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HomeMy WebLinkAbout020-1173-40-000 (2) ^txr~ns~ Ucaartment m cammeroe PRIVATE SEWAGE SYSTEM County St, Croix Safety and 8. ~Id ng Jrv v orr INSPECTION REPORT Sa-.tary Permit No 60,51701 GENERAL INFORMATION (ATTACH TO PERMIT) Stxe n ar .D No PCrSWlal ut'efinal on ydb orcv4e map to "CO lot aecendaei p~fpOSCS lPn';acy L;w, S C4 i I:1M.11 Perm t Holder's Name CCy V l',.ge Tcv;-ship Pa'cel Ted No Mary Abel TOWN OF HUDSON 020-1173-40-000 CS' EIA Elea. P'sp. 61vt E'ov. r ptic,. Sention+Tcvr; R,ilgt haap NO 0o Btv1 De3c 0 0 a~ 17.29.19.1086 TANK INFORMATION ELEVATION DATA + TYPE MANUFACTURER .t, CAPACI IY S7ATION BS HI FS ELEV. Sep: C, Dencnmar~ W. s 5,rv2 ios,o rQa A l yl 320 Alt ar7zb 0 3.L /6Z,.3 7 Sz 5 Bldg. Se'A•e t Holding SGHt Inlet TANK SETBACK INFORMATION SL•'HI Ohtlel 7A °1~-FSg TANK 10 P: V.1ELL BLDG Ven~ Ai'rota.e ROAD D: Inle: qq f ~•OZ X7.(0 16 Sotd 4+1 ZS 7.1 3zo o S, Is 97' 417 Dosing 76 r Header.Mar 11-14, G3` G'Aerat on DIs:. PI^„e ~l Holding Bot System cl PUMP/SIPHON INFORMATION F:nal Grade 'S, 19 °I m1rulacture' Demand SI Cove, GPN1 32p jr. c6j 16Z' 3 V-del Nurvr;er - TDH Lr: Frc:ion Loss S'yse ad TDH Ft Forcer..... Length Dia. Dist. :c 'oven SOIL ABSORPTION SYSTEM BED;TRENCH t^: dth I Lergth N2 UI "o'r'es PIT DIMENSIONS No. CI P 11-side U ~ Linad Du stn DIMENSIONS 2 7D re - s,f~ SETBACK SYSTEM TO P:L BLDG :"JELL-^J LAKE+STREAM19 LEACHING i!arufac:uref ' INFORMATION Ty ? 0` S^ste- CHAMBER OR ~ F' r p > UNIT Idecel u''lie'. e, q eAUen~'e"((l~_ ~a3 S~ DISTRIBUTION SYSTEM 7 +-r-l+ r7%5 ✓s ,7577 .."1" V IC Disrlt,tipr o. x HOte. S za a Hole Spacing Vent to Ar rota" P relsll So J Le•rgP• till ~ Lengt- Dia .,.ram-a ~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only DCA- Ovcr Duey, Cvel xx Ocp1h el zs Seededscaddetl xx M.,lched Re_Jjfench Ccn:er RedJfench Edges ` Topsc. ` ps No Yes No COMMENTS: (Include code discrepentoes, persons present. etc) Inspections #1: Inspection #2: Location: 4h OVERLOOK PASS 1.) Alt BM Descril = 3z~c) 2.) Bldg sever length = `iK x s~~tn.-~ - amo.lnt o' cover = t1 Plan revisior Required? Yes X110 /O 1Q ~Q ~Q ~3T Use other side for additional irforma::on ir _ Date Ilse r5 Sign fe Celt NO SBD-671C rR 7:3:j _ i ll=f* Safety and BuifdingsDmision Crnmty S1 fp' u t 201 W. Washington Ave, P.O. Box 7162 Madi~ i• W1 53707-7162 Smi°tQS' Pmuil No~ be Shed io by Co j - sFi' za~a 6;0517b I ~1t 1~PpjIC3flOi1 StnoeT~mtsaarmMutmbe - CDq N accordmoc wim SY$l$12HYJ: Wfa'.[ytbtuusigi of this k,mi ' {rtRoverluffaind unit - ts regnued prior m ° n yutary permit Niue: A bcalim forms for s,atrowced YOWTS are subautmd m I , the Dgianronut of Solpy and Prnfcssiru,ul Sennc Yaao,ud m>o,uw Y+ol~'f Address Gf drfG7m Ntan user ,n rexvr Wm F`10 i1 a 111Y t" mM In, sumndmy w . L Alw licatioa Wor atm7irt5 addrrs:) hffl ith IC, riv~Lrw. ~ l A-Wl Cm). SCtts. tirn - - ySd matioa-Please -Print ABlnfo lion t.l1~QG.~Or P.,de f PrapertY pwncr'a N/yart~m. - - Prq~tify Owner'r-Malmo ~r1 h e y - _ o o~ I M 3 -y o- a o t: P1opt++Y loca TAB--- tion 1yi4, i'I. 68t. Gtry. Smic - (feel fat Zip C.odc ~ Phrmc ntuxrba - is, ''A. Sena, 1T_ T'ype of BuOdiDC (ckcck ail that apply) T N. R j-E or W f`I 1 o. 21'MAY Dwelling- Natalia of Be(h. ~S f / Subdivitiar Name Block i I PrdtlirlCoaimen;ial--1)esatlx Use ~t - 'Ll , - t-_.-- ❑ Cay of I) STate Chemed -De=iihe Usc - CSM Number ❑ V7ia?e of 3 - - - ,,II ~ [XiTowaof tYI.f~Sbti _ L' _IiL Type of PezmiC (Cpech a A. Complete fine $ if nppiicable) f 4. ~f-.-.- ❑ New Systrat *eolaceatertl Sys*c"i i kealma dHoldiao'rsal Relac.amat Oul E p Y ❑ C)ha htmdibentim tp fJwawtg SYSIem (=plain) ~ R. I ❑ Vamit Rwtrztal I n Permit Rm isiar ❑ Pcrmir ltansfa to New UVE 1'revi m1 W --w I l1 C7raoge of Plum'tta Dare JSSUeo //7Tl / I Before Ezpitati(rri . ° 'om __armbDevicc (C$ec$ a8 teat anpivJ 1~,,es,r - - r' I lMToo-Piessavat (n-Cuw,ml Ynssurrsral lit-Around ❑ qr (iradc ( 1rlmuW > 24 in mf suitdilc sod I A4oma1 = 24 ui nl suitable sod Holdimv Tnnk Other UlsposJ ('ompmti•ot (crplam) ❑ Pieaeatrtten(J]evirs <<WymL. -V_ DisucrsaVJ'r eat Area fnfdrmatioa- - Dwty flow (-,W m' Soil Application e(~dsQ lI Dispersal ArmReque,e-d -Tr p (s!) pyy - U ✓ i 1 fl ( ayd Aria Proposed 1) SYSmm Elmiioa VJ.TankJnfo - r-~- r , ~ f°pacny m Twat 8 of A4auf¢rYttrv L Cmllmts Cialfarts Units Nem}Ta~il¢ Fi%di~Taa7cs 1 a o °n-' y '.r+_. R I p L orie a Holdura Tool T I J`--d -i _ - ,'v O ~a 14 i t4 i a :i m 6 i a ! a 13~ic - - 1-- - L - 1 VD.- Rtspolfsibility Statement- J. tftc aadcrs' - PSunihcr s Nznte (P(ort) - .~aa sssatne resposdiiiblY for iaaallatima of tba N)WTS chows on the attached plans - { '.SS e he/MPRS Nttmbc Bui s f'botm Nuotlner - .1 Plu,-one's nad~ (Sri. (itY Siam. 2P C. d I VIfJ no riment use - V . /t.-..-ate pprovrxi I PamG Fee A bsucil i Fasiri $CaSi wit a, ltrssun 11=fRntal , cWd 4 85 9 i`t /'8 1. _ X411th for Disapptrovnl _ atfl(an; ttltr rni ~iBlWr.'Li cell rtvst dll ~a x~r: ~ 'r~~i ~nli''es, « pK 2. rr nbedc~* 'T•>1GN4MMaea! epaltn p~o,ided Vv yunnbr . muut wt r. girt, o.E-t - I '(mod' m ~Wr+c Waco far (6esYSem ~.a ab~ m the Caw+t• my oo roMam fra rton8onslt meaecm~ ~UU-G39R lR- t Vt! I I fAW t3~H~t~ ~f Systp~ T II -I I urc!, r I j Jjlvy ~~.-~C Ii ~1• - A, a.it W•. i; r pp pp ~ t 14 Lj _ t t I I I i CONVENTIONAL COMPONENT DF-S!GN Resident!&f Apptic?4j!`n Mnn X AtNJ 7PAGE PRIM Name: r, fC CwrersName; Owner's Address: Legal Descintior:_ rl Township Ccrmiy SJLerojsjnn iVame W ~ 1 1 rjW Pit r.oi Nurlber ?'9 fCG1 ir' i.Jllft}i',:. l1~ - I 113 - -yb obU Page S - l tifeXBnrJ tike Page 2 _-,.Pref. page' _Sys- G2;r, 2 Crass-Se iion Page n Rlt r i7 MfainiErance !n:onnat_u7 anp 6 _ Maraq`c ,re ; i?an =rage 7 St Ctoi Cty Septic Pa j ank 1/~t ~epg E Form ge fi _ - Vrfarrent Deed 'ago 9 A,'taehinWs: Icnif Te:v s F'rn+se r-runs jc5lsa Nurnbsr - -i Phone Number r II. .In r; rr; pur a - re- / i , O 4Akow. mfi2 fA6 ZCMijjo~n yso avQrL.c~ok PASS ero. t3oN~~, systp~, leer = ` 5 f~ 9D UJ~(~(laeE~tS ~rS~-}RoH~' h..cRvS~1l D5 j p ( ( a ,k 1°~- ~.Lq 3~ay~ltaN Sr wry t, y I y ~ct<i! 4,_.. b~n~,r~p~oFS ~ s~ua a~__~~£ae88u~s . 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ET:!L`..a nt'C.t1y~ ~c:.a may Ityl.~:aR E :-1= a CRFIil[k=1 .•i l ~aQ~as ~F. ~1C-' . aG!1CY~ irnmearm nof6m'-lien e; ;he Rmsd t_-p4. lzni tiitilEn tho sa:Wriad twuzzzam im Q5 "lU g? ariti s wl o ui My unk arIv* aJrre^ftil.~$} or mm & Nn* ia* ttra''Ama, !be nriire ;at-te e. :Da zzz,k ziWfi 1 C r vexi Ly a C_aiaga E~_yV0.'Ftg opwar-.r of d Qstas='ci c:-- Im a'^C- `ardarra vim'- NN ')1 W. lM1!iSC:~dm:SdadnitrntiV9 Cade- All n i:C S'vl'Agzs. SaCit;~:rsa_ M got li=:.1'id4 to zhe E vii inn T ^v-M 9 M flfka.-`"., n'-Gii°-`-'1c'al `ir i7.r-Lmmnini ur.iL' and :r.ti ~2i1 :5'Sfg is a=s?2 mrnt -_',-.A he im?rormav by ~.amt(t'!6`FBLt:>LJ2~.'..Ffi_''P.'.?il:fC- A a2xV cn r scar..;h&r ;mvi6al If-'L !.'a: rscui cv !;rjm~in~ .+i:[Hn pie, 34 e.~-n. _'s 3;.... _Lry • erase: {.t,~D97 rQr now zo o,& of e~p'vViS C~edc may hpffee td &--reeo"Gnt pa pass andlor . t c°imen: t[~~~k(9) Pa an vreso~ce aei*_+v t5 acc=ts ar `,n S{ ramov,- by s otays sb;vic&s smzg3 s d saersa' c a [I (a), If high ~ r eri ar hem cats g op<rsm: priar m esa. cer~tk, era dpi hens •Es ton. e-mss 5Y:-..m sr_r UP shy nc accia :v'ren soil ^ -odiaons ar iraeen s<:ha;rY!KraJva eu•fzcs. 3u: MZ; Povra: cutq- ;•.np ...nits ,aay YII e7ave ^am digchargad to The t nte`r~+etcr [cvels Ar is the ~P"=a one MiTe dose, averloadfng a czlilst c7sdar. r. p_awtq r~'t,:e7C o "tavm=rWill be aY'loart. csl(s) in Ta avatti ;;iL; s~ttr-'JCn have wit Come= of the p-,~:- i?n4 "=r~rad by resW; h the power :b fie eca.-a ,m_^ria or . "'"='p er su:;>re.ci[args a; =siara ncnz'_i iaYals p:. oort22^t a Plt,m r ar p0}a/1•g M-'n=i.:ar t,- ZZ a -a ~Ji al:~'t wr Wier to t2starL:~ fNtir 3t_ punp ni rn -z4-any ara oa rLate vii, in d rh's 1 a pa ve;;i~ ova t1.LS and dicaer_i calls. '~a naY drhna of c2 any mound rk aver, or olhHcuiS vri:hi 15 ;z dman slops of or at•a-ade sell abscrpdon eras. ` dt-,_b or ~.Ap^`a, !he arx~ tedu .tan or ermiaevien of the ;7 atairg fro:r, r ?'e am r;q 77.31-ova the t=r;a^„ryalt~ a;:d a~ler,' ;cundeiia-: dts'c, fsL A o'-TnR) was^ ?nri; znd V 3: b!S D acotton swebs d=raSer; dory-? ~s tta of s A-~T rg sra5~~a.~- T°b.s ?naa; ea_eeli- ess diavire, c~=4teCf?.'tYS; rwda, c „ar greaaa; i~•_:a TAM sn..SLIa> : ^ a A&t?c:3~it1:TrL4.r; r i_ and v sr~rta• bring. R" ">~7cn^s prop r1y=_pd sG^i=1y 9bgrdon/ in 'r- ?n jv `a;Zn cu: o.` servic= ~w• ?oliavrin3 ate rr,^.G~co v -d: c5n Ccrnn fiS 3, V:is,-ns:- gall 6a Taken G7Se e: [nor ;h^ ;yetern itL2 sC'~;.iw di! pipirc xe F,-3 and plsa wy?i' bs ci~,onnec~sd abaedcned ~~S ngs sealEtl. end zi'G°_ ^~^ap.-c as c">7Y a aeyTytC a'=.r_ _ 0,.9:?_'= 1.~ yyyMyil. ercl Or ,T'ia~7E 17;5r- 7: >7;i~ S,':imat~:sriiel.he MF piEd crd T6 V0..2 seac2 iTtl will, W ~'i1Y1~iJYL~ LI~.Iy •fcn.^,K•.t~ rlssu.-mss i;i,?,_ u , a.• ~'1~: - 1, c ~V_a a aesit:,. sroa .i as o baen svaluatad aid may be Otifzed systam. Ti _a zapla_tem t Ama shcu?d it for 'Ut=_ lOfi3"Bl1 of a ~t1~~+'ffiL eE snu' n r5quiad srtbectm AmbL•:ud imm drv ba»ea erd cornet d sP,twld not be '.m om sY Jr; and pr Fas_d _ruc u: ia< ffnos 'Id are tmgad aeoi by raatl? ' n_=d mr a rsw ectl =nd sit= eveiu~on to _ ; . ! F 0uF stt t an acp'he r 7 5ma,p arse ir, th Will Co., ply vin ttt> nila ir. affECt zi r'a_ ;;.r.~-. =='abir„ ,.~¢acie ieptz=:n=_nr ac. ?a~^ -~'ata:" sys•K"ms raumt G C. su"teble mPei2cemant area is n.;, ~al)ahle dae to segtoack and/or zoi! li~tedcro tscl'.r:olagv a ha!dina ia;k va be 17; a n' ~r)_!t u o -zr•as in 0}h' i r Y st51(~ s _ Est n;=_a:; m rp aca'ti;e ;mod Pow,-a. G Tre siz yes etr 2c Lielzlfy a zuimbts -ptya'ner., are:.. + ova uauon mue ha Pg aorrt is tact e a sulizbte ,tee pan a tug a , rn'y ba Lea as a lest resort ~nie t era H no replacemenY Paz is ' evCKvn~~ shk a ®i. Fnd alts reA(scz the laid cbvvTa a holding tank G lvioLnd and a grade sag absatption ristaMs rr=y he z-co--L,,M, d in 91,=.= calWwlr; infii:rmr-e =„rixa, r'1Mans~J;tticns of ;u . < <WARMNG>> ch 7;Yatxta ,-rxsY CO,SISjt•, with tha ages in e4'•.''ect g at t[raYS e tftot t .r, Y'ra_ niatrut sr titz ma SEPifl, f"sfiP OF. 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'I ~ypA lam u Yvzatr~ztl detl {a ' olr usi+~dsu! aac r~}~ F .p!,;t~l az ac zr'r=~ ac G31is t~2ds!p 9va s-,rs~n:::ys7YY sstay4sta)~ae .sue Stdtri~in'~ , v(t r P. ~I :F.2F2 sauc 3ac04?N t:,[.2!E SIO.'Snrs eu!-A zi="d ]aod5ul : cam! d ' - 'ln^•<_ ~ :ne'a.^xG ante :4113 a=o _ vll 117 ilv G Ssti.~,?::e r ,y form -CsraseA l' HN n _ >tltg} ;n 47:]c1b:1 :n9 'itujj' I i 76T46y '+~9j x7a "~'t t;t i >a~fi;k4 ti3P3 pt:b a6pn{> eGvRw~:1 .,§tl/:h ao 3;s§a'%tR dN ausl~ uT ('Q at = {51 m uaPu ~=~i f :ri:~ rua SEt2! 3H ~ m it6r g j .n C. •,„.',yn~lanl3g i -s i'-- a~ ~ -r=n?0 ~ HT~ G i uerto f - c ,a o: i atsctvd GIs^ u6~c 4 Ni V14 E3 -L, uv rs aGy n '-Ac a V- t7 I V N ❑ I Jot p5lp-dawwiz lo! 51 Au=:) A~ Q i Ss7 !aaluayaa!g VI . ~1 ~•-7t:xJ~%1 © !,A'-sn~ -tt S oom {gr r~s31 . a ~7 'teraa ~ 7~•a6s, ESzxane .*dilwcJd wa2;- - "/N G I5Ilr i ec t sp cA _ lec r hest LT HY ❑ -1 OTa '.'IL?3} ~U•sa a 6kFL laa!udexx.2 1 u- nov ISL. i~ t: )ice 9 j ~,a'3ax.rts n!tuvu~ ! ><aesnC `.*~'n'c3f3!?s•'t~l B=A?~- S Hit 0 - f .'.,!i3:.-~1cs ! :SCd Ciel~u!I~v'>' 1!Da dN ?a2w6Y d~ ~ ~ t "dumdlI p-tom` n i S5.? r~ti, 1'y~--3CI itcc ~t ~ HP! . h:~:= {'c_~WA21 ;rtC: y9le:7T.~ v 4'•P§deo Kue; YN, m ;c~ ?ryoa , nut:72 4 sCu aN 3 4 vr•{ A letu>i1N M4 CJ NiMs Hat N >1 a , C-r"~z~ryx-, rRa,~i rx'- ; r a a!~.u1d j •~t~ ~ - r,!.x+,6 'ir13-_-43+p~ t~~T1C11~_-~..~.I 1 ~9f✓:~~7di~d6'~:Lio.dB ~~G~(VY ML•tE~D~-°'E fFl3 NW-W IM30MY yt'M V WClisrM s.u,43`--rYAO S1}A06 Technical Specifications PL--525 EFFLUENT FILTER (COtl MERCIAL) IavlsisoY i yy- ~ I, i / fd FfFt[trU A'A IIFI 7), Hb lf~ ~ =.UIUIi 9MLL ~ UGI I sn I PLSSFILIERRGG9NG r, I I -•i u~' i , y PARING.-331425b MAOIAL HDJ9NG-PGLIPNGPILEME !1 ^I 1 GGnHMIRING -P%C 6SBkL -HOPE Lt v -xnel_unsNOVSaa .-yam---' i'--- I 11. ' 1--7 (~a1QLFAIPIIi'. i I 1 ;ICY _ `1 = i I L -aualenvn Iw I ii I i r If ! 1 ~i J' [I ~ nr., tt j. r=-- 1: ~ I ~ I~ of j1 Ie~ PGLII.GNPLS25FR.iCRGARIRDGE ! I i t I i l PM1 NQ - 30141.525 !t MAIFRIN.-PGLIPRGPAFNF ! IOP I. I ST. CROTX COUNTY ZON[NG OFFICE CRRTIFICATION STATEMENT FOR 17TILl.ZATTON OF AN EXISTING SF.PTTC TANK This is to certify that 1 have inspected the septic tank presently the serving _j{~Pn residence located at.: U_W SW ~ Sec. l RA3 -W, Town of _ PuosoN St- roix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good cond•ti and it appears to be functioning Last time serviced properly. - --1 _10 0 E. - - Did flow back occur from absorption system? YP_9_ - No V/ (if no, skip next line.. Approximate volume or length of time: Capacity: gallons minutes Construction: Prefab Concrete Manufacturer Steel. Other (f known) : W icieq - Age of Tank (if known): r (Sna -ur - - - i (Name) • Plea.^.e Print ` G (M cense Number - r- ~ ~ V~ I EU (Date - Form to licensedbdisposert(NRh1131WisconsinlrAdministrative6Code)consin Statutes) or Plumber (applying for sanitary permit) Certification; In accepting the above statement regarding existing septic tank condition], I certify that the tank, to the best of my knowledge, will conform to ~he requirements of ILHR 83, Wis. Adm. Code outlet baffle). (except for inspection opening o er Name Signature _ MP/MPRS - - aaa ~ c~ y CRO1X ('01-1-TV 9,4fN"TEN?vNCN• AGRET3NtF=N'C AN D c %VVNERSFII_F C'ERTT-FICATION FORM Leiline address - - e~ 1-- -71 :'t n; city :\ddress _ ~t fVerification required from Platuninlg & Zmftig Dcpa^tment for new cinsrmtrtion.)--- - - C jiv'State Parcel ldenvficat on Number LFIGA.I, DESCRIPTION F"opnrt}' LnC:3itnnS ,S . Ser. - 1 ` n- 1 r h; R Tn ;m of __14 1~S b rv divisinnT`Ir.t: W Il\bW - I`ldpps~ d Lot s crtificd Survey 11TRp" Volume- Pape#. \5'arrantyT)cci4 (icfore200T)Volsmc paacIi Suet hoasc :'yes iu, Liu lines ideati,ink!e ❑ ves: no ti'FF 4AL'~ FPNANC'E 4tin OWNER CERTTI+7C ATION improver use and maintenance of your septic. s; stem rvWd revel:. in its Premature- failurr. en handle wastes Proper ,.,..irecnau.c ;.onsistc of pumping out the sentic tank even: three years nr sooner. if med.^d, by a lirensed pumper. Vviiaf yo- i„d into -'ern can affeet the function of rite. ann r;o lank as a treatment st2;[c it the. waC.^ disposal sy.atem. Owner tntnit.natt::r >nnsihi!;ties are. specified ❑t §Comm. 33.52( t) and in Chapter 12 - St. Croix County Sanitary Ordinanoe. The property owner a_vrexx to miba:it to st. Croix Cunnn- Planning Zoning Department a cwtification form, signed ir, lhi err and by a master i,iumhcr, jow neymau plmnher, resuivip.d plumber or a licensed pumper verify-ing that (l.) tic on-sire •ater disposal system is In propr., operating condition andsor (2) after inspection and pumping (it necessa.: r), the septic t.ark )i3 full nfsludge- ilwe. the :ndersig;trd have read the above rcquu•clnmts and muee :o maintain the private sewage disposal system with Ov- ' W113 sec fo-m. h-erein as set by the Dchattment of Commerce and the Depamnent of Naratal Resmtrc<s, State of Wisconsin. ' -ibr, i ante Il'ai to.r scotir svsmm has bean t a:ration l must he rpmplctnd and rctumcJ to the k. Croix Coaniy °latair_ n'. ' -i,-panment within 3^ iavs of the. three, year ca titatinn laic.. L tsr .entfj :'tat 1 ttalemcn s I, corn arc n.. tc 11. '...t 0(-;m o'r 1- ,„v la. ire L ,.r r„ J s._nhe bovr ht art,°,a ive +tr;a e'..,-,;ter'n's ISr tber bedr ont IGtA. 1. OFAPP'•IC'A\1tS) T)A'rT `'*Any infor:rati m the.: is nis, . -c'r.'lice may re, in the sanrcap, permit. heini:, revoked by the Planning Zoning Denarme.rr. tr.ch'dc wi[F Uv nl' aoan r r . is .ia--2~n ti: ro frtur. 9; r. r rcfcr nc -nd coi•, ;i ,':-,._nin :I q:rt-cv r'an is 4 WKV f1g+0?t Form- STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER. Y '.V ~~B[/Q~et>p~.e,Jj~f051NSRIP Nw./s..t/ SEC. _ T N-R H ADDRKSS OR' .(/,,.,ts,~, ST. cROIE cOUNPY, WISCONSIN SUEDIVISION 1,/jjtm", ayeC. eyLO'f ~7 LOT SIZE 2ra c r--s PLAN VIEW Distances and dimensions to meet requirements of ILHR 81 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM a~2 W' S. t I N tY D c ~ r r. J INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used a j 1/ 6 Elevation of vertical reference point: 1D0, " Proposed slope at site: SEPTIC TANK: Manufacturer: A Liquid Capacity: Z j jo Number of rings used: Tank manhole cover elevation: _ Tank Inlet Elevation: Tank Outlet Elevation: - Number of feet from nearest Road: ProntoSidejoReer,O_/DS feet From nearest property line 'Froot 0S1de 0 Rear, 01,06- feet Number of feet from: well _$,,d , building: 2.7 ' (Include this information of the above plot plan)( 2 reference dimensions to septic tank) PIMP CLAMBER X.i,T,pfsFturer; Liquid Capacity: Pump Model: pump/Siphon Manufacturer: &p Size Elevation of Inlet-. _ Bottom of tank elevation: Puny off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, ORest. O FE. Nmber of feet from vell: Member of feet from building:______ (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: x Trench: Width: fem. Length:Number of Lines: Area Built: lS Fill depth to top of pipe: 2 w C Number of feet from nearest property line: Front, O Side, Rear.n t. 9s , Number of feet from well: CVO ; Number of feet from building: GJ (Include distances on plot plea). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box0 been used on any of the above soil absorbtion sytems7 (Check one). iOLDING TANK Manufacturer: _ Capacity: Number of rings used: Elevation of bortom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt._ Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: I Inspector:- Dated: 1%;L plumber on lob: License Number:Q T 3/8A:mj 'o"J,consnn Dc;!arLnent o'Safety and professional:ierViCeS Page lof3 Drrisbn cf Ind. St;,' Seraices 2 9 Lrm SOIL A RT In acroroanoewi;h SPS 385, Ws. Adm. Ccae County A7ar;n cono el site r.I on caper rot 'es than 8 1!2 x 11 aches m size Plan must me tale. St. Croix bt.t 1ot I rrrrxl to ver.'cal and h;n-,waial,:efe'ence po rt (6411, Cirocuu-1 ann percent s. Cpe Parcel I.D. scale ;:r dimznscn:; n n,t, 3rovr. and Ior:ab;:n and distance (r. nearest road. G20-1173-40000 Ref. #2012 Please pan[ all information. Revs day Date / PCr r i I'll :rmulir-gLprr.vrf - r m, ne asco I.n secu dan• rue}':>zeti pria9ry Lo-ar 1 4;`'timli - f 7 - P'c: t v Ov -r - P•ope4Y Location Mary Abel Gout. Lot SF N SW S S 17 29 R 1 E (ol 4'd Properly Owners Mating Address I.ol # B:ark # Subd. nc or CSr.1# 450 Ovoroca Pass 87 na - P at of Wil lour Rrfge Fast City Stwo lip Code Phcre Number C1y ❑ Village ❑ Town Neared Road U ucson l•VI 154016 061. 1 598-6666 l Iudson _ I Wen Rd J New Ccrsi,uClion Use X~ HesrdenUal i Nu»bcr of tedrooms 4 Coale dewed ces gn 0ow !ste 600 GPD Replacement ❑ PubbC of cornnercial - Describe _ Pared •ralerial Glacial Ou:•,vash _ - flood Plan elevation it applicable ra ft , 0cnaal comments and recommendations Sur evluaoon completed to verify soil surabA:ty for •eplacemer.l dispersal cell instalation. Site suitable far renlacemonl in-ymunc d speisal eel writ L' 6 pgd: iq ` loading role RecommendeO 3 venches •wth infiltrative su-tace clevimil - 92.75. Exishny <ospe,sal ::e I infiltrative surface elevation - 9443' is, s.nlable for reconnection with diversion valve. Bouny # Boring ❑ pit Ground surface elev 99 74 ft. Pepdt' to ironing factor 5146" n. _ Soil Apnhcanor Ra;z Horizon D"11- f;ominarl Cover Redox Descnp/ion Texture SlfnCafe Consistence F3cuncary Roots GPD:Ff In Mursell Ou Az COn:. Color L'• Sz Sh. 'Eff#1 -F'flt?_ 1 0-19 1i;yr:!:3 & 4:4 Tune sills' fill 21ntl R dsh At 2vf,f 0.0 00 2 '9-36 _'Gyr2il none si 2fshk ds q•.v tuft 06 0.8 Ir a 38-52 10yr3:4 rone sl 2fsbk rnvlr q•n• vfJ 0.6 0.8 1 52-71 10y*4 rare sicl :msbk rnfr aw h4 0.2 G 3 0 71 '8 1 5y*6 - none _s 0.s (j _ all cn 07 '6 6 7R-146 10yrz.16 none s ^sq d: - I - 0 r 1.6 105-140 hand- augcred - I T - _ Bonny "1 t Boring it L Pit Ground surface elev. 100.41 ft. f Depth to hontai la 4 ctor 130 r, - - Soil Acol.ca uo .tafe Horizon Depth Dormant Color Redox Desolation Texture I St'urture Consistence Scurdary Roots _ GPD FI In Alcnsef Ou Az Cont. Colo• 11 GI S7 8h 'Eff#1 E11#_7 G9 1Gyr3:4 - mire sil fill 219• mvtr q5 2vf,11 0.0 (7 G _9-32 1Cyr5:4 lone SIT IN tfsbk ds as 1vf,f 0.0 OA 3260 '0yr3t2 none sit 21shk ds' qs 06 0if 4 (i0-94.. IOyrM1•4 rove sa 2msbk tlsh as 06 0.8 94.100 10yr5:4 pore sr 2'sbk dsh cs_ 0.6 - r, 105 111, I;iy:4:4 none III gr Is Osy dt - cs - G 7 1.6 115.13` 1Cyr4.4 ~•1 a grs ,csy__,• tl 1 07 16 Efflux nt#1- BUD- 30 ?70 •Land TSS~~O'-150nc,1 r _ ff~ucn_1 A2=HOD_. 130 22C mg:L and ISS>30 r: i50m ill CSI Name ~Please Printi - Signal re CST Nunozr Jarnesl< h 1 cn:pson yr_ _ :1002' t-- 1, Adoress ate Evaluator Conductet - Telephone Number 340 Paulson Lake Lane. Osceola, WI 54020-54 L: July 09 20111 • r^ 5! 248-7767 / I Hai rr k :5 Iiomul J _ Pi: Gr,:um: suface elev. 59.02 ` Depth limit rg factor p'24" n• Soil Applica_ho•r Rale Hcr zon Depth I Dominant Color Redox Description Iexlure Structure Consistence. Boundary Rods GPUiht' In. fAunse. I Qu. Az. Cont. Co or Gr. Sz. Sn. 'Hf#' 'hIH/2 t 0-8 '0 yr3i3 none sii 2fgr mvfr cs 2v`.1 0o 08 621 'Oy14i4 none sl lmsok mfr es ivf 04 06 Y-2ro 6y' r4i6 none IS 05g ml w - 0 - 1.6 4 26,28 1Ovr4:4 none s Ogg dl cs 07 1 G 6 76 124 10y'6+4 none 1 dl 07 1.6 5 48-78 i0yi5+4 none iGlivel 4saf,acp idl cs - 07 16 U Roving a14 Bo rg # ❑ Pit lev Depth to limiting factor _ in. Solf n Rate Horiion Del Dominant Color Redox Desrnpti Texture S'ludure Consistence Boundary Roots GPD:FI` In R1unsell- Ou Az Conl. Coloi Gr Sz. Sh 'Ftti/t Al Boring # Gonng r Ground surface elev II Depth to I,miting facto' _ in Soil Applicator Rate Horton Depth Deminanl Colas Redox Description I l ex:ure. Structure Conss:ena: Bounoary Roots _ GPD;R' In btunscll On Az Con:. Color G• Sz Sh. 'EH#1 'Eff#2 E`fWern #1 - BOD. 30:L* 220 nail and TSS 1 30 < 150 mull ' Effluent #2 - BOD 30 e: 220 mgt and TSS > 30 5 150 moil. 0/7 e-10 /Q ~S~/C✓Q /KQ ~im fJi~ ✓ ~ EX.s E,ny 9~dtt/e.! 5ca/ : J S'~/ ~ir¢7S/2 ~r«-v w~ a v- ,t/i.dSor+, H.V. Ss/Q16 ~r87 '0/-f<{.~:/~>~ fit Sr %05,,1W mac7192 /0u. rvs0-//73-+/Q - I ~ I ~aru9( I ~x/'s 6 ~1 ~ ~ J Qt S. ~s..q c 1 ~ . u well ` F E.1ecb;~ I 12 I Wov O.~ t o J_~ A/o%,ca i' EXiJfin ~cio d~ o Y ~ ~-rte I - k:~~C.ncrcft d ~ W w ' r j 3..cpFrL6s.t~ ~ J I I L~ • 8 2 01 o ~..,t e.w. Assn /Ooi0.'f Eve ~~Frtu t/s✓= 96!43, r - 990' /~a15