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HomeMy WebLinkAbout020-1356-16-000* .. soor)~in Department of Cgmmerce ' Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Hol er's Name: ^ City ^ Village .^ T~wrto ST B E ev.: Insp. BM Elev.: 8M Description: UO SOU ,~' ,• e TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic( ~ 5 Q p Se~:~#z .cr ~ U Hol TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. vent to Air Intake ROAD Septic ~ I > { ~ -1- ~ YS ! ,/, "" . NA tpft~_~Z 7(b~~ ~ ~'4~ fs~' `_ NA Hold ~ _~ PUMP /SIPHON INFORMATION Demand Model Number TDH Lriction S stem TOH F Forcemain Length Dia. ist.Towell CAII ARCnRPTInNI tYCTFM FI FVATION DATA County Sanitar~t P~rm~t No.: State anI o.: T~y~ Parcel Tax N~ • f~ /~ STATION BS HI FS ELEV. Benchmark , Z %GY/- Z ~~ ~ r DZ . ~ Bldg. Sewer ~ ' ,gj, qS, J S Ht Inlet 2 s Ht outlet . / q3.O 9 ~+ Inlet ~ Z . Z s~ o~~l~} . y ' . Header /Man. ~ , Dist. Pipe T d.0 'Q Bot. System 3 . ~. _ Q , Final Grade 3 Q3. Z ' Q~ ~ ~ ~ SG s # 7, z Q h BED /TRENCH DIMEN I N width Length No. Of renches Z.'' sts~ SYSTEM TO P / L BLDG WELL PIT DIMEN I N LAKE /STREAM No.Of Pits Inside Dia. Liquid Dept Maya urer• - SETBACK INFORMATION Type O System: ~'svr ~ ~17C7r 7 (C>U~ - CHAMBER M e Nu er: S i f11tTQIR11T1A111 CVCTCM Header / Man of v Distribution Pipe(s) ~, ~ 3 x Hole Size x Hole Spacing Vent To Air Intake ` Length ~_ Dia. Length Dia. / Spacing / ~ y cnll cnVf`R x Pressure Svstems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) 4 S Inspection # 1: (/ / O /Inspection #2: / / Location: 718 Paul Burch/D/rive, Hudson, WI 54016 (NE 1/4 NW 1/4 14 T29N R19W) - 1429192078 Grass r'Range Addn. II -Lot 16 b Tr ~ '~, S~/S~lq+,.. G~t V ~'•;~. GvQ,S iM.S~-~~el~' ih s~y 1.) Alt BM Description = ~ ^^'~ D~ s` '~, 2.) Bldg sewer length=SS ~ ~.Ori ~`"~ ~ af" a ~~~~ ~~pl~ ~`` -am. ouQQnt of cover = 7 y ' p'r''Ao ~`°~ Plan revision required? ~] Yes / No Use other side for additional inforl>y~tion. j{ ~ ~9 SBD-6710 (R.3/97) Oat Inspector's Sig ture Cert. No. I .. . r Safety and Buildings Division ~O11ttn' ~ 201 W. Washington Ave., P.O. Box 7162 iseans~n Mad' 2 , ' 07 - 7162 Site Address De artment of Commerce ~ Sanitary Pormit Number Sanitary Permit ate In accord with Comm 83.21, Wis. Adm. C c Law, s 5. 1 m prov' ~ Check if Revision ~ f~~'/Z tin be used for seco se State plan I.D. Number I. Application Information -Please Print All tio~ EP 2 J 2001 ~ Yd~~ Parcel Nwnb4r~ ~ ~~ property Owner's Name //''(( q ZO ... - d~ ,~ 7.(X'I~' ~.. ~~ ~ /T~ ~ property Location property Owner's Mailing Address _ ~ 9 yl •S T N R ~' Lot Number Bloch Number CuY. Stau Zip Code Phone Number ~,~ Subd[ uion-Na[ne CSM Number II. Type of Bull (check all that apply) ^C[ry 1 of 2 Family Dwelling -Number of Bedrooms S^ ^Village ^ pubtic/Commercial -Describe Use owttshi Nea[es[ Road ^ State Owned Gj¢ ~,t III. Type of Permit: (Check only one boa on line A (numbering scheme for interval use). Complete line B if applicable) For County use A• 1 ^ New 2 ^ Replacement Sysum 3 ^ Replacement of 6 ^ Addition w S stem Tank Onl Eris S sum Dau Issued Permit Number / ZG B. ~Cbxk if Sanitary Perini[ Perviously issued ~ Z .. .. - - ~-. gyrpe of Permit: (Check all that apply)(numbering scheme is for internal use) . 21^ Moues 47 ^ Satd Filter - " 3B•^ Coaatructed Wetlud 44 ~Noa -Pressurized In-GrourIIl • . 41 ^ Holding Tank 48 ^ Single Pass S1 ^ Drip Lice 22 ^ Pt6sta[rjzed In-Groutd 30 ^ Other 4S ^ A[-Glade 46 ^ Aerobic Treatment Unit 49 ^ Recircula' V. D rsa!/1'reatment Area Information: ~ ` Percolation Rau System Ekvatio S Final Grade Design Flow (gpd) Dispersal Area Dispersal Area Soil Application tn.Mch) C-f p~[~~ Ekvadon Required Proposed Ra[e(Gals./Days/Sq.FtJ (L'I G 2.. 93.6 . 7 G-S P.1.7 ---. 7s ~ / '~ Prefab Siu Suel Fiber Pla: Capacity in Total Number Manufacturer Glass VI. Taal[ Info Concreu Constructed Gallons Gallons of Tanks Ncw F.xistioj Tankt Tanks ~,- ~ - 3 4rE~' Doting Clamber VII. Res risibility Statement- I, the undersigned, assume respoasibili fo~MPRS Number~~s shore on thBusmess Pho~ Number Plumber's Name (Print) Plumber's Signature ~ Plumbin & Perk Testln r»„m~l$~ddre~~st~t.~tjty' Stau. Zip Code VIII. Count /De artment Use Onl Dau Issued Issuing Agem Signature (No Stu Sanitary Permit Fee (includes Groundwaur , Approved ^ Disapproved Surcharge Fee) ^ Owner Given Initial Adverse .,._~ a ~ Deurminacion IX. Conditions of Approval/Reasoru f//or Disap/proval /'/ I Gc rh ~r ~ I / ,/~ +~ ,/~ ` G/A S Su/o~n ~~c~ ~ r~(ar~ Gi /y lt/QS{ (.U~CT~~ I' ~• _. d r, r /,~ ~i 5 Y@~/!Sr`Ot~ / // ih b><.Cl~d iii SQi~S ~tJi~ ~' • ~- ~stQr~A i^Q'~2 . ' `04-Glt~ . Z) ~Ntj.r ~oerrio•r` 0 ~ !dl.~ve/ nnws~ ~~` ~ ~ B2.' ~/S" g3-~" B'/- /` ~~ bs Zz" (bat - ~~('~~, 623 - yp , a I' a.~ e- r S P ra SPi~ Gl,"f DL ~1~ 0 . b ~ " ~' ~ i ~ 1 .~ J ~ 1 s / .,~. Atlach oomplde planer (to We County on17) for tLe rptem m papa' not lea [Lan 51/2 =11 IoeLa fn aLx ~ ~- ~o r " X'S ~~ ~ ~~~~ ~ N~ ~°~a~fy5 r~ q~~L ` ~S <~ u P 'P ~vwr` ... QB _~1 ~'l, b ~, x ' I~ p. o f ~/ 6 ~ ~,yt ~`.~_ ~s s y. ~ Ly _~ - -~"~ _~ ~ ~~,`~ b •..r( ~,2~3 /~ p S 'l3 _ ir.sa 8.~a -~ z / rs j L t~ S 8~~ c-~ x ~h w~l( I \I t I ~' ~~ ~ ! ~~~, ~, - _~ ~ i ~E- ra ~~E~~ ~~ ~ ~~.y ~ x~z C~~) G-2 Q3 ~ G-3 92• c- ~ .~-~' 8'~- c-`( ss xx G~. ~ftoiv~ Fcrc.rt= Grv,E ~ i'=C1~~t~ ~ ~oo.O ~ , ~4~1= SGT- ~~. ~Couivlj~ Tc~ e/~ ~i ~Y~ l~r~,E f~ ~~ • Try li,/~ Lmr^ ~ ~,,~s ~~ ~d ~- Fogerty Plumbing ' -_ a~~L,c #221180 E-~ ~a ~Cl.~i~ 28288 McKenzie Rd. (~ ~ ` z _..~~J ~' s' 1. w~ tfi~ !~ =--- Spooner, WI 54801 o ~ FE.c~vD 7~'V(~ (715) 635-9609 ~)~ ~~-- ~~~ 30~ ~.Sb ~ QBi ti -~z K /J •= 6'~ c~~ I ~~ rl i! I' ~ i ~- Ta FsE~D ~~ - ~~.~/ ~~ ~ ~ ~~ ? x r2 s t~, \~: a.e~ ' ~j~ri~~ G - z y'3•i G-3 92. ~ c- ~ ~` ~~. scfrGt= / " = ~a ' ~-1~~~ 3 A,~¢E 3 x sG.. E-`/ ss xx 62. ,~ # ~ z 8iit jd~ D~ •vi~C ~"~/ c~Gl~ Tf2~ ,c. •ito~~ F~it.Ct~ G.T.tiE ~ J~t'!~~v ~ /ao.0 ~ ~ tt1= SGT. ~~ . ~ /~=pli/(/.l) ~ T~ 4/~ 2i ~D Y~c. ~ t~~ f'~ a'T 6 =~ ~~o ~ri/~ • rolrN~ LmT c~zn~ies ~~~o~- Forty PlumbM~ -_ c~~Y~ #221180 ~ 0 = 2 -~l~ ~7C• S'~l. w~ r~E-~ ~ ~d ~r•E-~` 2Sp 88 McKenzie Rd. WI 54801 ~'~ F~ c~v~ T~'f'ulG (715) 635-9609 ~' J~f-, . ' 0 °' II b ~ c ~~g ~ •II II v ~o ~~~ ~ ~ ~ ~ ~ d~ ~~M .~ ~ K o a~ ~N~ N~ cd ,1-+ o# N a~ ~ ~ b~A O I I w ~ Wy .. ._ .._._.--~ b,Q v~ ••.,, . ~ . ,. .. Y ~ >r:.! O C. _ ., • ~ Rio ~ a ~' • • • • •••..• T~l ~ v ~ V ~ U r.+ ~ • ~ 'd ~ ~ . ~ j .~ o • . .., • ~ • .:. v, ~ `~ ~' .~ ~ ~ d'• ~• .. • . U ~•. ..,. 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SO{L EVALUATION REPORT Wisconsin Department of Commerce s d Build'+n f S f t g y an e a Division o in accordance ,tY yep: VYs. Adrr+. Code qty Attach complete site plan on paper not less than 81 1 ches ' size. Pia~i+must `Z ion and - ` rc~t l U P indude, but rat limited to: vertical and haizontai re , . point { _ F. o nearesYt~a . tion ~ . a .... percent slope, scale or dimensions, north arrow, a . ~~ , . ' ' Please print all in 1 atian. , ~,.~, ~~ 1 w by Re Personal information you provide may t>e used for seta ~- ~ r lg. purpo ~jivafy Liiw, a'''~`s.od (1) ragj. r e m Property OM gZ operry 4ocation , ,, r /v ®~ ~ s ,. :„ ., t/4 /4 S Property t~vvner's M titling Address ! ~~ ~~ Lo ` ,~ ,Bfodc # Subd. Name a L ~:~., State Zio Code • Phone Number City ^ Village Town ~- [~ New Constnxtion Use: X. Residential / Number of bedrooms _, ~ ... Code derived design flow rate LLi Rgpi~nent ^ Pu c or commercial -Describe: Parent material .~'-~~~~~ Flood Plain elevation if applicable . Page =t-'--- =-_L ~.~..-...L.L N R ',E. -~ Nearest Road ~ ~ ~w C1 (J Boring Boring # Depth to limiting fades `~" in• ft ~~ i • ~ Pit Ground surface elev. _ ~ istence C Boundary Roots GP }{orizon Depth Dominant Cola Redox Description Texture Structure ons .E~ in. Munseil Qu. Sz. Cont. Cola . Gr. Sz. Sh. ... 7 Z ~! G ~....-- ~ •- 7 .Z, .. ..S - - '~ lr I 3 c i ^s s ~ ~- .~ (_J Boring tl ~~ Bonng # (~ Pit Ground surface elev.,~,,2• ~ _ ft• Depth to limiting fads } /~7 in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munseil Qu. Sz. Cont. Cda Gr. Sz. Sh. ~ ~ z .~._.._ d /'f3 2 3 2.. - ~ . ~ - S'" ~, ~ -.r -- .~' ~ ills' t~- G ... ,Z `...- _. Yn - bl1r 1 i 7A .~n Effluent #1 = BOD > 30 <_ 710 mgn. ant t ss >su = ~~+ ~~~~ -...--.° ..- --- - - - ~~~i~~ng & Perk Testing ' neitdfe-- Address C en2 a Date Evaluation Conducted Spooner, WI 54$02 y ~ ~ / a ~~ pto~~ Fc~ GsvE , fG~~v , ~vo. o ~ d tt1. = ~T- ~~ . ~ C=OU/~c/1~, T~ 0~ Zi ~A Yc. v r~~ F = i~o ~~~ -_ w~lL f ~ a~ Fogerty Piumbin~ ' " #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635-9609 r~,~ ~~., ~ ~ l~F P„ ~ l~ . ~ t_ rte. ~ Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washin on Ave gt ` ~ ~ isc See reverse side for insttvctions for completing this application PO Box 730: onsin Department of Commerce personal information you provide may be used for secondary purposes Madison, WI 53707-730: [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if no Attach compl - ete plans (to the county copy only) for th~tattlY n ^~ ex less than 8 state owned. -1/2 x 11 inches in size. County C State Sanitary ~ ~ umber ^ Cheep, if rev' w ~ prev' , q8 apylication State Plan I. D. Number ~ v \ I. Application Information -Please Print all Information ~'~~~~~ 'r• ',~. Location: Property Owner Name ~ .~ ~ Property Location . 1~~/ f . ~ ; ~ ~,' /~' 4 ~/k11/4, S / T29,N,1;/ (oQ~ Property Owner's Mailing Address '~ ~ _..:` is~-, . ._ Lot umber Block Number City, fate Zip Code he Number Subdivision Name or CSM Number L,u sO~ /7' ~~. ~ ~ ~1~",i "~~d-, X77 /~ hN' ~~ ~"~-- Z II. Type of Building: (c6ec ne) ~~ pfec~5 s~~,„.~tf ~a 5 ^ City P ~ 1 or 2 Family Dwelling - No. edrooms : ^ Village ^ Public/Commercial (describe use):_ - ~ a G,~. ~ Z/t ~ Town of ^ State-Owned .~ ~~~CfI~E-~ 1~1~f~A/ ~_ ~•--,r~Jv ~ ~ 2~/ ~ 9 `~~~n ~ c G*_/`-r ' 7 Nearest Road Z ~ d~I l~ ~• 7 ~ ~ ~ Pazce Numbe r III. Type of Permit: (Check only one box on lin A. Check box on line f applicable) Z f, . ~9 A) 1. New 2. ^ Replacement 3. Replacement of 4. 5. 6. Addition to System System T Only Existing System B) Permit Numb Date Issued ^ A Sanitary Permit was previously issued . Type of POWT System: (Check all that apply) ~ , Non-pressurized In-ground ^ Moun ^ Sand Filter ^ Constructed Wetland- ^ Pressurized In-ground ^ Holdin ank ^ Single Pass , ^ Drip Line ^ At-grade - ^ Aero c atment Unit ^ Recirculating ^ Other: V. Dispersal/T~reatment Area Information: ~a .r ~ 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Ar 4. Soil A ication 5. Percolation Rate 6. System elevation 7. Final Grade Required Proposed Rate (Gals. /sq. ft.) (Min./inch) ~ ~ Z ~~ _ ~ 9Y 5 Elevation ~ ~ ,3 ~ ~, ra, } 9~'.~ VII. Tank Capacity in tal # of Manufac er Prefab Site steel Fiber- Plastic Information Gallons allons Tanks Con- Con- glass New Existing Crete sttvcted Tanks Tanks ~~' T-tG- .~ Gve~ ^ ^ ^ ^ ^ ^ ^ ^ ^ VIII. Responsibility Stateme I, the undersigned, assume r onsibility foc installation of the P TS shown on the attached pl Plumber's Name (print) Plumber's Signature (no slam MP/MPRS No. i Business Phone Number rlrD o~ r r z i d - 63s = ~ Plumber's Address (Street, ,State, ip Code 2~~ C E' T-.Z' ~,C' p IX. County/Dep ment Use Only Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued suing Agent Signature (No stamps) `~ Approved ^ Owner Given Initial Adverse Surcharge Fee) _ Determination ~ Z Z~ ~ zD Lo ~ VYY[{[VYJ V2 n~tr• u~a• incuavu~ rur V~Ji1IrI/ruvalr: ~ ~ ~ ~ J ?tr 5)r5~p~ n.kS/Fp, `t4de > /'rit,7~ >~ GovCr ~ il` ~'YzL. ~~ t, a~'J~C~ ~p ~~ SG~r[/%LPG7 ~Ct' M.QYeG4 fem. ~``4/~r S VLL.G~s'lfylG'f~a~~'.~~ S / ~ . ~ ~ys>l« CIPJ~t7liist !r/a5 IGGUe/oA~ ~ .~14.n742rrt ~Q~~~r`~ s~ ~n~/Pr jv~ ~~ CORq,;,~~ /'Q~C SBD-6398 (R. 07/00) 7~~CL i ' moo. ~' ~a,~\ ~E w~~/ 1 / ~~ ~ ~ ~~i ~ `-DSO Gz ~ 6~.s '~ T- 3 -~? s6.~.~ , f.+0 i t ~: _ _ _ .~~ J t7l d" ~~. s~9 ~ ~ PS r=s r 2 s , ~~ s ~r $ q~+es T / ~/ t(/ SGT a-i ~~ .~'~~ 'h~ ~ -~ ~c ,~, Loy- ~~- ~~x~ ~~~ ~~1lC fr/ c.J ~ / / ~8~- /~ F6 GoT # pvG /~rl~i ~sS"~ ~' = ~~~' z~s~ ~:Od ~v1t~ > .So' ~~ .~ " Wisconsin Department of Industry, SOIL AND S 1 T E EVALUATION REPORT Page 1 of 3 • Labor and Human Relations I'1i.ncln.. of C~fnfv R Rnilrlirv.c ~_~_ ' - III QVVVIU ~Illl ILI Ill VJ.VJ, •.IJ. /lVl1~. Vvvv COUNTY but Plan must include in ize 8 1/2 11 i h i t l th l h l S , nc . an x es s an on paper no ess ete s te p Attac comp not limited to vertical and horizontal reference point (BMAdirection and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dist e t nlearesTr~~d. 0 _ _ ION APPLICANT INFORMATION-PLEASFj'~l~Jl]~T~dLL INFORM,A~, REVIEWED BY DATE , PROPERTY OWNER: -~' "r(1 PROPERTY LOCATION i ~ ~~~ ~ ~"`" GOVT. LOT 1/4 1/4,S T ,N,R mot(or) W ' Kernon Bast ~~ ~......- NE PROPERTY OWNER':S MAILING ADDRES , ; ,'~' ~ -, ~~~$ ~--.. LOT # BLOCK # SUBD. NAME OR CSM # 948 LaBar e ~- CITY, STATE ZIP CODE PHOt~ R ~`~,. QCITY []VILLAGE MOWN NEAREST ROAD Hudson, WI. 54016 ~ .> ~-~1G 77 ~~' Hudson McCutchen Rd. 'Jt~rgp 4 [ ]Addition to existing building New Construction Use [xJ Residenti~ Nu~ide ` a J ~ef'di j j Replacement [ ] Public or comm ' Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2 Recommended infiltration surface elevation(s) area A=93.45 Area B=93 . ~ (as referred to site plan benchmark) Additional design /site considerations none Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system CONVENTIONAL ®S ^ U MOUND ®S ^ U IN-GROUND PRESSURE ®S ^ U AT-GRADE ®S ^ U SYSTEM IN FILL ®S ^ U HOLDING TANK ^ S L~ U U =Unsuitable for s stem SOIL DESCRIPTION REPORT Boring # 1 Ground elev. 97.45 ft. Depth to limiting factor84 11 Boring # ~~~;2 Ground elev. 97.45ft. Depth to limiting fact+8411 Depth Dominant Color Mottles T re t Structure Consistence BoLrrtcfar Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color ex u Gr. Sz. Sh. y Bed Trer>ch 1 0-9 10 r2 2 none 1 2msbk mfr w 2f .5 .6 Z 9-17 10 r 4 4 none it m 3 17-27 ZO r 5 4 none sil c b m 4 27-84 7.5 r 4 6 none b Remarks: 1 -12 10 2 2 12-40 10 r 4 4 none sil lcsbk mfr 3 0-45 10 r 5/4 c2d7.5 r 5/6 sil Icsbk mfr w if .2 .3 4 5-84 7.5 r 4 4 n ~g Remarks: PROPERTY OWNER Kernon Bast SOIL DESCRIPTION REPORT Page?' ~f 3 ' PARCEL LD. # 020-1020-90 Boring # <~ 3 ..: Ground elev. 97.051. Depth to limiting factor +84" Boring # :::: .... w> 4 Ground elev. 95.8. Depth to limiting fac+80 ~~ Boring # 5 Ground elev. 95.59 ft. Depth to limiting fact +80 ~~ Boring # Ground elev. ft. Depth to limiting factor ~. i H Depth Dominant Color Mottles Texture Structure Consistence Bourxiary Roots GPD/ft or zon in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-8 n sl 2m r mvfr 2f .5 .6 2 8-16 10 r 4/4 none sl 2m r mvfr if .5 .6 3 1 84 7.5 r 4/6 none ms osg ml na na .7 .8 ~; ~ qS~ 7g.ro ~G z y" Remarks: 1 0-16 10 r 3/3 none sl 2mgr mvfr gw 2f .5 .6 2 6 80 7.5 r 4 6 none ms os ml na na .7 .8 ~, ¢ 9 y. 4' i ~ ~+ ~l . ~- r ~ ~ ti i f. ~~ Remarks: 1 0-9 10 r 3 3 none 1 2msbk mfr 2f .5 .6 2 9-22 10 r 4 4 none sil lcsbk mfr gw if .2 .3 3 2 80 7.5 r 4 6 none ms os ml na na .7 .8 ~ Q3, ~ az. p~,~ Remarks: Remarks: SBD-8330(8.05/92) .; r, ,• STEEL'S SOIL SERVICE Gary L. Steel Kernon Bast 1554 200th Ave. CSTM2298 NE4NW4 s14-t29N-R19w New Richmond, WI 54017 MPRSW-3254 town of Hudson (715) 246-6200 lot #16-Grass Range Second Addn. This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were-not established at the time the test was conducted. N 1"=40' BM.= nail in Elm tree ~ el. 1C Alt. BM.= top of 12" pvc pipe ~.2 r~ Gi ,wtcatnsin oepartrnent of Industry, SOIL AND SITE EVALUATION R E P O R T t abor and Human Relations -i C..i..•.. D. 0..:1.1:...... Page 1 of 3 ' ~ - - C~UN11 but ust include Pl i i 8 1/2 11 i h l h S , an m n s ze. an x nc es ess t Attach complete site plan on paper no4 not limited to vertical and horizontal reference point (BM direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dist e t ~,re`st;r d. _ r ~ ~ ~ REVIEWED BY DATE A ION LL INFORM APPLICANT INFORMATION-PLEAS ~fi , r-~, ~ ~ 3p 9~ PROPERTY OWNER: y' 7 j"~ It /~~ ' '-: ; PROPERTY LOCATION Kennon Bast ~ ~,--;' ~ _ GOVT. LOT ~ 1/4 1/4,S T ,N,R or) W PROPERTY OWNER':S MAILING ADDRE - - -~ ,~'~ ~'? 7 ~ 'LOT # . ~ sss ~-~ BLOCK # SUBD. NAME OR CSM # ~ N STATE ZIP QODE., PHO~ R ^CITY ^VILLAGE ~]fOWN CI NEAREST ROAD Hudson, WI. 54016 `~ ~ `. ~->l~lc 77 ° Hudson McCutchen Rd. ;;~ [~ New Construction Use [xJ Residenti Nu~itae ~(r~ 4 [ ]Addition to existing building j J Replacement [ J Public or comme ' Code derived daily flow 600 9Pd Recommended design loading rate • 7 bed, gpd/ft2 • $ Vench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2 Recommended infiltration surface elevation(s) area A=93.4S Area - eferred to site plan benchmark) Additional design /site considerations n Parent material outwash ood plain elevation, if applicable na ft S =Suitable for system CONVENTIONAL ®S ^ U MOUND ®S ^ U IN-GROUND PRESSURE ®S ^ U AT-GRADE ®S ^ U SYSTEM IN FILL ®S ^ U HOLDING TANK ^ S ® U U = Unsuitable br s stem SOIL DESCRIPTION REPORT Boring # 1 <~< Ground elev. 97.45 ft. Depth to limiting fact+84 1 Boring # :C '~ 2 :. `::: Ground elev. 97.45ft. Depth to limiting fact~r8411 Depth Dominant Color Mottles T t Structure Consistence Bour>da Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ry Bed Trend'l 1 0-9 10 r2 2 none 1 2msbk mfr w 2f .5 2 9-17 10 r 4 4 none si f 3 17-27 10 r 5 4 none sil bk 4 27-84 7.5 r 4 6 none b Remarks: 1 -12 10 r 2 2 2 12-40 10 r 4 4 none sil lcsbk f 3 0-45 10 r 5/4 c2d7.5 r 5/6 sil lcsbk mfr w if .2 .3 4 5-84 7.5 r 4 4 93.7 93• y ,k8 Remazks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave. ew Richmond I 54017 Signature: Date: 8-25-98 CST Number: m02298 PROPERTY OWNER Kernon Bast SOIL DESCRIPTION REPORT Page? ~of 3, ; PARCEL I.D. # 0 -1020-90 Boring # 3 ~~4r ,~; Ground elev. 97.051. Depth ro limiting ~+84" Boring # .? 4 ::a'? Ground elev. 95.8. Depth ro limiting factor +80" Boring # ,~.::~ w~~- 5 ~:x Ground elev. 95.59 ft. Depth to limiting factor +80" Boring # •EiM1 :n{ ~ v i.:.''::iry~'ii Ground elev. ft. Depth ro Nmiting factor Horizon Depth Dominant Color ~~ Texture Structure ~~~~ Baiffiry Roots GPD/ft in. Munsell Cau. Sz. Cont Color Gr. Sz. Sh. Bed reach 1 - s 2m r mvfr 2f .5 .6 2 8-16 10 r 4/4 none sl r mvfr if .5 .6 3 16-84 7.5 r 4/6 none ms os ml na na .7 .8 ~7 .~ `t3y Remarks: 1 0-16 10 r 3/3 none sl 2m r mvfr gw 2f .5 .6 2 16-80 7.5 r 4 6 none ms os ml na na .7 .8 2. Remarks: 1 0-9 10 r 3 3 none 1 2msbk mfr 2f .5 .6 2 9-22 10 r 4 4 none sil lcsbk mfr gw if .2 .3 3 22-80 7.5 r 4 6 none ms os ml na na .7 .8 Remarks: Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Kernon Bast 1554 200th Ave. CSTM2298 NE4NW4 S14-t29N-R19W New Richmond, WI 54017 MPRSW-3254 town of Hudson (715) 246-6200 lot #16-Grass Range Second Addn. This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1"=40' ~I.= nail in Elm tree ~ el. 10 Alt. ~I.= top of 1 z" pvc pipe ~.2 r~ G; ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner er ~E,t,~ilJ/c/ ~ii¢¢S~T' Mailing Address `~'y~ L~,P/ft,~~ ~ f~~~dSa,r/~, c.e,~T' ~ ~/C/~ Property Address (Verification required from Planning Department for new City/State ~tGl ~SD~, ut-~ Parcel Identification Number ©,Zp -~ ~ Flo -' /6^G~ LEGAL DESCRIPTION Property Location /~ '/<„d~ '/,, Sec.~~, T~N-R~~\~l, Town of - Subdivision _ ~d'~f tea/<,E' ,Lot # /~ Certified Survey Map # `~- ,Volume `~- ,Page # Warranty Deed # _ S',1.~~-y5^ .Volume l/~ ~/ ,Page # ~~y Spec house ^ yes f~ no Lot lines identifiable ~ yes ^ 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 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 wastewaterdisposalsystern 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 Office within 30 days a~f the three year expirati date. 1 f -~ l l SIGNA OF AP CANT DATE OWNER CERTIFICATION I (we) certify that a!! statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of t e roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. .c,~ ~ / / SIGNATURE OF LICANT DATE **«**« Any information that is mis-represented 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 a copy of the certified survey map if reference is made in the warranty deed ~1~ \ N~ -. ~ o.~i ~ ,~~1 ~ r ~-~ : o ~~~ 3 ~~92 ~ ~ ~ ~s sag 26 g .~ o ~ o ~.g,~, S, 6 -- ~ G,~ X02 ~ ~ ~ °~ ~ °cJ ~ ~ ~ a N ~ ~ 3 \ o~c ~ cu ~/ ~ ~~ ,~ ` r> r~ Y ~ `~ ~~ \ . \ ~~ Z . ~~ ~~ q°` ~, ~ ~j~ ~b1 ~~ ~.Zt~S ~. ~ ~ ~ f r O ~'b'0$T 3„60,~Z.OOS ~ I ~. c ~ o ~; o ~ , I ~ rl .. ,I ~o :.. I 117 ct) o~ ', N ~ ~'1r " . 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