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HomeMy WebLinkAbout020-1017-90-100 a p N 0. 0 C OM O ' 'O f0 wp O O ~ ~ v'i COIN ~ N fd ;v N N C ~ y y y Y CO 0O Q~ L O O p ~ ~ W a'- a Or c "OaLOc ° (D a E E cam.. m c E, C y O O N ~C C t~ a O c a N v z v c" E E N L 76 2 U. C: 0. Co 0 "D 3 0 vv a~ c a> L a j 30 7 a m to 0 O 0 3 S LL 2 E 3 ~ z y U) 0 z a CL co M U C O O 2 b) z :!t N z E o O M N • C N .O L O c O O 2 z z o N Z N M E co O E d N ° o .0 G D N CL bap Z0)0 C3 U) U) H-- Z •N ~aaa IL _ N N O c0 O M J U S rn rn z w a O O N 0 N O O = a O a y CO m a a m Q } in co O O O M N C Q o m 3 c w v a a) 0) rn rn a a zz :z 0 0 0 O C C 0 0 C O N N Li O Oi N C LO d N F- C_ a) cli N CO O O O C E U O S F- N O z O i v~ 0s IL L: a a • a m m c r`Iv ~ ~ c c ~ r A L) L2 iO) U Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations - INSPECTION REPORT ST. CROIX Safety and Buildings Division r _ (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268581 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: TENNANT, KEN Hudson CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.. / GO . Gb ~~Cc rr lF Cc S YC-`~( . , 9 t L< 1 r'L: - 1, '7 TANK INFORMATION ELEVATION DATA 1( E, -5 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic i' ZGd Benchmark s 6. Dosing dd G Aer Ion Bldg. Sewer 1 lr 2,r y Holdi St/Ht inlet $,0R 0- ('16 ANK SETBACK INFORMATION St/ Ht Outlet. TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom 7, ZZ ol`a8/o' /vai'9~ Dosing / NA Man. Aeratio NA Dist. Pipe8 Hol Bot. System x.51 ` 09, d V PUMP AHOM INFORMATION Final Grade ,~rt o = -r- I errand t m-~, C'~ ti 3.~~ U~ S Manufacturer Model Number W kw P _eo/D 0-,, c UAV. VIA TDH Lift x103 Friction 3(pl System TDH ~,al Ft I Loss Forcemain Length b I Dia. HDist. To Well v SOIL ABSORPTION SYSTEM PIT BED/TRENCH Width Length/ No. Of Tirenches DI N No. Of Pits Inside Dia. Liquid Depth DIMENSIONS C ING acturer. SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM INFORMATION Type O mew / UNIT I o e um er: System: - OR "UNI DISTRIBUTION SYSTEM +tg3jEr/ Manifold Distribution Pipe(s) / r 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 ❑ Yes ❑ No ❑ Yes No COMMENTS: (Include code discrepancies, persons present, etc.)5~ Z17~ 17e Q) - ippewa P a h/J LOCATION: Hudson.13 29.19W, SW, SW, Lot #3, Ch ale dk~ Plan revision required? ❑ Yes Use other side for additional information. SBD-6710(R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: . SANITARY PERMIT APPLICATION BureaSafetyu o oand ff Building System,. g Water 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 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number I 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 I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name SProperty Location 1/4,S / T N, R ` E (orISP 5 I.-Li Property Owner's Mailing Address Lot Number Block Number Div IP7- '_3 City, State Zip Code Phone Number r CSM Number ( ) 7o 'p r II. TYPE BUILDING: (check one) ❑ State Owned ❑ Ity Nearest Road village #0I sON Public 1 or 2 Family Dwelling - No. of bedrooms y E3 Town OF C r t,v1f h~ThF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo - lell 7 -QD -/m0 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Exi sting 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 210 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 S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft-) (Gals/day/sq. ft.) (Min./inch) Elevation Feet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank - Z ^P wz=,r ❑ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ea) ® El El El El 1:1 VI11. RESPONSIBILITY STATEMENT - I, the undersigned, assume responsibility for installation of he onsite sewage system shown on the attached plans. Business Phone Number: Plumber's Name: (Print) Plumber's Signature: (No Sta ps) AA44MPRSW No.: rr r~ P 1 -7 4C s-G lumber's Address (Street, City, State, Ip Code): a 0 o F' 7T ea 3 IX. COUNT / DEPARTMENT USE ONLY E] Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Ag nt Stamps) Surcharge fee) ❑ Owner Given Initial 611 (9 - kApproved :Ago Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) _ 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, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 112 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. SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 63707 State of Wisconsin Department of Industry, Labor and Human Relations May 17, 1996 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 ~ D vl' y~ o u lv~ ULBRICHT & ASSOCIATES ROBERT ULBRICHT ivrrT" V 50 V, 655 O'NEILL ROAD S os ,.6Gyc HUDSON WI 54016 l~ RE: PLAN S96-01330 FEE RECEIVED: 190.00 TENNANT, KEN SW,SW,13,29,19W TOWN OF HUDSON COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. S' cerely, ames Quinlan Plan Reviewer Section of Private Sewage o Gm (608) 266-3937 R SBD4998(R. 01/91) ULBRICHT & ASSOCIATES CO. 655 O'Neil Road - Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants PROJECT INDEX DILHR Plan I.D. # S96-01330 _ T Date May may 17,!1996 Owner Kenneth Tennant Phone 612-578-1926 Address 469 Geneva Ave. No. Oak Dale, Minn. 55128 Legal Description --j~----- parcel. Tax Parcel # 020-1017-90-100. Part of a'N acre SW 1/4, SW 1/4, Sec. 13, T29N, R 19W Town of County - Hus]s_on-- - - St. Croix C.S.T. David B. Fogerty CSTM3223 v Installer Local Authority/ Supervision f-Croix County Zoning Dept. PROJECT DESCRIPTION New construction, for a proposed 4 bedroom sized home. Daily estimated wasteflow: 600 gals. Owner is building a metal pole building th#t will have a scrub/bath room for his personal use only. No extra water waste needs to be added into the system treatment area. Soils are slowly permiable in the upper 12" (.3 GPD/ft2 for trenches). A very long narrow trench type mound system is proposed. Limestone dolomite occurs at 28" beneath the slowly permiable sandy clay textures. 24" of sand fill is required in the mound system. 150 A seperate septic tank (minimum'8$Q gals.) shall serve the seperate pole building. x 3.r< - ~5 Y'.i y a_ ~ aL~ey RECEIVED P PR ® VED MAY 1 7 1996 DEPT. OF INDUSTRY, LABOR & HUMAN REUITIONS (VISION OF SAFETY AND BWLM03 SAFETY & BLDGS. DIV. Q IQ~ \\p"`aqumrr►►nryiy~~ry NNI is C ONS SEE CORRESPONDENCE rte. ~4s Pg.l PLOT PLAN VIEWS ROBERT W. ULBRICNT Pg•2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS D1160 q U= HUDSON, WI P9 . q .3 PIPE LATERAL LAYOUT S I ``~°o !16 GS Pg.4 DOSING CHAMBER CROSS SECTION Pg•5 PUMP PERFORMANCE SPECS ® t 7-io elf 6 7- ~/PO~cciPTy L i;c>~ I 1 (31 , ~ _ °,Y1 /.0WEs7"/ P/pr sr C. I ~I Ql~y . SE ~2 00 p Eris T' I I 98 2p yo.o~ S~TiC' TiM/ I it j A s•e' I /iPosT PWoor- I 'r ~J C16 14EkD of f Zs~ .~IJ~ t,ly N /cam' Torfl of v ° j 2 % r~ i eZ FoAY,-- M4ZU r. o; I rr ~ a TREES cam. ~ a■o I rte ~ p v f 1 ~ PPoiE 4 13M. St t IV- Cyr., -75TO J&e. ~OXee-,4S r- siSPric 7,- -rep of NA/Z.,/54567 of 7rftr (1111,P41.=s7"Al PAP&rhST o,~ FEN« L~~F . ~ I t~v1=R7' o F ~Z I,eRA I S X02, FO Top of ~z IATE RAIS 102.'9.S • To P ~f Rock /03-13 s ysr~M EIEvATt vAj 102.30 Straw, Marsh Nay, Or Synthetic Covering Medium Sand Distribution Pipe Topsoil H _ zasssr,~ 3 E ~ I V"tFORM 2 % Slope Trench Of u- 2? Force Main Plowed 1 Aggregate Layer X00.30 (Undisturbed, Did-0 Ft. Soil E 2./ Ft. Cross Section Of A Mound System Using 2 F . 90 Ft. Si * i E' Trenches For The Absorption Area G /•0 Ft. A V Ft. H X 5 Ft. B (03 Ft. ~ $s C 49 K 10 Ft. L 152- Ft. J 8 Ft. Positio4 of Force Main I 13 Ft. W ZS Ft. L i W Observation Pipe s 2 ~0 P~ R FoR AT~D P 1 P e SET" 1 L vP A,~c~ FOR THE N G H''5 ~~,~EQhI i"U \ vRRTEv Z Gy7 NEB T //A~~ jalD FOP \6T N~~, fbI yoli0 ENS L F p'~~ ~P`~~Ea Nn kE I.Ast ~Nfl cAP T n NEST P Fr 70TA L V U l y tI E OF C F r- ~RTL rAL NtTLo dle I~cO~ yg INGIIs i/c7ID Ud/U~YEa/p /dam ~j LATEQhL I r 2 MAWRAO " 2. ~ F"O'RCE- MAP-3 2- # ho Es P! P E y= 4 g Imc N ~s zNUER r E (e L);NTtoA-3 6F L-r R ,0~ L S /02-80 • ) % ST R i F3u TI o,3 D I' S Ct-' A'P6-E- RA't'E- FOR E A Ct, I `Tl2q C._ DTI S 2.7 /9.72 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS P,4 E of 5 -VEIJT CAP 4"C.I. VEf`JT PIPE WEATHER PROOF APPROVED LOCKING > JUNCTION BOX MANHOLE COVER )DOW FROM OR M FRESH R, W/4„,4RN1A)6- /,g13E/ 12"MIN. WIIJD r~ AIR INTAKE I L5 1/^7ION GRADE I i 4" MIN. I G F l7 COIJDUIT ~IEU~+nnv INLET PROVIDE I ~ ! AIRTIGHT SEAL I i I I APPROVED JOINT A INSI kNK I III APPROVED JOINTS C.I. PIPE 1 ~OM~ I III W/C.I. PIPE EXTENDtNG 3' Cpl '10 I II ALARM EXTENDING 3' ONTO SOLID SOIL B bj , I II ONTO SOLID SOIL b yo'' ~3, 3~ I I ow ELEV. FT. 1 /.r~ PUMPS OFF D k gt pvw 6- II y t'EVA find I BLOCK RISt•_R EXIT PERMITTED OUL4 IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFI•GATIOI~JS DOSE TANKS MANUFACTURER: 1ffb E-ST6XAII ;Deac,,fS7" IJUMBER OF DOSES: PER DAS TAIJK SIZE: X400 GALLOMS DOSE VOLUME 17 217 ALARM MAIJUFACTURER: DUEL ~'M ep INCLUDING BACKFLOW: GALLONS MODEL UUMBER: CAPACITIES: A= SWITCH TYPE:LGJaY INCHES OR O GALLONS _ B = INCHES OR 5 GALLONS I PUMP MANUFACTURER: C= INCHES OR 2-17 GALLONS MODEL WUMBER: e~G&A /EGAD ~2 D= 3!13 INCHES OR 353 GALLONS SWITCH TYPE: 'pI f5r44cl~ /~'~F euRy ~O/9T NOTE: PUMP AND ALARM ARE TO BE j MINIMUM DISCHARGE RATE `/D GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEF EIQICE BETWEEN PUMP CFF AND DISTRIBUTION PIPE.. 17,0 FEET -rAfjLF 9'kc5 • -F- MIIUIMUM NETWORK SUPPLY PRESSURE . . • . • . • • 2.5 FEET EAGGI, yt p - i + BUD FEET OF FORCE MAIN X 2'4Z F~ ~'•4~- L loo Fr.FRICT101J FACTOR. 2 FEET ~-/~U~ I S 25 TOTAL DYNAMIC HEAD = 22..I Z FEET Q ~ .r G w • INTERNAL DIMENSIOMS OF TAUK: LEIJGTH " ;WIDTH ' •;LIQUID DEPTH 7~ LL RHEA D/ W CAPA 115 CITY ~ 119 32 10S CURVE 30 100 95 28 90 26 9s EFFLUENT 24 80 MODEL and Q 75MODEL 189 20 185 DEWATERING = 22 70- U ~ 65' s 1e G 55 J _ 9 18 50 ODEL C 183 MODEL 1- 14 4S 189 12 40- 35 - 10 MODEL 30 137, 139; MODEL 185 SEWAGE and ° 25 DEWATERING 9 20 MODEL 15 MODEL 181 4 7 q 10 - - ` ¢ Cj 2 MODEL S 53, 55, _ 57,59 0 GALLONS 10 20 30 40, 50 00 70 80 90 100 110 24 75 LITERS 0 80 180 240 320 400 22 FLOW PER MINUTE 70 20 es 0 19 - IODIL 295 Q Yi 58 x /9 V so 74 MODEL 4S 294 12 40- a 33 MODEL F 10 293 O 30 MODEL 284 MODEL 9 20 282 15 10 MODEL Tj~g- 2 S j I :1267,268- 0 3280 Old Nllli Lane GALLONS 20 30 40' so 601 TO $0.1 90 goo 1110 120 '130 140 '15p 160 170 180 180 P.O. Box 16347 LoubrAle, Kentucky 80216 LITERS 0 b° 180 240 320 400 480 500 840 720 (502) 778 M1 FLOW PER MINUTE S96-0138; HIGH HEAIa "1 V I " K'63*7 &fl65*" "-"18r-" (%2 HP) (%2 HP) (1 HP) / (1 HP) (1% 14P) f189 2 SQIf@S 7-1-AE Ire, brTFF2(I!!reT d-009L-PrOV Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _ of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 10s in size. Plan must include, but not limited to vertical and horizontal reference p ' I,~r d % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and en APPLICANT INFORMATION-PLEASE. f fNT A, L INF70R REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION IEN s, - GOVT. LOT 1/4 513 T .2 3. N,R E (er t PROPERTY OWNER':S MAILING ADDRESS ;LOT # BLOCK # SUED. NAME OR CSM # G v 3 - CITY, STATE ZIP CODE PHONE NUMBER OCITY E]VILLAGE MOWN NEAREST ROAD (~f New Construction Use [/4 Residential/ NumBef-- ms y [ ] Addition to existing building [ J Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd$ ~trench, gpd/ft2 Absorption area required bed, ft2 trench, 112 Maximum design loading rate bed, gpd/ft2 . S' trench, gpd/ft2 Recommended infiltration surface elevation(s) ;!Z2 i~zX It (as referred to site plan benchmark) Additional design / site considerations A4yu✓vD Ty de .tt L V'VA dllftRizo~ r'b~rBl~. Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem D S m U j7J S❑ U Os o u ❑ S O U ❑ S O U Ds o u SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trer>dh Ground 2- SC S7-Z • 3 elev. /0AZ6 ft. ! Depth to .3 _•z~ , S S c 2 ili'S& F S • •2 3 limiting factor ff 76 Remarks: j9,X ©Ic SAD Aw sS o tRtE' S~DyL~ gr . 'E'A Boring # / 0 _ JP O ^3 'c l -ZM5,5X FA .4 <:< M c 2 Z p - SG F c .2 ._7? Al 54 't A4 -s iF 3 Ground elev. 3 ..S - 5~ - z. . 3 Depth to limiting factor 6 z _ - - ,o a Remarks: 10-IS- ? s CST Name:-Please Print ~ r/z v C Tt Phone: ZZY .3 d Sb Address: yox5 3v '__1?VAEJZy att o~.3 to > 2 Signature: f+~ Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of PARCEL I.D. # 4D7` Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxdary Roots Bed Trench in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. fi t. Z _ o .3 Depth to limiting fact - ~S O Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground & FOGEF PER TESTIN , INC. elev. P. Be* 13 1 ft. ROBE TS, WI 5 023 Depth to limiting ZZI factor Remarks: 6 ; W v f i d x 14 FYI 10 p m rn S?~1 tn n `A fi STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER J~6iUll/~T~ Of _A4y,¢V? MAILING ADDRESS (10? 4;?E.V e_VA N.. ©Xle- , '*/V '5'6-12.7 3 PROPERTY ADDRESS "J gw,* 5-Y (location of septic system) Please obtain from the Planning Dept. CITY/STATE C' PROPERTY LOCATION :k4u,; 1/4, S tit 1/4, Section TOWN OF ac4j25oiV ST. CROIX COUNTY, WI 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 year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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 &rj & JZL7 7'CACMg2_- Location of property g7ec,; 1/4 fc4) 1/4, Section LTJI_N-R j,~ W Township #t4,03oo Mailing address Address of site Xa2. C i AaretrJ N e yi _ uosgy Subdivision name Lot no. Other homes on property? Yes No Previous owner of property 4.416gS e&rAj(ES Total size of property & AkxEs Total size of parcel Date parcel was created I-q!gs- Are all corners and lot lines identifiable? Yes No / Is this property being developed for (spec house) ? Yes t/ No Volume 1141 and Page Number 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. ~r:a6 s.~ , and that I (we) presently own the proposed site-for - he 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. a~3 6 VA ign ture of Applicant Co-Applicant ~ Dc1Yle r,r Tifi9hci THIS SPACE RESERVED ,OR RLCORDINO DATA DOCUMENT NO. STATE BAR OF WISCONSIN FOB][ 1-1982 x WARRANTY DEED I 1 ' VOL 11 1 •.r a; 52625 - `1 78---__ ---ii REGISTER'S OFFICE I ~ ST. CROIX CO., WI This Deed, made between _-Eugene C. Green I Rec'dfor Record k a Eu ene O. Green and Dana Berres-Green f~kJa_,-Dana-M.--Berres, as joint tenant s . MAR 2 1995 Grantor, `4 at 11:45 A.M Keriiiefh C. ennarit and DaL Tene D- Tennant, a nd _ husba-.d anc wife, as survivorshi marital proper P ' ty-............ ~terofDe_ds ' - Grantee, (i _ Witnesseth, That the said Grantor, for a valuable consideration _ . - RETURN TO-_ - conveys to Grantee the following described real estate in __.St rO1_ _Z I County, State of Wisconsin: ~ O - A parcel of land located in the NW4 of the S104 and the SW%t of the SW4 of Section 13, and Tax Parcel No: also the NW'4 of the NW% and the NE4 of the KW4 of Section 24, all in T29N. R19W, Town of Hudson, St Croix County, Wisconsin described as follows: Commencing at the SW corner of said Section 13; thence Nlell'56"E ' Ii (assumed bearing referenced to the West line of said SW'-t of Section 13 t which bears N1°11'56"E) 359.49' along the hest line of said SW4 of Section 13 to the point of beginning; thence N74'05'42"E i054.18'; thence S15°54'18"E 1457.23'; thence S27°59'51"E 147.02'; thence N62°00'00"E 'I 66.00' along the Northwesterly right of way line of Yellowstone Trail; thence N27°59'51"W 140.03'; thence !115'54'18"W 2307.591; thence i Southwester! 566.78' along a 2739.79' radius curve concave Southeasterly whose chord bears S76°31'47"W 565.77' along the Southeasterly right of Ij way line of the Chicago and Northwestern Railroad; thence 870°36'12"W II s 133.13' along the Southeasterly right of way line of said Railroad; thence Southwesterly 188.36' along a 1428.68' radius curve concave l Northwesterly whose chord bears 552'19.16"W 188.23' along the i Southeasterly right of gray line of said railroad; thence Si'11'56"W II { 840.63' along the West line of said SW%4 of Section 13 to the point of beginning. i. ffMSF£h This i--s-----not homestead property. (is) (is not) ~+~+p Together with all and singular the hereditaments and appurtenances thereunto belonging; U Eu ene C. Green and Dana_Berres-Green And-_.-_.4---------- ! warrants that..the title is--good, indefeasible in fee simple and free and clear of encumbrances except ' those of record, d' and will warrant and defend the same. 28 `"h day of February , 19.95-.. Dated this G..-X✓ .e.~~n. (SEAL) (SEAL) Eugene C. Green a/k/ _D we 0. Green -19 6 _ dCRl 1--~~~_1 (SEAL) (SEAL) A. . ' a Dana Berres-Green f/k/a-D3oa-M. Berres 1 i AUTHENTICATION ACKNOWLEDGMENT ji Signature(s) STATE OF WISCONSIN l 83. St" Cro' x County. I authenticated this day of 19 Personally came before me this 2$ h._day of i _Felruary_................... 19.95___ the above named Eugene _C -Green,-••a(__ - - k O. =-Green and Dan. _ -_Green- TITLE: MEMBER STATE BAR OF WISCONSIN _ Dana_ M __--Be~ yife I~ (If not authorized by § 706.06, Wis. State.) $ 1 i to me 1®own to be the person , ~fted the t fornstrument and ckn thg ~ame. j n y p 3 m 0 d IN CD 3 ~ n n d 3 O O~ W C W N O _ CO O CL N Q 0..I • Q n N W O O d p `A\ o N( 7 O O = O O C 1 0- 7 V O W t0 CO 0 O to 0 O W = CO O o p O r. H co O p N N N lV 0 y ~ n w (n ~D a T N co c m' CL 3 o O CD i ~ O , CO rn cx 3 SO r c IAa ooo~'N W Z ccc co (1) CO) o D 0 rE3 C'D M y p rn W No 0 c) CD (n G `m 3 oy, N I z N 0 c c D D o 21 O c o a m a c m 3 `D r: c I w 9' ° m 3 z 8 C 1 CO) Z' c n r A z O Ox Q S N N < co a w 3 Z a ? X o co y Z (D A A S CD O N 42 O N C CD N Oz d 7 CL d ~ 7 j N N O CO 7 O p y y 3 (D O s y N Q n O C. CD a a) CD ' p O y O C<D7 V CD O) O N O_ C O CD c°„ (D I n O CD 0 q Owo O oti a CD CD Parcel 020-1017-90-100 04/07/2005 10:25 AM PAGE 10F1 Alt. Parcel 13.29.19.83B 020 - TOWN OF HUDSON Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner " TENNANT, KENNETH C & DARLENE D KENNETH C & DARLENE D TENNANT 932 CHIPPEWA PATH HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 932 CHIPPEWA PATH SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 10.007 Plat: 0545-CSM 12/3310 '97 SEC 13 T29N R1 9W PT NW SW & SW SW BEING Block/Condo Bldg: LOT 3 CSM 12/3310 LOT 3 10.007AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1113/178 WD 07/23/1997 921/301 07/23/1997 827/181 2004 SUMMARY Bill Fair Market Value: Assessed with: 47700 310,900 Valuations: Last Changed: 04/26/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.007 84,000 156,500 240,500 NO Totals for 2004: General Property 10.007 84,000 156,500 240,500 Woodland 0.000 0 0 Totals for 2003: General Property 10.007 84,000 156,500 240,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 148 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 001-WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 STC - 104 AS BUILT SANITARY SYSTEM REPORT ,~f ti 1 r OWNER /I P,p /f f9gs a ADDRESS 0 ` n'+ ONING CFFICE 7 \ c SUBDIVISION / CSM$ LOT SECTION /9 T .21 N-R-L_L_W ,Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f?stlf' / yo i 9 O ,~ouND 403 wFz yEr .~c~urvrEl~ FDA- r` INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center -r n„4 A BENCHMARK: ~d AC v .4 ALTERNATE BM: / ~ /00 a SEPTIC TANK / PUMP CHAMBER / BOLDING TANK INFORMATION Manufacturer: V,, CS /.ZVO Liquid Capacity: f oov Setback from: Well House Other ti Pump: Manufacturer Z if~c~ Model# / Size Float seperation Gallons/cycle .Z Z o Alarm Location $x ;SOIL ABSORPTION SYSTEM Width: Length / Z 6 Number of trenches / Distance & Direction to nearest prop. line: s Setback from: well: House Other ELEVATIONS 77.0 .IV Building Sewer 10 /12a~ ST Inlet: ST outlet /,go. 2-P PC inlet 420.2' PC bottom 7, Pump Off fS. LC' Header/Manifold IcPZ. jV I-'** Bottom of system lp 1 -T' Existing Grade Final grade 1*t7693 DATE OF INSTALLATION: p PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Parcel 020-1017-80-100 04/07/2005 10:24AM PAGE 1 OF 1 Alt. Parcel 13.29.19.820 020 - 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 ' TENNANT, KENNETH C & DARLENE D KENNETH C & DARLENE D TENNANT 469 GENEVA AVE N OAKDALE MN 55128 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 0545-CSM 12/3310 '97 SEC 13 T29N R1 9W PT NW SW BEING PT CSM Block/Condo Bldg: LOT 3/4 12/3310 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1113/178 WD 07/23/1997 827/181 2004 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 02/09/1998 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 001-WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00