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HomeMy WebLinkAbout020-1380-39-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. CCOIX Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 597464 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. hi L Permit Holder's Name: City Village Township Parcel Tax No: Dennis Gatzke TOWN OF HUDS 020-1380-39-000 CST BM Elev: Insp. BM Elev: BM Descripti n: $ection/Town/Range/Map No: I~' "'n P^ 11.29.19.2365 TANK INFORMATION ELEVATI N DA A TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM l U Aeration Bldg. Set Holding Val inl~k °I.°1 qnn TANK SETBACK INFORMATION VaI~ I .'J5 9 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe 7 Holding Bot. System `r7 r PUMP/SIPHON INFORMATION Final Grade Id 0. VV, Manufacturer Demand St Cover . U~ G v Model ber 1 I TDH Lift Friction Loss System Hea T )H Ft For main Length Dist. to well SOIL N SYSTEM BED/TRENCH Width Length/,* 1 No. Of Trenches PIT DIMENSIONS No. Of P' Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTE TO P/L BLDG IWELL LAKE/STR LEACHING Manufacturer: n yn INFORMATION T e Of S tem 1'! 71 96' ` CHA UNIT OR Model Nu r:I~f a DISTRIBUTION SYSTEM {S~ S U Header! anifold i Distribution x Hole Size Ix Hole Spacing Vent to Air Intake Pipes yLength Dia gth Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only % Depth Over xx Depth of xx Seeded/Sodded xx Mulched Depth Over Bed[Trench Center N Bed/Trench Edges Topsoil t J o 77es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 705 OLD HOPKINS PL 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover =1 N VVS Plan revision Required? ❑ Yes o ~I ~v V_~L' l 1 6b Use other side for additional informati0 V SBD-6710 (R.3/97) Date Insepct ' ignature Cert. No. County <I - a ^ ~tt Safety and Buildings Division s K I ~ U i 201 W. Washington Ave.; P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, Wl 53707-7162 q , L..-r_0 ngvr 0 1)( CO LdP J ! ~Q~ Nanitary Permit Q StateTransaetion Npr~cr In accordance with SPS 383.21(2), Wis. Aden Code, submissic XF PW 4 R Lt is required prior to obtaining a sanitary permit Now: Applicati -aw-owned POWTS are submitted l Project ass (if different than mailjng adjryss) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary t a/1\ v J purposes in accordance with the Privac Law, s. 15. I m), Stats. ` I. Application Information - Please Print All Information J P~ Property Owner's Name Parcel 4 C59 0 0- 00 C t-, 1 1/1 &C11 19" Property Owner's Mailing Address i~ rrwl I Property Location Crty State J , ( s s 7 I Govt Lot 1 , Zip e Phone Number &1&2 Section -le ype of Building (check all that apply) Lot # T N; R E r W I or 2 Family Dwelling - Number of Bedrooms Subdivision Name ock ❑ Public/Commercial - Describe Use 4LCA- { ❑ City of ~ i ❑ State Owned - Describe Use CSM Number ❑ Village of Town of III. Type of Permit: (Check ly o box on line A. Complete line B if applicable) i [ New System eplacement System ❑ Treatment/Holdina Tank Replacement Only a _ ❑ Other Modification to Existing System (explain) ❑ Permit Renewal ❑ Permit Revision 11 Chan ge of Plumber D Permit Transfer W New List Previous Permit Number and Date Lssued Before Expiration Cyw n~//(, i IV. T of POWTS S stem/Com onent/Device: Check all that a lv I -Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil~~ Holding Tank 11 Other Dispersal Co S Component (explain) ❑ 'retrcatment -vice ( lain) 1994 'C' f e_ V. Dis ersaVTreat ant Area Information: Design Flow (gpd) Design Soil Application dsf) Dispersal Area Required ( Dispersal Pro d (sf) System Elevation i r use VI. Tank Info Capacity in Total # of T Manufacturer Gallons Gallons l Units , ' ` o T New Tanks Existing Tanta T s U to r, n Septic or Hol Tank I I / , fj D 421 Dosing Chamber J -1 VII. Responsibility Statemen F, the undersigned, a e responsibility for installation of the POWTS shown on the attached plans. Pl s ?game - ~ (Print Plum „ig-Imire MP/IvIPRS Number Business Phone Number it ~ 2 - 6 cw~ Plumber's Address (Street, City: State, Zip - ounty/De artment Use Oniv - --1 ~enuit Fee -_r Date sue Issuin^ t Si ature pproved rsaPpro b • gn lr~ 1-7 Owijaprv R on for Denial DL Condi 1 ason~4or Di~approval t apt . tank, erft e~ mi uispersu cell rust till be s?l :k _S IL! ln as,per ?par.aicement plan pro-tided by plumber. e 2 a k regtiiret~lertts n~u Gree r}airrtcfirer! '~-a . - is W rpFhCf+bllt GUdw I ~:rdlJtstm3. L J, Attach to complete plans for the system and snhmit to only on paper not less than 8 ra z 11 inches in sift A. BD-6398 (R. 11!11) U'l J System PLOT PLAN PROJECT Dennis Gatzke ADDRESS 705 Old HODkinS Place Hudson Wi 54016 NW 1/4 SW 1/4S 18 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 94.1/94.0 5.5' below grade DATE 8/17/17 BEDROOM 3 CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 2" iron lot stake ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WEAL *H.R.P. same as benchmark B . M. * ~a Vent Old Hopkins Place Scale = 1/4" - 10' 6', Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 4' Long 12" 5.6ft^2/pair of end caps B-4 1 io Vents 2-3' X 90' cells with >3' spacing 3 130' B-3 B-5 5 70' 45' B-2 35' ~i 01 c e 1 I B-1 15' 'xisting 4 01-0 30' ST 30' -Bedroom 60' Well House Valve O ti Property Line All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 r Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/17/17 Owner:Dennis Gatzke Location: NW1/4 SW1/4 S18 T29 N,R19W 705 Old Hopkins Place Hudson Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan n 3. Leaching Cham ' Cross Section 4-6. Maintanance did Contingency Plan Signatur, License number #226900 System PLOT PLAN PROJECT Dennis Gatzke ADDRESS 705 Old Hopkins Place Hudson Wi 54016 NW 1/4 SW 1/4S 18 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 94.1/94.0 5.5' below grade DATE 8/17/17 BEDROOM 3 CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 2" iron lot stake ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WEJL *H.R.P. same as benchmark B.M.* Vent Old Hopkins Place Scale = 1/4" = 10' >6" Quick4 Standard \ Leaching Chamber of Cover with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12 B-4 10 Vents 35' 2-3' X 90' cells with >3' spacing 130' B-3 B-5 70' 45' 35' 0' o e 1 B-1 15' 10' xisting 4 30' ST 30e room 60' Well Valve House Property Line All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells i Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1, above grade Finish grade elevation Typical Installation 99.5' Vent Grade Vent 3' 4" 3' x/30/34 Septic Tank 5' Long 1 5' S' Long 1 3 6 " Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tube/Vent At end of cell A B 22 chambers per cell System elevations: A-94. 1' B-94. 0' ST. CROIX COUN,1-y SEPTIC TANK MAIN'T'ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer cx Mailing Address f A Property Address (Verifieationrequired from Planning & Zoning Department for new construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Locatiioa NL,~ 1/ ;`cam t/4 See. , T TI N R~W, Town of d Subdivision SO Lot Certified Survey Map # Volume , Page # Warranty Deed # ✓ f , Volume Page # Spec house yes no Lot lines identifiable y I Ono SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature faiture to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, it needed, by a licensed pumper. What you put mto the system can affect the fiuuction of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities am specified in Women 83.52(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, r+estaated 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 filll of sludge. V--, tbm undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set fortb, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system bas been mainhimed 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 form are true to the best of my/our knowledge. Uwe amlam the owner(s) of the property desk above, by virtue of a deed recorded in Register of Deeds Office. ,Number of b ms 4,-. a SIGNA O APPLICANTS} DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Inchide with this application a recorded warranty deed from the Register of Deeds C)ffice and a copy of the certified survey map if rcferc= is made in the warranty deed. (RE'V'. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION / SYSTEM SPECIFICATIONS POwnet r aA` ~4; I Septic Tank Capacity al ❑ NA Septic Tank Manufacturer tr O NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms f ❑ NA Effluent Filter Model f ❑ NA i Number of Public Facility Units 'ZLNA Pump Tank Capacity al ❑ j Estimated flow (average) f~ iJ gal/day Pump Tank Manufacturer NA i Design flow (peak), (Estimated x 1.5) al/da Pump Manufacturer NA ? Soil Application Rate Pump Model r' aUda lftZ p odel Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) X120 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/!. ❑ Disinfection ❑ Other !Pretreated Effluent Quality Monthly average gD* persaI Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L[yA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: !Maximum Effluent Particle Size X in dia. ❑ NA Other. ❑ NA Other. Other: NA ❑ NA *Values typical for domestic wastewater and septic tank effluent Other. ❑ NA IAINTENANCE SCHEDULE Service Event Service Frequency !Inspect condition of tank(s) At least once every: ❑ month(s) ears (Maximum 3 years) ❑ NA (Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA !Inspect dispersal cell(s) At least once every: month(s) year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ~ l ears s) ❑ NA nspect pump, pump controls & alarm At least once every: ❑ month(s) NA ❑ year(s) 1=lush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) JNNAA ether. At least once every: 13 month(s) ether. ❑ year(s) MAINTENANCE INSTRUCTIONS :.Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber,, Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must linclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of icembined sludge and scum and to check for any back up or ponding of effluent on the 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 indicate a failing condition and requires the immediate notification of the local I-egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of I:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. INI other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment 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 4thin 10 days of completion of any service event. Page of START UP AND OPERATION or other chemicals tEr{t For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products impede the treatment process and/or damage the.dispersal ell(s). If high concentrations are detected have the contents of tho tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when sal conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will ble discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result 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 ft effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump cxmtrois to restore normal levels within the pump tank. Do not drive or park yehides over tanks and dispersal oils. 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 improva the performance and prolong the fife of the POWYS- antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental foes; diapers; dlsmfedaumts; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medicaions; oil; Ping produce; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and for is permanently taken out of service the following steps shall be taken to insure that the system is propetly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits 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 fined 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 a code crompli*nt replacement system: 13 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requiiled 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 that time. A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 13 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sal and site evalua*on 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. 13 Mound and at-grade sod absorption systems may be reconstructed in place following removal of the biomat at the infiltralive surface. Reconstructions of such systems must comply with the rules in effect at that time. <NVARNiNG» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAN UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name 1 i Name / ' Phone r +d d j Pbon SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY Name '1 Name Phone I - ' ~L Phone j ~ This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK 'T'his is to certify that I have inspected the septic tank presently serving the residence located at: 1 Section T_ZLN, R f-W Town of Upon inspection, I certify that I have fou:id the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Did flow back occur from absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes "apacity: Construction: Prefab Concrete- Steel Other manufacturer: (If known) Age o4Ta f known).: ~ . 1/ ig (Name ) Please print (Title) (License Number) Date r'orm to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regar n existing septic tank condition, I certify that the tank to t b st of my knowledge will conform to the requirements of ILHR 83 s. Adm. Code (except for inspection opening r outlet baffl Name,.- tl Signa a MP/MPR 1b b: _ O - L.JJ HC. y a p c-- -p'~ z 101352 s ft 2.15 A q' ory9/ N/ g;.2 ds. ° 93602 sc S89'35'43"E 6.22 - - o/© I I 11 I 43.76' v ^ ac W N89'33'14'E 186.55' N86'59'27"E 126.48' \ ?r'o6sb6 -OLD HOPKINS PLACE ° W O - 1 ~1 1 'ee oOF AR3g3 OLD HOPKINS PLACE- a I w N89 '33'14'E 189.03' ~n) N86. 9'27"E 131.60' 8O1 \ 9 `6 g9 - - - - - - \ _ ~9 N8919'14"E r - ~ 96.09. \ \ ~6 \ t,6 j9 ' 35.51' a \ \ \ - 12' UTILITY u. \ \ EASEMENT DRAINAC S89'51'43'W 225.44' \ \ i \ HWE _ N S89'51'43'W 225.67' - \ RUCTED 20' DRAINAGE EASE NT 3! \ \ \ 7 Pq S~"W \ LOT _6 ¢ DRAINAGE E\ASEMEN7 ~ N~ CkER a la. \ ~O r i 00 HWE = 901.00 9\go 3j:1 R/Vf\ \ \ w w \ s2.39' P\R~E v CD 23a 43 \ QR o SB4'46'52 W 330.82' \ \ n \ O 0 CD 4 ~ SOP. O O w o \ \ \ z z LOT 39 m w LOT 40 - LOT 41 )UNTY, AND -2m62 2.27 Ac. \ OT SIZE, °o 11,4244 sq. ft 98956 sq. ft 2.11 Ac. \ \ u~ 12 Z o 3 PARCEL OF oo 91873 sq. ft \ \ I n. 'ROPRIATE I 3 MATCH LINE o O SEE SHEET 2 •1O - N BENCH MARK TOP OF 3/4' IRON PIN N ELEVATION = 944.09' ' 1927 USOS DATUM • o 749.41' ON 224.08' 190.37' 334.96' STATE N89.41'32"W o, SOUTH ~W 1/4 - SW 1/4 OF SECTION 11 N89'35'43"W 1412.83' Y ISE OF 6.22' o RVE THE SOUTHWEST CORNER o SW C FOUND OR MNERONUMNW 1ENT AS OF NOTED THE \ HOMESTEAD ADDITION SEC. 11, T29N, R19W SW 1/4 - - 3" ALUMINUM I \ \ LOT 7 COUNTY MONUMENT o LOT 6 / I „ l soatok, orparoneDMsi «nrr.eroe PRIVATE SEWAGE SYSTEM ekay and Btrlldlrtgs Division County: INSPECTION REPORT St. Croix GENF9RALINFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal Information you provice may be used for secwfty purposes (privacy Law, 8.15.04 (txm)). Permit H Holder's Name: City Village Tatan o : Late an ID No.: T BM E Insp. 8M E v.: BM Oescnptw Hudson Township Parcel Tax No.: d 2'1 it '~-DOO " 4t TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Mfsr'- Benchmark 3 1613 D"ing, Aft 13M 3 3- o^ Bldg. Sewer / P Alt I,/ Holding / Ht inlet 9, - TANK SETBACK INFORMATION / Ht Outlet d TANKTO P/L WELL BLDG. Ventto ROAD Air Intake Septic 2 - NA Header/Man. Aerati NA Dist Pipe R oldi ig Bot System 12. 0 2 2 PUMP/ SIPHON INFORMATION Final Grade 6 , o AI/ 3 2- Man rer mand t cover S 3 Model Num G TD 'ft Friction tem TDH LOSS eKircemain Length Dia. of SOIL ABSORPTION SYSTEM BED / Width Len h No. Of Trenches PIT NO. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3~ 3. s z DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM INFORMATION ype , CHAMBER u r > 7, S OR UNIT System DISTRIBUTION SYSTEM Header I Manifold r r Distribution Pipes ~r x Hoe Size x Ho Spacing Vent To Air Intake Length ~i~ Di.. Length d.D Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded I Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil Yes No [I Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1. 71/2-/a( Inspection #2- Location: 705 Old Hopkins Place, jufis , W1 54016 (NW 1/4 SW 1/4 11 n9N R19W) - Homestead-1st Addition -Lot 3! 1.) Alt BM Description= o lock 2.) Bldg sewer length - 3y -amount of cover = 71,,Y 7,f I 3., ibSC~JGt~Sy, .Jar,~S /11..6~Q(l'~d o Plan revision required? ❑ Yes No Use other side for additional information. Z SOO-6710 (R8I97) Oa a nspector'ssg tune cert. No. ,X 1305 Wisconsin Department of Commerce, SOIL EVALUATION REPORT Pap 1 of 3 Division of Safety and Buildings A.C.E. Sol 8 Site Evaluations ~ in accordance with Comm 85, Wis. Adm. Cade Atlach complete site plan on paper act less than 8'h x 11 inches in size. Plan must Cwnty St. Croix ndude, but not limited to: vertical and horizontal reference pant W, direction and percent slope, scale or dimem"s, north arrow, elite ce to nearest road. Parcel I.D. 020-1012-40 ID# 11.29.19.54B Please print all Reviewed By Date Persmal nMrmalbn you provide may be ie Pml* (P^,-Y Law, s..115,04 (t) (m)). Property Owner o _ P Location Miller, Sam Govt Lot NW 1/4 SW 1/4 S 1 t T 29 N R 19 W Property Owner's Mailing Address S E P V6 2000 Lot Block # Subd. Name or CSM1f P.O. Box 151 ~c x 9 I ist Addition To Plat Of Homestead City State tq~le Pnrornp lbi bor City Village M Town Nearest Road Hudson WI 1 94 Z W2Z769'- Hudson Pad(er Drive lM New Construction Use: 19 Res 4 Code derived design flaw rate _ 600 GPD Replaoerrrent PutXic or carrme cube: Parent material Glacial outwash _ Flood plain elevation, 'uf applicable na General comrrrents _ and recommecdations: Do not include slit inclusions as absorption area is found at system elev. while installing system. Increase trench length bD compensate for any excluded area. Baring # Baring 10 Pit Ground Surface elev. 101.61 ft Depth to limiting factor > 134" in. Sol Appkalion Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPDII' _ 1 0-12 10yr3/3 none sl 2msbk ds as 2f,lm 0.5 0.9 2 12-20 10yr4/4 none sl 2fsbk dsh cs 2f 0.5 0.9 3 20-28 10yr4/4 none s Osg dl cs if 0.7 1.2 4 28-82 10yr5/4 none s Osg dl gw - 0.7 1.2 5 82-134 10yr6/4 none s Osg dl - - 0.7 1.2 MRedlEald!•af~i0ln~T:.-'r x~)r1dev. wtWe system. Increew ty+trdr er ;d area. , Mg., any Boring # Boring jM Pit Ground Surface elev. 100.94 R Depth to limiting factor > 133" in. Sal Application Rate Horizon l Depth Dominant Color Redox Description Texture SMX;Wre Consistence Boundary Roofs GPDfle 1 0-14 10yr3/3 none sl 2msbk ds as 2f,lm 0.5 0.9 2 14-21 10yr4/4 none gr.sl 2fsbk dsh cs 2f 0.5 0.9 3 21-33 10yr4/4 none s Osg dl cs if 0.7 1.2 4 33-88 10yr5/4 none s Osg dl 9w - 0.7 1.2 5 88-133 10yr6/4 pigne Osg dl - - 0.7 1.2- ( ' Effluent #1= BOO 30 < 220 moll- and TSS 4" 50 mglL ' E #2 = BODS < 30 mg1L and TSS <,0 moll- CST Name (Please Print) Sign CST Number James K. Thompson 3602 Aftws A.C.E. Soil B Site Evaluations Oda Evaluation Conducted Telephone Number Osceola, wit 54020 9/19/00 715-248-7767 property owner Miller, Sam Parcel ID # 020-1012-40 ID# 11.29.19.546 Page -2--of 3 F3 ] Boring # A 69 1d Pd Ground Surface elev. 100.52 ft. Depth to WTOng factor > 130 in. Sod gpplic-o Rate Horizon Depth Dominant Color Redor Description Texture Struchne Consistence Boundary Roots GPOW _ 'Eff#1 'Eff#2 1 0-11 10yr3/2 none sl 2msbk ds as 2f,lm 0.5 0.9 2 11-19 10yr4/4 none sl 2fsbk dsh CS 2f 0.5 019 3 19-26 10yr4/4 none s Os9 dl a if 0.7 1.2 4 26-85 10yr5/4 none s Os9 dl 9w - 0.7 1.2 5 85-130 10yr6/4 none s Osg di - - 0.7 1.2 0 E Wng # Boring Pit Ground Surface elev. 99.19 _ ft. Depth to limiting factor > 132' in. Soli Application Rate Horizon Depth I I Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'ETf#1 ! *082 1 0-23 10yr2/1 none 2msbk ds as 2f,im 0.5 0.8 2 23-44 10yr5/4 none -5 ( 2fsbk dsh a 2f 0.5 0.8 wow 3 44-54 1Oyr4/4 none is Osg dl Cs if 0.7 1.2 4 54-91 10yr5/6 none s Osg dl 9w - 0.7 1.2 5 91-132 10yr6/4 none s Osg di - - 0.7 1.2 i igrnd east of ude silt' as is Boring # Boring Pit Ground Surface elev. 99.41 ft. Depth to limiting fadar > 128" in. Sop AppMcsUoi Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIr 'Eff#1 'Eff#2 i 1 0-17 10yr3/2 none sl 2msbk ds as 21"lm 0.5 0.9 2 17-38 10yr5/4 none sit 2fsbk dsh Cs 2f 0.5 0.8 3 38-47 7.5yr4/4 none Is lmsbk ds CS if 0.7 1.2 4 47-90 10yr5/6 none--`- - S Osg di 9w - 0.7 1.2 5 90-128 10yr6/4 none s Osg di - - 0.7 1.2 Z7 in inclusions W • Effluent SOD ? 30 < 220 mgA- ano r ao ~d0 < 150 mglL • Effluent #2 = BODS < 30 mglL and TSS <30 mglL The Department of Commerce is an equal opportunity service provider and employer. 1175m need assistancew aocess services or need material in an alternate format, please contact the department at 608 266-3151 or 608-264-8777. 1 a W - `Seal ~ST- CO-44rs Otis;, . •proparty Owner, Miller Sam Ps ID # 020-1012-40 ID# 11.29.19.546 Page 2 of 3 F3 # Bodrg Pit Ground Surface elev. 100.52 ft Depth to limldng factor > 130" in. Sol AWcWon Rate Horizon Depth Dominant Color Redox Description Texture Strwcure Consistence Boundary Roofs 'EfWI 'Eff#2 1 0-11 10yr3/2 none sl 2msbk ds as 20m 0.5 0.9 2 11-19 10yr4/4 none sl 2fsbk dsh Cs 2f 0.5 0.9 3 19-26 10yr4/4 none s Osg dl Cs 1f 0.7 1.2 4 26-85 10yr5/4 none s Osg dl 9w - 0.7 1.2 5 85-130 10yr6/4 none s Osg dl - - 0.7 1.2 Boring F4 Boring # Pit Ground Surface elev. 99.19 ff. Depth to limiting fakdar > 132' in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM? 'EfW 'Eff#2 1 0-23 10yt2/1 none so 2msbk ds as 2f,1m 0.5 0.8 2 2344 10yr5/4 none sil 2fsbk dsh cs 2f 0.5 0.8 3 44-54 1Oyr4/4 none Is Ogg dl cs if 0.7 1.2 4 54-91 10yr5/6 none s Osg dl gw - 0.7 1.2 5 91-132 10yr6/4 none s Osg dl - - 0.7 1.2 Boring # ,rjl Boring Pit Ground Surface elev. 99.41 ft. Depth to limiarg factor >128" in. SoN Application Rabe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW 'Eff#I 'Eff#2 1 0-17 10yrW2 none 51 2msbk ds as 2f,1m 0.5 0.9 2 17-38 10yr5/4 none sil 21sbk dsh cs 2f 0.5 0.8 3 38-47 7.5yr414 none is 1msbk ds es 1f 0.7 1.2 4 47-90 10yr5/6 none s Osg dl gw - 0.7 1.2 5 90-128 10yr6/4 none s Osg dl - - 0.7 1.2 *r. t5 eL- %Aw t . ~ 4A 5 - • Effluent #1 = BOD ? 30 < 220 mg& and TSS >30 < 150 rtg/L ` Effluent #2 = BOD5 < 30 mglL and TSS <10 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altematie format, vicase contact the devartment at 608-266-3151 or TTY 608-264-8777.