HomeMy WebLinkAbout020-1393-20-000 Wisconsin Department of Commerce PRIVATE SEWA& Coun St. Croix
Safety and Building Division
INSPECTIO ORT Sanitary Permit No:
453335 0
GENERAL INFORMATION (ATTACH To" IT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j.
Permit Holder's Name: City Village X Township Parcel Tax No:
Bruhn, Nathan Hudson Township 020- 1393 -20 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
12.29.19.2393
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration -.._ Bldg. Sewer
2Z lot -Ng
Holding
St /Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet 8.0 IDa.7
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Z !� Nor a Dt Bottom
Dosing Header /Man.
)Do. 1L)
Aeration Dist. Pipe
Holding — Bot. System T Z to _ k q
98.6
PUMP /SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
GPM Z -1 lam •d
Model Nu er 4 fK J* - 1— �, c f /QQ,, /07j
TDH Lift ction Loss System Head TDH Ft
Forcemain length
! D�toWeil 1
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS g It - -L
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR Cj wyv
Type Of System: / UNIT Model Number:
1. ato "Q -. , C' L- X10 S7 75 �1 13�R. -I<. _
DISTRIBUTION SYSTEM_
Header /Manifold Distribution r I x Hole Size x Hole Spacing Vent to Air Intake
`' ipe(s) '~ —
Length (7 Di ength 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 xx Mulched
Bed/Trench Center j S Bed/Trench Edges Topsoil Yes No Yes [ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 / I� / ° Inspection #2:
Location: 870 Charlie Ryan Rd Unknown (SW 1/4 SE 1/4 12 T29N R19W) Moonbeam Ridge L 20 M f � t Parcel No: 12.29.19.2393
1.) Alt BM Description = 1 0 P c"6 `. � nc(c.1 ; c � ` V
2.) Bldg sewer length N8 y� god {�� c lk S c Y�r h, (L. L-) 01n
- amount of cover
Plan revision Required? j '] Yes ,,, No ?
Use other side for additional information. __
L4
SBD -6710 (R.3/97) Date Insepctors Signature Cert. No.
Safety and Buildings Division County r
201 W. Washington Ave., P.O. Bpx 7162
N V "' scons l n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
.Department of Commerce (608) 266 -3151 4 S-33 3S-
Sanitary Permit Applie State Plan I.D. Number
In accord with Comm 83.21. Wis Adm Code, E PR
I _ u Provide
may be used for secondary purposes PH Law f o 5.04(ixm) Project Address Of different Breit mailing address)
y }
I. Application Information - Please Print All Info
v
Property Owner's N� �, &I-, � �� Parcel # Lot N Brock # ; ((Q n
Property Owners wing Address Property
ZiLI
City, State Zip Code Phonc Number 'A '+ Sidon
JS Z� T ` N. r�
IL Type of Building (check all that apply) 41 ab Pars
�Ur 2 Family Dwelling -Number of B ms / .. r�a1� Subdivision Nam
FublidCornmerttial - Describe Use 3 1 tb &4 D D rV
�a A co
State Owned - Describe Use 3 r , 2S City_ Village worship of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Ozp - 13 - ZD - M . Z37 3
A System Replacement System Treatruent/Holding Tank Replacement only Otber Modification to Existing System
B. Permit Renewal Permit Revision Cliange of Permit Transfer to New List Previous Pamit Number and Date Issued
Before Expiration Plumber Owner
IV. Dr of POW1S S Check all that apply)
n -Pressurized In Ground Mound Z 24 in. of suitable soil Mound < 24 in. of suitable soil At -Grade Single Pass Sand Filter
Constructed Wetland Pressurized in- Ground Holding Tank Peat Fidler Aerobic Treatment Unit Rje6irmlaft Sand Filter
Recirculating Synthetic Media Filter A ng Chamber Drip Line Graveldess Pipe Other (explain
V. Dispersal/Treatment Area Information: E16j
Desi Flow (gpd) Design Soil Application Rate(gpdsl) Dispersal Area Required (sf) Disposal Area Proposed (sf) m Z1
VI. Tank Info Capacity in Total Number I Manefactarnr Prefab Site Gael Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
Now Existing w� �olbeQ + _ C
Tanks Tanks ,
Se* or Holding Tank r 06.0
Aerobic Treatment Unit
I
losing C Umber
VII. Responsibility Statement- 4 the assume responsibinlity for installation of the PORTS shown on the attached Plans
Plumbe's Name (Print) Pl MP/MPRS Number Business Phone Nu
ZL6,9 66
Plumber's Address (Strut, City, State, Zip
voce l P &% -3_1V0
VIII. Conn artment Use Onl
ppmved Sanitary Permit Fee (includes Groundwater Date issued Agent signature (No Stamps)
owner or Surcharge Fee) i 2 9D ( �
IX. Conditions of ApplFonMeasons for Disapproval
SYSTEM O NER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
as per management plan provided by plumber.
2. All setback requirements must he maintained
as per applicable code1orr iir
Attach complete pleas (to the County only) for the system oa paper not less than SM x It incbes in sine
P JN/R N
PROJECT Nathan Bruhn S 4831 Helena Lane #2 Oakdale Mn 55128
SW 1/4 SE 1 /4S 12 /T 29 W TOWN Ku dson COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 6/15/04 BEDROOM 4
CONVENTIONAL XXX IN- GROUND P f6O RE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1 al lons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .55 ABSORPTION AREA 1212 # of chambers 39
BENCHMARK V.R.P. Top of Steel Fence Pos t/ �,U*() ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H,R.P. SameasBe� ark
218' Prop erty Line SYSTEM ELEVATION 103.0/102.0/101.0 4.5' below qrade
242'
WB:.M. stop of nail in tree
P ans Designed Usin
(Well is to meet all onventional Powts
setbacks required by a ual Version 2.0
105 B- PNR S T_
12% Vents
Slope
60'
Zc'
> 5 �) B -3 cc Pro 4
Property 0 35 p -- Bedr m 10
B-4 o se
60' 20'
70' 0' T
2
B-2 3 -3' x 83' cells with
B.M. 1
>3' spacing
Vent
100' >6„ Standard Biodiffuser
of Cover Leaching Chamber
with 3 1. 1 ft2 of Area
6, Long 11
34 55 4" Grade at System Elevation
51' Pro Town Road (��
P JN/RW N
PROJECT Nathan Bruhn S 4831 Helena Lane #2 Oakdale Mn 55128
SW 1/4 SE 1 /4S 12 /T 29 TOWN Hudson COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE6 /15/04 BEDROOM 4
CONVENTIONAL XXX IN- GROUND P f6O RE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1 al lons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 39
, BENCHMARK V.R.P. Top of Steel Fence Post/ ywe l ASSUME ELEVATION 100' Filter ZabelA -100
❑ BOREHOLE O WELL *H.R.P. Same a Be�ark
218' Property Line SYSTEM ELEVATION 103.0/102.0/101.0 4.5' below q r a de
242'
*B.M. s top of nail in tree
10
Well is to meet all
Plans Designed Using
setbacks re , Conventional Powts
required b /
q Y Manual Version 2.0
105 �VPNR
12% Vents
Slope
.4
60'
Property 0' 35' 5 B -3 Pro 4
t Bedroom
B -4 House
60' 20'
70' 20' T
B -2 3 -3' x 83' cells with
K_
-�' >3' spacing
B.M. #1 Vent
100' j „ Standard Biodiffuser
ver Leaching Chamber
with 3 1. 1 ft2 of Area
Long 1119
34
Grade at System Elevation
51' Pro Town Road ��
Wisconsin Department of Commerce SOIL EVALUATION REPORT g Pa e of
Division of Safety and Buildings .
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, slope, scale or dimensions, north arrow, and location and
distance to nearest road.
Please print all information. R awed b Date Q
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Ct� (! /
Property Owner �,,p Property Location C q
(� I !1""` , ,A��. Govt. Lot }1+31 /4sG 1/4 S T a� N R
Property er's Mailing Address 3 �� Block # Subd. Name or CSM#
7 C 0�0 (� DO M b&^ tM 1� i G.. ! O bA
City J S C Phone Number ❑ City ❑ Village ®Town Nearest
O &M A �5 � P O - 08 �ID t� u&J v f=
v h r� p
New Construction User. Residential / Number of bedrooms .3 Code derived design flow rate ysD GPD
❑ Replacement ► ❑ ` Public or commercial - Describe:
Parent material g. G t a l C► e.l� 443LA L+ Flood Plain elevation if applicable ft.
General comments m 5 v S'tf a _ S 40 r rR 'E W C h . f< IFp •A 'C 0. G L' S +C.
a n d recommendations: .5 S r
a T T. T � 9g.7�
R t ) 4C,aeW-+
Pty: rv, at_�+y -X 99.91' P ea1 T ' y C 97,s3 •�
C
a Boring # Boring
® pit Ground surface elev. J0 ft. Depth to limiting factor taZ 0 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
---- L. a7 F6 A •� � 5
a -at 10 -fR3/ I— a f3 W. M fo- -'o
7.5 ypylq 6 L a F6 0 4 1 M , - I o F .
o, z e 4 6
Fa-1 Boring # [] Boring
EA pit Ground surface elev. � Q 3. ft. Depth to limiting factor � a 0 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/FP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2
- ,13 A3 / 5 L X55 tic f r
L - 011%6614- WFr 6 lo
• 5
ML
M li
1
Effluent #1 = BOD > 30 220 mg/L and TSS >30 _< 150 mg/L *Effluent #2 = BOD •_30 rng/L and T � —
CST Name (Please t) 1e Signature
4 a1'1% + 1C. ate Evaluation Conducted Tetephdn� ber
-"�
sy o I - IS -a f '��1�- 358
7
Property Owner P. C . CD r,] Z�v Parcel ID # QG� v1�_ Page of
a Boring # Boring - - L Pit Ground surface e l � Yft . ..aN�� to limiti , .actor 1� S in.
Soil Application Rate
Horizon Depth Dominant Color Redox scription Texture Structure Consistence Boundary Roots GPDff
in. Munsell Qu. Sz. Co-n . Gr. Sz. Sh. 'Eff#1 'Eff#2
4- a F(v r2.
-IL 754010 L a FS wi F•- e. w I
1 4 -49 s `f R -- ._._._ s L a FS V- rK r.- Ct.., 1 O F J S
q
B oring �° ❑ 19. ® Pit Ground surface elev. � ft. Depth to limiting factor 10 � in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
O- b 4,031- _--. 5L d F L 2 wt rr 4 a P . S
•fig 7154A Y .1ol b b M1gr I CWj > F , s
' 3 !- - 7.610 1-4 •--- Se.. el f5bw r+P w C w Ivy
l e t
F-1 Boring # Ground surface elev. _ ft. Depth to limiting factor in. Boring
❑ Pit Soil' Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD > 30 _< 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD 130 mg/L and TSS _< 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (5t.6100)
CURVE DATA TABLE
10�f/1A KANA Rd* OW" AnOsCho9d DOWN Chad WV90 LWVnTWVftW TWV-%4N
01 aas.ro' 9r4VW NW4MU•W 140Ai IU'W WOW14WIMOWAWW
ca 1nAa aa'erw NM•4T1ew lalm lMAW Norara WNaa'4mvw
T29N, R18W a 16'.0& 43%KW NtD W"W 8021• 09a1 N2?4&l&W NatVe
04 ase.00 1?4e1r 140e•14'UW M.W alA4 Ml'=4Ti N11973P
OF PLAT BOUNDARY .
S (951,356 SO. FT.)
D_
w1ou1
LJ
W/4 CORNER
XATa CONTOUR W/4 12
S
NAYM SBY W-M ro eT31
77 t01S'd
aq
.A COUNNY 6ECTON
/ s
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K room
NAY SEW= -
q .
/ GAEFA1ENf -
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>.
otlG o Is e _�_
Uelt AREA 619'67119'3 424.96' I
0% aLCPE
WAATER HOPE
1AMNP&1WrKWAF"'M I I
M Lai 8"AMP4
X0H WATER Lai R"ATON
_ 30'
,OULD MRowwo vmw CA CKAN09 Ti
'N CP"APFRO ED OCMPREMENSIVe
Y1Ae" AI•D WL 01081CN PLAN POR �-.� LOT 21 LOT 2 I
�OB8f�1r 0 XL P� I I
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(2.1 AC
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a wATaR as volra aevAS oR aRAas I ee I : °: I t LC+GP�CL�t� gem
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/ I _ 96s'5 T29 423.02'
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Maintenance and Contingency Plan for a Septic System
Maintenance Plan mps d once every 3 years.
1. Septic Tank is to be pu
' larger filter is being- installed in
er is to be cleaned once a year. Please note: a
2. Effluent fitt
order to extend the maintenance interval of the filter; he ins actions pipes at the ends of
3. Once evj:ry $ years, cells are to be inspected via t P
the ceus.
rbage, and water conditioner discharge into the system.
4.Owner aer,rees to limit greases, ga
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershod is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
ti ;in ncy Plan
option If system fails, determine cause of failure, use aftemate area and install new
tested replacement area.
option #2. Install system at a lower elevation, by removing chambers, removing biomat,
Op
and install new system.
O P tion#3. PJo adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace ,any other failing components as needed.
plumber: ��haun Bird 715 -246 - 4516
Plumb _
St. Cro ix Count Zoning 715- 386 -46
Pu mper er
Tom Mondor 715 - 246 -5
Shaun Bird #226900
FROM :PC COLLOVA BUILDERS, INC. FAX NO. :1 715 294 3632 Jun. 15 2004 02:16PM P9
08/15/2004 14:09 FAIL 851 493 7338 NOME BUILDING EQUITY @002/002
rpm : � r,(,i hn FW NO, Apr. 13 2M M 9 P2
IT CROIX COUNTY
SEMC TANK MAINTENANCE AGR
AND
CWNMSliiIP CERTIFICATION FORM
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U. 2 5 9 4 P 6 3 8 REGISTER OF DEED
ST. CROIX Co.. WI
STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD
Document Number
WARRANTY DEED 06/14/.2004 10 :10AN
WARRANTY DEED
THIS DEED, made between Home Building Equity, Inc., Grantor, and EXEMPT #
Nathan E. Bruhn, a single person, an Brian L. Z a single person, as REC FEE: 11.00
joint tenants, Grantee. TRANS FEE: 240.00
Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE:
CC FEE:
the following described real estate in St. Croix County, State of Wisconsin: PAGES: 1
Lot 20 oonbeam Ridge First Addition in the Town of Hudson, St. Croix
ounty, Wisconsin.
Recording Area
Name and Return Address:
Edina Realty Title, Inc.
400 S. 2i St. — Suite 1 ] 5
Exceptions to warranties: Hudson, WI 54016
Easements, restrictions and rights -of -way of record, if any. 426062
020 - 1393 -20 -000
Parcel Identification Number (PIN)
This is not homestead property.
Dated this 10th day of June, 2004.
Home Building Equity, Inc.
B
* Ed Murray, Prat nt/Owner of Home Building Equity,
Inc.
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) G STATE OF WISCONSIN )
02 r �fVST. CROIX COUNTY. ) ss.
authenticated this 10th day of June, 2004 NO ��g Personally came before me this June 10, 2004 the above
�e 6 named Ed Murray, President/Owner of Home Building Equity,
*
c Inc. to me known to be the person(s) who executed the
TITLE: MEMBER STATE BAR OF WISCONSIN
foregoin ' trument and acknowledged the same.
(If not,
authorized by § 706.06, Wis. Stats.) *Cheri lf rown
THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin
My commission is permanent. (If not, state expiration date:
Peterson, Fram &Bergman — Steven H. Bruns 3/11/2007 )
50 East Fifth Street, St. Paul, MN 55101
(Signatures may be authenticated or acknowledged. Both are not necessary.)
*Names of persons signing in any capacity must be typed or printed below their signature
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000
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FROM :PC COLLOVA BUILDERS, INC. FAX NO. :1 715 294 3632 Jun. 15 2004 02:15PM P8
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