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HomeMy WebLinkAbout020-1329-20-050 C c I, ~ °o I ~ °o M O~ 64 0 °6e~ M 0 ~ a °o 0 E N ooa) i ry" c 2 a r O co N O C o- 0 L V j 3 3 O N y Q CL CD .L.+ N 0) a) O m C ;A L O N O L a) m O z c a w 0 0 _ 0 Z O C z 0 Y Cl) 7 N- 7 c0 N O 0 LL O U) LL O p m N Q C Q H o 0 0 0 M M ~uiE E z z rn o o ~ ~ 0 0 a N 3 a m a co N H z c O I O z d c c w avi Z d lp N 0 Z N H ~ i', I c E E '2 o Cl) O N O N 3 co N 0) o a~ O O m o N Q o N Q •U z co z z m z o c E z C e c N w~ n) c I ~i E o N ai £ > vi 3 L L ~ W d d d . 0 L ~ L m 0 C a7 Q M Y C CO O N o a) A a d N O O O D E L;z N C a a O IL N LO H H H O H P H ~ v w N tv 333 ° LL 333 zo • 3 a a a a 0a a 7 0 N '0 n r n a) 0 a) z T- _ a) _ a) ~ o co J h .0 r E aL Lo_ O O m O m C d a) 3 'O N Q 3 'O O a) a) >10 d z >o o d Q ro Q LO O c Un O -0 E O 6) ~V O O O ~t N y C rO to C co 0 O C co 0 C Qe O O O L H m y E E m N E C N N 0 Lo v N C O O C y ry 7 N C6 0 0 M t)) a) H -00 N '00 LLl C N c)) 2 O N 0 a N E o ~ c~ N o o o • > N v' m N Z-~ Z co N 0 Z- Zw (n a E rid y E a #t a n a L: L • ca a m .2 m c d m c c c 3 c o o m 3 o 3 ;4 0 in v O cn V A U a 0 Y ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT RECEIVED n !l Owner JA Al 1 6 t Address f~~ Asa ~J ,r 'q98 l S7 CROI,X City/State Zd. ' COUNTY a ZONINGOFFICE f f Legal Description: Lot Block Subdivision/CSM # ,y6 L-, Sec. .2 f , TAN-RAW, Town of J . ~ 5 PIN # OZO - 13 2°1- ZO SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer m °4) es- 7- Size ST/PC I 0 )'76 b Setback from: House Well 5' fi P/L Pump manufacturer e5l 1,4s Model t pa V Alarm locations s (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: p Width 4f Length S Number of Trenches Setback from: House33- Well P/L 3d Vent to fresh air intake ELEVATIONS: Description of benchmark 4 37u ll Elevation Description of alternate benchmark ~,n a F o w~- ~f~-f o Elevation ~G ell /P.c. to e r 7- Building Sewer 10-71 r ST/HT Inlet ST Outlet S • `l PC Inlet PC Bottom Header/Manifold 9 Top of ST/PC Manhole Cover Distribution Lines ( ) ` Y-1" Bottom of System ( ) q77.1 sj" ( ) Final Grade ( ) ( ) ( ) Z( Date of installation /.7 Permit number Z-q6t 170 State plan number Plumber's signature License number /a(,gfg 2 Date Inspector 19 Z Complete plot plan r 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. A PLAN VIEW a ?h0 J X 14ra INDICATE NORTH ARROW Wiscofisin pepartment of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy La S.15.04 (1)(m)]. 299170 Mt1Wer's f LCit~~V lage Town of: State Plan ID No.: tv - CST BM Elev.: Insp. BM Elev.: BM Description: CS Parcel T928-:1329-20-000 ~ ~ ! o~ • To o-ES~~~ or •s t e TANK INFORMATION ELEVATION DATA A9700487 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic jj (QUO Benchmgrkz 3 2S 03 25 /00 osing \0/ P -750 All. Aeration Bldg. Sewer `x&-73 G -bZ 9'0.71 Holding Inlet v 1107.3 TANK SETBACK INFORMATION Q'40outlet Q9-51L' Vent i~to let 0AP-7 ?l.S 2 2 ROAD Dt In TANK TO P/ L WELL BLDG. A Af ~5 Septic -I- 1 q t 2p' NA Dt Bottom P OMP-13 15-W •'7 10-0 gd p ` 2 p NA Header / Man. m-?S7 q0 / SI 2 Aeration NA Dist. Pipe ID32 q - g od4(~ Holding Bot. System 1032 !D / 9'3.)3` PUMP / SIPHON INFORMATION tM Final Grade 1031S-79 `l? Manufacturer 0LAA 5 Demand ITP 5 0C.) 1G-73 H S2 91 _73' Model Number e, PO GPM b33 S7, -70 1/. 03 TDH Lift1oZ.51 Frictior:~7 System _ TDHI;.Zf Ft Forcemain Length 50 r Dia. 2" Dist. To Well 0~ SOIL ABSORPTION SYSTEM TRENCH Width Length 5o, No. Of Trenches PIT No. Of Pits I ide Dia. Liquid Depth DIMENSIONS / Z' 1 DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Ma ufa urer: SETBACK CHAMBER INFORMATION Type o 2 OR UNIT Mo I Number: System:~y DISTRIBUTION SYSTEM S7" 7_'7 Header/Manifold Distribution Pipe(s) x Hole ize x Hole Sp cing Vent To Ai Intake Length _90__* 6 Aia. -r- Length _~C Dia. -7 Spacing -7157 SOIL COVER x Pressure Systems Only xx and Or At-Grade Systems Only Depth Over Depth Over yTxepth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges il ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons pres nt, etc.) LOCATION: HUDSON 24.29.19,NW,SE 854 WYLDWOOD LANE - WYLDWOOD LOT 2 C/O-/Scj(o) r D / 1 R~I f a r cam- ' i - r _t = .ter.. ~n> [yam TTj p~t~ s w u ~ tn~ G+~-P ct _ J , at .tom -`v" U tQ~t L SL~ 3oq ~~nal /t•2!•~'~ Plan revision required? 'Yes ❑ No -71 Use other side for additional information. 7i) 1q71 3 SBD-6710 (R.3/97) Date Inspector's gnature Cert. N ADDITIONAL COMMENTS AND SKETCH z SANITARY PERMIT NUMBER: A Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. Visconsin In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. 57lew X • See reverse side for instructions for completing this application State Sanitary Permit ~Nuummb~er The information you provide may be used by other government agency programs E] Check if rMioA to0previbus application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT AL INF RMATION - Property Owner Name Property Location 1/4 5 1/4,S V y T a cl , N, R E (or& Property Owner's Mailing Address Lot Number Block Number 4/ /6(we Z A~J 41) City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms. Town OF s cal S I L III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 2A. li . -i t7 1 ❑ Apartment/ Condo QUO r / 3 2 5Y ~d 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise:SalestRepairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1 _ ® New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an System System Tank Only ExistingSystem 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 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank LI epage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-in-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) g3 ~S Elevation y~e 4111" 1D0 - Feet Feet VII. TANK Capacity gallonTotal # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App- New Existin strutted T nks Tanks > Septic Tank or Holding Tank 10910 U Ae Y.t~ 19 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber -75V A' .1d ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PRSW No.: Business Phone Number: Plumber's Name: (Print) Plumber's Signature (No Stamps) Ark x.A AKt,,4 -WrL Plumber's Ac dress (Street, City, State, Zip Code); t~ .i O~ Jet IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved nitar Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved Surcharge Fee) X ❑ Owner Given Initial 1 D nOf ~ / (/'S+ f/NF Adverse Determination d 66 P 1 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R 11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on systE-m type. VI. Absorption system information. Provide all information requested for numbers 1 through 7_ VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlll. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ,~,e4eO 4L/ oo ~tcS'C G3~ s ~D ~ PL G 6 b PAGI GF PUMP CHAMBER CROSS SEC T IOIJ AMD SPECIFICA-r10k15 VC JT CAP 4"C.I. VEA1T PIPE WEATHERPROOF APPROVED LOCKING > JUAICTIOU BOX MAMHOLE COVER 25' FROM DOOR, WIMDOW OR FRESH 12"MIU. AIR IAITAKE I GRADE I Y" MI IJ. 41, COI.IDUIT IMLET PROVIDE I _ AIRTIGHT SEAL I~ ~ I I I I ALARM B I II ( I *APPROVED I ow JOINTS WITH ELEV. FT. APPROVED PIPE I 3' ONTO PUMP ` OFF D SOLID SOIL COUCRETE BLOCK RISER EXIT PERMITTED OWLy IF TAUK MAUUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOUS DOSE TAI1K5 MAUUFACTURER:197.da)e5ey IJUMBER OF DOSES: PER DAB TAMK SIZE: 7 67/1 GALLOUS DOSE VOLUME ALARM MAUUFACTURER: Z +eU P~~~~ IIJCLUDi1JG 6ACKFLOW: I,33 GALLONS MODEL AIUMBER: U CAPACITIES: A= 3(eUICHES OK 7 GALLOAIS SWITCH TYPE: PY'r' B = .~S IWCHES OR 3 GALLONS PUMP MAMUFACTURER: C7d.c/~ O~.S" C=L~ IULHES OR 7~ 3 GALLONS MODEL MUMBER: .©O 5~ D INCHES OR a GALLOWS SWITCH TYPE: MOTE: PUMP AUD ALARM ARE TO DE MIU11MUM DISCHARGE RATE _a, GPIA IN~S^TALLED OM SEPARATE CIRCUITS VERTICAL DIFFEKEMCE BETWEEAI PUMP OFF AUD DISTRIBUTIOM PIPE.. /-6_ J FEET + MI►UIMUM NETWORK SUPPLY PRESSURE . _ -ONL' FEET + lr_ FEET OF FORCE MAIN X FYo FLFRICTIOU FACTOR._I,.~S^ FEET TOTAL DyJMAMIC HEAD = FEET I 411 IMTERUAL. DIMEMSIONS OF TAIJK: LEAIGTH -;WIDTH ;LIQUID DEPTH Goulds ~A~GE 6 o>r b i - , Submersible Effluent Pump 3871 EP04 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high 6 Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. z Motor Cover: Thermoplas- components. tic cover with integral handle • • Farms Homes Motor: manual Available for operation. automatic and Automatic and float switch attachment • • EP04 Single phase: 0.4 HP, points. Heavy duty sump 115 or 230 V, 60 Hz, 1550 models include Mechanical • Water transfer Float Switch assembled and a Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. [ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM: Pump: EP04 built in overload with ■ EP04 Impeller: Thermo- construction. • Solids handling capability: automatic reset. plastic Semi-open design 3/4" maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. @ 51, Standards Association • Total heads: up to 24 feet. with three prong grounding a EP05 Impeller: Thermo- Discharge size: 11h" NPT. plug. Optional 20 foot (GSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for improved performance. end in "F" or "AC".) rotary/ceramic-stationary, three prong grounding plug BUNA-N elastomers. (standard on EP05). m Casing and Base: Rugged • Temperature: thermoplastic design provides 1040F (40°C) continuous superior strength and 140°F (600C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET T____.__T._.______ stainless steel. 10 • Capable of running _ - - i dry without damage to s 30 - - components. i SGPnn $ Pump: EP05 i - - zFr I I _ • Solids handling capability: 0 25~ - - 34" maximum. W • Capacities: up to 60 GPM. • Total heads: up to 31 feet. 6 20i i - • Discharge size: I1h" NPT. Z 5- s •Mechanical seal: carbon- 0 15-_--- _ ± - - - rotary/ceramic-stationary, 4 BUNA-N elastomers. o I EPOS • Temperature: 3 1oF - - 104°F (40°C~ continuous EPOa 140°F 600C intermittent. 2 I 51 0 10 20 30 40 50 GPM L L 0 2 4 6 8 10 12 m3/h CAPACITY O 1995 Goulds Pumps, Inc. Ffiprtivp Mpv i44~ wiscdnsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page . _4 of 6. 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 I s tlian'8 1/2 x 11 iricloes in size. Plan must include, but St. Croix not limited to vertical and horizontal r ear rj e'poi (BM), directio and % of slope, scale or PARCEL I.D. # arest roa 020-1329-20 dimensioned, north arrow, and loca'o d d' tar7INFO.M REYIEWE BY DATE N APPLICANT INFORMATION- ` SE ~TIO t i(• +q PROPERTY OWNER: O to r PROPERTY LOCATION Bob & Carol Benis u'A 5T : F'Oly GOVT. LOT NW 1/4 SE 1/4,S24 T 29 ,N,R 19 ~ (or) W PROPERTY OWNERS MAILING ADD ' LOT # BLOCK # SUBD. NAME OR CSM # 854 W ldwood Tn. zoaii;otCE~ 2 n Wy1dwood CITY, STATE ZIP j' --HONE NUV ❑CITY ❑VILLAGE [TOWN NEAREST ROAD Hudson, WI. 54016 / Y'I Hudson Badlands Rd. [x] New Construction Use f ] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 4 5 0 gpd Recommended design loading rate .5 ed, gpd/ft2_Ltrench, gpd/ft2 Absorption area required 9 OObed, ft2 750 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 . 6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 93.18 It (as referred to site plan benchmark) Additional design/ site considerations trenches spaced to code 4/17' below surface cfrade Parent material outwash Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem [?FS ❑ U )CIS ❑ U 12S ❑ U ®S ❑ U ®S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed TMr>ch Lj 1 0-9 10 r 3/2 none 1 2m r mfr 2m .5 .6 2 9-22 10 r 5 3 none sil lcsbk mfr C[W 1M .4 .5 Ground 3 122-45 10 r 4/6 none scl m na na n .2 elev. 97.3$ 4 45-88 7.5 r 4/4 none is os mvfr na na .7 .8 Depth to limiting factor 88II Remarks: Boring # 1 10-8 10 r 3/2 none 1 2m r mfr cs 2m .5 .6 U 2 8-24 10 r 5/3 none sil 2msbk mfr lm .4 .5 24-50 10yr 4/6 none sicl M na gw if np .2 3 Ground elev. 4 50-90 7.5yr 4/4 none sl 2mgr mvfr na na .5 .6 97.58. Depth to limiting factor +90" Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Aye., New-Richmond, W0154017 Signature: Date: 10-21-97 CST Number: m02298 PROPERTY OWNER Bob & Carol Benish SOIL DESCRIPTION REPORT Page 5 ,of. 6 PARCEL I.D. # 020-1329-20 Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw& 1 0-9 10 r 3/2 none 1 2m r mfr 2m .5 .6 2 9-20 10yr 5/3 none sil lcsbk mfr 9w lm .4 .5 Ground 3 20-48 10 r 4/6 none scl M na C1w if n .2 elev. 93.85 ft. 4 48-88 7.5 r 4/4 none sl 2m r mvfr na n Depth to limiting factor +88" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) w STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Bob & Carol Benish New Richmond, WI 54017 MPRSW 3254 NW4SE a S24-T29N-R19W town of Hudson (715) 246-6200 f lot #2-Wyldwood N 1"=40' BM.= top of SW lot stake C el. 100' Alt. BM.= top of culvert C el. 98.90, this $oiL evaluation is in addition to soil evaluation of 10-15-96 3K F c~a 11 At VI) C qt 5014- Gary L. Steel 10-21-97 N 0°14'08' W U i-+ UU L All 10099 + ©r 408.23' 2217.39 z n Z, n ra ~ G Q` a = 4 I z /a \ ° c o ~ < 9 m V) 70 9" < k,D N m i o r 3 M a r- M C3 Z IZ ' OD 00 o m ~ N m • ° o G1 ID ~r °.W ::c I W N 0°14'04' W o I IM Z o`D f 411.55' Id rLn w d w z I Ln v m • • I 6_ r i' cn rlu d Dry (IN ~M 0 ru I t= 00 w d CD r~ CD I I o v Q1 ~ I . 00 ro r F- Cil N 0°14'00' W - - `D zl F l I 414,88 m (4 _u W pro D Z Q` I p -Di o ~l Zd (3 N D w V ` UTH 680.9') I N 0°21'47' W r I I 418.21' .00'OSi M f~F fs0 0 00 °o Cn \ c I ~ I n ro x co I C: *:D ru I In Iz N ~z .D o' mww r C co p~ N D o co w r Z I, Cn ° 1 CO I o 0 CD At 0 91% m o I d o L' 16 ee°09, U l I~ d r 08. e SIO ° IN Id w 0 I ~I r, X11 ID ~ + Cfl 8900, C) \ S \1 C) j STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER &!'fl fn / 6 h MAILING ADDRESS .12,RD % ro A 112-4d PROPERTY ADDRESS _7 U,) n L_ 0,0 f. (location of sep ' system) Please obtain from the Manning Dept. CITY/STATE Z(446 ry~L' S ~/QL PROPERTY LOCATION ~ 1/4, A1,C 1/4, Section T 2'1 N-R1f W TOWN OF < 0471 ST. CROIX COUNTY, WI SUBDIVISION ,~~C o LOT NUMBER -Z CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER _ 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year piration date. SIGNED: L4W DATE: z St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property 6jr-,rd I ccr.&Z ge,Al I SZ~ Location of property_&&// 1/4 WZ 1/4, Section TAf _N-R_Zf_W Township 14WS,671 Mailing address 17r pp ,f, Address of site -Xb/ ~v` f ®d~ za'me ~z Syv/¢ Subdivision name Lot no. 1 Other homes on property? Yes No Previous owner of property , Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for (spec house)? Yes No Volume 1A.S-0 and Page Number ~ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. sG >-.z o , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. ~.a' 2 .z. 6 Sig a e o pp icant Co-Applicant Da e of ignature Date of ignature 1K MftE595 WARRANTY DEED REGIS LK`) U: r,E Document Number: $T. GROiX CTY., VNt 562226 Me 10 1997 Return Address: Ltt Ov 4t O.J4' Register of Deeds Parcel I.D. Number: • , THIS DEED, made between Greenwood Enterprises, Inc, a Wisconsin corporation, Grantor and Robert K. Benish and Carol J. Benish, husband and wife as survivorship marital property, Grantee. WITNESSETH, that the said Grantor, for a valuable consideration of one dollar and other good and valuable consideration conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot 2, of the Plat of Wyldwood, filed in the Office of the Register of Deeds for St. Croix County, Wisconsin, on October 28, 1996 in Volume 6 of Plats, at Page 72, as Document Number 551306. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; and Greenwood Enterprises, Inc. warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and reservations, if any, of record and will warrant and defend the same. Dated this r~ day of July, 1997. TRANSFER $ GREENWOOD ENTERPRISES, INC. GREENWOOD ENTERPRISES 16 ?'70 ~p-- By: . 4 5~~44q- tl~ _ By: FEE , rea mes E. Rusch, its president Mary rACKNOWLEDGEMENT AUTHENTICATION Signature James E. Rusch, its president STATE OF WISCONSIN ) this ay of Ju1,.~199 ) ss. ST. CROIX COUNTY Lois y Personally came before me this TI MEMBER fLWISCONS day of 1997 the above na ed Mary R. Rusch, its secretary to me known t be the perso7whhigexecuted the foregoing instrument and ackn edge the same. THIS INSTRUMEN BY: Lois A. Murray Zilz, Estreen & Ogland No Public, State of Wiscons' 304 Locust Street My commission expires I ! /d ODa P.O. Box 359 Hudson, WI 54016 Brenda Poulin Notary Public State of Wisconsin ~I e IQ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM ' -Safety and Buildings Division Countvk. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitarMr9Wt j.: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)). BENIPerm it er' 'R_' 0 ~RT & CAROL o a-C1 71 illage Town of: State Plan ID No.: CST BM Elev.: li Insp. BM Elev.: BM Description: Parcel 1329-20-000 TANK INFORMATION ELEVATION DATA A9700238 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet rl Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH I Lift Lriction System TDH Ft oss FHead I Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Mode Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 24.29.19,NW,SE 854 WYLDWOOD LANE LOT 2 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building water systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check i rev to pre ious application lPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Pro ert Owng rN me Property Location tr,.- - p ' W1/4 1/4, S ,7 T , N, R E (orW Property Own 's-Mailing Addres Lot Number Block Number A2- 11~ Z ne Number Subdivision Name or C Numbe o City, State Zip Code F(P' /0 f4l .=17 ) II. TYPE F B III DING: (check one) ❑ State Owned !ty Nearest Roa ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo © Lv 3 Z l D 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. 1;3 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 110 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. Syste Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 9 Elevation p .7 .7 low4r Feet jP.p `e Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank S ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of th onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: No Stam ) MP/MPRSW No.: Business Phone Number: Pfbrh . r's Address Street, Cit , State Code): e 23 2A, IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Ag t Sign N t ps) Disapproved ❑ Surcharge Fee) n Owner Given Initial Adverse Determintr X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL. SOD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Ons to sewage systems must be properly maintained. The septic tank(s) must be pumped Qy a licensed pumper whenever . necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code'administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be completeand.accurate this sanitary-permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed' II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line 13 if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),• address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans an'd specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the follovving. 'A) plot plan, drawn to scale,or, with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and. F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. I V PLUMBING DAVE FOGERTY PWMM pwk Test pknnber um" #3233 DATE: RO F 54023 , JOB PT: ~ . p pone 7464M .108 .p.' toT # ,2 909_ G dYQ COq AF Lf = /~sH , TD, or l ~~/L g1SG/~uc IOO. D ~ x = f~aerivl ® = ~ u,U~ L dT (O,tvc .~s O = Y /3Uizrn, / aaa 6rgL, S.T, ~yst~'m Fc~v = 9~l5 ~ 9y ~ / e- / f P~ ,r LE V_ 4T ` 7~~ fry?~CJ~ %D, 2F /~I/ 9,7 yy L ~cS 30' I, i I 9s 3 g 6.3 -I -r_9 y G q~P 97o z4/ Tank 97. yv ` x x i Dolow"Am IT"" • i T19 SOL Wisc6nsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 kabor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, o ~ COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size ustjj qt but CEL I.D. # not limited to vertical and horizontal reference point (BM), direction and op 'J dimensioned, north arrow, and location and distance to nearest road. pending EWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMAT G*' PROPERTY OWNER: NiELAdE OCtATl N Greenwood Enterprises, Inc. , I4 ~ µta,S 24 T 29 N,R 19 f (or) W PROPERTY OWNERS MAILING ADDRESS OR CSM # 14116 3rd. St.naldwood CIT ,STATE WI. 54016 ZIP CODE PHONE NUMBER RrOWN NEAREST ROAD (715 386-3674 Hudson Badlands Rd. [x] New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building [ j 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 "8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 95.3 ft (as referred to site plan benchmark) Additional design / site considerations alt area= system el. 94.67' system backfilled to code Parent material 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 fors stem IK] S ❑ U 19ES ❑ U KI S ❑ U ES ❑ U 23(.S ❑ U ❑ S &U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 2 none 1 - 2 12-34 10 r5 4 none sicl 2msbk mfr if .4 .5 Ground _ elev. 99.6 ft. Depth to limiting factor +84" Remarks: Boring # 1 10-12 10 r3 3 none sil 2msbk mfr c1W 2m .5 .6 2 112-46 10 r5 4 none sil lcsbk mfi lm •2 •3 Ground elev. 99.1 ft. Depth to limiting factor +86" Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave. e Richmond 154017 Signature: Date: 10-15-96 CST Number: m02298 PROPERTY OWNER _Greenwood Ent. SOIL DESCRIPTION REPORT Page 2 of3_ 4 PARCEL I.D. # Pending Lot #2 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-15 10 r3 3 nnne I 2msbk mfr 2m .9 J; 3 2 15-47 10 r4 4 Ground 3 47-9 7.5 r4 6 elev. 99.3 ft. Depth to limiting factor +93" Remarks: Boring # 1 0-1 ..4:.: 2 10-52 Ground 3 52-88 7. elev. 99.0 ft. Depth to limiting factor +88" Remarks: Boring # 1 0-15 10 r3 3 none 1 2msbk mfr 2m .5 .6 5 2 15-47 Ground 3 47-88 7.5 r4 4 none Cos 0SQ m n .8 elev. 99.0 ft. Depth to limiting factor +88" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) r STEEL'S SOIL SERVICE Gary L. Steel Greenwood Enterprises, Inc. 1554 200th Ave. CSTM2298 NW4SE4 S24-T29N-R19W New Richmond, WI 54017 MPRSW 3254 town of Hudson, (715) 246-6200 1 lot #2-Wyldwood N 1"=40' BM.= top of 1" pvc pipe C el. 100' Alt. BM.= nail in tree @ el. 104.00' 1 jg'l /0D Gary L. Steel 10- 96 ~