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HomeMy WebLinkAbout020-1478-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552370 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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: Bird, Shaun R. Hudson, Town of 020-1478-20-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: qCf - % 13.29.19.3019 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic O / Benchmark CS 1 + 03- 63.4 U GJ ~f Dosing Z ' `~66 Alts. C 5.1 W .3 ( Bldg. Sewer 13, Z G.' 1 Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/Ll~ WELL BLDG. Vent to Air Intake ROAD Dt Inlet .1 Septic y 56 Dt Bottom © V. Dosing 511 , A- Z ZZ. Header/Man. Aeration Dist. Pipe Holding Bot. System 7 PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cove r/1~ i GPM , q ~ 1. L r 7jj9J Model Number ZY, 3 ,D t TDH Lifi.~, F Friction Las Syysttem Hea T/ , I2_ Forcemain LenWC)O Dia. Z it I Dist. to Well ~ 2 SOIL ABSORPTION SYSTEM n BED/TRENCH Width Length No. V hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 17- '**__1 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type f ystem: CHA UNIT OR Model Number: I ;-7F 124' 1,qT DISTRIBUTION SYSTEM a6, - Header/Manifold Distribution x Hole Size x Hole Spacing Ve o Air Intake Pipe(s) U Z ✓ Z, Length Dia 1 Length Dia Spacing L v SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of r~~ m Seeded/Sodded xx Mulched Bed/Trench Center '7 Bed/Trench Edges Topsoil 1 A- Yes Rfl No Yes FN7~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: -7 / Z ' Z In pection #2: Location: 887 Hillside Trail Hudson, WI 54016 (NE 1/4 S 1/4 13 T29N R19W) Alexander Meadows 1st Addition Lot 33 Parcel No: 13.29;19.3019 1.) Alt BM Description = I t 6%4, ~.A 5 a v,, 2.) Bldg sewer length = ZZ C'J - P. - amount of cover = ~ ,n~ 3 ew 4 Plan revision Required? Q Yes No -7 ' Z 3 s Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's S' nature Cert. No. PLOT PLAN PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NE 1/4 SE 1/4S 13 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 98.8' BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEST GF10-8 ❑BOREHOLE O WELL *H.R.P. Same as Benchmark Road 2.5 Acre Parcel Road Scale = 1/4" = 10' 119' 98' Grading is to be done to divert run-off away 991 98 8' from system Area 15' below B-1 2% Slope system is to remain undisturbed Tank is to be properly bedded B-3 and provided with a lockd rsw, rge Je., th approved rning labels B-2 Pro 3 Bedroom House Huffcutt Combo Tank Well is to meet B.M.* all WDNR setbacks 120' COPY Road Safety and Buildings Division County .arl.gov - . Washington Ave., P.O. Box 7162 i s i Madison, WI 5 3707-7162 Sanitary Permit Number to be filled in by Co.) 3 d StateTransaction Number Sanitary Permit Ap ica p In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submissio of this fo ropriate governmental - unit is required prior to obtaining a sanitary permit. Note: A lication form r caned POWTS arc Project Address (if different than mailing address) submitted to the Department of Commerce. Personal info ion you provide ma or secondary purposes in accordance with the Privac Law, s. 15.04 1 (m), . S. O 0 A 1. Application Information - Please Print All Infor ion parcel # Property r' Name ^ a. Nr!r,~c R~i,~ c ~Oj ~120-1(17F-20 rt-~ y opery / ~ Locaetion Owner's Mailing Address Pr VG Govt. Lot City, State Zip Code Phone Nu x/4,_''/4, Section i C Cleo N; R II. Type of Building (check all that apply) Lot It - Subdivision Name _3 3 .2 Family Dwelling - Number of Bedrooms - _ p ,`)'J(LA/_'l Block # ~ G ❑ Public/Commercial - Describe Use _ ❑ City CSM Number ❑ State Owned -Describe Use - ❑ Village t_ _ I III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued - B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: =rd. - Mound> 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Non Pressurized In-Ground ❑ Pressurized In-Groan ❑ Pr trea nt Device (explain) _ El Holding Tank 11 Other Dispersal Component (explain)-- y YD ersal/Treatment Area Information: low (gpd) Design Soiltion Rate(gpdsf) Dispers rea equired (std Disp~alArea Proposed (sf) ys m Elevation JR2 k Info Capacity in Total # of Manufacturer LQ r t ) a Gallons Gallons Units f w U °Up New Tanks Existing Tanks U in y rn w C7 R. Septic or Holding Tank - Dosing Chamber X 4 3 VII. Responsibility Statement- I, the undersigned, assum ponsibtlity for installation of the POW TS shown o th attached Business Phone Number pIu er's Name (Print) Plumber' ature /MPRS Number Plumber's Address (Street, City, State, Zip Code) j c I l VII Coun /De artment Use Only $ermit Fee Date I ued Issuing Ag t Si atu ~1 t Approved ❑ Disapproved ❑ Owner Given Reason for Denial 2 IX. C 1fiWa 0W0kEAYReasons for Disapproval 1 Septic tank, effluent filter and ' ' ~r ~p~ dispersal cell must all be serviced / maintained rq n as per management plan provided by plumber. §Uta 2. All setback requirements must be maintained S a4l, oT Attach to complete plans for the system and sublMM the County only on nttt less than S 112, x 11 inches in size ' SBD-6398 (R. 01/07) Valid thru 01/09 ' o. O4Q,M • ~1 LOT 27 ry'1k f,~V' ``-`~l. ti~~ BENCH W OF 10 IF leg, 30\ ELEVAD 501 f = , LOT 33% 1 LOT 28 DRAINAGE EASEMENT X "111 i } ` /il { j T ! Jo CONS; 1 t t i { ! EASEMENT fj' ! ` • CaV57??UC V/W EASEMENT j LOT 34 ' ` _ - . t', ',y 8B2e @ t ~ 1!5.3. t Z - 153. 11 11 ~ S C~ts ~9rrnxT~rF~ro Safety and Buildings n \N 3824 N CREEKSIDE LA D 9 HOLMEN WI 54636 Contact Through Relay 1 www.dsps.wi.gov/sb/ www.wisconsin.gov ~O ssrovPS~' ~ Scott Walker, Governor Dave Ross, Secretary June 05, 2012 CUST ID No. 226900 ATTN.' POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/05/2014 SITE: Identification Numbers Oevering Homes - Lot 33 Transaction ID No. 2091636 Town of Hudson Site ID No. 779927 St Croix County Please refer to both identification numbers, NEl/4, SETA, S13, T29N, R19W above, in all correspondence with the agency. . Lot: 33, Subdivision: Alexander Meadows First Addition FOR: Description: Three Bedroom At-grade System / 2% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1374394 Maintenance required; 450 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854 (N.03/07), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code PRIVATE SEWA requirements. l~l No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: AP; Reminders DIVISION OF SAFETY( • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SEE CORi ESP • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. SHAUN R BIRD Page 2 6/5/2012 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WSMART code: 7633 jeny.swim@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety& Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Cover Page Mpg' 201 [jUILDINGS Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 5/17/12 Owner: Oevering Homes Location:NE1/4 SE1/4 S13 T29 N,R19W Lot 13 Alexander Meadows Hudson System type: At-Grade Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01 /01) Page# SYSTEM 1. Cover Page 2. At-Grade Plot Plan nally 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout t# ~t33i~~~o~5 5. Pump Chamber Cross Section 6. Pump Curve U1- MC6 7-8. Maintance and Contigency plan 9-12. Soil test 13. Filter Specifications Shaun Bird Signature License number 2 00 PLOT PLAN 'PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NE 114 SE 1/4S 13 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 98.8' BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEST GF10-8 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark Road 2.5 Acre Parcel Road Scale = 1/4" = 10' 119' 98' Grading is to be done to divert run-off away 99' 98.8' from system Area 15' below B-1 2% Slope system is to remain undisturbed Tank is to be properly bedded B-3 and provided with lockdown covers with approved warning labels B-2 Pro 3 Bedroom House Huffcutt Combo Tank Well is to meet B.M.* all WDNR setbacks 120' Road At-grade System Sloping Site Cross Section and Plan View E Dimension Feet A 2- B -4 W.F. r... r fti 1 i 1 ;1r r:r'rr:r3r}f3~;ap7' s.7 3} Fti} r r4r' 1 /6 B $r S■•~ }.•.■}.ti... ti.'L ~ii r■~ ~iS'. i4 . 4 •..•'.'L•'L~•L 4 ~ ti r 1 rr} . Frrr'~i W A r r•r r•r r .SN } r 1. - ■'ti S.'ti.5i.'h'4 i.y.~ '~•'~•Ki■ ~i''i ■ i S r } r. .3 r.r.r.r. .r..r■~ r. r r •ti`tidrF~'~;r ~;,r}i} ~•ti~' $ ti'Si 1 C / ti.ti.w.ti~•rCw tif.,~ti,;s"~ s"~ r r. r. " ,tr I Lrti:'!'ry:~:'ti~~■.;~'}+~. ~'7: ~s~}~{~~~ ,~'~rtirJ■~■ ~~',F~r 1 D 2.0 _ , ;••rtirti 1~•r; 1 'C~== +LS$'~~~j~~ '~.~i'Yi ~ r ~ ~ ".L ~ ~ . • ~ 1 ti ti $ ti ~ ti. 'G •j' • • '~f L i ~ }j.;'C~,~ ; ~ a 1 E 5.0 0.5 G 1.0 E 1/6 B ~i L W Z Z E -B L % Slope Z_ Plowed Clean aggregate r + • • Q = 4 in. sch. 40 pvc basal area %z to 2 `/z in. dia. observation pipe Lateral with 2" Topsoil Cap aggregate over pipe Geotextile Observation Pipe Fabric G With Cap Ft La a feral Invert r r Topsoil Cap •r• r ` " $ Ft Contour T"-- D -y Plowed. Surface Slope Direction GENERAL INSTALLATION: The at-grade area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a'/4 inch soil wire when a sample is rolled between the palms of the hands. The A x B area is covered by clean aggregate deposited overhead by a backhoe.. Special care must be used when placing the aggregate to minimize compaction of the plowed surface. After'the topsoil cap is placed, the entire at-grade is seeded and mulched to promote vegetative groom, limit erosion and protect from freezing, The observation pipes are perforated in the lower 6 inches and secured in place. 03/051gj Page of Pressure Lateral Layout One Lateral End Manifold 4 Threaded Cleanout Force Main Lateral Turn-up Plug X L Long Sweep 90 Bend Pressure System Construction Distribution Network S ci#iications 4.5-rM D -ZGG J- Lateral Diameter 2 In. Laterals are constructed of Schedule 40 PVC Orifice Diameter 5/ Z In. pipe. Orifices are drilled perpendicular to X Orifice S acin In. the pipe with a sharp drill bit and face down. L Lateral Len th g Ft. Lateral turn-ups terminate with a threaded Force Main Diameter -!Z In, ceanout plug and are enclosed in a 6-8 inch Force Main Length 50 Ft. diameter lawn sprinkler valve box accessible from finished grade. Grade Q: 6-8 Inch Lawn Sprinkler Valve - Box 03105 1gj page of Septic'-Dose -'auk Cross Section. And Pump Pearffaft"cO SPWifc fiOm Tar, ManufaoauriQa~aror Tank. Iylcx6i Number Total Taub Ca Pam l~o~e~Y ~luur bar Q~ >it~ 3 D Alarm Mr~ufsoot~u+dr C &fBi bury Depth .U.~s Alarm Model Number Switch Type filter Msnufcturer Filter Model Nr~rmbar r=k otal Dynamic Head awo Feet Head eetwre S" _ - u Minimum ~Puwp'etorrnanee ~tequired in Lou CZ GPMi Lou - ~ / 5 ' rlit MH outlet imwnhole 11 in. V Above Grade With Looking De, ike. Ink* ale Manlwle Min. 4"Above Grade ti>' $elouv +Ci~rade Sealed Watertight Securely Mowrtad With LoMng Mvic:e •w - r• Fipished Grade J'unwon sox 0M 4 ftw Vent Min. 12" • Above Grade lliwonneict With Vent Cap Means t/ i Y Y+ Y Y Y t t Y i f t! t i I~r~r Vr+ ,iii'I•a•I•i•1•t a+1, 1+I1i ili'f'I.4•1'V`t'i f „ ♦ a V outlet Fawr Inlet - Wet Baffle Y' I f 4fWitch S RWerve CapaCit A y " Tauy_ .II J GPI , t Dimension: ruches Weep - Volume Gar. Dote (resenre3) A; B / . 15 2 a,; f 2 30 /if,i / • Off Wevadon Cdose) C . S C t. r • (dead) % Tr . ; Bottom :•:1,1 a,.,.~T i,rTiP,t~~C{-t-isT t:a: _ V (\/Q~',y~'i a•i•!•tl iV1•t ft Vi•i iV/ tii t l IIa . i . t•1•, ••Yalilal Vl lit`i ~'1 •V•i•a~a•1•I+'•'•'vi`V ~i ,•!iV a I'i•1 . 1 . i i I 'i!i'1•a •f•i•V i V•i+1 ri ~r' V F1 V t I e 1 1 t 1 Y Vi/i~ ~+'1'{'{Yil~ ~•:':•'lt+i YaY'1•ilf •YVi `YI/VYIt Y11i/•, 1 i,a V, I, I,. a _-~Vw V V f/ 1 i f s f i t I t i f f t /•;'t't'I a•t f 1 t'1,;i+•: GENERAL INSTAILLATIOS. exc, ctrarvr's pwduct be oval dDBO tank is bedded and bwk tilled in a~ with the be a:xc~rlad without pint ~p~ R Mujmum depth of r as gMi&d by the manufacturer May not installed. Piping at p ' Manhole covers exPoned to VU& have an Y uyndt and outtet is of approved tnw ri oa active he manufacturer device (padlock) laic! on stable soil to prevent u$ m sa ' to the tank with watertight fktlu excavation and Ow peeve is SB+ng' The force main is sleoved with 4" &h. 40 PVC to bridge the+tanan(I k sealed might. F,1@0 rical service complies with NEC 300 and Comm 16.28. 02/01 I J Page of AP LaserJet 3100; 50z vul - Hari s Y • o-1N0 a .jtav wt , +9I'~1►r^ ~ r Aq 9E H SERIES SUMP/EFFLUEN+T" PUMP 11.55 8.95 ~ M1 t ~ 0 itlcatiwn>~ Ct 3MI185q IIMi l1N59MIrlY1 MIMMf wlttss flsnrr Mgt K Mstp N/ 1 1 ftk1 NO Mfr V 1fP ar MLl ~ Bil ad Blalte 2111-CW mm MA 41.8 115 34 13.0 1000 70 V 6s 41 32 13.8 20 14 9.11 r11AI 124 W"N 5=0 No& Va 230 34 6.5 In 70 64 55 41 32 13.9 20 24 9.11 ~ 11.M4ti184 M-Di •FEB 506= W= 400 115 m 13.0 10M 70 64 55 0 32 19.8 m v 8.11 t 1frA %to 210 41 64 56 41 32 13.1 W 21 Lit ItImats Gan1»uaec OulyRneO-'LBMe 6ieM1YAa0rxMiq[plsnpsetersudconenneacdslree:bA8aliayaaltelwl8dnM1ya1MNledRan8ekrlMasq~lnrn..' FLOW- LITERS/HOW Consstmetku 0 1000 zooo 3oa0 Moor Flour fs~ox~+ Coated Cast Iran Impeller Material Pot CMUfionate so 10 Im llor' Closed ili1g5. Volute _!B w ,,s W Power Cord SjTW_A zo Machaoicxal Shack Scal Nitrile with carbon and _ ceramic fun w ~ Fasteners StainleMS S6eal 10 Shah Stainiefs Staal Bear' D Upper Sleeve and Lower 0 0 1 Halt Beldngs 0 20 40 60 so FLOV- GALLONVAINUTE PUMP PERFORMANCE CURVE Little GiOnt PUMP CAP. t18v 60HZ '~+'v Miles IMH v (Wftetaa C t 731S? j 1'1p0MS1:0947,35t1.Fan; 40942 I MM 1 Www.t fttleG1uutftmp.cfstm 0 fpm 996236--07103 POWTS OwNaws MANUAL & MANAGEM PLAN Oe tq C2,- 13 NA -70 ftPft ABM f fl[ilialt t it I Or 13 NA t rabrrd' IdJ~M6ef''IYlkw~t C7.~/ © HA ~a!Gwralww Uflb >-NA a Pout " Phlmp 1'eutk Mto~tirr OA Amdoom n elm S` pump me" 11rr~*IIeIWw EAW Fow= a Qwm w (pea s 0 nwL b rrwuu lsisr a Post ruw WWVand ,~-l- I- l Ou"New mm MIOL Ilarlr6e a a c A106 lllet CLAW fitA mon ~mBe" caw TOW ~nMper~ so" tym 930 n%WL r-.asi modmm EmmiE PWWO am 4brnsew N: W~~bl!d=*M#w++srrs~wrrpll we~Ir.i.re end vwruser~w~MrrRwMe.wrew sreu"r~wt riwnt 9ieew~tM ~eina~r Inspect aosdoun of bmiKa) At OM =ms Amery Q is to 0 s e) Guns 3 yM) Pump WA VOODOO of Wnlae) When awnbined slufte and SOM 4016b OMNW M of ftnk voimme s iaspr~ tlbpemti a Iki brat arm emy Gt fit} (MaelmuRe s yam.) ,tit ellluerk~Osr leeuitmm wry [Imp" 1 sum donut& a eibtrne At WmW anoe e my t3 a NA iro~rair.aa pneert~ra pest Apt t~it+~a..wry ) d NA nxa~r.c vnee wary 0 mina a yaws) CII NA = At ltr~uet ernes sorry Q a "so) DNA i sum r l AW caft afea ba ror by gn.ttl i aew**W onr of 1 ~ IIawom or `31eNbw v Gpw■Wr. 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If1~e me~oe~nd~rier are +d hairo ble wiMMr eif l>~lrii~ ~MO~ by a srpbbr opvrr~or' ifabe' air M.t Syaftarn start tip snail not Omar wlmn'aairc andMons aare.*ozen at the infiltrative WrW*_ page--, v Darya ~ ~ ~rorwsr aru a wimp tam alT~ ~B atSGVe notrflal hlgtivar~318P t~!lPet6, ~1l~ieri 15 rfa~tl~d tflC @lp~ .3 'M ralM be dtststWlPd In clue ftMolt s dkPWNW deli(s) in one large dose oveiioodkV. the oWsj and may n in the b~soloyp ar rrs> r6arrst dh aa9ae sm~' To 8atl W this i have the c onftnft of the Pm'+p tiartlt rernos ed i s a614a"awavldrso ch"Wea>ta" aRrlerr wMrsmhalg! h 'povvsrr-av the emu"* pump or contact a 14tmw eror POWM himhugr. to 3 Morin MWKM lygWMft 00 f W MR1096"lbb reMOM naval Mvew virllltitr Me pump tatsk. Da md' dit orpwkideti Qm*ltafl aid &Mva! c ak On Wt drive or Pam 09W, ordhw*iw der orconvaq the sin uftb 15 !feet dan s bp s taW Mmind or at-grade so ahsoM tm at". Raldsx Wn aar-ElbttiitOW otMe MkMNft Own dw vara r strum may impmt" this perfaMWM nd pmbV than tt of Wo PClWM WAMMOk t t 'tea bt,m ; «mdonu , oDUW swabs; deata em. dwW flow dgmM da kcftldir, fat: finch t.t!fh& ^M PAP) ; *Uka std trog W* FWf godkw 910101a hWW* ; mom scM . M&NOW + * *ij*dkV podLob. prides: napkins; mtnpaaaawa; -wed wwWr soy enaer bt ine. When Ma POWYS faits and4br is pertownW-Uken cwt of service the foliowkV stems shag tw taken l insure that ttce sYdNe ie 9WleftjfMWSV*abwWunW in Wmphancwe w IM ch_ Comm 83 33. Wboonain Adrirdnlsaftft a Coder AN p4 ft to b uilm and pft satttstlt be disconne ctsd aarscl the abandoned pipe gperongs somed_ The abalwafs of aR tanks and Oft shall be ftnhave:i and properly dispos W of by, a 3 e Sftvfcma cWwakK, Attsr Pula ba. a0 tomko and PM sahid be rxavat{ed and removed or thelrovvom taarnxavede nd the void sprat fftdwM PoK gravel orant#sit'fnert wMd rang kviaL CONTrrH NCY PLMM' ff the tk3UVM Wr and cannot be swpm hud the *29owlrsg measures have been, or cartel be takrst, to pre mWe a code cam CPCg~tmptestt eves sul liti fa rs o~stnsrtit has been evaluated and may be utilized for the ksa Lion ofs nephmment soil aabm a *bn sptmsait. Wo repluadMent should he protected from disturbance and compaction and should not be infrin8ed upon by requifrad s Fc+ wn existing and proposed struc tri'ta. lot tines and v/ 8116- Falure to P *0 anent am W N 14sult in the need for a new soil and sitaswvaluglion m e.Mbbb s suftbie rephKmment areas. Ropia cement systerns must comply iMth the rules in effgct at that time- 0 A scrltable MpAwenwnt erea is Trost avaitable'due to setback aand(or soil tirriitad ins. Barring advancW Fa p0WCS WuNiogy a hold ft tartkitny be installed as a last resort to replace ttte faged PC)WTS_ © The sea cues not been +rava d to iderttr€jr a suitable replacement area_ Upon Wure of the pC WVyS a ss5ii.and $me evuJuntion must be Oerfcwumd to k as tia a' suitable rsplacernant area, If no rapft0Mtsent area is available a 'soidatg tM* MW cis i cad 86 a last lesart to MAIM the railed POW-M t1 kWWM and at-grade sae0 a6a mPtInrn sSrsteM s may be rGo onsaWxW in place hrliov&V tmsvoval of the bict wt at lfse kdita Ma s+ur&W of such sys,taanrs must comply witha the rules in ealibt at ulauT UMe:. <<tlfiARlW[JNlc>a SEPTIC ; PUMP AND CVfM R TRF.A,TM@►TF TANKS MAY CONTAIN LETHAL GASBM AMLNOR WoUFFIMENT OXYGEN. co tll0'r EpIT~!i A C PUMP OR OTHER TF1t ATMENT TANK UM M AMY CM CU'MSTAMCES, DEATH MAY RESUL.'I'_ . RESCUE OF A FERRCM FROM THE INT MOR OF A TANK MAY RE DIFFICULT OR NA POSSIBL.L. A00MOVAL cofilwwrt POWTS INSTAL"R AOWI°S MitAiNTA94M Name - - - cr- phone Name '7 %oz t<7 = S&TAtsi ;p*&t 'Ng Ua E~tArvt Pct LOCAL REGULATORy AgMoRtTY r rYJ Phoft ._7 - Agency /o `J Phone ;7j,-•...- 8 0 rrrb aa~aaraKa..®s drra~ad' Ilryume; stdQr a°Irru ell' am Lalire, srro rrrint rwnr, OL OW hlmr and Waralrara C ,=Mr Zonfw and Mtr mdanai"- This draaaWWd meats gaaranlee tries Canssn M3fiff and e3.srtCty, i~) t 3. rosin pssrfiuragrvrse oftlae POWTS. Adrrrttlufsa , Carly:. U11i of Usti d'ocwnwtdoes vat - `Y 41, ( ailr rxr AW .Cfi R ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ -C- a.u r✓ J n~e - Mailing Address 1 Z sc of Property Address sLde- -FKrt. D P (Verification required from-Planning & Zoning Department for new construction.) City/State Parcel Identification Number LEGAL DESCRIPTION r Property Location Nhi5 '/a , Sec. , T N R~ W, Town of ~ Lot Subdivision ~ Certified Survey Map # _ , Volume Page # U r Warranty Deed # 2!/~ee 6 , Volume , Page # Spec house 45e 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. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of b s SIGNATURE OF APPLICANT(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) 'G/•. ' NVIsconsin REC~ME&AL ATION REPORT #2036 Page 1 of 3 in accordance wit Comm 85, Wis. Adm. Code Commerce Depart DEC 0 4 2006 Dix;ision o of f Safety y and Buildings Steel's Soil Service Attach complete site plan on paper n t les a County {{ll~~'/~ '~1 in siz Plan must St. Croix include, but not limited to: vertical an horit~f'rLPh (BM) direction and percent slope, scale or dimensions, orth a4secon and location and dist nce to nearest road. Parcel I.D. (y' . ) 7} Please print all m on. Revie d By Date Personal information you provide may be used for urp s (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location LaCasse Development, Inc. Govt. Lot na NE1/ , SE1/4, S13, T29N, R19W Property Owner's Mailing Address Lot # 33 Block # Subd. Name or CSM# 573 Cty Rd "A" na Alexander Meadows First Addition -,4e 1 City State Zip Code Phone Number ❑ City Village ❑ Town Nearest Road Hudson WI 54016 715-381-5405 Hudson Alexander Rd. ❑ New Construction Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: na Parent material Stream terraces and pitted outwash plains Flood plain elevation, if applicable na ft. General comments At grade or mound design. System elevation 100.50ft based on contour line 100.00ft minimuum of 6 and recommendations: inches ASTM33 mo nu d sand. F 1-1 Boring # ❑ Boring ❑ / ❑ Pit Ground surface elev. 99.00 ft. Depth to limiting factor 40 / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-18 10yr3/2 none sl 2msbk mfr gw 7na 6 1.0 2 18-40 7.5yr4/4 none sicl 2msbk mfr gw .4 .6 3 40-50 7.5yr4/4 c2d 7.5yr5/5 sicl 2msbk mfr gw .4 .6 4 50-78 7.5yr4/4 c2d 7.5yr5/6 ms/sil om ml na na .0 .2 Horizon #4 has silt inclusions mixed in layers with ms. ❑ Boring 2 Boring # ❑ Pit Ground surface elev. 99.00 ft. Depth to limiting factor 60 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-30 10yr3/2 none sl 2msbk mfr cs 1vf 6 1.0 2 30-60 7.5yr4/4 none Is osg mvfr cs na .7 1.6 3 60-100 7.5yr4/4 c2d 7.5yr5/5 Is osg mvfr gw na .7 1.6 Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD5 <.30 mg/L and TSS S.30 mg/L CST Name (Please Print) CST Number David J. Steel 248956 Address Steel's Soil Service Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 11/21/2006 715-760-0347 SBD-8330 (R.07/00) Property Owner LaCasse Development, Inc. Parcel ID # Pending Page 2 of 3 . Boring # ❑ Boring J ❑ Pit Ground surface elev. 99.00 ft. Depth to limiting factor 36 in. Soil Application Rate Horizorh Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2 1 0-23 10yr3/1 none SI 2msbk mfr gw lvf & 1.0 2 23-36 10yr4/4 none sl 2msbk mfr cs na .6 1.0 3 36-84 7.5yr4/4 c2d 7.5yr5/5 Is osg mvfr cs na .7 1.6 4 84-100 7.5yr4/4 c2d 7.5yr5/6 ms/sil om na na na .0 .2 Horizon #4 has silt inclusions mixed in layers with ms. ❑ 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/ftz ry in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2 i Ili I i I ❑ 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 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 (x.07/00) Steel's Soil Service i • STEEL'S SOIL SERVICE 3 of 3 David J. Steel LaCasse Development, Inc. 994200 th St. CST-POWTSM NE1/4,SE1/4,S13,T29N,R19W Baldwin, WI 54002 Lic. #248956 Town of Hudson, St Croix Co.~Direct 715-760-0347 Alexander Meadows First Addition, Lo 13 Fax 715-684-3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend N 1" = 40' = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 100.10 ft Top of 3/4" pvc pipe ❑ = Borings U.JR Boring Elevations ~6S B1= 99.00 ft B2 = 99.00 ft B3 = 98.10 ft B4 = 0.00 ft 3~ - v 1 PIP C ~-o Parcel 020-1478-20-000 06107/2012 09:38 AM PAGE 1 OF 1 Alt. Parcel M 13.29.19.3019 020 - TOWN OF HUDSON Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 07/25/2007 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - BIRD, SHAUN SHAUN BIRD 1008 192ND AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 887 HILLSIDE TRL SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 2.514 Plat: 11-022-ALEXANDER MEADOWS1STADDN 020-07 SEC 13 T29N R19W PT NW SE ALEXANDER Block/Condo Bldg: LOT 33 MEADOWS 1 ST ADDITION LOT 33 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-19W NW SE Notes: Parcel History: Date Doc # Vol/Page Type 01/05/2012 948366 WD 10/20/2010 925081 DEED 07/25/2007 856211 AGREE 07/25/2007 856210 11/22 PLAT more... 2012 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/17/2010 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.514 53,300 0 53,300 NO Totals for 2012: General Property 2.514 53,300 0 53,300 Woodland 0.000 0 0 I Totals for 2011: General Property 2.514 53,300 0 53,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 IIIIIIIINIIIIIIIIIIillllllllll DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2 8 0 4 6 0 1 6 Tx:4033496 WARRANTY DEED 948366 BETH PABST Y' Federal Deposit Insurance Corporation as Receiver of The RiverBank REGISTER OF DEEDS conveys and warrants to Shaun Birda 5/hA]~ ~rrso7-t the following ST. CROIX CO., WI described real estate in ST CROIX County, Nate of Wisconsin: 01/05/2012 11:36 AM Lots 23, 31 a 33 lat of Alexander Meadows First Addition in the Town of EXEMPT*: NA } Hudson, St. County, Wisconsin. REC FEE: 30.00 TRANS FEE: 210.00 PAGES: 1 1 E RETURN TO St. Croix County Abstract and Title Co., Inc. 219 S. Knowles Ave. New Richmond, WI 54017 119274 Tax Parcel No: 020-1478-18-000 020-1478-10-000 020-1478-20-000 This is not homestead property. (is)(is not) Exception to warranties: Municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, and further except 2011 real estate taxes. Dated this 4th day of January, 2012. Federal Deposit Insurance Corporation as Receiver of The RlverBank 1 By: Zachary R. McBroom, Attorney in fact AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF 3 20~. ss. COUNTY OF W tks~ t'n TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me this 4th day of January, 2012, the above (If not, named Federal Deposit Insurance Corporation as Receiver of authorized by § 706.06, Wis. Stats.) The RlverBank by Zachary R. McBroom, Attorney in fact to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY F t Robert L. Loberg Notary Public ~Q t K V3 W0ountY,3 i'S-- % rltlGSld~l Loberg Law Office lmg/sw My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are ) not necessary.) •Nsmea of persons signing in any capacity should be typed or printed below their signatures. MARIA L. RODLUND 49Notary Public Minnesota l„ y C0nnlwn ecpm.ianuay 31.21115 WARRANTY DEED 1 oil