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020-1487-05-000 (2)
e 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: City Village Township MURRAY & MALLORY SILVERBERG TOWN OF HUDSON CST BM Elev: Insp. BM Elev: BM Description: 10Q.010 SM �DKA TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic V� J25D of e n Holding Pol I ok 52S - C����`�I I TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 0-0 �?L�_ Dosing Aera 'on H Iding LZI E PUMP/SIPHON INFORMATION Manufacture ---11 Demand GPM Model Imber TD 7 Lift Friction Loss System H ad TDH t Forcemain L ngt Dia. i st. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 648488 State Plan ID No: Parcel Tax No: 020-1487-05-000 Section/Town/Range/Map No: 14.29.19.3096 STATION BS HI FS ELEV. Benchmark lDo.or0 Alt. BM ADM of �Yrscrv►en+ clDo� I Bldg. Sewer St/Ht Inlet 1015.0 St/Ht Outlet (09 OVnre Ke de t. Bot. System I Final Grade St Cover 91.52 l 04IJ Tl Y2 fi3 ID.b9 gcj.11 BED/TRENCH DIMENSIONS Width 3 Length gay No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM I LEACHING CHAMBER OR UNIT Manufacturer: Type Of System: COnI�EuT1Dn1AL f � �LDV�J v 3:5t Nor x�s��Lp 'v IR Model Number: _ �� ��01� DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length - is acing 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 2)2- B /Tre dge To Yes No ❑Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 908 GAVIN PASS 1.) Alt BM Description = . �,�" 0� 66,l tm SDI i f WI 05 Imlim, rcic. Jacf,,w- 2.) Bldg sewer length = 12` s,�J,L 4o ?4(- - amount of cover => 01 G.J. ����� MD IVE4 Plan revision Required? ❑ Yes No Use other side for additional information. I SBD-6710 (R.3/97) Date sepctor's Signa re Cert. No. County SAN-2023-102 RECIEVED Industry Services Division St Croix 0S 06/08/2023 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) PP. S P.OBox 7162 Madison, W1 53707-7162 r. Sanitary Permit 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 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(1)Lm), Stats. 908 Gavin Pass 1. Application Information — Please Print All Information Property Owner's Name Parcel # Murray & Mallory Silverberg 020-1487-05-000 Property Owner's Mailing Address Property Location 519 8' Street Unit B Govt- Lot SE 1/4, SE 1/4, Section 14 City, State Zip Code Phone Number Hudson, W1 54016 (circle one) T29N R19Eore) 11. Ty p e of Building,(c h ec k a I I th M apply) Lot P Subdivision Narne Z I or 2 Family Dwelling - Number of Bedroorns 5 Hunter Hill Estates Block # L1 Public/Commercii-d - Describe Use City Of State Owned - Describe Use Village of 7 !' \ �-' CSM Number Z Town of Hudson I III_ Tine of Permit! Whprk nniv nno hny ran line A- Camnletp line R if nnnfienhiel I A. New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. El Permit Renewal Before Expiration ❑ Permit Revision ❑ Change of Plumber I El Permit Transfer to New Owner List Previous Permit Number and Date Issued 1Y--T-YPeXd'T-0,1WTS System/Com o ice: (Check afl that gment/Dev" _4pply) on -Pressurized In -Ground El Pressurized In -Ground 0 At -Grade 0 Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil 7� Holding Tank _LJOther Dispersal Component (explain) ❑ Pretreatment Device (explain) I A A T 0 A-V 1,3 1l %, it a" I a I %w " I, III a %,Am V r-WR %'" ARE xug Ran" iLX%P RJR 9 [--" J � i �- 0'--' L FtOW LRAM L,.-) I ., I W - — --%— 11 Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed (sf)) stem Elevation"O" 600 Rate(gpdsf) 1200 1200 983; 97.9; 97.5 0.5 V1. Tank Info Capacity in Gallons Total # of Manufacturer E! (5 7U New Tanks Existing Tanks Gallons Units U v Gi, C-1) a. Septic or Holding Tank- )250 1250 1 Wieser Concrete 0 11 El Dosing Chamber El 1. 1:1 El El El V11. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plug r' 1i MP/MPRS Number Business Phone Number 223760 715-760-0486 John Schmitt Z114 -Ile ZIc, Plumber's Address (Street, City, State, Zip Code) A 586 Valley View Trail, Somerset, W1 54025 Vill. County/ epartnient Use Only ❑ Approved ❑ Disapproved Permit Fee Date Issued Issuing Agent Signature ❑ Owner Given Reason for Denial IX. Conditions of A pprova. [/Reasons for Disapproval SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code / ordinances. Attach to coml)lete lilans for the system and submit to the County only on paper not less than 8112 x I I inches in size SBD-6398 (R03/14) SYSTEM PLOT PLAN Silverberg 4 Bedroom Septic System Project Address, 908 Gavin Pass BM1 Symbol BM Elevation: 100.00' BM Description: Top of 2" PVC pipe BM2 Symbol: L BM Elevation: 96-55' 13M Description: Top of 2" PVC pipe Slope Gradient of Tested Area: (10%) Well Symbol (if applicable) Notes Design Flow: 600 GPD Attach design flow calculations for commercial plans: Pipe Materials / ASTM Standard Tables 384.30-3 & 384.30-5 4" SC 40 PVC pipe ASTM- D2665 4" SCH 3034 PVC pipe ASTM-D3034 I I V% rage 2 CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Silverberg 4 Bedroom Septic System Owners Name: Murray & Mallory Silverberg Owner's Address 519 8th Street, Unit B Hudson, WI 54016 Legal Description: SEA./4, SE1/4,, S14, T29N, R19W Township Hudson County: St. Croix Subdivision Name: Hunter Hills Estates Lot Number: 5 Block Number Parcel I.D. Number 020-1487-05-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Effluent Filter Information Page 5 System Sizing & Cross Section Page 6 EZ Flow Information Page 7 Management and contingency plan Page 8 Sanitary System Ownership/Address Form Page 9 Warranty Deed Page 10 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 6/8/2023 Phone Number: 715-760-0486 Signature: In -Ground Soil Absorption Component Manual Version 2.1 May 2022 Page 1 SYSTEM PLOT PLAN Silverberg 4 Bedroom Septic System Project Address, 908 Gavin Pass BM1 Symbol: A BM Elevation: 100.00' BM Description: Top of 2" PVC pipe BM2 Symbol: BM Elevation: 96-55' 13M Description: Top of 2" PVC pipe Slope Gradient of Tested Area: (10%) Well Symbol (if applicable) Notes Design Flow: 600 GPD Attach design flow calculations for commercial plans: Pipe Materials / ASTM Standard Tables 384.30-3 & 384.30-5 4" SC 40 PVC pipe ASTM- D2665 4" SCH 3034 PVC pipe ASTM-D3034 WA rffA FA, fA ��UAWJM WAFA WI&IVA WA IVA V% rage 2 4" CAST -A -SEAL INLET < 2� io'-oj $2 �-iimmmi 4" CAST -A --SEAL I OUTLET CD WLP125 MR TANK SPECIFICATIONS C) © 0- DIMENSIONS: Ix 0 WALL: 2 1/2" BOTTOM: 3" 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: BOTTOM 4,945 LBS. E COVER 3,865 LBS. INLET AND OUTLET: 4" CAST-- A --SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 Lo (OTHER STATES SEE CHART) r- qt Lo LIQUID CAPACITY: 34.81 GAL/IN HOLDING TANK: 0 '14- OUTLET HOLE PLUGGED w 00 ACTUAL CAPACITY.- 1,323 GALLONS u'i I 0 LOADING DESIGN: 8'-0" UNSATURATED SOIL tn TANK CAN BE USED AS: 0 1 am u SEPTIC / HOLDING / PUMP OR SIPHON � 0 r 00 Ln COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) r-- CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WESER CONCRETE 0 0 04 REVIEWED BY REVIEW DATE SHEETNO. OF I TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS r TMTM 0 AWqVX ft P4 DLI 0. , 1 1, PL 525 Effluent Filter Innovations in Precast, Drainage Zabel' & Wastewater Products 10 A Division of Polyiok Inc. 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. ,b 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 servich-ig. 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 I Alum Switch 10,000 GPD] (Optional) 01 Accepts 1" PVC Extension Handle Accepts 4" & 6" SCHD 40 pipe MAMMWO "#,I Mop Outdoor SmartFilterl-R-) Alarm Polylok, Zabel & Best filters accept the SmartFilterO switch and alarm. Rated for 10,000 GPD 525 Linear Ft. of 1/16"' Filtration Slots Certified to NSF/ANSI Standard 46 Gas Deflector Automatic Shut -Off Ball Extend & Loki" Easily installs into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8-514 www.polylok.com C I md IN -GROUND GRAVITY DISPERSAL AREA Stepped Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) min. 12W Geotextile (typical) Cover bps 0 E =0006M SOIL COVER 41,W &N, im M 04.0. 0 i # * 0 Me 12 'WP WN I ilow rnin. trench 040M= '%few b6 4107*5 depth (typical) Septic Tank(s) Manufacturer: Wieser Concrete Septic Tank(s) Volume(s): 1250 . gal gal gal gal Effluent Filter Manufacturer: Polylok Effluent Filter Model #: 525 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Highest Trench Lowest Trench (as applicable) Provide rninirnurn aft separation between trenches. OBSERVATION PIPE DETAIL (No Scale) Systern Elevations= 96.3 ft. � /.� ft; ft, ft Screw -Type or Slip Cap (loose) WPICAL TRENCH (Show location of inlet / outlet pipe connection on plan view.) observation pipe shall be installed PLAN ■ VIEW 4110 at junction between two units. 10 ft (No Scale) Perforated Lateral Observation Pipe (typical) (typical) (typical) J_ B = 80 ft (typical) INSTALL PER TRENCH: 8 1 0-ft bundles @ 50 ff EISA/unit = 400 ft2 + 0 5-ft bundles @ 25 ff EISA/unit - ® ft2 4"0 PVC Pipe — Top of pipe to terminate at or above finished grade (4) 1/4"-11/2" X 611 Siots @ 90 apart Anchoring Device A= 3.0 ft (typical) \___ P:719MW PtHnfilp (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturer's instructions. Proposed EISA per trench = 400 ft2 Required Infiltration Area = - 1200 ft2 x 3 trenches = Proposed Total EISA = 1200 ft2 — Finished Grade (mulched & seeded) Topsoil Cover (min. 1 foot) nfiltration Surface Distribution Method: distribution box FRI Installation Instructions for AAA Zfl, in ow ���� Wisconsin EZfl �m��� OWTM bv IN by INFILTRATOR ^~^^~^~~^~^~~^^^^^~^^~~^^~~~^~~ see ^~^^^^~^^~^^^~^~~^~^^~~^~~^`^^^^~~~^^~~~~~~^~~^^~~^^^~^~~ Wisconsin —�--'--of Commerce, Safety and Buildings 5. The Absorption area (SJ9 necessary for a given site shall o� � � ^ Division, has reviewed the specifications on�/or. ~ �o���� ��� c�������� ~ ' ^ product and determined it to be in compliance with chapters ~ ' the �e eabUdxfo the site. If the e mn ' r � . u* . ^ Comm 82 through 84' Wisconsin Admin. Code. and Chapters , B3A bd b �dinVWsconsin nosu|�nBin�4OY6 o n�c�o �u� . 145and 16O.Wisconsin Statutes. All sites must meet the Site smaUerdnainfia)d. & Soil Conditions & Locations & I ion distances asnoted: in ' loca} regulations. , � Place E��lovv bundle(s) in the EZf|mw configuration ap- ' -' � proved by system design permit specified for the parUcu The approved products are 1203H (3-12" bundles with pipe in |ar site, The top or center -most bundles containing pipe center bundle in 5' or 10' lengths) and 1203HP C3-12" bundles are joined end to end with an internal pipe coupler, Any with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required, ~ should be butted against the other aggregate -only bun - A single pipe bundle contains a four inch perforated pipe sur- � dles and do not require any type of connection. rounded by EPB aggregate and is held together with poly- ehty\enm netting. A single aggregate bundle contains aggregate�^ 7. The top of each GEO cylinder contains a filter fabric pre - only and is held together with polyethylene netting. manufactured in between the netting and aggregate, The � fabric is inserted to prevent soil intrusion. The installer ^ Materials and Equipment Needed ~ shall make sure the the GE[} is poeitiioned upward and is ^ � EZf|�w Bundles ~ in contact with the fabric contained in the adjacent cy|in- ^ ^ � EZf|ow Geotaxti|e Fabric ~ d�rb�fonob�ckhUing . ° EZMmw Internal Pipe Couplers � � Pipe for Header and Inlet 8. The EZDow Dnainfie|d Systems should be installed in a ° Backhoe/Excmva±or |nma| trench in all directions (both across and along the � trench bottom) and should follow the contour of the ground Installation Instructions surface elevation (uniform deoth), with all continuous The instructions for installation of EZflmw products are given adjoining 10-foot cylindrical bundles placed end to end. below. This product must be installed in accordance with state with central bundle distribution pipe interconnected, rules defined in chapters Comm 82 through 84. Wisconsin Ad- without any dams' stepdovvns or other water stops. ministrative Code. and Chapters 145and 160`VViacomain 3tat- utea as ��as the local health department's current design � 9. The trench top shall be graded such that water will not manual. pond. BachfiU should be seeded or sodded immediately � after completion to reduce erosion. 1' localarthe |o�health department has determined sizing. � configuration, and layout for the EZf|mm systems. ��e � 10. EZf|mm EPS bundles are flexible and can fit in oumed or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid tnses, bou\dero, or careful to set correct tank, invert pipe. header line or dis- other obstacles. tribution box and trench bottom elevations before instal- |etion of pipe bundles. 11.EP3 aggregate is lighter than water, therefore, it might ^ be expected that natural buoyancy forces would tend to 2. Remove plastic EZflow shipping bags prior to placing cause EZ5low assemblies to float out of ground when bundles inthe trench(es).Remove any plastic bags inthe ponding occurs. Field experience has ahown, however, trench before system is covered, � that this is not problem when systems have o minimum � of8"ofsoil cover asrecommended bymanufacturer. 3. This product must have Beotoxb|e fabric that meets re- � quiremonts ofa. Comm 84.30 (6) (g)` Wis. Adm. Code. � installed directly on top of the product and extending � 1203H_GEO down along the sides of the product to a point at least six � inches from the bottom of product. ~ ^BarrierMaterial -------- Ge�r`�|e --- -` 4. When installed in a trench, the trench should be dug to awidth of88inches. This not only saves labor \nexcava- VVVI `zVV 9 tion, but also provides better load -bearing capacity after VV backfiU\ng is complete. � � /.._ � ~ ~^~^~^~^~^~~^~~~^~^~~~^~~~~~^^~^^~~^~~~~^~~~^~~ 0 PAGE 4 OF 4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operatin-g Limits: Design Flow = 600 gpd; BOD5 :5 220 mgL-1; TSS:5 150 mgUl; FOGS 30 rngU1 Inspection Checklist INSPECT EVERY 3 YEARS * type of use * age of system * nuisance factors (i.e. odors, user complaints, etc.) * mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) * material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., disthbution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) • Se tic and dose tanks l shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. • Effluent filters shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Local government unit: Schmitt &Sons Excavating, Inc. St. Croix County Community Developement Phone: 715-386-4680 Phone: 715-760-0486 Local government unit address: 1101 Carmichael Road, Hudson ZIP: 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency -Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383,33, Wisc. Admin. Code. Page 7 He #: SANITARY SYSTEM S-r. C R o1-X Q. UNTY Office Use Only Wiowr- ®r 01NNERSHIP/ADDRESS FORM Created 2,12027 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 Murray &Mallory Silverberg Mailing Address 519 8th Street City/State/Zip Fp Hudson, WI 54016 Phone Number (required)651-470-9201 Email Address (required)st.croixcustombuilder@gmail.com Parcel Identification Number 020- 1 4$7-05-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SE /4 ISE 1/4 ,Sec. 14 f T 29 Subdivision Plat: Hunter Hills Estate Certified Survey Map # Plat Warranty Deed # 1166432 Number of bedrooms 4 New Property Address (Staff Initials) N R 19 W, Town of Hudson , Lot# 5 Volume (before 2006)Volume Page # Spec house 13 yes E no Lot lines identifiable E yes 13 no OFFICE USE ONLY 9o�S G19 \/I f\j Piss (Verification of new address required from Community Development o12 �o 2,3 (Date) epartment for new construction.) This form must be submitted with all Private Onsite Water Treatment System (PoVvTS) 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 cdd2sgcw1.90v 1101 car michae-I Road, Hudson, W1 54016 715-245-4250 Fax W4 "W-5-(CW11'V9' P 0 KU C! --- o State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number it Docuynent Name BY THIS DEED, Oevering Homes Investments, LLC, a Wisconsin limited liability company, (hereinafter "Grantor," whether one or more), conveys and warrants to Murray Silverberg and Mallory Silverberg, husband and wife as survivorship marital property, (hereinafter "Grantee," whether one or more), the following described real estate in St. Croix County, State of Wisconsin: Lot 5, County Plat of Hunter Hills Estates in the Town of Hudson, S[. Croix County, Wisconsin. -4— Exception to warranties. easements, restrictions and covenants of record; highway and street rights of way; and Municipal and zoning ordinances and agreements entered under them; and further except real estate taxes accruing in the year of this conveyance. Dated 3Z � Z Oevering Homes Investments, LLC, a Wisconsin limited liability, B': SusanT. 0evering, member AUTHENTICATION Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (if not, authorized by Wis. Stat, § 706.06) THIS IN STRUMENI'D RAFTED BY: St. Croix County Abstract & Title Co,, Inc. by Andrea S Carpenter at the direction of the Grantor. 23-S36008 1166432 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 05/04/2023 03:02 PM EXEMPT#: REC FEE 30.00 TRANS FEE 450.00 PAGES: 1 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address St. Croix County Abstract & Title Co., Inc. 575 N. Knowles Ave., Suite #B New Richmond, WI 54017 Burnet Title 2171023-02341 020-1487-05-000 Parcel Identification Number (PIN) This IS NOT homestead property ANDREA S. CARPENTER NOTARY PUBLIC MNNESOTA My Umm�� Wres January 31. 2(127 I - -00 ACKNOWLEDGMENT STATE OF«ar�r�nhrcr�; (t-J w A--& tt, r-j ) , . COUNTY Personally came before me on the Mhl the above -named Susan T. Oevering, member of Oeverin 110111es, LLC', ,I ".1sconsill limited lialbilitsf company, to me known to be the person(s) who executed the foregoing instrument and the same. Notary Public, State 1/�� My Commission (is permanent) (expires: _ (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FOPLM SHOULD BE CLEARLY Inv N'r I T, I IV 1). WARRANTY DEED C 2003 s'rATE BAR OF WISCONSIN ).1-2003 * Type name below signatures. St. Croix County 11606432 Page 1 of 1 Page 9 t t I TGw it 'sue c+ �.•dnion � _ _ FRONT ELEVATION 8CAL€- W . V-C" r aF a 3 1 I IL _ALl RIGWT ELEVATION BGAL E-: 1/4' . 1'-0" - !pp} Tear ar Fovra+l " nu. W41JT s RL xRVC[ N.Y..37. vs4?! a4.:tyr.L ��. re..+µ •+ .sw.h�•+Y ryu —** V ..tram Ta Dc ,A.. r .s . r 4 a.w R• wf .r f.a— Ie W, ' ra~te — a•9 • 1.c. Pyerrr. T— --Pr. -4 w � a irArPbtYr mw"wj S �tv Y W RYa i ../ew w%' Wwj- 1i�. w Y ! • ii .� .ws. . ... ,,,. aarr uwr rr F•Wt !�y gJ— W wuw ,a V[ cps! plVt�� 6ILVEROERG MiJcL--- G "A ji, £mmoLL Zt5� D"\Vw 15y, Vwz C WytsL 4•--1 REAR ELEVATION zooF PLAN se-wo 'rft'" W�P� to ~ru all ho circa to orq*wlqo OU C'Dv&mww Lo ~jrw j&X16timo avorh" ewvmrwtcn Ard WWIFW dilth ru" O_Vpllor prler to ard0rime WUMOO. 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I . . owhw-a �00 PLC-" 'wil" Offvwl 8 ex-L C-7kcWM K,%OA-FON fit "Olt OLAW] mkTa-thow 2' 21;f1D I h*,,A' (-,% 110 JfA' "-4ftm. k 'NIULal ION JL Ov 4- TYPICAL LUALL SECTION fit Or % Dums # lot %W A~ wwr-w'-W aw _FM, ff-cad I v "44�'Ww 04 ps e 090" 466*-is" AvUWA13W Iu� N Vw7 -3OF A I W,rn ON 0Ow i"W L*6m N O Qkra;a.0 a=wnso I IxT v4*1W"Tw 0" JA" J -www u --------------- . ............. -- --- ------ . . .•...................... .... ................ ............... --------------------- . .......... .......... ........... -C —4G> it it 0-3 q"L 4 Z A Tf °C) cr u 9 s 0 lip" —'T [� '4 4 5° ai�111 SERVICE p ig 1 RESIDENTIAL DESIGN rEf FF 7 [. D) A Department of #2256 OIL EVALUATION REPORT SP Safety and JUN 0 f" igcidance with Comm 85, Wis. Adm. Code Page 1 --of —4--.- Professional Services Schmitt Soil Testing, Inc. County Attach complete site plan on par.er not -less than 8Y2 x 11 Jnc.hes in;�size. Plan must St. C - roix include, but not limited to: vertica'-'t'gri-d-,tTo&zontat-ref,6fenfApointASM), direction and - percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 020-1487-05-000 Please print all information. __._. -___.Rewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �/� �2023 Property Owner Property Location Silverberg, Murray Govt. Lot SE1/4, SE1/4, S14, T29N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 164 Heritage Trail 5 Hunter Hills Estates City State Zip Code Phone Number City 'F—I Village F' Town Nearest Road Houlton WI 54082 651-470-9201 Hudson Gavin Pass New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Outwash (Burkhardt-Sattre Complex) Flood plain elevation, if applicable NA ft. General comments Area is suitable for a conventional system wih a 0.5 gpd/sqft rate. Possible system elevation for Area 1 is 98.3'(high trench), 97.9' and recommendations: (mid trench), 975 (low trench). Slope of area is 10%, ZI Boring it Boring Ground surface elev. 101.30 ft, Pit Depth to limiting factor in. ISoil Application Rate I Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consisten Boundary Roots GPD/ft2 *Eff#1 *Eff#2 0-12 10yr3/3 none sl 2rngr mfr as 2fr I Vf 0.6 1.0 2 12-28 10yr4/4 none scl 2msbk mfr gw 2vf 0.4 0.6 28-33 10yr4/6 none grsl 2msbk mfr gw ----- 0.6 1.0 4 33-45 10yr5/6 none Ifs Osg M1 CS ------ ------ 0.5 1.0 5 45-63 7.5yr5/6 none grlfs Osg M1 gw ------ 0.5 1.0 6 63-81 10yr6/4 none ifs Osg M1 Cs ------ 0.5 1.0 7 I 81-96 10yr6/4 I none I fs I Osg i M1 L ---- I 1 0.5 1.0 Boring # F] Boring Pit Ground surface elev. 101.30 ft. Depth to limiting factor 96+ in, ISoil Application Ratel Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistencq Boundary Roots GPD/ft2 *Eff#'I*Eff#2 1 0-11 10yr3/4 none sl 2msbk mvfr as 2vf 1 0.6 1.0 2 11-46 10yr5/6 none ifs Osg M1 Cs 2vf 0.5 1.0 3 46-96 10yr6/4 none fs Osg m I ---- ------ 0.5 1.0 * Effluent #1 =: BOD 5 > 30 < 220 mg/L and TSS >30 <. 150 mg/L * Effluent #2 = BOD5 � 30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 ------ Address Schmitt Soil Testing, Inc. 1/00' Date Evaluation Conducted Telephone Number 1595 72nd St. New Richmond, WI 54017 5/18/2023 715-760-1978 SBD-8330 (R 07/00) Property Owner SilVerbe Murry Parcel ID # 020-1487-05-000 3 Boring Boring # k pit Ground surface elev. 97.55 ft. Depth to limiting factor 96+ in. Page 2 of 4 Soil ADolication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM2 *Eft#1 *Eff#2 1 0-15 10yr3/3 none sl 2mgr mvfr as 1f,ivf 0.6 1.0 2 15-23 10yr5/6 none Ifs Osg mI gw 2f lvf 0.5 1.0 3 23-47 10yr5/6 none fs Osg MI Cs ------ 0.5 1.0 4 47-58 10yr5/6 none ifs Osg MI as ------ 0,5 1.0 5 58-96 10yr6/4 none fs Osg MI ---- ------ 0.5 1,0 Boring Boring # pit Ground surface elev. Depth tlimiting factor f#. epo mng acor in. ❑ Soil ADDlication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD e *Eff#1 *002 ❑ Baring Boring # ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD1ft2 *Etr#1 *Efl#2 Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 -c050 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS -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 608-266-31 S 1 or TTY 608-264-8777. SBD-9330 (R.07/00) SChm tt Soil Te.ov, Im. 273' Conducted for: Murray Silverberg 164 Heritage Trail Houlton, WI 54082 P I D : 020-1487-05-000 908 Gavin Pass Lot 5 Hunter Hills Estates SE1/4 SE1/4 S14 T29N R19W Town of Hudson Conducted by: Thomas J. Schm' CSTK2274 5-18-2023 117' RUN LOT 5 Bm' BM 1 100.00' Top of 2" PVC pipe BM 2 96.55' Top of 2" PVC pipe 97' 99, 101, 103' B2 a • 256' BM 2 3 ' j 1 10% Slop t R/VV GAVIN PASS CN W <0 W W 87' < Q 90, 103' lit 50' 171' )01- 9�' 141' 99, 49' 151 260 71 25' JACK AVE. 1251 St Croix County, W1 Legend Lakes and Rivers Rivers and Streams DM Ifle"nMapt- PetTerini Interstates US Highways State Highways County Higl-ways Local Roads Rustic Roads Ramps Road Right of Way AWWone.j Pj*oad Private P4*id Rafted Road vacated POW Railroads Conveyance Division 0 20 40 60ft DISCLAIMEW This map is not guaranteed to be BCCLirate, correct, current, or complete and conclusions drawn are the responsibility of the user. I I D5121t23 8:� AM M Ia I St Croix County, WI Legend Lakes and Rivers Rivers and Streams cam InAmmilte"t Perrenial Interstates US Highways State Highways County Highways Local Roads Rustic Roads Ramps Road Right of Way Abondoned Rati-Dad Prwya" Road RaWoad Road Vacated ROW Railroads Conveyance Division 0 50 100 150ft DISCLAIME.R- This map is not guaranteed to be accurate, correct, current, or complete and conclusions drawn are the responsibility of the user. OW1123 8:30 AM Dq)mtwtof }dd � Safety and V 'k 4 PM&AMcy al Servers #22W SOIL EVALUATION REFORT Page 1 of in accordance with Comri► 85, Wis. Adm. Code 4 accordance Schmitt Soil Testing, Inc. [7 Bonng 1 BOOM # Pit Ground surface elev. 101.3# tt Horizon Depth Dominant ColorRedcrx T� in. Munsell Gu. ,SZ. Cont Color 1 0-12 10yr313 mane s1 2 12-28 1+ I4 none sd 3 28-33 111(�/6 none 9rsi 4 33- 45 10yr5/6 none KS 5 45-63 7.5yr516 none 9rifs 6 63-81 10yr6/4 none Ifs 7 81-% 10yr6/4 none fs Boring o Berk n9 � jE] PH Ground lf....] surface efev. 10 1. 30 tt. Horizon Depth Dominant Color RedoxDescttpuwv Texture in. Munseli Qu. Sz. Cont. Color 1 0-11 10yr3j4 none 2 11-46 10yr5/6 none none tfs fs 3 46-96 10yr6/4 Effluent, 01 = SM5:o � rr 30 220 gAL and TSS '30 -c 150 mgA- CST Name (Please Print) Signature, oe Thomas J. Schmitt . Addr Schmitt Sall T"*V, Inc. jo I fib 72nd St. Now Richmond, wl 54017 Depth to firniting Stru#ure factor Consistence 96+ in. Roots Soil Applicadon GPDW Rate Boundary *EW Gar. Sx. Sh. 2mg r mfr as 2f,1vf 0.6 1.0 2msb'ko mfr 9w 2vf 0.4 0.6 2msbk mfr gw ----- 0.6 1.0 099 -MI CS 0.5 110 MI 9w 0.5 1.0 MI a 0.5 1.0 OSg MI ...-- 0.5 1.0 . Depth to Cfmiting factor 96+ in. Soil Applicadon Rate Strnzcture Consistence Boundary Roots GPDW Gr. Sz. Sh. *EfI1 *EM 2msbk mvfr as 2vf 0,6 1.0 MI Cs 2vf 0.5 1.0 mi .0.5 1.0 * Effluent #2 !aS.30 rng/L and TSS 1.30 MY Number 227429 CM a Evaluation cwww* d Tawpph" Win,r 6/1 &P= 716-7 -1 PMperty Owner Si MUrraY Paroel 1D ## 020-1487-05-000 [] Boring 3 Boring Pit Ground surface elev. 97.55 ft. Depth to limiting factor 95+ in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots In. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. 1 0-15 10yr3/'3 none SI 2rrrgr mvfr as lf,lvf 2 1523 14yr5j6 none Ifs OSg ml gwf,1rrF 3 23-47 10yr5J6 none fs Osg MI Cs --~~ 4 47-58 10w5l6 none ifs Osg m1 as ------ 5 58- 10yr6/4 none fS Osg M1 ---. .--�-- Page 2 of. Sail Application Rate GPD/W *081 *Eff#2 Orb 1.0 0.5 1.0 0.5 1.0 O.S 1.0 O.5 1.0 [] Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. oil Application Ri Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPI In. I Munsell I Qu. Sz. Cont. Color I Gr. Sz. Sh. * *E . ❑ Boring Boring # Ph Ground surface elev. Depth to limiting factor In. Soil Application Ri Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDI`Itz In. I Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * 1 *Efl#2 * Effluent #1 = SODS> 30 s 220 mg/L. and TSS >30 - 1 50 mg/L * Effluent 02 a BOD5 - 30 mg/L and TSS 1-30 rngAL The Department of amerce is an equal opportunity service provider and employer. If you need assistance to access services or need material In an alternate format, Tease contact the department yet 08.2+ -3 131 or TTY 846447'77. aava� �a �.a�rooy Adwa so PID: 020-1487-05-000 908 Gavin Pass Lot 5 Hunter Hills Estates SE1/4 SE1/4 S14 T29N R19VV Town o-I'Hudson Conducted by - Thomas J. Schmitt CST 227429/ 5-18-2023 / BM 1 BM 1 100.00' Top of 2" PVC pipe BM 2 96.55' Top of 2" PVC pipe 7' 99, 101, 103' B2 256' p3j RIVV 0 P GAVIN PAS' Uii < Ir- Lu < Orf < f B" ■ at 17 1 01 1031" 50' 7' JACK AVE. St Croix County, W1 Legend Lakus and Rivets Rivers and StruarnS ante Sta It es US Highways State Highw--jys County 141uh-Nays Local Roads Rjsl,c, Ruad; R a rnp $ Roan R,,ght (4 V-'ai Cwiveyance D,-?Lslon N 20 40 60ft DISCL,-4MER This map is riot quarair,*ew to tse aerate co,rect- currer.t. or complete Wd condu-ii,)ns drk-iiwi are the responsibility of thr) user. t f.."." ro x County, W1 Legend ! aif es and River: t; . ,ts r3nd Strrw�ms 1 ,! k Irderstates 4 US HgnNays State Highways County HiLlh>, ayi -A* Loral Roads ,r Rustic; Roars t 4 Ramps Ravi Right o` V. r { } y ' i�e+k�s Ra.�4 4 . r �. ' a a Rsinad 4, Railroads 13 II , Conveyance ©iv sion %, 04, `_ £ T A t + 3 f ' ► �' , .� a 50 100 150ft DISCLAILIE_R This n,ap is not guar,w-t -4ad to be accurate, correct. current, a complete and wncciusor% dravoi ere the responsibility of tt;e uSE'r, AAAM, at AM rn Lo QD r 3 �-6 LOT 4 10 00 3 SQ. FT. Ln 98P119 SQ. FT. Ln L9 AC.) Lu rl-1 (2.2S3 AC-) Lu Ln 0 1 Cr) ro Z 0 Lf) z (cp ro 12'UTILITY cl,? EASEMENT LOT 6 LOT 9 L.B.( 871602 SQ. FT. 106;890 SQ. FT. (D. W-4 (2.011 AC.) /V Z6 048 S;z w 1.031 cr) P-� LOT c:5 r�� 8 FT. rIq (2.004 AC-) '04. 11 f 170.00, A PVC! S78 DS2 tj 313.9,51 (2.454 AC. ) L.B.O.z--962.0 N89042'22"E 5z LOT 10 L.B.O.=966.0 114,952 SQ. FT. (2.E39 AC.) L.B.O.=973.0 �CD �3 �1'2 �3" E59 2 - 7 8 --SPECIAL WELL CONSTRUCTION AREA LOT 11 128,607 SQ. FT. (2.952 AC-) N89'048'39"E 629.71' LOT 12 1321,878 SQ. FT. (3.050 AC.) 15r* C Wk. COUNTY Oq G4%'t'r0kj Piss F"Oml i itvi"v'%r IVmcWiv V: Wtii: PREVIOUS NO. OWNER ��.�Y £ r►�� s,���, . . . ... .......... ........ .......... ... ....... . . . . .... . ................ ......... . ......... ......... kW'L�V�� 460 AUTnuR1z'---,rjj ISSUING UVFICEI%, ........ ........ ........ .... .... .......... . .. . ....... 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, lease contact the coup authori P ty tY. 52-ooS . . .. ..... U "SS REN", WE"" T-'t"xA'- Y'%ATI", goo WWWWw" RM&M �WWW-IN NLT-j I --W M =I . .. . .. ......... . . ...... : : .%:.: - . ... .. ............. .... ....... ..... ..... SBD-06499 (RI 1/20)