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HomeMy WebLinkAbout020-1345-10-000 ST. CROIX COUNTY ZONING DEPARTM 9/" y AS BUILT SANITARY REPORT .. RECCI k Owner Address - Z S t' I� F I L Z tZ I V E I u s 1 tit n — v 1 ' T. City /State P I/D SO N W t ST CRU COUNTY ® ZONING©FFIU Legal Description: Lot Block Subdivision/ '/, 5 W ' /< S w Sec. jj_, TAN -R_! j W, Town of H V D'So N PIN # O 2 O / 3 `/ S = /O -00 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer WF / S F/Z Size ST/PC /ZS�/ Setback from: House - ?-z Well 7S lP/L ffs ' Pump manufacturer Model Alarm location �---- (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: L.F 11 C N Width 3 Length 7 S Number of Trenches Z- Setback from: House Well t So :` - - P/ - L W' - ' Vent to fresh air intake ELEVATIONS Description of benchmark T3 is o f T K E. E 67. S Elevation 100. ay Description of alternate benchmark To F OF itX fL FOU V DA r' lO�-/ 2,747 Elevation f g -7 9,�i l •g(o�1 .q�,2� Buildin Sewer 5r ' 9 ST/HT Inlet g, 8S S Outlet • 2 P Inlet PC Bottom Header/Manifold �� 7 Top of ST/PC Manhole Cover 5� v X Al Distribution Lines O 9 547 ' 1 4 0 H O 9 .$"O . g6,QV ( ) Bottom of System( ) 1 0 1 1 - - q' S Final Grade ( ) el, - ! Q 1,0� Date of installation ZLII — 7 / 9 $ermit number 35 13 State plan number Plumber's signature !,!� Z'`' License number Z 2�d .� �o // / / f / fl g � �� � Date Inspector r�-- Complete plot plan NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW � 1 2 y -ToT r� W (A J S !o Aed6E K i V E. wA 7 Wo w ST G LEQ} y ej ICATE NORTH ARROW r � r Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353113 Permit Holder's Name: ❑ City ❑ Village ❑ of: State Plan ID No.: Miller Sam I Town of Hudson CST BM Elev.:- Insp. BM Elev.: BM Description: rcel Tax No.: le v / ®� e4k . r 020 -1345-10-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark I� P1 3- e1� D Alt. BM 5 O/ /o - 3 Aeration Bldg. Sewer 3 ing St Ht Inlet �U U TANK SETBACK INFORMATION h Ht Outlet TANK TO P/ L WELL BLDG. A Ve tto ROAD Dt Septic 1 Z 2 1 NA o NA Header / Man. Aeration NA Dist. Pipe 6, y✓ ding Bot. System i3 - PUMP/ SIPHON INFORMATION Final Grade /oD: Z� facturer Demand St cover 160. Model Number M TDH Friction System TDH F F rcemain I Length Dia. Dist. II SOIL ABS RPTION SYSTEM z �- s �� BED E Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DI N 3 �' 7 — DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LE ING Manufac urer: INFORMATION Type O f 1 A B MO )I I Nuq�ber: System: d' DISTRIBUTION SYSTEM Header / Man Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake Length Dia.i Length � Dia. _ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑Yes [] No Mulched E] No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: // / /, /? Inspection #2: Location: 725 Packer Drive, Hudson, WI (SW1 /4, SWIA, Section 11 T29N - R19W) - 11.29.19.1851 I Ga�,�r z > y' o� coin / ✓ Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Da a Inspector's Sign re Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E FT 1 .. t £® S 9 n pr vvd 3 e i T + q PHI , °»� � �..... a ........., a -.-.,, amp.... °: ....<... ».. 3 m °° + .,., �, 4. a c ;.. E c m° e ` _ S } c 4 . TV— AA ., V w., ..... �., mm.. .... ° ° ° § .........»S € P E � _ k x 55 r i ° E 3 3 £ L t I E E [, . 1 : - - i 9 3 i p . „ __. _ .... mm. ,.. t [ 1, _ , ° ®m.e., emm t in FT � P 4 a S i t I E E c f °v Z + .17, t Y 4 p,n xW 9 € i .....�.. .... , , _ �..... ..... p . m_......._ , , , , ..,.,. _ , ,..,.,.. _ ..... __. ... ..,, E � J I ` E f i � ,._�.. n.° ._..£ „, .r.. V.( ZI F i ° B E i E ; E r i F m 1 1 i e a na 3 t — " l — 7 [ I EIIJAItt.1:1 17� £ P # P a s 1 r — _P51"u- ZA Safety and Buildings Division 201 W. Washington Avenue *6onsin SANITARY PERMIT APPLICATION P o Box 7302 g Department of Commerce In accord with ILHR 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 than 8 112 x 11 inches in size. - t • See reverse side for instructions for completing this application State � Sanitary Permit Number Personal information you provide may be used for secondary purposes n Tif re to preo 1 ss a pplication [Privacy Law, s. 15.04(1)(m)). -7 Z.'r 7�1A -Cte„ ` � ` f c. f+ -r �J State Plan I.D. Number L APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Prop y O ner N e Prp4 1/ ert y Lor, ion S `� T , , N, R E Pro erty ailin� Address Lot Number t Block Number //tt City, State ♦ Zip Cod Phone Number Subdivision Name or CSM Number (_ ) . TYPE OF B DIN : (check one) ❑ State Owned 0 it Village Nearest Road /� Public 1 or 2 Family Dwelling- No. of bedrooms own OF Ivr a (U vc III BUILDIN U E: (If building type is public, check all that apply) Parcel Tax Number(s) r 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales / Repairs 11 ❑ Restaurant / Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1, DC New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5 ❑ Repair of an ystem System Tank Only Existing System System B) Sanitary Permit was previously issued. Permit Number 3 Date Issued 9 V. TYPE bF SYSTEM (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 []Seepage Bed 21 []Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage TrenchlEAO 22 � In- Ground Pressure 01 42 ❑ Pit Privy 13 ] Seepage Pit AD /Af i`° /C rK# TO& 9-,K X 7S 43 ❑ Vault Privy 114E]System-In-Filr 3 1.7 VI. ABSORPTIO EM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 1 7. Final Grade Required (sq. ft.) Pro po ed sq. ft.) (Gals/day /sq_ ft.) (Min. /inch) Elevatiory 4 . ` Feet 4 �f Feet Capacit VII. TANK in Ca allo g Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existin structed Tanks Tanks eptic Tan r Holding Tank ~ ❑ ❑ ❑ ❑ ❑ Li ! R 7ump Tank /Siphon Chamber I ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No St ) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 1070 ILC)Wrx/t� e RD PUDSON W 1 4 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuin Agent Signat re o Stamps) pp ❑Owner Given Initial roved surcharge Fee) \ Adverse Determination r X . CON QITIONS Cj F AP_PROV /!SE O S FQ,�t DIS�APPRC}VAQ 2 SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary,Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -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. Ill. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill-in the capacity of every new /or existing tank, list the total gallons, number of tanks and• manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mainstwater 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. c � - Safety and Buildings Division Oisc SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 In accord with ILHR 83.05, Wis. Cdei; Department or Commerce \ `w. Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syste ¢aper/gt�. ss CouT than 81/2 x 11 inches in size. • See reverse side for instructions for completing this applicat on - state "Sarltary Permit Number Personal information ou rovide ma be used for seconda A 3 �3 l� .3 4r^. , Y P Y ry purposes r -, C "it revision to pre sous application [Privacy Law, s. 15.04 (1) (m)). � t `-rfjf`. !�� �Q 't}. State , PI I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL IN Pro erty Owner Name ert Loca N, R E (or Property Owner's Mailing Address Lot Block Number City, State Zip Coo a Phone Number Subdivision Name or CSM Number U Q 1 Q (3W Z7 Q M£ SrOAD 11. TYPE IN : (check one) E] State Owned o City Nearest Road El Public 1 or 2 Family Dwelling - No. of bedrooms 2-- Town OF V E/Z D k t L 4G 111 BUILD[ USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1'- 2'. 110j .' 1 ❑ Apartment/ Condo OZ- ! 13 YS ` l - 0© D 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. (` 2. ❑ Replacement 3. E] Replacementof 4 E:] Reconnection of 5_ E] Repair of an `_t_�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 LrA C P 22 E] In-Ground Pressure 42 [] Pit Privy 13 [] Seepage Pit a / K F( L'I" R-AT,4At, � >� 3 X S(.• Zs / 43 ❑ Vault Privy 14 ❑ System -In -Fill 3 f t'� /4 1 C A 3ii< f T C. 14 4 vK 7 1 E RL V ABS ORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade equired (sq. ft.) Proposed (sq. ft.) ,(Gals/day/sq ft.) Min.linch) Elevation S— '.... �. / rFeet Feet Capacit VII. TANK in Ca allo g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App New Existin strutted Tanks Tanks epticTank /0010 t ❑ ❑ ❑ ❑ ❑ Li ber ❑ ❑ 1 ❑ 1 ❑ 1 ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): t V ?d Hw NTE f A Q� IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued ent Signature (No Stamps) A roved Surcharge Fee) pp ❑ Owner Given Initial Adverse Determination 2 5. r X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 -266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. N L 3 ,N W � r; n Ilk ,a -4 o `a, Q x Q a \19 cue Qz- � a y W M ` V T d zo E c m r) a� N �. x c6� 0 o �� C y �•W x N M O ?L � ; T Q l0 w mom N N p N F c C S p o o ( D > a �l �- a 4J Q C rn — o = ,=c 5 x ca 5oc -v2 w cc cu n > o a� mwti O CL 2 c OF ho CL H V) V ' y T f� O ® s cc W • Z`�� w : Q) E �: p Z LU E � 3; co ui yy+ . r Wisconsin Department of commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmental By Lasigrt Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (SM), direction and _ St Croix _ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - Plea o tion. Date �! _ s. 15.04 (�? (m)) R !awed By Personal information you provide may be used for rposes Property Owner V Property Location MILLER SAM I I �' ovt. Lot - SW 1/4 SW 1/4 S 11 T 29 N,R 19 W Property Owner's Mailing Address k �: t # Block # Subd. Name or CSM# TROUTBROOK RD 194$ , ' 1 - Homestead City Stat r City ❑ Village ❑Town Nearest Road Hudson W1 - /� Hudson McCutchen And ❑ �'c6n�§b ors 3 ❑Addition to existing building ® New Construction Use: Replacement ❑Pub r ill cribe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft 8 trench, gpolft� Absorption area required 643 bed, ft 562 trench, ft Maximum design loading rate •7 bed, gpolft .8 tr ench, gpdA Recommended infiltration surface elevation(s) 96.30 ft (as referred to site plan benchmar Additional design I site consideration I Parent material Wind blown loess over glacial till Flood lain elevation, if applicable na ft S= Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U=Unsuftalle for system ®S ❑ U ® S El ® S ❑ U ® S ❑ U [IS ®u ❑ S R U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure GPD/ft2 Boring# Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 1 1 0 -3 10yr3 /2 - sil 2msbk mfr gw 2f .5 i .6 __ 2 3 -8 7.5yr5/6 - sl 2msbk mfr gw 2f 5 ! 6 Ground 3 8 -19 7.5yr6/6 - s Osg ml gw - .7 ; .8 elev 97.88 ft 4 19 - 42 10yr5 /4 - s Osg ml gw - 7 8 Depth to 5 42 -92 7.5yr4/4 - gs Osg ml - - 7 8 limiting , factDr f . >92 l s , V Remarks: 2 1 0 -19 IOyr2 /1 - is lfsbk mvfr cw 2f .5 .6 2 19 -36 10yr5 /4 - s Osg ml cw - 7 8 Ground 3 36 - 98 7.5yr4/6 - s Osg ml - - .7 .8 elev 99.49 ft Depth to limiting factor _*7 't- 38 '79 63 Remarks: CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson 715- 246 -2454 Address Environmental By Des Date CST Number Ref # ' 1432 120th Street, New Richmond, W1 54017 8/16198 227387 87 PROPERTY OWNER: MILLER, SAM SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL 1.D.# Environmental Bv Desi Horizon Depth Dominant Color Mottles Texture Structure Co nsistence: Boundary Roots GPD/fl? in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ! Trench 3 1 0 -5 1Oyr4/3 - is lfsbk mvfr cw 2f �_-5- i ' g .• 6 2 5 -19 10yr5 /4 - s Osg ml cw if .7 ! .8 Ground elev 3 19 -24 7.5yr5/4 - s Osg ml cw - 3 ; .8 99.87 ft 4 24 -63 7.5yr6/4 - s Osg ml cw - 7 ; 8 Depth to 5 63 -100 7.5yr6/4 - s Osg rw - - 7 i 8 limiting Its factor >t 2 X Remarks: 4 1 0 -10 1 Oyr3 /2 - sl 1 msbk mfr cw 2f .5 .6 2 10 - -27 1Oyr5/4 - sil 2msbk mfr cw if .5 .6 Ground elev 3 27 -31 10yr3 /2 - sl lmsbk mfr cw - .5 .6 99,29 ft 4 31 -38 7.5yr5/6 - s Osg ml cw - 7 8 Depth to 5 38 -96 7.5yr6/4 - s Osg ml - - 7 8 limiting factor Remarks: 5 1 0 -9 10yr3 /2 - sl lmsbk mfr cw 2f .5 .6 2 9 -30 10yr5 /4 - sil 2msbk mfr cw if .5 .6 Ground elev 3 30 -32 10yr3/2 - st lmsbk mfr cw - .5 ; .6 98.54 ft 4 32 -35 7.5yr5/6 - s Osg ml cvv - 7 8 Depth to 5 35 -98 7.5yr6/4 - s Osg ml - - 7 8 limiting factor >98 Remarks: Ground elev Depth to limiting factor Remarks: i � w r O B D 1��VI 1�1111t 1�TT L SIGN 1432 120th STREET, NEW RICHMOND, WISCONSIN 715 - 246 -2454 PROJECT NAME M014ES'TEAD PAGE 3 DESCRIPTION SW 'Y SW 1 /, SECTION 11 T 29 N, R 19 W TOWNSHIP Hudson COUNTY St. Croix 2 . ac T i A L ° p` Ld � 4� s a t(2r) w14 a W Tfe� rl 3 B� SCALE _ �/ Tom Nelson BM 1. B)r LLe l n ! {_ re e Q Ie IU0 1 CSTMO2605 (y h �� c l rn c,a.k � Trot BM 2. S W L of N q_ , ) 2 1 (9 3 7 r L c f C orry, puz- ST CROIX _'OUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Re' X Property Address r- f Z e- F /l. ( V o (Verification required from Planning Department for new construction) IF City /State CT y t) S O !'! l.t? r Parcel Identification Number LEGAL DESCRIPTION / l" Property Location S � 1 /4, S 1 /4, Sec. 1 , T 47 N -R, Town of e4.4) 50 IJ .Subdivision • 0 7 iEAO , Lot # Certified Survey Map # ! y 3 , Volume Page # a0 Warranty Deed # sy 12 3 9 , Volume / ,Page # ? Spec house R yes ❑ no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensed pum per verifying that (1) the on -site wastewater disposal 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 St. Croix County Zoning Office within 30 s of the three year expiration date. fl �/ / NA OF APPLICANT DATE : OWNER CERTIFICATION .'(we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of e ropMy described alive b virtue of a warranty deed recorded in Register of Deeds Office. 9 / 0o/ 9q N OE ' L +CANT 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 Re gister of Deeds office PP P h' g a copy of the certified survey map if reference is made in the warranty deed !t. \ It t tF WISCONSIN FI)RJI 1 - 19132 « . w. ,• +., � M. _oe:. u. *. �. WAI) DEEp. This Deed, rtt:d. L,tweel, 3on.1 i.. t_11 ie and Nao; R. Lillie, nusbarld anti 10: )tl A. nd Jdltl E. Miller, d Sl n�;le person r , Gr•ult.•c, 'ItVltlleSSeth, That :he aid (;raptor, for a valuable eonstderot,un tva�u..a ro t•. ( ;rentee the fulluwtt ; des. ribed real estate in S. t.. Croix C Unty, State of Wisccnsttl: See attached description. Tart l areal No: ... ......... ...................... . I TRA ' FER � �o EE 1 I 1 This i s not. hontestcad property. t1s) (13 not) Together with all and singular the hcredaaments and appurten..cces .: cre-untu 1— 441119; Aud Ronald L. Willie and Naomi R. Millie , ..arrant> that the title is gu,,J, unirie IL:c in lee simple and free ,no encumLr:..ne; r>:cpt easements, restrictions, and rishts -of -way of recocd, nd will %%im nt and defend Ue game. hated tilt,' day of March 19 90 . r' (SEAL) <r�ckl( L (SEAL) . Ronald L..Willie (S:.AL) V :f�r'r tc=- / s /_s C LCG (SEAL) . Naomi R. Millie AUTHENTICATION ACKNOWLEDGMENT STATE OF 15ISCONSIN .... ... ...... .... -. .. ...... .. .. ......_ -- - . -S t. CrQ1X ..- - County. 1 .r •� authcnticattd thi_ __ da • of 19.... Person:,,.; carte before me this ..41 .... day of h - � rc h., 19 91 the above named - ........... -------- ..................... . TITLE: 11EIIRER s *rATE I3. \It ( WISCONSIN ...... ... _.- ...... .__... ..-- (If not, _ _ _ .._..... _... _.... authorized by a 7m U % i;. Stat,) to me known t„ i,e the per r,.n .S. wf.v executed the furc„uing instr .went and the same. THIS "+efFUht,Nf was C .! .t 3 f,V �'��• ... C. L. Gaylord,_ - attot nay / 1 !r'46 - _ 1t er r2 / y River Falls, kJ _ 34022 _ Not•, c PuJ,4-- .._Lc - "SAe county", Wis. I TI[I..t'.. r. �, .y ho "utt.,.ntit':,t.,l �r .,•ti. a�.w {�: „,J. is..th JI) Contnu,tint: iyr p4rnlKnbnt. (if nJt, ,gate txPiration date; > '.•�' /..y /�,� 19 4 ;) l�:�RKA \TS" DLtD al "•. 1 112 OF N'hrY1C�IF 1l. �. r L. ':.I 1:;.,.. t• C•' L•c. F ul: \t moo. 1 -1763 tl,, .. ,,�6er, 1ru A parcel of lane located in the SE -1/4 of the .: ani tf'E St: - I/ 4 Of the art of SL -/ p 1 4 in of SEC Lion 11 7oa•r,sh Ve_t, Town of Hudson, being further described as foilows: E "nEE 19 be N6 anning at the S -1/4 corner of said Section 11 thence 29'G3 "1;, along the South line of the St•; -1/4 of said Section 11 231b.39 feet; thence NO2 16'Ob "M 1322.62 feet, of the to the Kcrth line S - of the SV -1/4 of Section 11; t }.E'cE S�90"''' " "E, alcn: said North line, 2446.:, feEt to the %orth - �cuth 1/4 line of sai d Section 11; thence S00 34'16 "i: 5 f E E , alone said Korth -South 1!4 line az:rEs cur d. Square FE ) (3,1 ,1 ,67. to the point of beginnini. ParCEl contains 73.32 r eEL and subject to all ease7,ents of record. Together with and subject to an easement for ingress and egress located in part of Lhe E -1/4 of the S1; -1/4 of Section 11 and in part of the SE - 311/4 of the SE - 1/4 of Section 10, all in Township 29 North, RanfE 19 Vest, Town n -pf Hudson, being, further described as follows: Corr ;c:encinZ at the 5 -1/4 corner of said Section 11; t) - -, E. NE9 29'03 "W, along the S uth line of the Sk -1/4 o said Sec.__•. 2376.31- fer.t; thence NO28 f 26'06 "►: 1256.54 feet to the point of bcginnint; thence cunt ;nuin9 NO2 li 26'0b "h; 66.06 feet to the North nt of the S -1/2 of the SW 1/4 of said Section 11; thence Nb� 35'50 "1.', along the Korth line of the S -1/2 of the S1 -1/4 of said Section 11, 179.28 feet to the NE corner of the SE -1/4 of the SE -1/4 of Section 10; thence N59 41'39 "1:, along the North line of the SE -1/4 of the SE -1/4 of said Section 10, 1318.24 feet to the Wes line of the SE -1/4 of the SE -1/4 of said Section 10; thence S00 25'39 "1.', along said Vest line, 66.00 feet; thence S69 "E, on a line being 66 feet distant Southerly and parallel to the North line of the SE -1/4 of the SE -1/4 of said Section 10, 1�1E -32 feet to the E line of said SE -1/4 of the SE -1/4; thence 569 "t; or a line beinz 66 feet distant Southerly and parallel to the North lire of the S -1/2 of the S1: -1/4 of said Section 11, 162.54 feet to tF.c pint of beg,innint. Parcel contains 2.27 acres (Q5,9.6 Square FEED and is sut3ect to right- of -wai• for town road d sutjEct to all easer.snts of record. (`cott ):.ead) ar, T: foreari eacc"._.. t. JF LIAN rmwe K 7 r N oo S9g• 33 y. y 4t4 +� i 1 � AoRls Acft,� roaat N y 'ga l " Kt4n P A. / 3r N r r r It'4,�� 1 Itt \4"Oft tp ZI r�. � � , � •, \ for _� r ~ l40. 14' • \4M \ pr 031 MR& u� r J 2 1 tat ACAl1 �, tr\ • 1 � Q't / 2%3 SQ RL ' ,� Ih i i ts _wl�.�' I�� _ Left A°IN �. A13. C.L 1 ss rN. .6 so. pr — Ap.W All •AA � y� f 3 J'�!t T � g' !I� �urM urn pR 4.4 sp, 'r \ �a i swr, " � 2378 i tes.tr SEC. lie w�N 0 Rig W