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HomeMy WebLinkAbout020-1336-00-000 o a 0. 0 a� h U N (D O !6 tl _ o E N � C y C C y • C ) N N y [r N d @ O O N Z j f6 C — w � LL c C N 0 C t� 3 -_ o E m r 0 'I a rn Z o Z am N H z li c 0 O z : c cu v � , :3 :�' N w y Z a ° U = o fA H rn a N Z c Yp E - a U c`) N O� N I ai = � y O •� N p O a m O m j p c� Q N Z cZ Q Z i C a C L . c Its @ N E Y N CL L .. y o CL « — C N C O N V U C O f0 — O D a o @ N bap � �y co 0 0 �1 z •N _� ° aaa a � _ 3 rn rn J U c (3) rn O 'mil j N N O O O _ E N m y c d O N m Q (4 O O O H C cl O 0 CO 3 n N a o 0 0 r @ N N N Y0 M O C U) O) O O N co M U L O .. O Li r M W a O N N H C 0 0 0 N 00 d 1..1 N _ O _ L N — o E •O �, O N n S H M O z c � � (A ^ ter .+ €a �t a u a t A c j0U)0 y Y ' ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner �� f?�( /yj I �. L E Address City /Statc N CA J L S`{Ol,e Legal Description: Lot */40 Block _ - Subdivision/CSM # AG�' /, , Sec. �, T 7 N_R i7 � Town of _f UX M ! PIN # d Zo-/ 2 !� EPTIC TANK DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer UI C(5� Size ST/PC /acv/ Setback from: House -'58 t Well / P/L 7 Z Pump manufacturer Model — Alarm location (HOLDING TANKS ONLY) Setbacks: Service road — Vent to fresh air intake -- Water Line "- Meter location Alarm location .� SOIL ABSORPTION SYSTEM: i Type of system: X Fl CTUTok, Width 3 SG. Z S Setback from: House S � • Well �' �� Number of Trenches Z-� �_ P/L f` l _ Vent to fresh air intake ELEVATIONS Description of benchmark "P�< I W C.47�N E I Description of alternate benchmark M E T $ Elevation �d . DO 3 I Ll G Al �( w ►1 OVT oa t. ElevationJ Building Sewer - ST/HT Inlet q �' ST Outlet - 11 " �' +V C Inlet PC Bottom Header/Manifold `' Top of ST/PC Manhole Cover .2- (co L Distribution Lines W $ , (o = 1'2 , �q (6) 1 - 2 ► Z ( ) Bottom of System 1, oc ( ) q. o : 4 ?1, p® ( ) Final Grade 1( ( ) t�'�s 14. Or ( ) Date of installation / / Permit number _ State plan number Plumber's signature License number S -1 TOODate /oV/p Inspector Complete plot plan l NOTICE Please provide the following: • X 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 V S � . 2 s . did J\ 7 2 e n „ L �.1 sct4 -I- IF vJ� L KA TO 2 'S Epr�/3tE a u2� I� INDICATE NORTH ARROW wl Lt.. D WisconsirV Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary PermitN Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 315869 Permit Holder's Name: I ❑ City ❑ Village rl Town of: State Plan ID No.: MILLER, SAM I HUDSON CST BM Elev.:- Insp. BM Elev.: Description: Parcel T BM V&13 36-00 -000 TANK INFORMATION ELEVATION DATA A9800259 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ° r, �C °..,,. ✓ i t _�,, Dosing f , x,7 Bld Sewer Aeration g. Holding " "' � St /�tt Inlet TANK SETBACK INFORMATION Stql, Outlet ' TANK TO P/ L WELL BLDG. A ir ir I ntake ROAD Dt Inlet Septic NA Dt Bottom Dosing ,„ .Y _ ...... NA Headed d5 /6 Aeration NA Dist. Pipe Holding - Bot. System 2 PUMP/ SIPHON INFORMATION naI Manufacturer Demand's Model Number GPM ' r'd'( TDH Lift Friction Syetem TDH Ft Forcemain Length L Dia. FFii Dist. To well F_ SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DI MENSION S SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold 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 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,NW,NW 777 WILFRED ROAD - d�-Q •k rim �+L4o (}�,r"T I`° "'.� f., °, � � ,�v �:,.: , � � �d� � u-�lx� �- .�,.� f'.!'' d� fi,t' "'z,� ^ '. c�•�� 1.0� �'' Plan revision required? E] Yes ❑ No (� Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No N)L Safety and Buildings Division cons SANITARY PERMIT APPLICATION 201 Box ashingtonAvenue 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 8112 x 11 inches in size. 01 • See reverse side for instructions for completing this application State Saanitar Permit Number Personal information you provide may be used for secondary purposes Whea it revision Zvious application [Privacy Law, s. 15.04 (1) (m)]. St a Plan I.D. Number • I. A INFORMATION - PLEASE PRINT ALL INFORMATI N Property Owne a Pr perty Location Wl4 W 1/4, S 7 T , N, R /? E (o W Property O tier's Mailing Address Lot Number Block Number Ity, State Zip Code Phone Number Subdivision Name or CSM u ber y(t I d ( ).>Z b LAWND 5 I. TYPE F B IL ING: (check one) ❑ State Owned Cit Nearest Road p village Public 1 or 2 Family Dwelling- No. of bedroom Town OF U LlJ1 L- lisle 111. BUILD[ E: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2"4 —/ 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 E] Replacement 3_ ❑ Replacement of 4 ❑ Reconnection of 5. E] 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;RSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 C] Seepage Pit N�� LT�I�Yo2, X 3 �� Z 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) q / Elevatio 4/ 9 - 0 1 SS40 3 .+ —" (� Feet 500 Feet VII. TANK Capacit in gallon Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks o do ► UV E Is F ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ c3i ❑ ❑ ❑ L VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Prip Plumber's Signature: o Stamp MP /MPRSW No.: Business Phone umber: P umber's Address (Street, City, State, Zip Code), a 7 v 12. 1D, IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) P A roved arge Fee) pp ❑Owner Given Initial 21t 8 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SB p• 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Visconsi 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 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permit N u � m bb e er r Personal information you provide may be used for secondary purposes ❑ Check if revision to previ s application [Privacy Law, s. 15.04 (1) (m)]- State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Property Owner Name Pr Location S / •C L r E 4a / A/&,)1 /4, S ..2 7. T Z r Nr R/ E Property Owner's Mailing Address Lot Number Block Number - o Cit , S ate Zip Code Phone Number Subdivision Name or CSM Number !� 5E? 4 l S D l (3 ) L. tN AO S6 / II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ cit Nearest Road Public Ix 1 or 2 Family Dwelling - No. of bedrooms ❑ Town OF .S 4 Gff �LCQ >D III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Numbers) 1 ❑ Apartment/ Condo d2. D /,,�(o DO 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. VI New 2. Q Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. Q 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 n Seepage Tr ❑ In- Ground Pressure 42 ❑ Pit Privy Trench 22 X 13 ❑ 43 Vault Privy Pit � � ❑ Y 14 ❑ System- In -Fil I VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area Al. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade ' / Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) o 10 Elevation `t 4 Feet '9.54W Feet VI1 Capacit TANK in gallo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass elastic App New lExistin structed Tanks I Tanks e ticfank � addn q fer ik ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I ❑ ❑ ❑ ❑ ❑ ❑ 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: (N Stamps) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 070 A.-WAir4 11 t' f1 verso N / IX. COUNTY / DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issui gent Signature (No Stamps) A roved Surcharge Fee) , �; pp ❑Owner Given Initial 1 d A oe 4 e� Adverse Determination ` O 0 toe X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber VIA 77 W1,dl /,Cc otiY,ci, ftlicci Iq S ------- ) 0 x 0 'W e j - To INRITZMA W'� o, 1%.k rz t F oL D Wt t+ 5 7 I � �� 0,6 4 k4 is LAJ (LG f X D e-' 1 b I � 8 V E E � c m x N L to (D Ch E 0) c° M co O O co - x cv a) 0- m a co ° (D o o a) o a) 1 m r — . o co V U C N C a) O = cn p D O N .> m m x .g. � C 0) - � c ` a C� Y— a C c p c >' m L "'�' c o R1 ] > O Q O J a3 LL E O' = U 4A� co LO c/ d V VA v a N o^, ;'1 • chi � U m E - u? R 8 cc w z b W rr — nn 3° L a Q UJ o CD . H C s� Z m C o o � L n, a .� • � � . U' 'a to IL LU E c Q w 'D CO n U = ca J d v I w m i ICA. �. F I � � ` v � , m i •� N ` o -4r G J �J y m � D� µ F O j m N � 41, r LA r 1 Wisconsiri Department of Commerce AND SITE EVALUATION " Divisiori of Safety and Buildings Page of Bureau of Integrated Services �� An h s. ILHR 83.09, Wis. Adm. Code �� �r(► County Attach complete site plan on paper not an S j�%iaaes in Ian must include, but not limited to: vertical ho ontal reference point (BM), and S f�C7 percent slope, scale or dimensions, irrow, nearest road. Parcel I.D. # ST CROIX ©c)o I 3(o APPLICANT INFORMATION - prihtt GO Revi � by D Personal information you provide maybe used C' O ( 15.04 (1) (m)). Property Owner" tJ Property Location WX + �-'e GovL Lot V (,r/ 1/4 P"1114,S ! 7 T gQ ,N,R E (or)w Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 0 I - � C/o r City State Zip Code Phone Number ❑ City ❑ Village 50 Town Nearest Road l I SYO/ !c 1 MCI 12t [� New Construction Use: Residential / Number of bedrooms 3! Addition to existing building ❑ Replacement EPublic or commercial - Describe: Code derived daily flow V 0() gpd Recommended design loading rate � bed, gpd* trench, gpd* Absorption area required � bed, ft2 trench, It Maximum design loading rate . 7 bed, gpd* f _ Y _ trench, gpd/ft Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design/site considerations Parent material CY fQG i l c-- 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 1 1 S ❑ U a ❑ U W S ❑ u ®S ❑ u ❑ s ® u ❑ S [2 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 1 © - 1 !p r S ! m 5 'L- Z'�d l U r- LS 1 s i'►'� �-S Ground 3 - /U j p r y /�i rn S C7S ' W\ elev. q��. Depth to limiting factor /Z/ in. Remarks: Boring # l o r3A `r' S/ y „" t j r L IE Ground elev. Depth to limiting factor f31_in. Remarks: CST Name (Please Print) Signature f Telephone No. Address Date CST Number PROPERTY OWNER OWNER 9 SOIL DESCRIPTION REPORT Pa e of• 3 PARCEL l.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 -I's ! -St l �nq� ..C/ c_S 10 ,sr - G Is m t C S —• 7;. d Ground CS — .7 Depth to limiting Min. in. Remarks: Boring # 0 3l S f , nab C S ! 0 y ; Z 16 31 N r V /3 ryk 3 ov rY /( — Ms l c 5 , 7 .S Ground elev. Depth to limiting factor 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 # 0 Z i6 U - Z G 3a — L-S /s I l C •� Ground d elev. Depth to limiting factor Z244�(-in. Remarks: I Boring # i I Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) Q' Of o AtW AIW 0 4 w JI&I . o L o-uc- Pipe M L c o. At 1 a Sy .s,Fc••-, t / -cu . N .00 bs � N N 3 � x L aZ f 1 t onsin Department of Industry SOIL AND SITE EVALUATION r and Human Relations Page 1 of 3 ion of Safety and Buildings I` in accordance with s. ILHR 81-09, 'Nis. Adm. Code no 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 . Croix 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 rivac Law, s. 15.04 (1) Property Owner 1 �y' . Property Location t Richard Stout { a^ Oovt Lot NW 1/4 NW 1i4,S 2 7 T 29 ,N,R 9 X IIX(or) W Property Owner's Mailing Address — 44 Block# Sutxi. Name or CSM# 1 353 Awatukee Trail�� 5� Ga � Badlands Prairie City State Zip Code `. Ohone NumON r,0 City ❑ Village E� Town Nearest Road Hudson WI 154016 7"x`5 )549 -6 Hud son lBadlands [R New Construction Use: ® Residential / Number of bedrooms 6 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6 0 0 gpd Recommended design loading rate -_7 bed, gpd/ft — 8 trench, gpd/ft Absorption area required 8 5 8 bed, ft 2_ 7 5 0 trench, ft 2 Maximum design loading rate 7 _ bed, gpd/ft gpd /ft Recommended infiltration surface elevation(s) 96 .50 _ft (as referred to site plan benchmark) Additional design /site considerations Parent material G 1 a r i a 1 d epo S i 1 Flood plain elevation, if applicable _ft S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for s ® S El U ® S ❑ U KI s ❑ u ® S ❑ U ❑ s ®u ❑ s K7 u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench 1 1 0 -14 7.5yr2.5/1 none L 2mabk mfr cs 2m .5 -.6 2 14 -48 10yr3/4 none sl 2mbk mvfr cs if .5 . .6 Ground 3 48 -90 10yr4/6 none ms osg ml cs -- .7 .8 100 tft. Depth to limiting fa§ l ff 1111 in. Remarks: Boring # 1 0 -14 7.5yr2.5 1 none L 2mabk mf Cs 2m .5 .6 2 2 14 - 48 10yr3/4 none _ sl 2mbk mvfr cs if .5 .6 3 48 -92 10yr4/6 none ms osg ml cs -- .7 .8 Ground 100 elgv5 ft. - -- - - - -- - - - - -- Depth to - — - -- - -, — limiting factor 92 in. Remarks: CST Name (Please Print) Signature Telephone No. .� X z. Address Date CST Number S ca t7` �� ^ ��' `� `P a ? ?ROPRTYOWNER Ri c- area Sc> >L SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# 3orin # Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 3 1 10-12 7.5yr2.5 1 none L 2mabk mfr cs 2m .5 ..6 2 12-48 10yr3/ 4 none sl 2mbk mvfr cs if .5 .6 around 3 4 8 - 6 _ Iev. 10yr4/ none ms osg l cs .7 .8 g 100,05 ft. 5epth to , miting actor ; 9 6 in. Remarks: oring # 1 0 -20 7.5 r2.5/1 none L 2mabk mfr cs 2m .5 .6 4 2 20-48 10yr3/4 none sl 2mbk mvfr cs if .5 ;.6 3 48 -91 10yr4/6 none ms osg ml cs -- .7 .8 hound lev. 100.0. jepth to miting actor 94 - - in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Boring # 1 0-12 7 . 5 r2 . 5 1 none L mabk mfr cs 2m .5 .6 2 12-36 10yr3/4 none sl 2mbk mvfr cs if .5 .6 3 36-90 10yr4/6 none ms osg ml cs -- .7 ,.8 Ground 100 ft- ft. Depth to ! imiting factor 9 0 in. Remarks: 3oring # around sdev. Depth to ;imiting factor � Remarks: SBDW -8330 (R. 08/95) 407" y /0� _ 3 O1 3 9r 3� t V 1 Q o / � yJ "v Y' //0 ,tea j3 l ip' ,�m2 ' 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 441 Mailin g Address X Property Address ?7 (Verification required from Planning Department for new construction) City /State _t 0 0.S O N W Parcel Identification Number m z d` 13 3 4o 'O a I LEGAL DESCRIPTION Property Location A/ %4, / %, Sea. 7 . T 2 9 N -R . Town of - Hy).Ll C .Subdivision ZA � t-ArIND 5 4 P_ 4 ! e LF_, , Lot # . Certified Survey Map # 5 (P (� �a , Volume _ Lo , Page # Warranty Deed # S ;� n , Volume , Page # o l I Spec house P( yes ❑ no Lot lines identifiable A 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 I can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restrictedplumbcr 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. 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 St. Croix County Zoning Office within 30 days of the three year expiration date. -- ATURE bF APPLICANT DATE ER CERTIFICATION 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 pro described ajajove, by virtue of a warranty deed recorded in Register of Deeds Office. S ATURE OF ' , i'i. a.i1T D // 7/ 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 frorn the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed W 17 STATE BAR OF WISCONSIN FORM 2 - 1982 �8 U10 WARRANTY DEED DOCUMENT NO. "tl 1397 w1641 F v .'W . ..�.�...�,�..�.. _ 9t f4t R RICHAR O STOUT JUN 0 2 1998 8:30 A conveys and warrants to SAM I- M T T LEE �� (�44�n R iW Of THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS - the following described real estate in St. Croi x County, $ /9/N i �� State of Wisconsin: Po '90v eft Lots 17, 27, 28, 39 and 40, Plat of Badlands /- /4JOran' �' S `( /6 Prairie, Town of Hudson, St. Croix County, Wisconsin. R PARCEL IDENTIFICATION NUMBER TT3 olFER , This 15 not homestead property. (is) (is not) Exception to warranties: easements, restrictions, rights -of -way and covenants of record, if any. 3 7 i Dated this 20th day of May A.D., 19 ___q_& _- i i _ Richard _O _S ut (SEAL) (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT State of Wisconsin, Signature(s) — ss. St. Croix County authenticated this day of 19_ Personally came before me this _20t.h_. _ day of M _ 19,C4L$_, the above named Richard ry__ TITLE: MEMBER STAI E BAR OF WISCONSIN (If not, authorized by §706.06, `Nis. Scats.) to me known to be the person who executed the foregoing � :.e -: � - •. ! irtstra ni and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY '' N, ( _. — Janet P. Stout } _ — � i c- oirginta R Gartman S t. Croix County, Wis. H udson, Wi . 5 4016 ''�'� —_____ 7 raary Public, — -- (Signatures may be authenticated or acknowledged,,B art aV 1►h commission is permanent. (I( not, state expiration date: �...,, , Janu ary_ 3 0,_- 2n s —J necessary'.) • Nanx> of per + signing In any cap:uiy should b% typed or printed I.vlow their signatures Wisconsin Lem t k Co- Inc. STATE BAR OF 1%i4.(?X?.IN MN;aa..ea. Ws. WARRANTY DEED Form No 2 - 1482 ' - .. ... .._ . ,.,,..: ..•. .,� ec.�;.a ase >�t:,,. .'..: • ^a� . } �.�#e f'� � -a ,..: s�' , trx ' 9 rJ • 42 LEGEND 4 5 " ALUMINUM COUNTY SECTION CORP. LLJ MONUMENT POUND 419 ACRES � � ).'•998 SO. FT. 1' IRON PIPE FO'UNE t I M O 2" Y 30' ]RON PIPE SET WEIGHIN 4 l CV 3.65 LBS. PER LINEAR FOOT J 6 " E 5560 _ r0 NOTE: ALL OTHEP LOT CORNERS Q 4ONUMENTEO 'WITH X IRON PIPE WEIGHING ' 68 y i J I Z PER LINEAR FOOT Y tJ 41 I . ' ' • • • • • • ROADWAY SETBACK LINE (AS SHE:: 24' 'MOE UTILITY rASEMENT 6' _. 6 ACRES n 1190N TRIANGLE ;_ECS ON S. T 150 i.CNG AEON 11 S 89'55' E }8.47 PROclJSED DRi E 8 11 ! t z 40 1 I F MASONRY NAIL FOUND O 2' IRON PIPE FOUND 2 65 ACRES ^P THL TWIN HOME LOT 1 1',570 S0. FT. '� AIL � W E r RA STORM 'ATER RETENTION AREA IA S 9'1'59')6" L 545 'g' N H.W.L. - HICH WATER LINE H W L. 1 911.0 F� 4'' c10 BUILDING BELOW N.W.L. OR AS .G5.96 88. i0 - ---- -x EXISTING PENCELINE NOTE: NO BUILLINC GRADING OR OTHER IMPRCVEMENTS W1Tti `H LINE- - - -- - - ,.._.._....�r__.,.._ - - VISION TRIANGLE OR STORS. SHEET 2 WATER RETENT.CN AREA C3 x� 'd ZA SElU16 $U, 1 OF 4 SHEETS SHEE nr