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HomeMy WebLinkAbout020-1303-10-000 \ f j Q) ¢ � � W � \ � $ z r \ 2 2 � � � � \ � # z } z \ ` 0 z ® % V % § \ \ a © ! § § z \ 2 \ « < J e 0 $ / o \ z ± E (D @ r j a / / \ �f ry L) \ 0 ) k } .� � .. _ E z } , ¥$ \ ] § CL E i \ \ \ k k k \ E m � a a 2 E _ 0 � 2-j 0 j\ k k ƒ 3 _@ ID 04 M o C E c JB � r E cl N L \ k \ ) k § 8 8 e , ¥ / / / �.� \ 2 Q) .9 / / / r 6 q 2 J § > § K 2 \ 3 / o ) { ) ) \ ■ � � § k L ; IL . F ) a § $ ( a 2 .o & v ST. CROIX COUNTY ZONING DEPARTMEN o, �, 10 AS BUILT SANITARY REPORT R11 A. 'r Owner s RECEIVE Pro a Address } p -/ J 1.1 �_ 2 1 1999 City /State S T CAUX — 0 CouN TY Legal Description: ' ... zaN,NP, o1cE ` A` Lot S�'e Block Subdivision/CSM # `l ' /4,x '/4, Sec. �_, T * N -R[LW, Town of PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: r Tank manufacturer j'h a/ w e s Size ST/PC /, W / Setback from: House ZS 'Well V,0 P/L i � Pump manufacturer Model Alarm location (HOLDING TANKS ONL Setbacks: Service road Vent to fresh e Water Line Meter location Alarm location SOIL ABSORPTI SYSTEM Type of system: e o,4 Width S' Length � , Number of Trenches z Setback from: House f/ ' Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark Elevation , /o. ° Description of alternate benchmark ��,p of f��v,��14„`,�/ Elevation ���s7 Building Sewer 4 OV, '77 ST/HT Inlet Y9 ST Outlet OV 4 1 1/ PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines Bottom of System Final Grade Date of installation 7 /• Permit number State plan number Plumber's signature " nse number 9 r Date /? / Inspector Ita Complete plot plan � - 1 I NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW 0 s N 1� O �oZQd 5 ,4a 7 C O INDICATE NORTH ARROW�d� Wiscorvsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION Sanitary Permit No.: (ATTACH TO PERMIT) ST. CR IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 344524 Permit6WW 's W&HAEL ❑ City ❑ Village Town of: State Plan ID No.: 1111�11tvvitvy 1K1C HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: �D l.0 u 020- 1303 -10 -000 TANK INFORMATION ELEVATION DATA A9900275 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C ����� �,2� Benchmark Dosing P't - 3 • Q. D J � — Aeration Bldg. Sewer S 7-2, too, 5 Holding St/ Ht Inlet 7-.32 2/91, TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air I to ntake Inl ROAD 4)t- et ir Septic >7 r 25 NA Bt ffm Dosing NA Header/ Man. Aeration NA Dist. Pipe ' fog 9S% 2 k, p S / Sf S" ff ,az Al Holding Bot. System y�'Z S /Z, PUMP/ SIPHON INFORMATION Final Grade Manufacture and (�.,� - /ep Model Number GPM TDH Lift L c ron System TDH Fo main Length Dia. Fi Dist. To Well SOIL ABWHPTION SYSTEM THE Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth 4 DIMENSIONS �-� DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O >30 r OR UNIT Model Number: System: C-01" , 9 5 DISTRIBUTION SYSTEM Header / anifold f4.0 a Distribution Pipe(s) � , r7 x Hole Size x Hole Spacing Vent To Air Intake Lenyt � Dia. Length 1 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 27.29.19.1499,SE,NE 761 ORIOLE LANE 0 4*- ��. Plan revision required? ❑ Yes ❑ No Zr! q 2 Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: : f , and m E a _. mom a ... , s [ E s 1 f .. E — s x v e f £ >.., A. em P• W.n. . ...._. .. me..�..i. me. ee ,.-. emma.e.f. eke t e 1 v ,. ee. ®. f E� { E x a > e 3 = q { € ! 2 f E � e.e t B E � e.em 4 g E ....W.. .em ,. ._... ..�.. .......... .d....... �'� .�...,... .w e .� ..... .... e....,._..mmm «..,_..�,..�mm i a F a - ...tw.�.me... ..... ,d..,. ., . ..,....,ems.. �< � F i SANITARY PERMIT APPLICATION Safety and Buildings Avenue Division . ' . 201 W. Washington Ave in �scons�n I n accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce 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. • See reverse side for instructions for completing this application State Sanitary Permit Number you provide may be used for seconds �� Personal information Y p Y secondary purposes ❑Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 1W 1 S T , N, R E (orW Property Owner's Mailing Address Lot Number g Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number a a ` d/ f ) / 11. TYPE OF BUILDING: (check one) ❑ State Owned 2rcit Nearest Road Public R 1 or 2 Family Dwelling p Village - No. of bedrooms 3 Town of I11. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 2'7. Z, , y q, 14 1 ❑ Apartment/ Condo 0 02 Q - 13 a 3 — l0 -- 0d'0 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 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 $.Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade D Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation Y ` S SG -7 S7d �y' �a Feet 17, J4 Feet Ca acct VII. TANK in g allo ns Total # of Prefab. Site Fiber- Exper INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks eptic Tank HetldiT q i a k pC qr' 7` ,ff ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber - 1 El 11 11 El El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signatur : (No Stamps) PRSW No.: Business Phone Number: Plumber's Address (Street, City, State ip de): d d .� 4.l� IX. COUNTY/ DEPARTMENT ME ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial 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 - 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 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. /� s�a,C - c l�I�. I r � � �, �� �� -- � ` � - .� � I � � �-� � �' ��' �` �. � �y � 6� �� � ��� , ����r Z '� M � �� �`� 0 � ���� �% a C� CJ�, _,_- --- ,� � �- � � �� ` � Wisconsin Department of Commerce SOIL AND SIM VALUATION Div!' "n of Safety and Buildings - Page of i Bureau of Integrated Services in accordance s. ILH f is. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 in ` i x ounty ch n size. Pl�gtrp �� include, but not limited to: vertical and horizontal reference poi t (BM), directio�4 1(� S4, percent slope, scale or dimensions, north arrow, and location d distance, to nearest road.. cel I.D. # APPLICANT INFORMATION - Please print all information . UNIX R viewed by Date Personal information you provide may be used for secondary purposes (Pfivagyl@wfl+ ,, ,t G Property Owner Property f` A C 0�t, 1/4� 1/4,S 7 T Z 7 ,N,R � E (or WW _- Property Owner's Mailing Address _Lo Block# Subd. Name or CSM# 2 � Pan Ie� IQaI 3& 14vY"\6; I IS City State Zip Code Phone Number fl ❑ City El Village ® Town Nearest Road ("New Construction Use: 0 Residential / Number of bedrooms 3 ­ 7 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 0 gpd Recommended design loading rate bed, gpd /fi trench, gpd /fie Absorption area required 95 bed, ft 7S trench, ft2 Maximum design loading rate -7 bed, gpd /fie ff__ trench, gpd /ft Recommended infiltration surface elevation(s) Z® _ft (as referred to site plan benchmark) Additional design /site considerations 4 U/, Do r•t c lo - 1 q r i 4vw13 ,-A y, 11.5 l ti AWP Parent material ��u G ` o u 4 wct Flood plain elevation, if applicable 0 h F ft S - Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U - Unsuitable for system M S ❑ U ®S ❑ U ®S ❑ U WS ❑ U EIS 5n U ❑ S IO U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. q72—Oft• Depth to limiting 3y factor 1240 in. '1 Remarks: Boring # a - -� ! r.3 %z bn s' t u-4' , ? Ground elev. Depth to limiting factor W L in. Remarks: CST Name (Please Print) Signature Telephone No. _ � G Address Date CST Number PROPERTYOWNER M +tk&Q ( v rlv\ SOIL DESCRIPTION REPORT Page -6�— of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench ,3 1 -io io r /Z _ m5 1n / C 1 u.-C . 8 Z eb -u — /0/ c Ground elev. Depth to limiting 31 factor 6 LZI -in. Remarks: Boring # ........................... Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ........................... .......................... ........................... ........................... ........................... ........................... ........................... Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) i Viz c 5 0+3 bYA 40 g oo ipp e elev AW 36 R elcv. l 3 v w e I( vY\, O f 36 l ti L 6nI we l l ,'S ljol 4 ion �e � Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in a s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than z''11 inches i size ' �anmlust County include, but not limited to: vertical and horizon �ference p{I direction, percent slope, scale or dimensions, north arro , arad location and4rrl�c e to near t road. Parcel I. D. # APPLICANT INFORMATION - Plea e.print all,�itaiorma��. Reviewed by Date Personal information you provide may be used for se day pu osi Law, s. 15.04 {1 (m)). Property Owner r " ! ti Z vi. perty Location Hi 1 ^ � J rl , � Lot E. 1/4 NX 1 /4,S ZI T ZCf ,N,R f q E (or) 1IV Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 22C) panley I , * t !" I � Ht imbird 14 1 1,s City State Zip Code Phone Numbber ast Road N "il6 L0 121 (I 1 5 ) 3 0(0$152 I ❑City El Village � Town I ® New Construction Use: ❑ Residential / Number of bedrooms 3 -�"I Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: o Code derived daily flow (000 gpd Recommended design loading rate • 1 bed, gpd /ft 8 trench, gpd /ft Absorption area required . " S � bed, ft 75t7 t rench, ft Maximum design loading rate • 1 bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) �r 40f (Yb in5.O ft (as referred to site plan benchmark) Additional design /site considerations ov er -werye.l, 10 f'1 eV • I Lao • o �f Parent material G 1 CLI (fit Awanb Flood plain - vation, if applicable ZZA : ft S = Suitable for system Conventional Mound In- Ground Pressure AT-( System in Fill Holding Tank U = Unsuitable for system ® S ❑ U 00 S ❑ U Q S ❑ U ® S U ❑ S ® U ❑ S ® U SOIL DESCRIPTION REPORT Borin g # Horizon Depth Dominant Color Mott Texture Consistence Boundary Roots Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench `-� 0 -1 z 10 1 �- I ma �- S t 2 t -2 ,o 1 r ko m4r C5 Ground 3 C- $ I Qj rj l S 2 elev. ►la.o Lf 2 (t,. r`I1 Depth to 5 3( I r`1 L 5 _ -7 limiting factor IIII 'Z in. Remarks: Boring # .......................... o-g l0 31 — LS I m1 l� Ground elev. l.1" ft. Depth to limiting factor ICY in. Remarks: CST Name (Please Print) S' natur Telephone No. Address Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 0'8 O r i L 5 ml f I^ 2. -IOb y (o m m Ground elev. it .Oft. Depth to limiting factor Ja in. Remarks: Boring # ........................... .......................... ........................... Ground elev. ft. , Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # I ' Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) O oe a r✓i Z / ' -i e( a, o N LcJw�e�' /v y.0 o r+k L- ay AL-4 *'4 6r �5 az . r w Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location H( `� n Govt. Lot 1/4 1/4,S Z 7 T Z � ,N,R �� E (or) Vtl Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 2- 2oy Ocknje,( ri ► * 1 &.a H t I m6k r ' t City State Zip Code Phone Number ❑ City ❑Village Sfl Town Nearest Road "UCA56n I wl 15H O11 a 1 ( 326 -8152 i I ® New Construction Use: ❑ Residential / Number of bedrooms -3-y Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow (00 gpd Recommended design loading rate , bed, gpd /f? trench, gpd /ft Absorption area required - 1 bed, ft 750 trench, ft Maximum design loading rate .1 bed, gpd /ft -- - 2 — trench, gpd/ft Recommended infiltration surface elevation(s) 4�C[ ft°[Yh ic�5.0 ft (as referred to site plan benchmark) Additional design /site considerations t O W er" -I eric-h 1 o L • o A 14 . el ( tao • o Parent material C:1 IQU 0.1 of J anh Flood plain elevation, if applicable /U�- ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system I ® S ❑ U W S ❑ U Ws ❑ U Fi] S❑ U ❑ S ® U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench y I 01 z 1014 Ima r eS If y 2 f -u, 10 r 1 — m-Cr C5 1V . ;.w Ground 3 o . g 10 r`I tp`-1 - - ' S i 2 -�'t G elev. 11o.o 1 4 2?-.YP lo r` 13 __ I 2 m-PI G 5 - 5 ( Depth to 5 Sa - 110 I r L4 I C- 5 . „ limiting factor __T 1 10 in. Remarks: Boring # I o-$ 10 3h — L S I mI 4:1S t Ground elev. 110 O ft. Depth to limiting factor Ion in. Remarks: CST Name (Please Print) S' !:nature _ Telephone No. C`7 /�� Address Date CST Number • ti SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boren # Horizon Depth Dominant Color Mottles Structure 2 Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench I v -8 p I L5 4_ I F Z - IOIo y (a — m m I Ground elev. 117 -Oft. Depth to limiting factor jc�Co in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) v v l o•�- • 3� o e I 13 nn Z 1 ' or\oc , q0 S +e c I O 6 LawVr o� By ALf�✓1 �5 6/ � Q1 I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM (G L yc t ,.�.� . OwnerBuyer � ►'�1 � �u Mailing Address Z- ( 4 h'--. K (,e y VU g ( ,,j S l o t(, Property Address Ca 6 K- (o t_ E Lqn i= 4t S c) (Verification required from Planning Department for new construction) City /State &d Sow , w Parcel Identification Number 0 Z u - 13 u 3- ( u - o ou LEGAL DESCRIPTION Property Location S E %,, N E %., Sec. 2- 1 , T Z 9 N -R l `� W, Town of 0 ^' Subdivision s�^^�'�f� S Lot # 3 G Certified Survey Map # , Volume , Page # Warranty Deed z i o E) , Volume ) 3 d , Page # D l2 Spec house ❑ yes ® no Lot lines identifiable yes ❑ no SYSTEM MAIN'T'ENANCE Improper use and maintenance of your septic system could result in its premature faihtceAo 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, 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 days of the three year expiration date. / S 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. SIGNATURE 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 stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed t 0"UMENT NO. ,- y. %'ARRA.tTY DEED Tills [ ►ACC RE9CRV[O FOR R[COR0INQ 047A a r" !STATE BAR OF W1S::4VS1N FORM 2 - 19821 q, t •• - "RE?'iSTFTS OFF ±CE M ............ ..... ..... ....._.. T _ _ . ... .................... - -• S ^: 'n ryyl ........Humbird. %and..Corpora.tion.. Minnesota Corpo�atibn � � � � ' _ . . ......._..- M 1 AR 3 � 9 9 : convvyn and w•arraots to .Michael..C. .Dunn_ and. Lori A. Dunn ...Husband. rid Wife... ....... . A U( I' .. ........... R cl K t 8:0 .,'h� y � w.,.�„ro, Qr 09-1d* 4 .� ... .. .. ... .... .... R[TURN TO} ..... .. . ..... .... .... . x the following described real estate in ........ $t. Croix ...... County, -- — � f --- ---- -- State of Wisconsin: ' Tax Parcel No: .............................. Lot 36, Humbird Hills Second Addition, i a Town of Hudson, St. Croix County, Wisconsin 1 _ 'Ya TRANSFER r z 1 This is not homestead s . ' 11 Property. I t (IS not) - Rxception to warranties: Easementsrestrictions , restrand rights-of-way fi k if any � Dated this .......... .. .................. day of ``march 98 ..... r fi ........................ ... ..... ...................... (SEAL) HUMBIRD LAND CORPOR ,T i ft x, ( SEAL ) • by.. Austin J. Baillon, Its President . ..... ... .... .......................... ....(SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) ................ ............. - ... STATE OF IMEXMIMXX MINNES A Ram ygY...........County. auihendcated "this ........ d o f ........... _ 1J....__ Personall came before me this ---- FS( .... day of -* - u ........... .. . Ma=ch..........., 19..98.. the above named Austin J. Baillon. President of --- -- --- .. - -•... .................... Hµmb ;d_ Land_ Corporation.. - -. TITLE: MEMBER STATE BAR OF WISCONSIN .. (If not, .............. ............... ............................... to me known to be the person f. authorized by $ 40G.11G, Wis> Stats.) � _ ............ who execute -0 the foregoing instrument and pcknowledgp_ the same,. s -' THIS INSTRUMENT WAS DRAFTED BY .+ •� ,l "yt' nor Humbird land Ecr 0o} ation � '� ' ... 1 -. ra •...Pau .A...Bailjon � Y u' ................ _..._...._..._ _ Washin tong Nntar m i s s m n, - E ... r- - expi ra ICI (Signatures ay be authenticated oz acknowle ;;gcd. troth �f�' Coo mmission Is p•>r Inrnt. (ir r;t, stat e xp i ration on .� a.e not necessary.) aa, d ..... - - -- ..... . .... artua ry a • 11 :�RIe3 a- ,riona Ahm-c in nay — ,.city 1h.p:ld he ty or prinini t +of. -c :3. a;n�Urrrv. I F "�. 'y i 4 n- lid r 1vlv�r ovlww 336 NORTH ROBERT ST. ST. PAUL, MN. 55101 LINE Al 1 N89 0 43 1 55 'W 473.39' 5 ' y a LOT 36 z r m 2.11 ACR 0 91,969 SO. FT. m w m s •. h z F9, 0 m O ° Dc LOT 35 cn \ �� ` �u'. • , \ 2. II ACRES z • ,•�. 91,761 SO. FT. \ 6E Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page l of 3 Labor and Human Relations Division of Safety b Buildings in accord with ILHR 83.05, Wis. Adm. I Code ' UNTO EP y ST. c�Po� - X Attach complete site plan on paper not less than 81/2 x 11 inches in size.,Plan must include, but 'P ARCEL 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 f REVIEWED BY DATE PROPERTY OWNER: 11l/. /f i/S �fwP D �d PROPERTY LOCATION WL j Q ,t/ — GtiAI,P.�! �Y GOVT. LOT -s F 1/4 N 1 /0 � 7 T 2-9 ,N,R /f E (or) W PROPERTY OWNER':S MAILING ADDRESS / dip vf, �/� LOT BLOCK N SUED. NAME OR CSM # 33� �oB TS S1 I� 3� }{UMRi R17 H 1'03 (P>1�5� CITY, STATE ZIP CODE PHONE NUMBER []CITY [3VILLAGE N NE ROAD T 1 12A" S5 (' r&) 1 -12 - 5SS5 +Iu Ds0,� 1 ///// ffel -I Vf' N ew Construction Use (kt Aesidential / Number of bedrooms Addition to existing building ] Replacement ] ] Public or commercial describe Code derived daily tow &oO gpd Recommended design loading rate � bed, gpd/11 trench, gPd Absorption area required bed, ft2 �S y trench, ft Maximum design loading rate '--- bed, gpd/ft 'f trench, gpolft Recommended infiltration surface elevation(s) It (as referred to site an benchmark) Additional design I site considerations �� S', CU,t' 0 S /o/� A '/ x'0/1 oY O�S77� ,8 T i o � Parent material Flood plain elevation, if appliFable tip It S = Suitable for system C� Q [1 U E S Np, IN-G JD PRESSURE F N F U SYST MI FLL [ HWOLDING TAW tem ®'S ❑ U C7 U ❑ S B U Unsuitable for s s SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bouncy Roots GPD /ft Boring # Horizon in. Munsell tau. Sz. Cont Color Gr. Sz. Sh. Bed rer>ch [3 2 - 33 o y Sly S>g7cu�L e S a, S n+,� Ground 3 3 So /o // 0 lffofll elev. MC VW Depth o Of actin factor g Remarks: 4 CM/ 57p-0'v L Boring # o -lZ /Q� 2/Z �S 1 � h► 4. 11,e / f ' 13 Z /1-zo /o .e 311 05 - �s r� y /cam /57 /� Ground S 0 ' -7 elev Depth to limiting face ,( Remarks: CST Name: — Please Print '� Q E �'r 2(L� 1 C(, �—' Phone: 71 3 A; F d d res s: 6 5 S 0' ,v t: i [� � fl �UP -So,J 40�S 5�y /Co e57 � y � 'Z Date: CST Number: nature: �> �j ORIGINAL PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of PARCEL I.D.! Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Soud3y Roots GPD /ft In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch 1� 13 1 L 1 //- ,l 2- / O r R -3/ l is I on Ile Ground 3 s' �s /.mot �.� r5 7 elev. 01 '001 Depth to limiting � fac tor t/ LLL --- Remarks: Boring # 0 r L�L �S M2 v7�ie e S tl El :... sly ----- .s . o , s Ground elev. 10 5 .20 ft. Depth to i limiting factor Remarks: Boring # / /D 16r2 5 /2 15 M2!/7�i�° �s I 7 d 75e f5 Ground 7 . l C �� �S/ r s �s a, elev. _ ft. i Depth to i limiting factor Remarks: Boring # � If I °P es Ground elev. /off, 32- 4t. Depth to limiting ta�,� Remarks: con eeenro ncrn� I zti iF- 8, y 13� s06GjE sTE� sysrfAA TP- f e(EW nTl'oA3 S S CA - I C ,, ( - 30 P�•rs N w o . p ` o I � , y1 � 02 8 i lo % l- y , `E 1J�T /b'N S Go /BUD ip hRFfi Z OF / /33 / /3y /G 0 4'I � /3 /off (Fy . L _ L . r z Dm Z O �O I� / N I � 473 39' �<v N89 0 D I Ln r Il .* m P 5• p 6 n W i a p 11 ACRES o m / 0100 9 29 Sp. f/ D CD O -n 0 ° c x LOT_ 35 r 1 s h Z 2 4 9• _ �O 1\ 2 11 ACRES N 91,761 F T. -4 0\ � EASEMENT T 26 F \ 0 0 =964 2.53 ACRES SQ. 110 _ '1 8 _ �� \ 34 o O 0D, \ LOT T ♦ A \\ 2.02 ACRES 0 \\ ,932 SQ. FT. 87 RENT N LOT 27 \ \' c pONbING 2.14 RES \ \ i 93,106 Q. . E, FT ASE \ EL :9 72 r \ v y 30 ^ E \ ` Ng4 22 W 9 46� 1 19a-7g 170 `SS, ' DO \ i � • �i I Q 0 p \ LOT 2!a' F (n 2.23 ACRES` " 1 �'1 o - .n78 SO- F J47