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HomeMy WebLinkAbout020-1376-63-000.sin Department of Commerce PRIVATE SEWAGE SYSTEM _,ety and r~uiidir=t~ivision ' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Dou hert ,Michael Hudson Townshi :ST BM Elev/: \ ~ f Insp. BM Elev: BM Dgscription: ~ 5-~ V /' ~ ~ ~ ~ ! ~'L~-`~ l t-ev ~~ (., ~j -fit-. ~~c.~ ~~¢- h ~ ~.=v~ h/` 1 '~4NK INFORMATION ELEVATION TA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration - Holding TANK SETBACK INFORMATION TANK TO P/L w ~> ~" WELL BLDG. Vent to Air Intake ~'~, ~ ,, ROAD Septic l ~ G ~ ~I ~(; ~ r ~ ~' ~{' ~ / Dosing Aeration Holding PUMP/SIPHON INFORMATION Nu n GPM county: St. Croix Sanitary Permit No: 399662 0 State Plan ID No: Parcel Tax No: 020-1376-63-000 STATION BS HI t/2 FS ELEV. Benchmarkt'tJ ,//~~ ~I/1 Alt. ~lyl ~-n~, (~~ rx5+t- ~ "` ~ 1 2 ~Q.r~ Bldg. Sewer ~Z ~•~ /Z/. / St/Ht Inlet IBS ~' ~,~ ,/ o. O ~.~ Dt Inlet ~, ~/ ~ ~--~ t Botto~ ~. ~„ Header/Man. ,~ ,2 -- /''tt.. '~~y Dist. Pipe ~.-~~~ b.~1~ ~ ~~ i ~~ l~ -f- ~ I'~:S (J ~ '~` ',~5 /d " D . Bot. System ~ "' !1 f' // ~~ Qz. Final Grade ~~ T ~, ~ 1 `D , ~_ Covgr H Z \ ~, S Z/. lp S '~+~ ~- s Ut'i.jlt.l~ ~ r t Z .l~ ~.~ ~]:~i~ ~ BED/TRENCH DIMENSIONS Width ~ / ~ Length / ~'/ No. Of Trenc s ~ __ PIT DIMENSIONS No. Of Pits ~. Inside Dia. .~-,-.-.--- Liquid Depth _.~----_ SETBACK SYSTEM TO P/Lw BLDG WELLI AKEISTREAM LEACHIN Manuf r: ' ~ INFORMATION CHAMBER O ~[~-'f K?-A~1'~ Ty Of System: C~'U ~ ~ Ian r ~ ~• ~ f%" UNI~ ..~ Mo el Number: ~~~~' ~ Zit DISTRIBUTION SYSTEM '~VIh' I" frrrh S/4S ~"" Header/Manifold/ ~ Distributio(n~L~(,/Gi_~ %~ ~~ /~ I ~ x Hole Size x Hole Spacing Vent to Air Intake Len th `~ Dia Len th Di2 7 ~l S acin -~ SOIL COVER Y Proecnra Rvcfamc Only YY Mrn~nd nr At-Grade SVStemS OnIV Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No ~ i''~I°I ''~ Yes ~`;~ No h' ~-r, r COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~~ /~/ ~ 1-' Inspection #2: / / Location: 898 Fraser Lane Hudson, WI 54016 (SW 1! SW 114 14 T29N R1 W) Sweet Grass Fart 63 Parcel No: 14.29.19.2324 ~~ ms- vl~ ~Z ~ ~ti'r-. ~' (try ~-~~ L'/Cti-v~ cL~~ -.~~ ~...~ ,~' yw%~,.~~,~.~'a i~-Cu'L~~ Gl j 1.) Alt BM Description = 2.) Bldg sewer length = ~ C~,~.~~ s.~¢.. NVd Ut'• - amount of cover = y >3 -- __ -- .. - i Plan revlslon Required? ' ~~ Yes o ~~"` ~ ~ - ~ __ ~ ~ ~~ ~ ~ Use other side for additional information. ~ ~ /~~ -6710 (R.3/97) Date Insepctor's Si nature Cert. No. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) i Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. TANK INFORMATION Permit Holder's Name: Dou hert ,Michael City Village X Township Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding LDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION TANK SETBACK INFORMATION TANK TO P/L WELL B Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM _EVATION DATA County: St. Croix Sanitary Permit No 399662 0 State Plan ID No Parcel Tax No: 020-1376-63-000 STATION -r BS 7-HI 7 FS f~ELEV. i Ronrhm~r4 II -I 1 II Dt Bottom Header/Man. Dist. Pipe Bot. System 'Final Grade St Cover DISTRIBUTION SYSTEM SnIL CnVER v Procenrc Sue4amc Only YY Mnund C)r At-Grade SVStemS OnIV Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil Yes No v es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 898 Fraser Lane Hudson, WI 54016 (SW 1/4 SW 1/4 14 T29N R19W) Sweet Grass Farm Lot 63 1.) Alt BM Description = 2.) Bldg sewer length -amount of cover = Plan revision Required? ~I Yes ,ij No ~~, ~, se other side for additional information. Date Insepctor's Signature -6710 (R.3/97) Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing Inspection #2: / /_ Parcel No: 14.29.19.2324 Cert. No Safety and Buildings Division County ~ ' ! r _ ~ 201 W. Washington Ave., P.O. Box 7162 ! - gyp r ,~ ~scons~n Madison, WI 53707 - 7162 Site Address Department of Commerce p ~ ~ p -26 D ~ T~~~.- ~-~ Sanitary Permit Applicat' Sanitary Permit Number J~ In accord with Comm 83.21, Wis. Adm. Code, personal ' 'o rdvas J ~ / ~ ~ Check if Revision ~ ~~~ (? C' ~ ma be used for seco ses Privac La , 5 (1)(m I. Application Information -Please Print All Informatio EO State Plan I.D. Number .~ R.E.c~~v .~--- Property Ow a r ' s Name {~ ry/ /{, /e~ Parcel Number ~ , 1 A ~{ ~ / { ; Property Owner's Mailing Address ~~ iNTv( `~ Proper ty Location ~) ~7 •/~ ; ~ t l' s. t/ ~;4 ~' ~r!I,l~ • S r' T ~ N, R ~ ~(~ f 1~ City, State ~ Zip Code um Lot N ber "Block Number ~ Z C •~? Subdivision Name CSM Number ~~ Typt of Building (Check all that apply.) ~ ^ City or 2 Family Dwelling -Number of Bedrooms ^ P bli /C i l D ^ Village u c ommerc a - escribe Use ~,~ ~ T , , ^ State Owned ~ ; t-i L pp Q^ f~,Q,, Q 2 7j' k `~3 • ~ ~ c.4~ ~S --'~ C.~ C~~OoM+-~iS ~ l"~ Nearest Road ~ / ~ Cr'~ ~ ~ :2..~ c III. Type o Permit: (Check only one box on line A. Numbering is for internal use.) (Compl ete line B, if applicable.) A. stem 2 ^ Replacement System 3 ^ Replacement of Tank Onl 6 ^ Addition to Existin S stem For County use B' Check if Sanitary Permit Previously Issued Permit Number ^~ ~ / _ / ~"Z Date Issued J ! to co / . I S IV. of POWT System: (Check all that apply. Numbering is for internal use.) 44, -Pressurized In-Ground 21 ^ Mourxi 47 ^ Sand Filter 50 ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^Aerobic Treaanent 't 49 ^ Recirculating 30 ^Other V. Dis rsaUTreatment Area Informat ,- ion: Design Flow (gpd) Dispersal Area Dispersal Area Soi] ]i lion Per olation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation ~~) ~/ s VI. Tank Info Capacity in Total Number anufacturer Prefab Site St~l Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank - Dosing Chamber VII. Responsibility Statement- I, the unders' , ume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum s i e MP/MPRS Number Business Phone Number / '- ` Plumber's Address (Street, City, State, od ~' .~ •_ ~ ~ r ~ ~ ~ ~ ..,(mot` . ~;...~ ~ ...> ~ Gi . Count /De artment Use Onl ~, Approved Disapproved ^ Owner Given Initial Adverse Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature o Stamps) Dete n Surcharge Fee) ~ ~_ ~ .Conditions of Approv easons for Disapprov~~ ~ _ ~S ~ ~~ _ n / _ /_~ ~ S 1 UL t, ~ P.u.) So r ~ a-vl.tX- .'Gt~K.>2-d~ ~' r` o- _S ~. complete plans (to the ounty only) for the system on paper not less than 81/2 x 11 es size PROJECT Michael Douahertv SW 1/4 S1N 1/4S 14 /T 29 PLOT PLAN ADDRESS 1057 N/R 19 W,TO ~St. Eaaan Mn 55121 ~ Hudson COUNTY St. Croix MFRS Shaun Bird 226900 ~ D E /23/02 BEDROOM 4 CONVENTIONAL X)OC IN-GROUND PRESS CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 514 # of chambers 30 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 100.5/99.5 ~~ - 7. ~~~ ~ Plans Designed Using Conventional Powts Manual Version 2.0 v a~ r, Alt. BM Top of Survey Iron @ 95.3' ' ~ PLOT PLAN PROJECT Michael Douahertv ADDRESS 1057 Keet St. Eaaan Mn 55121 SW i / 4 SW i /4 S 14 /T 29 N1R 19 W TOW Hudson COUNTY St. Croix ~'~ ~____r1 /23/02 BEDROOM 4 MPRS Shaun Bird 226900 DATE .~-- CONVENTIONAL )00C IN-GROUND PRESS CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 514 # of chambers 30 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL '"H.R.P. Same as Benchmark SYSTEM ELEVATION 100.5/99.5 Alt. BM Top of Survey Iron @ 95.3' Plans Designed Using Conventional Powts I Manual Version 2.0 Vent 2-3' x 94' Cells with ~ >3' Spacin `' a ° ~, ~ -2 95' 10% 0' 30' ,~ >12" of Cover 16" 6' Long 34" Vents B-3 100' Pro 4 Bedroom House Vents 8 70' Sidewinder High at System Elevation i w Alt. B.M. B.M. r ,~ ~. Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT -.a....... ...:ate n_~~ oc ~~r._ n.~~ r_~_ Page of ... ,..,.... ............................,.,, ...... , .,..... ,..,.... County ~~ ~. f {~ 1~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must , include, but not limited to: vertigl and horizontal reference point (BM), direction and d L t i i d Parcel l.p. ~ G ~Jrf j ~-~ "" ~ ~ ' ~~`'~ roa percent slope, scale or d ons, north arrow, an ocation and distance to neares . mens , Please print a/1 information. Reviewed by Date Personal information u rovide ma tme used for seconds u ( cy () ( )) yo p y ry p rposes Priva Law, s. 15.04 1 m ~ .2 7.l1a Property Owner Property Location ~ /' ~ ~ ~ Z'.~ ~, Govt. Lot SL?~ 1/4 ,~ 1~„~(/4 S~ T ~ N R E ( ) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# ~ ~-.: City State ip Code Phone Number ^ City ~ Villa e '~~wn Nearest Road w Construction Us sidential /Number of bedrooms Code derived design flow rate ~ GPD ^ Replacement ^ Public or cb mercial -Describe: Parent material ~~C-t~~/~~-~ Flood Plain elevation if applicable ~/?/ /~ ft. General comments /` i ~!% r-Y '~ and recommendafions: --~'=~-' "~ ~ `~~ v~~~-'~'~-~ ~ ' ~ t' ~ .. ~ a~ , ^ Boring s' 1 Boring # '3 /~p r) ,Pit Ground surface elev. ft. Depth to limiting factor /~-= in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 __ ~. c ~,J ~ -~ i ~ Z '"~~ - •- dam' ~ .~ ~ :r r-.~ ,- wf R4~s~ ___---~ 3ia Z r Boring # ^ Boring ~• --fGt-_, Ground surface elev.l~ ~T' ~ft. Depth to limiting factor ~ in. Soil Applig6on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ., ,/~ c ,Z 3(Q ~2 - ~muent ~~ = rsuus ~ su ~ zzu mgrs ana i as Hsu _~ i ~c m ~ - cmuem ~z = rsws ~ su mgiu ana ~ as ~ sv mgrs CST Name (Please Print) tuy~ CST Number r-~ ~ , J ~ Address Date Evaluation Conducted Telephone Number SBD-8330 (R07/00) n ~ ~ ., , Property Owner Parcel ID # Page of Boring Boring # it Ground surface elev. I D ~ , ft. Depth to limiting factor ~ in. Boil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 G Z Q . ,~lz ~--- ~ ,. ~- ~ S - -~~ -,- ~ ~--- ~ Oyu ~ ~ ~ , ~ , z ~ov.s-r7 (~~ ^ 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 GPD/ft2 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 GPD/ft2 in. Munse{I Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/Land TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 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 (R.07/00) ~. r ~~ ~~ ~ Soil Test Plot Plan Project Name Michael Dougherty Shaun: B' Address 1057 Keefe St. r Eagan Mn 55121 ~ M #226900 Lot 63 Subdivision ------- Date 1 /23/02 S W 1 /4 S W 1 /4S 14 T 29 N/R19 W Township Hudson [~ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 100.5/99.5 *HRpSame as Benchmark Alt_ RM Tnn of S11TVP.V Trnn n 95 ~' r ° ,~. Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County ~-. J , ' ~ / ~ _ ©~ onsin Madison, WI 53707 - 7162 ®sc Site Address g~~ ~~ Department of Commerce d.S Sanitary Permit Application sam~y P` 3 ~9 ~ ~ Z In accord with Comm 83.21, Wis. Adm. Code, personal information you rovide ^ Check if Revision tna be used for seco ses Privac Law, s15. I. Application Information -Please Print All Information i '° ` State Plan I.D. Number ~' ---1 (~ Property Owner's Name ~L~~I~~~U r-J ~ U 1 n Parcel Number H ~v -- I~~ ~ ,~ ~' ~J V ~~~ ~~~~, ~z ~ .. ~~ l ~ r Property Owner's Mailing Address ,(~ ~~ ~ ~ ~p~QZ roperty I-oration ~1~. ~, ^ aj~.~y` [f _~ % ~~.= ST (;Hf)9X G~ 14 Sk; S L N. R B Ci State ty, Zip Code ~ Phope ' w L(~IIf~Qf3FF1GE /'~~~~ : Lot 6 ~ r :~Qck N her ` ,~` ~ SM N b `~ ~ << <. J 5. / .~ t r~.~ . ; _ _i ,ti _ er um Subdivision Name C II. Type of Building (check that aPP1Y) 05 P¢/ ~,,. ~ ^City or 2 Family DweIIing -Number Bedrooms Qt~age ^ Public/Commercial -Describe Use wnship ^ State Owned ~' Nearest Road ~ 1 ~ h /1 ~ ~'S c~ ~ /~ at'JQ,t1X~ti III. Type of Permit: (Check only one box o line A ntmtbering~sch a 'tern .~ Complete line B if applicable) A. 1 ew 2 ^ Replacement System 3 Re lacea~n of ~tion f,- For County use stem T~ ~ S Pe um Date Issued B. ^ Check if Sanitary Permit Previously Issued l:V, Type of Permit: (Check all that apply)(numbering eme is for` internal use) i~-'(~ _ ~ ~''S ~ 44~Non -Pressurized In-Ground 21^ Mound `47 ^ Sand Filter 50 ^ Constructed Wetland ~ o L v'_ 22 ^ pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line ~(~, , ` P^" 45 ^ At-Grade 46 ^ Aerobic Treatm , Unit ^ Recirculating 30 ^ Other __- - ~ V. D' ersail/TYeatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Soil Applic 'on Percolation Rate System Elevatio Final Grade Required Proposed Rate(Gals./D s/Sq.FtJ (Min./Inch) Elevation ~] ~ ~~ V ~ a ~ ~` O ' V l~/ V VI. Tank Info Capacity in oral Number Manufac er Prefab Site Steel -Fiber Plastic Gallons Gallons of Tanks Concrete Constntcted Glass New Exis Tanks T Sepfic or Holding Tank Z _ ~L ~ G Dosing Chamber VII. Responsibility tement- I, the undersigned, assume responsibility for installation of the WTS shown on the attached plans. Plumber's Name ) Plumber'. cure MP/MPRS Number Business Phor~ Number ) Plumber's Ad ress (Street, City, State, Zip a „ ~ VIII. Cotmt /De attment Use Onl roved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agem Signature (No Stamps) A pp Surcharge Fee) ~ ^ Owner Given Initial Adverse ~~p/ 22 ~'. ~ S- ~ Determination lx. Conditions o~f,(A~p~prpo,(v) easons for pproval e g i ~' ~~p ~~ (.~.'~~p ~ A~_, _ $w ~,i,.,,'!~¢.. S~-. a mow"''`;'' .~ti~~~ O } vw~^2^ ~ S ~~'C ~ `~ r1/1 ~ ~ ~W . I ~ . r l o ~,..,~ ,,,~~ sa-. l S A-~I _ Attach Malpt p1aM (t0 t1U SBD-6398 (R. OS/O1) ~~~~ ~`~' pp paper Qpt ~~1/Z 7C 1 E6 Sat /~ /~ A _ ' ' LOT PLAN PROJECT Michael Douahertv ~ ,~ ADDRESS 1057 Keefe St. Eagan Mn 55121 SW 1 / 4 SW 1 /4 S 14 /Ti`;2 N/R 19 W TOWN Hudson COUNTY ST. CROIX ,' is i MPRS Shaun Bird 226900 •' DATE1/7/01 BEDROOM 4 CONVENTIONAL XXX IN-G (UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 514 # of chambers 30 BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100° Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Vent SYSTEM ELEVATION 96.0/93.8 > 12" Sidewinder High of Cover Capacity Leaching Plans Designed Using __ Chamber Conventional Powts- Manual Version~.0 ~~ 16" 6' Long „ , „ Grade at System Elevation n '' \/ S 6% Property Line 120' I Vents 50' 2 B.M. #; B-1~ ~--- ,~ .M.#1 B-2 .~- 2-3' X 94' Cells with^S3' Spacing ;. ,., ~,,, Vents 10' 04 House is to meet all courl~y setbacks Property Line ' LOT PLAN PROJECT Michael Dougherty ! ADDRESS 1057 Keefe St. Eagan Mn 55121 SW i / 4 SW i /4 S 14 /T %~ N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 , '` , ~ DATE 1 /7/01 BEDROOM 4 CONVENTIONAL XXX IN-G ~UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 514 # of chambers 30 BENCHMARK V.R.P. TOp Of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL sg,R,p, Same as Benchmark Vent SYSTEM ELEVATION 96.0/93.8 > 12" Sidewinder High of Cover Ca aci Leachin Plans Designed Using Chamber g Conventional Powts Manual Version 2.0 Prod Line 16" 6' Long „ , „ Grade at System Elevation 'Wiscon ' Department of Commerce SOIL AND SITE EVALUATION D'svision csf Safety and BLildings Bureau•of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and S"'~' percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # Page / of APPLICANT INFORMATION -Please print all infoxma~iQn, a 'wed by Date Personal information you provide may be used for secondary purp (P~iVacy Lbvd s 1,5.64,(1) (m)). `s Property Owner ~ ,- ~ Piop~rty Location ~l ,~ Tl9 ...- ftiV ; ., , ,.... Govt.,Lpt ~(,~ 1/45 1/4,S /~ T Z~'( ,N,R ~ ~ (or)~ Property Owner's Mai ing Address ` ~ "' Lot # Block# Subd. Name or CSM# ~~ t-.... 3 S ~-~-u ~- -~-e ~F- /~ ; ~ ~ s .. ~ ~ ~r e -e--f- (>- vas 5 City State Zip Code Phone Number w ^ City;' ^ Village [~ Town Nearest Road New Construction Use: ®Residential /Number of bedroom;; ~ r-'"F Addition to existing building ^ Replacement ^ Public or commerca`t~~.escrit~.--°'"` Code derived daily flow ~ gpd Recommended design loading rate ~ ~ bed, gpd/ft2~~trench, gpd/ft2 Absorption area required ~~ bed, ft2_~__ ~_trench, ft2 Maximum design loading rate ~ ~ bed, gpd/flz~_trench, gpd/ft2 Recommended infiltration surface elevation(s) c ~nrJ-er ~1,~• GG Gucr~~ y 3 ~~ ft (as referred to site plan benchmark) Additional design/site considerations v PDT ~' ~• U~ l-~w { ~~f ~/ ~ Parent material ~)-~-w~G- S ~ Flood plain elevation, if applicable /j/ ~ ft S = Suitable for system Conventional .Mound In-Ground Pressure AT-Grade System in Fill Holding Tank u = unsuitable for system l~ s ^ u ~ S ^ u ~ s ^ u Cis ^ u ^ s C~ u ^ s ® u SOIL DESCRIPTION REPORT IJ~ t~, rm~ ~e./ ~`'~ Boring # Ground elev. 9G• `•1G ft. Depth to limiting factor !'Lin. Boring # .~ Ground elev. X13 ~~ ft. Depth to limiting factor 90 in. Horizon Depth Dominant Color Mottles Structure i B d t R GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. stence Cons oun ary s oo Bed ,Trench -13 v ~ 5 ,1 w..Ab t - ~ ~ ~ -Z ~ -3 Z. ~ L 10 y s ~ 2 y~fa-bk - ~ ~~ - ~ 3 -ail io ~ -- w. s ~- ; . ~ Remarks: ~ 3i-9a 10 b ."""'_ VAS D tw. ~ 5 ~-- ~". ~S f , `ib•a/ ~6.3z~g2 •3Z Remarks: 2ST Name (Pleas~e/Prin/t) Signature Telephone No. G S.e~K.d~-~ L~ _ ~rs Z G~7r QCJ~ 4ddress Date CST Number z~ ~ "3 a ~' S ~ .~ ~-L-4i' se Gi' / .~~oz~- ~/- ~/_ o U z S3 3C~ j PROPERTY OWNER s PARCEL I.D.# Boring # 3 Ground elev. 97 31G n, Depth to limiting factor `j9 in. Boring # Ground elev. ~~ ~~ft. Depth to limiting factor ~ Z in. Boring # Ground elev. 9Y.96ft. Depth to limiting factor `1'q in. Boring # Ground elev. ft. SOIL DESCRIPTION REPORT Page ~ z of ~ Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 1 0 -13 l ~ tZ 3 ~ z. - - i ^^w6 K r~ Fn ~ v ~ Z ~ 3 3 by to was D s r~• ~ - ~- : ~ „~ °t3~ ~{$ - ~Z/ Remarks: 2- I3-vy -- s.1 ,~61~ ,~i cs -- ~~ 6 y - z 1~ ~ -~ "^s ® w•~ ~ ~ ~ ~.~' Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 1 0- 0 3 z ~" S,~ ~ a.A ~ ~. F~ es ~ VF Z' 3 ^-. 3 ~K- !0 6 -- v~ a ~ k~ ~ Remarks: Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) •,. ~ ~, PAGE -3 OF NAME S ~-E-C's ~+' LOT# ~ 3 LEGAL DESCRIPTIONSw'/,SW/4,51 ~-( Tz-°(,N,Rf~ E (or)(W~ SCALE: I"= ~~O ~ BM I ELEVATION SOU ` ~ BM I DESCRIPTION-bp ~ 2 'pv~ ~,' -~h r,J ~'la.~ BM 2 ELEVATION ~ ~ • ~ ~ BM 2 DESCRIPTIONS f3~ Z~`Qyc,OrO 'a r.~l F~«~j SYSTEM ELEVATION~pp<f q(,• O (o Low4( ~f 3• ~~ ALTERNATE ELEVATION~pP<,. 4 3, a U f5 9.9<0 CONTOUR ELEVATION ~(/~~ 1 _ ~_ xr c.~..c-e ~' I r1~--- - y °~ Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 ~~ ll Shaun Bird #226900 F'RQ" P C CCILI.CNJP 3~DRS, ire OwnetBuyer PHQNE= r,Q. 715 5•t9 591: .Jan. 03 2@@2 @F : Q1BPh1 P2 ST C1t0lX COUNTY Sl'sl'TIC TANK 1-dAINTI~NANCE AGREIaMENT AND OWNERSHIP CBRTIFICATI4N FORM 1VSailing Address (~ S 1 ~ ~ s i ,< _ ~ fo.,~r~ , v~ -ti} Ss'J Z 1 Property addt~ess (Verification required from 1'tsnaigg pepsrtirncne far new City/Stata Nv~ So vt/ ~( Parcel Identification Ntunber t.~AL I?LSCRIPTION Pmparty Location 5`^f % 5"'~ %., Sec. ~`) . T ~Z~ N-R~w, Town of .. Subdivtmon __- _ SvJ~~ (~s~ Gzd-13~~~v~3r~a~ ~r75o3J Lot # N Certitfied Sarvey Map # `___,~„____ Volume. .Page # ___- - - . Volume .Page # Spec house ~ yes~iw Loi lima iderz6fiabk yes O no iarptvptr uas sad ma~meeasnoeof your septic oauld rrsnlt m its prcm:a~,e faihu+e m Laodle wastes. Pro aRaiaOauaace oPpuegping sat >5s septic tank every three years or sooaet, d needed by a iietatcd pumper. What you put ' thr system oaa et~ect the tttaotion of tba septic teak as a t:radnept stage in tibe t+rasde dispaeal. systaa. '~ llt7' o~ ~~ to sctbt~t to St, tic Zvniutg DeparOmet:t a cereiSaatio~ farm. aimed by @te o and by a ~,JPlambes,tsstrieoedplumbaraalioetuedpuaapervrsilj+ittgtbat(ljibeoa-eitewastawatet ' tsyitecs is is proper operatiag oatditioa and/or (2) attar iaapectioa tad {if accessary), the soptic tank is leas thaw 1/3 of sludge. ih"a* the a~detsfaoed have resd the above regaitea>anti turd tgroe sn ma»riin the private sewage disposal system with the swuiaids act forth, heisia, as set by the Dept~tnaat of Cettin~re sad the Depertmesrt of Nattual Resouu~ces, Sbte of Wisconsin. Certification ebti~ thst your teptie ~ has been ttuiatt-iaed must be cattpleted acrd tcturacd to the St. Croix County Zoning 0 ca within 30 days of titie 1<k<roe ar iratioa te. ~ r .~ r Z ~ GAN'I' D~l'['E Q~RR CERT[FICAT,_,~OIV r (a^e} certify that all statements on this foam at+e tttrc to the beet of my (our) knowledge. I (we) am (arsy owner{:) of ttre de 'bed bout, by virtue of t werraaty doed recorded is itegiatcr of Deeds QfCicc ~r.~rdZ 5[GNA3 F CANT' 17AT'E r•••~es AQy infotrtutpion lhat is Luis-repnsentedmay rtcuit in the aanit~ery pccmit being revoked by theZoaing 33op at. •••••• ~`~` Taclude with title appliestfoa: a damped warranty deed fi+osn the Register of Deeds ot1'toe a copy of the certified antvey tnep if refateitce is trade in the warranty deed 12;i' ~ i I ~ -------'- I 1 N80"48'80"E 824.18' ~' I • LOT 65 ~'~~~ i I ~ ! ~~ ~ 2.42 /4CREg !per " I ~ ` Z ~Q 108888 8G FT G~~ I ~ V ~ I Q R V~" y a ~ ,5 MIN BUILDING I '/~,,~ w p I ~ = ~ ELEV. =888.0 ~ ~ . I ae~ao~E 82sa.~r I 'Ir.ir : p~~~.e3~ Q ~` ~ ,`~'~ ~''~ ~ ~ I W R ~ ~ j MIN BUILDING ~ ~ ~~ I ~ ~ ~ h ~.~ ~ ELFV.. see.o ~° ~ ~ q~ ~ ~ 25' ~ 25. ~ ~~ $ ~ I 41a • CENTERLIN 40' ~ LOT 64 ~ ~ ~ ~ RAINAGE ENT 5 ~~ I II ? i I I 1 ~ I~ ~ ~ ,o~, so ~ ~ s s ~; -_-.-. I fi~.l LOT 63 ~.. '~ I 2ao ACRES ~~ I i,r,8, eo ~ ~ ~ as ~ ~ ~•2 to \ ~ C1 si µ ~ / / s h~ ~_'•~ +'°~ ~~.;0 a 866•$6 • . :J 5? 0 • ` / A7/ ~~ ~~~9T N ~ t • ' \~ / /N 824 :o , h,~~ • f ~ p ~, r ~ / -f ~ / / -- / / ~ v~~~ ~ ,~P ate- ".W.L. _ ,a2'`'s ~ LOT 22 MIN BUILDING ~ 5.00 ACREB EI.lV. =028.8 ~ m 180880 9G FT MIN BUILDING O ELEV. =028.8 ~ ~ A STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED Document Number ~uph~ .~~0 This Deed, made between __. R_ T H~(j S-T(1[LT anr] ,TANFT v _...STO.U_T-, . husband and wife,. ___ __ _ Grantor. and MICHAF.T. .T I~n11G]jF.RTV anA .7Ti.i. ,.,a HOST HF.gTv~ hustaand-and wife, holding as snry v~orsfi~ marital nronerty __ ~~_ ---- -.__...-----_._, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following descrl esestate In St. CTOiX ~ County, State of Wisconsin: ~,_IS2t-tom", Plat of Sweet Grass^Farm, Town of Hudson, St. Croix County, Wisconsin. r 6 52005 Y,AiHLEEN H. WALSH REGISTER OF DEEDS ST. CkOIX CO., WI RECEIVED FOR RECORD o~-es-eool s:2s an WRkRRRTY DEED EXEffPT M CERT CORY fEE: COE'Y FEE: 7RAN5FEk FEE: 169.80 kECORDING fEE: 10.00 pRGE5: 1 Name and Retum Address ~~d2 N t~~~~~ 020-1376-63-000 ParcaV Identificatbn Number (PINJ This i5 riOt homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. Dated this 11th day of June 2001 ~.V.~.~i ~~~ (SEAL) Richard O. Stout Z ~ t E'y~Lf.~ ~ ~~ ~. (SEAL) ' Janet P. Stout (SEAL) (SEAL) AUTHENTICATION ACKNOWLED%MENT Signature(s) State of Wisconsin, 1( } ss. St. CrolX County 111 authenticated this day of Personally came before me this 1 1 th day of June X001 ,the above named Richard O. Stout and Janet P. TITLE: 64EMBER STATE BAR OF WISCONSIN (If Hat, authorized by §706.06. Wts. Stats.) THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout ~s-t Awatukee Tr. Hudson, WI 54016 _ to me known to bee~+ ~ P~'cuted the foregoing instrument and atrlt~~9v ~ ~CON81N KE ON J. BAST -~,~. Notary P blic, State of W c nsin My c mission is permanent. (If not. state expiration date: (Signatures may be authenticated or acknowledged. Both are not '~__~ ,~j necessary) ' Names of persons signing In any capacity must be typed or printed below their signature. ~ ~ ~ ~ ~~~ STATE BAR OF WISCONSIN Wisconsin Legat Blank l:o.. Inc, WARRANTY DEED FORM Na. Z - 1998 Mawaukee, was.