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HomeMy WebLinkAbout020-1005-30-000 o m o 0 0 0~ °p ~ c c M O ti N L N o X O O) O O 't a) c(pp ~ y X N L ey 0) - aD c a~i .0 C13 Q) o o w E L F N . a) c c ° o L) C w oY'OO o m Sao 0 'a 0) CD y a~ m yon (y m _0 N .O.tv~ (0 CU cl) U) f0 y - O .O C C C:, f0 y N '0 ca c m - 3' aNi E 0- Z~E c 6 ~ E _ o o w_ o-0 d V Z p V E y> 0 m cn o j l0 a o m y U) a .X C a v> LL O O N C U. O m U r N N .'L-' o So) c 3 o y vOi rnS E: a~ Q 0 E a3 E Q H N oW °LO U O M 3 a z y f/1 m LlJ E E U) w O i+ 0 0 E ~ z a m N a m > n H (A c 0 o Z :!t c w o Y o o CO H lp E m E o E N ] N y 7 O) O O N O N CL U) E N W • A~ L ►Z" a o o 0 a) O z m z z co z 0 w N _ z d C d E N R E m m E o o d co 'R .°i~. « O LO O W d N O o N coca D IL .Q FIE m E :3 5 U) N OI V O N N N 0 Z v 7 - U) CL IL IL 7 0 N O rn y 0 0U.) Lo ) 0) (D N n 0, (D to J U c v O O "mil > N N 2 0 Q 0 O O O - 'O c O O 'D j f`0 m C J m y _O N N .0 d Q } (n C Q } (n Q M 3 w N 7 O 00 p o H C a C 0 o 3 2 c M y a 00 C) 0 V; 0 a) CL O O O N O d In O N U O N U z c O N U L 'O N O M y N C U • N n O O C O N O C (n 0 0= = z H C/1 N O z - \ r L d a v v~ a`, R € n 3 a a V a • a d c c E c c A V a 2 O N V v) 0 STC - 104 J0 AS BUILT SANITARY SYSTEM R '✓J9 AW 04- OWNER_ T SQ I M O 1V LL// 11 i~ l- t Z ADDRESS P, T a~ L aoe SUBDIVISION CSM / # LOT I SECTION T N-R_f3 W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~S►k~ yy ~o~ 18xsa Ben 13 Bull Ru 3 BpRovvVA Iv,f ~J om-t q7,~9 979 010 Ale w 91. T,j vQ1Ve INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK- - __'r~Re5k0)d oi fate,v DouK a~ HNse ~L= 1UO-6 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION U S Q~ Manufacturer- NA Liquid Capacity: (000 A , Setback from: WellOYM SOHouse Other Pump: Manufacturer Model# Size Float seperation R,.,,,_._...-.• Gallons/cycle: Alarm Location CHI lc~ SOIL ABSORPTION SYSTEM Width: Length S Number of trenches f' Distance & Direction to nearest prop. line: Qy fg So, Setback from: well : OVe K So House a Other {Qpp ?~Z T y~ ^ )O{ ELEVATIONS Building Sewer ST Inlet. e ST outlet Nb 93.45 7 '3-95C inlet PC bottom Pump Off Header Manifold was / Bottom of system u U r~WeRtd s~f~'P~ Existing- Grade 19, 0 Final grade 9•30 DATE OF INSTALLATION: 5 PLUMBER ON JOB: w CTC~Y LICENSE NUMBER: Toy INSPECTOR: 3/93:jt Wiscon§in Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: state Ma SIMON, JOSEPH & CHRISTY X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA 77i2 a 9~ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Q Q Aeration Bldg. Sewer 'n9 St/ Ht Inlet n TANK SETBACK INFORMATION St/Ht Outlet ro,,Q9' 9-P. 3--7-/ Verit TANKTO P/L WELL BLDG. A irIto ntake ROAD Dt Inlet Air Septic NA Dt Bottom Dosing NA Header flMam Aeration N Dist. Pipe S 4to in9 Bot_ System 3?/ 9916-:Z PUMP/ SIPHON INFORMATION Final Grade S'`~/, . 99 r M a n u Demand Y~'/SC F (o,/~~ 4J•~/ Model Number P' t TDH Lift Frictio System TDH Ft Forcemain Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length No. Of jrenches PIT No. Of Pits Inside Dia. Li uid Depth DIMENSIONS DIMEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHI Ma cturer: SETBACK INFORMATION Type o A CHAMBER Mo a Num er: System: y( OR U DISTRIBUTION SYSTEM Header / Manifold it Distribution Pipe(s) „ x Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syste my Depth Over / y Depth Over o xx Depth Of x eeded /Sodded xx Mulched Bed /Ztmmiit..Center Cr - YU Bed /-bwreh Edges -Q Topsoil ❑ Yes ❑ No ❑ Yes 1❑ No COMMENTS: (Include code discrepancies, persons present, et) ifs c~ ~~¢?C'~'i.t LOCATION: HUDSON.7.29. W,SW SE, KRATTLEX L Plan revision required? ❑ Yes E!"ryo Use other side for additional information. gj E SBD-6710 (R 05/91) Date Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUP x.74 C rvl STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 7 -7 j w to preLious application 8% x 11 inches in size. Ch ANA -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP RTY OWNER PROPERTY LOCATION _ < - ' % < _'/4, S T ? ~W, R ( E (or) W PROPER OWNER'S, MAILING ADD SS LOT# BLOCK# 3-5 a ht/ev CITY, ,STATE ^ ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM N MBER art .~8 u 11. TYPE OF BUILDING: (Check one CITY /RAREST ROAD ) ❑ State owned VILLAGE 6~/ .a PAR ELTAX NUM ER(S) 3- OF: ❑ Public ❑ 1 or 2 Fam. Dwelling-#of bedrooms III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo C~ 2 ❑ Assembly Hall 6 ❑ Medicat Facility/Nursing Home 1o ❑ 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 in line A. Check line B if applicable) A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4.E] Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 9 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE /1 REQUIRED(sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. It.) (Min./inch) q X30 VATION S V Q u - . 5 .5 Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concr to Con- Steel glass Plastic App Tanks Tanks structed M- I H El M El F1 Septic Tank or Holding Tank l a o U Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps MP/MPRSW No.: Business Phone Number: 3VOY 7(s' 31) 1- 90a Q sue, a~ f~,~~ ~ Plumb is Address (Stre tt, City State, Zip Code): l 11 rn~l C, hp 5 p N S'` . Ntk VSD1~ s C _ U ~a IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial / `jam Adverse Determination ✓ X. ONDITIONS OF APPROVAL/RASOIgS FOR DISAPPROVAL: 13 ~ v My~ SBD-6398(R. /93) DISTRIBUTIO . Original to ounty, 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 the 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 & 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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. Vlll. 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% 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) Bo Lo. 6 7 PLOT' 1-11) _'0 S S 5 N A M E a C s- ",•r, N AM E ST-g,R i 0 C 1 0 Nl_, ~ Ne -1C E N S 0 -I' M A h ,a+ i8xsd t• a ~a S, • t ~ V(P T 1 ~Kolh SeP~1 Cd• Sly f~{m p~ I~ { yy a4i1 K~~ r; NO`e Ad~" mt 16t5 Wells o 4 tl,%>pm 160 ~ ~ ge1~► c.11 rn4,k 1000 FIZO1,, S 1'C S ERRS n~~~ 5c,~Sp L :,~C?~oR a f Rouse ~ f~Y-1ot). ! ink ~ ' Qpc,k~,r,e ~►~s S~. /Aj , FRES11 AI1: INLETS AND OBSERVA'P10N'PLPE CROSS SECTION Approved Vent Cap Minimum 12 Abovc I IP~ . ~ _ Finalrsle~--\•- P 1 I-~Q l ~~1 I Above Pipe Cast Iron ~ Ve~i~ Pipe To Final Gracie- Marsh Ha Or Synthetic y Covering Min. 2" Aggr.c+J.'+t _ Over Pipe Distribut-is_t +r I F_ Tee Pipe ._........_.I., i 9,40 , Svp Aggregate - rexf.oraLed Pi - p e Q c low j.v Dencath Pipe c _-Coupling Terminating P Rot•t . . om. of• System... ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the S Se h SIMOM residence located at: 3 LJ 1/4, 5 L 1/4, Sec. 7 TO_N, R 9 Town of Huos®nj 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_ ~j ,y Igo Did flow back occur from absorption system? Yes No~ (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Ion ~A I Construction: Prefab Concrete Steel Other Manufacurer (if known): Age of Tank (if known): vrr~, ~6LY, _ I fl-) $n U r*VN e Ste J~ (Sign tune) (Name) Please Print MAiumbQK 'Ru-~ijod MF RSo390Y (Title) (License Number) y 9~ (Date) 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 tangy: condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except fo-- inspection opening over outlet baffle) . Name -Jlm BUumee Q Signature,, MP/MPRS V 0 5/88 ~7 Wisconsin Department do Industry, Labor and Human Relations SOIL AND SITE EVALUATION REPORT Page L Of Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,b,~ ' ST not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or" ; ]PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ~ ) APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION rEDBY DATE PRPPEBTY OWNER: tr PROPERTY LOCATION Y r G LOT 114 k, 1/dS 7 T 2 N,R PROPERTY . WNER':S ILIN ADDRE L - LOTYI BLOCI4.Afn SUED. NAM OR M # 47 CI TAT ZIP CODE PHONE NUMBER QCITY GE OWN NEAR T D [ } New Construction Use ~q' Residential / Number of bedrooms (J Addition to existing building Replacement J Public or commercial describe Al # Code derived daily flow gpd Recommended design loading rate 5 _;'bed, gpd/ft2. 4 trench, gpd1ft2 Absorption area required bed, ft27fa trench, ft2 Maximum design loading rate ~ bed, gpd/ft2 . -4 trench, gpddt2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design / site considerations Parent material 04Crm;ln y9 Sr Fa,x Flood plain elevation, if applicable ft r:=Unsuitable table for system VENTIONAL ND IN- ROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK fors stem S D U S D U aS O U D U D S U ❑ S J8U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Rood GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed 5-rich l z o~ IBS Ct✓ / z 34 yr y y S ~Msb~c Iny 4 ~ ~ Ground 3 ';F0-f 5 %~yn y 2 r~ 'Lit 7 35-- y1 /a ye f ~s 1 sit r4~ lvf Depth to .S Yz- limiting Dyes ~ D 7 ~ factor s -1h 5 sow VV/ jil Remarks: aW/A Tcht h r 61 l ac~ tae 01 ~s in 5 ha ~D1'~53 ib 3 i~ ;G w t5 Boring # 0-4 0 3,12- 2- 1- yr )V1 '5 6 3 /I -22 /17 n Ground `~~j' Sb }vr✓l- l/~ Depth to limiting Remarks: Lomc /G S 3 5 n ~'s 7Ph ks 4, CST Name :-PI a int Phone: l,``v► 1 7/.S 8v ~0 2~ Address: U by s Signature: Date: CST Number: SOIL DESCRIPTION REPORT Page:? of .3. PARCEL I.D. # Boringf Horizon Depth Dominant Color Mottles Texture Structure GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Botrdwry Roots Bed Trerxh 3. p- ©M 312- s6~ W v Ground Z 19 ~I 5 m S~~ CL~ l y e s ~ Depth to limiting t„ Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # xt Ground elev. Depth to limiting factor LL Remarks: SBD-8330(R.0"2) Mmil ~G ~vp S2 'Pr o 63 I I ' ie, 2~ I i FYI, /pp.o - - - - - _ - s®!~~ AMP U k-lo A -I-Wes A Ito Daw got 6, ~r oe ~S 4A W l~ UT 5eloi, 46' ~x;st SNs`' 9BR r Z~ 4354.'76 CERTIFIED SURVEY MAP Located in part of the SA of the SEa of section 7, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; being Lot 52 of Eagle Ridge a rural subdivision. OWNER NOTE: Lots 1 and 2 on this Certified Survey ~ rn Richard E Mary Schmitz Map are to be deeded to adjoining s 6345 Krattley Lane owners. 9 IQ o d Hudson, WI 54016 1 / rr U w L.C. John Pick to Richard C cu 0 Mary Schmitz 4) .N 14- v~ ,1 a~ m 41 Alm ! F N = Ol O off C •OS \ 'V~ N L ale /O `v10 0, 0 ~~'~0~ \sr SCALE IN FEET V. 25 50 100 Lot 52 - - - s~9o s~ LOT 1 s~ LOT 2 S7s08- 35,765 Sq. Ft. 38,521 Sq. Ft. 06. 4~~,E O` 0.82 Acres 0.88 Acres O \d o ~ 'O 3 ~o $-1 44 ~7 ~0 LEGEND x'16 °,'~Ja 2" Iron Pipe Found vu ~S , d o 111 Iron Pipe Found rL J p 111 x 2411 Irom Pipe Set, C„e3~-~ . weighing 1.68 Lbs. per linear foot This instrument drafted by Fran Bleskacek Job No. 88-16 VOLUME 7 PAGE 1946 f~ C 9~ 6T S!)Vd L• SWnzon a-4sp ua6agAN •D uaTTK 'v • auks buzddsW pua buTA@Aans UT xzoaD • qS go Aqunoo aq4 Jo aouPUTPIO UOTSTATpgnS pupa aq-4 pup sagngp4S uTSUOOSTM aqq JO • gFZ a9gdPgD JO SUOTStnoad quaaano ago g4Tm paTIduiOo ,~TTng anpq I gpgq !p@gTlOsap PUP paAanans Aappunoq aota@gxa aqq go uoTgvquasaadaa goaaaoo L sz dPW Aanang paTjTga@D.sigq gsgy •paOOaa JO squauiassa TTp 04 goaCgns sT Taoaad pagTaosap anogv •UOTSTnzpgns Teana L 96PTU aT6PS 90 4PTd aqq go ZS qoq buTaq :uTSuOOSTM 'Aquno:) xzoa3 •4S 'uospnH Jo uMOs 'M6Td 'N6ZZ 'L uoz-.oas Jo t,/T SS 9q4 90 V/T MS aq4 3o gapd uz pa4POOT puaT 90 Taoapd V. :sMOTTOJ se pagzaosap sT paddpw pus paAanans Taoaad puPT aqq go Aaapunoq aozaagxa aqq gpgq !dPW AananS POTJTga90 STgq Aq paquesaadaa ST gOTgM TaoaPd pueT aqq paddaui pus pagTaosap paXanans anaq I 'ZgTuigOg paPgDTE JO uozgoaazp aqq Aq gpgq AjTgaao Agaaaq op 'aOAananS pupa uisuoosTM paaa4sT5aa 'ua6egAN •0 uaTTV 'I SIVDIJLL'dRD S , UO2~SAdnS 32945' FILED 02 SEP 291875 iv DES O, Co--4MELL 1pkhr of D.-d, a, Croix cow,ty, CO 329457 9 W W"'o 11 APPROVED ST. CROIX COUNTY 253015'30" dt 1#Wq PARKS SWOR 165.60 166.50 160.77 166.50 NO 2 '0 -0 4 N TRUE -C%j CC) _0 1.42 ACRES 0 1.42 ACRES 0 1.54 ACRES t t-: 1.68 ACRES BEARING t!) d M O M .n M M M Qj co o N a. c~ 0 M Z O M I W '0 M Z Z 1 _ 1 U) 1 _ 1 O . EST LINE OF WE SE 1/4 SW- SE o 40 POINT OF - _0 BEGINNING to 1% o %30 203.90 0 4 ,g0 3 126; 31 93 ~6, 11 ~ S 53.35 40 W 330.21 3S% 93o SCALE 0/ `r`~euNU~iooo,~ 100 0 50 100 G 01 ~i w POINT OF O AN 4t q 1 6 58N30 1~~~~~5 S~~ =o -d BEGIN IN WALTER J. 'M 270'3 LEGEND 5 - GREGORY 0 IN . S 89°31 '40'"W S-1224 ! Z 8.36 RIVER FALLS, SECTION CORNER MONUMENT i t r d o I" X 24" IRON PIPE WEIGHING < WIS. •.f-o~e®o 1.68#/LINEAL FOOT. • SOUTH 1f4 CORNER, ~~i ENO Su R,4 LOT 1 R=1876.86' SECTION 7, T'29 N, R 19 W 40►f111110 ~ Central, Angle = 4°48' 48" Chord = S87°14'16"W 157.63' CURVE DATA TABLE CURVE 3-4 R=1876.86' LOT 2 R=1876.86' CURVE 1-2 R=539.96' Central Angle = 6°03' Central Angle = 1°14'12" Central Angle = 27°33'10" Chord = S86°37'10"W 198.09' Chord = S84°12'461W 40.51' Chord = S69°49'05"W 257.16' Tangent Bearing = S89°38'40"W Tangent Bearing = S83°35'40"W DESCRIPTION: A parcel of land located in the SW1/4 of the SE1/4 of Section 7, T29N, R19W, Town o Hudson, St. Croix County, Wisconsin described as follows: Commencing at the S1/4 corner of said Section 7; thence N0°13'40"E (true bearing) 324.04' along the West line of said SE1/4 to the point of beginning; thence N0°13'40"E 369.39' along said West line of the SE1/4; thence N84°48'30"E 659.361; thence S21°56'E 314.531; thence Westerly 259.65' along a 539.96' radius curve concave Northerly whose chord bears S69°49'05"W 257:16'; thence S83035140"W 330.211; thence Westerly 198.18' along a 1876.86' radius curve concave Northerly whose chord bears S86°37'10"W 198.091; thence S89°38'40"W 8.36' to the point of beginning. I certify that the above description and map are correct and that I have fully complied with the provisions of Sec. 236.34 of the Wisconsin Statutes. DATE : APRIL 21, 1975 ~lL OWNER $ SUBDIVIDER WALTER GREGORY S 224 Job No. 75-461 EAGLE RIDGE, INC. Ogden Engineering Co. Hudson, Wisconsin 54016 123 E. Elm Street River Falls, Wisconsin 54022 Volume 1 Page 178 U 4 1 V U 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 ofproperty S c.( Location of property-SIV 11145E7 1/4, Se tior-,_9-/9,T N-R W Township Mailing address 36q Kr14 S4 ~ Address of site 35~, 9#114# La 1-tA Nv. rt ~,CQSp i.. Subdivision name Lot no. Other homes on property? Yes_ No Previous owner of property T-LialA, arxo3 Y Total size of property 2, a ~ j~_pn5 Total size of parcel a , U Date parcel was created Are all corners and lot lines identifiable? Yes No / Is this property being developed for (spec house) ? Yes ✓ No Volume Yz(e and Page Number2 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 forf«, by virtue of warranty deed recorded in the o f.1-ce of 1--he County Register of Deeds as Document No. an(.1 that 1 (we) presently own the proposed site for the sewage disposal system or I (lie) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded i.11 theL office of the County Register of Deeds, as Document NO. - at re of Applicant 71 [)at , of Si, nature Date of S1(4nature i i i sTc - 1os i SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County i OWNER/BUYER MAILING ADDRESS 3 S4 K-r A 41 ukso L. PROPERTY ADDRESS (location of septic system) Please oi?taln from the i'lanning Dept. a CITY/STATE U-CQ!S;C)t-1_ i PROPERTY LOCATION 1/4, S 1/4, Scction~ _N-R W TOWN OF fi~l~t v ST. CROI_. COUNTY, WI SUBDIVISION 4r, e- - LOT NUMBER - CERTIFIED SURVEY MAP - , VOLUMEDt, PAGE 3~_ , LOT NUMBERr'~ 5 a _L - ' 129-1, Improper use and maintenance of your septic systt m could AW ff5 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 I, 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. llte property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner j 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 xpiration date. P SIGNED: Dn rE: T _27 St. Croix County Zoning O((icc Government Center 1101 ('annichael lWad 1 (t)dscul, WI 54016 I I1'J-t i I 1 RLCORDINO DATA / - TNI• 'r4" R[f[R~[De/OR WARRANTY OEEO Z-•1981 ~17 T `wS OFFICE • •0000MENT NO. STATE BAR OF` WISCONSIN rOR ca. F 8001 82 PA E Ried for Record W"S -1- f, 0V 0 218 lo-.45 AJA g,SCE1MI'~2...and. 1!IARX?SCkI'~2 j 4w t ' ~A I RICHF►RA 0 ,i 1 $to"& Gi bow .......nd HRISTX--.------ ship----...- conveys and warrants to ..JDSand._wfs ss..-s aurviuor husband M~..S1140Nr ' ro e-r-ty,--....-..... PeTURN To - _ ..............................Co unty, Cro1 x the following described real estate in Tax Psrca No- State of Wisconsin: follows: I Section 7-29-19 described as1975 in I 1. Part of SW'k of SEA of filed September 29► 4 of Certified Survey Map Lot j I!Ij Vol. 01", Page 178. of Hudson, described 52, le Ridge in the Toy Map filed March 23, I I 2. Part Of Lot , Eagle of Certified Survey I as follows: Lot 1 0 1988 in Vol. "7", Page 1946. II I'I is homestead property I restrictions j I This (is) (t'g not) reservations, I Exception to warranties: Subject to easements, tl and rights-of-way of record, if any. 1988..... ay o I _ EAL) n I " Dated this , ~I (SEAL) 1 ardR...Chmit. Z . _ (SEAL) (SEAL) y.mi , • ,I" liar L, LEDG3iiNT Q , t3. I li ACHNOW Q _j N TICATION ~ b 4 AIITBSN STATE OF WISCONSIN J Signature(s) Gox----------•--County. this' Personally came before me g the l , 19..8.... this aAS~..1`'~a c i authenticated )31,C~Ld4J-0 ~ TITLE: .........R S who - - executed the MEMBE STATEBAR OF WISCONSIN to me known to be the person (If not+ --Wis. Stats.) instrument and ac n ledge the same. authorized by 1706. foregoing IS INSTRUMENTWAS DRAFTED By - - Robert . . . Attorney rgrhaxle.M...C.~~~--~--`'-~•'-_-- . TH Mudge. D-E County, wig W. . EhI p012'1'F' & LItN S ......Croi ate e i n Notflry Public My Corlmission is permanent. (If not, st xplra o 19 . GILBERT, 92..) MIDGE Uudsan-....WI._5.4D, ~.6 . date: _..4^`--------- . - (Signatures may be authenti_ated or acknowledged. Bo are not necessary.) t blow their eiRnahlres. should be tyDe"1 or )rinted wi•eonein 1,441 Rls::k 1'... Inr • of D/~°' eiinint in 4n1 C4D4cit7 \ Nom's g•fATB 13 AA 01 i{TLgCONSI:`I ` ' AS BUILT SANITARY SYSTEM REPORT ;DER' TOWD,'SHIP 0,01,1SL_SEC. N, ADDRESS , ST. CROIX COUNTY, WISCONSIN. :;DIVISION L ancle_ LOT~LOT SIZE PLAN VIEW -Distances b dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i f 1 ~ i + W. i Indicate TO t Ai o i i I ,SCAT: ! '.'TIC TANK(S) ? MFGR. STEEL CONCRETE NO. of rings on cover~_ Depth ~'DRY WELL rCHES NO. of - - width length area J no. of lines width_jf length 217' area , depth to top of pipe_el.,,,(,, ' ,3REGATE y - ` I , PvaTE ~ - AREA REQUIRED AREA AS BUILT _ °ciaimer: The inspection of this system by St. Croix County does not imply complete ~;r)liance with State Administrative Codes. There are other areas that it is not possible ..inspect at this point of construction. St. Croix County assumes no liability for :;:tem operation. However, if failure is noted the County will make every effort to -:ermine cause of failure. BASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. ~INSPECT02 . DATED ~l PLUMBER ON JOB WAj LICENSE` NUMBER 727) Plb. t-A , WISCONSIN DEPARTMENT OF HEALTH & SOCIAL SERVICES Division of Health r Section of Plumbing & Fire Protection Systems r I ON-SITE WASTE DISPOSAL INSPECTION REPORT Name of Premises ` ° Street city County Master Plumber Address Owner Address TrCounty Permits ❑ Appropriate State Permits Type of Building: ❑ Public 0 "Single Family or Duplex CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM ❑ Building Sewer [D-Conventional Soil Absorption System ❑ Septic Tank ❑ Conventional System-in-fill ❑ Holding Tank ❑ Alternate Mound System ❑ Seepage Bed ❑ Holding Tank ❑ Seepage Trench ❑ Seepage Pit ❑ Experimental System BRIEF, FACTUAL COMMENTS AND SKETCH: q I t 1 1 i, i ~ . j mm t r o i ~ z 1 ' a r s W. E e ❑SEE ATTACHED DISCUSSED WITH PLUMBER Yes ( ) No SIGNATURE (Voluntary) K t M DATE OF INSPECTION Signature of Inspector White - Inspector Yellow - Local Inspector Pink - Plumber or Responsible Party f ' Z REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM Sanitarsy Persmit-// State 1 Septic % SC~sl NAME Township IZ.W5(I~( St. Crsoix County Locatim-S~~ti1% o4S A, Section 7T.;7N,R~7W SEPTIC TANK Size 4go gatton.6. Numbers o6 Comparstment.6 Di.6tance Frsom: Wett 12% ors grseaters scope it $uitding U it. Wettand6 Nighwaters _ it. DISPOSAL SYSTEM Diztance Ftcom: Wet 12% ors gtteaters ztope it. Suit ding .2, it. Wettands Ft. ® Highwaters it. `L- FIELD D MENSIONS: Width aj trsenchit. Depth ob rsoch below tite~in. z it. Depth aj rsacFt avert ti2e Z gin. Length of each tine 7 Numbers, o6 Una Depth of tite below g&ade~kn. Tatat length o6 tines /1-0/ it. Stope o6 trsench in pet 100 it. 0. ~Diztance between tinea t. Depth to bedrsacFz fit. rvr' Total abborsbtian atcea7't2 Depth to grsaundwaters it. Requited arsea it2 PIT DIMENSIONS: Numbers of pitz Grsavet atcound pit,5 ye.6 no Out.6ide diameteDepth below -i.ntet it. Totat abz orsbtiit 2 A Arsea rse uite it ~ a INSPECTED BY 41r'e TITLE APPROVED ,'9ATE 197. REJECTED DATE 197` 1 V 04 PP_ 25 4~ _Z7 State and County State Permit # PLB 67 County Pe t# Permit Application b t s for Private Domestic Sewage Systerrls Count *DENOTES STATE APPROVAL ' R1=QUIRED Date. Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: f og C1ow-T; 3,Z &11,4,8s Av.;; B. LOCATION: V Y4 SAI Section T.,Z J? N, R_Z2 E (or) Lot# _ City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance Single family X- Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY ig,00_Total gallons No. of tanks I HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete- Poured-in-Place Steel Fiberglass Other (specify) New Installation x Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area X"Zo sq. ft. New X Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top)-No. of Trenches Seepage Bed: Length 661r Width ,E Depth -Tile depth (top) ~ No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private (N 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, NAME rNN/Si~~LS~~f~rn0/Y C.S.T. # •5 and other information obtained from ll ' (owne builde Plumber's Signature C MP/MPRSW# .72206- Phone Plumber's Address "o it w" , 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 ~p property. If well has not been drilled please indicate. E i 9 m m. m. w e~ r. 3 E. 12ell '-Se, c.: e,cz Yii , n _ r> tUC~ • , , E E Do Not Write in Spa Below F R COUNTY AND SWE DEPARTMENT US Date of Application Fees Paid: Stat '~-----o County D Q 7~ Permit Issued/Rej cted (date- Issuing Agent Name Inspection Yes No ~f State Valid# Date Recd 1. county (wh' a copy) .p 6 3~ owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1 /78 EH 115 Rev. 9/78 > REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATIONJ_T 'y4, Section r ,T.ZN,R2~7_& (or& ownship or Municipality— ~LLi,!~d~✓ Lot No. Block No.f CountyS ub!on ~ me Owner's/Buyers Name: Mailing Address: Vim'. TYPE OF OCCUPANCY: Residence-----,<-No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW x REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 44" -,.Z -7,q ._PERCOLATION TESTS SOIL MAP SHEET NAME OF SOIL MAP UNIT J/4 C PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHE NUM- INCHES SINCE HOLE BOLE AFTE INTERVAL RATE BER THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- /Vc 3 _3 3 / P- .7-- /fc 3 P- 3 /ze!' e eYv C _3 P_ fE` fC - r P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES OBSERVED ESTIMATED HIGHEST TEXTURE, MOTTLING AND DEPTH TO BEDROCK B- / / S6 !r IF OBSERVED IN INCHES B- ~ Is tel: 7~„ -S 3yii5',e /0 27 1. _5' PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the Ian the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy XZe 2 c Indicate scale or distances. Give horizontal and vertical reference points. Al,- A/ slope. i ~fiPs:de.•e e < rm N E ,p ! E o 3 i I~ fi 541111re dl E 14. _ I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) ~~s ~^/t47 L~il~v Certification No. - ~ ~S Address Address .Name of installer if known Copy A -Local Authority CST Signature State and County State Permit PLB67 Permit Application County Permit . 6 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: / CIeio e~ Awe, B. LOCATION: Section -7 T~ N, R/ (or) Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village _ / I Township 4/47, 1---!-C, 47- *Variance C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Single family K Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES "0 # of Bathrooms- Automatic Washer _ YES NO Other (specify) E. SEPTIC TANK CAPACITY a C Total gallons No. of tanks / *Holding tank capacity Total gallons No. of tanks - New New Installation Y, Addition Replacement _ Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) Total Absorb Area o q. ft. / New X Addition Replacement _ *Fill System ,2w 4ct~rc A Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length W Width /a-Depth Sa-Z" Tile Depth 6'1 No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land 3 c oLl'~. ~S WeS~a- v Distance from critical slope 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 C ified Soil ester, 01 NAME C.S.T. # ,r7:S--/5!7 end other information obtained from ApVlo Plumber's Signatur MP/MPRSW# Phone #711 -3'36 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). 66 &AI ~z Yk~ 17 ASS 0, OIL, _ • 01 NY A~ Do Not Write in Space Below FOR DEPARTMENT USE ONLY 2~ 1~ Date of Application - C Fees Paid: State C'C County !~C? Dat Permit Issued/ (date) - Issuing Agent Name Cam ,eei 6", Inspection Yes 7No Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 state (pink copy) 4. plumber (canary copy) Revised Date 6/1/76 I EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES ` DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TES/TS LOCATION: 5- 4, 5--A/4, Section !L, T~N, R &(orQ2Township or Municipality Lot No. - Block No. Jl r;County 4 Cktli t Subdivision Name Owner's Name: -IV* Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS 2-- S-2E PERCOLATION TESTS SOIL MAP SHEET .2 FF7" SOIL TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P Al-W /o .7 / Z 4Z sr' P-*Z s~ D 0~? lv / / 1/-0 P-3 I'S SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B J_ _ l2 •~,C~ ,2 6 •4 5.0 36 JV4 B 7 G b is s,6-4 4 s' B_ //3°' > y~j6 lo••'fs~ Iz 2 Y `.,~s~ 3d ,FG!► 0 PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)- Indicate on the plan the location and square feet of suitable areas. Indicate numb of sy~uare feet of absorption area needed for building type and occupancy. -66,t'T -OC-0 ~e ,r,~ 44ed Indicate le 1 or distances. Give horizontal and vertical reference point. Wic sl _ F'ov ~y P r Y- W{Q11_9e e_ y u -7as el r v C=- e~ ' / tN .461 i i .3 F•: I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with t e procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief Name (print) .fj"4r i . Certification No. Address Name of installer if known CST Signatur COPY A -LOCAL AUTHORITY