HomeMy WebLinkAbout020-1327-30-000 (2) ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
Owner T6 1" r
Property Address -/d ro s 6 Ar
City /State s ��
Legal Description: _---
Lot ?L Block v Subdivision/CSM #
AL i /4 !� '' /4, Sec. LZ, TZZN -R /F W, Town of h/ s PIN # o z'7 - :5 o
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer blec k r C, /P Size(�C i- Setback from: House 3X IV ell 3V ' P/L
Pump manufacturer /U% Model
Alarm location /?/�y
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: Width 3 Length 75 Number of Trenches Z
Setback from: House 1Vell �z " P/L 5`/' Vent to fresh air intake 160
ELEVATIONS
7. & Elevation
Description of benchmark A( z .� •Sw �° G°''u'"
Description of alternate benchmark n wLyk )&J A Z.,. L Elevation ti,13
Building Sewer ST/HT Inlet �� ST Outlet 9 a PC Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover
Distribution Lines () B y• 3 () ( )
Bottom of System () 2 — 8 () ( )
Final Grade () 14, `/7 () ( )
Date of installation �l t 9Permit number 33 8 t �'- ' State plan number
Plumber's signature 1 License number °Z �s z �_ Date l l 2 ,P1 ff
Inspector
Complete plot plan �
i
r
NOTICE: Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
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INDICATE NORTH ARROW
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Wisconsin Qepartment of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: IX
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)( 338995
Permit Holder's Name: ❑ City ❑ Village 9 Town of: State Plan ID No.:
GAGLIARDI, JOHN HUDSON —
CST BM Elev..- ' Insp. BM Elev.: BM Description: Parcel Tax No.:
10.0 — C�-Q�� 020 - 1327 -30 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
l i Septic (�5 �a ap Benchmar
Dosi ng
c
Aeration Bldg. Sewer h
Holding St/ Ht Inlet Q • Z 0
TANK SETBACK INFORMATION St /Ht Outlet
TANK TO P/ L WELL BLDG. Air I ntake ROAD *'Dt'tnfe
Air
Septic 1 > loD I 3 �/ �-- NA
Dosing NA Header / Man. 0.
Aeration NA Dist. Pipe y S 1 9, % ��• /
Holding Bot. System i $o
PUMP/ SIPHON INFORMATION Final Grade
Manufactu errand /69 ga .-36
Model Number GPM , g�^ a (( aC}Z 1-63
TDH Li F riction Syetem TDH Ft
F main Length Dia. HH Dist. To Well
SOIL ABSORPTION SYSTEM (Z ea,,. �-
BED/TRENCH Width ( Lengt�5- No. f renches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS �J _ DIMENSION S
SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manu ac rer
SETBACK
INFORMATION Type O CHAMBER �U � ,r � M del Number: -
System: D T I t 2- OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold u Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Lengt Dia. Length Dia. Spacing > fob
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.)
LO C H
TION: U SON 29.2 9 .1702 NE S 7
ur�� � . � }�' , , E 10 CROSBY DRIVE
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2 3� >
Plan revision required? ❑ Yes R No - I 2_6
Use other side for additional information. ) 9 6D 1�:
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No
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ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
N*Wonsin SANITARY PERMIT APPLICATION I 201 Box Washington Avenue
In accord with ILHR 83.05, W'
Department of Commerce _ e / Madi olt /WI 53707 -7302
• Attach complete plans (to the county copy only) for the sy n p er wt less` C ounty
than 8 112 x 11 inches in size. CO 1 ��, 3T, C,20
• See reverse side for instructions for completing this appl on l'� State Sanitary Permit Number
3 359
Personal information you provide may be used for secondary 705 ' i '^;� (heck if revision to previous application
(Privacy Law s. 15.04 (1) (m)]. .i 'r CF/ /�ri C IJ Q'� $ta Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT AL IN f `J
Propert O .ner Name P.fope o I
�rf^6_.a� - ) Z T �� , N, R
Propefty Qwner's = ress u r Block Nurp er
,O
City, State Zip Code Phone Nu er Subdivision Name or CS,M Numb l
o ( t Z �-
11. PE OF BUILDING: (check one) ❑ State Owned ❑ lt� Nearest Road
ED Vil age
Public X 1 or 2 Family Dwelling - No. of bedrooms Town OF
111 BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo : d . 7,6 - 132 7 — 3d — 6CJ O
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
5 ❑ 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. New 2, ❑ Replacement 3. ❑ Replacement of 4_ E] Reconnection of 5 ❑ Repair of an
- _____System ________System_____________ Tank Only_____________ Existing System ________ ExistingSystem
B) JR A Sanitary Permit was previously issued. Permit Number Date Issued —f
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank
12;(Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 []Seepage Pit - R — 3 ,N. 43 ❑ Vault Privy
14 ❑ System -In -Fill oA V &a 410, !i1 t ow
VI. ABSORPTION SYSTEM INFOR ATION:
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/da sq. ft.) (Min. /inch) Elevation
(06o 7 74p 3. 'Z._ Zj 8 Feet 87.6 Feet
acct
VII. TANK in Cap llo
g Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New __ Gallons strutted
Tank Tanks
eptic ank ^ Z� ! (J� ❑ I ❑ ❑ 1 ❑ ❑
Lift Pump Tank /Siphon Chamber 1 ❑ 1 ❑ 1 ❑ 1 ❑ ❑
VIN. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumbqjs Name: (Print) Plumber's Signature: ( o Stamps) MP / MPRSw run : Business Phone Number:
v ` � 2 �1, ?72 7-
Plumber's ddres reet, City, State, Zip4Code ):
y
IX. COUNTY / DEPARTMENT USE ONLY
❑Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued IsuingA ntSign ture(NoStamps)
Approved [ Given Initial Surcharge Fee) to /
Adverse Determination OD - FOR
X. CON ? l IQNS OF A PR VAL REASONS DISAPPROVAL:
= VJ�
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
l
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:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed_
IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type 6f 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 a// 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 number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 81/2 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
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through surcharges are used for monitoring groundwater contamination investigations,
and establishment of standards.
JOB
TIMM EXCAVATING OF
Route 1 Box 192 SHEET NO. l OF
WILSON, WISCONSIN 54027 CALCULATED BY DATE A? 7- Z
(715) 772-3214 (715) 386-5443
MPRS *3224 Wl MPCA #696 MN CHECKED BY DATE
SCALE 70 r
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PRODUCT 205-1 � Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1-8DD-225-M
:4iisconsinDepartment ofCommerce ND SITE EVALUATION Page 1 of 3
Division of Safety and Buildings OR ND Comm 83.05, Wis. Adm. Code
Certified Soil Testing
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. -- -- - - -
Parcell,D.# 070 - 1327 -30 -000
APPLICANT INFORMATION - Please print all information. -- -
-
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Rrewe By Date
Property Owner Property Location
Gagliardi, John Govt. Lot NE 1/4 SE 1/4 S 29 T 29 N R 19 W
Propert Owner's Mailing Address Lot # Block # Subd. Name or CSM#
710 Crosby Drive 31 St. Roix Estates, 2Nd Addition
City State Zip Code PhoneNumber ❑ City r� Village ZTown Nearest Road
Hudson Wl 54016 1 Tudson Crosby Drive
X New Construction Use: X Residential I Number of bedrooms 4 []Addition to existing building
Replacement E] Public or commercial describe
Code Derived daily flow 600 gpd Recommended design loading rate - bed, gpd /ft' .8 trench, gpd /ft'
Absorption area required 857 bed, ft' 750 trench, ft' Maximum design loading rate - bed, gpd /ft' .8 t rench, gpd /ft'
Recommended infiltration surface elevation(s) 82.8 ft (as referred to site plan benchmar
Additional design / site consideration i nstall 2 - 2.7'x 75' Sidewinder, Hi- capacity "turtle- shell" trenches
Parent material sandy -loamy 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 system M ❑ U ® S❑ U X S❑ U PC S U S❑ U S X U
Depth Dominant Color Mottles Texture Structure Consistence Boundary oots GPD /ft'
Boring# Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. rY . Bed Trench
1 1 0 -4 l OYR 3/2 - sl 2 m gr mvfr cs I f/m .5 .6
2 4 -21 l OYR 3/3 - A 1 m sbk mvfr cs if .4 .5
Ground - 3 21 -70 10YR 4/4 s _ - 0 sg ml cs 7 8
elev f {
87.8 ft 4 70 -96 ' lOYR 3/4 - cos 0 sg ml - - .7 .8
Depth to
limiting
factor `( °►
Remarks: horizon 3 h as occasronal gr & cob ,
2 1 0 -6 10YR 3/2 - sl 2 m gr mvfr cs 1 f/m .5 1 .6
- - -- - - -- - -- -- -- - - - -- - - -_. j
2 6 -24 l OYR 3/3 - sl 1 m sbk mvfr cs If .4 i .5
Ground 3 24 -110 lOYR 4/4 - s 0 sg nil - - .7 .8
elev �-
88.6 ft
Depth to -- - -- - -- I - ; - limitin (v
factor
> 110"
Remarks: - _ —_horizon 3 has occasi stratified mcos
- --
CST Name (Please Print) Signature: Telephone No.
Henry F. Grote _ 715- 665 -2681
Cert�fiedrSoi es6n _
Address g Date CST Number Ref #
P.O. Box 57, Knapp, WL54749 8/2/1999 222774 1243
PROPERTY OWNER:_ G agliardi , J ohn SOIL DESCRIPTION REPORT rfa Page 2 0 " 1 ,
PARCEL I.D.# 070 - 1327 -30 -000 Certified Sgil --sling
Depth Dominant Color Mottles Structure GPD /ft
Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
y Bed Trench
3 1 0 -8 1 OYR 3/2 - sl 2 m gr mvfr cs 1 f/m 5 j 6
2 8 -18 10YR3 /3 "1 Imsbk mvfr s If i .4 .5
Ground
elev 3 18 -34 10YR 3/3 - Is 0 sg ml cs i - .7 .8
- - -- -- - - -- — — - - -
87.8 ft 4 34 -96 1 OYR 4/4 s 0 s g ml 7 8
Depth to
factor
> 96"
Remarks: Horizon 4 Has some stratMea cos & If gr
Ground t r
elev !
Depth to -
j limiting
factor
Remarks:
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Ground — --
elev
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Depth to
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factor
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Remarks:
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Depth to r
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Safety and Buildings Division
V SCO/1S %/1 SANITARY PERMIT APPLICATION 201 Box Washington Avenue
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code
p Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size. < �;TL �`
• See reverse side for instructions for completing this application State Sanitary Permit Number
3 0 q�
Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application
(Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Propert " ner Name / Property Location (�
--� �C4\y G C i�r d t We 1457F 1/4, S 2-1 T Zcj r N, R `f' k(or)(
Propert M
Owner's ailing Address Lot Number Block Number
'f18
City, State / Zip Code Phone Number Subdivision Name or CSM Nu er
II. TYPE OF BUILDING: (check one) ❑ State Owned it ge Nearest Roa
Public 1 or 2 Family Dwelling - No. of bedrooms _ ❑ Villa
Town OF e - Dr
Ill. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) Z1 . tm . 19 . eZ_
1 ❑ Apartment/ Condo 20 " 1 Z -7 30 _ 600
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
5 ❑ 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. IK New 2. ❑ Replacement 3 ❑ Replacement of 4_,Q Reconnection of 5. ❑ Repair of an
- _____System ________System _____________ Tank Only______________ Existing System ________ Ex)stlnc�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 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ® Seepage Trench 22 ❑ In- Ground Pressure C , r X -7 S r 42 ❑ Pit Privy
13 ❑ J Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill a p(lr ` y fir
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
Requir (sq. ft.) Pro osed (sq. ft.) (Gals/ /sq. ft.) (Min. /inch) Elevation
'772> a 9S S Feet F 7# '5 # Feet
Ca ant
VII. TANK in gallons Total # of Con- INFORMATION Manufacturer's Name Prefab. on- Steel Fiber- Exp
Gallons Tanks Concrete glass Plastic App
New Existing structed
Tanks I Tanks
eptic an o k /2au f c, ❑ ❑ ❑ ❑ ❑
Pum /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumb 's Name: (Print) Plumber's Signature: (N tamps) MP /MPRSW No.: Business Phone Number:
7/-s'— 77Z F- -C<
Plumber;t Address (Street, City, State, Zip Code):
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Ag t Si ture (No Stamps)
Approved Q Owner Given Initial Surcharge Fee) /
Adverse Determination`s lQ� " r
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11/97)
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:
I. Property owner's name and mailing address. Provide the legal description and parcel tax 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.
III. 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 number. Plumber must sign application form.
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
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a 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.
+ JOB
TIMM EXCAVATING of z
SHEET NO.
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY /? �l�s� DATE
(715) 772 -3214 (715) 386 -5443
MPRS #3224 WI MPCA 0696 MN CHECKED BY DATE
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PRODUCT205-1 �Inc., Groton Mass 01471 , To Order PHONE TOLL FREE 1- 800.225 -M
TIMM EXCAVATING JOB
SHEET NO. 2 of 2
Route 1 Box 192 C
WILSON, WISCONSIN 54027 CALCULATED BY �" DATE �J
(715) 772 -3214 (715) 386 -5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
SCALE
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PRODUCT 205 -1 ®Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1 -800- 225.8380
L _.
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
DivisianRf $afety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PA , b,l _P9 _r
dimensioned, north arrow, and location and distance to nearest road
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION 1 � 01 JVA ED ; <,� ; ''a w; D
_.
PROPERTY OWNER: PROPERTY LOCATION
.
Brid eland Dev. Com an GOVT. LOT NE 1/4 SE 29T 19 _r W
PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. N CSM
11736 117th St. 31 na St. C £'s'e` ddn.
CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE [YOWN
Lakeland, MN. 55044 (612) 985 -5000 Hudson r-
[x] New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd$ • 8 trench, gpd/ft
Absorption area required 643 bed, ft2 563 trench, ft Maximum design loading rate .7 bed, gpd/ft . 8 trench, gpd/ft
Recommended infiltration surface elevation(s) 95.5 ft (as referred to site plan benchmark)
Additional design / site considerations alt. site = 94.33' system el.
Parent material outwash Flood plain elevation, if applicable na It
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem I C3 ❑ U CR ❑ U CR ❑ U ® S ❑ U fl S ❑ U EIS ® 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
`,vl......'! 1 0 -6 10 r3 3 none sl 2m r mvfr 2f .5 .6
2 6 -12 7.5yr5/4 none cos osg ml 9w 2f .7 .8
Ground 3 12 -84 7.5 r5 4 none cos oscf ml na na .7 .8
elev.
99 ft.
Depth to
limiting
factor
+84
Remarks:
Boring #
1 0 -11 10 r2 2 none 1 2msbk mfr c .5 i.6
2 11 -24 10 r4/4 none sil lcsbk mfr qW 1f .2 .3
3 24 -84 7.5yr4/4 none cos osg ml na na .7 .8
Ground '
elev.
9 9.7 ft.
Depth to
limiting
factor
+84 1,.
Remarks:
CST Name: Please Print Phone:
Gary L. Steel 715 - 246 -6200
Address: 1554 00th. Ave., Ww Richmond, WI. 54017 m02298
Signature: Date: CST Number:
8 -20 -96
PROPERTYOWNER Bridcreland Dev. Co._ SOIL DESCRIPTION REPORT Page 2 ofd_
PARCEL I.D. # pending lot e3l
.s
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
ed Tre &
Boring # Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ' B
>` 3 1 0 -7 1
2 17-24 10 r4/4 none sil if r mvfr qw I if .2 .3
Ground 3 124-80 7.5yr4/6 none cos osg ml na na .7 .8
elev.
98 ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
1 0 -5 10 r2 2 none 1 2m r mfr Cs 2f .5 .6
2 5 -18 10 r4 4 none sl 2mgr mfr qw if .5 .6
3 18 -80 7.5 r4/6 none ms 0SCI mvfr na na .7 .8
Ground
elev.
9 6.2 ft.
Depth to
limiting
factor
+80
Remarks:
Boring #
1 1 0-9 10 r 3 none 2 k mfr Cs f .5 .6
2 19-16 10 r4 4 none sil if r mvfr if .2 .3
3 1 16-80, 10 r5 4 none cos Os ml na na .7 .8
Ground
elev.
97 ft.
Depth to
limiting
factor
+13
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
3
1 .
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Bridgeland °�Dev. Co. New Richmond, WI 54017
MPRSW 3254 NE4SE4 S29 T29N - R19W (715) 246 -6200
town of Hudson
lot #31 -St. Croix Estates Second Addn.
N
1 " =40'
BM.= top of lZ" pvc pipe C el. 100
3
p ^ t 3
r
z31
`Y.
4Gary. teel
8 -20 -96
STEEL'S SOIL SERVICE
Gary L. Steer
CSTM2298 1554 200th Ave.
MPRSW -3254 New Richmond, W154017
(715) 248.8200
To whom 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 TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer GOB e /14 Mailing Address
��
Property Address o ��
(Verification required from P arming Department for new construction)
City /State ZcJ Parcel Identification Number 6 ZO - 13z - 7 - 3 -
LEGAL DESCRIPTION
Property Location ills_ r /4, S - 1 /,, Sec. 2 , T -R__�f W, Town of &2c.
Subdivision � sw y l d — les Lot # .3/
Certified Survey Map # , Volume . Page #
Warranty Deed # _ ::5:2 - , Volume , Page # 0211
Spec house ❑ yes [9 no Lot lines identifiable CR yes ❑ no
SYSTEM 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 (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
da s of the three y r e piration date.
(I I G /8/
StONATURE eF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
th ro erty describ d above, by virtue of a warranty deed recorded in Register of Deeds Office.
A. � /. C / 8 / Yy
S NATURE Of APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being 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
`.30CIJMENT NO. STATE BAIT OF WISCONSIN FORM 2 -1982 ....
WARRANTY DEED �y -OFFICE
T
P CR OIX CO-, W1
Rsc'a kt Itaaord
MAY 0 4 1998
8:30 A
«�
come - and warrants to ''K
A of
John J Gag(' rdi husband and wife
the following described real estate in St. Croix County, State of Wisconsin
Hsu
PID# 020 - 1327 -
.
Lot 31 , St. Croix Estates Second Addition in the Town of Hudson, St. Croix County, Wisconsin.
T AKIS ER
F EE�
This is r ,Ql homestead property.
(m) (is n , 7,1)
Exceptio=ns to Warrantcs:
Bated this -3 W—day of _ u� l, 19 --2&—
(SEAL) (SEAL)
' Neal I . zaniak Pr _ de
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated this _day of STATE OF MINNESOTA
19 Dakota County
Personally came before me, this 31st —jay of
March 1998 - -- -the above named
TITLE: MEMBER STATE BAR OF WISCONSIN Neal Krzyzaniak
(If not,_. --
authorized by 706.06, Wis. Stats.?
This instrument was dr°Aed by
to me known to be the person who executed the
Bridgdard DcvclQpmcnt CQm=y foregoing instrument and acknow edged the same.
2141 Icenic Tr. Suite B. Lakeville. MN 55044
(Signatures may be authenticated or acknowledged J. Baugh _
Both are not necessary.)
Notary Public >7akota . C aunty, MN
My conunission expires January 1, 2000.
:,, AatA J. B "
RY PUBIiC -Lt
- - -'- � 4 - DAKOTA COUNTY
Mssio n ripres Jan 31.2000
'Naincs of perv)ns signing in any capacity sbnuld be type! or priilotd below thei. signaf si=n N'r M2:
W {Ac u A1 'i "a' D£: Ls STA -7M: BAR OF WISCONSIN, FO NI N ;0. 2 -1982
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