HomeMy WebLinkAbout020-1380-38-000 (2)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 [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name:
Angela & Scott Holden
City Village Township
TOWN OF HUDSON
CST BM Elev:
Insp. BM Elev:
BM Description: Dorr., c)V v-�q1 o v+ Ide
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
�� nvz!��S�
I Z So a
Paz1fth*'_
�J+S
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
�
r
Dosing
I L)
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
X
Model Nu e
21
TDH
Li
r do ss
Syste He d
T H Ft
Force ain v
Length
Dia.
b1ist. to Wel
SOIL ABSORPTION SYSTEM
ELEVATION DATA
County: St. Croix
Sanitary Permit No:
651290
State Plan ID No:
Parcel Tax No:
020-1380-38-000
Section/Town/Range/Map No:
11.29.19.2364
STATION
BS
HI
FS
ELEV.
B 50- g4e 2Z
Alt. BM � �Oeo
� oJ
Bldg. Sewer
St/Ht Inlet
St/Ht Outlet
Dt Inlet
Dt Bottom
Header/Man. N o4- ;W-,Ai .
4- Vehe OF
Dist. Pipe
Bot. System �•
P
�
(�5
Final Grade
Wl"),
St Cover
"'Y-EQ On n
_'�QP 9--C C-oV4
10A
025
-1-op J� COY yf4 121'�5
102/
BED/TRENCH
Width
Length
No. Of Trenches
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid Depth
DIMENSIONS
2
rz claaC410M
SETBACK
SYSTEM TO
P/L
BLDG
WELL LAKE/STREAM
LEACHING
Manufacturer:
INFORMATION
CHAMBER OR
UNIT
F•��rG,��'�
Type Of Systemic
� Sov
�{
O
(n0 a
lI��JJ
Model Number: Ll
(�a
G �� n-�� o I
l
yy y� Q CHdro�
DISTRIBUTION SYSTEM
Header/Manifold
Distribution
x Hole Size
x Hole Spacing
Vent to Air Intake
Pipe(s)
Length Dia
Length Dia Spacing
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodde
xx Mulched
Bed/Trench Center
Bed/Trench Edges
Topsoil
❑ Y ❑ No
❑ Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.)
Inspection #1:
Inspection #2`.
Location: 704 OLD HOPKINS PL
1. Alt BM Description -
p
1 _ L h
e' 1L :591 415;Vl�_ �V4-tel'l r7��i 4 a��Gl�/
❑
2. Bldg sewer length
12Soil 5M Nd -6,r�• 95ed a0+6,-.
��nbe �
(scar t nc1
- amount of cover = ?�
Plan revision Required? ❑ Yes
❑ No
Use other side for additional information.
SBD-6710 (R.3/97)
Date
Insepctor's Signature
Cert. No.
lrjmrm�
Division
Madison Yards Way
4922
% crd
.r
i � 4 ManyP
=ritm(o .
3 �' R 0. Rox 7162 r�, �4V, 2 4VII)
Sanitary Peet Application .9tatcTramact-wn NuxrAKT
In accordaccordawe. with SPS 3812](2)• Wis, AdHL Co&. submissim of this form io tli�,, :arn rjwe_ gone rr L- I tLir
is ' p -n a Note: pp�licauon foans for � rtt ' e (if �� rim t� �1�� r � � ® than maillin,-,T_'
the Dqurbnent of Safcly mod. Profmsionaldie.Personaiinf tilan you pmvWcmaybeu for scmadafy
f. Application Info ` jm Pkmw Paint 1 inforamdon
PMKMY 0% r-n Name Parcel A
Propwy Owner's. Mii r �n �- Location
x.. .�
c1tv gum._t
_ _._..
Zip Cod e c Nmvba
'Clio n
II. Type ofi;5zg ch 11 that ate) ''Lnr -� � � R E ur
VT ? l= Jy l cl]L'ag - Numr of Bcd ms SLaxI.M%,-t%1Vn Narrrc
Block .0
I of
Elstate Owned - ��-ri be Use C& ..
lla_gt� of
[3rawn o
HL T)Ipe of POW". Permit Whe& eitber 'New" or "Rept
fi- NO wement7 and other
i
..�.
cw sy!;Wn r sygm Mod i [ica-Lion to Exisdug Sys ( '' ) ElAdditimal : I.1 (et p in)
R.
_. �..
U-1olding Tank at -Grade i Elmmr4 ITK50daW Site tficr l" (explain)
C- El ul Befi)Fe E]1R.cvi_sirjn harrge of P1 rrm1iL-r aramfer to New
�Sl PMVZ'Q x5 PtYMMt w-riber and Fkate Is cd
Expiratim
IV. DispersaYTreatment A"* and • ank Information. LZ 3 p
(MA) Aga Soi I Applicw1on Rwc(q9WW 9
CaNcify H
I Total a Of >
Tank Incmra+ryfi Gallons Galkmi nIL5 �.''f 0
New Tam - �- s W
r
�.
t., M Cr.,
V. Responsibifity S(alemeal- 1, the am� a� or t a . pia .
Pi ber' % NaTne (Wm
P I
MP/MIPRSNumbqr Ekniams ffione N -
P1umber's Address (Street C" iy,, SL&jr, .P ic
i � 1
� s
V1. CountyUse 061y
PLApproved pjDV PL-r Given fDr Dkil S Fee Date � : urn
:�� �- cl2�/2mZ3 1�
FMF1 i
ditions of A 111
. , _ , w E__
%
1, Septi, C '4 a rii;,; unt t i i r tl:I rl Ce I I 2z 1Z7�j
�
m u s i bey sE Fv1ced / rp. a a ncd_ Fts pc�� i. �
r wia m nt plan pri-o i,L,!c iI v ; ��., ril��ka r.
. A I s etba k, rat;ij7rc�rri7-,r,is irem.., L,e- m a'ntain e d
as per app1; l",10 ord i F;�"f �a.r
6.39 - 0312 1 )
��a�d sN��doli CIO
tA*,7 N 0
O)r �7 004
5,wd 0gwa4� rm c
)tb)( 0
s��Nny-?
p
lift °l\ ""2l I jvl�j
4 !,64 I°q°z q4i-a I -Pry �Md�.
'f��S vts4Wm ao��o5ospl �af,�S�x�
46eee S�tdW'�!�
Z[�S�uirio$ (At
pro hot, rgic��I
N �op 19 H
d�t�l -�-°td aLu Ilfv
Pa
y - ,
nag
NNW
,.."
walk
4
a ��
sN��doh Q19
tA*,7 N 0
O)r �7 004
5,wd Ogwa4� rm c
)tbx�.
s��Nny-?
Afo
dplvn axe
W
N
pro hot, iqolg��I
46eee S�tdW'�!� -
�[�saa+v� cu� W, 4,m-o
td
� �tl�
���
8'�� ���
it �'
� �g
«�' �
,H�
�
�
3�
of
OOG�y�p�
e
MRS
nao�
Lk
"v�i
vl w vi
v�i'vi
AVOL
dd
eauu
qLis
41
cop
IIA
�y a
�1
9�
11
di Mlb
wn OR
!g
B
La
P&3 ofll`
IN -GROUND DOSED�GRAVITY DISPERSA� AREA
Stepped Elevation Trenches with Qulck,4 Standard�W C,hambers
I
3=ft Trench (downmRsizing cred,it)
System Elevatlons =
TYPICAL TRENCH
CROSS SECTION VIEW
f Mn Qe%0101 I
.4
(typical) F
Highest Tranch Lowest Trench (as applicable)
ft ip ■a
t ftl
Quir*lamer -%N
w/ End Cap (Show location of Inlet / outlet pipe c;onnectlon on plan view.)
(typical)
dp.MdM &o�
ft
B=
e
INSTALL PER TRENCH;
Provide minimum 3 ft
-Separation between lrenc;hsq.
observatlan p1pe
(typle'al)
Install per rutnAdurees
/ Flair ucdons,
TYPICAL TRENCH
PLAN VIEW
� Mlal
4
A = 3.0 P[
(typical)
Q u I ck4 Standard- ha m ba r
(typical)
fmfij k it fill 6.
IF " Tq I i0yaL011101 11lu')
Instalf pqMar)t lo rrianuNiotureea fristrucilonu-
QUICO Std.-W @ 20 ff EISA/Chamber
+ Pairs of end ca a 6 ft2 EISA/palr fta
P
ft2 ft2
Proposed EISA per trench Reqtjlracj InfliltreatIcn Areel
Distribution Method:
x trenches Proposed Total EISA ft-2 branched man1fold
y
Sr Cp, rn-r SANITARY SYSTEM �#
0 ffiff, II""J� OWNERSHIP/ADDRESS FORM
IC
Con gent Mmi till wN utf'me fts Waffrodon to provide ttw prop" oww wft
UM UFMO of
RIMUM be as p of our on€go� to �� pubfic healft ycnx welL groundwater,,
adam water, p 'fit and cmmty resources. OrK a approve completed ioim and 'onal
mation wil be sent to you by enrol.
uu
owret wr�au►no�
sow
15-aaa-ic,09
fib
Emauaaamnton �:�oldeN � � y S fJ- CO
Parcawdur�s«�ra�. Oab-lbfa `{STD #�(.a9.Ig.SYB
ffix.W cur PI a.y, UK w)
Hcws�TEL aESCRIaTiOH
Property ,NwV4,�w ,A,Serl .Ta9 NR14 Town Of 1JuDs�a
SubdivMw Plat I � Al � r�� a►� �`� Ply e� WOV Pt�Lot* 39-
MW# ..(P 3 `] SJ . vaume_.$. . Page
Mi�nllt Dared # (befiore 2006)Volume .Page �
Num#3er of bedhnoms __� Spec house O yes O)f�o Lot lines able 10 yes O no
OFf;CE 1MOMY
(1f of new aftnm film x nerr ntia
This form nxa be submdW wfth aU Private Onsde Water Treatment System (POWM appUcadorm
�r 9 trx�ids �i #/pis dorm Q rec+ard�d w d�e+ed Pram d ue t�e�ar �f�ats C�/rC+ea�d a copy �f the ar�eai
strnwY map �'r ae a made le the war�tyr deed
Laid Use . -
715- St Crok Courity Govemment Caftw 71 a-24 Fax
1101 Carm►khad Htmism M 50016 v
STATE BAR OF WISCONSIN FORM I - 1998
Document Number I WARRANTY DEED
020-I380-38-000
Parcel Identification dumber (PIN)
THIS DEED, made between Tedd. A. Solheid and Stephanie L.
Solheid, husband and wife, Grantor, and
Angela Holden and Scott Holden, wife and
v rshi p marital property
T , Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate in St. Croix County, State of Wisconsin (the
"Property"):
SEE ATTACHED EXHIBIT A
This is homestead property.
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Property is good, indefeasible in
fee simple and free and clear of encumbrances except
Dated this.
"-1- 1,2 r /
Tedd A. Solheid
AUTHENTICATION
Signature(s)
authenticated this
TITLE: MEMBER STATE BAR OF WISCDNSIN
(If not,
authorized by § 706.061A Wis. Scats.)
THIS INSTRUMENT WAS DRAFTED BY
01
Laay S . Mountain Attorney at Law
1900 Silver Lake Rd. #200
New Brighton, NfN 55112
1111111111111111111111111111111111111111111111111
!lii
906797
BETH PABST
REGISTER OF DEEDS
ST_ CRQIX CO., WI
RECEIVED FOR RECORD
11/09/2009 03:33PM
WARRANTY DEED
EXEMPT r
REC FEE: 13.00
TRANS FEE: 742.20
PAGES: 2
Recording Area
Name and Return Address:
Land Title, Inc.
v
I cto s Si !v'cr- ►"k:.t Card � �-UC3
P% ortxr'i M �,
(3i
(SEAL) - G (SEAL.)
_Zk
-Stephanie L. S olhei
(S EAL) (S EA L)
ACKNOWLEDGMENT
STATE OF
(Signatures may be authenticated or acknowledged. Both are
not necessary.)
'"Names of persons signing in any capacity must be typed or printed below their
signature.
ISS.
COUNT, 0'�
Personally came befor the this jq- day of
, the above named Tedd A.
Solheid and Stephanie L. Solheid, husband and wife to me
known to be the person(s) who executed the foregoing
instrument and acknowledge the same.
Notary Public, State of nsinf-L
My commission t per man nt. (Ifnot, state expiration date
{ ... = EI_17-ABF-Tti C, VAN EYLL
I`�•]i n� pubtic-minnesota
`'t+r trl i.arn:.�: �S�r xp�res Jan 3'1. 2012
Y
1 of 2
Fife No.: 332239
EXHIBIT A
Lot 3S, tiomestead I" Addition in the Fawn of Hudson, 5t. Croix County, Wisconsin
2 of 2
SOIL EVALUATION REPORT pzw of
Division a( S*ty and BA*w
COWAY
to
or . ni err , ^ _ ! I �_ ++u}}��dd 0
P�l SEP 2-,6 2
Property CwWq Mai" Address rp IST CHOix-f, - for CSW
P:_ Box 151 i � To
city SOW ZIP Qw FI C Town Nwad ROW
PadKff Drive
Hum Hudson
Wl i ,,JI.J Rftc co - - Dwrbe:
Parent ram' l outwash • if n a
n is kwnd at system e4ev.+, hie mstging sysWn.
I:fl 16 Pit Gmund &xtwe oev. .1 ft
Horizon 131to r 'rnhaM Cokw Rtdw Dao*6w Terre '
1 1 0 1/
........
20-36 10yr4j4 I
-52 OY14f4 rone S
4 5 10yrS/4 _ non'
-1 i s /4
Haft
'ani I tCalm Redm Dmaom 70*01
1 WWII none sl
32-62 1 / I S
3 2- 7 10yr414 none Is
_. _... ,
2msbk ids
as
2f 0
I
OS9
.7 .
�.
Depth to,,,
_._. irL
'
a►
1t
0.7
1.
0M
dsh
CS
0.5
0.
o.`
1.2
CST Number
CST Nam .,
..
James K. i
yte y
C6r F
f aAa >135nin
_.
Pt Ground SurbM Skiv.
-_
Hkci�m Deo t � T � r _
I -1a 10vr4/2 none ZMSt* ds as 2fIrRC
fjn 0.5 0.
8
2 10-. 1. r no � h fmi T+ .5 .
0.7 1.
Ctt
i(p/� 3
Pit Gmuid Surtwefir_ 5.h I fir _ . 17 in.
SW Apocobw Rae
} T c ,�
Gpoff
I'd [m
TIM
0-70 1 none ts! 1CSt* dS gs 2flm0.5 0.
438-84 10yrW4 none S 059 9S 0.7
.a _
in.Ap*x*m Rate
Horizon,
Cda
T
BOWWWY
GPW
mEff#1
SI
d
none
IfM
0.7
32
I/4
none
S
OS9
di
CS
i
0.7
1,
4
95-1 8
10yr6/4
now
OS9
C1
9S
0.7
1,
<< 46V
55' WAII. Ef if
"j&L Ek not Wdude silt
a5 n ptl o 3 arw is found at
: . 'Afte Inst3lift system.
IrKrease truxb
W co r ewduded .
Tl of Commcrcx� LS in cqual opportunity i pnwktr and c.-mph_ l,f rid z S Or
roccd maWW in an ahemme fonna ptm-se contw the dement al 608-2W3151 or TTY 609-2644777.
rAV
t=.-.
■ dal (�c�'yo.�an
1. 1,04 coal"
SECUmpi 11 1.2w-RAM
Kumma CGMK"
LOK OF SECS k 3
040 Ir
LOT J
2,14 Ac.
LOT .1m
7 ow.
"4 7 wq�.
90.344 5M
v
oqj;
Stu
pr
CkC-q,
LOT 317
2. 51 At-
Ar LOT 30
2 33 AC
101344 in to
Ar
MR Z.
LAPLEFT
jo, 32
LOY 31
2 ad Ac-
AC, jW n
V3602 *4
d
4p /
45
IL An 4-
22
OT
2 72 Af.
WOMM"I now -7(a
sir, 16PIWIT
( op mKha E ATAMEN I
HOE 00
NZ
DoAmdwz
Apo
1pp
[RAU
LAST kocd
KE, I$, f7w opw
r mft�
Maly WMWMKMT
Sol 1w
�rca-t �353wvr
LOT 34
121 At.
air
I
LOT 33
2 06
Vi
L
it?, IF Not PGME
IFJ%
,p -P
IN.;
" •00.
53 1% -6
102,7 S,
LOT 2A
2 94 Ac,
L75127 sek. Ph
c ?
in
mn
4L
5t
LOT 39
2.62 Ac.
LM 40
1. 21 Ac-
1601 4-1
211 Ar.
N
S, 'k %
Lot 77
-
114ziaA 3% Pt
VMWA 64 11
9103 *4 F1
N
A. 20 AC
Lc,
I
111(mold Malik 1w 0
ILIA, � ow
CLIEVAWPN ho oww
Igo r ri1R OAVEN
Irwalm
JL—
LY
o
1/4 W 09crm it
WWWWW
U -5 CUT 04 MGKCP
wi
Uq-11 two
tc eQ
Lc
kl 14
Me
ML
4 P-kjr
Th 1' E
;�.T_ CROTX COU-NTy ZONITING OFFICEr;
CERTIFICATION STAT13MgNT
FOP" UTILTZATION OF AN EXISTING -SEPTIC TANK
0
xs to f certi-y"' t have iTISpected the
N""CA"j.-f U A I Tfj
Sec., j
T N
R. W T own 0,
rr . I
WL"11-i r V lsconai'n -
12M@W*vM
residence locatec] t;F
baffles to be j,, 900d
condi
-L certity that
h2ve fond tj
Last t6
Xvne servunctioni
iced
:L ns, and
it appears to
be rIng
D1,J f 1014 back occrux f rorn ahs orp t SYS
ew yes
AVIDrmni -
capac-Ity: 4.ength of u-ime:
Constructj
On
P
Manu retaff COncre'e
1:acturer Of known)
A e Of Tank (i j� 'T
r known)
gallons
lm.nutes
Steel other
ext
t Name)
Plaasc--, Pr2.n
3L
e)
itense _a7er
(Date t ep,
rM t 0 be cOmPleted by S
11
1-censled d:LaPoeer (NR 'P-z ed plumbe-r (s_ :L4S,0GJf W-'
Wi' Isconsin Stat-utes)l c)r-
OcOnsin Adml-nistratl've
L
Plumbe-r (apply-ng saw taxy perm t)
er
In accepting the above s
certofy ,
I - tement zreqa�rding exist -
t"hat the taTik, tO the - be � 1-119 septic: tank Condit'
qU11'e7nents 0 f -IAM at 7 lop, T
1 of InY kno",dedge, wi:Ll C=form ta Cl�
a Adm. Code C
Outlet baf ). Pt kar ine'j,
-sp,, open
Al 07je r
Name
ignatu-re
U U YI)
MP MPRS
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
0
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township
Miller, Sam Hudson Township
CST BM Elev: Insp. BM Elev: BM Description:
I- I CS0 Im .,D, C. ST Pm+-( C2"T.?.) I
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
, 1
�1
2.1
Dosing
Aeration
Holding
.01
PUMP/SIPHON INFORMATION
Manufacturer
Model N b
TDH Lift E
!ion Loss System Head
Forcemai Length Dist. -to MI
__ - P577 -
SOIL ABSORPTION SYSTEM K-)
Demand
GPM
TDH / Ft I
ELEVATION DATA
County: St. Croix
Sanitary Permit No:
384144 0
State Plan ID No:
Parcel Tax No:
020-1380-38-000
11-W Z 9& ( Q. C;23to C(
STATION
BS
HI
FS
ELEV.
Benchmark
f
�
Alt. BM
C
�
11114
Bldg. Sewer
St/Ht Inlet 6A
5.30
St1Ht Outlet ►
S.-, C
f
Dt Inlet
Dt Bottom
Header/Man.
•
Dist. Pipe
r.i
Bat. System
g �
I
qZ40
Final Grade
�
3-ZD9�.roD
St Cover
BE RE
DIM NSIONS
Width
3
Length No. Of Trenches
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
PIL
BLDG
WELL
LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
Manufacturer.
& I 0 0f k
Type Of
I co #
Model Number:
DISTRIBUTION SYSTEM
Header/Manifold �f
Distribution
x Hole Size
x Hole Spacing
Vent to Air Intake
4—R
i�
I
Length Dia
Dia Spacing
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx Mulched
Bed/Trench Center
Bed/Trench Edges
Topsoil
� Yes No
0 Yes 0 Nv
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: t9rl I 1 Inspection #2:
Location: 704 Old Hopkins Place Hudson, WI 54016 (NW 114 SW 114 11 T29N R1tlW) Homestead=lStAdOnion Lot'3$ Par : 11.29.19.2364
1.) Alt BM Description
2.) Bldg sewer length
amount of cover =
IL PF
VWA%T=j%RL NA
61166
Plan revision Required? Yes XNo
ie then slede for d do I informat n.
`. �G'`' 'd re C bN o_
e >/40 A7ed:PeAe11V5 41*44E' , Q�
1A. Tg::)
,1WE LL?-�z
i
7 T3 -1, p
L oT 3 C4
Ac
ST-� cH S
U.)/
bfo��Q..
lee d fi")
t
f
z5cw C40I)c
Noe..(s12`1C'
. .............
FN I
PelmC FLA A
r�.iv'pF�`;�`vvtiT PREVIOUS NO. 3<9Lf�`�'�
OWNER A*,3Q6t-A � Sco-c-r
L W.-.0 fj
PLUIVIBER�w.. �o��CCsTEe LIC.# 222�0�
TOWN ""' F 14UNSON
SEC ,T 24 N, R 19
SBD-06499 (RI 1/20)
ax) �)(
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 a
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.
(f) The sanitary permit is transferable.
History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314
Note: 1f you wish to renew the permit, or transfer ownership of
the permit, please contact the county authority.
— nA'rE 9/2b /2. o23
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