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HomeMy WebLinkAbout030-2131-43-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 597319 GENERAL INFORMATION State Plan ID No: Y?'I/ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Pik Permit Holder's Name: City Village Township Parcel Tax No: ELIZABETH CLARK TOWN OF SAINT JOSEPH 030-2131-43-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: Y 23.30.20.1097 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic. ! r Benchmark {rx D=N / Alt. BM Aeration' Bldg. Sewer Woidin SVHt Inlet I TANK SETBACK INFORMATION St/Ht Outlet ! TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet U,Septic i r Dt Bottom Dosing / Header/Man. Aeration Dist. Pipe Holding Bot. System ,r% 4,4 " 72(p. Flo, 6.1 Final Grade -7 _.t PUMP/SIPHON INFORMATION , Manufacturer Jae Mand St Cover J ~i1 T J Model Number i TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM AS BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturers/ INFORMATION CHAMBER OR r 1'✓° type Of System: UNIT Model Number: r DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake I Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ! Depth Over JDth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center .f /TEdges Topsoil Yes ~ No C Yes C ]No i. COMMENTS: (Include de iscrepencies, persons p s nt a c ir Inspection #1: Inspection #2: Location: 118 HERITAGE TRL j , ^ 1.) Alt BM Description l 2.) Bldg sewer length = W:11 Np 1"`~~/l a 0V~✓ vil C~( 9 n 1 i I /ls•~ IQ(( ! r amount of cove ~~~e~' 1~ i~~ ✓ VP*hi- in w o~ I`nspicch On ( Plan revision Required? ❑ Yes No I / 74 1WAY AdA ,,64 Use other side for additional information. IS &Tlr ~ Date In ctor's Signature Cert. No. SBD-6710 (R.3/97) Sarah Droher From: Mary Jo Huppert <hollisterdesign@outlook.com> Sent: Sunday, June 25, 2017 3:07 PM To: Sarah Droher Subject: Clark Attachments: Scan0074.pdf I Hi Sarah, Keith, plumber was there (they did the digging) and sent me this location of trenches. Trenches were staked when we left that day. Thanks, Mary Jo i L~ n ~ viP w ~ :n ""tA'~"_ ILA 0 0 ~ ~ 14V^. CGIC G O C+ ' V C ~ c a r! •yyy~ Imo'' L tni o c 9 z r a ts~* 3 47 ^ f 41 1 3 ~ ~ L w n T1 e,`Y,a J N t.~ Lu '~!t 4a f W. RECEIVED dG7-p2vZ 4t5 017 - 1 Industry Services Division ~ County ~ MAY 0 2 2 1 i 1400 E Washington Ave. C CU {=1 S' P-0. Box 7162 A Sanitary Permit Number (to be filled in by Co.) ST. CROIX CO NTY Madison, WI 53707-716 r~ ;OMMUNITY DEVE OPMENT '77 Sanitary Permit Application State Transaction Number 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 Project Address (if different than mailing address) the Department of Safety and Professional Services- Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 1 m , Slats. 4 1. Application Information - Please Pri ormation 11 ~-j i~EPJT7(Cz. l KA 1 Property Owner's Name Parcel q Eu bE TO =~~tkk 0?U- ~i 31 -4-3 - coo ` Property Owner's Mailing Address t Property Location ~ . , hu ; Govt- Lot City, State Zip Code Phone Number _ N(•J SYd Y, Section z3 11 A (h D G L/ /~J (circle on H. Type of Building (check all that apply) Lot €1 T __3(? N; R a~ E or~ a / 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name t Block s6~rr~r ❑ PubliclCommercial - Describe Use 0 Cityof ❑ State Owned - Describe Use se, p &!; ! CSM Number ❑ Village of _ ST JOS~'>y 3 Ui l~ f"J Town of IIL T e Check only one box on line A. Complete line B if applicable) A. New S t ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Pcrntit Rrncwal ❑ Permit Revision ❑ Chauge oCPlumber ❑ Permit Transfer to List Previous Permit Ntrmbcr and Dale Issued Before Expiration Owner "Y r t G~~ Coln onent/Device: Check all that apply) surized In-Ground 0 Pressurized In-Ground 0 At-Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil t ;Holding. Tank 0 Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Din rsalfTre ent Area Information- Design Flo- (gpd Design Soil Application Rate(gpdst) Dispersal Area Required FD,qE1vt l Area Proposed (sO S rem Elevation loo() c~.7 5 7. I N 73 t VI. Tank Info Capacity in Total p of acturer Gallons Gallons Units New Taoks Existing Tanks I et t; V N _ y O a% L ¢i A L Septic Holding Tank ° U N w 0 a rG'X70 7~~ (7u (-tS-(> x Dosing Chamber VII. Responsibility Statement- 1, the undersigned, r ,sate resp-4bintr for rnswl twa of the POWTS shown oa the attached plans. Plumber's Name (Print) Plumber's Signatryu\re M RS umber Business Phonee Number KEITti^ N1 \(/~j 37 ~~S_'; /z Y~-,~ Plumber's Address (Street, City, State, Zip Code) C141019€w;- ST c•'ADoiT G, 6-;f4-7Z-7 VI Coun /De arttae'at Use Onl ppreved Permit Fee Date tied Issuing ignaturc S ~g5•C 5 1z- even Reason for iai IX. Condi aso for rsapproval , 3 I~iNI%HINJ- 0 5}h tN Fv~IRk~ < Koer-Isi 004 must do W" 'h gam 2 ~ 7,3yemen! plan prorri by piumber. V41 L L W?V106 OLWPAN `f R'IFFiDMIT 0 ~ *Wii►er.'wm must.ptl i-,air* ire d V?S 121 N E tint Per WknbK cxldtT / Mi sAlrtF. r Attach to complete plain for the system and submit Spjke County only on paper Dot less than 8 r211~inebes ie sim ckh W1U5~ tJf rYisftt1l' }/Z" SBD-639$ (R. 08/14) be (ow rpat hail t~ an vsI~ Qv,ZC ~ndcr~- Gll err ~ufck..-~ ~l~!/S ~ ~mT T ~ - V m ~ T.Z1 ,T1~ T T ~ D ti m ® m O Z rn ~ 0 0 D N = = O ➢ 0 A m ~ ~ O O 0 ~ n -m+ v 0 io v N O O V ~ r T O ~ o 7 mo m ~w ~S> ~A m O Z N O O V W V TA -i ~ O m T M IF) m ~ rn D = m F= Z O m m ci);7 C7 G) G-) 0DZ -n -n u) O 0 0 o m 0 c-0~ooZG~ A ~ T V T 0 ° M4-2 > , N ~ N ~T T1 ~ N D G7 m> 0 z ill 112' 106' 100.5' 0 ~ z m m ti y I m N J J D TI J N N r D ~ 0 J z C3 m m D D e ~ D M Z 0 D r D m 0 A A N m Z m m O .T] - - - - - - _ w I I I I I ~ O D Z C I ~ r D~ A~ N V 0 m O N Z O :u m 3 7C r mgr 9* m = m j G I- m _ C7 D mo r C~ m ' m C3 Nm C v i m „ f I fNTI PROJECT: 4154 123rd STREET a o N.P. C. A. CERTIFIED PLANT 1,250 GAL. LOW PROFILE ~I CHIPPEWA FALLS, WI 54729 u N o = & HURCUTT N PUMP, SEPTIC, HOLDING, C O A C R E T E In C (715) 723-7446 x (800) 924-1516 g MEMBER OF: OR GREASE INTERCEPTOR • FAX (715) 723-7111 x www.huffcutt.cc" m NATIONAL & WISCONSIN PRECAST CONCRETE ASSOOATIONS 55' 47' 8' 3' 44' 5.75' 2' ey A D N N U 1' 2- U z r m IK 4' W A H D 20 2' A Z O~ ~O u F- m C < c~ m d = tJ t7 L J D O D D m £ Cl n :K 31 Z m D cn 7C m x m r w orr~ D £00 N CCm ru fTl m z ey d A 10 c7 Mnnz 6.5' m ~D Dn m d C3 U m = D o -U II II II D 3 Z £ UI UI Z N C7 -i cl Z T. 90 w is m m z m n ClA z 0 m cl m D m Z pj o V UI " O n A c [3 D n t7 C -1 C) 1 C O 0 C3 D 3 b C) m .T) M F- < D D N C:z G, l m rZ ~Z ClD m r r v) ;u e7 O p m m o o <m v z Z Z n m r C] m -i a D D m m) m r r cZ Am z na n r r mm meo c m D D A Dm < m m to t7 ty r~ zm m = m -i m m m£ Nr~ ~m m A o r r D~ m 45' 10' = D A A 'l 7-:1- M a 42' n O v ~ ey cc m z m < o a dA oN rzj m n cn cl z ~o ;Q A D m D D A 2' O.a £ p > ;u £ '4 0 (4 0 _0 r-_-_ Z ~ m m Cm ti p D r '9 m Q 1E r- _ A Z 0 -1 1> M O aO m N £ m 0Z c d% m c A zl Cl " m F- m _0 D at7 I L >m z -i Z 3 Z 'rT~ D Z p rm c zz z <rZ DUI a OO a M r m A Z b O m C-) ,U k7 D n D C O m D 1 r- z ey mN z 7K z w ~w A~ m m nfl m me U.. 1 -1 c c A Ar m A r m m z m n m A N PROJECT: 4154 123rd STREET m s a N.P.C.A. CERTIFIED PLANT HUFFCUTT CHIPPEWA FALLS, WI 54729 :,250 GAL. LOW PROFILE N PUMP, SEPTIC, HOLDING, (715) 723-7446 x (800) 924-1516 MEMBER OF: (U OR GREASE INTERCEPTOR l*C0nCRETr. In C FAX (715) 723-7111 A www.huffcutt.com m NATIONAL & WISCONSIN PRECAST CONCRETE ASSOCIATIONS PAGE I OF 4 In-Ground Gravity Plan Index & Cover Sheet Coa4=mt Aftwal De.*n ftftterices: Version 2.0. SBD-10705-P (N.01101, R. 10M) Pq I of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross-Section & Plan View Pg 4 of 4 Management Plan Attachments: Enclosures: POWrS Application for Review I I TAPW S fjt C-S Soil Evaluation Report & Site Map 71N F I t--rA-rc,,,P-- s TAXr, Project Name I Description ( __TF_YF Ownermarne(s): ELiz_AF-E.T1J (fc_4r_K Phone: OwnerAddress: - - Zip: Project Address: I -TKAIL El Goirt. Lot: 1/4 of. -t-,W 1/4, Section 7~ - N-R E or WW Township: f>T. County: _,:~T. c po i K Project Parcel ID - Z_/ 31 - L43-- Designer Information Designer Name; AX]AFV .I A-LePelli,:T Phone: -2)5 - Tz-J - lq'4b l3esignerAddress:. 2,~/qql KweAgnHads (I., nmpuke~_Uyx Zip: E-1mil: kolUsferclestan (a')t)u+fwK.e6~vk Tbiss ";f, stamp. zz Ucense Number. i ~,5q - Db -i Ar W Remarks: Wnyio T Huppan 01859 ,%RIM FALLS~.-- .0 Signature: ;7/- Date: _,fl- 0/ -ovi, 7 04 ~swat~we mmjWd on each uftftd Cow. Y (V C+ N ~ ~ 1~ ~ 3 ~ O 1~ 7~C~ V 7 l✓ ~e 17 ul A t D W fY ~ M IL i cl iL z Zl LL v ~ ..app - PS '16 . ~0 Ulf w 9Q _ o ~ XC ~ C . 4 ~ 7 , os 467 Q h' G+JS { n; ®Q ~ ~~,Z 's,3 1 C tiw s - o o tY 1 a 5 u r ~ 3 ¢A j U z _ U% Q o ~~~~~m 1C ~ M l1~ N mm~ mm_ - ~ na sv ° m~ n -t ~ aam cCq Z°-'ice nt~m Cy _ cv M W y. y- C Uu N ~7 D N ry r { to CD IN-GROUND GRAVITY DISPERS Uniform Elevation Trenches with Quick4 rd-W Chambers SepficTa4s)vd-K4 3-ft Trench creft _ - ILA sit EOMW FWw Mauer FJiiad F7na► Mudat* SCX COVER r lrYpG4 TYPICAL TRENCH CROSS SECTION VIEW F ma n: (No Scale) • Provide minimum 3 ft System Elevation = 9L rzo ft separation between trendies- (typlca) Qtdck4 Standa" End Cap typical) (Show kxmtim of inlet ! outlet pipe connedon on plan view.) TYPICAL TRENCH a PW UMMAKISeft PLAN VIEW (No Scale) d JA = 3.0 It M (tYPI~) Quick4 Standard-W Chamber W INSTALL PER TRENCH: (tY imo O (mrdyAng Syswne.rc) -n au;.k4 std-w a 20 = V. (a 4,tAo + - Pails of end caps a rT'& ` ft= b11 - Loo =Proposed EISA per bench = ~ft= 2C6 t ' V~~ bAftrd on Area'=[ $~7 Sfe DlStiibutim Method: x --~Ctrertc hes = Proposed Total EISA = tt= \ Win{ t p b $'23 4z x y' ~ t6`~ ~ ~ 1'tSF~Uc_H~~ .alt ~Ef►~ ~b r Qll%Cl(~~ i i LT A-ro r Low Profile (LP) f g5 4-i 4 I~ vi Ya vb^ w. _ y: a a~rz Maximum Strength PSize 34"W x 53"L x 8"H (864 mm x 1346 mm x 203 mm) Effective Length Quick4 Plus 48" (1219 mm) Endcap Benefits: Quick4 Pius Louver Height All-in-One 6.3" (160 mm) Periscope Benefits: Storage Capacity 32 gal (121 Q Invert Height - 3.3" (84 mm), 9.6" (244 mm) Officials (IAPMO) r _ micA4, Quick4 Plus Standard Low Profile Chamber . 8., i 34" 48" - (EFFECTIVE LENGTH) Quick4 Plus All-in-One 8 Endcap uick^ Redcap 10.4" EFFECTIVE ► LENGTH` When installed EFFECTIVE between LENGTH' 2 chambers. 8" 13.3" 18" - 18" EFFECTIVE 3.3" 6- 3.3" LENGTH' INVERT INVERT . When installed at the end of a trench. INFILTRATOR WATER TECHNOLOGIES, LLC ("INFILTRATOR') Infiltrator Water Technologies, LLC STANDARD LIMITED Drairfield WARRANTY Quick4 Plus All-in-One Periscope a The structural integrity of each chamber, endca , EZflow expanded polystyrene and/or other accessory manufactured by Infiltrator ("Units"), When installed and operated in a leachfield of an onsite septic system in accordance with Infiltrator's instructions, is warranted to the original purchaser ("Holder") against defective materials and woricrnanship for one year from the date that the septic per it is issued for the septic system containing the Units; provided, however, that if a septic permit is not required by applicable law, the warranty period will begin upon the date that installation of the septic system commences. To exercise its warranty rights, Holder must notify INVERT Infiltrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen 9.6" (15) days of the alleged defect. Infiltrator will supply replacernent Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrator's liability specifically excludes the cost 1 of removal and/or installation of the Units. } (b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THEPE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c) This Limited Warranty shall be void if any part of the chamber system is manufacturec b; u one other than Infiltrator. The Limited Warranty does not extend to incidental, consequential, si-e cial or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including 5 9„ loss of production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Helder or any third party. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions; failure to maintain the rnirimum ground covers set forth in the installation instructions; the placement of improper materials into the system containing the Units; failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the terms set forth in this Limited Warranty. Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any third party resulting from installation or shipment, or from any product liability claims of Holder or any third party. For this Limited Warranty to apply, the Units must be installed in accordance with all site conditions required by state and local codes; all other applicable laws; and Infiltrator's installation instructions. (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any parry other than the original Holder. The above represents the Standard 4 Business Park Road Limited Warranty offered by Infiltrator. A limited number of states and counties have different war- P.O. Box 768 ranty requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in { Old Saybrook, CT 06475 Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, 1111-117-7000 - Fax N LT R A T ®R 16800-221 4436 860-577-7001 and should carefully read that warranty prior to the purchase of Units. www.infiltratorwater.com U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,011; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Olher patents pending. Infiltrator, Equalizer, Quick4, and SideWinder are registered trademarks of Infiltrator Water Technologies. Infiltrator is a registered trademark in France. Infiltrator Water Technologies is a registered trademark in Mexico. Contour, Micro Leaching, PolyTuff, ChamberSpacer, MultiPort, PosiLOck, QuickCut, QuickPlay, SnapLock and StraightLock are trademarks of Infiltrator Water Technologies. PolyLok is a trademark of PolyLok, Inc. TUF-TITE is a registered trademark of TUF-TITE, INC. Ultra-Rib is a trademark of IPEX Inc. © 2016 Infiltrator Water Technologies, LLC. All rights reserved. Printed in US.A. PLUS01 0816 a a - • - i-•. - a I11 ST. CROIX COUNTY SEPTIC TANK MADTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/]Buyer ELl Z-( UT H C l fi~ f1 Mailing Address _ Property Addres 1 H L= Kt T-4c~-,U Tf<A ( l_ (Verification required from Planning & Zoning Department for new construction.) City/State U cM lJ l1J- Parcel Identification Number 5c - Zl.zl - Ll ~5- COGS -T LEGAL DESCRIPTION Property Location Nei '/4 See. L3 , T 3C~ N R W, Town of Si , ~L t Subdivision Plat: S TTCi2s Ed , Lot # Certified Survey Map # , Volume , Page # w Warranty Deed # (before 2007)Volume , Page # Spec house Oyes 01U Lot lines identifiabl vyesQno 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 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 Owner maintenance responsibilities are specified in §SPS. 383.52(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 (1) 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. Uwe, 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 three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe amlare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedr s 04/25/17 SIGNATURE OF APPLICANT(S) DATE ***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) t-LIZA B&TV O L KK PAGE 4OF4 In-ground Gravity Management Plan IMPORTANT: The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. i Maximum Dispersal Area Operating Limits: Design Flow = (O CL) gpd; BODES 220 mgL-1; TSS S 150 mg0; FOG 5 30 mgC Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i_e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re-cycling, float switch settings, etc_) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Slats. when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent niter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code/. Report any component failure or malfunction to: Name of individual or company: tt~h cxt~ ' SEP! IC 5I-s- F-/41S Phone: 71:5-- 7C,3-- 933`)( Local government unit S-t _ L Rf t (C + W TV L G y~v1 lT,y i tv D>` J ~n_ Phone: 7 I - 3 &c - Lt b $U Local government unit address: +4 U 1~ ti W-T P P, I A icr 140 a Sp zip: Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWfS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin_ Code. Contingency Plan In the event that any failed treatment component of this POWfS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. '~'a.tiaaa wr rr sao xica~'~u'auitvaa wr t~cao s ( 4W 10 x~ir~x w aroaen~o ago ofiaeiai a 3e ~7 ia+xvu orv'atvl iwxaado~eaivis aaura ♦v a3i~3iwld •WO:I'N~1S3<1XI(1N7'M.MM• EKI LSL (0L) XH! 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Plan must include, but not limi U%Sfonotal reference point (BM), direction and parcel I.D. 030 - 2131 - 43 - 000 percent slope ensions, north arrow, and location and distance to nearest road. Please print all information. Review by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 4~j~r C -2 Property Owner Property Location DONNA L. MILLER (Buyer: Elizabeth Clark) Govt. Lot NW 1/4 SW 1/4 S 23 T 30 N R 20 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 112 Bridgewater Trail 43 Settler's Glen City State Zip Code Phone Number ity ®Village Town Nearest Road Hudson, WI 54016 ( ) Heritage Trail El New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ® Replacement n Public or commercial - Describe: Parent material sandy outwash Flood Plain elevation if applicable NA ft. General comments Conventional In-ground Trenches 0.7 loading rate and recommendations: o,lSvo%~' Un ~t axlMvm b114 .1 r' 1❑ Boring # ® Boring / of / I j/ fpl r, pit Ground surface elev. 97.50 ft. Depth to limiting factor 60 in. Soil lication 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 1 0-9 7.5YR2.5/3 Is 2f-msbk mvfr cs 2vf-m 0.7 1.6 2 9-32 7.5YR3/3 Is Osg MI cs lvf-m 0.7 1.6 3 32-60 7.5YR4/4 - s Osg dl aw 0.7 1.6 4 60-65 7.5YR4/4 c2d 7.5YR4/6& IOYR6/2 s Os MI 0.7 1.6 2 ] Boring ® Boring 97.65 58 Pit Ground surface elev. ft. Depth to limiting factor in. F 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 1 0-9 7.5YR2.5/3 Is 2f-msbk mvfr es 2vf-m 0.7 1.6 2 9-30 7.5YR3/3 Is Osg m1 cs 0.7 1.6 3 30-58 7.5YR4/4 s Osg dl 0.7 1.6 4 58-62 7.5YR4/4 c2d 7.5YR4/6& I OYR6/2 s Osg ml 0.7 1.6 * Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number MARY JO HUPPERT Hollisters Soil Testin &Desi n 224832 Address Date Ev ion Conducted Telephone Number 28497 King Arthur's Court, Danbury, WI 54830 03 - 25 - 2017 715-426-1775 SBD-8330 (R071/13) Property Owner Miller, Donna(Buyer: Clark, E) Parcel ID # 030 - 2131 - 43 - 000 Page 2 of 3 ' Boring M Boring # ® Pit Ground surface elev. 98.05 ft. Depth to limiting factor 57 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 1 0-32 7.5YR2.5/3 Is 1 f-msbk ml gs 0.7 1.6 2 32-57 7.5YR4/4 s Os dl 0.7 1.6 3 57-60 7.5YR4/4 f2d7.5YR4/6& I OYR6/2 S Osg ml 0.7 1.6 Borin # R Boring g Pit Ground surface elev. 98.05 ft. Depth to limiting factor 58 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 0-20 7.5YR2.5/3 Is 1 f-msbk ml cs 0.7 1.6 2 20-58 5YR4 4 s Os dl 0.7 1.6 3 58-63 7.5YR4/4 f2d7.5YR4/6&I0YR6/2 s Osg ml 0.7 1.6 0 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. © Pit Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 ' F-- Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L SBD-8330 (R07 13) ' [V J a t t N -.3 e w 3 a ~/d lc~ w k= w t a ~o ~i M U ~ h ~-s J x ~r Qr, ®2< -Z a~ v N m~a m " sum CN o w s N H ~ G W cc O U~~ ~ <oT 'V N Wi`sconsin Department of Commerce SOIL EVALUATION REPORT Page I of Division of Safety and buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must ~7 C C include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 3 ~.2 3 (yam Please print all Information. Re 'ewed - Date Z Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner_ Property Location Govt. Lot ~r~ 1/4>Lu 1/4 S Z, T N R u> Cl E (or) Property Owner's Mailing A ress ; Lot # Block # Subd. Name or CSM# ~ n r r ~'o it 72L. :t l/r .l c r~'i If vl f S'~ •<<-s City State Zip Code Phone Number ❑ City ❑ Village O Town earest Road New Construction Use: Residential I Number of bedrooms ?'a Code derived design flow rate & GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material + Flood Plain elevation if applicable ft. L1 General comments S Y,> -eIh /7Zf)/YY1C1 Syb l/I` aG! / j 7 7 and dations: `~s ~ A.(~/ rU v C~ Y - yClI_A/k~/ j0dW-7T A~ . Boring # ❑ Boring r; a' Pit Ground surface elev. q j, C l G ft. Depth to limiting factor ~C in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 t in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 U ~ C_`> y - 16 ~r ❑ Boring Bo l r_ . - ❑ pit Ground surface elev. U U ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 IS I' 3) 2- '3 f ' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number ! S vr~ r Z533G91 Address Date Evaluation Conducted Telephone Number 2~ Gam' ~~.rr a 1~ l 5`ttSLS (-i r.~~ Z-q 7 `f CC