HomeMy WebLinkAbout020-1376-07-000 (2)
',~asccns,n Dcpamm~m or~ommnrcc PRIVATE SEWAGE SYSTEM St. Croix
melq and Buiiding Divisor
INSPECTION REPORT San ua ,,term Nc
f'~RrnlTl
GENERAL INFORMATION iA-TACF I O slate an IL' No 607088
r'crscna ^TO:mnl on nova: r. r;:y Iv+nxmd I:n f..tuc:lery Vurp.:,::e.: IJy I:re s _ :,.1 '.1 Yml)
'cone hcideL Name C,p; +;tli?.CC lawn:n,p Gart:ei i:n\u
Mark Langert TOWN OF HUDSON 020-1376-07-000 li
CSI Ehl =ev Ir:p RM Elne RrA p,v:niPlion n Kedan'1o.vn.Ranee'laar 'ac
Z.93 C36 vF (S(L 14.29.19.2268
TANK INFORMATION ELEVATION ATA _
tW6 MANUFACTURER AnA,^.ITV 141 II:J1 RS III S ELF,'
SCp11G HU!IG'lllldfY. ELI` 7. ! /60, `1Z•95
Dosing idt. BFA
~ 2. 100 E 9g, res
Aeration Bldg "over
Holding F;:f-t Inter
rm!k
TANK SETBACK INFORMATION
LANK I,,- P:L :S'L__ m Imel
SCI yoj Ir` S.7 9 3S
V 4
:losing Heanrrt ^arv. V. Z /3 .
Amatiou Dist lllpe
Y3.45
Hnlahnc; sy~.telr -7--5 92 . 75
=final C:rede
PUMPISIPHON INFORMATION 3.3 qq'
/(i •7S
Marl:daclulci ItminC t':ove'
[if IY1 Q
I,eoI Nllmher
I DI I _ f naion Loss SYsloni t Icad T DH : t -
Tor,.,.Mal9
SOIL ABSORPTION SYSTEM
RFD?TRFNCH '!md?i I cost- hl n^~-e PIT UIME NSIONS N,: fn o b. '.nsoe Ga. Lur.: ci 0,~:.ni
DIMFNSIONS
y~
SETBACK S l$ TLDd TO F':L L2LP3 .LLL 1 AKF:STRFAId LEAC14ING N11.~~1VS...
INFORMATION CHAMBER OR 7..nFr a
Tv:x 7 Si:?rc'n
f 1 A 1 UNIT ,Aadc urnt:F
CO J 2 8 7Z / /V RT ~j
DISTRIBUTION SYSTEM of r-7Z "pir r4I
Hoodc,:Ltan,111 osaihuarn x Hrne Sae r. •lclc $ ..111, eel~.I6SlF- S
cu91h ' '
Lcngtr ~ Ca:,
SOIL COVER It Pressure Systems Only xx Mound Or AI-Grade Systems Only S
rr.+p:rv :r~ of
5,,
I c-v':. G:c, ar Cev Soda<~'11Fn,fdx u. rd. :-~.2
netlIrenc^!.<nle- L/ Be.7 rerCn La_ee Tao=ell Tes Vn ,e_
COMMENTS: ilflauae coat, oisciccpcnacs, persons present elc l Inspection p> Inspecion 42
Location- Wk LABARGE RL: f . I" C III-
- i All RIA Descnpllon = 54-, C OJ{J...
2 1 Rldg sevmt K ogIV. _
- anK+Unl olcuvur=
Plan revision Required'? yes Xtin ~J L 7p4o ' I 1
Ilse nthm side fo: aaditiona inforrnahor.. /
Jain rose tore F:Ae re Cen Ne
SBGGfi!1o IR.3: J71
S~4►v-,, ul`I ~c~~
Szfe!y anG 3uilain s Divisio.
' f U t t 2~7 64'. 'Jtrashin t" Ave P O. Box. 02
I $ P 9 Sanna'}' I'cnu[ ymnuer ito be fdc2 i trv
r<~\~ S I;I II 1~ I, I "A 'W son. Htrl 537077tGZ
L &670'S:
Saa~ltar~ Permit Application SaeT:sO - -
1 aC'cY'lTE z ui.h S"$ S . s 1!m is - 1.~ , m.1 .his t-Ir a the apprcprL'a- eevvumcotal Iml; -
'rcgrnc e
Nut
rr,f s4r, SafGS N aid d httcssoiCSSVpcrtrl nrl l e L.urns tm _Lnr ounec l'ON IS sc s.ulaucd LO Yrojwv AJJrrss (J 1rTnalatao vn:nlio~aJdrecsl
ur.. DLpartnmt I io'LS: tirv Lc .^.1 n -n aTi m L v.ra I r.:vlde tun be aced fa >o=onda'} ^ /Sn
fUfa`.iC~1tE ":.rydail4'.iltl t.l IIIVait [~+\Y '„~LF,TI, `•'L.), 1 y~7 /[~/'l
1. Application Informannn Please Prlul All loformau-n/rr^~~ - 1 ~G„~r~_ q / L
OPUS
~y ~ / p ! ~ Pm.cl A
rYrnp~Owo.-rs Ma:lmg .<,dmcss eee... OOO ilope:ty l.ocatirn ,~-~ct ~ p~
Z7Z lc,-)5
1'rty, $'.art-' I , 1 Zit: C'x!e Yhonc 1:mrryer l~}~.o ~
~ Type of Bmldittg Ichack all tbat appl, I.~n f S@nn~f N= c
vl/ L c3
Fa-rly DvrAn hur~.n -yl
Al•>liuC.omnreaal-Des;aibe s:
~CRy pl_
: Sta'L•^\fAncd Desw,!e .sr I r I l-.M'JLT:i+cr M1114e x -
Z vt3~. l(6_L.J ZZ f'ZZ CWc.w'WtrS JTODU OI_Z ~AZ~-..-
II IIL "1)•pe of 1'u uu[: (Check onl, one bttrotr A. Comple4 line R if apip I ble)
q _y _ -
.'`.l, tticn Systan v1r..1 $y~aa Tma:mra i u s•.7 y Hi a: etrni (raly
7'• _ C1dta M1:odifienn,ar t =_xistla~ S}stan (eepiain:
Ft _l Hr tat cnewa -.:;'nut i Y.iun 1 _rvc. nt nl l'rl~ nsusfo to New t.i>t PreCviousy?I:an_il !~umbrl ,y(n~C U Iss ec
-u r Fs lnlt,.n i iMJC ~0.7 / /lL~ V~~eZ
I J_
~n spr ul ! OW fS SYUem C.ompmrenL Device ((:beck all that appl'1
Fla 1 ..c L.-'nnr L. r. :u. l.n n n LJ At Gm- 1 Mound 2-
m of sm•el Ic soil I~ rn Imd X u. of su.-t/ab~~lf'rxYil
I add. -:e l- I -rr r UI rs n 1 n xpl•urt _ _ PrCSelu Ieu; Uen.e explvm ~ _VAg"o
FM1.lltslcrmibr~at renT Arealnfnrmxhun -
I M?+~A~+ 21, /I [Ya S vl Appu n H to ll 1 I +•i-p.: il zrea Rcgn: , D:+Ix-aa1 L L paned' . vsten Ela':J+do
Z _IIu
\1. 'l'ank Info .I taFa iq :o --Tory a:;f M1 uhr,L'e: 0, sv10l~J
~ L 1 ~:uUc ~ y
NTf Respomibilih' Statement- 4 thr
undersigned. aau
Pnnarbtbhy for tmfaltau.n of the POW IN shown nu (hr .toothed plans. _
lu..tjt: le \vne Amll / I F~urnher ,n re s,!y uinra n:
r ~ Tv1YHS Ner r ' 6 Plw Nmobc
fIuznba'n -cC Jnr' 1. y Sta:e :ip",,z I Vlll, Couorv:Drpatiment Lsr Onh' -
Apprn'cJ ~ Ycnur[Fee Halt lssuvy ;csu .:gent S:mam
_ T'+'~y•~[.:,r rfn E I S 500 . mg /i9 I/•~IL~-].~(
I\. C.oudm9ncarv", a ~SOnsiR"r Dnsfapproval F - - -a-
cell -+v;: ml be s -n' _ 2L
is per-la, 3gemeN pl _n , L aaen Lv plu:noe, . 1
2. AN Pt4b ..k recur., semi mu.9 La ¢,r•L n t ;
as per nppkalblt 0)6! 1;rtl.rf1.x67. ,
RCarL a.c¢myrK Pam lo: racrym-m wd :aamn ,e. rhr r_ouan uul. on p¢pr n4l lLl rhnnRL:yti+¢cbes r¢ya; -
O
SRJ-6398 :R_ l 1 2
i ~4 I
OJ~-lGl
System PLOT PLAN
pR0,1E:C"I Mark Lanoer: ADDRESS 972 LaBafoe Roac Hudsor "-h 54016
SE 114 NW 1/4S 14 1'1* 29 N;R '9 1V TO1YN Hudson couNT1' ST. CROIX
SYSTEM ELE1'ATION 94.3/94.0 5' below tirade 5i ' 9 BEDROOM 4
DATE CONVENTIONAL, XXX COSY ENTIONAL LIFT IIOI,DING TANK
MOUND SEPTIC 'SANK SIZE 1200 gallons 1.1E"1' 'IANK SIZE. DOSE: TANK SIZE
1101,1)ING 'T'ANK SIZE LOAD RA'rE ARSORPr1O\ AREA 891 P of chambers 44
BENCHMARK N.R.P. `1 Op of septic tank mannole ASSLhIL ELEVATION Filter I-Ilctlrnc Filler
❑ BORE HOLE: O 111:1,1, . 11. it. p. same as benchmark
Scale = 1/4" = 10' LaBarge Road
All piping- shall be AS 1.\l SDR 30d~~, - i:hin
10' of tank, piping shall be ASTN1 FS9I
\'i~nt
WCIF
_6" Quick4 Standard
of Cofer L,-aching Chamber
with 20.0 ft' of area Fxisting 4
:"2 pair of end :aps Bedroor.)
4' Lon, llom-
Gracie a' Svstcrn F?~ ~adon
ST
B'= 9(1' B4
Vah~ 1(1.
Venn
201
20
B-1
cell: frith . ' s;~acir.e
10' X 90,
l tl(!'
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 5,''1119
Owner:Mark Langer[
Location: SE1/4 NW1/4 S14 T29N,R19W 942 LaBarge Road Hudson
Manuals Used: In-ground absorbtion system (version 2.0)
Page4
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-5. Maintance and Cor,,ency Plan
Signature
License nunA~er>#226900
System PI-01' PLAN
PROJECT Mark Lannert ADDRESS 972 LaBarge Road Hudson Wi 54016
SE 114 NW liar 14 rr 29 Nm 19 wTOWN Hudson COUNTY ST. CROIX
SYSTEM ELEVATION 94.3.+94.0 5'below,nrado 5%1;'19 BEDROOM 4 DA 11: CONVENTIONAL XXX CONVE.NFIONAL 1,114 HOLDING 'IANK
i\'IOI:ND SF:I1'1(' 'I':1NK SIZE 1200 gallons LIVI'IANK SIZE: DOSE TANK SIZE
IIOLDING'IANK SIZE' LOAD RAIL .7 ARSORVIION AREA 891 0 of chambcrs44
RENCIINIARK V.R.P. Top of septic tank manhole ASSL:NIE E:LE.V \ f1ON Filter Lifeline Filter
❑BOREHOLE O WF:LI. sII.R.P, Samoasbencnrrar<
Scale = 1/4" = 10' LaBar_e Road
All piping_ shall he AS I NI SDR 10.134. wilhin
10' of tank, piping shall he AS'IA1 FS91
Vent
Well
>6" Quick4 Slandard 0
of Cover Leaching Chamber
wish ?0.0 ft2 of Are" Existin-1
5.Gtt^2lPair of end cap, Bedroon)
4' Long 12" house
Grade at Spstent Elevation
34"
25
.T ST
13-2 90' B-1 Valve. too al. 11('
Vents
20 45' B-3 30
20
BI
t
40 2-3' X 90' cells with >1' spacing
100'
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 99.3'
A\,~Cnl
Grade vent
X30/34 Septic Tank 3
5' S' Lone
Grade at System Elevation
36 Gredc at SVStI'nl Llcva~ion
Spacing- 5'
2-3' X 90' Cells
Same on other end Observation tubeNent
At end of cell
C A
B
22 chambers per cell
System elevations:
A-94.3'
B--94.0'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_ of
Owner _
" INFORMATION SYSTEM SPECIFICATIONS
Ow
Aerrrit # - ~ - - Septic Tank Capacity
~a C NA
Septic Tank Manufacturer
)ESIGN PARAMETERS -ue O NA
Effluent Filter Manufacturer ~j //-(CL_ p NA
Number of Bedrooms - ~C.~ L
- - _ _ ❑ NA Effluent Filter Model NA
Number of Public Facility Units -
_ _ _ >cyNA Pump Tank Capacity ❑
Estimated flow (average) - dal ❑ NA
Ly(1 aVda Pump Tank Manufacturer
Design flow (peak). (Estimated x 1.5) - ~ ~ 9'- Y NA
L' ✓f/_ _~al/dam Pump .Wanufacturer_- - - NA
Soil Application Rate - - -
Standard InfluenUEffluent Quali - 9-~°aYffl Pump Model NA
tY tMonthly average' Pretreatment Unit
Fats, Oil & Grease (FOG) _30 mgrL NA
Biochemical D Sand(GraVef Filter C Peat Filter
Oxygen Demand (BODz) 5220 mg1L ❑ NA - klechanical Aeration 0 Welland
_ Total Suspended Solids (I-SS) <:150 mg/L
Prelrealed Effluent Quality ❑ Disinfection _ J Other:
Monthly average Dispersal Cell(s) -
BiochemicA, Oxygen Demand (Boos) I X30 mgR Ll NA
Total Suspended Solids (TSS) 730 rn t 'n-Ground (gravity) O In-Ground (pressurized)
- -Fecal CoNform (geometdc mean NA Q AI-Grade G Mound
) : X10' cfW100m1 ❑ Drip-Line
'Maximum Effluent Particle Size ❑ Other
- _T ~ in cia. [yfRln Othec
Other - - - - - ID NA
NA Other. - - - - - -
~Values typical for domestic wastewater and optic tank ¢(fluen! - - - - - - - - f❑ NA
Other.
IAINTENANCE SCHEDULE 0 NA
Service Event
Service Frequency
Ilnspect condition of tank(s) - - At leas', once every: q month(s)
Pump out contents of tank(s) - - - - - ea (,s)_ _(Maximum 3 years) Q NA ,
- - - - When combined sludge and scum equals one-tnjrd O Y,- of tank -
Inspect disperse! oelf(s) - - - - volume LI NA
At least once every: 13 month(s) - - -
lean effluent filter -I^--- - 28year(s) (Maximum 3 years) C NA
At least once every. l month(s) - - - - - - -
/ -ear(s) 11 NA
nspeet PUMP, Pump controls & alarm - - -
_ _ At least once every: ❑ month( s) -
=lush laterals and pressure test - - - ❑ Year(s) ❑ NA
':lush At least once every: O month(s) _
- - - - J Year(s) _ ❑ NA
_ At least once every . [7 month(s) _ - _ ,
~~ther- . - . -
- - - - - - - - - Year(s) - NA.
MAINTENANCE INSTRUCTIONS ❑ NAU
fnspecfions of tanks and dispersal cells all be made by an indid
iPlumber; Master Pl Restnded Sewer, POV✓TS Inspacfor: POIAr;'S Maint
jvual carrying one of the `ollovnng licenses or certifications: Master
ainer, Seolage Serncin O
include a visual ins pe pectio on of the tank(s) to identify any rn ss:ng or brrken hardware, idonti ny
combined s d
t the r g Perator. Tank inspections mull
luge and scum and to rheck for any bck
cracks or leaks, rnoasare the vowmC o4
brsially inspected to No the effl ue nt levels in the Observation pipe ll 19 and to Check fur any e pondiny of
a uo or ponding of effluen on
y pond surface
.
uent on the dispersal cell(sground) shall be
The pond autho ri ty . ,The
the pond;ng of effluent on the ground surface may iruicata a failing cOndifion and requires the immediate no~ficatbc of the local
surface,
vVhen the combined accumulation of sludge and scum in aey tank equals one-third (h) or more of the tank volume, the entire contents of
4dmmistrative Code.
he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chanter NR 113, Wiseonsn
14i1 other services, including but not limited 4
,0 the serviGrg Of effluent filters, meonaniral or pressurized componems. Pretreatment un@s,
and any servicing at intervals of <12 months, shat' bo ponormed by a Certified POVaS Maintainer.
N service report shal be provided 10 the local reyu'atcry auth]iitj vntfin ',C days of cornoletlon Of any service event
Page - 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 thet
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 fit above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cel(s) in one Large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent.
To avoid this situation two the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to ttre
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 yehid®s 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 at the following from the wastewater stream may improve the performance and prolong the Life of the POWfS:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental fkxss; 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 propelty
and safely abandoned in cornpliance with chapter Comm 133.33, 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 property disposed of by a Septage Servicing Operator.
• 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
H the POWTS faits and cannot be repaired the foltMng 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 soft absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by requitied
setbacks from existing and proposed structure, lot lines and wells. Failure to prated the replacement area will result in the neled
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruiest in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Baring advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POW i S.
The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
mThast be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as
a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infittraiive
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 Old A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name ilk Name
Phone Phone
SEPTAGE SERVICING OPERATOR JJPUMPERI LOCAL REGULATORY AUTHORITY
Name ~M Name . f - ^Ji r
Phone Phone l /J u2
G . ,
This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f, and 383.54(1), (2) & (3). Wisconsin Administrative Code.
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATF.MFNT
FOR UTILIZATION OF AN EXISTTNG SEPTIC TANK
to certify that 1 have inspectod the Sep-;(: ta::k prese:_?f
ir,g the J , ~ - residet;ce iccated
On To t.;,
Sect ~ _X
_Z? f
Upon inspection, . certify that I have
:e tank and baffles to be in good condition, and it appears tc b?
urctioning properly.
aY. ti^:e serviced: - -
Clow back occur from absorption system:
Y[-''s
- - Ne (it no, skip ne>a .:net
"1proximal:-e volume or length of time: ca_11on8 mir.ut-s. '
:2acity:
nstractior.: Prefab Concrete_x Steel Other
r.u_*actcrec: (If known)
n
w, or "'ink !lf known}
i'
L' 'gnature) - - - (Nam.-) PlaasP p V-it -
(License Number} -
22i2
to be Completed by licensed plumber (S.145.66, Wiscons n
tdtutes) or Licensed Disposer (NR 113 Wisconsin Administrat_-✓e
> jc1
:;ber (applying for sanitary permit) Certification:
accept n' the above statement regarding existing septic tank
tior,/ ertify that the tank to the best of *y knowledge 'N;l
lie l
~r.TOrr ~i requirements of ILIR 83, Wis. Adm. Code ;except for
pee - o[ opening over outlet baffle)
Signature MF?/MFRS Z7~~
~r £t'13k:t ~ r
214.043' 2044
{
rf
I ■Y!►) i
~Gy l !
E ( E
3:k
r l
ry
CD T
w
4 ~5 60(rlTl**E 214.434Y
Mf
2064.
w z
w co
co 00
# oel
46
LU
~t'fk O
I
WiscoasinDepartment ofCommerce, PRIVATE SEWAGE SYSTEM Canty. St. Croix
Satisfy and Building [NNalm
INSPECTION REPORT Sanitary Parent No. 405176 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan 0 No,
Persordl ofo W W you provide may his used for secondary Proses (Privacy Less. 1,15.04 (1)(m)J.
Pemlt Holders Name: City Village X Township Part ! Tax No:
Lan ert, Mark Hudson Township 020-1376-07-000
CST OM rwv. Insp. BM Der. Oascription.
99.3Sr 44 AAP at 61, { ca cR-Vwfd0)
TANK INFO ATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS III FS ELEV.
Septic Benchmark
Dosing Alt. BM
5•T.
(is$,
Aeration. Bldg. Sewer r
8•eh 9S•~
Holding SUHt Inlet 8• ~D -75-- yo
TANK SETBACK INFORMATION SUM Outlet
9e 4S• Zo y
TANK TO P1 WELL BLDG. Vent to Air this" ROAD On INet
Septic / I I DI Bottom
Dosing Header/Man.
,rSf 93.15/
Aeration Dist. Pape ,
_ lo•If 93.46
Holding Bot. System / f
rs 9z- 9s
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer Demand St cover M
4- tfc 5•2 9o•$S
at umuer
TDH Lift Friction Less System Head TDI1 FI
Mad
Force in Length Dia. Dot to WNI
SOIL SORPTION SYSTEM
ENCH @h Length I Nn. fx Trenches PrT DIMENSIONS No. OfPits Inside Dia Lipu.1 Depth
O /-o
-3 1315' SETBACK SYSTEM TO P!L BLDG WFl L LAKEISTREAM LEACHING Mnnvt~yivrm
INFORMATION Type Of System: CHAMBER OR p(OOIFF%kV'w-
i UNIT Model Nomtier. r r
200 55'
DISTRIBUTION SYSTEM
1Headealuandold Diseibulxar x Hole Sze Is Hob Spacing vend to Ail Yaat,
Pipe( s) r
long,h Dia Lengt Qa rig 7 L O
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Dyer Depth (Y+ra n Depth of xx Seedodr3oddmf xx Mulched
BeMrenm CMler Dxrmnch Tdgos Topsoil
:,l Yee 1 No ~f~ Yes u No
C~O~M~(N1IIENT~$: (Incl code ( reWyy ius, yorsoryusemI etc.) Inspecosn - f Inspechon N2: '"TT
[ IM1~ Cis` T` lA ed- I t: ylLyrIbn 1 1"
Loo Ion: 974 LaBarge Road Hudson, WI 540116 (SE 1/4 NW 1/4 14 129N R19W) Sywel am Lot 7 Parcel IN -14.29119.2268
E W.,, W(L eeotr • f) 5 sk•. aks= se (ksfeA earn ! 3 S
1.j Alt BM Descnpllon= S.Tiw, Zs'
y
2.) Bldg sewex length o r ~WS•s SG~Oe
- amount of cover = 2 if
Se i 1 ctaxr .
Plan revision Required? Yes Na LL t I _ -
U1e ulher 1Ndu fur additional infamati ~ ! 2 l ~'ypp 1
SB"710 (R.3,97) UU Data buepctors SgraWre Cerf. Na
Wisconsin Department of commerce SOIL AND SITE EVALUATION 2
Division of Safety and Buildings Pallet of 3
Bureau of integrated Services in accordance with Comm 83.09, Ws. Adm. Code
Atlech complete site Plan on paper not less than a 1/2 x 11 mraches in size. Plan must county
include, but not limited to: vertical and horizontal reference pore (BM), direction are
percent slope, scale or danierstons, norm arrow, and location and distance to nearest road. Parcel I.D.
II D.cO- /j 76- 07-CY3J
APPLICANT INFORMATION - Please p syfGitbdrretiWn R7NeweA y Date
Personal nlomntion you pm ride may oa vsad fw W?" ry Poia' (1X~ y Law, s. 15:04 (t) (m)).
Property Owner
Property Location
~ICh4Jr) ,v~A~ GOA,Lot114.,1.1/4.Srrj/ IN.R/,/ E(or)40
Property ovmers Mailing Address Lot a Bocktl Su bd. Name or CSM4
135:3 t r1` ~ Tr . 7 S:trree C-,T!io
city --44 State Zip Code' Phone Number city 1-3 village [B Town Nearest Road
['VSO LL,~ TOI (-1I ;S )'S4r ❑ t Cr,
~y New Construction Use: Residenlial / Number ofUodrooms Addition to existing building
❑ Replacement LJ Public or commercial - Doscnbe:
Code derived dairy flow J.M _ gpd Recommended design loading rate • ;'-'twd, gpMl2_ hanctr, gpMtz
Absorption area ropuirod5 S' /_bod. n2 C) trench, n2 Maximum design loading rate -bad, gpdrlt?---~trendt, WM12
Reeohmended infiltration surface elevation(s) 'YS It (as referred to site plan benchmark)
Additional design/sde consoerations
Parent material l-~ J / r-Li r j Ll_ _ - - - Flood plain elevation, if applicable l N-
S = Suitable or system conventional Mound In-Ground Pressure AT-Grade System in Fit Folding Tank
U = Unsuitable for system LA s 0 u Q's p u as Flu ®s ❑ u ❑ s r-.743.1 ❑ S ~u
SOIL DESCRIPTION REPORT
Boring k Horizon Depth Dominant Cofer Motes Texture 'Structure consistence Boundary Roots GPDRt2
in. Munsell Qu. Sr. Cont. cukx Gr. Sz. Sh. Lined Trench
I _Lc lv~ 2-
1/ 34 )b
around 3 1 rnl_ .
elw. `r
gffL - -
Depth to
Hinting
lector - 1r _ -
/ 20 in.
Remarks:
Boring If
Z 2 yl l - rx yI3 - ZrrZnly< c~ - 5 ' .
3 /nXC'i Cn - aS c -r m . 8
Ground
!1 '7- - / low !d. s.e<.<~ -
Depth to - - ' -
Iimidng
actur
111n. Remarks: ftl /nA s Y5 ;Evn
CST Name (Please Pont) / Signature =r Telephone No.
Address
Zil3 V. ~x,mer e} IoZS ~I-Da} oo Z-53
PROPERTY OWNER_ S~•~ SOIL DESCRIPTION REPORT ,
- - age Z._ of
~
PARCEL I.D.#
Boring # Honzon Depth Dominanl Color Merges Texture Structure Cons stence Boundpry Hoots 2
in. Munsoll Ou. Sz. Cone cuor Gr. Sz. Sh Bed Trench
3 r io yr sg2 - 5; r I fn~ _ rr) c I v-C . 3
Z 11 ID yr`l/3 Si L3 • 5
•to
/
Ground ZrncLkk V . 3 -d9 may! M 3 _ 03y M I G~ - T
elev. g
. - - _ . J
4~IL J
.
it
Depth to
limiting fi'b', L rn Z
facial - p - - ~-I-_ _ _
Remarks: ,Q/ Ml -
Boring #
l o-Ir /Q r3 Z - 1 I( rrrG Z 3_
H 2 ff• /D w 3 5,'1 2 n~Ci t5 5: •b
_31 Ir] /6 yr41/e rrtS_ 055 ~I .S
Ground
elev. - -
y~.,s n A~ Rs-o = ~r a-
Depth to - - - - - -
limiting e
factor
Remarks:
Homan I Depm Dominant CMor Molffes Texture Structure Cansist9rnce Houndary gaols PD
in, Munson Off. Sz. Cant- Cobr Gr. Sz. Sh. Bed Trench
Boring # r o -9 - Icf r 312- r- c 5 . Z . 3
5 . Z _ j3 14D v / Z rr><,bk rL - c_5
3 -1~0~~ t((e_ - - : -7
Ground
9rcry rt
Depth to
limiting
factor
I Zv in. Remarks: Boring #
Ground
elev.
Depth to
8mf8ng
factor
n.
Remarks:
SBD 8330(R "8)
PAGE >OF_
NAME ~'fUCt~ LOT# LEGAL DESCKIP'IIONS E Gtm/Y..S K( 'f!. y,N.K1Y E (orl
SCALE: I
UM I FLFVATION_ jC0 O
1
BM 1 DESCRIPTION{opo.L 1'bnd,*kj kf ,/0ai , - + Y
BM 2 ELEVATION 6-q , j 0 I /
BM 2 DESCKIPIION_WoS'- •tv-ta..:+- 1. ~i
SYSTEM BLF.VATION.~1, 4(~j _
ALTERNATE FI,F V A I'IONq5.~5
CONTOUR ELEVATION-
fir,
3; Pr; ~ g~ I frJ
O:
SIGNATORE DATE ~Jy`ldU