HomeMy WebLinkAbout040-1250-20-000 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 600342
GENERAL INFORMATION 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:
Stephen & Lisa Lockhart TOWN OF TROY 040-1250-20-000
CST BM Elev: Insp. BM Elev: BM Descript' n: I,, Section/Town/Range/Map No:
0~ .3 m6u_ Cc wck 19.28.19.1304
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
VT. It ()Dosing Alt. BM ~ • ~ ~
I
Aeration ewer
Holding
TANK SET CK INFORMAT et
Valve 8•
TANK TO P/L WE BLDG. " Vent to Air Intake ROAD rte. val vt r-vo
C5V
Septic
i Ivy valve 2
Dosing
ZI Header/
Aeration Dist. Pipe _
T bZ
Holding Bot. System
.3b L . ~f C~r~Q
Final Grade . `V
PUMP/SIPHON INFORMATION b
anu ac D and S
Model Number
I'TDH Lift Friction Loss System ad TDH Ft
emain Length Dia. Dist. to Well
SOIL AB ON SYSTEM ZI Z_ t' 61
BED/TRENCH Width L1 NPIT DIMEN NS No. Of Pits Inside Dia. /
Liquid Depth
I el
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREA LEACHING Manufact re : L` . /
`~J
INFORMATION CHAMBER OR 7 t4
o System: Model ber:
Type Of r`'stem: I W , I JT,
c k
DDISTRIBUIIDN SYSTEM LAS
Header/ i old /l Distribution x Hole Size x Hole Spacing Vent to Air Intake
9 Pip9s) p 9 Sf CitJ
iLenth_ Dia Length Dia S acin
SOIL COVER I x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over A r__ Depth Over ` r xx Depth of xx Seeded/Sodded xx Mulche
d
E
Bed/Trench Center Bed/Trench Edges Topsoil
l Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) I~ Inspection #1: Inspection #2:
Location: 322 ST ANNES PKWY fD Upr-
I Ewe
1.) Alt BM Description 4 2, 0b t uS J~_ \ AS I 11 (f'f U1]GA_S
2.) Bldg sewer length = @ 111W/ QWC .L1 1 ~ +11G✓) klf~
- amount of cover = C A I S IT 1~ S wS CIDvKh✓ q ~`~I
tYt ~ J
Plan revision Required? Yes i o ) 7
Use other side for additional informati
SBD-6710 (R.3/97) ate Insepctor ignature Cert. No.
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Safety and Buildings Division St. Croix
~201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
P ' Madison, WI 53707-7162
MA 663 Tz-.ej Sanitary Permit A*ppll l~ State Transaction Number
In accordance with 4P't383.2t(2). Wis Adm Code, submission ofthis t it Na
04 o
is required prior to obtaining a sanitary permit. Note: A lication WS
Project Address (if different than mailing address)
rs R5VT465E
the Department of Safety and Professional Services Personal in o _ on secondary
pu oses in accordance with the Privacy Law, s. I5.04(I)(m), Stars. Same
1. Application Information ase Print All Information 4•
Property Owncr's Name U, Parcel #
00~
Stephen & Lisa Lockhart 040-1250-20-3:gff
P~~r(!2e Owner's Mailing Address Properly Location
?q3 St, Anne's Parkway Govt. Lot
City. State - 'Lip Code Phone Number SW NW 4. Section 19
(circle one)
Hudson, WI 54016 (715) 781-1 176 f 28 N: R 19 -W
II. Type of Building (check all that apply) Lot #
® I or 2 Fancily Dwelling - Number of Bedrooms 62 Subdivision Name
Block # Plat of Troy Villa Je
❑ Public/Commercial -Describe Use Na
❑ Pity of
❑ State Owned - D~a~ CSM Number El Village of
ZZ.I~ZZ Na ® Town of Troy
III. Type of Permit: (Check only fine box on line A. Complete line B if applicable)
❑ New System ®Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ ' Change of Plumber ❑Permit Transferto New List Previous Permit Number and Date Issued
Before Expiration Owner
404971 issued 03/28!2002®
IV. Type of POWTS System/Component/Device: (Check all that apply)
(81 Non-Pressurized In-Ground ❑ Pressurized lo-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in of suitable soil
❑ holding Tank ❑ Other Dispersal Component (c. ) _ ❑ Pretreatment Device (explain)_
V. Dis ersal/Treatm t Area Information: 44 In Itrator Quick 4 Standard Plus cha bers & 2 air end caps, Fxisting Zabel A-100 effluent filter
Design Flow (gpd) ! esign Soil Application Rate p sf) Dispersal Area Required isf) Dispersal Area Proposed (sl`ystem Elevation
600.0 Gpd 0.7 Gpd'Sq. Ft. 857.15 sq. ft. 890.40 sq. ft. ".qS'& 97.00'
V1. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units U o $ u
New Tanks Existing Tanks ; L
G U f 2 f u.., d
Septic or I folding Lank 1,250 1,250 1 Wieser Concrete X
Dosing Chamber
V IL Responsibility Statement- I, the undersigned, assume responsibility for instatlation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signaturmo MP/MPRS Number Business Phone Number
. f
James K. Thompson AI MPRS 30021 (715) 248-7767
Plumber's Address (Street, City, State, Zip Cod,
340 Paulson Lake Lane, Osceola, WI 54020
Vlll ount /De artment Use Only
Approved 76,iven Date Issued Issuiure
Reason for Dc calr/ 3 !G
IX. Condi o » Reasons f Disapproval
1. a eI Car4ll a4
UK-pep. cell rIuLt all re
4s per ~nar.3gemen, pkn fro coact Uv irlwnoe,.
2. All ee!bsek rat elni9 mrrtbue R'IBiM~ q.e i
su Mw VX CO& I 'alfl xAl.
Allach W complele plans for the system and submit to the County only on paper not less than 8 1,7 z I I inches in size
S BD-6398 (R. I I/ I I)
Conventional POWTS Index & Title Sheet
Project Name: Lockhart 4 bedroom Repl Conventional Dispersal Cell
Owners Name: Stephen & Lisa Lockhart
Owner's address: 322 St. Anne's Parkway, Hudson, WI 54016
Site address: Same
Project Location:
Subdivision: lot 62, Plat of Troy Village
Legal Description: SWIM NW/4, Sec. 19, T.28N., R. 19W., Tn. of Troy, St. Croix Co., WI.
Parcel ID 040-1250-20-100
Page I Index and Title Sheet
Page 2 Site Plan
Page 3 Dispersal Cell Sizing Calculations
Page 4 Dispersal Cell Cross Section
Page 5 Infiltrator "Q-4" Chamber Specifications
Page 6 PolyLok PL-525 Effluent Filter Cross Section
Page 7 System Management Plan
Page 8 Septic Tank Maintenance Agreement
Page 9 Certification for Utilization of Existing Septic Tank
page 10 Parcel Map
page 1 1 Warranty Deed
Attached: Soil Evaluation Report
I
i
Mater umber Restricted Service: James K. Thompson, DSPS Credential 430021
Signature: te'h+1~+ c.._ y
y> Date:
Page I Of 1 I
Design pursuant to In-Ground Soil Absorption Component Manual for POW'I IS, version 2.0 SHI)"l0705-P (N.Olr01)
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Lockhart 4 Bedroom Dispersal Cell Sizing Calculations
1. (4bedrooms)(100 gallons estimated tlow)(1.5 design factor) = 600.00 Gpd design flow
2. Infiltrative capacity of native soil 0.7 gpd/sq. ft.
3. Absorption area required: 857.15 sq. ft.
4. Absorption area as proposed: 890.40 sq. ft. (44 chambers + 2 pair end cams)
Infiltrator "Quick 4" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end caps = 5.20 sq.ft, E.ISA/pair
857.15 sq. ft. - (2 pair endcaps)(5.20) = 846.75 sq. ft.
846.75 sq. ft./20.00 = 42.34 chambers required
Number of trenches: 2 ((i 22 chambers per trench (60 chambers total)
Trench width: 2.83'
Trench length: 91.00'
Trench spacing: 9.00' on center
Total system area w/ 6' trench spacing: 12.00'x 91.00'
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-.Quick4.
Quick4 Plus Standard Chamber
1 2'
34- 48"
EFFECTIVE LENGTH
Quick4 Plus All-in-One 12 Endcap _
PRESSURIZED PIPE DRILL
- POINTS LOCATIONS
/ (2 PI ACES)
/ - 18" -
l lnJ I l/J~ II/~II ` I~ 13
~.-1 1 1 1_ C-1 y 1 8" INVERT
33^-___-._-_-~
FRONT VIEW SIDE VIEW
Quick4 Plus All-in-One Periscope INFILTRATOR WATER TECHNOLOGIES, LLC ("INFILTRATOR")
Infiltrator Water Teclnologles, LLC STANDARD LIMITED Drainfield WARRANTY
(a) The structural integrity of each chamber. erdoap.. EZflcv expanded pulystyrene andror other
accessory manufactured by Infiltrator t'Umts"I when installed anc operated in a leachfield of an
QUICK4 PLUS 0nsite septic system in accordance with Infiltrator s nstrulltlons is warranted to Line original pur-
ALL-IN-ONE PERISCOPE
/ (360' SWIVEL] ~ chaser ;'Holder') against detective materials and workmanship for one (rear from the date that the
septic permit is issued for the seotic system containing the Units: provided hnwever, that t'2 septic
permit is not regmreo by applicable law, the warranty period will begin upon the Cate that installa-
tion of the septic system commences. To exercise its warranty rights, Holder must notify In'iltrator
fi f~\ in writing at its Corporate Headquarters in Old Saybrook, Connecticut within f Reen (15) days of
~I the alleged defect. In'iltrator will supply raplarement Units for Units determined by Infiltrator to be
j I covered by this L. mited Warranty. Infiltrators liability specifically excludes the cost of removal and:
/ I \\12.7" INVERT or installation of the Unit=_.
(bi THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH tai ARE EXCLUSIVE THERE
- _ ARE NO OTHER WARRAN i IES WITH RESPECT TO THE UNITS, INCLUDING NO IMPLIED
WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE
d) This Limited Warranty shall be void it any part of the chamber system is manufactured by anyone
other than Infiltrator. The Drilled Warranty does not extend to incidental, consequential, special or
indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of
production and profits, labor and materials. overhead costs, or other losses or expenses incurred b,
sii the Holder or any third party. Specifically excluded from Limited Warranty coverage are damage to
y the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units.
1 - the Urits being subjected to vehicle traffic or other conditions which are not pelmdted by the instal-
~I lation instructions; failure to maintain the, minimum around covers set forth in the installation insti,c-
I~ 5Imo. 9.. - - bons: the placement of improper materials into the system containing the Units: failure of line Urits
or the sep'Ic system due to improper siurg or improper sizing, excessive water usage. Improper
grease disposal, or improper operation. o, any other event not caused by Infiltrator. This I imited
Warranty shall be void if the Holder fails to comply with all of the terms set form in this Urnil~d
Warranty. Fortner. 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 Ilabil ly
clams of Holder or any 'hire party. For this Limited Warranty to apply, the Units must be installed in
accordance with all site cut dititms required by state and local codes, all other applicable laws: and
Infitrator's installation instructions.
x
4 Bus,riess Park Road (d} Na representative of Infiltrator has the authority t0 change or extend this Limited Warranty. No
( P.O. Box 768 warranty applies to any party other than the original Holder. The above represents the Standard
Old Sayu*ook. CT 06475 Limited Warranty offerec Ly Infiltrator. A limited number of states and counties have different war-
860-577-7000 • Fax 860-s77-7001 ranty requirements. Any purchaser of Units should contact Infiltrators Corporate Headquarters in
INFILTRATOR' t-SOG-221-4436 Old Saybrook, Connecticul, prior to such purchase. to obtain a copy of the applicable warranty. and
vv,atel le-dril0c)OgIOE6 www.infiltratorwater.com should carefully read that warranty prior to the purchase of Units.
U.S. Patents 4.759.661 5,017,0.11. 5,156188: 5,336,017. 5.401.116. 5.401,459. 5,511,903, 5.716 163: 5.588.E 7b: 5.839.944 Canadian PatEnss. 1.329.959: 2.004.564 Other patents pending.
Infiltrator, Equahzev WC*4. and SIdeWinder are regstered trademarks or Infiltrator Water Terhi),ologies. Infilrator is a registered trademark in France. Infiltrator Water Technologies
is a registered trademark in Mex co.
Contour, meroLeaching, PolyTuff. ChamherSnacei, MulnPort . Pos.Loce. Quicl:Cut. O uickPlay, Snapt-ock and Soughuro:;k are trademarks of Infiltrator Water Techndog es.
Peiy'_ok is a trademark of PolyLck, Inc TUF-TITE is a leulste!eJ trademark of TUL-1 tI E, INC. Ultra-Rib is a trademark of IPFX Inc_
70761nfd?ratnr Water Tectlndogies, LLC. WI rights reserved. Rmted in U.S.A. PLUSOr IS it
~ - • • ill .I~
I•
P OL'Ycak X nc
inrosoms i,Pretas?Vrainage Zabel PL-525 Effluent Filter
& A-asmvater Products a D: slob of Fdybk Inc.
IT-525 Filter
The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has
525 linear feet of 1/16" filtration slots. Like the Polvlok PL-122, the Polylok PL-525 has an automatic shut-off ball
installed with every filter. 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.
Features: 1/16" Filtration Slot:
• Rated for 10,000 GPD (gallons per day). GP~ (Opti pts Switch
mial)
• 525 linear feet of 1 /16", filtration. 1 r J 1~
• Accepts 4" and 6" SCI 1D 40 pipe.? (xte ,i mlliar
• Built in gas deflector.
• Automatic shut-off ball when filter is removed.
• Alarm accessibility. Rated for
70,000 GILD
• Accepts PVC extension handle.
PL-525 Installation:
Ideal for residential and commercial waste flows up to 525 Linear 11
10,000 gallons per day (GPD). 4 l/16,.
Filtration Slots
1. Locate the outlet of the septic tank.
2. Remove the tank cover and pump tank if necessary.;
Accepts 4" & 6" r_
3. Glue the filter housing to the 4" or h" outlet pipe. If sclin 40 pipe
the filter is not centered under the access opening use a
Polylok Extend & Lok or piece of pipe to center filter.
4. Insert the PL-525 filter into its housing.
5. Replace and secure the septic tank cover. Certified to
N5F< ANSI Standard 46
PI,-525 Maintenance: "
The PL-525 Effluent Filters will operate efficiently for
several years under normal conditions before requiring _ z.. . N.r
cleaning. It is recommended that the filter be cleaned
every time the tank is pumped, or at least every three
years. If the installed filter contains an optional alarm,
the owner will be notified by an alarm when the filter
needs servicing. Servicing should be (lone by a certified
septic tank pumper or installer. _ Autoutmatw
1. Locate the outlet of the septic tank. Sh -off fall
2. Remove tank cover and pump tank if necessary.
3. Do not use plumbing when filter is removed.
4. Pull PI-525 cartridge out of the housing.
5. Bose off filter over the septic tank. Make sure all
solids fall back into septic tank.
6. Insert the filter cartridge back into the housing making
Outdoor c,n,artI Ilie[ Alarm t xtend e I ol,
sure die filter >5 properly aligned and completely inserted. Polylok, Zabel & he sl Enters accept l: asily installs
i. Replace and secure septic tank cover. the SmartFilterR switch and alarm into existing, tanks.
Polylok. Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Frec: 877.765.9565 Fax: 203.284.8514 wvtw.polylok.coni
PO tj O-to
.
Conventional Septic System Management Plan
Pursuant to SPS 383.54, Wis. Adm. Code
General
The conventional septic system shall be operated in accordance with SPS 382-384 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. 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.
Septic Tank
Septic tank servicing mechanics comply with SPS 383.54(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
111 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 ofa 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 shal I he
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 scaled 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 Absorption 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 fiequent monitoring.
Effluent flow shall be alternated between dispersal cells on a two-year schedule by use of diversion valve. Effluent to
be diverted from new cell to old drainfield at 4 year anniversary of new system installation. Old drainfield to be utilized for a
2 year period. Effluent dispersal to be alternated between systems on a two year rotating basis thereafter.
Contineencv 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.
Pg. 7 of I I
ST. CROIX COUNTY
SEPTICTANK M:AINTE.NANCI; AGRE.EMEX 1
,AND
OWNLKS1111) (ER HFICATION FORM
Owner/Buyer Stephen & Lisa Lockhart
Mailing Address 322 St. Anne's Parkway
Property .-Address -Same - - -
erification required from Planning & Zoning Department for new construction,)
Hudson' WI 54016 Parcel 040-12505-20-000
CityiState Identification Number
LEGAL DFSCRIPTION
SW NW 19 28 19 Tro
Property Location 4 . Sec. l N R W, Town oI y
Suhdiyisit,t, Plat: Troy Village Lot h, 62
Certified St(rvey Map # Na VOILIt7te Na Page tit Na _
l'Varra(zty Deed # 703467 (before 2007)Vulume 2089
Pa'-'C 576
Spec house ElyesDno Lot lines identiliableE]ycs❑no
SYSTEM MAINTENANCE AND OWNER CEItTIFICATION
fmproper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists ofpumping Out the septic tank every three years or sooner, if needed. by a licensed pumper. What you put into
the system can affect the )unction ofthe septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 38__5?(I) and in Chapter 12 - St. Croix County Sanitary Ordinance.
I he property owner agrees to submit to St. Croix County Planning & Zoning, Department a certification torn, signed by the
Otvner and h. a master plumber. journey man plumber, restricted plumber or a licensed pumper veriN inc that (I ) the on-site
vkasieovater disposal system is in proper operating condition and Or (2) after inspection and punyiing (it necessary), the septic tank is
Icss than I,'; full ofsludoe_
levke. the undersigned have read the ahoo-c requirements and acree to maintain the private sewage disposal system with the
standard) set firth. herein, as set by the Department of Safety And Professional Services and the Department of natural Resources,
Statc of V't isconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning; & Zoning Department within .:0 days of-the three year expiration date
f ~vve certif}' that all statements c r this form are true to the best otrny:uur knowledge. I,"we aware the omier(s) of the
property described above, by virile ofa varranty deed recorded in Register of-Deeds Office.
Number of bedr(~)ms 4
02 20 18
SkINATURF OF AN'L,IC ANT(S) DATE
i
"`Any information that is misrepresented may result in the sanitary permit being is%oked by the Planning & ZoninL, Department
include with this application a recorded ~~<rn'anty deed from the ReListei of Dccds Office and a :opy of the certified surrey map it*
reference i~ made in the warranty deed.
(R I[N. 04/ 12 )
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) 322 St. Anne's Parkway, Hudson, WI 54016 located
at: SW '/4, NW '/4, Section 19 , Town 28 N, Range 19 W,
Town of Troy , 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 SPS. 384.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service February 21, 2018
Did flow back occur from absorption system? Yes No X
(if no, skip next line.)
Approximate volume or length of time: Na gallons _Na minutes
Tank Capacity: 1,250 gallon
Construction: Prefab Concrete X Steel Other
Manufacturer (if known): Wieser Concrete
A" Tank (if known): 15 years, installed 12/30/2002
S:,i~!e~nsed rmit )number (if kn ) 404971
James K. Thompson
Plumber ignature) (Print Name)
i
i
MPRS MPRS #30021
(Title) (License Number) MP/MPRS
February 21, 2018
(Date)
Form to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rev. 2/2012
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•ment of Gommerce PRIVATE SEWAGE SYSTEM County: St. Croix
.pg Division,
INSPECTION REPORT sanitary Permit No: 404971 0
cAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: /
it information you provide may he used for secondary purposes (Privacy Law, s.15.04 (txm)) N
A Holders Name: City Village X Township Pam el Tax No:
-ifes le Homes Troy Townshi 040-1250-20-000
CST BM Elev. Insp. BM Elev BM D ion: ~&M e
TANK INFORMATION ELEVATION DA
TYPE MANUFACTURER CAPACITY STATION BS ,~HII FS ELEV.
Septic ' Benchrp?ric„ _ ~ 3 t 1 l" ,
~N I'i. g , -i q
Dosing W A- t66 r Alt. BM wA.l~ 5~'•,L /01-07
Aeration Bldg. w
Holding StMtInlet S3J
TANK SETBACK INFORMATION St/Ht Outlet 5" 3 a 7,3
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Ver
Dosing Header/Man.
Aeration Dist. Pipe O~ 010 y- 6
q Q
irk L. q.04-.
Holding Bot. System %I 1A-1
Final GEpde PUMP/SIPHON INFORMATION ow S'' S
Manufacturer Demand St Cover 3• 10 t f - O
Model Number
TDH Lift ion Loss System Head TDH t
I Forcernain Length Dia.
SOIL ABSORPTION SYSTEM L),7 JAAa~ c
BEOIrRENCH Width Len I No. Of Triiiiiefies PIT DIMENSI NS No. Of Pits Inside Dia. r quid Depth
DIMENSIONS 3 r t j Y -r S r
actu r.
SETBACK SYSTEM TO _I PA BLDG L LAKE/STRE LEACHING
INFORMATION T Of system. CHAMBER O
ZV b' e~ Model Number
DISTRIBUTION SYSTEM na- 3 9
Header/Manifold DistributioW GV Ix Hole Size Ix Hole Spacing Vent b rttake
t Pipe(s) `v I1 1~r 4/yam >51 r
Length_ Dia ~f 11-ength_- Dia $-pacing-1--
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 62Ad
Depth Over Depth Over xx Depth of xx Seeded/Sodded r Mulched
BediTrench Center SedrTrench Edges Topsoil o i
s Yes No Yes IS No
COMMENTS: (Include a discrepencles, persons present, etc.) Inspection #1: -2.-/r 30/ 6 Inspection #2: 1 I
Location: 322 St. Anne's Parkway Hudson, WI 54016 (SW 114 NW 1/4 19 728N R19W) Troy Village otof 62 Parcel No: 19.28.19.1304
1.) Alf BM Description = or
tn.~°~~~irs-~ .~,-4
2.) Bldg sewer length
- amount of cover $ Low. ` I~I-W (04
3
~yS-~ 30' o~ Kd tj t M 1 r+v - W 8 Z /b ~t 1, s
Plan revision Required? m Yes I W No i
i Use other side for additional information.
SOD -6710 (R.3197) Date insepcio Signature Cert No.
Wisconsin Depar.. ~ it of Industry, S O I L AND SITE E V A L I QN REPORT Page ~ of 4
Labor and Human Relations =
Division of safety f# t3uikSngs in accord with ILHR . '.mss. Ad Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches i aize. Plan must include; twt
not limited to vertical and horizontal reference point (Blot), direction ohd % of r~A~ sgale or PARCEL I.D. 8
dimensioned, north arrow, and location and distance to nearest road. l-L 5 a - 2.Q
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION D Y DATE
PROPERTY OWNER: PROPERTY LOC ON 'c t 2 - SVC Z.Ll ,1 d R 10 w f
Co►.1'rt t,.1 '4t1. -Z~u OZPM q1,!'r (1-mp . f10CITY IKS kq T aq N,R 1~ E (or) W
PROPERTY OWNER':S MAILING ADDRESS. b SUED. NAMCSM r
~vE_ TLO4 \)ku_hGE
CITY, STATE ZIP CODE PHONE NUMBER []VILLAGE ®rOWN . NEAREST ROAD
~LWt +~t.~ ss~c~y (6t2I~s7-~SbB zu sr."W~ PAStkwR~l
New Construction Use I)q Residential / Number of bedrooms
Addition to exiting building
I I Replacement I ) Public or commercial describe
Code derived daily flow boo gpd Recommended design loading rate bed, gpuillt2 tench, gpd/ft2
Absorption area required 9 52) bed, 112 -150 trench, 112 Maximum design loading rate bed. gpd/ft2 -b tench, gpddlit2
Recommended infiltration surface elevation(s) SM '~-ftE, L q It (as referred to siie plan benchmark) `
Additional design / site considerations s M t to 'M 1ti OT i 1'-}6e y 0
Parent material- Lt i es s Ou e. S'PQ~Y our k-AIN S H Flood plain elevation, if applicable A ft
S = Suitable for system CQWE? 0NAL MOUND W.GROUND PRESSURE AT-GRADE SYSTEM IN FILL women- TANK
U= Unsuitable for stem ®S ElU 13S DU ®S O U ®S ❑ U ❑ S EIU ❑ S 011
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color f Moores Texture Structure Consistence Bmrd3y Roots GPD/ft
in. Munsell + OLL Sz. Cont Color Gr. Sz. Sh. B ru~Idn
ed
`.a: o_Q n_S`1Q 2S 1_3 S~k YA-(f c_S • Z.
.3
z vz_-6y -n -s -ra. q ty - i18.31 zmsbk wl~- JI.w •s J.
Ground 3 3~(-8S . s `r ! _ i 11t S 0- sbk Yn f l- d_ S
elev.
tL y _t~ -s'1 tZ ~l lb - d ~s 0%-, rn
Depth to
limiting
taclDr
LZ S"
-7
Remarks:
Boring # _
j o_7 -i.Sy1Z2.S12 st1 ZOnPI yef - cS ~p:.2
mom i
Z- Z -ZZ. z•S-/rt icy - Stla4[ Zrrt r wf S .6
3 ZZ-dlJ -~.s~t¢ is j/ st1 lasbtT
mf►- es .Z ?.3
Ground
o n ~t3 ~'I , .s -t dt 1Y s O s9 m 1 6-S
'
5 67 z.S`1R y!y - atI~SI O►~ m'('1- ~S 1,;~ ~Z
Depth ID cZ
limiting b $g LO `1 it S 13
factor -S `i czSY8 S I O ti,~ • Z
Yin
1$'
Remarks:
T Name:-Please Print Phm.
Arthur L. We erer' 715-425-0165
estirer Soil Testing & Design Service-P.O. Box 74 River .Falls,WI.54022 .
Sgnapue. 00 -.Z 1- 6 Z Da CST Number.
220254
I _
PROPERTY OWNER-_C0% P SOIL DESCRIPTION REPORT
PARCEL I.D.# C3 LLp_ \Z sp_~j Page? ~t
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft
In. Munseif Texture Consistence
- Qu. Sz. Cont. Color Gr. Sz. Sh. BMid3Y Roots gad ranch
}3 ^3 o-r~ -S Li P-- I2
si 1 7 T77, Lv S •S
~.s H~z ~t y si ► z'F~bk
Ground 3 VI Z9 7-S`•t2 my - c~ 3hr► r,,~o\~ ►►'1 ~h °LS _ • y . S
elev.
KAG ft. 29-~3 lta•'-irZ Ste y1Z S1~y st c1 pw~ f,-j Z
Depth to S 3a=-12 7 ,S `7IZ S9 c
limiting w► <
factor
3o~ b ,z_~o ~.s~liyJ6 - S p s~ w-,
} t Remarks: \Z,`` ►-Na tTLAM Zoug
Boring # -
p_\3 --1.Sytz z.s (Z
- s;1 lr►, bk m~i- C • z
3 U Z 13-?$ ~.5 X11- Lj"1 y
gs s r f 1 esbk rn . i. 3
Ground 3 -It Z 7 S '1R ~d l` - S O S
elev. Z 4~\ S't tz 313 ► , Lb
ft. a~TLES Ar't- Z 3
1DZ.-S
Depth to
limiting
factor
>tlZ" S't9
Remarks: C riUTTUL > -Z tOQQ J
Boring #
O- 10 -).c `9 R Z.S 12 S t I 1
t►9 Ak lvt'~CI-
5.4 Z t~ZS ►O'1tL3l3 sit z
~x,~<;}~: ~ c s btic wrfl- 1• w - . .3
Ground 3 S -Z9 ,.S `l tL S R 313 si l I \ Csbk -~I- CS
elev. 29-toy S IM X116 S c~ S(3 yvi
ft--s It. -
Depth to
limiting
factor
>tuy" -
Remarks: < \Z'` t~,~rn ® ~Ntr
3oring #
1 o_ty ~,s 7fi z.st z L ~\,4
V4 vj~-
Z t --Lg -),s `72 ?-.s 13 - 1 ~5b k m
M . ;
3 Z&~b t o ysZ ~Ib - s I
around 1 L-- Sbk M V`Fh LS • t( - 5
,lev. It. L41 36-qz S `r IZ 3 ty S 2 3 ~3 S Ow► vn`~h- @ S 3 .
)epth to S LR-tto '1•S `-tR y/6 - S C~ g9 m 1 - ~"1
imiling 1
acts
>lto" f, .6 E" . t-tj
< \ 2 t~101'i C~ Z p~,Jt3
Remarks:-
CO►.SZ1 U ~1.J-S- Psl.
PROPER`'OWNER 'Z~q\5-, CZRLP_ SOIL DESCRIPTION REPORT Page 3 of
*RCELL[~# O y O - 12S0 -Zo
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Beunt Roots GPDlft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
0-9 -S4a.Z61 i L e -5
Ground 3 1S~Zq-S`zR Slly - oL~ z `~S~,1c ~►>`~1~ ~S • ,S
elev.
tuz.s a. z9 3S S yRviv s~t`z ~i3 c) C- 5y
yn'f~ t_a - -Z. •3
Depth to s -ttS 'l •S `tti_ X16 S O ~4 I
limiting
factor =
?11S`
t
Remarks: < \Z,k MA'T'T' 24))JE
Boring # -
r
i
Ground '
i
elev.
ft. f
Depth to j
limiting j
factor I
i
Remarks:
Boring #
i
x ~
i
Ground
elev.
ft.
Depth to
limiting
factor j
Remarks:
3oring #
around {
;lev.
)epth to
imiling
actor
Remarks: _
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