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HomeMy WebLinkAbout020-1057-60-500 ° o h 0 0 6n, a a ° c C c ~i 0 0 I ai co o m o _o c w 3 C c c y m Co a ° > N t (0 ' c a c o '0 CN [r N N0) N N E N D I L Q1 C Z N C z C N LL C E 'L" c co LL O y 3 c O ° 3 = d. - N N N N N N Q .L.. LL Q « N i 3 3 co vII z ° 3 w z " rn z ° , 0 2 O O a m a co N F- fn L, O O z d C c cu (n N 44) Z a 2 c a c o CD a) z E _ E '2 h/5 O O O O O 'n CL CL N O y O • a (n a co c L 0 Q O O N Q O N Q z m z z co z o N z Q1 N N N > N > ca m CL 1. C'~ .OL.. O. 'm w Iii' (O N C! 1 O T o " N O oooa a~t oooa 0) (n cn u) L) zM>°,,',~ 333 IL LL 333 ° " Z 31, • caaa c aaa o O a N N z LO D LO U) fA J U Z '=O ~ ~ LO 04 N O N ~ E N O O O O N Cd co N Q =:J3 'C N y ::1F O z C'4 U) Q0 c d 000 O 7 w 7 .i.~+ V) C O Q O N C O W C LL C U y U O E 00 co ~Ol Lr _ _ lr (o N H C Y E " Y Y C~ N V ❑ o- 3 aUi c c ? aJi c c a rn °o l C C 0 N C C N w p C j UO n ` O O. U N zE N N O N N CD r- T C Oj ° N +lP N r- N TS p • y?,i' C. N 2 N O N z 0 Q) L) N O z N O rte.. r r+ j r. E 'M d CL a CD m L: (L i~ CL CL z 0) (D E L 'c c a) c - O N 7 3 ,C., O 3 w O Q U a. 0 fA U 0 w U STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER CQ~tJS . ADDRESS SUBDIVISION / CSM# /EG/1/ LOT ®T GSI~ SECTION .2- 2 -T-2 N-R_,~47 W, Town of i~Grc/Spt/ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM If ~ 3s. o d T°/ W- ~ wFcc D ~ ~ mod t~ t. T .x v INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: 22 4er- Cot (zxy 7x/_:YF SGfN1i`' i~.f> ' ALTERNATE BM: SEPTIC TANK''--/ PUMP CHAMBER / HOLDING.TANK INFORMATION Manufacturer: GAS Liquid Capacity: 404c) Setback from: Well House _Q r 3S' Pump: Manufacturer Model#_ e Float seperation Gallon Alarm Location SOIL ABSORPTION SYSTEM Width: 12- Length Number of trenches Distance & Direction to nearest prop. line: 5a Setback from: well: S4 r House S Other ELEVATIONS Building Sewer ?57,9,- ST Inlet; , 7 ST outlet PC inlet PC bottom - - Pump Off Header/Manifold &12- Bottom of system f:~• Existing Grade p3,,o Final grade /-.,O DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 3.1Af 14 INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX SafetyFand Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PIA WO DELTA CONSTRUCTION R CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: IL ..SIL ~i~✓ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic z_6 Benchmark D /00 Dosing 61 Aeration Bldg. Sewer .~36 9sFa Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet 9S-- z/f: . Verit TANKTO P/L WELL BLDG. AirIto ntake ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header/Man. y' qa~ s y Aeration NA Dist. Pipe dd, cry Holding Bot. System dl y CIS PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Z5 v 7-' /rl~rfir4 ~r!.~J y~ ~ ~l Model Number GPM TDH Lift I Lrictio System TDH Ft Forcemain Le Dia. Fi Dist. To Well SOIL ABS RPTION SYSTEM I No BED/TRENCH Width Length I Of T enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION /c2 ' Jay/ DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of 7LEW CHAMBER Moe Number: System: 1-1164 5~ ' ° ` 35 c~ 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 3 / Bed/ Trench Edges 3b'3a Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.22.29.19W, SW, NE, Lot 3 Plan revision required? ❑ Yes EfNo Use other side for additional information. 7 95~ IF _ ,_o u.j lb SBD-6710 (R 05/91) Date In pe is Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH f SANITARY PERMIT NUMBER: ~i~'r'■ i SANITARY PERMIT APPLICATION Bufereaauu oand f of B uildildinWater System: ingWater Bu201 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 count than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary pqrmit Number 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 qt4 1/4 1/4, S T ,,Z , N, R E (oro Property Owner's Mailing Address Lot Number VpL Block Number 2 (2 A rl 6.57M 43 .217-4 City, State Zip Code Phone Number Subdivision Name or CSM Number S II. TYPE F BUILDING: (check one) ❑ State Owned E !t Nearest Road ❑ Villy age Public 1 or 2 Family Dwelling - No. of bedrooms Town of lfeaC)faAl III. BUILDING USE: (If building type is public, check all that apply) a Parcel Tax Number(s) 1 ❑ Apartment/ Condo Alp 4 S -490 --206 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. Z New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank OnlyExisting 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 110 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42E] 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 e1 - Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation i>~ t~ ! + & Feet ,j';p Feet bll. TANK Capacity gallonTotal # Of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel lass App New Existin structed g " Tanks Tanks Septic Tank or Holding Tank {a~j ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber f ~ ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of th nsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: m PM4M>PRSW~pNO.O.: Business Phone Number: _,4f /-0 C-~,z ~ P. &; - 7: ~'g -AA 13 Plumber's Address (Street, City, State, Zi Code): .349 b-Z IX. COUNTY / PARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Iss ng Agent Signature (No Stamps) WApproved ❑ Owner Given Initial y Surcharge Fee) Adverse Determination / X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-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 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. 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 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which,can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. n Ilk w i M w k 4l ~o A h ~ f Q y~ O r ~ M C4 a \ M y ~ ~ a r A P ~t "Viscnr*n Department of Industry, SOIL AND SITE EVALUATION REPORT Page _ of Labor aad Human Relations Division'ofSafety & 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, but 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 REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION MI 77A Z2!A4~7- GOVT. LOT GJ 1/4 SE 1/4,S?:,T 3 AR E (ot& PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SU D. NAME OR CSM # --A AY ~fM 03 /R41111 CI STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ❑fOWN NEAREST ROAD 1,6 z I; /91~IP50A) - ely-C New Construction Use[/1 Residential/ Number of bedrooms [ ] Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow- gpd Recommended design loading rateed, gpd/ft2. p trench, gpd/ft2 Absorption area required bed, ft2 7 W trench, ft2 Maximum design loading rate _7 bed, gpd/ft2 . 5~ trench, gpd/ft2 Recommended infiltration surface elevation (s) fz.SB ft (as referred to site plan benchmark) Additional design / site considerations /ftV7%~AAC ~g& A ig sT•/~r/ 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 fors stem ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxxiary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench / 1 .rto F s - o Ground elev. J~+ ft. Z Z 22 0- L L L / f • S 6 Depth to limiting factor 3 -~2 s o S L - y Remarks: Boring # _ a - ACC LL ~s - . O •8 y0-5V 0- c s S F Ground elev. Aft. 3 - ?.f-- L Depth to limiting factor Remarks: CST Name:-Please Print , Phone: Address: Signature: Date: CST Number: ! -i S- .Z 33 gf PROPERTY OWNER ~~1~ CorriSl= SOIL DESCRIPTION REPORT Page PARCEL I.D. #CS& l f' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench Ground elev. 1* F~Q fi S . 2 3 P~7 2- - So D - C Depth to limiting factor 3 6 Z. S-- 1 S p l~ L - - Remarks: Z Li~c Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # M, Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) t~ O `h ~ `C ~y G ~ h► ~ li z o 3 w ~ lee 1 • I Q ~ 8 m N '9' o w -mg l y 1 w W - o V FILED AUG 1 6 1995 0 3 KATHLEEN H. WALSH Reoister of Deeds SL Croix Co., WI 53260£, v s T CERTIFIED SURVEY MAP Located in part of the SW1/4 of the NE1/4 and the NW1/4 of the SE1/4, all in Section 22, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; including Lot 1 of Certified Survey Map recorded in Volume N 7, Page 1817 at the St. Croix County Register of Deeds Office. L z 0 . 0 0 -1 N M W T I N LOT I LO_ A. ✓ L C) L. .PG. 249 0 o 3 0 N C. IA. VOL. 3, PG. 021 _ _ . IVI - - w o oa o , - - - - - - - - - S89°42' 26"W ° f° I 1644.59' °=0 S00°17'23"E If a CD U. 0. H. It 12 14.2 6 ' I North line of the SW7q of the NE>4 -S89042126"W-457.67' - 0 S89059'16"W 509.66' - _ z 0 -P CD "t ° o ° HIGHWAY DEDICATED TO O1 THE PUBLLC 0 r 1589°59'16"W~ NtCr, --589°59'16"W ---719.341- min ~ ~ I ~ ~.$19~.'. cr w o I rn o ; fD r In rn _ o II' z I•2.o'((~~~~\ ° 7 P y 9 j , I I-I Wni O v\ , I 3 r v N 5 g o SEPTIC ' o ooi r i z O I Zo V • o 33 ' ' T o HOUSE 33 o w I r i 1 In o Oo m w WELL 1' 16-6 I ~ o m ~ a ° 4 Il jl LOT 2 I _ I 'o' rv m -I GARAGE i 0' 4 m . •iJO ° J - I I-~7 A 12.67 Acres m Ir m 552,064 Sq. Ft. LnN v'N 0 rn I Y SHED _ m o- L I -1 - a N v N -h P~ - N to it CIO r -40) ce -1 :3 I 7 0 .il~i /o r o ~ IC) m z (D ' 'PRO a o X49"w ()I i I_J I~_ rn w 581 511491 F-t j It ' on 6 -7- co • i/ , S " 1 IV . I~t N (J) 0 'VOL. 11 II o I~ 10 a CROIX COUF Y Y' P I G: iii 14D I I-I Caaprehensive PIa it , o •~49\~E _ I- Zoning ancJ N815Iro 3 Parks Con=IIit;e ~'i' m POOL i 8.- LOT 5 0' o if not recordpje ° ° r~ o = I o yr oz wi;iain 30 d IF tO rn `D_ 2.33 Acres QHOUSE o 30{1rOVF1l '^r 4- o, 101,582 Sq. Ft. h WINDMILL wenval SN4 m 6 8' o E ®J ° Q~ N = N ('y v C7ti'[l = sHEDSQ O~ r,-. Ov" S89050'11"W ` I I I I S89°50'17"W SEPTIC c: r .s o cn < a 2.4'±- 29, .10' I I 292.34' ! N89°50'17"E Ea`°•~ x Ile 1 o I I 215.93 Ln C/) -n I N ~~0 ` LOT 3°° 1° LOT 4 z LEGEND ' o Aluminum County Section 01 it o - 2.00 Acres I o0 8.11 Acres Is o Monument Found 87,166 S Ft. 353 063 S q. ~ 01 q' I ' q' • 1" Iron Pipe Found v - „ - 0 1" x 24" Iron Pipe Set 0.2'~ 292.51' 66;0 292.50' weighing 1.68 lbs. per N89°50' 17"E 651.01' linear foot Z- 80' RADIUS CUL - DE - SAC (TEMPORARY) • • • • • • • • • • • 50' Roadway Setback Line _J i J _F'' A l T c D i ~ v S - 12' wide utility easement -I'--~- Existing Fencel i ne - ( ) Previously Recorded SCALE IN FEET 1" = 200' Dimension 100 50 0 100 200 300 SHEET 1 of 2 SHEETS Vol. 11 Page 2975 1 } CERTIFIED SURVEY MAP Located in part of the SW1/4 Of the NE1/4 and the NW1/4 of the SE1/4, all in Section 22, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; including Lot 1 of Certified Survey Map recorded in Volume N 7, Page 1817 at the St. Croix County Register of Deeds Office. C z (D M 00 o• ~ N M co ' Z N W LOT I LOT I ft 7 VC)L. 9, PG. 24 0 o 3 coo N C.S."A VOL. 3, PG. 6-21 - - - - - - - N O S89°42'26"W - - 1644.59' Ln Ln S00°17'23"E f m 0 z ' U. H 12 I North line of the SWk of the NEk 14.26 -1 M0 --S89°42'26"W-457.67' or; S89059116"W 509.66' 00 a HIGHWAY DEDICATED TO 01 THE PUBLIC - W ° W - S89 °59' 16"W - - 719.34' , 1 8905911611W 4- i V n S W 1$j,~3,', lD CD ;D Ln 0 0 1-1 N o g Ln 3 J' I- v N g O SEPTIC o d! 33 %3 O v o _ z HOUSE oo V I 1 33'I o O O m M• V CD :9 1 : WELL LOT 2 ' 3 o W ~ N j? o N M GARAGE a .o - v - I r) 12.67 Acres w ° ; r _ I~ r' 552,064 Sq. Ft. r> u'N - l N m N i y SHED N rn N 0 ^ r N ~ n 1 rfl W 'T O V Q1 CD i IC7 CD rn C - --4 o o~ 1 rj z co CD jr- c* O 00 F N a PR(A ED 581041'49"w 1-0 T I _--O -h 8' 0 00 CL I z i GVWi W N I (I C~UG N / i / p V 17 L. 7 I I' ICA a ~ , I o IrJ 17 , ' I o j PG. 1817 Iu~ 1-1 a S~ C ROiX C NAY , • N810 41 49"E - I - ° ::oc txei,ansiv~ 3aru 5 _ Ifo POOL Zoning a , pat*S Com fttee o 8. o ~ ° LOT 5 0 v I-4 = Ln ~.w z W tD m `o_ 2.33 Acres o ~HouSE h O S, not " ed r W F N O+ N+111i1 y5 OE a 101,582 Sq. Ft. ' h ~ m WINDMILL t0 6 6 0~ N S N °vw $ 0 1 SHEDSQ ~ ^~V ~ °m o'er 4 b689 50 17 W I I S89050117„W CL SEPTIC o to < ii r2S4V 293.10' I I 292.34' 0 W H I I N89°50' 17"E o'° 0 1 I 215.93' tt lD N C Ln (A ` V LOT 3°E a, ~ ° 00 LOT 4 z LEGEND ' o o, i0 v o Aluminum County Section o,m o 2.00 Acres I co 8.11 Acres to o Monument Found 87,166 Sq. Ft. 353,063 Sq. Ft. ~ o F" • 1" Iron Pipe Found n - 0 111 x 24" Iron Pipe Set, 2'i 292.511 66.0 292.50' weighing 1.68 1 bs. per N89050' 17"E 651.01' g linear foot Z- 60' RADIUS CUL - DE - SAC (TEMPORARY) • • • • 501 Roadway Setback Line UNP is I T cD L_ANPS - ---121 wide utility easement - -K-- x Existing Fencel i ne ( ) Previously Recorded SCALE IN FEET 1" = 200' Dimension 100 50 0 100 200 300 SHEET 1 of 2 SHEETS t. SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify, that by the direction of Virgil Fedorenko, I have surveyed, described and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in the SW1/4 of the NE1/4 and the NW114 of the SE1/4, all in Section 22, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; including Lot 1 of Certified Survey Map recorded in Volume 7, Page 1817 at the St. Croix County Register of Deeds Office; further described as follows: Commencing at the E1/4 corner of said Section 22; thence N0000215711E, along the east line of the NE1/4 of said section, 1327.95 feet; thence S8904212611W, along the north line of the SW1/4 of the NE1/4 of said section, 1644.59 feet to the point of beginning; thence continuing S8904212611W, along said north line, 457.67; thence S0001712311E, along the east line of Lot 1 of Certified Survey Map recorded in Volume 3, Page 621 at the St. Croix County Register.of Deeds Office, 14.26 feet to the centerline of U.S. Highway 1112"; thence S8905911611W, along the south line of said Lot 1 and said centerline, 509.66 feet to the west line of the NE1/4 of said section; thence S0001613511E, along said west line, 1369.62 feet; thence N8905011711E, 651.01 feet; thence N00011141"W, along the west line of Certified Survey Map recorded in Volume 7, Page 1891 at said office, 275.87 feet; thence N89050117"E, along the north line of said Certified Survey Map, 215.93 feet; thence N3403714511E, along the northwesterly line of said Certified Survey Map, 172.35 feet; thence NOOoil'41'1W, along the west line of said Certified Survey Map, 966.18 feet to the point of beginning. Parcel contains 28.37 Acres (1,235,644 Square Feet). Above described parcel is subject to right-of-way for U.S. Highway 1112" and all easements of record. I also certify that this Certified Survey Map is.a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. Each parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and appropriate Town Board for advice. CURVE DATA CURVE LOT RADIOS CENTRAL CHORD CHORD ARC TANGENT TANGENT NO. NO LENGTH ANGLE BEARING LENGTH LENGTH BEARING BEARING 1-2 2 367.00' 15001'21' 501032'56.5'W 96.58' 96.86' S00000'44'E SiOQ'6'314 3-4 2 433.00' 18048'59' S05042107.54 141.56' 142.20' 515,,~ 6'37'W S03642'22'E 5-6 2 167.00' 85024'11' 538059'43.5'W 226.51' 248.92' S03'°dMI-E S81041149IN 7-8 2 233.00' 81151'32' S40046'034 305.29' 332.89' 881041149-N 5000091431E 9-10 5 167.00' 81051'32' N40046'03'H 218.81' 238.59' N00009'434 N81041'49'H 11-12 RD 233.00' 85024'11' X38059'43.5'9 316.03' 347.30' H8104114918 N03042'22'W 5 233.00' 26026'32' X68028'33'9 106.58' 107.53' N81041'492E N55015'11'H 4 233.00' 58051'39' N25046-27.5'H 229.33' 239.77' R550151171E X03042122-W 13-14 4 367.00' 18048'59' 505042'01.5'9 119.98' 120.52' N03042'224 H150061371E 15-16 4 433.00' 15001'21' N01032'56.5'H 113.95' 114.28' H15006137-E H00O00-44-V CERTIFIED SURVEY MAP Located in part of the SW1/4 of the NE1/4 and the NW1/4 of the SE1/4, all in Section 22, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; including Lot 1 of Certified Survey Map recorded in Volume 7, Page 1817 at the St. Croix County Register of Deeds Office. OWNER Delta Construction, Inc. C/0 Virgil Fedorenko 206 Second Street Hudson, WI 54016 ' CORPORATE OWNER'S CERTIFICATE OF DEDICATION Delta Construction, Inc., a corporation duly organized and existing under and by virtue of the laws of the State of Wisconsin, and licensed to do business in the State of Wisconsin, as owner, does hereby certify that said corporation caused the land described on this plat to be surveyed, divided, mapped and dedicated as represented on this plat. Delta Construction, Inc., does further certify that this plat is required by S.236.10 or S.236.12 to be submitted to the following for approval or objection: St. Croix County Planning and Development Committee and the Town of Hudson. IN WITNESS WHEREOF, the said Delta Construction, Inc., has caused these presents to be signed by Virgil Fedorenko, President at thisNday of -Y 19cjS^, Del a Const ct' On, Inc. I presence of- By: Virgil do enko, President Witness STATE OF WISCONSIN )SS. ST. CROIX COUNTY ) Personally came before me thiss2Oday of_ 4') t- 19~, Virgil Fedorenko, President of the above named corporation, to me known to be the person who executed the foregoing instrument, and to me known to be such President of said corporation, and acknowledged that he executed the foregoing instrument as such officer as the deed of said core ration, by author' y. wnr,ro A. smrt Notary Public, ~8t0~Public ~ My commission expires ~O - / - 5C- TOWN OF T1~SON CERTIFICATE I hereby certify that this Certified Survey Map is approved by the Hud on Town Board. 7 e a prmd by J*A d Date ~6W>1 86ard d-" &i ~US SHEET 2 of 2 SHEETS 1 STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNEIVBtrYER MA ING ADDRESS L4j ~ T PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE / PROPERTY LOCATIONS Lt.) 1/4, IV V-* 1/4, Section Z ~ T_ N-R. W TOWN OF ~JST. CROIX COUNTY, WI 3 SUBDIVISION 4~ LOT NUMBER CERTIFIED SURVEY MAP 2 f~, VOLUME If PAGE.Z 7 , 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. i 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. lf\kle, the undersigned have read the above requirements and agree to maintain the private sc~vage 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 2tc J SIGNED. DATE 7 - - St. Croix County Zoning Office Govcrnment Center 1101 Cannichacl Road 1 1;9 Hudson, %VI 54016 S T C - 100 . i 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 t>t-V 0,6,~ L- Location of property t W 1/4 Al 1/4, Section 7, T 2 2N-R_j 'j_W Township Mailing address Address of site Subdivision name Lot no.3 _ Other homes on property? Yes No Previous owner of property Total size of property Total size of parcel ~D 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 PIX4 as recorded with the Register of Deeds. 5 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. I'3 e O 6 ' , 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. 6 Signature Applicant Co-Applicant l 7 _ C'T ~1 Date of Si.anaturP nat~ ~f c; .,„Y " STATE BAR OF WISCONSIN FORM 1 - 1982 3069 9 WARRANTY DEED DOCUMENT NO. VOL 1141PAGE 14 REGIST SOFFICE Recd for Record This Deed, made between ---Ruth L. Rock i a widow S EP Z 0 1995 and not „remarried, - - ~t 4:00 PA Grantor, 61P6,.,,-A. 0JJ, and Delta Construction Company r ~lc,ar of Deeds Grantee, Witnesseth, That the said Grantor, for a valuable consideration _Af_- THIS SPACE RESERVED FOR RECORDING DATA Ten Dollars and other good and valuableconsideration - - - - - - - NAME AND RETURN ADDRESS / O conveys to Grantee the following described real estate in St. Croix County. State of Wisconsin: pn f ao~ a.rid S7 FEE Part of the Southwest (Parcel Identification Number) Quarter of the Northeast Quarter (SWJ NEI), of Section Twenty- two (22), Township Tkmty-nine (29) North, Range Nineteen (19) West, described as follows; Lot One (1) of Certified Survey ft filed May 15, 1987 in Volume "7", Page 1817 EXCEPT condensing at the East Quarter corner of said S5&ion 22; thence NOO°02'57" E, along the east line of the NEI of said section 1327.95 feet; thence S89 42'26" W, along the North line of the S1 of the NEI of said Section, 1958.94 feet; thence SOO°11'41" E, along the West line of said Lot 1, 679.77 feet to the point of beginning; thence continuing SOO°1 l ' 41 " E, along said Vtst line 427.23 feet; thence N89050'17" E, along the South line of said Lot 1, 215.93 feet; thence N34 37'45" E, along the Southeasterly line of said Lot 1, 172.35 feet; thence NOO°11'41" W, along the East line of said Lot 1, 321.20 feet; thence N88 09'52" W, 266.01 feet to the point of curvature of a 233.00 foot radius curve concave Northwesterly whose central angle measures 16°17'04" whose chord bears S47°06'45" W and measures 66.00 feet; thence Southwesterly along the arch of said curve 66.22 feet to the point of beginning. Grantor releases any easement rights in the driveway crossing the real estate conveyed herein as shown on Certif' Surv Voltme 7 t Pam 817 as recorded in the office of the St. Croix County Register of `i'fiis _____1.5 __rlQt-_------_ omeS(ea)property. 4)1 (is not) Deeds. Together with all and singular the hereditaments and appurtenances thereunto belonging; And_.-. Ruth L. Rock,__a_widow-and-not.__r-emar-raed_, _ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except subject to existing highways and subject to easements and restrictions of record and will warrant and defend the same. Dated this day of Septente-r 19--C) . - - - (SEAL) (SEAL) • - - •-Ruth__L._Rack. - - (SEAL) (SEAL) . AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. Burnett--- County. authenticated this day of 19- Personally came before me this day of September 19_95_ the above named Ruth _ L. -Rock-,_a--w_idow_and-nat • -remarried TITLE: MEMBER STATE BAR OF WISCONSIN (If not, 43 authorized by §706.06, Wis Stats.) to me know o 6e:t who executed the foregoing ' stru(ne IR e e same. THIS INSTRUMENT WAS DRAFTED BY GEORGE W. BENSON, Attorney at Law - Box 370, Siren, WI 54872 its Notary Public JJMott- County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission t Vrnent. (If "not, state expiration date: necessary.) ••-still" .Names of persons signing in any capacity should be h_ped or printed below their signatures. WARRANTY DF.F.D S'I'A'I E BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. FORM No. I - 1982 Milwaukee, Wis. Purchaser promises to pay when due all taxes and assessments levied oil the Pruperty or upon Vendor's iatereat in It and to deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured uguinst luss or damage occusioned by Are, ea- tended coverage perils and such other hazards as Vendor way require, without cu-insurunce, through insurers approved by'Vendor, in the sum of Faok__Leguired/vacant landut Venndor stnull not reqyuire covers a is an amount more than the balance owed under this Contract. Purchaser shall pay the insurance prew un►s when dus. 'l'1►e policies shift! contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the ori`iall of all policies covering the Property shall be deposited with Vendor. Purchuser shall promptly give notice of toy to insurance companies and Vendor. Unless Purchuser and Vendor otherwise ugrun is writing, insurmi,ce praeeds sbali be applied to restoration or repair of the Property damaged, pruvidcd the Vendor deems the rusiurvlion or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property; to keep the PropertyY in good tenantable condition and repair, to keep the Property free from liens superior W the lieu of tills Contract, anA to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free slid clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: ....X14..~X~l',PTTRNS . • • • Purchaser agrees that time is of the essence and (a) in thu event of u default in like payment of uuy priaeipel or interest which continues for a period of ....3Q.- days following the spoeified due Jute or (b) In the event of a default in pperformance of any other obligation of Purchusur Which continues for u puriud of ...3U... days following written Doll" thereof by Vendor (delivered person 411y or mailed by certifie4 u►uil), thou thu cutiru outstanding buluuce under tills conkaot shhall become immediately due slid payable in full, lit Vellor's option and without nuticu (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to ally lituitutiuus provided by law) In addition to those provided by law or in equity: (i) Veudur may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Pro wrty and recover the Property buck through strict foreclosure with any equity of redemption to be conditioned upon purchaser's full payment of thu entire uulstuudingt, buluuce, with iuterealtIlereonfrom the date of default at the rate in effect on such date aud other amounts due hereunder (illwhichavuutull un►uunts previously paid by Purchaser shall be forefeited as liquiduted dumuges fur fuiluru to fulfill this Co►lruct uud us t•untal for th Property if purchaser fails to redeem); or 0i) Vendor may sue for specific performance of thin Contract to comp immediate and full, payment of the entire outstanding buluuce, with interest tho•cun at the rate in effect un ilia date of ,default and other amounts due hereunder, in which event the Property shall be uuctiuned at judiciul lulu and Purchaser shall be liable for any deficiency- or (iii) Vendor way sue ut luw for thu cutiru unpuid purchasu pries ur any ppaction thereof; or (iv) Vendor may declare this,Contn.act at an end and remove this Contract us a cloud on title in a qutsi4itle action if the equitable interest of Purchaser is mnsiguificunt; and (v) Vendor ►uuy have Purchaser ejected from possession of the Property and have a receiver appointed to collect uny rents, issues or profits during the peudei►cy of ally action under (i), (ti) or (iv) abuve.Notwithstandimg any oral or written statwuents ur actiumd of Vendor, un uluctiun of any of the foregoing remedies shall only be binding upon Veudur if and when pursued ill litigation mild all cults and expenses including reasonable attorneys fees of Vendor Incurred to enforce uny remedy hcreuudur (whether abated or not) to the extent not prohibited by law and expenses of title evidence Shull he lidded to principul and puid by Purchuser, as in- curred, and shall be included in any judgment. Upon the commencement or during the pendency of say action of foreclosure of this Contract Purchaser consents to the appointment of a receiver of the Property, Includin homestead interest, to collect the rents, Issues, end pro Aq of the Property during the pendency of such action, and suc~ rents, issues, and profits when so collected shell be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legul or li uitable intorest in the Property (by assignment of oily of Purchaser's rights under this Contract or by option, long-term ease or in any other way) without the prior written consent of Vendor unless sither the outstanding balance payable under this Contract is fit•at paid In lull or the later" conveyed Is a pledge or assignment of Purchuser'a interest under this Contract solely us security fur an indebtedasa o Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without aotice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any uoto secured thereby, provided Purchaser makes timely payment of the amounts then due under this Cu utruct. Purchaser may make any such puyments directly to the Mortgagee if Vendor fails to do so and all puynnents so etude by Purchuser 811 14,1 bu co►sidureJ payments made an this Contract. Vendor may waive any default without waiVing any other aubsequumt or pt•iur dufuult of Purchaser. All terms of this Contract shall be binding upon and Inure to the benefits of the heirs legal representagvee, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vaudor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to john In the execution of the deed to be made in fulfillment hereof.) Dated this day of u1X............ III .95........ I)EI 'A CON TR TION CQD1P NlC (SEAL) :Dlt~tal"'...,D .............(SEAL) .l l.' ~ - * --ED IN C. ALBERG . BY: Virgil. Fedorenko . (SEAL) .7............................... (BEAL) * . ~,o A . is Virgil udlrenku AUTHENTIOATION AONNOWI.EDGMUNT Signature(s) STATE OF WISCONSIN St. Croix ss. ......................................County. authenticated this ........day of 18...... Personally came before one this ................day of Jule 10.95... the above named ....Edwin... C....A.1b4TX ei?d...Y.4.r.E~i.1.. Fedurenko... TITLE. MEMBER STATE BAR OF WISCONSIN Lw (If not . y § 708.08, Wis. Stmts.) authorized by p to erson who executed the foregoi ► uieut and acknowledge thu sumu. THIS INSTRUMENT WAS DRAFTED BY I AttorneBarr C. Lundeen 1 . MUDGE, PORTER, LUNISEEN & SEGUTN "S':C: " IIO--Seoond--Stcoat:,..Hudson, .-WI. .mnh...... : Notary Public I....... *90 ...........Countyy, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. 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V.L`I ci e uoyl oilaoa'daoimaitU1w" j.I .._.....t1yf.; c : , puu (aJoW ao au0 ,1049044 ~~~Nvd1d00 N0113flH .SNO V i RI ~ . ---...........................................tioi ........aT4,Rb.......`................................ 1100 q P q 'j3 921:14I'iV 'O NTMcI l 4&10 1111 S pfd ilqa J . . i 11SWn6N00'NONI1121110 HI UNV Q3)NVNId 61 uoev`` pt3AO 31151114 BNOILOV6NV11i '•IV 1104 0311!1 All 04.1 sluo0m~ pus poplHPul .LOVd1N03 ONVI l Vavo oN,oaoasa 1100 oaAaaaau swan rlNa goal-111 1'111103 NISNOOSIAI do Ilva t3ivie 1 oN J.N3wnoQ low %lisconsir,,w-partmentof Industry, PRIVATE SEWAGE SYSTEM County: Labor anJ Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: ❑ City ❑ Village I Town of: State PI o.. DELTA CONSTRUCTION X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 1 7 1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Verit TANKTO P/L WELL BLDG. A irito ntake ROAD Dt Inlet Septic NA Dt Botto Dosing NA Header/Ma Aeration N Dist. P' Holding S e PUMP/ SIPHON INFORMATION FI Grad Manufacturer Dema Model Number GP IL I Friction System TDH Ft TDH Lift Forcemain Length Dia. Fi Dist. To Well 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 TypeO CHAMBER Moe Number: System: 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 Bed /Trench Edges Topsoil ❑ Yes E] No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.22.29.19W, SW, NE, Highway 12, Lot 3 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~ R Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water System: 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 erm t Number 4q The information you provide may be used by other government agency i Y Y Y 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 re A) P-, 52~d 114 1/4, S Z 2 T , N, R E (o~ Property Owner's Mai ng Address Lot Number Block Number V,ty,T tat e Phone Number SubdivisionNa4pX CSM Number YPE OF B ILDING: (check one) C] State Owne 't Nearest Road Public 1 or 2 Family Dwelling - No- of bedroo qj Towan O~ z III. BUILDING USE: (If building type is public, check all thata Parcel ber(s) 1 C] Apartment/ Condo L~?"DS 7 2 ❑ Assembly Hall 6 ❑ Medical a ' i ing Home 0 ❑ Outdoor Recreational Facility 3 E] Campground 7 C] Merch n ae Repairs 11 El Restaurant/Bar/Dining 4 E] Church/ School 8 E] Mobile a ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ fa J3 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one b tine A. ec box line licable) A) 1. New 2 E] Replacement place f 1:1 Reconnection of 5. E] Repair of an ------System System k On _____Existing System Existing System B) ❑ A Sanitary Permit was reviou ued. mit ber Date Issued V. TYPE OF SYSTEM: (Che n o Non-Pressurized Distribution P uriist i Experimental Other 110 Seepage Bed 1 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench In-Gro~ssur 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) yyd~ Elevation d v0 Feet s ' Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. CoSite n- Fiber- Plastic Exper. New Exist- Gallons Tanks Concrete steel glass App. structed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 0 ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation oft onsite sewage system shown on the attached plans. P ber's Name: (Print) Plumb 'SS' atur a s) /MPRSW NO.: Business Phone Number: hfe/'m R, Z 7 I er's Address (Street, Ci tv. State, Zip ode): d © " 2 z IX. COUNTY/ EPARTMENT US ONLY ❑ Disapproved S9tary Permit Fee (includes Groundwater ate Issued Iss g Agent Signature o Stain s) Surcharge Fee) _ /0 Approved E] Owner Given Initial Adverse Determination P196 ~~ft X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety s Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your orySi sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Divisio 87266-3815. To be complete and accurate this sanitary per plication t " Jude: " 1. Property owner's name and mailing addre vide the le a 'ption and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one a mplete of ms if 1 or 2 Family Dwelling. III. Building use. If building type is pubic, ck all rop es ply. IV. Type of permit. Check only one on l i A pl e B i e i 'for tank replacement, reconnection, or repair. V. Type of system. Check appropriate bo>e ing n stem tyke. VI. Absorption system information. Provide all i ati equeso bers 1 through 7. VII. Tank information. Fill in the capacity of eve y~e r e ng to , list th I gallons, number of tanks and manufacturer's name, indicate prefab or site c uc bnd tank r%a a plg ear all septic, pump/siphon and holding tanks for this system. Check experimen ov ly ifc experirrhental product approval from DILHR. y 100 VIII. Responsibility statement. Installing plumber is t I i. nse number % vappro'riate prefix (e.g. MP, etc.), address and phone number. Plumber must sign appl n for IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. O o --"I, A h e o 3 o v V/ c. p N d N N rt- 21 ti r 7 ,r a rn 1 "L1 O w h y f 1( f 1 A wool D~e,~► { 4 NJZj*tWNDA'% O1 N_ to r O In Page Wms onsin'* parbmnt of Industry, SOIL AND SITE EVALUATION REPORT of 3 Labor and Hurrtran Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/ Fe n size. Plan must include, but ` not limited to vertical and horizontal reference po' ti 0. of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and di a nearest ro REVIEWED BY DATE APPLICANT INFORMATION-PLEASE TALL fjlA PROP TY ER: OPERTY LOCATION LOT 111ty 1/4 114,S.2 ) T 3 1 N,R E (oo'2 PR PER OWNER'MAI1PNG AD ESS 3 BLOCK # SUB CITY, AT ~ ZIP CODE NE ER ❑C ❑VILLA E PrOWN NEAREST AD '44 _6`3 New Construction Use [/I Residential/ Number o rooms [ ] Addition to existing building j j Replacement [ ] Public or commercial describe Code derived daily flow a gpd Recommended design loading rate , 7 bed, gpd/ft2 . fi trench, gpd/ft2 Absorption area required fk bed, ft2 '75-0 trench, ft2 Maximum design loading rate __!-7 bed, gpd/ft2_. L-trench, gpd/ft2 Recommended infiltration surface elevation(s) k/, a " - rA 3' ft (as referred to site plan benchmark) Additional design / site considerations 0dl/G LDTl - c 5'! d/GG _W Vf.). ?7 S- 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 fors stem So U ❑ S O U 05 ❑ U ❑ S o u ❑ S CO U ❑ S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 7 ,o - 3 _ acs ( i 4f U Ground Z 7-11 3- - y 6 le- r 4 . s elev. - I Qf_}~ft. ► Depth to 3 limiting factor Remarks: 2 • c Boring # 2 - 0 O wr - Ground -7 7 elev. y,E,lz V ft. Depth to limiting factor Remarks: CST Name: Please Print Phone: 7 «6 Address: oa 3 S 333 Signature: , l ,.z9 ate: CST Number: r PROPERTY OWNERg SOIL DESCRIPTION REPORT Page? of 3 PARCEL f # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench w. 3 - v 4C :::ti:::.......:.,.... Ground 2- p ~v o 1 0 / s O • O elev. Depth to 3 . Z limiting factor Remarks: 2 v N 'H Boring # O - AT / arc C S Ground L 8- 2 r / rte. r c S - elev. tL/ ft. Depth to limiting factor Remarks: /v --15-21 54 HZ Boring # Ground ~ s -60 6 s v / - • ~ elev. "y ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. & PERK U STING, I NC, Depth to limiting ROGER WI 5402 3 factor Remarks: SBD-8330(8.05/92) DAME FOURTY PLU1MOM ummd Pq* Toter i Pk~ M3 A-MMIlim I~OdE~W13 23 Phone 749-3656 Z.~k 5 ~ 3®0 c s~► .x>7s 'I';-e 14~e< r,. le 7L1 I la200 t bPJ~~ 4IfHti'` /BO.O I c. ~N N~ / f !O/' N !/L 17 /rsl ~/w = 98./y X i3° I ' L L r h e ~G.~ C' f LO 1 C All. ~ . S IL1. VOL. PG. 6:1 I✓~~. PG. 2490 c NORTF w - - - - w - - - - m N89°59'16°E - N89°59'16"E 364.34' © 181.93' 3 _ - m 0 1 8 W I I °0 0 A , sl m 4 Z N 15 O LOT , A 0 ~ co ~I 5 ' 14 2.23 AC. nC W J r1C',1 n ~ 97,104 Sp. FT. IQOQ61 I~ n~~i O V I ✓ / 41 VOL. 1136 PG. 1419i LOT 6 S89°59'16"W 323.18' 6 13 i 2. 91 AC. Ln 126,914 SO. FT. 0 I C Z 0 40/ ac. O LOT 2 ~l rj - w N I lD I N ( $fV 8N I v N 2.27 AC. N fTl w 98,849 Sp, FT. I 11 ~ I I~~ ~t 1 7 ^L/ I f ✓ 3CNIDE EASEMENT FOR I N89°59'16E 355.00' INGRESS ANO EGRESS / .~'•/j/ 1 f' \ FOR FUTURE USE 0 0~\ ✓ / / ~f LOT 3 / ' o, i / I -a D 2.10 AC. D 91,450 SG. FT. 9 I'/ U N88°09'52w66. 01' 1