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Home My WebLink About020-1372-07-000W Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM_ Safety and Buildings Division INSPECTION REPORT' GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1 Miller, Sam - TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic e. ) L S p Dosing Aeration Holding TANWSt-TBACK INFORMATION TANKTO P/L WELL BLDG. ventto Au Intake ROAD Septic ? ZS ' `/ '?C a 5� NA Dosing NA Aeration NA Holding PUMP / SIPHON INFORMATIO Manufac an Model Number GPM TDH Lift Fri S Sat TDH Ft For: Length Did. Dist To well Hudson Township u it , ATION DATA County: St. Croix Sanitary Permit No 363975 State Plan ID No.: Parcel Tax No.: 020-1372-07-000 STATION BS HI FS ELEV. Benchmark to 04, 1O D' Alt. BM S•f. 8• Bldg. Sewer p 3 .4-/' St / Ht Inlet / o•} , 3 ' St/Ht Outlet (/•02 93.08� Dt Inlet -�- Dt Bottom Header / Man. Dist. Pipe " Bot. System S fo 9 •1T' Final Grade �.�(. •Zy' St cover SOIL ABSORPTION SYSTEM(I S V_�& ,,.-" onLJ,% 4.Ir"c_. K-&jFj&EN_CK Width r Lengt No. f h s T No Of Pits Inside Dia. Liquid Depth hs SETBACK SYSTEM TO P/ L I BLDG WELL LAKE/STREAM LEACHING Maannu act I INFORMATION CHAMBER T / r r -Model Number: System: ip� S� OR UNIT DISTRIBUTION SYSTEM L�p'{o Pja^re- cal Header/ n1 of M Distri ution Pi x Ho a Size sing Vent To Air Intake Length DIa gth Dia. SpacmI -L le 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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection # 1: 09' 10 / OOInspection #2: Location: 535 Raader Driv Hudson, WI 54016 1/4 SW 1/4 21 T29N 019W) - 21(29192227 Raider Estates -Lo( 7 1.) Alt BM Description eQec.�L{t's�••..� �n t Pe+{—� Jl�� . 2.) Bldg sewer length = -amount of cover = > f6 "S.�j t, Plan revision required? ❑ Yes CU No 6 Use other side for additional information. Ica I u. c>b SBD-6710 (R.3197) Date Inspector's Signature Cent No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r i j I I I N I SCALE 1 2 I.2`1 • l�. 222� Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 `�SCOgSfII sec reverse side for instructions for completing this application Madison, WI 53707-7302 Department of Commerce Personal information you provide may be used for secondary purposes (Privacy Law, s 15 04(I)(m)] (Submit completed form to county if not state owned. Attach complete plans to the coup livistem. on -13aper not less than 8-12 x I 1 inches in size. CountyT• State Sanitary P vision to previous application State Plan I. D. Number / „ „ I LApplication Information - Please Print orm Location: Property Owner Name v Property Location 5 i— NG 1/4501/4 S 2/ T 4N A W Property ownees Mailing Address l.ot Number Block Number ST GFOX City, State Zip Code Z�N141(3 Subdivision Name or CSM Number I1� N tom( o Z��S RA(Df—k sTA7JF5 II. Type of Building: (check one) aj Bedrooms O City ❑ village b1 or 2 Family Dwelling - No. of :� )iTown of N V S O K Public/Commercial (describe use):_ ❑ State -Owned Nearest Road ` Parcel ' 2 D 3 7 1.�1�1QS s) Tax Numberc tn-l3?�-0�-0 III. Type of Permit: Check onl one box on line A. Check b on fine B if applicable) 5. 6. ❑ Addition to A) 1. New 2. ❑Replacement 3. ❑ Replacement of 4. Existing System stem System Tank Only Permit Number I_i9 Date Issued ❑ A Sanity Permit was reviousl issued IV. Type of POWT System: (Check all that apply) ? O -'a Io7h Sc r of" ♦!A01V e-� - d -TRi Ale 4F-S - 3 ' X 9 S I ).Tlon-pressurized In -ground &E fie /i ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Drip Line ❑ Other: ❑ At de V. Dis ersaUTreatment Area Information: I Drsgn Flow (gpd) 2. Dispersal Area 3. Dispnaaal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Elevation . Required Proposed Rate (Gals/day/sq. R) (Minlnch) / 00 Soo S�1 � VII. Tank Capacity in Total p of Manufacturer Prefab Con- Site Steel Fiber- Plastic Con- glass Information Gallons Gallons Tanks crete strutted New Existing Tanks Tanks ?7 /C X IZSd ' WE 15F2 ❑ ❑ (3❑ ❑ T-)CTFe2 2A E3EL /ooA VIII. Responsibility Statement ],the undersigned. assume rrestpo ibility for installation of the POWTS shown on the attached tans. Busines phone Number Plumbers Name (print) Plumber's Signature (no Ps): MP? RS No. - �� z z so 3 G ro Plumbers Address (Street, City, State, Zip ) Ir n 7,r H V f1L 'YI-) hvaso N w IX. County/Department Use Only isap Sanitary Pertnil Fee (Include Groundwater Date Issued Caring Agent Si lure (No stamps) I3DP'0V,V Approved ❑OwnerGivn Initial Adverse S Fee) S. OD Determination II II X. Conditions of A roval /Reas ns for Dis pp oval: t.:niSL .�u AM-- &6+" wit...... C T ' � cst"o„� p,�,,n..•�,'t� P(.��',tis OL CS (� / r C gran. 0 5ADE TXT£; tcT� % 53S RAPDfrt bg�VE PI/V * 020=/07Z —07, 000 5�( S+4tys'. a1, = SeAIE �Iv /o ✓ 68q • 99 D•TRE�fc*IDS 3x�5i I S- 1jIOD��4�5c..r5 �AcN 30 - ToTA 12 4'AL, ST �v 24EEr _ /coA Fi17%c g•i �r a M a Z I r � ac -- o 13- NojS e. IOLOAM qIJID Sp�� /,��C�� L �tF,Yt /YI IL Lr,z ,eA iV E� ES r� TE S 4o Tst7 movif f user specincauons 4 2 t 5, 3 3d - TeTi4 L 76' 00 00 00 00 00 ors o0 00 00 0 00 0 0o Oo 0o QD OO oQ Chamber OD OO O Of0 OO OQ i�o QO OO Heighi O OO OO 00 Q 00 QO 00 00 00 0o Old 00 OQ oL� CAL-] QQ OQ OD OO 7 C=70 OD OO 00 00 All three BioDiffuser sizes can withstand H-10 loads when installed with properly graded and compacted soils. A mini- mum of 12" of cover is required for H-10 loads. The 14" High Capacity BioDiff user is designed for H-20 loads. A minimum of 18" of cover is required for H-20 loads. Available Sizes T Chamber PE7ndViCwj I 34' 4' Knockout Universal End Cap Chamber Dimensions MMMM 11" Stan- dard 14" High Capacity 16" High Capacity =OEM Wisconsin Department of commerce SOIL AND SITE EVALUATION Page I of 3 Division of Safely and Buildings in accord with Comm 83,05, Wis. Adm. Code A.C.E. Soil & See Evaluatiem Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must county include, but net limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dirnemisions, north arrow, and location and distance to nearest road. Parcel I.D.x1 APPLICANT INFORMATION - P/eaw paid an f eQrmattfon. 020-1055-60 000 2129.19.209A Personal information you provide may be used (grsecondary purposes (PrWq Law, s. 15.04 (1) (m)). wedBy �p Date Property Owner Property Location Miller SamRECEIVEO Govt. Lot NE 1/4 SW 1/4 S 21 T 29 N,R 19 W Property Owners Mailing Address _ Lots Block f 1 Subd. Name or CSMS P.O. Box 151 APP 2 4 7 Plat Of Raider Estates Cky - . Zip Code ❑ City - Vidage 'Town Nearest Road Hudson [ 5,4016 27 Hudson Raider Drive ® New Construction tial / Numb 4 Addition to existing building Use: ❑ Replacernernt i t be Code Derived daily flow 600 Recommended design loading rate .7 bed, gpolft2 .8 trench, gpolft' Absorptionarea required 857 bed, ft2 750 Wnch, ft' Maximum design loading rate -7 bed, gpdM2 .8 trench, gpdff Recommended infiltration surface elevation(s) 91.50 ft (as referred to site plan benchmark) Additional design / site considerations Install trenches using high capacity infttrators. Parent material Glacial outwash Food plairl elevation, if applicable NA ft S=Suttable for systemConventional Mound li -Ground Pressure AT -Grade System in Fill Holding Tank U=Unsuitable for sifstem I m s n u M s n u s n u .1 S u i :: S[ i U L s E U B *9v 1 Ground dew 97.75' ft Depth to limiting factor >108' 12 Ground elev 95.9c It Depth to limiting factor >102' FlDfii011 Dq* h. Dominant Color Munsell Mottles Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. IiOots GPD✓ft� tied Trench 1 0-18 IOyr4/2 None None None None A Is s s 2fsbk Osg Osg Osg mvfr ml dl di as 2C]m 0.5 ! 0.6 cs 2flm 0.7 0.9 gs 0.7 0.8 0.7 0.8 _I 2 9-17 1Oyr4/4 3 17-62 I0yr5/4 4 62-108 I0yr6/4 1 0.7 1Oyr4l2 None sl 2fsbk mvfr as 21;Im 0.5 0.6 2 7-26 1Oyr4/3 Norse sit 2msbk mfr aw 2LIm 0.5 0.6 3 26-58 10yr5/4 Noce None is Osg s & Sr. Osg d] dl cs gs - - 0.7 0.8 0.7 0.8 — 4 58-93 10yr5/4 5 93-102 10yr6/4 None s 059 dl - 0.7 0.8 CST Name (Please Print' Signahx 1 e"Plone �• JamesK. Thompson �, p Z_ 71 S 248-7767 Aftm A.C.E. Soil & Site Evaluations Dais 7 Dais CST Number Ref 0 Line, 340 Paulson Lake Le, Osceola,54020 4/19/00 3602 1201 PROPERTY OWNER: Md7ler. Sm SOIL DESCRIPTION REPORT PARCEL LOS 020-1055-60-000 2129.19209A Depth Dmir arlf Color Mottles Strrlchlre Horizon in. Munsell Qu. Sz. Cont. Color Texhlre Gr. Sz. Sh. 3 1 0-10 I0yr3/2 None sl 2fsbk 2 10-27 1Oyr4/3 None sl 2msbk Ground - elev 3 27-40 7.5yr4/4 None Is Osg 10yr4/6 None 96.50, 8 4 40_92 s Osg Depth b limiting5 None s Osg 92-107 I0yr6/4 sw factor >10T Ground elev 95.79' fl Depth to limiting factor >109, Ground elev 96.1t3ft Dapth b I rift Fedor >106' +2m Page 2 of 3 A.C.E. Soil & side Evalui r sslenoe BO m" Boole Bed ' Trench mvfr as 2flm 0.5 0.6 5 mfr aw 2flm 0.5 0.6 .5 dl cs if 0.7 0.8 dl gs 0.7 0.8 dl 0.7 0.8 3 1 2 3 4 0-18 9-13 1Oyr3/2 None sl sl Is s s 2fsbk 2msbk Osg Osg Osg mvfr mfr ml dl dl as 2f lm aw 2CIm cs if gs 0.5 0.5 0.7 0.7 0.7 0.6 0.6 0.9 0.8 0.8 1Oyr4/3 None 13-21 21-77 I 7.5yr4/4 1Oyr4/6 None None 5 77-109 10yr6/4 None s •r8 KemarKs: 1 0-9 10yr4/2 None sl 2fsbk mvfr as 21,lm 0.5 0.6 mfr aw 2flm 0.5 0.6 di cs 0.7 0.8 dl gs 0.7 0.8 dl 0.7 0.8 - 2 9-24 1Oyr4/3 None sit 2msbk 3 24-40 10yr5/4 None s Osg 4 40� 10yr5/4 None s & gr. Osg 5 85-106 10yr6/4 None s Osg � 4T .S - KerrlarKs: nurrmu"wu ■ JT aw�ca awa uwwica Ground slew Depth b kno+9 iador I Kemanrs: O�ne,r: //« �GG�• Co&7, /2 +P,clai Esz' r�s, AEyy 5tA-*, 5cc.2J, T. 2rrl, /9uJ; Tn. o•f lkdsa» St • cvlo b89.9% bl ■ F�. 3&( 3 z 5co-lt f ' ■ 5al ObwVat!�ion D,* . 1000L-led"Onvo. S6%Ae F O V N ■ a3 -u t S' z� Sl oe d F — Y,f,?7S" aG ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer S r i In Mailing Address RQ,X *i . r property Address S— (Verification required from Planning Department for new cc � City/State 1u � USC1.3 kJ ( Parcel Identification Number C, Z0 �O7 2 LEGAL DESCRIPTION property Location /_ '14,: W Y., Sec. Z 1 . T Z LN-R �q W own of AUl2 D %y Subdivision k A ► 1)F4 STf� T- .Lot # �._. Certified Survey Map # 62-51 y� . Volume Page # y� Warranty Deed # io 1 0-7 S 3 Volume I Page Spec house) yes ❑ no Lot lines identifiable t1 yes ❑ no STEM MAINWNANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What You Put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, Journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the en -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. g 1/we. the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 �Lthe three year expiria date. (may A F APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this;form are true to the best of my (our) knowledge. I (we) am (are) the owners) of tf ertY described abo , by virtue of a waaanty deed recorded in Register of Deeds Office. Z 3iGNATURE F APPLI DATE •••••s Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department •• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is trade in the warranty deed •ir SrncEcwol nua = u•`. A l is' s IN I CERTIFIES /$!l3�Ei einP 1aiue+E Lf• PAGE 3796 lO I • � � 1 J.OL1 iQLz s Lor 3 �� 1 N 811 E 633.4a' S. Lod c.S.W- Inr 2 N �Cf,i s ME C.Sr LOT 3 _ Ul ' Y ILLA I I' to _ v) 8 o 3 I - � R 2ae.b Iw�'F� '/DER—g� ® DRIYE— $' " na yr.®d a+v�s �' •'' 2». � ,Q Ll _ �n I 04" LA n� ()'J �1 I sa1Y'� Tit8 / 4m 4 $ a a1 i / y9ti< �� 1p.� \ �. mob•\ � / M Io -� n 12 \ e OlYI' 19i.2T 1N 4' •74. ' --» M114 E � Jr a{.It'-- Ji4r• ; g id v ? $ LN ' N•• g 1' y 1 we. ql U i Fi W Y?\ a It I ■ [A Io g W �� HZy 6 , >�� T / �% SeYV W M&74' Oia3» N a]'S�' N ) NIA �C� 1 I 9 �. y,• , �,.. ., Y!i•+ i N Li.l ,1`,� I' 1 d I . i0,. 9 St Croix County Government Center 1101 Carmichael Road Hudson, Wl 54016 Fax To: Tammy - First Federal Fronn Deb Zimmermann Fa:c Papas: # O-L' Phone: 715 386 4680 Dab: 10/27/00 Re: Inspection sheet CC: O Urgent ❑ For Review ❑ Please Comment ❑ Please Reply D Please Recycle Tammy - Here is a copy of the inspection sheet for Lot 7 - Raider Estates. Kevin has signed off on it at the bottom, so apparently it passed the inspection. If not, there would not be a signature. Hope this is ok. Let me know if you need anything else O ... Deb Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT - GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may he used for secondary purposes (Privacy Law. s.15.04 (1)(rn)j. Permit Holder's Name: ❑ City ❑ village ❑ T73wn o Miller, Sam I Hudson Township N r l f CD . a i CST- $µ# 1 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK -SETBACK INFORMATION TANKTO P/L WELL BLDG. ventto An Intake ROAD Septic -?2S' 1 OZ� NA Dosing NA Aeration NA Holding PUMP / SIPHON INFORMATION Manufac an Model Number GPM TDH Lift Fri Syste TDH Ft ead Force Length Dia. H Dist To Well rI " r /,_ 1 EVATION DATA I try 7-- County: St. Croix Sanitary Permit No 363975 State Plan ID No Parcel Tax No.: 020-1372-07-000 STATION BS HI FS ELEV. Benchmark (D IOU, (O a r Alt. BM 5-•6 8" Bldg. Sewer 0,3 St/Ht Inlet (o,.T 3 ' St/Ht Outlet !/•02 Q3•o8� Dt Inlet �— Dt Bottom Header / Man. Dist. Pipe Bot. System 5 (O 9 /• 3S" Final Grade 76(0 2tir St cover —+• 1 0 SOIL ABSORPTION SYSTEMrj Mof-EN Width r Length No. f h s IT No Of Pits Inside Dia. Liquid Depth hsDIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manu acty s �bdrt,Sel INFORMATION CHAMBER Type / r S� Model Number: System: {p� OR UNIT DISTRIBUTION SYSTEM L:R cA^�1 Header M m old M Length Dia Distribution Pi gth Dia Spaong x Hole Size rang vent To Air Intake SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only N 45 ' I i Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed / Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 0010/COInspection #2: Location: 535 Riader Driv Hudson. WI 54016 (N 1/4 SW 1/4 21 T29N g19W) - 2129192227 Raider Estates -Lot 7 1.) Alt BM Description � �Q.�a6 �n t P� t—°�� r . r 2.) Bldg sewer length = -,- z -amount of cover = > /S "5&a Cyr A-- (tom Q 0-- &-C�(eA 7 ST Plan revision required? ❑ Yes 0 No Use other side for additional information. Qg t1 t� SBD-6710 (R.3/97) Date LL�jfi LyL� _] 1-� 1 b Inspector's Signature Cert No