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HomeMy WebLinkAbout020-1491-02-000 (3)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes IPnvacy Law, s 15.04 (1)(m)) Permit Holders Name- City Village Township Matthew Lardinios TOWN OF HUDSON CST RM Flwv TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic qq Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG, Vent to Air Intake ROAD Septic �4 Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand Model Number :Z!7� GPM TDH Lift ;Fiction Loss S m H dFIForcemain LengDist. to Well enu �� rrvvr�r I ILI\ Q T J 1 r-M BEDITRENCH Width ` Lengt DIMENSIONS SETBACK SYSTEM TO INFORMATION Type Of System: DISTRIBUTION SYSTEM HeaderiManf old I I Dislr Pipe Length_ Dia Lanr SOIL COVER Depth Over Bed/Trench Center OI No. Of Trench, P!L JBLDG SdI /� ELEVATION DATA STATION I BS HI :F!S4:ELEV. Benchmark l "C�Cf7V'� Alt. SM Bldg, Sewer St/H1lnlet SUHtOutlet �.22 Dt inlet Dt Bottom Header/Man. Q a 4,17 Dist. Pipe Bol. System 7Z gZ•�1i Final Grade St r Cov FI,��d� Z3 too - l9VAOC -rurwaOA Of Pits LL LAKE/STREAM LEACHING Manufacturer . p CHAMBER OR I UNIT Model Number: x Hole Size Ix Dia Spacing x Pressure Systems Only xx Mound Or At -Grade Systems Depth Over xx Depth of xx Seededi; Bed/Trench Edges Tnncne `A4UcAcy, Vent to Air Intake xx Mulched Yes No Yes No Inspec iovn 1: Inspection ►l2: �Cl�ul COMMENTS: (Include code discrepancies, persons present, etc.) Location: ` �6�j�✓- 859 CRANE HILL TRL R3 r Cki 1.) Alt BM Description = 2.) Bldg sewer length = �, o ` p ' '° l f •n ,,,' R � � vv�C ll V t�C � 1� U -amount of cover = '�III47 I C] C�CUvuRt�Uyt. ��� �uM i�Eetck�lAl�}-eaccQ� V�UtiS � >ml.�ci, /'� 1�3t� P Out -(d-e. �V&IN a bc1 :v. �e�( P{✓ Sl all raj Plan revision Required? Yes X Noa vto ©'"` j 4(fil 1 `v'.tV Use other side for additional information, 7 / o) ! t5 Aign.t.,e SBD-6710 (R.3197) ins Can. No. f1L:ll\�� s,¢N- 20a3-601 2923 Deportment of Safety SS coin DEB & Professional Services, T CROIX st Indust Services Division Satin Permit Number (to be filled in by Co ) / Sani ermit Application State Transaction Number 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 Not Application forms for state-owned POWTS are submitted to Project Address (if different than nu i the Department of Safety and Professional Services. Personal information you provide may be used for secondary address) s in accordance with the Pnvacy Law, s 13.04(1 xm), Stats Q Property Owner's Name CRJWC— 41 L.L TR Lr Matthew Lardinios f Parcel a U�� R l l: 1-flit D f ro o I S 020-1491-02-000 Property Owner's Mailing Address Property Location 859 Crane Hiil Trail City, State Lot Zip Code Phone Number �� Hudson W 54016 r.. %, Section 13 Tyke •tllitecek ail tg,lt spy) Lot s T 29 N R g 0 1 or 2 Family Dwelling - Number of Bedrooms 4 2 Subdivision Name ❑ Public/Commercial - Describe Use Block # Crane Hill ❑ State Owned - Describe Use ❑ City of CSM Number Q Village of 0 Town of HUdson Ill. Type of PONTS Permit, (Check "Nnr" or "Repfaeestent" and other applicable on fine A. Cheek one box ON list S. Complete lime C i A. New System ❑ Replacement System ❑ Other Modification to Existing System (explain) P ) El Additional Pretreatment Unit (explain) B. ❑ Holding Tank In -Ground ❑ At -Grade ❑ Mound ❑Individual Site Design ❑ Other Type ype (explain) C• ❑ Renews] Before ❑ Revision Change of Plumber El Transfer to New Owner ist Previous Permit Numbnd tier aDate Isstred Expiration ❑ IV. Din tlll Mtment Area aril xspa4ion: Dtsign Flow (gpd) I)tsi Soil Application t7 6n ' pP Rate(gpolsf) rsal Aria Required (sf) Dispe Area Proposed SO ystem Elevation 600 .7 857 900 ----� . Capacity in Total # or 91.9 nemrW gz Q Tank Information Gallons Manufacturer Gallo Units Q � New Tonkf 6iirtiog Tanks Septic of Holding Tank X 3 a Doting nwmb ff 1250 WIESER X �5 V. Realwiitilibility Statimeatr 1, the aiadenigmed, aamtmr rrspomdbility for lastallattam of the POWTS shown om the attached Otani ` Plumber's Name (Print) Plumber's Signet ci PALIL R KOEHLER MP/MPRS Number Business Phone Number d{ 0 lr 225410 715-246-2660 umber's Address (Street City, State, Zip Code) 5'! 21 WISCONSIN DR NEW RICHMOND 54017 VI. Cons t Use Uk� Approved ❑ Di ved Permit Fee Date IS Wed Issu g Agent Signature s j O ❑ iv aeon for Denial ��� � � /�Z 3 yy Conditions Approve j M OWNER: 1 Septic tank, effluent filter and dispersal must be serviced ! maintained as per � a management plan provided by plumber. ` • *~ 2.Lsetback requirements must be maintainer All ix5�- 34 i Z°r lvqv. . 'plat for rysq� and t to fte only N pe; sot kit than in r 11 SBiD-6399 (R. 03/22) J� � 5 o � ( "� t�e a �"�^ �-•�. af- to wk MIJ-c' Ctft)C HMI( iota, M*�,G w Pr aao-+�f9i-o i-oo p CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Matthew Lardinios Owner's 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 Filter Specs Pape 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 DesignertPlumber. License Number. -.?7- , y�j Date: ,Zoa Phone Number Signature D660nad PWIMOM 1n the In -Ground Sol Absorption Component Manual for PowTS Version 2.0 S80-10705-12 (N.01/i01). Pape 1 cry Hill i Lot I vn 4ti,, w A i oS PT 0�0-��Y9r-ol-Opp w Ge s4LS 1 ' WTI �a _ Z-v -, •�4' � � is , SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Pep. a Project Name: Matthew Lardinios 2 No. of Calls 9 Per CeII 3 n Cell wroth 18 Total No of 10 90 It Cell Length 50 sq a BSA Per Cell 3 ft Cell Spacing 900 aq n Total EISA ht111raia Q120*1-� 10.0' Graveness Leaching Unit Manufacturer: Infiltrator Graveness Lsaching Unit Model: loft 25.0 Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent ■ :C� .tiY`S~:x k . td 'T '::' •}..{::■ SoilBacidill .Yr ��ti�• •>::{,■ Gsotextfle Fabric 4 4 n Infiltrative Surface 12 in � _ _ I n Limiting Factor Zf— In Slotted and Anchored VerW Observation Pips with Cap Plumber/Designer Signature: L"me t 225410 Data: feb6th PAL km - kwmuom n PW44 D„iu,, „ Zabel• & WNWAPS �r hoatutr A DMsjon of Poo* VC. PL-525 Filter PL-525 Effluent 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. 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. '06r' Filtration Slots 10,000 GPD Accepts 4" & 6" �+ SCHD 40 pipe #� NSF 71 Outdoor SmartFiltere Alarm Polylok, Zabel & Best filters accept the SmartFdter V switch and alarm_ Alarm Switch (Optional) Accepts 1" PVC Extension Handle Rated for 10,000 GPD 525 Linear Ft. of 1/16" Filtration SIots CertMed to NSFIANSI Standard 46 Gas Deflector Automatic Shut -Off Ball Extend & Lokm 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 52 j" AS REQUIRED 41" z rn UP 5" ro 4" CAS i , 1 i I .I I 5" I 1 W 1 � � I m� 7' r� \—LN--j i� u UP 7" +► 4- CAS n n I rn m D r s I D I m D r -4 r z C Z z ; -q'4 A �i 0 �g g SA-4,� �� o���oo�z x � �^ oo �o rosn so 0 Q ?C IS ooz V U.. cpsZ C N _\ CC �0 z at Q� D ggc -n _' S S N _ \Vl i m rrI m ~ A O Z N 2 g � C7 cn D LA ao n c-i0 z 0 v -� IVLA g D C � ; �7 > �H cl) w ;Q z o rn m rn WLP1250—MR MHER cawcAETE DRAW BY`"WCP1 _D REV. DATE: RE -POUR: rn \o SEPTIC MANUAL W3716 US HWY 10. MAIDEN ROCK, WI 54750 DATE: OO DD OD tOST-POUR: $00-325-8456 ni F- wIP125O-mr wit�oowsia SOIL EVALUATION REPORT 57� ap 1?� 19 PW I or-IL-14 0EXI Towel, to -, n ' oe v ilh Cam. 23, Wit Adw code • AnKh silt pfas on paper eat Iw dm i % a t t is I in aac. Plat MW coatr:y St. Croix C to: vertical rrd borimnial refr — point (BIB, dnecdw and I.D. JA SEP �k or One"i0m trorth anew, and SM RTerenew to Mr, W i 11 br - I3 i Please print A1nfernatlev ,ea pow MY be axed for seomtia, perPae IF41pR )(V 0T' GY+4 / g RoIhM N40 LLC. %WM le t vo x s 3 T N R 19 w P "OtY O «+ r MaM+s Ad&= to tt Subd Name « CSMr 965 Alexander Rd. 2cr City PbM O City O Village is Town No" Rand _Hudson WI 54016 651-248-0390 Hudson Alexander Rd. 0 Now Consvuction Use: 0 Residential / Number of Bedrooms Code derived design flow rate GPD O Replacement ❑ Public or Commercial — Describe: Parent Material Loess over Outwash Flood Plain devation if applicable NIA & General eommaeats sad reeomaseidatdum Instep the system ion the third horizon. 26%4„ W Baring # 0 Pit -�e Groamd Surface Elevation 99.9 it. Depth to Limiting factor > 110 bLv Sol Rob lloriaon Depth Dorttfeant Color R-11- Ouse VHm Tenn Sbuftm CauftI noa Boundary Roobr apye 'EMI 'EM2 1 0-10 10YR312 - GRLS 0-t30 ml ps 3f 0.7 1.6 2 10-53 7.5YR4/4 - GRS 0-69 ml 9r 2f 0.7 1.6 3 53-110+ 10YR4/4 - S 0-" MI - - 0.7 1.6 21 F BOrm'g OPiit� GrouW Surlace Elevation i t%. ft Depth to Limiting factor _ in. liorlxon Depth Daft"COW Rod= Daaalgan TOO" wu&n Conaf WIM "Wr eotrtttary fls Roots 3f Wve SON 0.6 'EM2 0.8 1 0-10 10YR312 - SIL 24-gr 2 10-8 10YR4/4 - GRS 0.49 ml gw If 0.7 1.6 3 39-105+ 10YR4/4 - S 0" mI - - 0.7 1.6 i ss ant �� c✓� h� or • Mum m 01- BM> 30 5 220 mall. mad TSS > 30 5 130 mull. • Emuem 02 - BM 5 30 =WL and TSS 5 30 ata/L CS1' Name (Pluto Prim) sure CST Number Mark Iverson 46672 Adders Date Evah afim Corrduoed Telepbme Number P.O. Box 155 Hamrimind, W1 54015 August 30, 2017 715-796-5664 Propie"y owner Rolling Ridges LLC. O r -z, ;--2—of_ 4 0 Boring J Fg Borin# ®Pit Ground Surface Elevation 99.6 ft. Depth to Limiting factor > 105 in. Flwkm Dapm Dwmno t Color Rsdox Dna%xbn Tastes Strua o Ci01MMW= Boundary Roots 'Ellrfi 'EM2 1 0-12 10YR3f2 - GRSL 2-f-bk Mfr gs 3f 0.6 1.0 2 12-42 7.SYR4/4 - VGRS O-g rn1 gw 2f 0.7 1.6 3 42-105 10YR414 - GRS 0-e9 rVA - - 0.7 1.6 O Boring 4 mg OIPir rnronvr Rud rr Flrviei.M rUm& to Limitin• factor In. 11mm I Depth 1000Mtt Color %NMX DWrOO a Taftm Mum 01- BODs> 30 5 220 not, seal TSS > 30 <_ 150 mg/L • EftmM 02 - BODs<_ 30 m&t sad TSS <_ 30 =W- 7U 17epattrnant of Commerce is on equal oppornutfty service provider and employer. 1 f you need assiumve to access services or Need materiel to an alternate format, please contact the departmem at 608-266.3151 or M 608.264-8777. POWTS OWNER'S MANUAL & MANAGEMENT FINE INFORManON PLAN Page J of 2 Owner SYSTEM SPECIFICATIONS~ Matthew Lardinios Perm it ti Septic Tank Capacity 1250 ❑ NA a! DESIGNSeptic Tank Manufacturer WIESER ❑ NA Effluent Fltsr Manufacturer POLY LOCK ❑ NA Numbs of Bedrooms Number of Bedrooms Number of Public Facility Units 4 ❑ NA Effluent Filter Mode! $25 ❑ NA Q NA Pump Tank Capacity Estimated flow (average) Ct NA 400 al Design flow al/d �p Tank Manufacturer It NA (Peak), (Eat)mated z 1.51 6�0 � al/d Pump Manufacturer Soil Application Rate i0 NA .7 Standard lnfiue al/d 1W Pump Model rrt/Effluent Quahty Monthly average* NA E Pretreatment Unit Fate, 00 & Grease (FOG) 530 mg/L >Y] Biochemical O ) ❑ Sand/Grave! Filter ❑ Per Filter xygen Demand IBOD6'=0 mg/L ❑ NA ❑ Mechanical A Total Suspended Solids (TSS) 5150 mg/L Aeration ❑Wetland ❑ Disinfection Pretreated Effluent Qualityy ❑ Other: Monthly average 1 r: Dispersal Collis) Biochemical Oxygen Demand (BODE) 130 mg/L ❑ NA Total Sus IR In -Ground (gravity) ❑ In -Ground (Pressurized) pended Solids (TSS) S30 mg/L ❑ NA ❑ At -Grade Fecal Coliform (geometric mesnl siO4 cfu/100m1 ❑ Mound ❑ Drip -Line Maximum Effluent Particle Size ❑ Other: Ye in die. 001°'" `-� other: ❑ NA ❑ NA ❑ NA Other. `Values typical for dornespc wastewater and septic tank effluent. Otlwr❑ NA: t. . MAINTBIANCE SCHEDULE L1 NA Service Evom Service FrequencyInspect condition of tankls) At bast once every: 3 ❑ month(sl Pump out contents of tank(s) ears) (IMaadrrarm 9 reel CZ NA When combined sludge and scum equals one-third (Y,) of tank volume Inspect disperaal cells) ❑ NA At least once ovary: 3 ❑ month(s) Clean effluent filter, ews) (Ma>tdrrrum 3 yeah) ❑ NA At least once every: 1 ( IN ear(s18I ❑ NA Inspect pump, pump controls & alarmAt b❑ month( once every; fsl O saris) jP NA Flush laterals and pressure test At bast once every: ' ❑ m�s)lal Other: 0 IR NA At least once every: ❑ Is) Other: ❑ NA MAWTENANCE INSTRUCTIONS Q Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certtf f Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS nations: inspections Maintainer; to a must include a visual inspection of the tank(s) to identify P 9 Servicing Operator. Tank missing measure the volume of combined sludge and scum b ken hardware, identify any cracks ny and to check for back or leaks, The dispersal cells) shall be visually inspected to check the effluent levels in the observation or eepipes effluent on the ground surface. of effluent on the ground surface. The ponding of effluent on the ground surface may indicatlin d to immediate notification of the local regulatory authority, Y Pon check for re g condition and requires the the When the combined accumulation of sludge and scum in any tank equals one-third (Y contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance Wisconsin Administrative Code. ,) or more of the tank volume, the entire with chapter NA 113, 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 912 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page ?,of 7/ For new construction, prior to use of the POWTS check treatment tankis) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal coals). If high concentrations are detected have the contents Of the tank(s) removed by a septage servicing operator prior to use. SYstsm start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels When power is ored the aXcess wastewater discharged to the dispersal cells) in one large dose, overloading the cells) and may result inthe eck p or surface dischargle 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 Maintainer to assist in manually operatkng the pump 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 within 15 feet down slope of any mound or at -grade Boll absorption area. area Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the Fife of the POWTS: antibiotics;draUbaby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental foss; diapers; disinfectants; fat; 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 shill 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 shall be disconnected and the abandoned pipe openings sealed. The contents of ell tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed end the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, ovmust be taken, to provide a code compliant replacement system: §a 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 wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. C WN A] 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 last resort to replace the faded POWTS. o rng ttank C &r5r»crc-n prJ 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 rules in ofteet at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL [SASSES 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 INSTALLER POWTS MAINTAINER Name COUNTRYSIDE PLUMBING Name PAUL R KOEHLER Phone 715-24fi-2660 Phone 715-246-2660 SEPTAGE SERVICING OPERATOR (PUMPER) - = E LOCAL REGULATORY r4UTNORfTY NEame POWERS SEPTIC Name ES • I glo Lo Zaclt1tJ Prone 715 715-246-5600 Phone —71 s— 3 F( !o This document was drafted in compliance with chapter Comm 83.22(2)(bI0)(d)&(f) and 83.540), (2) do (3), Wisconsin Admin' �etrative Coda. Illlllllllllll ..�...... Itlllll IIIIIII IlillllllNll Illlllllllllll� � ■ �• _ IIIIIIIIIIIIII r �rrti uwuuun r _ _� _ IIAIIIIIUII � 11111111111111111 11111111111 Illllllllllllllll IIIIIIIIIIIII OIIIIIIIIIII �"- � IIIIIIIIIIIIIIIII Illllllllllll � I�II IIIIIIIIIIIIIIIN„ '" t� IIIIIIIIIIIII IIIIIIII. "" :®- , � IIIIIIIIII_liin IIIIIIII '_ �I� IIIIIIII DERRICK HOMES 715-246-2320 �I I a LARDINOIS RESIDENCE lI F v I LOT 2. CRANE HILL I; L!� HUDSON TOWNSHIP, WISCONSIN I I Fr - El m N �Fl,1 DERRICK HOMES 7i5-246-2320 .—ssa�bs+emear v " IlR+ LARDINOIS RESIDENCE [GAR I P: CJ� LOT 2, CRANE HILL 111 wHUDSON TOWNSHIP. WISCONSIN F-r DERRICK HOMES 715-246-2320 it LARDINOIS RESIDENCE Cli LOT 2, CRANE HILL HUDSON TOWNSHIP. WISCONSIN -------- ------------- ---------- is OL -- ----------------- t aooa L }____ 1111HI 0 0 ji .............. ....... A --------------- W" % DERRICK HOMES 7f5-246-23Z0 WA LARDINOIS RESIDENCE IS LOT 2, CRANE HILL INV HUDSON TOWNSHIP, WISCONSIN jt� DERRICK HOMES 715-246-2320:1" � t r' LARDINOIS RESIDENCE } r = LOT 2, CRANE HILL I, n HUDSON TOWNSHIP, WISCONSIN � If S-T. CRo STY. SANITARY SYSTEM File :Office Use Only OWNERSHIPIADDRESS FORM c--waa zr 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 Property Files Scanned weblink. OWNER/BUYER 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) Property Location 5W '/s , N� NEW SYSTEM: LEGAL DESCRIPTION 1/4 , Sec. J:�_, T Z2N R/� W, Town of Hudson Subdivision Plat: Crane Hill Trail Certified Survey Map # Warranty Deed # Sc? l 3 g Number of bedrooms 4 Volume Page # Lot # 2 (before 2006)Volume . Page # -- Spec house O yes ■ no Lot lines identifiable ■ yes CI no OFFICE USE ONLY New Propert Address CR E 4 I LL L, Cr S (Verification of new address required from Community Develo ment partment for ne 21 (Staff initials) (Date) construction.) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New 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 i v 1101 Carmichael Road, Hudson, wl 54016 www.sccwi.gov Documan Number State Bar of Wisconsin Form 1-2003 WARRANTY DEED Dwiment Nam ly TIRS DZED, Rollin Ridgy, LLC, a R3scOm" limited liability company, r." WhOdw one or more), Convey and want to ftl1C�Y Urdinols and Valerie LardinWN, husband and w�tfe u rorshipp—"—be marital P ' ." whether one or more), the folio win estate M St. Croix County. State of Wisconsin: g described real Lot 2 County Plat of Crane Hi1i of Hudson, Town of Hudson. St. Croix County, Wisconsin. Exception to warranties: easements, restrictions and covenants of record; highway and strut rights of way; and Municipal and zoning p�� and agreements entered under them; and further except real estate taxes accruing m the year of this conveyance. n"ea 22 20 tZ Rolling Ridges, LLC, a Wisconsin limited liability company AUTHENTICATION Signatures) authenticated an TITI-E: MEMBER STATE BAR OF WISCONSIN (IfD, authorized by Wis. Star § 706.06) THIS INSTRUMENT DRAFrM BY; 1 St. Croix County Abstract & Title ``����"v Carpenter at the direction of the Cmantor. 22-S344 Iney Andrea S 1159138 BETH PABST REGISTER OF DEEDS ST. CROIX CO., Vn RECEIVED FOR RECORD 09/23/2022 10:13 AM EXEMPT*: REC FEE 30.00 TRANS FEE 600.00 PAGES: 1 "The above recording Information verifies that this document has been electronically recorded • returned to the submitter Reoordma Area Name and Return Addrcaa 575 KnowleCroix Cms Ave je Abstract &Bede Co., lnc. New Richmond. Wl 54017 020-1491-02.000 Parcel sae N)nmber (PIN) This 1S NOT homestead prWertY 0% N 1 StiO :t3 � 1 L 0, r sty 4tdCTNd ..�e ACKNOWLEDGMENT STATE OF WISCONSIN ) St. Croix COUNTY ) ) Personally came before me on ' �1• oDaa- the above -named David Robson President of R LLC a Wisconsin limited BabW to me known to be the comm an who executed the foregoing instrument a knowledged the same. • Notary Public, State of Wisconsin MY Commission (is permanent) (expi (S4A& NOTE: THIS IS A STANDARD FORM. ANY M 1� or aekaowbdisd, bath are jot necessary.) T'�1 WARRANTY DEED IFICATIONS TO THIS FORM SHOULD BE CLEARLY IDltr7MED. 7YPc name below rig wL,,e . O ]M STATE BAR OF WISCONSIN FORM NO. I-22d9 St. Croix County 1159138 Page 1 of 1 ..SEPTIC LOCATION 1.4 e6 H FOR: CRANE HILL OF HUDSON a ioa zaa tc 1 56, SIOR&O3 429.E 13 aye � � a`k � .f �� � � , � �� rr � ��tff/ • �. � . g37.27f I ` L28M! i L2B113 SB L763 • f -2p ! i L3 qf �OT lea : 5.00 i 931.gp 93 1 F .28 SPA -:_ .• y-. ,f � ,,�• DENOTES SOIL 2 BORING LOCATED �t •r ON 9-13-1 - M r NORTH CORNERSTONE LAND SURVEYING. INC J 0 N I , i I f ~u Ooc'-m U �LnrvJ N ! tv I X' I / I I J lQ � C. S�SSfl 00 �1 ' ■ �S` C_ Z ems\ /0.01N 0S1 19 3� gOIN Q s + Lu �� coow 0) o d Y7 L49� 3 r4 N M M N I r` 4 IT J u -ter Lg3 O qr rn O� w � 3 NaC _ ch ONQ II Co al 0 Joy m N J L76 1 ; �tisE, �osos O N 1 I I t Q I} U �-udrn J UN M O awn uT� �3 W no ry `\�Kr u, 0 ui m gal 8 M 7 60•, OL 7 9,1 0 732lR � M Z Li / o N I L6- n, v nt qSOIL EVALUATION REPORT p In accordance with Comm 85, Wis. Adm. Code $� I G'S-fi —2014- - IZ4 C 1#r/ Pager 1 or 4 An* nplte7silY4Aih on not less than 8 16 x I I inches in isPl ust Include but not limited to: verti and horamtal reference point (B Percept sl�Mr#gtffionension north arrow, and BM referenced Community Develop print all information oration you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)) St. Croix 'o2o/-�y9f'-o2-000 by t Property Owner Property Location / / " / / Rolling Ridges LLC. (,ovt. Lot Slr� 'f• N pv- S 13 T 29 N R 19 w Property Owner's Mailing Address Lot q _ r - D - 000 965 Alexander Rd. 2 IRlock# ISubd.NamcorCSM#/Q.7Q C rkrtc �' 1I 3. a 9, 19, 3 133 City State Zip Code Phone ❑ City ❑ Village ® Town Nearest Road Hudson WI 54016 651-248-0390 Hudson Alexander Rd. ® New Construction Use: ® Residential / Number of Bedrooms ❑ Replacement ❑ Public or Commercial — Describe: Code derived design flow rate GPD Parent Material Loess over Outwash Flood Plain elevation if applicable N/A ft. General comments and recommendations. Install the system at 65" below surface. Install the system beginning at the drainage easement boundary (see page 4). Reserve the area upsloa to 134, as the lacement area Boring BA was initially completed 15' north of the location shown on the map. There was muc an mggaana reduced below the an sat this location. St. Croix county inspector Ryan Yarrington observed the soil at B4 and agreed that the redox was no longer present at B-4. The redox north of 134 is not a result of a high water table. i I Boring # ® Pit - Ground Surface Elevation 99.9 ft. Depth to Limiting factor >110 in. i Soil ApolicafiQn PUft Horizon Depth in. Dominant Color munsell Redox Description i. Sr. Con . Texture Structure r. Sz. Sh. Consistence _ Boundary Roots GPDlR' 'Eff# l.... --'Eti#2 1 0-10 10YR3/2 - - GRLS GRS 0-sg 0-sg ml ml gs gw 3f _ 2f 0.7 0.7 1.6 1.6 2 10-53 7.5YR4/4 3 53-110+ 10YR414 - S 0-sg ml - - 0.7 1.6 Boring ❑ 2 Boring # ®pit Ground Surface Elevation �L'qo 1. Horizon Depth In. Dominant Color Munsell Redox Description u. Sz. Cont. Color Texture Structure Consistence G_ r. Sz. S_h. Boundary 1 0-1 10YR3/2 - SIL 2-f-gr 0-sg mvfr ml ml -- gs gw 2 10-39 10YR4/4 - _ GRS 3 39-105+ 10YR4/4 - - — S — O-sg - s - tnluent 91 ' Id"Us> JUf� 4LV mg/L arts 1 b3 ;13V' 13V mg/L Depth to Limiting factor S in. Roots Effluent N2 = BODs <_ 30 mg/L and TSS 5 30 mg/L 'Effol 'EfFa2 0.6 0.8 0.7 1.6 0.7 1.6 CST Name (Please Print) Si re CST Number Mark Iverson 46672 Address Date Evaluation Conducted 'Telephone Number P.O. Box 155 Hammond, WI 54015 August 30, 2017 / Nov. 9 2018 715-796-5664 L 6 T :), Property Owner Rolling Ridges LLC. Parcel ID# Boring # 0 Boring -- ®Pit Ground Surface Elevation 98.6 ft. Page 2 of _ 4 Depth to Limiting factor > 105 in, Horizprt 1 Depth in. 0-12 Dominant Color Munsell 10YR3/2 Redox Description u. Cont. Color - Taxturo GRSL Stnrcturo Gr. Sz. Sh. 2-f-bk 2 12-42 7.5YR4/4 - VGRS 0-Sg 3 42-105 10YR4/4 - GRS 0-5g 3° 4 Consistence i3oundary Roots mfr gs 3f ml gW 2f ml - I _ ru.. 'Eff#1 0.6 0.7 0.7 *01112 1.0 J.6 1.6 13 ;Boring - F1 Boring #f oPit Ground Surface Elevation 101.3 t. Depth to Limiting factor 105+ in, Horizon Depth Dominant ColorY Redox -- - Texturo Structure — i1 fi PD/ tion R t Consistence Boundary Roots 1 0-7 M n II 10YR3/2 n . - SIL r. h. 2-f-gr mfr 'ER*1 'Eflar2 2 7-20 7.5YR4/4 - SIL 2-f-gr gs 2f 0.6 0.8 mfr 1f 3 20-31 7.5YR4/4 GRS 0-S9 ml gs 0.6 0.8 4 3146 to YRu &511R re - --- - RSSF 0-sg - gS 1f 0.7 1.6 ml - -CS-- 5 46-53 7.5YR4/4 - FS 0-m 0.5 1.0 mfr 6 53-105+ 10YR4/4 - S a _ 0.5 1.0 0-sg ml - - 0.7 1.6 S 0 Boring Boring # 21pit Ground Surface Elevation ft. Hon Depth Dominant Cobr . Redox +n• MurtseN i-_ Qu. Sz. Depth to Limiting factor in. Description Texture Structure Consistence Boundary Roots t If n R Cont. Color -EfF#1 •Effrr2 ' Effluent # 1 = BOD3> 30 < 220 mg/l. and 'rSS > 30 <_ 150 mg/L ' Effluent #2 - BODsS 30 mg/L end TSS :s 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 60&266-315I or'ITY 60$_264-$777. ' Effluent # 1 = BOD3> 30 < 220 mg/l. and 'rSS > 30 <_ 150 mg/L ' Effluent #2 - BODsS 30 mg/L end TSS :s 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Need material in an alternate format, please contact the department at 60&266-315I or'ITY 60$_264-$777. Page 3 of 4 on. 24 ft. 40 ft. $0 ft. Lot # 2 1 BM#2 - Top of 3/4"PVC B-3 102' SWI - Top of 314"PVC Pipe 100.0' 101-3� 99.9 ,} � 98' • = Ground Surface Elevation BW & Descnptio Elevation = Bench Mark = Boring Location & Elevation Owner: Rolling Ridges LLC. 965 Alexander Rd. Hudson, WI 54016 Phone: 651-248-0390 Site Information: 114, 114, 513, T29N, R19W Town of Hudson St. Croix County Completed By: Mark Iverson 617 Cty. Rd. J Roberts, WI 54015 715-684-9125 CST# 46672 -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, NORTH 0 40 8( 7 "%" CORNERSTONE LAND SURVEYING, INC. W'soomin Dewranatt Commerce SOIL EVALUATION REPORT C 57- 017— 191 R��e�u dings In accordance with Comm 85, Wis. Adm. Code Page 1 Of SV+ Attach p County 1 I�� t to site Ian on paper not less than 8 V, x 1 I inches in size. Plan must St. Croix r limited to: vertical and horizontal reference point (BM). direction and C O� CD o c or dimensions, north arrow, and BM referenced:, ner r I PSI I.D. 020 I'll Iy91-D2-p0o GR �LppMENT Please print all informatinn Revie by Date n you provide may be used for secondary purpos F4PR2XV071 IGY4 �g caner Rollin Rid Yes LLC. rot �, v. s 3 T 9 N R 19 W Property Owner's Mailing Address 965 Alexander Rd. Lot # Block # Subd. Name or CSM# iry 2 �I state 7_ip(:ode Phone ❑ City ❑ Village El Town N Hudson WI 54016 651-248-0390 e Hudson Alexander Rd. ® New Construction Use: ® Residential / Number of Bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or Commercial - Describe: Parent Material_ Loess over Outwash General comments and recommendations: ]nstall the system in the third nFlood lain �nelevation if applicable N/A _- ft. Ze Ma.. )C J Boring It L.roortng EI Pit Ground Surface Elevation 99.9 ft. Horizon Depth Dominant Color in. Mun A 1 0-10 10YR3/2 2 10-53 7.5YR4/4 3 53-110+ _ 10YR4/4 Depth to Limiting factor >1 10 in. Retiox DastxiphT Cont. Structure Consistence Boundary Roots f I GPD/RZn� - Gr,$z.Sh_ 0-sg 'Elr*1 "Eff#2 ml_gs 3f 0.7 1.6 --- 0-sg ml gw 2f 0.7 1.6 -__ 0-sg ml - - 0.7 1.6 11 Boring Boring # ®Pit Ground Surface Elevation HorizoM." olor Redox Description Texture 1/2 U. Sz. nt. Color - SIL24 -GRS3 4 _ S i h_ 5 cn_L 1 Effluent # I = BC CST Name (Please Print) Mark Iverson 5�t9�iCr✓1 30 < 220 mg/L and T5S > 30 5 1 SO mg/L Signature P.O. Box 155 Hammond, WI 54015 Depth to Limiting factor_ }IOG in. Structure Consistence Boury nda Roots Soil lication Rat PDAf 3r-. Sz. Sh. _— — 'EB81 'EtT#12 24-gr mvfr gs 3f 0.6 0.8 0-sg _ml gw 1f 0.7 0-Sg ml - - 0.7 _1.6 1.6 • Ef icnt #2 = Bmg/1_ an OD, < 3 d TS5 —3o mg/L — --� — — CST Number 46672 1te Evaluation Conducted Telephone Number August 30. 2017 715-796-5664 Ld 1 Z, Property Owner Rolling Ridges LLC. Parcel I D# Boring # ❑ Boring OPit Ground Surface Elevation 98.6 ft. ❑ Boring F Boring # ONg Ground Surface Elevation ft. Horizon Depth Dominant ColorF Redox Description Text in. i Munsell Ou q7 rsnd r.A... a Boring # ❑ Boring ®Pit Ground Surface Elevation ft. Horizon Depth Dominant Color Redox Description Texture l in. Mu Qu. Sz. Cont Color • Effluent N 1 = BOD, a 30 S 220 mg/L and TSS > 30 � 150 mg/L Page —2 of—X—1 Depth to Limiting factor >105 in. Depth to Limiting factor in. ure Structure Consistence Boundary Roots Soiip lion - r. Sh. 'Ef l "Ef *2 Depth to Limiting factor in. Strut re Cortsialertce Boundary Root, • Effluent p2 = HOD, < 30 mg/1. and TSS 5 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 altemate formal, please contact the department at 608-266-3151 or TTY 608-264-8777. -Eff#1 I 'EOM Depth to Limiting factor in. Strut re Cortsialertce Boundary Root, • Effluent p2 = HOD, < 30 mg/1. and TSS 5 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 altemate formal, please contact the department at 608-266-3151 or TTY 608-264-8777. -Eff#1 I 'EOM gage 3 of 4 o ft. 24 e. ao ft. ao rt. Lot # 2 - N BW1 -Top of 314"PVC Q 100' ,00.o' BMM2 - Tom of 3/4"PVC Pin&3 t — 98 3' &_2 94.4 • = Ground Surface Elevation BNtaK a Desc 'io� Elevation = Bench Mark Owner: Rolling Ridges LLC 965 Alexander Rd. Hudson, WI 54016 Phone: 651-248-0390 L B-1 = Boring Location & Elevation 100' Site Information: 1/4, 1/4, S13, T29N, R19W Town of Hudson St. Croix County Completed By: Mark Iverson 617 Cty. Rd. J Roberts, WI 54015 715-684-9125 CST# 46672 SEPTIC LOCATION FOR: CRANE HILL OF HUDSON 0 100 200 %7%= DENOTES SOIL BORING LOCATED ON 9-13-17 NORTH CORNERSTONE L-Ar'40 SURVEYING, INC a dOIL 72 z 0 U a W O �I O L H O a z z oa Z 1