HomeMy WebLinkAbout020-1015-80-000
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ~OK to
ADDRESS UQ') rn~b ~aex~r~,~~
SUBDIVISION / CSM#_ LOT
SECTION 07 T,,_N-RW , Town of N
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
F-ou In
N a►~
v lGl,~ oJp~ .
Boo
iy
G
3 -Teeme e S ~ie~~~ 81~►1 RwU Va~vt
c l$'4'V Oufi
sy~ fiPy,,, N
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: O 6i ~11 -Y(~UN ~1 Q 100- 0
ALTERNATE BM:
SEPT C TANK / PUMP CHAMBER / HOLDING TANK INFORMATION y
ee~s To 1+~~
Manufacturer: Adze d OO Li Capacity: QO
Liquid Ca a I$UU
P
~ Ilo~t
Setback from: WellVvWg1kb4 vHouse 1$ r ~ O Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: S Length 0 Number of trenches
Distance & Direction to nearest prop. line:
S U ~t
Setback from: well :0Q Q House Oa Other
A" c1, I~S•N ► I ern 9 8~
95_~~ 9y.8S'
P1 1 r)
IoW 9335 93.►~ fi '~R~►~~~ ~uR~It S1w
4 N ELEVATI04S K~.S
Building Sewer ST Inlet. (01. qd ST outlet U~•
PC inlet PC bottom Pump Off
A'4 91..U6 Trip M o
Header/Manifold Bottom of system
Existing Grade Final grade SMrv4
vPi,)P
zN
DATE OF INSTALLATION: ~7,7
~p
PLUMBER ON JOB: old
V 911
LICENSE NUMBER: 3 OV
INSPECTOR:
3/93:jt
e
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
A
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
T p
serving the 1kc~, NuR44►I residence located at:
_1/4, S 1/4, Sec. , TA 4 N, RW, Town of
~ubSuN Upon Inspection, I certify that I have found the
tank and baff'leW"'to be in good condition, and it appears to be
functioning properly.
Last time serviced- 0~ A
Did flow back occur from absorption system? Yes No J (if no, skip ,
next line)
Approximate volume or length of time: gllons minutes
Capacity:
Construction: Prefab Concrete Steel other
Manufacurer (if known): W PI
Age of Tank (if known): KWA
~~.^N'- Qd1 .c V 7 ~%A 6014 M Q'R,Jf P-
(Sign ure) (Name) Please Print
(Title) (License Number)
(Date)
Farm to be completed by licensed plumber (x.145.06, Wisconsin Statutes)
or Licensed Disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR-83, Wis. Adm. Code (except for
inspection opening over outlet baffle). 1011
Name Ti rv\ OUt'~CC ~ Signatures-- ow MP/MPRS
5/88
Wisconsin Departmentof'kdustry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION
P~ ySS p 1Q' & BECKY ❑ City ❑ Village Town of. State PI
I JIM CST BM Elev.: Insp. BM Elev.: BM Dn: X Parcel Tax No.:
AMl b0 s
RMATION ELEVATION DATA
TANK INFO
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Benchmark 3 /Od
Septic
tit
/ 11x 1C~ 9 t7
Aeration Bldg. Sewer
Holding St/ Ht inlet a~ 1v/ y 7-
TANK SETBACK INFORMATION St/ Ht Outlet a,~q /60/
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic ~a S / 5 16 >a0 NA Dt Bottom ~
,aio 9-~-6
NA Header / Man. $.3 5 9 s, s
Dosing
~,F 3 4 7- 7
Aeration NA Dist. Pipe 6 8<u
L
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade _
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Forcemain Head
Length Dia. Dist. To well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length~D , No. OfTrenches P DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMEN 1 N Manufacturer:
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING
SETBACK CHAMBER Moe Number:
INFORMATION Type O 1o a l ' i OR UNIT
Systems./ 1I
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 4 Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
Topsoil C] Yes [I No ❑ Yes E] No
Bed/ Trench Center Bed/ Trench Edges /}~j
COMMENTS: (Include code discrepancies, persons present, etc.) O
LOCATION: Hudson-12.29.19W, SE, SE, Lot 1, Moon Beam Road
`6,35 jr6`
77
Plan revision required? ❑ Yes No
Use other side for additional information.
Date ns ecto-Cs Signature Cert. No.
SBD-6710 (R 05/91)
ADDITIONAL COMMENTS AND SKETCH 1F
SANITARY PERMIT NUMBER:
SANITARY PERMIT APPLICATION
t~al`?~ra In accord with ILHR 83.05, Wis. Adm. Code COUNTY
-Attach com lete lans to the coup copy STATE SANITARY PER
p p ( ty py only) for the system, on paper not less than a 1,10 (,I,~
8% x 11 inches in size. ❑ Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PRO RTY OWN PROPERTY LOCATION
S SE%4 S T N, R / E (or) W
PROPERTY OWNER'S MAILING A RESS LOT # BLOCK #
c e
CITY, STAT ZIP CODE 13HONENU MBER SUBDIVISION NAME OR CSM NUM R
QAJ 6-41
13
CITY NE REST RO
II. TYPE OF BUILDING: Check one
( ) ❑ State Owned ❑ VILLAGE :
Public 10 1 or 2 Fam. Dwelling-# of bedrooms I_ PARCELTAX NUMBERO
III. BUILDING USE: (If building type is public, check all that apply) 101'/_ /(~/~V 1/ o
f
1 El Apt/Condo C~ ( II~CJ
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 80 Mobile Home Park 12 ❑ Service station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 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) 9!V.,VATION
Feet 9, 1, 30 Feet
CAPACITY
VII. TANK Site
in allons Total
INFORMATION # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic f la .stic ~ Exper.
New xistin Gallons Tanks Concrete strutted glass App.
Tanks Tanks /.ve.e 4-j
Septic tic Tank or Holding Tank / /8oG A4,-L) ACAO - (.1,x,',11
Lift Pump Tank/Si hon Chamber (j CL /01"o
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number:
310LA"-e L I ( 7/ S D~VV O~
Plumber's Address (Str et, Ci , State, Zip Code)
o m
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing A nt S' ature (No S ps
AApproved ❑ Owner Given Initial Sumarg~ee) D _y
Adverse Determination ~J~J /
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(R.08/93) 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 the time of renewal any new
criteria in the Wisconsin Administrative Code will The applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
1
E) 7 P L OTA N ,
-'0 S S ~j
l_ I C E N
T- -15
1
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FAIIQA o
sys 3 A ?Jr_ ~
490
107A,
clClb:%A t _sct Tn~ q-T 1f ap l • P.
Lev = i m o
7(o° MAI(Q~ Nitt : 51A At oufi W1
~1,
gov 9A` t'j (NO 4f AT CrtD of
Its'
1 ~I~Ot ~1~W/11 VI C#
V F-----
FRESII A'L1: I~dL[ti.AND OBSERVATION YI.P1;
C1'0SS SECTION
Approvec9 Vent Cap
Minimum 12" Above
g c~ s5-
a" rn px
Above Pip 4 Cast Iron
To Final Gracie- Vent Pipe
Marsh Ilay Or ~Synthetic Covering i
Min. 2" Ay(jr.ct.j 11
Over Pipe
Dis tribu t'i_on; ~ -
Pipe _........_.I.t Tee
VnI)~ Aggregate ~S - I'erf.oraLod Pipe LZeloa/
Deneath Pipe IC4
•~u~ ga•a.~ --Cour7.ing Terminal.i.ng' r
. . Aot• tom. of. System,
r
Wisconsin Department
n Relations Industry,
Labor and Human Rel SOIL AND SITE EVALUATION REPORT Page l of 3
Division of Safety & Buildings
in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 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. C2.0 - 1016 - SO 000
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
FPROPERTY NER: PROPERTY LOCATION
% GOVT. LOT 1/4 s~ 1/4,S /z 29
NER':S MAILING ADDRESS T N,R E (a) yy
All e v l3 L0T# BLOCK # SUBD. NAMI~4R CSM #
CITY, STATE ZIP CODE PHONE~NUMBER QCIT OVILLAGE R
WN CC NEAEST ROA
D
rrvso,,~ wA A4-1 (-S~~o vso,~ ~ioovldE-4,+7
a
ew Construction Use [ tj'Residential / Number of bedrooms
(]Addition to existing building
j Replacement [ ] Public or commercial describe
Code derived daily flow l~~b gpd Recommended design loading rate
2
Absorption area required bed, ft2 1L~ 9 bed, gpd/ft trench, gpd/k2
trench, ft2 Maximum design loading rate / 2,
~ ' gP trench, gpd2
Recommended infiltration surface elevation(s) 5 [ 3
`d It (as referred to site plan benchmark)
Additional design/ site considerations D.P7-1a"--l
y 4ii 6 OX 0i's 7,&,,'13 v 7-1a"--l
Parent material 5L$ S/ - S Gvs ~S /3U,P,~ ,PDT- Flood plain elevation, if applicable /y It
ru =Suitable for system C~Ny~NrIOrdAI M~OU~ro IN GUhl"[] Rp U ESSURE AT_GfjA9E SYSTEM IN RLL- HOLDING TAN
= Unsuitable fors stem IM ('S U (td'S ❑ U r,$ p S - I
L~'U 11 S BT i
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPDM
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bound3y Roots
Bed tench
/'9 Y/oe ~141 I A-5
Z ~'-3 /o yie y
Ground 3 l-lo /o1 3/, S~ 1-7- s6K
elev. ft
Depth to
limiting
factor
i
Remarks: ~ /-,4
Boring #
/ D /ore 3/z-
3 ~,zZ 3
Ground /U z . 3
elev. ft L /0 316, 9 av S~ /f SGT~ie Z % y 5
Depth to S.y oC~ S ~s U7~
limiting of 2__a
factor
Remarks: ~Jpi'S7--
CST Name:-Please Print x2o&E.-P- 7- 01L/6/?i ~47- Phone:
Address: ~S5! O'ivr'i/ -
CPIs. Signature- Z4 Date:
. CST Number:
ORIGINAL
1't4 It /~f 70
r
PROPERTYOWNER ~dKa~'T SOIL DESCRIPTION REPORT Page 2-of
PARCEL w.# 2, f~~ l S D 2O - /214 - -f - 00 0
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed mr&
3 0-16 /01V 1312- - S./ / -je sf~.C ~,f r2 s .3 , 2 3
16 -3,P A6 Yle 51 / -Ile
Ground y / mss/ / / ~s M fie a - , 5
elev. W/ 1 cow vus W/
/3~f.vys j o /~~rs
6L71 ft.
Depth to o f _
limiting
factor /o 3f s/ f • ~'.5
,rte
~l
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor /
Remarks:
Boring #
z
Ground `
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
facto
Remarks:
Con o09M0 nctm%
u'9
2
(q
o
Ertl-~
~ I 5xdto' ~y
C/0
~rovvD /3M SST, 7-010 , i
I
r
y _
13tnR~1s ArTs
~iEv~r~-vNS -
o W Ell
13, ~ssy'
~ Z r 9 yy '
33 Zy .
NoT,-rs S06-GL-s7-ev sys7e-,y
To ~wsf•~//€~ ;
~
~ccX e'ecae- C ~ i v
SiTtiG r
7eevc,et 130II0 ,N e--I, W, lovs, #1'6-k 7,16,oja, l6,0
("S~X80'
507- D 5
/api,U /P~17 5 0~ ~dW Tipp 92 , Z S ~5^ ~X 8C
ewlt~ co Oeve-4-
T,a .Par>F 1Y1 ~ ~ T sy~Ps
FIL Ep
m" Y 8 1984 w 01
CERTIFIED SURVEY MAP CA,
Located in the SE 1 /4 of the SE 1 /4 and in the SW 1/4 of the SE 1 /4
of Section 12, T29N, R19W, Town of Hudson, St. Croix County,
Wisconsin
Surveyed for: B. & H. Excavating APPROVED
836 St. Croix St. No.
Hudson, Wi.
MAY 0 81984
N
m. , r :20IX COUNTY
CON %f iocuNGPioIeeun wwa
mma
m n (4 1's2O
z r m ' .;Vi UNPLATTEO j. NOS
010 a m > o koo,
m 0
o Plz
G) Iz c° 145,961 SO. FT,
= m A r 3.351 ACRES 30 kb
O
CM
(om Im b^ O~ tib
I r 1?o p~ „t"ttO O~Ir
=cap
Z 2,,o 11 + ^ 105,884 SQ. FT.
JC 1 y NSao 32'39"W ?ry 2.431 ACRES
zi •i~@o Ic
_ m C 343.30' 2 z z
ro h @. 0 I~
ry
N In
S 8032' 41 % -1
M 320.66 . 2 w m` w6 ab 0°' Im
7 O 159° 17'4X" C gyp ob` bb9 o Zb o
40" W o Ab
b N8803 2' pry I r
s~
s
/J 367.68 _ 116 437 SOFT. Iz
3 _ rTTSTr ATV 2.d 437 RES LP I f
`hb SL yT o O@ \ 1 y O
iri T T
V ?J 0@~ E J~ 0, 00.
FENCE _ 00.
66' roadway easement°\~ O S69°57'16"E 0e''
N 301.06'
y'''~ 0'~nb ~W \ @ J (R) EAST
Certified Survey Map
CS 4 156025'53' , Vol._1, Page 1?4 -
507,026 SQ. FT. 11.640ACRES qi - -
INCLUDING PRIVATE ROADWAY
160 EASEMENT o m 6' T-OF-WAY LINE,
0O _ NORT14ERLY RION
~ -
b
163.00' POINT OF BEGINNING 1071.32' R
1
91/4 CORNER SECTION 12 S 88056'43"E L
S.E. CORNER
LOCATIOM'FROM TIES-CORNER SECTION 12
FALLS IN LAKE T29N,R19W.
NOTE, THIS MAP IS INTENDED TO REVISE AND REPLACE
THAT CERTIFIED SURVEY MAP RECORDED IN
VOLUME 5, PAGE 1368. ,
SCALE IN FEET 1200'
200. 100 O 200 400
LEGEND
• 1" IRON PIPE FOUND
0 SECTION CORNER MONUMENT, BERNTSEN CAP NOTE = THIS MONUMENT NOT
i '
p OX 24°ROUND IRON PIPE WEIGHING 1.68 LS$. SET DUE TO ITS FALLING
/ IN THE ROADWAY
LINEAL FOOT SET y
@o
(R) SLANT DATA INDICATES PREVIOUSLY RECORDED -pOo P>,
INFORMATION 019
lq 3/4"3TEEL BAR FOUND `'J, 46.72
1 O aay69033, 37 G _ N 1032
'
EXISTING BUILDING 091,
o
/ o_
Vol. 5 Page 1417 / g
THIS INSTRUMENT DRAFTED BY J. H. LARSON 400-101
NOTE
THIS MAP IS INTENDED TO REVISE AND REPLACE THAT CERTIFIED SURVEY MAP RECORDED IN VOLUME S,PAOE 1388.
DESCRIPTION
A parcel of land located in the SE 1 /4 of the SE 1 /4 and in the SW 1/4 of the SE 1 /4
of Section 12, T29N,R19W,Town of Hudson, St. Croix County, Wisconsin, described
as follows: Commencing at the S 1/4 corner of said Section 12; thence S89056'43"E
:R (assumed bearing referenced to the East line of said Section 12, bearing assumed
N0005'01 "E) 165.00' along the South line of said SE 1 /4 to the point of beginning;
thence continuing S89056143"E 1071 .32' along said South line; thence Northeasterly
20.78' along the Northerly right-of-way line of an existing Town Road on a 603'
radius curve concave Southeasterly whose chord bears N8003313 1"'E 20.78'; thence
N81032151"E 46.72' along said Northerly line; thence NORTH 253.55'; thence
S89057' 16"E 301.06' along the North line of that parcel recorded in Volume 1, page
174 of Certified Survey Maps; thence NO002'46"E 475.00'; thence N620151W .'83$;.00';
thence 516008'29"E 499.45'; thence N88032'39"W 343.30'; thence 536055'27"W
821.47' to the point of beginning; containing 875, 310 sq. ft. , or 20.094 acres, and
being subject to the roadway easement as shown; and also subject to an easement
to St. Croix County Electric Cooperative as recorded in Volume 576, page 125, for
utility installation; and also subject to an undelineated 33' access easement to
Lorran J. and Doris A. Church as recorded in Volume 580, page 636; and also
subject to all other easements, restrictions and covenants of record.
I, James E. Rusch, registered Wisconsin Land Surveyor, do hereby certify that I
have surveyed and mapped the above described property; that such plat is a true
and correct representation of the exterior boundaries of the land surveyed; and
t that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin
Statutes, Chapter 5.4 of the St. Croix County Subdivision Ordinance, and Section
6.C of the Town of Hudson Subdivision Ordinance, to the best of my professional
knowledge, understanding and belief. GO m
a, ,,,z
Jai~nes E. Rusch, Wisconsin Land Surveyor S-1376 JAMES E.
Surveying & Mapping RUSCHs
421 'Second Street 5-1376
Hudson Wisconsin 54016 g r Huasoa,~
' 7 ` WIS. z O z
•r~
March 29, 1984 v`'!~''••»..«....••• ~i
S U
This map is hereby approved by the Town Board of the Town of Hudson.
Date Clerk
CUR' E DATA TABLE
Curve Lot Radius Arc Chord Chord Central Tangent
No. No. Length Length Length Bearing Angle Bearing "
1 1 & 4 233.00' 191.691 186.33' N23034'07"W 47008114" See Map
2 - 233.00' 168.39' 164.75' N67050'27"W 41-024'26" If "
2 3 233.00' 14.28' 14.28' N48053'35"W 3030'42"
2 4 233.00' 154.11' 151.31' N69035'48"W 37053'44"
3 4 167.00' 120.71' 118.10' N67050'27"W 41024'26"
4 4 167.00' 137.39' 133.55' N23034'07"W 47008'14" If of
5 4 603.00' 20.78 20.78' S80033'3711W 1058'28" 579034'23"W
5 - 603.00' 0.72 0.72' S 9036'26"W 0004'06"
5 road 603.00' 20.06' 20.06' S80035'40"W 1054'22"
Vol. 5 Page 1417
i
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
A
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
serving theM ; residence located at
S f 1/4, ' 1/4, Sec. TQ~LN, R-19 W
_ , Town of
--HuID Upon Inspection, I certify that I have found the
tank and baffles"'."to be in good condition, and it appears to be
functioning properly.
Last time serviced
Did flow back occur from absorption system? Yes No (if no, skip
next line)
Approximate volume or length of time: _gal minutes
Capacity:
Construction: Prefab Concrete Steel Other
Manufacurer (if known) :
Age of Tank (if known):
(S nature) (Name) Please Print
(Title) (License Number)
(Date)
Farm to be completed by licensed plumber (s.145.06, Wisconsin Statutes)
or Licensed Disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR-83, Wis. Adm. Code (except for
inspection opening over outlet baffle).
Name_.) + N\ Signature-a',
5/88
'T--
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
S~At.++ Croix County Dn
OWNEWBUYER I o rr~ u l st 1~2 b ecca' / 'o u ! Sf
MAILING ADDRESS ~ D D 7 N &p-iv be Q-~ Ki u-j S&n W1 i q D 1 lD
PROPERTY ADDRESS (DDS I"& -Abeay~ Ka. ~t d'S&n, Or
II ff (location of septic system) Please obtain from the Planning Dept.
CITY/STATE T~ CLdS6 w Z, S401
PROPERTY LOCATION 1/4, ~j 1/4, Section T~N-RW
TOWN OF H 1kd S &Y"- ST. CROIX COUNTY, Wl
SUBDIVISION 'r LOT NUMBER
CERTIFIED SURVEY MAP S-j-KVOLUME 5- PAG,LOTNUMBER
DDc u M ,eve+ *p 3 q 3 f! 1
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED-
DATE: 1 I -
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.
property meS
4 V i s~-
Location of property S lr/4 5E7 1/4, Section 1,2
~ T a ~N-R~W
Township S~ Crbr C,L
trailing address I DD P-d ;
Address of site 007 H*&nbQ&,r~ P-d
Subdivision name
~f t_4 Lot no.
Other homes on property?
Y e s___2~__-N o
Previous owner of property p o C~y~a
Lzc -Ervrn
Total size of parcel
Q C reS
Date parcel was created SLLY-V m
Are all corners and lot lines identifiable?
X_Yes No
Is this property being developed for (spec house)? Yes
_X_No
volume and Page Number J
of Deeds. as recorded with the Register
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
" WARRANTY DEED which includes a DOCUMENT
NUMBER & THE SEAL OF THE REGISTER OF DEEDS. VOLUME ti , a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing
references to a certified survess. If the deed description
shall also be required. Y Maps the Certified Survey Map
PROPERTY OWNER CERTIFICATION
(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 he
,warranty deed recorded in the office of the County virtue a
Peeds as Document No.~)1 r of
own the proposed site for the sewage ~di p salt system ) or preIsently
obtained an easement to
(we)
the construction of ,said run the above described property, for
recorded in the office of Countm, and the. same has been duly
No 393it Y Register of deeds as Document
Ogn ture of
licant Co-applicant
( ~f
D-ate of signature I~~ 3 `t
Date of Signature
THIS SPA.-.E REiERVED Von RECORDING DATA
DOCUMENT No. WARRANTY DEED
STATE BAR OF WISCO"ISIN FORM 2-1982
• x•83 VOL 1084P As 134
Cindy Lu Irvin, husband and wife, JUN 2 8 199'
Royce W. Irvin and
12:15 P•
point tenants, .
as
and .Reca %w of LOa .bec
Jallles D, Norquist. #
conveys and warrants to
_N.orquist,..husband . and-wife,
- -
1LTURN~
r
I
CrO1X . Count
_ St•. .
'w following described real estate in -
Taz Parcel No:
A., State of Wisconsin:
hip •
$ as Lot 1 of the ; located in the S1/2 of nl/4 of Section 12, Towns certified
Se 19 West, 29 Norte, described
R parcel of land Wisconsin 1417, Doc. No. 393111
Ran St. Croix County, "5", page
filed May 8, 1984, in Vol.
Spey Map easement shown on said
~1 11
Tosement to use the 66 and for utillity lines located so as not
~k Cerether tified wi,:h an Survey ea Map as access road d and
E$
I to interfere with its use as a road.
ri
,II
o erty.
homestead pr P
This ....19 .
I (is) of record,
Easements, restrictions and rights-of-way
Exception to warranties:
if any.
19.94
I C~
b,
y r~ 1 day of
Dated this (SEAL)
i
S
.-(SEAL)
i= ~oyce W. Irvin.. i
- (SEAL)
-
(SEAL)
Irvin
Clndy
ACHNOWI,ED(}MSNT ,II
AUTH$NTICATION STATE ss.
OF WISCONSIN
1 n I
- I !
signature (5)
r I $t..- Cl 01X_... County. n.
h.ic a'3
{ PxTSOnal'y : rr.:c v
the above named
this day of 19
authenticated 19_94.- t
d
d .
Gindy.. T.u.. Zrv
-day -~'---Z~11s---
{ !1
TITLE: MEMBER STATE BAR OF WISCONSIN .uw, the i
to me known to be e Persons
' w
(If not,
authortzed by $ 706.06, Wis. Stats.) e, ieg inst ent and II
C;W= cu m
- nsin
THIS INSTRUMENT WAS GRAFTED BY - - Alice joy n s -
I III
_ Count} Wis lil
Kristina g
Oland expiration
y Notary Public Cnr• 1 not, state _ --Attorney--at--Law---------------------------------------
M}• Commission is P yc~
i
be authenticated or acknowledged. Both 0 • • 1
date: - - '
- j
14 (Signatures n
# I may I
are not necessary)
_ - nacures.
N ' s orinted below their
signing in any capacity hould be typed r P Wisconsin Legal Blank Co.. Inc. I
•N&ma of persons siH
STATE BAIL OF WISCONS'N Milwaukee. Wisconsin
~
-
II WARRANTY DEED FOAM No. 2 - 1982
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
INN
NNNaa■ wrrwi
ST. CROIX COUNTY GOVERNMENT CENTER
- 1101 Carmichael Road
Hudson, WI 54016-7710
,JW (715) 386-4680
June 24, 1994
i
Mr. Roger Hetchler
Edina Realty
700 Second Street &
Hudson, Wisconsin 54016
~ j-, z y, 19 . 71A
RE: Septic Inspection for Residence located at
Address: 1007 Moonbeam Road, Hudson, Wisconsin
Dear Mr. Hetchler:
An inspection of the septic system on the property of Royce Irvin
located at 1007 Moonbeam Road, Hudson, Wisconsin, was conducted on
June 22, 1994.
At the time of 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
may be dependent upon proper maintenance of the system.
Should you have any questions, please do not hesitate in contacting
our office.
Sincerely,
ell,
A,
(`t ` t
Mary J. Jenkins
Assistant Zoning Administrator
mz
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
I~M~IMN~MM _
Mello ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
- - Hudson, WI 54016-7710
(715) 386-4680
SEPTIC INSPECTION / WATER TEST REQUEST FORM
Please specify desired test(s) & remit appropriate fee with
application. Outside water lines are often turned off during
winter months, making access to the home necessary. Please make
arrangements with this office to insure that entry can be gained...,
D Water (VOC's) $185.00 9 Septic $50.00
❑ Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria
retest $15.00
Owner: f \0 C C Requested by: D / II~A keALT t/
Address: f_ 'V-- Address: 70 o a -n T
7 ZIP 5_,017 (j) ZIP 5,1016
Telephone W: 7 .7 3 Telephone N°: ( 715 ) 386 - aZ
px~
~D
Property address (Fire M° & Street) : /00 `7 Location: _h, SE Sec._7Z , T o N, R__LjW, Town of
Realty firm:_&61,(_~ Lock Box Combo: Closing Date:
TO BE COMPLETED BY PROPERTY OWNER
,a PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS
Water sample tap location:
Is the dwelling currently occupied? ❑ Yes ❑ No
If vacant, date last occupied:
Age of septic system:
Septic tank last pumped by: Date:
Previous Owner's Name(s):
Have any of the following been observed?
❑Y ❑N Slow drainage from house.
❑Y ❑N Sewage Back-up into dwelling.
❑Y ❑N Sewage discharge to ground surface or road ditch.
❑Y ❑N Foul odors.
Other comments relative to system operation:
I certify that the above information is complete and true to the
best of my knowledge.
OWNERS SIGNATURE: c~ DATE : 4,- 7-a y~
1/94
OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION
IN
TO BE COMPLETED BY INSPECTION AGENCY
System design &/or permit on file? ❑Yes ONo
Soil series per SCS Soil Survey: sheet #
Type of soil absorption system: CE8elow grd DAt-Grd OMound
Approx. size 'X DGravity ❑Dose OPressurized
Ft.2 DBed ❑Trench DDry Well
DHolding Tank DOutfall pipe
OBSERVED DEFICIENCIES ❑Other OUnknown
Septic tank
Setbacks: DHouse DWe11L/ OProp. line DOther
Dose tank
Setback s er
❑Lock' g cove Warning label OPump/Floats _
[]Ala Elec. wiring
Soil Absorption System
Setbacks: ❑House ✓ ❑Well_ OProp. line ❑Other_
OPonding: ❑Discharge: ~tiCdh~
General comments:
INSPECTORS SKET SYSTEM LOCATION
Ins
ltle
~trc i iritu ou"tY MAF
yLocated in the 'SE 1/4 of the SE 1 /4 and in the SW 1 /4 of the SE 1 /4
of, Section 12, T29N, R 19W, Town of Hudson, St. Croix County,
Wisconsin
Surveyed for: B. & 1-1. Excavating APPROdED
836 St. Croix St. No.
Hudson, Wi. MAY 0 81984
$1, C-101% COUNTY
oe" COh%p AINENSIVE FAMS OLANtWO
ANO IONINO COMWTTIA
pO) D N
D N J.1B s~O~3 ~w
Z r; ; :Ir`v • m 00 UNPLATTED LANDS
m° 63'.
M S. o 00,
AAG1 I= ,n 145,961 $O. FT.
O Ny (r 3.351 ACRES dp a~O
1
o 000-
am ~0 tna o
jy
n z 2*~ n 105,884 SO.FT.
AII
M-0 I0 NBB°32'39"W~" a, 2 2.431 ACRES
2 S 00 %0JO 343.30r 2 z (f
a m ryy. Ae, it o
o~ 4 m
S88°3240 E F `F' 10 I>
320.86 2 W a0` h6 9k~ „i 0~ Im
138°17'47" \ o `h 0 yy 0`I pl o
• N8B°32'40"W p_ 't, a0 I)-
0j ~t 387.88' 116 437 SOFT. Io
,
O 2.6173 ACRES w
ss7 a I
14,-0
4, b
V ?J 09. F J~
J y RT0, sad{ .90O
FENCE Cb,
o V 9 890 5711611 E 0,
66' roadway easement 4, ` NI.` a 301.06'
ti ryy - ,,w (R1 E•As7
~
s Jai 1411 Certified Survey Map
by
156026'53' wA Vol. 1, Pape 174 _
507,028 S0. FT. 11.640ACRES w Y
INCLUDING PRIVATE ROADWAY WAY LINE
O1 by EASEMENT i m 6' NIGHT-OF
NORTHERLY
166.00' b ppINT OF BEGINNING 1071.32' '
12
91/4 CORNER SECTION 12 9.EN
LOCATION'FROM TIES-CORNER SECTION 12
FALLS IN LAKE T29N,R19W.
NOTE)
THIS MAP 19 INTENDED TO REVISE AND REPLACE
1 THAT C'ERTIFIED SURVEY MAP RECORDED IN
' VOLUME 5, PAGE 1368.
SCALE IN FEET 1"=200'
200 100 O 200 400
LEGEND
• 1" IRON PIPE FOUND ,
0 SECTION CORNER .MONUMENT,'BERNTSEN CAP NOTE' ST11 9 ET DUE MONUMENT 1S. FALLING
p 1".% 24" ROUND IRON PIPE WEIGHING 1.68 LBS. / IN THE ROADWAY
LINEAL FOOT SET 980
(R) SLANT DATA INDICATES PREVIOUSLY RECORDED
INFORMATION 00 29
3/4"STEEL BAR FOUND 6 2~3 46.72'11 e
9033 s., N 010 32' 51 E w
[ti.~.y EXISTING BUILDING
Vol. 5 Page 1417 /
ST. CROIX COUNTY
WISCONSIN
- - ZONING OFFICE
I~NppNpNR w~wwb"
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
- Hudson, WI 54016-7710
(715) 386-4680
June 17, 1994 F qk ~LO
o~ -l v1 -60D
Edina Realty Q
700 Second Street
Hudson, Wisconsin 54016
RE: Water Inspection for Royce Irvin
Address: 1007 Moonbeam Road, Hudson, Wisconsin
TO WHOM IT MAY CONCERN:
Enclosed is the original test results from Commercial Testing
Laboratory, Inc. for a water inspection of the above property. If
you have any questions with regard to said report, please let me
know.
in erely,
c
ames i~.Th~ompsof
Assistant Zoning Administrator
mz
Enclosure
AIV16CIAL TESTING LABORATORY, INC.
t
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
FAX - 715 - 962 - 4030
ST. CROIX COUNTY ZONING OFFICE REPORT NO.S 64219/01 PAGE 1
ST.CROIX CTY GOV.CTR REPORT DATE! 6/15/94
1101 CARMICHAEL ROAD DATE RECEIVEDS 6/09/94
HUDSON, WI 54016
ATTNS THOMAS C. NELSON
OWNER; Royce Irvin
LOCATION: 1007 Moonbeam Rd., Hudson
COLLECTOR. Jim Thompson 2
DATE COLLECTED! 6-07-94
TIME COLLECTED*. 21#00pm 1P
SOURCE OF SAMPLES Kitchen faucet
DATE ANALYZEDS6-09-94
TIME ANALYZED4421400pm oF` f!
COLIFORM,MFCCS 0 /100 ml E~
INTERPRETATIONS Bacteriologically SAFE
NITRATE-NS 7 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
Coliform Bacteria/100 ml
Nitrate-Nitrogen, mg/L
LAB TECHNICIANS Pam Gane
WI Approved Lab No, 19
o t Means "LESS THAN" Detectable Levei. Approved by# 1
PROFESSIONAL LABORATORY SERVICES SINCE 1952
ST. CROIX COU
WISCONSIN
ZONING OFFICE
M~■~~ ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
- (715) 386-4680
SEPTIC INSPECTION / WATER TEST REQUEST FORM
Please specify desired test(s) & remit appropriate fee with
application. Outside water lines are often turned off during
winter months, making access to the home necessary. Please make
arrangements with this office to insure that entry can be gained.
0 Water (VOC's) $185.00 0 Septic $50.00
Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria
retest $$15.00
Owner: VIC V- P-U I Requested by: A to ,fir 4
Address: Q 7 ) 061) f 4 Address: -0-0 a CA
k N. ZIP S (4 of 4 ZIPs
Telephone N°: ( IS) 3 $a3~~
Telephone N°: ( ) -&q 4 Telep Z--
A /Vl
Property address (Fire W & Street) : 100 7 #-1.Q. --P
Location- Sec. , T ____._,N, R W, Town of
Realty firm: Lock Box Combo: Closing Date:
TO BE COMPLETED BY PROPERTY OWNER
PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS
Water sample tap location: E` ~ ` 0 L r r\, q,/\, Nc-- 0-
Is the dwelling currently occupied? Yes ❑ No
If vacant, date last occupied: OCCu Pik' o~
Age of septic system:
Septic tank last pumped by: o~J2(2S i pate: 3 1- 9y
Previous Owner's Name(s): P-R%-
Have any of the following been observed?
OY 2;N Slow drainage from house.
❑Y 9N Sewage Back-up into dwelling.
OY 9N Sewage discharge to ground surface or road ditch.
❑Y 264 Foul odors.
~pmments relative to system operation:
N
:"I rti hat the above information is comp nd true to the
f,knowledge.
f OWNERS SIGNATURE: DATE.
1/94
r #
J •
OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION
IN
I
TO BE COMPLETED BY INSPECTION AGENCY
System design &/or permit on file? OYes ONo
Soil series per SCS Soil Survey: sheet #
Type of soil absorption system: OBelow grd OAt-Grd ❑Mound
Approx. size 'X OGravity ODose OPressurized
Ft.2 OBed OTrench ❑Dry Well
OHolding Tank ❑Outfall pipe
OBSERVED DEFICIENCIES ❑Other OUnknown
Septic tank
Setbacks: ❑House OWell OProp. line OOther
Dose tank
Setbacks: ❑House ❑We11 OProp. line 00ther
OLocking cover OWarning label OPump/Floats
❑Alarm ❑Elec. wiring
Soil Absorption System
Setbacks: ❑House OWell OProp. line ❑Other
❑Ponding:_ ❑Discharge: _
General comments:
INSPECTORS SKETCH OF SYSTEM LOCATION
N
Inspector
Title
F1[ ED
IWAY 8 1984 co
4 of o~ aA
CERTIFIED SURVEY MAP
Located in the SE 1 /4 of the SE 1 /4 and in the SW 1 /4 of the SE 1 /4
of Section 12, T29N, R19W, Town of Hudson, St. Croix County,
Wisconsin
Surveyed for: B. & H. Excavating APPROVED
836 St. Croix St. No.
Hudson, Wi.
MAY o 81984
N
00, C2OiX COUNTY
~Q~yPdlMBNSIVB PARK~611TT ElWl1(~
a a, t1°n ~y Ns r ANO 20NING CO
Z m r•ti+ ti 3 r•• a BOO w
q z v • UNPLATTED LANDS
y OM A 0 00,
y -n D ~ a r..
v y0 I~ m 145,961 90. FT. ~ o
Z in m I r- 3.351 ACRES 300 . k1O
o\m 'i
.04-0m :0 Io 40 oa tig
-n z
oym Ir• X20 •°pry
mmv 1 IZ ~2*~,' bry 105,884 SQ. FT.
A l I N 880 32 39 IN a 2.431 ACRES
o
z X rom =,J' 343301 • 2 o I~
C 0
S880321, " 6 o (D
y 320.66 2 W 0~ a6~ ' O p~ pa CIL
m
0 1590 1T4R" b` v
-N8832' 11W ~ o AR'b` b~90° m Ir
~J 367.68' JJo (D
Qt?, 116d 437 SO. FT. z
o p)~9F A 2.73 ACRES Ivy
I
a
4- O
(J) 0
~$o
h^ J~~. FENCE 0e)
00,
661 roadway easeme " O 9° 5T 16_ E OHO
%4 V.\ • 301.06' "Q-
J-U, Certified Survey MaLp^
C2 Ift 4 15s°25'5 , Vol. 1, Page 174
507,028 SQ. FT. 11.640ACRES w'I
INCLUDING PRIVATE ROADWAY
to EASEMENT o w 6' WAY LINE
b'~e0 NORTHERLY RIGHTT=OF-
POINT OF BEGINNING 1071.32'
R
S 89°58'43"E
S 1/4 CORNER SECTION 12 / J
-.OCATION FROM TIES-CORNER S.E.CORNER
~r SECTION 12
rALLS IN LAKE / rs ! T29N,R19W.
`
NOTE+
THIS MAP IS INTENDED TO REVISE AND REPLACE
THAT CERTIFIED SURVEY MAP RECORDED IN
1 VOLUME 5, PAGE 1388.
N
SCALE -FEET i"=200'
200 100 0 200 400
LEGEND
• 1IR IRON PIPE FOUND
SECTION CORNER MONUMENT,' BERNTSEN CAP NO}IE: THIS MONUMENT NOT
p 1"X 24°ROUND IRON PIPE WEIGHING 1.68 LBS. / SET DUE TO ITS-FALLING
LINEAL FOOT SET ZK
(RI SLANT DATA INDICATES PREVIOUSLY RECORDED i 9Jo
INFORMATION Ooo
4
3/ STEE
~"y~ EXISTING BUILDING ~69c~0 9`~Py E V
~ o
A. 5 Page 1417 / $
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3053 - 329291
Bk. 12G/57
Harry S. Johnson and Sons Co.
A DIVISION OF HARRY S. JOHNSON COMPANIES, INC.
421 FOURTH STREET, RED WING. MINNESOTA 66066 1 PHONE: (6121388-7550
SURVEY FOR NR. LESLIE , FLAHERTY
Surveyor's Certificate
ST. CROIX MONUMENT AT
SE. CORNER SEC. I2,TWP296R3E.19~ - '
O
* O
co
NORTH 64.0
SCALE 1 INCH = 100 FEET
O Denotes 1" x 2411 Iron Pipe weighing not
less than•1.13 lbs. per lineal foot, unless
If 33 33 otherwise stated 01 •
i000 I • ` Bearings Are Assumed
" PROPERTY DESCRIPTION
W N
z (Recorded in Book 508, Page 492, St. Croix
. 1 ? N Co. Registers Office)
W Q U I
W Beginning at a point which is 528 feet west
from the Southeast corner of the Southeast
W Quarter of Southeast Quarter of Section 12,
In Township 29 North, Range 19 West, thence
W North 264 feet, thence West 8.25 feet, thence
i South 264 feet# thence East 825 feet to point
z of Beginning, ,
329281
0 P4
1
FILED
CV 00 SEEP 181975
co
v O CONNE« I"
N AvWsr of D..y
S Croix~ h. 4
N
W
3 r W N I hereby certify that this survey was pre-
j o pared by me or under my direct supervision
i v and that I am a duly Registered Land Surveyor
under the laws of the State of Wisconsin,
4J and that I have fully complied with the •
( provisions of Section 236.34 of the-Wis-
consin Statues.
33 33
i
• vi f
g,o_-
i~. in, I is is qtstrumenl 1 Ha S. Johnson
S
y
WEST LINE. SE 1/4 OF SE 1/4 ~O, to Land Surveyor
OF SEC. 12, TWR29,RGE.19i' Wisc. -Reg. No. B-846
GD Dated: May 23, 1975
5. NSA _ ~ w~•,.
SOUTH 264.00
HARRY S.
..JOHNSON
XISL!!': S-846:
E
MPLS.,
MINN.
S I/4 CORNER SECI2,TWP29,RGE19
CORNER FAILS IN POND, USED SL POIX
CO. REFERENCE MONUMENTS.
'_y M..._ a
WARkAN ~ 1rrr~ii~➢► VORM NO VC .1 Page 174
.
AS BUILT SANITARY SYSTEM REPORT
OWNER ~t!✓ `T'OWNSHIP_J41#jo~?Z SEC. / TZON-R/f W
CONSIN. y
ADDRESS ST. CROIX COUN'T'Y, WIS
o2,0 -/0
!'~'1rru n C~e~~^^
AVS 100
SUBDIVISION .7 l - CTZE -7 3Cvt/l~d
!a
PLAN VIEW N f- l-
m~ t'S no✓4-~
o ' Lo~"1
Distances and di►ncnsior to meet requirements of- H63 IL
1
GS✓h
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
2
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4
got,
IV t
1
I di at N r h rr w
i
BENCHMARK: (Permanent reference Point) Describe: 7°~a 's
Elevation of vortical reference point: lo-z> Slope at site: _
SEPTIC TANK: Manufacturer: Liquid Capacity: t 0
Number of rings on cover Tank manhole cover elevation:
Tank Inlet Elevation /1~7~ ,fj✓ 'l'ank Outlet Elevationz _
PUMP CHAMBER
Manufacturer: _ _ _ _ Number of gallons
Number of gal pump set for a cycle gallons; Total capacity of
distribution lines gallon: size of pump head;
gallon per minute horsepower ;brand name of pump
and model number
Type of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device
SEEPAGE PIT SIZE; Number of pits feet diameter
feet liquid depth seepage pit inlet pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines 3 width !01' length Fb the depth
SEEPAGE TRENCH: widtt,, length
PERCOLATION L.A'TE AREA REQUIRED (~s$ AREA AS BUILT
INSPECTOR
DATED" PLUMBER O JOB_ ZZ -
_7~~(/
LICENSE NUMBER
1
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s
L 17-rd
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bee
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DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS
P.O' BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION
MADISON, WI 53707 BUREAU OF PLUMBING
E~ CONVENTIONAL ❑ALTERNATIVE tate an D. Number,
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If assigned)
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPEC I D E:
Ro en He tchteA RR# / AtexandeA Rd, Hudson, W1 BENCH MARK (Permanent reference point) DES IBE IF DIFF ENT F N-
REF. PT. ELEV.: CST REF. PT. ELEV.:
SE SE, Section 12, Lot #1 28N R19W. Town of Hudson ~
Name of Plumber: MP/MPRSW No. -
County: Sanitary Permit Number:
d-VII
Roger Timm
-4144 1 St. Croix 49414
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER ory / O~ ? PROVIDED: PROVIDED:
BEDDING: VENT DIA.: VENT MATL.. HIGH WATER ✓ . YES ❑ NO S ❑ NO
ALARM: NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
7 FEET FROM - l- LINE LAIR INLE/T
YES ❑NO ❑YES ❑NO NEAREST .10 v ~ I lO
DOSING CHAMBER:
MANUFACTURER : :18:E:D01:11NI:G::~LIOUIDCAPACITY PUMP MODELPUMP/SIPHON MANUFACTURERWARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L: NUMBER OF PROPERTY WELL BUILDING:I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall Cease unti=FORCE the so
il is dry enough to continue.) CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH NO.OF DISTR. PIPE SPACING COVER INSIDE DIA *PITS LIQUID
TRENCHES: / !J MATERIAL'
DIMENSIONS Z' Gf/ PIT DEPTH:
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NOlreb
BELOW PIPES: ABOVE COV
. STR. NUMBER O OF PROPERTY WELL: BUILDING: VENT TO FRESH
FEET LINE: G AIR WIET:
❑YES OVER ELEV. ❑INLET. ELEV END: PIP
(f 4~ X l✓ NEAREST
-s
MOUND SYSTEM: S12 UP 0?
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED SEEDED MULCHED.
CENTER: EDGES:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.: DIA.. ELEV.: PIPES: DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
❑YES ❑NO ❑YES ❑NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIG AT E: TITLE:
DILHR SBD6710 (R. 01/82).
wlsconsln APPLICATION FOR SANITARY PERMIT
,~IDILHR COUNTY
(PLB 67)
OEPC7RTT
EnT OF UNIFORM SANITARY PERMIT #
InOUSTRV. LRBOR 6 HUMRn RELRTIOr1S
Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8%x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
ClL C.I4 L- ~ T , DEM.- 121p ,
PROPERTY LOCATION q 2 ems..
S L- 4 !-:El /4, S I Z. , 2$ NI , R / 9 W Tow H- Q D soA i / C~ OF:
L NU BER BLOCK NUMB R SUBDIVISIO NAME NEAREST ROAD, InITIL'Alftft
STATE PLAN I.D. NUMBER
5 uR.v, M~"r►7 L
TYPE OF BUILDING OR USE SERVED
X 1 or 2 Family Number of Bedrooms: ❑ Public (Specify):
THIS PERMIT IS FOR A:
KNew System ❑ Tank Replacement ❑ Repair
El Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued -
El An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity ~GCG
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: E 2 Ci E-rir
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
Co + Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Na7of Plumber (PrintSigna
~Lw e: MP/MP, RS No.: Phone Number:
Plumb s Ad ress: Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
❑ Owner Given Initial
Approved Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
L
r
4
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
FORM NO. 983-A
} . • NCB WwCaro•+~ -
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CERTIFIED. SURVEY MAP
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301.06,
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t, w ~ h.; « ~o d` ~z 1- o RECORbEE~ IN VOLUME 1,
Y
11`0 4- to PAGE 174k
03
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Y ;r SECTION j<IZy 8c3t 32',x. "co :~5 e ? 2.Q880 "AC..
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LOCATION FROM TIES - (R1 EAST
SE. :CORNER
NER .;FALLS LI~THELAKE aW'4*r~~ ,
C a f P ~ a s SECTION;'42
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;;o~'-C, i T 2 9 NR 18-yW.
F1 r I i l 'I.+'N"p'?" bl*'~ .a f.. -Y ; t - 14rC~.S
' UNPLATTECi ANDS ~ ''TaNZ~~~ s
4 & F J~
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Fj } rs :Y 6iw r; F
1N~tPEEi k,h h`&,wkl a&y I -
s fls~;'~ t SCALE
r ;tOC) 0 400 7
l` 4' K N ~ ,a"~' t" z~^.tt} ✓ *,c 'f4
I.•~S +1 -ic• 4,t ti 6 6 f •n
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NUTEs THIS NIONUAi E:N1" =
1, IRON PIPE ` FOUND~°+ y j 4 Cu m
'
a 4 NOT SET DUE TO
sa .
<x i. a, r t', t y s7 <a? S FALLING IN
SECTIOtd CORNER MONUMENT, BERNTSFN CAA
~s,~~'-~~;~mr..• . , ~ ~ T}iF ROADWAY .
~~-3/4 X'-i4 IRON BQ 1NEIGHING #'502 L83./ r'9+
~,ILINEAL FOOT" SEl''~1
'S-' AIVT DATA' IND=ES'PREVIOUSLY RECORDED 46-f
INFORMATION
pir
9 q.
i'Ari Fivil^iV F Or RE~--O R'a 'r+.~7 ~ •s UL 8{.~.f~I~~: GS AND Sr~f t fY & ~iUILUIiVi~S
C` T
f?, I
37969
707
L MA AND PERCOLATION TESTS (H35) P.O. BOX
=iU?;IAN RELATIOrVSMADISON, bVl 537Q7
(1-163.09(1) & Chapter 145.045)
I ~~CA"fION: SECTION: TONJNSHIPJ OT NO. Ell-K- P:O. UD g SUBDIVISION NAME:
_ I_Z.. ~ ~~raj ~ I ~)>'i`~ ~
:-OUNTY: ovj'~j H S/ MAILING ADDRESS:
DATES OBSERVATIONS MADE
NO.EiECKiNtS: COMMER 1 ALESCRIPTION: FR FIC D ``C` IIHrIONS: A N STS:
f5fResidenca
New ❑Replace Z~r P34 Z
?A'fING. S- Site suitable for system U- Site unsuitable for system ~f U
.:U `J ENTI~NALi ~!OUN7: W•GROUND~PRESiUt3E: SYSTEM•IN•FILL HOLDING T NK: REC011MENDEC SYSiEM:(optiu»aq
!r Percolation Tests are NOT requ=radqESIGN RATE: If an
A ' Y portion of the tested area is in the aa ff
order s-FIS3.U9(S)(b), indicat3: J V . Floodplain, indicate Floodplain elevation: yu .
r.
&CzC:)r- PROFILE DESCRIPTIONS -S<=~ ' I...`3 • V > t
-TOTAL 261TH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE. AND DEPTH
":i;r^''dEA OEPTHt2ti JELEVATION OBSERVEC ES HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.)
3 f r O. (07r 3t 6-~ '~.140 r~nl S; L W/ M.P.O. P_ ~ C7 rAOYT,,' p,%-4•
- /~•~C~ a9-3& /iiJ 4-0 -Y S; w1MP0 R401,AM-►•)' 1.34' ,Brr L.; S./fe'3ti/ MED 465 w/6
8 z //,OQ gZ., lU (~O~C r O• S8r gL Lj 3•°J2 BN S L, w ErR.~ G•St~' ar4 m
ff"M
> /1' 06
S w C°r R.•
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- 3 G7 ylr 37 1"JON4 &7
/O.OO T /O•vU' 7' 8L L j Z,83l3N Mixn L. S W/ GR.) 7" N
')0.30 NON{ 0, Co
w 4,iGlIg -j ,75 5n/ M 5 w rt
' iv.vti 8$ Z' o i✓~ > /d, a o' C. -7 ' C3 L c.; Z.GG' 8N b I_ w GIQ; 6- (11-7' 8AJ 6 S
l4 r T~ *rr IZowS of 1~. rJ LS 4T t 9rr INTERV4 S
DEdlMatt_ PERCOLATION TESTS oT' L 9UMP9EP- Cx>2. C1N V~
T f3o1zJNes, ~
7cST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
`.:RER 40mi*+E$- AFTERSWFLLING INTERVAL-MIN. PERi002 PERIOO PER INCH
r . 7.6 0 _ t~1 c~ J~.J 3 17/i
? ON 3 5/8 9//
to 9//(0
jig
mop /
/
'e
I,
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i 0T PLAN: Show locations of percofa n tests. soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hpri-
mtal and vertical elevation reference ruts and show their location on the plot plan. Show the surface elevation at all borings ar►(1 the direction and percent
kind slope.
/v AL-TER.NA-M SITE ?_EGLiJ%%C",S 'MP
'I STEM,ELEVATIONh 64. s~ Q soft. ZZMoVAt- PP tcR_ TU 1NSTALL4-M
0 Due -1-0 07-r I- I N C-_1
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•nrfe srgnad, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
trattve Cod*. and that the data recorded and the location of the. tests are correct to the bast of my knowledge and belief,
17
p
rint TT'VVFRE COMPLETED ON:
7,5'jge
S.. CERTIFlCATIO,%f;JUNIf9i_aR: PHONE NIJM. IER►uprional):
C IGYNATURF.
TION Orrgimil anr• n.+v- npy rr► l rx a► Ruth wity, Proper ty Own r tnrl, Snit Testes.
fij r ~v}~lr~ r `1 r ~.t r~tx
JOB
ROHL & TIMM EXCAVATING
310 Arch Street SHEET NO. OF Z-
1 , HUDSON, WIS. 54016 CALCULATED BY DATE Z~ ~T
(715) 386-8664
CHECKED BY -BATE ~ZZ~
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JOB /l L/J L / C/'CX /Q (r
ROHL & TIMM EXCAVATING -z
SHEET NO. Z.
310 Arch Street °F
HUDSON, WIS. 54016 CALCULATED BY /
(715) 386-8664
CHECKED BY
SCALE
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- _ ` Gorier
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PRODUCT2011 Inc, Orton, Mm 01471.