HomeMy WebLinkAbout020-1061-30-300 (2)St. Croix County Planning and Zoning
14,"ednesihq-, October 24, 200� at 8:10 40 A:'#rf
Noe I of I
Detail Sanitary
Information
Computer #:
020-1061-30-300 Sub/Plat: NA
Section:
23
Parcel #:
23.29.19.231 D30 Lot:
5
TNIRNG:
T29N R 19W
Municipality:
Hudson, Town of CSM:
Vol. 09 Pg. 2535
1/4 1I4:
NW 114 NE 1/4
Owner:
Miller, Sam 886 Trail 12 Hudson, W l 54016
State Permit:
180272 Issued: 09/24/1992
POWTS Dispersal:
Non -Pressurized In -ground
Permit: New
County Permit:
0 Installed: 10/27/1992
POWTS Detail:
Bed- Seepage
Bedrooms: 3 WI Fund:
POWTS Pretreatment:
NA
Issue /Ins ector As Built
Plumber
Other Re uirements
Additional Notes
Money Owed
Jim Thompson Yes
Strohbeen, Douglas
$D•00
1 -Jim Thompson 6r= -T Yes
>tc=r,{$
Scheduled Pump Date Pumped
Notification
10/27/1995 711 /2006
04/20/2006
7/1/2009
AS BUILT SANITARY SYSTEM REPORT
OWNER Sa-m 01'1 h(L_v- -TOWNSHIP f�
SECTION z T N — R CWD
ADDRESSx zg —ST. CROIX COUNTY, WISCONSIN
SUBDIVISION -Fro,',k T w a- kvm_ LOT LOT SIZE _-5—. -f 7— 04 Ir
PLAN VIEW
SHOW
___.-EVERYTHING
__.,WITHIN 100, FEET OF SYSTEM
BENCHMARK: Elevation and description A,, 6
Alternate benchmark ic,
SEPTIC TANK: Manufacturer: z��rl'jcr Liquid Cap.
Rings used: _L_Manhole cover elev: 51 Final grade elev:
Tank inlet elev.:,/I,)'/ Tank outlet elev.:•
No. of feet from nearest road :Front X Side Rear Ft.
From nearest prop, line:Front k Side—, Rear Ft.
No. of feet from: Well rr Building:_2'_'"
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manuf acturer : /lam%` Liquid Capacity :
Pump Model: Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front_, Side , Rear Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed: Coh ��,b�, /Trench : Seepage Pit:
It
Width: IK Length `ldAI Number of Lines: Area Built 7 o? 05f
Exist. Grade Elev. Proposed Final Grade Elev.
Fill depth to top of pipe:... -
No. feet from nearest prop. 1 ine : Front,�, Side_, Rear Ft . ass
No. feet from well:1/o No. feet from building yS�
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front , Side , Rear Ft.
No. feet from: Well , building , nearest road
Alarm Manufacturer:
INSPECTOR:
DATE: PLUMBER ON JOB:
LICENSE NUMBER:��
6/90:cj
IQj9bhirPart�noinaultry3 . .19 NW NE O 5 TRAI T�i1TELVL RD .
Labor and Human Relations PAIV� E E&AGE SY TEM
ea INSPECTION REPORT
Safety and Busildings Division
N _ (ATTACH TO PERMIT)
'Ali INFORMATION
Permit Holder's Name: ❑ City ❑ Village [Town of:
ILLRR SAS HUDSON
CST BM Elev.: Insp. BM Elev.: BM Description:
led �b el /��PC?Z� I
TANK INFORMATION ELEVATION DATA
TYPE
Septic
MANUFACTURER
CAPACITY
D
Aeration
Holding
TANK SETBACK INFORMATION
TAN K TO
P 1 L
WELL
BLDG.
Vent to
Air Intake
ROAD
Septic
> 0 {
}:NO
'
NA
D
NA
Aeration
NA
Holding
PUMP/ SIPHON INFORMATION
Manuf Demand
Model Number GPM
TDH Lift Friction tem TDH Ft
Forcemain Length Dia. Di�tTo e
County:
Sanitary Permit No_:
18027
State Plan ID No.:
Parcel Tax No.:
A 9 2 0 0 3 5 1 //9/»,,6,;,
STATION
BS
HI
FS
ELEV.
Benchmark��,
G !
Bldg. Sewer
St 1 W Inlet
.S
Stl#t Outlet�
'
Dt Inlet
Dt Bottom
Header A
Dist. Pipe
1-7
ot. System
Aaa"f Gra d e
2 Z.
2Z
SOIL ABSORPTION SYSTEM
BED/TRENCH Width gr Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMEN I N U �- & I DI N I N
SETBACK SYSTEM TO P 1 L BLDG WELL LAKE/STREAM
LEA NG Manufacturer:
INFORMATION TypeOf CHAMBE Num er:
system: /� 4e� CAR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia . Length Dia _ Spacing
9 P g._
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over r xx Depth Of xx Seeded / Sodded xx Mulched
Bed 1 Trench Center Bed 1 Trench Edges Topsoil Yes No Yes No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HUDSON , 2 3.2 9.19 , NW , NE , LOT 5, TRAIL TWELVE RD .
C-49 IY�at� 62't �5" t
Gt,,)Cr-7 a4
C3 •.'-'
Plan revision required? ❑ Yes o
Use other side for additional information. I Z7j nil
t
9--
SBD-6710(R 05/91) Date Inspector's 5ignatur Cert. No.
UANCRUlamn I SANITARY PERMIT APPLICATION
13ILHR In accord with ILHR 83.05, Wis. Adm. Code
--MENEM
-Attach complete plans (to the county copy only) for the system, on paper not less than
81/2-x 11 inches in size.
-See reverse side for instructions for completing this application.
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
<5a "11
1), 1/1/41Td11
N9 R PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
C - ITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
if /I -,e 1,71 f -, a —
3 ?,Z ) -) 7 6, 4!
If" AL - I (
11. TYPE OF BUILDING: (Check one) AGEF� State Owned E3 VI
/_::, 0
On TQWN OF �4
E]Public 1 or 2 Fam. Dwelling-# of bedrooms-, PARCEL TAX NUMBER(S)_
111111. BUILDING USE: (if building type is public, check all that apply) 1 09 0 - 16 6 / - 30 - _?6 11
1 ❑ Apt/Condo
2 El Assembly Hall 6 1:1 Medical Facility/Nursing Home
3 E❑I Campground 7 F] Merchandise: Sales/Repairs
4 El Church/School 8 El Mobile Home Park
5 0 Hotel/Motel 9 0 Office/Factory
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
F7
A) 1. L2_J New 2. ❑El Replacement 3. El Replacement of
System System Tank Only
B) El A Sanitary Permit was previously issued. Permit # mw�
V. TYPE OF SYSTEM: (Check only one)
Non -Pressurized Distribution
11 [21 seepage Bed
12 ❑Seepage Trench
13 ❑Seepage Pit
14 ❑System -In -Fill
Pressurized Distribution
21 ❑Mound
22 [:1 In -Ground
Pressure
V1. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA
REQUIRED (sq. ft.) PROPOSED (sq. ft.)
I 7aO 1 2 Z e.-I
V11. TANK CAPACITY
in gallons Total #of
INFORMATION New ising Gallons Tanks
Tanks Tanks I
COUNTY,// f
STATE SANITARY PERMII'#
6009 -1
ElCheck i revision rf)iAs application
STATE PLAN I.D. NUMBER
/,7 E (or)V
NEAREST ROAD
14J -e-
10 ❑Outdoor Recreational Facility
11 El Restaurant/Bar/Dining
12 ❑Service Station/Car Wash
13 ❑Other: Specify
4. ❑Reconnection of
Existing System
I Date Issued
Experimental
30 ❑Specify Type
5. El Repair of an
Existing System
Other
41 ❑Holding Tank
42 ❑Pit Privy
43 ❑Vault Privy
4. LOADING RATE 5. PERC. RATE G. SYSTEM ELEV. 7. FINAL GRADE
(Gals/day/sq. ft.) (Min./inch) ELEVATION
Feet Feet
Prefab. Site Fiber- Plastic Exper.
Manufacturer's Name Concrete Con- Steel glass App.
structed
I/ I
Septic Tank or Holding Tank Q0- 0
Lift Pump Tank/Siphon Chamber Lj Lj I
Vill. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plum is Signature: (No St MP - /MPRSW No., Business Phone Number:
L,
4L. 4W
Plumber,'s Address (Street, City, State, Zip Code): te17
X. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved S nitaryPermitFee (includes Groundwater Date Issued issuing gent Sigjture Z(No tamp
Approved F-1 Owner Given initial ZL Surcharge Fee)
Adverse Determination
/�
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
S T C - 100
This application form is to be completed in full and signed by
the owner(s) of the property being developed. Any inadequacies
will only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor,(spec
house), then,a second form should be retained and completed when
the property is sold and submitted to this office with, t:hEi
appropriate deed recording.
------------------------------------------------------------------------
owner of property
Location of property1/4 1/4, Section T z N-R-LL9
Township _14 U16 6 n.
Mailing address Lax -0-
$'-
6 L�2
Address of site
Subdivision name
-Lot no.
Other hones on property? yes K No
Previous owner of property r _r
Total size of parcel
Date parcel was created 7,
Are all corners and lot lines identifiable? I/ Yes No
Is this property being developed for (spec house)? Y Yes No
Volume and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I
I(we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of
the property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No.�K41-7q5e4 - , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property,, for
the construction of said system, and the same has been duly
recorded in the office of County Register of deeds as Document
N o . a
r±Tnature of Etpplicant
!2, 2, 7 --- �Z_
Date of Signature
Co -applicant
Date of Signature
This i- s. not
am fits jjjj(j :i p p,i rte il;i lice,; therctinto belo"91fiv;
together with I'll itli(I singular the herediL.i
Aiid Kenton P. Stewart and Susie J0 Stewart
rrai-rmits Lhat the 1-I'Ll" is good, intlet'vasible irk "ev S11111100, 'kll'i alld 4-M-4- lit easemCTAts and
protective covenants or restrictions Of record and ('Xisting highways, if any,
,kiltj will %varvatit alid di'(end dIC'
April 1992
(SEAL)
• Kenton F. Stewart
S E Al-
Susi
e jo Stewart
ACKNOWLEDGMENT
fill 011�
lItvll 'Ile
V ce o'
.7
STATE BAR OF WISCONSIN FORK 1-19"
.MIS *rMX ftuapft-w
DOCUMENT NO.
481794
—WA D
PAGE
RE�iSTER'S OFFI"
MR
f
SECRMCOVVA
Welcord
This Deed, made between -------
APRI ass
.t.pwpr�t.. -Wif ............
.... ....... .....
-- - - -------- --------- - ............ Grantor,
--------
B. A.
........... .......... . ----------
an(_Sam E. Miller ......... — ........................... ........
... .......
............ ...... .................................... ............
0
- --- -------
----------- I ....................... .. .................. Grantee,
A@qW of Do$&
------------ -- ........
Witnesseth, That the said G,antor, for a valuable consideration_. _...
..... ....... . ..... ........... -----------------------
conveys to Grantee the following described real estate in
RETURN TO
County, State of NN-Isconsin:
A parcel of land located in the N-2 of the NE4 of
Section 23, Township 29 North, Range 19 West, Town
Tax Parcel No: -----------------------------------
of Hudson; as described in the Certified Survey
Map filed and recorded in the office of the Register
of Deeds for St. Croix County, Wisconsin, on July 6,
1976, in Volume I Of C.S-M-, Page 271, Document
9334002, which parcel contains 20.48 acres. -
rRA % . 013 Z!W---t
rlr=
Law
Dat(A Lhis 7th
t.-; FA 1.)
AUTHENTICATION
l"'11 tim 1'. fi I (-""" I I
April I
John 1). HeYWOOd
V
V"
C a 1). HeN '%Ood
54014,
on
FILED
6 �
AUG 3 11992opp
Reg;Ster (" -
487909 1, SL crox Co., '
j
{J T
CERTIFIED SURVEY MAP
L N Located in part of the NE4 of the NE4 and in part of the NW4 of the NE4f
ro all in Section 23, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin;.
= � being Certified Survey Map recorded in Volume 1, Page 271 at the St. Croix .
a r- County Register of Deeds office.41
LEGEND �,� u., ��� • � �,,, ;,, � -, ; " ..�
r- N • ill Iron Pipe Found
o - 111 x 241' Iron Pipe Set, weighing 1.68 lbs. per linear food."
... o ;'t' �. "�
vS w
-+-t -- --- --- ------ - Existing F e n c e l i n e [
- Roadway Setback Line
M co - Aluminum County Section Monument Found - =.
Q, L►- t- - 3/411 Rebar Found ;v,^ :yT
- Drainage Gully
m ,--, 4-j • . ..
NJ Corner of North line of the NEi NE Corner of
Section 23 N8905610111W 2605.861 Section 23
u' V�
` a(, v 1805. 841 800.021
� r� 1 1 �.• IJ
S85o2014211w 522. 2' OWNER
Sam Miller
P.O. Box 282
U) I 4, Hudsork, r,
1 ' � i+ • fit" '
3r w ci Z +
6.35 Acres -M x A':
L L r,
# 276,545 Sq. Ft. N •"r•c.%n 1 t
® 0 13111w \ / e-,r)
G—
Cn
C*
C'� I o
CO
"I M
m
0
a
8 `3
off E 818.10 ,
TQ 480' 10 124.4 6'�<�0(9
-'•�
I N86o091 1711E 8 9
1 1.
0
Uj
1
Lr)
N
C?
-.0-
#,-��,PROVED
S070f9l3711E I
2 , '92,
:R0(x COUNTY
pensive PiaRniuj
'oning and
�s Committgo
Iot r ec cxded
in 30 days of
proval data
*-V i s ! b®
54939 11w
43.231
33.00A VJ M
ti
L.. �. i V I . I I V `V. C)? r. L 6-0
SCALE TM FEET
,I��TTt" �a��
This instrument drafted by Fran Bleskacek Proj. No. 91-30 VQLUt•1E"9 PAGE
V 2535
SHEET 1 OF 2 SHEETS
SURVEYOR'S CERTIFICATE
I, Allen C. Nyhagen, registered Wisconsin Land Surveyor,
hereby certify that by the direction of Sam Miller, I have
surveyed, mapped and described the land parcel which is
represented by this Certified Survey Map; that the exterior
boundary of the land parcel surveyed and mapped is described
as follows:
A parcel of land located in part of the NE1/4 of the NE1/4
and in part of the NW1/4 of the NE1/4, all in Section 23,
T29N, R19W, Town of Hudson, St. Croix County, Wisconsin;
being Certified Survey Map recorded in Volume 1, Page 271 at
the St. Croix County Register of Deeds office; further
described as follows:
Commencing at the NE corner of said Section 23; thence
N89056'01"W, along the north line of the NE1/4 of said
section, 800.02 feet; thence S00043'22"E, 1170.25 feet to
the northerly right-of-way of U.S. Highway "12"; thence
S82030'23"W, along said right-of-way, 43.23 feet to the
point of beginning; thence N28046'10"W, along the easterly
line of said Certified Survey Map recorded in volume 1, Page
271, 743.00 feet; thence S85013'50"W, along the northerly
line of said Certified Survey Map, 255.62 feet; thence
N050 23' 14"W, along the easterl y line of said Certified
Survey Map, 475.12 feet thence S85o20'42"W1 along the
northerly line of said Certified Survey Map 522.32 feet;
thence S000 55' 58"W, along -the westerly line of said
Certified Survey Map, 529.77 feet; thence S000 55' 02"W, along
the eas"' terly line of Certified Survey Map recorded in Volume
2, Page 342 at said office, 380.39 feet; thence S700 48' 30"E,
along the southerly line of said Certified Survey Map
recorded in Volume 1, Page 271, 480.10 feet; thence
N86009'17"E, along the south line of said Certified Survey
Map, 124.46 feet; thence S58021'26"E, along the southerly
line of said Certified Survey Map, 155.74 feet; thence
S070 29' 37"E, along the westerly line of said Certified
Survey Map, 33.00 feet to the centerline of U.S. Highway
"12"; thence N82030'23"E, along said centerline, 488.45
feet; thence N070 29' 37" W, along the easterly line of said
Certified Survey Map, 50.00 feet to the point of be innin .
Parcel contains 20.74 Acres (903,263 Sq. Ft.).
Above described parcel is subject to right-of-way for U.S.
Highway "12" and subject to all easements of record.
I, also certify that this Certified Survey Map is a correct
representation to scale of the exterior boundary surveyed
and described; that I have fully complied with the current
provisions of Chapter 236.-.34 of the Wisconsin Statutes and
the Land Subdivision Ordinance of the County of St. Croix in
surveying and mapping same.
VOLUME 9 PAGE 2535
CERTIFIED SURVEY MAP
Located in part of the NE'-4 of the NE4 and in part of the NW4 of the NE4,
all in Section 23, T29N, R19W, Town of Hudson, -St. Croix County, Wisconsin;
being Certified Survey Map recorded in Volume 1, Page 271 at the St. Croix
County Register of Deeds office.
CURVE DATA
CURVE
LOT RADIUS
CENTRAL
CHORD
CHORD
ARC TANGENT
TANGENT
NO.
NO. LENGTH
ANGLE
BEARING
LENGTH
LENGTH BEARING
BEARING
0 -�2
2 233.00'
43033109"
N50032144.5"W
172.88'
177.11' N2804611011W
N72019119"W
2 80.00'
650381171'
N39030110.511W
86.72'
91.65' N72019119"W
N0604110211W
- 80.00'
245038117"
S50029149.511W
134.46'
342.98' N0604110211W
S7201911911E
2 80.00'
48059125"
N31010144.5"W
66.34'
68.40'
3 80.00'
86032147"
581003109.5"W
109.681
120.84'
4 80.00'
820511331'
S-03039100'.5"E
105.87'
115.69'
5 80.00'
27014132"
55804210311E
37.68'
38.04'
T - Q
5 167.00'
78048100"
S3205511911E
212.00'
229.68' S7201911911E
S06028141"W
PREVIOUSLY RECORDED DIMENSIONS
LINE
BEARING
LENGTH
V
N2905310011W
743.301•
<
S8400710011w
256.00'
'
`>
N0603010011W
475.25'
` >
58401310011W
522.35'
S0001210011E
530.00'
S0001210011E
380.65'
S00015'00"W
'
N
G
571057' 0011E
481.151
N85001' 00"E
124.50'
�i
S59031' 0011E
155.60'
- i-.�,r
APPROVED
508035100"E
33.00'.r
,�
\^/
N81025' 0011E
488.00'
^ ...
�.� <,� --�._..,�•- • .:
AUG 2,4.921
L,
N0803510011W
50.001
y CIRO1X COUNTY
rr;�)rphensive Planning
Zoning and
Pe ks Committee
If not recorded
w}w.iln 30 days of
ariprovat date
7-40provel shaMbe
,�Pstt & void
VOLUME 9 PAGE 2535
SHEET 2 OF 2 SHEETS
OWNER'S CERTIFICATE OF DEDICATION
As owner, I hereby certify that I caused the land
described on this Certified Survey Map to be surveyed,
divided, mapped and dedicated as represented on this
map. I also certify that this Certified Survey Map is
required to be submitted to the Town of Hudson and the
St. Croix County Zoning Committee for approval or
objection.
Witness the kand and seal of
day of
Witne s
said owner this
19, .
Sam Miller
,G�
N)'4AUV-k
State of ) SS
County of )
&"�nsty
Personally came before me this a-q, day of
19 the above named Sam Miller, to me known o be
the person who executed the foregoing instrument and
acknowledged the same.
)OANNE M. MAY
NOTARY PUBLIC ml:,tNFSOTA
RAM �
SEY COUNTY
Notary Pub is
MY Commission Expires Sept. 29, I99.3 �
My commission
expires
TOWN OF HUDSON CERTIFICATE
I hereby certify that this Certified Survey Map is
app ved by the Hudson Town Board.
44
Clerk Dat
Each parcel shown on this map (plat) is subject to.Sta.te and
County laws, rules and regulations (i.e., wetlands, minimum
lot size, access to parcel, etc.). Before purchasing or
developing any parcel contact the St. Croix County Zoning
office for advice.
VOLUME 9 PAGE 2535
S T C - 105
SEPTIC_ TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ADDRESS .1�0 � ��� Z FIRE NUMBER
CITY/STATE ��� ��4r,� ZIP
PROPERTY LOCATION:���/4,1/4, SECTION-Z. TN-W
TOWN OF � , St. Croix County,
SUBDIVISION eJ LOT NUMBER
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 septic -tank pumper. What
you put into the system can affect the function of the septic tank
as a treatment.stage in the waste disposal system.
St . Croix County residents may be eligible to receive a grant
for a maximum of 6 0 o of the cost of.,, replacement of a f ailing
system, which was in operation prior to July 1, 1978. St. Croix
County accepted this program in August of 1980, with the
requirement that owners of all new systems agree to keep their ,.
.system properly maintained.
The property owner agrees to submit to St. Croix Zoning a
certification form, signed by the owner -and by a matey plumber,
journeyman plumber, restricted plumber or a licensed pumper
verifying that (1) the on --site wastewater disposal system is in
proper operating condition and (2) after inspection and pumping ( i f
necessary), the septic tank is less than 1/3 full, of sludge and
scum . `
I/We, the undersigned have read the. above requirements and
agree to maintain the private sewage disposal system in accordance
with the standards set forth, herein, as set by the Wisconsin DNR .
Certification stating that your septic has been maintained must be
completed and returned to the St. Croix Co. Zoning officer within
30 days of the three year expiration date.
SIGNED:
DATE.
St. Croix co. Zoning Office
911 4th St,
Hudson, WI 54016
1
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of.
Labor a.-)d Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY
Attach co•vrnplete'site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. #
I to vertical and horizontal reference point (13M), direction and % of slope, scale or
COUNTY
PARCEL
not limited
dimensioned, north arrow, and location and distance to nearest road. VIE
APPLICANT INFORMATION —PLEASE PRINT ALL INFORMATION fFRIEVIEWED BY DATE
PROPERTY OWNER PROPERTY LOCATION
A rq M. i LLE7 GOVT. LOT t4L,) 1/4 t4(� 1/4,S-13 T 19 N,R E (or) W
PROPS
LOT BLOCK# SUBD. NAME OR C. M #
ROPE TY OWNEA:S MAILING DRESS -
I
27� 74
CITY,
k- NEAREST ROAD
E ZIP CODE PHONE NUMBER ❑[]CITY []VILLAGE OWN
S
ITY, S
WLT,1� —�
FNew Construction Use 4kj Residential I Number of bedrooms C 1 Addition to existing building
r[ I Public or commercial describe
I ]Replacement ndesign loading rateo, bed, g pd/ft2 (3.'�trench, gpd/ft2
Code derived daily flow4S6Recommeded
--gpd 2 ft2 -7 2 (1.1 trench, gpd/ft2
Absorption area required bed, trench, Maximum design loading rate 0. bed, gpd/ft U -
Recommended infiltration surface elevation(s) (1-3. ft (as referred to site plan benchmark)
Additional design / site considerations Flood plain elevation, if applicable ft
Parent material.
VENTIONAL CONIN- ROUND I ND PRESSURE AT--j5 RAH SYSTEM IN FILL HOLDING.T6NK
MO
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Ground
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Boring #
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Depth to
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SOIL DESCRIPTION REPORT
Dominant Color Mottles Texture
Munsell Qu. Sz. Cont. Color
Sc.
Structure Consistence
Gr. Sz. Sh.
2
GPD/ft 2
—
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d Trend
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Depth
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Remarks:
Remarks:
CST Name: —Pi - ease Print Phone. 46X6
Address:
Date: CST Number:
Signature: k-, 1,1AA,4 A TZ
PROPERTY OWNER
PARC EL I.D. #
w C z.3-i9-/9
2
Depth Dominant Color Mottles Structure GPD/ft
Horizon p Texture Consistence Bourxiary Roots
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends
C � MMMMMMMMM
4.4 .S
1 0.4 o-45
10.7
oig #
round
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1
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Depth to
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Boring #
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Depth to
limiting
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;;P. 5b
Ground
elev.
�L ft.
Depth to
limiting
factor
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SOIL DESCRIPTION REPORT
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Page z of -3
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Remarks:
Remarks:
SBD-8330(R.05/92)
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SCHEDULE 3034
\—,el! PERFORATED P[PE 1
60 PLA5T10 PIPE
Ir CMT VENT & INISPECMON ll---F-
47 CAST VENT INSPECT10i'4 Pll:'F---
I"' STRAW COVER GRN./EL ABOVE PIPE
—L BEL."N PIPE PERFORATED PPE 3114Y
cr GRAVE I
IN'SPECT10IN IEE cl 1011,
HO[Jc-3F
(REYERUNCE)
47 CA.s*T
REPT1.31 HUDSON ST. CROIX COUNTY
ZONING PAGE 1
10 28 92 09:43 REQUESTS FOR INSPECTION WORK. SHEETS FOR: 10/28/92 AREA: rJT
Act ivI ty : A9200351 - 10 28 92 Type: CONVSEPT Status: PENDING Constr:
'. Address". HUDSON,23.29.19,NW,NE,LOT 5, TRAIL TWELVE RD.
Parcel:
Occ: Use:
Description: 180272
Applicant: MILLER, SAM
Phone:
. owner: MILLER, SAM
Phone:
Contractor: STROHBEEN, DOUG
______
Phone:
------ -_-_--__________-__�._____�._�.__
_________________
Inspection Request Information.....
Requestor: STROHBEEN, DOUG
Phone:
Req Time: 13 : 10 Comments: �' !
Time Exp
Items requested to be Inspected... Action
Comments
00012 FINAL INSPECTION
Inspection History.....
----------- _-_--------- ______-
Item: 00012 FINAL INSPECTION