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HomeMy WebLinkAbout020-1088-10-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Krstich, Samuel & Violetta MANUFACTURER city Village X Township I Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ' TYPE MANUFACTURER CAPACITY Sept' -� S lo zoo V (/( Dosing t 010 I V) () Aeration Forcemain Length Holding Dist. to Well 32.29.19.371 C2 TANK SETBACK INFO RMATION PUMP /SIPHON INFORMATION Manufacturer St. Croix Demand GPM Model Number ELEV. TDH Lift Friction Loss System ad TDH Ft Forcemain Length MEME Dist. to Well 32.29.19.371 C2 Bldg. Sewer LAKE /STREAM CHIN Many tur St/H nlet' Stimf outlef2 L SL c..fO 5.�j PUMP /SIPHON INFORMATION Manufacturer St. Croix Demand GPM Model Number ELEV. TDH Lift Friction Loss System ad TDH Ft Forcemain Length Dia. Dist. to Well ELEVATION DATA County: St. Croix Sanitary Permit No: FS ELEV. 515275 0 State Plan ID No: to 3 . Parcel Tax No: 10p, o, Alt. B 020 - 1088 -10 -000 Section/Town /Range/Map No: JBLDG 32.29.19.371 C2 STATION BS HI FS ELEV. Benchmark 3, CS to 3 . Liquid Depth 10p, o, Alt. B P/L JBLDG Bldg. Sewer LAKE /STREAM CHIN Many tur St/H nlet' Stimf outlef2 L SL c..fO 5.�j l7 (oS� D o Id + 57 D ✓Bottom Model Number: eade /Man. • (v •Slo y 6 . � Dist. Pipe Bot. System I Final Grade, -- N 2 . yL / 0 St Cover S 2 • `� � �i s-�-rs vn I 1, SOIL ABSORPTION SYSTEM 3 "L -1 ( _ I ( / " 1/ fl 1. 1 4 -4LOA .2.f BEDITRENCH DIMENSIONS Width 3 Length i_ K � I No. Of Trenches 2--- Vo PIT DIMEN S No. Of Pits Inside ia. Liquid Depth SETBACK SYSTEM TO P/L JBLDG WE LAKE /STREAM CHIN Many tur INFORMATION HA UNI Type System: O + (� f / Model Number: DISTRIBUTION SYSTEM /1 - 1*OA'%1,LPn eade ani old if Distribution Pipe(s) r_ f / _ x Hole Size x Hole S pacing Vo Length Dia Length W Dia Spacin �- 0 Yes 0 No ❑ Yes ® No SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only �..� 4o Vent to Air Intake -e Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center , f Bed/Trench Edges Topsoil 0 Yes 0 No ❑ Yes ® No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1/ /0 Inspection #2: Location: 677 O'Neil Road Hudson, WI 54016 (NW 1/4 NE 1/4 32 T29N R19/W�), NA Lot 2 Parcel No: 32.29.19.371C2 1.) Alt BM Description =1b f 6f � G !wn'•' �-a tit v� 2.) Bldg sewer length - amount of cover Plan revision Required? Yes V No U yj se other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. 11 Os'1/A n A A^A A AA commerce .wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix ' sco n s i n Madison, )k 7 ' Sanitary Permit Number (to be filled in by Co.) epartment of Commerce Z_M 5 z 5 Sanitary Permit Application State Transaction Number J� Project Address (if different than mailing address) In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit, Note: Application forms for state -owned POWTS are submitted to the Department of Commerce. Personal information you provide may be used for secondary purpo in accordance with the Privacy Law, s. 15.04(1) (m), Stats. Same 7 7 BUG, ►C I. Application Informatio — Please Print All Informatio RECEIVED Property Owner's Name Parcel # 020 - 1088 - 10 - 000 Sam & Vick Krstich oe Property Owner's Mailing Address Property Location 3 7)C — Z ' ST. CROIX COUNTY � 677 O 'Neil Road PLANNING & ZONING OFFICE Govt. Lot NE ' /`, NW '/,, Section 32 City, State Zip Code Phone Number (circle one) Hudson, WI. 54016 715- 386 -5607 T 29 N; R 19 E or W II. Type of Building (check all that apply) Lot # Subdivision Name ❑ I or 2 Family Dwelling — Number of Bedrooms 3 2 D ❑ CSM Block # Public /Commercial — Describe Use F 4. Ge MAe Na ❑ City of ❑ State Owned — Describe Use ❑ Village of CSM Number 2 b, 64- � & C,�Lt s f J � t�.l�b�.rs CSM Vol. 2, Pg. 366 ❑ Town of H d n III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Y Re System e P Y ❑ Treatment/Holding Tank Replacement Only g eP Y ❑ Other Modification to Existing System (explain) �8 Y (xp ) B. ❑ Pemrit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner $' h IV, X&pe of POWTS S stem/Com onent/Device: Check all that appl Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (e la' ❑ Pretreatment Device (explain) V. Dispe rsal/Treatment Area InformationQ 2 Infiltrator "Q-4" s ndard chambers & 2 pr. endca s, Wieser Concrete filter canister of Lok PL -525 effluent filter Design Flow (gpd) 450 gpd Design Soil Application P�A 0.70 gpd/sq. ft. ! persal Area Require j 642.86 sq. ft. J ea Dispersal Area Proposes (s 651.60 sq. ft. ✓ System Elevation, 95.50' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units p New Tanks Existing Tanks w o o m c5~ U zn iw t7 rs. Septic or Holding Tank Na 1,000 1 Tdwlesun X Dosing Chamber Na Na Na Na VII. Responsibility Statement I, the and rsigned, assu a responsibility for hodytio. of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' Signatur MP/MPRS Number Business Phone Number James K. Thompson =Al— MPRS 30021 (715 ) 248 -7767 Plumber's Address (Street, City, State, Zip Code 340 Paulson Lake Lane, Osceola, WI 54020 Vffl. partment Use Onl pproved ia n D `(�Q�a"' �d Permit Fee $ 75. Date I s Issuing t Signatur Reason for / ,1 b ven Denial IX. Conditions of Approval/Reasons for Disapproval SYSTElyl OWNER 1; : Septic tank, effluent filter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2� Alf !"k requirements must be maintained Attacn to complete plans for the system and submit to the County only on paper not less than 8 t!2 x 11 Inches in size 0 O �fc:! .goa d IL ,, zSO ib,Cc tJ 41,4 � +`J ° d mc e le c&, 6,2.►se"er� a 9, P� %w�cdcv,csci cc��rc�c ;, f p,-oPo se d Q', SP�sa /ems/ /, , � . �t` ■ � 7'w0 67) cwd6 a- 6 $.Z e/ev` td lac = 9s sD,' 4 , i% ao' A ' t So, /edaluaL'a • EXla6V prude elevl • G 77 0')f el l 'VO4 4E/'siilwioe" seG 3�,T19� z f' /9�, T, of r�F- dso►,, ss. c'+n;x G J� ,o a/. A a zo - /off -/D - ate 0 Bi i �i ' �`k /Sin 1, tGtO -P eancruEc. e/tv - a� irldtr� ofau.�1� -f = 97..ZS �G radc a,6 o,,k&6 /Cl?.C�'Cerrdowr rSZ'd�y�O.WSa/ec// t_ io 64 d;vcrs,t+, ✓alvc. Sys�a�f eiev! : 96.cO't. 'A 8 3 � � � /ai o0' �n•fou,r br'aS(.d �r•.¢bs 52G. 63 ' O K A. 2 w// Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8'% x 11 inches in size. Pljrq ust County include, but not limited to: vertical and horizontal reference point (BM), direC llllllir ar percent slope, scale or dimemsions, north arrow, and location and distan ;A ea Parcel I.D. Please print all inform a -tticar"I Re ' e Personal information you provide es (Privy Law, s. 15.04 (1) (m)). Property Owner I I Property Location 2205 Page 1 of 3 A.C.E. Soil & Site Evaluations St. Croix 020-1088-10-000/, 3 71 G Samuel & Violetta Krstich OwR Govt. Lot NE 1/4 NW 1/4 S 32 T 29 N R 19 W Property Owner's Mailing Add r s t "i Lot # Block # Subd. Name or CSM# 677 O'Neil Road OUNN 2 " Eff#2 CSM Vol. 2, Pg. 366 City 1Oyr3/3 J City J Villa ge t/ Town Nearest Road Hudson I t AEII�Ri(7�15) 6 -5607 as Hudson O'Neil Road I New Construction Use: y! Residential / Number of bedrooms ( 31 Code derived design flow rate 450 GPD 16 Replacement —J Public or commercial - Describe: �— Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for conventional POWTS dispersal cell with 0.7 gpd /sq.ft. /day loading rate. Proposed / > trench elevations to be 95.50' f 9 7 q � C ' W Boring # 'I Boring Vl Pit Ground Surface elev. 100.17 ft. Depth to limiting factor >112" in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft *Eff#1 " Eff#2 1 0 -10 1Oyr3/3 none sl fill lfgr mvfr as 2vf,f Na Na 2 10 -16 10yr2/1 none sit 2fgr mvfr cw 1vf,f 0.6 0.8 3 16 -33 10yr4/6 none sit 2%bk mfr cw 1vf 0.6 0.8 4 33 -36 7.5yr4/6 none Is Osg ml aw 1vf 0.7 1.6 5 36 -112 1Oyr4/6 none s Osg dl - - 0. 1.6 %S• �� ' u Fil Boring # — I Boring Pit Ground Surface elev. 100.69 ft. Depth to limiting factor >119" in, Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft *Eff#1 "Eff#2 1 0 -10 10yr2/1 none sit 2fgr mvfr as 2fm,1c 0.6 0.8 2 10 -17 1 Oyr3 /2 none sil 2fsbk mvfr cw 2fm,1 c 0.6 0.8 3 17 -26 10yr4/3 none sil 2fsbk mfr cw 1fmc 0.6 0.8 4 26 -32 7.5yr4/6 none Is Osg ml aw 1vf 0.7 1.6 5 32- 19 10yr4/6 none i Osg dl - - 0.7 1.6 %S• �� ' u • Effluent #1 = BOD 30 < 220 mg/L an TSS >30 <) 50 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < MWIL CST Name (Please Print) Signat e: CST- Num qf,-' James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone'Number 340 Paulson Lake Lane. Osceola. WI 54020 4/15/2010 715 - 248 -7767 Property Owner Samuel & Violetta Krstich Parcel ID # 020 - 1088 -10 -000 Page 2 of 3 3] Boring # I Boring ✓i Pit Ground Surface elev. 101.01 ft. Depth to limiting factor > 120 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots ' *Eff#1 *Eff#2 1 0 -10 1Oyr2/1 none I 2fgr mvfr as 2fm,1c 0.6 0.8 2 10 -17 1Oyr3/2 none sit 2fsbk mvfr cw 2fm,1c 0.6 0.8 3 17 -31 1Oyr3/4 none sit 2fsbk mfr cw 1fmc 0.6 0.8 4 31 -36 7.5yr4/6 none Is Osg ml aw 1 of 0.7 1.6 5 36 -120 10yr4/6 none s Osg dl - - 0.7 1.6 ❑ Boring # I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz, Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots QPDM *Eff#1 *Eff#2 ❑ Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon I Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots ' *Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 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 alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) A.C.E. SO & Site Evaluations 0 0 7c ,Foci d l y eal�tdF I p e t Elc cfi' � fix+rs�►^�n er� � t� YJ /a/ ZO, A EXi�..� �rade eJe� Sa,,, 4` Jib /tea ,C'.s�, c ,do G 77 O'iW Rog d Al,, s o ,7, cJ / S`j016 1 e sw( da?. z .366, /!E�'siilwx' Scc rz9a„P /941.2, T. o{' B OG . dt oZO - /o�9 -/D -off o dd i f of ` O . Y/ S6 n 1, 6w evnGrt�C Sc46'e ,rK.sfi.nc. e(cv. rr! ✓t/'E ofa,,tt!<.f = 97.zs.� c� a/ e � t.// to 174 / .t— C_-n ncct d 6y use c e « d ;vers,�,, ✓aIve. 5,sy_- vie(! 9r' l 8 1 L \ /V 4 00' CrM'(Dt,c i J bPaAd � me sz (,. (,3' Conventional POWTS Index & Tilte Sheet Project Name: Krstich 3 bedroom Replacement Conventional POWTS Owners Name: Sam & Violleta Krstich Owner's adress: 677 ONeil Raod, Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot 2, CSM Vol. 2, Pg. 366 Legal Description: NE1i4NW1i4, Sec. 32, T.29N., R. 19W., Town of Hudson, St. Croix Co., W I. Parcel ID #: 020 - 1088 -10 -000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calcualtions Page 4 System Cross Section Page 5 System Management Plan Page 6 Filter Specifications Page 7 Treatment &/or Filter Tank Cross Section Page 8 Parcel map Page 9 Septic Tank Maintenance Agreement Page 10 Certification for Utilization of existing septic tank Page 11 Waranty Deed Attachments: Soil Evaluaiton Report Mater PI er L'cted e: Ja mes K. Thompson, Dept. of Comm. Cre #30021 Signature: Date: , P o2 241 Design pursuant to In- Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD- 10705 -P (N.01101) 0 0 �fLir �oct d rro/�scc✓u7 ;csc� Cv��rt.�C e✓Cr.+r;J6e, -c.jl Al Cod �L- 62S eft /k t14 4 r 16e-- a s Cie cl, : ro of'bri ! ' -.. ae cuts a d'4 a,e - �ara�C �jeq^rIfC4 dttlr: ere.rl � Eac = 9s sp,' ion zo' A 9. If Soi /edQfGCR�'On/ott • E ,V q. -cade e/e6.` Sam 4� 14 1 6 * �6t IriSL. P/c�0. G 77 O'i(e l )VO4 d L -a�.2, Csi+t Moe 1, I V. 366, /JE�'s�ilwYt; sec 3z,T 29�,p /9�, r r r �i �X; SEin !, C�gs� Cvnc�t�c StroEi'G �Q'. s�irnabed ¢lcv. �ndtr� oFou�lc -t = 97..z.s � Gradtouk�= P ` � ropoSld dtvcrs;an Va,1oc �. ��.cb'Ce+T6ewr �jtr"sE+ircj /.t X S2' d .crsa/ Cc// .�-- to 64 c.-nnecftd by use o 9 , d;vtis.t„ ✓a lvc. s y s eie = 96.E F y g p brus4 d frets me 5z6. O K P z �'rr KRSTICH DISPERSAL CELL SIZING CALCULATIONS 1. (3 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 4-50-00 ON design flow 2. Infiltrative capacity of native soil = !L7 - ad/sq. f} 3. Absorption area required: 642.86 sq. ft 4. Absorption area as proposed: 4. ft (33 chambers total) Infiltrator "Quick 4" = 20.00 sq-ft. EISA per chamber, Infiltrator "Quick 4" end cap (pair) = 5.80 sq.ft, EISA 642.86 sq. ft. — (3 pair endcaps)(5.80) = 625.46 sq. ft. 625.46 sq, ft. /20.00 = 31.28 chambers required Number of trenches: 3 @ 11 chambers per trench Trench width: 2.83' Trench length: 46.00' Trench spacing: 8.00' on center Total system area w/ 5' trench spacing: 21.00'x 46.00' Pg. 3 of 11 U A p � A T C}. ti P O � N� C r O m z 0 D A n 0 z r, d 7r J r� z z PA nn� tk O 3 no Sc4 /e, PS. �olei/ Soil Absorption Svstem Cross Section /04 cc' ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ft Leaching ♦— Chamber u 9s �' ft , System Elevation ,2.83 ft 6'.0 , ft Soil Absorption System Plan View 6 ft z. 83 ft ft Leaching Trench 1 Vent Or Observation Pipe Chambers �IIIIIIII ;1111111 ■� 4 D He Leaching Chamber Specifications Manufacturer And Model -:r, 'a EISA Rating 12,6 0sq ft per chamber Soil Application Rate 0, 70 gpd /sq ft J� L 0 gpd Design Flow T 0.76) Soil Application Rate + 20.C EISA = _.32 Chambers 2 rows of - --- Z4 chambers each. Page :�z — of // Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10705 -P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be <_ 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorntion Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October - March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two- year /1 -year schedule by use of diversion valve. Effluent to be diverted from new dispersal cell to old cell at 4 year anniversary of new system installation. Old cell to be utilized for a 1 year period. Afterwards, effluent dispersal to be alternated between cells on schedule to allow use of new cell for two years and old cell for 1 year. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248 -7767 or the St Croix County Zoning Department at (715) 386 -4680. 1 0� - EFFLUENT FILTERS "The PL -525 has 525 linear feet of 1/16" slots. It has an automatic shut off ball. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. No other filter on the market can make that claim!" "The PL -122 has over 122 linear feet of 1/16" slots. Rated for 1500 gallons per day, and can be manifolded together with other PL- 122's to double or triple the GPD. It has an automatic shut off ball that stops flow when the filter cartridge is removed for cleaning. Comes complete with it's own housing, no gluing of tee or pipe and no extra parts to buy. Accepts 1/2" PVC Handle Alarm Switch 122 Linear h. of 1/16 inch Filter Slots Filter Housing with 3 "& 4" Pipe Adapter Gas Deflector Automatic Shut -of Ball When Filter is Removed From Tnnk Order # Model # Description Alarm accessibility - }'t - - - - -_ Accepts PVC -' Effluent Filter System 203.50 eatrnsion handle 525 linear feet Effluent Filter System 62.50 oil filtration slots —�� Rated for over 10,000 GPO Accepts 4" & V SCHD. 40 Pip. a `\ Gas deflector —a Automatic shut -off ball when fitter is removed Accepts 1/2" PVC Handle Alarm Switch 122 Linear h. of 1/16 inch Filter Slots Filter Housing with 3 "& 4" Pipe Adapter Gas Deflector Automatic Shut -of Ball When Filter is Removed From Tnnk Order # Model # Description List Price PK -525 PL -525 Effluent Filter System 203.50 PK -122 PL -122 Effluent Filter System 62.50 6 -10 l 0 . 431" on N D D m i ul mm > D A (n rcnm m D Z ^ rnAr 1 „ 37� z„ N (n n i m �r rn D = m D L o 0 Z --I C) O m 18" MIN. _m < r I C> m < mm N m C � C D p � 37" I 22 r O m m m m m n A y D V1 �D n 20 � Lo I N (A N m W D r D (A m� m m o O �r. f D D D N M K rZ OC") n D D N _1 a) 6" 1 O m n 0 � �O Z D Q p � I m C fT1 fTl _, —1 D --1 70 (,1 D r m O m m D D z f r � Ln O_ Z \ o = FILTER CANISTER DETAIL SCALE:3 /4" = 1' REV N0. DATE: m MIESER coRGRETE DRAWN BY:SWT I J � ~ SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK, WI 54750 DATE: JANUARY 2008 ° REV. JAN. 2008 800 -325 -8456 FILE: SHEET 13 �. ?wd •�• uuuc;uaries and the subdivision of the land surveyed; and that this land is .located in the NWL of the NE4 of Section 32, T 29 hl h lei W., TCWn of Hudson, St.Orpix ;z County, Wisconsin, t o�wi t ; " T ` C orrlcaer�c i ZZ � a or ,. t AN � sy °05152a�.E Ion t�iaiti ''� c t�rr><er o3' 3ect #on ��"; thenl�'f �. 000 12 1 02" W 410,n& Lh1e East 3;,1n® of�the NWk 908C57 to the 'tint of beginning; thence continuing S 00 °12 W along the East' line of said Forty 451. to the South line of said Forty, `- then ^e S 8 9 9 U 5 1 55 -11 W along said South line 120 9.53 1 ;. thence 13"64 E 326.661 t•hencf, Northerly along the arcs of a 140Ul radius curve which is concave Northwesterly an( whose long chord bears N 0 7 0 55 1 48" E 25i -, thence K 0 50 1 00" E 22b..09 thence S 42 0 46 1 00" E 345.521; thence N 33 ° 56#3'0t 1 E 435.84 thence S 56 9 05 1 00" E 488693 to the point lof beginning. The above described parcel car :Lains .14•'d43 adres of land subject to exi4ting Town Road and C.T.H. "N" Right-Of-Way. Dated this 6th. day of ,�u I. �c�•��.,�L D.tttloff Engineerin 1 .. _River Falls, WI � S,R��i7's Arthur L Wegerer , • •••i��•��,, _ ___.� ..� ��..ex�r•��._.._ - __ ...- . ' • Wig.. R.�. � _ �- CURVE RADIUS 1 400' . CHORD 250.96' CHORD BRCL sNO7 • CENTRAL < 3 iO "' ' RiW CURVE s.ADiUS : 1433' Ci3ORu '269.44' .tiORD BRG. =NO7°4O'4O'E)C(V,0,mn,C CENTRAL < ■ 1 7 ° 47'20 • • r r f K , ` 1 • _ ro r ,• ARTHUR L '•. k • . �Y • • 1307.1► G U . • 0 . sairi/ 13 MLE Rm AT N : I • yy� -29 - ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) ( 77 �4,•( ,P �c�ols�, 6J/, sY016 located at: '/4, nE ' /4, Section 3 Town 2 N Range & W Town of �dso> , , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: _�/ gallons minutes Tank Capacity: - 4,1,0() Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): ermit dumber (if known) S icensed Plumber Sig ature) (Print Name) ��u •�, �i es�liG c 14( 3:5�1 (Ti (License Number) MP /MPRS ate) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 Pj. /0cyo - g i_0kT No_ rY�'{�,7yl�'}� M M FR` � TRi S- + 5 - FEE Tai Wwjd 1r ty. (is) (Ls suet) Exetepl'istt is Wetrattaca Dated IkIA 4 A d ev or ' -- - (SEAT..) (,SEt11.) AUTHENTICATION Signatures authenticated thi z7z - da y or A prl 1 t9 74 t J $i l'I D. up_ o o TI 1 l.E:' MEMBER ST BAR OF WISCONSIN (If ml, - anxhoaized by i06.Ob. Wis. Sfiats.) This iostrumeaY was dra lead by HZYW301) APti'} CARP 204 Locust Street Hudson, iAiscons 54 016 (Signatures may be authenticated or acknowledged. Both are not necessarv.) t • +cr.�..+- .-..e! /_-� ( SEAT.) B . C21 SANOVA d �r+yr+r. �� .2,re2'C( `,lc.�,' (SEAS,) DCfteway z CASANOVA ACKNOWLEDGMENT STATE OF WISCONSIN County. Personally came before ale, this day of -the above named 3 to me known to be the person— oho executed the fore- s going instrument and acknowledged the same. - - Kota— Public County, Wis. aty Commission is permanent. (If not, state expiration date- 19_.) WARA/ lr DLE D -STATE BAR OF' *15CO.'tMX. FORM NO 2 -1477 - _ {� •• ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Mailing Address 6o Property Address so-'?2 (Verification required from Planning & Zoning Department for new construction.) City /State ff� �✓Sah Parcel Identification Number oc LEGAL DESCRIPTION Property Location t t) 1 /a , f7 1 /a , Sec. 3�- T �1' N R_Zy_W, Town of drt.d Subdivision , Lot # Certified Survey Map # Volume - '� , Page # '3 Warranty Deed # Spec house no Volume , Page # Lot lines identifiable yes 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 §Comm. 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, 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 Commerce 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 am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedroom IGNATURE OF APPLICA (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. 08/05) / C7, 3 C: O co CD > C) =(a 0 c g o 3 :, : z =r M o 0 CD 3 cn N : - 7 > 0 (.n 0 CD 0 Q (/) 3 C7 7 0 CD < (n w CD 0 Sn (D tn 0 . p C) Q. 0 (A 0 m m m 5T z c 0 CD o E E F 3 ( D nJ Cl CD (D 1(3D 3 (D O III N) 0 CD LO D <D co 0 ( ,D - �:r rj C) Co C D CD 0 CD C) 0 -4 CD C: CD (D En 3 C: O co CD > C) =(a 0 c g o 3 :, : z =r M o 0 CD 3 cn N : - 7 > 0 (.n 0 CD 0 Q (/) 3 C7 7 0 CD < (n w CD 0 Sn (D tn 0 . p C) Q. 0 (A 0 m - V 0 0 0 CD (D ID 3 (D III N) 0 C: - K) 0) m co 0 ( ,D - �:r !� C) Co 0 N 3 0 -4 C: CD K) CD in 0— V) C:) ID (D CL CL .. C D c) c) a) CO A -4 6 -4 00 0 z LD. 0 r 0 0 a (0 (0 0 _0 - 0 _0 '0 w 0. 0 0 0 L C (n < N z 0 > (D CD (D tn CA Ol z D m > (D 0 CL =3 (D ( D ( D - m cn w ( C ) (D N (D C: :3 ii; z CL C) Z P,) N (0 Z 4 0 z 3 Z (D :E PL Ph AD h. O O O ti A Parcel #: 020 - 1088 -10 -000 10/19/2009 11:30AM / PAGE 1 OF 1 Alt. Parcel #: 32.29.19.371C2 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner 77,600 O - KRSTICH, SAMUEL & VIOLETTA SAMUEL & VIOLETTA KRSTICH 0.000 677 O'NEIL RD 0 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 677 O'NEIL RD SC 2611 HUDSON 202,700 280,300 SP 1700 WITC 0.000 Legal Description: Acres: 3.430 Plat: N/A -NOT AVAILABLE SEC 32 T29N R1 9W NW NE LOT 2 CERT SURVEY Block/Condo Bldg: MAP IN VOL II PAGE 366 ORD Tract(s): (Sec- Twn -Rng 401/4 1601/4) 32- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type , :)nno Q innnnAPV Bill #: Fair Market Value: Assessed with: Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.430 77,600 202,700 280,300 NO Totals for 2009: General Property 3.430 77,600 202,700 280,300 Woodland 0.000 0 0 Totals for 2008: General Property 3.430 77,600 202,700 280,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 312 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ° tp t / ' i c & m ' E � i F C C/3 E E o B o g §§ _— k k\ E m)$§ | A( EE §f R 2\§ 0) ¥ § 2 g ( g am £i §� k A C a ( i I■ « t C ■, § / 7 M � ® , 0 t E 0 r ■ ' co CD CL 9 | 2 -0 -0 -0 § k § z 0 0 0 - § § D § \ 3 CO) I' 2 E Q k��g2D \ k ® E @ C | CL w | z § 7 7 | 0 C ( ' C I C � � \( E \ a d - \ ICA § J z 0 » & / 06 ¥ z o � / : z N 0 -- g 2 0 m \ w ( � a CA � cn R a § §./ §Z8ƒ c % } _ � $ � kk 2 a) CD CD , JCL ' o $ . _ \} N CD �� � k 2 # 0 < % � i � § � f 8 CD a , � ■ AJOW M ���' z REPORT OF INSPECTION SEWAGE SYSTEM San.itatcy Petcm.it St ate SPpt.ic4;Z i NAME Township St. Cno.ix County Laca ion Section SEPTIC TANK Size gattons. Number Compatctments ztope 5 12 o an gneatetc t. Distance Ftcam: We.�.2� , Bu.itd.ing it Wettand.6 DISPOSAL SYSTEM Distance Fnam: H.ighwatetc it. W it. Bu.itd.ing it. I 12% on gneatetc ztope j f it. W ettands Ft. H.ighwatetc --- FIELD DIMENSIONS: Wi o f the nch it. D ept h o 6 ro below t.ite Length a6 each tine it. Depth a4 tack oven t.ite Zi n. Numbetc os tines D epth o4 tite b elow gtcade_gyin s- �� Totat. .length of tines it. Stope o6 ttcench `Z, in pen 100 it. / s Dis tance b etween tines t fi t. Depth to bedtcock 2 Totat abs oh bt.i on area G �� Depth to gnoundwatetc /r/7 it. Requited area (, / ,S� it Type of Covets: Papeti tc Sttcaw PIT DIMENSIONS: Numbetc o6 pits Gnavet around pits yes no Outside d.iameten 4 Depth below .i nZet St. ' 2 Totat anbt.ion tea it . INSPECTED APPROVED_ REJECTED ,DATE 197 s z A rn EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: /a, NE /a, Section �, T� R LY E (or) _W, Township or Municipality V S O PQ Lot No. Z ' Block No. County ST - - C R I X Owner's Name: RAV cA5 N O VA S e IlI sp Name Mailing Address: R ( ' 1 '5TA6e010E 120. 44 11 p500 W1S G, TYPE OF OCCUPANCY: Residence . X No. of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW A DATES OBSERVATIONS MADE: SOIL BORINGS Ju SOILMAPSHEET 1 FE 121 SC° SOIL TYPE ADDITION REPLACEMENT 9 0 7 Y PERCOLATION TESTS J V j r (A 1 3 1 130R4-� H 412 ' PERCOLATION TESTS TEST NUM— DEPTH INCHES CHARACTER OF SOIL THICKNESS IN INCHES HOURS SINCE HOLE 1ST WETTED WATER IN HOLE AFTER SWELLING TEST TIME INTERVAL IN MINUTES DROP IN WATER LEVEL, INCHES RATE MIN /IN PERIOD 1 PERIOD 2 PERIOD 3 BER ___ -- 3 � 5 L3 6 ., r5 17" 51- 4-f - r U 13 3 r3 P -� 3� 1ep -f,4 C!4 !% �15 P -3 1 6 kEFEiQ i3E 0 C7 � / / G i � / 7/6 `S SOIL BORING TESTS TEST NUMBER TOTAL DEPTH INCHES DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES (DEPTH TO BEDROCK IF OBSERVED) OBSERVED ESTIMATED HIGHEST ___ -- 5 L3 6 ., r5 17" 51- 4-f - PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of sWtable areas. Indicate number of square feet (f�absorption area needed for building type and occupancy. 4� 5 +V& '2 &o !24 615 361-4 1 /3 Eb Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. t N N M 5'Z 6 . I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) A136f T /��/ C � '� Certification No. �5T~ C) 2-4 Z Address 9T C) ' /(/!E SP - nl L4i 1 5 r j9y / Name of installer if known COPY A —LOCAL AUTHORITY CST Signature ]� ` " - Z" � 1 '""�O ' � � � 67 Permit and County State Permit # Permit Application County Per for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: % Seon� Subdivisioyr) Name, /y` nearest road, T 12 N, R E (or) W Lot# lake or landmark Blk# s City Village Township TYPE OF OTUPANCY: *Commercial *Industrial *Other (specify) Single family f � ✓✓ � Duplex No. of Bedrooms No. of Persons —3 ariance D. SEPTIC TANK CAPACITY r bC7 D Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured -in -Place Steel Fiberglass Other (specify) New Installation t-- Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate al Abs Totorb Area sq. ft. New � Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth ( No. of Tr ches Seepage Bed: A / LengthWidth f Depth _Tile depth (top)No. of Line Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land T% Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as Iisted on EH 115 if other than p owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certifi S 'I Te er, I ' NAME C.S.T. #-5 and other information from (owner /builder }. .�/��J —� � !� Plumber's Signature P SW# �� 9 Phone 9 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. Do Not Write ij Spac elow OR COUNTY AND STATE DEPARTMENT US ONLY Aj Date of Application Fees Paid: State 0 D D Co my ' Date r Permit Issued /mod (date) - Issuing Agent Name Inspection Yes Z State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, W1 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 I, Arthur L. Wegerer, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St . Croix County Subdivision Ordinance and under the direction of Ray Casanova, owner of said land, I have surveyed, divided, and mapped said parcel of land, that such plat correctly represents all exterior boundaries and the subdivision of the land surveyed; and that this land is located in the NWT of the NEB of Section 32, T 29 N, R 19 W, Town of Hudson, St . Croix County, Wisconsin, to -wit: Commencing at the North 4 corner of Section 32; thence N 89 E . a long said Section line 1307.1l thence S 00 ° 12 1 02" W along the East line of the NW4 -NE4 908 .57 ' to the point of beginning; thence continuing S 00 °12 W along the East line of said Forty 451.75' to the South line of said Forty; thence S 89 0 0515 5 11 W along said South line 1209.53'; thence N 13 °04' 20 E 326 thence Northerly along the arc of a 1400 radius curve which is concave Northwesterly and whose long chord bears N 07 °551 4811 E 250.96'; thence N 71 °50'00" E 228.09 thence S 42 °4610011 E 348.521; thence N 33 °56 E 435.84'; thence S 56 E 488.93' to the point of beginning. The above described parcel contains 14.893 acres of land subject to existing Town Road and C.T.H. 11N" Right -Of -Way. Dated this 6th. day of� Lu 1 «"•,4976• Dittloff Engineering ,, cJ�s'j'�., Arthur L. Wegerer River Falls, WI. 5`0..x••••••.. Wis. R.L.S. No S 9 �3 �.` ' +. N 89 °05 52 E n APPROVED MAY 3 1977 2.871 ST. CROIX COUNTY ��0,"Yjv �••••••��� �•` '� • � ° C COMPM111"SOVE PAWLS �%S11," SU1�VE ��� n� c�� AM 200040 CCMA#ITM � o 5�` U �'p,1111111110 % 1x 4 9 - 228ti CE CURVE ,� � �► � ° RADIUS = 1400 5 •ts 0�_(0 Q� ,cam a CHORD =250.96' ��,� CHORD BRG. = N07 'E ' LOT I `Q �' M CENTRAL < = 10 0 17'04' 1 R/W CURVE RADIUS = 1433' CHORD = 269.44' :(0 CHORD BRG.= N07°4d40. CENTRAL <= 10°47'20" :N 185 ARTHUR L. r WMI, e S - 963 ELLSWORTH Ay WIS. acres O5 55'E 49: 461.6— 2r---- lc>­1 LOT 2 3.433 acres V/0 (V C' .� 560.64 aV' 1 34.01 ' m 0 0 5266.63 Q�— S 89 66' . i 0 N O N r \ co N Volume 2 ORTM W 8 N LOT 3 ' m M °/; 4,988 acres . 0 N O N r \ co N N 288.89' 1209.53 1307.11 ,.S.M. AT N 1/4 CORNER SEC. 32 -29 -19 3 U O • 0 C \i obi r, C k 0 g8B qs 26q Q6` ` 8 ` ; , . Co F0 'v W �� 175 033 z LOT 4 M d 3.601 acres o En 910 0 a 360.00 (n o a: 0 U W 0-1% 24" IRON PIPE WEIGHING 1.13 LBS./ LINEAL FT. w • IRON PIPE FOUND Page 366 APPROVAL O F THIS hkIMOR SUBDIVISION scAtP� 1,R APPROVAL FOR SEPTIC H62.20 200 100 0 100 200 ~�/