Loading...
HomeMy WebLinkAbout020-1049-10-100 A o i f / « e z o b@§ q / \ A « M E % f - JCD I , o w w E M a " 2 ddkk \ Q 2 co ! ± 8 8 - Q @ % § \ k � ~ ~® I�% a 8 E � _ - m CD ® ° CC) ¢ k 3 / r 2 2 q k C ® §§r / (D co / . § E � co ° o \ 0 0 0 �- ^ ® § \s Eƒ ■ ■■ 0 § %\ �/ 7 # § � ■ � � CL 3 CD § z " E / g § 0 { [ Z \ \ T "d- GO co f CD c a Q / \ § ( o a 2 z CO) - § m & { ` a § $ g Z ¥ ■ T m m o a 2 2 0 2 co 7 z i � �% � � . ± r / c z % : / [ � � J \ � ƒ � } � $ \ 0 ■ < \ f ° ® + 8i �] r ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Property Address c c City /State I L A - C L)" tly 1 t. I �r ... 4 • , Legal Description: 70 Lot Block Subdivision/CSM # , N ' 4 NUJ ' /4, Sec. , Td9 N -RAW, Town of 9UV5 PIN # ' SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer W t-t S Size ST/PC Setback from: House LL Wel d�� P/L S� Pump manufacturer Model Alarm location --^� (HOLDING T Y Setbacks: Service road r m e Water me Meter location Alarm locatio ABSORPTION SYSTEM Type of system: N� �` � &P� Width 3 Length 0 Number of Trenches 3 Setback from: House — I L Well 7 S P%I��_ Vent to fresh air intake 5 ELEVATIONS Description of benchmark To o� w e, Elevation 4 Description of alternate benchmark Elevation Building Sewer ST/HT Inlet Y �- `� ST Outlet 8� PC Inlet PC Bottom Header/Manifold a Top of ST/PC Manhole Cover Distribution Lines () 5 Bottom of System( Final Grade ( I • O T 9 'UV O 9 9,0V Date of installation Permit number State plan number Plumber's signatur License number Date Inspector � � � � p `) � V, Complete plot plan Or 1 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 0 s /U 3� ly' 3 k 5v INDICATE NORTH ARROW 'v Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: 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)]. 338846 Permit Holder's Name: ❑ City ❑ Village R9 Town of: State Plan ID No.: TURANSKI, BRUCE HUDSON CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: 020 - 1049 -10 -100 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss m ead Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type of CHAMBER model Number: System: OR UNIT DISTRIBUTION SYSTEM Header! Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 20.29.19,NE,NW 890 WERT ROAD — WILLOW RIDGE II LOT 2 Plan revision required? ❑ Yes ❑ No Use other side for additional information. T1 L SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. A sconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. W ashington Ave. 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 r than 8 in x 11 inches in size. :5 t. C eo • See reverse side for instructions for completing this application State Sanitary Permit Numy�r X39( The information you provide may be used by other government agency programs p Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property ner Name Property Location , �C� TtA F_ � •� Nf- 1 /4 N01 /4,S�U T ot9 ,N,R E(or)W Prop y Owner's M Hing i-'d ress Lot Number Block Numbe City, State �� Zip ,(p�g ( Phon N ber Subdivision Na(ne p OW M Num r �— ��hSeu �ls , '(U) � l�.lt i 11. TYPE F BUILDING: (check one) ❑ State Owned 't age Nearest ad p 1 Public 1 or 2 Famil Dwellin o Vill - No. of bedrooms Town OF 9VIDSO-lJ t( 4 40 III. BUILDING USE (If building type is public, check all that apply) Parcel TaxNumber(s) 7p.?5l Iq .lp9D -! 1 []Apartment/ Condo & a 16 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 S ❑ 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. [] Reconnection of 5. ❑ Repair of an -__ � E] ystem ________ 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 [ Tank 12 KSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Requl�e sq�ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. g*ch) Ele ation Gr 1 g V s• gj Feet �-S 8 Feet Capacity VII. TANK in Ca allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glaze Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank "" I a 1) O 11 1:1 E] ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 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) Plumber's Signature: (No Stamps) MP/M No.: Business Phone Number: '► M�,�,e�e1z as 9 J� 8 (a- qoa� Plumber's Address (Stree , City, State, Zip Code): 0� U IX. rOUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issue issuing Age Sig Surcharge Fee) Approved ❑Owner Given Initial � Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: ...�........�...... .. _. _.__•._._.._... n__....... r... cs -...l O.,:1.1:,.,.. n:,...,...: V1wn•. olu.whw ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer r" u c- & - 7L, ra n Mailing Address _3� Z�!p 04 Property Address 8110 (kl`� (Verification required from Planning Department for new construction) CityNtate AJ /-�� -L Parcel Identification Number Wit) - LEGAL DESCRIPTION Properly Location ( "_ %, AW /, Sec. AQ , T__jY_N -R_2 W, Town of xlyc ,s; & Subdivision - r / -n- Lot # _ a Certified Survey Map # Volume :Page Warranty Deed # Sa Ile Volume .::f yl__� . Page # 8 h Spec house ❑ yes grino Lot lines identifiable i3 yes ❑. no SYSTFM;MAJNTENANCE - larroper use and maintenanceof your septic systcmcould result is its I. aro to handle v castes. Propermaiabcaance consists of pumping out the septic tank evay three years or sooner if needed by a licensed pamper. What you part into the system can affect the fimction of the septic twk . a treatment stage in the a raste.disposalsystem. The property owner agrees to submit to St Croix Zoning Dep t=at a certification form, signed by the -owner and by a z ph=ber. journeyman plumber, restrictedplumhcr or a licensed pumpervedf*g that (1) the on -site wastewaterdi gxml system is m proper operating condition and/or (2) after inspection and pamping necessary), the septic -tank is less than W dull of sludge. Uw+e, the undersigned have-read the above requiremeaft and agree to maintain the private sewage disposal system with the standards set forth, herein. as set by the Department of Commerce and the of Natural Reno Department urcxs; State of Wisconsin.. Certification stating that your tic system maintained must be completed and retumed to the St Croix.C:ounty Zoning Office within 30 da f the expirati tc. SIONAIURE I.ICANr DATE OWNER. CERTMCATION I (we) that all eats on this form are tare to. the best of my (our) knowledge. I (we) am (are) the owner(s) of d 'bed abov by a of a warranty deed recorded in Register of Deeds Office. / v / S NA APA C.AW DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department « « « « «« _s ** 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 1� AUG 19 2% 8- Jut 2 4 19 9 6 2 ST cR Olz couNnr �� p WkSli SURVEYOR'S RECORD CO., w� 54`249 TIFIED SURVEY MAP cn � LOCATED IN THE(NE 114 OF THE NW I/4 F SECTION 20, T29N, R19W, TOWN OF HUDSON, ST.CROIX COUNTY, Wt. l OLVA 'Vw heAu €Y � PREPARED FOR: BRUCE TURANSKI NW CORNER OF NORTH LINE OF THE NW 114 SECTION 20. (COUNTY S 89 N 114 CORNER OF MONUMENT FOUND). __N 89° 09' 2 E _ SECTION 20. (/' 2662. 33' 54.32 IRON PIPE SET FROM REC. AS N89 59' 50" W TIES). S 02 I 112. 80' REO, AS S88 °55'54'E — UNPLATTED LANDS W I 1 m © S 89° 46' 37' .C:. S.:M :...VOL.....1 � � 94.27' � y • PAGE 177 100' �o I ............... i WILLOW RIDGE 0 33 ' EAST II C. S m. 1 �� � P � � 2 , I9 . G• LOT Z NOTE: BEARINGS ARE �F. 2.00 ACRES I R NW 114, NORTH (87,154 S0. FT. ( RECORD BEARING FROM VOL. 6 N 88 °13'26'E ,WILLOW RIDGE) ............ 2. 00' REC. AS N83 04' 09" E I SHED (TO BE REMOVED a+ mo 9' 1 Ht?RnVED .PAGE ... 1508 .2 'a �cl N f N HIGHWAY SETBACK O p , ` JUL 2 4 SAL li 9 cs LINE / i i' . CROIX COUNTY °. mow. o ;Q ,omprebonsive PlatZlf $•$ �'� � Zoning and HOijSE ^'_�} ,� r...v. Parks yc�'ui ■tt" UNPLATTEb LANDS L OT'• 3 ` If net fecordod. .. ... 2.30 ACRES vl tthin 30 dtiya of ( 100, 105 SO. aiptxovafdot* 0, 1 " X 24" IRON ,PIPE WEIGH 1 NG 2. 13 AC. EXCLUDING R1W , J. 13LBS PER LINEAR FOOT. (92, 854 S0. FT. ) nwo & void • `= IRON MONUMENT FOUND (AS NOTED). p , / # 0 M�tNee0lMpo+� p C Q O. +�� , S 26 ° 30' 44'� g. '.�°� �+ `� 0 0. 70.01' JAMES M. WEBER 3 - 1804 , • SPRING VALLEY 1 ® Acs ' Q • / N WIS. cl UNPLATTED LANDS JAILS M. WEBER S -1804 .............................. NELSEN -WEBER LAND SURVEYING / DATED ..3 w-F � / REVISED TH 1 S le;h DAY OF i.+x -•% , 1996. / 96 -82 THIS INSTRUMENT DRAFTED BY JIM WEBER / 100 0 100 200 300 SHEET I OF 2 1111 11 11 11 1 [111 11 11 11 1 GRAPHIC SCALE — FEET VOL. 11 PAGE 3138 t Wisconsin Department of Commerce Count y PRIVATE SEWAGE SYSTEM Safety and Buildings Division 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)]. 338846 Permit Holder's Name: []City ❑ Village Town of: State Plan ID No.: TURANSKI, BRUCE HUDSON CST BM Elev. Insp. BM Elev.: BM Description: Parcel Tax No.: Orp dp 020- 1049 -10 -100 TANK INFORMATION ELEVATION DATA ", lq.lq, j p.. TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 2 Benchmark ,( o T. Dosing Aeration Bldg. Sewer Holding / }+t -trrt2t (�. , `$ .79 c.(t TANK SETBACK INFORMATION CEj kt_i0lutlet ( RQ, z TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic / NA Dt Bottom C2Z Dosing NA Header /Man. s Aeration NA Dist. Pipe —r Qf 81 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Man rer Demand , I Model Number GPM TDH Lift Fric System TDH Ft [ Forcemain Length DI . H Dist. To Well SOIL ABSORPTION SYSTEM 3 " ,C 5_0 BED/TRENCH Width Len th o. Of Trenches No. Of Pits Inside Dia. uid Depth DIMENSIONS 3 i DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEAC G ulacturer: S r e!t I INFORMATION Type of �+�, CHAMBE o el Number: 5 System: Cl�ti/, D 3� OR UNI DISTRIBUTION SYSTEM Header/ �elanifold u Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Q.�/ Dia. Length �' Dia. Spacing � S� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only [ Bed epth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No E] Yes ❑ No LI COMMENTS: (Inclucle ode discrepancies, persons present, etc.) UDSON 2 .29.19,NE,NW 890 WER I ROAD — WILLOW RIDGE LOT 2 ' # 4*4 G s`�`� ®S sue• �-��. �..� o) - ®L �► .se, / -�t'> lett S o.Q ca� - —r V%�� 4- �- - t w C # -C., Plan revision required? ❑ Yes JA No Use other side for additional information. D� oa gSuo SBD -6710 (R.3/97) Date Inspector's Signature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i E E a ..,. m .,. VIA J 'I, i 1 r i E e i L c a 1 b-4- t—t— t —t a r. ..._€ r € ,... �.., ...�' ...e __ ,4—ilnL i e In : [j;..j..j P i t -- 1711 a - 71� Jni 44-4-4+ ..1.111 E a g e ...,«2...... -, 14 ...,a . Y e F a ve € i a v++t _ e E s a . 3 ai $ —? ��m m S I E { j � ..,. .,; M_, ....._� t [ a 3 d [ 5 V 1 i t s ®� ? I e f £ Fes. x d i F d o A i 1 i 3 2a 1 r ,.A e. 3 w.�. ✓ .e...eva .e e«<w. _.._ � ee.. -s �.a..�.e ... ..,�a. .f. ama�. .».gym. m .. «, s § a .a �.j...e.»..u®m.e� 3 E i - + FT „, «. .. ._....... L ._ „ -. w.......< �, �. ?�....... ..,«§ - ? a eaem .«am.,.m me»a !. _ .[ e« . .,, C a E E ].... d ...... w...,e. m a a»..,�,._ AA e .....:.........._. �' . e..,..__...., ...., .,.5,. ...<. ......ter. .. .. _ _ �.. F V iscons in SANITARY PERMIT APPLICATION 201E sh� �r� °8 S'°n P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7%9 • 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. • See reverse side for instructions for completing this application State Sanitary Per mit Numyer The information you provide may be used by other government agency programs ❑ Check if revision to previous applicati [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Propert y ner Name Property Location R TA (L A N S' �l� 1 /4 N O 1/4, S -;,o 0 T N, R /9 E (or) W Pro Owner's M ilin dress Lot Number r. Prop �N 9 Block Numbe / City, State Zip,{~pd i 1 Phon N ber Subdivision Natneo[ �SM Num r �- II. TYPE OF BUILDING: (check one) ❑ State Owned E] itia Nearest ad Q Public Ig 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) n �O. ?9l. 19. 1 ❑ Apartment/ Condo J 16 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, pNew 2. E] Replacement 3_ E] Replacementof 4. E] Reconnectionof 5. E] Repair of an yytem System Tank Only System ________ _____________ ______________ Existing System ________ E g - --- --- -- 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 KSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade / Requ a s%ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. 'nch) Ele ation �Q Q V Feet TS $Feet VII. TANK in hallo Ca clt s Total # of Prefab. Site Fiber- Exper INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tanksl Tanks Septic Tank or Holding Tank I I — b U 1 W �� f ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I ❑ 1 ❑ 1 ❑ 1 ❑ 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) Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: 't M LkN4e� is - 8 ( qwo Plumber's Address (Stree , City, State, Zip Co IX. UN Y/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issue Issuing Age Sig A roved c � surcharge Fee) pp Owner Given Initial ,�S _ Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-63M (8.11/96) OMTIauTION: Ong" to Ceumy. One copy Te: Safety i 6u"ngs Division,'Oweer, Pkunber 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. V! 1. 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. smaller than 8 1/2 x 11 inches must be submitted to the county. The Complete plans and specifications not s plans must y p 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. e— if3 .-rs_ . 1�DRl 18 19 99 ® Iop C)+ s mc,)41 . f hUN-, 1'ea (s gARgTop) zlev - /Do. �d+e . wo is fptiTLh - f�P►J soi fa Se c Sys fi +m N��P; p4jPc .Crj hits Well is 4 Q�DR��r� ronfilik 4wl lud 1'rujm IV' J 9 � ROU p Z 3 I RQNChp S � ° N L "iN� 5�►"'S 3 x36 z Q3 uNae`2 Daivea►A� � Ap ati� '� 0 ZN31.13 Of. R� os w 6 � Bah v _ co i s i ster, O -ev. 95, m o� C1 � ' v' >c 9 B ca =�o C C = U C p E cfl N y .- CV) ® cd =O x to OL cc U D LU -- U ; ' 1. T E C x a ° u,' � ° ' to Q T` CO 'O to _. M T U) >O.0 .2!, O Z ; i 0) Q (13 Q = 'v L b o m o F� Q CO U to N Co 6 > C o CO m N J C 3 . x r■� — - -- 0 c cu yr v O J LL O= N N O CO Cj) r r vrrr 11 rorrr . a • • • • Cn (n Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of Labor wd Human Relations Division 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 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PA9P.E y:. # t �IE / dimensioned, north arrow, and location and distance to nearest road. ° °.' � t ° Fe APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R ED ,� y n +�9CIATE lt77 F PROPERTY OWNER: PROPERTY LOCATION r°° ` '` 412 1A 0. e- :]�nak),5kl GOVT. LOT � 1/4 � jj 1/4, T� G i 9 PR PER WNE ' ILING ADDRESS LOT# BLOCK# CITY, PTATIJI ZIP ODE PHONE NUMBER ❑CI ILLAGE N / �j New Construction Use b4 Residential / Number of bedrooms �3 [ j Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 4S gpd Recommended design loading rate 7 bed, gpd/ft . t trench, gpd/ft Absorption area required ll'� bed, ft S43 trench, ft Maximum design loading rate .7 bed, gpd/ft . g trench, gpd/ft ° �S SS ` as referre to site Ian benchmark Recommended infiltration surface elevations ft ( p ) Additional design / site con iderations - E/, ± /.!l ' '1f0 /,3s l � 9 rp Parent materia s A 5t c vto Co„ { ood plain elevation, if applicable ft S = Suitable for system ONVENTIONAL nn4� OUND IN- GROUND PRESSURE AT- RADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem W S [:]I U as El PS ❑ U ES ❑ U ❑ S CRU ❑ S [&ll 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. 7BedTrench 7 D i o yak c w 7�7 77 :.> ax 2 43 2�^4 6,e C LJ - Ground 3 S� Q e &J — S /7 ft. S d S St C S G>7 C lrl Depth to S ,60'103 / S Qvrt rpi C _' 7 limiting factor Remarks: Boring # Ground ev. y �] -$3 1, It ft. Depth to limiting fa &t�, Remarks: CST Name: —P se P nt GZ � / Phone: 6' G✓r I S DL t' Address: Q 7� w /U' f'� Sri'-► ` s���� Signature: Date: CST Number. PROPERTY OWNER SOIL DESCRIPTION REPORT Page of � . P PARCEL I.D. # J Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in Munsell Qu. S . Cont. Color Gr. Sz. Sh. B d Trench V Z ? Ground 3 3 7 `52 ' A., sw A `'� g VIA J Depth to .S �-1 ® L S' �^ / limiting I factor -g � qL Remarks: Boring # ,� / Mi Ground v. Depth to limiting of3 vo•o T or 6 Remarks: Boring # r 3 I jam, �6� �, . :::::::. Ground Depth to limiting of e fa for Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) g i I 5 D b I� L i CL = /- I I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer dal; Mailing Address a Property Address "f-} 4156A) Z) � (Verification required from Planning Department for new construction) ,? City/State ) i lT Parcel Identification Nmnber LEGAL DESCRIPTION Property Location /(/� %, AW ;, Sec, ao . TAN -R�W, Town of Ilad, D; 1� Subdivision Lot #. Certified Survey Map # Volume Page # .31 Warranty Deed # Sa / 9A Volume 9, . Page # _ 02 Spec house ❑ yes l� no Lot lines identifiable L7 yes O. no SYSTEM- 1ViA11 MNANCE ImRromuse ancizaabtenanecofyourseptLc systemoouldresaltmitsprematru+ e. failuretohandlewastmPropermaintenaaoe cons_ ists of pumping o the septic taak every throe years or sooner, if nec by a licensed pamper.: What you put into the system can affect .the fuaction of the septic tank a treatment stage in the waste disposai_systc= Tu property owns agrees to submit to St Croix Zoning Department a oerti&xtion foam, signed by the owner and by a nu.sterplumberjourneymanplumber, restrictedplumber or a licensedpumpmverifying that (1) fire on -cite wastewaterdisposal system is m Proper operating condition and/or (2) after inspection and ppmpmg.(if necessary), the septic tankis less than 1/3 full of sludge. Uvre. the mod have read the above requirements and agree to maintain the private sewage disposal system with the standards set fortk herein, as set by the Department of Commerce and the Department of Natural Rase ur tic urces State of Wisconsin.. Certification stating that yo system maintained must be completed and returned to the St. Croix County Zoning Office within 30 da f the cxpirati te. i SI TURD WAWLICANT DATE OWNER. CERTIFICATION I (we) that ;by eats on this form are true to.dw best of my (our) knowledge. I (we) am (are) the owner of "operty 'bed abov a of a warranty deed recorded in Register of Deeds Office. / U S NA APPLICANT DATE •' « « «• Any information that is mis- represented may molt in the sanitary permit being revoked by the Zoning Department. +4 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 d eed era ty a� DOC UMENT N(.) STA ?E AI AN .FpRrd 1 W � :I ILRAN ?Y DEED r _ 35248 Tr ,t , REGISTERS OFFICE This Deed. Ina,le betwee^ Ro�_er. E, T 40 :�xi - ST. C ROtX CO., WIS. !"Zry I.. Fetchler, his wi.fA . - _ Recd. for Record Ws lEt Grantor day of 'ctcl, er A.D. 1 and Bruce. A.'ltwanski.and.Cynthia. K.. Turansr:i, !u.tsbaril — M. and odfe, as ,joint tempts Grantee, ! g.gl.tr of Deed* YV itne sset h, That the said Grantor, for a valuable eol.sidVration Q'e ($l.CQ) & other good .& valuable co;isidera ion eonve;�, to Grantee the following described real estate in St. o 0 r 5t-ite of Wisconsin: rider is - Tax Key No. it the bear lnr, oV , rO 041 L. 20.85', ..hence on 1 z 4.32 t he et.t -11 n. .e J O S CO 7 ` �4 " E i :�a' " �i5t- _.�_..E �., �' _i L. c ". is 1. •!'7 ._ r l .. .. ,'!._ l t.11r "✓e t0 t!?rr 1� ,_17} _ LJi.!?L ",i ��6 .:I ?i'! ,� _ .'rl .. ? - •- - •. , o ) t , n . e thence .. 89 � 1 .,3 �3 � he. C IY C'U 13!' t C f' C3 c. F the r. ,, '.ti. e \ 1�0 17 t �llr'�✓: , f.nPrie'? on 3 �' .i 1C!F" - _• .i �o ,1 r ��.Jn 'n' ,' ..e�[U t . � • i 1' }f 2QF n�1 t_t...�... " Zlw: �� r r,!lrr .j r ih� /i'� �r •• - ,r =5 .�.�� friE' :'e r `< •• � i.� ,, tit... __. .. _.. _.. .. ... ._ to t ht >, eon 4 te . rr, -rr I i ce.• ... r ,.... .l _ V .� 3 250 2 r Gill 1 . L!� 6 rr _�+ 1 rr ! `f [I 7 S3 "d l _�_l: i ii , u _P. in WARRANTY DEED STATE BAR OF WTSr '.r'.m.,in L�,r•! R'a.- r„ FORM No ,I — 19 %11W421 B"!.. r.• ,1,33'2231 w J This is .......... homestead homestead property. (is) xis not) To ether with all and singular the hereditaments and u; p.:rtcnances thereunto helonging; ...Roger E...Hetchler and Airy I. Hetchler, his wife wary nts that the title is good, in,iefeasible in fee simple and :!te and clear of encumbrances except i and w0l warrant and defend the same. Dated this 1 3th _. -.. day of --- PCtOber� i9. 78. xw (SEAL) - .(SEAL) Roder E. Hetc er ..._ (SEAL) \\ ..._(SEAL► - P•Iary Is�ier - - AU'rHENTICATION ACKNOWLEDGMENT �i� r, :cures aiakenticated thii --- _ day of STAI - r' OF %4 ,4M.44 '4 -TI', I'SQTA Ramsey count.. Personally came before me, this 13th.. day of 1- t.' 1 the ahuyc named Roger E. Hetchler and i•hry I. Hetchler, his wife TII'lJ: .11ENIBER ScArE BAR OF WISCONSIN _ _. i i • not. _ _ _. _ -. ,;iov- . :d h,; § ;06.06, Wis. Ctats.) „ , NSTTtV wAgg CRAFTEEI BY to me known to be the person S who exceutrd t?e Steven ..erir1. I.4 C, o -er ImeEoing ,,mitrument artd acknowledge the same. Currel-I Realty, Inc. 521 ,. :aria Avenue t h ARY J. KELLY Nma Q . _ N,-T m t. lXSOC :.•jthenticated or vrk n Both S C Aw, Pl/Bts MtNN[ T lc . q � pe r l�'A�1��Y ��jt1�VTY da, V+� MY Commas n Eer ea ti q tA. t�)0 •�i „• :., ru,r,. -.. .. r�� in ♦ny :apAr itY .?:ne,1,# w• tae.• — e'ir.t. th.ir eiS�wkuyew WARRANTY DRF.D STATF, BAR OF WSS�ONSTN I -IMf afark Cc. .M. FORM Ya.t --14 - 77 Ml.euk.r, R'm el.111232E0# o mpkft 1996 2 1 Co H 3 547249 CERTIFIED SURVEY MAP Cn � LOCATED IN THE NE 1/4 OF THE NW 1/4 OF SECTION 20, T29N, R19W, TOWN OF HUDSON, ST.CROIX COUNTY, WI. PREPARED FOR: BRUCE TURANSKI NW CORNER OF NORTH L I NE OF THE NW 1,14 SECTION 20. (COUNTY ° S 89 N 1/4 CORNER OF MONUMENT FOUND). _N 89 09 2T E __ _ ��- SECTION 20. ( I' 2662. 33' 1 54.32 IRON PIPE SET FROM REC. AS N89 ° 59' 50" W TIES). S 02 I 112.80' REO. AS S88 ° 55' 54 "E — UNPLATTED LANDS W S 8 C. S. M. VOL. I 5Q 94.27 ......................... g PAGE 177 100 0 WILLOW RIDGE 0 b 9• EAST II .............. • c. • s. M, \\ ��6 P e 2 LOT 2 ' 2. : REF ERENCED B EAR NCED TO ARE 00 ACRES REFERENCED TO THE NORTH \ (87,154 SO. FT. :) L INE OF THE NWli4. (RECORD BEARING FROM VOL. 6 N 88013'26'E I WILLOW RIDGE) .............. 2. 00' REC. AS N83 0 04'09 "E 1 y X F C 1 1 SHED ( TO BE REMOVED A �` 32829' : \ �APPROVED � . PAGE •••I508 �"-►. A N 76 I: Na+ '9b 9 HIGHWAY SETBACK '• /`O : \ "I UL 2 4 a+ L INE / o, CROIX COUNTY :70 ;omarGhensive Plarx►ir o Zoning and • 1 • •� Parks Committsf UNPLATTED LANDS LOT-• 3 ` \ if nct recorded .............................. 2.30 ACRES v�ithin 30 days of ( 100, 105 Sa. approval date 0 -SET I' X 24' IRON PIPE WEIGHING 2. 13 AC. EXCL U$ I NG RIW , p oval sf►all be 1. 13LBS PER LINEAR FOOT. (92,854 SO. FT. ) �A L void • IRON MONUMENT FOUND (AS NOTED). AF C, 0.��i. N V ``N 0 5G ©� r ' St., ti S ti `�*� �. •$ 2 6 0 3, 4� _a� tits J 3 01 � O s• JAMES M. WEBER •` S-1804 =' SPRING VALLEY 1 / ® � ° P• ' / J . f �,. / C, / 9 O_ loll S R ' %j • �,..`.ti o. / UNPLATTED LANDS / .............................. JAMES M. WEBER S -1804 / NELSEN -WEBER LAND SURVEYING / DATED A%A%. q REVISED THIS% DAY OF�.,� / ••� 1996. / 96 -82 THIS INSTRUMENT DRAFTED BY JIM WEBER 100 0 100 200 300 SHEET I OF 2 HHH GRAPHIC SCALE - FEET VOL. 11 PAGE 3138 o h o 3 T n @ % § 7 § a $ % q m > _ � � 3 = a z z s z \ w = e o f « a 0 ® ` � m 1:,- \ E E \ \ k � § P m ` \ E « ' § G / E �kj /\ / \\ o co 0 00 0 ) ® E E j a 1 s Ar {: / 2 , (am, \ E \ C . 3 / \ e � CL E� � , ° �, j j j ^ < Lo \ 4 \ 0 / 7 7 OIQ (D § \/ w \ to ( e z j 0 a § I 0 \ / M M � \ . C ° N � \ k \ 2 f CD / ` \ 7 z E _ E j z ¥ ■ : m m o 0 } \ 7 $ d D \ o / �Et 2 \2 $ § \ c0 Z < E70 % /8E \\, 7/ V Gw \ , \ c % \ / ° . 2 \ ° ƒ CD k @ \ / \ Parcel #: 020 - 1049 -10 -000 02/02/2005 04:31 PM PAGE 1 OF 1 Alt. Parcel #: 20.29.19.189D 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): ` = Current Owner * PAULUS, MATTHEW & DAWN MATTHEW & DAWN PAULUS PAULUS, DONALD & PEGGY DONALD & PEGGY PAULUS 444 CTY RD A HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 444 CTY RD A SC 2611 SCH D OF HUDSON /` SP 1700 WITC , ; .6 ) �` , }� � I ���\ �, ( ( .P � �J� Vl Legal Description: Acres: 2.300 Plat: N/A -NOT AVAILABLE SEC 20 T29N R19W P_I-NW NW & NE NW 2.30AC Block/Condo Bldg: BEING LOT 3 CSM 11/3138 l3.�✓���'`� Tract(s) (Sec- Twn -Rng 401/4 1601/4) ICJ „ / / �� �k l l� ✓ /a � 20- 29N -19W Notes: <� Q Parcel History: 6 GSIM t�7� Date Doc # Vol /Page Type ���� 11/08/2004 779263 2691/151 WD 11/07/2002 697512 2039/213 QC Q ► I ' t l / 05/04/1999 602556 1424/113 WD M�o It 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 47985 311,300 Valuations Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.300 41,800 199,000 240,800 NO Totals for 2004: General Property 2.300 41,800 199,000 240,800 Woodland 0.000 0 0 Totals for 2003: General Property 2.300 41,800 199,000 240,800 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 120 Specials: User Special Code Category Amount 018 - RECYCLING SPECIAL ASSESSMENT 27.00 001 -WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 i c ' m 0 3 o 7 m A K m CD ! 3 .. O m O Cl) = N O "t 0 TD Z N W C O N '�! • CD 0 CL =3 N N u, A N ° O r N N W p 00 0 O O O O C 0 c O� A7 OD U� N a O N 0 p v/ y cn O ° O O Q d N O l� m t < D I _. C D w co .. � m tf.: N O. m '. ` C, I: «. A a N O a CD CD (D N ° c Z C 0 0C 0 C p A 0 C c lq W fA O 1 0 D N N 3 3 cr CD R O O N d 9 w N N C- W CL - O N z rr ° Z Z o - m w D O m n o CD : T �• T V> N "w N F E. O) CD W N co a a 3 m 5 Z m (6 to o a o A Z U) C 0 0 ° 0 O. Z N O m m m � C z 0 3 A Z y Z W CD A a a a O - m ° z a 0 0 3 CD CD O c CD m ., ° A 7 ' N ! n A S A p W w O � V CL a 0 O m W cn O o (D b ' p m O ti jl F AUG 7 9 1 1996 9 Jut �aIN 2 1 996 x 2 �SNECWORD R�� OWSy o, W% v, . 54'7249 CE T IFIED SURVEY MAP U � LOCATED IN THE( 1./4 1./4 OF THE NW li4 F SECTION 20, T29N, R19W, TOWN OF HUDSON, ST.CROIX COUNTY, WI. 111 a jjwyfe PREPARED FOR: BRUCE TURANSKI NW CORNER OF NORTH LINE OF THE NW 114 SECTION 20. ( COUNTY o " S 89 27" W N 114 CORNER OF MONUMENT FOUND). N 89 09 2 E �_�� SECTION 20. (I' 2662.33' 54.32 IRON PIPE SET FROM REC. AS N89 ° 59' 50" W TIES). S 02 36" E I _ 1 _ 112.80' ` -- REO. AS S88 °55' 54 'E -- — UNPLATTED LANDS W m © S 89 0 46' . C. S. M:...VOL:....1 \ 94.27' _ I PAGE 177 100 ................... �, O I 1 cb . ' WILLOW RIDGE ZA +� ................... ob 33' �R, �e� 2 E.A....... .. , ...C, C. \ � P LOT 2 ` ' I QUO. 2.00 ACRES: 1 R R BEARI ENCEDTO THE NORTH \ (87, 154 SO. FT.:) LINE OF THE NWli4. o " i ' WILLOW RIDGE) NG FROM VOL . 6 N 88 l3 26 E ..... .-.. A 2.60 REC. AS N83 ° 04' 09" E y Ik c� SHED (TO BE REMOVED }t ` p L� gyp t1� / C 3 2g; 29 ` fT".ilWYG© �� N 76 0 3 .g . ........ ... . .. ..... PAGE 1508 -•� 1 • � N ` F � ! eL cl a+� HIGHWAY SETBACK O p, .'•� 1 juL 2 4 , 19 9 cs LINE i p6 � r, \ �T. CROIX COUNTY i �o • a �,,prehensive riit ,Plari $�• Zoning and Parks Comn itt" UNPLATTEI� LANDS L OT'• 3 \ If not roeo:dod. ...... 2.30 ACRES vXt" 30 days 61 <� ( 100, 105 SO., PT )- ap"VM dato O •SET I" X 24 1RON PIPE WEIGHING 2.13 AC. EXCLUpING RiW 1. 13LBS PER LINEAR FOOT. (92, SO. PT. ) -AA & void •� I RON MONUMENT FOUND (AS NOTED). , f 00 O V ♦� t _ \ $' S 26 Q om 70. 01' I / o� � JAMES M. z ( / WEBER �. 3 1804 SSPRING VALLEY { �'® S UNPLATTED LANDS JAMES M. WEBER S -1804 �./ °' / ..... • • ................. • ... . NELSEN -WEBER LAND SURVEYING / DATED REVISED THIS %lb DAY OF !w\-% ' 1996. / 96 -82 THIS INSTRUMENT DRAFTED BY JIM WEBER / t 100 0 100 200 300 e..r SHEET 10F 2 moo GRAPHIC SCALE — FEET 1 VOL. 11 PAGE 3138 i 1