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HomeMy WebLinkAbout020-1314-60-000 Wisconsin Department o €.Commerca. PRIVATE SEWAGE SYSTEM County: St. Croix ' Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420303 0 GENE 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: Duerst, Dennis I Hudson Township 020 - 1314 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: /00 Z 01 ,B T / ,lyw sys TANK INFORMATION tLEVATION DA A TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark V�� iS �—i h 0.OI //0 100.0 Dosing U Alt. BM STr Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATIO , St/Ht Outlet TANK TO P/L ' 4 �� L . QLDG. Vent to Air Intake Ot Inlet Septic ` Dt Bottom Dosing (/!� Header /Man. �S ,e Aeration DjsL Pipe 4 P 4 / S. srJ gg, fly io• o3 Holding y em / 9. q . /a.S/ - 2 Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand er GPM Model N tuber Q ift Friction Loss System Head TD Ft ain Length Dia. Dist. to We SOIL ABSORPTION SYSTEM BED /TRENCH Width ( 3 Length q / No. Of Tres PIT DIME NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 0 SETBACK SYSTEM TO P/L< BLDG WELL LAKE /STREA LEACHI G MayyfeBxu�y:� INFORMATION CHAMBE OR / Typ Syste � 0 >� > / / UN Model Number: DISTRIBUTION /V /T_ Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Int e t M Pipe(s) �� /40 Length Dia L Dia cing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only G+ N,(A) Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center BedlTrench Edges Topsoil Yes �] No Yes � No � COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: //t Inspection #2: Location: 754 Crosby Drive Hudson, WI 54016 ( W 1/4 NW 1/4 28 T29N R19W) St. Croix E / states of 6 � I, - Parcel No: 28.29.19.1592 1.) Alt BM Description = 6T, 5 '(� Y � �Li t! �'ktu . Cv4, 2.) Bldg sewer length = 7 A - amount of cover = 1;Tu,� I o-V � ' �jth T Ua� _ 7 Plan revision Required? :T Yes No 0 Use other side for additional information. �� Q . _. — _ '�"r SBD -6710 (R.3/97) Date Insepctor's Sign re Cert. o. s IWO V 00) lL IL 2pi W WuhirOm Am P.O. sm 71a S • 1bdb WI SM 7162 Sire Mom DOW 1M -.0 -Is smniateury Permit Application `' pump pmemser 3 3 Zo 0 le esnord wig t�ae>•II Ri21. �1ia, tied code. > • 1"�!_1!'°'i D Chock V RvVWco an b0 good for 0=06a Emm leer r side rlee LD. Ykeebar L Applks" 10 rsdiaa - �"faera TirLR Alt r --- -_---- r►epera aweera Pf t ; ? 0 1 2002 Pdo.l rl deer fir' Elweer't 14Wes Aftese ST. C; C I X 0 U ! 'Y P4" Loo160o 7(�ti,�_�� (', sw,<n►��sa�Ta �f. 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Pram situ sw Post rissfic am&= Oa00es dTaets coeowoe CaOartaeoed Cow HOW Rriraea Tab VII. & re for wYOMia.�.rai. t�oHYlls i0� w �e m e live a M.�ber &min= ploee Number `TLS -135 rkr mWs momik aq4 sow Zip Code) 't* A U 41 IU mo a 0 Died ' pee Garda in tl0osd0raaer Due Iraeed Wain � cDb snmrps) 0 Or m GWm bided Apse D.w:a�inrioe ML C:a odida.a of Appe for Disa�pavaa+ t �0 * - >-� S s : 1- S � aAA.a S o✓vld k Sao+ Sys � ae..Mr.lons )wrOie ■•• ..e ...s? I/ — o ��t'� 1 CO y \D-Q-Q%�!ks�'er's S w yY N w a4 T N P i 9u) ''S C M1 ' ��` �� e v�o mss lC� Lsr Ip W-Y S 01 tv o /-S r c "sib �1 /� apo&A ao - + 3I y -too - oo � At 7 y �- ��� 93 75 "�iL. a.�c537 7 -3 / - 0.2— 75 �o r. L i 1 f wV s �T a(i N Q I qu) 78 C ro- �n` uQ �� Q V`O i x � � 6 � � W. e� 0 1 (p /Z rc,m � m l�,,:�. 1 /� 1 WSJ a0 -too - vo � Y y 40 Ln CSt Ow l ♦ Q' `' as 7-ir �-� V ,55 -�� �7,T< � 3 75 /D r, i 3 i 1 Page 1 01 3 ==0 �,�e�suy ,) I L AND SITE E V A L U AT I O N R ' O RT a7+d ns o;v;s;oa safely ' & eut�nys in accord wi �LH l e. 05, Wis. Adm. Code COUNT(; - � r S�R s CL'Ol QS hC i' Attach complete site plan on per not less than 8 142 x 11 s i Plan must include. but ,��L I D ,tt not knuted to vertical and horizo reference point (BM), direction and y° of slope, scale w ndg dimensioned, north arrow, and location and distance to nearest road. IEV�Ep�Y i 7 APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION PROPERTY LOCATION FPR , RTY OWNER: GOVT. LOT SW 114 NW 'L8 "T2� �) W Rauchnot LOT tt BLOCK >f SUED. N *" \ RTY OVYNER�:S MAt+ - ING ADDRESS 6 na St. croi 1 Co. Rd . #W ILLAGE 3f01NN NEAREST ROAD TATE ZIP CODE PHONE NUMBER Crosby Dr. Hudson, WI. 54016 (715) 386 - 3052 Hudson Fderived uction Use j x] Residential / Number of bedrooms 3 [ 1 Addition to existing buildwt9 t 1 1 Public or commercial des cribe 450 Recorrtrtterlded design loading rate . 7 bed. gpdm2 .8 wench. gpyft2 ily flow gpd . 7 bed, gpoltt .6 trertdt. gpoltt Absorption area required 643 bed. n2 563 trench, ft Maximum design loading rate Recommended infiltration surface elevations) 101 .55 & 99.85 trench K (as referred to site plan benchmark) Additional design / site consideratim alt. area 99.35' & 9 ' Flood plain elevation, it applicable na It Parent material outwash taouNO Mi GROUN0 PRESSURE GRA AT•DE SYSTEM N FN L FIOLDrIG TANK S= Suitable for system coNVENT�NA� WS O U I Os ®U I ❑ S [� U U= Unsuitable for system ®S O U a S ❑ U cgs ❑ U SOIL DESCRIPTION REPORT I Structure � I B Roots GPD /ft Depth Dominant Color Mottles Texture Gr. Sz. Sh. [ :Bed Rrerch Boring # Horizon) in ! Munsell Qu• Sz Color 1 2msbk mfr 2f 1 —10 10yr3 /3 none 1 >< scl 2msbk mfr 2 0 -23 10yr4 /4 none 3 3 -31 7.5yr4/4 none sl 2msbk mfr gw na . 5 .6 Ground na na .7 .8 4 1 -88 7.5yr4/6 none co s Osg L04 tt. Depth to limiting factor +88 Remarks: Boring # sl 2mgr mfr I gW 2f • 5 •6 1 —12 10yr3 /3 none w, na na .7 .8 :<�::.,. >.., cos Osg ml 2 2 -88 7.5yr4/6 none Ground elev. 105 tt. Depth to limiting factor +88 Remarks: Plane: CST Name: — Please Remarks: terry L. Steel 715- 246 -6200 .,r CA/11 -7 PRMffrYOWNER . John Rauchnot SOIL DESCRIPTION REPORT �• PARCEL I.D.# pendin Page 2 0, g Boring# Horizon Depth Dominant { Mottles Structure GPD /ft in. Munsell t I p Sz Co I Texure I Gr. Sz. Sh. COQ n� (Roots 1 0 -10 10yr3 3 none sl Zmgr m r gw Bed iTrerxfi <> 2 10 -16 7.5yr4/6 none Is Osg mvfr gw if .7 .8 Ground 3 16 -84 7.5yr4/6 none cos Osg ml na na .7 .8 �y ev. 10 t. t Depth to R SS limiting faM „ 6 z Remarks: Boring # 1 0 -6 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 <' 4 <> 2 6 -19 10yr4 /4 none scl 2msbk mfr ' >< gw If .4 ? . 5 3 19 -27 7.5yr4/4 none sl 2m r mvfr Ground — gw na .5 .6 elev. 4 27 -80 7.5yr4/6 none cos Osg ml na na .7 .8 100 ft. Depth to —1 T liming 7 , +8011 Remarks: Boring # 1 0 -8 10yr3 /3 none ?<? 1 2msbk mfr gw 2f .5 .6 5! 2 8 -27 10yr4/4 none sic 2msbk mfr gw if .4 .5 3 27 -60 7.5 r4 4 Y none cos Osg Ground g na gw . .8 elev. 4 60 -80 7.5yr4/6 none 101 ft. S Osg ml na na .7 .8 Depth to liming , factor 97 Al + 80 Remarks: Boring # W Ground elev. ft. Depth to limiting faL'tor i Remarks: , S8D4k1MR.05M2) STEEL'S SOIL SERVICE 1554 200th Ave. Gary L. Steel John Rauchnot _ New Richmond, WI 54017 CSTM2298 SWkNWa S28- T29N -R19W (715) 246 -6200 MPRSW 3254 town of Hudson lot #5 -st. Croix Estates 1 =40' ELI.= top of 1" steel pipe @ el. 100' Alt. BI. =nail in Juniper tree @ el. 103.40' 1 k ,5 S� 9o` `U�ary L Steel n etter Way! D-e h n ;s r- C-1 ) k`Q f"5� .� Usel xr 76 u coca b,°�m mac . a � . SiCIC+Un ` Aftd1p • hftpVDVw p�a�ra 4%cr ;kk �°► ���'� f � vi des lective is t Ieacig std arrant maimed side Provide an o ce. Its desi "llary actin �nl t allow eff n bottom and hom ed by combinin irthe trS. 7 bis ha b SPEC, with g the a r ' h a series of tr adition a l L thut � ` ant - the louvers alo open 9th.......- -..75. , � m mAte unit along the full ! cham chamber Mows � un t he sides. ��.... 34� % 76� co , design 8th of mpen Hetht .... - Wider - lo ° mPaated �, i° ' efflueent oide. the l ouvers i �►vert....... . � Height .......... �g into the chamber. PrevenP ng' t POP" "' of a ' +rei t...._......6.5^ aw at 12- ®r f withstand H_ �i1ed h t 0 ver -20 f actors POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FN.E SYSUM SPScawcemoNS Owner N 1 Q S Septic Tank Capacity T, E3 NA Permit df 0 Septic Tank Mararfacttxer�0 ; rS ❑ NA DESM PARAMETERS Effluent Filter ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units W NA Pump Tank Capacity al ❑ NA Estimated flow (average) J bD Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 1�0 p g ailda Pump Manufacturer ❑ NA Soil Application Rate g audayew Pump Model ❑ NA Standard lnfluent/Efflrent Quality Monthly average Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG► S30 mg/L ❑ Sand /Graved Filter ❑ Peat Filter Biochemical Oxygen Demand (BODj 6220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids ITSS) 5150 mg/L ❑ Disinfection ❑ Om Pretreated Effluent Quality Monthly average Dispersal Ced(s) ❑ NA Biochemical Oxygen Demand (SOD.) 530 mg& 9 In- Ground Igravityl ❑ In- Ground (pressurized) Total Suspended Solids (TSS) S30 mg& ❑ NA O At -Grade ❑ Mound Fecal Coilfom ►geometric mean! 510 cfu/100ml ❑ Drip -Lie ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ JNAA Other: ❑ NA ❑ Other: ❑ NA * Values typical for domestic wastewater and serutic tank eftkient. Off: ❑ NA MAANCE SCHEDUL Service Event Serii1ce Fregsncy Inspect condition of tank(s) At least once every: rmo►th (s) (Maxtn wn 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -thkd 0Y 1 of tank volume ❑ NA Irmapect dispersal ceilis) At least once every: O nwnthls) yearfsi nMaxirnum 3 pm ❑ NA Clean eff bent filter At least once every: Z ❑ month(s) ❑ NA l s Inspect Pump, pump controls & alarm At least once every: 0 marls) ❑ NA Flush laterals and ❑ monthls) pressure test At least once every: ❑ earta) ❑ NA Other: At least once every: ❑ m onth( s) 1 ❑ ye ❑ NA Other: ❑ NA ft A DICE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following menses or certifications: Master Plumber, Master Plumber Restricted Sewer: POWTS Inspector: POWTS Maintainer; Septage Servieumg Operator. Tank inspections must include a visual inspection of the tanks) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sledge and scum and to check for any back up or pondang of effluent an the ground surface. The dispersal kelps) shall be viauapy inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponds ng of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third IY or more of the tank volume. the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. AN other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, mall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01! r FART UP AND OPERATiON P"s of For new construction, prior to use of the POWTS check treatment tankfs) for the presence of painting products or other chemical that may impede the treatment Process and /or damage the dispersal cell(s). If high concentrations are detected have the content of the tank(s) removed by a septage servicing operator prior to use. System strut up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal h' discharged to the dispersal cells! in one u�water lauds. When Power is restored the excess wastewater will b lar dose overloading erloadin the cell(s) g and may result in the backup or surface discharge o effluent. To avoid this situation have the contents of the power to the effluent Pump tank removed by a Sept Servicing Operator prior to re storin( Pump or contact a Plumber or POWTS Maintainer to assist in manually wally operating the pump control tc restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the arw within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and POWTS: antibiotics, baby wipes; cigarette butts; condoms; cotton swabs; de greasers; dental floss; diapers; the life pers; disinfectants; s; at; foundation drain (sum fat; P Pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall tie taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. Fb The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installers as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name fl Phone S �O J i� Pho SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name %. Name ro 2 :0 t Phone // Phone 3E 6 This document was drafted in canpHance with chapter Comm 83.22(2)(b)f1)(d) &(f) and 83.540), f2) & (3), Wisconsin Administrative Code. a ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address _� ��{ ��I- c- ,S�,� � L' { „ Co � j �U 0 Property Address (Verification required from hanning Department for new construction) City /State S Parcel Identification Number an — _ Coo - oo 'c> LEGAL DESCRIPTION Property Location SU.3 %., Nw %., Sec. T N -R L9 W, Town of 14 S,Z4 . Subdivision , Lot # L Certified Survey Map # Volume , Page # Warranty Deed # Volume , Page # Spec house ❑ yes A no Lot lines identifiable yes ❑ no _SYSTEM MAINTENANCE Improper use and mainteru �annecof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. 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, restrictedplumber or a licensed pumper verifying that (1) the on -site arastewraterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if nccessary� the septic tank is less than 1/3 fidt of sludge. I/wc, 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 Deparhnent of Commerce and the Department of Natural Resources, State of Wisconsin Certificatibn statin that your tic system has been maintained must be completed and returned to the St. Croix County Zoning Off= within 30 da the three expirati to i A / 4 SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I .(we) c that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of X tSIGAC escri a bove, by vi of a warranty deed recorded in Register of Deeds Office. OF 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 the Register of Deeds office a copy of the certified survey map if reference is made in the warranty decd %JAN. ?3.2000. 7 � 2 c 8A n M ;M COMPANYal PO y'�. 6315 P. 2_ 5WJL0 ( ry STATE SM OP ONSW FORM 3 —1i82 WARRANTY DEED DOCUL&W NO. J, f'�3f3TEt"3 CSFFIG'� ,4 yer J oint Ventura a Wisconsin p artnorshIp gt C" CA.m itaeylriwat MAY, 2 9 Ifni. (cmae�c EOd avlanu to Dennis P. Tst Loi■ F. Doerlt. marital property ,� hu ■ban�eld wifa re ■urvivo.T 1P A.ahsE.r.tDeB�It T+a BRACE a Mamo MR N?OQM*4 DATA W W MO RBTYRN ADeafeT the fotiow�km desenW rtal eftw in St. Croix t ewuy Sum d vrbwasln: VA PARGIL INIt� � tI1�AN � R►��� KENW win oo _ Lot Six (6) of St. Croix Estates in tha Township of Hudson, St. Croix County, Wi■eonsin. i m* htlsneateaa ptopeny. ; na) f1on to teanaRUits: h Dard 27th May A n • al L. e c (BEAU �a Michael R. Stol Sts AUTHENTICATION ACKNOWLEDGMENT Sllaatuaef0 State of Wisconsin, H, m St. Croix Cam% ■hoockmd this �Ppf— l9 PeaauQy nme boo VA Ihb —_27th d� o f Kai 19—U—. tits above kA* ad _ ■ 4nd lon4d. L. glgrl k As o artnlra Of Willow River joint Venter TITLE: kempa SPATE OARoF wiScmm _a Wi■coneln partnership (v m. authodmed by 1 7 00A, vv, Sul&) to tat kn9yo to be die peram a who exscnkd chi &MtRck1E wom and t he same. TFRa IafTRU4CNT WAB DWTED aY P. 0. Sox A • Sal, Mai Nmy PLOePQBI■ of YYIhr�Rlso _.Le— Q�wt.�..,,,1 •T K6A19 NaaryPnbbe. St. Cto _ CamgcVAL Mrawn my b +auheatkhued or adavwkjpd loth at m My —= d- Is Wrmaaem. (if nm, state aptat" &lr. hEroesaT}) 19 99 ) I •Ma•T KPeaans saalsR ha �. e�ay R�outd ry Mtd w seessi 6slan thew+tytva .: ""'�'�`�`�- , •ARaANTY plZeO STATE aAt pi w7EQQr1Elr1 WgpW Law a "p Nhha NI. ] - ITe� Me7Na WA ST CROIX ESTATES of is• 29'j . nl;18.3r •w.• . , , \ ♦ . �� Qfl1H L*JBibF E $W -UA'CF THdWW W4 OF se ki�' . t • �••!- �~ _..t v.• `. ..r- �_` � O tt. 'y ..r._. �.�- � 1 \ , �,1 \ � / j `;�� f �,.� 1 _1•'' it , 911.2 y v f � 91x r. \...� ._•.•, 1 � -a Hw . • = ''' �1`�•��`.•, ••w` '1 't ' r•• \ t t ..� - ..� �• � - t � i.: ��.�.� , � • — , � = , o � t , 1 ti ; . •:.s• �, • ' l� /• � ' ij�# � t � o- 1 •' , }P• i f `•,�`e ;,r� \���rt,. °•! �. —�� : j /� / . fi r t lO.•� � l.+ // i''1 ?'.' �" 1 °� t 1 1 r �•�' t s t •t � 1 1 / � � ...y •. i, y .r f f : ... �h ` t � v It Uc.l 1 {} ( �r�; ! i 4 i ! � + s. �. cM + M � '� „ •' �• "^•tip'`• _ i /'I .i. `,,, 1 `•, . �• ••� 1 . -'A• �' t � ' �. : r >..v S � 2 1 r , /" 3 i ( •� t . { � f , :. 1 • 1 ti + � � f} :1 ,' l .i.. ~ t , � 1 •• •� ,�' : I . t $ : ! 4 r.a o :7 a / \ ` ` •� t W •� ♦ �' sw t zi B J= t1 i IN R S2J�r ' x �..?]S; 1,i� t �_ ' ' t • • ''- • 2 �' 9 • =tt 4., h a Mi 9 It .t 1 ' S - • t - - 1 • t lo O� `\ 148.6 - - -ago° - -CRC 3g' 0 0 M \$ g o o DED I C Al 5 147 0 N06' M — in \200 \ ro M � f m r 0 M h N � N � N " tD a N h �D U Q N �• N LL N i p� d W cV In O fo N Q N ap Nm N � ^ �►J g m w� h N p � Z U N — to a Z C1 t f� tD g N N f N 339.70' 289.99' 195.00' N00 0 09'22 "W 1325 .77' WEST LINE OF THE NWI / UNPL-A T i cL L/a^JLr.",\S EASEMENT LINES (BEARING & DISTANCES. S00 °01 "_6'W .83.33' 3 N66 °:2'54 "E X5.59 E N89 °58'44'W 95.00' S00 °01'i6 "w 446.5:' C S42 ° 11'41 "W :63.5s' M 300 1 35'42 "W .5.Z4 D S07 °57'36'E 158.73 N N89 0 47'16 "E 60.00' F 300 0 01'16 "W 219.22' 417 - E '12.06 N11 ° li'35 "H '.82.74' p S22'19'1. 9"E 202.94' N71 1 11'35 "E 42.226' Q S03 207.0" S81 ° 19'55 "E 74.95 M S83 A7 30' 300 "N 233.74 N05 ° 26'27 "W 204.31 N66 0 12 1 04'6 4;_72 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15. ( 353295 Permit Holder's Name: ❑ City ❑ Village ❑ Tbwn of: State Plan ID No.: Duerst Dennis I Hudson Township CST BM Elev.:- Insp. BM Elev.: zDescription: Parcel Tax No.: ( " � 020 - 1314 -60 -000 TANK INFORMATION 1 0 ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic s `Z� Benchmark 1G.1 Ib.lo� .o / Dosing Alt. BM l �o I t. 20 Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet 1. 2- 1 01. og' TANK TO P / L WELL BLDG. Air I ntake ROAD Dt Inlet Air Septic 9 r ti (� g NA Dt Bottom V Dosing NA Header/ Man. Aeration NA la., 3, ( 102 Holding Bot. System le ' t s 2 PUMP/ SIPHON INFORMATION Final Grade 1I. � L W M facturer Dem d St cover �o.q2 Model N er - G M TDH Lift L S stem TD Ft gad Forcemain Length Dia. Dist. To Well SOIL ABS PTION SYSTEM Ck 2 C k , BEW& TRIENCH Width r Length PIT No. Of Pits Inside Dia. Liquid Depth IM S No T nches DIMENSION SYSTEM TO P/L I BLDG WELL LAKE /STREAM LEACHING Manu ur r: , SETBACK CHAMBER Al • INFORMATION S a��' � � 0 ' OR UNIT Mo el Num er, S l Z `I ' C c DISTRIBUTION SYSTEM Header/ Mani old Distribution Pipe(s) x Hole Size x Hole Spacing Vent TP Air Intake Length Dia. __ I `+ + 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/Tr nch Center Bed/ Trench Edges Topsoil I ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:06 /01 /0D Inspection #2: L - Location: 754 Crosby Drive, Hudson, WI 54016 (SW 1/4 NW 1/4 28 T29N R19W) - 28.29.19.1592 St. Croix Estates -Lot 6 1.) Alt BM Description 2.) Bldg sewer length= 20 - amount of cover = V? + Sal "w Plan revision required? ❑ Yes ® No Use other side for additional information. 6(0 1 -2 t I oD I L, SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ` SANITARY PERMIT NUMBER: i m � .....�� 1 Safety and Buildings Division r `�SCO/1S %/1 SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County s ,� than 81/2 x 11 inches in size. M • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes s3 ❑ Chec If revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N ProperlxOwner Name Propert Location P, w 1/4 W 1 /4, S a , N, R I C1 *$r) W Prop@rty Own,r's M fling Addr ss Lot Number Block Number City, St to Zip Code Phone Number Su�di�ision N me or CSMb r o rY1 N SSl ( > 1 II. TYPE OF B IL ING: (check one) ❑ State Owned it Nearest Road I V Ej Village Public 1 or 2 Family Dwelling - No. of bedrooms own OF 14 jcnr% III BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) O ao -13 ►A4 -too - o0 c) 1 ❑ Apartment/ Condo ?-Q - Z-43 - 1 • 15 g v" 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3, ❑ Replacement of 4_ ❑ Reconnection of 5, ❑ Repair of an System ________ System _____________ Tank Only______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 RSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill 2- • U VI. ABSORPTION SYSTE INFORMATION: 1. Gal Ioris Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade 6 r Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 104 Ss Elevation 00 -5 g 99 29 Feet XDy, Feet VII. TANK Cap g aclt Site in llons Total # of Prefab. Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App N ew Existin structed Tanks Tanks Septic Tank or Holding Tank j .Q 16 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Prin PI tier's S nat a (No Stamps) MP /MPRSW No.: Business Phone Number: Q, r a�o "Ins a s� as Plumber's A ddress (Stree 11 1ateff ip Code): O V tVqAA-) fkAMnf\�. UL IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Surcharge Fee) IRApproved ❑ Owner Given Initial Adverse Determination -s.� Z!-Z= X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS > 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the countyprior to installation 5. Onsite sewage systems mustbe properly maintained. The septic tank(s) must be pump - edbya licensed pur peYwlhenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage systern, contact your local code administrator or the State of Wisconsin, Safety andBuiWings Division, •688 - 266 - 3151. - To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. s v X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, k5cafi6n of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. --------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. plot p pu: '.s 5 A) w �1 � s _ .� a ,� � � ? 9 N / 2 _ r _� l.orvV�1�..__ T� O-re .x --� l a t 7 G _ ,�_1�or+n__:_ ?p / "s i° �! /�' 1'Q� CP -r3J -tfl� _ o00 SL Xx0,537 b r �.0 . !$ ` | E - .f E � � ' 2# \ . mn em E c c _0 k 0 0 . c % \ ( !� . ■ % cx o ■; — – � co _ 7 (D f\ / k ¢ � ■ 01 � 7 i | G |\ a g - e ! / j _ q «j M . |§ t( � \ 9 | 7 a ? O ro 0. s « ��� c !c � R @ 2 =C, m 7 /(D G CD � p CL ! x 0 g B F 3 c R 0 c o �7 ® . f m o m 0 0 C, 0 g 2 k -0 m 2 $ .2 -0 ■@ \.0 R $ m m @ �k � � Q x . � CD � � A � � C: -4 . B n o V 3 : 07 7 0 R � m @ x 7 � ® , §_ U) = | 0 �� | (0 0 3 , �% c cD ] ` invert 11 | CD . , co | o � | ■ dr�scir`,;t: Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 =r and Human Relations Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code CO c - Croi Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and /o of slope, scale or ' dimensioned, north arrow, and location and distance to nearest road. r�L endin g APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION IEW Y' D I 2tran PROPERTY OWNER: PROPERTY LOCATION ' �;CAUNTY John Rauchnot GOVT. LOT SW v4 NW or) W PROPERTY OWNERS MA!I.ING ADDRESS LOT # I BLOCK # I SUBD. NAMtQ Gt � 527 Co. Rd. #W 6 na St. croi t'a CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE MOWN NEAREST ROAD Hudson, WI. 54016 (715) 386 -3052 Hudson I.Cro Qr. [ :4 New Construction Use (xj Residential / Number of bedrooms 3 ( J Addition to existing building I Replacement [ ] Public or commercial describe Code derived daily flow 450 an d Recommended design loading rate • 7 bed, gpd/ft .8 trench, gpd/ft Absorption area required 643 bed, ft2 563 trench, ft Maximum design loading rate . 7 bed, gpd/ft .8 trench, gpd/ft Recommended infiltration surface elevation(s) 101. .55 & 99.85 trench ft (as referred to site plan benchmark) Additional design/ site considerations — alt. area 99.35' & 97.95' Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL 111, IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system ®S ❑ U I f3 S ❑ U CA C] U ® S ❑ U ❑ S ® U ❑ S [RU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Cu. Sz. Cont Color Gr. Sz. Sh. Bed !Trench 1 -10 10yr3 /3 none 1 2msbk mfr cfw 2f .5 .6 BMW 2 0 -23 10yr4 /4 none scl 2msbk mfr gw if .4 .5 Ground 3 3 -31 7.5yr4/4 none sl 2msbk mfr gw na .5 .6 14 0 715 4 1 -88 7.5yr4/6 none co s Osg ml na na .7 .8 ft. Depth to limiting factor . +88 Remarks: Boring # 1 -12 10yr3 /3 none sl 2mgr mfr gw 2f .5 .6 2 2 -88 7.5yr4/6 none co s Osg ml na na .7 .8 2 Ground elev. 105 ft, Depth to limiting o factor +88 77 -�2 �e Remarks: CST Name:— Piease Print Gary L. Steel Phone' 715- 246 -6200 Add ress: 1554 2 th. Ave., New Pichmond, WI. 54017 Sgnature: Date: CSTN er. 11 -3 -95 c Ob PROPERTY OWNER John Rauchnot SOIL DESCRIPTION REPORT Page 2 of _,2 ,PARCEL I.D. # pending Boring # Horizon Depth Dominant Color Mottles I Texture Structure Consistence (Boundary I Roots GPD/ft in. Munsell Gnu. Sz. Cont. Color Gr. Sz. Sh. Bed iTrench ..' 1 0 -10 10yr3 3 none sl mgr m r gw Zr 2 10 -16 7.5yr4/6 none is Osg ravfr gw if .7 ;.8 Ground 3 16 -84 7.5yr4/6 none co s Osg ml na na .7 .8 elev. 10 2 . 8 5 ft. Depth to 99 limiting factor 36 Z +84" Remarks: Boring # 1 0 -6 10yr3 /3 none 1 2msbk mfr gw 2f .5 :.6 4 2 6 -19 10yr4 /4 none scl 2msbk mfr gw if .4 !.5 3 19 -27 7.5 y r4/4 none sl 2mgr mvfr gw na .5 .6 Ground elev, 4 27 -80 7.5yr4/6 none co s Osg ml na na .7 .8 100 ft. Depth to limiting factor + 80 Remarks: Boring # 1 0 -8 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 5 2 8 -27 10yr4 /4 none sici 2msbk mfr gw if .4 .5 x....... 3 27 -60 7.5yr4/4 none cos Osg ml gw na .7 .8 Ground elev. 4 60 -80 7.5yr4/6 none S Osg ml na na .7 !.8 101 ft. Depth to limiting factor +80 Remarks: Boring # vY %•i4 +: ?•i: iii: Ground elev. ft. Depth to limiting factor i Remarks: SBD- 8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel ,john Rauchnot _ 1554 200th Ave. CSTM2298 SW4NW4 S28- T29N -R19w New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246 -6200 lot #6 -St. Croix Estates i 1 =40' ABM.= top of 1 steel pipe C el. 100' -'Alt. BM. =nail in Juniper tree @ el. 103.40' O A i v\ S► 8' A aryl Steel 11 -3 -95 ' ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer PVtER -ST' Mailing Address 4 S ` 00 o f •� N Property Address GtioS , kn4 O 5 a r-L, VJ'z .s 4 01 to (Verification required from Planning Department for new construction) o ZA - 13I 4- (oo —eat City /State Parcel Identification Number L8 . Zq , I q , 154 L LEGAL DESCRIPTION Property Location 5W '/,, 1 "' W '/., Sec. Zb . T L N -R 19 W, Town of H DS a t Subdivision :' r. ' CAO t x Lot # Certified Survey Map # . Volume , Page # Warranty Deed # rytoa 101 Volume 1 �-4L . Page # 1 Spec house O yes Xno Lot lines identifiableXyes 0 no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and' by a masterplumber, journeymanpl*nber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification . stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three yearpration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p operty described abp�e, by irtue of a warranty deed recorded in Register of Deeds Office. '' �Z� SIGNATURE OF 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 the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed JAN. ?3. 20G0 7. 28AM 0 JM COMPANY NO, 63 i P� 2_ 560147 STATE BAR OF W !;C0NS11s FORM 1- 1982 WARRANTY DIED DOCUMENT W. Yt._3f3TE1, 3 OMCE wiilotr Oval Joint V■nture, a Wiseoneia partnershi ! ST. Cr'm M.m IeAYistllFlEe ' MAY, 2 g 1`�7. 1"a Rnd warnnn to DenAi9 P. 4u-erat and Lois F. Duarlt, _ ,� 11 :15 ". A husband and wiis, rr ■urvivor>E ip }marital proporCY Gat �15 A R.persFDssM + �If PACE I INEIIYED F011 11iQpl16WD pAA yAM MO RETURN ADRIIHS the (Dilowina desmw taal acute In St • Croix county Snw of vruconstn ��Sp0 � N{iDSOK i; - �D- i3ia- bo-000 FARCB Lot Six (6) of St. Croix Estatae in the Tmmahip of Hudson, St. Croix County, 7i Wisconsin. Tlw not h—ad propeny. (W fk taJ I ' F�toeplloa w warranties: �I Dwed rhlE dly o( - may .. A n w47 (1FA1J (SEAL) al L. e C (SEAL) FEU 1 ` Michael 1t, Stsysn>s AUTHENTICATION ACKNOWLEDGMENT J StgnaluRKil Sett: of Wleconefn, 1 St. Croix �„ !+ autheaticRxd this by of 19 PomantAy nine before Rw this _27th Opy of may 19_.2;_, du above Rataed ltichaol R. SC*Z And 19111414 L. Dejric ARR,artners of Willow River Joint Ventur TITLE: MEMDER STATE BAR OF w15CONSIN A Hisgansin nartnerahio (Y not, auLhodzed by 1706.04, w■. Ststs.) w the bwAr to bt the pawn a who vxs uW the (meoft inuru and wkvwWw the sRlnt THIS INSTRUY6NY WAS DRAFTED aY Hil�os,+ jXar Jo t Venture - 1 ftmftkX'n- P. 0 . >lox A • NoWy �b�iim of YYlsoorwwrt b "' D !.A- uT 5AA17 Notarypubbe. St. Cro COMrI+)Gww ($'VGCuns may b &4ARtlesad or eckno kdpd, Roth arc lux My commi>ision Is (xrmantat. (if not, state exptntfon dac to ys I NATO of pdmas $VIP In *ny r+1lickY by ;;O or ar that ftmtMKf. • • • ; - - - �: WARRANTY aLTD STATE aAR pF.A " SIN MhemW LpY■W. h,,,y, Rem Ne. 2 - wa ,Ay r r • ST CROIS ESTATES • `� ���� {11 {� \r.• ♦ �\ •,.: � X,0•11 I { 'II 1 1 I' S \,\�. •.• �� 1{ RTH LIN 11. 25' 26' E' , p1�10.]2' r ?r•.1� `. 1 V ►j 1 l ! 1 1 \\ ' `� \ ♦ ♦, p&OF T (IE SWAJA OF. THE'NW IN OF SE TON 20 L , ^ \• \,\ ` � , •�• v . , i • l 921., y �i �.S. i.l• 1.1 S � . / 1 til �i. . \ `�`\ - � i � �• . .�--� .� -`� � \ `, t sae. � !,•` `. � � I I I f I , 11.7 y ! I ; • �_`il' �i i I % ♦'�'� � ' •1 ' i - � t t 1 ; i Q. � ) ` ' � �1 1 ; � ' � ►� 1 .` � 1 . � + �, � p� -'� li.l yt ' 1 ' 1* •. •., ��.. (`� I 1' • ',. 1 ♦• w ?` •• •• : }, >� '• � �' r•1 % ! 7'~ 1 /,' ) I,�z'r� \ T � t. 4 :.} 1 • , 1•• 7, x , j J �•t i I � S. fl. k!' 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