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HomeMy WebLinkAbout020-1355-01-050 (2)St. Croix County Planning and Zoning Detail Sanitary Inforination Computer #: 020-1355-01-050 Sub/Plat: Homeplace Section: 21 Parcel #: 21.29,19.2067 Lot: 1 TN/RNG: T29N R19W Municipality Hudsn Town of CSIVI: 1/4 1/4: SE 1/4 SE 1/4 I Owner: Miller, Sam 801 Grant Avenue Hudson, Wl 54016 State Permit: 344539 Issued: 07/06/1999 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 07/29/1999 POWTS Detail: Infiltrator - High Capacity Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Issuer/Inspector As Built Rod Eslinger Yes Kevin Grabau Yes M a i n te n c, Scheduled Pump Date Pumped 7/29/2002 7/1/2006 7/1/2009 Plumber Other Requirements McDonell, Mike 1 st Notification 2nd Notification 3rd Notification Additional Notes Tuesda_r, 11to, 01, 20V tit / 1:06:55 111 pacre / 14, 1 Money Owed $0.00 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT ILb Owner r-J '? ���L L Property Address O I �, r� h1 A[7 ff l- ' � City/State 1) r) LA, RECEIVED L 2 9 1999 :: ST C44OX couNTY //,J"- Legal Description: ZVN1NkX%J / 'N - Lot Block Subdivision/CSM # /).,1 4 PIN# 1/41/4, Sec. T N-R AV Town b of SEPTIC TANDOSE CHAMBER -- HOLDING TANK INFORMATION: F- ", � -? 2 Tank manufacturer / Size ST/PC Setback from: House W el -7q 0 `P/L �4 Pump manufacturer x Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road. Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: Width Length Number of Trenches Setback from: House I Well P/L Vent to fresh air intake ELEVATIONS: �c Description of benchmark Elevation /C!: Description of alternate benchmark Elevation � Z, r : q Building Sewer ST/HT Inlet F I � 5 ST Outlet PC Inlet PC Bottom -� Distribution Lines ( ) Header/Manifold To of ST/PC Manhole Cover C.� Bottom of System ( ) ��,� � = / ���o O (O�S � �,� ( ) Final Grade (.0 4 7-.S- 7 �l, L �/�CDate of installation' Permit number State plan number Plumber's signature License number Date 7/�--/ �� Inspector -LD L Complete plot plan air Lo LQ mk t*,N. t+ t t-A tevrvo 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. 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. 1 ! -Lo . i fNOTE 1V0T-1A1JTX4(fa ILCVM (o.4 t A 4 0 e D� V E WAY INDICATE NORTH ARROW PLAN VIEW � ! k s61 Owl j r i 1 1 �t> 7-A L Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)]. 3 0Z Per lky�9�iVam9XM City [] Village Town of HUDSON 'ST BM Elev Insp. BM Elev.- BM Description: j� 44t44 AJ& C&LA%L ANK INFUKMA I 1UN TYPE MANUFACTURER CAPACITY Septic Dosi ng Aeration Holding TANK SETBACK INFORMATION TANK TO P / L WELL BLDG- vent to Air Intake ROAD Septic 32- NA Dosi ng NA Aeration NA Holding PUMP / SIPHON INFORMATION Man 9a �r Demaud Model Number GPM TDH Lift Fricti ead TDH Ft Forcem Dia- Dist. To Well ?:i SOIL ABSORPTION SYSTEM ELEVATION DATA County: Sanitary Permit No - ST. CR 344539 State Plan ID No Parcel Tax No.: 020-1355-01-000 L-ILPF 7 U Vj Z1 V STATION BS HI FS ELEV. Benchmark 2, f 9 2- Bldg. Sewer St / Ht Inlet 10-32 St / Ht Outlet /0 - 10 6P Dt Inlet Dt Bottom Header / Man. E 15- Ct Dist. Pipe 92- Bat. System LAr 12.5-0 Z - vs-- 93-3 2, 17 Final Grade 7. 35� i7ge C 0 -3 TRENCH Width Length No. Of Trenches PIT No Of Pits Inside Dia. Liquid Depth DIMEN;2;w /3)1 1 1 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING manufacturer - SETBACK INFORMATION CHAMBER Type Of Model Number.- System: 46 ------ OR UNIT DISTRIBUTION SYSTEM f. __ L I I C _ IX Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing en To Air intake Length ADia ll- Lenglt_FDja_ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Ll Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed / Trench Center Lo Bed /Trench Edges Topsoil [] Yes E] No 0 Yes E] No COMMENTS: (include code discrepancies, persons present, etc.) LOCATION: HUDSON 21.29.19.20671SE, E 801 GRANT AVE — HOMEPLACE LOT 1 A-, A0 (ANJ uu%dwr ^4 VA% "Jet-) W, 3Z,i) .41�t ctm� 4k"(Ir " _T� As- 6AA Plan revision required? El Yes 56) No •[1 ` 2— R Use other side for additional inform ion. �-_ C�_q _ SBD-6710 (R.3/97) Date Inspector's Signature Cert No Safety and Buildings Division • SANITARY PERMIT APPLICATION 201 W. Washington Avenue scons n In accord with ILHR 83.05, Wis. Adm_ Code P 0 Box 7302 Department of Commerce % d Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11- inches in size. c c +,i) State Sanitary Permit Number • See reverse side for instructions for completing this application 3y?001,`,r3? Personal information you provide may be used for secondary purposes ON Check it revision to previous application [Privacy Law, s- 15,04 (1) (m)]. Stale Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Pro o—ty Owner Narne )perty rc , ovation Af ise 1/4 /40 S T N, R E (o VV Property Ow 's Mailing Address 571 Lot Number Block Number City Statb , A& t Z' p Co e , Phone Number fto-i 7 iIVI Subdivision Name or CSN11mbe;.. 11. TYPE OF BUILDING: (check one) n State Owned 0;1 El it C 0 VII( Village Nearest Road 1^ 4 4*T, 0 Public 11 or 2 Family Dwelling - No. of bedrooms T( "V01450��] IG 9 Ill. BUILDINGrUS_ E: (if building type is public, check all that apply) Parcel Tax Number(s) � '� ��� �. '�" 1 EjApartment / Condo 2 F-1 Assembly Hall 6 Ej Medical Facility/ Nursing 10 ❑ Outdoor Recreational Facility 3 M Campground 7 0 Merchandise: Sales/ Rep 11 Q Restaurant/ Bar/ Dining 4 [-] Church / School 8 El Mobile Home Park I service Station / Car Wash 5 El Hotel / Motel 9 E] Office/ Factory specify IV. TYPE OF PERMIT: (Checkl only one box on line A. Che, A) 1. ;< New 2. E] Replacement 3. [:] Repli ci on of 5. [:] Repair of an ------ System -------- System ------------- Tan_l oystem ---------- Existing System B) O(A Sanitary Permit was previously issued. Perri.. Date Issued .v,'f 'f"" V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experiti., Other 11 n Seepage Bed 21 E] Mound 30 [-] Specify Type 41 ❑ Holding Tank 12 Seepage Trench L E 22 E] In -Ground Pr sure 42 ❑ Pit Privy 1 Seepage Pi K. 43 Vault Privy - it Ej 14System-in-Fill *"'It E]40i _ k 1, S 1I jL C j/ 4, vhtf a S V1. 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 q Required (sq- ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation ArOL 07 %*mL. is Feet Feet V111. TANK INFORMATION Capacity in gallons Total Gallons # of Tanks I Manufacturer's Name Prefab Concrete Site Con- Steel Fiber- glass Plastic Exper. App. New Existing strutted Tanks Tanks Septic Tank r AM (0400 U) cor I vs F i4L, El El❑ El 1:1 1:1 1:1 1:1 1:1 1:1 1:1 I i t ump mr) I Tank /Siphon Chamber Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumbq Signature:4po!jtampsl# MP/MPRSWNo.. lie 0 Business Phone Number: Z, 4 t, 4 jI .+ Plumber's Address (treet, Citu NoState, Zip Cod ): w* #400��.. qpp- I� () IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued ISSU, e I ur o Stamps) Approved ❑ Owner Given initial Surcharge Fee) F. �.—+�9 7 Adverse Determination X. CONDITIONS OF APPROVAL / R ASONS FOR DISAPPROVAL: C) SBD- 6398 (R.1 1/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber A Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue In accord with ILHR 83-05, Wis. Adm. Code P 0 Box 7302 Department of Commerce I i Madison, Wl 53707-7302 • Attach complete plans (to the county copy only) for the, system, on paper not less County than 8 112 x 11 inches in size. W, C�\ I 'tk • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION —PLEASE PRINT ALL INFORMATION I Property Owner Name Property Location Awvww"%%� 1)v UZ 5 E 1/4.5 E 1/4,, S 4 T 2 '1 , N, R ^j" E (oo W Property Owner's Mailin Address Lot Number Block Number A 4 r, City, State Zip Code Phone Number Subdivision Name or CSIVI Number L) 10.4 0?6) Z-7 HC h4 C --F 11. TYPEBUILDING: (check one) El State Owned V El Ei C't(Nearest RoadTow e Public Y1 or 2 Family Dwelling - No. of bedroom n OF 14() V11 Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) -C sud 700 1 ❑Apartment/ Condo 2 E3 Assembly Hall 6 Ej Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 Campground 7 n Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 Church /School 8 EJ Mobile Home Park 12 Service Station / Car Wash 5 El Hotel / Motel 9 [:] Office / Factory 13 ❑ Other: specify I IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. [:] Replacement 3. R 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 E] Specify Type 41 n Holding Tank 12 64 Seepage Trench 1,, 22 [] In -Ground Pressure 42 Ej Pit Privy 13 E] Seepage Pit - ivy To To Z, "' / l'` tTO 14 [] System-ln-Fill LO4 4o - 1 1", 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 Re d (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 17 C cni e�- C� -40 Feet, / I . -, Feet VII. TANK Capacity Con Ali INFORMATION in gallons Total # of Manufacturer's Name Prefab. er- plastic1xperNew Existin Gallons Tanks ConcreteSteel Fiber- glass App. Tanks I Tanks9 .S 'c Tank,"Allift A Lift Pump Tank /Siphon Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans Plumber's Name: (Print) Plumber's Signature'. (N tamps)y-1 Oov*, MP/MPRSW No.: Business Phone Number: L 6c. QNW_ Plumber's Address (Street, City, State, Zip Code): .L L IX. COUNTY I DEPARTMENT USE ONLY ❑Iss Disapproved Sanitary Permit F (includes Groundwater ate u Issuing A Siature (No tamps) Approved roved' Initial Surcharge fee) (77 Adverse Determination . 7----Z(UC/4 �f F;4 ;rW X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R. 11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. I All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to Installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: I. Property owner"s name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. V1. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X - County/ Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; Q complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination Investigations and establishment of standards. 14 r. i fro ---------- - -sue _ r .� r a , ��► 40000 Ai To PEI) ?HOME , - T r3 - cq 141- �. X To Tm L L IT' 5�1rf'1 M (LLwE1Z,. 40 rytE 4 f1cE y STD,,., F I„ = __ � � . 3010 s THE H£5;,. SIDEWINDER Chamber High Capacity Model Chamber End View ,� 2 c . J \ 3 1 14,40r 4:91- / --7. - Z,,i .. "Y q 3;rS�.2 S � c�.�Ff��nf3E25FR�fi zz .Chamber Side View as1 ToTi�L �.� _ 750 1 wila (&I a I i r4&jL 1../ SY=MS INC Leading the way in septic and stormwater chamber systems 4 Business nark Road • P 0. Box 768 • old Saybrook, CT 06475 8OD-221-4436 * 860-388-6639 • Fax: 860-388-6810 Closed End Plate open End Plate Product Information Chamber Specifications Size (WxLxH) 34"xi5"x18" Invert* Storage 122 gal!, 6.3 ft3 Weight -- S ; ;b 4" SOR 35 pipe Product Benefits • Lightweight units offer easy assembly and installation. • Fully -louvered sidewali provides maxi- mum infiltration. • Open chamber bottom allows addi- tional infiltrative area. High -density PoiyTuffl" polyethylene construction guarantees strength and durability. US. PataNsk 4.?W061; L617.011; 5.156.d: 5.305.t?t2: S.a0t.1N: S.401r4S9. 5.511.7m. 5.5"'7!. I.615925. 1.974.9X 1.779.311 60.7X Caen~ Powit 1.329.9W 2.001.5i4 01tw US_ CanPdw, @W lae+q" Darts C4""-9 V#A"M E4aUat p++^V% ane S aftdn Bra agawN rearnwKs am 1t kfto in we raawne a d rM*SW 9YOMM re— d¢aA. Cmx DMD% ukw Woruff Maxvft UlenjA owq. "Tuff. SneaLost. Ana uWOR.L 01997 Y+M.ror �tlew�s roc P+.ree in i1 s Wise° osin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code A.C.E. Soil & Sitc Fvaluations Attach complete site plan'on paper not less than 8'/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference.poir -�BM) direction and St Croix percent slope, scale or dimensions, north arrow, and�fi"Jon anti list,dnse to nearest road. + Parcell.D.# = ��. r 020-1056-90--000 APPLICANT INFORMATION - Ple e?dz rnt all i formatiao. Personal information you provide may be used fo ry p ri y Law,_ .04 (1) (m)). Reviewed By Date +-� 1 / 1 9 rBox Owner Pr erty Location , Sam [' (► Go. Lot SE l /4 SE' 1 /4 S 21 T 29 N, R 19 W 199 Property Owner's Mailing Address tot Block # Subd. Name or CSM# g co ST Gk w- 51 Trout Brook Road,, 1 NA Home Place State Zi 0�o 4� City Village Town Nearest Road n W1 541 715) 386-27a 1-iudson Grant avenue New Construction Residents`-%' dr0�oms 3 Addition to existing building - Replacement Use: Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •7 bed, gpd/ft' .8 trench, gpd/ft2 Absorption area required 643 bed, ft2 562 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 95.00' ft (as referred to site plan benchmark) Additional design / site considerations Parent material Outwash s & gr. 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 S U : S U S U S U S; U S U SOIL DESCRIPTION REPORT Bodng# 1 Ground elev 100.32 ft Depth to limiting factor > 123" �9 Ground elev 99.35' ft Depth to limiting factor >116" Horizon Depth Dominant Color � Mottles Texture Structure Consistence Boundary Roots GPDIft2 � in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-8 1ORY2/2 None sl I thin pl mvfr as 2f 0.4 0.5 2 8-12 1 OYR3/3 None sl l thin pl mvfr cs 2f, I m 0.4 0.5 3 12-23 10YR4/4 None sl 2msbk mfr cw 2f, 1 m 0.5 0.6 4 23-38 7.5YR4/6 None gr. Is o sg ml cw l f 0.7 0.8 5 38-123 1 OYR5/4 None s & gr. a sg MI - - 0.7 0.8 -?A Ci at C(q �emarres: 1 0-10 1 ORY2/2 None sl 1 thin pl mvfr as 2f 0.4 0.5 2 10-14 1 OYR3/3 None sl 1 thin pl mvfr cs 2f, 1 m 0.4 0.5 3 14-24 1 OYR4/4 None sl 2msbk mfr cw 2f, 1 m 0.5 0.6 4 24-36 7.5 Y R4/6 None gr. Is o sg m l cw 1 f 0.7 0.8 5 36-1 16 ; 4 10YR5/4 None s & gr. 0 sg mi - - 0.7 0.8 Kemams: CST Name (Please Print) Sign lure: Telephone No. James K. Thompson 715-249-7767 Address A.C.E..Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, W1 54020 5/3/99 3602 1013 PROPER-o-Y OWNER. Miller, Sam SOIL DESCRIPTION REPORT 1013 Page 2 of 3 PARCEL 1.011 020-1056-90-000 A.C.E. Soil & Site Evaluations F Horizon Depth Dominant Color Motfles Textu re Structure ' GPD/ft2 Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev 99.38'ft Depth to limiting factor > 120" rl Ground elev W62'ft Depth to limiting factor > 119" 0 /11� 5 Ground elev 99.05'ft Depth to limiting factor >1 15" Ground elev Depth to limiting factor 0-8 1 ORY2/2 None 8-13 1 OYR3/3 None 3 13-25 1 OY R4/4 j None 4 25-35 7.5YR4/6 None 5 35-120 10YR5/4 None t-RemarKS'. sl I thin PI mvfr as 2f 0.4 0.5 sl I thin PI mvfr Cs 2f, Im 0.4 0.5 sl 2msbk rn fr Cw 2f, Irn 0.5 0.6 gr. Is 0 sg M11 Cw I f 0.7 0.8 s & gr. 0 sg MI 0.7 0.8 1 0-9 1 ORY2/2 None sl I thin pl. Mvfr as 2f 0.4 0.5 9-15 1 OYR3/3 None sl I thin pi mvfr Cs 2f, I m 0.4 0.5 15-27 IOYR4/4 None sl 2msbk rn fr Cw 2f, Im 0.5 0.6 4 27-34 7.5 Y R4/6 None gr. Is 0 sg M1 41 Cw if 0.7 0.8 .'4-1 19 1 OYR5/4 None s & gr. 0 sg M1 0.7 0.8 qY Remarks: 1 0-13 1 ORY2/2 None S1 1 thin pl mvfr as 2f 0.4 0.5 2 13-18 10YR3/3 None sl I thin PI mvfr Cs 2f, I rn 0.4 0.5 3 18-33 1 OYR4/4 None sl 2msbk M fr Cw 2f, Im 0.5 0.6 4 33-46 7.5 Y R4/6 None gr. Is 0 sg MI Cw If 0.7 0.8 5 46-115 10YR5/4 None s & gr. 0 sg MI 0.7 0.8 Remarks: Remarks- cio I eq:5�'6 F J-cp bl 5; P-)- o I o �=d E- -fo e - gd rl1 OwnerBuyers1+ 01 ST CROtX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 114 1 t I.- JF-P12._ Mailing Address .B 4�) X 2� ( S il Property Address A (Verification required from Planning Department for new construction City/State � U D S O 1� Parcel Identification Number 3 ss'— Qo p LEGAL DESCRIPTION Property Location '/,, S � '/., Sec. T 71N.R W, Town of N�/D ,Lot # i4% �J Cerlitied Survey Map # � � 7 v .Volume ! ,Page # Warranty Deed # Volume ( G Page # � Spec house )i yes ❑ no Lot lines identifiable X yes 13 no SYSTEM _,., ., NANO Impraper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumpmg 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*becompleted and returned to -the St. Croix County Zoning Office within 30 the three year expiration te. 46 lc;t 61 NATURE AP LICANT DATE ►r R CERTIFICATION 4p. -11we) 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 y 4exribed above, b virtue of a warranty deed recorded in Register of Deeds Office. A Op CANT 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 Z111 Aeo 0-11 VOL '1361. PAU1-1 -4 D*cument Number WARRANTY DEED This Deed, made between, Robert L Rohl Grantor. and, Sam E Miller a single person Grantee Witnesseth, That the said Grantor for a valuable cc)rs&3eraf*n of one dollar and other valuable consideration conveys to Grantee the below nescnbed real estate in St. Croix County, State of Wmcrr-son This is nest homestead property Together with all and singular hereditaments, arc appurtenances thereunto belonging, And Grantor warrants that the title is good, indefeasible in fee s4irr-pe and free and clear of encumbrances except easements, covenants, and restrictions rcf record, and will warrant and defend the same iP*,cm Jentification Number) 1) 20- 10-56-90 R EG I STE, OFF - I. t $T. CROIX COO, W1 144;'do sw OCT 0 6 19,% W, �. 9--30 -'� J'6jJL,,j. ReAfer a 00948 1 Area Name and Retum Address San E. Miller P© Box 151 Hudson WI 54016 A parcel of land located in the SE '/4 cif the SE 1,4 Of Section 21.T219N, R 19W, To%,m of I ludson. St. Croix County. 'Wisconsin, described as follo%ovs: beginning at [Ile SF comer of said Section? 1. thence N ;':� 1 `� 89' I I 1319.10 feet to the monumented West line ofthe4SE 1.'41 of the SE. ',,A cif said Section 21, thence N00`5 1 @33 4 North line C 980.09 feet along said monumented West line of dw SE I.,' of the SE to the No h in of th South 30,,801hs of the E '/2of the SE !44 of said Sei, ion 21 as caflee cow in that documentation found in Volume 838, Page 2i'l of the St. Croix County Register of Deeds, thence S39'337'19T 626.85 feet along said North line of the South -'30/80ths to the intersection of the monumented '%;k%-uth line of the Certified Sur\e\ Map '"led in Volume 2. Page 484 and the said North line of the South 330 80ihs, of said E cif the SE '/'4-, thence S89'13'10T 31.88 feet to a found I" iron pipe being the SW Comer of said Ccrilfied Survey Map. thence continuing� S89'-13'1 01-- 660.24 fiect to the East line of the SE '/4 of'saici Section thence SW5 1'50"E 982.41 feet to the point ofbeglinninu. containing 1.9.725 acres Including rIgl of \&,a% 11-28.006 acres e\cluding right ot'\%a\ Dated this day of 199 TRAqIFER -"0. 000, 41t Robert L Rohl AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN COUNTY ST. CROIX Personally cam before me this 2 day of CST— r2f the authenticated this day of above named kobert L. Rohl to me known to be the person(s) who executed tle. foregoing signature ins tha ent and acknowacknowledgesame. type or print name swatkas type or pnnt name v Zlq,(_A TITLE MEMBER STATE B�R OF WISCONSIN .pNpo&*&ary Public County. (It not. P OMT'sslon is permanent (if not. state expiration date - /,I - authonzed bye706 06. Wes Stats ) 1 5 C-7 ► �a THIS INSTRUMENT WAS DRAFTED BY IN rsons signaiwgning esin any capacity should be typed or Rob%:rt F. gall 116n their si (Signatures may be authenticated acknowledged Bo are necessary Jr C I . 4 411111`6� ir r vAlOw. S 037'19"E 6 5 # 223.1s $377.63 .00 ( R N89 33 42-W } S 890 23 E 692.12 183.21 - 110.00 - 4 N 105 AGE SS PONOI�N EASEMENT ? Cl) 304. 24 `• angle paint.00 726 33.01 J �A HIGHWATER 6"'B+ ELEV = 9X © �_ EJ rn Z O 9`C3 C • 0 5 • 61 'cos cn D K) o _A 33' 33' CV m 00 100,163 square feet (2.299 acres } ' �a 11� acres � ^3 i`'- L1 7,896 square feet 2� C _ a C= 0 o ct N incl. temp. -sac �� p r4 79 95,037 square feet q -' j ( 2.018 acres } CAUTION; Highway setback restrictions- 9 Incl. temp. cul-de-sac 4 prohibit improvements. C*4 N _ (2.182 acres } m o 82,770 square feet 4�' 112,558 square feet ( see surveyor's notes) n 0 � excl. temp. cul-de-sac 111 0 " � 109�. ( 1.900 acres } � ( 2.584 acres } excl. CO gip. cul-de-sac '� Temporary Cul-de-sac to be removed co c4 00 j - Cp PONDING 1 DRAINAGE 4! `- r km_of the road. p7° ch EASEMENT 3 HIGHWATER (� 75 cn 11J v 30 41'1E 37� '� 6� 61 ELEV = 920.9' . 188,042 square feet 3 59 D` _ r, ,�,, _ $ or0 ( 4.317 acres) (uL V 1` r 85 n' -3 GJ G7 h a► �? �j C'O m- Q. LU J ILL = r+ j �• -�`� j' 7 ,V W ~ E- I'- o �- Q v /� 96, 801 square feet 84 w`0 0o fpd N � O r- • CL J W(0 cn N ��e5 r __- tiQ 68 9, �CiCID O 0 C w _ 83 �0 21 N Q U_ o N13 82 8 0o 0Q� w ,, �, ���� Scale 1" = 100' © o W J CIOO Q7 �, G��' ° 1 6 xNP �, pE`�S $, �� 20 X fib joint � �0 1 �� 0 1 gpveway easement 101,174 square feet 55 ��CO` o Lr) 106 rLr) 5 2.323 acres } on 1 �,� 0,0 �� �,{) 0 103 72 1 D 2� NIS fj, ��S � ` Ty�p ` ` 87 N 94 o 0 OS r 124,110 square feet `� 20' X fifi' oint 0 driveway easement �'�48 �l�L� �� © � `� 50 Q 3�` z cp U) } O '� ( 2.849 acres } a �, �o 7j,9SZ �- S �o w 10. ! rb ass 77 102 .88 1 101 Z11 Ul)g.� 00 PQNDING S� / DRAINAGE 4 6 1 W Cn n Q, 0 . et' EASEMENT 0 '\ 0 HIGHWATER �, 136,241 square feet q ,1.((/ 90,408 square feet :- o � 04 ELEV = 910 0'� { 3.128 acres) �, ( 2.075 acres) o W �..! � 4 existing dwelling Cn 80 Z � `.. 10 o © 91 92 J {� 0 _ � 87,837�quare feet A ( 2. CMS acres } -' 81 170 443 48 -' uI e4 .� w 41 rn w W O O0 28 9 23 �`' 501.64 0) 409.04 cn rn 2 5366.01 .92 2 W 89 S 89° 23' S1" E 910.68 DEDICATED TO THE PUBLIC 42 S 890 23' 51" S 1/4 24 Comer of Section 21 SOUTH LINE OF THE SE1/4 C. TH. V tt f hurt N89023,51 11 W 1.319.10 10 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 February 10, 2000 Home Realty Dave Anderson 602 3r, Street Hudson, WI 54016 RE: Septic Inspection for Sam Miller located at 801 Grant Avenue, Homeplace, Lot 1, Town of Hudson, St. Croix County, Wisconsin Dear Mr. Anderson: A septic inspection of the above referenced property was conducted on July 28, 1999. This property is located in the SE1/4of the SE1/4of Section 21, T29N-R19W, Homeplace, Lot 1, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386-4680. Sincerely, Kevin Grabau Zoning Technician