HomeMy WebLinkAbout020-1264-15-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
552342 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Frey, Charles D. & Jodell Hudson, Town of 020-1264-15-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
/W --9 /1
~j ~ 1~-- al 29.29.19.1282b
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
I • ~ hs2.c9 At 5
Dosing ~e,ejc Z,~p .~•5 ' Alt. BIM
1r•:1 /
Aeration Bldg. Sewer
l~•J ~0 1 a k ~~j ~
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet 77 97 ` .7 t7
TANK TO P/L WELL BLDG. Vent to Air take ROAD Dt Inlet ` S• c ~i
G- 7 CD `
Septic ~l7iJ 57 2-6 J}- 'f• 7 . 32
Header/Man.
Z(p 7 7/416 8 • / J - a
l
Aeration Dist. Pipe
Holding Bot. System 9. •5 1
J J
PUMPISIPHON INFORMATION Final Grade 7. 7 ~7•
Manufacturer Demand St Cover G QC~`
GPM 1 27.2- / ' 1
Model tuber , /qty i~• c,- 7, qq
TDH [Friction Loss System Head H Ft Va ~J '37- 44Forcemain Length -77-71 Dist. to Well
SOIL ABSORPTION S STEM
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS -17e ~ e
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer
INFORMATION CHAMBER OR 1 to
Type Of Systeml a Va-4 104-UNIT Modg J.mb~r: CLa
Aotj DISTRIBUTION SYSTEM 17 f-1-]' 4- 1 ?
eader/Manifold / Distribution x Hole Size x Hole Spacing Vent to Air Intake
4 Pipe(s) \ ~ \ S J
Length 3 Dia / Length Dia Spacing \ O e S
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges ` Topsoil Yes ❑ No Yes Q No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 500 Country View Rd Hudson, WI 54016 (NW 1/4 SE 1/4 29 T29N R1 9W) Rossing's Country View 1st Add Lo Parcel No: _29.29.19.1282b
1.) Alt BM Description = c5f l P;o dkj
2.) Bldg sewer length =
- amount of cover = ~X-1
Plan revision Required? 0 Yes )~/No
Use other side for additional information. I~
Date Insepctor's gnatur Cert. No.
SBD-6710 (R.3/97)
corn erce.ytfitgdib Safety and Buildings Division County
r U 20 W. Washington Ave., P.O. Box 7162 V 'x
s\r~ (,QV (}f~lG Madison, WI 53707-7162
Sanitary Permit Number (to be filled in by Co.)
peparimernt of C , 6%h,N S 3
ry Permit Application State Transactiop Number
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental f/ I/' t
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are ProjectAddres. (if different thanmailing address)
submitted to the Department of Commerce Personal information you provide may be used for secondary
purposes in accordance with the Privac Law, s. 15.04(1 L(m), Stats.
1. Application Information - Please Print All Information
Yl't~
Property Owner's Name Parcel #
I t ~rr✓ 0010 - -000
Property Owner's Mailing Address
-2 ifoiu e- LA.) Property Location f
ty Govt. Lot 1 , WG a~
City, State Zi Code
P Phone Number
/ o Section
Ua ~ b (l~,l ~1 ~ _ • r~ ~p (circle one)
11. 'Type of Building (check all that spp1 T _s~Z N; R /!q E. V>~✓
y) Lot #
X1- X or 2 Family Dwelling - Number of Bedrooms Subdivision Name
Block #
❑ Public/Commercial - Describe Use
- ~JA ❑ City Of.---- 9
❑ State Owned - Describe Use CSM Number ~❑,/Village of _
WIT.". or ld6oA
III. Type of Permit: (Chet k enly one box o A. Complete line B if applicable)
A.
❑ New System ~Klkeplacement System ❑9Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B• El Permit Renewal El Permit Revision ❑ Change of Plumber List Previous Permit Number and Date Issued
❑ Permit Transfer to New
Before Expiration Owner
IV. Type of POWTS System/Component/Device: Check all that apply)
NdNon-Pressurized In-Ground ❑ Pressurized In-Ground At-Grade ❑ `Moop d > 24. in. ofsuitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) H L"""v'/ Pretreatment Device (explain)
V. Dis ersalfrreatment Area Information: ( - e C 4-1
DeC Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (st Dispersal Area Propo d (s System Ievation
Jboo 0a0 (0 0
VI. Tank Info Capacity in Total # of Manufacturer
ry^ Gallons Gallons Units o 2
New Tanks Existhmg Tanks w C
a (p) a v rn H rn w C7 a.
Septic or Holding Tank f
Dosing Chamber l IC ~GC.G p) WPF S
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWT'S shown on the attached plans.
Plumber's Na(Print) Pit er's Signat t , MP/MFRS Number Business Phone Number
Vt r Foy
Plumber's Address (Street, City, State, Zip Code)
lo' lo
O
VIII. ount /De artm n# Use Onl
Approved ❑ Disapproved Permit Fee Date Issued Is uing Agent ignat t _
$
El Owner Given Reason for Denial 4/75-
IX.
Conditions of Approval /Reasons for Disapproval
SYSTEM OWNER:' ~(nC'c^lYt C•'1 ~f
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
as per management plan provided by plumber.
vas
, , U~ h G~? el,.C~ ~ ~
as per applicable 68UNIPMR9116fts for the system and sobimit to the County, only on paper not less than 8J/2 s 11 inches in size
GI
SBD-6398 (R. 01/07) Valid thnt 01/09
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CONVENTIONAL COMPONENT DESIGN
Fees-identiall Application
INDEX AND TITLE PAGE
Project Name:
clel L ~s1 8L
Owner's Name:
Owner's Address:
U
Legal Description:
Township:
County:
Subdivision Name: o S t-
Lot Number:
Parcel I'D Number:
Page i Index and title:
Page 2 _ Plot Plan
Page 3 Sy stem Slzing & Cross-Section I
Page 4 Prrtwr S ezs~ W {
Page 5 Mainter)8~nce Information - I
Page 6 _ M_an'emant Plan
Page 7 St. Croix Cty Septic Tank Mamie-riance ForM
Page 8 _WarrantV Dead
Page 9 - _ C SM ar Plat
Attachri'iMts: Soil Test & House Plans
S~esigr~et/F~'Ii~mkaer: ~ `
Lice`nsP Nu'rrrbar:lc
Date~
~
a Phone Number '
Signature
i)esfgned pursuant to the 11-Ground Soil Absorption Component Manual for r'OWT'S Vorslon 2.0 SF3D_101Cr5..P (N 0110y~
Page 9
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3 ~ (D S9p ~
® ~lev- Iva 4s
ea
Sots Absorfl a System Cross Section
9`l.~bft
4" Schcduie 40 Final Grave
PVC Vent Pipe
With Vent Cap
Leaching _ Q
Chamber
stem Elevation
3 fk 3 ff
Soil Absorption System Plan Vitw
b'7
i ,
Chambers
ff u4.M- jM&jffPff
Mff fl§IMF-- 4" D! a,
~rerrrl~ ~ Header
Vent Or Ob. erv~alion Pipe
_MM
~Tr~91oh
Legc 'n
Manufacturer And Model QQi
iSA aticq LLo o ` q fl per chamber Soil Application Rate gpd/sq ft
_~0 V U qpd Design Flow Soil Application late FiSA ~ 0 C hannbers
3 rows of.Y____ chambers each.
Page _ of _
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i i b"aal lot T,~»
N Inc. i3 r-airftald 51va, 11NTFktltnr~rR?9~3. CT OCfifl2 Rno#1 flry p" o$, $~k~
9l r 76"46,5
I~srt..tilr pa~rrd..... a
lfvsel,~'ra a > PrqowG,t Details
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P"LUE"T FILTER
I
Raisin's the bier in filter tochn 0
PL^525 R-ffte nt Fit f
Wit F111lo+r
P,,)lylok, Inr, Ira .Pieased i,o acld Its new core Merc6ssl filter to Its c.,xistiny line of gl.Wtty a' nyent n l"tskT^^
mm
filters. The, t^G•525 is r'atacl far agar 1 o,onr.1 Cr~D (CoAltans Per OAy)malain8 it ono of the
aria t c,~lmmerdal filTom in it;; daca6, If has ll linear 'feet of lil& (if#rsflnn ala#A. i~tae k}1a ~~9+~+~fSr ~ Rigor ~r~w
Polylok PL-122, the nesa Polylok PL-628 has, err ar,l'torllotic shut off ball instaliad with avary
fjiter, l,hftn the filter is rpmovr•-O for rlasaning, the ball will flbet up and temporarily sllr,tt off a
R45G~ r3a;9S
the sy§vtsrrs era the n'Fi4rantwon'# Mave the tank. Nit atller 111er on the market van make ;nrat f
1:. atatm! A~~s.~rsrRei~
i Now, & mine, i'arylt
tt rn9 InParrrr.,., tacit„rrr,..... f~egGea# a tra to . ct I ant p S Moms
P,+iatsr9 f~rO aO
Fp~iatvros
bra, Sanbry Tam
>~at~:d fat''10,DOQ ~Tq~ (t;Atlnns Per I~Ay) (~#$t(K9K.^a
628 l marc~e for detan~ m ~2 li s r, lee, of 1/1811 filfr~atinn R
apt and C' 8CCHD, 40 pipe Rtrar spacers
* gwitt in Ciaa blefleC~or ftoan
* AiutanlAtlr alli-Oroff mall when filtar is rramavaC! 4 + ei1r
P Alarm accesibliiy
0 Ac4apL PVC extr:nsiun handle l fi tt~
Tho, l}I,525 FfFlwrsnt FtIfer shouirl npamte WitzienfJ for asveral 1*+^ ..,,u.w „
conditions Liefore requiring ciaranrnn. it is rmoonvilanciaa that the fiittOl bO vl%er rroleanedrtrl
i Farms a Clam .
every w~.
time the tangs is Pumped or at last every t'hre& years. If the inslf.4194l filler mnta'It1s an
apttanal Warm, the rnNnar will fta nrattrtact l1, ns the,
Rta
Servicing shavld be lone by a cart(fted japti-tank ~lumpar orln$%jlr~reathds rye i ih~J. W I a ~ 9i
[Pressum Rum
1 t.arate the Outlet of theneefat?r, tAnk.
RamOlre tank ravmr, and pump t Odor Cranttral prodlu
nd CMU
2. Ctrs not trse (code , When h rank if n. cesgary. *Orf-r"-~l a
fi Pull PL-525 r i71t)vt?
. »825 out of the h ~.sin1[p~ r !S
5. Hrase, off filter over the septic, tank. I19Akra aorta all solids ~F4J! krAelC inky Septjr tank. i ~ piaE`i'~~r
r5, insert #hp Iter rarb'idge time rota the housing elating Wire GI1C filt~ar in t8 O t n
alignod Mini r-Omplatsly rn aert~r. / AN 10 ~
7. IieplAce leptir tank cover. P1 5-5
4n stall~stion; r __w
wa;ate flows 14p, to '14, One GGllons Per D, 4y rr]r t'a51C19rpkfal anti anmmPrr..ir~l "0P.G~0patt-
"J'ar;'hryfoal Sl~zi~sl
_
7. Lariats the Autlet of thh1 fie t . . l I a l q
2 F~etrtava tank aver sn c~ Ft ~Ranic. + Ptdf17, Filtst Ad $1
3. CN+e iha filter ht11.t8111( to thn~4"tar" k,lfb~d2lai'Mns`1
~ Rl PA
kha Arare fi 1 nine 2 Pal for , i 2fi"
If the filter it, flnt crAnBeras~ under Flltur Alarm P nit an
. Inien the m_,; r .7A
52~ (ittFcr Pinto n"l & ;_afc
its hat~sing. 1r pit9aa of iaipe tc, cyOMW filter 'martrllrArTM Control
irr~°v rir.ravP~ ~7cr~'~l~rnrir,r.~ l'T'br't
W~GI pith 'til 'inn
POWTS OWNER'S MANUAL, & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner" r Septic Tank Capacity al 13 NA
Permit # Septic Tank Manufacturer W ~'1 yf y N ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer POI L o ~ ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units A Pump Tank Capacity gal -13hNA
Estimated flow (average) i-L10 gal/day Pump Tank Manufacturer ANA
Design flow (peak), (Estimated x 1.5) & Q 1) gal/day Pump Manufacturer -ANA
Soil Application Rate 0,62 al/da /ft2 Pump Model -n*A
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODS) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (HODS) 530 mg/L Wn-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L 'P4A ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfiu/1 OOmI ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
tit l~ ear(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Ys) of tank volume ❑ NA
Inspect dispersal celi(s) At least once every:
a 13k ❑ month(s) (Maximum 3 ears) 13 NA
year(s) Y
Clean effluent filter At least once every: 1`i month(s) ❑ NA
a 43 year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) NA
year(s)
Flush laterals and pressure test At least once every: ❑ month(s) NA
Other: ❑ year(s) At least once every: d month(s) ❑ year(s) NA
Other:
NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surf ace may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third Wa) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer to I i e oi. J"I ~ r e_q
Mailing Address ,-pL2 Ao u A} 111~4 J1 e, i y AAA
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City/State c~gDti~ L . , S k Parcel Identification Number
LEGAL DESCRIPTION , /
Property Location 5W 1/4 1/4 , Sec. T S N RAW, Town of / t 0_(~ 6A)
Subdivision7)y~~ Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # 5 ~8 Volume Page # 30
Spec house yes no Lot lines identifiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms_
SIG?" E OF AP ICANT(S DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the ' ert'
Y py c died survey map if
reference is made in the warranty deed.
(REV. 08/05)
I
STATE- 13AR OF WISCONS N FORM 2 - 1982 f~
WARRANTY 'DEED
II
DOCUMENT NO. HUL 1195PA A*3 it REGISTERS OFFICE 1
ST c.90lX CO., W1
II Thomas G. bison and Jody E=-Di_son, Ree'dto:Recatd
A U G 1 9 1996
------F - + at 11:45 AM
conveys and warrants to Charles D. Frey and Jode3.1 P1^ I -}k
D l c ~l~crn I
nvyrowr vt niovcis
( THIS SPACE RESERVED FOP. PECORDING DATA
NAME AND RETURN ADDRESS
the following described real estate in _ S t _ C ^I-) i x County,
State of Wisconsin: Z
I
020-1264-15
PARCEL IDENTIFICATION NUMBER
l
Lot 15, Rossings Country View First Addition to the Town
of Hudson, St. Croi, County, Wisconsin. I
TR SAFER ~
FEE
This s homestead property.
(1s) C'
Exception to warranties: Easements, restrictions and rights-of-way of
record, if any.
c~~►-, August 9 6
Dated this day of A.D., 19--,-.
!f
(SEAL) (SEAL) i
Thomas G. Dison Jo E. Disor.
(SEAL) (SEAL)
{ AUTHENTICATION . t ACKNOWLEDGMENT r
Signature(s) Thomas G. Disop, State of Wisconsin,
Jody E. Dison 55.
County
authenticate th• day of August 19 9
_ G Personally came before me this - day of
2
19 , the above named
Kris Ana ,Og1and- -
TITLE: MEMBER STATE BAR CIF WISCONSIN -
(If not,
II authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing
1 instrument and acknowledge the same.
-
lI THIS INSTRVMG NT WAS DT2Af7ED BY
Attornev Kristina 0_-Land
__--Hudson , WI 54016 Notary puhlic,. County, Wt..; II
(Signmurcm; may be authenticated or arkr,owlc{t}cd Both arc nor My commission Ic permanent. (1f rim, s;air expiration dare;
I' ncc nt p: ru,nc signing in anp capauty chould by ,T~rc; nr nnnlnl bcln.v ~hc~ c~Rnauur.. -l!
i\'.IRR.V~15' hf Fn GTAT177SAR OF \4'IS(;(IY~IV W.^.rnr;:•nIMn1 {saes. (:n.lrr.
rniT tJn. 2- I1182 Mihv;w}p,-Y: r. 1
h
' ~~2279
Wisconsin epartnient of Comm SOIL EVALIf CN%CLT Page 1 of 3
Division of ety and Br1 J~` l dance with Comm 85, Wis. A.C.E. Soil & Site Evaluations
OO 0 -Cftnty
Attach plete site plan han 8%x 11 inches in size. Plan must St. Croix
include, b not limo t . onzontal reference point (BM), direction and
percent sl e, scale ns, north arrow, and location and distance to nearest road. Parcel I.D.
-1 -15-000 o
P lease print all information. Review d By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). t% q I2
U J
Property Owner Property Location
Charles D. & Jodell M. Frey Govt. Lot SW 1/4 NE 19 S 29 T 29 NR 19 W
Property Owners Mailing Address Lot # Block # Subd. Name or CSM#
500 Country View Road 15 na Rossing's Country View 1 St Addition
City State Zip Code Phone Number City I Village J Town Nearest Road
Hudson WI 54016 (715) 222-3272 Hudson Country View Road
I New Construction Use: J Residential / Number of bedrooms 4 Code de ed design flow rate 600 _ GPD
11 Replacement -J Public or commercial - Describe:
Parent material Glacial Outwash Flood plain elevation, if applicable na
General comments
and recommendations: Site suitable for conventional POWTS dispersal cell with 0.6 gpd/sq.ft./day loading rate. Recommended
trench elevations to be 92.00'. -1 /r
(11/0 za
Boring # J Boring
Pit Ground Surface elev. 95.95 ft. Depth to limiting factor >981, in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 *Eff#2
1 0-12 1Oyr2/1 none sil fill 1&2msbk mvfr aw 2f,vf 0.0 0.0
2 12-30 1Oyr4/6 none Is Osg ml cw - 0.7 1.6
3 30-70 1Oyr4/6 none s Osg ml cw - 0.7 1.6
4 70-98 1 Oyr5/4 none gr s Osg dl - - 0.7 1.6
Boring
❑ Boring #
Li/f Pit Ground Surface elev. 98.18 ft. Depth to limiting factor '124" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2
1 0-19 1Oyr2/1 none sil/s fill 1&2msbk mvfr aw 2f,vf 0.0 0.0
2 19-41 1Oyr4/6 none Is Osg ml aw - 0.7 1.6
3 41-46 1Oyr4/4 none Ifs 0 ml cw - 0.5 1.0
4 46-56 1Oyr3/3 none sl 2msbk mfr cw - 0.6 1.0
5 56-124 1Oyr5/4 none s Osg ml - )air 0.6 1.0
orizon #5 contains 1/8" - 1" bands of irreg wa s. Horizon loading rate reflects reduced permeability associated with Is banding. Horizon #5
was a uated from 8" 124" by use o an auger roug
Effluent #1 = BOD5> 30 < 220 mg/L a TSS >30 < 50 mg/L ' Effluent #2 = BOD5 <30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signatu : CST Number
James K. Thompson = 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020 3/23/2012 715-248-7767
Property Owner Charles D. & Jodell M. Frey Parcel ID # 020-1264-15-000 Page 2 of 3
3 ] Boring # J Boring
gel Pit Ground Surface elev. 96.51 ft. Depth to limiting factor >96" in.
F
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-7 10yr2/1 none sil 2fgr mfr as 2f,1mc 0.6 0.8
2 7-19 10yr4/4 none Is Osg ml cw 1fmc 0.7 1.6
3 19-25 10yr2/1 none sl 2msbk mfi aw - 0.6 1.0
4 25-40 10yr5/4 none Is Osg ml cw - 0.7 1.6
5 40-96 10yr5/4 none s Osg ml - 0.6 1.0
Horizon #5 contains 1/8" -1" bands of irregular, wavy Ifs. Horizon loading rate reflects reduced permeability associated with Is banding.
Boring # J Boring
F-1 J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
i
i
❑ Boring # - Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (R.07/00) A.C.E. Soil & Site Evaluations
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ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certif, that I have inspected the septic tank presently servin
the C l'lbri -o ~YQv 9
~ residence located at: S
Sec. of T a9 N R _J4 W, Town of ,
County, __~A y r, S L St . Croix
Wisconsin. Upon inspection, I certify that I have found the tank and
baffles to be in good condition, and it appears to be functioning properl
Last time serviced - 312,oe,~ Y
Ce' Lvi -j'y, re u, ch)
Did flow back occur from absorption system? Yes No
line. X, (if no, skip next
Approximate volume or length of time:
.Capacity:0 gallons minutes
Construction: Prefab Concrete
Manufacturer (if known): Steel Other
Age of Tank (if known): 0
(Signatur
(Name) Plea(s~e Print
(License Number.)
(Date
Form to be completed by licensed lumber
licensed disposer (NR 113 Wisconsin Admini(s. 145.0, Wi
strative6Code)consin Statutes) or
- - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
i
In accepting the above statement regarding existing septic tank con
certify that the tank, to the best of my knowledga wi
1 dition, I
requirements of ILHR 83, Wis:' Adm. Code ~ inspection conform to the
outlet baffle). (except for ins opening over
Name i, ►m e F ~ I
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