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HomeMy WebLinkAbout020-1395-39-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)). permit Holder's Name: City Village X Township Kuchenmeister, Dou Hudson Townshi :ST BM Elev: Insp. BM Elev: BM Description: / I ~' " i P~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic - 12.~~ Dosing Sv ~ Aeration Holding TANK SETBACK INFORMATION Z ac~Guf,Q ~. ~ Q Z3 _ i°-..~ TANK TO PIL WELL BLDG. Vent to Air Intake ROAD Septic ~~ 1 I'tD~ DVI S.. ~ ' S-' ~ i _____ Dosing Aeration Holding PUMP/SIPHON INFORMATION ~i~~ Manufacturer Demand ~~~ J~ GPM Model Number p, ~-~~ ,~ 3 v TDH Lift Friction Loss System Head TDH Ft Forcemain Length ~ Dia. ~~ Dist, to Weu (0'1 ~ ~ o ~' bit ~ ~2-- SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CrOiX Sanitary Permit No: 453323 0 State Plan ID No: Parcel Tax No: 020-1395-39-000 Section/Town/Range/Map No: 25.29.19.2433 STATION BS HI FS ELEV. Benchmark i ~ ~o[•a Dv .c7 Alt. BM -~:. Bldg. Se er SUHt Inlet t/Ht Outlet ~^ Dt Inlet Dt Bottom ccwz r ~~5. 1 g8.3 Header/Ma . ~,~~ qs°Z Dist. Pipe ~~ ~~ (o -73 6 , V ~',~ (2- Bot. System ~~ -7,gB 9 3 • ~J7 ,v Final Grade ~1~~3 St Cover s.3 d ,~ ~ Jt /, 7 /fF ~ I.~~ %D 6 BEDITRENCH Width 3 i gth ~ 2~ No. Of Trenches ~.~ ~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ / ~ ~.~~~, ~~ SETBACK INFORMATION SYSTEM TO PIL BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: T 1 --~"Y~r !~~ Type Of System: ~ Cy~U.u C~~t~~~ ~ ~ ~ ~ ~ ~'t o't" ~ 5` J~ UNIT Model Number. • ' I DISTRIBUTION SYSTEM Header/Manifold r~ / y Y y Distribution Pipe x Hole Size x Hole Spacing Vent to Air Intake Length Dia Length SOiL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Onlv Depth Over ~ ( Depth Over ~ xx Depth of __ odded xx Mulched BedlTrench Center ~ ~~ BedlTrench Edges / / ~~ ~- f Topsoil ~ es No ;Yes No ~~ ~ r i~ COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:~/~/~j%IA.lUnspec ion _ t--- Location: 805 Highlandye(r Tail Hudson, WI 54016 (NW 1/4 SW 1/4 25 T29N R19W) Scenic Hills Lot 39 Parcel No: .29_.19.2433 1.) Alt BM Description =~-' "y C L~~ 2.) Bldg sewer length = 1 ~ , ~w ~ ~~~.,~~ ~ ,S j C~ts..+k-t J.,,,,. ~--~~ ~„~~ ~~v,~.•-,~Ca•-L. -amount of cover = ~~ "J Plan revision Required? ~ Yes No ~b1~1 `~j ~~/, , LI --"-1.-= ~~/. ----- ~ ~C1-L.!~~~-- Use other side for additional information. G i L~U ~ ~ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County ;~~ . 201 W. Washington Ave., P.O. Box 7162 (~'"_•~ O~S~n Madison, WI 53707 - 7162 Sanity y Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 Jr3 ~23 Sanitary Permit Application ~-!p State Plan LD. Number In accord with Comm 8 - 3 21, Wis. Adm. Code, personal info may be used for secondary purposes Privacy L , sln~ ~• ~ Project Add ss (i ifferent than mailing address) I. Application Information -Please Print All Information 5 Z ~ ~ ~ ~ ` J ~ i'Y Property Owner's Na me O ~ :71~. ~;i?U;X C;CJ.'Ji~! Parcel N Lo k Block N zo~;:r~~;; o~~~ici= ~ Property Own 's M ailing Address l ,. S Property Location City, State ~ v `-'' t < t c~ /~ Zip Code Phone Number ~ k/ ~ k,Section ~_ r `~ ~ /„j`~ ~ ~ circle ) II. Type of Bui 'ng (check all that apply) ~ ~ ~~, T ~ N; R~E q~ or 2 Family Dwelling -Number of Bedrooms ` Subdivision Name CSM Number ^.Public/Commercial -Describe Use C ~„~~ 1//1~ ^ State Owned -Describe Use a ~~S'J-,, ~~,~ kl Z ~ f' ?i3 ~ /~ / ~~ cJ /T 'Lr .~ ^City_^Village Township of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ~ New S stem b tJ Y ^ Replacement System ^ TreatmenVHolding Tank Replacement Only s^ Other Modification to Existing System B• ^ Permit Renewal Permit Revision Chan a of List Previous Permit Number and ate Issued Before Expiration g ^ Permit Transfer to New Plumber Owner ~ ~ ~ ~~ ~ ~~ 6 Iy. Ty e of POWTS S 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 Leaching Chamber Drip Line Grave]-less ^ O er (explain) V. Dis ersal/Treatment Area Information: De//sign Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation ~ VI. Tank Info Capacity in Total Number Manufacturer Gallons Prefab Si[e Steel Fiber Plas[ic Gallons of Units Concrete Constructed New Existing Glass Tanks Tanks Septic or Holding Tank ~~Q _.~ /~~ < Aerobic Treatment Unit I,/ / Dosing Chamber (ADO `_ '~v C~ (jCS VII. Responsibility Statement- I,'the undersigned, assume responsibility for ' allation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's ' gnatu P MPRS Number Business Phone Number PlumJber/'s Addre ss (Street, City, State, Zip Cod ) /l (/ VIII, ount /De artment Use Onl ~ ~ u~ ~ `sir b~ Approved ^ Disapproved Satutary Permit Fee (includes Groundwater Date Issued suing Age t Sign tur tamps) Surcharge Fee) ^ Owner Given Reason for Denial ~ ~ O~ ~~~ D IX. Conditions of Approval/Reasow~val ~~ • ~ - Ccmoinat±o*~ Septy.c~ Tank Arid _ • PUMP CH~,IMBER CROSS SECTIOIJ A1JG SPEGF1CA710u5 ' P?G3 (~ G_ ~ ' l0~ 1-tiZ,F3N nUU\~ ~1\ ~ WCATHCP, PxCOF _ i 1vOll W U1~ ~ V E1~T C '~--v'Z~1.'4 'f~Ct'~ 1~Z^P;-yC.L ~ ~. ~~S J;.'I:CT101J EOx .IPPROVEp LOCX;R:G i 11A1JHGLE COVER k:1Tri wA~.vl>JG l.P.o~l_. t --~- - c:~.:~u~r 'C Z R.EO'n I2 N~ ~ ~ _ _J ~ I I I \\\ - ~ ~ - --._. I ~t r--l - ~~~`C I ~ _ PROVIDE. ( ~' I -AIRTIGHT SEAL. ~ ~ ~j ~aFFL.L eari^~~~. ..a ~I =~PProvec ~~~ II ,JoiAt w/ -~pR~v~ -~~,,,r - I II1 ~ aL.~;x t~ -~~~ s ~i.-.~~c i .I fig b C P' PG EtEV , ~. ------ - Fr. I I I P;1t',p-~ ('--~ ~ ~ i ,,~ l C CC~CRETC • .~ ~ i ~ R~SEn i=XIT PERr,tiEO CUL~ IF TAUK MA~;;,'FAC ~' I :"A: °"- T nCR HA: SUCH APPnCVA~ stPric F S.P~CIrlCATIOLS CCSE T~uR`- MkaJUFJ+CTUkER:W~~~1Z C.gUC``2s~ -~- l~.'LSS~En CF DC:CS: _/ _rER Ca; TAJJ}( SIZE ; ~ ~-~l~ ~ ~j 0 v C•AL.L0~;5 DCSC VOLUME _ :.LAAr~1 MAUUFACTUR,LR; S•J -~~'1"1Za S`~S~k'1S I~:cL.ue~u(, oACxr.o~,-:~~._.,. ,. MOGEL -.:UMBER: ~~~ t"F1~ ~,/,7 GA LCti, •CA?a::l'fES: ~(_-~1,!„~,1CHC`. Ci'i _-1.Lf~,a~LC~;: ~WtTCH TyPC: ~'1E1ZCv2`'r PUMP !'1AlJUFACTURCR; GOUL~ ~ Q/ / C=-=.! CiY!DCHES OR ..L-"~~G.t:LOI:_ MODEL DUMBER: (7, ~, ~ c-' ~~~` •~~ ' 0= J .''HES CR 1~l LOIrS SS..ItTCH TYPE: 1"~~1ZCV~ V1 '_ ~ _- - - uOTE: PU11P AUD XLAR'11~AKf~TOrpC U ~ M11JtMUM DISCtiAR6E FtaT ~ ~" ~pM INSTAlLEO OA) SEPARATE CIRCUIT. VERTlCI~L D~FFEREIJCF DETWCEU Pu OFf A STRtBUTlOU PIPE.. /O_'FEET (E~ ~-- MltJit'lUM -JETWORK SUPPL: PRESSURE ~ - """' ~-~-~ z . .. .. . .._._ _ _ FLET - ~, '~ -~,~' ©FEET OF FORCE !1All.J X ~', ~ F~ofLFRtGTiou FACTOR.. ,, E E T ~ ~ ~ ~' C~~~ ~. - TOTAL Oy1JAMIC .HEAD =. ~~oFEET As ~ er rLanufacturer 2-Z •Z~ gal/in. .Liquid depth 3 6 !~ Goulds _` " 7 11 r~" F 6 '~ ~, ? _ ' 9 ----___ ~ EP04 ~~ ~~ 4 ~: _ ~ ~ ~ ~ ~ EP05 3 ~ ; , ~~ 2 ' DIMENSIONS PARTS (All dimensions are in inches. Do not use for construction purposes.) 11 6"MINIMUM WATER LEVEE ~~~~~~~ SUPPLIED WITH FLOAT SWITCH MODELS N PT B Order No. HP Volts Phase Max. Amps RPM Solids Handling Power Cord Length Wts. (Ibs.) EP0411 115 12 10' 20 EP0411A ° 115 12 10' 21 ~0 EP0411 F* 115 12 0 ' 20' 20 EP0411AC* ii5 1 12 1550 /4 20' 21 EP0511F* ~ 115 13 20' 21 / EP0511AC* 115 13 20' 21 "A" denotes automatic operation. Pump includes float switch. "F" denotes CSA listed with 20 foot power cord. "AC" denotes automatic operation, CSA listed with 20 foot power and switch cords. * CSA listed units. * * 230 V models consult factory. Item No Description 1 Impeller EP04/ImpellerEP05 2 Rugged thermoplastio base 3 Rugged thermoplastic pump-casing 4 Mechanical seal 5 Ball bearings 6 " 0-rings 7 Power cord 8 Oil filled motor 9 Cast iron motor housing/ stator assembly 10 Thermoplastic motor cover PERFORMANCE RATINGS Total Head Gallons Per Minute (ft. of water) EP04 EP05 5 53 - 10 46 62 15 36 56 20 21 47 24 0 , 38 28 - 24 31.5 - 0 ~~~GOULDS PUMPS, INC. ~•--~"`~' WATER TECHNOLOGIES GROUP SEr~c.. Faun NeN rt~K i3ras SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRINTED IN U.S.A. Gou1~s ~~ ~ 3871 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ^ Motor Housing: Cast iron Specifically designed for the stainless steel grade turbine oil for for efficientfieat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems.. dry without damage to heat transfer. ^ Motor Cover: Thermo las- an . • Homes components. A bl tic cover with ihtegral h dle • Farms • Heavy dlaty sump • Water transfer • Dewatering SPECIFICATIONS Pump: EPO4 • Solids handling capability: s/a'" maximum. • Capacities: up to 55 GPM. • Total heads: up to 24 feet. • flischarge size: 1'/z"NPT. • Mechanical seal: carbon- ratary/ceramic-stationary, BONA-N' elastomers. • Temperature:' 104°F (40°C) continuous 140°F,(6O°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Pump: EP05 • SoiidS handiln ~a ~h'~It`~: g ., p~.,,. y 3/4" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/2" NPT. •-Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C)intermittent. ©1995 Goulds Pumps, Inc. .Motor:.. • EPO4 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM,`built in overload with automatic: reset. • EP05 .Single phase:-0.5 HP, 115 V, li0 Hz,1.55O RPM, built inoverload with automatic reset. • Power cortl:lO foot standard length; 16/3 SJTO with three prong grounding plug. Optional 20 foot length; l6/3SJTW with three prong grounding plug (standard on EP05). METERS FEET 10 9 30 8 25 o ~ a x U 6 20 z 5 0 15 J 4 H 0 ~ 3~ 10 00 voila a for automatic and and float sUiitch attachment ,manual operation. Automatic points. models include Mechanical Float Suuitch assembled and preset at the factory. FEATURES ^ I:PO4 Impeller: Thermo- plasticSemi-open design with pump out vanes for mechanical seal protection. ^ EP05 Impeller: Thermo- plastic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING $P' Canadian Standards Association (CSA listed model numbers end in "F" or "AC".) I ', -__ ~ .. --~~~-S.a F'~Jt- __ _ - - ---- ,- ..__ - -- - -- i i i ~ - --- --- i ----~- ---- -- -- ----- ---I -- -- - I --- - -- i - - - - I --j -- - -', - . --- =EP05 - _~ i --- ~--- ~~ - ~ EP0~4--- I ~ `~~ , I i i 10 20 30 40 50 GPM 6 8 10 12 m31h CAPACITY Effective May, 1995 ~~Q ~ L ~' 83871 N y O 3 ~ ro N O Cn Z y cQ D a c o= z 0 ~ ~ a ~ ~ IQ ~ ~ v 3 (D .~ fD C m m N fD '~ a N; ~ °. ~ ~ 3~ o a °' m ~ z a~ o n~ w O (~D ~ ~a ~ c ~~ rn~ ~~ o° a ao v n C fQ N a m a lO (D Q lO O Q. n to O i C w O A 7 A ~ ~ i ~ ~ ~ -. .. 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Permit Holder's Name: City Village X Township Kuchenmeister, Dou Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding ,t.. ,h.. ,~... ,~, ELEVATION DATA County: St Sanitary Permit No' 453105 0 Stat Plan ID N Parcel Tax No: (/V~ 020-1395- 9-000 Section/Town/Range/Map No: 25.29.19.2433 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Ht Inlet St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade ,,,li i 1t~. u . ua i~ N i~ ~m ~ia ~ . it ~~ , ,,,~~ pli~., i s~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division h'SPECTION REPORT GENERAL INFORMATION ~ ~AfiTACH TO PERMIT) ~ _~ f Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Kuchenmeister, Dou City Village X Township Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St Sanitary Permit No' 453105 0 Stat Plan ID N Parcel Tax No: 020-1395- 9-000 Section/Town/Range/Map No: 25.29.19.2433 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SbHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bedfrrench Edges Topsoil Yes ' No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 805 Highlander Tr Unknown (NW 1/4 SW 1/4 25 T29N R19W) Scenic Hills Lot 39 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No T Use other side for additional information. _ _ _ ___ _ _ _ _ SBD-6710 (R.3197) Date Insepctor's Signature Inspection #2: / / Parcel No: 25.29.19.2433 Cert. No. Safety and Buildings Division ~O°°~ C~ ~ ~ ~ 2p1 W. y~gghiagton Ave., P.O. Box 7082 v ~-. ~ Madison, 53'11~.~ - 7Q8~ Stinitary Patnit Number {to be 51Jed in by Co.) iscons~n (608~261.6$4f, 6 ~ Department of Commerce stag PIaaLD.Number,~ Sanitary Permit Applica ' n ~ . ~~ , ~ ~ i'~"v"II _ in accord with Comm 83.21, Wis. Adm. Code, personal info n you pl'bvrde ea privacy Law, siS. {1)(m) project Address (ifdiffereny taailinng,,sddra~s)-/ may be used for secondary purpos ~6 ~ ~ (C~(-'L~G~~4t-~. 1 I ~• I. Application Information -Please Print All Information ~ ._~_• _ - - 020 _ 1~jU5 ~ 3 -G~p 2 Parcel # Block # Property O 'Name ~ / 2 u ~~/ Pr + Lora n v 2 ~~ Pro~~ ~r~5`M~i1 .~/~V ~ / '~~t~ J ' /v~/ '/ti~e~'ti Sation~ City, State ///•..' v Zip Code Phone Number // ur Gfl ~~ ~ SSoI ~ T~ N: !t!~ or W II. ype of ullding (check all that aPP / ~ ! ~ Subdivision Name / CSM Number 1 or 2 Family Dwelling -Number of Bodroo ~~ I (/ J~ ^ PublidCotnmerciel- lksctibe Usc G ^City ^Villaga~Townsbip of ^ Stau Owned - Descn-be Use 1 ~ I lIL Type of Permit: (Cheek only one box on line A. omplete lice B if appli le) q, tmenNioldiag Teak lacement Only ^ Other Modification to Existing System New System ^ Replacement System ^ 'our Permit Number sad to ^ Chaage era»t Transfer to New ~~ B. ^ Permit Renewal Permit Revision Plumber ~ Before Expiradoa IV. T e of POWIS S stem: Check all that a I a _p~urized in-C3cound ^ Mouad ? 24 in. of suitable soil ^ o < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ ^ Aerobic Trestrneat Unit ^ Recirculating Sand Filter ^ Worland ^ PresSUrizod m rouad ^ Hoidiag Tank Peat Ft ~ y ^ Dri ine ^ el-less Pipe they lain) Recireulatia Sypthedc Media Filter hin Chamber I V. I)Is trsalrl'reatment Area Informs on: Dis posed (s~ Syysstteamn Ele do Desiga ow (gpd) Design Soil Applicatioa Rate(gpdsf) ersal Area``Required yr+ r ~ (f n /~ ~ J ! ~L Fibe7rG (/lastic ~~ `-' ~~ Maaufaeturer Prefab Site 1 P YI, Tank Info Capacity in Total N Concrete Caastructed Glass Gallons Gallons of its ~ Ncw l:aiuiog V" ~~ ~ ~ /~ / (~ Tanks Tanks Septic err Holding Tank Aerobic Tmatment Unit t 1]oaiag Chamber VII. ResponslbW Statement- I, the uncle got some responsibility for instsllatioa of the pOWi'S s oa the attached plans. , /~ MPlMPRS Number Business Phone Number Plumber's Name (Prins) Pl u's tY ~ J _ ~ ~ L~ ~5~~,~ i~ ~` ~ Z z J Plumber's Address (street, city, state, zip I ~- Ol ) . ~a~~ /~ ~ VIII nun /D artment Use Onl Dat iss tssuinG~ re o ps) Saaitary Permit Fee (includes Groun~ to 1~ Approved ^ Disapproved Surcharge Fce) ~/ ~ ~U v ~ a-0 D ^ Owner Given Reason for Denial IX. Conditions~f AQ rovaUReasons for Disapproval 3 /^ ~t(~'L~'`-~: y .~.a ~- ~ii•iS~A%~ W~ _ OC. ri, - o.~s~.tds. YSTEM OVdN ~~i,., GG&%~'~ 1 eptic tank, effluent filter and C~H'-• 0 3 ~S 1' 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. ,3 ~ .r Atttuh eonpk~ piam (te ele County only) for the system oa paper sot kss tbaa gll2 z 11 lacttes la size .IM,p' '~., ,~ .;~~. t r '" Y ~,, -~S~D-63 48102) J' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page i of~ Division of Safety and Buildings m aocoroanc~ wrm wmm aa, curs. ream. was ~' S-f- c ro ~ lete sibs er not less than 8112 x Attach com arr on a 11 indles in size Plan mist . ( p p p p . inducts, but not limitecf'to: vertical and horizontal percent slope, sole or dimensions, north arrow, a ti and ~. nce` areal road. ~ Paroel LD. 0 Z b ' 13 ~ S - ~ ~ - UCH ~ Please print all l ~ onn~ ~. ~ R by Date L G' ' Personal fifomtafton you provide may be used roc ,~ p w, s. 15. ) (m)). urp~s~ , `~- t~l ~ ~- G,(~liy~ G ~ / ~ 0 Property Owner ~ 1 Propert9r lion -2. " ~ , ~ ~ ~, 2 ~ ~ ~ 1 Govt ... ,,~ 1l4 ~ 1l4 S L s; T Z N R / Q E (or)1~ Property Owners Mailing Address S co Lot #° Block # ~~ Subd. Name a CSMp ~~ Z O S-~ ~ ~ ~ wu--1-~ - ~~~ S e p City Stabs Trp Code !K ity ^ Vllage ~ Town Nearest Road ~rti' ~ ~ Wa.~-cY' I~VIv~.. DSO ~Z ( ~'(} ~ v s ~~•n /~ ~A/ ® New Construction -Use: ® Residential / Number of bedrooms 3 _ ~{ Code derived design flow rate ~Sa ~~ O O GPD ^ Replacement ^ Publ~ or commerdal - Desc~e: Parent material OU fc~JCt.s (•~ Flood Plain elevation iF applicable /lil•~- Generatoomments 5 S~ rrt e_i e~0.f.bn - ~fv: P 4S 8d~i~P`''tr' ~ y~Y ~ scc. and recommendations: ~ ~ ,~ . o ,,~ . fi~ q gd /.o w -~ r ~( d V,Q.~ 9 ~. 3 ~Y /~° ~ ~ ^ Boring , - ---- • ~ • - -- -~,- „ ~..-- ~-..~_ -- - . ~~---- ~ ..... , r..~~,r. c.-a ... ~ „S -" J Boring # ~ Z~ pit Ground surface elev.9S y0 ft. Depth to limiting factor in. Solt ication Rate Horizon Depth Dominant Cobr Redox l)esaiption Texture Stn~cture Consistence Boundary Roots GP D/fF in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'EfFtf1 •Efi#2 L~--12, Id ~ r 2 S ~ ~ Z.rY,c l~ rY~~ ~ S ~ ~ ~ , `~ - 8 Z (2-31 ID ~tl'-I S~~I 2msbk m~i' cs l~ ~ • ~-I 3 ~-12b ~~ ~4~CD __._ S ~ ~ ml - .1 I. 2 3 2 ~~ Z Boring # ~ BO""g ®Pit Ground surface elev. ~ft Depth to limiting factor I I in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/LP in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ©-I~{ lv ~ 3~2 S~i I ~m~.bk m-~r c s I v-~' . 5 . S' Z ICI - fig. ID ~ ~ `i ~'~ - Si cl 2i,~5bk m-~~ cs I ~ . ~ - (v 'Effluent #1 = BOD_ > 30 < ~0 ma/L and TSS >30 < 1 50 moll. ' Etifuent #2 = BOD. < 30 msrlL and TSS < 30 msr/L CST Name (Please Print) ~ Sign tu-e CST Nun~er -~clc vv~. ~~ I~~~ vl•La~(~ e. r ,,.~~__; ~~~ ~ Z 5 3 30 ~ Address Date Evaluation Conduced Telephone Number 2113 ~0 ~'' 5-~- S~me~~-~-, ivl ~'-1~2~ ~ -/ G/ ~~ 15~ 2`t~- `-I Ck~$-- ~: . Property Owner /a..r' ~~ ~ ~ ~ Parcel tD # Page Z of _~ Boring # U Boring ® Pit Ground surface elev. qq ~ o fk. Depth to limiting factor I I in. Soil lication Rate tion cri D d Texture Structure Consistence Boundary Roots GPDlff? Horizon Depth in. Dominant Cobr Mansell es p ox Re Qu. Sz. Cont Colo[ Gr. Sz Sh. "Eff#1 'Eff#2 1 2 b--I'-I I~- 9 1C~ 31z i '-III ~ S"~ I ~. ~I Z,Y,~.b 2 sek m~\r- ~r cS ~ ~ 1 ~ ~ 1 v~ . `-f . ~' ~ ~ .3 I I I (-I ~~ - m S ~~ m I - ~ (. 2 ~~ ~{ ~' S ~~ S/ G S ^ Boring # U Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil ic~fion Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP[?lff? in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. "Eff#1 'Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. R Depth to limiting factor in. Soil licatbn Rate Horizon Depth Dominant Colo Redox Description Texture .Structure Constatence Boundary Roots GPD/f~ in. Mansell Qu. Sz. Cunt Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mglL and TSS >30 < i 50 mglL ' Effluent #2 =GODS < 30 mglL and TSS _< 30 mglL 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 608-2648777. SBD-8330 (R07/00) .~ .. -~ PAGE ~ OF_~ • k-e. ~ I LOT# 3 `( LEGAL DESCRIPTIONN~.J `/45c~-~/4 SzST Z9 N R )q E (or~ NAME ~ r SCALE: 1"= yU BM 1 ELEVATION ~CX~ • U BM 1 DESCRIl'TION ~~ o-~ ~ z Q v c_ TQ ~ BM 2 ELEVATION q 7~. y CJ Sec. ZS BM 2 DESCRIPTION}~~ a~' ~ z ~ pv~ P ~ P 4- SYSTEM ELEVATION-lop q5. `6~ GoL e r q°I• ~~ ~., +, _. ALTERNATE ELEVATION }~Pg3.71oGaw+. r-q2. So I v oN 3o a~ 3~ a~13o n ~ v° ~ 0 0 L~.~ ~ 5)tu ~G a-~ ~e~• ~~ a~~ ^ ~~r~~ L ' ~-~ -r r ~ ~~3 ,2 f ~0~ $~, ~ ~d-2 -~. CONTOUR ELE ATI G S LOT PLAN PROJECT Doua Kuckenmeister ADDRESS 8245 Johansen Ave S. Cottage Grove Mn 55016 NW 1/4 SW 1/4S 25 /T 29 N/ 19 W TOWN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE4/8/04 BEDROOM 4 CONVENTIONAL XXX IN-GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 ,BENCHMARK V.R.P. Top of 1.5" pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 95.0/94.0 4' below grade Well is to meet all Plans Designed Using setbacks required by Conventional Powts WThIV~Jent Manual Version 2.0 >6" of Cover ' 11" 6' Long at System Elevation Pro 4 Bedroom House Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area 25' i B-1 Property Line 5 , 70' 13% B-3 Slope 35' B- 0, .M. 25' B.M. #2 is top of 1.5" pvc pipe @ 97.45' 10'~"Z n B.M. #1 10 0' I \ Property Line . LOT PLAN P1tOJECT Doua Kuckenmeister ADDRESS 8245 Johansen Ave S. Cottaae Grove Mn 55016 NW 1/4 SW 1/4S 25 /T 29 N/ 19 W TOWN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE4l8/04 BEDROOM 4 CONVENTIONAL XXX IN-GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 ,BENCHMARK V.R.P. Top of 1.5" pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 95.0/94.0 4' below grade Well is to meet all setbacks required by W ial~Jent >6" of Cover 6' Longll l" 25' B-1 Property Line ~'~ 70' 13% Slope B- 0, .M. 10' 2 10' ~n~ Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area Plans Designed Using Conventional Powts Manual Version 2.0 at System Elevation 25' Pro 4 Bedroom House B-3 35' B.M. #2 is top of 1.5" pvc ~ pipe @ 97.45' B.M. #1 Line - - U~.2S`i1P y59. STATE BAR OF WISCONSIN FORM 1 - 2000 WARRANTY DEED THIS DEED, made between Carriage Homes XXI, Inc., a Minnesota Corporation, Grantor, and Douglas Kuchenmeister and Cari Ann Kuchenmeister, Husband and Wife Survivorship Martial Property,Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property"): SEE ATTACHED EXHIBIT A Recording Area 758694 KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO. , NI RECEIVED FOR RECORD 04/05/2004 11:45AII NARRANTY DEED EXEMPT # AEC FEE: 13.00 ?RAMS FEE: 218.70 COPY FEE: CC FEE: PAGES: 2 ,3 Name and Return Address: j, Land Title Inc. 1400 Silver Lake Rd. Ste 200 New Brighton, MN 55 a 3 L~ ~ S `1 Together with all appurtenant rights, title and interests. 20-1395-39-000 Parcel Identification Number (PIN) This is homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this 2nd day of April, 2004. Carria Homes XXI, I c. '/~ *Kellei 5t. Martin, Vice President l~ AUTHENTICATION Signature(s) authenticated this 2nd day of April, 2004 * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Gregory A. Booth, Atty, 1900 Silver Lake Rd Ste 200, New Brighton MN 55112 ACKNOWLEDGMENT STATE OF Minnesota ) WASHINGTON COUNTY. ) ss. Personally came before me this 2nd day of April, 2004 the above named Kellei St. Martin, Vice President of Carriage Homes XXI, Inc., a Minnesota Corporation, to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. ~~~ an 1 ~~ ~~t)~~ *Annette D. Theis Notary Public, State of Minnesota My commission is permanent. (If not, state expiration date 1 /31 /2005 ) s (Signatures may be authenticated or acknowledged. Both are not necessary.) ANNEI-1'E D. THEIS *Names of persons signing in any capacity must be typed or printed below their signature NOTARY PUBLIC -MINNESOTA My Comm. Exp~~es Jan. 31,2005 WARRANTY DEED STATE BAR OF WISCONSIN ^ 8.1-2000 EXHIBIT A Lot 39, in Plat of Scenic Hills, located in the Town of Hudson, St. Croix County, Wisconsin. Rpr 09 04 08:27a t~Wtter/Btlyec Mailing Addreas Pt+opacty Address Don Stickney (6511 501-2409 ST C~OIX COTIPTI'Y SB1sTtt~ TANK MAIN'I`~NANCi~ AGg~~'f ARID Q~1~I8RSHIP CERTIFiCATiON FORM Gh~ tJe.S. ~'„y~i.G ~- i ~ ~s RDS ~ (yeeifieatieunoquised from PLnaiag Depsttm~t fa ucW L p.l ~~. ss-oi 6 ~~~ ~fAtr(Sy n_~ Parcel Identification Number 0 Z4' l 39 S~ ,3~~x) SAL nFStzurT~O» , 2 ~ 33 t a ~ Gf N W, Town of ~ ~ ~o Pro~anty Locadioa IV L~_ y., ~-~ ~~~, Scc. ~~. T~ cen~cr ~-~ ~~L~ .mot#~_. s`ttbdivistan . Cawed Sarvey Map # _ Volume .Page # -~ warranty Deed # ~ ~ ~~.~ .Volume ~Sy ~ Page # S Spoc l~use~ y~ ^ rno Lot lines idetztifiable ~ no SY8'i'&1VI Mwir1'1`S~I~Al~It+E ~;~tobmdlew-ast+es.I'ropa ImproQex um aad maiatemnee o~ y~ouc septic systemeaald teailt is #ts pry ~ilLst Y'~a ~ itdo tlro system oooQisb ~pumpiag oat the septic 1wk cvuy tbr+oe goats or soorxr, if needed by a iroa~aedp~mpet cast a~oct the of the s+aplie tQeak as s seeatmeat stage is ~ waste dispoaal The property arwaar agues to sabss~t b SL t'~vpc Zaauug t s eat f~• by ~ owner aad by s jorroaeyuamplumbor.gcatric6edglc~eroralioeaoedpa~arve~fY>n811mt(1}tire o~6ervasteovster aY~~ is is p[opet opee><ti~ c~uditioa. a4dlor (2} after ssrd patnpm$ (tf }. ~ took is kss thou 1!~ fall of shrdge. tfste„ ttre t~gnad Dave teed tic ab~are ~ and ag~to msiudt6a the paivate sewage disposal t+Y~ wn6 the set ~'atth, ~. as act by ~r+e Depart~u: off~uzmrraee azid the D of Natanral ~ of Wi °u ~ y~ septic ayst~em been maiulaiapd mast be wed and m tic ~', GYoioc CaaatY Zoning Of~ioe w~ 30 davs,.f'+I,e dasew `_. ~~. l CANT. DATE OWNER CERTIFICAI'~ON Iwo eta are me oanerts) of I (wc) certify that all statements on this form ate flue to the best of my (~')~1 ( ) { ) tLe vo, by vird-e~of'a warranty deed ia~~ of Deeds Oboe. CC,, ~~~T 1URB OF APPLICAIQT DATB sst~+« ..a.ss qay inrormatian that is misa~el.-re~ted may t+asult in ttre sanrtary pemadt.being ~vol°°d by the Zoning napartro~- :. ~t8 tbb s~rplteation: a stamped war:aaty flood fmm the Reg?sbor of Deems office a copr of the sarmay map if eef~t+eope is made to dx .,raz:aaty- deed Si,~ ~~~~6,e.~(~e ~!a In v r_~~ .~ ~ s ~~~ (3cR~ Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Pian Option #1. If system fails, determine cause of failure, use alternate area and install new system in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 FRDM FAX N0. ABM' U1 U9 iU:U~a i,ION aLYCKRly Apr. 09 2004 09:41AM P4 tr,aa ~ aut°c~ua ~-~ ~r ~ ~ ~~ 4 ~~ ~ ~ ~~ FROM FAX N0. Mar D1 V4 !tl:U~a Uon °.;tsekne~ Apr. 09 2004 09:41AM PS tb~~l 'U1-~'~UJ P-D .~ 5 '~ ~~ _ ~ ~ ~ f~ ~~ Cdr ~ 5~ ,_.._ FRAM FAX M0. Mar til U4 lU:U~a lion SEf~~~~y Apr. 09 2004 09:40AM P3 14011 'U1'~TUJ N~~ FROM Mar 0t 04 ld:Oda FAX N0. Apr. 09 2004 09:39AM P1 Don Seickne~ 1651! SU1-'t'4Gy p•~ r ~ a ~~~~ ~~ ~ ~p ~!!~ ~ ~l FROM FAX N0. Mar Uf U4 fU: UUa llori 5'tiL'KFS~y Apr. 09 2004 09:40AM P2 ll,~ll SU1••~+lUy p.d ~a ~ ~ ~ ~ ~~ ~~ ~~ i r l 4TION 978.0 , ' / / ~ ~' is9°59"®6"W 481 ~_' . ' / ~ / ,~~ 458.33' ~ / ~ .'~~ ~~/ ~- J,. ~~ / t ~ 52,736 So ~ _ ~ ~~ a . - 3.506 ACRES _ ' / ~~~ `~~ / ~ , • ~ \ y~ ~~~ A °'/ \ \ /. a~~~ / g~ \ / ~\ • i • ~~ . /~ ~ / / / . / _ • - 106,674 SQ ~T 1002.0 • • ~~~, / ~ - - 2.449 ACRES ~ . ~t,~. s % / ~ //. . " • • `~ 26 i J / • ~~ ` pY .yl 39 W 41 z 138,779 SQ Ff 3.186 ACRES > 20,467 SCE Fr 38 `~ 2.766 ACRES r~ 93,570 SQ FT 2.148 ACRES ~~ J r I ~ ~ 2606.$1' 240.00' 219.32' x.11, ~ N89°42'16"E 2630.40' (~ ~-- e~ % H.W. 1014 i t\`y~,. 27~ ~ UNE ~'~