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HomeMy WebLinkAbout020-1367-04-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT 1� GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑ City ❑ Village ❑ jown of: C arolyj2 I Hudson Townshi CST BM Elev.: Insp. BM Elev.: BM Description: 101. b Z Z n (. 6 2 Brut' 2 O J t `ern TANK INFORMATION P/L TYPE MANUFACTURER CAPACITY Septic Septic y 35' Dosing ( Alt. BM Aeration Dosing r Ho Bldg. Sewer TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Ventto Air Intake ROAD Septic y 35' Liquid Depth ( Alt. BM NA Dosing r 9 e • sS� Bldg. Sewer NA Aeration SYSTEM TO P/ L St /Ht Inlet WELL LAKE/STREAM Holding 4 St /Ht Outlet _ ( 2 ELEVATION DATA County: St. Croix Sanitary Permit No.: 370204 State Plan ID No.: Parcel Tax No.: 020 - 1367 -04 -000 STATION BS HI FS ELEV. Benchmark , 2 g Inside Dia. Liquid Depth O I . G 2 Alt. BM 1 K ZS 3 - 35 9 e • sS� Bldg. Sewer SYSTEM TO P/ L St /Ht Inlet WELL LAKE/STREAM C- - 4 St /Ht Outlet _ ( 2 9s -n Dt Inlet CHAMBER S 10.18 9Z .TZ , Dt Bottom Model Number Header/ Man. 01� 02 Dist. Pipe 4t — c oo " Bot. System Final Grade St cover 1. 1-8 •,Z 3 �h cT - 3 �p •J •`� 1 Ci . Z'f �• 3 9S - _ — 6 PUMP/ SIPHON INFORMATION Manufacturer Model Number TDH Lift QD b 19 V­ I 1� 4 2 -t o . Z 5--; S7rc&t TRENC Width / Le gt No Of Trenches Vent To Ai` Intake PIT No. Of Pits Inside Dia. Liquid Depth DIM 3 1 K ZS 3 DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Man f tur r: r ' =�' SETBACK INFORMATION CHAMBER S Type Of r + Model Number System: - 01� 02 OR UNIT 4t — c oo " :W- q iction ,' -A� S ��JJ sb ICC HPai Demand qp GPM , I TD S.S`I Ft Forcemain Lengt Dia. Z -" Dist. To Well �� SOIL ORPTION SYSTE l3 DISTRIBUTION SYSTEM r (ff- Header / Mani Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Ai` Intake tof ,I�dy,� Length 'Dia. I Dia. Spacing Topsoil ❑ Yes ❑ No I '7 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: 1 °/ IB' / tb Inspection #2: / / Location: 684 Cottage Lane, Hudson, WI 54016 (NE 1/4 NW 1/4 4 T29N RI9W) - 32.9.9.19.2188 Stageline Ridge - Lot 4 1.) Alt BM Description= 2.) Bldg sewer length= - amount of cover = (• "" / 3� ` ,,� 8 5 0 4 Y tf) 'a l Cu P_I revision required? ❑ Yes No t Us - o her � or ad infoLn'iati n. I12- K ""� ` bate Inspector's Signature Cert No. 46���g17 � 5 cLs..- L �4 (o) Dr+n, So;l - 611 u,en�t rec. v D P - utlo.uA — CST' 1w pit f ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: s z ; V i sconsin SANITARY PERMIT APPLICATION lift Department of Commerce In accord with Cornnv O - V �A$ra Y"`� ��� l 5'Ival c Safety and Buildings Division 201 W. Washington Avenue P O Box 7302 Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for�tfls' stem, el&pa erl% t I s County S G R-0 ( than 8112 x 11 inches in size. REcovE� • See reverse side for instructions for completing th's� placation State Sanitary Permit Number ;� - 3 : 7 - 0 2 Personal information you provide may be used for secondary purp s [Privacy Law, s. 15.04 (1) (m)]. 'f 3T C�AOI X C] Check if revision to previous application State Plan I.D. Number 'TI( I. APPLICATION INFORMATION - PLEASE PRI IN 3�Ca ��' l� Property Owner Name % kOL P ' St - 65 Q r�LK P e • c q 4 Gt A, S T Z- I r N, R E (or (W Prop Z Owne Mailing Address ber /f Block Number City, State u ids' o I , Zi Code �yo �P Phone Number ( go atoCv Subdivision Name com er STLiN �'- �f�G - � -II. TYPE B IL ING: (check one) ❑ State Owned V 2- [I ity ❑ vlll g o f Ops � Nearest Road C JTA<rb� 4 I ' Public 1 or 2 Family Dwelling - No. of bedrooms III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 0210 13 _l 4 L - ?- b o -- -- 1 ❑ Apartment/ Condo 3"2_ ?- - 1 9 , 2f 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV TYPE OF ERMIT (Check�only one box online A. Check box online B, if applicable) A) 1. ew 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ------ System ___,____ System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 E] Holding Tank 12 Trench 22 In-Ground Pressure 42 Pit Privy page E] � _ ❑ 13 E] Seepage Pit ( i 43 ❑ Vault Privy , 2S— T 14 [] System-In-Fill 3 3 91 S -7 — !6Z • 0 VI. ABSORPTION SYSTEM INFORMATION: '4r5 • d ----- 7 g. S 1. Gallons Per Day V 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Sap — VIE Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min. /inch) t, -7 ,-_ Elevation ? 1 60 7 • / • ( Feet 9 ?-0 Feet 1111111 VII TANK INFORMATION Ca p act in gallo Total Gallons # of Tanks Manufacturers Name Prefab. Concrete Site Con- Steel Fiber- Plastic Exper. App. New Tanks Existin Tanks ` At I N strutted glass Septic Tank or Holding Tank I �' Z 'DTs r ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Stoem-Ehamber �4s (050 ❑ 1 ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sew sys s h o wn on the attached plans. Plumber's Name: (Print) Ro 2� RI � P mber'sSi nature: (No tamps MPRSW No.: 2 Business Phone Number: 3��•A9l�S � "- Plumber's Address (Street, City, State, Zip Code) O 1 heat R � ' �[OVSO� 40 SAD IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate I ssued Issuing Agent Signature (No Stamps) Approved []Owner Given Initial Surcharge Fee) \ Adverse Determination ova 5 r ' ZS-Z X. CON ITIONS�OF�A P / ,SONS FOR DI�PROVAL: SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber ;i� ' . e h� `�. `: � _. ?'.. '�.,.. ..e„4.. ms s. '.� -��•* INSTRUCTIONS A sanitarypq(M.i 4 valid $oi lwo (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in owner�h4p or plurot;er requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the ; county prigc to installation 5. V Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a`licensed Oumper Whenever necessary, usually every 2 to 3 years. 6. If you hrave ,.questions corice'r ring your opSite ?ewage system contact your local code administrator or the State of Wisconsin;'Safety and BuiOn"gs Division, 608=266 - 3151; •° , To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailingaddre5s. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI- Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP etc.), address and phone number. Plumber must sign application form. IX', Coynty/ DepartmkTf se Only. < : ,X a *�Cqunty/ Departmeq yse Only. ,_ `Complete plans and•s¢ocifications not smaller tha f`8.1/2 x 11 inches must;be submittectto t he county. The {zl,ons mkkL�st; -' include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding ta`1r k(sj, sZptre tank(s) or other treatment tanks; building sewers; wells, water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation rafe�ertc ,poi ts�_C� complete specifications for pumps and* dose volume; elevation differences; friction loss; pump•perfQtmant-rurve; pump nngd,e1 end pump manufacturer, D) cross section of the soil absorption system.if required by the E:) soil test data on 6 115 form; and F) all sizing information. _ G UND - • RO WATfR SURCH�RG E, 1983 Wisconsin Act 410 inclpded the creation of:surcharg9s (fees) for a number of regulated practices which can a s a effect groundwater.. _ The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Nvisconsin Department of Commerce Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 www.commerce.state.wi.us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 16, 2000 CUST ID No.226375 ROBERT W ULBRICHT 655 ONNEIL RD HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/16/2002 ATTN: POWTS INSPECTOR ZONING OFFICE ST CROIX COUNTY SPIA 1 101 CARMICHAEL RD HUDSON WI 54016 SITE: JEFF OSBECK - RESIDENCE ST CROIX County, Town of HUDSON; ONEIL RD NEIA, NW1 /4, S4, T29N, R19W Lot: 4, Subdivision: STAGELINE RIDGE FOR: Description: NON - PRESSURIZED IN- GROUND SYSTEM Object Type: POWT System Regulated Object ID No.: 663776 Identification Numbers Transaction ID No. 316729 Site ID No. 192204 Please refer to both identification numbers, above, in all correspondence with the agency. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: + On page 1, the three trenches will be 81.25 feet long and have 13 leaching chambers in each. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation /operation. CAUTION: Wis. Stats. 145.135(2)(b)., indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus, depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a otp ential for a lawsuit that may delay the effective date of the code so this status may or may not change. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. I cerel , PAGEL , PO S PLAN REVIEWER II Integrated Services (608)266-2889, M - F; 745 - 1630 HRS PEPAGEL@a COMMERCE.STATE.WI.US cc: JEFF OSBECK ULBBICHT & AaSOCIA,TE CO 655 O'Neil Road • Hudson, WI 54016 715 -386 -8185 N4t NP I - l k kb e'## neg. Designers of Engineering Systems b Private Sewage Consultants a � ohs or PROJECT INDEX DILHR PLAN ID # DATE M A`/• -q J � OWNER Eft F d's QEGK PHONE 71 ' 2 ADDRESS q ` STA &e'G1 RV. R Uj ?jo-v Gtr /s. SyDllo LEGAL DESCRIPTION LO y 5 T G'6LI A,5 E R1 PF �� �T• V1 'Of 0 - 30. v 9, vW, S-ec• 32.T (? Iq Lo. HuOSo� S • Ced r � TOWN OF _ COUNTY - CSTM (3 o t3 14 LQ R I C y l 2Z(r 3 LOCAL AUTHORITY/ SUPERVISION •T• CfeoC X CT Y. 2 0 1 Nlr PROJECT DESCRIPTION: Qew COMSTPOCT1 . FDle A ? O` &D Z eDIC'M • �� E . SO /4 R e pe pxj i S S ur�T1 ILc l�n Co,� vEti Tio.�C 7'F•vPS 'T'�Nk 3 rD 12/�i,�-fte�D �il� oC9 S i 2�b FOB + e w lUrfNTS 7�o Li �411•e. Gv A fe Se/?v�ce. � fF ICv# ,.V .� ti; Nom /" /d OS ev PDI,Q i31� St'7`� S �12�4t A eol4l3o 5,5? f rc. / pvk p OwLy ? TA �- 1zoo �. P >��t� -s�' S, p l �' T. wi U A iv e- �q. P� PLOT PLAN VIEWS pO Pg.2 SYSTEM CROSS SECTI t rnra VIEW Pg. 3 INFILTRATOR SPECS ONS dEP p 10�a�y `+SCo .. ........, -lam Pg.4 COMBO /TANK CROSS SE ROBERT W. Pg. 5 PUMP CURVE SPECS f� A � M UL HUDSON, VA X CORRECTION NEEDED SEE CORRESPONDENCE F 5 " s I Gt This design�or installation is based,entirely on measurements, elevations, landscape c ditions (slopes etc.) and soil suitability provided by CSTM The accuracy of his specs, as reported, shall remain the sole responsibility of the CSTM. Any use of this POWTS design ty any licensed plumber, or any related unlicensed parties or persons (excavaters, laborers) shall not be construed as an assumption of responsibility by the designer for the workmanship, construction, placement, substitution or selection of any components not specified, or , A any assumptions by the plumber that any unspecified components are state approved or proper, or the effects of poor judgement IR If working under adverse damaging weather conditions (wet /frozen soils) by any such parties or persons. G_ * G TV 0 r a t` I � o \ O I F • I I i i i t Zia I I I 1 M 1 I I I I( ro v a I I o I a I I w, II `Qi I -.kNI � i► iol 01 c ol 1 - g � O U ��r > �a - P o r-� nrrn �oic L rn i m- G '71 O O fi R/ 1! � c b� o MN s O �c T, Iff j dam' ---6_ ri -4-7 -.0 1 0 a - d -o - D Z o Z I I U,t1 I AJS I # Fe 770,v �O 1� .G— i 3 C 3 fr�� 1, ,tilt r To Al'yIU6 T 97 o ' re&M--< ,� J,p�4�L— /4 � • O ,i ./ 5. `70 CRo SS Sic �iov ©� Tr�E�uc�.�s 6- h���✓lc C��i¢�i'T � '��i1���i.vl7a��� '' � O��L , , 3 , x � , ,� Gl�.v �-- Gv 14 31 e S dl Fr To Tj- 4., p-e. S ,mac ?`ia.v - el 1,. 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Ulf . 11 1tuf41 ANa O1WA ►INN4 CAlAC11 fill MlIIRe OATS trill �O I'" It 273 of 231 is 1.01, 20 710 f/ 170 25 eS Lack V- ��. 6 Etectrfcel etl errtelors ( d CONSULT FACTORY FOR SPECIAL APPLICATIONS Is or t uplex systems, are OwIllable and • Mercury float twllches are available for controlling tingle and uppNlxl with an alarm. P lical aNernatore, I& duplex systems, are available with or • three phase tyalsmt. WWWA Mean twitch•*, piggyback mercury float twdchea are available for variable level long cycle controls. Bltndard All mode Welohl39lb• y 1. M*gfsl oatoperyed2 IRLECTIONGUIDE N terlee _ • t �' p ' !. sin le 1 "rnechenlcelewhch, 1110 external confr011equlred. Mod el Y F• Ph Control selecllon ! Piggyback mercury ty o ewNch or double PiOyback mercury, goal Mode Am a tlmplex •�Ich. peter b fM0111. M9e t 14 ( uto ' 0 1 — D uplex !. Mechanical t 10'0072 or 10 -6oj& 1 lJI__-L Hen 9 1. 610 FMOI12. 'or Correct model d Electrlcel Alternator, ••E•pak • D" 230 1 AutD 1 , w? i A — 6. epM ;' a nte e6WIIC , 1040225 2S 1ai►d N • eontrd aedvaia .peelh EOe 130 1 hn i S u it , i « / 1: p : ...� ; ;;i ;Igoe i r ak' . wJ_"; boat br x 0f duplex "radon, tocOO2. apfM eonnecibn a wired•In elm• 1. wo M Aale "J ►ek ", for waled;* Donn."__.. a eptloe. /r /ily� ea al2lMeer M•�+•M to" Is tat&" on cemmrv.eon t1Wt•� FM0611 CAUTION t N :: g r it= Ebc4kO np f (A1orEA; Nvch -kd N4rnalor, W itch •1•drk4 wol/e11on ilae IoM • r " • Ab1A1; am A +mpt.■ coned sox AN •4o1rb. M e.l�� Meldd b e iw p e lr Ing *• 010.1 r•e•nl Mallet•• bleu% C•d• (111,C) cod•• •AcuW 6. 1•eew•A Meld. 1`1490 Ad (OtNA1 •M IAe f. eeup•gen•1 14140t D RESERVE POWEPED DESIGN For unusual conditions a reserve safety lector la dngineered Into the design of o' ery Zoeller pump, p t' MAIL Y P.O. OOX 16341 Q Z A q1 1 0a"iff -lKy 40756' -0347 Mallufacfurers of, , , ,(, i SHIP 10:3 80 04 011011tin! F uIL/!r __ Isotf l/a•773I :9 r A j502) Q r so2� 7743674 r 1 1/2 -11 1/2 NPi Wisconsin Department of Industry SOIL AND SITE EVALUATION - tabor and Human Relations Page J of :. Dlvlalpn of Safety and Buildings in accordance with s. r , .11 8. rrt - , Attach complete 9119 plan on paper not less than 8 1/2 x 11 Inches in size. to ptust County ,,, ' Include, but not limited to: vertical and horizontal reference point (BM), d Wtgr(and <.r ... percent slope, scale or dimensions, north arrow, and location and dista 91", earest road.'' .A , APPLICANT INFORMATION - Please print all informat M y viewed by Date Personal Information you provide may be used for secondary purposes (Privacy Law 9, 15;04, U� y Property Owner . Property Loc lb Ell h •tom t R r F T /N - ��R 1V E y J� ' /k' ; 1/4,S 3L T 2 9 ,N,R E (or�v Property Owner's Malting Address Lot Subd. Name or CSM# y 2. q STA&E L. i to E_ R P• !f sT�4G i v E �'i�6 -E CI1y State Zip �C Phone Number Nearest Road E`L I �V sa j 40 1. ,5 O (7ls )36(O ' Z�O�O�j ❑ City E] Village Town New Construction Use: Residential / Number of bedrooms 3 _ 7 Addition to existing building ❑ Replacement El Public or commercial - Describe: &IZJ Aldr o &�-Cd�y�.,���� ` c O - &0 .0 Code derived daily flow _ gpd Recommended design loading rate bed, gpd/fl ` S trench, gpd/11 Absorption area required bed. ft 2 1 k o " trench, ft 2 Maximum design loading ratV�_bed, gpdifl - s trench, gpd/ft Recommended Infiltration surface elevalion(s) So" p L1.3 7X' 0 (as referred to site plan benchmark) Additional design /site considerations Z O�G' � *AOR ; " �•Ls' & /Wrl o 130Y �rsT Parent material Flood plain elevation, it applicable S = Suitable for system Conve tional I Mound in- Ground Pressure I AT -Grade System in FRI Holding Tank U = Unsuitable for system ❑ u I Lis' ❑ U C-s' ❑ u I E;W ❑ u ❑ S P-1 ❑ s Boring M Ground i DC1 t e 4— Depth to limiting factor 7 6f— Boring fi Ground �t 91 Depth to limiting f ctor g In. SOIL t7FSCRIPTInPJ RFPnAT Horizon Depth In. Dominant Color Munsetl Mottles Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/tt2 Bed , Trench 7 - 10 YF 2 /3 -_ 4 S- :. C . /o y y! 5 1 f S40e d v! cw - . 2 •3 • 7'S s� ---- LAS /� �� _ _ . S • (v Remarks: Remarks: CST Name (Please Print) Signature Telephone No. 1 POURT P 0T- '71 • 386. 8185 Address Dale CST Number -ZCo3 S Private sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54018 This test s it e APPROVED • for a conventional septic sYst• 4 0 ' /0 -? Z_ . 2 v S& ds W Remarks: CST Name (Please Print) Signature Telephone No. 1 POURT P 0T- '71 • 386. 8185 Address Dale CST Number -ZCo3 S Private sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54018 This test s it e APPROVED • for a conventional septic sYst• 4 k'NEf SOIL DESCRIPTION REPORT PROPERIV OWNER ____ __. _ _ .__ _._ PARCEL 1.17.111 " Boring # Qrrnmd elev. _ It. Dpplh to tirnittng Nclor S$ In. Page Z of 3 Horizon Depth In. Dominnnt Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Car. Sz. Sh. Consistence Boundary Roots 2 Bed . Trench •..Y4 C4 ..5 5�L z f , 6,t v�, 6 — _ sip lfrhye deA, c - • Z' • a Remarks: / Remarks: Horizon 0 1009 "13 �sYA� 77 16e Mottles 011. Sz. C0111. Color Texture Structure Qr. Sz. Sh. Lrl Boundary Roots G /(t 3__ •..Y4 C4 ..5 5�L z f , 6,t v�, •3 Remarks: Horizon Depth Ill, Dominant Color Mtmsr+ll Mottles 011. Sz. C0111. Color Texture Structure Qr. Sz. Sh. Consistence Boundary Roots G /(t Bed , Trench •3 2 �A_ I I I I Remarks: Depth to - 1lmlting lactnr in. __. ___ Remarks: sBDW -8330 (R. 08/95) IMPORTANT NOTE TO OWNERS & INSTALLER: All the finer textured soils (loams,silts, etc.) can & will be easily smeared Or compacted even by a backhoe bucket during trench construction. When this occurs premature failure will result. As per ILHR 83.13 U ( ), the installer MUST be very careful to properly hand rake t e sidewalls & bottoms to re- expose all of the soils natural structure. Minn. even recommends that scarifying devices be mounted on the sides of the bucket. Only in this way can treatment & absorption be most enhanced for normal longer system life. n' 'ts �I I i �I o oI � o I w � I c � � � I C3 I 4-1 ; I �o �z o ° -Its =- y C m� o► c m F kill A V�` �--�� n � � w o Oi �W � \ N �a r o ' PROPERTY OWNER 0S �£ SOIL DESCRIPTION REPORT PARCEL I.D.# L O T- i — 0o10 - /0 �O ' 3 0 _5'r4 Boring # E M Ground elev. p - 5Qft. Depth to limiting factor 7 /f -in. Boring # 4 Ground ele . /6)Q _Aft. Depth to limiting factor m. 7! - Boring # Ground elev. -ft. Page / of 5- Horizon D Depth D Dominant Color M Mottles S Texture C Structure 2 Consistence B Boundary R Roots 2 Bed , Trench o // / /o y,� 3 _ _ L L � �2,w0,& S S w w z z f. s s:. ell .s L L a a's6,t� c c - - • •s ' A s �.6/- c Remarks: %fI /�� � I irI■ti�� � � �S® Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Depth to limiting factor in. Boring # MMI Ground elev. ft. Remarks: Depth to limiting factor In. Remarks: SBDW -8330 (R. 08/95) OR�G \ h Ulbricht & Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 csr zz6e3'�s Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Depth to limiting factor in. Boring # MMI Ground elev. ft. Remarks: Depth to limiting factor In. Remarks: SBDW -8330 (R. 08/95) OR�G \ h Ulbricht & Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 csr zz6e3'�s Depth to limiting factor in. Boring # MMI Ground elev. ft. Remarks: Depth to limiting factor In. Remarks: SBDW -8330 (R. 08/95) OR�G \ h Ulbricht & Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 csr zz6e3'�s d li 1� 4 � �1 w d D ON r t�z o �• r l 1 1 ' I 1 rn rrf • h � 1 `'': I I w l l fir, �y -ol I �cl I x I J I Z-1 II I I . i I 11 i I i ®� iof W �G - � -33 w w � �c rn 1 \ �z sir :rno R/ o � rn �° 0 v L� 0 0 0 . — O � C-1 t, 4 Z d_ o I Z o 0 a--o k ;a ST C; ROIX COUNTY SU T it TANK M AINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /i3uyer 71 E FF � C A R D L yA) 0 S Q E L k Mailing Address q2 s TAr e 7 9o. ti UP1 D.J GPI J. s5/0l i'ropci ty Address �j0 C liA 6-E Vp r 0, rep /S • s y 0/ (Verifica(ion required from Planning Department for new construction) City /Stale Parcel Identification Number 0 2 0 0 "90 • 3 O LEGAL DESCIUP110N Property Location * N)E - ' /a, N� 'A, Sec. 3 Z , T � N - R � W, Town of Subdivision _ST 'FGiNE l2. t DL-4 Ql a` Lot # T Certified Survey Map # , o un _ ,Page Warranty Deed # &1 666 0 , Volume 1 " - ,Page # 37 2— Spec house 0 yes [9-110 Lot lines identifiable4 yes O no SYS'T'EM MAINTENAN improper use and nilinlenance 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 Ircatnuenf stage in the waste disposal system. 'i Ire properly owner agrees to submit to St. Croix Zoning Department a certification fonn, signed by the owner and by a master pinnrher, jornneyrnan plumber, restticted plumber or it licensed pumper verifying that I) 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. I /we, 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, Slate of Wisconsin. Certification slating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of file three year expitation date. ST .r TURP OF APT'T.1CAN i* DATE OWNER CERTTFICA170N T (we) certify that all statements nn this form are true to the best of my (our) knowledge file property described above, by vitlue of a warranty deed recorded in Register of Deeds Office. Sio E F APPIACAN'i' I (we) Am (are) lire owners) of S //v DATE ** "" Any information that is mis= represented may result in the sanitary permit being revoked by the Zoning Department.' * * * ** *' include with this appiication: a stamped warranty deed from the Register of Deeds office R copy of the certified survey map if reference is made in the warranty deed STATE BAR OF F II - 1998 VOL PAG� qj 1 2 Document Number This Deed, made between EINAR D. HORNE and RITA M. HORNS GRANDCHILDREN'S TRUST AGREEMENT, Einar D. Horne Trustee- and Rita M. Horne, Alternat Trustee dated October 14, 1991 Grantor. and JEFFR S. OSBECK and CAROLYN J. OSBECK _ husband and wife as survivorship marital propert 020 - 1090 -30 Parcel Identification Numbs (PINI This is not homestead property. (is) (is not) Together with all appurtenant rights, title and Interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except ^ none. Dated this da f 14th y February 2000 ,[ SEAL.) EINAR D. HOME, Trustee of the Einar D. Horne an Rita Horne Grandchildren's Tr Agreement (SEAL, Grantee. Grantor, for a valuable coon. conveys to Grantee the following described real estate in St . Croix County, State of Wisconsin Ftecold'mq Area (the "Property"): ' Name and Return Address Lot 4, Plat of Stageline Ridge in the Town of Hudson, r Fl— St. Croix County, Wisconsin. (SEAL) (SEAL) « Signature(s) AUTHENTICATION authenticated this day of 61 SIEs60 K ATHLEEN H. WALSH REGISTER OF DEEDS `IT. CROIX CO., WI RECEIVED FOR RECORD 02 -22 -2000 10:10 AM WARRANTY DEED EXEMPT # CEP? COPY FEE: COPY FEE: TRANSFER FEE: 225.00 RECORDING FEE: 10.00 PAGES: I ACKNOWLEDGMENT State of Wisconsin, ss. St. Croix County. Personally came before me this day of February named Einar D. Horne « to TITLE: MEMBER STATE BAR OF WISCONSIN me known to be the person who executed the foregoing (If not, ins ment and acknowledge the same: authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Barry C. Lundeen Pe . eissler MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. Notary Public, State of Wisconsin 110 Second Street, Hudson, Wisconsin 540 My commission is permanent. (If PFAIGY (Signatures may be authenticated or acknowledged. Both are not Notary Public necessary) _ - - State of Wisconsin ' Names of persons signing in any capacity met be typed or printed below their signature. Wisconsin Legal Blank Co.. Inc. STATE BAR OF WISCONSIN Md —wie. Wis. WARRANTY DEED FORM No. 1 - 1998 CV t0 T. /- 1 , 'IN V P 2.266 ACRES 98,690 SQ. FT. 1 � 1 9" E 35 8.20' to 0 Lo M M i� N O z N I R Lo Lo Lo M \ \ . I I 33'1 C 3,3 1 ' I� C 1�► 0- \ 5 oo\ w � LOT 2 OF C.S. M. cp. / �� 5 O 1.782 ACRES 77,618 SQ FT N J 3 ' •I 50' 1 1.107 ACRES 1 48,216 SQ. FT. 1 !w N 87'2759" W 382 44' --------------- - - - - -- ----- - - - - -- c3 IN V. 13 PG. 3711 ---------------------------------------- 95.02' ----- - - - - -- — — — — — — — — — — — — — — — — — — — � \ 1 / f �IE NW1 /4 (EAST 1249.3') , � \ I I \ I I �\ 6 i 5 \ I C I \ �\ I 6, NDSOR ` \ HEIGHTS ----- -- - - -- - S x 1.004 ACRES 43,731 SQ FT I 1 ._•- •_• -•.._ 1 co O' 1.111 ACRES 48,389 SQ. FT.,, Z � M P \ to 00 \ N SEE DETAIL �\ N tr +� 15pR_AINAGE I BENCH U.S.G.: ELEVA' TOP 0 1 IR S70•4 COMF N8 58 8'3247 "W 41 33' 33' �\ BE' / \\ E T0[ 4 1 TEMPORARY CUL —DE —SAC TO BE REMOVED S1, SE ES MC SHEET 1 OF 2 SHEETS ul T � V N r -.00 _ z _ W , o O M O L N ._•- •_• -•.._ 1 co O' 1.111 ACRES 48,389 SQ. FT.,, Z � M P \ to 00 \ N SEE DETAIL �\ N tr +� 15pR_AINAGE I BENCH U.S.G.: ELEVA' TOP 0 1 IR S70•4 COMF N8 58 8'3247 "W 41 33' 33' �\ BE' / \\ E T0[ 4 1 TEMPORARY CUL —DE —SAC TO BE REMOVED S1, SE ES MC SHEET 1 OF 2 SHEETS p� �afy STC - 104 r L'... . AS BUILT SANITARY SYSTEM REPORT" OWNER t'- PLI ADDRESS �, Sr GROIA a coury*v SUBDIVISIO N / CSM� 0 LOT � SECTION. T 2 "1 N -R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM oR ,GqjAL INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic .tank, manhole cover. Y w INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic .tank, manhole cover. Y z BENCHMARK • ALTERNATE BM: �Dh D� CQ,y ,e A& C K 6) SEPTIC TANK f / PUMP CHAMBER / HOLDING.TANK INFORMATION Manufacturer: �� Yw�S7 Liquid Capacity: � 01�t) Setback from: Well House Other Zo�� GJ p Pump: Manufacturer L & ! 0 Si �Z �• p Model � 1 Float seperation l +0 Gallons/cycle: f Alarm Location � N SiD E ��j f}• G-E r ':SOIL ABSORPTION SYSTEM Width: 3 Length 0 p r Number of trenches Distance & Direction to nearest prop. line: 2 ,5 10 So. LO % L Setback from: well: - 1 House 25 ' Other ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet PC bottom Pump Off Header /Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: q G+ • Z0 • 2, J c PLUMBER ON JOB: `` 13 E RT L C3 2 l C LICENSE NUMBER: J P95 2-2- & 3 l INSPECTOR: YA- u N G A 3/93:jt P6 a o f y Z1 13 IWlls r G 8 rA 5 �eue - fie 7`il- )T�f rp TO IA- o , M� Asso�►ets$ tan /y .(r , s� t)Ibtichl & e Consults private $ew yy�� g55O'Ne11Rd 501 Z�1j?C �/ 1'lr1`b, Hudson, Wis• 0 r 'I / 1 060 l ' V 1 A 5 , v P tA �� v m O r i O S u � � o Q) c 0 lk �l D s J - o � I I I I I I it 16 A � act i I I a I I I iI I � I I X °° II �i I I o; IQI lol I W � o Nl- r �� 7 � Z Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code C/�O( Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 577 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. 02 - 6? - lO 3 d Please print all information. Reviewed by ` Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 3 _ 9 • Z d Property Owner s� �� ; �i:v�¢jce �/�N_ . Property Location / �� �) / J U y,Z J e � i` �S G Govt. Lot Iv � 1 /4 NW 1 /4 S P L T Z� N R ! l /!�' E (o W Property Owner s Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village ( Town Nearest Road k New Construction ❑ Replacement Parent material Use: Residential / Number of bedrooms ❑ Public or commercial - Describe: Code derived design flow rate GPD General comments / � and recommendations: �- ,� i�v mil/ 7­1 M ., Flood Plain elevation if applicable ft. r IA- - 3 Pr - B itz:Z-c r Boring # u .......a I U - -- /� Pit Ground surface elev. ft. Depth to limiting factor } l LP in. Rnil Gnnlienfinn R.4a 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 7 10ye 2-13 L �,>Mfh s w z� . s • 8 /y .oye ---- -- �� s , Z • 3 3 524 7-Sy dVA 2 ? F-1 Boring # ❑ Boring J ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Aoolication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD /ftz *Eff#1 "Ef1#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 CST Name (Plea Print) /� % Signature Z ZCQZ Numb Address / Date Evaluation Conducted Telephone Number CUSS d ,v.Qi �3oti S` �6 /�i ac7� • /�J a 7lS' -3Y6 •( lP/ Property Owner 1-1 Boring # ❑ Boring ❑ Pit Ground surface elev Parcel ID # ft. Depth to limiting factor in. Page of Cnil Ann li—tinn Dn► Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh._ Consistence Boundary Roots GPD /ftz 'Eff#1 'Eff#2 s F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Snil Annli —fine Rntc Horizon Depth in. Dominant Color Munsell Redox Description Qu. $z. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ftz 'Eff#1 'Eff#2 s ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Snil Ann lir fin n R2ta Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD /ftz '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.6100) C v d f 1 %& 0 O u oI d 0 �o I �- �, t l I I I o r t rl ► � w I w t I W � II �i II ��i lal iot k r rl\c 0 1 00 kA t� V � O kA t� V