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HomeMy WebLinkAbout020-1359-10-000 Wisconsin Department of Corxnerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 353188 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2 Permit Holder's Name: City Village X Township Parcel Tax No: LaCasse Custom Homes I Hudson Township 020 - 1359 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: IOb -0' 100,0 4 ,Y N6 16.29.19.2106 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 9'-& 2 J4.6? 1IA i cQ Dosing ul Alt. BM CA t �J / •FEZ !o -� r Aeration Bldg. Sewer �p� t 8•� 8.39 Holding St/Ht Inlet IO.Z} 9 �, S► St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic J- Dt Bottom It 6 f 9 3 3 , Dosing ) Header /Man. Aeration Dist. Pipe *, 63 03�f5� Holding Bot. System �•Z9 oZ•`1� / Fin el Grade �f r PUMP /SIPHON INFORMATION t .Tu Manufacturer Demand St Cover S S � - .4s , 6� GPM Cd Model Number �f$ 6f d� 3n. - 4.48' 1 loar ItsD.D / gy p• DH Lift Friction Loss System Head TDH Ft t 2 .SD Forcemain Length f Dia. Dist. to Well V-0 Z It ,-) SOIL ABSORPTION SYSTEM BED/TRENCH Width Length ! No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS C C C SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHI Man et er. INFORMATION CHAMBER Type Of System: UNIT � A () del Number: DISTRIBUTION SYSTEM l J 1 / Header /Manifold Distribution It x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) t I� (/� if - 11 Length Dia Length Dia ' 2 Spacing r 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 K] Yes L] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: �� / / / Inspection #2: t'� / A. 1� Location: 506 Green Mill Lane Hudson, WI 54016 SW 1/4 NW 1/4 16 T29N R19W Parkwood Meadows Lot 10 Parcel No: 16.06 1.) Alt BM Description = eP 2.) Bldg sewer length = - amount of cover = � p � /r jet ��d�• '� -p� �*3.) Contour = Io( n• tc f.- C revision Requ? Yes X No Use other side for additional information. t I SBD -6710 (R.3/97) Date Insepctors Signature Cert. No. f i ��� �� rVL Safety and Buildings Division A Y PER TION 201 W. Washington Avenue Nv isconsin In accord with ILHR 83.05 #ml. Code, '' P O Box 7302 Department of Commerce 1 \. Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the e , on�pap& not less County than 8 v2 x 11 inches in size. S • See reverse side for instructions for completing this appli4tiop, „ State Sanitary Permit Nu b eL 353 109 Personal information you provide may be used for secondary purposes ` ❑ ,Check if revision to previous a [Privacy Law, s. 15.04 (1) (m)]. A COl1PJ ,� State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT A IIIVI�/�tl Property Owrier Name - Property l.'ocati9rh /a, f4, S T , N, R or) W Property Owner's Mailing Address Block Number ---� -- City, tat Zip Code Phone Number Subdi ion N e or CSM Numbe 11 T Y IF EM F B ILDING: (check one) El State Owned It ie Nearest Road Public 1 or 2 Famil Dwelling - No. of bedrooms Tow OF III BUILDING USE: (If building type is public, check allthata ) a 9 YP P PPIY Parcel Tax Number(s) I (O. 29), C l d a' U-- f 3S°) — � — �00 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 S ❑ 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. New 2. E] Replacement 3. E] Replacement of 4 E] Reconnection of 5_ I] 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 410 Holding Tank 12 [1 Seepage Trench 22 In- Ground Pressure X ,� F 42 ❑ Pit Privy 13 ❑Seepage Pit � / 43 ❑Vault Privy 14 ❑ System -In -Fill � D VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) — Elevation 6190 l 0 t_ Feet Feet Capacit VII. i FORMATION in gallo Total # of Manufacturer's Name Prefab. Con- steel Fiber- Plastic Exper. New Existing Gallons Tanks Concrete strutted glass App. Tanks Tanks j Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber .�� Q ❑ ❑ 1 ❑ 1 ❑ 1 ❑ Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Pi u r' a e' (P int) Plum s Sig / a re' ( mps) PRSW No.: Business Phone Number: u�G14- a63S 7/s Q tr S- Plumbe 's Address (Seet I y , Zip Code : �. j® N - T IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved j@ nitar y Permit Fee (Includes Groundwater [ ssue Issuin Agent Signat re (No Stamps) Approved ❑ Surcharge Fee) Owner Given Initial — Adverse Determination �S �W 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 Buildings Division, 608- 266 - 3.151. 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 servicei 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 LA CROSSE WI 54603 -1905 TDD #: (608) 264 -8777 Visconsin www•commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary October 15, 1999 CUST ID No.267341 ATTN.• POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN T -_._ v ZONING OFFICE 421 N MAIN STL�.. ST CROIX COUNTY SPIA PO BOX 74 `1 1,101 CARMICHAEL RD RIVER FALLS WI 54022 "SON WI 54016 i V L 0 RE: CONDITIONAL APPROV APPROVAL EXPIRES: 10/15/2001 ' ST Transaction ID AQ. 25163 Site ID No. 1 8234 9 SITE: OP OE 4 Please refer td "bot' identification numbers,'' Site ID: 182349 above, in all correspondence with the agency. St. Croix County, Town of Hudson SW1 /4, NW1 /4, S16, T29N, R19W Subdivision: Parkwood Meadows - lot 10 Facility: Richard La Casse /La Casse Custom Homes FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 495667 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. 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 10/07/1999 6to(pk,4_� FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 erard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM jswim @commerce.state.wi.us 4 T'ITLa S �-VEL. ' Page of 6 MOUND SYSTEM FOR A BEDROOM RESIDENCE LOCATED IN THE Sb3 /4 OF THE NW 1/4 OF SECTION 16 ,T N, R 19 W, TOWN OF iSr. Q-1 X COUNTY, WISCONSIN. 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 Z; tCti Pnz-Q L � C.1ri S E LR �s� ����, is RECEIVED 5 21 m oc'r 0 6 1999 SAFETY & BLDGS DIV. PREPARED BY WEGEF:;tEF SO I L . TEST I NG AND. DES 2 G�'V SEF��1 I CE r'��'' ?;3'r a;,..•e•..., °�'�� � F.O. BOX 74 421 N. MIN ST. fp ty = AR7H )R L RIVER FALLS. NI 54022 F e 4 e t P a ELLS} ,' `HTH. 7 15-42 2 5-016 5 a f . D� F Wi 5 -99 �E G�t«�� JOB NO. PLOT PLAN Page Z of Scale 1 60' , tT.L, �Ob•a0 ON M -� .1OO.p oN IT?-0Q PE vq• P I %B 1 17 �0 \ 1 I i gJ I Z J I Page 3 Of Approved Synthetic Covering T)sTM c �3 Distribution Pipe Medium Sand Topsoil - H s F Elev - . 3 E D e Z % Slope ( Force Main Plowed Trench of i " -2 1,2" From Pump Layer Aggregate Undisturbed D 1.0 Ft. Soil E Ft. Cross Section Of A Mound System Using F 0.% Ft. V Trench For The Absorption Area G N•� Ft. A S Ft. H S Ft. B loo) Ft. I 1 S Ft. Linear Loading Rate= GPD /LN FT D Ft. Design Loading Rate= 0 GPD /SQ FT K 10 Ft. L 1Zo Ft. - A4 4poe4e Position of Force Main W ZB Ft. L IE J Feree —g K Mein W " Distribution Trench Of Pipe Aggregate t Observation Permanent 1 Pipes Markers (Anchor securely) Mound Using I Trench For Absorption Area Page y Of Perforated Pipe Detoll 0 End View End Cop ) Perforated l `e y PVC Pipe Install permanent -marker at end of each lateral Holes Located On Bottom, are Equally Spaced Q End Cop * ti PVC Force Main t Distribution Pipe Lost Hole Should Be Next To End Cop Distribution Pipe Layout P ��' Z Ft. X 3 S Inches Y is Inches Hole Diameter JIV Inch Lateral Ii(I Inches) Force Main Z Inches # of holes /pipe 1� Invert Elevation of Laterals 103.0 Ft. �r Place 1st hole �_ 1 Z.from tee with succeeding holes at 3 5 intervals. Last hole to be next to the end cap. Combination Septic;Tank and PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS' PAGE S OF 6 -VENT CAP WEATHER PROOF JUk1CTIOW BOX 4 "C.I. VENT PIP APPROVED LOCKING lO' FROM DOOR, MAWIiOLE COVER wITM .rIIJDOW OR FRESH wARIJll.l6 L P.6EL A R IIJTAKE TI-C, r.�pu�r f I (3 b M P.-Y- . - I 16 "MIA1. � PROVIDE I -- - LET - 7 AIRTIGHT SEAL I I I I APPROVED JOIIJT � g FF�S S A I I i / �K APPROVED JOINTF W C. I. PIPE W /C.I. PIPEDR Tank construction I II ALARM shall comply with I ILHR (83.15 and 83.20 a ( I I I I ok, C I ao•6 -� I I_LI_V, f T PUMP — ' J OFF D COLICRETE BLOCK I 3" APPRo,et, - KI5ER EXIT PERMITTED OFJLy IF TAW MAIJUFACTURER HAS SUCH APPROVAL SEDOINQ SEPTIC f 5PECIFICATIOKIS DOSE TAL11C MAIJUFACTURCR: h' W I> ZZU � S T NUMBER OF DOSES: 3, PER DAB TA FAZE: [ UC GALLONS DOSE VOLUME I ALARM MANUFACTURER: Ste T) S�Sn S INCLUDIWCa BACKFLOW: 18 .5 GA LLONS MODEL IJUMBER: lGl "W CAPACITIES: A= I OR 14DO'0 GALLON SWITCH TYPE: �Z eCJ� l 5= IIJCHES"OR L4 1 G( LLOLAS PUMP MANUFACTURER: C.a 9 IAlCHES OR $ CL ' S GALLOWS MODEL NUMBER: 5 D = INCHES OR I68.4 GALLOWS z 800 SWITCH TYPE: MOTE: PUMP AUD ALARM_ AR TO K � MINIMUM DISCHARGE RATE 3q' GPM INSTALLED ON 5EPARAT1 CIRCUITS P OFF Au DI RI UT OIJ IPF_ �Z' �3 E ET IFFERE CE E WGEU PUM 0.. ST B I P F VERTICAL D kl D T + KIIJIMUM NETWORK SUPPLY PRESSURE 2 5 O FLLT F Y + � FEET OF FORCE MAIN X 3 ' 0 � orj.FRICTIOLI FACTOR_. ZZ FEET .— TOTAL Oyk7AMIC HEAD = Z O .0 S FEET Pump chamber DIAMETER ILITERIJAL. DIMLW5tokli OF TANK: LEk1GTH — ;WIDTH ;LIQLIIO DEPTH BOTTOM AREA 231= — GAL /INCH GAL /INCH AS PER MANUFACTURER Y"1 p FO R�"Z1 C�. GV`�V t5 c r 6 • Goulds Submersibl �- Effluent Pump a EPO4 EP05 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- • Homes components. Available for automatic and tic cover with integral handle • Farms Motor: and float switch attachment e manual operation. Automatic • EPO4 Single phase: 0.4 HP, points. •Heavy duty sump 115 or 230 V 60 Hz, 1550 models include Mechanical • Water transfer Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with 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 U, 60 Hz, 1550 RPM, construction. Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- 9 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. CO. Canadian Standards Association � • 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 I: carbon- length, SJTW with end in " plastic enclosed design for F or "AC ". ca sea ca bon g Improved performance. ) rotary/ceramic - stationary, three prong grounding plug 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 I k _ I • Capable of running + i dry without damage to s 30 ! -. SGPM' components. 1 Pump: EP05 $ • Solids handling capability: 0 25 1 /4" maximum. I ! a i • Capacities: up to 60 GPM. 6 20 • Total heads: up to 31 feet. • Discharge size: 1 1 /2 " NPT. Z 5 • Mechanical seal: carbon- c i�!•RS h► N 39. rotary/ceramic- stationary, a 4 04) ( i EP05 BUNA -N elastomers. o i • Temperature: 3 10 104 °F (40 °C) continuous f 140 °F (60 °C) intermittent. 2 EPO4 1 5 0 00 10 20 30 40 50 GPM r L L L 0 2 4 6 S 10 12 m °/h CAPACITY © 1995 Goulds Pumps, Inc. Effective May, 1995 R'2R71 Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1905 - - TDD #: (608) 264 -8777 �sconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary October 15, 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 AP )VAi Identification Numbers APPROVAL EXPIRES: 10 1001u Transaction ID No. 251633 `T Site ID No. 182349 COUNT` SITE: =^r�r �Ui7;G ` Please refer to both identificati on numbers, correspondence with the agency. above, in all corres Site ID: 182349 ',.,. � _ .. _.._.. ., ,� w,i -' p St. Croix County, Town of H i , �✓' SW1 /4, NW1 /4, S16, T29N, R19W —` Subdivision: Parkwood Meadows - lot 10 Facility: Richard La Casse/La Casse Custom Homes FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 495667 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. 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, It DATE RECEIVED 10/07/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 #erard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM jswim @commerce.state.wi.us Wi Wisconsirs Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Humah Relations Division otSafety & 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 not limited to vertical and horizontal reference point (BM��' cc n , %,of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance a ad_.' ', ' 020- 1029 -00 APPLICANT INFORMATION- PLEASE PRI N, INF "*AT10N R VIEWED B DADTE ZS PROPERTY OWNER: J Pfsil7P RTY LOCATION LaCasse Custom Homes, Inc. /l!/ GOVT; OT SW 114 NW 1/4,S16 T 29 N,R 19 5�or) W PROPERTY OWNER':S MAILING ADDRESS I �` `_' IJ LOT BLOCK # SUBD. NAME OR CSM # 521 McCutcheon Rd. sT CX 1 110. 3t., na Parkwbod Meadows CITY, STATE ZIP CODE ❑VILLAGE KrOWN NEAREST ROAD Hudson WI. 54016 �1`. 81 -�� Hudson Meadowood Ln. :k ] New Construction Use [X] Residential / Number 4 [ ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .5 bed, gpd /ft trench, gpd /ft Absorption area required 500 bed, ft 500 trench, ft Maximum design loading rate • bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) 102.45 ft (as eferred to site plan benchmark) Additional design / site considerations 1i�t system el. based on confour line of el. 101.45' Parent material Outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL I HOLDING TANK U= Unsuitable fors stem ❑S ❑U ®S 1:1 U1 0 ❑U Z]S ❑U US ❑U ❑S ] I 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>d� .................. 10 r 3/ none 1 2msbk mfr cs 2f .5 i .6 2 2 -27 10 r 4/4 none sicl 2msbk mfr Qw I 2f .4 .5 Ground 3 27 -31 10 r 4/4 none sil 2msbk mfr C1W if .5 .6 elev. 10 ft. 4 31-65 1 Depth to limiting fac or Remarks: Boring # 1 0 -13 10 r 2/2 none 1 2msbk mfr cs 2f .5s .6 2 < 2 13 -30 10 r 4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 30 -39 7.5 r 4/4 none is Osq mvfr QIW if 1 .7 .8 elev. 4 39 -59 10 r 5/4 c2o 7.5 r 5/8 ms sil M na na na n .2 1 01.8 ft. Depth to limiting factor 39" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200 Ave. New P WI 54017 Signature: Date: 7 -7 -99 CST Number: m02298 PROPERTY OWNER LaCasse Custom Homes M L , D E S C R I P T I O N REPORT Page 2, of 3" PARCEL I.D. # 020 - 1029 -00 e. Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourb3y Roots GPD /ft ................. in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh .................. ................. .................. ................. .................. 3 „< 1 0 -13 1 2msbk mfr cs 2f .5 .6 2 13 -28 10 r 4 4 n ne sicl 2msbk mfr qw 2f .4 .5 ee Ground 3 28 -55 10 r 5/4 c2 7.5 r 5/8 ms /sil M na gw na n .2 1 0 0e.8 ft. Depth to limiting factor 28” Remarks: Boring # Ground elev. ft. — Depth to - limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) r - STEEL'S SOIL SERVICE Gary L. Steel LaCasse Custom Homes, Inc. 1554 200th Ave. CSTM2298 SW4NW4 S16- T29N -R19W New Richmond, WI 54017 MPRSW -3254 town of Hudson (715) 246 -6200 lot #10- Parkwood Meadows 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 or may not be as shown as permanent lot lines were not established at the time the test was conducted. N \l i 1 ";=40' = top of NE lot stake C el. 100.00' t. BM.= top of mid -lot survey stake C el. 100.90 qj 2 l� 1 a 1 0o L Gary L. Steel 7 -7 -99 .r- • ` ' ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer AC4 6 SA dCO21e d /&C, Mailing Address ^ S / 10 C- a � c Property Address -50 G e. R --c., ,•� l o (Verification required from Planning Department for new construction) City/State (Y�� Parcel Identification Number LEGAL DESCRIPTION Property Location 6W ? ' /a, _M u) '/4, Sec. 1 , T ZE N -R Town of u.S►a4,L) Subdivision l iR �r K y Xd Ea sln 1, 0-!C% . Lot # � Certified Survey Map # /L/ , Volume , Page # Warranty Deed # Volume O q Page # Spec house yes ❑ no Lot lines identifiable P ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification statin g your septic tics stem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 P Y P da of the three ar expiration date. Y - 2 2 SIGNA F 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 operty describ above, by virtue of a warranty deed recorded in Register of Deeds Office. 9 zc - SIGNATORE,& 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 Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed VOL 981 17 STATE BAR OF WISCONSIN FORM S - 1982 KATHLEEN H WALSH PERSONAL REPRESENTATIVE'S DEED REGISTER OF DEEDS i ST. CROIX CO., WI DOCUMENT NO. RECEri'ED FOR RECORD Howard IAVe — 02 -19 -1999 11:30 AM _ PERSONAL REPRESENTATIV as Personal Representative of the estate of CERT COPY FEE: 17 Aetna IsVenttlre COPY FEE: — TRANSFER FEE: PECORDING FEE: 10.00 PAGES: 1 for a valuable consideration coneys, without warranty, to — — LBfass re e Custom Has, Inc., a Wisc oG — rpoiation Grantee, THIS SWAGE RESERVED FOR RECORDING DATA 9 the followin g described real estate in St. Croix County, State of Wisconsin (hereinafter called the "P NAME AND RETURN ADDRESS roperty "): Heywood & Cari, S.C. Box 125 Hudson, WI 54016 '3 SW z of NW z of Section 16, Township 29N, Range 19W, St. Croix Canty ! Wisconsin. 020- 1029 -00 THIS PROPERTY IS IN THE WELL ADVISORY AREA. _ _ ilFl ATION NUMBER' r This is in tial satisfaction of a Lsrtd Contract dated February 18, 1S99, Recorded in Vol `7 - t Page & it R h f< Personal Represer ve by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedents wrath, and all of the estate and interest in the Property which the Personal Representative has since acquired. A Dated this 181H day of February —• 19 -- 9 (SEAL) (SEAL) • Howard LaVenture Personal Representative Personal Representative AUTHENTICATION ACKNOWLEDGMENT Signature(s) H ward IaVenture State of Wisconsin, ss. — — County authe rfczted this 18 ay of FebtttarY 19 99 Personally came before me this day of 19 , the above named Smn,el R. Cari (LE MEMBER STATE B OF WISCONSIN — `n authorized by §706.06, Wis. Slats.) to me krx wn to be the person who executed the foregoing instrunuru and acknowledge the same. THIS INSTRUMENT WAS DRAFTED By _ He fyot - )e & C ari, S. C. Box 125 k Hu dson, WI 54016 _ Nixan' "ubhc, County, %\ is. (Signatures may be authenticated or acknowledged Both are not My a mmission is permanent. (I[ nut, state expiration date necessary) `— • Names of pe:wn, �pir.A in inv oapano sN)utd to irped or premed Ir',. ,heir <ignaiures. STAf E BAR OF N'ISGU \SI\ NhsCOns�n rega' 31ank e . me PERSONAL RFPRFSFNTATt \E'S DEED Form ho. S- 1482 '.Llw9uk . V>s. UKAIIVAUE o 33' :N . EASEMENT , N 89'46' .. - ° ..... o ..........I........ .. 400.00 . .... ... . 3 774.$ 8 .............. ............. !?. ....... .. to 3 EXISTING o o g 'O HOUSE v � ° jjO "°' � °, n - - 5 q- ° 3 2 ' 2.836 ACRES ° 2.319 ACRES ° .- 9 123,529 S.F. z 100,996 S.F. $ 2.319 ACRES g 2.319 ACRES ZA :� 2.319 ACRES $ 1 I 100,996 S.F. z 100,996 S.F. 01 • 100,996 S.F. z I 1 I I n M $ 2.504 ACR. (� 100 I z 109,075 S I� Ip � 5' , I� • 245.40' 200.0 N 89 W 1261.40' . 20 .00' 89 4 yy�97 216.00' 20 ?�Tt 0' 200 216.0 N 89 °46' 00" W 216.0 216.00' ao ' w 1 75.15' I iC4 7 0 tO ,N � 2.099 ACRES N u N - N Op C 91,438 S.F. I c M •- C M N N 89 °46' 00" W 397.75' o� 1 u� 3 a $ 195.01' ►� - e is 8 F:� z . DRAI AGE �;. 5' -- `° -- �' �i to to 8 jZ I g EAS MENT 1 O ) 1 1 0 12 ° ° 13 _ o o F, . 3 2.565 ACRES z 2.508 ACRES ° 2.505 ACRE 8 2.985 ACRES 109,228 S.F. z N o0 p,,V' 2.101 ACRES o 30 S.F. z 111,738 S.F. 109,126 S.f I g5. 6'L 91,519 S.F. 9 yti \ LO •'' N 90 00" w 398.10' o L ANE _ ° 25.00 373.10' z M 1�L r \ I 73' 19 . 25 gl _Z 1 �i I S 89 E 451.73' 100' � I--- - - - - -- -z N 89 W 400.03' r 2.450 ACRES 16 ��y ti ' / y ��' �' _. 106,716. S.F. / 200 �' _ ' tk 50 Of ^.-- 20' - - li' 3 3' 33 ,1 33 , w w 3 I h ��O o �� I .00, CIM4 S- 89 °53' 29" E 0 I� °,$ ,°'."� 14 - - ' I i g tn, c :�0 2.755 ACRES _ � I N 9 °53' 29" 1/ - - - _ _ _ _►� °•- o 'Ng 120_000 S.F. - C) fir- ---- C �' .o ire 0 (n Zo z rn 29 ul _ 0 b I I c c ^ -- -20' -'� o 0 1 .- so .- I of 2.928 ACRES I I O 127.564 I . I �i S .F. , o. o 4 0 S 89 o , " 53 .( 2 29 • o • f� 8 M .....11O.P.4: E 2.419 I ACRES • • • N 105,385 S.F. 180.00' :w o � 7 ••, N 5 25 H I I 100' N 89 0 53'29" IN ;N 392.77' irn o ° Ig DRAINAGE 8 -P 1 • ` z w .N.O.C.U129" w .N EASEMENT °:� ' Sg 1 ,� o Q< f. .-:o �^ 2.525 ACR , 0 2 •4.04.13' 180.00' :° - N 109,997 S.F. o: ' N $9 ° 53' 29" • •INN 3 0 ' °- °o_ 4 � ° in• ao rn - � o o 2.389 ACRES � g ' - I"' 104,082 S.F. N N ' ' N 89'53'29" W x400.0 27 w' Loo 2.320 ACRES t N 250.00' �, 150.00' 1\ 101,066 S.F. �Y I u. I ( �9e�;•: N AQ °FZ, inn