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HomeMy WebLinkAbout020-1437-05-000 4 ST. CROIX COUNTY ZONING DEPARTMENT AS QUILT SANITARY REPORT Owner MZKq- PE TEy0.t*o ,k5v f Aj V >W C b __ 4tltlt",s 1$(a -1 woob4.AwxE DFZ Svrr 2.. City-'Nlate WOW9,y0,Y , MN 6 ?6 . Legal Description: Lot 'T Block X Subdivision/CSM # ks -LL V- 1� 5 TA N Y• 5W 'A Sec_ � j , T 2q N - 1 1 W, Town of _1+vpSo N PIN # 0.L.0 -1 otoo - ooe SEi'TIC TANK --- DOSE CIIAIVISER -- HOLDING TANK .INFORMATION Tank manufacturer W Z E, s r, K Size ST/PC izso/ — Setback from: House `/ Well W P/L 55 Ptnnp manufactarer --_ Model --- ' -- -" (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORt.' SYSTEM. q LA'(k 4 - AroAS PREss0"7-Ev Type of system: TN' (- *x 0Q "0 Width 3 Length 9 Number of Trenches Setback from: House O Well -�Lf _ P/L 3�• Vent to fresh air intake ELEVATIONS: Description -of benchmark (S�avFY�Q` 1" gT£EL„, p=pq Elevation loo -e x, Description of alternate benchmark TOP QF MRMttat -E Elevation I ca Zis Building Sewer STAIT Inlet y' S ST Outlet �1 y 29 PC Inlet PC Bottom ^ Deader/Manifold 39 r Top of ST/PC Manhole Cover I00,2& Distribution Lines (►J) 1$,52- Bottom of System (k) g2. (5) gz. •( ) Final Grade Date of installation I P 8 1 0,5 Permit number y �2 9 (' State plan number N R Plumber's signature - License number 231 / Date c � �C Inspector R YA N COMPLft nw ow Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 5VV"V tooloo E AIL I t f 3 f � T- b y of- , . � F loe o �. i 93.5 :z 1 M S 8' ' - :' POWT SYSTEM Str, 'CORPORATE PER COMA; ' 53.44 (2)c A PROPER ZABEL FILTER MODEL # + xk ZZ t3 € M2,, o mm ffa-f- t F 4 IIJV, Y9 eZ U R,C CA i Ulbrlcbt & Associates Private Sewage Consultants 2812 1 0th Am Sprinq Valley, W1 54767 Wisconsin Department of Commerce r PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division - INSPECTION REPORT Sanitary Permit No: 463291 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: City Village X Township Parcel Tax No: Peterson, Mike I Hudson, Town of 020 - 1437 -05 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No 10 D Y V\ % GIST 22.29.19.2710 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic •.' (4- Benchmark 1 Z50 4.1(P 104 - Ap Jam DeSiR Alt. BM j Z Aeration Bldg. Sewer s q5 Z Holding �-- St/Ht Inlet ` ` LAO TANK SETBACK INFORMATION SUHt Outlet 1&,45 914 , 3 l TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic i ! -Z I/ / j Dt Bottom �\ Dosing � Header /Man. I' z3 3 .53 Aeration Dist. Pipe Holding Bot. System , 1 Final Grade 7 PUMP /SIPHON INFORMATION kit) 7. 2 5 7' S Manufacturer Demand St Cover _.._,. GPM 460 del Number y 1Z 3 3 9z . 3 TDH Lift ,� Friction Loss System Hea TDH Ft Forcemain Length ^ Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length I / No. Of Tre nches PIT D MENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �t0+' _7 SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: - INFORMATION CHAMBER OR .J—uN P— , 44 Type Of System: 3 Z / � / w /A— UNIT Model Number: ,,s J ; j j V (yl "f DISTRIBUTION SYSTEM d— Z 45 Tda-Q Header /Manifold J � Distribution x Hole Size x Hole Spacing Vent to Air Intake J Pipe(s) �� �� Ve. Length Dia Length Dia Spacing SOIL COVER x Pressure Systems O nly xx Mou nd Or At - Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulc ed Center Bed/Trench Edges \� Topsoil ,\ Yes No Bed/Trench No AjC COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2: Location: 816 Ross Road Hutson, WI 54016 (SW IJ4 SE 1/4 22 T29N RI 9W) e ates Lot 5 Parcel No: 22.29.19.2710 Q a k 11, � ` jr 1.) Alt BM Description = 14 � 1 5: � �5 2.) Bldg sewer length = /� J y� �r - amount of cover = 5 / Plan revision Required? j Yes WNo J Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County ST CRO/ 201 W. Washington Ave., P.O. Box 62 1'\ Viscons i n Madison, WI 53707 - 71 Q Sanitary Permit Number (to be filled in by Co.) Department of Commerce (�1$) 266 -3151 1.x•( 3 z 9 Sanitary Permit App 'cam E I V E D S tate Plan I.D. Number 1-114- In accord with Comm 83.21, Wis. Adm. Code, perso information you provide maybe used for secondary purposes Privacy w, s15J(M(ttt) 8 2005 n►g � II ( /�D SS /�f� • � UO.SO�tJ I. Application Information - Please Print All Information ST CROIX COUNTY Property Owner's Na me � t # Lot # Block # Property Owner's M ailing Address _ Property Location .SA) ,�, s � 4i,Section 2_72— City, State /�jf Zip Code Phone Number Gc�vOD/�Ul�� / "'�• I S / �gf— 77� T Zf N; R IJ �E eW II. Type of Building (check all that apply) a p C, or 2 Family Dwelling - Number of Bedrooms CAI.✓�iM S Su bdivi s ion L Name � T �� P ❑ Public /Commercial - Describe Use /� L El State Owned - Describe Use ❑City_❑Village ❑Township of . F III. Type of Permit: (Check only one box on line A. Complete line B if applicable) o20 _ 1 437— 05 C=C 2 A, � New System ❑ Replacement System ❑ Treatment(Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. of POWTS Sys stem: (Check all that a 1 ) Non -Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter )q Leaching ber ❑ Prip Line ❑ ravel -less Pipe ❑ Other (explain) V. D' r t Area Information: S L Z S Design Flow (gpd) Design Soil Application Rate( f) Dispersal Area Required (sl) Dispersal Area Proposed (st) System Elevation CP 0 • 7 F5 - 7 _ S 71 ! 3, so VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel -Fiber Plastic Gallons Gallons of Units( �,/Z (� �/� Concrete Constructed Glass New Existing !mob � , Tanks Tanks (� Septic or Holding Tank _ G J Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of t POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature *R/MPRS Number Business Phone Number R. Zt LI3R�G�?' 2- 3 s 7/5 3y5�Z Plumber's Addre ss (Street, City, State, Zip Code) ��� /y , /�/ ZV 5 LI , -19/2 /D -/14- ,4 v e . U ^7 V III. County/Department Use Only Approved Surcharge Fee) pprovhd Sanitary Permit F includes Groundwater Date Issued I u' Agent Si (No Stamps) : ner iven Reason Denial IX. Conditions o A rov val SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) ci C�v LN Ir . d Q oQ � R d I � / � oa A s ej { \ T1 N /( -.. r - P al V1 0, CL In m y P �►Om� -i 3 -a x m : � 0 N O W in a O S N. a z ULBRICHT & ASSOCIATES CO. 2812 10th Ave. * Spring Valley WI 54767 Reg. Designers of Engineering Systems 715- 772 -3442 Private Sewage Consultants PROJECT INDEX PLAN ID # All,+ a1 l — O D 5 DATE OWNER Itlti /(C f �RS /{, of V•CV• �O _ PHONE e ela • d 6 g • 77 4e 1 ADDRESS 1 *47 ev o o D 13 viP}/ 14V . 5 57 /2 5 LEGAL DESCRIPTION SU %7"E 7'1 S L o r #� 5 - 1 6s7_,;f-r_j65 /�i / z o • i o (v o . yo • ova 5 W Z7-, , r' z-- y, R11 TOWN OF � & U psp,y COUNTY S 7 CSTM 3i4 1.LP-- 5f_eoo --;f 2, Vf ys LOCAL AUTHORITY/ SUPERVISION S 7 ` & X Z o A- . PROJECT DESCRIPTION: T v C 77 f lov N � y' c�as� POWT SYSTEM SHALL���� 16VCORPORATA C PROPER ZABE 83.44(2)c Ulbricht & Associates FILTER MODEL # , _ Private Sewage Consultants 2812 1 Oth Ave. - ---® -- Spring Valley, WI 54767 P9.1 INFILTRATOR SIZING WORKSHEET P9.2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM, WTTR P.T.FVATTnnTQ } 1212 Z SOIL EVALUATION REPORT p e 1 of 3 Wisconsin Department of Commerce Steel Soil Service Division of Safety and Buildings in accordance with Comm 85, W is. Adm. Code C my Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must t t {qix include, but not limited to: vertical and horizontal reference point (BM), direction and Palcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. �- Please print all information. B Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (t) (m))_ 3 3 Property Owner Property Location 4= Reliant Developers LTD Govt. Lot SW 1/4 SE 19 S 22 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 9900 Valley � Rd. Suite 135 5 na Kelly Estates City LAroo ur(� State Zip Code Phone Number It City 2AVillage : "a Town Nearest Road MN 55125 651 731 - 3174 Hudson Ross Rd. New Construction Use: ig Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD „" Replacement Public or commercial - Describe: Parent material outwash plains and stream terraces Flood plain elevation, if applicable na General comments and recommendations: System elevation 94.35ft, trenches spaced and depth to code 4.75ft below grade P] Boring # mss; Boring Pit Ground Surface elev. 99.10 ft. Depth to limiting factor m. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *E GPDt1t`Eff#2 1 0 -12 10yr3 /2 none sit 2msbk mfr cs 1 f .5 .8 2 12 -24 10yr4/4 none MC 2msbk mfr gw na .4 .6 (►2'J 3 24 -36 10yr4 /4 c2d 7.5yr5/6 sicl 2msbk mfr di na .4 .6 J 4 36 -55 7.5yr414 none Is Ogg mvfr gw na .7 1.2 5 55-68 7.5yr414 none cos Ogg mvfr gw na .7 1.6 6 68 9 0 6 .1't 7.5yr4/6 none ms osg ml na na .7 1.2 Boring # ! Boring Pit Ground Surface elev. 99.10 ft. Depth to limiting factor in. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots �Eff#1 PD /fV 1 0 -11 10yr312 none sit 2msbk mfr cs 1f .5 .8 2 11 -25 10yr4 /4 none sicl 2msbk mfr gw na .4 .6 3 25 -35 10yr4/4 none scl 2msbk mfr gw na .4 .6 4 35-45 7.5yr4/4 none Is Ogg mvfr gw na .7 1.2 5 45 -96 7.5yr4 /6 none ms Ogg ml na na _7 1.2 5t' /`Iq- Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD L30 mg/L and TSS < mg/L CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address Steel Sal Service Date Evaluation Conducted Telephone Number 1564 CR 1 New Richmond, Wl 54017 10/20/2002 715- 246 -5085 Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST- POWTSM Reliant Developers LTD New Richmond, Wl 54017 Lic. # 248956 SWl /4,SE1 /4,S 20,T29,R19W (715) 246 -6200 Town of Hudson, St. Croix Co. (715) 246 -5085 Kelly Estates lot 5 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the soil test was conducted. Legend 1" = 40' / (�= Benchmark El. 1 00.00F t �( op of 1" steel pipe I Alt Benchmark E1.99.0017t top of 1 /2" pvc pipe o = Borings Boring Elevations B1 =99.1OR B2 =99.1 OR B3 — 98.40Ft B4 =00.00Ft ci �/• /ate �A O y- ' Octf k ?,+ w � ZONED AG-RES Mo MON Az" __J282.44 SO1'O2'11!jE�-::,, F — CZn, x ��r ri lax 1�jr ri I S 'Ap ji e Gr M & UL Wks? A-34 CRI :,rj "L 14&5 t a-A t•ttz E7 a k. I U .4 p g:o Iffil 44"S I r t V_ 6.2 Igo Zia K vwoowq� 940 ra 17 -TIE) g 74 ME. V.... q \ ` , L ri . % f 329.18 NO3'(7' Kitl.V mulyovo. ­7 rn ST CitOIX COUNTY • SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION CORM bWlfet /I3ttvet ,� "�� - -�jSa� 45P.4 2 &"L- t - De L) - (:f " Mailing, Address ���i / 4 fo od la*,6e, f, 5 7 6pl� 240 Co 0,0/1 ave propert Address 65 19�SL�.J (Verification required from Planning Department for new construction) city /Stale _ )l y ®9lJ'✓ Z4-) , Pntcel Idenfi6cation Number 020 — /43-T roS— � . 2f/0) LEGAL ll�SC1tIC "L ION Propetty Lbcation 50 r /,, 5 '/#, Sec. 2.2 , T L N -F W, Town of 110 ,0SO AJ Subdivision E�� G S ��T�j� , Lot # S . Cetif fled Survey Map # , Page # Warrneay Deed # - 7 - 732-33 Volume , 2 � . Page # 15' / Spec !ttttsel yes 0 no Lot fines identifiable (yes O no SYSTEM MMURNANC Improper use and maintenance of your septlb system could result in its premature failure le handle wastes. Proper mairdenane consists of pumping out the septic lank every three years or sooner, if needed by a licensed pumper. What you put into the systec can afrect the function of (tie septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by meslet plumber, joutneyman plumber, testricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdispos al syster: Is in pro pet operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge, 1 /we, the undetsigued have road the above reTtirements and agree to maintain the private sewage disposal system with the standard tel forth; hetein, as set by the Department of Commerce and the Depattment of Natural Resources, State of Wisconsin. Cettificatio !elating that ygnt septic Xyslem has been maintained most be completed and returned to the St. Croix County Zoning Office within 3- days of t1ro,41rtee y0t expiration date. ►fin uRE �r Ltc -} DATE 0WHER CERTIFICATION 1(wu) "certify It all statements on this form are true to the best of my (out) knowledge. I (we) Am (ate) the owner($) c lire propellidesctill Vabove, by virtue of a warranty deed recorded in Register of Deeds Office. SIONATUPM OF APP LI C A N "t DATE Any information that is "'is- teptesented may result in the sanitary permit being revoked by the Zoning Department. +* Include wfth lfds application: a stamped warranty deed frbm the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 4 2 6 4 8 P 15 9 773233 L� STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. TY MALSN WARRAN DEED REGISTER OF DEEDS Document number ST. CROIX CO., UI RECEIVED FOR RECORD This Deed, made between IaCass>r Develos►lnent, Inc.. 09/82/2004 09a30AM Grantor, and As= Development. 1iARRAHTY DEED Grantee. EXM # Grantor, for a valuable consideration, conveys and warrants to Grantee RRC Fn t 11.00 the following described real estate in St. Croix County, State of Wisconsin TRAITS FEE t 251.78 "re space is needed, please attach addendum): COPY t , Plat of Kelly Estat in the Town of Hudson, St. Croix County, PAGES; 1 Wisconsin. I Recording Area Name and Return Address /* � C / 020 1060 - 90400 Parcel Identification Number (PIN) This is not' hotnestead property (is) (is not) Exceptions to warranties: Easemeats, restrictions and rights of of record, if any. Dated this day of S&V&MRW , 2004 * * LaCasse iDeveiopment, c. AUTHENTICATION y �iEpGMENT Signature ` Signature(s) STATE OF �/. ) ) ss. _ County ) authenticated t1Ragerdq o % VerS- _ _ �dT Kota Personally carne before me this da y of Notar Ublie September , 2004 the above named e Of Wisconsin roc Knent, Inc. # _ b TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to Me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrum a wledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristin Ogland Hudson, WI 54016 Notary Public, State of My (If not, state expi 'on (Signatures may be authenticated or acknowledged. Both ate rat necessary.) r j� ) ' Names of persons signing in any capacity t urst be typed or printed below their signature. Infonution Professionals Co., Pad du Lac, WI STATE BAR OF wISCONSW 900.653 -2021 WARRANTY DEM FORM Na. 2 -19M TAL 4 .c Q � . 401.0 ._ — ." '_ _► -"'� -- a1 c� Cj 1 1` G y N Ov 1 in u t z 1 uj x O1 1 M W 1 N E_ - - --- - -_ - - - - - -- - - -- — - � z Z� c� 1 lz `�� 1 at at �`< o 1 z8o = i N f N J�O •0 _i °° 1 N � v! i S44*12'36 W std o 400'0£�� - 74 43 — — — — - - -- -- -- "- - -- ,n ----- - - - - -- _ - nvn n •Op- 3rZi,L OOSM �� = vvVC_ � 4LZZ " r •DON �M O ----- -' -- -- -- --- - - -- -- - -- _ — 30� M .[�,S>~w 5 � see l I � o i I I = CSI 1 % I I Z o I -.il i W I I O IN o 5 MR., F 8 I °z s °g a°iol I �q 1 v w= m S. E -1 I Wa I I ��N � 3 I �� � I I ° m x O Q Wx a � �. 1 zn z I J a a= z I ci°,d ° I m o � I I �� zU.0 ci _ ,LZ'99Z ,tZ'tSZ 1 QO.00 S LAI i T oV Or 'roe n _ 1 3 o- � POWT SYSTEM SHTA"i ' 0 RP0RATE PER COMM.. t-J .95.44(2)c A PROPER ZABEL FILTER MODEL # x f x zx y° a F fix. -r MU5 MAM Na-f- Y I CI' � �, to -� O w su. i BtsTTap� ��: VA d 3 gg A Ub ri I ht & Associates c Private Sewage Consultants 2812 1 Oth Ave. Sprang Valley, W? 54767 Ulb icht & Assonintac Wisconsin Department of Commerce ' PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463291 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)J. Permit Holder's Name: City Village X Township Parcel Tax No: Peterson, Mike I Hudson, Town of 020 - 1437 -05 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No Yh % CST 22.29.19.2710 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 40- Benchmark 1 Z!50 1 }. ic�+ J am 1 - Alt. BM ` f� I) ' Z Vim► Z o AZA. ".. S 4." 1 J Aeration Bldg. Sewer 9. 51 S -Z Holding --✓ _ ! r- St/Ht Inlet i6,5 c 17 . TANK SETBACK INFORMATION St/Ht Outlet qL4 , -3 /04rj TANK TO P/L WELL EBLDGGVent to Air Intake ROAD Dt Inlet Septic / � f �' Dt Bottom �\ Dosing 1 Header /Man. I I •3 C� 3 • C Aeration Dist. Pipe J S3 Holding Sot. System , 1 Final Grade 7 03 PUMP /SIPHON INFORMATION u ,� b 7.2- S 7 Manufacturer Demand St Cover �) �__ ..... __.,_....,._ GPM �` I 4 •SU Zw del Number / 1 I 1Z•33 /Z `'f 3 TDH I Lift - - --,, � Fr iction Loss System Hea /' TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width � Length f No. Of Tre PIT D MENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS t '�6 Z 1� Q , SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: 1 r INFORMATION CHAMBER OR .�—v� 1 44 Type Of System: 3 2' (,D / 1 5 / A' UNIT Model Number: �s ; 44 DISTRIBUTION SYSTEM - Z 3 = '15 Header /Manifold Distribution ` i x Hole Size x Hole Spacing Vent to Air Intake , G I Pipes) � \ �� e� Length o Dia Length Dia Spacing V SOIL COVER x Pressure Sys Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulc ed Bed/Trench Center Bed/Trench Edges \� Topsoil \ Yes I, ' No j No COMMENTS (Include code discrepencies, persons present, etc.) (Inspection #1: / Inspection #2: Location: 816 Ross Road Hudson, WI 54016 (SW 1 4 SE 1/4 22 T29N R1 9W) e /atesjLott 5 Parcel No: 22.29.19.2710 1.) Alt BM Description = Qa 5 '� 2.) Bldg sewer length= - amount of cover = - I Plan revision Required? i Yes _ o Use other side for additional information. - -- Date Insepctor's Signature Cert. No SBD -6710 (R.3/97) Safety and Buildings Division County S'T' Cf 201 W. Washington Ave., P.O. Box 62 i sconsin Madison, WI 53707 - 710 `O J \ Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 v � t4(0 32 Sanitary Permit App 'cafEIVED State PIanI.D. Number In accord with Comm 83.21, Wis. Adm. Code, perso information you provide may be used for secondary purposes Privacy w, sIS�MN(m) 8 200-9 in address 1 i4o sS RD • vps� ®,v I. Application Information - Please Print All Information ST. CROIX COON 1_ Property Owner's Na me A5p�� l # Lot f Block a s!a S Property Owner's Owner's M ailing Address ��• �U % / L S Property Location 1d & U o a O 14;V& / sW i4. s 9 'A,Section 2-72— City, State f � Zip Code Phone Number IUD 0013 up / "'�• 9 � T Z� N, R /j (i le g - Number of Bedrooms �te H. Type of Building (check all that apply) , / .4 S ✓. �l or 2 Family Dwelli '�/ t f �jL� µg S Subdivision Name CSM- P�aber �. - - �Sr—,¢rFS ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use ❑City _ ❑Village ❑Township of UAQ.tt1- III. Type of Permit: (Check only one box on line A. Complete lime B if applicable) o20 - `f 37 o SS cm C. 2.7/0 A, � New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal El Permit Revision 11 Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that a ly) Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Welland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter )� Leaching ber ❑ rip Line ❑ ravel -less Pipe ❑ Other (explain) V. D' rea t Area Information: S L Z S f r Design. Flow (gpd) Design Soil Application Rate( f) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation (.0 0 • 7 F5 .97/ 1 5 so VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel -Fiber Plastic Gallons Gallons of Units w/Z ab / j _/� Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank /Z �2 SO � E$ - G J Aerobic Treatment Unit Dosing Chamber 'bilit - f or installation of the POWTS shown on the attached 1 VII. Ices nsr Statement I, the undersigned, assume responsibili o plans. po y dersrgn Plumber's Na me (Print) Plumber's Si gpature •MP/MPRS Number Business Phone Number R. /Zd' 2- z C43 - 7 S 715"7 ' 3V 5 Z- Plumber's Addre ss (Street, City, State, Zip Code) , VIII. Corm /De ent Use Onl Approved ❑ tsapprov� Sanitary Permit F includes Groundwater Date Issued I u' Agent Si (No Stamps) Surcharge Fee) ❑ Owner iven Reason Denial 30'' aD ! 9 ? IX. Conditions o A rov val SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in she SBD -6398 (R. 01/03) f H � G -Z / R LN w '• I ' / .f \ J K V O T OL 1 ` r�m� ° gym to tom �r r• � � Z S r ULBRICHT & ASSOCIATES CO. 2812 10th Ave. • Spring Valley, WI 54767 Reg. Designers of Engineering Systems 715- 772 -3442 Private Sewage Consultants PROJECT INDEX PLAN ID # All+ x 0 0 5 DATE OWNER 141 141 IET_Rsa,J f�S��.v L .GU• CO _ PHONE Ella ' S 7 9 7. '77 ADDRESS 44 y 13 yi2)/ /f4y . 5 -57/2 5 - LEGAL DESCRIPTION ,SU�rE 7Z O r 40 T #� 5 �'� //y �'s7" � A /:A/ v z o• i o !o o• 9a • � 540 s i,: Sic. Z 2_ 7 - 2-?, TOWN OF T V ,Sp,y COUNTY .5' 77 CSTM DA LLR- 5 4 Zays 4, LOCAL AUTHORITY/ SUPERVISION S T e'eoi x PROJECT DESCRIPTION: C w N /��• �� G S T %tiI/�7 -may ---- a ` �v iF ti POWT SYSTEM SHALL ���r INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL Ulbricht & Associates FILTER MODEL # , _ O Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 s Pg.l INFILTRATOR SIZING WORKSHEET Pg.2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. OQ .d l m OR N �. tA 4 b 0 � � r z m 1 -,a o, q 11 n 0 L DO NA o • p -44 ch �v �a► O mom c_ o :33 h+ DOSO �9 R, o k4 n �n v > Pry r,. 12 1 ff ! t /1 .. s y s M�M z 5 liV rl �l 1 q. 1 Z _.... /9PPMA�P UA,v T Ifi -1 � 2 Iff j ►�„ . 5 �J C OWNER's NtAINTAINCE 0'F" SEpTiC SYSTEM - POWTS (landowner) is reponsible for proper operation an Maintenance of this system odic . Regular periodic d servicing is nece ssary inspection essary €or the safe health s and systee. The owner is required by code to submitrallonecessary maintenance /inspection reports to the controllin - g, authorities. SPECIFIC CONTACT AGENTS 5 7 C/2© /` k C ` / l * Governmental authority/ inspectors: 3 dr�l �lp �CPaO * Licensed installer, responsible for providin maintenance "Users" manual: g an operation/ �*7 S * Licensed service / inspection agent other than installer: *_ Electrician, for pump, electric controls, wiring units: IMPORTANT OWNER MAINTENANCE RE UIREMENTS 1. Winter traffic (sleddin area shall not be g etc.) across the the cell, freezingpupmtheesystemfrD trate into iscontinuos u winter -(a vac ac th system. in the lead to freeze ups,' g•'in no water use) can also 2. Water conservation- needs to be exercised! Or system can be hydrolically overloaded and destroyed. This sysCem was designed for a maximum wastewater flow of wQQ gals. daily. 3 - POWTS are not designed to . disposal unit, or an accomodate wastes from a Any introduction of such waste materials uwie8 of `wasteage r unnatural destroy this system. ll overload and 4 • If a power o,itage occurs, or a pump fails, it in a temporary overload of a may result ef fluen t which nt being pumped Into the cell, may y adversely impact the cell (leakage). It is that a Licensed pumper empty the dosing tank, allowing the pump to- return to dosing the correct Consult Your installer. immediately for advice. amounts. 5• Neglect of the vegetative erosion g ative cover pre (the cells insulation & ventive) can lead to traffic also can destrocan failure. Compaction or heavy REGULARLY WATER THE VEGETATION SOVERmA SYSys NECESSARY TO the 4,Ystem beneath IS NOT sufficient Effluent in �1 over. , ,alone to maintain a 6- Periodic inspections b y the owner, or his a necessary Inspection necessary. Pipes gents, is to P and th Port r Qv��o,,.. ___ . _ U is havo ar 1212 z Wisconsin Department of Commerce SOIL EVALUATION REPOR p e 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ,;, 8 i Steel Soil Service Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must C my r�t � include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Pa I D _ F C -i: N Please print aN infonnadon. gy Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ' O Property Owner Property Location Reliant Developers LTD Govt. Lot SW 1/4 SE 1/4 S 22 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 9900 Valle jjeek Rd. Suite 135 5 na Kelly Estates city j�roo pUr� State Zip Code Phone Number j6 City Village ,.: Town Nearest Road MN 55125 651- 731 -3174 Hudson Ross Rd. New Construction Use: J6 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material outwash plains and stream terraces Flood plain elevation, if applicable na General comments and recommendations: System elevation 94.35ft, trenches spaced and depth to code 4.75ft below grade Boring # '` Boring Pit Ground Surface elev. 99.10 ft. Depth to limiting factor 96 in. Soil Applicahon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft *Eff#1 I *Eff#2 1 0 -12 10yr312 none sil 2msbk mfr cs 1 f .5 .8 2 12 -24 10yr4/4 none sicl 2msbk mfr gw na .4 .6 C 12 r � 3 24 -36 10yr4/4 c2d 7.5yr5/6 sicl 2msbk mfr di nit 4 6 4 36 -55 7.5yr4/4 none Is osg mvfr gw na .7 1.2 5 55-68 7.5yr4/4 none cos osg mvfr gw na .7 1.6 6 y 8-9 6 7.5yr4/6 none ms osg ml na na .7 1.2 Boring #f Boring Pit Ground Surface elev. 99.10 ft. Depth to limiting factor 96 in. Sal Ap*atan Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 I *Eff#2 1 0 -11 10yr3/2 none sil 2msbk mfr es 1f .5 .8 2 11 -25 10yr4/4 none sicl 2msbk mfr gw na _4 .6 3 25 -35 10yr4/4 none scl 2msbk mfr gw na .4 .6 4 35-45 7.5yr4/4 none Is osg mvfr gw na .7 1.2 5 45 -96 7.5yr4/6 none ms osg ml na na .7 1.2 9 -4. o 5t .� /�� * Effluent #1 = BOD s > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number David J. Steel ( � 248956 Address Steel Soil Service r` �� ` / Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, W 1 54017 10/20/2002 715- 246 -5085 Property Owner Reliant Developers LTD Parcel ID # pending Page 2 of 3 3] Boring # Boring Pit Ground Surface elev. 98.40 ft. Depth to limiting factor 96 in. Soil Apo-cation Rate Horizon Depth Dominant Color Redox Descnphon Texture Structure Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0 -17 10yr3/2 none sit 2msbk mfr cs 1f .5 .8 2 17 -28 10yr4 /4 none sicl 2msbk mfr gw na .4 .6 3 28-43 10yr4/4 c2d 7.5yr5/6 sict/si 2msbk mfr di na .4 .6 4 43 -96 7.5yr4/6 none Is osg mvfr gw na .7 1.2 ❑ Boring # Boring I Pit Ground Surface elev. ft. Depth to limiting factor in. F S-1 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' *Eff#1 *Eff#2 F-I Boring # Boring =1 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' *Efl#1 *Eff#2 * Effluent #1 = BOD 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 I Page 3 of 3 STEEL'S SOIL SERVICE David I Steel 1564 Cty Rd GG CST- POWTSM Reliant Developers LTD New Richmond, Wl 54017 Lic. # 248956 SWl /4,SE1 /4,S 20,T29,R19W (715) 246 -6200 Town of Hudson, St. Croix Co. (715) 246 -5085 Kelly Estates lot 5 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the soil test was conducted. Legend 1" = 40' Benchmark El. 1 00.00F t �/ op of 1" steel pipe T Alt Benchmark E1. `Top OPW pvc pipe o = Borings Boring Elevations B1 =99.1OR B2 = 99.IOR B3 = 98.40Ft B4 = 00.00Ft 14 w � j, 70 S /ope ° l' SAO i3 Lf 2' iD ,'1 6cxf k ?,+ 8, � �' f4 "'��'� I j �^' ;'� ,,,��,„',`.�� � 1 u_ l y_ 1 __�-_�_ 1 - _i_•C•- �---- 'r- c��x = L —_ � IMW7111 NM ­ vim-mm ZONED AG-RES -- 1282.44 S01 !I l 275.01'_ 251-211, Fit -25MO K" CA I AP j, tic �4 I r;r 0 rn I COG 5 > -Mll 0 - Fri k VC%% it 7, 1"13 '33 W� 1 - T OL, jolow-doll, so I L 0 A, in it Is V A ir 6.24 117_77,_ 46 - .7 + 652 Ol e to M QQ Cri Is- j Ic \U If b —70 K 1EWW4D- " 4y cl ;o rn 4 Li "07 XI od, KA \V 1 1; X VI Lri 147A3 329j8 N Pol�F�R 03 Un R7' ,PEWW, 1416.§3 N01 1 m � :���� - F� :`, ��+� f � .n 1. CA&M. VOL 11. PC. .P. ST CROIX COUNT SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSIIIP CERTIFICATION CORM Owiter /Huyet C) - ef p Mailing, Address ���i / W oop Ia.-e, �, SG%f� ZO S' &0-0 lo p/s ale do Properly Address LP 9 S S - ! Aw . SS'l.Zs (Vetitication required from Planning Department for new construction) City /State ®a,J�. Parcel Identification Number` LEGAL` llESCItIP'I ION Property Location :50 /�, 56 %, Sec. 2.2 , T L N -R W, Town of Subdivision �S %� -Z L ot # s . Certified Survey Map # . Page # Wtltr arty Deed # - 7-732- 3 3 Volume _ 2� i � , Page # �`� 1 Spec 1t0tsel yes ❑ no Lot lines identifiable yes ❑ no SYS'T'EM / / ` `MA.INTENANC E Improper use and maintenance of your septl6 system could result in its premature failure to handle wastes. Proper maintenane consists of pumping out the septic lank every three years of sooner, if needed by a licensed pumper. What you pat into the sparer can alreci the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a cerfir ation form, signed by the vwnet and by master plumber, journeyman plumber, testrlcted plumbet or a licensed pumper vetifying that (1) the on -site wadewaterdispositl syster Is in proper operating condition and/or (2) alley inspection and pumping (if necessary), the septic tank is less than 1/3 full of abM*, t /we, the trndetsigned have read the above requirements and agree to maintain the private sewage disposal system with the standard set fotth herein, As set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Cediticatio Ruling that gput septle system has been maintained must be completed and returned to the St. Croix County Zoning Office within 3 days of th�,Ihree y r expiration date. DATE OWN CERTIFICATION t (we) certiry hat all statements on this form are true to the best of my (out) knowledge. I (we) Am (are) the ownet(s) c the property describabove, by virtue of a warranty deed recorded in Register of Deeds Office. SIONA'MR11, Or AP P LICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * ** *; include with thls application: a stamped warranty deed from lire Register of Deeds office 3 copy of the certified survey map if reference is made in the warranty deed U. 2 6 4 8 P 15 9 773233 L STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between I,aCasse Develoutnent. Inc.. 09/82/ 280! 89 s 30A1! Grantor, and Ashen DDoAm ment. Inc.. WARRANTY DEED Grantee. EXEIPT t Grantor, for a valuable consideration, conveys and warrants to Grantee REC M.- 11.00 the following described real estate in St Croix County, State of Wisconsin TRANS FEE; 251.78 (i re space is needed, please attach addendum): CO : Plat of Kelly Estates in the Town of Hudson, St. Croce County, PAGES: 1 Wisconsin. Recording Area Name and Return Address 020 - 1060 - 90-000 Parcel Identification Number (PIN) This is not' homestead property (is) (is trot) Exceptions to warranties: Easements, restrictions and rights-0f - way of record, if any. Dated this /� day of September , 2004 A �ZAAMF --A * * LaCasse Development, c. AUTHENTICATION ��WLE,pGMENT Signature(s) STATE OF ) ) ss. County ) authenticated 44ogere? NOta Personally came before me this �d� day of ry Ublic September , 2004 the above named Stat of Wisconsin IACa Inc. by TITLE: MEMBER STATE BAR OF WISCONSIN its __ _ (If trot, to known to be the persons) who executed the foregoing authorized by § 706.06, Wis. Stats.) � instrum d ac wledged the same. THIS INSTRUMENT WAS DRAFTED BY _ Attorney Kristin Ogland Hudson, W154016 Notary Public, State of My rmawnt. (If not, state expi on da _) (Signatures may be authenticated or acknowledged. Both are not necessary.) s zp ' Names of persons signing in any capacity must be typed or printed below dktir signature. 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