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HomeMy WebLinkAbout020-1122-30-000 e c ° o o M M ~ u r > n a) O Y ~ N '0 m M x I v, E ~ iv ~ C m rn ~ N a) _ 4- O a Un c 0 E O x U`° o E cc3ag o aaai co c m (o l O Y C O a An x aX YO N L-. Cap N N L L (cu O cn aNi 3 a) 3 a) a) r mmc 'm o £ o E ° + 3 c c c z° w° m m -°a ~ °-O'~70Q LL C Co y LL C N m O)aO O O) C 0 O o) -O O a) C •O N > a Q O a) 'O a) 'X m a) E Q w m m> a U 3 Cl) a M Z N N rn W co .r w O O Z a7 a) d d C\J W a m a m I- U) c 0 c C7 m O Z d c c U V' 2 yO avi Z fA F- r N Z g ~n 'O v 'p M N O N 0 0 m m 3 m a) Q) a) W a) © o a) ° Q O o m a°) Q '1 5 Z co z z co z N N N m ~ t6 ~ i w w c m - E W d i a) W d i y H 4 0 0 O O a 17 L O C a 6 A N N C) C) W F- h w cfl N Fes- V) fn N ~ o 04 N WSJ 10333 dco `°33~ zv~ w Lna~aaa Lnaaa O ° 7 O cn C N N N O O W 0) 4) 1 co 00 U) .J U "ONO C)) a) N ~ P4yy 3 m O '0 O O Cl) O O N = N M O O C N N O O O 0) m E m O C O C) (r O N co Lo d ° Y a" E w N C ° C I~ N U') C O O 3 Cl) U C Q) I- co U O U) 'W` N 0 c) ` M O E 'O -2 a) a C a N N N V o N ~ co N m E C a) C (n C N•, co C O 41 r 7 (D Co co C"4 a) 110 C~ Q) • N r 7 V to N O m ! (0 to U u) E m ri3 U O 0 0 2 N 1~ N Z 2 2 N 0 Ln "5 2 U) L N E E I E L E #t w ID a) EL a m a • m a m E i c c c STC - 104 AS BUILT SANITARY SYSTEM REPORT 41 OWNER 6 ADDRESS 3 SUBDIVISION / CSM# Q ~ /~tu LOT # SECTION TN-R_~ Town of /1/' SQ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM few ~~6X t~v © 6,~► . G'Y'P laob 0 6 s~~fi~c ~o ~~C1S~'Itn~ 1~Dbb ~q,7 J 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: 100 ALTERNATE BM: SE-M / PUMP CHAMBER / HOLDING TANK INFORMATION Manuf acturer: /1)00 E41-9 'hIM4 Liquid ca~ t Capacity: 7516 e it Setback from: Well ' t~)House v~6 Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM f Width: Length 1 49 Number of trenches i Distance & Direction to nearest prop. line: N ~ ~1 r Setback from: well: House d Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATIO • 9 / i(o PLUMBER ON JOB: LICENSE NUMBER: 303/ INSPECTOR: 3/93:jt t t ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certif~j that I have inspected the septic tank presently serving the 1^ Dy`1 residenc located at: 'VIZ' V4, 1, Sec. N, R W Town of St . Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition,, and it appears to be functioning properly. Last time serviced V9 Y N Did flow back occur from absorption system? Yes No (if no, skip next line. Approximate volume or length of time: S'06 gallons minutes Capacity: tb 6 Construction Prefab Concrete ~teel Other Manufacturer (if known) : ~JA Ai~~ Age of Tank (if known) : gp/o ~1,lk Qs (Signature) (Name) Please Print f f ~Sl~j 3C9 / (Title) (License Number) (Da ) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (exc for inspection opening over outlet baffle). Name $t h Signa re 14,~, MP/ P R S I 1 Wiscqnsin Department of Industry, PRIVATE SEWAGE SYSTEM County: `Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division Sanitar663 (ATTACH TO PERMIT) y 68 GENERAL INFORMATION Z HALLHOIderAs M?: ❑_Uty ~N page Town o : State Plan ID No.: CST BM Elev.: Kl{ Insp. BM Elev.: BM Description~i ll Parcel Tax No.: V L/ TANK INFORMATION ELEVATION DATA A9600368 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~f N~ S Benchmark ai Dosing Aeration Bldg. Sewer Holding St/Ht Inlet 45. TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ~O =oZ5 NA Dt Bottom Dosing NA Header / Man. Z 7 7 Aeration NA Dist. Pipe $ 95.3f' Holding Bot. System 7 b 941, 3 y PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 6:21 Model Number GPM TDH Lift Friction System TDH Ft oss ead _71 Forcemain Leng Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS GD DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O Mode Number: T , ) 14- OR UNIT System: fa-u JS (o -j/) DISTRIBUTION SYSTEM Header/Manifold 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 Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.7.29.19, SE, SE, LOT 11 Plan revision required? ❑ Yes ❑ No J lq~ Use other side for additional information. 11 Q 0, 6 SBD-6710 (R 05/91) Date sp cto Signature Cert. No. c 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. rl~ , Q_ • 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; vlslon Co p/rem/us [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION yv cation Property OnerN e 941 Property L v4 s 1/4,S Tigg ,N,R' E(or r.,~~ Lot Number Block Number Property O er' Mai 994- Phone P Subdivision Name or CS um er r City, Stat t Zip Cod 14 Ic 'n~ '2) II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit age y Ne est Road At Pub lic 1 or 2 Famil Dwellin - No. of bedrooms pVillOF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 69© - 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/ Mote[ 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. q 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 Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed IlIz- )(60 i 21 ❑ Mound 30 ❑ Specify Type- 41 ❑ Holding Tank 12 M 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) K. Eie~vation 50 /0 a ~'L7 r Z / Feet % 7. t Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank r t-,es ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage s stem shown on the attached plans. I~A o.: Busine~Phone NumeL: Plum er's Name: (Print) =tu re: ( oStamps) MP/ L r~s u 3 ~ y jc QJ~ PI mber's Address (Street City, S at Zip Cod IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing A nt Sign ure No Sta ps) ~ 6D Surcharge Fee) Approved ❑ Owner Given initial 7O Adverse Determination lJ X. CONDITIONS OF APPROVAL REAS NS FOR jISAPPROVAL Ile C•tn~ SBD-6398 (R. 05/94) DISTRIBUTION: Original to Counly, One copy To: Safety & Buildings Divrion, Owner, Plumber t , i 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 administratar, 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 numiaer(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. 111. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. 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. a • l vee( Posh of cerner 3 a b 7' ~Sfee ~ ~en~~ Pos rt sa ao' 1 ~'X6o ® elk' 7o -1 3 5 htA ~Ie~,qM Buyer: Larry Hall, 208 Wis. St. Apt. 310, No. Hudson, Wi. 54016,.386-6583 Wisconsin Department of Industry, SOIL AND SITE EVALUATION 1 3. Labor and Human Relations page ; of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. 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. # 020-1122-30-000 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 ^f G Carl * & Rosanne Erickson Govt. Lot SE 1/4 51 1/4,S ` TL l N,R l E (o Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 375 v Krattley Ln. 11 Ea le R'd e City Hudson, W 1 State 5 4 Zip Code Phone Number El City El Village ]Town Nearest Road (715)386-3440 Krattley Ln. El New Construction Use: Residential / Number of bedrooWf note Addition to existing building ED Replacement Public or commercial - Describe: Code derived daily flow 7 5 0 gpd Recommended design loading rate -_7-bed, gpd/ft2_,_$-trench, gpdHt2 Absorption area required 1 7 9 bed, ft2 A 3 8 trench, ft 2 Maximum design loading rate _,Zbed, gpd1*_._a_trsnch, gpd/ft2 Recommended infiltration surface elevation(s) s oo PC, • 3 ft (as referred to site plan benchmark) with drop Addlflonaldesign/siteconsiderations Strongly r omm _nd _d• iG _ long narrow t n ki_G boxes. Parent material _60!'0J451- A4 125 Flood plain elevation, If applicable 1v ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ®S ❑ U ® S ❑ U E] S ❑ U Fc] S ❑ U F] S ❑ U ❑ S Vu SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/tt2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 O 2 -12 10YR 3/2 LOAM lm 1 ds cs lvf 2 Ground 3 2-3 10YR 3/4 SIL lmsbk mfi as 2 .3 elev. 98.6A--ft• 4 32-39 10YR4/4 SL lfsbk mfr as 4 '.5 5 9-911 10YR5/6 ed. S O,sg dl 7 ;.8 Depth to limiting factor > 9A n. iRemarks: Boring # n-6 1 QVR-1 12 2,. 2 6-1 10YR 3/3 SIL lmsbk mfi cs lvf .2 ,.3 3 11-18 10YR3/4 - - - - - - - SIL lmsbk mfi cs / .2 .3 Ground 4 28-28 10YR4/4 SL lm r ds cs / .4 ;.5 elev. 5 38-104 10YR5/ me c. S Os dl .7 .8 99 . 1- ft-Depth to limiting factor 104 in. Remarks: CST Name (Please Print) Signature -1 Telephone No. Robert Ulbricht 715-386-8185 Address Date CST Number 9r,M AIXT_41 T]a v„a,.,,,, T.T4 Cnn1G r„~„ ~1 1AAG nomx,r7n07 PROPERTY OWNER Carl' Erickson SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# lot 11 Eagle Ridge Boring # Horizon Depth Dominant Color Mottles Structure 2 In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 1 0-5 lOYR 2/2 SIL 2msbk mvfr cs 3f .5 2 5-1 10YR 3/2 SIL lmpl mfi as lvf .2 1.3 Ground 3 10-15 10YR3/3 SIL lfsbk mfr cs / .2 .3 elev. 99-.-6-ft• 4 15-29 10YR 3/ SIL 2msbk mfi cs / .5 :.6 Depth to 5 29-36 10YR 3/ SL lfsbk mfr as / .4 ' .5 limiting 6 36-102 10YR 5 6 m Ed. S o sg dl .8 factor 10 2 in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor In. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots P In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground ; elev. R ~ Depth to limiting ; factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: 0f3- Ulbricht 6 Associates Private Sewage Consultants 858 O'Neil Rd. Hudson, Wis. 84016 Fo v~~ S f ~Evc~- pos r- 47- 407- 6p" to 47 SCA GE : = 2 D Ali -f~~L ~E,c1GE POS T o fovN~ 5 ` ° = ~3f1~i~~o-2 moo;, s~ yes T~~ ~tti~ , Zq 5 z 95 5U / r- ~ ioo,o n WWW~~v p i „ spree-4 0 Ile i 3 "o, fb L3 G , ~y J'k i y OA~~ S.T ppEol 007,t& GE,UG S q y..50 U X ~D I I STC-105 i SEPTIC TANK MAINTENANCE AGREEMENT , St.. Croix County OWNER/BUYER # ' MAILING ADDRESS kllra PROPERTY ADDRESS / hG1:~ l (location of septic system) lease obtain from the Planning Dept. CITY/STATE / / 1, JS b in 1 5VN~ PROPERTY LOCATION 5 t 1/4, ~ 1/4, Section T_2LN-R_Z~ _W TOWN OF AL J S b /1 ST. CROIX COUNTY, WI r SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP _,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 been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three y expiration date. SIGNED: irtb"4. DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 1 • 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,7Z /4 1/4, Section T C~ N-R~W Townsh'ip1 Mailing address Ya?~e ~1~ /,b ~l SO/~1 G✓ Address of site subdivision name &7q Ap A Lot no. Other homes on property? Yes No Previous owner of property 4 Total size of property 3423 Total size of parcel, ?v Date parcel was created~~~~ Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes ~XNo Volume / and Page Number 63~ 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 t e of ice of the County Register of Deeds as Document No. and that I (we) presently own the proposed site for the se age 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 o Tice~ f the County Register of Deeds as Document No. Signat a of Applicant Co-Applicant 7 914 Date of si nature natP of Cinnars„-A ' s ~'~'J STATE BAR OF WISCONSIN FORM 1 - 1982 WARRANTY DEED Q }t:.N~JILf1Jl.rr 1 DOCUMENT NO. VOL 11 PACEt s SL CROIX CTy. W1 F6.10 4N= I CA& JUL 2 6 06 -AND-,a1YE-- - M Grantor, 4:30 P. y;1 -R lu~ and Larry C. Hall and Marlene Ha husband and wife, as survivorship marital property Grantee, [ire~gQth, t said Grant ' for a uab co i rati TEN~~LLARS and other goo an va uable cons eratioff conveys to Grantee the following described real estate in ST. CKULX THIS SPACE RESERVED FOR RECORDING DATA County State of Wisconsin. NAME AND RETURN ADDRESS N~ PARCEL IDENTIFICATION NUMBER (SEE ATTACHED LEGAL DESCRIPTION) WN R FEE Subject to restrictions of record, conditions, reservations and easements, zoning ordinances, if any, rights of the public, and general taxes and assessments, not yeftisdue and payable. homestead property. (Ls) (is not) Together with all and singular the hereditaments and appurtenances th reunto belonging; And CARL P. EKICKSON AND ROSANNE L. ERICKSON warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Dated this day of~ I9 (SEAL) (SEAL) • • J (SEAL) • / ilQst.,t~C ~L KV5ANN CIIIOY K AUTHENTICATION ACKNOWLEDG N Signature(s) State of Wisconsin, -C l J E Y-- Count G authenticated this day of -19- Person came before me this day of , 19 , the above named • r ~ rl TITLE: MEMBER STATE BAR OF WISCONSIN ~Ja n F ri L SQl'1 (If not, authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ✓ -1/" l ~~Y f ice/ Vol 11 99- PACE Lot 11, Eagle Ridge in Town of Hudson, St. Croix County, Wisconsin:` Together With an easement for ingress and egress over following described parcel: Commencing at intersection of Ely right of way line of Krattley Lane and common boundary of Lots 10 and 11, Eagle Ridge; thence S55049120"E along said common boundary, 336.35 feet; thence S3401014011W 33.00 feet; thence N55049'20"W to Ely right of way line of Krattley Lane; thence NEly along said right of way line to point of beginning. 04' ON _ CD i-' %%\'0 W D Qo / V U m % ° _ N ~ ti° ww 00 - D 0 D LA N C N O w° y 0 Y, S Oti 9ti, _ as 3 2s°3 , lD y w z pw w w D N ti C,iy 30 0- Ow by w /gs / ,.~4~ 0_ +~w w C, j A D lJV 93°53,20 c~ m S y row p w OD ; 22 O 0\ q, m ro0i' 2Z~°G' v 2~ ~Z 0" O ` ` 2 O 6 (At Co W _ O > m V) F°p `s20', D C) x N m W ~ N !DD q ` 189.88 0= 191. (D N 626.00' Ln o _ co LANDS W Jt. OD vi O o_ 'O_ b% 79.9? ~p m• m °om0 c- Q 3 0 y to m to I C N m z 11 N 217.95' 161, 94.05 m tax r' rTM y ~ ,o SO°3510"W 312.00 m w AN~~. Dwo _ -i r = OD W U N Z r ° - r - N -n m J> 00 oan m 00zz Fri 8- T o v m v ftl s uawdolan~ s~lu}}V tool ;o tuawjJDdad zi b z rn m m m= gy m p Sou~SISSy /ylunwuto~ V 6uluuold louoiBab 'JapaJlQ = 3 m * 0m rm• Mo- to -°m Z z mt-^crxxG) ~O ' z = 3 T a _ , ...fi_~ir.:~~~~ ir• 10 ADE) Sita poLlU%ri --JAN 06/20/96 11:55 $ COUNTY CLERK tM006/007 7al.c.c.Qso~,, wr ~ yo i6 .7 l -.`Z '2- i;~ ► Q0 ~1S BUILT SANITARY SYSTEM REPORT i V OWNER 5a m A,^^ I UP p/rI ^ TOWNSHIP 4rl Teti SI:C.' '1'2/IV-ttl~w ADDRESS ri'ou 111/'veff 9W ST. CROIX COUNTY, WISCONSIN. _L tdd,cQi INKS r 4e-1c SUBDIVISION Or ~rj9e, LOT 1_0'1 S I % L PLAN VIEW , Distances and dimensions to meet requirements of H63 W-~]lE$YTHINC WITHIN 100 FEET Or, - - I di a 'p o th~ Arrnw BENCHMARK: (Permanent reference I'oiric) Describe: )V t/ 5y9to". f1 17V 7,J' Gornr'' Elevation o vertical reference point. DD SEPTIC TANK: Manufacturer: li(l'e see - Number of tinge on cover ~ _ Liquid Gajtc1i• i t y : f C o o 10c'477 Tank Inlet Elevation: 2 T a n j c manhole cnv-,r e l eve►i•. i.uiI ; _ Tank Outlet lilev• ar iun PUMP CHAMBER Manufacturer: Number of ;gal lurls Number of gal. pump set or a cyie^ _ gallons; 1.0L distribution lines gallon: sic~ gal-Ion per minute pump horsepowe i~t)l' . and model number r ;"lirilcl -nrii~,~• ~,um~, 't'ype of warning ev .ce HOLDING TANK: Manufacturer Elevation of manhole Fover - Number c,i t;:~l-1„iis SEEPo pi warning device T SIZE: feet liquid AAde.e pt -Nsuem seepage bottom of iCs ""['~.<i~1•;~,~~~,1 'inlei p.pe-elevaLion ouicv ao :04 COUNTY CLERK 10005/007 Gvf ~ l~ r 00, I ~-va-.•- o ie. 1 •.rT r t." Acol" ~j t.rs ActKf yr Ilej D A 1 .1, w NtIr~E~ sea 84. 'r N •~~~S ~1w~ li • ester' .o^ ~ e1•i~'IO'w ?ss IcwJ I ~ ! w 50,0" ' le + M UNP"TTED ~ p •T•p~•SOy 4~O.t~' boo so l,A110~t.r;i 16 itW ACOU 17 15 1.12 AMS ti w ru•tr'rfit 440AW I I ~ 1 M • i 14 Ofi N ST 4 ACMI ! I 13 1 1149 1 *T ArAlS U+" ' I II" ACKS c} , ~ ! I io ~DERAR-l"MFNT OF INDUSTRY, INSPECTION REPORT FOR • SAFETY & BUILDINGS LABORA~ iUIIA~ RELATIONS ~ ~O DIVISION P.O. BOX 796s PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING MADISON, WI 53707 I CONVENTIONAL DALTERNATIVE State Plan l.D.Numbef: (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: - INSPECTION ATE: :S Jq M M I LLC Z 'zo Ap z-- BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENVRS Ei lA REF. ELEV.: CST REF. PT. ELEV.: C 7 o 14 kill"D6 /p D dtr~ S E_ -S e, 410S Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number: ,a- 5 ,B a 41161,16 - 25- SEPTIC TANK/HOLDING TANK: MANUFACTURER: / LIQUID CAPACITY TANK INLET ELEV.: TANK OUT WARNING LABEL LOCKING COVER ¢ q^ PROVIDED: PROVIDED: ~v D / / • ✓ Z l~ YES ❑NO DYES ❑NO BEDDING: VENT A.: VENT MATL.. HIGH WATER l - - - NUMBER OF ROAD: J 'PROPER WELL: BUILDING: VENT TO FRESH L~ L ALARM FEET FROM T LINE: L 41 AIR INLET' YES ❑NO f YES ❑NO NEAREST- 0~ Ov N /Z DOSING CHAMBER: MANUFACTURER. JBEDDING: LIQUID CAPACITY. PUMP MODEL. JPUMP/SIPHON MANUFR URER WARNING LABEL JLOCKING COVER PROVIDED: PROVIDED: DYES ❑NO DYES ❑NO DYES ❑NO GALLONS PER CYCLE: rP AND CONTROLS OPERATIONAL:.." NUMBER OF PROPERTY WELL. BUILDING: JV (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) DYES ONO NEAREST-0 SOIL ABSORPTION SYSTEM. Check thesoilmoisture atthedepth ofpowing -wAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall -Cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: NIDTH. 111NITH- NO.O / DISTR. PIPE SPACING. COVER PIT JSIIE DIA.. #PITS. LIQUID BED/TRENCH r cH~s N AL' DEPTH DIMENSIONS ter.:. _~..c FILL DEPTH DISTR. PIPE ISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER. EL V. I L T LEV. END. n PIPE FEET FROM LINE: , AIR INLET. 1 121 eZ„ P V NEAREST, / / MOUND SYSTEM: 1 AF Mound site plowed perpendi~W' P, FC ck the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: ~~(Q~~ 77 mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ❑NO SOIL COVER. TEXTURE-. PERMANENT MARKERS. OBSERVATION WELLS. DYES ❑NO DYES ❑NO DEPTH OVER TRENCH'BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED: CENTER EDGES. DYES ❑NO DYES ❑NO DYES ❑ND PRESSURIZED DISTRIBUTION SYSTEM: NIDTH. LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL: NO. DISTR. ID ISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.: ELEV. DIA. ELEV. PIPES. DI A.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: DYES ONO DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVAT ION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: DYES ❑NO DYES ❑NO NEAREST Sketch System on ,,,Retain in county file for audit. Reverse Side. I A RE: TITLE. . w DILHR SBD 6710 (R. 01/82) /V//~• r /36z ae Syoi6 SANITARY SYSTEM REPORT AS elulfLT.- OWNER 5 0,1 TOWNSHIP~4/S?.`_'___._ SI?C . '►'2`% !-tz/~W ADDRESS Trd~ f Off ST. CROIX COUNTY, WISCONSIN. .ll ~ SIZE SUBDIVISION LOT LOT ~C rr~~, - - - - PLAN VIEW Distances and dimensions to meet requirements of H63 ~FVEUTHING WITHIN 100 FEET OF SYSTEM m r- I di a p otth~ Arrow I SC LE : --I- _ J 1 V BENCHMARK: (Permanent reference Point) Describe: ~ol' 0-f j ,fr G a / ~ I L Vv 5y,4 Fr 1 Elevation of vertical reference point: D Slope at. site: j 7 SEPTIC TANK: Manufacturer: It/j e 5A'~ L,iquid' Cap<ac i t-y : 1 0,0 v ICS 77 Number of rings on cover 2- Talc manhole cover elevation: Tank Inlet Elevation: A /,J1:Zf Tank Outlet: Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. PUMP set or a cyc,,e gallons; total captica.ty o - distribution lines gallon: size o pump- la~'~a gallon per minute horsepower brand name of pump and model number _ Type of warning evice - HOLDING TANK: Manufacturer Number of gallons Elevation of manhole gover ~.uf r ~~ur~~911 d~`~~r~r ~ ~T G ~ ~ / / r ~ ~ ~ i ~1~. ~z~~ r r1- I ~ ~ . ~ ~ _ I_ (~v fi ~ ~ r ( ~ ~~K ~ ~ I 1 1 a4 1 K" 1- s 1 State and County State Permit # * ~r PLB 67 o Permit Application County Permi # t 17.h for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: .S Q in , t/ l l ryr o 14 4 13P go k 14 5 B. LOCATION: '/4 Section "7 T N, R j / (or) v) Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Towns h C. TYPE OF OCCUP CY: Commercial *Industrial *Other (specify) *Vnc Single family Duplex No. of Bedrooms _ No. of Persons D. SEPTIC TANK CAPACITY J OO(Total gallons No. of tanks r jON/ =1,98 f fF/ t~ HOLDING TANK CCIT~Y Total gallons No. of tanks Prefab concrete Poure in-Place Steel Fiberglass Other ify) New Installation Replacement /C i Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Spe E. EFFLUENT P4SPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New ( Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: Leff Length- F-2--Width - _ 'l Depth ~ Tile depth (top) ~No. of Lines L Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits l Percent slope of land 07e Distance from critical slope ZU WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, ~r NAME A4 n ^ I y CA pflooArr Se A C.S.T. # and other information obtained from < .-n AA o r (owner/builderl. ,q 2 Plumber's Signature 0() Cn2~ P/MPRSW# jd 32- Phone # ~3.2f ~J w L Plumber's Address-,Q jU f /V PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. q x . . ,m.. W . . F > ` NDU9RY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ENDU3TRY; ■ C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 53707 HUMAN RELATIONS LOCATION: SECTION: OWNSHIP LOT NO.:BLK. NO.rDIVISION NAME: Sic /P'?N/ A(o sou ' CO.U~NT/Y::~ OWNER'S/BUYER'S NAME: MAILING ADDRESS: / /I r G e, !ti OO/C . O.Lt ~L~ t -2601A USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: OFILE DESCRIPTIONS A N TESTS: s d~ F Residence i/ New ❑Replace I O N Sol-/-t eel" PO Q Z/ ~a RATING: S= Site suitable for system U= Site unsuitable for system 40,10.0" _Se CONVENTIONAL: MOUND: IN-GROUND•PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) KS ❑U XS ❑U XS EA 0S ZII EIS J ~o / If Percolation Tests are NOT required DESIGN RATE: SYSTE ELEV. If any portion of the lot is in the under s.1-163.09(5)(b), indicate: 6(( ~ N Floodplain, indicate Floodplain elevation: /u~l PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO ROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED F -5-F. HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- / -Py" 100'-3tt y" 8",8/7's ,?o"Bo,c y" n S} 01 , 9A s; B- .2 ao'-~" 7 Y., .2 t' Its .2,1 1.4 C 34; S'+ 2s ,./jK B- -3 gyc% e- B- ~l 7 g l „ 9/M o? g? ",P^ C7 Qtr H , B-,~ Yrl /oo`-,zce 3 o s G•• 6h s"- B- ( $ y" 1106'-sIt. A40U e- 7", Y - &A c- z « k S 2tt s♦ 81 tS 3 PERCOLATION TESTS LNUMBER DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERT PER INCH `1 " o 3 -32 3 P P_ 9 PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. In scale }}}}cc~ees~s.~~..D, what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface ion ~/aY~biiha{i~ t action and percent of land slop. 7 ~L CO "~'r~a~ f~~98VJ? ~ SYSTEM ELEVATION B;M z P•r.. 'TAP fit, per Ad&- .v. CQ l/+ f f4s+,u Colt _dr.Qu ar lul~!!!r•~ t 1 pan 'S~' S7~q~e,4......... 13 13 r _ A t l~ ~ t 0 13 `7 styes~I APPROYEp". f.. 8 sue. ,f t 17 t .4~ nos ~ ~ Nill t %Jl a .",to liz 1