HomeMy WebLinkAbout020-1106-50-000Wisconsin Department of Commerce
Safety and Building Division
PRIVATE SEWAGE SYSTEM
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:
City Village Township
Stephen & Pamela Lallemont
TOWN OF HUDSON
CST BM Elev:
Insp. BM Elev:
BM Description:
c'?. /3
4 e, S3
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
q �ez C IL
Dosing
C�tLS
S-0
Aeratio
� e—
Ire
al
Holdi
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
—5
c
Dosing
, /
91D
101
[Ae ra
- � -
Hol
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
TDH
Lift `
Friction Loss
System Head
TDH Ft
Forcemain
Length t
Dia (!
st. to Well
I
I as,
2
E
SOIL ABSORPTION SYSTEM / X3� AreKek-
ELEVATION DATA
County: St. Croix
Sanitary Permit No:
651361
State Plan ID No:
Parcel Tax No:
020-1106-50-000
Section/Town/Range/Map No:
35.29.19.421A
STATION
BS
HI
FS
ELEV.
Benchmark
M+ vA
,r
l
Alt. BM
Bldg. Sewer
St/Ht Inlet
St/Ht Outlet
• �!
Dt Inlet
�- 2-0
�*
0 �
Dt Bottom
Header/Man.
Dist. P1:9
Bot. System
�6�
or, 6 �
�D � � r
Final Grade
aL
®a-�
p j
St Cover
TRENCH
DIME IONS
Width
Length
1 9,y, Q
No. Of Trenches
CZ
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
P/L
BLDG
WELL LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
Manuuffactu, r:
Type Of System:
I
/
1
OC)
Model Number:cl_� I nk_A_'%
DISTRIBUTION SYSTEM � row 1.4. o • W •
Header/Manifold
Distribution
x Hole Size
x Hole Spacing
Vent to Air Intake
Pipe(s
Length Dia
Length Dia Spacing
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx Mulched
Bed/Trench Center
Bed/Trench Edges
Topsoil
❑ Yes ❑ No
❑ Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 17-12.(11A2_,1 Inspection #2:
Location: 651 KINNEY RD
1.) Alt BM Description =
2.) Bldg sewer length = c
- amount of cover =3) wNLk VP-
. � � �y,,, 9+-• CDT �,� �c�vv�c�n. � � � � tM��n.IA�-Q Cl�2l t� � C� �r� �'—earl
Plan revision Required? ❑ Yes X No 1 ��
Use other side for additional information.
23
SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No.
"r 2 q 2-
lwh=Uy Su%qm= Divisiew County
4822 Madison Yards Way
5t
Mad inn, W1 5-3705
IP P-0- BHCkX 7162 &niLlffY Pc�� ?"mbw 0o be Ued in by Co-)
u-K
—7162
Madison, WT 53707
Permit Application State ]V3�I
raasw6m NunA)er
In 3r. Ordame it SPS 383-21(2). W is, Adm. Code, submission of Ws form. to ibt:appmpni att! governmcntal unit
Ls nN ui rud pnior to obtain ing a Sam terry permit No te: Apolcation forms for state-n %vned POWTS arr jued to Project Addrcss- 0i'diffcyrnt than malfing addressi—
the IkPaftrwnt of Safety � Pcrscx2W infumiation you pruvide may be uscd far semndary
PurPoses M accordance with the Privacy Law, s.- 15_04(T)(m), Stain
L Appllfcaflaim hideromflon — Please Mnttiz Information
ftpcny 0%kmcr"s Namr- Plar" I
P T1r14 A .1c VA
pmpeny owner's 1-11 C Addrevs Property Location
Govi. Lzt
City' %Wve Zip Code Pbunc Nurnbur
5 NTL -3
11. T�vpe of DOWUng (check all that apply) LoL T� 9 N R ForW
I or 2 1. anui ly Dweffing - Nurr6cr ofBedruouis Subdivision \Navrw
1 r6i
D'Jub I i c/Co mmerci a] - DewTibe Usc Block.#
[17sty u.17
EIS Ua le Owned - DtscTibe Use CSLMINU"Iller, 'I] Lagu of
r C r,U -iq I,. T3
a,-Q�vn of
-1, X r
111. Type of POW117S Perm& (Check either "New4w "Rmpbweme-at and other applicabie On fine A. Check one box an hue Et- Camper e line C if
car System
dw-r Mad i fitcal ion to Exist In S kcm (C--.PLqjP) UALtianaIPrchmatmcWU it fexplain)
systm [a) lu
Elu Folding Tamk Elhi.;-Graff Individual Site M-Sign DOther Typc (explain)
C. Reioewal Beforr EIRCV 151rn I T hmge of Pkunbcir rfer IaNciv Uwaer 'I sl Pv
ftieus FeNum nlail ber and Date Issued
I EXPITal - ion Eims172 511S m7
A
IV. Dispersairryeatua meat Area and Tank Informafiow 21
Design Floxv (gpd) Dcsign SO-11 Awlimfion RD.7_KxW Area Requirud (.sO DispjAm Pm
On system Elcvadon V
S dl� 9 bV qUMW
cap;jtoy Ull I ota I of Ulavu raallj V F
Tank, Information I G*JkW Gallon% Unit's
N"'W T rA
&R4 Existing Tziiiks W
U cr. 4A fA
ED
V_ Responsibility S(aletneut- 1. the under* me rvWrv;i insftilation of the POWTS lihown on the attaefwd pJams,
(UM MP/MPRE NurnbeT Bus� nc&-c; Phace Nmnber
iht�r s lamc (Print P�
Plumber's Ad&uss ( Sty q, Cit Y, swc, Zip ("ode)
a
VT. County/Department Use Only
Pauiffec DaEc Lssued Isto =_g Agmt Si Maure
Apptuved D_L%Z,Ppmv S 12-1 (0
vrWT Given Z __3 /2o 2 3
Conditions A J&DozO
5 Y S T E �A W N [E ir it
1. Ser.-Ji c tan k, effl U e 11 1 t `_. F1 d s p rs C9 CP,! CL F GLA
m u s t b e se,-v ice, d 7,1 ,-i J -3iined aS Pei -
menace ment plran provided by plumber.
2eq . A[I setaLck i rmust be maintained
as per app-l"T;a, bI code / nrd�n Rn ces
Aitarb to cow piete pLiton for the system and ibas to the Count) unly an paper non Irv% duo a ;a X II i0c ial LbW
wr.wrr+wwww-w�.+.�....r.�rwar.qrw�-r-�www�++Kr.ww+w..r....r.�..a�+w..•a...�.-.�.w.�rr�r+�w...e..rw....rw- „ e.. s � --...»,�:. -- �,.�.... .
4beee Sbd4l'��'�
wr
QSO`06 =nalaw
w.�iGS WQ,Nry
� aA tqf\ Nq� ire
7I �
(d5vo9/ IlaaM SN�,�rix�
oOor 1144 1��o
& v m 11 jaa
�S Ng ykM
���q�d�.d •1°�osL
-1 a�o� a'ay.�a41
".AiQW
AdOO
A Nowatfqom? u��,uda,.r �'�d� v
N
d��tl �-�
d
&MAD 'OP
AftTnlePAW
now
�name
L!3
T°'� tnnsb�
r
Arj -• _
wonr
I�
Ap
Nl�t'1'j� ' S'r«j�eN df7prrle�p C.h1 IQIYION�
J
LOCK+"O,v
N
f,�etl( .,)"N Mt ty, qw
40
fa S+pl'e TIC*4t
M0174bulf cove n.
r ki -�-Fwv 4,k I ;
�5dp1. P"nP�be�kt2
Wrt►tN!;3
i.<IkM ev Wf
5 ( M-fT 6) ofol R.'s K
Fxoto4j Weer lom5p)
Sp Fr) c N%,
Bol R,,w velYe �
Mart, 3y'01�)
titl- 90.5t)
PP,5 aa -a 9
o
IN-4GROUND DOS ED,'!=G RAVI TY, DISPERSAL AREA
Stepped, Elevat'�o` T
F1 renc s with QuJck4 StandardimW Chambers.
3wft Trench (downlimsiAn. ..g ceddit)
U
(typical)
'11PICAL TRENCH m
CROSS SECTION VIEW
(No Scale)
Highest Trench it Trench (aa applicable)
System Elevations a
QuIck4 Standard-W
w/ End Cap (Show location Of typ1cw) Inlet Outlet pipa connection on plan view.)
(
z.
� doom= OWREM igh.0
Prot Ide minimurn 3 ft
90iParadon between trenthe B.
Observahm Pipe
(typical)
instaN per men nets
/ Irstruedons.
TYPICAL TRENCk
PLAN VIEW
11 .
!ME
LIM
(ty P I Cal) Qulck4l. Standard-W Chamber
IN�TALL-!.ffl TRENCH: (typic-ai)
(MfO by InffiraW Systems, Ina)
& Ins tall p u r
tivant to ffmufsolu re -es in aw c�b=na.
'WIM Sdd!W
Q 20 fe EIISA/Ct�BM4f 0
''Pal ''t
ro.arm. oTA
-ffllimw� I ndi pis
14
per trench a;
Reqw'l red Infl It rau on Area a
Ali
tmnch0+S,M,�:P ed Total E ISA
ropot
jam
� , • _ wa a an �, � - a + � a a ^. , - ' w � �., . • - w �' - 7. a� +& �.. - - s
91
f
L-3 fa
y to
+� Y
a
al JL
Abm AL
a . s N'•+ • F ��
a
• r P
-
a
. a - . a S w - • - - _ - w • a
MAW
JL
Ly "
• a " _ ; yam, r - y y _ ..
R � .. � a �' w • as
• -
ya
, & • s _ _ � r. y , W� a y w- is
W �' • a a �I w! 4 a�
f a -
i
a
I
sinl/Tech 14 'iller.
1455 Lexamar Dri'Ve
BOYne Ci4j NIT 49712
Off 231-582-1020 Fa-x: 231-582--7324
T011 Free: 888-999-3290
SinllTcch Filtei-'s Last LineDefense of
Ir -
rhe ii SerienA",4i Presndol',iure Fi,tA0"Lr
Vorkx Action
The Sim/Tech pressure filter, �vith its unique design
and mounting location., allows th,e filtering screen to
be sertibbed during pump operation, prio�,iding
niaxinium maintenance intervals with unmatebed
performance capabilitleso
The filter screen is, a type 316L stainless %teci
with .062"" (1/1614, ) di-anieter holes. Optional socks
are available for finer filtration* ]"he screen is 3
inches in diameter and 18 inches 10119, with 41 %
open area. 'tins large open area 69.52 square inclh-
es) allows the filter to operate at up to 83.8 gallons
per minute at I Psi. With features like tliese even a
95�/4), plugeed screen wi11 keep your pressurized S-NrS_
tern svell protected -in(] Nvorking properl).--.
This performance product assures quality effluent
with lower TSS levels, keepingyour pressurized
systems funcdoning at 100% efficiency-
14 -Ongineers and designers can specify the Sinifl-ech
pressure filter to safeguard and assure sN,sterns will
fun Lion as designed now and In the ftittire.
411c Bini/Tech pressure filter is perk-lo for
hoth residential and coi�nnivrcial appileatio"s.
High flow-r-ate unanifold.
Multiple flitcor.% c:.In be
assenibled inter -I 1`11-1111U'Old tO
n. k iaccommodes le high flow -rate or
o
higli strength efflueW systems.
At the nia.), flovN--rlate 44 83.8
gpin, headloss for a clean filter
Is .21 psi t,jr 1/2 foot and head -
loss f0r a 95'/o plugged flilter
a
is .8.5 psi or 2 feet.
r'4 W-4 WM
FxPr
For ni(orcinfo and to
se v vidt-m. Isit
III (ec 11 f -I I te rx(l n)
FILTER BODY
61
1
FILTER SCREENI
PERFORATED METAL
22 GA. STAINLESS STEEL
TYPE 347 WITH 0,062
HOLES
ti
s
c
W_--1
TOTAL DYNAMIC HEA1
F L 0
0�0�
co
ir
LU
UJ
[JU PUMP PERFORMANCE CURVE
T
0
4
<
NIJ
&94'TDH
2-
10 20 30 40 50
GALLONJ 37 GPM disctiarge rate
LITERS F I-
0 80 160
FLOW" PER MINUTE Mft7
MODEL COMPARISON
Seal
Mode
voles
Ph
Amp
HP
H z
Lbs
K9
S I F-T) P I �X
Duplex
IMS31MY14
SIT) jIle
Atito
115
1
q, 7
3/10
60
?3
10
1
N53IN55
siligle
W)ri
115
1
9-7
3110
60
23
10
2
3 & 4
BN53
SLI'll-gle
Auto
115
1
9-7
3a 10
60
215
11
ESE 531'ESE 57
sin.(13e,
Auto
230
1
4.8
3V10
60
24 t 30
11 /13
d
smglc
Ar,11v
23,0
1
4,8
3110
60
23
10
1
L53/t55
Single
Nini
2'30
1
4. F
60
2-2
10
2
f8i, 4
M5 j f M59
Single
Auw
I 11�
3110
60
29133
13115
1
NiN59
Single
No n
111'.
1
9 1
3110
60
28179
12,113
2
3 & 4
BN57
smqle
Atito
11
1
9.7
60
30
13
D57. 1)59
Single
ALAO
23,0
1
4.8
3J10
60
30/33
13115
1
F Fi 7 :'F 53q
"Single
No
1 230
1
4.8
N1.0
60
28/2-9
12/13
2
3 & 4
F 5 9
Siriqle
Noi-
1 230
7
4.8
N10
610 —T
29
13
2
3 & 4
* Single p1g,gyback sw'M, h 1 ricluded,
I J *4 F.41 0 Or, [I 1012110:9 111% 111 : I *-
Additional cofd to the are available in 15' (5 im), 25' (8 rn) and 35' 01 rn). 50 t 1 5 m cord lerigi hs ava i lAbl e for 2 30 V units only.
RE and RN models include a piggyback variable level pump -witch..
Model 53, cast iroll svwiLull case, motor and pump housiiiij, cm j)1j-,G(j lrnptflli�T CHI(] ba,:5e. M�.)dij'[ 570, '311 cjst iron cmistruclion with a casi tion Impelleir,
Model 55, bronze switch inulor aii(A pi,jmp housing, a phi%lic iiripullvr and bxse Model 59-. bronic f7()11S[FLJCt1(-.iri vvith a, bronze impeller
Optional pump stand (PIN 10-2421),
SELECTION GUIDE
1. Integral fl4L)a k-wuf atuti f P iecl Id F)IC-a i sivvitt) i, fit) extirn nal coi i I F of reqtj i red,
2. Sinqle piggyback variable level Hoat switch or double piggyback variable [evel float switch. Refer to FM04/7-
3. See FMO712 for cGlrreaci model of Electrical Allefrialf-jr.
4. Variable level control switch 10 0743 used as � aclovator with Pleivical alternator (3) or (4) float system.
'W Q Iff.-T11 211111LITZa'. 1, 1 it
- Reduces patential dogging by debriKI,
- Fieplactocks or bricks Linde( the Pjjjrijj
- Made of dtirable, noncorrosive ABS
- Raises pump 2" (5 �m) off twtorn of basill
0 Pit)v4dt,-,-, [twdlillity to intake by adding soctions of 1"12" of 2'
(DN40 4) r UN 50) PVC pi p i rig
Anciches spiurcAy to punip
, -) ni mod a tes skimp, dewa te ri nq i I.' k.-I f I t I C! nt applications'
r'-4('a 11, Make swre float is fret trom obStF'UCti01j.
JA CA �10 N All of cKintrofis. dnd wiring should be done by a qualitiod liuDnSQLL ili2om-iin- Ali MW-VUAll and, safety Code should k)e
followed i n 6 u d i nq th e most rece Ai 1, Na (tof ia I Et I r ica I Cade (NECI a n d t, h e Occo) p is tio na I S.0 i ol y A ri ei I r I I h Act (0 SHA).
Copyright 2020 Zc)eller' Co. All rights reserved.
502-778-2731 1 800-928-7367 1 3649 Cane Run Road I Liaulsville, KY 40211-1961 1 Z0Q1II0rPUMPS.00(T1
WLP756-Mk Pump Chamber Calculations
p
1, Knue
-!S 41q I
w n 1 t, e 42,00galiniLin.±
Friclsoii loss, 1.44 w (50" X2,87 ft. I I OW) i n.
tot
-Ila a L+
N *.,41
I otal dMIC head-
r
N-fin. �upplv prcssurc OAXY (1-orccinwn diwhargcs to X' 1,-)vc header �!ravitv t-ecd% into tunchc-i-I
II.C. but I ont 8"0 oj I 1�z 4§0
0 rt
FrTicllan kl.,o;
'hitid dwamic hczid
Nlodol numher- Zoeller BN
Paillp will di.w.hargeapprox, 37 gpm foo 53 1'
4. Fluid FlowCalculations:
'V
-1,774 gpin
[N)w 01311A)c r 1-114fnu tdctuier & Capacl ty:
t LP750- I lquid depOi 37.00 k 202,8 gal_, meh (7 5036 &AL actual)
M&!g qLi e ha i i i be i
klaximum dnse volume: (450 gaL/5 doLeN dit.v) 164)(50") = 98,20 LvalInns pt:r dosw-
0
Dose Tank Information
Ti,irik conpor*rit t. p�L,4�erly vem, �_-d
pn dlanvutr
Wieser C(xicrete Maiiufadumr 2 in,
Capacity 750.36 Gallons-
VCAUMC L 20.28 gallinch
Weep hole �x artfi-
I
Dimension, Inches Galtorts sbhw degree 20.35 41Z66
B 2.00 4-0.56 PwTj off C-1M.q6pn_(fq_
36 2]8
C .2,65 53.84
D 12,00 24 3 � 36
Total 3-/.OUJ 750,36
tank ek�vaxlxw, (f 1)
Ot rT
Alarm Manuafacturer SJ Rbornbus Tank Air-rl
Alarm Model Nurnbeir SJF$ 1011421
pump Manufacturer Zoefler
P u mp M odd N tj m ber BN 53
_AVON
-EM
office use GnE7 I
CWHERSHIPIADDRESS FORM
tze�tito provide thep4r'operj�-[ Q'%A!DC-!- rlT'-n
infb` -tion --;-ding cpzeractztar, andw rna.,, Mary SysIb M! I at's
F-, T, E vs c e C yca u ear c r rep! acemen-it, san-,
information will be prc-v�cjed as e
of a u r o n c c i n c, e4�-T.co rts t c pro o to p
L;brl.c healtk vour Yve1j, g!-nun i-water
su rface watef, p roperty va lu as .CrM CIP6.
ancl counrz�-y TesouT..- a s n ce -a 1c, rov, d. e
in' ffnafm vA besm to you b`y, ernat-..
E. U-
:)rrR
A zda
-r— T_ 0 �w 6 L 1\ I
city/st Lae F.�jp
r%n ehL IL -
1641 L t1a -Lj ff,-Iqw I --".p J
Enlai' Address (r-equ&ed) e4
4�
(to Tun rd on -6-tea pmtie rzy, Lido
MEW M MOM
F_Tupefty 1/4,
"IN
A
Lccafion5. /,
,; T F T OVMf
iat p
LOL
.2,,Lr.L,Zld
9
dy Dwd 2
LJCZ 7 0 k..� Z L� L
71�
L
r ciy Ar
NI: u M. b er of bedTc 0 M S
iiines rdePUf abie a vns E2 no
I Property Ad,dn?ss,
_3=
6L,',LF�5 �=OUITEd I 1 COIL LfDE-V2127zr pEn
L cc I
(D a, t e)
r z
rcafi. l ,st be subm&W v4s_t aU Private Onsite. Water Treauxmen.& S StE, 17 170111f TS
po
pd
U; 'J. U' �-J C,? t
- - " G C-OP37 � zii 7ME6,
1-0 , j D E e cis G wl�c Car 4� L 00
V7, U; � Jrl�lt
LS
COM 'y: 'M LT JAL &,f L
--cLiLd USf= BP.Sla.n
71 S-386-46FO St. Croix CCU -my Govem. M. 715-245-4250 FaO-%-
:r4-
L � . I ,
w OW lu , 1-4, "-� 4,1L; , " I IL;LF 10 lAnAr,1.1, .Scc_� I'll IL at) V
i ��j � Ca Roe
it
V%Ascorsin Department of Safety and Professional Services Page 1 of 3
Divi-sion of Industry Services
SOIL EVALUATION REPORT 3,351
In accordance mith SIBS 385, Ws. Adm, Code County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, St. Grol.x
but not limited to- verfircal and hortzontal reference point i,BM), direction and percent slope, Parcel 1, D
scale or dimensions. north arrow, and location and distance to nearest road 10 ( 0 — S-0 —sto Ref#2733
Please print all information, R by Date
Pqrr3onal information you provide may be used for secondary 0S 5 Iva _pufp e (Pr'va Law, s 15 04(1)(m)`
Property Owner Property Location El
Stephen & Pamela Lallemont Gout Lot SE 1/4 NE 1/4 S 35 T 29 N R 19 E (or) VV
Property Owner's Mailing Address Lot # Block # Subd- Name or CSM#
651 Ki!jnq
yRd Na Na Na
City State Zip Code Pl.one Numbcr El c i ty El Village El Town Nearest Road
Hudson VVI 54016 (715) 386-8154 1 EEEEEErm�____ I I Hudson Riley Ln-
[] Now Construction usc� E Residential/ Number of bedrooms 3 Code d(rivcd design 'Row rate 450 GPD, X
El Replacement 0 Publi� of commercial — Desrnbe —
Parent material Glacial Outwash ;5w;A� Flood Plan elevation if applicable na ft.
u
General cornmcnts and recommendations Sitc suitable for In -ground POWTS installation with 0-5 gpd/sq- ft- design loading rate, Recommended infitrative
surfaco elevation to be 90.50' Pressurization required to reach system elevation infiftrative surface elev, of existing dispersal cells = 88,0 & 87A0".
E] Boring
Boring #
77 pit
Ground surface elev. 93,93 ft.
Depth to lirni1ing lfa�:tor 84" ir,
Soil Appll.,ation Rate
Hor[20n Depth
Dominant Color
Redox Description
Text ur,-
StrUCtLjr'0
Consistcncc Roots
D/ 7
GPFt*
In-
MunsQll
QU Az Cont Color
*Eff#1
1
0-10
1 Oyr3/3
nonQ
I
fir
mvfr i v . f
0.6
0,8
2
10-28
1 0Yr4/4
11.017C
gr sl
ms b k
mvfr 1 Vf t
06
1 0
3
28-72
1 Oyr4i 4
none
gr Its
Osg
mi CW
1.0
4
72-84
1 DyW 4
none
strat Is
& Ifs
OS9
ml gs
0.5
1.0
5
84-93
1 Dyr5/4
f2d 7 5yr5/8
IS/sl mix
Osg I I thin pl
mll/mfr
0-4
O6
41, 1 b
El Bo ring
Boring #
El Pft
G ro u nd surface e lev. 92.85 ft.
Depth to limiting fautor >1W in
I
Horizon
Depth
In.
Dominant Color
munsell
Redox Description
Qu. Az Cont Color
7 (�Xt U(C
Structure
Gr. Sz Sh
Co nsiste nce
Boundary
Roots
GPD,'Ft-'
*Eff#1
Eff#-2
1
0-8
1 Oy r3!3
none
Sill
2fgr
mvfr
0.6
0.8
2
3
8-15
15-60
1 Oy r4 A
10yi4 4
none
none
none
ra ve
-so
si I
Is& gr
s &,6
(4011%gr)
gr s
2fsbk
MV(r
C, 'Y'd 2vf1fm
gw 20,1f
C I f
0.6
0.5
07
0
0.8
0.5
16
1:6
. . . . .......
osg
Osg
Osg
ml
ml
dl
4
0-74
-1 0Y r 4
5
74-108
1 Oyr5 4
CST Name (Please Print)
C, Ig rWON re
CST Number
James K. Thompson
30021
Address
Davaluation Conducted
Telephone Number
340 Paulson Lake Lane, Osceo�a, VVI 54020-5413
October 5, 2023
7 5 48-7767 1
fff NO r., M
I .
3 Boring # 0 Boring
® Pit
Ground surface elev. 94.35 ft.
Depth to limiting factor >89" in.
Snil Annlina#inn Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture Structure
Gr. Sz. Sh.
Consistence
Boundary Roots GPD1Ft2
*Eff#1 *Eff#2
1
0-7
1Oyr313
none
sil 2fgr
mvfr
aw 1 fm 0.6
0.8
2
7-12
10yr414
none
sil 2fsbk
mvfr
cw 2vf1 fm 0.6
0.8
3
12-56
1 Oyr414
none
Is
r OS9
ml
cw 1 vf,f o.5
o.5
4
56-89
1 Oyr514
none
& fir OS9
dl
aw 1 vf,fm 0.7
1.5
`l0,�b
4 Boring # Boring
Pit Ground surface elev. SB.Oa t ft.
"4eAAA.
Depth to limiting factor 355
Snil Annlicatinn Rate
.Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az.- Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDIFt2
"Eff# 1 "Eff#2
1
0.8
10yr413
none
sl
2fgr
mvfr
cs
2fm 1 c
0.6
1.0
2
8-21
7.5yr416
none
g r sl
1 csbk
mf
aw
1 fm
0.4
0.7
3
21-27
7.5yr416
none
sl
Om
mf
aw
1 fm
0.2
0.6
4
27-35
5yr414
none
sl
1 mpl
dsh
gi
1 fm
0.4
0.6
5
35-53
7.5yr418
f2f 7.5yr414
strat. Ifs
Qsg
dl
aw
-
o.5
1.0
8
53-70
2.5y 414
2dyr518 8�
10Yr52
cl
Om
mfi
-
-
0.0
0.0
t
Boring # Boring
[] Pit Ground surface elev. ft. Depth to limiting factor in.
Anil Annlirtatinn Rate
Horizon
Depth Dominant Color Redox Description
In. Munsell Qu. Az. Cont. Color
Texture Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD1Ft2
"Eff#1
"Eff#2
" Effluent #1 = BOD, > 30 s 220 mg/L and TSS > 30 s 150 mg1L * Effluent #2 = BOD, > 30 :5 220 mg1L and TSS > 30 5 150 mg/L
Wirscon si ri D epartm ent of Safe ty and Prof eszs I ona I S e. rvices Page. 1. of 3
Division of Iridustrervices
SOIL EVALUATION REPORT
In accordance with SPS 385, is, Adm. Code I County
St, Croix
Attach complete site plan on paper not less than 8 112 x 11 incl-m In SiVe. Plan must include,
but riot linilled to vertical and hofizontal reference point (13M). diroction and percent slope, Parcel W,
scab: or dimensions, north arrow, and Imation and distan-ce to nearest road- Ref#2733
Please print all 11"for-mation. Reviewed by Date
—Personal Womiation yc u pLovide. riioy Lused fotsecandary purposes (Plyriv law, s. 15.04(1)(m)
Prop" Owneir Pmperty Location
Stephen & Pamela LaHemant G ovt. Lot SE 1/4 NE '/4 S 35 T 29 N R 19 E (or) W
Property Owner's MaMing Address Lot # Bkx* # SuM. Name or CSM,#
651 KiaRqy Rq, Na Na No
City State Zip Code Phone Number 0 City Village Town Neare�st Road
Hudson Wl 64016 (715) 38&8154 Hudson, Riley Ln,
New Construction U s� e Ex j F, um of bedrooms 3 Code defived dcsIgn flow rate 450 GPD
Replacement Ej Public or cooi-1--rnerci;-?l — Describe. -
Parent material Glargail Fk)od Plan elevation if applicable na ft-
General comments and recomnw-ndatiGns- Site stiltaUe f r Ire -ground POWTS irsteallallon wif1h 0.5 q design load' lVe
1) , pd 1- q 1. ing rite_ Recc)rrim(-.-nded infiftr�-&
surface elevation to be 90.50% Pressurization required to reach system elevation. infiltralive. Surface elev- of existing dispersal cells 88.0' & 87.0'.
BoriN # 0 Boring
N pit Ground surface 6ev- 93.93 ft-
Depth to limiting factor 84F in -
Soil Apolication Rate
Horizon
Depth
Dominant Color
Munsell
edoDescription
Qu. Az- Cont. Color
none
none
Texture
Structure
Gr. Sz. Sh.
Consistenm
Bo u rida ry
Roots
GPDIFt-I
*Eff#1
0,6
REM2
0.8
1
0-10
1 0Y r313
I
gr Sl —F-2-
gr Ifs
2f( f
M s b k
059
mvfr
as
CW
I Vf,f
2
3
10-28
1 Oyr4o'4
mvfr
1 vt.f
0,6
1.0
28-12
1 Oyr444
FKWW
Ml
CW
0.5
1.0
5
72-84
84-93
1 Oyr414
none
t4
&fs Is
WSJ mix
Osg
Osg I thin P11
MI
9S
0.5
1.0
M^4
fed.
mUn*
0.4
06.
2 ] Boring # 0 l3cming
0 pa Ground surface elev. 92.85 ft.
Depth to tirnifing factor > 1: 08" in.
Soil App!icabon Rate
Horizon
Depth
In,
Dominant Color
Munsell
Redox Lie scniption
Qu Az. Coni. Color
none
none
none
[lone
none
Texture
sil
Structure
Gr. Sz, Sh.
Consistence
Boundary
Roots
1 fro
GPDfFt2
E ff # I
0.6
"Eff#2
0.8
1
2
049
B-15
1
2fqr
OS9
atvlr
10yr4/4
1 OyW-4
1 Oyr4/6
1 Oyr,9/4
CW
2vf1fm
0.6
0-8
3
15-60
60-74
74-108
Is & gr
(J/u
s &�gr
%)
nil
ratCW
9W
2vf,,If
0.5
0,5
4
5
if
0.7
1.6
1113
gr s
OS9
dl
07
L-1 ir1Jt-,1 R ff F - L-31JU, � AJ -L- &�.LIJ F11YiL all F,:,J,_-3 --,)u ::; i-,)U rTIWL tJ"UeM FFZ OUU, JU S ZZU Mg.'L �Jfl-(j 1 Z�1'5 > S I W n)g!L
CST Name (Please Print) signaLlUre CST Nkmibef
James K, Thampson 30021
.... . . ....
Address Date Evaluation Conducted Telephone Number
340 P aulwo Lake Line, CW-OCeC4a r Wl 54020-!�4 13 O(Aober S. 20 2 3 1"(715) 248-/ /67
SBD-8330 (RG4/15)
Boring # [] Boring
ED Pit G►axid surface elev. 94.35 R
Depth to Ilmiting factor ?M in.
Soil Amdication Rate
Horizon
Depth
Dominant Color Redox Dian Texture
SkKt r+e Consistence Boundary
Roots GPD/Ft2
In.
Munsell Qu. Az. Cont Color
Gr. Sz. Sh.
*Eff# '"'Eff#2
1
0-7
10yr3f3 none sil
2fgr mvfr aw
1 fm o.6 0.8
2
7 12
1 Byr414 Wane sil
21sbk mvfr Cw
2vH fm 0.6 0.8
3
12-55
10yW4 none Is & gr
or ml Cw
Iof f 0.5 0.5
4
9
1 oyr514 none s&g;
oss Ica aw
I vffm 0.7
1.6
4 Boring # [:] Boring
ED Pit GrourmJ surface elev. 88.00 ,1 ft Depth to limiting factor & in.
l OmGr-tniinn Pnfa
Horizon
Depth
In.
Donfiinant Color
Murmell
Redox n
Qu. Az. Cont Color
Ted Struct"
Gr. Sz. Sh.
Cow4stence
Boundary
Roots
GPD/Ft2
'Eff#
*Eff#2
0.8
10yr413
none
sl 211gr
mvfr
cs
2fml c
0.6
1.0
2
8-21
7.5yr4#6
Wane
gr sl 1 csbk
mfi
aw
1 fm
0.4
0.7
3
21-27
7.5yr4/6
Wane
sl Urn
mfi
aw
lfm
0.2
0.8
4
27-35
Syr414
none
sl Imp[
dsh
gi
l fm
0.4
0.6
5
35-53
7.5yr4AS
Of 7.5yr414
03L Ifs osgg
dl
aw
-
0.5
1.0
S
53-70
2.5y 4/4
rn2d 7.5rW &
d Om
mfi
-
-
0.0
0.0
Boxing # 11 Boring
0 Pit Ground surfbw elev. � ft. Depth to limiting factor in.
And Anr-&-tminn Pnta
Horizon
Depth
In.
Dominant Color
Munseil
Redox Description
Qu. Az. Cant. Color
Texture
Structure Consistence
Gr. Sz Sh.
Boundary Roots GPD/Ft2
*Eff#1 *Eff#2
* Effluent #1 = BC D, > 30 5 220 mg/L and TSS > 30 :5 150 mglL * Effluent #2 = BC D, > 30 5 220 mg1L and TSS > 305 150 mgiL
SPn�cc Tru.s � �y
e.y13z-nq d�sp4o�w W/,s 4,
5 L�AV
jo
r
SigoA oij#V414/4Ao.
fft
MW ACNi � See., A '.z94,,,
r Lid ! n r VY6 1'1�
maw,-CAeed lawn
R
i o-o rrr w
"e aVC94
I I Ada! . AV-57, � �•� Sty � ,, h v�f't
10
lop
0.1
♦I r
WOOD dam 4�
two
f r I r dob 1
441
������� 'j�
a
',d.'kit
V�
� /�� iQssio(yret
40
0\
VV
*t
E - I�oCt1fi+lF..h�T I�C7►_� S &TE BAR. OF WISCONSIN FORK :1 29M TH's 6"c E sE6Exvc0 ra;s REeaRDJPdc* D^TA-
{ E WARRANTY DEED �
42 51-95 ,777PME 85
Z � �..._ -- _- . __. - - -..... _-..� : --___. _.. -___ ._ REGIST
T This ]deed, ode between Robert-_W. .. -in
- - -- -------------- --- --
sbarfd__arfwife as dint tenants
___________________.___.._______.._ _ ___. .._.__,____.._._,__._.-__.__-.____.____.____ ......................... Grantor,
and ------ .te-p&an_X--.,_.L2t1-1emQnt_-and _.P`,e�' mela__$,___I ahem-49ntx_....___.___
--.husband_.and._w1 ........
_...._......_._..----------------------------------------------------------------------•---------, Grantee,
W1tnesseth, That the said Grantor, for a valuable consideratior,._.___
oo,�---------------
conveys to Grantee the following described real estate in _ _ _ _ S.t ._ _Croix _ - -- - _ _ _ ---
County, State of Wisconsin:
Southeast cane --quarter of the Northeast
one -quarter of Section 35, Township 29 North,
Range 19 West (SF -Az - NE&4, Sec. 35, T29N, R19W)
except the North 396 feet thereof*
ST. CROIX CO, WISa
Reed. for Record this i s t
ay of max A. a. 19B?
10 : oo A �
RETURN TO
Tax Parcel No: -----------------------------------
This deed is given in satisfaction of that certain land contract
recorded June 29, 1984 at 3 : 40 p.m. in Volume 691 of Records,
pages 460---4 b 1 , as document no. 394511, in the office of the
Register of Deeds for S t . Croix County, Wisconsin.
This _.. is not_ _ __ ___ _ ____ _ homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And------ ----grantor -- --- ------ ---- -_- __. _. ------ ---------- --------------•--- -------•--------•---------------------;-----
�vsxrrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements, restrictions, and rights---of--way of record,
and will warrant and defend the same.
Dated this .......... 17 ------------------------- day of ----_ -A ril------•---------------------------- --------- --$ -
-•-------••-•-------------•-----•--•--•---•-------------------------- (SEAM) - - ---- •----=` - --- -- ....-----• (SEAL)
-----------------------------•-----------------------------.-----
.---•------------•-------••-•------•--•---•-------------------------- (SEAL)--•=----•--------(SEA.L)
* * Janice M. Linehan
........... ------------------------------------------------------
A.UTHENTICATIO24
Signature(s) ...............
Janice M. Linehan
authenticate this J... -_d of ........... Y9_7_
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, - - ------ - - - -- - ----------------------
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
_Steven B . Goff, Attorney at Law
i5rFi :-Yfa17ii- Street ,...Hoic.-16 i------------------
s---his�v_nsirf-.--54022....................
(Signatures may be authenticated or acknowledged. Both
are not necessary.)
ACHNO W)LEDOMENT
STATE OF WISCONSIN
S9.
-------._... ___._._._____._.__...___County.
Personally came before me this ............ -.day of
..........................................0 19_..--_-- the above named
to me known to be the person __.... _.._. who executed the
foregoing instrument and acknowledge the same.
*---------------------------- -------------------------------------------------
Notary Public ___ ............... __County, Wis.
Mir Commission is permanent. (If not, state expiration
date: ....--•------------------------------------------------0 19......... )
61<amce of persons signing In any capacity should • be typed or prinLed below their nifrnatttres.
H,CMillar[.arrparrat M &TATE ISARYOF WISCONSIN
#Alf 'swbo., w,.R.o.s,► F[)ItM No. r LOSS Stock No. 13001
1'7AT-O'q OF AN
- �-
_ �j i -- m
TMG 1MIF
�. - .
m'
t�b=
����az.k
.�
the .�,
IT t tj
�ry �•
e4vinig
Cow. �, Tow: a . m �4 �
_
Upon '-nSPeC-tiOV-,r T
_ �
'F �, be
�Xtb
_ 1 - y r .
', 2 �. _ ape
klyd,
rZrn*? ya
��� r
��_`_ o _
$� -r,
%QaPaci
��. _ -
_-�� )Ooo�_
r
COrL
ula-z
a, TOILS
tC7
Mann of.� �,.
_ j--
CIL
_ o--OtImr
4 s
Y:a St:Z D
-r- .
9 6'Y
r
_-Lc�ed PlImibeur, fig :LA
I ive code
•
Plumber (,app1-yj_jj,,
s
_ Y .,mij:- -
n -
the - •�• --
tO tl4e
_'� _ i071 T
.
l�ients of lu-m
^�, knowledge
Out
to h
rev r
o
Niame YV-I ux
Cido
gna
IMPIMPR&
PUMP CHAMBER
Bottom of tank elevation:
Gallons per cycle:
Alarm Switch Type:
Number of feet from nearest. property line: Front, C) Side, Rear, Ft.
Number of feet from well:
Number of feet from building:
(Include distances on_plot lan) . LQwvr, �� i �� fj_ed
1. (1� Af_� :� 0� �,.o oQK 89.E
SOIL ABSORPTION SYSTEM o t, -{�.�_ f,rd
_ -79
6Bed: Trenc�y a
0, 17
Width: Length: Number of Lines • ` f a.7 B a,
...,.._._rea Built . �
Fill depth to top of pipe: Cti tJ
Number of feet from nearest property line: !
P p y Front, Side, Rear, Ft.�
Number of feet from well:1/0t
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Pump Size
4 Size : Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built
Has either a drop box 0or distribution box 0
been used on any of the above soil
absorbtion sytems? (Check one) .
HOLDING TANK
Manuf ac turer :
Manufacturer:
Liquid Capacity:
Pump Model:Pump/Siphon Manufacturer:
Elevation of inlet:
Pump off switch elevation:
Alarm Manufacturer:
Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, 0
Side, 0
Rear, 0
Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job:
License Number:
3/84:mj
Form -STC-104
AS BUILT SANITARY SYSTEM REPORT
I`■Pi f i i �l � - ,
.. j'. 4 �` '.; TOWNSHIP '.l .`�� SEC . �r T ,N-R
OWNER .. w
k � •, � �_ ; �
ADDRESS";�` .1 ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT - LOT SIZE
IDLAI` VIEW
Distances and dimensions to meet requirements of IZHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slopes at site: '-
c i Liquid Capacity: '� 1
SEPTIC TANK. Manufacturer • . V..
❑� : Tank manhole cover elevation:
Number of rings used ,�
�rmlefi - 97. (00
taR� (� � �4 , � � Tank In
let Elevation: Tank Outlet Elevation:
.out �� �.�--
Number of feet from nearest Road: Front go Side Rear, 0 feet
1, 39
From nearest, property erty line : Front, SideJaRear ,a
p feet
j0
I
Number of feet from: well , building:
this information of the, above plot plan}( 2 reference dimensions to septic tank}
(IncludeSEE REVERSE SIDE
t
I {
I
I
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUN AN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
Po_laox 7 69 BUREAU OF PLUMBING
MAD SON WI 53707
SEA NE% S 35 T29N-R19W 33 CONVENTIONAL ❑ ALTERNATIVE Sf assigned)1.0.Number.
.� ? 4 � � (If assigned(
Town of Hudson ❑ Holding Tank ❑ In -Ground Pressure ❑ Mound
Kinney Road
NAME OF PERMIT HOLDER: AOORESS OF PERMIT HOLOER: INSPECTION DATE:
Steve Lalle mont 85 Coulee Road, Apt. 1, Hudson, WI 54016 �1 --���7 1 l
BENCH MARK (Permanent reference pointl DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV:
Name of Plumber: MPIMPRSW No.: County: Sanitary Permit Number:
Richard Hopkins 1059 St. Croix 92544
SEPTIC TANKMOLDING TANK:
MANUFACTURER: LIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNINGROVIDEOLA EL LOCKINGCOVER
( ] l o- 55 I Q . `�'� IZYEs ❑ NO ❑ YES [ONO
BEDOING: VENT DIA.. VENT MAIL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT LE FRESH
ALARM: LINE: �l AIR INLET:
C_ IUNQ
FEET FROM V
❑YESUNO ❑YES NEAREST
DOSING CHAMBER:
MANUFACTURER: BEODING: LIOUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER. WRAOR'NIONGOVIDEDLABEL PROOVER
DYES El NO
Cl YES ❑ No ❑ YES ❑ No
GALLONS PER CYCLE: PUMP CO TROL ATIONAL: NUMBER OF PROPERTY WELL BUILDING V NT TO FRESH
LINE AIR INLET
(DIFFERENCE BETWEEN FEET FROM
PUMP ON AND OFF) ES ❑ No NEAREST
SO L ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH: DIAMETER MATERIAL AND MARKING
FORCE
or excavation. (If soil can he rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
11 WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA. #PITS LIOUID
BED/TRENCH T��be MATERIAL' PIT DEPTH -
DIMENSIONS z,
GRAVEL DEPTH FILL DEPTH DISTR. PIPE. OISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBEOF PROPERTY WELL: BUILDING V NT TO FRESH
R
BELOW PIPES: t ABOVE COVER: ELEV, INLET ELEV. END: PIPES. FEET FROM LINE: + % S Al 1N�T:
{ NEAREST II t� /U,2'
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW E LEVA-
meets the criteria for medium sand. TIONS MEASURED.
El YES El NO
SOIL COVER ITEXTUREi PERMANENT MAHKERS. OBSERVATION WELLS
DYES ❑NO DYES ❑NO
DEPTH OVER TRENCHIBED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL- SODDED. SEEDFO MULCHED
CENTER: EDGES:
[—]YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH: NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER:
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTHIBtJTION PIPE MATERIAL $c MARKING
ELEV.: ELEV.: OIA.: ELEV.: PIPES DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY. COVER MATERIAL.VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
❑YES ❑ NO ❑YES ❑ NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM
❑YES El NO ❑YES ❑NO NEAREST
NE
0ItT,
,Vr w r�
0-S6
` file for audit.
Sketch System o n R eta ( I n county n ty e o
Reverse Side.
SIGNATURE: TITLE:
Zoning Administrator
DILHR SBD 6710 (R. 01/82) 7�. 1
�, CIO f k COUNTY
OWNER So�{�N �
AND/1-Oxx
VC . a--
- tM -' N _IX F%-- i d-
T111S _wr"h-lmr--"JRMIF-Iml"'E"X-ffr"hIRES
SBD-06499 (RI 1/20)
:1 �
Noe..500'136 �
i2 to & ox
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
7� 17.... -
.. .. ....... . . . . . . . . . .. .
.. .. . ...
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(Emma