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HomeMy WebLinkAbout020-1441-77-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453214 0 GENERAL INFORMATION ( ATTACH TO PERMIT) v 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: Gavin, Mandy & Warren Hudson Township 020 - 1441 -77 -000 CST BM Elev: Insp. BM Elev: BM Descr Section/Town /Range /Map No: (D 0 (c ,-P.w' -- bu tom) st7 /' - -S 36.29.19.2803 TANK INFORMATION ELEVATI DATA TYPE MANUFACTURER CAPACITY STAT'I BS HI FS ELEV. Septic / / Benchmark �►J Dosing w/3- A /66 �`� v Alt. BM 5 , r -, c_ei 672_ Aeration Bldg. Sewer 3 9 Y Holding -- St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 10,3C f 3. P:r" TANK TO ^ ^ P/ L WELL BLDG. Vent to Air � Intake ROAD Dt Inlet —_ Septic / Nod ( 1 � ' +` Dt Bottom ,_._. -- Dosing T" " Header /Man. ( (0.SAS q 3 , 3 5-. Aeration Dist. Pipe t/e- t ,� 3' F'` lo, . `t3' Holding Bot. System ( (1.t 5 --- Y S a . io / Final 2 G ' ra d� PUMP /SIPHON INFORMATION - Latrt fr 2- ef- DOR Z ManufactureL Dema St Cover / \ S ri ..e- v5 ( t - 1 /CO , / Model Number /"------ � , -4 —r- O / TDH Lift Friction Loss stem Head TDH Ft / Forcema Dia. Dist. to Well `----,.....\ y1/95 • j /_ SOIL ABSORPTION SYSTEM (q c { za / h ,,, v J BED/TRENCH Width / Length No. Of Trenches / PIT DIMENSIONS No. Of Pits Inside Dia. 'Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO P /Lm/ BLDG WELL LAKE /STREA LEACHING anu re INFORMATION T e Of System: two / (Yid CHAMBER O c t U �. � u' 'u C 3 � f ,,f Model Number: s 1 �. DISTRIBUTION SYSTEM (Arke a,t ,.p,k, ci -- e t .4444 Header /Manifol Distribution / x Hole Size x Hole Spacing Veneto Air Intake g ,n k Pips) b jt / -------- �_ / (yam Length IP Dia Length Dia Dia Spacing acin g " = SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only _as". Depth Over ( 0 Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil [ Yes V No E Yes No COMMENTS: (Include code discrepencies, persons present, etc.) 1 ' 1 Inspec ion #1: 1 / -( / / Inspection #2: / / Location: 659 Mary Jo Court Unknown (SE 1/4 NW 1/4 36 T29N R19W) Cottonwood Ridge Lot 77 P Parcel No: 36.29.19.2803 1.) Alt BM Description = S 1 1. Z IfE � 1,-- 10 - ..,<w-1-0 6' V' y'1.6� - '� 7' i1 2.) Bldg sewer length = qt. ,, I ,�.. (J@ 0 - amount of cover = I f ���'�U o V� /-1CtA'°\"/"C---' 6� _ �� G� q 4'6/UAL O Plan revision Required? � Yes No `1� (r-4----7,(1 Use other side for additional information. s � 7 � _ �rAr'i C9 Date Insepctor's gnature Cert. No. SBD -6710 (R.3/97) l . PLOT PLAN PROJECT Mandy and Warren Gavin ADDRESS 5341 37th Ave Minneapolis Mn 55417 SE 1/4 NW 1 /4S 36 /T l N/R 19 W Tp N Hudson COUNTY ST.CROIX 5/12/04 4 MPRS Shaun Bird 226900 Jr DATE BEDROOM CONVENTIONAL )00C IN -G ' ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE • 7 ABSORPTION AREA 8 72 # of chambers 28 ■ BENCHMARK V.R.P. Top of 1/2" steel rod ASSUME ELEVATION 100' Filter Zabel A -100 El BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 94.5/94.6 4' below grade Plans Designed Using ap Vent Conventional Powts Manual Versio - ��, >• ,.�__ ' Standard Biodiffuser o -' 1 v Leaching Chamber MEN / o with 31.1 ft2 of Area Well is to meet all setbacks required b y 6' Long 10 WDNR le Grade at System Elevation 34" Property Line 'a -1---- / Pro 4 - . •om House _ w' 20' 10' ik , it> Alt. B. iL s top of 20' 1/2" stee � rod @ 10 , ■ 98.96' • • 1 ,--g 25' B -2 lease note: ale and 2 -3' X 88' S0' dimensions soil tes ont 5�� Cells with match, dime sions are a 50' >3' Spacing (� - aft educated gu ss ( 35' e 00 P B -3 I . Vents 50' 1 B -1 10' .D a) 90' B.M. #1 ' 1 operty Line f ► Safety and Buildings Division County C 1 , 201 W. Washington Ave., P.O. Box 7162 ' V � i ( v' ) X, Visconsin Madison, WI 53707 — 7162 Sanitary Permit Number (to be Filled ' by Co ) (608) 266 -3151 6 -/S13,-)/ (iKa n at Department of Commerce Sanitary Permit Application state Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal infonna..n you t /v A may be used for secondary purposes Privacy Law , , 1xm) C 1 E t • ej ect Address (if different than mailing address) L Application Information — Please Print All Information 0 Z 020- J I - 1 -60 0 Property s Name • 1# Lot* Block # AO , , Pro . Owner s Maili , 1 - /� ,� Pro perty Location / 3 / /�' / 040; ,533// �y/ � � -- -- - yM,21/4. Section City, State / y � ) .Tap Code � /> Phone Number / / /,,7/f ea", / J- y1 / tiJ sS . r 7 N; /$i �� IL Type of Building (check all that apply) U. o _ Y V h C n „ ����� /�� SuJjdivisio Na� /f �CSM Number 4or 2 Family Dwelling — Number of Bedrooms o Public/CotnmclVial — Describe Use Q � f! (1/-.7/111t., / State Owned — Describe Use c ts l.s r' 0 66.1 -.r 1 ' %7 /�,// / / City_ Village pwn i sbip of . III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. i,i,‘ System Replacement System Treatment/Holding Tank Replacement Only Other Modification to Existing System List Previous Permit Number and Date Issued B. Permit Renewal 't Revision Change of Permit Transfer to New . Before Expiration Plumber Owner 11 q C 37- C / 2 //6? IV. Type of POWTS System: (Check all that apply) ( 7 on. - Pressurized In- Ground Mound _ > 24 in. of suitable soil Mound < 24 in. of suitable soil At -Grade Single Pass Sand Filter Constructed Wedand Pressurized In and Holding Tank Peat Filter Aerobic Treatment Unit Recirculating Sand Filter Synthetic Media Filter / chi ng • p • Dti. Lane Gravel -less Pi. Other (explain) -/ ` , ` ,.' V. Dispersal/Treatment Area Information: ! d / r- p (/ - Desi ow (gpd) Design Soil A ' pplication Rate(gpdsf) Dispersal R equired (sf) Dispersal Area Proposed (sf) System El 40 ) zs� 7 g g 6 �? VL Tank Info Capacity in Total Number Manufacturer Prefab Site feel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Ezi.dng Tanks Tanks , Sepdc or Holding Tank _ l2, • • / / /� / Aerobic T tUnit ' T / , /'i� �--_ Dosing -__ -- 1 • :, ■ 0 , , It Sta ' m 1a.1�lf 2 'T. _i i . . e - , , t ibility for Installation of the FOWTS , n. Plumber' Nance (Print) Alp Plumber �" :. MP/MPRS Number Business Phone Number 276 a 7/.)= 2 14, - g..' /Z Plumber's Address (Street, City, S S. te, Zip - . ' WO a ' ffriere-- / VIII. Coutt /De , rim ent Use Onl sanitary p .r Fee (includes Groundwater pate issued . . signature 1. . ‘ , ,. ) Owner Given Reason for Denial '-.4Y / 5 4 V41 1 / / 111 0!.....lt , - t i / I n A 1/ / / d4- aa,„,_,,,, ,,,;...-4,-.... 4 / �. / J / / / Al d t , / , j / o -, / / ♦ ,... Attach complete plans (to the County only) for the system on paper not less than ti ' x 11 inches i 'size Soil Test and System PLOT PLAN 1_0- PROJECT Mandy and Warren Gavin � / A r DRESS 5341 37th Ave Minneapolis Mn 55417 S 1/4 NW 1/4S 36 /T I R 19 W TOWN Hudson COUNTY ST. CROIX j7.1.■ MPRS Shaun Bird 226900 DATE 7/9/04 ATE BEDROOM 4 CONVENTIONAL XXX IN -G ' �! D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 ■ BENCHMARK V.R.P. Top of Lookout foundation ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 92.6/92.5' Plans Designed Using ao Vent Conventional Powts Manual Version 2.0 > 6» Standard Biodiffuser of Cover Leaching Chamber Well is to meet all with 31.1 ft2 of Area setbacks required by 6' Lon g Grade at System Elevation 34" Property Line 1 75 B- A0' B -2 2 -3' X 88' cells with >3' spacing Z Vents I w _ �� 200' fiviiLifii- 20' A_ 'L1' 40' B -1 10' V5 9 7 0 P I 1 I I \ p i P fi P 15' ,.M. * Pro 4 Q: efib House Bedroom p�``)�p Road 7 I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page i of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code t County k . C (...1 D 1 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. /' 4/4l // percent slope, scale or dimensions, north arrow, and location and distance to nearest road. o2 0 —/� — 7 - 7 .6U !D Please print all information. • Date Personal information you provide may be used for secondary privacy Law, s. 15.04 (1) (m)). " • �{ ({ d Property Owner , Property Location /W� CL a e j.% a M,, t . 1 p, qvt. Lot C 1 /4/144) /4 S T O j N R E( r) W Property Owner's Mailing Addre Lot # Block # S d{. Name or CSM# 5 �. • 72 .I,4 City State Zip Code Ph•I lb City ' ❑ dlage V Town Nearest Road / N1 '' '''du r _ 6 Qd GPD 1 New Construction U _ I. Residential /Numb _.� derived design flow rate ❑ Replacement in ❑ Publi or commercial - Describe: _ — __— ______.__ Parent material (.J LCD ' ' ' Flood Plain elevation if applicable ft. General comments / Q • v and recommendations: Sy 5 o ! Z „ ( ,�t✓ - ' tA..f l 9 o 2 , 6 / / 2 . 7 't � e'. l r- R z tA, a ex.c , -- Boring # A Boring Pit Ground surface elev. /hrj• 1.-- ft. Depth to limiting factor / ✓ 4, in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 •Eff#2 j O /09/3/Z— C/ 11/1,, m 6 , 3 --- ' 4 / d - 9 1 0 ------ /4-yt.3 772 i P --- 4 - s7 0. 1 s f 4/, -,4 Ong # Boring J o3 Pit Ground surface ele� 1 ft. Depth to limiting fact in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ,h . • a • r; , ii 7 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 1 •'mg/L • Effluent #2 = BCD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) /.ignature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address ' Date Evaluation Co ucted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 7-- 715- 246 -4516 1 Property Owner _ Parcel ID # Page of III 3 Boring # Boring OD` - it Ground surface elev. ft. Depth to limiting factor / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft) *Eff#2 1 0 -1 z- /O (; /Z l a^- to (.1- o ' < l 1) 2 - Y D k ./s 4—..—______ ,,i `n A (4 . _ , - 3 ecr)- 137 /irl4 s 0 ‘Qv N /4' X 71 Boring # ❑ 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. I Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *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 (8.6/00) n co o E 1) n c k E o 6 § ] ILD m . . 7 f \ _ § % .• qt 1:1 tz V) 5 if 0 / ƒ 2 / ƒ ° & 2 c . q Q • CD / 3 2 E - { ; \ \ 1 5 / - ^ \ � j § � . \2G 2 %\ k g » 07 c ir E / ° 0 Z Q ; ( / § £ ; CD a) 7 - 9 7 _� 0 co a 77 � Z § E f n r z 1 ° i i § (.„0. • z 0 0 0 c \ 2 2 2 4 9 o $ ( R % / % "' • g d § § i © / .. 2 I § z .. E 2 z , & o / , x i • § 7 2[/ § /kX K � k m / $ E - / , \ /d /\ z o = , I z en / / , / z 0 • R 2 � ƒ '0 CO -0 CO § CO � t E § / 7, , 0 .• z I a. 3 z - / { % � .4 \7 ƒ 0. CO • a a. * c � / < z .0 5. .. • [ & $ ( 2ƒ3 ƒ \ \ ( k ) / �� $§\ a � R -o\ 7 I kD 2 / ° 2 (J \ 4. %§ 8k/ � 2 \ \ ..... j _ . ___ Safety and Buildings Divis' :. /�� Cribs � � re:. � Y.— . 201 W. Washington Ave., P.O. ' • 7�•/ &o kay Permit Number (to be filled in • Co) f Madison, WI 53707 - 708 - I I SCOflS Ifl ( 608) b546 State Play LD. Numbs— j Department of Commerce a h �••. FIV F�.., Sanitary Permit App on ou provide - Project Address (if different um mailing address) in accord With Comm 83.21, Wis. Am. Cade. persona/ fotmati Y be used for secondary p�as� pnvacy La + s l 5.Q4� may !VI } `}tLrr� � $cvc G5�3 ,�. Lot Maas L Application Information - Please Print Information OFFICE Parcel # 1 0 020 y VI '77 Property Owner's N e e_.) f i, n property ieestian �� o f Pzoptxty Owner's Ma Address � ' � '/� � /., Sation ' • � 3 st i � Phone Number City, State / N; p. E _ iB l.` � �� ) M ber Ai 1)4 r g(ch ht a • - ly) (cheek a l that ((/J�� II. Ype of Bull . r 8 WNW 4 1 or 2 /Ca nudity Dwelling — crivabor of Bed F • V ill a o witship of M s / p O Ct t) =" i� `` 0 Star Own ercisi — be Descr Use be Usc �I �/ be Use -} [) Stat Own -Darn 1.:1 , . a � ..'fiealioa to Existing System Treatment/Holding Tsak Rep t On1Y 0 Replacement System ❑ . us Permit Number61.) aadDate lssuad P a Perini ■ ❑ Permit Renewal ❑ Permit Revision Owner Before Expiration • Filter 0 that a • • 1 [] ,+t.Grade 0 single Pass Sand ❑ IV y of PO S stem: Check till t o es table soil 0 Mound . 4 in. of suitable soil r single g Sand Fiit • Mound? tUn it ❑Reri 1a a , ge l r I / e _p We d la Peat F, ter Cl Aerobic T t L7 G 0 Pressurized in '.round 0 Holding Tea . er _x -lain) 11777,11! Recire Wetland 0 Drip Lt ■ Gravel -less p" atio n; is ber is & — . SiMINIr ytte Fl lion V. D it laon . I/Tr Synthetic Media Fiats Dt6p� ` gS '' l J D - Die • Flow l) Area ormati R V � ' plow ($l?d Dai a. � • it Application Rat y '° � 16 `° Fiber P1aStie � Total Ne r / Concrete i Consnuc$itc ud r Fib — NEN NW liZailgliallr (3- Glass Gal lons eUnits -IIIII :KO inr.1 grass. willlemilmoN i;0.-bet S shown on the attached leas �� /` � Easiness Phone Number MP/MP 1 J J re Plumber's • Plum s�Name (Print} i ^ Plumber's Address (Street, City. Zip it • / ' � ; �II � Aril ■ Dat sue VIII. • un /D • sK r ment s se Onl � Sanitary pit Fey include Gro�� ter � 4 � �` ►l Conditions 0 Disapproved Surcharge Fee) �}� i a (] Owner Given Rosa or Denial D ConditlOf' of ApprOVaiJ US0' for Disapproval Of , e and I as per dispersal cell must a service provided by plumber ' setback re ement ply p 2. All setback s able s m mus nbe maintains 3 �i a s per app 3 n sin: ti Inches to sirs ` m l ' ss (m lye Cooney only) for the system ea Paper not s the Attae ►',eomAlete pis • crin_Al4R (R. 081021 PLOT PLAN PROJECT Mandy and Warren Gavin I ADDRESS 5341 37th Ave Minneaoolis Mn 55417 SE 1/4 NW 1 /4S 36 /T i A N/R 19 W TOWN Hudson COUNTY ST.CROIX ir 5/12/04 4 MPRS Shaun Bird 226900 / DATE BEDROOM CONVENTIONAL )0(X IN-G• /ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 ■ BENCHMARK V.R.P. Top of 1/2" steel rod ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H,R.p. Same as Benchmark SYSTEM ELEVATION 94.5/94.6 4' below grade Plans Designed Using imp Vent Conventional Powts Manual Version 2.0 >6 ,, Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area Well is to meet all setbacks required by 6' Long WDNR Grade at System Elevation 34" Property Line Pro 4 Bedroom House 20' • 10' L 20' Alt. B.M. is top of 10' 1/2" steel rod @ 98.96' al ■ 25' B -2 Please note: scale and 2 -3' X 88' 50' dimensions on soil test dont Cells with match, dimensions are a >3' Spacing educated guess _ 50' • 35' 2% Slope B -3 A Vents _ So' 1 " / ,B -1 kl 10' ,� 90' B.M. #1 �1 Property Line I 0- . KERvvN I3/4s r 3 r246N/v4r sPEE7 /3A-sr - 9 y,e L^- 13,R(rE RD • hi vpso -, w' /. s L/b/ 4 Wisconsin Department of Commerce SOIL EVALUATION REPORT / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis• Adm. Code Attach complete site plan on paper not Tess than 8 1/2 x 11 inches in size. Plan must County 5T GR 0l X- Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. S,G. 4e,-/6 Lv 4 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. Re • =wed . Date Personal Information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). f ( S � VO‘1 Property Owner "' 'ropery Location J�1 OP • dC 4/5/ • L W iLGD)(.S Div 3ovt. Lot .5E 1/4 0 S 3(0 T -2.9 N R 19 fr(or) W Props ' Owner's Maili Addr of B # Subd. Name or CSM# F/) f e .,uAi� (� cry. ` may. /V JA 0 9 2003 .7 O C> o60 iV,d Aidle, City State Zip Code Pin : 0 U Y ❑ City ❑ Village 0 Town Nearest Rt //14950A). //14950A). iV /. 1 S`fbf4 t(7/58 y ^ NT r O 9 #vpsa,. 1' Ifit. ,y ,t/ 6--N40;/ Construction Use: O Residential / Number of bedrooms 3 - y Code derived design flow rate Yce — 6 az GPO 0 Replacement ❑ Public or commercial - Des / Parent material /0E 0 S o c 7i Flood Plain elevation if applicable N l `--- ft. and re General recommendations: ' /eh-A. TE / 5 So/ r'M /-e„ //t' 't,) /eu /Peo..,v2) and recommendations: c&_ c9 C' ' leto ',(--G p. 0. £4) . 7•. S. Ws /,�f 4' O/ nF4,ge, cis ( - f3. / I Boring # ® '� Ground surface elev. �. D ft. Depth to limiti factor > Sy in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/if in. MunseN Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff #1 'Eff#2 / o ( /o 0 3/g L /fsI,t 4 41 fie C$ 3 f . y . 6 z 6.ie /0W Off sL l? X72 e5 .y .C 3 /;•3 .75'y, - IS /o,y, /s CS — •`7 / Z. cfq 5 ' Z Boring # ❑ Ong y S 0 > Pit Ground surface elev. ft. Depth to limiting factor 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsel Qu. Sz. Cont. Color Gr. SL Sh. 'Eff#1 'Eff#2 / 0-2 Aoire 38 Z / /r .S► g Cs 3 P • y 6. 2 - g '2 /DO i, ----- 5L / f5,6/1 4...1, "f C s z f . 9 . 3 ■ • , 7 S Y 2 6 9 S / , y , . ) 4 1 5 . 7 / 2 es . , A-, .1 /o Rs . S p, , . 41 • q tf. / = y,' y <, ii, - 'Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/_ • Effluent #2 = BOD, < 30 mgIL and TSS < 30 mgl1- ' CST Name (Please PM) Signature 22. CST Number 5 Ro PERT - Z! /h/r /CG1T Address Date Evaluation Conducted Telephone Number Ulbricht & Associates e • 13 - J-Qp Z 7/5.32G. VS'S rriva►e Sewage: Cuuattitaf1tS 655 O'Neil Rd. Hudson, Wis. 54016 - A/U S O ff-( - / /by•y °o N E F SE 0 pVt0 42(9-. / / 7 . 9 0 • • ■ � � e T • / T' ` 3 _ : f3 G DL r Property Owner /flea. Guilt 0 X So D.). p • //b ? • D • M r() 2 Parcel ID # Page of 3 1 Boring # o Boring 9 A& it Ground surface elev. ft. Depth to limiting factor Sc � �Z- in. Horizon l Application Rate Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • •E1f#1 •Eff#2 / 1 1 - "'T /7 - �/P 1 4) 3 r • 6 z 2`2._ /o may/( sz- ,7c54e 75e ceo /7a- . 3 2 -/ . 3s -7-s y2 �� - Z5 i�7 ds , C5 , - 7 Z 35 * 92. /19,,e 5417 O, . s , .e,e • 7 /• 2 I I Boring # ID Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM? In Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Ent 'Eff#2 , I Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 • l Boring # ❑ Boring - ❑ Pit Ground surfs •= -ley. ft. Depth to �g factor in. Sol Application Rate Horizon Depth Dominant Color - edox Description. Texture Stricture Consistence Boundary . Roots GPD/ff in. Munsell • . Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 • 1 • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg&L • Effluent #2 = BOD < 30 mgll. 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. sea11330 (IM OD) O) ( ,G o / 3 Z Sir Y/ � of � , To 5 v Dv d G ,,���� 1 f eo 0. /0 1/ 1 1 Pi s ,,,, I / / .0- / DO 9 a 4 t i A / • 9� o ff _ SET - o ' 4,6-5, T io r L. /".../J2- G 1 , Aotale— lien /0 \ \ For issuance of permits al iu uesigning Contact: Ulbricht & Associates Registered private wastewater consultant and plumbers 655 O'Neil Road Hudson, W4 X401$ 715- 386 -8185 or 715-772-3442 • / . — /34 `k,fie-e ,e 7_S Q 7 Coc) Yro U'IE.'. G /.).,Q S ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT • AND OWNERSHIP CERTIFICATION FORM Owner/Buyer / / ' iiid SS/! Mailing Address Property Address ,, ddress y (Verification required from Planning Department for new construction) Parcel Identification Number P �� _ � -- pp LEGAL DESCR IPTION Z O6 3 Property Location / , TN J W, Town of s�' /,�� y., Sec. N "� -t —`" i .h . Lot # Subdivision c i w� _ _ ... AL, / r- ,Page # �- .Volume Certified Survey Map # � �! Warranty Deed 3 Volume Z # 5 __L— Page # Lot lines identifiable ❑ y:I--no, Spec house 0 y2:6,30 SYST oA use an CE remature failure to handle wastes. Proper maintenance Improper use and maintenance of your septic system could result in its P a licensed pumper. What you put into the system in out the septic tank every three years or sooner, if needed by consists of pumping oralsystem. can affect the function. of the septic tank as a treatment stage in the waste disposal the owner and by a owner agrees to submit to St. Croix Zoning Department a certification form, signed by The property pumper verifying that (1) the on -site wastewater disposal system master plumber, journeyman Plumber, restricted plumber or a licensed pump the septic tank is less than 1/3 full of sludge. condition and/or (2) after inspection and pumping (if necessary), is in proper operating con set forth, herein, sal system with the standards ed have read the above requirements and agree to maintain the private sewage dispo Uwe, the h erein gn as set the Department of Commerce and the Department artment of Natural Resources, State of Wisconsin. Office of cat o 0 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning days of • e three year exp" lion date. ! 1 d A .d4 .�L1' L DATE SI t A kURE el APPLICANT OWNER CERTIFICATION our' knowledge. I (we) am (are) the owner(s) of deed I (we) certify that all statements on this form recorded in of Deeds Office. the prop rty described above, by virtue of a warranty � /� or //I 1. . .4/ i . DATE SI . ATURE •'' APPLICANT n that is mis- resented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ****** An tnformatiio represented d warranty d eed from the Register of Deeds office ** Include with this application: a stamped a copy of the certified survey map if reference is made in the warranty deed I L Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent fitter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner acrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Con ' a . - ncy Plan *lotion n #1. system fails, determine cause of failure, use alternate area and install new - in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, P #2 Y and install new system. and system elevation ment area, a y is suitable for re , Option #3. No adequate area replacement cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 -246 -4516 St. Croix County Zoning 715- 386 -4680 Pumper Tom Mondor 715 246 - 5148 Shaun Bird #226900 . FROM :ATL,AS CONSTRUCTION FAX NO. : May. 12 2004 07:20AM P2 TM Il i! l l 1Wil ; 090 a , i0QQ, r a .°) > • 0000 ' 2, > 11 ri V MIA 11:11411* 1 1 1 1 i. , lilt _....._ loses 13\ 1 ri 1 ......, • . , . ,�� IM�lIw' ll cY i��iN�l 1 1 411,F.E.' grig , _ ! i = ___,...... Ei 11111111 �©il � � g iI JIIJJJ1I11 1II II ,bilwr, _ i itiiin H1{I{ :: - ■■ ilk t tti ! {{II {{I {!1111 . - ill • ' I dry ,.. .�-- 1111111 II Illill .�� ni . D F E_ ! ,, _= . Q 0111111 !! 4 11 , o El Pl.n PFD: ll:iv --'�— • Th+ Omits ice d ..f�o g�.hk r 97 Wass Msdh ... ,. ... 1 A, RLSON ���wA Stee 71711 Des ntd For: Gavin Residence I FROM :ATLAS CONSTRUCTION FAX NO. : May. 12 2004 07:20AM P3 _ - 2'47— t i 1 el ti 4 4 H %o pq b _I 1 L F •us5 2.4). C J. s �' N 11 1 1 i ---, 1 .. ,, -; Va 4 iC ++. 1 r 1 ' 1 1 t — .-. ��� b _ .. ` FJ • ` _ " O [! , 1 " � IC I q A oi a ., _ _ 11111 ; I L I M • p 1" ril 14 II o G a 1' . 1 . C`0 0 ` pl T IAWN,r19.)W 1.�WIa))19 l,tivnS)19 ,...........,.,.. ......, N .A. �'�t; ��'.T Vie ;A 2%9 3/4" 15 , H „ Ilq. ?'.Y`x1 5 /1C' 14•0N1•:21:19 _— . 1T ♦ [1 R r I �r \ (bNS y7 W 'MI ril ma. siren 'M I. i Gavin Residence 11mr! i.16J1.1 ..... ....... .. �.,.. ... w / �\I `► FROM :ATLAS CONSTRUCTION FAX NO. : May. 12 2004 07:21AM P4 1S'•Ih" _ ..., .. _ .— .. "_-r• K 4 -1 5 "£ 6 K m bS b y � • y A " v / .:-.; 0 VI el r _ma 04" I A j rr" rr" • • o „z4„, ,.. ., ... �____�__ N 1, ..:, , a . 1 y 0 r Z . :... ,; i a •� '2 or S io tat w -�' y sa �. r l S j [i � ' / b 5 • - "'ate.. t_...-, 1CA2M.1W ICA1960.1W I 1 101.1414 ' !tn. ^•414•4/ 1i4" PA. 2'- 19;5'.01 1 n.®. $'d1 IG ",a'•u 114" s. 1Z-A” Pu.� r«. 1149 FTA S O NS 1 IV A")6" s tif nea9 u,1,:, -,4 u1 1►a.fKwcf rarl Gavin Residence . .1 N e.n a diwn kno and P.A. BaI 744 Sisal Nu. 7 aid . d .mw.e.11..e..d !mu Claire. WI $4702 Nu1118y: Atlas Construction q. "h: « «.� 11.76.1,1 .{.m�I.rU vtiu.{n.unh {Ya r;;;;;',;,‘„„,,, snoa �rn t i.v►rvo� � _ .. . . FROM :ATLAS CONSTRUCTION FAX NO. : May. 12 2004 07:21AM P5 e i : � 1 I :I I. I K I 1i . 4 • Y 1 1 I ( 1 • i i , I :l 1 4 I H I a I !' I yI - I ii I 1 1g I .• WI (ilk - I.6 1 33: 1 :1 a ri i ir ............ , ? � � -3-" -T - - - - --1 1 r — ipet .' .; • A.O. SA i '(:hifU Ir4^ � � .— a..:a.� -:. - �._._. —.... 14' - 4 )/4" , ]17.6" ...... .., Naas Not 2130 `I 97 Wen! MuUlaaa Sheet DaalK Residence Pan Gavin !)Ala: 3 -1641 "Mar p&aa•re • drwtu duM• • 1 J r� .RL S o f l o Pdt. BOW 748 a ,� V.... ( WI •min1 KodNKvt AtinxC'.nnstrnctiou U 2986P 211 \` - ��c25tA'�3 STATE BAR OF WISCONSIN, FOR1vi,2 - 1982 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO.. WI DOCUMENT NO. RECEIVED FOR RECORD 01/06/2004 02:30PN Kernon J . Bast and Donalda J. Speer -Bast, WARRANTY DEED husband and wife EXEMPT * REC FEE: 11.00 conveys and warrants to Warren_ S. _ Gavin and COPY FEE: FEE 257.70 : Amanda J. .pat (iCK Gavin, husband and wife, CC FEE: laYl fS PAGES: 1 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. Croix County, !--„I /N Vat 4, 7 1/ State of Wisconsin: �'G! T66 [ / i`. t ,y f � . ,t [71 SO 2!1 St#n,� Lot 77, Plat Cottonwood Ridge 1st Addition, tittelSO h , 1A)/ 5 /b in the Town of Hudson, St. Croix County, *4/6- / Wisconsin 020 - 1109 -10 -000 PARCEL IDENTIFICATION NUMBER 020 - 1109 -40 -000 020 - 1109 -20 -000 020- 1109 -55 -000 This i c nn •t homestead property. (is) Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 2nd day of Januar A D xi' 20 4// Gi( - Q_ �_ ' . KXO/�� '�'°` ((SEAL) r / /. 1 (SEAL) • Donalda J. Speer -Bast Kerno J. Bast . .4 (SEAL) (SEAL) • . AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ State of Wisconsin, ss. St. Croix County. authenticated this day of , 19 Personally came before me this 2nd day of January , 2004 $W the above named Kernon J. Bast and Donald J. , • Speer -Bast _.._. TITLE: MEMBER STATE BAR OF WISCONSIN (1( not, authorized by §706.06, Wis. Stats.) Pamela A. Willman. e known to be the persons who executed the foregoing Notary PUbiiClinstrumen /and acknowledge the same. _ THIS INSTRUMENT WAS DRAFTED BY State of Wisconsin ; 27 4 42 { , •i L CO %.2 1. 4Ytlr,1, Kernon Bast f a n4 e• 1 A 4 iii 1 I Y•.■e P. Notary Public, 51 • / re i ,� County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary) a-,2 - 01 1 , 19 .) • Names of persons signing in any capacity should by typed or printed below their signatures. ,,,,, ,,� STATE BAR OF WISCONSIN Wisconsin L•oat 6tankr tr, .. r LOT 76 • 4.71 ACRES 205,328 SO. FT. t 143 LOT 75 4 2.48 ACRES f ^ n T. to 107,917 SO. FT. ( 'r l <u iI e") O " 613.6 cb 8' 9E N 89 °49'5 Z o 2 � 463.61' 6 66 `.`` . CRES 0 � 10 -, ` 8 SO. FT. 11' - - • `` --- - \ 2 0 �\�� " I < LOT 78 • O .�° 3.30 ACRES Z \ `� \ ��' 143,696 SO. FT. REVERSE \ �' ° iF S' N • ; R DERSE \ \ • -Q-o 41 0 Q " fi r j. \ • �yy r °� •ib \.`pJ 9 6 • • • 0 .\ • ►1 L Es \ 1 • FT. t \ '� 2� o s , LOT 7 \ ' , ` ` k `y 2.15 AC RES ` � \ ` • z ® \ • 1'' \ 93,696 SO. FT. ,g c • O ,, . 1 �. 9°26Ar 45l ,z � ( 'a / , � 45 I 41N 118.6T ,_