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HomeMy WebLinkAbout020-1011-00-100 donsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Human Relations _ Division of Safety&Buildings in accord with I LH R 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 St. Croix not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL I.D.# O2_0 / ,/-O6 - dimensioned, north arrow,and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Joseph Kiewicki GOVT.LOT SW 1/4 SE 1/4,S10 T 29 ,N,R 9 x (or)W PROPERTY OWNER':S MAILING ADDRESS LOT# BLOCK# SUBD.NAME OR CSM# /// 2312 D. Cresent View Dr. suite 204 na csm pending- CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ['VILLAGE MOWN NEAREST ROAD Hudson, WI. 54016 (715 3867 '7 Hudson Scott Rd. /Q ZZ [x] New Construction Use [ Residential/Number of bedrooms 3 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate •7 bed,gpd/ft2 .8 trench,gpd/ft2 Absorption area required 643 bed,ft2 563 trench,ft2 Maximum design loading rate •7 bed,gpd/ft2 .8 trench,gpd/ft2 Recommended infiltration surface elevation(s) 105.75 ft (as referred to site plan benchmark) Additional design/site considerations alt site trenches @ 104.25 & 101.40' el. Parent material outwash Flood plain elevation, if applicable na ft S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for system ElS ❑U ElS ❑U ®S ❑U ®S ❑U IS ❑U ❑S =7U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots- GPD/ft2 Boring# Horizon in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Y Bed Trench 1 1 0-10 10yr3/3 none 1 2msbk mfr gw 2f .5 .67 2 10-28 10yr4/4 none scl 2msbk mfr gw if .4 .5 Ground 3 28-84 7.5yr4/4 �: � cos Osg elev. ml na na .7 .8 t� rz 105.4 ft. IIIP � i Pj Depth to • r limiting y factor ? a +84 e1h{F� Remarks: Boring # 1 1 1 1 0-6 10yr3/3 none - 1 2msbk mfr gw 2f .5 .6 2 2 6-13 10yr4/4 none sc1 2msbk mfr gw if .4 .5 3 13-84 7.5yr4/4 none co s 0sg ml na na .7 .8 Ground elev. 109.7 , Depth to limiting factor +84" Remarks: CST Name:-Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave. New Richmond, WI. 54017 Signature: kf Date: CST Number: l� -� TLC'. 4-18-96 cstm 02298 STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Joseph Klewicki New Richmond, WI 54017 MPRSW-3254 SW4SE4 S10-T29N-Rl9W (715) 246-6200 town of Hudson • N 1"=40' BM.= sw corner of cement base of tel. ped. @ el. 100' • q l` C o3 Il N cV'',2f1R-12 GAry L. Steel 4-18-96 • / ; pA r-RECEIVED T. CROIX COUNTY ZONING DEPARTMENT �002 AS BUILT SANITARY REPORT Owner — 1/57-4-7c-so,v 3,cpz • 2- 5(Te- rld ac12._ Co 7� City/State U o, ) S 445/ Legal Description: L/ /,D/ //. Pg . 36',R 3 Lot 26►3 Block Subdivision/CSM # 5-1/2 G 'Act() '% Se , Sec./0 , T zy N-R/y W, Town of ,?t'P "- PIN # 020 •/D// 00 • ezrz, 0,20•/b//•o-a /oo SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Go/e'S �d�Tank manufacturer . Size ST/PC / Setback from: House Well P/L)sa Pump manufacturer Model Alarm location ter. (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORI PION SYSTEM: /3/6 -Qi��<JS�P Cz//5 r � Type of system: _ Width 3 Length 76 Number of Trenches 2-- Setback from: House V6, ' Welly P/L Vent to fresh air intake > >50 , ELEVATIONS: f364" E�,e, E— Description of benchmark S Elevation Description of alternate benchmark 7`6p of 4,11 a- S Elevation/3.60 GOU-<v i Building Sewer Alik ST/IIT Inlet 13. 64 ST Outlet q13.33 PC Inlet PC Bottom Header/Manifold Ton of CT/PC. Manhnle Cnvnr I rT• "1� / I N 2 1(1ST1 /e/1 1j. /0._ t ,0. (fA5 11°A.41 ,o N , g d ,�_ o sb 1 � Pfff 111- / bit. cj______ ,I) CO • il/f' / NOV to ,‘65‘)2 i'pi� � S, T ' 0 .Po (30 � p,(� o 1/� T ,i" `z5 iN�ve+' 9 3, 2 V l U..r-- y 3. 3 3 ' ( o I1 I7 loi 1,51 o I I I I 5� 9 3 / /Z / -� r k" // 1 , iI Jp1if-. I I ' I II II q \ I ( I n 1 I ( I ;c 1, . M I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM , County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420480 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Gustafson, Jean Hudson Township 020-1011-00-100 CST BM Elev. Insp.BM Elev: BM Description: 106 a ( aa .0 13ni41 u r l TANK INFORMATION ELEVATION DATA • TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / �� l U V Ben mark ,, 4•3-3 ioci• 33 dad'. 0 Dosing V�/ Alt. BM t�a✓i..., + A —lDO _....6, Aeration Bldg.Sewer M44s1,. /mot et a-c = ` Holding ) St/Ht Inlet St/Ht Outlet TANK SETBACK N 4• - ' ATION /j„ 0 c/3, 33 TANK TO P/L VON BLDG. Vent to Air Intake ROAD Dt Inlet Septic > 5.0 w > 00 , mil -3 3 i Dt Bottom ' Dosing MEMIHeader/Man.t 3•Z Aeration iluim pm D-is�t._,Pipe ' r 1,2Z �3• Holding Bo16t.p a.F G�t�-r►►b. .- 2. q -' 3 mii ill Final Grade F�tem ( Z' / PUMP/SIPHON INFORMATION -o- (o•(0 9-7- Manufacturer Demand St Cover q GPM a lrr.1-e_ /2.1�� "Sf 1 9d t Model Number ) rUJ TDH Li Friction Loss System Head TDH Ft Forcemain Lengg ,Lia Dist to W^�P� 'I .-- SOIL ABSORPTION SYSTEM &.5 r 0 ( _ / / e- i / BED/TRENCH Width 1 4 Length No.Of T( nches y PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS r l0 2-- SETBACK SYSTEM TO P/L dBLDG WELL LAKE/STREAM LEACHING Ma r:r� c INFORMATION CHAMBER OR I DO I. / i Type f System�� r: V /Pt A• / /i�l , (06 jHc\.,.._ UNIT Model Number: DISTRIBUTION SYSTEM ( f) cUh d 64 i Header/Manifold Distribution i x Hole Size x Hole Spacing Vent to Air Intake f '"f Ile, ) (I t/ U ( , �- �� �_ --- Length & Dia Length ( O Dia Spacing T / b f���� j� SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only l.�G�i4.�/}�(�'�r`- 7 Depth Over _,0�4/ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center &I �" _ Bed/Trench Edges Topsoil Yes ""i No Yes No r►'• I COMMENTS: (Include code discrepencies, persons present, etc.) Inspection#1: l d /ZS/OZ Inspection#2: / / Location: 1022 Scott Road Hudson,ud WI 54016(SW 1/4 SE 1/4 10 T29N R19W) NA Lot 2&3 'PO Parcel No: 10.29.19.46A 1.)Alt BM Description= F26/ Cef.$ J 2.)Bldg sewer length= l5 k/ -�1 P/ra-`' -amount of cover= Plan revision Required? Yes 1 ^f.�L7 yyy �• i c l 4 Use other side for additional information. I u�I�Z �� d SBD-6710(R.3/97) Date Insepctor's ignature Cert.No. , Safety and Buildings Division County . G�0/ y 201 W. Washington Ave., P.O. Box 7162 '\ IsCOI1s►n Madison, WI 53707-7162 Site Address /D 2 2- 5-co# /e. - • Department of Commerce 1O-i 1i_0v 140f C /f0 Pre bt_ $V a'4 Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21,Wis. Adm.Code,personal information you provide 0Check it Revision �d6 !(�V may be used for secondary pm-poses Privacy Law,115.04(1)(m) I. Application Information-Please Print All Information State Plan I.D.Number el)//¢ ro rty Owner's Name Parcel Number o2o•/O//•GO • Op ('z) Ye,4A 4 ete44.9 • (r os rf1cs*0,t> o'LO./o//. oo • /0o Lois roperty Owner's Mailing Address Property Location 0� ZZ 5(D7 /'Zd • $� �S6iA:s /OTyNR/I City,State Zip Code Phone Number u her Block Number DS CSM Number 34 . 5-112_ Sy266 R0 // pi. 3a'83 II. Type of Building(check all that apply) L / ❑City XI or 2 Family Dwelling-Number of BedroomsLST7 Id,{liceig-a� iwillage Ll Public/Commercial-Describe Use .�6_ownship I2s��) !7`f' i-.)State Owned i ( ' / Nearest Road6.� III.Type of Permit: (Chectk.nu13une box on line A(numbering scheme for Internal use). Complete line B if applicable) • A. i 1] New �—2� Re lacement S stem For County use p y 0 Replacement of 6 CI Addition to System �_ 'Tank Only Existing System B• i_i Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) /`,( (._) , ,,,, _,i ,. ,/2t-r„ c",/2,/,.4 A/ 44 KNon-Pressurized In-Ground 210 Mound 47 0 Sand Filter 50❑ Constructed Wetland giJ-/ 4. jj / rt. 22 O Pressurized In-Ground 41 ❑ Holding Tatuk 48❑ Single Pass 51❑Drip Line oZ .G/� --/-,•..4‘2," . 1 45 U At-Grade 46❑Aerobic Treatment Unit 49❑Recirculating 30❑Other • z /�, �` V. Dispersal/Treatment Area Information: (I Design Flow(gpd)� /Dispersal Area / Dispersal Area Soil Application Percolation Rate System Elevatio final Grade Required , Proposed ✓ Rate(Gals./Days/Sq.Fi) (Min./Inch) (,,D" Elevation 9 yy y) 6,,c'V • 7 / per / 7/`% VI.Tank Info Capacity in Total Number Man facturer,4 Prefab�c Site Steel Fiber plastic Gallons Gallons of Tanks (�{�s?R�c2� -7 O� Co rete Constructed Glass t Tanks Tanks Tw Taling l C/Q �lA 14J/4r �- l/ Septic or holding Tank /O7 - /NY>1 / /11,o4 i7(� Dosing Chamber VII.Responsibility Statement- I,the undersigned,assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's S P/MPRS Number Business Phone Number:' ij R. z1/hRi cGf7_' Zace 3 i S. 76-3 PG - d7/cP-S • -- Plumber's Address(Street,City,State,Zip Code) ,•— it (p5-5- D ' tiI/ L PP. /jp5oA) S 9o/ 4 , VIII Count /Department Use Only Approved U Disapproved ' Sanitary Permit Fee(includes Groundwater Date Issued Is ent Signature No Stamps) Surcharge Fee) ' , - ❑ Owner Given Initial Adverse OD �' Determination do c,.i I-7� - , . IX. Conditions of Approval/Reasons for Disapproval 0 Ex/51-in -7ir�rEA_.5(z-) o fa 1. zcito-ua0//2)0. xnni, 13. 3 3 'Cl /&?-0. 1A-1 le/a4Are/a- 1-- ifirrit4rua-lPsi (/‘• eifil-V/2bfrhvi-i-' f "veng-KA-4--A-24-/arit-- - ni,e,i,,s-iliaexe___ rvellAc_) 14:.5 Ge a,,,ed/a1A//aeiale-e--e--c-- ' 31.0_,,,,,,,,,ia . (/k- if eompl e p a o e o ty only)for a system not less;II J x 11 Inches tdsa © /YJ ' SBD-6 98 (R.i�5/bG��z�,c�� Uh Go�G� ,�1 L�hr�,�.. �3. 3' 0 we bL . , ft 8 9b..So •�D��I? A,p�� fXr 5liab' M � riP6 p pki 6t A -3' . 16 011A1' 0 / 11) -,- eP)6 • • °11 gal( ,o Or 9 ' O i3/4 44 V 2/f i , 0 .,.....,.., (.,i1 11-014 1-5 130 of 3 to A, it,;Es n 5.T < k 0. r /two . 2 a3 /� . D iz � o, � � I � �\ Wow \ 1 d ��� , 'ol I0, \ } a Q z 1I, g' ; I My v U ErNk I X 1 1b,, Io =n. �a � p w 15 I , Ian I- ? COu. 2 11 1 ' iI I1 83 9 IOi ID1 - I U 11 ALL NON-CONFORMING ti �� THE TMFNT TANKS SHALL `3E BAt 1 ONED PROPERLY �_- >E CO `"../1. 83.33. 3/ 5//pw.o;( ) a/i S 4; sys�.- (lie - 9y.o ' - -)( /- I s > r ---' N -- .___. Noir' No AfbisI>me--e_- . _ 6/tre s ( Pelf I/ r1717- ) C6f.0 ?Tl l,/ -s 4(, S 0. " /3 4 c e /?., , TS /-5 r (y, ti7) 4' I--- • U UIIICiI1 & ASSOCIATES CO. 655 O'Neil Road • I ludSofl, WI 54016 neg..f)eslgners of EngIno ring Systems 715 386 £3185 Private Selvage Coasrilleafs • PROJECT INDEX PLAN ID i7 /Z ` d Z DATE owNrR 3E4 5TAFS0.1 3�1� •5z/ Z PHONE ADDRESS /('Z 2.. Scoff gp• pSat.) Avis . LEGAL DESCRIPTION ��y`"S 2i 3 C.SA-t 00/• //, 1) . 30.83 • - J 51v, 55 S,ec• /e, T-zyv, g /f w TOWN OF // US&S AJ • 61.ei"� CSTM iC *2?/ 1 22-Ce3 75 COUNTY LOCAL AUTHORITY/ SUPERVISION 5/ /wiJ� 2e-a r PROJECT DESCRIPTION: • p��c-��ti �— /'. O. W. '�`''� • MRS S � 2 03 Cz.T— ?�lL.61.001 THIS POWT SYSTEM SHALL • INCORPORATE PER COMM. Private Ulbricht &Associates 83.44(2)c A PROPER ZABEL 655 O`NaiI Rd.Sewage • Consultants FILTER MODEL # 4 ., Hudson, �vi�, e4n�� tk. gzirtgottatil 0 a • 1.• • ALL NON-CONFORMING TREATMENT TANKS SHALL BE ABANDONED PROPERLY PER COMM. 83.33. Pg. 1 INFILTRATOR SIZING WORKSHEET Pg . 2 SYSTEM PLOT PLAN Pg . 3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg. 4 " " Pg. 5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS Pg. 6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG. 7 (OPTIONAL) PUMP PERFORMANCE SPECS. The attached - _ plans and specifications are based on " In-Ground Absorption Component Manual For Private Onsite Wastewater Treatment Systems . " (Version 2 . 0) SBD-1075-P(NO1/Ol . . - 0 luell, • 1 - pp of .tt II-2/ Air- fil fA,K5 - 014AS/0- µiN(. Alkp Ag, „Ay 16tiu pA et)bfIA 1--.,(z)17 /3t DRf7 • NM • I�', Pv j v 7- . . 9K27/1 :\' /I. ? 'I N\ ' . r(el. ei /flo f 4,8 I it,ii.5trit (0 . ,,,, 5.1". I. n 0.U 0 / q a 1,1 ' ►oI a ; ; � o � B, I PIO NIC aN 1 •—= fp\ A WQd 0 cc o x — o • it i � � �5 i i 1 M F--- zmw /1 , ' 4 .0_,L --- t - )( —e) I/ J - 1 83 9 lot 1pl 1 I 11 I 1 ' ALL NONCONFORMING �'t �e THE TMFNT TANKS SHALL 3E BAT ONED PROPERLY �� 'E CC /i. 83.33. s/ 5//VW();'':)N) 6eJ(c 061*.{. 3 'r (ofl 4r Sy5i e'/.Oa - 9y0 ' N N O71 ' NO ,141,7151)P401-P--- //111%). 5 ( Pa y il AT ) _2_0 o ' C6 ) 7aU,-C i (floSS • = /34ckh ,' Ts 7-5 7` (y4tP') Aft.' • RI 1 'p o " - 4, IN kiN , inn Ili ----. t‘ N . ,..1 11113m ‘ii' 1 b . 1 tillill .._ i N. 0_ , N mU{J{J{Hrjtim -I k\ wwwih Q i3-1J MIR 0' -t\ y llHirm w 2 ---, —.-- tifilly____ 1 N irni!iiii lk H 11i i yyII f IU L1 �1 ,IJJJ \11,4 IlLijiti I )N 1 I I . N w v - 4\ - 0 - .).) 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I oe ,(34 - U rie S ys 7Z'A-1 , v, 9V,0 OWNER 's MAINTAINCE OF SEPTIC SYSTEM POWTS (landowner ) maintenance of thisssyspemsible for proper operation and servicing is necessaryRegular periodic inspections and syvec. for the safe healthy operation of. this The owner is required by code to submit all necessary maintenance/inspection reports to the controlling ,author sties . SPECIFIC CONTACT AGENTS * Governmental authority/ inspectors : ��O/� C�� 1 �d,(J/it! 3g6 • 4/6 .9'o * Licensed installer, responsible for l : providing 9 an operation/ maintenance "Users" /ti wg - Z z-4 3?S' R. Zl/`✓/c'i cG% .3,1 e/kS * Licensed servthce / inspection agent other than installer : TA°/ - ct/ S441/7"47-7o41 PU,19 * Electrician, for pump, electric controls i - wiring units : ------------- IMPORTANT OWNER MAINTENANCE RE UIREMENTS 1 . Winter traffic area inter not (sledding, shovetin g, etc. ) across the the cell , f be be permitted, or frost can/will penetrate into witr g up the system. Discontinuos use in the (a vacaction trip, resulting in no water use) can also lead to freeze ups. 2 . Water conservation needs to be exercised ! hydrolically overloaded and destroyed . This system asn be designed for a maximum wastewater flow of system s 9.SQ galls . daily. 3 . POWTS are not designed POWTS unit, es gan to accomodate wastes from a disposal garbage . Any a unit , or n of y other unnatural sources of waste. destro such waste materials will overload and Y this system. o Ai - .2),,/sfa-se- 6r-_Ae7e Lei,/-T .vaw.� 4 • If a power Outage occurs, or a /LG7 n in a temporary overload of pump ,fails, it may result cell ,a which mayeffluent being pumped into the ecommehdch that adversely impact the cell (leakage) . It is recommended a licensed pumper empty the dosing allowing the pump to return to dosinga tunt Consult your installer immediately the correct amounts . 5 . Neglect for advice. of the vegetative cover erosion preventive ) can lead (the cells insulation & trasfic also rev can dpreventive ) to failure. IS NECESSARYCompaction or heavy REGULARLY WATER THE VEGETATION sOVERmA SYSTEM! ! fflue tTO the system beneath IS NOT sufficient alone t0 grass Effluent in cover, maintain a 6• Perin bons by the owner, necessary. Inspection , or his agents, is o he system: on pipes an ports ave een incorporated inspection s ms the mound basal area (effluent level laterals ,nspe pipes) , cleanout terminals on at each tip - for flushingthe pressutrized out . The filter system in the tanks (via ac lockedig aboveb laterals ground cover/manhole) . Only a personoud coveld a licensed properly severe be performing this work which Y gvesified safety risks . Evidence involves healthh system 's tre?tment cell shall also effluent be regulaplyding in the • • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT • AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 7E4A-1 /3/4-6e4e y -sZ/ Mailing Address /D 2"1- 560 #- /? . //UI7so.J S yd/ • Property Address• (Verification required front Planning Department for new construction) ✓1 0,910, all — Odd City/State Parcel Identification Number 0,20 /O//- "/Ob • LEGAL DESCRIp'I'ION Property Location s� ' , (51 '/e, Sec. /6 3' 2 N_ �VQSO.tJ R W, Town of Subdivision Lot # a �3 Certified Survey Map # s 92(,6 , Volume , Page # Warranty Deed # S /`3 786 Volume /38 , Page If //6 • Spec house El yes no Lot lines identifiable yes 0 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 heeded by a livens eT. What you put into the system can affect t e function o t ne septic tan as a reatmen 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 oft-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. , 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 the St. Croix County Zoning Offite within 30 days of the three year expiration date. 416.# 0 'I t NATURE Or APPLICANT / DATE • OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) 9m(are) the owner(s) of the property described above, byvirhne of a warranty deed recorded in Register of Deeds Office. 0•1 \ (\/ tka. e Ade_,tt6- 1 SR( A•TURE or 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 Wisconsin Department of Commerce SOIL EVALUATION REPORT / 3 , iivision of Safely end Buildings Page / of in accordance with Comm 85,Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County 5 f.. e e`/. include,but not limited lo:vertical and horizontal reference point(BM),direction and Parcel I.D. LOY- 2 • Owl G•/O//• 00 • 466 percent slope,scale or dimensions,north arrow, and location and distance to nearest road. Please print all Information. rt t we y Date Personal information you provide may he used for secondary purposes(Privacy Lew,s. 15.04(1)(m)). / /J ��� Property Owner G���' ��7Ytit�' I���/D,A �- Property Location T�/}�ll M. �sUS 7F47cSo,U `- /d G „ Lot SW 1/4 is 1/4 S /O I Z9 N R 1 Property Owner's Mailing Address (or)W `� Z Z SCQ � • �I Block# Subd.Name or CSM# cny ie 3 Cs,i SV2 G6 y �o/.// /�f. 3°P3 Stale Zip Code Phone NQ,tt� r /LV9�4 �/, S VO/� �6 L11;� �2/Z ❑ ly Li Village Town Nearest Road • 111 New Construction Use:VI Residential/Nu L N1NG OFF E ode derived design flow rate y�' GPD btReptacement ❑ Public or commercial-Describe: Parent material /, -5s O(AA. ,S,14,z/tf V//¢/ Flood Plain elevation If applicable / -- General comments ft. and recommendations: Oil �� • 5•,•r&- 50i'T/f-/3/E" i '/2. //0 •�'/Ppv vD • Go.v UE,�%idN�9-L, A .4>. j 4 i Q PirpoSts?e Ce..Ll5. — ,S.ee.. , 3 6 b//4 ki- ,ar I / Boring LI Boring 7/+�.3 Q ( >// • Pit Ground surface elev. ft. Depth to limiting factor 6 y in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda Roots Soil Application Rate In. MunsellY GPD/fie. Qu.Sz. Cont.Conl Color Gr.Sz.Sh. 'Eft#t 'Ef(#2 ' / a •9 /OY4 21'2. sib /fs,die 4V174/Q .L✓ 1/43 f. . z • z 7.it iiyie /3 - s/L ZfsA& 4116e ,24 3 rc •s • g f 33/•3y / % 3iY - sic. Z,-sie f/e e S / f- . s • 2 • ` `/ /o/'re yl — Z..5 / i ft Le Gs — . 7 /• a_ S y re sty o S a S d� c - /..� ��. � bo ? n • .1 I Boring# El Bor ng 9 r. 0 til pp) Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence BoundaryRoots Soil Application Rate in. Munsell Qu.Sz. Cont.Color GPD/Ill Gr.Sz.Sh. •Eft#1 'Eff#2 _ / 013 /0Y/ey/Z 5/L /7es6,e f/e i4) 3 f ..2._ • 3 Z g•2e /Ghe.3/y - 5/C 274-shk 44,75e ,,, 'w z f • S . e' . 3 2 •37 /40rg y/& - 5/e. 2-f-sh,t 40f/. 2.5 -- . 5 . ? m 2 W /mom• .S. D,S Ag , (- ;) /• . &O 4/g' (/ it 'Effluent f11 =SOD,> 30<220 mg/L and TSS>30< 150 mg/L 'Effluent#2=BOD;<30 mg/L and TSS<30 mg/L CST Name(Please Print) Signature ZoBER T-- ?- '/1el.c4]'--- �/Jl/ CST Number 1\ddress / l / 3 5' ' Dale Evaluation Conducted �7 � Telephhoone Number� l ' A soc1ateS °e v • cZdD //J"'•3g •Gl` • Private Sewage Consultants 655 O'Neil Rd. Hudson,Wis. ORIGINAL . �. O LAtLL `,P. , a� � � o � s jJi . Ali' �, lb f31 1Aj 5 ever- 7/ . --') U• 3? . V y 6 13O f /".77 zs 5 T { BO•0 I ci ./ 1 , II 11/11) N • - I j i_, I I I `` I I 1 , 41 15 - I I 1 1 I U , _ ! j I I_ ALL NON-CONFORMING e TREATMENT TANKS SHALL ' I BE ABANDONED PROPERLY ���� PE COMM. 83.33. /1 5/fn/00;, ) a lisi .Pgti, 3 'X (of ' i 5y51 111° 9y� , _ Y I / ,._...,.. r r 4' A)°' pfi , . G ,v_,Q �cf/1-c ; / - zp _,:dive ,5 ( Pe_ie y /1/IT ) 0 )f,ni VOL 138 7 P4E 116 STATE BAR OF WISCONSIN FORM 2-1982 593'7'8Es WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT NO. ST. CROIX CO., WI RECEIVED FOR RECORD Joseph A. Klewicki and Tanae G. Klewicki, 12-15-1998 9:30 RM husband and wife, WARRANTY DEED EXEMPT R CERT COPY FEE: conveys and warrants to Jean M. Gustafson, COPY TRANSFER FEE: 561.00 _ a_single person, _ RECORDING FEE: 10.00 PAGES: 1 THIS SPACE RESERVED FOR RECORDING DATA NAME AND/R�ETURN ADDRESS the following described real estate in St. Croix County, /'��Li State of Wisconsin: 020-1011-00 PARCEL IDENTIFICATION NUMBER Part of the SW1/4 of SE1/4 of Section 10,Township 29 North,Range 19 West,St.Croix County, Wisconsin,described as follows.Lots 2 and 3 of Certified Survey Map filed April 24, 1996,in Vol. 11,Page 3083,Doc.No.542664. • This_ is homestead property. • (is))0006:, Exception to warranties: Easements, restrictions and rights—of—way of record, if any. Dated this 11 th day of December ,A.D.,19 98 (SEAL) (SEAL) Joseph A. Klewicki Tanae G. lewicki (SEAL) (SEAL) • • AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County. authenticated this day of. _,19 Personally came before me this 11 th day of December , 19 98 ,the above named • Joseph A. Klewicki and Tanae G. • _ __ Klewicki, husband and wife, TITLE:MEMBER STATE BAR OF WISCONSIN ter}` rolAVIn Of not,_ t'ubli • authorized by 5706 06,Wis Scats.) T"' ti'Is c o be the per-,o —_.who executed the foregoing mstruruet and acknowl the ame. THIS INSTRUMENT WAS DRAFTED BY lGv Attorney Kristina Ogland B da Poulin Hudson, WI 54016 St. Croix Count Wis. Notary Public,.. _._ y (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expirationdate: necessary) — 9 .) •Names of persons signing in any capacity should be typed or pruned below their signatures. STATE BAR OF WISCONSIN Wisconsin Legal Bane Co.,v,c. WA RNA rs I Ylit Fit Form No.S-1982 Mawauaee,Wis Description. A parcel of land located in the Southwest quarter of the Southeast quarter of Section 10, Township 29 North, Range 19 West, Town of Hudson, St•.Croix County, Wisconsin, described as follows: • Beginning at the South quarter corner of Section 10; thence North 00 degrees 21 minutes 11 seconds East 1281.96 feet along the North - South quarter section line to the Southeasterly right-of-way line of an abandoned railroad; thence North 45 degrees 04 minutes 39 seconds East 58.45 feet along said right-of-way line to the North line of the Soithwest quarter of the Southeast quarter; thence South 89 degrees 44 minutes 13• seconds East 1276.32 feet along said North line to the East'line of said quarter section; thence South 00 degrees 19 minutes 47 seconds West 1322.09 feet along said East line to the South line of the Southeast quarter of Section 10; thence North 89 degrees 47 minutes 41 seconds West 1318.00 feet along said South line to the Point of Beginning, containing 1,742, 165 square feet (39.995 acres) more or less, and being subject to all easements, restrictions and covenants of record. Johnsgn,r x gis,tred Wisconsin Land Surveyor, hereby ce �ry:t1iat under)tflirsction Of Joe.Klevvicki, owner, I have surveyed and mapped the above described property; that such plat is a true and correct representation of the exterior boundaries of the land surveyed; and that I have fully complied with the provisions of Section 236.34 of the Wisconsin Statutes,- the.St..Croix County Subdivision Ordinance, and the Town of Hudson Subdivision Ordinance to the best of my professional knowledge, u+ - -r standing and belief. rg1111h/0 , wV 3/22 9 j 144% ,``Harvey G. &4.41son S-1899 • Johnson Surveying, Inc. ARVEY G, * Z 216 Meadow Drive North JOHNSON Hudson, Wisconsin- 54016 • HUDSO9 •y WIS Nr' • 4tro#04N �� SUR`� r //I�INIt�����, NOTE: Each parcel shown on this map is subject to state, county, and township laws, rules, and regulations (i.e. , wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the Sr.Croix County Zoning Office and the appropriate town board for advice. Vol. 11 Page 3083