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HomeMy WebLinkAbout020-1176-60-000 o a ~ c r. 0 o o I ~ I y o I w v O '0 ~ i N s a x (V _O I N U N C Z N LL. c m O m ~ N Q I'! 3 `r z N Cif C Z co ~ Z a co C\j 0 z : o 't v d Z v ° ~ o z E -o O O M ` _ N N 7 co a) N Q) N • ~i d U) C O U D O O Z o Z 47 z N Z a a) C O N w E O N to ` ;0 > - co a ~o co cD rm 21) 42 or- C) C) 0 'O V G G a. N N N N N O E N N N LL Z 0 0 0 C O O O d ►V 0 m m m ' a a p~rryy S ~r o 0 (1) rn rn (p j U co O) 0) o C) N N a) O ° N co LO J m N IL co m LO _ N Yl O 'O N C ca O C C O O E N 47 O ° o a) 0 °o °0 0 Q o° Q C O c 'B N N N 00 C H N E l=yam') Li O O M ` L `U ^ N 'a -c- 00 U) c0 U N 0001 O U (C) ® y' O N= V) N O N .2 U) CC a. E a) (D a CL `1v 6 .2 a a rr~~ CJ L O C O STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 'z ADDRESS lam/, ~~iu,i ce "Ilk 7 SUBDIVISION CSM# J LOT 1 SECTION 2 T 9 _N-RTW, Town of ST.,CROIX COUNTY,, WISCONSIN P' aN. VIEW SHOW YTHING WITHIN 100 FEET OF SYSTEM 6M 7~ , ya ,1y ~ III S~G~ I 3 ,1 1 J INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. or 'aENCHMARK: m 1- S ~r r yr ~ca~ 7'~tr,~ " G ~ a o h, DBE.. f ~ .Grj~.~r ALTERNATE BM: :SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: ;;L®v Setback from: Well ySo' House_ 37' Other Pump: Manufacturer 41odel# Size Float seperation Ga s/cycle: Alarm Location \ SOIL ABSORPTION SYSTEM Width: L~ Length 7Z~ Number of trenches S Z Distance & Direction to nearest prop. line: Setback from: well: >/soy House ~y~ , Other ELEVATIONS Building Sewer pg'.z ST Inlet: !27,77 ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system ~y, Z,) Existing Grade -f.31 Final grade DATE OF INSTALLATION: v PLUMBER ON JOB: f'I LICENSE NUMBER! 1J'1 . INSPECTOR: c"4 3/93:jt ~Wiscornsin 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 268.538 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: SCHWARTZ, RANDALL HUDSON CST BM Elev.: Insp. BM Elev.: 77escription: Parcel Tax No.. 00 r ~y TANK INFORMATION ELEVATION DATA -f-&S TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 1, 1 Benchmark /03, S /60 . Septic Dosing Bldg. Sewer j 3 Aeration Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet vent to ROAD Dt Inlet TANK TO P/L WELL IgAintake r ISeptic >as/ a NA Dt Bottom Dosing NA Header / Man. g 3-' Ti 45 a 411, Aeration NA Dist. Pipe S1 7 Holding Bot. System 9f1.1~ 1 ' PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand r a, S /d •t7C) Model Number GPM TDH Lift Lricti n System TDH Ft Forcemain Len Dia. Fi Dist. ToWell SOIL ABSORPTION SYSTEM BED / TRENCH Width Length r No. Of PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N .2f DIMEN 1 N LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM CHAMBER 4 Model Number: _J, -461 INFORMATION Type O OR UNIT System: DISTRIBUTION SYSTEM x Hole Size x Hole Spacing Vent To Air Intake tri Header /Manifold Disbut i on Pipe(s) 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 Topsoil E] Yes ❑ No ❑ Yes ❑ No Bed /Trench Center Bed /Trench Edges COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.28.29419W, NE, SE, U.S. Hwy 12 pd, C,, a Plan revision required? ❑ Yes ❑ No ior Useother side for additional information. SBD-6710 (R 05/91) M Date I p s Signature Cert No. ADDITIONAL COMMENTS AND SKETCH r a. SANITARY PERMIT NUMBER: ^F 1~"`emirs Safety and Buildings Division . ~■~r■~a 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 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Per ? mbar The information you provide may be used by other government agency programs Check if r~reeevvisiCpon/ to preevioouu's 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 /4 1/4, S.!2. TZ , N, R /I E (o SnE Pr perty0w~ 's Mailing Address Lot N m er Block Number Y 441 -7 City, Stat Zip Code Phone Number Subdivision Name or CSM Number 9 issS ~s A rf-~-/~- lyrrt a7 11 11. TYPE F BUILDING: (check one) ❑ State Owned ❑ city Nearest Road Village ❑ Public 1 or 2 Family Dwelling - No. of bedrooms_ Town of b4ot~ /A 0&1 III. BUILDING USE: (If building type is public, check all that apply) arcel Tax Number(s) 1 ❑ Apartment/ Condo -a l 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 Q 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 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 HSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 E] Seepage Pit 43 E] Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate f,S tem Elev. 7. Final Grade Req 'r q- ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 7T Elevation D ffl-w-0 Feet . Feet VII. TANK Capacity Total # of Prefab. Site eel glass Plastic AppExper INFORMATION in g Tanks Manufacturerrs Name PConcrete Con- St Fiber- New Exist in Gallons strutted Tanks Tanks Septic Tank or Holding Tank Qr Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the 0 Ate sewage system shown on the attached plans. PI r's Name: (Print) vo7 Plumber's Signature: (N9Siarlt'pS) O44UPRSW Noy.: Business Phone Number: S/ I F, tier's Address (Str et, Fty, Kate, Zip C e): G tr L''' m 2.3 IX. C UNTY / D ARTMENT SE ONLY Q Disapproved Sanitary Permit Fee ( nduciesGroundwater ate Issue Issuing Ag t Sig tur (No am s) AA /roved Surcharge Fee) pp ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398(R. 05/94) DISTRIBUTION: original to County, One copy To: Safety & Ruildinys Division, Owner, Plumber L 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. ' 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. .Wisconsin Department of Industry, SOIL AND SITE EVALUATION { Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. I 4 09.VNiS. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in siab" II&K M sit ~wty include, but not limited to: vertical and horizontal reference point jBM [ on ar+W' percent slope, scale or dimensions, north arrow, and location and di Q(to rtti kSt A, e Parcel LD. # APPLICANT INFORMATION - Please print all inforfon. Rew r' by Date Personal information you provide may be used for secondary purposes (Privacy `La44, y. 15.04 (1) fm)): `o Property Owner Prope )(4lacation Gout. Lot 1/4,S T N,R r E (o/► Property Owne s Mailing Address t.ot #yAfo~ Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village ~ Town Nearest Road ® New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement g Public or commercial - Describe: Code derived daily flow &6",' gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) 0, , ft (as referred to site plan benchmark) Additional design/site considerations • a . d : ; 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 Q S ❑ U p s ❑ U ] S ❑ U 0S ❑ U ❑ S ❑ U ❑ S 0 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench a r _ f 3 7 Ground elev. ft. , 1,_ r Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: CST Name! (Please Print) Signature Telephone No. Address., y " 4 Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. ft. , Depth to limiting factor in. Remarks: Boring # Ground y\ elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Boring # ; Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor -in. Remarks: SBDW-8330 (R. 08/95) Safety and Buildings Division v~:~ii~• 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 81/2 x 11 inches in size. 57- C • See reverse side for instructions for completing this application State Sanitary Permit Number (v~S38 The information you provide may be used by other government agency programs ❑ ck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Propert Owner Name Property Location C Z 1/4 1/4, S T Z r N, R E (or~D Property Owne s Mailing Address Lot Number Block Number ddmw City, State Zip Code Phone Number Subdivision Name or CSM Number 'G C- 5"Y7,07 Sar > CAD a y- II. TYPE F BUILDING: (check one) ❑ State Owned !t Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 0 rowan OF A41pfa/V III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment /'Condo 22 11 - loD 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. 8 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------System --------System Tank Only______________ Existing System _________ExistingSystem 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 0a 57 Z _7 9S; Feet. 99.,p 'Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex per. INFORMATION New Existin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App structed Tanks Tanks Septic Tank or Holding Tank 2.00 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of )49e onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No St ps) MIPIMPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zi Code): f4 lib Z-t= IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued issuing Agent Signal s) roved ' surcharge Fee). pp ❑ Owner Given Initial / 01A Adverse Determination / o CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05194) 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 tanks must be pumped by a licensed PumPerwhenever 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: L 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. 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. V1. 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 experimenta 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 roquired 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. f • Z / fry - ~ J J v q ~ o v ti e+o y` N ~ 4 I ~ j ~ I rL lib M _ -a go lcv {O 1(\ I mV~ 4M6 PA 401 Pagel of 3 ' wiscoi`i'sinDepartment ofIndustry, SOIL AND SITE EVALUATION REPORT Labor and Human Relations Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code FAR TY St. Croix Attach complete site plan on paper not less than 8 ches in size. Plan must include, but EL I.D. # erenc % of slope, scale or not limited to vertical and horizontal ref f.~B2 0 -117 6 - 6 0 dimensioned, north arrow, and location ar cl~ct;To ne REVIEWED BY DATE APPLICANT INFO RMATION-PLEkpttPRIN,T,, 1k iINFO ON PROPERTY LOCATION EPROPERTY OWNER: GOVT. LOT NE t/4 SE 1/4,S 28 T 29 N,R 19 IE (or) W ndy Schwartz LOT # BLOCK # SUBD. NAME OR CSM # RTY OWNER':S MA!IING ADDRESS Cedar Hills 4 W. Curtice 7 na CITY, STATE ZIP E:'-'P HON, (]CITY OVILLAGE MOWN NEAREST ROAD IUS. Hy~ #12 St . Paul , YIN 55107 X612) 171 Hudson 3 [ J Addition to existing building FCodederived ruction Use [ iq Residential 1 fluitrber drooms nt J Public or commercialdescribe 2 450 Recommended design loading rate ' 7 bed, gpd/ft '8 trench, gpolft2 aily flow 9pd .7 bed, m2 .8 trench, gpd/ft2 Absorption area required 643 bed, 112 563 trench, ft2 Maximum design loading rate 9Pd Recommended infiltration surface elevation(s) 95.80 It (as referred to site plan benchmark) na Additional design / site considerations Flood plain elevation, if applicable na ft Parent material outwash S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM ~rr FILL HOLDING ANK ~S 0U IBS Du [9S ❑u ~9S 13U DS ©U OS til U U =Unsuitable for svstem SOIL DESCRIPTION REPORT GPD/ft Depth Dominant Color Mottles Texture StrGr.uct ucture Sh. Consistence IBotlnCfafy Roots Bed Trerxft Boring # Horizon in Munsell Qu. Sz. Cora Color Sz. 2f . 5 •6 1 0-14 10yr2/2 none 1 2msbk mfr 9w if .2 .3 2 14-29 10yr4/4 none sil lmsbk mfr gw cos Osg ml na na .7 .8 Ground 3 29-84 7.5yr4/6 none elev. 99.7 ft Depth to limiting factor +84" I Remarks: Boring # 1 2msbk mfr 9w 2f .5 .6 1 0-12 10yr2/2 none .3 sil lmabk mfr 9w if •2 .~~'.2.,:;.~ 2 2-26 10yr4/4 none 3 co s Osg ml na a .7 .8 26-84 7.5yr4/6 none Ground elev. 98.9. Depth to limiting 44" ac Remarks: Phone: rAddress: T Name _Please Print Gary L. Steel 715-246-6200 10-2-95 cstm 02298 1554 200th. Ave., New Richmond, WI. CST Number: nnaf, na• Data: PROPERTY OWNER R• Schwartz SOIL DESCRIPTION REPORT 2' 3. PARCELI.D.# 020-1176-60 Page of Boring # Horizon Depth I Dominant Color Mottles Structure (Texture Consistence I Roots GPD/ft in. Munsell Gu. Sz. Cont. Color Gr. Sz. Sh. ~Bed iTrerch 1 0-11 10yr2/2 none 3 1 2msbk mfr 2 11-27 10yr4/4 none ~ 2f .5 .6 sil lfsbk mfr 9w if .2 .3 Ground 3 27-84 7.5yr4/6 none cos Osg ml na na .7 j ,g 99.. 2ft. I Depth to limiting factor +84" Remarks: Boring # 1 0-13 10yr3/3 none <~~~::.<? 1 2msbk mfr gw 2f .5 .6 Lj 2 13-26 10yr4/4 none sil lfsbk mfr gw if .2 .3 3 26-84 7.5yr4/6 none co s Osg ml na na .7 .8 Ground elev. 99.3 ft. Depth to limiting factor +8411 Remarks: Boring # 1 `i:•. ,::\,t'K•i iii::: 0-15 10yr2/2 none 1 2msbk mfr gw 2f .5 .6 5 2 15-36 10yr4/4 none sil lfsbk mfr gw If .2 .3 3 36-84 7.5yr4/6 none co s Os Ground g ml na na .7 .8 elev. 98.8 ft. Depth to limiting factor +84" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SM8330(R.05/92) . a STEEL'S SOIL SERVICE Gary L. Steel Gary L. Steel Randy Schwartz 1554 200th Ave. MPRSW 3254 NE4SE4 S28-T29N-R19w New Richmond, WI 54017 town of Hudson (715) 246-6200 t lot #7-Cedar Hills N 1"=40' Bm.= top of turning point survey stake C el. 100' 0 jZC7 VA a- kA 6'A N~ Gary L. Steen 10-2-95 A0 A I 9 t Z W 3 W J z2 O F- Q df V v ~ ~ ~1✓ W 8 W a: O ` f. O - / O DWI ` - m ao o W Z s72 .as o (as s 0 •1# a o '~~9e z ~ w~ o°~•ha a~ 3 a CO J W 6 60 O 2d m W N 6 5 N a 7 W a L w W If) to Y O V V.' W t~ m O W CA POINT OF BEGINNING o 206.00' ~ 12' 224.76 0 SECTION LINE 'N 4- EI/4 Co NER 0 All lots restricted from direct vehicular ingress SECTION 28 T29N RlQw0 - 0 V. M u STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERR ~/V/)y fC,y Gv~¢,E TL MAILING ADDRESS G~• PROPERTY ADDRESS (location of se system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION lVe 1/4, _S',E 1/4, Section 2 T~N-R1 f W TOWN OF loo ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER 7 CERTIFIED SURVEY h Jf7! 6tH ?)OLUME , 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: 0 DATE: 23-0140 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 c 77 Location of property _ /45 1/4, Section ZS T_2,E_N-R / y W Township ~F~rOS Mailing address 73 !Z Gy G'U~P i ~E S~ ~/9^ ACT mar/ 5C5"/0 7 Address of site !Z99' Lerner t.,_ Act. Subdivision name Lot no. Other homes on property? Yes P--' No Previous owner of property Total size of property 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 ✓ No Volume and Page Number _dO 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. S'3i9&d , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. S~Y9sa . Signature of App icant Co-App icant r r IV 1 ~I 0 t t t I 4 t a --Z -v Iv 534910 State Bar of Wisconsin Form 2 - 1982 WARRANTY DEED _ pyre REGISTER'S 0"r~ICc DOCUMENT NO. stir _ ST. CROlX CO., "141 Rc,;'a for Record Len Company, Inc., a Wisconsin Corporation--.---- O CT 1 2 199f :.t 2:25 P. P~ Randall Schwartz and Molly Schwartz, RegictarciD-~ 5 - - conveys and warrants to - - pe-rty- husband and wife as survivormarital-ro ;76_ j6e) THIS SPACE RESEn VED FOR RECORDING DATA Ij NAME AND RETURN ADDRESS ' r / I'~ St. Croix 24 the foVlowing described real estate in _ County, State of Wisconsin: - l tParcel Identification Number) I, I, • I~ j Cedar Hills Estates in the Town of Hudson, St. Croix County, Wisconsin. ~ Lot 7, ` i l MAV Se I FEE f I~ This is not homestead property. (W (is not) ii Exception to warranties: of record, if any. easements, restrictions and rights of way I fir? day of October 19__95. j Dated this Len Company, Inc. (SEAL) - Robert J. Lenertz, esident (SEAL) (SEAL) By' GP~d - Secretary s I! • I~ ACKNOWLEDGMENT AUTHENTICATION STATE OF WISCONSIN ss. Signature(s) - County. - 19- eromB' came before me this /D day of authenticated this day of October 19-9-5- the above named Robe_r J Lenertz - TITLE: MEMBER STATE BAR OF WISCONSIN - (If not, be t who executed the e authorized by §706.06, Wis. Stats.) to me t>w.a me. for _ agstrum THIS INSTRUMENT WAS DRAFTED BY ^ - ac t f ~ + , a _r>