HomeMy WebLinkAbout020-1095-90-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 579091
GENERAL INFORMATION State Plan ID No:
J
Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City village Township Parcel Tax No:
Bonnie C. Ahlers Trust TOWN OF HUDSON 020-1095-90-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
00 ANN* 71) P OF 14P 0AJ r 091'r/ rS 33.29.19.388F1
TANK INFORMATION ELEVATI N DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic lvg5gl- ~Ltx Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
k44
Holding St/Ht Inlet
ioq. 7 s~ 7 0l
TANK SETBACK INFORMATION St/Ht outlet ( . iy 7Y Q , ~6
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ~J
Septic > I l ze, ) 2a t Dt Bottom
Dosing I Zr 1 Header/Man.
Aeration J Dist. Pipe
Holding Bot. Syst@m
5.0. I 6. 87.63
Final Grad
P P/SIPHON INFORMATION
Man acturer Demand St Cover L
rM dlti o Y lO~I 106. 00
Model Nu ber
GtC
TDH Lift on Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEMy.
n~ll (
BEDITRENCH 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 Type Of System: CHAMBER OR
UNIT Model Number:
DISTRIBUTION SYSTEM
Header/Manifold Distribution Ix Hole Size Ix 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 Bed/Trench Edges Topsoil
Yes [R No Fm-] Yes ~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /0 , /S Inspection #2:
Location: 672 BRADHURST DR n C
1.) Alt BM Description = tPt 61,11 L 4r-
t /ljL LL//
2.) I
Bldg sewer length = (7,
- amount of cover = tit ✓ 4e (14
Plan revision Required? Ug Yes No Q
Use other side for additional informati n.
Date Insepctor's Signature Cert. No.
SBD-6710 (R.3/97)
rnr E County
~Industry Services Division St. Croix
p? 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.)
SE
P.O. Box 7162
S P,
jt13 , Madison, WI 53707-7162
UNITY 0_v,_e::.0r1V.ENT
Sanitary Permit Application <:ransactionNumber
in accordance with SPS 383.21(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
the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address)
purposes in accordance with the Privacy Law, s. 15.04 1)(m), Stars. Same (O ;KJ 7~ A J"4-
1. Application Informs - Please Print All Information
Property Owner's Name Parcel # C ~ VAS'
Bonnie C. Ahlers Trust 020-1095-90-000 ca
Property Owner's Mailing Address Property Location y, I , =jT 1
672 Bradhurst Drive
Govt. Lot
City, State Zip Code Phone Number SW 1/4, NE Y<, Section 33
Hudson, WI 54025 T29N; R19Eoo (circle one)
H. Type of Building (check all that apply) #
® 1 or 2 Family Dwelling - Number of Bedrooms 1 Subdivision Name
❑ Public/Commercial - Describe Use Block #
El City of
❑ State Owned - Describe Use
CSM r_1 Village of
Number
J*I G 1'GuJ ®Town of Hudson
III. Type of Permit: Check only one bo on line A. Complete line B if applicable))...- D ^AL~
A. ❑ New System ❑ Replacement System ® Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner ~4 l48
IV. Type of POWTS System/Component/Device; (Check all that apply)
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
450 Rate(gpdsf)
VI. Tank Info Capacity in
Gallons Total # of
Manufacturer U
Gallons Units o
New Tanks Existing Tanks p U vz v w C7 CS.
Septic or Holding Tank 1000 1000 1 Wieser Concrete/Pol lok 525 ® ❑ ❑ ❑ ❑
Dosing Chamber I ICI ❑ ❑ rl ❑
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plum s i lure MP/MPRS Number Business Phone Number
John Schmitt 223760 715-760-0486
Plumber's Address (Street, City, State, Zip Code)
616 150th Ave. Somerset, W154025
VIII. Coun /De artment Use Only
Approved r d Permit Fee Date sued Issuing ent Signatu
❑ r Giv Reason for Denial $ ZSa °b 9 Z'
IX. Cond r6 (tri~UReasons for Disapproval a, a
1 S~tidtank,t t,t'~~~ 3) 011 6e/
dispersal cell -must all be series I `malnWrl6d
as per msrtegement plan provided by plumber.
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x It inches in size
SBD-6398 (R03/14)
PLOT PLAN I N
Project Name: Ahlers Replacement Septic Tank j
Legal Description: SW114 NE1/4, S33, T29N, R19W P.I.D: 020-1095-90-000
Subdivision Name: NA _ Lot 1
Township: HUDSON Parcel Size: 3.99 Acres SCALE: 1" = 40'
County: ST. CROIX
Existing Soil Rock and pipe bed approximately 18% 38'
Absomption area II
A BM1 Elevation: 100.00 I
• Backhoe Pits:
4 inch Sch 40 -ASTM D2665
NOTE: See page 10 for a complete plot of the parcel. 4 inch 3034 - ASTM D3034
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Page 2
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Ahlers Tank Replacement
Owners Name: Bonnie C. Ahlers Trust
Owner's Address 672 Bradhurst Drive
Hudson, WI 54016
Legal Description: SW1/4, NE1/4, S33, T29N, R19W
Township Hudson
County: St. Croix
Subdivision Name: NA
Lot Number: 1 Block Number
Parcel I.D. Number 020-1095-90-000
Plan Transaction No.
Page 1 Index and title
Page 2 Plot Plan
Page 3 Septic Tank Specifications
Pane 4 Filtpr Infnrmatinn
Page 5 System Evaluation
Page 6&7 Management and contingency plan
Page 8 Septic Tank Maintenance Agreement
Page 9 Warranty Deed
Page 10 CSM or Plat
Attachment Boring
Designer: John Schmitt Licnese Number: MPRS 223760
Date: 9/16/2015 _ Phone Number: 715-760-0486
d-, Signature: ~7
ln_G/ro/und Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01)
Page 1 of 10
PLOT PLAN FN I
f Project Name: Ahlers Replacement Septic 'dank j
Legal Description: SW114, NE114, S33, T29N, R19W P.I.D: 020-1095-90-000
Subdivision Name: NA Lot 1 SCALE: 1" - 40'
Township: HUDSON Parcel Size: 3.99 Acres
County: ST. CROIX
Existing Soil Rock and pipe bed approximately 18% 36'
Absorption area
BM1 Elevation: 100.00
Backhoe Pits: -
4 inch Sch 40 -ASTM D2665
NOTE: See page 10 for a complete plot of the parcel. 4 inch 3034 - ASTM D3034
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Inc.
nov r intr: C; :na~eE Zabel" L-525 Effluent ''Utej`
{W sr_i.aJ~rPrr r/ A Division of P*ok Inc.
PL-525 Filter
The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has
525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball
installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off
the system so the effluent won't leave the tank. f
i ,atdJas., ,f 10"'a91f 1i!ol2 Slt3"'; 1
Alarm Switch
Rated for 10,000 GPD (gallons per day). ' (optional)
- 525 linear feet of 1/16" filtration. Zfly~Q GPD
Accepts 4" and 6"' SCHD 40 <:3- Accepts 1" Pvle
pipe. Extension Handle
Built in gas deflector.
Automatic shut-off ball when filter is removed.
Alarm accessibility. Rated for GPD
Accepts PVC extension handle.
FL-:525 Installation:
Ideal for residential and commercial waste flows up to 525 Linear Ft.
10,000 allons per da GPD . of 1/16"
$ l~ Y ( Filtration Slots
1. Locate the outlet of the septic tank.
2. Remove the tank cover and pump tank if necessary. Accepts V 3. Glue the filter housing to the 4" or 6" outlet pipe. If SCH p pipe
the filter is not centered under the access opening use a
Polylok Extend & Lok or piece of pipe to center filter.
4. Insert the PL-525 filter into its housing. s-
5. Replace and secure the septic tank cover. Certified to
NSF/ANSI Standard 46
1'8 ~'',r, t~vr.JiJ~tefJaJJ►ce:
The PL-525 Effluent Filters will operate efficiently for
several years under normal conditions before requiring
cleaning. It is recommended that the filter be cleaned
every time the tank is pumped, or at least every three
years. If the installed filter contains an optional alarm,
the owner will be notified by an alarm when the filter
needs servicing. Servicing should be done by a certified Gas Deflector
septic tank pumper or installer. Automatic
1. Locate the outlet of the septic tank. Shut-off Ba11
2. Remove tank cover and pump tank if necessary.
3. Do not use plumbing when filter is removed. z
4. Pull PL,525 cartridge out of the housing.
5. Hose off filter over the septic tank. Make sure all s,r
solids fall back into septic tank.
6. Insert the filter cartridge back into the housing making
sure the filter is Pr0Pte'lY aligned and completely inserted. Polylok Zabel Outdoor tlf~~ & Best est ; filters s accept 1i t 1,0'1"
aEasily installs
7. Replace and secure septic tank cover. the SmartFilterS switch and alarm. into existing tanks.
Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com
Page 4
CHMITT & SONS
VPVGINC.
586 Valley View Trail
Somerset, W154025
schmittandsonsexcavating.com
(715) 760-0486
10 Inic
JGj.IGG'iiliVGi 10, GV1✓
To Whom It May Concern:
An evaluation of the septic system on the property of Bonnie C. Ahlers Trust property
located at 672 Bradhurst Drive, Hudson, WI was conducted on July 28, 2015. At the
L1I1iG Ol L11 GValuc'IL1U11 the JlliI abJl11pL1VU area a°pvurcu iv b.iux>C1.20ruag prop4.rly. ]
i uN.
septic tank is steel and will be replaced. This evaluation does not in any way warrant or
guarantee future functioning or operation of the system.
If you have any questions or concerns, please feel free to contact me at
715-760-0486 orjschmitt@somtel.net
Sincerely,
John Schmitt
Master Plumber Restricted Service #223760
Page 5
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner: Bonnie C. Ahlers Trust Tank Manufacturer: Wieser Concrete r NA
Permit # f= Septic 1- Dose f-Holding Volume: 1000 gal
DESIGN PARAMETERS Tank Manufacturer: NA
Number of Bedrooms: 3 rJA !:Septic !:Dose E:Holdin Volume: al NA
Number of Public Facility Units: 0 WA Vertical Distance Tank Bottom (s) to Service Pad: ft
Estimated (average) Flow: 300 gal/day Horizontal Distance Tank(s) to Serivice Pad: ft
Design (peak) Flow = estimated x 1.5: 450 gal/day Specific servicing mechanics must be provide If vertical is>15 feet or if
In Situ Soil A lication Rate: 0.5 al/da /ft2 horizontal is > 150 feet. Specific instructions to be provided on back.
Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Polylok NA
Fats, Oils & Grease (FOG) s30 mg/L Effluent Filter Model: 525
Biochemical Oxygen Demand (8005) 5220mg/L I NA Pump Manufacturer: NA
Total Suspended Solids (TSS) 5150mg/L Pump Model:
High Strength Influent/Effluent Monthly average Petreatment Unit
Fats, Oils & Grease (FOG) 530 mg/L Manufacturer:
Biochemical Oxygen Demand (BOD5) s220mgiL fv NA I Mechanical Aeration a Peat Fitter lv NA
Total Suspended Solids (TSS) S150mg/L r Disinfection r Wetland
Petreated Effluent Monthly average I~ Sand/Gravel Filter ) Other:
Biochemical Oxygen Demand (BODE) 530mg/L Soil Absorption System
Total Suspended Solids (TSS) 530mg/L NA I✓ In-Ground (gravity) I" In-Ground (pressure) f- NA
Fecal Coliform (geometric mean) 5104cfu/100m1 I- At-Grade r Mound
Maximum Effluent Particle Size: Ya in dia. r NA r Drip-Line Other:
Other: 1" N Other: NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
When combined with sludge and scum equals one-third of tank volume
Pump out contents of tank(s) When the high water alarm is activated
Inspect condition of tank(s) At least once eve : 3 Id myea
(Maximum 3 ears) NA
month(s)
Inspect dispersal cell s) At least once eve : 1.5 f•✓ year(s) Maximum 3 ears r NA
moon(s)
effluent filter At least once eve : 3 f✓ year(s) NA
month/a1 _
Inspect pump, pump controls & alarm At least once eve - vesris) I NA
Flush laterals and pressure test At least once every: r" moyear(s
os) r NA
month(s)
Other: At least once eve : I- year(s) r NA
Other:
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
rtulnlJt;l; n/f8alrtr Ytutnuer tCtleu l(iteu atlwel; l"V VV7J IIISCptllilUl, TUYV Ia7 IYItl11RGI11C1 JCi/IGgP. all-.I YIUIi tw VpCl afro \}1Vnit)G tp,m
inspections must include a visual inspeciton 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 ground surface. The
dispersal cell(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 on the ground surface may indicated a failing condition and requires the immediate
notification of the local regulatory authority.
When the combined accumualtion of sludge and scum in any treatment tank equals one-third ('/3) 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 113, Wisconsin
AUriiin0ihAtaiive Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment units,
and any servicing at intervals of 512 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.
(Rev.2/05)
Page 6
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 dispersal Moll(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 extended 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 and may overload them resulting in the backup or surface discharge of 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. 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 POWTS:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain
(sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; 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 shall be taken to insure that the system is properly and safely
abandoned in compliance with chapter Comm 83.33, WiSCOnsrii Adriririi,stratrve Code:
• All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a sanitary permit for
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 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.
❑ A suitable replacement area is not avaiiable due to setback andlor soil i'imitations. 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 replacement area. If no replacement area is available a holding tank may be installed as a last resort to
replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT
If OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY
1 CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT.
ADDITIONAL INFORMATION:
POWTS INSTALLER POWTS MAINTAINER
Name: John Schmitt Name: John Schmitt
Phone: 715-760-0486 Phone: 715-760-0486
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name: Owners Choice Name: St. Croix County Zoning
Phone: 715-246-5738 Phone: 715-386-4680
This uGciiiiiotn i5 lv ^ ,,,E^c1 • min; mcnFc Cornrn R3.99/~_
irnain:,c,a ~,W^; o ,,,f Ch
91(b)(1)ld)A(f) and 83.54(1, (2) & (3). Wisconsin Administrative Code.
Use of this document does not guarantee the performance of the POWTS.
(Rev. 2/05)
Page 7
ST. CROIX COUNTY
SEPTIC TANK MA' N1M1 A NTri~ A GREVE + NT
C- I
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer Bonnie C. Ahlers Trust
Mailing Address 672 Bradhurst drive.
Property Address (7
p , 1>rc. bc~dc--
(Verification required from Planning & Zoning Department for new construction.)
City/State Hudson, Wl, 54016 parcel Identification Number 020-1095-90-000
LEGAL DESCRIPTION -10 Property Location SW l4 , NE '/a , Sec. 33 , T 29 N R W, Town of Hudson
Subdivision Plat: CSM Vol 5/1220 Lot #
Certified Survey Map # Volume . Page #
Warranty Deed # (before 2007)Volume , Page #
Spec houseDyes0no . Lot lines identifiable Oyesono
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
:maintenance consists of pimping nut the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
r --r - -a
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 3$3.52(1) and in Chapter 12 - St. Croix County 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, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-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.
I/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 Safety And Professional Services 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 Planning & Zoning Department within 30 days of the threeryear expiration date.
Uwe certify that all statements on form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described stove, by virtue of a ty deed recorded in Register of Deeds Office.
Number of beArooms 3
9/8/ 15
SIGN E OF APPLICANTS
7 DATE
Try.
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
Page 8
Department of SOIL EVALUATION REPORT 1800
P safety" and to accordance `."mh +.Comb. ,3.5 t ij, : Ad"n, Ccde image ! of
Professional Services
Sa:t':tiiitt Soil Te`.~tir;g, °°°n
Attach complete site plan on paper not less than 61,z x t t Inches in size Plan must t county
include, but not limited to verticai and horizontal reference point iSM'r direction and St. ~rc~t
percent slope sr,alki or dimensions north arrow. and location and jislar" e to nearest road ~2rCE I t i~
Please print all information. #~2CS-1t}95-U-OC1 J
Reviewed Ely ogre
i~
crsor:a{ in`orrnat:on you prr3viris3 may h- a _d f' a~~.^,':xr~, F ran't'
Property Ow, ner Property Location
Alders, Bonnie C "rust G1vt. Lot SVV?14, N E11,14, 533, T2W R19Vv
Property Owner's Malting Address Lot # Blcc~ r Subd Name or i."SM41
672 Oradhurst Dr t CSM Vol 511:220
City State Zip Co,!e Phone Number :t! ,llage Tnwn Nearest Road
Hudson vvl W16 651-434-5217 Hudson Bradhurst Car
New Construction Use ~esiq rtt;at Flurnher of Lecirooms 5 Cr 9e rleri°:er_+ ves qn fis,.r mute 450 GP iJ
Replacement Pubic or ccmnieic al - D,-.cobe
Parent matenai Ciuhvash (Burkhardt-,Sattre Series) Flood piaw i?r>rva?*o it a
pp C'ibte Nt'! ft.
General comnients were `rt Ck d to ver Py ep,~ra:0 130 f S-Parals n vas `4 nd dug in!o the l ram to u. 6 7,'e
and recommendations, 3 n, #u
`l ,l.(,I nbspv. 7,.'4 vi itCf i?l ne J.a;`7t C-t(I Thy ~C it n}far j --,t'5te, YPvat17 :;I , 1,
Suring # Boring
Pit Ground surface etev_ _ ft. Depth to tirniting factor 89+ ;i oil ApPatreattan date
Horizon Depth Dominant Color Reciox Description Texture Structure Consistence Boundarv Roots
in.1. Mansell Oil sz. Cont" Color Gr Sa SL EIr#i Eff42
l 1 0-5 10yrS/3 none -A 2fstrk rrtvfr as 2,vf 0.6 1.0
2 5-16 _ 10yr4/6 none is "Csbk c11 -'s ivf {i.7 i.v _
3 16-89 10yr6,14 none s ils~ nti 0,7 t
Effluent #1 = BOD 30 r 220 mgiL and TS S -,-',3i? e 150 m..g.1 Eff uen #2 = S CD_ 30 `ng,L and TS S --'30 mgiL
CST Name (Please Print Sic7natare _ _ GST Nun;t^er
Thomas J Schmitt ~
A227429
ddress Schmitt :poi Testing, inc.. Date Evaluation Conducted Telephone Plumber
15595 2nd St New Richmond. Wl 54017 8J2812015 715-760-1978
P a a e '2 of
Conductcd by: Condtrc°tet! For:
Schmitt & Sons Excavating. inc.. Name. B" Anic C. Alders Trost
Thomas J. Schmitt, CST 221-429 Address. 6`2 Bradhurst [)rise
586 Valley View Trail City, State_ zlp: €€adson, 1 540 1 tj
Somerset.Wl 54025
Phone-, 715-7~0-197e P10 € 20-1095-90-000
Lot No
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Parcel 020-1095-90-000
02/28/2006 04:56 PM
Alt. Parcel 33.29.19.388F1 PAGE 1 OF 1
Current X 020 - TOWN OF HUDSON
Creation Date Historical Date Map # ST. CROIX COUNTY, WISCONSIN
p Sales Area Application # Permit # Permit Type
00 0
Tax Address:
Owner(s): O =Current Owner, C =Current Co-Owner
BONNIE C TRUST AHLERS O - AHLERS, BONNIE C TRUST
672 BRADHURST DR
HUDSON WI 54016
Districts: SC =School SP - Special
Type Dist # Description Property Address(es): * = Primary
SC 2611 SCH D OF HUDSON 672 BRADHURST DR
SP 1700 WITC
Legal Description: Acres: 3.990 Plat: N/A-NOT AVAILABLE
SEC 33 T29N R19W SW NE LOT 1 CERT SURVEY
MAP IN VOL 5/1220 Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
33-29N-19W
Notes:
Parcel History:
Date Doc # Vol/Page Type
01/15/2004 751621 2492/197 WD
11/13/2003 746546 2455/583 WD
01/30/2003 707694 2126/66 WD
EZ
2005 SUMMARY Bill Fair Market Value: Assessed with:
92155 241,200
Valuations:
Last Changed: 10/25/2005
Description Class Acres
RESIDENTIAL Land Improve Total State Reason
G1 3.990 80,900 165,100 246,000 NO 05
Totals for 2005:
General Property 3.990 80,900 165,100
Woodland 0.000 0 246,000
0
Totals for 2004:
General Property 3.990 51,900 134,600
Woodland 0.000 0 186,500
0
Lottery Credit: Claim Count: 1 Certification Date:
Batch 125
Specials:
User Special Code
018-RECYCLING Category Amount
SPECIAL ASSESSMENT 27.00
Special Assessments
Total 27 00 Special Charges Delinquent Charges
0.00 0.00
AS BUILT
SANITARY SYSTEM REPORT
OWNER Q TOWNSHIP
' SECJ.5 T,;~N -R / 4W
ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT- LOT SIZE
PLAN VIEW
Distances and dihensions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
.
I di at N r h rr w
-ST Art
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference
point: Slope at site:
SEPTIC TANK: Manufacturer:
Number of rings on cover ; Liquid Capacity:
Tank manhole cover elevation: O
Tank Inlet Elevation: P. C-2 Tank Outlet Elevation:
PUMP,CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set for a cycle
distribution lines gallons; Total capacity of
gallon gallon: size of pump
per minute horsepower head;
and model number ;brand name of pump
Type of warning device '
HOLDING TANK: Manufacturer
Elevation of manhole cover Number of gallons
Type of warning device '
SEEPAGE PIT SIZE;
feet liquid depth Number of pits feet diameter
bottom of see a seepage pit inlet pipe-elevation
SEEPGAE BED SI'ZEP ge numberelevation
lines ~ 7 feet. ~
width__jj_length ~-tile depth
SE AGE TRENCH: width
PERCOLATION RATE .3 AREA REQUIRED le57 ngth-
. AREA AS BUILT
DATED INSPECTOR
PLUMBER ON JOB
LICENSE NUMBER
I
!
~ 9,
~
3
~ ~
~-~---r... _...w....~
ENT OF I NDUSTRY, INSPECTION REPORT FOR P SAFETY & BUILDINGS
rr, ARTMm 4/
OR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION m"mm BOX 7969 BUREAU OF PLUMBING
,ISON, v'JI 53707
l.D.Number:
C~dCONVENTIONAL ❑ALTERNATIVE S If fare assPlanigned)
I
El Holding Tank El In-Ground Pressure D Mound
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTIO TE:
Bonnie Ahlers Hudson, WI 1--5--
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
SW;4 NE14, Sec.33, T29N-R19W, Lot 1, Town of Hudson
Name of Plumber: MP/MPRSW No, County: Sanitary Permit Number:
Richard Hopkins I1059 St. Croix 43659
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: _ LIQUID CAPACITY TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
' PROVIDED: PROVIDED:
CJs 3r YES ONO DYES ONO
BEDDING: VVENT MATIL HIGH WATE NUMBER ROAD: PROPERTY WELL: UILDING: VENT TO FRESH
ALARMLINE ~AIR INLET:
Q, FEET FRpg
YES ONO 1? t~/ DYES ONO NO
D SING CHAMBER:
ID CAPACITYPUMP MODELPUMP/SIPHON MANUFACTURERWARNING LABEL LOCKING COVER
MANUFACTURER. 7INGS
LIQU
PROVIDED: PROVIDED:
ONO DYES ONO DYES ONO
GALLONS PER CYCLE: 7ND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET
PUMP ON AND OFF) DYES ONO NEAREST 30 1
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing It rrvr;TH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH LENGTH: NO. OF DISTR. PIPE SPACING: COVER JINSIDE CIA #PITS. LIQUID
BED/TRENCH / TRENCH M IAL: PIT DEPTH:
DIMENSIONS Mi 'ali- Aj
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. R. NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH
BELOW PIPES. ABOVE COVER. ELEV. INLET. ELYE=dV. ENPIP LINE: _ AIR INLET:
3 7° FEET FROM
NEAREST-
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
DYES NO
SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS
DYES ONO DYES ONO
DEPTH OVER TRENCH/BED JDEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED. SEEDED. MULCHED.
CENTER. EDGES.
DYES ONO OYES ONO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH TRENO. LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: INC. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
ELEV.. ELEV.: DIA.. ELEV.: PIPES. DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
DYES ONO _ DYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
DYES ONO DYES ONO NEAREST
i
Sketch System on Retain in county file for audit.
Reverse Side.
TITLE: ri_„F^
D I LH R SB D 6710 (R. 0 1 /82) f
""5` ir
~ l APPLICATION FOR SANITARY PERMIT
ILHR (PLB 67) r L_,0-0 BOUNTY
OEPRRTR1IrIOI.ISTRV0g6NUTRrIgELRT101"IS UNIFORM SANITARY PERMIT #
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER
MAILING ADDRESS
PROPERTY LOCATION e. i
e+T-Y
Vmi=6A E:
5&1141fle114, S , 127, N, R (or) W To
OF:
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
N M NEAREST 0.4 D, LA E OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
4 1 or 2 Family Number of Bedrooms:
„3 Public (Specify):
THIS PERMIT IS FOR A:
X New System ❑ Tank Replacement
El Replacement Soil Absorption S System ❑ Repair
y ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection
❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
Seepage Bed ❑ Seepage Trench ❑ Seepage Pit
El System-In-Fill ❑ Holding Tank
❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit &A
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions, issued
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity d
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound
❑ In-Ground Pressure
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY:
3( Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signature:
1001,c A4P/MPRSW No.: Phone Number:
Plumber's Address: (.2151 ~29V 3y~
Name f Designer:
LtJ ,
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee:
Date:
/ ❑ Disapproved
❑ Owner Given Initial
Reason for Disapproval: Approved Adverse Determination
Alternate coursels) of Action Available:
D I L H R -S B D-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
F 1
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
very 2 to 3 years. If you have questions concerning
must be properly maintained. Have a licensed pumper clean your septic tank whenever
Snecessary usually tate of Wisconsin.
your system, contact your local code administrator or the Bureau of Plumbing, DILHR,
AOL
3.6
DID"
3519 71
CERTIFIED SURVEY M n - -
Form - S '1' c 100
Owner of Property A2
Location of Property SGfJ Section 3_ T_7 N R_Z7_W
Township- L~~S~sz
Mailing Address I Al 5
Subdivision Name-
Lot Number l
Previous Owner of Property-
Total Size of Parcel x,79.3 4,
Date Parcel Was Created s p
Are all corners identifiable? 'Yes No
Include with this application one of the followin :
tified Survey Map
. Deed
.Land Contract, or
.Other I:egal Document which describes the property
PROPERTY OWNER CERTIFICATION
1 (We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in this
information form, by virtue of a warranty deed recorded in the Office of the
County Register of Deeds as Document No. / cZ~ ; and that I (we)
presently own the proposed site for the sewage disposal system (or 1 (we) have
obtained an easement, to run with the above described property, for the
construction of aid system, and the some has been quit' recorded in the Office
of the County Register of Deeds, as Document No.
f~ -
SIGNATURE or OWNER SIGNATURE OF Co-owNER (IF APPLICABLE)
DATE SIG to DATE SIGNED
1 cyN,KIyW .
ty
'n AUG 3~V~-G
Form - S T C 100
Nr 1983
ff/i
z
Owner of Property C, CI`1 SG I-~
Location of Property / k.&(E~jt, Section__~TZ-c-)N R_13 W
Township
Mailing Address lZ 1 C~~t~r_ D
Y_ EL I M- 6= Q~ 7
O
Subdivision Name 2-2-
Lot Number
Previous Owner of Property-
Total Size of Parcel
Date Parcel Was Created Se-FT lC~0Z
Are all corners identifiable? -Yes No
Include with this application one of the following:
.Certified Survey Map- 5EL-::~ "/oV2-
r~+~ Su f3J P~v P~7 r l3 : u~ i'TT t-o ~r~
..Deed
.Land Contract, or
.Other I:egal Document which describes the property
Cert"k:aft of property Owner's Agent
I, James E. RuSCh, Certified Soil Tester, hereby certify that all statements on
this form are true to the best of my professional knowledge, understanding and
belief;, that the above stated is owner by virtue of the following legal document
recorded in the Register of Deeds Office as
instrument document number
~a
mes E. Rusch .fr.T. 568 Date
';F P ARTS tIIIT'OF' R R .
I`'')USTRY, EPOT ON SOIL RING "ETY & BUILDINGS
t- ,.OR'ANpDIVISION
ilUtb1AN RELATIONS PERCOLATION T-ST (/P.O. BOX 7969
3 DISON, X11 53707
3707
(H63.090) & Chapter 145.045)
LOCATION: SECTION: M
SW
4 3S
TOWNJ1 NICtPALi Y: OT Q~ LK DiVISI A:V1E:
COUNTY: OWNER'S S NAME: MAILING ADDRESS' IZZ
C_-13.Jt/ L• JE.N~,,'c,U E~
USE
NO. E3EDRMS: COtL1MER AL DESCRIPTION: DATES OBSERVATIONS MADE
RResidence PROFIL D GRIP IONS A N TESTS:
WNew ❑Replace
RATING: S' Site suitable for system Ua Site unsuitable for system
ONVEN
TIONAL MOUND: IN-GROUND PRUFtE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
S F1
If Percolation Tests are NOT required DESIGN RATE:
under s,W63.0915)(b), indicate: t If any portion of the' esed area is in the
Floodplatn, indicate FloodPlain elevation: ( J"y
P4~ JAr1AL
PROFILE DESCRIPTIONS
r#±NG TOTAL PTH TO GR UNOWATER-FICHES CNARACTE'i OF SOIL WI I
TH 1 ti1CKNESS, COLOR, EX7 Ur3E, AND DEPTH
LB_/ N18ER DEi'iH cLr VATiON BSERVED EHIGHES TO BEDROCK IF OBSERVED ISEE A88RV. ON BACKI. i l3 _ \A~.Je i-F~. /_/lG A 1. SG• - v - J -
c..MVC>51 1.0o't3,v(r5wIGK~61.tj/.90'31 G'~;1 '.o
1`IOr.,i:._ C7 01 ~..r,.~!-•r°~. ~ ~.r'.O ~r.~;",'~~ S'.r/CiP_' rr''~ _ ,.n ,r~ ,
- a J7. y C3. 52>, 1,00 dt_ L,; 1.ZO gti/ M t-S
B- ./Gr z; 1.<v ~N n u/;arz.
7,3 /~fonl /
z . Z J Y r✓,j r} 0, B- 4- 3J' 84-2-8 OnJE a 00' aL °33' i:O S
5L L.~/..;i")•
C°a• ' 3 •B~ R.1 Pd r~ S w ~z °o~c r 5
t%EGJ+n A
=T PERCOLATION TESTS
TEST DEPTH WATER IN HOLE fiEST Tlfv1E
NL*ABER S AFTER SWELLING INTERVAL-MIN. DROP IN WATER LEVEL-INCHES RA T E MINUTES
PERIOD 1 P glpp 2 ' pE'R PER INCH
_ 3 3//G
- y
_
E/k
P_ 1 7:7,
L~°~ ,
G 1
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION i k,f Ar L_ : 77,7 A L.
1.
I ,
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,
:
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,
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L_..._ _ -L
- L L _ .
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsi t
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief-
N:0."AE (print
TESTS WERE COMPLETED ON:
4- CERTIFICATION NU;vIBF~.R: i'HOME~^ALJ >i~-R i•?pt~onall.
l S f _ rr
{e 7- -4 u C)
' T IGNATURE:
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