HomeMy WebLinkAbout020-1346-20-000 ST. CROIX COUNTY ZONING DEPAR f � J-- A?
AS BUILT SANITARY REPORT R '/ a
Owner S/4 Ll9 Gz.- to
Property Address ' 1 60 Z L- to ,aA C!� 4
t Y � " f.r ST CRUX
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City /State w o—" K t � n 1l COUNTY
ZONINGOFFtcE
Legal Description
Lot Block Subdivision/CSM # NO AA E- Z. Tt /4 d
4 /4 „ ' SU) 1 /4, Sec. Tz ',N -Rff-W, Town of Hw D Q M _ _ PIN it 0 20 • Yea— 40 Z-
� S�EPT�ICTMANK DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacture Size ST/PC� Setback from: House Well P/L�
Pump manufacturer — Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road r Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: L Width Length
��O 2 Number of Trenches '2...
Setback from: House = - '2 • Well too' P/L $� , Vent to fresh air intake Ci t
ELEVATIONS
Description of benchmark r - 19.0 N 0 e' Att Cl, - 7+ q Z Elevation I 60 40
Description of alternate benchmark or a /OAK LoU nrt�T Cx( -- .S`dc; ` Elevation d1 1.4 2 -
�,S B
9 4-7 ST/HT Inlet`3 74' " -7 - 4 §T Outlet 11 IV-14-0 PC Inlet
Building Sewer 7� �
$,51 t t? 'tw
PC Bottom � Header/Manifold � �'� �` 5'" 5 5 Top , of ST/PC Manhole. Cover
Distribution Lines (1)
Bottom of System (c) !t �� !n� (Z) �'� F� 1 •fi ( )
Final Grade (�) ( ,Oct �t ('t.) ( � ,C+O " � -z )
Date of installation !` /Permit numb r� State plan number
Plumber's signature License number z ZS D 3 (o Date
Inspector e h--
Complete plot plan �
I� —
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
av
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INDICATE NORTH ARROW
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y:
Safety and Buildings Division Count
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.. IX
Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 338881
Perm Ar Name: El CityHUDSOg_ Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: 1V E Parcel Tax No.:
Cry, 0 r QU, 0' , SCt)' ( i mt,,,�r 020- 1346 -20 -000
TANK INFORMATION ELEVATJON DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic , 1 M7D Benchma ( 6. 70 [06 T U0. �
Dosi ng A# -q# Y. i o2A6
Aeration Bldg. Sewer
Holding St/ Ht Inlet T.
TANK SETBACK INFORMATION St /Ht Outlet
TANK TO P/ L WELL BLDG. Air l to ntake ROAD
ir
Septic 7 7f Z3' _ NA E34 904912A
Dosing NA Header /Ma 4 �' g3.g
Aeration t Dist. Pipe --
Holding Bot. System 13. C12. 0s
2- S
PUMP / SIPHON INFORMATION Final Grade 9. gS.6
nufacturer D
�c Nnrrt I
Model Nu r -- °` GPM
TDH I Lift F System TDH Ft
F aln Length Dia. Dist. To
SOIL ABS RPTION SYSTEM
THE Width Lengt No. f T en es PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 "' DIMENSION
SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Man: tu�c� rej: S - n
SETBACK CHAMBER model
INFORMATION Type O Number:
System: CWVA) i ,` OR UNIT
DISTRIBUTION SYSTEM
Header / anifold y Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length t, Dia. Len Dia. Spacing > & S
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 -�J ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) CA) f 1 = U:sS,
LOCATION: HUDSON 11.29.19.1855,SW,SW 726 PACKER DR - HOMESTEAD LOT 12
> Ie' swi eat
Plan revision required? ❑ Yes 5d No t� .S Z
Use other side for additional information. 1 /0 ked
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
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ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 W. Washington Avenue
Visconsin In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302
Department of Commerce Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 vi x 11 inches in size. 5 e�
• See reverse side for instructions for completing this application State sanitary Permit Numb
Personal information you provide may be used for secondary purposes heck if revisiok a out a pplication
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION
Pro ert Ow�ner N �� / 4ert ((J Loc
1 14, S T 7-5 , N, R E ( W
Pro erty Own s Mailin Address Lot Number Block Nu mber
50 y / -Z
City, State Zip Cod Pho Number Subdivision Name or CSM Nu er IF Q11
II. YP BUILDING: (check one) ❑State Owned It Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms ° Town of f
III BUILDING USE: '(If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo C�l 2.o — / 3 q (
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. 1;6 New 2. ❑ Replacement 3. ❑ Replacement of 4, ❑ Reconnection of 5. ❑ Repair of an
______ System________ System_____________Tan kO nly________ ____�_�_,/Exi----- ystem________ Existing ----- System
B) C] A Sanitary Permit was previously issued. Permit Number 3 3 tka l 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 Eg Seepage Trench L UL '4 22 In- Ground Pressure 42 E] Pit Privy
13 ❑ Seepage Pit i� / 91Z 71194'fOA, ax 3 xsY. • 43 ❑ Vault Privy
14 ❑ System -In- Fill $' - 3 t1TS sq F s7 y
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
.4 1 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
1 15 - 4 - 5 Z- 12.0 Feet G , t
VII TANK Capacit g allon s g Total # of r Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass. Plastic App
New Existing structed
Tanks Tanks
ept c Tank o Holding Tank / C70 If F ❑ ❑ ❑ ❑ ❑
p 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) Plumber's Signat No St ) MP /MPRSW No.: Business Phone Number:
Plumbers Address (Street, City, State, Zip Code):
l o 70 a RTF4, I I a 0 s o A w
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary P mit Fee (Includes Groundwater D ate I ssued Issuin Agent Ignature (No Stamps)
Surcharge Fee) �� / ^ r
n-� ❑
oved Owner Given Initial CT'
( / 7
Adverse Determination
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.
11. 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 8 if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or 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.
� � Safety and Buildings Division
•ISCOif15 %11 SANITARY PERMIT APPLICATION 201 Bo Washington Avenue
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 81/2 x 11 inches in size. 5 � , • See reverse side for instructions for completing this application State Sanitary Permit Number
Personal information you provide may be used for secondary purposes E] l�o Check it ievn ot" previous a(plication
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION
Property Owner Name Pr Location
( L.LC fit.- 5&A /4S W 1/4, S / T Z , N, R/ � E (DWD
Property Owner's Mailing Address Lot Number Block Number
City, State Zip Code TThone Number Subdivision Name or CSIV Number
11. TYPE OF BUILDING: (check one) ❑ State Owned E] fit lI yy earest Road
Public 1 or 2 Family Dwelling - No. of bedrooms ° Tow OF �.% S Qnr ?lat R ( re
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) j' . M
1 ❑ Apartment/Condo L O Lo l 3 y4 — &a - — 4OC74
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. XNew 2, ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an
System System - _Tank Only Existing System - -------- - Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non- Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
1210 Seepage Trench t eAcH 22 ❑ In- Ground Pressure 1 42 ❑ Pit Privy
13 ❑ Seepage Pit 0 ! M PILTAA10 v1 X 3 K SZ. -ZS 43 ❑ Vault Privy
14 ❑System -In -Fill la +► 3 /, fj Q Ftr q/ Co& 0 11✓INCIt T9,4704 s
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
Ael O Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
5 co 3 S -1 7.- '$ /62. Feet / O4.. Zr Feet
Capacit
VII. TANK in Ca allons
g Total # of Prefab. Site Fiber - Exper
INFORMATION Gallons Tanks Manufacturer's Name Concrete con- Steel glass Plastic App
New Exist in structed
Tanks Tanks I.'
Se is Tan or l4@LduLy,Ipk J o ao / W / 4� ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ 1 ❑ 1 ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) nature Sig ( 5tam MP MP SW No.: Business Phone Number:
Plumber
Plumber's Address (Street, City, State, Zip Code):
!� ,J UJ I l
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit F e (Includes Groundwater ate ssue Iss
VA /roved uing A nt ignature (No Stamps)
pp ❑OwnerGivenInitial � OI> Surcharge Fee)
Adverse Determination X. CONDITIONS OF APPROVAL /'REASONS FOR DISAPPROVAL: &_-rO4 - C - C4 i
,
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.
----------------------------------------------------------------------------------------------------
i
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
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Wisconsin 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 Design
Attach complete site plan on paper not less than 8Ys x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix
percent slope, scale or dimensions, north arro cation and distance to nearest road. parcel I. D.#
APPLICANT INFORMATION `I ii 9 onnation.
Personal information you provide may sewn L y puipo( y l.aw, e. 15.04 (1) (m)). Re B ate
Property Owner I I CE,I V E .1 Property Location
MILLER SAM /' ;, _ Govt. Lot SW 1/4 SW 1/4 S 11 T 29 N,R 19 W
Property Owner's Mailing Add F F e ! Rn f)s J : J Lot # Block # Subd. Name or CSM#
TROUTBROOK RD & T C , . R X 1 t 12 Homestead
City St to Zip ax* %neNum ❑ City ❑ Village ®Town Nearest Road
Hudson J ZONING(7M69r, Hudson Labarge
® New Construction Use: �Re>�ti��k IQI, r of bedrooms 3 ❑Addition to existing building
❑
Replacement le mercial describe
Code Derived daily flow 450 gpd Recommended design loading rate + bed, gpolf'P trench, gpd/ff?
Absorption area required bed, ft' trench, fF Maximum design loading rate I— bed, gpolffs , 9t tr ench, gpd/f 2
Recommended infiltration surface elevation(s) A- :p2 �! � X) it (as referred to site plan benchmar
Additional design / site consideration
Parent material n Flood plain elevation, if applicable ft
S=Suitable for system Co ventk7al and In-G and Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system S ®u S ®U s® u ❑ S E U ❑ S ®U ❑ S® U
SO L DESCRIPTION REPORT
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary oots GPD/ft
Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. rY Bed Trench
1 1 0 -11 10yr3 /2 - sil 2msbk mfr cw 2f .5 .6
2 11 -28 10yr4 /4 - sil 2msbk mfr cw if .5 .6
Ground 3 28 -49 7.5yr5/8 - gs Osg ml cw - 7 8
elev
- - -
q 4 49 -98 7. Syr6 /4 s Osg ml .7 ; .8
limiting
�factor
0'1
Remarks:
2 1 0 -14 10yr2/ 1 - I 1 msbk mvfr cw 2f .5 .6
2 14 -34 10yr4 /3 - A lmsbk mvfr cw if .5 .6
Ground 3 34 -61 7.5yr5/8 - s Osg ml cw - 7 8
elev
QQ 4 61 -70 7.5yr7/1 c1t2.5yr3 /6 s Osg mvfi cw
D` ptfl t01 5 70 -100 7.5yr5/8 - s Osg ml - - 7 8
limiting
factor
Remarks:
CST Name (Please Print) Signature: C Telephone No.
Thomas C. Nelson `�— 715- 246 -2454
Address Environmental By Design Date CST Number Ref #
1432 120th Street, New Richmond, Wl 54017 8/19/98 227387 67
I "
PROPERTY OWNER: MILLER SAM SOIL DESCRIPTION REPORT Page 2 of 3
PARCELIDA Environmental Bv Design
Horizon Depth Dominant Color Mottles Texture Structure � onsistence Boundary Roots GPD/f 2
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
3 1 0 -10 1Oyr2 /1 - sil 2msbk mfr cw 2f .5 ' .6
2 10 -19 10yr4 /3 - sil 2msbk mfr cw I f .5 .6
Ground
elev 3 19 -27 7.5yr5/8 - is lmsbk mvfr cw
`T� 4 27 -44 7.5yr5/6 - s Osg ml cw - 7 8
thto 5 44 -96 7.5yr6/4 - s Osg ml - - .7 .8
limiting
fac
Remarks:
4 1 0 -10 10yr2 /1 - sil 2msbk mfr cw 2f .5 .6
2 10 -32 1Oyr4/3 - sil 2msbk mfr cw if .5 .6
Ground
elev 3 32 -43 7.Syr5 /6 - s Osg ml cw - .7 .8
4 43 -63 7.5yr6/4 - s Osg ml cw - .7 i .8
t1e t 6 5 63 - 98 7.5yr5/4 - s Osg ml - - .7 .8
limiting
factor
Remarks:
5 1 0 -13 10yr2 /1 - sil 2msbk mfr cw 2f .5 .6
- 2 13 -20 1Oyr4/3 - sil 2msbk mfr cw 1f .5 ! .6
Ground
elev 3 20 -40 7.5yr5/8 - s Osg ml cw - .7 .8
4 40 -42 2. Syr4 /8 - cs Osg ml cw - .7 ! .8
QDepth to
5 42 - 94 7.Syr6/4 - s Osg ml .7 i .8
limiting
factor
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
i
0 RL BY DE51 �I � �
1432 120 STREET, NEW RICHMOND, WISCONSIN
715- 246 -2454
PROJECT NAME HOMESTEAD
PAGE 3
DESCRIPTION SW % SW %, SECTION 11 T 29 N, R 19 W
TOWNSHIP Hudson COUNTY St. Croix
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SCALE I"= n --� r Tom Nelson
BM 1. �,p f2 ` 1 0 0 �o p °t �' �� P' �� csrnzo 2605
BM 2. - 0 j o 2.73 Im a � ? 39'0- sd
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 51 dot L L f tL
Mailing Address 0' 5'/
Property Address '�
P Y
(Verification required from Planning Department for new construction)
City /State K V ID S Qr1 Parcel Identification Number
LEGAL DESCRIPTION
Property Location w '/4, '/4, Sec. , T z g N -R / W, Town of y D S Q N
Subdivision T t`{ ,Lot #
Certified Survey Map # s7 6 / '� - , Volume - , Page # � Q
Warranty Deed # w , Volume Page # 2e�
Spec house V 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, restricted plumber or a licensed pumper 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.
Itwe, 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 exwration date.
1 Z y' �
',� NATUREI OF APPLICANT DATE
�: .40WNER CERTIFICATION
' a.' - 1'(we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
pro � ` .described abo , by virtue of a warranty deed recorded in Register of Deeds Office.
GNATURB F A1 DATE
* * * * ** Any information that is mig- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
I
•,c: STATt. IjAit uF 11•ISCONSIN FORai 1 1962 «•. .r..i N1aCN.1.` 1JN u:oen.w: o•r�
This Deed, III. dv Lctwcen
ona I( L. t+ i I I ie and
Nao;li. R. toil l ie, husband and w -,fe MAR
liran:or, 10: 30 A.
.,ml Sam L. Miller, a .sinile .p.ersoa ,
Gr•Intee,
W itnesseth , That the aid (;motor, for a valuable constdcrat.on
ro.tc.•;N to t;r:urtcr the folluwu. des.nbcvl real estate in $.t..
C roix gL+uNq ro
c unto, State of N•tscinsln:
See attached description.
Tax It &reel No: ... ............................... .
TRAW&I
1
This is no t.... homestead property.
(IS) (Is not)
To,trther with all and singular the hereditament& and appurten..nces .:.vreunto Lt. -aging;
And Ronald L. Willie and Naomi R. Willie
%%arrant. that the title is gaud, lu•icfe . +tL;e in fee simple and free ; i,u rlrai .,f encumbr:,u.es cx%: pt
easements, restrictions, and ri;hts -of -way of record,
;,nd wI!I , .arrant and defend U e ,ume.
hated tilt. d.,y of March
(SEAL) ,t rye k� L• t l � �� �tt (SEAL)
Ronald L. Willie
(SLAL) jsc"rs <G- / .` /tGLCC (SEAL)
. Naomi R. Millie
AUTHENTIC A•rION ACKNOWLEDGMENT
Sibmaturc�s) _.. _..... _._...... -..... STATE OF %� 1SCONSIN
....... -...
sa.
... ...S.t... CrQ17C ....... Ibunty. „
authenticated this ..,. day of _...., 19.... Person:,,.: came ber,re me this .....day of
hd.G h., 19 9.6.. the above named
... ..Ro.n:31d...L....Wi. Le...and._ ........... . .. •
__ .._ .... ... _ _ ..
....... ... I.... ....... ................. --
TITLE: NIENIRER STATE B.tit (-F WISCUNSIN _ ............................
tIf not, ... ._. ... _-
authorized by a ;UG.0 i, %Vis. Stat. - )
to me known t,. W the pen„n .$. . .... aiw executed the
foregoing instr .went and.,q}',k>?owlcdge the same.
THIS ,N aTRUMf N "r WAS D F.CL) IIY
.... .... ... t . ..- - ... ..
C. _L. Gay.l.ord,..A,tto.rney.
/
River Falls, WI a4U2Z j �.��� cnuno, W is.
, Not:v I' 1 1 •
I�Inu,t,,r, a ,y Le ulti,cntie :a,a ur :,,Ln•,wkJ oJ. 11•,th Jly Con kill ,tale expiration
.r: not t:,•r.....,n.) '
date: 19 Q 1.)
....., ..., ..eiu:.q , —1 r,1.., thy., — jc—t .r,
NARkA%TI' nfchp art. r. (It OF N'I�,'U \SIN .. N. i� �• L. :.� 1::,..1. C. Ire.
Fuk)1 :M. 1 — 196: \li• +eo ►ro, M v
1
l
parcel of land located in the SE -1/4 of the FV -1 and in part of
the S"I of the S6 -1/4 of Section 11, Towcship 29 !north, R;;nfc 19
We.t. Town of Hudson, bEirF further described as follows:
beganninE, at the S -1/4 corner of said Section 11; thence
h69 29'03 "i;, along the South line of the SV-1/4 of said Section 11
237&.39 feat; thence NO2 2 &'06"i: 1322.62 feet to the North l ine
'If LhE S-1 /2 Gf the $1,' -1 /4 of Section 11;
said forth line, 2446. LF.ECCE �
$ :
:, fEEt to the North -icuth 1/4 line ofsaid
Section e
1325.66 f eet thence S00 34'16 "1;, along said Ncrth -South 1/4 line,
et to the point of bEginnini. Parcel contains 73.32
acres (3,1y3,674 Square feet) and subject to all Ease -,eats of
record.
Together with and subject to an easement for ingress and egress
located in part of the 51.' -1/4 of the SW -1/4 of Section 11 and in
part of the SE-3/4 of the SE -1/4 of Section 10, all in TownshiF. 29
North, Range 19 West, Town the' Hudson, being further described as
fol ows: Commencing. at the S -1/4 corner of said Section 11; ti. nce
AE9 29'03"x,', along the S ath line of the Sk -1/4 of said Sec::_..
2376.3Y feet; thence NO2 "6; 1256.54 feet to the point of
DEF.inning; thence continuing K02 26'06 "1;, 66.06 feet to the north
lin& of the S -112 of the SW -1/4 of said Section 11; thence
K6� 35'50 "W, along the Korth line of the S -1/2 of the SW -1/4 of
said Section 11, 179.28 feet to ;he NE corner of the SE -1/4 of the
SE -1/4 of Secti.,n 10; thence K99 41'39 "1;, along the Korth 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 "w, along said West line, 66.00 feet; thence S69 "E,
on s line being 66 feet distant Southerly and parallel to the Korth
line of the SE -1/4 of the SE -1/4 of said Section 10, 1118.32 feet
to the E line of said SE -1/4 of the SE -1/4; thence 569 35'50 "E; on
a line bEinz 66 feet distant Southerly and parallel to the Korth
line of the of the SW -1/4 of said Section 11, 162.54 feet to
tY,C oint of heginnint. Parcel contains 2.2? acres (95,9-6 Square
FeEt� and is sutiect to right-of-way for town road (Scott F.ead) ar.c'
subject to all easerents of record.
T _
I 1
l lA.N' Uh6.34' M1.41 N.43' p.1r IN•N'N1 14161'11.1 K 1 711.14' 1771
I Wt. N "1 ".r. 114.14' wall-M-1 = 31.71 1 161.14' 47
I DJ.14' 3a Lu%i "M M 1/' w6)'lsa 04 114'11'1 as 111 411.14' 131
I 1A."' il Is1121'23.SM in.3N 1".4)' 134 !661'11'1 1 411.11 31
I 111."' 4) • R4 111.4)' s6.4)' A367'11'1 01414'14.1 S 411.14' I1
I MR 16 13)•31'43.19 60.74' ULU 1335OU'l19 klhl'$4'1 S .... 4 411.14' 11
i 1A."t 11 A5 N.N. M.N' 611111'04'1 1 111.04' 3l/N'44'
I MAI 4 1"121'0.1'1 111.34' 114.11' 6N A lh l'N'1 - • 1 UI.11' 41
I 371.114 " 561'11.6'1 4)."' 43.14' 1/1 IoNN'31'1 j 11.37 l 3U.N' 1161'17
I_ 373.11' 4) 111 164.11' 161.17' Ilt M/ )1.14 1 141.11' 31
f 3 FW 41 04123 111. "' lum "NN'N 14) 8 IS•!f 1 311.11' Nowls'
1: 1.1.114 14 13464'"•6'1 "1.51 414."' 111 "9 "4
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,'10.10 34 Qlhl'34.6'1 331.11' 311.4)' 5 01
I W-W #63 71 1 1376r31.s 311.71' 313.31' 1]1 11SOS1'14'1
10.0 13 11N"•3s9 us-iil 135.31' ulssl'14'1 114
UNPLATTED (� V ! ANDS
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UNPLATTED LANDS
LOCATION SKETCH r
1101 Carmichael Road
Hudson, WI 54016 St. Croix County
Phone: (715) 386-4680
Fax: (715) 386 -4686 Zoning Department
Fm
To: Tammie From: Shawna Moe
Fax: 386 -9281 Date: November 16, 1999
Phone: 381 -5000 Pages: 2
Re: Inspection Report — Homestead Lot 12 CC:
❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle
-Comments:
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
p p n x p ST. CROIX COUNTY GOVERNMENT CENTER
U411■
" " ■ ", 1101 Carmichael Road
airy _„ Hudson, WI 54016 -7710
(715) 386 -4680
November 16, 1999
First Federal
Attn: Tammie
201 S. 2 nd Street
Hudson, WI 54016
RE: Septic Inspection for Sam Miller located at 726 Packer Drive,
Homestead Lot 12, Town of Hudson, St. Croix County, Wisconsin
Dear Tammie:
A septic inspection of the above referenced properly was conducted on September 29,
1999. This property is located in the SW'/ of the SW' /4 of Section 11, T29N -R19W,
Homestead Lot 12, Town of Hudson, St. Croix County, Wisconsin. At the time of the
inspection, this septic system was found to be code compliant for a three (3) bedroom
home.
If you have any questions regarding this, please contact our office at (715) 386 -4680.
Sincerely,
Kevin Grabau
Zoning Technician
/s �--