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HomeMy WebLinkAbout020-1088-40-000 ~o w o o6 ~ I M t h 0 N ~i I A. h I Z v z c LL c LL CO E Q U O O > W E Z w 0 _ z m F a rcvi z c O co O z c a0i Z o cl o CO F- rn I S (D '2 'a 0) N m (~1 O O • ~l a t O o C O Q Z H Z 0 z N ~ ' y ~ ~ I j E 0 I N ~i m d - is w LO c y N d N O G G a U .ro N co m m a~ =3 E 5 a 5 o z •N ~CL aa a fA J V j ~ O O r N 0 LO (D Vl a W (D O 'p d Q (/J t0 ~ N y H ~ 0 E C) V) O C o o N lot 4) :1 c u a °o °o 00 M~ ' y 0 'D N eN`- O CMO CD d 2 N 5 o .2 N C, cn N N N M L CO f0 00 0) t w l!y~,) • ~l O M C-4 (n 2 C~ N O Z C F- Cn Am. ~ 0 a #ti n d v~C~ _1 A c)a2 0 Parcel 020-1088-40-000 04/05/2005 03:09 PM PAGE 1 OF 1 Alt. Parcel 32.29.19.371 D 020 - TOWN OF HUDSON Current XST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * GISH, STEPHEN G & TERRI L STEPHEN G & TERRI L GISH 461 STAGELINE RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description *461 STAGELINE RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.500 Plat: N/A-NOT AVAILABLE SEC 32 T29N R19W PT NW NE LYG S OF HWY N Block/Condo Bldg: & E OF TN RD COM CL HWY N 835.8' N56DEG- W OF INT E LN NW NE, S 34 DEG W 225.1'S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 21 DEG E 37.51'S 48 DEG W 13.42'S 42 32-29N-19W DEG E 51.2'S 71 DEG W 340' TO CL TN RD NLY ALG CL TO CL HWY N SELY ALG CL HWY N more... Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1128/404 WD 2004 SUMMARY Bill M Fair Market Value: Assessed with: 48328 316,400 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.500 49,000 195,800 244,800 NO Totals for 2004: General Property 3.500 49,000 195,800 244,800 Woodland 0.000 0 0 Totals for 2003: General Property 3.500 49,000 195,800 244,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 145 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 -7 5 0115 e,'40 eO ? 1 o✓.4c~i Tv ,r. ri v~ • S,YS?E'y - Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page Of Z Labor and Human Relations _ Division of Safety & Buildings I r . t g .83.05, Wis. Adm. Code COUNTY ST' Attach complete site plan on paper not les 1/2 x 11 • ches in an must include, but not limited to vertical and horizontal refer int ~M), an pe, scale or PARCEL I.D. # U dimensioned, north arrow, and location tance t~~ar dd. O 20 - APPLICANT INFORMATION-PLEA NT3I~1.L "FOffilfilATI REV Y jDATE l5 (.01-1 C111 A_ ~yazvvp~' Q PROPERTY OWNER: 4 4y, ROPERTY LOCATION H U& J Q y G LC GOVT. LOT NO 1 /4 NE 1/4,S 3 2 T Z 9 N,R (o Wi W PROPERTY NER': MAILING ADDRESS ` LOT# BLOCK# SUBD. NAME RCSM# CITY, STATE ZIP CODE PHO []CITY []VILLAGE N NEAREST ROAD ffv S~~ GJ/. Syo/(o c7r~ 3~ -a3~S vpso.~ ST~4(rE~~;v~, ( ] New Construction Use [Residential / Number of b6drooms [ ] Addition to existing building ( [ Replacement [ ) Public or commercial describe Code derived daily flow 610 ° gpd Recommerided design loading rate t7 bed, gpd/ft2 trench, gpd/ft2 Absorption area required Z57 bed, ft2 7,4_0 trench, ft2 Maximum design loading rate 7 bed, gpd/ft2 trench, gpd/ft2 =5 r/Al .filtration surface elevation(s) 2 C, ft (as referred to site plan benchmark) Additional design / site considerations S£E- P6- • L Parent material -5~-e5 66P C3 o R K L., A R-D'T- Flood plain elevation, if applicable It S =Suitable for system CONY-ENTIONAI MOUND 74, R¢JN[]D U ESSURE AT=G U SYST u HOLDING S G~~ U = Unsuitable for system _S U S O U Ly'$ SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bot.llxI3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed fench / D, ~ ~ s/ Z~, •f,C/ GCs s . ~o L /3-1 /O r 1/2- 4S .fit -s G Ground e5 elev. 7:119 y f. l6 ft. - 174 /o 5111,1 es- Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: CST Name: Please Print Phone: ~71 Address: CSrdf 1 Sl Ainnnhira C nafn MT Numhwr PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. N " Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourd3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to liming factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: 1 16A '1A R Boring # i .w I Fw Ground elev. it. Depth to limiting factor. 40 O, ) U\ -4 U n C b " y m Ci c .b _ 11 it C Y 1 ,~jV STC - 10 4 AS BUILT SANITARY SYSTEM REPORT Tool ;F2.7 2.0 s o,~ c~,e G, ADDRESS r4~1/ ~l~~o,J Cv /S- S fro ~ ~v n~fs; l3ovc~~ S SUBDIVISION / CSM# N//1 LOT SECTION 32- T Z! N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM %f v 5 (3 d S K/e A-4 ItE 4f y IS/ ic 4 R o flL TA NL-s CAP" I'Al a4we- j~ God NeW T~tiit i S Q yr ORIGNAL INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. A T N w. Rasr- pTi~ o f tee.+ BENCHMARK: File(,, - /OD-a ALTERNATE BM: /,J Z, S-7 SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION D Manufacturer: LD Liquid Capacity: ~2 dD dY"` ' Setback from: Well House 36 , Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S / Length 75 / Number of trenches 2 Distance & Direction to nearest prop. line: 9 ate' ~/w Setback from: well: X/d ' House 5 , Other ELEVATIONS , Building Sewer ST Inlet: ~4' 3d2 ST outlet: S' lcl~ PC inlet / PC bottom Pump Off T ya.31 ~F 3, Header/Manifold Bottom of system Existing Grade 171"0 Final grade 36 y~- 13,q C,elt.ll l0 j/ DU-Gti DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 330-1 14f/"l~; INSPECTOR: ~D/h 3/93:jt t oF T P i CK Ptr/o _ /oa.a 13e PAP ~ocv~R w~~~ow s~/~ T We w 2~ \I SE~Ti' c 71- l oo ~a P . y" iwflve-7ivA-~ AF/pwES7~=~°t/ C C 1, 0 2y'~ ° f zN".vim A441 S yo h ~ is N~ /N/.lf~i I I 1 /fox Ilk ~ ~ ~ ~ TAP ~y ' ~ ~ ~ I ICI 0 `<I~I 1 y3. 26, fit 0 /1 o ~ a syST - 9 3 . /G y2 CG STG~Gia~" Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: 4aborandHumanRelations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 289326 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: GISH, STEVE HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 020-1088-40-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift `riction System TDH Ft oss Forcemain Length Did. I f Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION TypeO CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Mani old Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only DeOver Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched BeTrench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 32.29.19.371D,NW,NE 461 STAGELINE RD Plan revision required? ❑ Yes ❑ No Use other side for additional information. FE 1 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' 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 s/ Gi~~/X than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary 3Permit Number The information you provide may be used by other government agency programs E] Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION A-111+ Property Owner Nam Property Location ~ S4.cu e- ~ -5 VIJ /4 Nom' 1/4, S 3L T 21 , N, R E (or)(D Property Owner'Mailing Address Lot Number Block Number All Cit , State~O die Phone Nu ~1~ Subdivision Name or k`SM Numb r t OU _ rlfs II. TYPE OF BUILDING: (check one) ❑ State Owned 1` El City ~y Nearest Road ! ❑ V lage h/U,J 5! IRIT or 2 Famil Dwelling- No. of bedrooms 6rTown OF Public III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ©~D-~o88 -4ro~"a3a.a~.Iq.3~~D 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. [placement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an _____System ______System_----- __TankOnly Existing System _________Exi----yytem 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 Uj- eepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit + 7 R 43 ❑ Vault Privy 14 ❑ System-In-Fill 2 -neExAc4e.S .S 5 AULi/ VI. ABSORPTION SYSTEM INFORMATION: f 37, 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) ! Elevation & OV ?S© ~j • Feet rf S Feet VII. TANK Capacity Total # of refab. Site Fiber- Exper. INFORMATION in Gallons Tanks Manufacturer's Name PConcrete Con- Steel glass Plastic App New Existin I trutted Tanks Tanks Septic Tank or Holding Tank 7-60 D El E] Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ EEl 1 1:1 r_1 l ❑ El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu ber's Signature: (No Stamps) PoYWMPRSW No.: Business PF1Qne Numb Ulmer Iz/Ail334? If- 3,66 Plumber's Address (Street, Cit State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issue I ignature (No Stamps) XApproved ❑ Owner Given Initial / Surcharge f ee) Adverse Determinationi 9 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Dive ion, Owner, Plumber INSTRUCTIONS 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. 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 a-nd specifications not smaller than 8 1/2 x 11 inches must be submitted.to the county. The plan's 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 Joss; pump.,pgrformance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county;'E) soil test data o66 115 form; and-F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) fora 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. oTE- ny . 3 o-F 3 ~~i S7"/~v ~ f~/~ ..~P~-P~~, aQ2~d a~ ~ Two 1S iUo 7"' F /r 13e- y.-eWE- No QE~,~R Q~/~•t~.,., a. ~T G~9yi~V ~'s ~ ssv-y~D /.v ~/oT y ~Do tf°~ . ~,PE<,f s r 50fi c 7- A i& f -A 7i~ vu-~s /o w 7',~au q 3,x'0 F Ro,~ Iii C~ 5 oRa►~G~ (3 olp~ Tj~ExVGj~- _ P~ a ScALE . t 30 A`4 N~Nx TANKa°P~a~Y SACk4o~e /-).'TS AB~HA 33,03121 c~ STS' 6'EL i~vE y ` sus r' ~ . X56 11 1~`~ ~3 97, D l 1 13/ O , 1 1 1 1314 ` 8 1 ~ ~ 11 PEW jL w MPS ~sr \ - s Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations page of 'v"` Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. 1. 7L Rp ' Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must 4Rby Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. APPLICANT INFORMATION - Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). fi Property Owner Property Location ~ UE ! 0i~'RJ 4 (r•/-$ Govt. Lot 1/4 11b,S'~9 Ty r ~ E (or) W Property Owners Mailing Address Lot # BI k# Subd. Nam@ or CSM# 1F/ StA G~"~/N~' F0 N M~ETs '~b City State Zip Code Phone Number Nearest Road ff U~So~tJ GV/ S~o~W (7/~) 38C - 2g).1 El city Villas L•'J Town ST 1AW- Now Construction Use: Residential / Number of bedrooms 7 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: p Code derived daily flow gpd Recommended design loading rate ~ bed, gpde • d trench, gpd/Ftz trench, gpd/ft2 Absorption area required bed, ft2 7~~ trench, ft2 Maximum design loading rate gybed, gpd/ft2 • Recommended infiltration surface elevation(s) S.~ 3 ft (as referred to site plan benchmark) DiP~ ~dK ?>!ST,t~~,C~ v fio~J Additional desigNstte consl ations/1 ~s~ .CDiv Tip--,V a a5 Parent material S~J VR k~j ~D T Flood plain elevation, if applicable N it S = Suitable for system Conventional MMouunnd In-Gro wn Pressure ,AAT,-Gr a System In Fill Holding Tank ua s ❑ U L~ s El U S 11 U Lr~'S ❑ U El S U = Unsuitable for system ❑ U ld' SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDfft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench l / -a /a yJe 3/3-- //,fAe S 2 f . Z- 3 z /0 31/ sd~ d ti 2s / 2-:- Ground ,•S S/ .S s S elev. 97. Sift. Depth to limiting factor f fin. Remarks: Boring # <Si~ A/C v,6r 'el/ h S 7c-' • 2 ' • 3 y - j a JZLl SL / 5r,k danl CS /f • `f ; • S 3 o S s ~s '•S Ground % elev. nR r. i hii a I 111 19%0 Depth to limiting factor 7 A2e-in. Remarks: ` CST Name (Please Print) Signature " Telephone No. R-0 3 EER r W-4 6i l-44 f- 71,S 3 81x• 9/96 Address Date CST Number r n. PROPERTY OWNER S. 6~ 4SOIL DESCRIPTION REPORT Z .3 PARCEL LDS 02- O -108 S ~ /O Page of Boring # Horizon Depth Dominant Color Mottles Structure 2 In. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots Gr. Sz. Sh. Bed Trench x' I b-i 14YR 12 - S~'L 17~ fhe .3 d OA c s z -F .2-: L 3 /o WR / LS /c ~S Cs ' • S Ground l , 7S yR S/ elev. S. d s cs o yl? Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor In. Remarks: Horizon Depth Dominant Color Mottles Structure In. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots P Gr. Sz. Sh. Bed Trench Boring # Ground elev. tt. Depth to limiting factor in' Remarks: Boring # Ground elev. -ft. Depth to limiting factor -in. Remarks: py.3of3_ /VOrF- .TF i r c~N 13e- 4e low No DE AR r Grlyiv If ~9 SSU~~I~ /,v /0/o7- s. P MAJ c q,v 40- 3~ 0,1 v5 K ski v~D, i~' 7,(a /.700 PW4,,t.5 r' ~f 7-PEAJ e-Itl X15, D /o cv r,P~" q 3,So FRoM 1~1.OS 100, a t= P BIZ ~c~i~~tr~D OR 1\1,36~ RL)12~ -rj?e~j~ SCALG: 30 ' STS 6'EL itiE 3033 133 97, 90 4(j' 13' )3L ~fl 000 /33 9f'0 B • yg o~ - 2(0 ~ BZ I V2,c e1,t 16f 7/ 0,,) OF 5 of/S ~3&1,960 ? 1W,7 4ce~F-A-,i TO ~ ,r.5 Ti v~ 6X5- 7E14, Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT P M Z Labor and Human Relations - Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY S7' e,Poi' Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. fi dimensioned, north arrow, and location and distance to nearest road. 4 24 - /O&.V- y0 ov APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION UU& Q R y C E GOVT. LOT 4W 1 /4 NE" 1/4,S 3 Z T 2 9 N.R E (o io PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK N SUBD. NAME OR CSM If ~G/ EGi E. XV • - - 4//f. CITY, STATE ZIP CODE PHONE NUMBER QCITY FIVILLAGE N NEAREST ROAD v So,✓ GJ/ , Syc~/(o (7i~ 3 - z 34 S vpso.,a ST~9 ~F G •;v~ I I New Construction Use IA-Y'Residential I Number of b6drooms Addition to existing build'utg I ) Replacement I ) Public or commercial describe Code derived daily flow 61'00 - gpd Recommended design loading rate ~ bed, gpdm2 trench, gpoln2 Absorption area required f,$7 bed, 112 76~_19 trench, 112 Maximum design loading rate bed, gpd/ft2 trench, gpdM2 Ex r5r/A l' f~ Z s o infiltration surface elevation(s) 11 (as referred to site plan benchmark) Additional design / site considerations SEE- P 6- • Parent material -5~65 &60 6 r, R K U, A R T Flood plain elevation, if applicable /V6" It S = Suitable for System CON DITIO L MOLM IN__ _ ROUND ~ ESSURE Al-11 SYYST13" FILL HOLOgJ(3 TMA( U = Unsuitable lots stem aw U In U [ B'S U CC'S O U ❑ S C}tt' + SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft In. Munseli Qu. Sz. ConL Color Gr. Sz. Sh. Bed lard ZS~i~ ~S `fit . S C Ground 3 /4 Y ' ~S /fir{ ~S CS , 7 elev. ~4 171, j< -7 Depth to limiting factor /E& Remarks: Boring # Ground elev. ft. , Depth to limiting t factor Remarks: ST Name:-Please Print 9o8&4VT Phone: 71i ;d PC Address: 0 " 2 7 - f5"' CsT.y 1 Sl nc_ISb t tetM.{fMS _ _ rri b w rq 0 N y ~ Fresh Air Inlets And Observation Pipe Approved Ven# Cap Minimum 12".Above n ~(1 Final Grade A " 0/ ? e- 4" Cast Iron 3 Above Pipe Vent 'Pipe' 'to Final Grade Synthetic Covering ' Min. 2" Aggregalb Over Pipe Distribution Tee Pipe 0 0 0 0 0 00 Aggregate 0 Pertbrated Pipe Below Beneath Pipe 0 Coupling Terminating At ell Bottom Of System Fresh Air Inlets And Observation Pipe 160 Approved Vent Cap Minimum 12" Above Final Grade flV 4" Cast Iron AV - S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER AMER ADDRESS_ ~~l~ ✓ r' lTw' FIRE NUMBER CITY/STATE tS ZIP PROPERTY LOCATION ! /001/4 , 1/4, SECTION 31" , T 2/ TOWN OF St. Croix County, ' SUBDIVISION' 114 , LOT NUHBER__!f/_/~_ 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 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 mair'►tain 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. Zoni officer within 30 days of the three year expiration e.' f A SIGNED: ~ Y DATE: St. Croix co. Zoning office 911 4th St. Hudson, WI 54016 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 the appropriate deed recording. Owner of property Location of property NO 1/4 -16, 1/4, Section ~Z IT Z/ N-R_/ W Township Mailing address Address of site , Subdivision name Lot no. Other homes on property? Yes No Previous owner of property , 1ffX yCA?- - Total size of property 3*•'~ If eLe 5 Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developeL/d for (spec house) ? Yes Volume 112*2f and Page Number 70 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 n e office of the County Register of Deeds as Document No. 30 4e3 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. hi~atuZre o Applicant Co-Applicant Date of Signature Date of Signature State Bar of Wisconsin Form 2 - 1982 WARRANTY DEED DOCUMENT NO. VOL 1128P►GE 404 J Hunu 14i- J G. Bryce and I~erne M. Bryce, husband JUL 3 1995 w e' - :rt 8:00 A _ Y i ~ •'v conveys and warann to Stephen G. Dish and Terri L. Rvg!.: etci rislo _ Gish, husband and wife, THIS SPACE RESERVED FOR RECORDWO DATA NAME AND RETURN ADDRESS 14? dor Aof~~ the following described real estate in t. Croix ~s = y County, state of Wisconsin: (rum] Identification Number) (See Attached Exhibit "A") Tbis is homestead property. (is) l Ewepr'.ion to warnetes: Easements, restrictions and ri&ts-of-gray of record, if my- Dated this 30th day of jive . 19 . SEAL (AM) • Rugs 1 G. L) (SEAL) :ar~ • • L8y12> M. BLWA AUTHENTICATION ACKNOWLEDGMENT Sigaature(s) SPATE OF WISCONSIN IL St. Croix Conroy. authenticated this day of rersondy tame before me this 30th day of June G. . ~ , 190 the above maned Hugh G and = mid Iac~ M. &WA- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, : authorized by $706.06, Wis. Stan.) to me known to be dw oe.sos. S Q - axwood ft e meet and l L l tr THIS INSTRUMENT WAS DRAFTED BY WAL I%- 09ft 14 Kristin OgLsnd _ ~rt«t awn ? kt.. L v t*A~ l 1128PAGE 405 EXHIBIT "A" A parcel of land located in the MW% of Y2% of Section 32, Township 29 Worth, Range " past, St. Croix County, Wisconsin further described as lying South of C.T.S. "NO and lying East of a ;North-South Town Roid and further described as follows: Beginning at a point on the centerline of said C.T.B. "N" a distance of 835.0 toot X56005"W of the intersection of said oenterline with the east line of said M#% of M*; thence S34409"W a distance of 233.6 feet; tbenee S421146'B a distance of 3o.0 feet; thence 3710501W a distance of 140 fast, more or less to the eenter'of the Town Road; thence Nly along the centerline of said Town Road to the ~ttersection of the eentarlins of C.T.R. "NO; themm 3Ely along the eanter4ine of said C.T.B. "N" to point of beginning. RLAO, 1 parcel of land located in W^ of "1A, Section 33, Tovaship 29 North, Ramq* 19 West, Nudson Towns hi St. Croix County, Wisconsin described as follavs: Comaneing at the SE of said NWT of NE%; thence N00910Ps 433.4 lest along the East line of: id M* of M& to the centerline of C.T.S. "!•j thetwe NS49061W 835.4 fart along the conterline of C.T.M. ON"; thence S341P09PW 225.10 foot to the Aoint o! beginning of the parcel to be described: thence continuing 834.09 37.3 feet; thence 54204613 28.2 feet; tb~ee 54005V2 33.4,2 teat; "hence 21.37 "W 37.51 feet to the point of beginriirg. . !