HomeMy WebLinkAbout020-1418-20-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
538866
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
r1
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Anderson, Andrew & Kimberly Hudson, Town of 020-1418-20-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
/Do- /,a D, o /--mod- en*tA,-c. 20.29.19.2650
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic LLA~~~_ /2DD Benchmark gD to-2.,$
Dosing Alt. BM W
Aeration BI D ~ U K ~ 9,6
Holding SUHt Inlet D 16efq D >1# 7O
SUHt Outlet
/r7 v cj y
TANK SETBACK INFORMATION -56q o
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet /
Septic I Dt Bottom
Dosing 7D Header/Man. p D
0 9~-
Aeration Dist.- Pi S 041 qyf o m
Holding Bot. System
~Q n,~ ~ Final Grade
PUMP/SIPHON INFORMATION C- ' k K44, s,~t( (33 3 .(o °r GI - Z
Manufacturer
C Demand St Cover
GPM 'rti~-P_ r5 3-0 -714
Model Number
jWjj ILA
TDH Lift Friction L System Head TDH Ft
Forcemain Length % Dia. Dist. to well
SOIL ABSORPTION SYSTEM 2 1 Q~h v
BED/TRENCH Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS J 5 fi
SETBACK SYSTEM TO D V/ P/L BLDG WELL LAKE/STREAM CHING Mir I ( ~Y 0( n
INFORMATION HAMBE _F
Ty Of System: ,~~N ( / IT Model Number: ZD
DISTR TION SYSTEM. L.1) Ae
ead is ion 4-A4S , x Hole Size x Hole Spacing Vent Air tak
K Pipe(s) ti t 5~4 D-f [ /i 1_0
Length Dia Length Qq Dia Spacing / 4
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
VJ El Yes [ifl No [j] Yes M No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 ( / 1( / 1( Inspection #2: / /
Location: 460 Wren Circle Hudson, WI 54016 (NW 1/4 NE 1/4 20 T N R1 9W) The Glen Lot 56 -Parcel No: 2,0,..29.19.2650
1.) Alt BM Description = ► vT`~"'' (wR Q~G `aQ~t~/E~'~ W S 't ~~%Lh
2.) Bldg sewer length =Gf5/
- amount of cover
Plan revision Required? ®Yes No s`
Use other side for additional information. I G~
SBD-6710 (R.3/97) Date Insepctor's Si nature Cert. No.
cO1T1merce.vvl.gOv Safety and Buildings Division County
w~ 04-W. Washington Ave., P.O. Box 7162 t~
' *adison, WI 53707-7162 Sanitary Permit Number (to w filled in by Co.)
y S3 SfS
Sani ary Permi*;^ppl anon State'frwlsactionNumber
in accordance with s. Comm. 83.21( Wis. fission of th Ybrm to the appropriute gov tal
jij~ o forms for state-owned POWTS are Project Address (if different ban mailing address)
unit is required prior to obtaining a anita knit: Note-,
submitted to the Department of Co erce. Persc~palri, Ira rovide may be used for secondary
purposes in accordance with the Privac aw, s.` lit/ 6,4 (f
1. Application Information - Pie nfor etion
Property Owner's Name i m6 11- / Parcel 4
A Otto A/i S, v J v v
Property Owner's g Address Property Location
~Govt. Lot C IE
City, to Zip Code Phone Number / ° ~ y,, &4= y., Se lion
clrc le of~
W 17 T Z~- - N' R// E
Type of Building (check all that apply) 0 - /
1 or 2 Family Dwelling - Number of Bedrooms ✓4 Subdivi " n Name
Bloc
❑ Public/Commercial - Describe Use
❑ City of
of
CSM Number ❑ iwnllageof
❑SState Owned - Describe Use / /
7, '121 ~ G 1. L.,. G!
III. Type of Permit: (Check oily one box on line A. Complete line 13 if applicable)
A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Lxis, ing System (explain)
List Previous Permit Number t nd Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer to New
Before Expiration Owner
IV. T e of POWTS Slate omConent/Device: Check all that a 1 2 4✓ cZ 4 C"
effNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil El Moww < 24 in. of suitable softp~ J S
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)__-
I
V. Dis ersaUTreatment Area Information: Zs,gn Flow (gpd) Design oil Application ate(gpdst) Dispersal ea Requ' d (s f) Dispersal Area Proposed (st) Stem Ele% tkjon
VI. Tank Info Capacity in Total 0 of Manufacturer
Gallons Units a °
Gallons U
ti
New Tanks Existing Tanks NO w w
Qe64L
Septic or Holding Tack ~S -
Dosiag Ciwmber
VII. Responsibility Statement- 1, the undersigned, assu sponsibility for installation of the POWTS shown on the attached plans.
Pl s Name (Print) Plumber' store MP/MPRS Number Business Phone Number
7' '
Gz6 ) 7~ ~~~0X
r;
Plumber's Address (Street, City, State, Zip Code) 7
Z
2 /
VII . Conn !De artment se Onl
Permit Fee Date Issued Issuin eat Sign ur
XApproved ❑ 13 $ s511>0 2 It
❑ ven eason for Denial t
IX. Conditions of App~ppr~oval/Reasons for Disapproval r, Gam. e~ 5 a ,
SYSTEM;OWWER. 3~ eve
1
1. 'Septic tank, eflluent"ti w and
dispersal cell must all be services I maintained
as per management plan provided by plumber. et (Z~
2. AN. $60aCk Tt!gtdrements must be maintained
Attach to complete plans for the system and submit to the county only on paper not less than 8 l!z 111 inches is s'-
SBD-6398 (R 02/09)
S it Test and System PLOT PLAN
PROJECT Andv Anderson ADDRESS 586 Ctv Rd A hudson Wi 54016
NW 1/4 NE 1/4S 20 /T 2 ZN/R 19 W TOWN Hudson COUNTY ST. CROIX
10/20/11 BEDROOM 4
MPRS Shaun Bird 226900 _ DATE
CONVENTIONAL XXX IN-G UND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 860 # of chambers 42
BENCHMARK V.R.P. Top of survey iron . ASSUME ELEVATION 100° Filter BEST Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 94.4/94.3 4.5' below qrade @ B-1
Well is to meet all
setbacks required by / 169' property line
WDNR
i
Plans Designed Using 40'
Conventional Powts 40'
Manual Version 2.0 ii 59
B-3 40 B.M. * C~
25
0'
Vents
ST 1% Slope B-2
50' 2-3' 86' cells with >3' spacing
Zo '
Pro 4 Bedroom
house 110' Property Line
2
cwje~e-
313' Property Line
Wren circl
COPY
S it Test and System PLOT PLAN
PROJECT Andv Anderson ADDRESS 586 Ctv Rd A hudson Wi 54016
NW 1/4 NE 1/4S 20 /T 2 jN/R 19 W TOWN Hudson COUNTY ST. CROIX
10/20/11 4
MPRS Shaun Bird 226900 DATE BEDROOM
CONVENTIONAL XXX IN-G UND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 860 # of chambers 42
BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100° Filter BEST Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 94.4/94.3 4.5' below qrade @ B-1
Well is to meet all
setbacks required by 169' property line
WDNR
Plans Designed Using 40'
Conventional Powts 40'
Manual Version 2.0 5,
B-1 B-3 40 B.M.*
0'25'
80' Vents
ST 1% Slope B-2
50' 2-3' 86' cells with >3' spacing
Pro 4 Bedroom
house 110' Property Line
313' Property Line
Wren circl
r) i
Wisconsin Department of ommeZCI C" 111 _ \.S IL EVALU S Page of
Division of Safety and Bull ' s
r iwith Comm 85, Wis. Adm. Code
County
Attach complete site plan o p1' ass than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: v ' and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. A -my
Please print all information. Revie by Date
Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). zl `l
Property owner Property Location
Govt. Lot (,J 1/4 1/4 JZO T 1;2y N R E ( ) W
Property Owner's Ili Address Lot # Block # rme or CSM#
g~ s6
City Stafe Zip Code Phone Number ❑ City Vil age own Nearest Road
w .JYv/.6" ( ) /
New Construction Us Residential / Number of bedrooms Code derived design flow rate G GPD
❑ Replacement ❑ Pubr or commercial - Describe:
Parent material LLhtJ~ Flood Plain elevation if applicable ft.
General comments
and recommendations:
System Type System Elevation
BoriM # E Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
2 U, r 3 - 6--- Z~
I ~
11
ng # ❑ Boring Q
® jo:-pit Ground surface elev. cJ ft. Depth to limiting factor/ tn.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2
12
Z 0- ~ r
D rs1~
,t
Effluent #1 = BOD > 30.< 220 mg/L and TSS >30 _ 150 Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) lure CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 /D~ 715-246-4516
Property Owner _ Parcel ID # Page of
❑ Boring
n Boring #
L i ~ Pit Ground surface elev./ ft. Depth to limiting factor Il r'~ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
E Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
F-I ❑ Pit Soil Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BOD, < 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 608-266-3151 or TTY 608-264-8777.
SBD-8330 (R.W00)
Property Owner _ Parcel ID # Page of
2 Boring # ❑ Boring 9
pit Ground surface elev.! ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl:
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring # ❑ Pit Boring
❑ Ground surface elev. ft. Depth to limiting factor in.
• Soil Application Rate
Horizon ')epth Dominant Col Redox Description- Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 `Eff#2
Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mgA. ' Effluent #2 = BODE < 30 mg& 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 608-266-3151 or TTY 608-264-8777.
SBD4330 (8.6/00)
X7*1 MMOSIS LOOS
a t t, ti { I
d~a=
Ix 1 ' t t t I
ZW A-OVJ 21 -4A
1~ .h19 z°e, 9 t l 1 I
I t t I t `
4
a'Q t t I {
44
Jy~ at 1 4 1
m
\'~r J 1 t Ln ng `
,H \ 1t t I I
s ~ ~ t t I f
~~a ~ t t t i I
_ \ Y \ t I
r; % \
t1k
cOf uTie •wi ety and Buildings Division County
~o1~O I W. Washington Ave., P.O. Box 7162
i sco C 1 Bison, WI 53707-7162 Sanitary Permit Number (to '>e Belled in by Co.)
Dsparhnent of p 5318S(0 10
San, a~~~~ ° pplieation ate Transaction Number
In accordance with s. Comm 83.21(2 m. Code, submission of this form to the appropriate governmental _ A4-
submitted is required
to required the prior to Department of obtaining a Commerce. erce. anitary permit. Note: Application forms for state owned POWTS are Project Address (if different &n mailing
address)
Personal information you provide may be used for secondary
ses in accordance with the Privac Law, s. 15.04(1 m), Stats.
I. Application Information - Please Print All Information~I
Property Owner's Name ; ry~ Q • , _ Parcel #
~'jv( _ Dav cj
Property Owner's Mailing Address Property Location -
Govt. L t_ < Z (,'5 O
City, Slate Zip Code Phone Number -X Se.Iion
B 1- 737 q cut le o
II. Type of Building (check all that appl I.ot # f Z f-- N° 1Z f p r
1 or 2 Family Dwelling -Number of Be ms Subdivision Na~me
Pic",- Block #
El V
Public/Commercial -Describe Use.. ~
❑ City of _
❑ State Owned - Describe Use (L CSM Number ❑ Village of
Z, W +-LLwK! own of
III. Type o Permit: (Chet only one box on line A. Complete line B if applicable)
A.
ew system ❑ Replacement System 11 Treatment/Holding Taal: Replacement Only El Other Modification to Exis! ing System (explain)
4!!~ -
N. ❑ Permit Renewal ❑ Permit Revision El Change of Plumber E] Permit Transfer to New List Previous Permit Number s nd Date Issued
Before Expiration Owner
IV. jr_vpe of POWTS S stem/Com onent/Device: Check all that a 1
Non-Pressurized In-Ground ❑ Presstuized In-Ground ❑ At-Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) _ ❑ Pretreatment Device (explain)__
V. Dis ersal/Tre meat Area Information:
Des* Flow (gpd) Design Sod Application te(gpdsf) DisperJ ~a Required (s Z sal Area Pro sod ) s~ h'Igo ati
Q~J 11v , (~/J S A
VI. Tank Info Capacity in Total # of ufacturer Z
Gallons Gallons Units
New Tanks Existing Tanks U i
U cn rn w 0 R
Septic or Holding Tank
J^
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume r p sibllity fur installation of the POWTS shown on the attached plants.
Plumber's same (Print) Plumber's Si a MP/MPRS Number Business Phone Number
Plumber's Address Street, City, State, Zip Code)
VII oon rtment Use Only
Approved trap Perm=;FeeDatc Issuing Signat
rffVW9 Given Reason for D '
IX. CoaditReasons for Disapproval 4r,
1. Septic tank, effluent filter and !¢~ve ,
dispersal can must all be services I maintained
as per management plan provided by plumber.
2.- AIk`i*ack fet(uiremeltts must bamaintained
as plk apptic" code 7 ordmattces.
Attach to complete plans for the system and submit to the County Only on paper not less than 8 in x I I inches in size
SBD-6398 (R. 02/09)
PLOT PLAN
PROJECT Andv Anderson ADDRESS 586 Ctv Rd A hudson Wi 54016
NW 1/4 NE 1/4s 20 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/10/11 BEDROOM 4
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 44
BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 94.6/94.3 4' below grade
Well is to meet all
setbacks required by
WDNR
Plans Designed Using
Conventional Powts 169' property line
Manual Version 2.0
Pro 4 Bedroom
house
B-3 10,
2-3' 90' cells with >3' spacing W8'l 3% Sloa
B-2
27' 110' Property Line
Wren circl 36' 64' 45' 131' j 1, .4 10 04
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715-246-4516
Date: 10/10/11
Owner: Andy Anderson
Location: NW1/4 NE1/4 S20 T29 N,R19W 460 Wren Circle Hudson
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-5. Maintanance an ontingency Plan
6. Filter Specificatio s Sheet
Signature
License u ber #226900
PLOT PLAN
PROJECT Andv Anderson ADDRESS 586 Ctv Rd A hudson Wi 54016
NW 1/4 NE 1/4S 20 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/10/11 BEDROOM 4
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 44
BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 94.6/94.3 4' below qrade
Well is to meet all
setbacks required by
WDNR
Plans Designed Using
Conventional Powts 169' property line
Manual Version 2.0
Pro 4 Bedroom
house
B-3 10'
2-3' 90' cells with >3' spacing ST
3% Slope
25'
B-2
27' B-1 110' Property Line
Wren circl 78' 15'
36' 64' 38' 45' 13 1'
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber To be >1' above grade
10.2ft 2 pair of end plates
Finish grade elevation
Typical Installation 98.6'
Vent Grade Vent
3' 4" 3'
X30/34 Septic Tank
5' Long 199 5' S' Long 1
3 6" Grade at System Elevation Grade at System Elevation
Spacing 5'
2-3' X 90' Cells
Same on other end Observation tubeNent
At end of cell
A
B
22 chambers per cell
System elevations:
A__94.6
B 94.3
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Eff luent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. ischarge into system is not exceed those required as per Comm. 83
Co in ncy Plan
Option #1. If system fails, determine cause of failure, use alternate area and install new
stem i ested replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option#3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber. Shaun Bird 715-246-4516
St. Croix County Zoning 715-386-4680
Pumper Tom Mondor 715-246-5148
Shaun Bird #226900
L.01- IV
rFr _
Waa
cn n'
I
a
C6 C
-
_
r~
.*L-Ztt M..OS.S LOOS
•[C .osbss 1 1 .o► s I
$I a ~ l 1 I
d• a 1 ! I I
49~ 1 1 { I
f t10 0 i 1 LO€£ bYd 'Li '7QA ` {
1 - ws o 3118 Alm !
oil
1 1 I_
t
Q r co
So 0 WI 1 S I !
1 ♦ m ~1 1 I t
l~.y \ ~ 1 1 ~I I
1 I
' 1 1 Ln H8
r 1
<o ♦ 1 1 I
` o so- 1 , S I
~ ~ ♦ I 4
\ ♦ 1 1 I I
♦ 1 I
i
\ 1 !
" It
' \f I
q , `J i ,
tZOESdM I
I I
-
-a- - - - a - Q- - - - - - 1 -
~
1 L _ N ~ I I I I I ~Z ~ a
o'O .Z6 s3ssmu 2iooij--,s -
6 I w Q I j
w m I 0 LL J X >
= WXI
07
w Wa01 ~o I-c
I
un
=o ~
O 00 I ° L
w OLO ° LLI
Jo I 3
U-aN N N
-41 --2
LL
u
II
I o O „Z 66 S3sma bool3,,s
PE,
r----i-iJ i i
~ I I I I ~I I I I I I I I ~ I I I I I
1.9 -Z -4
v. , --a-- a ° t
I I
I
I I „0L-IE L-3 3-1
co
I I 'v
3L N - -
I I -
I al I N -
o I ~
I ~ O
00 I ~ i
CD
r
0 C~cl p'
CD NIVHO HON3HI
I a ~ J r
I ~a rn
I I o
z0
Q' I o
w
' --v 0
r
I 0
Qo
1~/ L V - .9 co
1 I w I w
w 99vZHSdM 99vZHSdM-
7 II N
II
U- o .,Z6 S3ssn:l aoo,
J
U- m I
> II o
J
r
O w~ a F-- cli
I I M Z N w wcn I of O
o- a- x U- w
U 00
_ o I I Q o co U- I N LL
x
°W CO Q-
I I I =g8 00
X~
O O N cxG j j co
i '
x - - - - - - - - N - - N
~
C°
z O
00
- ? N w
II J Wo
J r za
o .Z6 L S3ssnHi aooij..8L
10 W
_
„v/L8-.9L
w0
~U
W
c¢i z M LLI
a Q
~ d.
M
0 0 ~IYm
QU ~
1Q o 0 o a '
M Z O I ..N Ic .9 - ,Z 6 I .9 -,9
~wN _ II II
X
Y 04 I I N Q I I I I w
II ~c
O - - - - - 01
I~-
O r
w I I In
s
>
J
O
11 0 0 Co
II N
O QII
LL
00 ? i i
N N „vlE L -,5 C w V- w
~ N
N
.I-V/ v 19 QQx ~ "II
N Od O ml l
N U-
l l a
0
II Jc
J ~
I I r
------JJ a
[waW I I i i
I ~I i I I
8b8t~lSdM
o
-v
¢ N
LL
- O o
O
m CV
r ' X CV
O J N ❑ (O
O a ~Y w
❑~t Na m~ N
W ' a -
m ~ >
0 N M
00 00
N N
00
N
r- ..7/£ 6 -31 o0
00 N
.
M u~IE E - .Z L
d'
Cl)
T r z w
N Q
1£9-.Ol ..9-.Z 1.0-.9
SM-iiing 32ininj _
F W
cfl cfl _ a
N N M Q 3
o 3 ..b/E L - 1374
to , T W n
N in o >
/I
a'1- I I W
N W U I I ~ m N
°D w
z a
IL o I I 4
.0-.Z ..9-.0
o~ I I
00 00 I I (0
,Y
X N U
❑ I I a Z~ a - -
m~ I I LL $ ~
C N I I N co
N
G ~
I I 03HSINId „b93813nW
LO AiINVA 0-L
Z
I I W
4
I I *BWnld 9XZ
I I
~d
I \1'1~ I a:)
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ~ Mailing Address 5 7 (v j4 5YO
t
Property Address (g" L2
(Verification required from Planning & Zoning Department for new construction.)
City/State Parcel Identification Number ®~~1 -00y
LEGAL DESCRIPTION
~ , r
Property Location 1/4 , 4,9 1/4 , Sec.,Z-,O, T zt N R W, Town of
Subdivision (7 r~ , Lot # s~
Certified Survey Map # , Volume - , Page #
Warranty Deed # , Volume , Page #
Spec house yes no Lot lines identifiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
I ATURE O PLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application 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.
(REV. 08/05)
II III IIIIIIII I
IIIIIIIIIIIIII
8 0x34028 7 8910 i
STATE BAR OF WISCONSIN FORM 3 - 2000
QUIT CLAIM DEED 943117
Document Number BETH PABST
THIS DEED, made between Premier Bank, a Minnesota REGISTER OF DEEDS
corporation, Grantor, and Andrew C. Anderson and Kimberly G. ST. CROIX CO., WI
Anderson, husband and wife, as Survivorship Marital Property, 10/13/2011 08:34 AM
Grantee. EXEMPT#: NA
Grantor quit claims to Grantee the following described real REC FEE: 30.00
estate in St. Croix County, Wisconsin (the "Property"): TRANS FEE: 202.50
PAGES: 2
Lot 56, Block 6, Plat of The Glen in the Town of Hudson, St Croix
County, Wisconsin.
t
Recording Area
Name and Return Address:
First National Community Bank
PO Box 89
New Richmond, WI 54017
Together with all appurtenant rights, title and interests. 020-1418-20-000
Parcel Identification Number (PIN)
Dated this October (P , 2011 This is not homestead property.
Premier B nk, 077 rporation
BY:
Andrew Nath, Executive Vice President
I
i
QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000
1 of 2
1131
Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Soil Service
Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Crob(
include, but not limited to: vertical and horizontal reference point (BM), direction and >
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel 1. D. -L6t
Please print all infonna6on. R 5eOy Date
Personal information you provide may be used for secondary purposes (Privacy taw, s. 15.04 (1) (m)). (~3
Property Owner Pr rty Location
Sienna Corporation Go 4- Lot NW 1/4 NE 1/4 S 20 T 29 N R 19 W
Property Owner's Mailing Address Lot Block #J Subd. Name or CSM#
4940 Vilking Dr. Suite 608 LO 6 The Glen (Z
-100
City A-W1,74 State Zip a Phone Number City jj Village a Town Nearest Road
MN 554 5 ~?9' B Hudson Dorwin Rd.
New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
_ Replacement Public or commercial - Describe:
Parent material Pitted outwash Flood plain elevation, if applicable na
General comments / o q / v/
B Z
and recommendations: System elevation 95.1 Oft, trenches spaced and depth 3.50ft below grade--
3'-4v S'6e~or.~J
Boring # Boring
✓a Pit Ground Surface elev. 98.60 ft. Depth to limiting factor 96 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtftz
*Eff#1 *Eff#2
1 0-6 10yr3/3 none sil 2msbk mfr Cs 1 f .5 .8
2 6-14 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 14-22 7.5yr4/4 none Is osg mvfr gw na .7 1.2
4 2-96 7.5yr4/6 none ms osg ml na na C2) 12
3(0~'/-7 J v ~ I to 1(
~Ir
❑ Boring # Boring
lor Pit Ground Surface elev. 98.60 ft. Depth to limiting factor 96 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtft2
*Eff#1 *Eff#2
1 0-13 10yr3/3 none sil 2msbk mfr cs 1f .5 .8
2 13-25 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 25-96 7.5yr4/6 none ms osg ml na na .7 1.2
A
* Effluent #1 = BOD ? 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
David J. Steel 248956
Address Steel Soil Service Date Evaluation Conducted Telephone Number
1564 CR GG, New RichmHnd,WI 17 9/12/2002 715-246-5085
t
Property Owner Sienna Corporation Parcel ID # Pending Page 2 of 3
3] Boring # Boring
Pit Ground Surface elev. 96.40 ft. Depth to limiting factor 96 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
'Eff#1 'Eff#2
1 0-12 10yr3/3 none sil 2msbk mfr cs 1f .5 .8
2 12-20 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 20-32 7.5yr4/4 none sl 2msbk mfr cs na5 .9
4 32-96 7.5yr4/6 none Cs) osg ml na na 0 1.2
❑ Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
*Eff#1 'Eff#2
❑ Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
'Eff#1 'Eff#2
I
' Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 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
Page 3 of 3
STEEL'S SOIL SERVICE
David J. Steel 1564 Cty Rd GG
CST-POWTSM Sienna Corporation New Richmond, WI 54017
Lic. # 248956 NWl/4,NE1/4,S 20,T29,R19W (715) 246-6200
Town of Hudson, St. Croix Co. (715) 246-5085
The Glen lot 56
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for
your use. The location of the test may or may not be as shown as permanent lot lines were not
established at the time the soil test was conducted. Legend
1" = 40'
♦ =Benchmark El. 100.00Ft
Top of 1" steel pipe
• = Alt Benchmark El.99.20Ft
Top of V2" pve pipe
o = Borings
Boring Elevations
BI =98.60Ft
B2 =98.60Ft
B3 =96.40Ft
134 =00.OOFt N
Ibq4 ,
i
~y
11n
jrX, 9r 5b
boF-7-
Gys~
Z
3~' X15' 'AOm
s►
3(0 ~
A-C
• + ~ mi'''l _ -91 II _
I
~ iII 11
.f^ ^ ' ar' l 11 II
i ,
"IT
57 If
d ro I7 III II
b , s
,
_ rW 417,
i 1
-
J J J J ,,g2 I n / /i; rL,l
J
, t, ♦ r J tea, / I
`may pG ~ a ,
fJJ
1 I I -py. p~ 1~ 1
' ♦ i ''V! . (~y is , ~ 1 "\1 i 't t I
OJT SJ "CIA. QI`r I I
- 1 I
429
, J .
I I IJ 79 r 1 1.' I I f' - - I I'C _I' I 1
5
J; 78 I ; 65
rv
l ,I
"
1 n n
66
a~
t
. _ - j - 344 I
,
c
,
67
' % it \ 1 W N
l`
77
It, C_
1
332
\
39-
+
64
J , ` !1 i H I I %I 1.43 ' i 138 332 1
r , , ...1 t \ : \ 1 I
`V\ ` I I I, I
_ 1 . IJ i 1 J'
\ I
, t fit, , ! ,I, I~
32 p
I , , - I t 4 r
20
~ III
t fit
-1v Ili / , `t
I I 1 _ 1. 1 r II 1
I I 1
I 1 • I 1. r , t -.lam/
I I 261
I III 26 ~ i tN0 '1 ~ ~ I ! 1 •1 '1
tipa ` ^ , I , J J t .1 1