM
EXEMPT#: NA
REC FEE: 30.00
TRANS FEE: 1155.00
PAGES: 1
Edina Realty Title
400 South Second Street, #+i+5
Hudson, WI 54016-1974
File# 1164oll
Tax Parcel No: 020- 1454-00-096
This is I is not homestead property
Exception to warranties: Municipal and zoning ordinances and agreements eiftered under them, recorded easements for the
distribution of utility and municipal services, recorded building and use restrictions and covenants, and further except 2015
real estate taxes,
Dated this 31 st day of March, 2015.
AUTHENTICATION
Signatures authenticatcd this day of ,
20
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
-------- ---------
authorized by § 706.06) Wis. Stars.}
THIS INSTRUMENT WAS DRAFTED BY
Robert L. Loberg 1 Loberg Law Office
1522887 1 alm
(Signatures may be authenticated or acknowledged. Botli are
not necessary.)
,:
April . Boe
�. `�i «r rty ' �� `�■ tea,
+i
ACKNOWLEDGMENT
STATE OF WISCONSIN
ss. •ff•�,• ��. �,..
COUNTY OF ST CROIX
_ _ --__
Personally came before me this 31 st day of March, 2015, the above
named Daniel R. Boe and April D. Boe, husband and wife to ine
known to be the person(s) who executed the foregoing instrument
and acknowledge the same.
* / i n a 111 •�'
Notary Public"County, Wis.
My Commission is permanent. (If not, state expiration date:
1:;)-l�r-17 )
WARRANTY DEED
St, Croix County 1020581 Page 1 of
Form No. 1-2003
# 1642
Vlsrconsln SOIL EVALUATION REPORT page 1 of 3
Departrnentof Commerce in accordance wtth Comm 85, Wis- Adm. Code
f 1; nfcov rid Pt I AM 't steel's Soil Service, Inc.
County
comp
lete mplete site plan on paper not less than 6% x I I inche Plan must St. Croix
include, but not llmi%ed to: vertical and hoftontal reference pol tion and F_
percent slope, scafiE or dimensions, north arrow, and loc-ation and d' t Paroel I.D.
o �qarest road- Pending
Please P t all information. a ewed By Date ._��,
Personal lnforma5on you provide rnay used f, Pdva Law, s. 1 M)).
IL L
Property Owner Property Location NW 1 /4, S36. T29 N R 1 9W
Bast, Kernon Govi. Lot n Ei SW 1 /41
Property Owners Mailing Address Lot Ala# Subd- Name or CSM#
948 Labarge Rd. na Cottonwood Ridge 2ND Addition
City sts Zip C 1�3 t�nber City Village Town Newest Road
LMINC Cty R
Hudson i W1 1 54016 1 715-3867-7-75 Hudson d N
New Constructicn Use., Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
�P.._ ; Replacement Public or commercial - Describe, rya
Parent material Str-,,,am terraces and pitted outwash plains Flood plain elevation, if applicable na
General comments Conventional system, systern elevation 95,15ft. Trenches spate and depth to code 4.75ft below grade. ( Vi-CL-o- Z
and rewmmendatjois,
Boring # Q Baring
pit Groundsurface elev, 99-90 ft. Depth to limiting factor 120 in. Oil Application Rate
IS I
Horizon
Depth
is
Dominant Color
Munsell
Redox Description
Qua. Sz. Cont.. Color
Texture -Struclure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD.:ft�
1
0-11
10yr3/1
none
511
2msbk
mfr
CS
lvf
.4 .6
2
11-22
10yr4/4
none
sicl
2msbk
mfr
gw
na
3
4
22-33
33-120
7.5yr4/4
none
sal
msbk
mfr
gw
na
.6
1.0
1.6
7.5yr4/6
none
Cos
osg
ml
na
na
-owl
5- q3
0
72z log
- 2.]13or1ng
4 E] Boring
Z Pit Ground surface elev. 99.90 ft. Depth to limiting -factor 120 in. Soil Application Rate
I
Horizon
Depth
Dominant Color Redox Description
Texture
Structure
Consistence
Boundary Roots
G9V
PIS
munsell Qu. Sz. Cont. Color
Gr_ Sz, Sh.
*Eff#1 `Efts
O10yr3/1 none
Sil
2msbk
rnf r
CS
1Vf 11
J
16
.8
2o 9-22 L"y r 4 /4 none
sid
2rnsbk
mfr
g W
na
.4
.6
3 22-48 none
51
2mob k
rnfr
9W
na
.6
osg
ml
na
na
.7
1.6
T
4 148-120 y r 4 16 nc)ne
WS
-
- - --------
V O
t
2 jog
9 Effluent #1 = BODE;> 30 < 220 mg/L and TSS >30 <. 150 rngil_ '* Effluent #2 = 130 Ps � 30 it and T. < 30 mg/L
CST Name (Please P dnt) -&Wajure: CST Number
David J_ Steel 248P56
Date Evaluation Conducted Te;i.,phone Number
Address Steel's Service, Inc.
Q94 200,�i St. Baldwin, Wl 54002 411112005 7-1,5 7(3,0-0347
.1
S [ I [ �_M A 50 1 it 0 T.Ickl)
P'toperty Owner Rasty Kernc)n Parcel ID # - Pending A Page 2 of 3
3 Boring # Boring Ground surface elev. 98-20 ft. Depth to lirmffing factor 120 in. Solt Application Rate
LK] Pit
Horizon
Depth
in.
0-8
Dominant Color
Munseii
10yr3/1
10yr4/4
Redox Description
QU. SZ. cont. Color
none
Texture
sal
Structure
Gr. Sz. Sh,
msbk
2msbk
Consistence
nnf r
mfr
Boundary
CS
gw
Roots
1vf
na
na
na
GROM"
-EW
.8
.6
1. D
1.
"EMI
.6
.4
.6
.7
2
8-26
none
none
sid
3
26-41
7.5yr4/4
S1
2msbk
mfr
gw
na
4
41-120
7.5yr4/6
none
Cos
059
M1
.
...........
(5
BoriTig
Boring # L Pit Ground �surface elev- ft. Depth to limiting factor in. Soil APO'calion Rate
HarLzon
Depth
In,
Dominant Color
Munsell
Redox Description Te)du re
Qu. Sz, Cont. Color
Structure
Gr. Sz. Sh.
C-orisistanw
Boundary
Roots
GPM"
"Efffl *Eff#2
Boring # Boring ft. Depth to amking factor in. �t�
Pft Ground surface elev. [Sof Application
Horizon
Depth
in.
Dominant Color Redox Description Texture
Munsell Qu. Sz. Cont- Color
Structure
Gr. Sz- Sly.
Consistence
Boundary
Foots
GPD/ft'
*Eff#1 'Eff#2
I A
Effluent # 1 = BODE > 30 < 220 mg/L and T55 >30 < 150 rngfL EfflUent #2 = 8011) < 30 rng/L and T35 -30 mqiL
I I I I" you need assistalicc to accev. -Vices of
71'he Depanm.-nt �.v P; [111 e(jUk,1. oppor-tun �CFVICC scr
6 , I r ",1-3151 orTrY 608-264-8777,
. 1;, Pl"asc 60X-- A-
i L k 1: 1 r, 1 1, L k-
S13D-83 30 StP424'9 SNI Secvk--)e, Irv',
STEEL'S SOIL SERVICE INC. 3 of 3
David J. Steel K t 994200 til St.
CST-POWTSM SW 114, I /4IT29N , R 19 W Baldwin, W1 54002
Lie. #'248956 Town of Hudson, St. Croix Co. Cell (715) 760-0347
Cottonwood Ridge 2ND Add. Fax.(715) 684-3449
Lot, 96
1-his soil evaluation was conducted to satisfy a zoning requirement, it may or may not be Isuitable for your use,
Legend
LOT 97
2.07 ACRES #
90292 SO FT.
:,� w
o p 2.57 ACRES vs f
09
0� 112036 SC. FTr � f
L. B.0. - 988.00 a� f
LOT 92 %0,*tx,
2.35 ACRES
102446 SO. FT C f
ON PIPE FOUND � ,� � � � BE NCN�AR�C
-- ff ff TOP OF REBAR
Y 0.56 FEET FROM❑' � 9 ```•.,,` "' f *�� ELEVATION 1041 88
'UTEQ POSITION
BENCHMARK
Tier REBAA �xOle
g
ELEIVAT-ON = 1065.83
46
ooe
LOT 93
2 71 ACRES`
118047 SQ. FT. ,�
LOT 94
' 2,02 ACRES p LOT 95
87992 SC. r'. 2.02 ACRES
� 88007 SO. Fi-
x
/ 20 / ` ' 2.00 ACRES � 1�4� 0 f�
40
49
,._._ OHM
M-�. LET 97
3.80 ACRESlk
65553 SO. FT.
L.B 0. -~ 1031.00 �LOT 110
�Icn
2 03 ACRES
I •— / 88243 SCE FT.
S89Q 34 51 W 645.29 f f
410, 73` I,Lu, f r
DRAINAGE EASEMENT
WATER ELEV, - 1004 2
� JA. S. 20�s � � LOT �.� �� �� � � � �e.a 1,�
1w�
3.12 ACRES 1� 1
136104 SO FT;
L.B.O. 1031.00 �'�
f /t
HWL 1025,00
t BENCHMARK 1
r I
CROIX CO -
UNTY ZONTNr
CERTJFj0)�jj-,2:0N .1 opj;ijrc�,
FOR UTILIZATION STArTEM.p I
OP AN EXISTI �nT Le TANE
to cert. S El I-
IfY that I have *
"ell-vi-nu the Inspected the Sept'
-lC Lait
1,j Y
""Ice
e C t 3
UPon inspect
I Oil Ify that
tO be in 9-0d c(3nf [(Xmd
Clit
10ning propel-ly, N I on F 'a rl cl it aPVR-az-s t0 be
t *
-
line Sel.-Viced: wo"
OCCUr P'-r.011n absorpti
�-
on
"qo
-1p
-L-
0-r- le
n(Ittl Of time,
�l C i ty a -11 on s
Prefab c(:)ncr.t.
1) Ij f Other.
,(lot
known)
A q e
a ture) 7>
4
�-�,
(Na
Ploase print
wr F
'Pool, 1
ILt
(Lcense tryMOO- iA e'l
);-I t e
V01-111 bc-l- by lic
F;tatutes) or L e
Icenseq PluMber
U16POser (NR 113 WiFjc0]ls
ra t -i V
(appl-Y -lyl(-1 fO-r p(2r .Mit) Cert.,-
If A -,at ion
acc-ept-'119 'L-110- above stat -reg
xisting Sept.
t1`0 (lank to ti.lp ic 'ttjnk
conforl, of 'Ely kn-)wledge I UIR 8 j
Lon o p e e r a Ljj- 1Adin Code r w
0
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division • ;�
r INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.94 {1}(m)].
Permit Holder's Name:
City Village X Township
Bast, Kernon
Hudson, Town of
CST BM Elev:
Insp. BM Elev:
BM Description:
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
J
NJ
Aeration
Holding
TANK SETBACK INFORMATION
--I,Tr.�int to Air Intake
Aeration
PUMP/SIPHON INFORMATION
anu ac urer
Demana
GP
moclel NUM
i ric ion Loss System Flea
orcemain Lengin
ELEVATION VATA
County: St. Croix
Sanitary Permit No:
488110 fl
State Plan ID No:
Parcel Tax No:
020-1454-00-096
SectionfTown/Range/Map No:
36-29-19.2911
STATION
BS
HI
FS
ELEV.
Benchmark
Z.
A10
Alt. BM nn
AX
3.z.~%&W
'Bldgg Sewer
< r-L
cm/. ZS
t t Inlet
lit55
St/Ht Outlet
I.1Z
73' Z8
t Inlef
Ut t3ottom
�
Header/Man.
Dist. Pipe
o. System
ctii14
Final Grade
4.b
91s4
St ever
�
* ..�
all[L ► 0aVMr 111UN 0 T a 1 CIvt
E D 1 T R E N -V-V-!11tl1 LIVIYU I Of DIRIENSIlulma 114U. Of PIT'S 111510e DIN. Liquid Deptil
DIMENSIONS I f
0- 92.
INFORMATION CHAMBER OR
i UNIT Model NUITIVel.
4r
33 31 175 5 /1 ArII I C�0 ` 4 ko
DISTIKILS11.11
��
ok
6f q.
Length Dia
Pipe(s)
Length �
Dia Spacing
�
-4r (`o
e
x Pressure Systems only
xx Mound or At -Grade Systems only
Bed/Trench Center
&� rq�
Bedf rench Edges
. I \1*40
Topsoil
\Ss�.
.. � Yes
-, No
I Yes � Na
COMMENTS: (include code discrepencies, persons present, etc.)
Inspection #1: 1 1
Inspection #2: 1 1
Location: 681 Mary JoWulrdttdson, u
1:0) a1.
5 (SSW 114 NW A 36
T29N' R19 } Cottonwood Ridge 2nd Add Lot 96
Parcel No: 36.29.19.2911
Alt BM Description =0
L C Q
2.) Bldg sewer length - 319
- amount of cover =
Al
Plan revision Required? Y ~�
1' � es __ No i � �
Use otherside for additional informati n.
---�nse�pctor` natn--
SBD-6716 (R.3197)
FLA
N e rJ eft 5
sc�rr��E i".%gyp,
0 0-7, ldv%5v
N T 4,41,4
w
/0
621��6
�b Z
44? az b�47
c 44sopy
{�
/nRnv�
eoua f �
4500107 I dP
CEDIX COUNTY
NOO .. .................. . 6-5�1
.......... 1111in! M ..... . .....
. . .... ..... . ...... .....
... . . ....
INK..
TR* , 3-r'EIC)
. . . .......
MAf---0y .So C;F
V -w-rA4 NO
r -1 7-lqojf& U k"q) 0
...... ....... . ... . ...............
tr .
AV
oil
L 1 Uff-'r M I E' 5h R S PC U A) 22[o
P W N 0""" " k F
W ---Iw 4
29 Nq 19
S 3(0 9'
AND/
SU101
-`A-'tV1S'1%0J-N
&b M09
ISSUING
4,1111 OFFICER
1AUTHORIZED
........... .. ..........
. . . ....... ............................... ..........
.... . .. . ..
........... ..... . ...... .................. .
SBD-06499 (RI 1/20)
CHAPTER 145.135 (2) WISCONSIN STATUTES
(a) The purpose of the sanitary permit is to allow installation
of the private sewage system described in the permit.
(b) The approval of the sanitary permit is based on
regulations in force on the date of approval..
(c) The sanitary permit is valid and may be renewed for a
specified period.
(d) Changed regulations will not impair the validity of a
sanitary permit.
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal is sought, and that
changed regulations may impede renewal.
(f) The sanitary permit is transferable.
History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314
Note: 1f you wish to renew the permit, or transfer ownership of
# ca authority.
t e erm�t lease contact he uu h
permit, P ty
— DATE ID 112 . 12OZ3
. .. . .. ......... . . ...... ... ... ... . ...... . ... .. .............