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HomeMy WebLinkAbout020-1264-30-000 n CO) O j 3 d c d + O 3 1D co C, n .6 Z O N f/) 2 .cNO N w m c • m H t o cNO o R j co tD (D p ° v F3 F~ co co CL O 00 A O O ! N° O cn o c a) Do ? ° o p o g y CD p C rn _ W 0 v) N co ° 0 m ca N co 4 ~ 3 O co con 10 CD o tin F 4 -4 a 3 Ch 0 rT c z 000 rr cn o' CD m eD H co m CD jll co 0 I c. w o Z Z~Z p I n ' c m:F s H• o m y D ~ a ;a cn CD N FL W CD z (D c6 cn a v z a o. ~ Z`2 c~NO CL Z A O Z m ~ I w Z O Q i d C I 0 v c o a cD N I 'I e I ~ I ! I t I Q' I i a I O N vA 0 b b I a CD aro A W b9 0 r O O CD C °o a- f r STC - 104 ~~9 ? AS BUILT SANITARY SYSTEM REPORT <pNN UNnk p f ppppjOF c4OWNER DLA LC) SF)A~J'~~'. ~1 OT t a ADDRESS SUBDIVISION LOT j SECTION o$ / T_al_N-R I g W, Town of--AkAlllSCt` ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM _ "4 4 y BeOROar~ acs' 0 ,y. ` a -TRQN~~PS IaOU ~i' ~ A~ s~ IC 1 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to cent- ~ ti BENCHMARK: f0 0 ALTERNATE BM: SEPTIC TANK''/ PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:- Wye ks Liquid Capacity: aUQ I Setback from: Well fVo iri House ( Other t Pump: Manufacturer Modell Size Float seperation Gallons/cycle Alarm Location ;SOIL ABSORPTION SYSTEM Width: Length j Number of trenches a Distance & Direction to nearest prop. line: OV Setback from: well: NoiN House Other S? L - I~{p~h <9S.S3 - 95~~ ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system H 9S S v Existing Grade SA,E Final g rade y S Il 4q Rb ~ DATE OF INSTALLATION: TY PLUMBER ON JOB: 7,4 LICENSE NUMBER: 1~o INSPECTOR: 3/93:jt t Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor acid Human Relations INSPECTION REPORT ST. CROIX S-Pety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 289317 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: SHAVER, MANILA HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 020-1264-30-000 TANK INFORMATION ELEVATION DATA A9700131 '101E Z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark S7~ /GU-Gci Dosi 9 6 Aeration Bldg. Sewer Hol mg St /A Inlet TANK SETBACK INFORMATION St/ Outlet 3,y,3 TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet rl Septic c~as' ~ / y4 NA Dt Bottom Dosing NA Header / Man. 70'OS Aeration A Dist. Pipe 31 Holdih _ Bot. System /-11' PUMP/ / SIPHON INFORMATION Final Grade Manufacturer Demand Mo el Number GPM TDH Li Friction Ft F cemain Length Did. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIO SYSTEM TO P / L BLDG WELL LAKE/STREAM LE Manufacturer. SETBACK AMBER / INFORMATION Type O //a,,~ r Moe Number: System: Erg n~ OR UNIT DISTRIBUTION SYSTEM Header'. ~ Distribution Pipe(s) ~ Hole Size ~x~~J_Vent`ro Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mou r At-Grade Syste Depth Over Depth Over x epth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No r ❑ Yes ❑ No n R r COMMENTS: (Include code discrepancies, persons present, etc.) VA, LOCATION: HUDSON 29.29.19.1284,NW,NE 50ja COUNTRY VIEW OT 1, r f / ~ a'..,:' ~'lli.".,~✓~ s r r~-r'...~,y/ 6-.~.,r tr, A.✓; ~~n.,t.~~~ j~..l/t + . .~~'-'i1f.c(~ 1?..~ CFC <~f' ~Y~U~. ~Y ,L~-•~ ,G~^~ ::1r-~C ~'cP 14- Plan revision required? ❑ Yes ❑ No Use other side for additional information. I SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: - ' Safety and Buildings Division ^•p`'■•i ; SANITARY PERMIT APPLICATION Bureau of hinging 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 r than 8 1/2 x 11 inches in size. 5+. C-PO)x • See reverse side for instructions for completing this application State Sanitary Permit Number ❑ Check if revision to 7pevious application The information you provide may be used by other government agency programs (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION P erty Owner Name Propert Location r~AV e W/4 /4 1/4, S o~9 T a9 , N, R' E (or) W Property Owner's Mai Ing Addr Lot Number Block Nu b r 4 Co R vj,e w City, State jj'' NI/W(P ode Phone Number Subdiv on Nagte or CSM Nyumber n G N 1 ( ) os o N S 1.04R V e II. TYPE F BUILDING: (check one) E] State Owned ❑ cityy 10 Barest Roa ❑ Illage Public 1 or 2 Family Dwelling - No. of bedrooms own OF LADS d ~,K W III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 Q I 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. E] Replacement 3, E] Replacement of 4, E] Reconnection of 5. E] Repair of an Tank -__~System ________System_____________ ly______________ Exist-- -ystem Exf--- -System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ;Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ 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/d /sq. ft.) (Min./inch) H '?S~50 EI va#~ 1 QU 750 Tsc) r l.. 9`f, y0 Feet F 2 1 ~•Wet VII. TANK Ca in g Capacity Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank ~a QQ 1 (wee ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ 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 Sign ture: (No Sta ps) P/MPRSW No.: 7-113usiness; Phone Number: M kA n!~Ksjd-:2 F, I Plumber's Addres''s 44 Street, City, State, Zip C de): 010 h w S (ADJa ~ f 5 yo (p IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A ps) proved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety a Buildings Division, Owner, Plumber INSTRUC=TIONS , 1. 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 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. 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 8 112 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; 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. N A M E E~k S h p e Pl- t E~ L C A 10 f~1_.ou N I C E N S E h ' °r~ o i ►.Q • • % ~o IZ~Z G 4 J rt~m P , W e 11 i s z FO N 01 I (ar pVc ; IQ 0 ' Sk7J ' ~1 1 C i S~3 C'1^~, &nac,bw. 0° l9al By . Slbp~ lob P~~11G tin ~ND G 1 ~►uC~ FRESH AIR INLETS AND OBSERVA'r10N PIVE C1:09S SECTION Approved Vent Cap (9P" Minimum 12" Above I 1 Nb Final Grade__ H I I A % L U,7 4" Cast Iron Above Pipe Vent Pipe To Final Grade! WiscBnsin Department of Industry, SOIL AND SITE EVALUATION ",,Division abor and Human Relations Page of of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 81/2 x 11 inches In size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and 6r. C f percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # azo- ~Z~y-3~ APPLICANT INFORMATION - Please print all Information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location G G /3vO Syi~}U~R Govt. Lot /(/iV 1/4 NE 1/4.S T Z9 N,R E (ore Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 3Z2 piv& 5r • t7 (~oSSI►-BU'S 461j.,TjeY D(Gw City State Zip Code Phone Number Nearest Road ~j/UQSd.J ~l/. S 4 Ol 4' (7/.-) 3$(O• (00 S,8 ❑ City ❑ Village own Ld' U,u)4'P AeS ~ New Construction Use: [B Residential / Number of bedrooms 13 Addition to existing building F04 E'~ B B ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 7? gpd Recommended design loading rate bed, gpdHt2 _'O trench, gpd/ft2 Absorption area required bbd, ft2 trench, itt2 Maximum design loading rate bed, gpd/tt2_P_trench, gpd/Il2 Recommended infiltration surface elevation(s) Sow- p5 .3 - n (as referred to site plan benchmark) Additional design/site considerations Parent material 4&44Y ~u Ss}.vDY 00740/t 94-L • Flood plain elevation, if applicable LVI ft S = Suitable for system Conventional Mound In-Ground Pressure ,AST-GG!a e System in Fill Holding Tank U = Unsuitable for system 8 ❑ U D s ❑ U Ers ❑ U L_f S ❑ U 2-g, ❑ U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/112 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench / o -/o /oy/2 1-z- SZ /-fsh& M1 v s 2 f • y ; , S z -17, 16 3/ SL / f 5-ewAf s / • Ground 3 7• 1. /O y 31z( SiL Z -F s tiL- A, Yom' ' 4_5 / v f . 5 ; Ploy. Z - /oY / s /fir ~S c s g 9 6 Vve S/ S CAS - •?'.e Depth to limiting factor Remarks: Boring # p /0 2-/Z SL 705, Am u 725 C 5 L • . S 2- C_2z) /019 36- Ground o 3/ she f - - . S g' ft. Depth to limiting factor in. Remarks: • TjephQn, e6 9165 CST Name (Please Print) A O R e R'F 74LO R f C Signature L IS O Address IC Date CST Number Ulbrlcht & Associates 4 V 3- rj' C 5jr A! 2V S 2_-__ PROPERTY OWNER (3 .5ffAV~{~ SOIL DESCRIPTION REPORT /ep S'5~.~(rS page 2 - PROPERTY -3 PARCEL I.D.# d Z d - l Z. (I Y • .3 a 1-6 7- / 7 411,-,7f Qv Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench o-~ AlYX 2/ SL / 7,~s,6,e 'j" PAS 91 s 3 -f _ q s Ground elev. ,3 2 /0 3/ lL 1 f s h' U, 6e cLv . s ; . Cp . y'~.~ott. A S 0S GQ C'S' Depth to d /o /Z S D ,Q_ - - . S limiting ; factor Remarks- Boring # V4 2-/z- L2- .31Y /0 31 t/ LS / eS '•Sp Group VA 1 J0 Yt 516 s d s Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure G D/ Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # / -8 10 M Z SL l ~J ."U-FK C S f- .4 ' . S 3 /o S! S D ~.Q- - Ground elev. 5. (.eft. Depth to limiting factor Remarks: Boring # Ground elev. n. Depth to limiting factor In. Remarks: SBDW-8330 (R. 08/95) .z2 o /9o Nd • Apr 3Y6 ZoY SGT} = /3.4 P rS ~~.t U~tTio~ S 13R SET: 7-dp of yy~ ~ltv, = /oo T9.6 3 s -y~G3 I~~ I~~ I 5 r,+let0 I IIy our 137, slre- is I ~S (3, 135. 112' 0 T of of l°UC ~dtc~ fit/'-et-rGG~ I ~ ~Q ! ~/tom, = / G 1. YZ' d M O o N N 0 i t to N ~ . 1 ® 1 v 3 v N 8 ~ 25 O N 1 ` ~ ar t` 89,087 SO. FT. 1 , 0 C ` t 100,375 SO. FT. Z 2.05 ACRES 2.30 ACRES to o N88°28'00°E 346.22 w ~ to N1 O } t \ 2 ~sS J 9s , ` Wt J I V, t O S`S90 z ' ~3 F 00 v 150,889 SO. FT. z Z 3.46 ACRES c 16 112 , 955 SO. FT. 2.59 ACRES 246.79, 370.95, S 89° 15'22° W 617.741 .908 1 . OUT-LOT I in 296,338 SO. FT. 6:87 ACRES ORp,~NAGE ,'I WATEa FILED 2 UL27 00► O'COWELL 460842 r CERTIFIED SURVEY MAP Located in part of the NWh of the NEh and in ppat o h 'aip SW's of the NE4, all in Section 29, T29N, R19~1'3lgytz N Hudson, St. Croix County, Wisconsin; being s &y',~~'` , 25 and 26, Plat of Rossing's Country View Viist A 4, O y, r T 41 u 3 4 V) N NOTE: No additional land parcels have -0 = been created; does not need Lot 23 i , Cpl l r r• o r_ d O approval from the St. Croix ~'L+yl :rz C. County.Zoning Committee. d c 0 n 1.. c,tuir'y, ~X1r }4y. ' N89 15 22 E (~*:13.'i.~•rxr; ~ 'r 166.001 41 N O N j l`. 01 N 'O , L L. 7 A L. N T N O In N M C ,off Lot 24 3 r r SCALE IN FEET ti`' O 1 y,t a Y~~ x- 100 0 100 200 I 66 o a tl\ z , s. NJ Corner of N8901512211E 300.00' 70..00' 3ci Section 29 _ N8901512211E 370.001 (P-K Nail) T (I C; I O O N IC9 O 1 w jC Z Lot 18 5 r, co I I~ LOS 26 N~ LOT 25 0 , d CD 165 B39 S Ft 100,976 Sq. Ft. q' 2.32 Acres co 3:81 Acres °i N8802810011E 346.221 1 w~ 4 ; i N O t0 `V, , 4 . h tiZ'if./ ,,S oc `p•' 04 141 ti~hv~ CIO / O vjF 'yS9oSS Lot 28 O ~ SS~ `912 1.00, ~n0 of / 90 N08°57101 t1W v i 4, 0'66 .90q 0 \ L 3 0'4 , `84.951 0 41 LOT 17 L.o,t 29 N 0 C\; u o w o °O 156,288 Sq. Ft z LOT 16 z ~ 3.59 Acres 107, 546 Sq. Ft. 2.47 Acres A*t°~ Ooze . ~ e+ a • 995_nfi1 322.68' a~" ~.°w'o" '~L. ~4.•; CURVE DATA CURVE RADIUS CENTRAL CHORD CHORD ARC TANGENT TANGENT NO. LENGTH ANGLE BEARING LENGTH LENGTH BEARING BEARING 1 - 3 300.00' 26043'04" S46°34'05"E 1138.63' 139.89' S33 01213311E S59°55'37"E 1 - 2 300.00' 15022'04" S400 53'3311E 80.22' 80.46' 2 - 3 300.00' 11°21'00" S54°15'07"E 59.33' 59.43' 4 - 5 234.00' 59045100" N3000310711W 233.12' 244.02' N59°55'37"W NO0°10'37"W 6 - 7 300.00' 24°07'49" S420 08'17.5"W 125.41' 126.34' S54°12'12"W S30°04'23"W SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify that by the direction of Sam Miller, I have surveyed, described and mapped 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 NA of the NE4 and in part of the SA of the NE4, all in Section 29, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; being Lots 16, 17, 25 and 26, Plat of Rossing's Country View First Addition; further described as follows: Commencing at the Na corner of said Section 29; thence S00017112"E, along the north-south 1/4 line of said section, 1228.42 feet to the point of beginning of this description being the NW corner of Lot 17 of said Plat of Rossing's Country View First Addition; thence N88028100"E, along the north line of said Lot 17, 346.22 feet to -.a 300.00 foot radius curve concave northeasterly, whose central angle measures 26043'04", whose chord bears S46034105"E and measures 138.63 feet; thence southeasterly, along the arc of said curve and the southwesterly right- of-wthe town road (Country View Road), 139.89 feet to the point of tangenc~;"-thence S59055137"E, along said right-of-way, 366.34 feet; thence N08057101"W, 84.95 feet to the southerly most corner of Lot 26 of said plat; thence N59055137"W, along the northeasterly right-of-way of said town road, 312.85 feet to the point of curvature of a 234.00 foot radius curve concave northeasterly, whose central angle measures 5904510011, whose chord bears N30003107"W and measures 233.12 feet; thence northerly, along the arc of said curve and said right-of-way, 244.02 feet to the point of tangency; thence N00010'37"W, along said right-of-way, 120.90 feet; thence N89015122"E, along the north line of Lot 25 of said plat, 300.00 feet; thence N00010'37"W, along the west line of Lot 26 of said plat, 290.42 feet; thence N89015'22"E, along the north line of said Lot 26, 166.00 feet; thence S19005'26"E, along the north- easterly line of said Lot 26, 460.24 feet to a :.300.00 foot radius curve concave southeasterly, whose central angle measures 24007'49", whose chord bears S42008117.5"W and measures 125.41 feet; thence southwesterly, along the arc of said curve and the southeasterly line of said Lot 26, 126.34 feet to the point of tangency; thence S30004'23"W,,along the southeasterly line of said Lot 26, 286.56 feet to said southerly most corner of Lot 26; thence S08057'01"E, 84.95 feet; thence S40048122"W, along the southeaserly line of Lot 16 of said plat, 220.17 feet; thence S89015'22"W, alon-g the south lines of Lots 16 and 17 of said plat, 617.74 feet to the north-south 1/4 line of said section; thence N00017112"W, along said north-south 1/4 line, 444.30 feet to the point of beginning. Above described parcel is subject to all easements ror.~rrl S '1' ( ' - 1 0 S SEPTIC TANK MAINTE.NANCF, AGREFINIFXF St. Croix Count, oWNl:wl;uvF,Tt M"ANG ADDRESS 3_ZZ. PIAJ STR~ (-lvnso,~~_ ~4J~ ~SY~Cb_ PROPERTY ADDRESS 506 Ce u,~jrg e Uc e:~jJ c.Je Syo~-~ (location of septic system) Please obtain from the Planning Dept. [S C'c.7$I,~.J Hoos - E PROT'F,RTY LOCATION NW 1/4, Vly 1/4, Section -I' N-It TOWN OF ~-tu►DS©I1 ST. CROIX COUN'T'Y, \%,I SUBDIVISION (R056/N(~S ~OrJl~3TIP1 Ult'h.) ,0'1' NC)M13EIt _ 7 CI:RTIFIEDSURVEY MAI' ~6o"I'VOLUMT 8 , PAGE-V, L,01' 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 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. 'llic 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 systcm 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 /We, the undersigned have read the above requirements and ag,rce to maintain the private sewage disposal system in accordance with the standards set forth, herein, as scl by the Wisconsin DNR Cell ificattoll stating that your septic has been maintained must he completed and Ictun►t•d to the tit Croix County %oning; Officer within 30 days of the three year expiration date SI()N1:1) DATF St Cloix Connly 7.Iming; OIlicc S-' ~Z-9~ ( ~IIVI.•Illln~'lll ( elllt'I 1101 t'attnn-havi Read 404 1111dst,n. %YI 'A016 S ►Z~i~ 8 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 the appropriate deed recording. Owner of property MAAl,)1L,4 zz""k ,z 4- T]eese- x-(/}-(, pE Ack Local ion `o:f property s2~Ll/4 ~ 1/4 , Section T~N-R /~j' W Township )L100S0,AJ Mailing address ~ZZ j01AJt?- STET Address of site SOCK (6--)2-)rRyU1="LJ Subd i vision name _I&CS'Pros &nj,~Jm-e Ulo-j Lot no. Z Other- homes on property? Yes_~4 No Previous owner of property Opr A Total size of property Sa /~.~`S Total size of parcel 3 5~7 /~-CtQ~"S Date parcel was created ZS-9a Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? X Yes No Volume 8 and Page Number 7F,4(2 as recorded with the Register of Deed!:. 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 reforonces 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. "IS7 C? SZ and.that I (we) presently own the proposed site for the sewage disposal system or'~,T (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' nature of Applicant Co- ppl fit W"-.4jl Li+ l Z -ter ~ - _ - - s 1,.It " l iflil it.ure Dat-o c,f Signature oocuMKylT No. BTATR BAR OF W@)CONM PORN 1-I M me esaea seeavaa m asaeaa•ae 6"A A WAR RAM CM CAM 18 REGISTER'S QT*X This Deed, =a& between 1MA..M,114tx-a- thnc~+t ~~a. _ _ ~%ed %r Qcbp APR$ 5 IM r. aui......llitt►11a1..5~,...~A#7!!~t_ .ad................................ v. h a'v_if0 a 4:00 P. arital ro rt - - That the said Grantor, for a valuable aomiderstieft- r y.. to Grantee the following described real estate in ...._...St..-CCO <Z--- swr'L mart ~.~t Ceunq. Kit:,e at wlseon.ia: Boy -2 s ! M'.scs~e..~ W. SV a Task Pared No: Lot 17, Rossins's Country Viers first Addition to the Tom of meson, ft Croix County, Wisconsin. F. i f This ba®esaad property., i! Tagother will aR and singular the beredhawaste and appartewaaeas thasnoate belonging; AaAb......... BM.I...21i]Le........................................... wa rams that the tit, is good. indd%mmbie in too simple and ree sad ebb of encumbrances essept and defend the sane. aM wilt warrant Dated . ..................;7-! Ll day of ..........I1p>~il-------•---------............--•- 19.9II... if ......(SEAL) • • 1 (SEAL I'. SAM E. KILLER - - (SEAL) (SEAL) II r ~ AIQTHNNTICATION AaNNOW LNDGMZNT If it its) _ a.._ E. Millet • STATE OF WISCONSIN 9!!~ .~.A-!----_-_.__---•---••- - . a• County. came before me this ----------------day of aotleUtkett this t!..dq oL------- /lptil......... 19jM_ PrtssasHs - 19-------- the above named ..._...b..- .toffs z~ Kit - ?WMS ItEYBM STATE BAR OF WISCONSIN " Ea i wed b-r♦ 70A-OA. wig. Stab.) to me known to be the person who executed the foregoing iaetrmommeat and acknowledge the same. l . t +x. OCCUMENT No. STATS "a of WISMU M Toax i- Iwo w kcs aseeeMO FM MOM"* am « QUIT CLAN OW SW ,YC k REGISTERS OWAN Sam so »Miu.: - qW w fzl IIK°i ii i...»~..._. _ - _ xPel . d 11:31 A F, k.`t N » a~. Is co ~soi .»...........w... a..y4 As Moviar de wbW at"* of wkeonda t .BRIM Ve All that part of Lot 17 of the Certified Survey MY In Velma "$"e Page 2249 that was previously sort of Lot 169 ~ amming's Country Vim First Addition ...a..,,......: TMParaoi not r.~. .ra beneelnd "$rW* Y t "b m (it not) Ammmat ,a . • vF _ ..»............(sset.~ ..:..ts • ~ 4itTSS~raeAaolr - •o=sowLSaa~aar~- JIi~Mbw( StA?SS ce••bz lux Tins: M STATZ i»....... » si t of Rie~oi~an r- 7►'-t'JK f. be u. p~r$= " dw Parcel 020-1264-30-000 02/08/2005 09:10 AM , PAGE 1 OF 1 Alt. Parcel 29.29.19.1284 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * SHAVER, MANILA & TERESE MANILA & TERESE SHAVER 506 COUNTRYVIEW RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 506 COUNTRY VIEW RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.590 Plat: N/A-NOT AVAILABLE SEC 29 T29N R19W 3.59 ACRES PT NW NE, SW Block/Condo Bldg: NE & NW SE LOT 17 ROSSING'S COUNTRY VIEW FIRST ADDITION A/IVA LOT 17 CSM 8/2249 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 29-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 869/18 2004 SUMMARY Bill Fair Market Value: Assessed with: 49325 336,100 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.590 38,000 222,000 260,000 NO Totals for 2004: General Property 3.590 38,000 222,000 260,000 Woodland 0.000 0 0 Totals for 2003: General Property 3.590 38,000 222,000 260,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 119 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 ely o FILED 2 1 JUL27 19900 , AyIES O'COWUL 460842 CERTIFIED SURVEY MAP 1 f r t ..yvi .r t Located in part of the NA of the NEB; and in .aZt~,.'.o'~';: \ y SWh of the NE 4, all in Section 29, T29N, R19Wt...Town -.of*.*...'.,~ ~T Hudson, St. Croix County, Wisconsin; being Tidt''s 1;rfxy',cl;~ jV 25 and 26, Plat of Rossing's Country View Vi' I6t ABtk'!Yiti~,•<'` " . 41 41 (n NOTE: No additional land parcels have n 'r a w '0 = been created; does not need Lot 23 ~t r'~ . v' r+'o 4) 0 r, 4) C W o approval from the St. Croix i `L+ c , f. ,r, c CD County Zoning Committee. rl N d L N89°15' 2211E W .0 166.00' ,i 4J -j L .4.: 7 O N L Vl M W O 0 N " M C A fnt....': , Lot 24 3 , 1 ^ t t 4k. SCALE IN FEET ~ 1 66' o : 100 0 100 200 I o a. i. N} Corner of N8901512211E 300.00' 70.00' Section 29 _ N8901512211E 370.00' (P-K Nail) I rn % 0 0 If7 O I O N w 10 O , IC Z , Lot 18 5 LOT 25 o LOT 26 N O N I , °o - w 1650;8.39 Sq:'` Ft. ' N 100,976 Sq. Ft. o0 0; co 3.81•. Acres' 2.32 Acres 1,41 ! I z N N88°28' 0011E 346.22' O 0 l~ f tiO~Vy' w / 0 S90 SS. Lot 28' SS10 9 v i w B 1R0 N'08°57' 0111W a 1 i s N, 04 84.95'. 0 C'j LOT 17 0Lot 29 ~o ° ~i 0 = 156,288 Sq. Ft z LOT 16 3.59 Acres 107,546 Sq. Ft. 2.47 Acres 295.06' 322.68' ~O°~0 } ~~a• ~ ` 1'` r, Gj