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HomeMy WebLinkAbout020-1456-15-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes IPrivacv Law, s.15.04 (1)(m)1. Permit Holder's Name: City Village X Township Miller Homes of Hudson, LLC Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: /BU ~ I'Y1 cs TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic („~; ~,rur, ~ 1 Z 5Q ~ ~ ~b 5 Aeration - - - - Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~ t' ~ /t 1~ '" r 5 ~~~ / Dosing - Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Forcemain th Dia. ist. to Well SOIL ,4BSORPTION SYSTEM ELEVATION DATA counts St. Croix Sanitary Permit No: 47 83 0 State Plan ID No: ~ Parcel Tax No: Section/Town/Range/M o: 11.29.19. STATION BS HI FS ELEV. Be 1cohmar ~. I_'i ~e ~-f~. -°- Zb .~. 20 /43 ~o-r__, Alt. B F; ~~.~. 3. g5 Q 9. 3 5 Bldg. Sewer ~ ~ q ~ 95.33 St/Ht Inlet ~ ~ SUHt Outlet $ ~s ~ ,1. Z~ Dt Inletlnlet '~ ~ Dt Bottom ~ ~ Header/Man. 5• z7 3 . °~3 Dist. Pipe ~ z~ A 3 I Bot. System /d.Zs Z.~S Final Grade /~ 7 •® St Cover~1 ~ Go 3 85 Q ~ 35 BED/TRENCH Width / Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 92 z ~ e~~-~'"~~ ~ -~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. , ~ INFORMATION CHA UNET OR ~ ( f~ .1- /~ ~ ~ y t ` ~~ ~ ~( ~~ ~ /~ ' / 11 _ Model Number. a J i G}Z ~ o GD , b~ DISTRIBUTION SYSTEM Glo~~- L~ ~c..t.... '`~ ~~_ Header/Manifold ,~ ~ Distribution x Hole Size x Hole Spacing Vent to Air Intake . ~ (dad-Iti ~ ~ pipe(s) \ th ~ Di \ S i \ \ , c.,. ~ Dia Length Leng pac ng a SOII :OVER v Drnccnre Sve4nmc (1nl~i YY Mnllnfl t7r 0+.hr'AfIP_ SVSfemS OnIV De th Over / De th Over xx De th of xx Seeded/S ded xx Mulched Bed/Trench Center / ZG Bed/Trench Edges ` Topsoil ~ Yes ~ ~ No ~ ~ Yes i] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 1044 LaBarge Road~~Hudson, WI 54016 (NE 1/4 SW 1/4 11 T/29N R19W) Sunset H/ills 1st Add Lot 15 1.) Alt BM Description = F'tt`~' ~`~~ G ~a: ti 5 ~ `°~ t7 ~ 2.) Bldg sewer length = ~~ -amount of cover = ~ Plan revision Required? j ]Yes _ No ~ (Z 1 ~~G, Use other side for additional information. L._! ~ 1 J._J Date SBD-6710 (R.3/97) Inspection #2: ! / Parcel No: 11.29.19. G~ ~~ 3 7 Cert. No. Ip - Saf Buildin Divi ' County ' $ rt- C / ` 201 m ~~62 0 1 X M iSO Permit Number (to be filled in Co Sanita )r I ~~0~~~~ De artment of Commerce 08) 266-3151 ry . y~ q c~ ~ 3 Sanitary Permit p tl~ri - ' State Plan LD. Number ~~ In accord with Comm 83.21, Wis. Adm. Code, personal i format y ~pXi~OUNTY may be used for secondary purposes Privacy La , s15. FICE Project Address (if different than mailing add s) ING OF io Y y ~,.,~qs ~ ~.~ I. Application Information -Please Print All Informati b';~ " I ~1 Z - ~"' '~i°~ ~ Pso ~ ~~ c~/9/~ ~'4` ezo- foi 3^ yo -coo Property Owner's Name Parcel # Lot # Block # 5~v~ (LLB i!L~2 p 5 L,L ~ /~ Address Property Owner's Mailing Prope Locatio 1 QOX # /S / ~'/. ~ '/. Section l / City, Stat e Zip Code e Number Phon , , rt ~'~.i b3 O v.. W i Sr yO~ fo p 3 p s!o` 'Z.-? X09 Zp ~ (circl e T _ / N; R~E (check all that a l ) f Buildin II T pp y ype o g . STa L ~ ~O-~ - Subdivision Name CSM Number ^ 1 or 2 Family Dwelling -Number of Bedroogts ! r / // rib U ^ }. J~ Sv K S vl ~'~ ~ ~ ~ S ! $~ PubliclCommercial - Desc ,se . e` t~ ^ State Owned -Describe Use 7 ~ - Qt+ r ~~~ r s ~ ~ ~q ~ y" ~~~ S Q' S'9 ^City_^Village~T'ownship of ~ .t 0 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) L ~ ~ - ~~.~(5 2 ~ -(-23 C f+.c. wt b~-~1 ~' ^ New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal Permit Revision ~~ ge of ^ Chan b ^ Permit Transfer to New O List Previous Permit Number and Date Issued `~ T Q 3 ~r / / ~ Before Expiration er Plum wner ~ f ~9 ~ D, IV. T e of POWTS S stem: Check all that a I ^ Non -Pressurized In-Ground ^ Mound ? 24 in. of suitable soil ^ Mound < 24 in. of suitable soli .. ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Gr nd ^ Holding Tank ^ Peat Filter ~ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Ch bar Drip Line ^ av - es t e ^ Other (explain) V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil Application Ra e(gpdsf) % Dispersal Area Require Dispersal Area Prop sad (sf) System Elevation ~ / boo ;~ , gs7 ggo.z 93.00 ~ VI. Tank Info Capacity in ll G Total Gallons Number of Units Manufacturer Prefab Concrete Site Constructed Stcel Fiber Glass Plastic ons a ~~... ` New Existing ` P~ ` ~ ' ~~ T'. (*dr` 'ranks Tanks Septic or Holding Tank ~ Z~ ~ ~~ f ~ ~- Aerobic Treatment Unit i _ / W / 0 ,~ •/~ `` Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached pleas. Plumber's Name (Print) Plum~ber~'~s Signature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) ~o, ~.k-~~~ ~.~~ ~.-- ,~~~.~o ~ .s-yo~>~ VI . Coun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surcharge Fee) ~ / ~1 ~ D/a/te Issued ~ `/ 22 ~ Is ng Agent ig re ps) ^ Owner Given Reason for Denial (~ V Q r IX. Cctnd~~f,Qtp,~x~~UReasons for Disapproval ~ _ //{ ~ + _ „~,L~Z~~~ ~j ~,.~~ OyyQ U ~ w L vvvv ~' ~V Y '^V! F ~ ta r1 S c n k , effluent filter and v dispersal cell must all be serviced / maintaine ~' as per management plan provided by plumber- / v ~ 2. All setback requirements must be maintained ~% ~ / ~ as per applicable code/ordinances. ~~ ~ „ ~~~7 ~,~ ~~/b7/~'~~,L~'~ Attach complete plans (to me counry omy) ror me sys¢m on paper no. .w~ ...... ..,,..... ~v SBD-6398 (R. 01/03) ' ~ . ~ ~~~ ~~ ~ ~~ ~~ J ~ ~ ~ ~ ~ ~ ~ 9 1 s n l~ ~ ~ 4 ~ T ~i a In ° ~ o ea ~ ~ ~ ~ ~ --~ ~ ~ --- Q~ ~! o h i 5 "~ l1J o , ~_ Q" M J ~ -~ ~ A J m Q` y r , ~ Q ~ ~ ~ ~~ W M ~ ~ ~ "~ O M ~ ~~ ~F ~ ~ ~+ ~ ~ c~ ~ ~ ~ W ~ ~w~ ~ ~ ~ - ~. ,C ~ ~ N V ~. ~ ~'- ~ ~ 'v z~ ~ e J e ~. ~ ~~M ~ ~ J ~ ~ ~ ~ ~~ ~ ~ ~ \\ .30 ~ ~~~ rW n Q .o ~~~ ~ 3~ 4 ~~ ~ r ~ ~ w ' ` , 3 ~ r~ J / - J ~ ~ ~ o~ ~Q ~ ~~ ~ ~~ ~ ~ a~ ~-. W l v -~ ~ \ rn ~ O ~ ~' ~ ~~~ ~ O O ` 1 N S~ -/ r D '~ ~ m F ~ ~. ~ ~ .~~ . ~~~ ~~ ,~ _~,,, ~ ,~ ~~ r 1 ~ ~ Ri - .c ter, t~ _~ O d ~° 0 3 ,~ t .+ W/ ~~ ~~ ,, ,o o~ 0 o ~, ~. ~, Q T ~_ 0 S `C ~ N ~ V N ' I a N e ^ m e r I ~~ ~ r . }~ U fi m _C ~ ~, ` ~ ~ ,,~ ~ m ~'~ ~0 0 ~' ~ N w ,~~ , ~ ~---~~ m ~ ~_ ~: v' f `~ r W W ~ ~ C Gl r ~' r W !` U Q z Q, s, ~, r P •n r~ ~ r 0 U N 1~ Wisconsin Departrr~r-t~Commerce SOIL EV,`A,L~rUA PORT Division of Safely and Buildings in arxo nce ~~ yy • Adm ode 1954 Page 1 of 3 A.C.E. Sal 8 Site Evaluations County Attach complete site phan on paper not less than 8'~ 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal re ence po~q(6NI), ~ree~ior~jr ~ t t ~ T~d d~ parcel I.D. percent slope, scale ar dimemsions, rxxth arrow, a cee r o near i bcation r ~ssta pen ~ fro 020-1012-00-000 Please print all info Lion TY $7. CROIX COU f~ 1 Date Reviewed y ~~ ~~ Personal informsRion you prcnride may he used for sewn Purposas~i7 party Oar Property Location Miller Homes Of Hudson, LLC Govt. Lot NE 1/4 SW 1/4 S 11 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 868 Kelly Road, Unit A_ 15 Sunset Hills First Addition City State Zip Code Phone Number ~ City ~ Vllage N" Town N~rest Road Hudson I WI 54016 (715) 531-0714 Hudson 1050 LaBarge Road /f New Construction Use: ~ Residential /Number of bedrooms 4 Cade derived design t7ow rate fiUU GPu Replacement ~ Public or commercial -Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General r~mments and recommendations: This report is 2nd evaluation of lot 15 to allow Chan al cell location. Install two trenches at 3' X 92' w/ 23 "Quick 4" chambers per trench (46 to at 93.0'. # ~ Bonng ~ Pit Ground Surface elev. 98.50 ft. Depth to limiting factor >120°_in. ~ Sal Application Rate D h t C l D i Descri tion d R ry Texture "` Roots ~ ~ Fbrizon ept in nan o om or Munsell p ox e Color Coni Qu Sz Y r ~ ~ Etf#1 Eff#2 1 . 0-10 10yr3/3 . . . none ~ ~V ~~ sl ~~~ 2fmc 0.6 1.0 2 10-15 10yr4/6 none Is ~Y ~ 1fmc 0.7 1.6 3 15-45 10yr5/4 none s 1vF,f 0.7 1.6 4 45-52 5yr4/4 none gr s ~ ~ A ~~J r „ s` ~{~N~" {" `^ " _ - 0.7 1.6 5 52-120 10yr5/6 none s I - ~ "~ v~ r - 0.7 1.6 ~3a = ~ /bZ~ Boring # ~ Boring . Pit Ground Surface elev. 99.20 ft. Depth to limiting factor ' 123" in. Soil Application Rate Horizon Depth in. Dominant Cobr Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP "Eff#1 D/ftT •Eff#2 1 0-G 10yr3/3 none sl 2fsbk mvfr as 2fm,1c 0.6 1.0 2 6-20 10yr5/4 none sil 2msbk mvfr cvv 2fmc 0.6 0.8 3 20-24 10yr4/4 none sl 1msbk mvfr aw 1fm 0.4 0.7 4 24-27 ~ 7.5yr4/6 none Is 0 sg ml cw 1vf 0.7 1.6 5 27-123 10yr5/6 none s 0 sg ml - - 0.7 ! 1.6 3= 7y `' /oy g * Effluent #1 = BOD ~ 30 <_ 220 mglL an TSS >30 < 1 mglL uent #2 = BOD < 30 mglL and TSS <~0 mg/L CST Name (Please Print) Signature CST Number James K. Thompson 3602 Address A.C.E. Sal & She Evaluates Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane Osceola WI 54020 11/82005 715-248-7767 property Owner Miller Homes Of Hudson, LLC parcel ID # Pending from 020-1012-00-000 Page 2 of 3 Boring # Boring 1~ pit Ground Surface elev. 99.61 ft. Depth to limiting factor > 128" in. Soil Application Rate ti i t T Structure Consistence Boundary Roots Horizon Depth in. Dominant Color Munsell on Redox Descr p Qu. Sz. Cont. Cobr ure ex Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-6 10yr3/3 none sl 2isbk mvfr as 2fm,1c 0.6 1.0 2 6-19 10yr5/4 none sil 2msbk mvfr cw 2fmc 0.6 0.8 3 19-23 10yr4/4 none sl 1msbk mvfr aw 1fm 0.4 0.7 4 23-27 7.5yr4/6 none Is 0 sg ml cw 1vf 0.7 1.6 5 27-126 10yr5/6 none s 0 sg ml - - 0.7 1.6 ^ Boring # ~ Boring pit Ground Surface elev. ft. Depth to limfting factor in. Sal Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 'Eff#1 *Eff#2 ^ Boring # J Boring ~ pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth in. Dominant Color Munsell Redox Descr~tion Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 'Eff#1 'Eff#2 'Effluent #1 = BOD $> 30 < 7Z0 mglL and TSS >30 < 150 mglL 'Effluent #2 = BODS< 30 mglL and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. ff 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. ~ So// e /a/ca~'~~ p~'~ EXiSra' fo~nc'e/,',~e ~i1 of /af ln~ Sc.a1e: / .~O , Qe,~' `~/9St/ r'I; //~ l' f/i.,9P3 o/'~-ds 39.93' S/qoc r~~- -8Z ---~--- _ _-~1 ~~i`\\ r .z1,z,~ ~ 5/apP ~ 99 so= --- - - -- -- ~- - ~ 1 ~; ~ ~Jb ~s/o/~ 43 _ _ ~ 99.0 - --- -__ - - - - ~~ - -' ' >010 oF~oa.»d~s~s on. 9c~S'n'COrr~o~cr ASSK~'lF,dc/Eµ: lc+D.c~' ~ 932, "~ b ec~~ad.•+ ~ -~ r Q~~'a/agCC ~~ ~~~ J~ Elegy! = 93 ~?' ~/ / P~. 3 0~ 3 ~ Safety and Buildings Division ~ " ' County , C / p 1 S t ( ~ ~ 1~ve , P.O. Bo 2 -39t i Y Ii . . ~ ~ ~ 53 7 - 162 ~ i N f ll d i b C S i P b b rsconsrn ~"" t i e n y o J an tary erm um er (to e (608) 266 51 Department of Commerce Sanitary P mid ~~pp~te ` State Plan LD. Nu ber In accord with Comm 83.21, Wis. dm. Code, personal information yo de may be used for second purpt>~~.IYdt~IXdvf,Jtl6i Project Address (if different than mailing address ~ ZO~11Nr Of=FiCf~ y L.a,(~ arS m-- tZ ~p Y I. Application Information -Please Print n ormation / ~~tl~J .S O „~ c,,G> / J~yO/ 4 Property Owner's Name Parcel # Lot # Block # s~~ /~c~' /yIiLLF2,~ln.Nd ~.~.~. Qa ~ ~ /,~ .-, Property Owner's Mailing Address Property Locat /~d ~S ~ Section ~ ~'/y~~'/~ City, State Zip Code Phone Number _ , n t! h .,i p ~ l ~ yi~ ~ ~ ~ ~(P'Z.7 (+~ T z' /R ~ (cE or ~ ~, (check all that a T f B ildi II L ~( ~ ' (~..~ ., p ng ype o u . 6~ ~ S D ~` `' Subdiyi~ion Name CSM Number / ^ I or 2 Family Dwelling - Number of Bedrooms ib U ^ / Public/Commercial - Descr et se ~t n 9 i ~~ '~' ~ ) EI ~O ^ Q ^Village~Township of~ C.E ~ ~CitY 4f . v - Tf / U ^ State Owned -Describe Use I _ ZC- li-cflo-oc7 III. Type of Permit: (Check only one box on line A. Comple line B if applicable) Z ~ .. I p ; _ CJ - oed ° A' New System ^ Replacement System ^ Treatmen ding Tank Replacement Only; ~ ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of Permit Transfer to;New List Previous Permit Nttrrtber and Date Issued Before Expiration Plumber weer ., z /\ , w [•!~ Z ~ IV. T e of POWTS S stem: Check all that a 1 ,Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24`' . of suitable soil . , ^ At-Grade ^ S e Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Gr and ^ Holding Tank ^ Peat Filter Aerobic Treatment Unit ^ Recirc l ng S d Fi r ' r Recirculating Synthetic Media Filter Leaching Chamber Q Drip Line ^ Gravel-l ' Pipe ^ Other (explain) V. Dis ersaVTreatment Area Information: `' Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requi ed (sfj `~ ispersal Area Proposed (sf) ste ation ~ VI. Tank Info Capacity in ll G Total Gallons Number of Units Mhnufacturer ~ ! Prefab Concrete Site ConsUucted Steel Fiber Glass plastic ons a \ New Existing ~ I ,' I D ~ ~ Tanks Tanks a ` 1. 1. Septic or Holding Tank /Z s~ ~ i ~ f' ~ Aerobic Treatment Unit ~ !~ 7' f ~ /~Q~~ I `ti Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume respon ibility for installation of the POWTS showltpn the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number ."ra 5• \~ -~/s 7FD- z ~ . ZZ-So 3 ~ t .~ ,M" k~ = QJ~ m,~~ Plumber's Address (Street, City, State, Zip Code) ': ~~~ ,rte f~ VIII. Coun /De artment Use Onl `~ d ~ ^ Sani ry Permit Fee (includes Groundwater Date Issu Issuing ent Signa re o S pproved D sap Sur arge Fee) ~ k~ ~ q r ~ DG J ^ easo enial U I IX. Conditions of Approval/Reasons for Disapprov 1 ~ ~ and ~~r ~~ ~ r maintained .~att p1oJlti by plurrr~er ~ ~~ s M~ Msr must' marnt'~ine~"` •' `. ' cdr~'% olTdiii~ es ~ '''° . a r~ ~/ d~~ t = [ f ,a ~c cao a co e p o~ pe -'- - Attach complete arnms (to [he County only) for the sya[em on paper nor ,eas wan o,.., ,.., .......w .. ~~' d1a~.. ~ `~` ~ Ql~e,~ ~a~ t,.in.a~ SBD-6398 (R. 01/03) Pp t,J~'~ ~'V1 a,~ ti-csZ-~~~"°'-'"' (.~) . d~-C~~ ~r~ ~ . t~ J 3°3' S3 v rn u ~ ~r e ~~ A 1 A T b /~/'. ova wa. y 0 .~~ ~ Ip V, - .~~~ .~ ~ '~ u ~U'~ t ~. ~~ b i+ ~ ~ ~3 -4 ~~ ~ -,. i a~ i. ~I ~'~ ~~ .~~~ m r vo =~~ S- .Ap k `'~ ~ O ~ t P ~~~ 2SG,. gyp. `S ~Q ~~ ~~ ~~ ~ ~ R ~ 1~ ~,- ~ ~ i . ~! M. ~ x. '~ 4 1 ~. ~ ` ~ ~ ~ ~ r ~ n; :; ~ ! R ~ ,r J~ C~~Y W 0 W 3 303, S v r ~, ~ P e ~~ ZV~ ~ .~ g ~ 'fi "` ~ ~t A 1 A ~ ^-..~_ ~ ~r.Tv~- way ~ r4 ~ IQ ~~ I ~j ,~`~ .~"°~ m r ~ ~ Al x ad Qrt ~ ~ ~ oQ ll `"' Q ~ ~, I ~ ~--~J _ M~~ u G ~ ~3 -! ~ ~. ~ .~ N :y ~'i .,~~ Q ~~ =~ ~~ ~~ R ~~ ~ ~' ~ ~~ W w , ~ ~ . 1 4 , , ~ ~ ~ ~ ` ~ ~ ~~ m ~ n :> 0 .. ~- ,r ";. ~~ ~ : J W ~o w ~s~. ~©, • ~. _, ~. ' Wisconsin Department ~ ommerce OIL EVALUATION REPORT Division Of Safety and Bui ings ,J ~; ~I ~., ~n ~t~fiianra ,iArirh (: Wic Attm (:ncie 1877 Page 1 of 4 A.C.E. Soil & Site Evaluations - - -... `y ~, County Attach complete sit plan o~ t~~{~s~,~i an 13% x 11 in es in e. l b~k~Ndfa v 4 i 0 St. Croix inc ude, but not limi to: e 1iar z rence int (BM), dir on percent slope, sca ~ Nr6tl~r~i end locati nand distance to es dl~ v Parcel LD. Pendin from 020-1012-00-000 Please print all infonnaLon. Ravi By Dat Personal information you provide may be used for secondary purposes (Privacy Law, s . 15.04 (1) {m)). `, ` ~ aZ 7 d j~ 1 Property Owner Property Location Miller Homes Govt. Lot NE 1/4 SW 1/4 S 11 T 29 N R 19 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 868 Kelly Road 15 Sunset Hilts First Addition City State Zip Code Phone Number J City ~ ~Ilage f/ Trnrm Nearest Road Hudson ~ WI 54016 715-531-0714 Hudson LaBarge Road /~ New Construction l1se: /~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD :_f Replacement ~ Public or commercial -Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Recommend installing two trenches at 3' x 87.50' using twenty eight (28) 11"Standard Bio-Diffuser Chambers at elev. = 96.00'1~,/,~ r n ^ Boring # ~ Boring 1/ Pit Ground Surtace elev. 99.82 ft. ~~ Depth to limiting factor > in• Soii Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-9 10yr3/3 none sl 2fsbk mvfr as 2f,1m 0.6 1.0 2 9-22 10yr4/3 none sil 2msbk mvfr cvv 1f,m 0.6 0.8 3 22-32 7.5yr4/6 none Is 0 sg ml aw 1vf 0.6 0.8 4 32-107 10yr5/6 none s 0 sg ml cw - 0.7 1.6 a Boring # _:~ Boring Pit Ground Surtace elev. 100.03 ft. >116" in. Soil Iication Rate ~' Depth to limting factor App Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10yr3l3 none sl 2fsbk mvfr as 2f,1 m 0.6 1.0 2 9-24 10yr4/3 none sil 2msbk mvfr cvtr 1f,m 0.6 0.8 3 24-30 7.5yr4/6 none Is 0 sg ml aw 1vf 0.6 0.8 4 30-116 10yr5/6 none s 0 sg ml cwv - 0.7 1.6 `Effluent #1 = BOD ~ 30 < 220 mg/L d TSS >30 < 150 g/L ,.' Effluent #2 = BOD < 30 mg/L and TSS <30 mg/L CST Name (Please Print) 'nature: CST Number James K. Thompson d =---~'~ 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola W! 12272004 715-248-7767 Property owner Miller Homes Parcel ID # Pending from 020-1012-00-000 Page 2 of 4 Boring # _l Boring /~ Pit Ground Surtace elev. 101.08 ft. Depth to limiting factor > 125" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0-9 10yr3/3 none sl 2fsbk mvfr as 2f,1m 0.6 1.0 2 9-34 10yr4/3 none sil 2msbk mvfr cw 1f,m 0.6 0.8 3 34-40 10yr4/3 c2d7.5yr5/8 sil 1msbk mvfr aw 1vf 0.4c 0.6 4 40-46 7.Syr4/6 none Is 0 sg ml cw - 0.7 1.6 5 ~--~- 46-125 10yr5/6 none s 0 sg ml - - 0.7 1.6 ~2 `~ hce LeJ - /~ • ~ ~ ~• Redox. concentrations in H#3 ar ' dicative of tension saturation within finer texture sifts over coarser foamy sand and are rrot indicative o groundwater saturation. Comm 85.30(3)3 applied to discount redox. features. ^ Boring # J Boring _f Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 ^ 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mglL * Effluent #2 = BODS<30 mg/L and TSS a 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. SOIL AND SITE EVALUATION 1877 page 3 of 4 • PROPERTY OVIMER: Miller Homes PARCEL I.D.# Pending from 020-1012-00-000 AC.E. Soil & Site Evaluations REPORT MEMO Soil evaluation completed prior to plat review. Changes in lot line locations or building site may result in additional soil evaluations being required. Lot line locations must be verified prior to permit issuance and system installation. SP~uc.C t.~t~. e'/e~: 990 ~ ---_.- _ of ~YD~~:c~~, a-. :~/a: ~a psi; S ~4; ~ • ~7¢J4t~ion I~ I Scc~~u ~ ; ' .C.ot is Su~ssf its T . of .iludso,~ S~. Croik Le.. cJ~ 99.0' C~~-.{ok. l~. ~loF~ ~-~- ~~ P/'oPcst~f Toufn ~oaol ST. CROIX COUNTY SEPTIC TANi~ MAINTENANCE AGREEMENT . AND OWNERSHIl' CERTIFICATION FORM OwnerBuyer Sl'l/L L.E~ o /yj ~- s S ~, ~ ~ /~_ Mailing Address ~3 a k / -S ~ /~~ c! s o vl Gtr/ Property Address /v `/ S~ ~~ ~ a. rs ~- . _~~~ (Verification required from Planning & Zoning Department for new construction.) City/State ~v ~s p h ~.C~ ( Parcel Identification Number ~ ~~ LEGAL DESCRIPTION Property Location'/4 ,S~-QJ y4 ,Sec. ~, T ~N R~~ Town of vc(/,.s Subdivision S~ K 5 a. -~ ~' /s F' rsT ,~d'~ j '~ i O H ,Lot # Certified Survey Map # ~ ~ /,~ / ,Volume /U ,Page # 5~ Warranty Deed # ~ ~ a ~ y~ ,Volume ~. l ~ ,Page # y~ 7 - Spec house ye no Lot lines identifiabl ye no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What, you put into the system can affect the function of the septic tank as a'treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe 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 9 / /s oS SIGNAT 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) U 2711 P 41? STATE BAR OP WISCONSIN FORM I - 2000 WARRANTY DEED Document Number tC ~ -T~ Th1S Deed, made between Celeste M. Bennett ands-ir~~re pers~oha Grantors, and Miller Homes of Hudson, LLC, Grantee. Grantors, for a valuable consideration, convey to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Propel") (if more space is needed, please attach addendum): Part of the NW'/. of SE'h and the NE'h of SW'/. of Section 1 1, Township 29 North, Range 19 West, St. Croix County, Wisconsin described as follows: Beginning at the NE corner of the NW'/. of SE'/. of said Section 1 1; thence West 2640 feet to a steel stake; thence South 613 feet to a steel stake; thence East 1320 feet to a steel stake; thence North 288 feet to a steel stake; thence East 83 5 feet to a steel stake; thence South 75 feet to a steel stake; thence East 485 feet to the center of Tanney Road; thence North to the point of beginning. e c ei KATHLEEN H. MALSH 5'C. ICROI XOCODEEM I RECEIVED FOR RECORD 12/09/2004 09:05AK rIARRANTY DEED EXERT i TRANSE fiE: 197400 COPY FEE: CC FEE: PAGES: 1 ALSO All that part of the NE'/. of SE'/. and the NW'/. of SE'/. of Section 11, Name and Retum Address Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Sam E. Miller Homes Wisconsin lying Wiy of the following described line: Commencing at the E'/. P.O. Box 151 d1 corner of said Section 1 1; thence S89°30'00"W along the North line of said SE'/., Hudson, WI 54016 1296.55 feet to the point of beginning; thence S07°49'36"W 296.01 feet; thence S00° 1 1'33"E 107.1 1 feet and there terminating. Together with all appurtenant rights, title and interests. ACKNOWLEDGMENT STATE OF~~Gt//.5C G/lSrh~ ss. ~TC~/~ COUNTY ) Grantors warrant that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: None. Mail tax bills to: Sam E. Miller Homes P.O. Box tA~ l S/ Hudson, WI 54016 Dated this ~ day of December, 2004. AUTHENTICATION > Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.~ ~u.~. ~~~~ggttt THIS INSTRUMENT WAS DRAFTED BY ~ _ ~ P R.Y ~'.(~~4rh Kevin K. Shoeberg, Esq. ~ •., ~ KEVIN K. SHOEBERG, P.A. °i n 1805 Woodlane Drive ~ TAMARA 1(, 1 3 a ~ HERBST ) Woodbury, MN 55125 ~ •,/ x (Signatures may be authenticated or acknowledged. Both ~d-~t~('ItepessaryJ .,, ~yt -Names of persons signing in any capacity should WARRAi~'"I'V DEED Personally came before me this ~_ day of December, 2004, the a named Celeste M. Bennett and Keith D. Johnson to me kn a the person who exec d the foregoing instrument p'and ~ t~y~~e Publio, State of~i,~~~iit 5~~~ ~tnission is permanent. (If not, state expiration date: Recording Area 020-1012-00-000 020-1013-40-000 Parcel Identification Number (PIN) below their signature. 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