HomeMy WebLinkAbout020-1327-70-000 (2)
Vibsconsin Depannxnt Cl Comnwr!• PRIVATE SEWAGE SYSTEM County St. Croix
Sa`ely a'.d 3ui IJ".c Di;isiCp
INSPECTION REPORT San 1Jn, ve`ma No
(ATTACH TO FERMI I i 605094
GENERAL INFORMATION slate P au ID Nn
Persn-al rfar-r-C P u p-u.ne may be -sec kx secc•)Jmy pmpoee, IN r..eev t emv, s Ir J:
PrRI lt If.!DC'I NZ °.e (;y Vi age 7oxr rip Pa-.-olTaxNo
Kevin Bodick TOWN OF HUDSON 020-1327-70-000
CSI LIME NF.:. BI,'FBM Des Pion n ' Section+Tcvr'v Rar•j91Map No
2. w~ 6L ha o~t.~ 29.29.19.1706
TANK INFORMATION ELEVATION DATA
TYPC MANUFACTURFK CAPACITY SIATION HS HI FS gELLV
Septic' 0.' - w- S / z d~ Benchmark J1, Z51161,10 / y eP x/
Dou!KJ•
All Bb - , Z. 55 /00. 3Z.
Aeration B rg Sev .r
< n
Holding SUHt Imet
TANK SETBACK INFORMATION SUM Outlet
TANK TO PtL 'HELL BLDG `en n r n uke ROAD Ot Inlet
eJll~.
Septic x 9 b/ 25 3(o t 1 7 Dt Bottom
Dosing Header dan
of lDx% 16r t3 91. !o
Aeraticr - Dist Pipe
/o• 5 92 •td(
Holding Ba.System q1. 3
PUMP/SIPHON INFORMATION Final Grado 4.95
9 7, e
Manufacture, Demand St Cove Z S5 /a~
Model Nurnbei GPIA • e- Gp 7
TDFI L.fl F, ct on Loss Systrrr .ad TDH Ft -
Foncema r Lerk.) Ia. o,r I°, a:er
SOIL ABSORPTION SYSTEM
HEDtTRENCH Ydrel', . enatn No D' Ttu-:.tnr. PIT DIMENSIONS No ('(Pit, Irside D.a. 1 rq.iln .k-p-h
DIMENSIONS -3 7 C~ _j I
SETBACK SYSTEM TO P'L BLDG WELL LAKUSTREAM LEACHING "rr' ac:ur
INFORMATION I Pe~)IS •1~n) II - 72p- / CHAMBER OR /y T7GL1.
Q zd 1 / ! UNIT I.~Cd N,,rr6 44
V ~D
DISTRIBUTION SYSTEM Sp zL a' zz. f 'y 5
h e.,nerbte ni`c, / C strbcl err. r hr, e Size v 11,11P. SFa crag Ven• in A r k-tak,
P'pIa~51 ;41
LeugPr V U)_ j- Ir,•~th _ Dia a)'i9 e/Ld
SOIL COVER x Pressure Systems Only xx Mound Or Al-Grade Systems Only
Dcprr IDc: r,C':r +Deai ~.:sacdr7 ?oen +.l.futirad
3eo? a -n CcNC.r / L81. encl• EJgcs soil Yes NU Yes no
1P 1
COMMENTS: r Include Cdce discrepenc es, persons rresent, elc. j Inspecholr _>rt I!!! n. tl~ Inspection a2.
Location: ..'23 CROSBY ORR Goa"'' Y~-+'~ a
I ) All HM Descupt on = ~ GaJt,`.
2. Bldg se•.ver length =
-amount C(cover= XtD~/~5
/t J
Plan revision Required? Yes 4 3
Uso other side for addi:.onal information V ..-Y- -J o
-
Date In SCpCt 9 Srgr, • e ('.en No
Slili EllJ fR 3;5'1
ST. CROIX COUNTY ZONING OFFICE.
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEP'T'IC TANK(S)
IIli s is to certify that I have inspected the existing septic andlor dose tank
presently serving the following residence:
(Street address) located
at Section` Town N, Range W.
Towm of t.:.,,i• St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of illy
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_ Nom--
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
tank Capacity: -
Construction: Prefab Concrete _ Steel Other
MxnUlacturer (If known): 1,~~'
Age of I'ank (if known): _%U~G~> -
Pa•mit nunyber (i known)
(I .icenscd Plumber Signature) (Print Name)
(Title) (License Number) MI'/MFRS
(Date)
Dorm 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
a~cS
County
r >i Industry SeMces Division ! x
S - 1400 E Washington Ave Sanitary permit Number (to be filled in by Co.)
P O. Box 7162
~ u I i Ll)~~ Madison, WI 53107-7162 D 9~
Sanitary Pet~t7lit Application Slaw Tange inn Nmnle
In auodanm adh SPS 333.21(2). Ik ts. ;halm Cole, submission of this Timm to ate apt L ntaL -
is required prior to obtaining a samwrr permit. Note: Application forms fur swteyn\ruerl POWIS arc suwuimed to a~~dddddd,,rss)
2) (if different than OSmn mailing n
the Dhpmhwvl of S.Tfcty mid 14ofessioml Secs -ices r rsa"nal infprnalimn you provide may be used for secondary t Address
n e % in accon dorme \v if It the Pmac IAss. _G y 1 '
1. Application Information -Pleasej~}y~pt All lnformariun
i'unperly O\mv s `lam • - / Na¢d 7:
Pmpcrt) Owners %failing Address Property l.oation . q9 . 1 Q . U
(ro\L Lot
Ctly. Scat / lip Cale - Yhotx Number
j (arse)
IL Tpe of BuIl ing (shed- allthat apply) i -
/
O1or2 Famih'Uuelling.. Kumbat off)sdram Subdn isioit Name
- -->w-' i
❑ 1'ubliNCommacial Ucscribe Use
r
❑ Cily of
❑ %late (TYned- Describe Use
U;kl Nmnb" ❑ village of
77-+-Zz ~3 Tm\m of
Ill. TNT of Petnvt Check-{tmly on box on tine A :Complete line B if applicable)
A. ❑ New System litqAtacement ern ❑ TrmnnenYHOdutg"f:ml Repww-mem Onlr ❑ 01her,ltudifialion to F=isting Suxtem (esplait)
U. ❑ Pettit R mescal ❑ Permit Recision ❑ Change ul' ❑ Pemlit Trare&r to\e\e List Precious permit Number and [late issued
Delixe F>pialimn Plumber ~0%tna - ,5, - • / / 7 ;
I d( all that apph9 1
rVAA. "C~pc of POWYS S% etnlConlponent/llevicc: (Gee
` W Iron-Pressuciz rl lwCaound ❑ Preami7ed ",,wnd ❑ V-Grade ❑ 11omd _ 24 in of suitablesoil ❑ 'Mound 24 nn- ofwitable sod
44 if
I ❑ Holding Tani; ❑ Other Dispersal Component (csplain) ❑ Pretreatment Deciec(aapbti)
V. Dis tsalfPreatment rea Information: -
Design Flosr(gd) Design Soil .lpplication Dispersal -4ca IL;tpnird (sl) Dispersal Ar. Prprosed(1Q system Fleration
Rat Yspdsf)
V1. Tank Info Capaan'm o.. o° -
<xt on< Total = u
altars LL is 'j 3 G _2
Ole s(- J s :n v
N~ ' I.ml s Ea+unG l'ad:v
Septic or liolding'fad: I / ❑
Dosing Chamber E~ El Q ❑
VIL Respo tbt s~Statemen[ 1, the undersigned, assume_responsilf v for hactalladon of the PONVFS station on the attached plans. _
Plumbet.1 Nam (Print)` Plumber Snppatun•// 11Y~\IPRl \tmtb.r Utrsin-vs Yhartc Nhun6.'r
~X
Ylmdrn''s Address (Street, Cily. Slale.7-iii Code)
i
mntvfDepartment Use Only
Ned p Pu a FFa fAta sw,ted / lasttiug Si.mturc
Os rs•en 12casun . ial S ~O u • - - -
iX. Condtl . SeptSepti 't lark, Uni,Re•tsnns for Disapproval
- e- : n 1
3, r---e.1 t4
II . tar•,k c flLOn Itt
As pv'i ra V t ill LE 9lte ! U
•ts per n me, -pt n vNIU nrt
2. All nett»rh req recUlm. tins m t : i~rf. It a 4-D
- .lnacb in complete idmtt for tar s)slem amt subadt to for Cotmty Duly w paper not Io\ [ban 8 t2 s 11 iMhei in vac
' .d JAL
.4
11I
w
S1
it
I
I' ~ 1d0
I
i
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Prof Name: _ -
Owners Name:
Owners Address:
Legal Description: _ c r2 - J<? ! - -
township:
County-
Subdivision Name:
Lot Number
Parcel ID Number
Page 9 Index and title
Page 2 Plot Plan
Page 3 System Smng & Cross-Section
Page 4 Fdter Specs
Page 5 Mainterwnce Information
Page 6 Management Plan
Page 7 St Croix Cty Septic Tank Maintenance Form
Page 8 Warty Deed
Page 9 C:SM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber. ..LicenseNumber Z-
Phone Number
Dale:
Signature f/
Designed punpaut to the in Ground Sall aes«prm canpa lent manual for POWTS Vas(on s.o SOD-10706-P In.ovol 1.
Pane 1
• / liar f ,~,t,d
1lJ~~ti~,:~/~•'rK-7~b/'e~ ~.,u.f7~ha.~, 'G~~. /c.". /f7~? i
. T I -N/ >dyl
t,
K I +I
I
J
11
t- 1
r ~3 t 10
I
i
- .mac Ys /~~~."k=
Soil Absorption System CrOss_ Section
I . - ZL ft
4' Sdrdu{e 40 Final Grade
PVC Vent Pipe
With Verrt cap
leaching
Chamber
- System Elevation
ft ~ft
Soil Absorption System Plan View
H
/ ft
J Vent Or Observation pi teaching rTrench 17
IIII - Chambers
W 11Jdill W1L111j1J1.(1 i i i i I I I UlW 11 11ll111llhilllllll` ~4• Dia
~I_rench 2 Header
Leaching Chamber Specifications -I
Manufacturer And Model
EISA Rating sq ft per chamber Soil Application Rate ,
9pd/sq ft
gpd Design Flow _ Soil Application Rate , ,/i
EISA = ,L~ Chambers
2 rows of chamberseach.
Page of
PL 525 EFFLUENT FILTER t ' t
Polylok Inc is pleased to add its F
new commercial filter to its existing
line of quality effluent filters. The
PL-525 is rated for over 10,000 GPD Alarm t~` Accepts PVC
is
(gallons per day) making it one of accessibility " - extension handle F
the largest commercial filters in its f3-
class. It has 525 linear feet of 1.16-
i_
filtration slots. Like the Polylok
PL-122, the new Polylok PL-525 has
an automatic shut off ball installed 575 linear feet
with every fitter. When the filter is of 11W k
Rated for over ?
removed for cleaning, the ball will ft7lratian slats
i t0,oop GpD
float up and temporarily shut offr
the system so the effluent won't 3
leave the tank No other filter on
the market can make that claim! 2 ( SD. ao Pipe
PL-525 Mla;lctl-enar1k;e: i
The PL-525 Effluent Filter should
operate efficiently for several years
_ under normal conditions before
requiring cleaning. It is recom-
mended that the filter be cleaned i
every time the tank is pumped or
r
at least every three years- If the
installed filter contains an optional . I .
.4
alarm, the owner will be notified=``. ;
by an alarm when the filter needs
Air 00-
servicing. Servicing should be 6asdeflector
done by a certified septic tank Automatic shut-off
pumper or installer, ban `uhenfitter
z I,
t 1." is removed i'
1. Locate the outlet of the UL^ Pawn N" 6.015,489
septic tank. ° 5,871,640 E,
2. Remove tank cover and pump -
tank if necessary. € T 5r 5J Inst^ila-fier: 1. Locate the outlet of the Z L.- e_1 3_ Do not use plumbing when septic tank
filter is removed. Ideal for residential and com- 2. Remove the tank cover and
4. Pull P11.525 out of the housing. mercial waste flows up to pump tank it necessary.
5. Hose off filter over the septic 10,000 Gallons Per Day (GPD)_ 3. Glue the filter housing to the
4'
tank. Make sure all solids fall e or 6 outlet pipe. If the
filter is not centered under the
back into septic tank access opening use a Polylok
6. Insert the filter cartridge back Extend & Lok or piece of pipe
into the housing making sure to center filter.
the filter is properly aligned and 4. Insert the PL-525 filter into
completely inserted. its housing.
S. Replace septic tank cover. RN- -a: , . Replace the septic tank cover.
7;7
=of_
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page
FILE INFORMAT OW SYSTEM SPECIFICATIONS
FfIm"It, Tank Manufacturer: r'r ❑NA
o Septic I I Dose ❑ Holding Volume.: (gal)
DESIGN PARAMETERS tank Manufacturer ❑ NA
Number of Bedrooms. 1-1 NA ❑ Septic ❑ Dose ❑ Holding Volume: (ga0
Number of Public Facility Units: [3 NA Vertical Distarce Tank Bottom(s) to Service Pad: (ft)
Estimated (average) Flaw: (gapd-ay) Horizontal Distance Tank(s) to Service Pad. (f1)
- - - - Specific serviang rnerhanics must be provided if vertical is >75 feet or
Design (peak) Flow= (estimated x 1.5): _ (gallday) if horizontal is >1 w feet. Specific instructions to be provided on back.
In Situ Sal Application Rate: (gapdayrA7) rffluent filter Manufacturer. rl NA
Standard (Domestic) InfluenuEffluent Monthly average Effluent Filter Model:
rats, Oil & Grease (FOG) s30 mg1L Pump Manufacturer:
Biochemical Oxygen Demand (BOD,) X220 mgnL ❑ NA /151 NA
Total suspended solids (TSS) <150 mglL Pump Model:
High Strength InfluenUEifluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer. (BOD,) >220 mglL NA LJ Mechanical Aeration f I Peat Filter
(TSS) >150 mglL ❑ Disinfection ❑ Welland
Prelreateed Effluent Monthly average _n sarxUGravcl Finer ❑ other.
_
(BOD,) -:30 mg/L Soil Absnrphon System -
(TSS) <30mfill_ NA
,
Fecal Coliform (geometric, mean) •;10' f' In Gmund (gravity) U In-Ground (pressure) ❑ NA
U
Maximum Effluent Particle Size 'X in dia. U NA At-Guide fl Mound
❑ Drip-Line ❑ 01her.
Other ❑ NA Other ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Punip out contents of tank(s) t?J When combined sledge and scum equals one-third (k) of lank volume.
H -When the high water alann is activated
Inspect condition of tank(s) At least once every: - ❑ month(s) (Maximum 3 years) ❑ NA
- Col yeas (s) _
Inspect dispersal call(s) Al least once every' - F1 monmg:) (Maximum 3 years) ❑ NA
Lf ycai(s)
Clean effluent filter At least once (-very: - I I month(s) U NA
(3 yea[($)
Inspect pump, pump controls & alarm At least once every U month(s) ® NA
❑ year(s)
Flush laterals and pressure test At I(Ast once every: Fl month(M.~ NA
❑ year(s)
Omer' At least once every. U month(s) ❑ NA
U year(s)
0 NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the follovang licenses or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWfS Inspector, POWIS Maintainer or Septage Servicing Operator (pumper).
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 a clieck for any backup or pending of effluent on the ground surface- The soil
absorption system shall be visually inspected to check the effluent levels in the obscrvabon pipes and to check for any pending of effluent
on the ground surface- The pondmg of effluerd on the ground surface may indicate a failing condition and requires the immediate
notification of the local regulatory aurf nit ity
When the combined accumulation of sludge and scum in any treatment tank equals one-third (Y,) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113,
Wmconsm Administrative Code.
All other services. including bid not limited to the servicing Of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of !A2 months. shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
(A W-005 (02105)
START UP AND OPERATION Pape ~ - of -
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are
detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use,
Purnp tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these
conditions is not recommended. as the excess wastewater will be discharged to the soil absorption system in one large dose Causing an
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber
or POWIS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. 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 improve the performance and prolong the life of the treatment
tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge.
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 properly
and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks, pits and other soil absorption systems sha71 be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servidrhg Operator (pumper).
• 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 fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system*
L A suitable replacement 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 required
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 replacement area. Replacement systems must comply with the rules in
effect at the time of their permit issuance
.
tl A suitable replacement area is riot available due to setback and/or sal limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.
❑ 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 maybe installed as a
last resort to replace the failed POW I8.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such sysleirhs must comply with the rules in effect at that time.
WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
tR~ SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POINTS INSTA ER POWTS MAINTAINER
Name Name
Phone - Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
me / - -
Name F
Phone
ne Iha document was drafted by the staffs d the Green Lake, Marguelle and Waushara County POINTS regulatory agencies in compliancr with sections
Comm 83.22(2)(b)(1)(d)8(f) and 83.54(1), (2) 8 (3). Wisconsin Administrative Code.
oagl;. a,
START UP AND OPERATION
For new nonstructior., prior to use of the POWTS check treatment tanks; fa the presence of painting products, solvents or other
chemicals or sediment that may impede the beatrrienl process andior damage the soil absorption system. If high comoentrations are
detected have the contents of the tank(s) removed by a Septage Serviciriq Operato- (Dumper) prior to use.
Pwnp tanks may ill above normal highwaTff levels prior to starter Or due to pump failures. Stan up or restorabon o` power under these
conditions is not recommended, as the excess wastiewater will be dischargod to the soil absorption system in one lame nose causing an
overload that may result in the backup u• surface dCsaharge of effluent and damage to the system. To avoid this situation have the
contents: of tire pump tank removed by a Septage Servicing Operator (pumper) prior to restcrirg power to the pump o' contact a Piurnb r
oI POW?S Meintaime to assist in manually operating the purnp controls until normal effluent levers are restored within the pump tank.
.
System start up shall not occur When soi: conditions are frozen at the infiltrative sirlace
On no'. drive or park vehides over tanks or the soil absorption system. Do no. drive or parr, over. or otherwise disturb or compact, tnc
area within 15 fee: eown slope of any mounc or at-grade soil adsorption, area.
Reduction or elimination of trin foliowng from the wastewater stream may Ini the performance and prolong the life of the treatment
tanks and soil absorption system. acids. anibiobCs. baby wipes. cigarette butts, condoms, Cotton swabs, degreasers, cental floss
diapers, disinfectants, fats, foundation drain (sump pump; discharge, fruit arid vegetable peelings., gasoline., greases. herbicides meat
scraps, medications, oils. painting proouets pestiages, sanitary napkins, solvents, tampons, ano Ovate: softener brine discharge.
ABANDONMENT
WVher the DCANTS fails and+or s permanently taken out, of serv;x'.ne to!!ovong steps s``,a;l be taken to insure that the system 16 prod ly
and sanely abandoned in compliance wile s. Comm 83 33, Wisconsin. Administrative Code'
• All oiping to tanks. pits and othor soil absorption systems shall be disconnecfec and the abandoned pipe openings sealed
• The contents of ail tanks anc pits shah bic rcnoved and properly disposed of by a Septage Seviong Operator (pumper).
• After pumping al' tanks and pits shall be ex•.:avatau and removed or their covers removed and the void space filled with soi:.
gravei or another inert solid maienai.
CONTINGENCY PLAN
F the POWTS fairs anc cannot to: repaired the foliowing measures nave been, or must be taken, to provide a code compliant
replacement system'
~0 A suitable replacement area has been evaluated and may be Util,zed for the location of a replacement soi' absorption system:
The replaCr:men`. area should be proteGled from disturbance and Compaction and should not be infringed upon by required
sotoacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need
for a new soi: and site evaluation to ^_stablish a suitable replacerent area Replacement systems must comply with the rules in
effect at the time of their permit MSU?ilr:(.
_1 A suitable replacemen: area is not avai;at)le due to satiack and+or soil limitations. If the soil absorption system cannot be
rehaoilitated and barring advances in POINTS technology, a holding tank may be inslalied as a last resat
❑ 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 a-ea. If no replacement area is available a holding tank may be installed as a
last resor. to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the bioni at the. infiltrative
surface. Rtvnnstructions o.` such systems rijst comply with the rules in effect at that time
WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER
Name I Name
Phony- Phone - -
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name None
Phone Phone -
This dorannuat has dl altotl by tile stair;. cif the Gruen I-axe. MaiyuLUL uric Vvaushw,, Counh. -ow IS Ieyulalory apenar- in compliance with sections
Comm 8322(2)(b)(1)(d)&(fi and fi3i,4(1 (2) & i3; Vdlsconsin Administrative Cone
cunr;
..~,:,n,rCc;:adramo•Conmc:o PRIVATE SEWAGE SYSTEM St. Croix
S u'vly ar: RuAtlinq C'd5lan
INSPECTION REPORT
135
GENERAL INFORMATION (AHACH TO PERMI F) SlatePlanlo14,
Prn r. Olin yvu Gm. Ca nJy GV USEQ Iei +....ndSiY l:grpn: I°-NPyJ . S. lu r_; I:tn'iI
C ty 'i An-ye X Tnr•rz•in Parce' Tax N:
Booick, Kev.I, Hudson. Town of 020-1327-70-000
SST SIJ E'cv ins;: 310 C.le~ El.l Oesmebar SacliGnTOanRangr,'Ltap No
29.29.19.1706
TANK INFORMATION ELEVATION DATA
TYPE N•ANIf•'ACTJRER CAPAQlY STA-ION BS HI FS EI EV.
Septic x I De,cnnlars &zd Gcsing C d
Aeratior BIe 1. Sever
He Irvg St:-l inlet Z
St'I!t Outlet ~Q 1
TANK SETBACK INFORMATION
TANK TO Y1 WELL B::-1G-- •+e::o Alr n:a,o ROAD Dl nkt
Septic Cl BaLLc^
25
Donny • •eaecRtlan.
Aclalwil 125' Pipe
Homing act. System
13y5 iaY, 74 7 sl aI
~:nal Grade
PUMPISIPHON INFORMATION _
Marulac.:urer Demand St Co , 5. Gb 99.310
GPRA
Model Numbe'
ipn lid IT.clior loss Sysler Head TOe Ft
For:err'a v '_englh J a. I'Dls~. IoWel
SOIL ABSORPTION SYSTEM
BEOrTRENCH I::h L.n..l n N ::p in:- :1, PIT DIMENSIONS No. Cl mzitla Cx 1,,,c 0epln
DIMENSIONS
SETBACK SYSTERt 10 F`L P.LCG :10F1I LAKE:STREAIA LEACHING NanJ"c"..
INFORMATION - - CIIAIABER OR
7,w Of SyslOm: UNIT IJ.x;ct Num!x:r
DISTRIBUTION SYSTEM
1 l.rLtinn':: r`.o-hW - ~n H,.n S¢a arlnl. at:a~ ~ :vnt to 4ir Intake
P pelsi
I -n pia LCnaln _ _ Ca__ SVS5n9-._
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
DeVP UA, Cc;:h Cn- n.•. C^pr' ✓I r> ;uvdeyl6aJde0 a N;,.IGta:
<?nut; o.-,,,( Fod'Tre^..r[:ges I:-,:I vc. No ]Yes No
COMMENTS: (Inr-lode cnno diSGePeacies, parsons present. claj Inspecion ftl - - Inspection A2:_
Location: 723 CrcI Orive Hudson. '1"1 54015 r E V4 SE 1;4 25 729N R 19Y: j SL Qoix Ls(e'es 2nd Add Lct 35 Parcel No: 29.29.19.1706
I) Alt DRA OoscoPhon - I e.. 1-; I fq. I-~-o.~SQ• Ger'1 nP.e,
2 : 11,19 sewer wr;i'h
alnourl of w:e, . J
flan rev sion Required? -Yes )I l to 30 b-b - 7
Use other s de !cr addiciera ml.rmition
S9U-a ✓,o!' III s Ctt.>; G.
rt ~sT: ~
^t9 County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN
`.p In 'u twcl wish Chap.n 2 SI Cruu ounh San.larJ anu I ANNING E ZONING DEPARTMENT
Ycr,inal mluunaliun vru pia ide may tin u. QC ltr e:("T' wr C % CCrJNTY GOVFRNMENT CENTER
00 s4f' IPr ary l,av. S i0-I rival) 11r1t a :haa ltoan
H,rr..~u, ..I 5e6^e 7710
_ ;l15; 7N5-<fiII0 is+li 15;0B046p6
f.Racb coniplole plans for Ihn ,Y::Imn rvr pope: na rss IY=.n 0 12. I : aches in siza.
(S udy Saaitary• Perme u LI v ,k d mas Ir -inc.:. --a inn
_
C>135
. ApPllgllon Information_ Please Print all Inlor n Location:
lnprv Pr?True, Nana
14 I
L I E 1 , 1r4 &i, -L
I~ (j ( I L Ol,i = I 4 29 ti, R /17 1. (o w
=rDpc•ty OIS ~We 1.4nhnq Audress Lo' N~,ober Riock Number
?ZS «osF~ pR- 35-
.il • Slab Ap';od' rx.7t Njr-,rr ~uGd'.cicion Nanao of CSM Number
uelSov, GJI 5-Y6((. €stq'ta5 2r A~lA,
II Type, of Building: (check one) _ City ❑ Vdl"J own of
RI I ,.cr V anuly OwvIh q - No. ct Bo:hrxnrs y~,~ OCR ry
U F'uP;_,:~CCmmernial lde=crbn we,.. J kl
❑ Slate-cNrn<t Nraoosl F1,0 'n 111111.40 14~ I. Type of Permit: 'Check cnly one hex on hoe A. Check on(on Ie 13 1 :41;h¢ahlel e D Lf . ✓a.~
Vmccl l av rLmb.. (s{/zq. Z.y. I9 • O O
A) 1. P.u 2 sC ,o'!, Linn n ❑Ncn-picmhrog 4. ❑F?nlu•:anaD nn
Sanitation 020- 27- -000
B) Perini! 1,11:11Der p Dale Issued
T5 blalt' San m'y Permit w•as preciously issued 36 3 CJ O8 Or{ . 2000
IV. Type of POWT System: (Check all that apply) a - 3'X 75 ' T•e6NCN.- s / 2 -Ck<w.bvs
~o~a 1-zy
NongnCSSer.ZM ImgmurM ❑ Mound 2 24 ir. 5uital>c v: 1 Ma,nd 5 24 in. ScIInCV• roil
- - 7 ❑ Mound A.0 f('iw
❑ Sand 1771 1 1 1 Cureau••r.: Watlantl ❑ Peal Filter ❑ Dnp ❑ne.y''AIG fau•y
❑ 1'v.rs11671-C In. gnn.nc ❑ lie J.o l lank U ;LUDIC Pass U Olhnr
Ll at'9redn ❑ '.ache Trealrr eni low I 1 9eclrttriaLnq
V. UIY rsal Tcntmnnl aea lUlormallon:
1 IL r: or i InN rg Dd; peead Area 3. Jr.7a., - I '.na 4 i l lpplicanon Pale Pce.nldlion Ralo 5. SyswU .at on . Feel .:race
R gwred t Prc{ws d Cal 'n t..anL!ai ' J Ller ipr i
W. Tank Information Oapaicty n fiafhns Total X el klant,"Clun r Prclab S le Cc," Steel Fit,, Plastic
New Exs,ng Gallons Tanks Crxu:n::u sheclxJ gias::
ranks Tanks
(20d t a ❑ ❑ ❑ ❑
❑ ❑ ❑ c ❑
II. Responsibility Statement
I. the ravloJ rgnud• assume ewnrbany for repaiNreconneneKrn'rc,evccrknri inslallahon ul nor, pf,.mbing for pro POWTS stwwn w the attached plans. A
<ensn ca nrd urcgrircd for mnalih re, nir c Iho installation of nnmph,mb_ kul sanaalron tisic i.
tn"', t-l s Name (pnnl;r Pk.nMV Srgnalwe Inc'lam IAP:AAVHS Nn. ILarrres° Phone Mirt
Alt o e Ll 71l✓ae _ ZZSD 13 (L' Gf'/T27
fl.mdX,is Adrpess l`~beet, i:ily Slap`, Zip Cnr4aa
(O O un`fo.i '1 CLi. ukso I S v
VIII. Count Use Onl
. Isni Agwat ;i9n as j Limps)
I [hreyaroys,~ Su1hari-P7enri1 FF..r. 2_~
Appro'cetl !'\Owner Gi I:iA~.ll'Adversa y J 0O 1/0 O
Geier aecn
`('i l~
X. Conditions of ApprovalrReasons for Disapproval:
SYSTEMOWNER: M a~~~ ~-•p h`!~
1. Septic tank. efnl ' fitter and
dispersal C#.w must all t'+'triT".• ma,^.tairAw r'
as per management plan ptovaded by plumber. ~A. ~'`o J`+~ . 1(0.J ~s,~ VC«~ D (al.(~1
2. All s ngl cod must be maintained
tl rl ~t l
par r oppi aPPauble code I ordinances. ~j ~ L.uHy~ aJ ~
.L.
K~ v; n B ,el;e- k
7z 3~ c ~osay Di;%)a-
ckosay
N
uJ~~ I r
~ i4 I2 ✓ 7~ P-O
'rill,
ITS Xl z
i, s"yy
r
ystlscoMin Department of Com.mercu PRIVATE SEWAGE SYSTEM
Safety and Bui•4.ngs Division County
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) f samtary9e'tS 0
Personal Inlormaeon you provice may be used lot secondary purposes IPrrvury Law, s. 15.04 (11fm)J. 3 S
Per mrt'~+O~dC~'s Narne. Q City Yn~lgy~ L-t fnwn of Statr Plan iD No:
Bodick, Kevin Hutson Township
CST HM EIev :D Insp BM I e" NM Descnpt G . Panel Taz NO:
02~-I 327-70-000
O Imo)-D{~~_
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACIfy STATION BS HI FS ELEV-
Septic Benchmark Z rp].2 f 0
5. / y
Dosing__ Alt. BNI
Aeration Bldg. Sewer
Holding.. - (1/ Ht Inlet 3
TANK SETBACK INFORMATION aHt Outlet 3 7/S
TANKTO PIL WELL SLOG. J1 °t to ROAD DLInlet- Au irtake _
Septic fDp ` /3 lOg ' NA J)ILBnlwtn _
Dounr}. -iJA Header / Man.
-
Aeration- _ - NDist. Pipe C y
Holding got. System oa L
4 0 f-
PUMP / SIPHON INFORMATION Final Grade C ovi- q 2
PAACulacturer DeinsOd St cover _ fop,
\ ~f-
Model NumbeP - GPNI
TDH lift Fiction S stem TDH Ft l'
Forcemain Length Dia. to wen
SOIL ABSORPTION SYSTEM 12,
-
BED / RE CW Width Length x No. Of trenches PIT- No OI Pits inside Oia. t~awd Depth
f 5 2
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM-_LEACH11MC M°`uyttty`er'
C
INFO CHAM pi RMATION Type 14T M e N~ m r.
System(Cy~J_ •rz' a1~UNT X Qom'
DISTRIBUTION SYSTEM
Ileadw rMan~tnld Dauibutron Pipe(s) Hole See xHole Spacing Vent To All r 111t4ke
I
Length/0-~` Dia Le0q'hDra lparinq~' 1 N() L A/ r
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth OzerDepth O"er xz Depth of zz seeded r Soddrd zx Mulched
--~yes LI No ~Q s'es F7 No
Ned r trench Center Bed f Trench Edges Topsail
COMMENTS: (Include code discrepancies, persons present, etc.) In cction g 1 t. J/ /GO Inspection #27 Location: 721 C'rosby' Drive, Hods tn, VJI 54016 (NT 1 rd SE l/•t
9 T29N R19W) - 2929.19.1706 St. Croix Estates fat 35
1.) Alt BM Dcscription= tav.da~rn A0 a fr brae ~aa-aka
2.) Bldg sewer length = ex l~~J So ho. 'may `2?`Y a O
-amount of cover mltc i c"efe
V `I C~~M,1 vP 'brow Q ~//l !LO s< ±v`n. {h ~.nGs- ~f/JC/e~ -
Use r other er side for for
Use additi nal inf rmation.
)r SBD-671 0 (R.3197) '\Jo - i f! Date Inspector's Signature Cert No
Wisconsin Department of Commerce
Safety and buildings Division PRIVATE SEWAGE SYSTEM "^~t. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sand4fyeGAHi No
Personal information you provica may de uued for secondary purposos pnvacy law, 5.15 04 (1)(m))- SUSbVB
Permit Holder's Name: f n City u Villa e LJ. uwn0 State Plan -D No.:
odick. Kevin Ilu~son few
CS70'dklev. InspBMElev_ 11NDc5alu'llllun' =auP0 LU-X1_7770_000
l
TANK INFORMATION ELEVATION DATA _
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic V }l/:i Benchmark
DesiAg_ All. TIM `
Aeration = Bldg. Sewer
EieiBing I ;$Y/Ht Inlet
TANK SETBACK INFORMATION /STyHt Outlet I~ } f
TANKTO P/L WELL BLDG. vAeunt to ROAD M Inlet _
atdkP
Septic 7A),i jJt j; NA ZLBetterw
Downg__ - NA Header/Man.
Aeration - NA- Dist Pipe 6,;-
Holding Bot. System ` '10 ap
PUMP / SIPHON INFORMATION Final Grade
M"UJAQUref _ Demand St cover z
Model Numtier M
T lift Friction"---._T5 stem 7DH
loss Forcemaln Length Dia. Well
&AIION SYSTEM FNC 'Wroth - Length Ne. of TFWEL
ches PIT No Of f'01 Invde Ola. _ pauid Depth
)IMN
VS'
SETBACK - SYSTEM TO P! L BI DG L LAKE/STREAM LEACH a^u eriareu
y
1 I C_ BER IdO e
INFORMATION TYPeOf
Syaem i cl Z V -FOR UNIT
DISTRIBUTION SYSTEM
Huadc~'ManTi.ld~/ DnUi6UtIfIrlPpelil - - H°IC 4[C• x Ho•e spacing V~e(nt lo/AU 'flntakl:
rl enylb !d-!/ Dle / I 1 engirt D~a A/& sGacmq - `_7 Lx . 1_ I J ID /
SOIL COVER it Pressure Systems Only xx Mound Or At-Grade Systems Only
n nh It 7 1 peer wK JP in Uf I xx Seedeo,'Sudded lftl&ed
11 d r I I r rmel 11 IPUCh I dues lopsu I rl '-'es I 1 Nn ❑ Yei U No
COMMENTS: (Include code discrepancies, persons present, et(I Inspection #'1 -7/44,,oJlnstlection#2: / /
Location: 72:3 Crosby Drive, Hudson. W1 54016 (NE li4 SF. 14 29 T29`.It 19Rr) °9.29.19.1706 St. Croix Estates -1.ot 35
l.) All B34 Description = ~J , !
2.) Bldg sewer length = 4 F' r h~
-amount of cover = /,,l
1
Plan revision required? dQ
Yes at No
Use other side for or additional information I-L-LJ ~
SDD-0710 (R a'g]) Dote eyp,or, s Lgratu•e Celt Nu
- ~z=J l~/SB j' J~K Safety and Buildings Division
j SANITARY PERMIT APPLICATION 201 W. Washington Avenue
jsconsin P O Box 7302
4epartmensof Commerce In accord with Coroern, t. Adm. Code Madison, W) 5 3707-7302
• Attach complete plans (to the county copy only) for thon~peP~not less co unty
than 81/2 x 11 inches in size. tS
• See reverse side for instructions for completing this ap t , c r t ~d 3$~I
Personal mformahon you provide may be used for secondary purposes li - a , 1 yr_ ,o Sanitary Permit u ber
n~me.w io Prerwus eprxraeinn
IPnvacy law. s. 15.04 (1) (m)I i
ale Pion I U Number
APPLICATION INFORMATION - PLEASE PRINT AL tNF R N
Property r Name PrnpertyiL r
t;a. 4, S T_ N, R E (Or 6p
Property Owner's Maihn n neu T!svv+'Dir Block Number
City. St- a 2i Code Phone Number Subdiws,on ameor CSMNumb r
Gl 1 ) l
11. 1 YPE OF : (check one) Q State Owned Neares uad
❑ vd~aye
Public i or 7 Family Dwelling - No. of bedrooms town or -
111. BUILDING USE: (if huddmgtype.spubhc.d,e(kalltharapply) paicetTo.Number(s) 2.4.2q Iq, 1?04
1 [_3 Apartment/Condo 02G -13a9-- 70 l M
2 ❑ Assembly Hall 6 U Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
S ❑ Hotel/ Motel 9 ❑ Office/Factory 13 Q Other: speufy
IV. TYPE OF PERMIT: (Check only one box on IineA Check box online 8, if appli(able)
A) 1.o New 2. ❑ Replacement 3. ❑ Replacement of q ❑ Reconnection of S. ❑ Repair of an
System System _ lank Only ExisInt3System_--------- ExntingSYstem
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non -Pressurized Distribution Pressurized Distribution Experimental Other
1 t ~]c Seepage Bed 21 L] Mound 30 Specify Type 41 ❑ Holding Tank
I ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit I l 43 ❑ Vault Privy ,
14El System In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq ft. Proposed (sq. ft-) (Gals/day/sq. ft) (Min. nch) Elevation
_ Feet Feet
VII. TANK Ca
in P Moact ns Total p of Prefab. Sao fiber- Exper
INFORMATION g Gallons Tanks Manufacturer's Name cpncrete con. Steel glass PldSbs App
New Fxistin strutted
_ Tank} link
Sept,( rank or Holding Tank - ❑ Er-l-t ❑ ❑ ❑
Ids pump Tank 6i hon Ommoer ❑ L1 ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for in ation of the onsite sewage system shown on the attached plans
Plumb r'S me:(Pi / Plumb 1$i ,ui Sta ) MPIMnRSWNu.. Bos.neu Phone Number
PI m ¢isA ress( rget. City. ale. ZipC
o /
IX. COUNTY/ DEPARTMENT USE ONLY-,
Sanitaryewrna ee'°"'xb ('•oonlwnn ao sfue Isswng Agent S1gnature(No Stamps)
E Disapproved
Approved ❑OwnerGiveninitial
Adverse Determination -
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6399(R. 4199) rxsrxiaunux aw~+:wt...•irA,,. wnv tx. sd.ryae.wn w. a.... u.. o.+w..vwmn.~
INSTRUCTIONS V R
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Admwive Code will be applicable.
3 All revisions to this permit must be approved by file permI%issuing authority.
a. Changes in ownership or plumber requires a Sanitary Perrcit Transfer/ Renewal Form (58D6399) to be submitted to the
county prior to installation
S. Onsite sewage systems must be properly maintained' The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years
6 If you have questions concerning your ons, to sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608.266 3t 51. -
To be complete and accurate this sa)tary permit application must include-
Property owner's name and mailing address Provide the legal description and parcel tax number(s) of where the
system is to be installed
II. Type of building being served Check oNy one and complete p of bedrooms if 1 or 2 Family Dwelling.
In Bud Wing use. If building type is public, check, all appropriate boxes that apply.
IV Type of permit Check only one on 6ne A Complete 1: fie B if permit is for tank replacement, reconnection, or repair.
V. Typeofsystem. Check appropriate box depending onsystem type.
VI- Absorption system information. Provide all mformaaon requested for numbers 1 through 1.
VIL Tank I n formation. Fill in the capacity of every newlor eraung lank, list the total gallons, number of tanks and
manufacturer's came, indicate prefab or sate constructed and tank material Complete for all septic, pump/siphon and
holding tanks for thissystem Check experimental approval or•lyi' tanks received experimenta! product approval from
DILIIR
Will . Respons,bilily statement Instaiiirtg plumber is to fill ,n name, license number with appropriate prefix (eg MP, etc.),
address andphonenumber Plumber must sign apphcalior, form.
IX County/ Department USe Only.
X County/ Department LiseOnly
Complete plans and speclhcauons not smaller thar 8 111 x 1 I inches must be submitted to the (ounty- The plans must
include the following; A) plot plan;orawnto scale o7with compleiedimensions, to(ationof holding tank(s),septrc
Tank(s) or other treatment tanks; building sewers, wells; water mainsiwaler service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; G complete spec licanons for pumps and controls, dose volume;
elevation differences; friction!.oss: pump performance :urve, pump model and pump manufacturer, D) cross section
of the soil absorption system if required by the courtly; 9 salt test data on a 115 form; and r) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act a 10 included the creauon of surcharges (fees) for a number of regulated practices which can
effect groundwater
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards
i t
1
t
t
//Sf_
I I
W.u,nsinDePartmentof Industry, SOIL AND SITE EVALUATION REPORT Page of 3
.abor Ind Human Reiatlau
1: awe. ~j safety s BulairIgn in accord with ILHR 83.05. Wis. Adm. Code
COUNT'
Anadt complete site plan on paper not less than 8 V2 x 11 ircnes in size. Plan must incluce, but ' oix
not limited o vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL ~.Q r_._ 7
dimensi'~red, north arrow, and location and distance to nearest road \ type _
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R IEWED6~y SATE
N,
PROPERTY OWNER. PRC°ER'v LOCATI
Bridgeldnd Dev. Company GCVr I-- NE qTi tcE V4S 29T Z9~ N. -j 1la;W
PROPERTY OWNER'S MAI'.ING ADDRESS LCT a BLOCK a 'f UA, NAME 0? C§SIA I
11736 117th. St. 35 na Croix Est to and Addti.
CI"Y, STA'F _(IPCOCF ---ON=NUMdci ❑C TY ❑VILLAGE NEARc .A D -
Lakeland, M. 55044 61z 985-5000 Hudson osby Rd.
I j New Construction Use Ixl Residenoal + Number of bedrooms 3__ _ I I Addition toe) asting building
I J Replacement I I Public or commeroal describe
Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd*2_.8 trench, gpdAi2
Absorption area required 643 bed, h2 563 trench, ft2 Maximum design loading rate _.•.7 bed, gpdrh2 _ 8 trench, gpo1ft2
Recommended infiltration surface elevation(s) 94 .55 If (as referred b site plan benchmark)
Additional design I site considerations -a1t. site system el.- 94.2'
Parent mated outsash -Flood plain elevation, it applicable na ft
S =Suitable for system CONVENTONAL MOUND I INGROLND PRESSURE j ATGRADE❑ Svs`rli N Fl-L HOLDING TAW
U = unsui able fors stem I& S ❑ U IRS : 1 U ®S ❑ U S U ®S ❑ U ❑ S C3U
SOIL DESCRIPTION REPORT
BoringN Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDift
in. Munsell 01.1. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
mfr cs if n ! 2
10-10 10 r2 2 none 1 2c pi
2 10-26 10yr4/4 none sil lcsbk mfr 9w if .2 .3
Ground 3 26-29 ~1 7.5yr4 4 _ -none is ps mvfr (TW na J .8
elev. -
98.55 It 4 29-84 7.5 r4/6 none ms os mvfr na na .7 i.8
Depth Io
limiting - - -
factor
+84" yV.Sv - -
F v~
Remarks:
Boring p
_yr2 2 -none 2TSbk mfrrs_.• if .5
0-13 10 6
2 2 13-38 10yr4/4 none sil 1 lcsbk mfr yr if 2 .3
tt, I
Ground 3 38-8 7.5yr_4/6 none ms os• m na na .7 ` .8
elev.
99.0 h - - - - -
Depth to
limiting
factor
88~
Remarks:
CST Name:-PleaseP,it Gary r Steel - - Phone 715-246-6200
_ „
d (e95:
1554 Lh.. Ave 54017 mn??c)g
Date. CST Number:
SgnaNre
8-20-96
.
PROPERTYOWNER Erridgeland-nev. Cn_ SOIL DESCRIPTION REPORT Page _201-3--
PARCELI.D.t pen3ing, ra #35
Dominant Color Mo0es Texture S
Boring Uucture Roots 4 Drlt in Mansell W. Sz. Cont. Ceior Gr. Sz. Sh. lConststencielftinotty Bed ?rerrh
g 10yr2Lnone 1 2msbk cs if 5 .6
" 1 0yr4/4 none sit m na gw if np •2
# P322
na na 7 .8
Ground 7.5 r4 6 none osg ml
98.2 N.
Depth to _
limiting ! - - - -
factor ,A 1A.6
+84"
Remarks:
Boring 8
„;.;r< 1 0-_1G 10 2 2 none 1 2msbk rafr _ cs if .5 .6
s
.,,4 2 10-29 10Yr414 none sil m 9w if np .2
Ground 29-84 7.5 r4 6 none. cos osg r m1 .T na•7 .8
elev.
97.9ft
-
-
Depth to
limiting
factor
+84
Remarks:
Boring N
* 1 - -'.OYr2L? ne 1- 2msbk mfr ~ cs if .5 .6
2-_ 12- 10 r4/4 none na - _9w na - _.2
3 30-82 7.5 r4/6 1 none ms osg ml na na 7' .8
Ground
elev.
97.1 ft. -
Depth to
nifing
factor
+82"
Remarks:
Boring i
i
Ground
Nev.
ft
Depth to - -
timiting I
factor
Remarks:
sBi}e3301R.05r92)
I
STEEL'S SOIL SERVICE
Gary L Steel 1554 200th Ave.
CSTM2298 Bridgeland Dav. Co.
NE',-SE, S29-'1'29N-R19W New Richmond, WI 54017
MPRSW-3254 town of Hudson (715) 246-6200
j7 lot 1x35-St. Croix Estates Second Addn.
✓''-40'
~SN.= top of l" pvc pipe @ el. 100'
I
r~
`12p
30'
3i 50
53 " 200.
3o ze'
Gar} L. Steel
8-20-96
STEEL'S SOIL SERVICE
Gary L. Steel
1554 200th Ave.
CSTM2298
CSTM2298 New Mohmond, WI 54017
(715) 24&8200
To whom it may concern:
This soil evaluation was conducted to satisfy a zoning requireeent,
it may or may not be satisfactory for your use. :he location of the
system may or may not be as shown, as permanent lot lines had not
been established at the time of the test.
Gary L. Steel
ST CROIX COUNTY
Si11' ilC ''^.VK h1AINl'ENANCE AGP.IiiiN1@\
AND
Q'WNl:RSHIP C/CRT:FICATtON rOR-Nt
Owner-'Buyer 11 £ ~~~L ZJd II C_,/C
yU7 *4 (ff t/ud~l- L-L
Ntail;r.g Address
1X
Property Address -7a3 ~`"Ieq
J
(vcr.Gcatton rcqu red 'om Planning Department for new corstrtzuoc) l'
Ci!N'S!ate i ! - _ Parcel lc nrfication Nu ber ~ oerJ ` 1~~ '
LEGAL DESCRIP'l ION
Property Location Sec.,--,:261, T.-;' N-R 19 W, Town of
Siihdiviciori T01 it
Certified Survey NInp d Volume _ - . Page #
, Page q y
Warranty Deed tt 0,2< Volume 1376
Spec ho,:se :J ves 9 nv Lot lines idcnuflable jx yes C r.o
SYSTEM MAINTENANCE
improper use ana :ra.nrCtcu~.c,{ •::ur. up:¢ rysicm cootp resul! :n ,is premature fai:u:c to handtc v,a5t^_s. Proper mamtenan:c
consists of pumping out :he septic tank every truce years or sooner, if needed by a licensed pumper what you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner acrccs to s hm i io s 0 x Zoning Dcnamrer' a certifca:ion form, signed by the owner and by a
rnastrrp urnhc ,iw ue: rat,; L.mher. rx a h.i f," 6ccrtca;tnmper Curing iliatf 1l the o7-s tee wa see wa IC t dt sposa l Sys:cr:t
.n prapcr r>p rut n•..; art <a nrv. nr 1 :,f:o~ w.p:vnon tmp:ng itl oc;cssary1. me septc tank is :ess than i~i full Of sludge.
we. the cndersigned have read the above regu::cn:crls and agree to maintain the private sewage disposal system with the vacdards
sc: forth, herein, as set by the Department of Commerce and the Ucpartmew o1' Natural Resources, State of Wisconsin. Cernficatwn
':atinp that your septr: r: strm h:a':,C n mn•u.t rv..i nwst he cn•r.pletcd and icmmcd to the St Croix County Zoning Office vv a:•, ci
:Invs of the inree ycai ty+rain tc
SIGN.ATLRP OF APPI.ICANT DATE
OWNER CERTIFICATION
I (wei certify this air 51ab;n,enl-:r r,.~ Icru a-c tn,c to the best of my (our) kncwici;be. I lw'C am ?arei the G%rcr(al of
-roprrty rlescrtS: I;J,c. c. -t• 1 n- nt v,nwivy aced accorded it Register of Decds Office
SIGNATURE OF APPLIC.AN'i' DA'fc
Any infonnatiun that is m:s-rcprescr!c:l way resuil in the sanitary permit being revoked by the Zoning Department.
InCtudc ,vlrh thin -1Pl1:i,;v un ~ .wire.! Yrnnty decd from dre moist- of Dccdz off.;e
rt n:: cer.:ier_ s,rr,,•r *rzp t'r; fe re 1 ee s ma !e m :he ,varrar•,y deed