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HomeMy WebLinkAbout020-1343-16-000 n y O 3 m n C M [� > ; ° 3 to < O Z O W O = A N P . 7 �' N A CD 7 a N ' O 0* O = W r"y A CT N A @ 7 O A r , CD CL 01 m ' O O C O N C N O 7 U7 N O O ■�i. 7 tll -n O O �1 o p H� t C C4 ►� !V cn D CD o o ♦� A O co N 3 j W N G L f.J W O. N = { 0 r to cn c cCOo cn 3 a z 000 • O 0 o' 3 CD e F g n co = a < - m = N 7 3 ID z _ N D= z p v� t0 N C 7 N W o O. n 3 � 7 (D O n p A Z n cn C ;a 2 N O A C 3 O. A A m O A CL p z Z A z C :: M co z CD A A � ° Rr a • 3 o v co 7 CD C T N. N °' O C (D C O OZ d N N y O a a fD N v3 I y ° 3 I N N A a N O I a•' W N A 3 N CD j N O O H A O_ O O O ~ O C CD O L � ti Parcel #: 020- 1343 -16 -000 03/24/2005 02:53 PM PAGE 1OF1 Alt. Parcel M 24.29.19.1844 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 VIRGIL F PERRY * PERRY, VIRGIL F ZAHRAD ZAHRADKA DIANA L ItA DIANA L 893 YOUNG RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 893 YOUNG RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.731 Plat: 2647 - WYLDWOOD III '98 SEC 24 T29N R19W PT SE NE LOT 16 Block/Condo Bldg: LOT 16 WYLDWOOD III 3.731AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 24- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 06/10/2002 681397 1908/48 WD 03/03/1999 598694 1407/482 WD 2004 SUMMARY Bill M Fair Market Value: Assessed with: 49855 371,500 Valuations: Last Changed: 04/29/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.731 44,400 243,000 287,400 NO Totals for 2004: General Property 3.731 44,400 243,000 287,400 Woodland 0.000 0 0 Totals for 2003: General Property 3.731 44,400 243,000 287,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 515 Specials: User Special Code Category Amount 018 - RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 ST. CROIX COUNTY ZONING DEPARTMENT , . l AS BUILT SANITARY REPORT ' RECE VET 1 i' h • 1 i+ Owner •- : ,_. _ t -....1 Property Address i dJ p lcx999 �� 1-, City /State 6 Z& ' couk*ry ZONINGOFF1 E Legal Description: �p 1 / Lot 1( Block Subdivision/CSM # 91 C ' /4 & t /e, Sec. �, T ?N -R4W, Town o PIN # O 00 - /354 3 - -/Z, SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer t, u-,.— _ Size ST/PC / I- Setback from: House J Well, N& P/L /Z S. 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: 1� 7 /`'° -- Width Length Number of Trenches Setback from: House Well - P/L 9" F Vent to fresh air intake ELEVATIONS / Description of benchmark TO D a �1) L Elevation 1& Description of alternate benchmark Elevation Building Sewer ST/HT Inlet ST Outlet 14 PC Inlet �^ PC Bottom Header/Manifold r l'9 Top of ST/PC Manhole Cover Distribution Lines (I ) %, 9 3 Bottom of System Final Grade Q) -- Date of installation 2 11 9 pPermit number 3 3 W Q State plan number Plumber's signature License number Date Inspector 4 1 14 4 (1 — 'TQI Complete plot plan * rax� aAA I NOTICE Please provide the following: everything within 100 feet of the system. A plan view sketch showing ryt g y p g • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. L VIEW o � V i �5 Gt►'� i INDICATE NORTH ARROW l _ Wiscgnsin Department of Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division INSPECTION REPORT G/0 1 GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: n ST CRPI X Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338802 Permit Holder's Name: ❑ City ❑ village Town of: State Plan ID No.: JOHNSON, MARK HUDSON CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: 020- 1343 -16 -000 TANK INFORMATION ELEVATION DATA 9900065 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Z O Benchmark qg /�c�q (&o. 1 Dosing e 9� 2� // S6 Aeration Bldg. Sewer Holding W Inlet �.�� /197- TANK SETBACK INFORMATION St Ht �, 7G TANK TO P/ L WELL BLDG. ventto ROAD Air Intake Septic >/M 35- — NA D o tom Dosing NA Header/ Man. y, q� /JO . o Aeration NA Dist. Pipe Holding Bot. System E X �g, (, Z PUMP/ SIPHON INFORMATION Final Grade /?.66 Manufacturer Demand ✓�- Z3 �p g s Model Number GPM TDH Lift Frictio System TDH Ft Loss Forcemai n Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM �, f 3 � q �' ` /Zc�a -S 461i�- REN � Width , Length No. Of Trenches PIT No. Of Pits Insi Dia. Liquid Depth DIMEN3TUNS DIMENSIONS - SYSTEM TO P / L BLDG WELL LAKE/ STREA LEACHING anufactur r: SETBACK CHAMBER INFORMATION Type Of , .�/ Mod tuber: System: OR U DISTRIBUTION SYSTEM Header / Manifold n Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake q, i 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 E] Yes [j No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 24.29.19.1816,SE,NE 893 YOUNG RD — WYLDWOOD LOT 16 3 5 "Plarevision required? ❑ Yes ❑ No / Use other side for additional information. (3 SBD -6710 (R.3/97) Date Inspector's Signature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: x rx p 6 _� _� : 1 —A . e ...�.. — , P. E 6 a � a ,�s m E ....., mN „4 . _ .4 ,, ""A ..., ._ 1 - 7 - 1 1 V 4 6 x� e i a e� a �. .__ W m i ... _ 64 3 a zv 1 i m r } i 3 E , E c , s n t. t a I +444 { e 1 tt E J AI.! E } = i 7 }° ? p vq 3 4 ini ' = F ✓ .,�.. ..,.. .. .. m. «� .. ,.a, >r.. � ,,, ._.. ..m. ., ... ... _ ...e m. m tee: ...,.., 6 4 e I r pa 1 14 - 1 i � a 9 t r i x 6 f i r ............. ,,,.....,. ,_., N .g....._.. .... ... .. .,. ,., } 1 d E — till _ 9 a sa s ' i ��a f a x x o t tl W _s Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Vi iconsin r wit I H P O Box 7302 Department of Commerce accord t IL HR 83.05, Wis. Adm Code , Madison WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less Count �� than 8 1/2 x 11 inches in size. ry • See reverse side for instructions for completing this application State Sanitary Permit N (` uu mm b } er Personal information you provide may be used for secondary purposes heck if r evision t previo application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Property Location r 1/4 Nr - 1/4,S a T ,N,R JCJ E(or Property Owner's Ma Ad�ess Lot Number Block N u ; e Woo r > �v City,Stat Zi Code Phone Number Sub (vision meorestNumbe II. TYPE ILDING: (check one) ❑ State Owned it Nearest Road ❑ Village Public 5Z 1 or 2 Family Dwelling - No. of bedrooms fugl OF a LA r, IACL III BUILDING SE: (if building type is public, check all that apply) IPJrcel Tax Num er(s) 1 ❑ Apartment/ Condo Q a 0 -13 J43 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 1 ^ ^ -, utdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales / Repairs waurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park rvice Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory �1`'' her: specify IV. TYPE OF PERMIT: (Check only one box on line A. Che A) 1. New 2. ❑ Replacement 3, ❑ Replal �� 1 tion of 5. ❑ Repair of an System - - - - -- System - - - - -- Tank ( I � d I stem Existing System B) E] A Sanitary Permit was previously issued. Permit P (� - 6� �,/ Date Issued /4s" 5,�' j t 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 %n ee a e renc 22 E] In-Ground Pressure 42 [] Pit Privy Seepage Pit ./ �. 1 43 C] Vault Privy 14 E] System-in-Fill ��-rgo 3 " k VI. ABSORPTION SYSTEM IFQRMATION: 1. Gallons Per Day 2. Abs p. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation Ll —^ q:, (o Feet 10 Feet VII TANK in Capa allo u t s g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existing structed Tanks Tanks Septic T or Hddiagk i rS ❑ ❑ El 13 El Lift Pump Tank /Siphon Chamber ❑ ❑ 11:11 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins Ilation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) n P tier's Si atur (No tamps MP /MPRSW No.: Business Phone Number: 15 Plum er's Address (Street, City, State, Zip Code 1 969 1. h t X e e IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary F (Includes Groundwater ate I Issuing Age iture (No Stamps) proved ❑ Owner Given Initial ..��rJ Surcharge Fee) / 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 -66 -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. 11. 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 8 112 x 11 incoes 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 ``/SCO/1S %n SANITARY PERMIT APPLICATION 201 B Was in Avenue Department of Commerce In accord with ILHR x3.05, 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. • See reverse side for instructions for completing this application State Sanit Permit umber ar �3a8oz Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application f Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Prope y Owner ame Property Location F114NE 1/4,S T ,N,R1 E(o W Property caner s Mailing Address Lot Numb Bloc Block Nu ber a t 2-. rcc. I IV City, St t Zip Code Phone Number Sub division ame or C M Numb r ©c � S! ( > w II. TYPE Of BUILDING: (check one) ❑ State Owned Cit I Near st Road Public 1 or 2 Family Dwelling - No. of bedrooms ° Tow OF OK r k III BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) 02-0 +3 I 1 ❑ Apartment/ Condo ' 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1 _ New 2 [] Replacement 3 E] Replacement of 4. ❑ Reconnection of 5 E] Repair of an _____System System Tank Only 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 11eepage Bed 21 E] Mound 30 E] Specify Type 41 E] Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure . 42 C] Pit Privy 13 E] Seepage Pit j" 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 (000 Required (sq. ft.) Pro osed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) p Elevation 9 51 k 5-L t( / k Io Feet `e // Feet a It VII TANK in Ca g Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass App. New Existin structed Tanks Tanksl Tanks Se tic Tank i `PS 'P /' ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for inst tion of the onsite sewage system shown on the attached plans. Plumber's Name: (P n PI =Sign mps) M P /MPRSW No.: Business Phone Number: 0 05 7 �5 a (asG�5 Plumber's Address (Street, City, State, Zip ode): } y /V `Q.4.J 6 O� � 0 1 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued I lssumAgent Signature (No Stamps) Surc Approved ❑Owner Given Initial ,5 D / ur 8'��q ' Adverse Determination 1 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 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> naroe a r)d 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. Vlll. 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. D. � c k 0 a) 60 5y CG.»� orb h4l ` ts�ri w&04 b o w T Poc. F-oce f ZL 7s' c!�f ►.l'n�QI+Nxp. aWW '7- r Al o G � � S cN ►���I p I 6g I A (� L 7 3 , . ■ r !! � 2 Z _ ° Z |/ $� ) \ D . m ■� § ¥ m � C i \§ !& E f ■ % a o 2; � © & ) k � - � (D B � � � \ |% {® ° C3 0 ■ `5 � k\ co a e !■ 08 2 |_ ) ® \ 7 \ � ■ |i !z , / at L S @ EE aGO� C CL !� • m � r 9 7 �_ m {\ � � � � � 0 � � -n . x �q�K3 CD ! x q« 2 K J « x ■ CLz a c U2 o k¢ | cr r = 0 k�k$ 77 0 3 2r . C -0 R $ .2 -J. \ k R 0 �K2(n � 7 =3 3 m — cn cr 0 \ f 3 x : a #7aa A� { U� e k 0 k 3 | \ 3 . K § O Invert | CD - $ A 0 | » ro zo s� -) 1&0 5Xeck-rPorlt A Lk v�dS W Y Iawoad PIS. b� ���c�(Ynurk, TLrc7 PIK fGl lcsr� � /any L W c� e Y i r c L, p a a© s37 g� N 5 a? ' Cr U SS J`C�IVr1 � �e�7 �•1s1'en - 1 . • - - � r 1•� �l o I� v�S o vim. a 1 to S y C'a rho r !U • S's /dS hash Alt Inlet► And OD►errotion Pipe L •• V ii, �L e sF y�r,u� y Say{ Taq u 121�� ()-- Approv%4 Vent Cap t ' . T . ( Sw� •� F7 Ift el 12 Ab ove I�vf/ G1�oc� Aci- -e f�In elGraO• i r 20. 42' Apova Plpp _4' Coil Iron To float Or4ae Vent Plpa ►taeh Hoy Or SIn1M1k Carel ' 111n a * AgprapaU •. Over Plpe D1e1rlDvllan —� iee a pipe - o o o ti' Apprepote o Perloretof Plpo Lelorr Done 11 PIP e p �Ce.ptIng 1e•n1lWInp At r Dotlem 01 Sj►1em cl" - SOIL FILL. '. 015TRI PIPE ;� ". APPROVEt) t4a!•r1IETIC COVcP "�-- Mj1T�IZIJ�1 OR 9" OF 5'fRI.4/ 2 OP \GGREGATE -� Y= h � p� � y(!r t; -2 1 AGGRCGATE �L. E V, o f z0. � . E> T._ � DIST RIB'JTIOIJ PIPE Tp 0E AT LEAS'f IIJGI•IES BCLOW ORIGIIJAL GRADE AIJU AT LEAST LO ItJCHCS BUT {,10 MORC THAI) `12 IUCIICS OELOW FMAL ORAOC MAXUI MP-rvi OF E%CMATICIP r? ,011 0 KIbW AL 6stAvk WILL BE � IIJGHES nHltAVM p Epr1l of EACAVA f KOI'1 '6tt�gL �R�tD wltt eE INCNCs SIGIJCO: LIG CtJ SC ►JUMBE It: s - DATE* _. - -- -• • -• - -• • � to ... _ .. .. .. Wiscoiasin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and 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 St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 020- 1329 -90 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R IEWEp_BY DATE PROPERTY OWNER: PROPERTY LOCATION Greenwood Enterprises, Inc. GOVT. LOT SE 1/4 NE 1/4,S24 T 29 N,R 19 )E (or) W PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 1416 Third St. 16 na W ldwood hase 2 CITY, STATE ZIP CODE PHONE NUMBER [:]CITY [ []TOWN NEAREST ROAD Hudson, WI. 54016 (715)386 -3674 Hudson Young Rd. : k] New Construction Use [x] Residential / Number of bedrooms 3 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate _ bed, gpd /ft gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 98.60 alt. area =98.00 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem [2 S El El FL] U [R S El [I S ®U E7 S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmrtcfl 1 0 -12 10 r3 2 none 1 2msbk mfr 9W 2m -5 -6 2 12 -26 7.5yr4/4 none sl lcsbk mvfr gw lm .4 .5 Ground 3 26 -36 7.5yr4/4 none is Osg mvfr gw na .7 .8 elev. 4 36 -82 7.5yr4/6 none co s Osg ml na na .7 : .8 10 ft. Depth to limiting factor fir!• Y +82 Remarks: Boring # 1 0 -16 10yr2 /2 none 1 lcsbk mfr cs 2f .4 .5 La 2 16 -38 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 3 38 -84 7.5yr4/4 none is Osg mvfr na na .7 1.8 Ground 1 02.6 ft. Y Depth to limiting factor n, +84" COUNTY Remarks: ZONING OFFICE X . ; CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. e. New Rich and WI 54017 it Signature: Date: 4 -10 -98 CST Number: m02298 PROPERTYOWNER Greenwood Enter_ SOIL DESCRIPTION REPORT Page 2 of PARCEL I.D. # 020- 1329 -90 Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Baxxiary Roots Bed Trerxh 1 0 -12 10 r3 2 none 1 lcsbk mfr cs 2f .4 .5 2 12 -22 7.5yr4/4 none sl lcsbk mfr gw if .4 .5 Ground 3 22 -84 7.5yr4/4 none co s Osg m1 na na .7 .8 elev. 1 02.0 ft. Depth to limiting factor 84" A -4 Remarks: Boring # 1 0 -8 10yr3 /2 none sl 2mgr mvfr cs 2f .5 .6 2 8 -80 7.5yr4/4 none cos Osg ml na na .7 .8 Ground elev. Depth to limiting factor +Rn Remarks: Boring # 1 0 -12 10yr3 /2 none 1 lcsbk mfr gw if .4 .5 `. KKK 5 2 12 -20 7.5yr4/4 none sl lcsbk mfr gw if .4 .5 3 20 -80 7.5yr4/4 none co s Osg ml na na .7 .8 Ground elev. fit. Depth to limiting factor +R Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Greenwood Enterprises, Inc. New Richmond, WI 54017 MPRSW -3254 SE4NE4 S24- T29N -R19W (715)246 -6200 lot #16- Wyldwood phase 2- Hudson township N 1 40' BM.= top of 2" pvc pipe @ el. 100' Alt. BM. =nail in Cherry tree C el. 99.70' This soil evaluation was conducted to satisfy a Zoning requirement, it may or may not be satisfactory for your use. AL Gary L. Steel 4 -10 -98 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 6 Property Address 01_3 � 204j� ff/lo W &4r �Gyz (Verification required from Planning Department for new construction) City /State fZ__P_.SbA/ Parcel Identification Number � - l34 LEGAL DESCRIPTION Property Location '/4, W '/4, Sec. off , T_QaN -R_L�__W, Town of Subdivision L0 Vo CL , Lot # Certified Survey Map # S_ C(p 3 �' , Volume -] , Page # aq Warranty Deed # S !2 9 , Volume 1 Page # IV 9 Spec house ❑ yes ❑ no Lot lines identifiable J� yes ❑ 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three ye expiration date. pq, +- 3 /B SI NATUKE OF APPLICANT DATE OWNER CERTIFICATION 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 pro rty describedgabove, by virtue of a warranty deed recorded in Register of Deeds Office. /8/99 SI A OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a sta d warrant deed fro the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed IDOL 1407PAA8 595694 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Greenwood Enterprises, Inc., a 03 -03 -1999 8:00 AN Wisconsin corporation, Grantor, and Mark H. Johnson and Cynthia S. Johnson, husband and wife as survivorship marital property, Grantee. WARRANTY DEED Witnesseth, That the said Grantor, for a valuable consideration EXEMPT # of one dollar and other good and valuable consideration conveys to CERT COPY FEE: COPY FEE. Grantee the following described real estate in St. Croix County, State TRANSFER FEE: 174.00 of Wisconsin: RECORDING FEE: 10.00 PAGES: 1 Recording Area Name and Return Address (Parcel Identification Number) a7-0- 13413 -16 Lot 16 of the Plat of Wyldwood III, filed in the Office of the Register of Deeds for St. Croix County, Wisconsin on July 31, 1998 in Volume 7 of Plats, at Page 24, as Document Number 584038. This is not homestead property. Together with all and singular hereditaments and appurtenances thereunto belonging; And Greenwood Enterprises, Inc., warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, reservations and restrictions, if any, of record and will warrant and defend the same. I Dated this k6 of February, 1999 GREENWOOD ENTERPRIS C. BY: *J s E. Rusch, its president G NWOOD ENTE Y: * * Mary R. - its C AUTHENTICATION ACKNOWLEDGMENT Signature James E. Rusch, its president t/ STATE OF WISCONSIN nn ST. CROIX COUNTY ul Ruse k t i'fs cec-Y 4-a r y Personally came before me this day of February, 1999 the above named Mary R. Rusch, its secretary to authe ' ed this '� of February, 1998. me known to be the person(s) who executed the foregoing instrument and acknowledge the same. sign3sdre s A. Murray signature type or print name type or print name TITLE: MEMBER STATE BAR OF WISCONSIN Notary Public St. Croix County, Wisconsin (If not, My commission is permanent. (If not, state expiration authorized by § 706.06, Wis. Stats.) date: ) THIS INSTRUMENT WAS DRAFTED BY Lois A. Murray, Zilz, Estreen & 0gland, LLP *Names of persons signing in any capacity should be typed or 304 Locust Street, Hudson, WI 54016 printed below their signatures. (Signatures maybe authenticated or acknowledged. Both are not necessary.) Information Professionals Company Fond du Lac, Wisconsin 800 - 666.2021 584038 WYIaDNYOOD III REGISTERS OFFICB S.CRUO(C0.9YLS LOCATED IN THE SE 1/4 OF THE NE I/4 OF SECTION 24, 129N, R19W, TOWN OF HUDSON, ST. C70Ix COUNTY, WISCONSIN, at faReaadtL�fbf BEING ALSO ALL OF OUTLETS 2, 3, AND 4 OF THE PLAT OF WYLDWOOD .: ! } C c1 , AD..I d ndcgMmr,k Rdia OWNER'S ACCESS DRIVEWAY REST- OCT1ON CLAUSE; All driveways which require culverts are ` Volume °f hereby required to hove the appropriate apron endwoll on botn ends of such culvert. NE CORNER �arq SFCTIUN 24 Wrwierd[)rdr 129N, R17V qJ 2 Owner of Record, July 21. 1998: UNPLATTED LANDS en Ln W Greenwood Enterprises. Inc. North line of the SE1 /4 of the NE1 /4 to 1416 Third Street NE Corner of the SE X of the NE M •�� £ Hudson, Wisconsin 54016 S 89'25'51' W 502.22' \ — 316.00' 18622' 17 ono 18 0 2.693 ACRES ZOT Cl m c o ry 117,299 SO. FT. 2.188 ACRES A 14 (2.443 ACRES OR C3 . ^ 106,403 SO. FT. ^ oD rn ' - °o m 0 95,298 S0. FT. EXCL. R/W ESM'T.) o r- Go H O< o rn 8' 'y c A X)r 2 0 f< D, N Zr'n 7 0Cr fq r \ O_ N Z Z 1 � 509'25'51' W 340.65' 133.92' —� \ D�VI a 9 N 89 E 474.57' w \ \\ \ _ N • z rl A YOUNG ROAD — \ \p ZNC g: N 89'25'51' E 474.64' S m 0 s n 305.00' —169.64'— r '6 ��' S t p z m r ®S6c'S- s ° � f N89'1.4'05'E 7 N ^ I h / N \"50.00'0 D N89'44'05'E $� I 15 y nt Z' / - o LOT 16 / m 3.731 ACRES o PENDING ry I 1 / 162,538 S0. FT. N nl N I EASEMENT - r ry PERMANENT po (2.741 ACRES OR rn w STRUCTURES I 1 D 119,406 S0. FT. I BELOW ELEV. go Z �µ EXCL. PENDING ESM'T.) i 952.62 PROHIBITED I I N 344.12' 534 190.00' $Dj1 I I eEry�1 AR g eszl 702 of Ri ON 6 -�3-9e N 89'42'32' E 534.12' (N 89'50' E) SCALE IN FEET UNPLATTED LANDS Vol. — Page — o too zoo 300 400 L E G E N D SECTION CORNER MONUMENT FOUND -- ALUMINUM CAP N • Wn0 to 2' IRON PIPE FOUND 0,4 z n CNCC • 1' IRON PIPE FOUND of rn rn , r _ _ CS z W C-r0 - X-* -' EXISTING FENCE b, zo r',W a zor, — — UTILITY EASEMENT- -WIDTH SHOWN IF OTHER THAN 12' z :ru,-,D. • BUILDING SETBACK LINE - 50' OR 100' AS SHOWN i N u ~' . nr O 2'X30' ROUND IRON PIPE WEIGHING 3.65 LBS PER FOOT, SET e � CZ A t ALL OTHER CORNERS ARE MONUMENTED WITH 1'X24' ROUND 4C la Jo IRON PIPE WEIGHING 1.68 LBS PER FOOT 'C z 1 rn ALL ELEVATIONS ARE REFERENCED TO USGS, 1929 ADJUSTMENT N ca w x PROPOSED DRIVEWAY LOCATION - ACTUAL DRIVEWAY PLACEMENT Azo WILL BE DETERMINED BY TOWN BUILDING INSPECTOR. - ' LIKA (N 0'00' W) PREVIOUSLY RECORDED DATA c --- 'FILLING OR GRADING WITHIN PENDING EASEMENT AREA ON LOT 16 WILL REQUIRE NO NET LOSS OF STORAGE AREA, AND WILL REQUIRE APPROVAL OF THE TOWN E 1/4 CORNER OF HUDSON, ST. CROIX COUNTY ZONING ADMINISTRATOR, SECTION 24 AND ST. CROIX COUNTY LAND CONSERVATION COMMITTEE T29N, R19V GENERAL NOTICE STATEMENT The parcels shown on this plot are subject to State, County and Township laws, rules and regulations G.e. wetlands, minim lot size, access to parcel, etc.). Before purchosing or de""OPing o -y Parcel, contort the St. Croix County Zoning Office and the appropriate Town Board For advice This statement put on this plot at the direction OF the St. Croix County Plnnning, Zoning and Parks Committee