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HomeMy WebLinkAbout020-1067-75-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552380 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: Johnson, Justin & Jill Hudson, Town of 020-1067-75-000 CST BM Elev: Insp. BM Elev: BM Descr o Section/Town/Range/Map No: / 06 , a /Ol~- 6 T~ 24.29.19.257H TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C-~ 2 5S Benchmark U I Dosing Alt. BM lD S Aeration ~r - Bldg. Sewer Holding SUHt Inlet al &'04't Y-7- 2 St/Ht Outlet f TANK SETBACK INFORMATION G H I j 'Z/ TANK TO P/L WEL BLDG. Vent to Air Intake ROAD Dt Inlet 4V t Bottom eptic 1 / oi + -7 Dosing r Heeadder . / Z Aeration Dist. Pipe (p- 2, Holding Bot. System 120 i Final Grade l7V'e_ Zz U io d ~ PUMP/SIPHON INFORMATION (0- Manufacturer Demand St Covgr / GPM Y, I J7 D 3 Model Number ( Viil/n TDH Lift Friction Loss System Head TDH Ft / Q 2, O Forcemain Length Dist. to Well / - I Vjj a4' SOIL ABSORPTION SYSTEM 2 Cd BED/TRENCH Width 2 f Length No. Of Trenches PIT DIMENSIONS No. 'Of Pits Inside Dia. Liquid Depth DIMENSIONS J g !O SETBACK SYSTEM TO P/L BLD WELL LAKE/STREAM LEACHING Manuf rer: ~Y INFORMATION CHAMBER OR Type Of System: v / I. UNIT Model Number: DIS BUTION SYSTEM 4- &9_jjzd d 1,- I j-y 01- Koac-. SC A l ead anifpld Distribution ] x Hole Size I--- king en Air Intak / / r Pipe(s) ~x/ i Length Dia Length Dia Spacing --L SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over f Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / Bed/Trench Edges Topsoil Fim~ Yes ❑ No 7 Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: f D /3 D / 1 Z Inspection #2: Location: 845 Badlands Rd Hudson, WI 54016 SE 1/4 SW 1/4 24 T29N R1 9W) NA Lot 2~ Parcel No. 24.29.19.257H 1.) Alt BM Description Of 2.) Bldg sewer length = qS 4-t - amount of cover = Ll / Plan revision Required? ❑ Yes No lji S lD 3d l ~ ` Use other side for ad itional ' fa io Date Insepctors Signature Cert. No. SBD-6710 (R.3197) ev G s PLOT PLAN PROJECT Justin Johnson ADDRESS 1187 McCutcheon Rd Hudson Wi 54016 SE 1/4 SW 1/4S 24 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/18/12 BEDROOM 4 CONVENTIONAL )00( 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 860 # of chambers 42 BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 1001 Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 100.0/98.5' 6' below grade High All piping shall be SDR 30/34, within 10' Side of Cell of tank, piping shall be Schedule 40. [TJ4- 'rue- Badlands Road b014,o C4 Scale is 1 = 40' ~Vj ✓Vents unless otherwise B-2 noted 2-3' X 88' Cells Plans Designed Using 15% Sloe 90' Conventional Powts Well is to meet all Manual Version 2.0 373' Property Line setbacks required y WDNR B-3 B.M.* 401' Property Line 30' 30' B-1 ' S ti~ ~i y 100 ST CS~ 30 150' E J Be Hou Vent 6' 2 >6„ Quick4 Standard 645' Property Line of Cover Leaching Chamber with 20.0 ft2 of Area 10.2ft^2/pair of end caps Long 12" 4Lon Grade at System Elevations P Y 37 LL ~ 0 AL 7, 1988 ~s y JAMES O'COUiJEIL Register of bands St. Croix Ca. WI CERTIFIED SURVEY MAP Located in part of the SE1/4 of the SW 1/4 of Section 24, T29N, R 19W , Town of Hudson, St. Croix County, Wisconsin. Surveyed for: Nell Ruemmele Rt. 1, Badlands Road Hudson, Wi. N1/4 Corner SCALE IN FEET I = 200 Section 24 200 o zoo 400 T29N, R 19W I Lot 1 contains 122, 321 Sq. Ft. (2. 81 Ac.) bpi Including R -O-W , 108,900 Sq. 'Ft. (2.50 15 Ac.) Excluding R -Q -W . I oti. '.7 ~ /I/INIt a4 ~ / rGQIyS~>~is All ~22/ 'j~'y~.0ii ke 101 ' M HARVEY d• ' Gee/ I / g0.0 392%~' .JOHNSON L r w ' I / V~ / / /.'9 01 ✓3 /390 A s 5-1899 I A6/ 1 v 6A HUDSON o boy % N 6 / '"rn ~9 WIS ~m . rO o° / 5• i~ •O'f ti y,~ O Sl1R;~~~'O PN/ 6~~ AO •ON6'f N 'q 'N 8118last% eN in / Io M 0 m ' N Lot 1 0 NI (~u Z 0 Z: I 401.65' 84'31'33" cu ~ JI a) N E Q e I 01 W al CO W Bearings referenced J o l nt~2. I- to the south line of o 01 _ 0 v aI the SW 1/4 of Section o_ a 658,205 Sq. Ft. (15.11 Ac.) °o Q 24, assumed al a°, o Including Right-of-way zI 2 :D S89°16'26"W. T 645,283 Sq. Ft. (14.81 Ac.) N ml n o , Excluding Right -of -way > v " it c 0F, OI In zv ~y (D 0 H Z W I Q F- U_ W N89°16'26"E \I" IRON PIPE FOUND NO°06140"W SOUTH LINE OF 1872.54' 2.18' OF SET PIPE. THE SW I14 -~Il S 89'16'26"W 748.36' (T50.7') S1/4 Corner S Corner UNPLATTED LANDS Section 24 Section 24 - - - - - - - T29N, R 19W LEGEND Section Corner Monument • 2" Iron Pipe Found A • 1" Iron Pipe Found 0 111x24" Round Iron Pipe weighing 1.68 lbs. /lin. ft. set JUL 07 8 (750.7') Previously recorded information 3r CR Ccxxw LM= =W VOLUME 7 PAGE 1997 0- This instrument drafted by: 488-1444 ~mme~•w~•9~w Safety and Buildings Divisto County 201 W. Washington Ave., P.6 -Box 7162 /~p f isco naim n Madison, WI 5 3 70 7-7 1 62 Sanitary Permit Number (to be filled in by Co.) ~P~ertt of Coerce Sanitary Permit Application State Transacti on Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental N~ unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary u ores in accordance with the Privac Law, s. 15.04 1 XT), Stats. C L A lication Information - Ple se Print All Information J Property Owner's Name Parcel # - Property Owner's Mailing Address roperty Location ! 257H i?:2 1061 9 ~O ,..'FF\c Govt. Lot City , tate Zip Cod Phone Number C \ SI GF01 ZO~ sue( d'/,, Section 4 _ v C R~ ~jf N. R c ie ° W H. Type of Building (check all that apply) Lot # or X2 Family Dwelling -Number of Bedrooms ~ LL ~ Subdivision Name 6/L td IVa_► Block ❑ Public/Commercial - Describe Use n /.4'1 r El - City Of! ❑ State Owned - Describe Use CSM Number O Village of 2 b, ts+ It t.✓ 2 t 2 C4,4 wv o f own of _ III. Type of ermit: (Check only one box on line A. Complete line B if applic b A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. E] Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. of POWTS System/Component/Device: Check all that apply) 17 e-- Z _ on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil .00 ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) - V. Dispersal/Treatment Area Information: e - Desi low (gpd) Design Soil Application Rat dsf) Dispersal Area Required (sf) Dispersal Area Pro ed (s S ^em Elevation V it? VI. Tank Info Capacity in Total # of Manufacturer C Gallons a Gallons Units ~ o New Tanks Existing Tanks o+ y Jo «ti d/61 U in rn ii C7 G Septic or Holding Tank X Dosing Chamber VIL Responsibility Statement- 1, the undersigned, assume re bitity for installation of the POWTS shown on the attached plans. Plumb ame (Print) Plumber's Si MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) i VIII. Conn /De artment Use Only A If Approved app Permit Fee Date Issued Issuin ent Sign ure r Given Reason vial $17-5. 411711 Z' IX. Condit'l01PONONlReasons for Disapproval '$eptic tank, efflubnt toter bri dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All-setback requirements must be maintained as per appkable code / ordilmcn. Attach to complete plans for the system and submit to the County only on paper not less than a 12 x 11 inches in size SBD-6398 (R 02/09) Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 6/18/12 Owner: Justin Johnson Location: SE1/4 SW1/4 S24 T29 N,R19W Lot 2 Badlands Rd 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 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet Signature License number #2 9 PLOT PLAN PROJECT Justin Johnson ADDRESS 1187 McCutcheon Rd Hudson Wi 54016 SE 1/4 SW 1/4S 24 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/18/12 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 860 # of chambers 42 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 100.0/98.5' 6' below grade High All piping shall be SDR 30/34, within 10' Side of Cell iP~mg of tank, piping shall be Schedule 40. Badlands Road Scale is 1" = 40' Vents B-2 unless otherwise noted 2-3' X 88' Cells Plans Designed Using 15% Sloe 90' Conventional Powts Well is to meet all Manual Version 2.0 373' Property Line setbacks required by WDNR B-3 .M.* 401' Property Line 30' B 30' 10' B-1 5' 100' ST 30' 150' 10' Pro 4 Bedroom House ic Quick4 Standard 645' Property Line eaching Chamber ith 20.0 ft2 of Area 0.2ft^2/pair of end caps Grade at System Eleva tion 3 4 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 10.2ftn2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 106.0' Vent ACI Grade Vent 3' 4" 31 X30/34 Septic Tank 5' Long 199 5' S' Long 191 Grade at System Elevation 3691 Grade at System Elevation I Spacing 5' 2-3' X 88' Cells Same on other end Observation tubeNent At end of cell A B 21 chambers per cell System elevations: A--1 00 B 98.5' s tJwrwvS MANUAL. & MANAGEMENT PLAN P©VYT E SPS~CATtONS r-R F- Vfr-0 ►710N Sspft Tank CY $ D NA eau nw Tank Manu r n NA ffEferrt F~ter leer ,3-e ❑ Na Dl Ply - a l~f~ Fir MQ" 13 NA NA NM W of 8odroams PurnP•Tank ~ gal NWIW C(Ca0UT%0fCW Unto ® al! Pomp Tank MfluW w NA a dmded fJOW ( } Nk Pia mP ossvnftw (61 Lb x 3.frT) NA Pump Mode[ 308 APP~e RSW f p~n,~rneent Unit NA Monthly avetstges` rrrlluantlEMuertt Qusi€h+ C3 SartdK3t4vel FRw ' D Post FEW tl Wetland S~ OWW Slaerinvid gypsy mg ❑ n a Other_ Total susponded ~s (TSS) SO A- Q Mvtrt Y 8"M90" gtsporsd t ed [ (gM ' 0 In~ground (Pralwi taed) c*yjjan t~~ 530 mg/L Q At-gcad ❑ Mound Btvdte:rrticAlf TOW[ Suspended ) ~ cimg/L irtlfJf]rrti Q ~ ne 13 Other moon Fecal Co Vskt~s>s'P dOz sa+dt ' $ inch diSmetar . ~Nc elltrr.ca. ~MardttturnEflfuentPatrifdtSflzs vat~cas~vt~~rvr+~a+.aya M, VnMN"CE SCNFDULE Service Frequency Serrke Event p month ris) tM~rleaurn 3 yro.) At feast Inspect condMon of tank(s) once every When combined sludge and scum squats one-Wrrd (Ys) of tank volume pump out ca ntents of tank(s) D m:r+tr r(S) (maximum 3 yrs.) cal!ts At least once eve? iris dlapersat 3 At least once every © months r(e) f Lleart>r[lfuentfUter D morethS ©y~eartSl NA anspea pump, Pump c~ontro& 8 alarm At leecst once every NA At least once every Q months II yew(s) r'luslrlr$ emd pum fast II martths II year(s) NA COW. At least once every oelfrr At IesSt flntAe elrery 13 monltts II years) NA NADETIMIANCE INSTRUCTIONS oath shalt be made by an iru~tivtduat csarrying one of the tt~iivwing licenses ar ca€MU&NOM M o Of&fw Plumber; and umber; we P~~ ResW9d Sewer. POWTS 1nSpectDr.. POWrS Mainbainrl: SWtWO ~tlcatBcta: t kWrsft any ewe foray rib bards up swvtayg OpsraW. Tank frapWRioN" must Wfude a visual Inspection of the tanK s) to rrar+d~IwM kbrAKY any di I" S or , t O+'a the volume of combined sludge and fd d>eok the effluent Petrels or ponding Of a fmwtt on that gm wmd arface- The dispersal Ceti(s) shalt be VIWAOV ink the t Vw obse►rva On ph-mincicaft w and to d w* for arty ponduV of effluent an t f It g=nd vhf fine- The ponding of effluent an gcpWd surface may a f0no C wW requites Me immedie fa notification of the local regulatory aut'ority entire ronben>ba of ~tlPMkshad b e and scum in any tank equals orl"rd (V or more of the tank volUMV, t NR entice the comtf atxxmthag beoft r+eft:oved PY a SeptWe ServWng OPen3W and disposed of In 9cordaf= II 13, V110a0l1ein Adffdrtb ftdm Goole t >~omtaonems; and any The stexjcif~g of e~lffent tliEar S, melr~nk:W or pr murl ed POWrS comporMIS, p ,nY I~,i rrnalnteatanraa or rlacli~rin9 at ltl#el~rSts Of 12 mvnf}l8 or less stfall be service eVwL A SMVIcte mpoi t stt8tl'be pmNdsd tD life k>Cal regulakxY authart(y wffhin lO Of COI~P i AKr UP AND OPERATIOM ~ For new =lsbllal~iM t~ bum of ew PO rS s~ck.tr Tiara tank(s) for tilt ~ of paw l~ctCtS of czt that may E j - 0s on fitltrtblfent process snotar dwn.dge tts dispersal asks). If hbgh CWWW*VRW am hmthe wnse to of ow ocelots) removed by* soptage ser okkV operator prior tous& Page l of $ shall not occcfr when' 5vf1 `c°nditians are 'hozen at the in" trative sur[aace- f • ~Effn Stall up Duriar•,cl powsr outages tip tanks ow t i above normal tfJQtm dWr ievets, When pow" r5 rE5"lDred the exWSs w=bmatem-wo be domed to the dl 4XX3W dell(s) in one large dose, overloadmg the ,pelt(s) and may result in the ~[t. To avoid povlrter his situation have the c antentq of the Pump ta»k remmOved by a t>a~cio~P or $e of to the effluent pump or contact a Plumber or POWTS Maintainer to rvildmang 4 NNK prlctr t5o Seevi Sapdia~e i asust. in rrlanuanyopersurf ese p mp oE><7 S to restore normal IaYets within in the pump tank. Do ate: Me or park vd** 8 0W- brft and d"t5p321 COS- Do not drive or park OVW. or otherwise disturb orcoillpact, the atc!awithin 15 feet ditn sklpe of any moaW or at-grade std absorption area. Reduction or-erarlinattarm Of the R000wing from Me wastewaW stream may iinp[mt the perfoananve and ptniong the Gfe of rhtu POW & arablow bewww "ggalette butts; condoms; cotton swabs; degreasers; denfat fbw. (bpw. dlsW iec b mW, fate foutida6on dicta {sump pump v rater, tuft and vegetable peefmgs gasoline: grease herbid des, meat sex Wc. meWca6w s; G* odln t9 guars: ,P 'des: sanitary napkins. tampons: -amid wafter softener bunt=.. ABANttt]NjUENT trNhen the POWTS fails andfor is p,eiManently.taken old of service the following steps shall 49 taken too insufa that time systern is ptopedy and safiely abandoned in oompGance with ch_ Comm 83-33, tWl*iso trmsin Administrative Code= Amt piping to tanks and pits shall -be disconnected and the abandoned pipe openings sealed.. Thee contents of all tanks and pft shall be removed and property disposed Of by 2 Septmage Servic ing Operator. • After pumping. ail tanks std pits shall be excavated and removed or their mvears removed -and the void space tided wNt sail, graver or another inert solid material. CONWIGENCY PLAN if the IN:)WTS falls and cannot be repaired the foffovAng measures have been. or must be taken, to provide a code comphent replacement systerl1: suffabte replaoementar+ea has been evaluated and may be utilized for time location of a reptaement soil absorption sysMrn. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required settraacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area vall result in the need for a new soil and sitwevaluation to establish a suitable replacement area- Replacement systems must comply with the rules in effect at that time- 0 A suitable replacement area is not available due to setback andfor soil limitations. Boning advances in POWTS installed as a last resort in replace the failed POWTS- be technology a holding tank may ❑ Me site has not been evaluated W identify a suitable replacement area- Upon failure of the POWTS a soil and site evaluation must be perforrved to locate a suitable replacement area If no replacement area is available a. iolding tank may be installed as a last resort to replace the failed POWTS. 13 Mound and atvmde soil absorption systems may be reconstructed in place following removal of time biomat at the infitrativesurface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARhi:tjNG>> SEPTIC:', PUANP AND OTHER TREATMENT TANKS MAY CONTAIN N LET14AL GASSES ANDIOR INSUFFICIENT OXYGEN. DO Nar Em ERA 8EP?IC, pump oft OTHER TREATMENT TANK UNDER ANY OrRCUMSTANCES. DEATH MAY RESUL.•m _ RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COM&W-61TS POWTS INSTALLER POWTS MAINTAINER Name X e Name Phone SEPTAGE.SERVICING OPERATOR UMPER) WCA.L REGULATORY AUTHORfIY Narne'Agency J~• v( Phone - C' Phone 3 b This docamiv¢was Qi tfFi9d by the'Oft of VW Geetera Luba, MarquaUe and Wausha►a County Zoning and SarUf um This docturNA meets u>r mmtamum nmqubavei cs of rim. COMM 83-ZZ(Zjtm X1X(Qd fffj and 83--154(1).(2) & (3). Wisconsin .Admfnt0afim. Cede LN6 of thlo docwwnt does rrpt guarantee the Performance of the Pows. c~AAW (ZNi) 1 ILTER CARTPJDGE INSTRUCTIONS Installation STET' I Dry fit the filter case onto the eyed of the outlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of %-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. r t' .3 For installations utilizing the optional supplemental side support: solvent weld the V4-inch pipe onto the filter case. If side support method is not utilized, proceed to step four, Solvent weld the filter case onto the outlet pipe. Insert the filter ;'r' cartridge into the case, pressing down until the filter locks into the bottom of the case. If a VRS switch utilized: insert clockwise 90°. into the filter and lock by turning Y'rs!y" ana ~y'.~ 47~.'~ Vii: • '1,' ~'k,s 1.''A~_ Maintenance I. The effluent filter should be cleaned every time the septic tank is serviced, f 2. Open the outlet access opening to inspect the tank and filter. 1 3. Pump the septic tank completely, making sure to remove the sludge . y layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been lowered below the invert of the outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. ` 5. Slide the cartridge up and out of the case for cleaning. b. If a VRS switch connected to an alarm is present, the switch should be removed by turning counterclockwise 90° and cleanedk with water only. 7. While holding the cartridge on its side (large fiat surface facing a { down) over the access opening, rinse off the cartridge with water h only, making sure all septage material is rinsed back into the tank. S. If VRS switch is utilized, replace by inserting into filter and turning clockwise 901. 4. Insert the filter cartridge back into the case, pressing down until . the filter locks into the bottom of the case. 10. Replace and secure the access opening on the tank. www beamnsitexom 877-MLRLTECts (653-4583) 12 R (;F . t T Wisconsin Department of Commerce SOIL EVALUATION REP Page of W Division of Safety and Buildings ir'f'a~(~ ~rttance with Comm 85, Wis. Adm. Code County Attach complete site plan on papsrtn6t~,,e'§~~~$C171*,ti inches in size. Plan must include, but not limited to: ve aNWM ntal reference point (BM), direction and Pa percent slope, scale or dimensions, north arrow, and location and distance to nearest road. rcel )Q a J 1 7/ Please print all information. Re ' ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ct) A Govt. Lot ,S/, 1/46(d 1/4 T N R E Property Owner's Mailing Address Lot # Block # Subd. Na or CSM# 7 v c City State Zip Code Phone Number ❑ City ❑ ViII Town Nearest Road ~el ( ) k: A& I AA I 91 New Construction U Residential I Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material L,cf Flood Plain elevation if applicable ft General comments C and recommendations: p p System Type ~i1/Yl_/1~ A.Gs6, System Elevation / F-/ I Boring # ❑ Boring -A Pit Ground surface elev. IP-ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 to -oz r - J- ate.- Boring # Boring ® Pit Ground surface elev/0 --V-ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 011 ' 2 - 60- 5 r S -7r 11 Effluent #1 = BOD > 30 1220 mg/L and TSS >30 < ' Effluent #2 = BOD < 30 mg/- and TSS < 30 mg/L CST Name (Please print) ignatu CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 Property Owner _ Parcel ID # Page of Bodng # ❑ Boring a . %Pit Ground surface elev. 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 a rti , 2 D F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a Boring # ❑ Boring ❑ Pit Ground surface elev. ff. Depth to limiting factor in. 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 = BOD, > 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. saD-8330 (c.6100) Property Owner Parcel ID # Page of Boring # E] Boring `..,Pit Ground surface elev. 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 a''`' 2 f0 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 a Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil lication 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 i it ~I ' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD, < 30 nxA and TSS < 30 mg/L i 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 (8.6100) Soil Test Plot Plan Project Name JustinJohnson ShauJBi Address 1187 McCutcheon Road Hudson Wi 54016 CST #226900 Lot 2 Subdivision Date 6/18/12 SE 1/4 S W 1/4S 24 T 29 N/R19 W Township Hudson F-I Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1" pipe System Elevation 100.0/98.5 *HRpSame as Benchmark Badlands Road Scale is 1" = 40' unless otherwise 105' 103' noted B-2101 15% Sloe 0' 373' Property Line B-3 401' Property Line 30' B.M.* 30'B-1 5' 100' 30 IF, 150' i I Pro 4 Bedroom House 645' Property Line • ,IUi~sacurrnsu. "y Rc3tstarof Osid~ ;y tt StCokC0.,Va 439211 CERTIFIED SURVEY MAR Located in part of the SE1 /4 of the SW 1/4 of Section 24, TZ9N, It 19W , Town of Hudson, St. Croix County, W3aconsin. r Surveyed for: Nell. Xuemmele Rt. 1. Badlands Road Hudson, W1. sOAL8 IN rrar 1••¢GO' N1/4 Corner Section 24 :00 o soo i TZ9N,R19W Lot I contains 122,$21 Sq. Irt.(Z.81 Ac.) ` 656 Including R -O-W . 108,900 Sq. Irt. (2.50 (i 3 •9s " AC.) Excluding R-Q.-W. [iARVEY Y "r om r ~urK'` ra61 %f `~pZ'~ HCtDSQtI A~at v J °t~ 'too. Wis 0 41 Ole + m i "/4 M of 1 l! m~ o+ z o AO 8 a~1 134 1! Bearings referenced .Ii Lot 2 to the eouth lino of v q~ the SW 1/4 of Section y~ 638,205 Sq. Ft. (15.11 Ac.) a 24, assumed. w Inciudit►g Right-of-way yI S89oJ61Z6"W. $ 645, 283 Sqq. Ft. (14.81 Ac,) f "I Excluding Right-of-way CIO o N I rz tu l U N69o16'an z Rot! PIP[ rouHn Na^os~10'~W BouTH W811 Or 72.54 1.26' of oRr 4`104. tHlc ovi l^ f SW Corner " 69,16 t3 tf 49.98 tron.7q S 1 /4 Corner Section 24 UNPLATTED LANDS Section 24 T29N, R 19W LEGEND Section Cornor Monument 1► 21, Iron Pipo Found APPRO"O • .111 Iron Pipe Found 0 1x2411 Round Iron Pipe weighing 1.68 lbs, /lin. ft. sat 3R 07 troo.rl) Proviously recorded information VOLU1113 7 PA09 1997 i I This instrument drafted by, 488-1444 i ST. CROIX COUNTy SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address IV Z al Property Address 41 (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number Oc~_p LEGAL DESCRIPTION Property Location , 1/a , %4 , Sec. T Z N ICIW, Town of Subdivision Lot # -Z~. Certified Survey Map # 9 , Volume , Page # Warranty Deed # Volume Page # Spec house yes no Lot lines identifjiabl ye 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. 1/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. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Num r of bedrooms SIGNATURE OF APPLICANT(S) 2- 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) 8 0 5 6 4 2 8 Tx :4042022 STATE BAR OF WISCONSIN FORM 1 - 2000 956056 Document Number WARRANTY DEED BETH PABST REGISTER OF DEEDS ST. CROIX CO. WI THIS DEED made between Nell L Ruemmele f/k/a Nell L. St. George, Grantor, and Justin Johnson and Jill Johnson, joint tenants 05/09/2012 1:16 PM Grantees. EXEMPT#: NA REC FEE: 30.00 TRANS FEE: 390.00 Grantor, for a valuable consideration, conveys to Grantees the following PAGES: 1 described real estate in St. Croix County, State of Wisconsin (the "Property"): Part of the Southeast Quarter of Southwesterly Quarter of Section 24, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin Described as Follows: Lot 2 of Certified Survey Map in Volume Recording Area 7 Records, page 1997.. Name and Return Address: Title One Premier Group File # 17970 Together with all appurtenant rights, title and interests. 020-1067-75-000 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements & Restrictions of Record. Dated this 4th day of May, 2012 * Nell L Ruemmele Fk/a Nell L. St. George * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST. CROIX COUNTY ) ss. authenticated this Personally came before me this 4th day of May, 2012 the ~••.•`•P~`l PA~FrP,s,,~~ above named Nell L Ruemmele f/k/a Nell L. St. George to me *-~s known t~ be the person(s) who executed the foregoing TITLE: MEMBER ST A#FE 8A F SIEONSf ! inst meuit and owe a the a e. (If not, _ authorized by § 70 IS. ale THIS INSTRU~s flRA Notary Publ , St a of Wisconsin R WIS My commisst it permanent. (If not, state expiration date: 10/27/2013 Michael H Forecki (Signatures may be authenticated or acknowledged. Both are not necessary.) 'Names of persons signing in any capacity must be typed or printed below their signature 1 of 1 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000