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HomeMy WebLinkAbout020-1359-02-000 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)). 353140 Permit Holder's Name: ❑ City ❑ Village W Town of: State Plan ID No.: I'acagge Homes- Lot Z Town of Hudson CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: p Z?3 —/35 QoZ —00 1106 1 3"cr f - s9ZrJ�� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3 0 O Dosing Alt. BM A Bldg. Sewer Ho St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. A ion Dist. Pipe Holdi Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St cover Model Number GPM TDH Lift Friction System TDH Ft ead L oss Forcemain Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM AtW TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth 15 IMENSIONS DI E SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM CHI anufacturer: INFORMATION Type Of C Mo a Num be r: System: '-- OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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: (0/x/99 Inspection #2: Location: pending, Hudson, WI (SW1 /4, NW1 /4, Section 16 T29N -R19W) - 16.29.19. Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM unty: 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)]. 353140 Permit Holder's Name: ❑ City ❑ Village W Town of: State Plan ID No.: Town of H udson 2Y = T 4-so AK /b. CST BM Elev.: Insp. BM Elev.: BM Description: Nrcel Tax No.: /Da 1 3 , 6 / TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ( aQ 447 F It zoo 40V Benchmark 3 5 ZC2 O Dosing (� Alt. BM �`s �($• S� A Bldg. Sewer �• 9�<. 3 Hol St / Ht Inlet I2JR 12.5 TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Ventto ROAD Air Intake Septic )50 S1 / NA Dt Bottom ►�. { O ��• 3 Z Dosing >SO �' 6 �-� NA Header/ Man. a� 3 � A tion Dist. Pipe . tv CFO , 32 Holdi Bot. System 5 ' } � PUMP/ SIPHON INFORMATION Final Grade � Manufacturer s # 3T+ )r St cover 7• SZ Oj4. O Model Number OS 3 GPM vx TDH Lift �l,� t> Friction 3 ,56 System TDH • TDH t j • '1i Ft Forcemain Length p Dia. z N Dist. To well '� SOIL ABSORPTION SYSTEM Width Len t / o Of T PIT No. Of Pits Inside Dia. Liquid Depth EN I N / 9 (v s S DI E :: SETBACK SYSTEM TO P/L BLDG WELL LAKE STREAM > OR I anufacturer: INFORMATION Type o Mode Number: System: ?/� � • NIT DISTRIBUTION SYSTEM Header/Manifold U Distribution Pipe(s= / x H le Size x ,Hoollee Spacing Vent To Air Intake length ? Dia- Length � Dia. T/ Spacing � W� `CO SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes o COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #l: (d /x /0 Inspection #2: /t / f Location: pending, Hudson, W (SW1/4, NW1 /4, Se 'on �� ` 1 3t*A= 9W) - 16.29 � r L.J ►^ ° 5`�rw �`� kl a;E" C � Yw wt1tR. a,� i �t ln�.� 1$" .iu•A ever —. � � w r� �u►ow�w�ll �¢. u � t o — 11 — lot - " 'tts" t Plan revi ion required? ❑ Yes No /0 /z Use other side for additional information. >S SBD -6710 (R.3/97) Dat Inspector's Sign ure Cert. No. l I ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ° € e a ° ° °_ .. ......... e a m� � ° °..ee ° naa _ 3 e x e Q 1 5 o- e �. i�® awe. °.. .. .;. ,. S t t n � C r � - 3 fa .. _ .... .. ._. ..,,. _._ d .. _. .. i a e... >,�. �. ,.e.. _ e..„ ........� x.°.,.. .. .... .... v v 3 } v ma m„m. me.� ® ° ....° g 3 S S ( € # E a x. �.WW. ...�.� .f.,..r ...... ..... W _ ... v,. .m.. { F E _ f e ....... .. r � F � e E _ i E 4 i 3 ! s e € 5 n } _ s s a l s m. E € c a a� f e �e e t � x � { 511 Mc Cfuc�le a� �- • -_..,_ Safety anulldings Division SANITARY PERMIT APPLXAT�OW 2 01 W. Washington Avenue Vi s * consin In accord with ILHR 83.05, . Code P O Box 7302 Department of Commerce r if�A Madison, WI 53707 -7302 r� • Attach complete plans (to the county copy only) for the sygoriii-on pa 66@t% Count* t than 8 1/2 x 11 inches in size. rt l' n ,�? nrtar • See reverse side for instructions for completing this appllc tion f °n 7 State � y Permit Number Personal information you provide may be used for secondary purposes (- 4)IJNTf UC*k if revision to previous application [Privacy Law, s. 15.04 (1) (m)1 E XWPI an I.D. NyLnber I. APPLICATION INFORMATION - PLEASE PRINT ALL IN A -ION - Property Owner Name i i eat /4, S T p� , N, R or) W Propert Owner's Mailing Ad f s Lot Num ✓ Block Number ao City tate Zip Code Phone Number Subdivision me or M Number u4r ( ?/ 6- S A- 11. TYPE OF BU ILDING: (check one) ❑ State Owned 't Nearest Road Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo © — a 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 online B, if applicable) A) 1 • FfNew 2. ❑ Replacement 3. ❑ Replacement of 4. [] Reconnection of 5 Q Repair of an System ________System _____________ Tank Only______________ 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 ❑ Seepage Bed 21 Mound 30 E] Specify Type 41 ❑ Holding Tank 12 E] Seepage Trench 22 In- Ground Pressure / 7 , 42 ❑ Pit Privy 13 ❑ Seepage Pit k' 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: �6 ,:�,k 0� 1_ Gallons Per Day 2. Absorp. Area 13. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 17 Final Grade equired (sq. ft.) Pr posed (s ft.) als/day /sq. ft.) Min. /inch) / levation DQ Q . r q , 9 4etj Feet Ca acit VII. TANK in allo s Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted _ Tanks Tanks ptic Tan oFiiOfrliTf�TdTtk �--- � ❑ 1:1 El El 11 Pump aherrCl�Ter 1:1 El 1:1 El 1:1 ESPONSIBILITY S ATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum s Si ature: (No S a s) P/ PRSW No Business Phone Number: Q 3�� a6 - Plu er� Address (Str City, St Zi Cod (� J •. u e IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (inch udegGroundwat ate Issued Issuing Agent Signature (No Stamps) • ; 'Approved ❑ Owner Given Initial Surcharge Fee) _ _ Adverse Determination o �= ia,�_ -,�, 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 i 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 Buildings 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. 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, 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 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 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. Safety and Buildings ' 2226 ROSE ST LACROSSE WI 54603 -1905 TDD #: (608) 264 -8777 Visconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary September 09, 1999 CUST ID No. 267341 ATTN: POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 09/09/2001 Identification Numbers Transaction ID No. 243782 SITE: ST CROIX COUNTY, TOWN OF HUDSON Site ID No. 179730 SW 1/4, NW 1/4; S16, T29N, R19W Please refer to both identification numbers, FACILITY: LA CASSE CUSTOM HOMES above, in all correspondence with the agency. FOR: OBJECT TYPE: POWTS REGULATED OBJECT ID NO.: 488092 NEW MOUND SYSTEM The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 08/23/1999 Q FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 eroy G. J ky, Wastewater Spec a ist /` l "BALANCE DUE $ 0.00 Field Operations Bureau ( , '' +',di / (715)726 -2544 Voice (715)726 -2549 Fax f WiSNIART code: 7633 ljansky @commerce.state.wi.us S7 CFQiX �titi ZCA U�FICF TITtE, Page ti of 6 MOUND SYSTEM FOR A BEDROOM RESIDENCE LOCATED IN THE S 1/4 OF THE 1/4 OF SECTION 1 - � 6 ,T �9 N, R 19 W, TOWN OF l'�1�SpN , ST.0 \LX COUNTY, WISCONSIN. 1_rz Z OF Pf�%Z tZwocb mLPtDUWS INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW - CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PA GE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR RECEiva) A u u ? '1999 R.AFETY & BLOwi M. 2 4 3'7 8 2 ;. PREPARED BY WECEIE=EIFZ SO I L TEST = NG AND. *' N �o+se DES = Gpi S1EE;ZV = CE �%S,C ®NS+ ay P.O. B11I 74 421 N. ISAIM ST. � �,,••'�� RIVET? FALLS. VI 54022 Af"HUR L P.O.W.T.S. lly 715- 42`,-0165 WEGEREA Conditiona �S TH, APPROVED DEPARTMENT OF COMMERCE b� ��S I G 14 S DIVISI N OF SAFETY AND BUILDINGS EE GO ESPO ENCE JOB NO. PLOT PLAN ' Page - L of Jo Scale 1 "= SO ' - zao I i � f I I 1 � I rvT L" sT So ` o I s -e I Page 3 Of Approved Synthetic Covering �-S7M C Y; Distribution Pipe Medium Sand Topsoil = F Elev. . 9 —� E ;; D 3 It / b % Slope Bed Of 2�— 2 %2 Force Main Plowed Aggregate From Pump Layer D `• Ft. Cross Section Of A Mound System Using E x.08 Ft. A Bed For The Absorption Area F o•'3 Ft. G \ Ft. A S Ft. H \-S Ft. Linear Loading Rate =q.5 GPD /LN FT B b3 Ft. Design Loading Rate =o.4 .GPD /SQ FT j Ft. J q Ft. K \O Ft. n L 8S Ft. W 3 3 Ft. L j Observation Pipe -� W 7 - - -- - I• - - - -- ----- - - - - -- ------------------ - - --�I Force Main o 01?P0S1 EKA) Distribution Bed Of 2 2 2 Pipe Aggregate I Observation Pipe Permanent Markers (Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area Page Of 6 Perforated Pipe Detail 0 End View Perforoted End Cop �� PVC Pipe a 't Install permanent marker 10 ' S o "` at end of-each lateral Holes Located On Bottom, Are Equally Spaced � @ S PVC Force Main I Q PVC Manifold Pipe Distri ution PiQe Lost Hole Should Be Next To End Cap End Cap P SZ Ft. Distribution Pipe Loyouf S Y Ft. X V8 InChP.s Y �O Inches Hole Diameter ley Inch Lateral I ply Inches) Manifold Z- Inches Force Main I Inches # of holes /pipe b Invert Elevation of Laterals \oo.o Ft. gkk. k 9 -3� x _ k4y GPM Place 1st hole � 4y from center of manifold with succeeding holes at L/V intervals. Last hole to be next to the end cap. Combination Septic;Tank and PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' PAGE S OF VEIJT CAP WEATHER PROOF JUIJCTIOIJ 9OX y'C.Z. VENT PIPC , APPROVED LOCKING ' —•10' FROM DOOR. MA►JHOLE COYER rvIV d1MDOW OR FRESH wAR►.�I►.16 1.A6EL. A�IUTAKE co�0u�r C tj 15' MIW. y�INSr�ctloiJ P PROVIDE I -- - -- U.1LET AIRTIGHT SEAL I I PPROYED J010: APPROVED JOI A I I I A w /C.Z. PIPEoR Tank construction i iiI W /C.I. �IPE�E shall comply with . I ALARM ILH ('33.15 and 83.20 a I I I I IJ I o A b LLEY. F 7 PUMP J FF D COIJCRE BLOCK 3" AAPRo R15ER EXIT PERMITTED O►JLy IF TAN MA N UFACTURER HAS SUCH APPROVAL gEDD SEPTIC E SPEC.IFICATIOUS DOSE M`DWty�1�1 1 P �s B TA�.1K MA�IUFACTURCR: WUMBER OF DOSES: PER DA TAWK :,IZC : \Zoc� 80 GALLONS DO5E VOLUME t ALARM MANUFACTURER: S'S' S�iS�T l S IMCLUDIWG 6ACKFLOW: � ` GALLONS MODEL 1JUMBER: ti'L tW CAPACITIES: A= IWCHES OR GALLOWS SWITCH TAPE: ` " B = IWCHES"OK ` GrLLOUS PUMP MAUUFACTURER' G ouL1�S C- 9 IULHES OR 'S GALLOWS MODEL MUMBER: 3 - 11 kP0 S D= INCHES OR Ib�3'� GALLOWS W1L'1ZC -C11Z IMTt'1 -= SWITCH TYPE: Y ►DOTE: PUMP AUD ALARM ARE TO DE MINIMUM DISCHARGE RATE 31'l� GPM INSTALLED ON 5EPARATE CIRCUITS vEKTICAL DIFFE DETWEEiJ PUMP OFF AU0.015TRIBUTIOU PIPE.. \z.a"S + MIIJ IhtUM NETWORK SUPPLY PRESSURE . . 2.50 FEET + FAO F O F FORCE MAIN X Z '�y FYo FT.FRICTIOU FACTOR_. �'� FEET TOTAL Oy1JAMIC. HEAD = ��' FEET Pump chamber DIAMETER 38'' IAITERMAL DIMLW510W� OF TAIJK: LENGTH -' ;WIDTH ;LIQUID DEPTH BOTTOM AREA - 231 GAL /INCH AS PER MANUFACTURER = 2 � 0S GAL /INCH Goulds Submersible Efflu Pump \ y • , 1 Ji ll ' \1J 38 EPO4 EP 05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- components. tic cover with integral handle •Homes Available for automatic and g • Farms Motor: and float switch attachment • • EPO4 Single hose: 0.4 HP, manual operation. Automatic points. Heavy duty sump 115 or 230 V 60 e: 0.4 H0 models include Mechanical • Water transfer RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty • Dewatering preset at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, construction. Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- • Solids handling capability: automatic reset. plastic Semi -open design 3 /4" maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. R. Canadian Standards Association 1 • Total heads: up to 24 feet. with three prong grounding _ • Discharge size: 1 NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running dry without damage to s 30 _.� - components. � Pump: EP05 $ 2.5 Fr , • Solids handling capability: 0 25 j 3 /4 ° maximum. Q W. , • Capacities: up to 60 GPM. s 20 • Total heads: up to 31 feet. ` • Discharge size: 1 /2" NPT. Z 5 • Mechanical seal: carbon- e rotary/ceramic- stationary, 4 BUNA -N elastomers. o E __ • Temperature: 3 10 104 °F (40 °C) continuous EPO4 — 140 °F (60 °C) intermittent. 2 1 5 0 10 20 30 40 50 GPM _ L 0 2 4 6 8 10 12 ml /h CAPACITY ©1995 Goulds Pumps, Inc. Effective May, 1995 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 t a e�t J� 020- 1029 -00 APPLICANT INFORMATION PLEASE PRI FORIIIiiijO'P�'', R VIEWEDBY AT 8 /� S PROPERTY OWNER: CEIVE9 -PROPERTY LOCATION LaCasse Custom Homes, Inc. lJ ';GOVT. LOT sw 1/4 Nw 1/4 16 T 29 N,R 19 R(or) W PR OPE R TY 521 McCutcheonlURNdd ADDRESS S 199 LOT ,> BLna Parkwood K # SU CMeadows CITY, STATE ZIP CODE ONE N Y []VILLAGE [SOWN NEAREST ROAD Hudson, WI. 54016hlr 5 Hudson Meadowood Ln. [x] New Construction Use [ ij Residential / Nu rlf s' 4 Addition to existing building (] Replacement [ ] Public or commercial Code derived daily flow 600 gpd Recommended design loading rate • 5 bed, gpd /ft - 6 trench, gpd /ft Absorption area required 500 bed, ft 500 trench, ft Maximum design loading rate • 5 bed, gpd /ft •6 trench, gpd /ft Recommended infiltration surface elevation(s) 99.70 ft (as referred to site plan benchmark) Additional design / site considerations tX system el. based on contour line of el. 98.70' Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system ? S ❑ U 0 S ❑ U EIS U U El [R U ❑ S U U I ❑ S U U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer>ch '....1 „...' 1 0 -13 10 r 3/3 none 1 2msbk mfr qw f .5 i .6 2 13 -22 10 r 4/4 none sil 2msbk mfr qw if .5 1 .6 Ground 3 22 -34 7.5 r 4/4 none sl 2msbk mfr CfW if .5 .6 98 elv. ft. 4 34 -50 10 r 5/4 2 7.5 r 5/8 os sil M na na na n .2 Depth to limiting fact 1 Remarks: Boring # 1 0 -21 10 r 3/3 none 1 2msbk mfr crw 2f .5 .6 Lj 2 21 -32 10yr 4/4 none sil 2msbk mfr qW if .5 ` .6 Ground 3 32 -42 7.5 r 4/4 none sl 2msbk mfr gg Ilf .6 elev. 4 42 -65 10 r 5/4 c2 7.5 r 5/8 ::os/sil M na na na no .2 98.4 ft. Depth to limiting factor 42” Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. v . New Rich and WI 54017 Signature: Date: 7 -13 - CST Number: m02298 i PROPERTY OWNER LaCasse Custom Homes SOIL DESCRIPTION REPORT Page. 2 'of 3 PARCEL I.D. # 020- 1029 -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 ................. .................. ................. .................. ................. .................. 3 >> 1 0 -20 10 r 2 e 1 2msbk mfr Cfw 2f .5 .6 2 20 -34 10yr 4/4 none sl 2msbk mfr 9w if .5 .6 Ground 3 134-45 7.5 r 4/4 none co s Osg ml gw if .7 .8 elev. 98 ft. 4 4 os si na na na n .2 Depth to limiting factor 45" Remarks: Boring # Ground elev. ft. — Depth to -- limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. j ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel LaCAsse Custom Homes, Inc. 1554 200th Ave. CSTM2298 SWQNW4 S16- T29N -R19W New Richmond, WI 54017 MPRSW -3254 town of Hudson (715) 246 -6200 lot #2- Parkwood Meadows N 1 =40' BM. =top of SE lot stake C el. 100.00' Alt. BM.= top of SW lot stake @ el. 98.65' i V) j q0 r 9 4 •1 11.3 3 32- )Ott �j Gary L. Steel 7 -13 -99 ST CROIX COUNTY r° V ' kZ SEPTIC TANK MAINTENANCE AGREEMENT w, ANDQ A ry OWNERSHIP CERTIFICATION FORM Owner/Buyer L &C- 45Sx. jjemt" i �c Mailing Address -521 c u 5 Sl �.C �o rl RcQ , Property Address L •+ s tw (Verification required from Planning Department for new construction) City/State t+ Parcel Identification Number LEGAL DESCRIPTION Property Location S W ' /a, X11 ul ' /4, Sec. I (, T -R � W, Town of Subdivision P'a,-xx� r + n rA m eu- 1C;,n. L-') . Lot # Certified Survey Map # . Volume . , Page # Warranty Deed # S G/ 1 7 , Volume O L / Page # L Spec house ❑ yes 2--no Lot lines identifiable UX yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. i 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 days f hre the t year expiration date. z91z±:nS- ? l49l r SIGNATUKtOF APPLICANT 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 erty escri ed above, by virtue of a warranty deed recorded in Register of Deeds Office. /Z/ SfMAfUPXbF APPLICANT 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 Re gister of Deeds office PP P h' g a copy of the certified survey map if reference is made in the warranty deed �I VOL 1404PAC1619 I STATE BAR OF WISCONSIN FORM S — 1982 Ii PERSONAL REPRESENTATIVE'S DEED KATHLEEN H. WELSH kEGISTER OF DEEDS '. DOCUMENT NO . ST. CRDIX CO., WI RECEIVED FOR RECORD Tlowaid taVenture 02 -19 -1999 11:30 AM PERSONAL REPRESENTATIV I as Personal Representative of the estate of EXEMPT R 17 �j Arma LaVetittire CERT COPY FEE: C FEE: TRANSFER FEE: ("Decedent "), RECORDING FEE: 10.00 l i for a valuable consideration conveys, without warranty, )o ..I MAGI 1 I! LaCasse Custan Names, Inc., a Wisconsin Corporation I: r II ii I, Grantee, i St. Croix THIS SPACE RESERVED FOR RECORDING DATA the following described real estate in County, State of Wisconsin (hereinafter Called the "Property "): NAME AND RETURN ADDRESS I !I Heywood & Carl, S.C. II Box 125 Hudson, WE 54016 � I li SW i of NW of Section 16, Township 29N, R ange 19W, St. Croix County - .- . ii Wisconsin. - 020- 1029-00 :I TRIS PROPERTY IS IN THE WELL ADVISORY AREA. jl 1 ATION NUMBER I I i t 1 This is in partial satisfaction of a land Contract dated February 18, 1999, Recorded in Vol Page i i s I. ;I i I Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedents death, and all of the estate and interest' in the Property which the Personal Representative has since acquired. ! Dated this 18111 day of Februa 19 99 (SEAL) ( SEAL) Howard LaVent Personal Representative Personal Representative AUTHENTICATION ACKNOWLEDGMENT ii Signature(s) lbward LaVenture State-of Wisconsin-, lI ss. County. ! ' authe icated this 18 ay of February 19 Personally came before me this day of is 19_, the above named SatueI R. Cari is i� TLE: MEMBER STATE Bodof WISCONSIN ! I !i authorized by 5706.06, Wis. Stats.) to me known to be the person who executed the foregoing it instrument and acknowledge the same. � THIS INSTRUMENT WAS DRAFTED BY Heywood & Cari, S. C. Box 125 :I j; llUidscal. Wl 54016 Notary Public, County, Wis. c ii (Signatures may be authenticated or acknowledged. Bah are not My commission is permanent. (if not, state expiration date: ! t necessary.) 19 ) I; • Namos o f persons signing in any nI)Khy should be typed or pnmed below their signatures STATE BAR OF WISCONSIN Wi—Mn Legal Blank CO.. Ike. PERSONAL REPRESENTATIVE'S DEED Form No. 5 — 1982 "Waukee, Wis. NW CORNER SECTION 10 12*1 RIOW (8ERNTSEN CAP, PARKWOOD MEADOWS LOCATED IN THE SW 1/4 OF THE W 1/4, THE M 1/4 OF THE SW 1/4, AND THE SW 1/4 OF THE SW 1/4 OF SECTION 16, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. L*CLATIEP LAtP§ Tit SW 1/4 OF TVs NW 1/4 Fi 123ILW c f17 21 --. - "T k! '. Fh4A* NOTES: I ALL L I NEAR MEASUREMENTS HAVE KEN ID111111101 MADE TO THE NE-AAEST ONE HUNDREDTH - 254 lot mmm OF A FOOT AND ALL ANGUILAR 33 MEASLMIENTS HAVE BEEN MADE TO THE NEAREST FIVE SECONDS AND COMPUTED 5 4 3 M THE VALUES SHOWN. IS ACKS 2.319 — ZVI ACKWS 2.319 ACRES 2 ,,W, 4 ,ACR" U19 ACM § sr. 121 20 2F. 100�m 9.r. z too.011 V. 10O."s 91. Z 2. WFIENTMVInER: LOCATION MAI too. LACASSE CUSTOM HOMES, INC. SECTION Ia. T29K R119W. TOI Iw 521 McCUTCHEON FWD HUDSOK ST. CROIX COUNTY. ft 114 HUDSON. WI 54018 I W-M N[-*W 1 2640' N SV44- 00- 1261.40' r4V I' 7 K-N* 1 1.14 ACV N1— l K_ Aup _ _I — $IAN ILF. w z z NE-sw ARKW( EADOY N, N 'mr.w I Z' Imall 5 1 — 12 13 U-sw 2 -6. 10 11 — "T At 11505 RES 2.945 ACRIM 2.568 'C .%IACU. 8 1111738 sr. K SCAI E 1 2000' 2.101 ACRES mum" 91,619 sp. L ANE e lk LEGEND 20' 9 COLINTY KCTION CORNER MONUKIf FOUND (TYPE OF KINUMENT NOTED� tw 9 2" X " IRON PIPE WEIGHING 0 430 .460 3.8 AINEAR FOOT. SET. I X 24" IRON PIPE WEIGHING 1.6af/L NEAR FOOT SET AT ALL F OTHER LOT CORNIERS. 10 lomw 14 1p I 2.753 ACRES I" IRON PIPE, FOUND. — IMAGO If. t BUILDING SETBACK LINE (WIDTH 1 . MAI 6 1 —. UTILITY EASEMENT (10' WIDE 29 h t .. f —A: . w 2Aft'" , S I DE OF THE COIMMON LOT L I NET ow "AWCURn - " qmw N 28 ' — M6 1 . 1 9 25" w 0 U T L 0 T 1 .......... ORA, I NA" EAS"NT. X419 ACRIES 0 (R ) PREVIOUSLY RECORDED INFORMATI 10AX5 I.F. V)l 0.720 ACRES �AP I DRAINAGE I ' - " &L- 1 31,367 ST. X 1 EXISTING FENCE. L58 100, 1 I[ASEMINT 2.523 ACRES a // I I ...... *r" Ir W j 39"r SOW7 91. x GIMIND WATER MONITORING WELL. 15 %wh v PROPOSED OR I VEWAY LOCAT I ON 30 N 19-83- 22- W '40WO' 2-309 ACM 250AW Igo 27 SCALE IN FEET I= ACM L 10110" 111.. w *, , o, 1 0 7*5 150 300 450 33 53 aw - 0: yl 41*AW all 31 1 iCURVE TABLE 2�309 ACFO 104.082 OF. M U 26.1 W AIM CN= TANZNT Hil NO. L PMIUS LSHM14 LINK" I= IN 101.140 2F. N Bgi'p' w Cl 6 30.00? 90'2V 30* 47.3V 42.. 45:0'r' 40. DO 30' It 3 31-40' 46- W ON a 91 O 31 4a: 45 0: 4r N ir- 1 1 b 04 10 q.. w 11 17: 94.7"P 48" It N b 05 it w 1: n- w 1 03: w u w I -, 2:" mol A U 404,7r z 17 00 13 1 1 2.525 ACFV C7 w 0-911: HI w w 32- 4 100" SF. cm Ia M:w Is- 03" INS. IP 64 1 n- a a 1 as is 36 1 1 L 32 w ce Is MOO 3 31- 144. 1 1 40 33- * a 2—VO ACM a 89 n f CIO 20 DO w 1 71 1 117 0: 104M ILF. C11 21 m:— so g: : :: - 45' 61 w w m Mm. " w III CI It- 2' 25 1 33 200.001' 32 2XV C 37 41- a L324 ACM C 1 00 411 13' *14' J 30" W I 1 19 20 533. DO an 4V : 4r 70 I 1 :9 w I a an N IOIA13 8F. J 3 is N ow- Iff N a" C 34' 03' 20" IN N C17 21 IM*w 'Ir It" 272*44' 2.9: 3 2r 11.9 IN 3 00 4. N IN 33 124 I LIN ILF 24 LN 1321 ACWS IOU 5 ILF. is V. 1001 - 100111