HomeMy WebLinkAbout020-1454-00-100 sconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
r SEfety anti Building Division v
INSPECTION REPORT Sanitary Permit No: *Eb.
506222
' 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:
Gregerson, Glen & Emily Hudson, Town of • 020 - 1454 -00 -100
' CST BM Elev: Insp. BM Elev: BM Descri tion: Section /Town /Range /Map No:
I �. (� I� 0� .0' � � 36.29.19.2915
TANK INFORMATION 6� ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI ' FS ELEV.
Septic � Benchm j,�, O , 'y Q
Dosing I I) Alt
_BM
_AO Jinnp, vV Bldg. Sewer .20
7 9�. 90
Aeration ���
ACITY S NM -'"-- Arr. '•••Wir/ / St/Ht Inlet
VIA i St/Ht utlet r .
TANK SETBACK INFORMATION
t X 30 3 y sQ62 —
TANK TO' P/L WELL BLDG. Vent to Air n Inca e ROAD Dt Inlet chit., ..-- �-
Septic / 7 a Dt B �' ° �J q /5 7 !- 1
Dosing �( fr‘ d iti vre4g /t Header/ aan. 7 f-- maid."4„, 4. 6 9
Aeration i A Dist. P ipe � � d 7• q 93.
Holding \,, Bot. System S(p 2 . •
AP ` Final Grade DD C �f
PUMP /SIPHON INFORMATIO Pro+ . ' . _ jj,e,,�.4 a. ��.u14.1P ,„ Z''/ I Pics
Manufacturer 11- -1 tCo z
L "" s _� GPM `'�- 3• 1? •
Model Number `,►- Li 1 10 o� /I ten-e� { /
TDH Lift Friction s ` L . System Fi ad TD v Ft
Forcemain Length i Dist. to Well
I 2' S'7 * 2 ) (Cb
SOIL ABSORPTION SYSTEM Sam - dl4..Q.4G1-.(. .,
BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3, /T� // a
SETBACK SYSTEM TO VV ((// P/L BLDG V � LAKE /STREAM EACHING Manuf t r // warp( O e 7 24
INFORMATION � CHAMBER O
Typ Of System: / / / M Number:
UTION SYSTEM 5014 Si 3 ^tr (i_•J
Header/ anifold Distributior x Hole Size x Hole Spacing Vent to Air Intake - ,i \
r p Pipe(s) / -. l
Length Dia Y _ Length I 3 Dia Spacing 3 L .ii-M1- d 1 ! : j
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only \J( t ., ...a
Depth Over Depth O xx Depth of xx Seeded /Sodded xx Mulched
Bed /Trench Center a rench Ed.- � f Tops Yes No Yes No
f L
L : 6v �
• COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: f / / PQ Inspection #2: / /
Location: 689 Mary Jo Court Hud n, WI 54016 (SW 1/4 NW 1/4 36 T29N R19W) Cottonwood Ridge 2nd Add Lot 100 Parcel No: 36.29.19.2915
1.) Alt B Descrip T V� Yt t
~s
2.) Bldg sewer length = � � v / 04 - amount of cover = t � L Piz
k lrev ision Requi . Yes . No // {� � ' VIA' i
her side for additional information. !S rr L u� �� �i'
Date Insepctor's i nature Cert. No
(R.3/97)
1
66044 /924 Co C a. e-L
1 1,.., Of TIOINION NI 0,VANOTI r Irfl !' [ ! = / / / COUNTY PLAT OF:
1 OWNER ..,, ••.,••■ ,•,•• ■
/ COTTONWOOD RIDGE 2ND ADDITION
LOCATED IN PART OF THE SW1/4 OF THE NW1/4 AND PART OF THE NW1/4 OF THE SW1/4, OF SECTION
I ..,•:;;;:,,,, / \ -,- .I.I,V - ‘ , "'
.. : „'I ./.., 36, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN.
1 SURVEYOR wir,,, t■N .. 1 '1;'! ,!,.:`:,;',,::..,';,,,,,,..,,
1 ', 1C1 ‘. ■■ ! ;:■ ', ,T,Tt,,o,n1.. , ,,,. • 3fi,: ,,, ' , , ,1,. II: ,,,_ .', , '.:.%,,,:','',"--(;',.
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NB9'2858'f 118270
ENGINEER '
LOT 91 / /
1 :,.. t .. 1)' ....-- .1 '''..'"'-'' \ '' ,,,,,su ■1 „ .
I/ 0 08 00
''' 13 7 .
LOT90 . ,';' , - - aidi) l ' :!,;
W., f,', 8 -4- 6,,,,,,14, 2 1 , s., !„,„, •, 4 ,
„ \ , 4 414'Y i'; • TO AC1TES
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1 'f, , 1 6„, [T\ 1`o .. Imo 0 -1""I'''',,,,"", • , .s2/ ,4
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LOCATION SKETCH III T. VATIOTT W4,10
i :4 1!; 7 -,,,,-
1 I Fr r
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H If
LOT 93 / , t '
, AA ',
. T 7 - Is, 1 \ s'
1 1 \ 1 1 1 .'s . , \ , , ■t,:anO' ', 1 i 11): 7„,,,. /,'
/ L - L - A \ ‚7
/ 68 (
' , ' C L- \, L S \ A ,.. , A-LLL LOT ',..,1
LOT 94 , ;''y ° ,/,' '
4
FT /
1 :
....
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L
----; T
LOT 98 -C c-4-::
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4
1 - SECTION 36, T29N, R19W
1 '-, d. r, A'';' '--•'''.I.,..,„ , 4e; - 7 ---- -
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\ ' ,
'
LOT 97 '' 1
( r
, ...--,
, ■ SCALE IN FEET 1" .-- 100' I f10 . 0E , TO ; \ / '!!' e e'
, .,
, 10
LOT 110 '- 1
0 100 200 Eo , I „ IS
'
71
.„,
}mos OFFICE bc
1 , ST. CROTX CO, WIS.
'7 '; g' ' • DONNA(. : CASEMENT
0,5.1
0o3095.-
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-' LOT 1 0 9 • ,,., MN , T.■ II/ OT NEN, E. , . T ,
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• I I
T LOT 108
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gig.tiEki .%•'..,: F. l':-,,‘
TIN
OSLO
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M LOT 99 Z••■ ..--j
c o""" ''"Y"' '''''' .
11 , 1
: STAKE OP OFIEWUr VISION ME/GA/NOT rIEOR
:„„ , Ti Iii AMEN :
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, „TA WOE LAU/ InSLIKINE AS HEREIN sp TONT./
11'7 • "°4- • . ). -TB
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, , • _ 1 1 WV 41
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4,4,1'.....L STTOrl01.1 FON noVENArITS SAWS TO , / . \ '''';',,, ■ . , P u i ,:72 - \
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.-
I
: NNE C.INETT / AND Tr/NEI p IM/5, NEES/. N w 1 . , ,,
„ T , , : '. ,9.E. '. LOT 107
, FTIST,TrorTS T WIT OEN. N LOT Sar. /SIFF T !"! 4 . '- "": I I O / 7 . "
: No, NC OWN/ oTt 'II EN ell SHOT INIANNi oro , - -- 2Tt , , ,
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LOT 101 LOT 105
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1 • I TON 0 0 PON NE FOIE. LOT 104
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1 Z 1 6 : 1 '''.1, LOT 102
LOT 103 .. „
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11 !,,I.:re61,1,11 11/ /TA ADANE NO 4 ._. IS ------_ —..—__---....
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,
cornmerce.wi.gov i Saiitty anti Buildings Division i County ,,,, . .
1 201 W. Was,. Tionion Ave.. P 0_ tints 710 I '16.*'/ .
1 1 Mailimn, WI 5370?-1 ritt" :`sAiiiitiij 1 OTilii NtiffIbtf kii, ix filIsil tit ti5 Co )
I sconsin ,
Department 01 Commerce I .50‘,..7.2.2
1 i
Suite Transaction Number
Sanitary Permit Application
, -
accordance with s Comma R3 2 i t 2 ), Wis. Aiiirt Code. mbanissimi of ibis ibtril tO ihe arrixopriate governmental AI Pr
1 unit is ormirred prim Er ribteirring it irsimilmy permit Note, Applicatioo limns for Atit.r.i-ortmed POWTS me p Add, Of din: ..., ih ma ili ng .
i submitted to the Department of Commerce Personal infonilfit1011 you provide may be used for secondary '
m.r Jo
-eclipses in. accordance th wi Mc Privaz - Lire, a. 1503 I im Stsla
# 6s7 ..
'
T tkpplicatio' ti informal - Please Print All information aja11111111:4 4111 V I
Ca" CA-
s,_ WARP'
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i Property Owners Mailing Address APR 07 2008 .ropert Location
i
1 city, State I Zip Code f 'Moue Xiiirr- 5'60 'J., .44) 14, Section ,......
I 3 ' ' NING OFFICE
i , (cheek onto
i 6 - 6 - 7 / 7 1 H ,qN ; 14 1 I f 0 E rk,W
1 11. Type of Building (check all that apply) 0 k c .,4„ L '
0
e
1 01(1 or 2 Familx Dowelling - Number if ticAtaatm pg.... pa „,,,i_ Sabdiviskoa Nam
e
i i K,-7X-a.Aii-e),,04/19/1-,'-2-41
n Public/Commercial Describe Use
1 1 1 City of
.. ,
■ 1 i
1 1 1 State Owned Describe Use CSM Number L j Vitiage of
1 of i 4i
I Z ,0:64. cu .- L ., 1 z6 4- ZS cL-10e.r 4/1 <0 • • e,
i Hi. Type of Permit: (Cheek only one link on line A. Complete line 13 if applicable)
1 ' 1 VI New -System I 1 1 Replacement 1 1 'treatment/Holding tank Replacement Only I 1 Other Modification to Existing System (explain)
1 I • , 1 System I
5 5 i
e"° .
{ 1 Permit 1 0 Permit Revision '----1
L j c hange ot - i Li p ermit 1 com to i List Previous Permit Number atd Date issued
Renewal Berme i Ptumbei 1 Nei; 014/14,1
...-
i Expiration i 1 50 , L4-- ,r,
c1/4,
1 Ix Tv., -f POWTS If 'hack. - 41 that ="7 a) t r-k-
1 - 23 N o . - n i r . i r ; r c , l i t r i z c d !q.t 1 1 pr. ti.s.cr.-.,,,,ri.4. . . At-i . k../rwr.^7 ',... ';k1 4r: .rlf tlit-.0 tni! 17 Mrwr e;'. ta.4 tat .,-atti,aptal.: sataa!
! F Haftlit O t h a a - , a - D i s p e t r a i n i 1 7 a r n p a r - e m e at-Tar:in a n P m t.''!'!IT 11:'?.."., tfairttaaint
t V 'Dispersalarestment Arta Information:
1 Design Flow (god) 1 Dcsigit Soil Application Ri/Agp4ist) 1 Dispersal Area Requited rst>„.-- ( Dispciaal Arcya Pr op/kit-A ( sft i Systkin Ekvation ./
' --
1. o...e10 l ' i 3 r 1 / 0 i / e e a V I
1 VI. Tank Info 1 Capacity in 1 Touti 1 # or i Mumnitvlorsa Material _
1 1 tlitili ions 1 Gallons i Units i
I i I I I I
, a a
I , aat t laira nr I foNin r Tnnt I 1 / i
l i 1 14).01
• ri.•,-..•.,, chz,,-..1-
1 ' 1 X 1 1 ZOO 1 / 1 Al, 'e-5"" e v 1 Co ....e,
1, v 11. Responsibility Statement 1, the tindersipmed, assume responsibility for installation of the POWIS shown on the attached plans.
1 11umber's Name I Pt in 1 Plumbei 's Signature / / i MP/MPRS Nottitivr ( &mom Mom Norther
i 14 5 - ' A a 44 , ., I,- - ' -.SO - ‘1 ..22.77 7/1r- .5/.2/
1 Phintber Atititt'SS (Strafts City, Strtte Zip (1
I
i 7n el . '77/ 4/ l<4 4.1 Ze9 z
1 vill. Cfuintv/Denartment 17i4e Only
[ roved triTiroved 1 , i oved 1 Permit fee 1 Date 1 7 i Issuing t Signa
1 illiniguir. 4-. • it rot Denial l $
f-
IN, Conflitiont of Ari, %trowel/Reston-a for fl
SYSTEM OWNER: 3) t
t ._ 1-- be..toL.4.
1. Septic tank, effluent filter and yaal. nAa
r
dispersal ceff must all beLmteliminiosi
as per management plan provided by plumber. Cu tre ,A--k 6 ' ioca.1-4 A Q-`
2. AN setback requirements must be maintained
as per sposassim „.,,,,,,, , .... si 4 ,5.91a3,1421- twa g.., CA, ..,..,14, 0, 1,4,s,:- aa..nt t nitb, a tit. , i i tre, ii, ,i,,, t
1 . oo
'RD-639 11 (R. 01/07) Valid thrti 01/09
A
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/94 eM/e—Pd,s0,44
i
jfilsr RECEIVED
v‘
/ IA ) ;1 -
ila g 1, APR 0 7 2008
I • 5V ST. CROIX COUNTY
ZONING OFFICE
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29/WA d,/e--P..//4.4 a
RECEIVED
go/ l o D c� ` APR 0 7 2008
5ef ST. CROIX COUNTY
ZONING OFFICE
6
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- . SEPTIC { TANK & PUMP C iAY.13ER CRCS5 SECTS AND SPECIFICATIONS
4" CI VENT PIPE 12" MIN. ABOVE GRADE 4 WEATHERPROOF
25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER
W/ PADLOCK
FINISHED GRADE GI RISER WARNING LABEL
r r
6
I T - i -----....—...„,
--- 4" !"SIN
16" IN. 6" MAX. r **
INLE " ''••
....
`, WATER TIGHT SEALS G AS - ( ,
T IGHT ', IIAPPROVED
A SEAL JOINTS WITH
,PPROVED _ _ . - ,' ALM APPROVED PIPE
'IPE 3' B ' ' ON 3' ONTO
)NTO SOLID ' i SOLID SOIL
}OIL PUMP OFF ELEV . FT...-_ _ -- — , OFF it RISER EXIT
D
PERMITTED ONLY
IF TANK
3" APPROVED BEDDING UNDER TANK MANUFACTURER
HAS APPROVAL
CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE
TANK MANUFACTURER : 1.Z m,5�� NUMBER DOSES PER DAY :
TANK SIZES: SEPTIC l �"j Q GAL. *JOSE VOLUME INCLUDING
DOSE 2 c GAL . FLOWBACK: /S 9 GAL.
ALARM MANUFACTURER: Ltyltt,ckrn CAPACITIES A = a'k INCHES = ( I b a, GAL.
MODEL NUMBER: yL.'s/
SWITCH TYPE: t''n..0.r_.. B _ 2 INCHES = L1 3-• GAL.
P UMP MANUFACTURER: FACTUR R: Cvictl s
C = g INCHES = 1 GAL.
— v
MODEL NUMBER : E,P a
SWITCH TYPE: rnetpC D = (0 INCHES = J a,(b GAL.
REQUIRED DISCHARGE RATE 4 0 GPM PUMP E ALARM WIRING AS PER I LHR 16.23 WAC
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . . /off FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . .5 F ET
_
ET
+ �j Q FEET FORCEMAIN X .�,(o4FT /100 FT. FRICTION FACTOR 0 . . «/
TOTAL DYNAMIC HEAD = FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ..--�' ; DIAMETER ___
LIQUID DEPTH f a eQ I 6 1 / v
SIGNED: ,.
4/ i: -- LICENSE NUMBER: ,P. Qg' DATE:
1/88
. , .
, .
GOULDS PUMPS Submersible ,
Effluent Pump
: i MODEL
At 'If
EPO4
3871
EPOS
APPLICATIONS • Fully submerged in high • EPO5 Impeller: Thermoplas- • Bearings: Upper and lower
Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing
5
Pe Y 9 lubrication and efficient improved performance. construction.
following uses: heat transfer. • Casing and Base: Rugged
• Effluent systems thermoplastk design provides AGENCY LISTING
• Homes Available for automatic and superior strength and corrosion
• Farms manual operation. Auto- resistance. � Canadian Standards on
• Heavy duty sump matk models indude
• Water transfer Mechankal Float Switch • Motor Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C ".)
factory. strength, and durability.
SPECIFICATIONS • Motor Cover. Thermoplastic Goulds Pumps k KO 9001 Registered.
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
3 /4" maximum. • EPO4 Impeller: Thermoplas II Power Cable: Severe duty
• Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: 1 l/ NPT. seal protection.
• Mechanical seal: carbon -
rotary/ceramic- stationary,
BUNA - elastomers.
• Temperature:
104°F (40°C) continuous
140 (60`C) intermittent.
METERS FEET : -. ... ... _ ..._ .. . _.... ........ __ - ....
• Fasteners: 300 series 10
Stainless steel. ,
30:..... ._... _.... ._.. _ .._.. ._.. f - GPM - _ ... .
• Capable of running
dry without damage to 8 - *2.5 Fr i
25
components. . ..; . .._.. j_ __.__ 4 ... • ... -..._. I. _... .
9 i
Motor: i
• EPO4 Single phase: O.4 HP, —
115 or230V,60 Hz, 1S50
RPM, built in overload with s _ E_ —_._ ...__,,_.._;
automatic reset. .
EPO5
• EPOS Single phase: 0.5 HP, o 4
115 V, 60 Hz, 1550 RPM, 3 10 -.- - _.
built in overload with EPO4 _.
automatic reset. 2 i Ada
• Power cord: 10 foot WNW'
standard length, 16/3 1
SJTOW with three prong
grounding plug. Optional 20 0 ° o 10 20 30 41 50 GPM
foot length, 16/3 SJ1W with ,
three prong grounding plug 6
0 2 4 6 8 10 12 rnV/h
(standard on EPOS). CAPACITY
Goulds Pumps
02000 Goulds Pumps ITT Industries
Effective February, 2000
83871
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/ k.£2\' ROAD LENG 1. '107 3- =.80' 7'? ..A.
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i "' / . -- `r' - ,. � o 1 1 — ' — — • — -
' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 7
Division of Safety and Buildings
in accordance with Comm 8 ' s. A• . Code
County /
S ev "y
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. - "1'. us t , `
include, but not limited to: vertical and horizontal reference point ( irection a . Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distant earest ro
Please print all information. is Revie by / D
Personal information you provide may be used for seoondary p�pec �Lw. ,0.vy <f tm))• ( , I 1 10 6/6 7
Property Owner — ropery Location / /
� �,r Mack- U JU $ 200 ? Govt. tat
JUN O 1/4 1/4 S T N R E (or) W
Pro erty Owner's Mailing Address Lot # Block # / Subd ( . Name •r CSM# /f 0 f
Lam W ( "r i t U YX /! rC .
City St R
ate Zip Code ,one N um b er �y COUNTY /
❑ Ci y ❑ Village (Town NeaPest Road
0et5ci Ic,✓l ISL /o/& 1(745 ) (06 ezt/ 1- 11,4 I
New Construction User Residential / Number of bedrooms 3- Code derived design flow rate y 5U /'6 0 0 GPD
El
❑ Public orcommercial - Describe:
Parent material a c..>rx S A
Flood Plain elevation if applicable / ' ft.
General comments
and recommendations: Sys t ✓ et / -e 0 , q J, /6) M /�� vb
/
and rec
g o c - is g c0 4- 5 r4- -
. 71L Boring # ❑ Boring ,,/ 7j)
Pit Ground surface elev. i 7 )C-- ft. Depth to limiting factor /30 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft°
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2
i 0 -1Y loy( 3 51'I dnr5I/< 144.1 (5 k ) ,S F
L - z‘/-3i loyir zi/4 S: c1 _ r (5'
— , y . 6
3 3 ioy�Sl� .c ,9 h ms�- � gym.. r c A & /e C3
y ' aCo lei /6yiV7Ce — , S an lin / -- , ? / Z.
/?
. 7 4 i , ; 1 q i .4 '
Boring # El Boring \� . ,l
I pit Ground surface elev. 4 ft. Depth to limiting factor 1 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
O' z /6-/(3/3 5 1 2,41, 5Uc 14 r ( 5 ' L , IS , � • 8
L Z1 - /oyd4 / 5, "I►t.Sdt — _ V (.S — -11 - 4
3 Y(pZ 9/ 10y,, ' S 1— 0901.511( .511( 11 CS /
• (, 4 '
i ,S oD i iyi I , , ?- I 7
1 l'1, /1)
I II
, II - n � 3 Z. .
11\ 6 1(1
'Effluent #1 = L, • • 31, 0 mg/L and SS >30 < 150 mg/t. * Effluent #2 = : • • < 30 mg/L and TSS < 30 mg/L
C Name (Please P ') Si CST Number
Cl (Cc h� ww - S 3M .
Date Evaluation Conducted Te -p • e N mber
1 I ge a, id i r�� k4 hl 5'4/ 6 – 1 -0 7 7/5 -76 0 -Z -7 9
•
Property Owner _ e L.
Parcel ID # I0 /0d Page of
5 Boring # ❑Boring <- 2, d
r
G round surface elev. _ ft. D Depth to limitin factor G 0 in.
Pit — p g Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 1 GPD/tf=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2
—
r a ta,r3i3 5'! 2/n ,3 , wt -f,�' (5 (U-( , (p - -.8
‘z-, 11)-3'-1 /0,11 'ic�l ,,'1, 5L y r cs — , • (o
5 3/1-1-to /0y(5* 141., c y -c/ c 5 , 6e / 0
'1 LW 114 /l)y! yT ( ► S o I/Vl 1 l 0
1 lib 4
iii t il ti, ,
Boring # ❑ Boring 11
❑ 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 # El 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/tf
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 (Rbttp)
IMC Co(rvsa ch- 101 /Ov ('40n o
6m. i 1411 -6 4 o'-r te(e -fri,
c y s i e m . e / - e U . 1 1.1 0 o r 76 a o
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° i COUNTY PLAT OF:
OWNER T'� „s ,' / 7 COTTONWOOD RIDGE 2ND ADDITION
,u sa,ww a + +n a 7 ,- .,,3 ,,, ,...,..,, , ,, ,, ' LOCATED IN PART OF THE SW1 /4 OF THE NW1 /4 AND PART OF THE NW1 /4 OF THE SW1 /4, OF SECTION
n++,.c Nrkn � 44> ' r 36, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN.
SURVEYOR r r /
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ENGINEER r
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N o,en G�NA
EA N1 0 %0 \ R EASE ME N
':4 ., R n M o G� 0. s, � ,, \ ruo ac niem h LOT 99 ., tis G
a L OT N 92 4'* ` .x seam I i
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LOCATION SKETCH a +�' a /
LOT 93
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ar � � � v � Lor eB x� 1
!% q/ �� ^e LOT 90
I mm,s,�, \ ; 1
— ', i Z \ 471
of LOT 8 \ � — 1 A,,,,,,aaa, _ _ARY JO COU
__ __.. SECTION 38, T29N, R19W J Ni ^ s'n�,`'!T ;"� - � i>z ° z.a - — --
(l, A's/ / \ \mow,•„,' G ,
a,/ Gr+wN - �40 /fir ��
I ! . - LOT 97 „,,,vi.,,,,,,...,,,,
= 100' r I C \ x ��
SCALE IN FEET 1” ,1• \
� . _��, -. I `__._ " — x _ \ a � _.. -_____ � / / 1 O T 111 '
loo O OD / LOT 110 w n
L'crsTLR's o6T'1C5 ll O c Y$ /
R r,na, ,:1:1„,1
, .._
ST.CROIX CO. wLS.. 8075 8 1 o N SE EASE ENT '� 3' jt ✓ �
a ppf� .mss I _
47'loee y. ua1.o A� - t. LOT 99 /; ,7 __ — ei.,, I%
w!: IAAA/
i �S db ( \ wi cm (, / , 0 II.RX M r y V I '
Cab �) + � 1 /,..7 _,
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I r 47' L OT 11008 �i
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tea,
1 =2 LOT 106
I LOT 100 ' vu / \" \ \
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sxrx so 'fceu,r
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— N99° 245'W 337.41' e5 T — \ �1 LOT 105 x
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Z LOT 102 I ! I �,
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SHEET OF SH 11
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• ..........._____
commerceAvi.gov 1 Safety and B ' dings `' ' n I County .
201 W. Washington .. P. 6 ! . ox 7 2 57O1/6
1
tisconsin i Madison, WI 53 , -716_ -.: Sanitary Permit Isiinber (to be filled in by Co.)
' . Department of Commove 1
H---
Stare Transaction Number 1
Sanitary Permit Applic. ion
In accordance with s. Comm. 83.21(4 Wis. Adm. Code, submission of this .rrn to the 4144" i ii 'ove. . mental , . , -i-,---1
unit Is required prior to obtaining a sanitary permit. Note: Applicatio forms for state- 4 " '' ■ TS are 1 Project Address (if different thannyling aodress)
submitted to the Department or Commerce. Personal information y . Provi4f4r be use' ' • - '4 . ' ' r Y ' ll' c -- 1 0
purposes in accordance with the Privacy Law. s, 15.04(1)(m), Stats. ----
I. T: A . 0 )17
Application Information - Please Print All lnfor , '■ n Si _ °Ad r 4-
f Owner's Name r . C% 40 ,
-A-0 Parcel #
6 e .,./ . ,c0,/ ..f..- ,.. v go ' o O2 I 54 - 60 - /
Property Owner's Mail Address Proper( • ation /
L A ., _ #y"7 de-h 5 - . Lot
City, State Zip Code Phone Number
,51) 1/4 Alai 1/4, Section _.-.T.O
-
. •4-e‘ 7 i 1/9' circle one.,
--- -- T 9 _ N; R /7 ENJOY'
I. Tye of Building (check all . ., t app)y) c.. o Lot #
!uiovv., !
1 or 2 Family Dwelling -- N'orither.of - mms o p.e../.....
' tiloc• li ___. _______.., l _ 0 Subdivision Name
.
I_ Col z al /fkolife-- 2401 -A
Li Putt!teComntereial - Desertbe Use _ ...--. 1
E1 cit or
Nu. .. r _
- 0 Vil/age of
D state o,,, - Desci Mt: Use !
1 .: . ) Town of 44-1.6
2- 10 ; S4- 661S 1-4.) ) 22 ' CIA, ....s. . •• _
ill. Type of Permit: (Check only one box on line A. omplete line if applicable) '
---
--1-- --T — — ---
' A '
*.New System 0 Replacement System ' D Tr!. mentil ding Tank Replacement Only 0 Other Modification to Existing Systern (explain)
i
!_-------,
, -- 1 —
- . — L ist Pr Permit Number an issued
B. 0 Permit Renewal 0 Permit Revision [ Chan. o. •- lumber 1 D Permit Tcansfer to New
0 I
' Before Expiration , I Owner .
L 1 —
IV. Type of POWTS Svstem/Component/Device: (C all that a • ly) ___t r.51
, W Non-Pressarized !n-Giound ii Pressurized hi-Ground 0 At-Grade iound >24 in, of suitable soil 0 Mound < 24 in, of suitabie soil
•
, ! 0 Holding Lank 0 Other Dispersal Component (expl• ) 0 Pretreatment Device (explain) __
__________ __.
, ....__
V. Dispersalareatment Area Information: _
—
_ Design Flow (gpci/ Design Suil Application Rd - .pds1) Dispersal Area Required ' i Dispersal Area Proposed (st) System Elevation
■ 2 I 2.3 9 5" , /6
7/.
Vil.Itit (do 1 Capac; in Total # of ' Manufacturer
I G. ns Gallons Units - '0_
•
• -
1 New Tanks A Existing Tanks ___ $
Ili l' 'ri ;1
__14 0j
a L
•
- .§ -- e - n - ticulTacii4 TiinC- _ _______ __ _ . ..
Dos,ng Ciianiter I l4 - _i gee' I _ jij ' kr .:1 4- " — ± ----! "
VII. Responsibility Statement , the undersigned, a for instit the - POWTS 6 0 on the attached pia -- I
, , ,
' s Name (Print) TPlumber's Signature T i . 1P' Number Business Phone Number
i .....
4 eey 1/-4).-
1 027.5 7f5
Plumber's Address (Street, City, State. Zip Code)
! 1 c 1
. ,Z,.:2 C.•____7/ 'J. it_4:,_____ I
IN 1 . Counti/Department Use On y i / I
■ 1 Permit Fee l Dates sued Af--; Issuing A Signature i i i '
pproved I D Disa I
1 $ 2
1
'- I D Owner .) Reas n for Dental i ij - . a::: 6 /6 4 *( C)7 I Anoonally_
IX. Conditions of Approval/Reasons for Disapproval - 6 - L
/ -
1 SYSTEM OWNER:- 3) 41, .1,...4 ( 3 t.) c k-. - p . %, 15
1. Septic tank, effluent filter and
1 .dispersal cell must all be services / maintaineq " Ace. riit G. a ii 7
2. AN setback requirements must be maintained - 8
as per management plan provided by plumber.
4 - 2- 1
_ .
-05 PeraPPItaktiNTPATAIte su th
to anti btnit to e County only M paper sot less than S 1/2 x 11 inches in size
1 SV"
/06 ...-i-- oF
SBD-6398 (R. 01/07) Valid that 01/09
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. ' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of ,
FILE INFORMATION , • , „; ��, i 'L t SYSTEM SPECIFICATIONS
Owner ,&9..4.\±_s::......._16. •S'eptic Tank Capacity /eZS 0 gal ❑ NA
Permit #
f?rapt)c Tank Manufacturer W t e.se.1 ._ ❑ NA •
DESIGN PARAMETERS Effluent Filter Manufacturer Z a„ b k. ❑ NA
Number of Bedrooms ie p NA Effluent Filter Model __. too _ ❑ NA
• Number of Public Facility Units Ci NA Pump Tank Capacity 8 Oil a 0 NA
Estimated flow NA (average) b ump (7
8 O ® • al /tfti P Tank Manufacturer fie. S � R
Design flow (peak), ^ (Estimated x 1.5) Make. 0 p . alma Pump Manufacturer G o v.\ 0k ❑ NA
Soil Application Rate '_ageheay /fts Pump Model ❑ NA
Standard Influent /Effluent Quailty I Monthly average” •
• Pretreatment Unit O NA
Fats, Oil & Grease (FOG) e30 rng /L 0 Sand/Gravel Filter 0 Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg //L 0 NA • 0 mechanical Aeration ❑ Wetland
___ Total Suspended Solids (TSS) 5150 mg /L ` 4 Disinfection ❑ Other:
Pretreated Effluent Quality fvfonthly average Dispersal Call(s) ❑ NA
Biochemical Oxygen Demand (80D 530 mg /L 0 In-Ground (gravity) 0 In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L 0 NA 0 At -Grade 0 Mound
Fecal Coliforrn (geometric mean) s10 cfu/ 100m) 0 Drip -Line 0 Other: _._
Maximum Effluent Particle Size Ye in dia. 0 NA Other: ._ ❑ NA
Other:..__.. Q NA • 15P* _ _ , _ . ______— ❑ NA
"Values typical to domestic wastewater and septic tank effluent. d ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
❑ month(s)
Inspect condition of tank(si At least once e very. (Maximum 3 years) 0 NA
_ �l y _ _ __
Pump out contents of tank(s) When combined sludge and scum equals one - thirst (Y3) of tank volume D NA
Inspect dispersal cellls) At least lance every: 0 rrionth(s) ( Maximum 3 years) ❑ NA
month(s) 0 NA
Clean effluent filter
_ lit At least once every; /. / + ^� 0 yeartsl _ _ ___ __ _ _!_..A
Inspect purnp, pump controls & alarm At least once every: , _, 0 monthyear(s) ❑ NA
Flush laterals and pressure test At least once every; _ _.. ❑ month(s) D NA
0 year(s)
Other: At least once ever � __ 0 month(a) ❑ NA
Other: 0 NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber: Master Plumber Restricted Sewer; POWTS inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank($) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of affluent on the ground surface.
The dispersal cetl(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The pending of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scurn in any tank equals one - third )%') or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
Ail other se rvices, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of s12 months, shall be performed by a oartified POWYS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
'nt
START UP AND OPERATION rage
For new construction, prior to use of the POWTS check treatment tenkfs) for the presence of painting
that may impede the treatment
ent process and /or damage the dleperaal cell {a1. if high concentrations are detected hav the contents
of the tankls) removed by a septage servicing operator prior tQ use.
System start up shall not occur when soil conditions are frbaeh at the infiltrative surface,
During power outages pump tanks may fill above normal hlghwatpr levels, When power is restored the excess wastewater will be
discharged to the dispersal cells) In one large dose, overlgeding the collie) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tArik removed by a Septage Servicing Operator prior to restcrinq
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or perk vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the westewater stream may improve the performance and prolong the life of the
POWTS antibiotics; baby wipes; cigarette butts; candonlel cotton swvabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump, water; fruit and vegetable peelings; aasaline; grease; herbicides; meat scraps; medications; oil:
painting products: pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken put of seryice the folloWing steps shall be taken to insure that the system is
properly and safety abandoned in compliance with chapter Comm 83,33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected And the abandoned pipe openings sealed.
• The contents of all tanks and pits shell be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled w,th
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated And may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturpanoe end compaction and should not be infringed upon by
required setbacks from existing and proposed structure, let Moan end wells, Failure to protect the replacement area will
result in the need for a new soil and site evaluetiOn to eltebiish a suitable replacement area. Replacement systems must
comply with the rules in effect et that time.
O A suitable replacement area is not available dud to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
‘1 Q❑ The site as not en evaluated to identify a suitable replacement area.
e vaieeation be performed to locate Upon failure of the POWTS a soil an
11 a suitable replacement ea. if d site
nk
may b it cane s a last resort to replace the failed P�?WTIa no replacement area is available a holding rank
.
0 Mound and at - grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply With the rules in effect at that time,
< < WARNING»
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY SE DIFFICULT OR iMPO5$iBI.E.
ADDITIONAL COMMENTS
POWTS INSTALLER t 'P0 a MAINTAINER
— Na �� t q� t- *y.O.�l�.+s„ _ _ Name
Phone L.21, s ' - 3 g r. -• 3 / a/ Phone ____
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL Re r ULATORY AUTHORITY
Phone ( Phone
-- ---�- 7/5 - 31(- - q to 10
This document was drafted in compliarnce with chapter Comm 83. a(2)(b,(ti(di&(fl end 83.6401, (2) & (3), Wisconsin Administrative Code.
START. UP AND OPERATION Page of
• For new construction, prior to use of the POWTS oheck treatment tenkte) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal celita }, If high concentrations are detected have the contents
of the tanks} removed by a septage servicing operator prior to use.
System start up shall not occur when Soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal hlghwater levels, When power is restored the excess wastewater will ba
discharged to the dispersal cells) in one large dose, overlgeding the cell(e) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the puttee tank removed by a Septage Servicing Operator prior to festering
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
•
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil abeorption area.
Reduction or elimination of the following from the wastewater etreem may improve the performance and prolong the life of the
POWTS: antibiotics; habv wipes; cigarette butts: oandoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pumps water; fruit and vegetebre peelings: ®eeoline; grease; herbicides; meat scraps; medications; oil
painting products; pesticides: sanitary napkins; tempon3; and water softener brine,
ABANDONMENT
When the POWTS fails and /or is permanently taken out Of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm $3.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed And properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks end pits shall be excavated and removed or their covers removed and the void space filled with
soil. gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following reassures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated And may be utilized for the location of a replacement soft absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, let lines and wells. Failure to protect the replacement area will
result In the need for a new soil and site evaluation to establish a suitable replacement area, Replacement systems must
comply with the rules in effect at that time,
0 A suitable replacement area is not available due to setback endlor soil limitations. Barring advances in P
technology a holding tank may be installed as a last resort to replace the failed POWTS. aVV7S
N pt C The site as not en evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation be performed to locate a suitable replacement area. If no replacement area is available a holdin t
may wile s a last resort to replace the failed POWTS. g .an3
❑ Mound and at -grede soil absorption systetrts May be reconstructed in place following removal of the biomat at the
infihrative surface. Reconstructions of such systems must °amply With the rules in effect at that time.
«WARNING»
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DiFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWYS INSTALL^ER c
I pp iNTAtNER
Name' Wl\\tq� �.J c....6._, _ ., Name .
Phone 7 / � 3 $ r _ -� a Ph1�no ,
SEPTAGE SERVIGiNQ OPERATOR (PUMPER)
'LOCAL AID , uIArORY AUTHORITY
Name eminummon Km
Phone • C!`• %>,-- Co. Ze,n,:
Phone 7r S - 3/c• - 4/(010
..A.,...
Chia document was drafted in cnr: I;Ance with chapter Comm $ &(f1 and 83.54(11, (2) & 13), Wisconsin Administrative Code.
1
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer _ /-e " - e.--. •
Mailing Address 2S/ �c K-. 4 ;, d i, s y � c -, I 4 s.-,51 //?
v f
Property Address d Aelf ,- o .0 , �i� / G(/ • C
(Verification required fr. - Pla & Zoning Department for new construction.)
City /State Parcel Identification Number Lo /CAD
LEGAL DESCRIPTION
Property Location 1 /4 , , UW 1/4 , Sec. 3 , T N R /9 W, Town of i ds .
V7 ,2, Subdivisior�� 1 �a „ �Q t`, (2? � did . , Lot # .
Certified Survey Map # , Volume , Page # .
Warranty Deed # , Volume , Page # .
Spec house yes Lot lines identifiable 3 no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & 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 Planning &
Zoning Department within 30 days of the three year expiration date.
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, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms . r
Sca.3/U7
ATURE OF APPLICANT(S) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
1 111111 11111 11111 !
* 8 4 9 9 0 4 1
849904
STATE BAR OF WISCONSIN FORM 2- 2000 KATHLEEN H. WALSH
REGISTER OF DEEDS
Document Number WARRANTY DEED ST. CROIX CO., WI
RECEIVED FOR RECORD
THIS DEED, made between Kemon J. Bast and Donalda J. Speer- 05/04/2007 11 :25AM
Bast, husband and wife, Grantor, and Glen O. Gregerson and Emily N. WARRANTY DEED
Gregerson, husband and wife, as Survivorship Marital Property, Grantee. EXEMPT II
Grantor, for a valuable consideration, conveys and warrants to Grantee RFC FEE: 11.00
the following described real estate in St. Croix County, State of Wisconsin: TRANS FEE: 245.70
Lot 100, Cottonwood Ridge 2 Addition, St. Croix County, Wisconsin. PAGES. 1
Recording Area {(
Name and Return Address:
Edina Realty Title, Inc.
400 S. 2 St. — Suite 115
Exceptions to warranties: Hudson, WI 54016
Easements, restrictions and rights -of -way of record, if any. 823344
020- 1454 -00 -100
Parcel identification Number (PIN)
This is not homestead property.
Dated this 27 . , y of April, 2007.
* Kernon .. Bast 1 * Donalda J. e er- ast
*
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
ST. CROIX COUNTY. ) ss.
authenticated this 27th day of April, 2007
Personally came before me this April 27, 2007 the above
* named Kernon J. Bast and Donalda J. Speer -Bast, husband and
wife to me known to be the person(s) who executed the
TITLE: MEMBER STATE BAR OF WISCONSIN forego' instrument and acknowledged the same.
(If not,
authorized by § 706.06, Wis. Stats.) 0-1 /11 a a, to tA,.
THIS INSTRUMENT WAS DRAFTED BY *Pamela A. Willman
Notary Public, State of Wisconsin
Peterson, Pram & Bergman — Steven H. Bruns My commission is permanent. (If not, state expiration date:
50 East Fifth Street, St. Paul, MN 55101 1/2/2011
(Signatures may be authenticated or acknowledged. Both are not necessary.)
*Names of persons signing in any capacity must be typed or printed below their signature
Pamela A. Willman
Notary Public
State of Wisconsin
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000
1 of 1
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\ 4SCOfl5Ifl SOIL EVALUATION REPORT #1646
Department of Commerce in actor• =r with Comm 85, Wis. Adm. Code Page 1 of 3
Division of Safety and Buildings Steel's Soil Service, Inc.
County
Attach complete site plan on paper not less than 8% x 11 inch. le. Plan must St. Croix
include, but not limited to: vertical and horizontal reference poin = , , •' -ction and
percent slope, scale or dimension - , - , nearest road. Parcel I.D.
811►Q C��i`� O , Pen ■ing
Please rint Revie /d By / Date/
Personal information you provide may . - used for secondary purposes (Priv. Law, s. 15.04 (1) (m)). I J 2 b7
Property Owner APR 1 3 2005 Property Location I
Bast, Kemon
ST. CROIX COUNTY Govt. Lot na SW1/ NW1 /4, S36, T29N, R19W
Property Owners Mailing Address ZONING OFFICE Lot # Block # Subd. Name or CSM#
948 Labarge Rd. 100 na Cottonwood Ridge 2ND Addition
City State Zip Code Phone Number I City Village Town Nearest Road
1 Hudson 1 WI 1 54016 1 715 386 - 7775 Hudson I Cty Rd N
1 New Construction Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe: na
Parent material Stream terraces and pitted outwash plains Flood plain elevation, if applicabl na ft.
General comments Conventional System, system elev ' n 95.18ft. nches spaced and depth to code 5.42ft below e.
and recommendations: ��
ti^- � -°'
1 Boring # El Boring
❑ Pit Ground surface elev. 100.60 ft. Depth to limiting factor 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
—
1 0 -12 10yr3/1 none 1 2msbk mfr cs 1vf .6 .8
2 12-44 10yr4/4 none sl 2msbk mfr gw na .6 1.0
3 44 -100 7.5yr4/6 none cos osg ml na na .7 1.6
2 Boring # Boring
❑ Pit Ground surface elev. 100.60 ft. Depth to limiting factor 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -16 10yr3/1 none I 2msbk mfr cs 1vf .6 .8
t• 8
2 16 -38 10yr4/4 none sil 2msbk mfr gw na . * :6,
3 38 -56 7.5yr4/4 none sl 2msbk mfr gw na .6 1.0
4 56 -120 7.5yr4/6 none cos osg ml na na .7 1.6
,..,i-75'.19 -
6s.
* Effluent #1 = B09-? 30 < 220 mg /L and . TSS >30 < 1501L * Effluent #2 = BOD <30 mg /L and TSS <30 mg /L
CST Name (Please Print) - Si nature: CST Number
David J. Steel _
248956
Address Steel's Soil Service, . - - Date Evaluation Conducted Telephone Number
994 200th St. Baldwin, WI 54002 4/11/2005 715 760 - 0347
SBD -8330 (R.07 /00)
t *
• STEEL'S SOIL SERVICE INC. 3 of 3
David J. Steel Kernon Bast 994 200 St.
CST - POWTSM SW1 /4,NW1/4,S36,T29N,R19W Baldwin, WI 54002
Lic. #248956 Town of Hudson, St. Croix Co. CeII (715) 760 -0347
Cottonwood Ridge 2ND Add. Fax.(715) 684 -3449
Lot,100
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
?• Legend N K
n - 1 „ = 40' I
�i �V I C= Benchmark Ele. 100.00 ft
00 0,\ Top of 3/4” pvc pipe
A lt Benchmark Ele. 99.55 ft IV
�` op of 3/4" pvc pipe
`H' � \ ' 0 = Borings
\ Boring Elevations
B1 = 100.60 ft
B2 = 100.60 ft
B3= 98.10ft
B4 = 0.00
1
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Feb 21 06 08:Ola Steel's Soil Sevice Inc. 715- 684 -3449 P.2
3of3
STEEL'S SOIL SERVICE INC.
David J. Steel Keeton Bast 994 200 St
CST - POWTSM SW1/4,NW1 /4,S36,T29N,R19W Baldwin, WI 54002
Lic. #248956 Town of Hudson, St. Croix Co. Celt (715) 760 -0347
Cottonwood Ridge 2ND Add. Fax.(715) 684 -3449
Lot,100
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
Legend N
RECEIVED 1"= 40' `
A = Benchmark Ele. 100.00 ft
FEB 2 1 2006 Top of 3/4" pvc pipe
• = Alt Benchmark Ele. 99.55 ft
Top of 3/4" pvc pipe
ST. CROIX COUNTY l7 = Borings
Boring Elevations
B1 = 100.60 ft
• . B2 = 100.60 ft
/ / B3 = 98.10 ft
B4 = 0.00
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