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Home My WebLink About020-1472-00-001 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 579037 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Duran, Joseph Hudson, Town of 020-1472-00-001 I 1- Insp. BM Elev: BM Description: Sectionrrown/Range/Map No: CST BM Elev: 22.29.19.2990 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT 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 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 BedlTrench Edges Topsoil Yes Efl No Yes No a COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 826 Germain Lane Hudson, WI 54016 (Unknown 0 Unknown) Cedar Wins Estates Lot 1 Parcel No: 22.29.19.2990 1.) Alt BM Description = ; . 2.) Bldg sewer length = - amount of cover = Mj I i Plan revision Required? ® Yes No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3197) d ! ~ i ~R Cf` ~ `X v~ V ~ K O e c T h h a 0 t f \j y ° Nq -13 I1~ r ~ a ^ \Q~ V Z~ o` I •n ° G Z % % `O Y~vN V 1r.~~r3~r9d3Y t ~ V 3 ~ `a v v, 0~ \~t ~J p C `o W ~ ~ I v "t N1 JC Py v Q , VZECEIVED !r~ du ervices Division Count} I~lOashington Ave S1 0/ x 0UNW P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) S C 94T noix [JEvaopmENT S L i NV153707 3162 _ 1 l.J Y Sanity Feign Applications State Transaction N b In accordance with SPS 38321(2), Wis. Adm_ Code, submission of this form to the appropriate?overnmental unit is required prior to obtaining a sanitary permit Note- Application forms for state-owned POWfS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary Lane u ores in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 1. _ lication information-Please P E'% All Information -K L7Ei~~l~ir✓ & " Property O«nees Name Parcel A N 6WO- /Y7.7- ao - oo t -J-6 4- URA Property (Owner's Mailing f Address Property Location z q - l V 2 `IL4 - r 2-t-tkh S+ Govt. Lot Zip Code //Phone Number V., Section o?e2 Cityy,.State 5. - `1,I /~1, / T R ~~circ~0 V0 r 11. 't'ype of Building (cheek all that apply) Lot f 191 or 2 Family D.veiling-Number of Bedrooms / Subdivision Name ,1 Q in t) Block ZEQAR C5 TATds ❑ Public/Commercial-Describe Use o, 1 t ,n~1•~ A d State Otified - Describe Use 4-vYJ S-M Number of 2 61 9-160 -DN C S A 6 Z 5 ) MS" Toy of uDSe.J 111. T eek only one bog; on line A Complete the B if applicable) A- New System Replacement System II Treatment/Holding Tank Replacement Only ❑ Other Modification to Existine System (complain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber II Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner o = Cog nent/Dm ice: (Check all that anply) F\ la i +f ,9Non-Pressurized In-Ground Pressurized In-Ground ❑ At-Grade ❑ 1iound > 2d in. of suitable soil II Mound <24 in. of suitabl oil ' . q ~~lV o mg er Dispersal Component (ex-plain) ❑ Pretreatment Device (explain) J 1y V. Dispersal/ Treatm nt Area information: Design Flow (apd) Design Soil Application Ra~e(gpdsfl Dispersal. Arm Required Dispersal Area Proposed,le{'l System Elevation e 6o , G /ooo /00 91. 93.8 / 93. 0? Vt. Tank Info Capacity in Total ii of Manufacturer U Gallons Gallons Units i o New Tanks Existing Tanks V Vk n ~ `v n ~ C v art-I U ,L ~ rn lis W2 Scptiz or /,?So - ago / ~1iss~~ Coelt.6~rE I Dosing Chamber I V11. Responsibility Statement- 1, the undersigned, assume responsibility for • tallation of the POWTS shorn on the attached plans. Plumbers Name (Print) Plumber's Sierr IvIPR~S Number Business Phone Number ~f 0/I/,eJ ~EL,ttE , ~ ,?3 131 5744 Plumbers Address (Street, City_ State, Zip Code) /V L.? 98 6Sr. wA S ~u/t.~aD GJ.I- SY734 VW. County/De artment Use Only Approved =2iven Permit Fee Date Issued? Issuing Agent Signature -7/Z-J Reason far ial $ 1X. Conditions~g llReasons for Disapproval SYSTEM: V~C ij I l't'' NIL~Z 1. Septic tank, effluent (alter and ✓ il e L) i'nt wn]S J dispersal cell ll mersk Must l~,serv~iced 1 maintained I as per management requirements plan provided by rained plumber. e Z co 2. All setback ack must be maintained r as per ap e Q .e dr the system and submit t e county ooly on p r less thin 3 112 x 11 inc ensue 1 A6t IS) SBD-6398 (R- 08114) N LO M (Y) N un o 0 0 r-i -0 0 0 0 O cd LO o v N p r- N O p V N O Ln Q m ~l O N h Ln N Q O cd Z .x ~ H U r..s: 1 :3 N U N OU U U Q a~ -I s X1-4 4 ~ Z o U U a C7 > -P J 0 Q O .J N a N > r w J o f4 W O Q o o X h m o •,i Q Ln to o Q0 QO 0 Z ~ tS Ln LO ~.O m u a 4 aU Y 0 J w a Private Onsite Wastewater Treat ment System hidea and Title Page Project Na m: f0~' ,QGRA-J 1~,~. ~•J l tau,+4 ~asr TS du mes Address- Legal Desadptrom .Sa1, g,.? 9 N. i 9t.~ unidpaw- Tower , @KY of Almosad _ Couuty: Sr ~iGO/ X Sibd?visi(n Name: LE' ,m Ah., $ Es rfres Lot Number. / Blockivumber. Parcel .!.D. N13mber: 0,2o - /y72 - ed - ao Page 1 .-~ea- x + VI-re c Sf~~ r Page 2 Aor A-4-j 'VAG~eoss- sic rio,-j 6~4 4),;Z-is Paige 3 .-.50~coorzo do t-/~c ~l~ er~rc~ria. s Pageor~T'.S G~J,t>EY1 `s ~~+~I.,Iu~~ r ~~A.~t Page tt dt rt tt tt Page 6 rex Alfr1w rg- -~v.,. Pa;e 7 Page 8 F~Gj°9~Rr:rs a so~~cr~ [asti+-roa /~Ed~oa r- Page 9 Dame of Designer. o y.V f x£ License Number: /Y/- 07313 yi Sigre: Date: 7- /8- aoiS Designed fio #:be PoiloAng POD Oomp6nonj Manuel a ad -5,4-5 81-83: -Ground Sod Abso ion CoMou t Mauusl fog pow Ts (Ver. 2.0) SBD-10705-P (N. 01101) Th- ~ r Nn '4, `mot y ~ ~ 'Z W ~ +v zz M13= rv~ x IV T Q Jy - i, d T a~ W a v o a: M J v N ~ ~ a :a `oQ ~ y ~ ~ C o 0 ~ m \j 43 \j -4 'k Q ~°p mop h to ---C- 0 ~ v lit W V V V pZ h dN`~ V ~ J 0 C::3 ,x ON 0 'C Y~vI' V 1r7sra)r9S3Y lb b o. vz\ h ~ C o ~ +u ~ I h 14 W~ p ~ d ~ Q~ o c® y Q v 72r ss" ' a rR 53" a z c m 0 m o UP 52" m 4" CAS / ~ i rn r O to D m 3-" 47" 4" o x a m C s a v -n rl can UP 49" \ m r' 4" CAS N N v m rn o"'-°n c ~D~ m 50" k v n z m r > D Z m CD z 0 m r t cn 0 > D mn r O a rn r- x~ 0 D z a m O w Z A Z Z O O 'D rZ- D D j,Z Z DOZ v D G~ D ~m ~m~0 ODEn 0 c: C, rrl cv vX rri z vrtn > ~00 v wow cm)- 2=m :1 F, -Niy wrn CC.) m (n >-miZ > rn0p rn~0 erg.. ~-10~ ANN (f} c: - OD rn Z 2 cn DOr --1Zrn 0> r, NrA m °o NN pmt m (JI - 0 D O OD rn a -4 a t N F =I 0 ; s, r- -o N C) D z D N toaD to d v n z o ao v_ rn -4 N W cnz 2 N m - tnm~ ta> =wb;vV 0 9-0 9) o C) 'rl ° c 0 o O z z .0 En 0 m m U) m cn o v'o D v m z o Z n CD C C ~ (A 0 r C i= > D O 0 2i °D rp mm m D rn K r*1 0 D p z r -I C-) D v m ~o H z 0 z D v m a v m Z r O ~ D y _4 0 'n Ojo U) 0 v z 0 rn cn 22 0 O rr~* .0 0 V) ~ m '0 0 m N z ~D 0 o n =O 'a O N m r m ODD F D O z ;D H 0 0 z m 'o i m W1250-MR MISER 68~CBETE DRAViRJ BY. SCALE: 6E-POUR O -4 SEPTIC MANUAL DATE: JANUARY M310 DAREV. TE.. DST-POUR Z W3716 US HWY 10 MAIDEN ROCK, Nll 54750 ° REVISED JAN. 2010 800-325-8456 FILE WtW-W 'I POWTS € WNER'S MANUAL & MANAGEMENT PLAN Page V of -i~ FILE INFORMATION SYSTEM SPECIFICATIONS Owner C Tank Manufacturer. All C-594 LO.JuirE ❑ NA Permit iTSeptic ❑ Dose ❑ Holding Volume: 1,?,Sd (gal) DESIGN PARAMETERS Tank Manufacturer. UNA . Number of Bedrooms- ❑ NA ❑ Septic CIDose ❑ Holding Volume: (Sal) Number of Public Facility Units: ® NA Vertical Distance Tank Bottom(s) to Service Pad: (ft) Estimated (average) Flow : .flpd (gaUday) Horizontal Distance Tank(s) to Service Pad: 84 (ft) Specific servicing mechanics must be provided if vertical is >15 feet or Design (peak) Flow = (estimated x 1.5): Zoo (gaUday) if haftmial is >150 feet. Speci is instructions to be provided on back. In Situ Soil Application Rate: (gaUday/ff) Effluent Filter Manufacturer. !a E.9 T . DNA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: Lsf-/4 Fats, Oil & Grease (FOG) <_30 mg/L Pump Manufacturer. Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA - ZNA Total Suspended Solids (TSS) <050 mg/L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L - Manufacturer. (BODs) >220 mg1L [1 NA p Mechardcal Aeration ❑ Peat Filter 19 NA (rS5) >150 mg/L ❑ bisinfection ❑ Wetland Pretreated Effluent Monthly average p Sand/Gravel Fil`.er ❑ other: (BOD3) 530 mg/L Soil Absorption System (rSS) 530 mg/L ❑ NA Fecal Coi"form (geometric mean) 510, " Ag In-Ground (gravity) ❑ In-Ground (pressure) El NA ❑ At-Grade ❑ Mound Maximum Effluent Particle Size '/a in dia. ❑ NA 0 Drip-Line Other. Other: ❑ NA Other. p NA MAINTENANCE SCHEDULE Service Event Service Frequency ('When combined sludge and scum equals one-third of tank volume Pump out contents of tank(s) 17 When the high water alarm is activated Inspect condition of tank(s) -At least once every: 3 y year(s) (Maximum 3 years) D NA Inspect dispersal cell(s) At feast once every: 3 El month(s) (Maximum. 3 years) 0 NA Clean effluent filter , At least once every: 13 19( month(s) ❑ NA ❑ year(s) n (s) WNA Inspect pump, pump controls & alarm At least once"every: 0 year(s) 0 Flush laterals and pressure test 'At least once every' 0 month(s) ,)f' NA 0 year(s) Other- ~ At least once every: ❑ month(s) 0 NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorpton systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any [Hissing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground 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 treatment tank equals one-third (X) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113. Wisconsin Administrative Code: All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shalt be performed by a certified POWTS Maintainer. A Service report shall be Provided to the local regulatory authority within 30 days of completion of any service event Page S of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process -and/or damage- the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will b&-discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to#he pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the area within 15 feat down slope of any mound or at-grade soil absorption area Reduction or elimination of the fidlowing from the wastewater stream may improve the performance and prolong the life of the treatment tanks and sat absorption system: adds, antibiotics, baby wipes; -cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fnrit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, 'and water softener brine discharge. - ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is property and safety abandoned in compliance with s. SPS383.33, Wisconsin Administrative Code. ® All piping to tanks, pits and other soil absorption systems shalt be disconnected and the abandoned pipe openings sealed. e The contents of all tanks and pits shall be rerioved and property disposed of by a Septage Servicing Operator (pumper). ® After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soll, gravel or another inert solid material. CONTINGENCY PLAN If the PO falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant r Tla ent 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 frm disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot fines and welts. Failure to protect the replacement area will result in the need for a new. soft and site evaluation to establish a suitable replacement area. 'Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ 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 repiac eipent area. if no replacement area is available a holding tank may be installed.as a failed POWTS. last resort to replace the ❑ Mound and at-grade soil absorption systemsmay be reconstructed in place following removal of the bfomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: - POWTS INSTALLER POWTS MAINTAINER Name d EGKE - 73 /3 yL1 e J oi✓~ E F ~ELKE turvQ~JL Phone J S G7•7- 5,7`G Phone 7/S G7.? - 5;? 44 SEPTAGE SERVICING OPERATOR PUMPER - li~wlK J LOCAL REGULATORY AUTHORITY Name EPEw T. L/toax Zo,,We. Dff/tI Phone 714r J J04 - G _O I - Page S of STAIN UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process -and/or damage- the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be: discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent. and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soii'absorption system. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or eli ninaiion of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, -cigarette butts, condoms, cation swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. ABANDONMENT When the POWTS fails and/or 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 s. SPS383.33, Wisconsin Mministrative Code: : a All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. e The contents of all tanks and pits shall be rerftoved and property disposed of by a Septage Servicing Operator (pumper)- • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the PO fails and cannot be repaired the following measures have been, or must he taken, to provide a code compliant repla ant 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, tot lines and wells. Failure to protect the replacement area wtA result in the need far a new, soil and site evaluation to establish a suitable replacement area. -Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and baring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon faikire 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. 0 Mound and at-grade soil absorption systems frtay 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE ADDITIONAL INSTRUCTIONS: POVtrTS INSTALLER POWTS MAINTAINER. Name ELKS e7313 YZ Name f ilenj ELKS ~ELKE ~lurr rS/JL Phone 71S G7.?- S.764 Phone 71s G7? - S?G6 SEPTAGE SERVICING OPERATOR (PUMPER) - a.,V '^J0vJ LOCAL REGULATORY AUTHORITY Name Name T ~itoix Zo.J/.Jc dff/cam Phone Ph°n 714- 38&l - G S_O z ° = o o a ° C~ t~9• 1 =h ro r- r - C' - - .Q_ ~ a _ 44 4 q -4 iryr/e~ m I one a cn z ~ 3y:o- l ~ro ~ i a~tr~..~ O m r, m - 3 tid 0 N n t - O ~i Ft - r - - - !d ~ o m ro ro~ m C~ ' n T~ n O m etN - m ~ jq ? ' fD N C_ fD :J W 7 ? !D fJ i ~ Vs fJ t9 O ~ m .e N ^J ril - F? N 3 N ~»t x O cn m ~ 'a m ro Q n -C ~ O fl. ra 0 y EMU ro ti c 3 ~ r. W~ ~ ~ tD o n o o I•°~'a a °m' 3 = o ~ ~ V o 3 o ~i o 0 ono 0 C$ kit = m ~ s o ~ ID ° Q r m Er," as" U'll _ID- v n- . o I CS IOL m 'Cl 6 ' 'G C y~ n ro N - a'4 a LA n D D O v1 O. N ."5 9 rOO O m ° 1D 1 3 ~ J ~ fro` 1 S N m 8 ° 3 i~ `((D Z cS z a s pCD~ Q T3 r ro C r+ ^ 0 m to rD o° m (D m z m LD r+ m _ O' CD s m r t -Eh, m zz I;- 0 rD t" < ID 'D -4 N ln.. O r G r-!• O w j m (D x 3 3 3 C} = is o 3 cQ (D 0 C, e• 3 O y _ - W ' 0) On O FU - 7 (D G - e 77 VS 9: m N ^A ci' ~ 0 3:p ~ Y < l V Q Q A CD rt ^ O B - n J ` \v 5 a rD n'a '0 m I ~~fD3y I! ~ ~ . c L a + S m r 77 I ST. C'ROIX('(I;rNTY ANN'D OWNERSHIP CEPT11-1C'A'rI0N PORM Mailing Address AC r' 141 - o~J v (Vcriti,,atiozz rcqu red lim tt Planning c Zoning I)epartmettt for n--,w c onstruction.i C ity"!State Parcel Idcntitication Nurnber LEGAL DESCRIPTION Property Location sec ~ Z T R 1V, Totivn of (/7~f Subdivision G✓~.~ Lot Certified Survey Map # Volume , Page It Warranty Deed # ~ 0 tiictrzte Page Sp, _ laousc yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its preaLiture failure to handle wastes, Proper z :intenancu consists of pumping out the septic tank every three years or sooner, is needed, by a licensed pumper. Alhat you put iota the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner rmintenance responsibilities-ire specified in ~Comm_ 83.52(l) and in Chapter 12 - St. Croix f'ounty 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. iourneynaa plumber, restricted plumber or a licensed pumper verifying that (l) the on-site wastewater disposal system is in proper operating condition andlor (2) after inspection and pumping (if recessary), the septic tank is less than 1>3 full of'slud-e. I/we, the undersigned have read t,: above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as scat by the Department of Commerce and the Department of Natural Resources. State of Wisconsin, Certification stating that your septic system has been, maintained must he completed and returned to the St. Croix County Planning & Zoning Department within 30 day,, of the three year expiration date. P we certify that all statements on tli form are true to the best of zny!our Iczzowledge. L we am/arc the owner(s) of the property= dcscri A above, by virtue of a rranty. deed recorded in Register of Deeds Office, Number of drooms 4 iJ- SI TA" E OF APPLICANT(S) SATE ***Arty information that is rrisrej~resentcc? r y result in the sanitary being p revoked by the Planning & Zoning Department, Include with this application a recorded warranty deed fto-m the Register of Dctds Offioe and a copy ol'the certified survey neap if reference is made in the warranty deed. iR~ ~I}f#If1„~} y \ 10 100 I ~v~ou ~o m C) nT cnau~~a~'' Im I (vn I 11 N D KELLY ROAD 1 .z M AD -fl-VV Id. lee I :1- 0 i> , s) s La A (M.M.Of~DDN)`VOW M.6If.M00N I I~ rn Z 5i'6L5 V 51 99 .96'f9f Z iA m " X R -i ~y ' m \ ar vi E A qm En to Z;J", 6z m m 'JW a ~v " I= m CD Ln c4b ;j P2 m m J V r°pN, / N c -i 10• / = J -c / $ J j.~, Q ~3• mr 'q fJ~ 1 .j~ / I N m O Al {3 0£0(IN C~ m m / r a i i !x Ana m Rz o :ono = tea 1 i p 1~ f ~ a Iw Sq~S co ?I ,-cLQ / o?E:~Z n- iq v.. 9 ~ .u N Q ZIA p V v~ z of r m I^ E ern ~,~a~•m Gd a. o~mr P Qi 02 00 elag too 559 \ ayd► ~ y_ ~ r„~o 90 r ao m e \ z o QR m F7 z o - z 191~ E3 S ZI• 5 RD ~ s O a $ ~Ft WATERS EDGE CONSTRUCTION rec~nuro~ SPEC 2014 RY51DRNf1AL.Ml1T1FAMILY•LIGXTCOMMFRCUI , 11 EXTERIOR ELEVATIONS 9 ME. u»SRtH Saal01•tludron,w7s o,e PH 71 c. 1.07! I 1 v I I • I 4 ..t I (1 'e t f 'e ~ ~I • 1 le 111 I ~ I 4 6 < v ~ e= , II D i ~ yt..; i , ~M•;- I i , I S 1. i ~ I I F I le .(._i , e ~M. I 4 I" 1 I 4 ~ T ' I I 1 , I I I Q O 5 9LI~ Z $ a WATERS EDGE CONSTRUCTION g ME ma. SPEC 2014 RESIDEMUL• MUL FOUNDATION PLAN :v:n ~l~ suoa, s~u~. oir ao~I~EeECrAI a iM 71 i.iAl•97,V I } ~ i i I 1 e a a I I `i 1 + A3 -F e 3 y t Im le ! { e I I` w.r•--- I ~ O IL1- ' ~Z c9 6 ■e ~ t i a R g 1 WATERS EDGE CONSTRUCTION ° ►poxa: rec[ ~ 1 SPEC 2014 MAIN LbVF1.PLAN REND9~Fwkw eet.,5wu1ioi '1.1GFiTcoelMkACN° ~ Haavq. Ri t19b V1° 71 t.iAt.9758 Wisco e~nt of Safety and Professional Servces J' Page of _,3 Division of Industry Services 4 N 0 SOIL EVALUATION REPORT rapox COU Npp In accordance with SPS 385, Wis. Adm. Code County Attach I 9er MEW than 8 1/2 x 11 inches in size. Plan must include. 1" Ro/X but noD o: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 0o70- /Y72 - co - col Please print all information. Revie Date ~j Personal information you provide may be used forsecondary u oses Priva Law, s. 15.04 1 m . - 1 -1 / 2,1 /5 Property Owner Property Location ' J'q V ❑ Q OE yAwv Govt. Lot S Z- Z- Y. s~ S 07,? T 9 R $ (or) V1l Property Ovyner s Ml iling Address Lot # Block # Subd. Name or CSM# " S zziL.~~ '-ff e~r,04A W/.d 5 Es rv ri's city State Zip Code Phone rv ber ~y ,~~e IN Town Nearest Road News c ~rvd Sri v t'1 test > ~ 4,osa.✓ B•~G ~ERiyAi.I 1.1A1' New Construction Use: (2 Residential/ Numberof bedrooms 7 Code derived design flow rate Gd0 GPD- ~a ❑ Replacement ❑ Public or commercial - Describe: skk~ Parent material 04 f ir)ASN Flood Plan elevation if applicable AW ft. General comments and recommendations: 1n/ Gaze a,o o low r5/ G ypd~f r OEEO IwJSraf144 riea, SS-6EG-orJ acs l YG~ F-/1 Boring # ❑ Boring - Y ` ' ' V^S 98.5 > ® Pit Ground surface elev. ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 / 0-.70 /a m .?/a S1 -P M P, 35 /ul't y -.7 .2o - y3 /o rA 312 - s/ sbk aN -'/1 - y 7 3 3-s7 /OYA 13 sl 'sbk If ;P/- G y 7 y 7- 9.? o YR S/ S s l c~ s _ 7 -j -AA S 9.t- 98 ora s/Y >ssl ® Boring # Boring ®pit pp Ground surface elev. 956 'ft. Depth to limiting factor > A0 in. M o r L ~u~"` 2 Soil Application Rate Horizon Depth Dominant Color Redox De ption Texture Structure Consistence Boundary Roots GPD/Fe In. Munsell Qu. Az. o t. Color Gr. Sz. Sh. *Eff#1 *Eff#2 l d 0 Yak.-,//- Y12 AV` ~SS~ x F/cc- 1-70- c cd /d''f - - a 6- 3 0 r4 a/ ! 7 3 33-'/`/ /o,-.L 3/3 -sbk aY -P, - 7 Y'/ -S/o /o,A Y13 s l / ~ s b/{ aN To s 5/ 7 - 9.7 7S Y14 sAs G 9.7- 98 q ky 4 11 oY.L S/3 3 7s ra s/si r- / abk q s - , a 3 7 9s-.,o '7 s YR 1//6 - s d/ - - 7 14 * Effluent #1 = BOD, > 30:5 220 m /L and TSS > 30:5 15 L Effluent #2 = BOD, > 30:5 220 m 2 < 150 m L CST Name (PIff;@ffiol I Hasse# Signature CST Number 1503 Fairway 9L OW Address Eau Claire, WI M701 Date Evaluation Con cte Telephone N er o/S SBD-8330 (R04/15) CST, MPRS-224974, D-1 152 3 Boring # ❑ Boring i _ ® Pit Ground surface elev. 47-OJ ft. Depth to limiting factor ?&,~in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 • .2 170 - ! /OY t .7/.2 - s ! M f.~ s . .7 3 Yy-sY /arit Y - s / -P bk - .7 If - ,/4 7's YA Boring # Boring ❑ Pit Ground surface elev. 98,8 ft. Depth to limiting factor? in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh_ *Eff#1 *Eff#2 O- 9 /OYt s a 9-3 oY.¢ 91.7 - s/ .3 37-SS a - s ❑ 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/Fe In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD, > 30:5 220 mg/L and TSS > 30 5 150 mg/L * Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30:5 150 mg/L x' Boring Boring # FT ® Pit Ground surface elev. 9,f.8 R. Depth to limiting factor S// in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 L0 rca/~-3~ - flLc /sl cs a .70 - ! /osvc Z'12 - 51 7 sik s y .7 3 5~4~- sY /ar't - s s d/ - - . 7 Y., s'le, 1A Boring Boring # R ❑ pit Ground surface elev. 9Q8 ff. Depth to limiting factor > //Win. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 0-/? ioY't - s/ /p 3 oYA .I .7 - s / 3 s7-ss er,2 Y - s 7 s i'a s c - S ❑ 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/Ffz In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD, > 30 220 mg/L and TSS > 30:5 150 mg/L Effluent #2 = BOD, > 30 220 mg1L and TSS > 30:5 150 mg/L Y y H o O z L o Ilk~ to( ~ a ~ ^ Z y y n p A q A M a ION o No ~ "O ro a ~ H 0 t- ° c U O \ \ 0 a "1 A 0 ~ a ~ a ~ a t a (w V. A N I ~1 i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3- Division of Safety and Buildings► t, 4 in acc clan " vjh omm gREC ounty Attach complete site plan on paper not less than 81/2 x 111 i es in size. Plan must r i include, but not limited to: verticer"~-Jznotal rafarnnCSa int (B~~ ctiQn and F7,, LD. ) percent slope, scale or dimensions, north arrow, U l ~ 7 Please print all informatio Dat ST. CRO1) Zl) Q~ Personal information you provide may be used for secondary pu s (Privacy Law, S. 1 Property Owner awl ~t Govt. Lot _5,ff 1/4,Y0/4 SZC' T N R E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1 r Z ` (I C;iy State Zip Code Phone Number ❑ City Village Town Nearest Road -A 60,1/77 New Construction Use Residential/ Number of bedrooms.,,?&- Code derived design flow rate XJ-~ 1X09 GPD ❑ Replacement ❑ Public or cumm a Describe:~ Parent material Flood Plain elevation if applicable ft. General oor►vnents and recom ons: Boring `r Boring P-1 # ft. Depth to limiting factor l,-in. ~`Pit Ground surface elev. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh_ `Eff#1 'Eff#2 /f / # Boring Boring a it Ground surface elev. ► Depth to limiting factor ` in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 0--2-41 C , s~ t a m cs zY)7 , y - r r 7 Effluent #1 = BOO > 30 220 mg/L and TSS >30:S 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Nam ~ Please Print) CST Number 226900 Bird Plumbing, Inc. Shaun Bird Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017-- 715-246-4516 Property Owner _ Boring Parcel ID # Page of ❑ Lpq . Boring # a pit Ground surface elev.ft Depth to limiting factor rn. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 /a -7 i a Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # E] Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Stricture Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *E f#1 'Eff42 I I' ` Effluent #1 = BOD, > 30:< 220 mg/L and TSS >30 < 150 mgll. ` Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOD-8330 (R.6100) Soil Test Plot Plan project Name Dave Alwin Shaun Address 413 6th St. N Hudson Wi 54016 C #226900 Lot 1 Subdivision Cedar Win's Estates Date 1 /12/05 SE 1/4 S W 1/4S 22 T 29 N/R19 W Township Hudson Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe 5" above grade System Elevation 100.0/99.0 *HRpSame as Benchmark Alternate Benchmark Top of lie' pipe 5" above grade @ 100.0' 574' Property Line B-3 35' 103' 101' B.M. 80' Ad.B.M. B-1 B-2 5' 10% Slope Y V l Scale is F = 40' unless otherwise 574' Property Line ,,tea noted Germain Way I ~ I I I I I ONJ4d04 9 (PG~~C1fn14 G3NJG~ P00334 -0,04 9~3 o DD 04000 ft ] LOT 2 ' 2.61 AC. / d04 9 \ `e°'"°oss° I LOT 3 ~MO~OG~ 2.71 AC. / IW&M@ LOA-905M LOT 1 ' 3.39 AC. \ LOT4 2.35 AC. n ISO4 4 ;..°aaa~oo~~a~~~ooo loo 2W DRAINAGE EASBADFT - - - - - - \ ~ hP ` \20f DRAINAGE EASOM Q~s i1y`TS9 1\~a~~~ 1 . 2 ~ ~ ~ ~ '~Lt~ 1 ~ ✓ LOT 5 11111111 \ 2.18 AC. LOT6 2.01 AC. \ \ LOT 8 2.66 AC. Lob.-916.00 NU 0 o Lea-9os.w , o'lwiuce eR~9`a1FFe IMA eaFalaiFC LOT 7 0004 2 2.43 AC:----- OFPRESSION t ao-91a1o ie.a-91s10 106 m HM-914.00 106 YR FAOIINN ML-914.00 L. I &O-910.00 100 YR Fx0° N °NNM-91110 [1004 9 @A. 06. 9009 I ~ L.e.o.als.lo IPME 2s I ' I 1 49 1 I I J I i I I I I i 604 9 i I REMOVE iiNG DRIVEWAY CONNEC7ION TO BADLANDS ROAD. MORE o a &