HomeMy WebLinkAbout042-1086-10-201
vaiscc rsir 7cp.:rtrne-I of -uMr cc PRIVATE SEWAGE SYSTEM ..ourq St. Cr01X
Saly ene nu d rg Di:' fl Sai Pi No.
INSPECTION REPORT 606940
GENERAL INFORMATION (ATTACI I TO PERNI IT) State Plan ID No
j Lan', s 1S!14.' 1im;].
~ersOnal In format Jn, PrO, de °.='1' Pe Used 'C Secu°dafy PII'POSers IPIIvj,
Per... t Holders Na_,,. Cry' V age 'oanSPip Pa'a•I lax Na
Roscon Properties TOWN OF WARREN 042-1086-10-200
CST BM Eli I -5D. MO Le'r BI•d Devrip:ion SeG.on:Tw: r'Itargertdap No
Q ew fiH 31.29.18.481 B-20
TANK INFORMATION E EVA ON DATA
TYPE MANUFACTURFR CAPACITY STATION BS HI FS El EV.
Septic r?Y,~lr-' Berchmark
t cs ,aid Gs~f•4 9
Dosing r, Alt. BM
-7~ r'~ L Lam.
` Bldg. Sevier l Qty
Holding SYHt In et
TANK SETBACK INFORMATION SUHt 01
TANK TO / RL .'VELLf BLDG. erl Air lrcame ROAD D: Inlet
`J ~ gin Si d DI Bottom -7 w • 4
I
Dosing 1 Heador:ifi 3
Aeration ~f Ulsl. Pipe e '
Hold rg Hcl. System .7. 6 Q
Final G'adc r7
PUMPlSIPHON INFORMATION 7
Manu'aclu^e• Demand St Cove'
GPM 1l. ~1 79-1
Iacde. Number z"
100 Lij, 7 Fnclim3Loss System He TD/ ' Ft
/1 L
Forcemairt _en-th / Dia Z I( Est
ZQ
SOIL ABSORPTION SYSTEM 2-
BEU:TRENCH 'lord If / _m*gtn ry No. Of irerchee PIT DIMENSIONS No 01 Pits Ir title C a. Llcuic DeP:h
DIMENSIONS t9~1 Ld ~
SETBACK SYSTEM TO •/L P;L G WELL IAKE+STREAPA LEACHING Idaruta ~wcr. +
INFORMATION CHAMBER OR f't
Tyke Of Syslcr" r /1
UNIT D,ICd NumLKr
I 1 5 / t
GO CfMI 1~ J
01 11 44
DISTRIBUTION SYSTEM rJ S
-leacc '~A;,n tole Distfrounnr x Ilok Sve x He a 5paairg Ve oAir In
P Vets) .00
le-g:h_ Ora Lenyln ~ Cre_` Spacir•g
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
De-I, Uacr Cup U' O':e' +s Crph 01 xx Seeaec.'SuCded xx MdiChed
nel,Trent Crr;cr IteA+Trerch Edges 71PS01I es _ No Yes _ j Na
~~lr) nspection tt2:
COMMENTS: iIneljde ccdedlsc(eponces, persons ciesem, etc.) Inspe;tangt. f?1,jp
Location: 703 61TH AVE /A,` 1(6((t- I Al: BM Description = F,•l ~J~i~
2.) Bldg sewer length = Lt r. ~ O ^
Af Ac
-amoJnl or cover= . 9W
f•
YyInWirs Plan revision Reghhedv Yes No 0 a Use other side for aodlticnal informatiKn Gent NeD'a:c grata
703 y'-,i .6 ":!5' a
_TnC
n n7r,~
j--- ~ Safety and Buildings Division
x f i D 32 ~ ~ 20 8 207 W. Washrlgio- Ave P ^ &-x 7162 -}mueny ?mnit t.umbc (t be Ellec in b. Co )
$ • Mid ♦(JI., i^J: 53707-7
. ~bZ
(06(o 9q -7^---i
Samkarv 1'ennn Appllultlc'n
s 2 rdancc with SYS J 8 I I. l L . da c," . submt -no a. tnia 1 m I:• Ilc a Prop% -2J
t<.^Q,[jrLd I nor to UFlim.utC a Ca11..1N p-tt^J I;tL A fll n I (n:, l+f .31L-,wnel Pr )W } y. •aJ Wn' :U I'T' lG .4~S: iL U111CC]t Il1ate:nad:0'; Jdd.eSS',
th L) pattvt~t I }atcN s,d 4 J-.I } , ns il n r. :rtr. a you pnwidr. mm be J- cnix
1' 3. a lincc'anY b 1 :i r I--, i W, I t I <-..:IS
L App ice i -n lnformanon Please Print All Informal' n
r IKrr'. -!w- 'ch2:t_^ t'aricl
ropcrry Oil=s klailm, Add:cssJ?r 210%
CM, Stsr Ip jr l-o1?one:Vmnbc
S. k all, l Gael
Lti/ i
oc W,
j U. Typo of Building (check all that app 1 0 - -
i IJi'm~:amily Dwrlhn_ \IUnbcrrc FSaim~ - Sr td von !:arx _
i'ubhaCommnual - Lkvalhc Use (JIB a.~i . _
Stale tiunrd _ICSCrh Lx V _ i:)M Ntnabr. ) _ b u rr of
Tt NT yl./
dal 2.4 fs5
III. T - (Check only u c box on line A. Complete line B if ariplieI i LZ&AAs x
i5ew Syswnl Reps . rrr. Sv+tuv rcaun_n t -'ug. Ti:A rt :S_anwt Jnh lah:2 ?dC:.ltlrai0e to EXiStL4. system (=p!."
R. r - .t Lr.t Previoru faint tsrunlrr m:d d>aar Limed
Pciml Renewal Pe t of Re, sine Ct3n~e n ?i.xnba rrm;t ]:aasla t Xew 1 q
t. B I'cc Xnifativ. Oly
l\.'fv u Svsnem:Compnnent Ues•¢e heck all that appls r w!' _
1<oo-P cv.uccd Ir.-G:..•vtn Rc+c r. r..v L:.r and r :n:xic [ ?+Inuii Lv :•f smablc soil L Moanf 24 in. of nRablc w,i:
(((//N~~~~~Ar
r RPelstil t run t •cx1 I n I r"m atn erl Txuu xpLt-n; J
4 Pispersal?re _ -ea-rex Iv(ormauov _ ✓ ' ° ~C ~„K/
cjr Soil Apph~ana k ,-pdsf`. Dispersal .Area Rcyubel isil Usprsnl a i'r :e.1 is Sco2crt. Eln'aunn / - /
~:srgn i1 v t_prl` Dcsi e
VL Tank Info Capanty ra vai K. • Mawfm.m- _ V J
GalloaS -sii:•nc :Ir-rtt
::ew Taalr busing - _
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VfI. $cspunsibllity Stateme - Lm, undrruge,d, ass Lie -ponarbduv fnr ineiallaoun of the PORT ahoxn ov the altarhrd plaxs.
Iurd.Ltt\artx Firm: , Mm went >„fP:\F'RS ?Q•,%.ta u"mes, Mono
i'Iun:Ler c aSrtta fSied, r ns. Stain, dl j, J - ~[l
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la- (:nvddi tlV t .imnc for llisappros• rn a Dal, L aec 1 r c
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Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 10/18/18
Owner:Richard Stouv,CO_,
Location: SW1/4 NW1/4 S 31 T29N,R18W Lot 2 67th Ave Warren
Manuals Used: In-ground absorbtion system (version 2.0)
Pagc#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4. 6. Maintance a ontigency Plan
7. Filter Cross S on
Signature
License nu r #226900
System PLOT PLAN
PROJEc,r Richard Stout ADDRESS 1353 Awatukee Trail Hudson Wi 54016
SW I/4 NW 1/418 31 /T 29 N/11 18 w TowN Warren cuLNTY ST. CROIX
SYSTEM ELEVATION 92.01192.8 5' below grade 10/17/18 3
DATE BEDROOM
CONVENTIONAL XXX CONVENTIONAL LIFT XXX HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK sIzE630 DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABS0ItI1'11ON AREA N of chambers
BENCHMARK V.R.P. Top of survey iron
nssLnuc r:l.hvnru)x ulo' Filter Lifetime Filter
❑ RORF.HOLE. O w'EI.L "H R.P. Same as benchmark
B.M. x
330' Property Line
Area of poorer soils 100' B 2 90' B-1 S'
5'
98,
I -0 vcnts 30v[J`~
96' 45'
B-3 4 5' -0
IN
•
9% Slopc
- 70' 100'
Pro 3 Bedroom 10'
Ifouse Scale is F = 40'
Combo Tank unless otherwise
noted
Installed to system on neinhbors property
with casement
Scale = 1 /4" = 10'
- Vent
>6^ Quick4 Standard
Leaching Chamber 307' Property Line
of cover with 20.0 112 of Area
5.61`02/pair of end caps
4' Long 12,E
Grade at system Elevation
34"
To Hillary Farm Road
All piping shall be ASTM SDK 30/34, within
10' of tank. piping shall be ASTM F891
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
5.6ft^2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation 97.0'
Vent Vent
Grade
3 X30/34 Septic Tank 3
5' Lon_ I 5' Lone ]
Gradc at Systcm Elevation
36" Grade at System Elevation
Spacing- 5'
2-3' X 66' Cells
Same on other end Observation tube/Vent
At end of cell
A
B
16 chambers per cell
System elevations:
A92.81
B 92.0'
Septic-Dose Wank Cross Section And Pump Performance Specifications
tank Manttfacttrer t_ , 1 Putnp Manufacturer , ; -
tank Model Number q Pump Model Number
i focal Tank Capacity Alarm Manufacturer
larm Model Number L Max. Bury Depth A
Switch Type [
Head (TDH) - Feet
Filter Manufacturer :jam Total Dynamic
Filter Model Number Elevation Head
Distal Pressure
Network Loss
Minimum Pump Performance Required Force Main Loss
V GPM, ~Ft TDH Total
outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade
I A)cking Device. inlet Manhole With Locking Device
< b" Below Chide Sealed Watertight F Securely Mounted
- ~ Junction Box
W~~ ~f
Finished Grade
Vent Min. 12" Disconnect
Above Grade Means
With Vent Cap
Outlet Filter
~affle
inlet Wet I
A
Switch Settings and Reserve Capacity y~
Weep
f TankVohtme= S GPI B Hole
pimertcion Inches Volume Gal.
(reserve) A off Elevation C
(alarm) B 2 Ft
(dose) C Bottom
(dead) D n 13 j D Elevation
Ft
Total
GENERAL. INSTALLATION: The septialdose tank is bedded and beck fined in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not
be exceeded without prior gVroval. Manhole covers exposed to grade have an effective locking device (padlock)
installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight f' wings, and PVC to laid on stable soil to prevent settling or sagging.
The force main is sleeved
vn i Nor ch. a40 nd Commb ridge the tank
excavation and the sleeve is sealed watertight. Electrical service comp
Page of
02105 U
280-SERIES
112 hp Submersible Effluent/Sump Pumps
The Liberty 280-Sens provides a cost effective "mid- Performance Curve: 280-.Sens
range" pump for on-site waste water systems, liquid 40
_
waste transfer and commercial heavy-duty sum 12
P Pump
applications that require higher head or more flow. 35 11
Designed around Liberty's unique "Uni-Body" casting, 30 the 280-Series will provide years of reliable performance. 25 t
All Models Feature: 1 6
LL 20 . + ! s
• Vortex style impeller permitting passage of solids 1 m
up to x" 5
• 416 stainless steel rotor shaft = t 0 3
• Permanently lubricated upper and lower ball bearing 5 2
• Epoxy powder coat finish Y
0
• All fasteners - corrosion-resistant stainless steel 0 5 10 15 20 25 30 35 40 45 50 55 60 65,700
• 1 Discharge U.S. Gallons Per Minute
• Stainless steel bottom screen -easily removable I- -f- -4 i - i 114
• Maximum fluid temperature: 140' F. 0 38 78 156 192 226 270
Liters rs Per Minute
280-Series Cord Lengths
Data:
Model 10' 25'(-2) -35'(-3 Dimensional Weight• 29 1bs.
- __50'(-5) 280 -Standard _ Optional- Optional Optional
_281~Standard Optional_ - Height: idt
Optional Optional Major Width: 10" (model 287)
283 Standard _ Optional _ _i0ptional WA -
287 Standard optional _ wA -WA Minimum Sump Diameters:
10' cob length standard on all models For - Model 281, 283...14"
-
and "-2,-3 or-5" sutIw to model number. opnenal lengths, Model 287 VMF...10"
Example: for model 280 with 35' cord, order 280-3
Factory switch Model 281, 283 Model 287
Motor $ settinys VMF
peC/f/CatiOnS Tum on level 13" 9.5"
hp 60 Hz 3450 RPM Tum off level 7" 4.0"
Oil filled, thermally protected
(PSC)PermanentSplit Capacitor TneModel 283feabn atWlyadjustablewide-anglofloat.DifrwenbeJ
8.0 amps (115V) adjusbranlts can be made easily by tethering the float to the Chit-
charge pipe or other mountinq point. vertical float model 267 is not
ddiustable.
Model 280 Model 281 Model 283 Model287
Manual, Wide angle i Wide angle VMF43eries
no switch y float switch float switch Vertical m -
with quick- with series netic float for
i disconnect / (piggy-back) smallerpits -
plug will operate in
/ a 10" diameter
sump
SS ~a SAe
c us Certified Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phorte 800-543-2550 Fax (685) 090 1839
wwwdibertypumps.com crrpyright o Liberty Pumps, arc 2017
All rVft re W d, LUT 2000 tO5/1
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page- of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner # ~
_ _ ~rt77,_1 _ Septic -ark Capacity r _.~I n NA
?em lit - -
l Septic Tank Manufacturer NA
I7E$IGN PARAMETERS Effluent Fitter Manufacturer 0 NA
Number of Bedrooms
O-NA Erfluect Filter Model 0 NA
Number of Public Facility Units _ ~Tp NA Punip Tank Capacity NA
a9~
Estimated flow (average) aVda Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1 5) l g -
/S-2 aaVtlay Pump Manufacturer { r VA
Soil Application Rate Pump Model l-~ NA
Stancard InfluentrEffluent Quality Munthty average- Pretreatment Unit - NA
Fats, Oil & Grease (FOG) s30 mgfL D Sand/Gravel Filter 0 Peat Filter
Biochemical Oxygen Demand (BODs) -5_220 mgfL ANA O Mechanical Aeration D Wetland
Total Suspended Solids (TSS) -5150 mgt.. ❑ Disinfection ❑ Other
Preheated Effluent Quality Monthly average Dispersal Cell(s) El NA
Biochemical Oxygen Demand (BOD,) .30 mg/t. _ -Ground (gravity) O In-Ground (pressurized)
Total Suspended Solids (TSS) •_:30 rrgf, D Al-Grade D Mound
Fecal Cohfonn (geometric mean) :10° cfu/100ml 0 Drip-Line ❑ Other:
Maximum Effluent Particle Size i4. in dia. ❑ NA Other. - O %A
Other. - - -
.NA -Other--
J NA
'Values typical for domestic wastewater and septic tank efluew Other ; NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
'Inspect condition of tank(s) At leas! once every: 0 month(s) (Maximum 3 years) 11 NA
- _ _ "year(s)
Pump out contents of tank(s)- When currbined sludge and scum equals one-third ('b) of tank volume ❑ NA
'nsoect dispersal cell(s) At least once every 0 month(s) (Maximum 3 years) p NA
J94ear(s)
lean effluent filter At least once every. rr°fnth(s) - IJ NA
- - _ _ earls,
nspect pump, pump controls & alarm At lead once every: D month(s) - -
D year(s) ANA
=lush laterals and pressure test At fea.st_once eve D month(s) ry' D year(s) Other -Ai Least once every -t Other: Year(s)
tau MAINTENANCE INSTRUCTIONS
Inspectons of tanks and dispersal cells shall be mace by an individual carrying one of the following licenses or certifications: Master
Plumber; Master Plumber Restricted Sewer; POWTS Inspector: P01A?S Maintainer, Septage Servicing Operator. Tank inspections must
include a visual inspection of the tank(s) w Identify any missing or broken hardware, identity any cracks or leaks, measure the volume of
;ombined sludge and scum and to check for any back op or bonding of effluent on tie ground surface. The dispersal cell(s) shall be
visually inspected to check the effluent levels in the obsorvaton cipps and to check for any ponding of effluent on the ground surface
.
'The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local
!regulatory authority.
When the combined accumulation of sludge and scu•n in any tank equals one-third (h) or more of the tank volume, the entire contents of
!:he tank shall be removed by a Septage Serwang Operator and disposed of !n accordance with chapter NR 113, Wisconsin
(Administrative Code.
IAII other services, including out not limited to he servicing of effluent fillers. mechanical or pressurized components, pretreatment units.
:and any servicing at intervals of ='12 months, shall be pcrfurrned by a certified POVJTS Maintainer.
A service report shall be provided to the local regulatory authority wM:in 10 days of completion of any service event.
Page _ Of
START UP AND OPERATION products a other chemicals d*lt
For now construction, prior to use of the POWTS check treatment tank(s) for the presence of painting may impede the treatment process and/or damage the dispersal cell(s), if high
concentrabara are are detected have the contends of the
tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface. will be
During power outages pump tanks may fit above normal highwater levels. When power is restored the excess wastewater effluent.
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge e
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operates' prior to restoring power to the
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank. the area within
Do not drive of park vehicles over tanks and dispersal cogs. Do not drive or park over, or chwwise disturb or compact
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 fife of the POW -R:
antibiotics: baby wipes: cigarette butts: condoms; cotton swabs: degreasers; dental floss; diapers: dishlectants: fat; foundation drain
(sump pump) water; fruit and vegetable peelings: gasoline; grease: herbicides; meat scraps; medications; oil; painting products;
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS tails and/or is permanently taken out of service the following steps shall be taken to insure that the system is property
and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• Ai piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed aril property disposed of by a Septage Servicing Operates.
• 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 code compliant
If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a
replaic7lhient system:
noble replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systern.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by re4uhled
setbacks from existing and proposed structure, tot lines and wells. Failure to protect the replacement area comply will result in the with ~ Nlee d
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a
holding tank may be installed as a last resort to replace the tailed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sal and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tarik may be installed as
a last resat to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomet at the infiftrafive
surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
r r~
l Name J54?- Name
Phone 15 - /7 , Phone
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name, Name >
F Phone r L Phone
This document was drafted in compliance with chapter SPS 383.22(2x1b)(?)(d)&(P and 3M.54(1),(2) & (3), Wlsconsn Administrative Code.
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S"h- CROIX COIJNI (
S1 P'HC7,A-Nt.NIAINT'I;'NANCE -tvRFFNKNT
At D
OWN6RSIIIP CRR'1'fhTC_A•f1C N PORIv1
f
Owuer/13uyur _ ~ l ~1~Ls~, Y n
Mailing Address_
property Address
(L nfici Lion rerpuned from Planning, & Zoning Dcpattnenl tin rc•a' consnnciion j - - - -
City'Statc_ _ _ Parcel Idelifi6catiotl Nut thcr~~p~ -~~~~~~j~
LEGAL DESCRIPTION /
Property Locabott I6--Al ; /✓ct/!!, . Ser• N R /ZV, l owtl of C C/~
Subdivision
- -
Cer-tified Survey Map d _ VI- j ttt, N l,luluc . Paye ti
Warrant} Deedtt ~l
Vaiuntc. ,p~•er
Spec hour ye Do Lot line identifiable yes no
SYSTYM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of vow serlic: sNsr;.ru uniht result in its pr-matnn> talunc to handle wastes. Proper
rnaintcna ace consists ofpunrpuig out the septa: tans every darn yams w sooner, it needed, inI a licensed pumpei What you Ina into
the system can affect the function nl'tbe septic twk as a treaunent stage in the wasre disposal system. Owner nmiutcnanec
responsibilities are specified in t;Comm 83.32(1) and in (7rapict 12 - St Croix CountySatutarY Urdittutcc
The propertv owner agrees to subin l to St. Croix County Piarrrtiug Zon.m; Dcpai tin nt a cetllicatiou login, signed by' the
owner and by a master plumber, loumcynian plrnnbei, ra,artcted plumber or a hcei.sed pumper vcr rtymg that (I) the on-sar
wastewater disposal system is in proper operating ecnd:nun alnNn (2) alter inspo,:ion and pumping (if necessary), the septic rank is
less than I;3 full ofsludge._
Uwe, the nndensened hacc read the ahovc regwn'ments and apr'e,~ w main lair the Private sowage dispoell svsteai with the
staudards set forth, Lercm, as set by the Department of Contmcrce and the Deparar. ml of Nannal Resources, Stare of wisconsiu.
CertiGcaurnh siatnrg that goat scn11C system has been wauntai;wd roust he complere;land reuuncd n the. tit. C'tois Cutmry Ylam iig &
Zoning Depintinta t within 30 days of rile three y ar expir-mton date.
Ilwe cettity that all statements on form ale mre to Jie best of ury7ow k mewl<:Igc. I/wc smJate the, cwncr(sj of the
ptoporly scribed attnve, by virtue of a wa ent_y dud leeorded m Register of Deeds Office.
Number of bedrooms
S1G\ATURfi Of~ APrL1C.ANf(S}
DATE
tt t Any )nfomiation chat is misrepresented nary result in the sanitary permit being r poked by the Nanning R. Zoning Department.
Include with this applicaton a recoidetd warranty deed front the Regisiet of Dents Office and a copy of (fie cerlified survey map if
reference is made: in the warranty deed.
(RF.V, 081059
x
Wisconsin Department of Comma --------SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85. Ws Adm Code
t
1 X
Attach complete site pan on paper nut less than A tit z 11 inches in size. Plan must County
include, but not limited to: verecal arc horizontal reference pant (BM), direction and parcel I.D
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 1 ^--r-
Please print all information. `1v ED Reaeweo, / Date
Per nal informaon you provide may oe used for secondary 41iacy Lew. S. t5.W 11) (m)) /C C1
Property Comer 11 r7a Imperty Local,
K' } PUG I Govt Lot I. , d t:4 &1,,) V4 S T N R I E (or W
Property Owner's Mailing Address 0Z 01 1 Block if Subd Nana CSM#
!J
City S to Zip Case Phone N ,r city ❑ Villag Town Near st Road
r - New Construction use.0-Residenual l Number of bedrooms Code derived design BOw rate a - GPD
❑ Replacement ❑ Public commercial - Describe:
Parent material flood Plain elevation if applicable ft
General comments Ie «-~z-~~•
and nroommendations: y _ r l n
System Typc ,7 t/ n 44 System Elevation
Boring At ❑ Boring 2-1-
pit Ground surface elev. ft. Depth to limiting factor L> in.
Soil Aepliczition Rate
Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD.. f
In. Mansell Ou. Sz. Cont. Cola Gr. Sz Sh. 'Eff#1 'Eff#2
c.
Bering # Boring
Ff f Pit Ground surface elev_ - ft. Depth to limiting factor in. -
Soil Iication Rafe
Houton Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD.Mt
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Z O
Effluent #1 = BOD > 30 1220 nxyL and TSS >30 < 150 mg& ' Effluent #2 = BOD < 30 mgtL and TSS < 30 mg(L
CST Name (Please Print) Signatu( CST Number
Bird Plumbing. L'c. Shaun Bird 226900
p.r:^. ress -,vte F.,9.t i, ri,^^97rine,^. r aPnre N.ir
1008 192nd Ave. New Richmond, t:Vl 54017 ~ 11 ~-2-:6-1516
Proprsh Owner Parse: ID#_____ Page _c`_ '
1 D
Boring # Boring
~ pit Ground Surfaceelev. ~~Jh Depth to limiting factor in. Spl Iiration Rate
Horizon Depth Dominant Color Redox Description Texture, Structure Consistence Boundary Roots GPD#f _
in. Munsell Qi Se. Cont. Color Gr. Sz. Sh. 'Etf#1 •E"2
Z_ -11 ~ ,S~ /nor - r17. ~Cd 6
v
I f~
❑ Boning # D Boring
D pit Ground surface elev- ft. Depth to limiting factor in.
Soil Iication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in Munsell Ou. Sz. Cont. Cola Gr. Sz, Sh 'Eff#1 'Eff#2
Boring
F-1 Boring # D Pit Ground surface elev. ft. Depth to limiting factor M.
Sell licafion Rate
Horizon 'lepth Dominant Cdrx Redox Description. Texture Structure Consistence Boundary Roots GPDfIf
.n. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Ett#2
F
y'L and TSS >30 < 150 ing& ' Effluent #2 = SOD, c 30 ng4 and TSS 5 30 mgt.
Effluent #1 = BOD, > 30 1220 nx
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need matenal in an alteniatc formal. please Contact die department at 60R-266-3151 or TTY 608-264-8777.
tel?InM IR 6V.1
Property ' Owner___ 'droolC Page 0
_ Boring # ❑ Bonrx; v 2 t
elev. Depth to Grnniny Ia:AP /I- in. cabon Rate
J pit Ground surface Soil b
i ioitzon Depth I Dominant Color. Reaux Du motion Texture Structure I Consstence Bounoarv Roots GPDtff
i m. Mu_nsal 1 Qu 57 (loot Colo- Gr. 5:.. Sh, 'Eff#1 'Eff#2
Iv~I ! i✓v 5/ nom/ 10`-v:.r~
Boring# ❑ Boring
❑ Pit Ground surface elev. f.. Depin to lirrinng factor in.
$OI NnCSrabon Rate
rHOnzon Depth Dommanl CWe Rodox Description I Texture Stru.-ture Consistence Boundary I Roos I GPURF
in Muasell Ou. Sz. Cont. Color I G: Sz. Sh. I f 'Eff#1 'Ett#2 I
~ I
~ i
I i
I
1
1
Bonng Y Bonng Ground surface eiev. fl. Depth to broiling facia in
❑ Pit $OII ~1;lDIIphOr1 Ra:E i
Horizon 'lpth Dominant Color Redox Des;npbon Texture Structure Consistence Boundary Roots GPD."f
n n. Munsell Ou. SL Cont. Color Gr. Sz, Sri 'EB#1 'Etl#2
n
Effluont #1 = BOD, > 30 < 220 m9!L and TSS >30 < 1K mg4 ' Effluent C2 = BOD. < 30 mg-'- and TSS < 30 mq'L
The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services o-
need material in an alternate format, please contact the department at 608.266.3151 or TTY 608-264-8777.
SUU'RY W trt 6M1
Soil Test Plot Plan
Project Name Richard Stout Shaur ird
Address 1353 Awatukee Trail
Hudson Wi 54016 Ua x/226900
Lot 2 Subdivision Date 8/3/09
SW 1/4 NW 1/4S 31 T 29 N/R18 W Township Warren
7 Boring Q Well Pi. Properly Line County ST. CROIX
BNf or VRP Assume Elevation 100 ft. Top of survey iron
System Elevation TBD *HRpSameas Benchmark
330' Property Line ~I_;.J1/`
R 2 90' R 1 5'
100'
Scale is F = 40'
unless otherwise gs•
noted 30•
s-3
96' 4s
Area of poorer soi I s Slope
C~
c
r* ,
30T property Line
To I lillary Faun Road
j Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix
Safety and BugOM Dwrsion Sanitary Permit No.
INSPECTION REPORT 567273 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan 10 No
Personal information you Ostrom may be used for semMary purposes IPnvaw Law, s x5.04 (1)(m)I
PomM Holders Name CM Vdlage X Townsnp Parcel Tax No
' Payne, Timothy Warren, Town of 042-1086-20-020
CST BM Elev. trip BM Elev SM Deadysix on QQ ' / L Sectonrrowndtangerls No
rJm f- A 31 29.18A82A2
TANK INFORMATION ELEVA ON DATA
TYPE MANUFACTURER4), CAPACITY STATION BS FS ELEV.
y5
Septic~_ :i Benchmark
' 5. Z /e5 L ~aa
t,~; F I y.s' /z s a 17.01
Aft
4-; 1 7-- 116
Aeration Bldg. Sewer JI$•7
99(o
"ding SUHI Inlet `P r
S 3 I
Z
TANK SETBACK INFORMATION SUHI Outlet 3 7 //✓aJ
TANK TO PIL WELL BLDG. Vent 'r Intake ROAD Of Inlet \
s•JrrA-
\
T DI Bottom Septic 54 S 1-7
I
Dosing _ Header/Man L qp
9!`O,
Aeration Dist Pipe ',is
b
Holding Bot. System
I:_:,_ ilt(~
Final Glade
PUMPISIPHON INFORMATION
Manufacturer Demand St Cover
GPM ~I Lw I.b / .
t0er
Model IN
TDH LM Friction Loss System Bead H Ft
Forcemain Length to Well
SOIL ABSORPTION SYSTEM 11
No. Of Trendras ' n PIT DIMENSIONS No. Or Pd, Irsule Dia GQaitl Dept;
BED/TRENCH Width Length
DIMENSIONS (oz Y5g 3 1 fe.~•cltna,~
SETBACK SYSTEM TO P/L BLDG WELL LAKEISTREAM LEACHING Manu~tur L~-
CHAMBER OR r f7raX
INFORMATION
Ty~J stecri onnX,., 7 7 2f✓ 7 /d0 /4J4 UNIT Mod I1 Num r.
DISTRIBUTION SYSTEM AJd ( /
HeadenManilold fl DiWioutlun x Hole Size x Hole Spaang vent to Air lnla=e
Length 6 r~ Dla I P ngth \ Dw_._ Spacing \
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depin Over Depth Over xx DOW zz Seeded'Suddinj Mulched
Bed/Trench Center Bed/Trench Fogey Topsoil
Yes EN: No s ~ No
COMMENTS: (include code discrepencies• persons present, etc) Inspection et-. IZI Ss / 1 '-S inspection ts2:_ 1.__!
Location: 900 Alex Lane Hudson•WI 54016(SW114NW1/431T29NR18W) NAALLot6 1 7Z-k- / Parcel No: 31 ' 29,118` 482A2
a- /0
1.) Aft BM Description = t Ceje,-, C tYwse..R- C.lGa4 a.+ 7.5'
2.) Bldg sewer length
- amount of cover = L ~f J -7 If a lo4ks 0&%,
4
Plan revision Required? iii, Yes ><ONo 2-7
Use other side for additional information.
".~1 a hale In poor nature Cent No.
SBDA7f0 (R 3197)