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HomeMy WebLinkAbout020-1355-07-000 i . i 1 t� ST. CROIX COUNTY ZONING DEPARTME R�CE►VE� �`�,� AS BUILT SANITARY REPORT Qu �! N Cv 0 9 Owner ,-5A/,�ii */I ' + ST opol f Property Address 11 V m Ftt City /State rry1� S� �/ ,1 S/��� Q ZONINGS �. Legal Description: Lot 7 Block — Subdivision/CSM # 1 '/4 t /4, Sec.z-t-, T N -R2 Town of 4 rJDSO V PIN # 420- 13SS- d L EPTIC TANK -- OSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer WIF/S,E %L Size ST/PC / Z LO / Setback from: House 7 -Z Well ' -- P/L Pump manufacturer r- 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: Width 3 Length �S Number of Trenches z_ Setback from: House Id C Well 116 ��' P/I, • Vent to fresh air intake 06't ELEVATIONS Description of benchmark 1 Z �� 2 a O w o C p y /y Elevation o T F /c � /,e. �. fp ►y Elevation '77, 7 f a benchmark m o< Description • a r • ,�/ q - Building Sewer ` "�� ST/HT Inlet` � O � R ST Outlet 5,6 PC Inlet PC Bottom Header/Manifold r Ste: ' of ST/PC Manhole Cover S =5& yj `.`6 - `�� � Distribution Lines () 013 () � � H 'I ( ) Bottom of System( I i : q3 3 , 00 ( ) p t-93,00 ( ) I r / Final Grade () �P .3 S q 7 5 ( ) ( 3S :, q 7 is- ( ) Date of installation / / `� Permit number 0,5 State plan number Plumber's signatur kA V 5 aL6� License number Z Z s4 �• Date Inspector � r L�� Complete plot plan NOTICE Please . rovide the following: g • 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 RE 814 9— " /4 0 10 U t�� 9 YE M 1TJ4 jCP -0, n INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count 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)]. 344605 Permit Holder's Name: ❑ City ❑ Village Q Town of: State Plan ID No.: Miller, Sam I Town of Hudson CST BM Elev.; Insp. BM Elev.: BM Description: r,,p 2 Parcel Tax No.: !1 i9 Ui) . 0 ao p6 r" 4W TANK INFORMATION ELE TION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �cae� 2s� Benchmark 3 D Dosin Alt. BM n vl Ae tion Bldg. Sewer 0.3 Holdi St/ Ht Inlet , YB `ls,gly TANK SETBACK INFORMATION St/ Ht Outlet 9S,6 j TANK TO P/ L WELL BLDG. Ventto ROAD Air Intake Septic f I NA Dosing NA Header / Man. q--z- Aeration NA Dist. Pipe 4. / qq, Zg Holding Bot. System I p's3 qo? q I S3 PUMP/ SIPHON INFORMATION Final Grade anufacturer Demand St cover 3.1to 9`1 Model Number GPM TDH Lift Fri Fie TDH Ft Force In Length Dia. Dist. To well SOIL ABSORPTION SYSTEM d� ) BED/TRENCH width / Length 1 No. R f Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 DIMENSION SETBACK SYSTEM TO P/L I BLDG WELL LAKE /STREAM LEACHING Mau fa turer: ' INFORMATION Type of CHAMBER mod Number: System: `---- OR UNIT (,t DISTRIBUTION SYSTEM Header/Manifold ", Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing — ` 1 7 Z) 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 El Yes El No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 814 Grant Avenue Hudson, WI (SE1 /4, SE1 /4, Section 21 T29N -R19W) - 21.29.19.2073 � A41 0_ w 4-164 No ca ,� - Plan revision required? E] Yes 4 No T—)-(o Use other side for additional information. i l ct� SBD -6710 (R.3/97) Date Inspector's Signature Cert. No I ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E r p a t } i r r f _E F E s � t r ' i e_ _. F 3 I 3 .m R .. .. r ��. r r^ wM_. m K r , i E � ------ ,... 3 _e z, ..ma, .z m. . e�y m.eam n� x ,..� ,.,�.�, ... ... , F t t F = � F g g i t F i � s e e p ... mom . . .. .... e -. °_.. ....... .... __ . _. �.... ....« m t m.m m s r ` r ...... ...<e _. ', ; a ¢ .. .� F € k .m. ..... ..... t .... a. . 3" s � i f j g i r � F t i � f € I F gew i ! € a * 1 E € 1 ate. Safety and Buildings Division SANITARY PERMIT APPLICATION 201 B W shington Avenue N* 6onsin Dppartment of Commerce In accord with ILHR 83.05, Wis. Ad ] Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syste a Oer not less ` ,\C my than 8 112 x 11 inches in size. ` �z • See reverse side for instructions for completing this applic i�Zi js,"? stat itary Permit Number P '/ Personal information you provide may be used for secondary purposes "! if reon cO reviou pplication [Privacy Law, s. 15.04 (1) (m)]. ] r ;f 4 Pl an I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL r Propert ner Name Pr ration r !4 S F' 1/4,5 T N, R 1 E( W Pro ertyCGw e�s Mailing Address b r; Block Number CitX,State Zip _Code PhD n Number Subdivision NarAep4CSMNu ° m r Il. PE F B IL IN (check one) ❑ State Owned E] It� ge �+ Nearest Road Public 1 or 2 Family Dwell p VII ( age - N o. of bedrooms Town of ME III BUILDIN SE : (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ v Apartment / Condo ?W O 13 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_ ❑ Reconnection of 5_ ❑ Repair of an _ System ________System __________ ___ Tank Only______________ Existing System ________ ^ Existing System B) A Sanitary Permit was previously issued. Permit Number 3VV60 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 1T Seepage Trench t� 22 E] In-Ground Pressure j 42 ❑ Pit Privy 1 Seepage Pit R t j:I LT 14 "M X 7 - 43 ❑ Vault Privy 14 ❑ System -In -Fill t .0 I No Sjj S VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Require (sq. ft.) Pro osed (sq. ft.) (Gals/da /sq. ft.) (Min. /inch) A � i Elevation I J O • .. Feet , Feet Cap acity Site VII. TANK in allo Total # of Prefab. Fiber- plastic . Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existin structed Tanks Tanks Septic Tank or Holding Tank �`LS W ❑ El 1:1 El 1:1 Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ I ❑ ❑ ❑ 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: ( tamps MP /MPRSW No.: Business Phone Number: Z Plumber's Address (Street, Cit , State, ip C de ): 1646E I&i*D 1 IX COUNTY / DEPART NT USE ONLY E] Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature o Stamps) P Approvecl [:]Owner Given Initial Surcharge Fee) Adverse Determination —1!5 /1 —, ?_ X. CONDITIONS OF APPROV / REA ONS FOR DISAPPROVAL: , was -tw_ ACS 46 Q ?• Y 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 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. ll. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ' Safety and Buildings Division Bo V6on SANITARY PERMIT APPLICATION 2 1 x ashingtonAvenue n accord with ILHR 83.0 Fs� Ljepartment of Commerce 1 " Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) fort m, on apertfs count than 8 112 x 11 inches in size. 1 b y RECEIVES State Sanitary Permit Num er • See reverse side for instructions for completing this ication Personal information you provide may be used for secondary ul tSutsion 1 `` ❑ Check it revision to previous application IPrivacy Law s. 15.04 (1) (m)I. �� State Plan I.D. Number EA I. APPLICATION INFORMATION - PL'S PRIN I Prope y Owner Nam ti erty. o ion LL /'``, v4, S T Z �', N, R/ E (o Property Owner's Mailing Address Bl Number City, tate Zip Code Phone Number Name o CSM Number 9(- 7- 76L,4c II. YPE F BUILDIN G (check one) ❑ State Owned , Nearest Road Village El Public U 1 or 2 Family Dwelling - No. of bedrooms __? own o e /- /4 (/, III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) AI - -1,01 . I C� ' -;�v 3 1 ❑ Apartment/ Condo a D ZO /'3 S -S 0 7" ©U' o 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] Replacement of 4 [] Reconnection of 5 [3 Repair of an - _System ________ System_____________ Tank Only______________ Existing System - --------- Existing System B) El 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 5f Seepage Trench LEAC-H 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit J % /N F tTIZgTb Z Q X 3 X 43 ❑ Vault Privy 14 ❑System -In -Fill 3(.$ SOFT S/Dr.W1A1DF_2 c MQr�i2S - OTt4L- 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 �L ,.� Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) cy Elevation 7 � 3 'Z __ - / Feet 9IX Feet Cpcit VII. TANK in a a all ons Total # of r Prefab. Site Fiber INFORMATION g Gallons Tanks Manufacturers Name concrete Con- Steel glass Plastic Exper_ New Existin structed App Tanks Tanks eptic Tank Holding Tank coo S� /Z ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: Plumber's Addres (Street, City, State, Zip Code): D 70 v /�lT / X90 11V 4. 5 01v Cam/ 6 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S itary Permit Fee (Includes Groundwater D att Ilssyed Issuin A nt S* nat e ( Stamps) Approved E:] Owner Given Initial r -42-a5ldfl Surcharge Fee) , ( 6 � Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. - 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD =6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 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. r LoT-t� - I q 644N 14t)F - 3 � I z A�F� PIN © ? -000 SL- F- 1..= S ,N w J 5TH C l . - e? � .00 qel, vu- w , �� —TO i ,4 L Vo ' Ul w -7 � 4 o a a� 3a z n m -- ��GE a plc AA � { m A Lt j3. VO BoX tL-P R � I AU � S �i Department of Commerce SOIL AND SITE EVALUATION h�"� w` g �� �' Wiscon ' Pag 1 Of 3 Division of Safety and Buildings .0 in accord with Comm 83.05, W is. Adm. Code . A.C.E. Soil &Site Evaluations Att.)ch 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 referencepoiat.t$M), direction and St. Croix percent slope, scale or dimensions, north arrow, 5peK oeatiod and distance to nearest road. - - Parcel I.D.# 020- 1056 -90 -000 APPLICANT INFORMATION - Pl/ se'pint all " formations Re iewed By Date Personal information you provide may be used f kecohdary p poS1 (Privacy Law, si .04 (1) (m)). Property Owner P perry Location Miller, Sam c GQ.. Lot SE 1/4 SE 1/4 S 21 T 29 N,R 19 W Property Owner's Mailing Address t Lot 7 Home Place # Block # Subd. Name or CSM# Y C;R,aX , Box 151 Trout Brook Road yTy �__ City State 4p Code jf aed k*1QbE .]City J Village [ 'Town Nearest Road Hudson Wl 5 '1,,6:• 1715) 386 -2769 Hudson Grant Avenue I New Construction Use: L Reside tial.r beb'edrooms 3 (Addition to existing building Replacement j Public or commercial describe 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, gpolft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 95.00' 1 4 S - 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 E S❑ U M S❑ U Ej S❑ U ❑ S U j ❑ S U ❑ S® U SOIL DESCRIPTION REPORT Depth Dominant Color Mofties Structure GP D /ft Burin Horizon Texture Consistence Boundary Roots 9# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 - 1 0 -1 4 IO /2 None sl lmc mvfr as 2f 0 0.5 2 14 -28 10 /3 None fsl 2msbk mfr cw 2f, lm 0.5 0.6 G ro u nd _ 3 28 -54 IOYR4 /6 None s 0 sg ml gw 2f, lm 0.7 0.8 - -- 9 9.78' ft 4 54 -122 1 None s & gr. i o sg 0.7 _ 0.8 -- Depth to limi factor -- - 122" . Remarks: — 2 1 0 -23 IOR /2 None — — sl lmcr m vfr as 2f 0.4 0 2 23 -40 + 1OYR3 /3 None sl 2msbk mvfr r c w 2f, lm 0.5 0.6 elev Grou 3 40-61 10 /6 None s o sg ml � gw 2f, lm 0.7 0.8 - -- 9396'ft 4 61 -115 1OYR5 /4 None s & gr. o sg ml - - 0.7 0 8 Depth to limiting - 1 - factor - >115" Remarks: -- CST Name (Please Print) Signat e: Telephone No. James K Thompson 715- 2 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, WI 54020 5/7/99 3602 1019 PROPE", 0W IER: Miller, Sam SOIL DESCRIPTION REPORT pots Page 2 of 3 PARCEL LD # 020- 1056 - 90-000 _ A.C.E. Soil & Site Evaluations Depth Dominant Color Mottles Structure GPDIftZ Horizon Texture nslstence Boundary Roots -- -- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 -12 1ORY3/2 None is 0 sg ml as 2f 0.7 0.8 2 12 -26 IOYR4 /3 None Ifs 1 m sbk mvfr cs 2f, lm ! 0.5 0.6 � Ground ± - -, -- elev 3 26 -36 10YR4 /3 None gr. Is o sg ml cw 2f, Im 0.7 0.8 4 1 324 97.04' ft 6 -1 � 4 1 OYR5 /4 None s & gr. o sg ml - - - 0.7 - 0.8 Depth to limiting - -- - - - - - -- _ _' _ - - - -- - -- factor Remarks: I I 4 1 0 -14 l ORY3 /2 None is - o sg - - -- - ml — as -- 2f 0.7 0.8 2 14 -21 1 OYR4 /4 Non IS l m sbk mvfr cs 21, l m 0.5 0.6 Ground- -- - ' - - - - - -. -- -- -___ -- -.. _ - — - -- - -- - - -- — -- Non s & o sg cw 1 f & m 0.7 0.8 elev 3 21 -31 gr. ml � 10YR /4 I _ - 95_72' ft 4 31 -124 10Y /4 None s & gr. o sg 1 ml - 0.7 - 0.8 Depth to � -- � -- - -- limiting factor >124" I I I Remarks: - -- - - - - - -- - -- - -- - -- - -- - 5 1 0 -7 l ORY3 /2 None sl 1 thin pl 1 _ mvfr as 2f 0.4 0.5 2 7 -12 1OYR4 /4 j None sl 1 thin pl mvfr es 2f, lm 0.4 0.5 Ground elev 3 12 -24 10YR4 /4 one sl 2msbk mfr cw 2f, lm 0.5 0.6 -i - - -- 100.12 ft 4 24 -42 7.5 None gr. is o s ml cw If 0.7 0 Depth to 5 42 -12 10YR5 /4 No s & gr. o sg ml - - 0.7 0 limiting >128" factor -�_ • �'`�� �- - - -- - Remarks: i i Ground - - - - - -- - elev Depth to limiting - factor - -- - - - - -- - - - : Remarks: a4& - w 4 • U o O UZI o � c � � T7 P Q tp N �w U IZIO 1 �a m CA UN v " en N N 7 � r E v x cc N .: • y .a S. co cm ' y m CY CL h w c c� 3 c o m cc i= vs c0 2% 4 N p ME E tz .y O NI a c` x C% • Tv a Acvc Cc. � W 3 . ._ l •o cc Cm v►'° a a� y tZ E O 2 § 'd { N w W �� N .c o M ARA L d W u - L. a L 5r � p • �; Z . • � ..�. O C L i. I r Lu .Q U o o c , CL o E w 0 cu h-- g _ -C c , sm ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Sd -M /1VlL L o Mailing Address X Property Address (Verification required from Planning Department for new construction) City/State 4 U A S © N U2 Parcel Identification Number D Z O 0Z-O ©Q LEGAL DESCRIPTION Property Location E ' /,, '/,, Sec. Z , T_�ZN -R /9 Town of y�44S01 I bdivision o/YI� �L/�G� , Lot # 7 CetrNfied Survey Map # l0 ©Sc 77- , Volume 7 Page # T'- Warranty Deed # Volume 3(� 3 Page # Spec house yes ❑ no Lot lines identifiableo yes ❑ no SYSTEM NAN 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 masterplumber, journeyman plumber, 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 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 St. Croix County Zoning Office within 30 days of the three year expiration date. / NA LICANT DATE OWNER R CERTIFIC AT ON I . '-i; I'(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 the prop&ty.iieseribed above, by virtue of a warranty deed recorded in Register of Deeds Office. K 7 Qsf& ATORE bF APPffCANT 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 i t — veL 1 :361 pw 114 Document Number WARRANTY DEED This Deed, made between, r ' Robert L Rohl Grantor, ►' and, Sam E Miller REGIS1 — �' —1 } +' a sin le rson ST. CROIX CC. g pe Grantee. W 11111 Seth, That the said Grantor, for a valuable comicwahon of one doNar and on lw �eeew+l other valuable consideration conveys to Grantee the below zescrnbed real estate in OCT U 6 1998 St. Croix County, state of 1Wss a�,n This is nowt homestead property. 9' M Together with all and singular hereddaments arc appurtenances thereunto Ae f of Orei µ' belonging; And Grantor r 1< warrants that the title is , indefeasible in fee +� 9� s;r.-pie and free and clear of •' encumbrances except Recording Area Y, easements, covenants, and restrictions r f record, one and Retum Address + R and will warrant and defend the same San E . Mall.er iPa m :entikal+on Numberl PO Box 151 020- 10-56-90 Hudson WX 54016 A parcel of land located in the SE '/4 of the SE , L,f Section 21. T29N, R 19W, Town of I ludson, St. Croix ~ a County, Wisconsin, described as follows: beginning at the SF corner of said Section 21; thence N 89 °23'i 1 1319.10 feet to the monumented West line of the SE ',4 of the SE ',/4 of said Section 21; thence N00 °51'33 "W 980.09 feet along said monumented West line of the SE '/4 of the SE 'A to the North line of the South 30:80ths of ! t the E'' /: of the SE 'A of said Se. ion 21 as called out in that documentation found in Volume 838. Page 252 of the St. Croix County Register of Deeds; thence S89°37' 19 "E 626.85 feet along said North line of the South 30 /80ths to the intersection of the monumented Sc-uth line of the Certified Sune% tap tiled in Volume 2. Page 484 and the said North line of the South 30 80ttu of said E ',: of the SE '/4; thence S89 °23' 10 "E 31.88 feet to a ; found I" iron pipe being the SW Corner of said Certified Survey Map: thence continuing S89 °23' 10" E 660.24 'f � feet to the East tine of the SE '/4 of said Section `I : thence S00 °5 1'50 "E 982.41 feet to the point of beginning. containing 29.725 acres including rigs . of %%a% t _8.006 acres excluding right of vka% ). a oa this day of 199_ T AIJoFER 3 0 - Robert L Rohl AUTHENTICATION ACKNOWLEDGMENT. Signatures) STATE OF WISCONSIN •% k COUNT, ST. CROIX t Personally carngp� tore me this day of Cx T `?f the J A authenticated this _ day of above narrowed Kobert L. Rohl to me known to be the person(s) who executed. the foregoing t, signature o< i +ns 7nt a nd acknowledge ge ttr! same IA..�. � �c� ! • 'ype ,� t� type a print name v1/1G.s.r L e c- -�" K T l TITLE MEMBER STATE BAR OF WISCONSIN tary public County. (If not. Y PV own is sion is permawwN (If not. state expiation date aufti:w byt 706 06. We State.) THIS INSTRUMENT WAS DRAFTED BY 'N a arsons signing M any capacity should be typed or Robert F. Wall BEN 14n thew signatures -. s (Signatures may be auth011kated .: acknowledged Uo are li d y y necessary.) Z. 4 41r. ' SOMV7 0311V7dNn o LZ N01103S 30 V4 3S 3H1.40 3NI11SV3 ,w aZ6„ AMH .S.n 6VZ96 3 x,05 X 9 000 S (3.0130 oS21) O i onand 3H1. O1 a31V01030 0^ o LZ N01103P r XI) i -. s ZZ LVLO£ Z5 99L H3NL100 3 N £6'Z69 M ,.05 ,L5 0 0 N CN N 0 W � OD �� N �N � `L Gi o - � C x d r N << O� v N M N 01' 41'43 E °f N °L, T 66.36 co N ao N g V) o a Cl) -- n G 9 V 67.62 N S 01' 41'43 W � w d co m m P " y Z z A ' c E U O 00 w D N O O a N . 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Lo E E £9'092 \ 9z 9c 1 rge / 96'VZ£ 60'096 M „6£ , 9 000 N ( 3.6V.19 0oS N M W < L 107 VIl3S 3H1 d 0 lr/M 3H1 d 0 3NI11S3M a31NmnNOW 9107 '89L 6 3Jdd `9 3YVn7OA db'W �l3/12�InS O31d11 t�30 VI SI/13R�1 b'?�d -40 1 t�7d :10 P 101 1101 Carmichael Road Hudson, WI 54016 Phone: (715) 386-4680 St. Croix • Fax: 715 386-4686 Zoning Department Fc w 3x To: Pam O'Keefe From: Shawna Moe Fax: 386 -9281 Date: April 19, 2000 Phone: 381 -5000 Pages: 2 Re: Septic Report — Homeplace Lot 7 CC: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle •Comments: ST. CROIX COUNTY f'. WISCONSIN ZONING OFFICE mss s - r r n r r u r n■ -- w,,,� ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 Fax (715) 386 -4686 April 19, 2000 First Federal Attn: Pam O'Keefe 201 South 2nd Street Hudson, WI 54016 RE: Septic Inspection for Sam Miller located at 814 Grant Avenue, Homeplace, Lot 7, Town of Hudson, St. Croix County, Wisconsin Dear Ms. O'Keefe: A septic inspection of the above referenced property was conducted on November 9, 1999. This property is located in the SE' /4 of the SE'/ of Section 21, T29N -R19W, Homeplace, Lot 7, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sincerely, &I /� �,�� Kevin Grabau Zoning Technician Ism . i