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Home My WebLink About020-1128-80-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 605038 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. fvff Permit Holder's Name: City Village Township Parcel Tax No: Sue Brandt TOWN OF HUDSON 020-1128-80-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: exislia T 17.29.19.603 TANK INFORMATION ELEVATION DATA TYPE nu, SANUFACTURER f,e QPA IT Y STATION BS HI FS ELEV. Septic l , _ , - v 2GO G ` Benchmark # i 66 . 68 4iT AA. BM i Aral ion Gr ve 1 1 Holding t Inlet 17-74W 90, 9 F3 ' ~ ff j , t/ t Outlet TANK SETBACK INFORMATION C / TANK TO P/L, WELL BLDG. Vent to Air Intake ROA``D Pt 4nfet- W4t voive oahtl Septic 70' Zo Dosing Head Man. Aerati n Dist. Pipe Holding Bot. System I PUMP/SIPHON INFORMATION Final Grade Z• j Manufacturer Demand St Cover Y-W M DH Lift Friction Loss Sy ad TDH Ft Fo main Length a. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width LNo. Of Trenches PIT DI SIONS No. Of s InsiLiquiD DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREA LEACHING Manu ur r.. INFORMATION Type Of System: CHAMBER OR ` t]/~~ I J17 C 00 # UNIT Model ber:L DISTRIBUTION SYSTEM ' p L Header i old Distribution IX Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth / Depth Over xx Depth of xx Seeded/Sodded xx Mulched B ranch enter f Bed/Trench Edges > It Topsoil COMMENTS: (Include code discrep(e'ncies, (persons present, etc.) Inspection #1: Inspection #2: f Location: 448 PARK LN COt,. On A -ha (r ~ ~ Qr,~'(~W~~A p~ 1.) Alt BM Description = 577' 1 'vII A~ jVJ I ~(0(JVl et"a Tail Ue 1 we - ~b/ v , 2.) Bldg sewer length = ( ~ST LA'S -AIM otb ✓,A C1 4- - amount of cover ►1'1 S tie CST Plan revision Required? ❑ Yes No ~n Use other side for additional informati n. L L QO Date ~Ij Insepctor's Signature Cert. No. I SBD-6710 (R.3/97) Sly -dd1S- 2F~v a Safety and Buildings Division T : 1 t 8 K JUN 13 2018 2 1 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, Wl 53707-7162 wefop en[ ! 615 63 481 taly Permit AppFe ion Tr271CaMionNumb In accordance with SPS 383.21(2), Wis. Adm. Code, submission of tho the is required prior to obtaining a sanitary permit Note: Application fortes for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary Purposes in accordance with the Pliy4cy Law, s. 15.04(1) m), Stats. ~j L At lication Information - Please Print All Informatio Propety Owner's Name •---7 Parcel # Uuo Property Owner's MaitutAddress / Property Location 17, ~ , 1 ~ . lr`J~ I Govt- Lot Curti, State zip Code/t Phone Number ) '-J) Y4, SechonP -'V V J l/ qcircle Type of Building (check all that app r, 111-1-4 T z N; R L / or amily Dwelling -Number of Bedr ms Subdivision Name ❑ PublicJCommercial - Describe Use ❑ City of ❑ State aed - Describe Use CSM Number ❑ Village of e Z Z2 j,.-77 awn of ✓ III. Type of Permit: (Check only one bo on line A. Complete line is if applicable) A. ,r Q Wew system acement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explaur) B. ❑ Permit Renewal El Permit Revision El Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued / S ' Before Expiration Owner W. Type ofPOWTS S stem/Com onent/Device: Check all that apply) -Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil )q ,1$ ~ ❑ Holding Tank- m.~ er D~ispersa! Component (expl "n)_ ❑ Pretreatment Device (explainj' V. Dis rsaYrreat entArea Information: .S l e Design Flow (gpd) ¢ Design Soil Application dsf) Dispersal Area Required (s Dispersal Area Pr posed (sf) System Elevation VL Tank Info C ac aP n5' in Total # of Manufacturer Gallons Gallons Units " - New Tanks Existing Tanks m u J „ Septic or Holding Tank U i7~ " Q Dosing Chamber VII. Responsibility Statement the undersigned, ass ' r ponsibility for installation of the POWTS sho n on the attached plans. Plumber's Name (Penh Plumb S' ature MP/NMRS Number Business Phone N her P/hmm s Address (Street City, State, ip Code) , = / m VIII untq/De artment Use Only proved ❑~i AMW8v Perjm,~it Fe~ej Dat Lssu Issuin ent Signature ZX~ ~G 6 O n8f'eny Reason Denial / ' IX Condi Wr R MA it; ;sons for Disapprove 1. Se* tank, 01MIR ilW ilml iK{a . s„ cell must all h , tare: I ♦~aaS per nar.3gemer' p! o !1. lu nbW. l 2. A1m1tw*rP.cWP?t,^.f' ; tr Ed - Attach to complete pleas for the system and submit to the Coup only on a ry p per not less than 8 irz z IZ inches in size SBD-6398 (R. 11/11) System PLOT PLAN PROJECT Sue Brandt ADDRESS 448 Park Lane Hudson Wi 54016 NE 1/4 NW 1/4S 17 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 95.7/95.6 4.5' below B-1 6/12/18 BEDROOM 4 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/280 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of ST cover ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark kale = 1/4" = 10' W e I l Property Line 1 W Existing 4 Bedroom House L KN 20' 0' 120' 20 B.M.* T 10' 124# Failing Drainfield 220' Property Line '-Valve S?~~5 0, 20 100' 5' 5' 90 101, 2% Slope B-2 2-3' X 90' Cells with >3' spacin All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 ~nts. 102' B-3 Park Lane Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 6/12/18 Owner:Sue Brandt Location: NE 1/4 NW 1/4 S 17 T29N,R19W 448 Park Lane Hudson Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Secti n 4.6. Maintance and Conti en Plan 7. Filter Cross Section 8. Existing Septic Tank f Signature License number #226 System PLOT PLAN PROJECT Sue Brandt ADDRESS 448 Park Lane Hudson Wi 54016 NE 1/4 NW 1/4S 17 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 95.7/95.6 4.5' below B-1 6/12/18 BEDROOM 4 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/280 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of ST cover ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark IScale = 1 /4u = 10i Property Line 15' Well Existing 4 Bedroom House 20' 0' 120' 20 B.M.* T 10, 12' Failing Drainfield 220' Property Line -Valve ST 30' 20' 100' 15' B-1 AL AL 90' 101, 2% Slope B-2 2-3' X 90' Cells with >3' spacing All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 102' B-3 Vents Park Lane Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 100.5' ,jV ent Vent G rade 4" 3' X30/ 34 Septic :an k S' L ong 1 Grade at System Elevation 6 "Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A-95.7' B-95.6' ST. CROIX COUNTY SEPTIC "TANK MAINTENANCE e.~GREEMENT AND OWN HIP CERTIFICATIGN FORM Owner/Buyer J ~ J Mailing Address L1tj-L.1 Property Address (Verification required from Planning & Zoning Department for new construction.) - City/State _ Parcel Identification Nur-iber LEGAL DESCRIPTION Property Location '/a , Sec., T ~N R~ W, Town of Subdivision cz b2~ Lot # Certified Survey Map # _ _ , Volume Page Warranty Deed # Volume Page # ~~=-~,-f-----. Spec house yes no Lot links identifiable yes no 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, d 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 Coimty Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zon ing 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal systern 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. I/we certify that all statements on this f m are true to the best of my/our k-aowledge. I/we am/are the owner(s) of the pro4E ove, by virtue of warra deed recorded in Register of Deeds Office. Nno TURB F APPLICANT(S)DATE **Any information that is misrepresented may result in the sanitary permit being r,:voked 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) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION- 4 SYSTEM SPECIFICATIONS Owner 7 Septic Tank Capacity 7 al ❑ NA Permit # Septic Tank Manufacturer~NA 3ESIGN PARAMETERS Effluent Filter Manufacturer Z/ . ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA C. ~2 i Number of Public Facility Units A Pump Tank Capacity al ❑ NA 1 Estimated flow (average) ( al/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) C' al/day Pump Manufacturer NA Soil Application Rate alida /fe Pump Model NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD$) 220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) s30 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) Gi0 mg/L ❑ At- rade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: (Maximum Effluent Particle Size 36 in dia. ❑ NA Other. ❑ NA Other. NA Other: ❑ NA `Values typical for domestic wastewater and septic tank effluent Other ❑ NA IAINTENANCE SCHEDULE Service Event Service Frequency (inspect condition of tank(s) At least once eve El months} every: ears (Maximum 3 years) ❑ NA (Pump out contents of tank(s) When combined sludge and scum equals one-third ('/3) of tank volume ❑ NA ilnspect dispersal cells} At least once eve ❑ month(s) ry' ear(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: month(s) ❑ NA l ear(s) 1 nspect pump, pump controls & alarm At least once every: ❑ month(s) NA ❑ year(s) 1=lush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) ether. ❑ month(s) At least once every: D year(s) NA ~3ther. NA MAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must linclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of =mbined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of !:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority ;within 41 0 days of completion of any service event. page of START UP AND OPERATION ducts or ~ chemicals th~jt For new constriction, prior to use of the POWTS check treatment tank(s) for the pnwce of painting pro may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thi; tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will ble discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surlhoe disofrarge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improv* the performance and prolong the fife of the POWT$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectarrts; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting produc*; pesticides; san'km napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is prope(ly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Opemtor. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space fined with soil, gravel or another Inert solid material. CONTINGENCY PLAN ' If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compGont replacement system: ❑ A suitable repiacernent area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requirled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the neled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ suitable replacWment area is not available due to setback and/or soil limitations. Bening advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be instWW as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biom at at the infitrajive surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANW UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE 0 A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER NameE Name 'CLI Phone j { phone SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY f n Name A % ✓ Name = C Phone Phone 1 J, f This document was dratted in compliance with chatter SPS 383.22(2)(b)(1)(d)&(f and 383,54(1), (2) & (3), Wisconsin Administrative Code. N ) WWy t I=~}=Ii l { t: LL, i ~ t ,1 l r, i j I i? O y P ~ 1 I w I - - P O P ~ O Q G J I i S t~ 1 ~ F i i - f ST. CROrJ{ COUNTY CERTIFICATION ST T E OFFICE FOR pTILIZATION OF STATEMENT AN EXISTING SEPTIC; TANK is to certify that I ha rving thev inspected the se ptic tank Preserlt:ly Section %--0 res dente located the tank and upon inspection baffles to be ' T certify that I 3rrr~ct t~unctionin9 in good condition, have t( Properly, n, and it aPPears to be a,t time serviced: 1:}' ~ flaw back occur from Yes absorption system? _ Na (Tf do Approximate voiultle o r length skip next line). .~Ipacit of time; Y •r~ iC 471~ gallons IT, -i rr t r t_ c' ~'onstructlon: Prefab concrete r9~rr~uf_acturer. Steel Qt (If known her - of nk (zf known tX, ~C. (Name} Please print`--------- ( I' t ] e --------__7r 6 r.~ (License Number) 1~~, to ['orm to be completed or by licensed Code} Licensed Disposer plumber (s.145.06 (NR 113 Wisconsin , Wiscorrs.i.n _ Administrative ?'lumber (applying for sanitary Permit) Certification: -Cr' accepting the above c.andition statement regarding Certj confor Y that the tank existing septic tank m to the re to th est of my knowledge w.i1.:1 1.rzspeCtion openinqu rements of ILHR 83, s. ver outlet baffle Adm. Code (except for. Signatur MP/MPRS _e~` 4E NE 1/4 OF THE NW 1/4* OF SEGI N. WILLOW RIVER STATE _PARK V 89013 ` 09"E 3228. 10' NOI 23 0.00` 180.00 ` 180.00, 1275.23` o ~ - 0 - N o 0 0 o w o • o 23 ° 22 2! _ °o o `t v 2.11 ACRES 1.65 ACRES 1.65 ACRES 0 0 1.65 rn~ m co ih N N 0 0 0 o o 23 0.00 o 180.00, 180.00, - 18 PARK S 89°13' 09" W 1228.00' LANE l • ~ c i t i r' ~,....a,_. J _ i . Form- STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER S eV ert L~k'I~~ t TOWNSHIP 14VASON SEC. T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION ~sfie5 LOT LOT SIZE I PLAN VIEW I Distances and dimensions to meet requirements of ILHR 83 ! SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i O 000. r I 0 jla I / QV o sed INDICATE NORTH ARROW i i BENCHMARK: Describe the vertical reference point used -OQ dk l{'~k olfhje Bay Elevation of vertical reference point: Proposed slope at site}}: SEPTIC TANK: Manufacturer: e Q Liquid Capacity: Iwo q A) i I , Number of rings used: t - a Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front 10 Side 0 Rear, p Ol feet 611 V ~ From nearest property line Front ,~Side Rear, O Q0 feet Number of feet from: well building: ly I^ (Include this information of the above plot plan)( Z reference dimensions to septic tank) SEE REVERSE SIDE 7LABOR RTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS & HUMANJIELATIONS PRIVATE SEWAGE SYSTEMS DIVISION OX 1960 BUREAU OF PLUMBING SQN, WJ 53707' CONVENTIONAL ❑ALTERNATIVE Slate Plan LlD N.,M.t (11 asarllnwt ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound • NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER. INSPECTION DATE / Steven J. Bradt Rt. 5 Hudson W1 54016 t V BENCH MARK IPermanenl reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.. CST REf P1 TV NE NW Section 17, T29N-R19W, Town of Hudson, Lot#22, Parkveiw Est. N:nne of PI.-b- JMPIMPRSW No. Co..IV Sanitary P,-1 N-1- Richard Hopkins 1059 St. Croix 83825 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANK INLET ELEV ITAIKIUILETELEV WARNING LABEL LOCKING COVER 1 , PROVIDED PROVIDED W U 0 CJ /.~a 90.,q WYES ONO OYES NNO BEDDING VENT CIA. VENT MATL HIGH WATER NUMBER OF ROAD PROPERTY WELL BUILDING VENT TO FRESH C JALARA7 FEET FROM Z LINED S 5 111 AIR INL r DYES NO OYES NO NEAREST J DOSING CHAMBER: MANUFACTURER JBIDDING 111OUBICAIAC11Y JPUMP MODEL 1PUMP-SIPHON MANUF ACIII17EH WARNING LABEL LOCKING COVER y OVIDED PROVIDED OYES ONO OYES ONO OYES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL N E PHO)'lillY JIVILE HTOFH S)1 (DIFFERENCE BETWEEN F F OM NE 4111 INII I PUMP ON AND OFF) DYES ONO ST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing EFNI,TII JIBAIIIIIII 111AII HIA1 AND MAHKINI• or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH NO OF DISTR PIPE SPACING COVER INSIDE MA ayllS 1 IOOIO BED/TRENCH THE NCHES N FNI AL! PIT OfPOI DIMENSIONS F Z 'Pt 67AVEL DE PTH FILL UEPTH OISIH PIPf DISTR PIPE DISTR. PIPE MATERIAL NO D W- NUMBER OF PHOPEHTV WELL BUILDING VENT 1O/111 tin BF LDW PjPESy ABOVE CD ,)H fl:f EfJy ~w 2- 9 PIPES FEET FROM ALINE ry ~Q AI'H71NI FJT ~h{1 (o1 (D] tV` 3p NEAREST O / O V G l MOUND SYSTEM: O Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- OYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TFXTI/HE PFRMAN[ IMAHKIII$ RSIHVA11ONWIIIS DYES ONO DYES LINO - - UEPTH OVFH THENC)1 HEU ELXAS 11111`111OVIIIIIIINCHBED DEPTH OF IOPSOII SODDED ~FFOfO MIIL['IRD CENTER EDGES ' OYES ONO DYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENUTR TRENCHES LATERAL SPACING GRAVEL UTPTI/ BI LOW PIPI f It L DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIE (ILO DISTR PIPE IMANOOLDMATIRIAL N!) IIISIIf 1:1$Ift PIPf I1ISIIIINI111[IN PIPI 111AIIHIAI AIIAIIKINI. ELEV ELEV DIA ELEV. PIPFS UTA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DHILtEDCOHHEC)I Y COVFRMAIE/IIAL V11+111:A11111(:O14HFSPI)NOSIUAPP)IDVII) PE Ants YES ONO OYES ONO COMMENTS: aERMANENT MARKERS. OBSERVATION WELLS NUMBER OF PROPERTY WELL BUILDING FEET FROM LINE OYES ONO OYES ONO NEAREST Sketch System on l Ret in in county file for audit. Reverse Side. SIGNATURE TITLE DI LHR SBD 6710 (R.01/82) 11,~, 3 2p1B Wisconsin Department of C~did 1 'SOIL EVALUATION REPORT Page of Division of Safety and Buildings co' nt-M nt Jt Cr') Deis with Comm 85, Wis. Adm. Code County r `ty Attach complete site plg o6flt"riot less than 8 1/2 x 11 inches in size. Plan must ' include, but not limited td: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. C C. c.' Please print all information. Revie by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). at Property Owner Property Location ~ 07 Govt. Lot 1/4 ~/4 S{ T , gir N R t1ly- (o rw -b IQ Y-V Qi- l Property Owner's Ma~ ~ Addr ss % Lot # Block # S . Name or CSNW t~ 4~ Y~~~ ✓ Cl z State Zip Code Phone Number [I City ❑ Village own Nea st Ro d ISYN ❑ New Construction Use: esidential / Number of bedrooms Code derived design flow rate I tJ`~tJ GPD M~Ipiaoement ❑ Pu 1' or commercial - Describe: - Parent material tJC ZLe✓~ ~J Flood Plain elevayon if applicable A General comments and recarrxr*ndations: ~~S T System Type ~ G~fer System Elevation Boring Boring # E] 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/f ` in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 -Z- -3 Boring # Boring ~Ift Ground surface elev. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f ` in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 n .lo fl Effluent #1 = BOO. > 30 < 220 mg/L and TSS >30 < 1 ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 nxyL CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird /1~ 226900 Address Date Evaluation Co ucted Telephone Number 1432 120th St, New Richmond, WI 5401 f1 715-246-4516 Property Owner _ Parcel ID # Page of 1Z Boring # ❑ Boring , Q Pit Ground surface elev. ft. Depth to limiting factor _ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z- d" r Boring # ❑ Boring F-1 ❑ 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 F Boring # El ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. _ Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 ng/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS 130 mg& 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 (8.6/00) Property Owner _ Parcel ID # Page of 1Z 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 64 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ' )epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 -Eff#2 Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BODS < 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 (RAW) Soil Test Plot Plan Project Name Sue Brandt Shau4B' Address 448 Park LaneHudson Wi 54016 CS #226900 Lot 22 Subdivision Park View Estates Date 6/12/18 NE 1/4 NW 1/4S 17 T 29 N/R19 W Township Hudson ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of septic tank cover System Elevation 95.7/95.6 *HRpSame as Benchmark Scale is F = 40' unless otherwise noted Property Line Y 15' Well Existing 4 Bedroom House 20' 0' 120' 2E12'FaillingDrainfield 10220' Prope rty Line 30' 100' B-1 15 i I 5' 90' 101' 2% Slope B-2 102' B-3 Park Lane