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HomeMy WebLinkAbout020-1356-17-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Villa e ^ own off:. ast, Kernon Hudson ownshtp CST BM Elev.: Insp. BM Elev.: BM Description: TA I F MATT N ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic G ~ z~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic -+• YZr ~-~ ~ NA Dosing NA Aeration NA H ldi ng o Pl1MP / SIPHnN INFORMr4TInN Manufactu errand Model Number GPM TDH Lift Lrlction stem TDH Ft Force In Length Dia. Dist. To SOIL ABSORPTION SYSTEM {~s +~ ~~ BED T~.91 width ( Len th r o. Of s PIT No. Of its Inside Dia. Liquid Depth EN I N Z Z S DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manu acturer: SETBACK INFORMATION Type O r r CHAMBER Model Num er: ^ System: l.~ V , ~ ~S ~ OR UNIT DISTRIBUTION SYSTEM ~,R~~,.~1-/j:~; ,~ r~tz•~~ ~ ~~•~) Header~l panifold u Distribution Pipe(s) ~ ~ x Hole Size x Hole Spacing Vent To Air Intake Length ~ Dia. ~ r Length ~~ Dia. ~ Spacing ~ ~ `~ ~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over w Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Cen r ~c( •(- Bed/Tr nc Edges Topsoil ^ Yes ^ No ^ Yes ^ No ^'~'` °C1- ~` °~'''• ~' `"'~~ lnspectlori ~l' ~/~/ "UmSpel%L1UI11tG: ^-i---I'- COMMEN nclu e c e discrep ties, persons present, etc.) Location: 714 Paul Burch Drive, Hudson, WI 54016 (NW 1/4 NW 1/4 17 T29N R19W) - 14.29.19.2079 Grass Range Addn. II -Lot 17 ` 1.) Alt BM Description = ~ ~ ~-~' S' ~ °~"` 5~- ` /A J g tµ ` "~ ` C7 2.) Bldg sewer length = ~ `/`F ~ 1..~~ J -amount of cover = ~` (~,~ (0 p ~ a,~ ~ pv ~ ~s) ~-~ Plan revision required? ^ Yes ~ No o~ p0 ~ ~ ~ S ~ Use other side for additional information. ~~ SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. Coun>~jt. Croix Sanitaf~EQrpi,jt NO.: State..SSPIaSJn.ISDJJN44o.: ParceLT~,lc Nq,56-17-000 STATION BS HI FS ELEV. Benchmark ~ , ~ r ~p3. o r (6fl_a Alt. BM (o -• !s o~• ~s'- B. `f~ ~ Bldg. Sewer q~. fS ~ St/ Ht Inlet /S 9`i/•O r St/ Ht Outlet ~ 3~ ~3. -fir Dt Inlet ~~ Dt Bottom Header/Man. `~ 4's° . rz foS r R !. Dist. Pipe q; ~ ~J~. ~$ ~ Bot. System `~' 90, 63 ~ Final Grade St cover cj- ~ qS 3 3 ~ r i' tl i~ ADDITIONAL COMMENTS AND SKETCH , SANITARY PERMIT NUMBER: ~m ~ ~ mmrm i -,-4~~,. ``~~-- ~risconsin Department of Commerce ~ 12evi ~ ~ ~( SANITARY PERMIT APPLICATION In accord with Comm 83.05, Wis. Adm. Code Safety and Buildings Division 201 W. Washington Avenue P O Box 7302 Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, on paper not less county than 8 to x 11 inches in size. S C • See reverse side for instructions for completing this application state sanitary Perml Number ~ f;,~tl L $N,LL,lS~ 3 S 7j ~ ~~ Personal information you provide may be used for s~ r~o y ~ neck if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. ~~.~ ate Plan I.D. Number /... - I. APPLI ATION INFORMATIO =~~P EASE>d~R T F RMATION Prope yOwner Name 7 ~r~„]~ r ~ O.r/ / ,..~ t`.: L.~, . \ .~-- . Property Location ~,il/a t/a, 5 TZ 9 , N, R E (oI,~J Property Owner's Mailin Address f ,~ ., ~L~~ - ~ Lot Num er Block Number City, 5 ate Zip C ~ , ZS umber ;`~- Subdivision Name or{-SM~w~ber a+ caz r II. T PE 6 ILD NG: (check o ~ e Own~eiti~~ ^ !ty Nearest Road Public 1 or 2 Famil Dwellin ~~ ': ^ Village Town OF III. BUILDING USE: (If building type is public, ply) Parcel Tax Number(s) 1 ^ Apartment /Condo -- - ~ 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/Repairs 11 ^ Restaurant/Bar/Dining 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office/ Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1. ~ New 2. ^ Replacement 3. ^ Replacement of q_ ^ Reconnection of 5. ^ Repair of an ______System _~______System_____________TankOnly______________ Existing System ________ ExisttngSystem B) ~ A Sanitary Permit was previously issued. Permit Number jf' Date Issued ~.. Z T_ _ ®~ V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11~7j5eepage Bed 21 ^ Mound 30 ecifyType 41 ^ Holding Tank 12 ^ Seepage Trench 22 ^ In-Ground Pressure , , 42 ^ Pit Privy 13 ^ Seepage Pit /~2 ~ Z 43 ^ Vault Privy 14 ^ System-In-Fill .~ VI, ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Galslday/sq. ft.) (Min./inch) Elevation oD ~"S~ D. Feet p Feet VII. TANK Ca aclt INFORMATION in gallo s Total # of Manufacturer s Name Prefab. Site con- l Fiber- Plastic Exper. N E i ti Gallons Tanks Concrete stee glass App ew x n s strutted Zo Tanks Tanks Septic Tank or~lk r- ~,~® ^ ^ ^ ^ ^ L ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of a onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No St s) /MPRSW No.: Business Phone Number: .-. 7"" ~ Z / / ~d 7 ~- Plumber's A dress Street, City, State, Zip ode): a ~ w~ o Z IX. COUNTY / DEPARTM NT USE ONLY ^ Disapproved tary Permit Fee (IndudesGroundwater ate slue Issuing Agent Signature (No Stamps) Approved ^ Owner Given Initial Surcharge Fee) OD ~ 5 ~ Z < Adverse Determination J . ~ C~ON,DITIO~NS OF APP O~ / R~~~FOR iS~V`fL~~S~ ~j~e~ ~/ u _ ~~~ (R. M99) DISTRIBUTION: Original <o County, One~copy To: Safety & Buildings Division, Owner, Plumber ` 'INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be~~approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD-6399) to be submitted to the cognty prior to installation 5. Onsite sewage systems must be properly mairi'tained."The septic tank(s) must be pumped by a licen`sed~pumper vvhenever necessary, usually. every 2 to 3 years. 6. If you have questions concerning youY onsite sewage system, contact.your local code administrator or th_e State of Wisconsin, Safety and Buildings'Dtws'ron; 608-266=3151. - ~ ~ ~ - To be complete and accurate this sanitary permit application must include: I. Property owner's. name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. ~ ~ '" ~~ ~ ~ ~' II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. Vlt: Tank i~riformation. Fill in the capacii:y of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),' address and phone number. Plumber-must sign application form. IX. County /Department Use Only. _ X. County/ Department Use Only. Complete plans anda~ecifications not smaller than 8 1/2 x 11 inches mustbe submitted to the county. The plans must iridude the following: ~A) plot plan, drawn to scale or with complete~dii'nensions, location of holding tank(s), septic" tank(s) or other treatment tanks; building sewers; wells; water mains water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose_volume; elevation differences; frictionaoss; pump performance curve; pump modeh and pump manufacture~;,p) cross section of the soil absorption system if required by fh'e"ciur~fy; E) soil test data on a `I 1 S form; and F~afl sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ~ °~" '~/7 '~ tC,~CF l "= yD ~ X~ _ ~, jd~ ~F ilJf~L ~iJ S.w~Ct '=~G~t «z.o ~. ~~ y X = ~,~ ~*jtr,t/~ G.r coc,.~ E/r '%t` = sr.~ ~ mac r~E ~ ~/ .~A-'t z~Y' ~i ~~Z~ ~~ cry ~,vs~; s~s ~gd I -~' ~~ ~~ d 6-~ ~~rrr~~ ,. ,. 1 ~ ~/ I' ~~ j ~.,, ;~. " ~8 ~ ._.- s~f ' '~~ ~ r 8- 4 --- Fosrey ~~bi~s X221180 28288 McKenzie Rd. Spooner WI 54801 (7-115) 635-9609 ~J ~~ fi , ~s-~ ~ ~-sr Wiscon$i Department of Industry, SOIL AND SITE EVALUATION REPORT Page ~ of ,3 • gabor a~ Human Relations Division of Safety 8~ Buildinsis __~ ...:.., n ~ ~n nn nc \A/:_ AJ.~. n_.a_ ~~~ axVVal~a. ..~u~ ~~~ ~~ a al~.vv, •.~~a. .~an~ vvaav COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan must include but ~~ f~to ~ . , not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ~ ,~~--/ ~-ODd APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION IEI~/EDBY DATE ~~ PROPERTY OWNER: PROPERTY LOCATION X/O~ 5/ GOVT. LOT k/ 1/4~~1/4,S/ T 2~ ,N,R E (or~ PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY STATE ZIP CODE PHONE NUMBER ^CITY ^VILLAGE OWN NEAREST ROAD .,~ ~r/ c~t~ S o !6 ( - S rS~cr,OSo~C/ ~RchF ~K• New Construction Use J/j Residential / Number of bedrooms [ ]Addition to existing building j ]Replacement [ ] Public or commeraal describe Code derived daily flow d~sd gpd Recommended design loading rate • z bed, gpd/ft2~~trench, gpd/ft2 Absorption area required ~_ bed, ft2 ~, 7~7 trench, ft2 Maximum design loading rate . ~ bed, gpd/ft2~trench, gpd/ft2 Recommended infiltration surface elevation(s) yiZ.rr~ci yb.b ~ BEy ft (as referred to site plan benchmark) Additional design /site considerations 7. ~'it~,'tK~S d Parent material ~;~i„ss`r T s ~c. s' Flood plain elevatio , if applicable ---- ft S =Suitable for system U=Unsuitable for s stem CONVENTIONAL fa S^ U MOUND ^ S ~U IN-GROUND PRESSURE S^ U AT-GRADE ^ S U SYSTEM IN FILL ^ S U HOLDING T NK ^ S ~U SOIL DESCRIPTION REPORT Boring # Ground elev. ~j~~ ft. Depth to limiting factor > 9Z Boring # ~~~ ~.. ~. Ground elev. . i n. Depth to limiting factor H i Depth Dominant Color Mottles Texture Structure Consistence Bour>da Roots GPD/ft or zon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed Trench 4 -- Z ---' L ? C' ~ 3 3 S - ~ w-G R®. Qi 3~. Z ~3. Z Remarks: ------ ~FS.Io (. b a Remarks: Name: Please Print ~ ~li~Sl') ~ ~~~.,~ rt ~ Phone: „7 ~ f, ~ ~~ 5...~ Date: CST 3~ f/~o ~.i // c PROPERTY OWNER ~/4r/G;rt'~ ~S~ SOIL DESCRIPTION REPORT Page~of 3 s. PARCEL I.D. # 02 0 -- /3 ~ -! ? - d~'r~ Boring # :tit tiffAA<'CC::;iihµti 4~y\ ::;: k•+x Y 4: rte::::::: ni:i~ ..~.. Ground elev. ~~ ft. Depth to limiting factor ~`~ Boring # :<r .<f~ s:: Ground elev. ft. Depth to limiting factor >~~ Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend / - 7. ~'' - 3 -' ,tr F . 8 2- - - v B ~ hr L -- / f=- . ~ Remarks: ~ o-~ . s - 3 LS ~ ~sdx ~dF r w, .8 ~- / ~ s ~ L Remarks: Boring # .................. ::: <:: i :: ; :: :: :: :: ; :: \~4 Ground elev. ft. Depth to limiting factor Remarks: Boring # ~:v\ ii,. 4,ii Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) Feprly Plumbing #221180 2$288 MdCeraie Rd. j 635! X91 ,~ r~ ~<<~ ~~~ 3/1'/a zzy= ~y ~ i X jr~ r ~.~ X ~- c ~ ~ P~~ r_~ i-l_ ~~x B~ 5:3 s~ ~- ~~ ~ ~ ~ = T 3 = ~ ~~~ ~'S ~~~~ ~3- s~ ~~ I ~t/o f/SE I _ $i - ~z~v. GvT st/ 7 L1yU/ = dM~ jb~ 8!t Nll~rL .~'~ s'no'Alf ,eG~r T~~ 1~0.d ~ ~- #2 '` BN'J ~ Tod Aj 2"~dG ALo~%'~' ! Elt.~aE' L.tiVE! ?~ ~/ r x = Be,crv 6 Finav1) 6or coiW~~ = s~r~GC E"LN7 TRFF ! = 77Qalvcff - s,~I,ELGS ova y ~ C'3 - 3 X s~, ~(.tY= 90.6 ~ ~FD~ /2 jC7a. 1 ~/, o ~-D /dla Z- io/. f iAa ~ 3 ~ s ~z ~ ~y y ~ 6 P 9s ~ 9y s ~~!! ~~/SC0I1S%n SANITARY PERMIT APPLIC , Department of Commerce In accord with ILHR 83.05, Wis. Adm. Coy • Attach complete plans (to the county copy only) for the system, on paper than 812 x 11 inches in size. • See reverse side for instructions for completing this application Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1) (m)]. ~~ x ,n ~^ ~' ~ f £ ~-~~ Safe: and Buildings Division ~~JN - ,•- 20a: .Washington Avenue ~~; .'. 'P ox 7302 ~' ~~` . ~ P,IL~i.~{i~E ison, WI 53707-7302 no r s ` ceunty t State Sanitary Permit Number 35-'3 3.5~ ^ Check it revision to previous application State Plan LD. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Pro rty Owner N me f Property Location is 1 ia, S ~ T , N, R E (o Prope y Own 's Mailing Address Lot Number Block Number City, State Zi Code Phone Number Subdivisi n Name or CSM Number II. PE IL ING: (check one) ^ State Owned ~ it~ Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ~ Town OF y III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) ) 'J1~ , Iq , Zo ~;~ /3s6 - ~7- ~o ~ 1 ^ Apartment /Condo 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/Repairs 11 ^ Restaurant/Bar! Dining 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicabie) A) 1. d( New 2_ ^ Replacement 3. ^ Replacement of 4_ ^ Reconnection of 5, ^ Repair of an ______System ________ System - -_ Tank Onl~______________ Existing System ____-__^~Existln~S~fstem B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ^ Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 1 Seepage Trench 22 In- roun P s re (~, , 42 ^ Pit Privy n ~ ~ 1 ^ Seepage Pit ~~~L 2 - 3 X 7S 43 ^ Vault Privy 14 ^ System-In-Fill 7 /. , S8 ..Z T = ' ^' ~ ~ . 7 EIS VI. ABSORPTIONS STEM INFORMATION: ~Cittx~0~' o Tn /2 ~ .1s . s.~ ~~ ~~~.~ 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading ate erc. a e ystem Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Galslday/sq. ft.) (Min./inch) ~pE/ ^ Qlt' ~ Elevation Sd i~z. ~ , SFeet ~'1- f• SFeet TANK VII Ca acct . INFORMATION in allons g TOtal # Of r Manufacturer s Name Prefab. Site con- Fiber- Plastic Exper. N i E ti Gallons Tanks concrete steel glass App ew x s n strutted Tanks Tanks Septic Tank or+4eWing-terpk ~J ~+~E f ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of th Hite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber' ignature: (No mp MFPfMPRSW No.: Business Phone Number: ~ ~.,- 8a 7 --3G s P tuber's Address (Street, City, State, Zip de): ~ v Yo ~ IX. COUNTY/ PARTMENT SE ONLY ^ Disapproved Sanitary Permit Fee (Includes Groundwater ate slue Issuing Agent Signature (No'Stamps} .'Approved ^ Owner Given Initial ~ A Surcharge Fee) 5 ~ 3 Z~"Zt~ Adverse Determination • X. C.UNDI I IVNS Ut APPKC~V ASO~IS~F~R I~ISAP~~VA f ~~ .~ . ate-, ~~{'--rr ~'e'/ ~ ~ ~-~ SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. - 6. If you have questions concerning your onsite sewage system, contact your local code administrator or-the State of Wisconsin, Safety and Buildirigs Division, 808-286-3151. To be complete and acwrate this sanitary permit application must include: I. Property owner's name and mailing address,. Provide the legal description and parcel tax number(s) of where the system into be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on-line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval fro-n DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.:), address and phone number: Plumber must sign.application form. IX. County/ Department Use Only. _ t X. County / Department Use Onty. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacture; D)..crosssection of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ,~ cr.~ F.~'~ GsT ~ L ` Goy ems! /S/ ~ c-- ~3'• w~ ~~ G=' F~~ni , ~.,~. ,' 1~ i ~ ~Z E~~~`~ J~~~ 3~~~~~ '~ Sc.~cc ~ ~• = yv ~zn- Titer ~ / /AOi 0 ' X = 3ErcrivG /.tan ~ 4 S'. r^^. ® = G.9~L 71' = Ss~~tc ~cw, ?~~E C,~ ~ryr., s~r.~k ,~av~'r'r~ FAr2J v ~ ~ ~~ ~I ~I r i 7 8~ .,. r 70 ~ - - ---~ • wsconsi~epartmentoflndustry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 • L~SOr and Human Relations Ilrolcinn ni Rnfoty R Rllilr~inns w ~~ /+...,1.. 111 QVVVIV Wllll ILI 111 VV.VJ, ..IJ. /~4~~1. vvvv COUNTY but Plan must include h s i ize th 8 1/2 11 i l l i l A St. Croix , e n s . x nc an on paper not ess an ete s te p ttach comp not limited to vertical and horizontal reference point F ajrec-tion~nd % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dis c@`towiAakesi road ~~,., 020-1021-00 APPLICANT INFORMATION-PLEASE fE~11J~'I`~~A L IA~ORMAt,FO~ RE IEWED BY DATE ~ r 4 , ~B PROPERTY OWNER: J _.~',• -`"' ' "'' ' - ROPERTY LOCATION ; Kernon Bast ' ~~^~F~ ~ - VT.LOT ~ 1/4 ~ 1/4,S 14T 29 ,N,R 19 ~{lor)W PROPERTY OWNER':S MAILING ADDRESS ~. ~ ~ •` T # BLOCK # SUBD. NAME OR CSM # 948 LaBar a Rd . '} r `" RC3ix 17 n r CITY, STATE ZIP COD ~~ ~''PHQ~ I ~~;~~ • CITY ^VILLAGE [MOWN NEAREST ROAD `'~1~ 386-77 . ~ '~" Hudson WI. 54016 ~~:'~ Hudson McCutchen Rd. .,. [~ New Construction Use [X ] Residential / Nu'~ ,'Q ~ d 4 [ ]Addition to existing building j ]Replacement [ ] Public or commercial describe Code derived daily flow 600 pd Recommended design loading rate . 7bed, gpd/ft? 8 trench, gpolft2 Absorption area required-'bed, ft2 750 trench, ft2 Maximum design loading rate ~_bed, gpd/ft2-trench, gpd/ft2 Recommended infiltration surface elevation(s) 98.00 ft (as referred to site plan benchmark) Additional design /site considerations trenches spaced to code 3/50.% below surface el. Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system CONVENTIONAL ~] S^ U MOUND ^ S fl U iN-GROUND PRESSURE ~E] S^ U AT-GRADE ^ S ®U SYSTEM IN FILL C~ S^ U HOLDING TANK ^ S fl U U=Unsuitable fors stem SOIL DESCRIPTION REPORT Boring # 1 Ground elev. 101.5t. Depth to limiting factor +80 Boring # 2 Ground elev. 101.8 ft. Depth to limiting fac+84 1 Depth Dominant Color Mottles T t Structure Consistence Bourxdar Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color ure ex Gr. Sz. Sh. y Bed Trer>ch 0-8 10 r 3 2 8-18 10 r 5 4 none sil lcsbk mfr w if .2 .3 3 18-80 7.5 r 4 6 none ms os ml na na .7 .8 -B ~ti 32.E rg . Y - ',~`~..! Remarks: 1 0-8 10 r 3 3 none 1 2msbk mfr w 2f .5 .6 2 8-20 10 r 4 4 none sil 2msbk mfr if .5 .6 3 20-84 7.5 r 4 6 none ms os ml na na .7 .8 ,Q. S aba 34 /~ z- Remarks: *24" x 36" Sil lens c2d7.5yr 5/8 sil M non contigeous in boring. PROPERTY OWNER Kernon Bast PARCEL I.D. ~ 020-1021-00 Boring # h'i:~,t` 3 Ground elev. 99.5 ft. Depth to limiting factor ±~.0" Boring # ... 4 <> Ground elev. 96.3 ft. Depth to limiting factor +80" Boring # ~< 5 .... Ground lev. ~6.5ft. Depth to limiting factor + " Boring # Ground elev. ft. Depth to limiting factor SOIL DESCRIPTION REPORT Page ~,~of -3 . ~• Horizon Depth Dominant Color ~~~ Texture Structure Consistence Bourxiary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh 1 0-15 1 2 15-80 7.5yr 4/6 none ms os ml na na .7 .8 lb 3 6 ~~ Z' Remarks 1 0-6 10 r 4 3 none sl 2m r my r 2f .5 . 2 6-80 7.5 r 4 6 n f 90. o ~--- Remarks: 2 10-20 7.5 r 4/4 none sl 2msbk mfr if .5 .6 3 0-80 7.5 r 4/6 none ms os ml na na .7~ .8 Remarks: Remarks: SBD-8330(8.05/92) . °, ~ . , STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. Kernon Bast New Richmond WI 54017 CSTM2298 NW4NW4 S14-t29N-R19W ' MPRSW-3254 town of Hudson (715.) 246-6200 lot #17-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 mayor may not be as shown as permanent lot lines were-not established at the time the test was conducted. 1 ,s~~~ ' =40' ~~ nail in Elm tree t el. 100' t ' ~ ~~~'~ ~ t. BM.= top of 2" pvc pipe C el. 93.40' ~.D {~ 1~ ~ 4 l t 1~~ a5 ~ ~4 ` `Z` ~'" ~ r~- ~.~ 3 tOti ~° ~~H ©rh ~ ~~ 9•~ \\'' C ~ 1 ~ l t~i'~ ~~~ 3 °~a ~~ ~''l Gary L. Steel 8-19-98 .~- ~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ~ ~ AND OWNERSHIP CERTIFICATION FORM Ownerlr 4~~~0 ~ ~i~3T Mailing Address ~'Si~ ~.~ .c ~~ Property Address (Verification required from Planning Department for new 020 _ /3r b ,/7~ ,A~ City/State ~S'~- _ ,~ SY~/~ Parcel Identification Number ''~ .,, ~"-''; LEGAL DESCRIPTION Property Location ~li~ %<, .r/~/ '/<, Sec. ~ TAN-R ~~i~, Town of ~6/~Soit/ Subdivision ~,~Itt~-S Jp/~i~/~~' ,Lot # ~_. Certified Survey Map # Volume ,Page # Warranty Deed # S2~7y.S~ ,Volume /i.z~ ,Page # ~ Spec house ~ yes l~ no Lot lines identifiable yes ~ no SYSTEM MAINTENANCE Improper use.and maintenanceof 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 masterplumber, journeymanplumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal 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 Office within 30 day of the three year a iration date. SI A P iCANT DATE OWNER CERTIFICATION 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 e roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. 3 //~'"/ O a SIG TURF OF PLICANT 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 r~bc.uMEr~T No WARRANTY DEED STAIR ISAfi OF WISCONSIN FORM 'L-1982 5~02:~1 ' y11 1 `%~'~FK~c j~~~ L J /~ r. Ray.G,...Orown. ~nd_>rl,eanore Brown, husband.and_wife,- ;. ~ - 1 ' ,~• - - _ _ . .._ _ ... _ _ .. _. --.... JUN 2 191 _ ._ _ _..... _ ...... _ a a : Rio . r'OUV CYS anll Warfant~c t0 .. _. .-. .. __ .... -..._ .- - .... - - , ~ ,~ ~.. Kennon Bast and .~onalda .Speer-Bast,a/'.c/a Donalda J.. S~ae~~' ,r ~4~ .t ,~ .ra. husband-.and r~i.fe ......... ._......._ _ .. .. _. _ ............ ..._ .r!srn,.,ro<e.::; for $1.00. and.other---valuable consideration _ .. _... .- ~ , _ ..... .... ... ..... .... .i I:1111 irN '7 ~:I - - St. Croi:c ...--Count ` ~` the following described real estate in ..................._...._........_... y, State of Wisconsin: ~ Part Of Taz Parcel No: --020-102.1-n0,-_--. i ~' ~ ?art of N•W 1/4 0. NW 1/4 and Part of NE 114 of \d 1/4, All in Section 14, ++ ;ownF,hip 29 North, Range i9 Weat, St. Croix County, Wisconsin., described as ~; follows: Begi:rr.ing at :he r'w cc;rner of said Section 14; ttlence X139°43'45"E: along the Vorth sire of the N:~ 1/4 ci said Section, 1387.25 feet; thence S00°23'09"~ 91C.~5 feet to the Point of Beginning; theZCe S89°32'31"W 558.46 ~ee~; thence S00'07'20"W 105.90 feat to *_he h'W corner of ti~at parcel of land 1 recorded and described ir. Vol. "952", Page 382 at tY.e St. Croix County 2egister of Deeds Office; the:ce N89°24'30"E 157.00 feet alor_g t::e Nort '' line of the parcel of land recorded and described i.: Vul. "952", Page 332 to the NE corner of said Vol. "952°, Page 382; tFeres S00°07'17°W along the East line cf aaid Vol. "952", .Page 382, 299.42 feer_; r_hence Nf39°24'30"E 405. C5 feet; thence N00°23' 091"~ 405.00 feet to the Poir.*_ of Beginning. ~' This deed is given in partial performance and satisfaction of a Land Contract dated July 2. 1992, recorded July 10, 1992, in Vol. 958, Page 577, Doc. No. 985728, in the office of the Register of Deeds for St. Croix County, Wisconsin. The above- d reel is to be reconve ed to an adjoining landowner, Thomas I. Wiley, to describe Y Pa be merged into and become part of his existing cor_tictuous parcel, and shall not thereafter be conveyed or encumbered separate from said contiguous parcel into which it is to be merged, unless subsequently subdivided pursuant to applicable state, ~i county and town laws and ordinances. Thi:; 1S tlOt-- _...-_. homestead property. '1'hg real estate transfer fee was paid at ~ (is) (is not) the time of recording said Land Contract. P:xccption to warranties: Subject t0 town road right-of-wsy over the southerly side. O?Q ~~ May is 97 Uated thi> _ ... .. _.... day of ._ _ . s ~~ ~i ~ .....(SEAT.) ~~~- (;;I;A1.r - Ray..G,-Brown-.-.-..-.. _. •Eleanore Brown _. - - __ ......... . ..._ _ _ -.(SEAL) _ _ I:;EAI.- AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN S$. _ ST_._.(.'BOIX-----------------County. ~~ authenticated this ..__....day of_...__....___.._.._____., ]9...... Personally came before me this _ _. -.-.__...day of ------ •-------•-- -1`'Sd}!-•-------- -' ' ]9. 97.. the oboes name,{ •----------------•-••------...-•-- ------------------------- -----•---••---- - Aay- G.,..BzoWnt__and ------- - - - .... - -----...... .. TITLE: bfEMI3E :STATE BAR OF WISCONSIN -.~~~df]QL'@-Br'own,_ .................. - _ .... (]f not. -- -----• ........ ............ .......... authorized by § 70G.oG, Wis. St.~.ts.) Brenda Poulin ..husba>.d--and-_wl._fi- _, _ Notary Public !o me kn vn to be the per~On S..- _.... who c~cocuted the State of Wiscon:~are~°i instrunrcnt an •tck~,wl (dge the saint. THIS INSTRUMENT WAS DPAFTED BY `'L y %(, /LV~ William J. Gilbert, Atty. ' - ~-- --- - `-~- - '- _... _ _. 206 Second St., Hudson WI _~Olb - -~ - - -. - --•---••-•-----•----•--------------°•--°------•-•-•----_._----------------- Notary Public ...... St. Croix- _Connty. Wis. (Signatures may be authenticated or ackno•xle.'ged. Both My Commission is permanent. ((f not, •stntc expiration are not necessary.) date: ----~~f ~~ . t9a~°.)~ -, rti~ k . z vrh'JS~fi.'0 ~ : ~'t,.A ' , . ; ry + ~ ~' ~ ~ k F Ir ~~', rt^i ~ ~, `~-a. -{! -s • i+ -~ ~ :r.~ • ' ' h-Aa. 1 ,t. U. ; ~ ti:^ , .. .. ~.. .~ •~ ~ ~-. LOOATInN 3Jl~":'1CH ~~~~~ ` ~ . LOCATED IN FART ' 0. ,~ ~ ~ N `' ~ THE N~° 1/4 OE T.~~.A~ =--~ 0~' NUI1 SON, ST. t'~t 1(]! i ~~IIP Q~ ~Z"r~F_LArfp,~ tER 14 LOT 2 LOT 3 N B9°43 ;~~" E 1387.25' F~ 265.93' ~'~ ~H.W.L 919A ~M.W.t,. ~ _ 583.28' w ~ / ~y . t 922.0 \ S VATER T~ EN AREA. ~ f 8 r' N ~ K ~ `.SS ~EYEgTIQ'1 ~ N ~ 93,388 ~ ~ ~ ~/" ~- 2.563 ACRES t~ . `~ ~~ Ss 111,644 5Q FT. z , ~- __ n ~ ~•-~ ~ / H•W.1. = 9s.2.Q ~ ~.~394 ACRES 1 126.059 SQ. FT. `9~, \ . ' ~,•, ~f ---. `'. STf~til VATER RETEIITfDi AREA ~1 ~~ ~,~j~/~ ~ ~ •~'!- Nf9~` .:'V 447. _R ~ ~kA~. . ~.AL'.~ ' SP.9'S2'25"E 446.78' nt `~ _ .~ ~ ~ ~ ~ w . -u w d ~ • ~~x • ~ 2.2E AcR~~ -' .~. ...a r. r.n r'T 1 ~ ,~~...... .. 7~.-- _.. ^ ~1~. ~L:a7 ~ , 2,875 ACRES 125,?46 Sfi. F` ~~ti a y •~ STt1RP+ u;:TE i SECTION 1~ ~TZBx, Rr$~r 1' Wit.-,-"~~ y'^~~., ~~i - - ., ~_"~ -~"-~- i,gxy sr ~'' ~ i~_.-a ter, ~ a~'~ ~.i "J!1' 1 ... ~... M ~ ~ ~~ ~' ~s 1 T.~~'~s N~1/4 (1~' ~'~.~ Ni~f/4 ~1ND L~ P~fi OF oaN~.oA .,. SPEER- ~ ,`'~ 94$ LoBARGE ROAD ~/4 0.~ s~CT~O~ ~ 4, T29N, ~ ~ s ~r, TO ~-N HUDSON. ~, s~0, s COUNT, 1/ISCQ~NSIN. OF HOMESTEAD _" .i ~ ~ ' IAT 1 ~ I I.OT 26 , ~c+»w~ Q. = eeb. l.I~ OF THE NWl/4 N 89'43'45_E~ - ~ ~n _.L.____ -~-- ---~ .44• ~S~`' ~ 1237.08' ' \~ Nt /4 CORNE H.w ~ ~ SECTIOfV 14 Es oti ~ LOT f4 ~ ,.~i, `~ 0~2 ~ sue, ~ ~~~ ~' / ,~ Ln~, f3 !6~ \~ ~ :. \ \~~~ \~ 127,676 S9. fT. `f~ 9 / '"Vf~ ~.Q~ • QUO ~k.. ~ \ ' \ os, .h ~ r . ~ J~ ~ ~. S ~ 2.505 ACRES ~. \ ` ~`''l+ . \ ~~~> , ~ ~ 109,113 SQ. FT. ~ ~ ~gC9l~~~- ~ ~ ~ ~ ~ _ -; - ,ter..: ~-.~ ; ~'a, ~, IAT f~^ _.~ ` -