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HomeMy WebLinkAbout020-1334-60-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT RECEDE Owner S,-401 M riZ. 1 12 1498 j-. ST CROIX Address 6,71 RC P O (P P4 f- L A N E COUNTY City/State P L,,, D z p ri W 1 S~/a ~4 ~ ZONINGOFFICE ! ~w V,10 Legal Description: Lot Gp Block _ Subdivision/CSM # & D LAN O L %4 ti '/4 , Sec. Z_*7, T Z9N-R /Q own of MaosrAY PIN # - 024b43FI-- (eQ bQ'~• SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer W E I S IF if Size ST/PC 2sb / Setback from: House 3 5 'Well 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: Type of -system: T2 E K G N Width S Length G C / Number of Trenches Setback from: House C'S' Well 9:5'" P/L SC' Vent to fresh air intake ELEVATIONS: Description of benchmark NA/4- IN T 0-£ S, toe y_ Elevation I DO. 0 .Description of alternate benchmark TOT C 4 r,1,04 ,e_ S k✓aorN~R MAUVE Elevation ~ n ~:~,5~=x(0,01 Building Sewer ST/HT Inlet 7 ST Outlet 11 • 3 9 PC Inlet PC Bottom Header/Manifold 11,bZ= 93 $3 Top of ST/PC Manhole Cover` -N 5 .1 ~is bution Lines, `7~ j 1-(off d , I L Bottom of System ( ) 12 2 9 J _2','60 T2, 0 a Final Grade ( ) _c~ 71 Date of installation 1 /'2t 1/ Permit numbero- 7.~- State plan number Plumber's signature ~e W° 60a License number AW05.OS'Se4 Date ► /Z05 Inspector ' Z'573 Complete plot plan y r 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. ~F-D rY1N~°LE LANE PLAN VIEW ifs ayk2y, ~ No~SE ~ As cF I-2►-9q w ELI Nor r wr Tpc cF D Ell F NAT ~ it ~ ~1 2 NAIL IN ~YJ ofd' :zd~' i±3 E S' S S SS Sov`r' N LoT C i NF_ INDICATE NORTH ARROW Wiscon'sig Department of Commerce PRIVATE SEWAGE SYSTEM County: nl Safety and Buildings Division INSPECTION REPORT `,l , C✓~x GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2~qyi7' Permit Holder's Name: ❑ City ❑ Village © Town of: State Plan ID No.: u, M1 vAon CST BM Elev.: Insp. BM Elev.: BM Description: r rcel Tax No.: 41 - ®0 G0 iK,~ e -IZ nT• OZa- /33 -~o- ddU TANK INFORMATION ELEVATION DATA '7pDC/ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Sep ti 1~cS~✓ ! 25a 61-98 ~rgZ /Ctf z / as 1 Dosing Alt. SM 1•7Z 96 Aeration Bldg. Sewer QI $'~J 94l.`I3 f Holding St/ Ht Inlet 11.,57 q1f 31 TANK SETBACK INFORMATION St/ Ht Outlet 11.77 O6- TANK TO P/ L WELL BLDG. Air'0"l "ke ROAD Dt Inlet nta eptic >2 1 NA Dt Bottom Dosing NA Header / Man. / f 93 93 0! atop. la-" Aeration NA Dist. Pipe 1210 t •o luz. 613.75 - p Holding Bot. System 13,3 47- PUMP/ SIPHON INFORMATION Final Grade Manufacturer 1 -11-1 'Demand /p,p ' •76 Model Number GPM TDH Lift Friction ystem Ft Forcemain Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM BE N Width Length No. OLTrenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Z DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LE CHING Manufacturer: SETBACK INFORMATION TypeO 8~ Y~ Z CHAMBER m er: Systerrt~6 S51S OR UNI DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x 4Hole Spacing Vent To Air Intake Length Dia. y Length r ~ Dia. Al K Spacing ~ A57M * 2,74in ( SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Se dded xx Mulched Bed /Trench Center Bed /Trench To Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) (p`71 lea ~iltutt7lG`L`Qyr,Q. H (J O&L CU Q)i(0~ AV d k rwwd 1.- 7, Plan revision required? Yes 1'Z No Use other side for additional information. I v ~8 / ? s SBD-6710 (R.3/97) Date Inspector's S nature a o. ADDITIONAL COMMENTS AND SKETCH t SANITARY PERMIT NUMBER: Safety and Buildings Division v■~r■r, SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number V1,9 1-7 IT The information you provide may be used by other government agency programs Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. l (-1 Rte/' N" le ~ /'1~ State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT JALL INLE RMATION Property Name P opert Location ~'L 1± alANF 1/4,S ?7 T Z`? ,N,R/ E(o Property Owner's Mailing Address Lot Number Block Number d '`S City, State Zip Code Phone Number Subdivision Name or M Number o / Sao/(o c~3k~>Z76 AA[-AND YkA1e1F I. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village ~/`~~PL Public 1 or 2 Family Dwelling - No. of bedrooms Town OF !7 UQ0 E 44 III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) a7. a9. P7. 17/_ '0 3,3 4, 1 ❑ Apartment / Condo 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. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an -----System System Tank OnlyExisting System ---------Existing System B) A Sanitary Permit was previously issued. Permit Number q I'?~ Date Issued /-/$-9 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 124+:4 Seepage Trench 22 ❑ In-Ground Pressure 42 E] Pit Privy 1 WE4 Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade &00 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation -7 5 la ~a ® •'8 a+ Feet Feet VII. TANK Ca in galloacitns Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks . Manufacturer's Name Concrete Con- steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank / Z S~ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamberl I I 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) L, Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: 0 [me ;L Plumber's Address (Street, City, State, Zip Code). I IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issue Issuing Agent Agent Si nature No Stamps) Approved 1-1 Owner Given Initial Surcharge Fee) IZ,3E7.~ Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) DISTRIBUTION: Original to county. One copy To: S-fety & Buildings Diw.ion, Owner, Plumber INSTRUCTIONS 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. 3. 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, 608-266-3815- To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. 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. VI. 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 1/2 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 •:urve; 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 (`ees) 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- I N v N- 4, i i z w ~ ~ ) o ~1 ~I L_-. .....l~....... I a i ? I l1 ! n i i `L I Lai I I a ~ S I o M I ~ o I I •o W a V) 14M /1l /IL F14 13N0LN1VD5 j~kAlrzr~ ~vT ~ ~?9 ptEUYhAIJtE GA,gi~c TX~*oZv-I33 ~,,o sys7Eni ~r~ 92,~~Sc,c,E~jy~'=~Q'R~V_!SI~N13f£r~ _ Ara1 % h~~ d~rr~ S-o3;ac~ P ~rnlT- Z9q 7S EAS7 leT L INE -L 3 Z ,q~ SE CoQ,~tl t . y DoT ~ 2 to j g oo Ae I bklVE 4, w rt p 6~ f ii bd ~J.rvSE ;o N w 'N to c e ,3 V► ~ _ - _ -_=._.~.._~_~._-off - Al. ~ i `y /4 l7~/LNA-1C - T dM 2" ~vC I I c t (1 B,~*~z AfR/~ tAr ?IL F r ~oc,aoi i 1 µ Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County GI~'D f than 8 112 x 11 inches in size. 'j • See reverse side for instructions for completing this application State Sanitary Permit Number : -iql~~ The information you provide may be used by other government agency programs ❑ Check it revision to previous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Propert Owner Name Property Location {r~+ U,~ /4 At P 1/4, S T j , N, R t E (o., Property Oner's Mailing Address Lot Number Block Number City, State Zl Code Phone Number Subdivision Name or CSM Nu ber II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town of 111. BUILDING USE: (If building type is public, check all that apply) arcel Tax Number(s) 1 ❑ Apartment/ Condo 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. Iq New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an _____System ________System Tank Only______________ Existing -System _____ExistingSystem B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 E] In-Ground Pressure 42 E] Pit Privy 13] Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) c~ Elevation f 0 __1 . Feet 1". SO Feet Cagacit VII' TANK in aNo s Total # of Prefab. INFORMATION Site Fiber- Exper. Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank %f-f-a 1:1 El ❑ Lift Pump Tank /Siphon Chamber ❑ ~ El ❑ 11 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stampsl NMP/MPRSW No.: Business Phone Number: h o Plumber's Address (Street, City, State, Zip Code): n IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa tart' P rmit Fee (Includes Groundwater ate Issue 9 Issuing A ent Signature (No Stamps) `Surcharge Fee) Approved ❑Owner Given Initial/~(~ Adverse Determination (((JJJV X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHO-6398 (R. 05194) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 11- A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. 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, 608-266-3815- To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of uvhere the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. 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. VI. 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 1/2x 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; C) 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. x t oS k}y7 T 3 4~~ ~L L N-~. N r r rN, v _ 00 v v a d g w w~ 4 71 r s CIO . ee. Q ~ T1 'ISN r) w kAr o r N rq •i 41' i y 01 I I O ~ I ~ cil rq I 9 I 1 it I z o ~ I I I I ril U L ' M W 42 'o r c 71 t.y o 0 1 °;s z ; r Wiscohsin Department of Industry, SOIL AND SITE EVALUATION • Labe; and Human Relations Page of 3 • Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 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. # 0,2o-i~ ~y-yv APPLICANT INFORMATION - Please print all information. Re iewed by Date Personal information you provide may be used for secondary purpos , s. 15.04 (1) (m)). Property Owner Property Location Richard Stout Lot 1/4 SW NE 1/4,s 2 7 T 2 9 N,R 19 (or) W Property Owner's Mailing Address LoI Block# Subd. Name or CSM# 1353 Awatukee Trail adlands Prairie City State Zip Code , , Phone NPmbe T - ;pity ❑ Village FC1 Town Nearest Road Hudson WI 5401h 1Yg731 udson Hill Farm Rd (X] New Construction Use: ® Resident / ft~e of bedr 's - Addition to existing building ❑ Replacement ? t ❑ Public or cc 61, a f s n ~a Code derived daily flow6 0 0 gpd Recommended design loading rate • 7 ._bed, gpd/ft2 • 8 trench, gpd/ft2 Absorption area required- bed, ft2 7 5n french, ft2 Maximum design loading rate -_7 -_bed, gpd/ft2 • 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) _ q $ ft (as referred to site plan benchmark) Additional design/site considerations Parent material _-G lao ial depesit_~- 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 [3d S ❑ U [ S ❑ U k] S ❑ U Ws ❑ U ❑ S ®U ❑ S k1 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots - Bed ,Trench 1 1 0-10 10 r3 2 none L 2mabk mfr cw 2m .5 : .6 2 10-32 10 r3/4 none sil 2mabk mfr cs 1f .5' .6 Ground 3 32-89 10yr4/6 none s osg ml cs .7 .8 elev. 100 -.5_ft. Depth to limiting factor 8g__in. Remarks: Boring # 1 0-1 10 r3 2 none L 2mabk mfr cw 2m .5 .6 2 2 12-42 10yr3/4 none sil 2mabk mfr cs if .5 .6 3 42-90 10yr4/6 none ms osg ml cs .7 .8 Ground elev. 9 8 .9-0_-__ft. Depth to - - limiting factor g0 _in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST NUrrlber ~`"?~iOP€RTYOWNER Richard Stout SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# 30ring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 3 1 0-2 10 r3/2 none L 2mabk mfr Cw 2m .5..6 2 24-52 10 r3/4 none sil 2mabk mfr Cs 1f .5;.6 around 3 152-90 10yr4/6 none ms osg ml Cs .7 .8 alev. 9 6 ._9 -ft. depth to uniting actor 9 0 in. Remarks: 3oring # 1 -6 10 r3/2 none mabk fr w _2M ~.6 4 2 -24 10yr3/4 none it mabk fr s if .5 ;.6 3 4-9 10yr4/6 none s sg 1 s - .7 '.8 ;round >lev. 96 -1 0 ft. )epth to imiting actor 9.0 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 1 -6 10 r3/2 none mabk fr Cw 2m 5 2 -38 10yr3/4 none it 2mabk mfr Cs if .5'.6 3 8-9 10yr4/6 none s sg 1 Cs .7..8 Ground elev. - 98.40 ft. Depth to - limiting factor -5-0-'n. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) toy I-a $c a/ -G / '1G" o~~a 41 Q~ b aa' ~ e STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERIBUYER r „~d Nr 1 1 ld Lm- It , MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE + r.{ f 1/4, Section T N-R(W PROPERTY LOCATION 1/4 TOWN OF .t'_.j ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER +7 CERTIFIED SURVEY MAP- -6 I VOLUME(-, , PAGE ~ ~ LOT NUMBER - lea 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 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 60% of the cost of replacement of .a failing 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 mater 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 (if 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 County Zoning Officer within 30 days of the three year expiration date. SIGNED: c-4 J DATE: l 7 7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 S 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 the appropriate deed recording. Owner of property S 14 t`ki fj j'/ Locationofproperty_c3L1/4NF 1/4, Section 2-,TAN-R/ 0 Township, v,. ` '-t•/ Mailing address c"n,k °x" N + r D -n 4 k/ ► Yo l ' Addressofsite Cc"?`' PEI, ~i . f /sl,c>'~ Subdivision name L f011) 1 A M D Lot no. Other homes on property? Yes=~ No Previous owner of property P IC 14 jo tC t~) ~ o u r Total size of property ? , p tA- t,_ Total size of parcel Z' 0 y4 C, Date parcel was created 1 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? N- Yes No Volume 124and Page Number A;*4 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 AND 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 (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.Gal , 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 the County Register of Deeds as Document No. S_Ignatu of Applicant Co-Applicant Date of signature Date of Signature 565615 STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED DOCUMENT NO. WOL 1265 PACE 53 WISTER'S OFFICE i Richard 0. Stout ST, CROIX CO,, WI IReo'd for Record SEP 19 1997 conveys and warrants to Sam E. Miller M Register of Deeds n I THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS I~ the following described real estate in St. Croix County, State of Wisconsin: Lots, 33, 26, 41 and 43, Plat of Badlands "T ~S! Prairie, Town of Hudson, St. Croix County, Wisconsin. i' !i ~I PARCEL IDENTIFICATION NUMBER I( +I I i T N I~ F li I I I~ li li ii This is not homestead property. (is) (is not) Exception to warranties: easements, restrictions, rights-of-way and covenants of record, if any. I! it ii Dated this 19th day of September , A.D., 19-_CL7-. (SEAL) (SEAL) *-Richard 0. Stout i (SEAL) (SEAL) .I ii AUTHENTICATION ACKNOWLEDGMENT j' Signature(s) State of Wisconsin, ss. St. Croix County. authenticated this day of 19 Personally came before me this 1 9th day of Gl FILED ~ a 7 1998 ,1UN Y ~ THLEEJ•1H•WALSH Register of De W 9 1/ SLCco►xCo~ ` C\~" \ SS11.54 CERTIFIED SURVEYMAP Located in the SW1/4 of the NE 1/4 of Section 27, T29N, R1 9W, Town of Hudson, St. Croix County, Wisconsin. Being Lots 25 & 26 of the Plat of Badlands Prairie. Bearings referenced to the East line of Lots 25 & 26 of OWNER the Plat of Badlands Prairie, previously reccorded as and SAM MILLER / MILLER CONSTRUCTION assumed to be N00°00'20"W. Trout Brook Road Hudson, WI. 54016 LANE / / - - / rs N 89' 53' 36" W 187.80 24' utility easement LOT 1 87,120 square feet ( 2.000 acres de . Nolffi CO & septic ver" .05 N 8 ' 59' 47" E 1 3 N 02' 35' E 213.23 Sys ~j o t{89' Note: o~adupiebywp°ned. rrE ? Q T Z j $ zl W/LFRED ROAD LOT 2 WI W ~ ~I 87,121 square feet 05 ( 2.000 acres ) - - - - - - - i $ N O. 0?' 'f~'il•i9po of ~ drainage easements co H. W. L. 934.7s i- , ' 66' 1 R1 9A N • '$5 w'F 149.57 I I N 89' 59' 42" E 425.28 NOTE: no new lots have been created. The purpose of this map is to rearrange the lot line between Lots 25 & 26. The LOT 24 I septic system on Lot 26 encroached onto Lot 25 so the lot SCALE IN FEET 1" _100' line was moved to accommodate the septic system. This map will replace Lots 25 & 26 of the Plat of Badlands Prairie. 0' 50' 100' 200' 300' CURVE INFORMATION LEGEND CURVE 1-2 CURVE 1-3 . -indicates 1" iron pipe found. Radius- 237.00' Radius- 237.00' Delta- 89°12'53" Delta- 90006124" ti i CERTIFIED SUR VEY MAP Located in the SW1/4 of the NE 1/4 of Section 27, T29N, RI 9W, Town of Hudson, St. Croix County, Wisconsin. Being Lots 25 & 26 of the Plat of Badlands Prairie. DESCRIPTION.- A parcel of land located in the SWIM of the NE1/4 of Section 27, T29N, RI 9W, Town of Hudson, St. Croix County, Wisconsin, further described as follows: Lots 25 & 26 of the Plat of Badlands Prairie, containing 174,241 square feet ( 4.000 acres ) more or less and being subject to easements, restrictions and covenants of record. SURVEYOR'S CERTIFICATE I, Joseph W. Granberg, Registered Wisconsin Land Surveyor, hereby certify that by the direction of Sam Miller ( owner I have surveyed, divided and mapped the lands shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes, the Land Subdivision Ordinance of St. Croix County and the Land Subdivision Ordinance of The Town of Hudson and that this map and description are a correct representation thereof. 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 St. Croix Zoning Office and the appropriate Town Board for advice. This instrument drafted by Joseph W. Granberg G $ Dated June 11, 1998. , JOSE GRANBEK t N RI D •S U IR