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HomeMy WebLinkAbout040-1024-95-000 ~ ~ i a o I Q o 3 c) p ce N N C i ~ O • O co O L O) N O C O N 0) O ~ 3 E~ Y O _ i aE "o h - a x y 0L in in ~a .3 N cn (D S ~ m 7 v _ a o c C z o w a) c N LL ~ ~p cC O -0 N C Y C 'C E ¢ o ca 0 N V~ CL co rn w E Z = O U E L Z m y ( a m (N ~ H U) C O c C7 ro O z d c y 7 oVi z z E -a O N M N C O N M 13) N C) t O • d c o o 2 Q E © zF-z o c : - N m z ~j cv 7 N E O d ~ ~ C w w1 C (0 ' N CO N d a 'Eu O N y C) O 1 El a) It cn u) u) m N w E ,n a U) •~v w ° o z aao0. C FL N Lo Lo o N ° rn 0) vi U = rn rn } 0 o 0 0 o Q co co E N O O ~ 7. N 3 m n ~n a) 4 ~ m }ice N N i~ O N C O C C E W 0) 0 I w o 3 avi N w 0) ° I N rn M C Q a C C N O C O O 7 0 N C) = r_ LO ~.r ~ 0 co N F- F- C N " o N M M y E E ~I yT' o o F- = N o a ef)i rte. V - E ~ xt L a w • cv a d d y c tt'iwV a o mm o `~1 A 0 m 2 ,I 0 m U eC o ° I M 0 Gn, m M 4 , o I N U) I o ~ I 0 N I Oi N Z ~ I v~ D ti n . m N i x o fy r° p o I Y ~ C y y co O O N ~ O N it C Z E a 0 o II ¢~n I ~ I'I z I H r O rn Z Y O Z ° r a m N H U) O c C7 ~ o z v c V ~ r O N N Z c H r N N j N m CL S~1 N N C N (DI .0 a I N m ~i O o aa) Q 0 z co z - N ~I z I N N N t N O c ~ a 0 4) 0 ~l y N C a o L G G 3 ~ II ~3~3 (L U) z t •N ° a a a ;n t6 0 a : o o U) co 00 0) U) -1 0 ~ r } ~l ! ~ N Cl) ~ N I C) C) ~ rn N II 'I ~ to Lo 4) O r'a ° N C E O O O N t N> to p H O C V 4. p r p N a7 N N O o0 p N C O N C r 7 d N O O N U) N Z C N iz: to N 0 CD • ' O N CA Y LO Z C H 2 (n V - EL ; Q i d • CC C. d .2 N E L c c r A U a t o v) C) COMMERCIAL TESTING LABORATORY, INC. 914 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 8378 (WI) 800 -962 -5227 FAX - 715 - 962 - 4030 ST. CROIX ZONING REPORT NO.: 33270/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 8/31/89 COURTHOUSE DATE RECEIVED: 8/29/89 HUDSON, WI 54016 ATTN: THOMAS C. NELSON L36T OUHER: Z LOCATIONHudson, NI COLLECTOR: St. Croix Zoning SOURCE OF SAMPLE: Kitchen Faucet COLIFORM: 0 /100 nl INTERPRETATION: Bacteriologically SAFE NITRATE-N: 5 ppn Under 10 ppn is safe for hunan cansunption. COLIFORM + NITRATE LAB TECHNICIAN: Pan bane VI Approved Lab No. 19 t Means 'LESS THAN' Detectable Level Approved by: .R r a T. CROIX COUNTY ZONING OFFICE St,. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telene (715)386-4680 W~ The St. roix County Zoning office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. X WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at time of inspection) Property owner's name Property owner's address e~•-tet~ Legal Description 1/4 of the 1/4 of Section T_N-R Town of (9,d4&n Lot Number Subdivision Name FIRE NUNB= bQQK BOX NUMBER-, Color of house ealty sign by house? If so, list firm: EAi PLEASE INCLUDE, IF AT ALL POSSIBL A P,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: EA Telephone Number REPORT TO BE SENT TO: PCX= -7 00 S Closing date Signature l r._ ~ na: R INC. Info. Sheet V DProperty ~ - ADDRESS -7T M~ 2 t PRICE- r gcfj : . F' CITY/TOWN "cJ d S 8 i- ' DISTRICT LOT SIZE/ACRES n.e ADDITIONAL SALES HELPS: e_ , n!' y ~r y q o o c~ Ca TId .1-, o ti? , s INFORM UON DER-M RMIAMY, BUr Mr UJARMN1EED /QS Sao PRICE: $ bip # BFDROCMS: 3 # BATHS: 2 PM M Wr n BB n TERMS: Cash ZN: A~Sa 374 Tow" Rd. CITY: Hudson ZIP: 54016 COUNTY: St Croix IT S Z--200 450 DIST: 01 SCHOOLS/ ELFM: E p Ruck MID: 4th Street NIGH: Hudaon~~-I PAR: St. Croix Street_ LEGAL: Sec. 6 T28N.Town of Troy STYLE:Ranch FXfERIOR: Redwood & Brick YEAR BUILT:1960's TM S: $ 2242 YR: 19 88 SQ Fr MAIN LEVEL: 1614 1UTAL FIN FT: ROOM DIMENSIONS L W F IPMFNr / MISC LR: 22 X 15 M X X RErT.IC: Yes C. WIR: DR: 13 X 11 H X X Mll: Yes C. SWR: KT: 12 X 11 H X x WME: Yes WELL: Ye FR: 17 X 15 L X x rwsl:r: Yes SEPTIC: MB: 15 X 14 H x x EILT': Yea DECK: BM: 12 X 12 H x x vs: Yes PATIO: BR3:12 x 10 H x X A/C: EASMt: Fu 11 BM: CAR: CEO: FP.PLC: FR TOSS FATE: Closing HEAT:oil nu LISIFR: PII# ER 213 (3/84) S/B/C 0 260 imm. 715- 386-8236 612- 436-7072 lb + - ST. CROIX COUNTY WISCONSIN .r 3 a s A. Y, ZONING OFFICE ,z. ST. CROIX COUNTY COURTHOUSE APP .vY, 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 August 29, 1989 Edward Hanson 374 Tower Road Hudson, WI 54016 Dear Mr. Hanson: An inspection of the septic system on the Hanson property located in the Town of Hudson was conducted. At the time of the inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance of the system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary J Jenkins, Assistant St. Croix County Zoning Administrator MJJ:sa s Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 577• eA"'oi•X Attach complete site plan on paper not less than 81/ ize. Plan must include, but not limited to vertical and horizontal reference ti of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and d' nearest ro GAS 02 APPLICANT INFORMATION PLEAS T ALC , FO,,RMAT REVI BY PROPERTY OWNER: "C OPERTY LOCATION E Q N 1~1$ o ~J (cf- e ''IJ VT. LOT S W 1 /4 NE 1/4,S & T 2 N,R 19 E (or~ PROPERTY OWNER':S MAILING ADDRESS I T # BLOCK # SUED. NAME OR CSM # 37V Tb w E R RE) JEyw 5_ 41A- CITY, STATE ZIP CODE NE CITY []VILLAGE WON NEAREST ROAD V j2S60 W1. 54014a 7%,C..- New Construction Use [ residential / Number o ms -3 [ j Addition to existing building j replacement [ j Public or commercial describe Code derived daily flow ysd gpd Recommended design loading rate / bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 5"63 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) SZA 3 It (as referred to site plan benchmark) Additional design / site considerations /U S t"J// Z 'o V G- S t'+et' S "x 15 w/ P&/O Parent material SG 5 73 8 VR eXi 14 0 T= o aTwi4 R:K Flood plain elevation, if applicable A-4 ft S = Suitable for system COt~WENTIONAL MOUI~B IN-GBOUND U ESSURE AT-GE ADE SYSTEM-IN FILL HOLDING TANS CAS 2S ❑ 2t ❑ U 018 ❑ U ❑ S RCJJ U = Unsuitable fors stem [JS ❑ U ❑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 Tiench 3 y -It .3' /o R 2 S If .s bk 40 F R 5 of . S . 6 1 41 / -2 /o YX 313 s/ 2 f She ,v~ -Fie S Ivf . 5 Ground 3 10 -zf /o y,- 3 [j s Lf s he /►v-•f,e 0L s • S cS D S a(Q- - . 7 ft. ~ 1 O 11R e1 7e/-6(' 5/ 0 Depth to limiting faactoorr' „ Remarks: Boring # 0-Y /0 Yin 1-F sh,C -R S V f • y 5 h z$ z , a /o ye 3 S/ f she ~►.,f R s f. 5 s . G z'3 io t/R 31s/ Zf 67k 40 fie 6E5 Ground elev. 516 1.8 q4~ ft. Depth to limiting factor n Remarks: CST Name:-Please Print Ro (3 E R -f' Zf i 3 R I' C k f Phone: 71y 3 RG . 9/cP,5- Address: (F 5.5 0" N r= 1 C- (2 H V ©so t • 5- _q S CS TM 1, yg*~_ Signature: syd/to Date: CST Number: ORIGINAL 11 it. PROPERTY OWNER /MwSSOIL DESCRIPTION REPORT Page of 3 PARCEL I.D. # d Yo ~O Z yr j S Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxiary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmrxh 2.~o V/? ~r sl Z f sb,~ &,,,F le a. s - . s . Ground / ~j $ C S D S Q elev. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks.: Boring # v 4NM.?:dKM~ Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: con 0oo-D nc.e"), J AS#~ I y + w N ~ ~ N z 0 0 w£sr c.o T (,I1J w o y o l rr l i w m I^ Z rc~ r N / u~ lrr l l y A/ / i r v, / I 1 LAI ~ O N N y w W Cy ~ R~ H ~ F -4s T Go T . it STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER_,C- / ADDRESS - SUBDIVISION / CSM# LOT # SECTION T -'?F N-R_~W, Town of Tie ST. CROIX COUNTY, WISCONSIN PLAN VIEW I" SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM GQ d e A G 1C INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: iic C S f ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: y r~ a~GJ[sTL~,t~,y Liquid Capacity: Jo0edD Setback from: Well .6'D~- House v5" ' Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Z Distance & Direction to nearest prop. line: G'Q Setback from: well: House Sd / Other ELEVATIONS Building Sewer ST Inlet. ST outlet i PC inlet PC bottom Pump Off Header/manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: S S 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 (ATTACH TO PERMIT) Sanitary Perm it No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI HANSON, EDWARD i( CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA p TYPE MANUFACTURER CAPACITY STATI6N BS HI FS ELEV. i Septic r Benchmark Dosing-- Aeration Idg. Sewer 1 Holdi St/ Inlet TANK SETBACK INFORMATION St/ Outlet 9S` TANK TO P/L WELL BLDG. Ventto Air Intake ROAD Dt Inlet Septic > St / Qom! NA Dt Bottom Dosing NA Header-LPNrr.- Aeration Dist. Pipe 9/. 9 .zo o ding Bot. System W, PUMP/ SIPHON INFORMATION Final Grade Manufacturer De nd Model Number GPM TDH Lift tion TDHFt ForcemaLength HSyste Fi Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width / I Length / No. Of renches PIT No. Of Pits Insi ia. Liqui epth DIMENSION s DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHIN Manufacturer: SETBACK INFORMATION Type O t f CHA R Model Number: System: l eN.3 OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) , r x Hole Size x Hole Spaci Vent To Air Intake Length ~11 Dia. Length 61=c Dia. S~ Spacing /.-a' I SOIL COVER x Pressure Systems Only xx Mound Or At-Grp a Systems Depth Over „ Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched =3r~ Bed/ Trench Center -30 j19 Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.)r~% LOCATIO Troy 6.28.19W, SW, NE Tower Road ii G~~'.~Z. ~4~/G~ GCL6L/~. G.>~~~'/ r'~✓"`-t_~~.L-/ `-~'~I7~.-~,i•. ry'3"".IL,r-, ~^./r-~. - ..Ci.. C}-K~'`. J Z2 Plan revision required? ❑ Yes a-9-0 Use other side for additional information. 1610d SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I m i t , Safety and Buildings Division e-~■a.lnr,t 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 Pe mit Number C; 3q The information you provide may be used by other government agency programs ❑ Check it revision to previous application lPrivacy Law, s. 15.04 (1) (m)]. State Plan LD. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location FZ~lc 'W 42 5,~d 1/4 1/4, 5 Ta8' , N, R Q E (orV Property Owner's Mailing Address Lot Number Block Number 4/ City, State Zip Code Phone Number Subdivision Name or CSM Number r` YQ ('lS> ?n - 72 r Nearest Road II. TYPE OF BUILDING: (check one) E] State Owned El cityyage ❑ Vill Public 1 or 2 Family Dwelling - No. of bedrooms Town OF d T' III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo e y~ 10;2 y 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. W 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 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 [jd Seepage Trench 22E] In-Ground Pressure 42E] Pit Privy 13E] 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) Elevatj.Dn Lj' S 3 f~ IF d Feet Jo if Feet Ca aut VII. TANK in gallons Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel lass A New Existing strutted g PP' Tanks Tanks Septic Tank or Holding Tank ~j.~ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite s ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (N Stamps) MP PRSW No.: Business Phone Number: 71- Plumber's Address (Street, City, State Zip Code): 7e a r" IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved san ary Permit Fee (Includes Groundwater aature ( Stamps C_qrA"pproved ❑ Owner Given initial 14 /p/~ Surcharge Fee) Adverse Determination IOC1 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: original to county. One copy To: Safety & Buildings Divnion, 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 systern, 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, nL.irroer of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for al/ septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks receiveti experimental product approval from DILHR. VIIL 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. I X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be sul_l,litted to the county. The plans must inciude the following: A) plot plan, drawn to scale or with complete dimension,, locati in of Welding tank(s), septic LankO or _,ther treatrr.ent tanks, building sewers, wells, water rnains/wate,- s.~i-,ce; stn,<,rY:s jnd lakes; pump or siphon tanks; distribution boxes; sot! absorption systems; replacement system areas; ant- the io-<st.'ocf the building served; B) 'hw! or'tal and ver,_,cal elev,:tion reference points; C) complete specificat:c.~ ; for purrp,, anc contr6s; dose volume; e'evation dif*erences, friction loss, pump performance curve; pump mode, ar c ump manuf ),er; D) cross section of the soil absorption system if required by the county, E) soil test data on a 11':, 'orm, a-id 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. A < avsd GJ~ S %d drJ i I i 'a a ~GJ ~ __,p m U Pb~~ 5 n a u 3 e l` N ti h ~I r' ~o cJ 2 f/ ~C c~ - - pr^wcFi- oqo- ) 02q - qs Wisconsin Department ofIndustry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 57". e,Poi'X 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. If dimensioned, north arrow, and location and distance to nearest road. tits O e/0 • / D2 y • 9S o -7 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION E D A N$ o 0 GOVT. LOT S W 1 /4 NE 1/4,S do T 2-~ N,R 19 E (orOD PROPERTY 0 NER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME ~ M # 37 Y TbtoE P_ RD CITY, STATE ZIP CODE PHONE NUMBER OCITY VILLAGE WN NEAREST ROAD I If OOSoO W1. 5401 (7113FCo• 1373 ~ Z- o Tow~~ ( J New Construction Use [ residential / Number of bedrooms -3 (J Addition to existing building I replacement [ ] Public or commercial describe Code derived daily flow yea gpd Recommended design loading rate / bed, gpd/ft2 trench, gpd/ft2 Absorption area required _z~ bed, ft2 5'63 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd1ft2 Recommended infiltration surface elevation(s) See .3 ft (as referred to site plan benchmark) Additional design /site considerations 14JS f 4/1 -'-o V G-- 7,f 4-. 5 t hce, S Is ' w/ P4010 Parent material SG 5 73 /3 yiPjC 44,407 r ovrW jS'e- Flood plain elevation, if applicable Nlf ft S = Suitable for system C90 NtWIONAL M_ OUtjB Q U IN GgOUN❑ o U ESSURE AT-GRADES U SYSTEM-IN FILL HOLDINGTAN~- U=Unsuitable tors stem [3 S, U [s~S 2t 11 0.8 0 U ❑ S e 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 O o 21/ .s AK cwt R S o f . S . 2 f s lvf .S z /o yje 313 Ground j /o v a 3 y s Lf S 6~' /►+^-F11;' ®C S .5 • 6 elev. 9y. ft. S -oO1 -0kiA 51C-s Depth to limiting factoorrj „ Remarks: Boring # d -1 f~ /O )/1je V f • Y 5 Z 2- ,i rove 3-3 s~ fshe P. s (vf S -fie Ground elev. 0 e o 51& 74!~-6 ft. Depth to limiting hIS to t Sit( factor r or conv ntiona! ptic sys fn. Remarks: CST Name:-Please Print Ro GS E R T 7A L 13 P, I* C t:~ I Phone: 7i y^ 3 A; . P/J03^ Address: U 5.5 O' N E 1 L V. H' U j9SO 0 w 1• 5- 1- 9 S C5 TM L yS7-X_ Signature: 5(>I t`j~~o Date: CST Number: 6 Cr1-v~~' 'S i C(DPY 1 PROPERTY OWNER SOIL DESCRIPTION REPORT a Page -.Of = PARCEL I.D. / ~ ~fO ~O Z y- 15 Boring # Horizon Depth Dominant Color Mottles Texture Structure in. Munsell Qu. Sz. Cont. Color Consistence Boundary Roots GPD rer Gr. Sz. Sh. Bed Trey 3 /O Z l S a_/ / / <S R r:: s Z f y .s 2,/0 yR 3l s~ Z f sbk ~,~F' a 5 - . s . G Ground /CR S CS OS elev. ~C Q .1 f 3 .S ft. Depth to limiting factor 1~ Remarks: Boring # - Ground elev. ft. Depth to limiting - factor Remarks: Boring # Ground elev. Depth to limiting factor Remarks: Boring # YS:: Ground elev. It. Depth to limiting factor Remarks: Y °k ?ice L 00, 4 (-p N fil y y h Z wE5r L-o r L"J k6 w 00 R o ~ o I 11 l i "Q p v / Z l l i ~ y qll I . ~ LA) y N w W J g~ m -A R, o ~ ~z 0 R, R~ H 15,4 s T Lo T S T C 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Fh w ff2 0 F JT~yN A #I - NSyn) MAILING ADDRESS -q"? ~J 4UE?L dV 4056 A) E 60- '!51(d / PROPERTY ADDRESS 6eV77F (location of septic system) Please obtain from the Planning Dept. CITY/STATE KJU 7 /J W T_ PROPERTY LOCATION 6&d 1/4, P f 1/4, Section T ZT N-R l BI W TOWN OF 'r/?.Oy ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY 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 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 t be completed and returned to the St. Croix County Zoning Officer within 30 days of the three ye piration da . ~ans4rJ sIGNE ,ara DATE: 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 1:-~'DWAJU f_-. + bzr9 O 01• d? N5oN Location of property 5,10 1/41/4, Section 6 ,T 09 N-R_Lg W Township 'T-90q Mailing address '97q Tc WCR izeP dup6bt'), w a:- 5((01(0 Address of site 3-1q TOu m 05na C'U Z 5qo /G Subdivision name Lot no. Other homes on property? Yes X No Previous owner of propertyl? -4 k -,c, 67Jt9oN Q ~l~iV/yELL Total size of property sus 0 1tC E5 Total size of parcel a0.7 Date parcel was created Are all corners and lot lines identifiable? K Yes No Is this property being developed for (spec house)? Yes /C No Volume _U 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. f)(1 v -q- q5" 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. Signature of Applicant to-Applicant S~2(, ~~j _ a SJ Date of Signature Date of Signature S50 Ph :E AWL--5 •,r I STATE BAR OF WISCONSIN FORM 1 - 1982 I ~~1 gla WARRANTY DEED ST. CROIX CO., WI Recd for Record This Deed, made between SLP 011989 Richard K. O'Donnell and Sharon B. O'Donnell, at 11:10 A. M husband and wife, as survivorship marital property Grantor(s), and Register of Deeds sn anti T~ian M H^nGnn husband Edward F . Grantee, and Wife - Witnesseth, That the said Grantor, for valuable Return To: consideration conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: Tax Parcel No: - See Exhibit "A" attached hereto and made a part hereof. T-RANSEXR homestead property. FEE , This (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And le and free and clear of warrants that the title is good, indefeasible in fee limp encumbrances except and will warrant and defend the same. X ` day ofx i~~'C~~G~~~ 19 Dated this X.~ 'Z~LZ .h~ fJ L Twvt1~ (SEAL) X (SEAL) \ *Sharon B. O'Donnell 4Rc rd K. O' ell (SEAL) (SEAL) ACKJiJWI.EDGMENT ACl1TfICATION SPATE OF M 1 Signature(s) )ss' X County. 1 authenticated this - day Perso ly came before me this A~ day of 19 the of V 19 - above rva-d Richar,1 K. O'Donnell and Sharon B. O'Donnell to me known to be the persons who execut- ed the foregoinq instrument and * TITLE: MEtrBER STATE BAR OF WISCONSIN ackx")1"edge the same. (If not, w authorized by & 706.06, Wis. Scats.) THIS INSTRUMENT WAS DRAFTED BY Notary Pub is `r z county, S0LZ8. Relocation Resources * `)y C(,~nission is peminent. (If not, state i;or~~rell, "a~aachuset, expirat1, V 1 _ GanerslNotary-StdsdtJebr. I In (Signatures may be authenticated or ackrow- y cA{~t+v.!rbr9a ledged. Both are not necessary.) *Names of persons signinq in any c,,ipacity should be typed or printed tx-lctw their siq- natures. . 6 A parcel of land located in the SW 1/4 of NE 1/4 of Sectioisconsin nfu they North, Range 19 West, Town of Troy, St. Croix County, described as follows: From the NE corner of said Section 6 go S89'031W along the North line of said Section 6 a distance of 1540.7 feet; thence SO'451E a distance of 2682.0 feet to the centerline of the ow 15oad along point of beginning for parcel to be conveyed herein; thence pathence rallel to 5 said the centerline of said road a distance of 200.0 feet; distance of 450 feet v thence N891151E along centerline of road a distance of 200.0 feet; thence S01450E a distance of 450 feet to the point of beginning.