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HomeMy WebLinkAbout020-1038-70-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s 15.04 (1)(m)] " St. Croix Sanitary Permit No: SAN 2021 153 State Plan ID No: Permit Holders Name Keith Hussey City Village Township TOWN OF HUDSON Parcel Tax No. 020-1038-70-000 CST BM Elev linsp BM Elev IBM Description Secbon/TownlRange/Map No TANK INFORMATION ELEVATION DATA 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 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg Sewer /• ( (; St/Ht Inlet SVHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Sot. System Final Grade St Cover BEDrrRENCH DIMENSIONS Width Length No Of Trenches PR DIMENSIONS No Of Pits Inside Dia Liquid Depth SETBACK INFORMATION SYSTEM TO Type Of System P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer. Model Number DISTRIBUTION SYSTEM Header/Manifold ID,stnbut,on x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Da Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of >a Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil — Yes ❑ No Yes — No COMMENTS: (Include code discrepencns, persons present, etc) Location: 307 KRATTLEY LN 1 ) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? [ Yes No Use other side for additional inforthaT n. SBD-6710 (R 3197) Inspection #1. ���/�pj.� Inspection #2: 14 Date pgtoes Signature Cert No t ^D _a kb,j G �t/r�y r pry. Wyk lVl i`>—$Rw Q/ i��S f-153 County Sanitary Permit MlicatlGn ST. CROIX COUNTY WISCONSIN In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT Personal information you provide may be used for secondary purposes ST CROIX COUNTY GOVERNMENT CENTER Road SC.N' [Privacy Law S. 15040)(m)) 1 1 2021 1101 Carmichael Hudson WI 54016-7710 1 (715)386-4680 Fax (715)386-4686 Attach coin fete plans for the system on paper not less than 8-1!2 x 11 inches in size - County Sanitary Permh # ❑ Check if revision to previous application 1. Application Information - Please Print all Information Location: I G. 7 Prope wM1rr,�N,,ame`1 _ e X L p NW 1/4 IV N%1/4, sec Ip Z [ 't \ x,)DC, N, R E (07 Property Owner's Mailing Address Lot Number Block Number 3c l ISM-G�t�-iz, Ltd City, St at Zip Code Phone Numer Subdivision Name or CSM Number 11 Type of Building: (check one) ZOA' 1% 1 2 Family Dwelling No. Bedrooms: 3 Mity ❑ Village own of or - of ❑ Public/Commercial (describe use). Nearest Road G ne- ❑ State-owned II. Type of Permit (Check only one box on line A. Check box on line 8 if applicable) ber arcel Tax Number ) r I ax 1.0 Repair ( Reconnection 3 ❑Non [3 Rejuvenation -plumbing A) I 1.1J7O LJ Sanitation B) Permit Number Date Issued State Sanitary Permit was previously issued - IV. Type of POWT System: (Check all that apply) C� Non -pressurized Inground❑ Mound z 24 in. suitable soil ❑ Mounds 24 in. suitable soil ❑ Mound A+0 ❑ Sand Fitter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3 Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6 System Elevation 7 Final Grade Required Proposed (Gals /day/sq ft.) (Min /inch) Elevation 760 9S, y(� 99 VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- "a Steel Steel Fiber- Plastic Gallons Tanks Concrete glass New Existing Tanks Tanks ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement I, the undersigned, assume responsibility for repairrreconnenction'reluvenationhnstallation of non -plumbing for the POWTS shown on the attached plans A license is not required for terraldt repair or the installation of non -plumbing sanitation system Plumber's N me (print) PI 1�l Plumber's Sig stamps MPRS No. Business Phone Number 2313L[ tp 15 2-26(0 Plumber's Address (Street, City, State, Zip C t\3 o L(1y 5�rtiarc z �vv wo SL III. County Use Only Disapproved Sanitary Permit Fee ate Iss ad Issuing A rrrrrr������tttttt������ ignature (No stamps) Ly Approved Owner Gwen Initial Adverse [Determination �J Q r o �7 C �f 6 Z I G- I 1` X. Conditions of Approval/Reasons for Disapproval: !n'') r— 3 /2eLokW1-eCr et`Pt' 1 T- rO tonh-�- -- n et,.f CS' r��,., 1.SYSTEMOWNER: r !- 1. Septic tank, effluent flier and �•tlJ (ita.e, � 2}(N S(-tYw dr0OtM f S'Yr dispersal cell must be serviced 1 maintained �J as per management plan provided by plumb()Q>(Jtd( f�i) 4-'OVIll 5'1 A;4-, V1L4l'14k K6LV)L{ 2 All setback requirements must be maintained pp as per applicable code ordinances /f'L Y-o �O (�olC e r 17/0 W k"t(- Rev 8/05 Pelke Plumbing & Well Drilling, Inc N6298 State HWY 25 Durand, WI 54736 715.672.5266 Fax 715.672.5267 Email: john@pelkeplumbing.com St. Croix County Zoning 1.101 Clarmiiichaei RD Hudson, WI 54016 May 4, 2021 RE: Keith Hussey — 307 Krattley LN Hudson, WI 54016 To Whom It May Concern, I have verified the existing -'stem is capable of hgnrllinaa tho prn'nngnii ;ua�4c �;iatnr flour an�j containment load from the structure to be installed. The system is functioning properly at time of inspection and is not failing. The new structure meets the set back requirements. Pelke Plum ing & Well Drilling, INC John Pelke— MP231346 i (\v �LJe �Soposa 3-br- it C- \ Ke,--\ )Auss-e-/ �e �Gnhccf' 3 — iOD �remc�,es Wisconsin Department or Commerce PRIVATE SEWAGE SYSTEM urLty' St. Croix Safety and Building Division . INSPECTION REPORT Sanitary PermilNo: 363854 C GENERAL INFORMATION (ATTACH TO PERMIT) State Plan to No: Personal Information you provide may be used for sewndery purposes [Pnvacy Law, 9.15.04 (1)(m)1. Permit Holders Name. City Village X Township Parcel Tax No: Keith, Hussey Hudson Township 020-1038-70-000 CST BM Elev' Insp. BM Elev: IBM Descnption SectioNTowrVRargelMap No: 00.OrIwo, cd-q�- P, wti#1 c4a, 18.29.19.161B TANK INFORMATION ELEVAT N DATA TYPE MANUFACTURER CAPACITY Septic C-6KS 1� sr�rz w 6-61LS �o Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BL GG. Intake ROADSep c�$/5 r ]Ventu .7r0-Z ?S� �Jr� Ot � Aeration � I I Holding PUMP/SIPHON INFORMATION Loss ISystcm Hoad INFORMATION Zs+ 25-1 i 401 DISTRIBUTION SYSTEM STATION I RA HI FS FLEV Benchmark Alt. BM Bldg. Sewer SUM Inlet ;•8b r as.85- SuHt Outlet 15 B ttom�i g, 9S-z I' Header/Man. 20 Dist. Pipe I 'T-o 5 � \ 1 rj.yo a, o J Bot. System U !o•(.Z (o•ro7 g3.o3 Final Grade n..riobw+ - St Cove Yz y,yz r CM z3 z :�s Pits CHAMBER OR UNIT Header/Manifold tl Distribution Ix Hole Sae Ix Hole Spacing Vent to Air Intake Pipets) " 2- 6' Length Dia Len Die Spacing )V IL t.V V CR x Pressure Systems Only xx Mound Or At -Grade Systems Only Mpin Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched 3ed/Trench Center Bedlrrench Edges Topsoil - -- „� i r' '� Yee LvJ No I L_ Yes �l NO COMMENTS: (Induce code discrepancies, persons present, etc.) Inspection #1: OS-/ (31 / c!o Inspection #2: ---F --- 7= Location: 307 Krattley Lane Hudson, WI 54016 (NW 114 NW 1/4 18 T29N R19W) NA Lot Parcel No: 18.29.19.161 B 1.) Alt BM Description 2.) Bldg sewer length = - - amount of cover = 3) 5�"y�e�ww� orla"—ss G Lei ' 1- t CSTa+.�a--� i+ta'I�rs.iltA� t?oll� CA:1�j't' t" k 4 luoGTcW.y niS�u.a •VSJa iu Mt �..i7LL Plan revision Required? Yes No U=eDtheri.5ide jor additjopal�inf rma n. ('t'"Q� f!l_ 1 I`•�3L'V— - '}B)trW )4(R +kS 106! © A _gyu A 7 �sepclWs Sig_ _ _ n �,. a *T _ Cer1. No. 5 0.6710(R. 7) �dLi•fMM11.V ��/ MiOMMdatipct ignatu '� u++ lt�.M�'QYiu� • w- Safety and Buildings Division SANITARY PERMIT AP CA ION, 201 W. Washington Avenue Lmnsin " - P O Box 7302 Department of Commerce In accord with Comm 83.05, 1r \ f Code .A' Madison, Will 53707-7302 Or Attach complete plans (to the county copy only) for the systo-, trt1 paper'r1 E§[ County', than 8 1a x 11 inches in size.y) • See reverse side for instructions for completing this application State San Lary Permit Number a 363 ?5 Personal information you provide may be used for secondary purposes , -t ' 1:,� Mr, }r ❑ Dui it revision to plevlwa ePPUcatnn I D. Number [Privacy Laws 15.04(1)(m)) 1. APPLICATION IF M TI N-PLEASE PRI T ALL I T MKeRllan �—' Property Owner Nam. / _ I v - % Pip._ 1 Msfin I% 'ir4- �' ! 1;d', S /�• T .7 , N. R/ E (o W Pri erty Owner's aihn dress Lot Number Block Number _ - City,Start el1 l_-I Zip Code Phone Number Subdivision Name or CSM Number 11. TYPE Of : (check one) ❑ State Owned / ity Li VIIPublic Nearest Road 1 or 2 FamilyDwelling- No. of bedrooms ]f� Tolwn OF I �J III. BUILDING USE: (if building type is public, check all that apply) Parcel TaxNumber(s) / r2 1 ❑ Apartment/Condo 0_a _ c fl- a�`) - t 47• G r7 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel / Motel 9 ❑ Office / Factory 13 ❑ Other: specify IV- TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) ). ❑ New 2. Replacement 3, ❑ Replacementuf 4- j 1 Reconnection of 5. ❑ Repair of an - System --- -- System Tank Only -- _- - _ ExistinQSystem ---- --- ExistingSyystem ------------------ B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11❑Seepage Bed 210Mound 30❑Sped fly Type 41❑Holding Tank 12-JaSeepage Trench 22 ❑ In -Ground Pressure 42 ❑ Pit Privy 13 n Seepage Pit I / 43 ❑ Vault Privy 14I] System -In -Fill 3 lco VI. ABSORPTION SYSTEM INFORMATION: U qr. Y( 1. Gallons Per Day 2. Absor Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6 ev. 7. Final Gra g bev H 1r QQ Requ1'� C(sQ. ft.) Prop j ft.) (Gals/d y/sq. ftJ (Mi /inch) S M �9 U(sg. J V (j Feet eet VII. TANK INFORMATION Capacity ingallons Total GallonsI # Of Tanks s { Name ' laru.a.turer;h Prefab Site Sreel Fiber- Plastic Exper I ADD. New Ex isti I Concrete) suuaeo I glass Tanks Tanks Septic Tank or Holding_ Tank :>l .Qt� 1 W& • d ® ❑ ❑ ❑ 1 ❑ ❑ Lift Pump Tank di hon Chamber ❑ I ❑ I ❑ ❑ ❑ ❑ VIII. RESPONSIBILITYSTATETEt4 yf p,:r AKA)-,"5 To bp bory e%+f x,)m� 1, the undersigned, assume responsibilit4 for installation of the onsite sewage system shown on the attached plans. Plumber's Namerint) / Plumber's Signature: (No Stain s) MP/�Mj PRSWNo: Business Phone Number: Plumber's Address (street, City, State, Zip Code): ,/�y / IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee onciuots Groonewater a e 69ue ISSUIn Agent Signature (No stamps) App roved s"rcha,ge f ee) ❑ Owner Given Initial �eL��t -62D0 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS DISAPPROVAL: -FOR 90"204(R. 4100) DISTRIBUTION, Driginal to County, One copy To SabtyaeuiWugs Divuwn.Owneq PlumMr INSTRUCTIONS 1. Asanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary_ Permit Transfer / Renewal Form (SBD-6399) to be submitted tothe cou niy prior to instal at: on 5. Onsite sewage systems must be properly mainiained. The septic tank(s) must bepumped by alicensed pumperwhehever, necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. � I • -• - - — • - - - I I. I .. To be complete and accurate this sanitary permit application must include. L Property owner's name and mailing address Provide the legal description and parcel tax number(s) of where the system is to be installed II. Type of building being served Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is public, check all appropriate boxes that apply. IV- Type of permit. Check only one on line A Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on syster type VI. Absorption system information Provide all information requested for numbers 1 through 7 VII. Tank information. Fill in the capacity of every new/orexistmg tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for a//septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR VIII- Respon6hllity statement Installing plumber is to fill in name: license number with appropriate prefix (e.g. MP, etc.), address and phone rwrnber Piunlbenmustsign application form. IX. County/ DTartment Use Only. X. County/ Department Use Only - Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the foll'o�vfng: A) plot plan, drawn to scale or with complete dimensions, location"of holding tank(s), septic tank(s) or other treatment tanks; buildina sewers; wells; water mains/water service; streams and lakes; pump or siphor tanks, distfibution boxes, soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil teat data on a 1 1 S form; and F) all sizing information GROUNDWATER SURCHARGE 1983 Wisconsin Ad 410 iric)uded the creation of surcharge (f=esj for a nur^ber of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. O y -t�1,wrcl,S 3Xt��1 1 oven )Uo lye' PRVV4 IINQ • �{�` ✓�+B� i PrcoP II�+i WeR lw 33 3 p a� DQ' to d8'. o aouy,i kPr r_ O 104E P�JIpQI11C .��� DDQIeAO BM 1- toy o{ S�P;n 1.a,d„ QM]= T,? of Dooa -TA�b '1 u � i�laN�oUP� , V =[36R1 �ot1J D I R � 1 V e �.T10h TRoN ��S �1 ti aI ��,oP� J ry gS,gc if 4.4 � 0C� a �• `°`'o t5 .— c oEcb io .AAkl� X In I SOIL AND swezvALUATION in Oooad with Comm 63.05, Wis. Adm. cods -i sbrFlag mid APPLlCAWT ffd;ORMA7M - Phrase pdw aU kr*mn@mnn. Y �r� PSW l of 3 By lCWM Gat Lot NW U4 NW 19 S IS T 29 NA 19 W Pq"OwnWsMoftAddees lot# IFw* t 1Swbd.Mw". orC'S1W 307 Kfatillby 1 Stmb ❑ Clq ❑ VI—m [RTown ]lowest Read Hodme W1 54016 386 415 If I i [Gsaley [.tee .pJ New Co mbodon L/w N ResidmU / Nunbw o(Wdloms FWddon b ea ft 6nidip ❑Rep[aoetaett ElPubicoreonumialdesmbe AmlaDwkvt4ddy4ew 450 ipd I oatendeddesileloadnprale :5 lvdll`—S_feeodk9vt�' AbsmOm am tegt* n %0 bed. ftr 750 kwdL IF ibmun dmsipt ba*0 rye .5 - bed. WW6 trick Spy` Ri6or7iilrll5fl'fI01INdC@tl19iiN<d11js? q(St IANIYtifMl'SMEEpTfi151111Y AdtiionaldWpllskwmww* 91, Parent material Locss Ova Glaaal OutWash Food Plain elevabon, ll aookcable Na ft J titwtade forSYSISMc «wenwocut Wucd YtGcound PwAtie AT Grade FiddiwS TaNc System n Fill forsysiorn ®SpU ®S❑U ®S❑U I ®SpU psou I ❑S®U BMW I kou d AM lazM A wpm b M ft KAN s120 i) laid' Aew Tag I� epm b ON >122 Fiamatt 000 in. t7odm*Caoior Morsel moon OIL Sz Cat Color Todwe 56trebae Or. SL Sh t Boatdary Rats C;PQA1' 1 0-3 7.5yW6 s 038 mi ea 2f .7 i 8 2 3-41 7.5yr5/6 _ is 2wsbk MM& cs if .7 `: 8 3 41-73 7.5yW6 059 as - 5 6 4 73� 1 7.5yt' 4 `d Y . C>< - 7 5 U-120 7.5yr5/4 _ cs _ _ 7 i 8 IrwllgrJ, urwa aq ua •JrI'tl7 "AI Y..wiai /.7Yr7r0 1 0.7 7.Syr4l6 - ' is 2m" mv& cs ' 2f .7 .8 2 7-29 7.5yr5/6 - is 2msbk mvfr cs If .7 i A 3 29-45 7.5p6/6 - s Osg ml a 8 4 45-71 7.Syr5/6 _ s 099 nit C& - 7 8 5 71-W 7.Syr7l6 _ fi 2msbk mvfr cs - 5 i .6 6 W-i22' v5yr7/4 _ s ' pr{1 nil - _ .7 i -8 ctk `t;.,rJ = I-, Tbm Pmq .e Twlsphwe lb. 71KMW (., mcb m �� ...�--� 715-2A6.24i4 - - A&bm LvimmmwByD=*m Dais mymmAa-�._..-..R, x 143212D& So=41Vw RicbmnncLya 54417 > 12115/jm 227357 Z92 t i II i i .... 11111111 ............................... ..... 11- t i er .Vill-Is m _r J yF' 0 r pr ..., � J....V.. J I ..... ...... 00 P. Cr GO CO Ce 77" � q 4 ,. Q INVIPORAFSTAL gY Pf%K 1432 12& STREET, NEW RICHMOND, WISCONSIN 715-246-2454 Tom Nelson Caged Soil Tesw 227387—Rc"cmd Sanitarian SR00713 •airrr ps HaaragaN/HpgN aaarr Ha q ra�arrttrrl rtiirsaaarrr sta 91 1 oa. 3-� 61 1 00.70 Q$ 9q 55 Kie.kl, 14,.,s s fDGn S l rkem Ve- 3(" irk+cy Lkne_ t4 ti4Qsvn w ( 5,40iL SCALE 1 B DM2 '"P YSI of (an�anc, Top of dlooa , 6 z.iav 100 Tom Nelson ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT - AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address (verification required fWm Planning Department for new construction) City/State i Parcel Identification Number L LEGAL DFSCFir InN Property Location I L- %., Y,, Sec. —IL, TAN-R i c W, Town of ii L i ; c • / Subdivision , Lot # Certified Survey Map # Volume . Page # i11ra„anty Deed #.. _j .- y,_' volume Pa6 # x Spec house O yes $1 no Lot lines identifiable ❑ yes 0 no SYSTEM MAIN ENANCA 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 a_ff tot the R•�lion of the septic tank as a treatment stage in the weals 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, matrictedplumber or a licensed pumper verifying that (1) the on -site wastawaterdiRmW system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 fall of dodge. 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 Wiscomio. Certification stating that Your septic rj—�— has been maintained must be completed and rammed to the St. Croix County [,cuing Office within 30 days of the ym expiration date. / /'go A OF APPLICANT ATE OWNER CEMUCATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(g) of the property above, virtue of a wa. ty deed recorded in Register of Deeds Office. f f F APPLICANT A� •a.a.s Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. include with this applkation: 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 W*00%ein DepaMierit of commerce .Divisaof Safety and Buildings Attach comwdCde site Plan on paper not less than Include, but net limited to: vertical and hor¢afdal percent slope, scale or dimensions, north APPLICANT INFORMATION-/�PTgsS Personal into moon you pnW1e maybe aer SOIL AND SITE EVALUATION in accord with Comm 83.05, Wis. Adm. Code 11 incites in Size. Plan must v4gL nt (BM), direction and pc4tim distance to nearest road. jet pqp I R. �iqubps (Pilyd�y .9. 15 04 (1) (m)). Property Owner 1 Keith Hussey ^ Property Owners Mailing Address o vv 307 Kral ley Lane _ cOUN r° City - - S we Sip cvdi t'�ii(dPoer Hudson ,54016 715-386-841,' Page _1 of 2 &C.E. Soil & See Evaluations County St. Croix_ - Parcel I.D.# 020-1038-70-000 M#18.29.19.16)B •. rmyo,p www., Govt. Lot NW 114 NW 1/4 S 18 T 29 N,R 19 W -, Lot # Block # Subd Name or CSM# - - — 1 [ I City II villa-0 EjTown Nearest Road ky - Iatle F New Consbuction Use: Residential l Nurrker of bedrooms 6 ` (Addition to existing building E Replacement G Public or commercial describe Code Derived daily flow 900 gpd Recommended design loading rate • 7 bed, gpolft' .8 tretch, gptlllP ;4bsoro!loop area requirem1296 brld, ft2 1125 trerI&,, fla Maximum design loading rate .7 bed; clodr __ .8— trench, 9Pd» Recommended infiltration surface elevation(s) System installed at 93.03'. ft (as referred to sRe plan benatmadc) Additimal design I Site Considerations Soil evaluation to determine suitability of soils to a depth of >W below system as installed. Parent matadal Glacial outwash Flood plain elevation, if na ft S=Suitable for System Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U=Unsuitable for System S U j S❑ U Li S O U E S L- U ❑ S �] U ❑ S U Boring# Ground elev 100 12It Depth to limiling factor > 124' 2 Ground elev 99.81 It Depth to limiting factor >120• Depth uominant Color i Mollies Texture I Structrlre iCorss;ten Ba ndary I Roots ' GPDH!' Horizon In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0-5 10yr3/4 None Is fill Ogg ml as NP NP -- --- - 2 5-17 7.Syr5/6 None s i Osg ml es I - 0.7 0.8 d —. 10yr5/6 None s � ml es -- _- 0.7 - 0.8 3 17-44 1 _- — 4 .4-91 - 10r6l4 None s Ogg ml cs 0.7 0.8 --1 None — s + --- 5 91-128I 10yr5/6 None _ s&gr Ogg ml 0.7 0.8 � � �S-oG� (Z1 •� rz n rke- Horizons Om Ifs at 8-1 1 0-7 l0vr3/4 None Is fill Osg I ml 2 7-21 1OYT4/6 None s Ogg ml 3 21-48 7.5yr5/6 None - --- s _.i Ogg -�_mI 4 48-90 10yr6/4 !, None s Ogg I ml 5 90-120 10yr5/6 None a&gr Ogg L ml .5yr4/6 Osg s._ lT l; D cs 0.7 0.8 cs 0.7 0.8 cs 0.7 0.8 0.7 0.8 CST Name (Please Print) Signaturk Telephone No. James K Thompson l„q„d — 715-248-7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake bane, vsceoie, l't t o4u"2"v 6/2'00 3602 1254 Owner e/I Assel. 30 7 Aia-&/eY Ln. fiudSon, we. 6-401b EX%sEil We�L v 0 r----I 1 ewe"� fe5,dence mare,TcP of �w'� nnc,:'ng. Rsr�,ntd cle%=p0.ld, 81 !/ rd. B• 3 • -ct.d-2 op� rif' S!o ` 1 S�oC .5/otag / SE 5ys6.� /oco ee &*I f 54:ioAser'4z by r,,, /IC.(Sor) E�n.From�la�lei-cJo�'��'%td w� Son, fa y ,o O(, 4 a 3�385 411 &e Lmcs > /m,• Q^;S;nyr 8rao% !educed by-8 0E e/eda-&m zo,/eualrgoris. �V.4 of Tom+ KcLso» u,//a% ,Q,-' 0,1250 05 Parcel #: 020-1038-70-000 olrzonoPAGE I OF 1 '�. i OF 1 Alt. Parcel #: 18.29.19,161B 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map » Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ' = Current Owner " STRUEMKE, DANIEL J & KEITH HUSSEY DANIEL J 8 KEITH HUSSEY STRUEMKE 307 KRATTLEY LA HUDSON WI54016 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description 307 KRATTLEY LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 13.550 plat: NIA -NOT AVAILABLE SEC 18 T29N R19W NW NW W 706 FT OF N 835 Block/Condo Bldg: FT Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 1202/118 WD 07123/1997 6371404 LC I07/2311997 07/2311997 434/21 2004 SUMMARY Bill M Fair Market Value: Assessed with: 47899 316,600 Valuations: Description Class Acres Land RESIDENTIAL G1 13.550 104,700 Totals for 2004: General Property 13.550 104,700 Woodland 0.000 0 Totals for 2003: General Property 13.550 104,700 Woodland 0.000 0 Last Changed: 10/26/2001 Improve Total State Reason 140,200 244,900 NO 140,200 244,900 0 140,200 244,9W 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 120 Specials: User Special Code Category Amount Oi 8-RECYCLING SPECIAL ASSESSMENT 27.00 001-WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 27.00 00 0.00 CERTIFIED SURVEY MAP LOCATED IN PART OF THE SW 1/4 OF SECTION 7 T OF' THE NW 1/4 OF SECTION 18, ALL IN T29N, R19N, NUDSON, ST. CROIX COUNTY, WISCONSIN. OWNER LEGEND NILBER CASPERSON • 3 611 IRON PIPE FOUND 1D13 M. Mertyl St. i Stillwater, Mn. 55082 211 IRON PIPE FOUND- • 1" IRON PIPE FOUND O 1"x 240 IRON PIPE NEIGHING 1.68 LBS per linear foot, SET. SECTION 7 NW CORNER SECTION 18 ��QQ------48605710311E COUNTY MONUMENT N 1/4 CORNER SECTION 18 SECTION 18 COUNTY MONUMENT small tract N8904914911M 703.671 (recorded as 7061 IRON PIPE IS 1.261 NEST Of COMPUTED LOCATION. n J O O H this instrument drafted by Douglas Zahler job no. 78-91-186 \`_ 661 PRIVATE ROAD \\ 1 e 71 w N630161574 3.521 10 c W o DETAIL �t tip? 16611 M8905414111M --i 1 •1 237.871 1 (recorded as 2381) �I J( '7 13 < LOT 1 803,321 sq. ft. (18.44 acres) a C.S.M. V. 5 c a P. 1442 0� n N� N r. 0 N O J 0 O 0 z o - o DETAIL O N O ti N a° 1 south line of the N 1/2 of the NM unplatted lands owned by_others J St. Croix County Zoning Thursday, January 20, 2W5 at I2, 09:04 PM Detail Sanitary Information Page J of l Computer Al'. 020-1038-70-000 Sub/Plat; metes & bounds Section: 18 Parcel 9: 18.29.19161B Lot: TNIRNG: T29N R19W Municipality: Hudson, Town of CSM: 114 114: NW 114 NW 114 Owner. Struemke, Daniel J. 307 KratBey Lane Hudson, WI 54016 State Permit: 363854 Issued: O5/085'000 POWTS Dispersal: Non -Pressurized In -ground Permit: Replacement County Permit: 0 Installed: 05/09r'000 POWTS Detail: High Capacity(Infiltrator) Bedrooms: 6 WI Fund: No POWTS Pretreatment: Unknown Notes Inspecto_ As Built Plumber Other Reeuremems Additional Notes Money Owed Kevin Grabau NA Boumeester, Jim 13.55 acres plus acreage in sections 7 & 12 $0.00 Signed Off: Yes Maintenance Sche led Pump Date Pumped 1 st Notification 2nd Notification 3rd Notification 51W2003 1 vratea., ma 7ffAI tMTA r1.nlEalAtLLlp)AkY 1r_^NPROV[0 6Y ARno'MYP 1D y1![1VP C UEYM%IAfMI YMk BnY9�Ml'hOfnM TkSCOMBM IgYlS. ' wsCON;IN_H9ME�WC :leasgwcavafflt -.- ct.n_o:ec •a oexeUe•asaEer>EcoasraucTan •,•- _..^ ppawrUevsrrccisr• -' awnlo .�• M • YCYa.IAM sr - ct:9C.15TROOMP1M1 9SNT (TNUVL Pppl a'14 W9T. YN18BEY ^NE: 919' 1' � tOGTION f111D90M Y1 Zi RVO M I. IU NPR l . tOAMLRf a1M �M 110P !O� M' MYl IdIGRM I.MP MIO i . M>,sna a w 11M iauvesm >o w4ue TM* as aolut tafrnwa.�P, Kn meoe rAe m K Innnor V Ale rwN wsnlR x wn I ' i ' 1 �� i ' - IM'IIIIPI MRIPIYWW. QYY$. � M. IIE11f Y00l1fG1 91bAW, ) � aaaaM4 44AM- f;Ablf, lelaall Pn011rinnl mIM. 1tlt MI .M' in'E Iel'BN 1 � 'f �' ! % . � i 1 • raaMOY M M NnRb fpflOO M WN le6i i wo IK rowm . / r%.; i . / ; aRs. IaaYm Pna.s f.l � a Zlllnas ti FK6�rID <>rr IRB 00T+ 1¢T/Rlf IWIW � I,P t ! o-ietif/ r � � I I puW10 Ib001a Yb,C.fO IUOIIeO fbi0i10 MAeC epgi IOe�P9 ' � I�naaw IWM1L f/rVt ItPAe'D al-m n m.oe S AWM can ronefl on-airt nr IAlun 1 I{ 1 I, 1j Tww sA[11 � - Ilwla Irn .. I r I tt IlOA1 YYIMa[ t// 41 ICGNfP� (�]011�� IaOR R MfYMlll r016 NC YM IN14:e0 W�ft M OiNlt Q MWM Nn :.1pli ffpYY�af: .............m _.. ��.,..rw.....g,....... v..-..ter - .... ..-.� w 425 w fw gr ,'zmx 3eovucwufFn �OE6C .. ` , . ... �._aHc, w, /n r,>Fxtri•�Ei�uut wn,iHuclioir CU9T - . .` y _ ......_� . _ • . ._ auun�er sT WI - 1 - 8421 6656 A31 YMWIEtDf �I NNY FIXMDATgN PLAN B_SNI CRAWL, PITCH 4/" HUSSEV ., _ t9CNE 3ry E"-V EREWM312NVt0 LOCATKIH MUOSOH _. 1 .,. .�A ^... ,..... _ S! ` 1 V —Zoz 1 P REPAIR ❑ S Tt CR OIX CO UNT Y N O. STC - — REdbNNECTION $ /� NON -PLUMBING ❑ " TATION t T� R Y PER MIT REJUVENATION ❑ V �� , I Frejuvenatlon, The purpose of the sanitary permit Is to allow repair, reconnectlon, OWNER 1e l/hl, or Installation of non -plumbing sanitation as described In the lication for permit. PLUMBER (b) The approval of the sanitary permit Is based on regulations In force on LAC. # 2313 k4 the date of Issue. TOWN OF glUdso V1 LOCATED ,VW & YW Iy SEC AND/OR LOT THIS PERMIT EXPIRES POS 18 T Z1 N;R BLOCK SUBDIVISION The sanitary permit Is valid for 2 years from original date of Issuance r be renewed for similar periods thereafter. Application for renewal shall s through the county and shall comply with regulations In effect at the Changed regulations will not Impair the validity of a sanitary permit until time of renewal. i Renewal of the sanitary permit will be based on regulations In force at time renewal Is sought. Changed regulations may Impede renewal, The sanitary permit Is transferable. A sanllary permit transfer shall be ned from the St. Croix County Zoning Department. If you wish to renew the permit, or transfer ownership of the penult, contact the St. Croix County Zonino Dennrlrn oM AUTHORIZED ISSUING OFFICER - DATE 7 / z ( I Zp� 3 UNLESS RENEWED BEFOR THA DATE 7 ORIGINAL DATE OF ISSUANCE IN -PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION