HomeMy WebLinkAbout020-1140-40-000o
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/*
vVisconsi~ 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.~5.04 (1)(m)l.
LinseH~a~ern pie. ^ City ^ Viljage,~T~~~hlp
nUC1
CST BMElev.:. ~ Insp. BM Elev.: BM Description:
c~0 . to (csc~ , a'
TANK INFORMATION
U ~LEVATION DATA
TYPE MANUFACTURER CAPACITY
Septic (~ ~~ l~~
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P J L WELL BLDG. vent to
Airlntake ROAD
Septic y 5 p r r -~ ~ ~. ~ NA
Dosing
Aeration
Holdin
PUMP /SIPHON INFORMATION
Manotfacturer
Model IZkimber
TDH Lift Friction System TDH
For ai n Length I-f ell
'St. Croix
n
a Plan ID No.:
140-40-000
STATION BS HI FS ELEV.
Benchmark • 28 p-p , D'
~/~
Bldg. Sewer ~ '
St/ Ht Inlet
StJHt Outlet S• 3 S`-`fr
Dt Inlet ~~ ~-
Dt Bottom --~-
Header /Man.
Dist. Pipe ;~~ ~2,~2~
Bot. System Io` Z /, 0 3 r
Final Grade c~_„~~S
t cover
S•~~ 2r.8~r
Q• Ir~s~
~ ~
6 ~}~~ i
q~, s3
~ ~- ~ - 6-~-6 4`j~ SZr
L ABSORPTION SYSTEM/t [ ~~- Q h .. L~ ..t ~...,Q, „I,,,.-,~ l~' ~--4° rt,{,~ dIN~,~,~eldl. 6 --~-~ = g `f- 5Z
$~ TRENCH Width Len th
A N Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
IM ~
3 _
g-~'~ aZ DIM N 1 N
SYSTEM TO PJ L BLDG WELL LAKE /STREAM LEACHING of ctu r: _~~
t
SETBACK ,
INFORMATION
Typeo
r
~
Q
~
~~
o CHAMBER
OR UNIT
Mo a Num er:
System: t1 . 3(p
DISTRIBUTION SYSTEM ~
Header i nifold ~
~ Distribution Pipes x Hole Size x Hole Spacing Vent To Air Intake
r
- Dia.
Length Lengt Dia. Spacing
SOIL COVER ~ x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over r' ~, Depth Over xx Depth Of xx Seeded /Sodded xx Mulched
Bed /Trench Cente f Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: I~ / In /bt~ Inspection #2: -~-'-t
Location: 354 Audubon Lane, Hudson, WI 54016 (NW 114 NE 1/4 19 T29N R19W) - 192919715 Mallacove Addition -Lot
10
l .) Alt BM Description = N ~"•
2.) Bldg sewer length =L?u.. ~„a~ ~_ ~,; y~w,~ ~~, f~ ~-- t~l~~.6~, ;
-amount of cover =
`~4-~`s-t,~. ~ ~, ,~`h~ s~~ ~A to ~ ~` g''
PIa~iS revises io~requi~ ^ Yes ~ No
UseQt:$er~si~e fo add' ional informs Ion. ;
~5)) 1~ w ~~ Date u ` ~ ~~ I~ ct is Sig ature ~~~
SBD-6710 (R.3/97) ~ e ~C. ~ ~--~. C ~ ~ ~~~.~..~ Op~~~i / ti"^""
i
ADDITIONAL COMMENTS AND SKETCH ~ ~ '
SANITARY PERMIT NUMBER:
~. ~.~
__
t
Sanitary Permit Application Safety & Buildings Divisimt
' to accord with Comm 83.21, Wis. Adm. Code
201 W. Washington Ave.
~ See reverse side for instructions for completing this application PO Box 7302
•- r~'~~+~~
+~ Personal information you provide may be used for secondary purposes Madison, WI 53707-7302
Departm~nt'of Cammeree ()( )~
[Privacy Law, s. 15.04 1 m (Submit completed fom- to county if not
state owned.
Attach com lete lens to the coon co onl for the ste on a cr not less than 8 -1/2 x i l inches in size.
County State Sanitary Permit Number Check if revision to previous application State Plan [. D. N~ r
I. A lication Information -Please Print all Info i Location:
,,4/~
P Owner Name .~'~ Property Location
~
t
~ ~
/VUU 1f4 ~ 1/4,S / T~ ,N R/?~ or
Property Owner's Mailin Address ~ ~ 4- - Lot Number Block Number
City, State Zip Code -~ Subdivision Name or CSM Number
_ _
sr c of
II. Type of Building: (check one) ~; .,~` INGOFFIt;F p Vil
~
1 or 2 Family Dwelling - No. of Bedrooms :~~ ~r'
~
'
~ lage
QTown of
Public/Commercial (describe use):_ \
. 7
~ /
~
^ State-Owned U EX .7 C)/l
Nearest Road
/
~
u C.-ct
_
~
~ ` ,~
~ ~ ~ Parcel Tax Number(s)
~ ~
t ~
a
III. T e o ermit: Chec one box on line A. Check box on line B if a Lcable (~1. ~~ . Gl . '1 I S
p) i. O New Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to
S stem S stem Tank Onl Existin S stem
B) Permit Number Date Issued ,
^ A Senile Permit was reviousl issued
IV. Type of POWT System: (Check all that apply)
l~lon-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland
D Pressurized In-ground r ^ Holding Tank ^ Single Pass ^ Drip Line
^ At- ~ 3 X 6 ~ • ~ ^ Aerobic Treatment Unit ^ Recirculatin ^ Other:
V. Dis ersal/Treatment Area Informatfon: $ )l~ W ; ~ t(Z ~ J
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Perko anon Rate 6. System Elevation 7. Final G e
y s~ Requirtd
s Proposed
37~ Rate (Gal Jday/sq. ft.)
.7 re .a (MinJinch) EI vation
8q. ~ ~3 . ov
YII. Tsnk Capacity in Total # of anufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing Crete structed
Tanks Tanks
i - I4bb ~ tSc~
~" a ^ ^ ^
~
e 1
^ ^ ^ ^ ^
VIII. Responsibility Statement
I, the undersi assume re nsibili for installation ofthe POWTS shown on the attached lens.
Pl~s N (print) Plumber's Si (no stamps): MP/MPRS No. Business Phone Numlxr
Ji ~f'N- ~` - U - ~8~ -'- '~
Plumber's Address (Street, City, State, Zip
p-
IX. County/Departm nt Use Only
^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Ageat Signahue (No stamps)
R9, Approved ^ Owner Given Initial Adverse Sur ge Fee) ~
Determination c)~S• ~ -1 Q- ~l9rrf~
X. Conditions of Approval /Reasons for Disapproval:
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1288
SOIL EVALUATION REPORT
in accordance with Camm 85, Wis. Adm. Code
page 1 Of 3
A.C.E. Sal & Site Evaluations
County
Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal r BM), direction and parcel I
D
percent slope, scale or dimemsions, north a , a~ ~n
nce to nearest road. .
.
020-1140-40 ID# 19.29.19.715
Please prin oration. ,~~ ~~ gy Date
~r seco
Personal Infortnatbn you provide may rives .5.04 (1) (m))• ~ _ I _ Z~Jfl
i
Property Owner }~; ~- operty Location
Verne Linse - ~ G vt. Lot NW 1/4 NE 1/4 S 19 T 29 N R 19 W
Property Owner's Mailing Address ~
~
; # Block # Subd. Name or CSM#
~°' 'r '~~~ix.
354 Audobon Lane ' 10 Malla Cove
City ---- !` Stat Zip,~odr~~'~~te ` - A,,,,\ City „~ ViNage Town Nearest Road
Hudson WI 715-3 Hudson Audobon Lane
Wisconsin Department of Commerce
Division of Safety and 8uiidings
';~ New Construction User Resid ~' ~ roans 3 _ Code derived design flow rate 450 GPD
Replacement ,;, Public or commercial -Describe:
Parent material Glacial outwash Flood plain elevation, "rf applicable na
General comments
and recommendations: Install bull run valve to allow future use of
existing hydrologically failed system. Existing system
elev. = 91.0'. Proposed system elev. should be 89.0'.
~~ # ~ Boring
~ Pit
~ 102 i
!
Ground Surface elev. 93.07 ft. Depth to n.
limiting factor Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dtft=
1 0-2 10yr3/3 none Is ~ - r mvfr as 2f 0.7 1.2
2 2-21 10yr4(4 none Is osg dl cs if 0.7 1.2
3 21-39 10yr5/4 none s osg dl cw - 0.7 1.2
-.
4
39-102
10yr6/4
none
s
osg
dl
-
-
0.7
1.2
~ i ~,
Baring # j Boring
Pit Ground Surface elev. _ 93.04 ft. Depth to limiting factor _ >98 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft~
1 0-5 10yr3/3 none Is ~ - ~ cr mvfr as 2f 0.7 1.2
2 5-22 10yr4/4 none Is osg dl cs if 0.7 ~. ~
3 22-45 10yr5/4 none s osg dl cw - 0.7 1.2
4 45-98 10yr6/4 none s osg dl - - 0.7 1.2
s• z~ 8 .Z
'Effluent #1 = BOD 5> 30 a 220 mglL and T >30 < 150 = BODs <30 mglL and TSS <,~0 mglL
CST Name (Please Print) 'nature: CST Number
James K. Thompson "'}~3---- 3602
Address A.C.E. Soil & Site Evaluations ate Evaluation Conducted Telephone Number
Osceola, WI 54020 8/24/00 715-248-7767.
prey Owner Veme Linse
ParcellD# 020-1140-40 IQ#19.29.19.715 Page 2 of 3
Boring # ~ Boring
,~ Pit Ground Surface elev. 95.19 ft. Depth to limiting factor > 118 in. Solt Application Rate
Horizon Depth Dominant Color Redox Description Texture Shucture Consistence Boundary Roots :
*Eff#1 *Eff#2
1 0-4 10yr3/3 none Is 1 ~ ' r mvfr as 2f 0.7 1.2
2 4-23 10yr4/4 none is osg dl cs if 0.7 1.2
3 23-48 10yr5/4 none s osg dl cw - 0.7 1.2
4 48-118 10yr6/4 none s osg dl - - 0.7 1.2
.t8 I o. 43 (.03 ,
Boring # j_..-~~ 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
*Eff#1 *Eff#2
^ Boring # J Boring
J P~ Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon De
th Dominant Color tion
Redox Descri Texture Structure Consistence Boundary Roots
p p *Eff#1 *Eff#2
* Effluent #1 = SOD 5> 30 < 220 mgtL and TSS >30 < 150 mglL
* Effluent #2 = BODS <30 mglL and TSS <30 rr>g)t.
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.
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DF S~J i/1py~. 354 ~Y12<
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently serving
• "the ~A 1~~K-v 1 ,f ~'~'-C residence located at:~_~, ~~ ~,
Sec. t ~} , Ta 9 N, R~_W, Town of kpSa~d , St. Croix
County, Wisconsin. Upon inspection, I certify that I have found the tank and
baffles to be in good co di 'on, and it appears to be functioning properly.
Last time serviced ~~ a9 ~~
Did flow back occur from absorption system? Yes No~ (if no, skip next
line.
prox ate volume or length of time: gallons minutes
Capaci
uction: Prefab Concrete Steel Other
Manufacturer (if known): ~ j
Age of Tank (if known): ~ ~~a
(Sign ure) (Name) Please Print
I~P~s ~~~9u~
(Title) (License Number)
9 ~ ~~
(Date)
Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or
licensed disposer (NR 113 Wisconsin Administrative Code)
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank condition, I
certify that the tank, to the best of my knowledge, will conform to the
requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over
outlet baffle).
~,
Name J \ -~^r ~b~- ~~ ~ S ignature ~U
MP/MPRS of ~ a, U
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In-Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWYS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
Table 1: System Design Specifications
.Sanitary Permit Number 3 ~ 9 ~"~'
Number of Bedrooms
Design Flow -Peak (gpd) ~{~~
Estimated Flow -Average (gpd) co
Septic Tank Capacity (gal) - ~
Soil Absorption Component Size (ft2)
Type of Wastewater Domestic
Table 2: Soil Absoration Comuonent -Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design F{ow -Peak (gpd) o~~t ii Qs
3~ 1
Maximum Influent Particle Size (in) U /8
Maximum BODS (mg/L) 220
Maximum TSS (mg/L) 150
~~
Tab le 3: Maintenance Schedule
Septic Tank Inspect and/or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the septic tank and outlet filter shall be assessed at least
once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure
proper operation. The filter cartridge should not be removed unless provisions are made to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound, defective, or subject to failure must
be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enfer a septic or other treatment or holding tank for
any reason without being in full compliance wifh OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lefhal gases, and rescue of a
person from the interior of the tank maybe difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ~, ~ 1. /.;;~/~;
Mailing Address
Property Address .~ `J 'S'~ ~ l ~Q /tl~ _
i9/
~w (Verification required from Planning Department for new conatnuction)
City/State _ ~~ ~, ~r5r~ l ~ ~1 Farrel Identification Number D~~ -~'/h~O - ~
Property Location ~ y<, ~ ~/,, Sec. ~ T~,~N-RAW, Town of _~i.~~~sy1i~
Subdivision
Lot # ~.
Certified Survey Map # ~ Volume ~--- ,Page #
.~
Warnwty Deed # _ ~~R g ~~~ ______v Volume _~~(~.~, Page #
spec house ^ yes ^ no
Lot lines identifiable ^ yes ^ no
Improper use sad maiatenanceof your septic system could result is its premature failure to handle ~-aates. Proper naintenatroe
coaaiab of pvmptng oat the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the timctioa of the septic tank as a treatment stage in the waste disposal system.
The property owner. agrees to submit to St. Cmix Zoning Doparta~nt a certification form, signed by the owrrar sad by a
~~'ld.~P~~~ r'eatrictedplumberor a licaaaedpun~er verifying that (1) the on-site wutewatmdiapoaal ayal~
is in proper operating condition andlor (2} ~apection and Pumping (if necessary), the septic tank is leas ~n U3~ of
~ , , ` ~'
Lwe, undersigned Gave read the abov sad agree to maintain tle private sewage disposal ' tandards
f°t ~ - ~ ~ ~' ~ Department and the Department of Natural Resources, State of WbtafleaiuCl~d~gHOa
~~B that Y~ ~c ayatnm has been ntaiata~ined.i;ntat be c feted and returned to the St. Croix Coup
rya O°iP ty Zoning OtHoe within 30
ei{Cpiration date.
SI ATURB OF APPLICANT
DATl3.
QWN$~R CLR't'~Fi~ON `. } • ••
;: ;, , . .
I (we) t:ettit~t that all atatementa onaLra form sire true to the beat of my (our) kaowiedge. I (wej am (are) the owner(s) of
~ above, by virtue of s nwarnaty wed recorded in Register of Deeds Office.
Y
,,
/ ~~. ~~
SIONATURB OF APP . .
LICANT ; ~ " DATE
..«••. Any information that ie min- '': •..*~~
w result is the aanita rnait bein revoked b th
rY Pe g y e Zontn6 Deparhnent.
•; Inclade Mth this a Ilea n: a stn ~fi ~` " __.._._
pP mped.waaauty deed firm the Register of Deeds office
a copy of the emtifled survey map if roterence is made in the warranty deed
UoC.t~htEr.r r~o STATE BAR of t~'!~ '(stiSI~S FORtit I -19a~ Mrs :..:.z wc9cavca row r.ccoR°•vo o.r~
WARRANTf GEED
3~5~44 voi fi(~~ :5~i
So-.en G, SoaeT.scn xEG1y7~~S OFFICE
This Deets, made between 5t. ~~,~{~ ~~ . ~, ~
R~c'd• yr Awed this 17th
~~rantor, day Of June q, f~, ~ 9 83
and Lavern L. Linse and c'arvl <T. Linse, husband and ----.-.__. -
wife as joint tenants, at_...~SS A M,
Grantee, ~~~ ~ D~~
~Vitnesseth, That the said Grantor, for n caPrblc consideration
of one dollar and other valuable oorsideration
St. Croix F`T`~"" '°
nonce; s to t;!-rntcr the foUuwing descrhe.i rea{ eats r in
(',iuntc. ~t::~ W'iac•~ns!n:
Int 10, *^allaeove ?lddition to 1'cx~mship ~f Hudson. Taa Parcel No: .....................
Subiect to the utility easements of recsrd and i7eclaration Establishing Protective
Covenants recorded in the office of the '~aister of [~eer~s for St. Croix Cotmty,
Wisconsin, on May 4, 1977, in Vol~a~e 553, pace 400, document 339E?3.
. ~O~•o ~
-. -- - -~,
}Y
r ,: 1S not nn;est.•ad proper'.:.
~~~~ i~: r:ut1
1'-;c, ::rr •.v... an i . !n::.inr the herr~i:...._, +it. u.,~l ,.1, .. ~ n..~~ce9 trerr~nto belor.~ir~.
~,,;, Soren ^. Sorenson
. ,rr rnt. .~. ~ e i. i. ...~ ~.:._a , ,,. ... _.:k; ,,.,~i ~,~ a! u[ <:n~umt~ran«s esc<pt
recorde<? pmtecti~m covenants, e~-3serens and restricti.~ns of rea~rd, if any
.. .i ,
~,i 183
Soren G. Sorenson
~E \t rSE:~Lt
AUTHENTIC:~TION
~ik~n;rture 1 :c ~
tat^+~fltiC:a{•,i tin '< il~i_~ of _.
TtTI.F: \(F''.I['.F:E{ ~T1; F. tt.\f, ~~F «''~r'~1~:~":
i ~ ` n,J.
Robert F tJall .
527 Second Street, P.f_1. Box 151
HutJson, «I .54016
ACKNO~~LEDGMENT
~T.~TE OF i~I~Et3?~FtiFN 1
~( i9.
Yersonnlh' came before nu this .__._ . ~.~.;~ _.day of
_:!. rte.`. .__ 19&3... the abo•.e named
Soren C. Sorenson
to r.:,~ I:r.„~.~-n t,. he the nFr;nn _ ~chn oxec'uted the
•ol,i ~ in<trurnr~nt ar.~i u•l:no~cl!~~~l~e ih!~ -a!.!e.
' Utl~ :1 ..~'-+ -.1
~t .
\•,t;,• I':~hli, .. r . <, _' . r. Cuunt~', iris. /' '~
c
.._. \T~, !-. i i=;i~n is prrmar.~~nt. (tr rtet, Mate t~cr~:ratio•!
r '~``~ = - ' i -
_ _ ~~ ~ • -1321.54-
- ~ /346.54 -~- 147.00 150.00
N I/4 COR. SEC. 19 I ._~~ '- ~ ~'~
T.29N., R.19W. y / \296g i~T~ ~
CO. MON. W/CAP ~ / 20 .~~
v~ ,09 ~ ~; w ~ I'`~ ,
GO~.~O ~6o Oy 00 ~ I ~ amp w
~ / E~~~ ' ~ 3O ,59 o I ~ ~ w
M (A
/ ~ , 6g3 O ~~ 1.6 13 Ac . °z I f a w
~ r' i 2 3 1.207Ac.
5a~,~ g~3f 2 co---{ -- Q
N76~'233.O~1 ,, ~ x`90 --~ - 3
65.09 T ~`' O° ~ u0
-~ 9p. Q, ~; ; ~~ I. 379 Ac. ~1 1$
a~ ~ o
~o Q`~'' ~r I I '= 1'~ °36~'
w ~5., ° Z,
M ~o = ~ ~ ,~ p ~ /
M ~ 1 .359 Ac. o ~ ~~
in - AS tT _
o ~ Q . 00 N
s -Y ~_
2 1.433 Ac. ~~ ~~~ / ~ 5 ---- ~-
~ ~ N~
495 Ac. o /~~ u~.~ ``~~. ~, OAP` / ``~O , 5 ~ ~ ~,~'~~- SEAS IT
8 ww ~~.~'(~ O~ ~ Via- . `O~+ 00°~ A O \~. 'O ~, `~ EM
i
!- ~ ~ ~ o O°~/ A~9 ~ ~i9
33, 3 Z O ~" ~~ / p ~0,
F
0O F96 ~ '
a~, ~~ 3T, / 1.167Ac.
O ~~ 4
~ ~ g9o -- 3002 ~ ~o
f
N ~ ~
' 79.67 0 / ,~~ ~ ~, v I I ~0`~s 5
c
~e Public ~~~ ~ ~:'' 1.099 Ac. o o,
w '~ 26 N I I ,, ~0 ~ ~ ~ s-, i.202 Ac. _~
0.00 -'_ 'c3J 108.40'~`~= '12
• • ~ ~ ~
O°O~\ ~'~ ~ ~ 0659" -- 907.68-
~ ~,~~ • ~ 372.60
~---- ,\6; ; 178.87
ION SHALL NOT 0~ ~_-
949.50
3TION SYSTEMS M ~~ S 86°49'49" E
~UTLOTS I AND 2. in'LrO
0
O ~
`~ ; o LOCATION MAP
o .
....NPLATTEp 0~
•••••-••••••-• ~~ Section l9,T.29N.,R.1~
o~ &
~ ` Y
~~-aS
r~
';~.
,~ ,~.>.
ST. CROIX COUNTY
WISCONSIN
ZONING, -IIEFICE
ST. CROIX COUNTY CzOVERNM~NT,CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
~~
,;
June 5, 1995
Iii-2~i. ~9 ~<S
Lavern Linse
354 Audubon Lane ,~ /]~~~~ ~'~ ~~-'" ~~
Hudson, WI 54016 ~(J(
RE: Water Test Results for Lavern Linse
Address: 354 Audubon Lane, Hudson, Wisconsin
Dear Lavern:
Enclosed is the original test results from Commercial Testing
Laboratory, Inc. for water inspection of the above property. If
you have any questions regarding these results, please do not
hesitate in contacting our office.
Sincerely,
,Ytm ~l~nompson
Assistant Zoning Administrator
db
Enclosure
OWNERS-DRAWING OF HOUSE & SEPTIC SY~
1 I~ , ~v~.t~t.
~ ~..»
.)CATION
TO BE COMPLETED BY INSPECTION AGENCY
System design &/or permit on file? ^Yes ONo
Soil series per SCS Soil Survey:
sheet #
Type of soil absorption system:
Approx. size 'X '
Ft . Z
OBSERVED DEFICIENCIES
Septic tank
Setbacks: ^House
Dose tank
Setbacks: ^House
^Locking cover
OAlarm OElec.
Soil Absorption System
Setbacks: ^House_
^Ponding:
reT]P Ya ~_ !~rZ 1?1TY?e T?tC:
^Below grd ^At-Grd ^Mound
^Gravity ^Dose ^Pressurized
^Bed OTrench ^Dry Well
^Holding Tank ^Outfall pipe
^Other ^Unknown
^Well ^Prop. line UOther
_ OWell ^Prop. line ^Other_
_ ^Warning label ^Pump/Floats
wiring
^Well
OProp. line ^Other
^Discharge:
~g~
~'"r w ~ BUILT SANITARY SYSTEM REPORT
a
OWNER C/ er ~ ~ / yl5 '~ TOWNSHIP ~ v ~/~ h SEC .~T.,~° I-R~W
ADDRESS ~v ~50~7 L~""~ ST. CROIX COUNTY, WISCONSIN.
/ "~
SUBDIVISION !~! Q' /I5 L:,Gr~~ LOT 1 ~~ LOT SIZE ``'
PLAN VIEW
Distances and dimensions to meet requirements ofi H63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM -.
I
I di at N r h rr w
BENCHMARK: (Permanent reference Point) Describe: ~
~~ ~ ^ ~ ~~~ ~ ~ f
Elevation of vertical reference point: S1 :~~
SEPTIC TANK: Manufacturer: FiJ/~~/~5. Liquid Capacity:
Number of rings on covex' ''' r^" Tank manhole cover ele"nation: ,>
Tank Inlet Elevation: /(~ Z~, '~ ~ Tank Outlet Elevation~~~`1~f
~!
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set for a cycle gallons; Total capacity of
distribution lines gallon: size of pump head;
gallon per minute horsepower ;brand name of pump
and model number ;
Type of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover ;
Type of warning device
SEEPAGE PIT SIZE; Number of pits feet diameter
feet liquid depth seepage pit inlet pipe-elevation
bottom of seepage pit elevation Beet.
SF.F.PA(:F. RFn ~T9F.~ number of l;ne~ width % length .S'~. the dept
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
~ LABOF! & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS Dlvlslol
P.O. BOAC 7969 BUREAU OF PLUMBINI
`MADISON, WI 53707
C~CONVENTIONAL ^ALTERNATIVE State Planl.D.Number:
^ Holding Tank ^ In-Ground Pressure ^ Mound (If assigned)
NAME OF PERMIT MOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE.
Vern Linse 626 N. 4th, Stillwater, MN ~Q'/a7 '~.3 ~~lJU /w
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN-. REF. PT. ELEV.: CST REF. PT. EL V.:
SE NW Sec. 19, T29N-R19W, Lot lO,Malla Cove,Town of Hudso
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Richard Ho kins 1059 St. Croix 38479
SEPTIC TANKlHOLDING TANK:
MANUFACTURER: i /
/~ (,q LIQUID CAPACITV
-,
.. TANK INLET E EV.: TANK OUTLEJJ E y.~
.~ .- J ~~ WARNING LABEL
PRD IDED: LOCKING COVER
PROVIDED.
1~'/ ,~., L~` ~'~ ~
/ L ~
~'' j~` 4- . Z~ '%% ~ ;!`' YES ^NO ^YES ^NO
BEDDING: ~ VENT DIA
~ VENTM TL HIGH WA,TE NUMB R OF ROAD. ~
' PROPERTY WELL BUIL ! VENT TO FRESV
' ~
~...:: ~ ALARM. ]( ~
JI
OM J ~
~
r_ > LINE~,
` ~ ~/ hµ,
%
-~' aff AIR ~AIL~
,
^YES NO O
NO NEAREST ~
' • ,,;. >, ~,
DOSING CHAMBER :
MANUFACTURER: BEDDING: LIQUID CAPACITV. PUMP MODEL. , PUMP/SIPHON MANUF A~TURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
^YES ^NO _ ^YES ^NO ^YES ^NO
GALLONS PER CYCLE: PUMP AND CONTRO LS OPERATIONAL NUMBER PR OPERTV WELL. BU ILDING-. VENT TO FRESI
(DIFFERENCE BETWEEN FEET FR uNE AIR INLET:
PUMP ON ANO OFFI ^YES ^NO NEARES
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depRh of plo mg
~
(lf
i
il
b
ll
d i
i
i
~~ _
~
FORCE. ,-' 1 FNG iti
~ DIAMETER MATERIAL AND MARKING
,,~,y
or excavat
on.
so
can
e ro
e
nto a w
re, construction sF
all cease
"`
the soil is dry enough to continue.)
MAIN ;~
.-_-
CONVENTIONAL S YSTEM:
BED/TRENCH WIDTH:
f ,., LEN TH NO. OF
TRENCy,ES DISTR. PJPE SPACING:
O COV
M9T~R IA L:
PIT INSIDE DIA. . #PITS: LIQUID
DEPTH:
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DIST . PI F DIST R PIPE DIST R. PIPE ATERIAL~ NO. DI R. NUM BER OF PROPERTY ~ WELL: BUILDING V ENT TO FRESI
BELOW PIPES: AB E VER: ELEV/ IN ET.
~~'i•,~I ELEV. ND
~I~ ~ ` t~
~} "7 2~
~- / a PIPE
FEET FROM
NEAREST---s- LINF.r' ~
5
~
~
t(' ~
~ AI IrygET/
`~ >
/
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for P VIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make pertain that it REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. ~ T NS MEASURED.
^YES ^NO i i
SOIL COVER TEXTURE. PERMANENT MARIGERS OBSERVATION WELLS
i
^YES ` :`~NO ^YES ^NO
DEPTH OVER TRENCH/BED pEPTH OVER TR ENCH/eED DEPTH OF TOPSOIL SODDED. SE -DED: MULCHED:
CENTER- EDGES:
^YES .' ^NO -' ^YES ^NO ^YES ^NO
PRESSURIZED DISTRIRUTIDN SYSTEM:
WIDTH: LENGTH NO. OF LATERAL SPACING: GRAVEL DEPTH.BE LOW PIPE: FILL DEPTH ABOVE COVER:
B~EDiTRENCH TRENCHES:
DIMENSIONS
~
MANIFOLD PUMP MANIFOLD DISTP~ PIPE MANIFOLD MATERIAL: DISTR. :
M , DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.: DIA.. ELEV.: ~ IPES: DIA.:
ELEVATION AND /
DISTRIBUTION
INFORMATION HOLE SIZE- HOLE SPACING: DRILLED CORRECTLY COVER~MATERIA L: VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
^YES ^NO ,_ ^YES ^NO
COMMENTS: PERMANENT MARKERS: _: ~ 08SERV TION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
~''~ ' Z~,
^YES C~NO
^YES ^NO FEET FROM
NEAREST LINE:
_
~ t ~E, ..
f ~
~, ~`,,w~_ .. _......
:~~ ~ ~I
~,
Lin
1, ~~ 1
;.~ ~' ~
.-
~, ~~ Z,~...__ _ _. r _......_ _......_._w ~ ,~.-~ ,~~ ~
~.~
~~. ` - ~~
~<; L~.
l
~~ `~~ }~ S rz.
l/
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE: ~~ TITLE:
DILHR SBD 6710 4R. 01 1821 ,~ - l 1""" _' ~~'~ ,~'~" ~`' '~~
W
f DEPARTMENT OF APPLICATION ~
SAFETY & BUILDINGS
u1-NDlJSTRY, FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans. for the system on paper not less than 8'/z x.11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test. report or the ovvner's copy must be
included.
Property Owner. Mailing Address:
..~ z T - a
PropLe~rty Location:
G ~~a N~/4S ~ iT~ NCR ~ (or) W ~~orTownship: County: ~ ~~ee ~
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan 1.D. Number:
d G ~0 (lf assigned)
rrc yr oanwnvv
Number of
^ Public* ^ Variance* ^ Other (specify)* Bedroom
~1 or 2 Family *State Approval Required.
TOTAL
GALLONS NUMBER
OF TANKS PREFAB
CONCRETE POURED-IN
PLACE STEEL FIBERGLASS NEW
INSTALLATION REPLACE-
MENT OTHER
(Specify)
SEPTIC TANK CAPACITY ~h.Q,~
HOLDING TANK CAPACITY
LIFT PUMP TANKISIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feetl: New ^ Replacement ^ Experimental (Seepage Sed ^ Seepage Pit
G ~ Alternative (specify) ^ Seepage Trench
Nater Supply: Owner's Name as Listed on Soil Test Report (If other than present ownerl:
~rivate ^ Joint ^Public )r''a ~ ~
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signatu MP/MPRSW No.: Phone Number:
(~is~ s ys sr~ C
Plumber's drgss: Name Desi er:
//1 ~ f2 iv d
COUNTY/DEPARTMENT USE ONLY
Signatu a of Issuing Agent: F Date: 22 Sanitary Permit Number:
p0 ~ ~~ ~J ^ DISAPPROVED 8
Reason for Disapproval ,
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to-the county. prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DI LHR-SBD-6398 18.07/81)
Form - S T C 100
Clwner of Property_ -~~,~ ~ ~ ,~, / h S~P
Location of Property~Ew~~~, Section~,T~_N R ~~` W
T a w n e h 1 P .-_ /`-t it ,.~~ ,ti, --~-
Mail,ing Address ~ ~ ~ /V y ~j .s ~i J/ Uv o 7`P ~ ~~ y,
Subdivleion Name ~o // 4 ~ s fry
r
Previous Owner of Property f~id' f f a ~o ~..,~.
Total Size of Parcel_ _ I • ,~ ~ Gt'..®•w,.~. - - '
Date Parcel has Created
Are all corners identifiable? ___L___LeS No
Include with this application one of the following:
~~rtified Survey Map
.Deed
. Lard Contract ~ or
Other L'egal`Document which describes the property
PROPERTY OWNER CERTIFICATION
I (We) certify that all statements on this farm are true to the best of my (our) ,
knowledge; that I (we) am late) the owner(s) of the property described in this
information form, by virtue of a warranty deed r corded 'n the Office of the
County Register of Deeds as Document No. ;and that I Iwe)
presently own the proposed site for the sewage dispose! system (or 1 (we) have
obtained an .basement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of peels, as Document No. ).
~~4.~ „_ _1.~.r.~-ter ~~~~
SIGNATURE qty gWNE SIGNATURE OF CO~OWNER (IF APPLICABLE)
G ~ >~^ ~ °~
GATE SIGNEq ~ pATE SIGNED
~ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
~NDUSi~,RY, CC DIVISION
I~uMAN REDATIONS PERCOLATION TESTS (11J) MADISON W 53707
(H63.0911) & Chapter 145.0451
LO~ 10~/~,/ SECTIO% u
~ TOWNIP/MUNICIPALITY: L~~ O.: BLK. NO.: SUBDIVISION NAME:
/
lor) W ~T
COUNTY:
S7~
-
'~
' OWNER'S/BU ER'S NAME:
MA LIN ADDRESS:
~
~
,
r
~ r ~~
e ~ ~~
y
r ~~F
id
~ NO.BEDRMS.:
'° COMMERCIAL DESCRIPTION:
/
'
t
^
l
$es
ence 3 /
i Rep
ace.
New
RATING: S= Site suitable for system U= Site unsuitable for system
DATES OBSERVATIONS MADE -^ ~Q °- ~3
PR FILE DES RIPTIONS: P OLATION TESTS:
LCt~~TI^~ . M~~. ~~ IN G~~ ^~ E: SYSTEM-I~L OQLDING T~ : RE~
~
foop~ na1) ~
lam ~
P iY~/d
~
/
,
/
If Percolation Tests are NOT re wired DESIGN RATE:
Q I If any portion of the tested area is in the
under s.H63.09f5)Ib), indicate: Floodplain, indicate Floodplain elevation:
~_ ~ PRC1~ l~E~ DESCRIPTIONS
BORING TOTAL D PTH TO GROUN DWATER-IlY~9h1ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH)tJ, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B" ~ G~ D ~o~t ~ G~ •/7 ~/~SG LIMs~ = fir- ,~i'
s-~ D ~ 5' .zs'~l-,SG is Cfl~-
V9
~
e-~ ~ ys e ~ ~
- 5~. 3 ~ ~ ~ ~~
6-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD2 P R PER INCH
P_ 1 9 ~ 3
P-~. . iz-
P • ~
P-_
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION / ., p~
r~
_.
~_ .___ _ _ _ _ ~_ _ e ~~ _. _ M _ _ _ _ _. , . _ _~ __.. ,
A ~m. E
Ai . L4 L E_/~ ;1 i j I i ; All. !_ i \ i ! E .~, ~~ ^~-y..I S ~®
Q _
~'
~Y
TN
ti4 ~
9NSTRtlCTIONS FOR OMPLETIN FORM 115 - BD - 6395
To be a complete and accurate soil test, yorn~ report mrsst ii7clu<1e: ,
1. CaEnplete legal description;
2. The use section must clearly indicate whether this is a re ;: oce or commerc,ia! project;
3. MAXIMUM number of ' ~drooms or cc:>r-nrroeecial use Isla--:sect;
4. Is this a new ar replace ant systerzs;
~. Ccsnsplete the suita2,;s y rating boxes A SIT>= IS SUITABLE FOR A HOLDING Z"ANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDiTIONS~
6. PLEASE use the abbreviations spawn here far vvriting profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet may be used i~f desirec#~;
;3. Make sure your benchmark and vertical elevation reference ~ Dint are clearly shown, and are permanent;
9. Con r fete a!! appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
t ;,propriate;
10. If ~ ration {such as flor~~` Eevation} does root apply, place N.A. in the appropriate box;
~ 1 . Sign tl~= ;~rrro arod place your current address and your certification t7~smber;
12, Make legible copies anc{ distribute as required. ALL SOIL TESZS MUST SE FILED WITH THE
LOCAL AUTHORITY t+t1CTHlN 30 GAYS OF COMF'LETlON.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Sail Separates and Textures Other Symbc~(s
st - Sfot~e (over 90"} BR - Eiedroc?k
COE? -- C',Obble ` - ~O"7 S~J - u >;iP.
gr -Cara .- 3"} LS - Unsestone
~s -Saud NGW - Niyh GrUUrodwater
cs -~ Coarse Sand Pare ~~- Percoia'tion Rate
med s - i~'ledium Sand tN - Wel!
€s - Fine Sand 43ic3g - Builc9ing
(s -- Lrsamy Sand ~ - Greater 1-han
~`~sl :"~~,~-iy Loam ~ -Less Than
~! _ Bn -- Brov~~r~
~sil -~ L.,:on~o Bf - Black
si -Silt: Gy -Gray
*c! -- Clay Loans Y - Yeklcsw
scl -- Sandy Clay Loam R - Red
sicl -Silty Clay Loam mot -Mottles
se -Sandy Clay ~r~! -- witl~o
sic -Silty Clay ffif -few, f~i~
~'c -- Caay cc: - c<~rnn~
pt -Peat +rsm -Many, n;.:_ ,os~
ni -- Muck d -distinct
p - prot~inent
NV+1~ - Nigh vva9 eve(,
Sx ' < .°I text ores surf~a
f0!" ltgilid VUaSte di~pn~a! BM - Ben Ch ~.._
VRP -- Vert~c. R Ce POynt
TO THE OWNER:
~,
r
~ ~ /~ a. 3
~v7Yo~. ~j /~
/ ,~
~°
0
V~
Q`
~~~~ w ~~
/o s-~
~ ..~~~
(// ~ ~" r ` ~ r/.5~
~q~L q coL ~ = G°7` /o
~ G ioa ;
B~M~,
rv; 5 ~~~