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HomeMy WebLinkAbout020-1066-10-100 ti Co N O O 3 O M (D 00 20 w C i y p 0 a N E O c I N C N ` a a y i V ~ C 4 0 0) M. 0 0 _C L N = N co LO (7) 0) N CO GO ~N 4) O M U a z O O m u r = LL =O w m O fA O 3 C, Q o v 3 v I m I z H U) o o v z r d d rn W a m N F- z O O z d c v V~ r I O w I w o m 2 fA F- r O N z , = E N N = N N y N CO i co O o N Q w z m z o N Z co 0 r_ r- - N E N N m co d lm i Q a CL C co W ` N T O r c c a a N zv> § ~-0 =000 z •N yCL aa y B w N = LO LO 7 O •O rn (3) N fA J U m rn rn } o U') i VV Lo r a)Oo / N O O O r N r O O N N d N i cc 'O m N 2) O O m d < cu - co 7 am+ 0 CO 0 U) > c E ao co N U 0) =1 0 i 0- 00)j (D N = -O \ N G r H Q. N c o f c m O o C Coo a 404 r C y p) U OC y O r N t~ a d N _ r O D 0) E R • N m V c O N 2- E N O Z ~ (n ri `m € a • a d `m n `I~l E V 'c c rw v Vam 0U r A s f Parcel 020-1066-10-100 09/28/2005 08:32 AM PAGE 1 OF 1 Alt. Parcel 24.29.19.254A-40 020 - TOWN OF HUDSON Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 06/10/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - JACOBSON, STEVEN A & LAURA A STEVEN A & LAURA A JACOBSON 846 BADLANDS RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 846 BADLANDS RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 29.980 Plat: 4769-CSM 18-4769 020-04 SEC 24 T29N R19W PT NE SW & PT SE SW CSM Block/Condo Bldg: LOT 4 18-4769 LOT 4 (29.98 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/10/2004 765505 18/4769 CSM 07/23/1997 2000/329 WD 07/23/1997 955/586 07/23/1997 768/357 more 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/09/2005 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i 1' 71692),5 VOL 18 PAGE 4769 KATMEW H. ALS REGISTER OF DEEDS RECEIVEDXFOOR'kECORD CERTIFIED SURVEY MAP CER 11:15"" CERTTIFIED IFIED SURVEY MAP LOCATED IN PART OF THE NE114 OF THE SW114 AND IN PART OF THE SE114 OF THE REC FEES 17.00 COPY FEE: 5.00 SW114 OF SECTION 24, T29N, R1 9W, TOWN OF HUDSON, ST. CROIX COUNTY, PAGESs 4 PREPARED FOR: WISCONSIN. NORTH 1/4 STEVE & LAURA JACOBSON LOT AREA TABLE CORNER OF w 846 BADLANDS ROAD HUDSON, WI 54016 Lot # ACRES SQ. FT. SEC. 24 0 w COX 2 LOT 1 2.03 88,378 i° i o u- SURVEYOR: LOT 2 2.62 114,139 ; Q Z z LOT 3 3.00 130.535 r. I ILN] I w cr DOUGLAS J. ZAHLER w aw LOT 4 29.98 1,306,040 w . u m S & N LAND SURVEYING, INC. I :3 2920 ENLOE STREET 'TH[F. UDR.L% P OCr~ - I ° I o HUDSON, WI 54016 - I' O o ) NW CORNER ~_-OF THE NE1/4 N89• 34 ~~j 5297.16' p i i co c"v ♦ OF THE SW1/4 i z i i OF SECTION 24 N89°2r33"E 1320.00' EAST-WEST 1/4 LINE Ar4o 787.34' 2657.16 Y 1/ 1 20.00' EAST 1 /4 WEST 1/4 pp \ LOT 1 CORNER CORNER APPRO~ c ~ OF SEC. 24 OF SEC. 24 sr cwrrr~~ou►numr THM [pC~L,14 OO 0 I'M" O n V2 w U _ Io' U mtAevw111a~1 wbiilo9D LOT 3 < 0 i o o-~-WYLD]~i2QQj.ANT ° I I w v mdll r I~ I z - "HEET 2 OF 3 w ? r~° ~'~s~ I ~4' I I SHEETS FOR LOT 8 c OG~J[t~JLD ~J ~ o~ i Yf m DIMENSIONS LOT 2 cy g w T $ EXISTING GRAVEL mw O - - - DRIVEWAY NORTH LINE 1 I EXISTING FENCE _ OF LOT 3. CSM 1 LOT 4 HOUSE VOL 3, PG 658 csi 1" IRON PIPE FOUND EXISTING FENCE r S87°59'52"E 15.25' I %~1't SOUTH OF i FROM SET 1• IRON PIPE SEPTIC VENTS- ~a It-WELL ~%PROPERTY LINE PROPOSED ROAD PER_,_ LINE SOUTH CSM VOL. 3, PG. 658 `i 166' N89°24'18"W NE1/4 OF WEST LINE OF LOT 3-- 305.63' _THE SW1/4 EXISTING FENCE p~" `EXISTING (S88°24E 321 00' OF SEC. 24 2.5' NORTH OF I ~f! FENCE 1'± OF I j NORTH LINE j PROPERTY LINE CC WEST $I ,CC ~ A 1 PROPERTY OF LOT 2-i 1 SHED 1 LINE . co I F'L 07 t g 0o i i N89°44'04"W 943.83' I' NOWOW49"E i LJ L~04 9 I X83.80'-: ~ - ° I N LLI a ~/~I I (NQRTN) j 0 zI V~o~o vl! Uo I ~j~,~nQ°b i I'1 ♦ COR ER 1/4 OF 0o iI l/ OLSo I Vv~~ / / ♦ SEC. 24 pp4g: LEGEND I Pa° 40© I /sip of ° . ° FOUND ALUMINUM ST. CROIX COUNTY SECTION CORNER MONUMENT 9~ Sis61°33"~ • FOUND 1" OUTSIDE DIAMETER IRON PIPE Q SET 1" OUTSIDE DIAMETER BY 18" LONG IRON PIPE, WEIGHING 1.13 LBS. PER LINEAR FOOT • • • • • • • • • • • ROADWAY SETBACK LINE (50' FROM RIGHT-OF-WAY)41-L 12' WIDE UTILITY EASEMENT SCALE IN FEET 1" W FOUND 3/4" REROD • FOUND 2" OUTSIDE DIAMETER IRON PIPE 300 0 0 FOUND 1-1/4" OUTSIDE DIAMETER IRON PIPE THIS INSTRUMENT DRAFTED BPREVIOUSLY RECORDED DATA k17S. JOB NO. 8288-01 DATE: 07/01SHEET 1 OF 4 SHEETS ° w Page 4769 ti MAR 6 2005 CERTIFIED SURVEY MAP COMITY LOCATED IN PART OF THE NE114 OF THE SW114 AND IN PART OF THE SE114 OF THE SURV E ST. OYOR 'S RECORD SW114 OF SECTION 24, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY PREPARED FOR: WISCONSIN. SURVEYOR: STEVE & LAURA JACOBSON DOUGLAS J. ZAHLER Lu 9 846 BADLANDS ROAD S & N LAND SURVEYING, INC. N F- HUDSON. WI 54016 LEGEND 2920 ENLOE STREET OO u"'i F3 HUDSON. WI 54018 pp Wj p LLO FOUND 1" OUTSIDE DIAMETER IRON PIPE Sep z v z z SET 1" OUTSIDE DIAMETER BY 18" DOUGLAS J. y~2 w LONG IRON PIPE, WEIGHING 1.13 LBS. y ZAHLEq w m PER LINEAR FOOT S_21 * cc o j ® FOUND 2" OUTSIDE DIAMETER IRON PIPE H S our a w Q0 I ( ) PREVIOUSLY RECORDED DATA w ~ 1 3 ~ a I Zvi ~i / &Q 5 G30DCC5 -1 NO N89°27133"E 132W.00' ♦ - 787.34' 66.00' 466.66' (466.61) C1 $ R=233.00' 33' 33' \ CH.B=S60°35'02.5"E j © 1 CH.L=232.74 1 O I / cv ARC L=243.65' \1 / ! TAN. IN=N89°27'33"E j I I gw i N `g I \ N. OUT=S30°37'38"E 1 0~ j Q 1 z i I C4 \ \ LOT 1 C5 Z I R=167.Od R=233.001 n=59°54'49" ~u C2 c=42°41'13" CH.B=N60°35'02.5"W y R=167.00' N WI CH.B=N20°48'09.5"E CH.L=166.78' Q ON n=59°01'53" z1 CH.L=169.60' / ARC L=174.63' wi CH.B-S60°08'34.5"E ~I ARC L=173.59' / TAN. IN=N30°3r38"W ~~p Q 1672.08' TAN. IN=N42°08'46"E TAN. OUT=S89-2733"W ARC L a Q DI TAN. OUT=N00°32'27 W TAN. IN=S30°3r38"E ~TAN.OUT=S89°39'31"E 01 ~I (`y T >1 CD LOT 3 I ~ W1w- I C3 \ \ , r R=233.00' A=59°01'53' \ T eY CH.B-N60°08'34.5"W a~ CH.L=229.58' N. ARC L=240.08' / - j TAN. IN-N89°39'31 SEE DETAIL iii/// T TAN. OUT- N30°3r38"W BELOW 1 DETAIL NOT TO SCALE ~i ~i m~s~ ~ ' \000 WYLDWOOD ~ % 1~ o I ~IOI LOT 4 LOT 2 I Cs ~'vVF _ u►Ne ~ / +Ial ~I `"'LOT 2 ~-EXISTING / FENCE s85°1o'41"w470.41' 307.47'---' i N THIS INSTRUMENT DRAFTED BY: BRIANA GEISSINGER SCALE IN FEET 1 100' JOB NO. 6288-01 DATE: 07/01/2003 ' REVISED:06/04/2004 100 0 10o SHEET 2 OF 4 SHEETS Vol. 18 Page 4769 Parcel 020-1066-10-000 09/28/2005 08:31 AM PAGE 1 OF 1 Alt. Parcel 24.29.19.254A 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 06/10/2004 00 4 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - JACOBSON, RETIRED RETIRED JACOBSON Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 37.410 Plat: N/A-NOT AVAILABLE SEC 24 T29N R19W NE SW EXC E 321' OF LOT Block/Condo Bldg: 3 CSM VOL III PG 658 BUT INCL W 66' OF SD LOT 3 CSM 18-4769 TAKES ALL Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 24-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 2000/329 WD 07/23/1997 9551586 07/23/1997 768/357 07/23/1997 703/426 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/09/2005 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 is + 41 STC - 104, AS BUILT SANITARY SYSTEM REPORT OWNER 7~{jgBS©rl~ ADDRESS SUBDIVISION / CSM# LOT # SECTION 2 7 T~N-R W, Town of ;t ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM - ~ a 5 .51 ~o T A~ o wtCC - /t/a 74 41 / INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: /1?7/) 01/0C O i ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: vrelss Liquid Capacity: / -Zaa Setback from: Well House p Other - - Pump. Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location r; 3 f SOIL ABSORPTION SYSTEM Width: Length ;;7 Z Number of t-z-~es Z Distance & Direction to nearest prop. line: ? gyp 'O Other - Setback from: well: f`ic House ~ ELEVATIONS Building Sewer ST Inlet, le Z.9 ST outlet PC inlet PC bottom - Pump Off Header/Manifold Bottom of system "Z 0, Existing Grade Ad~ 6 Final grade DATE OF INSTALLATION: / d PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: r--~ 3/93:jt s 4 6 F a i k Wisconsin D ,partmentof 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 [I Village Town of: State PI JACOBSON, STEVE X CST BM Elev.: Insp. BM Elev.: BM Description. Parcel Tax No.: *9500363 TANK INFORMATION ELEVATION DATA U6 7/~5 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dcm ng- Aerat" Bldg. Sewer a )03,17 Holding St/ t Inlet oaf oa, ~ 7' TANK SETBACK INFORMATION St/ Outlet Vent TANKTO P/L WELL BLDG. A irIto ntake ROAD Dt Inlet Septic >16V1 ti NA Dt Bottom Dosing NA Headed-- NA Dist. Pipe Aeration Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Moe er TDH Lift Lric I stem _ 311 Ft ss ea For, ain Length Did. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT Inside Dia. Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHI anufacture`t"---- SETBACK INFORMATION TypeO 4e,- 1 (1) BER Moe Number: System: ecno- bzd >/C, ~j "/,0 ~ OR UNIT DISTRIBUTION SYSTEM Header / Manifold / Distribution Pipe(s), x Hole Size x Hole Spacing Vent To Air Intake Length G Dia. Length 76 Dia. Spacing =4i7 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade S s On y Depth Over (2~` Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center ~J Bed /Trench Edges ~ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUdson.24.29.19W, NE, SW, Badlands Road le~ Plan revision required? ❑ Yes o Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No. 70~ ~'Cy-'-`-~-1 ~~cG~G~.~7iu~-c..~,~►)~,G-.yam"'- i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I vi~'■'■n SANITARY PERMIT APPLICATION Bureau o off Buiui safety ildii nWater Systems gWater ~ 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. r • See reverse side for instructions for completing this application State Sanitary Permit Number A41 q 17 &1 The information you provide may be used by other government agency programs ❑ Check it revision to previo 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 114 &)1/4, S,2 T , N, Rlll~f E (o Property Owner' ailing Address Lot Number Block Number 5; yj Cit State zip code Phone Number Subdivision Name or CSM Number 6 ( 3) Bf> II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Town of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo d 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. p New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank _Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 m Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 b Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft-) (Min./inch) Elevation Feet Feet .111404? 1 1? 5T 1 9657 .7 .7 2?f .9 Cap cit VII INFORMATION in allons Total # of 's Name Prefab. Con- Steel Fiber- Plastic Exper. New Existin Gallons Tanks Manufacturer Concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tankp Lift Pump Tank /Siphon Chamber ❑ El 1:1 ❑ 1:1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation oft 4nsite sewage system shown on the attached plans. PI tuber's Name: (Print) Plu er's Signature: a ) PRSW No.: Business Phone Number: T 7 6J er's Address (Street, City, State, p Code): iGr1 O L IX. COUNTY DEPARTMENT USE ONLY Groundwater Date Issue Issuing Agent Signature (No Stamps) ❑ Disapproved Sarytary Permit Fee (Includes Surcharge Fee) q~ .4 Approved E] Owner Given Initial K.J _ Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Ruilaings 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- 11 . Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reo:rnnection, 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 se-.)tic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experi Tiental )roduct approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate )refix (e.g. MP, etc:,), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. CornF.!e--e plans and specifications not smaller than 8 1/2 x 11 inches must be suh nitted.t. ; tl!c :c ,..,nty The plans must rnz 4juk- the foiiovving: ,a) plot i lab, drawn to scale or with complete dimension;, local t, , 'Jinc tank(s), septic t ,s? o, other i reatm ( nt tanks; building sewers; wells; water mains"water set vice 0 ; ' lakt.!,. pump or siphon tank ~listribu~ion IJOxcs; soil absorption systems; replacement system areo+, ar. the io..,: the Luilding served; :,_il - i c6 vex ti(al elevzlion reference puii :s, '-i corn plete spec ior `or, pur 7r;;,3 rr ._ontcis; dose volume; fiction loss; pump perform n e curve; pump model and :mp m . c ..rer; C)) cross section of t j isorpticn system if required by the c'ciunty; l=) soil test data on a 1 1 iorrn, --oi:; 11 ' Jzinc: information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practise whic=h can effect groundwater The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ii w DAVE FOQERTY PLUMS" Licensed Park Tester F#3233 03 Road w-ON $ ROSE e 7N XXPF- J o~sVA ~ I 7 O ~t 6 w t oa 7) X C 3 rl py ,~s 3P' ~cR~s SCa~e /a= 30' d = Tip/' o N! 'G-~ ,sf of "mil Ai pry h.JU7#,Wg O= xco ir-44• sE?'rZc. TwNX .rte, .w r ,v v. as, a~Gt IW6 & ' Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Laboh and Page of Human Relations Division of Safety & Buildings j r 181 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not les 1/2 x 11 i#es jr? i Ian must include, but -57-- CZ4Q'K:X not limited to vertical and horizontal refer c int ( dir n slope, scale or PARCEL I.D. # dimensioned, north arrow, and location a stance to neareif ,j~ d. APPLICANT INFO RMATION-PLEASI" pRXT,.ALL i,NFC+TI REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCgJTION SI_AQ14 p w ,~'ta GOVT. LOT4164 1/4 1/4,S,,7y T N,R E (9r PROPERTY OW R':S MAILING ADDRESS 4 ' LOT # BLOCK # SUED. NAME OR CSM # 3 - CITY, STATE ZIP CODE PHONENUMBER ❑CITY ❑VILLAGE OWN' NEAREST ROAD o T--y014 ( )Arl ' Ov ]~L] New Construction Use (~J Residential / Number of bedrooms [ J Addition to existing building j ] Replacement [ j Public or commercial describe Code derived daily flow i~60 gpd Recommended design loading rate __,__bed, gpolft2 , _?trench, gpd/ft2 Absorption area required 4~;'f bed, ft2 7.g;:o trench, ft2 Maximum design loading rate y,Z_bed, gpd/ft2 . Sl trench, gpd/ft2 Recommended infiltration surface elevation(s)}'. 9 ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem PIS ❑ U ❑ S V U OS ❑ U ❑ S 0U.1 ❑ S O U ❑ S 011 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bwxby Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz- Sh. Bed Trends Ground 2- _ D G 3 elev. _ (64ft. 2 Z3- - r D 6- G - I _5 L.2 .8 Depth to S CAW 441- limiting factor Remarks: iV yO~ _06 Boring # Z - - v CS d .5 Ground elev. Z2 ,Z,~ Q S lr /I S /"ft. Depth to • S 4 ; G A(l -7 limiting factor Remarks: co(lAt CST Name: Please Print Phone: Address: ~-t2L s 023 / S f Signature: Date: CST Number: PROP.ERTYOWNER SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench pd. frr - L s P Ground RM-% K y c v 3 elev. Depth to 0 s B L - limiting ' factor Remarks: .z 30~ A #4 LmB Boring # <<:' S- - ~ LS s1~ r c v - s 45 2 Ground elev. 6 S _ /off fit. . If Depth to limiting factor Remarks: Boring # 'i 49 - 77 z - a , - G c S dF Ground elev. w j _ S O i1~rL /pt_,7 ft. Depth to limiting factor Remarks: Boring # Ground elev. DAVE F EFM LiiriYll~IK- ft. Depth to ROOF* e 2 Nei Road M v" limiting P one 749. 656 factor Remarks: ' ~ pub -~I►+IC /,i+a L 13yo DAVE FOGOTY PLUlM 'W2 I Licensed ~ eSt9 r }1 flei is ROSd X X J: ROBES WI 74~J0-36N 84023 ;ne I i ST{vE J ir{'oilSoN /31 I _ 1256" I ~I //3 ,94tss / - 71pP 9f irnst~ 6aj~ a~~j~t<t•► uslEi . Ll • z = • F ~viarr: 6~e m I- GrOor X Baas f, ggN~r►c i~».c 69~ I I d~y~~dS ?~y f Department of Industry, la SOIL AND SITE EVALUATION REPORT Page • Labor and Human Relations tions Division of Safety & Buildings in a cord with ILHR 83.05, Wis. Adm. Code 8 COUNTY Attach complete site plan on paper no a 1/ 1 in size. Plan must include, but eze z not limited to vertical and horizontal ~ ce point (B dir nd % of slope, scale or PARCEL I.D. # I a, dimensioned, north arrow, and loc n 'nd distce e res APPLICANT INFO RMATION-Pl: E PRlf~t`r A~~FO ION REVIEWED BY DATE fl PROPERTY OWNER: PROPERTY LOCATION f1~ GOVT. LOT 1l4 S 1I0,Z,54T ,N,R E (oov IVA PROPERTY OWNER':S MAILING ADDRESS.;, LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP C T OCITY QVILLAGE VjrOWN NEAREST ROAD o u9 oi6 • - ~ lfrfOSe~V ~ [~J New Construction Use (~f Residential / Number of bedrooms y [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow hQQ gpd Recommended design loading rate 2 ed, gpolft2 . $ trench, gpd>ft2 Absorption area required Z571_ bed, ft2 7.51y trench, ft2 Maximum design loading rate -_bed, gpd/ft2_,_k_trench, gpd/ft2 Recommended infiltration surface elevation(s) 5p3. s r ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable It Fu = Suitable for system CQNVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE T'SS HOLDING_JANK =Unsuitable fors stem lLlS ❑U ❑ S !~JU 17S DU ❑S U U S CdU ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BotrxIary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw& 1 5- Ground elev Depth to limiting factor Remarks: Boring # V`-~t { n Of2;. ii i:•:i:: }iii: iii:'v ^ ` Q ~ Ground elev. 2 20 ft. i Depth to limiting factor Remarks: # to CST Name:-Please Print Phone: Address: Signature: ate. CST Number: PROP~RTYOWNER 7A{O it) SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 9.' z d- 7 m- 3 sd ? 7 . Ground elev. J~C. 2 7 ~ / e ~L Depfh to limiting factor 3 3- a S S F L p Remarks:- s~ Go 7. Rocs cox Boring # UA Ground elev. Z -10 o e L o Depth to limiting factor 3 3- ICA /0 Remarks: ` L So Ta 6;e I , Ro%, ezr Boring # , © S nt L E .7 9f/'3r~•• . Ground elev. Z 7 -V? O Depth to limiting factor 3 m " S- ,3 5 p SG ht G - Remarks: Boring # ~.0 Ground elev. DAVE F Y ft Plu r . #32 #3289 Depth to Fo ° RUDE limiting Phon 749-36 6 factor r. , Remarks: ~ ~ olcC ~►+te /;n~ gyo~/✓~~ I DAVE FOURTY PLUS Licensed Pork TeSW SL P'U""r #3233 #32.69 X n " ' f a rty Hei is IROd f ROBES, WIS OO~N3SM 54023 I X~ X ST£vE J ~►{'vilSoN f I V 1 i1 ILK ~ 1 1 IS #'3 ~7D X +x~ `MS6o~ ~t i ~cmfiJ~y~ S<~}l.,E f =3o i I / ToP 2f ivRSt, 6/4n jfode e- /cc - v ' _ 1C- --tea /G6 I -X _ co~n~r ~aas~~ ~rsHn~►~ i~a.D' 612 i STC-105 SEPTIC TANK MAIN'11 NANCI, A(;1U'I,:N1FNI' St. Croix County OWNER/BUYER ,E(/~ ~i9EOC?sDn~ MAILING ADDRESS PROPERTY ADDRESS L ,d>S f8d/ Gc~ 0 (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION lf~E 1/4, _57ke.) 1/4, Section .2 y Z~* N-R i9 TOWN OF ST. CROIX COUNTY, WI SUBDMSION LOT NUMBER CERTIFIEDSURVEY MAP , VOLUME -,PAGE - , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix Count), 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. Me, 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 n date. SIGNED: DAIT: St. Croix County Zoning Office Government Center 1101 Carmichael Load Hudson, WI 54016 103 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 Location of propertyB~-;_ /4L 1/4, Section .,TAN-R,&_W Township _11~Cf05"DA) Mailingaddress ,r// A, p4g!r;el 1261iys Y©/yi Address of site Y~ B/JGdS r h`uc~ /V e'y_T `f 14 Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Total size of property -J? $ ~ Total size of parcel rr Date parcel was created Are all corners and lot lines identifiable? /Yes No Is this property being developed for (spec house) ? Yes r/ No Volume 9,r--5- and Page.Number o~ 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. 611 y eV1 I/ , 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. Vag F 6~ Signature f Applicant Co-Applicant Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1988 T` srAca RE""' IO" 11[co"C"m DATA WARRANTY DEED s~ 0 955 PA"E586 TWs Deed made between Verlyn E._eBenoy, REGISTER'S OFFICE Catherine A. genoy, his wife, Wayn. Benoy and $E CROIXCO Arlyn L.... enoy• toed forto=d Grantor, and-----Steven- A. Jacobson an8 Laura A. Genosky, JUN 18 1992 as... joint.-tenants,.. pt M 3:45 P. - Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... Qf one dollar and other valuable consideration ~%*cfDw& --------i St• CSO1X RETURN To ' conveys to Grantee the following described real estate in County, State of Wisconsin: Tax Parcel No: The Northeast Quarter of the Southwest Quarter of Section 24, T29N, R19 West EXCEPT Lot 3 of the Certified Survey Map filed and recorded in the office of the Register of Deeds for St. Croix County in Vol. 3, C.S.M., Page 658, Document 351145; ALSO, the entire 66-foot wide parcel as shown on said Certified Survey Map as "Proposed Road". This deed is given in satisfaction of a Land Contract between the parties dated February 6, 1987 and recorded February 9, 1987 in Volume 768, Page 357, as document number 422218 in the office of the Register of Deeds for St. Croix County, Wisconsin. This i s _ not homestead property. (is) (is not) together with all and singular the hereditaments and appurtenances thereunto belon 'nB; And..Verlyn E, .Benoy, Catherine A. Benoy, W..yne_.A-..Benoy a ....r Xn_I!`_.Ben°~' warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except beyond February 6, 1987 and will warrant and defend the same. Dated this 12th day of February 92 - , 19..--•• (SEAL) V1! (rif . rLJ •--•------(SEAL) 'v Ver n E. Benoy Mayne A. Benoy - `--------------------(SEAL) / (SEAL) Catherine A. Beno . Arl L. Benoy AUTHENTICATION ACKNOWL]IDGMENT Signatmv(s) STATE OF WISCONSIN es. _ST. CROIX Connty. 12th authenticated this day oi---------------------- 19 personally came before me this day of February 19..9_.Z__ the above named VerlvnE.__ Benoyx_-Catherine.. A,___Benoy ' L+layne_A.- Benoy- and Arlyn-L. Benoy, TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by ff 706.06, Wis. Stata) s to me known.•fs• •the,~eraon who executed the foregoing.irat`llaQ acknowledge the same THIS INSTRUMENT WAS DRAFTED BY - - ~~f Robert F. Wall - t d Y-------------------•----.-----. WALL---&--MILLER-•------------------------------------------------ 522 Second Street ffudsoli,--W-I------ 540.16----------------------------------------- Nota . £ . . X County, Wis. (Signatures may be authenticated or acknowledged. Both My - (if not, state expiration are not necessary.) date: 19--9.....) •Names of persons signing is any eaDaejty should be typed or printed below t6ea sian tsare~++,,,, tt4tsw, WARRANTY DEED STATE BA O 1 WISCONSIN i Wisconsin . WY. Blank Co. Ine. FORM No.