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HomeMy WebLinkAbout020-1327-10-000 o Z O 3 0 N O V3 M 0. C C n i O N tj i I I I I ~ I a~ C Z li C O Q a) Z y a) O O Z £ rn N u1 a m N H Z 1 O O l d C U w V O .N O tZ- N Z C ~ m N O U) C: '►V d U O O m o H Z o c N E Z N _ N C f0 -C N d U i R w d ~ L ~ X CO ° co O O O 0) y 0) N co d0' D d .n E O to y N N v N 0) F- IL O 0 0 0 3 Z O N CL a a o N a Q- fn J U rn rn z > 'O O co O y O (a i T ~ O C) E 0 O m d U m o }3) N N Q Z~ m O N O O O O N W C ` CC O C C 0) O Cs O O C0 ° ai o S n a a o ~ w E L ~ C O W V N N N C O 00 ~ O C O C ~ of N ` o -C m ' FL- ai C,4 co Q) cm 6 E O N= CL (N 0 Z N Z~j U) O CC I' ~ w CO d 'E C w 7 L) a. 0 U) 0 F Parcel 020-1327-10-000 03/12/2007 03:33 PAGE 1 OF 1 F 1 Alt. Parcel 28/29.29.19.1700 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - GILBERT, MARK E MARK E GILBERT 704 CROSBY DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 704 CROSBY DR SC 2611 HUDSON SP 1700 WITC i Legal Description: Acres: 3.230 Plat: 2494-ST CROIX ESTATES 2ND ADD'N SEC 28 & SEC 29 T29N R19W PT NW SW SEC Block/Condo Bldg: LOT 29 28 & NE SE SEC 29 ST CROIX ESTATES 2ND ADD'N LOT 29 3.23AC Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 29-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 04/28/2006 823932 WD 07/23/1997 1242/611 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.230 73,900 314,400 388,300 NO Totals for 2007: General Property 3.230 73,900 314,400 388,300 Woodland 0.000 0 0 Totals for 2006: General Property 3.230 73,900 314,400 388,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 126 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 k*Wisconsi'n Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Hunian Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299078 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: PETERSON, DENNIS HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 020-1327-10-000 TANK INFORMATION ELEVATION DATA 0/0 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. , Benchmark Or /ate-~ Septic ~ ~~✓~S ~~t~ C1 rr r Dosing Aeration---- - - Bldg. Sewer II Holding St/#f Inlet I' TANK SETBACK INFORMATION St/ptf Outlet Z' Vent TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Inlet 5753 Septic NA Dt Bottom s/Or ~nC;S Dosing NA Header - m. NA Aeration Dist. Pipe Holding Bot. System +f I~ PUMP/ SIPS INFORMATION Final Grade s Manufacturer Demand p, g6 6 ~r5 r~ Model Number GPM Friction ystem TDH Lift TDH Ft Loss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I N LEACHING Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM INFORMATION TypeO CHAMBER Mode 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 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.) LOCATION: HUDSON 29.29.19,NE,SE 704 CROSBY DR ST. CROIX ESTATES LOT Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: i r ~ Safety and Buildings Division `•ISC - SANITARY PERMIT APPLICATION 201 E. Washington Ave. ons~n 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 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number _~ggvr) ? L The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Property Location rs e 114 _.5 v4,S CJ T eI? ,N,R/p E(ortc Property Owner's Mailing Address Lot Number Block Number City, St~atg [Zip Code Phone Number Subdivision Name or CSM Number II. TYPE B ILDIN (check one) ❑ State Owned ❑ ity Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF o5 ,17v 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 1.0R 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. BINew 2_ ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank OnlyExisting System ExistingSystem 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 0 Seepage 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 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq_ ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation DdfJ t~0 c' tqr F-2 Feet g 3.Z Feet VII. TANK Capacity gallons Total # of r Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existing structed Tanks Tanks Septic Tank or Holding Tank y,*f ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ,Wqge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signat e: (No Stamps) P PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 41 .S ~ or d IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanigtry Permit Fee (Indude,Gmundwater Date Issued Issuing Agent Signature (No Stamps) pproved ❑ Owner Given Initi Surcharge Fee) al Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 11/96) - DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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 wit'n 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. j Safety and Buildings Division Vi SANITARY PERMIT APPLICATION 201 E. Washington Ave. scons/n 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 81/2 x 11 inches in size. S GYc -'X • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs X' heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Property Locaticgn 1/4..S~~ 1/4, S ~7 T T.4 Q , N, R /Q E (oro Property Owner's Maili g Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number e' 3 G A-s IL TYPE BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Vila Public 1 or 2 Family Dwelling - No. of bedrooms ~ Town OF w~16' N'• s'b Qr III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 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. MNew 2. ❑ Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System 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 11E] Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 E,Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14E] System-In-Fill 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) eel jr2 Elevation 10o lee d ,tJdl- Feet f-C 3Z Feet VII. TANK Capacity gallonTotal # of Prefab. Site Fiber- . INFORMATION Gallons Tanks Manufacturer's Name Concrete Co" Steel glass Plastic Exper App New Existing strutted Tanks Tanks Septic Tank or Holding Tank f ,'GrtIJ L's'T`e ❑ ❑ ❑ ❑ ❑ -F~4 I ~l Lift Pump Tank /Siphon Chamber's t ~E~SjiC!/.t~ ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) / Plumber's Signature: N/9 Stamps) - MPRSW No.: Business Phone Number: a 61 A-. .SGh u -c 2 ay ~o J ?,-7- 7r "91"21 Plumber's Ac dress (Street, City, State, Zip Code): Q 7 G 77"- It IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) ❑ Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber I T 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: L 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 online 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, pumpisiphon 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 thap 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. TiO-f C IR b s 9 C O'er- ~eR J L rn~1 PUMP CHAMBER CROS5 SEC T IOIJ AMD SPECIFICA-rious cr VEUT CAP 4 C.I. VENT PIPE WEATHERPROOF APPROVED LOCKIAIG 25' FROM DOOR, JUKJCTIOKJ BOX MAMHOLE COVER WIMDOW OR FRESH 12"MIU. AIR IMTAKE GRADE I Y" MIM. L__ 18"/11M. COIJDUIT _ _ _ _ 18"MIKI. 11~ IAILET PROVIDE I AIRTIGHT SEAL i I *f A I ~~I II I I I II ALARM a I II I I . *APPROVED I I ow JOINTS WITH I I ELEV. FT, APPROVED PIPE j 3' ONTO Pump-, OFF D SOLID SOIL COKICKETE BLOCK RISER EXIT PERMITTED OIJLH IF TAUK MAMUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOUS DOSE TAMKS MAMUFACTURER: (DUMBER OF DOSES: PER DA-4 TAAJK SIZE: 7SD GALLOIJS DOSE VOLUME ALARM MAULIFACTURER: _AedelarA4 IMCLUDIMG BACKFLOW: /Gk'ZO' GALLONS MODEL 1JUMBEK: 174 Z CAPACITIES: A= 8`IKICRES OR 424 GALLONS SWITCH TYPE: _ >°t~ C B =INCHES OR ,L^~ CALLOUS PUMP MAMUFACTURER: /~/.LG~c+AS C=fl?lf IAJCHES OR 10-2 GGALLOUS MODEL UUMBER: i x'e D = Z+'Y-9- INCHES OR / ~+5'Q3 GALLONS SWITCH TYPE: MOTE: PUMP AMID ALARM ARE TO DE MIKIIMUM DISCHARGE RATE_Gp/K INSTALLED Oki SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWECU PUMP OFF AKID DISTRIBUTIOM PIPE.. 12 FEET MIAIIMUM METWORK SUPPLY PRESSURE , , -afto-r FEET + .L~_ FEET OF FORCE MAIM X ~ es F-T00 FLFRICTIOAI FACTOR._ 22 S FEET TOTAL D9 JAMIC. HEAD = E. ET I IMTERKJAL DIMEIJSIOMS OF TAKJK: LE.U&TH ;WIDTH -;LIQUID OEPTH 1,4 V%G _ r Goulds Submersible Effluent Pump 3871 EP04 EP05 • Fully submerged in high ■ Motor Housing: Cast iron APPLICATIONS • Fasteners: 300 series grade turbine oil for for efficient heat transfer, stainless teel. Specifically designed for the Capable of running lubrication and efficient strength, and durability. . following uses: dry-without damage to heat transfer. ■ Motor Cover: Thermoplas- • Effluent systems components. tic cover with integral handle • Homes Available for automatic and and float switch attachment Motor: manual operation'Automatic points. -A • Farms • Heavy duty sump • EP04 Single phase: 0.4 HP, models include Mechanical m Power Cable: Severe duty 115 or 230 V, 60 Hz, 1550 Float Switch assembled and rated oil and water resistant.- • Water transfer RPM, built in overload with preset at the factory. • Dewatering automatic reset. ■ Bearings: Upper and lower • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing SPECIFICATIONS 115 V, 60 Hz, 1550 RPM, construction. Pump: EP04 built in overload with ■ EP04 impeller: Thermo- Solids handling capability: automatic reset. plastic semi-open design AGENCY LISTING 3/a -maximum. • Power cord: 10 foot with pump out vanes for ,Capac'ities`. up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. SP• canadian Standards Association Totalheads:'up to 24 feet. with three prong grounding m EP05 Impeller: Thermo- (GSA listed model numbers 1 plug. Optional 20 foot plastic enclosed design for end in "F' or "AC".) • Discharge size: l /2 NPT. length,l6/3`SJTWwith • Mechanical seal: carbon- rounding plug improved performance. rotary/ceramic-stationary, three prong 9 m Casing and Base: Rugged BUNA-N elastomers. (standard on EP05). thermoplastic design provides • Temperature: superior strength and 1040F_(400C) continuous corrosion resistance. 140°F (600C) intermittent. • Fasteners: 300 series METERS FEET stainless steel. , 10 • Capable of running s 30 dry without damage to components. 8 Pump: EP05 25 • Solids handling capability: 0 7 3/4" maximum. • Capacities: up to 60 GPM. a 20 • Total heads: up to 31 feet. • Discharge size: 11N NPT. z 5 • Mechanical seal: carbon- 0 15 rotary/ceramic-stationary, a 4 BUNA-N elastomers. o • Temperature: 3 10 104°F (400C) continuous 140°F (60°C) intermittent. 2 5 0 00 10 20 30 40 50 GPM S 10 12 m'/h 0 2 4 6 CAPACITY Effective may, 1995 83871 ©1995 Goulds Pumps, inc. Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT _ Page 1 of 3 Labor and Human Relations Llivision r_f Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S i x t not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or ARCEL I , w-a; N dimensioned, north arrow, and location and distance to nearest road. nd n' i- 'z APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED E PROPERTY OWNER: PROPERTY LOCATION try"-F Brid eland Dev. Com an GOVT. LOT NE 1/4 g f(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. 11736 117th. St. 29 na St. Croi Second Addn. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN NEAREST ROAD Lakeland, MN 55044 (612 985-5000 Hudson Crosby Dr. (X] New Construction Use Ix ] Residential 1 Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd/ft2 - 6 trench, gpd/112 Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 89.82 ft (as referred to site plan benchmark) Additional design / site considerations alt. area system el.= 89.12 Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND 7 IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U ® S 13 U ® S [31 U ®S ❑ U ®S ❑ U ❑ S [2U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bourifty Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0-14 10 r2/2 none 1 2c 1 mfr cs if n .2 2 14-25 10yr4/4 none sil lcsbk mfr if .2 .3 Ground 3 25-56 10 r4/4 none is os mvfr na .7 .8 elev. none 93.47 ft. 4 156-82 10 r4 4 Stratified ms sl osg/2mgrl mfr na na .5 .6 Depth to limiting factor +82" Remarks: Boring # 1 10-12 10 r2 2 none U2 12-34 10 r4/4 none sil lcsbk mfr CIW if .2 .3 3 34-62 10yr4/4 none is os mvfr na .7 .8 Ground none elev. 4 62-82 10 r4 4 Stratified sl is os 2m r mvfr na na .5 .6 92.32 ft. Depth to limiting factor +82" Remarks: CST Name:-Please Print Phone: Gar L. Steel 715-246-6200 Address: 1554 00th. Ave., Ne Richmond, WI. 54017 m02298 Signature: Date: CST Number: Q 8-15-96 PROPERTY OWNER Bridgeland Dev. Co. SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # pending Lot #29 Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0-13 10 r2 2 none 1 2c 1 mfr CS 1 np .2 2 13-34 10yr4/4 none sil lcsbk mfr if .2 .3 Ground 3 34-70 10 r4/4 none is os mvfr Crw na .7 .8 elev. 92.83 ft. 4 70-84 10 r4 4 none is sl os 2m mvfr na na .5 .6 Depth to limiting factor +84" Remarks: Boring # 1 0-16 10 r2/2 none 1 2c 1 mfr cs if n .2 Uj 2 16-26 10 r4/4 none sil lcsbk mfr Crw if .2 .3 3 26-67 10 r4 4 none ms os fr Crw na .7 .8 Ground elev. none 91.62 ft. 4 67-87 10 r4 4 Stratified ms sl o 2m :.6 Depth to limiting factor +87" Remarks: Boring # 1 10-12 10 r2 2 none 1 2c 1 mfr cs .2 <<....5. 2 12-32 10 r4 4 none sil lcsbk mfr aw If .2 i.3 3 32-70 10 r4/4 none is os mvfr na .7 1.8 Ground elev. none 93.32 ft. 4 70-88 10 r4 4 Stratified 1S /S1 os 2m r mvfr na na .5 .6 Depth to limiting factor +88" Remarks: Boring # v:4viii:::•.::L:ii Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Bridgeland Dev. Co. New Richmond WI 54017 MPRSW 3254 NE4SE4 S29-T29 29N-R19w 715 246-6200 town of Hudson lot #29-St. Croix Estates Second Addn. N 1"=40- BM.=top of NE lot stake @ el. 100' I rl 68 1 Liz 2- ~'b Gary L. Steel 8-15-96 I DS BENCHMARK PLAT ~I II. rF EL= 930.70 USGS DATUM 1929 80'RAD. TEMPORARY CUL -DE -SAC TO BE REMOVED UPON ROAD EXTENSION E I/4 COR. W I/4 COR. 1336.49' © a SEC. 29 SEC. 28 x ; 66.23'., 449.93 ' LOT 29 i i 3.23 ACRES 140,707 SQ. FT. ' 3.11 AC. EXC. ESMT. 135,650 SQ. FT. a~ ® 0>,3j lY Q LOT 30 / F \ O ° 3.44 ACRES 00. l 150,022 SQ. FT. 10 ~ti 3.43 AC. EXC. ESMT. 149,666 SQ. FT. LOT 31 Asp 0 A. 2.57 ACRES % 111,818 SQ. FT 011.) lip 1.73 AC. EXC. ESMT. C.~ 75,458 SO. FT. _ 305.~~ „W 26 740' 225.81 S79 0-38 .O _ S79°38'01..W 257.14 I 79.I9~ 435.26 403.93 rn STC - loo This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when 11 the property is sold and submitted to this office with the appropriate deed recording. . Owner of property P~J~ ,e eh-) Location of property 1/4 S 1/4, Section IZ_N-R IT Township Mailing address J'AG 7 Ceu-&O-Z 0 Address of site ,0 y tya~,~ .~sra' U e F./..~(~/-✓ Subdivision name Lot no. Other homes on property? Yes ----No Previous owner of property Total size of property 3 23 AC-ne,6 Total size of parcel Date parcel was created Are all corners and lot lines identifiable? '1.1/ Yes No Is this property being developed for (spec house) ? Yes v No Volume j9-Al-Z' and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICA'T'ION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. S"~ 6F 62Fd and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Sign re of Applicant Co-Applicant (1,-it rl nf Fiirrnat-ir- f Siren ~t~irn STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER • MAILING ADDRESS 1~3~' 7 Ge V / d$•-.~_ PROPERTY ADDRESS _ 761,41 bra s ~ ~ ~y, ► z1 r ,tea ~si.J (location of septic system) Please obtain from the Planning Dept. CITY/STATE. ,~~5_ t PROPERTY LOCATION 1/4, 1/4, Section T Z~ N-R 'OWN OFD! ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER >-Cl- CERTIFIED SURVEY MAP , VOLUME, PAGE , LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replncenicnt of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) a(ler inspection and pumping (if necessary), the septic tank is less than I/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 ✓v V WARRANTY DEED $T GROIX CTYN Q *AV L "so- ' 1 Brid¢el? ~d lkvelooment ru; ° "",.w" orp tioo - VU N 2 1991 >R 8:30 A. M conveys and warrants to ,I Dell s _ Dennis J Pe, enA gnhin K Pcter~on _ _ _ 1 husband and wife ~~xh 7iPc0 I ~ ~ the following described real estate in St. Croix Camty, State of YY Q/,7 Lol 29 St_ Croix Estates Second Addition is tic Team of Hudson, St. Croix County, Wisconsin. TR ; i~t:ER This is not homestead property. lqw-( (e) (6 nut) Exceptions to warranties: i-. SI ~ Dated this 1Sth day of May, 19 97 (SEAL) - I r n • (SEAL) " (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF MINNESOTA J. .19 Dakota County Personally carne before me, this _150 day of Mav 1997 the above named Neal K nick TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 706.06, Wis. Stats.) - This instrument was drafted by " to me known to be the person who executed the foregoing instrument and acknowledged the same. a.iilnot~n.t rlrvrtnnment ComoanY / ~ ~