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HomeMy WebLinkAbout020-1400-01-000Wisconsin Department of Commerce ,~ ,~ PRIVATE SEWAGE SYSTEM Safety and Building Division • x INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Bast, Kernon Hudson Townshi :ST BM Elev: Insp. BM Elev: BM D ri ion: ~o~ a ~r~. v ~~ f TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~l~ Dosing ~ ,.. ~ t~ Aeration Holding TANK SETBACK INFORMATION TANK TO ~ P/L ~ ~ ~~ WE~ BLDG. ent Air take ROAD 1 Septic ~ l ! ~ ~ i Dosing Aeratio / -, Holding PUMP/SIPHON INFORMATION Manufacturer _ d GPM Model Numbe TDH Lift Fricti ss System Head Ft Forcemain Length Dia. Dist. to Weil SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 429998 0 State Plan ID No: Parcel Tax No: 020-1400-01-000 Section/Town/Range/Map No: 11.29.19.2491 STATION BS HI FS ELEV. Benchmark ~ Alt. BM T • r ~, ~ l_• ,~ / Ip [w Bldg. Sewer ~r, ~~'~ SUHt Inlet ~ -ZZ St/Ht Outlet 3 ~ % Z-97 Dt Inlet .1 _~ Dt Bottom / Header/Man. i I Yz ~ Z Dist. Pipe ~ I ~ ~ (1y ~ -~ LJ / !! Bot. System ~~ ~ Final e Z ~~ n - ~{j St C~~ 3. ~ ~ • !~!O BED/TRENCH DIMENSIONS Width / Length / No. Of Trenches PIT DIMENSI o. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WEL LAKE/STREAM EACHING Manufactur ~ INFORMATION CHAMBER OR : -''~1' 1 Typ Of System: ~~~ /_~'~ 35 ~ ~ UNIT Model Number: DISTRIBUTION SYSTEM ~o2>c ~3 I/ Header/M' nifoldp~ s}• 7V~ q Distribution ~ ~ Pipe(s) ~- ''ee ~~ g ~/ x Hole Size x Hole Spaci Vent to Air Intake Length Dia Length Dia ~~n SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv L~ ~ ~ J Depth Over t Depth Over xx Depth of xx Seeded/Sodded xx Mulched ~ Bed/Trench Center ~~ ~ Bedrrrench Edges Topsoil yes LJ' No i ]Yes ~] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ t?!~, Inspection #2: / / Location: 1018 Tanney Lane,(H'u~dson, WI 54016 (SE 1/4 SE 1/4 11 T29N R19~ns Esta~""' °--'~ 1"~~ Par o: 11. 9.19 1 1.) Alt BM Description = ~~ f ~~~ 2.) Bldg sewer length = ~i.,~~o `~~~ S~~t'~' ~'`-~ -amount of cover = ~ ~ S~~e~ r~~~~i Plan revision Required? 'Yes No Use other side for additional information. SBD-6710 (R.3/97) i ~~ ---~~ Cert. No. t . V VV ~r~SC~nS~It 201 W. Washingt4rl Ave., P.0.13ox 7162 Nltldlsoty Wl 53707 - 7162 Dep~rtm~nt of COIT)merCe (608)266-3151 Sanitary Permit Application In accord wiUf Comrtt 83,21, Wis. Adm, Codo, parsnnal infotrdation you provide may bt u9cd for 5econdaq pt,rposes PNvacy Law, s LS.pa(l)(m) I. Applicatioe Information ~ Phase Print A.II Informative `~ 2 3 ~w ~~+~ rnone~uo~~G OFFICE HUDSON, WI 54016 II.'iypc of building (chock tt11 that apply) +~ 1 or 2 Family DwcUing - Nuptbcr of 9tdtooms 5 'ems ~ o PUblic/Commerclel-Dcsoribe se ` d o Slato Owned - bcacriba Us ~ t~/L4 Wt 3 ~ ~.Q~ III- Type of Pe~rttit; (Check one boz on Ilate A. Complete line B If applieabla) i~ A• d Now_ System o Reploocmcnt o Trealmcndhlolding Tank Replace nt Onl System B~ o Pcnnit o Penttit Revision o Charlgc of o Pcratit rransfor to Renewal Plumbtr Now Owner [iefore Co. /~ rojeei Addres (if differtnt than mailing atldres 2ZU-/S~~ -DI- GQ ~ 'reel #~ Bloolc # l NA opo~Loqutio 2 ~~// ~~d, S E t~4, Sect1011 ~ 1 ~ ~9N; R19 w HOPKINS ESTATES City o Viuagc d rownslltp ofliUbS01~1 o Olholr Moditictlkion to Existing Sysltrrt y Non ~Ptesstirizod ln-Grol~nd O Mound? 24 in, oFFUitablo soil o Mound < 24 ih. orsultable soil O At-Grade o Single pass Sand lziltor o CbnetrUcte~l Wellohd o Pressurigcd L - 'Tool[ o Pte[ Filter o A,crobio Tra6thlonl Unit o RectrcUlating twdd Filirr o )iocirculnt-ng 5ynthotic Media ailtot eachi Chamber o Drip Lino svol.l Pit o Other ( lain V. Dls etsaU'Trcatment Area 1lnFpr ~ 2 D~~lgn Flow (gpd) Dcsigh Sull Application Rale(gpdsf) Disposal Area Required (sQ Dispergal ArcaprPposcd (sq Stem Elevation bQ9' ~ S(j 0.7 1071,4 w1 1119.6 .// ~ .~~ ~ O r YL 'l'ook Info Capacity ih Total Nutnbcr Manufuctutot Prct:tb Site Steel Fiber Gallons Galloh5 ol'Units Conctctc Coh6t1'tlctod Gags T'snks 't'ank,~~ or ticiainb' cock ~ 1650 ~ ~ 1650 Yl[. Rodponsi6ility Statements I, the underdi~gned, assu~ee respondibility 1'or ingtrtlatlon of the PDV1+'t'S shown otl the attached pltlna. Nlutribor's NtuAe (Print) I~Mbcr's Signature MP/MPRS Numbet Business Phont Number DARRELiL p'RAZ1;R 221071 715-ZB8-6225 OR I~iutnbor'5 Addtcea (Street, City, State, Zip Codc) CELIG 715-$28"5734 1631 160'~t.~ BLOOMER. Wi 54724 ~'[ . Couu /De artmerrt Use Onl Appt'ovod ~ Dis Sanitary Permit F (inoludca Grouedwatcr ps) opptovod Slvchatgc pee) ~ pb lSeu 1 mg Agent Si to d Owner Gi~eh Reason for Dental ~ 2 ~. `~ ~f D3 .Conditions of Ap rovaUReaso~a6 fps Disapproval , ~-1 - ~~,Uafz,,rn.. -~f s c~ l~ wc,~ 6.t- lv -- 7 ' • .~f cask ~ ~ ~~ ~ ~ '~~~` d ~ (oo ` ~ b~.~~a~~io ~uc~-~il~rXa.~, i~u fates o. ~~ . z ~d¢~ v~u a~-~~,~ ~lo~~~t~ w j ~- ~ P~~ ~'t~-f.p.~- , ac~t~r. ~-~-- v-a2a~(~-e2 ~ ~~h~i~-cam- C~~h~. 83 SZ ~ c~ mccQ~-~ a.~.~ ~~z ~! ch ~roiaplete plods (to the CJunty holy) tLr the 4Ye~Mn per tlUt Icaa tlultl tlt/Z x 1 t inches lu siYt Y3'tU-a.~ h2~ .e~Gt-d ~ ~ ~ Ce'~i:~Zl~/LJ ~, f ~ ~ y~p ~- ST~auTa ~.e~~ SRn~h:~9R (R. 111/t7 l~ ~G~7~ ~b .~~ ~~~`~~'~ u~E~ Li Z ' d t3 ' ON~~ ` ~~~~~ l~ WdStr : E E00~ ' 0Z ' J,dW BAST SITE PLAN sE-5E~11-29-19W HUDSON TOWNSHIP LOT ~1 OPkINS ESTATES sT, c~olx couNrr, wl LEGEND 6ENCHMARk ELEVATION ~ 1d0,0 (SCALD) (hall in e" plna tree) o LOCATION OF SOIL 90RING(S) ~_I LOCATION OF SOIL pIT(S) `.~G NO APPARENT COMM 83,43 SE79ACK5 i 0 20 40 * Pe,RCEL DESCRIED AS __.~ ACRLS (uwlCEe aNaw+ omb~wis). eus>or~+r ~,o. I ~z7e,o ~~ ~isa 6UIl01NG SEWER MU57 COMPLY ' W/COMM 82,30 W.A.C, (11)(c) LOCATION 0~' WELL MUST COMPLY ' WITH WONR CHS_ NR 811 ~ 812(b) I~-1~d ~ Lo ~- HUFFCUT7 t65Cr' ~~ j' I SBpTIC TANK ,/~ ~ 5-BR • Sl ~ ~ • I , (",, Lt ,~pl~~ I I' ~~ r,'; N10'-4' 3034 ~;' BUILDING SEWER ..1~ ~ ,~'~ ~ ~`•` -95'-4'' 3034 ' I ~ I ' v' prr~• '~ ``~ PLANTED RED PINS ~ ~~ ~. ~ I~~ OPE IELD ? ~9~~) ~ ~~ (94.5 \•ti p I:1 IM2 ~ ~ J ; ~ '~•~ `~ v ~ I :; l r r• f ~~,~ 3~~C 7S~ tl 230 T (3) NON~PRESSURIZED DIS UTION CELLS ~ ACH CELL USES (t2) LEACHING CNAMREks ; (MODEL = fhlFiCTFTAT 57AND RD ~ ~ G~~~ ' EISn BATING ~ 3t.t PER CWAMt3ER ~ I Cppy PAGE 2 OE 6 LiE'd 80Z'ON Wd9b:E E00Z'0Z'At1W f N (SCALD) 0 20 40 (UNLESS lHoMn on+plw~s). beie~tN ~ri 9 CU9tOl~p ~.0. 1 Zx7ehY , BAST SITE PLAN SE-5E~11~29-19W HUDSON TOWNSHIP LOT #1 OPkINS ESTATES 5T, CROIx COUNTY, ~ ~~~.~~`' SQL-s~s~~ LEGEND BENCHMARK ELEVATION = 1tl0,0 (Hall in 8" plna tree) o LOCATION OF SdL BORING(S) I_I LOCAriON OF SOIL p17(S) ~C NO APPARENT COMM 83,43 SE794CK5 ~C PARCEL DESCRIBED a5 __~ ACRES 6UILOING SEWER MUST COMPLY W/COMM 82,30 W,A,C, (11)(c) LOCATION OE WELL MUST COMPLY WITH WDNR CHS. NR 811 di; 612(b) HUFFCUTT 1650 SEPTIC TANK :. ~~•r r,C?~I~ ,~'~ ~ ~~•~ ~ -95~-4'~ 3034 ~' ` `\ ~ (93.3) fm ~ ; ~ E°~ ~•- I #3 ~ ~•• COY 1 `\ ~~, pI ~~ OPE IEtrD !I X91 I~~~ •, T r{~1~ r~ (94.5 1 `\•,, f ' ~. ' 4 r ~' 7 ;• r~~~,t ~~/,~ , N10'-4" 3034 BUILDING SEWER PLANTED RED PINES I I i n `U D c v I 1 ~~C ~ ff~~'' l 230 TO (3) NON~PR$SSU Z D D~Ttrt1DUTI0N CELLS f~ ACH CELL USES (12) LEACHING CHAM~RS ~' ~ C/~~ (MODEL -~VI FTCT ATb STANb RD EISA RATING ~ 37,1 PER CWAMBER PAGE 2 OF 6 L~E'd 80Z'ON Wd9b:E E00Z'0Z'htiW r . r • PAGE 3 OF 3 NAME ~ Gi 5 ~ LOT# I LEGAT. DESCRIPTION S F ~ ~ t~ ,S ~ ~ T Z 4 ~I\j,$, ~q~to ~-SCALE: I"= ~(~ r BM 1 ELEVATION O G ~ BM 1 DESCRIPTION Q ~ ~ ; ., ~ ~ ~ BM 2 ELEVATION O. ~ ~` /D h.~ BM 2 DESCRIPTIONS a •' ~ ,~n ~ ,P: n.Q_/ SYSTEM ELEVATION S~ , ~ ~ ~:~°~ ALTERNATE ELEVATION ~ ~. S ~ .S~'~"'_ CONTOUR ELEVATION q.~.OCJ ~ 9~, Q U N ~~r 1 1-f WL , SIGNATURE ~~".. ~ ~~~i ,' ~.1 ~. ..- <<~ (~~-c~~~s~~ K~v(~ o~ ~04~~. 4 Z 3d ~~ -4~rn ut2~h, 7 DATE ~ Z~O ~' Q ~- - + - eG . I ~ ,,u h.~- tie ~ ~ ~-f ~~~ S ~ V' 1 COUNTY PLAT OF: ' ~PKINS ESTATES THE SW7/4 OF THE SE1/4 OF SECTION 11, T29N, R19W, TOWN I DC COUNTY. WISCONSIN; BEING LOT 2 OF A CERTIFIED SURVEY I )LUME 15, PAGE 4098 AT THE ST. CRODC COUNTY REGISTER OF plclf~6[~6.OG'_1 _'V~_e_9990F_PC~Ia_o _ o_ MaPdQ44C~DD___-_aaa~ ,°,~' 1~•ONPPE ss9.51~zw 9~z.za' NE OF TFE SOUTH 195 FEET OF TNESWIµ OFTIE SEt/1 OF SECfgN 11 I I ~ I ao4 r ~e~ n ~ o~ ~ o c ______ ---_-- tv~ ~ u ~ ca l Y i V• oNJq IrlJo- UP-.6 I VMIML[ MIIOTN . ~ L ~ ~ ~ ~ _ ~ ~ - ----- NJapap44C~DD (~DD ~3 6 ------------------------------------- , I I PG~Gi6C~a Ofn~ NJ. 9~P l?C4~. 9C~ ------------------------------------------------- , 7! I i ~ ~ ~ I ~. ~' a i i ~~ 99 ~~ I ~Q; ~ O = s ~. I ~ ~ ~ _____ L ~ ~ ~4~aoc~ca4 ca~a~e :-i ~ W, ----- ~ Z' i I I i I g ;~ I ~ I z ji i I ~ , li . ~~ i ~o I i ~--- ----4CS~' I~ I 9 ~!~ III I LEGEND AWISWMCOUNTY BECIpN CORNER M ONUMENT FOUND I ~~, I • t•IRON PIPE fO1N1O I ~ 71RON PPE FOUND I I ~ P r iB' IRON PPE BET, WEIONNU 1.19185 PER LNFAR FOOT N ExLt~9w ORIrE~.~ I I I O 9.ss~ 1ia9 Pel a-°~--- 9 I ~aNR~ENiEDLOf CwRN°Ar"~x+rNONPPE C?.~3oDIL 0b ~ I wEroNING1.eeLBSP6iLNEMwOr ~ NJo 9~-PCsI.4109E3 I _ _ ---------------------------- $~ I I i I .. . ........ ~__ ___________ I I ~i-.~ FF31CE 9+F SOl/1H ~ I i I ~T~_ OF LOT CORIIHi I I7 I 890.00 a I ,9 UfILm EASBAENf ROADWAY SETBACK LNE Ih4 S11DW1S PROPQSEO ORNE E,DSnND FENCEIINE STORM WATER RETENTgN ATFAro HpH WATER LINE EIEVATgN ILW.L~ NIGN WATER IAiE ELEVATION ~~{ MIN. BUILDING MNBNM FlNBNED iLOOR OR WINDOW ElF/ATK N UIIE OF THE SETH OF SECfpN 11 ~ EL~• ° ~.~ NSP5IYE 1815.]9 SE COINER SECTgN 11 NB ~ u9LE5 AraE ro r>E PLACED such THAr THE NSTALlAT10N WDUD asnAeANT SUINEV salt!; OR DNAIpFA Mn Lm 11HE OR srREET 1RE THE asnA+BANCE GP A suRVEV srAKE BVANroNE s A FC110N 195.91 OF WISCONSIN STAMES. Vf41fY FASELOJTS AS HFABN SET FORM ARE FOR Tl1E IBE OF MD PRNATE PL•l1C 1INIIIES INM110 TIE RqM TO $EPNE THE Al1FA i10WN ON iHb AIAP (PMTI K SUBJECT TO STATE. COUNIV AN] lOFR61FP lAl'1'S. FlAES Alp '.E. WET1AN06. MN14M lDf SRE, ACCE59 TO PARCH. ETC.I. BEfORE PURCHASING pi CEVE1ppNO "UHD CONTACT THE ST. CROIX COUNTY 1ONINOOFFlCEANDAPPROPRATE 7TMH BOViD FORADVICE 1.1 OR IE•OH1T SHALL DO ANYfNIp AYNpI WOULp DJTERFF.IE WIT/I OR CIMNGE THE OPBUTgN AID CpLPABIBtlIYE WATER DIIANALiE MID 80L EROSION PLAN FOR 1HB FIAT. TMB 91CUl0ES BUf TO RRLDND UPO11.OBSTI1UCf81(A ALT91P1fi, Fl1JNl'i. OR E1C,' AVATlq OR PIAHTNO N ANV POND 'ATQI DRANAOE WfCMEB. WATER RLRAVAYB. WA791 CIR.VBf19, BERLM OR GRASS SEEDHGA SCALE IN FEET 1' = 100' ioo o too 200 1 OF 2 SHEETS THIS INSTRUMENT DRAFTED By MICHAEL ERICKSON JOB NO.00-07 GATE: 51302 u[IIi~14f.JU U~ ~~IJZ) '__`~__ ~ N/e_9~399_PC4~e_O GRAVELLESS LEACHING CHAMBER CROSS SECTION (typical) (installations may vory & require additional cells (not shown)- drawing hot to seole observption pipe (Where required) growth ~•O~ 12 NUMBER OF LEACHING CHAMBERS (per cell) 3 TOTAL NUMBED OF CELLS .. ~ TOTAL NUMPER OF LEACHING CHAMBERS (all cells) A MINIMUM OF 12" OF SUITABLE FILL MATERIAL IS ~iEOUIRED OVER THE CHAMBERS, INFILTRATOR STANDARD CHAMBER - OPEN BOTTOM ARI=A = 15.5 SQFT. INF'ILTRgTIVE SURFACE PER CHAMBER BASED ON EISA RATING 31,1 FT2 All material and piping specifications as per the Con~entiond) Soil Absorption Compohent Manual, PAr.F ~ CF 6 LiS ' d 80Z ' ON WdLb : E E00Z ' 0Z ' J~t1W The Standard Infiltrator' Chamber 'i`he Standard Infiltrator Chamber ~. 12° 1 I:1 - - _L__.. d 75" l:ffectlve Lonath Cl~,amb~~r End ViavV ~~ ~~Iz L r- g4" _,,,_~ INS. bn hl PCr~ILdck" End Alat~- to ~~ Sl~e(VI/kLzH).,....34"x75"x12d e~~ ~~®® Storage C.apaClk~l ....7g gaIJ10.4 ~' ®,~ ®®®® ®~~ ~ ®~®~ tap® Welpht ..................,.,.............26 I(is. Louvered Sldgwail Height,...,,,.....6" lv n dot w ccn m~r,y}gytl; hrk Fop q DAk>7CULOiip Yrctpa. IMIWattr ahel mitlr betlny a abvr4 r/rIlY7 B~~TeAlM/y'octl- ~ ua UIIIt4: pvuddl, r I dq dab: Innt 1NV~IRddquarlde W nYTtld by Yra4Mler m Iv UNLti VJITN PE9dFOT 40 ,=Hdtlogl ~ ahy~urd tbq~`thtl '~ antltllbd v tlnY Y~lv w'4neMlyntltl~69amP~ M4191xv Intl dq nrNllllAyy IP Ckv~pa rl{+ LINAtld TTntlrway YI Plly mattlor P41WNdt•M, a m tlxldlld Iht7 LlmYnl Warenl Pny gvly WFrv uYtlr tln dbNnl I;elda 7• 'rhtl nlroVa rvph.hrih rtn Nlnpdtlk LknYal Nlminry nlfaad by lnAffPtoS A IFnlmd num54r PI hh1Y]! and rolPllkl hvYtl ddPlaN W4rrYnh IerNlrarMrlN, ~I~opJy ~vt Ulttl nlgy~ ~IWc{ ~rGArNpb wrl~hla hcvtpunrlMM h dd S~vdrvPN, CGrrodleW, Wpr p tlut,M1 rultlWw, b ablail a nPpy d thU only WW YIW ~'tln`IIN Imd dnl Irdl,aµy ~ b P,o pukhnfa d ikr., IullAlaa Sy"wro tln{q IIPI medhtlnvnd YareMg oltslla ~,yY~Y~TI under Iwvarolu, chu,dTda mini by In'-Itl4U artlYrdr,d la vtiww+bNdarY Frlwaliwd rYluk Iv Mclnl ACcordNA n mtlltlrtecMaS Yawmh~ry wM Ydld YrnPrSµ MrltArv~ SytllaMl rcrarrmarde nyr Unt• vFs~Uc nlhY 11oM end leIlrlAy IMartl w~h vl algly B.(xIC tlyytlhq, SrilaM erg 61 dPldndrled by (fPYWrNMIII mtl INFILTR A TO R SYSTEMS I NC ~YTWronmedtelOnslle Weste-vale~SoluBortB`" B BUslhess Park 12oad pd, Box 768 old Saybrook, CT os475 800-2~1-4436 860-577-7000 ~Ax sso-s77-7001 www.lhfliv~ torsystems. co In 1-800-22'1 ~44r36 L ~'or technical assistance, installation irl~h'uctiarls or customer service, call Ir~iltrator Systems at 1~eoo~2Z1-4436 I 4. 1 U,s, pTilhhls 4,59.651; 5,017,041, 5,155,189; 5,336,017: S,e01,11e; 5r401,d99; 5,511,9tla; 5,714153; 6,585,7'78; 5,eag,e4~ ~~ Cahadlon paronta 1,32g,950,~ 2,OW,56d olhar pvlane palTdlnS, hSMota6 EWdIrM arld SWoWtlder drr. IcT~lStcral uedPmuky of hHyPla $yxnms 4rc, klhUf8laF IS O ICglStorol! MNlWmark h Fhdhcb, ~~Wr , }rsla one, Is P ropl5cerad Uarlifntdrk In McYlge, ~~r~ GohlaW, nniao Ting, polylllU, ShOpLedc, Chmher5ppecr. PvalLaek and pWekplyy oho Bddomatl~s d INtlhaler sy,lom9 he. o Zpn1 W;kroto15ys1ems MC, F~eY,ICd h U.$1Y C70o401PNL-3 Lfb'd 80z'ON Wd9b:E E00Z'0z'J,dW 7" Ovarlap qt I.atching MechshlsM • r ' Cover Sheet 1~ERNONBAST 9413 La Be~Qe Roan - Huds'an, W! 34016 NON P1tES5URI,ZED IN•CROUND 501E ABSORP'1"rON COI~I'ONEN',t' Reference SBD-lOSG7 P (.6/J9) "!n gid~hd Absorption ConrpoRen~ ManwaL" Location' Lot rlo.l, Hopltit~s Estates S$'/., 5E'/,, Sec, 11, T 29 N, R 19 W Town: Hudgorl Cotitity: 5t, Croix Designer's name and license #: Williarh J, Bergh (Llcenac No, 1577-007) 1 the undersigned state that these p ~ designed and submitted flnde,• m cutho,in,. Dc9igiuer's signature: Designer's address: Deslgner's phone number: 2667 113s' S Chippewa Fgl , WI 54729 715-723.5555 voice 715-7~3-7535 ~dx 715-5776838 cellular Corr errs 1 Page 1-Cover sheet ~ ~ ~~~ Pago 2-Site Platy ~S~ C7'f Page 3-Leachir-g Chamber x-section schematic Page 4-Lcachixrg Chamber -manufacturer specifications Page S~Mat~agement and contingency plan Page 6-Man$gement and contit-ge;racy plan ~•`'' `GQ ''• ~~5,,,,.,..,.,~~~ Wf LLIAM ~~~` ~'': BEt~GH s Page 1 of 6 LiZ ' d 80Z ' ON Wd9b : E E00z ' 0Z ' l,tiW Wisctlnsin Departn+ent of Commerce ' Division of Safety and Buildings SOIL EVALUATION REPORT ~~. a.,.,.,~,.~..,..` ....., .....~~~..,.,...w..,.......,.,,.,. Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County ~, C r0 include, but not limited to: vertigl and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel t.D. Q~ ' ~ 7 hh j}Q - d/ - ~v Please print all information. R ew y Date R Persaial ~forrr~ation you Provide may be used law. s 15.04 (i) (m}}. ~ ~ ~(~ Q 7j Property Owner Locati KP r /- o ~1 CL S~ vt. Lot , 1/4 S F 1/4 S~ ~ T Z N R~ ~ E (or W Property Owner's Mailing Address L t # Block # bd. Na me or CSM# u S // [~Gt ~Cc L° NTY i ' / / ''/ t7G' l~l~s ~ LL 1 TC.~ fC~ S City State Zp Code Phone~jt~q~OFFICE - City ^ ~Ilage [Town ~ Nearest Road ~v~SC~/l 1 S ~fGl~ (CIS )3~~-77>S l v~Sov- ~cK~~ dr. New Construcction Use: ~ Residential / Number of bedrooms ^ Replacement ^ Public or oommeraal -Describe: Parent material O General comments Jc ~S, f ~ ~ ~'8. and rec~mmendatwns: ~~ ' ~.~/ • .~ Boring # 0 Boring Code derived design flow rate L Page / of GPD Flood Plain elevation if appligble l ~ ~W L _ S' vH. ~'~.. t~bacf.~ ~~ ~ F'II vwunu auna~ c~cv. . s - n, vcNu~ w nuuwsy .aa.av~ ~ v ~ n.. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Etf#1 `Eff#2 G -12 IOyr 3 Z - ~ 511 ZMabK ~~~ GS 1~rf ,s , ~ Z IZ-Zy 10 r N ~ -- 1 ~ 2 MS~K iM~r CS -~ s , ~ ZN-~0 iG r - Z~S~ K wlf r' C S -- S , 8' ~~1. - ~ ems. w.t.e. ~~~ ` a / • ~ OV ~~ u U Boring # ^ Boring Ta 9L/ E71 _. i 1 C .=J tGJ F'!i v~vu~n~ aw ~a~.c c~cr. i ~w vcNu~ av ~u~xu..y ~awan i • u~. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 o-lo la c- 3/Z -- ~ ~ G K ~'~ Cs 1vF ~ s , ~ 2 to-Z6 -o ~ r ~ ~I - r 1 Zr~,sb K v~~r C S - , S ~ 8' 2 -iJS o r y ~ - ~ ~ ~s wi I - - ~ ~ 1~ Z ,D- „ ~ 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BODS < 30 mg/L and TSS < 30 nxyL CST Name (Please Print) ignature CST Number Address f W~, ~- ~~~ Date Evaluation Conducted Telephone umber L •~y T Property Owner iJ C~ S 1 Parcel ID # Page ~ of ~_ ~n9 # U Boring Pit G~~ surface elev. ~~ ~ ft. Depth to limiting factor Z~ S in. Soil Appliption Rate St ct Consistence Boundary Roots GP D/ftz Horizon Depth in. Dominant Color Mansell Redox pescriptice Qu. Sz Cont. Color Texture ure ru Gr. Sz Sh. ' 'Eff#1 ' 'Eff!!2 I Z d-10 Id-ZI ~ r- Z 1 _ Si I SII 1-~ Ir Zr~S K ~~ ~r Cw c 5 1 vF N~ , S- ~ P , ~ 3 ZI-~ r ~'l 7 ~, 2 ~- ~~ L1.~`~ S , 1 . ~ ba ~~ ~ Boring # U Boring ^ Pit Ground surface elev. ft. Depth to limiting factor ~ in. Soil Application Rate tion scri D d R Texture Stricture Consistence Boundary Roots GPD/ft~ Horizon Depth in. Dominant Color Mansell p e ox e Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#i 'Eff#2 Boring # ~ Boring Ground surface elev. ft. Depth to limiting facts in. ^ Pit Sod Application Rate tion x Descri d R Texture Stnkbure Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Color Mansell p e o Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 • Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mglL and TSS < 30 mgtl. 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 deparhnent at 608-266-3151 or TTY 608-264-8777. ssn~ssw cRO~roo) ~•.z~ Property owner (~ C~ S 1 Parcel ID#~~~, (~~~OI ~~UD Page Z of ~_ Boring 3 B°""g # r~1 p~ Ground surface elev. 93• ~ ft. Depth ro limiting factor Z~ S _ in. I~u Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Struchue Consistence Boundary Roots GPD/ftz ~. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i d-10 ~ r 2 Si I I-. I~ ~~ Cw 1 vF !v 6' Iv P ~ IO-ZI 1 _ Si I Zr~s K ~r c 5 Iv , S , ~ 3 ZI-~ r~ S l' ~ C , ~~ ~- ~~ L`1.~`c S ~.d ~a ~~~ - ~. , 1 61 . / / L - / /Y ~i L- / Ong # ~ Boling l7' L ~ Gff%jt/~ XxCiL/ G[i/ w ^- U/Gc-a' wax V i~ ~ ~~~ ~ / (~~~ ^ Pit Ground surface elev. ft. Depth to (uniting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stnrcture Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eif#2 o ~# ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soft Appflcation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsefl Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/l. ' Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L T7ie 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. sso.uw ~e.mao) i x _ -_ __ _ _ - fT1~ --N~ ~ ~ ~ ~ , ~ ~ ~ ~ ` \ -899. - - - -'•~• -i- ~ ~ ~~~ ~ . ~, C _ `~ ~ ~ .... . ,~ , _ - - /. _ _ Z t ~~~~QQ'~yy ~~ -- - . ~ o, - .~., _ - ~ ~ ~ ~ -~. - ~~ ~ -_~ ~ ~ ~ z - _. -- x ____J ~ ~ ' ~ a ~ ~ !~ T~V1 ~ . `gyp t-7 __ ) / ~ y Im'^ ;_ ~ ~ ~~ ~,~ /. ;, f 3'~ 0.' ' ~ i ~ , ~ I ' / -, - ~ ; ' - ._ , _ / ~ ~ ~__ Al ~z - ... - \ _ ~ _ C~ / .. ~ - -~ F `c ~. ~ _ ... tx. ~.. _ _,~ ~- ~ '_ ,~ _ - _ _ _` r. ins v y .~. --." ." T - ~ i.- . _.,.. .~ - .- __ ~, - -- i -. - --~ ,. / f u ~ ( ~ _ Z ~5 Safety & Buildings Division ' Sanitary Permit Application 201 W. Washington Ave. `~ _ ISCO/1SIff In accord with Comm 83.21, Wis. Adm. Code PO Box 7302 Madison, WI 53707-7302 department of commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned. Attach com lete laps (to the coun co onl )for the s stem, on a er not less than 8-1/2 x 11 inches in size. County State Sanitary Permit Number Checl'~'[~vvRSi~rgpr~r~ys appli ''``ClrG1 V CU ation State Plan I. D. NUMB ST.CROIX I. Application Information -Please Print all Information Location: 1 DI M ~ ~ ~, Property Owner Name KERNON BAST o rty Location ''/z, SE 1/4, S 1l T 29 N, R 19 W Property Owner's Mailing Address ZONING OF ICE Lot Number Block Number ~ ~ 948 LA BERGE ROAD 1 ~ NA City, State Zip Code Phone Nu er Subdivision Name or CSM Number HUDSON, WI 54016 715-38 -7775 HOPKINSESTATES ~ i~~ ~ II Type of Building: (check ne) /~ City ~ ~ 1 or 2 Family Dwelling - No. o edrooms: (, ~v l N `~ fr Q Village Town of H[1DSOV ~ „, d ~ Public/Commercial (describe use) ^„ Q /,/~~^-~ t !~'~ ('"'"~ , State-owned III Type of Permit: (Check only on box on line A. Check x on line B if applicable) Neazest Road E Q ~ N.Qi~/ A) / New System o Repla ement o Re acement of o ' ' to Parcel Tax Num er(s) (( S stem T k Onl Existin stem ~Z~~ ~ ~t7- -- ~~ B) ermit Number Date Issued ^ A Sanit Permit was reviousl iss d IV. Type of POWT System: (Check all that apply) / Non-pressurized In-ground ~ Mou o S d Filter o Constructed Wetland ~ o Pressurized In-ground ` Hol ng Tan o Ingle Pass o Drip Line o At-grade o Aero is Treatment Unit Recirculating o Other: V Dis ersal/Treatment Area Information: ,Phi o'f S L Design Flow (gpd) 2. DispersalArea 3. Disp sal Are' 4. Soil Application 5. Percolation Rate 6. System levat n 7. Final Grade 600 Required 857.1 Propos d 87~ Rate (Gals./day/sq. ft.) (Min./inch) NA 96.0"""-~'~ ~ Elevatio ' ~ 0.7 ~ ~9s.s - VI Tank Capacity in Total # Manufacturer Prefab Site Steel Fiber- P Information Gallons Gallons Tank Con- Con- glass New Existing Crete structed Tanks Tanks 12.50 SEPTIC 1250 1.250 1 [IFFC'UTT X ^ ^ ^ ^ ^ ^ ^ ^ VII Responsibility Statement ~ I, the undersi ned, assume res onsi tli for installation of the POWTS shown on the attached lans. Plumber's Name (print) Plumber's Signature (no stamps): P/MPRS No. Business Phone Number DARREL[. FRA7ER 2071 715-288-6225 OR CELLULAR 715-828-5734 Plumber's Address (Street, City, State, ip ode) 16317 160 ~" - BLOO'~IER, W 1.5472 VIII County/Department U eOnly ^ Disapprov d Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) ^ Approved ^ Owner Gi en Initial Adverse Surcharge Fee) Determinatio IX. Conditions of Approval /Reasons for Disapproval ~S - 0 ~ I S r~ trk u m d¢ p-~ ~l ! ewtcd b~ °i` o n ~' n ~. ~ Sot 7 o t%!-• f~/S-{~Cm Q o~ CC~x.~t cl yvtOv~e C ~oS-Q~ ~ '6o12.rN'C~ # Z 5 Ur-~C~2.. ~~~ISS'` ~~f. S~. ~ b l~a'i' C~~"t/~D CF-f~M'i$ I~L~NG~f o-IZ sys7lEm wtw ~k`a~~ I3~lbn3D -~'T+'~~ /~rR ~ZS~OV'nto~o~ 8Z~ t~3) ~. Cover Sheet KERNON BAST 9~8 La Berge Road -Hudson, W! 54016 NON-PRESSURIZED IN-GROUND SOIL ABSORPTION COMPONENT Reference SBD-10567-P (.6/99) "In ground Absorption Component Manual" /o/~" ~aha~ ~-~-- Location: Lot no.l, Hopkins Estates SE'/4, SE'/<, Sec. 11, T 29 N, R 19 W ~Z Q ~c~py _~~_~ Town: Hudson County: St. Croix Designer's name and license #: William J. Bergh (License No. 1577-007) I the undersigned state that these plans were designed and submitted under my authority. Designer's signature: Designer's address: Designer's phone number: ~" ' 266711 ~' treet Chippewa ails, WI 54729 , ,s'::~ FPM ~'~ .dam: ;~~~'' ~ : Q~tiG;. .• ~•'•.~.SSIONP': •~ Contents Page 1-Cover shf Page 2-Site Plan Page 3-Leaching Page 4-Leaching Page 5-Managerr Page 6-Managem Page l of 6 715-723-5555 voice 715-723-7535 fax 7]5-577-6838 cellul B A ~ T 51 TE PLAN SE-SE-11-29-19W HUDSON TOWNSHIP LOT #1 HOPKINS ESTATES ST. CROIX COUNTY, WI ~ I LEGEND ~ ~ BENCHMARK ELEVATION = 100.0 (SCALE) (noil in 8" pine tree) o LOCATION OF SOIL BORING(S) ~ ~j S I I O , 1 C O %~~~i~~~%J 43 SETBACKS NT OMM 83 AP PARE C * NO ~ 0 20 40 * PARCEL DESCRIBED AS ____ ACRES (UNLESS SNOWN OTNERYNSE) NIWAM J. gERGN MASCONSIN CERiIFlEO SOIL TESTER OE9gYER OF ENgNEERWG SrSTEuS cusrorER LG. ~ sa~ae9 UILDING SEWER MUST COMPLY ' W/COMM 82.30 W.A.C. (tt)(c) , LOCATION OF WELL MUST COMPLY WITH WDNR CHS. NR 811 & 812(b) / / , HUFFCUTT 1250 SEPTIC TANK ''~ 1 /~]%~ 3.3) _: #3 OPEN FIELD (94.5 ,~q~t lI f" '/ ~- ^-95'-4" 3034 \\ 2 ~ ~ (2) NON-PRESSURIZED DISTRIBUTION CELLS EACH CELL USES (14) LEACHING CHAMBERS (MODEL -INFILTRATOR SYSTEMS "STANDARD") EISA RATING = 31.1 PER CHAMBER I 4- SIT i .n. /.L~ / ~/ X10'-4" 3034 BUILDING SEWER PLANTED RED PINES \ D Yom"' (94v'~) - ~t ~ ~ < I fin' t~~ t "~ ~ m 230 TO ' PARK IVE I old I i ~ , PAGE 2 OF 6 GRAVELLESS LEACHING CHAMBER CROSS SECTION (typical) (drawing not to scale) growth SYSTEM ELEVATION = nn~• ~" U 14 NUMBER OF LEACHING CHAMBERS (per cell) 28 TOTAL NUMBER OF LEACHING CHAMBERS (all cells) A MINIMUM OF 12" OF SUITABLE FILL MATERIAL IS REQUIRED OVER THE CHAMBERS. INFILTRATOR STANDARD CHAMBER - OPEN BOTTOM AREA = 15.5 SOFT._ INFILTRATIVE SURFACE PER CHAMBER BASED ON EISA RATING = 31.1 FT2 All material and piping specifications as per the Conventional Soil Absorp ponent Monuol. PAGE 3 OF 6 observation pipe (where required) The Standard Infiltrator Chamber The Standard Infiltrator Chamber ~ , i--f I,I ~. lr~ ~ I ~ t ~- I i ~ I --- t '~ I 12 ~. r ~_ _ ~~ ~ I - ,~ I 1 I^ 1 __ ` y 1' Overlap at Latching P>.9echanism -75"-- Effective Length Chamber End View Posit_ock" End Plate 12" • ~' ~ ~ ~/,~ o \,, ~ ii ~ J°-, ~c o000 '~._._: ~ r - sa° -----..1 INFILTRATOR SYSTEMS. INC. STANDARD LIMITED WARRANTY I.."JFI _ knTJR ~ ~ S'~, .:I.1... I ;^. ' .. c,pJJARi).Itv11TE_, !,'ARRAN ry FGk SC??IC F k~,: GUCTS ; " , in .. ,~:. r„-...,^~ ' n y ;-; a - e::n nl.,, -. m=.r :. ..:, c., by Int ,ra,n. j..ol'e/ vely rrEerrco rc , .;nits I v+nm 'ns[al., n .. •tl ap^rarrr; n a :, ,.. ,.,(.., ,, . ' : L, ,Lrar Y ,c. }z: o.. r.'.r_..t <, .'. s rr r..:. -a :o J' or'ri .:I purcl t cr ioiAcr' i : .:: c:.:: uv:, m ~ n r tn• r:at: po. .tine a ~. pee punrut n :.rJ :or . ~: _p.ic sy,.,.m ~o ning tl:c J its prove 0 !~,o c '~ i ~ n :p7. ys emD ar pl cabl IY'1. m 11y-ar vrr. my p..r' o ub,. pc. date roar I , m< s. , r , o ;.xcr, - .y r,- rs. i.:,a •r :nr.sr r.,C:y Ir Y.rr ~r r wri roc, zr ., rPOr..:r. hrar,. ,arti.r, -r 06 h : , r a 7 r L. t,ratr -n {;:ply re} trc 'u tz th '~,r tlr' ,rm:. r, t+, 1 . Lr^ar m b; ,.< ~, ter t.::.1 , n, ,rr o ry ~' ,,., r 1 : Rr, nr s hal V ly stx,ri.irelly lucles lire cn'. n ro,noval :. ,:~or install' et ,3f rtln Units. iui HE .A?EL V ~kW? Sv - ~Et.'. > ItJ Y'3PARAGRAr' I r I ARE EXC 'NE' IERE ARE UO G I fER t1vARRAN fItS J/I': H RESPEC' TO TI IE L111 i, INCL..JIv„ <01'I: ~ ,ak iF;rJ IES Gf MERI.-In.J k611.'Y OR I' NESS r-0n A Pf.RTICJ!_MR oURPOSC. Ir,! -'., ,. nirr.t v+arri•::y ro<~s n nc ; , tl...t ,~.: ; tr.l, +I,.,...I u r n' . ^.r ..^,a~.n~;ns. In`JV ;t:u shaA rn hk liable `or ,a+naltirs or ur,,.,.: rd ' .g-s. 2r.1:.r11 ., IJ15 o prop: ~ -af r;, latxr sn,; rrie rel., oaerh::: o , os : or .i.her losses or axpans=s rtcurcetl by the Hok, ;r ra n...y nirf pe. ~F Sp-;. ,.all! r..rluuvU iron, ^rayc ', pia t,.'_3...o ?e „ , due .c orti a y ++! ar anc t... r, akeratip aui'uu n;, m.;w; ,:Gu' c ur ,.. o rr . ~c . ~ i,s ~:: - .^. ro _ ~ .ac :: z:fic . :r a r ? aor, vrrich _ ., r'it permrr,M C . ~'- i ,:ailaJO ~. nstr _c;rons; ~atlvr.: to mam- •ain .nr ~,n,:m r, a, tl rovr.: -. u t 91r ;p ',,:str ,.:o ts; , ,. pl.3rr=:na n ,it mproper m=:er = s into the system rn x;i •i~+g m .Units: `ailum oltc !ra x: }c y t. i r '.c t U,-nV:ot ''ny cw- r 'cr,:.. -n'}rxr4ra n pmlr ~.'yr}:rYVl~at rna:•.y ort c, , /C.: r v[ _a x( U, Infiln,. ht• _ o,..:. Wy -ar ly s i5tl UC X0.1 I .: e I Wltler ad. ,~ GJmUIy wi.P all o r,. 0.Lrn .:~. (x,h r ,his Lim 0.C lJarr3nry. Fur;Jror i ^o eve . ,I all 15L'ral:+ b^ r ~ xrs ul;` for any loss or tlamaga to the IiGlecr the U~ir. „r fr y t,:irc party res~: Uing ao ,:allalio : o sYipmM?:, u `rnm am prncurr haY hry cla.^,s .,. ~ ~ .1i1,.r o a :y r^,ird party. ~. Limr;nd Warrar;y ;o rpFly .1-e lrnrs must oe instalMtl i:, accorfarce with all sire ... S vJ ~.5 q.:ir.:r' h/ Sra'e 2^,' Ic . 1 .. ^as, nll . tr. ?k.+!'.^.ahlr 1 .< and I:t:Jn ator s iu2lit ~. r ,,^.nn.~5. rl Vn (p(, S^t'a r'lirra nr r.,, .li <, t, l .r::l~i. hS ~ nl(:r`. :/vnf :3 ,y I :,n mf,. :ter Nh;3. S.M:vCr ,1r ro ,.x[r,~ .h15 ,.i'n :tn ,unri'f:v. N~ 'arfanty apPL ~. ~'y pal r, f lY ri ~t:lt: 01 y!tal IIgCeI. T.":e atm.: re{uek -s : r star t~rr . L'n .;.: vVSr. t, . "`ertr; trJ rfihra.nr. A Nmi,r+C nu'nUnr o` •ta:a err. co.n.'es nav:~ CY.r,.,, m3rrr.:r, a1.irtr .n4. NnY p r i. e cr J is n > 4f -n It i:r [ ny.',i a. t A et - , ll ~ y7r .ok Con ,v' ¢. prior n surf purF`asa ;o oC[ai'. ' -c.~y nt the apNlrz._b.~ ..a•ran,y m:c ,.•oulC c, r L.Lr r. w .ul uana~ ,p pr x .u, c pu. to • o[ Un'. In(iloao' S ~ ~-+ns u~: ~ not rero f ... ,allir - r "n ~~ sy,:ei 1: < e: pavement. C hambersmust be .,.i0,. a~-:.-n':y Unlan~.a.It.n.r. -'stn;,.. or s. ~ailur•>tor .,tit a..-:ore ny .. n'i t~:acturCrs r^SCJCt- ~: +~I VOi vvarran[v. Inid:racor Systems rr nm,+nr1~. r s. - s-+pir ':':c fil;his a~ ] la~ ~~:iry (I;ers 'h all onsiu=, sr:pbr. sy;tams. Sys:e;n sing is neter minc:l by tlov.s r:n:; nr. y~lrtic>n.,. c~ in c ~ Size(WxLxH)......34"x75"x12" Storage Capacity ....78 gal./10.4 ft' Weight ..................................26 lbs. Louvered Sidewall Height............6" SYSTEMS I N C Environmental Onsite Wastewater Solutions `" 6 Business Park Road P.O. Box 768 Old Saybrook, CT 06475 800-221-4436 860-577-7000 FAX 86G-577-7001 www.infiltratorsystems.com 1-800-221-4436 For technical assistance, installation instructions or customer service, call Infiltrator Systems at 1-800-221-4436. U.S Patents: 4,759,661; 5,0'7.041: 5.156.466: 5.336.017: 5.401.116; 5.401.459: 5.511,903: 5,716,163: 5,566.776: 5,639.644 Canadian Patents: 1.329,959: 2AL'4.564 QIh2r patents pending. Infihrator. Equaliu:r and Side'V` index a«: registered trademarks of Infiltrator Sys[<~~ms tnc. Infittrawr is a rogistered trademark i1 Prance. nECreeea POSen Infiltrator Systems Inc. is a rey~~stered UaComark in Mexico. 0ontour. MicroLeachiny. PolyTuff. Sn pi_oCk, ChamherSpacer, PesiLOCM:, anB QuickPlay are trademarks cf !nfil[ra[or Systems Inc. ++ 2001 Infiltra[nr Systems Inc. Printed in U.S.A. 0700401 FNL-3 POWTS OWNER'S MANUAL MANAGEMENT PLAN PERMIT NUMBER: Owner/Agent: Kernon Bast -Lost no.l Hopkins Estates POWTS Maintainer: Geo Tech Soil & Site Evaluation -Chippewa Falls, WI 715-723-5555 Local Regulatory Authority: St. Croix County Zoning Department -Hudson, WI 715-386-4682 POWTS Installer: Darrell Frazer -Frazer Excavating -Bloomer, WI 715-288-6225 Septage Servicing Operator DESIGN PARAMETERS Influent/Effluent quality (values typical for domestic (non-commercial wastewater and septic tank effluent) Fats, Oil and greases (FOG) <30 mg/L, Biochemical Oxygen Demand (BOD) <220 mg/L, Total Suspended Solids (TSS) <150 mg/L Soil Loading Rate (SLR) = 0.7 gpd/ft'-. SYSTEM SPECIFICATIONS The components of this septic system are intended to serve afour-bedroom (600-GPD) single-family residence. The components include a Huffcutt 120 gallon septic tank, a Zabel A-100/effluent filter and (2) non-pressurized distribution cells using graveless leaching chambers. A total of 28 Infiltrator standard leaching chambers are required when applying an EISA rating of 31.1 as specified by DCOMM. All parts of the components .must comply with WI Adm. Code COMM 84 and be installed per manufacturer specifications and approval letters. DESIGN CRITERIA o "Design of conventional Soil Absorption Trenches and Beds". R.J. Otis - ASAE Publications ~-77 and Design Manual - Onsite Wastewater Treatment and Disposal Systems:. EPA 625/1-80-012 October 1980 / SBD - 10567-P (R.6/99) "In ground Absorption component Manual" o SBD - 10705-P (N.O1/O1) "In ground Soil Absorption component Manual" Version 2.0 MAINTENANCE & MANAGEMENT Inspect the condition of the treatment tank(s) and dispersal cell(s) a minimum of every three years. The septic tank contents must be removed in accordance with Chapter NR 113, WI Adm. Code when the combined sludge and scum equals one-third (1/3) the tank volume. The effluent filter should be inspected annually to ensure maximum performance. START UP For new construction prior to use of the POWTS check treatment tank(s) for presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage-servicing operator prior to use. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of wastewater will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also, the brine or waste from water softeners, iron removal units, and other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. The system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced be a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins, condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics (medications), solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain regular steady flow by spreading the laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the unit may cause it to freeze up. o Alarms Alarms should be tested on a regular basis by the homeowner. If an alarm sounds, contact an individual licensed to serve POWTS. There is normally a one day reserve capacity under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surface. Page 5 of 6 INSPECTIONS Inspections shall be made by a person carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, PUVb'TS Maintainer or Septage Servicing Operator (per the attached Maintenance Sehedulej / Septic Tank Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks of leaks, measure the volume of combined sludge and scum and to check for any backup or surface discharge of effluent. Access openings used for service of assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental of unauthorized entry into the tank. The outlet(et~luent) filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank during cleaning. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating properl} . o Pump Chamber/Treatment Tank(s) Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must me made for leaks. backups, surfacing, missing or broken security devices and other hardware and the condition of the filter- Any service needs or repairs shall be promptly taken care of. / In-Ground Gravity Component dispersal Cells 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 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. o Divertor Valve The divertor valve shall be switched to serve the opposing distribution component every three years (when the septic tank is due for it regular maintenance). However, if ponding is observed in the observation/vent pipe of any cell, the divertor valve shall be switch to the opposing component. Furthermore, ponding greater than 7~% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMIVi 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 opening sealed. - The contents of all tanks and pits shall be removed and properly disposed of be a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN 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 be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure(s), 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. o 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. o The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation 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. o 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. WARNING SEPTIC, PUMP AND OTHER TREATi4IENT TANKS MAY CONTAIN LETHAL GASES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OF OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH il1AY RESULT. RESCUE OF A PERSON FRONT THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. Page 6 of 6 ST CROIX COUNTY SEPTIC ~ TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer I> ~ ~l ~ ~~~ Mailing Address 97'i~ ~-A`~ /~.7~ ~UDSD~ ~/tl ~~ Property Address ,vet, 1.~J~ (Verification required from r Department for new construction) - City/State 1"( y~%SD rJ Parcel Identification Number D ? 4 ' /~DD- D/ ~ ~FCiAL DESCRIPTION 2~ ~ T ~ N-R 1 W, Town of ~U UJa/J Property Location'/4, s~ '/., Sec. _~, Subdivision t~ D ~ ~lNS > S i~~ -Lot # ~. Certified Survey Map # ,Volume ..Page # Warranty Deed # ~ 3 a ~~ ~ ,Volume 1 S ~ Page # ~ ~ ~ Spec house ~ yes ^ no Lot lines identifiable ~ yes ^ no 'STEM NIAAINTENANCE 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 fimctioa of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, joumeymanplumber, restrictedplumber or a licensedpumperverifyingthat (1) the on-site wastewaterdisposal system is is proper operating condition and/or (2) aRer 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 stn ' y ur septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 of uee Year expirgtiQn_date. ~ .TUBE OF ~~ I~ l ~~ DATE I (we) certify that all statements on this form are true to the best of my (our) lmowledge. I (we) am (are) the owner(s) o arty descn'bed above, by virp}e of a warranty deed recorded in Register of Deeds Office. .TUBE OF 4S j~4~/ ©3 DATE arhnent. **'`**'` Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Dep ~'` 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 POW'I'3 OWN1rLR'S MANUAL M,r~NAGEML~tYT PLAN P~IitV!<1T NU1v113ER ~ J ~~~ OwneC/Agent: ICernon $asi-Lost no, I Hopkins )Jstatos POwT5 Maintainer; Ceo Tech Soil ~ Site 1"SValuation -Chippewa Falls, WI 715-723-8855 Local Regu)atoCy Authority; 5t, Croiz CtSUtrty Zoning Department, Hudson, W1715-386.4682 POWTS Installer: Dattcll Frdzer - Fraser Excavating -13ioomer, W1715.288.62,25 Septage Servicing Operator DESIGN PARAMETIl;It3 lnflucnt/Etiluent qua-ity (values typicol for domestic (nett-comthcrciai wastewater and septic tank eFFluent) 1~ats, Oil and greases (FOd) 4'0 mg/L, Biochemical Oxygen Dert~and (130D) c2z0 mg/L, Total Suspended Solids (TSS) <150 mg/L Soil Loading Ratc (SLR) ~ 0.7 gpd/t12. SY5`~EM SPLCtIFICnT1pNS Tho components of this septic system are inte~tdcd to serve a five-bedroom (750-GI'D) single-family l'tsidcnce, Tho componer~tf Include a NUffctitt 1650 gallon Septic tank, a Zabel A-100/effluent Filter and (3) non-pressurized dislrlbution cells using graveless leaching chambers. A total of 36 Inflltraior Standard leaching chambers are requi>!cd when applying ah k;ISA rating oi' 31.1 as specified by DCOMM. All parts of the components must comply With Wl Adtn. Code COMM 84 and be installed per mnAUfacturer spc`cificatlbns and approval loiters. DESIGN CRITEISaA o "Design of con~entiohal Soil Absorption Tredches fund Beds". R.J. Otis - ASAE Publications 5.77 and Design Manual - Onsite Wristcwiitcr 7`reAimcht and Disposal Systems:. EPA 625/1.80.012 October 1980 ~ SAD -10567-P (R.6/99) "1n ground Absorption component Manual" 0 Sl3D -107US-P (N.O1/Ol) °'In gtouhd Soil Absorption cotrtponcnt Manual" VeCSion 2.D MAINTENANCE & MANAGEMLrNT ~ ~y~~" a~i»ti- .~~, S"Z- Inspect iht conditibtt ofthe treatment tanks snd di rsal cell s a min' um ol'e e t c () ape () _~,~ ty hre y ors fine stpttc tank contents must be reknoved in accorddnce with Chapter NR 113, WI Adtn, Code when the combined sludge and scum ecjuals ope-third (1/3) rho tank Yoluthc. xhe c{Ilucilt ilter should be inspected annually to ensure maxitnuni perkbrmance. s'rAt~T vP For now construction ptlor to use of the POWT5 check trcatmelit tank(s) for presence of painting products or otltor chemicals that may impede the treatment process and/or damage the dispel'sal cell(s). I!'liigh concctiuatiaris are detected ha.Yo the eotitents of the tank(s) removed by a septttge-3clvicing opctaiot prior to use. OPERATION The property owner is responsible For the opetatiob and mainteoancc of the POW'I'S and submission of required repoHs. 'Cho quantity and c)uallty of waslcwater will affect the perform~ca and fonge~Ity of your POWTS. The Installation of water•saving appliances and fixtures along with prompt repglh of leaks rcduoes rho wastewater volume. Also, the brute or waste front water' soflcncrs, iron removal units. and other clear water tretrtmcnt devlees and foundation drains 9heuld be discharged to the ground surlhec whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. The system is designed to handle domestic strength wastewater, however rho disposal of food based gtcasos and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced be a garbage disposal should be minimized. Toilet tl3sue i5 the only paper that should be discharged into the system. Ocher non-biodegcadtible Reins such es baby wipes, tsitipon9. sanitaty napkins, condoms, elgarette butts, dental floss, and cotton swabs should not outer the system. Chemicals such a5 pettoleutri products, paint, diSinFcctarwts, pesticides, stttiblotlcs (r~ledicat%otAS), solvents, etc., should not be Flushed into the system as they can seriously damage yew' 1'OWTS and contaminate your drinking water supply. Maintain regular sies~dy flow by spt'eading the laundry washing throughoin the v~eelt. Avoid vehicle traftlc over all system components. ColTapaction of snow over the writ tray caUSe it to t}eeze Up. Alarms Alarms should be tested nn a regular basis by the homeowner, Tf an alarm sounds, contact an Individual licensed to serve POW7'S. There is normally a one day I'eser~o capacity under regular opcrating conditions, howc.~er avatar should be conserved until any problems with the system are cotrected to prevent baek~up of sewage into the dwelling or sUrihec. .Page 5 of 6 'd 80~'ON WdLb:E E00Z°0Z'JIdW ~jfil. l~r~~f,^~r ~.~e7 63t~1707 STATE BAROF WISCONSIN FORM2- 1999 Y.R~FHLEEN H. WALSH Document Number WARRANTY DEED kEGISTEk OF DEEDS ST. Ck!}IX CO., WI This Deed, made between Wallace L. Billy, a/Wa Wallace Lee RECEIVED FOR RECORD Billy, a/Wa Wallace Billy, and Katharine M. Billy, a/k/a Katharine Billy, 09-28-2400 9:15 AM d/k/a Katharine Bi11v husband and,wife,_ _ __ WARRANTY DEED __ _ _ _ Grantor, and Kernon J. Bast and Donalda J. Speer-Bast, husband and EBEIIPT 8 CERT COPY FEE: wile, - COPY FEE: o,oo TRANSFER FEE: 135 - RECORDING FEE: 10.00 PRGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): SW I/4 of SE1/4 of 1 I-29-19, EXCEPT South 198 feet thereof, St. Croix Counry, Wisconsin. Recording Area Name and Retum Address I/~ ~ L/ 20=~ni3 80 000 Parcel Identification Number (PIN) This is homestead property. (is) 08x00 Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this __~~~Y day of August 2000 AUTHENTICATION Signature(s) Wallace L. Billy, a/Wa Wsllace Lee Billy, s/Wa Wallace Billy, and Katharine M. Billy, a/k/s Katharine Billy, a 1 a Katherine~yB-illy, husband and wife, authenticated this ~da/Iy-of J-.~,r~tJ~- 7Q,G'LJ V' ~- • Kristina OKland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Krishna Oeland Hudson, WI 54016 (Signatures may he authenticated or acknowledged. Both are not necessary.) • Names oTpersons signing in any capacity must be typed WARRANTI' DEED + Wallace L. Bill , a/Wa Wallace Lee Bill , s/Wa Wallsce Billy ~ -- •Katharine M. Bill , a/IJa Katharine Bill , a/k/a Katherine Billy ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. County ) Personally came before me this _ day of the above named to me known to be [he person(s) who executed the foregoing instrument and acknowledged the same. Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: •) Iriam~rwn Prorwnbruls Comrwrry, FaW tlu Lx, WI eooass•zoar ~~ or printed below thou signature. STATE HAR OF WISCONSIN FORM No. 2 - 1999 w...~, ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 Phone: (715)38611680 Fax (715)386686 5 - -~~ Z ~ ~,~ r u ~, , - ~ ,3 ~~ ~~ ~~~ ~ ~ ~~ R ~,~ ~ tease Reply ^ Please ecycle /~~"~.. ~j~'s,~e~ ~-f, ~ y~-~~ ~ ~~ alit ~~i ~il~l+~ ~ Oh~~'. Fay (-~ 15~`~88 (~ 22~ 7 ~~ ~ ~--6 (~67° ~ ^ Urgent ~or Review ^ Pleas c~x.,f~-~ ~ mac. ~ ~ '.~,~~ ~f~ y~,ced sG~-s~i~ ~ ~, S~de~~J ~zo~-° h \~ r~ 1 RESIDENTIAL .I !l1S3 :N - - - - - - - - ao4 ~ oR ~,~~ao as I I ~ d~ pc~, 8 ~ I ~ MU P6Gil4_4C~D ~DQ \ P ~ I?pL36C~6 UG~J N/, ~i9 Ro p(4l~ B~ ----- ----- ---- bi~l I° I Ipl ol~l Ipl 191 I I ~ I ° Idl ~I~I LEGEND ~I ~ AwLauuauNTrsecTaNwwA<x I %'~ NONIMEIlTralT+o a l • ,• FON TRPE FOUID ~ 2' NON PIPE FOUND j// J _ ~ ._._._._ +zuTRnrr~EUEArr ... • • • = R04DWAr sETrwx urE ps sNO1Mq Z X 10DIA 8POT EUYATgN > -1010- NDE7(CONiO11N ~A.~ //}i/V / \ Li _~ NIER/AEDIATE CONTOUR PROPOSED ORR1E 1 I Q ~~ . a EIOgTNO FENCglIE ~'j~ L.J EIXiE OF B(IIMNWB W Z 1 P R O ® 2-20 E CEMSU)PES N ® ZDi'E11CENfANDGREATERSTDPFs aGOa (2.0 AC) auADATAEANEA 1 H.W.L = STORM WATER REiENTTON AREA 70111011 ~ 8~, ~ WATEii WE EIEVAiION ~ N.W.L~ NqN WATER UNE ElEVA7gN MIN. BUILDING MNMIM FN6NED FIDOR O ELEy, 011 WINDOW EIEVATgN ~, J EIOSIND TREEUNE Q EIOSTNG 7REE8 ~~ o I I P~ NOTE NO OWNER OR RESIOEM 61NLL 00 ANYTIN1q I WMCN W WlD NfFAFERE WRN OR CINNDE THE y I OPEMl10N OF THE AT'M10VED CONPREHENSNE WATER ~I ®~ DIMNAGE AND SOL ERDSgN P1AN P0R 7HS PLAT. "~^ "~ TN1sNCUUESSUr1SNOruMREOlONA1DNOUPOfA 4S I Ofi51iM1C7V1G. ALTERING. FiLLNq OR ElICAVATNG OR ~I , PIANINGNAVYPONDEASEMENf&,WA7EAdWNAOE PI ~I OR BASS ASEEDNOB. AV4 WATER CULVERB, BENAS I 9i SE COMER ~I SECOON 11 ~~ _ SCALE IN FEET 1' = 700' 100 O 100 200 S ESTATES 31/4 OF SECTION 71, T29N, R79W, TOWN OF BEING LOT 2 OF CERTIFIED SURVEY NIAP