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HomeMy WebLinkAbout020-1053-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563830 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: Miller, Scott & Kristin Hudson, Town of 020-1053-20-000 CST BM El v: Insp. BM Elev: BM Descr Section/Town/Range/Map No: C W=: Af, 01, 9 - CLw. 20.29.19.197F TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark n Dosing J r 2 7 Alt. BM •.C Aeration a Bldg. Sewer (e% ' , ► / v p Holding St/Ht Inlet -Z)-7, L L' sc ► j 0.1 26 - utlet TANK SETBACK INFORMATION St/Ht j j""? 0' /3, TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ti > 1 V Dt Bottom Dosing H er/Man. , Si7i Aeration Dist. Pipe C' trrr~ 4rz y" Holding Bot. ystem 1 PUMP/SIPHON INFORMATION, Finde 2 7 , Manufacturer emand St Cov GPM Q 3,3 Model Number TDH Lift Friction L System Head TDH Ft Forcemain Lengt Dia. ist. to Well SOIL ABSORPTION SYSTEM ~o 1to ero O Qom, BED/TRENCH Widths Length No. Of Trenches PIT IMENS S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~3 -7 a SETBACK SYSTEM TO P/ BL WE LAK "SAM CHAMBER HING maw4ferctu OR ~ 14-m li. Y- i 4 INFORMATION Typ?Qf System: r ~7e r ~I Model Number: ~ 1. QJS:~R.IBUTION SYSTEM er/Manifold Distribution P t Ix Hole Size Ix Hole Spacing Vent t it Intak@ ? 1 1, Pipe(s) -j r S 'f/'aL Length ( Dia Length /ol Dia Spacing t7-K 11 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only i' t Depth Over I 1, Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center- f Bed/Trench Edges Topsoil ~ 0 2 Yes 0 No R Yes f No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / r 7 Inspection #2: / / Location: 454 Jacobs Lane Hudson, WI 54016 (SW 1/4 SE 1/4 20 T29N R1 9W) NA Lot 3r Parcel No: 20.29.19.197F 1.) Alt BM Description = l 1 tG✓ ~M ~ 17 te GC Y ~r 2.) Bldg sewer length = rV _ - amount of cover = / f N Plan revision Required? ❑ Yes 51/No I ~1 Use other side for additional information. (per J SBD-6710 (R.3197) Date Insepctor's Sign ure Cert. No. o map 00, OOOP A4me, CA+ ~A- vNe k, t3 9~, kkp"v- volm OBattmeesiar. 1~1154 JV-J~s 04ugov F , i 0 ~ II j 11 t~`o~tsp! }r S-C Pit'. li- rvvu)) N J t f i 0 f 1 , i 3 ~k f• E i 1+ V M1 ,yy~nn~,r County Safety and Buildings Division f r 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) y p Madison, WI 53707-7162 Permit Application State Transaction Number In accordance witjobt 3. is. 'An Code, submission of this form to the appropriate governmental unit is required prior tsanit' pe rmit. Note: Application forms for state-owned POWTS are submitted to ojectAddress (if different than mailing address) the Department ond P essional Servies. Personal information you provide may be used for secondary Tj~ ~ S ~~.~e u oses in accor e Privacy Law, s. 15.04(l)(m), Slats. T V vuVo 1. Application Information - Please Print All Infor a 'on 0 W 7v Property Owner's Name ¢ Parcel # Kr- 4. e.r QZD-103• Za-aa~ Property Owner's Mailing Address roperty Location / 9 u 3r 1 0 Govt. Lot / " 7 r,~' City, State Zip Code Phone Number OBI u'- Section 10 i , 1 y ,<-LLD (circle one II. T pe of Building (check all that apply) J 'T / t! Lot # r cA 9 N, lZ or W t Subdivision Name 1 or 2 Family Dwelling - Number of Bedrooms C y O r 11 Public/Commercial -Describe Use A5 Block . rA 1l1 ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of 77 3 - / 21rown of _141L .0 3 ► z z9 III. Type of Permit: (Check only o fie box on line A. Complete line B if applicable A. ❑ New System Replacement S System El Treatment/lIoldina Tank Replacement Only Other Modification to Existing System (exPlain Y p ) List Previous Permit Number and Date Issued B. ❑ Permit Renewal A Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner ,/ff +n„`_ IV. Type of POWTS System/Component/Device: Check all that a l Non-Pressurized In-Ground 11 Pressurized In-Ground 11 At-Grade El Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soiY~- "1 ❑ Holding Tank ❑ Other Dispersal Component (explain) - ❑ Pretreatment Device (explain)_. V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate( st) Dispersal Area Required (si) Dispersal Area Proposed (s System Elevation 00 Q_%-.60 ft l-106 L U00 rr] 0 a ` I 0 VI. Tank Into Capacity in Total # of Manufacturer Gallons Gallons Units .o ' ~ New Tanks Existing Tanks y o Z ;j w ldik S wU v wt7 w Septic or Holding Tank z ` Dosing Chamber VII. Responsibility Statement- 1, the undersign umc respo ility for installation of the POWWTS shown on the attached plans. Plumber's Name (Print) P mber's 'gnatur MP/MPRS Number Business Phone Number ivy Plumber's Address (Street, City, State, Zip Code) /I II ~ D tAW k4aisoij ~A if .5yU ( VIII. oust /De artm t Use Only Approved Permit Fee Date Issued Issuing eni Signature x ab D / /J' on for Denial IX. CondtTJWf,Reasons for Disapproval_ 1.' `S°eptic tank, effluent filter and 5OJ dispersal cell must all be servk:es / maintained as per management plan provided by plumber. All tsetl ck requWements must be maintained n pff awcable code for*ar'tces Attach to complete plans for the system and submit to the County only on paper not less than 8 to x I I inches in size SBD-6398 (R. 1 VI 1) 0,00 Map wo~ k , A4me,-Cowov,bkio 9, i s r mi 0 4**ceA5C. *04Uqdf 83 I i ` E7 ~ 3 I ~N~~s 3 x e~ I ~ c,~~M~ahs ~a 15(P5 gA) S-~ P. co(~'I CuNtCLt~~ Wa1I AISGHQ/~ 1-P /6997 NC,1 rlbn,~ /gin 0 1 l 0 ~ Q~12et~c~Tl w~~l IV 100,E ft 4" Jci1r'.dUll? fib ~ •-__-'..--,„~,~._,...,,,,a.,,~.^,.-_..,_,,,,.~~ 'Final PVC Afem Pipe WiPi11 engt C. jp f`6 (alSambe 9 .60 I ~ ~ 3 a:, ~ i~ ~°~4"t S~~{~ ~ytr~n-1f;le~o►~ki~aM~ §_0 LIAbsoMtL 'MI 4" No. V ant Or bs ,tA&jfion Pipe i,01yr-,h l Header -__f . _I:.:- I ~R- 111_;;_.:; M, anUfackurerAnd Morlpt tis)t, ~ ~ l2 ~ V'Oamber SO. A pplir;afion Rate ~'9~r:1 @JF,igF~ Fica~nr ~fi Application Rate O7_~. ESA y Chambers Page of ~ R 2344 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations eW"A splan on pape r not less than 8% x 11 inches in size. Plan m County St. Croix to: vertical and horizontal reference part (BM), direction and or dimemsions, north arrow, and kx~ion and distance y east ~O Parc et I.D. 020-1053-20-000 Please print aU information. ~ evie B Date a6on you provide may be used for secondary purposes (Rivacy I.&, sC15.04 (1) ( )Drr3 Gw - I f7 `T I Pner P Location N Miller Govt. Lot ~1- SW 1/4 SE 19 S 20 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2316 Donegal Way 3 na CSM Vol. 12, Pg. 3292 City State Zip Code Phone Number j City J Village 16 Town Nearest Road Hudson WI 54016 Hudson 454 Jacobs Lane Id New Construction Use: 16 Residential / Number of bedrooms 5 Code derived design flow rate 750 GPD Replacement J Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for conv. dispersal cell at ading rate. Infiltrative surface elevations = 93.0'.94.0'& 95.0'. Repl, cell loading-ra - 0.5 gpd./sq. ft. C , c . awE- ,~v~~ ~@ 1 Boring # -I Boring i 10 Pit Ground Surface elev. 99.26 ft. Depth to limiting factor >1 n Soil Application Rate , Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDJ[F in. Munsd Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 -Eff#2 1 0-5 10yr3/3 none gr sl 2fgr dh Cs 2mf1c 0.6 1.0 2 5-12 1Oyr4/6 none $l 2msbk dh as 2fmic 0.6 0.8 3 12-16 1Oyr4/4 none gr Is Osg dl Cw 1vf,f 0.7 1.6 4 16-111 1Oyr4/6 none s Osg dl - - 0.7 1.6 9 r ( 1 l Boring # --j Boring 1 J A Pit Ground Surface elev. 93.47 ft. Depth to limiting factor >98 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texhxe Structure Consistence Boundary Roots G in. Munsell Qu. Sz. Cont. Coke Gr. Sz. Sh. -Eff#1 *E 1 0-12 1Oyr3/3 none sl 2fgr dh CIS 2mfc 0.6 1.0 2 12-28 1Oyr2J1 none sit 2msbk dsh gw 2frn1c 0.6 0.8 3 28-48 10yr4/4 none sil 2fsbk mfr cw 1vf,f 0.6 0.8 4 48-68 1Oyr4/6 none Ifs Osg dl 9w 1vf 0.5 1.0 5 68-98 1Oyr5/4 none s Osg dl - - 0.7 1.6 Effluent #1 = BODS> 30 < 220 mg/L a TSS >30 450 Mg A- ' Effluent #2 = BOD 5.30 mg/L and TSS S30 mg/L CST Name (Please Print) Signat CST Number James K. Thompson - _ _ 5.-- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola WI 54020 8/30/2013 715-248-7767 Property Owner Socott & Kristin Moller, _Parcel ID # _P20-1053-20-00t? Page .of,-3-- Boring Boring Pit Ground Surface elev.. 99.40.... ft. Depth to limiting factor >119" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ? ___.......__._Cf'R[f in. Munsell Qu. Sz. Cont. Color C Gr. Sz. Sh. ' *Eff#1 *Eff#2 1 O-12 1Oyr313 none sil 2fgr dh Cs 2mfc 0.6 0.8 r 2... 12-22 1 Oyr4/6 note sil j 2msbk dsh as 2fm1c 0.6 0.8 _ 3 22-27 7 5yr414 a none is 089 dl cw ( 2vf,f 0.7 i 1 6 4 27-42 1Oyr4/6 none s i Osg dl gw 1v# 0.7 1.6 5 142-119 10yr5f4 none s ( Osg dl 01 ? 1.6 , x Boring # Boring le Pit Ground Surface elev....... 9§•54.... Depth to limiting factor >115n in. Sob Application Rate Horizon ' Depth i Dominant Color Redox Description Texture Structure j Consistence Boundary Roots CzPI?lf . in. I Murlsetl Qu. Sz. Cont. Color Gr. Sz, Sh. i *Eff#1 *Eff#2 1 0-10 10yr3/3 r._. none - i sll 2fg r dh cs 2mfc j 0.6 0.8 2 10-23 I 1Oyr4/6 none sll 2msbk ? dsh as 1fine 0.6 0.8 _ 3 3 23-33: 7.5yrV4 none Is Osg dl cw 1 vf,f 0.7 { 1.6 4 33-60 1Oyr4/6 none s Osg dl 9w j 0 7 1 6 5 60-115 10yr514 none s E Osg dl j 0.7 1.6 , i F-I Boring # Boring 3 Pit Ground Surface elev. ft. 13epth Io limiting factor in. Sod Applicaton Rate Hoazon Depth Dornlnant Color Redox Description j Texture Structure Consistence Boundary Roots *Eff#1~ Eff#2 In, Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. , ......._._j . i _ ' i i * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = SODS <_30 mg/L and TSS -1_30 mg/L The Department of Commerce is an equal opportunity service provider and employer. Ifyou need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or'l`I'Y 608-264-8777. SBU-8330 (R.07AW)A.C.E. Soil & Site Evakedoas ~ r ' r I 83 i ~.Qea~cQl la tl,~ P ! P r r / r r r f rr rr ~ - ~ Scr«le. r' r r ~ l ~Pt• ~~.~f~y I r ~ e~c.obs ! t ~ { r ~ flu, Cvr ltcrc {t. ~tsor, w~ s/o/~ r , ou.n . t t f{ s s u .ne:d t da 'dn ~ G-!Srrt rf t C3. a ,faun . Cr ! D, GLYJ DO t' ' '019 r t f r 1 I f d 'n 1 ~ 47 .Q d t 0 t ~ ~ler1. F9. t t r t 8! r ~4 t qj ~ badr, ~ Rr'~(QQr}(,Z < .p pp * f i4OCJ~ s j~cvbs ,1~~e. _ ~.3afi3 commerce_wi.gov Safety and Quildings Division County 201 Washington Ave., P.O. Box 7162 ~ isLros~ adison, W1 537()7..7162 CRV Department of CammerCe Sanitary Permit Number (to he filled in by C.'o.) - 5 (a 3 ~s 3 b Sanitar r PPiication StateTra in accardartce with a Comte. 83 21 2 , C' R O Wis. film. Code, su te: A t» t of this ftxm to the appropriate gnvcntm~ unit i5 required prior fu obtaining a sanitary permit. None: Application forms for state-o, ned POWrs arc Il submitted to the Llepartment of Commerce. Personal inl4rmatiott you provide may (m used fib/. ondary ddres (if dil'1'erent thanmailingaddress) u ses in accord----- with tlfe Privacy Law, .5 f 51 04(I)(ntl Slats. I• E licalion information- Pl~ ease Prim All Infmmadon Property Owner's amc c T yl--' JaebbJ r~_ S~' ~ d" 1~n~S~-e rv 1 , t ^ I CROy,I, a /e1~N Property Owner's Mailing Addr v:0 - 1 O 3 r V U otterty Location /770=_ ('ity•sla - flout. Lot J t Zip Cade Phatte Number (circle one) ll. Type of Building (check all that apply) Lot T °S - N R 1 , F or W U I m' 2 family Dwelling Numberol'Scrlroomc 3 Subdivision Nan 6k ❑ Public/Commercial Describe Use p City of ❑ State O n¢ - Dcscriln Use L'SM Nunther -AL _ 5j 173 ❑ Vilhge of _ 00 ~j g t0 l /Z 3 Z9fivrvn o vi 6hl - III-Type, of Permit: (Check of one box on fine ZAArC'onlplete line B i usable) A. ~T NqJew System - O Replacement System ❑ "Treatment( olding Tank Replacement ! Y _ Ot c MoslrRcatian to Existing System(explain) ❑ Permit Renewal U Permit Revision Change of Plumb. fer to New _is( Previous Permit Number and Date Issued U het 'r`T" Before Expiration f ra Own -IV. le otPOWTS System/Component/Device• (Check all flint a1 Ply ~ti~t rev Ids Non-Pressm-i7ed In-Ground 11 I'm-sswized 1114O4ound ❑ At-Grade utt 24 in, ttfsuttablt: sod - ~Ma ❑ Mound < 24 in, ofsuitabie sail U Holding "tank U Other Dispersal Component (explain) ❑ Pretreatment Device (expdain)_ V. llispersa[/Tre_at tent Area Inforntatioa: - - ^ Design Flow (gpd) Design So+ikA~ icalion R te(gpds f)ispcta 1re• squired is [Jispetsal Yea P osed T) System Elevation ~5 ~ fyy~ r - i 5 0 3AU Vl. Tank W. Capacity in _ ' 0 Trial If of Manufacturer Gallons Gallons I.htits New Tanks o Existing Tanks, w o d U ~ yy _ Y `~J N C w O N 0 CcpriclinldiugTank in Y is.. t5 p„ JG Dosing Chamber (1l V11. Respolisihility S(atentCnt- I, the undersigned, assurne responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pt is S ature~ MPIMPRS Number Rusines Phone Number r B Plumber's Address Snset, City, State, Zip Code) Vill. rintwDenlrtin t Use 011 Y pprpyed isap Permit Fee Date L tied Issuing A ignature ven Reason cola! ~ 9 ~3 IX. Condi Tµ e1sons for Disapproval I' :SepW'tank, effluent filter and ` r e [J dispersal cell must all be serfili: I. (nt= rled INS per management plan provided by pgJmbbr. X)c l~ p~7 4. ✓etlr' 2• AN tllelacl(mqulremetit trwst, be Mak r '~-PK • c~ f ort nerir»s. ' a , _ 1 et , . Attach ht cmn A ~wrrh ptch• plans tw Uie s.•steur and sub.rdt to the Canutr nnlr nn paper not Ipss tParl R Ill(n~11 inches in size yA~ S1-3130398(11 - 0l/07) Valid thrtt 01/09 4 164d[ 0 ~~t'L d~ CJ r1e J AA- ' ~ 7" t ~r 4 ~1 1 70 1 f a~ tad ' ~ I S LS ~b~ 3 k'1 ~ ~ ( f ~ ! l l ' i i CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: S~` F~1Zr) l I V~~ i Owner's Name: Owner's Address: J, 0 LLb S D 36~J_ 1 SL ~a9 1` Legal Description: S (,J l I S '1 1 5 a o Township: l~ ~S 6 County: C Subdivision Name: Lot Number: Parcel ID Number: Page: 1 Index and title Page ? Plot Plan Page 3 System Sizing& Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank M'aintenanc'e Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: _J1n~8auMQ,,tt~License Number: 0~~0 9 b Date: 7 , Phone Number `71 _5 3t6'4d 0 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-1070,5-P (N.01/01). Page 1 I i A4me ~lclslt,~ M, l m Bow a 'sier Zomiion Jb(,61ru Lpt4~ ;e. e 4se 4*4u - K-Na ~1pW-) - I L2oN A f . G►.~v I vu ~ o 70 i 1 n/ C) ~Rf4 i SS ~a y T-it~r~ c~~ s (5LS gal 3k11a S,VV ~ W I y c1,p 6~ a ot k t r _ ~gc- 0bs LAm~ i Soil Absorption System Cross Section 9 4a oft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap Q 0 ft Leaching Chamber 3+ _ T~ u y ft - " System Elevation ' ft Soil Absorption System Plan View ft ft { Leaching Trench 1 Chambers lililllill 111111[liff=111 E: - 4" Trenc19 _ Header Vent or Observation Pipe JRr~~1, 3 Leaching Chamber Spectf°ications Manufacturer And Model _ ::]U1 X-O oVL >A) ~-1 USA mating sq ft per chamber Soil Application Rate . J` gpd/s ft S d gpd Design Flow-, i ° oil Application Rate EISA = XIC ambers Z rofrus of chambers each. I ro ~ d G ~ ~ ~ c5 Page _ of PL-S25 Effluert Filter-Effluent niters Polylok Inc, Page 1. of2 i Polylok inc. 3 Fairfield Blvd Waliin fo , g r , T 08492 Calf i'4f1 Free, W-765-9565 Email: potylok COtr1 ......:....:.:.w „,,....•,.n•.n,vari:"'. YOU are Here: Home Product Details r EFFLUEN T FILTER' Raising the bar in filter to-chnolo PL-Sea Effluent Filter Description i;:,l,,,~e!,;, ;•,•i..•,;%~, ~,~l~4"~!!~• i Efflurnt Filters Polylok, Inc Is pleased to add its new commercial filter to its existing line of quality effluent I Extend & Lok rm filters. The PL-525 is rated for over 10,000 GPD (Gallons Per Day) making it one of the largest commercial filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the 1 Risers! & Riser Covers Polylok PL-122, the new Polylok PL-625 has an automatic shut off ball installed with every filter, When the filter is removed for cleaning, the ball will float up and temporarily shutoff I Distribution Boxes anc ' the system so the effluent won't leave the tank, No other filter on the market can make that i Accessories claim! Pumps, Basins, Pump C?rderir, Information I and Stop systems S Request a Quote I Related Products r Seals/ Gaskets Features . ~ Baffles, Sanitary Tees, i Dr'fl8t3tOC5 • Rated for 10,000 CPO (Gallons Per Day) I- * 526 linear feet of 1/16" filtration i Reber Spacers Enlarge for details * Accepts 4" and 6" SCHD, 40 pipe * Built in Gas Deflector Handles and Receivers; * Automatic shutoff ball when filter is removed * Alarm accessibility 1 Signs +r Accepts PVC extension handle . i Landscape I Drainage The PL-525 Effluent Filter should operate efficiently for several years under normal - conditions before requiring cleaning. It is recommended that the filter be cleaned every I!!r, l taps ' time the tank is pumped or at least every three years. If the installed filter contains an j SulyI Sealants optional alarm, the owner will be notified by an alarm when the filter, needs servicing, Servicing should be done by a certified septic tank pumper or installer. ~Concrete Accessories Maintenance Instructions: ~ I •Pressure Filter 1. Locate the outlet of the septic tank. Der Cronitnl Product 2, Remove tank cover and pump tank if necessary, 3, Do not use plumbing when filter is removed, ~ Debar°Ldk and CINU 4. Pull PL-525 out of the housing. Accessories 5. Hose off filter over the septic tank. Make sure all solids fall bank into septic tank. Reber Safety and la C: 6, insert the filter cartridge back into the housing making sure the filter is properly aligned end tompletaty inserted. Decorative Landscape 7. Replace septic tank cover. PL-525 Installation; Idosl for residential and commercial waste flows up to 10,000 Gallons Per Day (GPD). Technical Speottatiot Installation Instructions: ' Related PrW4Ct: 1. Locate the outlet of the septic tank ; Pump, Filter and Sun 2. Remove tonic cover and pump tank if necessary, i 24" x 12" Riser 3. Glue the filter housing to the 4" or 6" o> rilet pipe, if the filter is not centered under Miter Alarm Panel an the access opening use a Polylok Extond & Lcakrcn or piece of pipe to center filter, I SmariFfltar~+ Ce ntral 4. Insert the PL-525 filter Into its housing. httn'/Awiv"! r~ dnir ,990 '°Ni„~ t4 rf,'•t,iic s,c'n~ +n~ir,l-t f~-~ INHiI.4 nine fii •,io _ u L 14 ZUIG 9:12AM No. 3066 P, 2 T T~y~4QT, SamOc s, ~ T w z 0 rm rn cn r va P -ml Q n cl CD rnco v Q Fv $ -P. cm Cb A n IF C n Oo ~ 7 E~ b~~ v w~ i C N n ,G n O ~ N w 3 ~a - ~ ~ o 1-0 ~ o p CO M~ w n rn o Q G1 uc t, 14, 2010 9:12AM No, 3066 P, 3 -~ISO cn C:) r 141 ~ z crti ° C.n G3 0 a-: m ~ 0 b cv zm Tm 0 o O° b X ~ C) -I c+ J ~ i L Pi t1lb C-0 w o GD ■ ° Nov-11-2010 10.45 A1`1 St. Croix County Plan/Zoning 7'15-386-4686 1/2 POWTS OWNER'$ MANUAL & MANAGEMENT PLAN Page _,_of „ FILL; INFORMATION SYSTEM $P9011110ATIO .S 'Owner Sc, r fl) S YN ' `~1t Septic Tank Capacity S G Val C1 NA r T5 - Permit # Septic Tank Manufaoturer W © NA DESIGN PARAMAT RS (Affluent Filter Manufacturer P0 ~ l01! ANA Number of Eedrooma 5 ❑ NA Effluent Filter Model S ~ Q NA Number of Pubtlo Facility Units D NA pump Tank Capacity al NA , 11 Estimated flow (average) U U al/da Pump Tank Manufacturer NA Design flow (peak), (Est)mated x 1.5) ands Pump Manufacturer NA Soil Application Aare ` SN aUday! x pump Model NA Monthly average* pretreatment Unix 19 NA Standard Influent/ixffiuent Quality Fats, oil & Grease (pOG) Sao mg/L D ~aand/Brave) Filter d Peat R11tar Siochemlool Qxygsn Liemand (BODb) X220 mg/L D NA D Mechanical Aeration E3 Wationd D Disinfection D Other; Total Suspended solids (TBa)~ fi0 mSlt, Dispersal Cents) © NA Pretreated Effluent Qwailty Monthly average Nn-Ground Biochemical oxygen remand 18C1Da) s30 mg/L Nn-Ground (gravity) A In-tSrcund (Pressurized) 53Q mgl~ ❑ NA ©At•Grade D Mound Tate) Suspended Solids (TSB) 510° ofull00m1 D Drip•Llns 0 Other, Fecal Coliform (geometric mean) t7herr DNA Emaximum Effluent Particle Size in dla, b NA Other: DNA ❑ NA DNA other: ovaluss lyplosl rer domestic wastewater and sepTlo tank effluent. MA1N'ff NANfwE SCi~I RULE $erviva trwsq►retc(ensy S#rvtae Idvent nr~wnt) lMarcimum 9 years) 0 NA Inspect 0cndition of tank(s) At least once every" 5 ear(s) © NA volume iNhen combined sludge and scum equsis one third (YQ) of tank PUMP out contents of tank(s) » month(s) (Mtli(nturn S Years) 0 NA At least once every: 01, marls' Inspect dispersal cell(s) M Mont (s) D NA At least once Ovary" a r Clean effluent filter a month(s) NA At Least anon every: Q V00051 NA Inspect Pump, pump controls & alarm ( fndn {g) test rie t. NA Flush laterals and pressur8 At least once every: G~ ee rrlonth(s) Other: At least once every: C3 earls) NA Other" $ of tanks and dispersal Belts shall be made by anInspector, Indlvldua! carrying one of the following ttot+n$a or certifications' MAINTI3NANCE INSTFt1rt01" ONO poWTS Msintalnsr; l;eptage Setv)ctngY cracks o Tank rnapectrcn or leaks, or broken hardware, identify Master Plumber; Master plumber Restricted sewer: PoWT inspeotiOns must Include a visual inspection of the tank(s) to Identify any missing ending [OV any bank the volume of combined slwdge and amain and to check for measure the ogserrrationgplpea andntoQCittan andsreq ores the cted to check the The dispersal sell(s) shall be visually Inspe dtQata of affluent on the ground surtaos. The ponding of effluent on the ground surface may in a failing can immadlate notif(oatian of the local regulatory authority, tank equals one-third (Ya) or more of the tank volume, the entire udge When the combined accumulation ( e Servicing Dperatar and disposed of in accordance with chapter NR 11S. cvntsntsof to tank shall be removed by a aeptagrt in any Wisconsin Adminlatrativa Code• presBuft All g of efflu~e adiby a oartlflOdnPL1WTS Main~tameracmPonents, Pretreatment din box not I'lrrlited to the servicin ilters, other Servlaes, lnclu i~ ia0 ho~ty within 10 days of Completion of any serene event, amw 44101) units, and any servicing at intervals of X10 regulatory A service report shall be provided t 'epa en13eJ3elulwpy UlsuoasJllA'(tr) (tf (L )V912 pus WV1P)W(gJW4z"s9 ~uwo ~euiego 4~1M eaueildwan u1 Pa sJ>s geM aueutnao 6141. 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I f~llllil( 1 8 8Tx:4040789 2 STATE BAR OF WISCONSIN FORM I - 2000 954841 Document Number WARRANTY DEED BETH PABST REGISTER OF DEEDS THIS DEED, made between Dean Wellman and Pauline Wellman, husband ST. CROIX CO., WI and wife, Grantor, and Scott P. Miller and Kristin K. Miller, husband and 04/20/2012 12:52 PM wife as survivorship marital property, Grantee. EXEMPT#: NA Grantor, for a valuable consideration, conveys to Grantee the following REC FEE: 30.00 described real estate in St. Croix County, State of Wisconsin (the TRANS FEE: 214.50 "Property"): PAGES: 1 Lot 3 of Certified Survey Map Vol. 12.-Page 3292, Document Number 561773, located in the Southwest Quarter of the Southeast Quarter and the Southeast Quarter of the Southwest Quarter of Section 20, Township 29 North, Range 19 West, being Lot 2 of that Certified Survey Map recorded in Volume 11, Page 3128, Town of Hudson, St. Croix County, Wisconsin. Recording Area Name and Return Address: Land Title Inc. File # 376348 2200 W. Co. Rd. C. Ste 2205 Roseville, MN 55113 Together with all appurtenant rights, title and interests. 020-1053-20-000 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 Easements, Restrictions, Reservations, Roadways and Rights of Way, if any, of Record. Dated this 17th day of April, 2012. * Dean Wellman * Pauline Wellman per. e~a * a, AUTHENTICATI 1 , r ACKNOWLEDGMENT Signature(s) 1 N 7TARY S ?ATE OF WISCONSIN ~S CROIX COUNTY. ) ss. authenticated this 17th day of April, 201 ~~A Personally came before me this 17th day of April, 2012 the S~. O= ,hove named Dean Wellman and Pauline Wellman, husband * F Wl and wife to me known to be the person(s) who executed the TITLE: MEMBER STATE BAR OF WISCONSI ' 'regoing instrument and ac do the same. (1f not, authorized by § 706.06, Wis. Stats.) * rte J. Bune THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin My corn nission is permanent. (If not. state expiration elate: Lany S. [viountain, Attorney at Law ~oJ~ ) (Signatures may he authenticated or acknowledged. Both are not necessary.) "Names ol'persons signing in any capacity must be typed or printed 11CIM their Siena4ne 1 of 1 wARR.AN rY Drl:D STATE B R Or WISCONSIN roRwt No. 1-2000 isce~ U, -561773 s►.aaco.,vui C ER T_TF_I ED 5 UR V E Y MA P Located in the Southwest quarter of the Southeast quarter and the Southeast quarter of the Southwest quarter of Section 20, Township 29 North, Range 19 West, being Lot 2 of that Certified Survey Map recorded in Volume 11, page 3128, Town of Hudson, St. Croix County., Wisconsin. Owner: Dean Wellman -CERTIFIED SURVEY MAP V. I/ P. 3128 455 Overlook Pass I c I Hudson, Wi. LOT 1 6~6, S 00'10'36"W 419.57' i 386.12' 33.45 ®~o~eeueHroB~~i Z i ®m® \qc o/v 130,660 Sq. ft. (3.00 AC.) I ~0 O~ Including right-of-way. 120,201 Sq.ft. (2.76 Ac.) - I QI Hu 'S0tv Excludin ri ht -of -way. o ® r N N I 06` 9/~/°®anaa ecaa OO m k^ L. J7 C9 S U R u7 I r r o I m C\j 'UN '07 vi :Q z: :m CU Q; to J- w 33.49, IN SE Corner ;;Urfiri ;uj +`f"niew3 22-Id 388.98` I 3 I Section 20 fz,m- N 00'48'31"E 422.47•' ~o O N ~s o (r) o co 110f. ILlcafdod .~-100' yI z 01nPr0wil d~te Irn 0) ~PPTO•r i : h II k~ m k (0 nur ,d 707 Sq.ft. (3.00 Ac.) Iz W ' w? N Including right-of-way. I C): M 120,243 Sq.ft. (2.76 Ac.) I Z Q1 Excldding right-of-way. -)I_. I c~`o Q. oil I Z cu L1_ Q~17T 4 N m Z CU (01 :3: m W Z I o ,j I Q I m N00012'52"E 5260.15'• :m • I v~ tl{ _ I N 56780' I X Y 39.95 33 NOO°12'52" S 4 Corner N1/4 Corner N 01"58'13"E 425.4_9_'_____41_ Section 20 I Section 20 UNPLATTED 6 6' LANDS I Bearings referenced to the South line I LEGEND of the Southeast quarter of Section 20, assumed to be S89°55159"E. TAasonry nail at Section corner. Section' corner monument, Berntsen cap. SCALE FEET l"- 100' 0 1" Iron pipe weighing 1 .68 pounds nar lin fnnt cat, ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~j Lam ' l i lI e✓ k / l i I C L~" Mailing Address 23kp ~)6rs~k I WT-- 'Sqoja Property Address 4-5-¢' )'tGojS- LQn C "el -s n A// A6 (Verification required from Planning Department for new construction.) City/State 401 ^ A// Parcel Identification Number 377 3 - 20 -400 LEGAL DESCRIPTION Property Location 6_'/a , 6 f, '/a , Sec. 2.0 , T 2-q jq W, Town of H-9-J5e,-- 1 „S Subdivision , Lot # Certified Survey Map # Volume j j , Page #/a$ Warranty Deed # 9 5745 , Volume , Page # Spec house ❑ yes Uno Lot lines identifiable Ayes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix County 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. Uwe, 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 Zoning Dep ent within 30 days of the three year expiration date. //3 SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION 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 e cribed above, by virtue of a warranty deed recorded in Register of Deeds Office. ~p / 2r / t _ 4~ SIGNATURE OF APPLICANT DATE Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Wi.hconsiMepartment of Industry, SOIL AND SITE EVALUATION REPORT Page --Lof L10or andd'Ouuman Relations Division of Safety & buildings in rd*"t 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not les 1/2 x inq~es in ~~z~lan must include, but not limited to vertical and horizontal refer int (BM nd'e~kollslope, scale or PARCEL I.D. # dimensioned, north arrow, and location stand nears d. D26-~ f'05 --RO q RWE-K D DATE APPLICANT INFORMATION-PLEA RINT STI~I~Fd MATI(' PROPERTY OWNER: Qlry~6 ROPERTY LOCATION 1 D 4Q p O GOVT. LOT -SL,) 1/4-5t 1/4,S26 T 29 N,R E (or) W PROPERTY OWNER':S MAILIN DRESS ` . V'EQTW BLOCK # BD. NAME OR CSMM # Ian G / r , a lrJ~l 32 2 I CI TATE ZIP CODE PHO FZE?ffy ❑VILLAGE 07OWN NfAREST ROA 1-4 U&_0 W I ( ) &ShcJ 1_)64<6&k ANLr New Construction Use Residential / Number of bedrooms ►J K Ad ' n to existing building j J Replacement [ ] Public or commercial describe :~:Iz U1 I Code derived daily flow gpd Recommended design loading ratein 4-bed, gpd/ft2 Q trench, gpd/ft2 Absorption area required bed, ft2 tre ch, ft2 Maximum design loading rate 0. bed, gpd/ft2 6. SJ trench, gpd/ft2 Recommended infiltration surface elevation(s) d N ~4IE S 0~ 3 It (as referred to site plan benchmark) Additional design / site considerations 7 ro 6 4 t-qa_ 6► -7 f~~ S211-r Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING T K U= Unsuitable fors stem S❑ U S O U OS ❑ U RS ❑ U S❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench T7 o .4 - I Lj ~_q `1p3 L.. 1 m sbk rn~r w / .4 6,s Ground $ . j- fS2 6`/ 3 - ; L Vl► Sb w l Z 3 elev. eft. $ 2=74 y 3 4 'S L m sloe, !4 r qW - o~ Depth to v A 4 _ ► r 11~ 0.7 6.9 limiting factor 3 • j 11 1 a0 5 Remarks: Boring # 2 ell o Q ► 6-IL 16 R3 l' L r_r Al r L,J Q L j rh •sbk /l f r j A 3O ' > Z - Y~ 443 ►~t sir Ground elev. $ SL I r'"' S IaK r1 S - • O. S ft. A. Depth to _7 , V R 4/4 5 0 >h g r- Al C W limiting 04 S m 9r ni a • $ al, Remarks: CST Name: Please Print Phone: Address: IY Signatu e: Date: a CST Number- ~9 f d 1 PROPERTY OWNERLEAM WLLLt*qiW SOIL DESCRIPTION REPORT Page of X r PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench f,~ -2~ 6 YU I r., s 6 K r t„) z 0 t 1~6 3 S l L r'!~ S 1c~ ~r C9 Z 0.3 4 Y 4 3 Ground 5 ! t~ - SL r rn '~-r elev. . ! ft. / b Yk 4 S (3 1h r l►°i Depthto 4 I'/I rZ4 s M I 0 limiting ~ ct~Z Remarks: Boring # I n '7 -33 16tiQ4- 3 - 5;L 1 rn sbK n,Fr 1 d,2 0.3 Ground BLS 1 J &Y R- 4 4 - 5 C -C r f'ti C 5 0.4 aS elev. 03 1-61 .7.19tik 4 m 1 es ca 91 ft. Depth to 19-1 / R 4- m r w► limiting factor F Remarks: Boring # A 6- 1'9 16\1P,311 6A 8; S;L mSM~ ,'h r s I b.Z 0.3 Ground $1 SZ /C)'1~24 4 SL. YI~► r rh r GS a,4 OaJ ellev.~ ft. ~;2-123 ILA`/R 4 4 S r- to 0 ,.7 :6 r t Depth to limiting factor Remarks: Boring # sm. a. Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) 01/19/2012 12:56 2187229560 OFFICEMAX PAGE 09/04 PROPER'i'YOWNER ALA-M (A)JL Lr"y SOIL DF.SGRIPTION REPORT Negev of PARCEL I.D. Depth' t7aEnlnantGolor Mottles Structure CansisberEt Bcundary Roots ©PD/ft Boring# Horizon in Munsell Ou,Sz.t:ont,Color Texture Gr.Sz.Sh. Bed 91 SIL -S ZN tic. VC) O-S Ground . SL ( rr- III fL Depth 10 4 )eft /a~ N► r- rn 6.7 6% Gm9dng 1 ` Remarks: Boring # - 17 db ! Lo 6A /3,il Ground elev. E '17 s~? 4 I m l 6-1 Depth to GmtBng E Boring Remarks: # -1 l ! , Yh'5 ` t•~' i1- E5 ~`I7 r1r I.ZO. 111 13 Ground ~ !~`l~~ A• ~L ,kt~r ~Y GS ~ ~1.~ eievv, 1/4 M f- nti ~ ;7 I Depth to ,I Cmiting -73 7• factof S ` Remarks: Baring # 1 i 13 i Ground elev. tG ' Depth to limiting factor LI Remarks: cortoovnrd nRM91 ~~cf 3 oa ~ a V " E m ~o Lij 4 W v Q I~ act ..w,ASni ~ ~.J a L L l~J4VL~ Tv ~ ~ '~Ih ~UC~~ ~j ~ F~a~ SYSiEn. ~d,Q~As -ra E~vSt~l~ `TH~~ ~ N . No fnbkC IrMAw SC of Cove EXZSi'S 0TlLre. Sy-sat.n. 1 n1 i'IQLL, dT i QN , Q a Parcel 020-1053-20-000 02/02/2005 04:40 PM PAGE 1 OF 1 Alt. Parcel 20.29.19.197F 020 - TOWN OF HUDSON Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * WELLMAN, DEAN W DEAN W WELLMAN 455 OVERLOOK PASS HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 454 JACOBS LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.000 Plat: 0528-CSM 12/3292 20 T29N R SE & SE SW BEING Block/Condo Bldg: LOT 3 POT 2 CSM 11/312 N LOT 3 CSM Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/19/2003 736262 2378/496 TI 1193/607 WD 730/624 644/298 2004 SUMMARY Bill Fair Market Value: Assessed with: 48019 59,500 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 46,000 0 46,000 NO Totals for 2004: General Property 3.000 46,000 0 46,000 Woodland 0.000 0 0 Totals for 2003: General Property 3.000 46,000 0 46,000 Woodland 0.000 0 0 I Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 001-WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 FILED JUL 0 1 1997 1 9 01 Deeft C ER T .I F-.I ED S UR VIE Y MA P Located in the Southwest quarter of the Southeast quarter and the Southeast quarter of the Southwest quarter of Section 20, Township 29 Nooth, Range 19 West, being Lot 2 of that Certified Survey Map recorded in Volume 11, page 3128, Town of Hudson, St. Croix County, Wisconsin., wner: Dean Wellman CERTIFIED SURVEY MAP V Il P. 3128 455 Overlook Pass L.OT:s./ I ss' Hudson, Wi:.. I i S 00'10'36"W 419.57' I I 1 386. 12 3.45 'W I I ,,`,~Kft111Nlijj, roh ' I I ~ H 2 I I ARvey G. 13.0,660 Sq.ft. (3.00 Ac.) JO' Including right -of -way. I W I = S 8,9 120,201 Sq.ft. (2.76 Ac.) c~ N . I QI L HUDSON Excludijigight-of-way. + mi ~ J WIS i M y 0 a I a I j4PA OVEDLL 7T 3 ° mi m . I p I. 11 ~Icl o N JUN 26 '97 ~ m l 1 I" (0 CU sr. cRO+x COUNTY Cu SE Corner W Comprehensive Planning y 33.49' ° Zoning and 388.98' 3 I Section 20 r' Parks Committed 00' 48' 31 "E 422.47.:' 1o O N P7 If not recorded loo' -40 2 m ~ within 30.days of O I Q'. approval date ' 1rn • co 0) apRrova a I m nulla07 Sq.ft. (3.00"Ac:) lz W N Including right-of-way. v I o: 120,243 Sq.ft. (2.76 Ac.) I z Lu'; Excldding ri ht -of -way, (M ° . I o I ti CD a: 0.: n Cn I J' N Cu 'll= 4 7T h 1J1 ~i Cu o ml OI m =o N I V I h ZJ I;Z, I I h h I+ ~ NOO°12'52"E 5260.15'• . • I CD > I _ y N 567.80' 391.95' NOO"12'52"E S1/4 Corner N1/4 Corner N 0158'13"E 425.49' l 5 s 6,. Section 20 Section 20 UNPLAT'TEO LANDS I Bearings referenced to the 'South line -LEGEND of the S - outheast quarter of S ection '20 . assumed to be S89.55r59"E. ?5 ,Masonry nail. at Section corner. Section°•corner monument, Beritsen cap. SCALE IN FEET l'= 100' o ' 1 ".Iron pipe weighing 1, 68 pounds o roo 200 soo per lin. foot sep, • 1" Iron pipe found. Previously recorded information. This instrument drafted by 4962548