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HomeMy WebLinkAbout020-1353-57-000 r i--7 — Wisconsin Department of Commerce Y Safety -Ind Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 363941 Permit Holder's Name: I ❑ City ❑ Village ❑ Tawn of: State Plan ID No.: Hudoba, Kurt Hudson Townsh CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: e U /46i 4(72 e'-( 4,4.7f1,. / 020- 1353 -57 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1,divi , 5 ,, fe. e_-- pQ ea t `t! ( L SL v6 Benchmark �. 7e) A < ..i ? //c Dosing (( f� F�t� Alt BM Y T / . 2 -S - Aeratiert- Bldg. Sewer 9, 5 9 ?• '3 Ht Inlet / Z 16- h TANK SETBACK INFORMATION ut et TANK TO P / L WELL BLDG. Ae Intake ROAD 13t et I. Septic > ZS z 1 I F I ' NA Dt Bottom I-2 jS A 9 / / 5---- Dosing > 75' 0 -Z -7i NA Header / Man. A r i n : --------- - )__ NA Dist. Pipe (e - -7' 7 q "5 e) (-) -r s- & 3 le. ing Bot. System h) 7 4, 7 9f, /lJ PUMP / SIPHON INFORMATION Final Grade k. ''Y l62.. 1:4■ - ,,r. Manufacturer G /,4 i ��' Demand St cover f-d'<J- `Gr '73 I Model Number . 1s- - GPM TDH Lift Friction G stem TDH � . Z Loss , � `�9 H � Forcemain Length f/ W Dia. 2 i Dist. To Well SOIL ABSORPTION SYSTEM L s ez BED / . Width , Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME �. 4 Z Z DIMEN I• N SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEA I rap y INFORMATION Type O AM -BE Mope um .e: r System: G., NS 1101 O �► '. � _ � �_ DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length /( Dia. y ,/ Length //y cl' Dia. 411A-- Spacing 6 3 ' I N ` [ i I 7s- -/ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over I xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges 1 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 0 / 3 /DO Inspection #2: / / Location: 633 Hillary Farm Road, Hudson, \ WI 540 lfi (E l 1/4 36 T29N R19W) - 3629192057 Cottonwood Ridge - Lot 57 3 )0,6 ae/( i, 4 1.) Alt BM Description =`'P c) ( 9a wtyl �) 74 re w rrc d- `> w Jes (W� 00cc_ Cc 5 2.) Bldg sewer length = 1 2 �l � 11- ,r, ,�}f / �r/ s „/ a_ (Q uc' amount of cover = 7 Y f 'Si f / (, ( e a efel --- Plan revision required? ❑ Yes TI No - Use other side for additional information. e 0 (R.3/97) ,,.,` �1 t s- - /U SBD - 671 De - � Inspector'sSign ure Cert.No. I 1 ADDITIONAL COMMENTS AND SKETCH t SANITARY PERMIT NUMBER: r 1 J - 1 - 11 - 1 -- T _ 1 i 1 1 . 111- _ �. III gg 666 yy 1 -----1-+- ; 1 -1- 1 -4--- . 1---- 1 - 1- -- r -- -- f _.W __ _- w._ _._ _ ___. .. . _ t , : , -- - al 1 ''' • 1 i • t - i ' : 7 IIII MEIN ,:. ±-, I 7 sai ' i i '. 1 : i : - II NMI" a_ ... 111a , : i '----1-1:: - - . 1- -- v 7 2 INN _: _ ._1_ ' .: , ' . ' • Illnalll 1 7 f r A ,,,,,, 1,,,, 717 : . . • p ruilr om 1 1 mit i E : , : r : 11111 . . 11 . IMP. I I 11111.1.1.1 IIII AIM MB ME 11111111111116MOWN t 1-- ' : . . NI HI sma o r 10 . immimi in ---: 4 : . 1_,..„: : : r 111 ' : 11111 ii ' ,, ! I . ' 110. : • 1 A . 1 111 ._1_ : WHIENION . 1 : ' ,i_ : C NEI r r I ' =111111111111 i : 7 , . ..N1101111111111 ., . mumER 11.11111111 is I I 011111 1111 1111MO ' 11 1 1 1111111 . 111 1 . 11111•01.1.101011 IIIEIM.IIMSIMIMII en., imommismins. ammem......sommui mm: menommom r 1111111111111 MIMI INIII 111 41 I II r ' 1111111101110111111. 11111111111611111111111111111 1111 ' tr ' : 4_,.. Imo iheammololl , : , 111111.11111 d a l 1 . IL: : : tal . . MS IMINIII N ''''- r . , • t : i ----- RIM 1 .'" --- 1 — ,' - : ' . - 1 - ± , 1 ' t imam , [scALEH, i -4 , 1 1 f ---4--- ��� F . , ---- 6 3 3 l Large -; F,4+2_w‘_ 2.D ��� Safety and Buildings Division f ` `ISCOnsin SANITARY PERMIT ' ' l 201 W Washington Avenue P O Box 7162 Department of Commerce In accord with Comm 83.1 . Code Madison, WI 53707 - 7162 4. • Attach complete plans (to the county copy only) for the s , on ]Bess • my f than 8 1/2 x 11 inches in size. 5 (.Ap-C • See reverse side for instructions for completing this appl on J E1i 3 0 i . = Sanitary Permit Numb r 363 9' 1 .. �.. �Y1a1 Personal information you provide may be used for secondary purposes ST CROIX r C eck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. COUNTY ZONINGOFFICE 4 Plan Review Transaction Number I . APPLICATION INFORMATION - PLEASE PRINT ALL 'i i' k ATIO ► Property Name 1/ 8 r . o a' • �l(� Own �� 14• 3(s, act •N•Rig or)& Property Owner's Mailing dress , ,,„ .. . e .. Lot Number Block Number - 7 L 'T 7 Cipstate 1-14.--Z dress Code , Phone Number S N me or CSM Numb II. TYPE F BUILDING: (check one) ❑ State Owned ,,/ ❑ city Nearest Ro �,/ i Village �f .11`�- 4 ❑ Public Kt 1 or 2 Family Dwelling - No. of bedrooms / gown f1 c A...4&_ 0 III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Num4grjs,)0_ 1353 ,� 5 7-- r . 1 ❑ Apartment/ Condo 3( 9. I ?. ?o5?- (JG( 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 PERMIT: (Check only one box on line A. Check box on line B, if applicable) - A) 1. r'. New 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 ❑ Holding Tank 12 Seepage Trench d'; o 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit // 43 ❑ Vault Privy 14 ❑ System -In -Fill a — Jto C�-fyCJ� 7 RAM:: 307 _)/ 9 /cD 17 A r VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade 600 Req c 7 uired (sq.. ft.) Proposed (sq. f9 (Ga / � ayy " /sq. ft.) (Min. /inch) Elevation /Ooo J/ 7, v to _ _ 9$, 46 — Feet Capacity VII. TANK in Ca gallo s Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION New Existing Gallons Ta Manufacturer's Name Concre st acted Steel glass App. Tanks Tanks Septic Tank or Holding Tank j/30 — 13 / zir ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber RO5 8 / _ jii- ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum r' Na m (Print) u : -r's Si; nature 11Yr Stamps) PRSW No.: Business Phone Number: , i /��� G�7- CSIIR� PI 037 � ?/5) CGS- 6775 Plumb dress ( / Syeet, it , Sta ,Zip Code): U + ,� / N , c.n ...T SV ( IX. COUNTY / DE ARTMENT USE ONLY ❑ Disapproved S�ppary Permit Fee (Includes Groundwater a e ssue Issuing Agent Sign ture (No Stamps) 'Approved 0 Owner Given Initial 7 Surcharge fee) `_�?�,, Adverse Determination p .S , 69 J° Mx.. . /.------- X. CONDITIONS OF APPROVAL / RE S FOR DISAPP O � ' : � eat S i fitalTrtse . SBD -6398 (R.12/99) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division. Owner, Plumber INSTIkUCTIONS } valid ea rs .. 1. A sanitary permit is va d for two Y Y. 2. Your sanitary permit may be 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 f�eapprove0y t permit issuing authority. 4. Changes in ownership or plumber regtjres aSanitary Pgrmit..fransfer / Renewal Form (SBD - 6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly Maintained: 'The septic tank(s) must be pumped by alicensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. ' To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to oe 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. County / Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic 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 reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by they county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. • The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. r J // badirc 4 s7 4j1 ' lit-A--e-d 4 <elk .;-. /Or) r ri 4 ,tai,AJ 1 /% s/ _ /d /` g5 ( 1 / 1 1 1 =q° 1 d - /6 c i_efi-6 7 _ / i s oic-- , D E 6 fk ;x° `_ 6 . r s r' ,- ,3-3_ Y )1 �7 I 0(7100 / iUc_ 34301-6 Lfr___ . F �-� 6 14-g> i d r (.5y _ele,, . 4' N 84 ri---.. /),,,,,O .?,-. 7 r ld ,t /tLJI ` • • Wisconsin Department of Industry, � ' " SOIL S A N SITE A L U AT I O N REPORT Page 1 of 3 Labor arad Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 020 - 1353 - - 000 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION yVIEWEDD B PATE al 6 - 3a-zeoo PROPERTY OWNER: PROPERTY LOCATION Kurt Hudoba GOVT. LOT SE 1/4 NW 1 /4,S 36 T 29 ,N,R 19 (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 375 Flora St. - 57 na Cottonwood Ridge CITY, STATE ZIP CODE HONE NUMBER ❑CITY EVILLAGE [MOWN NEAREST ROAD Prescott, WI. 54021 ?15 3 62 - Hudson Cty. rd. "N" [d New Construction Use ]K ] Residential / Number of bedrooms 4 [ ] Addition to existing building t ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 5 bed, gpd /ft ' trench, gpd /ft Absorption area required 1200 bed, ft 1000 trench, ft Maximum design loading rate • 5 bed, gpd /ft • trench, gpd /ft Recommended infiltration surface elevation(s) 98.15 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material drift over outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system ®S ❑ U ® S ❑ U ❑ S at U ❑ S DIU ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .............. 1 0 -10 10yr3/3 none sil 2msbk mfr gw 2f .5 1 .6 = i 2 10 -18 10yr4/4 none sil 2csbk mfr gw if .5 .6 Ground 3 18 -38 7.5yr4/6 none sl 2csbk mfr gw if .5 .6 elev. } 10 4 (21 7.5yr4/6 c2d 7.5yr5/6 sl 2msbk mfr gw na .5 .6 Depth to 5 44-80 7.5yr4/6 none co s /sl 2msbk mvfr gw na .5 .6 _ limiting factor 6 80 -14) 7.5yr4/6 none co s Osg ml na na .7 .8 +140 .(S' Remarks: Boring # 1 0 -17 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 : 2 17 -29 10yr4/4 none sil 2csbk mfr -, gw ' 117 .5 .6 3 29 -46 7.5yr4/4 none sl 2msbk �,ir " " Or ` ' (' na - "• .6 Ground n 4 elev. 4 46 -13) 7.5yr4/6 none ms Osg — I k\ ha At 7 • 8 102.95t. i -i WI \. © 10* Depth to 1 01 ' " ._,.t G r �c� J . J limiting Sa. `,4 .4� 9, ,\ 1 aa "h Q', factor +130" 6 9 V. Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Avb ew Richmon. /WI 54017 W]/ Date: .- 21-2Q90 CST Number: m02298 • r PROPERTY OWNER Kurt Hudoba SOIL DESCRIPTION REPORT Page 2 'of 3 PARCEL I.D. # 020 - 1353 -57 -000 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour rry Roots re2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ed 'Trench !.: 1 0 -10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 ....... 2 10 -22 10yr4 /4 none sil 2msbk mfr gw if .5 .6 Ground 3 22 -37 / . 5 /4 none sl 2msbk mfr gw 1 f . 5 .6 elev. 103.05 ft. 4 e 37-38� 7.5yr4/6 c2d 7.5yr5/6 sl 2msbk mfr gw na .5 .6 Depth to 5 48 -128 7.5yr4/6 none co s Osg ml na na .7 .8 limiting .--- -___ factor 58.9A cf. g +128" Remarks: Boring # 1 0 -11 10yr3/3 none 1 2msbk mfr yw 2f .5 .6 4 2 11 -33 10yr4/4 none scl 2msbk mfr gw if .4 .5 3 034 3- '" 2 10yr4/4 c2d 7.5yr5/6 511 M na gw na np .2 Ground `�"� - - elev. 4 42 -60 10yr4/6 none cp.s /sl 2msbk mvfr gw na .5 .6 103.001. -- 5 60 -130 7.5yr4/6 none co s Osg ml na na .7 .8 Depth to - - - -- limiting factor +130" Remarks: Boring # 1 0 -12 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 5 0 2 12 - 22 7.5yr4/4 none sicl 2msbk mfr gw if .4 .5 ................. ' 3 22 -39 7.5yr4/4 none sl 2msbk mfr gw if .5 .6 Ground elev. 4 Ci9-` 10yr4/4 c2d 7.5yr5/6 sl M na gw na .3 .4 103.22. ` 5 47 -13C 7.5yr4/6 none co s Osg ml na na .7 .8 Depth to limiting factor - +130" Remarks: Boring # Ground elev. j ft. Depth to limiting factor - 1 Remarks: SBD- 8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Wort 6 New Richmond, WI 54017 SE4NW4 S36 T29N - R19W MPRSW - 3254 town of Hudson (715) 246 - 6200 lot #57- Cottonwood Ridge 1.N ✓1 " =40' 4M.= top of tel. ped @ el. 100.00' �rlt. BM.= top of 1" pvc pipe C el. 101.85' A 4- 5 ` /Q • t p„ , 040 „aor ary L. Steel 6 -21 -2000 II .... ..• 18mm 18m CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" Ifni. ABOVE GRADE E WEATHER PROOF > 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE c FINISHED GRADE 4" CI RISER W/ PAOLO( 6" MIN f WARNING 1 A80VF G AD •� 4 MI1 18" IN. 6" MAX. r�r�� INLET •• do ll E � • • •, WATER TIGHT SEALS GA • - 0 . _ _ _ _ __. C , : is. TIGHT v BATTLE APPROVED CI PIPE - A S 3' ONTO LM JOINTS w/ SOLID B ' ION PIPE 3' 0 "�" SOLID SO! SOIL PUMP OFF ELL'V . FT, C I 1 �"�' —OFF • RISER D '`,1 PE RISER i - IF TANK MANUFACTUi 3" APPROV BEDDING UNDER TANK HAS APPRO' CONCRETE PAD SPECIFICATIONS EPTIC / DOSE /� - - - - - - _ .... TANK MANUFACTURER: �(�' 3 NUMBER DOSES PER DAY: - TANK S1ZCS: SEPTIC :0 GAL. DOSE VOLUME INCLUDING DOSE GAL FLOWBACK: DI 3„ GAL. AU1RK MANUF AC 11.1 RER: CAPACI MODEL NUMBER: TIES: A :3S INCHES =s SWITCH TYPE: I �� i H x INCHES = PUMP MANUFACTURER: i ,I C fiNCHES = 23_r : HODFL NUMBER . SWITCH TYPE: D .' INCHES a Q C REOUIRED DISCHARGE RATE GPM PUMP E ALARM MIRING AS PER ILHR 15.23 VLRTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . • �,� • MINIMUM NETWORK SUPPLY PRESSURE . ---� FEET • .�� ` �7Y FT/ 100 F FEET FORCEHAIN X '��44f� FEET T. FRICTION FACTOR . • ` FEET TOTAL DYNAMIC HEAD = - j FEET r NTERNAL DIMENSIONS 01' PUMP TANK: LENGTH ____, WIDTH .� DIAMETER 1 V LIQUID DEPTH ____LO____: :IGNED: _ ■ �♦ L NUHeER: / �P da o$s 00 I -- •Ju -03 -00 09:20A P-O Goulds _� 1 i Submer - Effluent Pump '„- MODEL n 3871 EPO4 EP05 .."0411 APPLICATIONS • Fasteners: 300 series • Fully submerged in high • Motor Housing: Cast iron Specifically designed for the stainless steel- grade turbine oil tor for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability dry without damage to heat transfer. • Motor Cover: Thermo las- • Ettluent systems components. p • Homes Available for automatic and tic cover with integral handle •Farms Motor and float switch attachment • EPO4 Single phase: 0.4 HP, manual operation. Automatic points. • Heavy duty sump 115 or 230 V, 60 phase: 0.4 H0 • models include Mechanical • Water transfer Float Switch assembled and ■ power Cable: Severe duty Dewatering RPM built in overload with preset at the factory. rated oil and water resistant. automatic reset. • Bearings: Upper and lower SPECIFICATIONS •EPOS Single phase: 0.5 HP FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, construction Pump: EPO4 built in overload with • EPO4 Impeller: Thermo- • Solids handling capability: automatic reset. AGENCY LISTING 9 D tY� plastic Semi -open design '/a" maximum. • Power cord: 10 foot with pump out vanes for • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. a Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding • Discharge size: 1'/2" NPT. plug. Optional 20 loot • EPOS Impeller Thermo- (CSA listed model numbers length, 16/3 SJTW with p lastic enclos design for • Mechanical seal: carbon end in "F" or "AC ".) improved performance. rotary/ceramic - stationary, three prong grounding plug BUNA -N elastomers. (standard on EP05). • Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 "C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel- 10 - • Capable of running dry without damage to s - 30 -► ScPb1 components. Pump: EP05 8 - 2 -s Ft • Solids handling capability: c 25 3 /i" maximum. < ` fif • Capacities: up to 60 GPM. Z e _ ao • Total heads: up to 31 feet. 3 • Discharge size. 1'W NPT. i 5 - - Mechanical seal: carbon- a- 15 rotary/ceramic- stationary, < 4 - BUNA -N elastomers. o EPOS • Temperature: '' 3 - 10 104°F (40 °C) continuous -- - - -- - 140°F (60 °C) intermittent. 2 - EPO4 5 1- 0 - 00 10 20 30 40 50 GPM 1 1 0 2 4 6 8 10 12 m�lh CAPACITY (4: 1995 Goulds Pumps Effective May 1995 NI. • Wis cons i n Department of Commerce SOIL AND SIT . EVAL ION Division.of Safety and Buildings - Page I of Bureau of Integrated Services in accordance,Wi s p-iR 6 3. Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inc$eS r size n C ounty c 1 include, but not limited to: vertical and horizontal reference p5liat (1 M), dire biiiiit ,I 'r , Cr o4 percent slope, scale or dimensions, north arrow, and locatiorl?a`distap ce to nearest road l barcel LD # J'1 d "f APPLICANT INFORMATION - Please print all ikrmation' •'Rc »x 4 ;,� e ' wed b Date r -0' :r 1 /�� Personal information you provide may be used for secondary purposes rrvacy Latb� � 1 fr1). Y'' t 77 r Property ! p / � erty Ownerr L I \ Property- Lod gfi v K ohnr S7Uu4 N� -<' 1.-' �' G dot. E 1/4 /4,S 3 6, T� 9 ,N,R 1 9 E (or)� /0c0-1/4,S Property Owner's Mailing Address ` oTtf Block# Subd. Name or CSM# 135 3 4wq- -(1 kee -1r• _ 51 eu wed. 2, d�� City State Zip Code Phone Number ❑ City ❑ Village �! Town Nearest Road 1- 11ud5on i ‘NI 1.54014) i (I15 )549 - 6731 I-J u d son 1 C:ly Qd. N ®• New Construction Use: a] Residential / Number of bedrooms 3 -- ` - 1 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow (0C)O gpd Recommended design loading rate • 5 bed, gpd /ft . (o trench, gpd /ft Absorption area required LZ(. bed, ft L 0 trench, ft Maximum design loading rate • J bed, gpd /ft • 6 ' trench, gpd /ft Recommended infiltration surface elevation(s) q 7.10 ft (as referred to site plan benchmark) Additional design /site considerations - I l ro g I('ci O ai u4v jO h plain applicable �4J L Parent material Flood lain elevation, if a licable /034, ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S IN U ® S ❑ U ❑ S LK] U C] S 123• U ❑ S Et U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 0-10 IOyr 312. — Si 2 rnpldc fn C5 I C • 5 ; • to _ 2 0-24 IU q /1I Si 1 Z mabk m Pr c.S -- • 5 •4 — Ground 3 2y- 32I1) yr 51g C2 Si 3 INI - 15bk my -ti CS tvp, elev. gG • ZOft. Depth to ' limiting ' factor 2'-1 in. ' Remarks: Boring # 1 0-11 IOyr 3i2 Si 2rrnbk nn4r S I -P - 5 ; -, Z 2 H- 2lo 10 yr LI N -- . St 1 2 mabk m4r r G S - • 5 . • 3 D.-tic IU L1I I C. 2-p - 1.5yr 3i 1 5mr,sbk. mVC' CS — NP ;NP Ground • elev. 9S•Baft. ' Depth to limiting factor 2u, in. Remarks: CST Name (Please Print) nature Telephone No. dc(anA sGw q.,� Si / - ��s -- - avy- - yam Address Date CST Number 1/48 ems.- -r ;5'74 `'/ S'y i► ,- p /- l t l / (S"4"c&s S'-5 99 Z--C 3 0 ? • PROPERTY OWNER 510-c-}1— SOIL DESCRIPTION REPORT Page L. of 3 l PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 I O io 3I I Z mad m-Cr CS )� • 5 : •b Z 12.3 ib LI /V 1)1 I 2rmbk co-Cr C 5 — - 5 Ground 3 31-42 Ibyr ti/Li .C2e`1.5 SII 'rnsbk r'-Ci C NP NP elev. g5725ft. Depth to limiting factor 31 in. Remarks: Boring # ........................... Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /fie in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # .......................... Ground elev. ft. Depth to limiting factor in. Remarks: Boring # .......................... Ground elev. ft. Depth to limiting _ factor in. Remarks: SBD -8330 (R. 07/96) SocJ -e- l '` _ & rt aL'(( g Wry +r..z 1,rn ( elt(, toe, N " 41. / ', I 3� -• n d3 OJ 13Z • / 0; • Y Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites According to Chapters ILHR 20,'& 21 of the Wisconsin Uniform Dwelling Code, a soil erosion control plan needs to be submitted and approved prior to the issuance of building permits for 1 & 2 family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Stan- dard Erosion Control Plan is provided to assist in meeting this requirement. Instructions: 1. Complete this plan by filling in requestedinformation, completing the site diagram and marking ( ✓) appropriate boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. Site Diagram Scale: 1 inch = X50 feet EROSION CONTROL PLAN LEGEND _ _ _ PROPERTY LINE ■■■■■■..11\'A1111■■■11■■■ ■■■■■■ _ _ EXISTING GE ■■■■■■.40�■■■■.■■■■■■■■■ To TEMPORARY 111111511 DIVERSION FINISHED �'- DRAINAGE K,■ — - — GRADING ��11.11A■■1111 l :: 11M■■■■■■■■ ■ ' FENCE TCE ■ ■■M1 ■■11111121 I MMI1®' 11.111.■ � BALES ■■II11��■ "' MEMPJME�■�■■ 0,.; GRAVEL VEGE ■ RE ;Ii ®�_, ,R1.J21 lfrEUIM t■■ SPEC SPECIFICATION ■„111INIIIIIHM.MEMM2..■®■11■■■ r, TREE ■1■1-__ IIlflh PRESERVATION STOCKPILED SOIL Please indicate north by completing the ■■■■■■■■.■■■■■■■.■ ®■■.■■ arrow below. 4 - -N — PROJECT LOCATION kX )(X t LC, 12‘ /� 6 - 6d A.) 6(' 6TTOM &JOD d "_ T BUILDER t J deYfr4FirTLFAJC OWNER! Xe4 LL O 0 4 WORKSHEET COMPLETED BY A `k-E 2)d WA DATE O 2 - 6 —60 . , ■ EROSION CONTROL PLAN CHECKLIST \ c.7 Check ( ✓) appropriate boxes below, and complete the site diagram with necessary information. � o Fq =... Site Characteristics .1:3' North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. A Location of existing drainageways, streams, rivers, lakes, wetlands or wells. ❑ ) Location of storm sewer inlets. • Location of existing and proposed buildings and paved areas. The disturbed area on the lot. Approximate gradient and direction of slopes before grading operations. Approximate gradient and direction of slopes after final grading operations. I ❑ jirOverland runoff (sheet flow) coming onto the site from adjacent areas. Erosion Control Practices ❑ Location of temporary soil storage piles. Note: Soil storage piles should be placed behind a sediment fence,) a 10 foot wide vegetative strip, or should be covered with a tarp or more than 25 feet from any downslope road or drainageway. )8( Location of gravel access drive(s). Note: Gravel drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick. Drives should extend from the roadway 50 feet or to the house foundation (whichever is less). /1 ❑ Location of sediment controls (filter fabric fence, straw bale fence or 10 -foot wide vegetative strips) that will pre- vent eroded soil from leaving the site. ❑ y4r Location of sediment barriers around on -site storm sewer inlets. ❑ Location of diversions. Note: Although not specifically required by code, it is recommended that concentrated flow (drainageways) be diverted (re- directed) around disturbed areas. Overland runoff (sheet flow) from adjacent areas greater than 10,000 sq. ft. should also be diverted around disturbed areas. ❑ Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade). Note: Such ractices include maintaining existing vegetation, placement of additional sediment fences, diversions, P 9 and re- vegetation by sodding or by seeding with use of erosion control mats. ❑ X Location of practices that will control erosion in areas of concentratpd runoff flow. Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of such practices as in- channel fabric or straw bale barriers, erosion control mats, staked sod, and rock rip -rap. When used, a given in- channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area. In-channel practices should not be installed in perennial streams (streams with year - round flow.) ❑ Location of other planned practices not already noted. . ,.. I . b . c c0 Indicate management strategy by checking (d) the appropriate box: �a ` c 4 a a � ( 0 = o` %1n ' • Management Strategies • ❑ Temporary stabilization of distu areas. Note: It is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (between April 1st and September 15th), or by other cover, such as tarping or mulching. Permanent stabilization of site by re- vegetation or other means as soon as possible (lawn establishment). i Indicate re- vegetation method: Seedy Sod ❑ Other ❑ Expected date of permanent re- vegetation: 0CT Re- vegetation responsibility of: Builder ❑ Owner /BuyeAr Is temporary seeding or mulching planned if site is not seeded by Sept. 15 or sodded by Nov. 15? Ye, No ❑ ❑ Use of downspout and /or sump pump outlet extensions. Note: It is recommended that flow from downspouts and sump pump outlets be routed through plastic drainage pipe to stable areas such as established sod or pavement. ❑ ( - Trapping sediment during dewatering operations. Note: Sediment -laden discharge water from pumping operations should be ponded behind a sediment barrier until most of the sediment settles out. Proper disposal of building material waste so that pollutants and debris are not carried off-site by wind or water. Maintenance of erosion control practices. - • Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to half the barrier's height. • Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be replaced (typical bale life is three months). • All sediment that moves off -site due to construction activity will be cleaned up before the end of the same workday. • All sediment that moves off -site due to storm events will be cleaned up before the end of the next workday. • Gravel access drives will be maintained throughout construction. • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. For more assistance on plan preparation, refer to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook, and UW— Extension publication Erosion Control for Home Builders. The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available through State of Wisconsin Document Sales, 608/266 -3558. Erosion Control for Home Builders (GWO001) can be ordered through Cooperative Extension Publications, 608/262 -3346 or the Department of Industry, Labor and Human Relations, 608/267 -9360. EROSION CONTROL REGULATIONS UNIFORM DWELLING CODE (DILHR) PROJECTS AFFECTED MAINTENANCE AND WASTE DISPOSAL • All new 1 and 2 family dwellings inWisconsin started • Sediment controls must be maintained until the site is on or after December 1, 1992. stabilized by mulching and seeding, sodding or • b er 1 built after`J�ine 1 Additions to dwellings b 1, 1980. landscaping S APPLICATION PROCESS • All building waste must be properly disposed to pre- vent pollutants and debris from being carried -site • Erosion control plan must be submitted with building permit application to the local building inspector in ENFORCEMENT communities where the dwelling code is enforced • Erosion control inspections will be made during other • Erosion control plan must show: regular inspections (footing and foundation, rough con- — Location of the dwelling, other buildings, wells, sur- struction, final, etc.) face waters and disposal systems on the site with • Violations must be corrected within 72 hours respect to property lines • Stop work orders may be issued for noncompliance — Direction of all slopes on the site. FOR MORE', INFORMATION, CONTACT — Location and type of erosion control measures • Local building inspector CONTROLS REQUIRED • Department of Industry, Labor and Human Relations • Silt fences or straw bales along downslope sides and side (DILHR), Safety and Buildings Division, P.O. Box slopes 7969, Madison, Wisconsin 53707, (608) 267 -5113. • Gravel access drive • Straw bales, filter fabric fences or other barriers to protect on -site sewer inlets • Additional controls if needed for steep slopes or other special conditions STORMWATER PERMIT (DNR) PROJECTS AFFECTED — Proposed erosion and storm water pollution control • Any construction project that disturbs 5 acres or more practices during and after construction • Smaller sites that are part of a planned development —Documentation that an erosion control and storm involving 5 acres or more of land disturbance water management plan which meets DNR standards • Effective October 1, 1992 for any new or continuing has been prepared (plan does not weed to be submit - project ted with the application) • Exceptions: Indian tribal lands and work done by local —Other information related to site location and per- government staff mit holder APPLICATION PROCESS CONTROLS REQUIRED • File a "notice of intent" application (Form #3400 -161) • Erosion control measures specified in the Wisconsin with the Department of Natural Resources (DNR) 30 Construction Site Best Management Practice Handbook days before construction begins • Measures to control storm water after construction • Application must include: FOR MORE INFORMATION, CONTACT — Timetable for land disturbin g p activities and installa- • Department of Natural Resources, Storm Water Per - tion of erosion control measures including project mitt, P O. 7921, Madison, WI 53707 -7921, (608) start and completion dates 266 -7078 LOCAL ORDINANCES Check with your county, and city, village or town for any local erosion control ordinances including shoreland zoning requirements. Except for new 1 & 2 family dwellings, local ordinances may be more strict than state regulations. They may also require erosion control on construction projects not affected by state or federal regulations. A publication of the University of Wisconsin— Extension, in cooperation with the Wisconsin Department of Natural Resources and Depart- ment of Industry, Labor & Human Relations, Ron Struss, UWEX Water Quality Specialist, Westem Area, and Carolyn D. Johnson, UWEX Water Quality Specialist, Southeast Area. University of Wisconsin - Extension Is an EEO /Affirmative Action employer and provides equal opportunities in employment and programming, Including Title IX requirements. GW0001A Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites 1- 06- 93- 15M -10-S -t ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ow; :.r/Buy:;) ... cti�T 1-1c4 „on 84. -- Mai ng Ad';: ;s S c. S'1 �2�5 Cc� Try eiJ G33 Proi arty A ,?tc .x; ss k k A U S o tiJ ✓ _� .. (Verific ttion required from Planning Department for new construction) 1 Cif) State 4,405 lit) Parcel Identification Number 0 —) / 0 - O `040 LEI AL DIf,;; RIPTIO;4 Proi yty Lt:;c ; i ; on' r /<, NW %, Sec. 3 (42 , T Z 9 N -R 1 W, Town of /-1 O 5 e Sub ivisioi i. ,,.,. (e) 7'7 -) Gu o 4 .() R) L) 6 , Lot # _ J . E c Volume Pa Ce>< hied Elm �u t ; cy Map # � , Volum e g Wa ranty :ll e'; d # 6 / / / 3 5) , Volume 1 y 19 , Page # e Spe house I::: • es nc Lot lines identifiable Xyes O no rEM I.riT A]N Impi nl u:.i use and ma: ntenance of your septic system could result in its premature failure to handle wastes. Proper n;: ttenancc cons ..ts of pet lr.i t.g out the s :ptic tank every three years or sooner, if needed by a licensed pumper. What you put into ;•, system can 11:ct the f :don of the septic tank as a treatment stage in the waste disposal system. The ;in gal; f;rty owner Agrees to submit to St. Croix Zoning Department a certification form, signed by the own.: ' nd by a mast . rplumb er urneyman p lumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disp.: t system is in 'roper op( i .,ring conditic n and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full : i sludge. I/wc the und;:r;i!ined have re, id the above requirements and agree to maintain the private sewage disposal system with th.: :andards set f herr: x ; s set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. C:+ :; it'ication ' �� � maintained must be completed and returned to the Si. Croix County Zoning O ffict ithin 30 u . ,; : tics steer. has been stag ; p y � days A the . ear exp - on • e. Ulf SIGI ATURI: (J:; APPLICA0 IT DATE • Ott NER 42 i,1 •;TIFICA';'ION I (w, °;) a: rtify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the 4: zer(s) of the I 'ope ,le ;r,. i.bed ab•. , b virtue of a warranty deed recorded in Register of Deeds Office. SIG A • t l APPLICAT lT DATE r —. *** . Any it .;F,: rmation tha is mis- represented may result in the sanitary permit being revoked by the Zoning Depart= * ** ** 1 elude v [ii h :iris appllca Lion: 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 STATE BAR OF WISCONSIN FORM 1 - 1982 1 1 1 39 WARRANTY DEED KATHLEEN H. WALSH DOCUMENT NO. �]((�� REGISTER OF DEEDS 1459 - .PAGE395 ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between RICHARD O. STOUT and 09 -29 -1999 9:00 AM JANET P. STOUT, husband and wifp, WARRANTY DEED EXEMPT N Grantor, CERT COPY FEE: and s•:1 _ a - 'h e e COPY FEE: husband and wife, TRANSFER FEE: 113.70 RECORDING FEE: 10.00 PAGES: 1 , Grantee, Witnesseth, That the said Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix THIS SPACE RESERVED FOR RECORDING DATA I County, State of Wisconsin: ' NAME AND RETU N ADDRESS �4r+t /4J Lot 57, Plat of Cottonwood Ridge, Town of Hudson, St. Croix County, Wisconsin. t.6zo 020- 1110 -20 -000 PARCEL IDENTIFICATION NUMBER This 1 s not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Birhard 0 Stout and Janet P Stout warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, rights - of - way and covenants of record, • and will warrant and defend the same. Dated this 23rd day of September ,19 99 - Richard 0. Stout (SEAL) Janet P. Stout (SEAL) • (c)►. C (SEAL) (SEAL) w � AUTHENTICATION ACKNOWLEDGMENT signature(s) State of Wisconsin, ss. St. Croix County. authenticated this day of , 19� Personally came before me this 23rd day of September , 19 99 , the above named Richard n- Stout and Janet P. * Stout TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 1706.06, Wis. Stats.) to me known to be the person S who executed the foregoing 'NI( in ru t and acknowledg the sam THIS INSTRUMENT WAS DRAFTED BY Pve( /f �� ���^ Janet P. Stout MAUREEN K. Hudson, Wi . 54016 . M ary Public, ST 0 4 5 V County, Wis. (Signatures may be authenticated or acknowledg44. I are nos Pig commission is permanent. (If not, state expiration date: necessary.) 11•trl• y= f — l� —G3 ,T9- .) • Names of sons st nm any sa t • should b • typed or planted Ae1en3yy. pa,StA2 ar� B B' "' S P'�' 1 by 7P la e P STATE HAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. WARRANTY DEED Form No. 1 — 1982 Milwaukee. 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