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CROIX COUNTY ZONING DEPARTkF - IT AS BUILT SANITARY REPORT i ` `sVEL Owner _�f� r t 4 T9 Address 79'0 fal J4 ,,r 1 o,, -e ° sr CROIX � �a-e�S �,� , CouNry -, Go FF City /State ONIN ICE Legal Description: Lot ,1, Block Subdivision/CSM # '/, _ 86 %, �, Sec ,TAN -R aW, Town of _ �,( Q�,�— PIN # 020 10 22 20 - c3Z� SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer A1,1111,1 c a ]`+cyst/ Size ST/PC I / W Setback from: House Well P/L Pump manufacture_ r. Model E e y11 Alarm location Al," s r (HOLDING TANKS ONLY) Setbacks: Service road fresh air intake W me Meter location - Alarm location SOIL ABSORPTION SYSTEM Type of system: L Width - Length 7 Number of Trenches 57, Setback from: House o Well SG P/L a T Vent to fresh air intake ELEVATIONS Description of benchmark S' �- a- s / / , j Elevation / e e, Description of alternate benchmark Elevation Building Sewer ST/HT Inlet . ` ST Outlet PC Inlet PC Bottom S 7 , ,Ir Header/Manifold Top of ST/PC Manhole Cover 93_ ld Distribution Lines( Bottom of System(_ 12 () ( ) Final Grade Date of installation ?/ / � number 3�s`�� 9 State plan number Plumber's signature License number 9 Date Inspector �c Complete plot plan it 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 i g 0 t � 2 .3 VIO c�a � _ d � �(. 7 7 -� INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division $ INSPECTION REPORT ST. CROIX 'GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. M929 15929 Permit Holder's Name: ❑ Cit ❑ Village Town of: State Plan ID No.: ALESSO, KEITH HUDSON CST BM Elev.:. Insp. BM Elev.: B escripti n: Parcel Tax No.: 1� !� �w 020- 1022 -20 -000 TANK INFORMATION ! ELEV TION DATA A9800317 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. j ptic07� Ben ..// ch sing r �� # , IOC Aeration Bldg. Sewer Holding St -16 Inlet TANK SETBACK INFORMATION St I Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic -7S' 2d' ,% NA Dt Bottom Dosing It .1 3a� NA Header /Man. 7 - - 7(, q - 7 . 3C / Aeration NA I Dist. Pipe 'j ` Holding Bot. System PUMP/ SIPHON INFORMATIO il l , 3 10 Final Grade S.Z,� ��, C/ Manufacturer C.� S Demand_ A 3 Model Number s GPM l 7-Se I. &fo q7, 411 TDH �' Li 0 & Lriction 'stem,,,- TD1aGf t oss FFiie Forcemain Length Dia. r ` Dist. To Well SOIL ABSORPTION SYSTEM BED ENC Width n Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid De th DIM DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEA HING Manufacturer: INFORMATION Ty � CHA R Model Number Sy to / / ' OR UNIT DISTRIBUTION STEM Header/Ma nifold y Distribution Pipes N x Hole Siz w- - _ x Hole $Patin Ve Air Intake Length Dia Length Sparing ,-�� r h� 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.) Sy LOCATION: HUDSON 14.29.19.103A,NE,SE 780 HOLDEN LANE A Vk< Plan revision requlld? ❑ Yes [ No Use other side for additional information. v (�• ( q � I FR 7 SBD -6710 (R.3/97) Date Inspector's Si ature rt. No. Safety and Buildings Division Visconsin SANITARY PERMIT APPLICATION P 1 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 8 1/2 x 11 inches in size. 5 7 ro�e • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes q/ [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Num I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Property Location 41r� 1 /4 S r- 1/4, S T , N, R E (or)� Property Owner's Mailing Address Lot Number Block Number �� o City, State Zip Code Phone Number Subdivision Name or CSM Number h�Ldg S of ( ) . .r/ : rNZest 10 / II. TYPE F BUILDING: (check one) E] State Owned 13 It Road Public 1 or 2 Family Dwelling - No. of bedrooms ° ro w a n OF � l��.d 1•.�,u Mir III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) lI;z4- /Q .9 �7, - 0 O 1 ❑ Apartment/ Condo I q dj, 1 16`5 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. W New 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ______System System Tank Only System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Pa Seepage Trench 22 ❑ In- Ground Pressure f 42 ❑ Pit Privy 13 E] Seepage Pit 6 )— ,3 ' )c 7 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 1evation G (16 X5 �G3 Z .tea- � .75- Feet Feet VII. TANK Capacity in gallons Total # of Site g Prefab- Fiber- Plasti Exper. INFORMATION Gallons Tanks Manufacturer's Name li Concrete con- steel lass A New Existin strutted g Pp . Tanks Tanks eptic Tank Holding Tank a ?00 / f y 1--e v l-/ 10 ❑ ❑ ❑ ❑ ❑ ift Pump Tank phon Chamber ❑ ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sew ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signat re: (No Stamps) PRSW No.: Business Phone Number: MU" Plumber's Address (Street, City, State, Zip Code): -e -e' d G IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater at I ssued suing Age t Si ture (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 Safety and Buildings Division Vi scons i n SANITARY PERMIT APPLICATION 201 W. Washington Avenue In accord with ILHR 83 0 5, 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 8 1/2 x 11 inches in size. s ? — C>-b " • See reverse side for instructions for completing this application State Sanitary Permit Number 3 LsC7a Personal information you provide may be used for secondary purposes E] Check if revision to previous appli ation [Privacy Law, s. 15.04 (1) (m)]. State Pla I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Property Location 1 ia�! - 1 i4, S /, T1l? , N, R E (ork Property Owner's ailing Address ` Lot Number Block Number �O- N -e_ /d City, State Zip Code rP Number Subdivision Name or CSM Number a' > s S II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ !t� age Nearest Road Public 1 or 2 Family Dwelling ❑VII - No. of bedrooms Town OF A III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 626 — /6 A-, ~ � � �� � 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. W_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 C] Pit Privy 13� Seepage Pit v " S Y IS 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation eL - 9G Feet . J() Feet Capacity VII. TANK Ca a in l Ions Total # of Prefab. Site Fiber- Exper. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete st acted Steel glass Plastic App Tank Tanks pp�� ep ank r� ` e Y�f/ [3, ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ 1 ❑ ❑ 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 Signature: (No Stamps) P OMPRSW No.: Business Phone Number: Tor !Nit A",. k k1. _$ Q ! r• " .�l Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMEN USE ONLY f ❑ ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate - issued Is ing Si at re (No Stamps) Surcharge Fee) -7/ � i Q Approved Owner Given Initial � b�� i V 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 h i • p� IO Alex e - f Sca le, 0 k7 fi W � J n i Yo C Q = m� r � w _ n w A 4 y ` CO D 0 A y e 1II c) uY o m J AA �AAAA I W - N CC] T m w F T 1 03 �,� ��0m 0 Q `J M N) .: m CD m CO CL • Cb co a v w 3N oQ 000 3 3 o I' 0° y � 1 Lu � II Z NIS\ �I =e I cn < v � s Cn Cn O m m o N X 20 - n r a m c w _ 2 cQ m * cn cD a `� x �( �o m r CD W U (<D� wlli� 0-K � m _ U) Q o � °- � co 0 _« c O CO CO — � - U) 1 Q CD C --i 0 cD O I — Cn I c -* = o g 0 CD 3 (D w � 0 (D I O O 0 to Cl CD a m v 0 cn 3 0 c r cn C x o CD 2) w c w w cn 3 Q rn 0 w ��, W ( ° o In 11" ►I - 1 ^' n � W s lV C (n A Cl PAGt GF PUMP CHAMBER CROSS SECTIOW AUD SPECIFICATIOAI5 VEUT CAP 4"C.Z. VENT PIPE WEATHERPROOF APPROVED LOCKMIG > ?_5' FROM DOOR, JUUCTIOU BOX MANHOLE COVER — WINDOW OR FRESH IZ "MILI. AIR IUTAKE GRADE I I A&I I `I" MIM. _T ` — _ 18" X1 k). COAIOUIT 18 "MIN. -- - - - - -- \ 111 IIULET PROVIDE I —_ _T AIRTIGHT SEAL i * * A � I I J ill ALARM B I II I 1 . c *APPROVED i OIJ JOINTS WITH I ELEV. FT. APPROVED PIPE - -� 3' ONTO PUMP —� OFF D SOLID SOIL COWCRETE BLOCK RISER EXIT PERMITTED OIJL'J IF TAUK MAUUFACTURER HAS SUCH APPROVAL SEPTIC E SPEC.IFICATIOUS DOSE TAUKS MAWUFACTURER: (�ILIMBER OF DOSES: y PER DA-4 SIZE: 261 GALLOIJS DOSE VOLUME ALARM MAIJUFACTURER: 4 felt — Ion 7?� INCLUDIWG BACKFLOW% ,lG� GALLONS MODEL AIUMBER: PZ y CAPACITIES: A- _ IUCHES OR Y2'! GALLONS SWITCH TyP[: eP c g = 2 p IUCHES OR GALLONS AI PUMP MAUFACTURCR: Al GauP�`S C = AV o IMCHES OR 1 G GALLOW5 I MODEL WUMBER: 6pO�/l/ D- Y r - _Y r WCHES OR / 4 1 � L GALLONS i SWITCH TYPE: CMG MOTE: PUMP AMD ALARM ARE TO DE MIMIMUM DISCHARGE RATE _ �� GPM INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEU PUMP OFF AMD DISTRIBUTIOU PIPE.. 15— FEET + MIIUIMUM METWORK SUPPLY PRESSURE FEET 77,,// L _ FEET OF FORCE MAIM X a,GZ F too FLFRICTIOU FACTOR_ 7.S FEET TOTAL DyWAMIC. HEAD FEET I s r IMTERAIAL DIMEIISIONi OF TAIJK: LEIJ6TH ;WIDTH ;LIQUID DEPTH I 51GAIFT): Goulds 7_1-�q 6 or 6 Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover. Thermoplas- • Homes components. Available for automatic and tic cover with integral handle •Farms Motor manual operation. Automatic and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewaterin g preset at the factory. RPM, built in overload with rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, construction. Pump: EPO4 built in overload with ■ EPO4 Impeller. Thermo- • Solids handling capability: automatic reset. plastic Semi -open design 3 14' maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. Co. Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding - • ■ EP05 Impeller Thermo- Discharge size: 1'/2 NPT. plug. Optional 20 foot (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F° or "AC".) rotary/ceramic- stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running , - dry without damage to s so ; r , SGPM components. •t __ -- Pump: EP05 8 x j 1 U:. • Solids handling capability: 0 7 25 i V4' maximum. a W • Capacities: up to 60 GPM. s 20 • Total heads: up to 31 feet. 4 • Discharge size: 1 NPT. z 5 - - - • Mechanical seal: carbon- 0 1 5 — rotary/ceramic - stationary, _j 4 BUNA -N elastomers. 0 EPO� • Temperature: s 10 104 °F (40°C) continuous 11 3-41 140OF (6VC) intermittent. 2 5 1 I� N OL 00 10 20 40 50 GPM L L 0 2 4 6 8 10 12 mVh CAPACITY y ©1995 Goulds Pumps. Inc. Eftcdve May, 1995 I i wi- n Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page l 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 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and s G Yd 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 f Govt. Lot 1/4 1 /4,S L/. T oC N,R E (orks Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# ; 1�1,11_4.Aol 40A-e— /1� � A _5 W,'//s City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road New Construction Use: ® Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow ysy gpd Recommended design loading rate =gy bed, gpd /fi , � c trench, gpd /ft Absorption area required �v `� bed, ft SS6 3 trench, ft 2 Maximum design loading rate 7 bed, gpd /ft ( r7 trench, gpd /ft Recommended infiltration surface elevation(s) ��v -� 3 ft (as referred to site plan benchmark) Additional design /site considerations �� �4.CGC d' �a r clr�s�•`�� atia / ec Parent material d a 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 [K S❑ U I 0s ❑ U 19 S ❑ U 0 S ❑ U ❑ S ZI U EIS ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 6- Ground /6 Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: CST Name (Please Print) Signatur Telephone No. S� � Grp /` X13 3�� ��`•�� Address ,J Date CST Number O 2d 1Z-� 7 I SOIL DESCRIPTION REPORT aw PROPERTY OWNER A Page 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 Ground elev. 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. 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) � � �p �,r ! Sr�t�P� jie � ✓sai �uTsT�,�e bra /N � -- �[sS T�S ae X �" fY' ►�` ��TG � � 1 1 I J C r Wiscgnsin Department of Industry SOIL AND SITE EVALUATION REPORT Page _ of -Lan Human Relations Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code —. . COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 's . not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 9. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION N- V L Z GOVT. LOT N C 1/4,5, 1 /4,S/-' T Z ,N,R I I ,Kor) W PROPERTY 0 NER':S MAII.ING ADDRESS LOT # BLOCK # SUBD. N E 0 CS M # (9,0 . ,4 /0 VA- s an Wills CITY, ST TE ZIP CODE PHONE NUMBER ❑CITY VILLAGE 2gTOWN NEAP PT ROAD / •/ S O - S ! IL) S7 /- 6a-60 1 f 'L � o1951671 (New Construction Use Residential / Number of bedrooms ( ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow .,3eo gpd Recommended design loading rate _ bed, gpd/ft . 8 - trench, gpd/ft Absorption area required bed, ft 37' trench, ft Maximum design loading rate gi bed, gpd /ft . trench, gpd/ft Recommended infiltration surface elevation(s) to ZS' ft (as referred to site plan benchmark) Additional design / site considerations Parent material / 0 s h Flood plain elevation, if applicable lt, It S`= Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE ATIG SYSTEM IN FILL HOLDING TANK U � C3 = Unsuitable for stem S U 2-6 El U 5eall 11 U ❑ U [I .®-U ❑ S SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz., Sh. Bed Tre & jeq y n- 3/z s \ Ground 7- lo ml IV O G- elev 5 c Ott a e, o S Depth to limiting factor Remarks: Boring # razes 4d :.r.: l D - d rL �/ ?1 = a nit sad m� ,,�• C2 n11 6 r In 1 Ground elev Depth to limiting Remarks: ` CST Name:— Please Pri / Phone: Address: lv G G— . 5 Signature: Date: CST Ntxnber: 1 PROPERTY OWNER S Q F 2 SOIL DESCRIPTION REPORT Page L-,of 3 PARCEL I.D.# �� Z`1. 10.3 A Boring # Horizon) Depth Dominant Color Mottles (Texture Structure Consistence Bounclxy I Roots GPD /ft in. Munsell Gu. Sz. Cont. Color Gr. Sz. Sh. Bed IToich L Yft 2/z— f i Ground a 5Z elev. 5 elev. Z 5 f t l Depth to limiting factor Remarks: Boring # OZ � Ground � 21 �S Z y" r kl o c / � , v • 6 e1�3 _ lv t/ !� Gr C S ©S , Depth to limiting facAr Remarks: Boring # moo Ground S A /e Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor T - 1 Remarks: SBD- 8330(R.05/92) v STEEL'S SOIL SERVICE Gary L. Steel C.S.T. 2298 New Richmond, WI 54017 MPRSW -3254 r S - 4A A lZ (715) 246 -6200 N 54'/ 5, - - r�z9 a !2 ) 9 to -�� sow L� �o o yh 1tv . a � ,�5.., iov ' 0 Let 1p0p, \ 1 J-5 .5"O ' 'Yo • /s� XD' ' /3' /OO'� 0 lies �� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 4 L e- 5.5 D Mailing Address Property Address A. , L (Verification requited from Planning Department for new construction) V City/State a (,I_d � ' Parcel Identification Number 0 c) D — I oaQ --;k3 — Ocyo LEGAL DESCRIPTION Z� Property Location 814 ' /,, 6,6 y4, Sec. T d N -RL"Z Town of 4 CA Subdivision M �� S Lot # /z . Certified Survey Map # a Q . Volume _ 1,0 77 . Page # e ls9 Warranty Deed # J 1 / �� CJ Volume I S vI 7 Page # D do S Spec house 0 yes W/no Lot lines identifiable J] yes 0 no SYSTEM MAH4TENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Vwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, a s set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certi 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. kGf4ATUkE 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 roperty 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 ENT NO. WARRANTY DEED L 579918 V O L I 12- 7 PA 065 ty A. Buchite, a single person, Grantor, conveys and warrants to th M. Alesso, a single person, Grantee, the following described real ate in St. Croix County, State of Wisconsin: ,,iicel of land in the NE 1/4 of the SE 1/4 of Section 14, Township 29 ,th, Range 19 West in the Town of Hudson, St. Croix County, Wisconsin n p scribed as follows: b' -e1 #10: Commencing at the E 1/4 corner of said Section 14; thence N! AY 1 9 1998 N rtn 88 degrees 31 minutes 45 seconds west (true bearing) 589.38 feet 8:00 A Ivy the point of beginning; thence South 4 degrees 44 minutes 20 seconds ry ' sC 575.60 feet; thence South 68 degrees 24 minutes 20 seconds West 2.95 feet along the Northwesterly right -of -way line of a proposed L ri 0—ids rn road; thence South 88 degrees 55 minutes 40 seconds West 249.88 -t along the Northerly right -of -way line of said proposed town road; rnce North 1 degree 06 minutes 20 seconds West 620.62 feet; thence rth 88 degrees 55 minutes East 287.94 feet; thence North 88 degrees minutes 45 seconds East 50.00 feet to the point of beginning. NAME AND RETURN ADDRESS tI) I)I / k5S6 / TRANSFER $ /1S FEE 020- 1022 -20 -000 s is not homestead property. Parcel Identification Number (PIN) .�ception to warranties: , i casements, restrictions and i ight s oil 1 t .ury 7� atad this �f ) day of May, 1998. (SEAL) -- -- - -- - - -- "- - Betty K7 F3uc e SEAL' (SEAL) ACKNOWLEDGMENT AUTHENTICATION = .inature(s) - — - ) ss. J , nenticated this day of �nal'.y came before me this 7 day of -_ - 19 / the above named h 10 to F.,,wn to he the person(s) who executed the t,i yoin) u,: ;t,.wnent and acknowledge the same. 1LE: MEMBER STATE BAR OF WISCONSIN ;If not, -- - ,1 t "� !� c n by 5706.06, Wis. Stats. . ) - -- - t� t _„ y ruul:l it County, Wis. THIS INSTRUMENT WAS DRAFTED BY: - t <�,uuasi n is permanent. (If not, expiration ate: Joseph D. Boles Rodli, Beskar, Boles & Krueger, S i C. CHARLENE A. LAHSUb - -- - -- _ - -- 1. 0 . Box 138 Notary Public is i ver Falls, WI 54022 State of Wisconsin My Gomm. Expires 2/7/99 ' t S & N LAND SURVEYING EYING, INC. HUDSON, f1'I 5 4016 OWNER (715) 386 -2007 BETTY BUCHITE 780 HOLDEN LANE HUDSON, WI 54016 DESCRIPTION LOCATED IN PART OF THE NE1 /4 OF THE SEi /4 OF SECTION 14, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY LEGEND WISCONSIN; KNOWN AS PARCEL #10 AND PARCEL #11 AS DESCRIBED ON DEED RECORDED IN VOLUME 1077, PAGE 159. ALUMINUM COUNTY S MONUMENT FOUND SECTION CORNER NOTES: 0 11. IRON PIPE FOUND A 1" IRON PIPE FOUND 0 1" X 24" IRON PIPE SET WEIGHING N "E, 5.37 FEET 1.68 LBS. PER LINEAR FOOT FROM LOT CORNER X -�— EXISTING FENCELiNE B 1" IRON PIPE FOUND S84'13'07 "E, 5.47 FEET FROM LOT CORNER (N88 50.00 iN EAS T – WEST 1/4 LINE N89 "E (NB8 377.00') (N88 287.94') 50, �' _w 89.32'11 "E 377,37' N89.21'56 " E E1/4 COR. 5281.32' SEC. 14 Wi /4 COR. ® 287,64' S89 "W 589.68' SEC. 14 (S88 589.38 Z N .. C (n 8 p Z Z PEIL- p c0, W O "' V PARCEL #11 � � o r �; #10 r o rn A rn 0% o c c US J Ln U� rn 0� � o Z �50 O EXISTING I 377.00') 1 DRIVE 377.03' (249.Be�)! ,,W z S89.24'S4 "W 6 _ 69' 95 ' 9 � 5'�py - - -g g2. I o _ H LANE w OLDEN cs ------------------------ I m State of Wisconsin) County of St. Croix) ss, w I, Douglas J. Zahler, registered Wisconsin Land Surveyor, do hereby certify that I. surveyed the above described and ma � 0 records and that the accoman n P a property according to the official ° z ' to scale of the boundaries, that all buildings c or r ectly ectly di ensio ee in r epresenta tio n the w boundary lines, and that no encroachments b adjoin owners a � y , appear from said survey. P� /�fr Z 1 r- t