HomeMy WebLinkAbout020-1088-10-000Wisconsin Department 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:
Krstich, Samuel & Violetta
MANUFACTURER
city Village X Township
I Hudson, Town of
CST BM Elev:
Insp. BM Elev:
BM Description:
TANK INFORMATION '
TYPE
MANUFACTURER
CAPACITY
Sept' -�
S
lo zoo
V (/(
Dosing
t
010
I V) ()
Aeration
Forcemain
Length
Holding
Dist. to Well
32.29.19.371 C2
TANK SETBACK INFO RMATION
PUMP /SIPHON INFORMATION
Manufacturer
St. Croix
Demand
GPM
Model Number
ELEV.
TDH
Lift
Friction Loss
System ad
TDH Ft
Forcemain
Length
MEME
Dist. to Well
32.29.19.371 C2
Bldg. Sewer
LAKE /STREAM
CHIN
Many tur
St/H nlet'
Stimf outlef2 L SL
c..fO
5.�j
PUMP /SIPHON INFORMATION
Manufacturer
St. Croix
Demand
GPM
Model Number
ELEV.
TDH
Lift
Friction Loss
System ad
TDH Ft
Forcemain
Length
Dia.
Dist. to Well
ELEVATION DATA
County:
St. Croix
Sanitary Permit No:
FS
ELEV.
515275 0
State Plan ID No:
to 3 .
Parcel Tax No:
10p, o,
Alt. B
020 - 1088 -10 -000
Section/Town /Range/Map No:
JBLDG
32.29.19.371 C2
STATION
BS
HI
FS
ELEV.
Benchmark
3, CS
to 3 .
Liquid Depth
10p, o,
Alt. B
P/L
JBLDG
Bldg. Sewer
LAKE /STREAM
CHIN
Many tur
St/H nlet'
Stimf outlef2 L SL
c..fO
5.�j
l7 (oS�
D
o Id
+
57
D ✓Bottom
Model Number:
eade /Man. •
(v •Slo
y 6 . �
Dist. Pipe
Bot. System I
Final Grade,
-- N
2 . yL
/ 0
St Cover
S
2 • `� � �i s-�-rs
vn
I
1,
SOIL ABSORPTION SYSTEM 3 "L -1 ( _ I ( / " 1/ fl 1. 1 4 -4LOA .2.f
BEDITRENCH
DIMENSIONS
Width
3
Length
i_
K � I
No. Of Trenches
2---
Vo
PIT DIMEN S
No. Of Pits
Inside ia.
Liquid Depth
SETBACK
SYSTEM TO
P/L
JBLDG
WE
LAKE /STREAM
CHIN
Many tur
INFORMATION
HA UNI
Type System:
O
+
(� f
/
Model Number:
DISTRIBUTION SYSTEM
/1 - 1*OA'%1,LPn
eade ani old
if
Distribution
Pipe(s) r_ f / _
x Hole Size
x Hole S pacing
Vo
Length Dia
Length W Dia Spacin
�-
0 Yes 0 No
❑ Yes ® No
SOIL COVER
x Pressure Svstems Only xx Mound Or At -Grade Svstems Only
�..� 4o Vent to Air Intake
-e
Depth Over /
Depth Over
xx Depth of
xx Seeded /Sodded
xx Mulched
Bed/Trench Center , f
Bed/Trench Edges
Topsoil
0 Yes 0 No
❑ Yes ® No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1/ /0 Inspection #2:
Location: 677 O'Neil Road Hudson, WI 54016 (NW 1/4 NE 1/4 32 T29N R19/W�), NA Lot 2 Parcel No: 32.29.19.371C2
1.) Alt BM Description =1b f 6f � G !wn'•' �-a tit v�
2.) Bldg sewer length
- amount of cover
Plan revision Required? Yes V No
U
yj
se other side for additional information.
SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No.
11 Os'1/A n A A^A A AA
commerce .wi.gov
Safety and Buildings Division
County
201 W. Washington Ave., P.O. Box 7162
St. Croix
'
sco n s i n
Madison, )k 7 '
Sanitary Permit Number (to be filled in by Co.)
epartment of Commerce
Z_M
5 z 5
Sanitary Permit Application
State Transaction Number J�
Project Address (if different than mailing address)
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
submitted to the Department of Commerce. Personal information you provide may be used for secondary
purpo in accordance with the Privacy Law, s. 15.04(1) (m), Stats.
Same
7 7 BUG, ►C
I. Application Informatio — Please Print All Informatio RECEIVED
Property Owner's Name
Parcel #
020 - 1088 - 10 - 000
Sam & Vick Krstich
oe
Property Owner's Mailing Address
Property Location
3 7)C — Z '
ST. CROIX COUNTY
�
677 O 'Neil Road PLANNING & ZONING OFFICE
Govt. Lot
NE ' /`, NW '/,, Section 32
City, State
Zip Code
Phone Number
(circle one)
Hudson, WI.
54016
715- 386 -5607
T 29 N; R 19 E or W
II. Type of Building (check all that apply)
Lot #
Subdivision Name
❑ I or 2 Family Dwelling — Number of Bedrooms 3
2
D
❑
CSM
Block #
Public /Commercial — Describe Use F 4. Ge MAe
Na
❑ City of
❑ State Owned — Describe Use
❑ Village of
CSM Number
2 b, 64- � &
C,�Lt s f J � t�.l�b�.rs
CSM Vol. 2, Pg. 366
❑ Town of H d n
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A.
❑ New System
Y
Re System
e P Y
❑ Treatment/Holding Tank Replacement Only
g eP Y
❑ Other Modification to Existing System (explain)
�8 Y (xp )
B.
❑ Pemrit Renewal
❑ Permit Revision
❑ Change of Plumber
❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration
Owner
$' h
IV, X&pe
of POWTS S stem/Com onent/Device: Check all that appl
Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (e la' ❑ Pretreatment Device (explain)
V. Dispe rsal/Treatment Area InformationQ 2 Infiltrator "Q-4" s ndard chambers & 2 pr. endca s, Wieser Concrete filter canister of Lok PL -525 effluent filter
Design Flow (gpd)
450 gpd
Design Soil Application P�A
0.70 gpd/sq. ft. !
persal Area Require j
642.86 sq. ft. J
ea
Dispersal Area Proposes (s
651.60 sq. ft. ✓
System Elevation,
95.50'
VI. Tank Info
Capacity in
Total
# of
Manufacturer
Gallons
Gallons
Units
p
New Tanks
Existing Tanks
w o
o
m
c5~ U
zn
iw t7
rs.
Septic or Holding Tank
Na
1,000
1
Tdwlesun
X
Dosing Chamber
Na
Na
Na
Na
VII. Responsibility Statement I, the and rsigned, assu a responsibility for hodytio. of the POWTS shown on the attached plans.
Plumber's Name (Print)
Plumber' Signatur
MP/MPRS Number
Business Phone Number
James K. Thompson
=Al—
MPRS 30021
(715 ) 248 -7767
Plumber's Address (Street, City, State, Zip Code
340 Paulson Lake Lane, Osceola, WI 54020
Vffl. partment Use Onl
pproved
ia n D
`(�Q�a"' �d
Permit Fee
$
75.
Date I s
Issuing t Signatur
Reason for
/ ,1 b
ven Denial
IX. Conditions of Approval/Reasons for Disapproval
SYSTElyl OWNER
1; : Septic tank, effluent filter and
dispersal cell must all be services / maintained
as per management plan provided by plumber.
2� Alf !"k requirements must be maintained
Attacn to complete plans for the system and submit to the County only on paper not less than 8 t!2 x 11 Inches in size
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Wisconsin Department of Commerce SOIL EVALUATION REPORT
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8'% x 11 inches in size. Pljrq ust County
include, but not limited to: vertical and horizontal reference point (BM), direC llllllir ar
percent slope, scale or dimemsions, north arrow, and location and distan ;A ea Parcel I.D.
Please print all inform a -tticar"I Re ' e
Personal information you provide es (Privy Law, s. 15.04 (1) (m)).
Property Owner I I Property Location
2205
Page 1 of 3
A.C.E. Soil & Site Evaluations
St. Croix
020-1088-10-000/, 3 71 G
Samuel & Violetta Krstich
OwR
Govt. Lot
NE 1/4 NW 1/4 S 32 T 29 N R 19 W
Property Owner's Mailing Add r
s
t "i
Lot #
Block #
Subd. Name or CSM#
677 O'Neil Road
OUNN
2
" Eff#2
CSM Vol. 2, Pg. 366
City
1Oyr3/3
J City
J Villa ge t/ Town Nearest Road
Hudson I
t AEII�Ri(7�15) 6 -5607
as
Hudson O'Neil Road
I New Construction Use: y! Residential / Number of bedrooms ( 31 Code derived design flow rate 450 GPD
16 Replacement —J Public or commercial - Describe: �—
Parent material Glacial Outwash Flood plain elevation, if applicable Na
General comments
and recommendations: Site suitable for conventional POWTS dispersal cell with 0.7 gpd /sq.ft. /day loading rate. Proposed / >
trench elevations to be 95.50' f 9 7 q � C ' W
Boring # 'I Boring
Vl Pit Ground Surface elev. 100.17 ft. Depth to limiting factor >112" in. Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/ft
*Eff#1
" Eff#2
1
0 -10
1Oyr3/3
none
sl fill
lfgr
mvfr
as
2vf,f
Na
Na
2
10 -16
10yr2/1
none
sit
2fgr
mvfr
cw
1vf,f
0.6
0.8
3
16 -33
10yr4/6
none
sit
2%bk
mfr
cw
1vf
0.6
0.8
4
33 -36
7.5yr4/6
none
Is
Osg
ml
aw
1vf
0.7
1.6
5
36 -112
1Oyr4/6
none
s
Osg
dl
-
-
0.
1.6
%S• ��
'
u
Fil Boring # — I Boring
Pit Ground Surface elev. 100.69 ft. Depth to limiting factor >119" in, Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/ft
*Eff#1
"Eff#2
1
0 -10
10yr2/1
none
sit
2fgr
mvfr
as
2fm,1c
0.6
0.8
2
10 -17
1 Oyr3 /2
none
sil
2fsbk
mvfr
cw
2fm,1 c
0.6
0.8
3
17 -26
10yr4/3
none
sil
2fsbk
mfr
cw
1fmc
0.6
0.8
4
26 -32
7.5yr4/6
none
Is
Osg
ml
aw
1vf
0.7
1.6
5
32- 19
10yr4/6
none
i
Osg
dl
-
-
0.7
1.6
%S• ��
'
u
• Effluent #1 = BOD 30 < 220 mg/L an TSS >30 <) 50 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < MWIL
CST Name (Please Print) Signat e: CST- Num qf,-'
James K. Thompson 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone'Number
340 Paulson Lake Lane. Osceola. WI 54020 4/15/2010 715 - 248 -7767
Property Owner Samuel & Violetta Krstich Parcel ID # 020 - 1088 -10 -000 Page 2 of 3
3] Boring # I Boring
✓i Pit Ground Surface elev. 101.01 ft. Depth to limiting factor > 120 in. Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
'
*Eff#1 *Eff#2
1
0 -10
1Oyr2/1
none
I
2fgr
mvfr
as
2fm,1c
0.6
0.8
2
10 -17
1Oyr3/2
none
sit
2fsbk
mvfr
cw
2fm,1c
0.6
0.8
3
17 -31
1Oyr3/4
none
sit
2fsbk
mfr
cw
1fmc
0.6
0.8
4
31 -36
7.5yr4/6
none
Is
Osg
ml
aw
1 of
0.7
1.6
5
36 -120
10yr4/6
none
s
Osg
dl
-
-
0.7
1.6
❑ Boring # I Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz, Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
QPDM
*Eff#1 *Eff#2
❑ Boring # J Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon
I Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
'
*Eff#1 *Eff#2
* Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 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 -8330 (R.07 /00) A.C.E. SO & Site Evaluations
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Conventional POWTS Index & Tilte Sheet
Project Name: Krstich 3 bedroom Replacement Conventional POWTS
Owners Name: Sam & Violleta Krstich
Owner's adress: 677 ONeil Raod, Hudson, WI 54016
Site address: Same
Project Location:
Subdivision: Lot 2, CSM Vol. 2, Pg. 366
Legal Description: NE1i4NW1i4, Sec. 32, T.29N., R. 19W., Town of Hudson, St. Croix Co., W I.
Parcel ID #: 020 - 1088 -10 -000
Page 1
Index and Title Sheet
Page 2
Site Plan
Page 3
Dispersal Cell Sizing Calcualtions
Page 4
System Cross Section
Page 5
System Management Plan
Page 6
Filter Specifications
Page 7
Treatment &/or Filter Tank Cross Section
Page 8
Parcel map
Page 9
Septic Tank Maintenance Agreement
Page 10
Certification for Utilization of existing septic tank
Page 11
Waranty Deed
Attachments: Soil Evaluaiton Report
Mater PI er L'cted e: Ja mes K. Thompson, Dept. of Comm. Cre #30021
Signature: Date: , P o2 241
Design pursuant to In- Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD- 10705 -P (N.01101)
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9.
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KRSTICH DISPERSAL CELL SIZING CALCULATIONS
1. (3 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 4-50-00 ON design flow
2. Infiltrative capacity of native soil = !L7 - ad/sq. f}
3. Absorption area required: 642.86 sq. ft
4. Absorption area as proposed: 4. ft (33 chambers total)
Infiltrator "Quick 4" = 20.00 sq-ft. EISA per chamber, Infiltrator "Quick 4" end cap (pair) = 5.80 sq.ft, EISA
642.86 sq. ft. — (3 pair endcaps)(5.80) = 625.46 sq. ft.
625.46 sq, ft. /20.00 = 31.28 chambers required
Number of trenches: 3 @ 11 chambers per trench
Trench width: 2.83'
Trench length: 46.00'
Trench spacing: 8.00' on center
Total system area w/ 5' trench spacing: 21.00'x 46.00'
Pg. 3 of 11
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Soil Absorption Svstem Cross Section
/04 cc' ft
4" Schedule 40 Final Grade
PVC Vent Pipe
With Vent Cap ft
Leaching ♦—
Chamber u 9s �' ft
, System Elevation
,2.83 ft 6'.0 , ft
Soil Absorption System Plan View
6 ft
z. 83 ft
ft Leaching Trench 1
Vent Or Observation Pipe Chambers
�IIIIIIII ;1111111 ■� 4 D
He
Leaching Chamber Specifications
Manufacturer And Model -:r, 'a
EISA Rating 12,6 0sq ft per chamber Soil Application Rate 0, 70 gpd /sq ft
J� L 0 gpd Design Flow T 0.76) Soil Application Rate + 20.C EISA = _.32 Chambers
2 rows of - --- Z4 chambers each.
Page :�z — of //
Conventional Septic System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained
in accordance with component manual SBD- 10705 -P (N.01/01). All local and/or state rules pertaining to system
maintenance and maintenance reporting shall be complied with.
Septic Tank
Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with
bottom of tank to be <_ 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be
assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in
the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR
113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are
not removed 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 necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank
that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be
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 completion of
service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater
than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank.
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 generally not required. If
such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings
Division.
Soil Absorntion Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for
vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface
within and above the system and will promote frost penetration during cold weather months. Cold weather installations
(October - March) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not
exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the
owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Effluent flow shall be alternated between dispersal cells on a two- year /1 -year schedule by use of diversion valve.
Effluent to be diverted from new dispersal cell to old cell at 4 year anniversary of new system installation. Old cell to be
utilized for a 1 year period. Afterwards, effluent dispersal to be alternated between cells on schedule to allow use of new cell
for two years and old cell for 1 year.
Contingency 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 ponding within the dispersal cell will be eliminated by installing a new soil
absorption cell to bring the system into proper operating condition.
Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715)
248 -7767 or the St Croix County Zoning Department at (715) 386 -4680.
1 0� -
EFFLUENT
FILTERS
"The PL -525 has 525 linear feet of 1/16"
slots. It has an automatic shut off ball. When
the filter is removed for cleaning, the ball will
float up and temporarily shut off the system
so the effluent won't leave the tank. No other
filter on the market can make that claim!"
"The PL -122 has over 122 linear feet of 1/16"
slots. Rated for 1500 gallons per day, and
can be manifolded together with other PL-
122's to double or triple the GPD. It has an
automatic shut off ball that stops flow when
the filter cartridge is removed for cleaning.
Comes complete with it's own housing, no
gluing of tee or pipe and no extra parts to
buy.
Accepts 1/2" PVC
Handle
Alarm
Switch
122 Linear h.
of 1/16 inch
Filter Slots
Filter Housing
with 3 "& 4"
Pipe Adapter
Gas Deflector
Automatic
Shut -of
Ball When
Filter is
Removed
From Tnnk
Order #
Model #
Description
Alarm
accessibility
-
}'t -
- - - -_ Accepts PVC
-'
Effluent Filter System
203.50
eatrnsion handle
525 linear feet
Effluent Filter System
62.50
oil
filtration slots
—�� Rated for over
10,000 GPO
Accepts 4" & V
SCHD. 40 Pip. a `\
Gas deflector
—a Automatic shut -off
ball when fitter
is removed
Accepts 1/2" PVC
Handle
Alarm
Switch
122 Linear h.
of 1/16 inch
Filter Slots
Filter Housing
with 3 "& 4"
Pipe Adapter
Gas Deflector
Automatic
Shut -of
Ball When
Filter is
Removed
From Tnnk
Order #
Model #
Description
List Price
PK -525
PL -525
Effluent Filter System
203.50
PK -122
PL -122
Effluent Filter System
62.50
6 -10
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.
431"
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\ o = FILTER CANISTER DETAIL SCALE:3 /4" = 1' REV N0. DATE:
m MIESER coRGRETE DRAWN BY:SWT
I J � ~ SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK, WI 54750 DATE: JANUARY 2008
° REV. JAN. 2008 800 -325 -8456 FILE: SHEET 13
�. ?wd
•�• uuuc;uaries and the subdivision of the
land surveyed; and that this land is .located in the NWL of the
NE4 of Section 32, T 29 hl h lei W., TCWn of Hudson, St.Orpix ;z
County, Wisconsin, t o�wi t ; "
T ` C orrlcaer�c i ZZ � a or
,.
t
AN � sy °05152a�.E Ion t�iaiti ''� c
t�rr><er o3' 3ect #on ��"; thenl�'f �.
000 12 1 02" W 410,n& Lh1e East 3;,1n® of�the NWk 908C57 to the
'tint of beginning; thence continuing S 00 °12 W along the
East' line of said Forty 451. to the South line of said Forty,
`- then ^e S 8 9 9 U 5 1 55 -11
W along said South line 120 9.53 1 ;. thence
13"64 E 326.661 t•hencf, Northerly along the arcs of a
140Ul radius curve which is concave Northwesterly an( whose long
chord bears N 0 7 0 55 1 48" E 25i -, thence K 0 50 1 00" E 22b..09
thence S 42 0 46 1 00" E 345.521; thence N 33 ° 56#3'0t 1 E 435.84
thence S 56 9 05 1 00" E 488693 to the point lof beginning.
The above described parcel car :Lains .14•'d43 adres of land subject
to exi4ting Town Road and C.T.H. "N" Right-Of-Way.
Dated this 6th. day of ,�u I. �c�•��.,�L
D.tttloff Engineerin 1 ..
_River Falls, WI
� S,R��i7's Arthur L Wegerer
, • •••i��•��,, _ ___.� ..� ��..ex�r•��._.._ -
__ ...- . ' • Wig.. R.�. � _
�- CURVE
RADIUS 1 400' .
CHORD 250.96'
CHORD BRCL sNO7 •
CENTRAL < 3 iO "' '
RiW CURVE
s.ADiUS : 1433'
Ci3ORu '269.44'
.tiORD BRG. =NO7°4O'4O'E)C(V,0,mn,C
CENTRAL < ■ 1 7 ° 47'20 •
• r
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K , `
1 •
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ARTHUR L '•.
k • .
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•
1307.1►
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13
MLE Rm AT N : I
• yy� -29 -
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) ( 77 �4,•( ,P �c�ols�, 6J/, sY016 located
at: '/4, nE ' /4, Section 3 Town 2 N Range & W
Town of �dso> , , St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of Comm. 84.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service
Did flow back occur from absorption system? Yes No
(if no, skip next line.)
Approximate volume or length of time: _�/ gallons minutes
Tank Capacity: - 4,1,0()
Construction: Prefab Concrete Steel Other
Manufacturer (if known):
Age of Tank (if known):
ermit dumber (if known)
S
icensed Plumber Sig ature)
(Print Name)
��u •�, �i es�liG c 14( 3:5�1
(Ti (License Number) MP /MPRS
ate)
Form to be completed by licensed plumber (Dept of Commerce Chapter 5
and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin
Administrative Code)
Rev. 9/2008
Pj. /0cyo
-
g i_0kT No_ rY�'{�,7yl�'}� M
M FR` �
TRi S-
+ 5
- FEE
Tai Wwjd 1r ty.
(is) (Ls suet)
Exetepl'istt is Wetrattaca
Dated IkIA 4 A d ev or '
-- - (SEAT..)
(,SEt11.)
AUTHENTICATION
Signatures authenticated thi z7z - da y or
A prl 1 t9 74
t J $i l'I D. up_ o o
TI 1 l.E:' MEMBER ST BAR OF WISCONSIN
(If ml, -
anxhoaized by i06.Ob. Wis. Sfiats.)
This iostrumeaY was dra lead by
HZYW301) APti'} CARP
204 Locust Street
Hudson, iAiscons 54 016
(Signatures may be authenticated or acknowledged. Both
are not necessarv.)
t
• +cr.�..+- .-..e! /_-� ( SEAT.)
B . C21 SANOVA
d �r+yr+r. �� .2,re2'C( `,lc.�,' (SEAS,)
DCfteway z CASANOVA
ACKNOWLEDGMENT
STATE OF WISCONSIN
County.
Personally came before ale, this day of
-the above named
3
to me known to be the person— oho executed the fore- s
going instrument and acknowledged the same. - -
Kota— Public County, Wis.
aty Commission is permanent. (If not, state expiration
date- 19_.)
WARA/ lr DLE D -STATE BAR OF' *15CO.'tMX. FORM NO 2 -1477 - _ {� ••
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Mailing Address 6o
Property Address so-'?2
(Verification required from Planning & Zoning Department for new construction.)
City /State ff� �✓Sah Parcel Identification Number oc
LEGAL DESCRIPTION
Property Location t t) 1 /a , f7 1 /a , Sec. 3�- T �1' N R_Zy_W, Town of drt.d
Subdivision , Lot #
Certified Survey Map #
Volume - '� , Page # '3
Warranty Deed #
Spec house no
Volume , Page #
Lot lines identifiable yes
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal 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 Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedroom
IGNATURE OF APPLICA (S)
DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
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Parcel #: 020 - 1088 -10 -000 10/19/2009 11:30AM /
PAGE 1 OF 1
Alt. Parcel #: 32.29.19.371C2 020 - TOWN OF HUDSON
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address:
Owner(s): O = Current Owner, C = Current Co -Owner
77,600
O - KRSTICH, SAMUEL & VIOLETTA
SAMUEL & VIOLETTA KRSTICH
0.000
677 O'NEIL RD
0
HUDSON WI 54016
Districts: SC = School SP = Special
Property Address(es): * = Primary
Type Dist # Description
" 677 O'NEIL RD
SC 2611 HUDSON
202,700 280,300
SP 1700 WITC
0.000
Legal Description: Acres: 3.430
Plat: N/A -NOT AVAILABLE
SEC 32 T29N R1 9W NW NE LOT 2 CERT SURVEY
Block/Condo Bldg:
MAP IN VOL II PAGE 366 ORD
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
32- 29N -19W
Notes:
Parcel History:
Date Doc # Vol /Page Type
, :)nno Q innnnAPV Bill #: Fair
Market Value: Assessed with:
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.430 77,600 202,700 280,300 NO
Totals for 2009:
General Property
3.430
77,600
202,700 280,300
Woodland
0.000
0
0
Totals for 2008:
General Property
3.430
77,600
202,700 280,300
Woodland
0.000
0
0
Lottery Credit: Claim Count: 1 Certification Date: Batch #: 312
Specials:
User Special Code
Category
Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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REPORT OF INSPECTION SEWAGE SYSTEM
San.itatcy Petcm.it
St ate SPpt.ic4;Z
i
NAME Township St. Cno.ix County
Laca ion Section
SEPTIC TANK
Size gattons. Number Compatctments
ztope 5
12 o an gneatetc t.
Distance Ftcam: We.�.2� ,
Bu.itd.ing it Wettand.6
DISPOSAL SYSTEM
Distance Fnam:
H.ighwatetc it.
W it.
Bu.itd.ing it.
I
12% on gneatetc ztope j f it.
W ettands Ft.
H.ighwatetc ---
FIELD
DIMENSIONS:
Wi o f the nch it.
D ept h
o 6
ro below t.ite
Length a6 each tine it.
Depth
a4
tack oven t.ite Zi n.
Numbetc os tines
D epth
o4
tite b elow gtcade_gyin
s-
��
Totat. .length of tines it.
Stope
o6
ttcench `Z, in pen 100 it.
/
s
Dis tance b etween tines t fi t.
Depth
to
bedtcock
2
Totat abs oh bt.i on area G ��
Depth
to
gnoundwatetc /r/7 it.
Requited area (, / ,S� it
Type
of
Covets: Papeti tc Sttcaw
PIT DIMENSIONS:
Numbetc o6 pits Gnavet around pits yes no
Outside d.iameten 4 Depth below .i nZet St.
' 2
Totat anbt.ion tea it .
INSPECTED
APPROVED_
REJECTED ,DATE
197
s
z
A
rn
EH 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: /a, NE /a, Section �, T� R LY E (or) _W, Township or Municipality V S O PQ
Lot No. Z ' Block No. County ST - - C R I X
Owner's Name:
RAV cA5 N O VA S e IlI sp Name
Mailing Address: R ( ' 1 '5TA6e010E 120. 44 11 p500 W1S G,
TYPE OF OCCUPANCY: Residence . X No. of Bedrooms 3 Other
EFFLUENT DISPOSAL SYSTEM: NEW
A
DATES OBSERVATIONS MADE: SOIL BORINGS Ju
SOILMAPSHEET 1 FE 121 SC° SOIL TYPE
ADDITION REPLACEMENT
9 0 7 Y PERCOLATION TESTS J V j r
(A 1 3 1 130R4-� H 412 '
PERCOLATION TESTS
TEST
NUM—
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
BER
___ --
3 �
5
L3
6 ., r5 17" 51- 4-f
-
r U 13 3 r3
P -�
3�
1ep -f,4
C!4
!%
�15
P -3
1 6
kEFEiQ i3E
0
C7
�
/ / G i
�
/ 7/6
`S
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
___ --
5
L3
6 ., r5 17" 51- 4-f
-
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of sWtable areas. Indicate number of square feet (f�absorption area
needed for building type and occupancy. 4� 5 +V& '2 &o !24 615 361-4 1 /3 Eb Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
t N
N
M
5'Z 6 .
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures
and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct
to the best of my knowledge and belief.
Name (print) A136f T /��/ C � '� Certification No. �5T~ C) 2-4 Z
Address 9T C) ' /(/!E SP - nl L4i 1 5 r j9y /
Name of installer if known
COPY A —LOCAL AUTHORITY
CST Signature ]� ` " - Z" � 1 '""�O
' � � � 67 Permit and County State Permit #
Permit Application County Per
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required
State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: % Seon�
Subdivisioyr) Name, /y` nearest road,
T 12 N, R E (or) W Lot#
lake or landmark Blk#
s
City
Village
Township
TYPE OF OTUPANCY: *Commercial *Industrial *Other (specify)
Single family f � ✓✓ � Duplex No. of Bedrooms No. of Persons —3
ariance
D. SEPTIC TANK CAPACITY r bC7 D Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured -in -Place Steel Fiberglass Other (specify)
New Installation t-- Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate al Abs
Totorb Area sq. ft.
New � Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth ( No. of Tr ches
Seepage Bed: A / LengthWidth f Depth _Tile depth (top)No. of Line
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land T% Distance from critical slope
WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑
Owners name as Iisted on EH 115 if other than p 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 Certifi S 'I Te er, I '
NAME C.S.T. #-5
and other information from (owner /builder }. .�/��J —� � !�
Plumber's Signature P SW# �� 9 Phone 9
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
Do Not Write ij Spac elow OR COUNTY AND STATE DEPARTMENT US ONLY Aj
Date of Application Fees Paid: State 0 D D Co my ' Date r
Permit Issued /mod (date) - Issuing Agent Name
Inspection Yes Z State Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, W1 53701
2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78
I, Arthur L. Wegerer, registered land surveyor, hereby
certify: That in full compliance with the provisions of Chapter
236.34 of the Wisconsin Statutes and the provisions of the
St . Croix County Subdivision Ordinance and under the direction
of Ray Casanova, owner of said land, I have surveyed, divided,
and mapped said parcel of land, that such plat correctly
represents all exterior boundaries and the subdivision of the
land surveyed; and that this land is located in the NWT of the
NEB of Section 32, T 29 N, R 19 W, Town of Hudson, St . Croix
County, Wisconsin, to -wit:
Commencing at the North 4 corner of Section 32; thence
N 89 E . a long said Section line 1307.1l thence
S 00 ° 12 1 02" W along the East line of the NW4 -NE4 908 .57 ' to the
point of beginning; thence continuing S 00 °12 W along the
East line of said Forty 451.75' to the South line of said Forty;
thence S 89 0 0515 5 11 W along said South line 1209.53'; thence
N 13 °04' 20 E 326 thence Northerly along the arc of a
1400 radius curve which is concave Northwesterly and whose long
chord bears N 07 °551 4811 E 250.96'; thence N 71 °50'00" E 228.09
thence S 42 °4610011 E 348.521; thence N 33 °56 E 435.84';
thence S 56 E 488.93' to the point of beginning.
The above described parcel contains 14.893 acres of land subject
to existing Town Road and C.T.H. 11N" Right -Of -Way.
Dated this 6th. day of� Lu 1 «"•,4976•
Dittloff Engineering
,, cJ�s'j'�., Arthur L. Wegerer
River Falls, WI. 5`0..x••••••.. Wis. R.L.S. No S
9 �3
�.` ' +. N 89 °05 52 E n
APPROVED
MAY 3 1977
2.871
ST. CROIX COUNTY ��0,"Yjv �••••••��� �•` '� • � ° C
COMPM111"SOVE PAWLS �%S11," SU1�VE ��� n� c��
AM 200040 CCMA#ITM � o 5�` U �'p,1111111110 % 1x 4 9
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Page 366 APPROVAL O F THIS hkIMOR SUBDIVISION
scAtP� 1,R APPROVAL FOR SEPTIC
H62.20
200 100 0 100 200 ~�/