HomeMy WebLinkAbout040-1278-50-000 (2)
Gc.my. SL. Croix
an5a's n Oepa t^em ~t cc Dice PRIVATE SEWAGE SYSTEM
salery a•rd'sm ary Diwsion INSPECTION REPORT Sarrtary Penm: No 6069221
GENERAL INFORMATION (ATTACH TO PERMIT) slate Plan ID No
Pulsoral i-fir,m,9y De used fc- secorda'y parpeses r,ivacY Law s'5 C4 ;,1 )(m)',
City VJlage Ica^shia Parwi lax Nc
Petml: I'Cie 5W...e 040-1278-50-000
Todd & Diane Hovland TOWN OF TROY
rnST Bill l eIu.P BM E7 SM Des: ipvon Seetia'v'l o.vn!Rany~ M16.28.19.15571
6p.gI '5` GoJ« TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION HS Fit FS ELEV
Septic Benchmark 05 , Jy.4 9ag~
1 bit n QStti. Z Sa ,
Dos n; Alt. BN1 Z ,05 z~ •1D
1 c✓ zS
Aeration B'dg. Sewer '
Y`1~+
Told 119 SUI(t Inlet
SvHt Outlet
TANK SETBACK INFORMATION
I ANK TO PL 77oj'E_LL HLDG. VeM :o m!a'.e ROAD Dl Inlet
/ `fi'r
Septic t /05 7 DI Bottorn
Uosing Heaaa'fn9an. 9,0 go,9/
• V
- Dist Pipe '7. Z art
Aeratian • 7
Bot. System L /Q
Holding _
Final Gracc 3, p 9(0111
PUMPISIPHON INFORMATION O Manu'actu,er Demand St Cover 2-116
.
GPM ca
Model Nurbe' ~6
7DH I 1 Friction Lass Sys7err TDH F: f /d, 79, 7
O
I-crcemam Length Dia. Die; io'vNull -
SOIL ABSORPTION SYSTEM
EINFORMATION t'idCi _englr If No O(^urC es PIT DIMENSIONS No. O' I'CS I•rside Oia LIcmC Dep:h
3 CM too 2
SYSTEM TO PiL HLDG V'ILL LAKEiSTREAfv1 LEACIUNG F/d w
CHAMBER OR
VX W r UNIT plcde'Nl.mbr:r
Irpe of SjS1Cin 7A 17 /V
Cs 7r
J
DISTRIBUTION SYSTEM E r _ ZC i--~-
x lc a Size x Hele sPaorg Verryt to Air In:a'1e d
Head'fVa-iru, Disttol".C1 Ldr„~tia
P peisi
IIII ~ v~
'..enoU D n 7 I nrg:h_v_. Iha Spacing_
SOIL COVER x Pressure systems only xx Mound Or At-Grade Systems only Mul ruJ
~„ptn C'et Ixx Dcol•rof x,: SeecuJ!Epdoutl
Bc•Jr lre_nC';;en-er 5 Br:'"enc^. Edgcs~ F` ~ -~.ync~hNO I Yes I No
COMMENTS: ;Include code oiscrepenaes, persons present. etc inspection #1 Inspection R2
Location: ?gc CEDAR C7
1 Alt BM Deser'pOcn = t ` 11-°V~L•-~ 1 U
2.j Bldg sewer length = jr-'t
- amo,lnt of cover = I ) VVV~~` AAArrx!!!
Plat, revision Requ~red7 Yes No I ( Q q1
I 0
Use o:ner Sde for additional lnforn2tiOn Doe - - - Inseaulo S'gt a Cert. N0.
tAil; 510 it 3 i'
~pAXfNI yt \ I (Ilnlll\
Industry Services Division St CrolX
1400 E Washington Ave Natiamy Perms Numtwr i lu be filled in b Co. i
P.O. Box 7162
MadisoA•WI 'IV-It /_Y_QzZ_
hrPN ~,I r
~
Sanitary Permit Application I Stake] n.I c11,11INumber
In acaminnce n.ill) ~1 } n%3:r1L~ +r-+c01n Colic, suhmu. um n(Ihis ILun to the appn•pnalc governmental unit r~.1}..
6 Ryulf !l j!r1d[latdi. Illllg i Sind n permit Note Application lolls for >laIPON'kiCd P(M IN are Nubulllted to
the Ikl uml:nl of Stlcn and Pr Icy uw;ri Sen 1 c. 1 cnonnl inlOnnation you provide mar be used liir accnndmS'r~/Iruicct Address (it dil7ircnt than mailine address)
pu11s m aecurdmlco I s all the I l l 'sas s 15 (H+ 10,111, Stats 99 Ccdm C UUn
1. Application 11 far I t* It - Please Print All information
Propc n l Iwrci Name I parcel d
I k s land t dd Dimul WO-12'8-5(i{all' S S 7
I6•a8.~9.
Pro{nny lhvner'. Mallow Address Pfo{hrli I oc:u w n
i
S%9 Ce'lar [',,kill
Goal I ,q
Cin, St:m' Zip Code Phoac Number NW Ia,\kV Section 16
liudsm 1S'I 54016 Icirelcone)
i29N : K19ForN'
11. "I}pe of Building (check all that apply)
.S Subdivision Namc
®I Or-' Pamih ihvcllm_•.-Nm::hc: of Bedrooms
Pagle Bluff
❑ Puhhc'Commercial - Dewrthe I.sc _ _ Block n - -
❑ (ltv Of
❑State Owned-DaoflbeFse ❑Villaecof
M CSM Number
n'a~ rl1)t q fl^..j C7/%O-losvn o(Trou -
Ill '1'' a of Pernlil: (Check / \ee AA.. Complete lin B if app'icable)
il ❑ Ness SN,lem ILcplaccnl 3}-,turn ~I lYCalnlcnt HoIJm, 7:alk ILepls:cmcnl <hdy I ❑ Odiu Maldicalimn la Fsisung Syalcm (csplaml
N. ❑ Poina Renev,al I'euna R,:, I1l0ki ( hans,c Ot Pcnnil Transfer to New I kit f icnokis P:mot Number and Dare Issued
Beadle Ilapiruioll I IulntNr Owner 463423, &1IR2l)(K
N NVSIUn Componult!Device: (Check all fhatapply)
Q 4 n I ssstnvcJ 111-CI unc [ PrcswlrcJ Im( ,,kind ❑ At-Grade [I Mound 24 in. of suitable sod El Mound, 24 in of suilable sod
Iloldo. .w l ltha lhpsra!(bmpancnl,csplain) LlI'rcucaunsnt Delve i"Plato, /z
V•. DlspersaliTreatmc Area Information: G- r Ow e7/QG~7 M7
Dcsl n flow 0•.pd1 D"I n tied \pplicamai Dispersal Areae Reyune sf)s Dispersal :\rea P p:,,c is0 S)stcm Flevat
611(1 RanlirJstl 900 9[,50
n.
N 1, Tank Infa l apacilq in
r o
Gallons 'I'ota' k of -
M8111119elllrer
Gallons it
-
New Tanks IXisling ranks
1
Ss.P I or H,, Idme Tmlk 12511 _ 1251) 1 Wieser [bncrrl ❑ ❑ 1 ❑ ❑
U,,ving Chamher I 1 _ 0L. ❑ ❑ ❑
V I I Responsibility Statement- I, the undersigned, assume responsibility for installation of the 110%k I S shown on the attached plans. -
I S \t Pk(S \lunher Business Phone Number
I'ImmII r s \mm J'finn Plun)ner I l Were MP
Zahn Schmitt ~/h~
1'1 label Addles Isttwc f'as Sial.. Zip Glxlel
616 150h Aver:. suiwr.ct. NV i s402i
unts'i De iartnlent tlce Only
\pp:r all' Vernal I cc Date I q) Q Isslu Agent Sig' it
/s
` .rE v-n Kcx,, of Denial S ~ O _ - -
1\. C'ondi IN JHF~fi1 R>'itflptfR,h Disapproval 3/ 1
`dr.•n cell 'S( ail I I iti_ e'
ds per mw3tion rn! Fyn p.o 4osn W piwnoe:.
t s
2. AN eelbvtlc PoCOW16M fnwt w r• AMII it
as per sppkMle cads /:Kwcur.
: M'ere'tN colnplew plan, for Ihe.rysiran and submit w the County hots on paper nut w" Nan 8 1': x 1I inebas in sire -
SBD-6198 IR0314)
SYSTEM PLOT PLAN
Project Name: Hovland Dosi0o Flow* 603 N
Anacn desillc flow calculations to'
Project Adaress: 383 --Oda, Cnur.' commerotal plans: r
BM1 Symbol: - BM Elevation: t37.66 Pipe Niater.als ~ ASTM Standard Scale: 1" = 40'
Bld Descnpbon: Sep@c tank manto* corer _ Tables 304.3G3 8 384.30-5 C 40 60 80
BM2 Symbo! A BM Elevation: as 63'
KZZ
BMDesenption: Sepdctanko Aet "3b3: PVC 0.;?+d-73034
.C.
B'ope Gradient of Tested Area. 000>:
%"It Svmbol ;if aopllcaoRl
Nolen: Notes
Existing T1- 3'X90' EZ Flow trench E1.=90.01'
Existing T2- 3'X90' EZ Flow trench E1.=90.01'
Proposed T3- 3'X90' EZ Flow trench El.= 92.50'
Proposed T4- 3'X90' EZ Flow trench E1.=92.50'
r Omaha Road WW
t
OC
'o 2
~
~U AN
We f~l~ t 10% ~
B ; J
/i Bedrooms` B1 i QL
,r Drive House BN~~ a
;--Valve
Deck
C
Exlst~ng 1 250 Gal.
grope Septjc tank wilter
rt
11 1
Cfne
7 95 93 i
Pace 2
-
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Hovland 4 Bedroon Replacement septic system
Owners Name: Todd Hovland
Owner's Address 389 Cedar Court
Hudson, WI 54016
Legal Description: NW1/4, NW1/4, 516, T28N, R19W
Township Troy
County: St. Croix
Subdivision Name: Eagle Bluff
Lot Number: 25 Block Number
Parcel I.D. Number 026-1090-10-200
Plan I ransaction No.
Page 1 Index and title
Page 2 Plot Plan
Page 3 Septic Tank Specifications
Page 4 Effluent Filter information
Page 5 System Sizing & Cross Section
Page 6 EZ Flow Information
Page 7 Management and contingency plan
Page 8 Existing Tank Certification
Page 9 Septic Tank Maintenance Agreement
Page 10 & 11 Warranty Deed
Page 12 CSM or Plat
Attachment 1 Soil Evaluation Report
Designer: John Schmitt Licnese Number: MPRS 223760
Date: 9/20/2018 Phone Number: 715-760-0486
Signature: I /L 11 `
17
In Ground Soil Absorption Component Manual Version 2.0 SBD-10105-1' IN. 01101)
Page 1
SYSTEM PLOT PLAN
Project Name: Hovland Design 11dw: hoc N
Attach design flow calculations toi
Project Address 389 Cedar Cnur. _ commercial plans:
13M1 Symbol. - BM Elevation: 97. Be' Pipe Matodals I ASTM Standard Scale: 1 49
BM Description: Septic tank mmnhore cover tables 384,30-3 8 384.30-5 0 40 60 80
3112 Symbol. 0 BM Elevation- 93 63' 4' SCH 40 P'vC ASTM.D2665
81A Description: Septic lank o.alet 4" 3034 PVC. ASTM J3034
113,
Slope Gradient of Tested Area. (10'%) Well Symbol iif applicable) _
Notes. votm
Existing T1- 3'X90' EZ Flow trench E1.=90.01'
Existing T2- 3'X90' EZ Flow trench E1.=90.01'
Proposed T3- 3'X90' EZ Flow trench El.= 92.50'
Proposed T4- 3'X90' EZ Flow trench E1.=92.50'
Gmaha Road R
1 ° ~f 48 2
~ •C
U '
i
N
U
Well 10% C
O
4
(tD
Bedroom B 1 ' o
Drive House a
Deck 1Valve
Garag
Existing 1250 ri.
Properk Sepi c tack w ter
y Cine I ~ ~
_97 95 93
Mau =la 9Sb~-SZ4 -JGR ci\
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anod-isod N301vY1 0. AN,F Sn SILt~N I
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Page 3
INSTRUCTIONS MAINTENANCE USA
10013001600
PAGE 2of2 ~
The interval for servicing septic tanks is set by state and local code. Throughout the United Stales, there is a wide difference of
opinion on what this interval should be, but most regulatory agencies suggest two to five years The Zabel filter, which does not
increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped.
However, our filter is virtually self-cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged
particles to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFiltel® alarm, you will be notified by an
alarm when the filter needs servicing.
Step 1: Step 2: Step 2:
Locate the outlet of the septic tank Remove the tank cover and pump the Firmly pull the filter handle and slide
and remove the tank cover. tank if necessary to prevent any solids the cartridge out of the case.
from escaping to the the drain field
when the filter is removed.
Ser~icing any Zabel filter
should only re done by a certified
ii
.r
r .
spray cleat7 the outret opening
before ien~al-ng the filter
0
Step 4: Step 5: Residential Applicalrons
While holding the cartridge over the Insert the filter cartridge back in the Certified to ANSIINSF
access opening, rinse off the cartridge case, making sure the filter cartridge Standard 46
with fresh water, being careful to rinse is properly aligned and completely
all septage matenal back into the tank. inserted in the case. Replace the septic
lank cover.
Copyright 2014. Pory!w, Inc. AN ngMS reserved
Pnoduetrs) covered by cne or more u. S. and/or lntornalonnl patents Ot"rV.S. and lahmnahmiai pelenfs may he.oemmnp.
Page 4
} PAGE 3 OF 5
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Page 5
Installation Instructions for 41 EZflow~
EZJIow Systems in Wisconsin Ey INFILTRATOR
Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area (SF) necessary for a given site shall
Division, has reviewed the specifications and/or plans for this be sized based on maximum early sewage flew (GPD) and
product and determined it to be ir, compliance with chapters the Permeability tot the site. If certain criteria ie. met, the
Comm 82 through 84, Wisconsin Admin. Code, and Chapter.; FISA sizing can be used in Wisconsin, resulting m a 40`Yo
145 and 160, Wisconsin Statutes. All s.tes must meet the ` iitp smaller diainfield.
Soil Condi:ions 8 Lac ins I I i n distances as noted in
local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap-
proved by system design permit specified for the paiticu-
-he approved products are 1203H (3-12" bundles with pipe in lar site. The top or center-most bundles containing pipe
center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles are pined end to end witn an internal pipe coupler. Any
v,•th pipe in each bundle in 5' or I U lengths. addrtonal aggregate only bundles that may be required,
should be bulled against the other aggregate-only bun-
A single pipe bundle conta ns a four inch perforated pipe sur- dies and do not require any type of connection.
ro.rnded by EPS aggregate and is held together with poly-
chtylene neaing. A single aggregate bundle ccnta.ns aggregate : 7. The top of each GEC cylinder contains a filter fabric pre-
only and is held togetncr with nolyethylene netting. manufactured in between the netting and aggregate. The
fabric is inserted to prevent soil intrusion. The installer
Materials and Equipment Needed shall make sure the the GEC is positioned upward and is
• EZflcw Bund!es in contact with the fabric contained in the adjacent cylin-
• FZflew GeotcAric Fabric : der betorc backfilling.
• EZflow Internal Pioe Couplers
• Pipe for Header and Inlet : 8. The EZflow Diainficlc Systems should be installed in a
• Backhoe/Fxcavator level trench in all direction, (both across and along the
t!Cnch bottom) and should follow the contour of the ground
Installation Instructions surface elevation (uniform cepth) with all continuous
The instructions for installation of EZfiow• procucts are given adjoining 10-loot cylindrical bundles placed end to end,
below. This Prod,rct must be installed in accordance w^th state wit, central bundle distribution pipe interconnected,
nae s detinec in chapter, Cornnh 82 through 84, Wisconsin Ad- witnout any darns, stepdowns or other water stops.
ministrative Code, and Chapters 145 and 160, Wisconsin Stat-
utes, as well as the local health department's current design 9. The trench top shall be graded such that water will not
manual. pond. Ra::kfill should he seeded or sodded immediately
after completion to reduce erosion.
1. After the local health department has determined sizing, :
configuration, and layout for the EZflow systems, stake 10. EZflow EPS bundles are flexible and can fit in curved
or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or
careful to set correct tank. invert pipe, header line or dis- other obstacles.
tribution box and trench bottom elevations before instal-
lation of pipe bundles. 11. EPS aggregate is lighter than water, therefore, it might
be experaed that natural buoyancy forces would lend to
2. Remove plastic EZfiow :chipping bags one, to placing : cause EZflow assemblies to float out of ground when
bundles in the trench(es). Remove any plastic bags in the ponding occurs. Field experience has shown, however,
trench before system is covered. that this is not a problem when systems have a minimum
' of 6' of sot cover as recommended by manufacturer.
3. this product must have geotextile fabric that meets re-
quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code,
installed directly on top of the product and extending 1203H-GEO
down along the sides of the product to a point at least six
inches from the bottom of product. - Geotextile
• f Barrier Material
4. When installed in a trench, the trench should be dug to
a width of 36 inches. This not only saves labor in excava- llhy+^ '
tion, but also provides better load-bearing capacity after
backfilling is complete.
Page6
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) 389 Cedar Court _ located
at: N'W ~iA, NW_ 'in, Section iS , Town 28 N, Range 19 `V,
ToNvn of Troy , St. Croix County Wisconsin.
Upon inspection, I ccrtifV that I have found the tank(s), to the best of my
knowledoc, will conform to the requirement: of SPS. 354.25, and it (the,,_ )
appear(s) to be funetionin° properly.
NAi ct re.nnt rinta of injnr•.rtinn cir cr i~r
1. -
Did flow back occur from absorption system? Yes__ No
('if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: _250
Construction: Prefab Concrete X _ Steel Other
Manufacturer (if known): Wieser Concrete
Age of Tank (if known): 13 Years
Permit number (if known) 463423
John Schmitt
(Licensed Plumber Signature) (Print Name)
MFRS 223760
('T'itle) (License Dumber) MR*WRS
(Date)
Form to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and s. 145.06. Wisconsin Statutes) or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rev. 2%2012
Page 8
PAGE 4 OF 4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin, Code, this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code
Maximum Dispersal Area Operating Limits:
Design Flow= 600 gpd; BODE 5 220 mgL"; TSS <-150 mgL"; FOGS 30 mgL"
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
c age of system
o nuisance factors (i. e, odors, user complaints, etc.)
o mechanical malfunction (i e., pumps, valves. switches, floats, etc.)
material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution /drop boxes)
neglect or improper use (i.e., exceeding design capacities. prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
dosing irregularities - if applicable (i.e., pump re-cycling. float switch settings, etc.)
• electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc )
o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification)
v surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113. Wisc. Admin. Code.
o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturers specifications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: John Schmitt Phone: 715-760-0486
Local government unit: St. Croix County Community Developement Phone 715-386-4680
Local government unit address: 1101 Carmichael Road, Hudson, WI ZIP: 54016
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code, Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Contingency Plan
In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be
abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33. Wisc. Admin. Code.
Page 7
i
ST. CROIX COU'NT'Y ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) 389 cedar Court - located
at: NW ''/4, NW''/J, Section 16 . Town 28 _N, Range 79 W,
Town of TroY St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of SPS. 384.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service
Did flow back occur from absorption system? Yes No
(it'no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: 1250
Construction: Prefab Concrete X Steel Other
Manufacturer (if known): Wieser Concrete
Age of Tank (if known): 13 Years -
Permit number (if known) 463423
John Schmitt
(Licensed Plumber Signature) (Print Name)
MPRS 223760
(Title) (License Number) NIP/MPRS
(Date)
Form to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rev. 2/2012
Page 8
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/13uver Todd & Diana Hovland
Mailing Address 389 Cedar Court
Property Address 389 Cedar Court E}
(Verification required from Planning & Zoning Department for new constructicn.) I
City/State' Hudson WI Parcel Identification Number 040-1278-50-000
LEGAL DESCRIPTION
Property Location NW 114 , NW %a , Sec. 16 , T 28 N R19 W,'town of Troy -
Subdivision Plat: Eagle Bluff --,Lot a 25
Certified Survey Map # _ , Volume , Page # _
Warranty Deed # (before 2007)Volumc Page
Spec house oyesao Lot lines identifiable ycs[Ino I
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic systetr. could reault in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three 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. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
t
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 vCrtying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is ;
less than 1/3 full of sludge.
I/we, the undersigned have read the abcvc requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resoofces,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Phuming & Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statementsn this form are true to the best of my/our knowledge. l/we am/are the owner(s) of the
property described above, by virtue of warranty & -cd recorded in Rcgistnr of Deeds Office.
Nutnbe rooms 4 VVV4APP
SIGNAURE. OCANT(S) DATE
i
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. ` f
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
Page 9
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Page 10
WlsoonsinDpartmantotComm oxf PRIVATE SEWAGE SYSTEM Corny St. Croix
SrsN and euWirg oNvision INSPECTION REPORT Sankey Prmtt Nn. 463423 0
GENERAL INFORMATION (ATTACH TO PERMIT) Stets Plan ID No:
Personal infomudion you provide may be used for secondary purposes [Privacy Lew, 9.15.04 (IXM)I•
Perrin Holders Name: City vi ww X Township Pa" Tex No.
Troy Development Co ration Troy, Town of 040-1278-50-000
CST BM Elvv. 1 Insp. BM Elev: BM Dwcdptldn: SecdrJiovMRangeNsp No:
16.28.19.1557
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark H /
~ Z5D 2.~5 oz on.D
Dosing Alt. BM
Aeration Bldg. Sewer g•fl~ ~e1.
Holding SUM Inlet ! 7 /
Ol q3 b 3
TANK SETBACK INFORMATION SUHt Outlet
TANK TO P1L WELL BLDG. Vrdto Alrlnleks ROAD Dt Inlet
Septic t r Of Bottom
Dosing _ HelderlMan. 1 90 gDl
Aeration Dist. Pipe l'q0 O.S r
Holding Bot. System R-Q i Z. b CIO.0
Final Grade /
PUMP/SIPHON INFORMATION g'am'
Manufacturql\ Demand St Cover 4.49 94.?on
GPM
Model Numbs
TDH Lift Loss System Head TDI Ft
Forcemain ength Dist w Well
SOIL ABSORPTION SYSTEM
BEDRRENCH Width t Lengthy No. Or Twichas PR DNMENSIONS No. Of Pes Inside Dia. Liquld Depth
DIMENSIONS 3 0 Z
SETBACK SYSTEM TO PIL BLDG WELL LAKFJSTRF1tM LEACHING ManufaCW
INFORMATION CHAMBER OR !~1
Type Of System: 15, 50, UNIT of Number,,..'
DI S~
STRIBUTION SYSTEM
li 1 bederaAanifold DlstrLrtlion x Hole Size x Hole Spswv rent to Air Intake
Lertgtl, Dia_. LengthDios Spacing_
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx SeedediSodded Mukw
Bed/Trench Cann BeNT,ench Edges Topsoil (Mi Yes ENJ No Q Yes *1 No
COMMENTS: (include code discrepancies, persons present, etc.) Inspection, Mt~'y Inspection 1t2:=r=7^
Location: 389 Ceder Court Hudson. Wl 54016 (NW 114 NW 114 16 T28N R119W) Eagle Bluff Lot 25 Parcel No: ~16.288.19.15~57
5 T= w.lt tMXr ( SyO~-, C~LaAt OAQ4 J.» vjA.~t4x+~•~
1.) Alt BM Description=
2.) Bldg sewer length = 3O r ~0 A +
- amount of cover = 19 `t+ Sa-k COLAr. 0A
3) WRY ~ tv,# Cev.S~r~at~RL), o-~ ~'6{YIC-'{tbs., Qs~.e. - P°^
Plan revision Required? W Yes )(No 0 v.Z9,
24~
Use other side for additional information. Lis .'•S
e s - r m-
seoe710cR.397>"a `+5° 4 1 E re_Sa .C51 RtdC w6~
t,5 --0.49PA;;w- Snis ~y s•a Q ~ Cat 2 c.. Qa~i a Q~.l+~~ns Cr.rec~ . -
'WisoosinDepartmentofCommemo SOIL EVALUATION REPORT Page L of
Dlvislal of Safety and BulidkVs _
In accordance with Comm 85. Wis. Adm. Code County
3C. CRo~x
Attach complete alte plan on paper not less than a 112 x 11 Inches In sizo. Plan must
Include. but not llmlled to: vertical and horizontal reference point (BM), dirudion and Parcel I.D.
percent slope, scale or dimensions, north arrow. and location and distance to nearest road. _
Date
Please print all information. Re,4 wed by
Personal Wonnelbn you provide rosy be used ror secondary Purposes (Privacy 4w. s. f 5.aa 'nn
property Owner Prrnlody [.;cation
C41Al2L-95 5 LU0Y~ G&A- t NVJ 114NW 114 S 111e T ZS N R 19 tWW
PropertyOYMI's Malting Address Lot # Block 0 Sid)d. Name or CSM#
11800 RrSFYZDEE 5T, NE SulTe t0O 55 j - BLuF~_--.
qty Sleto Zip Code Plxxle Number ❑ City ❑ Village Town Nearest Road
-TRov TovJ~UAU-EV 20,
6UAlaj;~ NvJ L1~+9 (763) 75bY
1 \ ~
53 New Construction Uso: J?31 Residential! Nundrer of bedrooms LiCode derived design flow role (o GPO
El Replacement ❑ Pub lc or commercial - Describe: - -
Parent material SAWbSToNE I" Plain elevalkxr Ile ble \Q. ~
.
£ zwEp
General w m er is 2 f IzFiJCr18s C 1104
O~I •A2zl.Ul
and recommendations: SVSTEihE~cVA~l I
I I NOV 0 7 2000
t S S ca Cm
4Mr
ZONrNGO,rl r.
~ ❑ Boring - .1
A ® Pll Ground surface ale 921..45 1t. Depth to krilli lg factor In. to
P
1 Depth Dorninanl Color Rlxlox Description Texture Structure Consistence Boundary
1 EttQ2
In. Munsell On. Sz. Cant. Color Sz. Sh.
I io Iov?-711 A -m rnl O ~S O (o
z b Iwif-47 i b aG 0, 0.2
s I~-msb dsh s _ D,l 1.2 ~
3 Z-20 3/g
\jC31 r cis 5 - 0 1 I'
zo- D
5 DYK3i ml c-5 1 m l LZ
H 94 to ml
I❑ Boring
5 Boiling r
Q IOI Pit Ground surface elev. _ 2q 3• 3~L lt. Depth to gmi0ng factor -Z-Pi- In. Soil Ifon Rate
GPDIfF
Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots •Effpt •EQk2
In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh.
-i -m d 1 b Z 0,5 0,
I 0-b o r4I
2 -0 3 1 2msbK d'5 b L-f-GO 0,5 0.. - (P
3 t 1 0 314 SI I sb Ls a5 . - 0 O .4
1.2 3-
IS J5 Z{.m
y I -
-40 Oy 3/ IS h - ahl u G IF -m
L 40-58 0 e _ 5 ^ I c 'r b I
-S I C6 mi - C 1.2-
7 S8 4S I o N
• Effluent M7 a SOD, > 30 < 220 nlgk and TSS >301 150 mg/1- ' Effluent p2 a DOD < 30 nglL and TSS < 30 nlg4.
Si I love CST Number
CST Name (Please P" 2Z4t13Z
STE3
R O
Dale Evabal'on Conducted Telephone Number
Address '
I,AR1S (df0 .iuEtZFA ND lo- -00 01042b-1-1-75-
LOT 2s
rProoper~ty Ovatef ~0 r 4" hRLj _ Parcel lU N Page 2- of.
I I Boring p ❑ Buring
I - I Pit Ground surface elev. g2y;2L DeMh to limiting tech in. ~p Ilcatlon Rate
Horizon Depth Dominant Color Rodox Descripton TexWro SducWro Consistence boundary Roots GPDM
in. Munsen Go. Sz. Cont. Color Gr. Sz. Sh. 'E1701 'ERfi2
I 0-b to - st d I 3ff- s a.9 Iv
21P 1 0.9 .b
z I7 10 Z - s m tnYfr b
3 Z •l 3 ~ fr CS _z- lp
2(4J40 )7.610411 5 r G rn, 1 5 2 m 7 ,2
J D14 Vt 4 . 1.2
gt Z" A - 1 rn I
Be" # E] Be" 14
~ pit Ground surface elev. ft. Depth to landing factor in. Soil Application Rate
I+ Horizon epth Detriment Color Redox Description Texture Slnrluro Consistence Boundary Roots E GPDIfFEfT>IZ
In. Mansell Ou. Sz. Cont. Color Gr. Sz. Sh.
I
❑ [IOfhlg N El Pitt Ground surface, elev. _~._..-rt- DapLlr to IimiUnp factor
Sol Applicat Rate
Horizon Depth Dorniianl Color Redox Description Texture Structure Consistence Boundary Roots GPD f
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sit _ 'EIfd1 'EQK2
' Effluent at =BOO,> 30 220 npn, and TSS >30 < 15o myl. ' Elnuenl p2.. = BO(). :S 30 nVIL and TSS 70 MWL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate formal, picas: contact the department at 608-266-3151 or TTY 608-264-8777.
Sao 600ta.iW1
PLOf PLAN 7AL ;~ff
f'RGi"ORfYOWN~R: COO: CNAftLYS ICGc~:_ ~ y(J~
6L LuF ~Oh'r- *LTO 0FA) IL N h
A-ml) THE uoFZ ,p1~J I VC PIPE I~ E WJp 54R
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224832
PAT: 10-30-00
PAGe Li of 4
COWTOwZ LANES FOK Lars
IN EA"C- ISLt4FF SUED.
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q Decartrne of SOIL EVALUATION REPORT #1957
5 P 5 Safety anv :n accordance with Comm 85.'vVis Aom. Code Page 1 of 2
Professional Services Schmitt Sol Testing. Inc
Atlacn complete site plan on paper not less than 8%; x 11 n[hes in size Plan must Counly St Croix
nclude. but not limited to. vertical any horzomal reference point rBM), Vector, and - - - -
pe•cent slope. scale or dimensions, north arrow and location and distance to nearest road. Parcel LC.
040Z2- 50
Please print all information. -
Review By Date
"'=rsona: nhlrr.iriCO you prnv Ce rcay re'...d for secOnean' p..rM,:e. iPra icy 'i aw 5 15 da (t', (m+, 13 '11611S
Property Owner Properly Location Hovland. Todd & Diana Govt. Lot NW1!4, N 1!4 16. T28N, R19W
Properly Owner's Mailing Address Lot # Block # Subo. Name CSM#
389 Cedar Ct 25 Eagle Blutt
Civi State Zip Code Phone Number City Village Tows, Nearest Road
Hudson WI 54016 Troy Cedar Ct
New Construction Use. Resbentia!; Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe
Parent material L +%/-a~21-,arc/f- Sc.~_ Flood plain elevation. if applicable _ N•~_
General comments 1 Sci auger boring was ocmpleted See aerial pcture for ocation.
aria recommendations ~f
Bcnnc
I 1 I Bmin3 # _d Ground surface e!ev 96.6 It Depth to limiting factor 784 in
IL.--JJ Soil Application Rate:,
Honzor Depth Dominant Colo, Redox Description Texture Structure Consistence Boundary Roots GPDAI'
n Mansell ou Sir Cont Color Gr. Sz Sri =vat -E/Ht2
1 0-7 10yr3/3 none sit 2mgr rnvfr as 2vf 0.6 0.8
2 7-18 10yr4/6 none 511 2fsbk mfr gw lvf 0.6 0.8
3 18-30 10yr4/4 none sicl 2msbk mfr qw 0.4 0.6
4 3041 10yrz/6 none sl 2msbk mfr cs 0.6 1.0
5 41.78 10yr5/6 none qrs Osg nil 0.7 1.6 - to If
Q - -
- y ar, ljj- k
- Effluent #1 = BOD,> 30 < 220 mg+L and TSS >3 < 150 mg'L 'Effluent #2 = BOD- < 30 mgiL and TSS S30 mgtL
CST Name 1Peease Print) Signature' CST Number
Thomas J. Schmitt 227429
Address Schmitt Soil Testing. Inc. Date Evaluation Conduced Teleohnne Number
595 72nd St New Richmond. tal 54317 101512018 715-760 1978
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