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HomeMy WebLinkAbout020-1395-64-000Waconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION i (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, a 15 04 (t)(m)) Matthew & Ashley Cook OVro/ TANK INFORMATION TYPE N F CTURER b CAPACITY Septic Do Aera H rig TANK SETBACK INFORMATION M®Mm® . e • a PUMP/SIPHON INFORMATION SOIL ORPTION SYSTEM �1 EN Wbth Length r No. Tr riches DIM MS 31 tir S-81 3 SETBACK SYSTEM TO JPIL B DG WELL INFORMATION Ty Of System5 / W r ' l oo 1 DISTRIBUTI SYSTEM 62fs /L TOWN OF HUDSON rw. ELEV ION DATA FS I ELEV 1__.._._ _.- ISsa,6 /(wS.V ) 11196. oo' 1 Iaunt meet I I ) I9111i3 119 0,J— r suHt OutletgSZ AL_ cr 1 CHAMBER OR UNIT S.Z0 E& HeaderlMandti IDistribution x Hole Size x Hole Spacing Vent to An Intake M Pipe(s N pnl Length Dlq Length Die pacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedfTrench Center SedlTrench Edges Topsoil -- Yes No Yes No COMMENTS: (Include code discrepencies. persons pprresseent. etc.) Inspection 01 !�y Inspection #2: Location: 823 HIGHLANDER TRL _�� 1,) All BM Description = �� b lGh►.'�I' _ * ! �, 2.) Bldg sewer length = O r Yee- r 49'r ��/1�r�r ►w�� amount of cover 2 = Plan revision Re ired? ❑ Yes ` No Use older side for additional informati n. �+L Date ins�pctois ignature �r Cert No yB�o,-6M710(R 97)1,.-..L �sc��a� J' � —S� 6..&Wur— " d4 L^� �l"PMG%v� w; l� Jf�7L[[�. obis us u D' a. drMrW,l InatrShy Services DIVLSI0n Way County J L F� L 4822 Madison Yards d i .Q 7 202 Madison' W153705 Sanitary Permit Number (b be filled in by Co.) P.O. Box 7162 W1537 716 9rateT tMadison; LGroiXCo��tY com Permit Application Number �— In accordance with SPS 383.21(2). Wig, Adm. Cade, submission of this form in the is required prior to obtaining a mritary permit NOW: Application forms for snteowned POW are b Address lif diflerat tltsn mailing adNess) i �y� me Department of Safety and PmSessional Services. Personal information you provide maybe used for somodary �� f ►� al J A l�J C4 / I purposes in accordance with the Privacy Law, s. 15.04(ixm). Silts yap/ L AppYw�a lafor=kd= — Please Paint A• Iaf er tlaa Prapaty Owner's l,l� �oblZ Oab - l 3 9s - - a to a Property Owner Malmg A `1�fV 1 1N�� I PPsro{' _ 14. '� Q �%lt 1,01 S W ,, N W -J., Section City t� ^ �ybSbu4 Zip Code Phone Number T� N R I E or W tild IL Type of Blq (check W that apply) Lot a Subdivision Name%% j'� 1__S" or 2 Family Dwelling - Number ofBadrooms �� r r eH 44 1 S « Dublic/Canm ercial - Describe Use Block ity of Dstift Owned - Describe Use illsge of �1kDkCN CSM Numbs Zov�. � �fownof III. Type of POWTS tennW. (Check either "New" tar "Ra}ieemecot" cad other appMcmbie oa Mae A. Cheek olae M: on Mae IL Cotaplele Mae C A-D!14ewSystem System �t)dw Modification to Existing System (explain) itional Pretreatment Unit (explain) 8' Golding Tank Irsl�ironmd t-Grade htdividu d Site Design Other Type (explain) W C. Renewal Bet i of Plumber ' ❑1'raosfer b New PreviorrE Ptxmil N bar and Date Issued R0, 1 IV. Desi� �, �+d) sad Tact ign Soil A�lication gf) Dispersal Ara Pm ( SvcV 0 8�3 1�9Capecity m To�TGallons Gall"j" 8 q71 Tank Infomation New Taira Fiieiaa Tanks Lr c r G. to 9 N N. 0 a Septic or Holding Tank j 1 ;SO j ql t)C t] V. R speauMlYNy Steteaeet- I, the aadereignei. aseae respeellhNy for leadRathae title IFOW S slaws a the aaaered Maass Plumber 'aName ) i aMPRS g y ousyeass3$Cib"961 r�. bk'►�n IC Planbq s Address �(Sbac C � �' Il 1 v 9 Ij V3 b u 1 /� (/ 61 VL CeaatylDepartsaent Use Fee - -r/02 IssuedIssuing S. APPr"� O DisapprovedPaJmi� !" r / 3 Z ❑ Owner Given Remo for Dnatial Conditions of Approval/Reasons for "ap j 4* j^ svmm OWNER: v I. Seplic tanit, effluent finer and L JI�I �✓� s• f dot!'% L('f0/' N a n 4t_ -1 dLspersal call most as per management plan provided by pNtlab�t /!'^K+�'+•'lilrt�-fbv� requirenronts moat a maMMailMd �' "'J"c �r 2. All sMbsck as IW eupl,able todelordtnertcas 5) , Alfas r 004eM eases W Yr snare wa ltarak — s w-1 . " r-r• SBD-63" (R. 03121) 'Picto Mvip NA me ; r11 a-��sl��� co OL C.o �oN 7, 8a 3"���1 a�a,eK T'n)A'j1 N F-- al-In voumeesk L-ic.NPKS aaa4o, &n(A rNaek o? @� kt S% 5ky:1ao.0 ID) I I �-T N (,VP5 1 " b ti� apsPKIZ, M�� y . 1�PS W Ia50 a s ' Sr�'► c�AN k w� Poly�ok �- t 14 I n ", -4 00 YOmV) y �DRoo�1 l rotes P� \° Iq Be T lot MAP NArlie LoPOW $a 3 Lot, boy .7,rn BoumeQs-6p ClC.mpp,5 aaa9ay &mfA n6p-k TP o-(- kt N.6 9kv.I60.0 ----t e N F-- aT4 b`�qS �a hb�, y5� ia�Gl o e� w� Wly�tit Q a o �A l Boo goo rn ypNh IN -GROUND DOSED -GRAVITY DISPERSAL AREA Stepped Elevation Trenches with Quick4 Standard-W Chambers 3-ft Trench (down -sizing credit) IMwln.,1' sOL coves t TYPICAL TRENCH ffs,r CROSS SECTION VIEW (No Scale) 40 Provide minimum 3 ft Highest Trench rr1� Lowest Trench (se applicable) separstlon between trenches. System Elevetione ■ . 9 t0- 5 n, �' V Oft: ft; ft;A Qulok4 Standw s-W wl End Cap (trplrW) (Show location of Inlet / outlet pips oonnectlon on plan vlew.) BAB (tYf►lal) INSTALL PER TRENCH: ```��, Quick4 Std-W 0 20 fP E1lWd entbar ■ =oO 1N + Palre of end an Q a A' EISNpalr m W mm"' n ftoc Maw p■ mmoubmft / rnanear. TYPICAL TRENCH PLAN VIEW (No Scale) JA ■ 3.0 A WPICO "Quick4 Standard-W Chamber (M*4 (mtn by IMl mkw k0mr ft) hatA pwwwn to mnuftftme. MOualbn. ■ Proposed El$A per trench ■ ' tt2 Required InflRMtlon Area ■ "" v A' x_ a trenches = Proposed Total EISA a $• A' Distribution Method: branched manifold E. kA M q a FWDL *clot ftovewr.hPftaK zowr 6 Waaw+w Prafura A 0Vb= 0(Pdkft Ync PL-525 Filter PL-525 Effluent Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16- filtration slots. Like the Polylok PL-122, the Polylok PL525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank Features: • Rated for 10,000 GPD (gallons per day). • 525 linear feet of 1/16N filtration. • Accepts 4" and 6" SCi D 40 pipe • Built in gas deflector. • Automatic shutoff ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 10=1 gallons per day (GM). 1. Locate the outlet of the septic tank 1/16" Filtrate a, Switch domq septa 1- PVC tension Hardie Rated for 10XU GPD 525 Linear Ft. ail/16• Fi)lndan Slots 2 Remove the tank cover and pump tank if necessary. Accept3. Glue the filter housing to the 4' or 6 outlet pipe. If SD 44_ 0 i 6• Pipe the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PLr525 filter into its housing. 5. Replace and sectae the septic tank cover. PL-525 Maintenance: The PL,525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarnt, the owner will be notified by an alarm when the filter needs setvi=tg. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank 2 Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pall P1r525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank 6. Insert the filter mrtndp back into the housing making sure the filter is propedy aligned and completely inserted. 7. Replace and secure septic tank cover. coroner to tMuaat rr0 ��� a.uara 71 Outdoor SmartrilterB Alarm Potyink, Zabel k teat RPoas accept the SurrtFUterm switch and alarm. Car Deflector Anmmatic Shnt-0[f Bell Extend & LokTM Easily installs into emtmg tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Tbll Free: Wn.765.9565 Fax: 203.284.8514 www.polylok.com pm*mftww omuft momr T PVMNIDNNmmr S w► N SAS uIPJol� �Vjsib)ti oao �00 E pvm1 _ Ream E PbtPlan P%e3 Pea gm-:, t page Fftr pawa C8►Taolt F IM P%e s oe.d - �Teat�t�� 't�� M tnsan r�� ST. CRO NTY SANITARY SYSTEM File a "" se only OWNERSHIP/ADDRESS FORM �v Community Development Department will utilize this information to provide the property owner with informmation regarding operation and maintenance of your new or replacement sanitary systeml This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. OWNNt/BUWA INMRMATION Owner/Buyer 1110k Mailing Addri City/State/Zip Phone Numbs Email Address (found on Use properly tmc bill) Property Locations W +/4 1/4 , Sec. e�'S. T N R] I W, Town of (AYES bN Subdivision Plat ce N CI L u�l �1s Lot # Coed survey Map # Volume Page # Warranter Dead # 0 (before 2006)Vokume . Page # Numper of bedrooms 14 Spec house O yes w no Lot lines identifiable ■ yes O no New Property Addrer V�A— OFFKE use ONLY a2 3 f �(4ikf4�1Df� 00 of iMR d new eddais ragLd d fiom Gc5 Depwwwit nor new corshuabn,) This form must be submitted with all Private Onsibe Water Treatment System (POWM appficatrarus. NOW Sys tndude with ttils farm a neaonded warranty deed (ram the Ragkw of Deeds 0&e and a copy of die carEgw survey map if reference is made In the warranty deed. Court Ln* DMIOporent Department— land Use Division 715-386-4680 St Croix can" CwA n ment Cuter 715-245-4250 Fax dd®va 2M• 1101 Carmichael Road, Hudwm VA S4016 wMw vnui nnv VAscomn Departrnem of safety and Probssional Servloes Division of Industry Services Pape 1 00 SOIL EVALUATION REPORT In aooadanos with sps 3%, Wfs. AdM Code county Attach complete site plan on paper not lass than 8 112 x 11 itches in size. plan must hick , St. Croix but not lirrled to: vertical and horiza�l reference point (B11), die[Jiorr and pen0entt Slope, Parcel I.D. scale or dimensions. north arrow, and location and dtetance to nearest road. 02a1395.84-M MMUS - - Plsees print an Infor natfom Revbned by Date - - - �-- uw a 1e. t m . Property Owner �F LAN Mathew 8 Ashby Cook Property Location ❑ G0vL Lot SW % NW % S 25 T 29 N R 19 E (or) W Property Owners INainp Address Lot 0 Block ! Stbd. Name or CSIM 1443 1660 Ave. 64 No P{at of Senic Hills City State 27P Code Phone wwdw ❑ City ❑ vow ®Town Nearest Road ®Neii" Cornstrualon US& ® ResidenlW / Number 0f bedrooms g Cade derived design flow rasa QM GpD ❑ Replaoerllent ❑ Public or commeroal — Deavloe: _ Parent mabrial Glacial potwash Flood Plan elevation if appltable na ft General comments and recommendations: Sib suitable for f "patrnd POINTS with 0.7 surface elevation to be 98-W at cmkxrr 103.5 god/sglll. design loading rate. Recorrrrtentded system infiltrative ❑ Boriup f ❑ 8orag ® Pit Ground surface ebv. 101.45 ft Depth 10 Willing favor �= in. Horizon Depth In. Donimani Color Altrtael Redant Description Ou. Az. Carat Color Textras 1 0-11 1oyrJrJ none 31 2 11-19 10y4l3 none sl 3 19-24 7.5yr4g none pat 4 24-51 7.5yr4 6 note le 5 51-126 10yr418 none a EBoring # Strttrhae Gr. Sz. Sh. Connsislerice Boundary Roots GPDJFF •E4p1 •t: 2f9► dsh a 3kn2c 0.6 1.0 21sbk dsh ce 21irnte 0.6 1.0 lnbbk ds ce tfm[c 0.4 0.7 099 Frill ce lvff 0.7 1.6 089 0.7 1.6 ❑ Bort9 ® Put Ground surface eiev. 100- ft. Depth tow .Wth ftClcr ?�in HorizonDOM In. Dominant Coo Muee1 Pad= Description Ou. Az. Cool Coo Tatdue Strur111r8 Gr. Sz- Sh. Consisbnoe Boundary Roole Soo RA& � •� 1 0-13 lOyw none sit deh cw •Efll2 2knc 0.6 0.8 2 3 13-27 27-41 l0p*4 10yr514 nob none sit 81 2fsblc 1rtte6k ds do m ow 2kn1c 0.8 0.8 tkn 0.4 0.8 4 5 4150 50.123 7.5yr4R 10yr418 more none Is a 0" tlep ml try to 1vf 0.7 1.0 _ 0.7 1.6 • E�9U" a DW P 30 r = n dt. and TES > 30 t Rn w a CST No is Jaynes K �� Print) ig CST Wtartber Thoirripsoin Address s`•—_ 30021 Evaluation Corrducied L10Telephone Norther 3I Boring• F❑pit Ground surface ebv. 102.85 ff. Horizon Depth In. Dm*m t color fAameA Redox Description Qu. Az. Cent color Taxlure smxw a Gr. &- Sh. conewenoe " 1 0-13 10y313 none 31 2fgr dsh 2 13 25 10y►4/3 none 1F at 2msbk dsh 3 25-47 10y1 none sit 2nmsblc ds 4 47-W 7.5y" Osg ml 5 55-96 10yr4n6 VE Osg ml 6 95-128 10yr814 a Ong dl 4 Boring i Boring pit p Ground sauce ebv. 103.721L Depth to muting factor >= in. �- Boundary Roots --- GPDIFtz OEM *01111112 esr 21mte 0.6 1.0 arr 2in1c 0.6 1.0 CS time 0.6 0.8 ua 1vf,f 0.7 1.8 CIS 0.7 1.8 0.7 1.6 Depth W tir1b taetor>14V in. Horizon Depth In. Daninarrt Color Munsell Redw D iColoo Qu. Az Cant Color T� Stnuctae Gr. Sz. Sh. � Boudary SoilRace 1 0-15 t0yw norm s1 2FW dsh ew 'E1R2, 0 2 15 23 3382 t0yM/4 7.5yr*6 10yr4J6 roue noned naa al a Is 2rnsbk 0 9 dsh rnl cw 823-33 84 Cs cs65 82-140 10yr514 none a pag dl Boring i ❑ Boring ❑ ❑ fit Ground surface elev _ ft, Depth torn9 (actor_ bn. HorizonDepth Derninar�t Color Redmr Deacrlption Teactae Sfructue Cerrdmleroe Boundary Rods In. Mmum Ou. Az. Cont Color I I Gr. Sz Sh. Efflrerrt i1 = BOD, > 30 5 220 rrng& and TSS > 30:5 150 rnWL • Effluent R2 = BOD, > 70 5 220 rtglL and TSS > 30 5150 rng/L i IL i �xtOkUet 491960.p py Xrw.l�C�.►•� � syo/Ic 04M0=AO157 t 1 ♦ / f�i ATy�F�oryarSrd ol 1 i i 1 i is e I � I1 ��• � '� �_ ����� ids. 3 W,3 Wvisio of all foes [ 2 liq Division of Indus loss JJ Page 1 of 3 JUL 13 2022 SOIL EVALU ION REPORT Croix County In ance with SPS 385, Ws. Adm. Code County Attach complete site an on 9. 1 inches in size. Plan must include, St. Croix but not limited to: ve scale or dimensions, north arrow, and location and distance to nnce point (BM). 'eaarest road.ion and percent slope, 020-13Parcel 195-64 000 Ref#2688 Please print all info"natlon. Reu(Lwnn hu , r Property Owner Mathew 6 Ashley Cook Property Owner's Mailing Address City State Zip Code ry purposes Priv Law S. 15.04 1 m ( yt Property Location ❑ Govt. Lot SW %. NW %, S 25 T 29 N R 19 E (or) W Lot # Block # Subd. Name or CSM# 64 Na Plat of Senic Hills Phone Number ❑ city ❑ Village ® Town Nearest Road Tr. ® New Constriction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate §W GPD ❑ Replacement ❑ Public or commercial — Describe: _ Parent material Glacial Outwash Flood Plan elevation if applicable na R. General comments and recommendations: Site suitable for In -ground POWTS with 0.7 gpd/sgM. design loading rate. Recommended system infiftrative surface elevation to be 98.00' at contour 103.5' EI Boring # ❑ Boring I ® P8 Ground surface elev. 101.4 R. Depth to limiting factor >126 in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary 1 0-11 10yf3/3 none sl 2fgr dsh cis 2 11-19 10y4/3 none sl 2fsbk dsh cs 3 19-24 7.5yr4/6 none gr sl lmsbk ds cis 4 24-51 7.5yr4/6 none Is Osg ml cs 5 51-126 10yr4/6 none s Osg ml Roots 3fm2c 0.6 1.0 2fmlc 0.6 1.0 1fmc 0.4 0.7 1vf,f 0.7 1.6 0.7 1.6 2 I Boring # ❑ Boring / U ® Pit Ground surface elev. 100.25 ft. Depth to limiting factor >.M inr Horizon Depth In Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary rlor Fo 1 0-13 10yr3/3 none 2fgr dsh cw 'Esil 0.82 13-27 27 41 41-50 10yr4/4 10yr5/4 7.5yr4/6 none nonesil none sil Is 2fsbk 1msbk peg its ds ml a0.83 cw cs t .64 1.65 ` 10yr4/6 nones Qsg ml .6 Effluent #1 = BOD > 30 5 220 a d TSS > 30 1 ue 2 = BOD > 30 5 220 and 1 CST Name (Please Print) ignatu CST Number James K. Thom on .1 30021 Address ate Evaluation Conducted Telephone Number I 3 1 Boring # ® Boring ❑ Pit Ground surface elev. 102.85 ft. Depth to limiting factor >128 in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Ou. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' 'Effarl 'Eff#2 1 0-13 1Oy3/3 none sl 2fgr dsh cw 2fm1c 0.6 1.0 2 13-25 1Dyr4/3 none grsl 2msbk dsh cw 2fm1c 0.6 1.0 3 25-47 1Dyr4/4 none sit 2msbk ds cs lfmc 0.6 0.8 4 47-55 7.5yr4/6 none Is Osg ml cs lvf,f 0.7 1.6 5 55-95 10yr4/6 none s Osg ml cs 0.7 1.6 6 95-128 10yr6/4 none s Osg dl 0.7 1.6 Q aBoring ❑ Boring ® Pit Ground surface elev. 103.72 ft. Depth to limiting factor >140" in. Soil ADDlica0on Rate Horizon Depth In. Dominant Color Munsell Redox Description Ou. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' 'Eff#1 'Ef *2. 1 OA5 1Dyr313 none sl 2fgr dsh cw 2fmc 0.6 1.0 2 15-23 10yr4/4 none sl 2msbk dsh cw 2fmc 0.6 0.8 3 23-33 7.5yr4/6 none Is 059 dl cw 1vf,fm 0.7 1.6 4 33-82 10yr4/6 none s Osg 1 ml cs1 0.7 1 1.6 5 82-140 10yr5/4 none s Osg dl 0.7 1.6 ❑ Boring 0 ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ADolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Ou. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' 'Efl1f1 •ERAr2 ' Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L ' Effluent *2 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mglL / tl� S ♦ r.P •fPrpos�d i i i So,YC✓dL4d" c.,lAdit EX��b�J jvua(c c Ee% 11W 1GG Ai44✓[- /l Wd.;,9A3 As 114, ccr.T Qswi'ynwytr sea: z ,P /9svy 7rh . a/l"Ofsorl, :5*, ISATICotrJ/. rro?a-/,3it5'-69� r� 5borWN VJDAv 4 Assawltd tkr: �/��' 62- 6. 3 VP3 SAN-d_aaa. - 14 w., p industry Services Division CountyIst C r Q r) 4822 Madison Yards Way Sanitary Permit Number (to be filled in by Co.) � �' 1s�� 112022 Madison, W153705 P.O. Box 7162 MAY Madiso 53 /_ Q ma JIL it Applicati $ateTnmpr%iomNumber Comm In accordance wi .21(21, Wis. Adm. Code- suasion of Ibis form to govcmmraW unit is required prior to obtaining a sarritQy permit. Noes: Appliotion forms for stateowned PO%M are sudrnud au Project Address (if different dart nailing address) the Department of Safety aad Professional Services. Personal information you provide may be used for secondary . 4. purposes in awordamce with the Privacy law, a. 15.04(l xm), Sbd& D PrW AS dfir'Mad" L Apweadete InforizatIm - Please Property Owner's Na s�� Cook Parcel H Gao-1 6()o Property Owner's Marlin A 1r Property l p r4 e 15 I Govt. Lot ,. ,Q a S City. Sate 160m 1�'+ zip Code S11 1/ Phone Number o T a q N R f r W Mat Ica N IL Type of Balking (cheek aB apply) �lor2Family Dwelling -Number ofl3gdrmoars � •E` SubdivisionN.me a 1 f llr Block # E)N"ic/Conm ercial be use Ily of e (Tuned - Describe Elster• Hinge of ('SM N �NE JC OFaownof HSO1J. Ill type of rovrrs rer.k ( elMer "New^ or "AcphicessayFinad a& applicabb err Ire AICIliecliltilbillair w thine IL Comwleie lime C it andkow) low A- Sysrem ❑otbQModi to ( Prebdrmeot (end) B- aolding Tank Individual S' Other Type (explain) conventional) C. (renewal Before ❑Revision ge of Plumber to .ist Prey umber and Der learned Expiration %I / 1V. Dhpa=vrrtsttmeat Area and Tank Design flow (19d) ou Design Soil liatiom Raae(gpd! Arm Requmed (sf) 85 Diapasal (ef) 8 Syse® Elevation M 43.0 L 9a.bo Tank Information Capacity in/ Gallons T3W GaJkN N of Units fYI� l/V S u t; Eai 7Nr 1Jcw Tattles 6 J U in .n w C7 Septic orl elW Tank CIS 'i< C Dosing Cbw*w ED V. Aape adblilky Stat4eneat- 4 Me adertJped, awe responsibility for fastialladen •rtae pOWT3 darwa w the attached plow Plumber's Name (Rim) Si ' m b0kk -ekA Iaaa MPlMPRS Number 9 oy Business Phone Number '1 S-3 lr 4 u�i0 PI Address (Street. City. Sate, zip Code) t' b Nw N unsex 5 d VL CNaly/Departo mit IN. only Approved 13 � Permit FeeDate : Ageal S' ❑ Denial Conditions SYSTEM a 3)�¢agp atila�� 1. Septic tank, effluent filter and 11\ n 1_ Or�y{�L 5,,• fly, NtMGe I dispersal cell must be serviced1maintaiaW as per management plan provided by plumber, -io NwexP p LPr I r 2. All setback requirements must be maintained as per applicable code/ordinances. Meta to eaw/YM plea R tea a)Maw r raawrr m eras x my wry w pww w s � • USA a, � = SBD 63" M 03121) T 4 2 Tpwad*X 5wIly N y 5 as Taoy14 uDs-0 L V PMW 3 —Qywbnm mmy a crpB.$eo�i mod_ [ p-W FiRp P�W7 SE Oraie Cb�!MTa# 16 Fq pbge� Dtid _ �8 L'SNtPlef 3oQTeot� }!� p� -P bS 'A NAm-e . MW4 s�,1�y Cook N.W.• `i aar�2c,o M Nome well to is lasogal, o P�lyl,e 3S' " W'sD ,--Ia �+ d4 00 DA' a -�6 K)�s �1Cj �x b A TtW N Y� LI airn �umeesi6l, UcAPRS aaa9ay Sys�Qrn �I�v� H 93,0 6 oor, ■Alt bi"b g1 pot �"pVc F oo.b 1" Pv c z"4LI / S 0 page Of bb ,00 . it 0 I g00lIOb0❑ MI • J. "Al . . . . . . ell. lie C\7 t 44. % F m it 1'00-y. Cis, ;MfisconAn Department of Commerce - Division of Safety and Buildings 1 o"At F SOIL EVALUATION REPORT Papof-3— in so omoanaewrm Gonetr eo, ►vm Porn. %A= Attach complete site plan on paper notless than 81/2 x 11 kwhes in staa. Plan must include, but not limited to: vertical and immhontal referen udtru and percent slope, scale or dimensions, north arrow, a tresrastrosd. Please print am I Pwsafwlirdormalionyou prov""'Yanwar { .•..1� t)cm))•. Coin 5 1, Peal I.D. '-i/ "' %•�'(a Dab % 0 Properly owner jUiv o � 7 tdc.�on 114 w 114 SZS' T2c/ N R /r{ E(wpar Prxpsr 0wrrwesMWkVAd = Blom* Sub&1i. me or Caw City stab_TV Goo P Sri It Wm}er i 1A k . I C-S'a JMJ C3VMW QTown NeamastRow ® NewCane6x*m use®Re.we.w►t+r.,,b.rawar cadsd.rweaaeel�n+lowra� wsdlCco GPD [j Repwoww" ❑ Pubic or commercial - Dsocdw Parent material QUi-LOO-9 h /oZ 7• 40 R General rrcommentsS S �{ II L G (G 110.�.b /� o c n n) �r rry cncommentscomments_ .tr 42-GO and n commendaiorr� *fq 9C-' �j ha,P,.c--3z7Boring S ua Pit Ground silface dev.gs Q 0 a. Depth to tirn*V. *dW I l V —in Rate modzon Depth hr. Dominant Color Muu®ell Redox Devalption Qu- Sz Cont. Color Tteulae Structure Gr. Sx. Sh. Condolence Boundary Roots GPM -EW -M yz ' ©Boring 0 ❑ Borfrre ® Pit Groundstaface elev.G 7- CO o ft. Depth to limiting factor• /Q In. Bop Applicsion Ret1 Hart= Depth in. pon*wdCow Munsei Redox Description Qu. Sz Cortt Colon Texture structure Gr. Sz Sh. C mMence Boundary - Ruda GPDihI° 'M -EW2 1 6-17- 10 ray � SDI Z � � rr'�r' cS I v-I• Li ..fo — 1. Z. EMuerdit=EM a30522DrV&ana Ib.7;'M�IOU "WL onusw.c-•••� � CST Name (Phase Prtrt) Sirellure CST Number er Z5330 Address Date Evaluation Conducted Telephone Number L115 80--! S+. -I —115-2 7— Property Owner ar Kt 1 PefCel ID# �Boring# EkxvQ ° ® Pit Ground sarlaw stay: 9'a• L/o IL Depth b ki.ft bclor I b 1 in. p of Sa Ann —Maio- Rater WAMMMIMEM6 KM . Effluent #1 = BOD, > 30 < 220 mg[L and TSS >30 < 150 mg[L ' Etuent #2 = 0OD3 < 30 nxYL and TSS :E 30 ngll 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 TIY 608-264-BM. raD403.(0.07190) PAGE-3 OF-_ NAME Ay- k e, l I LOW (. Y LEGAL DESCMMONsw ''/..vw S z,5-Ter .NR !a E (wr SCALE: 1"= y0 BM I ELEVATION eW. o BM I DESCRIPTION 46o o.l 1 "puc- proms BM 2 ELEVATION /Od . a BM 2 DESCRIPTION 4o g o. SYSTEM ELEVATION 40( 5'. 00i ...e q y. 0 0 ALTERNATEELEVATION_4csp 9S vv Low+• 4P.00 CONTOURELEVATION f .Sb , so q 7, sg so rc�•�%yN Jam` L I \/ .. Punt 0,&,+ OtAx P � Aciva•f � � N.W.• I ka p •C ST- Z �«,r ,. SANITARY SYSTEM muse OWNERSHIP/ADDRESS FORM C••ftd� Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary systeml This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources Once approved, this completed form and educational information will be sent to you by email- Owner/Buyer 1 ► A Mailing Address _$ City/State/Zip Phone Number (require M_ Email Address (required)_ Parcel Identification Number (found on the property tax till) OMIN9t/BUM INFORMATION �. u-116 Property Locations W 1/4 ,1SW 1/4, Sec eQ 5 . T a N R �W, Town of f; Lou on subditfisia, Plat S«N, N►11s Lot #1�. Certified Sarvey Map # Volume . Page # Warranty Deed # re 2006)Volume . Page # Number of bedrooms Spec house 0 yes 14 no Lot lines identifiable N yes p no New Property Address �4A- (sileff ir��w OFFICE USE ONLY �2- 3 444L"we, T9L . (Veriria0on d rner address required from �As I math zz GCS Department for aeon construction) This form m list be submitted with all Private Onsite Water Treatment System (POWTS) appkations. New 5ysftm Indude with this farm a n0 rded warranty deed from the Register of Deeds Oftice and a copy of the c erred survey map ¢reference is made in the wurranty deed Community Development Department — Land Use Division 715-386-4680 St Croix County Govemrnent Center 715-245-4250 Fax cdd&ilsccwi aev 1101 Carmichael Road, Hudson, VA 54016 QlZLi -MEN ILAN! ,qq . . . . . . . ... 11w row I r^W e ni f sD DESIGN uD I NOTICEI I I ELEVATIONS II P,W IF A1.1 30 01111N LL0 Aiuuenuu Lugo (715)248-3010 w' ..r wr .w n.r .iw ti r a.r M NOTICE rovF�. u. or.+ron. �. wo tourow woMra* �uor rwo� ro ua ewr.e....w.w aR & Ash 1 Bbwy UPPER LEVEL w. w A4 w w.� 0 30 018I111N LLC b 16 u.❑oa Su....I NOTICEI MAIN LEVEL A3 4 I I fir: SO FT 1F %CRES I l : I 1 H I I I — ------- I =1Z 10 Jv r 1 2.186 ACRES 1024.0 I L I H.W.L- 1027A E 2892, r 4D SEMENT UY EACH SIDE OF LOT LINE IS I I SO FT ACRES ; I i I { I I ' WE 295.W : 1 • I l E 250.1 4D I 61 \1 88.947 SO FTC` m 2.042 ACRES F` H.W.L- 1027.7 ;ACRES e�$��. es R / 65 93,959 SO FT 2.157 ACRES 66 : 120,091 SO FT 2,757 ACRES 60 F- ci 0) 72 1 1 � DsvmlvmrtdCornmaoe DCvlaion d Sily and Bul kW SOIL EVALUATION REPORT in aomrdaroe rih Canrn Pm Vim e.a., Pape I or-1- nftm* compete ape Plan on Paper not hm than 8 to x 11 kxtm in size. Plan must Couwy 5 C o i 1 ndude, but not lnAmd to: vardcaf and hor¢onad rafaramh lion and Pad LD. P Now Scale ordirnerriorra, raAarrow. ; dla rreareet road. P10000 print am Pwbmd Di1e kft m *m mar be %mW for . a. 1 3 Pi0pafy Ownwr tt "� II A, �]C J Loation Y` r 1 /we7 V@m C:Ro q Nay GOWI 114 N&4j 19 S Z S T 2 91 N R Lot*-., Mock SW Her orCSW EPmPWtY0W(or� S < < 1 E Sri I l wa i-c r VM ❑ Wage I3 Town Neaeet Road ® New conehuckn Uae: ® Reilk darlal / Nranbar d bedrooms 3 coda aertwd dsW sow rate ySa /G D o GpD ❑ PAPW Mrront ❑ Pul3k or oorrvnacW - Daarrbe Parent malerdal Ou fWo -6 5mdPAKkk4WA5onff aPPfirabls v Z 7 0- R . General and reom mendatione: S%!S ►�L GIG110.f.b/� - fpjo Q —� — 96P 4 3• o o Gow �.✓' ? Z• o o 6 ✓fin d �.24i1.Q/Y�� S�i•vt .I1X-lc�-wtu,._. C'!�-r_- 6a /ik�.c--ftc.�-Q.�I r�i�l�iyv _ +� ❑ E �e a ® ri► Ground aa�am alsN �'/ S 0 O A - mrw-/rr�/w rj, II��_---_ .�, 7i .n. a u... .. • .. _ _ � • MT No. (Please P" Swift" MT Nurnber Address Date Evaluad n Corrdoied Tebphons Number Z113 S1. Sod,, z-� e�v-/-0/ -7rs-2 7- Parcel ID # Page Z of _ 3 Property owner Boring * p Borkrg ®Pit Grourrdsurfaceelev. q�n Depth to limiting factor I C 1 in. Soil ication RaU Texture Structure Consistence Boundary Roots GPDM Horaon Depth Dorinant Color Redox DescriptionSh. 'ES#f -Eff#2 MunsonIn. Ou. Sz Cont. Color I b-I�i I `i — sc-! Z `i rn D Z B • 1 A'J__125�— E Boring El ElBonr+g in. ❑ pitGround surface elev. R. Depth ro limiting factor Sod iration Re Redox Desafption Texture StrucWre Consistence Boundary Roofs GPDIFF Ronson Depth Dominant Gr. Sz re 'Etf#1 'EfitC2 in. Munse11 Ou• SL Cont for 1:1 Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. Sa ❑ Pit Hor¢on Dh fbnrirrant Rector Deaaiption Texture Structlxe Cortsistarroe Boundary Roots eptC in. Munsell_ t1u. Sz. Cant Cdor Gr. Sz. Sh. 'Efi#1 Effluent #1 = BOD, > 30 c 220 ng/L and TSS >30 ` 150 m9IL ' Effluent #2 = BOD, < 30 n-4L and TSS < 30 m91L 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 Try 608-264-8777. SBD4330 (ROW00) Property Owner 4r Kt I I parcel ID Boring # ❑ Boring ® pit Ground surface elev. 9 UD R Depth to limiting factor I b l In. pow L of 3 3• LWAd BOring # ❑ Boring ❑ pit Ground surface elev. it Depth to lirnitkrg factor in. u B0nng # U BwN ❑ pit Ground surface elev. R Depth to limiting factor in. So9 AMACOIJIM Ram Hor¢on Depth Dominant Redox Descroon Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz Cont Color Gr. Sz Sh. 'Effi1 I MW . Effluent #1 = BOD, > 30 _ 220 mglL and TSS >30 < 150 mglL . Effluent #2 = BODS < 30 mglL and TSS < 30 mglL 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. sen-nw Maroot I__ PAGE 3OF_ NAME A r K4-1 l LOT# Y LEGAL DESCRIPTIONSw /.u.1/. S z5-TL4 N R 19 E (or)'* SCALE:1'�= yo BM 1 ELEVATION /60 a BM 1 DESCRIPTION BM 2 ELEVATION /OU • d BM 2 DESCRIPTION SYSTEM ELEVATION ALTERNATE ELEVATION {vp 9Svv (wwr+(q -•tlo CONTOUR ELEVATION QS 7 So 00 B_l J' r aS• 5 �.i gb • 5-0 c �� 11 . 1 elf, ` � �- ,i7„ sue,,, �� C.��%I �Oii(�i/.✓ Parcel #: 020-1395-64-000 02/26/2008 04:22 PM PAGE 1 OF 1 Alt. Parcel #: 25.29.19.2458 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): 0 = Current Owner, C = Current Co -Owner CHRISTOPHER M & KELLIE O ANDERSON 0 - ANDERSON, CHRISTOPHER M & KELLIE O 2405 DONEGAL WAY HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description ' 823 HIGHLANDER TRL SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.259 Plat: 08-076-SCENIC HILLS 1172 020-01 SEC 25 T29N R19W PT SW NW SCENIC HILLS Block/Condo Bldg: LOT 064 LOT 64 2.259AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-29N-19W SW NW Notes: Parcel History: Date Doc # Vol/Page Type 07/09/2007 855268 WD 04/29/2004 760959 2559/418 WD 10/04/2001 658318 8176 PLAT LUU?J JUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.259 86,000 0 86,000 NO Totals for 2008: General Property 2.259 86,000 0 86,000 Woodland 0.000 0 0 Totals for 2007: General Property 2.259 86.000 0 86,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00 ap M m/d �a r p~ � rAra�irir4A W M m� o` m W1A a M auVErac m/A Its A AC71M K MK Ar". "M N NZWK ff. am mwf. . tiwmm/. r°�aei it r.wmr SSE SHEET F OF 5 SHEETS r�cfaan 1UAM sae w�rw�aw b ' wmuawar.a .uwawr�e ,a.Cw[n couN NO. 641980 STATE SANITARY PERMIT � S13 041rxWNZM TR.Le []TRANSFER/RENEWAL PREVIQUS NO. T lo"NO . ♦-� M�I SEC 9T_ N, RI_0& AND/OR LOT &It BLOCK �" _ _ a As SUBDIVISION WISCONSIN STATUTES (a) The purpose of the unitary permit Is to allow Installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specieed period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (1) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. t` Afto%unt"uZE OFFICER -DATE ZS IERMI EXPIRES ISSUING ESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)