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Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353259
` Permit Holder's Name: ❑ City []Village ❑ x Town of: State Plan ID No.:
1 Town of Hudson 2�'{q = T•w�c • ia' -
CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.:
VD • ft • o ` C s� 09Xc _' - 020- 1320 -10 -000
TANK INFORMATION ELEVATION DATA - .2 ?� /9 It 31
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ZS�-U Benchmark 6p , J
Dosing h►� Alt. BM
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic fo r,' bl
3 r' NA Dt Bottom Pe 'Kb 5 • ( ! -
Dosing " f 1 ` NA Header/ Man.
3•S9 I
Aeration NA Dist. Pipe 160.0 1
Holding Bot. System �; s� I
PUMP/ SIPHON INFORMATION Final Grad �— 4(6 11V s wao'cr --
Manufacturer Demand St cover
Model Number GPM PA J" ze .
TDH Lift I�,O` Friction I S1( System2 S TDH 1�' Ft
oss Forcemain Length Dia. H 2 4 Dist. To Well
SOIL ABS PTIO14 SYSTEM C 1. p fi e,
Bf N Width r Length f No. Of Trenches PIT No. Of Pits Inside Dia. uid Depth
DIMENSIONS `'( 63 a DIMENSION
SETBACK
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEAC anufacturer: INFORMATION Type O CHA ER
I o r _ um er:
System: � -K O� UNIT
DISTRIBUTION SYSTEM 6 -F ? Header/Manifold a Distribution Pipe(s) I x Hole Size x Hot Spacing Vent To Air Intake
Length 2- Dia. 2 Length ( Dia. 2 Spacing 2 L ( / (( u u
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 #l• dS OS'/tDInspection #2: •-- ,L --f
Location: 730 Crosby Drive, Hudson WI 54016 (NW 1/4 SW 1/4 8 T29N 9W) - 28.29.19.1637
1.) Alt BM Description= `� W `'^� -1. $
2.) Bldg sewer length = %L q0 1) g
- amount of cover = > '�z -5;j Cam%
3.) conto:I , 3 o q 0 3.6 5 $• 3 5 )
.Jf-C C* a"+
Plan revision required? ❑ Yes R3 No
Use other side for additional infor ation.
SBD -6710 (R.3/97) �Da n ns ector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
SANITARY PERMIT APPLICAT s P r 201 W. Washington Avenue
Visconsin
„ P O Box 7302
Department of Commerce In accord with Comm 83.05, Wis. Adm. C tt Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on p ; of lef ; . ��
than 8 v2 x 11 inches in size. � / c /
S{etef Perm Number
• See reverse side for instructions for completing this application; ar y t
f�OtX
Personal information you provide may be used for secondary purposes P S1 ck it revi�ior� tti previous application
[Privacy Law, s. 15.04 (1) (m)]. 10.,Nomber
I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMA xo>
Pro rtyOwne Name Prope c6tzoo
ltT r N(,(/ i $' 'T �� , N, R /g E (or(D
Property Owner's MailiVddress Lot Number Block Number
,3 0 77 ZQ v2s
Cit , St to _ Zip Code Phone Number Subdivision Name or CSM Number �:sxck T PE OF BUILDING: (check one) ❑ State Owned cl it yy Nearest Road
!/ ❑ Village
Public 1 or 2 Family Dwelling - No. of bedrooms Town OF 14t 1 0- , 04 , 4 k
111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) -� = I I. 1 t o 3
1 ❑ Apartment/ Condo 0Z0 /3 Z4 /� - 0000
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
S ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. g New 2 ❑ Replacement 3 ❑ Replacement of 4_ ❑ Reconnection of 5 ❑ Repair of an
______System System Tank Only Existing System Exi1tl , System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non- Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21Z) Mound 0 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure j` !_ l 42 ❑ Pit Privy
13 E] Seepage Pit .I, r ll���W d • /6- / 43 ❑ Vault Privy
14 ❑ System -In -Fill wIf , 2 k Cv3
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
00 -0O 0 /, Z 9� /� Feet Feet
Capacit
VII. TANK i Ca allo s
n Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tan or Holding Tank 49S-p /ZS 'O A91 ❑ ❑ ❑ ❑ ❑
VP
Lift Pump Tank iphon Chamber 7S 1 '2S 1 1 1 ❑ 1 ❑ I ❑ 1 ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: o Stamps) Mtr RSW N Business Phone Number:
Plumber's Address (Street, Chy, State, Zip Code):
.3 yo S r X hi tg X lyr S Soo 1
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved T -31ar ary Permit Fee (Includes Groundwater ate Issue Issuing Agent Signature (No Stamps)
Approved ❑Owner Given Initial Surcharge Fee)
Adverse Determination dV
x. CCOND ION P APPjt L REASONS FOR DISAPPROVAL:
/ems
SBD -6398 (R. 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber ,
INSTRUCTIONS
1- A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper - whenever•
necessary, usually every 2 to 3 years_
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 -266 -3151. -
To be complete and accurate this sanitary permit application must include:
mailing address. Provide the legal description and parcel tax numbers
I. Property owner's name and ma gad ss g p p number( s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
111. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone nu. tuber. Plumber-must sign application form.
a
IX. County/ Department Use Only. ,
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
----------------------------------------------------------------------------------------------------
GROUNDWATER SURCHARGE
3
1983 Wisconsin Act 410 included the creation of surcharges (fees) fora number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
1 +
Safety and Buildings
10541N RANCH ROAD
HAYWARD WI 54843
TDD #: (608) 264 -8777
isconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
November 12, 1999
CUST ID No.221471 AM. POWTS INSPECTOR
_,ZONING OFFICE
DENNIS J GILLE ST CROIX COUNTY SPIA
372 140TH ST 1101 CARMICHAEL RD
AMERY WI 54001 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 11/12 /2001 Identification Numbers
Transaction ID No. 274969
SITE: Site ID No. 184002
Site ID: 184002
Please refer to both identification numbers
ST CROIX County, Town of HUDSON
above, in all correspondence with the agency.
NWIA, SW1/4, S28, T29N, R19W
Lot: 25, Subdivision: ST CROIX ESTATES
Facility: PAT & JANELL WESTERHAM LOT 25 CROSBY DR, HUDSON 54016
FOR: MOUND SYSTEM, 600 GPD
Object Type: POWT System Regulated Object ID No.: 636749
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
1. This plan action is subject to designer comments on the plan.
2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular
to the direction of maximum slope.
3. The area 25' below the downslope edge of the mound must remain undisturbed.
4. Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a).
5. The downslope distance from the edge of the lower trench to the edge or the downslope toe labeled as "I"
on the plan view calculates to 24 the total width ( "W ") calculates to 56'.
6. The minimum dose volume calculates to 208 gallons. The reserve capacity "A" calculates to minimum of
400 gallons.
7. The designer proposes to install a 1250/750 combination tank manufactured by Huffcutt.
• NOTE: A soil absorption system should be designed as long and narrow as possible. This s t�eh►has a high ,
linear loading rate of 9.6 gallons per foot.
A copy of the approved plans, specifications and this letter shall be on -site during construction an open to
inspection by authorized representatives of the Department, which may include local inspectors. `1'l;permits anr,I
required by the state or the local municipality shall be obtained prior to commencement of -# f,'.'','''
construction/installation /operation. ' ST CFO'
CO UNn
Inquiries concerning this correspondence maybe made tome at the telephone number listed below, at$he
on this letterhead. ''�
-' f
`�, 4 "
Sincer DATE RECEIVED 11/03/1999
FEE REQUIRED $ 180.00
C FEE RECEIVED $ 180.00
P RICIA L S DORF , PO PLAN REVIEWER BALANCE DUE $ 0.00
Integrated Services
(715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM
PSHANDORF @COMMERCE.STATE.WLUS WiSMART'code: 7633
Safety and Buildings
10541 N RANCH ROAD
HAYWARD WI 54843
TDD #: (608) 264 -8777
N visconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
November 12, 1999
CUST ID No.221471 ATTN. POWTS INSPECTOR
ZONING OFFICE
DENNIS J GILLE ST CROIX COUNTY SPIA
372 140TH ST 1101 CARMICHAEL RD
AMERY WI 54001 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 11/12/2001 Identification Numbers
Transaction ID No. 274969
SITE: Site ID No. 184002
Site ID: 184002 Please refer to both identification numbers,
ST CROIX County, Town of HUDSON above, in all correspondence with the agency.
NW1 /4, SW1 /4, S28, T29N, R19W
Lot: 25, Subdivision: ST CROIX ESTATES
Facility: PAT & JANELL WESTERHAM LOT 25 CROSBY DR, HUDSON 54016
FOR: MOUND SYSTEM, 600 GPD
Object Type: POWT System Regulated Object ID No.: 636749
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
1. This plan action is subject to designer comments on the plan.
2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular
to the direction of maximum slope.
3. The area 25' below the downslope edge of the mound must remain undisturbed. ��"
4. Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a).! ?"
5. The downslope distance from the edge of the lower trench to the edge or the downslope toe labeled as "I" u
on the plan view calculates to 24'; the total width ( "W ") calculates to 56'. Gf PAR t,`EN'
6. The minimum dose volume calculates to 208 gallons. The reserve capacity " A " calculates to minimum of R04Elao 11 SAF
400 gallons.
7. The designer proposes to install a 1250/750 combination tank manufactured by Huffcutt.
• NOTE: A soil absorption system should be designed as long and narrow as possible. This system has a high SEE CORR
linear loading rate of 9.6 gallons per foot.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 11/03/1999
FEE REQUIRED $ 180.00
G�1� f ` FEE RECEIVED $ 180.00
CIA L SHA ORF , POWTS AN REVIEWER BALANCE DUE $ 0.00
Integrated Services
(715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM
PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 7633
R ECEIVE
MOUND SYSTEM DESIGN NOV .
Residential Application tf�� 1 999
INDEX AND TITLE SHEET i � ETY& 8LID
GS DIV.
Project PAT JANELL WESTERHAM
Owner PAT JANELL WESTERHAM
Address 30710 AVE
HUDSON WI 54016
Legal Description NW SW S28 T29 NR 19 W
Township HUDSON County ST CROIX
Subdivision Name ST CROIX ESTATES Lot No. 25 V.T.S.
Parcel ID Number s`IO: t a rt y
Plan Transaction Number
OF COMM CE
ETY AN DINGS /
Index and title sheet page 1
Mound calculations P 2 ESPONDENCE
Mound drawings p age 3
Pres. dist. caics. and laterals Page 4
TDH and pump tank drawing Page 5
Designer DE GILLE license Number 221479
Signature Phone No. 715 268 - 6637
Date 10 -25 -99
Notice: Tamperin0 with this file by unauthorized persons is prohibited.
Deliberate modification will result in disciplinary action under s. 145.10, Wis. Stats.
Personal information you provide may be used for secondary purposes [privacy Law, s.15.04 (1)(m)I.
SBD- 10482 -E (R.05/98) Pagel of
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AUK
,/ !i► Stape Trfnth Of 2" FOrce Main PIOr1�O
AggfeqOti LOW —
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rranthas FW Th# Abscrpt,pr Arep
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• � . CO OpRRE,S40��ENC�
�y�. • �...w ii.+ �� Aw war . M ".... ..r._ ..�. w... ..•.w ' rr.
MOUnd ueMI TrenChes Fpr AOsorp! pn Area
4
Total Dynami Head TDH and Pump Tank Drawing
Operational head 2.50 ft 0.76 m
Vertical lift / . /J ft 5.76 m Are l aterals the highest point in ft
Friction loss s ft 0.37 m system? Yes "X" here.
Total dynamic head If rro, what is the h' nest elevation
Dose Volume
downstream of pump?
Dose is >
10
_ @S l ateral volume Forcemait� drain
Lateral void volume gal 46.6 L back to tank? ( "x" one)
Minimum dose d gal 465.6 L x Yes
Drain back 2 gal 98.8 L No
Dose volume TZ. al .4 L
Typical Pump Chamber Layout
In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC.
approved manhole cover with
7F weather proof warning label and lodung device
grade levels junction box —"'� —' �•
disconnect grade levels alternate --.�
WO vent DIPe electric per NEC 300 and �_�
Comm 18.28 WAC
location
18" (48 cm) min.
wall of m
Pu P roved
chamber or outlett joint
combination tank
A Provide 114" weep hole or anti -
alarm on siphon device as necessary
pump on S
Grade tevels
pump 81.1 ft C - pump tank manhole = 4" (10 cm)
off eiev. 24.7 m minimum above finished grade
- vent = 12" (30.5 cm) minimum
above finished grade
$0.0 R Pump tank
3 " (75 mm) of bedding under tank 24.4 m bottom of tank
Tank manufacturer
UTT
Pump tank capacity 1121galfin
Pump tank volume 1
Pump manufacturer Inches Gallons N tJ��EDED
Pump model number P A s, z I .�- 0 REC \O
B 2 o CORRESQO`�DEN
Alarm manufacturer 1EVIL ALARM C / ,3
Alarm model number JUVL D
Project: PAT JANELL WESTERHAM
Transaction Number: Page 5 of
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• lli /lama 16:34 rA.i iiiz)i,;4Ul; -zi U ALLC ISl'11.LDAa ''� a 1LL C ��
PHONE NO. Nov. 01 11 09* 09M P1
wieoor rair!OoPer�►a^tollt►6sratey- SO IL AND SITE EVALUATION REPORT P �-�--
�eor am wwn w pmkAam
thvlckrr of 80ety a 9u M"ps in accord with ILr 83,05, Ws, Add. Code
M1
A wh nor* Nto P1*14 en Pspmu 14 01 10 03 than 8 t td X 11 irgh" in Nee. P l !. . A
nor pitUud to rsrtlCrd and heriZeASit rotvfgrxe. (AM), diractiCn and'* o i� �J Z 6' pentSing
drimnsiormd. nodh w ow, end loaaWn srW dist0r10s 10 n8 rW MOO. / ` oa . N �.�
n
APPLICANT INFORMATION PLEASE PRINT ALL INFORM
PftOl�teRNCNM�cF� '"' F'�QPE
Srid eland Day. Can. 'rt t10V+i.� 1t4 1t4,S 28T 29 ,N 19 3ww
PFCP OWNERS LWUNG ADDRESS ti. � &r N „�, K K S . AME Oa CSIA s
V
GfTY, 8TATI ZIP C E NUMBER r NEARS
1=4& 117j i e p 1612) 98
[AMMI*nalft f NEW Cron Um ( A fimi *Ajai l Numtw of bedrooms 3 1 l Ad*W to e>el 6V bu kfiV
! t j
Pubic Of wwmircio daeaiba
oAt derhW 4W Aow 45 0. Wd 'fie ,V,*WW d� IN" t= —OIL -00- gpd - . 2 4et OK Wd*
nequ W V , _ bed. Itz _ 37 5 Te"M ttz M L%kn en d9OW bWAg rile n bW, gpdRtz • 2 ._ Ter+Gt.
90wrimso ed kA&doe surleos eisva wX3) 93 .15 A (as referred to s% WN► berelmark)
AdalA W ded8n I We Ct *derauona a,V® aim ... - -
PefentA'1tNrlil arlaCia2. dr Pt �G Flow pialnslaaw,Nappiasble m R -- N fILL U U�itflble El's s u s d u lJ s o s ®u s " s
TANK u
SOIL DESCRIPTION RIEPORT
smin811 F 2 - ort Off' U+mlinant Cok r Mai 9 Texture structure �+ Rte <3PDttt
In. iulutisell tom. S=. Cent Cold Or. Sz. Sh. Hid
Boom 1 2 ?. nvnc_ _..__ .. 1 mfr. � . .2
9 - 26 I :_O n M s'cl (7!c,bk mfr if .4 .5
Ground 3 26-63 7., r416. ' ncn� s t mvfr 2K na .9 1 .8
dw.
1 15 ft. 4 63-80 7. p - C ,_�1no na i -5
Dgm to Il
Rmtdn _
War
If no 2
w
f'�marka:
Bvrtr►p
0 -13 lgjr �2 2
2 2 13 -30 1 r 4 rie S1c1 mfr .4 ! .S
naL— Gourd 3 Ipyr5 cz 7 r5/8 _ i -t n :.2 in
4 4§=55 7.5 r s—_ __ t °e 7
I
FlAnta>7ri'
Mrtra, -f'1w wmt steel_- 715-246-62
L.
54 Avt. lnc'. WI 017 229@
Nttnqber.
"A.: < f L +Aft
PEWps
r���� mo
10/19/99 16:34 FAX 171:52467227 HALLE BUILDERS _)44 GILLE 1903
� a
•FROM . PHOM Nbv. 01 1598 09:09M P2
S'- 'EEL'S SOIL SERVICE
Cary La Steel Sridgetand nw. Co. 1564 20M Aw.
CSTM2= r4SWl 528- TzgN. -R19W New Ric*nwW. W154017
UPRSVV-3254 ton of H udson (715) 246 =
Lot VZS -St. Croix $ststes First Aden.
N
1
NS. top of M lot eta" 0 Al. 100'
Q •
ti
A ll
Gary L. Steel
6- 26--96 7
Wisconslr` Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
,' Sor a N : -luman Relations
'�icision or Safety &Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach compiete site plan on paper not less than 8 1/2 x 11 inches in size. P t n I a Bt. Croix
not (united to vertical and horizontal reference point (BM), direction and ° /9+bf� ojse "sc - �fi
e
PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. ' a r pending
,.,�;
o. .
APPLICANT INFORMATION PLEASE PRINT ALL INFORM , �' R DATE
7' -L
! -
PROPERTY OWNER: PROPER LgC�1TON '
Brid eland Dev. Compan (' GAVT.to NW va , va,S 28T 29 N,R lg �or)
PROPERTY OWNER':S MAILING ADDRESS `;,' LOT # ` LQt;K # S AME OR CSM #
11736 117th St. First ddn.
CITY, STATE ZIP CODE PHONE NUMBER i1' VIL N NEAREST ROAD
Lakeville, NIN. 55044 (612) 985 -5000 Crosby Dr.
N
3
Addition xi tin buildin
f bedrooms
to s
New Cons tructio n Residential / Number o bed oo s
e Co structio Use [ 1 9 9
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate np ed, gpd /ft .2 trench, gpd /ft
Absorption area required np bed, ft 375 trench, ft Maximum design loading rate nE? bed, gpd/ft - 2 trench, gpd/ft
Recommended infiltration surface elevation(s) 99.15 ft (as referred to site plan benchmark)
Additional design/ site considerations system el., based on average el. of area
Parent material glacial drift 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 fors stem ❑S ®U C3S ❑U CIS OU ❑S ®U ❑S ®U ❑S ®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 Trenctn
1 ?< 1 0 -9 10 r2 2 none 1 2c 1 mfr if n .2
2 9 - 26 10 r4 4 none sicl 2msbk mfr qw if .4 .5
Ground 3 26 -63 7.5 r4 6 none s oscl mvfr CrW na .7 .8
elev. o. Y
98 ft. 4 63 -80 7.5 r4 6 none sl m na na na :4 .5
Depth to
limiting
factor
+80"
Remarks:
Boring #
1 0 -13 10 r2 2 none 1 2c P1 mfr Cfw if n .2
2
2 13 -30 10 r4/4 none sicl 2msbk mfr qw if .4 .5
Ground 3 30 -46 10 r5 4 c2' 7.5 r5 8 sicl m na qW na I n .2
elev. 4 1 46-55 7.5 r4 6 none s osa my na na 1 .7 1.8
98 ft.
Depth to
limiting
factor
30
Remarks:
CST Name:— Please Print Phone:
Gary L. Steel 715 - 246 -6200
A ddress: 1554 2 0 h Ave.,
Ne Richmond, WI. 54017 m02298
Signature: Date: CST Number:
6 -26 -96
PROPERTYOWNER Bridgeland DEv. CO. SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. # trend i ng
Lot #25
Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft
Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trrdi
1 0 -10 10 r2 if
2 10 -24 10 r4 4 non
Ground 3 24 -43 7.5 r4 4 n
elev.
9 4 43 -60 5 r4 4 none scl m
Depth to
limiting
factor
43"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
I I
SBD- 8330(8.05/92)
1 " i
i
STEEL'S SOIL SERVICE
Gary L. Steel Bridgeland Dev. Co. 1554 200th Ave.
CSTM2298 Nw4SW4 S28- T29N - x 19W New Richmond, WI 54017
MPRSW 3254 town of Hudson '(715) 246 -6200
lot #25 -St. Croix Estates First Addn.
N
1 =40'
BM.= top of NW lot stake C el. 100'
�
Z2 -/4� �U
C�
Gary L. Steel
6 -26 -96 Sbv�
PrV
I
� e
STEEL'S SOIL SERVICE
Gary L. Stee!
CSTM2298 1554 200th Ave.
MPRSW -3254 Now Richmond, N 54017
(715) 246-8200
To wham it may concern;
This soil evaluation was conducted to satisfy a zoning requirement,
it may or may not be satisfactory for your use. The location of the
system may or may not be as shown, as permanent lot lines had not
been established at the time of the test.
Gary L. Steel
ST CROIX COUNTY
SEPTIC 'ANK MAINTENANCE AGREEMENT
AND
OWt CERI'IFICATION FORM
Owner /Buyer P. - A, - S
Mailing Address � d� 1 Dt v '�
Property Address _ 3 G Vim-_ y �
(VeriGcatwn rcguirt d fron i Planning Dvartrnent for new construction) _
City /State Parcel Identification Number
L EGAL, DESCRIPTIO
Property Location dl/ � /., �I✓ ,',, Ss c. �� Ta29 / � W Town of
Subdivision c ^ Lot 9
Certified Survey Map # Volume �� Page. #
Warranty Deed # S 7 s9
_ Volume /�z s' Page # _� 7 s
Spec louse 0 yes a no Lot lines identifiable T yes ❑ no
SYSTEM MAMENANCE
Improper use and maintestanceof your sel pc system could result in its premature failure to ii—die wastes, Proper maint -n—
consists of pumping out the septic tank every throe years or soorter, if tieaAod by a licensed pumper. What you put into the system
call afftct the function of the septic tank as a trri went stage in the wasto disposal system.
The property owner agrm to subxruit to St. Croix Zoning Departracut a cnrtifloation form, signed by the owner and by a
master plumber, journeyman plumber, resttictedp).; umber or a licetmeApumper verifying that (I) the on -site wastewater disposal system
is in proper operating condition and/or (2) after ir: �ection a:ad pumpimg (if neeetsary), the septic talc is less than 1/3 full of sludge.
I/we, tho urtdersigued have read the above requires nomts and agxeo to maintain the private sewage disposal systems with the standards
set forth.. herein., as set by the Department of Cava "me and the Departmont of Natural Resourt6a, Stato of Wisoomsln. 0-xi Sioation
stating that your septic system has been maintainei I must be completed and rthh=d to the St. Qrdlk County Zoning Office Within 30
days of the three year expiration date.
0 /
SI ATURI OF APPI,IGANC DAVE
OW NER C:ERTIFI TA ION
I (w) ceztify t hat all statements O n this ; irm are true to the best of my (our) kuowledga. I (we) am (are) the owner(s) of
the property dascr' d �Vlrtlj wama ity d eed recorded io Rtgirter of Deeds Office,
0!
SIG, TURF OF APPLICANT DA'IT
"41*0 Any information that is mis- represented u ey result in the sanitary permit being revoked by the Zoning Department.
Include with this application: a stamped wart inty doed from the Register of Deeds office
a copy of the a rtified survey in ap if reference is ,Made in the warran deed
it
1H'AP _!!T`n� '.,4t , -.aN . i, 7 :FY:. .fr ', s.... _...1 • ,. ,...'..r ..
- :J `:6 1...:
� 1
WL 13?5 75
S�'9591
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2 -1982
WARRANTY DEED
REGISTE'R'S OFFICE
Brideeland Development Company. a 11Unnemta corporation ST, CROIX CO, WI
Rsc'd r R�eerd
MAY 2 G 1998
conveys and warrants to 8:30 A M
Patrick P Westerham and Janell L. Wwcrhem. _ , t,j.L.
husband a n_i% * _ Re st.r of Deeds
the following described real estate in St. Croix County, State of Wisconsin
Lots 20, 24 and 25 _ SL Croix Estates FirstAddition in the Town o[Hodson, St. Croix County, Wisconsin.
Ni
ER /�y N TRAy§FER
tfl FEE
FIES
FEE
This _ is not homestead property.
(is) (is not)
Exceptions to Warranties:
Dated this J 2th day of M, 19 _2.&- -
(SEAL) (SEAL)
� • 1 1
(SEAL) (SEAL)
* i
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated this day of STATE OF MINNESOTA
19 Dakota County +
Personally came before me, this 12th day of
Lys I"s the above named
TITLE: MEMBER STATE BAR OF WISCONSIN Ness Krzvzaniak
(If not,
authorized by 706.06, Wit;. Stat&)
This instrument was drafted
by
to me known to be the person who executed the
T�J__,__J r__._,_____._. l,_.._____ � :..M-a..nenf An� elal.M.,lt oa,�,.,t tj, C7tr.& _
I
4 CORNER OF
TION 24 �I I
O 66.36'
LOT 28 ° I
• 930.70 1 91
'S DATUM � 2.37 ACRES
0 N 103,410 S0. FT. 1 0 f
OD
C4 N to I
6 Z9,
0
~ � llJ
U 511.03 I
rn
M83 050 02" E 1 !+� I :'
OD
. LOT 27
� 0 I N � 33' 33
2.25 ACRES I
J Z
97,962 SO. FT.
r ,W N (�
i m
I I 1
J � 5,0;p" w 19
O I
W 522,Q2.
3
% LOT 26
N 8
2.79 ACRES
/►�� te a ° '
121,650 SO. FT. 1 w
� 2.56 AC. EXC. ESMT o
�3k
111,514 SO. FT. i-
O 21
N �
11
N N LOT 25 s
Z z 2.47 ACRES `�9 • /
00 �Aio 107,711 SO. FT. O
N N ," 1.98 AC. EXC. ESMT. b
86,374 SO. FT. / C
5� iF i A
. C
to 0 LOT 24 E 1 0�
p � HWL =908.0
`r 2.71 ACRES ' ,
118, 035 SO. FT.
6
2 .70
2.70 AC. EXC. ESMT. /
117,612 SO. FT. % \6 ot.
y
2 J c'
K
° W — '
216.58 -
S89 23 26 "
i
g _ 2 ��o `� �,� LOT 21
DEDICATED - �O %, \ 0
1 \ v',.
N89 "E 216.58' I �' 2.03 ACRES
1
_ - 136.58' _ _ .- / ���� �s 88, 296 SO. FT.
�' 6
CT .''••,r --- %0 2.00 AC. EXC. ESMT.
N 3 3'� MI \ 87,342 SO. FT.
N
\ -346 .91
o 45" W
4
w LOT 23 , 91 S Te 04
5
v - Fl
I
M 2.34 ACRES
1
102, 159 SO. FT. \ U) C O!
ICI =� N e El
0 2.22 AC. EXC. ESMT. N p Z n �$
S!6,924 SO. FT. i to q rn -
I O 6 6'
Ull 394.91' M 66 57
TO BE REMOVED UPON EXTENSION OFSROAD �I N89