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HomeMy WebLinkAbout020-1300-70-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety I and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)]. Permit Holder's Name: Ei city [I village a Town of: PETERSON, BRIAN HUDSON CST BM Elev.:- insp. BM Elev.: BM Description: too-O ELEVATION DATA TANK INFORMATION F_ T _- I TANK SETBACK INFORMATION PUMP / SIPHON INFORMATION SOIL ABSORPTION SYSTEM County: 5T- Sanitary permit No.: ST. CROIX 338984 State Plan ID No.: - Parcel Tax No.: 020-1300-70-000 DISTRIBUTION SYSTEM _0 - x Hole Size x Hole Spacing Vent To Air Intake Header / Manifold Distribution P1 s --TO Spacing Length JLL� Dia Length Dia. 9 L_ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only xx Depth Of xx Seeded Sodded xx Mulched Depth Over Depth Over Bed /Trench Edges l 0 Yes No Topsoi— EJ Yes No Bed /Trench center L - COMMENTS: (include code discrepancies, persons present, etc.) LOCATION: HUDSON 17.29.19.1476,NE,NE 934,CARVER CIRCLE Al r� a4 6u_r4 S.4 D > q Z Qptp4vl� LIJ4-- Plan revision required? [] Yes tg No Use other side for additional information. 00 I SBD-6710 (R.3/97) 9 qj lkev LI 81 M Date Inspector's Signature Cert. Na. ST. CROIX COUNTY ZONING DEPARTMENT Ir AS BUILT SANITARY, REPORT I Owner z_- Property Addres , 1 7- -7 r 7,,,, - .I - -.4 _3 City/State—., 1.-e I as&2 " Legal Description: Lot Block Subdivision/CSM 9 2 Tnvirn of E ST 1.X0 ZONING OF:FICE '/4 V4 Sec. 2L.Z_i N - lx-Z;L- SEPTIC TANK -- •DOSE CHAMBER -- HOLDING TANK INFORMATION: Size SVPC/A&_ Setback from: House Well P/L 7-1-- Model tL Tank manufacturer Pump manufacturer Alarm location (HOLDING TANKS ONLY) Water Line Setbacks: Service road Vent to fresh air intake Meter location Alarm location SOIL ABSORPTION SYSTEM: __7 Type of system: Width Length Number of Trenches - I gel- Setback from-;,t: House Well. P/L Vent to fresh air intake - ELEVATIONS: benchmark 4--c _e,7 elpe, Elevation Description of be ____7_ 7 L2 Elevation Description of alternate benchmark Building Sewer ST/HT Inlet -- J-� _'7 ST Outlet PC Inlet PC Bottom �7��. Header/Manifold 9cle, - 2 Top of STIPC Manhole Cover Distribution Lines ( ) 9'/ P� ( ) Bottom of System ( ) �' lel� Final Grade 9!Z/ 7 � ) � � Date of installation 2_1:?l P rmit number State plan number 1- License number Date Plumber's 1 1 signature Inspector Complete plot plan 1r Z))A) � f r k NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Cou nty Safety and Buildings Division e-�T- - I INSPECTION REPORT GENERAL INFORMATION ATTACH TO'PERI�IT) Sanitary Permit No., ST. CR IIX Personal information you provice may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)]. 338984 I Village Permit Holder's Name: El City El Town of: State Plan ID No.: PETERSON, BRIAN HUDSON CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No., 14 tffet— 020-1300-70-000- ---I A9900246 TANK INFORMATION 0 ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosi ng Aerati Holding TANK SETBACK INFORMAI K N TANK TO P / L WELL BLDG. vent to Air Intake ROAD Septic > c) 5 0 �o� NA Dosing- NA Aerati OK NA Holding PUMP/ SIPHON INFORMATION Manufacturer Model Number L 31 t L Fr iction�.,- stem TDH Lift Loss ea d Forcemain Length o&%Lyo Dia. SOIL ABSORPTION SYSTEM Demand TD�H"�v I Dist. ToWeil el* 50 STATION BS HI FS ELEV. Benchmark 6 .9 Bldg. Sewer.% $5*Z St/ Ht Inlet y 15,-- ow+ St / Ht Outlet /<wr 3 . 7 .3 - Dt Inlet 2_ (a Dt Bottom Header / Man. -5 2 Dist. Pipe 5-t-33 Bot. System `' `'r Final Grade �7 Lyf` DISTRIBUTION SYSTEM xH Size Vent To Air Intake Header/ Manifold Distribution Pipe(s) Ole S x Hole Spacing I + In n 0 Spacing Length ula C"q - - SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded Bed / Trench Center Bed /Trench Edges Topsoil Yes ❑ No COMMENTS: (include code discrepancies, persons present, etc.) LOCATION: HUDSON 17.29-19-1476,NE,NE 934,CARTER CIRCLE A x Plan revision required? [-] Yes JR NO Use other side for additional information. SBD-671 0 (R-3/97) xx Mulched 0 Yes ❑ No C1 - Z,(- q Date inspector's Signature Cert. No L I Safety and Buildings Division NvAl SANITARY PERMIT APPLICATION 201 W. Washington Avenue isconsin In accord with ILHR 83.05, Wis. Adm. Code P 0 Box 7302 i Department of Commerce Madison, WI 53707-7302 0 Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. 0 See reverse side for instructions for completing thus application State Sanl6ry Pe_rmirt Number! Personal information you provide may be used for secondary purposes 0 Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION- INFORMATION - PLEASE PRINT ALL INFORMATION Propert-y Owner Nam� Property Location T N R (Or 1/4M'' 1/4 ,S _Z Property owner's ing dress Lot Number Block Numb City, t to Zip Cod , Phone Number Subdivision Na or CSIVI umt er 11. TYPE OF BUILDING: (check one) ❑ State Owned El CityNearest Roa �Z E] Village - No. of bedroom - - 2 411 IL, e Public 1 or 2 Fam iyDwel I i ng _ (X Town OF , , 1wj &; -_ — - Ill. BUILDING USE: (if building type is public, check all that apply) Parcel Tax Number(s) 1 —1 . I.-Idi . 11. 14 -01 1 E] Apartment/ Condo LLOC.�_,�r L S..6r 2 [] Assembly Hall 6 n Medical Facility/ Nursing Home 10 Ej Outdoor Recreational Facility 3 [] Campground 7 Fj Merchandise: Sales/ Repairs 11 C] Restaurant/ Bar/ Dining 4 F1 Church /School 8 F-1 Mobile Home Park 12 Ej Service Station/ Car Wash 5 f-1 Hotel/ Motel 9 F] Office/Factory 13 E] Other: specify IV. TYPE OF P 11 ERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ES New 2. E] Replacement I E] Replacement of 4. E] Reconnection of 5. Repair of an System System ------------- Tank Only ---- ---------- Existing System -------- Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 [ 30 n Specify Type 41 E] Holding Tank ,U Seepage Bed 21 [:] Mound y 42 Pit Priv 12 [:] Seepage Trench 22 E] In -Ground Pressure Ej 43 E] Vault Privy 13 E] Seepage Pit 14 E] System -In -Fill V1. ABSORPTION SYSTEM INFORMATION: Elev. 7. Final Grade 1 - Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Required (sq- ft.) Proposed (sq. ft.) (Gals/day/sq. ft-) (Mil n /Ii c h) Feet, Elevation An,+ A 0 F e 11;w 9. Id VII. TANK Capacity site Expe. in gallons Total # of Manufacturer's Name Prefab. Con- steel Fiber- Plastic INFORMATION New Existin Gallons Tanks Concrete strutted Tanksglass Appr. 19 Tanks ............. Septic ptic Tank or Ja EJ E:11 IftPump Tank ipMmber E:❑ EE11 -M 6U 1101 RES ONSIBILITY STATEMENT 1, the undersigned, assume responsibility for i stallation of the onsite sewage system shown on the attached plans. Plum er' Nam (7) 7n Plum er' -S/Ign N t p MP/MPRSW No.: Business Phone Number. 4 I I __;2 4 - Pluber'OAddre's'-s- (Street, City, Sta eziper): Re A9Z - 6 �e 'L / I _ IX. COUNTY / DEPARTMENT USE ONLY (includes Groundwater E� sued issui r/iq;�at (No Stamps) r ate Is ng e S u E] Disapproved Sanitary Permit Fee Surcharge Fee) L�(Approved [:]Owner Given Initial Adverse Determination / I ; 5 dz� I X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber Of PUMP CRt4^15CR CX055 SCCTIOl XNC) t-JPECIFICATMKS je, r1 VENT PIPE 2. 5' FROM DOOK, W140ow oft FRESH AIR jwTAKE 160 oll1 I U. IM LE: T FI- T APPROVED JCIM' A W/ PIPE CXTEUDIW(p 3 JQT0 SOLID SD',L- b L �- c V. FT— ,,, —VIE WT CAP Wf: AT H E KPK 00 F' APPAOVED LOCKING JUWCTIOP-J BOX MA�JHOLE Covf-R WIT'" izomiu. \ WAKNIP4G Lm�LL C Q Q D U I T 3N v PROVIDE AIRTIL.HT SCAL APPROVED J01�' W/ " PIPE ALARK CITCUDILIC. 3' Jj P Li M p OF F COQCF,LTL tjLL-,lC9 - RiSCF, EXIT PER/lkilTED OWLS IF TAWK MAQUFACTURZK HhS UGH APPROVAL 5 P C C, I F I C A T 10 Q 5 bLPTiC f C)o 5 E TAW4S MAIJUFACTURLCK. i �JLLA.t['R OF DOSES z P L F, DAB 005Z VOLUMC TAWK 51ZE: IKILLU01"Ci bACKt'LOW: C, X L L 0 N ALARM MAlJuFALTURLR: CIO MODLL WUMbEK: CAPACITIES: A = OR ZGALLOWS 5WITCH T�FC4-' zf2/-�, B = WCHES OK G A, L L 0 Q S PUMP MAWLIFACTURER'. C= WCHES OR C, A L L 0 U INC rlcs OF, 0- -IF E pUMP A, JD kLA.KM ARE TO BL SWITC H T�JPE:: rUITS JN57ALLEU (-JJ 5CPI�RATL CiK mill-ollmum IDISCRAlkGE RATC VEKTICAL DIFFEKE . WCE bETWEELI PUMP C)FF AkJ0 015TRIbUTICW PIPL.. FELT 4- MIkJlMLJM QCTWORK SUPPL4 PRESSURE - F-LET x Y, 0 0 F C C T , + FIET OF FORCC MAI�J TOTAL 0'-JQAt"lC- HEAL) = 2�F -t- L T )iJT[-RQAL nIMEWS QQ OF -T-AQK: LF-�,16TH ;LIQUID DEPTH IDA T E: E 1) 0 rut I Ul 4 iio I 1%bAl-; Curves MMRS FIET r- 90, 25 ful 40 20 ,a 0 L 0 -,w It tit, Pumps 7- 1�10DEL Y�65 SIZE 3/4 ids' MEN 0 ■N � 0 10 20 30 40 w 60 70 60 Go CA P m 0 14 M'/'h CAPACI" j­ Irk 0 U L 0 INC. METERS FEET 1210 110 100 25 70 60 0 4-0 10 30 5 - 01"3 G"10# Pvmpo, Inc, 20 0 10 20 30 40 50 60 70 LAI) 110 Co GPM 0 10 CAPACITY C P,',ODE.3865 SIZE';4" Solids [-7 --T - -- - i-'�-'-I WE 15HN T— 4-+ ------------ --T Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Bureau -of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. I # Page of APPLICANT INFORMATION - Please print all information. Rev* ed-by -----Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). A, Property Owner Property Location 47 J A- . 4) Govt. Lot 1/4 1/4,S/, 17 1 T2eo), XR Z4�7, (06�) '51/ Properfi Owner Mailing Add Lot # Block# r, Subd. Nam r CSM# �v city Stat Zip Code Phone Number 0 Nearest R7o d City E Village Town New Construction Use: Residential / Number of bedrooms Addition to existing building El Replacement ❑ Public or commercial - Describe: Code derived daily flow &/-Zo gpd Recommended design loading rate bed, gpd/fil , _.trench, gpd/ft2 Absorption area required bed, ft 2 trench, ft 2 Maximum design loading rate -bed, gpd/ffS trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable 4 4� ft S Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for systerni ® s El u [Z S El U [0 S El U 1 2 s El _u El s ® u Ds Z U Ground elev. ft. Depth to limiting factor Boring # -- ------- --- Ground elev. 14Lj2jft. Depth to limiting factor SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots G P D/ft2 r Bed Trench Z-V Z 4 Remarks: A- rn SIREN r-_k1.1iLW7 CST Name (P ase Pri Signature r r,, rr Telephone No. Address Date CST Number 'Z' cog 54 L-) z > SOIL DESCRIPTION REPORT .jA e PROPERTY OWNER PARCEL I.D.# Boring # .......... ......... . . ........ Ground elev. /=i2p. Depth to limiting factor ;>& in. Ground elev. Depth to limiting factor in. Ground elev. Depth to limiting Page of A Dominant Color Munsell Mottles Qu. Sz. Cont. Color Structure Gr. Sz. Sh. Consistence Bed Trench Mw MOM. - Remarks: Remarks: Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' Bed Trench I L factor in. Remarks: Boring # 1115 Ground elev. Depth to limiting L factor in. Remarks: SBD-8330 (R.9/98) o o le't - 5 F - e; leo o ri �� I Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 3 Labor and Human Relations Division,of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St Croix not limited to vertical and horizontal reference pointf*ction and % of slope, scale or PARCEL I.D. # COUNTY PAR CEL 0 VI Un 4" R FEE -1300-70 dimensioned north arrow, and location and d' s for 020 1 is c� REVIEWED BY DATE APPLICANT INFO RIVIATION-PLEAS E,," r,R1,f4W_AL1L FORMATION PROPERTY OWNER - PROPERTY LOCATION PROPERTY ',,GOVT. LOT NE 1/4 NE 1/4,S 29 N,R 19 k(or) W Brian Peterson 17 T PROPERTY ROPERTY OWNER'S MAILING ADDRESS; LOT # BLOCK# SUBD.NAME ORGSM # ST 136 na Parkview Estates Sixth Addn. 911 Wert Rd. -]CITY [:]VILLAGE [SOWN NEAREST ROAD CITY, STATE ZIP C P DER Hudson, WI. 5401 6N!�"X*%, F � 1 I `8k�1CM8 Hudson Carter Cr. [ New Construction Use 1k ] Residential l�&e 'Kn�rbo'rp ing df� 3 Addition to existing build' Replacement Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate - 5 —bed, gpd/ft2 6 Absorption area required 900 bed, ft2 75u trench, ft2 Maximum design loading rate * 3 bed, gpd/ft2 Recommended infiltration surface elevation(s) 93-65 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na - ft S = Suitable for system CONVENTIONAL U = Unsuitable for system I EO S El U Ground elev. 96.9 ft. Depth to limiting factor I e"% A Ground elev. 97.7 ft Depth to limiting factor +8611 trench, gpd/ft2 -trench, gpd/ft2 MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK C% E0 S El U I R) S El U S ouwmw�Ks Liu El S IR U SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell Modes Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots G P D/ft2 Bed 7mn& 1 0-18 10yr3/3 none 1 2csbk mf r gw 2f .5 .6 2 18-36 10yr4/4 none s icl lcsbk mf r mvfr gw if .2 .3 3 36-55 7.5yr4/4 none sl 2mgr gw na 95 06 4 55-84 7.5ry4/6 none is Osg mvfr na na .7 .8 Remarks: 1 0-15 10yr3/3 none 1 lcsbk mf r gw 2f 2 .3 2 3 15-36 36-86 10yr3/3 7.5yr4/4 none none scl is lcsbk sog mf r mvfr gw na if na 2 .3 .7 .8 Remarks: PROPERTY OWNER Brian Peterson PARCEL I.D. # 020--1300-70 SOIL DESCRIPTION REPORT Page ' of. 37 Boring # 9 Ground elev. 96.9 ft. Depth to limiting factor . n w .. Boring # Ground elev. ft. Depth to limiting factor Ground elev. ft. Depth to limiting factor Boring # tititiz Ground elev. ft. Depth to limiting factor Horizon Depth i n . Dominant Color Mu nsel I Mottles Qu. Sz. Cont. Color Texture Structure G r. Sz. 5h . Consistence Roots G P D if t 2 Bed Trench 1 0-16 10yr3/3 none 1 lcsbk mfr g-w 2 f • . 2 16-28 7.5yr44/ none sl lcsbk mfr 9w if .4 .5 3 28-38 7.5yr4/4 none sicl lcsbk mfr 9w if .2 .3 4 38-84 7.5yr44/ none sl 2mcgr mvfr na na .5 .6 Remarks: Remarks: Remarks: Remarks: SBD-8330(R.05192) r • DMsicn of Saf*V & 8+ kiiinp :n accord with ILH R 8 .05, Wis. Adm. Code COUI Attach complete sit* plan on paper not � than B 112 x 11 imhas in size. Plan must include, but st, PM firnft to V� a hor enta! reference . , dre' on of cope, wale or PARCEL I.D. e dmensioned, north arrow, and location and dWame to nearest road. 0 2 0 - 13 0 0 - 7 0 A�. .. � REVIEWED BY SATE PPLICAN INFORMATIO PLEASE PRINT ALL INFORMATION PROPERTV OWNER: PROPERTY LOCATION GOVT. LOOT tE 1/4 NE 114,S 17 T 29 •rN,R 19__. ftw)W P'ROPERW OWNER':S SLING ADDRESS LOT BLOCK SUS0. NAME OR CSM � 457 Jaen T n. 1 136 1 na I_w. Park CITY, STATE ZIP CODE PEE h111MBER JJCITY a LLAGE GWOWN NEAREST ROAD Hudson, Wl ,, 54016 (71 381-2902 Hudson =er !�j Lgle JKI New Comte Um ReskkmW i Number of bedrooms Action to extistirg btilding L 1 Reoacwwt Public or commefdai ill. w dedved dOy fiow 450 gpd �� �ing ram bed. Q � trench, �gpd2 2 Aare ; uj'red 64 3 � � 56 � l�� � � ' lor� ._..�..7..., bed� � ...tench, WW R'eoommended infiftrabon surface eWvatbXs) 96,00 ft (a referred to silo pin mark) AdaknW deem i site woffli6mraale* site LMuires Pant na*W i teed vutwash Flood p Wn aWA900 if apt mble , eta„ S = Swwe kx System CONVENTKML MAD 4GROUND PRESSURE Ai -GRADE SYSTEM W FILL SING AXK =U ale stem 13 OU S 0U 0U JOS oU Kis oU 05 U SOIL,, DESCRIPTION REPORT Boring ohzon Depth ln.� Dominant Color Mansell Qu. --17 7 . r4/4 r 17- 84 r Mottles 0 Texture Structure iConskwnw ri�8oixjW Roots � G P lit1 Sz. Cont. Color I Gr. Sz. Sh. Bed Mn WIN R��rke; Boring • 1 -8 10Xr2Z2 no e 2 -17 7 . 2r4/'4 none S1 ICO12LC mfr If 4] 3 — 7 . r4 6 none Cc . n n rw . 7 . S Gmwd 987 40 h +8P Reffar: FCSnTam:--P� Prrit G L. Steel Pam: 715-�200 s: 1554 � e. a 'c and4�TI �17 l t�: CST Nurttber r 2M - OWSMV&v%ff a SIDIP w O'"WOM a "MOM 'aws-0 a PAWELI-ELP 2 0 - 1300- 70 • BMng # [ 3 3.; Gmund elev. 9818 ff. Dom 10 k"N Gmund 01W 97*9 ft. Dow to k"Ag +Vol Boring # 6 Groum Aev- )6. 2 ft, 0" to Wong ism 44 Dominant Color Munsell lion �M-, M.L3,,22 1 1 Oyr4/4 I none Remarks: 1 -1 10yr2/2 none S1 1 fr cm 2f n 2 46-40 10 4 ..Xro none YU1 1051A Eli... aw If .-,2 'I 3 0-80 a Tv 5vrx.4Z� CO& MI- -4.7 08 Remarks: 1 -12 IQyr�Z2 DA4 9. - fik- MILK 2 F 2-31 IS11 n9n Ic m r crw jf '05 3 31-50 10 vr4/6 none Oscr mvf r I na o5. *6 4 0-70 IQXr:4Z4 ---.jc2p joll. In na na DA 1 0-14 1 1 Qyr2Z2 &M r Mtr aw j 2 14-25 10 r4L4 none Sil lcs*.Q% i mfr cfw 1f *4 .5 3 125-44 19 ,yr.4/4 none fS Osg .tea qw na .5: .6 4 144-60 1Qyr4L6 Ic2p7.5yr5/6 lcbk mfr na na 021 o3 NMI I Remarks: Ab STEEL'S SOIL SERVICE Gary L. Steel Tw perillo 1554 700th Ave. CSTM2298 NEknk S17-T29N-R19W New Richmond, WI 54017 MFRSW-3254 town of Hudson (715) 246-6200 iot #136-Parkvietit Estates Sixth. Addn. N 1n-g4r BM.= top of NE lot stake 0 el. 100' for borings 1-6 BM. for borings 7-9= base of elec, transformer el. 100' Alt. BM, for borings 7-10= top of tel. ped. �' el. 102.40' y A-41 e' � . , Sys f � gA CpA 40 <57 1 �0t � b�b� � 4�I{t) °I� 177-" 90 9-I2-98 Gary L. Steel s-z4-% Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division, of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in ,size. Plan must include, but St • Croix COUNTY St not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL LD. # dimensioned, north arrow, and location and distance to nearest road. 0 2 0 - 133 0" 0 - 7 0 6 C - APPLICANT INFORMATION —PLEASE PRINT ALL INFORMATION FREVIEWED BY DATE PROPERTY OWNER- PROPERTY LOCATION LOT . NE 1/4 1/4,S 17 T 29 -,N,R 19 Tom Perillo GOVT. NE , jpr) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SUBD. NAME ORCSM#- 457 Jensen Ln. 136 na Parkview Estatgq Sizth. CITY, STATE ZIP CODE PHONE NUMBER []CITY ©VILLAGE MTOWN NEAREST ROAD . ' Hudson, WT. 54016 (715) 381-2902 Hudson 'Carter Circle New Construction Use Residential / Number of bedrooms 3 Addition to existing building Replacement Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate 7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate - .7 bed, gpd/ft2 . trench, gpd/ft2 Recommended infiltration surface elevation(s) 96-00 ft (as referred to site plan benchmark) Additional design site considerations -alt. site ruires a mound sVstem q� P-1. 97.61 Parent material pitted outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system E3 S El U N S El U [IS El U -ji S Ej U S El U El S U SOIL DESCRIPTION REPORT Ground elev. 100.0 ft. Depth to limiting factor +84,,_ Ground el,M%f 98.W' ft. Depth to limiting factor I rlf"% It Horizon Depth i n. Dominant Color Munsell Moues Qu. Sz. Cont. Color Structure Gr. Sz. Sh. Consistence Bouncivy Roots GPD/ft Bed 7mnch 1 0-9 10yr3/3 none sl 2m a mf r 2 2 9-17 7.5 yr4/4 none is osg mvf r gly if .7 .8 3 17-84 7.5yr4/6 none MS osq Ml na na .71 .8 Rem. arks: 1 0-8 10yr2/2 none sl 2mgr mfr Cs .51 .6 2 8-17 7.5.yr4/4 none sl lcsbk Mf 9LW_ if .4:: .5 3 17-80 7.5yr4/6 none cos osq M1 na na- .7: .8 Remarks: CST Name: --Please Print Gary L. Steel Address: 1554 200th. Ave., New �Riclfmand, WI tAkl6k 54017 Signature: Phone: 715-246-6200 Date: 9-24-96 CST Number: m02298 PROPERTYOWNER Tom Perillo SUIL UtSUKIIJ I IUN ttr.VUn I PARCEL I.D.P20-13GD-7G rctvu 2 Boring # Horizon Depth in Dominant Color Munsell Mottles Chu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Roots G P D Itt Bed Trench �� nX.�:.1ti . z .. 3t -:: 1 0-9 1Gr22 sl k . 4 .5 2 ~ss:sLti ssz =.:: 9 -- 2 2 1 G r4/4 none s 1 lgsbk mf 9N if . 4 Ground 3 22-80 7.5 r4 6 none elev. 98.8 ft. Depth to limiting factor +8G,, Remarks: Boring # s:�tis:r�:: :tit1 •::S : S .•. i .❖: 1 -16 10yr2/2 none sl 2c 1 mfr 2f n .2 L- s: 4~= 2 16-40 r4 1 G 4 / none s i t l c sbk mf ' i f . 2 .3 3 0-80 7.5 r4 6 n n cos os ml na na .7 .8 Ground elev. 97.9 ft. Depth to limiting factor +8G" Remarks: Boring # 1 -12 10r2 2 none sl 2mar Mfr aw 2f . . =� 2 12--31 16 r4 4 none s ' l f . 4 . 5 .. 3 1-50 1 G r4/6 Y none f s os mvf r na . 5 .6 Ground elev. 4 a--7G 10r4 4 c2 7.5 r5 8 n .2 96.9 ft. Depth to limiting factor 50" Remarks: Boring # : 1 G-14 1G r2 2 2f .5 .6 6 y: 2 14 -25 1G r4 4 / none sil lcsbk mfr if .4 .5 .............. 3 2 5 --44 1G r4 4 y / none fs os mvfr 9w na . 5 .6 Ground elev. 4 44--60 1 G r4 6 c2 7.5 r5 6 s i 1 lcsbk mfr na na . 2 .3 96.2 ft. Depth to limiting factor 44" Remarks: SBD-8330(R.05192) STEEL'S SOIL ! SERVICE Gary L. Steel Tom Perillo 1554 tooth Ave. CSTM2298 NEkNEk S17-T29N-R19W New Richmond, W1 54017 MPRSW-3254 town of Hudson (715) 246-6200 lot #136-Parkview Estates Sixth. Addn. N 111=401 BMO= top of NE lot stake @ el. 100, I Gary L. Steel 9-24-96 'i 't OCT-09-99 10:02 PM BELISLE EXCAVATING 71524730364- P. 01 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 16 ri kr\ Luy\o Mailing Address Property Address 9'13:� �.e" 61 (Verification required from Plaraiing Department for new conswico on) , I City/ state r7 Parcel Identification Number LE-GALPF4 .._§CRIR110N ✓� Property Location IXG 1/4, Sec. T N-R..LLW, Town of cr b Lot Subdivision 112 kle Certified Survey Map Volume page 0 Warranty Died # C L , Votume ry 7�' page # Spec house 0 yes no Lot lines identiflable !Yes 0 no EYS-371M MAINTENANCE re failure to handle wastes. Proper malct=ance imptoM use andwintenam-we of your septic system could"M result in its PreMA consists of pumpiag out the septic tank every three years or sooner, if needed by a licensed pumper. What You Put into the system can a5ect the function of the septic tank as a treatment state in the waste disposal SYStern. 'sae property owner apecs to submit to St. Croix Zoning Department a cerbrIcAHOD form, signed by the owner and by a I ifying that (1) the on -site wastewater SYStcm rn a ste r p! umber, jou ruoyman plumber, res ttic te d pt umbcr or a licensed pumper veri i is UM proper operating condition andlor (2) after inspection and pi=ping (if necessary`), the septic tank is less than 1/3 full of sludge i g tu.&rds Vwc, the undmirned have read the aboN c re I.TtMents and agrcc to maintain the private sewage'disPos" system w th th set forth. hireiz� as b the Do:partrnent of Commerce and the Department of Natural Resources, State Of Wisconsin. Cen' icafict stating4hat our sep maintained must �x cornpictcd and returned to the St. Croix County Zoning Ofrict withir- 10 .00--/- ye 't�iystern has '�.,%een mainia. da f the three r expiration date. DATE SIGNA-rI,�JtE APFLIIANNT OWNER_!CERTJF1CAM:S . I (we) am We) the Owne*) of (we) i y that all staiem.�cnt& on this form are true to the best of. my (our) knowledge the pro dl 9 ed above, by virtue of a warranty deed recorded in Register of Deed$ Office. s SIGNATU" OF APPLICANT DATE 0*40000 Any information that is mis-represented may result in the sanitary permit being rrwoked by the Zoning DeP&ffttnT- 00 intrude with this j1pplicatlan. a stampcd warranty deed from the Register of Deed: office a copv of thc ceriifted survcy map if reference is made in the warTarity deed