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HomeMy WebLinkAbout020-1099-30-000 Wisconsin Department of Com,oerce PRIVATE SEWAGE SYSTEM County St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420672 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. �— Permit Holder's Name: City Village X Township Parcel Tax No: Miller, Sam E Hudson Township 020 - 1099 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 1 Oa. o I to.o' Cr S Wm*1 N. ;.,tia.. 33.29.19.399C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark , ( 12 1.3 60(.3z) I Cv -o Dosing Alt. BM Aeration Bldg. Sewer � Holding St/Ht Inlet ET bZ 12- TANK BACK INFORMATION St/Ht Outlet 3 13,02— �• o TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic e Dt Bottom 11� — o r C4) i 9 Dosing Header /Man. 13, {e 1 S }. b2 Aeration Dist. Pipe 13 , } Holding Bot. System ry•�g H. 1b F6•S`f PUMP /SIPH > <---_____ ORMATION Final Grade (g144'42`) -` ((,0 90.3Z• Manufacturer Demand St Cover _ • M IBS- ! q 1 -` t Model Nu • •er TDH'Lift ric'= Loss 'System Head JTDH Ft Forcemain -ngth ••- Dist. to Well SOIL ABSORPTION SYSTEM (I5) 1/4 , Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM • S 31 15' .c.1. 2` SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR E•IOOt a F 4-SE2 �+ I� Z r / / ` UNIT Model Numbr .. 0 11 n /I 1 1 l.•'ti,v. ( J �µp�(Q,L J DISTRIBUTION SYSTEM Header /Manifold „ Distribution x Hole Size x Hole Spacing Vent to Air Intake Length Dia Pipets ------ --- .•r,. Z� / Length Dia Spacing 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 11 Yes E No Lc Yes N No COMME TS: (Include code discrepencies, persons present, etc.) Inspection #1: Z . j 3 Inspection #2: L Location: 652 Bradhurst Dr Hudson, WI 54016 (SW 1/4 NE 1/4 33 T29NR19 -O - NA Lot 2 Parcel No: 33.29.19.399C 1.) Alt BM Description = u..St S;T• '"°"� �.wer, i( `) zJ Q k `reo 640-0,24- 4 2.) Bldg sewer length = 1 1a 1 u - amount of cover = "• t S • 00 3) loo D ozk .kspecl , dt, • kg- -ils) ' r '! , ( Plan revision Required? , Yes XNo I -n ' , Use other side for additional information. J4 ' ..C- i . / J 1 Date lnsepctor Signature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County �.r a. 201 W. Wash'.: on Ave., P.O. Box 7162 5?• C✓01 y �SCOfSI n Madison, ' - I - 7162 Site Address Department of Commerce e-elilfj1 &n. (OS Z Beloit 2Sr Wk. Sanitary Permit Number Sanitary Permit . . • ; - : ' 1 I Z o 4. 7 L In accord with Comm 83.21, Wis. Adm. Code, personal information you provide W i Check if Revision may be used for secondary purposes Priva .7 Law�„g(�, D !C — I. Application Information - Please Print All Information 1•(tt C State Plan I.D. Number Property Owner's Name APR 1 4 2003 Parcel Number S ekt. ltr- 0 /to- a 9q. 30 -1000 Property Owner's Mailing Address ST. CROIX CUU v Property Location 11 C �� / ZONING OFFICE u A/CA• S 33 T -iN,RIgA City, State Zip Code Phone Number Lot Number Block Number Subdivision ame CSM Number /74..A 4A Ir.- V.,/ C L ib 8 3$L- 2 7,,q CSM 1# �S 1 S 7 Z 31(01 II. Type of BtuIding (check all that apply) OCtry or 2 Family Dwelling - Number of Bedrooms i ❑Village ❑ Public/Commercial - Describe Use t, ' 'ownslrip 4 ✓ , f s O W ❑ State Owned - /t. N C t st S t 'X !� 6 /$ / - 4 o = CA &444f CA, tt Nearest Road a Sr- 7 704 / rira.d� k to1S- - .if ■ J•■.- $ III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A w 2 ❑ Replacement System 3 ❑ For County use p Sy Replacement of 6 0 to System I Tank Only 1 Existing System I 1 B. Check if Sanitary Penait Previously Issued 1 Permit Number 1 Date Issued `f2©6 1-- 2 6i '� 3 g IV. of Permit: (Check all that apply)(numbering scheme is for internal use) 44 Non - Pressurized In -Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal , . - . . il Application Percolation Rate System Elevation Final Grade Required Pro... -• €4.0 . IS • Gals./Days/Sq.Ft.) (Min./Inch) , Elevation „.0o 7 karma _ e4-, / 92, ©a , -1 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing krks Tanks Septic or Holding Tank 1, � C 1 � c E, 0.1 At p, ( irle - --Ci VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature �} MP/MPRS Number Business Phone Number f�f1ke,. 144= 3 I J 7#71.414, / -4 z .s0 z fie. to( t- 8,45-192.7 1 Ptumber's Address (Street, City, State, Zip Code) / o 7 o riu k-tlx-v el e. tC 1 g h ✓ r S ram,.. u / S ` e0 1 L V -4 III. County/Department Use Only T Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) t'') Surcharge Fee) ❑ Owner Given Initial Adverse $ S0 • Determination _ .0 I e ( Z. t t lti ..)L4------ IX. Conditions of Approval/Reasons for Disapproval / * 4-11 ac-�s A o..L. • ' . +..n,-- A) / c4 P� �yP.A.0 ... (..k_c,,,,,„_1,,t eiconk4 /AACILI/efti2s0 04 / ifk&ttAikafeVA144 ,,, 1.6,,,,,,,,, : r40..„.,,,, �p /� com plete plans (to the County only) for the system on paper not less than 81/ x 1 Inches In size '� 1 k, S � .t,0 tT*+.1C S t? Q } i8,,, a•,•-t .. S a A. l' { l • Le t trC - tov� U iL SBD -6398 (R. 05/01) (,, .. 5��,. - �z r 5�m /I?ILLE2 C'S 3Z /? 7Z i T z" 41 /y� , aY z \LJr -h_ _ 54 . \ \ & . AIfPfir Df / .- ; 4 F ���Islov\ — � 't" It L( O N PER- 1'� Z (07 Z ,,0„., A /_._ we _ , I , zo 4 a. \ VI / r. 3, t4 .Mt; ( '14 4 DqK eit N - _ Loo */ , ±if Z a e) \ r. \A„Lje I a \Gr ' t \\\ t-2, So 6A L ST o � s t k° \\ cfa x"o 3 -I 44* ��� -T IJCV\F 3 F5 yr... 1 Lf - CIA a.,.,,.6a -: E Ac-1-1 -� C Law•b.,I s 1- 6 \ S 7 s vl . E 1 ?, 0 O I 5 m1LLE2 es /no 37 /? 7z, I -r- z____ 711-;‘ t 1,__ /3( ea( 4 Poo Dpi ✓c.- 1-ifi', S ; A eEvi.S i o v\ PE2 Kit' It II a 6 2_ i , lio �:, I / . .gam : tic: ( zo 1 - , \ —rs-- ogiAt- J ree:e --=- / 0 S. 24.. A r yr• ` \ \ $ kt4• � N a i Et= ► o� o e, 'BZ` 4 ` , / O l, \ "Ir. \ N VA 3 - _ Lor */ Q e� E r4 fr ok. , r 1Z so 64 ST V i)s ri-Ds ice F. Itel d 3., '*t a -T )40 F S 3 v F5 I L(- CHaw.6%• a F Ac-N -- Ckevwla ¶6 o\ S7s-teYv- E1 7, 0c ' 1617 y SOIL EVALUATION REPORT Wisconsin Department of Commerce Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8'16 x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. 020 - 1099 -30 -000 Please print all information. eWed y Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). R i- �1' . _ ll Js ka ( 17,0-)3 Property Owner Property Location J �� 1 Miller, Sam Govt. Lot SW 1/4 NE 1/4 S 33 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 151 2 CSM Vol. 3, Pg. 692 City State Zip Code Phone Number 1 City J Village a Town Nearest Road Hudson 1 WI 1 54016 1 (715) 386 -2769 Hudson 1 Bradhurst Dr. e New Construction Use: Y' Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement 1 Public or commercial - Describe: Parent material Outwash s & gr. Flood plain elevation, if applicable na General comments and recommendations: Previous system area inaccessible due to driveway location. New system area identified requiring Installation of two trenches at elev. = 89.00' using 28 leaching chambers. 1 Boring # J Boring ✓J Pit Ground Surface elev. 92.35 ft. Depth to limiting factor >132" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' *Eff#1 *Eff#2 1 0 -13 10yr3/2 none sl 2fsbk mvfr gs 2fmc 0.5 "9J�• 46 2 13 -18 10yr3/3 none gr sl 2msbk mfr dw 2fm,1c 0.5 1'77-• c61-'° 3 18 -30 10yr5/4 none gr sl 2msbk mfr cw l fmc 0.5 a'7■ -Q 2,0 �Q , 4 30-42 10yr4/6 none gr Is 0 sg mi cs If 0.7 1.2 td` l - 5 42 -76 10yr5/6 none gr s 0 sg ml cs - 0.7 1.2 �� V 6 76 -132 10yr6/6 none s 0 sg ml 0.7 1.2 "1p y°• H#4 & 5 contain approx. 20% gravel. 2 Boring # 1 Boring /e Pit Ground Surface elev. 90.95 ft. Depth to limiting factor >122" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure ' Consistence Boundary Roots GPD /ft' *Eff#1 *Eff#2 1 0 -31 10yr2/1 none sil 2fsbk mvfr gs 2fmc 0.5 0.8 t 2 31-42 10yr4/4 none sl 2fmsbk mfr dw 2fm,lc 0.5 '67-7 0 . p 3 422 ✓ 50 7.5yr4/6 none Is 2fmsbk mfr cw lfmc 0.7 1.2 9ti a �q, A 4 50-69 10yr4/6 none s 0 sg ml cs If 0.7 1.2 5 69 -83 10yr5/6 none s 0 sg ml cs 0.7 1.2 0 6 83 -122 10yr6/6 none s 0 sg mi - - 0.7 1.2 4 ' g s , H#5 contains ,. - ed pockets of gravely sand with approx. 15% gravel. . } . * Effluent #1 = BOD? 30 < 220 mg/L and TSS >; • < 150 m, t #2 = BOD <30 mg /L and TSS <30 mg /L CST Name (Please Print) Sign- re: CST Number James K. Thompson �:-- ... 3602 Address A.C.E. Soil & Site Evaluations ate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 3/27/2003 715 - 248 -7767 9 Property Owner Miller, Sam Parcel ID # 020 1099 - - 000 Page 2 of 3 3 Boring # 1 Boring e Pit Ground Surface elev. 90.55 ft. Depth to limiting factor >125" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftW *Eff#1 *Eff#2 1 0 -12 10yr3/2 none sl 2fsbk mvfr gs 2fmc 0.5 "'� • 4 ' / 2 12 -20 10yr4/4 none sl 2msbk mfr dw 2fm,1c 0.5- f3,.$) 3 20 -36 7.5yr4/6 none gr Is 1 msbk mfr cw 1 fmc 0.7 1.2 4 36-60 10yr5/6 none gr s 0 sg ml cs If 0.7 1.2 r O' 5 60 -84 10yr5/6 none gr s 0 sg ml cs - 0.7 1.2 �" 6 84 -125 10yr6/6 none s 0 sg ml - - 0.7 1.2 fig• H #4 contains approx. 30% gravel, H #5 contains approx. 15% gravel. �',-' 1 Boring 4 Boring # 1 Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftW *Eff#1 *Eff#2 Boring # J Boring 1 Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ GPD /ft' *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. c. 5.6: i Pe.. /4/7 Cu /_de - Sae 1 50,/e ✓a /ua6 0,, are.- dhur's& 10, /\\ • E/G f/a 'o i ..L rive_ ✓e_ / • /oca.L6ed / o r p i o, „. A 5ca./e: / 9o' l / 13O • Ah. 1 le 1 l c _ c9 S "q, �r P Z /O c(1. szt,c) a, / y- :Loc% a .: /lirI (o "Gaaietree. a2 ' (0` Assu ied ¢lei •= /0O.M: V • 1( X > • -7 / • BI J ktil S%\ '` r S tope .-A- ' 'fir 1 -....--- � � o e y roa��c� 92 b a ce �, �\ ' °x s( ° 90. /0-6 6( C.-5m 3f 9� � , 8, o' erm+.04tr Cs-\......„ . /ot Z 83 CsM 3 /6 P3. 3.13 Wisconsin Department of Comn4,erce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420672 0 GENERAL INFORMATION (ATTACH TO PERMIT State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Miller, Sam E Hudson Township 020 - 1099 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 33.29.19.399C TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH (Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing 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 g p Yes E No 0 Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 652 Bradhurst Dr Hudson, WI 54016 (SW 1/4 NE 1/4 33 T29N R19W) NA Lot 2 Parcel No: 33.29.19.399C 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? LO Yes E No Use other side for additional information. I SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ' at 1K \\ on sin Madison, WI 53707 - 7162 Site Address ' Department of Commerce 4 (1:52. 'Eckbt.i-LUL-S b . Sanitary Permit Application Sanitary Pernik Number I f2.0 61-2_ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 0 Check if Revision may be used for secondartpurnoses Privacylaw. s15.04(4(m) I. Application Information - Please Print All Informatior RECPrkir=r) State Plan I.D. Number -------- Property Owner's Name Parcel Number - ' nri), /4-)1 fn ( L-1-- EW . , 0 ,,, , , , 0 --e - / 09 q - 1 a - e)eye.7,. Property Owner's Mailing Address Property Location S 1 - N(11\ (..L)I, , I ( I 1 C t e Bov* ZON1NC OFFICE 5 qA4 NF--54; S2 , .3 T Z-1 N,12/ 7 At' City, State Zip Code Phone Number Lot Number _ Block Number/ 5 ivl A ‘51-. Subdivision Name CSM Number 5 40 74r-361.- 2 7 4f G-5 ni ' 5 f' 2.-- II. Type of Building (check all that apply) 1 airy 01 or 2 Family Dwelling - Number of Bedrooms 1 °Village 0 Public/Commercial - Describe Use 'p 0 State Ownecr 't ' R a I, - ° 17 z L . e a-1/4 = / 3 CA Fis N st Road — --- 5 - elicfra4/ .- ...5 - r 7 #4.rvii. P est Di i oa.-- la. Type of Permit: (Check only one bo . line A (numbering scheme for Internal use). ' .. plete line B if applicable) , . k A. F , unty use 1 New 20 Replacement System 1 Replacement of 60 Addition to System T Only Existing System ..'t Number Date Issued ii• B. 0 Check if Sanitary Permit Previously Issued • IV. Type of Permit: (Check all that apply)(numbe . • scheme is for inte 1 , ..e) 44 A Non -Pressurized In-Ground 210 Mound 470 S. ' ilter ■ f Constructed Wetland 220 Pressurized In-Ground 410 Holding Tank 480 • d , e Pass 1 ' 1 ■ .. Line li ef 450 At-Grade 460 Aerobic Treatment ■ . 49 F • ecircula • i, 0 Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil •lication tion ' ,, - ti. F . Required Proposed • , P. /Days/Sq.Ft.) h) I e -, / / 2_1 a fi ,,, / i 1 1/ f •' 7 i '# ' VI. Tank Info Capacity in Total N ... . ■ turer Prefa. Site S Fiber Plastic Gallons Gallons of T A. Concrete Construe Glass New Existing Tanks Tanks Septic or Holding Tank X - /xi, p / WA" ,,s1A,____ X a saia 6 " 1 "c(..u.4-13P 4.- l 00 Fr 4 VII. Responsibility Statement I, the und • ed, assume responsibility for installation of the • A shown on the attached plans. Plumber's Name (Print) Plum. Signature 1 MP/MPRS Number Business Phone Number Mikr 1 f 0 0 kl. a-II IP 'avtif Z-2- 5 3 0 4/z- nr- /f2-7 Plumber's Address (Street, City, State, Zip' ..e) /" O 4a Olt, kei e., 12.1 Ilvilo k k.)/ .5'0/4 Val. County/Department Use 0 Approved 0 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) 0 Owner Given Initial Adverse Determination '1 22.c ...--- Ft 0 L I ?d3 ' Ad • IX. Conditions of Approval/Reasons fo Disapproval , . , s • -X Atk sa 1 ` t A 1 ' eg ' VJAA A LIZ C-64Aa /vA a);1111"ka ki d4-ej- -4#642441t- •*-• t : . • ,. : .,.....-46 t 14- 0.4, Ii4.4.- , i ' paci Attach complete plans (to the County only) for the system on paper not leas than 81/2 x 11 inches In she SBD-6398 (R. 05/01) ao , P Atz. 1 it° tr. Sr 4 0. t A fito 50 -rye, $.(aLLE►t- C 5 ni .r , ..5 / 9 7 ! 44 0-- 1 G SZ & &44/h uvst".Dro . dc__, Sc // l ey '/r = / I 7'i,' / `J2 4Z 2 . (b 3 c i3 64 I. DI: J . g t.I — da_ .. SA. i _ t L °T 11 1_ eTt' I N ,,, 44, , 441 $ 141. 4: O . ♦ i ' � S. 2 fe i 3- sr/ . a Q.�. it.. � ', � ;\ 4 E 1 �--- -_ � ♦, 35 — Tott ,` A ` 1 T . �A /i v S \ The • f • *� El z- ' ewe, tit N N l-L Z I H [0444E 1 r ------- i , # /oo 71.1 • 4, , v 49 ‘19 fr k..011-1 .K. I ,,: ,4 1, ftitagt f '1,. ? Me �N ,. ' � t 1/4 ,,,,,, , v, .a it o tip II 1 5 AO L.L. Eve- 6 5 ild it 3.5. / '9 7 Z. zo / S'Z 8iacli,, ',Dr; de; ,_., Sc . ht f ly ' "= /o ' �•:.4.ef `'f2- -'"r° 3 c J3 f4a ku it 5 .,vr : Jet..,.... `` / -c... L. 5,4,4-- ■r I L-°7 tt 1_ L- 1- I Y % ,w1 011 / %,, 3 , •t 1 i 3 /.2 5' - rQ ,ta It ` * ‘ *� /3.. >3:c 'P, s E,4414 ♦ ` S z n c 3/ - Tbter I ,�► . ,` li s, F,, we N i, q '! \ ♦` N, G pA K Tr,,� ..Q1 — ` ":,1 'V .:.�, w \ w11 'V \\\\:., ktiF LL ....� , W' LSE A Diirc wai �aE AO / 2. 40 457 ( t d t i / 64. r7s - 1 . 4%.*) *)ibl ,4 4* • *" 44, va. - **14 ' NO Air 040 111111111 ' • 1613 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 020 - 1099 -30 -000 Please print all II • •■• %• • - § R �- �-,r-I , B Date Personal information you provide may be . - i for s�ukjieY(� law, s. .04 (1) (m)). [ �... 1 F O4 2CO3 Property Owner ' roperty Location Sam Miller AN 2 1 ?O03 tovt. Lot SW 1/4 NE 1/4 S 33 T 29 N R 19 W Property Owner's Mailing Address E. # Block # Subd. Name or CSM# P.O. Box 151 S i cA0)i C uU i' ' 2 CSM Vol. 3, Pg. 692 City State Zi Code *r. rIr`:�, - 1 City 1 Village 06 Town Nearest Road Hudson 1 WI 1 54016 1 (715) 386 - 2769 Hudson I Bradhurst Dr. 1 New Construction Use: l ei Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement J Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install three trenches at elev. = 94.50' using 39 leaching chambers. 1 Boring # - B o r i n g Pit Ground Surface elev. _ 97.69 ft. Depth to limiting factor >93 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft *Eff#1 *Eff#2 1 0 - 10yr3/2 none sl 2fsbk mfr as 2fmc 0.5 0.9 2 5 -17 7.5yr4/4 none grIs lmsbk mvfr cs 2fmc 0.7 1.2 3 17-40 10yr4/4 none gr Is lmsbk mvfr cw 1 fm 0 : 7 1.2 4 40 -93 10yr6/4 none strat gr.s 2msbk ds - - 0.7 1.2 tit TOO 3 *. 2.V --`(. ze' 2 Boring # '` Boring , Pit Ground Surface elev. 96.68 ___ ft. Depth to limiting factor _ __ >92" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 *Eff#2 1 0-4 10yr3/2 none si 2fsbk mfr as 2fmc 0.5 0.9 2 4 -21 10yr5/4 none gr fsl 2msbk mvfr cs 2fmc 0.5 0.9 3 21-34 10yr5/4 none sil 2fsbk mvfr cw 1 fm 0.5 0.8 4 34 - 92 10yr6/4 none fs & Ifs 2msbk ds - - 0.5 0.9 26 • f , H#4 consists of an sorted mixture of 10yr6/4 2msbk fs & 7.5yr4/4 2msbk Ifs. * Effluent #1 = BOD 5 > 30 < 220 mg/L and TS'. >30 < 150 e L -* ffluent #2 = BOD 30 mg/L and TSS <,30 mg/L CST Name (Please Print) '• nature: � CST Number James K. Thompson . • 3602 Address A.C.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI ,020 1/17/03 715- 248 -7767 • Property Owner Sam Miller Parcel ID # 020 - 1099 -30 -000 Page _ 2 of 3 3 Boring # Boring A Pit Ground Surface elev. 100.31 ft. Depth to limiting factor >127" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ GPDIft *Eff#1 *Eff#2 1 0 - 10yr3 /2 none sl 2fsbk mfr as 2fmc 0.5 0.9 2 5 -17 10yr4/4 none gr Is 1 msbk mvfr cs 2fmc 0.7 1.2 3 17-40 7.5yr4/6 none grIs lmsbk mvfr cw 1fm 0.7 1.2 4 40 -127 10yr6/4 none strat gr.s 2msbk ds - - 0.7 1.2 OA. /z/i07. cf Boring # ,J Boring Pit Ground Surface elev. — ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft *Eff#1 *Eff#2 Boring # A Boring A Pit Ground Surface elev. __ __ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft *Eff#1 *Eff#2 * Effluent #1 = BOD 5 > 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. 5.6 g /G / - Sac ■ Sof/ e ✓a /ua6 o +'' , p, i3 r o d h o r s • E/c da6'o• ) • /occc►.:6ccl / Drop..Sfa Ir���� INEMEMMI ioz /19 S/0p49 • elect _ / ©.5-26 1- 0/ \\3:, \S- - �3 • t Benchnta ie: la; 1 hi (o owe -tree. •-- Msccmcd tie : = / an ev, s � o 94 ,00' /o / CS M 3 (04. /o t e.sM3 /61.2 P�3c;3 5 14-:. 6111(1 ... 452— 2 rte,( k 4d f .s"T°" ,D, ; vas `j'.. 74 { , 3 T(4-14.44./4 3'tr 10.2 -r BioDif fuser SpecifiCatiOfls 2 2 4-6 3 4 76' OO Ors OO CEO OE 00 G 7C] CM C10 ...„...,. 00 00 00 00 00 00 00 00 00 00 00 00 00 n 0= r�0 0 0 ° 00 0 00 0 Oo CIO 00 0c� o0 00 00 °O o0 coo t Chamber Chamber Height ' T 9e E nd IieW _IL_ • II f - - I ,..•-,: 4' Knockout Universal End Cap • Chamber 11" Stan- 14" High 16" High Available S1ZeS • - Dimensions dard Capacity Capacity i j ,J .. Ak `' ;I 44 a ; ' r r r. tU� } " L., . ., A ' Z �. _ 51: i i t w� s � ), e a fs9 N1VF 7. t... l � t ` i S, I �. f ' .... LL jkkj.. e t4 . LL '. .... " F t - 0,_ 4.` le'.+I ,... t 4 - A r^ w� W .' 1 " 1"i i q h Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. 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.6/99). Table 1: System Design Specifications Sanitary Permit Number +20 6 Number of Bedrooms Design Flow - Peak (gpd) (© o Estimated Flow - Average (gpd) d Septic Tank Capacity (gal) f z... SO Soil Absorption Component Size (ft2) ■200 Type of Wastewater — Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) ( �` L I260(71_ 1212 -. Maximum Influent Particle Size (in) S orb 2 2 1/8 Maximum BOD (mg /L) 150 Maximum TSS (mg /L) Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. 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, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). • The operating condition of the se. ;• _ and outlet filter shall be assessed at least once every 3 years by inspection. T : outlet filte shall be cleaned as necessary to ensule`" proper operation. The filter cartridge shou • 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 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 enter 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 holding 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. Soil Absorption 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 should 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 • , Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. or i '7/- p ; s ► s GL S • S Q.. "� [� Cc /�Or^ ✓�, ND cJ S , � c I O L!a / 0.r c a W, o 1 S ✓� � ° S b : <a 7 Y Ce L�y Zon;h 7 /S- 3' - P 7 1 d 3 • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 51 ' ri .) / L.. L. F t . Mailing Address K Property Address 1 r Z r. (Verification required from Planning Department for new construction) City/State i4,0 ve• W t Parcel Identification Number D 2 - e ' ` 1 D 7 / ` - 30 - o o o LEGAL DESCRIPTION Property Location r, N r, Sec. 3 3, T 2 5 N -R / 7 Town of 11 41 0.3 O ISt . Subdivision C 5 "IA 3S 19 7 , Lo # • Certified Survey Map # 3 '117 2_ , Volume , Page # 10.1 7 - - Warranty Deed # 7o 7 ' l 3 , Volume " , Page # 0 . Spec house yes ❑ no Lot lines identifiable yes ❑ 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 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. 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, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. �.� A/ii /f// / l 23/ 03 • F 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 described above, • virtue of a warranty deed recorded in Register of Deeds Office. ! , / l 2 b3 • /• TURE o F '` PLIC ~t - 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 U • 2 1 2 6 P 6 5 7 76`33 STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO. , MI Document Number RECEIVED FOR RECORD ■ This Deed, made between Thomas C. Jensch, 01/30/2003 12:45PK EXEMPT # REC FEE: 11.00 , Grantor, TRANS FEE: 375.00 and Sam E. Miller, a single person, COPY FEE: CERT COPY FEE: PAGES: 1 , Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St . Croix County, State of Wisconsin: Recording Area Name and Return Address First Federal Savings Bank LaCrosse- Madison ;201 South Second Street Hudson, Wisconsin 5416 020- 1096 -30 -000 and 020- 1099 -30 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Part of NW 1/4 of the SE 1/4 and part of SW 1/4 of NE 1/4, all in Section 33, Township 29 North, Range 19 West, St. Croix County, Wisconsin described as follows: Lots 1 and a) of Certified Survey Map filed September 26, 1978 in Volume 3, Page 692, Document Numb r 3 1972 and Cul -De -Sac as shown on said Certifies Su ey Map. Together with the Roadway Easement for ingress and egress as shown on Certified Survey Map in Volume 5, Page 1220, Document Number 380020. r � FIL Mats a� 1 78 351972 1 � SURVEY MAP 1 CEF�TI FI V 66' I vw,:://70* - ROADWAY EASEMENT FROM PROPERTY TO CTH "N" RECORDED IN VOL. 3 PAGE 691)F 1 CERTIFIED SURVEY MAPS. I % I S 89° 50' 00" E 575.68' M 576.21' R a 160.00' � , ' 415.68 0 \ � c ° Q�,. / / A = 77 °21 90 0 0., ` . / R = 80.00' �`. i CH= N38 ° 50 . 56"E • 100.00' 66' 1 • 1 .. D =102 0 3808 R = 80.00' CH = S 51°09'04 E 124.90' (, I 3.757 ACRES .TO . I 2 RIGHT-OP-WAY _ O Fl o N o o I N 0 N N w Q / o CD ' W a W 1 _._ - - -- i - O ° o Z O o n 1 4.239 ACRES TO Z RIGHT -OF -WAY 66' A5 \ \ \ 1 0 135 ° \) "' �. , I Q. A. ego r O 1 9 S 89 00 651.60 ° 1 66 578.56' R `. °G, 4 oN N 89 °50`00 "W 578.03' M tom'" '' o f APPROVAL OF THIS MINOR SUBDIVISION , ' g ' ' a i l `APEROV,AL F. R • W '440,1 " '' -0- 3UILDIAG oar.: OR SEPTIC SY„ TEM. SCALE r N F T REFER TO 1162.20. _ 8 , Z 1 00' 5d 0 ' I Nab °moo 'E a 4 . ._....,"': ..A't'' # APPROVED P 471''!1 P RwED VE,AC' g t \y R 12 1978 EV ST. CROIX COUtvfiiI I cop, AaV{ENSIVE PAR1Ca I I CERTIFIED • SURVEY MAP I 66 1 i t ~ ROADWAY EASEMENT FROM PROPERTY TO CTH N RECORDED IN VOL. PAGE OF % CERTIFIED SURVEY MAPS. . ■1 S 89°50 . 00 0 E 575.68' M 576.21' R • R ` 160.00 / 415.681 C� o ‘• � ` �� a = 77 °21 of d O., .\. // R = 80.00' CH= N38 ° 5056' E • 100.00' 66' I a = 102 °38'08" R = 80.00' CH = S 51 E 124.90' 1 • I 3.757 ACRES . TO 2 RIGHT-OF-WAY O N 0; I cb , N (0 W 1 0 " co D W 0 O o 2 0 O O. ° , a 1 .�.. o v ' 1. 4.239 ACRES TO Z RIGHT -OF -WAY 66' C \ \ . \ \ 4 \ \ t e \ 1 •, ' *: , ,. ��+ o X35 1 I �� , �; • ■ 1 04 0 ' 1 ,, Tv 4' ' . f. • S 89°5 ^ V s', 0 o 0 651.60 a I 66 5 78. c R, c , cv N 89°50'00'1W 578.05 :4.1 ,--z,---,--------\ a�., . • In TESTT 'CONY WHEREOF, I have hereto c.; subscribed my• name and a,ffix.ed my • L w ' • seal. this 7T /f • day o/// - ,,,1 • " 5. - SCALE 'IN FEET 1� + . 76g4-& b . 100 5d 0 100 ' 4 ona l 4- ' S7 lies Z Notary Public, Hamilton N88 °560C# E ' County, Ohio 75.00'00 My Commission expires • IRON STAKES FOUND i • o' , 0. I PIPE;WEIGHING , August 10, 1�9 + 80 113 LBS. /LIN. FT. ,SET - ' ff x w M " DISTANCE MEASURED R DISTANCE 'RECORDED AS ( Ct `J vac. !:-� � . ' (1 2 f) r " '� w O Z , ° cn U -- b w S1/4 CORNER 3 SECTION 33, i1 • . . �, ' 7,. Si �I I ``v � � , l �7 , T29N R19W: RF 77 -118