HomeMy WebLinkAbout020-1372-05-000 (2)
%N, cOnvr Department et eommeee PRIVATE SEWAGE SYSTEM .,c oy St. Croix
Safe:y a^c Bmldi-I Dimsrcn
INSPECTION REPORT Sarrdmy vermrt r,c
GENERAL INFORMATION iAl TACH TO PERMIT: slate r"ISn o r+o
Peso al nJnrnnlu:n y::u prceidc 'na': oc .-srd 1e' sceonc ar/ c.rpe soy ~°'vat~ _d A', 5 15.04 r";
vemn; H-,=c's%a,c C:y 'Tillage -Crmsh c Parcel Ta,
Judith Munkelwitz TOWN OF HUDSON 020-1372-05-000
-5-3VElc, nsp 6K 5 ev 31.IUev-vmon nclmNlorrn:Haege Va.',c
7J Z5a 21.2919.2225
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER e CAPACITY STA I;.N HS HI FS ELEV.
Septic 611144 A,4 Wt 7 1 /ZCQ Benchmark 1517
t.~p~- 5.3 /c~.e yl.S at. ell
nC_ 1. Jul *37A 4~4, /r G-I
iae'nhom Bldg. Sewer
G! ~ Pe a Gr.
Holding S-."r•t Inlet
TANK SETBACK INFORMATION SvtIt oxfet 6. 3 ys• 77
Jib '8a_LL H +G. 'aenCO Asrl-ai,o ROAD
> 5a 1d 7 "ender. tan 93 • b -11
Dist Pipe
if'•" -
Dol. System
_4
Final Grate 3 r-7 icJ7. 3
PUMP/SIPHON INFORMATION ~ T'14
Marr.faolurel Demand St Crver ~ ~3 76 /
' 4-7
CiPNI v
NlodelNumbei 3 .-7 9z .571
-Fa TD- Li Frictionless Syster d iUH N 31 9z•(0
Farcella I, Le1gtn D.a. o~sl m e•;.n
SOIL ABSORPTION SYSTEM
BEDfTKENCH a`: 7C' '-nn:h `!n of Trc-c-es PIT DIMENSIONS r,e C" P1::: trs oe C ; l iqu a: 7a :0
DIMENSIONS
SETBACK SYSILM 10 "L HLDG1 Vv6LL LAKEiSTQFAh• LEACHING r,'...... r
INFORMATION C14AMBER OR ,4 6
r'P O _,r e t11 117 J/ P V UNIT ry'cdcl Vumher~ ~
DISTRIBUTION SYSTEM DD +-g
r•eacaYt.4mduLj II Di4rr sffem -Die -ule ;;__c.ng V",,lttaA ^lase
P,::eixj V
/
r.•.g~I, :)a__ '_e^ain U s ` Spa:,?
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 4k -
I :c n C c Ja:.R it A , c' d. I •dca:5 .'1nd +a `dulchc~
.2"1 rnr h IrI q / i'r i'1 er ::h 1 lges 1445 1l rm ~ s No
COMMENTS: !IncWdc code dscf0clic es persons present. etc.) inspection#1- Irspect a2
Location: 536 RAIDER DR JjLW IIn~~4~
1 A!t BY Uescnp'icn = 3Zb
2.i Bcg se"A'er length = L C~a k-',J O
- air,mvil of cover = V X1 D
Plan revsior Requlred9 es No 1 yr 2
Use other side for additional inforrna 63
tron. l
lime Insep-tc's n'Lae Cert . No.
SBD-iTIS (P. J~cTi
ST. CRUI\ COUNTI' ZONING OFFICE
CERTIFICATION STATENIENT
FOR UTILIZATION "OF EXISTING SEPTIC TANK(S)
This is to certih~ that 1 ha%c inspected the e,eistingseptic andJor dose tank
presently serving the follm in. residence:
(street address t 536 Raider G, ,w located
at: NE SW >d, Section 2. fown 29 X. Range 19 W.
l oven of Hudson__ St. Croix County Wisconsin.
Upon inspection, I certif% that 1 have found the tank(s), to the best of nrv
kno~+Iedgc, will conlirrnn to the requirements of SPS. 384.25. and it (they)
appear(s) to be functioning properie.
Nlost recent date of inspection or sen ice
Did tlow back occur from absorption system? Yes No-
(if-no, skip next line.)
Approximate volume or lem,th oftimc: =_:jllons minutes
Tank Capacity: 1250
('orstruction: Prefab Concrete x Steel Other
~lanutacturer (if knovan): Weser Concrete
Age of Tank 61' kn.osvn 19
Permit number (if kn(,wn) 363933
Jolin - - Schmllt
(Li ned PLttttbcr 40 (Print Name)
F~ 273760
Il itlet (License Number) MRAIPRS
Mate t
Form to be completed by licensed plunnba' (Dept of Steel\ and Professional
Services Chapter 305 and s. 145.06, WisaMnsin Stanrtcs) or licensed disposer
(NR 11.1 Wisconsin Administrative Codei
Rey. 20,
Page 4
aAn~
...wan ,,.r ~ II \~l IL~t~= I i un'.)
Industry Set-vices Division 11(rr"'
° , D 2019 II 1400 E t4'ashington Ave `
'D~p~ 11~N RO BO '162 yularv i'cmut NumMrltu Ile lllhJ in by Co I
1- UN V:•I J; - 62 61,532 3
L~~~it ° Sr lc ).;or n Number
-1111d appli ro cation
!ni u
ord.m.e wnh V\ +i' k :m 1. 1. ni r r I s an t Ihr , nyma0. gusannx'n
1
s rruured pntr t ,biauunp a a[ it r ,.ru 1 p .h r m Irma, brt ,Inn.nwa,i Ili N. I S arc suhn»•ttt11u
Ih hp'+r.r,cot r I l,dcn ;r.1 i nu' ~ o I ui •rnanm, ,in pnnrdc Ora, he used lot Cs, lid; i'roicct Addros (it different than mailing addras5)
p[9, as nn„ elan: ,•10111, rn Iell 1 'J+IInr1 Mat, 5:6 Raidcr drive
1. Application Inforn, [ i - Please Print ,\11 Information _
Proparr I reel ..amc I - Parcel.
mdnh \qunkeA, iv 020 -1372-0$LW
Prop irl, Owner's Manor, %11wa, Pmpcn} I malavr
°ih Raidcr I)rlCc
( il)VI Lilt
1u1a /tp ('(dc Milan: \urnlRl ?JP's. Mk Ncuon 21
iu,:,~m 'd clolb k~tiulleol
I 29N R 19110(.
11 1 , pv of Budding Ich nick nil that apply l of a
[ lo, :u, g. N,antx•r of RcJnv:m. la der I law ~
R ~
In1 ,.t . m .rc;1! Itc,sn+c l vc _ I4l,rck a
❑ (%IS of
]swa („.seed IRsclrhr line U IrVillage of
0 ,wool IluJmm
7
Cft(Ch~erk Q -~//~jOs\t ♦umbc
I It. I vpc of Permit: pl-.cc n line Compl ete line 1f if applicable) C\e, Ss,h,m [^crn 1•slen'r ❑L•umnuitiloldme lank itcptacemcnl lh,h 1)I11n\krlilicution
lu Cxisnnr SYStemlesplmni
II. ❑ ❑ El ('flange ref ❑ ! cm,it Tnm,lcr to \cw I ill I rcnous 'crtnil bomber and Date 6sued
I'cl_a Rc sr,u~
'<nna Rcnnod
.4,^I rc 1 tprrwoa, I'lumher 0. 110
363933, 61J2I70NI
• Iun'C'on,ponant'Dcvicc' (Check all that applyl
❑ N n I'rcmrnnJ h -(doand _ P-cssurw. Indnound ❑ •\I-Grade ❑ Mound - 24 it of tatai srvi 11 n d 21 to M sulubk soil
an ,.,peril raponcnt [evplam: ❑ I'relremnunl Dc%,(V ie,plam,
1 Dis ersal/Tlcat» n[ Area Information:
1',i,n Iles, ,gild; Ue.r r. Sod :\npr,ce n Uispursal Area Rc ued Dispersal Arcu I mpos tell ,,,tcm Hev;dior -
u'. 14 na LMlill X5? HOfI 939
\ 1. Lu,k Info apacnp in 6:Jlom 1 rJ r4 -
_ l a l on, lyres \1:u IasLacr L .il
New Iauks Fv,wng Innk. 1~ y i - -
~ept,c .n !IolJh,g Earl. 20 135(1 Ic'0\[c•cr r, .,cr~ ❑ ❑ O -
\ 11. Responsibilit, Statement- I, the umlr•reigned, assume resp0mibtlily for installation cWthe 1'0\s 15 shown an the allached plans,
n 1 an rl , n IV.auhc/yl+/r • Jlwc / %W AIPRN Vumbut 4iglICS1 I'honc Number
I hn 1 Irun.[I
Ilu olU ,:\d.l ,(s. r; tL(d, Stun :.:rl rJCl
sxl.1';,11, V.cu Ir~il, in[°.er,e1. AA' 154tl`5
\ III unts'De arnne[ I,I,
l tpn, ed [ r`~rl,`(i ~r~ bate L,u 9 I„w gem 1 p.n ore
.:r t 7,_.1, rl;cuint
~tny54,l,yisnppruval ^
I\. (0nditIV. %W C
alpae:•z,r erg ^.ret all be IC s as
is per mar.3gement plzr, TOacea by ylu,nbe . w - -~-A
2 All atTrk incurxran;s m'a+ct uu r. z:.rt if f i ~'j'e
~ par rpFAulbl~ arir ; : fA;: a.Y:te. _
4rn,ht.rr•ngdrv.•p~am lur ehe,,,eaa anJ,.rhrr~rl~t\,hr( rryr nh un yarur nm le..lhan %rrt, ll mrhn in.ize (/~,T ~r ,
1\ --T; f I\/~ 1
1 1 Cew{ p 1 c,eks~, a.
SYSTEM PLOT PLAN
Project Name: FAUnkdwt7 bas~_r =1r+: soo ya~oi~.car
- At3Ch U.. 7n11 amWZl ~ S for '~A~J'
or 9IeV ANre E ,3f Pnee
3h! S'+Irmo A BM EIev2G9n :c.'T F :r a•?-.a i 4:' i?:.rc-arc S;.we 1" = 60
BP/ ItesntTIt cxlstllc sep-lc tan1. 0u5et -aP?E 3'.. A & 354?:-_ oC 9:i 12C
e '
S G6"a' 0.S-h! ~2?05
9.' vv .xt 5D.1 FIPVaLr•11000IC
e4 GG..r, nae 7o~ o` lot sime
Jl 1 ~I
Slutx .~me~i o' TPsta7 /+'ua _ I
va<es n_ss _ _
I
Drcper-.~ Line
~-2
n~ gore 5 tc be
93 - . ~ ~ 56 wine- to
i
1 T- 2 x T5' 51odJW,er T eqt r E o2 BS
T2- a,'5' SiotllPcse' Trercn e. 9° s
TS 3'r 90' CZ Flcw renor _I =93 90'
TA '-'re(: EZ Fl-w 1 rench =1 -93 .90
a,
c
/ Propcscd %"2C-tn; r'ilte-tan. n
[t'Isiinq V.Seser 1250 Gal Septic tank
A
s~~<::. z~ Well
1 Beoroow
MJLSf
~aara9-~
Gnveway7
\r 1
r
1+ a y - Cu.-oe-sac Kaioer Grwe
I
Page 2 - -
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Protect Name: Munkel,vitz 4 Bedroom Rep acement Septic System
Owners Name: Judith Munkelwltz
Owner's Address 536 Raider Drive
Hr60n,`A154016
Legal Description: NE1/4, SW1/4, 521. 729N, R19W
Township Hudson
county: St. Croix
Subdivision Name: Raider Estates
Lot Number: 5 Block Numbe•
Parcel I.D. Number 020-1372-05-000
P,.r Travaction No
Page 1 'ndex and t tle
Page 2 Plot plan
Page 3 Existing Septic Tank Spec fications
Page 4 Existing Tank Certification
Pages Fi ter Tank Specifications
Page6 Effluent Filter Information
Page 7 System Sizing & Cross Section
Page 8 EZ Flow Information
Page9 Management and Contingency Plan
Page 10 Septic Tank Maintenance Agreement
Page 11 Warranty Deed
Page 12 CSM or Plat
Page 13 2000 Inspecton Report
Attachmert 1 Soi' Evalue:iar Rcnort
Cesigner: term Schmitt Licnese Number: MPRS 223760
Date: 5/31/2019 Phone Numbe,. 715-760-0486
S fcatu•e~ 7r
In-V .ir-1 So-l Ab--j*Lion Comporent %LinU.j! Ver,ion 2.0 S3J 10/OS-P (N.01/01),
Page 1
SYSTEM PLOT PLAN
- Name: " Munke-hv'.lz Design Flm 6009albnvday
Project
E
AnaGn design flow rasa aeons for rcreC Ayrress +m pans.
Pra1l J'inr " B1rt E e:a:.oo 45 TT Pipe Materials tASTM Standard Scale: l" = 60'
PM Desoioton Erishn_3 septic tank oollet Taoles 344 30, & 384 30.5
- - . C 60 90 120
BM2 SymOd A BM Elevahcn 100 00 4' SCI-40 =VC 1 AS-V D2.6e5
BM Descruton Top o` lo: SlaKe 3034 PV_ ASIA 73034
Slope Gadle'd o'7es:.d A ei, (2°,+
Well Symtol 1, t aFpllcaele
I
Naes lamas
I
Property Lire IN B-, ir
9G
2
T4
Bore 5 to be
g" - ~B5 54 verified to 110'
i
_ T1 - 3'x75 BlodiHuser Trench El =93 95'
100 T2 - 3'x75' B;odiNuser Trench El =93.90' m
\ T3 - 3'x90' EZ Flow Trench F: =93 90 E
T4 - Tx90' EZ Flow Trench El=97.90
\ m
~ Proposed N:320-MR Fdle• tank a
Ao s!;nq Wieser 1250 Gal Septc tank
ue
7
Well
/ 4 Bedrooli
House
\ Garage
Driveway
I
1
Cul-de-sac Raider Drive
- - - -Page 2 -
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Page 5
PJ31 LYA 0 COAM t
1 fflucttl Fill",
The F9.-525 Filler is rated for 10,000 GPD (gal!cn.c per day 1 making 11 one of the ;argest filters it, its class. It has
525Itnear feet of I lIn - filtration slots. Like the Pohiok PI -1-2, the I'olvlok PI -525 has an autumatics I I ut-off ball
Installed with every filler 'Nhen tho filler is rernove.i for cleamny„ the ball Ill float up :Ind I. mpnrarik, shut At
the sysleln so the effluent t,on'l leave the tank.
I •\Lu n1 sa 11111
• Rated tor 10,(i)0 GN I (gallons per day) - (Optional)
• 525 linear feet c•t I{In' filtration. 10r000 GPD_i
Accvpl~ I" PVC
A,, eels 4•' affil o" 1,C'HD 40 1,tpe' P
,t,,,wn }candle
- Built in gas dcfl •rtur.
.L .r
• :\ulomatir shut-Litt hall ,+han filter i•: ronx wod ,,.y
'
Alarm ai e'e55ib Ralydfort
111h•_ t IU.ICMI t:PD
• Accepls PVC extensimt handle. u
' .
Ideal for residential and commercial waste flows up to 521 Linear F[
10010 gallons per dae jGPDj _ Iu I/In'
Filtraaan Vols
1. Locate the ootlel of the septic' tack.
2. Remote the lank cover and pump tank it mx:essary.
Aryl 1'.6
.1 ldul the oiler housing to the 4" or o- outlet pipe It L; I ID au pq -
the filler is not entered under the arcess opening use a
PA\ lug P.stend X Lok or piece of pipe to center filler.
1. Insert the Pl. 527, filler isle its housing.
Certifled to
5. Re ,face and srrure tow optic tank cover.
f P I NSVANSI Standard 46
Me 13I,.-525 Effluent Fitters will operate efficiently for
scvcrol \cars under normal conditions before rcyuiring
clramIIi" It is iwonmmended that the filter be cleaned
c,,. I y luny the lank is pumped. it at least every three
•.'.,u'. If the installed filter contains an opuona! alarm.
tf ,•,,%%tier will be notified by an alarm when the filter C-- ea OeOcrwr
n a.~d, servicing. hen 1611.0 shunld tae dune by a certified
f•:ic tank pumper or installer :Whmeano
shut-k at wall
I of Me tine oullel of the svhhc tank.
L.I mote tank over and pump lank it nececsarv.
1!,~ :ud uao plumbing rv hon filter is rcmovod. i l
t 11111 I'I -525 cartridge nut if the housing.
I io>e Lilt filter over the septic tank. Make sure Al 'OP
,.•.ids fall back into septic tank.
,..ii,oi t the filler .it n'idge Ivck uttn the h,tusctg makr;•
..:IC dm tiller is prolx•rh aligned and compleleh• tmortcd I..:,:. :1 s n:.t fd1.•r.... rrla F.ISiIS installs
G~. plau• and s_eelre septic Lank Lover :,t71d1,0 .,r'Ir'1and alarm umoe,nnng:enl.%
,k. I:I, ? I :i-1I,1,:Ii1%d AV1.I n_''ol.l. ("I lit. Inl' Mee: sibc,!I`t~s uww.poIvIok,Conk
Page 6
PAGE 3 OF 4
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Page 7
Installation Instructions for 4&EtZflOw,r
EZ/h' Systems in Wisconsin by INFILTRATOR
.a:rr,ir. 7epartnr~. -f ~crrm• r :e, Sriely nd ht.ildings 5. The Absci: y a ;£F'. rice ry 'e• a a r n c to ;Hall
on, as •ene:vec thr• spcci5<a!iur ardor plans for thus be rued based on max mum Gaily sewage flow fGPD) and
,I iuct and dewimt-ed is to be in compliarce with crao:e the Permeabil ty fcr the site. If certain criteria is met, the
-:r~nm 82 tbrrr_yh R4 Vv5s~nnsin Admen. Code, and Chan',e,, EISA sitinc can be used in Wisconsin, res~ilfinq in a 40%
and 150, •WiSCe-NI" S:atules. All sdes must meet the Site c:rralle: diainfield.
r-nl Lpr n- d _ c^atans R Isolaticn distances as noted n
1 11 reoula:ions, ; 6 Place EZflow bundle(s) in :ne EZ(low configuration ap-
f:n~ec by system dcsiryn permit snecifind for the nadia.-
approved products are '203H (3-12' bundles with pine ii ; if , te. The lop of cenlei-must uundlus conlaini !y ppe
r • ter bundle in 5' or 10' lengthsi and 1203HP (3-12' bundle. a e ;u1ned end to end with an internal pipe coupler. Any
:,nir pioe in each bundle in 5' or '0' lengths. additional aggregate Only biri :ha! may oe required,
• should be butted against the omen aggregate-orly bur-
. irglc pipe bund a contai-s a 'our inch perforated pipe ,u- T,-' and do not require any type of connection.
n~ed by =PS aggiegate and is held together wrh ncly-
_ -t,lr-c ria:ti-c.., r. nrI^ agg,ega:c bundle contains aggregate : 7. Th,: tap of each CEO cylinder contains a filter fabnc p•e-
I; .:rd h •Id trp•P mlh polycthylaco nct:nr,
nan,i(sclured in between the netting anc aggregate. The
fafaic i, nscrtcrl :o prevent soil imrus.cn. The nstaller !
Materials and Equipment Needed shall make sure the the GEO is positioned .:pvvarcl and is
• I ZIIL:v _"li ri cortact with the fabric contained in the adjacent cylin-
• LZtl nv osJ;cxtlo i acr,= der befors baekfilling.
• LZflu•,v Internal Fr,L Cc~tlcc
• p: to, t•eaCer an9 rte: r. Tre EZflow Drainfield Systems should be installed in a
• ht:~_k°r.-,: _,:_,;utrr~ ~eee ti in all cl, ectrens (both aeroes and along the
7cnr'r ocllam) aro should fellow the CentOU1 of t-e ground
Installation Instructions ~'rcace elevation (uniform depi with all continuous
- t•uracne trr irstalatrr of 'i_Zhow Omdccts are gi:'en ; adjcinng 10-foot cylindrical bundles placed end to end,
. ~h er.~^r,r:' must oc i,stalled in accorda-cc Nth .sta:e wit- certial bundle ds:nbuton pipe nlerconnected,
, Ariuc m hap;ou -s•n•n 82 through 84, Wscans n Ad- ; w'itnout any dams, stepdowns or other water stops.
st*Ave Code, and Chapters '4E arc f 6C, W,ce'rsin Sta-
. as well as inc local health departments anon: dczign 9. The trench top shall be g-aded such that water will not
_.l. tone. Rarkfrll should be seeded or seeded immediately
afler con'Ple4on to reduce erosion.
ditcr ton icral ^.•a%th dt•;),.rl'n Pnf hLr-'._c torrrerc:l
~ntig,.rahon, an„ i1i,3A to' aye Ezfl-w ~;tem take ts. L?'low EPS bundles are flexible one can lit n curved
ra•k mi:h pant the location 71 berrnas and lines. Rc lie- rhos as may be necessary to avoid trees, boulders, or
sneful to set correct lank, avert ppe. header line or ni rxre• cbs.acle-s.
i-icr hex and tienrh hi elevations before ins:.: -
L,S_~r of pipe bungles. -S aggregate is ligh:or than water, therefore, it might
-:aectec :nat natural buoyancy forces would tend to
i"r Ove plastic EZflovv shipping Lags prior to plaei ~~nu-e EZI'.cw assemblies to float cut of ground when
Luncles i^ the trench(es). Remove any plastic bags it :r. D, d.ng occurs. Field experience -as shown, however,
:rent` before s,.•stem is ceve•ec. tlthis ~s not a Pcolem wher systems have a minimum
; , - ' r: , I co,'rr as re.-~~mr-vended by manufadt.rer.
3. This prucuct yr 3l have geetexfile fabric :hat meet, f ;
quuemer:s of s. 'Comm 84.30 (6) (g). 1Nis. Adm. Coda
instated daectly on loo of the product and extenc,r ; 1203H-GEO
down along the s~Ja e' t^c product :o a poi^.t at lea',t :
inches f•em the bottom of prod,,ct"'
4. When installed in a trench, the trench should be dg t : V ~\t
Q
a width of 36 :n:r r T^is rc rd ,ors lat-,r in
lion, but also pi i;, 1.: Ii" l ,i,t, ,
bacuf (ling s car i
Page 8
PAGE 4 OF 4
In-ground Gravity Management Plan
IMPORTANT:
The cwrer of this in-ground gravity system shall be responsiole for its perpetua. operation and maintenance pursuant to
requirements cr SIPS 382-384. Wisc. Admin. Code. Pursuant to SIPS 383.52 (2), Wisc Admin. Code, this system shall
be consioered a human nealth hazaro if net maintainer in accordance with this approved management plan
Furthermore W msoecton anc maintenance activities shall oe performed by a registered POWTS Maintainer in
accordance witr Si 383 52 (3) W sc Admin Cooe
Maximum Dispersal Area Operating Limits:
Design Flow = 600 gpd: BOD,:s 220 ingL"; TSS 150 mgL''; FOG 30 nil
Inspection Checklist INSPECT EVERY 3 YEARS
'ype cf use
aqe o` syster
nuisance factors (r e ocors user comolarhts, etc
'I
mechanical malrcnetion ii.e., pimps, valves. switches. flcals. eta)
material fatigue Ir e. leaks, breaks corrosion. etc.)
a solids volume in anaerobic treatment tank (s) and any distr oution appurtenances; fie ,distribution /drop boxes)
neglect or improper use (i a exceeding design capacities. prohibited activities etc)
extent of pending ih distribttion cell prior to dosing
dosing irregular lies - t applicable p e pump recycling, 'loat switch settings, e!c )
electrical components - if applicable (i . e., wiring. connections switches. controls. timers, alarms. etc.)
distrbuboe ateral or lateral orifice p4.ygny {measure lateral distal pressure - compare to design specificalion)
surface discharge of effluent er sewage bWk up into structure serves
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
Septic and dose tankis) snail oe pumped by a certfied septage servicing operator licensed under s. 281.48 Wis.
Stars when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or
as required oy local erd nance. Disposal of contents shall be pursuant to NR 113. %Nisc. Admin Coue
Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to reanurac:r.mr s soeci`icat,nns A sere icing De,icd well always De greater than 12
merits
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin, Code. Report any component failure or malfunction to:
Name o' ndividual or company John Schmitt _ phone 715-760-0486
Local government unit St. Croix County Community Developement Phone 715-386-4680
Irural governmert unit address 1101 Carmichael Road, Hudson, WI Zip 54016
Any defective part of this system shall be repaired, replaced or removed pursuant to SIPS 383 51 (1). Wisc Admin
Code Repair or replacement of failed or malfurct-.oning components shall romply with SPS 383 Wisc. Admin Code
No product for chemical or physical restoration of the POWTS may be used unless aopreved by the oepartment in
accordance with SIPS 384, W sc Adm n. Code
Contingency Plan
In the event :hat any failed treatment component of this P0'W7S cannot be repaired. it sha be replaced pursuant to
a can submitted to the approi age-icy for review and approval. A failed in-ground dispersal component maybe
abandoned and replaced cy. a ccde-complying dispersal component in a pre-determined area of suitable soils.
System Abandonment
If ~,se of th.s --0%'.7S is r.socnt rued t snail tie abard:merr n acccrcanco w th SPS 33. b"d.sc A min- Code.
Page 9
ST. CROIX COUNTY
Sill) IIC I'ANKMAINTENANCE AGREI:Nll.N'I'AND
O\\ NI'RSI IIP CERTIFICATION FORM
iJudith Munkelwitz
O„nerBmNrt "U;,
'9
536 Raider Drive, Hudson, WI St.
5401
Mailing Addr xs
r
Property Addle 536 Raider Drive ,
i\ crification required fiolm Planning & Zoning Department for new construction.)
City/State Hudson, WI Parccl Identification Number 020-1372-05-000
LEGAL DESCRIPTION
Property Location NE 4 . SW !-5. Sec. 21 f 29 N R 19 k\V.'rctxvn of Hudson
Subdivision Plat. Raider Estates Lot 4 5
Certified Survey Asap # Volume . Page;;
Warranty Deed # (before 2007)Valume _ Page ;t _
Spec house❑yesdto Lot lines identifiable0 yes[] to
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your scplir sy+ICnt could result in its premature failure lo handle wastes. Proper
maintenance consists of pumping out the septic lank cvcq three )cars or sooner. it needed, by it licensed pumper. \Vhat you put into
the system can aflccl the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. ?S±1 ) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to SL Croix County Planning & Zoning Department a certification l6rm, signed by the
owner and by a master plumber. journeyman plumber, restricted plumber or a licensed pumper verify ing that ( I ) 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 I:a full of sludge.
I%we. the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
aandards set forth, herein. as set by the Department of Safety And Professional Services 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 tit. Croix
County Planning & Znnin' Department within 30 days ofthc three year expiratiun date.
Ilwe certi(y that all ,talenten/Odus form arc true to the best of myuur knowledge. Uwe. arware the owner(s) of the
property described Am e, by virtue oanty deed recorded in Register of Deeds 011ice.
Number of bedrooms 4
Lam''
SIGNA"I't116. OF A IC. T(S) DATE
t
'«":\ny i ormalion that is misrepresented may result in the sanitary permit being revoked by the planning & Zoning Department.
Include with (his 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 decd.
(REV. 03:12)
rOY1S E 1009!
, =5. !o LOT TO
T 4 r f _ a I,
x r~ • Y LOT r p/l' yY
»LOT 9
m?", s FT
M.921 SC
1 01,01-2
r I C• IC 023 i v A
z
LOT 12
i. ~ i e.~~s, s; r•
r
V r.Y 9: C r
119 c
3
r
.vw. • LiLK]C' -.5.3
d
L^, i 6 7 s
N ; \
s h:]1Es
^'lwvr EIV.EW s
rr.. ntf~'.'naLn[:r, r,1~ ~v Frc 3 rll-l.2v~
' ~t . r+4~T RD
'agc 12
'io ca
Wlfxcfri&n il BuildingsmeOntWofisbCtsmmi
Safely PRIVATE SEWAGE SYSTEM y
Safely entl Bindi Ount
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) sanitary Permit No
lsersona' m(crmatior you arovlco n y be usee [or secondary purPOaas IPnvacy Law. s I s Cd (1;jm)J. 363933
Parmj il-7,Far(r SNam¢ Cny ; V. age ❑ T no tale an iO No.:
Miller, Sam Hudson -township
* 9M f er Inp am Elev 6 7 UaunPlm,, vmcTe No
C5-r-3n.c+`l 020-13'12-0S-coo
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPAC 17Y 1 STATION BS HI FS ELEV
Septic LU (2S0 Ben)I ,°)O e{j.`(o 1G0. 1
Dosing
Aeration Bldg. Sewer
HoldingHt Iilet `fr~Z o8'
TAK'K SETBACK INFORMATION f StlFlt Outlet /0.13 -;L
J
r-
TANKTO PIL WELL BLDG. a~'n°ro'"tte ROAD Dt Inlet
a _
Septic ) 5-G r ~S' Y NA Ot Bottom
Dosing NA Headerl Man _ /_(J.9L ~s•
-f -
Aeration NA~ Dist. Pipe ~ cp 9 Or
Is 93-YS
Holding j _j ~I-So-Syst-em_ 5 ,pD or
PUMP / SIPHON INFORMATION Fin' 3 ra % 9-dD o
Manu" urer / Demand
6.20 .90
Model Number - GPM;
TDH LOT ti On em
_TDH Ft
Forcer»a< Length DIa DI •c
SOIL A PTION SYSTEM(IZ .jCDws t~cE t~t~_
qw.E R6 vnh r Ir^yrn r no tF~enches %T N:nr~ni ioude nia tr a 'w
DIN ~I_Q[y~ 3 Y ~i" 7 DIMENSIONS.
"1t"" Manu act r
SETBACK SYSTEM TO P/L BLDG WELL tAKE ISTREAM LEACHING g-o l
INFORMATION Tyur y r CHAMBER o e rmm r.
. Q yy OR UNIT
system ^
DISTRIBUTION SYSTEM
neeuer•NSa~-,',e I. I Untt~hutmn erneW--- enulesve vHoleSpacing Veniy-57-U lntae
1 rngl•~LG ;iia 1"ertg•~% Dm sPecng__ 7 ITv+l
SOIL COVER It Pressure Systems Only xx Mound Or At-Grade Systems Only
-lc p+n Uvcr ~Oept'+Over a. UeGV VI -~ar SeededfSodded •v Mulched
~fi.•J+Incidi Ccr!r Bed: 1-Tench Edges TUpwf c]Y.s l] No nYes 0NO
COMMENTS: (include code discrepancies, persons present, etcl Incnection114i'0/0oInspection #2: 1
Location: 536 Raider Drive, Hudson, WI 54016 (NI: 1~4 SW 14 21 T?U\ R!9Vi1 - Raider Estates -Lots 21 a
1,) All BM Description = SYhL. (`^j v Ce 1
2.) HIc1; scscer :ength = -2-5--c r n VY
-amount of covcT - 18 " SP:A Cr+s+•~
Plan then on for adds ❑ Yes X No 1T1 Z
Use other side fo for additional information 09 0 lro •~Qh~J
SBO.671C (R,"7; Uate insPeucr\ Signature Cell NO
;5ssoocgin Doparavent of commerce SOIL AND SITE EVALUATION Page I of 3
r 0"n M Safely and Buildings in accord wdh Comm 83.05, Wis. Adm. Code
A C. F.. Sal d Sne I:a1'uslime
AJ4xJ1 wniDlcee solo dal on paper rqt less Ihan B'/, x ' 1 uM1xs In eiZe. Pla+ muet County
nckxde, but not limited to verncaf and horRpnta refarerice point IBMi 7inrlim and
percent slope. scale aaknansknrs. north anyw,ywJ.eay,r:Lay ceilatce to nearest road ..__$t.Criaix_-- _
Parcd 1. D.%
APPLICANT INFORMATION - P/ease print alllrtlo)madon. 020-1055L-04W 11w 2f29.19.206A
iR(svewedB Dale
PwRprol inromieeon you ucwde mwy tae ,/!ea P,w sa'4r•>rpvr[oxsk ;Awa:Y Lxw, a • 5 o,, (i I n.)I y
Prppetl Owver Properly t ]t-3, - zbCS~'
. ora!bn
Miller, Sam Gov. Lo? NE 1 4 SW 14 S 21 T 29- NR 19 W
Properly ;.vine's Marina Address ` - Ly a Bba a Subd. Name or CSMV
P.O. Box i 51 _ Plat Of Raider Estmes
City Stale Lp Cafe-4>wdM1fgtor----- -City Village ;Teen Nearest Road
Hudson WI 540116,'41 38(,-2769 Nwlwn RAxler Drive
New Ccnstructon Use Residw al / Nt, mbet of bedrooms _ 4 _ Addition to existng building
Replacement P.Iblic or comrrM.razl Jescnbe
Code Derived daily flow 600_ gpd Recommended design loading rate .7 bed. gp&I = .8 I ench, gpd r
.Absorptlon area required__ - 857 _ bed. fY ?50 trench. M Maximum design loading rate .7 bed, gpdrM .8 trench, gpdV
Recommended infirk-abon surface elevation(s), _ 93 . 50• _ ft (as referred to site plan benchmark)
Additional design; site oonsiderabons In :A ~Nridws usng high capacity mfiltntors
Parent material (;aria; oomash Flood an elevation, d Wpkdew NA A
S-Sit4abfe for system Ca mrocnal kswnd nGrtund Prossuro ! AT Grade System in Fill Holding Tank
U=Uri,Sudable for system :S - U S 1i - S U i- S U S U
SOIL DESCRIPTION REPORT
:Fptr~ Dominant Color tIodles Slrucww GPDAp
eonrpr iia¢at n. Munsell a Sz. Cont Cola Texlule Gr. Sz. Sh CmsYalence Boundary Roots Bad Trench
I G-II IUyN; Nonc sl _fshk mvfr w -f,tm 0.5_ 0.6
'.I-22 IOVr4!4 None Is Osg ml Cs 2f,lm 0.7 0.8
Grrxmd 1 ".16 - I1))T5+4 None s Osg dl Ills - 0.7 0.8
96 3T It 4 %6-10f+ 10)r6:4 None s Osg dl - 0.7 0.8
Dupa~to
taUOr ..t 7a.fo _ _
106.
MYO'f Y'/
Remarks
2 I 'J-10 lo>r4~2 None sl _tsbk mvfr-_-- w 2f,lm 0.5 0.6
2 10-16 IOyrt' -t Nonc is Osg ml cs 2f,lm 0.7 0.8
end 7 16-75 IIIeT54 None s Osg dl gs - 0.7 0.8
- _ - -
_96811ft 4 7x-IDS I(tvr6)4 None I s Osg dl - 0.7 OR
Dept- -c
IIm9n; -
facky . 31.7-4/*.4 t
>P;x'
Rerrarks*
CST Name (Please Pnnl'r Sgna Telephone No.
James R. I humper) 15-248-1761
Abdress A.('.h.. 6111 K' tine Fvaluslu>nc - - isle CST Number Rod
140 P uLscrr lake Lane. U>mda. 54020 4+19;1)(1 1602 [ 199
PROPERTY OWNER N1.11,0.. SOIL DESCRIPTION REPORT 1,9e _j Page 2 of 3
PARCEL I.D.9 02(-1C55biiC9 IrM-'I.xY. 19 ZQ65 4 c.F.. Sua & Sft i!..1"t.,
Depth Damant Color Abtlles Sth)cWre Consstmce Bwndary Rook GPD&
Horror n. Munsel Cu. SL Ctrl Color ektlre G. SL Sh, Trench
1 y.7 I0y'r4.2 None sl 2fsbk mvfr a. 2f.lm 0.5 0.6
7-IS MO 4 Sone is Ow ml Cs 2f,im 0.7 0.8
Groclr
elev I5-10 Wwv ,4 None > 0sg of gs _ - T0.7 0.8
977Zft 4 110-103 I0yr6A None ~j6QOsg AI - 0.7 0.8
Depth ;o
Imi[n 1 1
~,c3• - s° or, ~ ~ Z ~ -
I
Remarks:
4 1 0-8 IOyr4:2 None sl 2fsbk mvfr as 217,lm 0.5 0.6
8-12 IOYr414 None Is Osg nil ;s - 2f,lm 0.7 0.8
(irount 0.7 0.8
elev t 12-72 I0yr5 4 None s - Gsg dl - Bs-- L.
ga r€' « 4 7 101 10vrb.4 None S - OSg dl I'I- - _ 0.7 0.8
";Yh to
factor
Rerfark5'.
1 0-10 10yr4,2 Nnnc s1 2fsbk mvfr as 2f,Im 0.5 0.6
r 1021 10vr4,4 None sl 2msbk niff as 2f,lm 0-5 06
elev 1 21.26 10Yr4A None Is Osg AI cs - 0.7 0.8
'0x:.'.211 4 26-80 10yr5;4 Now s 0sg AI gs - 0.7 0.8
Depai to I -
5 80-102' I0yr614 None n Osg dl 0.7 0.9
"coi
P.emarks:
_ 1
n. om to
rc.:rr
Rerrarks
3,,r3
z
~~ne~
ScaCe
r? G ~s?' /S/ ■ So; l Odserda ~'on
R't
• /c ca~eJJP.-a/o.
Lots P a~ oC ~t derESeS
/iEyY; cJ% $rc 2/,T29r/. G. OP'
dz
BN ■ S/6. y1
■
v
V
V L
h ■
r a3h
vl
F
d
4
1 ■
1
iLA~a EI
Ai6.Q-m. rpW icL -
SEnti. CAW = ICOV'--
179,9 7'
✓aa nc~ W1trR~: Tq~ of/at 5 -Ae
A ssuMC.1 9 w ✓ = ~OD.CO'