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HomeMy WebLinkAbout020-1356-26-010 0 a : ' ° $%7!k k M ' : ° 1 � k_i ƒ m(( 5 z C3 k o # 8 i E[ §) g %- Q e _ $ w § E £ = e } ® q x i § 9 \§§/ k i i CD § o\ k ) 8 B e 3; r@ a C - &§$ O � 3 % E � &� � � � E � E c 0 © } / / / CL �� t , w 2 $ _ _ C § / ] 3 \ § 00 ® � 0 0 o m § §§ f 8 E q / 2 2 $ § o c � co §� ■ � � � 0 0 0 �- %/ Oro [�/ 7 � m to c 2 N § © C 2 2 a k \ E 0 k k aa- » f 2 2 k � 8 8 0 E :3 m m§ 0) a) , _ W 0) g m m i Or o CL 3 k � cn / z E CL @ 2 . ■ T Z « E § 2 § § $ � / z � ! a2CL (D § q k � } gƒ OR , §�ƒ £ � f$ E_E 7 U 2/ B � \k ) §[ o \ < § D E o } 8 E % MAR 1 a ` VOL 78 PAGE 4689 KATNC1rM H. MAL - AL -- REGISTER OF DEEDS o �r P�� , � 5T. CROIx co. wI RECEIVED FOR kECDRD ( tl ° �m o o Z 01/21/2004 02:30PM � � z o cn N m a°v .�.� CERTIFIED SURVEY MAP �a z 2 IYI REC FEE: 13.00 b m g y � ryn' Fn o 0 q 0 N COPY FEE: ° m 5 o z E c 0 „ PAGES: 2 z N v� v� C7 f7 ���a�\a�0 c�F - z�r1r z �o x-+(na x ° m 00�2��ady0 �`6 vmmmz v yc c ,� °Drm- g O �i ran j w E � p 6 ,°' / � S z z z z % _ m pp {� s 0 O �3 ✓�� 'A` �Z$CJo�� I 33' 33' sv ` i 8 6' Z ;r cn z > m mm! nzD m � ,� I I ZpT z cn z ra iON UZ)Z ♦/ Q C2 m ?T � / z o o co_ ;= is o o =ff -- J n m r- rr � i j "� m z cpw m 79.02' 78.02' 80.02' 9.02' 79.02' i rrTl � cn ---0 N38 °50'40 "E 395.10' i r) :7 z I O C> � RI in �� OR I v m O `� \ �mzm `Q8 —1 id p p 2 u, N ° -„ i rn G)° m m v \ VMT1 m S+\ N a z z w v c -i9 �9S 9$E 0 C slow 0 200 m �c, c " V) ^��^ r 1 C cg: -! " N SHEET 1 OF 2 SHEETS V01.18 Page 4689 Parcel #: 020 - 1356 -26 -010 01/15/2010 11:10 AM ' PAGE 1 OF 1 Alt. Parcel #: 14.29.19.2088A 020 - TOWN OF HUDSON Current 0 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 01/21/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner 0 - SMITH, JOEL A & JAMIE L JOEL A & JAMIE L SMITH 721 PAUL BURCH DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 721 PAUL BURCH DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.105 Plat: 4689 -CSM 18 -4689 020 -2004 SEC 14 T29N R1 9W PT NE NW & NW NW GRASS Block/Condo Bldg: LOT 1 RANGE 2ND ADD'N LOT 26 (2.967AC) NKA CSM 18 -4689 LOT 1 (3.105 AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 14- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 05/18/2005 795306 2805/177 CO AFF 01/21/2004 752316 18/4689 CSM 01/19/2004 752077 2494/88 WD 05/03/2000 622334 1507/498 WD 2009 SUMMARY Bill #: Fair Market Value: Assessed with: 27256 323,700 Valuations: Last Changed: 05/07/2008 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.105 79,400 236,400 315,800 NO Totals for 2009: General Property 3.105 79,400 236,400 315,800 Woodland 0.000 0 0 Totals for 2008: General Property 3.105 79,400 236,400 315,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY ZONING DEPARTMENT'; AS BUILT SANITARY REPORT' Owner Address City/State s ^YO /fi _wI,w i.;rFIC;E Legal Description: Lot .2-4_ Block -- Subdivision/CSM # �S ifiKk '/4 "/4 "Sec. Z, TAN -R-j Town of # CeLN0A 1 PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION / t Tank manufacturer 6r/�'� Size ST/PCI from: House 72 Well , ! %f P/L Pump manufacturer Cb Model � y Alarm location i�f (HOLDING TANKS ONLY) Setbacks: Service road Vent to air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: f" Width Length Number of Setback from: House 7g, Well 0 & P/L Ae Vent to fresh air intake > ELEVATIONS Description of benchmark m a d CCA fAfW L e,44 74( Elevation ^ Description of alternate benc ark c..W I - ^ ?c ? Elevation Building Sewer 1 ► y Q ST/HT Inlet /< © S ST Outlet e2,97 PC Inlet ? Ta PC Bottom ? D 3 Header/Manifold 9A J: Top of ST/PC Manhole Cover Distribution Lines () 'F d � ( ) ( ) Bottom of System Final Grade Date of installation lam' b/ ? 1 "ermit nu er State plan number Plumber's signature License number Date(�f / .6 Inspector t Complete plot pian x I F NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. r Two horizontal reference points to center of septic tank manhole cover • Show alternate benchmark, if applicable. e-VO Z ,0 7 - /-ZA/E PLAN VIEW N H rrx -&( �7 0O, © 37 0 t �cvuNll'�17 FO (L , INDICATE NORTH ARROW Wisconsin Department of Commerce Count y PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. 344652 Permit Holder's Name: ❑ City ❑ Village [jj Town of: State Plan ID No.: Town of Hudson CST M E{ev.: Insp. BM Elev.: BM Descnpt n: u� / Parcel Tax No.: • O r l oo. a C� $M`2 000 - ?19 7 """ � 020-1356-26-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 00 Benchma k 2 /. (oS 1 0 1, 6 1 00 -0 Dosing S� Alt. BM Aeration Bldg.. Sewer I06 � l Holding St/ Ht Inlet O. b0 y'/,05 TANK SETBACK INFORMATION St/ Ht Outlet !0 �g p TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet ! Air Intake q ' Septic NA Dt Bottom , L2 , 0 3 Dosing g o , NA Header/ Man. 00 .30 9 3. Aeration NA Dist. Pipe 9,3�07 Holding Bot. System q, 34 q'a. 31 PUMP/ SIPHON INFORMATION Final Grade 'ho T;;t rs - ' Manufacturer o5 Demand St cover S, ` f Model Number 20 GPM b� S rictio sem O DH F n Lift fo p S t ,S m TDH( L oss i Forcemain Length 8 � Dia. .2" Dist. To Well v SOIL ABSORPTION SYSTEM ED TMICH Width ! Leng / o. f PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N l2 Z DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of ? OR UNIT CHAMBE Model Number: System: + 0 DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size I x Hole Spacing Vent To Aiir Intake Length Dia Length ia. Spacing V t 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 ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / Z111 -111 Inspection #2: Location- 7 ` x, 1 Paul Burch Drive, Hudson, WI (NW1 /4, NW1 /4, Section 14 T29N -R19W) - 14.29.19.2088 c pa. Q,0iJ ; 6.1eQ c� Plan revision required? ❑ Yes JK No _ Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH " SANITARY PERMIT NUMBER: , e 3 ; e t € t , E F a a � , f E 3 e , p o i x t i �m 1 F E i � € 3 i € i f o- ......,. _... _�. ,. .f ._.... _.,._ ,-... ... ,... .�,... ... �.. ..,..p. .. ... .�.,.,. ... .. ..... v -. , a e t g � F i ._. e .w ... ..,,.,._ ..,e....p, _...�... ., .,� .. A . .m _ , .. - .„..�.........._ E � € m a E ate, t 6 E § � S g 555 � E i € E I i E E i ¥ � i E i Safety and Buildings Division Viscons ' SAN ITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 In accord with ILHR 83.05, Wis Adm. Code Department of Commerce Madison, WI 53707 - 7302 • Attach complete plans (to the county copy only) fo the! yy pa er not less on County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this appl 1 rt. " ..:� State Sanitary Pe it Number 3 �F "5 y ou y second purposes Personal information ou p rovide ma be used for seconda ;Ly� A `� (Privacy Law, s. 15.04 (1) (m)). �' q A ` t•, }jj, � . s Check if revision to previous application ate Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT l - � INFOR TI N Property Owner Name r P o "Location , 4 va, S � T , N, R E (or 0� Property Owner's Mailing Address r�bd ber Block Number eqvs Ci y, State O - / � Zip Code (hone umber Tn �art�gor CSM Number T YPE B ILDING: (check one) E] State Owned Nearest Road e Public 1 or 2 Family Dwelling - No. of bedrooms own of Gl SO AWIZ 111 BUILDIN USE (If building type is public, check all that apply) arcel Tax Number(s) J4, V-1 - M . W98 1 ❑ Apartment/ Condo 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) 1. rJ( New 2 ❑ Replacement 3_ ❑ Replacement of 4 ❑ Reconnection of 5 ❑ Repair of an - -- System - - - - -- System_____ ___ _____ TankOnl�r _ ___ - - - - __ Existing System - _____ -_ Existing System B) A Sanitary Permit was previously issued. Permit Number r.2 Date Issued V. TYP OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 p4seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 1 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit �- 43 Vault Privy -' ❑ Y 14 ❑ System -In -Fill V1. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (q. ft.) (Gals/da /sq. ft.) (Min. /inch) Elevation dm v )' 6 , t Feet Feet VII. TANK Capacity ns Total # of in gallons Manufacturer's Name Prefab. Site Con- Steel Fiber- Plastic App- New Existing Gallons Tanks Concrete strutted glass App. Tanks Tanks Septic Tank or F+ek}irnTFfmk 0 � ❑ ❑ ❑ ❑ ❑ Lift Pump Tank fiber �� ��' 1 ❑ ❑ ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation oft onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb 's Signature: (No Stam It11PMPRSW No.: Business Phone Number: ail > 2 / o S Plu is Add ressiltreet , City, State, Zip de): o o2 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa Itary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signa re (No Stamps) Approved ❑ Owner Given initial , d O Surcharge Fee) c� Adverse Determination 50 10-y-4 l X. CONDITIONS qF A PROVAL /, SONS FOR DISAPPROVAL: u 0 ,,A - - V" :50 SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary 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 to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever 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. - To be complete and accurate this sanitary permit application must include: 1. 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. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one online A Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and` manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department 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 following: A) plot plan, drawn to scale or with complete dimensions, "ocationof holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution 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 test data on al 15 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. A4' ,. X07- C °° �4%ti - r s 4 I F -- / x 7Z Q # / — K VG �i e ,� —ref o f wiu-[ 7 lysrx•� � � �- i - fts 17 1"S N7KC /t Wisconiin Department of Commerce SOIL AND SITE EVALUATION Division Safety and Buildings Page _/__ of Bureau df Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # --- 2 APPLICANT INFORMATION - Please print all information Reviewed 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,S pt T ,N,R E (� Property Owner's Mailing Address Lot # Block# Subd. Name or CS M# City fate Zip Code Phone Number ❑ City ty Village fxJ Town Nearest Road L Z 72J New Construction Use: ,�I Residential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate o 7 bed, gpd /f1 trench, gpd/ft Absorption area required bed, ft 7SV trench, ft Maximum design loading rate ' ' - bed, gpd/ft trench, gpd /ft Recommended infiltration surface elevation(s) O.2• J ft (as referred to site plan benchmark) Additional design /site ns' erations C Parent material QS Flood plain elevation, if applicable ft L :L Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank Unsuitable for system I V1 S❑ U S❑ U VS ❑ U P IS ❑ U I ❑ S U ❑ S ;Z U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench SlKe © G F Gr W 0 O ^S G .S /3/r J_ ..Z •� elev. ft 7, M S S 0• O� Depth to limiting 1 o6 , factor Remarks: G/ �O�v �/�i¢/�,� gf Boring # FS l3 — �. elev. ?WX Depth to limiting factor in. Remarks: CST Name (Please Print) Si nature Telephone No. � �'R• �6S Address Date CST Number O d 1 ewx SOIL DESCRIPTION REPORT PROPERTY OWNER Page L pf PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ........................... .......................... yz l z- - 0 7-5 bor>Q — .J ,S B J p elev. Depth to limiting factor in. ' Remarks: '43 Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles ' Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # V Ground elev. ft. Depth to limiting factor in. , Remarks: Boring # m Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) A x4 C Ph \ /1S' `I6 1 /A9l 1 JL ' PA(:t GF -- 1 PUt-kP CHAMBER CROSS SECT IOU ANG SPECIFICA•r10x!5 VEUT CAP `"C.I. VEMT PIPE WEATHERPROOF APPROVED LOCKIAIG JUNCTION BOX MAIJHOLE COVER 25' -- ROM DOOR, WINDOW OR FRESH 12"MIU. AIR INTAKE GRADE I 1 `i" MILL I � IB "/r11U• COAJDUIT 19 "MIN. ---- - - - - -- INJLET PROVIDE I I - - - -- AIRTIGHT SEAL I \ / / A * I II I - I I ( ALARM I *APPROVED I ON. c JOINTS WITH I LLEV. FT., APPROVED PIPE 3' ONTO PUMP -� OFF D SOLID SOIL CONICKETE BLOCK RISER EXIT PERMITTED OWL4 IF TANK MAMUFACTURER HAS SUCH APPROVAL SEPTIC E SPCCIFICATIOUS DOSE TANKS MAWUFACTURER: &45�iej IJUMBER OF DOSES: - 3 PER DAS TA SIZE: GALLOMS DOSE VOLUME 200 f ?9f ALARM MAWUFACTUILE.R S��L�CrRtr INCLUDING BACKFLOW: - � - T? GALLONS MODEL WUMBEK: 401 dW CAPACITIES: A= Z2 / UJCHES OR GALLONS SWITCH TYPE: i?.l 4E INCHES OR w yl� GALLOWS PUMP MAMUFACTURER: �u� C = IIJI:HES OR GALLOWS MODEL MUMBER: D s — — INCHES OR GALLOWS SWITCH TYPE: LIOTE: PUMP AMID ALARM ARE TO BE MINIMUM DISCHARGE RATE 1 G GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERE BETWEEU PUMP OFF AAIO DISTRIBUTION PIPE.. FEET + M NETWORK SUPPLY PRESSU -kE . . , , , .. , "��' FEET + z Yo FEET OF FORCE MAIN X 7 /ioo,LFRICTION FAC70R..— I.LSL— FEET TOTAL Ot WAMIC HEAD = 17—f FEET c / jel IWTERUAL DIMEWSIOWS OF TAWK: LENGTH ;WIDTH ;LIOUID DEPTH ._ clf. ►trr %. /�f t.�'7"7 �rr►1rr iuiwnrn• >j P �•--�• MODEL 3871 • - • '04 P0 Su bmersible • GOULDS ump Specifications HP METERS FEET 40 GPM 10 p ' MODEL: 3871 ' Discharge size 1 %4 "NPT 9 Solids'., ' /e maxlmlim" 8 30 25 Single phase: 11 f Materials of C ��struction a 6 20 { x Brassfthermopl�lstic ; 5 Features and Benefits ^ 15 EP05 *Top suction eliminates 3 10 impeller clogging. s 2 • Corrosion resistant 1 5 construction. * Float actuated switch. ° ° + 20 30 ao so us o i a s a ,o ,z ml/hr METERS FEET a CAPACITY ' MODEL DVP03 Pump Specifications Features and Benefits 6 20 4 / , ° and 1 /2 HP • EPO4 impeller- semi -open design = 5 Up to 60 GPM with pump out vanes to protect 4 15 Maximum head to 32' mechanical seal. 0 9 10 Discharge size 1 NPT • EP05 impeller - enclosed design Solids: 1 /4" maximum for improved performance. 5 Motor • Rugged glass - filled thermoplastic All motors feature ball casing and base design provides bearing superior strength and corrosion ° 0 g construction. 1s 20 25 90 95 ao U.S.GPM resistance. Single phase: 115V 0 2 4 CAPACITY s a 10 Oft Materials of Construction • Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • CSA listed models available. I All Models are designed for continuous operation and feature stainless steel hardware. i 1 Safety and Buildings Division • `V= SANITARY PERMIT 12 201 W. Washin Avenue isconsin In accord with ILHR 83.0 , vole dm. goe P O Box 7302 Department of Commerce J Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the sys on p�e not I Co n gFFr�ii than 81/2 x 11 inches in size. l° • 1a ��:� �' S t itar reverse Y Pe it Number See a erse side for instructions for completing in this li I t t s a ca o Personal information ou p rovide may be used for nda C� Cx f ' Y p Y ry pur oses 01, if k if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. , L -79 �- �.�� Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF Prop rty Owner Name Pr ation 1/4 1/4, 5 T ,N,R E(o Property Owner's Mailin ddress Lot Nunfber Block Number IVY Z, •{ 2 6 City, ate Zip Code Phone Number Subdivision Name or CSM Number PA r D > s - 11 I. TYPE OF (check one) ❑ State Owned o Cit f I Nearest Road Village Public 0 1 or 2 Family Dwelling -No. of bedrooms Town OF /¢LiL G. III BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) t , 1' ^7 1 ❑ Apartment/ Condo �- 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) 1. pf New 2_ E] Replacement 3 E] Replacement of 4_ E] Reconnection of 5. E] Repair of an `_System ________System __TankOnly______________ Existing System ________ Existing System 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 VrSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 1 " E — ]Seepage Trench 22 ❑ In- Ground Pressure / e 42 ❑ Pit Privy 13 ❑ Seepage Pit /--" k 7 Z 43 Vault Privy 14 ❑ System -in -Fill W i 92WIrm VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. ste Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) •� Df- Elevation �} Feet j 2 Feet VII. TANK Capacit gall Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Wok ng•?vft 0 ❑ I ❑ ❑ ❑ ❑ Lift Pump Tank /Sien{iWarrtber ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No S mps) PRSWNo.: Business Phone Number: A a Plumber's Address (Street, City, State, Zip ode): AZ-- IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate I ssued Issuing nt ' nature � (No Stamps) Et)C P - Proved [ Given Initial 1- dy urcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be 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.to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever 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 Division; 608 -266 -3151. To be complete and accurate this sanitary permit application must include: I. 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. III. 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 system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII- Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. 1X. County/ Department 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 following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution 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 perfor )ance curve; pump model and pump manufacturer;. D) cross section of the soil absorption system if, required by the county; E) soil test data on a 115 form; and F). all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. 0 /Q9•o � �{if�0� �1� 11l 7 Or = l-� ��Ts�' (o � 3tti.� 7.TGK/ ' � ��C` r7 '�►Gje�s' I 1 �71-m r 4 C — r 1 l F f b , z 6'! � r ,� Z sub v�yo� �/ i9fy� DAVE WOMY PUNWAG ROSE party I Road I�`fS.1M NISIN 0 . Phone Zr 7a0 a de- ol l y y r of �0 d� j T � o = ©LI/v� SN�V/�t► 0 ` 1 Ffa p l ,�,tF f a/r �Eyoz rT.i� d Ltflf MC s� for Lr �vr - . TZ c 1i/tLs t/ S- ; 3� y, r >3 -// •� /� /� wee .vo7 - VW-- Jeer, -D ci�L v� frrY /cF ?��.►� �e �//�.� 1 I ' : 1 I I , J t I { i r I I I i Y I I j : I , i + i - - - - -- I + i I , i : I 1 } Wisconsin 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 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nswestiQa 020 - 1021 -00 7 �" FjE IEWED BY DATE, APPLICANT INFORMATION- PLEASE PRI � b FAiIATI�N (o/ f� PROPERTY OWNER: .� J'" ""'� NOPERTY LOCATION Kernon Bast ' '_ LOT NW 1/4 NW 1/4,S 14 T 29 N,R 19 E (or) W �. J . .. PROPERTY OWNERS MAILING ADDRESS LD41 BLOCK # I SUBD. NAME OR CSM # 948 LaBArge Rd. `+� - 2 na Grass RAncie Second Addn. CITY, STATE ZIP CODE PHONE % 9ER)iX 7 TY ❑VILLAGE [MOWN NEAREST ROAD Hudson, W1. 54016 (71 75 - Hudson LaBAr a Rd. [x] New Construction Use Pc ] Residential /"Notlerpf bedopme -`� [ ] Addition to existing building (J Replacement ( ] Public or commei >gPr Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 858 bed, ft2 750 trench, ft Maximum design loading rate - 7 bed, gpd /ft • trench, gpolft Recommended infiltration surface elevation(s) 94.70 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U ®S ❑ U EIS ®U ❑ S [ R U ® S ❑ U EIS ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Be Trend 1 0 -12 10yr2 /2 none 1 2msbk mfr gw 2f .5 .6 2 12 -38 10yr4 /4 none sil lcsbk mfr gw if .2 .3 Ground 3 38 -47 10yr5 /4 c2d 7.5yr5/6 sil lcsbk mfr gw if .2 .3 elev. 9 4 47 -84 7.5yr4/4 none ms CSg ml na na 1 .7 :.8 Depth to limiting factor +8 4" Remarks: Boring # 1 0 -10 10yr2 /2 none 1 2msbk mfr gw 2f . .6 2 2 10 -29 10yr4 /4 none sil lcsbk mfr gw if 1 .2 .3 3 29 -40 10yr4 /4 c2d 7.5yr5 6 sil lcsbk mfr gw if .2 .3 Ground elev. 4 40 -84 7.5ry4/6 none ms Osg ml na na .7 .8 98 ft. Depth to limiting factor + TV Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. New Richmo d WI 54017 Signature: Date: 8 - 2 1 - 98 CST Number: m02298 1 PROPERTY OWNER Kernon Bast SOIL DESCRIPTION REPORT Pagel 'of 3 PARCEL I.D.# 020 - 1021 - 00 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench <' 1 0 -14 10yr2/2 none 1 2msbk mfr gw 2f .5 .6 k;: 3 2 14 -38 10yr5 /4 none sil lcsbk mfr gw if .2 .3 Ground 3 38 -47 10yr5 /4 c2d 7.5yr5/6 sil lcsbk mfr gw if .2 .3 9 O ft - 4 47 -88 7.5yr4/6 none ms Osg ml na na .7 .8 Depth to limiting s fact r �� Y +W8" �g g� Remarks: Boring # 1 0 -16 10yr2 /2 none 1 2msbk mfr gw 2f .5 .6 4 2 16 -38 10yr4 /4 nose sil lcsbk mfr gw if .2 .3 3 38 -47 10yr5 /4 c2d 7.5yr5/6 sil lcsbk mfr gw if .2 .3 Ground elev. 4 47 -88 7.5yr4/6 _ -- none ms Osg ml na na 1 .7 .8 9 9.4 ft. Depth to limiting SZ- factor +88" Remarks: Boring # 1 0 -17 10yr2 /2 none 1 lcsbk mfr gw 2f .5 .6 <'? 5 2 17 -32 10yr4 /4 none sil lcsbk mfr gw if .2 .3 3 32 -88 7.5yr4/ no ms Osg ml na na .7 .8 Ground elev. 9 9.4 ft. 15 Depth to limiting factor +88 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) r STEEL'S SOIL SERVICE Gary L. Steel Kernon Bast 1554 200th Ave. WI 54017 CSTM2298 New Richmond, MPRSW -3254 to o s f Hudson (715) 246 -6200 town of lot #26 -Grass Range Second Addn. This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 11 =40 1 BM.= top of 1z" pvc pipe @ el. 100' Alt. BM.= nail in Elm tree el. 99.90' h a` o' ra 2 Gary L. Steel 8 -21 -98 ' PA (,F ' PUMP CHAMBER CROSS SCC710IJ AMC) SPEC►FICArIOK!S VENT CAP Y" C.Z. VEMT PIPE WEATHERPROOF APPROVED LOCKIAIG JUNCTION 80X MANHOLE COVEF Z5 F ROM DOOR, WINDOW OR FRESH IZ "M AIR INTAKE I GRADE I COIJDUIT _ _ 18 "MIN. -------- lh IIJLET PROVIDE AIRTIGHT SEAL I * A i 1 III I I ( ALARM d I II I i c *APPROVED i om JOINTS WITH i ELEV. FT. APPROVED PIPE __� 3' ONTO PUMP OFF D SOLID SOIL ` COAICRETE BLOCK RISER EXIT PERMITTED OWL'J IF TAWK MAIJUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFI'CATIOUS DOSE TAWKS MAM UFACTURER: k�'r "oer IJUMBER OF DOSES: a PER DAS TAAIK SIZE: GALLONS DOSE VOLUME A4C4 4QV — - �40 ALARM MAUUFACTURER: ^ IIJCLUDIIJG BACKFLOW: 3 — GACLON5 3/� MODEL I.IUM 'Q r�Gt BER: _�� / CAPACITIES: A= --- 7 L_ UICHES OR zG GALLOWS SWITCH TYPE: —.�� C!!R� 8 = 2- IIJCHES OR GALLOWS [� PUMP MAMUFACTURER: _ e�l /_ /� C = — INCHES OR GALLOIJ5 MODEL MUMBER: -_ &5- D- & Z INCHES OR G� GALLOMS SWITCH TYPE: Ae "eetew MOTE: PUMP ARID ALARM ARE TO BE MINIMUM DISCHARCeE RATE -- 3o GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEKENCE 15ETWEELJ PUMP OFF ARID DISTRIBUTIOM PIPE.. v_ FEET /�� / + MINIMUM NETWORK SUPPLY PRESSURE . , , ' P. FEET gam' + -f-,62— FEET OF FORCE MAIM X /• -$ FTC /lo fxFRlCTI0A1 FACTOR. �_ FEET TOTAL HEAD = FEET 1UTERMAL DIMEWSIOMra OF TAAIK: LEAIGTH ;WIDTH ' rte ;LIQUID DEPTH StGIJED: LICEIJSE ►JUMtER: DAT 3L 01 MODEL 3871' • ' • '14 '1 Su bmersible Pump GOU1D5 J �ump . Specificafions =hH r r METERS FEET M'UOto 40;GPM '° MODEL: 3871 Discharge size 1%," s ,° Solidss maximum 8 Motor r,= - a ' « aY F 5` 25 7 Single phase: 115V ° Materials of C astructlon = 6 20 Brassfthermopstic + S2 5 Features and Benefits Y 4 15 EP05 ° *Top suction eliminates Q 3 10 •, impeller clogging. 2 EPOa • Corrosion resistant 5 construction. • Float actuated switch. ° FT ° 10 20 30 40 so USGRN _.. 0 2 4 6 8 10 12 noft METERS FEET CAPACITY 7 MODEL DVP03 Pump Specifications Features and Benefits ° 6 20 ° /10 and' /2 HP • EPO4 impeller- semi -open design 5 Up to 60 GPM with pump out vanes to protect 15 Maximum head to 32' mechanical seal. 10 Discharge size 112" NPT • EP05 impeller - enclosed design ° Solids: 1 /4" maximum for improved performance. 5 Motor • Rugged glass - filled thermoplastic All motors feature ball casing and base design provides superior strength and corrosion ° °° 5 10 15 20 zs 30 bearing construction. 35 40 U.S.GPM resistance. Single phase: 115V ° 2 CAPACITY 6 e 10 Oft Materials of Construction • Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Z,_Q9&2 / A#,S T Mailing Address Property Address (Verification required from Planning Department for new construction) O City/State _ E" u&_ Parcel Identification Number k LEGAL DESCRIPTION Property Location ' /,, �t/�J /,, Sec. , T . ? N- R__ZI_W, Town of i3' M;r X) Subdivision d/ o£ .7- 'k- , Lot # -21, . Certified Survey Map # Volume , Page # Warranty Deed # 3 7 y Volume //A Page # 8 Spec house ❑ yes no Lot lines identifiable yes ❑ no SYSTEM MAI 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 =71 ee yxpiration date. sidN DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr perty describe bov by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF LICANT DATE Any information that is mis- represented may 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 .a.y�, 'r•.._:K.�. '�'� :�,h•.� , �R. - ,fci.f. Ate.+: ai DOCUMENT N O. WARRANTY DEED THIS SPA, RE5ERVL0 FCR RECORDING DATA STATE BAIL OF WISCONS K�[ 2 — nK2 5:9'745 VOL E� PA; ST. CFA.:. RAY - -G -. -BROWN and ELEANORE., BROWN a /k /a E1 J._ Brown tao; a», hu $ band..and- -wife . - . .. . ...... UN 5195 ; i ... . -. ......---..." ................................................ ............. --------- _ Ct 8:00 conveys and warrants to . ... 4Q - .J.• . $PEER - BAST__ - - - _••- •••,- .••• - -.- - - - -� ,,, i _ ��. l ................................".._.._...-' -_ -.....--......... ........._....- ••_..•_........ . --- - -- ..................... - - • ..... .................. .. .... ........ ....... ..... ... ."....... ............................--- •- .... .. .. .... ..... ........... "... ....... ... -._ .I RLTVRN TO /D 01 l for ..... . and other ,/, . •. ............ /lGG �J� i -- St,...�roix � l the following described real estate in ...... ....... .................................. County, -- -:- f State of Wisconsin: 020- 1019 - 1 020- 1020 -90 l� Tax Parcel No: I NW'k of NEk of Section 14 -29 -19 EXCEPT part to Hudworth, Inc. in i , Vol. 604 Page 226. a NE'k of NWk of Section 14 -29 -19 EXCEPT part to Thomas Wiley in Vol. 958, Page 577. �I Subject to torn road right -of -way along the southerly line of said landsl1 Grantee is responsible for payment of real estate taxes for the 1 1 year 1994, payable in 1995, and subsequent years. • PLAT OF HoAfESTEAD - - -- --- - - - - -- _l•OT 1 . IAT 26 E 1387 ..25 ' NM TH LINE OF THE NWl /4 . 538. 44 • _J— N 89.43'45' STaim W --17 v 1237. 8' fk �0 H•W.L v 2.155 ACRES • ^ 93AM SQ FT. Oti Z LOT 14 2.931 ACRES . 127,676 S9. FT. 1875 ACRES d o s � • f c�p �,p 2.505 ACRES , 109,113 SQ. FT. STOW � TI 31.43 "E 30 HAXL no"0 J � t V ..t_s R tid .•w.r.'_ 26 \ / — 24 . vN 2.967 ACRES 2.187 ACRES `= 129,225 Sal. FT. 95,i:63 SQ. FT. a 2.323 ACRES W 3.164 ACRES STORM vATE►. 179 SQ. FT. - 137,842 S--1 f -00.26 Al:EA $ s 5.80• Lr H �.w.�. # „ 92s N S 00 ' ' UxP -� s 89 �:�� O c "ro DEARING cc►roRn LENGTH ARC i ENCiT4 TANGENTS S27.46't6"E 208.76• 216 � — 3Q 301.11 "E S3 • 127 126.92• Sss•2s'tr'E r ? \ o, O S40 "E 2r� �.:• X6'43'21 "E IT URN 1. a ntC-"SAW siab• „'21 -� ss4.OU'ol•'E !'35.s7C' 163'1 =°io V NSt'!!9'20"v vATEit 0 �' NB9•Q9'40.:• "v 410.08' 44L7,r N51'09'20V S32.4" -4-w TENTION AREA N69 "V ` Q .tIV 2�23, ea qw S72''.W z N N87 ^ ? i C , N87'35'43"V S52 r f