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HomeMy WebLinkAbout020-1435-05-125Wisconsin Department cf Commerce Safetv~nd Buil6ling Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Schweer, Walter and Ladonna City Village X Township Hudson, Town of CST BM Elev: insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION ~~ ~ ` TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding P NFORMATI Manufacturer ~~ Demand GPM Model Number TDH Lift Friction o m H ad TDH Ft Forcemain Length Dia. Dist. tow I ELEVATION DATA county: St. Croix Sanitary Permit No: 506327 0 State Plan ID No: Parcel Tax No: 020-1435-05-125 SectionlTown/Range/Map No: 11.29.19.2705A20 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer ~ /~ ~ /~~- Zc, t Inlet /16.29 iii. Zq /~5 SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover SOIL ABSORPTION SYSTEM ~ y i~-~~~ ~ '~ ~; ~ /~~~ .~ BED/TRENCH Width Length No. Of rench PlT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pracsure Svstems Only xx Mound Or At-Grade Svstems OnIV Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil f~ Yes ~ No ~ Yes u No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /. Location: 1031 Labarge Rd. Hudson, WI 54016 (NE 1/4 SW 1/4 11 T29N R19W) Joshua Hills Lot 6 Parcel No: 11.29.19.2705A20 1.) Alt BM Description = ~ + ~~ ~- 2.) Bldg sewer length = Z~ ~d~~ 16GC'~~0~ ``,, i l - amount of cover = ~ ~ +~ ~ (v~q,~, ~'V~Ov~~J1 ~{' ` ~ V aV~ ~ P4an revision Required? [~ Yes ^ No /0 ~~ ~~ i / ?ljl~~Q Pt Use other side for additional information. _'___ _ : ~' _ (® ~~ __ _ _ - SBD-6710 (R.3/97) Date Insepc is Sign re Cert. No. .~ e~ b~ -rte' ~,.u~*"`~', ,s~ ~t~~n~i rl~l cvmmerce.wi.gov ' Safety and Buildings Division 201 W. Wasitatgton Ave., P.O. Box 7 i 62 County i , .- ,' ~ ~ ~ Y~ ~ x i s co n ~ i n Madison, WI 53707.7 i 62 t Number (to be filled in by CoJ i Sanitary Perm Department of Cottunsrce // ~ lJ ~---- - Sanitary Permit Application State Transaction Number ` ~ submission of this form to the is o~'enunental I Code Ad 2! Wi i h C &3 2 F , m. omm. ( t . ), s. In accordance w s. unit is required prior to obtaining a sanitary permit. Note: Application Yorms i'or w PU are _ Project Address (if ditTerent thanrnailing address) ~sub+mtted to the Uepanmt:nt of Conunerce. Personal ini'omration you provide may be u s ntfar to roses in xcnrdanec witlt the Privac Law, s 15.04(1 m , Stets %/~~ ~ ~ ~ ~~. er~jLp~ G X077 i. .A tlicution Infannntion -Please Print All Informah n Parcel rr 1'ropeny Uwner s Name Properly Uwner's Maii,ng Address Property Location ~ ~0 ~ /L /-t f ~'j~/f ~ j ~;,, f q i ~d ~ 'r,. ~ ST. CROIX COUNTY 1 govt. Lot / State=- Zip Cody i C,ry- Phone N„mber it/~ y.~~~ '/., Section ~ , _ (circle o,te ' 11. Type of Suildi,eg (cheek ull that apply) ~ ~ Lot # ~ _ _ Subdivision Name ~l or 2 Family Dwelling - Number of Bedrooms __ ~ LL Block # T~s`! W ~ f ~''~Cc ~ Q PubliclCnmmercial -Describe Use ___~_~ ~r ^ Ctly of ~_, _. i i ^ State Owned - Descrii,,: Use _ CSM Number ^ Village of __ V~ lli. ype of Permit: (Check only one box on line A. Complete line B if ppltcabk} _ A. ~ew System ^ Replacernem System ^ TreatmentlHolding Tavk Replacement Only ^ Other Modificauan to @xisung System (explain) ~ ti. [] Perttut Rene al ~J'ermtt Revision ^ hange of Plumber ^ Pamir Transfer to New Uwner List Previous Permit Number and Date Isstteti J ~ ~ 7 ~ ~/~ 7 ~) ~ Before Expiration v O p . lV. T e of PUW'T'S SystemlComponatt/Device• Check ail that apply} il Non-pressurizNd In-Ground ^ Presswized In-Ground ^ At,-~/G,ra~c).e~ ^ , and ~ 24 it oFs~t~le soi ^ o td 24vn. Fsuitable so ~ ® ~ ~~ ~"~y{ e~~ ~~^ Pfettre5tnte r in) ) ~ ~ ~^~ ', ^ Holdrny Tank ^ Uther Dispersal Comportent (explain ~'. Dis ersalll'reatntentAren [nfurmation: Design Flaw (gptl) Design Soil Applicativn Rate(gpds[) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation f Vl. Tank Info Capacity in Total ~ f! of Manufacturer M ~ u Gallons Gallons ~ Units a ~ t j ~ I H •~ 1 Ncw Tanks 7'snka Existin 0. ~ ~ gt ~ ~ a g ~ U y -Segue or Hawing ?ank ~~,) / ! y~ Dosink; Charnbcr ~ ~'~ ~, 1 Vll. Res tonsib(lity Statement- 1, the undersigned, assume responsibility for installatiaa ofth4 POWT wn on the vttached plans, f MPJ PRS NumUa Business Pitone Number I ' ' s Signature s Name (Print) Plumber f Plumber i Plumber's Address (Street, City, State, Zip Code) ~/ VIIL C nt !Dc artntent se Onl _ --1 pproved ^ Disapproved Permit Fee s --dv Date issued ~ ~/) Issr .g Agent natu ~ i ~ /~ / ~ ^ Uwner Given Reason for Denial ~ J ~ ~ CJ ~/ JQ ~ k G IX. Conditions of ApprovnllReasons far Disapi.roval I G ,~~~ ~~ ceq to~ plans for h4 syst4 only onlynly rC~not is uan 6 to - r, U in sia~/GZ ~~~ 5F3D-6398 (R. OV07) Valid ihru Qi/09 SEPTIC TANK ~ PUMn CHAr!F3c:R. CRASS ,~,£C'S'IU~I A~tn SYLC:1t1LH1}w~~ 4" CI VENT PIPE 12" M7N. A80VE GRADE E MEATNERPROQF ?'25' FROM DOOR, WINDOW OR JUNCTION HOX APPROVED FRESH AIR ZNTAKE WITH CONDUIT MANHOLE COVER ~ Lr' / PADLOCK E FINIS HED GRADE ---~-- ---WARNING LABEL ~" CI Rzs~R - ~......- ~ " MIh . 18" IN 6" MAX. ± ** ~ ~ ~~ NLET , ,, , ~ ' ~ ~ WATER TIGHT SEALS ~` , ~'R'' ~ ~ TIGHT ~ ~, _. "~ pPROYEa A SEAL ~ ~ JOIPtTS WYTH ~PROYED ~-~--~- ~ , ALM APPROyEa PIPE IPE 3• ~ $ ~" ~ t ON ~ 3` ahTfl so~YO saY~ N70 SOLID ~ ~ 01L F T ~ PUMP OFF ELEV . --~-- OFF ~'~ RISER EX :T ____ PERMITTED ONLY D IF TANK MANUFACTURER HAS APPROVAL 3" APPROVEp BEDDING UNDER TANK CONCRETE PAD SPECIFTCATIflNS SEPTIC I DOSE ZANK MANUFACTURER: l)_rs_:_~.~~~...~. N'JN;BI:R DaSE5 PER DA`!: 'TANK SIZES : SEPTIC ,lodid GAL. DOSE _ ~,,~,~ GAL t~I.~ARM MANUFACTURER: 1,.-!!a`ya-~~+ ~"~`"` MODEL NUMBER: ~ ~ ~ u SWITCH TYPE : 7_nc rte, PUMP MANUFACTURER : Gov~'s~ MODEL NUMBER : ~~,_,,,,_,_ SWITCH TY P E ~ ,_„~„~~_„_.. REQUIRED DISCHARGE RATE _ il,;[,,, GPM DOSE VQLUME INCLUDING F LOWBAC K : j~ ,___,,,, GAL . CAPACITIES: A = ,~ INCHES = ~,~ GAL. B 2 ~,~, INCHES s__ ~____GA L . C = S INCHES = GAL. I7 = ~„~ INCHES = ~.~GAL . PUMP ~ ALARM WIRING AS PER I LHR I5.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF A"~D DISTRIBUTION PIPE ~ ~~~~ ;MINIMUM NETWORK 5UPFLY PRESSURE ~-~~' + G~ FRET ~'gRCEMAIN X a. FTI100 FT. FRICTION FACTOR ~ FEET TOTAL DYNAMSC HEAD = ~r.~_.Z..FEET INTERNAL DyMENSIONS OF PUMF TAI3K: LENGTH ; WSDTH~„___,,,; JZAME'."ER ,_~„~,,, L I QJ I D L'F~`~ '" ~L' ,~ ~~t r l f~~~ t TCENSE Iv"AMBER: ~?~77~~d RATE: ,,,~/3,~~~•~' _ :/88 Wisconsin fJepartment 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)]. Permit Holder's Name: City Village X Township Schweer, Walter and Ladanna Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION r. TYPE MA _. ~ Septic cv~ (.J t ~~. b o }-1... ~~ F 1~ d a lw Aeration Holding TANK SETBACK INFORMATION u v TANK TO P/ /~ a C~- WELL BLDG. Nom- J.~n. Vent to Air Intake ~'¢.~' ROAD Septic ,7S ~~ 3 1 7 Sid 1 _--_ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss Syst ead TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM County. St. Croix Sanitary Permit No: 506327 0 State Plan ID No: Parcel Tax No: 020-1435-05-125 SectionlTown/Range/Map No: 11.29.19.2705A20 ELEVATION DATA STATION BS HI FS ELEV. enchmark ~r /~ d ~' Alt. BM ~ p /DC~ • d Bldg. Sewer ~, ~, 5 ~tS 7. ,s SUHt Inlet S. C.P /a 5 SUHt Outlet 6,d /n5~• Dt Inlet ~ Dt Bottom ,_ ~ Header/Man. (o ,~C, ~Q Y y5 Dist. Pipe (p. ~Z. 7•~+S /6 . 7 o3•~S Bot. System WQ,'~~" -~ • $Z •y5 /O Z • -7~8 • ~ 5 ~nz Final Grade 3 •,..i // ~~ to " St Covet!'." t Za.~.. c~ Z • Z.. ~ ~ /ls9 BED/TRENCH DIMENSIONS Width t 3 Length ~ ~( T No. Of Trenches Z Ce~c.~~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth _~ SETBACK INFORMATION SYSTEM TO P/L WELL LAKE/STREAM LEACHING CHAMBER OR Manufactur r: ((~~ ~ k'+ ~ ~'Co.,'~'~`, TypC o ~ J ~D Z I / ~ ~,,,, 1~ A'~ UNIT Model Nu ber: G~ ~ w DISTRIBUTION SYSTEM N~ri.~l.. " ' Rt- Header/Manifold ~ Distribution x Hole Size x Hole Spacing Vent to Air to / ~ ~ Pipe(s) ~ ~ Di i ~ \ z r~ Length Dia Length a pac ng SOIL COVER x Pressure Svstems Only xx Mound Or At-Grade Svstems Onlv Depth Over Bed/Trench Center k 1.~ Depth Over Bedlrrench Edges ~ xx Depth of Topsoil xx Seeded/Sodded Yes ~ No xx Mulched Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1031 Labarge Hudson, WI 54016 (NE 1/4 SW 1/4 11 T29N R19W) NA Lot 6 Parcel No: 11.29.19.2705A20 1.) Alt BM Description = ~~ I ~" G~J~~" G ~; ,.,g t~ ~Oc~.~ ~'~ 2.) Bldg sewer length = ~'s ~ ~~ ~ ~ 5°~~ ~. - amount of cover = ~ v``"' Plan revision Required? ~ Yes ~No ~_~ L _ ~ __. __ _-_-__ _ _. __._ __- _- ~ ( / ~'~~. _ Use other side for additional information. ~ / ~ ~ ~~ li tQ Date Insepctor' Signatu Cert. No. SBD-6710 (R.3/97) COtT11Tt@rCe.WI.~OV ,'~ Saft:ty and Buiidn~gs Division 201 W W hi P County - , ~ . as ngton Ave., .O. Box 7t , ' x ____~ ~~~,~ ' ~ C 4 ~ ~ ~ n Madison, WI 5370 9-71 b2 3ani Permit Number (to be filled in by Co.) Gepartr+IOM of Commoros ( 1 ' '~f 6 Sanitary Permit Application : slat n "° m a ~r In accordance with s. Comm. 83.21{2), Wis. Adm. Cade, submission of thts form to the appropriate governmental / ~ • I /V -"t' ~i unit is required prior to obtaining a sanitary permit. Note; Application fornts I'or state-owned submitted to the Dapa+,ment ef• Commerce, Yersm,al information you provide may be used fo secun ~(If i rentthanmaitingaddress) i ~ur~xtses in at xudance with the Privacy Laws. I S.U4(I){m), Slats. ~J. ~ ~jetje~•~. ' 1. A licattmr information - Plense Print Al rmatton /~ ~ ~ ~(~' I' ' O ropeny wner s iVan>e P n ` / ' rt ' A a~ C ~ ~ ~ < Propcny Owner s Mailing Address ! ~~-lGf ~ / G ' ~ ST• ~ n ~ j . Z7~5~ -~ cr ~ s- ~.~ - ov<. t Ciry, State zi C d p o e ~ Phone Number .~~ y., ~' '/.. Section ~,[ ~~.~ ~/~ ~~~ ~ , / ~~~~ CSC ,~ , (circle one ( ~f T ~ N R L l I. 3'y a of Buihlin p g (check alt that appiy) Ok ~ t.ot # ~ _ ar( ; ~___ I f ~! ar ?. Family Uw oiling - Numt+er of Bedronnu _ Subdivi sia nNa me ~ ~ ~ d PublitlComn,erctai - tkscribe Clse _ ~--P -q,,~ `~ ^ city or __.. t Q State Owned - Descrilx Use CSM Number [] Village of _____._~ / L ~ U~Sa'"• ~',5 c...~ ~ f`l C`(,,~ _ v~ ~~ ~9~5 ~7ownof ~/'6G Sd-~ t lU. T ype of Permit: (Ckteck onl one box on lice A. Complete line B if upplica le A• 1 ~_ ew System ------~ ^ Replacement Systcrr~ ~ O Treaurrtrnt/Floiding Tank Replacemen[ Only ^ Qtfier Moditicatiun to Existing System {explain) ~ R. O Perqut Renewal Before Ex iration ^ Permit Revision ^ Chan of Plumber ge ^ Petmit Transti,r to New List Provisos Pern,it Number and Datc Issued ~~ ~ ~ p Owner ` r ~ tV. T yne of POWTS SystentlComeonent/Device: (Check all that appiy) ~~~ ~~~,~ ~ ~tion-Pressurized in-Ground O Presstuized In-Ground ^ At-Grade ^ Mound ? 24 in. ofsuitablP sail _ ^ Mound < 24 u,. of swtable soil ~ ^ Bolding Tank Ot,er Dispersal C'umpanent (explain)__ ~ [~ Pretreahnent Device (expiaini ~ ~ r I y'. Dis ersal/I'reatmentAroa InformptFan: ~ ~~~t U - - , esign Flow (gpd) Design Soil Application Rate{gpdsf) Dispersal Area R uired (st) Dispersal Are a Proposed (sr) System Elevation +~ ~ y'1. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ~ ~ ° ~ y • Ncw Tanks Existiub Tanks ~ / ' ~ ~ ~; a 1 `~.° r; i ` a J ~ a ~ ~ ` ~ w ~ _ ~,~/ / d! i t i t r n t.7 a Septic or Holding Tank `/UG/ l 4 ~i ." ~ !~ , , /.~ ~ Easing Chamber - ~'ii. Responsibility Statemtnt- I, Ilse undersigned, assume reaponsibillty for installation of the POW'1'S ~ own on the uttuched marts. ~ Plumber's Namc (Print) Plumber's Signature Pits Number ~~ C~usiness Phone Number Plumber's Address {Street, City, State, Zip Code) ~,,. ~- /~ j ~'lIl. Count !De artment Use Ont -~-i i t Foe Date sued lssui+,g Approved Disapproved $erm t Signature ill ~ j iven Reason For I 7 ~~ '~ 9~ 7 D 7 1 IX. Condl;Qjy`I~easons for Disspi.roval pp , 1. $optic tank, effluent lifter acrd 3) ~o ~ p~ raj tAti. ~ Va.a, r ti ~o.. ~ i P ~ dispert;al ce8 must all be services /maintained as per management plan provided by plumber. ~° A~~~^ 0 f 2. •Aq stttback tt~tirements must be maintained i ~ i~ aPP t~ / otdtrinces. Masco +o co+npwrr puns to,• the system ono submit to it+e County Duly oa paper not toss Ihan 8 to x I I inches in sire SF3D-6398 (R. Ot/07) Valid thtu Ol/09 1 v V 6Qa c °~ J V 4: ~ ~ ~\~ ~JJ ~ : ~ ~ t, ~, ~ O Q e _` ~~3~ ~~ ~~ ~~~ ~~ ~ar~~ ;~- ~~ -'~ z ~~SC011S11! Department of Commerce rlivicinn of Rafo4v and Rnilrlinna SOIL EVALUATION REPORT A ~--yn accordance with Comm 85, Wis. Adm. Code #1660 Page 1 of 3 Steel's Soil Service, Inc. v v County Attach complete site plan on paper n %: x 11 inches in size . Plan must St. Croix include, but not limited to: verti d al reference point (BM), direction and D Parcel I percent slope, scale or dimen 1 n , rrow and location and distance to nearest road. . . ' Pen g Pleas in all infd~V E D Reviewed By Date Personal information you provide may be u for secondary purposes (Privacy L , s. 15.04 (t) (m)). y Z ~ ~} Property Owner qp~ 2 i 2005 ropertyLocation Felling, Bitl & Liz ovt. Lot na NE1/4, SW /4, S11, T29N, R19W Property Owner's Mailing Address ST. CROIX COUNTY of # Block # Subd. Name or CSM# 1026 Tanney Ln. ZONING OFFICE 6 na Joshua Hills City State Zip Code Phone Number ~ City ^ Village ~ Town Nearest Road Hudson WI 54016 715-381-1240 Hudson Labarge ^ New Construction Use: ~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ^ Replacement ^ Public or commercial -Describe: na Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable na tt. General comments Conventional system, system elevation 9~_ Trenches spaced and depth to code 5.75tt below grade. and recommendations: Boring # ~ Boring ^ Pit Ground surface elev. 104.40 tt. Depth to limiting factor 110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP Dlft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#t 'Eff#2 1 0-15 10yr 3/2 none I 2msbk mfr cs if .6 .8 2 15-53 10yr4/4 none sicl 2msbk mfr cb is .4 .6 3 53-110 7.5yr4/4 none cos osg ml na na .7 1.6 L a Boring # ^ Boring ^ Pit Ground surface elev. 104.40 tt. Depth to limiting factor 110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EH#1 'Eff#2 1 0-12 l0yr 3/2 none I 2msbk mfr cs if .6 .8 2 12-50 10yr4/4 none sicl 2msbk mfr cb is .4 .6 3 50-110 7.5yr 4/4 none cos osg ml na na .7 1.6 Effluent #1 = BODS> 30 < 220 mg/L and I1"SS >30 < 150 mg/L `Effluent #2 = BODS <_30 mg/L and TSS <_30 mg/L CST Name (Please Print) -• ignat re: _ CST Number David J. Steel 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 4/19/2005 715-760-0347 SBD-83301R.07/W 1 Property Owner Felling, Bill & Liz Parcel ID # Pending Page 2 of 3 Boring # ^ Boring ^ pit Ground surface elev. 99.30 ft. Depth to limiting factor 110 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 0-24 10yr 3/2 none I 2msbk mfr cs if .6 .8 2 24-60 10yr4/4 none sicl 2msbk mfr cb 1c .4 .6 3 60-110 7.5yr4/4 none cos osg ml na na .7 1.6 3~ ^ Boring # ^ Boring v ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description TeMure Structure Consistence Boundary Roots GPDfftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ 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 GPDfft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Et(#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BODS < 30 mg/Land TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/001 Stcel'S SON Service, Irl[. STEEL'S SOIL SERVICE INC. David J. Steel Bill & Liz Felling 994 200th St CST-POWTSM NE1/4,SW1/4,SI1,T29N,R19W Baldwin, WI 54002 Lic. #248956 Town of Hudson, St. Croix Co. Cell(715) 760-0347 Lot 6, Pending Fax.(715) 684-3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend 1" = 40' • =Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • =Alt Benchmark Ele. 99.20 ft Top of 3/4" pvc pipe ~ =Borings Boring Elevations B 1 = 104.40 ft B2 = 104.40 ft B3 = 99.30 ft B4 = 0.00 ft ~\ 95~ ~~~ ~v ~'~ ~ ~ ~ ~'~, ~oz,a~- ~~~- ~~ ~~. ~ 3~~ 1310 (off. ice. ~ ~ 3c~a- 3of3 N ~'. ~L- ,~5, ~s~ l~~ ~-~~ t _ ....~~ _ n'2 ~4 ~„ - ?9 9 _ .~ • b r z m ~`~ OD OD CO --~ •~ ~1 • „„ ,,~ ~~ w ~~. -. 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CROIX COtTN1'Y SEPTtC TANK MAIN?EI~iANCE AGREEMEI3T AND OWNERSHIP CERTIIt'ICATION FORM Ownear/8uyer Mailing Address Property Add City/Stdc ~~Lf (~SOr~-„_,_„~ ~ _, Panx, Identification IVUmbeC Oaf' - 1 X3.5'- y5 - /as . Pra{xatty Location ~. I~'/.. ~ •'h . Scx~. ~ T ~N R._~W, Town of .__,~~___c~t.~._._.• Subdivision ~~ ~ I.t ~ ~~ ~_ ~ ,Lac # ~t$ cer~a sates r~ a ~•Z~~- v , voittme > ~ , Pttg~ ~ ~7r'S . wtttrraaty Deed N _,~~' ~ ~ T ~ ~____ ,Volume __, ,page ~ Spbc house yea 1..~ Lot tiler idaati!$ble ~ ac+ Intpeopeir tilt: wal taritrreaaape of y~ov reptic sy~teat coald temp fa Its ptettWare grflute W lnodle wt~+oes. ~"tv(ta r:w'ra~aaaoc v~msbxr of ptrnpiog oat the saptic soak every tree l~ or sooner, if needed, bP a liorrated ptutpee. VVltat you pnt mto tltt tyarota Can ttTaCt the fttoctiot- of the tepoic Wmic u a kottttteat ~ o, the waste ditpioal sy:7em. Owner uMi~eotu+ce tt~pansi6~ei uc apcc+'l4dd is ~Conutn. 63.52(2) and in Chtrpeet 1 t -ac Glraix C.cwaty Sttittry tSrditnoce. Thr pe+operry+ awaer ~ to submit to St. Croix Goody Plntt~og ~ 2miag Ikptttnaeat a pertilicatitta tarn, signed by the owner and by a artrfer plumber, joeaneynra phatiiKr, restricted pkmober br a l+x~ed patapar xatifyiag thtt (1) tltc oa~i®e wa~ewatet disposal ayateta is in pt+npa operating caadioioa tudler (2) slttic intpa~lion sad putopioJK (if tt~ota~rrty), the eeplic a~ u lens than tf3 tittl of tJttdge. Uwz, the atwlrtsibaed iltve retd IMe above trxpdrraratts tad tgter• rn t~tietaia the prieate ttewage di~osii syancm writh t6s: wttduda let Barris, herein, u set try tba Degtaaeat ot(:oaunerce tqd the Ugpnnrnan of hatt;rtt Rttottrcet, Sd-te of K'tcuontitt. Catd6cstiop t that >rxte srpoc ayatten hss betc- aaidained mast be. eoropkted told retttra~ed b Ate lat. Croiu County !'ltaaiug dt ZtmietE witbia 30 days oT lire ttota yen espaatioa date_ Uwe certify thtt ap staeenteatr oa this £orra ate ttwa ao the best of ary~oac knowledge. Uaro atnhrs the owtttr(s j of the v-avtnY described sitoue, by vittte~ta wnraanr deed m~ded in R~grither otDreds Otllce. 2 a Natrpber of J AT[IRE OF 9~ G; a~ DATE ~, "'•Any iafortttatiast tbu tt taiataptetetttedmoy resWt in the mniatry pextttit being rew>ved by the Plutaieg dr 7.,oniug Aeprraaettt "`• It-c lade witl+ d~;+ rM,lirreiet- K rc~•orderd wncttay deed tmm Me Red+aa of lkedr Cttllne sad a copy of the cettificd survey tarp it trfettaree it spade is the +-wrtaaty dried. tlitlf". OANS1 Q ~~- ,~- has o rl n a, ~ ~ l~ t?~ ~ -_.-..._ . POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page FILE iNFORMATiON owner -~/~ s~~r~ ~ ~ Permit ,~ DESlQN PARAMETERS Number of Bedrooms ~' ^ Nq Number of Public Facility Units ^ NA Estimated flaw (average) 1f~"'d __-__ al/da Design flow (peak!, (Estimated x t .5! ~-() at/da Soli Application Rate :al(daylft~ Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease )FOG) 530 mg/L Biochemical Oxygen Demand tBOD6? x220 mglL ^ NA Total Suspended Solids (TSSI 5150 mglL Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand {BODbi 530 mg/L Total Suspended Solids (TSSD ~ S30 mglL ^ NA Fecal Coliform dgeometric mean) 510' cfu/100rn1 Maximum Effluent Particle Size Ya ivt die. ^ NA Other: ^ NA "Values typical for domestic weacewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFlCA'nONS of Septic Tank Capacity d®d ai ^ NA Septic Tank Manufacturer l~ir~•.x'c~ r ^ NA Effluent Filter Manufacturer e ' a ~ ^ NA Effluent Filter Model SZ ~j ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ~' ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ NA ^ SandlGravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal CeU(sl d NA ^ in-Ground {gravity) ^ In-Ground (pressurized) ©At-Grade ^ Mound ^ Drip-Line ^ Other: __ Other: ._ ^ NA ~ Other: . ^ NA Other: ^ NA Service Event ~ Servrce Frequency lnspect condition of tank(s) Ai least once every: ~ month(s) (Maxirrntni 3 years! earls) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third {Y3i of tank volume ^ NA Inspect dispersal ceills! ~ _ _ At least once every: ^! month(s) {Maximum S years} .~ ~ ear(s) ^ NA r Clean effluent filter At least once every: ! ~~{s) ~ ~ yearisl ^ NA Inspect pump, pump controls & alarm _ ~~ At least once every: _ r-- ^ montt-Isl ^ year{si . ~' ^ NA Flush laterals and pressure test At least orsce every: ~ ^ month(e! , ..-' ^ year(s) ^ NA other: __ At least once every: ^ month(s) ^ yearlsi ^ NA Qther: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shalt be made by an individual carrying one of the following I'rCenses or certifications; Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; 5eptage Servicing Operator. Tank inspections must include a visual inspection of the tankls! to identify any missing or broken hardware, identify any cracks or teaks, measure the volume of combined sludge and scum and tc shack for any back up or ponding of effluent an the ground surface. The dispersal ceil(s! shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent an the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third tY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR t 9 3, Wisconsin Administrative Coda. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized pomponents, pretreatment units, and any servicing at intervals of 512 months, shag be performed by a certified POWTS Maintainer. A service report shat) be provided to the Iocal regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION , For new construction, prior to use of the PQWTS check treatment tank{s! for the 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. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal celllsi in one large dose, overloading the cell{si and may result in the backup or surface discharge rf effluent. To avoid this situation have the contents of the pump lank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or PQWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade sail absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the PQWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump} water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; nil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the PQWTS fails andlor is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: + AI! piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, ail tanks and pies shalt be excavated and removed or their covers removed and the void space filled with sail, gravel or another inert solid material. CONTINGENCY PLAN If the PQWTS faits 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, lot lines and weds. 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 PQWTS technology a holding tank may be installed as a last resort to replace the failed PQWTS. ~~ ^ T sit d site e ;ank .~ O Mound and at-grade sot! 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. <WARNINO> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND10R INSUFFICIENT OXYGEN. Utz NOT ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DtFFIGULT OR IMPOSSIBLE. ADDITIONAL COMMENTS PQWTS INSTALLER Name ~~ ~li ~ ky"~ ~ ~C~s'~f? y' Phone ~ l _ ~ _ ~ PQWTS MAINTAINER Name Phone SEPTA(iE SERVICINQ OPERATOR (PUMPER) LOCAL RE[iULATORY AUTHORITY Name Name Phone 4 Phone this document was draped in compliance with chapter Comm 83.2212i1b}Itiddi~lfi and 83.54(11, 121 & 13), Wisconsin Administrative Code. pegs of START UP AND OPERATION -- For new construction, prwr to use of the POWTS check treatment tanks} for the presence of painting products or other chemical, that may impede the treatment process and/or damage tote dispersal cell(s). !f high concentrations are detected have the contents of the tank{s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. buying power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge Gf effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells, po not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade sail absorption area. Reduction or elimination of the following from the wastewater stream may improves the performance and prolong the fife of the f'OWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump} water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ails painting products: pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shah be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shah be disconnected and the abandoned pipe openings sealed. • The contents of ail tanks and pits shah be removed and properly disposed of by a Septage Servicing Operator. • After pumping, ail tanks and pits shalt be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid ma±erial. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code complianx replacement system: ^ A suitable rep#acernent area has been evaluated and may be utilized for the locat"-on 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, lot lines and wets. Failure io protect the replacement area will .:...result in the need for a new sail and s'ste evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect ai 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 insta3lled as a fast resort to replace the failed f'OWTS. U/~ ^ T sit d site //"~~ e ~, tank O Mound and at-grade sot! absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reaonstruations of such systems must comply with the rules in effect at that time. < <WARNINO> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. Lta NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFF(GULT OR iMPOSSiSLE. ADDITIONAL COMMENTS POWTS iNSTALLER POWTS MAINTAINER Name ~~~f~,~u ~, ~~~~ y, Name Phone ~ l -_ ~ _ ~, a Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY iVame Name Phone Phone phis document was drafted in compliance with chapter Comm 83.22(2#(b?ti }{df~fflf} attd 83.54111, t2} & 131, tMscansfn Administrative Code. August 16, 21107 6:13 AM From: Schweer Fax Number: tiTa1F Rr1R OF tt`ISC:URSI\ FORS 2- ?tH)E) ii'~RR.tNI'Y t)F.ED 'flll~ UEh:ll, utadr bru~relt Jat}Irs 3. tlliott a•k'a Jaa}es LElia{t and rcnaifcr J. I•:Ilil)tt a:kla .Icunifcr I-aliutL latshaltd and wife, ("iranlcK, aitd w"ailer c;, khr~•~cr ancj t.adunn:t ti. tirht~rer, hu~hand and w°ifi•, tls Snrtiit•txS])il~ iriarital Ym~cny, tirantec. (Jrarnor, for a kalrlaE~le c~nsictzratiun, can~eys atrcl ~\•alrams t~ (.iralnee thr Rrlluwinl; drrribcd real esWtr in St. ('ruix C'ount}•. State c)f ti'isexH)silt SFF. 1TT~Ci1F,D F.\NiR1T A Page 2 of 3 Kl'tnr(iiOC Area \untr ;tnd Hcttun Atldtt~s- Gdina kcaltp ~Cir(c, Inc. =l(At S. 3 ~ St. Suilr I i i 1:~rc1)ti.~nc rc) ~iannnties: 1 luct;nn. ~1'I 't-tU 1 h iasrntrnts. rrstrictiuns:ual rights-a1=~\ay u( crcr-rrd, if uny. fit126i1 U2U-l~z~-0~-13~ _ P:u:,d kirnuhwtinn Vmulxr [I'IK-- This is tart huntcstead pnrpcny. I)ntrcl this 1 [th r4r~~ ~d 4pril. Z(N)7. t ~' ~ r } /~'^ ~~ 1_ ~ • ,: J _: ~ ~ `~~_~ ~ . J,Yturs J. L•IhtsK'av~:aJatnes Eiliutt :f /: :1t1'1'HE11'ICA'CION ~~ tut~tlt~~t;~ m~ 1 , ,~,y( bra. ?ao. ~~ l I'I 1.1': i•11i1dliliR 11',1 fL R:1K OF 1i`ItiCU.\'S1\ 11f uot. authurizcci b~• ti ?I)b.Ob, t5'u. ~tals.j I1Uti SKtilk{C~{FA I \1:\ti tlMaH r1;U ltd Pittr.<uo, Dram cC Iitrgrnan - tilcticc) ii, i3runti ~U L:.:is1 l~il'th SErCCt, St. Yaul. iil\ ~~ It) [ I Sianal.uc. qia}' ~~x- a.dhcaraJti•tl ar :_ i.~mwlcd~tivt {So II: arc uol m~CCaS:nT. i 'Y;utr> al Im~suc. >tp,uu~ in Jae C;t~RIC{1~: nw;>I ac typed or pt uut~l aelew ttipr ~i~rteUU~c ,~ ~ •) / ~ ,. , ..- f .,1~ cnnifrr J.~t-jliiuu •ia.lcllciifcr 1=lli~xt --* - aCK,~C)VYLCDC;~IEV 1 ST.~TT C?F 1~'c'ISC'C)VSii~ ) 5'r. c'kcxx t'c)unr"rv_ ~ 15s. 1'crsonaily came hefixl.~ nw this ~il)ri! 1 I, d(!n"i the ahon Wanted Janlt:5 J. liUiult aka James Rlhutt and Jennifer J. I:Iliatt aik'a .lumifcr 1:11iott, 1)urband and }~~ifc to ntc I:tx)wn to be the pecson(st w•hn executed the toreeoine instnunent and aektro~+Ird~.ecl Ihl: +att~e. i 1 ~ *1'amela J. Goulet hotar.• Public:, Stale of R'isamsin _-- A~Iy cummissinn is pcrmm~rnt SI1 nut, state expiration datr:: l0%lI=2UUU j 1'~'I tt:11.~lt UF' a 1SC'U`Itil V 1'UR\I \n.2-2W11 ~, August 16.2007 6:13 AM From: Schweer Fax Number: Page 3 of 3 r