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HomeMy WebLinkAbout020-1392-01-000 n N o 3 -0 n _1 c° f a t O _1 o ID o a, v d � cn ;r\ z z p W r _ p N Q r O O_ "" O N 0 CO N O � CD N N E O O 0 O' O W CD O N C C N n S j Vt p y o 3 a i m O H a p p N � d A C.0 CD �, v D a .tit, CD ? a o T o m W 3 O X d N Q rn o O a CD N a c P c°� �.. a C N b CD p z a 0 0 0 j N to 5D O O = CD 1 CD Cr a O N C O 0 0 O lr N N = (V C d N O O. C1 PQ O N CD z n N z -i O o D O C ? o W O (D CD p > � N O C N CD W 7 "00 N D O. d (D O 3 CL CD cn c6 O p z O N N C n 3 CD ' A z o sv -o o a C C { . X W N C N rn <, z cn CD 0 3 A CD o - cn � cc 3 0 to z Q CD a C) o W o Q cn 0 N - O G N W T C p - o ° C 7 O W C j O I(D SM�o N O N N W 0 y CD 0 C o a o CD !II CL 0 O v ve O N �v O O p N p A_ 0 W O CD S O r� 0 v O CD O "O O L ti Parcel #: 020 - 1392 -01 -000 04/10/2007 02:57 PM PAGE 1 OF 1 Alt. Parcel #: 16.29.19.2385 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - LEE, HOWARD D & CHARLOTTE L HOWARD D & CHARLOTTE L LEE N4659 455TH ST MENOMONIE WI 54751 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 921 A MEADOWOOD LN SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.916 Plat: 2180 - MEADOWOOD LN CONDO 1 &2 020/01 SEC 16_T29U W PARKWOOD Block/Condo Bldg: LOT UN 1 ,—MEADOWS 23 NKA ME DOWOOD LANE CONDOMINIUM UNIT 1 1.916 C Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 16- 29N -19W SW SW Notes: Parcel History: Date Doc # Vol /Page Type 09/25/2001 657418 1725/040 WD 08/31/2001 655479 1/41 CONDO 10/20/1999 612351 1464/348 WD 10/20/1999 612350 1464/347 WD more 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.916 75,000 147,700 222,700 NO Totals for 2007: General Property 1.916 75,000 147,700 222,700 Woodland 0.000 0 0 Totals for 2006: General Property 1.916 75,000 147,700 222,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 020- 1392 -02 -000 04/10/2007 02:54 PM PAGE 1 OF 1 Alt. Parcel #: 16.29.19.2386 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - ELLSTROM, GREGORY A GREGORY A ELLSTROM 921 B MEADOW LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 921 B MEADOWOOD LN SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.093 Plat: 2180 - MEADOWOOD LN CONDO 1 &2 020/01 SEC 16 T29N R19W PT SW SW PARKWOOD Block/Condo Bldg: LOT UN 2 MEADOWS LOT 23 NKA MEADOWOOD LANE CONDOMINIUM UNIT 2 1.093AC Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 16- 29N -19W SW SW Notes: Parcel History: Date Doc # Vol /Page Type 07/02/2002 683280 1921/206 WD 08/31/2001 655479 1/41 CONDO 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.093 55,200 147,700 202,900 NO Totals for 2007: General Property 1.093 55,200 147,700 202,900 Woodland 0.000 0 0 Totals for 2006: General Property 1.093 55,200 147,700 202,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 00�n01 3"00 d d p i C g 3 3 3 r; !D m A m I '! ' a rr O z j Z O C N C O N a m m N p O N N j W CD i N I CD Wo O a ° s o 3 M a it o 0 0 A N a I I cn z D co D �' a a m O rt N p cl I I� z o p l,�0rTca �� 3o c "IFA� ° a ��,,,s,� M M M u `� 0 0 0 CL yyy o N I >. I s N fA fA II w m m v vv Iii a T I -0 0 rn CL c-iz *� O 0 0 3� ° ? 3 o m y Q 1 CD a x c a 7 C N N _ m r G_. 7 7 fD a iI O p N m N (6 -� -1 fn I = -o 23 z rn c . o m a A a 3 y O C � W < co O i m a z A ;C1 _0 ° o cn to CD CD N O I Q a I I v c o n y o a I a y I , b I c�a I I o I I o N I m 'I aro v <n O ti ° o C) ti IF • Wiscor%in Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildvigs 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)]. 353191 Permit Holder's Name: ❑ City ❑ Village 10 Town of: State Plan ID No.: Town of Hudson E lev. : , Insp. BM Elev.: BM Description: Parcel Tax No.: l/W 3 3 5 spit, f�Vl �' 020-135f23 00 Z 1 J TANK INFORMATION ELEVATION DATA /7 0� TYPE MANUFACTURER CAPACITY STATION S 2 S LE Septic Benchmark Q� '� O r Dosing Alt. BM q& Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St /Ht Outlet ��Y2 10,38( . 0 l y TANKTO P/ WELL BLDG. Ventto ROAD Dt Inlet - - �---� Airintake Septic a 3' NA Dt Bottom _ Dosing NA Header / Man. It - If 6 13. 3 Aeration NA Dist. Pi e Hol g Bot. System Z ' r �JZ:Z PUMP/ SIPHON INFORMATION Final de T M cturer emand cove Model Number GPM 2 Yi S-Z-' / Yz TDH Lift riction TDH Ft Loss ea r Fo main Length Dia. Dist. To well SOIL, PTION SYSTEM �Z TRENCH Width r Length ( No Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME N 3 3 DIMENSION SETBACK SYSTEM TO P/ BLDG WELL LAKE /STREAM LEACHING "u r. - r INFORMATION Type O r AMB Mod Numb System: C o ow, -5 �fl OR UNIT �; DISTRIBUTION SYSTEM '1 4- Ste'-- PIt, Header/Manifold � Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. a. Spacing > `lo S 1"OV x Pressure Systems Only xx Mound Or At -Grade Systems Only �d Depth Over / 1 Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑Yes [] No E] Yes El No OMMENT (Include code discrepancies, persons present, etc.) Inspection #1: 11 /c Inspection #2: l 1 f 01 Location: 921 Meadowood Lane, Hudson, WI (SW 1 /4, SWI /4, Section 16 T29N -R19W) - 66 211�ri No A--,.ksr ^ 5 l ��a+�� tt.D lZ�z tt oo�r3 « 3� t.o5 Plan revision required? ❑ Yes D 4101 / Use other side for additional information. t � SBD 6710 (R.3197) Dade Inspector's Si ature Ce o. I 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: �w mF mmee ��e., F E � 4 a ., a .. t k _ a E F j& d k T 4 � 3 1 i{ £ 4 t ! t € a a 1 - £ r t k s Y � i f � f - 29 _.�,.wm.- .. ! ...B+.m 1 ,a...o. .w .,......w..�.d..«.». .....,..m 6,a .....W .® # .. ,.«�... ...,........, k ..,.»,,. ._.« �.�..w.... I S c Al , I I ; A,.,, »...�.,« A .�.e.... .... �,.... � ..�..- +5...........L m..,..» o,...... � R..« .....di, n.«......�...®,.,.. a ...�.,.,. 5 ...,.e..,.....w.... --- ... 3...dw ......- .�.,a..,. ,,._ �i........,......Yw. H. � 1 ..5 .. ..,..,, ...m.,.,w�,.......«. �..m,� T ol rU q,-,2 -7, �a � y (fjo r tr✓ Ai r Io V), I r'st, Pip e qv Safety and Buildings Division SANITARY PERMIT AP 20 1 W. Washington Avenue NO s cousin In accord with ILHR 83.05 s. Adm_ * � . P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the sys tn;%'on pa�1<I,�ss ty than 81/2 x 11 inches in sizL. • See reverse side for instructions for completing this apple n r State nitary Permit Number �` �S _ _35 l Personal information you provide may be used for secondary purposes ®'�' G�iC7i„ l] � k if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. ✓� COUN rY ,eta- Plan 1. D. Number Z r e I. APPLICATION INFORMATION -PLEASE PRINT ALL I ATION Propert Owner Name oae t c` tia ,S gy V% r �14 ro T 2 N,R � Property Owner's Mailing Address Lot Numbe Block Number bor \I]eLo Cit h � ate Zip Code Phone Number Subdivision Name or CSM Number t ude. on W z 5L+01 tc (7is )3131 L 5 11. TYPE OF BUILDING: (check one) ❑ State Owned Nearest Road Public al or 2 Family Dwelling- No. of bedrooms `� /� n QC - d Ill. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) C2 Zj , 13S9 vZ3 — OO O 1 ❑ Apartment/ Condo 1(O'2-91 11 X1 101 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. gl New 2. ❑ Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ______System ________System ____ Tank Only______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 [:]Holding Tank 12 9 Seepage Trenc f"i r'¢10 r 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit f A 43 ❑ Vault Privy 14 [] System-In-Fill k __. VI. ABSORPTION SYSTEM FORMATION: fi (�pW 51D97 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. inal Grade qOO Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min- /inch) EI a1 ion T Feet Feet Capacit VII. INFORMATION in gallo Total # of Manufacturer's Name Prefab. Con- steel fiber- Plastic Exper. New Exist'n Gallons Tanks concrete strutted glass App. Tanks Tanks Septic Tank or.4eWinj4awk- f p — /6 99 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamberl 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) PI er's Signa ur : (No Stamps) MP/ NO.. Business Phone Number: Pte- O..s �,n�r � � aa y51 ?ls 4 1C9 5 u Plumber's Address (Street, City, State, Zip Code) : IN ?R,30 94 41-, vl✓ -- krver Fct 60 _T 5 0 7- Z- IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signat a (No Stamps) Appro Surcharge Fee) f► pp ❑Owner Given Initial Adverse De termination 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 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, dfawn 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. r - ~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM /} J Owner/Buyer Z!54pF Z is o��' (���s7,2UcTiO Mailing Address Property Address l aZ 1 V lkn. r�t (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPT N Property Location � ' /•, V., Sec. b , T 2 2 N -R _ L - 1 W Town of 1 2 Subdivision 2,�GVvot� ,�IO w S Lot # . Certifled Survey Map # , Volume Page # _ Warranty Deed # (a t& 35 - - - -- . Volume Page # Spec house 0 yes 0 no Lot lines identifiable �l yes ❑ no SYSTEM E 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 p lumber, restricted plumber or a licensed pumper verifying that (1) the on - site wastewaterdisposal system , is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 fuU of slu ge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards e and the Department of Natura set forth. herein, as set by the Department of Commercl Resources, State of 7onwg Of'fi�wwitliln 30 sc that your septic system has been maintained must be completed and returned to the St. Croix County days of the three year expiration date. � ,�a � QjQAL5T. C D t3y Zf l 9 Si v DATE SIGNATURE OF APPLICANT O_WMR CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property describ above, byy �virtue of a warranty deed recorded in Register of Deeds Office. AWS APPLICANT �/ DATE SIGNATURE OF eat. 4444** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Depsrtm ** Include with this application: a stamped twarranty e iee�ey ma p if reference i made in the warranty deed WmcoruinNpartmentofIndustry. SOIL AND SITE EVALUATION REPORT Page - �L of 3 Labor and Human Relations ' Wision of safety a Buildngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include. but ST • CW�1 k not limited to vertical and horizontal reference point (BM), direction PARCELID.# irection and %of slope, scale or ��_ IOZq- • dimensioned, north arrow, and location and distance to nearest road. ' d APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OW, NER: \R, tCM7Mp \-h UMS g PROPERTY LOCATION 1 StIUL V Ou\Ar ca dew -EeT S►v 1/4 SW va.S 16 T 7-q NR tq Et w PROPERTY OWNER'S MAILING ADDRESS. LOT # BLOCK # RMY093--) UBD. NAME OR CSM # at) �t�lz Vi�v t�'Ptv - pMtV*'v u�1 meflvbaw S CITY, STATE ZIP CODE PHONE NUMBER OCITY OVILLAGE ®TOWN ' NEAREST ROAD SON IAJI SL101 (, (7lS }381 - 5195 - hJflSb1V � L. New Construction Use (3q Residential / Number of bedrooms 6 ] ] AdditiQn to existing building (] Replacement (j Public or commercial describe Code derived daily flow o1 n° gpd Recommended design loading rate bed, gpdl2 -6 frees gPdIR Absorption area required \Z b 6 bed, ft \ \ Z 5 trench, ft Mabmum design baling rate •, bed. gpd/ft2 ' trees, gpd1ft2 Recommended infiltration surface elevations) � C'k iE 3 It (as referred to site plan berximark) Additional design / site considerations 111=5, Cttc *7S'Lm'6 wAiAGtV e�q PACt't`f Zm'Et'W bER umm Cft"amr Parent material S�'54 e V TW hSt1 Rood plain elevation, if appficable MA It I S = Suitable for system CONVINIONk MOUND NRROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U=U Rs o u > s❑ u ®s D u ®s O U as o U o s (9U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Motdes Texture Structure Consistence Bw dary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Traxh >�r ( _ • S Z 10 - 3i 1ta�1.tz 31L . L : Zm SD .. yvt�.: c S Ground 3 37_91 L n L ( ff 6 -S (� S) Wt •� '� elev. g ti:.1 f Depth to limiting factor , Remarks: Boring # ' o -1; \% -L tz Vn 0-S - • s Z 3 23 -98 k t �(t S �S9 1vl� - '6 Ground elev. °1� fL Depth ID lam cls fimitirtg w • Remarks: Name: - Please Print Phone: . - 425 -0165 Arthur L. We erer 715 f e gerer Soil Testing & Design Service- P:O...Box 74 River Yalls,WI- 540 e• CST ' nadue: Date. Ntxgher: . 99 - 136 -Z3 6- is-� 2 20254 9 . ti3ui tr2 � `�. PROPERTYOWNtR StwiejL ZLpciZ- 04%jsr. SOIL DESCRIPTION REPORT Page Z- of 3 PARM W. # o Z.p - loZq _fib Boring # Horizon Depth Dominant Color Mottles in. Munsell Qu.Sz.Cont.Color Structure Texture Consistence Boundary Roots GPD /ft Gr. Sz. Sh. 3 '�'' - Bed Trench € - tart �2 ZCZ ►- 9-VS - S 1z -) }3 � g 9 1 Ground 3 IS_ ocl I O Y rz elev. S CJ sg 0 13 S ft: Depth to limiting , factor I I Remarks: IM Boring # 41'Ft Ground elev. 9 3•S tt, i Depth to limiting 1 . j Remarks: Boring # L t $ 0`112 Z Z`Fs�,lz Yr1`�1^ CS 3 3s -9 Z 1 04 P_ V/6 Ground elev X 6.9 ft. Depth to L limiting factor , Remarks: Boring # .a { r L. ", .:a €?,} i Ground i elev. ' Depth to limitin factor Remark _ __ PLOT PLAN P 3 of 3 s • SCALE 1 "= 60' ZZ �7T erg `�] - �-- lUo . 0 � 0►-� �" tt�.► Pt P E' L��' COR�YZ . -- Ar1b4L 84 3' o bv�E `l0 LSE >r Q�• rJ11 L�Z� K K K 7 SOt K k /v I t!L � � T3 - � 8v t �atuG S�ei2 `W e S s� 17�g � �`fti Foe R.s I Nut �O 11V ST(�tLE� w sTtC� - , V\ 1 C*zs Lis �'. �b sz bEzp R3r T*t t�owtiswP� �E. �►�s��� �v 136 -z3 '� l `2Z.oZ5y c7 ) � 15 4 ?. �, a; CST Signature Date Signed Telephone No.. CST # 9 9 - LOT - - P LAN Page 3 of 3 A . • - -_ r SCALE 1 "= 60' o � �rovgElo %F: fifi U�M ZS' - Ruj t I �VCH� K K K T So( K k rj J I B' av t LaluG Stm) Lwl'S U i ���1 CHfii�aL�S ! 8� NOS 1� 11U STP�L,LE� _. � lJOw+.,SWP� AGE. i►vs�L� �_ ! I �} 'RM E O� @Oh1 S`TR�1�TlU1J 3r'1 tfir � Rq- 136 -Z3 7 '7- ZOZSy ( 715 ) 47A -0169 CST Signature Date Signed Telephone No.. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page-), - Labor and Human Relations t • Division of safety& Buildngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST • CR-4 1 not fimited to vertical and horizontal reference point (13M), direction and % of slope, scale or PARCEL I.D. dimensioned, north arrow, and location and distance to nearest road. 0 2A— 110Z9� O APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVI 0 B DATE I o -zr -fl PROPERTY OWNER: Vj- g LOCATION sewn_ R41)6e CONA'r, c0, StV 1 /4SW 1 /4,S 16 T Z9i ,N,R 19 E( W PROPERTY OWNERS MAILING ADDRESS. LOCK It SUBD. NAME OR CSM # all lit7lu�ir_ %\1 1ZAPSD -- Ptwp092D — pPCRkwcub S CITY, STATE ZIP CODE PHONE NUMBER []VILLAGE ®TOWN ' I NEARESTROAD SON IAJI S401(� (7lS)3$I -5u95 1 J�SUTV b �- New Construction Use Residential / Number of bedrooms b j) AdditiQn to existing building [ j Replacement [ I Public or commercial describe Code derived dairy flow 15 ,M1_ gpd Recommended design Wing rate bed, gpd/ft • trench, gpdtft Absorption area required NZ8 6 bed, ft2 Z S trench, ft Ma)dmum design loading rate bed, gpd trench, gpW Recommended infiltration surface elevation(s) SZ`E_ @k 1� 3 It (as referred to site plan benchmark) Additional design / site considerations MM 3 i' - w/WCtL CAIP VG r SIDE Ww DEr Vet` * Ct4f "Bel Parent material S et_A�`-f o VTW its u Flood plain elevation, if applicable W A It S = Suitable for System cONVENTIONAL MOUND "ROUND PRESSURE AT -GRADE SYSTEM IN FILL I HOLDWG TANK U =Unsuitable for system IRS [1U I gS ❑ U I IRS ❑ U ®S ❑ U as ❑ U ❑ S [3U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bot - day Roots GPD /ft in. Munselt Qu. Sz. Cunt Color Gr. Sz. Sh. Bed rer� ' J o —LO 1o`LR— zt L vlF 3 b1� e S S Z tb -3Z 10KfL 31(, - 1_ Zwt S Dk .. Yn'�- c. S . 5 Ground 3 3t -q 9 S elev. q 'z_l fL n � Depth to eo limiling Jot ? factor 9C) Q n� Remarks: Boring # . o - f; to v - Z L 5bk art - • S Z_ Z g� 3 �•SYIi_ — 1S IJS9 tivt� cs — .`� .8 I Ground elev. °t fL Depth to 6rttiting factor W Remarks: CST Name - Please Print Arthur L. We erer 715- 425 -0165 ' -,egerer Soil Testing & Design Service-P.O. Box 74 River - Falls,WI.54022 , Sgnadxe: Date: CST Number:. I ' 9 -Z3 �a SSA? 220254 PROPER UER Z�p�� rsr_ SOIL DESCRIPTION REPORT Page Z of PARCEL W.# OZ) — lOZ9_tFb Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft Boring Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence BourKk�ry Roots Bed Tmr Z () -VS -1 •S `fz 31 Ground 3 ►S a-I 10 o sg �n 1 - •Z .S elev, ° l3.S ft. Depth to limiting factor,, Remarks: Boring # 4 t 1 -t0 tt,4 V 71Z 1 y 3 - �b l0� R V1� — SS y►t I — ,� •8 E Ground elev. q 3•S ft. } . i Depth to limiting facto f Remarks: Boring # t 2 L Z�Fshl wt`Fh cs -3S 3 zs-a . , 'tt ti' (/A — Ground S S3 1N► — '� •� elev. Depth to limiting factor ?9Z`� Remarks: Boring# I Ground { elev. i ft. Depth to limiting factor Remarks: ___ _ . PLOT PLAN Page 3 of 3 SCALE 1 "= 60' � �n t�nt✓ y tzo� — _ _ 0►-j t" kv wa a �Vov3E m %E Rr Ult ZZ V Tl S 1 'I t gL J I i3.a � av ti �.ali�G S�gp�e1 v \ t!L L ��ceN C�a LA � B.5 � I -- tNSZ'iC - V\W-I� ei{-eS . 1!$" 'Tt�. SZ" DLZ.P +Rfi C L;�rhl _`5 ( 715 ) 425 -D7 E,5 CST Signature Date Signed Telephone No. CST # /o ` k Vo;-1464PAGE347 STATE BAR OF WISCONSIN FORM 1 — 1982 6 1 2350 i WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT NO. ;I I' ST. CROIX CO. WI ii RECEIVED FOR RECORD This Deed made between Howard LaVenture, three — fifths 10 -20 -1999 9:00 AN (3/5) interest in and Arlene LaVenture, two — fifths WARRANTY DEED (2/5) interest in, as tenants in common. EXEMPT D 17 Grantor, j CERT COPY FEE: and TACA44P Cjictnm Hnmoc Tna COPY FEE: TRANSFER FEE: RECORDING FEE: 10.00 i! PAGES: 1 Grantee, • i� h That the said rantor, for a valuable consideratio Witnesset G n ;; conveys to Grantee the following described real estate in St. Croix !! THIS SPACE RESERVED FOR RECORDING DATA County State Of Wisconsin: NAME AND RETURN ADDRESS ii I I �v/ 1 a`✓ �S LOTS 22 & 23 OF PLAT OF PARKWOOD MEADOWS, TOWN OF HUDSON ST. CROIX COUNTY, WISCONSIN ! �i - irk TTl TATS.+T�� PARCEL IDENTIFICATION NUMBER Ip�9 k7o 3� i; This deed is given in partial satisfaction of certain land contract dated February 19, 1959 and recorded in Volume 1404 Page 616 as Document Number 598116 which was subsequently assigned by assignment dated May 28, 1999 and recorded in Volume __1 1 , Page 352 as Document Number 604323 This is not homestead property. ( (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; I! And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except all liens, covenants and restrictions of record, if any and any liens or' encumberances created by act or default of the Grantees and will warrant and defend the same. Dated this 1 day of October 19 99 (SEAL) (SEAL) * * Howard LaVenture (SEAL) -2A A.-, _ (SEAL) i * Arlene LaVenture AUTHENTICATION ACKNOWLEDGMENT i Signature(s) State of Wisconsin, 55. County. authenticate of October 19 99 Personally came before me this day of 19 , the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Heywood & Cari, S.C. by Walter Hodynsky * 204 Locust St. PO Box 125 Hudson, WI 54016 Notary Public, County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary.) 19 ) Names of persons signing in any capacity should by typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc WARRANTY DEED Form No. I — 1982 A Milwaukee. Wis