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HomeMy WebLinkAbout020-1491-02-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Counly --o----- Safety and Building Division St. Crob INSPECTION REPORT Santary Perms No GENERAL INFORMATION (ATTACH TO PERMIT) 648405 Sla'e Plan ID N Personal information you provide may be used for secondary purposes )Privacy La:v s 1 fi.'la i 1 )P•ij Permit Holder's Name City VillageTcwnshi Matthew Lardinios P Page' Tax" TOWN OF HUDSON 020-1491-02-OOC CST BM Elev. Insp, BM Elev. BM =Descnpfi�nn. Section/Town:Pangelhlap No. 13.29.19.3133 TANK INFORMATION ELEVATION DATA TANK SETBACK INFORMATION BLDG. Venl tc Air Intake ROAD R PUMPISIPHON INFORMATION (Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist to Well .avr" MOAVRP 1 Ivly J T b I tM STATION BS HI FS ELEV. Benchmark All oe. SVHI Inlet SUHt Outlet Dt Inlet Of Bottom Header -War Dist. Pipe Bot. System BEDRRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid Cepth SETBACK INFORMATION SYSTEM TO PIL BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Mamlfl[Hirer Type Of System, UNIT Model Number nl-RTRIRIITIArU cvereu Header/Manifold joisirmution x Hole Size x Hole 5 acm Pipes) P 9 Vent to Air Intake Lenglh Dia Length Dia Spacing enu inure - - - -- - x vressure systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded'Sodded .. f,tulched 113ed/Trench Center Bed,Trench Edges To soil P Yes No Yes No --v..n..�r. r .,• lincivae code discrepencies, persons present, etc ) Inspection #1: Inspectior 02 Location: 859 CRANE HILL TRL 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional information. SBD-6710(R.3/97) Date lnsepcIDr s Signature Carl. No �1 f s4,v- 20z3-001 2. 2023 Dep rtment of Safety c�ST CROIX G E' & Pro ional Services, Sanitary Permit Number (to be filled in by Co, ) Ied_Ngt Services DivisionS— SaniizOerrnit Application State TranvaclionNumber In accordance with SPS 383.21(2), Wis. Adm Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note. Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) purposes in accordance with the Privacy Law. S. 15.04(l Km), Stats. 1 (Klt av Property Owner's Name t Parcel N Matthew Lardinios f %j4I-DV l& /-flRc.,�jno is 020-1491-02-000 Property Owner's Mailing Add ss Property Location 8 9 ran Hill Trail Govt Lot City, State Zip Code Phone Number Hudson Wi 54016 section 13 T29 N R 9 , Lot# 0 1 or 2 Family Dwelling — Number of Bedrooms 4 2 Subdivision None ❑ PublirJCommercial — Describe UseBlock Crane Hill N ❑ City of O Village of ❑ State Owned — Describe Use "CSM �N6 �/O Town of Hudson y ' rAjNew S stem Y ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) ❑ Holding Tank Econvo:�=onal At-Grade ❑ Mound ❑ Indivdual Sne Design ❑ Other Type (explain) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Dare Issued Expiration Design Flow MEEMENEW Design Soil Application Ratc(gpd/si) rml Area Required (sf) Dispe Area Proposed sf)` 'System Elevation 600 •7 857 900 91.9 twarBl g Tank Information Capacity in Gallons Total Gallons N of Units Manufacturer L t 'E ( ' ' I j/,�'�I. I�p� O �•L "(� l �—'1 L' ! 1 ^ 1 News Tanks Fxumg Tiiiti.s ��U,,JJ _ -2 �, L�, 45 {i 0 a Septic t< Holding Tank X 1250 WI E S E R X �6 tbm6a 4 the turetri iR� irilYt� tar t+.andttrr of #,b11oslijws N 11e attiAN riv Plumber's Name (Print) Plumber's S1 MPIMPRS Number Business Phone Number PAUL R KOEHLER 225410 715-246-2660 iariher's Address (Street, City, State, Zip Code) 21 WISCONSIN DR NEW RICHMOND 54017 . - . Issu' g Agent Signature o ` K Approved rmit Fee ❑ Di ed Permit ❑ &Awrd�ason �� Date Issued Z IZpZ for Denial 9 3 Conditions Approve M OWNER.�1DaaF(S ' 0 a Septic tank, effluent filter and dispersal must be serviced 1 maintained as per _ management plan .'rcvided by plumber. e I setback requirements must be maintain /vNe) Sv 71"'Qo-+e Gt/t.�ta0 iA- uSV' VDIZOI 16 . 51 J� `e01� cy So�� �e�i -- vt1 SBD-6398 (K 03/22) A x ��;``Q C ronc Ni II Lots pPq \ SCalc. i fit `` 1 GOPN CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Matthew Lardinios Owners Name: Owner's Address: 859 Crane Hill Hudson Legal Description: 1 /4 1 /4 sec 13 t 29n r 19w Township: Hudson County: St Croix Subdivision Name: Crane Hill Lot Number. 2 Parcel ID Number. 020-1491-02-000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross -Section Page 4 Fitter Specs Page 5 Maintenance Information Page 6 _ Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans DesignerMumber. � � , License Date: Number: p Phone Number Signature DeeWW 0""nt t0 fla! In -Ground SON Abearptlon Component Manual for POWrS Version 2.0 SBD.10705-P (N.01101). Page 1 ;ronc N�I� f1�j{,c W AfA nibs �r oso-IY9�-OZ-ono Scalc. r 3• S.J90 �Tr�,v.e 1 /rev. ;Pis) I 10 1:.44t . .010 I SOIL ABSORPTION SYSTEM DETAIL I GRAVELLESS; LEACHING UNIT Pap_ot-_ Project Name: Matthew Lardinios 2 NO. Of CWIS 3 a Call Wkfth 90 a Cell Length 3 fl Coll Spacing 9 Per Call 18 Total No of 10 .50 eq ft FJSA Per Coil .900 sq ft Total EISA EZ1203M-50 25.0 EZ1203wim 10AY 50.0 Gravelleas Leaching Unit Manufacturer. infiltrator Gravelless Leaching Unk Model: loft Finished Grads ft Plumber/Designer Signature: License 225410 Typical Cross Section Observation Pipe with approved cap or vent Soil Backfill Geotextile Fabric Z ... n Infiltrative Surface ft Limiting Factor Data: feb6th �Slotted and Anchored Vent/ Observation Pipe with Cap PaL &N3Xnrawtam in Murt, DrahuqZahel• & Wntmatar ProductsA Wzion of Po" kc. PL-525 Effluent Filter PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. Features: • Rated for 10,000 GPD (gallons per day). • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" SCHD 40 pipe. • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover. PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace and secure septic tank cover. 1/16" Filtration Slots Accepts 4" & 6" SCHD 40 pipe CSC Outdoor SmartFilterm Alarm Polylok, Zabel & Best filters accept the SmartFdter® switch and alarm. Alarm Switch (optional) Accepts 1- PVC Extension Handle Rated for 10,000 GPD 525 Linear Ft. of 1/16" Filtration Slots CertNlad to NSF/AN51 Standard 46 Gas Deflector Automatic Shut -Off Ball u Extend & LokTM Easily installs into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com 4" CAS WLP1250-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2- BOTTOM: 3' CAST -A -SEAL COVER: 5* MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 52 1/2" LENGTH: 10'- 0 1/4" WIDTH: 7'-0' BELOW INLET: 41" LIQUID LEVEL: 36" WEIGHT: 8.810 LBS, INLET AND OUTLET: 4' CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: 0 w <cr as w A in OUTLET IV) I I a 7• M a I a U am a I 2 j' I I a n i� ARE ofN WISCONSIN. SEE DETAIL 010 (OTHER STATES SEE CHART) c o W � LIQUID CAPACITY: 34.81 GAL/IN L W HOLDING TANK: �. OUTLET HOLE PLUGGED co ACTUAL CAPACITY: 1.323 GALLONS Ln Coo z LOADING DESIGN: 8'-0' UNSATURATED SOIL Q.� u1 TANK CAN BE USED AS: tod SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN /B (NO FIBER) o z 00 1i1 j TANK: MIX DESIGN /10 (STRUCTURAL FIBER) � CUSTOMIZED TANKS: 3 FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: J j I 0 _N U g F s a OF wiaao.n+. SOIL EVALUATION REPORT rain I ar—'k-14 to awardum wine Como $5, wit. Aft Code Carney Attars gift plan On Papa gal k g man a % n l l Indus in sin. Plu WHO St. Croix S`r �iu.iled W. atier and borimnbd reins. point (BW direction and I.D. C do le err d' note gnaw. and BM refnenoed to nv roa� j it by - QL Aftie Pleami pt all lafmonation r+ >� pvvt& my be yea y 1„•ra F4PR2"071 GY4 / /g Rolling Ridges LLC. rJum ram V. u s f3 r N R 19 f w properly Owner's Ma ft Add= t o s Block 0 SubQ Now or CSW,1 ` 965 Alexander Rd. 2 rP. , . Wit � l cry sme zip code Phone 10 City ❑ Village 0 Town No" Road Hudson WI 54016 651-248-0390 1 Hudson Alexander Rd. ® New Construction Use: 0 Residential / Number of Bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or Commercial - Describe: Parent Material Loess over Outwatb Flood Plain elevation if applicable N/A ft. General comments lad rteommendatbn: Install the system in the third horizon. 160A . fit; J Bo ft * 0 Pit ro Ground Surface Elevation 99.9 ft. Depth to Limiting factor > 110 in. ©�� ©sue®■�a�� ❑ Boring 2 BorinB # Wit Ground Surface Elevation ft. Depth to Limiting factor > 10G in. Horizon Depth Dorrinnant COW Redw Description Texhirs sevch a Consistence Boundary Room GPW 'M1 OEM 1 0-10 10YR3/2 - SIL 24-gr mvfr 95 3f 0.6 0.8 2 10-39 10YR4/4 - GRS 0-s9 ml 9w 1f 0.7 1.6 3 39-105t 10YR4/4 - S 0-69 rnl - - 0.7 1.6 1 n5 all �� c.�► � � ('1• � . or 0Rn1..bar.a(N1�an<7]0. A_andme>an<1Sa.gA_ •rmiuma2- Roo. <30null. nod TSS < 30 mall. CST Nuae (Pkae Print) Stpnonre CST Nraober Mark Iverson -r-Yl..0 46672 Addtess pre Evnimbon Conducted Tdcpbmc Number P.O. Box 155 Hammond, WI 54015 Aught 30, 2017 715-796-5664 �—G 7- property owner Rolling Ridges LLC. � / Parcel [D# JPage �_of ___�_"f Boring # Boring ®Pit Gmmld Surface Elevation 98.6 R. Depth to Limiting factor > 105 in. �^ DaPM In. lor Redox Deeeriptlon SL Cwt Collor'E1Kt SOucture Con @YW Boundary RootsSON 1 2 0-12 12-42 42-105 t7.5YR4/4 'EfW2 - - 7VGRS 2-f-bk 0-ag O-69 mfr ml rrd ga 9w - 3f 2f - 0.6 0.7 0.7 1.0 1.63 1.6 E Boring 0 Boring Wit Growid Surface Fle tim A ✓vt/Y. W Y.W NY1a .�b.V. _ aI. Florizern Daplh DomYrnnt Color Red.Oaseriptlon Taranae Saurlure CornalMerra Boudary Roots 'E1l1 'EfiM2 Boring # 0 Boring ®Pit Ground Surface Flev■H.,., a -•- Horizon Depth DontirraM Cetor Rod" Description Terdnpe Spur M Consyparnoa Bttnrrrdary Roots in 'EMI 'EO2 • Eeluennt A 1- BODs> 30 c 220 mg& nd TSS > 30 5150 mg/L • Effkwd 02 - Bt7l), < 30 mall. and TSS < 30 mg/L The DeparttrIent of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or Need material in an elternue format, Please cOnW the depa wwn at 608-266-3151 or TTY 608-264-8777. POWTS OWNERS MANUAL & MANAGEMENT PLAN RLE INFORMATION °wrier Matthew Lardinios Permit nccrnu Number of of Bedrooms 4 Number of Public Facility Units ❑ NA (E7 NA Estimated flow leverage) Design flow IpeakI, (Estimated x 1.5) 400 aUd 600 Soil APPlcation Rats al/d Standard Influe rtt/Effltrent Quaky .7 alld /ft2 Monthly average• Fats, on & Grease (FOG) 530 mg/L Blochemicel Oxygen Demand (BODs) 5220 mg/L ❑ NA Total Suspended Solids fTSS) SI50 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD6) S30 mg/L Total Suspended Solids (TSS) S30 mg/L ❑ NA Fscal Col'tforn (gsometrk mean) St04 cfu/100m1 Maximum Effluent Particle Size Ye in die. ❑ NA Other: ❑ NA #Vakres typical for domestic wastewater and septic tank effluent. Septic Tank Capacity Septic Tank Manufacturer Effluent Filter Manufacturer Effluent Filter Model Pump Tank Capacity Pump Tank Manufacturer Zp Manufacturer Model Pretreatment Unit Pays I of 2 LbU gal ❑ NA WIESER ❑ NA POLY LOCK ❑ NA 5 ❑NA al Ot NA 60 NA !D NA JN M NA Sand/Gravel Filter ❑ Peart Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other: Dispersal Call(s) ❑ NA Q In -Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip•Uns ❑ Other: ❑ NA ❑ NA ❑ NA Service E~ Inspect condition of tank(*) Service At bast once every: 3 Frequency morntt(al Pump out contents of tank(s) sl (MnMt 3 years)) ❑ NA When n combined sludge anti scum -- equals one-third (Ys) of tank volume Inspect dispersal cellls) ❑ NA At bast once every: 3 ❑ month(&) Clean effluent filter serfs) (Maximum 3 yens) ❑ NA At bast once every: ( I a) Inspect pump, Pump controls & alarm At bast once every: • ORont ❑ mortth(a) ❑ NA Flush laterals and pressure test ❑ am( sl Q NA Oti»r: At beat once every: ❑ month(al earl ❑ aerial � NA ether.M At bast once every: m (a) O❑ NA MAINTENANCE INSTRUCTIONS Q NA Inspections of tanks and dispersal cas shall be made by an individual c Master Plumber' Master Plumber Restricted Sewer; POWTS In carrying one of the following licenses or oertif Inspections must include a visual ins sPector, PDWTS Melmainer; ncations: inspection of the tanks) to ides ' dw g Operator. Tank measure the volume of combined sludge and scum and to check identify any beck up or hardware, identify any cracks or leaks, The diap n a cell(s) .hall be visually inspected to check the effluent bveh in the observationgof effluent on the ground surface. Of effluent an tits ground surface. The pondmg of effluent on the ground surface may indicate pipes falling condition for �po immediate notification of the Iocal regulatory authority. requires the requires the When the combined accumulation of sludge and scum in any tank equals one-third (Y) or more of the tank volume, the errors contents of the tank shag be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Coda. All other services, including but not limited to the Servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals of St 2 months, shah be performed by a certified pOWTS Maint A sakner. ervice report shall be provided to the local regulatory authority within 10 days of completion of any service event. Fags Z of Z START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal owls). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump Lanka may fill above normal highwater levels. Whan power is restored the excess wastewater will be discharged to the dispersal cattle) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintakner to assist in manually operating the pip controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; tat; foundation drain (sump pump) water; fruit. and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code; • All piping to tanks and pits "it be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septsge Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid materiel. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: l' A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and walla. Failure to protect the replacement area will result in the need for a new soil and she evaluation to establish a suitable replacement area. Replacement systems must comply with the rubs in effect at that time. ❑ A suitable replacement area is not available due to setback and/or sod limitations. Barring advances in POWTS technology a holding tank may be installed as a lest resort to replace the failed POWTS. wfilalu ,q, o mg ank ai TKPti19TfSi] �bQ.A% L'OI�JST7[CJC4lDN ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rubs in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALIM Name COUNTRYSIDE PLUMBING Phone 715-246-2660 .. ..,� �mn! ^DCanTno 10,II1aPFR1 Name POWERS SEPTIC Phone 715 715-246-5600 POWTS MAINTAINER Name PAUL R KOEHLER Phone 715-246-2660 LOCAL REGULATORY AUTHORITY Name S C ( 20AIIAJ Pboinel —71s— 3g40— (0 D ode This document was drafted In compliance with chapter Comm 83.22(2)(b)0Xd)&(f) and 83.5411). (2) & 131, Wisconsin Adminietr — C �1w� Kcrwu j •r 1• �p ssi - JA 0 FRONT ELEVATION FRONT/GARAGE ELEVATION N to lit a cn Z lilt V=Er w ck: 6 Q32� Ol t wi-.Y ftt -t END/GARAGE ELEVATION �.m ---------------------- ...-..____..____...______.,___. __--_-_.- _-.. aro mnf •sw REAR ELEVATION BID SET —NOT FOR CONSTRUCTION I S — a L BID SET —NOT FOR O N CV N I p 7 Z CV h >t .. p V H V � C4 Vorl co� a:tih Wgoj 41Ntq L O N CV M YuhNrpoh � N�«btn FLLy 3° 5 KlcuT SIDE ELEVATION I/I"- l'-0" LEFT SIDE ELEVATION BID SET -NOT FOR CONSTRUCTION 0 N M N to to O t` U IQ !� V �a?ht � co Nt �aoF,o 4�Nizz IlAlln}Ip¢f, k +�ocwln r.r qa i iR M �.I T ryRf I ✓ q. .� tiI r1I -N'T gM.pry .FR MY "may � 4 �u w/r r/snrr - ITI I I4L �r omws SVlfl � ' wsr . •m ti is tiw � 1 r/1M[ � Y ✓/ti./F/a M/ qti Ire � T MrY nqv� wFw / r x If1100Y �r R wu,/� ra• m . M� ✓ R r.rYp rs W ✓R T/ peYIS en/.. e~w SECTION/2 .ti e K... ,. cosRri iT... u.r MI.IR rOW TYPICAL HALL SECTION 112'-1'-0' 1 _ M04 MY � Yl0/I10R T i C SECTION#3 r/t"=t'-0" BID SET -NOT FOR CONSTRUCTION [ nsiNcnic omo� O h N N h � n V y co Cwa Z p�4 Z O�Zy � C4 Vtoc� vZ � Z, W041� A:12i4 IulWnpon k 4w ialn qir 77. R-r,-„ ma ar, 5�5 ST, CR NtTY. SANITARY SYSTEM Rles: OWNERSHIP/ADDRESS FORM cmated 2aOffice o�ty .�reon Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Pro e{�rty Files Scanned weblink. OWNEKMUYER INFORMATION Owner/Buyer Matthew Lardinois Mailing Address 859 Crane Hill Trail City/State/Zip Hudson WI 54016 Phone Number (required) 715-914-7274 Email Address (required) mlardinois80@gmail.com Parcel Identification Number 020-1491-02-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location -5Wt/+ , N� '/+ , Sec. 17T Z2N R_ftW, Town of Hudson Subdivision Plat: Crane Hill Trail Lot # 2 Certified Survey Map #f , Volume . Page # Warranty Deed #t I I Sci( 3g (before 2006)Volume Page # Number of bedrooms 4 Spec house O yes ■ no Lot lines identifiable ■ yes O no New W ss (Staff Initials) OFFICE USE ONLY t (fK -rrE 41« -MI, (Verification of new address required from Community z16 (Date) (LS for no construction.) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. Now System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St Croix County Government Center 715-245-4250 Fax cdd(a)sccwi.aov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.00v State But of Wisconsin Form 1.2003 WARRANTY DEED Document Numbs Document Name BY THIS DEED, Rolling Ridges, LLC, a Wh>cossin ►� llabitl con (hereinafter "CAumor," whether sae or more tY per ), convey and warrant to 4ew Lard& and Valerk Lardinois, husband and wife as survivorddp marital Pry ' er Grp" whether one or more), the following described real estate in St Croix County, State of Wisconsin: Lot 1 County Plat of Crate Hill of Hudson, Town of Hudson, St. Croix Cotmty, Wisoonmo r — Exception to warranties: easements, restrictions and covenants of highway under tight• of way; and Municipal and zoning ordinmces and agr �p and furdler except real estate taxes accruing in the Year of this conveyance. Dated S�Prrynsrr,e 22 2otL Rolling Ridges, LLC, a Wisconsin limited liability company AUTHENTICATION Signature(s) authenticated on Tom: MEMBER STATE BAR OF WISCONSIN authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFI ED BY St Croix County Abstract &Title Co., Acy Andrea S. Carpenter at the direction of the Grantor. 22-S34453 1159138 BETH PABST REGISTER OF DEEDS ST. CROIX CO., wl RECEIVED FOR RECORD 09/23/2022 10:13 AM EXEMPT*: REC FEE 30.00 TRAMS FEE 600.00 PAGES: 1 "The above recording information verifies that this document has been ekttronkally recorded t returned to the submitter Recording Area Name and Rehm Addrms St Croix County Abstract & Title Co., Inc 575 N. Knowles Ave., Suite SB New Richmond, WI 54017 M1491-02-0pp Parcel Ido,uficaO°n Number (PIN) This IS NOT bomestead property. (fGVt... N I S!ir0 "" dc; cr 1 a` r • Q ,p`., ti P '0Zi12b0 Nd ....��`. ACKNOWLEDGMENT STATE OF WISCONSIN } St. Croix COUNTY } n' } Per "O"Ry came before me on 9 -.2/- VWa.;- the above -named David Robson, president of RoWar 6 LLC, a VVIwondn liaalted HabDity a mnaav to me known to be the penon(s) who executed the foregoing same. +ns menitrut lmowledged the Notary Public, Stau of wisconsm MY Commission (is permaneot) (expires: iw Nrylg: THIS 18 A STANDARp may be audwatfutad or acknowledged, Btu are cat accessary.) FORM ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDEPrMED. 7ypee name WARRANebbe�� O 21M3 STATE BAR OF WISCONS4V FOAM NO. 1-2sa3 St. Croix County 1159138 Pape 1 of 1 : SEPTIC LOCATION 4 db H F R: RA E HILL OF HUD ON 0 100 200 l� 9up 1 SB SiORry''63 429.54 ( �� i olFll '13 Y SB L2BI \ o 937.27' 5B L28M: 6 a L2BM3 - -SB L?B3__._ 937 2� �\ l S8 L3 Q35.20- -R5 .92 i 9r , I LOT 2 ; sB � � -Area-: 5.00 i O 1 931.80 930 ` .28 =- DENOTES SOIL 2 BORING LOCATED s` o ON 9-13-17 \ NORTH CORNERSTONE LAND SURVEYING, INC a `SLIT i:J IISUL- 14 �t- a�ilmvm ° <I "S03°37 2(, , _ 133.22' / LOT 15 ��SI .49 S.096 ACRES 221,976 SQ.FT. so.00' 36 5 r`�3�08, LBO=957.0 1 p_49-W C38 5 3'wso..W N83'08'57-W / 64 � 9BE �2.p7� STT3g5 1L 58—;— E- 117.49 62.E CRANE -N1l� C6 50.00' SA t �N1T3g5DE \0 as o00 H.W.E. s4'-{ -----� ----------------- II =929.6 V �� D&U ! 146 �C30 C8 �. SLOT 1 (S l 4.948 ACRES 21S,S27SQ.FT. zI LBO=936.0 N1 �� LOT 2 5.002 ACRES s h 217,900 SQ.FT. 1 I LO DRAINAGE I I� LBO=936.ODIW�cE f �� N S.000 EASEMENT `O (� EASEMENT o ^ 217,79� H.W.E.=934.0 I I ��3^'-4 H,W,E.-934.0 ' I, LBO— I°00 •.\<s �' I � ems.=�� •\�� , 357.82' `4 7L.aL0. EAST -WEST 1/4 LINE OF SEC. 13. "29N, RIGW C. 13, T2clN, R19W s C / LOT�_25 �T 2 _. r. rr-. I AAC- ^rin W(FIRST I D SOIL EVALUATION REPORT Pa ]_ of 4 w�57.lnclule (t, %59 ant Nil �el Diviy to In accordance with Comm g5. Wis. Adm. CodeSt. Croix & IA P t r on not Icss than g 'e x 1 I e poin ii PI ust Parcel LD.Qzo'1491-02.-000 but not limited to: v _rlic and hori�nntal reference point IBo�s�o! gRr tlYrtension , north arrow• and BM referenced Revi ed b)Datc m peve'oo print all informationPmation you provide may be used for secondary purptnes lPnvacy law, s. I5.041l ) n PropertyLocation 1-1 19 W roperty Owner Ciovt. Lot N V" v. S 13 T 29 N K Rollin Rid es LLC. 0 a0 - I - 0 - °"O Yoperty Owner's Mailing Address Lot # Bhxk # Subd. Name oIr CSM# 2 Cftin< h.�1 13 a`i. ►q. 3133 965 Alexander Rd. Nearest Koad State TpCodc Ihone ❑ City ❑Village 0 Town Alexander Rd. Hudson WI 54016 651-248-0390 Hudson Code derived design flow rate _ _GPD ® New Construction Use: ®Residential !Number of Bedrooms � x ❑ Public or Commercial - Describe: -- ----- - ------------- ---- -- ❑ Replacement Parent Material_ Loess over Outwash - Flood Plain elevation if applicable N/A _ -- - fl. he sNs ginning the nage casement at 65" ow surface ystem be General comments and recommendations: areadupsluns, to 13 4 as the rstall eplacement arlc�Bring B-4twlas initially completed 15` north of the location shown boundary (see page). on the map. There was muc an mg an re uce sot ow t c an sat this location. St. Croix county inspector Ryan Yarrr tablegion . on the m the soil at B 4 and agreed that the redox was no longer present at B-4. The redox north of B 4 is not a result of a high water table. 1 Boring # 0 Boring Pit Ground Surface Elevation 99.9 ft. Depth to Limiting factor > l 1 in. Soil Application Rate Roots GPDW Horizon Depth Dominant Color Rtfdox Description Texture Structure Consistence Boundary ,Effatt Efflt2 Gr. Sz. Sh. , in. - - - Munsell - _ Qu. Sz.. Cont. Color ml gS 3f 0.7 1.6 1 0-10 10YR3/2 GIRLS 0-sg , GRS 0 sg ml gw 2f 0.7 1.6 2 10-53 7.5YR4/4 ml - 07 1.6 3 53-110+ 10YR4/4 S 0-Sg ❑ Boring q�} in. Boring # Wit Ground Surface Elevation F/ -q- ft. Depth to limiting factor _ _ Soil Application Rate ' — � RedoxDescription Texture Structure Consistence' Boundary Roots - GPD/ft2 'EffMt EfF#2 1 n. 1 unsell Qu. Sz. Cont.. Color Gr. Sz. Sh. , 0.8 Horizon Depth Dominant Color' • in, Munsell -- SIL 2-f-gr mvfr gs 3f 0.6 GRS 0 sg ml gw 1f 0.7 1.6 2 10-39 10YR414 - ml 0.7 1.6 �— S 0-Sg 3 39-105+' 10YR4/4 t e GF 17 • I[Blucnt 42 = BOD, 136 mg11, and I SS 5 30 mO, • E luent # I = BOD.> 30 5 220 mg/L d lSS > 30 < 1 SO mg/l. C'S"f Number CST Name (Please Print) Si rc 46672 Mark Iverson Fete hone Nunrlxr lYate I{valualion Conducted Address August 30, 2017 / Nov. 9 2018 715-796-5664 P.O. Box 155 Hammond, WI 54015 L6T .2 Property Owner Rolling Ridges LLC. 13 Boring ParcellD# — Page 2 of 4 - aBoring # @Pit Ground Surface Elevation 98.6 _ft, Depth to Limiting factor >105 in. Horizon Depth ! Dominant Color Redox Description in. Munsell Texture Structure Consistence Boundary Roots ' Soil Application Rate Qu. Sz. Cont. Color Gr Sz. Sh. ry GPD/R' •Eff#1 •Eff#2 10YR3/2 GRSL 2-f-bk mfr 2 12 42 7.5YR4/4 --_ VGRS i 0-sg 9s ml 3f 0.6 1.0 -105 , 10YR4/4 - - gw 2f 0 .6 GRS 0-sg ml 0.7 1.6 - - - -2• SV -. ❑ Boring Boring # @Pit Ground Surface Elevation 101.3 ft. Depth to P Limiting + b factor 105 in. Horizon Depth Dominant Color Redox Description n_ Nl3insell Texture Structure Consistence Boundary Roots Soil Application Rate , -- ; - _ Qu, S2. Cont. Color 1 0-7 10YR3/2 Gr. Sz. Sh. •Eff#t •Eff#2 — - - 2 7-20 7.5YR4/4 SIL 2-f-gr mfr gs 2f 0.6 0.8 _ - 3 20-31 7.5YR4/4 SIL 2-f-gr mfr gs 1f 0.6 0.8 4 31-46 10YR4/485YR4/6; GRS GRSUS p-s9 0-sg MI s ' 9 1f 0.7 1.6 5 46-53 7.5YR4/4 ml Cs 0.5 1.0 - 6 j 53-105+ 10YR4/4 ! FS 0-m mfr CS - 0.5 1.0 _ - - i S 0-Sg ml 0.7 1.6 Boring Boring# Wit Ground Surface Elevation ft. Depth to Limiting factor in, Horizon ' Depth i Dominant Color j Redox Description in. Munsell Texture Structure Consistence Boundary Roots Soil 4 l Dtion Rate ; Qu. Sz. Cont. Color- Gr. Sz. Sh. i _ •Eff#t •Eff#2 I ; i • Effluent N I = BOD,> 30 < 220 mg/I. and TSS > 30 < I50 mg/1- • Effluent #2 = BOD, < 30 m I'/l. and "rSS < 30 mg/l. The Department of'Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Need material in an alternate format, please contact the department at 608-266-3151 or'f-IY 608-264-8777, V anC oil �p 4JfJ 3�Qz f I I I I I I II II II II II II II I! II � I � - SOIL BORING LOCATIONS AND BENCHMARKS SHOWN HEREON WERE FIELD LOCATED ON SEPTEMBER 13, 2017. -CONTOURS SHOWN WERE DERIVED FROM AVAILABLE LIDAR DATA AND NOT FIELD VERIFIED. 40 80 0 NO „„ r CORNERSTONE LAND SURVEYING, INC. Wisconsin SOIL EVALUATION REPORT C S7- aw- 19*? Depertrnent Commerce Page � _ of Divisip�o(fejlpl u�dings In accordance with Comm 85, Wis Adm, Cock REAttach h ` to site Ian on C°u^ty p paper nut IcSs than 8 /, x I I inches in sire. Plan must St. Croix SEP I/I�IG�c I limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. P[br nt slopc.-S lc or dimensions, north arrow, and BM referenced to ne��l roadC 1� S 020 - 111l - 02 - 00c) CRp��Gp2�NptP,MEW Please print all information {�� i jRc�C p,r, pVhltrn yuu provide may tx used tix secondary purp r F4PR2XV071 GY4 J ppW11wner Rolling Rid es LLC. tAt v. v. s '[3 "r 9 N k 19 W 'roperty Owner's Mailing Address Lut # Block # Subd. Name or C•SM# 965 Alexander Rd. 2 �•, ; l iq State Zip Code Phone U ❑ City ❑Village 0 Town Nearest Road Hudson WI 54016 651-248-0390 Hudson Alexander Rd. 0 New Construction Use: 0 Residential / Number of Bedrooms_ Code derived design flow rate ❑ Replacement ❑ Public or Commercial - Describe: Parent Material Loess over Outwash Flood Plain elevation if applicable _ N/A fl. General comments and recommendations: Install the system in the third horizon. Z6 A - 7eC _l Boring # 0 Pit Ground Surface Elevation 99.9 ft. Depth to Limiting factor > 110 in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary in, Munsell - Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-10 10YR3/2 - GRLS 0-sg ml gs 2 10-53 7.5YR4/4 - GRS 0-sg ml gw 3 53-110+ 10YR4/4 S 0-sg ml Boring # ❑ Boring Soil Application Rate Roots GPDW •Eff#1 'Efl#2 3f 0.7 1.6 2f 0.7 16 0.7 1.6 OPIt Ground Surface Elevation 9J. q g. Depth to Limiting factor - Horizon Dinth Dominant Color Redox Description Texture Structure Consistence Boundary Roots i Soil Application Rate GP_D/ffz Qu. Sz Cont- Color Gr Sz. Sh.. 'Efh11 'Eff#2 1 i 0-1 O 10YR3/2 SIL 2-f gr mvfr gs 3f 0.6 0.8 2 10-39 10YR4/4 GRS 0-sg ml gw 1f 0.7 1.6 3 39-105+ 10YR4/4 S 0-sg ml I 0.7 1.6 1 nS4c.l1 Z4-94c!c t lie- • I'Muent # 1 = BOD,> 30 < 220 mg/I, and TSS > 30 5 150 mg/I. • Effluent #2 = BOD, < 30 mM. and "I"SS < 30 mull - CST Name (Please Print) Signature CS'r Numbcr Mark Iverson ,,e 46672 Address 17ate I valuation Conducted Telephone N'umtxr P.O. Box 155 Hammond, WI 54015 August 30, 2017 715-796-5664 property owner Rolling Ridges LLC. Lei -2�, — � Boring Parcel ID#__ -- Page _ 2 of X `Y / Boring # 0pit Ground Surface Elevation 98_6 J ft. Depth to Limiting factor >105 Horizon j Depth 'Dominant Color Redox Description is Munsell Texture Structure Consistence Boundary Roots Soil Application Rate i Qu. Sz. Cont. Color 1 0-12 10YR3/2 Gr. GPD/ft2 •Eff#1 •Eff#2 2 12-42 7.5YR4/4 GRSL 2-f-bk mfr gs 3f 0.6 1.0 - 3 42-105 , 10YR4/4 VGRS j 0-sg ml gw T 2f 0.7 1.6 GRS 0-sg ml - 0.7 1 g Boring # Boring BPit Ground Surface Elevation Horizon Depth ! Dominant Color Redox Description in. _ Munsell_ Qu. Sz, Cont. Color ft. Depth to Limiting factor _ in. Texture Structure Consistence Boundary Roots SoiIAGPDMt`ion Rafe i Gr. Sz. Sh • 'Eff#1 •Eff#2 ' f Boring # 0 Boring opit Ground Surface Elevation _ ft. Horizon Depth Dominant Color' Redox Description Texture in. Munsell Qu. Sz. Cont.-Color • 1 Depth to Limiting factor in. Structure Consistence Boundary Roots Soil Application Rate Gr. Sz. Sh.I GPD/R' 'Eff#1 •Eff#2 '':Muent # I = ROD, > 30 < 220 mg/I. and Tss > 30 < 150 m t. � • L tiluem #2 =ROD, < 30 mg/I. and TSS < 30 mg/l. The Department otY'ommerce is an equal opportunity service provider and employer. Ifyou need assistance to access services or Need material in an allemate format• please contact the department at 608-266-3151 or'1-1'Y 608-264-8777. SEPTIC LOCATION 11, �{ FOR: CRANE HILL OF HUDSON 0 100 200 DENOTES SOIL BORING LOCATED ON 9-13-1 7 CORNERSTONE LANE) SURVEYING, INC r 41ro MG IX couNrY NO. 648405 STATE SANITARY PERMIT _ 859 CznNt ew-'nu- PREVIOUS NO. PLU TOV SEC AND/OR LOT 2 BLOCK �- 72A* HILL OF Nu�al SUBDIVISION EXPIRES CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described In the permit. (b) The approval of the sanitary permit is based on regulations In force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not Impair the validity of ■ sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (1) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,27p; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. D ISSUING OFFICER - DATE �. UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONST UCTION SBD-06499 (R11/20) bertakJAW a'� • 4 f4 Jf' 1 i • i i r. 1 .•'s, L A MI L2B3 -f L2B1 _ - L2BM3 MGM= L2B2 I I