HomeMy WebLinkAbout020-1441-66-000 (2)
St. Croix I
PRIVATE SEWAGE SYSTEM
ru Minn rw s'o~ canna„': nrtrln •,n 5304
INSPECTION REPORT 61
;ATI ACH TC PERN11 I 1 5cuc plan IC NC
cRALINFORMATION a:1 R
_,c a I rmur :,r vn - ✓rs.nr n v c- +eC rm : , .n:nv vumn 11 n':,_. La Trr~.nsh e Pw[e Tan Ne
ozo-laa1-66-000
e-r, N~ •.taa,,.
TOWN OF HUDSON
Jerome & Marie Rudie oa iuwmna:?e ;w,
ev E, , r,N s.:,aalvtla^ 36.29,19.2792
1
TANK INFORMATION ELEVATION DATA
e ♦ F CL
C:A~AC~`Y rr I'>N
TYPE fL)d
ac Lit"
Inn3-0it Infer 1
- - SW It Outlet
TANK SETBACK INFORMATION
IANKIC; WILL BILY 'v nu•tc 4.-mrssc ROAD DI IMe~~
7~ D: 3ollOw~ l-
;,~pnc. 7~ppl pot 33 k~ u "
Huldirv7
Final (;:ade d• /.'7 `~'B'
PUMPISIPHON INFORMATION 0D (YT
Iotanlrta:AUrer Demand ;1 novel ~VaA
;aNl !SF'
tata7e~ Ni J.(,~( Nl a, r • a
mH
7DPI tin nnhon os= Sy;,;en, as
-ur cem.aa, I ci
Lea.. r,. Cca[^
SOIL ABSORPTION SYSTEM
Lc~olr T Ns TlgnGnm PIT DIMENSIONS tw :11
RCDrTRCNCN :'ntlm
DIMENSIONS 3 IG 6 \ -
IAKE.SIR-tk!0 LLACNING Nnn-taaurc- ~~1~, ~.J
SETBACK $YtiIEAr T(1 P.I HLG3 'u •.r11 CIIAMRCR OR ,w+1N'dor~ Vc+`~
INFORMATION _ V O I O 7( UNIT N:,lel %pn'oe,
(.0'1O ettil
DISTRIBUTION SYSTEM m
dr) Moa:rrr9R~ln.c 7i ~ F- % % - %
a,~ at C r
SOIL COVER z Prossure Systems Only SK mound or At Grade Systems Only
bldTleneh FAC~e T.::SeY Vc_ Vv
✓1 r
soCT
Rm Trr.- anfer ~ G ~1
0 o Ir_°.pCellOn 42
COMMENTS: ilnruIDe colic disracwnru's. persons pr-:sent =Insp°::non
r ~ W Lp `if~5 ✓
Location: RL%; Vvli ::;:XSr)N Lt.-, 4-1,11
3my sewer;` n cov v • _ ~ Cam
,,Mount . j A ( ^
ml of er= J` Iv ray
1C 1~XY - y,d4 ~(,¢✓„P_
nit revrslon Required', Yes. No
f!A 61/ 14 -
14,
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nit,;, Id F lu fnnn:una'vNer c
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r`t Safety and Buildings Division I ST CROIX
i!'t 1 Is 7 Q 19 2P1 W, Washington Ave.. P.O. Box 7162 II-
s Saniuiry Permit Number (to be filled in by ('o.)
'E Madison, WI 53707-7162
66364
-=Sanitary Permit Application ransactionNumbcr
In accordance with SPS 3x3.2112). 'Xts. Adm (uric. submission of -this fpm to the glt~ld is required prior to of ainmP a samrurrv penr..I NoteNpplicauon for ma Tor sate-owniv
414 Add ress (ifdircrrcoI than mailing ademss)
the lkpanmrnt o(Snfpv and Pwfessronal Setvies. Personal Information you provide xs in accordance ith the Pm•ac ly nw . 15,041 j ym). Suits. '1 / normeon-ease Print AI
ormaNoo p l1 'D(e-
Properly Ownci s Name a
JEROME AND MARIE RUDIE Z' -1 4N I - ~ -0,C
Property Owner's Mailing Address
826 WILCOXSON DRIVE PmpatyL um 1171
Govt [.at
f ny, Suite Zip Cafe Phone Number SE !4 NW 36
Section
HUDSON WI 54016 651-895-0307 Icuclennc)-
11.'1'y a of Building (chtrk all that apply) ~ Lot is
_
I trc 2 Family DweRmg - Number u(ffMrornre 66 Subdivision Name
oGA-v`im' Blocks COTTONWOOD RIDGE 1ST
❑ Ptdmha('ommc•.reial Ikxnbc l!sc
D ('it) of
D State Owned - Describe Gse ('SN1 Number ❑ Village of
3 /O Z r /OL 1`~ ~I Town of HUDSON
111. Type of Permit: (Check only one box9Rli_ne A. Complete line B if applicable)
A
w System Rcplacanrnl G•stan msmumt,l Inkling "rank Replacement Only D Other Modificnliw to Existing System (explain)
mit Renewal D Permit Revisin L hg, o f Plumber Expiration onenUDevice: Check all that a h'
rtud In Gund \ O Pmrsmowed lnGround D AI-Grade C Moimd> 24 m. of suitable soil M1lomd' 24 m. ofsuitabe soink D 01 ()the' Dispersal Cu nponeot Iexplain)_ ❑ Pretreatment
Met" (explain)
V. Dispenil/t'rea en( Area Informat a m
Design Flow Igprli Design Soil Applicatiu Ratetgla6l) Dispa.al Nra Require si) Utspcosal Area Prop xd (s0 System Elev t
600 J .4 1500 1500 o.r
V1.'fank Info C'apaaty us 'foul a of Nlunufacuaer
Gallomc Gallnec Units 8 `c Q.J
New Tanks Fxialny Tanks 1 r _ 51
'-0 f
W Er. Zebe1 n v, v c
septic n: n„lamg rank x 1250 IESER
rWin ChResponslbillty Statemenr 1, thr undersigned, assume responsibility for installation of the PO%% -S shown on the attached plain.
Plumkm's Name (Print) Plmnbcr•s Sognat - NIPTIPRS Number Business Phone Number
PAUL R KOEHLER 225410 715-246-2660
Piu s Admhcas (Street, City S Lip Coda
,321 1 WISCONSIN DRIVE NEW RICHMOND WI
Vill. Counts/Dc artment Use only
Pcmmit Pee Date I's PN-, Approved Fc:{p~norcd, Own_er(ifvcu Rcasoro tot Denial ltiwr asons f
ur Disapproval ^A 1. Stplk: tark• e~,*%Yn: )1Re- n1 , • , , . ° I ' f _5
Cf~
,r;spar,-..I Cf~~'1V>: il~be Qai_1C-. e, '/N
As per .n a r. ayerienJ plan pro ~ioe; Lv plu,noa.'.
i 2. All MRsark rf<t.irs-en y mra;t LV r-MX..Va e i
as parWikmbh ur6:1:M.ra.7o6R
Arbab m rompletr plan fur rbe system and sabmlt to rbr (foasry oaly on Patterson hss that a tT a 11 mabes to %in
SBD-6398 (R. I I? 11)
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: DRAIN FIELD REPLACMENT FOR THE RUDIE
Owner's Name: JEROME AND MARIE RUDIE
Owner's Address: 826 WILCOXSON DRIVE.
HUDSON WI 54016
Legal Description: SE Ii4 NW 114 SEC 36 T 29 It 19W
Township, HUDSON
County: ST CROIX
Subdivision Name: COTTON WOOD RIDGE
Lot Number: 66
Parcel ID Number:
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber. PAUL R KOEHLER License Number: MP 225410
Date: 05/09/2019 Phone Number (715) 246-2660
Signature
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P IN.01/0i).
Page 1
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2
FILE INFORMATION SYSTEM SPECIFICATIONS
owner JEROME AND MARIE RUDIE Septic Tank Capacity 1250 al O NA
P~mtk
Septic Tank Manufacturer WIESER NA
i
DESIGN PARAMETERS Effluent Filter Manufacturer ZABEL 0 NA
Number of Bedrooms 4 0 NA Effluent Filter Model 100 0 NA
Number of Public Facility Units 0 NA Pump Tank Capacity al X NA i
Estimated flow leverage) 450 gal/day Pump Tank Manufacturer C9 NA I.
Design flow (peakl, (Estimated x 1.51 600 gal/day Pump Manufacturer Qi. NA
Soil Application Rate •4 gal/clay/ft' Pump Model X NA
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit 19 NA
Fats, Oil & Grease (FOCI 530 mg!L 0 Sand/Gravel Filter 0 Peat Filter
Biochemical Oxygen Demand 130D6) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L 0 Disinfection 0 Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(sl 0 NA
Biochemical Oxygen Demand IBOD,l S30 mg/L X In-Ground (gravity) 0 In-Ground (pressurized)
Total Suspended Solids (TSS) 53D mg/L C NA 0 At-Grade 0 Mound
Fecal Coiiform (geometric mean) 510` cfu!100ml 0 Drip-Line 0 Other:
Maximum Effluent Particle Size Y. in dia. 0 NA other: 0 NA
Other: Other:
❑ NA ❑ NA
'Values typical for domestic wastewator and septic tank effluent. Other ❑ ryq
MAINTENANCE SCHEDULE
Service Event Service Frequency .
Inspect condition of tank(s) At least once ev monthlsl
3 earls) (Maximum 3 years) 0 NA
Pump out contents of tankfsl When combined sludge and scum equals one-third (Y.,) of tank volume 0 NA
Inspect dispersal cell(s) At least once every. p month(s)
' 3 month(s) year(s) (Maximum 3 years) ❑ NA
Clean effluent fiber At least once every: ~~77 month(s)
. 1 Qi year(s) ❑ NA
Inspect pump, pump controls & alarm At least once eve 0 month(s)
ry' O yearls) Q~ NA
Flush laterals and pressure test At least once every: 0 month(s) x) NA
0 yow(s)
Othe-: At least once every: 0 month(s) Q( NA
Cl year(s)
Other
QG 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 cells; shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a tailing 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 I 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 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 1C days of completion of any service event.
Page Z of v
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(sl for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal ce(lls). 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 cellist in one large dose, overloading the cellist 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 manualfy 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 Isump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meet 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
property and safely abandoned in compliance with chapter Comm 63.33, 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
If the POWTS fails and cannot be repaired the 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.
Iv~ T -Sirs
alua ' o ing ank
be' a ai 19RN405TE1, flC2-N cab"STKtJ~TL00
❑ 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
POWTS INSTALLER POWTS MAINTAINER
Name COUNTRYSIDE PLUMBING AND HEA IN Name PAUL R KOEHLER
Pnone 715-246-2660 Phone 715-246-2660
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name darrels septic service Name t;-:-r. G t~D I tit 2DAi/J
Phone 715 426 1025 Phone -7lS- 35'Co- 41(&,S
C7
This dwument was drattec in compliance with chapter Comm 8--.2212J(bl0)ld;&(fl and 83.54(1). f21 & ;3), Wisconsin Administrative Code.
SOIL ABSORPTION SYSTEM DETAIL/ GPAVELLESS LEACHING UNIT aage~ or
Project Name: JEROME AND MARIE RUDIE
3 No. of Cells 10 Per Cell
3 ft Cell Width 32 Total No of 10
100 11 Cell Length 50 sq n EISA Per Cell
3 ft Cell Spacing 1500 sq rt Total EISA
Manufacturer Mo6W Laying Lon en EISA Rating
L Infltralor EZ12031-1-5r, 5.0' 25.0
EZ120311-1011 10.0' 50,0
Gravelless Leaching Unit Manufacturer: INFILTRATOR
Gravelless Leaching Unit Model: EZ12031-1-10FT.
Finished Grade 99 ft Typical Cross Section
Observation Pipe with
approved cap or vent
Soil Backfill
in
Geotextile Fabric
Infiltrative Surface
12 it
W 11 Limiting Factor
_ in Slotted and Anchored Vent/
Observation Pipe with Cap
Plumber/DesignerSignature:
License 225410 Date: MAY 9TH 2019
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner!BuyerJEROME AND MARIE RUDIE
Mailing Address 826 WILCOXSO_N DRIVE
Property Address SAM E
(Verification required from Planning & Zoning Department for new construction.)
City/State H U DSO N WI Parcel Identification Number
LEGAL DESCRIPTION
Property Location SE NW , , Sec. 36 , T 29 N R 19 W, Town of HUDSON
SubdivisionPlat.COTTON WOOD RIDGE 1ST ADDITION ►nt#66
Certified Survey Map # Volume , Page #
Warranty Deed # 708880 (before 2007)Volume 21 35 Page #355
Spec house❑yc.iwo Lot lines identifiable 0yesisno
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 arc specified in §SPS. 393.52(j) 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 an&or (2) after inspection and pumping (if necessaryi. the septic tank is
less than L3 full of sludge.
Uwe, 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 Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification slating 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.
hwe certify that all statements on this form are true to the best of my 'our knowledge. Uwe anvare the owner(s) of the
property described above, by virtue ofa warranty decd recorded in Register of Deeds Office.
Number of bedrooms 4 _
5 9 19
SIGNATIiRE OF APPLICANT(S) DATE
'Any information that is misrepresented may result in the sanitary pennit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranly deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranly decd.
(REV. 04/12)
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CE TIFICATION FORM
olamer/Buyer JEROME AND MARI RUDIE
Mailing Address 826 WILCOXSON DRIVE
SAME
Property Address
(Verification required from Plarmittg & Zoning Department for new consUUetion.)
City/State HUDSON WI
- - Parcel Identification Number
LEGAL DESCRIPTION
Property Location SE NW V4, Sec. 36 . T 29 N R 1 W, Town of HUDSON
Subdivision Plat:COTTON WOOD RIDGE 1 ST ADDIT1 NN
_
Certified Survey Map # _p_ Lot # 66
708880 Volume , Page #
Warranty Deed # - 2135 355
- - _ - (before 2007)Vohnnc ,Page #
Spa house 0yes(]ao
Lot tines identifiable ❑yesOno
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 orpumping out the septic tank every three years or sooner, if needed by x licensed
the system can affect the function of the septic tank as a uratment stage in the waste dis pumper. What you responsibilities are p system, Owner maimanance
pm into
specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sa wel nitary ordinance.
The property owner agrees to submit to St. Croix Coun
owner and by a master plumber, Journeyman tY Planning & Zoning Department a certification wastewater disposal system is in plumber' restricted plumber or a licensed
signed by the
proper operating condition and!or (2) after inspection rand purmpping (if ning nthat (1) the the siteptic tank is
less than 1/3 full of sludge. pumping
es sary), the se
Uwe, 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
scan Wisconsin. Certification by [be Department of Safety And Professional Services and the
County PI stating your septic system has been maintained must be comply eteda d `Natural Resources,
State of that arming & Zoning Department within aft days of the three year expiration date. timed to the St. Croix
I/we certify that all statements on this form are true to the best of mylour knowledge. Uwe amlare the owtier(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms 4
5 /9 /1s
SIGNATURE OF A LICAN~I'(S - _
DATE
+..My information that is rnisrepresonted 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 surve
reference is made in the warranty deed.
y map if
(REV. 04/12)
ST. CROI_1 COLT-Nn' ZONTNG Of EICT
CERTIVICA HON STATEMENT
FOR L TILIZATION OF F-V TLNG SEP f'IC I'AN K(S)
i~7.IS S t:, C'--M 'Y 7h', :!L; ' sl-pii: and\) t,'i
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Sr..t ajdr S,;~-
r
1 Vol,.
T 0 Na n a r * o T~ C:ro x Uoun, is s
?on inspc..rion, 11 c l-,, rt- that I h2; 1~.r ne to ~ };i: I, to b r. ;
k!OWI!'L?.oc ,v1 :ArLorm to nt-r '..1 .d ii 1 1:1-y
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_OSt_.GC_iC}E1.:0I 1nS~e l"P 07
?id i.o-,v pack occ~r;om a^so-ration s~ste:::;' 1-a ~ '~o
it no. Shia nex: Line. i
_'-pp:ox late z v,h-mc or length ortitne: _L zllous -I"!in-Ivs ar:u?lore-
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:_nd
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix
Safety and Building ®ivisbn ,
INSPECTION REPORT Sanitary Pam* No
GENERAL INFORMATION (ATTACH TO PERMIT) 430540 0
State Plan w No:
Personal Inlmmaeon you prcvide may be used for stiocru ry proposes (Privacy Law, 5.15.04 (1 km)).
Permit Fbldefs Name' Cxy Usage X Township Parcel Tax No
Bast, Kemon Hudson Township
CST BM Elev Into BM
. ElevaM Desmiptim Sooionrr, nRango.Mmp No
14,y r~` :
iu of Ya y <<f Sfr l 36.29.19.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic I Benchmark
Dosing Alt. BM II
41Gn 11 pI. - Ga GAi
Aeration Bldg. Sewer
Y.c4 Y7.1
Holding SVHt inlet
Z (u{ rl . BA4 94. 1
TANK SETBACK INFORMATION SVHt OSir)
Sm.,hr4.., 3 94•.cy
TANK TO PIL WELL BLDG. Vero m Air Intake ROAD Dl Inlet
fo
Septic h,t et+I ex Dt Bottom
/oQ A41 jh CIO SI
Dosing Header/Man.
r~ x.20 `/b•o=
Aeration Dist. Pipe
`~•ZU '/a • cz
Holding / Bol. System
Lxv } /o zS 9Y. 4 7
PUMPlSIPHON INFORMATION Fnal Grad m. s s 4- yt.r. ryl S 3 S ~>`1 J
Manufa rer Demand St Cover
GPM .3.1~ /UG.o
Model Number a
tny! Ipp c~~%6tavH /irr y./0 to
Cs
TDH Litt Fn n Loss System Head T Ft
Forcem Length DI DI51 m Wen
SOIL ABSORPTION SYSTEM
BEDTTRENCH W-dm Length No. Of Trenches ; PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth
DIMENSIONS 3 y1.2 5
N LI tad .+ofa) 39 1
SETBACK SYSTEM TO PIL BL G WELL LAKE/STREAM LEACHING Manufacturer /
INFORMATION Type 01 System k CHAMBER OR -1n F' I I ~'C
ttv p.t UNIT Model Number
1> 9 ~
DISTRIBUTIQN SYSTEM /
HeoderMannad Dstnbulion y x Hole See Ix Hob Spacing Vent to Air Intake
y M Pipe(s) 3
Lengm 1 Z, Dia I e~pm Dia y Spaonp
SOIL COVER x Pressure Systems Only xx Mound Or AKarade Systems Only
Depth Over Depth O.rer xx Depth o' xx Soodod/Sodded xx Mulched
BedRrench Center
as FI No es o
COMMENTS: (Include code discrepancies, persons present, etc,) Inspection #1: I L ! 4 C C Ill I
11:acitln
Location: 826 W iicoxson Drive Hudson, WI 54016 (SE 114 NW 1/4 36 T29N R19W) Cottonwood Ridge let Lot 66 Parcel No: 36.29.19.
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2.) Bldg sewer length
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Plan Use otherl Required?
for additional information. 1'4,11
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The Deparhnent of Commerce is an equal oppolemity service provider and employ". If you need saistance to access service[ a
need material in an aNemae (omul pirae con"" the departmea u 60d-266-7131 or TTY 605-264-8777.
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contact U bdaa a naeocWn
Re&terad pdvale wsWewaW cMMAW and Owftra
855 O'Ne8 Road
Hudeon, M 54016
715-3868186 or 7157723442