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HomeMy WebLinkAbout020-1302-20-000 o 03 6 a) a o c 0 o N i C I , O1 d Z y m C Z LL O 3 a 3 M g a� � Z CD E E z = c 0) a m rn C O O z - c v � � o � w o W FZ- rn N z C O M N d cy cy N CD ry a) y y C •� a L L O C C O U o 0 z z N Z I •• N N V7 � l0 E p 2 d N a O O G a N l i ° �� w ° ~ z •►� �aaa N a �l O O O y Z 7 O N U) J U v 0) 0) } 1I � Wawi = co 4-- aa)i C 0 E J O O (D m y C d 0 V M a) C O d o j N y O O p ^ y C Q . N C Y ! V a 0 0 0 N r r M O CD y O O d 0 'd' O CA C, of _ a) y C 1 N 'D � .0 � y C •� L � • N n 7 �' M O �a C O N ��' � m a € a • ea c d :2 E c «: 0 r A v a m o y 0 ` ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT ill• ` . `? Owner Ale d-t�L41- e Property Address ✓ 1 ,511 - r VY, City /Stat 1 ZW� � Le gal Description: g � ✓`. � L Lot Block _ Suyhvision/CSM # i 1:0 ,jam '/ _ t /4, Sec. 21, T_7iN -RAW, Town of PIN # -o Z - 2-0 - 06 'v SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Zc%a� k T l; /' Size OPC / / Setback from: House 6o" Well 6 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 I � z Type of system: Width 3 Length 6 - 7 - Number of Trenches Setback from: House 1P ' Well � P/L 5z, Vent to fresh air intake ELEVATIONS Description of benchmark e > -i d . Elevation Description of alternate benchmark Elevation la. 7S Building Sewer ST/HT Inlet 1610, y ST Outlet ����U . V1 PC Inlet PC Bottom Header/Manifold 75 Top of ST/PC Manhole Cover ,/O � Distribution Lines (r,) % (,, ?S () � , -7 -3 ( ) Bottom of System O V�% 3?1 O 9 ! 5 - - : 5, 5 ( ) Final Grade () &- �� () ( ) Date of installation Permit number 33 q State plan number �— Plumber's signature / License number - 24-SZ-{ Date '1lltl Inspector Complete plot plan � I J NOTICE Please provi e e 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 d U .� i o � � L INDICATE NORTH ARROW Wisco.sin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST. IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338994 Permit Holder's Name: ❑ Cit ❑ Village Town of: State Plan ID No.: BREEDEN, MIKE HUDSON CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: OU It) 1) c A 020- 1302 -20 -000 TANK INFORMATION —1 ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic �el,' o&0 Benchmark � '�. o Z /00 BM v P7 10 1, C Aeration Bldg. Sewer olding Ht Inlet TANK SETBACK INFORMATION Ot/ Ht Outlet , Z TANKTO P/L WELL BLDG. Air to ir ntake ROAD N1_11� Septic 7 �I 7 S� (Od l NA D m sing NA Header / Man_ Aeration NA Dist. Pipe T Z /p_,?f - q din Bot. System - r / Z - ZI 9 y z .z PUMP/ SIPHON INFORMATION Final Grade `— 2 L 3 - � ' facturer and 54 uev 3 Z G Model Number GP TDH Friction S stem TDH Ft L oss Forcemain Length Dia. Dist.Towe SOIL ABSORPTION SYSTEM r 5 BED / EN H Wid r Len No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME S h. 2� Z DIM N I N SYSTEM TO P / L BLDG WELL LAKE/ STREAM LEACHING Mater ufa ure SETBACK �w INFORMATION Type Of �� CHAMBER ( 7l OR UNIT Mo a Number: System: DISTRIBUTION SYSTEM T/p Header /Manifold Distribution Pip x Hole Size x Hole Spacing Vent To Air Intake Length J r Dia. � Length Dia. Spacing NA AIA 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 ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 27.29.19.1490,SE,NE 754 ORIOLE LANE 0 ,.l k _gm- k yl r /Ow. .- /-10/ � �' y�" oF�r.•urr Plan revision required? 171 Yes ❑ No Use other side for additional information. L4L SBD -6710 (R.3/97) Date nspector' nature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E i i w a a e« f ° ° A t e ° ° t e ° 5 f y a L E ° F ° i r f i S 4 m a t i 3 ° S a E E 3 � F a f am ° b i � L i I ° Vi sconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 Box Washington Avenue 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 81/2 x 11 inches in size. ST - t T • See reverse side for instructions for completing this application State Sanitary Permit Number 3 3 W9' Personal information you provide may be used for secondary purposes ❑ Check it revision to previous appf tion (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Propert yOwr Na ,7 S� °g jjq S ZZ T 24 , N, R /f (OrQ Property Owner's Mailing Address Lot Number Block Number l 4 2 City, State Zip Code Phone Number Subdivision Name or CSM Num er d Gc1 .s' DEG ( ?ig ] - �i a�cH•..e�� II. TYPE OF BUILDING: (check one) ❑ State Owned- it Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms .3 ❑ Village I j Town OF or /aj III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo .4 - -- 1.362 — 2D 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. [!VIVew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System_______ _System_ _ ___________Tank Only Existing St Existing System --- --------- -- - __ xisng ysem ________ 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)R Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit ��) 3 t Sjo• Z� � 43 ❑ Vault Privy 14 ❑ System -In -Fill 18 y4�t � C 4 VI. ABSORPTION SYSTEM INFORMAT ON: 1. Gallons Per Day 2. Absorp. 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 1/ e> I 67Z . `t+ 8 F51 y Feet F6, 7 Feet VII Cap acct . TANK in gllo Total # of site INFORMATION Gallons Tanks Manufacturer's Name Conc Con- Steel gl Plastic App New Existin structed Tanks T anks Septic Tan k -^ ` l ❑ 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. Plum is Name: (Pri Plum er's Signature: (No tamps) Me /MPRSW No.: Business Phone Number: w 71 3e i Plum is Addr (Stre ity, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A t si ature (No Stamps) ff E] Owner Given Initial Surcharge Fee) �]. / Adverse Determination �S I 1 � y kit �`1 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 7Y4 Q2.ta"_W t_At.AlS SBD- 8398 (11.11197) 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'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 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 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. JOB TIMM EXCAVATING SHEET NO.— OF 'Z— Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ................... . ...... .. ... ....... .......... ........... — ......... ........... .... ........... ........... ........... . .. ...... ........... ...................... .......... ................. ........... ...................... .................... ....................... ...... ................. ........... .......... .......... ........... ........... ........... .. ....... ..... ........... ........... — .......... .......... ........... ...... ... ................... .......... ... ... . . ......... ..... ..... ........... ........... ........... ...................... . .......... .......... ............ ........... ........... ........... v— ............ ........... ........... ........... .......... ........... ...................... .......... . ....... .. .......... ........... ........... ........... ........... .................... ........... . ........ ....................... . .. .......... .......... ........... ........... ........... ........... ........... ........... ----------- . .......... .......... ........................ ....... ..... .......... ........... . .. ... ........... ........... ...... ......... .......... ............. ............... .......... . . .......... .......... ........... ...... .... .... — .............. ... ............ ........... .......... ........... ..... ........... .... ...... .. .......... -."13 ........... .......... .......... . ..........<.............................. ...................... ........... ........... .......... ........... .......... ................... ........... ........... ...... ..... ..... ........ ........... .......... ... . .......... ........... ........... ........... ........... .......... ........... ........... ....................... .......... ..... . ...... .......... .......... ) � v ........... ................ ........... ........... ............ ... ...................... ........... ......... . ........... .......... . ........ .......... . ........... ........... .......... ........... ...................... ........... ........... . ........ ........... ........... ........... .......... . ............................ ........... .......... .......... ........... .......... ....................... ........... ........... ..................... ...... ...... —6 . ......... . ........... ...... ................. ..................... ...................... .......... .......... ........... ........... .......... .......... ........... .......... .......... ........... ..... ..... ................... .. ........... . ........... ....... .. . — ....................... .......... . ........... ........... ........... ........... ........................ ............... .......... ....................... ........... .......... . ..... ............. .......... .......... ........... .... ................. ........... ........... .......... .... .. ........... ............ . ............. ........... ........... ........... ......... ....... - .......... ..................... ............ ........ ............ - ........ ........... ........... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... ... ----------- ........... ........... . ........... ........... ....... ..... ✓ ........... .......... ...................... ........... ..... .......... ........... ... ...... . . . .... ........... ................. .......... ... ......................... ................. ........... .......... ........... ............ .......... ........... ........... ........... ........... ............ ................................. ................... ................. ............ ................ . ........... .......... .......... ................... ............ ........... .............. ........... ......... ........... ....................... ....................... ........... ............ .......... .......... ................. ................ .......... ................ .. ............. ........... ........... ........................... ........ ................ ............................ ........... .............. ............................... . .......... ........... - ---------- . ................. ' 0 ................. ............ .......... ......................... ................. .................... ..... .................... ........... .............. ........... fC .......... /a /, ................................. ................ ........... ..................... ---------------------- A .......... ; -- ------- ........... ............. ----------- ........... ........... .......... .................... .......... -------------- ----------- ........... ----------- ........................... ----------- .......... .......... ----------- .......... ............................................. ................. ....................... ................... ............... ............ ................. ----------- ------------- ............... ..................... ........... ........... PRODUCT 205-1 Inc., Groton, Mass 01471 To Order PHONE TOLL FREE 1-800-225-6380 JOB TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE l ....... ..... f y� -. .. - -.. .��. "V R 1 .... .. ..... .. .. - - TJ f/ ..... . -. L y` < .. r .... -- ... . ........ ... PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1- 800 - 225.6380 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page __ 1 _ of -3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code ' Certified Soil Testing 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 horizonta4r6%0, t (BM), direction and St. Croix percent slope, scale or dimemsions, north arrovv, lottgtl. n istance to nearest road. -- — - -- — Parcel LD.# 'F ,! Reviewed B - _0 f APPLICANT INFORMATION /ease prinll inf'pta 'on. 0 - - -- - - - - -- - - Personal information you provide may be e . fpi'secon Priva to s. 15.04 (1) (m)) y Date Propert Owner I _ Property Location Breeden, Mike V 1 ?' 19 S T SE 1/4 NE 1/4 27 29 N,R 19 W - - - -— — Govt. Lot Pro Owner's Mailing Address ar -4CXX :' -' Lot # Block # Subd. Name or CSM# 642 Badlands Road { NT`r' 27 Humbird Hills City State Zi �q de P h ' , ❑ City �_ l Village ZTown Nearest Road Hudson WI 501¢- -386F 0 Hudson Oriole New Construction Use: Residentl`a umber of bedrooms 3 �_ jAddition to existing building Replacement [] Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •7 bed, gpd /ft' •8 trench, gpd /ftZ Absorption area required 643 bed, W 562 trench, ft' Maximum design loading rate •7 bed, gpd /ftZ - t rench, gpd /ftZ Recommended infiltration surface elevation(s) 95 _ ft (as referred to site plan benchmar Additional design I site consideration install 2 - 2.7'x 56.25' (3' x 54' nominal, 9 shells ea) Sidewinder, Hi capacity "turtle - shell" trenches Parent material saridy /loamy outwash 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:] U ( S D U X S❑ U PC S C1 U S U L S U Horizon Depth Dominant Color Mottles Texture Structure Consistenc Boundary Roots GPD /ftZ Boring# if Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1_ 1 0 -5 10YR 2/2 - sl 2 m gr mvfr cs 2flm 5 .6 2 5 -14 1OYR 2/2 - sl 1 m sbk mvfr cs lm .4 .5 Ground 3 14 -21 10YR 3/4 - is 1 m sbk mvfr cw lm 7 1 elev � - - -- � .8 - 100.1 ft 4 21-47 7.5YR 4/4 - s 0 sg ml i gs t lm 7 8 5 47 -110 IOYR 4/4 - s 0 s _- - - .7 .8 Depth to -- g m I, - -- - -- rt- ,- limiting -- - factor > - 110" - - Remarks: hori 5 has occasional strati m cos & occasional gr 2 1 0 -6 l OYR 2/2 - sl 2 m gr mvfr cs I fpm .5 .6 2 1 6 -28 10YR4/4 - sl 1 m sbk mfr cs 1m .4 .5 Ground 3 28 -50 IOYR 4/6 - mcos 0 sg ml CS - .7 .8 elev 98.7 ft 4 50 -65 10YR 4/4 - fs 0 sg ml CS - .t, Depth to _5 -- 65 -100 10YR s 0 s ml - -- - _ .7 .8 limiting - factor > 1 00" i Remarks: occasional gr below 21" CST Name (Please Print) Signature: I Telephone No. Henry F. Grote ' - 715- 665 -2681 Address ertifre Soil - Testing Date CST Number Ref # P.O. Box 57, Knapp, WI.54749 5/3/1999 222774 1150 PROKATY OWNER:_ Breed Mik _ SOIL DESCRIPTION REPORT ( P age 2 o f � ' PARC LD.# __020 - 1302_20 Certified Soil Testing Depth Dominant Color Mottles Structure GPD /ftz ` Horizon Texture ,Consistence Boundary Roots " in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -4 10YR 2/2 - sl 2 m gr mvfr cs 2f1m .5 .6 2 4 -10 1 OYR 4 /4 - sl lmsbk mfr cs i lm 4 5 Grour tl g elev 3 10 -34 l OYR 4/6 - mcos 0 sg , ml cs 1 - 7 - - - -- - - -- - -C { - 96 i ft 4 - 34 -78 10YR 4/6 - s i 0 sg ml cs + .7 .8 5 78 -95 10YR 4/4 - fs Depti, to 0 sg ml - .5 .6 factor Remarks: 0"lional gr below �t I G 1 1 0 -6 1OYR 2/2 - sl 1 1 2 m gr mvfr cs 2flm .5 .6 2 6 -15 10Y 2/2 - sl 1 m sbk mvfr cs 1 m .4 .5 3 15 -20 l OYR 3/4 - sl 1 m sbk - mfr i gs - if t 4 .5 Groi -�d - -- elev 95 J ft 4 20 -29 7.5YR 1/4 - is 1 m sbk mvfr cs If .7 .8 Dept[; to 5 9 -48 7.5YR 4/4 - s /mcos 0 sg ml cs - .7 8 limltu g r - facto 6 48 -70 IOYR 4/6 - s /mcos 0 s ml cs 7 8 - -- - -- - - - -- 7 70 -96 !, IOYR 5/4 - s 0 sg ml - - .7 .8 Remarks: 1 0 -7 l OYR 2/2 - sl 2 m sg mvfr cs 1 f/m 5 6 - -- - -- -- — - - -- -- — - - -- -- 1 . , . 2 7 -21 IOYR 4/4 - sl 1 m sbk mfr cs 1m .4 5 Ground 3 21 -50 7.5YR 4/4 - s /mcos 0 sg ml cs j if 7 8 elev 981 ft 4 50 -61 l OYR 4/4 - fs 0 sg ml as - .5 .6 Depth to 5 61 -96 IOYR 5/4 - s I 0 sg ml - - 7 8 limiting -- r - - - factor - -- - -- -- -- - i I 6" Remarks: i Ground elev I _ Depti to limiti; i, _ factor Remarks: _____ f+1 d' Ll _ b r► M I r o J f rA 4 go ve c l S9 o � C) IA s f A r A A . A J r� ^1 `^ W V O ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 4y Zg,� H Mailing Address (0 Property Address - 75 - � ®i✓'l a je° , (Verification required from Planning Department for new construction) 12T_ City /State Parcel Identification Number Dam 132 - LEGAL DESCRIPTION Property Location SC %, ' /e, Sec. 77 , T -RLL-W, Town of art Subdivision 9' /a'w 'L �j A71 % s , Lot # 2 7 Certified Survey Map # . Volume . Page # Warranty Deed # 67'Yt6� , Volume / 177 , Page # IW Spec house ❑ yes 0 no Lot lines identifiable lssl 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 masterplumber, journeymanplumber, restrictedplumber 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. Uwe, 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 d/a�ys; of the three year expiration date. SIGNATURE 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nlza bA&d -75 / ! 4 SIGNATURE OF APPLI ANT 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 LINE I N89 0 43'55 "W 473.39' 5 �P 5 5 LOT 36 2.11 ACRES 91,969 So. FT. i tis2o •� gO �\ 2 o 0 Ds �U�, , � 2.11 ACRE ®` \ • w 91,761 So. PONDING \ ��0�0 .• _ EASEMENT �..• \ 6 ' " o�Cs� LOT 26 \ •.���� \ .• EL• =964 2.53 ACRES \\ •s� \ \ Q iC� / ~� 110, 208 SO. FT. Ile bt �� / PONDING EASEMENT 6 1 �\ •\ LO 2. S EL. = 964 `� \ \ \` , 87,9 zi�g3o LOT A 27 \ 00 F 93,106 So. F PONYING T. 'EASE ru NT •. \ EL.= 972 \ \ I lJ�o �y.Lill S89 E 29 9 -46' \ I (J lJ ° LOT 26 \\ \ IC7 0 2.23 ACRES \ �0 97/078 So. FT. ( \ D 33' 33 1 N EASE — I ('r'1 � �p�'/ �''- .�.'_ a cis • I f — , �� ; �o IQ) N N87 0 52'18 "E / 330.79' a m f;V EL. = 969 / 1 ' PONDING EASEMENT v o L OT 29 NN N t0 I —I 0 2.00 ACRES O I IV JI p 87,164 SO. FT. w �N89 °39'42' 1> I Ir--, �:� �= CHICKA► 10 i V . VOL 1327 ' 188 DOCUMENT NO. , / WARRANTY DEED i STATE BAR OF WISCONSIN FORM t—tam cmiveyti and warrmsLs to 3reedjen. and 8:30 AM . ....... ............. .......... ......... . . . .. ------ . ..... ­ - - = t »u1"°h"x oesc,o"u m..l *,/at" in UP +rnt:K County. ~~--~---^ state of Wisconsin: Tax Parcel No: 3 2 Lot 27, Humbird Hills Second Addition, Town of Hudson, St. Croix County, Wisconsin TRANSFER FEE � - � ` , � � J E xcep ti o n to wa rranti e s : ' Easements, restrictions and rights-of -way of record, if any � � ^---------------------- *by-* � Pres Austin J. Baillon, Its / � ---_...................................... —........... (nuAL) � � ^.... ....... ... ...... .... ...... --------- U ' . ] AmrzummrxCATzm»v ACKNOWLEDGMENT � ` Signature(s) ............................................................ STATE OF XERNIONM MINNES TA � ` ---------------'------'--'----- 19 ="===' ^""=' mxxenu,atoamm ........ duxoi .---_—.--., m-- .. �ex /vn8 mmabove n"mo | —'------'----------'--------' of—.--' ,.................... ................................................. ....... .. - �JAIvLqqcPxnr�tom—.-------. rrrLo: MEMBER STATE BAR onWISCONSIN ...................... `........... .............. ........... 1 (o not authorized by ----'---'—'------------------ to me known u"be the person ---. who executed the THIS INSTRUMENT WAS DRAFTEO BY PAUL A. CAM ........ HxThird'���d'C�������iy�-------' — — � � ........ Notary Public OW 14m (Signatures uuunnu,uma or acknowled Both w cv"""`"°°* is permanent. (If not, state o"p=n"n are not m,"ss" »/ «"t". ------ J�� ........... — ^names of,crs°=AiRnw«*"",cnp=u'sh .... u+*+,,",,w*+" |} G b'i t 3 '9 0 _ 1 p <D ' a 3 X O L Z O W Co . S N O s n3i = N p a K) c' CO N 7 (1) N A O CD N co `A\ O O. = O N = CL = O O < N N N Q CD 7 N c.n ? N to f�D 7 O p �O1 M v p O !� ra �t N C o cn < D 0 4 O ! • N a o `C O\ Q N W N 3 co Q O O j 7 fD �, A C? a .. � A Z cc) cG 0 ! n r C CA p co CD 7 3 '! a 0001 ( � co N N o v C 3 o v o Q 0 �° (D 3 d y ! I N z D 'm 0 d O � N N 7. c (a CL w m CD z N t� + � fA o a A Z e in C A n' A z o m CL 3 o. fn -I IV M o co z o z 3 .. m co co o :E CL 5 — N c z c 0 N c �o j a � y O VC Q' t fi A O I N O it Q) A 0 A O (DD Op w A , w O . e O * ° o a r 1 Wisconsin Depertrnent of I S OIL AN II, E EVALUATION REPORT Page of 3 Labor and Human Relations �' Division of Safety &Buildings in @ccor;1th II-HR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper no 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: 1111,y1/,QQ fills AtiI� O �P / d PROPERTYLOCATION VL GOVT. LOT 3Z' t /4V t= 1/4,S 2 T 2-9 ,N,R /J E (or) W PROPERTY OWNERS MAILING DRESS oB � 1 �/� LOT # BLOCK # SUB D. NAME OR CSM # 33C� ?Ts S . ✓ Z� }{VMRi�17 Nl'(Is (PtinS� �- CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE N NEAREST ROAD L.�1 /t1N• 5 /0/ (Grz) 222 +fU9so, New C Use ('� es idendal / Number of bedrooms ` °� 3 [ J Addition to existing building (v (] Replacement (] Public or commercial describe YSa - 7 2 trench. Code derived daily lbw Boa gpd Recommended design loading rate bed, gpolft 9P Absorp area required IS b 1 ' trench, ft Maximum design loading rate 17 bed, gpd/9 gpd19 3 to site n benchmark ) s S� tt (as re ferred pla Recommended infiltration surface elevation( ) Additional design /site considerations Parent material t S Flood plain elevation, if appliFabie 4 n S = Suitable for system ca N IONAL MOUND 77cals W- -G D PRESSURE AT -GRADE S FILL HDLDWG TANK U = Unsuitable for s stem L�S ❑ U ❑ ❑ U ❑ S t ❑ U ❑ S Rtj SOIL DESCRIPTION REPORT FDepth Dominant Color Mottles Texture Structure Consistence Bamcl3y Roots GPD /ft 13 7 Boring # Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed f $,, C' Q 5 C / S /f Z s �-� Ground 22 -50 7,S l yl . S _ O , S cs — , elev. r , © S 7 GG ft. b - a /6 / 5 S, — — Depth to limiting fac ? 4A� Ll Remarks: Boring # S v z a 33 X10 si /, a 6.� 4,1 3 _ , sib 0-s o ,s d� — ��; -� Ground elev. (, it. Depth to limiting factor ,, Remarks: _ Phone: // / S Fddr ess: : — Please Print L ' C f'�t � ,. 7/5 � 3 �CO - �¢5 S O17 • 4 UP -SOA) W �S 5�1 /lD T�! Date: CST Number: "his t site APPROVED rn, for a vsf�0onsi i� sys� i PROPERTY OWNER SOI DESCRIPTION REPORT Page? of 3 PARCEL I.D. ! Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Glu. Sz. Cont Color Gr. Sz. Sh. Bed TMnch Ib ,e s i fsdr ,►� �.e s Z y s Ground 3 S/ , S. a, S elev. gam/, j !o ft. i Depth to ` fimiting factor 7 Remarks: Boring # . 5 � • � 2 //-4 /bY,e 3l �( — s� 1,,„ s6� �►►, vf,2 5 – .S' . G Ground FS ,, ( ft. V , Depth to limiting � Remarks: Boring # 2 s6,� � U�,P z , S �(- So 7 yje y , s cs 1 Ground 1 Depth to limiting f > �'.3 ' I Remarks: Boring # F i Ground ` elev. ft. Depth to limiting factor Remarks: con enonfo ^rl"% ti G m L o LA ,� 3 -1 m o � °1) Ln ID N —' i r_ - Q4 =� o V , w - w uq ej h �r wr mz Dm a 0 0 0 i i o O N N -- L INE NE I N89 0 43 5 "W 473.3 �w 5 I r m fij D �� / m Q ev 5 O o A 2.11 ACRES m 0 -< 91, 9 S Q OD, y w m IV 0 .2�gs.w o a0 3 5 ti - TY LO Z 2.11 ACRES N 91,76 FT. \ o \° 6 ENT _ °;, \ \ ► I EASEM LOT 26 � `� 99 \ \� =964 2.53 ACRES So- FT. \ \ m Z —� 110 , \ \ 0 O 208 D, \ a SOT 34 Q O o o "5 ES 0 R * D� AC ,. \ ! SQ. FT. VG \ \ J\ \ \ 87,932 N ,RENT i LpT 27 J \ — / 2.14 F2ES PONbiNG 93,106 Q. F7. `\EASPkNT �\ EL ,= 972 \ \ 1 N 4 22 30 E co S89°06'22 "E 299 46 / 1 79 ° \ , LOT 2� ' 2.23 ACRES rl 07078 SQ. F 4