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HomeMy WebLinkAbout022-1014-90-426 'Alisconsin Departrnen:of:c-nmerce PRIVATE SEWAGE SYSTEM County Safety and Bwlding nrvision St. Croix INSPECTION REPORT sanitary Perm it No: GENERAL INFORMATION (ATTACH TO PERMIT) 584788 State Plan ID No: Personal in•e oration ycu p w de may be used for secondary purposes Privacy Law• s.1 C4 (1)irr); 2709746 Permit Holder's `Jame C,-y village Tmenship -arcel Tax No: Chris & Deanne Koss TOWN OF KINNICKINNIC 022-1014-90-426 CST DR1 Elev: IrsF ,13ry1 Flev: BM Jescnpfin Section,' lu.vc!Rangc'Mao No l~r 06.28.18.86D-32E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 5 CAPACITY STATION BS HI FS ELE`J, 9 / 6G. 0 ZS Septic y~ ( Benchmark Z6 n Dosing -f-p ✓ ~ U I 1 gdd Alt BP,1 , [ t 6 J cam. S. S /a ` r d 16 7 z Bldg. server 3 Holding S_U•Ht Inlet TANK SETBACK INFORMATION SUHt Outlet TANK TO G /L V1FI L BLDG. ` err l? ,4i, intake ROAD Dt inlet Septic 33 A q 1716ottcm ^ r Dosing /V I ~ 7 ~i 8 lleader!blan 3. Aeration " Dist. Pipe Holding Bot. System 16Z. SS PUMPISIPHON INFORMATION Final Grade z 7 16 f Manufacturer Demand St cover ~t,l.~,, 5 , S ! • dcy GPM Model Number TDH Li Friction oss System HpadS TDH t r a Z oss (I _ Forcernain Length. Dia.Z it Dist to Well f 0 SOIL ABSORPTION SYSTEM BEDITRENCH Widt'i Length Flo. O4rer:;~j PIT DIMENSIONS P,o ar Pc : aside Dia. Liquic Depth e DIMENSIONS 166, SETBACK SYSTEM TO, P,L BLDG WELL LAKEISTRFAM LEACHING P.lnrufactu'cr. INFORMATION Type System CHAMBER OR dtri e J C AL A~A- UNIT Mudel 'umber: DISTRIBUTION SYSTEM I r jleacrrWznifol)il it Distribution / K Hole Sipe S y / zS , I I 711cle c ..pacing / I'veptyo Air IrtaKe pip) y1J~ Leno[h 3 Dia 7- Le igth Ca ' spa ira Z , Q SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth C.•er Cepth Over xx cepth of xx Seeced;Sodded xx mulched Bed7rencn Center / J Z BecrTreneh Edge Topsoil f 1 - ♦ YeS, Pao es No COMMENTS: (Include code discrepencies, persons present etc.) Inspection #1 Inspection #2: Location: SaoB 90TH ST Ca 1.; Alt BM Description 2.) Bldg sewer length - amount of cover = / ~ ~ !ll~~~ GJ•~-~ 7 ~Z I a~ Plan revision Required? Yes >(/No Use other side for additional information. 4 SBC-6710 (R.3197) Date Insepetor's 4-vll Celt Safety anc Buildings Division S1. Croix 201 W o 62 SA -1 BOX I S2 S urilatS Pcrntn \umhcr ito hC filled in ht' Co.) S 31 ~~zg - JUN 01 PUS 1J $'q 7-6 Sanitary Permit Apg o J1R18ouNm Stcdc fraosa:li \mmhcr a ordane< p ith SPS ..N 3 `1 i i tl Will C,nle. ,uhnustQ 1 rl l~~i~nnnenud umt 4 -/6 9 74 -<quired pi for to obt unm a to rtn pertmt \otc:.lpplicati'm I is for state-oared Pt )A-I's are submitted to PrelcS :\ddres II diffewid than mailing address i iii: Depatlm nt of sales} and I' 1 stonal Services Peron tl infornialion sou pto6de ntat he used for secomhuN ~ lu_irPxcv in a5<~rdan. ;5 ith site Pn ~'t t.ut. s L5 t!a; 1'Rrtl ~[:.ts 1. Application InformatWhq- Please Print All Information ~'1`lN9OT'' St. I'rapetty Ott ncr \:nnc Para - 422 /y 9a S~L(o Chris ~ Dca_tmc Rose I ~ .lcidre„ • ''It~l!i ll5 I.,,i alts?rl 601 90"' SI t im t. Lot Cie.. stare - ~NV MV st erion 06 (circle oriel Hudson. W1 1016 222-92 R T-g !v: R 1 '\t 11. Type of Building (check all Ihat apply) Z 1F 1 or 2 Pamih DS-,cihn,_, \urihcr a?fHcdro•nns [ t suhditii:ion \ame A4 Lane, 61~ Cra Ilh,cl. CSA1 Vol 21. P571 I i Puhhe.Commcrcial DCSer(he 1',.e K I C& .~p WW*4, City of Slate Omwd Dcscribc 1',e CSM \mnl'er VillaYe of ' r055„ of Kinnickinnic (O Jr 166 8 3411t 111. T} pc of Permit: (Check only one box on line A. Complete line B if applicable) v \ctc SS,ten1 Reptacemem ti,stem frcann:nt Bolding Tank Reptaa•enwri( Only I (hhet \l,,airicauon io Existing s%slem (explain) 13. 11 Permit R u:55a1 Permit Re6siott Plumber Pei mil I rattst~r u? \•c%% Lis: Precious Permil \uttther and Date Issued I3efbre I,spiratinn Owner IV_ Type of PONNA S S~'~ten>/C'omponent/Des ice: (Check all that appll, i, L Non-Pressurized In-Oroaiid L l Pressurized In-OwUlld al-Gr.rde \lotllld _ 24 in- nr,uitablc soil _~rotmd 21 in .4- suitable soil Holdutg'I'ultk t>llier Dkpcrs:,l C,)mpoltcrtl Ie\plautl Plrtn:untetiu Deice (acplain) V. DlspersaL'Treatlnent Area Information: 11olvLok P1 525 effluent filter t - Desl n 1 1055 i 'I'll f 1 sr~•n S„il Application Rate(~pdsl) Dispersal -\r ea Re tUirA rst l Dispci,al Area Proposed is[') ut Elr.auon 1.0 gopd/sqll. ASThIC IsMid 102.:18 11 16 abotc Illk "woo Gpd 0.5 gp&sq.ft. mnive soil 600.00 41. fl, 600.00 Sq. I't. V VL Tank Info C rp,tct[t' in Tots! f \tanulaetutrr C Illon> Cndlons t nit,. y L >epGc M Huldu:gl`'OI 1.200 0 1.200 W'icsc Concrclc L i, r;i~i C'h?:nh_r 800 0 KoO I I Combination ST.'PC t VII. Responsihilitt' Statement- I, the Undersigned. awinie responsihilit% fm insiallation of the PO\ti Ts ship-An on the attached plans. Plun,hcr's Yarn, (Pr'utt) Plumhcr's Si-P.ilu-r \IP UI'125 \'t:n,h<°r nusirwss Phone . unther %Villlam Schurrlaker 11bIP 227990 (715) 386-2131 1'lumh ~ \dd-<s, i Strc<t. Cis,, t:nc, !IP Codcl ~ 1070 Scott Road, Hudson, W1 54016 VIII. ount~!l)c)artmcnt Ilse Onl% apprcted Permit I ec Dill Issu fssumg mt signatt: ccn Rcar•;nr I.,r Donial S 4940r 7 1 0 IX. Condit' Reasons for Disapprutal t, 11- 'taNrt. k.~Ea: u#tal~.n,f 3 Cb~d~ e+rlA(rn~(~.1~ ulsper ,*0 r. o i 0 ,s! rr 'nta:,-2 } ti Gt ee.X L4 ~.QQf M~v V'"' afe~ as pat man4pfr om glen pro :,zed by plumber. f1' 'AN nftoq* 2. Wt@11114 lM Ff14s4: narltz lest Pro' eJ- are, per W r u..,l ti. 51~a (`Q~ +Ioolloilblll a* / liffilillwo. +-o A11:101 n teA11:101 to:ontplah• plaza fresh. s5'sA•m and suhmil l0 the ('oun15 unl• m r r, 1 Ir5' this 1 p n 11 in has silt ~ SBD-6398 ;a. I Ii I I) ~Q I CL v~ ruG^/_Y-•t`~- ~ . CJ's, i~,i nr., q,'aOC ~_~i✓ /ili, drrcK. • :LC~r'+.-c' D0; 'y:. .`>~~t .f'f' i / p~ Gr'/per - • lv~ iG.~4.l~ C«..~,~aES~IGr'C.G, I ~-rte ' ~ - Y,,"~ y~., - ' ~ ~ f~f ! I :.~J~1~i1GC:~f'CG[i►(P !~'.')Y, Gr~,' I 62 I ~ i r ! t ~.SCi . v~' f' Y. ~ C of E"'-'~" 1 i~' GJ'.t ~ J 41cf;~~ ~ 7'0r-t re, CA; n `N~ t ~ f i I h f I - r•ti ~ ~ I I~ I R I f f '1 ~.:i'~~ u-~ ou..i ("V d ~ 5~7', oKti•~r, it AI / I t L-- 5 'v 3,D Z2x!lot Pl,rs ~aL 606 X. 3q zc~o 3, W6 12-10, Ey ,t'; ~R;.~) DIVISION OF INDUSTRY SERVICES 3824 CREEKSIDE LN HOLMEN WI 54636-9456 Q ` _1 Contact Through Relay S P httpJ/dsps wi gov/programsiindustry-services .S wnvw.wisconsin.gov kJf~?sro~•~.=t`' Scott Walker, Governor Dave Ross, Secretary May 24, 2016 CUS I IF) No. 227990 A7TA': POIhT.S Inspeclor WILLIAM C SCI IUMAKER ZONING OF ICE SCHUM.AKER PLLINIB1\6 ST CROIX COON I Y SPIA 1070 SCOTT RD 1101 CARMICHAEL RD HUDSON Wl 54016-7302 HUDSON Wi 4016-7705 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05i24i2018 SITE: Identification Numbers Chris Koss Transaction ID No. 2709746 599A 90TH Street Site ID No. 824095 Town of Kinnickinnic, 54016 Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. NW14, NW1%4, S6, T28N. R18W FOR: Description: Dour Bedroom Mound System,' 2'-" slope Object Type: POWTS Component Manual Regulated Object ID No.: 160161 t Maintenance required; 600 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade Svsteml;s): Mound Component Manual - Ver, 2.0, SBD -10691-P (N.0P0 1, R. 10,12), Pressure Distribution Component Manual - Ver• 2.0, SBD-10706-P (N.01:01, R. 10!12): Effluent Filter The submittal described above has been revier%cd for confortnance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. COND The owner, as defined in chapter 101.01(.10), Wisconsin Statutes, is responsible for compliance with all code requirements. AP No person may engage in or work at plumbing in the state unless licensed to do so bN the Department per s. 145.06, DEPT OF stars. PROFESSIO DIVISION OF IN The following conditions shall be met during constnuction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of See. 14-5.19, Wis. Stars. SFE • inspection of the private sewage system installation is required. Arrangements for inspection shalt be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stars. • A state approved effluent filter is required. Maintenance information must be given to the wwrier ofthe tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must he provided per SPS 384 product approval conditions. • The area,.vithm 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized represcntutiecti of the Department. which may include local inspectors. U F[ IA\1 ( 5('111:\1;\KIf, t'z_C 2 1i2O16 Owner Responsibilities • The current owner. and each subsequent owner, shall receive a cope of this letter includin= instructions relatin. to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual andr'or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • 1he owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking. purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in tile POWTS. In ,rantin this approval the Division of Industry Services reserves the right to require chane,es or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the desi-ner of the responsibility tier designing, a sate building, structure, or component. Inquiries concemi•rm-, thi, corre;;pondcncc m<rv he madc to me at the tcleplhorc number listed below. or at the addre,s on this letterhead. The above left addressee stall provice it copy of this letter and the POWYS, mana,~ rr.~~nt plan to the owner and any others who are responsible for the installation, operation or maintenance of the POW I S. Sincerely. Fee Required S 250.00 Fee Received S 250.00 Balance Due $ 0.00 (_~erard lit Swim POW'I'S Plan Reviewer. Division of Industry Services (608)789-7 892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 ,j el-t~ .swim(~iwisconsin.~_nv cc Edwin A Taylor. Wastewater Specialist. (715) 634-3484 . Monda} - Friday 8:00 am to 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of lndustry Services (formerly Safety & Buildinus) will be modified. Code references with prefixes startili" with "Cornrn" have been replaced with "SPS" to reargnize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (fonnerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the k1 isconin Commercial Building Code will be addressed by SPS Chapters 360-366. 0,vvner Responsibilities • The current owner, and each subsequent owner. shall receive a copy of this letter inciudin.; instructions reiatin2 to proper use and maintenance of the s, 'stem. Owners shall receive a copy of the appropriate operation and maintenance manual and.-or owner's manual for the PORTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption svstetr or any of its cornpOnent parts malfunctions so as to create a health hazard, the property owner must follow the contim~cnc, plan as described in the approved plans. • The owner i, responsible for submittui.2 a maintenance ver, icatior, report acceptable to the counn fo- maintenance tracking' purposes Report~ 5} ~Il bA submjttc-+ a-, intervai: apprapria_. ;'or tIm: components i utilized in the POR'TS_ in -~rantlml this approval the Division of ir-dus!-\ Sen ice, reserves the :-i ht to : eauirc chin<_=cs addaions shouid condition, arse making- them necessar\ fo- code compliance. As per state star, 101.12(2,), nothing in this revie~t shall relieve the desi_ner of the resnonsibilm for designing a safe building, structure. or component, inquiries Concerning this correspondence may be madc to me at the telephone num. ber listed belo4r. or at tie ^:~dr~cc on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and a.i% others who are responsible for the instaliation, operation or maintenance of the POWTS. Sincereh;. Fee Required S 2~;0-00 Fee Received S+ 250.00 Z---~_~ Balance Due S 0.00 Gerard M Switn PO11'TS Plan Reviewer, I)ivisior_ of fndustn Services (608) 89-7892. Mon - Fr, 7:15 am, - 4:00 pm \ iSMART code: 763 3 jcm-.swim a;wisconsin.gov cc: Edwin A Taylor. Wastewater Specialist. (715) 634-3484 . Monday - F: iday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & BuildinUs) will be modified. Code references with prefixes starting with "Cotntn" have been replaced with "SPS'' to recuL ;ni7e the relocation of tote Di% ision of Industn• Services from the former Denartment of Commerce to the DeparLmcnt of Safety c- Professional Services. Additionally. all IS (formerly S&.R j codes have been renumbered and addressed in a "300" series. For future reference. the WiSCOI]Sitl Commercial Buildine Code will be addressee by SPS Chapters 360-366. ,1 --RECEIVED MOUND AND PRESSURE DISTRIBUTION COMPONENT DEOPW ZA Pesidential Application _ INDEX AND TITLE PAGE ~I I-zv1CES Project Name. Koss 4 bed: o;~ ri ! eplacement rreund O,,ncr's Narrw Chris & Deanne Koss ~;ner's Address: 601 90th St., Hudson, WI 54016 Property Address: 599B 90th St Hudson VVI 54016 Legal Description: NW1/4NW1/4, Soc. 06. T 28N-. R.15*. Tmwn hip: Kinnickinnic County St. Croix Subdivision Name: CSM Vol. 21. Pg. 5271 (FKA L(,,,t 10')f CSfv''~.'N 1C:. P_l 4108; Lot N~imber 16 Block Numher. na Parcel I.D NurTlbFl 022-1014-90-426 1`IQ NA I- Y Plan Transaction No.: RAVED +VAL gE ND Page 1 Index and title Page 2 Data entry )(/S RV/G~ ~ rRY gRR ~1cS Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications V` - Page 8 Site Plan Page 9 Soil evaluation report Designer: Bill Schumaker License Number: 227g9Q Date: 04!28116 Phone Nr:mt,er: %151 ~~~F 31;'1 Si~anature:lv~~~i Designed ?ursua-. %,Iound Camponen`. M1 in„a for POWTS Version 2-0 SE3D-1rsy1-P frd. 51r'l 1 K 1 U'2i, aria both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manua Ver 2 0 S8D-10706-P (N 01/01, R 10/12) Version 7 0 (R. 11;12) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information r? R. Residential or Commercial Design ri-c:e Sand f+i i0) calculations assurre a 400.00 Estimated Wastewater Flow Table 383-44-- m-s to soil tre (yPd) atrnen' for rrrg rUlrtr~ucr r~` 3 inches. 1.50, Peaking Factor (e a 1.5 600.00 Design Flow (glx 2.00 Site Slope (°o} - 101.25' Contour Line Eleva`icn (tl) 20.00'; Depth to Limiting Factor (in) 0.50; In-situ Soil Application Rate (gpci ;i Distribution Cell Information 100.00; Dispersal Cell Length Along Contour (ft) _ 6.00 Cell Width (ttj 1.00; Dispersal Cell Design Loading Rate (gpdr'ft ^1' Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y ;r F) c' Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation itfj 41, Number of Laterals of the highest point. 01.25 2 Orifice Diameter (in) 2.00! Estimated Orifice Spacing (ft) = 6.00 ft `orifice 2.00; Forcemain Diameter (in) 160.00; Forcemain Length (ft) Does the forcemain drain back?- Y _ 93.001 Pump Tank Elevation (ft) Enter Y r]r N 6 50 System Head (ft) x 1.3 26.10 Forcemain Drainback ~'_faIi 9.17 Vertical Lift (ft) 62.76 5x Void Volume (gal) 5.58 Friction Loss (ft) 88.85 Minimum Dose Volume (gal; 0.00 In-line Filter Loss (ft) 41.19 System Demand (gl;r i 21.24 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection y in. dia options choice in. dia. options choice ll 0.75 1.25 x - 1.00 1.50 x 1.25 x x 2 00 x x 1.50 x CC 2.00 x 3.00 x Gallons/Inch Calculator +;epti r 1!' Treatment Tank Information 800.644 Total Tank Capacity (gal; 1200-OD! Septic Tank Capacity (gal) 3_6.00 Total Working Liquid Depth ii Wieser Concrete ;Manufacturer 22.24 gallin (enter result in cell E349) Dose Tank Information Effluent Filter Information 800 64Y Dose Tank Capacity (gal) Polyl-ok Filter Varufac--.,r 22.24 Dose Tank Volume (gal/in APL-525 Fi~!+ ^~o"~ii `t.i ~b~ Weiser Concrete Manufacturer Pnojp'-j Koss 4 bedroom replacement mound = ,ra,- C N 0d-_SGc VO l0/CJ, 00 •3170 09L 7S M 7:~ `:70i fYv Cl lM, S- 9L.4m nay ivnNVh 3Ild3S 313H anod-,a~a =.s %i 7~NJS :.~a rtmvaa OUDOV33310 M-008/00Z ld-W r' 0 LU V) Ix f- -I C) H < < o > U LLJ x , ° ^ 0 V < V cn LU l/~ Q oz p 0 W a~ 0 w d Cn V w F-- W O d Z F- L7 af O pF < w ~ m mvi 0m oikQ zz Q: m w° < H O - _j m LL > <JV JJ < J z o j.. w O°m s ° ° oww~ z WJ U Q a o o V Q m F O V1 _IwLi UU 7 W z~ s O p c Ca 00 <<~ O V) N t V) 0 `-'v Y CC) L1_ 0 n: E w vwi ~ m w ~ n N ° < a ci a zokz \ U t N t O 1 K V, < N pp p I` V) In ~ O W r)t ~~~pL>m0~<j V w~Z~ Lw/~WU z z Zm CV COQ rnzL~. OV) F= Dz U °\F wv°-i ~o °_~=gyp= °Vy O0E a w ©~Uwl C) LL) pV Cl- O ~F- >ZOOD°0_U ° (f) 0co < 0 OL xX ti _o z Q W J w Y K Y N C7 O I[ O z z O O J < < U w < -S K L-~ CSI C i F- z III I' W II II M ~ t II II I I or U > ~ II I ww O I J W I I ~ I a cn w )I Cie Q I ~ I r7 cn 1 1 I W 1 I~ ~ II W W I ~ C_. . i 1. i t I• ~ i <t. ~ I r I ~ ~ I I C C t I < ~I J~ < z ~ ~10?a w cr „9Ey < i 5 Cn Y z < H T Technical Specifications PL-525 EFFLUENT FILTER (COAVIM ER I L) Z b+..::Ei; ' t FIUF 15 V3a-[ ~ps'~~ ~ r If ?,eF T A ~ r:4 47- 5,5 N4'ERIU HX,3JG-PG-'•PR',PAF%E CI-LET EUSi,N3 x T;. 1 REM I ?:7 `ai.cr aE.rF _aa phi nC - 3r 4'-515 - _ f~_ oP 7 S1. C'ROIX COU \ Li ti t P l W TANK MAINTENANCE iNGREFNIENT AND OWNERSIIIP CFk i I11-1('.\TI(_)N 1-OIt\1 nevBu%er Chris & Deanne Koss V ti , Address 601 90th St., Hudson, WI 54016 599 0th St.. Hudson WI _ - 54016 e:IIicaIion re,Iuirc~_l i'loin PI,lrnlin't ~C !oiling I)cirartClcrlt for IICtl Coa.,trurtio 1. City Slag - - Parcel Identjlicalioti Number 022-1 014- 0-426 LEGAL DESCRIPTION Kinnickinnic Propert% Location NW ' I NW , X11.. 06 T 28 N R 18 W. Town of Suhdili jsjon Plat:--- Lot r 1 6 (c►tified st,l,ey NIaif 834439 Voltt►ne 21 pat,, 5271 ge . NN :11-1-:1111y Deed P (before 2007)Volume . Pa!-,e ~e•C nt~.1;e. p• pl ~i .es x~ Lot' r, 1,Icn'.::I<lhlc❑•'.c~n1;,. ~l"TF:N1 I1 11`TLti:1~ICIF: A1\D ONN"NER CERTIFICATION i 111101)C` INC and I l latlitenalicc of -w ur septic m tclr cool l R•ti'_II 111 I I'.r~lll',Illtr-c fill l! 11 ILrl.:l I'; Vllc,' 11,IAIten,lIce eOn,IStS Of pUntping 0111 The septic lank cvm ihnc ~ curs of .loner- it ll edcj . ov a ll.cll,cd p iripcr V nal I1..' II C ~Iem can atlcet the funclion ofthc septic lank as a trcatment slaye Ili the Nasle disIxisil ststcttl. Oliner Ilitlitlll'ntii'L- ,t~ll~il lltties arc, specified in PI'S ss;.52I 1 land in Chapter t? -St. Croix County- Sanitan Ordinance. I I.c propert omiet agrees to submit to St. Croiy Count Pla►uting /oning Department it certifie;ilion lorta, si ncei 1~, 111 r II.11 h\ it master plumbei, joumcrnYm plumbei.. restricted p111lnher or a heentiCd pnrnpcr x eril•cing th ll i ! )(lie on-~11e .'~r,!,e• I i[ ''nsposal symcill k I'l llrl'r!q•i I •-,!j:Ill l - `I ''!'il ~1111-I :1'1 Cr Ic;>. tlu:1: I; : full of shxiee .1e_ the UndcrsignrLl .I,. Ire I .I' 11 '11 1.1 '-[t II 1.'YI I. I~ ,IC -.l '.c;l-. 1. :'I . -l t idoid cl torlh herein. 1; -.t h, the k I lnlef.t e11 a~Il~t \:r_l C1r tu:.: r al~1i Set "Ict- ally tiir ;hhatnuutl of NaIIIIal KC.Noulcc:;. t l c of ~ l,consin. Certi heanon stating that our septic. ,cslem has been maintained Inust be e.omplcted and returned to the-. Sl U I 'i c ru nl•• 11I lnlnng K /oning Department althin i0 dac, of the three reai expiration date .c certify Ihat all miitcmcnt; on this Colin arc .r-to ltl flit, hest nl lug./t>I-r.' Rr.t»tih;3e•c 1'•,. r,li-.lrc II;; ,1~~n~•1',', „I fl,~_• I:~ :I11 d';,' I':bed alw\c. hvvirtne t>I `./I .I ~.I.'. Numher of bedrooms 4 NATURE OF AI'PLIC':1N'I(Sj DAI I. ,5_tr~, - `'-Airy mi'Otinalion that is misteprescnteel nm.N result in the ; initarv permit being revoked be the Planning ~ /.aping Department " 111 ll ;le rilh this apl)hCAiort a recorded ~.~a-ranl~• t3ect: fro7li thr hcs stir ul T)ec~!> ()ll`ce .u':'..1 C(yy I tie ccrtllic.: snl~rr plot it 1cLcrencc is mid" in tllc ;eurrrll•', d,•rd t 1Z f: N'- OJ 121 P~ r 0~ ~ Wisconsin DeP'Ar aunt nfnnnerce SOIL EVALUATION REPORT page / of 3 fJiv~sion of Safely and Buildings cRPC d B (t±rtim R5. Wis. Adm. Code Alfarh complele site Plan on paper nn1 ss 111;3311 08•'112 x 11 inches in M703. Plan must County s~ include, but not limited jr) vertical and h .67o11lal refer encq,po~rr W,A), direction and percent singe, scale or dimensions, nor1~ a row: grd Ircillem aid dislan4 to nearest road, parcel LD. ZZ Please pritif all information. R iewe Dale Personal wrormalion yntr prc.ide may b- user for seCO t' ~.G f F " (Y t W. s 15 04 (1) !m)} l 7 Property Owner property Location Govl. I nl NM) 114 /V 114 S T N R I~f Prn erl Owner'!; F ;ilir Address l~ E (orC 6 ~~L S 7 Lo BI k tt Subd Name or CSM# M 1' 1 L- e~' I ~zi r 1 r if 11 Ci1y Stale Zip Code phone Number - ~/Ul?S ❑ ity Village Town Nearest Road r ' IUI. 5'10 16, 11 )V? /23Z k1;V1V1~~1,t11V1C-- H- 5 7- New Construction Use: Residential ! Number of bedrooms Code derived design now rate 610-0 GPD F1 Replacement L] Public or commercial - Desr_ribe: Parent material Flood Plain elevation if a plicable _ General comments ^ and recommendations: ~ ? Si TL . ~1~% S C,N.{ 9 C'~•~l ({..4C , ~;3/t✓ .3~ ~ -1OU-uD 7`y s sT~ t,~'•t, ~!L ~ ~ r f- y, ,~Ct 7~ - /S ..S~U i % ~'(3lE 6,E' p S- S / I Boring # ❑ Boring l I Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Deplh Dominant Color Redox Description Texture Structure Consistence Boundary Pools Soil Application Rate In. Munsell Qu. Sz. Cent. Color Gr. Sz Sh. 'Eft#1 'Eff#2 U-7- Boring # U Boring Pit Ground suNare elev. _ ft. Depth to limiting factor in. - Soil Application Rate I Iorizon Depth Dor,unant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' In. Munsell Qu. Sz. Cont. Color Gr. Sr. Sh. •Eff#1 'Eff#2 Effluent #1 - BOOS > 30 < 220 mg/L and TS5 >30 < 15U mgil- ' Effluent #2 = BOD, < 30 rnA and TSS < 30 rng/L CST Name (Please print) S-ignalure CST Number R0r-56,07-' Z-~~~ 22-(037 57 Address Date Evaluation Conducted Telephone Number '}ZO 0 • /cam ~ 17 pis ~3R, •cP/Rs ' Ulfir c I ss Private Sewage Consultants 2 OZFU 655 O'Neil Rd, - - Hudson, Wis. 54018 Ulbricht & Associates l~`'t"` Sou °->u Private Sewage Consultants LO~'-!G 2812 10th Ave. C•s~ a 5 . ~ ~ ; ; ~y'_~ ~ Spring Valley, WI 54767 ~•'.i 1~ r'rnperty • Owner -7 _ Parcel ID # _ Page ` of 3 P-1 Boring # Boring U pit Ground '"irtace elev. ff. Depth to limiting factor _ in. Soil Application Flale Iiori7mn Ueplh Dominant Color Redox Description Texture Structure Conslstpnr~ Boundary Roots _ GPD/flt In. Munsell Ou. Sz. Cont. Color Gr. Sz Sh. Eff#1 'Eff42 i • Boring # ❑ Boring ❑ Pit Gromid surlace elev. _ ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texlure Structure Consistence Boundary Rots GPDAV In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 Boring # ❑ Boring ~--j ❑ pit Ground surface elc±v ft. Depth to limiting factor in, Soil Application Rate Florizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft' In, Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 EMuent #1 - SOD, > 30 < 220 mg1L and TSS >30 < 150 mg/L- ' Effluent #2 = BOD_, < 30 mgIL and TSS < 30 mg/L 7 he Pepartment of Commerce is an equal opporlimity service provider and employer. If you need assistance to access services or need material in an ahemate format, please contact the department at 608-266-3151 or TTY 608-264-8777. Snn-Rile (R r-"I nrnperDy ormer S . ~E,E'/`l/~/~ Parcel 10 M 02- 2-, /O/y' l D / 07J Z 3 1 3 I Boring a ❑ Boring 7 7 Page of F -J Pit Grrxred suriaoa Nev. _ it, Depth 101hniN f ng acts In, Horizon Oepth Ihminant Cdt.K RedOx Oraol Sail Application Rate paon Texture Sinrclure t;onsislence Rourafary Roots GPD/flr In. Munsell thr. Sz. Cont. Cola Sz. Sh. •EPaI 'Effa2 b- y io yp ~-/3 S/~ fs6K .,7,e w s~c_ z f s 4-71 z ,30 S "R ;o{ Hof s , , fiP cs .y " D•~ z c2~ MATS ~G /fs _ , z .3 Boring I ❑ Being ❑ Pit ground sonata ekrv _ it Depth to Nn*" tactw _ Hin. App ortzon Depm Dominanl Color Sal Nuitirm Rate Rer10x OesaV-C Texture Slruciure COnsislence Boundary Roots GPD11111 In. Mansell Ou. Sz. Cant. Color Gr. Sz. Sit. •EKe1 •FRa2 i i ❑ Baing 7Y f❑j Rrxinp t Ground PiGround smlace elev it, Depth to lirniting factor _ in. Hnnzon Depth I?orMnant Cdor Redox Desrxiption Texture Shc Appllcetlon Rate Strvclure Consisler Bourwary Rook GPDIII In. MunsrN Ou. Sz. Cont. Co10r Gr. Sz. Sin 'Efro1 'EIfe2 P'RUenl Al ROD, > 3D < 220 mpti and TSS >30 < 150 n g& ' ETueM 112 -ROOT < 30 ffV/L and TSS < 30 rrplL The Derrartment of Commerce is an equal oppnrtunily service provider and employer. If you need assistance to access services or need malelial in an alternate format, please contact the department at 61),R-266-3151 or'l-1Y 608-264-8777. [nr, n,n n r,m~ ' ,.is)-nslnDrpar!Frwd,.JCommerce SOIL I V LUATION REPORT Page l of 3 f i •;von of Sarety, and StAkf ngs II I A5, Adm. Code - - - [jtt • Counly 5 / • C~t7/ X. Alindi rnn7dete site plan on paper r I 55 rhnn A 4r r t 1 1"' lies In SR 1'lau must r----- nvJ.•,Idet, hid vest limiled la vertical and h di0ntal referee`sft1I cw,r,A~;~` "t. di lion and parcel 1.0 d Z~ /Q(~. T D yt-~c OL [:rrrvnt 4fOpe, Scale Or dirnensirms, nort anovjj~ii~109aM?in21VJslarv~ tonearest road. Please Prin a1llnr 1P- Dtte ,~Lta- i'ersn^al I•,rnnnNrcn vmi nrn•,We rn:.y M vse• •,y seca ANlltH4~ s. i50a (tl lra)1- ,(/yV}~ 7 D~ Prlpwl)• Owner ,t n ~C ,yl/~C C Prry)nly Lo ati~tso ~j fC- o' - !1-/,L" is V•~ ✓ GM, LM VW 1!a A" )'4 S (I T Z"Q N R F (or C C'rnrierl navel's t ail' Address - - - 0 0 Subo. Name or GSMk r or 9pl. sT ,dlr -5'41 _ / ~5 0 C.ir; - -Stale Lip GOde Phone Number I~ 'ty b'il:'age pt].Town Neared Road f~l~ySe~ IWI.I 54o1(c ,-715)711?• 1/232. Kw,vi~', v,L 90 - 57. New ConslructlOn Use' M Residential I Number of bediwuvs Cods derived design Anw rata GPD ( j Rvplaicnrwnl 11 r'ubbr or c^rn erdat DescAi 3, r'a•niil maleual _ rlr»A Plan elevalion if a nficable 'C it. ,,'M'at 4e144m :~•ed recomnienda!iOns: yPF_ u~~/~F-srF_,✓'l5 ~ f • ~ . ~ 3~ ~-1OG'ti!? ~'}/~e~- S f/STE~`!S Acu -r / p Rnr,nq y Owing if ~ PA I roix+d slnlarv elev. ~U . 1 2- tL Depth to limlting factor In. Soil Ap icatfon Rate Horizon Depth D,xnvnanl rotor Redox Description Texture Structlae Consislence Boundary Roots GPDIft' in PAtinsell Qu. $z. Cont. Color Gr. Sz. Sh. 'Eff>Yt 'Eff82 f o-/b 10W V3 5'1(- z -{sOt /1- l~ 2 f s r.2 cs s 1- 16-15 /00,313 3 15,M /oyR y/U SAC z .~)fR cf s j 7. SyR et F t o r S l! / ~i' y G Painq-.__. P. xin L f Pit Grcamd surface elev. It Depth to Ilmleng factor I^- Soil Application Rale Horizon Depth Dominant Color Redn. fles(!ipllun texture Structwe Consislpiwr Boundary Roots GP(MP In. Munsell Qu. Sz. Cont Color Gr. Sz Sh. 'EfFa1 'Efb12 o g Ally,? SAC- z s 7W ~ L f s P 2- /0 Y,t'3~ SI C_ s k w yf f • S • 6 3 20/0 V / sL 7 fle 0? 'fS - G -9~JZ 51k /;0 PY1' -3 7r- -Z ' EfQuenl Of ` 130Dr > 30 < 220 mprL and I SS >30 < 150 mWIL EI".aenl A2 = HUD5 < 30 myL and TSS < 30 npll .a CST Name (PIe ~Prnt) Q 7 1h1e e-11_{ Spnalurn 2- 2. §7 5loot AcMress Date Evaluation Conducted Telep>hnne tJiixrdwtr ulb 2- Oa U P 71Vj Coneultanta -7 8 5/ Hu401t3 IV~-7lort' LGi2Ch»+e2~-~of~d 1~5-X'71 Ulbricht & Associates Private Sewage Consultants ~1 L 2812 10th Ave. ~~R l C, I y A j Spring Valley, WI 54767 Or- Ila )AOVPP PPOPOS L-ZD J3 z / rte"' ~a I r , P I ~I r 33 I , oi- .,J I O I M o u,O L) ys7 q5- 2000 CSw~ - r~~~~-IIOY I~ i ~ I v ~ SaG 7~T k T. ~ w use j V j I s ~~d. l i t U -VI 373 .Q~, ~ I'T:~ TESy { 4,1 37-5 46 ~p I H, 1 ~ 1 K . N 373 3y i I -~°rn Fad SC ~r ly Z x