HomeMy WebLinkAbout020-1265-90-000
a STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER v ~f'«'N f' n n
ADDRESS 495 Ca►. View
f 7 Q) , ✓u~a~ ~ fy.~
SUBDIVISION / CSM# m t/~ F LOTr
SECTION. Z 9- T Lf N-R/f _W, Town of ~/trdloy-
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
~Ij
i
w //O
s ~c~ i~'F~ ~ Y 4
i - Z >o
S E INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
f
O VIC
BENCHMARK' Iwo. O
ALTERNATE BM/- Of
+ r
,lr~ 144
way f
SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION
silk
Manufacturer:
Gt Liquid Capacity: ,Bpd
Setback from: Wel House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
:SOIL ABSORPTION SYSTEM
Width: / L Length Number of trenFhes
Distance & Direction to nearest prop. line: 7 S"D
Setback from: well House ZSO Other
ELEVATIONS
i
Building Sewer 9. p ST Inlet. P2. 7F ST outlet QZ. S"w
PC inlet PC bottom Pump Off
Header/Manifold Q~.3 Bottom of system .3
Existing Grade Final grade 99.y
DATE OF INSTALLATION: Z Cf 3
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR: Fiat
3/93:jt
LQahTsI@NF1artldV9MN.,,20.29.19.1-WV11#V)§EWAGE SYSTEM County:
La6orand Human Relations INSPECTION REPORT
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitar rmit
GENERAL INFORMATION
Permit Holder's Name: ❑ City Village ❑ Town of: State Pt
B BM Descriptio Parcel Tax No.:
0 44LL- 020 1265 9-0- 0100
TANK INFORMATION ELEVATION DATA A9300198
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic .0 Benchmark 0d , 3 /0 0
Dosing /0 L /00,
Aeration Bldg. Sewer
I
Holding St/ Ht Inlet g~ ga. 7Y
TANK SETBACK INFORMATION St/ Ht Outlet 9_ qa~
TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet
Air I
Septic > 0 - / urt~ 35' s 3S / NA Dt Bottom
Dosing NA Header / Man. Iff
Aeration NA Dist. Pipe y~3 98, (3
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade 3 c{~ 9`I- d
Manufacturer Demand N(9
Model Number GPM
TDH Lift Fri ion System TDH Ft
L mead
Forcemain Len h Dia. Dist. To Well
SOIL ABSOR TION SYSTEM
BED/TRENCH width Length G r No. Of Tr ches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Typeo r CHAMBER s Moe Number:
System: &,Q ~.3v fSCJ om OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over ~q Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center J Bed/ Trench Edges 3~O Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LQCATION:-OMSON 29.29.19.1299 (HWY 12)
F ~ tf .
Plan revision required? ❑ Yes eNo
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's signature Cert. No.
1
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
F
SANITARY PERMIT APPLICATION
M:0 LHR In accord with ILHR 83.05, Wis. Adm. Code CS- TM
STATE JS.'T.~s ~%Z#
-Attach -complete plans (to the county copy only) for the system, on paper not less than
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.
PROPERTY OWNER PROPERTY LOCATION
%a S :r-- TZ9,N,R E(or
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZI DE PHONE NUMBER CSM NUMBER
x4
CITY NEAREST ROAD
E3 01
11. TYPE OF BUILDING: (Check one
❑ State Owned ❑ VILLAGE t/!*_ Z.
B
❑ Public ~Z 1 or 2 Fam. Dwelling-# of bedrooms : PARCEI AX NU (5)
Ill. BUILDING USE: (If building type is public, check all that apply) D 1 2 ^ t,~
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 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. 2 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 21 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) ELEVATION
415-0 7 2e 7 zo 3 ,7 Feet W, a Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Se tic Tank or Holdin Tank 'Wo FA
I El 1:1
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sew a system shown on the attached plans.
Plu er's Name (Print): Plumber's Signature: o) MWMPRSW No.: Business Phone Number:
J`SY~
f t r ~ Z), 3.~-d A
umber's Address (Street, City, State, i Code):
IX. COUNTY/DE ARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater water Date Issued Issuing Agent Signature (No Sta ps)
❑ Approved ❑ Owner Given Initial Surcharge 5--
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) 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 (:f renewal any new
criteria in the Wisconsin Administrative Code will be ap::iicable.
3. All revisions to this Permit must be approved by the perr:~it issuing authority.
4 Changes in ow-,ership or plumber requires a Sanitary Pw. j cit Transfer/4enewal Fol In (aBD 6399) to be
,submitted to ihe county prior to installation.
5 Onsite sewage systems must be properiq maintained. 71-i tank(s) must be F(,~€tr c:f by a•licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concern inq_your-onsite sew+3ge system, contact your locaMode adrnmistrator`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.
11 Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
II;. 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
V1. Absorption system information. Provide a!! information requester'. in #1-7.
V11. Tank information Fill in the capacity of everN new and/or exisi:rr.; ;a+ik, ;ist the total gesilons, number of
tanks and °-,,anufacturetr's name. Indicato ;orefab or site construe'!-..` and tank material Complete for all
septic, purEtp/siphon and holding tanks this system. Check w:s rinmental approval, only if tanks -eceived
experlm, -;tai product approval from Dlt-h-9
Vill Responsibility statement. Installing pirirrsb='r is to fill in name .tse number with a7propriwe prefix (e.g.
MP, etc.;, address and phone number Plumbe- must sign ~f i r; ion form.
IX. County/Department Use Only.
X County/Department Use Only.
Com.r!et: ;.Mans and specifications not .+,,dller than 8'/z 11 cF 'r rua:7t be to the county. The
oians rriusi include the foliowing: pl(t = an, drawn to scam C?r r i rlete flmG ;floe of
holrfi^g tank(s), septic tank(s) or ot'r,,er t.eatment tanks; bui + n-, ells; water ^ a ,:ter service;
streams and lakes; pump or sigh.,. la4s distribution boxes ~c am4ion systems repln..orrent system
areas, ar„t the location of the bu ( r;g ser,rscl, 3) horizonta' er; elevatior, reference i nt
C) compete specifications for pumps and controls; dose ~;!evation differences; fricti-,n 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.
- - - - - - - - - - - - - - - -
GROUNDWATE14 SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fte, o! for run-):wr (if
regu!ated pr_,c:' ;es ,w',ich :;an o`fec;•t gii.-undw 'or
The- ntrim 'S ] hrC`ehE'se `cha gc-- Wised for rrl~n yr:: . U caN ;I")
h
Wafer irive`,;"rat ons ano establisrwnl,:; ! of standards
SBD-6398 (R.11/88)
A -tit
TNIS SPACE RESERVED Pon RECORDING DATA
f eat t - issa
Doc.UmF_NT r:o. T 11 BAR \Li
WARRANTY DE 'D
450149 Sf i Pn~~ REGISTER'S OFFICE
ST. CROIX CO., WI
Sam .E.._Mi.l.ler
This Deed, mad, benscen Q@C1CI Of °COfd
jUL31. 1989
Grantor, of 8:30 A.
V
F..ich.ard..Samue.l..Ch -ccyne_.. . -
and
. . . - Register of Deeds
- Grantee,
WitnFSSeth, That the said Grantor, for a valuable consideration. ..m.
RETURN TO
conveys to Grantee the following; kscribed real estate in
Counts, State of Wisconsin:
Tax Parcel No:
3
St. Croix
Addition in the Town of Hudson,
Part of Lot 32, Rossing's Country View First .
County, Wisconsin described as follows: Lot 6 of Certified htsve ownersle Lots 54,
1989 in Volume 6, Page 2129, Doc. No. 449969. SUBJECT to rig of of
i
anhaccess roadWest,
and 7 to use the at--a marked "Joint Drivewayoasshent29 as Nor, ange 19
ALSO, Part of the SW4 of NEi of Section 29, l p corner of
St. Croix County, Wisccnsin described as follows: Commencing at the Ni
aid Section 29; thence S00°17'12"E 62.00 feet along the West line of said
)said
N8 9015122"E 120,.63 feet along the Sly right-of-way of C.T.Ii."UU"; thence
Csclooine 0°12'38"E 2473.88 fe(.t to the point of beginning of this description; thence
ntinuing S00°12'38"E 110.0 fet; South
of said NE'; thence N35 gran
Lot 6 By executing and recording tnas7dhQ bytayree that thescost ofwmaintaining the "Joint
grantor a owner of Lots 5 a
Driveway Easement" and the cost of sbew att~'obutedlto eachllot~ Thitagreement~shallf
the three lots. Equal shares shall
be binding on future caners of each of the three lots.
NS~"~ '
ThisL... homestead property. „r
(is) (is not)
i
rtenances thereunto belonging;
Tog,th.~r w•!th all and singular the hereditaments and appu
Sam F.. ;?ill_r...
And. c d, indefeasible in fee simple and free and clear of encumbrances except
warranty that the title. is g
utility easements of record, if any, an6 the reserved easements as shown in the
description
and will warrant and dcfenJ tile bome.
July 19.9.
G day of
Dated this
(SEAL) ......(SEAL)
_ .(SEA
ACKNOWLEDGMENT
AUTHENTICATION
S'1':\T F: OF WI3COV3l~i
Of Sam G,.MIer_ s.
Signature(s)
...County. I
. July 1 89 Pers„naily came before me this sy o
authenticated this f._.L,} of 19._-.... the above named
hn .
John Heywood - -
TITLE: NI ENIRFIt ST.\ rb: BA it (}F `,\'I:I 1
_ wl.n ,•xecllted the
I If not,
nuthnrizcd by 70•.,06, wi+. St:,".) t.. nlr hm,wn to Le the per-;on
in.Arnrnent sr.d ickoow•le lge tF.e =ame.
Heywood & Cari, b; John D. Heywood
\Vi
P.O. Box 229, 1lud::on, WI 54016 C l nt >
f~;i•tnntni'r., Ili nut, !aL• ,••<nlratinn
lnay I.t u11 ! 1. i:.,!l 1(1
is t
Y. it 11'I: \1: nl .t -sue ' I
ARFt A`.rY U:'i U :(1111, •1 1
. .___~,..,~.......oe..apDA4'Sa!!S~'+.-. '~'",.y" -.F. ~~a" ~-*'~.5:'z•; t i
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER RC k C1"wA S- i L V1
r
ADDRESS:
FIRE NO:
LOCATION: 1/4, 1/4, SEC. c'L T2 ~_N-R_L_2_Wp
TOWN OF: - ST.-CROIX COUNTY _
SUBDIVISION. Cr Uie%(/ 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
help- 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
zoning a certification form, signed by the owner and by a master
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. 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
the standards set forth, herein, as set by the Wisconsin DNR.
Certification form must be completed and returned to the St.
Croix County Zoning officer within 30 days of the three year
expiration date.
SIGNED:
I.
DATE : - ~i~'
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, _ DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969
N WI 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNS HIP/Mbi WtPA-ItT-Y: LOT NO.:BLK. NO.: SUBDIVISIOU NAME-
5c0 1/a
1/ /T.z N/R j E (a F _ ,roni.y 41 COUNTY: OWNER'S MAILING ADDRESS: fy/
USE pYo~ 63 S' DA S OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS:
Residence w ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMEND SYSTEM:(optional)
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5) (b), indicate Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
-906ntWS.
B pr 1 R( nr D -Po 4/49 _z Alms. ~x s- s s r d toe(
wlpr Act
oo, /0/•6 ed a- Z / 1- 2 Z o Vo -iao 'r" ec
B- 3 d4 > Po e -~7 r 2 -,?eggj s.
13- 7 0
32- e' erns.
6- v > rX d-ti z - i
A-7 PO PERCOLATION TESTS
nS - a c - 3r 7,9m -s e- 7- s
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P_ / 2 7 3
P-
P- Z Z 3 rr
P-
P- 3 2 7 3 • Jr-
P_
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
E .
' 7 l
? gy r
Lmt
i t I /.e H
-A tN
E -
. _
3
✓ hL 3
j
I, the undersigned, 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 the location of the tests are correct to the best of my knowledge and belief.
NAME (print): DAVE F=M PLUMBIN, TESTS WERE COMPLETED ON:
UCensed P~~Tester2& Plumber f 3
ADDRESS: orty el Tffs o8 CE I ICATION NUMBER: PHONE NUMBER (optional):
WISCONSIN 54023
740 -3656 CST SIGNATURE:
GL
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
INSTRUCTIONS FOR COMPLETIN FORM 115 - SRa - 6395
To be a complete and accurate soil test:, yaur report I", 'Include.
1- Complete legal description;
2. The use section rnust clearly indicate whether this is a residence or commercial project;
1 MAXIMUM e3r.11T ,r cai: bedroorrrs or comr7aercial trse piar~ned;
4. Is this a new _ ,--ement system;
b. Complete ti y ratting boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYST = r'=RE RULED OUT BASED ON SOIL CONDITIONS;
0. PLEASE uses t, abbreviations shown here for writing profile descriptions and completing the plot plant;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet may be used if desired;
8. Make snare your benchnsark and vertical elevation reference point are clearly shown, and are permanent;
9. Complete all ,p,-opriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion. i te,
10. If the n (such as flood #rs, elevation=) does not apply, place N.A. in the appropriate box;
11. Sig lace your ' clsaress a~ad your certification number;
12. Make s?ies and distrib v as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION,
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Sail Separates and Textures Other Symbols
st - Stov 3over 10") BR Bedrock
rob - C _ 3 - 10") SS Sandstone
gr r (under 3") LS LirnestOne
-s S' Id II£aW High Oroundvvzater
cs arse Sand Prlc Percolation Rate
M(€Cl S Medium Sand "e'
fs - F+nte Sand Bldg ~'rtg
Is - t 3my Sand Fhan
Loan) _ ~ . _'an
L -._.vn
su - Loann Black
t`
Xci lay Loam y 'low
scl Sr'aady Clay Loarn R
sic! Silty Clay Loan, rnot - €tles
sc Sandy Clay Vl>,r f
sic: - Silty Clay fff - fine, faint
kc - Clay °r; t.-)n, coarse
pt Peat Mrn I gray, med<urn
In - Muck of €fistinc;t:
p prominent.
11VV1 High water level,
Six general soil texture surface water
for IiC€aid w<:ste d' .pr> Bench Mark
/ertical Reference Point
TO THE OWNER:
This soil test report is the first step it) securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private
sewage system and a permit application must be submitted to the appropriate locaf authori€~ In order to
obtain a permit. The sanitary permit must be obtained and posted prior to the start of any coriSIr'bi ion.
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DAVE FOGERTY PLUMBING
Licensed Perk Tester & Plumber
03233 #3289
Fogerty Heights Road
R08ERTS, WISCONSIN 54023
Phone 749-3656
i
,~cc - • 1 . _ ~ 97..3
AND V -Trvy
I 3I 6 t a
• ~ err O
FILED
JUL 2 41989► 2
'COWELE
3
~ ~O6c co.~w~
449969 Q
CERTIFIED SURVEY MAP
Located in part of the SW4 of the NE4 and in part of the NW4 of the SE4 and being Lot 6
of the Plat of Rossing's Country View Addition and Lots 31 and 32 of the Plat of
Rossing's Country View First Addition, all in Section 29, T29N, R19W, Town of Hudson,
St. Croix County, Wisconsin.
Ni Corner of -o
Y H
Section 29 r
(See County Surveyor for corner ties) 20
W co N
N89 15'22"E 1207.63' o,
c' Southerly R/W of C.T.H. "UU" 9i 9 Fd 4 N
. X~ Y o
.r N C
A
W 4J
d
C~l LEGEND
N o N W
A
•d ~ N
Section Corner Found Y
• 2" Iron Pipe Found 407
o
C_ _J • 1" Iron Pipe Found HUDSOpa
H ~
Wits. W c rr ~
0 1" x 24" Iron Pipe Set, weighing J0' .,.•y' a, co C_ 4 o
m Cn y',
1.68 lbs. per linear foot. ®aqN~ SU` cl
Rossing's Country View First Addition cb" N
Lot 30
Outlot 1 I
3 _ N89°15'22"E 241.98'
OWNER
o
Sam Miller
c / P.O. Box 282
41
Hudson, Wisconsin
Lot 14 / LOT 5 54016
° 107,002 Sq. Ft. Z, o,
2.46 Acres N .N
Ln
s
A
y 19~ 2 ~ J+p✓,y .r~s `POD ~
3 5
0 CD
41
86,70
FgsF r 00"
ti S6~o3 MfNT 45..011 f d
LOT 7 135.64143.17'
z 500215 "E-
C1 pJi 131,854 Sq. Ft. c o~
3.03 Acres _ South Line of the NE}
0
- ° N89°27'04"E
co 132.01' 4-
° r
o , - - 490.67' - 30.65' LOT 6 _
I 1 M ~ ~I
66' S8901512211W 460.02' 0 123,692 Sq. Ft. N 4j
LOT 8 ?c 0 2.84 Acres =
2902 Sq. Ft. r-
T 11 , Cr)
_j uj
Lot 5 0.07 Acres c~ c4 x° o -W N
- o co Co •-N d
O O b t
O W W 4J
2
Sj Corner of
CountynSection Monument RoSS?ng's Country ple S8901512211W 332.70'
Adds ti on
SCALE IN FEET Lot 4 _ Lot 2
0 100 200 300 NOTE: Lot 8 as shown on this map is to be
deeded to an adjoining owner to the
west.
This instrument drafted by Fran Bleskacek Proj. No. 87-52-189
VOLUME 8 PAGE 2129
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
- (715) 386-4680
PERMIT APPLICATION CHECKLIST
A. m COMPLETED Sanitary Permit Application.
B. m COMPLETED 511c' 100 & 105, Property Deed, Original Soil
Report, CS,'r or Subdivision plat & detailed plot plan
which must include the following:
1. Owner, buyer (if applicable) & legal description.
2. Q Project location: Provide a reference from the project
site to the nearest road intersection or section corner.
3. Q] Lot or parcel size. z 6
4. 0 North arrow & Legend.
5. m Scale or give dimensions from two directions.
6. m Locate & describe both the Vertical reference point (VRP
or BM) & Horizontal reference point (HRP): The HRP can
be the same as the VRP/BM if so described.
7. m House/building locations with reference to the HRP.
8. (3 Building sewer, forcemain, well & water service location.
9. Septic tank/lift chamber, distribution box, & diversion
valve locations. Existing tanks: Provide Certification
for the Utilization of an Existing Septic Tank Statement.
10. m Absorption system(s): Both primary and replacement
systems drawn to scale.
11. IJ Effluent systems: Distribution piping and vent detail.
12. 0 Setback distances from the system to lakes, streams,
building, property lines/easements, critical slopes, etc.
13. Adjoining property information: show setbacks or state
that setbacks are greater than the minimums required.
14. D Pump chamber cross section, including dose volume & TDH
calculations, pump manufacturer, model # & pump curve.
15. fp Master plumber/designer signature, date and license
number on each page of plans or coversheet.
l~ • ~ ~o r 5;.~-e ~4doPress
l
/
1
O
s FILED
JUL 2 41989•-
g JAM
Regift ES CONNELL Of j
4499"9 ~c~ca°; w'
CERTIFIED SURVEY MAP
Located in part of the SW42 of the NE4 and in part of the NW4 of the SE4 and being Lot 6
of the Plat of Rossing's Country View Addition and Lots 31 and 32 of the Plat of
Rossing's Country View First Addition, all in Section 29, T29N, R19W, Town of Hudson,
St. Croix County, Wisconsin.
Ni Corner of
Section 29 '
L
4-1 S
(See County Surveyor for corner ties) o N
W Z
L N89 15' 2211E 1207.63' s ro
°o Southerly R/W of C.T.H. 11UU" 0
41 C
LEGEND a`/ rn
Section Corner Found ' o
i\\l f~ N 1~
• 211 Iron Pipe Found ( ~~vS_14, )7
L J O
ro o
• 1" Iron Pipe Found HUD- It co
Mw N \
`R i W C1 .-1 L
0 111 x 2411 Iron Pipe Set, weighing 9^ < ><,,,44,,,• ' _ CO s
'J. I , Cn M L 4J .G
1.68 lbs• per linear foot.
P n~9 J4~ N W O O
Rossing's Country Vied First Addition °
co
Lot 30
Outlot 1 I -
N89°15'2211E 241.98'
N N
_ O
.--O)
N ' O G~ OWNER
C)
z Cs~ Sam Miller
2
° P.O. Box 28
41 Hudson, Wisconsin
N lot 14 / LOT 5 54016
4- -
°
107,002 Sq. Ft.
2.46 Acres
~ OQQ' \ N N
t0
-11 W
o ~ M
p
v1~'v. b j OO tG o
n
02 o,
°
S67osfAlf- ?Is. °o„F i
i . 11'p 30 r T
LOT 7 35.64°0"F 1 .17' 411
z i ( N85 E' - i
voJ% 131,854 Sq. Ft. ° =i
' 3.03 Acres
--C1 -South Line of the NE}
Ch ')-I f
L" I°. 9°27104Jc4
o ° A 32.011
_
z 490.67' 3
3
0.65' 6
661 S89°15'22"W 460.02' 123,692 Sq. Ft. '
LOT 8 2.84 Acres 2902 Sq. Ft. Lot 5 0.07 Acres ni ; W
M O7 O OO 0
O N W
O ro S} Corner of .61
Section 29
Rossi
County Section Monument - grs S89 15'22"W 332.70'
count
SCALE IN FEET 6di
Lot 4~ tl0!► Lot 2 t
0 100 200 300 NOTE: Lot 8 as shown on this map is to be
deeded to an adjoining owner to the
This instrument drafted by Fran Bleskacek Proj. No. 87-52-189 west.
VOLUME 8 PAGE 2129
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