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020-1327-20-000 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GE RAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Frost, Michael & Michele Hudson, Town of SST BM Elev: Insp. BM Elev: BM Description: / ~ /3M I GST TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic x; ,3 ; .~, /Z ~?S Dosing ~~ F-: ~~ ~ ~`r d O ~ SZ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 5~ 7 ~ 7~ 5 3 ..._- Dosing 5~1 ~ y /Z(, ~ /O~f 7 /SO' - Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand PM Model Number TDH Lift Friction Loss System Hea TD Ft Forcemain Leng a. Dist. to Well SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 515228 0 State Plan ID No: Parcel Tax No: 020-1327-20-000 Section/TownlRangelMap No: 28.29.19.1701 ELEVATION DATA STATION BS HI FS ELEV. Benchmark IS JatS ~ ~ Alt. BM ~~ 1 l.s, w ~ ~ Y 1 97 Bldg. Sewer // I l ~Sxt1~i ~ SUHt Inlet ~/ ` SUHt Outlet y. +d~ ~'s, a~ Ok-laleb G;~~ Tti. ,to7 95.33 Dt ottom :~1.~. a~ ~•b~ rTs ~ 3 Header/Man. ~ 3b `j 5 ..,7 Dist. Pipe o ' . CC r 9 f Bot. System 7• Tg yZ , aZ Final Grade ~;f 7. ~.0 9 3 St Cov r ~; i ' ~S•~ v~~~ L~ y.7~ ss.3 Vale v~~ y.7a 9S•3 0~~ ~ y.gZ• ~S ./ 8' BED/TRENCH Width i Length / No. Of Trench r r PIT DIMENSIONS No. Of Pits Inside Dia. ~ Liquid Depth ~ DIMENSIONS 3 j ~~ _ _ I _ ~ J~ / 0 V v" ~) ^ ' ~` - _ SETBACK SYSTEM TO P/L BLDG LL W E LAKE/STREAM LEACHING Manufacturef. _ //~~ I ,. INFORMATION CHAMBER OR 1,~f•i ~~-{ Type Of System: t Q ~-, on. ~Q G ~ lSo Ill ~~ UNIT Model Number: 5~'v ;~ Z . _, - o~ „ ~, ~' DISTRIBUTION SYSTEM /~Jer~_ /5 x S = 75 GC..,.~LoafS Header/Manif~d ~ I LLLB ~,( LengtF~ ! Dia I Distribution Pipe(s) ~ \ \ Length Dia Spacing x Hole Size ~ x Hole Spacing \ Vent to Air In~ce 3c'c9 0+~ N SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedlfrench Center ~ Bed/Trench Edges ~ Topsoil ~ Yes "~ No `Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 708 Crosby Drive Hudson, WI 54016 (NE 1/4 SE 1/4 28 T29N R19W) St. Croix Estates 2nd Add Lot 30 Parcel No: 28.29.19.1701 F't 1.., Cam, ~.: ~.•., Go dtz.~, a1 ~ (~o~•er.. ~-o ~. 1.) Alt BM Description = ,\.. 2.) Bldg sewer length = lx, ~~J~{ ~ r i ~ 1C0~ ~G ~ ~ e~. ; ,n. ~ ~ ~~k S -amount of cover = V 1 ~ (~~ ~+-M.~, ~ Plan revision Required? Yes ~No 3 ~'j ~ ~ 7 Use other side for additional information. ~ ~ ',_ _ SBD-6710 (R.3/97) Date Insepctor•s gnature Cert. No. commerce.wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix i sc o n s i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce ~'• 5 ~ 5 Zz g • ~ ~ Sanitary Permit Application ~~,~ , State Transaction Number tip. ~ d i C 8 e l a nta In accor ance w th s. omm. 3.21(2), Wis. Adm. Code, submission of this form to the appropri te gov~~m ; Project Address (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS,aze f da ' e ~ ~ 7a~ 1 fo ~ or s con ry submitted to the Department of Commerce. Personal information you provide may be used , .. Same ` u oses in accordance with the Privac Law, s. 15.04 1 m ,Slats. - n I. A lication Information -Please rint All Information U C' J~ i.! Property Owner's Name 1 Parcel # Michael M. & Michele M. Frost 020-1327-20-000 Property Owner's Mailing Address Property Location 708 Crosby Drive ST. CF101X COUNTY PLANNING & ZONING OFFICE Govt. Lot City, State Zip Code NE '/<, SE '/<, Section 28 Houlton, VJI. 54082 (651)336-6544 (circle one) ~ T 29 N; R 19 E or ~ 7~ ~ , II. Type of Building (check all that apply) Lot # ^ 1 or 2 Family Dwelling -Number of Bedrooms 3 30 Subdivision Name ~~ Block # St. Croix Estates 2nd addition ^ Public/Commercial -Describe Use ~ Na ^ City of ~ ^ State Owned -Describe Use CSM Number ^ Village of 5 ~; ~- Cep 15 ~ /~J ~,.~ ec'S ec..cl,~. Na ^ Town of Hudson III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ^ New System Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Numbet and Date Issued Before Expiration Owner ~'~• ~~,r~,F~ ` IV. T e of POWTS S stem/Com onent/Device: Check all that a 1 Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank Other Dispersal Component (ex 1 ") ^ Pretreatment Device (explain) V. Dis ersal/Treatment Area Informatio 76 nfiltrator " -4" standazd chambers & 10 endc s, Wieser Concrete filter canister w/ Pol Lok PL-525 effluent filter Design Flow (gpd 600 d ~ Design Soil Application e(gpdsf) 40 d/ 0 ft Dispersal Area Required (sf) 1 500 ft Dispersal Area Pro sed (sf) 931 60 s ft ~ System Elevation / 91 00' 91 50' 92 00' gp . gp sq. . , sq. . / . q. . ~ ~ . , . , . , / ' ' 92.50 , 93.00 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ~ ~ U ,b, N ,Y I3ew Tanks Existing Tanks ~ I Y ~a SZS ~ c a ~ ~; ~ v~ ~ h p ~ w c~ ~ a p ~./ 1L H Septic or Holding Tank Na , 1,200 1 Wleser Concrete X Dosing Chamber Na Na Na Na ftJ,'g~,,, 'l .,,,, ~ VII. Responsibility Statement- I, the unde igned, ass a respo 'ill fo ells n of the POWTS shown on the attached plans. Plumber's Name (Print) lumbe s Signature MP/MPRS Number Business Phone Number James K. Thom son '~ _ MPRS 30021 (715 248-7767 Plumber's Address (Street, City, State, Zip Code 340 Paulson Lake Lane, Osceola, WI 54020 VIII. Coun /De artment Use Onl pproved Permit Fee Date Issued Issuing t Signatur ^ r Given Reason for Denial ` 75 • ~ c3 ~0 ~d Ix. (;ontilti>?~~r easons For llisapproval 3~ ~t.Ma,.~ 't<b rro I(o~„) ~•+~.~^~+~' ~la,.~ ~'°f 1 Septic tank, effluent filter and' ~ ~~"~ ~ dispersal cell must all be services / maint~In,~J °j''~~`~' ~ [~c..rwtCr` S~1~c"w'`s ' as per management plan provided by plumber, l1 2: AN setback requirements must be maintained ~~ P/~~~ ~o /e~~ ~,._ ( o ~ /C~~~ b~ code /ordinances. c~c.1~tQ4 Attach to complete plans for the system and submit to the County only on paper not less than 81n x 11 inches in size . sA ~ ~ ~ ~.~ ~ ti~P~~, . SBD-6398 (R. 02/09) Valid thru 02/11 Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.O1/O1). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be 5 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BODS, 150 MG/I, TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on atwo-year/1-year schedule by use of diversion valve. Effluent to be diverted from new dispersal cell to old cell at 4 year anniversary of new system installation. Old cell to be utilized fora 1 year period. Afterwards, effluent dispersal shall be alternated between cells on schedule to allow use of new cell for two years and old cell for 1 year. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St Croix County Zoning Department at (715) 386-4680. • So%leda/ua-~~~v~ 6y Sftc/ ~//Ca/9(o~~P%r./o~ ~iom p Son ~/0 3i~ .~ e: ~P~' '` z~ /yfc.~4-e/~ nl'vFe./< Frost 708 eras6y,~: ~ ~s~ ~~. ,C~~ 30, ~/u.i oFsE. ~~olr r/EYs~SEI''s; Sew 28, T.,29~' Q. /9u>,,Tn. of h~n'S~,r, S~. Crair ~'o., ~~ ' /Jc/ ~ Oho -i3~7- ~o-cer C;t...(.-cue-~tG 11a~`e: f~OUSP 4P uJeii /oca~~dQF'i~r'°X. /GCS ~..SouL`~. G4 Sf aF SySEFrn a.i't4 . fie: E"XacE~ laca~c~ of /1or~ /off /iht mush ~.e dt~~r.n,i~col ~^iar~ t~ SyS~'.~ d~S.~r ~/ in S~La.Ei~. 0 o faro"9~ .~ .t p ~ c 0. a 5YS ~,rr 7s ~ ~ o, ~~o ka~c • ~ ~/ 9~0' ~' ~ \ ~y~' 9~.0• 97.0 ~~.,s6our' ~~~ `~ ~ ~/tom, \`\~\'~` ~. ~r I ~"tw ~ y q ~ - ~~;~ --~ . d.'sacrse/ ce//s a 6 s'X 7,3"' ~nfi/~ra.fi7/P Surface EpjS~,*~j cJiesc~ C'vncwv.~c u.1/,~GU-ate 3~~ ~.~ • rop ohs T ~i/e u~xk.. , Yo s ~ ~~~ _ i 9~~c~-Py ~i~C!'SiOn ei~/u ~nv~ L~/L,: s n .~A~ ~ ~~~~ ~. ~ 5~%l ¢~/ua~•~~ by Sftt/ ~//~o/9/v ~~,oP%c• /a~n ~ 5o~%e/a/ua~'o~ ,~ by -j~i~vr,P Svr~ '~/0 3/~ .. e: ~~' ~ zz /~fc~Q.e/¢ ~uf e% F-ros~ 708 cras6y ~: A .~-~.Srir, cJ/. 0 J ,C~~ 30 ,~/a~ oFSE. c~o~,~ Q. /9u~,,Tn. of h~a'Srr~ S~. croir fe., ~~ pc/ ~ oho -i3~7- ~o-cco c~o~b y ~. Cam-- ~e-~C, /~ ~,.SouL`t. !R Sf of SysFtrn a.rui . /' 6~~ ~Xoc~/ocaf~~ oFi1o~/~ /inC mush 1,.t dc~cr.n,i~col ~.ar` ry sys~ dcs.r~ ~+~'' in S~~~z~-, . e ~rou9~ \\ o ~ a boa s `''r 2~s'r 9S o' ~~ok'~c ~ ~} ~PrOX./oca~'a~o~'t,X,:s~'-~ 9~ v % ~' ~ ~y~ ' 9~.0' 97.o erm~ou i d.'s~s~c/ c~//s a ~ s'x ~.s"' ~' ~/e 8 ~ ~nfi/tra.bve Sur~ce ~~\ \ `t`s;G~ \ ~ \ ` `~ ~-\`~, 1 ~\ ~UC~ ~ I C'trn u.1/, 2c,2~-yrce- `~ ~ , 3pt~~rOrt~i~G,. ~n~ ~ ~ i L7i/GrS~on da~U2 3~,. ~,c7 teu ~ Co~vc tc ~' I~F.~r ~.~;S~.~pdyi~ ~~~5~ ~ ~o •s v m C ~ v ~~~ ~ ~ ~ ~. ai ~ h ,~. ~a ~' I• -ms's ,..i. ~i ~' f ^ I. iFri ~ 1 ~, ,\~ ; a , _-~~_~ 1 ;a~,~7 i< -~...; ~, ~' ~. { ; ;, 1~~ X ~ ,~ ~. ~ 'f -.~,..,~ . ;. i, h' U ~ ~ ~ `1J yJ ~ ~ ~ ~ ~ ~ j F d ~ ~ ~ ~ ~ _ ~ . ~ ~ ~ \ o ~ ~ ,r ` 'n zk ~ ^n ~ ~~ 'Yl v t~ ~ ~ ~ ~ ~ ~ ~ v ~ a a ~ ~ ~ ~ a ~ ~ ~~ ~~ ~~S °~~ uo ~~'S SSO.r,) cu~~.S~ S r, '~' _ :~ . ,.'a ,s ~ ~,, ~~ .--. ;...; ,:. RR k I ,.VI ~~~~ 11. ~, :~, i .. ~,,, ; ~ ~ I ~ 2203 Wisconsin Department of Commerce SOIL EVALUATION REPS' ~-""-'- page 1 of 3 Division of Safety and Buildings A.C.E. Soil & Site Evaluations in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must i l d li b t i d t i l h l f i i St. Croix nc u e, not u m te o: vert ca and orizonta re erence point (BM), d rect on and percent slope, scale or dimemsbns, north arrow, and location and distance to nearest road. Parcel I.D. 020-1327-20-000 Please print all information. Reviewed Date Personal information you provide m , s. 15.04 (1) (m)). ,3 /~ /tj Property Owner Property Location Michael M. & Michele M. Frost Govt. Lot NE 1/4 SE 1/4 S 28 T 29 N R 19 W Property Owner's Mailing Address MAR ~ 0 2010 Lot # Block # Subd. Name or SM# 708 Crosby Dr. 30 St. Croix Estates Second Addition City St a Zip~ga)~~pp®dp~¢er J City ~ Village f~ Town Nearest Road Hudson ~ P & Z Hudson Crosby Drive New Construction Use: rl/J Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD N Replacement J Public orcommercial -Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for conventional POWTS wi 0.4 gp lsq.ft./day loading rate. Proposed tren ch elevations to be 48" - 54" below existing grade. Boring # ~ Boring >124" f~ Pit Ground Surface elev. 96.90 ft in. . Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dl4' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-22 10yr3/2 none sil 2fsbk mvfr cw 2fm 0.6 0.8 2 22-42 10yr4/3 none sil 2fsbk mvfr cw 2fm 0.6 0.8 3 42-46 7.5yr4/6 none Is Osg ml cs 1vf,fm 0.7 1.6 4 46-110 10yr4/6 none s Osg ml aw 1fm 0.5 1.0 5 110-124 10yr5/4 none / s/Is/Ivfs Osg ml - - 0.4 0.6 ,t ~3 N~ Horizon #4 contains 1/4" - 1" bands of 7.5yr4/4 Ifs. H#5 contains stratified layers of 10yr5/6 Osg s, 10yr4/6 Osg fs, 10yr4/4 Osg Is & 7.5yr4/6 Osg Ifs and 40% SS & LS cobbles . Loading rates reflect most restrictive permeability found within horizons. Boring # J Boring Pit Ground Surface elev. 94.25 ft. Depth to limiting factor >104" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/R' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-11 10yr3/3 none sil 2fsbk mvfr cs 2fm 0.6 0.8 2 11-28 10yr4/4 none sil 2fsbk mvfr cw 2fm 0.6 0.8 3 28-39 7.5yr4/6 none gr Is Osg ml cs 1vf,fm 0.7 1.6 4 39-60 7.5yr4l4 none fsl 2msbk mvfr aw 1vf,f 0.4 0.8 5 60-104 10yr5/6 none - s/fs/Ifs Osg ml - - 0.5 1.0 '' ~5 H#5 contains stratified layers of 10yr5/6 s, 10yr4/6 Osg fs, 10yr4/4 Osg fs & 7.5yr4/6 Osg Ifs. Loading rate reflects most restrictive permeability found within horizon. * Effluent #1 = BODS> 30 <_ 220 m Land TSS > 0 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) S' nature: CST Number James K. Thompson ~ =-- 3602 Address A.C.E. Soil & Site Evaluaf s Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceola. WI 54020 3/3/2010 715-248-7767 Property Owner Michael M. & Michele M. Frost Parcel ID # 020-1327-20-000 Page 2 of 3 Boring # -~ Boring tr' Pit Ground Surface elev. 95.11 ft. Depth to limiting factor > 106" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 none sil 2fsbk mvfr cw 2fm 0.6 0.8 2 10-31 10yr4/4 none sil 2fsbk mvfr cw 2fm 0.6 0.8 3 31-47 10yr4/6 none gr Is Osg ml cs 1vf,fm 0.7 1.6 4 47-67 7.5yr4/6 none 1 sl/s 2fsbk/Osg mfr/dl aw 1fm 0.6 1.0 5 67-87 10yr5/6 none 12 ~ s Osg dl cw - 0.7 1.6 6 87-106 10yr4/6 none 3~ s/Is/Ivfs Osg dl - - 0.4 0.6 Horizon #4 contains an unsorted mix of 1"-2" bands of 7.5yr4/4 1fsbk sl & 10yr4/6 Osg s. H#6 contains stratified layers of 10yr5/6 Osg s, 10yr4/6 Osg fs, 10yr4/4 Osg Is & 7.5yr4/6 Osg Ivfs and 20% SS & LS cobbles . D Boring # -~ Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Descriptbn Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/Land TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) A.C.E. Soil 8i ~ Evaluatlons • So%/ e~/ua~•~h by SEtcl ~/~to/9(o ~~P/b,~. /ova. • 5o~%e/a/ua~'a„ ;6 by ~tcrnP' Seri '„y/o 3/~ l: ~~` ~ ~ /rlr.~4~e/¢ rrjc,/e/< Frost 708 ~os6y ,~. ~ ~~ ~~. 0 ~~ 30~ ~/a~ of SE. c~o;,r gEj'f SEWS! Sew ZB T.,29i(. Sf; . croir G, ~i pc% ~ Oho-i3~7-~'~ C(OS b y J~. fie: ~ou5t ~ We//%ca-~tdczPir~°,r. /~'.Sau~ CQ Sf o~F Sys~.vn a./tr( . C.~.-C~2-~G I' ~e~ ~XaG~ /ocr ~i~.~ of /la~z'~ /off /:nt rr~us~ ~t dc.~t.,•mi~cor ~^~ar- ~z7 System de.S•~ ~''~/ in S~6o-LLa-Ei~ ° o ~rou9~ \ ~ ~ Q Ica s ~''r ~~ok~iL~ • ~PpraX./oca~a.~o~'e.X,~:s~~q 9~ v ~ \ ~y~ ' 90.0, 47.o cHSboc~ i c(,'s~sa/ cc,//s a t s'x ~.sy' \~C. --9ts ~ t~3 ~ ~ \~, elev: - 951.,SZ~•r \\\ -. \~ ``~~' \ ~~. ~ ~ ~C7q ` \ \ ` `' V \\ •. \\\ ~~ E'x/Su~ u~i eSer~ 3c~i c ~n~ 7"op o{S.T. \ /e uw~! / `'-~ 3 0~~3 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: /~~~~/~. ~ laic-fie/% /'%l• ~~~ (Street address) 70~ Cros~i L~~:, }~~s~,-,, W/. S~'o~,6 located at: ~ '/4, ~s E'/4, Section ~, Town~N, Range_ j~W, Town of ~,lu /s~,,--, , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service ~a~/, zo/o Did flow back occur from absorption system? Yes No ~ (if no, skip next line.) Approximate volume or length of time: V ~ gallons minutes Tank Capacity: /,~~~ Construction: Prefab Concrete / Steel Other Manufacturer (if known): ~,c..~; e.se~ ~,c~~.u. A f Tank (if known): ~~_ ;,,sfr~/o/ /D/zG'/9Z ermit number (if know~~~~Gp ed Plumber Signature) ~~Q.rrlelS f ~ ~~~ (Print Name) P ~~ (Title) 9 a.®~a (Da e) 3ao,2~ (License Number) I~LMPRS Form to be completed by licensed plumber (Dept of Commerce Chapter S and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.O1/O1). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be <_ 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1 /3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BODS, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two-year schedule by use of a diversion valve. Valve to be turned diverting effluent from new dispersal cell to older cell at 4 year anniversary of new system installation. Afterwards, valve should be turned diverting effluent from cell currently in use to resting cell on a two-year cycle coinciding with septic tank inspection and maintenance. Contin~ency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St Croix County Zoning Department at (715) 386-4680. V~ 1 I V V~ v~• _ ~ _ C'iIRVE DATA (drainage & ponding easements) CURV& LOT. RADIUS CBNTRAL CHORD CHORD ARC TANGBNT TANGBNT, ~, L N ABC .$ BAR LBNGTH LBNGTH HBARI $~~.$~N.~ AA 31 00' 383 0838'04" N60~30'19"H S7.6b' 57.12' N64~49'21°8 N56°11'17"B AF 31 . 383.00' 0131' 31' N52~2S'28.5"E 50.28' 50.31' N56~11' 11"E N48~39' 40"E 'E 1336.49' ~ J C 66.23' i i D 44~ /' ~ l 1/ ~ ~ / /~ Ij~_ i ' LOi -s ,~ ~ ~ ~~ ', ). FT. ~ r ~ ~ ~ / 3.23 ACRES ExC. ESMT. ~;~ /% i ~ 140,707 SO. FT. i j 0. FT. ~ CC ~ / D ~~ ~ ~ ~ ~ ~~ 3.11 AC. EXC. ESMT ~ / ~ ,~~ 135 , 650 S0, FT. % ~ / N v 150,022 SG. FT. 3.43 AC. ExC. ESMT. 149,666 SG. FT. ~ -- - - / / ~ EL = 903.5 / 2.57 ACRES I ~ 111 , 818 S0. FT. / 1.73 AC. EXC. ESMT. ~'~ / 75, 458 SG. FT. ~ \ ~ ~f ST9o 38 O~ W ~ , ~~ ~ ~ ~ 435.26 lf' _ 1~';~ ~,' ~~ ~~ 3a ~+ 7 c~ .19 ~~ 'J n, ~! ~_. ~- BENC~+r:?.;KK L i~i'~~J E~= 93v 7J r-80' RAD. TEMPORARY. CUL - CF -SAC TO HE REMOVED UPON RJAD EXTENSION E I/~ ! ~-R. '~N'li -+ __. -F~ PL-525 Effluent Filter -Effluent Filters .: Polylok Inc. Page 1 of 2 Ntade in the U, 5,1~, Polylok Inc. 3 Fairfield Blvd, Wallingford, CT Q6492 Call Toll Free: 888-785-9565 Ema __ .._ You are Here: Nome > Product Details EFFLUENT FI Raising the bar in PL-525 Effluent Filter P~ Description Eff Palylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent Ex filters. The PL-525 is rated for over 10,000 GPD (Gallons Per Day) making it one of the Ris largest commercial filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylak PL-122, the new Polylok PL-525 has an automatic shut off ball installed with every Dis ~~ , „~ filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off Ac the system so the effluent won't leave the tank. No other filter on the market can make that 11~. ~ . claim! Pu . ~; `" d P d t R l t am ~ ~ ~ ro uc s e a e ~ Ordering Information Request a Quote `~-~ _.. _. + Se ~_ Features Ba De • Rated for 10,000 GPD (Gallons Per Day) " Re filtration • 525 linear feet of 1 /16 Enlarge for details • Accepts 4" and 6" SCND. 40 pipe • Built in Gas Deflector Ha • Automatic shut-off ball when filter is removed Sic • Alarm accessibility • Accepts PVC extension handle Lai The PL-525 Effluent Filter shauld operate efficiently for several years under normal Fo r be cleaned eve t th filt d th d I i ry a e e s recommen e t conditions before requiring cleaning. time the tank is pumped or at least every three years. If the installed filter contains an ds servicin th filt l h Bu g. en er nee arm w e optional alarm, the owner will be notified by an a Servicing should be done by a certified septic tank pumper or installer. Co Maintenance Instructions: Pri Od 1. Locate the outlet of the septic tank. Re 2. Remove tank cover and pump tank if necessary. Ac 3. Do not use plumbing when filter is removed. 4. Pull PL-525 out of the housing. Re 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly De aligned and completely inserted. 7. Replace septic tank cover. PL-525 Installation: Ideal for residential and commercial Te' waste flows up to 10,000 Gallons Per Day {GPD). Installation Instructions: 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & LokT"' or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. http://www.Polylok.com/products_details.asp?Product ID=3 3/9/2010 i ..- /- ~( JJ~~ ~i-~lt~ U-~it all` \1.'1tiC-a);~~i^. Y~tl<SI -- fd8! 1~~7J i~ «'r~Rl2At~ fr~1' 1)i l i) .. .-.U^.tFTJT h,i~ y!!! ~ '34q' Q 4~rr'~ '~Q F31 ~ mann_ iiomr.~~- _L.cic~r.po.:r at,acL, _a. _.. - . .._. ••n ,Ila! =' i~~C-old-~-~---F•I~--F~6~~-d-Rd - - ---- - - - : i i c-t, Nl e- Ed - Fr-o s-L ,-cre-s-tra-F-d-~-nd--s•.~ i f e --__- thr fultaa.~t1E d~scntx.! real ecute m St _ ~rOiX -,__ __ ~,,Ta,~ly. ~rat>: of t4ititulstrr. .... .. ~_ i g~ ~ r ~ % 4 ~"~ ~ 5 .30 A ~q ~,.. '~ [.< + , t. it-t~S SP4CE r,ESER*: Ems: r•t+a ACC)R OrN~ ( `, -_-~• -•_ - .cry-.. l..r>.:._''.3 Return Gocumr=r)CS to: Dakota County Abstract & Titl., f'.U. e3ox 450 ! ? 250 HigFsway 55 Hastings, MN 55033-0456 U20-1327-2U P.,.RGEL 'GENitFk, tiilOv NUMBEG, ~~ Lot 30, St. Croix Estates Second Addition to tY,<a Town of Hudson, St_ Croix County, wisconsin_ =~iA~SF~~ ~ ~ 0 1 a.o ~E ThSs _., 1 _Sr~,,-n0 t hom>sead progeny. xR7sX (la nnr) E''`~r7O1f"""•"''""'a'S Easements, restrictions and rights-of-way of record, if any. Darr) this ___ `__~ day of - E~10velT.bel' A. D., !+~ 9~t Biermaye s, Incorporated -._._ - __ _ .Plarlc P. B;LCrmarsn, Eresidenc AUTHL-NTICATIOIV ACKNOWLEDGNIGNT !SEAL) ~14nmure(s)_ ~ _ Stulc of VVXi~~cwlr,~~pDJinnesnta -_ ~ q. aurin-nttcsrcd rhts _-- day of _ -_ -. ----- County. - Ptrsunaih~ came l:lel.-,n. uu ,hi> __.5 ~ _ _ day of -----,_.-,-- KAFtEMK.30FiN~a --',L',o'ut~aQi~.r°~Uc_,C~:b_"'~ 19_0 ,the abua-c aat„eal __ ,_ '`4°`°--- ma n Home 3! 1. Fj(plpEg E~.l Arm- ,._~ncor~CL~orat~ _ _ PM~,z~ *l7rlt P Bic rm,nn nrc+s, 'C^tC ~f the -~ ililL S.ffnS>aFR ~i VFLiAR:~r l IS 1 - ..rarp~~r.,.-..cal t ~ ~t n~c t t,(: i a.or tar ,t t<.a~ t+ ta,t - ..- .. ._ --- - --.._ ~_~ ._.... ..- ._ ~_..-'- --_-..._ tC 1 uh.•ra 1\ s tl ;r`. ~ :. ;tat: ~, ../~`. KA~i~lvd .~i!''e-~ A- _ - -. ._ __-.. _. ._._ _. .La t.[Ctt4F'PtIV. ': trN,h~'~y~a It ~! ni It f~. r~a tl aa~t t~l ~ ~c. fl[it] I!x t..ti ~. •tttF• nnYCC~r`;~r S~~ri~\t~iti: It .HI a\'I,••.i.; h >.,:~, .?. ~, ., ~..t tt L. a.= 't7AF tL (l L9l ~ s „t ~,,~ /,.1 l~ttcarnc:.y_.Kri.stin~, .Os33.and ._._.. ~~ ~1 -.J ~ ~~,~ _c `~` _ Fi13C~FrOIl _!1J-I ~...+~.o ~ !~-. ""a ..:~ F~.th:., n ,t, ~t a . i, rtn . v:,n_. ix .,... .. .,. >,:..,\clral;;, ft. •lh .ur ~.. \1} •n~;,.. "..rl .. iti•rraP. .. .it r.,i :-taci :titttt., n,n, l,.ar z 1.7 .•\ixti \~1, 1.1 1` ~:\11 RaA .,1 •1~. .1~.1~ I .., n: ~.. 1 •lr.: STC-105 SEP1"IC TANK MAINTENAiYCE AGR>E;IEIV)3rNT St Crviz County OWNEKtBUYER ///r A ~.~ `~' i~ ~G~.e.(...~ /~/QOS MA~iNG ADDRESS / J` SS ,Q t,~ ~Pti S ~I V r~ PROPERTY ADDRESS (location of septic system) Pleas6 obtain from the Planning Dept, CTTY/STATE PROPERTY LOCATION. 1/4, _S ~ i/4, Section a 9 • 'r a~N-R. 1 Gl W TOVI-N OF N ~. S a ~ ST. cROIX COUNTY, wI SUBDIVISION ~ • GRt' ~~ ,~ ~ ~-~Te.S LOT rIUMBER 3 ~ CERTIFIEDSU,1tVEYMAP .VOLUME__,PAGE .LOTNUlVIBER~ 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 yews or sooner. if rreeded by licensed septic teak pumper. What you put into the system can .afi'ect 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 gtant for a maximum of 60% of the cost of replacement of a failing systemm, which was in•operation prior to July 1, 1978. St. Croix Gounty accepted this program in August of X980, with the requirement that owners of all new systems agree to keep their system properly maintained. 1be properly owner agrees M submit to St. Croix Zoning a rectification 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) after 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 requitements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as sot 6y the Wisconsin DNR. Certification stating that your septic has been maintained must be co[npletod and returned to the St. Croix County Zoning Officer within 30 days of the three year exp" tion date. SIGNEb: ~ DATE: ~ 7~~1 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W! 54016 11/93 ,~tio'~ ~Zo - ~3Z~ - zv -obU ~~ County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN ~ Gp In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT t0~f* Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER ~i [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road $~~" `"~ Hudson, WI 54016-7710 ~ (715)386-4680 Fax (715 386-4686 Attach com lete tans for the stem on a er not less than 8-1/2 x 11 inches in size. County Sanitary Permit # ^ Check if revision t s placation 5 e /~ p I. A lication Information -Please Print all Information Location: Property Owner Name 0 ~ 2006 /}~'~ 1F" 1/4, sec L ~ "~~~ ~ ~ AUG N;~ R E (or) Property Owner's Mailin g Address CR~~X C~ , r, SS Lot Number Block Number nn p ~~ ~~ ~ N~ U ity, State ~ ' ~ Zip Code 5zlal 6 one umer ~~Z-~l~ - 7/~ 7 ubdivision Name or CSfvf~Number 5t~'~QF~c ~'~ zH ~ ~ ~ ~ , II Type of Building: (check one) ~ il i 2 F D lli N - amity ^ Village own of y or am we ng - o. of Bedrooms: ~ ~_ ~~ 5 _ ^ Public/Commercial (describe use): I . I O N ^ State-owned Nearest Road II. Type of Permit: (Check only one box on line A. Check box on line B if applicable) ~/ S b Parcel Tax Number( ) A) i.^ Repair 2.~ Reconnection .^Non-plumbing 4. ^ Rejuvenation - a~ a~ 1 ~ "~ Sanitation ' . ~ c ~ B) Permit Num~ Q ~ ~ ~ _/ Date Issued ^ State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) _Non-pressurized In-ground ^ Mound i' 24 in. suitable soil ^ Mound s 24 in. suitable soil ^ Mound A+0 ^ Sand Filter ^ Constructed Wetland ^ Peat Filter ^ Drip Line ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Other ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating V. Dis ersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Cj Required Proposed (Gals./day/sq.ft.) (Min./inch) ~ Elevation ~,'~7 ~~ f~-5'~ VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks r^/'a i~Qj ^ ^ ^ ^ ^ ^ ^ ^ ^ VII. Responsibility Statement I, the undersigned, assume responsibility for repair/reconnencLion/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A license is not re uired for terralift repair or the installation of non-plumbing sanitation system. Plu,~!ber's Name (print) Plumber's ~Si nat (no st s): MP/MPRS No. Business Phone Number Plumber's Addres (Street, City, State, Zip C e) ) _ ~ l~ ~ o a- ~ d 1..-- ~/ 1 .5 c L.i ~ i VIIL County Use Onl `~ Di ed Sanitary Permit Fee Dat Iss~ Issuin ent Signature o sta ) ~f Approved Owner Gi n dverse ~ ~ ~~~ Q(A ss ~~ D r ion j IX. Conditions of Approval/Reasons for Disapproval: cn ~~~ o~ c~ ~~ Z ~ ~_ m n~ 0 ~ zy (n p ~~ -n-~ z zZ ~ ~~ m r O rn 2 C z D m /~ D m D C N m 0 c z 0 m D rn V n o~' O _~ O z m z v 'o ~ O ~~ r O N Z ---I z 0 ~. O ~D m 00 ~~~ C~ G m ~- D -~, ~, r n N ~, Q m ' °Q~ ~ ~ ~ n 3 m ~ o a ~ m m w o i a ~ ~ ~ m~ ~? m~ ~~ s~~ o. ~_ ~;,~ ~ g a~ ~ ~ o ; 3 ~ ~ ° ~ ; o m 3 , . c~ ~ ? s 6/ ~ m d o ~ n f D s~? ~noi w v m < ~ c °~ ~ s m o m ~ ~ $$ 03 m ~ m m S+ f ~ tp ~ ~ rn c ,~ ~ ~ ~ ~ ~ y m ~ N ~ w m ~ y m ~3~ o ~ ~ "~~, a~ a ~~ ~ ~ ~ ~ ~ s X~ x .+ d ' _ j~ y y 7 m C7 ~ v ~ N o ~ C7 'Z ~ ~ d m N y ~ p ~ -., m ~ c ~ ~ ~ ~ ~ 'o ~. ~ m n d ~ o_ o ~ ~~ . °~ ~ m- n~'O m ?Z 7 0 ~ ~ N ~ ~ O ~ N v' ~ ~ ~ ~u- ~D c~* _ mm .~~m x w 3 Q~ w ° ~ y ~ d sm m ~p ~ ~, a y ~ '°N m mo ~ X01 w~ n a ~.a3 n ~o 3 3 3a m ~ '~ c~ i ~ -'m ~ ~ '~ ~~ ~~ ~ hod `~ m ~ mom ~ a~ ~ ~ ~ ~ `Z ~! ~~.~ ~ N 7 N ~ N ~ r ~ m ~ ~ ~ ~ ?w ~ ~ ~d~ = ' 3 7 ~7 y :y n O y ''C Z O n r ~, z m m z n < D ~ Z m z~ z -DI ~ Wei ~ 2 D Z Z ~ Z ~ O D D J ' c~ cn O I c ~ ~ ~ ~ ~ '', ~ ~ I 7.a ? m '' l L 3 Z y Z 0 ~ o .. O N T ~'~. °° o a I o n. ~_ ~ ~ m m y ~ ~ =. C I N ~ ~ 3 ~ N fD ~ a v ~' ~ ~ ~ o~ ;. ~ a o Q, H y ~ ~ ~ cn ~ D ~ ~o~a. coo ~ ~ w `~ a co -n I ~ ~ c~ a ao ~ ~ ° h 3 -= o \o o o a ~°a I „~ -~ N ~ ~ ~ N v v I ~ ~ ~ ~ I~ o O O O ~ m v a 0 N~ ~ 3 y N N $ j ~ ~ ~ ~ v v ~ ~ ~ v _~ d. ~ d o I ~ I a v, ? .. ~ rt Z ; O o I =+ A ~ ~ ~ ~ I o" ~ '~ ~' ~ I ~ N ~ N ` C V N~ I W ~ ~ a ~ I n 3 ~ ~ ~ m y a I y a I ~~ W ~ °' 3 ~ I I w F; TI a ~ .. a ~ f0 p~j V - C I o ~ a I I I I ~ N I o I 7 !D O ~ 2 ~p O ` ~ m o ~' ~ ~ d C ONO N N ~ Q O W ~ ~ N --i ~°g ~ ~ Q 3 O n a. m N d N N 7 a a a A Z ~ J '~ A Z O O mN~ z ~ A ~ m A d a ~~I. ... ~ ^ m \ 1 0 ~• O K O rti ~~ N 0 ~• v~ ~C .Z' y A a ti `V N a A ti N W !p ;O 'r b y ti y IIENCHMARR' I~ ~, OQ ALTERNATE DM: ~~ p /~~- ~,{~- T (~~. 6EPTIC TANK / PUMP CHAMIIER / HOLDING TANK INFORMATION Manufacturer:_~:-J~ f ~'Q~ Liquid Capacity: ~ ~.b~ Gpl ~lG~ Setback from: Well / .3 Z ~ ~ g ~ House Other Pump: Manufacturer ~ Modell Size ^" Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: ~~ Length ~ S Number of trenches ~ Distance & Direction to nearest prop. line: /\,(Qr'i"},( (~ ~ Setback from: well:_ House / ~'7 ' Other ELEVATIONS Building Sewer ld L o yd ST Inlet- i a f . 3 ~ ` ST outlet - ~ ~ ~ ~ ~ 1 PC inlet PCi bottom - ~." Pump Off Header/Manifold -"' Bottom of system ) vQ' , ~j`j Existing Grade ~ C) ~ ; ~ ~~ Final grade ~~ • ~~ DATE OF INSTALLATION: ~Q/~~ 1 ~7 .. , PLUMBER ON JOB: _ ~q y~,~ x'1'1 ~~G~T€~) ' LICENSE NUMBER: " /!'1~-r~t,~--_ 3 i 3 INSPECTOR: 3/93:jt oao !7U / 6TC - 104 `^~ AS IIUILT SANITARY 6YSTEM REPORT OWNER ~ (C ~l ~ ~ ~ G ~l -~ 4 ~. 1 ~. ~~ ~ ADDRESS ~OFS C f c35~ ~ ~ ~ ~"~''~ SUBDIVISION / CSM~ ~7. G~pi,~C ~ j~A ' SECTION E%~~ Z~ N-R (~ W, Town of ST. CROIX COUNTY, WISCONSIN LOT ~ 3 rrovide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. Dao - /~~7 -.2a -mod z8~-~,24~rg, e ~v ~ 6TC - lOt AS IIUILT SANITARY SYSTEM REPORT OWNER ~ l C ~t.e ~ ~ ,~i ~.1i:1,~ ~~ <) ~'~~ ADDRESS 76~ ~ f a5~ •-~ ~ ~ ~; ,,,~ SUBDIVISION / CSM~ ~T ~,~Qt,,k' ~~~-,q7--~S SECTION E ~ $~ ~ ~_N_R (~ W, Town of t . t~ Sro ST. CROIX COUNTY, WISCONSIN IAT ~ 3 d Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. DENCHMARR_ ID V, O~ ~~'~7' ~iU~(~i" v ST~` ALTERNATE flM: FI2r~ JET StOZS~ ~~ ~Q+^~,~-. lI d.. "T ~J 6EPTIC TANK / PUMP CHAMIIER /HOLDING TANK INFORMATION Manufacturer: _ ~--J ~ ; ~ G ~ ~ giquid Capacity: ' ~ _b ~ GA ~~G~ Setback from: Well ~.3 ~ ~ House -'~ Other Pump: Manufacturer __.. Model$ r Size Float seperation Gallons/cycle: -' Alarm Location SOIL ABSORPTION SYSTEM Width: ~~ Length ~ ~ Number of trenches z Distance & Direction to nearest prop, line: /~Ip('T~l (~ ~ ~ ~ Setback from: well : ~ ~~ House ~ ~y Other ( "~~ , ELEVATIONS ~> /Ob'~ine w~C/e~thor.~~ / Building Sewer ~d Z e `~~ ST Inlet • ~ a 1. 3 ~ ST outlet- ~~ PC inlet PG bottom -` Pump Off `-~ Header/Manifold "" Bottom of system 1 V 0 . X17 Existing Grade it)3; J(~ Final grade ~~~ J~ DATE OF INSTALLATION--: ••_ I D/Z(„ I ~ PLUMBER ON JOB: _ ..l~~.~,q,~ m ~LiLi~,T~~J LICENSE NUMBER: /l'1~ t~p~7313 INSPECTOR: 3/93:jt Wis~~nsirl Department of Commerce PRIVATE SEWAGE SYSTEM • Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) personal information you provice may be used for secondary purposes [Privacy La~nr, s.15.04 (1)(m)]. 1~~~~~~de~~AEL & MICHELE [~~~~illage ^ Town of: CST BM Elev.: Insp. BM Elev.: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~„" . ~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift `riction System Fi TDH Ft Forcemain Length Dia. Dist.TOWeII SOIL ABSORPTION SYSTEM ELEVATION DATA CountyST. CROIX SanitaryZP~~t~Pl~.: State Plan ID No.: Partel~xZfl~,,;1327-20-000 '~ ~ A9700285 /d/~/~y 9 STATION B HI FS ELEV. Benchmark "'gy'p o~i~r"~ lafs .~z ~ GJ ~ ; Bldg. Sewer ' ~ ~ ~ i' St /~C Inlet .2l , S/i~ !Dp 'f- //(o fir! ' St / ~ Outlet ~r,?O~ ~ Dt I l t n e Dt Bottom Header-- Dist. Pipe Bot. System Final Grade BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth IMEN 1 N IMEN i N SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK T CHAMBER m M N INFORMATION ypeO er: o a u 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 BedlTrenchCenter Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 29.29.19,NE,SE 708 CROSBY DRIVE LOT 3 ,~ ~ z ~~ - ~O~ae- ~~c~~~ Cr1'~c~~b-~2~t Gc `~- L ~ -tom `~~Z~-~e~ ~ X00 / bltic /d'~=~,,s~'~~~~~ ~ z ~~"~ " ~~zs n-~ Plan revision required? (~es ^ o /~z..~t~ f ~ Use other side for additional information. SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: /~~ ~~ `1/ __ ~ ~ of `q1 G ~-~~ ~ ~1 ~" 1 ~ w l~ ~~~ 1~IS~'0~15%~1 SANITARY PERMIT APPLICATION Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code • ,Attach complete plans (to the county copy only) for the system, oripapernot less than 8 v2 x 11 inches in size. • See reverse side for instructions for completing this application The information you provide may be used by other government agency programs I Privacy Law, s. 15.04 (1) (m)]. Safety and Buildings Division 201 E. Washington Ave. P.O. Box 7969 Madison, WI 53707-7969 County ~T e/LoIX State Sanitar Permit Number heck if revision to previous application ~~y6~ State Plan I.D. Number I. APPLI ATI N INFORMATI N =PLEA E PRINT ALL INF RMATION Property Owner Name ` r C/~OST Propert Location q ,~ S a ~ T 19V f Zia ~~ 1ia N, R I Z E (orL ~ ~ , Z / , r a ! . .~ Property Owner's Mailin Address d Lot NufTIbO Block Number s ,E ~~rs v J City, State Zip Code Phone Number Subdivision Name or CSM Number ST- ~~ L J~il~ S: /a( ( r~> 77y13 `13 5T, c.~ o ~ ~ T.g II. E B LD1NG: (check one) ^ State Owned ~ !ty ~ a Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms g OF ~ e~/ row l Number(s) Tax III. BUILDING USE: (If building type is public, check all that apply) Parce ~ . n P~ ~ ba~~" - 13.E 7 ''~ a 1 ^ Apartment /Condo 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/ Repairs 11 ^ Restaurant/Bart Dining 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: speufy IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) q) 1 _ ~ New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5_ ^ Repair of an ______System ________System______~______TankOnly______________ Existing System ________ ExlstingSystem 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 ®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 y5b ~,S p , G / po. ~l Feet l 0.97 Feet VIL TANK INFORMATION Ca acft in allo S Total # Of r Manufacturer s Name Prefab. Site Steel Fiber- Plastic Exper. N i E i Gallons Tanks concrete ua glass App ew x st n ed st T n ks Tanks Septic Tank or Holding Tank ~ / !' r1 Ioc00 s~ ^ ^ ^ ^ ^ Lift Pump Tank /Siphon Chamber ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum er's Signature: (No Stamps) PRSW No.: Business Phone Number: ~ .~lCS ~LrG f~ et5673/r,3 / -- ~ -rg$OSCa Plumber's Ac dress (Street, City, State, Zip Code): ' P~ . ~ ST c~ wY IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing gent5ig s) Approved ^ Owner Given Initial Surcharge Fee) c~. ld/o - -- Adverse Determination " X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: / S8D-6398-(R.11/96) DISTRIBUTION: Original to County, One copy To:. Safety & Buildings Division, Owner, Plumber '_ I than 8 vi x 11 Inches in size. J T ~~. nbt)C • See reverse side forinstructions for completing this application State sanitar ~ r~migtlNumber ' The information you provide may be used by other government agency programs heck if revision to previous application IPrivarv I aw c 1 S 04 (11 (m11 _. _. _ .. 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. 5. If you have questions concerning your onsite sewage system, contact your focal 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 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, 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 Warne, 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 'I 1 inches must be submitted to the county. The plans, must include the following: A) plot plan, drawn to scale or witr, 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; replacerent 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 1 15 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. INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration ~~ate, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. ~ All revicic~ns to this permit must be approved by the permit issuina authority. .ELK RIVER CONCRETE PRODUCTS • 6550 WEDGWOOD ROAD • P.O. BOX 1660 • MAPLE GROVE, MN 55311-6660 (612) 545-PIPE • WATS 800-557-PIPE • FAX (612) 545-8399 1 ~DUNDED 19 ~~, ~,~c e ~Ut cvT Nr~ % S~ 'i~l~ S ZIT Z~ N.~~ 1 v w~N ~ ~ UDC I~ PROJECT 5 T, C- ~d ~ X ~'_~r~1 dF .,`~ ~~ +:~ ~ ~ i/ _ ~ ~ ~~ ~h1~ ~uC ~Je.~ F2a~5~.~ ~~~Se ~, d,~~G P.~~-~ r--_______ ~.......... ~r~ ~ ~. ~~~ ion-~ 5 X _ _ q~-°° o =,,~ 3 ~o9~~k ~ ~ T~ p off` ~' ~"- CM'~o1 L~-~- 5v~c vCv~ s+tik¢. Lio1 0~~ _ ~ `~ ~~'~~El~ ~ • = IOrJ,Up 'tt. ~~'_ ~Utr- . b2. ., C+ ~ ~ ~` 7pwnt6e.~c- S,~g •di ~"~c~,~E ~ ~' ~, ~~.5c, ~ oo x73/3 ~ ~ . ~ ~ _ _ ~1 - ~o' ~ ,~~ t'•; ' ', ~, ~~ ~ ~O t ~~ tiJ.~Z ~ 1 ~~ ~ ~ ' ~ $~x ,- ~iG w a Po~~~_D o ,~~T:..,:. Scp _ ~ y~ ~ ~_~t~ ,~ r aE O A_ oL ~--s ~c SS t ' ~.. ~ E(e VOc'TIC? JV fo S`.20' j 4i.1 .. / ~'?C`~. ~ tti~ ~~ ~ C t..c. Ld 64 ~ : J t~.,' drI ~ 2 ~~ O w ~._ ~ 4 /~ Q.~~•vU ~VlJ~S ~°~ist1 ~~ Li,RU~.)tnl 2 ~ ~ y ~{ tik y""'~,a'" /-~Citote'S. Utz. F~oMJ I~,f~t`r -! __ { i.:.,i ~ev10~'~,5 ~~aG~fiCAll~li~tEL t t ~ ~.ldP~' ~ ~R ~ ~' no`~'E S Se ~'} it '('Lh N ,n. r Wisoons~nt)epartmentorrndustry, $OIL AND SITE EVAL<;~ATi~1 REPORT ,Labor and Numdn Relations ~IViswn of Safety & Buildings in accord with I LHR 83.05, Wis. Adm, Code Attach complete site plan an paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference paint (13M}, direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATIBN-PLEASE PRINT ALL INFORMATION PROPERTY OWNER; PAOP6RTY LOCATION ~ridgeland Dev. Co. GOVT. LpT~ 114 SE tl4,S 29 T 29 ,NCR 19 fc(a} W PROPERTY OWNEA':S MAILING ADDRESS LOT # BLOCK # SUBO. NAME OR CSM # 11735 I17th. St, 30 nor St. Croix Estates Second Addn. CITY, STATE ZAP CODE PHONE NUMBER ^CITY OVILLAGE [SOWN NEAREST AOAD Lakeland, MN. 55044 (fib 985-5000 Hudson Crosb Ar. (xf New Construction Use ~ j Residential / Number of bedrooms 3 ( )Addition to existing building () Rep-acement [ J Public or commercial describe .,.,, Cade derived daily flow 450 9Pd Recommended design loading rate . 5 bed, gpolft2 .6 trench, gpolh2 Absorption area required 900 .bed, tt2 750 trench, ft2 Maximum design baling rate , . 5 bed, gpd/ft?~_trench, gpd/fi2 Recammended infiltration surface elevation(sj _ 100.23 tt (as referred to site plan berx~markJ Additional design /site considerations nor Parent material ~, ©utwash _ Flood plain elevation, it applicable .,~ n S =Suitable for system U~ Unsuitable for s stem CONVENT{ONAL ®S O U MOUND ®S O U IN-GROUNp PRESSURE ~.S ^ U AT•GRADE ®S ^ U SYSTFJut IN FILL D S [~ U HOLDING TANK ^ S ® U SOIL DESCRIPTION REPdRT Horizon Depth in. Dominant Color Munsel) MotgeS Qu. Sz. Cont. Golor Texture Structure Gr, Sz. Sh. Consistence Aour>~r Roots GPD1ft Bed Tter'~tt 1 0-12 20vr3/2 none 1 2 2 I2-28 7.5yr4/4 none ~„ siI Xcsbk mfr gw 1P .4 .5 3 28-68 7.5yr4/4 none laFs 2atgr ~ tttvfr gw nor .S .6 4 68-84 5yr4/4 none si ifsbk mfr nor nor .4 i .5 Remarks; Remarks: CST N.unc:--Please Print Gary L_ Steel Photte~ 715-246-6200 Address: 1_ 5~, 5 T2,f~_Ave.~ ~ti mond,,~WI 50'17 M ^^^^^ J...m - . ~ STEEL'S SClIL SE~'VICE Cary L. Steel ~_-- --- - - - ~_ -- - - - Page 1 of 3 ~, F` SANITARY PERMIT APPLICATION •~ ^s~ns#n In accord with ILHR 83.05 Wis. Adm. Code Department of Commerce ' s • Attach complete plans (to the county copy only) for the system, on paper not less than 8 v2 x 11 inches.in size. • See reverse side for instructions for completing this application The information you provide may be used by other government agency programs [Privacy taw, s. 15.04 (1 } (m)]. Safety and Buildings Division 201 E. Washington Ave. P.O. Box 7969 Madison, WI 53707-7969 County _ cj ~ CRaf~. State Sanitary Per it~~ er-~/~/ Check ir'Fevrs on t previ{/o(u~s, application State Plan I.D. Number I. APPLI ATI N INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name ~ ,} L e ~~~ s % Y1 l l Property Location N ~1 /a a, ~ 1 /a, S ~ ~ T a. ~ . N, R I E (or~W . v •,e~ ~,e/ t c „ Property Owner's Mailin~~yy Address Lot Number Block Number 555 ~ScdRiys ~4y ~ 3`a City, State ' '~ Zip Code Phone Number ~ ' ` Subdivision Name or CSM Number ' v7 ~ • ivv., ~-. SIN $~$ t~ (o (G /~ > 71Y- ! f .,38 . c.Ra~~ sTA-Te. S s7 II. Y E F B IL IN (check one) ^ State Owned O rty Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms D village Town OF ti ~~S Dam/ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ~~- /3 ~- ~'~ ~PQ~1~ ~ 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 online B, if applicable) A) 1. 14( New 2. ^ Replacement 3. ^ Replacement of 4_ ^ Reconnection of S. ^ 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 Seepage Trench 22 ^ In-Ground Pressure 42 ^ Pit Privy 13 ^ Seepage Pit 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 7_ Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade ~1 Requir (sq. ft.) Proposed (sq. ft.) (GalVday/sq. ft.) (Min./inch) Elevation ~ 5~ 7 ~ ,Sa 'T./ . ~ /©U.'17 Feet /`~ 3 ~ 97 Feet VII. TANK INFORMATION Capactt in allons g Total l # of k Manufacturer s Name Prefab. Site con- steel Fiber- Plastic Exper. E i i Ga lons Tan s Concrete glass App New Tanks x n st Tanks We-Q~~s strutted Septic Tank or Holding Tank ~, 1~G0 ~ ® ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) PI tier's Signature: (No Stamps) M /MPRSW No.: Business Phone Number. ~A vh. e s />'!'2 ELI G ~.T ~ a~c-d - Ooo 7 3 ! 3 '~ /$ - Y8 3 -9 y `/ 7 Plumber's Ac ress (Street, City, State; Zip Code): l~ -- ~--~l~ ~~~fr- sT .sT• ~a~~ ~~5 w~ y~z IX. COUNTY /DEPART ENT USE ONLY ^ Disapproved Sani ry.Permit Fee (Includes Groundwater Surcharge Fee) ~ " ~ ate slue Issuing A nt Si ture (No S s) pproved ^ Owner Given Initial 9 ~~j / / n,~ ' `~ ~~_ Adverse Determination v //~~ T t 7C. C.VNUIIIVN~ tAl'YKVVAL/KtA~VN t K AI'I'KVVAL: SBD-6398 (R.11i116) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber tNSTRUCTtONS 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 wilt 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 1 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. ll. 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 Warne, 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 'I 1 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or withi complete dimensions, location of hooding 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; replacerent 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. w ~- Z ~' w ~ . ~R ~ S ~. ~~•, P ,,a„d d~ ~~ O rs ~ Q -~ ._ ~ `~~--~ i o[~ ~, LD -~' N ~ ~ OG Q ~d o ,~c, o' M 7 -~ ~ ~~ S N od ~~I o/ a n, "~ s - " ~' a- ~ r' ,t . N .!~ ~ --r" ~ J ~ f 7 ~ j ~ ~ LL O d T~ ~- ~ a ~~ ~ ~~~ ~ ~" ~ ~ ° ~' _.f.. o t y~ N (Q.~ 1 M~ V1 Qf p :.9 ~ ~ £ ~ s o I T u ~~ ~ "~ ~ _~ }~~ '~J J 4 O ~~ a ~ u -{- 7 v X ~ ~ L d d ~ In 1 ~ d ~ --+- ~ N ~ _o 0 ~ ~' J -~ N ~ 0 ~ ~ o~ ~ S N D ~ ~ ~ ~ ~ __ V ~ ~ S ~-'. o .~ ~ o c~ ~ ~~ ~ ~ ~ ~ ~ d Z .~ a- ~ } ~' _ ~ j C ~ c~ ° ~~ ~ W fl M ~ ~ ~ C 3 -1- ~,, o 0 Wisconsin,Department of Industry, Labor a,.nd Human Relations ' • Division of Safety & Buildings Depth Dominant Color Mottles Texture Structure Consistence Botrtdar Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. y Bed Trerxh 1 0-11 10 r2/2 none 1 2msbk mfr 2 11-28 10yr4/4 none sil 2msbk mfr if .5 .6 3 28-82 10 r4 4 - SOIL DESCRIPTION REPORT Remarks: Boring # 1 Ground elev. 105.9 ft. Depth to limiting factor +82'° Boring # 2 Ground elev. 105.5 ft. Depth to limiting factor +80" 1 0-9 10 r2 2 non 2 9-28 10 r4 4 none if .5 .6 3 28-80 10yr4/4 none sl 2mgr mvfr na na .5 1 .6 Remarks: ;ST Name: Please Print Phone: Gar L. Steel 715-246- 4ddress: 1554 200 Ave., New Richmond, WI. 54017 m02298 Signature: Date: CST Number: 8-16-96 SOIL AND SITE EVALUATION REPORT 1 1r1 A \.I'~ A ~l~ /'~~J~ Page 1 of 3 111 4lVVVlV •.1111 IVI 111 VV.V V, ••IV• /~VI vv Vv COUNTY Plan must include but lan on paper not less than 8 1/2 x 11 inches in size lete site Attach com St. Croix , . p p not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R ~' TE PROPERTY OWNER: PROPERTY LOCATION -... "~r;.~,~,t~~ ,~ Bridgeland Dev. Company GOVT. LOT NE t/a S g~/ ,S 29-T , 29 ,R 19 ) w ~ PROPERTYOWNER':SMAILINGADDRESS LOT# BLOCK# SUED E0 CShY#~° ;,,J4 11736 117th. St. 30 na St. "~` oix to ,es Seco ddn. CITY, STATE ZIP CODE PHONE NUMBER ^CITY ^VILLAGE ~]f0 = "`;,~ ROAD Lakeland, MN. 55044 C 12) 985-5000 Hudson -'` ` = ~~ r,,Q;~'. }~ D ~., pu~d~ [ ~ New Construction Use [x j Residential ! Number of bedrooms 3 [ ]Addition tie tistlr~ . (j Replacement [ j Public or commeraal describe ~~ "'~~ Code derived daily flow 450 9Pd Recommended design loading rate • 5 bed, gpd/ft2 •6 trench, gpd/ft2 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)102.10 ft (as referred to site plan benchmark) Additional design! site considerations alt. site system el. = 101.00' 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=Unsuitablebrs stem ®S ^U ®S ^U ®S ^U ®S ^U ®S ^U OS CCU PROPERTY OWNER PARCEL I.D. # Boring # <~ 3 Ground elev. 104.8. Depth to limiting facto+88 Boring # `~~~ 4 :'i '. Ground elev. 104.0 ft. Depth to limiting factor80 ~~ Boring # 5= Ground elev. 104.0 ft. Depth to limiting factor +80" Boring # Ground elev. ft. Depth to limiting factor SOIL DESCRIPTION REPORT Lot #30 Page ? of 3 .,. Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G'PD/ft Horizon in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed Trends 1 0-13 10~ r2 2 none 2 13-29 10 r4 4 none s' 3 29-88 10 r4 4 none 1 Romarkc• 1 0-8 10 r3 3 none 2 8-22 10 r4 4 none 3 22-80 10 r4 4 none na na .5 ``°•.6 Ramarks~ 1 0-14 10yr2/2 none 1 2msbk mfr cs if .5 '.6 2 14-34 10 r4 4 sil lcsbk mfr if .2 .3 3 34-80 10 r4 4 none sl Remarks: Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel CSTM2298 MPRSW 3254 N 1"=40' BN Bridgeland Dev. Co. 1554 200th Ave. NE4SE4 S29-T29N-R19W New Richmond, WI 54017 town of Hudson (715) 246-6200 lot #30-St. Croix Estaes Second Addn. 8-16-96 8 T C - X00 `This' application toraa 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 comer/contractor, (spQc house), them a second form should be retained and completed When "the property is sold and submitted to this office with the app=apriate deed recprding. OwneroPpropezty YVI~c.~.~,fl~-1.~ `F Vf'1 ~G~[...~ f~?os i _ Loeati~on of property_ ~l/4 5 ~ l j 4 , Section ~_, T a~N-R~w Township u.45o~ liailingaddress /S S ~SU.rtis ~9v~ sT~ lA~+~.l. { ~lr(J ~ ~~lt> 6 Address of site 7~ R ~ R ~~/~ ~ . ~.li ~ ~ 4 ~ ~ subdivision game ~T- c~o~ K ~~4T~s ~itAA.TiM/Lot no. ~3 O Other homes~on property? Yes ~ No ' Previous owner of prop Total size of property Total size of parcel Date parcel vas created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes ~No Volume and Page Number _____~ as recorded with the Register of Deeds. xNCLODE WITH THIS APPLICATION T8E FOLLOAING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL of THE REGISTER of DEEDS. In addition, s cez'tified survey, if available, would be helpful so as to avoid delays of the reviewing process. Zf the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OidNER CERTIFICATION I {we) certify that all statements on this form ar® true to the best of my (our) knowledge that Z (~.-e) 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 o~ Deeds as bocument No. _, , 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. S" nature of App icant Z ~ Date f Signature Co- pplicant Dat ~ Si nature STC-105 SEPT)<C TANK 1VIAIN'I'ENAiYCE AGREILIV)~NT St Crvii Goodly OWNF.Kt/BUYER /yI r r~ A ~. '~- Y-'l' ~ G~e..(.•P, ~~ 05 ~ MAII,II~?G ADDRESS .~ / ~ S S ,~ a ~P~u S ~I y P`ROPTRTY ADDRESS ~ O ~ ~ ' (location of septic systenn) Plea obtain from the Planning Dept. CTTY/STATE PROPERTY LOCATION N ~ _ i/a, ~ ila, secuou a 9 , T a~N-R,~~~W TOWN OF u~ ST. CROIJf COUNTY, WI SUBDTVLSION ~• Gf1b~l~ ~~ ~~+TeS LOT NiTNIDER 30 CERTIFIED SU,itVEY MAP , VOLUME ~ PAGE _, LOT NUMBER fmproper use and maintenance of your septic system could result in its premature failure to handle wastes, proper maintenance comsists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. Wbat 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 o£ replacement 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. 'Ibe property owner agrees to submit to St. Croix Zoning a ceRification 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) after inspection and pumping (if necessary), the septic tank is Iess than 1!3 full of sludge and scum. UWe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordattcc with the standards set forth, herein, as sot by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and rtturned to the St. Croix County Zoning Officer within 30 days of the three year exp' tion date. SIGNEb: / DATE: ~ 7~~ St. Croix County Zoning Ogee Govenunent Center 1101 Carmichael Road Hudson, Wi 54016 11/93 J • ~ DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2- 1982 WARRANTY DEED conveys ana warrants to Michael H Frost and Michele M Frost husband and wi witch survivorship, marital property :~~ the following described real estate in St. Croix County, State of Wisconsin i _'. -,<. Lot 30 . St. Croix Estates Second Addition in the Town of Hudson, St. Croix County, Wisconsin This is not homestead property. (is) (is not) Exceptions to Warranties: Dated this ~,l~day of Mav, 19 97 . (SEAL) * (SEAL) * AUTHENTICATION Signatures authenticated this day of . 19 * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 706.06, Wis. Stats.) This instrument was drafted by Bridgeland Development Comoany 20141 Icenic Tr Suite B Lakeville MN 55044 (S+'gnatttres may be authenticated or acknowledged. Both are not necessary.) ~~ p~A~ . Br~IER WfTAOV DI fIt tr~NNESOTA ACKNOWLEDi STATE OF NIINNESOTA Dakota County Personally came before me, this Mav. 1997 the Neal Krzyzaniak to me known to be the person who execu foregoing~nstrument and acknowl gei ~~~ ~ ~~ *~~r a J Bauer Notary Public Dakota My commission expires January 1, 2000 „ For completion see separate "instructions for Real Estate Transfer Return" PE-SODA. WISC.~INSIW HEAL ESTATE TRANSFER RETURN -CONFIDENTIAL Submit all parts to Register of Deeds with document(s) to be recorded. F ~ GRANTOR; V. PHYSICAL DESCRIPTION AND PRIMARY USE BY GRANTEE 1. Name Brid~p T and T1a~r t^,n . 15. Kind of property 16. Primary use 2~ Address -New address 'rf propeAy transferred was primary residence [~ Land onty a. [~ Residential: 2 0141 I c en i c Tr . , S u 1 t e B ^ Land and buildings ^ Primary Residence for Lottery Credft ^ Other (explain) ^ Single Family/condominium La k ev i 11 e , MN 5 5 0 4 4 17. Estimated land area and type ^ Mufti-fatuity - # un~ 3. Grantor a ^ Individual ^ Partnership ~ Corporation ^ Other a. Lot size x ^ Time share unit II GRANTEE. b. TOTAL ACRES ~ . 44 b.^ Commercial 4. Name M i ~ h a P 1 H _ c. MFL / FC / WiL acres c. ^ Manufacturing _ & M i c h e 1 e M F~ A S 1; d. Ft. of water frontage d. ^ Agricultural ^ Yes ~No 5. Address ~ , j "5>T ~v~NS A v~, adjoining land within 3 miles? ^ Yes ^ No ST ~ PquL , N~ /~/ SS/D (o - 6. Grantor/grantee related: ^None ^Corp/Sharoholder/Subsidiary ^ ^ Fktaricial ^ Family or Other, explain 7. Bead lax bill to: Name sad address III. ENERGY 8. Is this properly subject to the Rental Weatherization Standards, ILHR67? ^ Yes ~ No Exclusion codej~ If W-11, explain . 9.' ^ City • . ^ Village ~] Town N t t cl S n n County $,t _ (:rni x 10. Street address 11. Tax parcel number 12. Lot no.(s) 30 Bik no.(s) PlatnameSt. Croix Estates 2nd Addition 13. Section Township Range 14. Legal Description metes and bounds: (attach 2 copies p necessary) e. VI. TRANSFER 18. Type of transfer: ~ Sale ^ Gift ^ Exchange ^ Other (explain) 19.Ownership interest transferred: ~ Full ^ Partial (explain) 20. Dces the grantor retain any of the following rights?^ Life estate ^ Easement 21. ^ Deed in satisfaction of original land contract? Dated? 22. Points (prepaid interest) paid by seller a 23. Value of personal property transferred but excluded from (25) S 24 Value of property exempt from local properly tax Included on (25) 3 VII. COMPUTATION OF FEE OR STATEMENT OF EXEMPTION 25. Total value of REAL ESTATE transferred s 4 ~ , n n n n n 26. Transfer fee due (line 25 times .0113) Z 1 ~ A n n 27. TRANSFER EXEMPTION NUMBER, sec. 77.25 28. Grantee's financing obtained from If box a or b is checked, complete Part VIII - Flnttutcktg Temte a. ^ Seller b. ^ Assumed existing financing c. ^ Financial institution /Other 3rd party d. ^ No financing involved Vill. FINANCING TERMS (FOR SELLER/ASSUMED flNANCED TRANSACTIONS ONLY) 29. Total down payments (Line 29 =Line 25 minus Lines 30a and b excluding payments for personal properly) 30. Amount of mortgage/land 31. Interest 32. Principal and interest 33. Frequency 34. Length of 35. Date of any lump sum 36. Amount of lump contract at purchase rate (stated) paid per payment of pymts contract (balloon) payments sum a. S 96 S - -/- -/- - s b s % s --/--/-- t 37. If the dollar amount paid per payment (32) is scheduled to change (not as a result of a change in the interest rate), fill in the line letter from above Enter the date of change / - -/ - -and the amount ft will change to S IX. CERTIF TION e d under penalty of law, that thi return has been examined by us and to the best of our knowledge and belief lt is true, correct and complete. G r o g k ~ Grantor's social security number or FEIN Date Grantor's telephone number SIGN 4~=18147 ( - - HERE 4e Grantee's social security number or FEIN Date Grantee's telephone number x{70 q 2 3 5-Z 5! q ) - X38 Print name and address of gran s a Agent's telephone number conveyance FOR Parcel number ASSESSOR'S L USE parcel classification I ONLY RES COM MFG AGR S/W FOR T 1 2 3 4 5 6 Assmt.year 19 _ ^ Field Sales number County _ _ ^ Use Tax dist _ _ _ _ _ Assmt. dist. _ _ ^ Reject 1 2 3 4 iMsconsin Department of Revenue DiSTR1CT SL!PERY!SOR'S COov ~-soo ra. e-esl