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HomeMy WebLinkAbout020-1044-80-075 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561020 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: Runk, David M. & Kristin Hudson, Town of 020-1044-80-075 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: Gm I 19.29.19.177H30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic l e I Benchmark , xQ U f u Dosing Ga Alt M Cc3.1 Bldg. Se er Holding St/Ht Inlet 7 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vggt to Air Int R AD Dt Inlet 71 Septic Dt Bottom /b 34, q5cl Al Dosing / Header/Man. ~f Jr Aeration Dist. Pipe 6.7 cf~'!y Holding Bot. System -7-3 C~ PUMP/SIPHON INFORMATION Final Grade 3,15 ~f7-$ Manufacturer Zd eQw r GPMand St Cover ~r Model Number ~6 / 47 / Z//Ft TDH Li~, 74, Friction Lost System Hea jA TDH i 5 V Forcemain 11-enctDj. gDia.2 Dist. to well SOIL ABSORPTIONS STEM BED/TRENCH Width Length/ No. Of Trenches PIT DIMENSIONS No. O its Inside Dia. Liquid Depth DIMENSIONS 7d r. `re SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION /1 CHAMBER OR T~N-i~~~-Ia+,1-d_ TyQN,J stem: , (f"0 1 `J/~F_ UNIT Cv~ +O '5 1 Model umber: DISTRIBUTION SYSTEM $7 *in A P, s'& LL cf % J Header/Manifol{! / Distribution x Hole Size x Hole Spacing Vet Air I ke Pipe(s) ~ \ ~ Length Dia_ Length Dia Spacing \ ✓ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded 1xx Mu hed Bed/Trench Center Bed/Trench Edges` Topsoil - Yes No Yes `J No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 879 Canterbury /9t. Hudson, WI 54016 (SW 1/4 NE 1/4 19 T29N R19W) NA Lot 3 Parcel No: 19.29.19.177H30 1.) Alt BM Description = / Cz L• J Q.uD w ~G rc ~J s 2.) Bldg sewer length = 3s - amount of cover = nn Plan revision Required? 501 Yes _j(No ~ / t Use other side for additional information. 6 ~ ~ SBD-6710 (R.3/97) Date Insepctor' natur Cert. No. ~ r\ rn s ~ V ' r O I \,i 1 l' ~r i rte.. ~ ~ ^^l5 ~ - Fk ~J 1 'I t ` FFF ~jj 5 1 f/ i C V' w vli y , (a i i fJ° 'Y 1 ~a UvJ- U (IN or, J~ ~ C commerce.wi.gov Safety and Buildings Division County a 201 W. Washington Ave., P.O. Box 7162 ~O 1 i sc o n s i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce C/ 2 (J Sanitary Permit Application State Transact ionNumber in accordance with s. Comm. 83.21 js. Adm. Code, submission of this form to the appr to ovemmental ' "i unit is required prior to obt ' i anitary permit. Note: Application forms for stag-own TS are Pr ct Ad ess (if different than mailing address) submitted to the Depa Comm rce. Personal information you provide may be u e , son G purposes in accordanc t e Priv , s. 15.04 1 m), Stats. I 1. Application Informatio I se P 'n I Information 2 buf Sfi Property Owner's Name J y Parcel # D 2 0 - l D qY 4U- 0? 5' Property Owner's Mailing y ss Property Location ( / l ) '"7 P ~.J T t I- C_ LL_ Govt. Lot l l 7 7~/ ~ 3~/ City, State Zip Code Phone Number WTI y, ~E /G, Section T a.G 9 N; R / ~(circlE on S114N L~~ I ( - ' 29 II. Type of Building (check all that apply) Lot # I or 2 Family Dwelling -Number of Bedrooms X Subdivision Name Block # 1~ ~4'1'►7 ~/fT~~ ❑ Public/Commercial - Describe Use ❑ City of State Owned -Describe Use CSM Number-FF 2021 ~j El Village of ❑ ' ] Yd i 2 D 517 1 ~ Town of J,tt~dS~ Y III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New 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 TS S s Com onent/Device: Check all that apply) Non-Pressurized In Groan Pressurized In-Ground ❑ t Grade ❑ Mound > 24 in. of suitabl s91 Moun < 4 in. le oil. Holding Tank ❑ Other Dispersal Component (explain) Prtreent Device ex ir► J V. Dispersal/Treatment Area Information: _ Design Flow (gpd) Design Soil Ap lication Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sf) stem Elevation I OW f-!S~ , GGS_I so Y4 In 1m VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ~j ti 2 New Tanks Existing Tanks °o 0~ `ak SZ~ ~j^I ~Qt~ P. U v) on w C7 a Septic or Holding Tank /O CO , e r e Dosing Chamber CrCD / ' ` ✓ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's S'gnature M PRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) 9 t CA Q l4 w c~ r c r~c-A S~ G VIII. oun /De artment Use. Only Approved ❑ Disapproved Permit Fee Date Issued uing Agent ign $ CID ❑ Owner Given Reason for Denial If 7S-, / ` , n, G lam` IX. Conditions of Approval/Reasons for Disapproval l/ k Si Z& o7A- SYSTEM OWNER; 3 sySy~ 1. Septic tank, effluent filter and ~rrotL cell must be serviced / maintained as per management plan provided by plumber. ~~u~" 4 oL~4 J 3D-0 '46 2. All setback requirements must be maintained - as per applicable C% Qr Ifh3W6jplans for the system and submit to the County only o per not less than 8 1/2 x 11 inches in size (G SBD-6398 (R. 02/09) Valid thru 02/11 page- PRIVATE SEWAGE SYSTEM INDEX AND TITLE SHEET PMerty thvner(s): r U eC cTn G Project Nam: V\ Pmjcct L4cation: CrIK14 e-- b cA r ki COL-'-,f Sind Afros Sw ~v E s 1`~ ~~g VZ (C( w Tv o~ ~uds~. _ ST-. ~~o~ x CUce~.'~v Coudy CeIIt~ents: Page 1: 1 rx e k t ~2 s~ ert Page I h w L c~S S Se c~ 2M Page 3: `=>e i c / l~w~yt O G ~i C< w► ~C~. Page 4: A -f m D( T liyt d n C e u. ~J~ /~~a v~ C c aX /"lay rya cxe vt^ e r F'~4~ Page 5: _ V W Y\ e C5 Page 7: C' be 1 a ~D r I Va L, IJ t csvA f~ 2-+pd Nam : ~a ~ ~ ~ Gr d ►t !Number: Date: A~ld~ress: ~ Sfi~ e ~ ~ Phone Number: ?4!5- ~ 7~- ~~C Jcn S V c. o ry ~ ~ N LA yr, Z G m o 7C7 r a p 1 0-1 4 ~ro ~ Cl~ O VJ r x A r 0 \ W p ~ ~ A 0 d. ~ 7 a 15\ G k 6 o tp ~C'c~ -V 9 Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer a Pump Manufacturer a Tank Model Number /CRS /60-0 L Pump Model Number 1 Total Tank Capacity G 6~ ~ ( Alarm Manufacturer 5 3 E h vw~ b a Max. Bury Depth S ` C vv 21- Alarm Model Number TG A k a (e r-t- SwitchType me-c-ha" .C,a~ Filter Manufacturer a 'r Total Dynamic Head (TDH) - Feet Filter Model Number Elevation Head /0 Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss a© GPM 1O.~ FtTDH Total Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof Junction Box Finished Grade . -0 . IF of T Vent ent Min. 12" Disconnect Ft With Vent Grade Means ith Vent Cap 31 Outlet nlet Inlet Baffle I Outlet Filter jacity + , A Switch Settings and Reserve V4" Tank Volume = 6...53, (0 GPI Wee Dimension Hole Inches Volume Gal. B (reserve) A o,,50 346 158 a (alarm) B 2Off Elevation C ,t < < Ft < > > dose C > ( ) 13N. C> < < < Bottom (dead) D ,5 j4/~, <y. D Elevation Total Ft > a > > > > > a , a , a , > . > > , > a > > > , > , , , > ><a~><>~>~>~a+a~a~a+s<a<a~>;>~>~>+a~>+>•y+y+y+>+>+y+,+,+y+y+,+y+y+,4,+y+,+y+,+y+,+y+,+,+y+,+y+y+y+y+,+,+,+y~,+y<,+~< GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling g .The force main is sleeved with 4" Sch. 40 PVC to bridge the tank i excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC. i 02105 LJ Page 3 of D~. y of WL TOTAL DYNAMIC HEAD/FLOW LL PUMP P FORMANCE CURVE PER MINUTE ---MODEL 151/152/153 EFFLUENT AND DEWATERING 14 45 153 MODEL 151 152 153 12 AU ! Fee, Meters Gal. Liters Gal. Liters Gal. Liters 5 1.5 50 189 69 261 77 291 10 152 ` 10 3.0 45 170 61 231 70 265 30- 15 4.6 38 144 53 201 61 231 o B 151 20 6.1 29 110 44 167 52 197 r 25 7.6 16 61 34 129 42 159 ° 6 20 30 9.1 - - 23 87 33 125 I 35 10.7 - - - - 22 85 15 40 4 12.2 - - - - 11 42 1D Shutoff Head: 30 T(9.1 M) "Aft 4 (11.6m) 44 ft. (13.4m) 0145MB 2 5 Model 151 Models 1521153 10 20 30 40 5D 60 70 80 90 100 GALLONS 67132 67132 LITERS 0 40 80 120 160 200 240 280 320 360 3716 4518 - 37/8 45B -j j FLOW PER MINUTE 01450BA 3718 3716 ® I 3718 i 3~/8 • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and j supplied with an alarm. j • Variable level control switches are available for controlling single phase systems. T I • Double piggyback variable level float switches are available j for variable level long and short cycle controls. I - • Sealed Qwik-Box available for outdoor installations. See ,111116 j j 12116 FM1420. Over 1 n 3007 007 (54'C) special quotation ti uon required. - _ i 415H6 5" SK2444 SK2064 151H521153 MODELS Control Selection Model Volts-Ph Mode Amps Simplex Duplex N151 115 1 _Non 6.0 1 2 or 3 BN151 115 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 2 or 3T BE151 230 1 Auto 3.2 Included 2 or 3 "Easy assembly" N152 115 1 Non 8.5 1 2or3 discharge pipe BN152 115 1 Auto 8.5 Included 2 or 3 (pump not not included.) E152 230 1' Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2 or 3 BE153 230 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level ° - float switch. Refer to FM0477. Reduces potential clogging by debns 2. See FM0712 for correct model of Electrical Alternator E-Pak Replaces rocks or bricks under the pump. Made of durable, noncorrosive ABS. 3. Variable level control switch 10-0743 used as a control activator, specify duplex Raises pump 2" off bottom of basin. (3) or (4) float system. Provides the ability to raise intake by adding sections of 1'h" A CAUTION or 2" PVC piping. Attaches securely to pump. Accommodates sump, dewatering and effluent applications. NOTE: Make sure float is free from obstruction. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 0 Copyright 2008 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity a ❑ NA Permit # Septic Tank Manufacturer (JJ ,'e s¢.., - ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer e ? ❑ NA Number of Bedrooms (100 d/bedroom) Effluent Filter Model 16F/p ❑ NA Number of Commercial Units 10- Pump Tank Capacity c!)--o al ❑ NA Estimated flow (average) Pump Tank Manufacturer ❑ NA gal/day Pump Manufacturer ❑ NA Design flow (DWF), estimated x 1.5 al/d. Pump Model ❑ NA Soil Application Rate , 7 gal/day Pretreatment Unit ❑ NA Influent/Effluent Quality (NA❑) Monthly Average ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) < 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODO 220 mg/L ❑ Disinfection ❑ Other: Total Suspended Solids (TSS) Manufacturer: Model: 150 m L S H Absorption Component Pretreated Effluent Quality f Monthly Average In-ground (gravity) El In-ground (pressurized) Biochemical Oxygen Dem d D5) < 30 mg/L ❑ At-grade ❑ Mound Total Suspended Solids (TSS) < 30 mg/L ❑ Drip-line ❑ Other: Fecal Coliform (geometric mean) 5JR-W 100m1 EX Dispersal Units -Manufacturer ~n~o (1 r Maximum Effluent Particle Size 1/8 in diameter ❑ Aggregate Cell(s) Model C~k; c k K L~ /3-0 le Calculations: Soil Dispersal (EISA) or DWF _ Application rate = Area Required _ (Aggregate Trench Width) Units or Total Length of Aggregate Trench(s) ~q - ~O = 33 DESIGN CRITERIA ❑ "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publication 9.6 (SSWMP Manual) ❑ "ICC Flowtech Mound Component Manual" Version 1.2 ❑ "EzFlow Mound Component Manual" Version 8/20/2007 ❑ SBD - 10854-P (R.1/12) "At-Grade Component Manual Using Pressure Distribution" Version 2.0 X SBD - 10705-P (N.01/01) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD - 10691-P (N.01/01) "Mound Component Manual" Version 2.0 ❑ SBD - 10657-P (R.6/99) "Drip-line Effluent Disposal Component Manual" ❑ SBD - 10706-P (N-01/01) "Pressure Distribution Component Manual" Version 2.0 ❑ Other - MAINTENANCE MONITORING SCHEDULE - MAINTENANCE AND MANAGEMENT Service Event Service Frequency Pump/inspect tank(s), inspect dispersal cell(s), clean filter At least once eve : ❑ 13 months 3 ears ❑ Other - Inspect um & um controls, alarm, pretreatment unit At least once eve : ❑ months 3 ears ❑ NA Flush and pressure test laterals At least once eve : ❑ months ❑ 3 ears ❑ NA START UP AND OPERATION: For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, Page _ of _ disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds one-third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Solids washed from the filter shall be retained in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1. day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. ABANDONMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. SPS 383.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping; all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN: If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area render it unusable. Replacement systems must comply with the rules in effect at the time of replacement. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name v h - /!-C- Name ✓ oA r ) 4, /~c l kc u.,,,r, h,, Phone 7 ,S. G ?d - ISD 6 6 Phone 7i5 6 72 - S~r-n (8 SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name Agency 5f, Crc); x 20 Phone Phone ! 06 '16 Page - of - i _ ~=Y:3 - ~.tm W° y ~ y 0 n n t ~X.i.' 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CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owne Buyer A V I Kgj .ST Mailing Address # 74 F C I C I e~ f pS6 f'J Property Adder i g 7 !g (shy ll ~T ~T (J f &l\ (Verification required from Planning & Z ning Department f r new construction.) City/State Parcel Identification Number 0 L 6 - f ®W 6- LEGAL DESCRIPTION A I Property Location ~'/a , ►v C'A , Sec. , T 2N RJ I W, Town of Subdivision Plat: ~ S f A _ , Lot # Certified Survey Map # Volume -20 , Page # - ,?11112-01 3 Warranty Deed # (before 2007)Volume , Page # Spec house ❑ yes o Lot lines identifiable es ❑ 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. m e bedrooms 3 2 11-5-1 SIGNATURE OF APPL (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. 09/07) 'R a Wsconsin of Commerce ~E~ UATION REPORT Page 1 of 3 Division of a uildirgs E( in accordance with Corn`"85, W Adm. Code COSY ST. CROIX Attach te site p not thaN@AP)1x t~ size. must iA, but t4: onto reference Qf), ion and Parcel 1. D. Q percent scope, scale nslons, harrow, and [location and distan to nearest road. P e alit T. ROI LINTY Reviewed Date Personal IMonttetiw you provide may I used ror secondary p ICE s. 15.04 (1) (m)). ~Z D 44, PropertyOwner Property Location SE t f F Tft ` .R ro 0 IJ El VIVIAN KAMARTH Govt. Lot SW 114 NE 1/4 S 9 T 29 N R -119 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSW Z ing) 5l / / 342 C.T.H. A 3 City State Tip Code Phase Number DCq Village own Nearest Road Hudson, WI 54016 ( 612) 203 - 8641 ..BN117a1 El New Construction useEl Residential / Number of bedrooms 4 Code derived design tow rate 60() GPD Replacement Public or commercial - Describe: Parent material outwash Flood Plain elevation if applicable ETA fL General Conventional In-ground trenches 0.7 loading rate and recommendations: / t 0 To hp designed by installer. ❑ Boring # • PBoring it Ground surface elev. 98.27 ft. Depth to Wrift factor 96 ® Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-4 7.5YR2.5/2 - is 2fsbk mvfr cb 3vf-co 0.7 1.6 2 4-11 7.5YR2.5/2 - Is Ifsbk mvfr cb 2vf-co 0.7 1.6 3 I 7.5YR3/3 - Is lmsbk ml cs 2vf-m 0.7 1.6 4 20-96 7.5YR4/6 - Is & gr Osg ml - lvf-m 0.7 1.6 2 Boring # El 100.17 98 F El Pit Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Stnxlure Consistence Boundary Roots GPDIfP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -002 1 0-4 7.5YR2.5/2 - Is 3fsbk mvfr cb 3vf-co 0.7 1.6 2 4-10 7.5YR2.5/2 - Is 2msbk ds ab 2vf-co 0.7 1.6 3 10-21 7.5YR3/3 - s Osg ml cs 2vf-co 0.7 1.6 4 21-98 7.5YR3/4 - s & gr Osg ml - lvf-m /110.7 1.6 (Few cobbles and stonm•) <~1 ' Effluent #1 = BOD > 30:< 220 rrgfL and TSS >30 < 150 mgfL ' Effluent 92 = BbD. < 30 mg& and TSS < 3o rnglL CST Name (Please Print) gnature CST Number Mary Jo Hollister j 224832 Address Date Evaluation Conducted Tetep vin Number W9875 690th Avenue, River Falls, WI 54022 10 - 27 - 05 (715) 426 - 1775 Owner Katnarth, Vivian (Lot 3) (Pending) Property Faucet ID # Page of 3 Boring 99 1-11, ❑ Bomv El - Ground surface elev. 99.67 ft. Depth to limiting factor in. S Application Rate Horizon Depth Dw Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. "Ef#t1 "Eff#2 1 O-3 7.5YR2.5/2 Is 3fsbk ds cb 3vf-co 0.7 1.6 2 3-10 7.5YR2.5/2 - is 2fsbk ds cs 2vf-co 0.7 1.6 3 10-22 7.SYR2.5/3 s Ogg Ml cg 2vf-co 0.7 116 4 22-34 7.5YR3/3 - s Osg ml cs lvf-m 0.7 1.6 5 34-99 7.5YR4/4 s Osg MI - Ivf-m 0.7 1.6 (Some g, ,,t 3 & 4 boundary; few cobbles) ❑ Borng # H Boring Pit Ground surface elev. ft. Depth to IkT ting factor in. Sod Application Rate Horizon Depth Dam Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. M ell Qu. Sz. Con. Color Gr. Sz Sh. '01101 "Eft#2 # Boring F-1 Ground elev. ft. Depth to Gnutg factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Cavistence Boundary Roots GPD/ft'- in. Munsell Qu. Sz. Con. Color Gr. Sz. Sh. "Eff#1 "Eff#2 ' Effluent #1 = BODS > 30 1220 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-8330Test (R.07100) _ MorpLm RAC R - ! ~48.~~' 1 o.\\\ 2 T j' SF 1q _ *T US 82021 D VOL 20 PAGE 5171 REGISTER Ojj. F DEEDS RECEIVED FOR'hECORD 03/08/2006 08:06AA CERTIFIED SURVEY MAP NO. CERTIFIED SURVEY MAP VOLUME 205177 'LZEF--15. 00 PAGE COPY FEE: BEING A PART OF THE SOUTHEAST 1/4 OF THE NORTHWEST 1/4, AND PART OF THE SOUTHWEST 1/4 OF THE NORTHEAST 1/4 OF SECTION 19, T29 N_, R.19 W., TOWN OF HUDSON. ST- CROIX COUNTY, WISCONSIN. car. PREPARED FOR. N-1/4 19-219 UM CAP MONUMENT NUM VIVIAN L. KAMRATH ALUMI 342 BAER DRIVE r------------`----------- HUDSON WISCONSIN 54016 LOT 2, VOL. 6 p.g45 Found 1" iron pipe-t, I i 1 OUTLOT 1 8 i 1 , 1 , VOL. _11P- ~_-_3164 ~ UNPLATTED LANDS S' 1 , Found 1- iron pipe ' Found 3/4- iron pipe ° Found 2" iron pipe S88'58'30"E 33' 467 Q7' ' f - - 196.36 , i LOT 2 i 1 ' 1 C -.43. 39 sq. ft./ 1.26 Ocres .''J - 74 sq. ft. net buildable ' I t"T STORM WATER 1 V / b .1 Mi MANAGEMENT AREAS p "Ji d LOT 3 FOR lOT 3 ONLY 1 -00 Q 49,102 sq. it. / 1.13 acres i OO J~ 49,10 sq. ft. net buildable m 1 N 1 STORM ATER L.8. 864,$ i MANAGE NT AREA 1'7 , FOR LOT ONLY 5 1 t 24- O ` 1 a 3 yA i 25' i i D --Sr7$'23 ~ w 1 ~ d N N 1 - i y11.75._..-.._.._..-i 1 ! ' W d ti v i 04 En s89 49'19'W r106.A6 G O iLOT 4 C5 r z°via 49.172` sq. 1.13''ocres i N tC ; Goroge t 43,944% s t. net Z1doble ' O i Db'e rem a r' 1. a~8 b 1 ' la 1 33 1 339) 10• ; LOT 1 ~ I ~ DN,o 22c ,$ti ' Sr 1 O~ ^N 1 f8.036 sq. ft./ O'ocre ©N 76.633. / ~b~ ♦1~`,I p'S~ g F 43565 sq ft, net b ble ' L. ....9...846. - n+ r n vP ~ Mho 7 N O ' 1 RECEIVED { N>g?zJ~6tp^` s 191?4'12'w 1 587'14'39"W AUG AVV 2 3 AfylC 1 33' 193.58'ily 1 1 ST. 1 1 i ~ LEGEND N W! ' RECORD Fs Government Corner (as noted) ; Found 1" iron pipe $ ° Set 3/4" x 24" rebar weighing , SCALE: 1' = 100'- 1.502 lbs./lineal ft. 1 Found iron monument (as noted) 0 - Building setback line as shown typical 19-29{19 100' 200' D Soil Borings COUNTY SURVEY NAIL This instrument was drafted by P.J.G. L-B.O.......... Lowest building opening ' Shaded areas are 20% slopes or greater. SHEET 1 of 3 ~r Vol 20 Pa e g 5171 I IIIIIIIIII III III 11 III 8 Tx341066179 1 973055 BETH PABST STATE BAR OF WISCONSIN FORM 7- 2000 REGISTER OF DEEDS ST. CROIX CO., WI Document Numbs TRUSTEE'S DEED 02/11/2013 11:33 AM Gerald A.Johnson and Linda D. Johnson, as Trustees of The Johnson EXEMPT#: NA Family Trust for a valuable consideration conveys without warranty REC FEE: 30.00 to David M. Runk and Kristin J. Runk, husband and wife as survivorship TRANS FEE: 201.00 manta pro rant -the following described real estate in St. Croix PAGES' 1 County, State of Wisconsin: Lot 3, of Certified Survey Map filed March 8, 2006, in Vol. 20 of C.S.M., pg. 5171, as Doc. No. 202A being a part of the SE i6 of the NW and pan of the SW `4 of the NE of Section 19, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin. Recording Area Name and Return Address: Land Title Inc., File No. 395623 2200 W. County Road C, Ste 2205 Roseville, MN 55113 020-1044-80-075 Parcel Identification Number (PIN) Dated this day of February, 2013. 'Gerald A. Johnson + Linda D. Johnson Trustee Trustee AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF FLORIDA ) COUNTY OF LAk ) ss. authenticated this Personally carne before me this 74J day of February, 2013 the above named Gerald A.Johnson and Linda D. Johnson to me known to be the person(s) who executed the foregoing instru nt and acknowled ed the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Slats.) t u.n THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Florida My commission is permanent. (If not, state expiration date: Larry S. Mountain, Attorney at Law (Signatures maybe authenticated or acknowledged. Both are not necessary.) JUSTINE Bl1NN8L 'Names orpersons signing in any capacity must be typed or printed below their signature i., •s MY COMMISSION # DD 972667 EYPIPES: July 1H 2014 ~y ` 8tunded TV ildaryPublic thdaaritets TRUSTEE'S OFED STATE BAR OF WISCONSIN FORM No. 7.2000 1 of 1