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HomeMy WebLinkAbout020-1015-50-300 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 597500 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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: STEVE & KIM POWERS TOWN OF HUDSON 020-1015-50-300 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: d C- 5:,4, 12.29.19.69C-30 TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic &)eC '4.4%6 041 /Z a Benchmark q-77 /O jt 4 CY& Dosing \j i Alt. BM Aeration Bldg. Sewers c7 Holding St/Ht Inlet G7r / TANK SETBACK INFORMATION St/Ht Outlet O TANK TO PWELL BLDG. ent to it Intake ROAD Dt Inlet Septic 1 / 64. Dt Bottom Dosing Header/Man. 12.2 Ss~d . Aeration Dist. Pipe 12j, Holding Bot. System s~ S 13.7- 15, PUMP/SIPHON INFORMATION Final Grade 7. 7 93• $ Manufacturer Demand St Cover GPM 1 Model Number 6 4 7a TDH Lift riction Loss System Head TForcemain Le h Dia__ ist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS :3 SETBACK SYSTEM TO v P/L BLDG WELL LAKE/STREAM LEACHING Manufacture INFORMATION T Of : CHAMBER OR G & System UNIT ModgjNuT be; : DISTRIBUTION SYSTEM 7.6 X.3 =-(0 c-3 Header/Manifoltl / Distribution Ix Hole Size Ix Hole Spacing Vent to Al ke Pipe(s) 1--- vt~v Length Dia Length \ Dia_*-~~ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over 1xx Depth of Ixx Seeded/Sodded Ixx Mulched Bed/Trench Center BedlTrench Edges Topsoil Yes ~ No ~s No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ! Inspection #2: Location: 1012 ARCTIC TRIL 1.) Alt BM Description = 51' e.4- 2.) Bldg sewer length = ( 4-4 oo~ - amount of cover = `u ` c5+1 h.. it /,.sP~ Plan revision Required? ❑ Yes No / 7 3 S Use other side for additional information. I ! - Date ICert. No. SBD-6710 (R.3l97) P1 Wisconsin Dr~of e_ ter and Professional Services Page 1 of 3 Division of In epar~~~~ ~Y]E SOIL EVALUATION REPORT OC I 0 5 2017 In accordance with SPS 385, Wis. Adm. Code County St. Croix Attach complete ~it~e g than 8 1/2 x 11 inches in size. Plan must include, but not limitp ~ I of rence point (BM), direction and percent slope, Parcel I.D. scale or dirri ~A~' T 1 nd distance to nearest road. 020 1015 0-300 Ref #2487 A Please print all information. Review by Date Personal information you provide may be used for seconds purposes Privac Law, s. 15.04 1 m ~a Property Owner Property Location ❑ Steve & Kim Powers Govt. Lot NE '/4 SE % S 12 r29 N 19 E (or) W Property Owner's Mailing Address Lot # Block # Subd. N me or CSM# 1012 Arctic Tri 03 na CSM 14/3949 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Roberts WI 54023 (715) 220-3242 Hudson 100" Ave. ❑ New Construction Use: ® Residential/ Numberof bedrooms 4 Code derived design flow rate 600 GPD ® Replacement ❑ Public or commercial - Describe: zd)te, Parent material Glacial Outwash Flood Plan elevation if applicable na ft. General comments and recommendations: Ammended soil evaluation - B1 & B2 extended deeper to allow deeper dispersal cell installation and B4 added to allow dispersal cell to be move approximately 40' north of originally tested area. Site remains suitable for In-ground POWTS with 0.5 gpd/sq. ft. loading rate. Recommended infiltrative surface elev. to be 87.60'. 1❑ Boring # ❑ Boring ® Pit Ground surface elev. 93.66 ft. Depth to limiting factor >128" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-18 10yr3/3 none sl 2fgr mvfr cw 2fm1c 0.6 1.0 2 18-36 10yr4/4 none scl 2fsbk mvfr gw 2fm1c 0.4 0.6 3 36-53 10yr4/6 none cosl 2fsbk mvfr gw 1vf,fm 0.6 1.G 4 53-69 10yr4/6 none gr Is Osg ml gw 0.7 1.6 5 69-128 10yr4/6 none Ifs/s mix Osg ml - 0.5 1.0 Boring # ❑ Boring LLL~~~ ® Pit Ground surface elev. 93.63 ft. Depth to limiting factor >136" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-28 10yr4/4 none Ifs/sil na na cs 2vf,f 0.0 0.0 backfill 2 28-38 10yr2/1 none sil 2fgr mvfr cw 1vf,f 0.6 0.8 3 38-44 10yr3/3 none sil 2fsbk mvfr gw 1vf,f 0.6 0.8 4 44-80 10yr3/6 none sil 2f&msbk mfr cw 1 of 0.6 0.8 5 80-136 10yr4/4 none gr Ifs Osg ml - - 0.5 1.0 * Effluent #1 = BOD, > 30:5 220 m /L and TSS > 3 150 m /L ` Effluent #2 = BOD, > 30< 220 m /L and TSS > 30!5 150 m /L CST Name (Please Print) Signat LVL1 CST Number James K. Thompson s 30021 Address Date Evaluation Conduc d Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020-5413 Jul 11, 2017 (715) 248-7767 SBD-8330 (R04/15) t3 Boring # ❑ Boring ® Pit Ground surface elev. 92.58 ft. Depth to limiting factor >105" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-17 10yr3/2 none sil 2fsbk mvfr cw 3f2mc 0.6 0.8 2 17-24 10ry3/4 none sil 2fsbk mvfr gw 2fm1c 0.6 0.8 3 24-49 10yr4/4 none sil 2msbk mfr cw 1vf,f 0.6 0.8 4 49-80 10yr4/4 none strat gr Osg ml aw - 0.5 1.0 Ifs/s gr Is w/ 5 80-95 10yr4/4 none ifs Osg ml 0.5 1.0 banding 6 95-105 10yr4/4 none Ifs Osg ml 0.5 1.0 ❑ Boring # F-1 Boring ® Pit Ground surface elev. 95.21 ft. Depth to limiting factor >138 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-16 10yr3/3 none sl 2fgr ml cw 2fm 0.6 1.0 2 16-33 10yr4/4 none sl 2mbk mvfr cw 1fm 0.6 0.8 3 33-56 10yr4/6 none sl 2msbk mfr cw 0.6 0.8 4 56-68 10yr4/6 none Ifs Osg ml cw 0.5 1.0 5 68-91 10yr4/6 none s Osg ml aw 0.7 1.6 6 91-138 10yr4/6 none stratgr Osg ml 0.5 1.0 Ifs/s E Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD, > 30 220 mg/L and TSS > 30 5 150 mg/L * Effluent #2 = BOD, > 30:5 220 mg/L and TSS > 30:5 150 mg/L i J k r r V .ewe. d r~ Nv'~ ~ E r t Y". a VT i County t RECai ~ Safety and Buildings Division S u l~ V 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit dumber (to be filled in by Co.) ~~o w Madison, WI 53707-7162 SEP 22 201 10 D it ~ -DIi at1O) State Transaction Number In accordance with SP5 3832I(2)_ Wis. A m. , sili( inn of this form to the ZvQKEV38,ZKR06 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are subnUU. U - - Idress (if different than mailing address) the Department of safety and Professic a] Servies. Personal information you provide may be used for Vcondary 'V u uses in accordance with the Privacy Law, s. 15.(}4(1 (m), Scats. L Application Information - Please Pr'nt AI formation Eerty Owner's Name { oft 1 Parcel A Property Owner`s Mailing Address t Property Location Govt. Lot City, State Zip, Code t ~~s s Phone Number Y<, ~f f section T-a I (circle on Type of Building 7 g (check all that apply) Lot 4 N; R E o NA or 2 Family Dwelling - Number of Bedrooms Subdivision Na II. T me V~ lock # ❑ Public/Commercial -Describe Use B ❑ City o f I ❑ State Owned - Describe Use CSM Number d ❑ Village of d l? / y Vjwown of vs b A _ III, Type of Permit: (Cite k only one box online A. Complete line B if applicable) A' ❑ New System 15KRcr ni_ _meet System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) S i ❑ Permit R.enewai ❑ Permit R.CVISion 0 Chauoe of Plumber ❑ Permit Transfer io New List Previous Permit Number an Daze, sued I Before Expiration der ~ 3 V Oa o ~ ~j~ 1I IV. 'type of POWTS S stem/Com onent/Device: Check all that apply) Non Pressurized In-Ground 11 Pressurized .In-Ground 11 At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound t 24 in_ of su~~l ❑ Holding Tank ❑ Other Dispersal Component (explain) i ❑ Pretreatment evice (explain) LO V. Dis ersal/Treatment Area Information: to Des' Fl w (gpd) Design Soil Appliation Rate(gpdsf) I Dispersal Area Re uired ]lJ~ 0 0 ,q Dispersal Area Proposed S%- r~- - u ( ~v - , VI_ Tank Info Capacity in Total 4 of Manufacturer Gallons Gallons Units o c 11 Nc~v Tautcs Tanks g0 2 , U o ° Existin Mkt sff , dc,~ w r2 e y s w C7 c% Septic or Holding Tani; a 5'ae Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumher's Name (Pr t) Plumher' ature MP/MPRS Number Business Phone Number Plumber's Address (Street, City. State, Zip Codc) VIII. Conn /De artment rise Only ITppmved F1 rsapproved Permit Fee Date Issued Iss in A S g at Signature ❑ caner Giv on for. Genial IS;. Conditions of Approval/Reasons for Disapproval I SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must be serviced / maintained as per management plan provided by plumber as per applicable code/ordinances. ° e system end submit to the County only on paper not E~ than A in_ s 7 t inches in si>x SBD-6398 (R_ I 1 /11) ST, C"R.OIX COUNTY SEPTIC TAN-K. t..L { AND C)WN.l_.RSTTTP CT✓R.TIFTCATTU"',T FORM ~tae;/~ttSer - - - Mading Addt-ess •rificatian ; equired ~~roan T',iaruning ~Sr.l_;on.ing Depa.rrrnez~t for i]e~r ~,o.nstrr.actiorz.) - !~j On 41 ! T arcel ddenti.scation hSunlbcr 10 d ^ L (0 b" -0 00 t rc)porty Location '-j Sttticliisiclxx Lot _ Al Voila-me._- 1--_.----, Page N 1 J Srzee house ,e ~ _ s Lot: lies ide wifiable S ❑ no SYSTEM F1NA'I (7T A-ND 01 9 -_R1T C.ATJ0 T Improper use and ma.i.nte ome eyour septic, syst.ern couid result in its prema c M we to handle Iuastes. Prover Ill'arn(ena,nCe Corac7S'CS Of j1Laiil~l.n ouf ri. I 1e scp,•rc tank c'~ , t1rr~~e ynars or.soonno if needed, i)y a licei~se,d pi3niP the St Stem can a.'"fec, the fianction ct sta.. ,e~ ,c tank as ~n Pr. VIZ wi you past into t tCb2pw,tn$ 9 g j, i% Croi C,1) 1a9pp,9ai 5"~,S~1:C3Y1. ~1-~I',f~lOP QT~2..ii7tCt.aAlC.e. responsibilres «ue fi~,ocitcd in §Co~nr11. 83.52(1) arul it) <~I1apCer 12 -Sl:. Croix Couslly Sa.uitrlq ()rdinarace. The propel l , Owner agrees to subnli2 cry St. Croix County I'lanlr.rag ~ opt cr and by a rmater plum er, ;oa.arraeytaaan plu;tther, restricted hLa 1e, Zoning Depaq.1nent a ce;-t.i' a cation font, signed by the 1 - or a licensed pnra>per vr-ri.fying tht (1) the. on Site Wastewater disiaosat systen,z is rn proper opcrati-zac candition and/or (2) aRer inspection and p= less than 1./3 ~Sali of sia.actge prszg (ifnt oessa 7:hr 5 i.~i.ic tank is alanda /}v tbP'.and'I Si 3ed have read So above jnqu ]Y4n'eats and agree to in inajn %I]C P' r~ra1.P. SeWa~ rds s. too, th, herein, as sr.. bS~ i.1~e Doparr_rnenr. of (o a;nc: cc a 1 r disposal syst:ena with the r1dre ,Dca,,,ine,3 o~ Nat:~ara>i.pesouroes S~.ai:e o:f thiiscon in. ~:cr Lificatio, s ;ing Am Sroaar s[; e s->.Stem has been rnainta.ined mpg he cotxl;r ,,d a~1d retur; e Zoning Dcpartttmw Min 30 days of the three Y 02T expi~ ltrcr,7 date. 1.d t'o 1,71e Croix Count-;, I'lan.rtistg & i/we certify that stai.exnentis on t. WPM described above, ~ is foam are tae to the best: of r;a s'/our k~tou,led.ge. I/1n,e am /are iaae ota%rCr(s) of 1:Iae by ii ze of a ~w a.niy deed recorded in Register er of Deeds EJfce, NIA m, re be cry L~_. - Aw Inv, S I L Ir (?r A~:I~TIC~_r T(5) my A nl AGM i:I]?t is n1.IMYTI-ewed ZUR Y TGSa.liS: 111 t1.1e Sar1Pfia.i)% I)eii~lrt l)c,ir r'eVbi ZAd ail~~ the I'1ann:a~g cQL ng.Depar n)ent. Inci,.,de with this applic Zoni ation a recorded wan,,imy deed ft,lni Cile re.fercnce is aalacte in the art,at:a.u y deed.eQister o(L>~^ec3s a cc ad a coL~~' o; -,he certified gurpe , !~*1v+Rr. 9}9/Pr's }man if Relsidenti?i Apjalicwjnn, INDEX AND TTTLE PAGE owner's Name. CNnvnctr's ndfrress: U~c T(.)minsh;p u 1) so (.:aunty: +ubc,' lion NarYir.- Lot Number. 1C Nur lmtr: V 10 `p j U U Page tnI&,x and I fie Pagi- az~St 117 _ir,h v & Caass-~;. l7csn j Pare ? FiU~r fac ! Rap 5 fVir i:rtt:E n rTGP Itiform• ti .a,.izm I Pa-me 7 St- Cr f3G' IT - C; tic Tank IUiairrtentn°c Fc~rtt Page. 1 - 'am of plat ~~'~'~h't'~Pl'tt5:.s°c~it ~i•~~i ~ t^lo~ri;r;~ i'7a~~s "hnnr It1i.;mber 9n:~t~.rrn Cir'-airjneN, htlrSuan* to Ir round 531r .4bswpfian Conipnneni'Man;.ra! .n; PQVVTZ; Version 1.i) SF3[1..10'"7CTa.n (N,01lOi) L -Pou"N-~Jzs "Batt v*l*e's+pr 4 NO Ap-ti c- c I V-(-.l c 4;come 04M t n/ r T I DI pi T 2NU b!4, ~X)sfl"51PJN l dome 2~~~~ l 8- -T~~Fr, tIq Sy n, ~ ~ p v $0°) ~ #011 Abs t 4 tw R" Suiledule 40 PW Vent Pipe t-irial Oraoe With 5f13pli (:8p Civarriber See Eziev ion S!M A bgorw onnth wj~ j Rt~achit~g i mnch 4 , s t IL art !E _ Vert Jr ObSe;vaVon Pipe tench Header Trench i Chamber nce;~c~En~e And Model L lf W ~b u~c V►1 t- RSA Rating, 4 pes chamber Soil. Appt'rcati&n p 0 at,. ~ ~O 9~d/sq ft - d besi ra FiQ,~t Soil Aptziica#ion rate o o r D Charnbers chambt:ts each. Page of t~arr-vii ` l $,Rptla Tank ~I mofiaawrar t t e~ NA ti ' 1:~rz+~wrar - tl U ~ M -WA 1lRWa*'t {1eCl~8Y11~• [Number of ~edmcmg f C1 ,,4A rutlur~nt Ftlrer Made[ M MA Number Of Pubilo t poil'r Y irn€ta i M. N/•! Pump T grfk capacity t~ NA ~ ~$tl=ted flow favaraga} rump Tank MRnWf=ttrw NA € 'wurar s 7frs€gn'lavu lr~e~}c}, Sawsxirr7aed x 9,5} Pump itAstnuf 4t ~U a€tr3a Pu~sp ftR+s tai MA Stall ap~all=0rn P,e'Ge ;ane3arcl lr, lugtst/ i`1usnF ~e i',tlr rlil~ri € snrars~e~ P-gve=ment Unit 13 AA Fars, Gii a Sr L. tit w X313 X79 0 Wd/GrzfeiFilter n Frw kilter SiaaS~arrrirrpi x;lgsn emend xroa} 420 rmo/L l MA G iVlpfvilei7Te a1 Aer ickrk CP nd W Tmmt S~;s kar der? SnfSds a4S, - -n a LSis(~$rS~t Ceti{a} C1 S~9A 9 Fratzae ~ ; rtrA nt t4u~iiiy Mcirrthly average i ©1n~ rA d 8preasurT a lJ x tx fi l ' Ajn,r round jgmvi~i 51=hternical Ow3an Domand 1~~1~~1 ~ S~ Arta?adn G Wend i nral Suspended eel' ds lTSS} & Q ntg/i i NA l~rip~t itsa Q 1q.4hur: FeWal Gait t Yin (iPtsrn9rirs r-taart) S t' afu.l9 G ~rrsi - MA urr;er: Maxltrt~ml is~afit; t~sr4lcSa Sizeg in Q NA SP u Jr'r 0 SSA i~t1 eC G ne~~ ~7 t~ A "wtlSd l tg~Ica, Yrr r3a~rsios 1G w~scau~rFYar and ssptiD ;Fmk a lua 4. hfilkiar'm'i` nR'SznO,'ULE r~rtn$ i^tb~j~t a;t +i&CXi9tR . y~~11 G €nspwk c~ndtsn az' 4arsba(W} 1 A-4 s-----^--~' tlU{te~ Go;rikrirsad sts,sd9p, arty' scsarrs sr~uat~ Gfts4third t~s) all tae ms C] IdA v,STrkt1 atsr r.nranx, of tfirrkle} rYttrt€$~} flitYltst wrs9 Q IN At €~n9r 3roe evss`~7a aril Inspeatdisoarsal nall(s4 t 5 tp hl } M MA At, tass't c,tit:e a,eenVs t 'w?aan afflsaant fltar Q iY1tSttz 11 ) MA Ag leagt ana~ RON' I"? ab5, ~1 9 a ;~sgoc~ wrnu, pu?aP contr+ls a1+ PTA, a Segst once e;Vary; MA latarftg Ind ~as~sure Ter, At ~ t.,S .~f1~iYi w 1•,. { ~z(ias; A~ iaesr ,~nWa eaery> t~ : r ~sYl~} - t M 'A 's r wth&~ t: _ f C ~p~, ,Y:pps~ RR -~!p~; x 7~,,,~~,,t~ ~yfy~yi ~S'¢IW[ ~y,[R'S .1~ oft N9t~ G .zlw J.M'9TWO'f~ insptmtMs of I.0 and d,€sper~l Restrloe_, ERs tae, qj5wpy, OWT'Srylnsp; ate ; PO Yttt7"a M&`C15'llX~"i~' fdAnvsli~ lGeensa~ ar carzSfl~Wtiarrp; mor. TP* V.estar i'luml at Nie, ar °1c miler -~sy ally rratsM wr l n of s u€suaS issslasctian of 4ha war?c{s} to tie}n"Siu arsy6 missing or fm grountt gurPxaoe, A nt3t$i11 t =t ant, inspectsons must iMMILid'a msaaura tha u,kki rte of "I'A }nad slwdva and c~:cir, And to check for snv htaaic up e€rrdinq Tha disparsai eelQsl ehslS ;ae visu~lly itrt=pscted tp drank the l fiuc levels in uha abservad'i e lt $ Ah4 tb) ~h n or ~q~etrae the of Offluer,ti an ttie grotir€al ssir ca. 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Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, St. Croix but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I. D. scale or dimensions, north arrow, and location and distance to nearest road. 020-1015-50-300 Ref #2487 Please print all information. Reviewed by Date Personal information you provide may be used for seconds purposes Priva Law, s. 15.04 1 m . Property Owner Property Location ❑ Steve & Kim Powers Govt. Lot NE % SE % S 12 T 29 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1012 Arctic Trl 03 na CSM 14/3949 City State Zip Code Phone Number City E] Village ® Town Nearest Road ❑ Roberts WI 54023 715 220-3242 Hudson 100'" Ave. ❑ New Construction Use: ® Residential / Number of bedrooms 4 Code derived design.flow rate 600 GPD ® Replacement ❑ Public or commercial - Describe: Parent material Glacial Outwash Flood Plan elevation if applicable na ft. General comments and recommendations: Site suitable for In-ground POWTS with 0.5 gpd/sq. ft. loading rate. Recommended infiltrative surface elev. to be 88.50'. 1a Boring # ❑ Boring ® Pit Ground surface elev. 93.66 ft. Depth to limiting factor >106" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-18 10yr3/3 none sl 2fgr mvfr cw 2fmlc 0.6 1.0 2 18-36 10yr4/4 none scl 2fsbk mvfr 9w 2fm1c 0.4 0.6 3 36-53 10yr4/6 none cosl 2fsbk mvfr gw lvf,fm 0.6 1.0 4 53-69 10yr4/6 none gr is Osg ml gw - 0.7 1.6 5 69-106 10yr4/6 none Ifs/s mix Osg ml - - 0.5 1.0 (7V IFK'O ,Q ❑ F2 Boring # Boring ®pit Ground surface elev-08-62-ft. Depth to limiting factor >104" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-28 10yr4/4 none I b ackckfill na na cs 2vf,f 0.0 0.0 2 28-38 10yr2/1 none sil 2fgr mvfr cw 1vf,f 0.6 0.8 3 38-44 10yr3/3 none sil 2fsbk mvfr gw 1vf,f 0.6 0.8 4 44-80 10yr3/6 none sil 2f&msbk mfr cw 1vf 0.6 0.8 5 80-104 10yr4/4 none gr Ifs Osg ml - - 0.5 1.0 * Effluent #1 = BOD, > 30:5 220 m /L and TSS > 305 150 m /L * Effluent #2 = BOD, > 30:9 220 /L and TSS > 30 5 150 mg/L CST Name (Please Print) Signature CST Number James K. Thompson 30021 Address Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020-5413 Jul 11, 2017 (715 248-7767 SBD-8330 (R04/15) I Boring # El Boring ® Pit Ground surface elev. 92.58 ft. Depth to limiting factor >105" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-17 10yr3/2 none sil 2fsbk mvfr cw 3f2mc 0.6 0.8 2 17-24 10ry3/4 none sil 2fsbk mvfr gw 2fm1c 0.6 0.8 3 24-49 10yr4/4 none sil 2msbk mfr cw 1vf,f 0.6 0.8 4 49-80 10yr4/4 none is gr Osg ml aw 0.5 1.0 gr Is w! 5 80-95 10yr4/4 none ifs Osg ml - - 0.5 1.0 banding 6 95105 1Oyr4/4 none Ifs Osg ml - - 0.5 1.0 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. 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. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I Boring # ❑ Boring ❑ Pit Ground surface elev. 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. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, > 30:5 220 mg/L and TSS > 30:5 150 mg/L A EXi7u'nq 9rad~ cI¢y 5# e =!e4f,<, poavc~ 3 lorojo. /aim. Are.~;L-T . ~db~rts cv~. SS~?3 ~.t~ C3.q rod 39s''9 'V" tE c2o -!o/S- sO-d~0 Eks•3rf,;, b~;~r 7 SSIQCres " ~XisEr~ ulufs t~.~r+uEe mss. /,2Gv ~ sc,.6c Ec.-Kcd/ Jt -f~~c,,C ~ ~n✓sr~, e{ s.~; owbi = 90 7o"s Crd• tu' 'k-t S,T. abtt ~9G,86~ CcrwrcSTarr0!' r+a~SyS~a... &:~n,n E. rv;,-6 97-31 ~ - _ ~ ~ Ejc~.s~:nq o(/3~3a/Cc/% 7'~re~ (S~ G~d~ r ` Ls/a~' 3'xB/sr'Cdns~-«cfcc✓ ~ k Sin i3 •~!9"d ~~~r-' /Zcl,. MAO ' t 81 I h h ~ \ plJ~n I (a wn wccds,tnwit6rks1. t / , I I h 9t.so 93.s~' ~ !~lsy' k 3 oIC3 i • I ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMEN'T' FOR UTILIZATION OF AN EXISTING-SEPTIC TANK I This is to certify that I ,have inspected the septic tank presently se vin the g residence located at: Sec. t T 9 N, R W, Town of ~iAbS~~y St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tan and baffles to be in good c ndi ion, and it appears to be functioning properly. Last time serviced i Did flow back occur from absorption system? Yes No (if no, skip ext line. Approximate volu e or length of time: Capacity. 1~U gallons minutes Construction: Prefab Concrete Manufacturer (if known): Steel Other i Age of Tank (if known): (Signature) ► m I (Name)- Please Print (Title o~a~3o ' ~.A {License Number) . V (Date) Form 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 regarding existing septic tank condition,,I certify that the tank, to the best of my knowledge, will conform to he requirements of ILHR 83, Wis., Adm. Code (except for inspection opening over outlet baffle) Name _ 1 m ~U~y►~~~,f _ ~ Signature MP./MPRS Wisconsin DeUCelfy rofessional Services Page 1 of 3 Division of Ind t C" j AUG 3 0 Inaccordasewi4V87Hv9E09DRE4 iy St*Croix Attach comRllgtg,9~+QN4* ~~fej$s than 8 1/2 x 11 inches in size. Plan must include, but not limite~b++l~dll r0l ce point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, aed lo ~nd distance to nearest road. 020-1015-50-300 Ref #2487 Please print all information. Review by . Personal information you provide may be used for seconds purposes Privac Law, s. 15.04 1 m G Property Owner Property Location ❑ Steve & Kim Powers Govt. Lot NE Y4 SE Y4 S 12 T 29 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1012 Arctic Trl 03 na CSM 14/3949 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Roberts WI 54023 (715) 220-3242 Hudson 100" Ave. F-1 New Construction Use: ® Residential/ Number of bedrooms 4 Code derived design flow rate 600 GPD (L\ (~1P~ ® Replacement ❑ Public or commercial - Describe: Parent material Glacial Outwash Flood Plan elevation if applicable na ft. ral comments and recommendations: Site suitable for In-ground POWTS with 0.5 apd/sa ft_ loading rate. Recommended infiltrative surface elev. to be 88.50'. 1❑ Boring # ❑ Boring ® Pit Ground surface elev. 93.66 ft. Depth to limiting factor >106" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-18 10yr3/3 none sl 2fgr mvfr cw 2fm1c 0.6 1.0 2 18-36 10yr4/4 none scl 2fsbk mvfr gw 2fm1c 0.4 0.6 3 36-53 10yr4/6 none cosl 2fsbk mvfr gw 1vf,fm 0.6 1.0 4 53-69 10yr4/6 none girls Osg ml gw 0.7 1.6 5 69-106 10yr4/6 none Ifs/s mix Osg ml 0.5 1.0 2❑ Boring # ❑ Boring ® Pit Ground surface elev. 93.03 ft. Depth to limiting factor >104" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-28 10yr4/4 none Ifs/sil na na cs 2vf,f 0.0 0.0 backfill 2 28-38 10yr2/1 none sil 2fgr mvfr cw 1vf,f 0.6 0.8 3 38-44 10yr3/3 none sil 2fsbk mvfr gw 1vf,f 0.6 0.8 4 44-80 10yr3/6 none sil 2f&msbk mfr cw 1vf 0.6 0.8 5 80-104 10yr4/4 none gr Ifs Osg ml - 0.5 1.0 Effluent #1 = BOD, > 30:5 220 m /L nd TSS > 30:5 150 m /L * Effl 2 = BOD, > 30 5 220 m /L and TSS > 30!5 150 m /L CST Name (Please Print) gignature - CST Number James K. Thompson X/_. 30021 Address ate Evaluation Conducted l;f Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020-5413 July 11, 2017 (715) 248-7767 SBD-8330 (R04/15) 3❑ Boring # ❑ Boring ® Pit Ground surface elev. 92.58 ft. Depth to limiting factor >105" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 1 0-17 1Oyr3/2 none sil 2fsbk mvfr cw 3f2mc 0.6 0.8 2 17-24 10ry3/4 none sil 2fsbk mvfr gw 2fm1c 0.6 0.8 3 24-49 1Oyr4/4 none sil 2msbk mfr cw 1vf,f 0.6 0.8 4 49-80 10yr4/4 none strat gr Osg ml aw - 0.5 1.0 Ifs/s 9r Is w/ 5 80-95 10yr4/4 none ifs Osg ml 0.5 1.0 banding 6 95-105 10yr4/4 none Ifs Osg ml 0.5 1.0 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz In. Munseil Qu. Az. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munseil Qu. Az. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30:5 220 mg/L and TSS > 30 5 150 mg/L ' Effluent #2 = BOD, > 30<_ 220 mg/L and TSS > 30:5 150 mg/L