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HomeMy WebLinkAbout020-1129-30-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Beadle, Kent Hudson, Town of CST BM Elev: Insp. BM Elev: o-a BM Description: GSA ~ ~ ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / ~ ~ q ~ Aeration ~ t7 I~ ,` L CtrSt~/"~ Holding TANK SETBACK fNFORMATION TANK TO ' 1P/L IVo [' WELL BLDG. Vent to Air Intake f ROAD Septic i ~0 ~ 75c~ ~ 3 ~e~~~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand PM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain ngth Dia. ist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CrOIX Sanitary Permit No: 514952 0 State Plan ID No: Parcel Tax No: 020-1129-30-000 Section/Town/Range/Map No: 17.29.19.608 STATION BS HI FS ELEV. Benchmark / y S ~ ~Q/•5 /~ Alt. BM ~~ ~~ 4S~ ~f ~.~ 1 G~ ~ J .~p~ Bldg. Sewer 1 St/Ht Inlet ~ SVHt Outlet Dt Inlet ,~p~4 ( , Dt Bottom `~ Header/Man. ~~` $ 9 ~ - 7 Dist. Pipe C• I( p `7 •~7Z Bot. System Z ; ~ ; 7 .T Final Gr d $ 7• ` .~ S r. ~ ei-r-- ~ 3 a.a..~ ~ 7 ~ . ~7 T ~ C ~ , BED/TRENCH DIMENSIONS Width ~ ~ Length/ j',~( ,~ ~,~`++ No. Of Trenches / +e PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLD G WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ,~ n,,~~~v~ -~'r'~I' TYPeOf~J~O ~' • ~ S7 ~~~ ~ JG® UNIT Model Number. ~ J `~ ~ ~~ aISTRIBUTION SYSTEM JLbc~.l _ / ~~ - ,4.- Q T, ,J l / Z + 1 ~ ci~ )1 Header/Manifol ~ ~' Distribution x Hole Size x Hole Spacing Vent to Air tak ~ ~~ j~ i ~ U Pipe(s) ~ ` i h Di S ` ` ~ t- ~ v~ D a Length / pac ng Lengt a ~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over BedlTrench Center ~ , Z Depth Over Bed/Trench Edges \ xx Depth of Topsoil xx SeededlSo ded xx Mulched N " ~ ~ es ~ No " Yes ~ o COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 429 Park Lane Hud o~ n, WI 5 16 (NW 1/4 NE 1/4 17 T29N R19W) Park View Estates I Lot 27 Parcel No: 17.29.19.608 r tl-{.~- 1.)Alt BM Description = ~' S-t ..~_ eGV ~~~ ,Te+~ ~~A~ ~ /~ ~ ~~ xi~.~ 2.) Bldg sewer length = ~ ) ~'1'~~ - amount of cover =~1~' ~~ SO v ~ O~~e.J~lQep~~p,~, Pi r ---- ---- ---~- _-~ it ~ ---.._ - Plan revision Required? ^ Yes No ~ ~ ~ ~ D ~ ~ V I j ~p ~! Use other side for additional information. _ I L~ __~I Date Inse or's ignat Cert. No. SBD-6710 (R.3/97) ORIGudAL Safety and Buildin Di County ~~ ~• h Off, 1, /~ J~ ` 201 W. Washington Ave., .O. 2 - ,~CO~~~~ Madison, WI 53707 716 (608)266-3151 Sanitary ~~Number (to be filled in by Co.) De artment of Commerce Sanitary Permit Application State Plan LD. Number ~ ` / In accord with Comm 83.21, Wis. Adm. Code, personal information you provide maybe used for secondary purposes Privacy Law, s15.04 1 m jest Address (if different than mailing address) I. Application Information -Please Print All Information ~ ~ Q , ~~~ 7 • 3 d ^ d~?7 Owner's Name Property Ai I f'° ^ ~ e1 U o cal # t # Block # / ~C ~i(~ ~ ~ ~/U~ ~L~~~~ Z Property Owner's Mailing Address ^ h /~ ST. (,R I ZONING OFFICE party Location ' J / ~ ~ ~ oG /`~ !~ Section % r '/. City, State /.,, ~DJ!//l/ l~CJ~• / / Zip Code ~%t~~(.O Phone Number /' ~~3 , , ~Q(circle one) T ~'1 N; R EorW l ) (check all that a f Buildin II T y pp g . ype o 1 ~ ~ ~ o F ~ ~ " Subdivision Name CSM Number ~S o vt~Glxi 1 or 2 Family Dwelling -Number of Bedrooms ~ - ~Ui~t~tJ ~,sr~-r-~ ,4 e - ib U ^ , i 5 0, se e Public/Commercial -Descr ^ State Owned-Describe Use ^City_^Viilage l~ownship of-~~I_6~~ T III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) A' ^ New System eplacement System ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner / D ~'? ~ oZ t'i -J IV. T e of POWTS S stem: Check all that a 1 ` Non -Pressurized In-Ground ^ Mound > 24 in. of suiffible soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ / ` T Constructed Wetland ^ Pressurized In-Gr d ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Ching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatmeat Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area os System levation Piers sue - ~so •7 ~ ~ ~ ~.n VI. Tank Info Capacity in Total Number Manufacturer P Site Steel Fiber Plastic Gallons Gallons of Units ~ u~- Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank /~ [ ~• Aerobic Treatment Unit ~ O (~'~ 5 /~ Dosing Chamber A- VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the P shown on the attached plans. Plumber's Name (Print) bar's Signatu MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) VIII. oua / Approved De artment Use Onl Sanitary Permit Fee (• dudes Groundwater Dat Issu I mg Agen Sign re (N ps) ^ Disapproved Surcharge Fee) ~//'-Jj ~ ~ ~~ D~ / ~ V ^ Owner Given Reason for Denial t ~~~~~~ IX. Conditions of A roval/Reasons for Disapproval ly /J / ~ SYSTEM OWNER: :~fiyrLfL `.~~/~-~- ~NU ~ ~/~/ '-- 1 Septic tank, effluent filter and ~~ ~ _ ~ ~ 5~ /',/~ dispersal cell must all be servi d / i t i d ~r ~ ~ _ ce ma n a ne ana ement plan provided by lumb 2. I setback requiremen s mus a maintained as per applicable code/ordinances. __.,-_ ~.__ s,., . „ :~.....:...:,. Attach COmplelt pleas (t0 me a.ouory on,yr wr ,uc s~a,c.,, ...• p.l ~(F,~ f~/U li SBD-6398 (R. 01/03) ~~+ ?Q n a ~] { ~- ~t~ ~~ 0 3 o ~ a ~, Z 3 _! ~ `~( y rn ~. '~ ~ / ~' rr 1 ~ ~ ao ~ ~. ~• S N ~ g '~ 'v ~ o~ ~~~ o ~y . ~~ ~ ~ `i _ a~~ ~ ~ 1° ' ~ I ~ ~ ~~ i ~ ~ ~ t i ~ ~' 0 i 2 i ~ ~ i ~ ~ ~ 1 C1 ._ 3X`/'~ '----~ o X ~ - - -~ _ ~ _.. 231 ~ 1 ~ ~- ~'~~ d - ~ 3'X yy _ _,Z- 1 _--~ _ _ _ _ _ ~ _ _ a ~ 3 ~ ~ U .~ ~ ~ ~ ~_ -~, ~~ o - J ~' ~ I a~ e ~ ; w ~, -. as ~ ~ ~. ~'@ ~ ~ i D d' h ~~ ~ ~ ~~ ~ ~ ~~, ~~ N ~~ v 1 °'~s cC' ~ ""'1 \'~ ~ ~ ~~~~ ~D ~c 'CG ~ r ~ ~ G~~ 1v ~ C' ~VB l'V' i'°BAs/ V~Y a 281210th Ave. ~ Spring Valley, WI 54767 Reg. Designers o1 Engineering Systems Private Sewage Consultants 715-772-3442 PROJECT INDEX ,L~ PLAN ID # ~ / ~~ "/` O~ DATE ~j p OWN~;R /~~it! ~ ? A-/ViCJ ~~~~"• PHONE ~a ~ ~ 4 /~ ~j! T~' ADDRESS ~~ ( P/~',e~ ~~-L1 ~l~S'DtiI ~iU~• ~ yD/~p ~_ LEGAL DESCRIPTION L oT',~~ ~ ~ /sr~t/~~; T P•9ie~ Ui~W ~s r,~ PiN duo ~ i/a~' 30•~ Nw N~, ~. ~7, t-~~~, R t~'w TOWN OF ~~OSD ~ COUNTY `S~ ~~~ LOCAL AUTHORITY/ SUPERVISION ~T CIO/',~ •~~` ~/ ~Q .V/~NG-.. PROJECT DESCRIPTION: Fla rv = ~/So ~°'P. ,p~' - V~- f~ Co v v c,~ ~~ ono ~, u~'e" c~ wi,~~ suf.-~ Govp ~~' ~"`~ INCORPORATE SYPERM COMM. ,~~ A PROPER ZABEL n (-~ ~ \ V 83.44(2)c V ~~1 V FILTER MODEL # ~-~g ~J ~ V Pg.l INFILTRATOR SIZING WORKSHEET Pct.2 SYSTEM ptnm vr_n*, ~13~'~-7~" Ztl~b ~~~ Ulari<~ht & Associates Private Sewage Consultants 2812 1 OtE. Ave. Spring Valley, Vill 54767 MOKS ~.~375 ~-~. ~1-aoo8 n c i r A C .p a C. n m i- ~ I. Z O `! ,Z~ a~ ~~. ~-~~~~ W W w ~ ~ ~ ~ ~~ ~~ ~ ~ ~•. ~ '' ~ ~~ ~ ~ ~' ~ v .~ °, ~ f~ X ~°' ~ ~~' --~ a S ~~ C ~1 ~~ © o -.-`~, ~ ~ ~~ J ~ °C c_ ~ ~ v1 ~~ ~, o ~ l^ v,~ ~~ ~~ ~~. ~, Vv ~t o! \t V ~ T \ ~+ `- O O ~ W ~~~~~ ~ ~ s n O r `~ ~ ~ ~- ~~ °~ ~ Q 0 3 o ~ 7 L ~~ `` ~ ~ ~ ~ ~ O _ 44 .E '~ ~ ~ ~~ ~. ~ ~ -_ - ~ ~.~. 1 ~~ ~ ~ ,~ ~~~ Z-g ~~~~ ~ g ~ ,~ ~ ~ `~~ ~ . ~~ o ~ ~~ ~ ~~ .~~ Q~~ ~ ~ n b `Tl '~~ I ~ ter-, ~ o ~ ' ~ ~ ~ fi ' ~ ~ ~ ~ ~ I ~ ~ I ~ ~ ~' ~ 1 ~ ~ ~ ~ ~ a 1 ~ ~ ~-- \w I i c _ P a_ 3 -x y~ ~ ,_ I _, o x ~ ..~ o ~ ` i.;~. 0 Q . ~.. . r ~. ' ""~ ~ ~ I ~ ~ o 1 ` 1 ~ I 3 Xyy ~ 1... ~ ' _ ._._. _ ° ~ _ ..-. ~ -., ~J m ~ is c p _ _ __ _ ___ _. _.__ .. a _.. .,, ~ ~ nt ,3 ~~ yy o ~- - - --- ~- - - ~ -~ -,o y ~; , C ~ ~ ________.~~_ ._,_____._--- .__ _ o _ .. ~ ~ _ ~ ~ ~~ --~ ~ ~ W G Q o ~ C'~ ' ~~ ~' ~~ ~ Oo . J ~`• oo ~1 I h o 'N o TrP~~vc~s C~Po SS S~cT~o~ ~ ~ \ ,, ,,, ~ ~, ~ ~ y s 2lS/ti G- lN~i L ?~f'.4.7-o~'S / y~~ c,~p,4c~ r~ 5~'~ Ti'o~ - c~~S s• ~ sq. -~--~- , t~~ __--- ~~, flPf'~L~h U~,v7- c,4jo u,v ~NSp Ec T/®,v p /~Q, yR~~~-- ~______ ,, ~g 1 ~~ l2- 1/// 5c~ . ~o ~~~c ~- Ti~~ti ~ ~ -i ,, ~ s y~~M ~i~v, ~ . 50 OVER: See Reverse Side for Vent/ Observation Pipe Details. __ ___ .___ C~/cv~/F*~ ~ i 5'tRN~ ~~~ ~ ~ i ~(~ .~5 rJ ~~ ~~ .~~ ~J iNS/~~c iid~ ~~1~ ~~.,~T" , ~~ ;~9P1 ~i~DU~J> Usti T ~~9~' ~ a,V ~,rJ,s'~1 ~c T/D,v ~ /~ 1 ~r 1 ~~~~ ,, sc~. ~0 9~~~L= ~ N a~ a ~~.. .~_.~_ L~ ~~L ~'~rf'~D Ti+P~-~ ~r.~ T~P~ti ~~ ,, •~ ~ s ~r~M . y ~o ~i~v, ~ 7, C~Po 55 sic ~ ~o~ o~ T 2t!Sfiv (s- l/V ~i ~. 7it'~ To,eS ~ wig ~ C/ . f ~ Q ~'T, ~fi~~.~~1~~ ~~.~c.~.~~ ~t,t~, 5~~ ~~'~~t1 ~.,. ----' s. ,s~ - f--~- , ~,~P,~IT y ~ s~~ ~ .~ c~/s ----y i ~, av iNS~1~cT/o~v ~~~ r tili~v • i 2 1~~ 1 1~~~ o ., 5c~ . ~0 9~~I~C_ ~~ K ~----- r----- T,~~ti cif ~~ n '~ OWNER's MAINTAINCE-~OF SEPTIC SYSTEM • POWTS (landowner,} is reponsible for proper operation and maintenance of. this system. Regular periodic inspections and ~- servicing is necessary for the safe healthy operation of; this - syste~re. The owner is required-by code to submit all necessary' maintienance/inspection reports to the controlling ,authorities :. . SPECIFIC CONTACT AGENTS s•7- ~/CdIX G~`'/. *- Governmental authority) inspectors: zD~iti y~~'O - ~/S • 3 d'G * Licensed installer, responsible for providing an operation/ .- maintenance "Users" manual : D.C~C2 r 2t'dd/~~C Lr T 7/S • 7 7L • ~3~~f z . ~E _* Licensed service / inspection agent other than installer: * Electrician, f;oir pump, electric controls, wiring units: IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic~~{sledding, shove ring, etc.) across the - area shall not be permitted, or frost can/will penetrate into the cell, freezing up the system. Discontinuos use in the - winter_(a uacact_ion.tr_ip, resulting `in no water use) can also lead to freeze ups. 2. Water conservat-ion needs-to lie exercised! Or system can be hydroli.c-ally overloaded and destroyed. This svs~em was •• designed for a maximum wastewater flow of L~S"a gals. daily. 3. POWTS are not desi<gned to accomodate wastes from a garbage disposal unit, or any other unnatural sources of was~e~. - Any introduction of such waste materials will overload and destroy this system. ~. If a power o~itage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the cell. which may adversely impact the cell (lea~~'ge}. It is recommended that a .licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer ~iinmediately for advice. 5. Neglect of the vegetative-"cover (the cells insulation ~ erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent 3•n the,~ystem beneath IS NOT au€ficient alone t0 maintai;~ a yl `~~cover. - 6. Periodic inspections by the axner. nr ~,~~ a..d,.a.~. :.. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM O~~~ner/Ir ~~-~iyl f ~ ~.~vtn~v 3~'`~~~ Mailing Address ~~- ~ p~~K LN' /~jLU~tiyt. ~~. S yd/~,o Property Address S ~'~' (Vet'ification required from Planning & Zoning Department >ror new construction.) City/State Parcel Identification Number d a ~ ' f ~.~ ~' ~ O 'OzJZ~ LEGAL DESCRIPTION A ' Pro erty Location N ~';; , /v ~'. '~ ,Sec. ~ ~ , T ~ ~N R ~ ( W Town of /~~~s4 ~Ll . p , 2Subdivision Plat: ~~F y~L~GV ~ST/~-PS~ /ST~ /~~1~~•~`'- ,Lot # Certified Survey Map # e . ,Page # Warranty Deed # ~ ~ ~ ~~ ~ (before 2007)Volume l ~~~ ,Page # Spec house yes n Lot lines identifiabl yes no Sl'STEI~~I' MAINTENANCE AND OWNER CERTIFICATION „ Improper use and mainte4~ance 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 pumperr 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 §Comm. 83.5(1) and ip Chapter 12 - St. Croix County Sanitary Ordinance. 'fhe 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 (I) the on-site wastewater disposal system is in proper operating condition and/oo(2) after inspection and pumping (if necessary), the septic tank is less than I'3 full of studge. 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 refurned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. t/we certify that all statements. on this form are true to the best of mylour knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 3 . Number of bedrooms r~. _ ~ ~_/~/ SIG A U OF APP I ~ T(S) DATE ***Any information that is misrepresented tnay 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. (RED'. U8/US) Ulbricht ~ Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, ~1/I 54767 R~~~li/~D vvisoor~ Department of rce S L EV oivi~on or safety errd t3 AU err ~x'~ r witi, ata~ Mete site pixy ~,, ~ size. Irrdtxie. but riot r eo: peroeMStope, scaleor ~ dis Please print all i~ormatlon. PeoonN idormauon you Pr'rw~ naq bfa used iorseoaMWy purpaees (PAv+q tsw• 'roP~Y i KEN r ; ANN 3~•~o/E ~rapenyOwnersrde~ngAddress z _ G~J • UATION REPORT ~ ~ ~ 3 . Adm. code , c«rny Sf. C,Q CJ~' X must l.p. oZO.//~~l• 30•aoo ~o road. t~ 5.04 (m)~. l:ocatiot, F ~j Govt. Lot NW 1/4 ~'• 1a S ~ 7 T ~• + N R I ~ e V !~ ~ elaac # sr,bd. blame « /s ~tnD~r. pi9Rx U~~w Fsr~r ^ City ^ Town Nearest Road . ~yOSo.y i Pflc'K LN. , ^ New Carrs6tx~ion User Resid~rtial / Number of bedrooms 3 Code derived design flaw rate y/rO ; . Repiaoanrent ^ PubBo or oornrrrerdal - Descr~e: Peres material /UES S Dl~i2 SANOy aVTu~~4S Flood pin elevation if appscable ~ General aornrrerrts Viand Area ~ Spot Tested suitable for t1 conventional inground system {P.O.W.T.S.) - GPD . R 8ahtg # 0 °~ Grourrdeurfaceelev. ~ 3 3. R oepar to tim~rg rector > ~ ~ - s Horimn pepth orrr~rrt Redox Deeaiption Texture StrurAure Corroe 8otxrd~y Roots h R Muneew Qu. Sz. Cant Color Gr. Sz. Sh. '~i1 'EIFwi2 I i2 s --~ SIC. I f l c s ~ • f~ 6 3 0 7 --~ SL 1 ACS a s ~ - s n,~- p r C ~- ~• Cp ' U r -~ Private ;wage Gonsult~nts ~s i 2 ~ oti~ ,4ve.. pE/2 Soi G TES 7`- ~i'r ~ ~ - Spring Valley, WI 54767 ~vJhcE~~ ~-o Sys'7`~~~`'/ -'" ,s of L S ~7 '/P~" Cl D~ ~O ~y~ /i'i¢ N ~' FC~R ~,~ ~~gQOv~u Sys~~~- a~~ sysr; ~°'`~~` ~° Gro~ardsurfaoeelev. g3' S° lioriaon Depth Dominant Redax Desaiption in. tN Clu. St. Cor>f. Color m > ~~ ~- .. ~, Texture Stiudrre Cor+oe 8owrdary Roots GP Gr. Sz Sh. '~#~ Rate WtE 'Effr~ a• o R 3 -- SL Zn+~l ~C' S ccv 3 . Co /, o 2, .~, --- G. C~ / ~ D S ~" • t~INierrt #1 ~ eOD > 30 _< 220 mgA. and TSS >30 _< 1 50 mgll.. ' Etfiuent rl2 = 8oD <_ 30 mglL and TSS _< 30 mgA. csT ~ t~ ?~C.B i C (~ s tSrrdurnber iz.43? 5 q,~,~ - pate EvaN~alion Corrdrxted Teledrorre Number ~ ~- X008 s•~~ L d r- ~7 /~~9~~Vi~`cv ~s r~tT~s 9 z 3 Property owner Paroei >D # Page a Pit Ground surface elev. R Depth to factor in. Sob Rabe Horizon Dep>fr Dorrw~ar-t Itedooc Description Te>drxe Strtrr~ure ' Cooe Botmdary RAds t{aP OVII' in. Munse9 Glu. Sz. Cant. Color Gr. Sz. Sh. 'Eftlf1 'E1flR2 a• ~ /o` R 2 5L t s6 ~s ~w .~ ~ ~ 7 z.. ~ •~, -- L ~5 c ~ F . • - ~~- s ~, s ~S -- - /. ~ o - S ^ ^ Pit Ground surface elev. R Depth Yo factor in. ~ # ~ Horizon Depth Donimartt Redox Desaiplion Textue Strucdre C~ Boundary Roots GP DJIE irr. MunseA flu. Sz Cant l,,dor Gr. Sz. Sh. `~F1 a ^ ~ Ground strfaoe slur. ft. Depth - factor in. ~ Rate Horizon Depitr Dominant Redox Desaipdon. Texpre Boundary Rods GPDUFI? ir. Mu>se1 t1u. Sz. Cant Color Gr. Sz Sh. 'E~1 'Etf#2 a # a Ground surface elev. ! R Depth m lfrt~ing >ec~ irr: Sot Rate t d i Do Rsdooc Oasaipdan Tex4rne Strrrc4ne Corisistehoe Bota~ary Roots; Horizon r Dept kr. na n MurseN . flu. Sz Cott. Color Gr. Sz. Sh. 'Ea#1 'EEttl<Z r ~ ?~ m C O ~ ~ ~ ~- ~ 0.~~ _ ~ ~ ~, -i ~ ~e ~ $ ~ ~ ~" ~ o 3 - ~ ~ a ~y ~ ~ o ~ ~ y o ~ o ~ - ~ ~ °~ ~ - -, ~ Z y ~~ ~ ~ ~ ~ i ~ ~ ~~ ~ n b ~ ~~ ' I ~ ~ I ~ a ` ~ 1 ~ G ~ -~ n I i ~ d ~ ~ ! ~ ~ ~ ~ ~ ~ ~ ~_ r P a- ~ ~----' o " ~ v~ ' • ~ • .-- ------ ~..- --.I ~ IT( 1 ~iJ M ~ _. .__ . __.. _ __. ~,,, _ ..__ __. __.___.. ~ ~ ~ a U C y ~, ___ D _ _ ~ 0 - ~: p~ ~ ~ ~ 1 o s w A -,, ~, 4 _ v1 ~ ~+ ~ ~ 'N 5~29459~ ~ s~ e~ dr wl,cors,te ~~ t - t9as ~A~~ ~ ~,~ 7~•~.LS'DSED, ~~~y=~ Winnebago SoFtvase ^o., a yinn_esota Cprparativr: ..... ........... . :•---.....•--.._..-----. _. _.....-.............. - Grt~atcr. and __ Kegf_,~,,..¢e$c~jl~_a~d, M~• M.,_Beadle, •husband._and ._w.i¢e,..~xs..sNr~R~co-ss.hx.p. as~_S3.Gas1 .propeccy_ _..... . .. ...........••-•-•--•----• -•-• --..._. ...........--• --•--• aa~ sx, WPfJVii€'~I, 71st tlse usd C-i:nrot', for. rarwbk eaaabtezrebaa taaTtys <a t3uustse the foQow~p 6nu~d rci! esu.k is St . Crof3r: :.atsaQr, Starts of Wiscaasb: i~ ~~~ JUi~ ~ 9 1958 10:45 A F ct .~.. ~ a.~~s ~a r~ wr.uw. wt>at~aa /.~~ ~v ~J ~ 020-!l29-30 2'JU~CtR ~@i72rYGRiiCila tKilinait l.ae 23, Park Vfev Estates Fnrsc ~4ddieion io the Tavn of Hudson ~~p,N~~ER ~~~~ is Ri`C 'rhk ..... ...... .....r+oe»csee=avtoxr:y- ~ Gs tsotj 3o~ts~r aids at! aind tai,;nter Qee heredieataaan•aad appcrrrrna~rs ~e.~unto besuaji+ty: . AttQ . Gcar+,t;or ..................... wrarrabts that rise ti[io ii soad, ierasiblc is its •fmpls twd free aoe eiear ut enaat~brancFa sarcept . easemeeets, roadways and rest;sictlons of record. amd w!!t srartaet aad tteitated the t+ara>fl. '~ .......... day of Dated tale ........... ....~.~.~:~~.~............ . ~.~e is ti..,r.. ~...4.•~..N..YS}...4 ..1. ?d~~ ~`;~,; „arnav Fueiktil~hKE~4Tq. x ~--- - ~14y Can;,- °-~~ Jan. 31.L000 ~.. (S&AL) • ',.r-~'~c-.. ... ~ .... ;~-g-- .~~~~<.... ................... Atl7`K1tiPlTiCATION ~U ~ ~S~ • ~ -~ (SFsAL? Gzor~e B: Griffith, ~ __._... ACKlRlOWLEDGM$NT a-,tl-cn+;caai tbis ...... day of ................ . .. 19 ... . + .... ...~~~1 TrILTa: MEsMBER STATE BAR OA tiYlSCOiVSlN (if nor, ....: . ............................ . . .. .... . asttborized by S~ttoa 706.06, W~latoaaln S ~~ ~!- Y ~%• Tees rrasrnueat:ntT wws o+wreo ev ~,., • - • •MlC-i-iAEt.•H: FOR~CiCi: ACtomeY- ... - - - - • • ~~~~ ... Eau C~ai~e,.Wisconsin ................. ......... . (Si~aaNrea :aay be aud~eatlwfed or edcno~.tedead. HoUs m nor eeeaararyj • Nttoes otyatsaoa a1~a{ fr u,f ea9.art .he.,ra s. rp~c ss sW,rae 6HOs oxk,ian.arss. ~ i `i. ~ v~ ~~L~1~\ X71 lift LJ V 1 ss. (SEAL) • - ~~' (~Ot- X - - - - ConotY, `' PlfsotM!!y cams fit~cts tae this .... .~ . .... _ .. flair of ...~:?~+^-~- 19 .. the abme aaased -""George B':'CciEEi'fH;' ' .. .... ..........i persv ... .............,................ ktwsro w be ttr~ a .............. srbo eatsw4ed the r fug iastcutebear raid ackauwhsdSe the throe. .. ~.~-~.-.~- D~~- :............•-- xovsay` Sfe .......... ~. '.x+':4.1 ~ ...... Coemty, Wis. .fly w , . ton b peeena to nor. stua eupitlioa °, ~. ~ ~ d N O V N 3 d ~ O fl. ~ N n N I O ~ 3 a ~ W 07 O O ~ ~ N ~ ~ O ~ N ~ (D ~ (Q fD N w C a O L m y .N-. Z O ~ ~ ~~ ~ c 3 ~~ cg m v N C a tO o~ Z N O o o~ ~ ~ ~ ~ ( D C I W d ~ O w _ n ~, o~ 3 I D 00 °-' co o~ w ~ - m ~ z ~ o ~ m O N N X N N Q I O 7 fD b9 Q O S~ °o ~ nM~ 3°~' c~ d `~1 eo ~ ~ ~ eo v A~ i~' :: ~ ~ ~ ~ ~ z O (00 O ~ C V N j `C • w ~ a o ~ ~ ~ Cp ~~~ ~ ~ W ~ ~ 3 M ~ Q l~ ~ ~ ~ I . O ~ a a w 7 m ~ A C V ~ ~ -' cJO cvo ~ c~rcn 3 o. .. ~ 0 O' c C C ~ w ~• S S V N N ~ ~ ~ < ~ ~ ~ ~+ .. 3 N (%~ d N N Duo O a ~ tr m ~ m y ~~v • ~ C l~l t0 7. ~ ~ d 7 ~ ~ ~ N 2 ~ A ~ C ~f j ry M a ~ ~ ~ CC ~ < ~ J !D ID a ~ z ~ ~ A ~ O " Z B m ~ fU Z f W r A ~_ r c a a R A n O A ti N N O H w H d0 W !p V ~ b ~°, , ~ ~ Parcel #: 020-1129-30-000 Category Alt. Parcei #: 17.29.19.608 020 - TOWN OF HUDSON Current ', X,', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-owner O -BEADLE, KENT R & ANN M KENT R & ANN M BEADLE 429 PARK LA HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 429 PARK lA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description; Acres: 1.130 Plat: 2274-PARK VIEW ESTATES 1ST ADD SEC 17 T29N R19W PARK VIEW ESTATES 1ST ADD LOT 27 Block/Condo Bldg: LOT 27 . Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/29/1998 581969 1335/501 WD 12/26/1997 570378 1284/500 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.130 32,700 214,000 246,700 NO Totals for 2005: General Property 1.130 32,700 214,000 246,700 Woodland 0.000 0 0 Totals for 2004: General Property 1.130 32,700 214,000 246,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 204 Specials: User Special Code 10/12/2005 04:59 PM PAGE 1 OF 1 Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • AS BUILT SA~*tITARY SYSTEM REPORT d~,~Gso.~, ~ "ER ~ Gt. ~ M ~~ 1 l I .^ ' , TO~rTNSHIP ~`u~c~~o •1 SEC. I ~ T~N, R~W --- '; .~ . ABDRE~'S _ ~-~ u ~ ~Sc ~_ r S , ST. CROIX CuLr*~TY, WISCONSIN. ''~ 3DIVISIO,TM~~,• ~ ( n < <,,; , LOT 2-~LOT SIZE ~ - • PLAN VIEW . i Distances b dimensions to meet requirements of H62.2fl - ~; ~ ~ 1~- l SNC}G7 F.V'~'RVTT?r~r_ x.17 TUTAT t A!1 t~C rm e1r e.V[+.nr~t i ---- --- ---- ••- ~.•~.. a vv auu a v l .lLJ iL~l UO i - ; - ~ 1' ~~ 'rR l~ ~ ! ~ 6 ' ~ - r - - ,- ~ + II I j ~ ! } k ~ ~ ' ~ i ~ ' i } ~ ~ ~ ~ ~ .-_ ~ ' { i ~-. ' _T ~ _. ' z . l I ,.~ .~ ~ I I L _~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ , ;~ ~ ~ i ~ ~ t ._ ! } ' - ~ ! ` I I I _ ~ ) ~ r iii 1[,tv~~a) ~ ~- - - r'trvx. w ~ r: 5 ~~,~ C02ICRE~E V' STEEL - --- S ca.ee _ N0. of rings on cover_~, Depth ~ DRY ?FELL •~.NCHES N0. of - --- width length area ~ no. of lines, width, length area ~ ~ _ depth to top of pipe ?, ~ ' "LEGATE .W: RATE AREA REQUIRED (~ (~ AREA AS BUILT ~Z ,claimer: The inspection of this system by St. Croix County does not imply complete ~:raliance with State Administrative Codes. There are other areas that it is not possible -, inspect at this point of construction. St. Croix County assumes no liability for ',i ;tem operation. However, if failure is noted the County will ma'~C~-every effort to -'::ermine cause .of failure. . ~ ~.vASES A.'~1D OZLS SHOULD NOT BE .DISPOSED THKOUGH THIS SYSTE.*i. • REPORT Or ITISP~CTIO?t--IiJ7IJIDiJAL SEZ~IACE llxSPOSAI, SYSTEI~i • - ~ Snriitary Pernit • • ~, ~' State Septic • r f7J~1t~ - ..LLLL iLi To~•n~Sxlp - t. Cro~.~ County .~xze gallons , 'umber o£ Conpart:nents ..~ ~• 1 • Distanc~~~~M: *~~ell ~- ~~ f t. ' DISPOSAT, SYSTF,:1 Distance From: Building ',,,_,~~ft. liigtiwater ft. ~__.. Tile Field or i~ell --- ~ ~ ft. Builcin~ w___ ~__ft, 127, or ~reater slope ft Wetland f _ SeePa~e Pit(s) 127, or Treater s Xone ~ f t Wetla-~ds " f;-, RIFLn `r'.ighwater ft. ~ . Total length of lines©0 ft, l~Turaber of lines _~_. Length of each line ~ft, Distance between Lines ~o ft. Width of file b' ~' trench ft. Total absorption ar~- q, ft, Depth " : L~ - frock below file ~ Z in, Depth o~.x-ctck over file ~' in.. Cover ~nver . xock,, Depth of file below grade ~~in. S2ope of . - - trench ~i i per lt~~) ft. Depth to Bedrock ft. Depth to ground water ft. PITS . _____._ . :dumber of pits Ou c:e diameter ft. Depth below inlet _______ft. Gravel -r n it : yes no, .Total absorption area ~. ~sq. ft. ~ . Square feet of seePape trench bottom area required ~, yquar~ feet of s epa~:e nit re required . • Inspected liy : Title :. ~ ~ • . - . . Approved _ /II~~ ~ ,.. Date __-- (i • .Z- „~ 197. Rejected Date 197 c EH 115 ~ ~ WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 ` MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS / LOCATION: ~'/a, /a, Section ~ ~ , T~N, R~ E,.(vor) W/, Township or Municipality ~~ tA~•Sp,,ycc-~ Lot No.~~, Block No. 4..~~Q~l ~..~j~-l c, I~ County ~~ L.~l''D i V //~ Subdivision Name Owner's Name: ~~f jj~~_~~~Lc-~Ger^ ~ - Mailing Address: `~I`-`~~~•. ~~-~.-~ TYPE OF OCCUPANCY: Residence ~~ No. of Bedrooms -~-~ Other EFFLUENT DISPOSAL SYSTEM: NEW DATES OBSERVATIONS MADE:nSOIL BORINGS-~ SOIL MAP SHEET {~ ~ ~ ~~ SOIL ADDITION /~ ~ ~/ - 7 TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN HOLE AFTER TEST TIME INTERVAL DROP IN WATER LEVEL, INCHES RATE NUM- BER INCHES THICKNESS IN INCHES SINCE HOLE 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN [~ , SOIL BORING TESTS .TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) ~ ~~ ~ ~ ~ 30 `~ S y '~ ~^ 3 '~ ~ ~ ~ 7 3 ~ -~ '` _ ~r ~ ~ ~ 7 7 J ~~ .. S ~ S ,~ ~,, PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square a suitable areas. Indicate num r f square feet~n area needed for building type and occupancy. ~ ~~ ~' ` n i scale or distances. Give horizontal and vertical reference points. Indicate slope. __._ REPLACEMENT RCOLATION TESTS ~ ' ~ `~ ~' 7 ~ 7 State and County P~ ~6 ~, Permit A lication pP for Private Domestic Sewage Systems *DENOTES STATE APPROVAL REQUIRED State Permit # C7 County Permit tl County Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY iliny A Ma ddress: / ~~ ~t N~ ~ r ~ ! !~ ~ / r ~ c`-~ rc cl ~ v ~t ~r S' B. LOCATION: '/4 '/4, Section T N, R E (or) W Lot# City Subdivision Na~ nearest road, lake or landmark 81k# Village 1 r ,~-~rn ~/ ~~',/i . 1 Township 1 u S'C:~1 C. TYPE OF OCCUPANCY: "Commercial 'Industrial 'Other (specify) "Variance Single family ~/ Duplex No. of Bedrooms No. of Persons D• SEPTIC TANK CAPACITY ~ (~~ © Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete r/ Poured-in-Place Steel Fiberglass Other (specify) New Installation ~ Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUEN DISPOSAL SYSTEM: Percolation Rate + ~ Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Leal Ft. Width Depth Tile depth top),No. of Tren hes Seepage Bed: ~gth____~_ ~ Width_~.~._Depth ~' Tile depth (top ~~ ~No. of Lines Seepage Pit: Inside d'ameter Liquid Depth No, of Seepage Pits Percent slope of land- ~ ~P,. ~ Distance from critical slope WATER SUPPLY: Private Joint ^ Community ^ Municipal ^ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord wish Section H62.20, Wisconsin Administrative Code, and that I Have sized the effluent disposal system from the EH-115 prepared by the C tified Soil Tester, / NAME I ~ ~~ ~/l/ ~~ it C.S.T. # ( ~ ~ 3 and other information obtained from .~/• (owner/buil _ 2 Plumber's Signature /MPRSW# /~~' 3 f~~ Phone # ~gT- ! Z ~ 7 Plumber's Address _ _~.G/~_S.. __ PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord. with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. .-~ e _ ~. ._ ._ a _v ~ _.. .~ -_ E E r_ .e__. ~e ~-~~7 _ ~ __ ~~ _ a ~ i-~ ~ ( ~~ ~ ~ . f 3 t f i ( a. ..,.,.. .~-. .~.,s ,., a~=.. ..., r e _,.. ~. ~ ~ ~... , _ _~-. ~ ~ ; ' ~ ~~ J~ ~..mv ~~ _ - ,~.~. a a_ . ~~~ ~ y~ ~ ~ru5~'~ ~ _ .. ~~ c ... ~ ~ m. a.. _ ~ ' ... ~ - ~- _ . ~ ~ ~ va y ~ l _ ~5''~T f~ c '~q ~ ~ ~ .. m~ _ m ~ .~ w_ ~ m _... _ ~ _ . ~. ' __ ,~- .,_ /~ , ~ ` ~~~ ~. . w_ .. .. ~. P, i~ .. ti n I 1 ^~ P« ...m k..s, 5 , ~~, E _ .. _ _. __ m, ~ ~ .a s ..w,w~ .v ._..e., e ~. S'~'. CRU1X COUNTY ZUN~NG llEPARTMENT AS QUILT SANITARY REPORT ~ II// / Owner ~NN ~ ICON T 73~'9'I~l~ ~~/' ~/~ 3 !~ dcit c~,s ~f a•. N CitS~iState ~}. B ~ W { , S ya/~~ Legal Descr lion: ~1~(I/~zJ ~S~"~-~'~S I.ot ~_ lock Subdivision/ ~S7` ~}-!~~/'~/O~ '/~ -~W'/• 1J~, Sec. l? , T~N-R.,jy~W, Town of l9 .SO nl . PIN # ~~O •//1y'• JO • ~a'Z ~~~n~ EPTiC T~vK -- ~ ~~~ N: • loan ~ • >so `a1 Wank manufacturer L(J /~~ Size ST/PC / Setback from: House Wel ~Z' 1 P/I.. Pump manufacturer Model Alarm location ~ .. ([IOLb1NG TANKS ONLY) Setbacks: Service road Vent to fresh a the Meter to Alarm location SOIL A,l3SORi'~~'lUN SYSTEM: C~vi~~ `f t ~ f' !t~ R l /J/~l ~ 2 Type of system: ~ cl' Width ~ Length ` ! Number of Trenches 3 Setback from: House Welt P/L .Vent to fresh air intake ELEVATIONS: ~~ ~ ~ ~ 0 of ~' ~ ~~°~' T- ,}~ ~~ °' Description of benchmark T ~ ~ ~D~/~ ~j~ Elevation Description of alternate benclvnark Elevation Building Sewer ST1fiT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines () ~~~~ () () Bottom of System ( ) Final Crade ( ) ~V(r.lg-~.z .a.oofi' O O () () Dafe of installation / / ,, Permit number ~~ ~~s, State plan number N~i`~ Plumber's signature License number ~~" x'03 ~~ Date / / ~ inspector ~ I~Q,,,,~ {~-(~ . 2 0 ` O Complete plot phn • tJlbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valle~r, Wl 54767 I T t d O ~ ~ ~'~'` ~ ~ ~ ~ N ~ n ~, ~? ~ c ~ 0 ~~ ~ (' ~ N ~ ~ ~, ~ ~ ~ - p ~~ ~ ~ ~ -~ .__ ~~-~ ~ y a ~. ~.- ~'~ o ~~ ~ ~ o ~ ,s,~ 1-° J ~ ~~ ~ ~ ~., 6 ~ ~ I ~• ~ ~~~ I~~' I,N a~ 70L ~ 1 I I i ~ I) .~ ep t~ ~`i't o Z \S1 III 1 il"~`. GIs () .~~ ~~~~, ~ ~ ~ ( III f~ ~t ~ ~ ~ o~ ~ ~ ~?~ ~ ~ I ~~ ,I~ ~i i ~~ ~ I ~ _ --~ - ~ - s a ~*' n ~ N_ ~O ~- ------- -- ---i ~ ~ ~ ~Ry - ~ ~ ~-~ _. x ~ ~r"+ ~ ~ ~_~ ~ C ,~ ~ ~ ~ m