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HomeMy WebLinkAbout020-1330-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Cougt INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitara2r4 -i Personal information you provice may be used for secondary purposes [Privacy La, s.15.04 (1)(m)]. tffpMVer's STOPHER J. ERMS011 ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel T QxZ3!.-1J:3 U-19— ilrrn�l >kmemn h TANK INFORMATION ELEVATION DATA �, /T. TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benc hi r G . Z `fir fip� Dosing ,41�,P�tn� /�•2 (a•tc' /00./ Aeration Bldg. Se yv r /Ob•Y Holding St /Ht Inlet 106. 92 ?q TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ve Intake ROAD Dt`t`nlet / NA Dt Bottom 106 2, 1 -O ' 17 Dosing ii +� NA Header / Man. Aeration NA Dist. Pipe 7 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer G c4 t Demand u ,,,,, ( ( `Djo 7,ZS q5' 9S� rlu� Model Number GPM TDH I Lift Friction System -, . TDH Ft orcemain Length Dia. a � Dist. To Well F l SOIL ABSORPTION SYSTEM ' BE THE CH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liqui Depth DIMEN __T_ 75 DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING anufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: system,046 (Fa- OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length I Dia. Q Length S 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 El Yes El No E] Yes El No COMMENTS (Include code discrepancies, persons present, etc.) LAC fTTON : HUDSON 2 3.29.19 , SW , NW 714 � WALDROFF FARM RD — EVERGREEN EST. Al4, /9 A ^ p� MArd( 0fttV'd< _ W W4kkj » #L T(/ )b�1� 5(rv0( y s# NS 1 d o f� Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert No i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e E r 3 e i e ; 3 . m [ r a # E ° ( 4 ° r 3 r ` i { 1 3 j ° em_. ., e. T .... ...... .. .,.:�.... tt. ..... .,.......... ......: .. m ,.... .. -—.. � +.ewe . », Z i �- i m d � ➢ € 5 S r 3 ( } 4 m' e x i t ; a ,.r,�. . , .�. ... :, q �.....e. ., . ..,.s...... .., .... ... .., ... Ewa ..... .._. �..._.... sa ....� r .— ,,,. -... �. ....gy 3. n ....� ...... ...,, _ � .�, .,.. C .� „.. .�� .........� ° q � 3 ®� r mm . � t i i a i E i £ E � t k k p a . b 2 t { F a ' 4 .,.. .,.. 7 i � t � E 1 f e.:. Me °A� e ,� w"-k•. g .,....m,... a —..ter ...*« . m m o- _ 3 3 SANITARY PERMIT APPLICATION Safety and Washington Division Vi scons i n 201 W. Washin ton Avenue I P O Box 7302 Department of Commerce n accord with ILHR 83.05, Wis Adm. Code Madison, WI 53707 - 7302 • Attach complete plans (to the county copy only) for the system, on paper not less County r than 81/2 x 11 inches In size. � • See reverse side for instructions for completing this application State Sanitary Permit Number a Personal information you provide may be used for secondary purposes ,.` `I� � C] Check if revision to pre Io us application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATIO O 2a 2 Pro y Own r Name Property Location LkL /a /,/ 1 /4, S 3 q , N, R l y '(or) W Property Owner aili g Addr ss V Lot Number Block Number City, tate� f Zip C Phone Number Subdivision Name or CSM Number 11. TYPE F BUILDING: (check one) ❑ State Owned it p Nearest R o Public 1 or 2 Family Dwelling - No. of bedrooms Town OF C�x�d -thl� ao III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) P 0M. I a 1 E] Apartment/ Condo O "" J33 - ,1 6 — 00 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, &New 2. ❑ Replacement 3 E] Replacement of 4 E] Reconnection of 5_ ❑ 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 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 2 ❑ In- Ground Pressure 42 E] Pit Privy 13 E] Seepage Pit 61r- 9's r 43 ❑ Vault Privy 14 ❑ System - In - Fill 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 7, JOZSFeet Feet acit VII TANK in Ca allo s g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App New Existin structed Tanks Tanks epticTank rlrtptdTiSg'Ta'nk 600 � 1 666 ❑ ❑ ❑ ❑ ❑ ft Pump Tank i4aQQQQbUj &57n t ❑ ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb 's Sign ture: ( S mps) H /MPRSW No.: Business Phone Number: RD Po Y ri� Ame 97 1 ;9,- P mb Address (Street, City,,Sta , ip Code): / , 6 / W( IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary 325 Surcharge Fee) Permit / Fee Includes Groundwater ate I ssued Issuing Agent Signature (No Stamps) �/ Approved []Owner Given Initial / Adverse Determination 7� ' /�/ / 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 -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' 11. 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 LA CROSSE WI 54603 -1905 A Visconsin Tommy G. Thompson, Governor Philip Edw. Albert, Acting Secretary Department of Comm October 09, 1998 CUST ID No.267341 ' . A7TN. POWTSINSPECTOR WEGERER SOIL TESTING & D�SIGN t A! ONING OFFICE R\ 421 N MAIN ST l S CROIX COUNTY PO BOX 74 -- ; f), 1998 11;01 CARMICHAEL RD RIVER FALLS WI 54022 _ _ ST CRUX . WI 54016 U' COUNTY r RE: CONDITIONAL APPROV ZONINGOFFICE `a •� APPROVAL EXPIRES• 10/09/200 > ;� - o Id_entfficafon plumbers ' '" Transaction ID No. 180727 Site ID No. 161428 SITE: Please refer to both identification numbers Site ID: 161428 above, mm. ll corre with the St Croix County, Town of Hudson a en SWl /4, NW1 /4, S23, T29N, R19W Evergreen Estates Subdivision - Lot 1 Richard La Casse FOR: Description: Mound Object Type: POWT System Regulated Object ID No.: 428886 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(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 09/30/1998 FEE REQUIRED $ 180.00 AerardM. Swim FEE RECEIVED $ 180.00 POWTS Plan Reviewer - Integrated Services BALANCE DUE $ 0.00 (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim@cotmnerce.state.wi.us p age of 6 MOUND SYSTEM R FCE /VE . D FOR A BEDROOM RESIDENCES SEP 3 �gg8 AFt l y & B LDDS DI V LOCATED IN THE ' V 3 1 /4 OF THE WW 1/4 OF SECTION � , T Z 3 1 N, R W, TOWN OF N1 , ST c4ZUUC COUNTY, WISCONSIN:. LOT OFV�126a- 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 ' PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR P.O.W.T.S, Collditionull R N ClA fi TLD - _LR C SSA A 0 LR e�sE cvs �Km es OVE �`- Ci QPhjc)01� LfNE. DEPARTrjFNT U� SO>J �JI S q , 31 b FE A 1NGS '�� GOFtkESP �. NCE PKEPAP BY WEGEE�ER SQ = L .TEST = NG AND. �etlN Dl�s = Gtv sl�F�v = c �P �Sc �' P.O. BOX 74 421 K. KAIK ST. ARTHUR L. RIVER FN IS. KI 54022 rTWEG a-n�, Wis. A - �'�p► �s I Gl� �. JOB NO. PLOT PLAN Page Z of ( a Scale 1"= all 0 N �O'oc j �/ y PVc x zs I / � I I I U Cr I / � I c��Z �1STc`li -t3 TIAI S R� _PA. et.toi6 �LO�`! � B °�'T0� -t eP TZS�ve.N 6TZ . l62_S' r 4� f � llJ O, lS �.► � TO �. NOTES •1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be gallon capacity manufactured by Jrv 5. Bench Mark UF 6. Divert surface wat er around system to prevent ponding at the uphill side. I . Page 3 Approved Synthetic Covering Distribution Pipe 19' STM C 3 3 Medium Sand Topsoil F Elev: lOZ.S 3 E b % Slope Force Main Plowed Trench of 2" - 2 2" From Pump, Layer Aggregate Undisturbed D \ -O Ft. Soil E \ •ZS Ft. Cross Section Of A Mound System Using F 0 Ft. I Trench For The Absorption Area G N. a Ft. A S Ft. H t• S Ft. B - I S Ft. I \S Ft. Linear Loading Rate= 6'0 GPD /LN FT J Ft. Design Loading Rate= 0.3GPD /SQ FT K �O Ft. L q S Ft. W Z o v Ft. L Force B j -F K Main A — �c- -- — — - -- — — - - M ' r W Distribution Trench Of 2 - 2' 2 Pipe Aggregate I Permanent J Observation Markers Pipes (Anchor securely) Mound Using I Trench For Absorption Area Pag Of —6 Perforated Pipe Detail 0 End View Perforated End Cap.) a PVC Pipe Install permanent marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q End Cop P f •'! ti PVC Force Main Distribution Pipe Lost Hole Should Be Next To End Cop Distribution Pipe Layout P 3y• S Ft. X Inches Y 3 Inches Hole Diameter 1 —� Inch Lateral 1 1 ry Inch(es) Manifold Inches r Force Main Z Inches #of holes /pipe \Z Invert Elevation of Laterals Ft. ZZxl,17 - lU,�yx Z= �-B -�B GP►� Place lst hole l$ from tee with succeeding holes at 36 " intervals., Last hole to be next to the end cap. Combination Sep.t:icz Tank and PLS-MP CHAM BER CROSS SECTION AND SPECIFICATIONS PAGE S OF ` WEATHER PROOF .vc T CAP JUU CTIOM BOX 4'C.I. VENT PIPE APPROVED LOCKIMC lO' FROM DOOR, MANHOLE COVER tvt'M E H � wAR � FR ESH O IJO 0 A1k INTAKE r,�Dulr s I tj I ---- - - - - -- y "lAitolcow PIPE �h -- -- PROVIDE I IIJLE T AIRTIGHT SEAL I I I . S gFFL�S � I I I I APPROVED JOINT A I I I APPROVED J0I1I7: W /C.I. PIPE OR Tank construction W /C.I. PIPE�pv� shall comply with ALARM ILHR ('33.15 and 83.20 e I II I I Ow C I LLEY FT. PUMP OFF D CO �` 8�i -o0 BLOLK 3" ApPRotiFD �- RISER EXIT PERMITTED OIJLy IF TAUK MAl.1UFACTURE.R HAS SUCH APPROVAL g600llvit SEPTIC f SPECIFICATIOKIS DOSE 3 13 TAUK MANUFACTURER: eyC IJUMBER OF DOSES: PER DAy TANK :,IZC: �.OUO ASO GALLOIJS DOSE VOLUME Z ALARM MAUUFACTURER: S'S' f-Z�TRD S`�S1�1i.S INCLUDING BACKFLDW: �,� GALLONS MODEL IJUMBER: �� t �W CAPACITIES: A= �a INCHES OR 3O , � I GALLOyg SWITCH TuPC: � B= Z INCHES'OR 3 T G�LLOUS PUMP MANUFACTURER: C-20 b C= YO INCHES OR 110 CALLOUS MODEL NUMBER: 3S 7) � D =— INCHES OR i3 y GALLONS SWITCH TYPE: M OTE: PUMP AND ALAI'm ARE TORE z �, pS INSTALLED OW SEP A RATE CIRCUITS MIAIIMUM DISCHARGE RATE GPM VERTICAL DIFFEILENCE DETWECIJ PUMP OFF AUO..D15TRIBUTIOIJ PIPE.. ` 3 ' 2125 FEIT + MIIJIMUM NETWORK SUPPLY PRESSURE .. . . . .. . . . . 2 FEET l F7 Z.SS + � �D FEET OF FORCE MAIN X .0 ,FKICTIO FACTOR_. FEET -- TOTAL DyIJAMIC HEAD = ��'yL FEET Pump chamber DIAMETER INTERAIAL DIMEIJSIOMJ OF TAUK: LEAIGTH ;WIDTH ;LIQUID DEPTH 38 � BOTTOM AREA — 231 — GAL /INCH AS PER MANUFACTURER . • GAL /INCH Goulds or- Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged 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. tic cover with integral handle Motor: Available for automatic and • Farms manual operation. Automatic and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical RP points. • Water transfer 230 V, Hz Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, , built in ovv erload with automatic reset. preset at the factory. rated oil and water resistant. • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower SPECIFICATIONS 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 built in overload with construction. • Solids handling capability: automatic reset. ■ EPO4 Impeller: Thermo - 3 /4 " maximum. • Power cord: 10 foot plastic Semi-open er: pen design AGENCY LISTING with pump out vanes for • 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 1 /2 * NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (GSA listed model numbers Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for • im roved erformance end in "F" or "AC ".) rotary/ceramic- stationary, three prong grounding plug p p . 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. i0 • Capable of running —T — -- — , LI dry without damage to s 30 components. Pump: EP05 s • Solids handling capability: 0 25 3 /4 maximum. W • Capacities: up to 60 GPM. x s 20 • Total heads: up to 31 feet. • Discharge size: I NPT. • Mechanical seal: carbon- ,Z. 5 4 rotary/ceramic - stationary, � 1s 4 BUNA -N elastomers. .* Temperature: ° 3 10 I •o I 104 °F (40 °C) continuous i 140'F (60 intermittent. EPO4 2 — — -- - -- — -- 5 1 I 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 rnth CAPACITY ©1995 Goulds Pumps, Inc. Effective May, 1995 Wisconsin oeirartnmerrt of kAfthy, SOIL AND SITE EVALUATinN - +. tPbw and Human nelaxon 3 1/ tDly dm of Seley err h . & Ma ccordance vtrilh s. ILHR 83.09, Wla. At" complete one plan on paper not Mss then a 112 x 1 t Inchee In size. Plan must Cdrny Iricltde, but not llrnitsd. to " ftel amd hoizoMd reference PON (BMJ, drecom am parcent Slope' Wak or dimensions, MM arrow. lad k>caxon hand d*Wm to nearest road. Pucel I.D. ! p APPLICANT INFORMATION - Please print- ell lnlormaflon. Reviewed by D PertonM trrlornrllon you W.M. ""W be es.d p Lary, a 16 tm�ll• Prgary Owner Properly Locseon U,�1 /QV G Coif Govt Let -4 114N#J 1/I,8 z3 T 7 - to Pr Owner's MV see f Block/ S or CSMI 337- Hipm r,� Sr A� �' / EvERG�PeE.v ESTi¢T� -S C11Y SMIs ZIP Code Phone Number � /Z Rood Pa t_ ti1N� E;5101 (61 z) tzz- SSSS u O Vaasa Town Y D AST ❑ New Conslmc0on Use: nesldeneal / Number of bedrooms 3 — Addison b sxislkp btAldfp nooncamere ySu — (] Pobac or kxhrhnerdel • Dssobe: derived deny now (O D ft ad@ e arse required S 00 bed. nZ Sd� hem Recommended design loo rate ' S Cods d bid, ppolne G ker�h, ppd* ch, ffz Maxhmen design loadkrg role ` bed, Ol1d �_ kermcm, 2 Recommended hrltthexon eureka Nevenon(s) n (as referred to ette plan benchmark) Addikxal deslgn/sils attona 7'1 T S /TE iPEr9 c! /.FMS J lO vc� O 1 Y E S J/S 7 . Parent materiel SC i'l /0 T i S,f t�� � D�I�YS p oWmft M appNcebls N p S system I In•Ground Preas T•Grade System In FIN N* u kx system p u ❑ s L g"u ❑ s Lu O s O s SOIL DESCRIPTION REPORT Boring N Norzon Depth Dominant Color Mottles Structure In. Munsee Ou. Sz. Coral. cp or Texhxe Or. Sz. Sh.. Consistence Boundary Roob t3 Bed . Trencr 1000 3 /Z SQL 2 fi irv� Cs L f . X • G around Z—Oyle L_L �� S/L Z7s7.� + eS // •s �o Deppthro cps' C3P 5 /CL /f `j " Z-' •.3 emtor S Y/Z /t- fact 5r. 515 • nernarks: Boring N $/L 2 fS6,e nsi,G 5 1 . s . L �0Y/k c 3 Oroud U 3 elev. , .f ,t r,:2 •') . 8 UJI. h Is o UPP"I to Smiti factor t " . Remarks: CST Na— (Please Prkmue Telephone No. Ro6ERT l) Slgnal • l�cr�ZLLla./ 1►ddress Dols CST Number lee 'IZO y- /9y<P CSJ Private Sewaps Consuitsnls •� 055 O'Neil nil. d Hudson, Wise Will , Wisconsin Department of Industry SOIL. AND SITE EVALUATION �, / � 3 Labor and Human Relations Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must County Include but not limited to: v 57 C al , X end horizontal reference point (BM), direction and x percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. ff PE�VD /N fs-- APPLICANT INFORMATION - Please print all Information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). , Property Owner Property Location q 1111 I&A GAN/� L'D/t Govt. Lot SGV 114IVA) 1/4,S 23 T 2 / ,N,R / / E (or) Property Owner's Mailing Address E S TT Lot If Blockff Subd. Name or CSM# f3h0K L 6 . 33Z �'•I i NN D r� Sr . / SO � UE R(r�PEC iV ES City State Zip Code Phone Number Nearest Road //IV/ /1 -IT PAU L NINe1 5510 (�I Z) 222 " SS$S El iU Village To� errZ AL-44y New Construction Use: EIResidential / Number of bedrooms 3 - Addition to existing building ❑ Replacement ySev _ ❑ Public or commercial - Describe: — 1 1 Code derived dally flow 69 gpd Recommended design loading rate S 9 9 — gpd/fi trench, gpdfft Absorption area required S O O bed, ft 2 S trench, it 2 Maximum design loading rate S ` bed, gpd/ft trench, gpd/11 Recommended infiltration surface elevation(s) 5EE Pf • 3 It (as referred to site plan benchmark) i� Additional design /site con ations TLS 7 S )(��4 01A ; - 5 A-f D u- O TY P F $ )/ 7" . Parent material SGS 8 P /'Mo T -sue} rrpE" l0-4 Flood plain elevation, if applicable S = Suitable for system Conventional Mouu In Ground AT -Gra;--u- System in Fill Holding Tank U = Unsuitable for system El S U S ❑ U ❑ S � U El S ❑ g ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /1`11 In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench �... o - /y. 10YR 3/2 51L a fsb e tita es .2 f s Q Z - o 5 2 - fShe l y l ; ® ir C' J f • s • 6� Ground J 2 � �-- 15 / /yN /D/. pl ev / t S 1e 44'.4 /usL 5 e S �� Q � � . Q Depth to limiting S yR /,-// factor in. d YR C y S s`S Remarks: Boring # 0 /0 z Z $ /L- Z fSb4 / - S / . s 2- 2 - y-`( /dYf c 3 P 5 /6L Shy 444 Ground 3 V4 S (� S el /0/. LTff. Depth to limiting factor In. Remarks: CST Name (Please Print) Signature Telephone No. Ro6ERT '2,4LBP 21 �7/ Address Date CST Number Asso cia tes �ZOv• � /�%l? CST z y�Z Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 ' NA L PRO Z PERTY OWNER SOIL DESCRIPTION REPORT 3 Page ot PARCEL I.D.11 6 r't7 S T Boring # Horizon Depth Dominant Color Mottles Structure 2 In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots f � ° Bed ; Trench � io y/? 3 � S/L a fs�e f/2 C ! 57: - Z 1 1 - 3 io y 3! <SiL /fs ,� •>~-► a w 2-: • 3 Ground 3 elev. lol.�Ltt. ✓'o o 5/CL /f Depth to limiting G factor �_in. ; .5f Remarks: Boring # 3 ZL /o LS / -so S C 7 43 Ground L l r1K. 5; elev ?S ft. 'e Depth to limiting C Z factor Remarks: SSf Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # , Ground elev. tt. Depth to limiting factor tn. Remarks: Boring # i .. Ground elev. Depth to limiting factor In. Remarks: SBDW -8330 (R. 08/95) 7:� ti c 2 yo e = /3Rc�Ckoe P i Tg Yd f3�N 5&-r. Tap ° 3 /y 7tt4,;, - c v �clL 00 r/410 � /E u�-T io � S 1 3, / O /. yZ � z5 z /O /. 3 J a3 /o /6/ /0 /. - 7 5 ty . e t3 3 1 LD 7 -14— I ' r ' X 00 boo 1� �t *ff . -5 0 er s Y's r. Ix f� UAI ; fO C A- s �a�-• 50 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S k e-Li— r! cl. G h v.�s 4 ky-jo"4 w Mailing Address dress ! 4 C o � 4 /fA /41/ -tom L Property Address L l (Verification requited from Planning l for new construction) City/State -94.,A Sm., , (LZ Parcel Identification Number ORO -1 330 - -)C -- 6cl LEGAL DESCRIPTION Z7 Property Location 15? 1/,, A&L y,, sec, A, T - L *R -L�—W, Town of _ /AL Subdivision ,l �i/ r 3 y -.et t- Lot # �. Certified Survey Map # 6 � _ �, ,,�, a., A, , , . Volume . Page # Warranty Deed # .�� 7 3 3 / Volume Page # v � Spec house ❑ yes 2' no Lot lines identifiable Oyes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can 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 masterplumber, journeyman plumber, restrictedplumber 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. 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 of the three year expiration date. �• f l /9j GNA11JR11 OF APPLICANT DATE O_ WNER CERTIFICATION I (we) certify that all statements on this form are true to the best of m Y( (our) knowledge. I ( we ) am (are) of owner(s) e property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ) the owne UO-4�� /9/ 9 tI GNATLIM OF APPLICANT DATE * * * * ** Any information that is mis- represented may suit in the sanitary permit being revoked by the Zoning Department. * * * * ** -- t* 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 '!OL FAGE58� �° WARRANTY DEED 5C378_ KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD 02 -15 -1999 2:00 PM WARRANTY DEED EXEMPT # Return Address CERT COPY FEE: COPY FEE: TRANSFER FEE: 98.70 EAGLE VALLEY BANK, N.A. PAGES: FEE io.00 1301 Coulee Rd., Unit 2 Hudson, WI 54016 Parcel I.D. Number: DaG- 1 5 -C -0o LaCasse Custom Homes Inc., a Wisconsin Corporation, conveys and warrants to Christopher I I hrman _& S helley D. Ehrman .husband and wife, as survivorship marital property, the following described real estate in St. Croix County, State of Wisconsin: Lot 1 Evergreen Estates in the Town of Hudson, St. Croix County, Wisconsin. This is not homestead property. Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this / d-y�' day of February, 1999. LaCasse Custom Homes, Inc'., / BY l�v�(SEAL) Richard W. LaCasse, President ACKNOWLEDGMENT STATE OF WISCONSIN ) 'PP ) ss 6 x COUNTY ) Personally came before me this /- day of February, 1999, the above named LaCasse Custom Homes, Inc., by Richard W. LaCasse, President to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. MARLENE K. LIMN Notary Public -State of Wisconsin * t2nv Li n n p;:, C;,mmiszion Ex1:43;' Notary Public v ; X County, WI My commission expires ` 31 1 l T THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016 i 1~i OO) co M w o Z -. X (f) �, O U O F J - N 3 d- LL V) a w \ u S0 ) 54, 231E \ \ 00 ti ^� 35 g • g0 V 0 N o ,00.b 0� , 1 � N s2 0 � s2 N � •�< O J \ �0� O ff• In \� \ �� 050 P w N ` \ N N �\ \ ' � O ,00'OOb 100'091 ,00'Otz I Q ,ZI'LSb M „15,b0o00S 3 3 ,£5' I L£ M „15,bOo00S - Q C N M g 0 C d' 0 0 N Orn r _ _ to Z io-I M M o. 0 IOA XX �Cj P�oS ■ o Q1 � O 0 � 41 l(1 Z