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Home My WebLink About020-1327-50-000 ST. CROIX COUNTY TONING DEI'ARTMENT AS QUILT SANITARY REPORT Owner Si Address City /State Legal Description: Lot_ Block Ott Subdivision/CSM # S�e0jN �q�]�Cs Sec. - TON -R/&W, Town of PIN # Od0 - 3- -sa SEPTIC TANK -- DOSE CHAMBER -- HANK INFO RMATION r Tank manufacturer ___5 ley f t Size ST/PC Pump manufacturer — — Setback from: House Well P/L Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road = Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: Width _ l� � Len Setback from: House C� Well -* - P/I, of Trenches / _ Vent to fresh air intake to ' ELEVATIONS: Description of benchmark roe Elevation Description of alternate benchmark Elevation Building Sewer ST/HT Inlet 97. ST Outlet- 9 7, 1 (o PC Inlet PC Bottom _ Header/Manifold i c� Top of ST/PC Manhole Cover Distribution Lines O 9a O ( ) Bottom of System Final Grade Date of installation i/ 9/? Permi ber .� �9 State plan number Plumber's signature License number —,22 t Date 9 / 9 9� Inspector —le"4 <'omplcte plot plan � e � 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 benclunark, if applicable. PLAN VIEW i5 2 I `y INDICATE NORTH ARROW 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)]. 315991 XF Permit Holder's Name: []City ❑ Village Town of: State Plan ID No.: HALL, RICK HUDSON CST BM Elev..-- Insp. BM Elev.: BM Description: Parcel Tax No.: 020- 1327 -50 -000 TANK INFORMATION ELEVATION DATA A9800379 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic "l, � �"�', /v? Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet ' 5�0 25 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. A ir ir I to ntake ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe, Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand �`' �` Model Number GPM TDH Lift Lriction System TDH Ft Forcemain Length Dia. He Dist. To well 7 F SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DI MENSION S ' >- D IMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manufacturer:, INFORMATION Type Of } .x. _ CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing _ i 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 ..- '• I , ` Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 29.29.19,NE,SE 722 CROSBY DR — ST. CROIX EST LOT 33 �O Al Plan revision required? ❑ Yes ❑ No Use other side for additional information. ,?-? SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION 201E WashingtonA Di vision In accord with ILHR 83.05 Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. ` • See reverse side for instructions for completing this application State Sanitary Permit Number y ou p rovide may be used b other government agency p rograms '3 1 -5 9 V The information y p y y 9 g y p g • ❑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 RMATI N Prope Ow r Nam Property Location Q IV5 1 /a SE 1 /4,S T � 1 ,N,R 90) W Propert Owner's Mailin ddress Lot Number Block Number (AD ` 1® o3 S N City, State Zip Code Phone Number Subdivision Name or CSM Nu be I. TYPE ILDING: (check one) ❑ State Owned ic Nearest Road p Village Public 1 or 2 Family Dwelling - No. of bedrooms Town of C 111. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo D ° 1307 ' S 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 V6 New 2. ❑ Replacement 3, E] Replacement of 4. ❑ Reconnection of 5, ❑ Repair of an ( — S ystem ________System __ ________ _ __ Tank Only______________ Existing System - ________Existing 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 E] Mound 30 E] Specify Type 41 ❑ Holding Tank 12 ffSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1_ Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4_ Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min. /inch) q. Elevation 9.5'7 �(v r ! , is Feet 0 1 . 4. to Feet VII. TANK Capacit gal Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Exist in strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I I I ❑ 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 Plu er's Signat St mps) MP /MPRSW No.: Business Phone Number: I. r5 � 1.5 S Plum er's Address (Street, C't , State Zip g e): I IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee ('"dudes Groundwater D ate Issued g Agent Signature (No Stamps) Approved ij Surcharge Fee) pp []Owner Given Initial l�D Adverse Determination AD X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: fR-f DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber I _raq tJ s o015 ST C� I , :?m_ 0 7 -- _ JI _tJ Ji -- p � � I , i I ' I I I II i I I C r U SS S�c�'lor,_�o� � Zito S (!in cY,, I�l FrotA Alt I111012b And 00►orrallon Plpo ' E X4 ' Yq ! 01� �fq lit 1. r1 p r Approri/ Vent Cop T /� •.• la lnlmwn 12•Ap S l C—co \X gs�=9 Co I 3 _ ' _ 'not ds 20. 42' Aoora Plpj _ 4 Cast iron To Final Orodo Vant Plpo W Itor Or 51mMtk Co or Lin 2' Agpropolo Ora, Ptpo OIII /iCYt10n ' Plpo 0 0 0 — Too s b' Aggi agat 060441R Pip ° Pulorotsd Pipa Oslo. o �Co.gllnp Tsrwdnallny At ' nollai° 01 Sr►Ioro �Icv•,�' ion � � SOIL FILL 0ISTRIBUT10 PIPE ' APPROVED ZSyJT1{CTIC c0vcA ?" hGGREGAlF- oR 9" of s-rakw "_Y`... OR MARSH HAY El-EV. O r. r OPJt - 2 1 � z AGGRCGATC F F EY-- DISTRMUTIOM PIPE TO OC AT tUCHES BCLOW ORIGIIJAL GRADE o•UU AT LCAS7L0 IIJCHCS BUT 1.10 MORC THAW 4 2 IuCNES BELOW FINAL GRADC MAXIMUM DaPrH OF EXCAVATIo1.D FXom oAjtNAL 6RA0a WILL BE �` IIJCHE5 1'UN1MU1� OC of EACAVATImN r 0� 1644AL (3RADf- WILL BE INCHCS 0 SIGHED. LICCUSC IJUMBER: Q �f y Q p� — DATE: � V ( t p Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & 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 St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # r dimensioned, north arrow, and location and distance to nearest road. O 13 �, - 5 d APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE k''5 a(13(�S PROPERTY OWNER: PROPERTY LOCATION Rick Hall GOVT. LOTNE 1/4 SE 1/4,S 29 T 29 ,N,R 19 &(or) W PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 302 Willow St. 33 na St. Croix Estates CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN Mosby REST ROAD Somerset, WI. 54025 (115)247 -3514 Hudson Dr. [14 New Construction Use [ Residential / Number of bedrooms 4 ( ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 g pd Recommended design loading rate • 7 bed, gpd /ft .8 trench, gpd/ft Absorption area required 857 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 97.0 - 95.3 - 94.0 -91.85 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 system ®S ❑ U ® S ❑ U ® S [I U ®S ❑ U ®S ❑ U ❑ S F 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 - 10yr4 none sl lcsbk mfr if .4 .5 .1.......... 2 8 -20 7.5yr4/6 none is Osg mfi gw if .7 .8 Ground 3 20-120 7.5yr4/6 none co s Osg ml na na .7 .8 elev. 9 5.5 ft. Depth to limiting factor +120 Remarks: Boring # 1 1 0-8 10yr3 /3 none sl lcsbk mfr gw if .4 i.5 2 8 -17 10yr4 /4 none sil 2csbk mfi gw if .5 .6 2 >' 3 17-110 7.5yr4/4 none co s Osg ml na na .7 .8 Ground elev. �( 96.1 ft. - Depth to limiting c factor 4ALD 1 s Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715 246 - 6200 ! SCE Address: 1554 200th. AY2., New Rich nd WI 54017 Signature: Date: 8 -4 -98 CST Num a m02298 PROPERTY OWNER Rick Hall SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0 -7 10 r4/3 none sl lmsbk mfr 9w If .4 .5 2 7 -17 5yr4/6 none is Osg mfr gw if .7 .8 Ground 3 17 -86 7.5yr4/6 none co s Osg ml gw na .7 .8 98.3 ft. 4 86-110 7.5yr4/6 none ms Osg ml na na .7 .8 Depth to limiting factor +11 " Remarks: Boring # 1 0 -6 10yr3 /3 none 1 lcsbk mfr gw if .2 .3 4 2 6 -14 5yr4/6 none sil 2msbk mfr gw if .5 .6 3 14 -21 5yr4/6 none is Osg mfr gw na .7 .8 Ground elev. 4 21 -96 7.5yr4/6 none co s Osg ml na na .7 .8 101. 5t. Depth to limiting factor +96" Remarks: Boring # 1 0 -7 10yr3 /3 none sil 2msbk mfr gw if .5 .6 5' 2 7 -18 10yr4 /4 none s i t 1 csbk mf i gw if .2 .3 3 18 -43 7.5yr4/4 none co s Osg ml gw na .7 .8 Ground elev. 4 43-100 7.5ry4/6 none co s Osg ml na na .7 .8 101. 0t. Depth to limiting fact V1 n Remarks: Boring # Ground elev. ft. Depth to limiting factor i Remarks: SBD- 8330(8.05/92) ✓ f STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 New Richmond, WI 54017 MPRSW -3254 Rick Hall (715) 246 -6200 NE4SE4 S29- T29N -R19W town of Hudson lot #33 -St. Croix Estates N 1" =40 BK.= top of 2 pvc pipe @ el. 100 Alt. BM.= top of 2 pvc pipe @ el. 103.45 2 P� ok Gary L. Steel 8 -4 -98 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer _ Mailing Address �_0 Property Address (Verification required from Plannini Department for new construction) City /Stat eSnrn,,pe,-,Z� Parcel Identification Number Q a„O -- I al-S LEGAL DESCRIPTION Property Location N'�- '/4, '/4, Sec., T,'29_N -RCW, Town of J , �o Subdivision ",coo �S , Lot #. Certified Survey Map # , Volume , Page # Warranty Deed # �q"� , Volume Page # Spec house O yes no Lot lines identifiable [K yes 0 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 wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 stating that your septic system has een maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of OF P ee year expiration ate. p� A L CANT DATE OWNER CERTIFICATION I (we) certify that all state ents on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prop escribed above, by v' a of a warranty deed recorded in Register of Deeds Office. L�s OF APPLTCANT 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 5'79253 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2 -1982 F WARRANTY DEED R -- bFFICE SROIX CO.. WI RM•� hit RNOr� Brt�r:lattd Dcr nk Cttily, a Mip MAY 18 1999 conveys and warrants to ++- ..8.00 LJa.A.M Richard W. Hall and Sbsal W Of 0006 � husband and wife the following described real estate in St- Croix Count, State of Wisconsin Lot 33 33 . St. Croix Estates Second Addition in the Town of Hudson, SL Croix County, ` Wisconsin. $ T InFER This is not homestead property. (h) (a not) Exceptions tr Warranties: Dated this 12th day of _May_ 19 (SEAL) (SEAL) • • nt (SEAL) (SEAL) • • AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated &,is day of STATE OF MINNESOTA ' 19 Dakota County Personally came before me, this 12th day of Ma 1998 the above named TITLE: MEMBER STATE BAR OF WISCONSIN Neal Krryzaniak (If not, authorized by 706.06, Wis. Stats.) This instrurr::.-nt was drafted by to me known to be the person who executed the Brideeland Deyd%ment CQraWay fortDoing ins ment and acknowledg the same. 20141 Icenic Tr, Suite B. Lakeville MN 55044 (Signatures may be authenticated or acknowledged. * Darla J. Bauer _ Both are not necessary.) Notary Public _ _D akota . County, MN My commission expires January 1, 2000. 0%JiIA 1 bitiUER 110uM K BJ040MESOTA OaWTACMRM •... 1 M (aaRrn+ssicxt lil�ires Jan. 31.2000 *Names of persons signing in any capacity should be typed er printed below their signatures. See vrF 0021 WARRANTY DEED STATE BAR OF WISCONSIN, FOR M NO. 2 -1982 Wiscansin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Laz or and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY -- ` on Attach complete site Ian paper not less than 8 1/2 x 11 inches in size. Plan must include, but P P PP o PARC not limited to vertical and horizontal reference point (BM), direction and /o of slope, scale or L, ' dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION RE BY ATE PROPERTY OWNER: PROPERTY LOCATION Brill eland Dev. Oxnpany GOVT. LOT NE 1/4 SE 1/4,6` 2� T 23 N R' °19 PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME GR'CSM # = = ': r.,., _ r .�_ 11736 117th. St. 33 na St. Croi` es Se dn. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE 19OWN b. Lakeland MN. 55044 1612) 985 -5000 Hudson 1:1 New Construction Use [xj Residential/ Number of bedrooms 3 [ ] Addition to existing building j I Replacement [ I Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate _ 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) 100.8 , alt= 101.87 ft (as referred to site plan benchmark) Additional design / site considerations none 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 fors stem ® S ❑ U ® S El 2 S El 12 11 U f7 S ❑ U CIS 01 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G D/ t in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trertcti 1 0 -11 10 r3 3 none 1 2msbk mfr cs if .5 .6 2 11 -21 10yr4 /4 none sil lcsbk mfr 9W if .2 .3 Ground 3 21 -48 7.5 r4 4 none cos os ml QW na .7 .8 elev. 10 ft. 4 48 -88 7.5 r4/6 none ms 0sq ml na na .7 .8 Depth to limiting fact 8 Remarks: Boring # 1 0 -14 1 L 2 14 -36 7.5 r4 y 4 none cos osg ml C1W if 3 36 -96 7.5 r4/6 none ms osq ml I na na .7 .8 Ground elev. 1 Depth to limiting factor +96 Remarks: CST Name:—Please Print Phone: Gary L. Steel 715- 246 -6200 Ad dress: 155 00th. &ve.,,New Richmond, WI. 54017 m02298 Signature: Date: CST Number: 8-14-96 PROPERTYOWNER Bridgeland T)Fv CQ SOIL DESCRIPTION REPORT Page2_of 3 PARCEL I.D. # Pend i n g-_ Lot #33 Depth Dominant Color Mottles Structure G1PD /ft Boring # Horizon P Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -10 10 r3 3 none S1 2msbk mvfr if -5 -6 3 2 1 10-84 7.5 r4/6 none ms 0SQ ml na na .7 .8 Ground elev. 10 ft. Depth to limiting factor +84" Remarks: Boring # < K* ..,, :W 1 10-11 10 r4 4 none sil lMgr mfr r .2 .3 2 1 11-29 7.5 r4 4 none cos 0 3 1 29-82, 7.5 r4/6 none ms 0sa ml na na .7 `:.8 Ground elev. 10 ft. Depth to limiting factor +82" Remarks: Boring # 1 k-10 10 r3/3 none sl 2m r mvfr cs if .5 .6 2 110-18 7.5 r4 4 none cos 0SQ ml ow if .7 i.8 ................ 3 118-88 7.5yr4/6 none ms OSQ ml na na .7 1.8 Ground elev. 1 05.3 ft. Depth to limiting factor +88" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Bridgeland Dev. Co. 1554 200th Ave. CSTM2298 NEgSEq S29- T29N -R19W New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246 -6200 lot #33 -St. Croix Estates Second Addn. N 1 =40' BM-= top of SE lot stake @ el. 100' bl 4' ,1T 10' (P to Gary L. Steel 8 -14 -96 STEEL'S SOIL SERVICE Gary L. Steel CSTM2298 1554 200th Ave. MPRSW -3254 Now Richmond, WI 54017 (795) 248-6200 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 I l