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HomeMy WebLinkAbout651304 020-1376-02-000Wisconsin 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 Kernon Bast TOWN OF HUDSON CST BM Elev: Ins. BMlev: BM Description. , Iu� G� +O (,Nf wcll TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic VPt5&- tom to 1260 a) Aeration Holding TANK SETBACK INFORMATION r Charn�� lSers TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dos;og f Aration Hoidi ig PUMP/SIPHON INFORMATION Manufacturer Dem Model Number TDH Li Fri tion Los System ead TDH Ft For main Len Dia. Lt. t ell ELEVATION DATA County: St. Croix Sanitary Permit No: 651304 State Plan ID No: Parcel Tax No: 020-1376-02-000 Section/Town/Range/Map No: 14.29.19.2263 STATION BS HI FS ELEV. Benchmark Alt. BIM Bldg. Sewer 2 SUHt Inlet � • � r' / �` J SUHt Outlet Dt hilet Dt ttom Header/Man. Bot. System yt.oq �Il _l 13-Y Final Grade .3s 9F-w St Cover j/�2Z SOIL ABSORPTION SYSTEM V&Mtl f Sea led l can f ank ena -a, Vi" an R .A an4 BED/TRENCH DIMENSIONS Width / Length �� No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAK /ST AM LEACHING Manufacturer: INFORMATION Type Of System: Lvn+�n�ron�l 7 7 / n` T� CHAMBER OR UNIT 1 of r la-tr�I r- Model Number r �S ciV.Ih- DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Length Dia Length is SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over r D }vj Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center y_ L9 FG Be Yes Y No COMMENTS: (Include code discrepencies, persons present, etc.) Location: 954 LA BARGE RD 1.) Alt BM Description = 2.) Bldg sewer length = go bo;IJ;�g dvnn' t - amount of cover = _� Inspection #1: M2 U Inspection #2: Bedchmr44- 3 he loe o� well @ Jpo' CrL e� 1 Z� IUo bwla;n, Or Qua in6plllei coat STJ Plan revision Required? ❑Yes ❑ No vy (J /x—, Use other side for additional information. 1 Date Insepctor's Signature Cent. No. 1,441-)r)iY_)`)-7 �ti`1r f )fildb5tij' SCJV1tY.5 QlVt5lr1t1 `e 4M Madison Yards Way F �-- Ctlenitjr }, �' cx(� LX Madison, WI 53705 P.O. Boz 71f Z Madisork WI S' PctIItit Nib (to be filled in by Cn.} &51 53W1771b2 3ol Sanitary Permit Application V-- (Svo State Traasacxion "ter in aCXardanre with SPS 383_21(2}. Wis. Adm. Code. submission of this form to the appropriate g-tal unit � is required prior to obtaining a sanituy permit. Note: Application roans for state-owned POW TS ale submitted to the Dcpartmott of Safely and Pm&ssiow Savmn- Per xn infaratatwn fin provide may be used for secondary Ptajas Address (if different than mailing acid7essl Puq►uses in accordance with the Privacy Law, s_ 15.04(1)(ml Slats. j 6 1. Appll=Wn Lnfora2tiat4 Ph== lariat All laform - glen Prcaperty Own crN('�. �1 ti N ame ��/5�( �bs, Ptutel # Property Owner's Mailing Address hopelty Location Gb b % Govr_ Lat , + W City. State } y W Zm C Phone Number V S 4 �4 I —� '_ f� %r Section T � 7 N R ! j E or W It. Type of Bolding (check all that apply) Lot # I.__.11 or 2 Fawily Dwelling - Nurn6a ofFtedrooms � Subdivision Name OPttbiielComtnereial - Describe Use S � Si2e� 5Wt )CXl S SEock i ily of n _- -•^ IVIRMC of State Owned -Describe Use CSM Number ZD14C )< 19Town a€ p S (;rt ILL T)Ite of POVnS Pei ndj (Check either -New" or "Replacerttent" and other applicable on floe A. Check one box an line 0_ Complette Line C i Licabie. 5ysteut System Modifnation to E. wtag Sy-- (avlain) dffidneal Plstrew ent Uret (titRia) ']folding Tank rotutd v Qht-Grade ElMound hrtlivvdua6 Site 13esiga Other Type (explain) C. Renewal Before Revision of Plsmtbes �taosfer to New Owner Previous Pertnit Number and Issued Expiration 1 Z IV. Oispersal/Treatment Area ami Tank Infortnation: 2 X 10 "—Ales es D c F7ow�(gjtd) co Design Snit A licarioo a[gp�s€1 Area Rc tired (-st} Dis(rdsa A Reposed (s1) system Uera" [.�' �'`V V � Capacity in Tnml m of Manufacturer Tarok IttRmgttion Gallons Galiotrs Units �f11 k 5 New Tanis Existing Tanis y ,� F _ u t; _ t1 tj an to [i7 Et. a R. Septic or Hakliug Tank _ j (� i 0 V. Responsibility Stalemea(- 1, the crud signed, assume respensibilitr for imtalbIii on of the POWTS shown on the attacker! plans. Plumb Name t} 1 's Si MP/MPR5 Nutuber $us xs Pltooe Ntmnker Plumber's AMtess (StneK City,State, Zip C.ode`-)`` Dn 13Ao� 1 V VI. CountyfDepartmeat Use Only Approved Disagpru Parma Fee slate Issued I.ssu 'n$ Feat Stgttatme 5 '2ls/Zo2_3 Conditions qtAp6lProva 3 , cDAJ r mesa_ SYSTEM OWNER. "M2023. 1. Septic tank, effluent filter and dispersal cell must be serviced ! maintained as per q) management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code i ordinances. .ranch to comptrto Plans fur the s)seem and sa&ota to the Coeat} un1% = paper aw kss than a in x rt inches is sim S8D-6398 R.03/21) NArrve PAR sf L-io(.ALA Ay �d . Bf"llmN.; NNfiA) E4ovj 'I-P -� wtil 6 �1 B4; Jw, pqO i is� r o I iaso bi St�'ic T'otik �/ � 'Traort►c� S 3 x93 '71-M L'�c.htPRS aaa90 LA 6 Ract r o;1D Pm*Rmwtw LAod aftaba= Tam -oao-1 74-6b -oop PTW V pqpx pa —� pftm3 PbM7 SL _ DMd oaw Lama *mobs: Aadsw NArrve PAR sf L-io(.ALA Ay �d . Bf"llmN.; NNfiA) E4ovj 'I-P -� wtil 6 �1 B4; Jw, pqO i is� r o I iaso bi St�'ic T'otik �/ � 'Traort►c� S 3 x93 '71-M L'�c.htPRS aaa90 LA 6 Ract r o;1D ST R JUNT-Y SANITARY SYSTEM Fde office use oni OWNERSHIPIADDRE-SS FORM Geaudzam . � Community Development Deparmwnt wili utilize this information to provide the property owner with information regardkq operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public heaftft, your well, groundwater,surface water, property values, and county resources. Once approved, this completed foam and educational information will be seat to you by email. �j OWVN'ER/BUYER INFORMATION C�rj6� _ F 1(I r'� Ro S l ' Citylstategip LP U©�W'j W) "1�96 Email Address ( 1, 3 G N , N A Parcel ldenffxation Nor (tound on the property tax Ui F G • b-'~ [pub NEW SYSTEM: LEGALQDESCRI1MO Property Location )Jf 1/a ,514 '/4 , Sec ' V, i � 1 N R 1 +� LIV Towrn of Subdivi6iun Plat S fW � -C f G a JD Sj rJ0 K M 00/)s i'k Lot 4P Certffi+ed Swvey Nlap 9 Volume_ Page 4 . L4 3 rr,,,, uraYe . Page V Number of bedrooms q Spec house CQ yes E3 no Last lines identifiable U yes ® no OFFPCE USE Cur,! t New Property Address !7,q �'C' �h �" > ) (W ` of nary address repo from Co --Iv Dev .pmeM i for nrctidn ) {5raffalsi ('Date) This form must be subrnfted with aU Private unsi-te Water Tra2finenrt System (POWTS) applications_ t'e 535U= fnc#ude r:t+�ri1 dra Srr,r a reed w vr�rl�y deed 15 7 ,, u,e RegisWr of Deeds Owe anal a copy of the ceitilied Community DevalopmEnt Department -- Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4254 fax ctid@sc gQV 1 101 Carmichael Roars, Hudson, ul 540in" wwwasxmgflv Ste . , ed.:i�eva,ti.Q.n.:`t•h�$''.5: l., d-1IUManbers 3-ft„Tflopo,p-09W. P.1- i74no crea tj :aOIL COVER :, 5 ' TYP'lA�.,:TRENCH + CR08 .$ C'T1QN VIEW = " , �t�ta• kale) ' Hlphdst Trench Lowest Tronoh (as e j leper Provide n between trend", system Elevations ,0 k ft; Quaok4 Bfandar6 W w/ End Cep (typl (Show location of inlet I outlet pipe connection on plan view.) cq hold pw mw4* TYPICAL TRENCH PLAN VIEW (No Scale) JA 3.0 4 �- — — — — — — — .u� w .u� ty 1fto �y'� ,:,r., , •. fir, , u: r„il;• tN$_TAL4'' P ER TRENC104h.�WO*W.c*nbat H? • 2 (!�'' , r, ;es ' , ,' �!It�d•4Y Ii91'ey�11.�11R alto.); . ' ' � 'I� •'Pap'�•pf,an�, ` P!!'. ,'t„i.�l2�,LQfii(�r,�,' s���;y� , ;, , `+ ., , . •., • •'�;p ,{�,�'' �'''s'-+�+�+,•�,r;.• '' Nlnd;Ir>1�,ItrtnArji��l .51 yr�1'.,`•'�1'�Y�,�''!il''''I.'�'1t.( ,•y'..%1,,,1., 'ti,' 'I• .', ..1.. ,Y y...:,•. /. ��t .�I''�: ..5p',',I f,' i'tr .{r ,4� t'• X. �ioi',' phi:; :�T' !Alt W1 -41 1.11I. —rnl F I �n 'v + N s WIN Y tic M T� ' �, � • ,�,r � �� t .'r •�t���ws `�ti.' 7M"1.'. .,r ' th 'c 1•, ',�. :, .� :. ' ftiti•'' , .i~ .� '+' ],5 4'1i � ,.7,`•• .��'i;;�"� �` !`•'s:t,jir`;� i. �''' "'r'''R,�^:s.:. ,;};,'•i.• •,+ .;}s '.'�' i ��'�+:, '•i :!. .. ',;,r .si ., !!�• 1 �s�;r ",.1 � i '•.�� ,�•1 '•,;.' f,' 'y,,, ,'♦�. 1. '�;;'. ;• '.: ••t•r 'r' '� �:'t •r.r.i ... rt' �:,� 1•�'. �'� i' °.� '�A i•'tt� L , •'fit'+1 t.' .,ti ' 1 ' '' {,':;• •) ,•' y{." ,,,'» ..�.' r � 1 . . ' ;t'' ! , ,.1, �' *,, � •i'� ; ,t'';si�"r:: r.:.i;�'y ,♦.L' •;,}r• :.Iv:• .p,i, rrfr. « IV" r„ •, ,X', r �,. , ' �•' r'.�,'s •�. s,is•, i.� '„J;.,:r ry. ;., '+' ,'ems ,h';,, ,, � "• � r, '�I+t P �'"�t' •'•«�� ' ia. .'a;'•? '�'t :',,'furs. !''riij,��••Y,•...:.�"'�•�.! N+' ��r;;';' tr.t•. �!'. t.,.•h ": � :`'.': ,�' i� •4,�,•i: ' ',w • • ,}�%',,1, w,i5• f'• ''''•'s.i�•"y;• • ry,7,t' :s.;r' 's:' »� r;,•• "i r:•''st ' 'is. . Wisconsin Department of Safety and Professional Services Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 385. Wis. Adm. Code minty Attach complete site plan on paper not less than 8 112 x 11 inches in see. Plan must include, St. Croix but not limited to: vertical and horizontal reference point (BM), direction and percent slope„ Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road- 020-1376-02-" Plea" print all information. Reviewed by Personal information you provide may be used for seconclaq wirposes Law s.. 15.04MWm1l. Page 1 of 3 Ref #'2737 Date -Property Owner Property Location ❑ Kemon Bast & Dann Speer Bast JT Revocable Trust Govt. Lot SE % NW % S 14 T 29 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 948 LaBarge Rd. 02 Na I Sweet Grass Farm City State Zip Code Phone Number ❑ City ❑ ViLNe ® Town Nearest Road Hudson WI 54016 11 1 Hudson I Pd. Add.: 954 LaBarge Rd. ® New Construction Use: ® Residentialf Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial — Describe: Parent material Glacial Till Flood Plan elevation if applicable na f . General comments and recommendations. She suitable for in -ground POWTS, Recommended infittrative surface elevation to be 94.00. Boring oring # ❑ pit Pit Ground surface elev. 98.10 it Depth to limiting factor >123' in. tirjt Arv-Ai M6r Rana Horizon Depth In. Dominant Color Munsell Redox Description Qu- Az- GwL Color Texture Structure Gr, Sz. Sh. Consistence Boundary Roots GPD1FF 'Eff#1 `Etf#2 1 0-9 10yr3/2 none sit 2fgr mvfr as 2vf.fm 0.6 0.8 2 9-27 10yr414 none sil 2msbk Mvfr 9w 1 Vf f 0.6 0.8 3 27-36 7.5yr;06 none Is 0s9 rrtl cW 1 of 03 1.6 4 36-82 10yr416 none s 0s9 ml cW - 07 1.6 5 82-123 10yr514 none s 0s9 di - 03 1.6 2 Boring # ❑ Boring ® Pit Ground surface elev- 9e-03 IL Depth to limiting factor >121" in. Soil Appkation Rate Horizon Depth In, Dominant Color Munsell Redox Description Ou. Az. Cont Color Texture Structure Gr, Sz Sh, Consistence Boundary Roots GPDIFt7 'Eff#1 'Eff#2 1 0-12 10yr3f2 none sil 2fgr mvIfr cs 2Vf,f 0.6 0.8 ...-._ 2 12-25 10yr414 none sil lmsbk mVfr cw lvfm 0.4 0.6 3 25-36 7.5yrr4f6 none is 0sg ml Cw 1Vf 0.7 1.6 4 3"1 10yr4t6 none s 059 ml cW - 0.7 1.6 5 81-121 10yr5f6 crone s 059 dl - - 0.7 1.6 rorrriwsn�•�ra:t�:���errLwr.�r:�-.�i�r. :�w^�^�'c��r�� �r-.���a::rr-T�s:i.w-e�:�t.'errr�rr:�r.. :��sr.+.��+�+e�er�r�� sr..mii CST Name (Please Print) Signature CST Number James K. Thom_pson 30021 Address Date Evaluation Conducted Telephone Number 340 Paulson Lake Carve, Osceola, W1 54020-5413 November 9, 2023 15 248-7767 SBD-8330 (K04115) F Boring # ° Bing ® Pit Ground surface elev. 98.78 fL Depth to limiting factor >1 in. �_.. .... 7r77.1 77 Horizon Depth In. Dominant Color Munsell Redox Description Ou. Az. ConL Color Texture Structure Gr. Sz. Sh. Consistervce Boundary Roots GPD/Fe 'Eff#1 'Eff#2 1 0-14 10yr3/2 none sil 2fgr mvfr cw 2vffm 0.6 0.8 2 14-28 10yr4/4 none so lmshk mvfr cw lvtfm 0.4 0.6 3 28-34 7.5yr4/6 none Is Osg mi cw 1vf 0.7 1.6 4 34-76 10yr416 none s Osg ml cs - 0.7 1.6 5 76-120 10yr5/4 none s Osg dl - - 0.7 1.6 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate F] Boring # [IBoring ❑ Pit Ground surface elev. fL Depth to limiting factor in. Sod Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Ou. Az. ConL Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Fe 'Eff#1 'Eff#2 ' Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L « Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30 5150 mg/L eefi56:no bN;/drl3jkrd . Ma.K r1,,&ak fvp o� wc,!/ h t xd - ---- Assa,ma dd of 0 Ex;JtK�wt11 ir ,�rLd 5lope�'�i�oag� sy,sbcr•� A�ea ■ 82 ■ Sol! C daltca,E on ♦ Ejr;3� �rwd¢ e.lu' 737 9s�!-a���crPd ��.ctsar►, �v t. syoib loe az, oFSwe&Z &'ass arm,-50114AA(Se a /,/, QO�"a*ir, P. /9oo.. 7'a- of f/cdU;?, .S4-• it D;JeaO.,1-2i. /a:z -4oao-137b-a2-4w !beoI .Z,3f a c res b v a 4 1A 3 �aed �a a3 3 ■ I P.343 Wisconsin Department of Safety and Professional Services Page 1 of 3 Division of Industry Services SOIL EVALUATION REPORT `7 �-2,02-7 — 2— I In accordance with SIPS 385, Wis. Adm. Code County Attach corgi plete site plan on paper not less thin 8 1/2 x 11 inches in size. Plan must include, St. Croix but not limited to: vertical and horizontal refereince point (BM), direction and percent slope, Parcel I.D. scar• or dimensions, north arrow, and location and distance to nearest road. 020-1376-02-000 Ref #2737 Please print all information. Reviewed by Date t Personal information you -ovide may be used for seconclaa purposes Priva Law, s. 15.04 1 m . e 121f-/223 a'-- Property Owner Property Location ❑ ED Kernon Bast & Donna Speer Bast JT Revoca hie Trust Govt. Lot SE % NW '/a S 14 T 29 N R 19 E (or) W Property Owner's Mailing Address .f Lot # Block # Subd. Name or GSM# Rd. 1 02 Na Sweet Grass Farm State Zip Code Phone Number !] City ❑ Village Town Nearest Road r._ WI 54016 Hudson Pcl, Add.: 954 LaBarge Rd. Novel construction Use: ® Residential/ Numberof bedrooms 9 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial -- Describe: Parent material Glacial Till Flood Plan elevation if applicable na ft. General comments and recommendations: Site suitable for in -ground POWTS. Recommended infiltrative surface elevation to be 94,00'. 1 I Boring # 0 Boring ® Pit Ground surface elev. 2LLO ft. Depth to limiting factor >123" in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu, Az. Cont. Color Texture Structure Or. Sz. Sh. Consistence Boundary Roots GPDIFtz 'Elf#1 Eff#2 1 0-9 9-27 10yr3/2 1 Gye4r4 none none sil 2fgr mvfr as 2vf,fm 0.6 0.8 2 sif 2msbk mvfr gw 1vf,f 0.6 0.8 3 27-36 7.5yr4/6 none Is Ogg ml cw 1vf 0.7 1.6 4 36-82 1Oyr4/6 none s Osg ml ow - 0.7 1.6 5 82-123 1 Oyr 5.'4 none s Osg dl 0.7 1.6 0 Boring Fs�0 Pit Ground surface elev. 98.03 ft. Depth to limiting factor >121" in. Horizon Depth In. Dominant Color Munsell Redo): Description tau. At. Cant. Color Texture Structure Or. Sz. Sh. Consistence Boundary Roots GPDlFtz 'Eff#1 "Eff#2 1 0-12 10yr3/2 none sil 2fgr mvfr cs 2vf,f 0.6 0.8 2 12-25 10yr414 none sil lmsbk mvfr cw 1vfm 0.401 0.6 3 25-36 7.5yr4/6 none Is Osg ml cw 1vf 0.7 1.6 4 36-81 1Oyr4/6 none s asg Usg ml cw - 0.7 1.6 5 81-121 1Oyr5/6 none s dl - - 0.7 1.6 4_1f 91F D yQ.36/8 34 CST Nance (Please Print) Signat � CST Number .lames K. Thompson I� M• 30021 Address Date Ealuation Conducted Telephone Number 340 Paulson Lake Lane Osceola WI 54020-5413 November 9 2023 715 248-7767 SUU-8330 (R04/15) I 3 I Boring # ❑ Boring l__l ® Pit Ground surface elev. 98.78 ft. Depth to limiting factor >120" in. Qnil A—li— i— 0o+o .Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 0-14 10yr3/2 none sil 2fgr mvfr cw 2vf,fm 0.6 0.8 2 14-28 10yr4/4 none sil 1msbk mvfr cw 1vf,fm 0.4 0.6 3 28-34 7.5yr4/6 none Is Osg ml cw 1vf 0.7 1.6 4 34-76 10yr4/6 none s Osg ml cs 0.7 1.6 5 76-120 10yr5/4 none s Osg di - 0.7 1.6 D Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. ���� I Horizon Depth In. Dominant Color Munsell Redo: Description Qu. Az, Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 D Boring # El El ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Qnil A— i—+i— Df- Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ftz *Eff#1 *Eff#2 -41 = BOD, > 30 <_ 220 mg/L and TSS > 30 <_ 150 mg/L * Effluent #2 = BOD, > 30 <_ 220 mg/L and TSS > 30 <_ 150 mg/L � � e Ad. 6- o z, Ala eov 5cve e ^ass a� w.W. ast /Ovd r lk 51vp2 r o ct lndu=y SaNit s Division County /� `tc` 4922 Madison Yards Way �¢f :F isY Madison, W1 53705 Sanitary]PI—oft (to be lilted ur by Co.) P.O. Box 7162 Madison, WI 537g7-T162 O —aviary pencriit Application StrmeTmalt iiumbdr in ac-rdant:ee with SPS 3&3.x44 Wis_ Adnt. Code, submission of this foam to the appropriate governrrx-anal unit is required prior to obtaining a sanitary permit Now Application forms for state-owned POW" T^S are submitted to Project Address (if mailing address) the Department of Safety and Pmfeownal SMNK= Personal information yoo provide may be used for secondary Purposes in accordance with the Privacy Law, I. 15_04(lXm), Slats. 1 "J 1. Aprlllittilra Inf ttun -Please Pr mt Ali ]fnfarmatien 9 Property Ownees N _. Pauoet # Property Owner's Mailing A r L�►b� � ylr, G�t U c tate Zip Code Phone Number G�S� I t I �) r r,�5 w ,;jinn ll. Type of Bm'ldhrg (check all that ) Lot s T ;11 N R 0 E err W 151 or 2 Family Dwelling - Number of Subdivision Nlame �Wt 2psS laublieiComrrrercia] - Describe Use clock ai ` of OF to Own - Dtscnbe Use Numb= tllage of N% U DS liJ_ T5`Pe of POW FS Permit: (Cbeck either "New" or cement" and other LnL&&MJ mw box an liar IL Complete line C if 2ppficablc) A_ Syn. m Systemm flan to Rxisting -iem `,banal Pretrzatmeat Unit (explain) g oldi Tank � vetatianal LIMrutnd Individual Site Design t7tlrer `fype (explain) C- Arai $ef. F]Rcv. ge of Plumber ransfer to New st Previous Perma Number and Date Issued E.xpiratieat IV_ 1€lispeWtb Treatment Arta sad T lnformatioa; Z 3 X D v\ ` Design Flow (gpd) Design Sail ion R te(gpol's0 Di Area. Required (sfl 00 System 0 C) Capacity in Total : of Mamrarr 'tank Information Gallons Gallons Units r� d o $ v NewT Fxistirag Tanks Po �-J ' L� u c w u o A q U e U yr n v A Septic orHolding Tank f !as II Dosing Chamber or V. Re "asponity Statemeiiat- 4 do7co&) responsibility for instaNatiaa of the POWTS shown date sttaebed plates. Plumber's Naatc (Print) Si 11"IMPPIS umber N &b�ury�� Dix y �-3t t Plumber's Address <5beet City, Same, Zi i,) A\Aj Vi. CountylDcpartmesst Use only rorved Pmrrait Fax Date kmed issuesAgent SWW= s t7tvxrer Denial 3j !317,023 00�� lq� Conditions Md. SYSTEM OWNER l C O _ r5 S r ZL �.1'61B►MS . 1. Septic tank, effluent filter and dispersal cell C4 must be serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained /) as per applicable code I ordinances. S �C `IS 5v't a� _ate q7/ — t /4 S 4v;�e as w , Attarta to awmpbdme pi nrs far lie Sy >� rs A l a tim oar pp er am twsrr s v3 111 arias is sine 5F3F1-5398 (R_ 03J21) -pilot map NAM-e- ; kR�N�w BAS-f LocafjoN 9sy Lot a S0,em EIRv= 95.33 I fIVAMOK =- NA" PVC COPY Q.? 11110 a rk IPVc IJ50j� srvet4 1 r 0 ux �l -Tm �«•►nees-�R L'�c.ntPRS aaa90 Alt moo �3 a14NCe tS 3x 4a as cl,br�b��� a -pilot map NAM-e- ; kR�N�w BAS-f LOCKfIOTj 9Sy Ln6kcp E6pr] Lot a Sys�,em EIRv= 95.33 AI ac� Mac ' a P Vc �i�v- lOa.o IJ50j� srvet4� "roN V- W t l � �--� Poly t,o� 5a5" T -Tm �«•►nees-�R L'�c.ntPRS aaa90 Alt moh 7IX70 �3 r 0 URI] 1�4WAIS 3x 4a as cl,br�b��� IN -GROUND DOSED -GRAVITY DISPERSAL AREA Stepped Elevation Trenches with Qu1ck4 Standard-W Chambers 3-ft Trench (dawn -sizing credit) IN 8ClIt. COVER 12' rnIn. trench (tY Ca System Eltsvatins = 9 Trench h k_ ft; Quick4 Standar&W wi End Cop \how (typical) min. 12' ltyP'a�f TYPICAL TRENCH CROSS SECTION VIEW (No Scale) IF Provide minimum 3 ft t Lowest Trench (as applicable) separation between trenches, ft: ft: ft location of inl fl outlet pipe connection on plan view.) B=I --/-- —;01---- III (typloetj INSTALL PER TRENCH: NOV Qu1ck4 Std-W (� 2t3 ft' ElSAIc . her @ + + .�l�.,. Pairs of end asps oft, pelt„r fti observation Instal per manulact Ws / Instructions. TYPICAL TRENCH PLAN VIEW {No Scald A=10ft (typical) Ird-W Chamber (tyoow) imfd by inibliratar syst rns, Ina j Install pursuant to menuraot tea Inwuctlans. = Proposed Ei�-, ft� g p per trench � �.� r.Ilre,d Inflitradon Area � � t? ft, x - trenches Propo T EISA � 4aa� fits Distribution Method: branched manifold I vi u Pil HP td vi V1 vi Yl V1 LV— �fll I p 00 do S� It Ol mono ritint 9 a HJ rw A ` . . . � � " IY IqTy SANITARY SYSTEM OWNE SHIPIADDRESS FORM °qF" Use Only Community Development Department wdl utirtze this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information ►gill be provided as part of our ongoing efforts to protect public heai#ti, your well, groundwater, surface water, propergr values, and county resources.. Once approved, this completed form and educational infomrwa#ion will be sent to You by email. (Avner/Buyer _ lading Address City/StateF-ijp — Phone Nlu b.-r i Email Ad.:r7ass (n 01') 1 t) 5 l LPL] �(jW (*I W) VC�, 9b K 13 ds op rjit4A I Parcel tc- ,motion Number (7 �t o _ 1 � 7 G IG Round Gn 6te property tax bill) Wo w1 L1111- ^ Property = ocaiion � � ya ,S �1 1la , Sec. � � . T � ��-~N R I + W, To. of f'+ 410 S V A; Suwi:^.s=ori :'tat: W -i P rt i� 5S t'p �t r�1 jot 4 Certff W. Sze-uzy Map 9 / %�� �� Volume . Page # ,' �+ - 3�o�ilJ ^� �i►ic i jVviiiiiE__ Page Number of bedrooms Spec house 0 yes 0 no Lot lines identifiable 0 yes 0 no New Property Address -- (Strt n�15) (�2- 1,r, P, (Verifi - of new address �© 17 z (Date) lJ-oYi-.;- from Community This form must be submitted wifh A Prrvate anstre Water Trea&aent System (PQVV75) applica ors. Ww 5•y^*" s.: fPudade wah usi, jIbian a i war, ►ny deed )Tom Me RegLw of Dee& Of m and a cW of Me Cvhjted survey Mop i f ►e*ww" is rnadL�, in the warrarny deed - Community Development Department-- Land Use Division 715-386-4680 St Crobc County Government Center 715-245-4250 Fax aId0_ 5,QALgoV Z iu i Carmichael Road, Hudson, WI 54016 wwW_aCwri.gQ State Bar of Wisconsin Form 00-201 t CORRECTION INSTRUMENT t)nder W is Stat r 706 085 Doctimeitt N11111her 11 Dociirnent Nanie Undersigned hereby states that a certain document ("conveyance") titled as Qttit Claim Deed (type of document), and excctited hetvvicen Kertlon . Spe J. Bast and l7onaida Jer-Bast" , Grantor, and II: Kern on least and Doti aIda " Grantee, was recorded in County, '~,Wisconsin, on Januarx 3 2017 , in volume page , as doctmeut number 1041388 , and contained the following error: The name of the Trust was missing the middle initials of Kernon Bast. and Donalda Speer -Bast. l� �l��il��lll��l�� 1 4 5 7 1 4 T0357479 1043686 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 02/ 16/ 2017 2:56 PM EXEMPT#: 3 REC FEE: 30.00 PAGES: 8 Recording Area dame and Return Address Undersigned snakes this Correction Instrument for the purpose of correcting the Edina Realty Tittc„ Inc, conveyance as follows: 400 So. 2nd St-, 4130 'I IIQ correct name ol,[lie oust is: I Ile Kernon J Basi and Domilda J Spcer-Bast Joint Hudson, WI 54016 Revocable Trw;i Dated Decembe[ 29, 2015 r1 -7 7� `hushmid and wise ' *Speer- Bast Joint Revocable 1 rust Dated IDeneniber 29, 2015 i The basis for Undersigned's personal knowledge is (check one): See attached X Undersigned :s i:w Grantor/Grantee of the proverty described in the conveyance. t':,r c,,°,trcaunr Numhcri.T'iti l ndersigned is the drafter of the cotiveyan:e :hat is the subject of the Correction Instrument l_indersigned is the settlement agent in the transaction that is the subject of this Correction, lnstrumcllt f )tlter (Explain): •- htisbond and wile "Speer -Bast Joint Revocable Trusl Datcd December 29, 2015 "'tircer-Bast. Iltisband and Gvite A copy of the conveyance ( in hart ;�r whole)Q is El is not attached to this Correction Instrument (if a copy of the conveyance is not attached, anach ;hc legal dc.LL i; . Undersigned has sent no'.ice oI 'lic execution and recording of this Correction Instrument by 1" class mail to all parties to the traitsaclion [�Astias the st 1ject - 'Ile conveyance at their last known addresses. Dated on TITLE.- MEMBER STA-11% BAR OF 1W'ISCONSIN (If not, authorized by Wis. Stat. §706.06) THIS INSTRUMENT DRAFTED BY: Kernon .1. Bast, 948 LaBarge Road, Hudson, WI 54016 (SEAL) Dnnalda J. 5 cer- ACKNOWLEDGMENT STATE OF WMM7SIN FL ] ) ss I CC7UN'I'Y ) Persona came before me �)t: rf ' p (u,:C I 7 ;y O / [he above-nained teem rn t- s.: :nd 17crna[d_a i. to me known to be the person v ho executed the foregning inst upicia a td acknowledge Ie aisle. _ N Notary Public, State of Wisconsin � pl LL My Comm ission (is permanent) (expires _ ly Q -- — — sr T (Sigimttire% may be mithenticxted or acknowledged. Both sire not necessary.) NOTE'Fit IS IS A STANDARD FORM. AN)' MODIFICATIONS TO THIS FORM SHOULD SF: CLEARLY II)EN'l-IFILD. � 7 w C:0RRF,(-rI0N INSTRUMENT STATE BAR OF WISCONSIN T) pe mviw [+ulow.cisnatures FORM NO. 00-2011 3 St. Croix County 104368S Page 1 of 8 9/25123, 9.53 PM 715628291.jpg HUDSON AREA CHAMBER of Commsrce i Tourism Burosu 715.396-&411 1 Huds+omWl.or9 502 2-4 St, Hudson. W'1 54016 l e) 1 7 1 Ne-)r https/Imail.google.Gorn/maiVu/01?ogbiffinbox?projector-i 1/1 9/25/219:48 PM IMG--4471.jpg h":Ilmail,google.com/maiVu/0t?ogbi#inbox/p5?projector--1 1/1 9/25123, 9:48 PM I 71557065644�84257FD4-DAF3-4576-A36 i -8OD61 CA3E987.Ipg -' riGogle.cam/maiUu/d/7ogbiffinbox/p5?projector=1 1;1 - Department of Colnme �NI] SITE EVALUATION ` f _ �n of Safety and ftwidirrgs Page of gy eau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than B 1f2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and S'17 t;,p'jZ c percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # &1226 37�-6-2- APPLICANT INFORMATION - Pl a ►ill_ alf f afFan. a ewed by date — Personal information rovrde may be use dt��rifaryp ses [19Yd6w, 5. 15.04 (t) (rrr)}. ` 5— Property Ow,rne = - Property Location Govt. Lot �r 114 Sw) 114,S , T E (or L ,N,R Property Owner's Mailing Address �, r 4�� Lot # Block# Subd. Name or CSM k(e If CRax City State Code I idllll�TilGmber ❑ City El Village [ETown Nearest Road i l J L�,,C"� N I L^-3� I 1�� I ► r 1 � �J`�}� �1 �-1 `.d C{ .F U ifs �- `° � �` ✓ �— T G� [ New Construction Use: FResiden l of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow_ gpd Recommended design loading rate_ ®bed, gpd/f� trench, gpolft2 Absorption area required S_ bed, ft2trench, ft2 Maximum design loading rate 7 bed, gpolft2 ' Cyr vtrench, gpd/ft2 Recommended infiltration surface alevation(s) �~ ft (as referred to site plan benchmark) Additional design/site considerations { S~' - Parent material OLJ-4 fN £ .5 - F Alain ele lion, if li bi i S = Suitable for system Conventional Mound% in P essure I AT -Grade -E Solftem in Fill Holding Tank ❑ S O U U = Unsuitable for system ET ❑ U [�l S El [5;�S ❑ U I S [__1 U ❑ S E' U SOIL DESCRIPTION REPORT r k't], Baring # Ground elev. Depth to limiting factor e, r in. Boring # Z Ground elev. ft. Depth to limiting factor in.. Horizon Depth in. Dominant Color Munsell Mollies Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 Bed . Trench Z -- '� Remarks: 1 � 't �� 3 - 5 i, 1 1 t'��i ti, `r ►'-�, c- a .� 3 z 1-1 C S Remarks: ST Name (Please Print) Signature Telephone No. ddress Date CST Number fU1''j :S� . �a�ne� 2� ,+)I -_--i'iC� Zj ZS _) D PROPERTY OWNER PARCEL I.D.# SOIL DESCRIPTION R Rage � of Boring # Ground elev. ft. Depth to limiting factor 4L�_Lin. Baring # Lj C Ground elev. eft. Depth to limiting factor I ! `� in. Boring # Ground elev. Depth to limiting factor 1L`Lin. Boring # Ground eiev. n Depth to limiting Horizon Depth in. Dominant Color Munsell Mottles Cu. Sz. Cont. Color Texture Structure Gr, Sz. Sh. Consistence Boundary Roots 2 Bed Trench ly Ll i & C� Remarks: 0 C r S � Remarks: Horizon Depth in. Dominant Color Munsell Mottles Ou. Sz. Cont. Color Texture Structure Sz. Sh. Consistence Boundary Roots GPDIft2 Bed Trench `Gr. tAL Remarks: factor in. Remarks: SBD-8330 (R.9198) P It PAGE_3 _OF 3 NAME &f0,+ LOTO � LEGAL DESCRIPTIONS 'AjUZ/,.Si4T,-'q,N,R(qE(orx2k) SCALE: I"= BM I ELEVATION BM I DESCRIPTIONj,��_", 13M2ELEVATION 1CC)-0 BM 2 DESCRIPTIONtao_4. I SYSTEM ELEVATION ALTERNATE ELEVATION CONT01 IR Fl.rVATTON wA DATE Parcel #: 020-1376-02-000 t 10 2007 11:59 AM PAGE 1 OF 1 Alt. Parcel #: 14.29.19.22::; • 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner D - BAST, KERNON J & DONALDA SPEER KERNON J & DONALDA SPEER BAST 948 LABARGE RD HUDSON WI 54016 Districts: SC = School SP = Special Type Dist # Description SC 26! I HUDSON SP 17,_)u °vITC Legal Description: Acres: SEC 14 T29N R19W PT SE NW SWEET GRASS FARM LOT 2 2.390AC EZ-U-1558/119 Property Address(es): = Primary 954 LABARGE RD 2.390 Plat: 2530-SWEET GRASS FARM LTS 1/78'00 Block/Condo Bldg: LOT 02 Tract(s): (Sec-Twn-Rng 40114 1601/4) 14-29N-19W SE NW Notes: Parcel History: Date Doc # VollPage Type 04/01Y2003 715473 2190/531 WD 08/31/2000 629124 1539/081 WD 07/27/2000 627130 1529/538 WD 07/23/ 1997 1081 / 16 WD more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 101`25+'2005 Description Class Acres Land Improve Total State Reason RESIDENTIAi- G1 2.390 55,400 0 55.400 NO Totals for 2007: General Property 2.390 55,400 0 55.400 Woodland 0.000 0 0 Totals for 2006: General Property 2.390 55.400 0 55.400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0 OC, T W+ mK ROAD i I ............... ............. b T CY) e Q / _..1 tJepar#merrt of Commerce jr,ND SITE EVALUAT1ON Page 1 of jn 1 f Sofety ai d Duddings •• �.' Beau of Integrated Senricas in accordance with Comm 83.09, Wis. Adrrl, Code Attach complete SSte plan on paper not less than 8 1/2 x 11 irx:rw in size. Plan roust include, but not Kmiled to-. vertical and horizordei reference polyd (81101), direction and percent s", scale or dimensions, north arrow, and location and distance to nearest road. APPLICANT INFORMATION - Personal informabon yq�,prnvide m�ay De us �� JJ Property o-,ek_ i pr;)erty owr-,ar s Mai iN Address i 3 5_3 Alm city �00SON Parcel t. D. ' ed by Date +d ry �l rives s. 1 .04 (1) (mi). n _ ,t-r►_ I IQ 1. r Property Location GovL Lot 1/4(�I.� 114,5 r r uL U Lot N 8locklt Subd'. Na" Of CSt ,A r de n0kWT4Wnber ❑ City ❑ SAIiillage ® Town 0%, • zi q'�Lr C+Y, i5� ri i i 941� 04 9 a I) T Z� ,N.R { I E Nearest Road Z« J?weCek V4 New Construction use-. 4 ' of bedrooms 3 t° ° belldirlg ❑ Replacement ❑ Public or commercial - Describe: � 1`' �d Recommended design loading rate .'7 -bed. gl� ' F' ' 9P Cade derived daily Aosv�" �J � Absorption area required g bed, ft2 4 � trench, h Maximu n design loading rater 2 bad. gpd* _ � WW%ch. gpdRte ReoDmr>ended infitlraUan surface elevation(s) S� _.. ft (as referred to Silo plan bertdxrrarltJF Additional design/slte considerations Wet r n Parent material L G^F S -'' tivn, rf r Conventional Mound n-Ground P essum AT -Grade m in fill FHio" T; S = Suitable for system [� S❑ U [`' S❑ U S ❑ U ©S U ❑ S U Unsuitable for system &S ® U SOIL DESCRIF liarizon Depth Dominant Color mimes in. Munsell flu. Sz. Crlrlt. Cokw a / .-.. 3 -3 1 ��y 6 Remarks: TION REPORT �►" 3+> Texture Structure Consistence Gr. Sz. Sh. Boundary Ro 1 D-w Remarks: PROPERTY OWNER ` j PARCEL 6.D.1 Boring #i t-tonzon Depth Dorninartt Color " - in- MurLwl U o Z - n Grow d 3b k7l elev. 7 qq'gS. Depth to ornftfrlg factor — Remarks: Baring # E1913R. Ground elev. Dept, lo limiting factor Jl!i in - Remarks: H(MizO 1 Depth [ointment Cokx in. Murrseg SOIL DESCRIPTION RE Mottles Qu. Sz, Corn. Cobr Mollies Qu. Sz. Cant. Color Texture Stnicture Conststeno Gr. Sz. Sh. ",1 1 rAAZ)&wry 1 z t^n�q ,+✓� �� Texture Structure I Consish Gr Sz Sh Boring # 10 i VA k u. Z. ti l -`t z C r +7; f H r t Ground Depth to limiting facto? f1 A in. Remarks: Boring # lb Ground elev. t4 , Depth to lintitlng !actor _ `in - Fiemarks: SBD-8330 (R "8) Rego 4 'of m i i MIN mr -mm� amp M ■ M ■M- 1 IWr PAGEOF NAME Jf- LO`I`# LEGAL DESCRIPTION / /.5 T N R I q E or O SCALE: I = La BM I ELEVATION q41, 10 BM I DESCRIPTIONJ.��� -1 y � BM 2 ELEVATION 100 Q BM 2 DESCRI PTIONttg OA ! 'fiA c prOt SYSTEM ELEVATION °I s• g ALTERNATE ELEVATION C? S • q .EJ' CONTOi1R ELEVATION �L Fa � b► Dz r : I Ok6 flf r r + �r I � I i W r Z - CO cc OH 2 OH I 12' x 14' 12' x 14' an 4 G7 na PQ 1 nJ _ v N KA � O f - � M z PO I r t N °. I a Cq f.J � < i O ■ U"+ OH 12 x 14' J hJ r. m4 1 �i For other design systems search "Design & Buy" on Menards.com _ROAD • • • • • • • • • • • • • Exhibit A - Legal Description Lots 28, 29, 30, 32, 33, 34, 35, 36 and Cutiot 3, County Plat of Cottonwood South First Addition, St. Croix County, Wisconsin. Lot 1, 2, 13, and Lot 14, Sweet Grass Farm in the Town of Hudson, St. Croix County, Wisconsin. Part of the NE % of the NE % of Section 33, Township 29 North, Range 19 West, St, Croix County, Wisconsin, described as follows: The East 352 feet of the South 408.52 feet of the NE % of NE % of Section 33-29-10, Except part conveyed to State of Wisconsin, Department of Transportation in Vol. 1194, Page 463, as Document No. 548040. Lot 3, of Certified Survey Map recorded in Volume 22 of Certified Survey Maps, page 5431, as Document No. 856771, located in part of the Northwest Quarter of the Northeast Quarter (NW l of the NE %), Town of St. Joseph and in part of the Southwest Quarter of the Northeast Quarter (SW Y of NE %) and in part of the Southeast Quarter of the Northeast Quarter (SE % of NE X), Town of Hudson, all in Section 10, Township 29 North, Range 19 West, St. Croix. County, Wisconsin. St. Croix County 1,041388 Page 2 of 5 St Croix County 1043686 Page 5 of 8 C'J C^a�—'�'P.d�' �s�3 S6k � S�.w. 5�2e�Q � q -+gW'&m. �01couN�W 1vo. 51 a F-1 75-q t.%A- b&p4L_ g b, . "RAMFERJPITNEWAL PREVIOUS NO. OWNER �i&IVOIV 3P'tS� PLUMBE LIC.# ?22 %q_ TOWN , • • - - r AND/OR LOT 2 BLOCK SUBDIVISION XLAO�� -AUTHORIZED ISSUING OFFICER SBD-06499 (R11/20) 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: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. - HATE J° i3) 20n