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HomeMy WebLinkAbout020-1472-00-001 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579037 -6' GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 O1(m - )1• Permit Holder's Name: City Village X Township Parcel Tax No: Duran, Joseph Hudson, Town of 020-1472-00-001 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /b 1 C-6 -r 22.29.19.2990 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. dcl`le /156 Septic -X_ Z Benchmark F I /V Cfj t~lr Alt. BM / I 1 cAJ •~t S ~a ~o- 3 Aeration Bldg. Sewer d~tw. I J15 ~ '~5 • 3 Holding St/Ht Inlet (p. 3 Idz YS TANK SETBACK INFORMATION St/Ht Outlet, 6 /p2 • a S TANK TO P/L WELL BLDG. ent Air Intake ROAD Dt Inlet \ Septic 7 :56 Z , Dt Bottom Dosing Header/Man. Z5 yG• 3 Aeration Dist. Pipe 4.1 1 ?3 _8 Holding Bot. System 7•a5 '73-IS5 7. 93 • l Final Gra PUMP/SIPHON INFORMATION M I, . `7 77 . `f Manufacturer GPM Demand St Cover f=1 I t ebb iti y z"45 /0(..3 Model N ber TDH Lift riction Loss System DH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches ' A PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Ib Z Z k /a, SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: -r• /1 1 INFORMATION CHAMBER OR-,nh.• r^~atfar•L. Type f System: UNIT Model N mber: I DISTRIBUTION SYSTEM Z 5 k Z 56 1-64 4, [Length eaderlManifo) d ~ Ji Distribution x Hole Size x H Spacing ent to Air Iptake Gad ice- ✓`d/ ~1 Dia Pipe(s) Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seede /Sodded xx Mulc ed- Bed/Trench Center 7 Bed/Trench Edges Topsoil Yes 0 No es 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 826 Germain Lane Hudson, WI/ 5-4016 (Unknown 0 Unknown) Cedar Wins Estates Lot 1 Parcel No: 22.29.19.2990 ' C~Je~a~ C~a: o•~, 1.) Alt BM Description= 2.) Bldg sewer length = - amount of cover 6 e_ ,per I ,7~ I "b ra o w 666eNi S'`JGS a~ G Plan revision Required? Yes No Use other side for additional information. ✓ _ SBD-6710 (R.3/97) Date Insepcto Signatur Cert. No. c I r. o v `mil ~ p o V "6 y `t b 0 \ "q N 0 rv; 'Zli n/ n M o N a s : a o Q h tv a h V44 x k 04 14 o ro ,V M ° `+J d ~ 0 O. lot 3 V ~0 k o ~ ~ V j ~ ~ a V \ ~i w O~ Q' Q ~ i 4j Q V s Division County `2~ M140whington rvice Ave '--'894T. O. Bo:: 7162 Sanitary Permit Number (to be filled in by Co.) nOo((,,OVNV P.O 1 i iTY DiviwPMENT S 1 g1VI 53707-7162 Sanitary Permit Application State Transactio" In accordance with SPS 38331(2), Wis_ Adm. Code; submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS 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 u uses in accordance with the Privacy Lary, s. 15.04(1)(m), Stats. Let tie L Application Information -Please Print All Information ~T ~7~itM,~i.✓ Zb*?- Property Owner's Name + Parcel t E URA 6.t0- /5~7,?-ao - ao I Property +Owner's Mailing Address s+ Property Location q 2`l it4 - t. Z~'~.~h J+ GovL Lot I City, State Zip Code /rPhone Number L 1 '5&J Section 1? 2 rz ` C Y'r"C)U" d W 105 5 - L J circle one 11. Type of Building (cheek all that apply) Lott T 9 N; R / $oW I$( I or 2 Family Dwelling-Number of Bedrooms Subdivision Name 0..9 , 0 Block- CEO,e~ G)i.)s Es nfres C1 Public/Commercial -Describe Use lr'k 1 ❑ State Owned -Descril>v Use ~V ? ~ q CSM Number of E11 of 06114601-ON rrus 5 r } t?Z To~V - 4DSonJ Ill. eck only one box on line A Complete tae B if applicable) A New System Replacement System Q Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (emplain) ❑ Permit Renev.al ❑ Permit Revision 1] Change of Plumber O Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ` o i? Corn nent/Device: (Check all that anply +f t ) VILIT- Non-Pressurized In-Grotmd Pressurized hrGround ❑ At-Grade ❑ Mound 2:24. in. of suitable soil ❑ Mound <24 in. of suimbl oil a r g er Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersalt? rests nt Area Information: Design Flow (gpd) Design Soil Application Re(gpdsE) Dispersal Area Required f Dispersal Area Proposed System Elevation Cho , G /ooo 1o0 9P. .7 93. 07 Sri. Tank info Capacity in, Total ii of lUkanufacturer Gallons Gallons Units 51 o New Tanis Existing Tanks 7V' c; Septic or RoWingTantt ,SD ~Sd l✓/GrSE.r: Co.J6.66rE Dosing Chamber I V11. Responsibility Statement- 1, the undersigned, assume responsibility for' tallation of the POyVTS shown on the attached plans. Plumber's Name (Print) Plumber's Sien IvIPRvl;?FseS Number Business Phone Number 'j 61W llezleE ~ W3 13f~6 >iS d2.7_5744 Plumbers Addrm (Street, City, State, Zip Code) IV -/a 94? 6lr. wr s ~uR...~D ws sy~3~ . County/lDe ailment Use Only Approved =;h!,en Permit Fee Date Issued Issuing Agent Signature 47 -7/'-7j Reason foiai Zb' 1X_ Conditio of ~~,n l/lieasons for Disapproval SYSTMUw~: lfe''T NQ 1. Septic tank, effluent filter and dispersal cell must ke_serviced /_maintained as per management plan provided by plumber. " (W4 ft 2. All setback requirements must be maintained cn a as per ap Q ns or thosystem and submit t e County only on r less th rt 3 in x tt inc in s~arye t, IS) SBD-6398 (R. 08114) In M M N Ln 0 0 0 O cd u-) o 'r N a t` Cl) a-~ N O O N O E L m -1 0l M ~:l O N h Ln O E -C ZQ ~I U ° c X. ) U U QU u 4 3 4-4 N N 4-1 4J A Z O n a P +p Z -,A a ~4 J 0 U @, J ~ N I P4 N >1 N 4 Ga p -J O ~ 14 J ~ ~ Q w W p (n o o N ad x N h m X 0 Q Q0 Ln LO Q0 CD Z ~ -z~ Ln Ln ~,o m u P- 4 W J ~ W a Private nits Wastewater Treatment System hdex and Tide Page PrDjectNme: ~~E ©ast,~,r - y- %✓~.r~. ~o maw rs Ownees Name: •t OwnWs Address: Legal Descaptron: _ SE. Sc~J~ 9 N i ?a) MuDic4vaty: TQw~. fie, try of County. Sr; ~,Go, x Subdivision Name- 4J/, s Es r,►rES LottNumber. BlockNumber: Parcel LD. Number. 66 - o a Page 3 ~.~fOE x err Page 2 ~~a g-.Q.._- svG~A►o ss - S~~c x~la,J t~~~r, t Page 3 Pap4 - DGfT 4~J,l,~ s ~'~.O•~u~r !~i~.J~~6s~E~r SEA Page 5 ! t { r t { tt Page 6 O '.,z- rr,. iw r"It" Page 7 Page S G`T~c~aE.~rs _ Sorg ~"v~Ec~~+-lQ.aE'~oar Page 9 Name u F esigaer. aH~ xE L ic=e Number: ^4- Z313yi Sigaatore: Date: 7-1g-.?41s, Designed to the Pollovng POD'S Cmponenl manual and -5,0-5 91-85; Tn-Oroimd S(a A.bsoratirf Component Menem for POWTS Mer. 2 2-0) SBD-Toms-P (N won r' o V o J n ~ W n X k ~W ~ v W Ilk o n v ` Y~vY b lr~~r~~r9/3l/ lh cd~t 0~ Q O ° W I O v Q v <n 72: 86" a _ W rn 3: 53" a z - Z m c ~ rn a N o UP 52" /N1\ \ 4" CAS 41 ILA m (n rn Y 47" 4° O 1 o A a ' D to rn > UP 49" m \ r 4" CAS o + \ l N N V m o g c 50° r ° D z n Irn rn o- m rrnn > (A z nm~ I O i t -n -a 0 (A ?am OC D X m r OX 2 D Z O rn n 3 r = r v U) ZA a D z z O O r 'n O T X -i p v C 1 ~i ~~*rtt D mm XM rr, a Z*ZT O nCO A O~Z DPZ jm0T~m>o OD0p T\ CQ ox Z or-tn a ~j-t aU ~n~ ~Oz f- ~ =v~G7==~ O~tZ!) r. ~-10•• N -iD ~r~n chim _ ~--~z y m0 rn a p N (7 ~ Z ~ -4 N C za C t-< z n= N~r~ I =tmz~~vrn? N (n z 2 to a0 -IZrn natty Nr~~*t SO NN Orn~ m ~x~ m O D rn N D -4 ~ 1 -;1 0 [7 p la t- "0 ) rrl U) 0° ! m ptn~p zn v a v om o y m 0-p inrnn O A m u n V N` t!f~ md> ar ow CIpO OW n a m cCn n O z C O 0 m"_;rr. ~n07 O 0'0 ~s _ > v o c x 3 n CD a D fa =~Z r-0 0^ ~ .:j 0 Z r O N m D D SO-n 0;0 z -n m m c r- -i rn n C 21 n n O to u, z a o p z W° 0 = O rn p U) rn r z r D ° z ~ v O > r- rn Iw z o lc-, \ w1250-MR NIERERsillIETE DRAW BY SCALE- , 4"-,•-0' -POUR m REV. SEPTIC MANUAL DATE. JANUARY 2010 oATE - oSI--POUR W3716 US HWY 10 MAIDEN ROCK, WI 54750 \ ° REVISED JAN. 2010 800-325-8456 FILE: VM()-W POVWS OWNER'S MANUAL & MANAGEMENT PLAN Page-/1 oft. i FILE INFORMATION SYSTEM SPECIFICATIONS Owner O Tank Manufacturer. 6✓/6564 LO„lGt1J'F ❑ NA Permit r _ Septic ❑ Dose ❑ Holding Volume: 1,?5'6 (981) DESIGN PARAMETERS Tank Manufacturer WNA Number of Bedrooms: ❑ NA ❑ Septic O' Dose ❑ Holding Volume: (gal) Number of Public Facility Units: ® NA Vertical Distance Tank Bottom(s) to Service Pad: /.Z (ft) Estimated (average) Flow : ypp (gallday) Horizontal Distance Tank(s) to Service Pad: 8.6 (ft) Design {peak) Flow = (estimated x 1.5): Specific servicing mechanics must be provided if vertical is >15 feet or GDO (9atfday) if horizontal is >150 feet. 5peciffc'Instructimxis to be provided on back. In Situ Soil Application Rate: ` (gal/day/fe) Effluent Filter Manufacturer f C5 T _ ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Etter Model: Lsf-/D Fats, Oil & Grease (FOG) 030 mg/L Pump Manufacturer: Biochemical Oxygen Demand (BOD$) 0220 mg/L ❑ NA RrNA Total Suspended Solids (TSS) ':5150 mg/L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L' - Manufacturer. (BOW >220 mgtL ❑ NA ❑ Mechanical Aeration ❑ Peat Pilfer 9 NA (rss) >150 mg/L ❑ bisinfection ❑ Wetland Pretreated Effluent Monthly average ❑ SarKVGravet Filter ❑ Other. (BODS) 030 mg/L Soil Absorption System (TSS) 530 mg/L ❑ NA Fecal Coliform (geometric mean) :_10` - At In-Ground (gravity) ❑ In-Ground (pressure) ❑ NA At- Maximum Effluent Particle Size X in dia. [I NA 0 Grade ❑ Mound ❑ D Dririp-Line ❑ Other. Other: ❑ NA Other. ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) IrWhen combined sludge and scum equals one-third of tank volume p When the high water alarm is activated Inspect condition of tank(s) -At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 3 0 year(s) Inspect dispersal cell(s) At least once every: 3 ❑ month(s) 9 year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: 13 19F month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once'every: ❑ month(s) U NA 0 year(s) Flush laterals and pressure test 'At least once every: - ❑ month(s) ,ff NA ❑ year(s) Other At least once every: Ll month(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption 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 missing 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 revels 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 (I) or more of the tank volume, the entire contents of the tank shaft 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 <i 2 months, shall 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 damagff 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 ►eveis 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-disdtarged 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 soil 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 elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: adds, antibiotics, baby wipes, -cigarette butts, condoms, cotton 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 shad be taken to insure that the system Is properly and safely abandoned in compliance with s. S&383.33, Wisconsin Administrative Code- o 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 rerrtoved and properly disposed of by a Septage Servicing Operator (pumper)- o After pumping, all tanks and pits shalt 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 be taken, to provide a code compliant re47A la ent system: suitable reptacrtent area has beat evaluated and may be utilized for the location of a repiac~ment soil absorption system. The replae:errtent area should be prole led from disturbance and cbmpadion and should not be infringed upon by required setbacks from existing and proposed strucdure, tot lines and w~ls. Failure to protect the repiacemort area wiW result in the need for a new. soil and site evaluation t° estadish a suuitable replacement area. Replacxment systems must comply with the rules in effect at the time of their permit issuance. Q 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 fatkire of the POWTS a soil and site evaluation roust be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be instatied•as a last resort to replace the fatted POWTS. 0 Mound a Reconstructions at-grade soil o s absorption systems sir must acomply y be with the rules d i i effect at following ~ oval of the biomat at the infiltrative surface. 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: I, POWTS INSTALLER POWTS MAINTAINER. Name -,?3/3W Name JoN•~ £ E !rE KE LurreSiJL EGKE Phone P1Oiie 71S 47.7 - 5-? e:G 7/S G7-?- SA' SEPTAGE SERVICING OPERATOR PUMPER - .V'V J LOCAL REGULATORY AUTHORITY Zama Ze/ e r. e4,vx Zo.~.Wt Difiee~ e 74r 3 - G _o Page 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 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 soil 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 eliirnination 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, cotton 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 shalt be taken to insure that the system is properly and safely abandoned in compliance with s. SAS383.33, Wisconsin Administrative Code- . ' s All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. a The contents of all tanks and pits shall be rerfioved and property disposed of by a Septage Servicing Operator (pumper). o 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)NTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant repla ent system: A suiable 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 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 the time of their permit issuance. 0 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 fail ire 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 'railed POWTS. ❑ Mound and at-grade soil absorption systerns shay 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. A13DMONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. Dame EGKE f = .?3I3 yG Name oN•~ 4- E - ~E4 S ~urr~tsi~~ Phone 716- G7.7- S,TIG Phone 71s 47.7 -.S•7~G SEPTAGE SERVICING OPERATOR (PUMPER) • ~i~wlid:'~iauJ LOCAL REGULATORY AUTHORITY Name Name T. L!Roix Zo.J/~J~ aft/cam Phone Phbn 7/S 38~ - G S_O n i1! - S :e `gin B 0n~ C1r: = n 0 to = a I < n 1 /may ~ z V; O m r fD O 3 ra _i k3 m ~ C l NJ & nAz 3 O '1' ~r np 1.0 au Np rf ~p 2 _ - .~-r N .r m w ~ 7 r R fJ Q7 l d ~ N f _ rs n i r $ g _ a so m v a m 3 3 m iD E ~fqq 'Ll !D !Z f1 V G F Vl ra 7 y !6 a rs ^ » Q O_ O C r v_ C --o G s o . O j X ? C N I; 3 coo 1 T ~ _ m o Q r N T O lit R c p 7 N tC rJ O Q. : i T^ 7' O T ni ti vR>rezvs.:ns. _ f eo it C o m Ci O c D 1 y~ O Q O Ti Q r~l JY ~ N -a 9l to n K > D 3 LA 2e a ^ m o rs v s n y u o v~~ J 3 .t " o - -o 3 « =K 3 0 ^p r! lit' L_ip i r~~- ran m > ~ o z aQ z ~ L m c m Q s m a+ N m fp C n n 3 3 T rr O O G r rD n o pp~ m fD O' z F M CD w r fl.) 2 j 2 c s TD -c,, m ° i ° n O C 1 0--4~0ID~ ~ G Y ~ ifi f~ N iL tTf d - C fl. l0 4 n 2 it1 n r Q t4d. J1 r =r LA o rD Fpm rs~ U+- Ss ru fl7 O n a c O AAk owl 3 ? d m U; N 3 m O'tn 0 PP m u c X rs < CL CL M CL r ID c g y rr 3 o d = cl v . al M G rt Q to o am ST. CROIXCOU TY es SEPTIC TANNX MAI,7'FE'` A. \f( `i-~, AGREE. vIENT' RTzT_ OWNERSHIP cl✓RTrTIcATlON FORM Owmm'Bayar Mailing !address fro e~y ~ddr~~> ~ / a~ v (y'eriiication rck f ,;rtt £'Ianuin~ing Department f"tar new 411ns tiara.} City `State hart:-,I IdeatifiCa€iO,n 'INTUrnber LEGAL DE Property Location -1fa,s 14 Sec.,-- T NT R Town of Subdivision 1~ Lot # Certified Survey Map # Volt7rne , Pagge # Warranty Deed # C~ © Volunie Page Spec house yes no Lot lines identifiable yeas no SYSTE I MAINTE iA CE AND 0 NER CERTIEICAT_10N Improper use and maintenance of your septic system could result in its premature failure to handle wastes. 'roper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed bumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Ovmer maintenance responsibilities are specified to §Cvontna. 53.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. 1'he property mvner agrees to submit to St. Croix County Planning & Zoning Department a certification forirz, signed by the o,evner and by a n ster plumber. journeyman plumber, restricted plumber or a licensed pumper verifying that (i) the on-site wastewater disposal system is in proper operating condition and* (2) after inspection and pumping (if necessary), the septic tank is less than 1"3 full of sludge. I,"we, the zandersigned have read ~ above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as s-ct by the. D ,3i=ent of Commerce and the Department ofNatrral Resources. State of Wisconsin, t enification stating that your septic s}ste, , ilas been maintained must he completed and returned to the St. Croix Gotunty flan l::I'- &Zoning Department within Sty days of the i:-,rce year expiration date. 11'we certify, that all statements on th' form are a-tie to the best of myrcnsr knovdedge, 1/we ativare the owncr(s) of the property by virtue ofa rxanty deed recorded it , Register ofDeeds Office„, s 4 RE CAP APt~I IC a~?~T(~') SATE*Any information that is misrepresented may result ; 'a :::vita, y permit being revoked by the Pluining & Zoning Departrnertt. Include with this application a recorded warranty deed -n the Register of Deeds Office and copy o the certified survey map if refeTenCC is made in the warranty deed. l o 0 1 J o m ( a~ N°~t~°~A~~ ~D jZ 1~ I ° o KELLY ROAD o M; A CM (M.1S.M0ON),£ti'0Lll M.64,0£w00N 1 1~ m ' " Z z Si'6LS V B9 tit B6'~9Y \v z m Q' It 22 (00 9, m p 05 P) 0 co cm n V Val r m oo m MOON •ron 'i f °=~a I~°, tGS m cog _ i tp 0* : DO mum'~nl ' I' ~ I or~y3gr• o c~ (''fir" O t~1~ j ~m 8 mIJ- > m o'er v~ !g9 w° ~'I t-1* 01 A IQ y> \ Na i in w SI oI u 00 ~LZ Mw ~M~p' O/N. ~N y i2~~p \ Cyy l ate. -a ~ r \ 90 '•r Pn~ C \ Ic 0 4 z I 0 w _ 6~ D i' z HE 00 i ' I ;I z g O a WATERS EDGE CONSTRUCTION re~~rln SPEC 2014 RESIDENTIAL•MIITLFAMILY•LIGHTCGMMEtCIAL EXTERIOR ELEVATIONS reEploesuH SwaIoI•IluMen,w7style PH 711 b07+R a I 1 1 1 4 i ! ~R j 0 Q e ~ l4 IR •R ~a ! njr~ i o I 17 I I~ I 4 I ~a ' i • 1Y It I 4 I ~ 1 ..........................................................................................t. I I ~b 5 Z 9 $ g N WATERS EDGE CONSTRUCTION milli p f•' P b RM.. PAR ma. AEMDEMffAL. MGLIWAMMY. LICNTCO!•M "MMANdff- SPEC 2014 FOUNDATION PLAN :v_E Eniro mmL sou Io1. w~ao~. a7 sale g GN 71S.101.97.,t •"Nr i I I ~I i I I~ ~i I m 1 ~2 a 4 ;'Y I ' -mot . (~IAi .Z I Z I ~Z E~~~ ? Y s 7yg ~ u ; e ° L a FF ~ ~ >3 ~ ~ i ~ WWDFt R~ $ a WATERS EDGE CONSTRUCTION w ^ 4 WIN& atx~otxnn~.siu.•nrnsn~x.iacx?cosrMmcup SPEC 2014 MAIN LEVEL PLAN 29.n Pnkrsn"a,7sPMImw w~ , 01 • -MHud.un. M SaOin VN Wiscoent of Safety and Professional Services ,2 S Page / of Division of Industry Services jUL Z 4 ?0 I" SOIL EVALUATION REPORT T CRODX COUNTY In accordance with SPS 385, Wis. Adm. Code County Attach %%j ik a92r n~o less than 8 1/2 x 11 inches in size. Plan must include, r' /lO/X o but n4 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. da70 - I V 7.2 - 00 - d o / Please print all information. Revie Date Personal information you provide may be used for seconds purposes Priva Law, s. 15.04 1 m . -7 Property Owner Property Location ❑ Q J- A OE ux,In/ Govt. Lot S 07~ Tap (1 R $ (or) 1IV Property O ne sMeailing Address L Lot # Block # Subd. Name or/C/SM# 2-Mailing - i2_41", s / ~E,04A Gu/w!5 Z-Sr.4rfS City State_ Zip Code Phone N~ We r An ems; l~ B.City e ® Town Nearest Road tv r^ur~C1 (qS~ °f d u~OSc+.J ~•7(. New Construction Use: ® Residential/Numberof bedrooms 7 Code derived design flow rate J/40 GPD Q1 11 ❑ Replacement ❑ Public or commercial - Describe: Parent material Ou l-aASN Flood Plan elevation if applicable r/ W ft. ~ ~rj " General comments and recommendations: /n/ Glce N,,, o ooa r5l . G ysd/Fr R DEED i.,~sr~~'~ r~ea, S 6E Cow ,rye ' -O.' ' / Boring aL . ~ Boring # El ® Pit Ground surface elev. 98. sft. Depth to limiting factor > /6 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/FP In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I o - ao /o YR .?/a S1 /oz's . y .7 .Za -,Y3 /o Yrt 312 - S/ -f sbk .N -P, - y 7 3 3-s7 /oYA a sl ~'sdk ~s~i' G 7 j/ 7- 9.7 o YR s/ - S s l et S - / S 9.T- 98 oY,, s/Y /sS~ /,o ® Boring # Boring i pit Ground surface elev. S6 fl. Depth to limiting factor > /D in. MUD ~)C QkCL Soil Application Rate Horizon Depth Dominant Color Redox &Ot.' ption Texture Structure Consistence Boundary Roots GPD/Fe In. Munsell Qu. Az. Color Gr. Sz. Sh. *Eff#1 *Eff#2 a 6- 3 0 Y2 a/a r-A 1 sbk 3 313 ! -P 1/ 7 Yy-S6 /oYA y13 s l / sb/~ S ^ y 7 VIV SL - 7SYlt 'Ile, - S .As ~ P1 a s - 7 G G 9a- 98 6Y.t s'/3 3 XTX C: l sbk J1 A' q s - - d 3 7 98 - //o 7..S Yit 1116 - s di - - 7 ` 'Effluent #1 = BOD, > 30:5 220 m !Land TSS > 30 15 L Effluent #2 = ROD, > 30:5 220 m /L 150 m L CST Name (P~l@film) J. flassett Signature CST Number 1503 Address Eau ~'~Al11'e, , 547®1 Date Evaluation Con ct Telephone N er _ ois "Mq 9V4 IF SBD-8330 (R04/15) CST, MPRS-224974, D-1152 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/Fe In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. 'Eff#1 `EfffK2 ~ F/« /s/ I f30 CS /~'-H o a a ,to - y /oY"r. - s! s6k ,y fr . H .7 55 3 y4/- s y /art ~ s / f' bk ~ y . 7 y sr- e/G r ` Yt s - s s all Boring # Boring ❑ Pit Ground surface elev. 98,8 ft. Depth to limiting factor in. V►' 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-/? /OYt - S! a 1p3 oJU d.? - sI 3 37-s:r /Ox felf' y ss-- 7 s Ya 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/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 fir., Y n v . a 'a. R, '3 'k1., - Boring # ❑ Boring -73 ® Pit Ground surface elev. 9,48 ft. Depth to limiting factor S// 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 Lorca/~-3a - Fi~c /s! J cs /~=M o a y /Oxlt. 2/2 - 51 70 sik y .7 3 Yf/-SY /art sbk rr f'~ c 1/ .7 Y sx-e~G 3 z YA s - s s d/ - - . 7 G 7 Boring # Boring {\\{.~\ryq~V~{jam.\~\{/~ ❑ Pit Ground surface elev. 98,8 ft. Depth to limiting factor >//.?in. R V 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 0-/q, io Yet - S/ - s / a? If'-37 0,U J1,? .3 37-S.S' era Y - s l ❑ 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, > 30 220 mg/L and TSS > 30:9 150 mg/L t i. y y O O Or z a~ M ~j o z Ll Ilk o a ° ~ ^ z ~ a a Z ~p y h 1. ~ V °ow l41 O NC n ~ a z bk t- e Z ,moo um x Y w a ~ a i ~ t a 1 Z 3 Z N on a a A to ° e °o A ~ Z 4 i C .t «WisconsinDepartment of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings g~ _jiin accotdan h omm ~ECE ¢'1 . J ounty S - f aD Attach complete site plan on paper not less than 8 1/2 x 11 i es in size. Plan must include, but not limited to: verti ^e 2Rd odzQuW rpfP-rPn a int (B=~~(~chpQn and arcel I.D. percent slope, scale or dimensions, north arrow, and locatio and di ride tc~tne' rejiG6* /q Please print all informatio ~►~IT ewed DaIt ~1 Personal information you provide may be used for secondary pu s (Pri acTy 'aR l5gp(Tf T)y. - ! 0--t1l 1 __7 Property Owner A iloI Govt. Lot _5, 114SO14 S2aT ~ N R / E (o w Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# If 2 a7 ej U > ' " Q 4t~ City . State Zip Code Phone Number ❑ City Village Town Nearest Road New Construction UseResidential /Number of bedrooms, - Code derived design flow rate Yr J GPD ❑ Replacement ❑ Public or comm cr Describe:/ Parent material Flood Plain elevation if applicable /j✓~ ft. General comments and recorn S. Baring ® E] Boring ~ r/ # o Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 -Eff#2 TL LN A-2, Z/ 24Z~ IT, ® Boring # ❑ Boring it to1 / f Ground surface elev. Depth to limiting factor 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~ ( s/ C l a ra►~ rn c'S 2m r 2 L, 1 n Ek- 7 l,~ 1 JA Effluent #1 = BOD > 30 < 220 mg/L and TSS >30:5 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg[L CST Items (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 la- /D--oz- 715-246-4516 Property Owner _ Parcel ID # Page of Boring # ` 9Pt Ground surface elev./ ft. Depth to limiting factor J 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 k /0"'-S7/9' C ) m r nql- ~ C5 Z 6-l) c ) a i L4 F-1 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/lf 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 ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD., > 30:5 220 mg/I- and TSS >30 < 150 mg& ' Effluent #2 = BODS < 30 mg/- and TSS 5 30 mg1L 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 608-2648777. SOD-8330 (8.6100) -MMMM T 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 11,1"2/05 SE 1/4 S W 1/4S 22 T 29 N/R19 W Township Hudson ❑ Boring Q 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 1i2" pipe 5" above grade @ 100.0' 574' Property Line B-3 35' 103' , B.M. 101' B 80' AtI.B.M. B-1 B-2 5' 10% Slope CV~~? Scale is 1" = 40'° V" unless otherwise 574' Property Line Ix noted Germain Way I I i I I I I (PGt1C~i!U"n14 G3NJfrvJ G~UG3g4 I 0° NJ4a0O 4 9 pDD DD ~4~Oo U7 a04 99 LOT 2 I \ 2.61 AC. / L@ V 5 LBO~O LOT 3 o o(~ I 2.71 AC. / LOT1 - - - - - - - 3.39 AC. \ - - \ LOT4 2.35 AC. a0o4~S /11 / loo lM V 1~INL90~.~p 20, DRAINAGE EASEIM - - - - - - - - ~ c~aarr \NNN \ ` "+~rD~\ ~O\ 1 \ zo DRAINAGE EASraoIT LOT 5 ~O 11111111 1\ \ 2.18 AC. V LOT 6 2.01 AC. I LOT 8 2.66 AC. l.e.o.-sos.so GONJ° o L9.0.-905M L&O-919.00 ` L~Quf~7 9eENCU~c - _ -LOT 7 9RNFw0E 8FMAIQM ao04 2 2.4d A1r O~ON L&0.~915_l0 L&0..915.10 loo YR R97.r914.00 100 YR FROZEN MIL-914.00 I 100 YRL&FR m,HW1L0r91&1o ao4 9 Cod. oa. 9009 I / I PQ6C~ ~ I I / - I I I I I I I I ao4 9 I I I I ~ REMOVE EbST1NG DRIVEWAY - CONNECTION TO BADLANDS ROAD mom NQT1 SCALE: 0 40 &