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161-2006-60-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Aivision t INSPECTION REPORT Sanitar Permit No: 488227 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City X Village Township Parcel Tax No: Ernie, Douglas I Village of North Hudson 161- 2006 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range /Map No: / ��;�� �, 5tti, w r Al �� - �10 13.29.20.845 TANK INFORMATION I c�bo i c-o� ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic —}-- Benchmark (� / � pd /. o /o /• v /vim . ao Alt. BM Aeration Bldg. Sewer 1 - c7. r• Holding n } � SVHt Inlet qq TANK SETBACK INFORMATION SVHt outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD $T m, -p c I CO- Septic � 3 t Dt Bottom v Dosing Header /Mans 8 -14 Aeration Dist. Pipe 1 `-4 4 71 v • .6 Z 9'0& av Holding Bot. System ; o Final Grade PUMP /SIPHON INFORMATION Manufacturer . Demand St Cover p GPM •3' �� - 3 u / 7 7% Model Number OA vQ- 3 b 1 TDH Lift Friction Loss System Head TDH Ft 7 i Forcemaiq Length Dia. Dis SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 54 SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufac INFORMATION Type Of System: CHAMBER UNIT OR Model NuK bt % 1 DISTRIBUTION SYSTEM W.& ,,` � �/.t.,-�I� Header /Manifold Distribution x Hole Size x Hole Spacing Vent o Air g ke a d i . Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes N No RE Yes :E] COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: to 1 �: i OLD• Inspection #2: 1 / Location: 223 Sommers Landing Rd., North Hudson WI 54016 (NW 114 NW 1/4 13 T29N R20W) Sommers Landing Lot Parcel No: 13.29.20.845 1.) Alt BM Description ='J* Cw �-« 2.) Bldg sewer length = +ay�e�G2 �6 0�� '�"�►^�� - amount of cover = Plan revision Required? Fal Yes No Use other side for additional informati Date Insepctors Signature Cart. No. 5BD -6710 (R.3/97) A Safety and Buildings Division County N V Isconsin 201 W. Washington Ave., P.O. Box 7162 St. Croix Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608 1 1 Department of Commerce oR Sanitary Permit Applicati Na Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal in hrmati n yali provide Project Address (if different than mailing address) may be used for secondary purposes Privacy Law s 15.04RECEIVED I. Application Information - Please Print All Information 223 Sommer's Landing Road Property Owner's Name __. Lot # Block # Doug & Kathryn Ernie 161 - 2006 -60 -00 lot 10 Property Owner's Mailing Address Location 223 Sommer 's Landing Road _i +, —i +, section 13 City, State Zip Code Phone Number T 29 N; R 20 W Hudson, W1 54016 (715) 386 -9152 II. Type of Building (check all that apply) U% _BP /^ ^�� /'b ! �divisi� N umber ❑Xl or 2 Family Dwelling - Number of Bedrooms 4 / ❑ Public /Commercial - Describe Use 13 e— ❑ State Owned - Describe Use ❑City❑Xvillage ❑Township of North Hudson III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ` ❑ New System y ❑ System ❑ Treatment/Holding Tank Replacement Only Other Modificattoil to Existing System _f- 3l0' B• El Permit Renewal ❑Permit Revision 11 Change of 11 Permit Transfer to New List Previous Permit Number and Date Issued / Before Expiration Plumber Owner 7� 3 J 0 p� IV. Type of POWTS System: Check all that a our 4 trenches, 13 " uick 4" chambers each 3' X 52', 52 chambers to ! 0 ❑ XNon - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil U At -Grade U Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized , In-Ground El Holding Tank ❑ Peat Filter El Aerobic Treatment Unit 11 Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter LIfL hing Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: 52 Infiltrator "Quick 4" Chambers at 19.1 sq. ft. EISA/chamber + 4 r. end caps = 1,016.40 sq. ft. EISA Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 600 gpd 0.6 gpd sq. ft. 1,000.00 sq ft 1,016.40 sq ft EISA 91.00' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallon Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding rank t,zuu 1,200 1 C Weeks Concrete X 1 ester to be X added in series with Polylok PL -525 effluent filter Aerobic Treatment Unit J / Dosing Chamber (ti(LO VII. Responsibility State ent- I, the u dersigned, assume responsibili llation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb s Signature MPIMPRS Number Business Phone Number James K. Thompson S MPRS #30021 (715) 248 -7767 Plumber's Address (Street, City ate, Zip Code) 340 Paulson Lake Lane, Osceola, WI 54020 VIII. C n /De artment Use Onl pproved ❑ Disapproved Sanitary Permit Fee (includes Date Issued uing Agen ignat (N p Groundwater Surcharge Fee I) ❑ Owner Given Reason for Denial /- W GC.L- IX. Conditions of Approval/Reasons for Disapproval 2 _ (jt/l S SYSTEM OWNER: 1 Septic tank, effluent filter and 5 / O ' QOV 9A dispersal cell must all be serviced / maintained 2o0 aY as per management plan provided by plumber. 2. All setback requirements must be maintained , l as per applicable code /ordinances. �/ N • J1-t Attach complete plans (to the County only) for ttWsystem on paper not I than 81/2 x 11 inches in size SBD -6398 (R. 01/03) ;!e✓alaa :�� / GY 6u ��3 so,►.�u�s �d.� nom, St c-, /3 T. of SE • L'o? ate' � ri lec�¢. SSu So.r+r►1F/S .�.a.. 9so �•G � ylbtd�aom Qeu�! O dec+C Pde/ ` •` 4 al STI ., c7 5 �a�;an ` / •.� `� � , Di ver5i on dQ /v[ C �/'c!e �( � •�� d� ': e Z � w; es� 9coY,c� X:' /E<i���' �Id Z�aoSr f1.roc�la` n; I r— - t l e✓a1aa6 �Y E ♦ EX�sE;rS g rack Scale' / "vo uC! ¢ ,(a- e- X y , i ;ePio/o Y, ,2,2 3 so.►.�nc is d, nix ,C•E io � /a.�eFSo�ina�' k L . i3, Tn. of �� • �d� !/.'! /a� e a� e7 isElr►�. td, U-0.0 _____ ��n o of �. E 96p co ',l bsalroo.n 4 eclC 5o,n►71e/S �R.o%%�5' yS pl y Qts:d <nce Pee/ ,�.✓ ': � - - Ex�sb'n� /�c0 . S Y,f�ein(' /ate. 5 fm� :on • � D; ver•s;on dale \0 � • � 9B C;rcle '� , ei cJleSt�Cva�c/� -� �• /Ee���'1�1/ kld Z.00 � ° 4 this f�.ro taE E"xiS %� oGs�da/ e 66 bQ B� OA t � -u5tc( W' �il�I'.�•i� ✓fit/ ✓C. tv w �r'as E rc cS � �c 1980 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with C Wis. Adm. Code A.C.E. Sal & Site Evaluations Attach complete site plan on paper not less than 8'% x 11 inches ' size. I County St. Croix include, but not limited to: vertical and horizontal reference pant ( direc and percent slope, scale or dimemsions, north arrow, and location and dis ce to n d. Parcel I.D. 161- 2006 -60 -000 Please pri all i►�o� � E D R Date Personal information you provide may d for seowdery purposes (Privacy Lew, s 15. 1) (m)). ! F Douglas Owner & Location Kathryn Ernie JUN 0 7 2006 Govt. Lot 1/4 1/4 S 13 T 29 N R 20 W Property Owner's Mailing Address ST. CROIX COUNTY Lot # Block # Subd. Name or CSM# 223 Sommers Landing Road Nort 10 Plat Of Sommer's Landing City State Zip Code Phone Num r City ✓J Village _j Town Nearest Road Hudson WI 1 54016 1 (715) 386 -9152 North Hudson I Sommers Landing Road New Construction Use: 01 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement I Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional POWTS @ 0.6 gpd/sq.ft. Install four trenches at 91.00'. Existing system elev. = 91.80 B or i ng # 1 Depth 108" in. Soil Bing 10 Pit Ground Surface elev. 95.98 ft. p h to limiting factor App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/11 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -20 10yr3/2 none I 2fbk mvfr cs 2fm,1c 0.6 0.8 2 20-44 10yr3/2 &4/4 none Ifs 1 msbk mfr gs lfmc 0.5 1.0 3 44 -51 10yr4/6 none gr Is 0 sg ml cW 1fm 0.6 1.6 4 51 -108 7.5yr4/6 none gr Is 0 sg ml - if 0.6 1.6 H#2 contains an undifferentiated mix of 10yr3/2 Ifs & 10yr4/4 Ifs. Horizons #3 & 4 contain approx. 40% gr. & cobbles. Loading rate of horizons reduced to 0.6 gpd/sq.ft due to clay content of Is. a Boring # Boring tI Pit Ground Surface elev. 93.37 ft. Depth to limiting factor >97" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -15 10yr3/2 none I 2fbk mvfr gs 2fmc 0.6 0.8 2 15 -22 10yr4/4 none Ifs 1 msbk mfr cs 2f,1 me 0.5 1.0 3 22 -36 7.5yr4/4 none gr Is 0 sg ml cW 3vf,2f 0.6 1.6 4 36 -97 7.5yr4/6 none gr Is 0 sg ml - 1vf,f 0.6 1.6 Horizons #3 & 4 contain approx. gr. & bles. Loading rate of horizons reduced to 0.6 gpd/sq.ft due to clay content of Is. ' Effluent #1 = BOD ? 30 < 220 mg/L and SS >30 < 1 mg/L cent #2 = BOD < 30 mg/L and TSS <_0 mg/L CST Name (Please Print) Signatur . CST Number James K. Thompson 3602 Address A.C.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 5/162006 715 - 248 -7767 • Property Owner Douglas W. & Kathryn Emie Parcel ID # 161- 2006 -60 -000 Page 2 of 3 F Bori ] ng Boring # 95.66 ft. Depth to limiting factor > 104 in. le Pit Ground Surface elev. g " Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0 -10 10yr32 none I 2fbk mvfr cs 2fm,1c 0.6 0.8 2 10 -36 10yr32 &414 none Ifs 1msbk mfr gs 1fmc 0.5 1.0 3 36-48 10yr4/6 none gr Is 0 sg ml cW 1fm 0.6 1.6 4 48 -104 7.5yr4/6 none gr Is 0 sg =I- 1f 0.6 1.6 H#2 contains an undifferpntiated mbc of l Oyr'3/2 Ifs & 10yr4/4 Ifs. Horizons #3 & 4 contain approx. 40% gr. & cobbles. Loading rate of horizons reduced to 0.6 gpd/sq.ft due to clay content of Is. ❑ Boring # Boring �] Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 I I F F-1 Borin Boring # Pit Ground Surface elev. ft. Depth to limiting factor in. gal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff #1 `Eff#2 " Effluent #1 = BOD s> 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD <30 mg/L and TSS <30 mg/L 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 format, please contact the department at 608 -266 -3151 or TTY 608- 264 -8777. i e✓ a 1 aa6,,, la E • EX :sv� � rack Se c-. /3 Tn, of S6 • c�d�j �' //a e �asq�e Qan of 46 ltc�e. ♦ SSue e�tv`• a /LO .a'>, �X/ SLAY• ✓ Sow'irde/S ,C.a..o(i yS,o' q�pcn.,txtw ybtdroe.n 4 ec.K O ,03 q7,o Qtsidcnce .I �.!- `�`..�� ��,/ c��, L �m i c�\ ...•� � ` � /Rl� f.2G0�- s�/G.'�►!� C 1 � Ie A,� M• N i 5ca ztrcd /4 2 •: i� V etS roes ��5 ffr 6ra5 A d '-re-es p.3o�� r N 0 C3 I - C qcD D 0 ai/ •m � � � D ■ �"' n 2 ■/� D N ■s.. m Nam - Y ✓ V - i _ wA� v a - I < M r Z 7 v = O > c z C T C r a ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the Do 4"� rn Ie residence located at: /4, '/4, gection - /,3 , Town 2 N, Range ¢ W, Town U l rQ of ✓4� , f� , 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 Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service �y �� �G Did flow back occur from absorption system? Yes '-� No (if no, skip next line.) Approximate volume or length of time: ? gallons & minutes Capacity: �, 2z'-o q w P Construction: Prefab Concrete ►/ Steel Other :: fa er (if known): Bees eoY,e� e Ag7eof Ta k (if known): —z 3 ensed Plumber Signature) (Print Name) 3G (T;ate) (License Number) - /MPRS Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) STATE $ AR{lrt WISCON294FV^R".it «,9ew-'-3 Ttsi*a SPACE AES R'4j3FO.1 RE ,*NQ0 -kTA Thi El- C. Cud.' Corp. , R ST. C�tx c?- ,t, W isconsfn C orpora 1`a Cfiar�e � °l ud ge T ; Rgt d. for Rx3 Ith Inc cirly O¢ June and Dolas Kattia�r� f rnae' GG t ._ d Gran tet, ' W1iff -. SS T , That the said GrantTr, for a vsluab:e coo. of one dollar an ot her valuab cons P-ruRNTOw �',3Gran ?. ? �- St. Crov.. COnve i y ee he folic+ving described r at County, State of Wisconsin: — s Tax Parcel No Lot Ten (10), Sommers Landing Addition to the Village of North Hudson. t 3 t t CANCT FEE 3 This i not _ — homestead property. XXX (is nut) F j Together with all and singular the h2reditaments and app ±irtenances thereunto belonging; i And_ Grantor __ -- j warrants that !he title is gon:,'. indefeasible in fee simple and tree and clear of encunbrarces except easements, reservations, restrictions and rights - -of - way of record. ` and will warrant and defend the same. i Dated this 7th —day of June j -- t9 85 -- (SEAL) C� * .Q.� . — — (SEAL) Xharlesqt, _Cudd, _Pr side _n - -----(SEAL) � ��CC — (SEAL) . Herbert D. C udd, Ex ecutive V ice Pr esident AUTHENTICATION ACKNOWLEOGMENT Signature(s) _ STATE OF WISCONSIN ' " - -- St. Crcix _— _County. authefit/4a�ea thisay,of__. 19 Personally carne before me this_ 1h _ -__day of June 19 R - the above named p R Charles C. C udd, Presid and Her ' ••+ i _ D. Cudd, E xec ut ive Vice P of ._ ,- _- -Uj13L1 Charle _C._ Cudd Corp. a Wiscon _ TITL`;E?i41 EMBER STAT D( WISCONSIN –_ Co r po ration. ot( to me known to be the person-who excuted the i aui�e dbY , oc, '01 S. Std; .) 19*e i rtstru neol and acknow' y the s THIS'NSTRUMENf WASDRAFTEDB'r P atricia A Do_t a - � -- f Plaza 94 Center Patricia A. Do - , -- i Hudson WL 54016 _ _ Notary Public S>:. Croix Wis. (Srgnat — ures may be authenticated or acknowledged. Both My Commission is permanent. (It not, state expiration are not necessary.) date. December 1 ^ -- 19 85 : ) _ - - -- 'Names p per3on9 s 3 M gin 3ry capar.ity should br ty, ?? i,r pnr,7� D9+rw the r 3 g a'uros. - NF 3571 WARRANTY DES ET+4Tr 8AR OF W IaC0NSIN Ne ca Forms, P.O. Box 1020 , 3, Grean Bay. W, 54307 -0208 FORM No, 1-1982 i l ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM o Ern Owner /fir Mailing Address 223 Sor,�m�'s Lr�.., -,,, 20 ��lu�Sn - �J /. 5 /4 Property Address �!: r e (Verification required from Planning & Zoning Department for new construction.) City /State 1. Parcel Identification Number LEGAL DESCRIPTION rl; llas� -e Property Location t/a , ! /a , Sec. � , T a 9 N R O W,e►rtof Subdivision f7�'/ n'I �/ �S i7 , Lot # _20_. Certified Survey Map # , Volume , Page # -- Warranty Deed # oo2.s� , Volume 3 , Page # Spec house -v+ no Lot lines identifiable yes )d SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, 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 §Comm. 83.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Itwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Num er of bedrooms SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** 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. 08/05) Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10705 -P (N.01 /01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be <_ 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October -March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two -year schedule by use of a diversion valve. Valve to be switched diverting effluent from dispersal cell currently in use to resting cell on a two -year cycle coinciding with septic tank inspection and maintenance. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248 -7767 or the St Croix County Zoning Department at (715) 3864680. " POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ' of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner ` �� Septic Tank Capacity a l ❑ NA Permit # o)- Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer - ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units 91N9( Pump Tank GaPaGiW 2a) al ❑ NA Estimated flow (average) 760 al /day Pump Tank Manufacturer GU�E� - ❑ NA Design flow (peak), (Estimated x 1.5) 600 gal/day P Soil Application Rate Q, 6, gal/day/ft' Pump Model A Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD <_220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Disper ell(s) Q Ve rn ❑ NA Biochemical Oxygen Demand (BOD S30 mg /L n- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <30 mg /L k11NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) _ 100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: /� h �� 36 ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once ever ❑ mo th(s) P y: 2 ' ear(s) (Maximum 3 years) ❑ NA Ins Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 2-- 3 ❑ mo t ,(s) (Maximum 3 years) ❑ NA Clean effluent filter onth(sl ❑ NA At least once every l �j ❑ year(s) Inspect pump, pump controls &alarm At least once every: ❑ month(s) ❑ year(s) NA pressure test At least once ever � ❑ month(s) A Flush laterals and P Y ❑ year(s) Other: ❑ month(s) At least once every: ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any 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 and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. I Page 2 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents 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. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator 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. Do not drive or park vehicles over tanks and dispersal cells. 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 POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; 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 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 chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and t void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN 5 � � JL" J6_ ' Ca /k afi7 j) If the POWTS fails and cannot be repaired t e following measures have been, or.must be taken, to provide a code compliant replacement system: ❑ 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 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 failed POWTS. T alua ' a o ing ank b e ai a 04415 rrM nR- w;/ CaNS7J2(1C?t D� ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS i POWTS INSTALLER POWTS MAINTAINER Name / Name Phone 7 /S l -7 ( � Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name sT. �i ( ew Z Phone Phone y o This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ol 0 d 0 % k 2 k rr # 0 / 0 ° .4 =r § & 0) Z E g / e = - z n- gy m: o � ; £ a 0 / E; Co P z C § S 2 g ' E i 0 %) =r CD � E E 9 _ \ o o § g © @ > ., a w; o E e m CL .. co , CD P °: a = o o 3 g - \\CD. CL / k CO E! n r CO) . C.0 co f ; Co % z 0 0 o f - _; 0 /ƒ §§ 0: o0 R. J% T o wo +: 2 ƒ J m ƒ ® § g_�c; - 0 £ % 0 z w z i ' > f ; e I I / Q m @ CL \ (D a ; � 2 g - § 36 / a § 9 Z w . z \ \ Lo k � ± . E ■ � \ e . � f % � C � ' 7 » � � � § � $ k-i . � \ 0 / CD /f UD 4 7U. °NW NW, Sec 13 " a�3 S' rrx2�s �ct« T29N -R20W , SVS' Hudson, WI Village of N. Hudson Lot 10, Summers Landing San.Perm.# 34829 5 - 13 - 83 R. Timm Conventional, New J. Rusch INSTALLED 6 -29 -83 Parcel #: 161- 2006 -60 -000 01/03/2006 09:15 AM PAGE 1 OF 1 Alt. Parcel #: 13.29.20.845 161 - VILLAGE OF NORTH HUDSON Current I X'' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner DOUGLAS W & KATHRYN T ERNIE O - ERNIE, DOUGLAS W & KATHRYN T 223 SOMMERS LANDING RD N HUDSON WI 54016 Districts: SC = School P = " = Primary Sc S Special Property Address es): Y ( Type Dist # Description ' 223 SOMMERS LAND'G RD N SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 04 /74- SOMMERS LANDING L5 -11 1980 g P OL 88 VIL NH SOMMERS LANDING LOT 10 Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 13- 29N -20W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 713/566 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 108677 299,200 Valuations: Last Changed: 05/20/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 97,700 195,100 292,800 NO Totals for 2005: General Property 0.000 97,700 195,100 292,800 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 61,100 156,900 218,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 125 Specials: User Special Code Category Amount I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT OWNER � �� S 6�`� =' j/` ` ��C� � C `1t4 - R vZb ADDRESS Z ST. CROIX COUNTY, WISCONSIN. SUBDIVISION 6ZW_' Wrl e''j T LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM rrk U f 1 Z I c,, _ I di at N r h rr w BENCHMARK: (Permanent reference Point) Describe: 1J Ltd �� n fOJ� Elevation of vertical reference point: g�, b� _ Slope at site: SEPTIC TANK: Manufacturer: k)c p� 5 Liquid Capacity: /'c 706 Number of rings on cover : Tank manhole cover elevation: aS Tank Inlet Elevation: 5 Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle gallons; Total capacity of distribution lines gallon: size of pump head; gallon per minute horsepower ;brand name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover ; Type of warning device SEEPAGE PIT SIZE; Number of pits feet diameter feet liquid depth seepage pit inlet pipe - elevation bottom of seepage pit elevation feet. SEEPAGE BED SI.ZE: nuu�ber of lines width j length -5'4, depth SEEPAGE TRENCH: width length PERCOLATION RATE AREA REQUIRED AREA AS BUILT INSPECTOR DATED PLUMBER ON JOB i LICENSE NUMBER 3 z {! DEPARTMENT OF+1N[RJSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS 'r LABOR & H[JMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O..BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 CX CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: (If assigned) El Holding Tank E] In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: I ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Charles Cudd Co. R. R. 2, Hudson, WI (o 8 3 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: NW NW, Section 13, Lot 10, Summers Landing, Vill of N.Hud Name of Plumber: MP /MPRSW No. County: Sanitary Permit Number: Roger Timm 3224 St. Croix 34829 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER ` 1 PROVIDED: PROVIDED: �J. t O (, , v OYES ONO ❑YES — ]NO BEDDING: VENT DIA.: I VENT MATL.: HIGH WATER NUM[„ ROA : PROPERTY WE L: BUILDING: VENT OfftR SH C / ALARM -. FEET FRUM AIR�1. YES NO ❑YES ONO NEAREST O� /r� V 1 .5 DOSING C AMBER: MANUFACTURER. BE DDI IIG : LIQUID CAPACITY. PUMP MODEL. UMP /SIPHON MA U ACT ER: WARNING LABEL KING COVER PROVIDED: VIDED: ❑YES ❑NO ❑YES ❑NO ] P R YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OP TIO AL: F_R F ! PROPERTY WELL. BUILDING: jVrNTTO1RESH (DIFFERENCE BETWEEN T I=R LINE AIR INLET PUMP ON AND OFF) ❑YES NO NEARE SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of Wing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall c se until ORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: ry,. a WIDTH: LENGTH NO. OF DISTR. PIPE SPACING. COV INSIDE DIA.: .PITS. I L IOUID "OF E , : TRENCHES. RIAL: PIT DEPTH: MEN�1 �' , .��. GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE M TERIAL N R NUMBER {'I 'PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES ABOVE C VER. ELEV. INLET. ELEV. END. PIP -..R�M .LINE: AIR INLET: f 00 100 �t 0 rd 3 NEAREST / MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES NO SOIL COVER I TEXTURE P ERMANENT MARKERS: OBSERVATION WELLS 1:1 YES ED NO ❑YES 1 NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED. CENTER EDGES. ❑YES ❑NO ❑YES ONO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: p ,' WIDTH: LENGTH. NO, OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: . SE�T11ifEkCH TRENCHES: MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.: ELEV: DIA.. ELEV.: PIPES: DIA.: E E-VA 40N AN IC00O R>�I�TI t HOLE SIZE HOLE SPACING CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED ff3RMATIgN PLANS: - ]YES NO DYES El NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMIIIL R !, PROPERTY WELL: BUILDING: FEET FROM; LINE: ❑YES ❑NO ❑YES ❑NO NEAR;E • '�•� __ b G.� 7 tan to q• A - Sketch System on — - R ain in county file for audit. Reverse Side. A TITLE: DILHR SBD 6710 (R. 01/82) e_� c r 1315PAFtTMENT�OF .' r APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include aplot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H =63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Pro er f ty Owner: Maili�Address: - Property Location: City, • 'I a e or Township: Count 'r- j'}�I,J' /aS "� �T ° NCR LL% W �'u /f+ U� Lot Number: BlkNo.: Subdivision Name: Nearest Road Lake or Landmark: State Plan I.D. Numb r. �0 V 1 ✓i l e f ,' 1 (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify) Bedrooms: 1 or 2 Family * State Approval Required. TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER ASS GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY j 1 HOLDING TANK CAPACITY A" Am LIFT PUMP TANK /SIPHON CHAMBER dA MANUFACTURER: f Y' t EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental_ Seepage Bed ❑ Seepage Pit r (f L 61, �} ❑ Alternative (specify) ❑ Seepage Trench Water Supply: ' `- Owner's ame as Listed on Soil Test Report (if other than present owner): Private El El Public ✓' I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. N of Plumber: Si �` MP /jjP�I,INo.: Phone Number: Plu?nbols Address: Name of Designer: o COUNTY /DEPARTMENT USE ONLY Signat re of Issuing Agent: e: ©10 /Date: o APPROVED T13 anitary PPermmiit Number: ay `� V '� d� DISAPPROVED J / O Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod - Plumber DILHR-SBD -6398 (R.07/81) i S O MNI E RS LA NDMv LOCATED IN THE N�VJ I/4' OF THE N1. "J I/4 OF SECTION 13 AND GOVERNMENT LOT 2 CF SECTION 14,T2 U, R2Olv VI OF NO H UDSON, ST CROIX , COUNTY WISCON SIN.. �.�BISYER'S OfFI�►E; � • ld ��lS.C1[1 � � .. "r l t(,.. .<. • i �'�V��' � Q� i I..t.;: � <� �!,`�r.1.5 1 .. .. , ]EMI M O 0 w.�a. y . >~ .. t 4�' a• }y +p 9_Q Yi� ' ,STATIQ� t ly PONT OF 31 E 4! 1 r BEGINNING NORTH LINE OP THE NW IM q • `.��... fl ,. m r S88 E 191.90 ,: '''�1 �•� A ,� /'� .// i N �y � CMR 1 �rt :4 1. � �► t 4 � . SECT ' ) :...Y'r� +rbc �nF*!'iw.� `�' '. N�,'��ty"�. },T29N�R20w <�tl'j�� � f i• � ;r�! .' I�r. (1 r ' N . , ' .. .. . /.� +_ 2q_I. i "�•';'SHy ;�* < a',Y 'R YI t� I �� y �,74 ��. =7 N N DAM Zs TABLE W WE D R4 LOT RAOaJb CIARO .t ENTRAL TANGENT 2S CHORD C O a0 LE LENGTH BEARING ANGLE BEARING 1�•�� �».." _�.,� N �Z(►E ,. �' � '.,• 11 30000 166.47' S4 "01w 3O'WO2" stO'31'E t '� " � +� � �f u . a pu •,, , 1 trot ;'' '' �` ,2 �. '�'d tiF 1a. lO a •: - — 10000 55.4S S2G•3941 E 32.11 22 SIO'34E 11 t•:;r• ., > y 1 O p rt • ' -7 7 100.00 141.42' S66.34 E 90'00 N 79.26E -7 — 100.00 9667 S71.39 41 E 5648 N 79•2fi E .L��I �� ' �� n ; F j l NT`��� E i . .. N a { M Z '' • 0 r T 63'SS O6 1 Ti •,• : • ,• -6 — 16000' CTS•73 SGB'Sfi2 E " N79.26E ] '��.�_� "�� •� � y1 '�... �.:, i S 16600 89.70 4&62't927"E 31'2108 I t1 '• ' !r ..'!.'' 6 ' 186.00 97.0 584.17' E 32'34' _r�.r. w . 4' l' tIr<, .!e;,, t� t v $`•l- s.M1••.. t; •7+ JAMW i r'.:,i'M::lKf.>1.r1• rlt.c.a.:.. • _ 1 . , �• '�1��, ' ,, 2 •,: t' 4 D $. LEGEND N �t �* y 0 1 COUNTY =TVN BERJi5D�1 • CM �•. •� .,1 • i yht�t' !�j 1 , WrJ11Et1i ■ lWr ry l ' � C E7asT1NC '2 Fat P" { J "7�� O r 2 x 3o PPE vtEIGIp G 4 f 365 L.BS/LINEAL RWT.SE `? �SSy1 ! 8c' F s•� G;r, fYt :.; 'm in, ,.,E N ;;.. .1 MI1TN�1 %2.4�iiONPIPE S M�QMNG *- *, ! !�; * tl' i :.: / / • t t�� . , 1 =9 4 4 LOCAL I=. i ' ? (�. TRUE ��� ll a& t � 'a , : �'�' 0�� r• 9 *' rte' \. 1 . . ..' •• 7 . • $• do •�, 'tk n 5 '�' •�pkY�,"{' M t,. �� . f� � 1 �_ , 00 2G . 'Fr M[/L4tVADTS F � { %'di 1 Ai t" 1 'c ' • I _ .�� �, I t t • a f •' • � . �, S ` \ � � ` � � 5 � o. K WOC TO 'et NE ONE r•.lr 4 .� �t t q, \ NCLT/ . ,, s .: • .�� .�ai t• 6� - V�IGoq` KPIORlUTN Or A rOQT ALL AN4ILAR ' • i' ��� t , 1 •���. 6W wfASlriOJtNTS 1WE B�EH YAOE �P �,� `' t a , �`r7 ep0 c1 b M W&gmT ruvay STlC " O y' + , I !r �9 y' �' t e�. 1110 CQVV LO TO T"a Wits 0"" 4u �� :. \; • ++ fix, +'•' 1, y , 41 ' '. 1, �'' N►,• Vl ALL WAIIIIIIN05 t $1410111101 AW 4� 0 -o rwod 80 0 a1 N fi� If \ i '''(•. 1 6 .� 2 „6•�i s 3 ' ..'i'. ',` r �` '^ .. Qj Co^\ 1�`, 1 . tl W_ •.' • , 1 ' 1 ••` ;�i t v��i4::. r �,- t .6 ,.. `�i. cy •` 0, N �` Z f \ ,.,tr t , yy �1r �,��r,1 j`.• }Y� \ • <• ��i , : 1 • .71 N ' � a ' +`` •''.ilr: p '` r. S '�ti ^ .';' •.;,: ' .w'.'j' �',7. \mot Y '. ; \•Q al. '� r n ' t ` \'.'11.7•.+ , , ?;f'.;j. ^�• SI'd�fi o/ /fir' N • �CH Je t' ' , " ♦ \ t' • i r t-d t�. s: r.. t' 4f NE 1 ` �`'\ i �;�•' ° �'� � !. X14 r� >r •,ri 7Y ` t��'' \� .• 1 I'�yd N 4T r , �i INDUS TMENT OF REPORT ON SOIL. BORINGS AND SAFETY & B U I LDINGS DIVISION 1Nfll.�STRY. >. ,. LABOR AND PERCOLATION TESTS (115) P.O. BO 7969 HUMAN •RELATIONS MADISON, WI 53707 (H63.09(1) &Chapter 145.045) LOCATION: — TCC 7 ION: TO WNStIM?MUNICIPALITY: OT NO.. BLK NO.: SUBDIVISION NAME: NVJ '141W4 /a /Tz H /R�.::�)�f �:�' �,: .e�r�.r L �� � �o�.) )O 4�/,E�s COUNTY: OWNER'S NAME: MAILING ADDRESS '�Z r '(Zo r USE DATES OBSERVATIONS MADE NO. B DRMS.: COMMER A RIPTION: 3`CR1PT10NS-. STS: [gRtesidence 3 .1\ New Replace L RATING: S= Site suitable for system U= Site unsuitable for system ON ENTI NAL: MOU D: IN- GRO0NaFR iJ S ST M -IN -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) S 0 S []U S ❑U S ❑U ❑ S U Co N V ENTIONh -t.. FSCID- / It Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(.b), indicate: 14A CL �}S`j Floodplain, indicate Floodplain elevation: DEL►Ml�L. �-� I>a �� Ft>cx:sICPROFILE DESCRIPTIONS 5 1LS Ff�G.T BORING TOTAL PTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) 3.83' 8L 8&t ) 0. 3 5N MISD Sj B- 5U 17, 4- K 5 0 �o (VIED 5 wl C-7 P, C 0 2.99 gN f S' o. 83' $L >r 6-J -P- S j ¢. - 7 5' 12c }3N B -' 2- ,50 9 ` 0 4 'y 8, 5 0 MMO s \AJ c-ft cos z,5�' IS L- f� 15 04 -F5 j bN;O' P -o.�.r MI:bS v G1 r— � & 3 "00 ��', t� omi= � 5.00 o 4,00' cs w UP_ Gc �. I-to7' $L 'F 5 j 5.33' RD Br.1 M ED S w/ d rI- B- 4 - 7 oo' �3, I'.e fJ > 7. U 0 Co a 2.20' '$` .� CJ� ¢, SO' P- D QN GS W/ &Z .7 GOB B - 7,vo °�4,3 ►�t0rj 7" 7,00' B- paC.IMAL_ PERCOLAnON TESTS NUME3F2 GoP� �1''D"l�s vVITN Bo�E ot_W_ N f:3 TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER S AFTER SWELLING INTERVAL -MIN. P - I p 1 PER:0132 PERIOD 3 PER INCH P_ 1 5, ota' '0 P_ 2 4,5a' Moo = 3 2 Ytc. :5 t P_ P _ At L� TE TS >✓u f4 O F, PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate state or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. �tc �+r✓H M EC- I ' TD oF 'SL Co, SYS'�EM >ELEVATION gz .4-o aoc:>o s_ a rreca.L-E r --� � - s�•� . 1.0 ( s I I I , - 4 _' - '7 1 � t I I (__ ' - - t - - Dr - ' - - - 1 -- - I ( i i I , 1 the undersi ned h eb certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin 9 Y Administrative Code, nd at the data recorded and the location of the tests are correct to the best of my knowledge and belief. 8t_NCH Mirk =� f" PIPE �T_ t�(z.• -- EL. cj3,O'=, NAME .(print): - TESTS ERE COMPLETED ON: ..� k f ADDRESS: CERTIFICATION NUMBER: IPHONE NUMBER(uptionall: 4 N 5 �- �_f t: S o •.� ti� I, S65 715- ��g� -4Ug0 CST ° NA1 LIRE: ry 1 DISTRIBUTION: O: i final an.+ttn? ropy o t ,Ma Aurh7rity, Proppi iy Owner an i Soil Tester. DtLHR ..�' FiJ to .n' :77821 _ OVEPI _ JOB ' ROHL & TIMM EXCAVATING SHEET NO. OF 310 Arch Street =? HUDSON, WIS. 54016 CALCULATED BY DATE 2-2 (715) 386 -8664 CHECKED BY DAT �— �' SCALE Ax ...... —_ — ^---- ` \ . ........ .. .t ............ .. ...._ ! ...... ......................... . .. .. \ -- .... .._.. .. .... J ..... .. C^ i _ { . -. .. . j yr. �. \. 1. �., ® — a , ...... v i I its �`, , , I Vim... _ ,\ .......... C J` - ..... ........... : �. ........ ... ...�— C• a �\ .....__ C ' ne ^4 (� �' C� � Zi P -, j { N ..... ...... ......... ....... ... _ . .... ..... . a " ..... . P. .. T� ............ ... PROOIIGf MI Inc., Gmton, Mm 01471. I � JOB r ROHL & TIMM EXCAVATING 2 2 - y o f 310 Arch Street SHEET NO. ¢ y ' g HUDSON, WIS. 54016 CALCULATED BY DATE 5 Z Z;? (715) 386 -8664 J 3 CHECKED BY DATE SCALE /C) ,o L- �, ..... _ ... .. + ..... ..... ..... __ 5 =` I . . .✓ ... ... r ........... .... "I ........ ..... _ ......... ..... .. ..... .... PAOOVMCI � Inc., Gmtm, Um 01471.