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855087
Document Number Document Title KATHLEEN H. WALSH
REGISTER OF DEEDS
St. Croix County RECEIVED CROIX CO. ,
Occupancy Affidavit 07/05/2007 03:45PM
AFFIDAVIT
TT EXEMPT I
REC FEE: 13.00
Name — (Owner) Typed rinted PAGES: 2
being duly sworn , states, under oath, that:
f. He/she is the owner /part owner of the following parcel of land located in St.
Croix County, Wisconsin, recorded in Volume Page Document
Nunober � St. Croix County Register of Deeds Office: Recording Area ,
Name and Return Address
A parcel of land located in thc '/. of the SE '/, of Section al - I - C e 1,,_, 0
T a N — R _�_ W, Town of , r, ,_ , St. Croix /^ �
County, Wisconsin, being duly described as follows (include lot no. and rc lr
subdivision/CSM or detailed legal description): t
/ ��
L o CY � - U !iU C C Parcel Identiticatton Number (PIN)
As owner of the above described grope wi
cknoedge at the septic serving this residence is sized for a
bedroom home, or a design flow of ow is calculated by assuming 150 gpd for 2
Individuals per bedroom. There are currently occupants living in this residence; -�& occupants are permitted
based on the design flow. Therefore the septic system serving this residence is code compliant. However, l
understand that if there are intentions to exceed the number of permitted OCCupants, the system will need to be
modified to accomodate any increased wastewater flows and /or contaminant loads. I also acknowledge that I will make
this information available to any future parties interested in purchasing this property.
Dated tNs rj day of
��A6
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
)Ss.
auttww*cated this day of St. Croix County. ) wJ.
Personally came before me this �_ day o
the abo named
TITLE: MEMBER STATE BAR OF WISCONSIN
(it not, to me known to be the person(s) who executdct fpge bk ,
autliorized by § 706.06, Wis. Slats.) Instrument and acknowledge the me. '•.� "''
THIS INSTRUMENT WAS DRAFTED BY
Notary Public, State of wisconsld
(Signatures may be authenticated or ackrwwledged. Both are not My Commissio Is pe anent. If not; state expiration date: ,
necessary.) pate: /
"THIS PAGE IS PART OF THIS LEGAL O=MENT — 00 NOT REMOVE" ti
ed and . OttrerLdOMMOon such as the
77t1s IINIOrlrlaflottmust be oorrlplet by subrrYQler• � name d retun address. �i (d re7crlr�
prwAll clarraes, legaa/ desm441ort eta msy be placed on Ws rwst pays of Iris docuM-4 or may be placed on addrtionaf pages of the
docurm wk NgW Use of this carer pays adds one peye to your doamnent and 5200 to are 1`e1a50n4 fee. Wsoonsin Statutes. 59.517.
1 of 2
ST CRD�x c OUN TY
A A A
PLANNING & ZONING
July 6, 2007
Jack & Jennifer Hartwig
623 Alice Circle
Hudson, WI 54016
RE: Remodeling /bedroom addition, Town of Hudson, St. Croix County
Code Administration Lot 64 Cottonwood Ridge Subdivision
715- 386 -4680 Parcel # 020 - 1353 -64 -000 - Computer #36.29.19.2064
Land In formation & Dear Mr. & Mrs. Hartwig:
Planning
715- 386 -4674
You have requested the Zoning Office review your remodeling /addition project for
Real Property compliance with the state sanitary code (COMM 83). When remodeling or adding
715 -386 -4677 onto a dwelling, you are required to examine whether or not the planned modifications
involve an increase in design wastewater flows to the Private On -site Wastewater
Recycling
715 -386 -4675 Treatment System ( POWTS).
I have reviewed your remodeling plans for the above residence. The project involves
an 18' x 28' addition with office and guest bedroom. There will be no change to the
three bedrooms within the structure. The existing POWTS was designed and installed
based on wastewater flow for three (3) bedrooms with a maximum occupancy of six
(6) persons. Technically the POWTS will be undersized for the number of bedrooms
within the residence; however, current occupancy does not exceed the design
wastewater flow for the POWTS. An Occupancy Affidavit is required to disclose the
disparity between number of bedrooms and septic system sizing to any future
owner(s) of the residence. The affidavit was submitted to the St. Croix County
Register of Deeds office for recording against the deed prior to issuance of a building
permit from the Town of Hudson (Document #855087).
The original system was installed in October 1999 by Kim O'Connell and was
inspected by zoning staff. The system was found to be code compliant at the time of
installation. Inspection report and sanitary permit documents are on file with the
zoning department.
To prolong the POWTS lifespan, the septic tank should be pumped at least once
every three years or when the tank becomes 1/3 full of sludge and scum. The effluent
filter on POWTS installed after April 2000 should be backwashed as needed to
prevent clogging of the septic tank outlet. In addition, water conservation measures
are recommended, such as repair /replacement of leaking plumbing fixtures, reducing
shower time, running the dishwasher only when full, avoid using a garbage disposal,
using a wash machine with a suds -saver feature, etc. The long -term function of your
POWTS is dependent upon proper maintenance of the system.
ST. CROIX COUNTY GOVERNMENT CENTER
1 10 1 CARMICHAEL ROAD, HUDSON. W1 54016 715 - 386 - 4686 FAX
i
If this POWTS should fail at any time in the future, the system will be need to be inspected by a
licensed plumber or POWTS maintainer to determine if it requires replacement according to state code
requirements in effect at that time.
The proposed remodeling and room addition project must comply with all applicable building
codes. Please contact the Building Inspector for the Town of Hudson to obtain a building permit.
Should you have any questions, please contact this office.
Sincer ,
GG��YVr --
amela Quinn
Zoning Specialist
Cc: Brian W9 A, Building Inspector
Kim O onnell MP #224263, POWTS Installer
file
i
i
ST. CRO /X COUNTY GOVERNMENT CENTER
1 101 CARM/CHAEL ROAD, HUDSON, W/ 54016 715386 FAx
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
Sys
ye scl/ ' ad d A y o - h
C r'e'd 0�4CR
jg-d r rani v,
? W.Ildfletl
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W
INDICATE NORTH ARRO'
�G�c �C S�� �n��iv l'Iccr'�cvl
r—
ST. CROIX COUNTY ZONING DEPARTME T -,- .;
AS BUILT SANITARY REPORT `�
Owner
Property Address
City /State
c�VING 0�FrCE
Legal De cription: i
Lot � Block Subdivision/CSM # f
1 /4 .5r_" ' /�, Sec., 'N -RAW, Town of PIN
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer 1ti��� C Size ST/PV Setback from: House � Well — P/L
Pump manufacturer Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location _
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: &,gS o Width Length Number of Trenches
Setback from: House IZ! - Well — P/L 3,� Vent to fresh air intake /zy
ELEVATIONS
Description of benchmark - Elevation
Description of alternate benchmark Elevation ,>r-�918
Building Sewer /�_i 7 3 ST/HT Inlet ,/� �G � ST Outlet l _,; � � PC Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover
Distribution Lines () R ;7
Bottom of System
Final Grade O 99," 9R O ( )
Date of installation/ e / % / P mit number State plan number
Plumber's signatu e License number ( --;2-_I2 _3' Date
Inspector
Complete plot plan
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
e�
i
INDICATE NORTH ARROW
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count
Safety and Buildings Division
INSPECTION REPORT
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)].
Permit Holder's Name: ❑ City ❑ Village Q Town of: State Plan ID No.: Town of 14udson
CS ev.° r Insp. BM Elev.: BM Description: Parcel Tax No-: ?� �-
. a 0 - 020- 0
TANK INFORMATION ELEVATION DATA , Zv�y
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic wul Benchmark Z 06 ( p "
Dosing A lt. BM a q° 0911&
Aeration Bldg. Sewer 7� 10 - 4-3o
Holding St/ Ht Inlet (°'`f3 05',65-
TANK SETBACK INFORMATION St/ Ht Outlet (o5', Z3
TANK TO P / L WELL BLDG. Air I ntake ROAD
Air
Septic 750 3p' NA Dt
Dosing NA Header /Man. 91.(
14 .16- 3
Aeratio NA Dist. Pipe 9S. 4g
Holding Bot. System
96 -3.0
PUMP/ SIPHON INFORMATION Final Grade 12,10 qq.q?
Man turer Demand
Model Number GPM 5,23 p ,g;s St Cover
TDH Lift Ion stem TDH Ft
Force Length Did. Dist. To Well
SOIL ABSORPTION SYSTEM I
E T40N4H Width f Len O I No s PIT No. Of Pit Inside Dia.
DIMEN I N �5 I DIMENSION
SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING an ,,rer:, _
SETBACK CHAMBE Mo
INFORMATION TYPe O �6 ► D r OR del e
System:
DISTRIBUTION SYSTEM 15)
Header/Manifold U Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing > '
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over 7Bd th Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center /Tr ench Edges Topsoil E] Yes E] No E] Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.) Date #1:10/ 1 /Qq Date #2: - t - '
Location: 623 Afice ' cle, Hud on SW1 /4, SER , Sec ion 36 T29N -R19W - 36.29.19.2064
All �
� CAJ
Cf CA '
t o —
I—
Plan revision required? E] Yes No
Use other side for additional informat on. oZ o If 5
SBD -6710 (R.3/97) Date Inspector's Signature Cert No.
1
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
SANITARY PERMITA
`�SC0�1S %/1. 2 1 Box ashingtonAvenue
In accord w ith ILHR 83.05 Code
Department of Commerce Madison, WI 53707 -7302
Ibtt
• Attach complete plans (to the county copy only) for the sy , on p�ss ' \ bun
than 8 112 x 11 inches in size. i .. '
• See reverse side for instructions for completing this applic t+ain � irn 0 `? 1999 St4t, nitary Permit Number
`} ST CA f` C� (0 T
Personal information you provide may be used for secondary purposes Nv ck if vis to revious application
[Privacy Law, s. 15.04 (1) (m)]. FFICE
t •, •. ZONING C ,S Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL
Property ner Name ,fir rty a
1 /4, S 3 T , N, R E (o
Property OwneM a ling Addr Lot Number Block Number
City, Sta Zip Code Phone Number Subdivisio N or CSM Number
( )
I. TYPE OF BUILDING: (check one) ❑ State Owned It Near% t oad
❑ Village
Public 1 or 2 Famil Dwellin - No. of bedrooms Town OF 1
111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)� , L
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 online B, if applicable)
A) 1, rid 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 E] In-Ground Pressure 42 E] Pit Privy
13 0 Seepage Pit I t 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPT SYSTEM INFORMATION:
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.) (MinA ch) Elevation
fi 7 Feet Feet
Capacity VII. TANK in g llons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete con- Steel glass Plastic App
New Existin strutted
Tanks Tanks
Septic Tank or Holding Tank Cl ❑ ❑ 1 ❑ Cl
Lift Pump Tank (Siphon Chamberl 1 1 ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the /undersigned, assume responsibility for i stallation of the onsite sewage system shown on the attached plans.
Plum r' Name (Print Plum is gna i • (N t mps) MP /MPRSW No.: Business Phone Number:
I I" .5~ � -&11)� �-.
Plu er's Address (Sheet, Cit ,State, Z' ode : L4);
'fie IX. COUNTY D ARTM T USE ONLY
❑ Disapproved Sa nitary Permit Fee OndudesGroundwater D ate I ssued Issuing Agent Signature (No Stamps)
urchargeFee)
Approved ❑ Owner Given Initial �, 0 q--19
Adverse Determination
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
r 2 yea
t permit i valid f w ea
. Asani ta sanitary t s o t wo )y
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
S. Onsite sewage systems'must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever,
necessary, usually every 2 to 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 owners name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
IL 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.
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Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of S
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 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 ro parcel I.D. #
7J - r
APPLICANT INFORMATION - Please print all information. kRe 'eweQy Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ! �_
Prope Owner Property Location
Z- , L� 4 Govt. Lot 1/4 1 /4,S T N,Ro
Property O ner's Mailing Address Lot # Block Subd. Name or CSM#
City Stat Zip Code Phone Number ❑ City ❑ illage fZ Town Neares Road
�i
® New Construction Use: Residential / Number of bedrooms ? Addition to existing building
'J
g
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow _�� gpd Recommended design loading rate .5 bed, gpd/ft gpd /ft
Absorption area required _5�20 bed, ft
�rO trench, ft Maximum design loading rate bed, gpd /ft ,_ trench, gpd /ft
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material @cei� Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system I ® S ❑ U �0 S ❑ U OS ❑ U I ® S ❑ U ❑ S (CZ U ❑ S 21 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
s
elev. ,
/ /J. - I ft.
Depth to c V4 Z 4 s f�
limiting
factor
� & ;2 in.
Remarks:
Boring #
S
Ground J /s
elev.
Depth to
limiting
factor
/& in. Remarks:
CST Name (Ple a Print) Signature � 1 Telephone No.
. 3jy
Address Date CST Number
1
PROPERTY OWNER - SOIL DESCRIPTION REPORT Page -,-W- of �?
PARCEL I.D. # -
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
7 a
Ground
elev
Depth to r- —
limiting
factor
t - &o in.
Remarks:
Boring #
r
Ground V ,, e,�
_ -
elev.
/ Al -
Depth to G
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 #
S.
�
. j
r
Ground — —
elev. _
/Oft. r
Depth to
limiting °� 5
factor
;>, / . in. Remarks:
Boring #
Ground
elev.
ft. '
Depth to
limiting
factor
in.
Remarks:
SBD -8330 (R. 07/96)
LO
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G
Y on D epartment of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated SerAces in accordance 3.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inc es Irisize. Plan rust
�• i County
include, but not limited to: vertical and horizontal reference irit (BM), dir Crot
M
percent slope, scale or dimensions, north arrow, and locatio�lariQ distanc oad. 7 - r Parcel I.D. #
j4
APPLICANT INFORMATION - Please print all nformat /off f999 Re 'wed by Date
Personal information secondary puMoseg ( cy ¢ (m))• ��_ -_ - -
you provide may used for seconds Priva Law, ,4 GIO j
,
Property Owner : '
0 ia
(^ �.� J 1 .�^� \ Gott 1/4 1/4,S .3 & T2Q ,N,R I c� E (or�
Property Owner's Mailing Address _W f* * lock# Subd. Name or CSM#
City State Zip Code Phone Number 0 City ❑ Village fj� Town Nearest Ros
\ 154W.0 I t 1' I I Cc3440n w o o of trc-le
56-New Construction Use: Residential /Number of bedrooms A Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow _iun gpd Recommended design loading rate • S bed, gpd/ft • trench, gpd1ft
Absorption area required gi bed, ft sad- trench, ft2 Maximum design loading rate . 5_ bed, gpd/ft . & trench, gpd/It
Recommended infiltration surface elevation(s) - 77, 76 ft (as referred to site plan benchmark)
Additional design/site considerations _Com-ivur4e•t•e.c/ 95;70
Parent material olt A1X Flood plain elevation, if applicable ** It
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
V o Unsuitable for system ❑ s [.� u I s D u EIS R] U ❑ S CZ u ❑ S (} u [Is El u
SOIL DESCRIPTION REPORT
Boring Horizon Depth Dominant Color Mottles Structure GPD /ft
g Texture Consistence Boundary Roots
U in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
OAq 10 v- 313 rrn-Cr c_ t
Ground -y I D r 5 ) Pi 10
elev.
0-yo it
Depth to
limiting i
or
in.
Remarks:
Boring # i
0-IO 1 r 3 I Mf -r c 1�
3
Z7_4 - 32. t 51 -- IL by e e- - s
I
Ground
elev.
9ZYl� '
Depth to
limiting
factor
min. Remarks:
CST Name (Please Print) Signature Telephone No.
P d am ?1 5) 2y 7- yooFj
Address Date CST Number
PROPERTY OWNER S ' y SOIL DESCRIPTION REPORT
Page Z of �
-PARCEL I.D.N
Boring # Horizon Depth Dominant Color Mottles Structure 2
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed , Trench
CHI 10-4r3fl
Ground 3 IS
elev. �vo r rG LShr
Jepth to
limiting
factor
Remarks:
Boring #
w s=
Ground
elev.
n.
Depth to
limiting
'actor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary oots PD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry
Bed , Trench
Boring #
Ground ,
elev.
n.
Depth to
limiting
factor
in. Remarks:
3oring #
around
lev.
n.
)epth to
miting
ctor
—in. Remarks:
ID -8330 (R. 07/96)
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SYSTEM ELEVATION AND SIZING CALCULATIONS
Below Grade Chamber Soil Absorption Systems
Permit Number 9/7199 Date
x • X • Gravity Distribution
only 1 Pressure Distribution
3 Ift Suitable Soil 1 Note 1: Bury depth as per manufacturer
16 in Chamber Height 2
g ft Maximum Bury Depth s
450 gpd Estimated Daily Peak Flow
0.60 gpd /ft Wastewater Infiltration Rate 750.0 ft Code SAS Size
40 % Down Sizing Credit 300.0 ft Reduction ( -}
450.0 ft Min. SAS Size
95.70 ft Proposed SAS Elevation
Soil Surface Acceptable Finished Grade EL 4 (ft)
Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum
Number Elevation (ft) Depth (in) Lowest Highest Elevation? 98.53 105.03
1 100.10 102 94.60 98.10 Yes
2 1 99.89 100 94.56 97.89 1 Yes
3 98.99 100 93.66 96.99 Yes
4 100.69 104 95.02 98.69 Yes
5 100.69 104 95.02 98.69 Yes
1. Depth of suitable soil required below the infiltrative surface for treatment.
2. Total height of chamber in inches.
3. Maximum bury depth as per manufacturer's recommendations.
4. Based on chosen system elevation, and chamber height. Top of chamber is
equivalent to top of aggregate. The addition of fill for cover or the reduction of
finished grade may be required to meet minimum or maximum code standards.
l i
SBD- 10553 -E (R.05/98)
M ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owncr /Buyer
Mailing Address f/o2 O h //L �o dje -127,5 !c1` S�t /U 2 - 3
- Property Address
����// (Verification required from (Tanning Department for new construction)
City /State 0 50 L--. Parcel Identification Number o-�G l /l0 c�70 00 0
I ` F GAi, DESCRIPTION
Property Location 1 /4, _ r /,, Sec. ,� , T_N -R . 9 W, Town of
Subdivision CU B'' wO C) /3 7?� G C= , Lot # �
Certified Survey Map # , Volume , Page # L �"
Warranty Deed # _Kv® V7 Volume 33 , Page # 3
Spec housex yes O no Lot lines identifiable; yes O no
SYSTEM MAINTENANCE
Improper use and maintenanceof 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,
iiwe, the undersigned have read the above requircments 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 :0
days of the three year expiration date.
/?
SIGNA UR • Ol 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 prop rt described above, by virtue of a \ %arranty deed recorded in Register of Deeds Office.
/C;?4 l
SIG TU E VF 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
STATE BAR OF WISCONSIN FORM I - 1982
WARRANTY DEED KATHLEEN His WALSH
REGISTER OF DEEDS
DOCUMENT NO. ST. CROIX CO., W1
1433PAGE 4" 413
RECENED FOR RECORD
This Deed madebemven RICHARD 0. STOUT and 06-11-1999 10:00 M
JANET P. SMUT, husband and wife,
W"TY DEED
EXM"T I
Grantor, CERT COPY FEE:-
and Gk'Y D. NELSON and JILLIENNE J. NELSO COPY FEE:
hus5 and wife, TRWER FEEt 107.70
RE"'ORDING FEE: 10.00
Grantee,
Witnesseth, - aiat die said Grantor, f ive
thousand nine hundred and 00 100thS Dollars
THIS SPACE RESERVED, OR RECOFIV,NG DAIA
conveys to Grantee the following described real estate in St. Croix
'DRESS
County, State of Wisconsin: NAME AND RETURN A
Y BANK, N.A.
Lot 64, Plat of Cottonwood Ridge, Town of Hudson, EAGLE VALLE
Rd Unit 2
St. Croix County, Wisconsin. 1301 COUIse
Hudson, W1 54016
020-1110-20-000
PARCEL IDENTIFICATION NUmsEn
This is not —homeStC2d property.
(is) (is not)
Together with all aod singular the hereditaments and appurtenances thereunto belonging;
And _ Richard 0. Stout and Janet P. Stout
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easemf - its, restrictions, rights-of -way and covenants of record, if any,
and will waffam and defend the same.
Dated this- 2nd —dayof June 99
Richard 0. Stout (SEAL) Janet P. Stout SEAL)
NTULk3
(SEAL) (SEA!:)
AUTHENTICATION ACKNOWLEDGMENT
State of Wisconsin,
Signature(s)
ss_
St. Croix
Co
fore me this n day of
authepticated this day of 19—. Personally came before me this
June 19-21, the alb-ove named
Richard 0. Stout and Janet P.
Stout
TITLE: MEMBER SrATE BAR OF WISCONSIN
(if not, K. LINN
authorized by §706.06, Wis. hft� Public-State of W=Crq* me known to be the person S who executed the foregoing
&:stm entandackricwled the n. e,
THIS INSTRUMENT WAS *AP"Q*`Si0n EXPI
Janet P I Stout
L;r. n
Hudson, Wi. 54016 Ncitary Public., County, W
(Signaturts rna� be authentic, or 3cknowledged 13 �' , are ncsi 1sly commission is permprient. (If ncit. b,ai-- expiration ds.'e:
necessa;
Names j. per�ns 5ign! in an) L?px�. hould b% type
their s:4-ji-es,
I _jqW Bar* co� sic
STATE BAR Uf 1,1 1,15CONSIN
WARPANCY DEED
ON CD CL
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............................... ................ .............N. .............. �� q i
Wisconsin Department of Commerce SOIL AND SITE EVALUATION t
Division of Safety and Buildings Page 1 of
Bureau of Integrated Services in accordance With ;s - 1t'i'R•,P.09, Wis. Adm. Code
• ' � � �
Attach complete site plan on paper not less than B 1/2 x 11 inches in, size. PlanAiust County
include, but not limited to: vertical and horizontal reference point (BM), dir4Ctian'nq �rL >i
percent slope, scale or dimensions, north arrow, and Iocation.;and distance to neai44 road. , Parcel I.D. #
APPLICANT INFORMATION - Please print all,informat %, Rev' we d by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 5.' + (m)).
y
Property Owner y lo�a'tbh
Govt - loot, r 1/4 1 /4,S 3lO TZq ,N,R 1 ci E (or�
Property Owner's Mailing Address Lbf.# , Block# Subd. Name or CSM#
City State Zip Code Phone Number
❑ City F1 Village fil Town Nearest Roa
Cat C )" 7 C0+40 n w 0 0 4 i t C_CZ
56-New Construction Use: tj3,Residential / Number of bedrooms _s'z4 Addition to existing building
❑ Replacement 1 ���� ❑ Public or commercial - Describe:
Code derived daily flow 1!260 gpd Recommended design loading rate bed, gpd /fi • trench, gpd /ft
Absorption area required __6?4 bed, ft OG�. trench, ft
Maximum design loading rate r 5 bed, gpd /ft trench, gpd /ft
Recommended infiltration surface elevation(s) 7, 7 ft (as referred to site plan benchmark)
Additional design /site considerations Ca n u r e-l-e U 9S; 7 d
Parent material l ' 11(l el t •) LkA 1X__ & Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system ❑ s [A Q S❑ U ❑ s 14 U E] S 17 u ❑ S 14 EIS ® 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
-� iQ ,r 313 c 1
SL
Ground -4
elev.
g Z•yd ft.
Depth to
limiting
f for
in.
Remarks:
Boring #
Ground
elev.
tzlynft.
Depth to
limiting
factor
_2±in. Remarks:
CST Name (Please Print) / Signature Telephone No.
64a Sc kn--- ✓1 - r__ (Ir 2y7 -L1avS
Address Date CST Number
` O S'4 _ S dmerse ! -_/(3 — `�`�S— q �5
SOIL DESCRIPTION REPORT
PROPERTY OWNER S �' y � Page Z of
PARCEL I.D.#
Boring Horizon Depth Dominant Color Mottles Structure 2
g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed ,Trench
2
. 11 - 5Z- 3 y m J - , c S — 5 . Cp
Ground ?j -(n0 r rr
elev.
5� 1(J 5( a LS
Y_ ^ Cl ft-
Depth to
limiting
factor
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. Be Tr
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)
1
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S & N LAND SURVEYING, INC.
HUDSON, WI 54016
(715) 386 --2007
PREPARED FOR:
NELSON HOMES
1128 100TH AVE
ROBERTS, WI 54023
DESCRIPTION
PART OF LOTS 63 AND 64 OF THE PLAT OF COTTONWOOD RIDGE
IN THE TOWN OF HUDSON, ST, CROIX COUNTY, WISCONSIN.
LEGEND
• 1" IRON PIPE FOUND
1
1, O 1" X 24" IRON PIPE SET WEIGHING
1 1.68 LBS. PER LINEAR FOOT
1
1 1 0 2" IRON PIPE FOUND
1
1
X ----X- EXISTING FENCELINE
62
� I
63
� I
� I
1
AREA PARCEL 'A
1 0.126 ACRES I
1 5,506 SO. FT, j
I
I
1 q� \,4 1 z
5�5•pA- A'
» A .0
, ,' 1 a' o
L
1 " -
14
100 � i 5'5 .05 0 'E 60.12' j x
S , . 40 "W N15.p5 Ap, I o ;
A I
✓ PARC , i m li,
Qj
AREA PARCEL 'B j i w
~ 0.061 ACRES I z
2,673 SQ. FT. O
LL) 0
I z
J ,^
61
- 64 i a
Z
, I
Q
I
O SP 16' # - -mil � A'T. DOUGL HUDS
Z
CURVE DATA
NUMBER RADIUS DELTA ANGLE CHORD BEARING CHORD LENGTH ARC LENGTH TANGENT
Cl 80,00' 72'22'33" S08'22'45.5 "W 94.47' 101.06' S27'48'31 "E S44'34'02 "W
Mop No, 98 -124
Drown By. MICHAEL ERICKSON
DATE: 6/28/99 SHEET 1 OF 2 SHEETS
S .& -N LAND SURVEYING, INC.
HUDSON, WI 54016
(715) 386 -2007
NAME NELSON HOMES
1128 100TH AVE
Address ROBERTS, WI 54023
PARCEL A
A parcel of land located in the part of the SW1 /4 of the SE1 /4 of
Section 36, T29N, R19W, Town of Hudson, St, Croix County, Wisconsin;
being part of Lot 63 of the Plat of Cottonwood Ridge; described as
f ottows:
Beginning at the Southeast corner of said Lot 63; thence
N00 °30'08'W, along the east line of said Lot 63, 41.47 feet, thence
S75 114.04 feet; thence S39 °37'59'W 69,24 feet to the
south line of said Lot 63; thence N75'05'40'E, along said south
line, 160.12 feet to the point of beginning. Containing 0.126 acres
(5,506 square feet),
PARCEL B
A parcet of land located in the part of the SW1 /4 of the SE1 /4 of
Section 36, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin;
being part of Lot 64 of the Plat of Cottonwood Ridge; described as
follows:
Commencing at the Northeast corner of said Lot 64; thence
S75 °05'40'W, along the north tine of said Lot 64, 160,12 feet to the
point of beginning; thence continuing S75 °05'40'W, along said north
line, 84.48 feet to the Northwest corner of said Lot 64 and the
easterly right -of -way of Cottonwood Circle, being a point on a 80.00
Foot radius curve, concave westerly, whose central angle measures
72 °22'33', whose chord bears S08 °22'45,5'W and measures 94.47
feet; thence southerly along the arc of said curve 101.06 feet; thence
N39 149.57 feet to the point of beginning. Containing
0.061 acres (2,673 square feet).
NOTE: These Parcels are to be deeded to adjoining land owners,
Of W1,9
O
DOUGLAS J.
co 7AHLEA
. 5-2145
HUDSON,
� IS.
z8M
SHEET 2 OF 2 SHEETS