HomeMy WebLinkAbout020-1357-21-000 0 N 0 R 0 r�
o �, f c d o d r/1
M m CD 0 m v tv +1
O W = = N O
' 0 (D (D (n 0) C W N
(O' < <
p Q 7 G ,,, U t p - �
W r l
CD N N E O O N >• —1 N J "S
O O £� N d (D O O O
0o W C C : N 7 Cn O
S N , o O
m m w
(D v _ f N
� (o ci a m
W a
W O C O �
i N �
CD N ::p 0 (D OZ � 0) N
cn
N ( D D O � C C
O a M
CD
CL 0 0 0 m•
d
cn D o j m V�
3 N y N m
3 - W o v IA
m
m 'm °_' CD A
co
v N
A z i z O il
D CD O !V
N o >
N 3 T "NA m CD 0 o y
w O C /y
N v L � 7 f
G T N
3 O O
CD (v00 6
co
C A A n
d
A z
CC
W ..
(D < W W
Cl. z
3 r: C/) g
z
O A
A
< Q
o a m =
CD v C
CD
a N Z G
O C '`
O D z
O N O
O
n �7
N
I ca
CD
I � �
(D o
a
I � a
CD z
ti
I �
(D ti
F
N
ID A
< 7 c O
O p �
0 O y
b
0 E V
NVisconft Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM County:
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)]. 353255
Permit Holder's Name: ❑ City ❑ Village (]KTown of: State Plan ID No.:
l aves. Thomas I Town of Hudson
CST BM Elev. - - 1 Insp. BM Elev.: t BM Description: Parcel Tax No.:
O 150 O 4 a - 020 - 1357 -21 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 7,eo Benchmark 3.3 o t
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St / Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet 6. qt) qlo •q
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet --
Air Intake
Septic �� ` f f -S ` NA Dt Bottom
Dosing NA Header/Man. et S qD
Aeration NA Dist. Pipe 5 2q `
Holding Bot. System 17.0 1`f 30 r
PUMP/ SIPHON INFORMATION Final Grade
Manufacture Demand St cover . 3 x•48 t
Model Number GPM
TD H Li Friction TDH Ft
Forcemain Length Did. Dist. To Well
SOIL ABSORPTION SYSTEM `t .
TRENC Width / Le t i No Of renches PIT No. Of Pits Inside Dia.
DIME DIMENSION
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACH G u acturer:
SETBACK CRAM
INFORMATION Typeo ��' 60 �Z CH M o e Num er-
System: ,
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) f u x Hole Size x Hole Spacing Vent To Air Intake
Length / � Dia. Length �( p g
S Dia. t S acin
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over I$ — 1 (2" 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 1 Inspection #2: -
Location: 848 Waldroff Farm Road, Hudson, WI 54016 (NW 1/4 SW 1/4 23 T28N R19W) - 23.29.19.2095
1.) Alt BM Description =
2.) Bldg sewer length= ���
3� �- amount of cover = > I $
0zac
Plan revision required? ❑ Yes 1@ No I
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert No.
1
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
Y r m _
c
3 a �
. s
F
c t
�
I E [
s
s a
}
t t
r-4- �.. ®��..�.. m 4--m -
J'
v • Safety and Buildings Division
SANITARY PERMIT APPLI N 2 01 W. Washington Avenue
isconsin P o Box 7162
,:.
Department of Commerce In accord with Comm 83.os, Wi �o�1e_ _t �^ Madison, WI 53707 -7162
• Attach complete plans (to the county copy only) for the syste ; on pa ril� le CrSun
than 8 1/2 x 11 inches in size. PR EEI EU reec, , aL
(� b
N
i
Perm
t itary
_
Permit Number • See reverse side for instructions for completing this applicaitiflr , �, Sta [CQv r
ego
Personal information you provide may be used for secondary purposes
ST G�dX if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. C�CkNdTY
Review Transaction Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INS RK
Property Owner Name Pry erty L
o� /t T N, R ` of E (or)
Prope y Owner's Mailin Address Lot Nu Block Number
4 e12 614 fe,- ; l .2
City, State Zip Code Phone Number Subdivision Name or CSM Number
!t G` - d •✓ t,J C it �
II. TYPE BUILDING: (check one) ❑ State Owned It� Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms � Town OF e - dso.rJ /J ✓d
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) - 'L ) 9 , Zof
1 ❑ Apartment/ Condo O
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 gg New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
____""System System Tank Only Existing System ________ Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number 39 7�S Date Issued (2r(o - 9
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 W Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 1 1 r 43 ❑ Vault Privy
14 ❑ System -In -Fill ZZ . T iwm�
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.) (MinAnch) Elevation
10 Q d 7510 d e Feet Qe. Feet
Capacity
VII. TANK in Ca allo s
g Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks
New Exist Tanks n strutted
Septic Tank or Holding Tank r ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber 1 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: o Stamps) PRSW No.: Business Phone Number:
c 41& lJ
Plumber's Address (Street, City, State, Zip d ,
rJ 7 G
43 � Q
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signature (No Stamps)
O Approved []Owner Given Initial Surcharge Fee)
Adverse Determination 50, OD 1 (,--5 286(
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
Z 1
r �--
t
C
SBD -6398 (R.12/99) ISTRIBUTION: Original 4a County. One copy To: SafetLA 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 76399) 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 thissanitary 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, dra3vn to scale QT 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 regu ?ated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
l ass
i6a',
,r
c�
r
v
V
tI
N v
6 ti •�
r
1 G
t
G
e
vvisuuiism uupiumu nt or 1.,ommerce SOIL AND SITE EVALUATION j 3
Divi$ion of Safety and Buildings Page of
Bureau of Integrated Services in accordance with -It r"8,3,09,,Wis. Adm. Code
Attach complete site plan on paper not less than B 1/2 x 11 inches i z ?Ian mu County
include, but not limited to: vertical and horizontal reference point irectior�P S
percent slope, scale or dimensions, north arrow, and location an � nce to n e Ar4el I.D. #
APPLICANT INFORMATION - Please print a!I In lion. �� ;, ' 1 R ' wed by Date
Personal information X
you provide maybe used for secondary purposes (Pri qr w, s. 15.
Property Owner
�� 114_5-4,) 1 /4.S T �,N,R E (or)Ny' kyl
Property Owner's Mailing A ddress # Subd. Name or CSM#
9
c hi t t y // State Ziip Code Phone Num ❑ City ❑ Village [9 Town Nearest Road J `
1 . � ���'^' (N f � J � � ✓O �J °P +i�� �5 G' /l� .Y� d�Ys �/' �l�'.'[.!'L
[� New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow g::�Dd gpd Recommended design loading rate ; bed, gpd/tf trench, gpd/11
Absorption area required _ bed, ft 2 D trench, tt 2 Maximum design loading rate f 7 bed, gpd/ft trench, gpdM
Recommended 'infiltration surface elevation(s) Z! y !Z2 ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material �,�•" �a 7',W, 54 Flood plain elevation, If applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank
U = Unsuitable for system I X S ❑ U 29s El U ®S ❑ U &S ❑ U ❑ s ®U ❑ S EXI U
SOIL DESCRIPTION REPORT
Boris # Horizon Depth Dominant Color Mottles Structure P t
Boring Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. Bed Trench
.75JY d i S . )M e-111-1
Ground
�L��Ln• _
Depth to
limiting y - 'O
factor L
in. 3
Remarks:
Boring #
,t1,� y:
D 3 �J .2 Al '
9 E€
WIN F7 R,
Ground
8 eV.
y�ft.
Depth to
limiting
ftclor
in. Remarks:
CST Name (Please Print) Signature Telephone No.
" & d 3-e �
Address Date CST Number
a za 2 rrr
SOIL DESCRIPTION REPORT
PROPERTY OWNER �� �h 4�— Page _'? of 3
PARCEL I.D.#
Boren # Horizon Depth Dominant Color Mottles Structure 2
Boring in. Munseli Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed Trench
a
4 O /D GY .2 h1 !" v
`>>�
Ground
elev.
S o 1y2 —
Depth to _ /-
limiting S3 •G r �- 4 ,
M or, ,
fin.
Remarks:
Boring #
s`
a E ,.
Ground
elev,
ft.
Depth to
limiting
tactor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GED/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. Bed Trench
Boring #
r
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
e
Ground
elev.
ft. '
Depth to
limiting
factor
' Remarks:
SBD -8330 (R. 07/96)
o/n 1 a e A 3 0! 3
_min c ,y
JA IOL6 tV, u l6D; a ✓
y ro
if
a�-
��
�
•
R�L
L
I
\ v�
I
a
J
wo-U F
Safety and Buildings Division
SANITARY PERMIT PPLI ! N 201 W. Washington Avenue
Visconsin a � � � P O Box 7302
.
Department of Commerce In accord with Comm 83.05, W . /C�I _1 -1 _., ` Madison, WI 53707 -7302
• Attach complete plans (to the count co only) for the s st a A less` Colunty
p P Y copy Y Y i p
than 81/2 x 11 inches in size. - / ' Mc6li - 0 - Ere— ti'o -
comp leting this a lic $ Stl�te Spnitary Permit Number
• See reverse side for instructions for com
p 9 pp ;y rsf'z 3s3 2s�
Personal information you provide may be used for secondary purposes I I ❑tChe¢k if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. CR�x
Ian I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL I � ��1@�Wc <`
Property Owner Name o erty L 1 n
,a S i �1�IA oC 5 T,20 r N, R/F E (or a
Property Owner's MailincjAddress B lock Number
e
City, State Zip Code Phone Number Subdivision Name or CSM Number
w�
A) t ( ) fr e_ -e-,v 4�5s T
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit Nearest Road
❑ Village
Public g 1 or 2 Family Dwelling - No. of bedrooms 9L Town OF dS' ,cJ GJ oI ? rYr•
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1❑ Apartment / Condo D a Q /3s 7— �1 o
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. j. New 2. ❑ Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
------ Syrstem ________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 ❑ Specify Type 41 []Holding Tank
12 05eepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 E] Seepage Pit � � 43 E] Vault Privy
14 ❑ System -In -Fill
VI. ABS SY S 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) Gy ye Elevation
$`lJ
77 r Feet e Feet
Cap acit y VII. TANK in gallo s Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existin structed
Tank Tanks
Septic Tank or Holding Tank [ ; ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ 1 ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP/ PRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zi Code): )
l G Lc �.SOr GL/
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps)
surcharge Fee)
pproved ❑ Owner Given Initial
Adverse Determination 4 " C
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
.SBD-6398 (R 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRIJCTfONS
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 Divisioa, 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.
Vlll. 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.
91J
�V
� U
n�
c v
o .
.,`
�b
13�
�/ d
r
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Pagel 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
Po ( ) P
not limited to vertical and horizontal reference po int BM , direction and % of slop e, scale or PARCEL I.D. # 0� D — 13 5 Zt--
dimensioned, north arrow, and location and distance t8rroad, n7n i non r�
APPLICANT INFORMATION- PLEASE PR ,f , INFORMATION RE WED BY DATE
z -6-
PROPERTY OWNER: F q �!1 P ROPERTY LOCATION
Kennon J. BAst '� ~ f ` �`U GVT. LOT 1/4 1/4,S 23 T 28 N,R lg(or) W
PROPERTY OWNERS MAILING ADDRESS _ J1� ; t, # BLOCK # SUBD. NAME OR CSM #
948 LaBarge Rd. � 8 fc' 21 na Evergreen Estates II
CITY, STATE ZIP COD 'PHONE k CITY [:]VILLAGE [�Q WN NEAREST ROAD
Hudson WI. 54016 7 v x/775 Hudson Waldroff Fm. Rd.
[� New Construction Use [ Residential / m�e� 00Ms +, �' [ ] Addition to existing building
[ ] Replacement ( ] Public or commer sr ri
Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft •8 trench, gpd /ft
Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate 7 bed, gpd /ft •8 trench, gpd/ft
Recommended infiltration surface elevation(s) 94.90' ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material pitted 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 fors stem ®S ❑ U ® S ❑ U ®S ❑ U ❑ S L3 U ®S ❑ U El S L U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trertdi
-12 10yr3 /3 none 1 2msbk mfr gw 2m .5 1.6
M1.......... 2 12 -26 10yr4 /4 none sil 2msbk mfr gw 2f .5 .6
Ground 3 26 -84 7.5yr4/6 none ms Osg mvfr na na .7 .8
elev.
98.0 ft.
Depth to
limiting
factor
+ "
Remarks:
Boring # 1 0 -9 10yr3/3 none 1 2msbk mfr gw 2m .5 .6
`'....2.:` 2 9 -24 10yr4/4 none sil 2msbk mfr gw lm .5 .6
3 24 -90 7.5yr4/4 none ms Osg ml na na .7 .8
Ground
elev.
9 8.6 ft.
Depth to
limiting
factor
+90
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. New Richmond W 40 7
Signature: Date: 6 -16 -99 CST Number: m02298
PROPERTyOWNER Kernon J. Bast SOIL DESCRIPTION REPORT Page 2 * of 3 M
PARCEL I.D. # 020 - 1020 -90
Depth Dominant Color Mottles Structure GPD /ft ,
Boring # Horizon Texture Consistence Bax>dary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr&
1 0 -12 10yr3 /3 none 1 2msbk mfr gw 2m .5 .6
2 12 -30 10yr4 /4 none sil 2msbk mfr gw 2f .5 .6
Ground 3 30 -34 10yr5 /4 c2d 7.5yr5/6 sil 2msbk mfr gw 2f .5 .6
elev.
9 8.3 ft. 4 34 -84 7.5yr4/4 none co S Osg ml na na .7 .8
Depth to
limiting
factor
+
y lb
Remarks:
Boring #
1 0 -8 10yr3 /3 none 1 2msbk mfr gw 2m .5 .6
2 8 -24 10yr4 /4 none sil 2msbk mfr gw lm .5 .6
3 24 -30 10yr4 /4 c2d 7.5yr5/6 sil 2msbk mfr gw 2f .5 .6
Ground
elev. 4 30- 84 7.5yr4/4 none co sog ml na na .7 .8
ggc ft.
Depth to -
limiting 8
factor
+84"
Remarks:
Boring #
1 0 -12 10yr3 /3 none 1 2msbk mfr cs 2m .5 .6
2 12 -32 10yr4 /4 none sil 3msbk mfr gw 2f .5 .6
3 32- 84 7.5yr4/4 none ms Osg m1 na na
.7 .8
Ground
elev.
97.5 ft.
Depth to
limiting
factor
+ 84 1,
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92) j
STEEL'S SOIL SERVICE
Gary L. Steel Kernon J. Bast 1554 200th Ave.
CSTM2298 NW4SW4 S23- T29N -R19w New Richmond, WI 54017
town of Hudson 71 24 -62 00
M W -3254
5 6
PRS ( )
lot 21 -Ever reen Estates II
# g
N
1 =40'�
BM. =nail in pine tree C el. 100.00'
"Alt. BM. =nail in pine tree C el. 100.65'
'IqO
9
PO
l • r,n
I
z.
Gary L. Steel
6 -16 -99
♦ C �
Aggregate SAS
SYSTEM ELEVATION AND SIZING CALCULATIONS
Below Grade Aggregate Soil Absorption Systems
Permit Number 12/6/99 Date
X .X. Gravity Distribution
only 1 Pressure Distribution
3 ft Suitable Soil ,
6 in Aggregate Depth 2
4 in Nominal Pipe Diameter
600 gpd Estimated Daily Peak Flow
0.80 gpd /ft Wastewater Infiltration Rate
750.0 ft Minimum SAS Size
94.90 ft Proposed SAS Elevation
Soil Surface Acceptable Finished Grade EL 3 (ft)
Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum
Number Elevation (ft) Depth (in) Lowest Highest Elevation? 97.40 99.23
1 98.30 84 94.30 96.80 Yes
2 98.90 84 94.90 97.40 1 Yes
3 97.50 84 93.50 96.00 Yes
1. Depth of suitable soil required below the infiltrative surface for treatment.
2. Depth of aggregate below distribution pipe.
3. Based on chosen system elevation, and aggregate depth. The addition of
fill for cover or the reduction of finished grade may be required to meet
minimum or maximum code standards.
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
SBD- 10553 -E (R.05/98)
r t ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM.
I
O wner/Buyer r ,4, M s V s
Mailing Address ?A a aAr -- 9t ---- -
't lie
Property Address
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number D._
LEGAL DE SCRI P TION
Property Location WW Sec. _ , T� N-R_,Y_NV, Town of da �Se.rl
Subdivision I_Czi e e �J .�' T _ ,Lot # .
Certified Survey Map Volume Page #
Warranty Deed # zS . Volume Page #
Spec house ❑ yes Z no Lot Braes identifiable k yes ❑ no
SYSTE MAI TENAICE
Improper use and maintenance of your septic system could result in its premature failure to handle, wastes. Proper rrrairttenaace
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 aitd by a
rnasterphunber, journey man plumber, restricted plumber or a licerisedpumPer verifying that (1) tile on-site wastewater disposatsystem
is ur proper operating condition an&or (z) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of shldge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the st rnd3rds
set forth, hereirt, as set by the Department of Conunerce and the Department of Nawral 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 ex iration date.
/ S
SIGNATURE Oh.A. PI1CA DATE -k�y
OWNE CERT IFICATIOIN
I (we) certify that all statements on this form are true to the best of my (our) knowledge. 1 {we} ant (are) the o�4�rer(s} of
the property desctibc above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICA' 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
i -------•---------------------------------- - - - - -- -
VO 1461PAGE234 ID
STATE BAR OF WISCONSIN FORM 2. I"S KATHLEEN SS SH
Document N-,mher WARRANTY DFRD kEGISTER OF DEEDS
ST. CROIX CO., WI
wife and husband
This Deed, made between Donalda J. Speer Bast and Kernon J Bast RECEIVED FOR RECORD
10 -05 -1999 2:00 PM
WARRANTY DEED
Grantor, conveys and warrants to EXEMPT M
Thomas E. Haves and Kathleen K Haves husband and wife CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 170.70
RECORDING FEE: 10.00
Grantee. PAGES: 1
Grantor, for a valuable consideration, conveys and warrants to Grantee the
following described real estate in St. Croix County, State of Wisconsin (The
"Property
Recording Area
Name and Return Address
7
o�,v - t3S�- at�0
Parcel Identification Number (PIN)
This is not homestead property.
Lot 21, Evergreen Estates II, St. Croix Valley, Wisconsin.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any
'
Dated this day of October, 1999.
* U * d r peer- ' Rkst
* ZATE on J. Bast
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) OF WISCONSIN )
_ ) ss.
authenticated this _ day of c eA 0') K County )
_ Personally came before me this /`� day
* _ of October, 1999, the above named Donalda J. Sneer -Bast
and Kernon J. Sneer, wife and husband,
111 LG: MG1Y1D�ll J 1 A 1 L DnA vt - �i i.a%va vaa.
(If not, _ to the known to be the person(s) who executed the foregoing
authorized by § 706.06, Wis. Stats.) ins trument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY I r CAL LL'.
Attorney Kristina Ogland * f�l\.Cc.r I e.. P '
Hudson, WI 54016 Notary Public, State of Wisconsin
(Signatures may be authenticated or acknowledged. Both are not My Commissi n is permanent. (If not, state expiration date:
necessary.) � t )0d I )
MARLENE K. Lli• N
N t&ry Public -Efate of Wi1sconsin
My Commission Expires -3) uG 1
*Names of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED sTATE BAR OF WISCONSIN _
FORM No. 2 -1998
INFORMATION PROFESSIONALS COMPANY FOND OU LACY
dog
k.0
O S 00'0 1 .. E
1 N 35.48' 35.48
y o /
y /Q c4 3 $/ o /
b fU J — — — .35.48' 35.4 '
8 ' /
W �S'' 0'51 "E 7 160 94' �
N00 °00'51 "W 160.94' \ �.
ul
81- 22' B
co
b
O \ .
�� � �� a pp• \ \
X O m tJ
3
m to - 0 -i c
Z m 0 N \ `
W O m A
00 Z 3 \
® Qc c 0 �o M C
r
rl � o d ; �
ry D C r ,..� 00 �
°
OD D �
`° °° w cn
rq M- ° ° w
D Cn I�
wwww �a m D r
wwww ry
0000 °oc 3 N C7
0 0 9R N m 5D ;
Z m
UI o UI W Z
0 00 10 A %0 � CO !
►' zra N D %,D j t 1 c
CO ��
D GJ IV �
C:)
M
' UI OD ? A Z
Q; N N 0% 0\ O
UI ? • N W .'D \
n.) Z co� w d
p� A A N A w \
£ 2
C) N \
00 \
fU o CJ1
c t- o o `V
c -NV o d W (� n /\