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HomeMy WebLinkAbout020-1334-40-000 C ST. CROIX COUNTY ZONING DEPARTMEN T AS BUILT SANITARY REPORT`�"' �s Owner �/ -l/// f1.1 /[1 .L i -1 tl ' 1� 8 Address (.7/ REo MgP LE 4.W,,y0. -?. ST CROIX City /State /j vp-1 a)4 4.Ul V 40 /r, COUNTY ` %� ZCNING OFFICE Legal Description: Lot � Block — Subdivision/CSM # ?AQ 44,4/p pod,4j R 14 '/4 /./ ,Sec. s7 , T e.9 N -R[L Town of 66t2,bSind PIN # OZO -/3 34--V47 - �PTIC TANh{l. -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer WE /Sr- '- Size ST/PC/ Setback from: House o Well P/L SS Pump manufacturer Model Alarm location (HOLDING TANKS Setbacks: S@Mce road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system 0 40 Width SS Length 7 S' Number of Trenches Setback from: House (,, I • Well 1 PP/L �K, 5 ­ Vent to fresh air intake _ ELEVATIONS Description of benchmark afi 1 IPf @� N �� ��� � � . I S� Elevation 00-0& Description of alternate benchmark of $1 ®C r �2.i Ul'1 � ��` � o1J - -� • l $ Elevation 10S 3 7 t Building Sewer (O. ` % " �� ST/HT Inlet ]),I S: foa .o ST Outlet (5 S % PC Inlet — PC Bottom Header/Manifold Top of ST/PC Manhole Cover • `� �- Distribution Lines (t ) 1 7 S = c ( 1 •`,( (r-) � (, 7 � � � ,� ( ) Bottom of System (t) 13. 11 4 (Z ) / 3 ,1 1 � 11.1$ ( ) Final Grade Date of installation / McPermit number 30 77D2_._ plan number Plumber's s' at e License numbe jspa Date Co p? / Inspector complete plot plan or I 1 t 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 b st L Tel, fi € A, y5� zSo GAS., .T. 21� ia r Na� T AW" pur .f ono T ANN~ 4 v I i INDICATE NORTH ARROW � � / lAZ E � 4yc Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM v : ' Safety and Buildings Division Count INSPECTION REPORT ST CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary.P�r�pttly ` Person information you provice may be used for secondary purposes [Privacy La S. 15.04 (1)(m)]. ii // / UU LL Permit MILLER, Holder' SAM ❑ tiUll�U1V YO % Wage Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Ta,�c. tJL 6I 13 34- 40 IUD 1� T4 v� 1 t ✓.�. $tit �3 t r TANK INFORMATION ELEVATION DATA A9800091 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e Ic yl/c e� �Z Benchm Dosing f. 61A J`� 7�L /OS� Aeration Bldg. Sewer f ob - Holding St /Ht Inlet SOU TANK SETBACK INFORMATION St/ Ht Outlet , SY -7 TANK TO P/ L WELL BLDG. Air I ntake ROAD Dt Inlet Air Sept t0*' NA Dt Bottom Dosing NA Header/ Man. Aerati Dist. Pipe Holding Bot. System t4.) 3. ZZ 417 PUMP/ SIPHON INFORMATION Final Grade IO. [ /D / • Manufacturer De and S� - 7. Model Num TDH Lift Friction m TDH Ft Forc gt Dia. Dist. To well SOIL ABSORPTION SYSTEM BED Width , Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid pth DIME ION S 7S 2. DIMEN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM ACHING Manufac INFORMATION Type O ,/ / , ..f• CH ER Model N Systems vel,' mL- `7 (p3 � O _ OR UNIT DISTRIBUTION SYSTEM Header / Manifold ff Distribution Pipe(s)� - t g , x Hole Size x Hole Spacing Vent To Air Intake Length _W Dia Length `75 Dia. �1 Spacing f--TvVl ' 6f- vl 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.) S� %,° :�4 LOCATION: HUDSON 27.29.19,SW,NE 671 RED MAPLE LANE 1 1) W, ;A- Tq) % - 2-} M-(of 4 I e4er ; .( Plan revision required? ❑ Yes J!3 No j Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's gnature ert: Safety and Buildings Division . SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue NVIsconsin In 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 8 v2 x 11 inches in size. 1 k • See reverse side for instructions for completing this application State sanitary Permit Number 3p "77o Z. Personal information you provide may be used for secondary purposes Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]- /„� �� M� /C Z_a k7� to Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL ' RMATION Property Owner Name P Oprt Location :56—w MLLCeL P /4 ;V 1 /4, 5 Z ? T Z N, R/7 E (o& Pro erty Ow�r's Mailing Address Lot Nuum be Block Number City, State Zip Code Pho a Number Subdivision Nam or CSM Number N w 1 I (310) !o � /- N F I )a I II. TYPE OF BUILDING: (check one) ❑ State Owned It N Roa Public 1 or 2 Family Dwelling- No. of bedrooms O Town O Flyv �O � �1� � A 1L E I11. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) g7. Aq Iv /7/_// 1❑ Apartment/ Condo Q ? c) .+ 3 q 4 y 8 (� 7 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. LJ4 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 120Seepage 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Eleon 1 5 0 7 5 © � $,� Feet 1 ,0 7 " ' Feet Ca g ci g allons VII. TANK in allons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank Rr ❑ ❑ ❑ ❑ ❑ 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. Plumber's Name: (Print) Plumber's Signature: No Stamp MP/MPRSW NO.: Business Phone Number: MoN . _11k I Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/ DEPARTME T USE ONLY El Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Is Age Signatu a (No Stamps) A Surcharge Fee) C` - -• - --- 4 ,1 J � pp roved [ Given Initial /`l8 CL 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 ^^ Safety and Buildings Division �. ■�Inra SANITARY PERMIT APPLICATION Bureau of Buildin water s 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County cg(- C*V than 8 112 x 11 inches in size. e See reverse side for instructions for completing this application State Sanitary Permit Number you provide may be used b other government agency programs O The information y p y y g g y p g ❑Check it revision to previous aon [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location I n In LL E /L. S I 1 /4 1/4, S 27 T 1 2 , N, R I E (ot Pro erty Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name o CSM Numbe „S o W s p ( .38'(0) Z 7 GdY Z 4,4 A/ 5 R/4 /x /f 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ C yy Nearest Road SO ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Village N Town OF NCJQ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo 0 2 0 ' / 3 .4/ y0 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 Hotel Motel 9 Office/ Factor 13 Other: specify S❑ ote / ❑ y ❑ p v 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 J_ 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation. V SQ 1 G -- 1 76 0 , 0 0 Feet /O ?,,o " Feet VII. TANK Capacit in g allons Total # of Prefab. Site g Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- steel glass Plastic App New Existin strutted Tanks Tanks I' epti an X �Od�C� VF-/ Q yf El El 11 1:1 E] Lift Pump Tank /Siphon Chamber El ❑ ❑ 1 ❑ 1 ❑ 1 ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: ( Stamps) MP /MPRSW No.: Business Phone Number: A /,� F f o l VCL Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issue Agent Signature (No Stamps) roved A Su,(harge Fee) pp ❑Owner Given Initial /+�f) .�i�� Adverse Determination `GV / X. CONDITt0NS OF APPROVAL / REASONS FOR DISAPPROVAL: SHO -6398 (R. 05/94) DISTRIBUTION: Original to County, One (upy To: Safety & Buildings Divi ion, Owner, Plumber 5 y s� « E 1, = j�', 9 c l 1 R 0 /A4 rat E A1, 7AA- out ca zo -I 3,3 y- o f3, m At *a- TE L x v csf O S PLIT We— Ile r_ h � a o � ,r Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 4 Division of Safety and Buildings in accord with Comm 83:05, Ws " r e, 1 Environmental By Design Attach complete site plan on paper not less than 8'h x 11 inches in size. Plan m t� \ - kldu& �tf16t f6f Wrf tmWditf�2 '6W&f$itt'eitCe}3t'ilAf{ St. CTO1X percent slope, scale or dimemsions, north arrow, and location and distance t e Feist roa t •t,� : Parcel 4D.# 0� 7 , APKICAHT fWC RMATfOM - Pfease print aff informatio Personal information you provide may be used for secondary purposes (Privacy Law, sl1 -'ck (1) . i r ^ ^ ^ R • Date Property Owner Pjwi perty LocafldnC'�_ ` MILLER, SAM ,'tot ° ' /4 NE. 1/4 S 27 T 29 N,R 19 W Property Owners MaTfing Address L # BTock # ! Subd. Name or CSM# TROUTBROOK RD � � � - Badlands Prairie City State Zip Code PhoneNumber L� City aae -- 'Town NearestRuad Hudson WI 386 -8692 Hudson i Hill Farm Road M New Construction Use: Z Residential / Number of bedrooms 3 ❑Addition to existing building F1 Replacement n Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 - bed, gpd/ftz 8 trench, gpd/ftz u rea Muired 643 bed, Its 562 trench, fh Maximum{ design loading rate .7 bed, gpdff .8 {t ench, gpW Recommended infiltration surface elevation(s) 98 ft (as referred to site plan benchmar Additional design / site consideration Parent material Loess over Qlacial outwash 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 ❑ u ® S ❑ u ®s ❑ u ®S ❑ u ❑ S ® u ❑ S z u SOIL DESCRIPTION REPORT Boring# Horizon i Dominant II Qu. Sz. Copt Color Texture Gr�Sh. Consistence Boundary Roots GP Tre nch 1 1 0 -10 10yr3/1 - sir 2mabk mfr cs IF .5 .6 2 10 -25 10yr4 /4 - sil 2mabk mfr cs IF .5 .6 Ground 3 25 -38 7.5YR4/6 - s osg ml cs - .7 ; .8 efei9 101.06 ft 4 38 -100 7.5yr6/4 - s Depth to limiting factor >100" Remarks: 2 1 0 -12 10yr3/2 - sil 2mabk mfr cs if .5 .6 2 12 -29 10yr4 /4 - sil 2mabk mfr cs if .5 .6 ereound 3 29 -52 7.5yr5 /6 - s osg ml cs - .7 .8 102.54 ft 4 52 -102 7_5yr6/4 - s osg ml - - 7 .8 Depth to limiting factor >102' Remarks: CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson 713- 246 -2434 Address Environmental By Design Date CST Number Ref # 1432 120th Street, Nm- Richmond, W1 54017 41 1v WW5 71 I r PROPERTY'OWNER: MILLER SAM SOIL DESCRIPTION REPORT Page 2 of 4 PARCEL h E cuaeatsl- By Des . Depth Dominant Color Mottles Structure GPD/itz Horizon in sell Q -Sz Cogt. Color I Texture � onsistence Boundary Roots Bed : Trench 3 1 0 -11 1Oyr2 /1 - sil 2mabk mfr cs if .5 .6 2 11 - 25 1Oyr4/4 - A 2mabk mfr cs 1f .5 .6 Ground elev 3 25 -54 7.5yr4/6 - s osg ml cs - 7 8 100.20 ft 4 54 -80 7.Syr5 /4 - s osg ml cs - 7 .8 Depth to 5 80 -100 7.5yr6/4 _ s osg ml - - .7 .8 limiting factor >1 Remarks: 4 1 0 -25 10yr2 /1 - sil 2mabk mfr cs if .5 .6 2 25 -32 10yr2/2 - sil 2mabk mfr cs if .5 .6 Ground elev 3 32 -45 1Oyr4 /4 - s Osg ml cs - .7 .8 99.40 ft 4 45 -53 7.5yr4/6 - s Osg m1 cs - .7 . g Depth to 5 53 -110 7..3yr5./6 - s 0, M, - - 7 8 limiting factor >110 Remarks: 5 1 0 -16 10yr2 /1 - sil 2mabk mfr cs if .5 .6 2 16 -32 1Oyr4/4 - sil 2mabk mfr cs 1f .5 .6 Ground elev 3 32 -51 7.5yr3/4 - s Osg ml cs - 7 .8 98.40 ft 4 51 -70 7.5yr6/4 - s* Osg ml cs - .7 .8 Depth to 5 70 -100 7.5yr5/4 - s Osg ml - - .7 .8 limiting factor >100" Remarks * WITH BANDS OF SAND 7.54/4 Ground elev Depth to limiting factor Remarks: • I V 1 if ' u y K of 'x N I 94 V1 In a'11F1 + j 1 m m ao c� � i I,r fC- i w Ntl A?1 I' .I \ l�l I i .. Zt nNl� Sn E77IH \CIyIQI 1 H i 107 ., t \ , i(an 1s`13 i 00.00 N r; 1 �N 311; itl 4,/ tms ili:.io z; ►n, 31it -+ 3L,SLL ! f r+ l'�n:.a5.ca.cos�r� _. 41 r N rn � (: =} i fi N r n , •��. +( n ci lal N �. •�2 �� ,O I / to ? �/1 aVl Y 1 ^. .Ln L I t. - , r,�l S \�aC� 1•+ wI C � 4 NN n tcJ.. r� or•. W IU I 4t \':r ♦ 1 ',r,t .l1 N `7{ , („ '.y\ • 1` a r f? a f ` I a, I / cn l cr. N t i \ 1 1 �•. � .` al ui N \ t `` i.. � ai r �'a' >'. Q 1� 1 7 //'584 °• 1 1 bj �s eZz > , •,1, I �* "cam <� •ti,. /; v7 '+5. /1 �,. III I III I t �. � vi ills' j ' .�� /i` �a� +� r � i .' •� I N � • I , •• :�' . . � � \. ' ice 1 .. m .,4+.,90.uu al In ' W I l l .� r � i l 3 - � ,,,i `t `, • . -• ` t 1 • �: i .. - Li ao - _- — :. ,f �— ''1 = 1. of • da �� <�' ,, � „ ,,� __ ,, I II` I w I I� OO ��B -. I ` I I ' I u II N 00'02 YI 358.18 O 4 0- y N BY DE51 1432 120 STREET, NEW RICHMOND, WISCONSIN 715 - 246 -2454 PROJECT NAME BADLANDS PRAIRIE DESCRIPTION: SW%, NEl/, SECTION 27 „T 229N, R19W TOWNSHIP: HUDSON COUNTY: ST.CROIX LOT: 24 SUBDIVISION: BADLANDS PRAIRIE _ U a Q cn C1 m 00 QS d3 Q 84 B� E1.= loo,00 a B tyn 2 SCALE 1 =40 ' Tom Nelson BM 1 NE LOT CORNER STAKE cstmo2605 BM 2 TELEPHONE PEDISTAL� i Wisconsin Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations page 1 of 3 Division of Safety and Buildings 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 St. Cr o i x 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 P ' s. 15.04 (1) (m)). Property Owner T') _ _Lj ope rty Location T. Richard Stout G Lot SW 1 /4 1/4,S27 T29 N.R1 g X§dor)w Property Owner's Mailing Address som 1 116,1 Block# ubd. Na Sme or CSM# 1353 Awatukee Trail �" 21 Badlands Prairie City State Zip Code �Ptlone Numbgr� grillage Nearest Road b 6S ❑ K] Town Hudson WI 154016 ('71'4 1 H dson Hill Farm Rd ® New Construction Use: ResidentiaN Nytnber ciW edrooms Addition to existing building ❑ Replacement ❑ Public or com rcral Describe: Code derived daily flow 6 0 0 gpd Recommended design loading rate _, 7 _bed, gpdAF- . 8 — trench, gpd/ft Absorption area required 8 5 g bed, ft2 7 5 9 trench, ft2 Maximum design loading rate . 7 bed, gpd/tt . 8 trench, gpd /ft Recommended infiltration surface elevation(s) 98 __ft (as referred to site plan benchmark) Additional design/site considerations Parent material Glacia d emos i t 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❑ U S❑ U S U ® S ❑ U ❑ S ® U ❑ S o U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 1 1 -6 10 none L 2mabk mfr CS if .5 2 -42 10yr4/3 none fs 1fgr ml cs if 1 .5 ;.6 Ground 3 42-90 10yr4/6 none s osg ml Cs - .7 ..8 elev. - 103. ft. Depth to limiting factor -- - -- 9 0 in. Remarks: Boring # 1 -14 10 r 2 2 2 14 -6 10yr3/4 none sil 2mabk mfr Cs if .5 ,.6 — 3 'DO-110 10yr4/5 none ms osg ml s - .7 .8 Ground 100 .q_�e6 ft Depth to limiting factor Agin. Remarks: CST Name (Please Print) Signature Telephone No. Wi ll ice- sa �i Ct 04- u AIe Address Date CST Number 4 l !F2 ?,'7 70 Richard Stout SOIL DESCRIPTION REPORT 2 3 PROPERTY OWNER Page of ?ARCEL I.D.1/ 30ring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 3 1 0 -6 10 r3/2 none L 2mabk mfr cs 2f .5 .6 2 6 -36 10yr3/4 none sil 2mabk mfr cs if .5 ;.6 around 3 36 -92 10yr4/6 none Ms osg ml cs -- .7 , .8 3lev. 10 1--2-0t. depth to uniting 9 �Gtor GG in. Remarks: 3oring # 1 -5 10yr3/2 none 2mabk fr s f .5 ;.6 4 2 -50 10yr3/4 none it 2mabk mfr s if .5 '.6 3 0 -9 10yr4/6 none s s 1 s - .7 '.8 around Aev. 100 ft. )epth to imiting actor 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 # 1 -6 10 r3/2 none 2mabk Tif r Cs 2 f 2 -34 10yr3/4 none 3il 2mabk fr Cs if .5 .6 . 5_ 3 4 -9 10yr4/6 none Ins :)sg T11 Cs - .7 ..8 Ground elev. 10 2 .-- 2 -0 -ft• Depth to -- — — — limiting factor 9 0 in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) J C a) -e '/Q ate/ - P,`Pe,a4A E,� { v 1 a �• ° B M� i f N } i s � 4 y[ / 66 z �s.Cc/pt 7% J--723 to ! vj cq w Z ko o 0 _ z� o "1 � w I � I M � I W n- I a. v LL. �C 1 Z I L7 O_ q a I U W 4'l ' M 1 1 � I �. v h vo � Q C) v m 4 ►L r Io �� V ` 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer S,4 -4 , 1 14 l L L g2 Mailing Address 8 4OX -* Property Address (67 ( R a j WA-? �. (Verification required from Planning Department for new construction) S ink C, Q p G City /State H U 0,10 1\1 LA) ( Parcel Identification Number 6 LEGAL DESCRIPTION Property Location,:5 ' /a, _f ' /a, Sec. z 7 , T 29 N -R / ? — W, Town of YULU@ J1/ 'Subdivision S �A I fz (j;. , Lot # Certified Survey Map # SD —,Volume , Page # 9 Warranty Deed # 7 ' , Volume _l 3 1 3 , Page # q4) Z Spec house yes ❑ no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards.. set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to St. Croix County Zoning Office within 30 days of the three year expir n date. Z A A /I <_ I�A_ AITURE OP APPLICANT DATE ..a pWNER CERTIFICATION i 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 de ribed abov by virtue of a warranty deed recorded in Register of Deeds Office. V ,• ATURE O ` PLiCANT 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 I VOL 13PACE162 S r� ryry `68 ` ( STATE BAR OF WISCONSIN FORM 2 — 1982 WARRANTY DEED DOCUMENT NO. REGIST R'S OFFICE 5T. CROIX CO W1 y� RTC'HARD C) STOTIT 9*;& j cif fIRK��r!d APR 13 1888 conveys and warrants to SAM E MILLER ER 8.00 A. M J Re later 9f 09000 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in R t- C r o i x County, . m #1 ( L L State of Wisconsin: X 1 S Lot 24, Plat of Badlands Prairie, Town of r{cJ(�50I`� W Hudson, St. Croix County, Wisconsin. �t/ A ll PARCEL IDENTIFICATION NUMBER TRANSFER E This i S n n t - homestead property. (is) (is not) Exception to warranties: easements, restrictions, rights -of -way and covenants of record, if any. Dated this I o t h day of Apr A.D., 19 . Richard Q_ 9tolit (SEAL) (SEAL) (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St- _ Crni x County authenticated this day of 19 Personally came before me this 1 nth day of ! April , 19 98 the above named * Ri chard C) St-nnt- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, `�. authorized by §706.06, Wis. Stars.) _or L °tne known to be the person who executed the foregoing a a ., instrument a ackno the same. N t NO t i�,�� g, THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout 0A. wa u ee Tr. — Hildson, Wi 5401 ti Notary Pu lic, County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is pe manent. (If not, state expiratio date: necessary.) ) Names of persons signing in any capacity should by typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. WARRANTY DEED Form No. 2 — 1982 Milwaukee. Wis. K I + I A �� `c? 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