HomeMy WebLinkAbout020-1359-16-000/*
Wisconsin 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)1.
Countyst. CrO1X
Sa n ita r~ P.~rg1i~IV o.:
State Plan ID No.:
Parcel T,ax~lol359-16-000
Permit Holder's Name:
C
l ^ City ^ V wn o
~uds~~ownshi
arper, Ear p
CST BM Elev.:. Insp. BM Elev.: BM Description:
,f>O (a~Q if
TANK INFORMATION
~LEVATION DATA
TYPE MANUFACTURER CAPACITY
Septic 6~ P 1 wid
A
Holdin
TANK SETBACK INFORMATION
TANK TO P/ L WELL BLDG. vent to
Airlntake ROAD
Septic > r 3 ~~ Zi NA
Do ' - ----NA
Aera I
H g
PUMP /SIPHON INFORMATION
Manufac Demand
Model Number
TDH Lift Lriction em TDH F
Forcemain Length Dia. Dist.
STATION BS HI FS ELEV.
Benchmark , ~
e3-
Bldg. Sewer ~ O 3
5 Ht Inlet - Q ep _ Z
/ Ht Outlet .Q lab d
m
Header/ Man.
Dist. Pipe (~ j / ~ Z
Bot. System /`~ ~ I
L ~' i ~
0 q~' '~ ~
Final Grade
t cover
~,d
2.
SOIL ABSORPTION SYSTEM ~ ~s
BED / T ENC Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMEN ~r
. DIM N I
SYSTEM TO P/L BLDG WELL LAKE/STREAM L M~u durer:
SETBACK r
INFORMATION Type O ~ HAMBE o e tuber:
System: ' ~ZU ~ ! ~ '~ ~
DISTRIBUTION SYSTEM ~ ~
Header /Manifold
'
~ Distribution Pipe(s) ,
~ x Hole Size x Hole Spacing Vent To Air Intake
Length
F (Q ~ Dia. _~ Dia. ~_ Spacing
Length ~.y
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 ^ Yes ^ No ^ Yes ^ No
COMMENTS: (Include code discrepancies, persons present, etc.) `-~
Inspection #1: a4' / r/ / 60Inspection #2: / /
Location: 945 Meadowood Lane, Hudson, WI 54016 (NW 1/4 SW 1/4 16 T29N R19W) - 1629192112 Parkwood Meadows -
Lot 16 ~~zyv~ ~ ~ ~P ~P C cr W ~,f GtO~ to c cd G~
1.) Alt BM Description ='~~ /~ S.y_
2.) Bldg sewer length = ~2 / s .~ ~a~~ ~~~-~~ cTu rc r C ~
-amount of cover = ~ «y
Plan revision required? ^ Yes [~ No
Use other side for additional information. ~' 6h ~
SBD-6710 (R.3/97) Dat nspector's Sig ure Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
~ 9~s- rv~o~o ~~E - rr~, ~.[~ Zi~2
Sanitary Permit Applic Safety & Buildings Divisior
~ In accord with Comm 83.21. Wi . ~e // ~ 201 W. Washington Ave
PO Box 730:
~ ~
`~seonsin
Department of commerce See reverse side for instructions for c is app tCSCion
personal information you provide may s for ecot~n• purposes .
~ Madison, WI 53707-730"
(Submit com
leted form to count
if
[Privacy Law. s. I ~
)(m)J ~~~E~UL ~
`
' p
y
r
,
~ . state ownee
•stem. on a er not less thanti
Attach com lete lans (to the county co • only) for e"s 1 x 1 1 inches in size.
County
S ~ State Sanita Permit Number O Ch ~i revi t ,. pr i s tion.
363 ~55 ~ --~ r. "S to Plan 1. D. Number
I. A lication Information -Please Print all Information COUN*v ocation:
~?
FICE `~
Property Owne Property Location
~
_
~ ~~~`- a~ /111vt1/4.5N~-if4, S (o Tr ~,N, $l or
Property Owner's Mailing Address LotJNumber Block Number
r~ ~/ /
City, State Zip Code Phone Number Subdivision Name or CS?`1 Number
II Type of Building: (check one) L J ^ City
J~- 1 or 2 Family Dwelling - No. of Bedrooms: / ^ Village
1~T1)wn of
^ Public/Commercial (describe use): ~
^ State-owned ~
III Type of Perr.:it: (Check only one bex on line A. Check box on line B if applicable) Nearest Road ~~~~
A) 1. New System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel
Tax Number s
S stem Tank Onlv Existin S stem _
{~ C --
B) Permit Number Date Issued
^ A Sanita Permit was reviousl issued
IV. Type of POWT System: (Check all that apply)
Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland
^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line
^ At-grade , / d S~~ ^ Aerobic Treatment Unit ^ Recirculating ^ Other:
~T ~l
V Dis ersaUTreatment Area Information: ~ - / -' - S '~ ~~
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) Elevation
r~
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing Crete structed
Tanks Tanks ~ A
~ ~%
1,~Sc~
--
1 ~sv
~ f ^ ^ ^ ^
~~~ • r- ^ ^ ^ ^
r
VII Responsibilit ent
I, tit rst ed, assume res ensibilit fer installation of the POWTS sho n the attached laps.
Plumber's Name (print) Plumb is Signature (nos ps): MP PRS No. Business Phone Number
Plumber's
A
ddress (Street, City, State, Zip C~ode~
/
yy
~~
' '
~
VIII County/Department Use Only
^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No stamps)
Approved ^ Owner Given Initial Adverse S rcharge Fee)
Determination ~ ~.S °a '~- ~ ~ -' 2 obv
IX. Conditions of A proval /Reasons for Disapproval:
~
~
"
.
.w~-
= 29 . t}- -~ 3o e
(goo ~ ,~.~- 5~~
SBD-6398 (R. 07/00)
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' WisconSinDepartmentoflndustry, SOIL AND SITE EVALUATION REPORT
Labor and Human Relations
flivisinn of Safety R Ruildinna n 1 1 A J~ f1~J~
Page 1 of 3
~ - 111 GiVVV14 ••Illl IVI 11 ~ VV.VV, ••IJ• r.v~~~. vvvv COUNTY
Plan must include
but
n 8 1/2 x 11 inches in size
a
Attach co
lete sit
lan on
er not less th St. C O'
,
p
p
.
mp
e p
a
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 ne ` 0 2 0 -10 2 9 - 3 0
APPLICANT INFORMATION-PLEASE PRINT ~ ~~IiINdTt'O ~~~., R VIEWEDe DATE
)M~~
f ar
PROPERTY OWNER: Pfd ERTY LOCATION
~,~„ ~
n
IxzCasse Custom Homes, Inc. f !C '°' ~rr'~ GOVT,, LOTNW 1/4 SW 1/4,S 16 T 29 ,N,R lg f(or) W
PROPERTY OWNER':S MAILING ADDRESS Oda j LOT.#~. BLOCK# SUBD. NAME OR CSM #
521 McCutcheon Rd. ~
ca ~ ~.~ 1Fi na Parkwood Meadows
CITY, STATE ZIP CODE NE NU EsRprx ^CIT'( ^VILLAGE OWN NEAREST ROAD
Hudson, WI. 54016 >/ $ 5 `-1'Hudson Meadowood Ln.
[~ New Construction Use [x] Residential I Nu rpdrQorr~s.- ~'~ [ ] Addition to existing building
j ]Replacement [ ] Public or commercia ~ ri l . ~'
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) 9 6.7 5 ft (as referred to site plan benchmark}
Additional design I site considerations na
Parent material outwash Flood plain elevation, if applicable na ft
S =Suitable for system
U =Unsuitable for s stem CONVENTIONAL
~l S ^ U MOUND
®S ^ U IN-GROUND PRESSURE
®S ^ U AT-GRADE
®S ^ U SYSTEM IN FILL
®S ^ U HOLDING TANK
^ S C~ U
SOIL DESCRIPTION REPORT
Boring #
..................
.................
..................
.................
.>.:::.1~:.:
Ground
elev.
gg•g ft.
Depth to
limiting
factor
+84"
Boring #
2
Ground
elev.
10 0 .ft0
Depth to
limiting
fact r
+$4"
Depth Dominant Color Mottles Texture Structure Consistence Baxtdar Roots GPD/ft
Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Bed Trench
1 0-11 10 r 3 3 n ~
2 11-26 10 r 5 4 none sil 2msbk mfr lm .5 .6
3 6-84 7.5 r 4/6 none co s Os ml na na .7 .8
Remarks:
1 0-10 10 r 3 3 none
2 10-32 10 r 4 4 none sil 2msbk mf
3 32-84 7.5 r 4 6 none
Remarks:
CST Name:--Please Print Gary L. Steel Phone: 715-246-6200
Address: 1554 200th. Ave. e Richmond WI S 017
Signature: Date: 7 _ 6 _ g g CST Number: m02298
PROPERTY OWNER LaCasse Custom Homes SOIL DESCRIPTION REPORT Page 2 of 3
PARCELLD.~ 020-1029-30
Boring #
3
Ground
elev.
100.3 ft.
Depth to
limiting
fa+90
Boring #
4
Ground
elev.
10 0 ft4
Depth to
limiting
factor
+90"
Boring #
5 <>`
Ground
elev.
101 .0 ft.
Depth to
limiting
factor
+90"
Boring #
..................
Ground
elev.
ft.
Depth to
limiting
factor
Horizon Depth Dominant Color Mottles Texture Structure Consistence Botx>da~y Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0-10 mfr cs 2m .5 .6
2 10-24 10 r 4 4 none sl 2msbk mfr gw 2m .5 .6
3 24-90 7.5 r 4/6 none cos Osg ml na na .7 .8
i
Q,F46•
qZ.6~ . ~
Remarks:
1 0-9 10 r 3 3 none 1 2msbk mfr cs 2m .5 .6
2 9-22 10 r 4/4 none sl 2msbk mfr gw 2m .5` .6
22-90 7.5 r 4 6 none cos Os ml na na .7' .8
Y3.`S~~ $
Remarks:
1 0-8 10 r 3/3 none 1 2msbk mfr cs 2m .5 .6
2 8-28 10 r 4/4 none sl 2msbk mfr gw 2m .5' .6
3 28-90 7.5 r 4/6 none cos Osg ml na na ,7 ,g
Remarks:
Remarks:
SBD-8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel LaCasse Custom Homes, Inc. 1554200th Ave.
CSTM2298 NW4SW4 S16-T29N-R19w New Richmond, WI 54017
MPRSW-3254 town of Hudson (715) 246-6200
lot #16-Parkwood Meadows
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.
"=40'
top ofl" pvc pipe C el. 100.00'
Alt. BM.= top of 1" pvc pipe ~ el. 100.10'
~v..
M7--
GAry L. Steel
7-6-99
- _-••• ....n~,ac.R t,KOSS SECTION AND SPECIFICATIONS
4" CI VENT PIPE 12" H?N. A80YE GRADE L
TS' PROH DOOR. MINDOW OR
FRESH AIR INTAKE
FINISHED GRADE 4* CI RISER
6" NI N.
---. A80V E G AD E
18" IN. 6" MAX.
I NLET f f ~ ..
" ! WATER TIGHT SFALS
a i f T
BAFFLE _..._/ A
CI PIPE ~_
3' ONTO 9
SOLI D -~~
SOIL C
PUHP OFF ELLV , _,•FT.
D
WCATHER PROOF
JUNCTION BOX
VITH CONDUIT
~~ ~
'~ ,
t ;
GAS- ~ •
TIGHT ~ ~.
SEAL ~
' ~'
~ F
3" APPROVED BEDDING UNDER TANK
LM
FF
APPROVED
ttANHOLE ~
M/ PAD LO(
M-ARNING
4" MIt
wk
APPR OY ED
JOINTS W/
PIPE 3' 0
SOLID Sot
~~ RISER
PERHITTCD
IF TANK
MANUPACTUI
HAS APPRO'
CONCRETE PAp
SPECIFICATIONS
+EPTIC / DOSE - -- -~ ----------- -- --...---._ ... -.... .
,~ /
TANK MANUFACTURER: ~ NUMBEti DOSES PER DAY:
~rANK 51ZZS; SEPTIC /0~~0 GAL.
DOSE DOSE VOLUME INCWDZNC, -~-~
--~.. ~ L , F LOiiiBACK : I ,3~ ,~ GAL •
n (ARM MANU FAC'I11R ER :
MODEL NUMBER: CAPAC Z TS ES : A z
~~SINCHES ~ ~/y~ ~
SWITCH TYPE:
' B = _,_ INCHES = ~Z~ G
t
UMP MANUFACTURER:
- -"`~-
~ MOD!~L NUMBER ; C ~ ~%~ INCHES = ~
~
SWITCH TYPE: _
REOUTAED DISCHARGE RATE D = ~ I NCHES ~`~
.~.L GPM
VERTICAL DIPF'ERCNCE PUHP E ALARM HIRING Ag p~ I~R.16.23
BETWEEN PUHP OFF AND DISTRIBUTION PIPE •
• MINIKUK NETWORK SUPPLY PRESSURE _ ~O f FEET
~
~
FE
~
~
_
ET FORCEHAIN X ~
- - FEET
/; 7 FT/ 100 FT. FRICTION FACTOR
r MTERNAL OIHENSi ONS ;
TOTAL DYNAMIC HEAP _ FEET
~ ',3 FEET
OF puMp TANK ; LENGTH
WIDTH
; DIAMETER
LIQUID DEPTH ,56~~
• IGNED
LSCENSE NUM!!ER : I~/" o~a~ ~ 3r~~
....~...
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer S'AY' ~- C ,4,r- f ,~,r-
Mailing Address ~ ~.~ ~c~ a~ ~~ ~c, a 5~7 /~ ~,~
Property Address ~ ~ ~/
(Verification required from Planning Department for new
City/State ~,VI~SrTYt~ Parcel Identification Number
nZo - [ 3sq - /~ - aua
LEGAL DESCRIPTION (~ • 29 . (4. 2 (~ Z. _ (off- ~ 6
Property Location ~~ '/a, ~ '/., Sec. ~ T ?~'t N-R~~,W, Town of 1.1ia~~ ~~
Subdivision ~~A~r-~ ~,r~c~ ~.~ ~1r~a a ~ :~ .Lot # ~.
Certified Survey Map # ,Volume ,Page #
Warranty Deed # ~° ~ ~~ 7 _ ~ ,Volume ~ f Page # ~ ~ .
Spec house ^ yes no
Lot lines identifiable Od 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 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
days of the ar expiration date. -
07 ~dSl~
SIGNA F APPLICANT 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
the property d ed above, by virtue of a warranty deed recorded in Register of Deeds Office.
~7, ~ a~
SIGNA APPLICANT 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
7~1. ~4UOPAUE 65
STA7E BAR OF WISCONSIN FORM 2 - 1998
771is Deed, made betwcen LaCasse Custom Homes. Inc.. a
Wisconsin Corvoration
Grantor, and Earl J. Carper . a a i n~ 1 a n_~r cnn
Grantee.
Grantor, for a valuable consideratioe, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of Wisconsin
(The "Property"):
61~17~1
KATHLEEN H. YAL3H
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FDR RECORD
i1-03-1999 10:30 AM
NRRRAFITT DEED
EXEMPF N
CERT COPT FEE:
caPr FEE:
TRAIlSFER FEE: 16.70
RECORDIH6 FEE: 10.00
PRfiES: 1
Name and Retum Address
EAGLE VALLEY BANK, N.A.
1301 Couiee Rd., Unit 2
Hudson, WI 54016
Pt or o2aIt128.90, 8201029.00 snd
020.1029-~o a o2ato29-ao tiK ego,
Parcel Identiflation Number (PIN)
This is not homestead property. 135eY-
lfo -Ct
Lot 16, Plat of Parltwood Meadows in the Town of Hudson, St. Croix County, Wisconsin.
Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any
Dated this oCG~ day of October, 1999.
LaCasse Custom Homes, Inc.
].
AUTHENTICATION
ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
nn •• ) ss.
authenticated this _ day of ~` l .l d` X County }
-Ipp1F1i~7QE K. UtdN
kOtnry Pubiictiiata ul lktsCOt~lr1 Personally came before me this O~ ~ day of
• __ _- _ _ _ ~,. n ~~~ ~ October, 1999, the above named LaCt~sse Custom Homes.
- ^inc. by Grace J. LaCasse, SecrMarv-Treasurer,
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the
(If not, person(s) who executed the foregoing instrument and
authorized by § 706.1)6, Wis. Stets.)
TEBS INSTRUMBNf WAS DRAFTED BY
Attorney Kristine Ogland
Hudson, WI SAOlti
(Sigroturea may be suthemicated or acknowledged. Both are not
resessary.)
ackttowledgc the same.
~~ l a~ l~~ `~`~ ~~ n
* 1 a~ EnP Lin.
Notary Public, State of Wisconsin
My Commission is permanent. (If not, state expiration date:
i~~lJac>o i .)
•Names of persom signing in any capacity should be typed or printed below their signatures
WA1tRANiY n® 6rAr£ aAA OF WISCONSDV
FORM No.2 • tt9a
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INFOfVAATION PROFESSIONALS COMPANY FgtD DU LAC, WI GUC-0SS•2077
2.985 ACRES
130,035 S.F.
II
2.565 ACRES
111,738 S.F.
I ~
I I3~w1. i
2.505 ACf1L- 5
109,1 ~ `i S.F.
.~ ~IJ
'oL / _` 6~
~~ SANE °ti~~
_____
~'
EN M _ - - - o ~~~ . _.
' ~ ~ S 89°53' 29" E 451.73'
G ~~_
Grk C3, ~ ~- - -~ - --- - - - - z----
J ~ j ~ ~ ~~ ~ N 89°53' 29" W 400.0:3'
~ ~ 16~;y~. '~ % I ~ _ u°~ _ ; 20.00' i'~' - - ~n
~, ~ ~ ~ ~ ~ 50, 616' S0' ~_"' '^_- 20~
~ 3
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G~6 I ~° °ai~ ON .Np 120,000 . ~.F.
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p I(n ~ Z t N
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,~ 2 g ~I I ~~ o
~ o, 2.928 ACRES i 238.84'
I~ ° I .. .._
~O N
127,564 S.F. ! ~
° .°.
o S 89°53' 29" E I I ~ ''~- 91.8"
I ° ~ . N 54°37' 25" W
180.00' ; W 212.
N 89°53' 29" W ;N 392.77'
~~ DRAINAGE o:M
N EASEMENT °o
:o
...
18Q.Qo' :~
u
i~l 89°5' 29"
1N
3
0 2.389 ACRES
0 0
o ~ 104,082 S.F.
III N
N 89°53' 29" W
392.77'
i
31
2.389 ACRES
104,082 S.F.
32
2.389 ACRES
104,082 S.F.
392.
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2.507 ACRES
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EASEMENT FOR TEMPORARY
CUL-DE-SAC, R =80' (TO BE
~"'- AUTOMATICALLY VACATED
UPON STREET E XTENSION).
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31,367 S.F.
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Ic^v 109,997 S.F. ~
S 89°53' 29" E N ~ 50'
I 150; OU'
50' ,..... ...
N 8°53' 29'"• W 400.0_0' --
200.!?0' ... 2U~~.00' ....
I 3 yE ~20'::.00,..
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° 124,223 S.F. ,°n a
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2.525 ACRES ~;o
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SCA~_E
0 75 150
CURVE TA
CURVE LOT RADI
N0. N0.
C1 6 30
C2 9 467
C3 533
C4 10 533
C5 11 533
C6 13 80
C7 266
C8 18 266
C9 19 266
C10 20 26E
C11 21 26E
C 12 33 20C
C13 29 1E
C14 29 46.
C15 53:
C16 29 53:
C 17 28 53;