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HomeMy WebLinkAbout020-1117-80-000 a o o ao 03 0~ I 0 I d ao y o H a 0 :2 C w W H V C C N N N o d 3a~i~r> E I L o o C C N .t. Y) O y p 0 ~pp L ad co U or-M~o I '3 I ~Ya-08 i)m0 it CD 4) CD oyr ~ ~w I c I cWn a) °mU E W 7 w Wo C v O H 7 'C O O f0 C z Otr: U C Z a O N O LL O y 0 N N 0 C U. G n O 0 M'2 M j o I 3 c 'a € 'o D> v N c 9 N E Q a L O 'O Q O E Q t~ ac) aM v E Z o o i 0 0 z v v rn N W € m a co F z o O z:t c c L v o w o c o I m H c ~ N CO N :3 N u a o (D C (DI c 1: z °mz z °mz 0 N O co cO z v 0 0 v m c Q aCi E C A N Its 4) 0 :2 d C 41 Y t O Va! Q O N CL LO d N CO O v p o 0 0 a co co O G CL E M N w N = fA rN fn G = rN fn fn p V~ m 3 n N m 3 n m z o 0 000 0 000 •►v 12n.aa ~aaa u, n o o I a+ 2 O O 2 fh M y d1 J V m O) O 'm 0 W m Q1 O) N 7 CD z AV ~aa 2 o I 'Coo a s = - CO nO C _ O E N co :3 a) m co m) 0 a a I C cn N C co N C } Q} .2 Q(n m v d U) ca Y! N od M N 00 w0 C W C O N C p C E f0 I~ F N a) CD O CC rn 0 r t N CO o = a (m N r \ F- f0 rA co O C N E C N _ v O rn Y c m Y _ 0 0 0 Crti C N N 0 c6 Cl) y d Z H C N O N *4 c5 :I N Lo It ° m o w E E m 0 a~ o m o a~ rn o • o Z N co z 2 z N o z F- crn ~ ~ Y I I ~ 4) €a I €a I V EL IL u IL L: m *0 c t~ t A 0ILM 0w0 0U)0 ~ Parcel 020-1117-80-000 08/11/2006 12:10 PM PAGE 1 OF 1 Alt. Parcel 19.29.19.495 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - GARZA, JESSE J & KATE M JESSE J & KATE M GARZA 885 TROUT BROOK RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 885 TROUT BROOK RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.540 Plat: 2626-WILLOW RIDGE ADDITION SEC 19 T29N R19W WILLOW RIDGE ADDITION Block/Condo Bldg: LOT 20 LOT 20 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 19-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 11/15/2001 662117 1762/330 WD 03/04/1999 598846 1408/275 WD 07/23/1997 1023/34 WD 07/23/1997 925/310 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.540 66,000 192,900 258,900 NO Totals for 2006: General Property 1.540 66,000 192,900 258,900 Woodland 0.000 0 0 Totals for 2005: General Property 1.540 66,000 192,900 258,900 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 AS BUILT SANITARY SYSTEM REPORT V i A/ , TOWNSHIP ,6.5p SEC._ TqN, R W .O, ADDP,.SS 001- Uonkl , ST. CROIX COUNTY, WISCONSIN. lV a t .73DIVISION LOT 7,0 LOT SIZE W J YS -7 PLAN VIEW -Distances b dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r A I FF I I diCa e No 'thI Afro I S CAL . - i 'TIC TANK(S)MFGR.~k),K Aji_) LO A.) CONCRETE STS EFL,, NO. of rings on cover Z Depth DRY WELL t1,NCHES NO. of width length area no. of lines width length= area 16 depth to top of pipe Z SC GREEGATE-~~ He j 11/211 Cork f9r, RATE 7,,;AREA REQUIRED_ f _ AREA AS BUILT "Q 5 ,sciaimer: The inspection of this system by St. Croix County does not imply complete a liance.w.1h State Administrative Codes. There are other areas that it is not possible o inspect at this point of construction. St. Croix County assumes no liability for I4Stem operation. However, if failure is noted the County will make every effort to jetermine cause of failure. iIGASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. 'INSPECTOR DATED y~ ~ q 7 ~ PLU11BER ON JOB LICENSE NUMBER / I~ w t Uri ~z y REPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM San•itany Penm.it - • State Sept.ie 22_ Townahi ' S4. Cnoix County NAME p Locatiom Section SEPTIC TANK Size gattons. Numben o6 Compantmentz I Vidtance Fnom: Wett St. 12% on gneaten stope St Bu•itd.ing St. Wettands H•ighwaten St. DISPOSAL SYSTEM • ViAtanee Fnom: Wett St. 12% on gneaten. atope St. Bu.itd.ing St. Wettand.6 Ft. H.ighwaten St. FIELD DIMENSIONS: Width o j tnench St. Depth o6 no ck b etow t.ite .in. Length o6 each tine St. Depth o6 xock oven t.ite=n. Numben. oS tines Depth oS t.ite betow gxade .in. Total tength oS tines St. Stope o6 tnench in pen 100 St. D•catance between t.inez_ t. Depth to bednock St- Totat abs onbt.ion anew 6t2 Depth to gnoundwaten St. _ --Requined anew St 2 Type o6 Coven: Pa en on Sthaw PIT DIMENSIONS: Numben os pits Gnavet anound pits yes no Outa.ide d.iameten St. Depth below .inlet St. 2 Totat abzonbt.ion anew St A 2 Anea nequiked St INSPECTED By TITLE APPROVED -,DATE 197. REJECTED ,DATE 197-. 01 s " . . 9 EH,115 Rev. 9/76 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 q~~`~ LOCATION JSE '/4, SE'/4, Section & T' N,R- E (or) W, Township or Municipality _ ' YI Lot No. , Block No. -County- Subdivision ~E~ Name Owner's/Buyers Name: Q Mailing Address: R U dv TYPE OF OCCUPANCY: Residence X No. of Bedrooms 3 Y COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE OIL BORINGS OCT; IG /J7 PERCOLATIOfNN TESTS nOCZ 17 / F7,9 SOIL MAP SHEET 5CS' 1J NAME OF SOIL MAP UNIT / M 6 ~`~~~'ufj£Ly `09~+/ ~ftiD PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- fAd P FAyNT !oN ® rP 4N /14oTs " P E S,-0w,0 - -0- / iT 7,5~ yal; P-z 3 p zo P- 3G" ,(!/3,J. S L~''Qv. /S, 2" 1~rE0. S L - O - Z(J y /y 2 •S P-3 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- 90 ONF 7 U l7',~N. /s 1 "QN. S/ L7" *--P. Gf- AA/ B-0 s B- Z D DUE > ~Q l'N S ~0"/3~✓ *A/. S Zd "•CS3 B- /P• B- 8o NaAIr 7 6?0 6 „ D,e-X v . Z s 2e "A5'v . A. /o " B,N, AMEv s B- 136,,13AI, S PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy 13-'P Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. PIRNS /v©i Td ScA/E~iSlA,vcEs . o = Peer- E OF, 0-0- 13 AOf 3 f/ --i ~ p /Q a ow TOM& ~ io tv~4~.E1Ea _ r " - _ ~3 q . of jvo MEAS~.PbtBIE y~+. _ a fvo yy c tN 541 /M,MEaihTr si# ° 07,077 TK . ( l4/Er4 •)~l. I~ ri SIS • a, y w4/ e I W CC i ~ti ~Ew I, the undersigend, 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 Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) ' ' bhe-AT R~ Certification No. j -d2~6 Address RT= 3 O%t 0 ;l VPS0wJ 6,215. Name of installer if known N DSON 4yJ 1 Authority CST Signature Copy A -Loco s . State and County State Permit # / 75 02~ VPL B 6 7 1 Permit Application County Permit for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Addres NE W I N ZE ZO-11 -r4 tart' 6>1<00 < Rp Utso", W/;, 5YO1 h B. LOCATION: r'/4 !;r- Section , T N, R E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village T_e0o-r [7r2 4oo ,r, db Township A ue-se ,Ov C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance Single family _X_ Duplex No. of Bedrooms ` -No. of Persons 3 D. SEPTIC TANK CAPACITY t 000 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement X Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width 5/0 Depth-Ti le depth (top), No. of Trenc Seepage Bed: -Length Width~DepthTile depth (top-No. of Lines, Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Le v&_ L U 47o Distance from critical slope WATER SJPPLY: Private R Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Cfied Soil Tester, NAME ;'OAI( ' K "r j / C.S.T. # :1~75- 0 Z O z and other information obtained from N /V own r/builder). Plumber's Signature MP/MPRSW# r6 l Phone #~b - Plumber's Address L i i a N rv + t a C PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. i p wt . 141 Pct ~T- ~ObO GAL. t . m ~ ~ m o Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application 9 Fees Paid: State County- O Date - Permit Issued/$e0=ti:d (date) - 7 /aiIssuing Agent N Inspection Yes _4No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 e r !v r -e7s- W A~ STC - 104 AS BUILT SANITARY SYSTEM REPORT p OWNER \-eeTJ f, oiuj OWr3412 IVP" J~ S~ haaAnfi p ~li"~Alk Syr~err ~pS ADDRESS'6v~~ SUBDIVISION / CSM# LOT # o v SECTION4T, 9 N-R W, Town of ST. CROIX COUNTY, WISCONftN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t'`IU Y`r~l . 47 7' I 10 Re U INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. y BENCHMARK: 1O,h 0 y~t'A O~ ~-y SfrJ~ ir, ~u SIPn~' ALTERNATE BM: SEPTIC TANK / `PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer: ~1 `R e 1 S Liquid Capacity: Setback from: Well U\RR S~ House Other 7 Pump: Manufacturer Model# - Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: ~ovtt Setback fro well: S' House 3 Other FJ ~e N V 9 0 uT ',A sy j, - 9 0 u~ o ! Ii is, q ELEVATIONS © Cov' K Building Sewer ST Inlet; ST outlet ~0.a9 PC inlet - PC bottom Pump Off NQP~N ~ND Header/Manifold 'll 9305 Bottom of system 9a d~ Existing Grade SDrf-Q Final grade DATE OF INSTALLATION: PLUMBER ON JOB: ~J ! M DU'~ i p 's K LICENSE NUMBER: U 7 INSPECTOR: 3/93:jt "V+7i~L'EYrt~~iartrtr2lt t~~st>7g9.29.19.4 ~W14ff1§Y§9'IBI) County: Labor and Human Relations INSPECTION REPORT Safety apd Buildings Division (ATTACH TO PERMIT) sanitar mit • GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village a Town of: State PI CST BM E ev.: Insp. BM Elev.: BM scnption: Parcel Tax No.: • • TANK INFORMATION ELEVATION DATA A9300176 9 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septi caw, 1 061,Y Benchmark - 1' Dosing Aeration Bldg. Sewer YtO-1~ or Holding St/y~E Inlet 9T./.3~ TANK SETBACK INFORMATION St/ Outlet Vent TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic '_'46 NA Dt Bottom Dosing NA Header 4en. //$Q 93• Aeration NA Dist. Pipe Holding Bot. System Z ,,7- PUMP/ SIPHON INFORMATION Final Grade Man Demand 6,f 27,81_ Model Number GPM TDH Lift Friction V TDH Ft Length Dia. H ~ Forcemain . To well SOIL ABSORPTION SYSTEM BED/TRENCH width l e r Leng9~~,,h i No. Of T enches PIT No.Of Pits Inside Dia. Liquid Depth DIMENSION 360 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING nufacturer: SETBACK INFORMATION Type Of CHAMBER Moe Num System: W 50 OR UNIT DISTRIBUTION SYSTEM Header / lWaO44W4 .i Distribution Pipe(s) Or x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length 33 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over sl p Depth Over y xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ TFe+TcrCenter rJ Bed/TTermhEdges gd 57 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Q W C41 LOCA ION . HUDSON 1 .2 9.19 495 TROUT B aOQK ROAD ) _ 5-x Plan revision required? ❑ Yes ItNo Use other side for additional information. SBD-6710 (R 05/91) Dale Inspector's Signatur Cert. No. 11g3 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Ea .7 a SANITARY PERMIT APPLICATION 13ILH In accord with ILHR 83.05, Wis. Adm. Code COUNTY =Noma .5- C ro ' . STATES ITAR~ RMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches. in size. ❑ c6ec I rev sion to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Z Z Z.w S* '/a SF '/a, S /P T A9, N, R 19 E (or PROPERTY OWNER'S MAILING A RESS LOT # BLOCK # .10 1 1 CITY,.STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR SM NUMBER L I.SVOI 1 3916 -.3S' II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLLL.AGE : NEAREST ROAD t~ U OF: -7 + k J ❑ Public l!] 1 or 2 Fam. Dwelling,# of bedrooms AR L AX NUMBER( S) III. BUILDING USE: (If building type is public, check all that apply) Q p{^ / D 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 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 in line A. Check line B if applicable) A) 1. ❑ New 2.-N Replacement 3. ❑ Replacement of 4.0 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 420 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 RE UIRED (sq. ft.) PROPOSED ~sq. ft.) (Gals/ ay/sq. ft.) (Min ch) O JUNE Feet VII. TANK CAPACITY Site in gallons Total #of Manufacturer's Name Pref Con- Steel Fiber- Plastic Exper. INFORMATION N w isti Gallons Tanks Con r to tructed glass App' T ks Ta Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber 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 Sig re: (No Stamps) rPRSW No.: Business Phone Number: ,-(SrT r11 ~60~►~,,~ Q -e 3 U IS 3 ~'g 4a Plum rs %ess (Street City, S te, i Code)- 1W V5 -S-V 0) IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Si pal ❑ Approved ❑ Owner Given Initial Surcharge Fee) 7.2017 Adve a Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber 'l_ 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 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/Renewat Form (SBD 6399) to be submitted to the county prior to installation. 5. bnsite 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: I.- 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. Ill. 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 I • 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 (Ra1/88) r 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,(pec 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 f Location of property Lt L1~4 6E 1/4, Section N-R/5? W Township Mailing address Address of site Subdivision name Lot no. ~ . j Other homes on property? yes ✓ No Previous owner of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes o volume 9a,5 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 & 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 (we) certify that all statements on this form are true to the best of my (our) knowledge that I we am the property described in this information form, the virtue so)f oaf warranty deed recorded in the office of the County Register of Deeds as Document No. ~%l SL%SL , and own the proposed site for the sewage disposal ~t system) orr I e(wee) obtained an easement, to run the above described property, the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No. Sig Lure of applic Co-,applicant Dat of S' n to e D-a-t-e ---o•-f --S-1:-9 n at ure • DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-19821 THIS SPACE RESERVED FOR RECORDING DATA j QUIT CLAIM DEED r$! - Vnl- -.925PAGE .10 UC7ISTER/S OFFICE ~i ST. CROIX CO., WI ~!.~I~, A: z1JzzA Recd for Record Grantor, ct DECD 1991 11:00 A. M quit-claims to .K.ATT.iL1JEN.... . ZE7.ZA? Grantee, A- Register of Deed . 'I the Collowinq described real estate in -..-._S r , F•Q- County, j State o f Wisconsin: i RETURN To K a t h l e e n Z e z z a 885 Trout Brook Road I Hudson, WI 54016 Tax Parcel No- Lot 20, Willow Ridge Addition, Township of Hudson, Wisconsin. This deed is given pursuant to a Marital Settlement Agreement signed on September. 18, 1991, and filed in the Circuit Court for St. Croix County, Wisconsin, in Case No. 91 FA 1, In Re the Marriage of Kathleen P. Zezza and Nevin A. Zezza. By said :a ital Settlement Agreement and this Quit Claim Deed, Nevin A. Zezza relinquishes all right, title and interest in the above described property. ME ii ii I This ?-s................. homestead property. (is) (is not) Dated this day of AJ••✓'j(!G--/41. r / 19.9-..... (SEAL) - •.-k~~/lJ..~. ................(SEAL) . Nevin A. ezza i~ - (SEAL) .....................(SEAL) AUTHENTICATION ACKNOWLEDGMENT l r Sinatyre>s) /-a STATE OF WISCONSIN ss. C-...................................... County. authenticated this day of...-._-..!s..l. Z~ 19._.-_• Personally came before me this ----------------daY of . 9 the above name N g :y. i n• -A.:..- Z•e z z.a.-..--•-•------------------•-•------- y 1 TITLE: MEMBER STATE BAR. OF WTS CONSIN If not, Y § 706.oG, Wis. Stats.) - authorized b to me known to be the person who executed the e foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY e~ orney Phillip z'-------------•-..-..-- 11 u d s o n W I -5-4.0.1.6 Notary Public --------------Wis (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state oexpiration are not necessary.) date I! QUIT CLAIM DEED STATE TZAR OF WISCONSIN St. Croix couriCy OWNER/BUYER LOCATION: aj 1/4,~1/4, SEC. TN-R ST. CROIX COUNTY r A TOWN OF: f SUBDIVISION LOT NO. 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 a 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 to teip with the cost of the.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 the St. Croix County Zon.,ng certification form, signed by the owner and by a master pl.ulabe::" journeyman plumber, restricted plumber or a licensed pumper ,..,eri.fyi.ng that (1) the on-site wastewater disposal 'syste;m' 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. Certification from will be sent approximately_ 30 days prior to three year expiration. I/WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with set forth, herein, as set by the Wisconsin DNR. form must be completed and returned to the St. "roix C r.o Zoning Officer within 30 days of the three year SIGNED: DATE: i St Crc X County Zoning Office 91: ,tk lh~d,son, 54016 Wigconsin Department of Industry, SOIL AND SITE EVALUATION REPORT P / of Labor and H-nan Relations - Dhfision~ & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Gi~tA Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 1- not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Z~L = a GOVT. LOT ,,C 114 ,C 1/4,S 9'T Z 9 N,R IiiKor6P PR ER OW R':S ILING DDR, SS LOT # BLIVQ SUBD. NAMfF CSM # h b Z Lc~ ~1l a- Oro Cl , STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OWN NEAREST R f% A [ ] New Construction UseV Residential / Number of bedrooms .3 [ ] Addition to existing building Pf Replacement [ ] Public or commercial describe Code derived daily flow q0 gpd Recommended design loading rate "bed, gpd/ft2 ° 8 trench, gpd/ft2 Absorption area required bed, ft2 trench, 112 Maximum design loading rate _.L~bed, gpd/ft2- F trench, gpd/ft2 Recommended infiltration surface elevation(s) 09' ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, U applicable It S = Suitable for system P%IVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE 7 SYSTEM IN FlLL HOLDING TANK U= Unsuitable for system S❑ U S❑ U S o u 0S C] U ❑ S U ❑ S U ESOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxlary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rich 154k Ground *L '0 *1 S~ w► g Depth to limiting factor Remarks: Boring # L /d z S /Yl ✓ G z 13 Ground Depth to limiting Remarks: CST Name: Please Print c Phone: 4 f3 Address: ~ So--~ L✓, syOIZ Signature: Date: CST Number: 11VIV rncrvn I Page Z- of PARCEL I.D. Boring # Horizon Depth Dominant Color Mottles Structure Texture Consistence Bounckjry Roots GP,~/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ~3 l 4~z Z' x. OIA" 7~~w Bed rerxh r S C. Z ~r Ground 3 ?j r' 5 Y Ls Nl C q,a~ft ~ s~ Depth to limiting L±7t . . Remarks: ik:j s f- r Ne Boring # Ground elev. ft Depth to limiting factor Remarks: Boring # } Ground elev. ft Depth to limiting factor Remarks: .Boring # Ground elev. ft. ' Depth to limiting factor Remarks: SBD-8330(R.05/92) / 3 b~ 3 E ~n T gz- v N~ lie 3,10 o/ 0 3y' ~ k (tfwd` R ~-/ohm y. 3 R '67 P J*1 SS SEC 1(*).I\-...-. P. B-L, L OTA H 1) NAME A eeU C A 0 n1__...1.v~~ E N- S E =~'~o VTE 4- P r j0r-~'~pU `7S f n~ 1t ' F2a~ SQp ; c 4- Sys err. IV i I I I ~ ~ - I ga 50' i i tJer~i ;dZ~ ~kt st1,G i I ~pl-: j It ?1 Prr r ` c~---3a' I G ~ r ` ~,x G Fyn p N RES11 All" INLETS, AND OBSERVA'PIOU PLP1; CROSS S!:.CTION - Appro`rc!d Vant Cap Minimum 12" Above Final_ Grade---`-- ~ , - til al, ,,q ; 4 Cast Ii- Above Pipes " Vent Pipe To Final Gracie Marsh Clay Or Synthetic Covering Min. 2" Aggr.cytil Over Pipe Distribution Tee Pipe . i Aggregate Perforated Pipe Ctr.7ow d8 13 ncath Pipe << -Coup .ing Terminating P ~a ~ w Bottom of System, a f -..mow 1 • t' ;d L p ; ct J J 't 1 I r ~ j 3 r1 _c S j z -L -71 ~ . ~ L•^ i .,,."'.may t. _ J a sy{ ~ _ ill :li ~ ~ ~os~ t4q f ~ 6`1 ,1 I l . r i e J 0 Z'. LO~_ , } f xi I y } ~ } of Gr, s~. i-I i ~ r4 4 } c T" f Ky _41 - f