HomeMy WebLinkAbout020-1314-60-000 Wisconsin Department o €.Commerca. PRIVATE SEWAGE SYSTEM County: St. Croix
' Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
420303 0
GENE INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Duerst, Dennis I Hudson Township 020 - 1314 -60 -000
CST BM Elev: Insp. BM Elev: BM Description:
/00 Z 01 ,B T / ,lyw sys
TANK INFORMATION tLEVATION DA A
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
V�� iS �—i h 0.OI //0 100.0
Dosing U Alt. BM
STr
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATIO , St/Ht Outlet
TANK TO P/L ' 4 �� L . QLDG. Vent to Air Intake Ot Inlet
Septic ` Dt Bottom
Dosing (/!� Header /Man. �S ,e
Aeration DjsL Pipe 4 P 4 / S. srJ gg, fly
io• o3
Holding y em / 9. q
. /a.S/ - 2
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand er
GPM
Model N tuber
Q ift Friction Loss System Head TD Ft
ain Length Dia. Dist. to We
SOIL ABSORPTION SYSTEM
BED /TRENCH Width ( 3 Length q / No. Of Tres PIT DIME NS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 0
SETBACK SYSTEM TO P/L< BLDG WELL LAKE /STREA LEACHI G MayyfeBxu�y:�
INFORMATION CHAMBE OR /
Typ Syste � 0 >� > / / UN Model Number:
DISTRIBUTION /V /T_
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Int e
t M Pipe(s) �� /40
Length Dia L Dia cing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only G+ N,(A)
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center BedlTrench Edges Topsoil Yes �] No
Yes � No �
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: //t Inspection #2:
Location: 754 Crosby Drive Hudson, WI 54016 ( W 1/4 NW 1/4 28 T29N R19W) St. Croix E / states of 6 � I, - Parcel No: 28.29.19.1592
1.) Alt BM Description = 6T, 5 '(� Y � �Li t! �'ktu . Cv4, 2.) Bldg sewer length = 7 A - amount of cover = 1;Tu,� I o-V � ' �jth T Ua� _ 7
Plan revision Required? :T Yes No 0
Use other side for additional information. �� Q
. _. — _ '�"r
SBD -6710 (R.3/97) Date Insepctor's Sign re Cert. o.
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==0 �,�e�suy ,) I L AND SITE E V A L U AT I O N R ' O RT
a7+d ns
o;v;s;oa
safely ' & eut�nys in accord wi �LH l e. 05, Wis. Adm. Code COUNT(;
- � r S�R s CL'Ol
QS hC i'
Attach complete site plan on per not less than 8 142 x 11 s i Plan must include. but ,��L I D ,tt
not knuted to vertical and horizo reference point (BM), direction and y° of slope, scale w ndg
dimensioned, north arrow, and location and distance to nearest road. IEV�Ep�Y i 7
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION
PROPERTY LOCATION
FPR , RTY OWNER: GOVT. LOT SW 114 NW 'L8 "T2� �) W
Rauchnot LOT tt BLOCK >f SUED. N *" \
RTY OVYNER�:S MAt+ - ING ADDRESS 6 na St. croi 1
Co. Rd . #W ILLAGE 3f01NN NEAREST ROAD
TATE ZIP CODE PHONE NUMBER Crosby Dr.
Hudson, WI. 54016 (715) 386 - 3052 Hudson
Fderived uction Use j x] Residential / Number of bedrooms 3 [ 1
Addition to existing buildwt9
t 1 1 Public or commercial des cribe 450 Recorrtrtterlded design loading rate . 7 bed. gpdm2 .8 wench. gpyft2 ily flow gpd . 7 bed, gpoltt
.6 trertdt. gpoltt
Absorption area required 643 bed. n2 563 trench, ft Maximum design loading rate
Recommended infiltration surface elevations) 101 .55 & 99.85 trench K (as referred to site plan benchmark)
Additional design / site consideratim alt. area 99.35' & 9 '
Flood plain elevation, it applicable na It
Parent material outwash
taouNO
Mi GROUN0 PRESSURE GRA
AT•DE SYSTEM N FN L FIOLDrIG TANK
S= Suitable for system coNVENT�NA� WS O U I Os ®U I ❑ S [� U
U= Unsuitable for system ®S O U a S ❑ U cgs ❑ U
SOIL DESCRIPTION REPORT
I Structure � I B Roots GPD /ft
Depth Dominant Color Mottles Texture Gr. Sz. Sh. [ :Bed Rrerch
Boring # Horizon) in ! Munsell Qu• Sz Color
1 2msbk mfr 2f
1 —10 10yr3 /3 none
1 >< scl 2msbk mfr
2 0 -23 10yr4 /4 none
3 3 -31 7.5yr4/4 none sl 2msbk
mfr gw na . 5 .6
Ground na na .7 .8
4 1 -88 7.5yr4/6 none co s Osg
L04 tt.
Depth to
limiting
factor
+88
Remarks:
Boring # sl 2mgr mfr I gW 2f • 5 •6
1 —12 10yr3 /3 none
w, na na .7 .8
:<�::.,. >.., cos Osg ml
2 2 -88 7.5yr4/6 none
Ground
elev.
105 tt.
Depth to
limiting
factor
+88
Remarks: Plane:
CST Name: — Please Remarks:
terry L. Steel 715- 246 -6200
.,r CA/11 -7
PRMffrYOWNER . John Rauchnot SOIL DESCRIPTION REPORT �•
PARCEL I.D.# pendin Page 2 0,
g
Boring# Horizon Depth Dominant { Mottles Structure GPD /ft
in. Munsell t
I p Sz Co I Texure I Gr. Sz. Sh. COQ n� (Roots
1 0 -10 10yr3 3 none sl Zmgr m r gw Bed iTrerxfi
<> 2 10 -16 7.5yr4/6 none
Is Osg mvfr gw if .7 .8
Ground 3 16 -84 7.5yr4/6 none cos Osg ml na
na .7 .8
�y ev.
10
t.
t
Depth to R SS
limiting
faM
„ 6 z
Remarks:
Boring # 1 0 -6 10yr3 /3 none
1 2msbk mfr gw 2f .5 .6
<' 4 <> 2 6 -19 10yr4 /4 none scl 2msbk mfr
' >< gw If .4 ? . 5
3 19 -27 7.5yr4/4 none sl 2m r mvfr
Ground — gw na .5 .6
elev. 4 27 -80 7.5yr4/6 none cos Osg ml na na .7 .8
100 ft.
Depth to —1 T
liming
7 ,
+8011
Remarks:
Boring # 1 0 -8 10yr3 /3 none
?<? 1 2msbk mfr gw 2f .5 .6
5! 2 8 -27 10yr4/4 none sic 2msbk mfr gw if .4 .5
3 27 -60 7.5 r4 4
Y none
cos Osg Ground g na
gw . .8
elev. 4 60 -80 7.5yr4/6 none
101 ft. S Osg ml na na .7 .8
Depth to
liming ,
factor 97 Al
+ 80
Remarks:
Boring #
W
Ground
elev.
ft.
Depth to
limiting
faL'tor
i
Remarks: ,
S8D4k1MR.05M2)
STEEL'S SOIL SERVICE
1554 200th Ave.
Gary L. Steel John Rauchnot _ New Richmond, WI 54017
CSTM2298 SWkNWa S28- T29N -R19W (715) 246 -6200
MPRSW 3254 town of Hudson
lot #5 -st. Croix Estates
1 =40'
ELI.= top of 1" steel pipe @ el. 100'
Alt. BI. =nail in Juniper tree @ el. 103.40'
1
k ,5
S�
9o`
`U�ary L Steel
n etter Way! D-e h n ;s r- C-1 ) k`Q f"5� .�
Usel
xr 76
u
coca b,°�m mac
. a �
. SiCIC+Un `
Aftd1p
•
hftpVDVw p�a�ra 4%cr
;kk
�°► ���'�
f � vi des
lective is t Ieacig std arrant
maimed side
Provide an o ce. Its desi
"llary actin �nl t allow eff n bottom and
hom ed by combinin irthe trS. 7 bis ha b SPEC,
with g the a r '
h a series of tr adition a l L thut � `
ant - the louvers alo open 9th.......- -..75. , � m mAte unit
along the full ! cham chamber Mows � un t he sides. ��.... 34� % 76�
co ,
design 8th of mpen Hetht .... - Wider -
lo
° mPaated �, i° ' efflueent oide. the l ouvers i �►vert....... . � Height ..........
�g into the chamber. PrevenP ng' t POP" "' of a ' +rei t...._......6.5^ aw at 12- ®r f withstand H_ �i1ed h
t
0
ver
-20
f actors
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FN.E SYSUM SPScawcemoNS
Owner
N 1 Q S Septic Tank Capacity T, E3 NA
Permit df
0 Septic Tank Mararfacttxer�0 ; rS ❑ NA
DESM PARAMETERS Effluent Filter ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units W NA Pump Tank Capacity al ❑ NA
Estimated flow (average) J bD Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) 1�0 p g ailda Pump Manufacturer ❑ NA
Soil Application Rate g audayew Pump Model ❑ NA
Standard lnfluent/Efflrent Quality Monthly average Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG► S30 mg/L ❑ Sand /Graved Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODj 6220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids ITSS) 5150 mg/L ❑ Disinfection ❑ Om
Pretreated Effluent Quality Monthly average Dispersal Ced(s) ❑ NA
Biochemical Oxygen Demand (SOD.) 530 mg& 9 In- Ground Igravityl ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) S30 mg& ❑ NA O At -Grade ❑ Mound
Fecal Coilfom ►geometric mean! 510 cfu/100ml ❑ Drip -Lie ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ JNAA Other: ❑ NA
❑ Other: ❑ NA
* Values typical for domestic wastewater and serutic tank eftkient. Off: ❑ NA
MAANCE SCHEDUL
Service Event Serii1ce Fregsncy
Inspect condition of tank(s) At least once every: rmo►th (s) (Maxtn wn 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one -thkd 0Y 1 of tank volume ❑ NA
Irmapect dispersal ceilis) At least once every: O nwnthls) yearfsi nMaxirnum 3 pm ❑ NA
Clean eff bent filter At least once every: Z ❑ month(s) ❑ NA
l s
Inspect Pump, pump controls & alarm At least once every: 0 marls) ❑ NA
Flush laterals and ❑ monthls)
pressure test At least once every: ❑ earta) ❑ NA
Other: At least once every: ❑ m onth( s)
1
❑ ye ❑ NA
Other:
❑ NA
ft A DICE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following menses or certifications:
Master Plumber, Master Plumber Restricted Sewer: POWTS Inspector: POWTS Maintainer; Septage Servieumg Operator. Tank
inspections must include a visual inspection of the tanks) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sledge and scum and to check for any back up or pondang of effluent an the ground surface.
The dispersal kelps) shall be viauapy inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponds ng of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third IY or more of the tank volume. the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
AN other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, mall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW (4/01!
r
FART UP AND OPERATiON P"s of
For new construction, prior to use of the POWTS check treatment tankfs) for the presence of painting products or other chemical
that may impede the treatment Process and /or damage the dispersal cell(s). If high concentrations are detected have the content
of the tank(s) removed by a septage servicing operator prior to use.
System strut up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal h'
discharged to the dispersal cells! in one u�water lauds. When Power is restored the excess wastewater will b lar dose overloading erloadin the cell(s) g and may
result in the backup or surface discharge o
effluent. To avoid this situation have the contents of the
power to the effluent Pump tank removed by a Sept Servicing Operator prior to re
storin(
Pump or contact a Plumber or POWTS Maintainer to assist in manually wally operating the pump control tc
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the arw
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and
POWTS: antibiotics, baby wipes; cigarette butts; condoms; cotton swabs; de greasers; dental floss; diapers; the life pers; disinfectants; s; at;
foundation drain (sum fat;
P Pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall tie taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
Fb The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installers as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< < WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name fl Phone S �O J i� Pho
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name %. Name ro 2 :0 t
Phone //
Phone 3E 6
This document was drafted in canpHance with chapter Comm 83.22(2)(b)f1)(d) &(f) and 83.540), f2) & (3), Wisconsin Administrative Code.
a
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address _� ��{ ��I- c- ,S�,� � L' { „ Co � j �U 0
Property Address
(Verification required from hanning Department for new construction)
City /State S Parcel Identification Number an — _ Coo - oo 'c>
LEGAL DESCRIPTION
Property Location SU.3 %., Nw %., Sec. T N -R L9 W, Town of 14 S,Z4 .
Subdivision , Lot # L
Certified Survey Map # Volume , Page #
Warranty Deed # Volume , Page #
Spec house ❑ yes A no Lot lines identifiable yes ❑ no
_SYSTEM MAINTENANCE
Improper use and mainteru �annecof 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, restrictedplumber or a licensed pumper verifying that (1) the on -site arastewraterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if nccessary� the septic tank is less than 1/3 fidt of sludge.
I/wc, 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 Deparhnent of Commerce and the Department of Natural Resources, State of Wisconsin Certificatibn
statin that your tic system has been maintained must be completed and returned to the St. Croix County Zoning Off= within 30
da the three expirati to
i
A / 4
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I .(we) c that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
X tSIGAC escri a bove, by vi of a warranty deed recorded in Register of Deeds Office.
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 decd
%JAN. ?3.2000. 7 � 2 c 8A n M ;M COMPANYal PO y'�. 6315 P. 2_
5WJL0 ( ry STATE SM OP ONSW FORM 3 —1i82
WARRANTY DEED
DOCUL&W NO.
J, f'�3f3TEt"3 CSFFIG'�
,4 yer J oint Ventura a Wisconsin p artnorshIp gt C" CA.m
itaeylriwat
MAY, 2 9 Ifni.
(cmae�c EOd avlanu to Dennis P. Tst Loi■ F. Doerlt.
marital property ,�
hu ■ban�eld wifa re ■urvivo.T 1P
A.ahsE.r.tDeB�It
T+a BRACE a Mamo MR N?OQM*4 DATA
W W MO RBTYRN ADeafeT
the fotiow�km desenW rtal eftw in St. Croix t ewuy
Sum d vrbwasln:
VA
PARGIL INIt�
� tI1�AN � R►���
KENW win oo _
Lot Six (6) of St. Croix Estates in tha Township of Hudson, St. Croix County,
Wi■eonsin.
i
m* htlsneateaa ptopeny.
; na)
f1on to teanaRUits:
h
Dard 27th May A n
• al L. e c
(BEAU �a
Michael R. Stol Sts
AUTHENTICATION ACKNOWLEDGMENT
Sllaatuaef0 State of Wisconsin,
H,
m St. Croix Cam%
■hoockmd this
�Ppf— l9 PeaauQy nme boo VA Ihb —_27th d� o f
Kai 19—U—. tits above kA* ad
_ ■ 4nd lon4d. L. glgrl k
As o artnlra Of Willow River joint Venter
TITLE: kempa SPATE OARoF wiScmm _a Wi■coneln partnership
(v m.
authodmed by 1 7 00A, vv, Sul&) to tat kn9yo to be die peram a who exscnkd chi &MtRck1E
wom and t he same.
TFRa IafTRU4CNT WAB DWTED aY
P. 0. Sox A • Sal, Mai Nmy PLOePQBI■ of YYIhr�Rlso
_.Le— Q�wt.�..,,,1 •T K6A19 NaaryPnbbe. St. Cto _ CamgcVAL
Mrawn my b +auheatkhued or adavwkjpd loth at m My —= d- Is Wrmaaem. (if nm, state aptat" &lr.
hEroesaT}) 19 99 ) I
•Ma•T KPeaans saalsR ha �. e�ay R�outd ry Mtd w seessi 6slan thew+tytva .: ""'�'�`�`�-
, •ARaANTY plZeO STATE aAt pi w7EQQr1Elr1 WgpW Law a "p
Nhha NI. ] - ITe� Me7Na WA
ST CROIX ESTATES
of is• 29'j . nl;18.3r •w.•
. , , \ ♦ . �� Qfl1H L*JBibF E $W -UA'CF THdWW W4 OF se
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N66 0 12 1 04'6 4;_72
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y
Safety and Buildings Division
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. ( 353295
Permit Holder's Name: ❑ City ❑ Village ❑ Tbwn of: State Plan ID No.:
Duerst Dennis I Hudson Township
CST BM Elev.:- Insp. BM Elev.: zDescription: Parcel Tax No.:
( " � 020 - 1314 -60 -000
TANK INFORMATION 1 0 ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic s `Z� Benchmark 1G.1 Ib.lo� .o /
Dosing Alt. BM l �o I t. 20
Aeration Bldg. Sewer
Holding St /Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet 1. 2- 1 01. og'
TANK TO P / L WELL BLDG. Air I ntake ROAD Dt Inlet
Air
Septic 9 r ti (� g NA Dt Bottom V
Dosing NA Header/ Man.
Aeration NA la., 3, ( 102
Holding Bot. System le ' t s 2
PUMP/ SIPHON INFORMATION Final Grade 1I. � L W
M facturer Dem d St cover
�o.q2
Model N er - G M
TDH Lift L S stem TD Ft
gad
Forcemain Length Dia. Dist. To Well
SOIL ABS PTION SYSTEM Ck 2 C k ,
BEW& TRIENCH Width r Length PIT No. Of Pits Inside Dia. Liquid Depth
IM S No T nches DIMENSION
SYSTEM TO P/L I BLDG WELL LAKE /STREAM LEACHING Manu ur r: ,
SETBACK CHAMBER Al
• INFORMATION S a��' � � 0 ' OR UNIT Mo el Num er,
S l Z `I ' C c
DISTRIBUTION SYSTEM
Header/ Mani old Distribution Pipe(s) x Hole Size x Hole Spacing Vent TP Air Intake
Length Dia. __ 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/Tr nch Center Bed/ Trench Edges Topsoil I ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:06 /01 /0D Inspection #2: L -
Location: 754 Crosby Drive, Hudson, WI 54016 (SW 1/4 NW 1/4 28 T29N R19W) - 28.29.19.1592 St. Croix Estates -Lot 6
1.) Alt BM Description
2.) Bldg sewer length= 20
- amount of cover = V? + Sal "w
Plan revision required? ❑ Yes ® No
Use other side for additional information. 6(0 1 -2 t I oD I L,
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH `
SANITARY PERMIT NUMBER:
i
m �
.....��
1
Safety and Buildings Division
r `�SCO/1S %/1 SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue
Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County s ,�
than 81/2 x 11 inches in size. M
• See reverse side for instructions for completing this application State Sanitary Permit Number
Personal information you provide may be used for secondary purposes s3
❑ Chec 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
ProperlxOwner Name Propert Location
P, w 1/4 W 1 /4, S a , N, R I C1 *$r) W
Prop@rty Own,r's M fling Addr ss Lot Number Block Number
City, St to Zip Code Phone Number Su�di�ision N me or CSMb r
o rY1 N SSl ( > 1
II. TYPE OF B IL ING: (check one) ❑ State Owned it Nearest Road I V Ej Village
Public 1 or 2 Family Dwelling - No. of bedrooms own OF 14 jcnr%
III BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
O ao -13 ►A4 -too - o0 c)
1 ❑ Apartment/ Condo ?-Q - Z-43 - 1 • 15 g v"
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_ ❑ 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
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 RSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill 2- • U
VI. ABSORPTION SYSTE INFORMATION:
1. Gal Ioris Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
6 r Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 104 Ss Elevation
00 -5 g 99 29 Feet XDy, Feet
VII. TANK
Cap g aclt Site in llons Total # of Prefab. Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
N ew Existin structed
Tanks Tanks
Septic Tank or Holding Tank j .Q 16 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ I ❑ ❑ 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: (Prin PI tier's S nat a (No Stamps) MP /MPRSW No.: Business Phone Number:
Q, r a�o "Ins a s� as
Plumber's A ddress (Stree 11 1ateff ip Code): O
V
tVqAA-) fkAMnf\�. UL
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sa itary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps)
Surcharge Fee)
IRApproved ❑ Owner Given Initial
Adverse Determination -s.� Z!-Z=
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R. 4/99) 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 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
countyprior to installation
5. Onsite sewage systems mustbe properly maintained. The septic tank(s) must be pump - edbya licensed pur peYwlhenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage systern, contact your local code administrator or the State of
Wisconsin, Safety andBuiWings Division, •688 - 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.
111. 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. s v
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, k5cafi6n 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.
plot
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dr�scir`,;t: Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
=r and Human Relations
Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code
CO
c - Croi
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 /o of slope, scale or
' dimensioned, north arrow, and location and distance to nearest road. r�L endin g
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION IEW Y' D
I 2tran
PROPERTY OWNER: PROPERTY LOCATION ' �;CAUNTY
John Rauchnot GOVT. LOT SW v4 NW or) W
PROPERTY OWNERS MA!I.ING ADDRESS LOT # I BLOCK # I SUBD. NAMtQ Gt �
527 Co. Rd. #W 6 na St. croi t'a
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE MOWN NEAREST ROAD
Hudson, WI. 54016 (715) 386 -3052 Hudson I.Cro Qr.
[ :4 New Construction Use (xj Residential / Number of bedrooms 3 ( J Addition to existing building
I Replacement [ ] Public or commercial describe
Code derived daily flow 450 an d Recommended design loading rate • 7 bed, gpd/ft .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) 101. .55 & 99.85 trench ft (as referred to site plan benchmark)
Additional design/ site considerations — alt. area 99.35' & 97.95'
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL 111, IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for system ®S ❑ U I f3 S ❑ U CA C] U ® S ❑ U ❑ S ® U ❑ S [RU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Cu. Sz. Cont Color Gr. Sz. Sh. Bed !Trench
1 -10 10yr3 /3 none 1 2msbk mfr cfw 2f .5 .6
BMW 2 0 -23 10yr4 /4 none scl 2msbk mfr gw if .4 .5
Ground 3 3 -31 7.5yr4/4 none sl 2msbk mfr gw na .5 .6
14 0 715 4 1 -88 7.5yr4/6 none co s Osg ml na na .7 .8
ft.
Depth to
limiting
factor .
+88
Remarks:
Boring #
1 -12 10yr3 /3 none sl 2mgr mfr gw 2f .5 .6
2 2 -88 7.5yr4/6 none co s Osg ml na na .7 .8
2
Ground
elev.
105 ft,
Depth to
limiting o
factor
+88 77 -�2 �e
Remarks:
CST Name:— Piease Print Gary L. Steel Phone' 715- 246 -6200
Add ress: 1554 2 th. Ave., New Pichmond, WI. 54017
Sgnature: Date: CSTN er.
11 -3 -95 c Ob
PROPERTY OWNER John Rauchnot SOIL DESCRIPTION REPORT Page 2 of _,2
,PARCEL I.D. # pending
Boring # Horizon Depth Dominant Color Mottles I Texture Structure Consistence (Boundary I Roots GPD/ft
in. Munsell Gnu. Sz. Cont. Color Gr. Sz. Sh. Bed iTrench
..' 1 0 -10 10yr3 3 none sl mgr m r gw Zr
2 10 -16 7.5yr4/6 none is Osg ravfr gw if .7 ;.8
Ground 3 16 -84 7.5yr4/6 none co s Osg ml na na .7 .8
elev.
10 2 . 8 5 ft.
Depth to 99
limiting
factor 36 Z
+84"
Remarks:
Boring # 1 0 -6 10yr3 /3 none 1 2msbk mfr gw 2f .5 :.6
4 2 6 -19 10yr4 /4 none scl 2msbk mfr gw if .4 !.5
3 19 -27 7.5 y r4/4 none sl 2mgr mvfr gw na .5 .6
Ground
elev, 4 27 -80 7.5yr4/6 none co s Osg ml na na .7 .8
100 ft.
Depth to
limiting
factor
+ 80
Remarks:
Boring # 1 0 -8 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6
5
2 8 -27 10yr4 /4 none sici 2msbk mfr gw if .4 .5
x....... 3 27 -60 7.5yr4/4 none cos Osg ml gw na .7 .8
Ground
elev. 4 60 -80 7.5yr4/6 none S Osg ml na na .7 !.8
101 ft.
Depth to
limiting
factor
+80
Remarks:
Boring #
vY %•i4 +: ?•i: iii:
Ground
elev.
ft.
Depth to
limiting
factor
i
Remarks:
SBD- 8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel ,john Rauchnot _ 1554 200th Ave.
CSTM2298 SW4NW4 S28- T29N -R19w New Richmond, WI 54017
MPRSW 3254 town of Hudson (715) 246 -6200
lot #6 -St. Croix Estates
i
1 =40'
ABM.= top of 1 steel pipe C el. 100'
-'Alt. BM. =nail in Juniper tree @ el. 103.40'
O A
i v\
S►
8'
A aryl Steel
11 -3 -95
' ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer PVtER -ST'
Mailing Address 4 S ` 00 o f •� N
Property Address GtioS , kn4 O 5 a r-L, VJ'z .s 4 01 to
(Verification required from Planning Department for new construction)
o ZA - 13I 4- (oo —eat
City /State Parcel Identification Number L8 . Zq , I q , 154 L
LEGAL DESCRIPTION
Property Location 5W '/,, 1 "' W '/., Sec. Zb . T L N -R 19 W, Town of H DS a t
Subdivision :' r. ' CAO t x Lot #
Certified Survey Map # . Volume , Page #
Warranty Deed # rytoa 101 Volume 1 �-4L . Page # 1
Spec house O yes Xno Lot lines identifiableXyes 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
masterplumber, journeymanpl*nber, 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 been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three yearpration date.
SIGNATURE 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 p operty described abp�e, by irtue of a warranty deed recorded in Register of Deeds Office.
'' �Z�
SIGNATURE 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
JAN. ?3. 20G0 7. 28AM 0 JM COMPANY NO, 63 i P� 2_
560147 STATE BAR OF W !;C0NS11s FORM 1- 1982
WARRANTY DIED
DOCUMENT W.
Yt._3f3TE1, 3 OMCE
wiilotr Oval Joint V■nture, a Wiseoneia partnershi ! ST. Cr'm M.m
IeAYistllFlEe '
MAY, 2 g 1`�7.
1"a Rnd warnnn to DenAi9 P. 4u-erat and Lois F. Duarlt, _ ,� 11 :15 ". A
husband and wiis, rr ■urvivor>E ip }marital proporCY Gat �15 A
R.persFDssM
+ �If
PACE I INEIIYED F011 11iQpl16WD pAA
yAM MO RETURN ADRIIHS
the (Dilowina desmw taal acute In St • Croix county
Snw of vruconstn
��Sp0 � N{iDSOK
i;
- �D- i3ia- bo-000
FARCB
Lot Six (6) of St. Croix Estatae in the Tmmahip of Hudson, St. Croix County, 7i
Wisconsin.
Tlw not h—ad propeny.
(W fk taJ
I ' F�toeplloa w warranties:
�I
Dwed rhlE dly o( - may .. A n w47
(1FA1J
(SEAL)
al L. e C
(SEAL) FEU 1
` Michael 1t, Stsysn>s
AUTHENTICATION ACKNOWLEDGMENT J
StgnaluRKil Sett: of Wleconefn, 1
St. Croix �„
!+ autheaticRxd this by of 19 PomantAy nine before Rw this _27th Opy of
may 19_.2;_, du above Rataed
ltichaol R. SC*Z And 19111414 L. Dejric
ARR,artners of Willow River Joint Ventur
TITLE: MEMDER STATE BAR OF w15CONSIN A Hisgansin nartnerahio
(Y not,
auLhodzed by 1706.04, w■. Ststs.) w the bwAr to bt the pawn a who vxs uW the (meoft
inuru and wkvwWw the sRlnt
THIS INSTRUY6NY WAS DRAFTED aY
Hil�os,+ jXar Jo t Venture - 1 ftmftkX'n-
P. 0 . >lox A • NoWy �b�iim of YYlsoorwwrt
b "' D !.A- uT 5AA17 Notarypubbe. St. Cro COMrI+)Gww
($'VGCuns may b &4ARtlesad or eckno kdpd, Roth arc lux My commi>ision Is (xrmantat. (if not, state exptntfon dac
to ys I
NATO of pdmas $VIP In *ny r+1lickY by ;;O or ar that ftmtMKf. • • • ; - - - �:
WARRANTY aLTD STATE aAR pF.A " SIN MhemW LpY■W. h,,,y,
Rem Ne. 2 - wa ,Ay
r
r •
ST CROIS ESTATES
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11. 25' 26' E' , p1�10.]2' r ?r•.1� `.
1 V ►j
1 l ! 1 1 \\ ' `� \ ♦ ♦, p&OF T (IE SWAJA OF. THE'NW IN OF SE TON 20
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