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Home My WebLink About020-1320-40-000 ST. CROIX COUNTY ZONING DEPARTMENT : ' AS BUILT SANITARY REPORT %` •�► RITTIVEO Owner j u,& --vim Ja,•� Si�rt �, Property Address `7 C rb s b g Pr City/State fi'c� a4� lr �� i - , ,r rourin- �� ' ? Legal Description: Lot 78 Block -- Subdivision/CSM # a k eroi.e �sP_r /G V. SaJ' /., Sec.' T ``IN -RAW, Town of u.�lsvy, PIN # Goa - /3zo -Slv SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer %/5. Size ST/PC /2 , 1t5/ Setback from: House q Well 7,q P/L li7 �� Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road 4 4 Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: i <<� Width Len - 7ln Z YP Y 3 Number of Trenches . � � Length Setback from: House _ L2_ Well l,-' P/L /z " Vent to fresh air intake - 7s ELEVATIONS Description of benchmark �� ire n Elevation Description of alternate benchmark 4 1 1j - k,H ,� c� Derma✓ < 1 ` Elevation �� . 7;� '-::� ',%7 Building Sewer ST/HT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold 2. Top of ST/PC Manhole Cover >� Distribution Lines Bottom of System Final Grade Date of installation aZ 1i 7 1 9i Permit number 2- State P lan number Plumber's s' ature ,„,,._ License number y1l/, 'S 3 a7 Date 1/11 Inspector Complete plot plan 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 T� 'L y 0 i y ��erckes 3x 3b �iL ►;� s � �-e., toy. �f r� INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Saf ety and Buildings Division INSPECTION REPORT TQCF6 / K GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, .15.04 (1)(m)]. %j am Permit Holder's Name: ❑ City ❑ Village ErTown of: State Plan ID No.: e_ G I aZ 56Y S O J�6y" � CST BM Elev. :- Insp. BM Elev.: BM Description: Parcel Tax No.: 6D 1 1 rya 7v ?1 i_�> 02o - / �za TANK INFORMATION ELEVATION DATA .04. 6 p 4e TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se ti BSc h Dosing P'l Ivl Z$ p 2 Off, 1. Aeration Bldg. Sewer `t'�vrr® Holding nlet zSt(S '1 • ? j CZO TANK SETBACK INFORMATION t Outlet TANKTO P/L WELL BLDG. Air to I ntake ROAD Dt Inlet Air Se tic (�� ( v r't ul 2 NA Dt Bottom Dosing NA Header/ Man. �S _6 Aeration NA Dist. Pipe �5;"?� 2 ' ] L Z Holding Bot. System G .3y 1 PUMP / SIPHON INFORMATION Final Grade 325 - l• Manufact De nd I2bD q.Iq 123, Model Number ,? �� 'z, (o7 If 2—coL TDH L' Friction S st TDH Ft L oss Forcemain I Length Did. Dist. To Well SOIL ABSORPTION SYSTEM BED Width , Length No. Of nches PIT No. Of Pits Inside Dia. Liquid Depth DIM I N Tre 7 DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STR LEACHING Manufacturer: SETBACK CM INFORMATION Typeo RA Moe Number: syst�vdam� Z G7 It C OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) IN r x Hole Size x Hole Spacing Vent To Air Intake Length � ( Dia. Length �(! r t Spacing _ �? 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.)�'P%QV 78 Zq. j ? • A)4_q 5t.J 7 02- Cfeo D2—__ "5 T. 1✓IF-a 1 N 6� I • Cam'` - Z-e> CI� 1f� �/ut - T,b P INS+✓ 6v7 �6' TY --DoC, (2, Plan evasion re quired? [:] Yes allo Use other side for additional information. �G SBD -6710 (R.3/97) Date Inspector's Sig ature Cert No ADDITIONAL COMMENTS AND SKETCH SANIT Y PERMIT NUMBER: , i e = m o a nm a� a x ,i..... _ _...:,.m ..... _a. x n�-.. ...,. _... __,. _.;.,. ........... �,r.,..__.. _. ... ...... � ...� � __ as a r 0 a � R E 9 9 I 5 � € P 1 ..., . €..,.. .. m eheme .. s m..> ... ......_..{ ( s 1� { a � l d E ' E e € m E € € E 3 . _,��se �� ®.m m . t q ,_ .. F .. .. 55 € # S t ¢ E a F s E �.... s a i 2 F a n Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Vis consin In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. S - F C il 1 X • See reverse side for instructions for completing this application State Sanitary Permit Number 3Zo26) - :�-> 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 INF RMATION Property Owner Name Pr pert Location I � n/U /4 $ 1/4, S � T �� , N, R /V Ik (or)0 Property Owner's Mailing Address Lot Nu �er Block er City, State Zip Coe Phone Number Subdi ision Name or CSM N m r T YPE F _ 01115 — ING: (check one) ❑ State Owned ❑ V Nearest Road illage Public @ 1 or 2 Family Dwelling - No. of bedrooms XTown of CKy1 III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) Ir 1 ❑ Apartment/ Condo DSO 13ao —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. X New 2. ❑ Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an System System Tank Only ___ ________ Existing System _________Exlstln�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 12OSeepage Trench 22 ❑ In- Ground Pressure r , 42 ❑ Pit Privy 13 ❑ Seepage Pit '� ><1 43 ❑ Vault Privy 14 ❑ System -In -Fill f}4 w C b 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.) Pro osed (sq. ft.) (Gals/da /sq. ft.) (Min. /inch) r/ /08.95 Elevation 6W — 7,D - Z . 7 � Tz 10 7. /!�_eet //2. 7 Feet VII. TANK Capacit g allons Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App New Existing structed Tanks Tanks A tic Tank p'IA0 �o?� (�,��, t� , , El El 1:1 Lift Pump Tank /Siphon Chamberl I I ❑ I ❑ I ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum s Name: (Print) Plumb( , s Signature: (No amps)_ MP /MPRSW No.: Business Phone Number: ��,,+rc . 3�� 7/ 772- Plumber' Addre areet,Cityty,St * CA 4 / 1� IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) �]c Approved E] Owner Given Initial I y O 04 1 Surcharge Fee) ID Adverse Determination 0 �8 X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: 7 Crosby SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber JOB— (-n TIMM EXCAVATING SHEET NO. – OF Route I Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 IVIN CHECKED BY DATE SCAL .......... .......... ........... . ......... ........ ........... ....................... .......... .......... ........... ........... ........... ........... .......... .......... .......... ........... .......... .. ............ ........... ........... .......... ... . ......... ....................... ........... ........... ........... .......... ........... ........... ................. .......... ........... ........... .......... ....................... ........... ....... ...... ........... ... ...... . .. ..... .......... ....... .......... .......... .......... .......... .......... ........... ........... ........... ........... ........... .......... .......... ........... ........... ........... ........... ........... ........... .......... ..... ...... ..... .... ... – ....................... ........... .................. ........... .......... .......... ........... ..... ..... ..... ................ .......... .......... .................... ........... ........... ........... ........... . ..... ......... ........... ...... ..... ..... ...... ...... . .... .... .... ... .... ...... ....... . .... .......... ..... ..... ..... .... ...... ...... ...... ....... .... ...... ... .......... ........... ........... ........... ........... .......... ........... .......... ........... ................ .................. ........... ........... .......... .......... ........... ........... ........... .......... .......... ........... ........... .... ...... .......... ........... ........... .......... ........... .......... ........... ............ .......... .......... ; ..................... .. .................................. .......... ........... ........... ..... .......... ........... ........... ........... ........... ........... ................... ........... ........... .... ... .. ....... ........... ........... ........... .......... ........... ................. ........... ........... .......... ................. ........... ..................... ........... .......... ............ ....................... ..... . ..... .......... ........... ... ....... ........... .......... .......... ........... ........... ......... .. .......... ...... ....... ............ — ........... .......... ........... ....................... .......... ........................ ....................... .......... ..................... ........... ........... ........... ........... ........... .......... .......... .......... .......... ........... ........... ........... ................. ...................... ........... ............. ..... ........... .......... ........... .......... .......... .......... . .... ....... .......... .......... .......... ........... ........... ................ .............. .... .... ..... .......... ........... ...... .... .......... . ....... ........... ........... ................... ......................................... ................. ir— ........... ........... ........... .... ...... ........... .............. ............... ------ ......... ............. .......... ...................... ........... .......... .......... ........... ........... .......... .......... ........... - ....... ..................... ........... - - - - - - - - - - - - ............ ............... .............. ........... .......... ........... .......... ........... . ....... ............... ........... & -------------- .......... ................... .......... ....... ......... ....................... .......... ............ . . ..... . ..... ... ....... ........ .......... ........... ................. .. . .... ... ............ .......... .................. ............. ........... ... ... .... ................... I .................. ...... .......... ................... ........... ........... .... ...... X 06 ' __ ' ... 4 ...... .......... ............. .............. .... .......... . .......... - ............ ............ - . . ...... .............. Tie r Ap 5 -V/n. -11-1 11 /4.00 oal j 4j ee- r od ................................. .......... ee r/ ........... ................. .......... . .......... .... .................. ............... ..... ..... .... ....... .......... ................. - ............... ..... ........ - ................ ........... ........... ..... ..... .......... PRODUCT 205-1�lrc, Groton, Man. 01471 To Order PHONE TOLL FREE I-M225-5380 JOB OG�i �r ��I`so�► TIMM EXCAVATING a SHEET NO. OF Route 1 Box 192 _ WILSON, WISCONSIN 54027 CALCULATED BY 'e* 00 1;' ^^ DATE / G (715) 772 -3214 (715) 386.5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE .. . .. ..... .... ........... ..... ...... ..... .... .... ..... .... : . — . .. ... .. .. ................... >..........! .......... i ..... ..... .... ..... ..... .... .... .... .... ..... ..... ..... ..... ..... .... ..... ..... ..... ..... ..... ..... .... .... .... ..... .... ... i... ... i.... ... i... i .... ....... .. ... ..... ... .....�, .. .. ..__ ._..._. .......... .......... .......... ........... - .......... ---------- y .. .... ...... .. - .............. .. PRODUCT 205 -1 ""`^'S lnc., Groton, Mass. 01471 . To Order PHONE TOLL FREE 1- 8*225 -M Wisconsin Department of Industry SOIL AND SITE E V A L U / PORT Page 1 of 3 Labor and'Human Relations Division 3f Safety &Buildings in accord with ILHR 8 � COUNTY Att'ath complete site plan on paper not less than 8 1/2 x 11 inches i sI Ply rraust'#iiOude, bu St. Croix not limited to vertical and horizontal reference point (BM), directio /o of scale oF. PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest ro i y `;;;`�" h pending '• � � � � R' APPLICANT INFORMATION- PLEASE PRINT ALL INFOR ON J' REVIEWED BY DATE PROPERTY OWNER: PRopii"'06A f r� Bridgeland Dev. Company OvfF O 1T4/ vas T N,R Z. (or) W -28 29 PROPERTY OWNER':S MAILING ADDRESS QT f( �; ,. [ 0 SUBD. NAME OR CSM # 11736 117th St. -`" C .9tates First Ad8n. CITY, STATE ZIP CODE PHONE NUMBER (]CITY []VILLAGE WOWN NEAREST ROAD Lakeville, M. 55044 (612 985-5000 Hudson Crosby Dr. [x] New Construction Use [ )4 Residential / Number of bedrooms 3 [ ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd /ft2 - 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) 108.95 trench ft (as referred to site plan benchmark) Additional design / site considerations trenches spaced to code and-3,45 below surface level Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE 7A8T SYSTEM IN FILL HOLDING TANK U = Unsuitable for system S El U ❑ S ® U kiS ❑ U ®U F] S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bo rx:13y Roots GPD /ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ..1 1 0 -20 10 r2 2 none 1 2msbk mfr cs 2 .5 .6 2 20 -44 10 r4 4 none sil 2msbk mfr crw 1 .5 .6 Ground 3 44 -84 7 r4 6 none s os ml na na .7 .8 elev. 1 12 . 7 ft. Depth to limiting factor +84 i Remarks: Boring # 1 0 -12 10 r2 2 none 1 2msbk mfr aw 2m .5 .6 Li 2 12 -22 10 r4 4 none sl 2m r mvfr if .5 .6 3 22 -84 7.5 r4 6 none s loscr ml na na 1 .7; .8 Ground 11 ft. Depth to limiting factor 84 Remarks: CST Name: Please Print Phone: Gary L. Steel 715 - 246 -6200 Address: 1554 200th. Ave. New Richmond WI. 54017 m02298 Signature: Date: CST Number: zz� 6 -26 -96 PROPERTYOWNER Bridgeland Dev, CO. SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # pending , Lot #28 Depth Dominant Color Mottles Texture Structure Consistence Roots 'GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed 'Trend► 1 0 -9 10 r3/3 none s1 2mcir 2 9-3a_ 7.5yr4 nane 10 1 Mvf r gw 1 f 7 - R Ground 3 133-80 7.5 r4/4 none s os elev. 109 ft. Depth to limiting factor +80 Remarks: Boring # 1 10-8 10 r3/3 none sl 2m r 4 << 2 2m r mvfr qw if Ground 3 1 16-8 0. na na .7 .8 elev. 106 ft. Depth to limiting factor +80 Remarks: Boring # 1 1 5 .. 2 13 -24 10 r4 4 .5 .6 3 4 -80 7.5 r4 6 none Ground elev. 10 ft. Depth to limiting factor +80 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. Bridgeland Dev. Co. CSTM2298 NW4SW4 S28- T29N -R19W New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246-6200 lot #28 -St. Croix Estates First Addn. T N 1 =40' BM.= top of SW lot stake C el. 100' s �00 SZ 24� Gary L. Steel 6 -26 -96 STEEL'S SOIL SERVICE Gary L. Steel CSTM2298 9554 200th Ave. MPRSW-3254 Now Richmond, WI 54097 (795) 248-6200 To whoa 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 Jun -20-01 P.01 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND {� OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address /7q,2/ (Verification required from Plavining Department for new construction) City /State _? ((��, Parcel Identification Number Do'lb— � 32a — 4 LEGAL DESCRIPTION Property Location iv w ' /4, 5 J /., Sec. , T -R_Zf W, Town of Subdivisio �'Ol�c /zc.�5 �, ,��' Lot #. Certified Survey Map # Volume , Page # Warranty Deed # S 0 ZS`7 Volume _ l2a , page # Zc 7 Spec house ❑ yes A no Lot lines identifiable Z 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 masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating ondition and/or 2 after inspection ection and () p pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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 ti n stating 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. D15 /?F SIQLATURE OF 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 the roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office e SIGN RE 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 / DOCLrM, FNT NO. STATE PAR OF WISCONSIN FORM 2 -1982 TN1S FACE RESERVED FOR RECORDING DATA 550259 WARRANTY DEED Brideeland Development CQCrilhtLlt. a Minnesota co t zonveys and warrants to - 0GT 2 1 9E Duane W Gilbertson and Betty A Gilbertson 8: 30 A. husband and w �� *�� - - NETL"R.N TO the following described real estate in St. Croix County, State of Wisconsin ac'r -53 VX PARACEL NO. _ Lot -A, St. Croix Estates First Addition in the Town of hudson- St. Croix County, Wisconsin - Tk NSFER This is not homestead property. (is) (is M) Exceptions to Warranties: Dated this 19th day of September 19 96 r # - -- (SEAL) —(SEAL) *-6r * (SEAL) -- (SFAt I s AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF MINNESOTA ' 19 Dakota County Perum ally came before me, this 19th day of s Septembr_ 1996 the above named TITLE: MEMBER STATE BAR OF WISCONSIN Neal KM (If not, -- authorized by 706.06, Wis. Stats.) - This instrument was drafted by to me kmm-u to be the person who executed the Bridgetand Development Company foregarrig nrsmrment and acknowledged the same 20141 Icenic Tr. Suite BLakeville MN 55044 (Signatures may be authenticated or acknowledged. • p ar k J Barer Both are not necessary-) Notarn FNAy bc _ _ Dakota . County, MN My won expires January 1 2000. DARtA J. BAUER NOTARY PUBLIC - MINNESOTA DAKOTA COUNTY My Commission Expires Jan 31 2000 t *Names of persons signing in any capacity should be typed or printed below their sib srrz VIT 0071 WARRANTY DEED STATE BAR Ot WISCO%S^. FOR M NO. 2 -1982 a C �t (A r m m 0 v W 3 z c1 D O D O 3 O m Z m m WEST LINE OF THE SWI /4 OF SECTION 28 O 8 S �t1 c 2 V z u0b ra 4F- p w ° 9 p\ OO v f N 0 0 w OD W W r 0 - Loo 0 z 0 O N N N V N D t7� 01 y N A ° N r VN O 'n m r Do oA A � y ° m om N 0 �► I -'' n m N o m ;-1 � � N � 0 N tt W i I� y � 406. _ - S06 °OV 58' -190-00,- �- -- w - -__ - w ,. 121.71 = - - 216.06 '_� 141:8 C' /► �/ - DR � V E O SIO ° 1 0 33 E 45 W W -- 76.7 m � PUBLIC- W — "- 0.00: _ I -- O _ _ _ N06 °09'S8'�W ; 25 I y C CD 01033 / _NI 121.71: Np6°p9,5$•oW X35.010 D f' ao 0 I O m (Q 1. OD - O i - I k v W iD OD I Ln to W J N r I 33 1 3.3 _ OD O1 N r,\,) 00 O I T � I OD N r A V I ' O w cn X N 0> --I 1' , S y �J ap .y cn r o p O ('497.00, * s_ -n N -4 r oy ; y x /S/;Po I 0 00 �� o ° n1 2g0 34 I O C �� J 8 ti's J ti W v" ! _ 0 V N t T' 01 O N r r e / Jf N V1 W O r _ o� / ► �► D tD v r m O m c _ m m„ i ly �. T rn - t�