HomeMy WebLinkAbout161-1062-60-000
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STC - 10 4 AS BUILT SANITARY SYSTEM REPORT OWNER 1'a w
rZONINGOFFICE
ADDRESS ~ SUBDIVISION / CSM# D 33aad LOT # A4
SECTION 13 T_~N-R ZD W, -
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Z
a
r ~I
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
r
'BENCHMARK: ~iw 44 7ZIeZ
ALTERNATE BM: Om 04~' 1J; On ivpse.
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Aj"., _S CP Liquid Capacity: /Dad
Setback from: Well 911' House 3y' Other
Pump: Manufacturer 11114 Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: S Length 76 Number of trenches Z
Distance & Direction to nearest prop. line:
Setback from: well: ~ House y8~ Other
ELEVATIONS q -
Building Sewer ~~.~-7 ST Inlet: jJk 3 ST outlet:
PC inlet PC bottom Pump Off 1
Header/Manifold 1S7/ Bottom of system
Existing Grade Final grade 8;G
5f !yl2hh~lc Covcr G] 7.
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBERQ
INSPECTOR: ri✓. 7/57,3
V
3/93:jt
. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety, and Buildings Division INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) sanitarx89470
Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)).
EliARTNERSHIP Iai Villao HUb town of: State Plan ID No.:
LW Wk
CST BM Elev.: Insp. BM Elev.: BM Description: N Parcel a o.:
- Tl~i~-1062-60-000
100 1 10 0 ill Y
TANK INFORMATION ELEVATION DATA 23 A9700286
TYPE MANUFACTURER CAPACITY STATION Iz BS HI FS ELEV.
Septic ppz> Benchm rk ~I(I /ol.a
Dosing 9 1 ' , O - I~ Z . / " 2 -Dy, Cl 13 -V/
Aeration Bldg. Sewer ? ~5.251 '7(,P-&7
Holding ~?J * Inlet 5~ 5- 51~ 9(0 •
TANK SETBACK INFORMATIONy Outlet S16'1. 5 S13~ 9~
Vent
TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet
Air
Septic f f ~t -3rf- NA Dt Bottom
Dosing NA Header / Man. 1_~ Aeration NA Dist. Pipe Holding Bot. System 37 qq PUMP / SIPHON INFORMATION Final Grade 3 Manufacturer
Demand ( Ir Model Number GPM ck
TDH Lift Friction- istem TDH Ft
OSS Forcemain Length Dia. H Dist. To Well
SOIL ABSORPTION SYSTEM
BE NCH _WRNh , Length /,)No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIM 2 DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM EACHING Manu
SETBACK
INFORMATION Sype ^j elNum er:
Syste m m r1v~ a v! t4lt4 MBER
OR UNIT
DISTRIBUTION SYSTEM Asr/-A
272
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Z5
Length Dia. Length Dia. ~ Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges_ ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: NORTH HUDSON 13.29.20,NW,NW 228 SUMMERS LANDING RD N LOT 106
F, t2,6~- cl7
Plan revision required? ❑ Yes o
U se other side for additional inform VN
on. lalcI IqJ7 SBD-6710 (R.3/97) Date Inspector's S nature ert. No.
ADDITIONAL COMMENTS AND SKETCH -
SANITARY PERMIT NUMBER: •
Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 E. Washington Ave.
Abconsin In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Department of Commerce 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
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan LD.,Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION
Property Owner Name Property } oc ti S T2
,
t",~ /Cr;I~T LIDS IWl Na) /j N, R20 k(or)~
Block NumbP4
Property Owner's Mailing Address A l/ Lot Number I /V Of
City, State Zip C d Phone Number Subdivision Name or CSM Number
II. TYPE F BUILDING: (check one) ❑ State Owned o City Nearest Road
Village / I
Public 1 or 2 Family Dwelling - No_ of bedrooms 010- Town OF
05
111. BUILDIN USE: (If building type is public, check all that apply) Parcel 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. ANew 2. ❑ Replacement 3, ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
System _______System _____________Tank Only Existing System _________ExlstingSystem
_
B) S (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) Elevation
7'20 76Q b 2 14 7Y 5 Feet , j Feet
z'e VII. TANK Ca
in gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanks Tanks
Septic Tank or Holding Tank G1GD " El El El El El
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
-24 i(A2-a~45 6 0
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plu is Name: (Print) Plum er's Signature: o Stamps) MP/M PM 0.: Business Phone Number:
-7/ 7 -7 Z
Plumb 's Address (Street, City, Stat , Zip Co e):
a L&fZ
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee 11n des Groundwater ate Issued Issuing Agent Signature (No Stamps)
urcharge fee)
Approved E] Owner Given Initial
Adverse Determination
It CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
11
SBD-6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, 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, 608-266-3151.
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 Dwelh-ig.
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 locatior 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 car)
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
INSTRUCTIONS
1 . A sans at'y uermlL IS Vafid ~Oi LwO tG) ;leap"~_
Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 E. Washington Ave.
ltsconsin In accord with ILHR 83 05Wi5. Adm. Code P.O. Box 7969
Department of Commerce , Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8112 x 11 inches in size. 64 1
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency #I Q
y y y programs 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
Property Owner Name Property Location
V_ i,:L 4w__S "M Vj 1/4, S /3T Z f , N, R ,Io Nori
Lc,
Property Owner's Mailing Address P J ~ Lot Num 3 r Block Number
City, State Zip Cod Phone Number Subdivision Name or CSM Number
~ U/ (G2 >Y5~ Tao ~ lsal > l
II. TYPE F BUILDING: (check one) ❑ State Owned 11 o qtyage Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms Vill Town OF eti~c~,al~o-y► S y Z& 41111111 III. BUILDING USE: (If building type is public, check all that apply)
Parcel Tax Number(s)
1 ❑ Apartment / Condo 161 Z -
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. fg New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ 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 ❑ Specify Type 41 ❑ Holding Tank
12 Dq Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14E] System-In-Fi I I
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) Elevation
1441161
6 1 r 4 Feet Feet
VII. TANK Capacity
gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks Tanks uJ''
Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VI11. 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: o Stamps) rPLOERSAU.11AD.: Business Phone Number:
v 7 - 7 y~~
-7 1
Plum is Ac dress (Street, City, State, Zip Code
_2 -7
M. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps)
X Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination _15 V g eI 7
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, 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, 608-266-3151.
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 septi(, 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 isto 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 puns 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 holdi rig 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.
,rC,pr
JOB
TIMM EXCAVATING SHEET NO. OF 2
Route 1 Box 192 30 -
WILSON, WISCONSIN 54027 CALCULATED BY DATE 7 7
(715) 772-3214 (715) 386-5443 J
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
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PRODUCT 205-1® Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1-BOO-115-6300
JOB L G~.d/ G JL /~c r ~jZC✓~(J
TIMM EXCAVATING SHEET NO. 1 OF 2
Route 1 Box 192 _
WILSON, WISCONSIN 54027 CALCULATED BY DATE 1
(715) 772-3214 (715) 386-5443 !
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
SCALE
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PRODUCT 2051 Inc., Groton, Mass, 01471. To Order PHONE TOLL FREE 1.806.225-6300
Wisconsin,DepartmentofCommerce SOIL AND SITE EVALUATION Page 1 of 3
Division of Safety and Buildings i ith Comm 83.05, Wis. Adm. Code
Attach complete site plan on paper not les i t Plan must County
include, but not limited to: vertical and horizont f ( tion and St. Croix
percent slope, scale or dimensions, north a a oc~ajtion and isfan nearest road. Parcel LD.#
APPLICANT INFORMATION - e prirlaj(►na ' Reviewed By Date
Personal information you provide may be u econdary purpose:; acy La .04 (1) (m)).
Property Owner i P operty Location
vt Lot 2,S 14 + NW 1 4 NW 1/4 S 13 T 29 N,R 18 W
Strub Jr. William -
Property Owner's Mailing Address ode of # Block # Subd. Name or CSM#
228 Sommers Landin Road N. GO ~C ~ CSM L 2 CSM Vol 3, P 876, #360463
City State Zip City ®Village []Town Nearest Road
Hudson WI 5401 s1- 120 North Hudson Sommers Landing, N.
® New Construction Use: ® Residential / Number of bedrooms 3 []Addition to existing building
1-1 Replacement ❑ Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate .55 bed, gpd/ft' .65 trench, gpd/f?
Absorption area required 818 bed, fF 692 trench, fF Maximum design loading rate .55 bed, gpd/fF .65 trench, gpd/ft=
Recommended infiltration surface elevation(s) 94.5 ft (as referred to site plan benchmark)
Additional design / site consideration sinsta112 - Y x 70' trenches
Parent material sandy/loamy outwash 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 I ®S ❑ U ® S ❑ U ® S ❑ U ® S ❑ U ❑ S ®U ❑ S ® U
SOIL DESCRIPTION REPORT
Borin # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ftz
9 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
....,.1... 1 0-4 7.5YR 3/2 - cl 0 m mfi as if NP NP
2 4-11 7.5YR 2.5/2 - s/gr 0 sg dl as - NP NP
Ground 3 11-15 7.5YR 3/1 - sl 1 f sbk mvfr gs lm .4 .5
elev
98.5 ft 4 15-22 7.5YR 3/2 - sl I f sbk mvfr as lm .4 .5
Depth to 5 22-98 5YR 3/4 - s/1s 0 sg m1 - Im .7 .8
limiting
factor
> 98"
Remarks: 0-11" is fill (old tennis court); 22-98" has mix cos w/ considerable gr & cob
2 1 0-12 7.5YR 3/1 - sl 1 f sbk mvfr gs lf/m .4 .5
2 12-23 7.5YR 3/2 - sl 1 f sbk mvfr cs lm .4 .5
Ground 3 23-66 5YR 3/4 - s/ls 0 sg ml cs Im .7 .8
elev
98.6 It 4 66-96 7.5YR 3/4 - moos 0 sg ml - - .7 .8
Depth to
limiting
factor
> 96"
Remarks: considerable r & cob 23-66'; some r 66-96"
CST Name (Please Print) Signature: Telephone No.
Henry F. Grote 715-665-2681
Address P.O. Box 57, Knapp, WI 54749 Date CST Number Ref #
7/21/97 222774 146
PROPERTY OWNER: Stmt 7r. William SOIL DESCRIPTION REPORT gas Page 2 of ' 3
PARCEL I.O.#
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/fF
Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
3..._ 1 0-15 7.5YR 3/1 - sl 1 f sbk mvfr gs If/m .4 .5
- 2 15-20 7.5YR 3/2 - sl 1 f sbk mv& cs lm 4 S
Ground
elev 3 20-60 5YR 3/4 - SAS 0 sg ml gs lm .7 .8
98.4 ft 4 60-95 7.5YR 3/4 - mcos 0 sg ml - lm 7 8
Depth to
limiting
factor
> 95"
Remarks: common r & cob 20-60 less below 60"
4 1 0-28 7.5YR 3/1 - A 1 f sbk mvfi gs lf/m 4 5
2 28-43 7.5YR 3/2 - sl 1 f sbk mvfr as l m 4 5
Ground
elev 3 43-108 7.5YR 3/4 - lmcos 0 sg ml - lm .7 .8
98.4 ft
Depth to
limiting
factor
> 108"
Remarks: common r & cob below 43"
1 0-6 7.5YR3/1 - s1 1 fsbk mvfr cs If/m .4 .5
2 6-18 7.5YR 3/2 - sl 1 f sbk mvfr cs lm .4 .5
Ground
elev 3 18-54 5YR 3/4 - SAS 0 sg ml gs lm .7 .8
98.6 ft 4 54-96 7.5YR 3/4 - mcos 0 sg ml - lm .7 .8
Depth to
limiting
factor
> 96"
Remarks: common ar & cob 18-54 some Ar below 54"
Ground
elev
Depth to
limiting
factor
Remarks:
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554051 CERTIFIED SURVEY MAP
LOCATED IN THE NW 1/4 OF THE NW 1/4 OF SECTION 13 AND GOVERNMENT
LOT 2 OF SECTION 14 ALL IN T29N ,R18W, VILLAGE OF NORTH HUDSON,
LEGEND ST. CRO I X COUNTY, WISCONSIN.
60 COUNTY SECTION CORNER MONUMENT FOUND, TYPE SHOWN.
• 2" IRON PIPE, FOUND.
• 1" IRON PIPE, FOUND. .
c
0 1" X 24" IRON PIPE WEIGHING 1.68 lb./LINEAL m
FOOT, SET. co
D
yj 1" X 30" IRON PIPE WEIGHING 1.68 lb./LINEAL z
FOOT, SET. mzm C-)
0m v)
NW CORNER
Z z rn SECTION 13
SCALE IN FEET J~z T29N, R20W
L4 BERNTSEN CAP, FOUND.
o
0' 50' 100' 200' LOT_ 2 ° POINT OF
1~
VOA.. 3 _ BEGINNING ► 10
EACE_876_ ► 33' 1 33 ► 1~
QOC. J~ 6Q463 0 0 6 N II 1;
N I rn S 88034'00" E 10 ► Ir
S 88°34' 00" E 317' t l o V 144.36' 1 1~ I IZ
292.1 o ~r1 ► 0
230.17' rn
l o i t 11
i25 + 80.00' 91.40' 58.7 62.01' Z n
WATERS EDGE r I
JUNE 11, 1996 oz a LOT 106 R/ ~0' : co 0 1~ I
ELEVATION = 678.60 = f0o 1.464 ACRESf .144 99, o(F IZ ►
LOT 3 ° IIN11~
63,768 S.F
. ° N o ! 1
LA
rv r- 68.48' o q I Z I
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(n I O VOL. 3_ '`GARA, 3 1
PAGE 876_ 1 l pF J~`NP
cn r- DOC. #360463 Q0" 11 1
C) IZ o \ i EXISTING N(~ ~JP ►
HOUSE G~ P~ 1
O I N N SEPTIC TANK ~~,I 20 1
X ° Io m 2.8027 ACROESt ►1 !
co 123,138 S.F.t a 1 1
I^~ ^2 m BOUNDARY OF I rti2 ►
I LOWER ST. CROIX ~g fir- WELL 1
= NATIONAL SCENIC d
/ z RIVERWAY Zb ,Opp, Z LOT 4 II
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER LG~v ~ -v pe.-+` `
MAILING ADDRESS
PROPERTY ADDRESS
(location of septic system) Please obtain m the Planning Dept.
CITY/STATE
PROPERTY LOCATION #A 1/4, 1/4, Section T '2'f N-R Z6 W
TOWN OF I oe~ u- S ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP SS Yd VOLUME / / , PAGE, LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by 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 bee st g completed and returned to the St. Croix
County Zoning Officer within 30 days of t e three yea
y
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - loo
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. 6 ;
Location of property 6U 1/4 rxi1/4 , Section ► 3 , T~N-R 9 W
Township Mailing address
Address of sites
Subdivision nameC:W I /0` <1 orb Lot no. _
Other homes on property? Yes X No
Previous owner of property ~(Z en 9u9
Total size of property 6 ~9c--er
Total size of parcel
Date parcel was created 3
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for (spec house) ? Yes ~_No
Volume /21-( and Page Number //.7 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. 6~15 :/{OO , 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
of the County Register of Deeds as Document No.
tihztur f can
t Co-Applicant
bate elf'Zignature Date of Signature
.'l..Rii. s•• F
*WRs osM
WAIF DEED ST MU C0011
DOCUMENT NO. a~tiMlllr
FES 3 1997
.10:00 A.
Ties Deed made between ALLEN P. PENFMD mW SANDRA -R Ojai.
4 tl~tor d ti~d1
J. PENF'IELD, husband and wife, tort and LANDMARK V
PARTNERSEIP, a Minnesota general per, Grontm
W#aesseft, that Grantors, convey to Grantxs the following
described real estate in St. Croix County, State of Wiisaonsim
Lot 106 of Certified Survey Map recorded on Jmwy 3, 1997 is
Vohune 11, Page32ooDocument Number 554051 in the St. Croix RETURN TO:
County Register of Deed's Office. t t
TAX WO
Subject to a permanent easement for mppmm and e~eas over tha /d 6Z ~ 60
above-deacn'bed property, said P. 0.1" P t bed lepally deaerlbed as foituw
Pant of Lot 106 Of do St. Croix County Cut" Survey Map wooded in Volenne 11, Page
3200, Document Dumber 554051 located in dw NW V4 of the NW-IM of Section 13 and
Government Lot 2 of Section 14 all in T29K R20W, Vi1lW of Howili 111eilson, St. Croix
County, W a, and de9cribed as follows: Co m inanciog at ie hlE c~ ,of sad Lot 106;
thence SIV34-00"E 143.06` along the Westedy right-of-way Sees of
Road; thence S69°03V4"W 47.07 along a South fans of'said Lot 106; hence S73°39'43"W
99.52' along a South Hm of said Lot 106 to the point of begiaeinw /reaoe N64°303"W
75.44'akmg a Souk line of said Lot 106; & ax P N85° IVWE 412+6; dome S36°5VO7"E
44.86 to die point of b . Thin eaaamcd colon 782 s pme fro, aanee or leas,
0.0180 scares, more or less. No vehi" *Abe left madift in ew mnrt property.
This is not homestead property.
Together with all and singular the heredihments and appm ieanaeces do io belonging;
And Allen P. Penfield and Saoeha l Penfield wa Tut that the title isVwkb dcfc'ble in fee simple
and free and clear of encemb mices, and will watraot and defend same.
Dated this At_- day of January, 1997.
(SEAL)
Men P.
L _ (S~)
qLprm" STATE OF WISCONSIN }
ST. CROIX COUNTY
Personally came befbmme this QR_ dory o0wwm IMrttte: a6e~Kaared AUM P. Pon" and
Sandra J. Penfield, to me lmown to be the persons who eao omd the foeegni■i iodnowdand a
the same.
x
NcWPublic, State of Wi~oa■s~ .