HomeMy WebLinkAbout020-1280-80-000
. Croix
Fr~partment o fCommerce PRIVATE SEWAGE SYSTEM county: St.
Division INSPECTION REPORT Sanitary Permit No:
556385 0
GENtr2AL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
2/
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
City Village
Permit Holder's Name: X Township Parcel Tax No:
OZO-1280-80-000
Blair, Gregory & Jennifer Semmler Hudson, Town of
CST BM Elev: Insp. BM Elev: BM Descript~ign: Section/Town/Range/Map No:
3 U -2,,' 34.29.19.1346
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Alt. BM
Dosing ~ D
Aeration - Bldg Sewe
Holding St/Ht Inlet 0 y!~ r)
St/Ht Outlet 7
TANK SETBACK INFORMATION 3
TANK TO P/LL WELL BLDG. Vent to Intake ROAD Dt Inlet _i
6~~~ kdjg4
i
Septic > h v Dt Bottom 5 n 7`c~ 6
y
Dosing v ! Head /Mangy 3 5 D ,gyp 6i bl / Z
Z 3 ` 1'J~2 "1
Aeration Dist. Pipe c1!/~, g
Holding Bot. System t/ D
Final Grade
PUMP/SIPHON INFORMATION /VAT tXJ14 -P ~ S J-- All
Manufacturer Tall- D nd St Cover 3 }'I 1( 2 ys .
Model Number 1~ 3 2 y 737 -Qho
TDH Li Friction Loss Syste H s T (2 hit /1 3 2- p~ .7~e
Forcemain ELern~cc.thDia Dist. to W ll 1 N 1/V 6'r C~ L r,f
SOIL ABSORPTION SYST M
BED/TRENCH Width Length No. Of Trenches PI7 DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS '7. '5 "1 100 /
SETBACK SYSTEM TO 1 P/L BLDG WELL LAKE/STREAM AC G Manufacturer:
INFORMATION CHA ER OR
Type,pf~ste ~ N Model Number:
1111-\\11 y !
DISTRI ON SYSTEM
Heade anifol t C Distribution x Hole Size Hole S cing Ven it Intake
/x A
Length Dia , Length is I' Spacing -4 `
SOIL COVER x Pressure Systems Only xx Mound O t-Grade ys s Only
Depth Over Depth Over xx Depth of Seede _ oodd/yed ulched
Bedrrrench Center Bed/Trench Edges Topsoil j~ C~„r/v~~- Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection ~/itInspection #2:2-
Location: Parcel No: 34.29.19.1346
Location: 653 Cherrywootod Lane Hudson, WI 54016 (SW 1/4 SW 1n Fill Atid/ . 34 T29N R19W) Cherry /q
1.) Alt BM Description
2.) Bldg sewer length
- amount of cover
I I I ?j ~s
Plan revision Required? ❑ Yes W/No
her side for additional information.
Use of - _t
Date Insepctor's Sig ature Ce t. No.
SBD-6710 (R.3/97)
A.1
nre,
~OaNA-,
27!
R Y
9
IA- Cf
66.0 N
7`
p r
3yg~ S
j~ 0
f
1
~3~ 9r,S 3v~
a h z
L C0 ~ y
q O
W N y A
' 3 y p p p p
_ F w a 0 " a =on `
~ y . A
co
OU m a a w a ~ d d~~ •E ~
r3 i y rR p C aLi L .p C .a d p
N y 9 .C CQ A~. G. r V t V
4 _ V
M y~ V y ec O L •T r V V rT O
Vl
V
H O d0 d d ~ y V O CL ~p y V
WW O y O w 'p L p w V y y
O ~ O ~ G eC y d bV0 ~ 3 y~ y C
a A ~ ~
dF_F ~U ~fS~ ,
k- w w
6. u
~ ~ w Q
0 O ~ ~ o
~ too
F--~
p.~ N A z z H
=now~ w o
~ ~ o N
o x ~Q
A H
ENO w a
w w
I- ~ w o
CD
0
O a w h
~n
3~exnxTO County
f° 1 Safety and Buildings Division '1 40
s7 - ck
201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.
t 0 H RECEIVEI`
ti p S Madison, WI 53707-7162
a~ NOV 0 201i State Transaction Number
► l ryikermit Application 21(e5,7909
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmen it
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailin address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary L, d /
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. / /v 7 s~
1. Application Information - Please Print All Information f~ S
Property Owner's Name Parcel #
GGl-e ~ld,;~ ~`Tsr~/~t F(s7L ~ul~I/ZtL~ ~c_o )LSD a
Property Owner's Mailing Address Property Location
6 (o ~ I'l "tl / % l C Govt. Lot J
City, tate Zip Code Phone Number Sw y4 360 +14, Section 2 V
Oil 4 Q (circle one)
[ZT T Z/ N; R/ E or W
I11.. Type of Building (check all that apply) Lot #
)TI or 2 Family Dwelling - Number of Bedrooms Subdivision Name
Block # "'E't
❑ Public/Commercial - Describe Use ❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of )-4
9 Town of 14 4c76 A-.)
III. T pe it: (Check only one box on line A. Complete line B if applicable)
A. New System ❑ Replacement S System El y Treatment/Holding Tank Replacement Only El 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. T e of POWTS S stem/Com onent/Device: C at a 1 d
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground Q"At-Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) resign Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed (sf) Syste El[e~vation '
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o
New Tanks Existing Tanks o y a
e t or Holding Tank j~ d A ~o
v" Q w
osing Cber ~C
4106
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
P ber's Name (Prin Plumber's Signature M /M RS Number Business Phone Number
a k L 2 L873`- X71. - Z 2
Plu ber's Address (Street, City, State, Zip Code)
0 IV
r• l Sd ~uc, : vC Y
VIIl. ount /De artment Use Only
Approved ❑ Disapproved Permit Fee U0 Date Issued suing Agent Si nat e
❑ Owner Given Reason for Denial l(/ t t Z~~ G/~- 4
(/h
IX. C~t"pffoval/Reasons for Disapproval C5)
-VL
1. Septlc tank, effluent filter and ,t -Jh~4
dispersal cell must be-Nryiced / maintained
as per management plan provide by plum er.
2. All s = il1laa
as to comp et 'plans for the s Vern and submit to the County only on paper not less than 8 1/2 x 11 inches in size
Attac
SBD-6398 (R. 11/11)
RESIDENTIAL AT-GRADE DESIGN
Pressurized - Sloping Site
INDEX AND TITLE SHEET
Project Greg Blair At-Grade
Owner Greg Blair
Address 669 Red Maple Lane
Hudson WI 54016
Legal Description SW1/4-SW1/4 Sec. 34 T29N-R19W
Township Hudson County St. Croix
Subdivision Name Cherry Hill Add. Lot No. 11
Parcel ID Number 020-1280-80-000 T.S.
/a:
Plan Transaction Number ,
K
Index sheet Page 1
~i4u~iVG~
Calculations Page 2 AN
At-grade drawings Page 3
Laterals and dose tank Page 4 pONDE CE
Specifications Page 5
Management & contingency plan Page 6
ki.
Pump curve & specifications Page 7
--7'V
Sanitary Site Plan Page 8 Designer Jacque Hawkins n License Number MPRS# 222872
Signature ~ Phone Number 715-472-2421
Date Q0/22/12
Designed pursuant to:
At-grade Component Manual Ver. 2.0 for POWTS SBD-10854-P (N. 03/07), and both
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) and
Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)
Version 7.0 (03/12) Page 1 of 8
PRESSURIZED AT-GRADE DESIGN
At-grade Design Worksheet - Sloping Site
Flows and Site Data Entry.
(r or c) r Residential or commercial?
300.0 Estimated wastewater flow (gpd)
450.0 Design wastewater flow (gpd)
5.00 % Site slope
94.30 Contour elev. below lateral (ft)
41.00 Depth to limiting factor (in)
0.60 In-situ soil application rate (gpd/f A2)
Distribution Cell Information
(1 or 2) 1 Influent wastewater quality
7.50 Linear loading rate gpd/ft
7.50 Effective absorption width (ft)
10.00 Max. effective width permitted (ft)
100.00 Aggregate length (ft)
Pressure Distribution Data Entry
(c or e) c Center or end lateral connection
2 Number of laterals
0.188 Orifice diameter (in) e.g. 0.25
Not a final
calculation 2.00 Estimated orifice spacing (ft)
2.00 Forcemain diameter (in)
3.37 Forcemain flow velocity (ft/sec)
60.00 Forcemain length (ft) y or n Does forcemain drain back?
90.00 Pump tank elevation (ft) y or n Are laterals at highest point?
3.25 System head (ft) x 1.3 NA
3.80 Vertical lift (ft) 9.8 Forcemain drainback (gal)
1.39 Friction loss (ft) 45.0 5x Lateral void volume (gal)
0.00 In-line Filter Loss (ft) 54.8 Minimum dose volume (gal)
8.44 Total dynamic head (ft) 33.0 System demand (gpm)
Lateral Diameter Selection Gallons/Inch Calculator (optional)
Pipe diameter Design options Design chore Total Tank Capacity (gal)
Designer 1 in Total Working Liquid Depth (in)
must select 1.25 in Gal/in (enter result in cell G46)
one lateral 1.5 in x x
diameter 2 in x Treatment Tank Information
3 in x 1000-Septic tank capacity (gal)
Skaw Precast Co. Manufacturer
Effluent Filter Information Dose Tank Information
Best Filter manufacturer 642.3 Dose tank capacity (gal)
GF-10 Filter model number 16.5 Dose tank volume (gaVin)
Skaw Precast Co. Manufacturer
Project: Greg Blair At-Grade
Transaction Number: Page 2 of 8
AT-GRADE PLAN VIEW
D _t
1/6 B Observation pipes (2 typical) A 7.50 ft
D 1 B 100.00 ft
1/6B 16.67 ft
C 9.50 ft
W D 5.00 ft
E 2.00 ft
L 110.00 ft
D B W 19.50 ft
A x B 750.00 ft"2
L T
Cap
= Total aggregate cell A x B slotted nh e I wer 6", and
= Plowed area L x W anchored securely.
-1
6"
AT-GRADE CROSS SECTION
Svnthetic fabric cover 96 09 ft Finished grade
elevation
Lateral '
invert elev. 94.80 ft . -
Observation pipe
at aggregate toe
E 5 % Slope
Surface contour 94.30 ft C A
and system D
elevation
® = 12 in. topsoil and subsoil Plowed layer
over aggregate and tapered to toes. below L x W
= 6 in. aggregate below
pipe(s), and 2 in. above pipe.
Project: Greg Blair At-Grade
Transaction Number: Page 3 of 8
PRESSURE DISTRIBUTION AND DOSE TANK
Lateral Diagram - Center Connection
P
x xn2 Laterals & for*e main C4 PVC Soh 40
Last hole drilled neat to end cap per SPS TWe 384.30.6
Holes drilled on the bottom of the lateral,
equally spaced • =Turn-upWballvatwordoanoutplug
Lateral Specifications
0.188 Orifice diameter (in) Center Lateral connection point
x 2.00 Orifice spacing (ft) 2 Number laterals
25 Orifices/lateral P 49.00 Lateral length (ft)
16.5 Lat. discharge rate (gpm) 1.50 Lateral diameter (in)
2.00 Forcemain diameter (in)
33.0 Sys. discharge rate (gpm) 60.00 Forcemain Length (ft)
8.44 TDH (ft)
Typical Pump Chamber Layout
Approved manhole cover with
Weather-proof warning label and locking device
junction box
Final grade 4"
disconnect
Tank component is Alternate
properly vented outlet
location 18" min.
Electrical as per NEC 300 and X' Appro
ved
SPS 316.300 WAC outlet
Tank full joint
Inches Gallons A Provide 114" hole
40 A B 22.6 333.0 Alarm on B asiphon or
=
m
E C 3.3 54.8 Pump on device.
C
o D 12.0 198.0 91.00 /.l off- ~Q rru ~yo a~ Sint J
Totals 38.9 642.3 pump off
D
3" Bedding under tank 90.00 ft
Goulds Pump manufacturer SJE. Rhombus Alarm manufacturer
EP04 I Pump model number Tank Alert 1 Alarm model number
Project: Greg Blair At-Grade
Transaction Number: Page 4 of 8
At-g-rade System Maintenance and Operation Specifications
Service Provider's Name Powers Sanitation Phone F71 5-246-5738
POWTS Regulator's Name ISt. Croix County Zoning Phone 5-386-4680
System Flow and Load Parameters
Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L
Soil Absorption Component Size 750.0 ftz Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service Frequency
Septic and Pump Tank Inspect and/or service once eve 3 ears
Effluent Filter Inspect and clean at least once eve 3 ears
Pump and Controls Test once eve 3 ears
Alarm Should test month)
Pressure System Laterals should be flushed and pressure tested eve 1.5 ears
Mound Ins t for ondin and see page once eve 3 ears
Other
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap,
and are secured in as shown in the at-grade component manual.
2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
6. Areas within 15 feet of the downslope toe will be protected from compaction.
7. All other construction details are as per the at-grade component manual SBD-10854-P (N. 03/07).
Lateral Turn-up Detail
Finished
Grade
6-8" Diameter Lawn Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Distribution
Long Sweep 90 or Two
94.80 ft 45 Degree Bends Same
Diameter as Lateral
Project: Greg Blair At-Grade
Transaction Number. Page 5 of 8
At-grade System Management Plan
Pursuant to SPS 383.54, Wis. Adm. Code
General
This system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall maintained in accordance with its' component
manuals [SBD-10854-P (N. 03/07), SSWMP Pub. 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706 (N. 01/01)]
and local or state rules pertaining to system maintenance and maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings
used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or
subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking
device to prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic
tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be
assessed at least once every 3 years by inspection.
The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions
are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the
filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous
alarm.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the
tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of
when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products
are used they shall be approved for septic tank use by the Department of Commerce.
Puma Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper
operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
At-arade and Pressure Distribution System
No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade shall be
seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for
vegetative maintenance) on the at-grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the
mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the at-
grade be heavily mulched as protection from freezing.
Influent quality into the at-grade system may not exceed 220 mg/L BOD5 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30
mg/L BOD5 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow
specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be
flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test
when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution
within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any
levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the at-grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or
replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and
dispersal media, installing new piping, and replacing other components as deemed necessary to bring
the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: Greg Blair At-Grade Transaction Number: Page 6 of 8
Page 7 of
ITT GOULDS PUMPS
Wastewater
PERFORMANCE RATINGS COMPONENTS
Total Head Gallons Per Item Description
(ft. of water) Minute No.
EP04 EP05 1 Impeller
5 53 - 2 Base 10 6
10 46 62 3 Pump Casing 8
15 36 55 4 Mechanical Seal
20 21 46 5 Ball Bearings
25 0 33 6
6 0-Rings y
30 - 11 7 Power Cord 5
8 Oil Filled Motor 4
Motor Housing/
g I
Stator Assembly
10 Motor Cover
METERS FEET
10
9 30 5 GPM
8 u~2.5 Fr
25
0 7
= 6 20
_V
Q 5
Z
0 15
a 4 EP05
0
3 10
EP04
2
5
1
0 00 10 20 30 40 50 GPM
0 2 4 6 8 10 12 m3/h
CAPACITY
3
. ~ ~'fjta.R-7 w~dd
Pal
e, 6f
~JC~lr "Y =Z0'
f /t v , /Q 0 , 4 ~r ,
30
W
p~~oJ PraP~zd
wE!/ $ch.~o gldl S/w/s,0 E
iod/4vo gar/ Prop~s~d ~•s~lOdJ/~
3~ff k w fjo 7~ H .ti., ° e tT f' ~e /n 4l mot(
ul a s.. of 9y,30
T7+ 1.4 y','
®
ror
~a ~m j y
sue. j ~7• ~r~ ~3 s
I y3 ~ 9i..f 3o d
P.~ f
4
V 611
Wisconsin Department o1 Commerce SOIL EVALUATION RE4 '01 Page of 3
Division of Safety and -
PBuildinggss 1ANkiNG & ZONING 9 eordance with Comm 85, Wis. Adm. Code • 1 "
County `f C'.~-or'k
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. OZ0 2,6,0 r j-d , U a
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information, ewe Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner J Property Location
E" O/ el i le Govt. Lot Sw 1/4 $w1/4 S 3 V T 7 9 N R 9 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
4 cr K,-d ~u j~ eh r,« W// a,1.1-
city State Zip C e Phone Number ❑ City ❑ Village Ej Town Nearest Road
New Construction Use: ❑ Residential / Number of bedrooms %3 Code derived design flow rate Y. F0 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if applicable / /f n•
General comments GEC "W " S(f'CXQQ
and recommendations:
Z-006-- '200 -7 44-6
Boring
❑
l Boring #
® Pit Ground surface elev. ft. Depth to limiting factor ~ s 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. * ff#1 *Eff#2
as 4,) -Y
C SQ a7 A y,£ q/
/V le
Y4 X
Boring # l Boring G~
[a pit Ground surface elev. /3• -7 ft. Depth to limiting factor Y3 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
/ ° l U y,c 3<~ s / 2,",S k .y„ A- a s - G - f
8 o;, je 0 ye_ "IV 2"",54K r-.. A- Q S' /
T 4< 7C
A Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Na Please Print) f Signature CST Number
a P k£ 6cwC1 i ,A.5 Z 22877
Address I 1 0. IV Date Evaluation Conducted Telephone Number
2,651 115`0 may, K-L,4e/c- 1A,1
t
Property Owner Parcel ID # Page of .3
ff[ Boring
a Boring # ❑
Pit Ground surface elev. 7 ft. Depth to limiting factor 4/1 in.
Soil A 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
j tv 3/1- S'.' / Z"'5;~K Cis , • L
a 8 aS layrc-Yip' ~ S':'C ~Z ~bK S ~ ~ 7~ • ~
Zf e(21A vii SC 1 Z~ c - 012- Vf"
y~"s9 -7-J'IZ- d ?.sy.~SiU
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil -Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
F-1 ❑ Pit
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
* 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 (R.07/00)
3q T~~ ~'jc r5~ Qw
AJI f S A4
l
'IA- 4 J
3yg~
Pet/
3 a AK N.-1,5o f
ITT ~Y.f -111
30, Z ft ~
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
r'
Owner/Buyer :?.CF" /a, A_
Mailing Address L yc14
Property Address OJann"A.,QddA, RLM-p- P,/,D
(Verification required from Plod ing & Zoning Department for new construction.) %J -I
City/State 1Jf Parcel Identification Number o Z o z8o ,;--9-o oo
LEGAL DESCRIPTION , l
Property Location-51i^_J '/4 zryy . '/4 , Sec. 3 , T Zq N R 9 W, Town of r~JON
Subdivision Plat: tc.c,, ,V,`// rtd~• , Lot # Certified Survey Map # , Volume , Page #
Warranty Deed # ('201 1) (before 2007)Volume , Page #
Spec house f-1 yesKno Lot lines identifiable Dyes ii 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 I/3 full of sludge.
[/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 bedrooms 3
t
11
Z'111~
IGNATURE 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)
Parcel 020-1280-80-000 PAGE 1 10/15/2012 E 1 OF A 1
1
Alt. Parcel M 34.29.19.1346 020 - TOWN OF HUDSON
ST. CROIX COUNTY, WISCONSIN
Current ~X
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - BLAIR, GREGORY J
GREGORY J BLAIR C - SEMMLER, JENNIFER E
JENNIFER E SEMMLER
669 RED MAPLE LN
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 653 CHERRYWOOD LN
SC 2611 SCH DIST OF HUDSON
SP 1700 WITC
Legal Description: Acres: 7.184 Plat: 05-073-CHERRY HILL ADDN 020-89
SEC 34 T29N R1 9W PT SW NW LOT 11 CHERRY Block/Condo Bldg: LOT 11
HILL ADDITION
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
34-29N-19W SW NW
Notes: Parcel History:
Date Doc # Vol/Page Type
12/13/2011 947168 WD
09/17/2009 903843 QC
12/07/2007 865275 WD
03/01/2002 672388 1845/484 WD
more...
2012 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/18/2012
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 7.184 98,900 0 98,900 NO 10
Totals for 2012:
General Property 7.184 98,900 0 98,900
Woodland 0.000 0 0
Totals for 2011:
General Property 7.184 115,400 0 115,400
Woodland 0.000 0 0
i~
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
State Bar of Wisconsin Form 1-2003 8 0 4 4 3 6 1
WARRANTY DEED Tx:4032425
947168
Document Number Document Name 'BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
THIS DEED, made between Elizabeth A. Bruch and Daniel C. Bruch, wife and 12/13/201110:39 AM
husband, EXEMPT#: NA
REC FEE: 30.00
("Grantor," whether one or more), and Gregory J. Blair and Jennifer E. Semmler, TRANS FEE: 303.00
husband and wife, as survivorsbip marital property, PAGES: 1
("Grantee," whether one or more).
Grantor for a valuable consideration, conveys to Grantee the following described real Recording Area
estate, together with the rents, profits, fixtures and other appurtenant interests, in Name and Return Address
St. Croix County, State of Wisconsin ("Property") (if more space is T. M. Title Services, Inc.
needed, please attach addendum): 315 E. LaSalle Avenue
Parcel l: Barron, WI 54812
Lot 11, Plat of Cherry Hill (in the Town of Hudson), St Croix County, Wisconsin.
Parcel II:
Together with an easement for ingress and egress over the private road described 020-1280-80-000
as Outlot 2 as shown on said plat. Parcel Identification Number (PIN)
This is not homestead property.
O~ (is not)
Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances except:
Highways, easements, restrictions of record, and any acts and/or omissions committed by grantee.
Dated 1 1~ Vet.,," c
\ a-~ xL;1J (SEAL) 0i \ ` • (SEAL)
* Eliza eth A. Bruch * aniel C. Bruch
(SEAL) (SEAL)
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
authenticated on BARRON
f^I
g 0 i~
Personally came before me on
* the above-named Elizabeth A~rucl nd Aanrel E.. ich
TITLE: MEMBER STATE BAR OF WISCONSIN husband and wife, = "}C
(If not, t me to p i ~t `foregoing
authorized by Wis. Stat. § 706.06) i stru t d ed th
THIS INSTRUMENT DRAFTED BY:
Gerald L. Liden, WSB#01007701 Notary Public, State of Wisconsin
425 E. LaSalle Avenue, PO Box 137, Barron, WI 54812 My commission (is permanent) (expires: a )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED 02003 STATE BAR OF WISCONSIN FORM NO. 1-2003
*Type name below signatures. INFO•PRO'm Legal Forms - (800)655-2021- inioproforms.com
1 of 1
1 p 3„01' 99.68N '
3
w m .90'V929
0 cc
~ in tv m N LL7 O } Z
l0 Oto mO U:)
40
!n to CD CD C;
N 2 to U 1L 3: CL z
E Q N F
FwM 3
I I < cn o IL
to 'D E
rnrn N U
I O C Y) Q O m (n
O N to f
.99 / N (r) o rl N v m W t
d O Z O
I / N rn
60.6tiE 3 „00,95 68 N
022'£9- ~L9.55Z
Q / ° o~ . 2g •268 3
3 • tz, e'o s~ s
w ,6L-992
3 .OV,95,69 N
° co
`SF e` O
/
CU
N (O C - •9O ~'j .
to bsS
I, , o o N
a tD
o cu
O I~ N
/ I I LO
r(D
/ I 00
9 3
cu N
I I m
`+ti • 99 / tp to
O N et
O
w cOn
_
h~ NO tn°
t0 ~m Om ti0
70 .O M
Pti
D a m rn m
Q
g Qw N a) a t`
cr)
IL mZ (O~ m I tr) a) m
O If) / Z~ 3 I
r¢i rn y2 ~,ti o►1J~-- o
a / M N~ i( O
J ,ZOO o oY~
LL 1
o uj( ~A9 J O ~l L H O I
W 3 cu n~ z w
.r
p O US I--• 3 i~
^ 1 U in
O
tn F- 0 IL N=F NI N V' Q ~
m CY)
x 7-
I n U)zEncr J A0tiA0h m
f o << w
io w cn cn cn
I Z oo ssti M. ov .d 9S O
. 00.99ti
00 • 9b t
0-0 9 S
0
c
s
U
c
° to
u
N F-
Lf) cN
e
m 9
►DO' O
a ss s~
N • ~N
.E5'9Ei Lh•EBS .00'082
02,02,98 N LP'E91, M •5E.2£,69 N
3E.9S,BBN)