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HomeMy WebLinkAbout020-1355-03-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner 4 1- f Property Address tJF City /State � Legal Description: Lot Block Subdivision/CSM ' R V4:=_ t /4, Sec. :?L, I N-RLLWTown of f PIN # oho -13 SEPTIC TANK DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacture - /�f le Size ST/PCr Setback from: House 9 Well ? P/L Pump manufacturer Model Alarm location -- (HOLDING TANKS ONLY) Setbacks: Service road `' Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: L F A t Width Length ' 1. Number of Trenc�es Setback from: House �_ Well �aS P� Vent to fresh air intake 1 9 ELEVATIONS Description of benchmark j �t �� 5 IF CCU ZAJft/LL '�' r Elevation Description of alternate benchmark `T -or" n L I 1< F 47 �-t L; A 2 0 N �' S Elevation 10' 46 Building Sewer �D ST/HT Inlet1 �' ST Outlet + I PC Inlet Q ' Zr PC Bottom Header/Manifold j 1 4 C Top S /PC Manhole Cover * 5 3 Distribution Lines () 10 11 S Bottom of System CPO ► ® () l + U Final Grade ( ) 7+ S `m 1 () "7 ° D q ( ) Date of installation / / Permit number Y 4 �/2d State plan number M ' Plumber's signature � & A License number Z 2S� 3iO Date I Inspector Complete plot plan R I NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. I • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW - � G fi l C . 0 12 L All 31 7 f 4a`...w y7 s .1 INDICATE NORTH ARROW V .onsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y: Saf and Buildings Division ♦ ♦ ♦ ♦ ♦ ♦�� INSPECTION REPORT IX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary 5%5 i�T Personal information you provice may be used for secondary purposes [Privacy Larx s.15.04 (1)(m)]. 3 44 4 4 PerrWMtgjkgarrSAM ❑ CituthyAbil ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tqj�& -03 -000 Oro, 0 1& 4AjL- A9900341 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark o . 6 X06, 51 t Dosing jN( 5'Y Aeration Bldg. Sewer Holding St/ Ht Inlet 4- TANK SETBACK INFORMATION St /Ht Outlet 2(3 TANKTO P/L WELL BLDG. Airl to ntake ROAD Air I Septic NA Dosing NA Header / Man. �• �S Q�- Aeration NA Dist. Pipe h } Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade ys ZS q _ 2$ Manufa r d `/, 33 OZ. 18 Model Number GPM 2 S TDH Lift Fr' n m TDH Ft oss Forcemaln ni. ea SOIL ABSORP TION SYSTEM TRENCH3 Width t Length N Of renches PIT No. Of Pits Inside Dia_ Liquid Depth DIME I - �- DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type 0 � 1 I D 11 ^ -- CHAMBER model Number: � J t� System: J OR UNIT DISTRIBUTION SYSTEM Header /Manifold �� Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake Lengt Dia. Dia. Spacing 1 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 CC MMENTS: (Include code discrepancies, persons present, etc.) LOCAON: HU SON, ?,1.,29 19. 0 9,SE,SE 807 GRANT AVE — HOMEPLACE LOT 3 RI ©o , a �z ; 1 �,(� &,, t/ Plan revision required? ❑ Yes ( No f Z I � T ( a Use other side for additional inform ✓ ation. l 1 . 5 SBD -6710 (R.3/97) Date Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: s i ° { < ° E E : F { d ° a 8 i ° 4 : .. v 3 S } ° 7 3 a v e f s 3 m ; € € W 6 B 3 eR _M M �m m j € e t [ : a J _ , . e x k i . ... ... v im,. °. W .1 �... ...... z..._ .. >._.... ......1 ,._. ... ...... ._ ,_ ..... .. .._ .., t i — . . ...�. ° E i r ( � t ° a" G ...... ....... ... »...., ., mm. E _. _,. .w, .. E t „�. i ' v € # k : Safety and Buildings Division 18 sconsin SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County, than 8112 x 11 inches in size. G • See reverse side for instructions for completing this application State Santarry Permit Number 3 Y Personal information you provide may be used for secondary purposes ❑ Check if revision to p?vous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location S N Ilj 1 LL„F /4 5 f, 1/4, 5 Z ( T Z , N, R E - (o Property Owner s Mailing Ad ress Lot Number Block Number O 7 __3 ....� --. City, State Zt e / (�iong�j 2 be6 Subdivision Fme L A Number I. TYPE F ILDING: (check one) E] State Owned � it� `_ Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF f'JD c>44 NT A► VF- III BUILDIN USE: (If building type is public, check all that apply) Parce � l T ax Number(s) u . l - ) - 2G C.9 1 E] v Apartment / Condo Z- 3 SS ^ d l 3 ©dam 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 E] Replacement 3. E] Replacementof 4_ ED 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 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 1 ICA Seepage Trench LEA N 22 ❑ In Ground Pressure i 42 ❑ Pit Privy a 1 Seepage r ePit /tom �-1�1'�L►4TaIZ. e2 � X SGs � 43 Vault � ❑ y 14 ❑ System- In-Fi - ( <AIONC CM A tM E2 3 �,.� (� :542 FT F -4 C 0 VI. ABSORPTIO STEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade 0 - Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) A Elevatioty d S 7 0 — Si OG Feet 9 Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Con- steel Fiber- plastic Exper. New Exist Gallons Tanks concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tank O W X s ❑ ❑ ❑ ❑ 13 Lift Pump Tank /Siphon Chamber ❑ ❑ 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 ignature (biQ Stamp MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 1 4070 v yt. -OLZ � N IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved janitary Permit Fee (Includes Groundwater E Is s Age ignature (No Stamps) Approved ❑ Owner Given Initial 1 Surcharge Fee) G/ Adverse Determination f/ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R.11197) 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 maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin AdministrativeCode 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 isto 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. r - • -c zt- ITT z ID L wi �pd t.d � -. C' LA I rN R T x � L1 t/' r— A m CL u: � i O O C) cr CD Z 4 'o v : c Q C C! .. .... c r a cn a �2 `. IA a �d N 3 M„y r IA i LA ® o ® rn y ' m o m LA e e e . , c m 3 o = O� c �' a m m o c co . flu y `�• y .< a ? cr a - o L cD Rl 0 w �p 0 � r. o x Cb 0 3 _ � m w o � � x O w c m I� f0 O d O - < m -. C 4 ro y t CD N C N 6 N fD � w y a m tt g e � co) 7 w '� (D N A• fu _ x < � N � -4 O N �p _ mom' w N y Q� ' rn OL CL co x . Q rn Q� co . r. WisceriA Department ofCommerce SOIL AND SITE EVALUATION Page _l of 3 Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, a distance to nearest road. _ t i Parcell.D.# f 020- 1056 -90 -000 APPLICANT INFORMATION - P age. ali information. - R viewed By Date Personal information you provide may be us ss ndary urpojls (Privacy Law, s. 15.04 (1) (m)). Property Owner :\ 4 /r Property Location Miller, Sam / FT w _ Govt Lot SE 1/4 SE 1/4 S 21 T 29 N,R 19 W Property Owners Mailing Address j , jjLot # Block # Subd. Name or CSM# Box 151 Trout Brook Road 1 "� 3 NA H ome Place Y: 7 - - - - - -- G - l_. 1sYk_ - i -- ' - — — City Statisr 1p Ct*My amber LJ City ] Village > iTown Nearest Road Hudson W1 � 5;49 j6 rift - 276' Hudson Grant Avenue j New Construction dentfal,l hlu iber,o rooms 3 LIAddition to existing building Replacement Use: _l public of crSmmerd6fdescribe Code Derived daily flow 450 gpd Recommended design loading rate •7 bed, gpd/ft .8 trench, gpd /ft Absorption area required 643 bed, ft 562 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 95.00' ft (as referred to site plan benchmark) Additional design / site considerations Parent material outwash s & gr. 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 for system ❑ S ❑ u ❑ S ❑ U I ® S El U ❑ S ❑ U ❑ S ❑ U L1 S E U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consisten Boundary Roots Bed ;Trench 1 1 0 -12 1ORY2/2 j Non sl I 1 thin pl mvfr as 2f 0.4 0.5 2 12 -17 10YR3/3 None sl 1 thin pl mvfr cs ; 2f, lm 0.4 0.5 Ground 3 i 17 -29 10YR4 /4 None sl 2msbk mfr c w 2f, lm 0.5 0.6 elev - -- - -- - - - -- - - - -- - — -- 98_77'ft 4 29 -40 7.5YR4/6 None grAs 1 0 s ml cw If 0.7 0.8 Depth to 5 ! 40 -123 IOYR5 /4 None s & gr. o sg ml =_ - 0 0.8 limiting l - factor +I- _ _ T >123' a�: v !1; Remarks: 1 0 -7 1 0RY2/2 N one sl 1 thin pl mv a 2f 0.4 0.5 2 7 12 IOYR /3 None sl 1 thin pl mv fr cs 2 lm 0.4 0.5 Ground 3 12 -24 10Y Non sl 2msbk I mfr cw 0.5 0.6 2f, lm - - -- 9915' ft 4 i 24-32 7 5YR4/6 None gr. is o sg ml cw if 0 .7 0.8 - 1 Depth to 5 32 -119 I OYR5 /4 None s & gir o sg ml - 0.7 0.8 - - - -- - - - - -- - - -- - - -- I - - -- limiting factor - tin >119" - - -- - r�'00 -- Q7 Remarks: - - -- -- CST Name (Please Print) Signatur Telephone No. James K Thom - �` 71 2 48 -7767 --- Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, 1 54020 5/6/99 3602 1015 PROPER, YDMER: _Miller, Sam -_- - _ - _ SOIL DESCRIPTION REPORT Page 2 - of 3 PARCEL LD,# 020- 1056 - 9 A.C.E. Soil & Site Evaluations Depth Dominant Color Mottles Structure GPDfft Horizon Texture nsistence Boundary Roots - -- - In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 -9 lORY2 /2 None sl 1 thin pl mvfr as 2f 0.4 0.5 2 9 -14 10YR3 /3 None sl 1 thin pi mvfr cs 2f 0.4 0.5 Ground - - - elev 3 1 14 -23 10YR4/4 None sl i 2msbk mfr cw if 0.5 0.6 i _9912 ft_ 4 23 -31 7.5YR4/6 None gr. sl 2msbk ml cw if 0.5 0.6 Depth to 5 31 -123 lOYR5 /4 None s & gr. o sg ml - - 0.7 0.8 limiting - - -- -- - { _ _ - -- -- - -- - factor >123" �- Remarks: - - -- - - - - -- 4 1 0 - l ORY 2 /2 N sl 1 thin P 1 mvfr as 217 0.4 0.5 2 9 -14 10YR3 /3 N si 2msbk I mvfr cs 2f, lm 0.5 i 0.6 Ground - elev 3 14 -29 10YR4 /4 None sl 2msbk mfr cw 2f 0.5 0.6 98.84'ft 4 29 -38 7 None gr. Is o s g ml cw If 0.7 0.8 Depth to 5 38 -118 10YR5/4 N one s & g r. o sg ml - - 0.7 0.8 limiting -- - - - -- -- factor >118" - -- + - - Remarks: 1 0 -9 1ORY I N one sl I 1 thin pl. m vfr as I 2f 0.4 0.5 5 - - - -- - - - - -- - - - - - -- iit 2 9 -14 10YR3 /3 None sl 2msbk mvfr cs 2f, lm 0.5 0.6 Ground - -- - -- - - - -- - -- elev 3 14 -25 10YR4/4 N sl 2msbk mfr cw 2f 0.5 0.6 99.11' ft 4 25 -32 7.5YR4/6 None gr. sl ! 2msbk mfr cw if 0 0 Depth to 5 32 -117 10YR5 /4 None s & gr. o sg ml - - 0.7 0.8 limiting - T -- factor >117" t Remarks: I I I Ground - -- - - - - - - - elev I E Depth to limiting factor j Remarks: i v . qO' 50; � �b serrla�y cr, I ocaitd prep She nuDntr: sans is 6x fl d n, Lj 1. SqO 14 ■ ■ Locu -�'o»; b -r � l.�t 3 °F pea�aF f�me�lace� ° :yl s , See . .2 /, T. 29 K, az pct. lg.rvr_ • Tole o{' 1 of S E - = �•/Y Ass u...,ed e Le Gtr: . 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 5 A& 117 Mailing Address B n k j:1- Property Address < 30 - 7 1V-r__ (Verification required from Planning Department for new construction) City/State 4 U 1' S ® Nf Parcel Identification Number O 2© 03 LEGAL DESCRIPTION Property Location -Z. � '/,, 1 / s, Sec. T ? N- R__ own of 0 ,ubdivision H o olf 4 L A ,Lot # Certified Survey Map # to () f 72-- , Volume Page # �— Warranty Deed # S� �{ C , Volume 3 CP , Page # Spec house> ,yes 0 no Lot lines identifiable yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, joumeymanplumber, 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 stating that your septic system has been maintained must be completed and returned to-the St. Croix County Zoning Office within 30 da the three year ex iration te. .D / 4�1 /cl, A O PLICANT DATE : YOWNER CERTIFICATION 11we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of de bed above, by virtue of a warranty deed recorded in Register of Deeds Office. C 77 O CANT DATE * * * * ** Any information that is miS- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office .a copy of the certified survey map if reference is made in the warranty deed , rep r " S" S PA �� VOL �1:3f:� cl 1 4 1 Document Number WARRANTY DEED ;2 This Deed, made between, - y Robert L Rohl Grantor, ►' - - -.� I! and. Sam E Miller ECIS'tt a sin le S CROIX CO., Wl 8 Peen Grantee. tMN„ Witnesseth, That the said Grantor, for a valuable conse IM tw eratron of one dollar and �n other valuable consideration conveys to Grantee the below 3escnbed real estate in OCT U 6 1998 St. Croix County, State of Wisaysn r This is not homestead property. 9`30 0(� « cJ.� Together with all and singular hereddaments arc appurtenances thereunto Dee* belonging; r And Grantor f warrants that the title is good• indefeasible in fee sae pe and free and clear of encumbrances except Area ' easoaents, covenants, and restrictions c f record, Nwm and Return Address + r and will warrant and defend the same. sae E . Hailer ipal Jent� cation Number) PO Box 151 ' 020-1056-90 Hudson WI 54016 a . 1 A parcel of land located in the SE 'A of the SE ' . of Section 21. T29v, R 19W, Town of Hudson. St. Croix County, Wisconsin, described as follows: beginning at the SF comer of said Section 21; thence N 89 '23'SI "1ti� 1319.10 feet to the monumented West line of the SE '.S of the SE !'4 of said Section 11; thence N00'5 1'33"W 980.09 feet along said monumented West line / e of the SE '/4 of the SE . to the North line of the South 30. of t A the E' /: of the SE 'A of said Se. ion 21 as calico out in that documentation found in Volume 838, Page 252 of the St. Croix County Register of Deeds; thence S99'37' 19 "F 626.85 feet along said North line of the South ,- 30 /80ths to the intersection of the monumented $:+uth line of the Certified Sure% Map tiled in Volume _2. Page � 484 and the said North line of the South 30-80ths of said E ' - of the SE VI; thence: S89'23'1 0"E 31.88 feet to a � ; •'; found I" iron pipe being the SW Comer of said Certified Survey Map; thence continuing S89 °23' 10"1: 660._24 3 !f ; feet to the East line of the SE '/4 of said Section = thence S00'5 1'50"E 982. feet to the point of beginning. containing 29.725 acres including rigl.. of %%a% t _9.006 acres excluding right of %%a% ). may,• oat this _ day of tgg_ T AI�oFER ,)/, 74Uz o Robert L Rohl AUTHENTICATION ACKNOWLEDGMENTS •, + Signature(s) STATE OF WISCONSIN `� k COUNTY S7'. CROIX c Personally carttg before me this day of C<- T ?f the above named Hobert L. Rohl t authenticated this _day of to t .� me known to be the person(s) who executed the foregoing fir' :y signature ?ns nt and acknowledge Or. same. tit» or �L� ,►tom �, �� sgnNV. or Print name " 1/14 TITLE MEMBER STATE B %R OF WISCONSIN tary Public County. (If not. Y PV om fission a permanent („ not. state expwatwn d a s • aeAhorited byt7060ti, vYee Stets.) O - �' - , 9 S t THIS INSTRUMENT WAS DRAFTED BY 'N a rsons signing in any capaaty should be typed or . Robert F. Wall YIIL>itEEN Ibn thew Signatures (Signatures may be authenticated .; wknowtedged Ho are d w, . I I ( 8.d►,10.1 OS w papmm s yy �tlonou►�y) ' 7«OS,If.006 po'ILrollt.s 3 �, a; Jo % as *Wjo "I MR ow a powanj a ,L, d ■mow � � .�'� � '� tI� " 00 r soNi�/ o i idlv �� - 19 NoLL039 io ML 39%U 310 3Nn Am 3.09 39 .1 OOOS � (3.f ►�0108,11�7rMNON'NIII�) onww3KL Ql 03LV01030 LZ NOLL039 • S9L V VINWOO W N 86'Z69 3.05 3 9 6N h ItllS3t/ SS3 :6V 335, I t z, W , \ i NOt i E:,V� �o �,' •t ga. . / w�V t�1-. 1 � 7- - 3W 41'49'W �R : G U� 4 + / i 0. at o o w l 0 Af La v ' `W K:ai'cairlrvir' idol N0722',1•E --- GRANT- Z, 273.Sr QQ 11117 'W •. i CD LY Uj rig k D T . fit }w i > G Go 9 - y ' 1`b L br S N I �� = Y I • I kp -- ' 68'09Z' ... ..9Z' I.9C............ , '. is �' .86:1►ZE. �F i O r ,60'086 M .£E AS 900 N (3.0►r1>i� a) L I I � «►39 iu ho W1,39 31u 40 a w \siN►a3iN7wnnow - = 0 '89L� 3Jdd `9W10A S /%13 /?l /b+?Jd �O 11�7d d dW �13112i%?S 031�I1N3J w N < V A 1101 Carmichael Road Hudson, WI 54016 Phone: (715) 386 -4680 St. Croix County Fax: (715) 386 -4686 Zoning Department Fcix To: Tammie From: Shawna Moe Fax: 386 -9281 Date: December 1, 1999 Phone: 381 -5000 Pages: 2 Re: Inspection Report — Homeplace Lot 3 CC: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle *Comments: I ST. CROIX COUNTY WISCONSIN lz� ZONING OFFICE p p p p p p p p ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 December 1, 1999 First Federal Attn: Tammie 201 S. 2 "d Street Hudson, WI 54016 RE: Septic Inspection for Sam Miller located at 807 Grant Avenue, Lot 3 of Homeplace, Town of Hudson, St. Croix County, Wisconsin Dear Tammie: A septic inspection of the above referenced property was conducted on August 31, 1999. This property is located in the SE'/ of the SE' /4 of Section 21, T29N -R19W, Lot 3 of Homeplace, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sincerely, �w u- dog Kevin Grabau Zoning Technician