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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER JZr';h,"Z'e, L&
ADDRESS
SUBDIVISION / CSM#_t LOT #
SECTION _T 9 N-R_22_W, Town of '
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF;SYSTE
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tNDICA E NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: ALTERNATE BM: 01
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity:
Setback from: Well 414 House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
:Distance & Direction to nearest prop. line:
Setback from: well:- House Other
ELEVATIONS
Building Sewer ST Inlet: 7a ST outlet: 95 5 l
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system- 22
Existing Grade Final grade
DATE OF INSTALLATION: i-
PLUMBER ON JOB:
LICENSE NUMBER:j
INSPECTOR: 3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations ST. CROIX
~SAfety and Buildings Division INSPECTION REPORT
(ATTACH TO PERMIT) Sanitar Perm' N
GENERAL INFORMATION ~ ,W6~3
Permit Holder's Name: ❑p Village Town of: State Plan ID No.:
MCALLISTER, JEROME 11mBSN
OCST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA A9600357
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV-
Septic /gyp Benchmark
Dosing '
Aeration Bldg. Sewer 9G , '
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet S/'
TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet
rl
Septic y/ b i 3 ~d y NA Dt Bottom
Dosing NA Header / Man. 9, ~S 93- c/S'
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer - Demand
Model Number GPM
TDH Lift ction System
Loss Head TDH Ft
Forcemai Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS FS' o / DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O 1,)D,,) CHAMBER Model Number:
System: d (o o? /U A OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia- Length 'V4 Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Deptfi Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center 3c~ Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HUDSON.28.29.19W, NW, SW, CROSBY DR
Plan revision required? ❑ Yes [°f No 6
Use other side for additional information. 1/0 1-7 1241 _ V'j [~6
SBD-6710 (R 05/91) Date InsWctor's signature Cert. No
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
' Safety and Buildings Division
-;oo Bureau of Building Water Systems
SANITARY PERMIT APPLICATION 201 E. Washington Ave.
ri7L■'■f1
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• 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. state anitar Permit Number
See reverse side for instructions for completing this application & F ~ 1-3
Check if revision to previous application
The information you provide maybe used by other government agency programs
ate Plan I.D. Number
IPrivacy Law, s. 15.04 (1) (m)].
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATpIIONocation N, R (or)0 Pro
Prope yOwner Name 1/4 1/4, S T
L t Number Block Number
Propertyner's fling Address `7
Zip Code Phone Number Subdivision Na or SM Number Sj
City, to ( ) '
El City Nearest Road /
II. TYPE OF BUILDING: (check one) E] State Owned ❑ village
❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town of
• .
Ill. BUILDING USE: (If building type ispublic, check allthat apply) Parcel TaxNumber(s)
1 El Apartment/ Condo 10 ❑ Outdoor Recreational Facility
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 E] Restaurant/ Bar/ Dining
Mobile Home Park 12 E] Service Station/ Car Wash
4 E] Church /School 8 ❑
5 El Hotel / Motel 9 E] Office/ Factory 13 F1 Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
New 2. Replacement 3. E] Replacement of 4. E] Reconnection of 5. E] ReExpaaiir of f an
stem
System
A) 1. Tank Onl ExlstingSystem _____________tin _9_y
A)
--------System --------------------y
Date Issued
B) ❑ A Sanitary Permit was previously issued. Permit Number
V. TYPE OF SYSTEM: (Check only one) Other
Non Pressurized Distribution Pressurized Distribution Experimental
30 F1 Specify Type 410 g
11 21 E] Mound Holding
Seepage Bed 42 E] PitPrivy
12 E] Seepage Trench 22 ❑ In-Ground Pressure 43 ❑ Vault Privy
13 ❑ Seepage Pit
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. . Fin i l Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./' ch) Feet Elevaton
Feet
VII. TANK Capauty Total # of Prefab. Site Fiber- PlasLEpe in gallon
s Manufacturer's Name concrete Con steel glass INFORMATION New Existin Gallons Tanks strutted
Tanks Tanks ❑ ❑ Septic Tank or Holding Tank ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for i stallation of a ons a sewage system shown on the attached plans.
MP/MPRSW No.: Business Phone Number:
Plu be sham : (P t)' Plum er's na r am s) _
r
I mber's Address (5~.reet, y, State, Zi ode):
IX. COUNTY /DEPARTMENT USE ONLY
❑ Disapproved Sa itar Perm Fee (includes Groundwater ate Issue Issuing Agent Signature (No Stamps)`
,~ire~yarge fee) )
Approved ❑ Owner Given Initial (/J(/ /V//,
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) 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, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. 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 8 112 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.
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Wisconsin Gopartment of Industry, SOIL AND SITE EVALUATION Page of
Labor and Human Relations
Division bf Safety and Buildings in accordance with s. ILHR 83.09, Wis.
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
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Govt. Lot 1/4 114,S T N,R G or I
Property wner's Mad' g A ress I Lot # Block Subd. Name or SM#
Ci Stat Zip Code Phone Number Nearest Road
ty ( ❑ City Village Town
11J2:7 I 141p,
® Residential / Number of bedrooms Addition to existing building
® New Construction Use:
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow = gpd Recommended design loading rate ~ gybed, gpdfft2-,,Y-trench, gpd/ft2
Absorption area required -,EiY_bed, ft2_trench, ft2 Maximum design loading rate --I-bed, gpd/flz-,S-trench, gpd/ft2
Recommended infiltration surface elevation(s) g2 7 ft (as referred to site plan benchmark)
Additional design/site considerations
Flood plain elevation, if applicable ft
Parent material 04k A
S Suitable for system conventional Mound In-Ground Pressure AT-Grade System in Fill H❑oldi g TTaanU
U = Unsuitable for system ® S El U ® S El U C11 S ❑ U ® S El U ❑ s [N U
SOIL DESCRIPTION REPORT
GPD/ft2
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Bed Trench
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
Ground
elev.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft. ,
Depth to
limiting
factor
~in. Remarks:
Signature Telephone No. /7
CST Name (PI ase int)
rXIS
Date CST Number
Address 1
PROPERTY OWNER SOIL DESCRIPTION REPORT
Pagof
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots
Bed Trench
7
i
Ground
elev. -
Depth to
limiting
factor
_in.
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
Bed Trench
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
n.
Depth to
limiting
factor
in.
Remarks:
SBDW-8330 (R. 08/95)
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Nrsccnsin (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, Adr1T.+CS
COUNTY
s
Attach complete site plan on paper not less than 8 1/2 x 11 inches in sizeleg most inglude but St. Croix
kEWED EL I.D. #
not limited to vertical and horizontal reference point (BM), direction and / of et sce* r t dimensioned, north arrow, and location and distance to nearest road. ending
BY DATE
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMAT17
PROPERTY OWNER: zOPERTYZI;OCATf /
Brid eland Dev. Company VT. LOT C' `:~14% 1 ,S 28T 29 N,R 19 2 (or) W
PROPERTY OWNER':S MAILING ADDRESS L K# S ME OR CSM #
11736 117th St. Croix Estate's First Addn.
CITY, STATE ZIP CODE PHONE NUMBER ❑CI I OWN NEAREST ROAD
Lakeville, MN. 55044 (612) 985-5000 Hu son Crosby Dr.
[ New Construction Use J Residential / Number of bedrooms 4 [ J Addition to existing building
j J Replacement [ J Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/0 .8 trench, gpd/ft2
Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate .7 bed, gpd/0 •8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 112.6 trenches ft (as referred to site plan benchmark)
Additional design/ site considerations trenches spaced to code and 3-.51 below surface level
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE TSYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ®S ❑ U ®S ❑ U ®S ❑ U ®S ❑ U ®S ❑ U ❑ S MU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Botx>dary Roots GPD/ft
Boring # Horizon in. Munsell Gu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1t> 1 0-13 10 r2 2 none 1 2msbk mfr w 2m .5 .6
2 13-25 10yr4/4 none sil lfsbk mvfr gw if .2 .3
Ground 3 25-80 7.5 r4 0 none s os ml na na .7 .8
elev.
116.1 ft.
Depth to
limiting
factor
+80"
Remarks:
Boring # 2f .5 's .6
1 0-20 10 r3/3 none sl 2m r mfr gw
2 20-27 7.5yr4/4 none is osg rnfr gw if .7 .8
LU
3 27-80 7.5 r4 6 none s os m1 na na .7 .8
Ground
elev.
115.8 ft.
Depth to
limiting
factor
+80"
Remarks:
CST Name:-Please Print Gar L. Steel Phone: 715-246-6200
Address: 155 0th. Ave. New Richmond WI. 54017
Date: CST Number:
Signature: 6-25-96
PROPEMOWNER Bridgeland Dev. CO. SOIL DESCRIPTION REPORT Page of 3
PARCEL I.D. is
Lot #27 _ M
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouncl3y Roots GPD/ftZ
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
3€€ 1 0-16 10 r3 3 none sl 2mgr mfr gw 2m .5 .6
2 16-32 10yr4/4 none sil 2msbk mvfr gw if .5 .6
Ground 3 32-80 7.5yr4/0 none Cos osg ml na na .7 .8
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
_<< 1 0-10 10yr3/3 none sl 2mgr mfr raw 2f .5 .6
2 10-22 10yr4/3 none sil 2mgr mfr gw if .5:: .6
Ground 3 22-82 7.5yr4/6 none Cos osg ml na na .7 .8
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
1 0-10 10 r3/3 none sl 2mgr mvfr gw 2f .5 .6
5 2 10-18 7.5 r4 4 none is 2m r mvfr
g gw if .5 .6
Ground 3 18-80 7.5 r4/6 none s osg ml na na .7 ` .8
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor L I
Remarks:
SBD-8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave. Dev. CSTM2298 Bridgeland Co. New Richmond, WI 54017
MPRSW 3254 NW4SW4 s28-T29 29N-R19w town of Hudson (715) 246-6200
lot #27-St. croix Estates First Addn.
N
1"=40'
BM.= top of SW lot stake C el. 100'
pJ. Z ~ h
l rnj.3
let
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Sz z
(FPM
Gary L. Steel
6-25-96
S'l'(;-105
? C!i'$ S_~rrU1,l4
u?
11y t y
• ."I7is aPP" is ltic7rl form is to be ccinTle:t.ed i s fLi:tl aria sigrned by the
owner(s) of thc' property I.-)eincj developed. Any in;,tdGquac:a_es will
only result in delays of tAle: pez-mit: issuance. Should this
dc.-vo ,t7p]Tent Ilea kntc.,`.11d,C'{ by i7Wi.C'1"` ~Gt)?7t:-T~~Ct C1x r spec
110,-I'se) , then a scr,"L Slid. j~Dr"1Pt :ijlOliLf~ I:'i? l"t 1_ -ineJ -,-nrI C:e:`n,ple3t"ed When
t:rc propex:t.r' i:: a 1d and r;iI ~f..1 t.t:t, Cs t.Ii.i-:} cfficc w.it3'i L'tie
rc :,i-atc ,iii+2ij re- v . r~' . , cr
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P0CUI.• ENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA
547501 WARRANTY DEED ~iPAE.
c~j4
VOL
Bridgeland Development Company, a Minnesota corporation Si. cil. iX CTY.' W1
nx J Li Pe--J
JUL 3 0 1996
conveys and warrants to at 10.00 ~ A~~
Jerome W McAllister and Hope L McAllister husband and wife -R
Ra,c::4i6r cP Ceeds
RETURN TO
the following described real estate in St. Croix County, State of Wisconsin
TAX PARACEL NO.
Lot 27, St. Croix Estates First Addition in the Town of Hudson,
St. Croix County, Wisconsin.
IR
This is not homestead property.
(is) (is not)
Exceptions to Warranties:
Dated this 29th day of July, 19 96 l
(SEAL) (SEAL)
* Pr
(SEAL) (SEAL)
* *
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated this day of STATE OF MINNESOTA
19 Dakota County
Personally came before me, this 29th day of
* July, 1996 the above named
TITLE: MEMBER STATE BAR OF WISCONSIN Neal K[azaniak
(If not,
authorized by 706.06, Wis. Stats.)
This instrument was drafted by
to me known to be the person who executed the
Bridgeland Development Company foregoing instrument and acknowledged the same.
17799 Kenwood Tr. # 265 Lakeville MN 55044
(Signatures may be authenticated or acknowledged. *Darla J. Bauer
OF SECTION 28, AND IN CAIHl ur- l r'lt lvL
R 19W , TOWN OF HUDSON, ST. CRO I X COUNTY,
wl
PLAT OF ST. CROI X ESTATES
33 133'
I
01 I N06°09' 58" W LOT 9
LOT 8
-W w% 48,17 -
2„ W 577491 '
SS-3015 I 66S89°47' 16"W 710.67'
I '
66.36' 397.35
O I - 644.3l'-
LOT 28
11 I , °o
2.37 ACRES LOT I5
1 iD d
103,410 S0. FT. ° I o
N 1 2.00 ACRES N
0 I I 3~. 1 87,295 S0. FT.
c
co 1
' ON
511.03 LLJ
M
W I 7 0
N83°50'02 E 1 ao o 0
z °
p I -
I ON
o
LOT 27 0
' pi io 33' 33 t_ - -
2.25 ACRES 1 0 .
I 18 M _
97,962 S0. FT. ~~.N PA ME
DEDICATED--
II a it M L A O T .
/ - _ THE 17
lv;.3 co .0 3:
5 7 W S i l0 ~00 \S 12
92, o
22 I 9 00 \30041x"
z
LOT 26 N g' ° 1
LOT 19
2.79 ACRES I 1 r.
121,650 S0. FT. W o 1
11 °ON 1 2.00 ACRES
't' Z 1
11 p ,p 1 1
s2~ 2.56 AC. EXC. ESMT. 87,294 SO. FT.
111,514 S0. FT. 0 21 11.93 C. EXC. 0
8 LOT 18 ESMT N 1
83,960 S0. FT v 2.12 ACRES
LOT 25 S1 / 1 92,256 SO. FT.
4 I
2.47 ACRES / I 3 2.05 AC. EXC. ESMT.
107,711 S0. FT M 89,257 SO. FT.
9 1.98 AC. EXC. ESMT. C N
b
o
86, 374 SO. FT.
[F / A z
1. \ u
E
HWL' 908.0