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HomeMy WebLinkAbout020-1125-90-0004 0 N ~ O C ..~ Q. C b O O N H ti i rd ^V O1 '~ • O N .~ ~) ~vv ~l •~ O ~V V' ~ W z z ~ I~~z o z v ~ ~- y H ~ N m a~ w v 0 a in ~ U C O C~ W ri ~I ..fir c~ 0 0 O O ~ ~ FO- ~ ~ C O N b O O Y #t a ~ ~, ~ G S ciao A ~ o I O ~ I C I I O 0 w C I E I N N a~ ~ I = z ~ I ~ !L C O {L 0 0 +- N I 3 N Q N 3 M M O N . N Z V1 ~ 1/1 ~ :. ~ .~ ~ a m I a m I o I ~ v I ~ ~ w ° Q I o z ~ v i ~ ~ I c d ~ ~ ~ ~ r N O _ O N .- 7 N N ~- O ~ ~ ~• N N ~ ~ ~ y ~ ~ ~ ~ d L Q W d ~ O N Q t~ O O Q Z o~ Z ~ Z m Z N Z ~ _N m ~ +-~ d lp ~ O N .. R ~ R ~ ~ 16 ~` n ' I a ' .. ~ . y d ~ ~ O O ~ O ~ ~ d ~ ooa EL ~~ IC°cca ~p V1 fn N rr ~ Q ~ ~ N M N rr a cn a ~ a Z a I~ a a a I ~ I o p 00 00 `~ N j O O N _ ~ O N •~~' ~ C O N M _ ~ ~ C O ~ O J y r - ~ ~ r ~ ~ J T ~ ml C N N Q7 d N. N ~ ~ Q~ <n . ~ ~ m I ~ y ~ O « O Y CD O :°. Y N C ~ ~ ~ O N' C M - CO O p ~ ~ ~ ~ ~ ~ C • ~ CD CD C 3 N ~ M ~• tp O N N '` .0 ~ ~~ O O r 'D r G N ~- C n O~ ~~ N Z N S 2 '2 Cn O V O r w I ~,a da a ~ I ~ a ~ C r C 7 C w C 3 O a O N U i U ~ °~ I N I C C N ~ I t9 a ~ I L •3 I ~ I N ~_ Z m a I c o co .- C ~~ Q o I I I I I _o I ~ I w z I ~ ~ I ~ M o I ~ I d C _ ~ I m w I Z I x N I I ~ I .~ ~ o °- ~ ~ ,~~- I a ~ o I z_ N I } «. [D c a I ~ y Q Z cn ~ I o ~ _ ~ I ~ C C = d ~ C N ~ C ~ O ~ O M y N '00 ~ c N `- I Z ~' Z d g fn ~ I I I I I • AS BUILT SANITARY SYSTEM REPORT • DER •--~ ` ~ yid ~, r ~ ~ r- ~' '~ ,r.. * , TOWNSHIP I7 ~ Os~~, SEC. T~N, R~W ~. ADDRESS u r. , ST. CR~IX COUNTY, WISCONSIN. • .~3DIVISION u ~ I,, _ ~ ti ~ , LOT '~ Sr LOT SIZE ~ q G 'r z~, ~ ~ . PLAN VIEW •Dstances & dimensions to meet requirements of H62.20~ - .~ .. SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~~TIC TANK(S) q u( MFGR. (~ + ~~ CONCRETE y STEEL NO. of rings on cover Depth ,~ / DRY WELL ~. 'r~,NCHES NO. of width length .area no. of lines 2 width J z length~2 area~_ ~ _ depth to top of pipe. 3 ~ ~~ ~ . ~6REGATE ~~ RATE AREA REQUIRED / ~ AREA AS BUILT ~`' Z ~ ~~ k~5~aaimer: The inspection. of this system by St. Croix County does not imply complete ;o:~liance'with State Administrative Codes. There are other areas that it is not possible 1o inspect at this point of construction. St. Croix County assumes no liability for yStem operation. However, if failure is noted the County will make every effort to (e'~ermine cause of failure. ,~$ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS _ `INSPECTOF DATED / ~ ~ PLUMBER ON JOP . LICENSE NUMBEF :~ - ~ _ __ L •• •.3 ~ . . REPORT OF~INSP-ECTION - 1NDIVI~UA1 SEIUAGE SYS7tM Santizany Yenm.i..t.~~ S .t a T e S e p xti c.-~--~~~- 1AM~ ~,__T.~ ~.,. Tawnah~.p ~ S.t. Cn.a~x Cuun.ty c,cat.ian f~lW S ~ Sec•~~.on,~Lox k,~_,Subd.iv.ia~.on ;I:PTIC. TANK $~ ze~ ~ Q ga~.2ane r---------- ~caxance (nom: Wex~. ,~?j ~~ H~,ghwa.ten '~ `uMPING CHAMBER Bu~.~d~.ng l ~ l 2 $ a .ape. ~-- S~.ze ~a~~on4 _..Pu.mp ManuSae.tune~ ~ Mader Number ~~LD1NG TANK S~.ze ga.Q.Q,ana N~umben a~ Campanxmen.ta ~• Pumper '~ A~aKm Sya•tem ~ia~tance bnom:. We~,Q H~.g hw a.ten__^___^___ (iSORPTION SITE Bu~..~d~.ng ~ 12~ agape. Bed_ ~ ' . 7nench <a~t,anee 6n.am: We~~.~ ~ But~d4ng ~ .~~ t2$ a~.ape N~.ghwa.ten (iSORPTION SITE DIMENSIONS W~.d.th a ~ ~tnench ~ ~ ~,~ Length a ~ each ~~,ne ~ ~ S.t Numbers a~ ~~.ne4 ~ .~, 7ota.Q~ ~eng.th a6 ~~.nea n ~• 6~ D~.a ~tarice between ~~.nea ~ 6~ 1 v { uA uLa uh~,.t~,urt anew, ,'~ ~.t '1T UIMFNSIONS~ Numb e n a (~ p.f.,~e ~Uu~ta.~.de d~,ame~ten Requ~n.ed aKea ~ l~~_` ___6x Depxli a ~ no eh b exaw .t~.xe / .cn Depth u~ Hach aver .t~i.xe___~,___,~.n. Depth u 6 .t~,~.e b eYaw gnade,~ _~,.i.n S.Eope. a ~ ~n.eneh~~,n . pe.h 100 ~x Type a ~ Coven: Paper o e •tn.~aw Gnave.E aaound p~..te yea nu 6x Depth be~aw tin~e.t Tu•tax abaonp.t~.an area b.t .Area n.equ~.xe:/d _ ~~ NSPECTED• BV J ~~. `~ ~l'PROVED ~'~~ '[ JECTED Numb en o ~ eampan.tmen•ta ~x TITLE _ ~,LL.~ DATE t 19 k_ DATE ~ !9K '3°1 REPORT OF-- INSP-ECTION - INDIVIDUAL SEWAGE SVSTLM S art i tan y P e n in.i.,t. 5-.5— State Septic 9 f j- �. aAM / ,,_, Townehip S-t. Cko€x County ()cation /V l Se Section 7 Lot a 4/ Subd.ivJe-ton ,1-PTIC TANK Size .10,0 0 . • ga.l.l'one Numbers 06 e0mpantmente i . )ietance 640m: Wett . `37 buitaing / 12% 4tope Htighwaten ' , 'LIMPING CHAMBER Size yattona _. .Pump Manu6 n actuen Mudea Numbers /OLDING TANK , Size gattone Numb en 06 Compan.tmento .. Pumpers. Atanm Syetem ' ietance 64.om: Welt Bu.itd.ing 12% e.Eope H.Lghwaten IiSORPTION SITE Bed I ' , Tench ( etance 6nom: Welt 5?) * Bui.Iding 096J t 2% 4tope H.ighwaten ,BSORPT1ON SITE DIMENSIONS Width 06 tench / 7. " 6t Requ.ined area ln,f ---- 6t Length 06 each tLvie LI Co 6t Depth 06 /Loch betow t-ite / (.n Numb en 06 E.i,ne4 ,Z, Depth u 6 /Loch oven t.ite _�, ,_ _tin TO ta.e 1 ength u 6 tinee . . 6t Depth o 6 t to below gnade .7 li> 4.n Die tartce between tinee Gi 6.t Slope 06 tnench "2 _ .I.n . pen 100 6t 104 ,< <(L4U/lJtcun anew 4'- ' ,- , 1 � ��' 6t Type 06 Covers: Pape.n oh' etnaw AIT DIMENSIONS , Nurnben 06 pits .Gravel around p4.te yee no Outer de di ameten 6t Depth below .intet 6t To tat abeonpt.ion area 6t ' ,Anea /equined 6t N S P E C T E D By a,,,�-r; rtiltAIn� TITL (-7 IMPROVED DATE // -0 R9 19 8 't JE CTED DATE 19 8 'IASON FOR REJECTION de,04.$0 Gt<AJ; se-A4/' 4 _-ge,. ,- e-sz ,td_to,6 itasNytet/e, .. .._ w....__._.....__. .............. _. ....... ...... •M......o... . ', _ •.w .�00�. 1851 1) Name and Address o REPORT ON INSPECTION OF SANITARY PERMIT # ~ 9~5' t Holder Person/Persons at Site ~(2)Date of Inspection , IIVVI GJJ, LI\. GIIJG 1\V• r Time of Inspection ;~L~,. .~ ~~Y/ 3 INST TION ONSISTS OF: ^ Septic Tank ^ Seepage Trench ^ Dosing Chamber ^ Seepage Pit ^ Seepage Bed ^ Holding Tank ^ Fill System ermanen re erence oin escri e: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to we~}1: (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower brand name of pump and model number Is the warning device installed? ^ YES ^ NO Wired? ^ YES ^ NO 8 HOLDING TANK: Manufacturer o ga ons ; construction depth to the cover ft; If septic tank is being used are baffles removed? YES ^ N0; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ^ YES ^ N0; Wired? ^ YES ^ N0; Locking device on cover? ^ YES ^ N0; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; t he depth.;. lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEP E EN H: Total length of seepage trench ft; width ft; t he depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ^ YES ^ NO (13) Has system been installed in floodway? ^ YES ^ NO Floodplain? ^ YES ^ NO DILHR-SBD-6095(N.05/80 Signature of Inspector: ' ' 'p LB k 6 7 , , ��� ,i State and County State Permit # /9a2`� I niiiPT Permit Application County Permit # �6 � . .E,- i ��� ( for Private Domestic Sewage Systems County C-1-4--i-1/ *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: 5 4 tii A if(iir 1-/ uI5 h lA-/t'S B. LOCATION: it/(N'/4 5- V4, Section 7 , T,2q N, R 1 / i (or) Lot# '___(.___City Subdivision Name, nearest road, lake or landmark Blk# Village R {c ,1 ' 61 yr Township H qat GPI C. TYPE OF OCCUPANCY: *Commercial *Industrial - *Other (specify) *Variance Single family ✓ Duplex No. of Bedrooms 3 No. of Persons D. SEPTIC TANK CAPACITY 1 6 G 0 Total gallons No. of tanks I HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete ✓ Poured-in-Place Steel Fiberglass Other (specify) New Installation —' Replacement _ Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENDISPOSAL SYSTEM: Percolation Rate Total Absorb Area—C-1 sq. ft. New T.. Replacement Alternate (Specify) Seepage Trench: No. of al Ft.- Width Depth Tile depth (top) No.of Trenches Seepage Bed: V Length 7k Width l Depth i.Z Tile depth (top) 3 Q No. of Lines Seepage Pit: Inside diameter Liquid Depth No.of Seepage Pits Percent slope of land� 7 7" Distance from critical slope / WATER SUPPLY: Private L��S Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil T,/�ster, NAME pi C '1 i1 !5 /" C l7 r r 5 fop/j ,,y n i C.S.T. # 5-4- -j - !g ?and other information obtained from 5 c ./l l C 0 n / (ower ner/buil e+),,.{{�� _ s� Plumber's Signature MP/m PRSW# /"1 , _ 5 Ir 32-phone #2f 7 32 3/ Plumber's Address • n 44/ t - A? a<7 cf Le/;l PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20.Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. I �_ _�� ii . I &ir(I( at "= '. / /I/: t/v. 7: ,74 5 /0 �, '. S y 5 to A v,„ ti '4\ lim-wir61;>1' <>.(.... ,,.- 5 effie- 4ies ` ter. . i;c r: !IA. A To( _et LerS/fig-k� Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY C / - /06'' Date of Application //-/74O Fees Paid: State `'/ , Wit' County c2/• o-c' Dat -/ - d Permit Issued/Rejected (date) //-/ 7 -,4?O Issuing Agent Name f4 Inspection Yes A No State Valid# Date Rec'd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 EH 115 Rev.9/78 q, 7 a 'REPORT ON SOIL BORINGS ANG-PERCOLATION TESTS ie,„ . .6WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES h IfP.O. BOX 309,MADISON,WISCONSIN 53701 yO (' LOCATION:/`' /4,SG '/4,Section 7 ",TAT?N,R/ / i (or 1�Township or Municipality �j�-G� ¢fir' ���� ® , NI Lot No. � t,Y, Block No. 4/€ i® I -- County fi' C)-4' S/�� `�! Subdivision Name ( / ��� Owner's/Buyers Name: 'i r Mailing Address: OLA-I P/� cti '/` 0k X(1• ilk,s/s"Au j �G^S, �4"/{c/ TYPE OF OCCUPANCY: Residence ^ No. of Bedrooms 3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS !/S 80 PERCOLATION `g TESTS � 7 f/� ob / / SOIL MAP SHEET V? NAME OF SOIL MAP UNIT 40 , Li ' / 6, '/�^o '4'L PERCOLATION TESTS HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES TEST DEPTH CHARACTER OF SOIL RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- I 52" .S-Ae- note A/4L /� //v 4( 3% 3Y �// P-2- -Gill', Sa�e gore /24/4 IA— /�o 02 VL 2/ /' O 02 - P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- i ,‘ " ,max- 7n 6„ ad- /%.,Y 'L/ IY"SL/ Q•'/s., 6+-., 2"5 6/ B- 2. 76 ' / « //u x C /v« Sk te "AS14, o". t6 . B- 3 n" / tic14— > Y6'' 6-I--5/ ?" /fa/ )" s4.,-6r# 7"%s .-.(07"Sd-66 B- / 96„ �, , "n" Fp.•t� io'. //u ' J /3-''54 02 l' 5LC*Gr•., 02/"5 NL 6 -, B- 5-- %'' /�t�,t(� 7<<c.�'�"'� F'1 yam' /� B i, eti�t /V•, ,S�(., 30` 51.°1-CTi",J ,36c''5+t}Otr, 6 't - B- IC - `r Aka 6c ti, !fVciSI4/ sa '. _s4-6I, PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy ae/ca, /�,3oA ndicate scale or distances. Give horizontal and vertical reference points. Indica e slopeA Sl:AO 4/e A 44- / 1 --r r-- 71 / x kt- core_ Pere_ / l ez.= /0'6..(' Gt11`�" / Orel) GrL rt z ie6 ' \ I7 R�IG�- II i 3 _ e1_- /c y' \ y �4- /C 7' \41.---4/14 kt "4- h)'Ore e 4( o \� � E/= /c^� 445: 4.i,e_ cs \ -• 1 �_ 6(c e /v.3 ' a i IN I I 7%a s/c)( '‘TOe \ __ i /'J rY 514*-- nr zq S s L+, 0 \ / ,.� _ l x S� e.tic 1,1_.�I l ,4 Her LI fel2- 4.r 44 7-o e: y 0 0.0 00 3 vk I I c J— iI'. rs h-//, 'rc ', , . 2. I Iii. s--V C'r.l �O O \ I I 1 6 P I ' \ as � �� Y�' a \ � . f j .ec M Li Li _ _I . _ r 1_ _ 1 ;_ Top P,��� zo eke :(,,/Qo' I,the undersigend,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and location of test holes are correct to the best of my knowledge and belief. 1 I C/C� j .PM a r ,,, To/Ier. Certification No. 's'�' /S / / Name (print) SgQ� Address //� �F}urQi/ f9 d e. cdiko j ,s , Ga Name of installer if known Copy A—Local Authority CST Signatur ___a „ . ~. i1 1~•~r. ' .,,,i,y~wrn ~y~ - """ ,.ti _.~ ~~ "',~,~ ~~. ~"~`` _ ~ •~ ~`t~ ~,. ~ x o ~. h ~ +~w~- ,1,j ,~C c ~. ~. ~, ~ .~.. . _ _.. _ ,~ ~~•`. ~...~ ~. ` '~ ~I i ~~~ ~- ~ ~ . - ~> 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)]. ermit Holder's Name: City Village X Township Dlson, Rolland Hudson Townshi ST BM Elev: Insp. BM Elev; BM Description: ,~dr~ 'DAttC IAIF~IRMATI(lAl CI C\/ATIAAI 1'1ATA TYPE MANUFACT ER- CAPACITY eptic ,~ Dosing ~'-'/Dv Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic , J / ~j ~ „ , `~ L~' ~~ Dosing ~~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand ~ GPM Model Number ~~ 3°1-~ J TDH Lift ~ Friction Loss System( d k ~ TDH Ft ro • • (ps /~ A ~ Forcemain Le r, Dia. ~~ Di t. to Well , ~ SOIL ABSORPTION SYSTEM BEr D/TRENCH Width ~ I + Lengl DIMENSIONS SETBACK SYSTEM TO ' INFORMATION Type Of System: D TRIBUTION SYSTEM •~ / county: St. Croix Sanitary Permit No: 420573 0 State Plan ID No: /~" Parcel Tax No: 020-1125-90-000 STATION BS HI FS ELEV. Benchmar~ ~j ~'Vt' L ~-P ~' ~ /a~` / O / ` Alt. BM 7 ~ q~- a~ Bldg. S wer 3x ~ ~ 9y_ ~ SiJt.~t ~ ~Z y. 9 ~ SUHt Outlet .~ Dt Inlet ~~ Dt Bottom Header/nn~ z~;.~ ~ ~~~ ~~ - ~3 ~s 99 Dist. Pipe ~4-~ a z ~•Z ti~`3 Bot. Systen~~,n r- Z ?~ Final Grade p, z St Cover C ~ CHAMBER O `~" ~ ~ Mode! Number: r./ -i,. ~~ e~ h011 Gl2S J D.uo~ yr fV<1o..... ..I. Header! ' o d t I Distribution Pipes} / "~ ~, ~t~ ~~ ~ x Hole Siz~e,~° ~ / v~ x Hole Spacin Dia i Length ~/ Dia Spacing SOIL COVES---j~ ~ ~-e~(~r~nly xx Mound Or At-Grade Systems Only VeQnt to r Intake / ~ 6 c ,~r/na nc Pi.. .L' s ..1 Depth Over ~, o,~/ Depth Over xx Depth of xx Seeded/Sodded xx M hed Bed/Trench Center ~ (/(~`'"" Bed/Trench Edges Topsoil Yes ~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ l3 / OZ Inspection #2: / / Location: 396 Krattley Lane Hudson, WI 54016 (NW 1/4 NE 1!4 7 T29N R19W) Eagle Ridge Lot 4 Parcel No: 07.29.19.575 1.) Alt BM Description = ~~~~~ ~S~~Z~~ ,~ p~ i ~Q~~ /~ f~J ~ ~~n~ 2.) Bldg sewer length = .L..,,,,r !, ~~__ ~ ®. ~T ~a~~' ~-..~~c~a~8/ (/~ "~ S~"~~ i/np~,,/ -amount of cover =~~~ L L ~ ~ J~~`~~" DR46r.~_ d"~O~' 4 n Yes L"~VO ~~ 0 a 2, G~%~~~ _~-~-: Use otherls de for add tional information. !! ~~~! I If ~p SBD-6710 (R.3/97) Date Insepctor's Si nature Sanitary Permit Application Safety & Buildings Division ~ to accord with Cotnm 83.21, Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 .. ~~ ~ ~ Sec reverse side for instructions for completing this application Madison, W [ 53707-7302 ~~+~n+ . ~' Oeprnrtment of Commerce Personal information you provide may be used for secondary purposes [privacy Law, s. 15.04(1)(m)] ~ (Submit completed form to county if not Z.-pt 11 d 3 3 state owned. Attach tom Icte lans to the coon co onl for the stem, on a er not less than 8-1/2 x l 1 inches in size. ~~h, State Pe it ber ^ Chock if revision to previous application State Plan [. D. Number I. A lication Information -Please Print all Informatio ~ ° '";:' °' Location: ~ ~ ~ Property Location Pro Own Name ~ O/S'0-yl ' a ' /4 l/4, S T,G,/,N, R or W ~ Property Owner's Mailing Address ., Lot Number Block Number City, State Zip Code )?~ ~, ~, 3~ Subdivision Name or CSM Number ~ ~f ~Sor, c.~7/, S yDi 6 - ,218 a /e II. ape of Buil ing: (check one) ' of Bedrooms :~ - No Dwellin il 2 F p City • ^ Village ~ f B . g y am t or ^ public/Commercial (describe use):_ wn o ~~Spy7 ^ State-0wned Nearest Road ~/ // ~ ~) ~ ~ k(o Z~SO S parcel Tax Number(s) O.zo- 2 D-~ III. T e of Permit: Cher online A. Check box on line B if a licable 5 6. ^ Addition to A) 1• ^ New placement 3. ^ Replacement of 4. Existin S stem S stem S stem Tank Onl Permit Number Date Issued $) ^ A Sani Permit was reviousl issued N. T e of POWT System: (Check all that apply 'lE, ~ `-I~ ^ Sand Filter ^ Constructed Wetland on-pressurized In-ground ^ Mound ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At- de ^ Aerobic Treatment Unit ^ Recirculatin ^ Other: V. Dis ersal/Treatment Area Information: ~ 3/ / C2, s //"b.c [~' u c~a,,, Percolation Rate 5 ~ r : a„~s 30C/w.~~+ar's .System Elevation 7. Final Grade . 4. Soil Application 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal y q tnJinch) Required Proposed Rate (t;,alsJda /s . R.} (M' Elevation ~ ~ z s q~s~ - y8, sn 9S/ d. 9~ 933 o• S d /1 S-O „ . VII. Tank Cap city in Total # of anufac rer Prefab Con- Site Steel Fiber- Plastic Con- glass Information Gallons Gallons Tanks ,~ Crete s trutted New Existing Tanks Tanks ^ ^ ^ ^ 5 "~ / ~ /, ct~d ~, ~ ~ cJ;es.~ wr~.s~~ ^ ~ ^ ^ ^ /o sco - s~ l cv;«~ VIII. Responsibility Statement assume res nsibili for installation of the POWTS shown on the attached laps. the undersi ed I siness l'::one T:umbcr B , , Plumber's Name (print) Pl Si lure ps MPMIPRS No. ~ ~~~ ~s0~3 ~ u ~7~s 3~r~ -~~9a Plumbers Address (Strcet, City, State, Zi e) IX. County/Department Use Only ^ Disapproved Sanitary Pemrit Fee (Includes Groundwater Date Issued ui Agent Signature o stamps) `Approved ^ Owner Given Initial Adverse Surcharge Fce) ~ ~~. ~//~/~ ~ ! Determination ~ ~Q rt~ditio f Approval /Reasons for isapproval: t X. ~ ~ ~ ~ vim' cJ~-R.A.( A''"`^""."` .- - -~<< ~~c~ ~ ~ ~ ~ , 2°~ a.nc.h~~: uaztauazta off' sra,~q assu.•~cd eXisriny 3 b.r~lrw~ res~dtdHC e... ~ , b. T ~ ~~ wQ, It c:a.s ,~ , _ t,~ l( ~~\~ ,Cradle y ~~ ~.~. ..,. ~~ 3 b~~ EX~S~i ;0~0 ~~. ~~ ~- o a°~`~ ~, Pro pOscal ; tZ~fscO 80.0. C~,,,bA,a~~S,T./f~C. ~','16~a~ S.Toc~tkt a• q~°' v8.° 30 ~ ^ 6~_ i 3~rinckts af,3/'yxG3.s' 396 ~'/a.f~/ey ~+~C /off ~6 1~/a~ o•f' T . o{'~{ad s an, lj~. C~i/c Co., ~/. ^ 3al ¢(K1~4a~ion p;t ,, ~,, s~.te: / ~'kis fi~ o%s,o~isaa / cc// ~ Lc ' /'.c cam ec~/w,/ ~ `P. /. C. 6kll-~u.n /~.//e. E di~CC~ a.E iz'x sz'. S~s-E..... e l.e.~ =9.~t~o' toad Be--~~~,~: ao-ao-~ oF' Sid; ~{ SS c~.•+tct e lei/:. rao. Qo' e,~sf~•~ 3 6~l~wr., res~d~HCe„ 0 ~ . b. To we tl ca.s,~ , cue t( ~~~~ ~ia~le y ~ ~r-e /3~ ~~/ /EX/S~F.i ;ado ~c- ~ ~Oi~ Q W ~4a. ~ian p;t ~~ ~ '~ ~~~ e: / e7r~s~'~ o(,s,o~isQ / cc// ~ Lc - r{cam ec~cd~yr ~'"P./.c. 6k/I-~k.n /c-l/e. Ejc f5~i nc d i~•rSuP Ce~ aE iz'x Si'. Sys{~•r• a (~,tr =9.3.fXO' 8~ 91 °~ 98. ~- ^ Qom. /~~ /~ o ~~ B~ ~ Pro po.se_d 1, ce~fs~ moo, e~6,7~a~~5,T./14C. w/~a~~/~-/!JO P{~/Car ~'~'lEvat S.Tou.{-Icf ~ ~~ 3 ~{re n ekes cL,~,3' x Gas' u S;n~30 do ~; f~'u sei / /ta t~i C/~aml~is ~? //aLr,d O/so» 396 ~ra.~L~ey ~ - /o~ ~6 1~/a~ o{' . o{'Hu.d s on, r ~~f Z6 s~-3 Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8%: x f 1 inches in size. Plan must include, but not limited to: vertical and horizontal reference pant (BM), direction and Parcel 1 D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Please pri °° R Personal information you provide may used fo ~cy Law, .15.04 (1) (m)). Property Owner Property Location 6 1575 page 1 of 4 A.C.E. Sal 8~ Site Evaluations St. Croix 1125-90-000 ~~ Z~' « S~$ -/~. , Date Rolland Olson l~v1J ~ ~ 2~~~ Govt. Lot NW 1/4 SE 1/4 S 7 T 29 N R 19 W Property Ovvner's Mailing Address Lot # Block # Subd. Name a CSM# 396 Krattley Lane ST. Ci~.oix Court r v 46 Eagle Ridge City Stye ~ City Vllage Town Nearest Road Hudson ~ WI 54016 715-497-4298 Hudson Krattley Ln. 8~ Miller Road __I New Construction Use: Residential /Number of bedrooms 3" }~ Replacement Public or commercial -Describe: Parent material Glacial oufinrash General comments and recommendations: Install three trenches at 94.50' using 30 leach chambers. Code derived design flow rate 450 GPD Flood plain elevation, if applicable na ly;~ /l/3 Ul zcrb ~Z~ Bonng # ~ ~~ L/j Pit Ground Surface elev. 97.34 ft. Depth to limiting factor ~94~~ in• Soil Applicetion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIftZ *EtT#1 *Eff#2 1 0-6 10yr3/2 none sil 2fcr mvfr as 2f 0.5 0.8 2 6-25 10yr5/4 none sil 2fsbk mvfr cw 1f 0.5 0.8 3 25-42 7.5yr4/4 none sl 2msbk mfi aw - 0.5 0.9 4 42-94 10yr5l6 none trat.s&g 0 sg ml - - 0.7 1.2 Y Gravel content of H#4 is appro~dmatley 10°x. Sal is moist at 94", indicating a restrictive layer below. Boring # -_:( Boring Pit Ground Surface elev. 98.13 ft. " !!~ Depth to limiting factor >g in• Sal Application Rate Horizon Depth Dominant Caor Redox Description Texture Structure Consistence Boundary Roots GP D/ftz *Eff#1 *Eff#2 1 0-7 10yr3/2 none sil 2fcr mvfr as 2f 0.5 0.8 2 7-25 10yr5/4 none sil 2fsbk mvfr cw 1f 0.5 0.8 3 25-34 7.5yr4/4 none sl 2msbk mfi aw - 0.5 0.9 4 34-42 10yr5/6 none Is & gr 0 sg ml gw - 0.7 1.2 5 42-90 10yr5/3 none trat.s&g 0 sg ml - - 0.7 1.2 Redox concentration observed within 3" high x 6" sr nodule at 56". Redox feature is due to greater metric poterrtial of sil within the coarser s & gr. and r not indicative of high gramdwater. * Effluent #1 = BOD 5> 30 <_ 220 mg/L and TES >30 < 150 * i'12 =GODS < 30 mglL and TSS <30 mg/L CST Name (Please Print) Sign2ture: -- CST Number James K. Thompson - ~ ~ 5__ 3602 Address A.C.E. Soil 8 Site Evaluations ate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceaa, WI 54020 8/9/02 715-248-7767 __ Property Owner Rolland Olson Parcel ID # 020-1125-90-000 Page 2 of 4 t~~ Bering 3 Bonng # 98.93 ft. Depth to limiti factor >92" in. Pit Ground Surface el~r. _ ~ Soil Application Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots p *Eff#1 *Eff#2 1 0-12 10yr3/2 none sil 2fcr mvfr as 2f 0.5 0.8 2 12-40 10yr5/4 none sil 2fsbk mvfr cw 1f 0.5 0.8 3 40-52 7.5yr4/4 none sl 2msbk mfi aw - 0.5 0.9 4 52-92 10yr5/6 none strat.s&g 0 sg ml - - 0.7 1.2 1"thick band of 2fsbk 10yr4/4 sl observed at 89". ^ 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 *Eff#1 *Eff#2 ~~ # ~ Borng ;, Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 * Effluent #1 = BOD ~ 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 T"I'Y 608-264-8777. SOIL AND SI~`~ EVALUATION 1575 Page ~ of 4 PROPERTY OWNER: Rolland Olson PARCEL I.D.# 020-1125-90-000 A.C.E. Soil & Site Evaluations REPORT MEMO Existing septic tank must be inspected to verify capacity & structural stability. Effluent filter must be added downstream of septic tank outlet. Dose chamber with pump required to reach replacement sytem elevation. Install bull-run valve after effluent filter to allow future use of hydrollically failed system. r ~~ r1,~ler 2o0.d e C. ao ~` s~a.^y, ,gss~..~cd e l ev` = rao. c7o' 1 e,~su-~ 3 6~l~c~~ !'c 5 r of c-H c.e, , 0 It . ~. .: T o WQ.~~ CC~Srrlq. ~21~ Ele.~l` _ /Oi. a2' \\ i~ ~ra~ le y \~ ~a,~e ~3~ ~`~~ ~EZ~s-~ /,ooo ~~~ -~- a°~`~ EX~yE; nc~ d;5pe.~5 ^ a` Q1o, 98. ^ Q ~- ~ //~,d O/sue 396 ~'ra.~/ey ~•C, /oz` ~ 1~/ate o-F' T . °~'~" ~s ten, lj~. C/t~i~c ~'o; ~..~/. .~~- ~e~ ~ /S7S ^ ~o;J ¢~czJc.ca~~o~ p,t ~~ ~. ~~y I^ ~'v~^"44 ~..uPa' ~ ~f rec.-et`~w" Ca ~SinfL ~t ~ C !'"' w.fa roc'R,~ ~S c~{~ `~ 1575 -- J''''/' ALUAT T '- o,,,~u:.~l P~ge t of 4 Wisconsin De artment of Commerce - --- Division of Safety and Buildings ~ in wr htComm 85, Wi .Adm. Code b,e.. ~- "O a & Site Eva nations ~"" ounty Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan ust ' St. Croix _ --- -- - nand include, but not limited to: vertical and horizontal reference point (BM), direct _ _____ D Parcel I _ percent slope, scale or dimemsions, north arrow, and location and distance o nearest road. . . 020-1125-90-000 - - - _- Please print all information. ewed gy -- - Date Personal information you provide may be used for secondary purposes (Priv Law, s. 15.04 (1) (m)). 2x.-.~M. l / ~ ~ Property Owner Property Location Rolland Olson Govt. Lot NW 1/4 SE 1 --- - --- /4 S 7 T 29 N R 19 W __ _~~------- 9 - --- -- Pr Owner's Mailin Address O r - Lot # Block # i Subd. Name or CSM# 396 Krattley Lane 46 Eagle Rid e City State Zip Code Ph umber ~ City J Vllage t!, Town Nearest Road Hudson ~ WI 54016 i 715-497 8 Hudson Krattley Ln. & Miller Road _f New Construction Use: ~/ Residential /Number of bedrooms 3 Code derived design flow rate 4~u ~ru 1-/ Replacement J Public or commercial -Describe: Parent material Glacial outwash __ __ Flood lain elevation, if livable P aPP na ------------------ General comments and recommendations: Install three trenches at 94.50' using 30 leach c hambers. Boring # J Boring ft 34 ?94~~ in lication Rate Soil A 1J/ - - . .___ Pit Ground Surface elev. 97. Depth to --- --- . limiting factor _- pp Horizon Depth Dominant Color Redox Description ! Texture ~ Structure Consistence ~ Boundary Roots ~ ' _- -__- GPDIft? _ - _ __.. `Eff#1 `Eff#2 1 _ 0-6 ~ ' 10yr3/2 none ~ srl 2fcr mvfr as~ 2f 0.5 0.8 - __ _ -_ _ - _. --~----. ------- --- -- 2 6 25 I 10yr5/4 ~ none sil 2fsbk I mutt ', cw 1 f ', 0.5 0.8 3 25-42` 7.5 r4/4 none sl 2msbk mfi aw 0 5 0.9 4 42 94 - -- -- -f '--- 10 r5/6 -T-- --_ none -- fitrat. & _~ Y 9 ----------- --_0 s ' 9 _ i_--- ml - r -- _ __~ ~-- i 0.7 1.2 ; -------r --__-_ _.. ~ 94 +~/ ~ ' ' 3'~ -oY }3 - ~' _'~ _. ' - _ -- I is Gravel content of H#4 is rowmatley 10% Soi moist at 94 9. _- ~ ', indicatin a restrictive I below. Boring # J Boring _-- _ - - 1/ Pit Ground Surface elev. 98.13 ft. Depth to limiting factor _ ~90~~ in. Soil Application Rate Horizon De th ! Dominant Color Redox Descri tion Texture Structure Consistence Boundary Roots GPDIft= _ p P ~ I *Eif#1 *Eff#2 1 0 7 10yr'3/2 none sil 2fcr - mvfr as ! 2f 0.5 0.8 _ _ _ - __ _ -~---- - - + -__ _ i----- - _ - - -- ---- fi ----- ~ --- -- - - i !- ---- i none sit ~ 2fsbk I mutt ~ cw ~ 1 f ~ 0.5 0.8 2 7 25 10yr5/4 _ ,_ - --_ ---I - - ~ -- fi - - ,- ,- -- --- - - -- -- 3 25 34 7 5yr4/4 none sl 2msbk i mfi ~ aw !i 0.5 0.9 4 34-42 - 10yr5/6 _ - none r Is gr}, 0. sg -i ml gw 1 - 0.7 1.2 . I -r _ _ _ 5 42-90 10 r5/3 none strat s, 0 s ml i - ~- -Y- -------r ---- ___ __ ~ -- -`-g~ --- ---9 ;Z-~ ---- ~-- - 0.7 1.2 `~ ~ Qom- --- ----- --- - - -~- - _ -- ~{b ~Sfr~,~f~, --- ---'_ R~~. feature is due to renter matnc otential of s' -- _-- __ - -'- ------ _- it wthin the coarser s ' Redox. concentration observed within 3" high x 6 wide sfft loam nodule at 9 P &,gr--and,is not indicative of high groundwater. ' Effluent #1 = BOD s> 30 <_ 220 mg/L and TSS > < mg/ ' ffluent #2 = BODS < 30 mg/L and TSS <30 mg/L GST Name (Please Print) Sign re: CST Number James K. Thompson 3602 Address A.C.E. Sal & Site Evaluations D valuation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 540 715-248-7767 ~ Property Owner f~olland Olson_ _ _ a Boring # J Boring 1/ Pit _ Parcel ID # ..020-1125-90-000 __ -__-_ ___ -_ Ground Surface elev. __. -._9893.__.... ft. Depth to limiting factor _ >92" in. Page _ ? of -_ 4 Soil Application Rate Horizon Depth Dominant Color i Redox Description Texture i, Structure ~ Consistence !: Boundary I Roots '; S~PQIft'_-. _- 'Eff#1 `Eff#2 1 0-12 ', 10yr3/2 ~; _ sil none ~ _ __- I 2fcr t mvfr I, __ as -~ 2f i 0.5 - .__ _ 0.8 _ _ 2 12-210 T . 10yr5/4 - ! none sil ~i _, . _ - ~- - - __ __ 2fsbk --_ -- - I~ mvfr i , -r __ cw ~ 1f 0.5 0.8 _ 3 _ __ 40-52 __ _.- --- 7.5 r4/4 y ~ - ~ none y sl !; 2msbk -_ mfi aw ~'~, _ ;_ - 0.5 0.9 _ 4 52 92 -- -- - 10 r5/6 - - -- y - none I,strat.s8~ ~ 9~ fi - - - ------ -- -~ -- - ---- 0 sg -- --- i ' m l I -!- -- - - -~-- -- -~ 0.7 -- - - 1.2 -- - ~ ~ ~ i i ._-- - -- -- - ------- - ~ G ~4'[V~ :L~'~ -- -} - -- , _ i r --- -- - 1 ~ -- - - - -{--- -- - -}------ - i ---- -- -~--- --- -1-- ------ ---- i ~ - --- ~- --...------~ ----- - _ _- - - 1"thick band of 2fsbk 1l)yr4l4 sl observed at 89" ~~ .. I Bnrina "`""'y ° ft. Depth to limitin tactor in. Pit Ground Surface elev. g _.__- ___- Soil Application Rate Horizon Depth Dominant Color ~ Redox Description I Texture Structure ~, Consistence Boundary Roots ~PDIft2_. - _ ', 'Eff#1 `Eff#2 ', I ' I I ~ T i II '~ T"- __._---Y _. _.___ .__._..___...__.. ''.. ~~ ^ Boring # ~ Boring ~ Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ', Depth Dominant Color Redox Description ; Texture Structure I Consistence ~ Boundary i Roots ,____SPI?Ift~~_- .~~,., ' Effluent #1 = BOD S> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employee [f 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. ' ~ SOIL AND SITE EVAh,UATION 1575 Page _____ of _a PROPERTY OWNER: Rolland Olson PARCEL I.D.# _020-1.125-90-00o A.C.E. Soil & Site Evaluations REPORT MEMO Existing septic tank must be inspected to verify capacity & structurdl st bility. Effluent filter must be added downstream of septic tank outlet. Dose chamber with pump required to reach replacement sytem elevation. Install bull-run valve after effluent filter to allow future use of hydrollically failed system. r~; I ler 20~ penc.h yV~p.r,(~: pauah, aF' S.d. , ASsu.„cd ele% -~ao,G~' exs~~~ 3 6.~d~c~..., r~s~d~NCe,, 0 ~.b. .~ To wQ, It cc~.s , rx~ . cue t! El~v~- = /oi, 02' ~~ ~+. l~~e /3~ b`~/ ~e~ '~ /S7s ~ foil ¢Uct~~.caEion P ~'t ,. ~, ~e : ~ - l ~ c ~ ; ~ d; ~ cer(X Ez~s~ ,laoo X~sE ~ sPe~ , ~'~~ ~~ a~ iz'x sz'. SYS-E.=-.r. e l.e~ ~9.3.s~o f~a-n ^\\1~ • a°~`~ a+ ^ ^ a~ ~" 91 ~, 98. ~ ~?i/~,d o/S~ 3961~'/a.-fey ~c . ~ot ~~ 1~~xt off' 5~. c~;x ~; ~~. ~. ~~y I^ B3 „°1~ , Wisconsin Departrnent of Industry, SOIL AND SITE EVALUATION REPORT Page ~ of ~. Labor and Human Relations ~.--..-.y. Division of Safety ~ Buildings In aCCOrd with ILHR 83.05, )p/1'~ ~•~i • ~,• ~ - ~~~~' ~~ COUNTY °~, ~ .-,. 'Attach complete site plan on paper not less than 8 1/2 x 11 inches in siz mus~ncly~e, but '-~~~- not limited to vertical and horizontal reference point (BM), direction an slo t~~2`k~;pt `a~- ~1RCEL LD. # p dimensioned, north arrow, and location and distance to nearest road. ~E•r~'" °~" ,,.~ Q a a~J ~' !~ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMA FO - ? fl~1lIEWEDBY DATE o~~ `~ _,~ PROPERTY OWNER: PROPER'F'~L,pCd-110N ~;,°'t ~s- ~ ,~, VT l.Q~, ,.. f/4 , ' 1/4,S T ~ ,N,R ' $(!r) W PROPERTY OWNER':S MAILING ADDRESS .~LFIeT~ ~, .BLS?GK•#; •S~UBf7. NAME OR CSM # (•757 ~?/a, ~- Addition to existin buildin '" """ [ J New Construction Use jx] Residential / Number of bedrooms [ ] 9 9 j)C] Replacement [ ] Public or commeraal describe Code derived daily flow gpd Recommended design loading rate , 3 bed, gpd/ft2 -'~ trench, gpd/ft2 Absorption area required~O bed, ft2 trench, ft2 Maximum design Ipading rate ~_bed, gpd/ft2. S trench, gpd/ft2 Recommended infiltration surface elevations r-o`~•• t]5'c' scit~ bOf ~mc~.S ~ i ~/ ~ (aS referred to site plan benchmark) Additional design /site considerations ~• ~~ -- Parent material dot c~ C~ c~ `~ t1 V ~--~_ _ Flood plain elevation, if applicable ~IL~ ft . S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FlLL HOLDING TANK U =Unsuitable fors stem ^ S ~•U ~ S ,C~ U ^ S ~ U ^ S 1~ U ^ S ~U ^ S ~.U SOIL DESCRIPTION REPORT - Boring # :~~: "~ ;: ~"si ~i~.XS.tx..w~. Ground elm ft. Depth to limiting z9 r, Boring # .t`,v:.. <-~ 2..~ ;~ri :# ~,.,: ~..K:. Ground elev. ft. Depth to limiting factor Depth Dominant Color Mottles r T t Structure Consistence Bour>dar Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color e ex u Gr. Sz. Sh. y Bed ranch ~ ~ ~~ ,e ~/ S o ~~ s ~~ ,~s ~ . ? . 8 ~ -1Q ~ ~2 ~ ~ C~ ~ a ~© s- Yrl ,~ -- Remarks: ~ (~C'l°llsl6rll ~ DN~,()ElS . a er ~ ~' v' y ~~ ~ s :~~ i 6~~ ~ ~o ~ '~ .~ Remarks: - CST Name: Please Prir~t~~o L _ ~ ~- S Phone: ~~s. _ / g a3 ddress: '~~ CS 11~~~ , (.m' /p~.~ 5~.. Y<~C' I.SC . /~~0~ !o Signature~ct~~Jril~ ~~ -- ~~~/o?o? /9 ~N'~~~ PROPERTY OWNER~otCXtnn~ q'SCM SOIL DESCRIPTION REPORT PARCEL LD. # Q~?L? ' ~~o2S ._ 9t~ Boring #~ ~:-. •~ Ground elev3 ~... ft• Depth to limiting fac or t~ Boring # ~~ Ground elev: fL Depth to limiting '" • factor Boring # ~~~ A~; .~:~ {~ Ground el ~n Depth to limiting fac~3 t, Boring # Y ~;.s e .~% Ground elev. ft. Depth to limiting factor Page ~ of !~_ Depth Dominant Color Mottles -T t Structure Consistence Bandar Roots GPD/ft Horizon. in. Munsell Qu. Sz. ConL Color ex ure Gr. Sz. Sh. y Bed Trends ~ o~S 0 3i~ s,l z-Fs k 2 .~ 3-F os .~ .3 ~b,~y ~,5 S/ to ~, I rn sbk I'n ~2 S `-` . ~ , 5 ~ a- ~s ~%~ Fez ~i S s ~, rn ~. ~ ~S - , ~ . ~ I D~ 3 ~ 31a. S~ 1 z -~F r ~ ~~- ~S 3-F ,5 ~ ~ a ~ gal ~~~ ~le I s, I z M sbk rn ~~ i4s 3 ~ /.,a ~ s 2 ~ s L 1 -~ _sbk i(1r1 1., C S t `~ ., ~ . 5 ~ 6~~3 ?~~ e ~l ® S o m m ~- l~ -S -- . 7 .8 s' • 3 53 ?; 5 ~/ ~' ~ l U eo YY1 Yn F 2 C.-S' - >N P .. ;Z Remarks' Remarks: Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page ~. of 2 Labor and Human Relations Division of Safety 8 Buildings in aCCOrd with ILHR 83.05, WiS. Adm. Code . COUNTY , 'Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ~ • C2a ~ °C C0~1 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. - /~aS~ •- APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPE OWNER: PROPERTY LOCATION GOVT. LOT~Ij,,)f 1/4~E 1/4,S T a ,N,R ' ~br) W PR~~,1' OWNER':S MAILING ADDR~~~ LOT BLOCK # SUBD. NAME OAR' CSM # n~ CITY, S fAT ,. ZIP CODE PHONE NUMBER ^CITY ^VILLAGE ,QfOWN NEAR/ECST AD /llor~ t~SC~ .S^ilD/lo (°~lS)3b' `~BC~'9 ~1~'7, ¢ [ .J New Construction Use [X] Residential / Number of bedrooms [ ]Addition to existing building ~~ ' Pr ~ Replacement [ ] Public or commercial desaibe J ` Code derived daily flow to0('~ gpd Recommended design loading rate ..3 bed, gpd/ft2.7 trench, gpd/ft2 Absorption area required ~ bed, ft2 ~s«~ trench, ft2 Ma~amum design loading rate , '~ bed, gpd/ft2 , S trench, gpd/ft2 Recommended infiltration surface elevation(s) c/~. S ft (as referred to site plan benchmark Additional design /site considerations ~o~ ur<zd~~ ~61P'_Cprry~ .s'~5`/~n-1 !Z°('y/~'! ~ Parent material ~ l C~.C lv -~ ~ ct ~to~lZ, Flood plain elevation, if applicable ~~~ ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FlLL HOLDING TANK U = Unsuitable for s stem ^ S ®U ~ S ^ U ^ S ®U ^ S ®U ^ S ICU ^ S ® U SOIL DESCRIPTION REPORT Boring # •~ ~x ;y# =~:i ~e- Ground elev~~ q~ . ft. Depth to limiting f for O Boring # a.:: ,:;~ >.:: ry Ground elev. ft. Depth to limiting factor Depth Dominant Color Mottles T t Structure Consistence Bour~d~ Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. y Bed Trertctl 3 >6~~D ~, ~ l a ~ c ~. m ~sbk Y-~~F" s ~ z m , ~/ ,~ ~-~Z ~,s. ~ ~" s' s/8 ~ ~ .s"1~ ~ ~s ~k n1 ~i2 19-5 - ,~ _ S 5 ~.3~ 2 / ® -~ 6 era S m ~. ~s r . ~ Remarks: Q S- }'~" ~`~t.YLUS ~ ©'~ GAS a ~~ l (~ SO t Y7t.U //~ ~ .SGCd-t~ / ~ l Ol~/~'! ! YY.f Remarks: CST Name: Please Pr r T ~ Phone: ~- ~ ` ~~ Signature' f ~t.u ~A ..p.(.p 1~.. Dat 9~~oZ/ 9(0 ~ OSGb/Y7~ ` __ ' PROPERTY OWNER I, 010.,Y~ ~L~nfNL PARCEL I.D. # ~02~ " `Jos -- 9~ Boring # :.'; Ground elev. ft. Depth to .limiting facer y Boring # ~~ .~ ,• "`~` Ground elev. ft Depth to limning "• factor Boring # ~• ~ +y `~~~w Ground eleV ~? ft. Depth ro limiting face, v Boring # ~.~:< {.;: ~~ ~~: Ground elev. ft. Depth to limiting factor SOIL DESCRIPTION REPORT Page Z of ~- Depth Dominant Color Mottles -T t Structure nsistence C Bo iar n Roots ~ GPD/ft a Horizon in Munsell Qu. Sz. Cunt Color ure ex Gr. Sz. Sh. , o y t c Bed reach ~ -3 ,~Q 3la S, l Z r I'n Fie Cs' 3 f' .s , z 3 ~- -s ~, 5 •e -5r1 ~ s, I z -~ s~k m -FQ s z-~ ~ ~` . ~ Co ~~ 7~ 7.5 e ~~ © S U . cv s M l` ~- ~ . 7 .. ~ Ramarks~ z.. ~ 3=13. 7.5~,e 3/a. s~ I z r~ ~bk ~ . ~ cS 2~ ;~~ ,. ,1 /~ s 1~2 y1 ~ s u ~ m ~ ~s ~ ~7 .~ - - Remarks: i 1 ~ c~ 1 ~YIC~ 0 ~50~ N ~ ~~scm, Uu-sG, s~ol b 9~~8~9(~ C ~s~ 3g~ -Q~a~ ~m~~n~ ~ ~~ y !~ ~ ~ d~~ ~~is ~s ~ ~ ~ ~e~ isin~ ~~s~vr~ ~~ ~L7 !~ safe ~r~ ~ GU~t~ ~ dry Gc~cZ~ GUE /,dq~/ ~i~e ~r~ ~ ~ GuS %~ a G7 ~ ~ Cr~v~~~r' ~,~c ~v2~ SCri QCs . -.~ f-r a~~~re2-~' ~~~ ~h~~.'r sarn~ i~s~ri~-iv~ 1a~~r ~ lo~v ~e~~~rl~ 7`/~r~ ~vr,~r c~c ~v~ ~~s ~ ~'rave% tf~.ry ~~' v~ ~r ~~~~ ~uav-~c.~ ~-~'~rr~rr~~/ el sy~s.~rrr -~ ,~ C~2~rvL'~~ ens'' ~~ /,~ac~ ~'~~- i 7~iv' l^~~~cl~'rn~/~ CZ~l. .So-i! .~br!/IC~S' s~ct~~ ~~ ~l'F_' ~~ ~ GC Sy~S'd~ii'L r~.~~r~c~~o-nom . ~~' j4/~ CCSr aBoas 9/aa/9le 4 3 ~ as ~! ~ • ~f ~ ~ ~~ f ~ ~ , ~ c 1 + ~ ' f 4 ~ ~ ~ ' Q ~ ~` S: ,~ ~ 0 o I ~ f P , ~' ~ ' + ~~ ~ ~ Q ~ +) '~ { , ^ " l~ ~+` ~' ~ ` ~, ~ ~ ~T ~ ~ L ~ ~ ~ ~~ f •~ a ~ ~~ o / 6- .. ~ i a~ m- ~ h ~ a~ ~ ./ ~ _--~- ~ M i~ ~ a ~~ ~t v ~ ~O ~~~~ Q L 3 ~ ^~'. 0 V, r ~~ 1 ~" l ao N h^ ~ A~ r C ,~ /~ 1 G s. '~ a ~,u \~~5 `° a ~ T -~ L / a ~. ~ ~.y m ~- ~ ~ Dose Tank Information locking cower with vvaming label and locking device and sealed watertight Electrical as per NEC 300 and -- Comm 16.28 WAC ~ 4 in. min. Dis~ __,_,~_ ~~~ Tank component is properly vented Wieser Concrete Ca aci 501.84 Volume 9.84 Dimension Inches Gallons A 30.75 302.62 B 2.00 19.68 C 9.25 90.98 D 9.00 88.56 Total 51.00 501.84 Manufacturer Gallons gal/inch 3" Beddi E-- Alternate okrtl~ location Forcemain diarr~er ~ 2 in. ~~''' weep Hole oranti- B siphon device .- _ oh C PI ump off elevation cft) °~ r-`- 90.75 D D~tank elevation (ft) un er tank. 90.00 Alarm Manuafacturer LevelArm -~ Alarm Model. Number DLV _~- Pump Manufacturer Zoeller Pump Model Num r 53 ~`~ ski , !•los ~ HEAD/CAPACITY CURVE N ~- TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT ANO DEWATERING j SERIES 4.v54 67 d9 97 90 tJ7~t J9 tel 19J tb6 IBb 10a tW ley ~ FT. M. GLL Ltr4 Gd. Ltrs Gd. Ltrs Gd. LIr4 Gd. Ltr7 (]4L Lae Gd, lln. GLL Ltrs. Gd LY,t. GLL Urs. Gd Ltrs 5 1.62 4J 163 58 212 72 27J la 3p4 106 401 81 201 el 2J1 6B 22D 154 587 156 587 to J. C6 J• 129 46 174 6/ 231 79 J00 100 378 61 2J1 6t 2)1 6B 720 t4B 480 151 672, 15 .4.67 19 72 J6 IJJ 46 170 61 242 9t J44 60 227 90 227 58 220 742 SJ7 la4 549 20 0.10 t5 67 25 96 J6 iJ6 82 J10 69 22J 60 227 68 720 1J0 616 IW~6J0; 26 7:Q2. 8 J0. 71 290 67 210 69 22J 68 220 129 484 1)J 6P'f ]0 At4.. db 2M 66 206. !N .220. 90 'J!10 6B 730 121 46B 127 481 40 1219 46 174. 46 172 66 209 76 1BJ 68 220 106 J97 tt/ 4JI 60 1 b.2~ -. 21 90 JJ 125 61 Ipl. 6a 21p 6B 220 90 u1 100 J79 ~ 10.ZO t6 -, 67 <J 16t-. J6 'IJ9 ba 220 71 268 06 J22 70 21. JI >D 111 10 J8 62 177 61 19J 70 266 90 24,yp.. 11 W a5 170 ?0 106 W 2041 90 27.4J >2 i2t 2 3 J7 140 100 .90,48 t B oe 21 79 110 J200 • 7 ~ , ~ Lxk VW.; 19.26' 2J.76' 2J' 26' 69' B6' B7' 7J' 11 b' pt' I t 2~ EFFLUENT &DEWATERING Warning: Model 185 should not be subjected to less than 30 feet TDH. Note: For Head Capacity on Model 112, industrial column-explosion proof pump, see FM 219. SEWAGE &DEWATERING WARNING: Model 293 should not be subjected to less than 15 feet TDH. ____ I I TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE SEWAGE qND DEWATERING SERIES 262 269 287 26B 292 234 292 29J 294 2 FT. M Gal. Ltrs. Gar Ltrs. Gal. Ltrs. Gal. Llra.' Gel, Ltrs. Gal. Ltrs. Gel. Llrs. Gyl LIr9 _ Gal llrs _ _ 95_ ~Gai Llr 5 1.52 10 90 341 128 464 128 494 128 484 130 492 1B0 681 ._ 140 530 196 712 s 225 B 52 3.05 60 227 _89 337 89 337 B9 337 95 360 t5B 59B 121 469 181 685 _ 205 776 15 / 57 22.5 BS 50 189 50 189 50 1B8 63 238 135 511 106 401 130 492 _ 165 625 1B5 700 20 6 t0 -__- ___ __70 38 10 38 10 38 33 125 106 401 88 333 119 150 ~~~150 548 168 636 -25 7 62 30 9 14 _ _-,__ __ - 76 2BB 68 257 106 401 - 136 515 . _ t 53_ 52n ___ - _..__ ___ ___ 43 183 47 VB 90 340 121 458 u0 530 40 12.19 - ------ -._-_ - 5 t 9 50 t B9 94 356 ~ - - t 15 435 50 1S 24 -, -___ _ -- _ -- _ --- 58 220 _ 89 3J: 60 1B 29 ___ ______ _- _ _ 13 /9 { Sy 2 3 ~ I 70 21.34 _ _ Lock Velve 1B' 21 5_ 21 5' 27.5' 26' 35' ' -- ' ~ _ _ 42 50 62 _ 77 __. _____ 0 GAI ~ -~ -- •~ -~ ~ av tw Ifu 12V 130 140 150 180 170 180 190 200 210 220 230 I--- - --t - --- F - _----- -- _ --- I ~-_~__ .. _ LITEFS 0 80 160 240 320 ---- W -- 080 __...._.-._-560----- ~ ---~- 720 800 880 . Bio~Diffuser Specifications :~;~~ r ~~I`~C ~I O C -_ _~ ~O C I ---= -~,~' I~ C --_ -- ---,'~ ~ ~ r~ ~ ~`~ ~~~ ? ,~,.:,~y..~~ ~I ;. All~tf~ree`Bio :. , withstai~~~,~t installed ~^!It,.. , . , ` , -and comp~e -~ mum of ~~' forFj 1.0 loa } 1•°~e CapacityB.iop designed fo~~~~ . ~ ~ ~i.'. „ • , A minimum .o 18:~ , •~ required for H,'2Q>r~p~ad ,~ ;~-~ Universal End Cap Available Sizes ,~ Cnamoe ~~~9~. -_-~ -- .,,:amoe ,e~gni -- =t- -- ~ uc1~ ~ Y .r~•"h ~ i.f ~ 'fh'{~ ~, t ~r ~lYdX ~: ~, Length- i 6„ ~~-~: ~ 1' Y 1 'F6~, - 76" ~ !~~{ ~ ~,1 9 ~ I 'Width , ~41 ~>~Nf~ # 4" , r, , 34" 34" ' <<; ~ (~.~ ,~ ~~f~~d ~~k~~i 'a .. , ~ f ~ ~ ~Height ;''~~~~i.~~t, ~'` '"14" ~ ; 16" ,,._~<.,, .F,~~ ,::. .. ~.~t , ~i~~, ~ }~ ~; :Invert ~ ~ ~it~~.5~ 9 11.3 , ~ ~ ~'~ s , Conventional Septic System Management Plan Pwsuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10567-P (R.6/99). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank 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 enswe proper operation. The ftlter 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 failwe must be replaced. Exposed access openings greater than 8 inches in diameter shall be secwed 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 not recommended. Soil compaction may hinder aeration of the infiltrative surface within the system and will promote frost penetration dwing cold weather months. Cold weather installations (October- February) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BODS, 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 4 inches indicate an impending hydraulic failwe requiring additional, more frequent monitoring. Contin~ency Plan If the septic tank or any of its components become defective the tank or component shall be repaved or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell wilt be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to installing plumber, Mike.:l!~D.onell at: (715) 248-7767, or the St. Croix County Zoning Department. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner Mailing Address ~~Gln Gr 0>'~ Property Address ~~~me. (Verification required from Planning Department for new construction) City/State ~- Parcel Identification Number b~- /~~?S- 90-~ (, • ~s/ LEGAL DESCRIPTION / / Property Location 1~Cc~ '/a, ~ '/a, Sec. _~, T ~9 N-R~W, Town of f7~~~ Subdivision Lot # ~~. Certified Survey Map # .Volume ,Page # (3~ Warranty Deed # Volume ,Page # Spec house ^ yes G~io Lot lines identifiable ~es ^ no SYSTEM MAINTENANCE 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. The properly owner agrees to submit to St. Croix 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. Uwe, 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 Zoning Office within 30 days of y ar ex iration date. l / SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION 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 d bove, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF AP LICANT DATE * * * * * * Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed