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HomeMy WebLinkAbout020-1139-10-000Wisconsinbepartment of commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Johnson, James R.& Jean I Hudson, Town of CST BM Elev: Insp. BM Elev: Description: 9$, (,o BM G - ) c sr' TANK INFORMATION IT TYPE MANUFACTURER rAf CAPACITY Septic / ROAD E;a aim 7 Z i�ara#+er�- F • � 11.a.v Forcemain Length Holding -7 � 29.29.19.702 TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic iaoo 7 System Head TDH Ft Forcemain Length Dosing -7 � 29.29.19.702 J 'NFORMATION Type Of Syste 6ty Aeration / � � St/Ht Inlet CHAMBER OR UNIT Model Number: � 4 ki Holding St/Ht Outlet T o 7 9 , PUMP /SIPHON INFORMATION Manufacturer St. Croix Demand GPM Model N er ELEV. TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: FS ELEV. 515164 0 State Plan ID No: 162.3 Parcel Tax No: SETBACK Alt. BM 020 - 1139 -10 -000 Section/Town /Range /Map No: J 29.29.19.702 STATION BS HI FS ELEV. Benchmark 1 3.7 162.3 Liquid Depth ` SETBACK Alt. BM P/L BLDG WELL J LEACHING Bldg. Sewer 'NFORMATION Type Of Syste 6ty � � / � � St/Ht Inlet CHAMBER OR UNIT Model Number: � 4 ki St/Ht Outlet T o 7 9 , et 2-b 1 (o r `��i• Z 261� Header /Man. Dist. Pipe 9` ` Bot. System 01-1 13 Final Grade 1 3. 1 St Cover 1 2-3 2 •. G w� iJ 0 1 3.1 Tz. 9yt y2• BED /TRENCH DIMENSIONS Width Length 6' 9;!� No. Of Trenches ? T ,7 Vent to Air Intake PIT DIMENSIONS `. No. Of Pits �-- Inside Dia. `-- Liquid Depth ` SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer�4 r ^ 'NFORMATION Type Of Syste 6ty � � / � � � /t /�- CHAMBER OR UNIT Model Number: � 4 ki nISTRIRUTION SYSTEM L GsJ_ "- I Header /Md fold.4 �, Distribution Ws) x Hole Size x Hole Spacing Vent to Air Intake Length 1 Dia Length � Dia Spacing xx Mulched Bed/Trench Edges ` Topsoil \ Snll_ COVFR v Procceira Rvctamc r)nly YY Mnnnd nr At Svstems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded I xx Mulched Bed/Trench Center Bed/Trench Edges ` Topsoil \ Yes 0 No 1 S .1 yes [T] No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / /. Location: 737 Gherty Lane Hudson, WI 54016 (NE 1/4 NW 1/4 29 T29N R1 9W) / Gherty's // Addition Lot 1 BIk4 n Parcel No: 2 1.) Alt BM Description = ZJ6 (,DJtA- �Z (_o�1tr6 (.✓� /�.� �q A&Zk - Q7\ 2.) Bldg sewer length = e +>{ . 2(4 1 - amount of cover = Plan revision Required? El Yes kNo Use other side for additional information. SBD -6710 (R.3197) r Date Inse tor's 4t., �s Cor✓Iw d Ci s 'A6#4a Cert. No. Safety and Buildings Division 7 t 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707-7162 Sanitary ark Number (to be Sanitary Permit Application AM - In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project �(ifdifferentthanmat� address) submitted to the Department of Commerce. Personal information you provide may be used for secondary 17 77 ((//�71)'s a in accordance with the Privacy i..aw. s. 19. 1 m , Stats. I. cation Information - Plea Print All InfOrma Property Owner's Nam RECEIVED Parcel # G a o- U34 -1D _moo Property owner's Mailin Address OCT 0 9 2009 Property Location 70 Z f -) Govt. Lot City, State Zip Code PhoneWwaber;in �UUN i Y _ y ,, � PLANNING &ZONING OFFICE k LA__) '1 ! T a R E Type of Building (check all that apply) I Subdivision Name 11 or 2 Family Dwelling- Number of Bedrooms Block ❑ Public/Commercial - Describe Use ' �` ❑ City of i CSM Number ❑ Village of ❑ State Owned - Describe Use own of 3 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ❑ New System ement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explam) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permjt Revision ❑ Change of Plumber 11 Permit Transfer to New Before Expiration IV a of POWTS S tem/Coni nent/Device: Check all that apply) S n- Pressurized In- Ground ❑ Pd sunned In- Ground ❑ At -Grade [I Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Other isp�llComponent (explain) ❑ Pretreatment Device (explain) V. Dig rul/Treatment Area Infbrmation: ti Design Flow (gpd) Design Soil Application Dispersal Area Requited Dispersal Area Pro A S tam Etev VI. Tank Info Capacity in Total # of Man ac E Gallons Gallons Units New Tanks Existing Tanks (r(�t� / _ N o Septic or Holding Tank Dosing Chamber VII. Responsibility Sta t- I the undersigned, assn a aslbility for Installation of the POWTS shown on the attached plans. Plumber's Narne (PriAt) Plumber' ature MP/IvIPRS Number Business Phone Number Plumber's Address (Street, City, State,! ip Code) ' _- ti / artment Use OY11 Permit Fee Date I ued Issuin t Signature Arsappro $ A 175 , 04> A �Z ven Reason fo ial IX. Conditifns for Disapproval O� 1. Septic tank, effluent filter and dispersal cell must all be services/ maintained as per management plan provided by plumber. 2. AM setback requirements must be maintained a system and submit to the Coaaty only on paper not less than 8 to Ill inches in size SBD -6398 (R. 01/07) Valid thm 01/09 PL PLAN PROJECT James Johnson DDRESs 737 Ghertv Lane Hudson Wi 54016 SE 1/4 NW 1 /4s 29 /T 29 R 19 TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/7/09 BEDROOM 4 CONVENTIONAL XXX IN -GROU D RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/261 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 45 kk BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Plans Designed Using Conventional Powts Manual Version 2.0 SYSTEM ELEVATION 93.0/92.8/92.6 6' below grade @ B -1 Scale is 1" = 40 Old 12 X 24' unless otherwise X din Vent noted >6„ Leaching Chamber Quick4 Standard -W of Cover with 20.0 ft2 of Area 5.8ft ^2 /pair of end caps 4' Long 12" Grade at System Elevation 34" :1 5'_ _ 30' 0' Weeks 261 20' WN 2% Slope Vents B -2 99' Gherty Lane `- � 98 \3-3' cells with >3' spacing !�7CopY M1 Existing 4 Bedroom House 10' Gherty Lane PL PLAN PROJECT James Johnson j DRESS 737 Ghertv Lane Hudson Wi 54016 SE 1/4 NW 1/4s 29 /T 29 R 19 TOWN Hudson COUNTY ST. CROIX 10/7/09 BEDROOM 4 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN -GROU D RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/261 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 45 BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Plans Designed Using Conventional Powts Manual Version 2.0 *440 /0 80' JV 10' B- 65' 2% SloZB- e \ Gherty Lane Vent 5'_ , 30' 0' Weeks 261 20 98' 3 -3' X 62' cells with >3' spacing Existing 4 Bedroom House .. 10' Gherty Lane SYSTEM ELEVATION 93.0/92.8/92.6 6' below grade @ B -1 Scale is 1" = 40 Old 12' X 24' unless otherwise drainfield Vent failed noted >6„ Leaching Chamber Quick4 Standard -W of Cover with 20.0 ft2 of Area 5.8ft ^2 /pair of end caps 4' Long 12" Grade at System Elevation 34" WEII Vents V A-1 j Wisconsin Department of Commerce SOIL EVALUATION REPORT 'b page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ,� 1 , � Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County f o T include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 Z 0 • 11 3 7 Please print all information. Revie by Date Personal information you provide may be used for secondary purpose s (t) (m)). Z O Property Owner Location ,Toh .Lot C 1/44/ 4 S ,T N R/ E( W Property Owner's Mailing Address Block # S . Name or CSM# e f SI UN%)1^ vuw 1 Y I 6,4 City State Zip We Phone Nu C] Village Nearest Road bA -✓ /-,--, /O ❑ New Construction UsgDSI Residential / Number of bedrooms �_ Code derived design flow rate r-7 !Tl> GPD 4 Replacement ❑Pub' or commercial - Describe: Parent material Flood Plain elevation if applicable General comments 9 Bel ,J g, 6 Z3 —r and recommendations: System Type G 4 J � System Elevation "' /?3 y 0] a Boring # Boring C g , CCU y Pit Ground surface elev. ft. Depth to limiting factor Soil Aooliration Rate © s ... a C C olor Ong # ❑ Boring � ® 0- Pit Ground surfs elev./ + ft. Depth to limiting factor Snit Annliratinn Rat Effluent #1 = BOD > 30 1 220 mg1L and TSS >30 < 1 s0 TW Effluent #2 = BOD < 30 mg/- and TSS < 30 mg/L CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 _ j _ ?/ 715- 246 -4516 I 55 Property Owner _ Parcel ID # # E] Boring © 04 it Ground surface elev. ' ft. Depth to limiting factor / Yd- in. Page of Soil Annlinatinn Rata Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDtff MMOZZO 'Eff#1 'Eff#2 Gi - 1-1 Boring # ❑ Boring I v I ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Annliration Rate WW ��; Off T, R MIR= Redox Description Qu. Sz. Cont. Color WNIMMIR Ereggy M. MMOZZO Boring # ❑ Boring F ❑ Pit Ground surface elev. ft. Depth to limiting factor _ in. Soil A Rate Effluent #1 = BOD, > 30 i 220 mg/L and TSS >30 150 mg/_ ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. M -9334) (RAM) Redox Description. Effluent #1 = BOD, > 30 i 220 mg/L and TSS >30 150 mg/_ ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. M -9334) (RAM) Property Owner _ Parcel ID # Boring # [) Boring 13 1 Pit Ground surface elev. ft. Depth to limiting factor / Yd— in. Page of Soil ADDlication Rata Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'Eff#1 'Eff#2 3 - --;-- -- � ,t w 13 if 1:1 Boring # ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil pli R ate ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor _ in. ISil Application Rate .. :.. rCon C o l o r ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor _ in. ISil Application Rate Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8170 (8.6(00) MPMM97 M, Redox Description. Qu. Sz. Cont. Color Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8170 (8.6(00) Soil Test Plot Plan Project Name James Johnson Shau Address 737 Gherty Lane Hudson Wi 54016 M #226900 Lot Subdivision Gherty Addition Date 10/7/09 SE 1/4 N W 1/4S 2 9 T 2 9 N /R W Township Hudson ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1" pipe System Elevation 93.0/92.8/92.6 *HRpSameasBenchmark 40' � _y Vent 40' Scale is 1" = 40' unless otherwise noted Old 12'X 24' drainfield failed 3@0' 100 80' 10'B- 65' Gherty Lane U B -3 Z2 98' WEII 10' 5' 30' 3T 20' Existing 4 Bedroom House 99' Gherty Lane M.-NO. 589 11 E 603.74' 7� S89 °41' 00"E 474.55 N89 00 "W 465.85' S89 463.6 O mea . .41 -4 ° wo � Q) ro .�0'b ti0 ti� l t� �!► JSOo '� m , r ` �N a r ro N 1 0 T O En m $ S89 "E 455.08 N # 1 o° �a r Z 0 N 4 / O fu N WO x ... i o a o $ m 0 o Ac to m i N g 0 N "W 3 79.17 1 1 0 w 40 cn m ru ~ A a m � m N87 ° 45v00"W 324.74' I C j r 0 C-) N WO x m w $ o Ac m o g N "W 3 79.17 1 1 w 40 A. 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 Plan Option #1. If system fails, determine cause of failure, use alternate area and install new � tes d replacement area. pti�#2. sta ll 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 ST. CROIX COUNTY owner/Buyer Mailing Address Property Address SEPTIC TANK MAINTENANCE AG AND OWNERSHIP CERTIFICATION -TO l " „ 6 re"red from Pleamag 8t Zoaaing City /State Parcel identification �.gAL DES __C7�[��'� property Location V. t2 i �+ , Sec. v l , T NR Subdivision G Certified Survey Map # _ Q c:k 7 Voll Warranty Deed # ` Z- Vol, Spec house yes no Lot hags SYSTEM is - T 'v'''�'v "'vim N QV;D R CERTIFICATIUN Improper use and maiateoa OM of your septic system could result in its pre ace consists of pumpnog oux the septic task every three Pc= or sooaier, if the system can affect the man of the septic tank as a treatment stage in the wasi rosponsa'bilities are as specified ba §Com. 83.52(1) and in Chapter 12 - St. Croix C The property owaM agrees m submiit to� restr icted Plumber at' a licex owner and by a masw pb abear, joutner= P ija wastewater disposal systm is in proper cpwatuog condition and/or (2) aver hOpec less than 1/3 full of sludge. I/w ,, the woajigned have read the above osh and agree to n standards set Borth, loin, as set by the Depwt0° w of Con=== and the Departr Certification stating tbat your septic system has been maintained =east be complete Zoning Deparm east within 30 days of the three year expiration date. new oomsnvcnon.) Town of Lot # page # .�- 1 sqj��,pav# b . Yes a t= White to yule wASW- md+ed, by a licensed pua4w- What you pm hAo disposal, system. Owner mai ntenance Lty Sanitary ordinance. g Departeoaat a cenif=fion farm, signed by the ad pumper vwif*g that (1) the om sate m and pumipiag (if necessary), the septic tank is M the private sewage disposal. sy3tom with the of of Natural Resauras, State of Wisconsin. and retumed'to the St. Croiac County Plamuug & 1/we codify that all statements on this form are true to the best of mry oens Office. pro�pody desaxbed above, by virtue of a warranty decd recorded m Register fD NumbA of bedrooms I/we arn/are tau owners) of ft SIGN OF APPLICANT(S) DA 4Aqy inifornation that is m may result in the sanitary Permit being �vOked by the Planning � 8 DeParte '� Include with this application a recorded warrantY deed from the Register of Deeds ffice and a copy of the certified survey map reference is made in the warratuy deed. j I (REV. 08" 0 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the 3 fiy- 30h/1 Swu residence located at: AA,, h Section �_ , T . &N, R W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. 4 mast time serviced: 1:)id flow back occur from absorption system? Yes 2!�,_ No (If no, skip next line) Approximate volume or length of time: gallons Capacity: Construction: Prefab Concrete Steel Other Manufacturer: (If known) :LG/!.�,., Age of Tank ( If known) .: �j0 O vgnature) 1/2 49 Date minutes (Name) Please print �2 z- _ (License Number) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) i Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the be of my knowledge will conform to the requirements of ILHR 83, Wi dm. Code (except for inspection opening over outlet baffle). Name S/ e —,5, Signature MP /MPRS ZZ " Vo i .1542P AGE 262 JEj. *E3041536 AL --Z STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Geoffrey W. Burgess and Elizabeth RECEIVED FOR RECORD Joyce Burgess, husband and wife 09 -13 -2000 10:15 AN WARRANTY DEED Grantor, and James R. Johnson and Jean E. Johnson, husband and EXEMPT M wife CERT COPY FEE: COPY FEE: TRANSFER FEE: 929.70 RECORDING FEE: 10.00 PAGES: AGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 1, Block 4, Gherty's Addition to the Town of Hudson. St. Croix County, Name and Return Address Wisconsin. F F L C- 020-1139-10 Parcel Identification Number (PIN) This is homestead property. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this � day of September 2000 AUTHENTICATION Signature(s) Geoffrey W. Burgess and Elizabeth Joyce Burgess, husband and wife authenticated this 9 day of September 2000 Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, W is. Slats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, WI 54OI (Signatures may be authenticated or acknowledged. Both are not necessary.) I � r ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. County ) Personally came before me this day of the above named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: ,v • Names of persons signing in any capacity must be typed or printed below their signature. Wr abon Pforea eft canpssnr. Fond du tae. W1 WARRANTY DEED STATE BAR OF WISCONSIN e00s6s -2021 FORM No. 2 - 1999 I l 0 cn y 0 N 0 S 3 ID m a Z n to CD C:, a ' • n CA C 3 I _� cn 2 D `D D I W 3 p_ 3 O CD I o N � o' m I � N a I o II v� O 0 (1 0 C Cl) CD EL 3 Z j O cn F 0 I � I I ao 0o a ac 0 a CD m 01< r su � d N CD 'O fl 0 N N O Z m 7 N CD N p CD CL C x a m v �3 D 6 0 a d o � v c Cn 0. OM CD 0 CD �p 0 CD CD O •- y O 0 0 C 0 _1 1 CD M d 1 W 0 C N °C • co ,C Co CO - IR. CD 0 1 7 W ►Q+� Q C V "1 o N O 3 CD 7 7 H - V O Q Q I c a w v a CL G) CD CD zz "m C zz N 0 o C N± CO) y Q (� N 9 CA N � O CD N d � d a N Z co Z 0 D a Il CD Cp • N I d ltVil O N CD CD CL 7 tp 1 -1 N A Z n CL A Z CD Z N m N O D (D CD C CD 1 Z 0 X p !* Z co N Z CD W A C CL l it x I A y I O I m O e I � A ti V Op a � O ti Oo a V Parcel #: 020 - 1139 -10 -000 06/09/2005 07:48 AM PAGE 1 OF 1 Alt. Parcel #: 29.29.19.702 020 - 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 * JOHNSON, JAMES R & JEAN E JAMES R & JEAN E JOHNSON Valuations: 737 GHERTY LA HUDSON WI 54016 Last Changed: 10/26/2001 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 737 GHERTY LN SC 2611 SCH D OF HUDSON RESIDENTIAL G1 SP 1700 WITC 32,200 Legal Description: Acres: 2.437 Plat: 1979- GHERTY'S ADD SEC 29 T29N R19W GHERTY ADD LOT 1 BLK 4 Block/Condo Bldg: 4 LOT 1 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 29- 29N -19W Notes: Parcel History: 219,400 Date Doc # Vol /Page Type Woodland 09/13/2000 629812 1542/262 WD 0 07/23/1997 1189/244 WD inner CI IIUIRAADV Bill #: Fair Market Value: Assessed with: Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.437 32,200 219,400 251,600 NO Totals for 2005: General Property 2.437 32,200 219,400 251,600 Woodland 0.000 0 0 Totals for 2004: General Property 2.437 32,200 219,400 251,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 502 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 lV88- W 383,47' 66' I • AS 'BUILT SANITARY SYSTEM REPORT OWNER C2, TOWNSHIP �i� Q� SEC . Z T N ADDRESS cr .ST. CRO C TY WISCON�.� R �� W SUBDIVI �� tTipN LOT SIZE Distances & dimensions to meet requirements H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM op '-1 d 1) SEPTIC TANKS)MFGR.�n CONCRETE _ N o rings on cover Depth PUMPING CHAMBER SIZE PUMP MFGR. ~ MODEL NO. GALLONS Per Cycle TRENCHES NO. of wi �Tr , area ntu Nu. of lanes width I tR ( length 3C, area 75 V dept to top oT pipe NUMBER OF SEEPAGE PITS Outside diameter total pit area AGGREGATE JnIA 14 �l - -/ 0(k / PERK RATE �; ' AREA REQUIRED r AREA AS BUILT Disclaimer: The inspection of this system by St. Gtoix c6unty does not imply complete compliance with State Administrative Codes. There are other areas tha it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM. INSPECTOR DATED 10 J'O PLUMBER ON JOB LICENSE NUMBER 4a U A e � REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM Sanitaty Permit // State Septic NAME Township OZ.2 St. Croix Countcl Location &6 (A) Sec n 9�9 Lot S ub'di vi.6 i o n SEPTIC TANK Size r gatto nb Di.6tance J tom: Wett f,� Number o6 compantmentb Building G 12% .6 tope Highwaten PUMPING CHAMBER Size ea.Z q n ` ump' Ma u Jaetunen Mo det Numb en _ HOLDING TANK Size gattona. N be o C antmenta Pumper Diztance 6nom: Wett A arm S b t llo o? l l Building 12% .6tope_ __..._. Highwaten L ABSORPTION SITE r Bed _ _ - - -._. 7xench s Distance 6?iom: Wett 7 Building � I.2$ a tope y Highwaten ABSORPTION SITE DIMENSIONS 2� Width o6 trench ,�_ 6t Req "led area Depth o 4 tite b etow grade Length o6 each .Zane St Depth o6 no ck b etow tite 1 i n Numbers o6 U-na Depth o6 tock oven tite Z in Totat Length o 6 tinez �J 6t DiAtance between tines 6t Totat ab.a onption area 6t PIT DIMENSIONS N umb e,t o6 pitz Outside diameters A 6t V IV Totat abz onption an a 6t Area requited _ _.� 4t INSPECTED' APPROVED I ri Stope og trench 4,n. peA 100 (t : n Type o6 Covet: apen n btnaw Gnavet around pity yez Depth below inlet At _... -__ ( t TITLE DATE /"� 19 F < REPORT ON INSPECTION OF SANITARY PERMIT # Name and Address of Permit Holder Person /Persons at Site of Inspection Time of Inspection (3)INST ❑ Seepage Pit OF: ❑ Septic Tank ❑ Seepage Bed ❑ Seepage Trench ❑ Holding Tank ❑Dosing Chamber ❑ Fill System (Permanent reference Point) scri e: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well M DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO 8 HOLDING TANK: Manufacturer of gallons ; construction ; depth to the cover ft; If septic tank is being used are baffles removed? YES []NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? []YES ❑ N0; Wired? ❑ YES [ Locking device on cover? []YES ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe - elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; the depth.; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEP . Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% failing away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? []YES ❑ NO (13) Has system been installed in floodway? []YES ❑ NO Floodplain? []YES ❑ NO DILHR- SBD- 6095(N.05/8 Signature of Inspector X1 15 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES REAU OF ENVIRONMENTAL HEALTH DIVISION OF HEALTH, BU P.O. BOX 309 MADISON, WISCONSIN 53701 _ �REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: �'�'/4, N� � / Section g , T �N, R i9 E (or) W, Township or Municipality Lot No. Block No. � County Sf C iPO/ Subdivision Name Owner's Name: �•- • yJC/i'.S• S DAPS Mailing Address: �''?� �u�`s0� /S • Jfb�� TYPE OF OCCUPANCY: Residence X No. of Bedrooms 13 Other EFFLUENT DISPOSAL SYSTEM: NEW x ADDITION REPLACEMENT. DATES OBSERVATIONS MADE: SOILBORINGS / /d� —PERCOLATION TESTS SOIL MAP SHEET 4P6 SOIL TYPE PERCOLATION TESTS TEST NUM- BER DEPTH INCISES CHARACTER OF SOIL THICKNESS IN INCHES HOURS SINCE HOLE 1ST WETTED WATER IN HOLE AFTER SWELLING TEST TIME INTERVAL IN MINUTES DROP IN WATER LEVEL, INCHES RATE MIN /IN PERIOD 1 PERIOD 2 PERIOD 3 P- y � x.16, 74 y� ° 31 a4 L 2- 4NG 2 - ",Q,v <Pi/ 1 •, L Ba . SI / "fc,•t Dili $L W .. f� ©R. -1 w i N AAA o w J e 13 _ P Z n Z3 "Qiv • S'L 9 "L�•/�.v • Si/ 7�— " ,s: "�a' N.v;c "off w _ � �� P -3 ,XP S ig3 fo 36 '' SOIL BORING TESTS TEST NUMBER TOTAL DEPTH INCHES DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES (DEPTH TO BEDROCK IF OBSERVED) OBSERVED ESTIMATED HIGHEST B_ S Lv . 31 a4 B- 4NG > 8 ",Q,v <Pi/ 1 •, L Ba . SI / "fc,•t Dili $L W .. f� ©R. -1 w i N AAA o w J e 13 3 72 �Vou� 7�— " ,s: "�a' N.v;c "off w _ PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. o" Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. . . 115 W ISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES �/ Z o� ly DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION:4cm.,� /4, Section 2 K, T R,I E �� (or r)� ) WW,�,,J Township or Municipality Lot No. Block No.__�, — County f�' ciP ubdivision Name Owner's Name: Mailing Address: t 00 0_ .ZG>"i 5 �� � TYPE OF OCCUPANCY: Residenc No. of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORING I fA9 TEST SOI L MAP SHEET SOIL TYPE PERCOLATION TESTS TEST NUM- BER DEPTH INCHES CHARACTER OF SOIL THICKNESS IN INCHES HOURS SINCE HOLE 1ST WETTED WATER IN HOLE AFTER SWELLING TEST TIME INTERVAL IN MINUTES DROP IN WATER LEVEL, INCHES RATE MIN /IN PERIOD 1 PERIOD 2 PERIOD 3 P S '' A4.Oe s Nav es } ,0• Jib "L . ,4.✓ , S' " D,P SL " w 1 " P_ C'S t le 7 2 — ND,vF L zL " AV , ViL "La' ,env : S, / a,P st ,� aM,Q P_ " Gt SOIL BORING TESTS TEST NUMBER TOTAL DEPTH INCHES DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES (DEPTH TO BEDROCK IF OBSERVED) OBSERVED ESTIMATED HIGHEST NoN€' > SO "QN �i� 13 IY S/ 0 ,1 0 ld ;e SG W '' A4.Oe s Nav es } ,0• Jib "L . ,4.✓ , S' " D,P SL " w 1 " C'S t le 7 2 — ND,vF L zL " AV , ViL "La' ,env : S, / a,P st ,� aM,Q " Gt PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. ❑r �6P1/1711i�i����1 •���� I I Ili I 11 .4 1 LCD , I Ye 1 719 I._,; (l.; I I I I I /(I I I '/ I I I I I I I 1 1 1 1 'P A I I 1.'�, I AV .,, .,A, 1 k, 1 1 1 1 1 1 1 !1' 1 1 1 1 1 F - I I 1If I 1 1 4 IZ I, I 1, I ,F /I I AV-1 1/ 1 1 1 '' I I I III I I I L B 6 7 S tate and County State Permit # Permit Application County Perm t # for Private Domestic Sewage Systems County "DENOTES STATE APPROVAL REQUIRED 020-i/3q, /0-&"'/ `]n Date Approval Received from State if Required State Plan I.D. # / A. OWNER OF PROPERTY Mailing Address: i 7No1 S . fIMEf �.P5l� �02� f/Gke S7 40iS B. LOCATION: .*V£ Subdivision Name, C. %, Section 2-� , TZg N, R nearest road, lake or landmark 04nfr,ys f�l>DiTiDN `ANE E (or) W Lot# _ City Blk# Village Township &apso v TYPE OF OCCUPANCY: Commercial "Industrial "Other (specify) "Var Single family X Duplex No. of Bedrooms 3 No. of Persons D. SEPTIC TANK CAPACITY 1CM Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete X Poured -in -Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab oncrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New X Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches X 32 3 Seepage Bed: Length - - Depth Tile depth (top No. of Line Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land 47-6 ° 0o Distance from critical slope Alowe WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if o than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the C3 71;�7- Soil Tester, // � NAME V16fl-CtiT" C.S.T. # SS,S other information obtained from SDi g�]37F (owner /builder). Plumber's Signature MP /MPRSW# Z W1 Phone Plumber's Address • Os✓ Gv/