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HomeMy WebLinkAbout030-2139-04-000 WiscorPsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix `3afety and Building D'vision INSPECTION REPORT Sanitary Permit No: 463327 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Miller Homes of Hudson, LLC I St. Joseph, Town of - CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No J070 �tM \ Cs — 04.29.19 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �. Benchmark Dosing Alt. BM A.i- / 1 � 66 "IL 756 4*Aj. Aecatiea- Bldg. Sewer a Z5 ?,53 83.57 Holding St/Ht Inlet 7. Gua Sl .75 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 / AJ 111 " — 3 / Dt Bottom 7 Dosing %75 6/ _ r l 3 / / Header /Man. �, I `� 6 • 3 �v Aeration /Uri Dist. Pipe Lo -aL- 14. �. i/, 55 W9 .5 Holding Bot. System gel L__) Final Grade PUMP /SIPHON INFORMATION Ad- 1 1- D 1 '13 Manufacturer Demand St Cover Z OeL(.a , _ GPM ' 6b0Q1 Model Number & 1 -1 f�� — f J 1Z 1� ?0, 2 \ TDH Lift Friction Loss Syste Head TDH / t �� /3. l6S 2 - 7c' T� 5. i L���- /3. Ls >5 Forcemain Length Dia. 2 i/ Dist to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches I PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Z Z e n I-- -_— '� \� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: N / v A— UN T Model Number: Qj r C O J1 w DISTRIBUTION SYSTEM 5 31 t31 = t0 7- ,,;ch. 4 S Header /Manifold �� Dibu istrtion x Hole Size x Hole Spacing Vent to it I ake Pipe(s) 3 rr� 4. �ow� Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center S • Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ 7 / 0 (p Inspection #2: Location: 1168 56th Street Hudson, �WII�54016 (SW 1/4 N 1/4 44 T29N R1 9W) Park Hollow Lot 4 Parcel No: 04.29.19. 1.) Alt BM Description 2.) Bldg sewer length = 33 �-- o - amount of cover Plan revision Required? Yes C7 7 Use other side for additional information. I ' -- - - rose ors Sig "ure Cart Date No SBD -6710 (R.3/97) Safety and Baclings Division . County - -- 201 W. Washington Ave., P,O. Box 7162 s� C �� x ` i SCDnsjn Permit Madison, W1 53707 - 7162 Sanitary Pet Num at (to b m GUed by C:, ; De artment of Commerce (608) 266 -3151 24 2 1 1 _ Sanitary Permit Application Sty" Plan ` °. !n accord with Comm 83.2 1, Wis. Adm Code,-personal information you provide A may be used for secondary purposes Privacy Law, s15.04(IXm) Project Address (i di9ereat than mailing add: _,s1 l 16 'S 45TREIFT 1. Application Information - Please Print All I ciform I 1 - s t ^ �� s P r �•, 4 _f_ P opcny Owner's Name Y I ' t✓, 4r- , lh r / i1 t B -I 1 w FEB. Noi-I Property Owner's Mailing UIQ 1T lion d w y- f. CR1 CUU'r' . ! r> L �► F City, State %, Nfi 7, Section T R�E Wr 11. Type of Blinding (check all that apply) I or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Numtsr I ❑ PDescribe-Use cJCorrial - Describe-Use ' PARtc IDOL LOW _ ❑villa e )(T—M&W of 5 *' S O 3Q -p 4. ❑ state Owned wned - Descri Use '2 s ' X I Zs '- e aKU'tas ❑City g p e - n•� o•D: -1-.6-OW T'lltGN 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) fO 3p - L O ( L4 ., j D - © p G A_ X New System ❑ Replacelnmt System ❑ Treatment/Holding Tank Replaceme ❑ Only Other Modification to sting System r U ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Vst Previous Permit Number and Date Issued Before Expiration Plumber Owner IV.T of PO WI S System: Check all that apply) Noa - Pressurized in-Ground ❑ Mound ? 24 is of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter i_i Constructed Wetland Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ R urulatmg Synthetic Media Filter l.eachin ❑ Dri line ❑ Gravel -less pipe ❑ Other (explain) V. Dispersal./Treatment Area lnf rmation: 4JA rive S O. Design Flow (gpd) Design Soil Application Ra f) Dispersal Area Required (sf) Dispersal Area Proposed (SO System Elevauou i 3 1 1 24 PP6�c 9�. SG �? - -- V1. Tank info Capacity in Total Number Manufacturer Prefab Site Steel Fiber ?las;. Gallons Gallons of Units Concrete Constructed New Exisaing Tutu Tanks _ 1 .pti or Holding Tank + J V � / �.,rubc Treatment Unit Coring Chamber 1, ResponslbUlty Statement - 1 the undersigned, assure responsibWty for lnstaUatlon of the POWrS shown on the attached plans. Plumber's Name (Print) Plumber's Signat MP/MPRS Numbs Business Pbone Number v�t ►M o " Z_ z-S - O 3� � ct -'RIbS 1? 2-7 Flutaber's Address (Street, City, State, Zip Code) / —_ -- 0 l O cr N'fi� i tX �-- �`1 t� S e v� UJ - VIIL oun /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater I Date lssuo-. suing Age Signat e (N s; ❑ Owner Given Reason for Denial Surcharge Fee) 3 03' — del ! V Conditions of Approval/Rersag9 f r Disapproval SY WNER 1 Septic tank, effluent filter and C dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained .i / E�? /t/ � as per applicable code /ordinances. GU U ttacb complete Tani to the not oat or the s stem on p aper not Less than 8112 s I I lucbcs in sire A m ( Co I f P P Y 7) Y P P J— GC � SBD -6398 (R. 01/03) ! 4 rYl t L L F t2 - PA i 0 < H L ST2 -T' �Zs ®34 � I v 5 c AL I /y / o Z- 3 X/ 2 s- Tit ,E�Ic S Lo ?R F.Nch' EL:- 47,Sv� VPFEIL (�2 ZD -i3 %v i� �E ✓scrs �flc.H 3' �"C'� �,,� z � b�- / � - /ate F� � �►►° , K �r r v \ - /E2 uA l IAI El lit EI. Inca, pca' 0 x ° o 4A � 1 Iv $e a- !4 M rr t L L L Z_ -N A IZ L oT Z- / zzs& 3 � a / I y c C � v `��`` Lo TRENc14 EL = '2 50 vpPF-). - r2EN4-H /:E/ ?g, S PJZ Zo i3 % v 7 �E�s�s S FAZ-H yJ - 7 07 A L.._ S t`.et E zo / /v2 IQ lit - 9 c5' P L I nca, p a '� / T ram AM EI. IA�E11�� 0 1`2fE T&l Z/7 PUMP PERFORMANCE CURVE PUMP CURVE • - . . -. • EFFLUENT ,... MEMO=■ ANSI ® ®® ■� ■ ■ ■ ■ ®� ° om ° 0e ■ ®0mo�m ■ ■ ■ ■ ��.emmmmmmeemae��m0 ®m ®� � ®em0memmmemma��eQee® 0 ®a�a0ma�■��m0ameee�mmm■� 110111 ■■■ o�ommmem0ao0vameemm00e ■MI ■� ■ ■��e�mmem�ea0ae0mmmem�■� �e0mmemmemm�eeemme�0e N ■WS��7 ■ ■�� ■ ■e ■ ■ ■ ° e ° e ° e ■m0 ■ ° a WON 6 INN ummel,u ■■■■■■■■■ mommilsommommomm MINIM 01198 ONE mom ®m ®.seo��m�mm� ■■ ■■11 ■1 ■\NU■ ■ ■ ■■ is. 81101, 11101110 RE m ®o ®m ®aav�mm ® ®0■� 0�m ®0 ®aao��0 ®m0� \n\w11'�■■ \! ■ ■ ■■ • ► 113.1 a\ ►` \101\\ ■ ■ ■� \ ■ ■ ■■ ee® ®mom ® ®o�m�o ®mom 0 MEN NOWERIKUMN eea� ®moo ®� ®�mmm■�■ � vaam00aa0�m0 ®�m.a� \W:40II \II\\■ ■ ■�■ ■■ ®� � aaea ®�� � mme ®��aaaa��as _0 9b� R �!IS mm ■ ■ ■M ■61 \i11�!\. \\■■OLIO o less than 30 feet TDH. ;' SEWAGEAND . ®mom © ®mom ®� DEWATERING ® mm®mmm �mm ®mmmmmo= MEMO 0 subjected to less than 15 feet TDH. �mmmmmmmm ® m ■mm�immm m ■mm�m ® mmm ■m ■mm�m ■ ■mmmmmm ■m��� ■ � ®mmmmmmmmmm mmmmmmmmmmm g mmmmmmmmmmm■mmmmmmm�mm • ®mmmmmmmmmmmmmmm i _ -••• � CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MtH ABOVE GRAOC E WEATHER PROOF. 25' FROM DOOR. WINDOW OR JUNCTION BOX FRESH AIR INTAKE WITH CONDUIT APPROVED MANHOLE c FINISHED GRADE 4" CI RISER W/ PADLO( 6" MIN. WARNING l A G ADE -- — v N MI1 18" IN. 6" 11AX. 1 NLET WATER TIGHT SEALS TIGHT - BAFFLE . 4 n ____/ T A SEAL , CI PIPE , APPR Y 0 ED 3' ONTO B LM JOINTS W/ SOLID —v-- ' ON PIPE 3' 0 "Of L C ' SOLID Sol PUMP OFF ELL•V . �..FT, OFF RISER D PERHITTCD IF TANK MA NU FA C TU 3" APPROVED BEDDING UNDER, TANK HAS APPRO' CONCRETE PAD .SPECIFICATION§ - ` �CPTIC / DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY: TANK SIZES SEPTIC (ZSv GAL. DOSE DOSE VOLUME INCLUDING 1.20 !"ttr��•+1�,.. S GAL. FLOWBACK: r 2_ GAL. A LARM MANUFACTURER: j ( 4-0,) 1 CAPACITIES: A : t MODEL NUMBER: 6 INCHES SWITCH TYPE: _ B _ ?_ INCHES = r'UNP MANUFACTURER: �� �� � ( MODEL NUMBER: INCHES SWITCH TYPE: �,, -,, �• �. D o 7 INCHES KEOUIRED DISCHARGE RATE _•_ GPM PUMP E ALARM WIRING AS PER I LHR 16.23 VIRTICAL DIFFERENCE BETWEEN PUMP - OFF AND DISTRIBUTION PIPE • MINIMUM NETWORK SUPPLY PRESSURE ..5 FEET FEET FORCQIAIN X - - 3 8' FT/ 100 'T. FRICTION FACTOR • . '— )- FEET '+ TOTAL DYNAMIC HEAD _ • FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH FECT WIDTH ; DIAMETER LIQUID DEPTH IuNED: LICENSE Nllt/DER: Z Z S d 3 G n......, Ad = 74,7 - f ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNS CERTIFICATION FORM (�f Owner/Buyer S A� In fl_ L� Ll� qM't Mailing Address JB��j� o -/ v (O Property Address .0 (Verification required from Planning Department for new construction) City /State /yam e(s o H Gv Parcel Identification Number i LEGAL DESCRIPTION q Property Location r J ''/4, '/4, Sec. �, T 21 N -R � I , Town of Subdivision 1�a �� H o LL O t.y , Lot # r Certified Survey Map # ? �0 3 S . Volume ( 0 , Page # 6 Wa ny D d # -7 1 Z' y y Volume Z Z q Spec house 0 yes ❑ no Lot lines identifiable Xyes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and retuned to the St. Croix County Zoning Office within 30 days of the three year expiration date. c � Z / Lo/ 4, stG�ATURE APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property scri above by virtue of a warranty deed recorded in Register of Deeds Office. D L lZ�l O NATURE QF AULICANT DATE •••••• Any information that is mis- representedmay result in the sanitary permit being revoked by the Zoning Department. «• « « «. '• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed - PA - P, K Ho l t o ct�' 4, POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ' of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner S #A- 1M ILL IE A— Septic Tank Capacity a l ❑ NA Permit # •' ❑ NA Septic Tank Manufacturer J �.t,� 9- � S � DESIGN PARAMETERS Effluent Filter Manufacturer A B - L ❑ NA Number of Bedrooms to ❑ NA Effluent Filter Model A - J a O ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity 7 SD al ❑ NA Estimated flow (average) Q g al/day Pump Tank Manufacturer ki-L" S ft-4e ❑ NA Design flow (peak), (Estimated x 1.5) DO g al/day Pump Manufacturer ZO 114-/ ❑ NA Soil Application Rate I ZOC4 nr ti:. D, gal/day/ft' Pump Model 3 N 1 7 1 9 ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia, ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 0 month(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: Z ❑ month(s) ❑ NA Xyear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: [3 month ❑ year (s) l ❑ NA ls) Other: At least once every: ❑ month(s) C3 NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may Indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and dispoged 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 10 days of completion of any service event. ,SUP AND OPERATION Page ?' of /hew construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals ghat may i k mpede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring discharged to the dispersal power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank, Do not drive or park vehicles over tanks and dispersal cells, Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area, Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) .water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; Painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Sep tage 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 replace ent system: replace suitable replacement area has been evaluated and may be utilized for the location of a system. The replacement area should be protected from disturbance and compaction and should l not beinfriinged upon tl by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time, ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T alua ' j b e el a �RD1 -t!1� 17�D �Gr�- /II I Cam' NS�'T�2UC n Wi O 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 TREATMENTJANK 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 Name POWTS MAINTAINER � -- - -�. �- NL L-L Name Phone 61 2 . ?G I Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ( Phone —7 /S"— 3eCo- !o o This document was drafted in compliance with Chapter Comm 83 .22(2)(b)(1)(d) &(f) and 83.64(11, (2) & (3), Wisconsin Administrative Code. / 1 r • B S p e c ifi ca ti ons _ �` �. �� rata ri. chamw rs) F= �� � �. � � �' ra• ... � �.■ ra � .�. �.. � � ate. �.. ' �� �. ri � a� .�. � � �• -� ram � �� �� � � �. �� ,.......� �.... ....■ ter,. .� .:. chifftw En Ww Knockout Universal End Cap Chamber 11" Stan• 14" High 16" High Available SiZeS D dard Capacity Capacity `i1? "�•'�l�iC���11!'� f r •r•f , :� c .�YjtS�� 1 . � { �` � .�'jP�w' •.',? 1 .{• �.J Nf y ' .Y • If ..1 `k ..1 r *�M; s�, ' F F •1 t p • 1 J V / �. � p �.1. 1 • � I U • ,.�e� • � 1 ijlL.r�w�J ,t 61t,^ .I��r �, i , � t 'YV l �j ` � Y1, ! rt \�r �.� y ...�,�r '� -• _ ' iiWi�. C. G16iM' ��11 :.�1/L':�lP,1G61;{��� ^�:G;ir �jlr:d'j;Fld'+4�C`: �:..7 � ►�..i......, .. ,`a 'fr � 1iN ry � ; ,�f r 1/ ���: •} . 1 �!,il.•... i t r ��f'�y ,:��il :�:• {'� + t , �..�'Ipv41,q!� 66" 50" 86" O — C r m m I 57" \ � Z 3 ., 6 " ^ I I D I n I I I � - I 1 I � I � N _ Nls Z � m m 53" m0 ? °- ° ° z z O n D D rW�r- MKOW :N - D �Z > . r- mmDOODO m - O ff ° D ° OCm ° Z z< --imZ D z x N� �mr mzco rnm� j� f � v>Zm m �<rrn Z o :1 v mcn - 0 --1 (D rmi O U ?. N �• CA D O � co v I u�U'o�o— U C NOS N ° � DO WJGi ° ° �m ;u M N _LJ�LI N DD mac? M O 0 p -0 1 O C Z Z D m Q w O \Mp ND Cm �� p m o -+ - m 0V) ° m� Z f Z cn �� Om -{ C S C m V r� z � � U � n o o O X RECEDED 1750 Wisconsin Department of JAN 16 1_0 04 S L EVALUATION REPORT p age 1 o f 3 Division of Safety and Buikti with Comm ti5, Wis. Adm. Code A.C.E. Sal & Site Evaluations ST. CRd County Attach complete site pla size. Plan must St. Crob( include, 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. Parcel I.D. Pending from 030 - 1014 -50-00 Please print all informattion. R By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Sam Miller Govt. Lot SW 1/4 NE 1/4 S 4 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM# P.O. Box 151 4 Park Hollow City State Zip Code Phone Number City Village ✓ Town Nearest Road Hudson WI 1 54016 (715) 386 - 2769 St.Joseph I River Road ✓ New Construction Use: ✓ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Glacial outwash Jf 0 A 0 1 Flood Alai n, if ap le na General comments S Yw and recommendations: Install two trenches at elev. 87.50' & 8.5 'using 40 leaching chambers. Dosing required to reach system area from proposed building site. ❑ Boring # Boring a0 7X0 ✓ Pit Ground Surface elev. 91.85 ft. Depth to limiting factor >117" in. Soil Application Rate, Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 I 'Eff#2 �- 1 0-4 10yr3/3 none sil 2fcr ` ds as 2fm,1c 0.5 0.8 ( 2 4-15 10yr4/3 none sil 2fsbk ds cs 2fm,1 c 0.5 0.8 ( 3 15 -34 10yr5/4 none sil 2msbk dsh cw 2f,lm 0.5 0.8 4 34-42 7.5yr4/6 none Is 0 sg dl cw 1vf,f 0.7 1.2 5 42 -100 10yr5/6 none s 0 sg dl gw - 0.7 1.2 fi 6 100 -117 10yr6 /4 none tra fs 0 sg dl Loading rate of H#6 reduced to relfect reduced p pe rmiabilft of horizon due to stratification of sand materials. Xt g 7� 9D a 6 g. SO SZ.z g 2 yfo. Ito . �- Boring # Boring ✓ Pit Ground Surface elev. 91.05 ft. Depth to limiting factor >126" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 `Eff#2 1 0-4 10yr3/3 none sir 2fcr( 1ri ds as 2fm,1c 0.5 0.8 .� 2 4 -20 10yr4/3 none sil 2fsbk ds cs 2fm,1c 0.,-, 0.8 (O 3 20-28 10yr514 none sil 2msbk dsh cw 2f,1 m 0.5 0.8 4 28 -34 7.5yr4/6 none Is 0 sg dl cw lvf,f 0.7 1.2 5 34 -108 10yr516 none s 0 sg dl gw 1vf 0.7 1.2 6 none t 108 126 10yr6/4 rat.fs& 0 sg dl - - 0.5 0.9 ob - . Loading rate of H#6 red reduced permiability of horizon due to stratification of sand materials. if 7-. V Effluent #1 = BOD ? 30 < 220 mg/L and T S >30 < 150 L - E nt #2 = BOD < 30 mg/L and TSS <j0 mg/L CST Name (Please Print) Signature. CST Number James K. Thompson S 3602 Tess A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 30 1 6 340 Paulson Lake Lane, a, WI 54020 11/132003 715- 248 -7767 (� 5 � (, ��,,� L�,,, •( -G,3 �v.� �3v�aa.�n '(b �2 6 - f Z � � w�e s o � � �� . � Property Owner Sam Miller Parcel ID # pending from 030 - 1014 -50 -000 Page 2 of 3 3� F Boring # Boring ✓ Pit Ground Surface elev. 100.00 ft. Depth to limiting factor > 119" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 - 10 1 Oyr3/3 none sil 2fc 8` ds as 2fm,1 c 0.5 0.8 �P 2 10 -21 1 Oyr4 /3 none sil 2fsbk ds Cs 2fm,1 c 0.5 0.8 (o 3 21 -56 1 Oyr5 /4 none sil 2msbk dsh Cw 2f,1 m 0.5 0.8 4 56-62 7.5yr4/6 none Is 0 sg dl Cw 1vf,f 0.7 1.2 5 62 -96 1Oyr5/6 none s 0 sg dl gw 1vf 0.5 0.9 , 6 96 -119 1 Oyr6 /4 none I stria fs 0 sg dl - - 0.5 0.9 S H#5 contains 118" - 1/2" bands of 1 Oyr4/4 Ifs at 4" -12" intervals. Loading rate reduced to reflect restricted permiabiility of hoizon associated with banding. Loading rate of H#6 reduced due to stratification of sand materials. F Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD S mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. f �� .1o�nt dri�ewa n vo ease.n¢nE f r'of�D•SeC1 �I "Tocan A2oa.d \� lot y P /at 0f S` 9�ao' 48 ' N n Top of 3 /B' ile A k•►+cd 0-Ito. CO.' = ioQ in As - Qe 7s0 3 0{3 • 6. 1'�•� :''..5.069......... 22i . ..... . ...................... . — 749.40'— � 4 ?o E �� LOT 8 - W LC .77' � l ��� 130, 700 sq. ft. _ 3.00 acres 131, 00 Drcincge ��\ \� : o J. \ O Eoseiri qn t \ Z N. • •,gyp D�h�1 S \ �� S6. \ F ........ � . . g6 2g j y \ Jo /nt OrlHewoy 5.55' G� 8' v ��SS, 7 F` Easement - ?25.62' j 1 r �► w . \ �Q • LOT 4 ry :cn rn 131, 708 sq. ft. rte\ d :- e' . 3.02 ocrec r i �� N77 rn • C �l 4' r 6 75.. , ti� ` . v r ` 2 h i *�0 `�?ss 5 sq. ft, ......... S acres , - • -. .......... Z17-69 r :� o Drainage V N 0 � : E 09e mmi U N 66 .. I i � 5 8 LOT 3 , / / J r 130, 907 sq. ft. 3.01 acres i \ LOT z SS . , �� "E� 130,772 s O), 6 g� 5 , 3.00 acr L. B. 0. = 8� ........ . .... ....... a, 6FJ �5 4� 83 6 f \ Ease en t ' �� •. ;��, j� LOT 11 ri �.S t. \ !�' G ^� 131, 306 sq. ft. �o -A� / , ,� .cP. �C:• 3.01 acres � � N N. MCE 3.0 ,i LOT12 ° �\ • ........ '00 131,457 sq. ft. U. 2704 P 537 is9 KATHLEEN H. VALSH STATE BAR OF WISCONSIN FORM 3 - 2000 REGISTER OF DEEDS QUIT CLAIM DEED ST. CROIX Co., YI Document Number RECEIVED FOR RECORD This Deed, made between Sam E. Miller, a single person 11/29/2004 03:45P11 QUIT CLAIM DEED EXEMPT # 15S Grantor, and Miller Homes of Hudson, LLC, a Wisconsin Limited Liability REC FEE: 11.00 Company TRANS FEE: COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor quit claims to Grantee the following described real estate in St. C County, State of Wisconsin (if more space is needed, please attach addendum): Lot 4, Park Hollow, Town of St. Joseph, St. Croix County, Wisconsin Recording Area Name and Return Address Heywood, Carl & Anderson, S.C. 816 Dominion Drive, Suite 100 P.O. Box 125 Hudson, WI 54016 Q 30- 0 fy - s d ooa Parcel Identification Number (PIN) This homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Dated this day of November , 2004 "�;� 8. • * * Sam E. Miller * * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. Signature(s) Sam E. Miller ST. CROIX County ) authenticated this day of November , 2004 Personally came before me this � day of November 1 2004 the above named Sam E. Miller * ��N•+• TITLE: MEMBER STATE BAR OF WISCONSIN �' ¢ ([f not, to me known to be the person(s) who exec ;2 '••, •, ;. instrument and cknowle ged the same. authorized by § 706.06, Wis. Stats.) _ THIS INSTRUMENT WAS DRAFTED BY • A4 G U . h Heywood, Carl &Anderson, S.C., 816 Dominion Drive, Suite 100 Notary ublic State of WISCONSIN. ry O P.O. Box 125, Hudson, WI 54016 My Commission is ermanent. (If not, state ex} qt' •• $dtap•••' (Signatures may be authenticated or acknowledged. Both are not necessary.) + Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN QUIT CLAIM DEED FORM No. 3 - 2000 INFO -PRO (800 )655 -2021 www.infoproforms.com I J 2 2 14 P 0 0 3 7 3. 8249 �( KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM I • 1998 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between James E. Ebbe, an adult single man and 04•/21/2003 03 :00P11 Thomas A. Ebbe, as custodian of Theodore A. Ebbe, a minor, under t he Wisconsin Uniform Transfers to Minors Act WARRANTY DEED EXEMPT i Grantor, and Sam E. Miller TRANS FE E: 1 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in SL Croix County, State of Wisconsin (The "Property .. ): Recordint Area Name and Return Address Sam E. Miller P. O. Box 151 Hudson, W154016 The SW 1/4 of the NE 1/4 of Section 4, Township 29 North, Range 19 West, St. 030 - 1014.50.000 Croix County, Wisconsin Parcel Identification Number (PIN) This is not homestead property. (is) (is not) v Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except continuing easements and restrictions of record, if any. 7 i Dated this l th day of April 1 2003 6,I,MgA4, Moz 4L- 2 99, ames E. Ebbe Thomas A. Ebbe custodaan for Theodore A. Ebbe AUTHENTTCATI,O:( p(Me�C ff'll/ ACKN OWLEDGMENT STATE OF WISCONSIN Signature(s) ✓,v SL C roix l) Coun ss. Count � Personally came before me this 17th day of A authenticated this day of % P April, 2003 the above named 'J James E. Ebbe and Thomas A. Ebbe O F TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me k own to be the person( s o executed the foregoing I ns [ d ac o ge t authorized by ¢ 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY William J. Radosevich, Attorney at Law d lax 502 Second Street, Hudson, W1 54016 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is ermanent. (If not, state expiration dale: necessary.) 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED , STATL RAR OF WISCONSIN FORM N.. 1 • Isto INFORMATION PROFP45IONALS COMPANY FOND DU LAC. WI $00. 651.2021 G• - ,� 2 - r 1 a N _ 1 ffnn � •z v,� i m 0 o • N > + A N I I O 1 1 1 1 1 11 • 1 1 1 1 1 Z LOT 1 LOT 1 I LOT_ 1 J I jz lo I I t CSM, VOL. 2, PG. 405 CSM, VOL. 2, PG.535 CSM, VOL. I, PG.198 °I D Ff .I _m v ro - - - -- - - - - - -- - - - -- INIM -- 50090'15 "E 5208.54' -- I N 0090'15 W 252>�t 21696 0000'75 "W 1320.85' 2635.84 8q/SouM !/4 L.iu .... ............... ....... . 1313 B...... 1 8.96' �c �o � - T - .............. ..................... 4�. ..... SW90'15 I ZB nto I,£F •a y ... 1249.65' ug NOS'37 __ _ to 7E 4 . O 4 N ti P F .• :r't �: S. ilk a co up v7 OD - � to 0 3_ 3.8f.9L105 > A � / 3 tj 02 98'- < i:3 y � I i w N W'46'31 "E 249,x' w$$ \ qV Sr p l� u: ooh o, � mti -' 3@ z (w I 500 46'31 'W 24A10� — ` cir '� �� ^ `l �� %• C:' �, I' m ! \ _ - I I D I z cr"'.. �°, S �.' � _ o � � `'w '�' - � • - `�, /4ti 7 c�' / o cn 14 -- h I s _ \ \ \ - - - -- -- _- / g . s" r ¢:• 56TH � 1-a NOSJ80 131nra� lz __6p ...................... I � _ 0 4 : _ / 3 5 � 9 �i c N0094'SB 0 ..._ 1 so y � s r ��� : d= . .- _.......M9 AT .............. u ,g S + `• �__ ., 1?, » b $ `3 �Q r 3 `ti �.1 ,, I 1 � L� "�, � a ��a� \, p� ~x � w N L ,� •� o ��� i I I I .................. :......... ,� �•�, � 301.48'- a, . 319.18' �• _ . F .. _ ... _ .. _ 528. 23'- .q ............ .... i __ . . .......... :._. _ 8223' 97. J1' n , r/ �.. � "`1r. \.._........_454 09' ....................:1.• i 1 F 500'04'58 "W '1322.47' I,FFI $ ° Eoaf the of the I I 1D a UNPLATIED LANDS a 5 ^ 6 L - 1 /E Of the W- 14 I rn I Off R �Q 1 & x S_ A a c 8