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STC 104
AS BUILT SANITARY SYSTEM REP RECEIVED
5 W AN N d N ISAWN ° JU 3 0 2001 w
OWNER D �,
• �, ADDRESS
�- N,tcy /�'� �•uo � Gam/ 9 C> .
SUBDIVISION / CSM# o LOT #
SECTION
2.
/ T 3 O N -R � W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
pR�G1N
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form-
Provide 2, dimensions to center of septic .tank, manhole cover.
I
7
BENCHMARK •
ALTERNATE BM:
13,Af -# 3 - 0P o f M, v 4 0 e co it e,
SEPTIC TANK / PUMP CHAMBER / HOLDING .TANK INFORMATION •'
Manufacturer: W /'esew Cp,vGQ�,e
Liquid Capacity: '
i
Setback from: Well > 1670 House Other �—
Pump: Manufacturer Model# Si
Float seperation Gallons /cycle:
Alarm Location
:SOIL ABSORPTION SYSTEM
.3 Lengt Width: g 0 Number of trenches
Distance & Direction to nearest prop. line: / � ` C4s7—
Setback from: well: } �-SD I
House Other
� ELEVATIONS
Building Sewer /06. ST Inlet; 149 -r b
ST outlet
PC inlet / PC bottom Pump Off
Header
/I"Iai fold t ' Bottom of system
5
Existing Grade Final
1
grade
e �f
/ !%z.
DA ( I
TE OF INSTALLATION:
PLUMBER ON JOB: " • Wlh le i (g 3 7 S
LICENSE NUMBER:
INSPECTOR: h � A) 6 f /3
3/93 : jt sT' �%� G7 Y ' Z0.v 1W -
i
r 19Zo 7 ft,-A All-
f i l l/ 7Aiv
3 Aepkm
N m 2 PUG
ti
Q �
33 � � � yy D Uf D
qV
1314 1 B
®g.e ar u; ,A) YL-
ip
30 0
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.� p�dr� � � � Tap a� roi �► �,� puL
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16 0
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Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page Z of 3:
Labor and HumAn Relations
<P D' isiorkof Safety & Buildings i�r accord with ILHR 83.05, Wis. Ad Code t - r
4 � lS— V y — y �t = �►c,ue^ COUNTY St. Croix
4M.444 L 60 Attac complete site plan on paper not ess than 8 :, nch in inc u e, but "
not limited to vertical and horizontal referenc ini f l)ll);, dl , n and % of slope, scale or PARCEL I.D. #
dimensioned north arrow and location ;a /' `t to 4 fe a . 026 - 1064 - - 000
APPLICANT INFORMATION —PLE $ ERIN INFOIMl1 ON REVIEWED BY DATE
PROPERTY OWNER: T ti' ' PROPERTY LOCATION 3 2 ZD
DAvid Waldroff �✓' p a r GOVT. LOT NW 1i4 SW 1i4,S 21 T 30 ,N,R 18 D%or) W
PROPERTY OWNERS MAILING ADDRE �) C "= LOT # BLOCK # CS
398 River Rd. sm M
c ,k.
-`� fi� � �.� � 2 na c � 3 3 ,� ��
CITY, STATE ZIP Cr ER !� ❑CITY ❑VILLAGE EAREST ROAD
Hudson, WI. 54016 `,(715) - nl Richmond 112th. st. Ic(3g
:k] New Construction Use [x] Residential / rooms 4 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd /ft . 8 trench, gpd /ft
Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd 1ft .8 trench, gpd /ft
Recommended infiltration surface elevation(s) area A =96.4 B= 96.17 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for s stem 13 ❑ U 13 S ❑ U [3 S ❑ U CT ❑ U 13 O U [:]s Pl U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -9 10 r3/3 none sl lcsbk mfr cS if .4 �.5
1...`:' 2 9 -24 7.5yr4/4 none sl lcsbk mfr gw if .4 .5
Ground 3 24-34 10yr5 /4 c2p7.5yr5/8 sil M na gw na np .2
98 ft. 4 34-84 7.5yr4/6 none co s OSg ml na na .7 .8
Depth to
limiting
factor
+84 U J v
a
Remarks:
Boring # , .
1 0 -10 10yr3 /3 csbk mfr 9w if .4 .5
S ae -aa?mur,
_< 2 10-33 7.5 y r4/4 none sl lcsbk mfr gw if .4 i .5
3 33-42 10yr5 /4 c2p 7.5yr5/8 sil M na 9w na np .2
..................
Ground
elev. 4 42-84 7.5yr4/6 none co s Osg ml na na .7 .8
99 . ft.
Depth to y
limiting 0 0.
factor
+R4
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. 44., New Richmon WI 54017
Signature: Date: 4 -28 -99 CST Number: m02298
i
DAvid Waldroff I
PROPERTY OWNER SOIL DESCRIPTION REPORT Paget of 3
PARCEL I.D. # 026- 1064 -40 -000
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Twich
'<< 1 0 -9 10yr3/3 none sl lcsbk mfr cs if .4 .5
3
2 9 - 10yr4/4 none sil lcsbk mfr caw if .2 .3
Ground 3 27 - 35 7.5yr4/4 none sl lcsbk mfr gw if .4 .5
elev.
10 ft. 4 35 -44 10yr5 /4 c2p 7.5yr5/8 sil M na gw na np .2
Depth to 5 44 -88 7.5yr4/4 none co s Osa ml na na .7 .8
limiting
factor
+88
Remarks:
Boring #
1 0 -9 10yr3 /3 none 1 lcsbk mfr gw if .4 .5
<' 4 2 9 -32 10yr4 /4 none sl lcsbk mfr gw if .4 .5
3 32 -39 10yr5 /4 c2p 7.5yr5/8 sil M NA gw na np .2
Ground
elev. 4 39 -84 7.5yr4/6 none co s Osg ml na na .7 .8
99.5 ft. -
Depth to
limiting 3q.'►�'
factor
+84
Remarks:
Boring #
1 0 -9 10yr3 /3 none sl lcsbk mfr cs if .4 .5
>`< 5 2 9 - 10yr4 /4 none sl lcsbk mfr gw if .4 .5
3 18 -32 7.5yr4/4 none ms 089 ml gw na .7 .8
Ground
elev. 4 32 -38 10yr5 /4 c2p 7.5y45/8 sil M na gw na np .2
10 ft.
5 38 -96 7.5yr4/6 none co s Osg ml na na .7 .8
Depth to
limiting
factor
+96
5
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel David Waldroff 1554 200th Ave.
CSTM2298 NW4SW4 S21 T30N - R18W New Richmond, WI 54017
MPRSW -3254 town or Richmond (715) 246 -6200
lot #2 -csm
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test,may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
N
1 =40'
BM.= top of 1" steel pipe by B-5 C el. 100.00'
Alt. BM.= top of 1" steel pipe by NE lot corner @ el. 101.50'
k
2�
X 170
Ir
Od
1 ,
C 9),
Gary L. Steel
4 -28 -99
wsoonsin Deparhnentof comffwce PRIVATE SEWAGE SYSTEM O
Saf _• and Birifdulgs Division : Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPefmitNO.:
Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)I• 3 g r /33
AP
Permit H er* s Name: ❑ City ❑ Villa ge own of : State Plan ID No.:
auer, Shannon Richmond Township
CS T BM BM E ev.: I Insp. BM Elev.: BM Description- Parcel Tax No.:
Z O l ot-10 r C5T g ;+ Z 026 - 1064 -40 -200
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic U-5t-6ce C Benchmark ,9 al . 10�
Dosing Alt. BM 2 o 1 4 '
Aeration Bldg. Sewer �j, BAG Jo(, •
Holding St / Ht Inletd oS • �'
TANK SETBACK INFORMATION St/ Ht Outlet�J S2o /o C"
TANKTO P/L WELL BLDG. Ventto ROAD Ot Inlet
Air Intake
Septic y lOC/ IS" / NA Dt Bottom ----
Dosing NA Header /Man.
Fea n NA Dist. Pip to I
o. lo(•SS'
Bot. System t 3q
PUMP/ SIPHON INFORMATION Final Grade � 0
Manufa urer St cover (A� t.3
Model Num;; GP in
TDH Lift Fn S ystem TDH Ft aM � `l. L7� I o•Zo O(. 10'
Forcemain Length Dia. Dist.Towell
SOIL ABSORPTION SYSTEM A IPA
BED / TRENCH Wid�h Length No Of Trenches PI No.Of Pits Inside Dia. Liquid Depth
% 1 lo$ 2 DIMENSION
SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manua urer
SETBACK U: — S�
INFORMATION Type Of ( -- CHAMBER Moe Number-
System: 69 > / OR UNIT
C
DISTRIBUTI N SYSTEM
Header / Maaif Distributi n Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length _k Dia. Length Dia. Spac. `~ (� /
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1: 0 / 27/tD l Inspection #2: '-/- 1
Location: 1438 112th Street New Richmond WI 54017 (NW 1/4 SW 1/4 21 T30N R18W) - 21301832IA20 -Lot 2
1. P
Alt BM Description = Std ��° � v' ode, t
I
Bldg sewer length=
2.) g 16
-amo
5) Q � � vlg���
Plan revision required? ❑ Yes CR No # �/
Use other side for additional information. Fe o sj lam
SBD -6710 (R.3/97) jeaLteA Inspectors Signature Cert. No.
r S- APAXe S S % y3 Y /'4)- al- Sr
Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
1* 16COnSin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce (Submit completed form to county if not
(Privacy Law, s. 15.04(1)(m)� state owned.
Attach corn let e lans (to the county copy onl for the system, on an 8 -1/2 x 11 inches in size.
Count �/f� Statc Sanitar Permit Nui her ❑Check if rcvisio cvY sa U State Plan I. D. Number A, f
I. Application Information - Please Print all Information - ','f'� "� 1[.o tion:
Property Owner Name q d e y Location
0 0 ,. _._ 1144 51t/ 1/4 1 S T I N R E or
Property Owner's Mailing Address I r ' Lot.Nuiriber Block Number
City, State Zip Code Phone palfe�. i; i+�0• b vision Name or CSM Number 11-01
�(,f�SO'v �/ • S �Ol � ( 7/ C ` 'S� o p ylo 7� 7
II Type of Building: (check one) ✓� •. w ❑ City
3
1 or 2 Family Dwelling — No. of Bedrooms: �� P �o'�, ❑ Village
— G #MONO
❑ Public /Commercial (describe use): � t�( of R% ,�I
El State-owned
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road
A) 1. WNew System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s)
System Tank Only Existing System OR -1 0 ( Y0 !go
B)
11 Permit Number Date Issued
A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply) aZ 3 I g -:3;Z/ /9
9 Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade 3 rx dog Z� _� n ❑ erobic Tie ent nit B Recirculating 11 Other:
Vt7.t�.KQ� t`h�U
V Dispersal/Treatment Area Information:
I. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
�� Required Propose Rate (Gals. /day /sq. ft. (Min. /inch) /02, Iry Elevation
D 315 3 .7 0. zaar / 0. s0 --jo. /,0y
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing t crete structed
Tanks Tanks
P ba
/� �,,, {, ❑ ❑ ❑ 1 -10
A
esponsibility Statement
I, the undersigned, assume resp onsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) , Plumber's Signature no stamps): A4P /MPRS No. Business Phone Number
1 2 037- II�Rlc
Plumber's Address (Street, City, State, Zip Code)
67 �e l°e A poi
VIII County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Sign cure (No stamps)
Approved ❑ Owner Given Initial Adverse Sur rge Fee)
Determination F ig , 1 260 l
IX. Conditions of Approv /Reasons for Di appro al:� _�a�
q t l ,, LkX -ice se?t; sY • a., res� ,
O , tA ,. V-0- -
�
SBD -6398 (R. 07/00)
rr
i
� V
_._. --- _ ---- --
" °' ° A
� s
v
0
lb
Al 4b
4
O
_ . 6 of
S o
r
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Q v � •�
LILBRICHT & ASSOCIATES CO.
-- O'Neil Road • Hudson, WI 54016 Reg-Designers of Engineering Systems
715- 386 -8185 Private Sewage Consultants
PROJECT INDEX
PLAN I b # DATE 1:20 ' � _ J-0 0 /
OWNERS 54#'Vow A4 UER 0 , 11w, O/SQ PHONE 311 &Y
5f'T16' AbbRESS <y3,? iJZ 1 - 5T NeZV /f/ rifer /VealP &.
LEGAL DESCRIPTION SO �" CS�t to /b0 1 6 Uo% /,3 pi. 37/7
P/ -A) a zGv • /D r'D �iw, 5�� �c /. Tao 0
TOWN OF /Ll COUNTY S T' tit -o
LOCAL AUTHORITY/ SUPERVISION JC� /`X CJ`Y• PROJECT DESCRIPTION:
DESCRIPTION:
tit:W liqti 57- acr4q) A- 3 %k-ePlAA^
AA
p.l
Ulbricht & Associates
Private Sewage Consultants
655 O'Neil Rd.
Hudson. Wis. 54016
Pg.l INFILTRATOR SIZING WORKSHEET
P9.2 SYSTEM PLOT PLAN VIEWS
Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS.
Pg.4 it it of of to
P9.5 ZABEL FILTER & MANAGEMENT PLANS.
"llris ctAs1 -qn tot installation 1 .s based
landGCape en tirely 'On measurements, elevations,
c�rulitions (sl -open el;c -,) and soil euit,bility provided by CSIM
'lire accuracy of his gppCS, as r
or the CS'[11. eported, shall remain the sole responsibility
t
f'
nny use cf this 1'OWTS design ty any licensed plumber, or any
related unlicensed parties or persons (exca
shall not be construed as vatere, laborers) an assumption of responsibility by
the an for the workmanship, cons
substitution or selection of an truction, placement,
any as sumptions by the plumb y components not placement, or
er that any unRpecifled components
at state approved or proper, or the effect" of poor Judgement
if aorking under adverse damaging Weather conditions g
eollR) by any Ruch parties or persons. (wet /frozen
iJ N-1
. m
N [
z
Cn m N
q
Hill
O � �
g n
d
C � o
o
•
' y
O
a o .
r
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d
n
0 O
o � s
d °
11V Ec ii4-v oiP '(p
/
�
2 '
ff Ili/
l N
y
C /VO 55 SEC TioA.)
ZtS�w G- �l L To
7e4 7 - o,< 1 ,5
w'�- / � • l y �sQ �T, rfi c�,�c� � S�� Ti'o•+J
.►-L U,v iNSpE� T /o,,v /���Q
Iff
1�
Z- 4 rle�D T ,V &Ve<
�i�v, bp0 �SO
" Pg. 6 Continued.
POWTS (landowner) is reponsible for proper operation and
maintenance of this system. Regular periodic inspections and
servicing is necessary for the safe healthy operation of this
system. The owner is required by code to submit all necessary
maintenance /inspection reports to the controlling authorities.
SPECIFIC CONTACT AGENTS
* Governmental authority/ inspectors:
* Licensed installer, responsible for providing an operation/
maintenance "Users" manual:
30& 91S5
* Licensed service / inspection agent other than installer:
3 3�
* Electrician, for pump, electric controls, wiring units:
IMPORTANT OWNER MAINTENANCE'RE UIREMENTS
1. Winter traffic (sledding, shoveking, etc.) across the mound
area shall not be permitted, or frost can /will penetrate into
the cell, freezing up the system. Discontinuos use in the
winter (a vacaction trip, resulting in no water use) can also
lead to freeze ups.
2. Water conservation needs to be exercised! Or system can be
hydrolically overloaded and destroyed. This system was
designed for a maximum wastewater flow of 1150 gals. daily.
3. POWTS are not designed to accomodate wastes from a garbage
disposal unit, or any other unnatural sources of waste.
Any introduction of such waste materials will overload and
destroy this system.
4. If a power outage occurs, or / a pump fails, it may result
in a temporary overload of effluent being pumped into the
cell, which may adversely impact the cell (leakhge). It is
recommended that a licensed pumper empty the dosing tank,
allowing the pump to return to dosing the correct amounts. ,
Consult your installer immediately for advice.
.� 5. Neglect of the vegetative cover (the cells insulation &
erosion preventive) can lead to failure. Compaction or heavy
traffic also can destroy t he system. It IS NECESSARY TO
REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in
O the system beneath IS NOT sufficient alone tO maintain a
grass cover.
6. Periodic inspections by the owner, or his agents, is
! v necessary. Inspection pipes and ports have been incorporated
�! into the system: on the mound basal area (effluent level
inspection pipes), cleanout terminals on the pressurized
laterals, at each tip - for flushing and cleaning the laterals
out. The filter system in the tanks (via a locked above
ground cover /manhole). Only a licensed properly quali6ied
person should be performing this work which involves health
& severe safety risks. Evidence of effluent ponding in the
system's treatment cell shall also be regularly inspected.
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
.,9iypic.n of `VW " 4 ss in accord with ILHR 83.05, Wis. Adm. Coe COUNTY
' a •r-d s - t ` c„Kc.J. St. Croix
Attach complete site plan on paper not less than 8 x inche siz an must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 026- 106 -40 -000
APPLICANT INFORMATION- PLEASE PRINT ALL INF RE IEWEDBY DATE
r
PROPERTY OWNER: c y ' -- % ROPERTY LOCATION
David Waldroff �y' P VT. LOT NW 1i4 SW 1i4,S 21 T 30 N,R 18 for) W
PROPERTY OWNERS MAILING ADDRESS f!i/ r: "�_. r � LO,, BLOCK # SUBD. NAME OR CSM #
398 River Rd. "�' " ` •`1
CITY, STATE ZIPCODE fIONMI6 MBT FIVILLAGE (MOWN NEAREST ROAD
Hudson, WI. 54016 co( 15) 542-6&31 , ^:� Richmond 112th. st.
[x] New Construction Use4c ] Residential Numbe4 `r fs 3 [ ] Addition to existing building
Replacement Public or com "erclj+ escribe F,c
Code derived daily flow 450 g pd �� /R�c �rtame design loading rate - 7 bed, gpd /ft •8 trench, gpd /ft
Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate • 7 bed, gpd /ft • $ trench, gpd /ft
Recommended infiltration surface elevation(s) 102.10 trenches ft (as referred to site plan benchmark)
Additional design/ site considerations trencheG Gnaced to c -ode 4.Q1 rei ow grade
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for s stem 12 ❑ U ERS ❑ U [31 S ❑ U �r7 S ❑ U 1E7 S ❑ U ❑ S ® U
SOIL DESCRIPTION REPORT
Boring Dominant Color Mottles Texture Structure Consistence Roots GPD /ft
g # Horizon ��Y in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Twich
..................
.................
1 0 -10 10yr3 /3 none 1 lcsbk mfr 9W if .4 1.5
2 10 -34 10yr4 /4 none sicl lcsbk mfr gw if .2 .3
Ground 3 34 -84 7.5yr4/4 none ms Osg ml na na .7 .8
elev.
1 0'1. ft.
Depth to
limiting
factor t o Z • 5'a
+84
Remarks:
Boring #
1 0 -10 10yr3 /3 none 1 lcsbk mfr gw if .4 .5
2 2 10 -33 10yr4 /4 none sicl lcsbk mfr 9w if .2 .3
3 33- 84 7.5yr4/4 none ms Osg ml na na .7 .8
Ground
elev. i
1 06. (It.
Depth to
limiting
factor
+84
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. New Richmongf, WI 54017
Signature: Date: 5 -4 -99 CST Number: mO229E
PROPERTYOWNER David Waldroff SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. If 026- 1064 -40 -000
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
3
1 0 -12 10yr3 /3 none 1 lcsbk mfr cs if .4 .5
2 12 - 10ry4 /4 none sicl 2msbk mfr gw if .4 .5
Ground 3 30 -84 7.5yr4/4 none co s Osg ml na na .7 .8
elev.
1 �-- rock . �t5
Depth to Z -: Z
limiting
factor
Remarks:
Boring #
1 0 -12 10yr3 //3 none 1 lcsbk mfr cs if .4 .5
4€ 2 12 -28 10yr4 /4 none sicl 2msbk mfr gw if .4 .5
3 28 -84 7.5yr4/4 none co s Osg ml na na .7 .8
Ground
elev.
101--Bft. —
Depth to --
limiting
factor
Remarks:
Boring #
1 0 -10 10yr3 /3 none 1 lcsbk mfr gw if .4 .5
Li 2 10 - 10yr4 /4 none sicl 2msbk mfr gw if .4 .5
3 22 -84 7.5yr4/6 none ms Osg ml na na .7 .8
Ground
elev.
10 1.8 ft.
Depth to
limiting
factor
+R4
Remarks:
Boring #
Ground
elev. j
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Ga ry L. Steel David Waldroff 1554 200th Ave.
CSTM2298 NW4SW4 S21 T30N - New Richmond, WI 54017
MPRSW -3254 town ichmond (715) 246 -6200
to #3- m
We soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as sham
as permanent lot lines were not established at the time the test Was conducted.
N
1 " =40' � I
BM-= top of 2" pvc pipe C el. 100.00'
Alt. BM.= top of 2" pvc p ipe C el. 101.10'
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5 -4 -99
50 WtIh
Standard Erosion Control Plan
for 1 & 2 Family Dwelling Construction Sites
I
According to Chapters ILHR 20& 21 of the Wisconsin Uniform Dwelling Code, soil erosion control informa-
tion needs to be included on the plot plan which is submitted and approved prior to the issuance of building
permits for 1 & 2 family dwelling units in those jurisdictions where the soil erosion control provisions of the
Uniform dwelling Code are enforced. This Standard Erosion Control Plan is provided to assist in meeting
I
this requirement.
! Instructions:
1. Complete this plan by filling in requested information, completing the site diagram and marking ( ✓) appropriate boxes
! on the inside of this form.
i
2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading.
Water runoff patterns can change significantly as a site is reshaped.
3. Submit this plan at the time of building permit application.
Site Diagram Scale: 1 inch feet
EROSION
/ CONTROL PLAN
' LEGEND
SI a
PROPERTY
LINE
--
EXISTING
DRAINAGE
I V 1 TD TEMPORARY
S DIVERSION
A FINISHED
DRAINAGE
F _ _ LIMITS OF
GRADING
� I
SILT
I gl 15 FENCE
,' \ STRAW
• i ` / �� BALES
GRAVEL
VEGETATION
C SPECIFICATION
` TREE
PRESERVATION
STOCKPILED
Sl ' SOIL
by
Please indicate northoL,;,\,_,-
by completing the
arrow below.
3 `M•• J , !. C to ''c
_
cc ,_L�N-: o..�
PROJECT LOCATION ' V L3 ��! o� ' ¢� f� ''� o� St C.} n.� 2 S i. & co �'e
BUILDER E 5 tG C ! C A - �rt.LCA OWNER
WORKSHEET COMPLETED BY DATE g �'�
EROSION CONTROL PLAN CHECKLIST
` a
Q� Check V) appropriate boxes below, and complete the site diagram with necessary information.
Q
�o =� Site Characteristics
L� North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways.
V ❑ Location of existing drainageways, streams, rivers, lakes, wetlands or wells.
❑ L/ / Location of storm sewer inlets.
[� Location of existing and proposed buildings and paved areas.
®' The disturbed area on the lot.
Approximate gradient and direction of slopes before grading operations.
V Approximate gradient and direction of slopes after final grading operations.
❑ V Overland runoff (sheet flow) coming onto the site from adjacent areas.
Erosion Control Practices
NJ ❑ Location of temporary soil storage piles.
Note: Soil storage piles should be placed behind a sediment fence, a 10 foot wide vegetative strip, or should be
covered with a tarp or more than 25 feet from any downslope road or drainageway.
Location of access drive(s).
Note: Access drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick.
Drives should extend from the roadway 50 feet or to the house foundation (whichever is less).
❑ Location of sediment controls (filter fabric fence, straw bale fence or 10 -foot wide vegetative strips) that will pre-
vent eroded soil from leaving the site.
❑ e Location of sediment barriers around on -site storm sewer inlets.
❑ li f Location of diversions.
Note: Although not specifically required by code, it is recommended that concentrated flow (drainageways) be
diverted (re- directed) around disturbed areas. Overland runoff (sheet flow) from adjacent areas greater than
10,000 sq. ft. should also be diverted around disturbed areas.
❑ Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade).
Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions,
and re- vegetation by sodding or by seeding with use of erosion control mats.
❑ V Location of practices that will control erosion in areas of concentrated runoff flow.
Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of
such practices as in- channel fabric or straw bale barriers, erosion control mats, staked sod, and rock rip -rap.
When used, a given in- channel barrier should not receive drainage from more than two acres of unpaved
area, or one acre of paved area. In- channel practices should not be installed in perennial streams (streams
with year -round flow.)
V( ❑ Location of other planned practices not already noted.
l
EROSION CONTROL REGULATIONS
7
UNIFORM DWELLING CODE (DEPT. OF COMMERCE)
PROJECTS AFFECTED • Straw bales, filter fabric fences or other barriers to
• All new 1 and 2 family dwellings in Wisconsin started protect on -site sewer inlets
on or after December 1, 1992. • Additional controls if needed for steep slopes or other
• Additions to dwellings built after June 1, 1980. special conditions
MAINTENANCE AND WASTE DISPOSAL
APPLICATION PROCESS • Sediment controls must be maintained until the site is
• Erosion control measures must be included on the plot stabilized by mulching and seeding, sodding or
plan submitted with the building permit application to landscaping
the local building inspector in communities where the . All building waste must be properly disposed to pre -
dwelling code is enforced vent pollutants and debris from being carried off -site
• Plot plan must show:
— Location of the dwelling, other buildings, wells, sur- ENFORCEMENT
face waters and disposal systems on the site with •Erosion control inspections will be made during other
respect to property lines regular inspections (footing and foundation, rough con-
, — Direction of all slopes on the site struction, final, etc.)
•Violations must be corrected within 72 hours
— Location and type of erosion control measures
• Stop work orders may be issued for noncompliance
CONTROLS REQUIRED FOR MORE INFORMATION, CONTACT
• Silt fences, straw bales, or other approved perimeter • Local building inspector
measures along downslope sides and side slopes • Department of Commerce, Safety and Buildings Divi-
• Access drive sion, P.O. Box 7969, Madison, Wisconsin 53707,
(608) 266 -2128.
STORMWATER PERMIT (DNR)
PROJECTS AFFECTED — Proposed erosion and storm water pollution control
• Any grading or construction project that disturbs 5 practices during and after construction
acres or more and is not covered by a building permit — Documentation that an erosion control and storm
• Smaller sites that are part of a planned development water management plan which meets DNR standards
involving 5 acres or more of land disturbance has been prepared (plan does not need to be submit-
• Effective October 1, 1992 for any new or continuing ted with the application)
project —Other information related to site location and per-
• Exceptions: Indian tribal lands and work done by local mit holder
government staff CONTROLS REQUIRED
APPLICATION PROCESS • Erosion control measures specified in the Wisconsin
• File a "notice of intent" application (Form #3400 -161) Construction Site Best Management Practice Handbook
with the Department of Natural Resources (DNR) 14 • Measures to control storm water after construction
days before construction begins FOR MORE INFORMATION, CONTACT
• Application must include: • Department of Natural Resources, Storm Water Per-
- Timetable for land disturbing activities and installa- mits, P. O. 7921, Madison, WI 53707 -7921, (608)
tion of erosion control measures including project 266 -7078
start and completion dates
LOCAL ORDINANCES
Check with your county, and city, village or town for any local erosion control ordinances including shoreland zoning
requirements. Except for new 1 & 2 family dwellings, local ordinances may be more strict than state regulations. They
may also require erosion control on construction projects not affected by state or federal regulations.
A publication of the University of Wisconsin— Extension in cooperation with the Wisconsin Department of Natural Resources and Department of
Commerce, Ron Struss, Water Quality Educator, UWEX Western Area and Carolyn D. Johnson, Urban Water Quality Educator, UWEX Southeast Area.
UW— Extension provides equal opportunities in employment and programming. This publication is available from county UWEX offices or from Extension
Publications, 630 W. Mifflin St., Madison, WI 53706, (608) 262 -3346. Copyright 1997 by the Board of Regents of the University of Wisconsin System
doing business as Cooperative Extension, University of Wisconsin— Extension. Send inquiries about copyright permission to Director, Cooperative
Extension Publications, 201 Hiram Smith Hall, 1545 Observatory Drive, Madison, WI 53706.
GW0001A Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites DNR: WT- 458-96 R -02- 97- 2M -1 0—S
I
a
�Q0a Indicate management strategy by checking (./) the appropriate box:
�a
Management Strategies
❑ Temporary stabilization of disturbed areas.
Note: It is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized
/ by seeding (between April 1st and September 15th), or by other cover, such as tarping or mulching.
M Permanent stabilization of site by re- vegetation or other means as soon as possible (lawn establishment).
Indicate re- vegetation method: Seed V Sod ❑ Other ❑
Expected date of permanent re- vegetation:
Re- vegetation responsibility of: Builder ❑ Owner / Buyer'
Is temporary seeding or mulching planned if site is not seeded by Sept. 15 or sodded by Nov. 15? Yes P� No ❑
❑ d Use of downspout and /or sump pump outlet extensions.
Note: It is recommended that flow from downspouts and sump pump outlets be routed through plastic drainage
pipe to stable areas such as established sod or pavement.
❑ h/ Trapping sediment during dewatering operations.
Note: Sediment -laden discharge water from pumping operations should be ponded behind a sediment barrier until
most of the sediment settles out.
f LV I Proper disposal of building material waste so that pollutants and debris are not carried off -site by wind or water.
I
l LGf Maintenance of erosion control practices.
• Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to
half the barrier's height.
f
• Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be
replaced (typical bale life is three months).
• All sediment that moves off -site due to construction activity will be cleaned up before the end of the same workday.
• All sediment that moves off -site due to storm events will be cleaned up before the end of the next workday.
i • Access drives will be maintained throughout construction.
• All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized.
For more assistance on plan preparation, refer to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code,
the DNR Wisconsin Construction Site Best Management Handbook, and UW— Extension publication Erosion Control for
Home Builders.
The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available
through State of Wisconsin Document Sales, 608/266 -3558.
Erosion Control for Home Builders (GWO001) can be ordered through Extension Publications, 608/262 -3346 or the
r Department of Commerce, 608/267 -4405.
ST CROIX COUNTY
y SEPTIC 'TANK MAINTENANCE AGREEMENT
A , 61S4A) AND
OWNERSHIP CERTIFICATION FORM
T•J r - �'�f,��r�vD,v ��-� �i % 3 Asa
O wner/Buyer
_
Mailing Address
Property Address i
(Verification required from Planning Department for new construction)
City /State /I/ 'W I� 1 � '�1 Parcel Identification Number 0 Z 4- /d G
LEGAL DESCRIPTION 9
Property Location No 1 14, 1 14, Sec. 2t , T 30 N -R 4 W, Town of kP1 A4 0�a
Subdivision , Lot #
Certified Survey Map # , Volume 13 , Page # 3 71 7
Warranty heed # /7/3/ , Volume , Page #
Spec house El yes Nno Lot lines identifiable kyes O no
SYS'T'EM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) 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
slating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
r 1
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form art true to the best of my (our) knowledge. I (we) Am (are) the ownet(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
e
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with tills 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
/0
VOL 146SPAGL 61
• 6131710
STATE BAR OF WISCONSIN FORM 2 . 1998 KATHLEEN H. WALSH
Doen ant Number REGISTER OF DEEDS
WARRANTY DFFD ST. CROIX CO., WI
This Deed, made between David J. Waldroff and Julie A. RECEIVED FOR RECORD
Waldroff, husband and wife, 11 -03 -1999 10:30 AN
Grantor, conveys and WARRANTY DEED
ERT C
warrants to ik itt;liee & Obw nd Sumo e Q. !;ly both ai§M* IDIOM C W
as Joint tenants, ERT COPY FEE:
COPY FEE:
TRANSFER FEE: 142.20
RECORDING FEE: 10.00
Grantee.
PAGES: I
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of Wisconsin
(The "Propeny "):
Recording Area
Name and Return Address
Heather Olson, Shannon Bauer
723 Green Brier Rd
Hudson, WI 54016
026 - 106440
Parcel Identification Number (PIN)
This is not homestead property.
I
Part of the NW Yi of the SW Y4 of Section 21 -30 -18 described as follow ( of 2 o ertifted Survey Map filed September
8, 1999 in Vol. 13 Page a 3717, Doe No. 610046
TOGETHER WITH and SUBJE O t wide access easement as shown on said Certified Survey Map.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of October, 1999.
* 4'dJ. off
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) David J. Waldroff and Julie A. Waldroff, STATE OF WISCONSIN )
husband and wife, ) Ss.
authenticated this County )
day of October, 1999.
Personal ly came before methis - day of
1999, the above named
'Kristin Ogiand
to me known to be the person(s) who executed the
TITLE: MEMBER STATE BAR OF WISCONSIN foregoing instrument and acknowledge the same.
(If not,
authorized by § 706.06, Wis. Scats.) i
THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin
Attorney Kristin Ogland My Commission is permanent. (If not, state expiration date:
Hudson, W154016
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
"Names of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE BAR OF WISCONM
FORM Nu. 2 - 1998
INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800855 -2021
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i
THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON J08 NO. 99 -43 DATE 8/23/
99
w � c o4 %
BEARINGS ARE REFERENCED TO THE d � �o r� Z�� n y
EAST - WEST 1/4 LINE OF SECTION 21. `~ , T ,
Z ASSUMED TO BEAR f 89.36'37'E S 6 c %v q
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I