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HomeMy WebLinkAbout018-2001-20-000 Wisconsin Dera,JnentofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' Sanitary Permit No: Q INSPECTION REPORT 579007 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: F City Village X Township Parcel Tax No: Thomason, Mitchel, Hammond, Town of 018-2001-20-000 I r, g- BM Description: Section/Town/Range/Map No: Ins . CST BM Elev: Elev: , f V ~ 14.29.17.884 p Mil TANK INFORMATION ELEVATI N DATA TYPE MANUFACTUIPW r APACITY STATION BS HI FS ELEV. Septic Benchmark 7-70 V) Do"r- COM60 Alt. BM Ln I O Bldg. Sewer Holding 7__j 1 S t Inlet dy . 3S ~q• 5 St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L lA WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1 \ o I ) I Dt Bottom 75 Head Man. V J 3.2 105, Aeration Dist. Pipe 605 I /CG, b Hol Bot. System 2 /5 All, ;;JJ V PUMP/SIPHON INFORMATION Final Grade Manufacturer V l Demand St Cover ( I --1 VlD~\/ Gp„AA~ 1 Model Number f 1 U~ dV l 6ZJ TDH Lift '01 Friction Los, System Head ~,n~ TDH Ft ~(I free U' /U r Forcemain Lengt I IDia. T 0 Dist. to Well -2 ,-15 SOIL ABSORPTION SYSTEM BED/TRENCH DIMENSIONS Width 16 N Length No. Of Trenche$ PIT DIMENSIONS No. Of Pit Inside Dia/ Liquid Depth DIMENSIONS ►l/I1/- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System I 1 UNIT Model Number. DISTRIBUTION SYSTEM 0' Hearre-rMwMattK Distribution 113 ) J) , Ix Hole Size i( x Hole Spacing Vent to Air Intake Length Dia Len th 3(0 )Dia ! Spacing- SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems y Depth Over Depth Over xx Depth of - xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ ! / Yes ® No Yes 0 No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: I D/ / Inspection #2: I-ra - Lv4id s t~t R Lot Parcel No: 14.29.17.884 Location: 951 193rd St et Hammond, WI 54015 (SE 1/4 NW 1/4 14 T29N R17V1~Forest ge 1.) Alt BM Description = 7 ` 1 i C C(, f I IS (5~ 2.) Bldg sewer length = Lilt" an ( - amount of cover Plan revision Required? Fal Yes No i I✓/G Use other side for additional informatio Date nsepctoes Signature Cert. No. SBD-6710 (R.3/97) Lo A pA (a~SST o ~ few pd A& it) u71 ` ~ /Jp1~1~1 ~'F ~o ell f 1bo• ~ 17.5 f 193 iY f e~J~~ RECEIVED Safety and Buildings Division Co S T L 4 p 201 W. Washington Ave., P.O. Box 7162 Sanitary (Permit Number (to be filled in by Co.) S p S JUN 3 0 201 ) Madison, WI 53707-7162 5 T 9 Dc_~:f_ ioxN ST. CROIX COUNTY _Omr<r~RRWT MR Application State Transaction Number U41 ordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit -25 ~ 2- uired prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) epartment of Safety and Professional Servies. Personal information you provide may be used for secondary ses in accordance with the Privacy Law, s. 15.04(1 (m , Stats. it 9 red lication Information - Please Print All Information perty O er's N e Parcel # A. M ti eat--aa- Property Owner's Mailing Adddre;Q Property Location ~E J ~ Govt. Lot C 8 y City, State Zip Code Phone Number 14 ~1, Section dat~~~ T 7 r, 0 cucle onj~ 11. Type of Building (check all that apply) Lot # T N; R E oiW K1 or 2 Family Dwelling - Number of Bedrooms a Q Subdivision Name Block # 5 ❑ Public/Commercial - Describe Use U K- ~ ❑ City of svb~~ ❑ State Owned - Describe Use , / CSM Number ❑ Village of /0 -7 m $ k / bV N ATown of - - III. Ty . Check only one box on line A. Complete line B if applicable) lk_New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• El Permit Permit Transfer to New List Previo P Renewal ❑ Permit Revision ❑ Change ofPlumber El Before Expiration ermR umber and Date Issued ration Owner W. Type of POWTS S stem/Com onent/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitabl Mound < 24 in. of suitable soil n • ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Devi fplftir - / V. Dis ersal/Treat t Area Information: Design Flow (gpd) Desi Sit Applic on Rate(gpdsf) Dispersal Area qui d (sf) Dispersal Area P sed (sf) System Elevation ! • 7-5-® 0-,5- 7S5'6 75-0 1:552.5 W. Tank Info Capacity in Total # of Manufactur Gallons Gallons Units 2 New Tanks Existing Tanks aU wC7 e, W Y0 ~OG ~52 0 Septic or Holding Tank Dosing Chamber ! y~ VII. Responsibility Statement- 1, the undersigned, ass! a responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb Sign e RS Number Business Phone Number . o?oZo. S 74s-- 74160-09 Plumb is Address (Stre City, State, Zip Code) VIII-C oun /De artment Use Only Approved Disa d Permit Fee Date sued jh~ Issuing Agent Signatur iv en Reason o $ by G(Jl DL Conditions of Approval/Reasons for Disapproval V01 _ SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must be $erylced / maintain-ed as per management plan provided by plumber. 2. All setback requirements must be maintained a9Lp map &d submit to the County only on paper not less than 8 in x 11 inches in size SBD-6398 (R 11/11) NU' t+' syJ"im eum I10n i5 /62./7! _ i p~rART.1f~,~, DIVISION OF INDUSTRY SERVICES 5ti~'% Toy 10541 N RANCH ROAD HAYWARD WI 54843 Contact Through Relay 3 $ P http://dsps.wi.gov/programs/industry-services S Gw www.wisconsin.gov A ~ ~OssroNScott Walker, Governor Dave Ross, Secretary June 22, 2015 CUST ID No. 220357 ATTN: POWTS Inspector BRADY J UTGARD ZONING OFFICE UTGARD PLUMBING & HEATING ST CROIX COUNTY SPIA PO BOX 413 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/22/2017 Identification Numbers Transaction ID No. 2560672 SITE: Site ID No. 813857 M Thomasen Please refer to both identification numbers, 511 193RD St above, in all correspondence with the agency. Town of Hammond St Croix County SWI/4, NWI/4, S14, T29N, R17W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1541142 Maintenance required; 750 GPD Flow rate; 16 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12), SSWMP Pub. 9.6; Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Please see corrections made to plans in red. Thanks. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. BRADY J UTGARD Page 2 6/22/2015 Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Carl Wert Wastewater Specialist, Division of Industry Services WiSMART code: 7633 (715)634-5035, M-f 7AM - 12PM carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Utgard Plumbing I MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: THOMASEN Owner's Name: M THOMASEN Owner's Address: Legal Description: SW/NW/S14/T29/R17W Township: HAMMOND County: ST.CROIX Subdivision Name: FOREST RIDGE Lot Number: 20 Block Number: Parcel I.D. Number: 018-2001-20-000 Plan Transaction No.: CONDITIONALLY Page 1 Index and title APPROVED Page 2 Data entry DEPT OF SAFETY AND Es Page 3 Mound drawings PROFESSIONAL SERVICES Page 4 Lateral and dose tank ®N OF INDUS Page 5 System maintenance sp i ns Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT PLAN qCFSpONDFENC E SEE Designer: BRADY UTGARD License Number: 220357 Date: 06 0115 "one Number: 715-760-0946 Signature: V Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 3.11 (R. 06/01) Page 1 of 8 Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design Note: Sand fill (D) calculations assume a 500.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150%) coliform of - 36 inches. F-750-0-051 Design Flow (gpd) -.7v *.W Site Slope 100.50 Contour Line Elevation (ft) 16.00 Depth to Limiting Factor (in) 0.50 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 10.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? c Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation (ft) 6 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 3.00 Orifice Spacing (ft) = 10.42 ft2/orifice 2.00 Forcemain Diameter (in) 100.00 Forcemain Length (ft) Does the forcemain drain back? Y 95.00 Pump Tank Elevation (ft) 3.25 System Head (ft) x 1.3 16.31 Forcemain Drainback (gal) 6.92 Vertical Lift (ft) 70.34 5x Void Volume (gal) 4.48 Friction Loss (ft) 86.66 Minimum Dose Volume (gal) 14.65 Total Dynamic Head (ft) 47.19 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.00 1.50 1.25 x x 2.00 x x 1.50 x 3.00 2.00 x 3.00 x Gallons/Inch Calculator Treatment Tank Information Total Tank Capacity (gal) 1585.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) WIESER Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 950.00 Dose Tank Capacity (gal) POLYLOK Filter Manufacturer 25.00 Dose Tank Volume (gal/in) PL-525 Filter Model Number WIESER Manufacturer Project: THOMASEN Page 2 of 8 Mound Plan View . 1/10 B . T Observation Pipe 3 .=,_A . K• O 5 . _ T A W _ B L Mound Component Dimensions z~. L A 10.00 ft E in H 1.00 ft K 1.06 ft B 75.00 ft F 9.25 in ft L 97.13 ft D 20.00 in G 0.50 ft J $.v 75ft ft W 22, W ft 750.00 (ft2) Dispersal Cell Area t~5Q~33 (ft) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.94 (ft) .err rf%fr. F Dispersal Cell 102.17 102.67 (ft) Lateral Dispersal Cell 3 Invert Elevation E D t 100.50 (ft) Contour Elevatio~' "~°/a Site Slope Geotextile Fabric Cover Shading Key T Dispersal Cell See lateral details on 0 Topsoil Cap c 1.5 ft Page 4 for number, size, Subsoil Crap o n5 0 and spacing of laterals. ASTM C33 Sand Laterals Tilled Layer m 0.5 ft Typical Lateral F are equally c spaced from the n5 Aggregate a c 1 ~5 distribution cell's A centerline in the distribution cell (AxB). Project: THOMASEN Page 3 of 8 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical s P S • = Turn-up w'balI valve or 1< -X----+-x12 I x1241 Laterals & force main of PVC Bch 44 clean out pl u g per COMM Table 34.30-5 Hales drilled on the bottom of the lateral. Number of Laterals 6 Orifice Diameter 0.188 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.20 ft Lateral Length (P) 36.80 ft Orifices per Lateral 12 Lateral Spacing (S) 3.33 ft Orifice Density 10.42 ft2/orifice Lateral Flow Rate 7.86 gpm Manifold Length 6.67 ft System Flow Rate 47.19 gpm Manifold Diameter 2.00 in Total Dynamic Head 14.65 ft Forcemain Velocity 4.82 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented E- Alternate outlet location Forcemain diameter WIESER Manufacturer 2 in. Capacity 950.00 Gallons Volume 25.00 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 23.53 588.34 C B 2.00 50.00 Pump off elevation (ft) C 3.47 86.66 95.75 D 9.00 225.00 D Total 38.00 950.00 iF- Dose tank elevation (ft) Bedding un er tank. 95.00 Alarm Manuafacturer LEVEL Alarm Model Number DLV Pump Manufacturer GOULD Pump Model Number EP05 Pump Must Deliver 47.19 gpm at 14.65 ft TDH Project: THOMASEN Page 4 of 8 i 61611 I III 66111111 IIIIB o 0 O O O O O 0 6661116 666 1 II co O N O N N CC) E N U O O Or m N U N ~ C'I O (J U ao N V m CR Lc' co LL O N r IpBRKdI t CO U O d co Lr; d ~PolP4mP'1~ d ~ C E c0 U ~ u W O U Of C. N W O_ U O cn m m i ' U W 00 N lzt co LO / r ul~ U) ~O u d Gras ~l~ r/~ -l 'r/ z ti U O N V5 O CD co o v W o r..~ m i~ t F- ~ S O cn w ~O W JO-- 1F- o v I-= W i9C,LL w ¢ o LL w d ~ O W o , in Q Z o rn U U-) cfl d U N 0'1 - La g In ~t J O UR ~r5~1 J d W j ~ ~ J m J J O Z J J _r WOQ Q \\\O\\\\\\\\\\\\ J Q 00 O ~0¢~0 - F- ~ a - To A r 7 5 ~ 193r f ` I! lil11lilillill li f liffill it i(( State Bar of Wisconsin Form 7-2003 $ 3Tx: 1 5 7 4 :4256980 TRUSTEE'S DEED 1014537 Document Number BETH PABST Document Name REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Thomas H. Cody and Suzanne M. Cody 06/29/2015.10:46 AM EXEMPT#: N/A as Trustee of the Thomas H. Cody and Suzanne M Cody Trust under Agreement REC FEE: 30.00 dated September 3 2002 TRANS FEE: 127.50 ("Grantor," whether one or more), and* 1~_i17d13tXiX PAGES: 1 A-&"XMXffaK husband and wife as survivorship marital property ("Grantee," whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in Recording Area St. Croix County, State of Wisconsin ("Property") (if more space is lt.C Name and Return Address 444 South SroadWay needed, please attach addendum): ma_ RPaI1v Tl+ip qu~g~omonle, WI 54751 40.0-Soutb-2nbl #G6t- Lot Twenty (20), Forest Ridge Estates Town of Hammond, K, udse4,-W+- e96 St. Croix Co , tsconsin. *M' chell V. Thomason and Kimberly J. Thomason / 018-2001-20-000 ✓ Parcel Identification Number (PIN) Dated June 2015 THE THOM S H. CODY AN S NN VA. CODY TRUSTAGREEMENT * (SEAL) (SEAL) * oas H. Cod Tr ste * (5EA L-) (SEAL) *z n e M. Cod stee AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. authenticated on ST. CROIX COUNTY) OTA'P N Personally came before me on jum-y-- 1:51 the above-named Thomas H. Cody and Suzanne M. Cody Trustees of TITLE: MEMBER STATE BAR OF WIS ,y the Thomas H. Cody and Suzanne M. Cody Trust Agreement did Sept 3, 2002 (If not, to me kn w to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrume t ged the same. THIS INSTRUMENT DRAFTED BY: Brent R. Johnson; Lommen Abdo P.A. Notary Public, State of tsconsin 400 South Second Street; Hudson WI 54016 My commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. TRUSTEE'S DEED ©2003 STATE BAR OF WISCONSIN FORM NO. 7-2003 *Type naive below signatures. INFO-PROS www.in(opra(orms.com St. Croix County 1014537 Page 1 of 1 40 rn r N 8938'57" E 482.40' ~ + 1 l 0.0 LOT 20 I w 121423 S.F. g 2.79 A c. d to m ry~ tip` /^ey _ _ N 89'38'57" E_600.91' 4 ! LOT 19 N 155732 S. F. I`i# 1 `y \ n . r-w --bl/fl l{-.6C ?o is :o s c 'A I I Go I I E~ I I V I I I , I , I I I a I22'40 zro- I , I , 45'-0" 40'-0" - - - - - - - - - - - - - - - - - - - - - - m I I I 14.0„ 14'_0 10'-1 1/4" I I I I I m I I I I I I ~ ~ I I I I ~ ~ ~ I I~ i I I I I A ~ I I a j I I I vm ~ ~ I I I I I I I ~ J I I N~ j l I I ~ m I I~ I I I I .J o I I~ I 2868 I ly t I I I I I I P I I I I I I I ~ - - - - - - - - - - - - - - - - - - - - - - o D , I I I I ~ I l o it I co If I Iy l I I I 1 I I I ~ ~JC:; zees I I ~ ~J I I~ I I I I ~ 417' I I I I ~ ~ I I I I I I I I 1 Ica 'y I I - 3~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND C OWNERSHIP CERTIFICATION FORM Owner/Buyer AL04- 77 Mailing Address _C37/ 1 . Property Address ~~7 - - - 51 ' Sl r (Verification required from Pl g & Zoning Department for new construction.) taon.) City/State 6/-4- Parcel Identification Number ®~[F~ 'RQey LEGAL DESCRIPTION Property Location, 1/4 , dIJ 1/4 ,Sec., T GN RW, Town of Subdivision Plat: `FeNte Lot#RO Certified Survey Map Volume , Page # Warranty Deed # l (before 2007)Volume Page # Spec house o yeskno Lot lines identifiableXyes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the'Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Departme thin 30 days of the three year expiration date. Uwe certify that all s nts on 's form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, b `e of a w ty deed recorded in Register of Deeds Office. Number of bedroo l SIGNA PLICANT(S) /j DATE TE * * *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 trade in the warranty deed. ME .04/12) , P Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Ws. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Cody ST. CROIX include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 018 - 2001 - 20 - 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all infofmation. R Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Properly Owner Property Location THOMAS AND SUZANNE CODY Govt. Lot SE 1/4 NW 1/4 S 14 T 29 N R 17 E❑(or))WW Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 796 112th Street 20 Forest Ridge City State Zip Code Phone umber []City r]Village ■ Town Nearest Road Roberts, WI 54023 ( 715) 749 - 3038 193rd Street E] New Construction Use(D Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Flood Plain elevation if applicable NA ft. General ments ns: Mound System 0.5 loading rate - 1.67 ft. sand fill ato- - / a Boring # El Boring Q Pit Ground surface elev. 100.75 ft. Depth to limiting factor 22 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 1 0-6 10YR2/1 - sil 3f-mgr mvfr ab 3vf-co 0.6 0.8 2 6-12 10YR4/4 - sil 2f-mabk mvfr ab 3vf-co 0.6 0.8 3 12-17 10YR4/4 - sil 2f-mabk mfr ab 3vf-co 0.6 0.8 4 17_22 10YR4/4 - sl 2f-njshk mvfr ab 2vf-co 0.6 1.0 5 22-27 7.5YR4/4 - sl Om dh 2vf-f 0.2 0.6 (Horizons 2 & 3 part to fgr, Horizon 5 is Wc.) F-B I ED Boring # Boring 102.25 22 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-2 10YR2/1 - sil 3fgr mvfr ab 3vf-co 0.6 0.8 2 24 10YR2/1 - sil 2f-mgr mvfr ab 2vf-co 0.6 0.8 3 4-10 10YR3/2 - sil 2f-mabk mfr ab 2vf-co 0.6 0.8 4 10-22 10YR4/4 - sil 2f-mabk mfr ab 2vf-co 0.6 0.8 5 22-25 10YR5/4 c2d 7.5YR4/4 lfs Om dh 2vf-m 0.5 1.0 ' Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mgA- • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sionature D CST Number Mary Jo Hollister 224832 Address Date Evaluation Co Telephone Number W9875 690th Avenue, River Falls, WI 54022 08-05-02 updated 11-2 -04 (715) 426 - 1775 w ` Property Owner CODY, Thomas (Lot 20) Parcel ID # 018 - 2001 - 20 -000 Page 2 of 3 P49 Boring # 11 Boring 99.55 16 ❑ Q pit Ground surface elev. ft. Depth to limiting factor n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10YR2/2 1 3f-mgr mvfr ab 3vf-co 0.6 0.8 as 3vf-co 0.6 0.8 2 8-16 10YR3/4 sil 2f-mabk mfr 3 16-18 IOYR3/4 flf 10YR4/6&10YR6/1 sil 2fabk mfr as 3vf-co 0.6 0.8 4 18-21 10YR3/4 c2d lOYR4/6&IOYR6/1 sil 2fabk mfr cw 2vf-co 0.6 0.8 5 21-28 10YR6/3 m3p IOYR4/6 sl lmsbk mvfr 0.4 0.7 (Horizons 3,4 & 5 have some gr.) F-1 Boring # IJ 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 GPDMI in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 ❑ Boring # 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 GPD/fF 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 = BOD, < 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-8330Test (R.07/00) Parcel 018-2001-20-000 12/03/2004 12:15 PM PAGE 1 OF 1 Alt. Parcel 14.29.17.884 018 - TOWN OF HAMMOND Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner THOMAS H & SUZANNE M TR CODY ' CODY, THOMAS H & SUZANNE M TR 796 112TH ST ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 951 193RD ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.790 Plat: 1961-FOREST RIDGE EST 1/30 018/03 SEC 14 T29N R17W PT NW NW FOREST RIDGE Block/Condo Bldg: LOT 20 ESTATES LOT 20 (2.790AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-29N-17W NW NW Notes: Parcel History: Date Doc # Vol/Page Type 02/07/2003 708637 2134/101 QC 01/29/2003 707467 2124/147 WD 01/14/2003 705829 9/46 PLAT 2004 SUMMARY Bill Fair Market Value: Assessed with: 271,200 Valuations: Last Changed: 07/16/2004 Description Class Acres Land Improve Total: State Reason RESIDENTIAL G1 2.790 42,600 0 42,600 NO Totals for 2004: General Property 2.790 42,600 0 42,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 RECEIVED' HOLLISTER'S SOIL TESTING Mary Jo Hollister MAR 0 4 2004 W9875 690th Avenue r River Falls, WI 54022 '37 (715) 426-1775 ---ZONING nFIC ~_f March 2, 00 St. Croix County Zoning Pam Quinn, Zoning Specialist 1101 Carmichael Road Hudson, WI 54016-7710 RE: Soil Evaluation Reports for Forest Ridge Estates, Town of Hammond Dear Ms. Quinn, After our meeting on February 13th and further review of the reports that were submitted here are the findings and facts: 1.) Lots 4, 5, 6 and 28 will need to be extended to allow for the 0.2 loading rate for longer mound systems. We have agreed to do this with hand borings that will be completed as soon as possible. The position of the driveway for Lot 30 can be worked around. A licensed plumber has reviewed and stated that lots 11, 13, 14,17 and 18 have enough area for a system. 2.) As per our discussion, driveway locations were not an issue at the time the tests were completed as it was requested by the County to complete these tests before approval. These will have to be addressed at the time the driveways are located. ALL mound areas were staked and taped as requested previously. 3.) Elevations were corrected on lots 7, 10, 16, and 18 and have been resubmitted. For many years now, my reports have had the accurate readings for BM #2 based on information-from your office. Now I will report them a different way. A new report for lot 15 was submitted on 11-25-03 due to location of lot line. The elevations for lots 20 & 21 are not the same due to different reading locations of the boring (Le. ups op ownslope side) due o sl e clearance. ~ is ~f~.snf ur0~✓/~ ~ uoti~~~ 4.) The notations for the Structures were corrected in the office. The "L" for large structure instead of "CO" has been reported on my reports for years. Thank you for clarifying that for me. -4y~ 4hC~ ~ari'n~ d~v~ If you have any further questions or comments, please call. Thank you for your time and 0, (03 attention to this matter. Property Owner Parcel 10 0 ?1N,~ Pape of 3 Ff--41nb-r oring a Cl.,4)R PN nd surface elev. tt Depth to limiting Newt ' Solt 4pllciatlon Rate Horizon Depth Dominant Color x Description Texture Stryctur ence Boundary Roots GPO/R In. Munsel Qu. Cola 'ERN1 •Effft2 I 0-B I u z - 71 r i 4-C pp- 2- Y-1`I 3/2- _ S fawt1 d 5 11 C.5 Zvi-co 0 10 11' 0- 3 14-ZI t0 2V3 1 s VYr r- 3 zq{-C 0 I Z 4 21- 1ov ~t/ 1 t^n ~r 0.trJ 24-) 1,'L 5 -L9 0 5 rvl ,-7 t, Z a P, L itj A' Cam, Sa l c so- ❑ r (m sh/1'Yn X119 7 lo~ ~T / /o I° 49 Boring x Boring (fATLL~21)9 Pit Ground surface :~r _ ,L~. If Depth to limiting lector In. Sd# Application Role Horizon Depth Oominant Color Redox 0e extwe Structure Consistence Boundary Roots GPDfK In. Munsell Qu. Sz. Cont. Color Gr. Sz. ST. 'EAR1 'Effp2 Z to 411L V 51 ZE'0 r a•S -t 1 5 0, 1-00 3 I6-11 0(31 0 4 1 1.f 1 St I zf abK Fr 0.s - o,5 0, it) Atu vt,r 11 Z-CAW m-fr Cw Z4-0 -S 0, -2 lb V Q 6I~ M3 ab mtf r DAA FID „g xICBoring18_Bloonif IdJ Pit elev. Depth to tlmltl `~fa in. Soli Icatlim Rate Horizon Oepth Dominant Color Rodox Deat:rl Texture Strut Ton3lilence Boundary Roots GPOIff in. Munselll Qu. Sz. Cont Color G • h. °EKfti '0022 Q-4 _'Y/Z u j--co ,5 10 z Q-' o Z ZVF- 0,5 I as 3 f to Y0-1413 St l -rrl sb zit-m ,S 0.2 ZIC-41 7. Y 315 M M i Z~{ m lkott --Aa%-Vl V.5 u! on1 0 ,dolor E Effluent 01 = BODr > 30 < 220 nVIL and TSS >30,c 150 mg& Eftent 92 = BODE ! 30 mWL and TSS 130 mg& The Department of Commerce is an equal oppttrtunlty service provider and employer. If you need asxistancc to access services or need material in m alternate format, picaate contact the department at 608-266-3151 or TTY 608.264-8777. sau•uro tK.saor