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HomeMy WebLinkAbout040-1269-40-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Safety and Building Division INSPECTION REPORT Sanitary PeGENERAL INFORMATION (ATTACH TO PERMIT) State Plan Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J Permit Holder's Nameity Village Township Parcel Tax TOWN OF D elc~, CST BM Elev: Insp. BM ElevBM DescriptionStioz~ . TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / (fie 2 " f Z P Y C t cZ z Alt. BM Aeration Bldg. Sewer .r• SS- Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L , WELL BLDG. Vent Air Intake ROAD Dt Inlet .7 Septic Dt Bottom Mo , l `7 1-7 L - Dosinp Header/Man. 7 Aeration Dist. Pipe Holding Bot System Y. t~ 7.5 iZ V7 51t Final Grade ill A/ PUMPISIPHON INFORMATION •r ! 4 t, ,g MDemand St cover -~r- GPM .At ' z. ~y Gv Friction Loss System Head TDH Ft Dist to Wel! SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenche_e PIT DIMENSIONS No Of Pits Inside Dia. Liquid Depth DIMENSIONS j '76 X I'e•~ ` SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer INFORMATION L. Type Of System: CHAMBER OR T/1 T,'~ ~lC G` /.Y 7 UNIT Model Number AA- DISTRIBUTION SYSTEM 1 74- 1-7 Header/Manifold i i Distribution x Hole Size Ix Hole Spacing Ven'tq Air I`nt'pKe y t Pipe(s) ~ a!. + 1. Length / • Gia Length Diz Spacing ' r SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded Bed french Center 5 Bed/Trench Edges Topsoil xx Mulched es No "'I yes ~ No COMMENTS: (Include code discrepencies.. persons present, etc.) Inspection #1: Inspection #2: Location: 1, 1.) Alt BM Description = 'ell i 2.) Bldg sewer length 9~z eke, - amount of cover ~7 Li Plan revision Required? L' Yes' / Sr i /Q 0 Use other side for additional information. ! O SBD-6710 (R.3/97) Date Insepctor' gnatu Cert. No. cHd--))t0j-'fo-000 17,dk,H, lqfl 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) located at: /a, '4, Section Town ; ~ ' N, Range W, Town of 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 l Did flow back occur from absorption system? Yes No` (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: Z , & _ Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): Pe umber (if known) (Licensed Plumber Sig4ature) (Print Name) -)(k (Title) (License Number) lm PRS (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 SAIV - 6, - 13 Industry Services Division County 1400 E Washington Ave LWke< P.O. Box 7162 JUN 0 $ Madison, WI 53707- 16 Sanitary Permit Number (to be filled in by Co.) ff K 1 St. State 32- Transaction Number it Applicat' 1 In accordance imion of this form to the appropriate governmental unit A A required prior to obtaining a sanitary permit Note: Application for(irs for bu- to project Address (if different than mailing address) the Department of Safety and Professional Services Personal m1brination you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15. 1 raStats_ l n n n I. lication Information - Pk ase Print All Information J U ~/a ( Ir/ `l Property Owner's Name Parcel # 1~~rrH A A ~E sHA A. BtA-rrEg ~►ss o40.- ► ~-qo _ oov Property owner's Mailing Address Property Location 713 14 1 3i3 ~ }E ~fl~N► o.r~D Govt. Lot City, state _ Zip Code Phone Number 14 ih DS U►v o/ SE S Y., section 17 T Zs N; R i Gt(circlE II. Type of Building (check all that apply) Lot # X1 or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name ❑ Public/Commercial - Describe Use /GiGQs n~,e ~ Block # 7loGy I ov4D ❑ City Of ❑ State Owned - Describe Use CSM Number ❑ Village of 7- e L. w 17+-17 Gv1 Town of Tip y III. Type of Permit: (Check only box on line A. Complete line B if applie bile) A' ❑ New System nne_ Replacement System 11 TreatmentMolding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous PennitNumber and Date Issuued 3 Q Before Expiration owner 4191o4 IV. i;We of POWTS S ore ent/Deviee: Check all that ,WNorPressuized In-Ground [Pressurized In-Ground ❑ At-Grade ❑ Maud > 24 in. of surlable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank other Dnspersal Conpauerd (explain ❑ Pretreatment Device (explain).J~I~~r a► V. Dis VI'rea t Area Info rmation: u Design ~Fkrw (gpd) Design Soil Application DispeWUmts isposal Area sf) System HSD d YI. Tank Lfo Capxity in Manufacturer Gallons c 2 1911 New Tula Talcs 3; 1 m U COD FeYTT X VFE II. Responsibility Statement- I, the eaderstwd, rtsponsibitity for installation of the POWTS sbwm ore the attached plans Plumber's Name (Print) P! igmatue *V/MPRS Number Business Phone Number Z-71b 171 Plumber's Address (street, City state, zip code) - 7/ r KqL-, 7z 7 70AME 'Ki Ua/ N -FALLS/ va~ 5' U1 VIII Coca t use Approved Permit QF.ee~ /Date) Issuing t Signature en Reason for Denial $ f " (p / IIt. Coed' # as r, s• 1. ark,: tun: tittor. n i 3) a .~.1C. Lc~r, Gc..V%r f Nl. ( vr~ re tihspertsk cell must all be stvfc:as +s nt ec as per 71ar.3yerttent plan o'u iidetl wv Niwnbe • re 2 L) ee><( C4n N f. <A A$:tlralt rei~urgtlen:5 rn~rylbt: ~ .a,M,irt:~: so of 111"k0h C46f 1 0114431100. / rat. 01 Atrxh to eompteye pig= for the sysr® ands to the C ..0 e.ty m pop,. sloe te,. d-r 1,7 z r in sir pryd47 .2- . 1 SBD-6398 (R- 08/14) e~-tK- / Plot Plan Page Z- of PROPERTY OWNER: - ~1L ^ rT=A t ~.ss 1° 40 FT. (except where noted) Legal Description: -Z I-4 S, T&Oy 1N oOD' ~C~ , Lo C 5cVy OF backhoe pit -rHC- 5y"1%Lf S--. #7 7zg1~i -,R ~otAIA) OF -rKbV CZ~tx CflL4 Ar i 4 W isC`a t S iN OLfo -1z-t-r1 Z 10 bOb j Ct~~ f}C ~S 1~11 3 DAY F;kgjv~ 9LAD orth ~ r ~ ~C\STIAt6 ~ r~~J.'~~o TER t E ~ 4 \V' pY• :t K r .i J i. Site location sst=7 ' U ~T L `sue AY eeu y x \ cao~u H tit PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manus Design Reifs wms: Version 2.0, SBD-10705-P (N.01101, R. 10/12) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross-Section & Plan View Pg 4 of 4 Management Plan Attachments: Enclosures: _T-v F► Tom -We-5 POWT'S Application for Review Soil Evaluation Report & Site Ma '',QEVt0U-1S FPAeE w w FIL1= ukjAwwr~ DEED S~Prtc ._fA fl Rya 4 F-A,' I Project Name I Description Owner Name(s): _)4a- A,~-AtE~Sft-A A. I t Ccm 1^A--,5 Phone: q5z - gs6 - zil Owner Address: N3 Day AKIA RD,, u Asp V Zip: I& Project Address: (SA mE ) GovL Lot: S~ 1 /4 of . U 1/4, Section i - , T z 8 N-RI cl E F] or W Township: _ V County: Sr cP-01x Project Parcel ID 0 Lq C) 1 ZwC1- `iC._ 00 0 Designer Information Designer Name: 46AKV J -E-ru0e0ZT Phone: W - z,~ -L'_?5- Designer Address: 28L197 KI V& katitkRs C+-. wx Zip: 6%*5D E-mail: h 011 t'sfe-yA estun r ou+f yoK . c46#^ A This sp se ~ g t stamp. License Number: 1859 - o©7 s,,..•.,._,.•°~ r Remarks:. MARY J®''• Hu Pc 3 A 1859 ~01WIg F1~1.l.Sy, aW1 tio N Signature: 1~4atz& lo Date: 5 Z f1l I P, sig i* each subnmlW copy. Plot Plan PWe -of 1 PROPERTY OWNER:_ A. ~1~ i o Ru- -r~,e mss 1° = 40 FT. (except where noted) Legal Description: L d 5,, hF OK W 00D{ &L. c.oce."Ef) 1,V T+f 6 5c/y W backhoe pit -t-H,e SO Z4► 5 + 7 TZgnly 7Z n I6 -rbLJA) D F -KOY~ i5 Ci l)k eOkAI ry W Ls0I)AJ5 )N OvD -l it ~n bOD f • Cfq,9 A CWES 3 13 DRY F.AKM ROAD ~ orth f~ ~ 3 x LgTIZ'FlJ~~~ ' roD: C a r lerl\STtN6 Ez~~ OO 4P %6 101D' Nj i Site location: Sri o~C gyp. 0 FJtST G ' F Li ~ c ncu ,pv ~ N ~ u Ro. A = PAGE 3 OF 4 U o w wW~ m ~ > V ~~d co m UgZ 11 > a CL o F... o c -p C C7 C > 0 11 V i CL m 22 Q ZEES _ ~c~ E y - = t11 0 8 I n/ T$ Jo Q ZZ atly w cc 11 JUN II N Q a W o ICI l a t/} N Ar, w . ~ n t c E rr ° i° co c I N N r o m w n W M I I r ~ 0 4) tJ U- CL Co = w a. ° I I m Lu Cl) E I I I I ntj N ~ I V nI v I II M ~N 11 X m a m C o AL in "17 N ( i a w a o _ w n I O = Cv I I Z o a~ Z N N E W a w co) i IL CL 0~~ w ~Vc~ I C I d C v~ c n I w `s x 0.0 V CO 1 Z> d L. _,r I JQ ° Q E - E .102 C D 2534224 DAVID LENTL Pagc 2 5/$/2U 1 S The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of May 2020. This approval supersedes the approval issued on 11/11/2014 under product file number 20120137. This approval is contingent upon compliance with the following stipulation(s): ® This product must be installed in accordance with the manufacturer's printed instructions, product approval, and plan approval. It there is a conflict between the manufacturer's instructions and the product approval and/or plan approval, the product approval and/or plan approval will take precedence. When this product is installed in a dispersal cell that is sized based on the EISA rating stated in the regarding block of the product approval letter, this product must receive wastewater having a BOD5 value less than or equal to 220 mg/L, a TSS value less than or equal to 150 mg/L and a FOG value less than or equal to 30 mg/I- on a monthly average. When this product is installed in a distribution cell that is sized based on the EISA rating stated in the regarding block of the product approval letter, this product must be installed in individual excavations that create a row of chambers that are horizontally separated from other rows in other excavations by at least 3 feet. The 3-foot measurement is measured between the closest outside edges of the leaching chambers. When this product is installed in a distribution cell that is sized based on the EISA rating stated in the regarding block of the product approval fetter, the distribution cell design must allow at feast six inches of ponding in the chambers without backflow of wastewater into the drainpipe that discharges into the chambers. When this product is installed in a distribution cell that is sized based on the EISA rating stated in the regarding block of the product approval letter, this product must be installed in a distribution system, which has the top of the distribution cell at or below original grade. ® When this product is installed with geotextile fabric on the sides of this product in a distribution cell that is sized based on the EISA rating stated in the regarding block of the product approval letter, the EISA rating with fabric must be used to size the system. When this product is installed next to each other in a distribution cell that is NOT sized based on the EISA rating stated in the regarding block of the product approval letter, the effluent distribution area is equal to the length times the width of the chambered area. The use of geotextile fabric in this type of installation is optional. * When this product is installed with geotextile fabric on the sides of this product in a distribution cell that is sized based on the EISA rating stated in the regarding block of the product approval letter, the geotextile fabric must meet all of the following specifications Geotextile shall be non-woven Weight shall be 0.35 oz/sq yd to 1.5 oz/sq y6 Apparent opening size (AOS) shall be 20-30 For mound designs, see the manufacturer's propriety mound component manual for this product line- 0 For mound designs, see the manufacturer's propriety mound component manual for this product line. boc y 7o 1 1 TROY WOOD N LOCATED IN THE NW1/4 OF THE SW1/4, THE NE7/4 OF THE SW1/4, THE SW7/4 OF THE SW1/4, AND THE SE1/4 OF THE SW1/4 OF SECTION 17, AND THE NE1/4 OF THE NW7/4 OF SECTION 20, ALL IN T28N, R1 9W, TOWN OF TROY, ST. CRIOX COUNTY, WISCONSIN N1M CORNER NJfi~PhJil41TDD _dry\gpp ~j 8EC710N 17 <~e oee7at~opnoyr[~aa 1ggql~ ~ EAST_COVE_ ROAD _ _ _ _ _ _ SECTION 7R EAST-WEST OUA/DE UNE SEC. 17 - _ _ - _ - - - - _ - _ LL - - - _ - _ - _ - - _ _ _ _ _ _ _ _ _ J N B 9 ° 4"7' E J1 _ -N 88.48'OT E 7601.90' p , _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - x - - - _ _ _ _ _ ~ - - ~ / I ~ 3778.11' - _ _ _ Bv~tlma - - - - _ - - - r g I ~ SURVEYOR: 102 W DOUGLAS LAND SURVEYING 1 I I I I I T - - 2920 ENLOE STREET I SUITE 101 I HUDSON, WI 64016 PREPARED FOR: i-------------- i I I I 0 9 I RJw2 p~ V_ I S NUMSI LAND CORP. I I I ; Cy.~,Ull. U_p._I m A]. P(& 695 I Z S332 UITE MINNESOTA STREET - SUR- E E14O4 G - I II i SAINT PAUL MN. 66101 0 IN ~ I W LI I 1 I i 1+/ I 1 1\ I I D ~ I I I \ 1 2 I O 10.09 ACRES j IO 439.404 SO. FT. I I \ I ` 1 ew~orvwurommR OAF nae un I . ` ! ~ e m°Bi.neo I A.OO'V 9 Off G~'.S;S.09. I 1 I I 1 ~1 \ ; 00.7 P'/_IXI94 D®_mE(0 ll 1 J ,1 \ 1 I 0 1 1 1\ 1 S 1 \ \ ~F 4B 1 \ >f 6;48' 1482'33ro0'E 685.88• ,nAE 1 iL61 ACRES \ 1 ` r--- \ \ I /.BD ACRES 86.986 80. FT. d \ \ 1 1 \ \ 1 1 I E \ ~ \ ~ 1 * 1 \ \69,683 80. FTi I I m U1 1 61 \ I ~ 1 i ~ ~ ~ 9 \ 3 ) 1.69 ACRES\\ 4+ \ - p \ \ 10.37 ACRES 73.7 1 77 80.'FT.\\ ; p F 4 \ o \ 461,908 80. FT. 201 DRNNAOE EASEMENT 7. ACRES CC 50.971 80. FT. !1 0 _ _ ' $ ul iY CENTER A TEMPORARY CUL DE-SAC 18 BBT498{'W SOUTFIREASST T TOE SOUTH CORNER OF \ ( \ 1.87 ACRES / YYY/ 1 1 44 81,460 80. Fr. `may ~ j I LOT„ 12 2.00 ACRES 11•~ W 4 97.083 so. Fr. 'D 1 $ i~ ?s \ .77 ACRES Y- ''a `J 1 I ~i - 3 ~~@p 9O 77.27480 . FT.~ n\ \ ` 'O ` II I I / $ - .L°J1f _ 1 11 CJ' Y Y~20• DRAINAGE ♦ ' / ,6 . \ 1.96 ACRES ,.I. 86,133 SO. FT. EASEMENT I g I 0 43 \ . ' \ 5 \ I 13 iii a~D eni \ 1.99 ACRES \ \ 1 I 2.OO ACR- III 1 ~I ~ \ \ / /1 I I 87.027 SO. FT. II alpp; 86.641 80. FT. \ y\, , I# / ~ \ \ 20' DRAIY"E FA~gEM ~ ~ ~~b,. ~ ,o X05 / / \ \ f -cRO 14 e C19 I OUTLOT 3 of wft 76 \ 15 I * w; * \ SEE SHEET 3 I IZ-2a-oo \ \ SCALE IN FEET 1' _ , 00' loo 0 100 200 TH5 NSTRUMEM URAFI'EU BV : WIUJM/ KNJE JOB NU. 0~ PATE: 10/16,00 RtVLSED: ,2/15A0 SHEET 2 OF 5 SHEETS . 1 sr-CROIXCOUNW SEPTIC TANK MADITEN,ANCE AGREEMENT AND OVINE SW CERTIFICATION FORAM JUN 01 2018 F17 F1 A A t~544A ~ T-~455 r~ St. Croix County Maili>}g Addrm 31.3 afl opment TEA - Property Addrm SOME (V~m iex~ired #kom ~ g ~nr >st':sv eoma~lroctioe. Ciwstate +4 u bsa y PWW -r--~ Idmwfication Number oyp.- ! ya--oo C? kw L DMC'Q3 -Mm Propaty Locabo n sc V'--9-0 V4 , Sec_ 17 - T Zg N R 1 j W, Town of 7 C~ Stebdividw Plat_ TICS LN oa Lti Ctrfiftd 5~trvaa► MaP # _ Lot # 5 - volume page # Waurrmty Dud # (before 2007)Vokme Page # ~ h=MDY%);f%q lot fiaee;daadfi We 1mp~n~per use and m OgyO~ ooul~i reQait is its pte~ ~e to Itamdie WmIWIMOm aoaaism r eat the =piic tamlr Paoper the otm cm &a fmckm meat a~tbe O*bc twat s dawyam or if °°°d°~ by &$ccseed pamper wh tit Pat min k6w am Vmificd is WS- 3833~1) and in ~ in ffia t ..X mot 12 ' SL Goy Sammy Otdi, "iO Psc+perg► °wna ages to sn6mit b St Croix a =mom plnasber, p~ pir a DpaMNt: o,o,a %In~ shned by So WOM Jess thm w ~ :d is in proper ° asd~or (Z) aver y l do saptw, tmk is sbwAmr& stet by *a &c aqakOWAM* Y Asd aAd apse to suitsift ~e pcivale sa*rage d ryslan wig ~e Sufi of Wiat~oet6s Seroictt Jed tba t^,oRafty Mamas & Zcoig ~a 3300 da m" be aoe and ro b~ c pwpany da m*W above, by vmr of ~ iewf&d t>e. ° Y"M Wow 'e ownsts) aafie lVoliCr of ieirtrst~s ~T SIGNATURE tV APPL (S) S l 2~! zDt 8 DATE '**Any nfb mrtior! Batt is mirmpemood =y MMO is &0 nmtwy Pcit bra ny.W by the J'iaeaqgk Tmeng D"Wraeat voce is ~rde ift at wwrAoty 4"d deed how ibe 7taVeger,ofDcads oftTioe mod a eggr ~tbe eertdiod =W if (MY- 44M) i and Professional Services SOIL EVALUATION REPORT Page 1 of 2 JUN d 1 201$ in accordance with SPS 383, Wis. Adm. Code County ST. CROIX i Attach~Ipn on r not less than 8 1/2 x 11 inches in size. Plan must inclu~; Br.(t' %J"`*~~tti I and horizontal reference point (BM), direction and Parcel I.D. 040 - 1269 - 40 -000 imensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location KEITH A. & ALESHA A. BUTTERFASS Govt. Lot SE 1/4 SW 1/4 9 17 T 28 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 313 Day Farm Road 5 Troy Wood City State Zip Code Phone Number []City rIVillage Town Nearest Road Hudson, WI 54016 ( 952) 456 - 2114 Day Farm Road Troy New Construction User Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material sandy Flood Plain elevation if applicable NA ft. General comments Conventional In-ground trenches 0.7 loading rate diverter to be added. and recommendations: Pit conducted to verify soil conditions in replacement area. Boring # Ll Boring _ El pit Ground surface elev. 95.41 ft. Depth to limiting factor >96 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 1 0-18 10YR2/2 sil 3fa&sbk mvfr cs 2vf-co 0.6 0.8 2 18-30 10YR3/3 sil 2fabk mfr cs lvf-m 0.6 0.8 3 30-36 7.5YR3/4 A 2fsbk mvfr cs lvf--f 0.6 1-0 4 36-80 7.5YR3/4 s Os dl cs 0.7 1.6 5 80-96 7.5YR4/4 s Osg dl 0.7 1.6 LL 1< F21 Boring # ❑ Boring 0 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/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh_ *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 CST Name (Please Print) Signat CST Number MARY JO HUPPERT Hollister's Soil Testin &Desi n ` / ~ 224832 Address Date Evaluatiducted Telephone Number 28497 King Arthur's Court, Danbury, WI 54830 05 - 03, 2018 715-426-1775 SBD-8330 (R07/ 13) ~„fie y~ ~ ~ . ~ ~ ~ ~ ~ J x Kam' ~ ~ z r A w y~ ~C t z': } 1 Jew" K A 7°'~+mdJls~ V'o K h i r II e „j 5 war'-`~ 'tP' C 1 . a uSyc Wiscons* Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453104 0 GENERAL INFORMATION (A1~TACH 1`O PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Dryer, Vince Troy Township 040-1269-40-000 CST BM Elev: Insp. BM Elev: BM Description: SectionfTown/Range/Map No: 8 .-0 v & ak S 17.28.19.1481 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic f7J' ~tJ 0 D Be ,''v~Co✓ l "I 44 Dosing A Alt. BM (If Aeration Bldg. Sewer 3039 3,0y 12-36, Holding (S pt inlet -343 9L (o,( TANK SETBACK INFORMATION Ht Outlet q. O `j j . L j TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' > ' 7 / Dt Bottom Dosing > Lax Header/Man. std Aeration DEC Pipe IZ,~~ 17• ~f I~ Holding Bot. System 13 13 4 o td~' 7 / 0 A PUMP/SIPHON INFORMATION Final Grade Manufacturer De Mand St (royEr IF 2 I/( q e J ~ Model Number ITDH Lift Friction Loss Head TDH Ft I ~F` 8~ r Forcemain Lengt Dia. Dlst. to weu SOIL ABSORPTION SYSTEM BED/TRENCH Width Leng No. Of Trenches PIT DIMENSION No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREA LEACHING Ma rer r INFORMATION CHAMBER 0 Type Of System: f / , Model u er. DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size Ix 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 Seeded/Sodded xx Mulched Depth Over Depth Over xx Depth of r Bed/Trench Center Bed/Trench Edges Topsoil Yes =i No //Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: fo Y Inspection #2:'4/I , '41, Zo9 Location: 313 Day Farm Rd Unknown (Unknown 17 T28N R19W) Troywood Lot 5 Parcel No: 17.28.19.1481 1.) Alt BM Description '•7~~ 2.) Bldg sewer length - amount of cover = `ij~e pl ty„ R wa dam' i Plan revision Required? Y ~':i No Use other side for additioi ation. _ - - - - _ _j it, 11 r's Sign~a~u)re~ c~p_ - -e~ Ce No. SBD-6710 (R.3/97) ~A• ~~/O r~ ate r ~ ~ _,~G/r''' Insepdo sk ..r•'T''~ Ill r - - 1323 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings in accordarice with Comm 85, Wis Adm Code Gustum Septic Service Attach complete site plan on County p paper not less than 8'/: x 11 inches in size. Plan must St. CfODr include, but not limited to: vertical and horizontal reference pant (BM), direction and - percent slope, scale or dimensions, norlh~uarI S(h r distance to nearest road. Parcel I.D. pending Please p " • ~nred P ersonal Information you provide biz for secondOyurposes (P:y s. 104 (1) (m)). ehric 7 Property Owner Property Location Humbird Land Corporation_ Govt. Lot n/a 19 SW 1/4 S 17 T 28 NR 19 W Property Owners Mailing Add Lot # Block # Subd. Name or CSfu # 332 Minnesota Street, East 148 - y0ix 5 Troy Wood Subdivision CRY Zip CodA%1Number J City J Village r Town Nearest Road Saint Paul zz V1 N, , 5F: -22 %'a51o1 b~51-22 565( Troy E Cove Rd./ Day Farm Road tv_l New Constriction Use: e R' , W hN rooms 3 Code derided design flow rate 450 GPD J Replacement J Public or OOfrnYle( 61- Describe: - - - - 6-0 Parerd material outwash plains Flood plain elevation, if applicable n/a General commerts - - - - and recommendations: Part of 1.99 acres. BM #1=100.0'. BM #2=89.0'. Recommend system elevation 88.2'. P40 and P41 from preliminary boring work done 5-"0. P40 Boring # Boring d PR Ground Surface slay 100.3 ft. Depth to limiting factor >75--_ in. W Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/11: -'Eff#1 -002 1 0-10 10yr3/2 none sil 2msbk mvfr as 1f 0.5 0.8 2 10-19 10yr4/4 none sil 2msbk mvfr cw 1 f 0.5 0.8 3 19-30 10yr4/6 none Is 1 msbk myth cvv - 0.7 1.2 4 30-75 10yr5/6, 4/4 none Is 1 msbk mvfr - - 0.7 1.2 P41 Boring # I Boring -e Pit Ground Surface elev. 92.1 ft. Depth to limiting factor >75 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fr 'Eff#2 1 0-10 10yr2/2 none sil 2msbk mvfr as 1f 0.5 0.8 2 10-21 10yr312 none sil 2msbk mvfr cw 1f 0.5 0.8 3 21-30 10yr3/4 none gr. sil 2msbk mvfr cw - 0.5 0.8 4 30-52 7.5yr4/6 none gr.sl 2msbk mvfr cw - 0.5 0.9 5 52-75 10yr5/6 none gr. Is 0 sg ml - - 0.7 1.2 ' Effluent #1 = BOD 30 < 220 mQ& and TSS >30 < 150 rrg1L ' Effluent #2 = BOD <30 mmglL and TSS <.,30 mg/L CST Name (Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St., New Auburn, WI 54757 11/15100 715-658-1344 Property Owner Humbird Land Corporation Parcel ID # e d!99 - - Page _ 2 of 3 F-1 I Boring # - I Boring Ad Pit Ground Surface elev. 90.8 ft. Depth to limiting factor _ _>72 in. Sod AWkafion Rate Horizon Depth Dominant Color Redox Des-a p Texture shwil a Consistence Boundary Roots GPWR*_ - _ "Eff#1 -Eft#l2 1 0-12 1Oyr2/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 12-16 10yr3/4 none sit 2msbk mvfr Cw if 0.5 0.8 3 16-2 7.5yr4/4 none gr. Is 1 msbk mvfr Cw - 0.7 1.2 4 21-31 7.5yr4/6 none 1 sbk 7 m* Ow 0.7 1.2 5 31-57 10yr5/6 none s 0 sg ml Cw - 0.7 1.2 6 57-72 1Oyr5/4 none s .0 sg ml - - 0.7 1.2 - TV, 2 3 2 -7 2 ] Boring # J Boring Id Pit Ground surface elev. - 90.0 fL Depth to limiting factor _ >72 _ in. Rate Sod Appkalion Horizon Depth Dominant Color Redox Description Texture Sbuctuie Consistence Boundary Roots GPM -Eff#1 'Eff#2 1 0-16 10yf2/2 none sil 2msbk mvfr as 2f 0.5 0.8 2 16-2 1Oyr4/4 none sil 2msbk mvfr Cw 1f 0.5 0.8 3 24-30 7.5yr4/6 none gr.sl 2msbk mvfr Cw 0.9 4 30-49 1Oyr4/6 none s Osg MI Cw - 0.7 1.2 5 49-72 1Oyr5/6 none s 0 sg ml - - 0.7 1.2 - i i F3 Boring # -j Boring 1d Pd Ground surface elev. _91,3 ft. Depth to limiting factor >75 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft= 'Eff#1 -Eff#f2 1 0-14 1Oyr2/2 none sil 2msbk mvfr as 2f 0.5 0.8 2 14-27 10yr4/4 none gr. sil 2msbk mvfr Cw if 0.5 0.8 3 27-34 7.5yr4/4 none gr.sl 2msbk mvfr Cw - 0.5 0.9 i 4 34-53 7.5yr4/6 none gr. Is 1 msbk mvtr Cw - 0.7 1.2 5 53-75 1 OYr5/4 none is 1 msbk mvfr - - 0.7 1.2 0- r7 ..Q~.- Effluent #1 = SOD 30 < 220 mg/L and TSS >30 < 150 ag/L - Effluent #2 = BOD5 S.30 mg/L and TSS <.,30 mg/L The Depamnent 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 departrnent at 608-266-3151 or TTY 608-264-8777. I LL- Ca O Ln .~°JJ 0 a a- M -.tiyJ 7 --J O- per.. v aO cr ~I tf Q m ~ CD I E 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 foll mg r side c (Street address) / 3 t ~located at: S C 1/4, S ~ 1/4, Sectio Town ' N, Range W, Town of , St. Croix County Wisconsin. Upon inspection, 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 Did flow back occur from absorption system? Yes No~ (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: /60b Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): PeYT4 number (if known) (Licensed Plumber Sig ature) (Print Name) /r rl& 4 r & , q 7V /I (Title) (License Number) MP/MPRS (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