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HomeMy WebLinkAbout020-1062-80-001 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572886 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: White, Nicole Hudson, Town of 020-1062-80-001 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: ~~0 • ~J Z 3 / (0• .j Z. 23.29.19.239A1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ng'S CAPACITY STATION BS HI FS ELEV. Septic 2 Benchmark 0 ~"e a G• 1Z60 ete. .9 Alt. BM r LL. bk I F1~,~. 3. 95.7 Aeration Bldg. Sewer v~ Holding St/Ht Inlet 7• ~3 11.51 TANK SETBACK INFORMATION SUHt Outlet 7,89 °Il'Z TANK TO P/ WELL :BLDG. ;C~e, Air Intake ROAD Dt Inlet Septic P` G _ Dt Bottom N., J 1h Dosing Header/Man. 4.6~ C Aeration Dist. Pipe 7 •7 .19 .Y Holding Bot. System 16,7 $ +4 11Z.3 .5 41 PUMP/SIPINFORMATION Fin;du rade 5', 5• Z Manufacturer DeP nand StVVCov 7.5. 7 ~F Model Number TDH Friction Loss System Head T H Ft Forcem ' Length Di Dist. to Well SOIL ABSORPTION SYSTEM PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth BED/TRENCH Width Length No. Of Trenches DIM ENSIONS Ito 411 ~~.L~ 1p v SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: A CHAMBER OR / I p ~1a ~L fy w f UNIT Mo4J:uCAr ST7►/~drw.f DISTRIBUTION SYSTEM brA.. A /v 7.2 1~►:t~ 2 l Lail Header/Manifoy Distribution x Hole Size x Hole Spacing Ve t to Air Intake /j \r E Length Dia Pipe(s) Length._ 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 Bed/Trench Edges ~ Topsoil "I-, Yes [A No Yes E] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 860 Waldroff Farm Road Hudson, WI 54016 (NW 1/4 SW 1/4 23 T29N R19W) metes & bounds Lot Parcel No: 23.29.19.239A1 1.) Alt BM Description = f:: t L._ $&GOJe.,_ p ca? GeV- 0"JV 2.) Bldg sewer length = IS I - amount of cover qJ( ^ ^ 7 /S p ti J~ Plan revision Required? Yes 'Flo f Z 10 G / G1~ ~7 Use other side for additional information. I ~ L_ Date rs re Cert. No. SBD-6710 (R.3/97) i 76 X16 T - CROIX. 5r- Safety and Buildings Division County 8I y t 1 4" 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) r~ Madison, WI 53707-7162 State Trausactio N her {-rmit Applicion N In accordance with3~$( Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to ` ' g a sanitary permit Note: Application fors for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary Q&O WALV QbFF- %A<P- oses in accordance with the Privacy Law, s. 15.04(1 (m , Stats. ~ L Application Information - Please Print All Information ' Property Owner's Name r, Parcel # N/c,ho le 02.0 - Property Owner's Mailing Address T2-9 Property Location (239A Clo 83/ y TzD Govt Lot (City, St/a~teC Zip Code Phone Number 15 ^ f W 1/,, 5 f 1/4, Section 2 3 W 1 1 V Y J 1~.~ ~j(~ 5 c! -Ae 3&' Ce 1-33 T N' R I q (circlE one IL Type of Building (check all that app)y) Lot # I or 2 Family Dwelling - Number of Bedrooms Subdivision Nam ock # ❑ Public/Commercial - Describe Use ~4/4 ~ ❑ City of V r W I ❑ State Owned -Describe Use d CSM Numbbeer V61 , ❑ Village of ' ~O 0 Z ! 75 ❑ Town of N V1/ S ~ Aj 2 Vis*ib0fi'on cells w / row o- ZI Ch • (0 III T Check only one b/bx li a A. Co 1 line ,,B if a ti le) ZoAl X, New System ❑ Replacement S Treatment/Holding Tank Replacement Onl ❑ Other Modification to Existing System (explain) X 8y' *3'X 8' B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner a of PO Com onent/Device: Check all that apply) ,~11 Non-Pressurized In-Ground Pressurized In-Ground ❑ Ai-Grade ❑ Mound > 24 in. of suitable soil ❑ o1J1 dZ24 in of suitable soil n/ o er Dispersal Component (explain) ❑ Pretreatment Device (explain) f'` V. Dispersal/Treatment Area Information: Design Flow d) Design Sod Application e(gpdsf) Dispersal Area Req ed (sf) Dispersal Area Proposed (sf) System Elevation 6 01 .7 B-1 C) - 2- C1 VL Tank Info Capacity in Total # of Manufacturer w 1. Gallons Gallons Units 6/ y /oc k 5 Z 2 New Tanks Existing Tanks c 15 -z ' m cVa p w U v~ v, v~ is. U P; Septic or Holding Tank 19-007 Dosing Chamber ~O U G r VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POOPTS shown on the attached plans. Plumber's Name (Print) Plumber's Sign lure MP/Iv1PRS Number Business Phone Number 1Roi315RT' U 3Ri Gk T- S •772 Z N& i 22Ce 57 -7 Plumber's Address (SlreetCrty, State, Zip Code) ~ 2 j 2- A. V.2 . SPRi~v C~ U~ ~ ,e Gv l • `7 oun /De artment Use Onl Approved Permit Fee Date Issued Iss " i =wne!r $ L ~D Given Reason enial DL Conditions of Approval/Reasons9V6 R: 1. Septic tank, effluent filter and dispersal cell must b-e.sQrYiced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 to z 11 inches in size SBD-6398 (R. 11/11) L m op o ? 1, E (~i4 s /5,f /Z {9 . rEC~ . d r C ~F E Olt e F t ` E \JF i tT~ ~ 1 . ~v i v! QIL ~ ~ 1 3i1 ~Y t COPY iz~ i i 5 1 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Nl C k D 1 E5 Al. Gtr kfE Owner's Address ~lD ~3! 1 ELL'! R l~)' /7 UPS O 'v Zv/. 5 V CS t ca S; rte- s5 d F,41FM RD . #vPSoti 6V/. <S Vol Legal Description: 407-1 CSM /049 Z 775f f D ZCv . 0 ~i O Township: Up.s0'-) QWI SaG 2_31 7 2. 'N ~ County: .7 7' G/Z O f R I w Subdivision Name: Lot Number: U V Parcel ID Number: O ;0 ' /D Ce Z ' Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: Rof3~RT~~.[~j(ZI G~1T License Number: ZZCe - Date: /tf,+QG& 2-d 0, 5 Phone Number 71 S• -77a• Z Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 c ~ c 1 s3 F- S 1 o ~ ~ o 1 s ZZ!A Aar r > I C~o 10 ZA5 A e 1 vz, • r CIO s ~ c7_ - ' w r 01 'Qis h N 1 Soil Absorption System Cross Section qp+G r ft k74"heed 40 Fina Grade ipe Y, ap cQ(P, G ft Leaching Chamber System Elevation G D W ft ft rR&, Soil Absorption System Plan View ft ft raw ft Vent Or Observation Pipe Leaching Trench 1 Chambers II 4°Dia. Trench 2 Header Leaching Chamber Specifications FEISA urer And Model ~A)fr /f RA-Ta "i sq ft per chamber Soil Applic ation Rafe gpd/sq ft w + Soil Application Rate + EISA = --f Chambers V rows of 1 chambers each. 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O CA mew fJ ~y I Di~M1EVWN 1 w f, 0 V A c O C7D ~ CD N W cD _ n A n ~ ~ N N CA , O CN 0 co v N N W O V C) 000 A I IIBI u O O O O p 16 Lv rn0 0>> Dm - C/) M ;o co ' C I r, , cNii <n = Cn -0 w -n -n Z z C = O o r r-Z M Z -Ph. ~ M n Nm G7 ~ i z --1 r 61 G) M =Z5 z U) O PI.) 2 < O C7 C C N m z z W m c) 0 r- a -n C) Cn -r--, C) D = On m pW z~ a~ Z X Cn m a n C/) o ® A m D o o z Cl) N CD n CJl Cfl N O ~ i r O A U'i N .A r ^ rn~ D w~ op~ n j ~ W IV O ~ u u ~ W W r ~ ~ n O ~ 3 ~'rl T p n O X p p -i m a ~ p Cn o Z Z Z a 0 Q o0 ~ M ' D = r Cn a = LL it -0 it cn m g CD m 0 ;r, m c~ ~ ~ ~r'~ 5~.(R ~~a~~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBr I G D M, w Mailing Address c/0 93' Kelly 99• 4L)pso/v W I ' S Property Address 8 6c W A 1- ap FF F~V--m KnAb (Verification required from Planning & Zoning Department for new construction.) owl City/State 40 P50 N Parcel Identification Number 1D ' ~O (p •~Q bt-o► LEGAL DESCRIPTION q d ,J Property Location N W 1/4 , 5 W 1/4 , Sec. 7-3 , T 2 / N R I1 W, Town of 0 Aj Subdivision Plat: , Lot # Certified Survey Map # 100:11'75 Volume Z(p Page # & b s ~ Warranty Deed # (before 2007)Volume , Page # Spec house ❑ yes ~no Lot lines identifiable X yes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all sta s form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by e of a warrahty deed recorded in Register of Deeds Office. Number of bedrooms 3 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning& Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) Page 2 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start' up shall not•oecur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the. dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this Srtudtionfhave the contents of the pump tank removed by,a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides;"sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permangntly taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and'the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T aluati a o ing ank be ' e a. a ?RD44,z TP>m• fbR- A/61.AJ CanrS77zCle,?'10 ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name RLOBERT- uL[3R t Gk Name Moffly G Phone 15 - 77 - q q -1 -2- Phone kj~a - ? P-`7'] SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ~-7V ~ r, Name ST. CILQ I o u 20AAlt Phone 115 - j g 6 - 9;?. '1 Phone (10 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of Z' FILE INFORMATION SYSTEM SPECIFICATIONS Owner ~ J i G D lg_ R. Septic Tank Capacity a, 69 0 gal ❑ NA Permit # Septic Tank Manufacturer ~~5 E2 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer e L /6 C& ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model pt-. 5'Z, 5 ❑ NA Number of Public Facility Units /V NA Pump Tank Capacity gal ❑ NA Estimated flow (average) 00 gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 660 gal/day Pump Manufacturer ❑ NA Soil Application Rate gal/day/ftz Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) :530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) :5220 mg/L { NA ❑ Mechanical Aer on ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly av ge Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) 530 m X In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) : 3 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) _104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ monk j(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: / ❑ month(s) ❑ NA yearw Inspect pump, pump controls & alarm At least once every: 11 month(s) XNA ❑ year(s) Flush laterals and pressure test At least once every: ❑ year(s) 11 month(s) NA Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on th.e ground srjrface. The ponding of effluent on the ground surface may indicate a failing condition and.requires the immediate notification of the local regulatory authority. When the combined accumulation` of sludge .and scum in any tank equals one-third- Wj) ar mote of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS, Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. sP II ill full 111111 III III I IIII III State Bar of Wisconsin Form 3-2003 8 Tx74224702 7 QUIT CLAIM DEED 1005725 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI , THIS DEED, made between Gregory L. White and Sandra M. White 12/i2/2014 11.17 AM EXEMPT#:S ("Grantor," whether one or more), and Nichole M. While REC FEE: 30.00 PAGES: 1 ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the Recording Area rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach Name and Return Address addendum): Gregg and Sandy White 831 Kelly Road Certified Survey Map Volume 26 page 6050 - Lot 1 located in part of Hudson, WI 54016 the NW %4 of the SW '/4 of section 23 T29N, R19W, Town of Hudson, St. Croix County, Wisconsin. 020-1062-80-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Dated 12/22/2014 (SEAL) ~1T n ~~X hA ~UL/ I t (SEAL) v * Gre o to * Sandra M. White (SEAL) (SEAL) * Nichole M. White * PAY P~ je f h AUTHENTICATION ACKNOWLEDGMENT Signature(s) JOp . STATE OF WISCONSIN ) YNE L. i authenticated on ) OULD St. Croix COUNTY ) / NJ s Personally came before me on 12/22/2014 l OF Vyl TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Gregory L. White, Sandra M. White and (If not, Nichole M. White authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing it nt and acknowled d the e. THIS INSTRUMENT DRAFTED BY: Gregg White Notary Pub , State of Wisconsin My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: TINS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003 * Type name below signatures. St. Croix County 1005725 Page 1 of 1 1002775 BETH PABST ~p REGISTER OF DEEDS ST. CROIX CO., WX EIVED FOR RECORD CER ■ I FI E® SPU F$VMV MAWF* REC LOCATED IN PART OF THE NW1/4 OF THE SW1/4 OF 10/10/2014 2:22 PM SECTION 23, T29N, R19W, TOWN OF HUDSON, ST. EXEMPT CROIX COUNTY, WISCONSIN- REC FEE: 30.00 COPY FEE: 4.00 Im I PAGES: 3 r- Im 1ES BEARINGS ARE REFERENCED TO THE cn - WEST LINE OF THE SW1/4 OF SECTION 23 BEARING SOO°27'39"E (ST CROIX COUNTY COORDINATE SYSTEM). LOT 2 I LOT 1 UNPLATTED LANDS I'1~ c C.S.M. V. 10, P. 2727, DOC. #512332 00°27'39"E rn SOO*27'39"E 678.90' (ra-679.02') S00°27'39"E o 1327.97' DEDICATED TO THE PUBLIC KELLY ROAD w 649.07' D W Soa°27'3s^E I s7a as' PART OF LOT 20 x O LINE OF THE SW1/4 ~z O p ! 0 33' S00°27'39"E 2655.94' m 0 O cn Z ~ m C/1 p N= Sy~ O d m O i ^M cm F. DO rx ` O o, -j m L! m o O o o c/) o m rrl 0 O m rn o < z 77 Z C/D p :P O m T Z m n , ZO v m v I~ III ~W O g T m z m n rn In II-Z, OWN O-mi p b ° O O-I p I N, m b o K °z p D O O I, I ? C-- a O z Iz mm T o 0 o N o V f ~ ~ Z O 0 I Z / m p ~m to o< m Z 4 4 10 f C) T rl-l N / I O m0 a a / I - ca .n P r 1~y~~i to mmm I ° -i_ m D / c~'o T m IaA, O WALDROFF o, N ~N N o o W 103.1 s' D o FARM ROAD II So0°15'47"E / o a 203.15' , ]33' rnN om O Z o O 0 D m m b OD KD Cn~m mm cr) O pm D ~ O OmZ1m C) Doob cn am N f cn o Ty~m v D m 2 ~oZmrTy m bmC) ! O D0-ZOTnb NOp~ m n ♦ II °z R = O rn p ➢ O T (7 ~m c-') 2 O~~ m m cCOi, ~ z -~w-iX mm* b„p~ O Ir- r i~ ~cn m I =cn K - m co O m O~ C) om Iw IO N>m m mp mOOm~C0OmZ z N m w •f/fNf~N~ , a om=~m~p=~°CO m O Cn a Z b> r~ ZO~m0D~Xmb C g" N ~O Z O a N =O y o m m c N Q O zZm D C b O c n N D O m m c..~ m F= 0 _ °~c b.mb-Ocmn m rn OZb~- o O-a. O®® D cn 4 75.60' N TOO = N x N EAST LINE OF THE en- m 38.48' D Z o m o K NW1/4 OF THE SW1/4 437.12' 203.15' b 0 0 0 1100°16'59"W 678.75' a ° r SURVEYOR (ra-679.02') LOT 24 LOT 23 'y m EDWIN C FLANUM OWNER EVERGREEN ESTATES dl m p NORTHLAND SURVEYING, INC. GREGORY & SANDRA WHITE °o o ° a I P.O. BOX 152 I 831 KELLY ROAD I ° o_ AMERY, WI 54001 UNPLATTED LANDS ! HUDSON. WI 54016 °o ° SHEET 1 OF 3 SHEET Vol. 26 Page 6050 St. Croix County 1002775 Page 1 of 3 h o2 0 • 80 . aoo Property Owner W W+E Parcel ID # gooZ• Page z of 3 Boring # I❑ Boring u :73 Pit Ground surface elev. 7 a ft. Depth to limiting f tor} 98 in. Soil Appli Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 1 0-15 /n Z~sbk Ow: - 3-P • Co . 8 X 15.31 /0YRS& 51L Z-F5bit sh c5 .8 3 YO p YR to so Ile) Y 6 ~[..5 p, s s 5 4 5 0.9 q'0YP, s o, s ~e,e - . 7 i F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 ❑ Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor E] Pit in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (P 11/11) CSM ctzEA' ORI(DiNAL ~ 'AID / 3 Wis. Dept.-af-3afeip~and Prof e I Services L EVALUATION REPORT Page of Division of Safety and Bui ~ ` in accordance with SPS 385, Wis. Adm. Code County JCT. GROt Attach com f Plan o II 1 ~r`not less tan 8 1/2 x 11 inches in size. Plan must Cab include, but, t°limited to:IxQiSal a o I reference point (BM), direction and Parcel I.D. Z V • IQ~Q 2.. 8'0 • percent slope, scalimens `arrow, and location and distance to nearest Toad. viewed Date print all information. ` Personal information may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). lj~ t Property Owner ♦G Property Location Q ~ (7 SAPPY to T9 Govt Lot N W 1/45 1/4 S 23 TZ N R 4 E (or)s; Pro erty Owner's Mailing Address Lot # . Block # Subd. Name or CSM# 31 tl ef,c.Y Tap. PART eF ~ on• 1 AVAy-McF-TS k ao~~up s City State Zip Code Phone Number ❑ City ❑ Vllage ®Town Nearest Road j+VOSoN wt 5g01(p 1(715)39(p. 4133 "VD,SoA; h4>,Ra f FARM New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: ft Parent material loESS out.R 5ANV Y O V 1 WhsiL Flood Plain ~ elevation if applicable General comments /ih41or IV- JW4-4&'A{ ~w4 and recommendations:. 147- ZZ v Ana 7(1 Spot Triad WAaW for a conventbnal ingmund system T O.W.T.S.) ! r] Boring } I /0& Boring # Pit Ground surface elev. U ft. Depth to limiting factor in• Soil App lication Rate - 51 Horizon Depth Dominant Color RedoxDescription Texture Structure onsistence Boundary Roots GPD:f z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 p.1-6 o y~ 1. 2-f 5bk 5 9 w f S z 3.20 to yRR y(o L If 5bK 5 g 3 D•38 /OYR5 8 SLL Z-~sb>k ~Sh C5 . Co • $ 7.5 YR 5 L If 3p, s h cs • Y • 7 §16 1, 5 5 d s . 7 5 10( 10 YR $ li 6, Boring q Q F Boring # n Pit Ground surface elev. • ft. Depth to limiting factor in Soil A lication Rate 2-1 pp s GPD/ft z Horizon Depth Dominant Color Redox Description Texture Structure onsistence aundary in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 j D•9 0YR 212 L 2.•C5bK •g o . y to R t 3 l~.3 ~,5 5 LS 0 S A4 G5 ~ .7 I•Co YP- .7 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number 9.013 ERT 2t1-5R t C VA T 7Ai C~4- 2.z to 3 7 5 Date Evaluation Conducted Telephone Number Address 2giZ It)* AAA SE'CtiN9 ally Wi. 58767 8-12--201 715.171 •y9Q2_ S13D-8330 (R11/11) s o N J J ~Ul% O o a U Z W $ _ r_ cr- - t QO • ~ v j "l - _ - o W W w Oo 0 0 z O o I C O \1I # ~ ~ tt 10 m +0 N ` i S ~ co o a_ °6 u) o C° ~r ,n v nsta:-~- 00 V3 ~`:3 ~a.N av©?1 NN3 001ad m o- ~o C7 C-1 3 N~ 67 f y Oley Rv 7/S 3fi6 •~3 3 y/p , 3 7s/• CERTIFIED SURVEY MAP O LOCATED IN PART OF THE NW1 /4 OF THE SW1 /4 OF SECTION 23, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. LOT_2 LOT _1 C.S.M. V. 10 P. 27 7, DOG. #512332 00°2739°E S00°27'39" E 678.90' S00°27'39"E 1327.97 KELLY ROAD 649.07' w S00°27'39" E 678.89' W 0 Q 0 • • • o D W v N Kc r ocn ? 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