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HomeMy WebLinkAbout020-1250-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579025 -8- 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: Hanson, Tab Hudson, Town of 020-1250-30-000 CST BM Elev: Insp. BM Elev: BM Descriptitiioon: Sectionrrown/Range/Map No: /c> b ~ •1+1 6P cJ it A-- 21.29.19.1253 TANK INFORMATION ELEVATION D TA TYPE MANUFACTURER t'.+ CAPACITY STATION BS HI FS ELEV. Septic ; T~ ~ 6 3 Benchmark ~I SO /al, $ / 6ZS Alt. BM Aeration Bldg. Sewer 3.8 98.a Holding St/Ht Inlet 3. 76 9-7 9 TANK SETBACK INFORMATION St/Ht Outlet 3.9$ 9-7 -c~ TANK TO P/L WE L BLDG. Vent Air Intake ROAD Dt Inlet Sb a kk--, Septic Z$, 1 1 ! > 1 Dt Bottom Dosing a Header/Man. q Aeration Dist. Pipe 79 9 7. d 7 Holding Bot. System ~j 9 j 55%`77 PUMP/SIPHON INFORMATION Final Grade -7-Z Manufacturer GPM nd St Cover i. / 67 Model Number Cr0 TDH ift Friction Loss System Plead TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length I' No. Of Trenches PIT DIMENSIONS No. Of Pits Insi ia. JLDIMENSIONS / ~e,n. c SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactur INFORMATION Typ~Of System: t , + , Z CHAMBER OR Model Nu i be,. DISTRIBUTION SYSTEM I lu-j /b GLia..a~ rac~D Header/Manifold FD stribution x Hole Size Spacing Vent to Air Intake ipe( Length Dingth Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only btio ~t'~~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bedrrrench Edges Topsoil Yes [id No "--tS~es Xe [H No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 830 Harbor Vieyl oad Hudson, WI 54016 (NW 1/4 SW 1/4 21 T29N R1 9W) Jacob's Landing 2nd Addition Lot Parcel No: 21.29.19.1253 I~ 1.) Alt BM Description = p La:, LS 2.) Bldg sewer length = v n, - amount of cover Plan revision Required? ~x Yes No 1 ~ Use other side for additional information. J I SBD-6710 (R.3/97) Date Insepctors nature Cert. No. l KC4C1 V GV '{4 0 JUL 14 2015 Safety and Buildings Division County St. Croix a rt; 201 W. Washington Ave., Box 7162 Sanitary Permit Number to be filled in b T.~ $ `ST. DR017C CfJUN'Tti' Madison, WI 707 7 16 ( by Co.) MUNITY DEVELOPMENT 5 77O2 C Sanitary Permit Application State Transacts Number in accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unitA is required prior to obtaining a sanitary permit. Note; Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) pj~Toses in accordance with the Privacy Law, s. 15.04 1 m , Slats. I. Application Information - Please Print All Information Same T► Property Owner's Name / Parcel # Tab & Sall Hanson 1266 -,3a - Property Owner's Mailing Address 020- 830 Harbor View Rd Property Location ' 7-53 . If City, State Govt. Lot Zip Code Phone Number NW z y,, jW _ , Section 21 Hudson, WI 54016 612} 216-8359 (circle one) II. Type of Building (check all that apply) Lot # T 29 N; R 19 W ❑ 1 or 2 Family Dwelling - Number of Bedrooms 31 Subdivision Name Block # scribe Use Accessory building restroom Na Plat of Jacobs Landing 2' addition ❑ City of El State Owned - Describe Use CSM Number ❑ Village of Na pxo<wn of Hudson III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ew System El Replacement System El Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision El Change of Plumber El List Previous Permit Number and Date ssued Before Expiration Permit Transfer to New Owner ~a IV. Type of POWTS System/Component/Device: (Check all that aPP1 1 7.5 Y) /t $N on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information 1 1 fil r Quick 4 Standard Plus ch hers & 2 end ca s, Pol Lok PL525 effluent filter Design Flow (gpd) Design Soil Application Rate gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (s0 System eva ion 60.0 Gpd 0.7 Gpd/Sq. Ft. 85.72 sq. ft. 205. s q. VI. Tank Info ~ q• 96.00' Capacity in Total # of Manufacturer Gallons Gallons Units I c b 110 New Tanks Existing Tanks U ~ o 2 2 a Septic or Holding Tank a. U y va w C7 A. 320 Na 320 1 Wieser Concrete X Dosing chamber Na Na 0 0 Na VII. Responsibility Statement- I, the nude igned, assu a responsibility for instal o the POWTS shown on the attached plans Plumber's Name (Print) Plumber' ignature MP/MPRS Number Business Phone Number James K. Thompson Plumber's Address (Street, City, State, Zip Code) 1VIPRS 30021 715) 248-7767 340 Paulson Lake Lane, Osceola, WI 54020 VIII Coun /Department Use Only pproved Permit Fee Date ssued Issuing ent Signature ven Reason for Denial $ q7:5 LS 7// lo l 5 IX. Cond Reasons for Disapproval L r' tank, etfltlp *ft w ikr d 3) Y O Jb d ; ersal celf.mgtif all ervtces !maintained / t1 per managemint plan provided by 'plumber. Z ill"i e►ck l*qu*v**must be maintained t'70~A^ IJII~, 4a per appkAble code / orainances. Attach to complete plans for the system and submit to the County only on paper aot less than 8 1/1 a I l inches in sin SBD-6398 (R. 11/11) Conventional POWTS Index & Tilte Sheet Project Name: Tab & Sally Hanson Conventional POWTS - Accessory Structure Owners Name: Tab & Sally Hanson Owner's adress: 830 Harbor View Road, Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot 31, Plat of Jacobs Landing 2nd addition Legal Description: NW1/4 SWl/4, Sec. 21 T.29N., R. 19W., Town of Hudson, St. Croix Co., WI. Parcel ID 020-1250-30-000 Page I Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell & treatment tank Sizing Calcualtions & Infiltrator "Q4" chamber cross section Page 4 Dispersal cell Cross Section Page 5 Filter Specifications Page 6 Septic Tank Cross Section Page 7 System Management Plan Page 8 Parcel map Page 9 Septic Tank Maintenance Agreement Page 10 Waranty Deed Attachments: Soil Evaluation Report Mater PI er Res 'cted Service: James K. Thom son, DSPS. Credential # 21 Signature: 3 ZO/~ Date: Page 1 Of 10 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01101) JOr~ a ✓WUQ EXi fCa^r} q l&dl C 10- lC: T 6,f Sa/yr74~so~ 830 Nkds~,, ~i Steil ~v~3/ p/~~oFTa~oE~s rQ1wp WN, C. 2/, 7-..2y?; ^ • 7 Lam., //J . O~ W.,.(5.nt SE , ~v %x Co 4420 -12 S-0 -.30 Enk;St%t/ /{is; j~E,YrsEi~ E.Yis~'n~ Sc~.zt~,('-y~ (V laJGll O O ~a/bur' j C cc.~ K d. of r~ 1 ~ l' E,Y,3-4:1 y ProPused csv C~tC!'t~f ~ ~o /e ✓ ~ ~ To oP' w ~1Q Sc~D,6 ~a ~t' 5-;-5 Stied de;~o ec6c, at bo t' e{~luw►E~;•/L-c.- oF~"d°~9• Assct..n~d nropo s c..d d; y p~sa/cc ~ at 3 ks/d",..y~oTn~/~r'afa+r ~ ~ ''q-y°cl a°,lrrs. lnlft/XVII ~pra~ /uca coo bur 5~.r{acc aIt~ -ZIo 162- ~y 2eF /A RANSON DISPERSAL CELL & SEPTIC TANK SIZING CALCULATIONS JOB DESCRIPTION: Accessory structure restroom located on private residential property. Structure is for the private use of owner. System to be oversized to maximize system life expectancy. DISPERSAL CELL SIZING CALCULATIONS: ~e~aily flow = 60.00 Gpd design flow 2. Infil afr tive capacity of native soil = 0.7 gpd/sa ft 3. Absorption area required: 85.72 sq. ft. 4. Absorption area as proposed:_211.60 sa ft (10 chambers total) Infiltrator "Quick 4" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end cap (pair) = 5.80 sq.ft, EISA Number of trenches: 10 10 chambers per trench Trench width: 2.83' Trench length: 43.00' Trench spacing: -9.00' on center Total system area w/ 6' trench spacing: 3.00'x 43.00' SEPTIC TANK CAPACITY CALCULATIONS: 1 • Design wastewater flow = 60.00 gpd 2. Minimum required capacity: 125.28 Gallons (60.00) + (11.61 x 3* x 0.80) + (46.77 x 0.80) = 125.28 *(Requires a maximum 3 year maintenance cycle) 60.00 gpd / 75 gpd = 0.80 gpd person equivalency 3. Proposed Septic Tank Capacity & Manufacturer: 320 gallon Wieser Concrete 4. Polyl-ok PL - 525 effluent filter to be installed at septic tank outlet.-~~~~~~ STANDARD CHAMBER 52" Quick4 Standard Chamber 48° (EFFECTIVE LENGTH) 8 12" = as a R'I IN 34 ! SIDE VIEW SECTION VIEW MultiPort End Cap 12" ~ ~ 16'• ( _ 34" SIDE VIEW TOP VIEW FRONT VIEW Quickt$tandard Chambe►~Noml~~ Nominal S e tic ions Size MN ,L X H) 4 Effectiu n th qg! «~r9 , 34 x 16" x i2' Invetty . 8 or1 25~ 4, }a~:3x'77k~i• 1S rc7F, ~a L;/Q Soli Absorption System Cross Section 99, ~.sft 4• Schedule 40 Final Grade PVC Vent Pipe Wdh Vent Cap ---j7,0 f} Leaching Chamber O F- System Elevation Soil Absorption Sysfiem Plan View C~ 3 ft Vent Or Observation Pipe Leaching Trench 9 Chambers 4' Dia_ Header Leaahtna Gh bar Saec r~s Manufacturer And Model EISA Rating .2-0. 0 sq ft per chamber Soil Application Rate G .7 d/ 9P scj ft gpd Design Flow + 2.7 Soil Application Rate EISA = Chambers 12 row* of / y chambers each. ' Page P~ . 000 Technical Specifications PL-525'E - FLUENT FILTER / y 1 6172' BALL CHECK 1 EXCEPTS B" SHD w l~ r FOR INLET EXTENT10N - - x.1.9 14.35 04 TLE 408 SINGEEXCEPTS iY~ I ` I 3Ip 40 5.23 I;I I it 3102 I ~ PL•525FILTER HOUSING ; - 16.34 PART N0. - 30142525 MATERIAL: HOUSING-POLYPROPYLENE ~L- OUTLET BUSHING - PVC J r &5BALL -HOPE SOCKET EXCEPTS FLOAT SWTCH 0.23 ORHTMMX.E EXTENRON ---7~ r.,.~ 10.64 ) ANW 530' OF 1716' SLOTS - I~ 624 I _L"947 - 956 - BLPUS XCEPTS 6.04 a BALL PUSH ROD ~ OPENING - , 7.09 OPENING 20.71 I 1902 12244 POLACK PL-525 FILTER CARTRIDGE PART NO.• 30141.525 \ I I II MATERIAL-POLYPROPYLENE 0f l+J O/ f o ~ ~t C! a;r o~cM :3,1~ 991~8-9Z~ -008 ZIOZ 'Ntlf 03SIA3L' 'i0d-1SOd Zl/9/~ ' ?1V0 ZIOZ laIvn yf :31VO 05LbS W 'NOpa N3CIVW Ol AMH sn 9LLcm z z 'ON -n3a 7~~~#1~g~(~~ fl3331M dnNb'W OI1d3S 3WS :1.8 NMVaO .•77 i~# UU bW OZCM w Ctf ~ r -j c H Q LLI z > W O .J z O CO O o ~w p p U :D Of z = o CK (A a w w Lo d } OU O FA m U) a m _j LLJ Z F w In Q 0 Of - X0 LL OH Q J 3 L7 i w o °m Zia ? a ~ z 0L o o x LLj LAj _ H O Ljj Q U Z < F- LL J N C~ d mN Wha-W J z Q=. mu z < o. C U l: m JQ ~0N O O~ C a s o° L_I QC) 0~~-~ ~wr mwtn o ° Q z Y d (n '00 o _ z U 00 r- I cn F co o :4 0 s ri NLn ~tO J>Nj _l al u ~ZU > 0 =O ZZ N~ J LLI .SJ nZJ 0F-F 0~ F- c' 0 C~ z S C~ 0i o ~0mt- 3 ~ O<w Opw ¢ (n w U wN z0 C F~ >Z~ U hz-05C=? 0UN au7- C. m a 00 ~z 7 z3m a~=-wim~3 Q<r~ z30 U c~ Za w xx °U D Z U N~ p ~O _j _j ? C 01 z >Z NOS ~I 0 Z F- F-- U J Q W Q i ~ F- U z W d C w J v a I SV0 ,rb r = _ st, do z W 10 T) u x o LLI W F-I - - I W c n J~ seo „b m zb do w 2 Of O ~ C7 J W F- of J OS z r,8b _J a b I U - Q N a ab3b 9S U Sd z Q W af Y z < ti Conventional POWTS Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the Polk County Zoning Department at (715) 485-9279. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(l)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be :5 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis, Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. 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. Septic tank manholes 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 the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contineencv 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. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Pg.7of10 P/ V ; / N O Q~ m z ~ ss <N w 1 0 . g8 N I I I U) N N 18 lO 30 I l 2V W hW W U N W O O hW G M O (n O 0 C) CO Lo 0 wo w n N rod - cwi`t Q= _ o N n W~ N N (YI 50 d 'Wr+ WN JNIaNd~ m " w W = O 3: ~h3 U) M N NI c9 U- N ( I .00 zve I Z ° X _ © s .011 W. w Z 4S: O I Q W? N k • m J h O cc> Z I I I ~ o I o C. ~ ;o . EZ ' SL17 „175.60.88 N cn a In m .EZ`s;a 00'092 -2 n O C-0 cu N CU. N ~O to r I ; W 0 N I1! 1 cl, 0 . jj c QI 6 . 0 a cr- 00 00'E 00 c 3r6f.OL_66 N Z W I I w W LL v o u~ O (J - O V ® NQ 7 O NQ Im In W N 1n z LL- ~ O I c- MN N dN Q a as M 0 M ti NMI m 9 tnF t- - f` N Y W O ~ xw _ u. 31 W t W .00 GTE .00'tiZS .00'6EB 3r61.OS.69 N - ~ ~ tL ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Tab & Sally Hanson Mailing Address 830 Harbor View Rd. Property Address 830 Harbor View Rd. (Verification required from Planning & Zoning Department for new construction.) City/State Hudson, WI Parcel Identification Number 20-1250-30-000 LEGAL DESCREPTION Property Location NW '/4 , SW '/4 , Sec. 21 , T 29 N R 19 W, Town of Hudson Subdivision Plat: Jacobs Landing 2nd addition Lot # 31 Certified Survey Map # Na Volume Na , Page # Na Warranty Deed # (before 2007)Volume 867 , Page # 214 Spec house Oyes[]no Lot lines identifiable El yes[] no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(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 Safety And Professional Services 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 f bedrooms Na 07/08/15 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) / I ( (~C/ P P.- A 'f 2403 R SOIL EVALUATION REPORT . Wisconsin Department o~ ~SPS L4,,07 Page 1 of Commerce A.C.E. Soil & Site Evaluations ,L.11 i accordance with fommM, Wis. Adm. Code Attach complete site plan than 8'/ x 11 inches in size. Pla County St. Croix include, but not liSECR eference point (BM), directio percent slojl ~I , and location and distance t( Parcel LD. 020-J250- -000 Please print all information. Revie By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. Property Owner Property Location / Tab & Sally Hanson Govt. Lot NW 1! SW 4 S 21 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Na or CSM# 830 Harbor View Rd. 31 na Plat Of Jacobs Landing 2Nd Addition City State Zip Code Phone Number City Village ✓I Town Nearest Road Hudson WI 54016 (651) 216-8359 Hudson Jacobs Ladder Cr. New Constructior Use: Residential / Number of bedrooms 0 Code derived design flow rate 50 GPD Replacement Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: POWTS to serve private out building. Soil suitable for conventional POWTS, 0.7 gpd loading rate at 96.0' infiltrative surface. F I 6e Boring # Boring Pit Ground Surface elev 99.38 ft. Depth to limiting factor >92" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff# 1 0-8 1Oyr3/4 none sil 2fgr mvfr cs 2vffm 0.6 0.8 2 8-18 1Oyr414 none sicl 2fsbk mfr cw 2vffm 0.4 0.6 3 18-30 7.5yr4/6 none Is Osg ml cw lvffm 0.7 1.6 4 30-92 1Oyr5/4 none s Osg ml - lvffm 0.7 1.6 11 2] Boring # Boring Pit Ground Surface elev 98.71 ft. Depth to limiting factor >88., in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft2 in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 1 0-14 1 Oyr3/4 none sil fill na na na 2vffm na na 2 14-45 1Oyr4/6 none s Osg ml cs 2vffm 0.7 1.6 3 45-88 1Oyr5/4 none s Osg ml - 1vffm 0.7 1.6 1 * Effluent #1 = BOD 5 30 < 220 mgJL and SS >30 < 1 0 mg * Effluent #2 = BOD5< 30 mg/L and TSS < 30 mg, CST Name (Please Print) Signatu CST Number James K. Thompson ewe 3M41 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 7/2/2015 715-248-7767 Property Owner Parcel ID # Page z' of 3 T Boring # Og IF Pit Ground surface elev. yl. 00 ft. Depth to limiting factor in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 o- Loa/ r,,.r S%Z Z4,9• Mfr ~-5 2,Oq,A Z (00, Iv s S r< 0,7 3 o ogre, 5 sus yd/ - O, 7 /h~ cool rt '37 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 fF#2 Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330(R11/11) Page of Wis. Dept. of Safety and Professional Services SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Date - - Reviewed by Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 1/4 1/4 S T N R E (or) W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# State Zip Code Phone Number ❑ City []Village []Town Nearest Road City " Code derived design flow rate GPD ❑ New Construction Use: ❑ Residential I Number of bedrooms Replacement ❑ Public or commercial - Describe: ft Flood Plain elevation if applicable Parent material General comments and recommendations: ❑ Boring ❑ Boring # E] Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture GStructure Sronsistence Boundary Roots ff#1 GPD/ft2 in. Munsell Qu. Sz. Cont Color ❑ ❑ Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate ❑ Horizon Depth Dominant Color Redox Description Texture GS ru Sre onsistence Boundary Roots ff#1 GPD/ft I in. Munsell Qu. Sz. Cont. Color = ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 BOD < 30 mg/L and TSS < 30 mg/L - Signature CST Number CST Name :(Plase Print) Date Evaluation Conducted Telephone Number - Address SBD-8330 (RI 1/11) EX:3 i~9 ?,-Ade e cctlc: i - _ T 6~ Sa~yy~so~ 830 fla~6oi ( -ck) ri'~. ~0~3/ ~/az`oFTaC.oEzs C . L/ 77-1 . kF./9~., i . do ff~cd~r> E.ti St%t/ tf O U~~ 4S/d~t.c/~ afr, ✓~c.~ ~ /pat%fJU~ I Jo) f~ J~ 3t ~ miler; ~~.C1J; pProK /ucFw! o bur,'e,~ gas r~ 3 of'3 ~9- So/i d~r+(UCt•~j0~ lJi~ E.t:3tnq radt e/ (ecf ca/c ,P~~'z ya3 ~f 5a//y1761Sor) 830 f,/ar6o~ l/, ca J r2c~. f/ao/SN ,L.~~3/ p/aL~or JaColz.s Lid, 1-"~-.~~i~~•,, /1 c~i c~%y, Sec . 2/ 7-..f SE , ~sv r Co., 0 tar U; ems'. o~ f~ Q4 s~.~y Pro~ouspcl c.~i ess. 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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * HANSON, TAB C & SALLY R TAB C & SALLY R HANSON 830 HARBOR VIEW RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 830 HARBOR VIEW RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description, Acres: 2.147 Plat: 2135-JACOBS LANDING 2ND ADDITION SEC 21 T 4N R19)JA W1/4 OF SW1/4 & SW1/4 Block/Condo Bldg: LOT 31 OF NW1/ LOT 3OBS LANDING SECOND ADDITIO Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 867/214 2004 SUMMARY Bill Fair Market Value: Assessed with: 49293 262,800 Valuations: Last Changed: 04/29/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.147 30,800 172,500 203,300 NO Totals for 2004: General Property 2.147 30,800 172,500 203,300 Woodland 0.000 0 0 Totals for 2003: General Property 2.147 30,800 172,500 203,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 220 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00