HomeMy WebLinkAbout020-1049-90-200 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 605071
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:
Scott & Kim Jonas TOWN OF HUDSON 020-1049-90-200
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
"tS Me,vAvA-- P,,,-1f 20.29.19.1928-20
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic t_ v~ Benchma i r~ ~
L. C~
k -N Lo tIL~! C o b~~ C ~ I ~P c(L `1 ~ .
Dosing Alt. BM 1
Aeration Bldg. Sewer /
2
Holding St/Ht Inlet
St/ Lit Outlet
TANK SETBACK INFORMATION o % _ -
_ cc
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Header/Man.
Dosing 30 (s2
Aeration Dist. Pipe
Holding Bot. System
I
PUMP/SIPHON INFORMATION Fi nalGrade Lj .~fO
Manufac rer Demand St Cover
G
Model Number
1
TDH Lift Fross System Head TDH Ft
Forcemai Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS J
SETBACK SYSTEM TO P/L BLDG WELL KE/STREAM LEACHING Manufacturer:
INFORMATION Type Of System: CHAMBER OR
f j UNIT Model Number:
DISTRIBUTION SYSTEM
Header/Manifold Distribution ray x Hole Size ix Hole Spacing Vent to Air Intake
Pipe(s) 1. C) -A-)~
Length d Dia L Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded 1xx Mulched-
----Bed/Trench Center Bed/Trench Edges Topsoil
❑ Yes ❑ No ❑ Yes ❑ No
1..1
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 423 CTY RD A
1.) Alt BM Description ^ 0
~ s 1.~..~
2.) Bldg sewer length=
- amount of cover = lll///
Plan revision Required? ❑ Yes ❑ No
Use other side for additional information. C
Date Insepctor's Signat re Cert. No.
SBD-6710 (R.3/97)
17
y~oFx""T r~ I Industry Services Divisi County
12+1710 E a 1 f QQ as iiieon Ave
/ JUL O ~Ow P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
/
Madison, WI 6370,
County Ent 162 ~-5 07/
~ ~ ~ ~,r. Croix
_ IG m
9 G - State Tran ion Number
unitary Permit Application
In accordance with SPS 383.21(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 Project ddress (if different than mailing addres
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
/f~3 ~J* _ _
purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. 7 ~Y
1. Application Information - Please Print All Informatio
Property Owner's Name Parcel #
-Iati~,9
Property Owner's Mailing Address Property Location
Govt. Lot J II-~~
City, State Zip Code Phone Number NZLAjy,, Section G✓ l./
1^i , circle o
V T L_- rI R E
II. T of Building check all that a Lot #
Type ( PP ` S
~ , ubdi ' ionNa
me
r 2 Family Dwelling-Number of Bedr
❑ Public/Commercial - Describe Use w c~ ❑ City of
El State Owned - Describe Use CSM Number El Village of
t .S~ fr~~r _ ~Tpwn of L ILZN~.J
-1 A III. Type of Permit: (Check line A. Complete line B if applicable)
A. ❑ New Syste ement System Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B• ❑ Permit Renewal 11 Permit Revision ❑ Change of Plumber El Permit Transfer to New Lis Previous Permit Number and Date Issued Before Expiration Owner
1 CL4
Corn onent/Device: Check all that apply)
4Ljgn In-Ground Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
Ho mg Tank Other Dispersal Component (ex lain)-- ❑ Pretreatment Device (explain)
V. Dis ersal/Trea ent Area Information:
Design Flow (gpd) Design Soil Application te(gpdsf) Disper al Area Required (sf) Dispersal Area Plevation S/ Yl
VI. Tank Info Capacity in Total # of Manufacturer ,
Gallons Gallons Units t7~, /`Q a o
New Tanks Existing Tanks IJJ/~~ ~c~ Qn R
W ~IK/ a U in ~ rn w C7 n.
Septic or Holding Tank 3 l1~~44 /1
Dosing Chamber
VII. Responsibility Statement- I, the undersign ssume responsibility for installation of the POWTS shown on the attached plans.
P~n is Name (Print) PI is Signature MP/MPRS Number Business Phone Number
6;
Plumber's Address (Street, J:~De,gV o-
III. oun /De artment Use Only
Approved pp;oy ed Permit Fee Date I ued Issuin ent Signature
venReason for Denial $
IX. Condit p easons for Disapproval
1. 'Zopt!a tank, vf1u6n: lilte- ensi
(imper-n cell must all be s~ctc; s 7nta'r ec
so per maragement plait pro iidieh by plumber.
N per ippawt s c6* ! aMirt mes.
Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x 11 inches in size
SBD-6398 (R. 08/14)
System PLOT PLAN
PROJECT Kim Jonas ADDRESS 423 Ctv Rd A Hudson Wi 54016
SE 1/4 NW 1/4S 20 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX
SYSTEM ELEVATION 91.0' 5' below grade 6/30/18 3
DATE BEDROOM
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1280 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 645 # of chambers 32
BENCHMARK V.R.P. Top of ST Manhole ASSUME ELEVATION 96.0' Filter Lifetime Filter
❑ BOREHOLE O WELL -H.R.P. same as benchmark
Cty Rd A Scale = 1/4" = 10'
15' B-4
25' 90' 2% Slope B-3
40' 1-3'X 130' cell
30'
EL Valve
B-1 100'
B-2
60'
M.*
S
18'
10'
Existing 3
_ Bedroom Vent
House
>6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
5.6f A2/pair of end caps
12"
4' Long
Grade at System Elevation
34"
i All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 6/30/18
Owner:Kim Jonas
Location: SE1/4 NW1/4 S 20 T29N,R19W 423 Cty Rd A Hudson
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cro4 Section
4. 6. Maintance Contigency Plan
7. Existing Sept ank for
Signature
License n er #226900
System PLOT PLAN
PROJECT Kim Jonas ADDRESS 423 Ctv Rd A Hudson Wi 54016
SE 1/4 NW 1/4S 20 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX
SYSTEM ELEVATION 91.0'5' below grade DATE 6/30/18 BEDROOM 3
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1280 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 645 # of chambers 32
BENCHMARK V.R.P. Top of ST Manhole ASSUME ELEVATION 96.0' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
Cty Rd A Scale = 1/4" = 10'
AL AL
15' B-4
25' 90' % Slope B-3
40' 1-3' X 130' cell
30'
EL Valve
B-1 100'
B-2
60'
M.*
S
18'
- 10'
r--
i tc A4-, Existing 3
Bedroom Vent
House
>6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
5.6ft^2/pair of end caps
4' Long 12
Grade at System Elevation
34"
- - All-piping shall-be-ASTM SDR 30/34,-"within
10' of tank, piping shall be ASTM F891
Cross Section of Quick 4 Standard-W Leaching Chamber
Typical cross section for 1 of 1 cells.
Quick 4 Standard Intial Grade Elevation
96
Leaching Chamber
To be >1 above grade g
with 20.0 ft2 of Area per
Chamber 5.6ft^2 pair of Finish grade elevation
end plates
- Typical Installation
Rven Grade
4
From SepticTank
4' 34Grade at System Elevation
1-3' X 130' Cell
Same on other end Observation tubeNent
Located at end of cell
A
32 chambers per cell
System elevations:
A-9 1. 0'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
'FILE INFORMATION SYSTEM SPECIFICATIONS
Owner r✓l-,j Septic Tank Capacity al O NA
Permit # Septic Tank Manufacturer ❑ NA
3ESIGN PARAMETERS Effluent Filter Manufacturer 0 NA
Number of Bedrooms O NA Effluent Filter Model 0 NA
Number of Public Facility Units A- VA Pump Tank Capacity al ❑ NA
Estimated flow (average) _11 aUda Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) j o aVda Pump Manufacturer NA
Soil Application Rate avda /ff Pump Model NA
i Standard Influent/Effluent Quality Monthly average` Pretreatment Unit NA
Fats, Oil & Grease (FOG) 530 mg/L 0 Sand/Gravel Filter 0 Peat Filter
Biochemical Oxygen Demand (BOD5) 120 mg/L ❑ NA 0 Mechanical Aeration 0 Wetland
Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODs) 530 mg/L 0 in-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L 11-PLEA ❑ At-Grade ❑ Mound
Fecal ColifbrTn (geometric mean) 5104 cfu/100ml ❑ Drip-Line 0 Other:
Maximum Effluent Particle Size Ya in dia. ❑ NA Other. ❑ NA
IOther. NA Other: ❑ NA
`Values typical for domestic wastewater and septic tank effluent Other ❑ NA
MAINTENANCE SCHEDULE
_ Service Event Service Frequency
(inspect condition of tank(s) At least once every: f] month(s) (Maximum 3 years) ❑ NA
~..~fB, ear s
(Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume 0 NA
ry~ D ear(s) month(s) (Maximum 3 years) ❑ NA
!inspect dispersal cell(s) At least once eve
Mean effluent filter At least once every: t month(s) ❑ NA
ear(s)
! ns ect pump, pump controls & alarm At least once everY El month(s) NA
P ❑ year(s)
19ush laterals and pressure test At least once every: ❑ month(s) NA
❑ year(s)
Other. At least once every: CJ month(s) NA
❑ year(s)
tither:
D A.
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
!include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of
combined 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
I-egulatory 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
lbe tank shall be removed by a Septage Servicing operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
INI 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 10 days of completion of any service event.
I
I
I
~I
page of
START UP AND OPERATION acts or other chemicals ttu}t
For new constr ution, prior to use of the POWTS check treatment tank(s) for the presence of painting detected have the contents of i*t
may impede the treatment process and/or damage the .dispersal cell(s). If high concentrations thO
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 by
discharged the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of eftluenlr
To avoid this s situation have the contents of the prune tank removed by a Septage Servicing Operator prior to restoring power to ft
the pump controls to restore normal levels
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating
within the pump tank.
Do not drive or park yehicles over tanks and dispersal cells. Do not drive or park over, or oth erwise 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 improve the perforrnance and prolong the fife of the POWTS,
condoms; cotton swabs; degreasers; dental floss; diapers; disiribdants; fat; foundation drakn
antibiotics; baby wipes; cigarette butts:
(sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting produc k1s;
pesticides; sankm 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 propeliy
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 Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS falls and Cannot be repaired the following measures have been, or must be taken, to provide a code compliiont
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systeim.
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 need
for a new soil and site evaluation to establish a suitable r'eplac'ement area. Replacement systems must comply with the rules in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a
t holding tank may be installed as a last resort to replace the failed POWTS.
'The 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 installed) 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 biornat at the infiltrative
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 TAN UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name,,,, Name . cU~ .
Phone Phone -7
SEPTAGE SERVICING OPERATOR (BUMPER) LOCAL REGULATORY AUTHORITY
Name Tv
Name
rr
_!5~
Phone r0- Phone - }
This doamws t was drafted in compliance with chapter SPS 383.22(2Kb)(1)(d)&(~ and 35IWI), (2) & (3), Wisconsin AdminWast ve Code.
ST. CROIX COUNTY
CFI`'SIF'IC ZONING OFFICE
FOR UTILIZATION CATION STATEMENT
AN EXISTING SEPTIC TANK
't'lri.s is to ce-rt'-fY that
, Y that z have
:=c~r. v '
1 ng the inspected the se
Ptic tank present.1Y
Section - residence lacatec <t.:
, T~-L.N`'
R °w)
the tank Upon inspection,
and baffles to I certify that
t~unctionin be in good I have fc~~lr~c~
9 p roperlyo condition, and it
appears tc~ he
i..,c3St time sere'
Iced:
Y
1?id flow back
occur irozn absorption system?
(If no, skip next
Approximate volume or length of time;
.'apacity: /)&O gallons
Construction: Prefab Concrete
rl._►act--- Steel Other-
"If (If known
Tank
(It known)
/iginature)
'Tr LL-4 (Name? Please rint`-
- (L.iae
Nwnber)
f'orln to be C~tn
Statutes pleted by licensed
Code) } or Licensed Dis Plumber
poser (NR 113 wisconsin~Administrative
}'lumber (applying for sanitary permit) certification:
condition g the above statement re
cunform t , I certify that the tank to garding existing septic t~an)c
pect ' an the requirements of ILHR he best of my knowledge w.i 7.1
i r75 openi
over outlet ba Wis. Adm. Code (except
ance for.
(C~ /
Sign a
MP1MPRS4j7,e " ~
ST. CROIX COUNTY
SEPTIC TANK. MAI TENANCE t'~GREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address _ 1 < r
Property AddressG~
(verification required from Planning & toning Department for new construction.)
City/State
Parcel Identification Nur:,lber
=r
LEGAL DESCRIPTION
Property Location.5 E' 1/4 , '><l,~ 1/4 , S ec. L C) , T _N RL - W, Town of
Subdivision ~~11r-1
Lot # Certified Survey Map # _ t , Volume Page #
Warranty Deed # Volume C7/_ Page #
Spec house yes no Lot liner: identifiable s 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, ii' 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 inspec.ion 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 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.
1/we certify that all statements on is form are true to the best of my/ouu k nowledge. I/we anJare the owner(s) of the
property described above, by virtue of a anty deed recorded in Register of Deeds Office.
Numb of bedrooms-
SI A E OF APPLICANT(S) DATE
***Any information that is inisrepresented may result in the sanitary permit being riwoked by the Planning & Zoning Department. x*
Include with this application a recorded warranty deed front the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
Sti,3Wn Birdie,
Birdie Piurnblri,
sbl,rd@floatf rn t,net
Jul"! 29, 201
Dear Shawn,
Ibis letter is to confirm that our home is a three bedroom modified two story, our b3svire +t is
not coo)plete. Please see the appralsat ;jtttisthod completed h„oaay 7 of 2103 showing our home,
w4~ h we 3 bedrooms, 2.5 baths :err 213+1 square fact of gross living. ywc} have not finishcr# any
tithe( p,3rt of our h aa)o since the potchase in 1arnw of 2003:
Please let me know if you tweed arvythin else. l appreciate the time you took t camt! out today
and quote a .ran installing a new drainage system. I took forward to working wtmt'h You and will
b.p horne Ox, days of the nstalL
Sit Icefely,
y
x)(1) Jonas
423 County Road A
Hudwn, Wl 54016
651.246.30+5
~le~ra~or+asyahc~rs.~c~rx~
Address at purchase was 859 Carmichael Road, Hudson, W1 54016
The County changed the address several years ago to 423 County Road A, Hudson, f 54016
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APPRAISAL OF REAL PRppERTV
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 420489 0
11 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID Nom
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)).
Permit Hotder's Name: City Village X Township Parcel Tax No:
Sienna Corp. Hudson Township OZd -'ow-fa-
CST BM Elev: Insp. BM Elev: BM Description:
Aj&nvA I'va.:w' Irt e2. a20, aQ. ~9~ /5~?d-ad
TANK INF MATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Be mark /
i W F. t S~ ~ 2 SO rw.4`eif'" i'S2. t y 96
Dosing Alt. BM
Aeration Bldg. Sewer ~a 9$. IT/
Holding St/Ht Inlet 1
~ 9y. 33
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 31 Dt Bottom
Dosing Header/Man. qp YZ 1S I
Aeration Dist. Pipe ,
Holding Bot. System a3 9
Q•
t
PUMP/SIPHON INFORMATION Final Grade
e 5' 0 4S;$S~
Manufacturer Demand St C ver
GPM ~b
Model Numbe
TDH Lift PKqion Loss System Head T H-
Forcemain Length 1. Dist. to W
SOIL ABSORPTION SYSTEM s
ENCH Width r Length \ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENStOM 3 43. / (-ZSETBACK SYSTEM TO P/L BLDG WELL LAKEISTREAM LEACHING Man ac
INFORMATION CHAMBER OR `
Type~Of System: r t UNIT Model Number
LI h V'. ~O t ^ 2 ll
DISTRIBUTION SYSTEM
Header/Manifold tl Distribution x Hole Size Ix Hole Spacing Vent to Air Intake
~p Pipe 4x11.1
Length te- Dia Length Dia Spacing T~
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bedrrrench Center Bed/Trench Edges Topsoil
Yes No [I~] Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:12_ / 03 Inspection #2:
Location: Hudson, WI 54016 (SW 1/4 NW 1/4 20 T29N R19W) The Glen Lot 2 Parcel No:
1.) Alt BM Description = 5•T r`v""r► Cdr.
j 2.) Bldg sewer length = ' 1
ALN amount of cover
Plan revision Required?' Yes No O O 2
x
other side for additional information. 112-
Use _ ~4~^•
Date
SBD-6710 (R.3/97) i J Insepctor s Signature Carl. No.
1079
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Sal Service
Attach complete site plan on paper trot leas than 9% z 11 niches in size. Plan must County St. Crops
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dinernsions, north arnaw, and location and distance to nearest road. Parcel I.D.
pending
Please pi fnt all o , R Date
Personal imtmretion you provide map be used 0s. 15.(4 1) (m)). L n- I b~~ D
Properly Owner Prot erty Location
Sienna Corporation A G u 2 6 2001 Gov! Lot SO: 19 NW 19 S 20 T 29 NR 19 W
Property Owner's Mailing Address Lit Block # Subd. Name or CSM#
4940 Viking Dr, Suite 608 ST C :CI? Cuur : i 2 na 7U Glen
Citv State Zip( 2ft Pfn ii iki&FlCF City fl] Village IN Town Near;e tRoad
Adi-% MN 55435 Hudson Carmichael
N New Construction Use: M Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
19 Replacement Public or commercial - Describe:
Parent material Pitted outwash Flood plain elevation, if applicable na
General comments
and recommendations: System elevation 91.70ft, trenches spaced and depth to code 5.00ft below grade
M Boring # Boring
Pit Ground Surface elev. 96.70 ft. Depth to rmidng factor 96 in. Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fr
'Eff#1 -EM
1 0-16 10yr'3/2 none sir' 2msbk mfr 9W 2c .5 .8
2 16-29 10yr3/4 none sit 2msbk mfr gW 1f .4 .6
3 29-47 t Oyr4/4 none siicll 2msbk mfr cs na .4 .6
4 47-96 7.5yr4/6 none /m) osg ml na na 1.2
Go
2 ]Boring
Pd Ground Surface elev. 96.70 ft. Depth to lirnbv factor 96 in. Sol Applics ion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAN
'Eft#1 'Efr#2
1 0-8 10yr3/3 none sit 2msbk mfr 9w 2c .5 .8
2 B-15 t Oyr4/4 none sicl 2msbk mfr cs 1 f ~.4 .6
3 15-96 7.5yr4/6 none ms osg ml na na ( .7 J 12
&0 Xq (10
' Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD <_30 mg& and TSS <_X mg/L
CST Name (Please Print) Signature: CST Number
David J_ Steel 248956
Address Steel Sop Service Date Evaluation Conducted Telephone Number
1564 CR GG, New Rlchmond, Wl 54017 8/23/2002 715-246-5085
I
property owner Sienna Corporation parcel ID # pending pap 2 or 3
®pit Ground Surface elev. 95.10 ft. Depth to Ntnfling factor 96 in. Sod APPS Ram
J ~ ~
Horizon Depth Dominant Color Redox Description Tartue Structure Consistence Boundary Roots GPD11P
*EfF#1 *Eff#2
1 0-8 10yr313 none scl 2msbk mfr 9w 1f ..6 .8
2 8-96 7.5yr4/6 none ms osg mi no no V 1.2
its ti
F Pi Ground Surface elev. 95.10 ft. Depth to limiting factor 96 in. Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPDW
*Eff#1 *Eff#2
1 0-11 10yr3/3 none sil 2msbk mfr 9w 1f .5 .8
2 11-28 10yr414 none srcl 2msbk mfr cs no .4 .6
3 28-96 7.5yr4/6 none Crn osg ml no no 1.2
0 ~r f
Boring
Boring #
Pd Ground Surface elev, ft. Depth to limiting factor in. Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boudary Rods GPD/r
*Eff#1 *Eff#2
I
I
I
* Effluent #1 = SOD 30 < 220 and TSS >30 < 150
y> _ mg/l. mQIL ' Effluent #2 = BODS < 30 mglL and TSS 4.$0 mglL
The Department of Commerce is an equal oppadmity service provider and employer. If you aced assistance to access services or
Page 3 of 3
STEEL'S SOIL SERVICE
David I Steel 1564 Cty Rd GG
CST-POWTSM Sienna Corporation New Richmond, Wl 54017
Lic. # 248956 SWl/4,NW1/4,S 20,T29,R19W (715) 246-6200
Town of Hudson, St. Croix Co. (715) 246-5085
17,t Glen lot # 2
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for + r
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