HomeMy WebLinkAbout020-1052-30-000sconsin G~partment of Commerce PRIVATE SEWAGE SYSTEM
afety and Building Division
` INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT}
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j.
Permit Holder's Name: City Village X Township
Fosterlin ,Dan & Rita Hudson, Town of
CST BM Elev: Insp. BM Elev: BM Description:
/03~0~ ~ i GST
TANK INFORMATION (~ ELEVATION DATA
TYPE MANUFACTURER +~ CAPACITY
Septic ~ ~ N
ism
sesmg t~' 1 ~-~.~.- ~a.
(~,'f,S~ ~ ~+b
Holding
TANK SETBACK INFORMATION
TANK TO ~ P/~ ~ L~~
}' BLDG. V~ t t~lnt~ake ROAD
s ~~I~ 7 J5a ~ ~
7 Z~ /
2 Z ---- -
Dosing ~ / ~
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
PM
Model Nu ber
TDH Lift Friction Loss System Head H Ft
Forcemain Length ia. Dist. to Well
snu aRSnRPTtON SYSTEM
county: St. Croix
Sanitary Permit No:
515162 0
State Plan ID No:
Parcel Tax No:
020-1052-30-000
Section/TownlRange/Map No:
20.29.19.1966
STATION BS HI FS ELEV.
Benchmark 3. 07 /G3.d1 /~
Alt. BM /
rr,`I ~.. ~an i 64G~. C-0J ~ 'T
w ~ 8Z
„
Bldg. Sewer
mac; 5~-;
~
/ I
St/Ht Inlet
i~ ~ ~
SUHt Outlet /z,' 90 ,
sF ~ ~,,` 8.b~ ~5. 33
nt.Bottorx~
~,•,,.~. a~~-
s .~
s 9 Zc~
Header/Man. 9, p
s ~
$
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7.
Dinst. Pipe
T ~ ~+'~ Q
9.3(7 ~/
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0 l~ • 6 T
Bot. System
~~ .,3a
B'7.72-
Final Grade
5, $
9Z. z
St Cover
F,•11.~ ;,~.,.,
7• L~
.BZ.
~' 9~. SI>
BED/TRENCH Width / Leng
th d-- No. Of Tren
c
he
s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 A
/
5~ E~OS ' I~
-
r
~
l f gwc~L~U ~ ~- ~
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer ^^ //
~
r~
INFORMATION CHAMBER OR T"14.~d`-
~1+~
Type Of System: ~J`a ~~ ~ i ,~ I ~ UNIT Model Number:
nISTRIR11TInN SYSTEM G_ c.~-''i`_'1 !0%. _
HeaderlManifold /1 Distribution ... x Hole Size x Hole Spacing Vent to fjjr Int e
~ ~
~ 7 Pipe(s) \ \ `
i
h Di
S ~ ` 3 ~ ~~OiM-
Dia
Length ng
pac
a
Lengt
Snll CnVFR ., o.e«...o s..~roma nnr+. YY Mnund Ar et-Grade Svstems Onlv
Depth Over
C Depth Over
h Ed
es ~
B
d/Tre xx Depth of
soil
To xx Seeded/Sodded xx Mulched
enter ~ ~
BedlTrench nc
g
e ~
p Yes ~ No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1,: /6 /~/ 0~J Inspection #2: / /.
Location: 832 Dorwin Rd. Hudson, WI 54016 (NW 1/4 SE 1/4 20 T29N R19W) metes & trounds Lot_ Par el No: 20.29.19.1966
1.) Alt BM Description - /~
2.) Bldg sewer length = E~~ 6,~,, ~ ~,~~~~ Q~~ f ~~ h S`~v~ ~ j` r~U ~~
- amount of cover = ~~ ~ ""~ 1~
1~.~~.a,~, ~; ~~ l2.G.~ ~ C7 /~ dr0 c5ed'JWt-~i a.-~
Plan revision Required? [] Yes ~No I~,x ~ ~ ~ ~ ~ ? ~~
Use other side for additional information. LJ U _ ___ ~J
Date Insepctor' Signat Cert. No.
SBD-6710 (R.3/97)
commerce.wi.gov Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 St. Croix
i sco n s i n Madison, WI 537072 ~ Sanitary Permit Number (to be filled in by Co.)
Department of Commerce s ~ `:.---~~-~ 5~ 5~ (O
Sanitary Permit Application ~ - ~~ NaeTransactionNumber
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS aze project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary
ses in accordance with the Privac Law, s. 15.04 1 m , Stats. Q n
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I. A lication Information - Ple Print All Informs
Property Owner's Name ~ Pazcel # 020-1052-30-000
Daniel E. & Rita J. Fosterlin
9
Property Owner's Mailing Address Y
J'~
E Properly Location /t^j/
/ /(
832 Dorwin Road „,.~,~"~'
pFFIC
~ ~
ZpN1NG ~
~
Govt
Lot
& .
City, State Zip Code Phone Number Nw'/<,SE'/<, Section 2~
Hudson, WI 54016 (715) 3$$'-4119 (circle one)
T 29 N
R 19 W
II. Type of Building (check all that apply) Lot # ;
®1 or 2 Family Dwelling -Number of Bedroo s 5 Subdivision Name
w~C Na Na
^ Block #
Public/Commercial -Describe Use
Na City of
^ State Owned -Describe Use CSM Number ^ Village of
/~[~~t/ ~,
TT Na ®Town of Hudson
III. Type of Permit: (Check o y on
e box on line A. Complete line B if applicable)
`~' New System Replacement Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain)
System
--~.
B. Permit ^ Permit Revision ^ Change of ^ Permit Transfer to List Previous Permit Number and Date Issued
Renewal Before Plumber New Owner
Ex iration
IV. T e of POWTS S stem/Com onent/Device: Check all that a 1
N n-Pressurized In-Ground Pressurized In-Ground ^ At-Grade Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil
Holding Tank Other Dispersal Component (explain) ^ Pretreatment Device (explain)
V. Dis ersal/Trea ment Area Information: a>r ~xs / r ~•6
Design Flow (gpd) Design Soit/ipplication Rate(gpdsfj Dispersal Area Required (s Dispersal Area Pro sed~sf) lev ion
750.00 sq. ft. 0.70 ,/ 1,071.43 sq. ft. 1,143.20 sq. ft. ~ 88.00
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units ~ `~ V
~ a ~
New Tanks Existing Tanks w O ~.aa
C ~ H ~ •~-~ a
Septic or Holding Tank Wieser filter 1500 1500 l Unknown
canister w /~/
Dosing Chamber %S fCEf u
VII. Responsibility Statement- I, the undersi ned, ass a responsibility for ins of the POWTS shown on the attached plans.
Plumber's Name (Print) lumbe s Signature MP/MPRS Number Business Phone Number
James K. Thom son ~- 30021 (715 248-7767
Plumber's Address (Street, City, State, Zip Code)
340 Paulson Lake Lane, Osceola, WI 54020-5413
VI . Coun /De artment Use Onl
Approved p~ Permit Fee Date I ued Issuin ent Signature
Owner Giv . a tt~ Denial $ ! ~J • ~ ~d cj Q~.~
IX. Condit~.~~~~easons for Disapproval 3~ D~ A L~~~~ ~ ~ / ~ ~ ~ ~
1. Septic tank
effluent fitter and' d C J (~,
,
~ ` -
dispersal cell must all be servkes /maintained l ~~JC ~.,.. p 1~ V,~,~ ~~`,/~ r-~~
l~_ ~r
n
as per management plan provided by plumber
~"
r
t
.
2. All setback requil'ements must be maintained I/l~~a~~( G ~ ~~ /~
as icable coda i adi
Attach jo complete plans for the system and submit to the County only on paper not less than 81/2 z 11 inches in size
SBD-6398 (R. 01107) Valid thtu 01/09
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~~ SOIL EVALUATION REPORT
Wisconsin Department of Commerce
Division of Safety and Buildings in arrnrrlanrl± with C:nmm A5 WLc Adm r:ntlP
2183
Page 1 of 3
A.C.E. Soil & Site Evaluations
County
Attach complete site plan on paper not less than 8%Z x 11 inches in size. Plan must
i
l
li St. Croix
ude, but not
nc
mited to: vertical and horizontal reference point (BM}, direction and
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.
02 105 -30-000
Please print all information. Revi ed By Date
Personal informaGOn you provide may be used for secondary purposes (Privacy Law, s. 15.04 (t) (m)).
Property Owner R
~C
I~ Property Location
,
Daniel E. & Rita J. Fosterling Govt. t.ot NW /4 SE 1 S 20 T 29 N R 19 W
Property Owner's Mailing Address
.~ ~ 9 2009 Lot # Block # Subd. Nam or CSM#
~~
832 Dorwin Rd Na Na
City State Zip Code,,RhortEY
OFFIC ~ City ~ Village ,~i Town Nearest Road
Z
Hudson ~ WI 54 NI~15) 386-4119 Hudson 832 Dorwin Road
New Construction Use: ~/ Residential / Number of bedrooms 5 Code derived design flow rate "750 GPD
/~ Replacement J Public or commercial -Describe:
Parent material Glacial Outwash Flood plain elevation, if applicable Na
General comments
and recommendations: Soil suitable for conventional POWTS with 0,7 gpd/sq/ft/ loading ratre. Recommended system elev. _
88.00'.
Boring # ._:1 Boring
il/ Pit Ground Surtace elev. 92.96 ft
. Depth to limiting factor
>111" in.
Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Raots GP D/ft2
in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Et1#2
1 0-14 10yr2/1 none sil 2fgr dsh cs 2f,1mc 0.6 0.8
2 14-22 10yr3/6 none sicl 2fsbk dsh cw 2f,1 me 0.4 0.6
3 22-39 10yr4/6 none sil 2msbk ds cw 2f,1 me 0.6 0.8
4 39-44 7.5yr5/6 none Is Osg dl cs 1vf,f 0.7 1.6
5 44-52 10yr4/6 none fs Osg dl gs 1vf,f 0.5 1.0
6 52-111 10yr5l6 none s Osg dl - - 0.7 1.6
$~ tl
2 . .. - ~ ~
Boring # -~ Boring
1/ Pit Ground Surface elev. 91 59 ft. Depth to limiting factor > 103" in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D(ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-14 10yr211 none sil 2fsbk dsh cs 2fmc 0.6 0.8
2 14-27 10yr4/4 none sil 2msbk dsh cw 2fmc 0.6 0.8
3 27-35 7.5yr4/6 none gr Is Osg dk cw 2vf,f 0.7 1.6
4 35-57 10yr4/6 none s Osg dl gs - 0.7 1.6
5 57-103 10yr5/6 none s Osg dl - - 0.7 1.6
`~$ f ~
3
CST Name (Please Print) Signatur : CST Number
James K. Thompson ~ -. ~ 3602
Address A.C.E. Soil & Site Evacuations Date Evacuation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020 9/16/2009 715-248-7767
Property Owner Daniel E. & Rita ). Fosterling parcel ID # 020-1052-30-000 Page 2 of 3
Boring # ~ Boring
Pit Ground Surface elev. 93.12 ft. Depth to limiting factor >114" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texuun; Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-9 10yr3/2 none sil 2fgr dsh cs 2f,1m 0.6 0.8
2 9-17 10yr3/6 none sicl 2fsbk dsh cw 2f,1 me 0.4 0.6
3 17-26 10yr4/6 none sil 2msbk ds cw 1fm 0.6 0.8
4 26-34 7.5yr5l6 none Is Osg dl cs 1vf 0.7 1.6
5 34-80 10yr4/6 none gr s Osg dl gs - 0.7 1.6
6 80-114 10yr5/6 none ~ gr s Osg dl - - 0.7 1.6
t
^ Boring # -j Boring (p~
J Pit Ground Surface elev.
ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
^ Boring # J Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Applicaton Rate
Horizon Depth Dominant Color Redox Description Texture Stnxture Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (R.O~roo) A.C.E. Soil & Si6e Evaluatbn5
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerLl3~ri
~~ ~~ cT.-~~r
Mailing Address 8.3.'Z !~'YWi~ ~oa.~
Property Address ~
(Verification required from Planning & Zoning Department for new construction.)
City/State ftu~So'~'-, l~ ~. Parcel Identification Number OZ d -/O S.Z - 3o-~
S~/6
LEGAL DESCRIPTION
Property Location ~ 1/a , SE t/a , Sec..2.0 , T ~-9 N R1~W, Town of _/~'~.ki!'1
Subdivision 1~R ,Lot # !'cam.
Certified Survey Map # ~e~ ,Volume ,Page #
Warranty Deed # ~8~~o~ ,Volume 953 ,Page # .387
Spec house no
Lot lines identifiable es
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 §Comm. 83.52(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 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 Planning
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe amlare the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Numbe f bedrooms ~/
SIGNA OF APP T(
/~''~f~
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. 08/05)
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence: ,1~•--~' ~P%~,~os-~/%^~-
(Street address) 832 ~c~:~ ,P~, ,~~so,.,, ~~ s~i~ located
at: n W '/4, SE '/4, Section ~-o , Town~_N, Range~~W,
Town of ,t~~sa,,.-, , St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of Comm. 84.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service 9~/8~~'
Did flow back occur from absorption system? Yes ~ No
(if no, skip next line.)
Approximate volume or length of time: gallons X45" minutes
Tank Capacity: --1,5~~
Construction: Prefab Concrete ~_ Steel Other
Manufacturer (if known): j~,~,~„~,-,
A ank (if known): 39 yews
ermit tuber (if known) ~,,,(,~,a~,
icensed Plumber Signature) (Print Name)
~r.A~?s.
(Title)
~~
(License Number) l~/MPRS
,, -.mss a~o9
(Date)
Form to be completed by licensed plumber (Dept of Commerce Chapter S
and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin
Administrative Code)
Rev. 9/2008
Conventional Septic System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
The conventional septic system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall be maintained
in accordance with component manual SBD-10705-P (N.O1/O1). All local and/or state rules pertaining to system
maintenance and maintenance reporting shall be complied with.
Septic Tank
Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with
bottom of tank to be 5 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be
assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in
the tank exceed 1 /3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR
113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are
not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be
needed to maintain less than 113 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions aze made to retain solids in the tank
that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be
serviced if the alarm is activated. Septic tank manholes 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 individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank
abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS
component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If
such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings
Division.
Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for
vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface
within and above the system and will promote frost penetration during cold weather months. Cold weather installations
(October-March) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BODS, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not
exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the
owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil
absorption cell to bring the system into proper operating condition.
Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim 'Thompson at (715)
248-7767 or the St Croix County Zoning Department at (715) 386-4680.
ii
-
~I
II II
.i~ ~ .
aocUMeN-r No. :~ 1NARRAt~lTY DEED. !~ TH:S SPAC.~ RFSCRYED P~SR R=~nRD1NG DATA
• ~ ~~ STATE BAR OF WISCONSIN FORM 2- 1962I!
1
_._.. r~
4134181 ~'
~~
~~~P1
GE
i
'
:-_~
- . ..
__ -~ ---:-_-~_ ~ _-______
t
!
~
---~! REGISTER
S OFFICE
`1
i
sr. cRO~x cam., wt i
~
;~ John R. McBride and Lori J. McBride, _, i
_ . .. .. ........._ -. - -
- ,~
®c~d~fN +
R Record
,
t husband
and wife,
~ .
. _. .. .. .. .... _. _ .... ... - JUNG X1932
... _._ .. .. .... ... -.. ..
convey, and warrants to -Daniel E. Fosterling and Rita J. a
~ 10:50 A, M
Fosterling Husband and nife~ as su_rvzvorship
-.-. ... .
marital 1,ro~~rtY r ..
- ... .. - --- ...-.._ ..
/
4
[.7
............. .. ... .. - - . ...... -- Register of Deeds
.... i o
__
_ - _._ _
- _ --- - -
the follmti•ing dcscrihed real estate in - St. Croix County,
State of Wisconsin:
Tax Parce] No:.--•--------•----------------
tart or the NW 1./4 or SE 1/4 of Section 20, Township 29 North,
Range 19 West, St. Croix County, Wisconsin desr_ribed as follows:
Beginning at a point or. the East line of said NW 1;4 of SE 1;4 a distance
a di.stancd of 7SII.0 £eet; thence N7°23~'W a distancevof` -623.0 feet;
ttxence N89°33'E a distance of 795.8 feet; thence SOO°27' E along said
East line a distance of 391.0 feet to the point-. of bec3in ning.
.;: •.
'1'Iri.. ~.~ linmcst!•:ai pf•fy+cr!>•.
( is) (is nod )
F:~r•c-tr;io!1 t`. ~~:u•rluilic~:
Sulu }e:ct to casements, rc>scrv=f e i 1~ns anc' restr. i coons of record.
I1:rt. I lh1>~ d / ~~ J:r~" rr~ M41 la )2
1~1•:Al.l
ATJTH~N'SICATI(?iV
-i x'1.1. i{ ri i::~i f, i--i: ~ (.~ t P. 1..\1: nl' t\ I~'1 n\,~I\
!' ru,l.
i //p)/~
SC. Cr~~i>. I '.
r l.~urt}.
I'c f'r"n:rl!}- C:uUf• irr.:~r ri• Ir:r 11;1: .ins ..i
i•ir1'r lp .)._ti.~• xiu.~-c u:,r.~r•r
.TOl~f1 1-:, •^4rI'r i.?1• an.? r.t~r i :I .
?ici,•rir.fo,
... ,. .. .., i 1... .. .. ..
-~
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~sconsip Department of Industry,
' labor and Human Relations
Division of Safety & Buildings
SOIL AND SITE EVALUATION REPORT
in accord with ILHR 83.05, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
PROPERTY OWNER: PROPERTY LOCATION '•. ~ aQll,~Tr' ~, ~
Dan & Rita Fosterling GOVT. LOT ATW 1/4 gE ` %4;'S 2 +~C~f~R ..: ' p r) W
0 ~
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. N ~OR M # ~~ r
832 Dorwin Rd. na na na 1
CITY, STATE ZIP CODE PHONE NUMBER ^CITY ^VILLAGE ®i'OWN NE ST AD
Hudson, WI. 54016 (71~ 386-4119 Hudson Dorwin Rd. ~~ v~/~
[ ]New Construction Use [ ~ Residential / Number of bedrooms 5 [ )Addition toe tin ulldin
[~] Replacement [ ] Public or commercial describe
Code derived daily flow 750 gpd Recommended design I ing rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2
Absorption area required 1072 bed, ft2 938 trench, ft2 Maximum design loading rate - 7 bed, gpd/ft2 •8 trench, gpd/ft2
Recommended infiltration surface elevations} 88.10 ft (as referred to site plan benchmark)
Additional design /site considerations back fill of area B-1 to be to code
Parent material outwash Flood plain elevation, if applicable na ft
S =Suitable for system CONVENTIONAL
~S ^ U MOUND
CAS ^ U IN-GROUND PRESSURE
CAS ^ u AT-GRADE
~7 S ^ U SYSTEM IN FILL
CAS ^ u HOLDING TANK
^ S ® U
U =Unsuitable for s stem
SOIL DESCRIPTION REPORT
Boring #
~« 1
Ground
elev.
93.1 ft.
Depth to
limiting
factor
+100"
Boring #
2
Ground
elev.
91.6 ft.
Depth to
limiting
fact +90
Depth Dominant Color Mottles T
t Structure n
istence
C Baxxiar Roots GPD/ft
Horizon in. Munsell Qu. Sz. Cont. Color ex
ure Gr. Sz. Sh. o
s y Bed Trench
1 0-21 10yr2/2 none sil 2msbk mfr cs 2f .5 .6-
2 21-45 10yr4/4 none sil lcsbk mfr gw if .2 .3
3 45-10 7.5yr4/4 none ms Osg ml na na .7 .8
Ra-marks'
1 0-16 10yr2/2 none sil 2msbk mfr cs lm .5 .6
2 16-33 10yr5/4 none sil lcsbk mfr gw if .2 .3
3 3-90 7.5yr4/6 none cos Osg ml na na .7 .8
Remarks:
CST Name:--Please Print Ga L. Steel Phone: 715-246-6200
Address: 1554 200th. e. New Richmon WI 54017
Signature: /~w ~,' ~ ~~- Date: 11-6-96 CST Number: m02298
Page 1 of 3
PROPERTY OWNER Dan Fosterling SOIL DESCRIPTION REPORT Page 2~ dT""3•.."•
PARCEL I.D. # 020-1052-30
Boring #
~}~~4i::iii.
3
Ground
elev.
91.8 ft.
Depth to
limiting
fa+90"
i
H Depth Dominant Color Mottles Texture Structure Consistence Bax>dar Roots GPD/ft
or
zon •in., Munsell Qu. Sz. Cont Color Gr. Sz. Sh. y Bed Trench
1 -8 10yr2/2 none sicl 2msbk mfr cs 2f .4 .5
2 -27 10yr4/4 none sicl 2msbk mfr gw if .4 .5
3 7-90 7.5yr4/6 none cos Osg ml na na .7 .8
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
f
t
ac
or
Remarks:
Boring #
..................
.................
..................
Ground
elev.
ft.
Depth to
limiting
f
t
ac
or
Remarks:
Boring #
Ground
elev.
ft.
D
h
ept
to
limiting
f
actor
Remarks:
SBD-8330(8. 05/92)
.-, i
STEEL'S SOIL SERVICE
Gary L. Steel
CSTM2298
MPRSW-3254
fi
N
1"=40'
BM.= top of NE corner of
Dan Fosterling
NW4SE4 S2-T29N-R19W
town of Hudson
1554 200th Ave.
New Richmond, WI 54017
(715) 246-6200
~`~
Gary L. Steel
11-6-96
~ , ?
Parcel #: 020-1052-30-000 04/09/2007 04:24 PM
PAGE 1 OF 1
Alt. Parcel #: 20.29.19.1966 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 -FOSTERLING, DANIEL E &RITA J
DANIEL E & RITA J FOSTERLING
832 DORWIN RD
HUDSON WI 54016
Districts: SC =School SP =Special Property Address(es): * =Primary
Type Dist # Description " 832 DORWIN RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 6.310 Plat: N/A-NOT AVAILABLE
SEC 20 T29N R19W NW SE 6.31A BEGIN Block/Condo Bldg:
'
1541.6
NOFSLNSEC200NELNNWSE.
TH N85DEG W 758 FT, TH N 7 DEG W 323 FT, Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
E 795.8 FT, S 391 FT TO POB E 33' FOR RD 20-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 953/387
07/23/1997 809/289
07/23/1997 707/128
0712311997 4631272
~nn~ cl IMMnav Bill #: Fair Market Value: Assessed with:
0
Valuations:
Description Class
RESIDENTIAL G1
Totals for 2007:
General Property
Woodland
Totals for 2006:
General Property
Woodland
Acres
6.310
Last Changed: 10/25/2005
Land Improve Total State Reason
94,900 328,400 423,300 NO
6.310 94,900 328,400 423,300
0.000 0 0
6.310 94,900 328,400 423,300
0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch #: 134
Specials:
User Special Code
Category
Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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a:'
j .. COMMERCIAL TESTING LABORATORY, INC.
I 51A Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
ST+ CRQIX ZONIi~
ST. CROIX COt.li'!TY
CEN1RTHaf1SE
i~JDS~I, WI
ATTNS TF~tiAS G+ 1~lElSOEI
5441fs
~~
REPORT NA.S 24831/01.
REPORT MATE: 4/i3/92
DATE RECEIVED: 4/09/92
,_
OWi~Rt John ~ Lor i ticBr i de
4 Q .Q''
LOCATION: 832 Darwin Rd., Hudson
_____ ~~ g
COLLECTORS M. Jeni<ins
DATE COLLEGTEDS M08-92
TIME COLLECTED: 10S15am
SOI~tCE QF SAMPLES -~itchen fauce#
DATE AI~L.YZEDt4-09-92
.TIME ANALYZEDS2SOOp®
COLIFORMS 0 1104 ml
INTERPRETATIONS Bacteriologically SAFE
NITRATE-NS 3 ppm
Above id ppe exceeds the recommended Public
Dri~dcing Water Standard.
Coliform Bacteria/100 mt
Plitrate-i~litrogen, mgfL
-~,~ .
LAB TECi~lICIANS Pam Gane
WI Approved Lab No+ 19
< Means "LESS TiiAi't" Detectable Level
91118
~o ti
~~
~=~~y ~~
~~'~ 'fir. ~.
~ M ~O
~t
RAGE 1
Approved byt
y
PROFESSIONAL LABORATORY SERVICES SINCE 1952
r
~ '~' / Q
• .. 1
~ ~ '~.BT. CROIX COUNTY ZONING OFFICE
((~~ ~, ~~ ~~ St. Croix County Courthouse
,\ /0 ~ ~ ~ 911 4th Street
1'~ ~ ~~ Hudson, WI 59016
Tele - 71 -4
phone ( 5)386 680
The St. Croix County Zoning Office offers the
and water inspections to Lending Institutions,
private individuals.
service of septic
Realty Firms, and
Completion of this form is essential so that the property can be
located.
Please provide the following information, enclose appropriate
fee made payable to St. Croix County Zoning Office, and mail,
along with form to the above address. Testing will be done as
soc:, as possible after fee and form are received.
WATER TESTING----------------------------FEE: $~~0
(For nitrates and coliform bacteria)
WATER TESTING FEE: $127.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00
.(Determines if system is properly functioning at time of
inspection)
Property owner's name John and Lori McBride
Property owner's address 832 Dorwin Road Hudson
Legal Description 1/4 of the 1/4 of Section, 20 , T 29 N-R 19
Town of Hudson Lot Number Subdivision Name
FIRE NUMBER LOCK BOX NUMBER
Color of house - Realty sign by house? If so, list firm:
Century 21-Jenny Olson
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPX OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the :,omc is vacant, and has been so zoz some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines
cocks are turned off, making access to
this is the case, please make proper
office to ensure time when entry may be
Firm or individual requesting services:
Telephone Number
REPORT TO BE SENT T0:
~~ HudsOn, WI
are turned off, or sill
the home necessary. If
arrangements with this
gained.
1St I~?at~ ~r ~1 Falk of I-~udsoYi
Closing date 5~-t5-
Signature
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
Apr. 30, 1992
First National Bank of Hudson
307 Second Street
Hudson, WI 54016
To Whom It May Concern:
An inspection of the septic system on the property of John & Lori
McBride located at 832 Dorwin Road, Hudson, WI was conducted on
Apr. 29, 1992. At the same time a water sample was obtained for
testing. The results of that testing will be sent to you as soon
as we receive them from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning. properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and did
not involve any excavating or chemical analysis. Accordingly,
there is the possibility of hidden defects in the system not
discoverable by this inspection. This does not in any way warrant
or guarantee the continued proper functioning or operation of this
system. It is recommended that the system should be pumped once
every three years. Therefore, the prolonged life of this system
may be dependent upon proper maintenance of the system.
l > ~ ~,~.-~ ~ ~.,.
C~` ~`
Mary J. Jenkins
Assistant Zoning Administrator
js