HomeMy WebLinkAbout020-1054-20-000
Q o -0 ° I
0o bq O
M 0. 0
o ~ I
O
l L C C
c m w
o '3 o Q ~
N ~
n O O O
d c 0
MD ~ ~ T y I
Z~E "
U)oy
a) c
a ? xU m
Lo O Z
c ~ y ai
C N C N
O O
O d Y V O)
N` N N O N
N O L Q) .0
'O z N L N j T
c (0 O O
6 O L 3
LL c W ClO 0740
O ~p».. f6p
C Z7 C p N N
O 'O 0 0 X .i- C
E d a N O
U
O M
rn w E
Z 0
0
z
c~ IN- z a m
0
c O o
0 2 d' c
U a o
v o
fA FZ- r m z
C N E O
N a O
N O
N U
N ~ C
76
Q 0 Q
z H z o
N _ T
_d =
N
a O CL m w Y C co
p N O IL a) cu 0
E O
U) E :3
LO cV
h w O
Z I Z > Z p
§ 0 0 0 U) 4
c
• a fn
a ~
g =
Ln LO
3 O N N
to V '0 rn rn }
m ,z r- 'D
N
N N O O
00 O O _ E
:D
7 m a
O 'O rn N
`Fri d Qm
CC)
O O
C: 0) 0 1
i ON pOj 30 O N C C r a C W 0
CF - N N
40. O 0 N n
LO ~
O N M a„ 'O W
(x~ ~..I O' N 'Np N p ~ ~ Z' Z' C N
] N O N .4 O N N N 8~9 L
• ^1 O N= Z N O z N U)
CC
Y, Q a
7
c~ CL d Cl a
A u (L O I u
Parcel 020-1285-90-050 09/17/2007 10:39 AM
PAGE 1 OF 1
Alt. Parcel 21.29.19.1386A 020 - TOWN OF HUDSON
Current ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
02/23/2007 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - SAFE-WAY BUS COMPANY
SAFE-WAY BUS COMPANY
596 SCHOMMER DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 596 SCHOMMER DR
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: 2496-ST CROIX INDUSTRIAL PARK
SEC 21 T29N R19W PT N1/2 NE1/4 LOT 9 ST Block/Condo Bldg: LOT 09
CROIX INDUSTRIAL PK (2.8AC) EXC PT TO
HWY PROJ 8949-02-23 ('03) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
21-29N-19W NE
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 963/200
2007 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 2.637 104,200 922,400 1,026,600 NO
Totals for 2007:
General Property 2.637 104,200 922,400 1,026,600
Woodland 0.000 0 0
Totals for 2006:
General Property 2.637 104,200 922,400 1,026,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER 2d,c/ ct~ol j'12~~
ADDRESS Co
_l1-1esr
SUBDIVISION / CSM# LOT #
SECTION T N-R W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I
~i
~o
Z'
. ,p
IND1 CATS - tO RTW- A- ROSS' ~0
Provide setback and elevation information on never ~ Hof th•is!f't--
Provide 2 dimensions to center of septic tank mai~yle~~;`- c~~
BENCHMARK: Scr/~ S- ~~S
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: ~_47PH ,,c/ Liquid Capacity: fl1D~_
Setback from: Well _5-Zf House +y6- Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length 5-'7 Number of trenches
Distance & Direction to nearest prop. line: S'p23~
Setback from: well: 5`G- House : Gpy- Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: r/.? J- 1"?"5-
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Wisconsin 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 PI o.:
NELSON, LEONARD X
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark oo -
Dosing] 9fa
Aeration Bldg. Sewer
Holding St/Ht Inlet
9,7 95„5,;z ,
TANK SETBACK INFORMATION St/Ht Outlet 7,`
Vent
TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Inlet
Septic ra~~ >a~ yc. >0?5 NA Dt Bottom
Dosing NA Header/ Man. 6.7$, 4q' yq
5.71/ 99,~5- 3
Aeration NA Dist. Pipe S gq,
Q9, ~ A
Holding Bot. System G'sy 9g. ?3
G.rs p~ E
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand 61 Model Number 1-179 3~ GPM
TDH Lift, t'3, Friction /54- System~a3' TDH /0,C Ft
Forcemain Length /liar Dia.a Dist.Towell
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER Moe Number:
System: dcG4 ~o' S(' y5O~ OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched
Bed /Trench Center ~v Bed /Trench Edges o? Topsoil ❑ Yes E] No [I Yes El No 7]
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HUDSON.21.29.19W, NE, NE CTY. ROAD A
Plan revision required? ❑ Yes Er/No/
Use other side for additional information. g gJ'L2~.kj,
SBD-6710 (R 05/91) Date nsaector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER:
• lxou~s°wu
Safety and Buildings Division
v~•~.r■r• SANITARY PERMIT APPLICATION Bureau of Building water systems
In accord with ILHR 83.05, Wis. Adm. Code 201 E. Washi ngton Ave.
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. Q
• See reverse side for instructions for completing.this application State Sanitary Perml Number
d 4Lo 7 7 4
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
.(Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
e &~Et/4 ,6 114, Sal T , N, R 1 E (or)
Property Owner's Mailing Address Lot Number Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
II. TYPE F BUILDING: (check one) E] State Owned ityy Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms Iowan of z O Zf '41 .,4j
I11. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1❑ Apartment/ Condo e`0 d M /e..5-v/ ZZ Q
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1- ❑ New 2. jo 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 CASeepage 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
t 9,?0 a Feet 1A Feet
VII. TANK Capacity gallonTotal # of Prefab. Site Fiber- Plastic Exper
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App.
New Existin strutted
Tanks Tanks
Septic Tank or Holding Tank JI( U7J f " 7` ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber V. S- I R ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No Stamps) PRSW No.: Business Phone Number:
160
r/~ 1
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY/ DEPARTMENT US ONLY
❑ Disapproved Sani ary Permit Fee (includes Groundwater ate Issued Issuin Agent Signature (No Stamps)
~ ` -
Approved E] Owner Given initial / U Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: VC/
SBD-6398 (R. 05/94) DISTRIBUTIONS Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7_
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smallerthan 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.
u
p A 4/ d
aZ
c ~
Wisconsin D. -artrnent of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Mrian Relations
Divis:an 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 1 c e?A^ si Ian must include, but
PARCEL I.D. # St. Croix
not limited to vertical and horizontal reference point ~ pe, scale or
dl
dimensioned, north arrow, and location and dista p to, Barest road. 020-1054-20
APPLICANT INFORMATION-PLEASE PR LL IWOf~ N ~ REVIEWED BY DATE
O
_tI
PROPERTY OWNER: P TY LOCATIO
OME for) W
Leonard A. Nelson c G4=10T NE 1/4 NE 1v4,S21 T 29 N,R 19
PROPERTY OWNERS MA!I.ING ADDRESS BLOCK # SUED. NAME OR CSM #
587 Co. Rd. #A na na
CITY, STATE ZIP CODE P NE' M ITY ❑VILLAGE MOWN NEAREST ROAD
Hudson, WI. 54016 CI1 - b5 Hudson Co. RD. #A
(j New Construction Use (xJ Residential I Number of bedrooms 3 [ J Addition to existing building
Weplacement [ j Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 ' 8 trench, gpd/ft2
Absorption area required 643 bed, n2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 98.60 ft (as referred to site plan benchmark)
Additio,~al design / site considerations na
Parent material outwash Flood plain elevation, if applicable na ft
I
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
[M S
❑ U EIS ❑ U ❑ S EIU ❑ S EIU
U= Unsuitable fors stem (t3 S ❑ U ®S ❑ U I
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Du. Sz: Cont. Color Texture Gr. Sz. Sh. Consistence Barxiary Roots Bed Trertd~
1 0-10 10yr3/3 none L 2msbk mfr 9w 2f .5 .6
2 10-23 10Yr4/4 none sil lmsbk mfr gw if .2 .3
Ground 3 23-90 7.5yr4/6 none co s Osg ml na na .7 .8
elev.
101.90 ft.
Depth to
limiting
factor
+90"
I e i IGarks:
Boring # 1 0-12 10 r3 3 none L 2msbk mfr 9w 2f .5 .6
2 2 12-24 10yr4/4 none sil lmsbk mfr 9w if .2 .3
3 24-96 7.5yr4/6 none co s Osg ml na na .7 .8
Ground
elev.
103.2n.
Depth to
limiting
factor
+96"
Remarks:
CST Name:-Please Print Gary L. Steel Phone: 715-246-6200
Address: 1554 20 h. ave., New Richmond, WI. 54017
Signature: Date: CST Number:
7-13-95 cstm 02298 I
I- CA
PROPERTY OWNER Leonard Nelson SOIL DESCRIPTION REPORT Pagk 2 of 3
PARCEL I.D. S 020-1054-20
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITrerch i
1 0-13 10yr3/3 none L 2msbk mfr gw f .
3
..v 2 13-28 10yr4/4 none sil lmsbk mfr gw if .2 .3 I
Ground 3 28-80 7.5yr4/6 none co s Osg ml na na .7 i .8
elev. i
101.6ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
is}v'~`+CO?T<iii
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft. i
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
n + K
i
STEEL'S SOIL SERVICE
Gary L. Steel Leonard A. Nelson 1554 200th Ave.
CSTM2298 NE 4NE 4 S21-T29N-R19W New Richmond, WI 54017
MPRSW 3254 town of Hudson (715) 246-6200
N
1"=40'
BM.= top of NW lot stake C el. 100,
2d~
0 ` Id/ 60'4-
Si5}r~
3o
~ 1 - -
s
z
lpa
Gary L. Steel
7-13-95
PAGE OF
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
VENT CAP
4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIKIG
JUAICTION BOX MANHOLE COVER
~ 25' FRCM DOOR,
WINDOW OR FRESH 12'Pil,Ll.
AIR INTAKE ~
GRADE
TLMIAJ.
• 18"MIN.
L--
CO►JQUIT
MIN.
\ 1o
IAJI_.F=T PROVIDE I
AIRTIGHT SEAL I I i I V
I I
APPR.OVEC JOINT A I III APPROVED JOINTS
W/C.I. PIPE. I III W/C.S. PIPE
EXTENDIKIC• 3' I II ALARM EXTF-mDIAlG 3'
OMTO $01.10 SCI.. B ( II ONTO SOLID SOIL
I i
I oN
C
I
PUMP
OFF
0
CONCRETE BLOCK
RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL
SPECIFICATIOILIS
SEPTIC AND
DOSE TANKS MANUFACTURER: ~!%G~6✓C'STeyr~ IJUMBER OF DOSES: PER DA4
TAMK ;,IzE : %ddd /G"S 6 GALL0US DOSE VOLUME
ALARM MANUFACTURER: .50- ggze'rYd 5y_yTc-,oys* INCLUDING BACKFLOW: GALLONS
MODEL UUMBER: ld4 NeJ CAPACITIES: A= IMC14ES OR GALLOWS
SWITCH TYPE: - 2ef-C- B= -INCHES OR GA'_LOUS
PUMP MANUFACTURER: Z~C~Le/ C = 7 S INCHES OR .7• :-E GA'-LOWS
MODEL NUMBER: OF S"7 D INCHES OR ipd GALLONS
SWITCH TYPE: /t 4--c NOTE: PUMP AND ALARM ARE TO BE yG
PUMP DISCHA.R`E RATE _9 -z~_GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFEKEIJCK Br-:?'WCEAI PUMP OFF AND DISTRIBUTION PIPE., o FEET
"F MIIlUIMUM NETWORK SUPPLY PRESSURE . . , , . . . , , . . FEET
♦ Q..SL-_ FEET OF FORCE MAIN X ~FoF>:FRICTION FACTOR.. FEET
= TOTAL DYNAMIC. HEAD = 5171 FEET
INTERNAL DIMEWSIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH
SIGNED: LICEWSE IJUMBER: ~ DATE:
-117-
( HEAD CAPACITY CURVE 4~8
W LL "57" - "59" SERIES
~ 25
W *4 /a
A 1'1h-11%NPT
3/16
6 20-
S05-40399
I
0
W
F**
U 15
Q
Q 4
yZ 916
J
Q
O 10 1933/32
2
5 TOTAL DYNAMIC HEAD/
FLOW PER MINUTE
EFFLUENT AND DEWATERING
HEAD CAPACITY
UNITS/MIN
0 FEET METERS GAL LTRS
us 10 20 30 40 50 5 1.52 43 163
GALLONS 10 3.05 34 129
LITERS 0 80 160 15 4.57 19 72
FLOW PER MINUTE 19.25 5.87 0 0
CONSULT FACTORY FOR SPECIAL APPLICATIONS
. Piggyback Mercury Float Switches • Available with special cord lengths of 15',
available. 25', 35' and 50'.
. Variable level long cycle systems .Alarm systems available.
available. • Duplex systems available.
Standard cord length - automatic 9 ft. SELECTION GUIDE
Standard cord length - non-automatic 15 ft.
t. Integral float operated mechanical switch, no external control required.
2- Single piggyback wide angle mercury float switch or double piggyback mercury
57/59 SERIES Control Selection float switch. Refer to FMO477.
Model Volts-Ph Mode Am Sim x Duplex 3. Mechanical alternator 10.0072 or 10-0075.
M57/59 115 1 Auto 8.0 1 Or 1 & 7 - 4. See FMO712 for correct model of Electrical Alternator, "E-Pak".
N57/59 115 1 Non 8.0 2 or 2 & 6 3 or 4 & 5 5. Sensor mercury float switch 10-0225 used as a control activator, with "E-Pak"
57 1 Auto 4.0 1 or 1 & 7 - duplex (3) or (4) float system.
E57/59 230 1 Non 4.0 2o. 2&6 3or4&5 6. Four (4)hole "J-Pak", junction box, for watertight connection or wired-in simplex or
2 pump operation. 10.0002.
7. Two (2) hole "J-Pak", for watertight connection or splice. 10-0003.
57 Series - Wt. 27 - .3 H.P. 59 Series - Wt. 29 - .3 H.P.
CAUTION
For information on additional Zoeller products refer to catalog on Combination Starter, ANMutallatlonatcontrols,Proteclondwlasendsting dmbb* done byaquMM.d
FM0514; Piggyback Mercury Float Switches. FM047 ; Exectrical Alternator. FMO486; Mechani- Neensed ebetrlclan. AN Naetrlcd and safety codes should be followed Including the
cal Altemator, FM0495; Alarm Package. FMO513; Sump/Sewage Basins. FM0487; and Simplex moat.em t Hadonat Ekwklc Code (NEC) and NCI ooeupmuond Sel* and Hoom Act
Control Box. FMO732. (OSHA).
RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO: P.O. BOX 16347
` Louisv* KY 40256-0347 Manufacturers of .
OELLE/~ O• SHIP LoTO. 3280 old MAWts u*, KY 02 6 lane
O N
(502) 778-2731.1(800) 928-PUMP QUALITY PUA/PB iYCE lf3x7
FAX /5021774-3624
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
/ St. Croix County
OWNER/BUYER 4oNAA4 k NE t S 0A1 -
MAILING ADDRESS 587 &vmrl ICoa h APSON GV~ SfD/~
PROPERTY ADDRESS 58 7 4V MM 4W A / l pso hi_ w/ V o
(location of septic system)) Please obtain from the Planning Dept.
CITY/STATE lIV40 SO Al 4WI 'rm` 1014 ~X C
r
PROPERTY LOCATION NF, 1/4, A16 1/4, Section Z~ T2q. N-R~ V
TOWN OF b414 SON ST. CROIX COUNTY, WI
SUBDIVISION N! A LOT NUMBER W11f
CERTIFIED SURVEY MAP , VOLUME PAGE 7/5, 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 ex ' tion dat
SIGNED: /
DATE: g (7
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 IFO*iK /Q I-SOAl Q¢I JM L • NMS0 /y
Location of property
NZ 1/4 NE 1/4, Section ,T~N-R~W
Township X4SOAl Mailing address
Address of site TV? C*VA1y A
Subdivision name ~r Lot no. AlA
Other homes on property? Yes- No
Previous owner of property ~IVI}- s/t! /77~F 'goe 10&srz )6-rV'V1 .P6r
.
Total size of property A • A. *,e6p-s
Total size of parcel ~V)t+
Date parcel was created -
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Yes _ C No
Volume 3 and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. S Z'7Z7 , 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
thg 2,~r of the County Register of Deeds as Document No.
Signature of App icant C -Applicant
lgS~ ?If7ll~e
Date of Signature Date of Signature
• /•S V-L C^?., E1716
PERSONAL REPRESENTATIVE'S DEED
THIS INDENTURE, Made t.his-5/ day of &Cke--' 1995,
between Robert T,. Loberg, Personal Representative of the estate of
Edna Smith, aka Edna G. Smith, deceased, party of the first part and
Leonard R. Nelson and Sandra T.. Nelson, husband and wife as
survivorship marital property, parties of the second part.
WITNESSETH, That the said arty of Ahe first part, for and
$ :!K, oo to
in consideration of the sum of 9
them in hand paid by the said parties c` the second part, the
receipt whereof is hereby confessed and acknowledged, has given,
granted, bargained, sold, r.emi.sed, released, aliened, conveyed and
confirmed, and by these pvese>nts does give, grant, bargain, sell,
r.emi.se, r.el.ease, alien, convey and confirm unto the said parties of
the second part, their heirs and assigns forever, the following
described real. estate, situated in the County of St. Croix and State
of Wisconsin, to-wit:
Part of the Northeast. Quarter (NF%) of the
Northeast Quarter (NE34) of Section Twenty One
(21), Township Twenty Nine (29) North, Range
Nineteen (19) West descr.i.bed as follows: Lot One
(1) of Certified Survey Map recorded in Vol. 3 of
Certified Survey Maps, pg. 715, as doc. no.
:352640, except the East 2.65 acres thereof.
Subject to easements of record. '
Tf this conveyance is not excluded from the DTLHR
Rental Weatnerizati.on Program, or if the use of
the premises changes so that it is subject to
such Program, then Pnrchaser shall be responsible
for the cost of any necessary energy audit or
r.epai.r% as may be required, either now or in the
future.
To have and to hold the said premises as above
dencr.ihed, with the hereditaments and appurtenances, unto the
said parties of the second part, and to their heirs and assigns
f.orevPr..
REGISTER'S OFFICE
SE CROX CO., Wl
Read for RecW
APR 3 1995
at A.M
n oo cN
.4 ! ~ V M
- - VOL j,l 1C~a9F j .l
nn
T
And ,.ho said party of the fi.r. ,t part convenant,s thF- game
are frt,r- and clear from all e.(tr•t:mhranres whatsoever. These
arf, sold in an "aA i.s" condition.
Tn Witness Whereof, the said part of the first rt as
hereixnto set the i.r. hands ar,d seals this day of ,
?995. -
i
Robe Loberr
So'nal Represen a .I of
the Fdna G. Smith Estate
State of Wisconsin )
(ITa''X ) s s .
County of Personally came before me this \51 day of
1.99=x; ?,.e above named Robert T,. T,,.)hF.rr3, Personal Representative of
the Fdna G. R?nith Estate, the person who ecuted the foregoing
i ntitrttrte'nL An acknowl.r --dg(--d the -1m e
Notary Public, I~nra.,eL
my commission is/expires
This i.nstrum, ,nt drafted hy:
Swanson & '-nbe:rn,
Rc>hert T,, T,c,~c>rg
I
I
I
I
i
I
352640 CERTIFIED SURVEY MAP
UNPLATTED LANDS
TRUE BEARING I I
435.48' c
NO°38'07 "W I Z N
402. 4 8 cr z cr
3
33 I o o
900 3~
F z
V1 Z~g w N
9 0~ 6 G' 1 Z Lo E-
-p r
W
o I -
-O co
G
to M
0) I =
~ HOUSE °~°N
w
w I U
z -o SO°38'g7"E 33 33' u.
- 17.00 I O
w w
Z
v 50 J
_ w
o of 0 8 3' I z
o - ° 1 cD
z w
- w
Q I _Q
i
I
Wi 9.56 ACRES INCLUDING }
C.T.H. RIGHT-OF-WAY O Q
13 -
NI
QI ° ~ r U-)
I in 0)
aI ~ N 8.26 ACRES EXCLUDING zi
z co ml z rn C.T.H. RIGHT-OF-WAY w =
O Y I
U-) Z QI W
0 :3
am c I W l z
co ~ ~1 =
NE NE w U) > I a~
O O f J1
Z 3 ~ti z
U-
0
ti 0 co oI DI O
4'
Fit ED U)
OCT 26 1978
JAMES O' Cot4NEll
Reylsfer of ~l I 2
Ds
S4 eds I.
rolx CeuMy,
Ql Wlrc~jjn
O
g g z
RIGHT OF WAY LINE
I w
W cm
Z N
Z
W
-
d'
0z~ p °
oii ^
~ O
N rST
NE OF THE NE 1/4 8 3 Vvm
w z W W N
f
~wN . I Z N
CENTERLINE 9 ~ 3
3
W~~ 7E 50 F
M$cD 435.48 S 0° 38'07" E-- O, _ POINT OF
O COUNTY TRUNK HIGHWAY "U" co M BEGINNING
UNPL_ATT_E_D LANDS
VoiuTre ~ pale 77-7
This...
iz~
w F •
>e,
DESCRIPTION
t4i
u.s
A PARCEL OF LAND LOCATED IN THE NE114 OF THE NE114 OF SECTION 21,
T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN, DESCRIBED
AS FOLLOWS:`4*BEGINNING AT THE NE CORNER OF SAID SECTION 21; THENCE
S0038'07"E (TRUE BEARING) 435.48' ALONG THE EAST LINE OF SAID NE1/4
AND THE CENTERLINE OF COUNTY TRUNK HIGHWAY "U"; THENCE N89050'W
956.45'; THENCE N0038'07"W 435.48'; THENCE S89°50'E 956.45' ALONG
THE NORTH LINE OF SAID NE1/4 AND THE CENTERLINE OF COUNTY TRUNK
HIGHWAY "A" TO THE POINT OF BEGINNING. SUBJECT TO EXISTING COUNTY
TRUNK HIGHWAY RIGHT-OF-WAY ON THE EAST 33' AND THE NORTH 33' AND ALSO
THE SOUTH 17' OF THE NORTH 50' OF THE EAST 730' OF SAID PARCEL.
I certify that the above description and map are correct and that I
have fully complied with the provisions of Section 236.34 of the
Wisconsin Statutes and Section 5.4.2. of the St. Croix County Zoning
Ordinance
Date
Walter J. Grego -1 24 Jo No.78-1 $
Ogden Engineering Co.
123 E. Elm Street
River Falls, Wis. 54022
I hereby certify that this map has been approved by the_Town Board.
Date:
i
LEGEND
O 1"X24" IRON PIPE SET, WEIGHING 1.68#/LINEAL FOOT.
EXISTING FENCELINE.
! SECTION CORNER MONUMENT FOUND, BERNTSEN CAP. r"011K1811 N,
pNS~ y*
,rOGREGOR
SURVEYED FOR: EDNA SMITH ',yI I~gNlJ Su R `j
RT. 01
~Ut~
HUDSON, WISCONSIN 54016
APPROVAL Df jrii~- M&4-K SUoDiViS►GN APPROVED
DOES NOT A1EAN APPROVAL FOR
BUILDING SITE OR SEPTIC SYSTEM. OCT 2 5 1978
REFER TO H62.20.
ST. CROIX COUrTY
I COMPHHENSIVE PARKS PLANNING
AND ZONING COMMITTEE
3