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HomeMy WebLinkAbout020-111390180 Wisdonro County: in Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix • Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514808 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: Grider, Jason I Hudson, Town of 020 - 1113 -90 -180 CST BM Elev: Insp. BM Elev: BM Description: G (� Section /Town /Range /Map No: / OCR A ( C 5T 12.29.20.459120 TANK INFORMATION 6 ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. l6Z.'f$ Septic t Benchmark Alt. BM �', l 9Y• 3Y F :1 k o t� qu Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet /a, ZS '9Z • Z3 TANK SETBACK INFORMATION TANK TO eptic P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet S Dt Bottom Dosing � L¢- Header /Man. 'Z• ,.q � 3q Aeration Dist. Pipe II. � �Q Holding Bot. System /Z - ( — G 5 PUMP /SIPHON INFORMATION Final Grade Manufacturer GPM nd St `�� C �, f pf/,3el F' � s _/ 7 Model Numbe TDH L t Friction Loss System H TDH Ft Forcemain Len Dist. to Well SOIL ABSORPTION SYSTEM llesl• `1e.r•e BED /TRENCH Width ( Length I lo. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 l Z_ I I'e KG'_ SETBACK SYSTEM TO v P /L BLDG WELL LEACHING Manufacturer. — +��� INFORMATION ` CHAMBER OR lti k Typ (f6 h ✓ � , Z -1 e. CY� 1 -30' „7! ' J_jA ,Q UNIT Model Number: L DISTRIBUTION SYSTEM / , 2 - z• l = 4 '3 A' dla_� Header /Manifold # 1 Distribution x Hole Size x Hole Spacing Vent sir In}�I Pipe(s) \, \ �_ I �r0 Length Dia � Length Dia Spacing h� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only W Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched 1 Bed/Trench Center •7 5 Bed /Trench Edges `, Topsoil _Yes No Yes _' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / �nspectib n�2: / * / 4r � D * CA_ Location: 907 Kirkwood Way Drive North Hudson, WI 54016 (SW 1/4 SE 1/4 12 T29N R20W) NA Lot 1 Parcel No: 1 9 20.459120 &j M b v., I T* (1'�•""�_ 1.) Alt BM Description = 1 4 11 111c- 2.) Bldg sewer length = qb tom. �,� S :: SLst c F - amount of cover - I I' 3 P lot P lums , 4f e'e' 'b`�.. s ate ?� q ..... Plan revision Required? Yes ` No J 7 Z Z b p� Use other side for additional information. r, // Date Insepctor's nature Cert. No. SBD -6710 (R.3/97) �jfjs ��� W� O �� � ✓; � a ^ � f� ^ n ` Safety and Buildings Division County commeree.wi.gov 201 W Washington Ave., P.O. Box 7162 W. � i s eo n s i n Madison, W 1 53707 -7162 itary Permit Number (to be lilted in by Co ) iff Department of Commerce J I Z b C� State Transaction Num Sanitary Permit Application Now ti � in accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appr tt govern ental f unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal infomnation you p' used for secundwy '767 � (� wr xises in accordance wi rho Privacy Law, s. 1 S.Q 4(I )(m),_ Slats. 1 pp�� L Application in - Please Print Ail information Property Owner's Name f ParceE q _ DEC oils - /i� - Property Location r Property owner's Mailing Address ST. CROIX COUNTY Govt. Lot City, State Zip Code Section circle one �i i. 'type of Building (check all that apply) Luc n ' t�r� / Subdivision Nano ;1 „ur2 Family Dwelling - NurolkrofRedronms l 6r t 1C., V%_ ❑ PubliclConimcrcial - Describe Use -� __ _ -- ❑ City ot,�__ ffi ! CSM Number ❑ Village of I ❑ State Owned - Descriix Use Z t I '0 / � t � - rown of K 111. Type of Permit (Check only one b ox on line A. Complet li ne S if applicable) { A ' ew System p y ❑ Re lacement $ stem ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Gxisting Systcm {explain} ` —_ List Previous Permit Number anti Date Issued R. ❑ Permit Renewal Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Helore Expiration Owner l V� _ Type of POWTS System /ComponentlDt vice: (Check ail that a siro{y) ( Non- Pressurized In-Grou C1 Pressurized In- Ground Cl At-Grade ❑ Mound . > 24 in. ot'suitabie soil ❑ Mound < 24 in. of suitable soil I ❑ Tank © Other Dispersal Component (explain) ❑ Pretreatment Device (explaiN V. Dis ersal/'1'reatment Area information: __ Design Flow (gpd) Design Soil Application Rate(gpds!) Dispersal Area Required (s Uispetsa! Area Propo d {�f) System E{e�ation I VL Tank Info Capacity in Total aY of Manutacturer Gallons Gallons Urns w e t j v r ' New Tanks Cxistirg Tanks n � L c' Ln — Septic or Holding Tank k U 15 �' — Dosing Chainbtr V11. Responsibility Statement 1, the undersigned, assum responsi for iustallatiou of the POWTS s wn on the attached plans. Plumber's Name (Print) Plumbers Signature 61P . IPRS Number Business Phone Numbet - 7a74q1: 5 ' 7iS-�t��-�/a/ I Plumber's Address (Street, City, State,, Zip Code) 7� V111. County / De artm Use Only _ A pproved ❑ Permit f ee bate Issued Issui, Agent Signal e wn tven Reason for Denial IX. C A for Disapl.roval A 1. Septic tank - tff'u­' `:".ter and d**rsal ceii m ,�ser,<< ,s / maintained }b iti per many r to ; by plumber. 2. ��Wtt2lback reyu r �• „ e ru >� a �r M, o as p e ails to. t syslent and submit to the County only ou y(ser aot loss iban a v] x I I inches in stxc _ SBD -6398 (R. 01107) Valid thm 01 /09 a efr:C e lt( v Sa ly a Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 x hes in size. Plan must County St. Croix Include but not limited to: vertical and horizontal re tp direction and Parcel I.D. Percent slope, scale or dimensions, north arrow, BM d to nearest road. 020 - 1113 -90 -175 Please print all infor t Rev Date Personal information you p (Priv La 15.04 (1) (m)) ie d by /Z+ �a d Property Owner Location David & Arlene Hart Govt. Lot SW v< SE v. s 2 T N R 20 E (or) W Property Owner's Mailing AddresE UEC 0 17007 Lot # Block # Tbd. Name or CSM# 604 Wisconsin Street 1 City tate Phone ❑ City ❑ Village 0 Town Nearest Road Z NING OFFICE - 1 -1254 1 Hudson Kirkwood Way North 0 New Construction Use: 0 Residential / Number of Bedroom Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or Commercial — Describe: Parent Material Outwash Flood Plain elevation if applicable N/A R. General comments and recommendations: i k e b a �� G S=map lV Lo 5 Zlb C b f 116 �r aZeA 5s. lb ; e f A'a eVQj0ck, a .� 4 ormg Boring # 0 pit Ground Surface Elevation 97.7 ft. Depth to Limiting factor <ISO in So il ftolication Ra Horizon Depth Dominant Color Redox Description ,Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Nib C- Gr. Sz. Sh. *Eff#1 *E02 1 0 -10 Frozen Frozen yf' Frozen Frozen Frozen Frozen Frozen 2 10 -16 10YR3/4 - S 1 -f -pi mvfr gs 2m 0.7 1.6 3 16 -38 7.5YR4/4 - S 0 -sg ml gw 1 m 0.7 1.6 4 38 -77 7.5YR4/6 - S 0 -sg ml gw 1M 0.7 1.6 5 77 -150+ 10YR4/6 - Cj0 GRS 0 -sg ml - - 0.7 1.6 F O Boring 5 Boring # OPit Ground Surface Elevation 96.8 ft. Depth to Limiting factor > 150 S oil ftolication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP /ft in. Munsell Qu. Sz. Cont. Col r Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-15 Frozen Frozen Frozen Frozen Frozen Frozen Frozen 2 15 -32 7.5YR4/4 - S 0 -sg ml gw if 0.7 1.6 3 32 -92 10YR4/6 - S 0 -sg ml gw - 0.7 1.6 4 92 -150+ 10YR4/4 GRM to COS 0 -sg ml - - 0.7 1.6 It W i d r ' Effluent # I = BOD > 30 <_ 220 mg/L and TSS > 30 < 150 mg/L " Effluent #2 = BOD, 5 30 mgtL and TSS <_ 30 mg/L CST Name (Please Print) gnature CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 December 3, 2007 715- 796 -5664 Property Owner David & Arlene Hart Parcel ID# 020 - 1113 -90 -175 Page -- --of 3 F Boring # 13 Boring >150 ®Pit Ground Surface Elevation 95.1 ft. Depth to Limiting factor in. So il ADDlication R ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *002 1 0 -15 Frozen Frozen Frozen Frozen Frozen Frozen Frozen 2 15 -30 7.5YR4/4 - S 0 -sg ml gw - 0.7 1.6 3 30 -95 10YR4/6 - S 0 -sg ml gw - 0.7 1.6 4 95 -150+ 10YR4/4 - GRS 0 -sg ml - - 0.7 1.6 F -1 ® Boring Boring # ppit Ground Surface Elevation ft. Depth to Limiting factor in. S oil AoDlicatl on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff #1 "Ef(#2 F -1 ❑ Boring Boring # ®pit Ground Surface Elevation ft. Depth to Limiting factor in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QP D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efr#2 * Effluent # 1 = BOD 30!5 220 mg/L and TSS > 30:5 150 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. Page 3 of 3 0 ft. 24 ft. 40 ft. 80 ft. N Proposed House BM#2 - Top of 1 1/4" PVC pipe 100.3' B-4 97.7 c� BM #2 85.4' g \oQe 3 ell Top of Utiity Box - north comer B-6 J Notes & Elevations 95.4' A grinder pump must be installed in the �o�0 O EL basement to achieve gravity flo he n, septic tan S \oP 9 � Top of Concrete Wall 95.3'* B -5 Top of Pipe 2.5' below top of wall 92.8' * 98.8' Header <8' below surface 90' to 91' * * Elevations are approximate and based the o assumed height of the basement wall from ?� the base of the excavated basement. There will be a minimum of 1.8' of elevation m change from the the house to the system due to minimum 1 % slope of pipe (1.4 ) and septic tank (0.49. If the depth of the infiltration surface is greater than 9' below surface the system location will need to be Property Line graded to reduce the amount of cover over the leaching chambers. BM# & Description OIL = Elevation V Bench Mark g = Borin Location &Elevation All unmarked property lines are greater than 100' from borings Owner: David & Arlene Hart Site Information: Completed By: Marts Iverson 604 Wisconsin Street SW 1/4, SE 1/4, S12, T29N, R20W 680 Larcom Street Hudson, WI 54016 Town of Hudson Hammond, WI 54015 Phone: 715 - 531 -1254 St. Croix County 715 - 796 -5664 PSS#198 / CST# 46672 commerce.wl. ov Safety and Buildin vision County F2001 W. Washington A Box 7162 S G i s co , W 537 7 Sanitary Permit Number (to be filled in by Co.) t)epartmrce I �� State Tr ansaction Number Sanitary Permit Application In accordance with s. Comm. 53.21(2), WIS. Adm. Code, submission of this form to the appropria over, I unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned WTS are Project A dress (if different than mailing address) j subtn,tted to the Depa lment of Commerce. Personal information ou pr ovide may be used for undary �/s\ ,urL,ses in accordance with the Privacy La w, s. i 5.04 t m Slats. '` �� L4 I_ Ar tplication information - Please Print Al it n tion �G� V G� Property Owner's Nana Parcel y J� �Y 0 20._/ 9 Property Owner's Mailing Address Property Location + )� 7 ST, CROIX COUNTY ` Govt Lot � n City, state Zip Code — y, Section _ 1 t,trcle one It,Type of Building (check all that apply) Lc' ' _J Subdivision Name 1 or 2 Famiiy Dwelling - Numl, of Bedrooms M Bloc i 4 ❑ Pub GcfC nmmercial - Uesenlx Use i m�,er_: i� ❑ City of ! Q State Owned - Dcscrilw Use CSM Number Q Village of Town of J Ill. Tyne of Permit: (Check only one box oif line A. Complete line B if applicable) A. X New System y ❑Replacement System ❑ ttnenl!lioldingTsnk lizp(acetnettt Only ❑Other Moditicanon to Existing System(explain) �^ List Previous Permit Number and Date Issued It. ❑ Permit Renewal El Permit Revision ❑ Change 'Plumber,;; ❑ Permit Transfer to New --*I*+ R Before Expiration Owner I V. Type of POWTS Sys tem / Component/De vice: Check all tits pl )K N on Pressurized In - G round ❑ Pressurized In- Ground O At -Grad Mound 2:24 in. orsuitable soil 0 Mound < 24 iii . o swta a soil a ! ❑ Holding'I'ank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V . Dispersal/T Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Disp I Area Requi Dispersal Area Propos (SO S stem Elevation VI. Tank Info Capacity in Total t1 of Manufacturer ! C V Gallons Gallons Units a � U •� t I New 'ranks Existut g Tanks w e u 6 P C Zak- Septic or Holding Tank e Dosing; Chamber __ O® l VII. Re sponsibility St atement- 1, the undersigne assume responsibility for in stallation of the POWTS shown on the attached plans. r Plumber's Name (Print) Plumber's Signature MPRS Numb B usiness Phone Number Plum is Address (Street, City, State. Zip Code) 2 q 6 -- Vill. County/ e artment Use Only_ pproved Pe� Dale lss Issuing Age S' nature U teen Reason o ial S ` - f� IX. Condl ' easons for Disapl.roval /IA A /�� � Ji e�/ 4-1 z� s�1-� t s t. Ssptio tank, effluent filter and / t dispersal cell must all be servkes / Maietfained I a as per management plan provided by pkprdW i 2. AN setback regt�rements rngst be rrdkbk d $ • r� Poll: Atlach to comp etc p ans rr the ma tem and sub a to the County of ou paper not less than ll Ill V l chi!sill size A A SBD•6398 (R. 01 /07) Valid thru 01/09 I t /� - r /i 17it l b� C A M n V K L Q �c A i V ' Wisconsin Department of Commerce AOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance. 85NAs. Adm. Code x �y SL Croix Attach complete site plan on paper not less than 81 inches m s ust include, but not limited to: vertical and horizon I reference p direction and p l p percent slope, scale or dimensions, north air location and dist 715.04 nearest road. h 6720 Please print I in Personal information you provide may be used r secondary purpo ( (t) (m)). Property°wner N o Localron 13 David and H .1 2O l SW 114 SE 114 S 12 T 29 N R 20 E (or) W El Property 0w mes Ma ft Address Rp� of # Block # S IM Name CSM# 1023 Highway 3 GUN 1 City State Zip Code Phone ❑Wage EITUM Nearest Road Hudson WI 1 54016 ( 715 386 Kirkwood Way North E) New Co rWh cbm UseM Residential I Mrrober of bedrooms 4 Code derived design flow rate 600 GPD Replacernert Q Pubic or commeircW - Desrxrbe: Parent rivowial Flood Plain pille'aiii°" d applicable _ 4 1t. General commeMs /0 07 7 E / �' CL�4,e �'� Gu and CtcC'�in�w � /l am Y can. 9 �w ttc- a to �a — Ste- . �� etiztjzt� Boring # Boring Q pit Ground surface elev. 97'4" ft. Depth to limiting factor 76 in. Sot Rate Horizon Depth Dorrrnant Color Redou Descir"m TeA a Structure Gar�wm Boundary Roots GPDI� in. Mansell OIL Sz. Cont Color Gr. Sz. Sh_ 'E1M1 `EfM2 1 4-10 10YR4 /6 SL 2 M BK MFR CS 2F .6 1.0 2 10-17 7.M4/6 SL 2 F PL Mf1 CS IF -6 1.0 3 17 -76 10YR51 S 0 SG ML .7 1.6 2 Boring # Bones 95'10" 72 D Pit Ground surface elev. ft. Depth to limiting factor in. Sot Rate Horizon Depth Dominark Color Redox Description Texture Struclure Cormisterice Boundary Roots GPDN in. Mansell flu. Sz. Cont. Color Gr. Sz, Sh_ TIM 'EfM2 1 0-11 10YR3/4 SL 2 M BK MFR CS 2F .6 1.0 2 11 -72 10YR5 /6 S 0 SG ML I M 7 1,6 • EAuent #1 = BOR > 30 1220 rrglL and TSS >30 1 150 uq& BOD < 30 ng& and TSS < 30 rrglL. CST Name (Please RW4 S9ginature CST Mumber Dale R. Stewart 220879 Address Evaluation Coruducled Telephow Nwdw 757107th SL Roberts„ WI 54023 05/318007 715 749-0145 y Hart, David and Arlene Parcel ID # Page 2 of 3 F 3 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sol Applicefion Rate Horizon Depth Dominant Color Redox Description Texture Structure Corrislerwe Boundary Routs GPOW in. Muusell tlu. Sz. Cont Color Gr. Sz. Sh. *EM *E1M2 1 0-12 10YR4A3 SL 2 M BK MFR C S 2 F .6 1.0 2 12-24 IOYR4P6 SL 2 M BK MVFR CS 1 F 1.0 3 24-75 10 4!6 S 0 SG ML 7 1.6 F Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. � Rate Horizon Depth Dorrrnarrt Color Redox Description Texture Structure Consistence Boundary Rools GPDdf in. M NIS M clu. Si Cont. Color Gr. SL Sh. 'Eff#1 *EN2 IH Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Sol Rate Horizon Depth Do *wt Color Redox Description Texture Structure Conwistence Boundary Rock GPOW in. Mue d OUL Sz- Cont Color Gr. Sz. Sh. *M *E1M2 * Effluent #1 = BOD > 30 < 220 mg& and TSS >30 150 mg& * Effluent #2 = BOD, < 30 mgA- and TSS < 30 mglL 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. ssn- 8330rest (IL 07/00) 2 9 4�2 9PL- PL r8(. 0 DI S PERSAL Z, oAJC ` 9t Utz A ME A� �� laz3 N .1 6 H WA �/ 3,5r P L- o - T - ,o , vj Al 44 Lt 1� 6 a Al q BI �-� P e t i L q,2 qPL_ 9' _._ - ------- ---- DT_ s PFRS A L Z. aN Cz fie"( 010. p:I- Aj A ` � ®1 # D Se � 3 0 Lo` B3 B l 97 a7- t 'I RECEIVED 0 CT 0 5 200 ST. CRO1X COUNTY CERTIFIED SURVEY MAP LOCATED IN PART OF 7HE SOUTHWEST QUARTER OF THE SOUTHEAST QUARTER SECTION 12, TOWNSHIP 29 NORTH, RANGE 20 WEST, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN The Bearings are referenced OWNER: to the South Line of the DAVID & ARLENE HART 0 Southeast Quarter of Sec. 12- 29 -20, 1023 HIGHWAY 35 zz assumed to bear N89°11 50 "W HUDSON, Wl 54016 LOT-1 LOT 2 C. S. M. C.S.M. Q VOLUME 6, VOLUME 6, PAGE _1778 PAGE _1778 7 55'E Southeast (N89 °0 924.65) Comer of S89 %6'06 "E 924.29 Lot 2 ye 474.59 449.70 Op South Une of the CSM, rn - T Vol 6, Pg. 1778 N 1q: Ft. Acres O) O U T L O T 1 L1 60 FOOT PRIVATE '4 t2I o (INCLUDING PR /VATS ROADWAY) ROADWAY EASEMENT 289,037 Sq. Ft. 60.01 ry � 6.635 Acres o L3 QO North Line of THE RIDGES `� 2 East Line of the C SM ° o 3 Sq. Ft. \ 5 0 a O o� Vo% 7, Pg. 1912 2 .164 Acres r N y + I ' - -- 715.63 (N89 %5'09'"W - ` - 319.94 4 lJ" �� � E --- N89 "W 1162.32--- 446. ° Q - - - N Northwest Comer of 1162.33) ,g0 , LOT _1 THE RIDGES CONDOM LOT 3 LOT 4 LOT 5 LOT 6 I i o LOT 9 C.S.M. THE RIDGES -- CONDOMINIUM THE RIDGES ------ - - - - -- - - - - -- VOLUME 7, --- _-- KIRKWOOD WAY DRIVE PAGE 1912 East Line of the Southwest Quarter of the Southeast Quarter 2 • — _ --- 1 326.52 = -- " Quarter Comer N89011'50 "W 2653 04 ' — — — — — 1326.52 • Sec. 12 -29 -20 Southeast Caner Found Aluminum Monument South Llne of the Southeast Quarter Sec. 12 -29 -20 Found Aluminum Monument 200 100 0 200 SCALE. 1 INCH - 200 FEET L GEN Ifii1i11111'' " "'ii111111 1111!1 IIlI 111111 II11 1111 * 8 J 0 0 1 4 860001 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., III RECEIVED FOR RECORD 09/06/2007 01 :OOPM CERTIFIED SURVEY MAP VOL: 22 PAGE: 5452 CERTIFIED SURVEY MAP REC FEE: 17.00 COPY FEE: 5.00 LOCATED IN PART OF THE SOUTHWEST QUARTER OF THE PAGES: 4 SOUTHEAST QUARTER SEC7101V 1$ TOWNSHIP 29 NORTH, RANGE 20 WEST, TOWN OF HUDSON, Sr C ROIX COUNTY, WISCONSIN OWNER: The Bearings ore referenced DAWD & ARLENE HART = to the South Line of the 1023 HIGHWAY 35 cr Southeast Ouarter of Sec. 12- 29 -20, HUDSON, WI 54016 zz assumed to bear N89 %150 "W LOT _1 LQT 2 C. S. M. O 7 7 - VOLUME 6, I VOL UME 6, IN PAGE 1778 I PAGE 1778 I Southeast I (N89 - 55 N 'E I 924.65) Lorne er of + ,IN S89 %6 06 E 924.29 h� 474.59 449.70 Z �! South Line of the CSM, L O T Z' Vol. 6, Pg. 1778 112,026 Sq. Ft. 2.572 Acres '`� U T L O T Ii L 1 66 FOOT PRIVATE C & EGRESS (INCLUDING PRlVA TE ROAD i EASEMEN 291, 652 Sq. Ff. '66.01 1 T 6.695 Acres L 3 0 North Line of THE RIDGES o L 0 T 2 N o e of the CSM, ro 49,453 Sq. Ft. 50 D q' Pg. 1912 1.135 Acres r c'o: N� 715.65 h6 �1 " ' - - --- N89 "W \ 11182 3Z - - - (446.67 \ '^ 4 0 001 I Northwest Corner of (N89 0 15 1 09 "W 1 1162.33) SEE DETAIL 16 o I I THE RIDGES CONDOMINIUM \ LOT 3 \LOT 4 LOT_ 5 LOT -6 LOT 1 I � I M I THE RIDGES CONDOMINIUM \ THE RIDGES M . 1 - -------------- - -------------- \ ---- - - - - -- - VOLUME I I I w NOTE. SEE DRAINAGE KIRKWOOO_ WAY NOR - IPA GE__1912 AND UTILITY EASEMENT gN DETAIL ON SHEET 3. East Line of the Sou,thwest--+ o Quarter of the Southeast Ouorfer z 1 I -1 32 6. 52- - - 1326.52 - South Ouorter Corner N89 °1150V 265J04 , Soul eosf Sec. 12 -29 -20 South Line of the Southeast Quarter —� Sec. 12 -29 -20 Found Aluminum Monument Found Altgminum Monument \ a��� 1111111 EtJlIJli f „�,� 200 100 0 200 c o ly DETAIL not to $Cole SCALE: t INCH = 200 FEET to MARK F. 316.78 - 69.77 MAISTROVICH f - l? 3. f 7 - 53.43 - ' 3.17 S -2624 0 Set J14 inch x 18” Rebor ` EXC weighing 1.50 lbs. /lineor ft. 0 Found I" (O.D.) Iron Pipe 0 N89 136.SJ rfl1 it11iti1si::lCwt�'`'�� ■ Found 1 -1/4" Diameter Rebor L2 NIOV7'34 9420 �i Found Section Corner LJ S891442T 137.88 L4 518@07'J4 E 72.58 (S39 "W) Record Doto 4j, / I Mork t, Moistrovi S -2624 50' Building Setback Line Posse Engineering Inc. Ingress & Egress Eosement 2003 0 Neit Rood Hudson, Wisconsin 54016 PROJECT NO.: 843 -06 715- 381 -1150 WING OA TE: JUNE 28, 2006 ORA WN BY JAMES WEBER SHEET 1 OF 4 .SY'lEEIS Oo ` e t Q Vol. 22 Page 5452 I + , ST CROIX COUNSTY SEPTIC TANK 'MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer G SOn aMC1 12eQ- m rome Mails Address (C'> `� i r �' a Mailing r ,Y -e., o Property Addres - t W Y A SO (Verification required from l for new construction' H "dac7) , .�,._..,... Parcel Identification Number L rAL DF5C_R PTYON i_ oi - I Property Location (.J /4, '/,, Sec. _ia,, T 2 -`l N -R Town of Su �- bdivision , Lot # Certifled Survey Map # Volume , Page # Warranty Deed # -�bq 7 I . Volume , Page Spec house p yes g no Lot lines identifiable lR yes C1 no lmpwper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic teak every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St, Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrietedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal 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. Iiwe, the undersigned have read the above requirements and agree to maintains the private sewage disposal system with the standards set forth, herein, as set by the Department of Co=erce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days otthe three year expiration date. DATE , SZNA APPLICANT 0 ER CER13F1CATION 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) o the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. S1 A LICANT DATE tit * M'k M M * * * * ** Any information that is mis- represented may result in the sanitary permit be4 revoked by the Zoning Department. �* Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed P' -' ' WANK PUMP CHAMAER C .OSS SEGION AND SPECIFI ;r,TTO:S� 4" Cl VENT PIPE 12" MIN. ABOVE GRADE S 25 FROM DOOR, WINDOW OR WEATHERPROOF FRESH AIR INTAKE JUNCTION BOX APPROVED WITH CONDUIT MANHOLE COVER FINISHED GRADE W1 PADLOCK 4" CI RISER --- °WARNTNG LABEL - --- .t ---. `r — :--- -- k " MIN. I8 "IN. 6 MAX. N L E T -- ------ ��, WATER TIGHT SEALS GAS- TIGHT `� `/APPROVED SEAL JOINTS WITH PPROVED ,PPE 3' I9 ALM APPROVED PIPE 'ONTO SOLID , ON 3' ONT SOIL 'OIL G PUMP OFF ELEV. FT4 ...... OFF RISER EXIT D PERMITTED ONLY !F TANK MANUFACTURER HAS APPROVAL. 3" APPROVED BEDDING; UNDER TALK CONCRETE PAD SPECIFICATIONS SEFT?C / DOSE TANK MANUFACTURER t,,� .Se.R. NUMBER DOSES PER DAY. TANK SIZES SEPTIC 1AS O GAL. DOSE VOLUME INCUIDING DOSE GAL. FLOWBACK: J GAL. A LARM MANUFACTURER: bepri j% tt►r�, CAPACITIES: A = INCHES = g62L GAL. MODEL NUMBER: D SWI TCH _ TCH TYPE. � � M a Z _ a.. _ INCHES GAL. " UMP MANUFACTURER: Cr MODEL C = INCHES = �$ GAL. MODEL NUMBER: p d SWIT - CH TYPE. � D _ INCHES ,,.� � � - GA L. REQUIRED DISCHARGE RATE L4 0 GPM PUMP & ALARM WIRING AS PER ILHR 15.23 WAC FRT:CAL DIFFERENCE BETWEEN PUMP x OF AND DISTRIBUTION PIPE IQ.. FEET * MINIMUM NETWORK SUPPLY PRESSURE . . 2.5 FEET FEET F ORCEMAIN X A FT / 100 FT. FRICTION FACTOR , 5 FEET TOTAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ,-.- ; WIDTH .--r ; DIAMETER LI QUID L?£'P'i' S ' :3 f " . 41 &,4 L pert ! �' r LGNED: -- ,,,�►'' LICENSE NUMBER: ZaX7 DATE :./88 [6]GOULDS PUMPS Submersible Effluent Pump 3 871 EPO4 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. • Effluent systems heat transfer. ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto- superior strength and corrosion • Heavy duty sump matic models include resistance. U1ladian standWsAssodatiem • Water transfer Mechanical Moat Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatedng assembled and preset at the for efficient heat transfer, in "F" or "C ".) factory, strength, and durability. SPECIFICATIONS ■ Motor Cover. Thermoplastic Goulds Pumps is ISO soot Registered. • Solids handlin g capabili bil' FEATURES cover with integral handle and 1 /4" maximum. ■ EPO4 Impeller: Thermopias float switch attachment points. • Capadbes: up to 60 GPM. tic Semi -open design with ■ Power Cable: Severe duty • Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water resistant. • Discharge size: 1 NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104OF (40 continuous 140°F (60"C) intermittent. METERS FEET V . _..._.. _ .... . • Fasteners: 300 series 10 1 --- -� stainless steel. _ • Capable of running dry without damage to 8 2.s Fr T components. 25 : __ _._.... Q Motor: i • EPO4 Single phase: 0.4 HP, 1 6 20 115 or 230 V, 60 Hz, 1550 RPM, built in overload with 5 automatic reset a t5 ..._. a___. _..__�._ _... .__..__._ _._...... • EP05 Sin phase: 0.5 HP, ? 4 EPOS 115 V, 60 Hz, 1550 RPM, ° built in overload with automatic reset. EPO4 _ 2 • Power cord: 10 foot 5 standard length, 16/3 3 SJTOW with three prong grounding I Optional 20 g 9 P u9� P ' o ° 0 1 o zo - .._ . 3o ... no . so GPM foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). 0 2 a s a 10 12 malt, CAPACITY G Pumps C 2000 Goulds Pumps ITT Industries Effective February, 2000 63871 ?$ifil lfill $1111 21vi 14H11 infil liL1 vigils 11Bi 1IlD �1f !r i 1!I!I 111 i1 II Mil I'll 111111111111 t 'D V � L i 1 1 L ' State Bar of Wisconsin Form '_ -?003 ` �'`—' W_ -URA TY D FFD IA lul cchl U In Al -U ,t?l I tt-"ll 11 ?ML-J1 i DC C ?L� n r7CLr:^ Document Number Document game L 71•J i L1v J. vLLVJ ^T r D1TV Pf 41T DC ^CTUCt1 I Wit ocrnGn Ott' ✓Li f LV I VIl i\LV VItU 1111 "W17 11.OWILA THIS DEED, made between David A. Hart and Arlene Hart, husband and wife nlr:aoa�lr•/ nccn H. 41A0 AM � U PNPT s ( "Grantor," whether one or more), and Jason A. Grider and Deanne L. Grider. husband and wife ;uc I p� . W I � r1n ! � L. IJ.VV ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ('Property ") (if more space is needed, please attach addendum ); T`� ; ,IRBI That part of SWI /4 SEil4 Sec. 12- T23N -R20W described as follows: Lot I of Certified Survey Map recorded in Vol. 22 of Certified Survey Maps. pacre 5452 as ' I` � "� ='��' '' Wi 54020 Doc. No. 560001. Together with a 66 foot private easement for ingress and egress as shown on the subject Certified Survey Map. St. Croix County, Wisconsin. Part of 020- 1113 -90 -171 Parcel Identification dumber (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated (SEAL) ��� (SEAL) x "David A. Hart (SEAL) , 4 1 1 /• (SEAL) * 'Arlene Hart AUTHENTICATION ACKNOWLEDGMENT Signature(s) David A. Hart and Arlene Hart. husband and wife I P STATE OF ) authenticated on I ) ss. COUNTY ) *Kr istina land Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. 3 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Attorney Kristina Oland Notary Public, State of Hudson WI 54016 My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICa"IIO \S TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED t 2003 STATE BAR OF WISCONSIN' FORK NO. 2-2003 * hype name below signatures. INFO -PROT Legat Forms 800- 655 -2021 www.infoproforms.com Grantor: David A. Hart and Arlene Hart Grantee: Jason A. Grider and Deanne L. Grider Legal description: Survey Map recorded in Vol. 22 of Certified Survey Maps. page 5452 as Doc. No. 860001. Together with a 66 foot private easement for ingress and egress as shown on the subject Certified Survey Map, St. Croix County. Wisconsin. ' POWTS OWNER'$ (MANUAL 4 MANAGEMENT PLAN Page of FILE INFORMATION YSTEM SPECIFICATIONS L� wner , /�d .S o.J � e— Septic T ank Capacity � 0 a! 1 13 NA e P ermit # Septic Tank Man ufacturer �' ❑ NA [LESION PARAMETERS Effluent Filte Ma nufacturer NA Nu mber of Be 0 NA Effluent Filter Model 13 NA c Number of Public Facility Units i Q NA, Pump Tank Capacity _. _ _ _ 8 0� �I ❑ NA Estima flow (ave rage) ~ r COO 4 0 al /da Pump Tank Man ufacture r � ;� ewe � ❑ NA Design f ( peak), (Estimated x 1.5 b d Cy al l/day Pump Manufacturer � O �1 � �! El NA Soil App lication Rat Y a Pump Model D NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit — ❑ NA Fats, tail & Grease (FOG) s30 mg /L i.Q San¢ /caravel Filter ❑ Peat Filter Biochemical Oxygen Demand (8001,) ' s220 mg1L Q NA E3 Mechanical Aeration ❑ Wetiand _ T otal Suspended Solids (TSS) 5150 mg /L Q pi infect)on ©Other: Pretreated Effluent Quality Monthly average Dispersal Cell( &) -� 0 NA Biochemical Oxygen Demand (800 ? 530 mg /L a 1n- Ground (gravity) 0 In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L Q NA Q At- tirade 0 Mound rty Fecal Colifo (geometric m ean) 5 1 0 4 cfu / 100m) Q trip - Line u Other: Maximum Effluent Particle Size Y in die. ]N�A 11 NA Utner ---- --_- -- ..�..___ ___ Clth4r; ❑ NA `'Jalues typical for dornestic wastewater and septic tank effluent. t}ther; v __ J C NA MAINTENANCE SCNEiDULE service Event Service Frequency inspect condition of tank(s) At (east ono Byer month(s) -.. —_ --- `� e Y e (Maximum 3 years) t7 NA Pump out contents of tank(s) _— When combined slud®ei and scum equals one -third (Y of tank volume C3 NA Inspect dispersal ce()(s) At least once eve tC month(s) _ *a yearls) (Maximum 3 years) ❑ NA :iean effluent filter A –' � At least once #very: _ El month(s) - --- ----- ,_ +� I At �l NA yearfa) _ Inspect pump pump controls & alarm At (east ttnce ovary: ..., (� month(s) 13 NA _._ CJ yearls) ( Flush laterals and pressure test ! At least onct every; d month(s) A� NA Gtiherr - � C] year(s) ..._.__...._ At least once every: Cl month(a) ❑ NA O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made py an indiv)ti.ua( carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Seer; POWT Inspector, pQW75 Maintainer; Septage Servicing Gperator, T ank inspections must include a visual inspection of the Tank(t$) to identify any missing or broken hardware identify any cracks or leaks, rneasure the volume of combined sludge and scum and to check far any back up or ponding of effluent on the g ound surface. The dispersal cells) shall be visually Inspected to check ?he Of(uent levels in the observation pipes and to :heck for any ponding of effluent on the ground surface. The ponding of effluee(tt on the ground surface may indicate a failing contrition and requires the immediato notification of the local regulatory authority. Wlien the combined eccvmulation of sludge and scum in any tank equals one -third (Y or more of the tank vo)urne, the entire contents of the tank shall be removed lay a Septage Servicing Qperator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of affluent filters, mechanical or pressurized components, l;retrdatment units, and any servicing at intervals of st 2 months, shall be performed by a certified POWTS Maintainer. A s.arvice report shall be provided to the local regulatory authority within 10 days of completion of any service event. 8 AART M PAAND OPERATION of For new construction, prior to use of the POWTS chook treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment p rocess and /or damage thq dispwool coll(s). If high concentrations are detected have the contents of the tank(s) removed by a saptage 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 hi0hvy4i6i levels. When power is restored the excess wastewater will bA discharged to the dispersal cell(s) in one large dose, 6 silraading thp coll(e) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump took removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS IViaintelrter to assist in manually operating the pump controls to restore normal levels within the pump tank, Go not drive or park vehicles over tanks and dispersal ceN$. Do not dr ive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade apil ebisorPtion ere. Reduction or elimination of the following from the We$towstor a r.04il7 rtlay Improve the performance and prolong the life of the POWTS; antibiotics; baby wipes; cigarette butts; 0,90dorhs, cotton swsbs; degreasers; dental floss; diapers; disinfectants; !at: foundation drain (sump pump) water; fruit and vegetable pebllnov, jNidline; grease; herbicides; meat scraps: medications 0: painting products: pesticides; sanitary napkins; tarriO�iins; and wiatoscifjohorbrine. ABANDONMENT When the POWTS fails and/or is permanently taken out of aeryI , q the following steps shalt be taken to inswe that the system is properly and safely abandoned in compliance with chapter Comm 83,33i Wisconsin Administrative Code: e 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. a After pumping, all tanks and pits shall be excavated and removed o their covers removed and the void space filled with soil, gravel or another insert solid material. CONTINGENCY PLAN if the POWTS fails and cannot be repaired the following tl sosUrop hove been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utillzed for the location of a replacement soil absorption system. The replacement area should be prote�it+'}d from distutbsnoe and compaction and should not be infringed upon by required setbacks from existing and proposed dtfvotuts, tot lutist/ and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to optabiish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 0 A suitable replacement area is not avail4le duo to setback and /pr soil limitations. Barring advances in POW i S technology a holding tank may be installed as a lest r crud toolace the failed POWTS. P ik The site as not en evaluated to identify a svitabie topla csMiSht area. Upon failure of the POWTS a soil and site l evaluation be performed to locate a suitable 40*corh area. It no replacement area is available a holding tank may a last resort to replace the fallild POW7r$. Ci Mound and at -grade soil absorption systerits may be tWnstructsd 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 CONUIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN, DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAN1t Li AN Ci}tDUMSTANCEB. DEATH MAY RESULT, RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE 0100I0wLt k tmobi lstiLE. ADDITIONAL COMMENTS POWTS INSTALLER P TAiNER Name �__ ►_��.._ G�U► Noma - - - --- Phone "7 / 6; 3 8 / A / _ Phone SEPTAGE SERYiCING OPERATOR (PUMPER) Q yLATORY AUTHORITY Name i+iiAme `j i�to:>✓ Phone Rlipnel "7/; This document was drAfted in complia -ce with chapter Cornm Il3,29(2llblit fid)&ifi and 01.54 & (3), Wisconsin Administrative Coda. Parcel #: 020- 1113-90 -175 11/29/2007 04:03 PM PAGE 1 OF 1 Alt. Parcel #: 12.29.20.4591 -15 020 - TOWN OF HUDSON Current ❑ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 09/06/2007 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - HART, DAVID A & ARLENE A DAVID A & ARLENE A HART 1025 HWY 35 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description ' 1025 HWY 35 SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 15.796 Plat: 1778 -CSM 06 -1778 020 -87 SEC 12 T29N R20W PT SW SE & NW SE BEING Block /Condo Bldg: LOT 2 LOT 1 CSM 5/1551 AKA LOTS 1 & 2 OF CSM 6/1778 NKA LOT 2 CSM 6/1778 (5.380AC) & Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) INC PT SW SE; COMM S 1/4 COR SEC 12;TH N 12- 29N -20W SE 89'E 1326.58FT; TH N 01'W 369.98 FT TO POB; TH S 89'W 1162.33FT;TH N 01'W more... Notes: Parcel History: RETIRED FOR 2008. CSM 22 -5452 WAS Date Doc # Vol /Page Type CREATED FROM THIS PARCEL. 05/17/2002 679266 1892/561 WD 020- 1113 -90 -176 (4591 -16) IS THE 02/23/2000 618675 1491/410 QC REMAINDER. LOT 1 IS 020 - 1113 -90 -180 07/23/1997 714/469 (4 -20). LOT 2 IS 020-111 more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 15.796 133,000 196,600 329,600 NO Totals for 2007: General Property 15.796 133,000 196,600 329,600 Woodland 0.000 0 0 Totals for 2006: General Property 15.796 133,000 196,600 329,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 06/19/2007 Batch #: 07 -06 Specials: User Special Code Category Amount 018 - RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00