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HomeMy WebLinkAbout020-1342-10-140Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division r • INSPECTION REPORT GENERAL INF6RMA6ON (ATTACH TO PERMIT) Personal information you provi( maybe used for secondary purposes (Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: Village X Township City Kin sborou h Homes Hudson Townshi CST BM Elev: Insp. BM Elev: I BM Description: co • O CO . D' M ' fns, l - dto"e io,` TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY Septic 1,L7 f�ts� ZSD Dosing 2 � /� J ' ., �! tS Aeration _ Force ma' Holding Dia. r TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 2 � /� J ' ., �! tS 22 I _ Force ma' Dosing Dia. r p Aeration r � 31 Holding No. Of Trenches (-3 r� z 14. IZ 30 t Inside Dia. PUMP /SIPHON INFORMATION County: St. Croix Sanitary Permit No: 404951 0 State Plan ID No: Parcel Tax No: 020 - 1342 -10 -140 STATION BS HI I FS ELEV. Bed/Trench Center Benchmark * 0 +1 1-13 Topsoil 0.93 � I C U-0 Force ma' Alt. Dia. r p Bld . Sewer r � 31 St/Ht Inlet No. Of Trenches (-3 r� z 14. IZ 30 t Inside Dia. St/Ht Outlet 7INFORMATION r N p� BLDG WELL LAKE /STREAM Dt Inlet Manuf cturer: 00 Type Of System: ri v ew�e�+. 4 Dt Bottom Header /Man. I 60.001 q�• I Final Grade 1 " �. �3 ' St Cover �j I k o} 9y.A f TDH Lift F ' Ion s System Head TDH Ft Bed/Trench Center Bed/Trench Edges Topsoil Yes No � Length Dia Force ma' Length Dia. r A AA SOIL ABSORPTION SYSTEM 31 ength � No. Of Trenches (-3 PIT DIMENSIONS No Of Pits Inside Dia. Liquid Depth 7INFORMATION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING CHAMBER OR UNIT Manuf cturer: 00 Type Of System: ri v ew�e�+. 4 Model TV: IAti r11CTRIRI ITWIN SYSTEM Lad.._.L A/I a..,I L- I at..lad! •Z' Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Bed/Trench Center Bed/Trench Edges Topsoil Yes No � Length Dia Length Dia Spacing C(111 Rf1VFR — 0 --. c fl.h' vv Mnnnrt Or At_Clrade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No ;-gj Yes i�! No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #I SP Z4A ?— Inspection #2: 7 -- ( - 4 - Location: 490 Carriage Lane Hudson, WI 54016 (NW 1/4 T29N [[2�19W) Win sor Heig s Lott 14 Parcel No: 32_.2 1.) Alt BM Description= (,,,•l�Ic.� 44-- 511(. '�• s C.Y► ski{ -- ' �.'(� S S� � - . 2.) Bldg sewer length = Z, 1 1� • Z9 9 / t r 0 � q 3 Z amount of cov � e . � r .. = �� /� JO • C� q(•�j 1(•oO 9a C5 � � 3�TIC4.4,^ 1.�'►S �Yr C dy , . V� Q!• 1( •S�'� `F�•'f3 1� �21u �1•c �1 t tision Required? i Yes No 'r side for additional information. � I. -- Date Insepctor's Signature Cert. No. (R.3/97) � NV IScon sin Department of Com merce Safety and Buildings Division 201 W. Washington n Ave., Av P.O. Box 7162 Madison, WI 53707 - 7162 Countyf Site Address Y!I Sanitary Permit Application Sanitary Permit N n if In accord with Comm 83.21, Wic, Adm. Coyle, personal information you provide _ m aybe used for seconds Privacy Law, s15.04(1)(m ChectiPiCiskm I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's N / n Parcel Number Property rte s Mailing Addre f e 7G �� City, State -- — Zip Coc'_e Phone Number Property Location /'/ 942 T Lot Number Block Number Subdivision Name CSM Number ]LI. Type of Balding (Chen] ult that apply.) i oI or 2 Family Dwel irg - Nurnber of Bedrooms _ 6 Publlc /Commercial - Dm ribs <t3e -- - -- - — -- ❑City ❑ Village Wowns 17 State owned Nearest Nearest Read ti _ III. Type of permit: (f ]trek only one box on line A. Numbering is for internal use.) (Complete tine B, if applicable.) A. 1 ❑ Now rmrnt System qty se 2 L� 1L 3 Cl Replacement of C 0 Addition to For Co u nlac S stem - ___ . _ - -. - Tank Only xistin sy stem _ B' e OWheck iF Sanitary Permit Previously Issued Permit Number Date Issued q � _ __ IV. Type of POWT System: (Check all that apply. Nttrnbering is far internal use.) 44 U Non - Pressurized In- Ground 21 ❑ Mound 47 O Sand Filter 5D C) Constructed Wetland 22 0 Pressurized lo- dUrixu%d 41 Holding Tank 48 E Single Pass 51 ❑ Drip Line 45 U At -Grade 46 ❑Aerobic Treat Unit 49 ❑ Recirculating 30 E3 O rsallTreatmeut t,r fnformatiarr. `tom* _ Design r - :. -- Flow (glxl) 1 ")i+i�E.s:l Area ,7ripersal Area Soil Application Ptteolation Rate System Ekvaric►n Pita] Grade T R,=irei -- Proposed Rate(Gals.1DayVSq.Ft; (Min. /loch) q0" /y Ve Rdan orcl v. _[ _ VI. Tank Inf'a Cap :cY;r in Cotd y r P�uott�er Manufacturer Prefab Site Steel Fiber r,4sllc tialJcns J - I Gallons I of Tanks Concrew Constructed Glass lvcw . _ kxisting 111 _ or Ho _ Ta�iicx Taz _ /_ Septic lding Tani" �/ fit - - — — e — lbxing Chamber _ — -s h e VII. r underslgtterl, assu respooslbility for in stattatlon of the PO% slrmnn an the attached plans. Plumber's Signature —� MPIMPRS Number Business Phone Number -- - -T - -� Plumber's Addreav (Street, City. Stale. Tip ('ode) Vlfl. County %I)epert O nly LJ Disapproved Date Lssued la i Agent Signs ( Stamps) pprovexi U Owner riven in+tial Adverse. Sanitary Permit Fee (' ^ludes Groundwater Determin Adverse Fee) IX. Condi#ions of AP oval/Reasons f ppr vat �r t� �nTw- °.�.� ww�.� w�a..►,t 36 s t>w Qe St>„ ' .r . -M H. 00.;F " ijk 7!1A k12A L _k)Lti j SY44e ^ 6ALM _ A 1 ` tttax ruplrte pTas (to the County only) for the srst on AAA "LL ppt -Lao OAF ee-1 [tom c,4c (4Tt4O Cec N�ER sne ng LAND PLANNERS • LANDSCAPE ARCHITECTS ;ate of Survey for: House Address: �r Ti;RfiEtiCE E. . 9 MOMCi+ER I •' i 9,300 (_�j:• .4 p LANG "p .T AJL. 1" = 30• 7VGSBORO UGC s ea+c�waec mP of tine EL � 945.00 .13 vacant l CyD 6r ' � S r 2422 Enterprise Or'" Mendota Heights. MN 55120 ( 651) 681 -19 14 FAX: 681 -9481 625 Highway 10 N.E. Blaine. MN 55434 (763) 783 -1880 FAX:783 -188 Lc,�- /q b I)r, .0 / X952.9 \ 0 a X 5 / 4 955.8 x-„ --" �' r . � r a / N L �j 252.17 LAND SURVEYORS • CIWL ENGINEERS .or ng LAND SURVEYORS • CIVIL ENGINEERS 2422 Enterprise Drive Mendota Heights, MN 55120 (651) 681 -1914 FAX: 681 -9481 LAND PLANNERS • LANDSCAPE ARCHITECTS 625 Highway 10 N.E. Elaine. MN 55434 (763) 783 -1880 FAX: 783 -188 :ate of Survey for: House Address: TERRENCE E. ROTHENBACHER 1 + MUMNIA NFIGMTS ON •tea p si OFD LAWD 10 s +sa>41% SBORO UGH HOMES Lc f q Stye. Agi ksas+.o / X952.9 BERCHMANC a •.� ti` EL OF PIPE ti a w 945.06 s>sa.s Q r f i % U X 5 • A� va ' � e j c, ; 955•e 1-4 too do 1_t `-le, s 942.7 ; ' r� TAIL: 1 = 30 , J.A -r yti ,v 'a,430 V EL • 952r r � A - - "?�; vacant �i y ti I r le A _ JjR �s� 117 ! - ____ _________ B� ire 252-17 �t •4VWW �a _ ..... ..... .� J_ + 4 .-.:. ..._ ._...,...._.� .._ ! �. III . T i -• r ' I i Ll 1 --j— Ji — a - -' . i i i i t l LO T i 242P14; _ I I Q �r N.O h s. n � kZ7 A Q c 4?� 1 F a h 1 a r l c Q ® I C C �. J I Z Itz N ~ N A Q �r N.O h s. n � kZ7 A Q c 4?� 1 F a h 1 a r l V4WaonWn DSPOM e� fw SOIL EVALUATION REPORT OtrlrlW d 6■f* •M IM r Vo Comm Bff, "a. AdOt Ode Cofr+fv Ad�•ch mrtrd•u WW .M POW Was W+f s 1rJ a 11 Irnf►. r Imam and POW Mduar. hNl n� AmN.d W. wtfle•1 O W heeltaMrl Mrfrner OvN+t (am fgrpr, $ere of dlMrnrfrNr, "alh rerw, •na I•e•do 0 n.nd plrfrt�es fo nw.rl r•rd. R prtaw PNsso AwAll All In/orm�dol>. ponwW Iillonn.IMrm f proms Mal M. w.e f r ■.�W ow Go (p'w"l low, •• 1r.e� If1 l�q .....Mr 13a1�9 N 0 as" " IM 7 n. Pit amodrudawdlrv..J✓ 9oflnp M o pit GMWW OWN" Ole -. h. 080 b LTA*q WW AE-- � o.oe+ d mrmo lodw h REyfw; 01 -16 -0 Vf1 /1/ V)1 A k S r f Wleoaneln Depodm rd of commerce SOIL. EVALU ATION REPORT Pep■ � amwn or e t ty ww Std i umdanm Wth Comm Se, Wis. Adtn, Code ANdl CeIvoea at po on psW not love don a 111 ■ 11 Irwhos In idle. Men mull Irtdudr. but ne! Iklttted bx verYoei end hclaWW jafmMlae p0W (9Li), drrotlon end POW 1.01 pwcw elope, mis a dknonWoae, north alraw, 4110 I4101110m and dbdutre to rd""M roed. v¢ D -• t S4 Q '� �4 p ass pme All hilb►m uop. Rrvtrwed by P■nrnMMlM■ you Pr■�■ r■■y �.r■d kr rr■aw■+y rwp■+■ iPrlvAfr L+w, �. te.e� N11�■1! oft 49, - Alw 114 t4*1 tN &3Z. T -Zq N R SIa e M . Now or W �. W1mn&0w. viisx-&4 25 Neereri Rand o..� �._ - -- ODt'TAr+>E 6KD111� !d �QI{s rt,K. — - — 114A9;SOgl I1RRtl1�� 4AN>E New Conellvctlorl U+e;,� RerWrntlel / Number o! hadreorrte � Code deAwd deign Aow retr GPo ReplaoenNN1 ❑ Pubic a gmem nerded • Dee(Abo If applceble Pewd msm" Flood PI+M rlevrllon a ndrecomMr CONIPLA 1Mll►t -. !N• artOrAA$U �'K' *A)C ►>1r.3 To !', v��etrr,Mt W4 d N � In. p drown! Ruche Nov. R. Doo b Ihlttn0 wcror Rate Nwbw Depth DomhWt Cebr Raft DaeorlpGon Texture St UC M ConslMenee Seurtdery Roofe P 'LmJlpt •SftMZ In, Mane# au-22. Ccnl. Cdw Or. Sz. Sh. t 6 yK I m -CA 2. 3 lb. t N.A,tl Z-�QbK sib -Ob 8.5 y _A Cs N A, 1 1 y►1 -rv► D.5 9 2 - w.a, al sb +n r 6-W o.-4 0.4 92- 7.5`► '/ A. X 1 3 2 s rwti W- o. (rY� SS I4y y 2 G 0 0,-7 ❑ Boring HaR�7.DN3' 4 -7 NAt@ soma Zmavok } Caeatalla. / E eat" M ❑ Pit DrourW et>rfecooMv. _ ..... M, Dptlt to INngtr+O terser �.._�.. �. Shc Ra1r Mtltltan I Depth pominem RWc �r oncriptlon Texture Struelutte Grnrlrtona Barewhty Roab �' 'CIRit 'l1b12 In. AAurteeA Ou. St. Qw- COI Grp St. Sh. • t;:it Wt $t * BDb t! 30 1 2Z q0L and TSS s30 16' ceKAV eteuent a u too. s 3o move. end TES s� Z OS-06-02— L7! 6 ILin' 1175 101 n-r ei A k i Nam kn Kele 4% &L j rs- Ta�� r ala $R�+ aleb FROM � OW& #"6 -ISO MME IOL 0 &AJ Li lay 9 3 Q PAM 05-06 -W- '- 1 wlsoonsin Department of Co m e SOIL EVALUATION REPORT Page I or Z Division of Safety end Builds in accordance with Comm 85, Wls. Adm. Code FRo owed by Date County ST, CR04X Attach complete site plan on p per not less than 8 1/2 x 11 Inches In size. Plan must Include, but not tinted to: verb nd hodzcntet reference point (SM ), direction and arcel 1.0. Z— O — percent slope, scale or dimensions, north arrow, and location and distance to nearest road. GYLD — l SL+ vi ass print alit Information. /11� Psnonat Information you provide y be used for Secondary purposes (Privacy Lew, e. 15.04 (r) (m)). l N(r•S KO 0 iE5 Ll.C. M\ t 114 t4%41/4 S32- T 29 N R Property ownees Mailing Address Lot Block p Sulxi. Name or CStrt# "1 'S0 90 ~h �� Wtr�1D t - -►�tTs it city State zip C lane Number ❑ city ❑Village Town Nearest Road CorfTA&E GOYS MM 1 550 A,1<. HU -SOS! j C APL IZI A&F, LAAC Ef New Constructlon Use. Residential I umber of bedrooms _ Code derived design flow rate , (,0(2 GPD ❑ Replacement ❑ Public or co mm rclel - Describe: R r F �UF Parent material W ^' Flood Plain elevation it applicable s_ _ General comments .��c 5 andrecommendations: CONULWY(W�IAL W C.KOut - MAY 1 0 2002 - Co P.t D wN EYVA N't o iI`4 Di:.S kc m \\ ST. CROIX COUNTY ZO NING OFFICE (J Boring \ gs f Boring # Depth to Iirniting factor 7 In. Pit Ground surface elay. _ O`d • oa ` / Soil Application Rate Horizon Depth Dominant Color Redox Descriptlon s exturs Structure Consistence Boundary Roots 'E �GP /f in. Munsetl Qu. Sz. ConL Color Gr. Sz. Sh. 1 0 -5 10 \K 1 Boring # In. (D Pit s " Ground surface elev. _` it. Depth to limiting fa or _._ _ L -m m Dom ant Color Redox Description Texture Con stance Boundary Roots in. unsell Qu. Sz Cont. Color Gr. Sz. Sh. 3 N.P', '31 7-fabX ab 9A - co 0.5 1 \I x I ri 4e N A a\ rnFr VJ Z f -m 0.5 0.$ .Z3- p�1 ' N,A, o1 1 3b m r avJ Z v -rn 0,-4 O�V 32- 1ZO 3 /y ny.�, 5 O m� 0� 1��-f" o.� 1.Z b8 - 8S lo ur � A, g 0 ^ �t -- _ a, 7 t• z U Boring Boring # In. (D Pit s " Ground surface elev. _` it. Depth to limiting fa or _._ _ Soil ication Rate Horizon Depth Dom ant Color Redox Description Texture Structure Con stance Boundary Roots GPDRf *E(fff1 'EttiW2 in. unsell Qu. Sz Cont. Color Gr. Sz. Sh. I! D 01.1.1 A3 \_ 6 0 12) x3i Gr R>c Qk \Rab P6 P^P, 01F O K\ Co t4 W— S b 0 1\ - t4 - 9 7 \A h D \57 eta. I El ' Effluent #1 = BOD > 30 22o rrq/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD c 30 mg& and TSS < 30 mgn CST Name (Please Print) —< nature ° % �i( CST Number A) 110 N L l_ SI E Date Evaluation Conducted -9937— 1 slephorte Number Address W9f! ?5 6ge v E "FALLS WT 51402Z OS- Ob - ( y2b -1']7S lb PI n-r al A K i / Qt>r H OMr 7 S I WtiscDwt%vo - V V V N p Mk r aa e. urAL-.1.JC •_ �R..l�1C�Z�a�j� ■ I• G�' G- z $ "1 U ,A. 43 EL cj9.40� �8ti r (I^"T "`� TRtctle�) / $oRwkL r RDA & tt ty -9'1 C ..� oR%C-A-!)kL - %P -ST 5 Lo PE 47' Rgvu►ceAW�JT A L Q Sec � 32 516KE12 C5f JdKdk�u 2z483� DAZE; LOT LwV T- Safety- and Buildings Division County _ mo I)( N v M 201 W. Washington Ave., P.G. Box 7162 1. ScOr� Madison, WI 53707 -- 7162 _Dep of Comm L� _Z —� -�CLZ_ Site Address ` �_ _ Sanitary r ary erm A pplication. Sanitary Permit Il A mber 1 q I S_I In accord with Gomm 83.21, W`Ns C Adin. odr., personal information you provide eck if Revision _ may be used for seco ndary jiurj_nses P'va Law, s15.04 (1) m - i. Application Information - Please Print All Infor ation RECEIVED me Plan I.D.�Number Property Owner's Name MAR 1 4 2x102 Property Owrwes Mailing Address ST. CRUX COUNTY Pmperty Location �C 11/4/, �(/� S 3 - 2 T N. �/ E U GDFFICE__ _— - -- R City, State Zip C Let Number Block Number C 6 Subdivision ame CSM N m r H. Type of Building (Check all that app ) "s S'`'"'' U City __ —� or 2 Family Dwelling - Number of Bedroom. - -- . -_ _._ S—__: ----- ❑ Public /Commercial - Describe Use _ -__ _ C]Township ✓ - - _ - U State Owned Nearest Road O/V o 111. 1'ype of Permit: (Check only one box un line �. Naamberin is for internal use.) (Cox to line B, if ap� p�l .) A. 1Ci New 2 U Replacement System 3 01 Rep cement of 60 Addition to y For ate use __ S y stern - - Tank Qrd Existing r �t eral . B ' U Check if Sanitary Permit Previously Issued + Permit m r Date Issued _ IV. Type of POWT System: (Check all that apply. Nat ring is for internal use.) 44�Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 © Constructed Werland 22 Q Pressurized In- (around 41 Holding ran 48 0 Sinfje Pais 51 U Drip Line 45 O At -Grade 46 UAerobic li orsent Unk 49 0 Recircuizting 3t l0Other V. Dispersal /Treatmen t A rea Information: llesrgn Flaw Dispertisl Area A licatitn Percolation Rate System n Pinal Grade (gpd) r-a tiuil �Izequired Proon, ;_nc(Ga, lDjy,)Sq.F't.) Elevation i (Min.?Ir.;h) I VI. Tank Info Capacity in -� Galicn T a! r :liititi i Number i o1'1'anY - -- - Iola facturer - Prefab Ct:ncrete Constntcted Steel Fiber Glass Plastic New Existing Tanks Tatiks � p Q•l -__. —� ._;. ._— ____. Septic or Holding Tank 7 1 D(Aing Chamber - - - - - -- ­_____ _ - VII. Respon Sta tement- the undersigrtrvf, a•:sume responsibility for rostallation a t POOWTS sho wn on the attached plans. Plumber's Name (Print) PEumtx s rarJre NfPIMPR4 Num r Business Phone Number Plumber's Address (Street, City, State, Zip t °tile) V111 Coun /De art_m LT se On__ Qom _ Disapproved - _ Issued Issuing Sig rta a (No Stamps) Sanitary Permit l ee (includes Cir duatri _ Approved O Owner Given Inititil Adverse � Determination 1 Surcharge tee) 22 ^ S IX. Conditions o Approval /Reasons for Disaproval `o s e(� 2 /'t /IAA tMg.tne tf-1 Attach eow40ete-pVU (tc' 1'�nni}')A* - M.Z _ ^ - tK 1 8 CFt-A-rf_Jnches in siz2 ** * PIONEe1 =! y engineeri T LAND S URVEYORS • CIVIL ENGINEERS LAND PLANNERS • LANDSCAPE ARCHITECTS 2422 Enterprise Drive Mendota Heights, MN 55120 (65 1) 681 -1914 FAX:681 -9488 625 Highway 10 N.E. Blaine, MN 55434 (763) 783 -1880 FAX:783 -1883 Certifica of s urve y for: KINGSBORO UGH HOMES House Address: a SSA A -, G n I ` TERRENCE E. ; _ \ ROTHENBACHER : COLUMBIA HEIGHTS 0 957 1 css4.o Ta \ 9 ,4 \ M N tc, m / \ 958. s . • t, ♦ . a ef \ \♦ i T •• .QJ; \ \ ', Dew ���� 990 't �0 6 , ♦\\ ' %932.9 O \ 20' 40 BENCHMARK TOP PIPE < V , 943.08 956.5 ♦ + . ° ` \, , `12 • . 0. �O �, ��� 13 ; ♦ ' `P X9 .5 'PP \ ♦, d� \ ♦ \♦ 'e va cant ,; ��0 6`• 9 .4 \945.1 \ 955.8 w . \ , �, 9 M ♦♦ Meg � DETAIL: 1' ' y4' `t 1 � h�%K''� 73jD nws.S A �' BENCHMARK •• TOP OF PIPE ♦ ; 1+ ���(�� ,� � T D45.6 EL. 952.85 ' � ,, d 9T, y ♦♦ 48. 949.9 �/ 9$2.9 b. '-' ♦ ' 15 vacant 9 0.3 ,% ry A,�'h \ \ i / /e -- - - - - -- -------- "' -- - -- - -- - -J 1 rf _74 5217 f 9sz _� Ftei -o ADSuS'r 14ouSE LLEVATIONS PeR 501-&S Avo Ors AJNAGE, I -{ouSE Pr- A�E^+ENT P�F U4+NEa PROPOSED BUILDING ELEVATIONS 907.0 Denotes Emergency Overflow Lowest Floor Elevation: 914- ■ fwo.o Denotes Existing Elevation Top of Foundation Elevation: 95 4.4 K ® Denotes Proposed Elevation Garage Slab Elevation: 54.0 (at door) Denotes Drainage Flow Direction 9 Denotes Drainage & Utility Easement NOTE: Proposed building site grading Is in accordance with the �O— Denotes Monument grading plans approved by the city engineer. �-+— Denotes Offset Iron Bearings shown are assumed NOTE: Controctor must verify all dimensions & drivewoy design. LO T 14 , WINDSOR HEIGHTS ST. CROIX COUNTY, WISCONSIN We hereby certify to KINGSBOROUGH HOMES that this survey, plan or report was prepared by m++te or under my direct supervision and that I am o duly licensed Land Surveyor under the lows of the State of Wisconsin. Doted this � � 7 day of /!7� A.D., 2002. Signed: PIONEER ENGINEERING, P.A. Scale: 1 inch = 501eel 1945 200493.02 JPS Terrence E. Rothenbocher, L.S. Reg. No. S -2300 co cn N ° N fI $ C o 1 O o Y a V1 a OA4Cp0000 CD �C T a 46 0 O00000 (D o ���H 1 y 0 N 1..,� � � O�O��DX � �• T T` °" a c o c y 3 r m a Z t --4 a� CD NN ���o�a� �m l� o y���� II C) C rt a. = y p O (D o sZ I O � N � 3a O 7^ VW'rr Z 06 z m o N (n L� §�yw T � � V r r+ r Z S Uf i v r p • m m •v D to < O n •� at Z c o o a X o ��s�ssass r V) C� D O 0 l� D r W O ~ a ?.v m Z ^ A v \) A Z 2 m O y N A a D 0 O O m Z ? o 0 0 h CD D m' •� ' a v° O it 1 0 Ic r � O G � C .. CO C7) ;o o c m o O •*1 t W Z n N j M m o �� o.�•o 0 �zf �2n C. cn co G7 A qm .�-► .Qi G OD 4'Z d r m `' a `_' H '• �• h �'' 'A Z m 5. ° A a '�' �' 4 v o tp 'o y � . I p C, �( � j0 Z D ?' 3 0 e t C 4 1 W O D a X to :. � ''� P to N C, w r 00 y 1 O ? a W OD N O =r A O O O — v - Wtscon"s n Department of Commerce Division of Safety and Buildings Bureau of Integrated, Service*; In Attach complete site plan on paper not less than 81 include, but not limited to: vertical and horizontal r percent slope, scale or dimensions, north arrow, !t APPLICANT INFORMATION - Please riRt Personal information you provide may be used for seco 6 SOIL AND SITE EVALUATION Ic �c r_ ILHR 83.09, Wis. Adm. Code Inches *ze. Plan mu County i1Ce poi �;Ii on and. at ion a�h to nearest ' d. Parcel I.D. # DtC' 0 ' 1997 _.. all infor 7 Reviewed by Doses (Pd%261kT.Ys. 15.04 4.(m) . Property er Location � a' • A,_, _ t �� Lot 114 1/4,S Property Owner's Mailin6 Address Lot # I Block# I Subd. I me or CS City Stag Zip Code Phone Number ' City Village ®Town 1 Page _'/_ of J T__ ,N,R E (orf 1 1/1 ® New Construction Use: 0 Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow teL gpd Recommended design loading rate _, _5 bed, gpdfiF trench, gpdt* Absorption area required 240 _ bed, ft Z0rSO trench, ft 2 Maximum design loading rate , S bed, gpd/f1 gpdV Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent materia D� �l (7� c�� �, _� ��. Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ® S❑ u us ❑ U 0 S U ®s E3 [Is ®U ❑ S Z U SOIL DESCRIPTION REPORT OR Dominant Color Mottles __ - .FMAM= NMA M, mm ���ri■���� mm Remarks: Boring # 13 Ground ele . Eft. �, vD • 09') Depth to limiting �M r % �1�M .FMAM= factor >Y2—in. Remarks: CST Nam (P ase P 'nt) Signatur Telephone No. r Address Date CST Number PROPERTY OWNER SOIL DESCRIPTION REPORT / PARCEL I.D.# Boring # Gro d elev. r ft � 1eptft —ZI , ' D limiting factor ?,5� in. Page of Boring # Ground elev. �ft. Depth to limiting factor ,>2.2 in. Boring # Ground eleu. �ft. Depth to limiting factor ,_in. Boring # 13 Ground elev. ft. Remarks: i M�1—�� Remarks: Dominant Color Mottles Structure E�A Boring # Ground elev. �ft. Depth to limiting factor ,>2.2 in. Boring # Ground eleu. �ft. Depth to limiting factor ,_in. Boring # 13 Ground elev. ft. Remarks: i M�1—�� Remarks: Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) Remarks: Dominant Color Mottles Structure E�A Depth to limiting factor in. 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Lu �.. w _ cts U7 In LO In Q N O U7 LC) .l') L.7 lf) 41 T- G ro (x) C N V) (L) v M tl 4) : I:) CD C, L`J CD a' W r LO c� .rra fh 11 I .'') to 4) L1D (7) s_ m N Q C) N"N 0 Y) C-) C-1 Z7 'p co M r- c3 ,y r., Cp LA d• M N 4) t� o4 cJ :'J (1) Ln ti O it I � L (n O O Ln V7 4 ) N ' 04 N N N N �• V co +J M 7. M ~ I C L � T 0 Cpl C'� t u N c , ( Cl) Lo r -. Rs Y tom- Cal Lt) cr M N --� O L C; c� ci Ci LJ O w. Lu O ;n _ U7 In LO In Q N O LL7 N 41 T- G •� :V MMM n v : I:) CD C, L`J CD a' W r LO c� .rra fh 11 I .'') to 4) L1D (7) s_ Q M C9 47 co M. O N n N CO M N cp m OC N L Of fU N C) LP r• Lo (� •M L� Qr �C Q Q L)T N Q C) N"N 0 � rtd C-) C-1 Z7 'p co M r- c3 ,y r., Cp LA d• M N d w ai ID CD I � L (n O O Ln V7 N ' 04 N N N N 41 V co +J M r M ~ I C L � T 0 Cpl C'� C E' �3 Y tom- Cal Lt) cr M N --� O L C; c� ci Ci LJ O LU ro ;n Q M C9 47 co M. 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The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6199). Table 1: system Design Specifications Sanitary Permit Number 9s' Number of Bedroom Maximum influent Particle Si (i1) Design Flow - P eak (g pd) y� Estimated Flow - Averag_e (gpd) Septic Tank Capaci ( gal) ; moo Soil Absorption Compon Size (ftz) 150 Type of Wastewater Domestic 'rnhlm, 9- AM Ahonref'nn Cmm nenent - L i mits of Reliable Ooeratlon Design Flow - Peak (g Septic T nk Component 2 'o Soil Absorption Component _ S Maximum influent Particle Si (i1) 1f8 _ Maximum BOD (mgf -. 220 Maximum TSS (m� _ _ 150 T able 3: M Sched Septic Tank Outlet Filter -~ - insect, andlor service once ev 3 years Inspect canoe a year and clean at least once ev ery 3 years Soil Absorption Com on m- inapect once e very :3 years a I t� lc T gnk The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Crease Interceptors, Seepage Bevis, Seep8gp Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The u et filter h be � Je:an e ; das ecessary to ensut pro per o tion. The filter c�artrid a shouad remov visions are made to in solids in the tank that may slough cuff the filter when removed from it-, enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced If the alarm is activated continuously. Intermittent filter alarms may Indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole 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 one should ender a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holdings tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. f oil Aber. Uon Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility.. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual Inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion shouid be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Managemont' Flan for a Septic Tank and Soil Absorption Component - Plantings of deep - rooted tr"s and shrubs directly over or within ten feat of the component should be avoided sirdce root intrusion into the component may obstruct wastewater flow. 3 Management Plan f9r a Septic Tanis and Soil Absorption Component • Plantings of deep - rooted trOW and shrubs directly o , , , er or lthin ten obstruct wastewater component should be avoided S nom? root intnision into the component flow. 3 CONTINGENCY PLAN If the POWTS falls and cannot be repaired the Wlowing measures have been, or crust be taken, W Arovlde a code compliant replacement system: A suitable replacement area has been evaluated and maybe utilized for the location 11 o!a replacement boll be In dying ed ups► flY don system. The replacement area should be prol"d from disubance and compaction and should rat rls� required setbacks from exisont and proposed stmcwrv, lot "t-As and wells. Failure to protect the replacement area will result in the need for a new soli and site evaiuition to establish a sultat>Ge replacement area. Replacement systems must comply with the rules in effect at that time. 17 A suitable replacement area is not available due to setback and /or soil limitations. Barring advances In POWTS technology a holding tank may be lnst"ed as a last Mon to replace the faiird POWTS. L? The site has not been evtluated to I�dentlfy a sulcabte reptacemeiit area. Upon fallurr of Ow POWTS la b e a holding tank may soil and site evaluation must be performed to locate a sultabie replaeeFntnt area. if no replacement area Is availa be Installed as a last resort to repia.e the failed POY/T5. D Mound and at -grade soil absorption systems may be reconmcwd In place following removal of the biomat at the Innivative surface. Rxconsuvalons of such systems must comply with the rules In effect at tl'wt time. < <WARNING> > SEPTIC, PUMP AND OTHER TRSATMENT TANKS MAY CONTAIN LETHAL GASSE5 AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMINT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE Of A PLR$ON FROM TKE INTIRICIR Of A TANK MAY EL DIFFICULT OR IMpnWIPtt V ADDITIONAL COMMENTS POWTS INSTALLER Name o �. Phone SEPTAGE SERVICING OPERATOR (PUMPER Name POWTS MAINTAINER _ Name Phone It OM REGULATORY AUTHORT" Apnc7 / .>1: _C roj,g j KL sue_ o ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer r� Of o ��� S, LL C� C10 Cc , ( i cc Mailing Address 'K 7-'S y - '"/ y y - V . CD H G` G rove , A441 S Property Address wz (Verification required from Punning Department for new City /State Parcel Identification Number 429s LEGAL DESCRIPTION Property Location NIA✓ %, /✓G� /,,, Sec. 3 2 , T Z 5 N -R L`-W, Town of 14 —� Sow Subdivision V 1 r�� S o,- Lot # Certified Survey Map # , volume . . Page # Warranty Deed # k 3 9 . C5 ----------.. / 5 3 Page # /b Spec house ❑ yes V� no Lot lines identifiable „Dyes ❑ 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 mastor plumber, journeyman plumber, restricted plumber or a licensed pumper vorifying that (1) the on 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 tic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three y xpiratio 3 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 property descn above, by virtue of a warranty deed recorded in Register of Deeds Office. 3/7/O 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 ? }L 1593PAGE 4t . A to ts39 -4 09 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 02-28 -2001 11:45 All WARRANTY DEED EXEMPT 9 CERT COPY FEE: COPY FEE: TRANSFER FEE: 1438.20 RECORDING FEE: 10.00 PAGES: 1 Recording Area Name and Return Address EAGLE VALLEY BANK, N.A, 1301 Coulee Rd Unit 2 Hudson, WI 54016 020-1342 -10- 030 ,020. 1342 -10- 0 40 , 020 - 1342.10 -07 020 - 1324 -10- 130,020 - 1342. 130 1342 - 10-140 Parcel Identification Number (PIN) This is not homestead property. , f record, if any. 0() (is not) eke Ba)lders, Inc. 7 ACKNOWLEDGMENT OF WISCONSIN ) ) ss. U ; K County } Personally came before me this /'1 _ day of 2001 the above named e Builders, Inc., a Wisconsin Corporation by C'�KuFf it's r:cSr r�cn� T ____ known to be the person(s) who executed the foregoing nent and acknowledged the same. y nlarltn.e . k' L, r, i Public, State of Wisconsin )mmission is permanent. (If not, state expiration date: 3 /t S/") C)6 / _ ) INOrmalian Pr0tessi0-1S C—p—y. F d. g,L-, 21 NamCS Or pe6u,u n,gumg ... "'I . -r - -.y ..._ -_ __ ., � . - STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2- 1999 STATE BAR OF WISCONSIN FORM 2.1999 WARRANTY DEED Document Number This Deed, made between West Lake Builders, Inc., a Wisconsin Corporation Grantor, and Kingsbrough Homes, LLC Grantee. 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): Lots 3, 4, 7, 13, 14 and 15, Windsor Heights in the Town of Hudson, St. Croix County, Wisconsin. Together With the right of access over Outlot 2, Plat of Windsor Heights in the Town of Hudson for the benefit of Lot 14 of said Plat. Exceptions to warranties: Easements, restrictions and rights -of -way t Dated this 1 `7 - day of February 2001 West L + AUTHENTICATION STATI Signature(s) authenticated this day of Febrtu West I TITLE: MEMBER STATE BAR OF WISCONSIN to me (If not, instru: authorized by 4 706.06, W is. Stats.) L 1 THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notar Hudson, 154016 My C (Signatures may be authenticated or acknowledged. Both are not necessary.) ..r.A Mlr„v fF,rir ciona tom _ 4t . A to ts39 -4 09 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 02-28 -2001 11:45 All WARRANTY DEED EXEMPT 9 CERT COPY FEE: COPY FEE: TRANSFER FEE: 1438.20 RECORDING FEE: 10.00 PAGES: 1 Recording Area Name and Return Address EAGLE VALLEY BANK, N.A, 1301 Coulee Rd Unit 2 Hudson, WI 54016 020-1342 -10- 030 ,020. 1342 -10- 0 40 , 020 - 1342.10 -07 020 - 1324 -10- 130,020 - 1342. 130 1342 - 10-140 Parcel Identification Number (PIN) This is not homestead property. , f record, if any. 0() (is not) eke Ba)lders, Inc. 7 ACKNOWLEDGMENT OF WISCONSIN ) ) ss. U ; K County } Personally came before me this /'1 _ day of 2001 the above named e Builders, Inc., a Wisconsin Corporation by C'�KuFf it's r:cSr r�cn� T ____ known to be the person(s) who executed the foregoing nent and acknowledged the same. y nlarltn.e . k' L, r, i Public, State of Wisconsin )mmission is permanent. (If not, state expiration date: 3 /t S/") C)6 / _ ) INOrmalian Pr0tessi0-1S C—p—y. F d. g,L-, 21 NamCS Or pe6u,u n,gumg ... "'I . -r - -.y ..._ -_ __ ., � . - STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2- 1999 UNPLATTED LANDS CENTRAL ANGE 57'36 CHORD BEARING N26 CHORD LENGTH 160.92 ARC LENGTH 167.91 TANGENT NO215'OrW TANGENT N55 SAf&4 0 TRACT SXALL TRACT rCoode w e no objectiom to tlds plat with respect to 36.15.236.16.236.20 and 236.21(1) WA (2). M6., and ch. Comm 65 of Ow Wig. Admin. s provided by Sec. 236. 12 (6). Wis. Stall. 1 919 — L 1 C.S. x [ImumLmot of Administration - - - - - - - - - - - - - -- o f NuCO VOL. 3, PC. 8 83 L OT 2 * * --------- - - - - -- `_ wis• UTILITY EASEMENTS No POLE OR BUREO FABLES ARE TO BE PLACED SUCH THAT THE INSTALLATION WOULD DISTURB ANY SURVEY STAKE, OR OBSTRUCT VISION ALONG ANY AN ANY LOT LINE OR STREET L THE OISI RBANCE OF A SURVEY STALE BY ANYONE IS A VIOLATION OF SECTION 236.32 OF WISCONSIN STATUES. UTILITY EASEMENTS AS HEREIN SET FORTH ARE FOR THE USE OF PUBLIC BODIES AND PRIVATE PUBLIC UTILITIES HAVING THE RmNT TO SERVE THE AREA LAWr3, RULES AND ftMKArdM (LE•��W[TIMD; MINIMUM LOT SIZE ACCESS TO PARCEL. ETC). BEFORE PURCHASING OR DEVELOPING ANY ND PARCEL OF LA CONTACT THE ST. CROIX COUNTY ZONING OFFICE AND APPROPRIATE TOWN BOARD FOR ADVICE. !� J / � >r N76 LEGEND --- ----- - - - - -- ALUMINUM COUNTY SECTION CORNER j o MONUMENT FOUND c X 4 YMAU 1 LION PIPE FOUND TRACT 3z +\- 1 PROPOSED DRIVE f X • • . ' .. ' ' • • • 50 ROADWAY SETBACK LINE OR AS SHOWN 3 \4' IRON PIPE FOUND - - - - - - - - - - - - - - . DRAINAGE AND UTILITIES EASEMENT 12' X WIDE ALONG R \W AND 6' ON BOTH SIDES OF LOT LINE OR AS SHOWN 1 r ^T ' Is'+ \- -1 IX H.W.L. C S. y 100 YEAR STORM EVENT NOTE: -------- - - - - -- NO BUILDING GRADING OR ANY OTHER VOL, 3. PC. 849 X IMPROVEMENTS ALLOWED WITHIN THE DRAINAGE AND UTI EASEMENTS. LOT 2 I EII r x 30' IRON PIPE SET WANNC 0 3.65 LOS. PER LINEAR FOOT NOTE: ALL OTHER LOT CORNERS YONED WITH X 24' IMENT �rX - - - - -- 1 ')••. RON PIPE WEIG MIC 1.68 LOS. ------- PER LINEAR FOOT to — X — EXISTING FENCEUNE 3 MALL TRACT °� CURVE DATA FOR DRAINAGE AN UTILITY AREA WITHIN LOT 24 0 I7 MANGER C62 0 ---- -- ---- - - - •tT RADIUS 167.00 Z - CENTRAL ANGE 57'36 CHORD BEARING N26 CHORD LENGTH 160.92 ARC LENGTH 167.91 TANGENT NO215'OrW TANGENT N55 SAf&4 0 TRACT SXALL TRACT rCoode w e no objectiom to tlds plat with respect to 36.15.236.16.236.20 and 236.21(1) WA (2). M6., and ch. Comm 65 of Ow Wig. Admin. s provided by Sec. 236. 12 (6). Wis. Stall. 1 919 — L 1 C.S. x [ImumLmot of Administration - - - - - - - - - - - - - -- o f NuCO VOL. 3, PC. 8 83 L OT 2 * * --------- - - - - -- `_ wis• UTILITY EASEMENTS No POLE OR BUREO FABLES ARE TO BE PLACED SUCH THAT THE INSTALLATION WOULD DISTURB ANY SURVEY STAKE, OR OBSTRUCT VISION ALONG ANY AN ANY LOT LINE OR STREET L THE OISI RBANCE OF A SURVEY STALE BY ANYONE IS A VIOLATION OF SECTION 236.32 OF WISCONSIN STATUES. UTILITY EASEMENTS AS HEREIN SET FORTH ARE FOR THE USE OF PUBLIC BODIES AND PRIVATE PUBLIC UTILITIES HAVING THE RmNT TO SERVE THE AREA LAWr3, RULES AND ftMKArdM (LE•��W[TIMD; MINIMUM LOT SIZE ACCESS TO PARCEL. ETC). BEFORE PURCHASING OR DEVELOPING ANY ND PARCEL OF LA CONTACT THE ST. CROIX COUNTY ZONING OFFICE AND APPROPRIATE TOWN BOARD FOR ADVICE. !� J / � >r N76 j z/ � • •�1 ` 1f 1 j 24 1.422 ACRES }4 •�i. 61,961 SO. FT. / 7 A %` UNPLATTED $i SCALE IN FE MzRlm 100 0 WINDSO war" nv par or Tar or=M114urn 32. TIlN. 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