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HomeMy WebLinkAbout042-1086-20-020 (2) t:ow-Ay. bVlsr_cre aaaartmentofCommcr,a PRIVATE SEWAGE S St. Croix: YS J sa y anc &.iitr; io, r)mmon INSPECTION REPORT s:,mor-y?emit N1 h (P 6-7 oYS GENERAL INFORMATION ATTACH TO PERIai Tj Smte Plar IC No'. Personal dnfomlaton you pr-vide may bu use: IY s... ..da-, pu-pcazs IPn'.w, La, 5 -1~ c'a '1- PCmrd Holoers. Name- :`ir; `i d:w;e i~•._~,~,.. Patel Tax No: 1x^A- Li 1r/cx V - 20 ~ 6 h 5 c Irf.p. Std Ehrv BM DeSCnaji0rt: SP.000roTOx+U^r.ange/Mep Nrr [-,KT 31. 7 C TANK INFORMATION ELEVATIO ATA CAPAGI TY STATION BS HI FS ELEV. TYPE MANUFACTURER Sepiic Benchmarx 16,34 lb-) .3 ©-y I C AII. ULA +I a ~ a(Ir ZS Aeration Bing Sewer Holding SIJHI Inlet STANK SETBACK INFORMATION ENK PI VdHLL BLDG. ROAD Dt Inlet 7` L p3. - - - - - - =)~st. Pipe [j, L /O~• T 46 7 Holding Bet. System f0 CJ PUMP/SIPHON INFORMATION Final Grade IAanc:az%ver Demand St Cover GPI:! 1 Model Number T 'r, P"nain TDH Lift Friction Loss System H TCH Ft S. ~d 4 ~,rcwrmn W.11 SOIL ABSORPTION ;SYSTEM BED,TRENCH 6'brt;h 1 .rq:h No. Of PIT DIMENSIONS No. O' Pas le;ade Dia. Liq..id Dcan DIMENSIONS 3 1 ~~L Z VeJY.C_ ~ SETBACK SYSTEId IO P:L ULDG AIFLL LAKE~STRILA111 LEACHING +j%I;,ctw O 0. INFORMATION ` CHAMBER OR 1*P Of Systom'. 13•! /`.j UNIT !.Iona amCa I' 1 7 r0 4Y .&,J ✓J DISTRIBUTION SYSTEM LS t Z S J S ileaner'F,lanilutd J_trn.nlen xHale Sac xHide Spaong vent ;o A,: lntake~ Lenga,. S Dia,_( _eogth- C.,:r L :uana SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Dept, Over Deptn v T. rzne j'?t.l:)e7 U %I rr. ied?tench Grnt-r F ed'Ter f f Cget. Topzail Na ~~^5 No COMMENTS: (Include rode discreix:ncios. persa:rs present, etc..) I:rspoctian #1: Inspect an #2: Locatior, r 11 Alt Btz Descrtpdor = G 17 2.} Bldg se•,vor length = • J - amount of rover = Plan rev:scm Required? Yes ZNo Use other side for adtlilional infurma/ - - - Ce1. Nn nate Insep:aoB Sign- .m SrM 6!10 flk.aB'j SAID 2ol County S Fis C/ 2D i Ni. of 'J'1Mfi AVE.; FSwux} I.VUmlxr Inc. Ohe 5:ird in M C<.? Id dsoa WI 5376 7-7152 -7 7~pG' 07 2 01 i9 _ _ f~ Sanitan Permit .Appl cati, cu.in:y 5;a4I:-.rasa..-non.Numhc In aamdaacc with SPS' 3ES ;(?h Wis Adru Code. sriuutisrioe of fim rr'.. . Develaq. I, ;cx!mree otio- to ohtaown& is clnin.n pemtn Note Apniicahor fonas fr, s[wr-owned POG1^.S are sttr:nv=d m Pool Address (r d:3a~mt than manioc address) the Dcpanmcm of Safrly enc Ptoiessional Snvics Pcnunal mfo:¢x:iun you tnuvi:ie l IT used fo; se:nndvv ' I C .purnnscs oc accercance with the !•rivars Lvw.s IS(';):m`,.5mu. / 1. Application Information - Please Peen I Information 11 / Proper, Ow„ N.:,.(- Parcel k 647- -/O.'l-TA-0zd Pnpen. Owner's Ma ' g Al Property' Locarrun 90~ t~e A C.n Lm _ City. SratIr' Zip ende Pnonc Nuabc section 3 'sya{(P Ir car j ti Type of Building (check all that sppH) ® '.olo T - N' R 't- a W CI : rr.: Family Dwclhng - Nil n;-Hearonms Sul Neil Block R L Pw IidC'omarcrc:al Uesc:ibc Lsr _ - I C cm of 0541 Numi~r:_- C Villaec of Sul CA ncd - Dct=bc ilsc _ _ 11 G Q - r 6~- W 251 2S ~1/~ 2'f•'7y O 7nwr. Of Lj 4. e1I. Type of Permit: (Check only ne box on line .A. Complete line B if applicable) Z CJt e~ A- r '•v^emce Syatcn'i Tirxnucntlioidin Tank Re emem Ony ❑ Odte: Ivlodifiratioe le • P:• [ F pac ' e-crsanF Sy.rtm lexplaioj R. J }'ctma RCllel\'ld .C T'rmt Rr\ KHA.' I Cheoge ofPlul F. Perot: Tran-afcr in New' LLtS Prcyiols Pernu[ Number and Dine izupc Hofn' ION" I'S Syste;/CumpoIChcck all that p dr) Pm s -d Ir-Ground At-iGadc Mo:nd,4 In of Sol sod ir. ihhc Drxprrsal i'oapuvx Ic%pimr P-=:==n= Ikvia (ezptain;_ V. Dispc -aliTrcatoent Area Information: Dcs: Vr. Flow' i gpd: ~e;:~. Soi: Arrphruor: Italc(gp Usrir% :.Area Requi:x (sII Dh pe:s:d Area Piopexd : i Systrm Ers•snon VL Tank Info :apa:i!y in '1 nta: of m=Lda:.t= Gallons Gallons :roar R Ne+Taols ixmn,Tmics `a o C i z a s p `D I .LTG L J <n v, = c. [ Sep= u Hudmp Tool /+J ~1_Snbe~L - JuAep Ca]p116G i VIT. Responsibilit)' Statement- L the under u.ned, assn a responsi in' for itut.11x)) lion of the IK)a howo on the attached p6nn -P'rnnb N=c ;ftmf) ((~`I- Par S:pranr I t.^'RfI'RpSNumhe: Itusmess Phone Nembc k,,- ~nubcr5o D ll- 7-37 Piuri r. Acarez (Snece Ciw, State, Zip Code! N -M. Cou_nivfDe rartment Use Onh .App:Dyed nprny. Perm:t Fee Ua ssu Issuing 1: Si[~atmr [.y ivrc , in. Dr:ma: 5 Sam S 1 `i M. Condi easuus for Disapproval 1. Sepis, taco, c rpl-: - AP', n 1 3) 261S JlyEd e , ` r aS~a l p p 7b v:1L•er ee I'~.c ei yg_.- s ,t_ec Jy/ tl-t+d /JeW CA SdW-J C As gr,ararayemen' pI n p o is«1 lrv,ilunoe NO 2. AI xeRw;k roC;tir.~ °pn.s hill to c.,-.rt. is t : d -1- e r v - ^ 1 IS rperflffilcnbl+ crr5!i trlici:f. 6+~ Nock- u.M Gowv..ec_I" .~tWea lC\V0p1<lepWL6lVr nle S; iRd IOQYVLOrI re rL<Cvnn[r•nl~uv pal"^na MU Oaan At:a ll invl~m>ae (~p14GQ- 2613 J k ti6U.G A f o h I o~U ssiws!)gIR.IInI) 5y6 I Ti, KNUDTSON PLUMBING X B / - ~L----_- -CONTRACTING, LLC 1 150TH ST. 648447MPAb k4ERTS, N 54023-8525 C LL p L6 T z 9L• s' ~ s r ~ /gS° 5T. 'Tr-f AO5 t C) lC Ci' ' t 2m°, olo ~ ~ a 9L ex, I Nlsonsin Deptartment of Commerce PRIVATE SEWAGE SYSTEM County St. Croix Sarety and Building Division ~ . INSPECTION REPORT Sanitary Permit No. 567273 0 GENERAL INFORMATION (ATTACH TO PERMIT) Slate Plan ID No Personal mlormallon you provide may be used for soowldary purposes )Pnvacy Law. a 15 04 (1)(m)) Pomvt Holders Name: City Village X lowosnip Pe,ioiitl Tax No. Pa ne Timothy Warren, Town of 042-1086-20-020 CST SM Elev. Insp BM Elev. SM Description / SecTonrTCwmRangeelap No. /°D g/►1 I A) t, 31 29 18,482A2 TANK INFORMATION ELEVA ON DATA TYPE MANUFACTURER,T CAPACITY STATION BS ~I FS ELEV. 1 Benchmark 17• C~ BSeptic e~m9 W:C1V.4 _ h /Z 50q F; I ~a ~d Szl Atl, BM rr•r~ z.L~ 6 , Aeration Bldg. Sevmr i►ill.~ Holding SvHt Inlet s I~ TANK SETBACK INFORMATION St/Ht Outlet 3 7 //yJ 31 TANK TO P/L WELL BLDG. Ven11 r Intaxe ROAD Dt Inlet Septic ) 54 $ 1-7 Of Bottom Dosing Header/Man. 7 Z p y Aeration Dist Pipe •'.V V ;9 Holding 1, _ Bot System ✓ la Final Grade PUMP/SIPHON INFORMATION ManWaauI rer GPMand St Cover Model N ber QI TDH Lift Friction Loss System Heatl H Ft Forcemain Length to wen SOIL ABSORPTION SYSTEM (Z BED/fRENCM Width Lenga+ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 'F 7 58 104 SETBACK SYSTEM TO PIL BLDG WELL LAKF/STREAM LEACHING ManuI4 w, INFORMATION Iy _ya -7 /VA - J uM r •C ~u~~' p (/J DISTRIBUTION UNIT OR "IN DISTRIBUTION SYSTEM (PL- `~XQY I'/ Ie41 a(/ G5© HeadeoManeold II D.st axamn Hole Size x Hole Spaying vent to Aar Intake y ~,LP pipets) ` ~ Dia Spaci•p„ Length b Dia 1 Length z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over n Depth Q1 xx Seeded:Salded n Mulched Becirrfencn Center Bed/Trench Edges Topsol \l Yes Itl'i No No COMMENTS: (Include code diecrepenaes. persons present, etc.) Inspection al. t Z 1 Js 1 13 Inspection M2:___ 11_ LocaBon: 900 Alex Lane Hudson, WI 544016 (SW 114 NW 1/4 31 T29N RI8W) NAALLo't 6 I^"" ~ Parcel No: 31 29 118482A2 1.) Aft BM Dexriptiort= Gi-Yt~w.- cle~ O..'~ 7S' f10/e 2.) Bldg sewer length = 2 0 ~jy~TG,A.b - amount or cover = L vy Plan revision Required? iM_ Yes _ No L 2-7 ~ ~ i /_y('S tl /'1 li Use other side for additional information. •J I L ({,/SIC/ i✓ S80-8710 (R.3197) Date I atwe Can. No. CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Pro)ect Name ~fA^- A.C Owners Name --r, .n e, :ni Owner's Address: `71101I0 )ojp n A. dL)S5e+A LJ 17~~(L Legal Description Sec- 3 ( 2-9 Township. rf~ County: Subdivision Name Sw~ ✓o ( - 4'7 q g Lot Number: Parcel ID Number: c) q2- - 109(o - ZQ - 6 2'0 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Secs Pace 5 Ma ntenance .rfcrmation Page G Management Plan Page 7 St. Croix Cty Seotic Tank Maintenance Form Page & Wara~ty Deed Page 9 CSM or Plat Attachm nts: Soil test House Plans Designer/Plumber: nse-Number: 4,-, Date: Phone Number Signature Designed pursnart:o the in nrot.nd Soil Aosorpuon Component Manual for PO'IACS Version 2.0 S13D.10705 P (N.01101). Page 1 Soil Absorption System Cross Section j /634 f If-- 4' Ssedule 4i I Final Grade PVC Vent Pipe YYth Va.7 Cap 6 ft Laacning .1 / Sysie:n Elevation ft ,~7ft Soil Absorntion System Plan View ft g bs ,ftIil _fi111~LITI .iilii I l I ~Ll Ig~1Fr Vent Or Ubservatior. Pip.- Lear.°iing `J ~Tren-c Chamber; i 4 Dla. Try ench 2 Heade- Leaching Chamber Speci icat!o ManufacturarA,Ic I'✓odel jn'Pl~a Q /L4 5b 9-5 EISA P.afing 20 Sq ft per chamber I Soil Application Rats O . (P gpd!sq ft apd Design FiDv;• ; , (p Soil Application Rata -U EISA = 56 ~ Chambers 2 rows of Z5 chambers each. Page of POWTS OWNERR^'S MANUAL Se MANAGEMENT PLAN F~a< FILE INFORMATION SYSTEM SPECIFICATIONS Cnvner i n ~z: - - Septic Tank Capacity ❑al - N A c :rmc r Septic -ani: Manufacture- NA DESIGN PARAMETERS E-fiuenc Filter Manufacturer ~e ❑ NA Numbor of Bedrooms -1 NA Et`luent Filter Model Su ] NA NUmber of Public Facility Jnits XNA Pump Tank Capacity na', y r..A Estimated flow iaveranel C(j gal,'dav Pump Tank Manufacturer JA Design flow (uaalcl, (Estimated 1.5i ( p66 aaVcav Pump Manufacturer ~;FVA Soil. Application Raic J I Q, (p pa0rim'1- Pump Model A Standard infuenvEfriuent Quaii:y Monthly average' P~etraatrnant Jmt 'A Fats, Oil & Grease iFOG't •e30 mg'L ] Sand!Gravel Fiher C Peat Filter Biocnamical Oxyyer. Domano IBOC~i -22,- m7'L NA ] Mechanical Aeration G Wetland Total Suspenoed SDk:s iTSSi =150 mgl= ] Disinfection ❑ Other: Pretreatec Effluent Oualitt Monthly average 7isoersal '107sj ] NA Biocnemicai Oxypen Demand IBODs1 -30 m3'L I!Ground igravity; ❑ in-Ground (pressurized' Total Suspended Solids fTSSi mg!! ❑ N^ ❑ At-Grade ❑ Mound Focal Coliform (geometric meard =fu1100ml ] Drip-Line ❑ Other. maximum Effluent Particle Size '.N i^ dia. ❑ NA Omer. ❑ NA )incr. l :1 NA ] NA duluas :ypieal for Dnne-ic vastc:vatci anc SeDtie :n ^.Y. E-i.i>.gr. ;~tne r: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspec: cpndaion of :an Kits s ~ ) A: ier.;a on::e every: 3_..- ~y>arsi (Maximum 3 years) ❑ !JA Pump ou- contents x tanks; VVile, combinoc sludge and scum equals Dne-thirc il of lank vi urine ] NA ] m this: Inspect dispersal cell:si At Vcast once eve,y:a (Maximum 3 years) ❑ NA _ vea~lsi ] onthis; Clean effluent filter At If- a, once eve-y: JI V"_tsi ] NA ] Inspect ;rump, pump controls & alarm At least once eve-y: monthts'' ❑ NA ❑ yearisS - - - ] monthtsl ] NA =k:sn 'aterats and pressure test At least Oncc cve-y: ] vearts! ] monthisl At leas: once evew: : i vears' NA .Me- IJA MAINTENANCE INSTRUCTIONS Inspocoons o` tanks and dispersal cells shall be matie :,v ar indwioual car-yi,n_ ancl of lie -ollovaing licenses o- cartifica;ions: N`astw PVumil Master Piumber Rest-ictad Sewer; DDW-S insoacto-; cC1NT5 Man:ainer• Septage Sarvicing Ooeralir. Tani: insoesvons must inciudc, a visual inspectior q,+ the tank'.sl to identify any missinq or brolcon hardware, identity any cracks or leaks, measure tine volume of combined si.idge and scurr and to check to- any pack up or ponding of affluent or the ground surface. The dispersaf cellisi shall pe visually inspectec to check ine el lurnt ieve:s in the observation pines anc to check for any pondrig of effluent or the y.ound surface. Tne pondinc of affruen. an the grounc surace may ia:iicat t failing condltior. an, reautres me immediate notification of mie local regulatory authority. When me combine: accumulation of siudpe anc scurr^, in any tanK eouais anc-third i'al o- mD-e of the tank volume, the entire contents of the :ark shall be removal ov a Sep:agC Servicing Operator anc disoosed of in accordance with chapter NR 113, Wisconsin Aoministretive Code. At other services, incfudinc but not fimited to the se-vicing of e'fhrent fibl mec`nanical or pressurized components. oretraatment units, an,.: any servicing at mservals of •_12 months. snali be perrormed by a ce^ifiec POVvTS Maintainer. service report shall DE provloed ;o the rocel reyulatory authority within `0 cavs of completion of anv service event. Par,& Z J1 START UP AND OPERATION Far nano construction. prior to use of the check tre.=.tn lent -arrj r I me a'esence of painting products or o'ho' chemicals that may impede the treatment process andior damage the dispersal callst. If high concentreTions are detected have the contents of trio tank;>; remov^.d by z seotaae servicing operator prior !o use. System s-arr up shall not acme wher. soi' conditions are frozen at the infiltrative surace. During power outages pump tames may 'ill above normal higawater levels. Wnen power is restored the excess wastewater will be discharged to the dispersa: celhs; In one large once, overineding the cefl;sl and may resui- in the baclmo or surface discharge of effluent. -c avoic this situation have the canionts or the ou:nn -am: removed by a Septage Servicing Operator prior to. restoring rower to the efffuen! nump or contact a Plumoer or ?C.V-S Maintainer to assis- in manually operating the pump contres to restore normal ieveis uviihin the pump tank. Dc riot drive or part: vehicles over tanks and cimporse' cells. Dc no- wive or ;ran: over, ar otherwise disturb or compact, the area within 15 lent down. slope of any moune or at-grade sail absorption area. i Reduction or elimination of the following fror^ :ne w•as?ewater stream may improve the performance and prolong the fife of the PD1h7S: Hniih19TI2S: oaby winrs: cigar-t-, out's: condoms: cD-or swabs: dexeasers; dewa, .`loss; diapers: disinfectants; fa-; ! iouncatmn drain isu,-rp pump) water i%117 and veoetable peelings; gashimc: Grease; herbicides: meat scraps: rnedica-ions; nil; hainring products: pnSrrnoes: sanitary napkins: tampor:Fr; and veatt,r softener brine. ABANDONMENT 1•d^er the 1 S fails arid or is permanently tai:en auc of service the following s!eps shat be taker, to insure that the svsterr is prnperit arc safely aoandonec ir. compliance with chapter -'omm. 63.33; INiscorsin Administrative Code: • All piping to tani;s an- pits shall be disconnected and the abandoned pipe openincs seaot. • -he contemn o: al. :a7. 1:s anti ni-s shall be removed and properly disposed of by a Sep-age Servicing Operator. • Ah=:r pumping, all -auks am pits shall be e=.avatcc and removed or their covers removed and tie void space filled with soil. pravri or anothe' inert solid material. CONTINGENCY PLAN if trio TS fails ann cannot ce ie:rained the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable roplacemen- area has Dean evaiuatec and may be utilize- for the location of a replacement soil absorption system. Tne rep;acc,-ment a-ea ::houid be protected from &stu,bare and compaction ana should not be infringed upon by rzqured sn!bacls from existing and p-oposec siructu,c. jot lines and wells.. Faiixe to protect -h replacemew, area will result in 1nE nerd for a neve soil and site evaipatio." to escabF.sn a suitable replacement area. Rep.acement systems must comply vdih ncc -uies in effe.:i a; that erne. 7 P. suitable reala::ecten- area is not availabie due to Setbac,, anvor soil limitations. Earring advances in PD''%7S toonnoiDgy a h:,Hirsg tank may be. ins-alird as c iast recap In rurl:ace the railed ?OWTS. I T'_ ~„~'-rr.arc r, -mac: rV a IJIOI 1 o':I:. i✓iound art- at-grade soil abso-ptiar systems May be rzconsrucrrd in place following removal of the biorrat at the infilva-w9 surface. %C.nns--p-tions of sue', sys?ems most comply Wit" the rUWS, 1' efie;a at that time. WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR 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 Nsmz _ _ _ Name ,one pl,o::e -173.7 L+-1o SEPTAGE SERVICING OPERATOR (PUMPER; LOCAL REGULATORY AUTHORITY (dam;: r'dame jV ~-!x;11 ~Ov hpJl Z:J/J!/.~1 Phone n:. rl:,In en• w~., c. a',;cc i:ul apl;ancr wL a :lo.er ,..,mr. J".. •;ii&If. e'if. F.S.; Gi 11. f2~ 5 'v 'oarsi• Aamini ;raUv9 Cope_ SL CROL\ COUNTI GO:NLNG OFFICE; CERTIFICATION SIA'I`MlN-C FOR UTILIZATION OF EXISTING SEPTIC. T.INKISi i:ds is to cdirri-t t a: 1 hav~- inspoated :I v exidn; sq?: and or dose to It p-esentl SC'I t"ln' -.b_ f,6oa vinng -csid nce: swvl adlr s5)` 900 ~~G~ La~..~_ _ lma d :a: StJ /J.J 3 / T: " Z9 3<n_ , s To;~ n o? OJatre^- S:.. Cru:x COlln:J i4` ijC;lr_ L. Cp n ,aec:ioa. I :at= < ti.at I law leans tie tatii: i to At V;1 of L_; kno'v], -11 to he -C Llr '!e7:ts 0-.C011=. S425. 5. and it q hey') a-p Lri_5r to be Most dzte : it ,n o- sew i:c Dig nack oc:::r f-om a`_1 .ntivn s aerl: ' 7 "No (f no. skip next h>>c. i Approximaiz;:,lune or Ien;t° of'ti nc: zal;ons -11in.1tes ran.k Capacity: lava Con--ruction: t-f£In Conc•ret cr f la lu:aa aimown?: 7'_e 01' l ar.~: (1f Ii]0;12i: _ S L "UM Je-ill Io-7'7- 7~ II'' - Lip 11S & IW7 J0- a: re) Fra,~\a--.r T.A A 11 QA L? .r t" b: comple'ed llceas d plutnnb r iDep- of Co=crce Chan:e- i d1L: _-105. St17:1.i:C.•: :'I Il:v_i1~1. .-JD.)SL.. tjl.on_tn ..'11:1 ST. CROIX COUNTY SFYHC 'FANK MAIN•1ENANCF AGRLFMF`NI' AND OWNERSHIP CIATIFICAIION FORM Oxvneu'Buver Tim Payne & Kim Best Mailing Address 660 Hillary Farm Rd - Propety Address (Venlicatton requlreA from tanning $ Zmnug Tepanmem for new cnnurucbnu.) Cily/State Hudson WI _ Parcel Iden,jecationNum! 042-1086-20-020 LEGAL. DESCRIPTION Property Location sw nw S,: 31 , 29 N u 18 tDecouWarren - Subdivision Mir - - Lot H Certified Survev Map $1 18-4798 Volume Page 4 Warranty Deed N (bclbre 2007)Vulume . Page Spa house ❑ esdso tot lines identifiable OycsOno SYSTEM MAINTENANCE ANTI OWNER CERTIFICATION Improper use and maintenance of your septic system could resu It in its premature (ail fire to handle wastes. Proper maintenance .nnststs of pumping out the septic lank every three years or 3 oner, if needed, by a licensed pumper. What you put into the svnem ant affect the function ot'Ihe seprc rank as a treatment stage in the waste disposal system. Owner maintenance respsmelbififics arc specified in ;SPS. 333.52( I ) and in Chapter 12 - tit. Croix County Sartuar) Ordinance The property owner agrees to cubm;t to St Cron Courav Plsnnmg $ Zoning Department a cetvticabun form, signed b) use owner and by a master plumber. jourucyutan plumber, rests ictcd plumber of a licensed pumper venfying that (1) the on-site wastewate; disposal system is in proprr operating condition auWUr (2) alter inspection and pumping (if necessary). the septic nick is less than 1;3 full of sludge. Vwe, the undersigned have read the above requirements and attree to maintain the private sewage disposal system with the scandal ds sex loch. herein, as set by file Department of Safety And Preff ssdonal Services and the Department of Nelural Resources, State r(Wi t'a,'!" ! ulihr,tl ion ssvino r at y. t. hr r.•.n t..m..-d v- c: Fr .wnpleted nod arumed to the S: Croix County Plaunut>; &7unmy. Dcparlmens within ~0 days of thr throe year cxpirotiun date Uwe ccnifq that all statements oil this ftr if are true to the hest of ins knowledge. Ilwe am/arc the owner(s) of the property described abuvc, by vinuc of a warren • deed recorded in Register of Deeds Office. Number of bedrooms 4 /1rBil3 IG, INTU OF' APPLICANT(S) - DA'11 ",Any mforntation that is misrepresented may result note sanitary permit being revoked by the Planning k Tuning Department, Include with this applicaliuu a recorded warranty deed from the Register of Deeds Office and a copy orthe certified survey map if refenmec is made fit the warranty fired. (REV. Ol/t2) 770>z26 VOLL~8 4798 [ATR~f N. ViLS~- R[LISM OF OS,SDS 8T. CROIX CO. NI R=C=I11=D FDR 6CORD 0671229,2884 62s3WN 840 iar r sultt[Y NAP COPY F=s PeM z FAO=83 2 I _ Z BEAR0NQS ARE REFERENCED TO THE S OF THE NWI/44 OF SECC710" ME i M 31. ASSUMED 70 BEAR NO1183rW f5 Nm1s'x'w. . x20.37' 1 LUT 46 i 1 OT 30 i LOT 29 1 L COTTOIVWOOD I , I O 1 RIDGE 1 1 I C__ OTTNOOD_RIDGE 1 HEST ll►E OF THE MWI/1 1 ~ 1----------------- 1 1 1 IM7.lYJ~ I El C-) 14\ ;r 1~~``~ •S ~ `I. p'er' % r; I 13 f m of Ilk ~,W I a f~ soil v e E 41s.st 13a` -4 at -00 SAM ` ; 0 Ncf ~tb i xx 3 g $ i = L'NYLATTED4LANDS ~ S i r4 ~~a 8N v ~ 4 19 .t~~ y~ a '47-E !'•y i 213.06' 1 Y : T y N`4a SHEET I OF 2 SHEETS Vol 18 Pace 4798 s WswnsinDepartment of Commerce SOIL EVALUATION REPORT ur,. ion of safety and Buildings Page of 3 in accordance with Comm 85, Wis. Adm Code Attach complete site plan on County S'1'. CROIX paper not less than 8 112 x 11 inches in size. Plan must ,dude, but not limited to. vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow. and location and distance to nearest road. Paroci I.D. ( - 1086 - 20 - 020 Please Print all infofmation. Rev by Date Personal nfa rlon you pmvae may be useo to &xrxidwy Puryoses (Privacy Law, 6. 1 S 04 i I) Im)). 9 / Property Owner Property Lolabon ❑ 0 KIMHL,RLY M. BEST•.TIMO.MY D PAYNE Govt. Lot SW 114 NW 14 S 31 T 29 N R 18 E or) W Property Owners Mating Address -E-Dix- ot # Block # Subd. Nanw CSM# _ 660 Hilhuy Farm Road 6 CSM 418-1798 CNy State Code Phone Number ity C]Village • own Nearest Road Hudson, WI 54016 I( ) _ Alex Lane - . _--~Alarrea Q New Construction Use©• Residential I Number of bedrooms 4 600 Code derived design flaw rate GPD Replacement © Public or commercial - Describe: Parent material sandy outwash Flood Ptam elevation if applicable ft General comments and recommendations: Conventional iu-gound trenches 0.7 , loading rate DDb h In Property rtY Address: 900 Alex Lane ti ff ❑ acting Of 11 Boring Q Pit Ground surface elev. _100.47 fl Depth to Mnding factor 88 in. _ Soil +ication Rate Horizon Depth Dominant Color Redox Description Texture Strudure Consisterrce Boundary Roots GPDRF in. Munsell Co. Sz Com. Color Gr. Sz. Sh. •Eff#t -Fry#2 1 0-12 IOYR2'2 - 1 3t=mabk&gr dsh cs 3vl=m 0.6 0.8 2 12-23 7.5YR3i4 s1 2fabk dsh es 2vf-m 0.6 lA 3 23-36 '.5YR416 Is - Osg dl cs lvl=m 0.7 1.6 4 Y( 88 1.5YR4i6 Os d1 Ivf-f 0.7 1.6 All horizons have some er. F2 Boring #-Boring 100.27 90 Q Pit Ground surface elev. R Depth to limiting factor in soil Application Rate Haaon Depth Dominant Color Redox Description Texture Structure Consistence I Boundary Roots GPDlff M. Munsell Du Sz. Coal. Color Gr. Sz. Sh. _ •Eftl •E0#2 1 0-6 10YR2,2 1 31'gr ds^ cs 3vf-m 0.6 0.8 2 6-24 IOYR2,2 I 2C--mabk dsh cs 2vf-m 0.6 0.8 3 24-37 I0YR3l4 sl 2fsbk dsh cs Ivf-m 0.6 1.0 4 37-90 7.5YR416 s Usg d1 lvd=f 0.7 1.6 some gr; 'M rs(m 1wllom Of pit. ' EfRuent #1 - BOD,> 30 < 220 mgR and TSS >30 < 150 mg/l ` Fffluem #2 =BUD < 30 mxyL and TSS 3p mgrL CST Name (Please Prim) Sig CST Number MARY )O IIUPPERT Hollister's Soil Testing & Design 224832 Address - Dale Evalu and Telephone Number W9875 690th Avenue, River Falls, WI 54022 09 - 10 - 13 715426-1755 Property Owip, BE1"l,'PAYNL UQ-10`56IPM 2 2 Pairxal ID # - Page _ of t_I pit GE round surface elev. Depth to limiting factor 92 in. t------ _ Soil Application Rate Horizon Depth Dominant Colors Redox Description Texture Stnrdure Consistence Boundary Roots GPDIIY I I in- Munsell Do. SL Cont. Color Gr. Sz. Sit •Eff#1 'ER#2 1 0-12 IOYR2,'2 1 3fgTK,abk ds cs 3vf-m 0.6 0.8 2 12-30 IOYR3/4 - 81 2fabk dsh cs 2vf-m ~06 1.0 3 30-92 1.5YR4/6 s Osg dl Ivf-f 0.7 1.6 some gr. ,q I Bofmg # Boring L- Pit Ground surfaceelev. it Depth to limiting factor Soil Application Rafe Horizon Depth Dominant Color Redox Description Text rte Structure Consistence Boundary Roots GPDM in Munsell - Qu. Sz C_ ont. Color Gr. SSz Sit, _ •EfT#1 •Eftk2 1 U zaa~ C K~r i t i7 K t-~ z - nit 1 x 73 G 3 3 7[- 7-'.' .h1. r(tt5 r Y G,i =Y 3 7 c 3/y 3 a~C r s re+" F 0,6 `f ".f5 7 ~ 'y_ mz 3/ scr r tv}~ t~.H o 5 1 - - 0 7 S 75 , 3/ Boring 4 Boring Pit Ground surface elev. 107. 50 5- D" to limiting factor > 7,7 in. Soil A licafon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Oounday Roots GPON in Munsell Du Sr. Cont. Color - Gr. Sz. Sh_. 'Ef i •Eff#2 1 U >1 /C ~r 111M c' 2Y' m 7 /,C n 1 -3Z r sit - ,¢T r i >r I, l o 41 bt 77 7SyK g/ _ ~L a 1 U, Effluent 01 = BOD, > 30 < 220 mgrL and TSS >30 < 150 mgrL • Effluent #2 = BOD, < 30 ng& and TSS < 30 mgrL 'fhe Department of Commerce is an equal opportunity service provider and employer. If you need assistance to ueem services or need material in an alternate f'orma4 please contact the department at 4508-266-3151 or 1-1 Y 608-2664-8777. srm.a,wrw (R fi?roo) Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner jA(,Yr#Y 1 40 ft Legal Description Lore CsM r9--.7vg ~v,„ / (except where noted) TJ =Backhoepit North a 0 ~ tREWL~M~J?F,RE-~~ti8~ Z "IDG UP W~'~ ~ +1~ i u- - :~',vw• ~T.~ /04,52. 41 r ^i p I I r) Site Location: ~~HwT9y Z _ x &OL isue~ ~I J O N N Y {i N w 0 T ~ 00 O `1y ~ y ~ R( M O 80Z 9Z'0 Z a; ' ~ o a4i 2 ° A ngay n c `m rc o ~aF 5~= N~ b M C ' / f Safety and Buildings Division 201 W. WaslvrgtDrt Ave., P.O. Box 7162 Saumry permit Number (to Ikd in by C'u.l f hl Mattson, WI 53707-7162 ' y --73 - Sale nNumber it Application. In aeco-dance with SRS 38 ,I - rs A ode, submission of this form to the appmpn to Suvernmrnml unit ss rcqurrcd prior lu ohomini It it Note. Applianion forms for stslebrned P ~xa,~msubmitted in Prejoa Address (if different dust nailing address) Owe fk;(mmmcnt of Safety'r~f ssiorral Srn res Pasonel mfomalion y vide may G'fg"s, secondmy s rn aamnlanwt with are Fhmvan law, s IS.( I m Sma. - r /1 r. G L Application Information - Please Print All Information I T, Property Owrcr's Name parcel0 o-aza Y ci f In s >~Q S / _ Pr y ()wncri Nlialirig Address t Property Incation t~ O 4 - ~ 61,6 [ L, 4 4 m ~ Orr Govt I.ot 1 " G City. Sam Zip Code Phone Number -A, &,~ZA-A, Sootioo ~L Q{~lrcle ors SGYrY C~ T~,2 N. R,/ 1 . ype of Buildmx (check all that apply) Inc 91 or 2 Family Dwelling - Number of Beckoning Subdrv s an Name ok 'SA C Publmc/Commercial-Deserrbe Ilse `4~.` ❑City of. P - 'CSMNumber 0 Village of U Sate Osurred - Ikscnfa Ilse yYrwnof fClgrfQ~.--- A; .rte -t,~1 i~t~l5 a /8 O)r H L I ype of Permit: (Cbak only one boa on line A. Complete line B if applicable) A y new System ❑ Replacement System (J TteetmentrHolding Tank Replacement (xdy ❑ Other Modification b Existing Systerrt (explain) B. ❑ Permit Rorw ul ❑ Perron Rensron I.rst Prevlous Pamir Number and [lam Issued ❑ Chwrxe of Piumha ❑ Permit Trartafa to New Before ExpnNron O"'A° y~1e"~ (Pl IV.1 of POWTS System/Compooe&VDUrviee: (Check all thatapp!y _ N.Pr..7,axl In-G.i 0 Ihucuvd In4nound U AI-Oracle ❑ Mourul? 1A in. ofvuahle veil J Mound s 24,n . otaurrnble wit ❑Iloldnptl'ank ❑Other Dispersal Comporrent(explain).. ❑ PreuWmem Dcvoc(explain)_ V. D6 ersaVl'reatment Arta information: _ Design Mow (gpd) Design Sod ApPl~wtwn Ratc(gPds Urspervl Area Regamd (si) Disperser Arco FYOposd ( SYS1em Ekvalion 1. Teak Info - Capflmt}in Total Nof Marrofadrxer Odlare Gallons lhof ag reeks / C L o `J b a ~f New Tanks Fiwa SramI1C a tiddarit Tan L.C) ! t' S . _ [kung Ctumba m . . Vll. Ira ibilily Stateent- I. the malersigned. mm me ' 'uty tar' wilNioa of tit pt3wTS ahoaa e n t►e sthehed plane. Plumber's Hu/me/(Prrnl) PI gnslue - MPIMPRS Numhv } B/usmten phone Number [ f G ~ C9U~ ~0 -r7 Lunba's Address ( Cit). Sae. "yip Cork) ~-7 /SZ) --.9./5- o I/S LUe V 11. bon /Dt rrment Use on - x Isso Bern Stgaa"c ppmved ❑ rod permit Fee D" f/'-3 Reason for W s T 7..1 /v IX. Condis1MMURY/) Messons for Disapproval seDkcthnk,eflAlC%Rltersew 3) /~r'n 11 C4.aKt.a. a~°.Q sM b~' =~4- !✓~•S.Er d,cpenwil cell must all be rrrlcn 1 rlmlMned / as par maraprrem plan ptovkMd by plumber. 2. All sedmk rewffemer>ts Illuaf be ttmlrltWnad r per appeeable code / tlPditlmlcaa. Arad 4 ea spl"e plus for the riles and sail b the Coeary Only a Pep" merit low Was a N x 11 isehes is size SBD-6398 (R. I I111) I CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Payne Best Sewer Owners Name: Tim Payne and Kim Best Owners Address: 66011illary Farts Road 14udson Wi Legal Description: SW 1/4 NW 1/4 Sec 31 T 29 N R 18 Township: Warren County: St. Croix Subdivision Name: Lot Number 6 Parcel ID Number. 042-1086-20-020 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Sedan Page 4 T Filter Specs Page 5 _ Maintenance Information Page 6 Management Plan Page 7 St Croix Cry Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: Keith Knudtson License Number: 648443 Date: 11/06/2013 Phone Number (651) 470-1737 Signature Designed punuanl to the InGrwnd sox ADaapbm Canpmerd rnenusl for PowrS Venlon 2.0 S80-1 0705-P (N.01/01). Pays 1