HomeMy WebLinkAbout020-1374-05-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) 592215
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 Township Parcel Tax No:
Patricia O'Connell TOWN OF HUDSON 020-1374-05-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
Tvtt 12.29.20.2238
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV.
I S
Septic ~11X Benchmark
IR { ! G3 Ua vo
6"i g t~ Alt. BM L.,
-e
Aeao Bldg. Sewer Z • 3 ~ZS~'
Holding St/Ht Inlet DM3
TANK SETBACK INFORMATION St/Ht Outlet
I
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dtintet
Septic
Dosing Header/Man.
ra.q~ 9o.q
Aeration Dist. Pipe c
ding Bot. System
3. 70 . alPUMP/SIPHON INFORMATION Final Grade q,7
Manufacturer Demand St Cover f~ !,p
GPM 1 l tvj- V
Model Num
fol.y(P
TDH Li Friction Loss System Hea TDH Ft
3,G 90.0
Forcemain Dist. to Well
SOIL ABSORPTION SYSTEM
BD/TRENCH IMENSIONS Width ` Length~t No. Of Trenches PIT DjME~FSIQNS No. Oaf Inside D Liquid D~pkl~
D
SETBACK SYSTEM TO ~~//CC,_!/ P/L BLDG WELL LAK✓E//SSTAEAA\M LEACHING Manuf cturer: ~1/
INFORMATION
Ty Of System: CHAMBER OR T~In ( v-
kv""J L` r UNIT Mod N Amber:
f
DISTRIBUTION SYSTEM V ( Jr,,c/ ~'S• i y
Header/Manifold Distribution x Hole Size Ix Hole acing Vent to Airtn ke
[ y t I t Pipe(s)
Length F :;t Dia L Length \ Dia pacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over I Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center .7. Bed/Trench Edges ` Topsoil es L No es No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 200 STARR WOOD
d
1.) Alt BM Description = G ~,pv~ J<.
2.) Bldg sewer length = 3a~ fff~~~"~~~
- amount of cover = t
Plan revision Required? ❑ Yes o 1 ~
Use other side for additional informa . n. r'1 P~~
~
SBD-6710 (R.3/97) Date +Insepctor's i nature Cert. No.
_ y~?e~a p,~~ t
/ ~ COUnty
- Safety and Buildings Division St. Croix
0 ' 201 W. Washin t ve., O. Box 7162
" g Sanitary Permit Number (to be tilled in by Co.)
PS Madison, 1(fr","537 -71
ff 5g zz ~ 5
Sanitary Permit Application State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Na
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if dillei ent than mailing addro,s)
the Department of Safety and Professional Services. Personal information you provide may be used for seconda
purposes in accordance with the Privacy Law, s. 15.04(l )(tit), Stats. 200 Starr Wood Dr.
1. Application Infor n - Please Print All Information
Property Owner's Name Parcel f;
Patricia O'Connell 020-1374-05-000
Property Owner's Mailing Address Property Location
245 Starr Wood Dr. Govt. Lot
City, State Zip Code Phone Number NE SW Section 12
(circle one)
Hudson, WI 54016 ( ) '1, 29 N; R 20 E or w
IL Type of Building (check all that apply) Lot # - -
❑ 1 or 2 Family Dwelling - Number of Bedrooms 3 OS Subdivision Name 7I
Plat of Starr Wood
Block #
❑ Public/Coamtercial -Describe Use Na :6b
Cit) Of
❑
❑ State Owned -Describe Use CSM Number Village of
16 Na Town of' Hudson
Ill Type of Permit: (Check only one box on line A. Complete line B if applicable)
A" New S stem
y ❑ Replacement System ❑ 'freattnent/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B• ❑ Permit Renewal ❑ Permit Revision ❑ Chan Change of I lumber list Previous Permit Number and Date Issued
g ' ❑ Permit Transfer I New
Before Expiration Owner
IV. Type of POWTS System/Component/Device: (Check all that apply)
Non-Pressurized In-Ground 11 Pressurized In-Ground ❑ At-Grade ❑ Mound> 24 in. ofsuitablo soil ~IOLlnd < 24 in. of suitable soil
F1 Hold ng Tank Oth rr Dispersal Component (explain ❑ Pretreatment Device (explain)
V. Dis ersal/Trea ent Area Informatio . 451ifiltr or "Q 4 Plus" Standard chambers &_3 air end ca , Poly Lok PL-525 of tilT t f lter
Design Flow (gpd) Design Soil Application I ersal Area Required (sf) Dispersal Area Propose s System ovation
450 Gpd 0.50 Gpd/Sq. Ft. 900.00 sq. ft. 915.40 Sq. Ft. 90.00'
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o v
New "Ranks Existing Tanks
i
lb kSZ y~ =z
W u s
Septic or Holding Tank 1,000 1,000 1 Wieser Concrete X
I
Dosing Chamber
VIL Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plats.
Plumber's Name (Print) Plumber's Sigtature N'IRAIPRS Number Business Phone Number
Gary Zappa MFRS 222373
(715) 386-2850
Plumber's Address (Street, City, State, Zip Code)
715 6d' St. N, Hudson, WI 54016
VIII. Countv/De artment Use Only -
Approved ❑ D Permit Fee Dat Issued Issuin gent Signature
Ow iven Reason for Denial
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Attach to complete plans for the system and submit to the County only on paper not ss thaf 8 1/2 x 11 r •lies in size
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Conventional POWTS Index & Tilte Sheet
Project Name: O'Connell 3 Bedroom Conventional POWTS
Owners Name: Patricia O'Connell
Owner's adress: 245 Starr Wood Dr., Hudson, WI 54016
Site address: 200 Starr Wood Dr., Hudson, WI 54016
Project Location:
Subdivision: Lot 05, Plat of Starr Wood
Legal Description: NEv4SWv4, Sec. 12, T.29N., R. 20W., Tn of Hudson, St. Croix Co., Wl.
Parcel ID 020-1374-05-000
Page 1 Index and Title Sheet
Page 2 Site Plan
Page 3 Dispersal Cell Sizing & Infiltrator "Q-4" Chamber Cross Section
Page 4 System Cross Section
Page 5 Setpic Tank Cross Section
Page 6 Filter Specifications
Page 7 System Management Plan
Page 8 Septic Tank Maintenance Agreement
Page 9 Parcel Map
Page 10 Waranty Deed
Attachments: Soil Evaluation Report by Thompson
Soil Evaluation Report by Johnson
Mater Plumber Restricted Service: Gary Zappa, Dep't. of SPS Credential #222373
Signature: th Date:
Page I Of 10
Design pursuant to in-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/O1)
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O'CONNELL DISPERSAL CELL SIZING CALCULATIONS
1. (3bedrooms)(100gallons estimated flow)(1.5 design factor) = 450.00 Gpd design flm
2. Infiltrative capacity of native soil = 0.5 yd/sq. ft.
3. Absorption area required: 900.00 N. ft.
4. Absorption area as proposed: 915.60 N. ft. (45chambers total)
Infiltrator "Quick 4 Plus" = 20.00 sq.ft. EISA per chamber, "Quick 4 Plus" end cap/pair = 5.80 sq.ft. EISA
900.00 sq. ft. - (3 pair end caps)(5.20) = 884.40 sq. ft.
884.40 sq. ft./20.00 = 44.22 chambers required
Number of trenches: 3 chambers per trench (45channbers total)
Trench width: 2.83'
Trench length: 63.00'
Trench spacing: 9.00' on center
' Total system area w/ 9' center spacing: 21.00'x 63.00'
Quick4 Plus Standard Chamber
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EFFECTIVE LENGTH
Quick4 Plus All-in-One 12 Endcap
PRESSURIZED PIPE DRILL
POINTS LOCATIONS
(2 PLACES}
18"
Q 13'
8' INVEHT
33 I
FRONT VIEW SIDE VIEW
Pg. 3 of 10
Soil Absorption System Cross Section
97 5z-
9~.cn' ft 9G.sa'-
9 7-6v
ft
4" Schedule 40 Final Grade
PVC Vent Pipe
With Vent Cap '910 ft
Leaching
Chamber Sy, v f
System Elevation
3 ft G ft k
Soil Absorption System Plan View
ft
3 ft
ft Leaching Trench 1
Chambers
4" Dia.
Trench 2 Header
Vent Or Observation Pipe
Trench 3
Leaching Chamber Specifications
Manufacturer And Model
EISA Rating -A- - D sq ft per chamber Soil Application Rate ~•S gpd/sq ft
#/S0•0 gpd Design Flow 0. S Soil Application Rate - 2.0. o EISA = Chambers
3 rows of / chambers each.
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Technical ecific~atio s
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PL=525 E FLU NT FILTER ( ERCIA
- 6117 BALL CHECK
EKCEPTSa SHO40
FOR INLET EKItN➢i,N 111'$7 _ 14.35
OUTLET 90SNINGE%,EPis-.
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PL-525 FILTER HOUSING 1e34 ~ ~ "
PART N0. -30142-525
MATERIAL HOUSING - POLYPROPYLENE
OUTLET BUSHING-PVC
6.5 BALL -HDPE
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FOR H MOLE EATEN TIO'r 1064 _
530 OF 116' SLOTS .
617
I -SOCIITEXCEPTS 6.04950
Bkl PUSH ROD OPENING
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POLYLOK PL-525 FILTER
CARTRIDGE r
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PART NO.• 30141.525
rdATERlA1-POLYPROPYLENE
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Conventional Septic System Management Plan
Pursuant to SPS 338-3.54, Wis. Adm. Code
General
The conventional septic system shall be operated in accordance with SPS 382-381 Wis. Adm Code, and shall be niadntam d
in accordance Nyith component nktnual SBD-10705-P (N.01/01). All local and/or state rules pertaining to systeni
maintenance and maintenance reporting shall be complied With. Questions on the operation or inaintenancC 01,1110 s~ stun
sl ould be directed to the installing plumber. Gar' Zappa at (715) 386-2850 or the St. Croix (bunts Zoning Department at
(715) 386-1680.
Septic Tani:
Septic tank ser icing mechanics comply with SPS 383.5-4(1)(e). Septic tank to be located within 150 of serice pad. with
bottom of tank to be < 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall br
assessed at least once even, two years by inspection. The septic tank contents shall be remoyed when the sludge and scum in
the tank exceed 1/3 the liquid volume of the tank. The contents of the septic Link shall be disposed of in accordance with NR
I t3. Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.-48. Stats. If the contents of the tank are
not remoyed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be
needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessar' to
ensure proper operation. The filter canridge should not be removed unless provisions are inAc to retain solids in the tank
that may slough off the filter when removed from its enclosure. If the filter is equipped with aw alarm. the filter shad: 'Dc
serviced if the alarm is activated. Septic tank manholes risers, access risers. and covers should be inspected for water
tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the conlpiction 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 entr, into dic t_a.h
No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank
abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS
component. The addition of biological or chemical additives to enhance septic tank performance is general(, not icquuA il'
such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Building,
Division.
Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption s} stem The area abo\ e avid around the s\ stem should
be seeded and mulched as necessan to prevent erosion and provide some degree of frost protection. Traffic (other tlctn for
vegetative maintenance) o-\,er the system is to be avoided. Soil compaction niav hinder aeration of the infiltnuiy0 surface
within and above the system and will promote frost penetration during cold weather months. Gold ~v cathcr installations
(October-March) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BODS. 150 MG/L TSS. and 30 rug/L FOG. Influent llo~i not
exceed maximum design flow specified in the pernut for the installation.
Observation pipes Within the dispersal cell shall be checked for effluent ponding. Ponding IO\ cls shall be reported to the
owner. Levels above 4 inches indicate in impending hydraulic failure re1t uirill" additional. more frequent monitoring.
Effluent tloiy shall be alternated betwe dispe A cells on a two-year schedule b use of diversion vitlyc. Effluem to
be diverted from new cell to old Drainrfield at . anniversary of new systeni installation. Old drainfield to be ttlilized Cor
a 1 year period. Effluent dispersal to be ante 11ated between systems on a o year rotating basis tlicrcafter.
Contim.,ency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition. Excessive pending Ni ithin the dispersal cell will be eliminated by installing a ncii soil
absorption cell to bring the system into propel- operating condition.
Pg 7 01 1 u
ST. CROIY COUNTY
SEPTIC TANK 11AINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner: Buver Patricia O'Connell
Mailing Address 245 Starr Wood Dr., Hudson, Wl. 54016 _
Property Address 200 Starr Wood Dr., Hudson, Wl. 54016
(Verificauon requited from planning a Zoning Department for n,-w• ;orL uu:tion.
City State Parcel Identification Number 020-1374-05-000
LEGAL DESCRIPTION
Propem Location NE, SW , Sec. 12 , T 29 R20 W. Town of Hudson
Subdivision Plat:Starr Wood Lai ,t 05
Certified Survey Nap # Na Na _ T Na
Volume page
Warrant} Deed # (before 2oo)Voiurne Patt>z
~;+ec h,n::eOtesC}i,
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SYSTEM 1iIAiNTENAN E AND ON NER CERTIFICATION
Improper use and ina:crtclualce of, our septic s;em . autd resu:t ail Its }xena.uu c :i:a: r :o i&::IJh' `,past !'ropt r
mainteriance consist-, of'liu:np:ng out ;he septic tank et er. aucc , cars tx wa+cxc. I: needed. b, .i.eaed pumixt What , ou p.:t :ago
the S%Stem can aticct t!u liaict:on of Ulc scq,tlC t:til.:IS a CC:SnIIClit StagC I:: ;I:e Ndc:C ta5tV,~.li ~'Ctt: t iwI:eT inata;eG,I:i C
resporisibilities are specoicd ill FSl',;
The propen} owner agree, h+ submit to St Crm\ Count% Piammny& /,w.ng I el•.irn:erit a ce ttic::uon :i,nn. sIf cirJ : ti.c
owrhK and by a master plwnlx'r. Joutnc\ man plutnivr. resincted plunther or a l enw l puirpez rera% wl; tix , t i the on-six
wastewater disposal s.\ stem is in proper ohhramw condition and tit 12 r alter im pecl:oii a:id p,,anrn.g 11 nd a<a R the 5elHIC L'ilik 1
less thin 113 full of .'Judie
Ihw. the undersigned hire read the at,t1,C ie 1=011Cnt. ,tit! agree It) il;dt:!IJlfi the prlr.i:e +ew..ge J:sp,+s d system waiI Lix
standards set forth, herein, as.,ec lit tlw 1.),parrucut w.swm% 11iJ 1'ruti+,:.>::,1 5cn ices and the i3ei a: n ;eii; „f Na:ulal 3te;u lien;.
State of Wisconsin, Certiticaucin swung slut t otu septic ..:tent hat; been maintaincd must he. o:n,iletc d wk'. retunwd to the tit C ; t i
Ctiuntn• Plaruung & Z,)nlnE Depanment ntti n ?u dal s of the three t. car e\p:rauoit date
1/wc Certif% thai as siaterrivnis of This farin are true it) the bc+t of nwo :r 1.n„wledac :hW do+.4rC he of 0'1::
propcm' described abt,re. h% x irtue tit a arrant% deed recorded tl !register of Deeds Of Ice
'lumber ofbedroorin 3
~ tIGNATLRE O4~LICAA'N\T(S) DATE-
••*Am truoormation that is misrepresented ma%. result in the sanitary perrinit be tV re%olced b~ the 11imung.~ Zotung Dcpant:tcn:
include with this application a recorded warranty deal from the Register of Leeds Office and a coie of the certified sun•c,6 map I:
reference is made in the w•arrant% deed
(REV. 04112)
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S8s°33t)8'~ 822.0'I 192.57' 14x3.65` 94 P7 304
26377
3 XIMAjj_ LtNE
71, 768 SO FT
1.6Q ACRES 6
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71.519 SO FT 6
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70,101 SO FT 1.642 ACRES ~ 70.9W SO FT
1 ACRES ' 1 M ACRES
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181.31'
----182.76 -
N M4,or
STARR WOOD
585-43VM 364.0 l
141.66 - X41' Y .
Cl ~3 23 Ce as, 150 S(
+ 2 AREA W EASEMENT ~ 1 Sig AC
75,907 SO FT
1.743 ACRES 1
AREA ExC. EASEMENT 33 33
L) 6t064 SO FT
1.402 ACRES
Ngr41'4rE 338.76" I t E
PR3VATE ROAD EASE;irt NT T3r
°3 oew Sgr41°48 W 393.6T w
1X50 2$3.87 low w _ 1t{fGt} tiJ6`~
A0CESSNG LOTS 24 AND 25
N87`41'4erS 324.86 22 9
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AREA IN. EASEMEw . • .
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Wisconsin Department of Safety-ond P°tlofes6ional Services k 1E
Division of Industry Services Page 1 of 3
A
~ 51
, _ E ALUATION REPORT . LU i r
In accordance with SPS 385, Wis. Adm. Code Coup#WUNW
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must inc ll, ' St. Cr
l npmp
but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D.
scale or dimensions, north arrow, and location and distance to nearest road. Pcl #0 -1374-05-00 Ref#2466
Please print all information. Revi ed by D e
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). $ /7
L245 rty Owner Property Location
a O'Connell
Govt. Lot NE % SW % S 12 T 29 R 20 E (or) W
rty Owner's Mailing Address Lot # Block # Subd. Name or CSM#
arr Wood Dr. 05 na Plat of Starr Wood
City State Zip Code Phone Number
❑ City ❑ Village ®Town Nearest Road
Hudson WI 54016 ( ) Hudson Hwy 35
® New Construction Use: ❑ Residential/ Number of bedrooms 3 Code derived design flow rate 450 GPD
Ldeterminedd ent ❑ Public or commercial - Describe:
Glacial Outwash Flood Plan elevation if applicable na ft_
nts and recommendations: Site suitable for In-ground POWTS with 0.5 gpd/sq/ft. design loading rate. System infiltrative surface elevaton to be
me of system design. Horizons #4 & 5 of all p rofiles contain 1/2" - 2" bands of 7.5yr4/6 Ifs spaced at 5" - 12".
Boring # ❑ Boring
® Pit Ground surface elev. 97.08 ft. Depth to limiting factor >144" in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz
In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh.
*Eff#1 *Eff#2
1 0-7 10yr3/3 none Ifs 2fgr mvfr cs 2fm1c 0.5 1.0
2 7-21 10yr4/4 none gr Ifs Osg ml cw 2fmc 0.5 1.0
3 21-32 10ry4/4 none I's Osg ml cw 1fmc 0.5 1.0
4 32-106 10yr4/6 none fs Osg ml aw 1 vf,fm 0.5 1.0
5 106-144 10yr5/4 none s Osg ml
0.7 1.6
El Boring # ❑ Boring - J
® Pit Ground surface elev. 96.62 ft. Depth to limiting factor >136" in.
Soil Application Rate
M74 Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz
Munsell Qu. Az. Cont. Color Gr. Sz. Sh.
*Eff#1 *Eff#2
10yr3/3 none Ifs 2fgr mvfr cs 2fm1c 0.5 1.0
10yr4/4 none Ifs Osg ml cw 2fmc 0.5 1.0
7.Syr4/6 none grlfs Osg ml cw 1fmc 0.5 1.0
10yr4/6 none fs Osg ml gw 1 fmc 0.5 1.0
1Oyr5/4 none fs Osg ml cw
0.5 1.0
10yr3/6 none cos Osg ml 1
0.7 1.6
* Effluent #1 = BOD, > 30 220 m /L and TSS > 30:5 150 m /L E luent #2 = BOD 30 2 m /L and TSS > 30:5 150 m /L
CST Name (Please Print) Signat e ST Number
James K. Thompson L- 30021
Address Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020-5413 December 28, 2016 (715) 248-7767
SBD-8330 (R04/15)
Boring # ❑ Boring J f
® Pit Ground surface elev. 96.35 ft. Depth to limiting factor >141" in.
Soil fan Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots In. Munsell Qu. Az. Cont.
Color Gr. Sz. Sh.
*Ef1 0-6 10yr3/3 none
its 2fgr mvfr cw 2fm1c 0.5 2 6-21 10yr4/4 none Its Osg ml
gw 2fm1c 0.5 3 21-40 7.5yr4/6 none grlfs Osg ml cw 1fm 0.5 4 40-74 10yr4/4 none fs Osg ml cw
1vf 0.5 5 74-116 10yr5/4 none fs Osg ml aw
0.5 6 116-141 10yr3/6 none cos Osg mi
0.7 ❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. De
pth to limiting factor in.
Soil Ap lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz
In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh.
*Eff#1 *Eff#2
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2
In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh.
*Eff#1 *Eff#2
* Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30<_ 150 mg/L Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30:5 150 mg/L
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020- 13754 v.T- --c
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W&W partment of Cummerce SOIL AND SITE EVALUATION
fe ty and Buildings /
Bureau of Integrated Services in accordance with C Page ` of
is. Adm. Code
go
d
Attach complete site plan on paper not less than 8 1/2 x 11 inches in s~ plan must Co tY
include, but not limited to: vertical and horizontal reference point (Bkg,41 ection ar.@ - p~
percent slope, scale or dimensions, north arrow, and location and di t~e to nearest ro \ t
i
Parcel D. #
elo-13-0S J6 ZZ 7
APPLICANT INFORMATION - Please print all infor I ion.
Personal information you provide may be used for secondary purposes (Privacy~aw- s. 15.04 (1) (rn)Review d Date
Property Owner
Property' t of n
Govt. Lot _ LT? J 1/4,S ~Z T Z (,N,R E (or) W
Property Owner's Mailing Address
~ Blo Subd. Name or CSM#
<1~Ji A f~' tJ JL
City State Zip Code Phone Number
❑ City ❑ Vjllage Or Town Nearest Road _
New Construction Use: ® Residential / Number of bedrooms
Replacement Addition to existing building
❑ Public or commercial -Describe:
Code derived daily flow , 9Pd
Recommended design loading rate 0.. bed, gpd/ft2 O- trench, gpd/ft2
Absorption area required j~~_bed, ft2~trench, ft2
Maximum design loading rate 0 j bed, gpd/ft2 V. ,P trench, gpd/ft2
Recommended infiltration surface elevation(s)
ft (as referred to site plan benchmark)
Additional design/site considerations ~ ^ I L: ~ [~rJI- dry 00
j 1 P<) ,"If-
Parent material
Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In Ground Pressure AT Grade
System in Fill Holding Tank
U = Unsuitable for system S ❑ U S ❑ U ~ S El U ~S ❑ U
❑S WU ❑S OKU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles
in. Munsell Texture Structure Consistence Boundary Roots GPD/fit
Qu. Sz. Cont. Color Gr. Sz. Sh.
Bed ;Trench
A :A
el Ground D Z- 1 1 r ' ~1
e7,1ft.
Depth to
limiting
ctor
c~ in.
Remarks:
Boring #
,,AMA D
V Z 0 7
r {
0 -77 6
Ground lt-~vk J~
> 4f? Cam'
lev
~ft. 04 7-92, Al
Depth to
limiting
ciWr
> e in. Remarks:
CST Na p (Please Print) Signature
NAR YE , J6-u~ ~ Telephone No.
ill ~N : Z,
Adc"ss ~S 41 y
~ ~ ~ ,.w Date CST Number 7, Z--z -7S7
SOIL DESCRIPTION REPORT Page of
PROPERTY OWNER
PARCEL I.D.#
Mottles Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring # Horizon Depth Dominant Color 2
Z3 P, 5 (h
Ground 31%, 7,52 s C ; Q1 ,O
levy, J DY' S
ft3 i(4)i 414
IS6 T S
Depth to
limiting
~t3 in.
Remarks:
Boring # f A`►{~ 0A o
0-7 16-IR Ground
.elev.
ft.
Depth to
limiting
fAc r
' 1 ? in.
Remarks:
GPD/ft2
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Bed , Trench
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ? r
Boring #
r,5
Ground t~
lev
Depth to
limiting
factor
7V) in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBD-8330 (R.9/98)
"47
/~0 2T 1-t
1
CLL~I-9~•1 5L>~LC
I
I i EERY- 9~j N 10
3 _ , Euv-9t377
1
I~
I) ~ ~L~ 1 ~ /LX~ •00
' Parcel 020-1374-05-000 01/12/2005 08:18 AM
PAGE 1 OF 1
Alt. Parcel 12.29.20.2238 020 - TOWN OF HUDSON
Current ;X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): Current Owner
DEAN M TRUST ERICKSON ' ERICKSON, DEAN M TRUST
1221 MCKINLEY DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 200 STARR WOOD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.642 Plat: 2506-STARR WOOD LOTS 1/25'00
SEC 12 T29N R20W PT NE SW STARR WOOD LOT Block/Condo Bldg: LOT 05
5 1.642AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-29N-20W NE SW
Notes: Parcel History:
Date Doc # Vol/Page Type
09/13/2002 690200 1975/266 WD
09/13/2002 690199 1975/265 WD
09/13/2000 629835 1542/324 WD
08/18/2000 628460 8/5 PLAT
2004 SUMMARY Bill Fair Market Value: Assessed with:
50137 186,400
Valuations: Last Changed: 10/30/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.642 144,200 0 144,200 NO
Totals for 2004:
General Property 1.642 144,200 0 144,200
Woodland 0.000 0 0
Totals for 2003:
General Property 1.642 144,200 0 144,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00