HomeMy WebLinkAbout020-1371-28-000 of :
t ,,,, PRIVATE SEWAGE SYSTEM Coun
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit
Peaonal kdorr udw you provice may be used for seoondary purposes (Privacy Lew. s.15.04 (1x 384155
Perm s Name: crty Cl Village Town of: tate Plan ID No.:
Hudson Township (Q /3 (o = 7nurs.
a efit s m s e tp ; Insp. BM E v.: Description: Parce Tax No.:
` (9 -a ( iC BM 0 .c7' (CPC. — C TF gw
TANK INFORMATION U ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septet W 2.l rvt.w.f? j2 v�p Benchmar V0 . o
Dosing u i t .'S / 10(, 14f i
Alt. BM
Aeration Bldg. Sewer �.z I.s
Holding St / Ht Inlet 3. (,S7 R -(. 30
TANK StTBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. ventto ROAD Dt Inlet ---�
Air Intake
Septic 1 so 5 66' 3 — NA Dt Bottom 35'
Dosing " " << e 3 (, NA Header /Man. $ • 3 0 6S J
Aeration NA Dist Pipe
Holding Bot System 4• /a c '
PUMP/ SIPHON INFORMATION Final Grad .� "al 6"
Manufacturer Demand ` St couer
�. ode( Number 6PO 57 /
rFocrcemain DH Lift �•3� Friction_, S term TDH )4,�Ft .� / 98' �r
I Length 5' Dia. Z " Dist.Towell
SOIL ABSORPTION SYSTEM
i 8 width Length f re PIT No. f P' Inside Dia. Pth
NSIONS e ga
DIMENSIONS LEA ^
SYSTEM TO P / L BLDG WELL LAKE / STR adurer:
SETBACK CHAMBER r
INFORMATION Type O f (S i OR UNIT
S ystem: ow.
DISTRIBUTION SYSTEM 1 °r `
Head I Manifold /1 Distribution Pipes r x WoleSizC1 x Hole Spacing Vent To Air Intake
Length -2 — Dia. �_ Length - 3 - 3 - 4 ) Dia. O Spacing . O ( S " 2 If //
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No Q Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1: K/ 30/ e'1 Inspection #2:05 ( / o/
Location: 1203 70th + Avenue, Hudson, WI 54016 (NE 1/4 SW 1/4 23 T29N R1 9W) - 232919222
Evergreen Estates -Lot 28 g
1.) Alt BM Description 4 I
2.) Bldd sewer length = ,-o wr
- amount of cover = I co ., -
Plan revision required? ❑ Yes IO No 6
W fqr addi tonal information. O
�"�Ken�. Date Inspector's Signature Cer[.No-
r
a1
5 -
I �D
i� i
o� tcAAOL-As + Q Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
NV isconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce (Submit completed form to county if not
[Privacy Law, s. 15.04(1)(m)) state owned.)
Attach complete plans (to the county copy only) for the system, on , per t less than 8 -1/2 x 11 inches in size. -t
u
County State San it ermit Number ❑ Check if rev„' '6h pr i0 Ejpp tion State Plan I. D. Number
s L r T
I. Application Information - Please Prijt all Information `e ` {', ,Location:
Property Owner Name (,C��`I L 'Property Location
�» ` t
QkR./1, bt/L- 1/4,5 (l.� /4, S — :5T - R (or
Property Owner's Mailing Address F �,! ` i . - L 4 t Number Block Number
a
City, State Zip Code Ph ne ,; tu , ber O ubdivision Name or CSM Number
, �pN1NG �r
II. Type of Building: (check one) ❑City
X 1 or 2 Family Dwelling -No. of Bedrooms: ❑ Village
❑Public /Commercial (describe use):_
KTown of
❑ State - Owned /' W411
Nearest Rod
N
P Tax Num r(� _ O _ , 6O
III. ' Type of Permit: (Check only one box on line A. Check box on line B if applicable) () — — AA 60 6
A) 1. F New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only A ' Gf a Existing System
$) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
❑ Non - pressurized In- ground XMound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -gra t rr ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
99.0 D _ 0.5,(4" sa kd
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation
D 600 6 0 - 3 A 1;� ,S
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
MOO ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
/-e� G
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installation of the POWTS sh wrlon the attached plans.
Plumber's Name (print) Plum is Sign ture (no /MPRS No. Business Phone Number
Plumber's Address (Street, CiVye, Zip ode)
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ing Agent Si ature (No stamps)
(,Approved ❑ Owner Given Initial Adverse Surch e Fee)
Determination �yZs OD
X. Conditions of Approval /Reasons fo Disapproval: -� .
� SeP�� S`t5�'`^^ a� ao.22 t`�rtetle -�nn� A��.rr► � �.e,�
SBD -6398 (R. 07/00)
PLOT PLAN
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NOTES:
1• Elevations shown are existing ground elevations unless other
2. Install 4" observation pipes with a wise noted.
3. Septic tank to be PProved caps. ( Z required).
) 200 �80o g� on capacity manufactured by
T
���3 lry e, w zlh� T F L-TI-np .
4. Bench mark
7 3. Divert surface
water around d system to prevent ponding at the uphill side.
Safety and Buildings
4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
I sconsi www.commerce.state.wi.us /SB
Department Of Commerce __.. -- -. -__. Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
February 01, 2001 f .
CUST ID No.69172T j ' } ATT'N: POWTS Inspector
1
ARTHUR L WEGERER ZONING OFFICE
421 N MAIN ST "c _ ° ST CROIX COUNTY SPIA
PO BOX 74 LC ty,N`' C 1101 CARMICHAEL RD
RIVER FALLS WI 54022 F HUDSON WI 54016
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 02/01/2003 Identificatio hers
Transaction ID N 613496
Site ID No. 626093
SITE: Please 'refer'to' both .identification numbers,
SITE ID: 626093, La Casse Custom Homes above, in all correspondence with the agenc
St. Croix County, Town of Hudson
Subdivision: Evergreen Estates III - lot 28
NEIA, SWIA, S23, T29N, R19W
FOR:
Description: Four Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 779506
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall
be met during construction or installation and prior to occupancy or use:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
"Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P
(R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems"
SBD- 10573 -P (R.6/99).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans. In addition,
the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of
the mound component manual are complied with. A copy of this information must be given to the owner upon
completion of the project.
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
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 Safety & Buildings 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.
ARTHUR L WEGERER Page 2 2/1/01
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 01/30/2001
&41&40& FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
Gerard M. Swim - BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
(608)- 789 -7892, Mon. to Fri. 7:15 AM to 4:00 PM
jswim @commerce.state.wi.us Wi$ 7 R code: 7633.
I
I
' TITLE SHEET Page 1 of - 7
MOUND SYSTEM
FOR
A L( BEDROOM RESIDENCE
This plan has been prepared in accordance with the Mound Component
Manual SBD -1057 P and the Pressure Distribution Manual SBD- 10573 -P
CCz. bla.9.�; Cam. 6199�
LOCATED IPI ►J
THE E . 1 5 3
/4 OF THE w 1 /4 OF SECTION Z , T Zq N, R 19 6d
TOWN OF r'3 ST_ CCw�K COUNTY, WISCONSIN.
INDEX
PAGE 1 of 7 TITLE SHEET
PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN
PAGE 3 of 7 PLOT PLAN
PAGE 4 of 7 PLAN VIEW -CROSS SECTION
PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT
PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION
PAGE 7 of 7 • PUMP PERFORMANCE CURVE
PREPARED FOR
S t1 o IC'4
141V �o
PREPARED BY 4 e /D
WEGEF:;-*EFR SO I L. . TEST S NG
AND . •
DES I GN SEF:ZV ICE
P.O. Box 74 421 i1.ifain St. '.4% ettese w,
River Falls WI 54022 ,' �1
..
...,,.
Phone 715 - 425 - 0165,"..'""' • ,��
Fax 715- 425 -6864
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JOB NO. QI - -
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Mound System Management Plan page Z of 7
Pursuant to Comm 83.54, Wis. Adm. Cade
Seotic.Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The erating condition of the septic tank and
outlet filter shall be assessed at least once every 3 years by inspection. Th utl t s hall be cleaned as necessary to
ensure ro er operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that
may slough o the t ter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if
the alarm is activated continuously. Intermittent filter alarms ma indicate sur a flows r
Y o an impending
septic tank shall have its contents removed when the volume of sludge and sum in the tank exceeds ceeds1 /3 the liqu liquid me of
the tank if the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise
the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in
the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required.
However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and
Buildings Division.
RUMP —Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to
verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
Mound and Pressure Distribution S tem
Nd trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound
shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic
(other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the
infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather
installations (October- February) dictate that the mound be heavily mulched for frost protection.
Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg/L TSS, and 30 mg /L FOG. Influent flow may
not exceed maximum design flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each
lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be
compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is
required to maintain equal distribution within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,
and any levels above 4 inches considered as an impending hydraulic failure requiring additional more e fie uent monitoring.
i q 9•
General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its'
component manual [SBD- 10572 -P
reporting. ( R. 6/99)] arid local or state rules pertaining to system maintenance and maintenance
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and
Pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed
unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall
be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component.
Continaencv 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.
If
the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be
immediately repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired
or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption
and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper
operating condition.
Questions about the operation or maintenance of this system should be directed to:
The County Zoning Office at L4 680 ST. C-M lx
The system installer 66
The tank manufacturer at SyO- .qRU— ZS10 1pWt'S1Z JV
The effluent filter manufacturer at E30O ZZl_ 5 -1 L1.7- ZPr$t:Z '
The pump manufacturer at
• // PLOT PLAN
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NOTES: _.
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4" observation pipes with approved .caps. ( Z required).
3. Septic tank to be ) Zoo /900 gallon capacity manufactured by
Pit 1p►,.� �ti' 1 l�)Cu\ ) Aj e; w Z 3e- e EUT F t L-1Z2 ,
4. Bench mark S
. Divert surface water around system to prevent ponding at the uphill side.
Page y Of 7
i�
.Approved Synthetic Covering
ASTH C33 Distribution Pipe
Medium Sand
_H Ia
Topsoil Fl q - S
=- --��-~ F ev .
—J
3 E D -
% Slope
Distribution Cell of Force Main Plowed
2" to 2- " Aggregate From Pump Layer
D C , S Ft.
E 0.11 Ft.
CROSS SECTION OF A MOUND SYSTEX F p.b Ft.
G 0. 5 Ft.
A Ft. H 1. 0 Ft.
Linear Loading Rate= °! .- /LN FT B b7 Ft.
Design Loading Rate= c).nGPD /SQ FT I 1 Z Ft.
i Ft.
` K Ft.
*i*em%4e Position L c6 3 Ft.
of
Force Main W 2(, Ft.
L
- Observation Pipe
- - - - - -- -- - - - - -- ------- - - - - == - - - -�
7 o- -�-- -- - - - - - -- --- - - - - -- -------- - - - - -- - - - --
W e�--. ---- - - - - -- - -- - - -- ---------------------
Distribution
Pipe •
Cell of : to 2-
aggregate
Observation Pipe
(Mchbr securely)
' ' - PLAN VIEW OF A MOUND SYSTEM
Distribution Pipe Layout Page S of �7
Place the holes at the bottom of the distribution pipes
at equal spacing. Remove all burrs from the pipe and holes.
Extend the end of each lateral up with the use of long turn or 45* fitting to a point within six
inches of the final grade. Te rmin a t e e the ends of the laterals with a valve,�threaded cap or
threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug.
-
T �t P C'i� L _ i;,�S S .. 5�`t•10 t�
PV C PV C JIT
Lateral Manifold Lateral
X x x x x2 x2 x x x x
'Lateral Length — Lateral Lenqth — p
Distnbution Line
• P -� `- Pr cr.�s sox
--0
hrsu�w�
S
_ Lq
P 3 3 Ft. Hole Diameter 1 / 6 Inch --
S 3 Ft. Lateral ) Inches)
X Zy Inches Manifold Z Inches
Force Main " Inches
# of holes /pipe 1
Invert Elevation of.Laterals W0.0 Ft.
1 X 6 -47u L4I.8z cP►,,
Combination Segt;ic;Tank and
PUMP CHAMBER CROSS SECTIOM AMD SPECIFICATIONS' PAGE OF ?
•VE1J7 CAP WCATH£R PROOF
JUIXTIOU 90X .
ti C.I. VEWT PIPC ti APPROVED LOCKIAIG
:10' FROM DOOR. 7MANHOLE COVER
.hUDOW OR FRESH wAtitJ1UG LP.gt:L..
wSPQ:;1o>J �z IPE AJR I>JTIIKE cor.�cutr `
w�PrttZllsq-r anp c
F N tgI{p LSZ p o t I
G z"Vo 18' MIU.
18'/'IIIJ. ---- - - - - --
a•: PROVIDE I
IIJLET •.•.
. •• �� AIRTIGHT SEAL
84FFttS I I I � v
Approved z8�t r-t� I I Approved
joint xv/ I IC I joint w/.
PVC pipe ALARM PVC pipe
_ �! tl
i Ow
C I I
° Jd-gZ I
LLEY F'L S — '�
PUMP OFF
D COUCKETE -
Lsz O.O'-0 6LOCK
ti: •
RISER EXIT PERMITTED OWLy IF TAwK MAMUFACTURER HAS SUCH APPROVAL 3NAPPRC
Br<OD i N 4
SEPTIC E SPEC.IFICATIOUS
DOSE
TAUK MAIJUFACTURER: MIZ PS T - Wl1MBER OF DOSES: y PER DA4
TAMK SIZE : ZzO ` Boo CALLOUS DOSE VOLUME r
ALARM MAUUFACTURER: IAICLUDIIJG 6ACKFLOW
MODEL WUMBER: 1Q1 «w CAPACITIES: A- _ IAICHCS OR 4212 GALLOAIb
SWITCH TYPE: - M�,�CU� -I'( g= / Z IAICHES`OR y-�-• � G�LL01J5
PUMP MAUUFACTURER: GOVT -DS C= b IUCHESOR GALLOWS
MODEL IJUM1jER: 3aZ � APO S ..•.
D = INCHES OR � 31 ` GALLOMS
SWITCH TYPE: __ Me DOTE: PUMP AMD ALARM ARE T 5
MIMIMUM DISCKARGE - RATE ' - 8 Z GPM INSTALLED OIJ SEPARATE CIRCUITS
VERTICAL DIFFERENCE DETWEEIJ PUMP OFF AUO..DISTRIBUTIOU PIPE.. OUR FEET
+ MIUIMUM WETWORK SUPPLY PRESSURE b - Sly FEET (S -r�
•f• FEET OF FORCE MAIN X 3 ' 9 F o FGFRICTIOU FACTOR _- S _.`L FEET
TOTAL Oy)JAMIC HEAD FEET
As per manufacturer gal /in. Liquid depth 3�a
- 7 c , F %
Goulds
Submersible
Effluent Pump
3871 EPO4
EP05
APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron
Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer,
following uses: • Capable of running lubrication and efficient strength, and durability.
• Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas-
• Homes components. tic cover with integral handle
Motor: Available for automatic and and float switch attachment
• Farms manual operation. Automatic
• Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical Points.
• Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty
• Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant.
automatic reset. ■Bearings: Upper and lower
RP
115 V, 60 Hz, 1550 RPM,
SPECIFICATIONS • EP05 Single phase: , FEATURES heavy duty ball bearing Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo
construction.
• Solids handling capability: automatic reset. plastic Semi -open design
3 /4" maximum. • Power cord:
10 foot
-- *
Capacities: _ up to 55 GPM. standard length, 16/3 SJTO with pump out vanes for AGENCY LISTING
mechanical seal protection. CO. Canadian Standards Association
j .0tal heads: up to 24 feet. with three prong grounding ■ EP05 Impeller: Thermo -
Discharge size: 1 NPT. plug. Optional 20 foot p (CSA listed model numbers
• Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in 7" or "AC.)
rotary/ceramic- stationary, three prong grounding plug improved performance.
BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged
• Temperature: thermoplastic design provides
104 °F (40 °C) continuous superior strength and
140 °F (60 °C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEET
stainless steel. 10
• Capable of running
dry without damage to 9 30. - GPM
components.
Pump: EP05 $ I I 2s Fr
• Solids handling capability: c 25
3 /4 ° maximum. w i
• Capacities: up to 60 GPM. s 20 1
• Total heads: up to 31 feet. 2 j
• Discharge size: 1 NPT. z 5
• Mechanical seal: carbon- } ! f b • 1 Z
rotary/ceramic- stationary, ° 4 15 i
BUNA =N elastomers. i EPOSJ
• Temperature: ° 3 10
104 °F (40 °C) continuous j ( ��•b 0•�• EPOa-
140 °F (60 °C) intermittent. 2 -
5
1 i 41
x= - 0 0 0 L___
10 20 30 40 M
50 GP
L _ 0 2 4 .. S 1 12 m =. h
CAPACITY
Cc 1995 Goulds Pumps, Inc. Effective May. 1995
Wit.10r, Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
L0or and'Numan Relations
Division of Safety & Buildings in accord with ILHR 83.05 Wis. Ad
,'�* t ~ ' , UNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan mvst,rriclude, biAU r St. Croix
i vertical and horizontal refer point BM direction and % of slope, or
no `` PARCEL I.D. #
t limited to vert reference ( ), p , scale
dimensioned, north arrow, and location and distance to nearest road
020- 1062 -70 -000
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION = - R VIEWED BY DATE
NMAU4 Zer, f
PROPERTY OWNER: PROPERTY LdCAT10fi1 A
Richard LaCasse d v dOVT. LO'T,.W IN SW 1/4,s 23 T 29 N,R 19 Z (or) W
PROPERTY OWNER':S MAILING ADDRESS 1_01 # I BLOCK # SOMNAME. CSM #
521 McCutcheon Rd. 1
CITY i4udson, WI. 54016 ZIP CODE 181 E5405 [:]CITY Hudson N EAR
Wald off Fm. Rd.
[x] New Construction Use ?c ] Residential / Number of bedrooms 4 [ ] Addition to existing building
I ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 g pd Recommended design loading rate ' 5 bed, gpd /ft ' 6 trench, gpd /ft
Absorption area required 500 bed, ft2 500 trench, ft Maximum design loading rate ' 5 bed, gpd /ft2 *6 trench, gpd /ft
Recommended infiltration surface elevation(s) 100.30 ft (as referred to site plan benchmark)
Additional design / site considerations system el. based on contour line of el. 99.30'
Parent material sandstone uplands Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ❑ S ®U ® S ❑ U ❑-S ® U El 12t U El [3 U El ® U
SOIL DESCRIPTION REPORTcsd
Depth Dominant Color Mottles Structure GPD /ft '
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture G Sz. Sh. Consistence Ba Roots Bed JTW&
..................
.................
1 0 -10 10yr4 /2 none sl 2msbk mfr gw 2m .5 1.6
1 2 10 -23 10yr5 /4 none sl 2msbk mvfr gw if .5 .6 ,
Ground 3 23 -36 10yr5 /4 none sl M na gw na .3 .4
99 ft. 4 36 -60 10yr6 /4 none sandstone residuum na na np np .{
Depth to
limiting
factor
36"
Remarks:
Boring # 1 0 -12 10yr4 /3 none sl 2mgr mvfr gw 2f .5 .6
2 2 12 -31 10yr6 /4 none is Osg mvfr gw if .7 `:.8
3 31 -56 10yr4/4 none co s Osg mvfr -gw na .7 .8
Ground Gro
Gro 4 56-80 10yr8 /2 none sands one resid um na na np np
9 9.5 ft.
Depth to
limiting
factor
56"
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715 -246-6200
Address: 1554 200th. Av . New RichmonA, WI 54017
Signature: Date: 11 -18 -99 CST Number: m02298
PROPERTY OWNER Richard LaCasse SOIL DESCRIPTION REPORT Page of 3 _ ,
PARCEL I.D. # 020- 1 -62 -79 -000
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourbary Roots GPD /ft
..................
in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
.................
1 0 -10 10 r4/3 none sl 2mgr mvfr 9w 2f .5 .6
3
................. 2 10 -31 10yr6/4 none fs Osg mvfr gw if .5 .6
Ground 3 131-60 10yr6 /4 none of s M na gw na .4 .5
elev. 4 60 -80 10yr7 /4 none sandstone residuum na na np np
9 8.1 ft. —
Depth to
limiting
factor
60"
Remarks:
Boring #
C3
Ground
elev.
ft. —
Depth to -
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev. j
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
r
STEEL'S SOIL SERVICE
Gary L. Steel Richard LaCasse 1554 200th Ave.
CSTM2298 NE4SW4 S23- T29N -R19W New Richmond, WI 54017
MPRSW -3254 town of Hudson (715) 246 -6200
lot #1-
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 test was conducted.
r 1" =40'
ABM.= top of 1 pvc pipe C el. 100.00'
v lt. BM.= top of P pvc pipe C el. 97.20'
L -f- 24 205 `
oe
Q
Gary L.� Steel
11 -18 -99
ST CROIX COUNTY
SEPTIC 'TANK MAINTENANCE AGREEMENI'
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer C•02,X; 1 1ye —
Mailing Address
Property Address _ 7 yb IV z c - 6 n L
(Verification uequired fiont Planning Department for new construction
City /State A LL1 5L---"� Parcel Identification Number 10 70" 1
LEGAL DESCRIPTION
Properly Location N 6: ' /,, w ' /,, See. Z 3 , 'I' Z c C N -R "Town of
Subdivision (t e-4A c - , Lot # 2R .
Certified Survey Map It , Volume , Page It
Warranty Deed It 6 ZZ ,2 38 , Volume z 666 , Page It 4
Spec house ❑ yes q no Lot lines identifiable V yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenanceof your septic system could result in its pieniahne failure to handle wastes. Propermainletmce
consists of pumping out the septic tank every flute 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 treaoncut stage in (lie waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying ilia( (1) the on -site waslewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), (lie septic tatilt 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, Stale of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the d e year expiration date.
r
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on (his fount arc (Erse to the best of my (our) knowledge. I (we) am (are) the owriet(s) of
the y despiticil above, by virtue of a warranty deed accorded in Register of Deeds Office.
/0
SIGNATURE F APPLICANT DATE
Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from (lie Register of Deeds office
a copy of the certified survey map if reference is made fit (lie warranty deed
VPI- 1460Pa Is
611238
STATE BAR OF WISCONSIN FORM 2. 1998 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Timothy T. Balsimo and Barbara R. RECEIVED FOR RECORD
Balsimo, husband and wife,
09 -30 -1999 9:00 AM
WARRANTY DEED
Grantor, conveys and EXEMPT W
COPY
warrants to LaCasse Custom Homes, Inc. CORY FEE: CERT FEE: FEE:
TRANSFER FEE: 390.90
RECORDING FEE: 12.00
Grantee. PAGES: 2
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of Wisconsin
(The "Property "):
Recordinp Area
Name and Return
�GI S�a�.r✓
020- 1062 -70 -100 & 020- 1063 -30
Parcel Identification Number (PIN)
This is not homestead property.
(See Attached Exhibit "A ")
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any
Dated this ayz day of September, 1999.
* * TigRothy T. Balsimo
* * Barbara R. Balsimo
AUTHENTICATION
ACKNOWLEDGMENT
Signature(s)
STATE OF WISCONSIN )
authenticated this day of ) ss.
County )
Personally came before me this O � day
of September, 1999, the above named Timothy T. BaWmo
TITLE: MEMBER STATE BAR OF WISCONSIN and Barbara R. Balsimo, husband and wife,
(If not,
authorized by § 706.06, Wis. Stats.) _ to me known to be the person(s) who executed the
foregoin nstrumea and ackrtowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland
Hudson, WI 54016
(Signatures may be authenticated or acknowledged. Both are not Notary Public, State of Wisconsin
necessary.) y ommission is perman nc. (If not, state expiration date:
pp����
ROM VX SWERS
#
AWE OF WISCONSIN
-Names of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE SAM OF WISCONSIN
FORM Nn. 2. 19"
INFORMATION PROFESSIONALS COMPANY FOND DV LAC, WI WD655 -2021
VOL 1460P 20
EXHIBIT "A"
'PARCEL I -
PART O NE Va OF W Y. OF SECTION 23 TO �NORT�H,RA%�NGE 8 ST, ST.
CROIX COU , WISCONSIN DESCRIB D AS FOLLOIED SURVEY
MAP FI LED SEPTEMBER 23, 1999 IN VOL, 13, PAGE 3726, DOC. NO. 610909 EXCEPT
BEGINNING ON THE EAST WEST QUARTER LINE OF SAID SECTION 23 AT THE
SOUTHWEST CORNER OF SAID LOT 9; THENCE ALONG THE SOUTHWESTERLY LINE OF
SAID LOT 9 N56 5"W 54.07 FEET; THENCE ALONG THE WESTERLY LINE OF SAID LOT
9 N00°13'54 "E 50.00 FEET; THENCE NORTHERLY 18.02 FEET ALONG SAID WESTERLY
LINE, BEING THE ARC OF A 167.00 FOOT RADIUS CURVE CONCAVE EASTERLY, WITH A
CENTRAL ANGLE OF 5 °29'51' AND A CHORD WHICH BEARS NO2°58'49.5 "E.AND MEASURES
16.02 FEET; THENCE SOUTHEASTERLY 218.77 FEET ALONG THE ARC OF A 233.00 FOOT
RADIUS CURVE CONCAVE SOUTHWESTERLY, WITH A CENTRAL ANGLE OF 53 °47'50" AND
A CHORD THAT BEARS S62 0 40'51 "E AND MEASURES 210.82 FEET; THENCE ALONG THE
SOUTH LINE OF SAID LOT 9 N89°46'06 "W 143.48 FEET TO THE POINT OF BEGINNING.
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