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C o f C Si 2 3 G rp rr r: (n y ? 0 Z O W W 0 7 Z O co d C A N • S 7 N W N CL N co p. IV O IM CD � ? 0 N m I y �^ cn m co ' O � A N) CL 3 CD O p W 7 7 ? A9 (0 O N 3 N 2 1 7 rn 2 i O O CD (a V D tD n m o I cn a n d c a CD °o �W a C a ° C CD CL 0 CL 'a 0 CD Z CL o { a Z a y a cCOO co 3 0 co m W Q oz n 000 080g00g o= w CD 0 � ! I � 3 CD M O C 3 Q C CD C y 7 A � !r N w N A D N M CD — rr a N z — zcoz zooz ° D a m I D a v O O s 0. CD (D CCD y • CD d N N c !�l c N N C CD N CD w m a a n 3 7 3 7 z CD I CD (6 N w n n ° 3 Z -I oo w M m A a W Z CL 3 a B a� $ f 0 Z 3 3 ::E y D N z A n w F' I � I -1.w a Q 1 = a <. �'CD a o va o n �.� o c o v c N n O N 7 0) CD a z n o+ = o Ul Cl- (a N O N CD p'aN f0 (D a a O CD Cy y CD cr N ° o m w m �. x � a N X fD A x v " ' CL N pp x O O q j N O r CL N I O w O o !� b ° m N to O v) O o g o ° o o 0 - o n Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1) (m)]. 353235 Permit Holder's Name: ❑ City ❑ Village [3 Town of: State Plan ID No.: Bast, Kernon Hudson CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: / 4- 020 - 1020-90 -000 TANK INFORMATION ELEVATION DATA 0 0-0 -)39 - N-00 0 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic L 5 d Benchmark Alt. BM Aeration Bldg. Sewer Hold' � St/ Ht Inlet eW q ��p, 3 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Air i to ntake ROAD ' Air Septic f y�D > 3 0 > 3Sl NA Dos' N Header / Man. Aeration NA Dist. Pipe /OG- 6 5 H g Bot. System PUMP/ SIPHON INFORMATION Final Grade �d f ;r cturer and St Cover -2, CW Z Model Number G TDH Li Friction S stem TDH Ft Forcemain Length Dia. Dis . wen SOIL ABSORPTION SYSTEM E RENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth 'DWEN5 44 DIMEN SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM HIN anufacturer: INFORMATION TypeO + CH o elNumber: System;t�p UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length -- Dia. Length �/ Dia. � Spacing k Z �© 3� 2- y� c 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 ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: !/ / / /glInspection #2: Location: 991 LaBarge Rd, Hudson, WI (NE 1/4 NW 1/4 T29N R19W) - 14.29.19.E $r SD - L O l 1.) Alt BM Description = m pot, /eWio, 3 -) ii0v tog Sk J y' P ;-P� P %�ef— e u rT- his �'� i I;c.,, , �- Plan revision required? ❑ Yes ❑ No Use other side for additional information. Z- z SBD -6710 (R.3/97) Dat In - spector'sAnature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I j j Safety and Buildings Division Vi SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. XP elayeA • See reverse side for instructions for completing this application State Sanitary Permit Number 3 53 X35 Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)). Num er I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location ti /4, S/ T -f , N, R ZI E (ork!�> Pr perty Ow ner' Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdi 'Sion Name or CSM Number )_ C9.j II. E OF 'BUILDING: (check one) E] State Owned ❑ !t� Nearest Road ❑VII age Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III BUILDING USE (if building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 10 — Duo — , ?e 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4_ Z Reconnection of 5 E] Repair of an - _____System ________System _____________Tank Only______________ Existing ________ Existing System B) 0 A Sanitary Permit was previously issued. Permit Number A W7-2-r— Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 E] Mound 30 E] Specify Tyr 41 E] Holding Tank 12] Seepage Trench 22 E] In-Ground Pressure Ail 42 ❑ Pit Privy 13 ❑ Seepage Pit 11 /Z X / .�' ❑ Vault Privy 14 ❑ System -In -Fill =cam ge 4� 3 VI. ABSORP SY TEM INFORMATION: 1. Gallons Per Day , 2. sorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade _ Re uired (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 7.0 p,s v Feet 7 Feet Cap acity VII. TANK in Ca gallo Total # of Site INFORMATION Gallons Tanks Manufacturer's Name Concret Con- Steel Fi ber- ass Plastic Ar. pp New Existing n structed Tanks I Tanks Septic Tank oak Ae Z 010*9MIty ❑ ❑ ❑ ❑ ❑ r ❑ ❑ I ❑ I ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installatipcof the onsite sewage system shown on the attached plans. P umber's Name: ((P�rint) Plumber Si r t ure: Stamps) IMMPRSW No.: �J Business Phone Number: oP� r 1 J— �� Q`� rP Plum er's Address (Street, City, State, Zip Code): a � kA. Al 0 IX. COUNTY t DEPARTMENT SE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate I ssued Issuing Agent Signature (No Stamps) P j Approved []Owner Given Initial Surcharge Fee) Adverse Determination j �S X. CONDITIONS O =PP VAL / REASONS FOR DISAPPROVAL: G,o Ge�2 z c so a.�ar�t 6 , SBD -6398 (R. 4199) 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'pu'mper 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 -M -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 ofwery 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 into 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 tb the county. The plans must include the following: A) plot plan, drawn to scale'or with complete 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 c - ounty; 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) fora 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 2226 ROSE ST LA CROSSE WI 54603 -1905 • ` - TDD #: (608) 264 -8777 isconsi►n www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary November 11, 1999 CUST ID No.267341 ATTN: POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 11/11/2001 Identification Numbers Transaction ID No. 273825 SITE: Site ID No. 183663 Site ID: 183663 Please refer to both identification numbers, St. Croix County, Town of Hudson above, in all correspondence with the agency. NE1 /4, NWIA, S14, T29N, R19W Facility: Kennon Bast Residence & One Station Beauty Salon FOR: Description: Non - Pressurized In- ground System Object Type: POWT System Regulated Object ID No.: 499751 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The existing septic tank must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of ch. Comm 83, Wis. Adm. Code. If it does not conform a state approved tank must be installed. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 11/01/1999 o FEE REQUIRED $ 120.00 FEE RECEIVED $ 120.00 &rard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM jswim @commerce.state.wi.us WiSMART code: 7633 CONVENTIONAL SCIL ABSORPTION SYSTEM FOR Page \ of LOCATED IN THE NZ - _ 1/4 OF THE UW 1/4 OF SECTION "4 ,T Z° L N, R W, TOWN OF — k-�j\z , COUNTY, WISCONSIN. Q6T' I N of GT?_A-S S Z GE - -sr MD. INDEX Pape 1 of 4 TITLE SHEET Page 2 of 4 PROJECT DATA Page 3 of 4 PLOT PLAN Page 4 of 4 PLAN VIEW -CROSS SECTION PREPARED FOR 'j " `+ �S L B r tallY c r- G��J ERA 1N�S �, MKT � g II.D ptiWaS oN 15 � PREFARE'D BY GORftE�P c ARTHUq 4 WEGEf�ER SQ I L TEST I htG = w c:_: AND U -95 ELwS CAP MS F_0. HMI 74 421 X. KAIK ST_ lj "••'• RIYfF -4 ;-OYS; o � ®���� �� lo- Z� - JOB NO. PROJECT DATA Page Z of This conventional system will serve a 3 bedroom home with a 1 station beauty salon and 1 employee in the home. The existing 12' by 54' bed and 1000 gallon septic tank were installed less than 1 year ago and were sized only for the 3 bedroom home. Due to the beauty alon y the soil absorption area and septic tank capacity must be increased. Additional area will be added to the existing drainfield and an additional septic tank will be installed in series. ANTICIPATED WASTEWATER 3 bedroom home X 150 gpd /bdrm = ---------- - - - - -- -450 gpd Beauty salon, 1 station = ----------------------- 140 gpd 1 employee = ------------------------------ - - - - -- 20 gpd Total = - -- -610 gpd ABSORPTION AREA 610 gpd - .7 (loadipg ~rate) = 872 sq.ft. required. The bed will be extended 19' ( 12' X 73' ) to provide 876 sq.ft. of absorption area. SEPTIC TANK 3 bedroom home = 975 gal plus 160 gal for beauty salom = 1135 gal minimum capacity req'd. An additional 800 gal septic tank by Henry Weeks will be installed in series to provide 1800 gal. total capacity. J• w PLOT PLAN Pa 3 of SCALE 1 "= LOT LIivE� gt�y�} -2 s.4 ` B.s 1 s3�r1 C,� 1sr too sue= L sVIM N SLPrc �0 @►1'l --- _'LZ...IDO - D�_(Y� - ZP of e-CV- -- - -- �0 d . 73� p o�s��BvTn>v P1PE � I O G � � C,2o s s Z:�.EcFl oN -- 4 "vE1. r pipe RPr�Ru�t�p C14.L?_� L �`RS_T_- 1Z"f?SollE tFStgt�� GRADE --'► Ft ru 1 s lf� %4 - L 1- 1A)LIMuh1 I e v U O O ,i-, J O O 0 6� ,� O O APA�VEO v s ° O J v G Pvc .zDISTR18L1nw _ 1/z 4 -� -Z ��i'�.�cG ��E�?�'t�• - __ �ERt= Ot�R��D_ -F' � �l�o aoZTO rte► 01= 8 �_ _ iq Department of Commerce PRIVATE SEWAYSTEM Safsty and Buildings Division GE S Count�T . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar9r2@4rr7i2I1!!p.: Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)]. Permit Holder's Name: C76itv &IIage E] Town of: State Plan ID No.: B AST, KERNON !1 17 C71V CST BM Elev.: Insp. BM Elev.: BM Description: Parcel N(Ja- 1344 - 14 - 000 Gt1 V`Ar Gi TANK INFORMATION ELEVATION DATA A9800617 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se Benchmark Dosing AI+. ism l - Ob / / 4 cff Aeration Bldg. Sewer S(o o, v- Holding S Inlet ,.2 TANK SETBACK INFORMATION St Outlet wj� TANK TO P/ L WELL BLDG. v ntto Air Intake ROAD Dt Inlet i S J�Z fj1A 0 1811 1 ' NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System 127-5 1 PUMP/ SIPHON INFORMATION Final Grade 7. 1 /6. 6y Manufacturer D and ( ev e4 3 °js' / 3S Model Nu r GPM TDH Li Friction stem TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM E ENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth N 1 N IG 5 5 DIMENSIONS SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM EACHING Manufacturer: INFORMATION Sype 'f' i �� ��� um b r: y �— OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake � r Length �O r Dia. Length ✓.� Dia. Spacing _Ar:2� I p ..Tm 3 5 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 ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 5 1 0 , ATION: HUDSON 14.29.19,NE,NW 991 LABARGE RD — GRASS RANGE LOT 14 Gt d t m4 cak4ivtr a� i 6w , I�� PI �Fevisi ' �r l Uri( C] Yes 14 No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: A isi: 6 ns in SANITARY PERMIT APPLICATION 201 E W shn Division P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 * Attach complete plans (to the county copy only) for the system, on paper not less County than 8 in x 11 inches in size. < C p, 0 See reverse side for instructions for completing this application State Sanitary Permit Number Ir z Z/ 73.5 The information you provide may be used by other government agency programs ,Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORM - PLEASE PRINT ALL INF RMATION Prope y Owner Na a Property Location Jf' oy �6 1 /4 1/4, S / T 2 , N, R E (o Property Owner's Mailing Address Lot Number ,,/ Block Number - Z r 7 City, State Zip Code Phone umber Subdivision Name or CSM Number Y F IL ING: (check one) E] State Owned ❑ Cit Nearest Road 3 C] V illage l� � _ / Public 1 or 2 Family Dwelling - No. of bedrooms TTo a own OF T "e c Ill. BUILDIN USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 1 -p O-;LU--&"/ 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. p'� New 2 ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair-of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number -5�- CL-72- Date Issued f Z• l 8 ' 9s3 V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 iA Seepage Bed 21 [:]Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure r I 42 ❑ Pit Privy 13 ❑ Seepage Pit /' 5Y —D 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 4 11 � _14 a 7 /&rO Feet 07.7 Feet VII. TANK Capacity gallo s Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existing strutted Tanks Tanks Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ 1 ❑ 1 ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation o he onsite sewage system shown on the attached plans. Plu er's Name: (Print) Plumber's Signature: (No S mps) MP>'AAPRSW No.: Business Phone Number: Plum is Address (Street, City, State, Zie Code): o c ^ p IX. COUNTY / DE ARTMENT USE O NLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Isswn Ag nt 'g ature (No Stamps) IgApproved ❑ Owner Given Initial Surcharge Pee) r Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBt16396 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, owner, Plumber I 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 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. f A is�onsft Safety and Buildings Division SANITARY PERMIT APPLICATION 2 . Washi Ave. Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. sx • See reverse side for instructions for completing this application State Sanitary Permit umber The information you provide may be used by other government agency programs ❑Check if revision to revious application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Property Location X14 114,S T2 j q ,N,R E(orla-3 Property Owners Mailing Address Lot Number Block Number �Ci , State Zip Code Phone Number Subdivision Name �_ © � i>~E & YP F ILDING: (check one) ❑ State Owned 0 Ityy Nearest Road Village Pu blic P1 1 o r 2 Family Dwelling - No. of bedroom y Town OF' t4 ©.(J /y!c III. BUILDING USE: (If building type is public, check all that apply) arcel Tax Number(s) oA — 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. p New 2 E] Replacement 3. ❑ Replacement of 4. E] Reconnection of 5_ E] 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 5%$ = ? 7 X (, JAr] Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12,a Seepage Trenc t *� ���' 22 E] In-Ground Pressure 42 ❑Pit Privy 13 ❑ Seepage Pit /*1A! l 43 ❑ Vault Privy 14 ❑ System -In -Fill K AEZ4,r _ -z _ r VI. ABSORPTION SYSTEM INFORMATION: � ,7`ffrXISWI f 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. Syste 7. Final Grade Required (sq. ft.) - Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) *7' Elevation y.� , Feet O. * * Feet t VII. TANK in Ca g u gallons Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks M anufacturer's Name Concrete Con- Steel glass Plastic App New Exist in structed Tanks Tanks eptic Tan k 4f/.=4tr 0 ❑ ❑ ❑ ❑ ❑ I ump Tank /Siphon Chamber r ^ ❑ I ❑ I ❑ 1 ❑ 1 ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation 91 the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No mps) f1 igMPRSW No.: Business Phone Number: Plu is Address (Street, City, State, Zip Code): 57 Ob © ; w a z-3 IX. COUNTY! DEPARTMENT USE ONLY 11 Disapproved Sanitary Permit ee (Includes Gr n water ate Issui g Age Signature (No Stamps) Z Approved ❑ Owner Given Initial c � � Surcharge r `� Adverse Determination O X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 3BD-BM (R t IM) 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. IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate. p "n2fix (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 rpust be submitted to ft -county. The plans must intlude the following: A) plot plan, drawn to scale or with complete dl-fnensions, 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 x it absorption systems; replacement system areas; and the location of the building tanks, distribution bo es, so p y p y 9 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) fora 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. cK� j o l x I cz ~ N, w W M i ' N ��x- Odisc^nsjn Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations wtivision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code . COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM d % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distant o�n aF t[r a .9 020 1020 - 90 APPLICANT INFORMATION - PLEASE P �IhLL INF MA �, R (IEWE BY DATE ig, F� PROPERTY OWNER: ^� P PERTY LOCATION IV Kernon Bast . LOT NE 1/4 1/4,S 14 T N,R or) W NW PROPERTY OWNER':S MAILING ADDRESS M - L97 PBT BLOCK # SUBD. NAME OR CSM # 948 LaBarge Rd. �'� yi cif✓;,_ _ na Grass Ran a First Addn. CITY, STATE ZIP CODE � ,AON TY ITY ❑VILLAGE KrOWN NEAREST ROAD Hudson, WI. 54016 (' `5 �8 Hudson McCutchen Rd. [ New Construction Use [x] Residential / Num of d 4 [ j Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd /ft trench, gpd/ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd/ft Recommended infiltration surface elevation(s) 107.40 ft (as referred to site plan benchmark) Additional design / site considerations trenches spaced to code 3.50' below surface grade 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 = Unsuitable fors stem ® S ❑ U M ❑ U M ❑ U I ®S ❑ U ® S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .....1.. 1 0 -8 10 r 4/3 none 1 2msbk mfr cs 2f .5 .6 2 8 -26 10yr 4/4 none scl 2csbk mfr gw if .4 .5 Ground 3 26 -80 7.5 r 4/6 none His os a ml na na .7 .8 elev. 11 ft. Depth to limiting factor +80 Remarks: Boring # 1 -12 10 r 4/3 none 1 lcsbk mfr cs 2f .5 .6 2 2 12 -26 10yr 4/4 none scl lcsbk mfr 9W if .2 1.3 ................. 3 6 -80 7.5 r 4/6 none ms os ml na na .7 1.8 Ground 11 ft. Depth to limiting +80r 04 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. AA., New Richrrmnd, WI 54017 Signature: Date: 9_26 -97 CST Number: m02298 PROPERTY OWNER Kernbn Bast SOIL DESCRIPTION REPORT Page l of PARCEL I.D. # r Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Twch ..............`..' 1 0 -9 10 r 4/3 none 1 2msbk mfr cs 2f .5 .6 2 9 -34 10 r 4/4 none scl lcsbk mfr Q1w if .2 .3 Ground 3 34 -82 7.5 r 4 none ms oscf ml na na .7 .8 elev. 11 ft. Depth to limiting falk.. Remarks: Boring # 1 0 -10 10 r 4/3 none sl 2m r mvfr if .5 .6 4< 2 10 -80 7.5 r 4/6 none ms Oscf ml na na .7 .8 Ground elev. 10 ft. Depth to limiting factor +80 11 3 3, Remarks: Boring # 1 0 -8 10yr 4/3 none 1 2msbk mfr cs 2f .5 .6 5' 2 8 -22 10yr 4/4 none scl lcsbk mfr 9w if .2 .3 3 22 -80 7.5yr 4/6 none ms osg ml na na .7 .8 Ground elev. 1 07. It. Depth to limiting fact 40 " I Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. � CSTM2298 Kernon Bast 4NW4 S14 T29N - R19W New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246 -6200 lot #14 -Grass Range First Addn. N 1 " =40'. BM.= top of culvert C el. 100' Alt. BM.= top of steel post C el.101.20' I N l� �d17P f t� R GAry L. Steel 9 -26 -97 ST CROIX COUNTY SEPTIC TANK MAIN'T'ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OvvnertBu Y er & A MeA Mailing Address 2ys za 4" Property Address_ = / , r� �' 12 (Verification required from Planning Department for new construction) City /State _ Parcel Identification Number _22 - LEGAL DESCRIPTION Property Location '/,, ,V&L ' /., Sec. , T L ZLN -R W, Town of t> Subdivision ��_ i ��, ,Lot # Certified Survey Map # --- , Volume , Page # Warranty Deed # S:Z ,Volume ��_y , Page Spec house Cl yes /7 no Lot lines identifiable yes 0 110 SYSTEM MAI 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. lire 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. I /we, 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 sta5ww5pyout septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 [ e ee year "piratio ate. SI TURF OF PLICANT DATE OWNER CERTIFICA'T'ION 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 -Ift op described above by virtue a warranty deed recorded in Register of Deeds Office. o r SI AZURE OF A P ICANT DATE • •"'•• Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. •� "'� •' Include wl(h 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 I DOC UMENT NO. WARRANTY DUO THIS A/A:;[ RESERVED FOR REGORO,Np DATA STATE BAR OF WISCON I' XM 2 -1962 529745 VOL PasF 1, ST Cr RAY - -G-. BROWN and ELEANORE- BROWN . a /k /a El i J_ Sro;rn, i husband- and wife . - -•- - - - - -- JUN 5 95 conveys and warrants to .- _V�ONA(�CA - -J. SPEER -BAST it �t 8.00 A. f . .................. -- --------- - -• -- -- •-- • - - - -- .._.. .. I I ! ---- ...------------------------------------------------------------------- -- - ; - ......... .. .. .. ..... ..... ..... ... —_ -.. .. R[TVRN TO for #1.00 and other v�l_uab� :e ... consider atio _ -- - n I /D i ... - -- -- - - - - -- - • - - - -- - - - -- ------- the following described real estate in $t. GroiX -- -minty, _.- ,_} . - _ Y:- T-=== . = State of Wisconsin: 020- 1019 -40 Tax Pared No: -020- 1020 -90_ NWT of NEk of Section 14 -29 -19 EXCEPT part to Hudworth, Inc. in II Vol. 604, Page 226. I i i NEh of NWk of Section 14 -29 -19 EXCEPT part to Thomas Wiley in Vol. 958, Page 577. i I I I, Subject to torn road right -of -way along the southerly line of said lands, II Grantee is responsible for payment of real estate taxes for the j� year 1994, payable in 1995, and subsequent years. ;I li II �i I F IT, I I i I 1 I _ 1 1 �I II I I This ------- is _n0t.......... homestead property. (is) (is not) � Exception to warranties: I II Dated this . ... ..... .....lqt_._......._...... - -- - -• day of ....... -- ---- ----- s7tll).Q ........_ . - .....__, 19.9.5. i II I - ------ - -- ------------- - ---- -------------------------- (SEAL) -' ._Q! I (SEAL) - -------------------- - - - - -- Rav G. Brown I ...... .......... it -- --- - - -- --•--- ----- •- ••---- -- - - -• -- _-- -- - -.- (SEAL) _ _....(SEAL) -------------------------- - - - - -- - -- - - - - -- - - - -- Eleanore Brown I ... -- _. -- ._ -... _... . AUTHENTICATION ACHNOWLEDOMENT signature(s) ._ Ray._ Gt,. ._Brown __and._E.Iean.Qre ...... STATIC OF WISCONSIN Brown jl -----•---------------- ---- -- -- ------ -- - - - - -- ----------- ••..... as -- -- -----•------ -_-- -••--•-- - .Count . suttee ' y ___ - ..... 1 189.5 Personally came before me this . y of - ---- -- -- -- ---------------------------------- 19 ........ the above named Wi1 iam J. i 1 bert - ------------------------------------------------------------------- ......... j t '•----- - - - --- ----- -• -..... -- •----- .....- •- - -• - -- ............. TITLE: MEMBER STATE BAR OF WISCONSIN --- ---- -_ - - -- ...................................................... - - - - -- q (if not, ................................. authorised by 4 706.08. Wis. state.) -- -- -- - - -- - - • - ------ - - - - -- - j 3 to me known to be the person ............ who executed the it foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED By William J. Gilbert. Attorne- - _ ------ - - - - -- ------ • -• - - -• ----- • - - -•- . .. ...... ................. ............................................. ................................... 206 Second St.. Hudson WI 54016 - - - - -•- e hnry Public ----- --- --- -- --- -- -------- - .----- Count y. Wis. h (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration are not necessary.) Sate . -, 19 ..... "Names of Persons signing in any capacity should be typed or printed below rfmi signature.. WARRANTY DEED STATB BAS OT wiseo `STN Wisconsin Legal Ble ik Co.. Inc. FORM Na 2 Isd2 Milwaukee. W,sconsn _n X _ _ ...' S+..Si:3.iaT.. sa.1. d6��i< 'iM:t - A�$:�"'�. °'se°i'nz..._ - rl: t�AV...: ',NFaa. ".,. – - � -:: �, . • - b .. . . . a ...aw �$ .,,,. .�w- ...;.. �•: yc; 'r . �'" �6fi�` 74.f �i- ?: �{! E` PN�t `��'�..�'�• +:`!llif�'�A1�_t.'t ss40ao 3?5�Pa VOL Cf 36� ' Document Nu REGISTER'S OFFICE ST. CROIX CO.. WI a.ti No— A AUd 18 1997 2:00 P M Recftding Am Name ad Rdwu KdeAWA) _r gAffl AA9w 6c /BD ° ®ao --qtr- cep r,.toa lams ,. iw. �p i i RMDW "THIS PACE IS PART OF IBIS LF 'CAL DOCUKW — DO ROT 1Lie iafotmriow awtrba 000gkosd by ate; oe erdr. �a�s ,rat addrv, ad o At pwa t� d—. � d-- ose„t, sae � 4 Other �zt..tisa and " "aAUAMPW4 AC Joe+wwatror ke IfaW ML X01 R: 4fPaK e4tr ewe P 7 �aawatr ad Od a Jk u. sharer 1!117. N7lDA 2/A6 r +pa i♦. "I • } •�• i � �„ ° � s �',+ �' f :l° A y � � 1 t r y ,t4 , ! 7p i .� y ' 1. t + � � a • � . Y � '� �'i 4 �R z A .t �_ •( r ; . 4 _. K 'r _ � G +,• t 'yl, ♦ t" .fit � y�_ a t Al 4k Af if y '� ♦ y • 4 '3' JS p a a . XI�"` P� y � �` dt.f "t.' F * l 'D` "X Y� A�° � },` �+7{`� �! •` �rt -, J. i DOCUMENT N O, II WARRANTY DEED � •'! • I! rills SrAcE RESERVED FOR RECORDING DAIA t i ( STATE BAR OF WISCONSIN FORM 2 - 1M2 :I I I 11 I RAY G. BROWN and SLBANORE BROWN, it II II husb�aricT - and wife .. _.._. _. ..................... .......... .... .- I !� - .. ..... _ .............. . ............. . .. - -. .. ......... ! ... conveys and warrants to .._........ RRNON j �T dA$_.DONALDA .SPERR- BAST,- ................. ............. ..... ii "sband• w ............ _ ........... -- .. .. ire I: ............... .I........ ..... 1 _ I f � ;I:00and- otlier valuable consideration - • • jl ...._.. 1 ETURN TO ........... . . . ... ... 1 the following descrihed real estate in .._ t CrOiX County, ! li State of Wisconsin: - -- - - -- - - - ----- - --- - i i Tax Parcel No: A parcel of land located in - • ........... .............. I j in Section 14, T2gN R19W Part of the NW of NW's and in part of the NEB of i described as follows: � of Hudson, St. Croix County' Wi . all j f Wisconsin, further I Beginning at the NW corner of said Section 14, T29N, R19W; thence N89 "E, along the North line of the NW� of said Section, , ! thence $00 "E, 1315.15 feet to the South line of the N of W k of said 35 feet] thence S89o3231 "W, along said South line, 5.05 feet; thence '00�0 " motion; 40 � East line of a 17 E, al ! I parcel of land recorded in Vol. "952", Page 382 at the St. Croix the jl Register of Deeds office, 299.48 feet; t those parcels of land hence $89°24'30 "W, along the North line o C B nty it in se "846» recorded in Vol. "952", Page 382, in Vol. "484» j' i . Page 386 at said Office, 994.00 feet the Test line ofPtlgie N,ofrtd li said Section; thence N00 "E, along said West line, 1022.58 feet to the point of ! it beginning. j� EXCEPT the Parcel Previously conveyed b Beginning at the NW corner of said Section grantor to grantee, described as follows: line nt of Be g i nn i ng; / ion 14; thence N89 "E, along the North Poi of 04 of said Section, 1387.25 feet; thence S00 "E, 910.15 feet to the l the inning; thence S89 "W, 558.46 feet, thence SOO 105.90 feet I , corner of that parcel of land recorded and described in Vol. 382 at the St. Croix County Register of Deeds office; "952 ", � along the North line of the thence N89o29 30 E, 157.00 feet �) 2 to the parcel of land recorded and described in Vol. "952 ", page 38 11 corner thereof; thence S "W, along th recorded and described in Vol. "952", Page 382, 299.4 eet; tthhenc line 89o24 said parcel Thi E it �l is not s homestead property. 405.05 feet; thence N "W h (is) (is not) to the Point of Beginnin 405.00 feet I! i Excevtion to warranties: This deed is given in final performance and satisfaction I of a Land Contract dated July 8, 1992 r l` 1992, in Val. "958 ", Page 577, Doc. No. 485728, Jinythe, II Dated this ....28th__ office of the St. Croix County Register of Deeds. II day of ... Jul �I yr 1997. _.. ._. _ ..... ....._, 19.. ......... (SEAL) J Ray - - - gO - Eleanore Brown _ISEAI,1 _. -- _. --- - - -- - -- - - -- --- - - - ...... - • (SEAT.) _ v AIITHBNTICATION ACHNOWLBDGMBNT i Signature(s) of RaX t. Broil and jl I - ----- •••• . ................ STATE OF WISCONSIN Eleanore Brown, husband anc9 wife -- ............ -• 4 au tt► ........_... "_.._ -•---• ...............County. h o JUlI+ - -•. ", 19.97_ Personally came before me this .......... ' ..---.day of �I C/V -- ------ -•---.-- .- --•--- ........... • --• --• ............•.... above named 19- --..... the abo ! lbert ._. r, ................. --- --........ TITLE: MEKBER STATE BAR OF WISCONSIN 1 a - --- -- ----------- •-- -.....................• ----- ......... .... i� authorized iiized by 7p6.p6. Wia. Stata.) It to me known to be the person ........ who executed the �I THIS INSTRUMENT WAS DRAFTED BV foregoing instrument and acknowledge the same. ! j W1111 J -Att - ... . . ............... 206 Second St, Hudson WT 54016 Y ----------- ... (?25"p "381 -- • .. ....... it Notary Public (Signatures may be authenticated or acknowledged. Both My Commission is ---•-"cunt Wis. I are not necessary.) � Permanent. (if not, state expiration date:._... ----------- 18..._.....) I emee or flKninL fR -- - - - -- -- -- — - -- - -- - -- ) Denwna •ny np }city SMluld be tYPed or printrd Deinw their elRn. pl rar. WARRANTY DEED STATR DAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc II FORM No. 2— 198E Milwaukee. Wisconsin .T,,•� 3� < „ r . 1.��s.i i..i t 9i: ” -� �t"rti.1. • •• b / / • • '° It O po- to 1 / ,��' / , • to ih i� N N O N ' Ln i b O� ' v ��. N • • C N O N �� bo CA 0 M v sR�ss� � GO Q i to 0 o �Q� r `I N , O S•• �J D � V N �� r c, i� U O .N y ° 0 to I o o w O �� N 09/03/1999 09:55 FROM Fogerty P1bg. /P.T. Inc. TO 17153664666 P.01 .. Dave Fogerty Plumbing SEWER SYSTEMS & PERK TESTING FOGERTY HEIGHTS ROAD ROBERTS, WISCONSIN 54023 (715) 749 -3666 FAX 1 612 - 490 - 7925 TO ATTENTION : O PROM- 4r or-4 ACCT. MESSAGE: r S TOTAL # OF PAGES SENT INCLUDING THIS PAGE. REPLY: 1�' Yr 09/03/1999 10:34 FROM Fogerty P1b9. /P.T. Inc. TO 17153664666 P.01 J • _- sue. `� "eosin SANITARY. PERMIT APPLICATION 201 F_ and A°ve. Wis. Adm. Code P.O. In atcord with ILHR 83.05, Box-Mg Department ofco'mmeme RAad�sdr�.1!V{ r '` t- •. Attach complete plans. (to the county.copy only) for the system, on paper not less county . th n, a S 112 x 11. inches in size. •. • See reverse side for instructions for Completing this application state Sa nitary Permit bet is The information you provide may be used by other government agency program/ ❑ Check if reoigion to app6rarian [Privacy Law, S. 1 S.04 (1) (m)]. Stale Plan 1_D_ Number I. . APPLICATION INFORMATION - PLEASE PR N -ALL INF RMATI N /Pro rty Owner Name Property Location -va l f 114, S / y' ' T . � • . N, R E (0497 . Pr Owne 's Mailing Address Lot Number Block Numb ��ic�, �S kate Zip Cod Phone Number Subdivision Name ertr5lrl►Mlrisiber 5' Ye la �) 5"_ - ; s 1?iv 'ms 's ST 11: BUILDING: (check one) E] State Owned o !�' Nearest Road Public 1 or2 Family Dwellin - No.,of,bedrooms Town OF rrt f ' 11L BUILDING USE (If building type is public, check all that-apply) Par< ta: Number(s) 1'. rtment/ Condo 2. ❑Assembly Hall 6 ❑ Medical, Facility / Nursing Home 10 El Outdoor Recreatiorial.F9Cility . 3 .© Galmpground 7 0 Merchandise: Sales 1, Repairs 11 ❑ Restaurant /.'Bar ' 4 �]. Church,/ School 8 ❑ Mobile Home Park .. 12 ❑Service Station %'Car Wash . 5 . E)': Hotel./ Motel 9 C3 Office /Factory 13 ❑Other' specify' 1V: TYPE OF PERMIT (Check only one box on line A. Check box on line B. If applicable) A) '.1 _ ❑New 2_ (j Replacement 3, ❑ Replacement of 4, ❑ Reconnection of S. 0 Repair of an -- ___ - -- - y .Ta nkOn l y_________ � - _ -- Existin�5�stem -------- "ExisUngSLfstEnt B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued. Y. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution EAiperimental Other 11 ❑Seepage Bed �54 5 / �. 7 K ( ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12aj Seepage Tren47 ��r ' 22 E] in-Ground Pressure 42 ❑ Pit Privy '1'3 [] Seepage Pit 43 0 Vaunt Privy 14 ❑ System -In -Fill 7�r/zT [ �t� c 4C i it l ; Div crr .Z — x et VL ABSORPTION SYSTEM INFORMATION: 1.'Gallaris. Per Day ' 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Ratee 6. S 7. Final Grade _ Required (sq_ ft.) Proposed (sq. ft.) (Gals/day /sq: ft.) (Min_rnch) Elevation 7 - y. Feet ' /!Q a9' . Feet VIA,. TANK Capacity Site .. Fiber- I r r. in gallons Total' # of Manufacturer's Name Prefab. Con- Steel Plastic II�IFORMATION [ allons Tanks. concrete g" AP New Existing strutted T Tanks epcicTanko k ! !'~' --' .fi•1 / G ✓�i�s ❑ ❑ ❑ �' ❑. tpu;;p Tank /Siphon Chamber ❑ ❑ ❑ a VIIL RESPONSIBILITY STATEMENT , J. the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans- plumber's Name. (Print) Plur nbber'ssignature; {No tamps) MPIMPRSW No.: Business Phone'Number Plug's Address (Street, City, State, Zip Code): ` IX- COUNTY / DEPARTMENT USE ONLY [�Disapp'roved Sanitary Permit Fee Ondudatdr�ate� a e ssu Issuitfgilge SigxaturerNo•Stamps) App roved } Su haege Fee) •I❑' C] Owner Given Initial Adverse Determination X:.CONDIMNS OF APPROVAL/ REASON'S FOR DISAPPROVAL: "` -..•. .. ., ... ••� .. - tlrs 1'mEOVnrl,�ore'topyTa: Srfl�asitlW6.� vioibt }Ow _ _ _ ..: ayakieaarnr�iruc'c ,. ... .. .. fR�9rfrWN:•,Ori9m9 ..... .. .. .. - ;pf .. ..nr:: PoriMlet ... .... ... .. _ . TOTAL P.014 � 7 I09iO3i1999 09:55 FROM Fogerty P1bg. /P.T. In,c. TO 17153664666 P.02, nDe va rtrrantofindust SOIL AND SITE EVALUATION REPORT Page Z of 3 tabor and Human Relations ivision of Safoty a Buildings in accord with ILHR 83,05, Wis. Adm. Code COIJ NTY Attach ounipiete site plan on paper not less than 8112 x 11 Inches in size, Plan must include, but St. Croix I limited to vertical and horizontal reference ;p (BM % of slope, scale or PARCEL I.D. R • -tensioned, north arrow, and location and di �n ,at r a 9 020 - 1020 - APPLICANT INFORMATION - PLEASE P tL INF(�MA �1 REVIEWED BY DATE n PROPERTY OWNER: t PERTY LOCATION Kernon Bast T LOT va 1i4,S T ,N,R g Nor) W PROPERTY OWNER'S MAILING ADDRESS Jun 1 1997 OT BLOCK fr suBO. NAME OR CSM 948 LaBarge Rd. ST Cr na Grass e First Addn. CITY, STATE zip CODE ON ITY []VILLAGE 9NOWN NEAREST ROAD Hudson McCutchen Rd. [ $ New Construction Use [xJ Residential / Num of s 4 [ ) Addition b existing building �� [ J Replacement ( J Public or cormierdal describe Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpdM 8 trench, gpolfl Absorption area required .. 858 bed, n 750 . trench, h2 Maximum design loading rate .7 bed, gpd/R gpd/ft Recommended infiltration surface elevation(s) 107.40 Q:9- 6 r it (as referred b site plan benchmark) Additional design / site considerations trenches spaced to code 3.50 belo`r surface grade Parent material outwash Flood plain elevation, if applicable na __ n S - Suitable for system CONVENTIONAL MOUfVO IN GROUND PRESSURE AT - GRADE S YSTEM IN FILL HOLOM TANK U= Unsuitable tors stem ®S ❑ U is O U ®6 ❑ U 91 S U ®S O U O ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence �, Roots GPD /ft Boring Horizon in- Munsell Qu. Sz- Colt. Color Gr. Sz. Sh- Bed IFlId1 1 1 -8 10 3 none 1 2tnsbk mfr es 2f ••• 2 -26 10yr 4/4 none scl 2csbk mfr 9W if .4 .5 Ground 3 6 -80 7.5 r 4/6 none 0s elev. 11 ft. Depth to limiting (attar +80 Remarks: Boring # 1 k -12 10 r 4/3 none 1 lcsbk mfr es 2 .5 €.6 2 2 2 - 26 10yr 4/4 none scl lcsbk mfr 9W If .2 .3 3 6 -80 7, 5 r 4/6 none His 0190 na na .7 .8 Ground 118e It _.-. Depth to _ - limiting factor Remarks: CST Name:-- Picasc Print Ga L- Steel Phonc: 715- 246 -6200 Addtt:ss: 1554 200th. AW, New Rich n W1 54017 Signatvrc; rat ° ' n is n,7 CST Numb= m02298 09iO3Z1999 09:56 FROM Fogerty. P1b9.iP.T. Inc. 70 P. 03 : IOWNER Kernan Bast SOIL DESCRIPTION REPORT page of PARCEL r Boring 9 Horizon Depth Dominant Color Monies Texture Structure ComsWenoe Baxday Rooms GP /W in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. • Bed Tmrr& 1 i 3 1 0 -9 10 r 4/3 none 1 2ms r ra f .5 .6 2 9 -34 10 r 4/4 none scl lcsbk mfr qw if .2 Grcund 3 34 -82 7.5 r 4/6 none ms 0SCI M1 na .8 elev, 111:0 It Depth to limiting Z" V Remarks: Boring P 1 0 -10 I 4/3 n one sl 2mgr mvfr 9w if .5 .6 4 2 10-80 7. 6 none ms — 0 . 5cl ml na na .7 = .8 Gmund elev. 10 It Depth to among ; tam +80n Remarks: Boring # 1 0 -8 lqrr 4/3 none 1 2msbk mfr cs 2f . S .6 5 2 8 -22 10yr 4/4 none scl lcsbk mfr 9v if .2 1.3 Ground 3 22-$0 7 . S r 4 6 none ms osg ml na na .7 .8 dev. 1 07. - 4t Depth to limiting Ip Remarks: Boring # Ground elev. /o 7. 7 po 7, Depth to stung l taclor Remarks: + ,� 09:57 FROM Fogerty P1ba.iP.T. Inc. TO 17153664686 P.04 STEEL'S SOIL SERVICE �. ary L. St eel 1554 200th Ave. Bast CSTM2298 Kennon - T29 I�R19W New Richmond, WI 54017 MPRSW 3254 to o S1 taws of Hudson (715) 248-6200 lot #14 -Grass Range First Addn. N 1 " =40' Hsi.= tog of culvert ® el. 100 Alt. HM.= top of steel post el.101.20' � , 6 b• c� GAry L. steel •7. 9 -26 -97