HomeMy WebLinkAbout020-1106-05-000Wisconsin Department of Commerce
Safety and Building Division
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)],
Permit Holder's Name
Urchins LLC
Insp. BM Elev: IBM Description:
TANK INFORMATION
City
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
TDH
Lift
Friction Loss
System Head
TDH Ft
Forcemain
Length
Dia.
Dist. to Well
SOIL ABSORPTION SYSTEM
TOWN OF HUDSON
ELEVATION DATA
County: St. Croix
Sanitary Permit No:
617838
State Plan ID No:
Parcel Tax No:
020-110&05-000
Section/Town/Range/Map No:
35.29.19A18B-30
STATION BS HI FS ELEV.
Benchmark
Alt. BM
Bldg. Sewer
SUHt Inlet
St/Ht Outlet
Dt Inlet
Dt Bottom
Header/Man,
Dist. Pipe
Bot. System
Final Grade
St Cover
BED/TRENCH
STATION BS HI FS ELEV.
Benchmark
Alt. BM
Bldg. Sewer
SUHt Inlet
St/Ht Outlet
Dt Inlet
Dt Bottom
Header/Man,
Dist. Pipe
Bot. System
Final Grade
St Cover
BED/TRENCH
BED/TRENCH
Width
Length
No. Of Trenches
DISTRIBUTION SYSTEM
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia Spacing
SUIL C:UVER
x Pressure Systems Only xx Mound Or At•Grade Svstems Only
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx Mulched
Bed/Trench Center
Bed/Trench Edges
Topsoil
[] Yes
COMMENTS: (Include code discrepencies, persons present, etc.)
Location: 770 MAGOO RD
1.) Alt BM Description =
2.) Bldg sewer length =
. amount of cover =
Plan revision Required?
Use other side for additional information. �____J
Date
SBD-6710 (R.3/97)
Inspection #1:
Insepctor's Signature
Inspection #2:
Cert. I
J
wQ 7
fliqla
County l/\
Division
Safety aTnA
Q'2<� 201 W.- WashiP.O. Box 7162
Sanitary Permit Number (to be filled in by Co.)
_
TB 2 8 2U2U Madiso,-716
r y /� �
/„
I ���
/ �J
Sll Croix County
((/
C o m m i i n i t > v q m
S Te mit Application
State Transaction Number
In accordance with SPS 183.21(2), Wis, Adm. Code, submission of this form `to the appropriate governmental unit
is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to
Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(1)(m , Stats.
�O
L Application Information — Please Print All Information
Parcel Q s�Q 0
#O
Property' Owner's Name
✓ f I D _
.` 0 I
C,
'
r
ProperOwner's
Property Mailing Address r�
Property Location 350
i t l r
I Govt. Lot
7J
^/ /, �{�_ t /., Section
City, tale
I Zip Code
Phone Number
��/�
iJ
(1 ucle ne
T N; R or W
Type of Building (check all that apply)
Lot # _
Subdivision Name
1 or 2 Family Dwelling —Number of Bedrooms
I
Alof (eV.
Block #
GG ifc Ct',�
❑City of
ElPublic/Commercial — Describe Use
�—
of
Q V=AM
CSM Number
❑ State Owned — Describe Use
r—
f
III. Tyne of Permit: (Check only one box on line A. Complete line B if applicable)
A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only
❑Other Modification to Existing System (explain)
❑
❑Permit Transfer to New
List Previous Permit Number and Date Issued
$-
❑ PermitRenew•al
❑ Permit Revision
Change of Plumber
Before Expiration
Owner
IV. Type ofPOWTS System/Component/Device: Check all that a I
on -Pressurized In -Ground ❑ Pressurized In -Ground Q At -Grade ❑ Mound > 24 in. of suitable soil
❑ Mound <24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatpent Device (explain)
V. Dis ersal/Treatment Area Information:
Des' Flow (gpd) Design Soil Appli Oon Ratergpldso Dispersal Axea Required (sfl DisbtrsalX=
-7
Proposed (sf) System Elevatio
rs
< <
VL Tank info Capacity in Total # of �`` r ufa
Gallons Gallons Units '=
i�C><""�c.
�� �.�J
New Tanks Existing Tanks
4 p .�-. � p m tv'V
U P .
on ' h 1:.
Septic or Holding Tank
A2 D
V
Dosing Chamber
VII. Responsibility Statem t- I, the undersigned, ass po sibility for instal afion of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber' i ature MP/I&RS Number Business Phone Number
C z 7 �r-� /W J'
n
Plumber's Address (Street, City: tate, Zlip Code)
�.
Z
l
County/De artment Use Only
❑Disapproved Permit Fee Dat Issued Iging
ent SignatureZA
Approved S
❑ Owner Given Reason for Deniallox
DL Conditions of Approval/Reasons for Disapproval1
3)
jSYSTEM
OWNER:
e
t M &A
r1,
Septic tank, effluent filter and Mlou.
dispersal cell must be serviced / maintaineAAL4r
as per management plan provided by plumber.
ch eo r 12n5 for the system ana snomn to me �•ounry �iy un pnprr um Je�> .uau o a.<> a..U..,..-� ....,..�
as per appiica ,Io co emFcin�nees.
SBB-6398 (R. I1/11)
1,
�D.
System PLOT PLAN
PROJECT Urchins LLC ADDRESS 1353 Awatukee Trail Hudson Wi 54016
NW 1/4 NE 1/4S 35 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX
SYSTEM ELEVATION 95.9/95.8/95.7 4' below qrade 2/25/20 BEDROOM 6
DATE _
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1250/750
HOLDING TANK SIZE LOAD RATE .7
IL BENCHMARK V.R.P. Top of survey iron
❑ BOREHOLE O WELL *H,R,P, same as benchmark
B.M.*
P Scale is 1" = 40'
,1 unless otherwise
noted
3-3' x 90' cells with >3' spacing
25'
Property Line
50.
Vents
0'
20'
ST
�11 piping shall be ASTM SDR 30/34, within
0' of tank, piping shall be ASTM F891
Magoo Road
3 0'
LIFT TANK SIZE
DOSE TANK SIZE
ABSORPTION AREA 1336 # of chambers 66
ASSUME ELEVATION 100' Filter Lifetime Filter
Vent
>6"
of Cover
4' Long J,12"
Pro 6
Bedroom
House
Quick4 Standard
Leaching Chamber
with 20.0 ft2 of Area
5.6ft^2/pair of end caps
at System Elevation
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 2/26/20
Owner:Urchins LLC
Location: NW1/4 NE 1/4 S35 T29 N,R19W Lot 3 Summer Prairie Hudson
Manuals Used: In -ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross
4-6. Maintance
7. Filter Cross
Signature
Ill
gency Plan
License nufnbef #226900
PROJECT Urchins LLC
NW 1/4 NE 1/4S 35 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX
SYSTEM ELEVATION 95.9/95.8/95.7 4' below grade 2/25/20 BEDROOM 6
DATE
CONVENTIONAL %XX CONVENTIONAL LIFT
►iT[II11►`� 1
System PLOT PLAN
ADDRESS 1353 Awatukee Trail Hudson Wi 54016
SEPTIC TANK SIZE 1250/750 LIFT TANK SIZE
HOLDING TANK SIZE LOAD RATE .7
IL BENCHMARK V.R.P. Top of survey iron
HOLDING TANK
DOSE TANK SIZE
ABSORPTION AREA 1336 # of chambers 66
ASSUME ELEVATION loo, Filter Lifetime Filter
❑ BOREHOLE O WELLg,R,p, same as benchmark
B.M.*
25'
Scale is 1" = 40'
unless otherwise
noted
3-3' x 90' cells with >3' spacing
100'
B-2
Property Line
5 Q:
Vents
t
1% S
20'
ST
11 piping shall be ASTM SDR 30/34, within
0' of tank, piping shall be ASTM F891
3 0'
Vent
>6„ Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
5.6f A2/pair of end caps
4' Long 12"
.. Grade at System Elevation
Pro 6
Bedroom
House
Cross Section of Quick 4 Standard Leaching Chamber
Typical cross section for 2 of 3 cells
Quick 4 Standard
Leaching Chamber with
20.0 ft2 of Area per
Chamber 5.6ft^2 pair of end plates To be A' above grade
Finish grade elevation
Typical Installation 99.9'
Vent Grade Went
4" 4
*;oo*�30/34 Septic Tank
34 Grade at System Elevation �-
Spacing_ 5'
3-3' X 90' Cells
Same on other end
22 chambers per cell
System elevations:
A 95.9'
13 95 ff
C 95.7'
1"
at System Elevation
Observation tube/Vent
To be located on end of Cells
c
C
n
POINTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
ILE INFORMATION
Owner
Permit
he 0I E W CAMCTCRC
1�(
Number of Bedrooms
❑ NA
i Number of Public Facility Units
❑ NA
j Estimated flow (average)
..6
al/dal
i
I Design flow (peak), (Estimated x 1.5)
0677 gavday
i
Soil Application Rate
aUda lftz
i
Standard Influent/Effluent Quality
Monthly average"
Fats, Oil & Grease (FOG)
530 mg/L
Biochemical Oxygen Demand (BOD5)
<_220 mg/L
0 NA
Total Suspended Solids (TSS)
:5150 mg/L
Pretreated Effluent Quality
Monthly average
Biochemical Oxygen Demand (BODs)
530 mg/L
Total Suspended Solids (TSS)
530 mg/L
❑ NA
Fecal Coliform (geometric mean)
<104 cfu/100m1
iMaximum Effluent Particle Size
36 in dia.
❑ NA
10ther:
❑ NA
"Values typical for domestic wastewater and septic tank effluent
CVSTFM APPCIFICATIONS
Septic Tank Capacity
❑ NA
al
Septic Tank Manufacturer
❑ NA
Effluent Filter Manufacturer
l
❑ NA
Effluent Filter Model
r ❑ NA
Pump Tank Capacity
al NA
Pump Tank Manufacturer
NA
Pump Manufacturer
NA
Pump Model
NA
Pretreatment Unit
NA
❑ Sand/Gravel Filter
❑ Peat Filter
❑ Mechanical Aeration
❑ Wetland
❑ Disinfection
❑ Other:
_
Dispersal Cell(s)
❑ NA
-Ground (gravity)
❑ In -Ground
(pressurized)
.in
❑ At -Grade
❑ Mound
❑ Drip -Line
❑ Other:
Dither,
❑ NA
Other:
❑ NA
Other.
❑ NA
IAINTEIV/iNla st.neuu��
MAINTENANCE
Service Event
Service Frequency
Ilnspect condition of tank(s)
At
least
once
every:
eve
> ❑ month(s) (Maximum 3 years)
,__>_,GI ear s
❑
NA
1Pump out contents of tank(s)
When combined sludge
and scum equals one-third (X) of tank volume
❑
NA
Ilnspect dispersal cell
At
least
once
every: ry:
s
fi
month(s) (Maximum 3 years)
_year(s)
❑
NA
,
❑ month(s)
❑
NA
Olean effluent filter
At
least
once
eve rY:
��--p-year(s)
! nspect pump, pump controls &alarm
At
least
once
every:
❑ month(s)
year(s)
❑
NA❑
❑ month(s)
❑
NA
I=lush laterals and pressure test
At
least
once
every:
❑ year(s)
Other,
At
least
once
eve rY:
❑ month(s)
❑ year(s)
❑
NA
1)ther:
❑
NA s
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; POA I S Maintainer; Septage Se►vicing 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 ('%} or more of the tank volume, the entire conter its of
!:he 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 hy a certified POV/TS Maintainer.
A service report shall be provided to the local regulatory authority; :vithin 10 days of completion of any service event.
Page of,_,__.;
START UP AND OPERATION
duds or other chemicals tt�It
uses andfor damage the .dispersal cell{s). if high concentrations are detected have the contents of th
*13
For new construction prior toof the POWTS check treatment tank(s) for the presence of pat ng
may impede the treatment P operator prior to use.
tank(s) removed by a sept89e servicing p
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
er levels. When power is restored the excess wastewater will bp
During power outages Pump tanks may fill above normal highwat result in the backup or surface discharge Of effluent -
During o
We
discharged to the dispersal cells) in one large dose, overloading the cell(s) and may operatorge Servicing prior to restoring power
To avoid this situation havelumb o� ppvVithS Mainptainer�to assist removed inymanuaplYoP rating the Pump controls to restore normal levels
effiuerti pump or contact pact, the area within
within the pump tanks
ce
lls, ea not drive or park aver, or otherwise disturb or com
Do not drive or park vehicles over tanks and dispersal
15 feet down slope of any mound or at1rade soil absorption performance and prolong the life of the POWT1$
improve the perfo foundation dralin
Reduction or elimination of the following from
the �n��s� adegreasers dental floss; diapers; disinfectants*, fat; rodut�s;
antibiotics; baby wipes; dgam#e butts' Mine; grease; herbicides; meat scraps; medications; oH; painting P
(sump pump) water, fruit and vegetable peelings; g
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT taken out of service the following steps shall be taken to insure that the system is prope(ly
When the POWTS fails and/or is permanently
and safety abandoned in comPllance with chapter Comm 83.339 Wisconsin Administrative Code:.
e Ali piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.a Servicing Operator.
The contents of all tanks and pits shall be removed and properly disposed of by a Septag
moved and the void space tilted with soil,
• After pumping, all tanks and pits shall be excavated and removed or their covers re
hei
gravel or another inert solid material.
CONTINGENCY PLAN the following measures have been, or must be taken, to provide a code Compii�nt
If the POWTS falls and cannot be repaired
replacement system: on systelm.
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
requit d
he replacement area should be protectedfrom
lines ad wells. Failure to the replacement Infrin and should not be inged upon
Yeti in then ed
setbacks from existing and proposed structureslot ems must comply with the rule: in
for a new soil and site evaluation to establish a suitable replacement area. Replacementsystems
effect at that time.
❑ A suitebte replacement area is not available due to setback
soil limitations. Barring advancers in POWTS tech o9N a
holding tank may be installed as a last resort to replace the failed POWTS.
evalualon
❑ The site has not been evaluated to identify �le replacement
pl If no replacement aarreaa Is avfailureailable llable af the ahholding tank may WTS a soil and be installed as
must be performed to locate a suitable replacement
a last resort to replace the failed POWTS. removal of the biomat at the infiltrative
❑ Mound ,Rec constructions of such systrade son absorption ems must ms complybe �nUn ees in d in effect at that tilace me.
<<WARNING>> CONTAIN LETHAL GASSES
SEPTIC, PUMP AND OTHER TREATMENT TANKS
TANY UNDER ANY C,RCUM3TANCES DEATH MAY INSUFFICIENT
RESCDo NOT
UE O A
ENTER A SEPTIC, PUMP OR OTHER TREATMENT
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
This documentwas dratted in compliance with chapter SPS 383.2g(2)(b)(1)(d)Sdf) and 383.54(1), (2) & (3), VlAscxansin Administrative Code.
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ST. CROIX C01jN1,y
Srl� I'1C TANl� IV1A1N I I N t1 NCE 1'�.CiRLEMI- NT
ANDt)WNrkSTdlp CrIZTII�)C'A'I IulV
• .. FORM
owner/Buyer
Walling Address J; At/I
I'roirUty Address 7Q _ �_ Z
(Verification rerecl Cxotrl f'IT1nI,.,� u, c,u71ln * rats -- —
b parrnent fin• neve+ consintction.)
tarty/state
r, AIr�; ao„rsc ul�JLINJN
l'�reelldenticatiolll�tll:iber Opp_
Properly 1/imuon �0/ , t '/� ,Sec. ; r 2 qN lZ
.-___/-. W, Town or
Subdivision SL
-- -
Low
Certified c Srtr�r >y rIti p #
Volunte Page
'1W:li•rayyty Deets #
V041111(; > Pilge �
Spec: house yes no l:ut line;. identifiable yes uo
Y TEIVr�I ..Al'lNT!'1NA1V•CE AND d)`uvwri w.i rlrr, "Pjnrti;wv. > ,... ,. _
.improper use and nraintenarTce of your septic system coulei result in its Prc;mahtre failure to Ilarldle wastes. Proper
rnaintenarrce Uansists ofpurl1Puig out the septic tank every three ycars or sooner, ii needed, by a licensed pumper. What you put into
the system can aiiect the fiulction of the septic tank as a treatment stage in the rvasre (iisposal systenT. Uwntsr rrinintenanre
responsibilities are specified in §(:onun. 83.52(l) and in Chapter• 12 •• St. C."•Ivix County Sanitary Ordinance,
The property owner agrees to subrnit to St. Croix County planning & Zon.Ing Department a certification form, signed by the
owner ate by a waster plumber, •loruneynsars plumber, restricted plumber or a licensed bumper verifying that (1) the ou-site
wastewater disposal system is in pxoper Operating condition and/or (2) after inspeo-:soil aTld ptrmpiirl; (if•necessary), the septic tank is
less rhan T/3 fall of sludge.
rhvefm , die ilrreic;rsi,;ncsci rttiw read the above reyuireulents tuttl agree to maintain the private scnvagu disposrt! systeuT With the
standards set tali g that
y as set by the .17eparhner4 of C ornnxurcc and the Dopartiriont oi'Natural $esourecs, State of Wisconsin.
Certification sighing that your septic system hits been rnairrtained must be colxrpletc� (anti returned to the St. G� oix County count Planning Z,orling Departirnent within 30 days of'the threes year expiration datv.
l/wv certify that all statements oil this forrrl arc q•ue to the best ot'nry/our. k uawledgr.. l/we arrJare tfre owuer(s) of•tlte
property described above, by virit►e/of a wttrxant}r deed recorded iu Register of Deeds Offset .
Number of bedt•ooins CJ
T>m� oli
DATA:
�`*`Any iufisxrnation tllat is inisrepresente(t Hilly result in the sanitary lrur'nlit being r�:vo1(ed by the I'Iarutin >
(> &Zoning Department. **
include with flits applicationthaa recorded warranty deed fiom thts Register of Deeds Office and a copy o.fthe certified survey reap if
reference is rrradts in the warranty deed.
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O 1082852
BETH PABST
REGISTER OF DEEDS
State Dar of Wisconsin Form 1-2003 ST. CROIX CO., WI
WARRANTY DEED RECEIVED FOR RECORD
06/11/2019 10:44 AM
Document Number Document Name
EXEMPT#:
REC FEE 30.00
TRANS FEE 2,719.20
THIS DEED, made between Robert W. Waxon and Christine A. Waxon, husband PAGES: 2
and wife **The above recording information
("Grantor," whether one or more), verifies that this document has
and Urchins, LLC, a Wisconsin Limited Liability Company been electronically recorded
& returned to the submitter
("Grantee," whether one or more),
Grantor, for a valuable consideration, conveys to Grantee the following described real
estate, together with the rents, profits, fixtures and other appurtenant interests, in
St, Croix County, State of Wisconsin ("Property") (if more space is Recording Area
needed, please attach addendum): Name and Return Address
See Attached Legal Description Results Title, Inc.
11200 W 78th Street
Eden Prairie, MN 55344
See Attached Parcel ID Numbers
Parcel Identification Number (PIN)
This IS NOT homestead property,
(is) (is not) '
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except;
covenants, restrictions and easements of record, if any
Dated May 31, 2019
AUTHENTICATION
Signatures)
authenticated orb
�i
EAL
� . ► sue►
_l
�qlaiLli
authorized by Wis. Stat, § 706.06)
THIS INSTRUMENT DRAFTED BY:
Stacy Lashinski,41114119
2677 Bunker Lake Blvd, Andover MN 55304
*Robert
* Christine
ACKNOWLEDGMENT
STATE OF WISCQNSIN
ss.
• St. Croix COUNTY
L)
Personally came before me on May 31, 2019
,
the above -named Robert W. Waxon and Christine A. Waxon,
husband and wife
to me known to be the person(s) who executed the foregoing
. instrumentacknowledged the sane. � J
(Signatures may be authenticated or
Notary Pubklc, State of Wisconsin j � ��j � •-�•
My Commission (is-per�an�nt) (expires:_�`�'a- !�_.)
acknowledged. Both are not necessary,)
NOTE: THIS IS A STANDARD FORM. ANY hiODIFCCATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED,
�VARRAN'fY DEED C� 2003 STATE BAR OF WISCONSIN FORM NO. 14003
* Type name below signatures.
St. Croix County 1082852 Page 1 of 2
Legal Description
l-ot Two (2) of Certified Survey Map recorded in Volume 29 of Certified
Survey Maps on page 6614 as Document No. 1077822, located in the
Northwest Quarter (NW1/4) of Section Thirty-five (35), in the North Half of
the Northeast Quarter (N1/2 NEB./4) of Section Thirty-five (35) and in the
Southeast Quarter of the Southwest Quarter (SE1/4 SW1/4) of Section
Twenty-six (26), all in Township Twenty-nine (29) North, Range Nineteen
(19) West, Town of Hudson, St. Croix County, Wisconsin.
Parcel ID Numbers;
Part of: 020-1106-10-000
020-1106-20-000
020-1106-80-OOQ
020-1106-90-000
020-1107-10-p00
020-1107�30-000
020-1072-40-000
St. Croix County 1082852 Page 2 of 2
NO ACCESS 087°4015411E 480018,
296,98'
50' HIGHWAY SETBACK
BENCHMARK
TOP REBAR
ELEV. = 991.17'
r
M
N
LOT 4
LOT 3
3. S
130,860 SQ. FT.
N88016'27"W 323.66'
w
N
0
Iz
BENCHMARK
TOP REBAR
ELEV. = 995.05'
- - MAG00 ROAD -
33' 33'
J�
�I
vl
LOT 1
J
1$3.20'
LOT 2
3.01 ACRE%
130,938 SQ. I
S2>
RE�rodE
Wisc o,nsin Department of Commotce� 6 20�9 SOIEAUA ION REPORT Page of
Division of Safety and Building's'
Cou��ordance ' h Comm 85, Wis. Adm. Code
t. :roi% County .
Attach complete site plan o�i,gqapf�4Dte�l 11 inches in size. Plan must
include, but not limited i&Vertical-aiHdW6dzontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Re eweit s by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 7 ZQZO
Property Owner Property Location
Govt. Lotr1XJ 1/ 1/4 S �' j�T N R E ( W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
City , ❑ � J�ge Town Nearest Road
New Construction Use: idential I Number of bedrooms � Code derived design flow rate �/?TJ GPD
❑ Replacement ❑ Publi r commerct I - Describe:
Parent material Flood Plain elevatio 1 applicable AI l
General corn rnents •S �'& SL C-B'`^aC 5 a'`' ��I
and reconvr,endations: ,�. � (-rCu i le -to ee Cto 4&, ` r<<-(..1..%
System Type L G / G t� s r'S System Ele�ion
Boring # � Boring {y
a Pit Ground surface elev. 11 ft. Depth to limiting factor (_l in.
Soil AoDlication Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft=
'Eff#1
•Eff#2
.�
-
1.
r
J f �
4q�
/
'✓/
� �
9S 3Z)
e
®Boring # Boring
YY
Soil Aoolication 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
Z -
�—
'
�.
- m
—
1
e
%• 3 °
�g e
' Effluent #1 = BOD, > 30 < 220 mg/l. and TSS >30 < 150 'Effluent #2 = BOD, < 30 mglL and TSS < 30 mglL
CST Name (Please Print) Si re CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1432 120th St, New Richmond, WI 54017 �� ^Jam` 715=24&4516
Soil Test Plot PI
Proj�:A Name Dick Stout
Address 1353 Awatukee Trail
Hudson Wi 54016
Lot 3 Subdivision
NW 1/4 NE 1/4S 35 T 29
Summer Prairie
N/R19 W
Boring Q Well PL Property Line
L
3M or VRP Assume Elevation 100 ft
System Elevation TBD
Bi
/CSTM #226900
Date 9/11/19
Township Hudson
County ST. CROIX
Top of survey iron
* H R PSame as Benchmark