Loading...
HomeMy WebLinkAbout030-2002-70-100 i • - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430102 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID N .. Personal information you provide may be user; for secondary purposes [Privacy Law, s.15.04 (1)(m)i. Permit Holder's Name: City Village X Township Parcel Tax No: Benedict, Michael I St. Joseph Township 030 - 2002 -70 -100 CST BM Elev: Insp. BM Elev: BM Description: Cti fectionrrown/Range/Map No: 00.V) f ibp , 0 / C ST r3 wr- I �trr - , e 33.30.19. 30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION S BA HI FS ELEV. Septic Benchmark / Dosing Alt. BM Aeration Bldg. Sewer 3. o o „ / Holding St/Ht Inlet / TANK SETBACK INFORMATION St/Ht Outlet •oI 00 O t TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic � � i v � � Dt Bottom Dosing 7 C Header /Man. ^. —f Aeration Dist. Pipe - 1S 97.OS 13 6 -+of Holding Bot. System 1 3 1,10 o n - 40 1 U wwC, PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM C D .4o Model Numb TDH Lift is ' oss System Head TD Ft Forcemain ength Dist. to Well SOIL ABSORPTION SYSTEM IM(rRENCH Width t Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM NS 3 Q }. 2 SETBACK SYSTEM TO P/L BLDG IWELL I LAKE /STREAM LEACHING Manufact er: INFORMATION CHAMBER OR 1 b I r'r =�s�s Type Of System: UNIT SQ I .� � S � Model Number: 1(.0 ( / DISTRIBUTION SYSTEM Header /Manif Distribution x Hole Size x Hole Spacing Vent to Air Intake u Pipes Lengt Dia Lengt Di Spacing _�� I > 10D 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 Bed/Trench Edges Topsoil Yes No [] Yes L - No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection # " / Inspection #2: Location: 1251 54th St Hudson, WI 54016 (NE 1/4 SW 1/4 33 T30N R19W) NA Lot 5 Parcel No: 33.30.19. '( 0 1.) Alt BM Description = 5 •T. . k- C"'c'. 2.) Bldg sewer length = i f$ 1 a ount of ver -,- - - Use other i s Q Yes No de for additional � —!— �(C information. _ Date Inse ctor's Si nature f Cert. No. SB -6710 (R.3/97) p g 7 Safety and Buildings Division copl AID 201 W. Washington Ave., P.O. Box 7162 Vscons�n Madison, WI 53707 - 7162 S ry Permit Num ( led in y E Department of Commerce (608) 266 -3151 3 �- Sanitary Permit Application State Plan I. er In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(l)(m) Project Address (if different than mailing address) 1� �? � Si Sao% J-7-, I. Application Information - Please Print All Information b -�Ud Z Property Owner's Na me '"7 4 t , y . t Parcel # t # Block # Property O er's M ailing Address } i Property Location Ci tY, P State Zip Code M Phone Number �A' SJ V4'Section � (circl , 3 3 1 v II. ype of Building (check all that apply) T N; E r w ��[ � Subdivision Name CSM� umber 1 or 2 Family Dwelling - Number of Bedrooms El Public /Commercial - Describe Use Cv El State Owned - Describe Use - ❑City_ ❑Villageownship of J fJs III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ew System p y g P Y ❑ Replacement S ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. Permit Renewal mit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) �`�C (� (J V+ ` n - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -G and El Holding Tank El Peat Filter El Aerobic Treatment Unit El Recirculating Sand Filter El Recirculating Synthetic Media Filter thing Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Info ation: 5 Design Flow (gpd) esign Soil Application Rate( I Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevatio 9- l O y tl VI. Tank Info Capacity in Total Number Manufacturer Prefab Site :eel Fiber Plastic Gallons Gallons of Units S0- a,-, Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, a responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si a MP /MPRS N urgber � Business Phone Plumber's Addre ss (Street, City, State, Zip ) , VIII ount /De artment Use Onl --- Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Iss ssuing Age Si alto tamps) Surcharge Fee) �j S O ❑ Owner Given Reason for Denial 7/ D IX. Conditions of Approval/Reasons � , fo Disapproval � � •„� 1L � ��- -� G /� /D 3 Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size i Ci2Tl_�ZOQ 117 n1 m�� Soil Test and System PLOT PLAN PROJECT Michael Benedict DDRESS 364 Ctv Rd E Hudson Wi 54016 NE 1/4 SW 1/4S 33 /T_! 19 TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/28/03 BEDROOM 4 CONVENTIONAL XXX IN -GROUN D CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 870 # of chambers 28 BENCHMARK V.R.P. Top of Wood Post ASSUME ELEVATION loo' Filter Zabel A -100 ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 98.0/97.0 5.5' Below Grade Alternate Benchmark is steel fence post @ 101.5' Plans Designed Using Conventional Powts Manual Version 2.0 Pro 4 Bedroom House 180' Alt.B.M. 0 , T B -1 45 , 10 B.M. 50' Vents 14% Slope 2 -3' X 88' Cells with >3' Spacing B -3 25' C> 25' B -2 Vents jL— Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area 3 4 Grade at Sys tem Elevation 461' Property Line Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Zi Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code v County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan include, but not limited to: vertical and horizontal reference ppiatFBhrf , 6 n and Parcel LD. _ percent slope, scale or dimensions, north arrow, ocatin I1�&6 Bares road. — Ud 76 Please print all in �mation. viewed b Date Personal inforrnation you provide may be used for secon ary purpgztes (Pri "c�Laj4oj;r.04 (1) m)). Property Owner /1 Property L cation J /j`,� Lot 114 /4 S N E nor)W Property�erp Mailing Address _ o Block # Subd. Name CSM# ��/ Gd'S 6 I T (ri city to Zip Code Phone Number ❑ city El Village Town Nearest R ad Sq V1.1, S',�s�• ew Construction Use�.OBesidential /Number of bedrooms Code derived design flow rate � GPD ❑ Replacement ❑ Public or commercial - Describe: _ __— Parent material cc Qy Flood Plain elevation if applicable General comments fj a and recommendations.. .S — &- - M # Boring Boring i Pit Ground surface elev,/-4� ft. Depth to limiting factor in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. M��u))nsell Clu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 2 - 12 41 U i� G' s 1 Ile Boring # Boring Pit Ground surface ele '� ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 62 -lam /0, - /�- f �'/ i • Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) SW&re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address ate Evalua on Cond pied Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715- 246 -4516 Property Owner _ Parcel ID # Page of Boring # ��1 Boring © pit Ground surface elev. ft. Depth to limiting factor L-3N 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 Z6 Zh'11 .� �; / 7 ❑ 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F ❑Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ication 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 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgll_ ' Effluent #2 = BOD < 30 mg/_ 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. SSD -8330 (8.6/00) Safety and Buildings Division Counry/ /� e 201 W. Washington Ave., P.O. Box 7162 ' Madison, WI 53707 - 7162 Sanitary Permit A ?umber (to be filled in by Co.) i5con� N 608 6 -3151 2 — Department of Commerce ( ) 26 / 30! a State Plan LD. Number Sanitary Permit Application / , V / A In accord with Comm 83.21, Wis. Adm. Code, personal information you provid may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Addre s if djfferent 4i4n mailing address) I. Application Information - Please Print All Information Property Owner's Na me Parcel # Lot # Block # Property Owner's M ailing Address �1J yivisionName ,i 'Z� / ction Ciry, State Zip Code Phone Nu ber rc ) , l �/ __ _ or W II. Type of Building (check all that apply) �� CSM Numb 1 or 2 Family Dwelling - Number of Bedrooms / ❑ Public /Commercial - Describ Use 1 + - - - -- S ❑ State Owned - Describe Use ( (A) S _ f ❑City_F - Villa wnship of a f7 �..✓ III. Type of Permit: (Check only one box o 'ne A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/ Holding Tank Replaceme Only ❑ Other Modification to Existin System Lis ious PermilN ate Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ ange of El Permit T sfer to New r Before Expiration Plum r Owner IV. Type of POWTS System: (Check all that apply) Non - Pressurized In- Ground 11 Mound > 24 in. of suitable soil El Mou < 24 in. of suitable soil At -Grade El Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank El eat Filter El Aerobic Treatment Unit ❑ Recirculating Sand Filter El Recirculating Synthetic Media Filter e, hi am ber ❑ Drip e ❑ Gravel -less Pipe El Other (explain V. Dispersal/Treatment Area In rmation: 1 p Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal rea Re - red (sf) Dispersal Area Propose (st) System Ele ation -7 g / - VI. Tan k Info Capacity in Total Number Manufac er Prefab S e S. el Fiber Plastic Gallons Gallons of Units Il Concrete i Constructed Glass New L•xisting Tanks Tanks Septic or Holding Tank r� Aerobic Treatment Unit e j i Dosing Chamber i - VII. Responsibility Statement- 1, the undersigne as responsibility for installation of the POWTS shown on the attached plans. 2 PI ber' 'Na me (Print) Plumber's Si e MP /MPR S urn r Business Phone Number Plumber's Addre ss (Street, City, State, Zt e) VIII. unty /De artment Use Onl Sanitary Permit F (includes Groundwater Date Issued I uing Agent ignature (No s) pproved 11 Disapproved Surcharge Fee) ZZS� w �O�ZL/ ❑ Owner Given Reason for Denial IX. nditions of Approval/Reasons roval /Reasons for Disapproval �CST��1.fl- r�d�G� �' �`` -�� titA a �' p �' � 3 , � K �ttach lete plans (to the County only) for the sy tern on pa less than 8112 x11 inches in size/ f PLO PLAN PROJECT Michael Eenedic . DRESS 64 Ctv Rd E Hudson Wi 54016 NE 1/4 SW 1/4s 33 /T 30 / 19 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE6 /17/03 BEDROOM 4 CONVENTIONAL XXX IN- GROUND W1 SS 2 URE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 60 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambe 30 BENCHMARK V.R. . Top of SW Lot Stake ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL •H.R.P. Same as Benchmark SYSTEM ELEVATION 100.7/101.4 3' Below Grade j ent Standard Biodiffuser Plans Designed Using Leaching Chamber Conventional Powts with 31.1 ft2 of Area Manual Version 2.0 „ 34" Grade at System Elevation pro 4 Bedroom House 27' C/) 30' ItT kn B -4 T 99' 10% Slope 50' 36' 32' B -5 28' Vents B -3 9 B -1 35' Vents 2 -3' X 94' Cells with >3' Spacing 60' Poo B -2 76' sh1 1 46 1' Property Line PLO PLAN PROJECT Michael Benedic', DRESS 64 Ctv Rd E Hudson Wi 54016 NE 1/4 SW 1/ 4s 33 /T 30 / 19 w TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/17/03 BEDROOM 4 CONVENTIONAL XXX IN- GROUND SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chamber 30 BENCHMARK V.R. . Top of SW Lot Stake ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 100.7/101.4 3' Below Grade jL Standard Biodiffuser Plans Designed Using Leaching Chamber Conventional Powts with 31.1 ft2 of Area Manual Version 2.0 34 Grade at System Elevation Pro 4 Bedroom House 27' rig 30' B -4 T 99' 10% Slope 50' 36' 32' B -5 28' Vents B -3 9 B -1 35' Vents 2 -3' X 94' Cells with >3' Spacing 60' B -2 76' SIrJ Covrt,QJt1 46 1' Property Line Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County rX include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 6 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 3 — 9 o02- — 7d 160 Please print all information. Revi ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location �/� Govt. Lot / 1/4 A S3.3T R E (or6w Property Owner's a!1l Address /) Lo� Block # Subd. Name or C P 6 / Y �f / .tea State Zip Code Phone Number ❑ city ❑ Village T wn Nearest Road New Construction Us Residential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: __— Parent material Flood Plain elevation if applicable ft. General comments and recommendations: x"O rl Bones # Ground surface elev. � Depth to limiting factor _1� in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color r. Sz. Sh. •Eff#1 •Eff r F-1 Boring # ❑ Boring El Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 • Effluent #1 = BOO > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/- and TSS 1 30 mg/L CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 �� -��� 715 - 246 -4516 : r roperty Owner _ Parcel ID # Page of 17 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff #2 T__ Boring # ❑ Boring Soil [] lication Rate pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'E1f#2 a Boring # ❑ pit Boring ❑ Ground surface elev. ft. Depth to limiting factor 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 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 1.50 mg/L ' Effluent #2 = BOD < 30 mg& 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. SOD -8330 (R.W00) f Wis: onsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 } Labor and Human Relations Division of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, bu St. Croix not limited to vertical and hori7,ontal reference point (BM), direction and % of slope, scale or RCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION l VIE e DATE 99 __'' !�'k Z 6� PROPERTY OWNER: PROPERT O1/4,s I ;Thomas Seim GOVT. LOT 1/4 SW 33 T 30 N,R 19 xETor) W PROPERTY OWNER':S MA!I_ING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # 529 Co. Rd. #E 5 na csm CITY, STATE ZIP CODE PHONE NUMBER CITY CIVILLAGE 9YOWN NEAREST ROAD Hudson, WI. 54016 (715)549 -6587 St. Jose h 7 Co. Rd. #E b& New Construction Use ( x)K Residential I Number of bedrooms 3 [ J Addition to existing building J Replacement [ J Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft - 8 trench, gpolft Absorption area required 643 b ft2 563 trench, ft Maximum design loading rate • _ 7 bed, gpd/ft - 8 trench, gpd1ft Recommended infiltration surface elovation(s) 86.30 alt area =89.40 ft (as referred to site plan benchmark) Additional design/ site considerations step down trenches could be used 3.5' below surface el. Parent material outwash Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system :91: S O U I ta S O U jo S O U LAS D U 0S 13U 0S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITirench ,t 1 ?� 1 -10 10 r2 2 none 1 2msbk mfr if .5 .6 N ow"119 2 10 -24 10yr4 /4 none sil lfsbk mfi gw if .2 .3 Ground 3 24 -82 10yr4 /6 none S Osg ml na na .7 .8 elev. 89.3 ft. Depth to limiting factor +82 Remarks: Boring # . 1 -4 10yr3 /3 none 1 2m r mfi C1W 1f .5 1.6 k 2 2 -11 10yr4 /4 none sil 2msbk mfr if .5 .6 j 3 1 -84 7.5yr4/6 none co s Osg ml na .7 .8 Ground 92.40 ft Depth to s� , limiting factor a k - r +84 11 ;!+ • �...� Remarks: CST Name: — Please Prin Phone: ; .. nary L. Steel 715- 246 - Q -`i i0 Address: 1554 200th. Ave., New Richmond, WI. 54017 r Signature: Date: CST Number: 12 -13 - 94 cstm 02298 Thomas Seim 2 ef PROPERTY OWNER SOIL DESCRIPTION REPORT Page PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots . GPD/ft2 in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed !Tmr& 0-13 10yr3/3 none sl 2msbk mfi Cs If .5 j.6 3 'M*'�" 10yr5/4 2 13-32 none sit lfsbk mfr 9w If .2 1 .3 Ground 3 1 32-48 7.5yr4/4 none 1 fs Osg mv r 9w na .5 j eev. 9 l 2.5 ft 4 48-96 7.5yr4/6 none Co s Osg ml na na. .7 .8 Depth to limiting factor +96 Remarks: Boring # 1 0-10 10yr3/2 none 1 2msbk mfr 9w 2f .5 ::.6 -20 10yr4/4 9w 2 10 none sil lfsbk mfr if .2 .3 MEMO 3 20-30 7.5yr5/6 none sl lmsbk mvfr 9w na .4 .5 Ground :: elev. 4 30-84 7.5yr4/6 none Co s Osg ml na na .7 .8 l 90.6 ft. Depth to limiting factor +84 Remarks: Boring # 1 0-8 10yr2/2 none fill na mfr 9w na np np 5 2 8-21 10yr4/4 none fill na mfr 9w na np np 3 21-41 7.5yr4/6 none Cos Osg ml 9w na .7 :.8 Ground elev. 4 41-43 7.5y r4/6 none is Osg mvfr na .7 y 9w 95.0 ft. 5 43-84 7.5y none Co s Osg Ml na na 7 .8 Depth to limifing factor ------ +84 Remarks: Boring # ii ktiiiiii: iii Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Thomas Seim 1554 200th Ave. CSTM2298 SE4 SW4 S33 T30N - R19W New Richmond, WI 54017 Town of St. Joseph h MPRSW 3254 p (15) 246 - 6200 1 lot #5 N 1 =40' BM.= to of .1 steel' i e- at -el. 100' Alt. BM. = top of 4" steel pipe corn post at. el. 104.70 , 0 2� 7 q, o - 30' 120 25` 401 30' 3p Gary L. Steel 12 -13 -94 w w"orwin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 I.,abor and Human Relations Division of Safety &Buildings in accord with ILHR 83.05, Wi N{ a i. COUNTY ti Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. I ust 'nclude, but/ S no limited to vertical and horizontal reference point BM direction and o o e, seq �, PRCEL I.D. # t Po ( ). ° P . dimensioned, north arrow, and location and distance to nearest road. �' ` pending ''a " RE IEWED BY DATE APPLICANT INFORMATION PLEASE PRINT ALL INFORMA - `' PROPERTY OWNER: PRO RT` N Tom Seim OVT. LOT c �gk 4,S T AR :R(or) W PROPERTY OWNER':S MAILING ADDRESS f21✓ K# AME OR CSM # 529 Cty E cs CITY, STATE ZIP CODE PHONE NUMBER V L ` OWN NEAREST ROAD Hudson, WI. 54016 b15) 549 -6587 ST. ose h ] New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building [ } Replacement [ } Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd /ft trench, gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd/ft Recommended infiltration surface elevation(s) 100.87 ft (as referred to site plan benchmark) Additional design/ site considerations alt. area trenches C el. 100.2 & 97.10' Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S El [AS ❑ U ®S ❑ U $] S ❑ U E2 S ❑ U ❑ S 0 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Baxtcbry Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed jTw& .................. ................. .................. ................. .................. ................. 1 1 0 -10 10 r mfr 2f .4 .5 2 10 -16 7.5 r4 4 none sl lcsbk mvfr crw I if .4 .5 Ground 3 16 -80 7.5yr4/6 none cos osg ml na na .7 .8 elev. 104 .ft4 Depth to limiting factor +80" Remarks: Boring # 1 0 -6 10 r3 3 none sici 2msbk mfr qW 2f .4 .5 ... >:<: 2 6 -12 10 r4 6 none sl 2m r mfr 9W 2f .5 .6 ................ Ground 3 12 -82 7.5 r4/6 none cos osg ml na na .7 .8 elev. 104 ft. Depth to limiting factor + 82" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 20A. Ave. New Ri mond WI 54017 I Signature: Date: 10 - - CST Number: m02298 f PROPERTY OWNER Tom Seim SOIL DESCRIPTION REPORT Page 2 of '3 PARCEL I.D. ending a' Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 -10 10 r3/3 none sici 2msbk mfr Qw 2f .4 .5 2 10 -16 7.5yr4/6 none sl 2csbk mvfr gw if .5 .6 Ground 3 16 -80 7.5 r4/6 none cos 0scr ml na na .7 .8 elev. 103 ft 7 Depth to limiting fa +Wo of ol Remarks: Boring # 1 0 -12 10 r3 3 none sici 2msbk mfr qw 2f .4 ':.5 . ' 4 2 12 -80 7.4 r4/6 none cos osq ml na na .7 1.8 Ground elev. 10 ft. Depth to limiting factor + 80" Remarks: Boring # 1 0 -9 10 r3 3 none sici 2 bk mfr 2f .4 .5 5 2 9 -15 10 r4 4 none scl 2mcrr mvfr c1w if .4 .5 Ground 3 15 -80 7.5 r4/6 none cos os mi na na .7 .8 elev. L 10 ft. Depth to limiting factor +80" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: I SBD- 8330(8.05/92) �r STEEL'S SOIL SERVICE Gary L. Steel Tom Seim 1554 200th Ave. CSTM2298 NE4Sw4 S33- T30N - R19W New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246 -6200 lot ## - csm 1 BM.= top of SW lot stake C el. 100' 10 1 R Gary L. Steel 10 -3 -96 l.abo l SOIL AND SITE EVALUATION REPORT Page 1 of 3 Division of Safety & Buildings in accord with ILHR 83.05 1 w COUNTY o .� Attach complete site plan on paper not less than 8 1/2 x 11 inches in s' n rri*io�de, bu ` St. Croi not limited to vertical and horizontal reference point (BM), direction a f s 0 *0,br - '" PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road ° �.,`w�'"� , pending R € - I EVIEWED BY DATE APPLICANT INFORMATION- PLEASE PRINT ALL INFORM N (� �'( PROPERTY OWNER: PROPE ► J�J� Tom Seim OVT. L0 t!E 1/4,S 33T 30 N,R 19 )E (or) W PROPERTY OWNER':S MAILING ADDRESS _BLQC1Ktk NAME OR CSM # 529 Cty E 3 a] csm pending CITY, STATE ZIP CODE PHONE NUMBER ❑CI GE ®TOWN NEAREST ROAD Hudson, WI. 54016 (715) 549 -6587 St. Joseph 60th. sT. ]K] New Construction Use [ Residential/ Number of bedrooms 3 ( Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate ._ bed, gpd /ft gpd /ft Absorption area required 375 bed, ft 375 trench, ft Maximum design loading rate __ bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) 101.9 ft (as referred to site plan benchmark) Additional design/ site considerations system el. based oncontour line of el. 100.9' Parent material pitted glacial drift Flood plain elevation, if applicable nit ft 71 un i table for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK suitab le fors stem I ❑ S i7 U as ❑ U I [IS Z U ❑ S RI U ❑ S 0 U ❑ S CCU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ''....1....`? 1 0 -11 10 r3 4 none sil 2msbk mfr cs 2 2 11 -33 10 r4/4 none sici 2msbk mfr cfw if .4 .5 Ground 3 33 -52 10 r4 4 7.5 r5 6 sicl lfsbk mfr n elev. 10 ft. Depth to limiting factor 33" Remarks: Boring # 1 0 -10 10 r3/3 none sicl 2msbk mfr CrW 2f .4 .5 2 `-? 2 10 -22 10 r4/4 none scl 2msbk mfr CFW if .4 ; . 5 Ground 3 22 -61 7.5 r4 4 none is oscf mvfr aw na .7 .8 elev. 4 1 61-80 7.5 r4 4 none scl lcsbk mfr n 10 ft. Depth to limiting factor = 80 " Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 20Qth. Ave. New . hmond WI 54017 Signature: Date: 10 -3 -96 CST Number: m02298 PROPERTY OWNER Tom Seim SOIL DESCRIPTION REPORT Page 2 of 3' PARCEL I.D. # pending Depth Dominant Color Mottles Structure GPD /ft , Boring # Horizon Texture Consistence Baxxfary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 < 1 0 -9 10 r3/3 none sil 2msbk mfr cs 2f .5 .6 2 9 -33 10yr4 /4 none sici 2msbk mfr gw if .4 .5 Ground 3 33 -68 7.5y 4 none is os m vfr qw na .7 .8 elev. 99 ft. 4 68 -84 7.5 r4 4 none sl icsbk mvfr na na .4 1.5 Depth to limiting factor +84" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Tom Seim 1554 200th Ave. CSTM2298 NE4NE4 S33- T30N -R19w New Richmond, WI 54017 MPRSW 3254 town of St Joseph (715) 246 -6200 lot #5 -csm t N 1 =40' BM.= top of 1" pvc pipe C el. 100' Alt. BM.- top of steel fence post C el. 103.85' 13 121 � t� �00k 1 � el . Gary L. Ste 10 -3 -96 i r Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 f ST CROIX COUNTY SEPTIC TANK ANK MAINTENANCE AGREEMENT AND ' OWNERSHIP CE TIFICATION FORM owner/Buyer �! � z Mailing Address le Property Address oZ-J S `f (Verification required from Planning Department for new construction) E- City /State Parcel Identification Number 030' )00� i LEGAL DESCRIPTION Pro Location 1 � +, <, S� T�G'v 1`1- W, Town ofl. P / Subdivision , Lot # Certified Survey Map # 5�5��� -� , Volume 41 , Page # 3 a do Warranty Deed # 7a Y U , Volume 2 2 3 , Page #� Spec house 0 yee tee- Lot lines identifiabl�es no SYSTEM MAINTENANCE 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. 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. Itwe, 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 en main ed must be completed and returned to the St. Croix County Zoning Office within 30 days of ee y exp' date. iGNA:rURE OF ANT DATE OWNER CERTIFICATION i I (we) certify that all state is on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope scribed above, b e of a warranty deed recorded in Register of Deeds Office. IGNAT[JRE OF APPLICANT 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 �I U 2 2 6 3 P 6 2 `f R KATHLEEN H. WALSH EGISTER OF DEEDS ST. CROI K Co., vi STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 06/04/2003 03 -gsa WARRANTY DEED THIS DEED, made between Timothy L. Gilbertson, a married person, EXEMPT # Grantor, and Michael Benedict, a single person, and Lisa Koepke, a single REC FEE: 11.00 person, Grantee. TRANS FEE: 277.50 Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE: 2.00 the following described real estate in St. Croix County, State of Wisconsin: CC FEE PAGES: 1 Part of the Northeast '/4 of the Southwest '/ and part of the Southeast '/4 of the Northwest '/4 of Section 33, Township 30 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Lot 5 of Certified Survey Man filed February 27 1997 in Volume 11, Page 3216 Document No. 5560 , St. Croix County, Wisconsin . Recording Area Name and Return Address: Edina Realty Title, Inc. 400 S. 2 St. — Suite 115 Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights -of -way of record, if any. 396810 030 - 2002 -70 -100 Parcel Identification Number (PIN) This is not homestead property. Dated this 2nd day of June, 2003. * Timothy L. Gilbertson * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. authenticated this 2nd day of June, 2003 Nicole Ann Suchy Personally came before me this June 2, 2003 the above named Timothy L. Gilbertson, a married person to me known * Not P ubl ic to be the person(s) wh executed the foregoing instrument and TITLE: ME > S M1%%A dfff CONSIN acknowledged the sam . (If not, authorized by § 706.06, Wis. Stats.) Y) THIS INSTRUMENT WAS DRAFTED BY * lco a Ann Such Edina Realty Title — Doug Berg Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 400 South Second Street #115, Hudson, W154016 1/14/2007 ) (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 WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 ' N � ll 0 2 1 2 1 . � J 608, � s�• This instrument drafted b y Mich y COD) Erickson Job No. Located in part of the NE CERTIFIED SURVEY MAP all in Section 33 J of the SWi and in Wisconsin. , T30N, R19W, Town of St, Joseph part of the SEJ of the NW , St. Croix Count 1 (Rec, LO Co N as 43 9.S8r) C. S. A4 k Nk Corn d) o V. Q� ('G. 9p� � o Sectio a� rl N84 °58'05 436 73 r z oo I U Z N C L L w 33 r 3 L t N CT N � lJl L 7 b a E YI c r 2 N O LOT 5 mz°r m l °' : 1 �� (n Ln 21 .63 Acres (201,731 Sq. Ft.) CN 0 ► C) (nl u I c} CA UI I —I L0 o <j JI I M CL I DI Sr CN 00 ZI APPR T1) 1 VVL L) - F E B? .. '97 • o ST. CROIY. r U n , o O N$ 8 ° 06'0 rrW 460.99, z 4 ' ning and Parks Committee 26 0,75' / If not recorded within 30 days of ` O approval date M ° 1 n, 3 approval shall be L T 4 ,: null and void o 3,00 Ac es (130 S v q. Ft.) z00 e.- _ _c M � lei �l C71