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SUBDIVISION / CSM# 6-011.2-y LOT # SECTION 2 T.2 f N-R W, Town of /,<<jfMs'oA/ ST. CROIX COUNTY, WISCONSIN 1PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF S STEM le Zo Q' 0 d ~if dto iffier ,yl ! C INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide-.2 dimensions to center- of septi-c tank manhole- cover: G~ BENCHMARK: ALTERNATE BM: SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: `mazer S Liquid Capacity: /roc Setback from: Well > ~s 01 House /1 'Other Pump: Manufacturer Mo # Size Float seperation Ga c cle: Alarm Location SOIL ABSORPTION SYSTEM Width: / Length S"d Number of tom, 3 .Distance & Direction to nearest prop. line: > .Say Setback from: well: 90o e House > 9D 1 Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold P/. D Bottom of system fa. ,9 Existing Grade Final grade DATE OF INSTALLATION: D Z PLUMBER ON JOB: w- LICENSE NUMBER: 9' INSPECTOR: /93:-jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268694 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: DOLAN, PHILIP & KRIS HUDSON CST BM Elev.: i Insp. BM Elev.: BM Description: Parcel Tax No.: /1d. (56 G&r a~ 1)4i'll TANK INFORMATION ELEVATION DATA Z)// TYPE MANUFACTURER CAPACITY STATION BS HI FS EE11LEV. Septic 24 Co a>> Benchmark O,S ~UC1. I Dosin Aeration Bldg. Sewer Holdin St/Y( Inlet TANK SETBACK INFORMATION St/ Outlet 93~ 7 G/" TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic }aS~ ~Z NA Dt Bottom Dos' NA Header- 9 57 / Sr'~ 90, ~/J Aeration NA Dist. Pipe 5P 7S Hol r w' Bot. System /p, r,-o, PUMP/ SIPHON INFORMATION Final Grade Manuf=Number; Demand 99-~2 Mod I GPM TDH System TDH Ft Head For-cemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width p / Length i No.Of Tjenches PIT No. Of Pits Insid Liquid Depth DIMENSIONS ~ / DIMENSIONS 'Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHIN INFORMATION Type O CHA R umber : System: is d 5Z5 2 j~- OR UNIT DISTRIBUTION SYSTEM Header# / L d Distribution Pipe(s) x Hole Size x H pacing Vent Air Intake Length ,v0 Dia- 7 Length /7 Dia. Spacing to SOIL COVER x Pressure Systems Only xx Mound Or At- a Syste 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.) LOCATION: HU , DSON.24.29. W1 L91T) 4, HIGHWAY 12 ;cam w y f-~ ~ J ~ . a goo ~ Plan revision required? ❑ Yes ®-fdo Use other side for additional information. Ile 1/vl fl6 SBD-6710 (R 05191) Date Inspector's Signatur 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 than 8 112 x 11 inches in size. C • See reverse side for instructions for completing this application State Sanitary Permit Number 4~?& &911 The information you provide may be used by other government agency programs Check it 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 1/4'r 1/4, S T ,2 , N, R E &A= PQ4AAJ C2 Property Owner' ailing Address Lot Number Block Number mT 7 uJ 1-4-A14 7-; City, State Zip Code Phone Number r CSM Number II. TYPE OF -BUILDING: (check one) ❑ State Owned _ ❑ city Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 2 Iowan OF Z III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo " - lv6'I O - seo 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. V New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of S. ❑ Repair of an System System Tank Only Existing System Existing System B) [21 A Sanitary Permit was previously issued. Permit Number Date Issued 7- V. V. TYPE OF SYSTEM: (Check only one) . Non-Pressurized Distribution Pressurized Distribution Experimental Other 110 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank . 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation '14040 t'S-f' P S'01-, .7 7 Q, Feet . ,s Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION New ExiGallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App- sting pstructed Tanks Tanks Septic Tank or Holding Tank - ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of onsite sewage system shown on the attached plans. PI ber's Name`. (Print) Plumber's Signature: (No St s) PRSW No.: Business Phone Number: I r I AJI P is Address (Street, City, State, Code): I/.~7 7 . ri(f IX. COUNTY 9 DEPART E T USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) pproved ❑Owner Given Initial surcharge Fee) Adverse Determination o X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Q-61 V SBD-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 narne, 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) al,l 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. Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of 3- Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code 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 T percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 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 Govt. Lot 114,e;~c- 1/4,S,~ T~ 9 N,R E (or~ r Property is Mailing Address Lot # Block# Subd. Name or CSM# t/017 /of 6X w ~lc c - ,aL . a ~GZ ra~i~ Z; I, I City State Zip Code Phone Number ❑ City ❑ Village Q own Nearest Road LL -~j VW- yYj3 L ❑ New Construction Use: Residential / Number of bedrooms /4/ Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow bIV gpd Recommended design loading rate - 7 bed, gpd/ft2 - ~ trench, gpd/ft2 Absorption area required bed} ft2_trench, ft2 Maximum design loading rate __,7 bed, gpd/ft2 Y trench, gpd/ft2 Recommended infiltration surface elevation(s) p0.0 ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In Ground Pressure AT Grade System in Fill Holding Tank U = Unsuitable for system El S❑ U ❑ S ❑ U [ZS ❑ U f z S ❑ U ❑ S 0 U ❑ S 0 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench I 1 6-.5- /0 -S' z r~ Fc /Z /~1 VFIZ s co Z .3 D 2- S- .S- S 7 rL -S VFR GS 2 /V1 Ground -3 _ Z S_ L e )'/s 6-' L GS = ele 7 i ~r `l 3 2-6 .5 - / n L - 75-- 5' 6 SEE ~vTE - LS YI-5 YI FS s Depth to limiting , S_ S d S G L , 7 factor in. Remarks: #3 - tN~/ /7rt e'/2 , td 5- e re,1 7 * LO -?"r 1',2J -rZ x 3eVr e-- Fr r< ~T-r4-1W- Boring # Z Z 30'-1S ca .K ztn 4d v Z zS S ,6 3 3, S'- s I Z S w 0 Is 1!3K o x s 8 Ground y 3 -2 . S- S - S 4" G L ffs -2 s g elf, 2 ft. - 7, S- /~l S ©S G Depth to limiting factor - in. Remarks: 45-2 ~-"V'70 G'/Z c V r= /Z 'f~ ABC CST Name (Please Print) Signature Telephone No. Address Date CST Number CL 0 o/If/2 ~zz fi- .z 3 9 -2 t 7' 31.3 3 PROPERTY OWNER 2J CLZ%~ -14dlzl{w SOIL DESCRIPTION REPORT ' Page _ of _ PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. I Sh. Consistence Boundary Roots Mft Bed Trench Ground elev. E t.~ So ,ez y Depth to F ELD E9 774,MC limiting factor in. Remarks: Boring # Z Y,Z 3~ -3 11/-zz 7 - - S Z_ d rev z e s = s ' , elev. z. -114 7. S- s ue L S - 7 3c s yr: 7 ft. s a 7. S S a S~ - Depth to limiting factor in. Remarks: l®~'8~~~ ~o e 7y//¢ ZE©f4,272 Aw 4U Zr~.rr c~v~ /s`p~i Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # 3 , Ground elev. ft. , Depth to limiting factor 'n. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. .Remarks SBDW-8330 (R. 08195) o~; i~ ~ J , ~1 f 't•! k ~ .y ~ ~ ~ 2 i T) th ; ~ , I 1~ j~-f 'v ~ n ~ . . ~ ~ ~ ~ w i ~ la. ~ - ~ ~ S 1 o I I X19 -A Z 7n i elf, S ! i f z 70 ° w ZP- Y . L,e GS 97 • .L A<3 jo~ or- Pi¢Rto SrLL E = ,2D ~ O~SE~2vr7-.tod t 44, COIF ms I ~ s I LVd3 Fj I t / I JZo~' -RTS t ~C ~Yo 13 ! i i , r K f ± x 7D' AZ7CPA)#7E i Z CUT ( x Xso' X,v2 ,ty Ze G/ -9ceEs ` 9 ' SzGL~ .¢tsu~F iao.D ' m = /HOC/,vJ !oT e4-t/.,6'2 O Sa f %tonr Fs~t J 0 9o.e ' I~I s . I 3 1.O i i I ID' - foe c Try ALB AEea K i f r r asb ' >y9-?bs'6 ~ si~f roc r jJ ~jfLc i..r,~nc.Hr t~`lt~,er ~K oawr.E t~ Foil WiKonw Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268526 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: DOLAN, PHILIP & KRIS HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA g 36 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Verit TANK TO P / L WELL BLDG. Airito ntake ROAD Dt Inlet ir Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding 1 +1 Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Head well Forcemain Length Dia. Dist. Ti 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 CHAMBER INFORMATION Type O Mode Number: UNIT OR System: 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 1 xx Depth Of xx Seeded / Sodded xx Mulched No Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes El No ❑ Yes ED COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.24.29.19W, NW, NE, HWY 12 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ♦ S r fs~liiiifr~ 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 than 8112 x 11 inches in size. S/~ ` v2 • 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 . `6T erapplication [Privacy Law, s. 15.04 (1) (nil State E] Ch f r vi u to previous~ Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location S ufIl4 V1=114, S y T N, R/ E (or~ Property Owner's ailing Address Lot Number Block Number crJ Jc G City, State Zip Code Phone Number Subdivision Name or CSM Number u 44 1 T, s /,Z Z ( ) VoL .2 62 v II. TYPE F BUILDING: (check one) ❑ State Owned ❑ city Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No_ of bedrooms Town OF P o /Y Z III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo ;Z - /0 o 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. jZ New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ------System ---T__--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 ❑ 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/day/sq. ft.) (Min./inch) Elevation S'8 2-1541 Feet 96.d Feet VII. TANK Capacity INFORMATION in gallons Total # of Prefab. Site Fiber- Ex per. Gallons Tanks Manufacturers Name Con steel - glass Plastic App New Existing Concrete structed Tanks Tanks Septic Tank or Holding Tank 121 ❑ ❑ E k-0 ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of he onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No S mps) MPRSW No.: Business Phone Number: A' 3.2 I' 7 el e -j j~ S-X umber's Address (Street, City, State, Zip Code): IoF 3,0 Z o Gr/ 013 IX. COUNTY [DEPARTMENT USE ONLY ❑Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Sin amps) Approved ❑ Owner Given Initial Surcharge Fee) / Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD•6398 (R. 05/94) DISTRIBUTION: Original to Counly, One copy To: Safety & Buildings Division, owner, Plumber 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 administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed- 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 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 al! 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 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. 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Nt-YR I _ M0014' 00'E • tsao° a.tes~ -I-. . 1 \ p,Iwl • IFx K_ 1 01- R ro t \ ~ I e/ a 2 v,C 7 I n NQ \ W I (~1 1 G t'I = ~ ~I vm 1 r tn► T N STN r 1 t I G L 8 _ t~ wI w ~ O le I .R I. W I SO°15 OI E 567.~I J uar uN. Nw-Ne _ G ~ O L' ; o c►y f-3 (V 4 i 6 I a r/ IV y I o I ~ m 61 U' carol IN O 0 az'rC Z0 ; C, ' V)_ o A 0 9 O . n ~ Ow 16-1 FILED Z JUN2.21993► JAMES O'CONNELL RegWw d Deeds 5(311.28 sc.c co.,WI v' CERTIFIED SURVEY MAP LOCATED IN THE NWI/4 OF THE NE I/4 OF SECTION 24, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN mz0z :0 1 ~wc m 1 m0 UNPLATTED• •LANDS• I Z A= m m x -A+ a m m i WEST LINE NW-NF y y Z D y 2 v N001408W 435.27' _ ; 0! 2 z N ° 150.00' 285.27' - I r" cl A I 50. 50' m i a not $ o I rnm a f 8 I D Z I r I m N rn N I Q APPROVED 8 W ~ I N VA y " W ?Dy ? mn r0 IW N A O~ ~m Ix Nm I 0 Z .7 ~ Irn co ho clok CL ::ann~reh«atvaPl~ry~+g v; o_ I a• '-v C ~ :C : r' Za~iq ~N x x E: '10 y Z y C °m i w-• I o Z ni' a M1s m r z • o :r b4 k a c) 7- rq rn=- m m' Z I (is Z y Z .y Z W = Cif I i 0 to 21 N Q rn +D V r y N Q m m rn AA m ~ N ~ w~' 2 ~ rn i C o rn rA , N b nv I CD z Z rn z py 42 IV e < z n~ r m (W ~"1 I 00 rn rn z m m 50' 50' c A gm roA ~r m y~ om Q y y~ ~y I = Cy V °y pr 1 r N~ mrn x m q_ ~ A 0 Z r rn Z C O 85.4d'' 482.00' SO°15'01"E w _ x S0015'01"E - - 56741 _ I I I iaa.5e' m 07-18-96 07:46AM 1201 92 G f STC-103 SEPTIC TANK MAINTENANCE AGiRVFM[ENT St. Croix /County OWNERIBUYER MAILING ADDRESS PROPERTY ADDRIF.SS K ({1 (location of septic system) PE se obtain from the Planning Dept. CITY/S'1 ATE L~'V' Cm GU-1 PROPERTY LOCATION &V 1/4, 1/4, Section ~ L/ T N-R W TOWN OF ~f C S C%Y 1 , ST. CROIX COUNTY, W1 SUBJ)MSION LOT NUMBER CERTIFIED SURVE'YMAP VOLUME ! PAGF, J64LOTNUMBER 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 a_s 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 fonn, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed purnper 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 scurv, 1/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 ol'thc throe year expiration date. SIGNED: /JG,C~ I'L DATE; St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 07-18-96 07:46AM 1201 43 S T C - 100 This application form is to be completed in full and signed by the o!* ie '(s) QJC Lhe 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 L•he property is sold and submitted to this office with the appropriate deed recording. owner of property LA i X/ k t-1 - Ala Location of property ~w 1/4 IV 1/4, Section 0 'T .`7 N-R 19 W// Township_ . 1 -Rd-sc-ki Mailing address ~/O % i?~(Q cz c'Owl d~- r Address of site ff L{ "ubdivision name Lot no. Other homes on property? Yes No Previous owner of property ln Total size of property ty Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes 1,-'No Volume and Pays: Number _ 3'z- as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which inoludet:~ a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAT, 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 Wy (vur.) krtvwledye L1iciL I (we) am (are) the owner(s) of the property described in this information form, by virtue of a waL t etnty deed L u,,;c)L ded in Lhe office of the county Register of Deeds as Document No. and that z (we) preselrtly own the proposed site for the sewage disposal system or I (we) obtained an ease,nerlt, Lv run the above described property, for the uuristx-uGLiun of said system, and the same has been duly recorded in the office of the County Reyister of Deeds or, Document No. 3 3 ~y~3 S.'Lyf1atur.-c_ of Applicant Co-Appl Stm.• &rr ,f \Ga.wan F,,w : 1462 r P.12403 W:1NN.\rtY DEED . _ r Burt R. King, a harried ;.van. A0(' 1 1 VL-: _ - - - j 1D-ES „and rr:mnll, Kris M. Dolan and Fhilip J. Dolan, I - m wife and husband, SC Croix the following Jewrlh.J r. al, r In C,mnr.. St+le of Wlwan.~n: 1 Partd IJcnul+n••••• S•1 *"•r" Part of NWINE}, Sec. 24-T29N-R19W described as follows: Lot f c'-rtifY= Su vey `Iap recorded in Vol. 9 of Certified Su-% Maps, pa$ 501129. Attached hereto and incorporated herein is the Grant of Well :ariartce June 22, 1995, from Cie Wisconsin Departr.*nt of Natural Resources. MVWSF-vH 3-6-CL 01:11 FEE rh., is not ho-11,td Property. )app I i. rnn l Ecapdon to warrants- Easements, restrictions ant rights-of-way of ree.crd, if 3nY- a Vti August- 95 Jay.d Dand Ihl, - 1 SE.\L I J Surt R. King SE W %UTHE14TICAPON ACKNOWLEDGMENT Burt R. King ST\TE OF WISCONSIN sign+tnrn.I August .19 95 P--11, came before me IM I., of Juth- nhealeJ Iho Jac of . _ _ ti t!!e AS- named Kristina Ogland TITLE%%%IRERST%TER\ROFWISC'O,w.IN - - .Ifnor. - - - einmcJ the aurhonrrJ h} §'Df• IM. 1,- SW O rn me tno-o t+e the pc-,. foregoing rll,lrumcm and 3,kr.-kdr, -.aaae w,5 .4S rnl;MEryi ,~n~ DB+f TED BI Kristina Ogland Attorney at law \-r, Put9w au.v, Jltr r ,on w germane., df .+ar -'•t•" . S~.nat'_rr< m- h aul henliralcJ or J.AnowleJgrJ. Il.nh are not My g . 1J .1 nett., 1 \ 1'~,..~..an„v .n .n, .i~i.+. •M1•+IJ rt,. r.'J.rr n.J M.•a ~,ne ..a,urum _ - '.e M \aN,~l)11tf 1) ,t)tFRI.M.1'ro r, IIIaN N.t - Iwll `