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020-1095-10-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 9575 110 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: Kleschold, Donald &Jennifer I Hudson, Town of 020-1095-10-100 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 33.29.19.387A10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER .'r��l� CAPACITY STATION BS HI FS ELEV. i Septic � e -I Benchmark +n9' Alt. BM Aeration Bldg.Sewer Holding St/Ht Inlet g .s 9?. 6 TANK SETBACK INFORMATION St/Ht Outlet •75 -77• T TANK TO P/L WELL BLDG. ent to it Intake ROAD Dt Inlet ` \ All Septic 7 Sd Dt Bottom Dosing Header/Man. 7.J/5 9 G , 7 Aeration Dist. Pipe '7- , ,`7 9 4 . q 7 Holding Bot.System /D•lys 9$• 17 /t--7 -7.5 5 PUMP/SIPHON INFORMATION Final Grade �• �( /d/• S Manufacturer Demand St Cove 'I d co Model Nu TDr Lift FrictionLoss System Head TDH Ft For main Length Dia. is I.to well SOIL ABSORPTION SYSTEM $. 5 /D. 17 BED/TRENCH Width Length / No.Of Trenches n PIT DIMENSIONS No.Of Pits Inside Dia. liquid Depth DIMENSIONS 3 176 Z L�I Cti G — SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer-r- INFORMATION CHAMBER OR IT It��'l � � \L TY�o -7 66 UNIT Mod I Number: I# ` J i 5 � tJs DISTRIBUTION SYSTEM ZZ, Z( ne Header/Manifold Dist ibution x Hole Size x Hole Spacing Vent to Air I-i / Pipes) `� --Spacing- SOIL Length 3 Dia Length Dia 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 O S Bed/Trench Edges Topsoil Q No \ Yes ❑ No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / ! Inspection#2: I I Location: 552 Cty Rd N Hudson WI 54016(NW 1/4 NE 1/4 33 T29N R19W) NA Lot 1 / l Parcel No: 33.29.19.387A10 1.)Alt BM Description= ��`)�� G�q : 1 V— 1 a v(L O LA 2.)Bldg sewer length= Z 5 -amount of cover= ' �J G n Plan revision Required? ❑ Yes If NO � - - Use other side for additional informs ion. SBD-6710(R.3/97) Date Insepcto Signa;01K Cert.No. 4 C F. I . SA NV 1 64 Aft l� spy►and S�C l�C�il� 241 W. A P. Box 7162 SwdWY ei s�tNumixr(to ba in by CoJ s � 0 Sta�eTraasa�anNamixr Perrn�t Application /�' /�- In a SPS� �ris A�Codes a of�ss foo�as do a�opchae NoWAp li�nfmmforsta�,�aPOVnSan lD PMWdAddtess � � of 552 L'f`1 rZp 1�1 uafhes 13 m)Stems 1. L Applipg#qn Iafaraa#ion—Prti�tAnI�f®rmatien P�oa PwpWyCww'sNMC QbOAL�J �1ESC+1LYLl dZD - 1Da 5- 1v — 1y�� PrapedyOwnCr's Addr= r yI°—e-a�a �, D 7/4 �bL)� Y��LAW I•/V Code PhoneN�er w� IUG. V' S"fim -3 CiMSM Sit X36 VAu2C�-1 W1 T 241 It R I ffff M Type of BWkrmg(Chwk Bff*d N� (L4)--mC4 or Z Fay Dwelg- ❑Poblm Camm�—lie Uw ❑(may CSMwwMber ' o f of Q Sidowned—Dea3e lse ET.of apply) d U DSDI la.Type of Perlsib (Cbeckoidyaw box an lse& Complete fte B if ate) A- KNWSysm 0 RepW=mCRtspsMm ❑TMM TaoY 9Wb=m=0* ❑over ooP sy�t�) $. ii ❑t afPlmaber Lm P.�GI Per®RNomTer a�Da 1 ❑Pam¢Truo Nw❑ ()VMW N T of POWTS Cheek a8 dint apply >2 - df sal 24hL9Esod ,�Noa-P��c� a P ❑ �r��m a -fm: [1 0&wDbpcMd C t � ti c'4- Y. Ax=InformatIOM-- 4 Ass Rapked W Area Ptopomod(SO 7 �/ S-7 ) Z 96,o V'L Tsai;Igfe m TC" oaf NCSTea1a T Tea ll Q o U.0 A L Sepik arBuldingTook ( vi fcfl CTL- - yiy g r Statemea�i,&e undersigned,assone r pbor of thePOWTS3 the attadeed l Pioa�ber's plwaeNnmGer PhoWs Name(�) 223242 `��5-`7�5- 2`1� t NUMIM'sAdd=(sue CRY.SO*,ZiP cam) To. Box S6S CRESS an use vra�ea © s � c� Z f _.._�f Z -- Cdr �►� OWM Owcn RCMw for Do" Ile.Conditions of Ayppr,,WReasons for Disapproval C{' L riitek is c idsu fkw tbespha -few 872s 71 i rases SBD-6348(8 11/11) - /' ogr u �.pSA __ Soil Absorption Svstem Cross Section ��► ft 4"Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ft Leaching Chamber �o ft ♦— System Elevation 3 ft 6, ft Soil Absorption System Plan View 9C) ft ft ft ►vi eAds o� ,�ti,rn � Leaching Trench 1 Vent Or Observation Pipe Chambers 4" Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model tz EISA Rating Z sq ft per chamber Soil Application Rate . 7 gpd/sq ft gpd Design Flow ,7 Soil Application Rate = 20 EISA= LI3 Chambers 2 rows of Z1,01 ZZ, chambers each. e4 j;(�� rau�-/-U -�'/Z V) Page o HM-MVA 3114 99tv8—SZc-008 OIOZ 'Ndf 43SIA38 ° \ anOd-1SOd 31V0 OIOZ AaVnNV( 31VO 09L44 1M 'N30N N301VW OL ,IMH Sn 9lL£M w O� •n3a �������� 13131M �dnNdW OIld3S W :anod-38d ,0-j=„4 L 31VOS 3WS :A8 NMVaO 2IW-09Z1M N \ LAJ z_ Q p U m_ J Of Z o I'_ J J w p Z �D: 2 W N V d w W z O O:p LL.O� 0U' L�09 LL ° Q F- Z w O Q Q °p° 0a Z �' >' Z 0. �� U H W W W m Q v U I--_j ZJx d' a OW 2 m� g Z W ° ° c Q ' a. mN QFQ-W 0 0� Z WZ O d �O m o m z > Q ow G U M C9 .A 0 M jl C9 Q a a W ap J F- O fN Z 2�� fn I'1 o a a o°ac I L� U? .'�o�"'�p NF! mWN cc n W y'' Q 90 z ° a a O w Li 04 F- N <~La�QV ~Za N Oa y� x y x Z �~ N dLi.r'-co 00 z�f� rFl �NN �_ YSU � >' � p � OZ �0 N� J .. -J N W O Z w U Z F-J V1 a W U W fn a F- ?J aL�,�2= 30S CQJY OW d H Q WO x an d a p >ZOZ��OU Z Q 2N0 V � Y� Z Z W Xx WU Y Z3°m ��i��m� <**c� a�., o Z°Q Z a� Q ° N m= o Q w `� `� v ° ~ z .. o W F— o ? ? x ° oa U►- U W 0 Z a 2 U W X LLI N OU O w L- < > ¢WO F m U W a JQ_1 M W y�j U O>0 F=! „09 0: Fad O a0 N O w n N N U Sb0 \ W N / a 1 „6b do Q Q m I 3 3 w 1 o I 5 x o FI N °� rL „ti „Lti „F w ICI - w � C14 / „ZS do ° —7 W w (14 U a F W J Z Z_ 2 a£5 W „99 „tZL Y Z Fa- Property Owner S Parcel ID# f��� -,/0' �-/�-/BD Page of Boring# ❑ Boring ® Pit Ground surface elev. AegoAr ft. Depth to limiting factor y in. Soil Application Rate Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 Horizon Depth Dominant Color p rY in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. -ff#1 * 02 _ 96?Z2 All s Al- e 9 a a R 4 // i F-1 Boring# E]F]❑ pit Ground surface elev. ft. Depth to limiting factor in. -Toi7l-A-pplication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 ff#2 F-1 ❑ Boring Boring# Ground surface elev. ft. Depth to limiting factor in. Pit Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 ff#2 I *Effluent#1 =BOD 5>30<220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD 5<30 mg/L and TSS <30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. S13D-8330(Rl Ul1) G��vE'V RE 14 , - 1 Wis.Dept`ofs e ��al Services SOIL EVALUATION REPORT Page of Divis � Qhl bb`` UUUU in accordance with SPS 385,Wis. Adm. Code nn County ,' %ch complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Please print all information. Revie ed Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). L{,✓f Vim.. / Property Owner Property Location - Govt.Lot 44d 1/4 ff 1/4 S23 T N R E(oQ0 Property Owner's Mailing Address Lot# Block# 11 Subd.Name or 9SM# Ciry State Zip Code Phone Number ❑City illage ®Town Nearest Road New Construction Use:f Residential/Number of bedrooms Code derived design flow rate GPD ❑Replacement n ❑ Public or commercial-Describe: Parent material 7� r� � 2s,r/ Flood Plain elevation if applicable ft. General comments f �1 and recommendations: Boring# F 71 Boring 1Z Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Co t.Color Gr.Sz.Sh. ff#1 ff#2 a v 3 4 q � _ 9 4 Boring# ❑ Boring p]C pit Ground surface elev.,/0T/,-52L ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Con Color Gr.Sz.Sh. ff#1 .1: ff#2 *Effluent# BOD >30<220 mg/Land TSS>30 <150 mg/L * ffluent#2=BOD <30 mg/L and TSS <30 mg/L CST Name a Print Signature CST Number Address Date Evaluation Conducted Telephone Number 4 7,917 SBD-8330(R11/11) I I I l I Lo ' I sAm I _ I I I I I �/ ' r 17�_r i I I ' � I I I � �`o 00 Safety and Bch D1v9ion Count 2b l� 201 W.Wast>ir0w Ave..P.O.BoX 7162 Shy Permit dumber(to be MW in by Co.) Permit Application `Try Number to vft SPS Vrz-AdaL Cod,submission of>Ifis fma os ft apprePrift enk '"A- i req,,,d p�m a saoitasy p� Nate Application forms for stato-osvnod PowfS ace sabm�ed rb Projax Adds=rif&ffaco t nwWns add—) the DCgPwUt amt of p meal senies l c you l Abe ,�2 2� in WM&C 2 LOO.S.15. m Sons L A"11990qu information- Print iaformatien PropertyOwnees Name ccv� e Af% Parcel LbOAUn -� S( t1U o zo i� Peopeny 0arner's Muting Address ft9ertyuabon � I�6� ICE ,D� z,� Phone Numb" Nh!Y seetim 3 S, K10b VAW-�—y 170 T `L`I It R 19 II.Type of Building(check all that apply) I a Sobd"erisimName or Family Dry-Number ofBedtooeees ❑Pub&X=mcrcW—muse ❑aw ❑State owned—Describe UM CSIANumber 0 0 DSD GS � ow M � P " G g-T -zZ, 4b M Type of permits (cbeekowy one box oe line A. Complete rise B if appBeable) X A 1]T Tank ❑ w Madaetan W System(-Pram) S— ❑Rp)acemcet System D*wed S. ❑Permit Renewal ❑P emit Revision ❑Cleaet�of plumber ❑PCMdt r' Bare °"� 1Y T of POWTS om aeatfDeyi= Cheek all that on-P kWfotx�d ❑Pressurized hWAound ❑At-rack ❑Mouad_>24 in.of 'soff ❑Mound<24 in.ofsuitabie sod Horan Tmk odes D40 3d CaaIPoaert(eaptaia) ❑Pr eneot 1>evioe(eacptain 1 Y.Dis ea#Area Information: d Ir t Design Flow(gpd) �Soil,Appfi�u > (si) Dispersal Aria PMPased( s�E]evarion ID 9V Yi Tank Info Capacity in Total #of Monster g . � Gallons Gallow Units o New Tonics > Tanks 2 a A o.U GO d y rs C7 C Septic or1 Twat N 17 I Dosing VII.ResponsibiEity Statemeat L the w-Jersknesk assume r for' of the POW f5 shown!ogjhe art Finns. Plumber's Name(Pried) Puer's 2 B?�I S-Phase Number Vow S 2Z� 7S5-2y 61 m Plumber's Address(.&Ceti;CSay Stack Zip 006C) P0, &�x SLIS :bj�f. 'e- WI SLll�9 VIWCounY/Dg!mtMeUt Use 02 pmt Fee DtisuinQ Siaaaure raved Given Ream Dzaial Is q7 b" DL Condi0M'jMM&V#WMg0qkexsons for Disapproval f; ;9epti4tank,effluontfilterand tFspersal 60 must all be services!maintained as per,management plan provided by plumber. Z ;i#se0.ar*.bsquttemertts must btr.maintained is per b1s cotta/ordnatoces. .4Hxh to tame pbos for the steam and seta the COMMY 014 OR Pia"kM than s vt z 11 bch*S ia sra SBD-6398(8 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Q-Dy3p .g KliggNaL Owner's Name: Owner's Address: W1/8 b Mr_t\�W Lt\' 36= SFt_i IJb VMLE`I W1 5 171ol Legal Description: _ 1J&A mJ 01,q 5-33 T za 1J f2 l R Ir✓ Township: H 06,SC)0 County: S5_r )- Subdivision Name: Lot Number: Parcel ID Number: OZd— 1 D 9S )0 1 L06 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test& House Plans Designer/Plumber: :::IgF� Q License Number: I�PRS �Z 32 -License Date: SIZZ flLl Phone Number Signature 1/ Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 1-113bLo KLlr--SO44t)Lt) Ln-f I Ot OSM 'C1qZ"7 NW Al 9C Vil -T-Zq �Ik lctW r j. 4+"t/.7-3,- q RCO IN S V L U-610 ITC c L --OPLC -nn(L- RbtZimiA ----------- i vmvwt ; B7 9a8 Lewdft ChwnlW it ? �3 s sy R ft Chwnbm r I N Trench 2 Neador vamor0buroOMPOR Chumbw T�s MentturerAnd SSA Rdlng�_eq t per clamber Sol Ap*Mm Rafe c 5 Apdf3q ft MW Design Flow a c S Sc!Appkmdm Rata 4. _ >asA /00 chambree 8 t�of�.- ._chambers sash. t Page or !, NSTALLATION INSTRUCTIONS FILTER PL-5251PL-625 FEArURES&BENEFITS III Y' features $eras= a Rated for 10,000 GPD on s PL-525=525 Linear Feet of 11I8"Ffftr =` PL-625=G25 Linear Feet.of 1132° F�ration PL- 25 PL-W5 a Acaq is 4-and 0'SGHD.40 pipe �Built in Gas Deflector ►he PL-5251625 Effluent Fa"should � Y for several years under normal conditions before a Automatic Shut-Off M when Fier is Removed requiring deank g. it is recommended#hat the filter be deaned every lime the irk is Pumped or at kost every a Alarm Accessbiiity three yeam if the installed Biter contains an optional eAccepts PVC Extension Handle alarm,the owner vA be notified by an alarm when the fitter needs Servicing. Seivicing should be done by a riffled septic tank pumper or installer. :- -'7. RECOMllWNDED PROI:tUCM 11 MW ' Po3ylok PYGSt # Extumion Handle MR --r-MI-m-01"t w LLok= rS ($ �G�i l 'Govern .� stxeens Poiyli�t y �� SM W We lei plc 2WM Pn81S t:ovsr - - dMw This alo++rs i0caiin9 9xl that can extend �0PGn a vis�eai SeMckV your easier the kf and ta<dc and WMMAn r i of ii�SOVIng by ellaij- make fear and/or baft Se iardc d th*A tic i wt. lk-ow a��aPp. serAdng- 1 J CY rii Ya C'p_- Fora full fist of PolyM products please visit Ow web site at .Pp'Y'aic CGM ;o aStd -Suuoliuoui luanbag ajoui SuuElpsaam azngTt3 ogntjpAq Suipuadwj io Suiptoljano aleoipui Xwz luouodmoo ag13o 1gSiaq aql jo%5L ump jalrofi sgidap 178 Smpuo.,l �Cluoglnu fjolup 2ol aql of polzodoi dlldmojd aq lsnui aaegms punojS aql of a2mgosip Aud•aSjtgosip jo aSudaas 2mims 3o aouapTna Cue ioj uonoadsm lensin a pue sagni uoliu uasgo agl ui Niue 3i`Suipuod3o slanal aql Suipjooaj apnlout llegs uoiioadsm aqJ s1loo lusiadsi(I luauoduio0 d4intj0 punoiD-ul ❑ jo also uo3M XIldmojd oq llegs snedaz jo spaau ooimos Xu•V sjalp,�A�Jo u0iitpuoo aql pull aj78Mpjuq jaglo puu saoT,A f4l moos ua3lojq io Sutssiui`SuToujms`sdmlouq`s3ltal job apeut aq lsnuz 3loago punstn d'sirog put suutl78`sdmnd st gons luaujdinba Ieauloala lit jo isal a apnloui isnur uopodsm atLL luauodwo0 sTmI luauuvaj l InqumD dumd ❑ •Sugejado uialsAs agl dawl of alnpagos aoueualuce<u aqi ut paieis uegl slenjaiui luanbag ojout Ir Amssaoau aq Xtui ftnmalo jal1i3•4unl agl uT spIlos unnoi of apmu aq of on suoTSTnojd-saoTltogToods s,jamlotjnuuEu of BuTpj000t spips palelnumooe:Sue anoujaj of pauealo put paloadsm aq llegs(s)jolli3 lallno aq•.l, •3po0 aAilujlsiuiujpd ucsuoos!M`£I IXN joldeg0 g1TM amupj000u m jo pasodsTp put jolmadp$uppuaS agtldoS 78 Xq panouuaj aq lltgs 31U61 aql jo slualuoo ngua agl`oumlon*m agi3o ajoui jo(C/j)pjigi-auo spaaoxo 3lutl Cut in umos put o5pnls jo uoiltucgmo3 agl uagm •3lntl aql olut"UQ pazpoglntun jo ItluapToot luanajd of aoTnap 2m3looj aAgoaga uu g1TM pomoos oq Ilugs jolourtip ut sagom g uugl jalvoB sSuumdo pasodxg•paloomoo AlIducojd oq hugs sloajap Cud•aoTejas 3o uogaldmoo uodn pa3pol jo/put papvas aq Iltgs luxassasst jo awaos joi pasn sSumado ssaood•aoujms punojS aqi of luonlja 3o Suipuod jo dn3pieq f_Ue jOJ 31oago 01 put umos put aSpnls pouTqujoo;o aumlon agl ams78aui`Mal jo s3lotjo Aut 4quopT Qjumpmq uo3lojq jo Suissm Cut 4nu2pi of Tl aql jo uon3adsui_lunsin u opnloui isnw suorloa&W Aue 1, Immodtuo0 s31119,L oildoS ❑ (alnpagos jouuualu!eW pagmMu mp iod)ioltiad0$upWaS aStldaS jo jaupqu!r w S.LMOd`jamaS palouisad iaqumld jalstW`jaqujnld jalsty :suoig M i m Sm Ilo3 agl jo auo guib"o lenpinipuT u78 Aq apum aq llugs uoiloadstq ' SI�TOI.LOddl�lI •Scoot s jo ft am a o i aStmas o dn- of luaAajd of aloauoo air utals�Cs agl g1Tm sutalgoId 3m .Ii P � 1 . 3 378 q P Am Iilun panjasuoo aq pinogs jaleM janamog`suoilipuoo Sugwado jelnSaj japun anjasaj Aep I e Alltauou si ojagiL`S,LMOd aotnjas of pasuaoil ltnptnTPT uu lotluoo`spunos mmle ut31 joumo awoq agl Aq srsuq npu2ai t uo paisal aq pinogs suutlV stuJuly ❑ :jauauar 2uimollo3 aql m paimado aq lltgs sanitn saejeA ❑ •dn azaoi3 o1 1T asneo Amu 11un I78sjadsip alp jeno mows 3o u011378dwo0 •sluouodwoo uialsAs t178 jano ogpit oloTgan piond 31aaM agl 1nog2nojgl SuTgstm Aipunel Smptajds Aq mojl Apeals j78lnSaj a mtluityq Slddns jaltm Sui3piiT mok aluuiumuoo puu S,LMOd moA aSeujep AIsnouas ueo Aagl se ujaisAs agl olui pagsnU oq lou pinogs`•oio`sivanlos`soiloigiiue`sapioilsad siueioa3uisip `luitd`slonpoid umologod s78 gons sluonuago•umis4s aqi joluo lou pinogs sgtms uonoo pue`ssog Imuop`sunq allalegio`suiopuoo suplduu Ajpims`suodmm`sodim Agtq se gons sujoi!algvpej'Japoiq-uou jog40 malsKs aql olui po2jtgosip aq pinogs Imp jaded Aluo agl sT anssn lalio.L•paziuziuTw aq pinogs Iusodsip a$ugjuS t Kq poonpojd asogl st gons segos poo3 put`sauoq`spaas put sjaad lmj;/alquIo2an`spo put sastaa pmq poo33o Iusodsip aql janamog`jalemalsem glSuajis ousoujop a1Putq of pauSTsop st uialsAs s!U •31a`jaltmgsip siomoils`alstm Xjpuntl apnlouT lou saop sigl :;)IoM•olgissod janauagm oorpns punojS aql of paSjegosip oq pinogs suTujp uopvpuno3 put saoinap lu3u4ua4 jaltm jeajo jaglo`sliun jtnouiaj uoji `sjauagos jolem uzojj olstm jo auuq aip osld•aumlon jaitmalsem aql sompaj Mal jo jiedaj lduzojd glim Suolt sajnmxg put somulldde SuTnts-jaltM Jo uoilull78lsm aqJ•S.LMOd 1nOX.Jo rCunaSuol puu aou78QUO3jad agl loage IITm uitajls jolumalsum aql jo fillunb put fgquenb aq•I,•sljodaj pajmbai jo uoissnugns put S,LMOd aql jo aoutualut_tuz put uoc_ltjado aql jo3 algTsuodsaj si numo Aljadoid aqJ MOLLVHddO •aotUjns angejllguT aql lu uazoj3 an suoTlipuoo pos uagM m000 lou lltgs do ljuls misAS •asn 01 joud jolmodo Suioyjas aSsidas a Aq pmouiai(splutl ag1 jo slualuoo aqi aneq paloaiap a=suopr-nuomw gSTg3I (s)nao itsjadsip aql oguamp jo/put ssaoojd luau>}eaji aql apadun lugs sltormago jaglo jo slonpojd Suiluttd 3o aouasajd agl io3(s)3Fm lum4rau 3loaga SIMOd aql jo asn of joud`uouon.gsuoo Mau 103 an.LHV LS POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner � C Septic Tank Capacity ) al ❑NA Permit# Septic Tank Manufacturer vtl NA DESIGN PARAMETERS Effluent Filter Manufactur4:_i__ ❑ Effluent Filter Model A Number of Bedrooms 100 droom JL60 ❑NA Pump Tank Ca acity NA Number of Commercial Units NA Pump Tank Manufacturer A Estimated flow(average)* gal/day Pump Manufacturer NA Design flow(peak),estimated x 1.5* gal/day Model A Soil Application Rate 1 0 5 gal/day ft Pretreatment Unit Influent/Effluent Quality(NA❑) Monthly Average" ❑ Sand/Gravel Filter ❑Peat Filter Fats.Oil&Grease(FOG) < 30 mg/L ❑ Mechanical Aeration ❑Wetland Biochemical Oxygen Demand(BOD5) 220 mg/L ❑ Disinfection ❑Other: Total Suspended Solids(TSS) 250 L Manufacturer: Model: XPI crsal Cell(s) Pretreated Effluent Quality❑ Monthly Average*** -ground(gravity) [3 In-ground(pressurized) Biochemical Oxygen Demand(BOD5) < 30 mg/L ❑At-grade ❑Mound Total Suspended Solids(TSS) < 30 mg/L ❑Drip—line ❑Other: Fecal Coliform(geometric man) _<10 cfu/100m1 ❑ Leaching ber Manufacturer Maximum Effluent Particle Size 1/8 inch diameter Model f Laying LengtblChamber *Wastewater Flow Verification and Calculations: Soil Application Rate fe Area Ref. /Z0( (Other than bedroom based) Infiltrative Surface/Chamber-ESIA Rating 2 0 ft2 Minimum Number of Chambers ❑Aggregate Design Flow/Loading Rate= fe min ** Values typical for domestic(non-commercial wastewater Materials:all materials must comply with WI Adm.Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ***Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ❑"Wisconsin At-grade Soil Absorption System,Siting,Design&Construction Manual"(Converse et.al.1990) ❑"Wisconsin Mound Soil Absorption System:Siting,Design&Construction Manual"Converse,J.C.and E.J.Tyler. Publication 15.22 ❑"Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems"Publications 9.6 ❑"Design of Conventional Soil Absorption Trenches and Beds". R.J.Otis—ASAE Publications 5-77 and"Design Manual— Onsite Wastewater Treatment and Disposal Systems".EPA 625/1-80-012 October 1980 ❑ SBD—10570—P(8.6/99)"At-Grade Component Manual Using Pressure Distribution" ❑ SBD— 10567—P(8.6/99)"In Ground Absorption Component Manual" $_SBD—10705—P(N.01 101)"In Ground Soil Absorption Component Manual"Version 2.0 ❑ SBD—10628—P(N.6/99)"Recirculating Sand Filter System Component Manual" ❑ SBD—10656—P(N.6/99)"Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572—P(86/99)"Mound Component Manual" ❑ SBD - 10691—P(N.01/01)"Mound Component Manual"Version 2.0 ❑SBD - 10595—P(8.6/99)"Single Pass Sand Filter Component Manual" ❑ SBD - 10657—P(86/99)"Drip-line Effluent Disposal Component Manual" ❑ SBD -10573—P(R 6/99)"Pressure Distribution Component Manual" ❑ SBD - 10706—P(N.01101)"Pressure Distribution Component Manual"Version 2.0 ❑ Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units ❑ MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency !Tpect condition of tank(s) At least once every ❑months ❑ e s 3 s.) Pump out contents of tanks) When combined sl!!4&e and scum equals one-third(113)of tank volume Inspect dispersal cell(s) At least once eve ❑months ❑ ear(s) Maminum 3 Clean effluent filter At least once eve /� ❑ months "sNA Ins ect controls&alarm At least once every ❑months A Flush laterals and pressure test At least once every ❑months Valves At least once eve ❑months A Other. At least once eve ❑months A Page of 'a ❑Mound,At-Grade,In-Ground Pressure The inspection shall include recording the levels of ponding,if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge.Any discharge to the ground surface must be promptly reported to the regulatory authority.Ponding greater than 75%of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing.The laterals should be flushed at least once every three(3)years.Pressure checks of systems with multiple laterals should be done to ens ure that equal distribution of effluent is occurring to promote the longevity of the s stem REPORTS Reports for maintenance,inspection,and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch.COMM 83.33,Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping,all tanks and pits shall be excavated and removed or the it covers removed and the voids p ace filled with V soil,gravel or other inert solid material. ' CONTINGENCY PLAN i" If the POWTS fails and cannot be repaired the following measures have been,or must be taken,to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system The replacement area should he protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure,lot lines and wells.Failure to protect the replacement area will result in the need for a new soil from existing and proposed structure,lot lines and wells.Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area.Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations.Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area.Upon failure of the POWTS a soil and site evaluations must be performed to locate a suitable replacement area.If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface.Reconstructions of such systems must comply with the rules in effect at that time. «wARNIIVG» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC,PUMP OR OTHER TREATMENT FAP FROM THE PERSON TANK UNDER ANY CIRCUMSTANCES. DEATH MA Y RESULT. RESCUE O INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name ::Xf'-(~ f o Name Phone '7(c5` 7 ` Z1/b Phone SEPTAGE SERVICING OPERATOR(Pumper) LOCAL REGULATORY AUTHORITY Name A enicy ij, v. Ga✓ Phone Phone '71$- 3 (o' 44O 10/2006 K:\WPDATA\EH\POWTS OWNER'S MANUAL.doe Page of ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Don & Jen Kleschold Mailing Address w1680 Meadow Lane Property Address 552 Cty Rd N vlo_� (Verification required from Planning&Zoni Department for new construction.) City/State Hudson WI Parcel Identification Number 020109510100 LEGAL DESCRIPTION Property Location nw 1/4 , n 1/4 , Sec. 33 , T 29 N R 19 W, Town of Hudson Subdivision Plat: NA , Lot# / Certified Survey Map # ��� U , Volume , Page# Warranty Deed# 913 &`7 / (before 2007)Volume , Page# Spec house❑yesOno 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§SPS.383.52(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 Safety And Professional Services 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�varranty deed recorded in Register of Deeds Office. Nu be of bedrooms 4 J 5 /8 /14 SI NA URE OF APPLICANT(S) DATE *** formation 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 certified survey map if reference is made in the warranty deed. (REV.04/12) IT i 10T 211.e ZY vj" 4r or Q5+ MUM rtixxV' £f°. * yt t s3 E w S KA- MAW, $�A { r k f IRA � ,� � �� � g a t tR+ gtfi r v .w5'3d` dr Ct as 5 3 ».. `. y, .,a{ f t F h Urn; W1,NIEL W looms. $ s r } g 9t our a j yt�„{ ; f k ,�•.' z�y��.b 4 y: x£4 �s �- ;&� t x"'. IOWA. t «tF °,k: y f try a �r � � F.f�{ r'y'!,< •trt�j°+�`� {� tg�x' � ,y,z�i} ,. z�����xk�,;s, � 4��i���' , p�� Jim +f � 3 �' l� r WS AWK QAQ Av maw{1�i vnv as s WAS Of Boa - Q� �s" h�m� Not w t w !}fr` m•+ ` r xyr �xF., $ "'x Y� .+s I WK Xf sty } # `� at F � Milli: YAW ..5 Ink AnnR €#Yy $l A� h`r` 4gi,' r t p�' �d1si a ,'t tom ; {� 2:''fi ✓` v .x a�a Tf {j * LLM HOW f ¢L yL ''1 Sx '$a Id' G 9 k by CEO MEN I z ;x ' l IT State 10ae of Wisconsin Form 3-2003 h WAARANTY DEED d ��" o�irniA�rl� �wcwaeat IVaaae �� � � t s; - ` Ct ,� 1 if+nr' aitd,wift,as MVivor*i l ? i Rf^j ilg: }c a Ir b 01 '11011WO 6,`b f, wwaft to Cinwee to*&Wing � � �- !tt 4 sRta pt tq and otlaw� { fi S v '& ' t } f pv+�r i +x "�k3,Zi:tocatler is 1�ciwna'i6 Pai1c -¢ ; �C t, r d '+ � ► . t9�l tat,_ t�No.6"Y9i 60 being i in a + 4si (NW'ltcfAiEll#)#ndir�p�t .ta�r .t e:N t QuwWt9W1/4 of"9114),all in Section a�ii�s{7t 1t.Range inerisEn !9)West, r d , niventi :A1k1a }ia3 �f t+ ddttt. { m 1 ,2013 1pwo SEAL} AM F.Klietz w j < . .�. ,. EA • Brims�.K!' . �4. �1rM�� '� '. ACKPIOWLt�Li ' IT tr STATE C f WISCONSIN z y 1 TATE 04iSOI* the abo�a- #t { #+ to.aria G;;n p1` iftWUMM— OldrWkftMW edged the fl • + Nor Pi blie,State of Wi My Coc wimion(is pmmsneet} w rar birdied ANY,"tow j i C� ��// SOIL EVALU lgpEPORT v v, '.„ #1202 I �= Professional Services Page 1 of 3 � MAY 212014 Ivi ' ildings y Keith E.Stoner in accordance wi%fc �)C6l Adm.Code County Attach complete site plan on paper not less than 8%x 31p VM UNT ,ENT St.Croix include,but not limited to:vertical and horizontal reference point B ire M �8� percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D. 020-1095-10-100 Please print all information. viewed Date Personal information you provide may be used for secondary purposes(Privacy law,s.15.04(1)(m)). , 2Q / Property Owner Property Location Donald And Jennifer Kleschold Govt.Lot NW1/4, NEi/4,S33,T29N,R19W Property Owner's Mailing Address Lot# Block# I Subd.Name or CSM# W1680 Meadow Lane 1 CSM Vol. 16 Pg.4297 City State Zip Code Phone Number City [:]Village ® Town Nearest Road Spring Valley I WI 1 547671 Hudson 1 552 County Rd.N ®New Construction Use: ® Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD ❑Replacement ❑ Public or commercial-Describe: Parent material Pitted Outwash Plains Flood plain elevation,if applicable Na ft. General comments Propose 3 cells usi a.5 SAR. upslope cell over the 93.00'contour w/a S.E.of 90.00'Center middle cell over the 91.00' and recommendations: cen er a lower cell over the 89.00'contour w/a S.E.of 86.00'.Cell C/L's staked. F-11 Boring# ❑Boring ®Pit Ground surface elev. 87.30 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 `Effn 1 0-8 10YR2/1 SI 2mgr mvfr Cs 3f-co 0.6 1.0 2 8-26 10YR3/4 Is ft ml gs 3f-co 0.7 1.6 3 26-50 10YR4/4 is/s OSg ml gs 3f-co 0.7 1.6 4 50-64 5YR4/4 sl 2msbk mfr gS 3f-co 0.6 1.0 5 64-108 7.5YR5/4 5 OSg ml gs If-co 0.7 1.6 6 108-115 7.5YR5/4 ft OSg ml gs — 0.5 1.0 7 115-124 7.5YR5/4 s Osg ml -- — 0.7 1.6 a Boring# ❑Boring ®Pit Ground surface elev. 93.60 ft. Depth to limiting factor >130 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 1 0-7 10YR2/1 SI 2mgr mvfr CS 3f-co 0.6 1.0 2 7-21 10YR3/4 Is Osg ml gs 3f-co 0.7 1.6 3 21-56 10YR4/4 Is OSg ml gs 3f-co 0.7 1.6 4 56-130 7.5YR4/4 s OSg ml --- 2f-w 0.7 1.6 Note:Soil borings completed with a shovel and hand auger from approx.90"to pit bottom due to caving.Same in Boring#1 "Effluent#1=BOD5>30<220 mg/L and TSS>30<150 m "Effluent#2=BOD5<_30 mg/L and TSS<_30 mg/L CST Name(Please Print) .Signature: CST Number Keith E.Stoner ,�F 224059 Address Keith E.Stoner Date Evaluation Conducted Telephone Number 23220 Wood Creek rd.Siren,WI 54872 5/9/2014 715-653-2324 sen-w"(x 11/11) Property Owner Donald And Jennifer Kleschold Parcel ID# 020-1095-10-100 Page 2 of 3 Boring# ❑Boring ❑Pit Ground surface elev. 94.00 ft. Depth to limiting factor >122 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftx in. Munsell Ou.Sz.Cont.Color Gr.Sz.Sh. •Eff#1 *Eff#2 1 0-6 10YR2/1 sl 2mgr mvfr a 3f-M 0.6 1.0 2 6-22 10YR3/4 Is Osg ml gs 3f-co 0.7 1.6 3 22-48 10YR4/4 Is Osg ml gs 3f-co 0.7 1.6 4 48-67 10YR4/4 s Osg ml gs 3f-M 0.7 1.6 5 67-75 10YR4/4 sl 2msbk mvfr gs if-co 0.6 1.0 6 75-83 7.5YR5/4 s Osg ml gs if-co 0.7 1.6 7 83-91 7.5YR4/4 fsl 2msbk mvfr gs --- 0.4 0.8 Boring F3a] Boring# Pit Ground surface elev. 94 ft. Depth to limiting factor >122 in. ® Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Ou.Sz.Cont.Color Gr.Sz.Sh. `Eff#t •Eff#2 8 91-122 7.5YR5/4 s Osg ml -- — 0.7 1.6 Note:Hand auger used to expand boring depth due to caving, ❑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 GPD/ft2 in. Munsell Ou.Sz.Cont.Color Gr.Sz.Sh. •Eft#1 'Eff#2 *Effluent#1=BOD?30<220 mg/L and TSS>30<150 mg/L "Effluent#2=BOD5<30 mg/L and TSS<_30 mg/L The Department of Safety and Professional Servicese is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. Page 3 of 3 Soil Test Site Plan For:Donald and Jennifer Kleschold Lot 1 of Csm 16/4297 Parcel in the NW 1/4 of the NE 1/4 Sec.33 T29N-R19W o so +o Town of Hudson-St.Croix County GI Inch (t) 17.58 Acre Parcel Lot width Approx. 650 ft. at building site. Approx. 900 ft. to North P/L Approx. 1500 ft. Wooded Slope 89.00' 91.00'93.09' 95.00' \ C2 of Ridge 87.00' � � �a �a � � >ZS% ABM 1 ; Cleared Building o i Site 20/ , Walk-Out Basement West P/L a ; } ; 101.74' Proposed 1 >25% a�•z Proposed 4 Bedroom Home Wooded Slope Wooded Slope v w Elevation Data o Note:Proposed System Elevations could vary from contours i need be,place 3 below grade. B#1 = 87.30' � proposed .f � gr A BM=Nail w/Pink Ribbon in 21"DBH White oak B#2 =93.60 * HRP=Same B#3 =94.00' ASSUMED ELEV.= 100.00' ' =Backhoe Pit ))FN# 52 Ma 9 2014 Approx. 565 ft.from County Rd.N y , ever Keith E.Stoner CST#224059 Z6Zh 062d 9L'IOA ZO-OZ-9:31V0 VO-ZO'ON 90f NOSA0183 13VHOIIN AS a31"801N3WnHISNI SIH-L £e NOU;DnS 30 VABN 3H1 30 3NIl 1SV3 I9'449Z 3 J9SS.L0N Wu 1 Wu ti, ? 6 1 � r pC W C4.p 0�� Q �W Z o z z o ~ wN w p is A S V Z cn _ c� LL I s_ Z m W a � O 3: �8 z UFgi W a W X to WZ° � j 2 z N ?O 0 Qi —I a ? cn N� Z z 6p W; W Z ~'�� £E N01103S 30 4/L3N 0 �, l £6 NOUO3S 30 Q Q i 3H130 VAMN 3H130 3Nn 1SV3 b/l3N 3H1 d0 b/lM5 T LL (/� � — — — — _ — — - 1 1 I 3Hi d0 3NI�1SV3 Z 3.£4,95,lON l �_ — 1 tj S21 CF W WTI W o� � I1 U ~Z a d' — b/13N 3H1301333 9'699 R-LSb3 3HJ-30 3Nn 1S3M COL}AL �+ 1--1 z - 0 w Z 9b'Z96 3.L9�8S.LON ' E—i w a, ------ --- 1 7 L4 z ! —00'SL£-`c L L-4- -------------- W LL ci W ch ca IL cr U �y ED w z W o', p Q f Nkv ~1`Ly9�L �� N OgAL — J (l0 d0 3NIl AVM-30-1H0W Al1431SV3 M.LZ 9 L.LOS ££NOLL03S - z 30 3Nn 4/�HM)OS-H1HON . z ° -------------- --------------------------- — cn 3.r>aas-/es brvae o103wnssv'ee 00'E :33A Ad03 NOLL03S d0 VA3N 3H130 3NIl HJ.UON l S0'ET =333 039 3H1 Ol 030NMS=13H 3HV S•JNIHV39 dvu A3ARns amlr.LH30 Rd ST3Z Z @0Z-EZ-SO U' QH0038 Hod Q3AI303a O`; IA '-m KIOHO -is SQ33Q 30 831SI938 HS'IVA 'H N331HLVX L6Zh 3'Jdd -9L 'T A 0966L-9 `� \`� uos n r)o �( uno m -�•.r,.,,�„ � � � ,� 9lOgS IM` P k `W P b � 7 ZSS d -_ c 0 Plouosal\A aa}luuaf 32 uod o ^'wooOj GUIMDJQ S.UpI c s o o o i o z A-Zb A-2I A-0I .0 OF .6-.6 o�3 I .CEO �0�,77 O r-------------! ----- --- — ----- IMMMEEMMEMEEM., I -------- ... — -- — — --r---- ---------- I ICI u I t�90 ���Itt I �s?� E sassnai booed.e l loo m I � ° o n Ev u5 i uA of q I I J I o o�` > m°_Ua it �b8a am� iu I u� L �a I IUx I r O Z Y 0 m I I s3ssnai aoo��.B r I I L II .6-£ I � b I � I I vl I O ----- ----------� r---------� Q z b I 22 - 0 P-21 .0-9 U W Q NI > W W 9 I irl I I ?o o �O� I I § O O a e en}A-s 7 I Q b bcvow�ml OS�\. ry I g o � � a, o \ < � ICI I ° oa I I § NI a N o ------ ----- — �$ �E I `m 20 E a- sEV° I N s m v- I L -- --- -------------------- 4 t7 OZ wood buIMeja s,UILIOO "° ,SMM'm' 10�S M'uos�n ' boob� unoZS9 co 9 Plops-alA aapuar? uod d LU oo ZI GUIMDJQ S Ulol 0 o noa aDuaav�n o A Zb .0 xA-,9'O'Tl 01 xZ-Z i.0-.B d01 .O-B d01 O�.....`��__...O... 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