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HomeMy WebLinkAbout020-1061-30-300 ~ o I ~ I o p t c c y ~ ~ I o I v N i O y r _N 'O O I lL G C7 Q I I I 3 r~ v ~ I Z N 3 W rn z y o z d d I ce) C14 Q' V ~ L am N I- Z I o z ? c U N ~ H ~ O N O N V 0) 0 N N O ! My (n .C ® a _ N N h a © No ® Z CO Z O N N O C Cl) N N E 0 V L d C C O m ~ d ~ N N C) D 0 a -0 E t Z in > FF- H FU- 3 o00 ~ ~ •r,a (0 a a a wN+. L qry~ N N N p~ t! o U rn rn ~ ~ o I p N N w O N O _ r O O = O I~ o aNi VV d C O 0 0 ~ N C I CQ co D C 00 U O O 7 O ° r0o E O Q 0. a m °o L`r} L N m E E cu N N , O O U) O O N O FC O N N y H H N O -0= = 0 nE E U N co • O N 2 O ~I -7 J7 v ~ E d a r • m a v .V d y c A U a 2 0 N U 4 AS BUILT SANITARY SYSTEM REPORT OWNER So_ m (rl TOWNSHIP ~1 u~-tout SECTION 2-1 T?g_N-R / W ADDRESS Boxes Z g~? ST. CROIX COUNTY, WISCONSIN 1-t so (01 t;-qo I Se SUBDIVISION Tra'. T W c- Iv- LOT S LOT SIZE S' 3 Z J'¢ C PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM . • l TW va.. I ofCh dot IR J E u/ 14 7S Y We-it as'x:v' ald Sa ISS t99 I r, I I I y0" I i I I 5" by °io' ( to old }m Nm/ ~avica e * I = Ioo,OO 30 _ X X x X INDICATE NORTH ARROW BENCHMARK: Elevation and description : 1-6 Nd<~~d„« Post = iva,~d Alternate benchmark _Too of /A k ~o ~H ~(JQ aH < f ~g SEPTIC TANK: Manufacturer: Liquid Cap. /ODD Rings used: z Manhole cover elev: Final grade elev: ~v•y3 Tank inlet elev.:-4-1 0 Tank outlet elev.: No. of feet from nearest road:Front_L_, Side , Rear Ft. i56' From nearest prop. line:Front Y, Side , Rear Ft. i No. of feet from: Well 6e~ , Building: Z 3 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer•/1/A Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front-, Side-, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: 1ohm /Trench: Seepage Pit: Width: Length `,/d Number of Lines:- -Area Built7205g Exist. Grade Elev. Proposed Final Grade Elev. (,-qS Fill depth to top of pipe: ~L No. feet from nearest prop. line:Front,)(-, Side , Rear Ft./ss No. feet from well: /O No. feet from building yS HOLDING TANK Manufacturer : ,/I~~ Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well building nearest road Alarm Manufacturer: INSPECTOR: DATE: PLUMBER ON JOB: LICENSE NUMBER:-3~- 6/90:cj tAo'hi~partrietn>DoOAiuA23.29.19,NW NE OT 5 TRAIL TWELVE RD. ry, Labor and Human Relations P~tIVd►E SEVI~AGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GIENEIMt INFORMATION 18027 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: MILLER, SAM HUDSON CST BM Elev.: ` Insp. BM Elev.: BM Description: Parcel Tax No.: Gd• ~b G C`a eS tTcf jC" ~c 7 TANK INFORMATION ELEVATION DATA A9200351 Z 2 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 1&e, O6. r Do Aeration Bldg. Sewer Holding St/ 6W Inlet S TANK SETBACK INFORMATION St/ fit Outlet f1 a/' TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic > P:~50' ln~6 / NA Dt Bottom D NA HeaderN OS~ Aeration NA Dist. Pipe 7 3, S Holding "lot. System 61 PUMP/ SIPHON INFORMATION inafdera e els Zg' Man feet- Demand ,yam-r,Sc~ ~O, d5~ 6 Model Number GPM TDH Lift Friction tem TDH Ft Forcemain Length EDia. Dist. To e SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION c. DI N I N SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEA NG Manufacturer: SETBACK CHAMBER-- INFORMATION Type O i Number: System: ;ik Vy O OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) r x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length 37 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Tr nch Center Bed /Trench Edges D Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON,23.29.19,NW,NE,LOT 5, TRAIL TWELVE RD. ~0 Plan revision required? ❑ Yes p3-f4o Use other side for additional information. Jp Z7 9 = SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No. r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I DILHFt SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMI # -Attach complete plans (to the county copy only) for the system, on paper not less than El l A 8%,x 11 inches in size. Check re swnto revlo sapplication -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 Gil '/a ~ '/a, S 23 Ta 7 , N, R If E (or)(0 PROPERTY OWNER'S MAILING ADDRESS LOT # s BLOCK # o a z 8 z_ CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER k nor wx Sr/v/k 3j''t s74 ia: / 7urm v~ II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned VILLAGE : o '1 1 Ti.; / T u 4- /u IPG4 ❑ Public ©1 or 2 Fam. Dwelling4 of bedrooms3 PARCEL TAX NU ER( III. BUILDING USE: (If building type is public, check all that apply) L9 ) 0 _ /e 3o - 3Da 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ~ New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ 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 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE ~SO REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 72,0 7Z0 (,,4ZS 930o Feet %•ZS Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Od / GtJt S Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsits sewage system shown on the attached plans. Plumber's Name (Print): Plum is Signature: (No S m ) MP/MPRSW No.: Business Phone Number: o Sfro~6.. ~p-S~ 3~ 2- 117 3L33 Plumbs Address (Street, City, State, Zip Code): c k )-,Z- avow fi,4r_4A16*j W15 s to/7 IX. COUNTY/DEPARTMENT USE ONLY tamp X❑ Disapproved nitary Permit Fee (Includes Groundwater Date slue Issuing an Sig lure IN Approved El Owner Given Initial 0~ Surcharge Fee) 9 0? ~r Adverse Determination 4~ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-8398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber it 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. _ Y 4. Changes in ownership or plumber requires a San,:tary 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 tanks must be PumPec by 'i'licensWd - pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact-y0ur 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. ll. 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 matetjal. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix 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; (lose 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. S13 D-6398 (R.11/88) J 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.' appropriate deed recording -----J Owner of property Location of property_ZA/ 1/4 Ne 1/4, Section 0`3 ; T N-Rfy Township _J1 t S o V\ Mailing address . Lay -0- ff6, ,A, a► ayl f - / to Address of site 7/-w: T.~ya.~✓~. ~t,~ Subdivision name _~/!ar Lot no. J5- other homes on property? yesX_No Previous owner of property U.1 Af Total size of parcel S• 1~~ Date parcel was created Are all corners and lot lines identifiable? 74 Yes No Is this property being developed for (spec house)? Y Yes No Volume-ql/V 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 I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. ~e4 l 79 , and that I (we) presently own the proposed site for t e sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No.T /7 91 nature of applicant Co-applicant Z Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-lfst arac= arsawlw'ros saooan+«o a~4 • 481.M Lisa MGE 6 Fowl OFFICE,, t , brlew d This Deed, made between I" I APRI OM2 ~ ..susi,e..Ja..Sialrarx...huakatlst..and..Wi.Ea.......................................... M Grantor, j d 8.30 A. and 'I and. E.~...Miller . I ~C~ I . Grantee, I . Witnesseth, That the said G, antor, for a valuable consideration...... conveys to Grantee the following described real estate in ....51 , ..C>tQ> x.....---- County, State of Wisconsin: A parcel of land located in the Nh of the NEB of Section 23, Township 29 North, Range 19 West, Town Tax Parcel No: of Hudson, as described in the Certified Survey Map filed and recorded in the office of the Register of Deeds for St. Croix County, Wisconsin, on July 6, 1976, in Volume 1 of C.S.M., Page 271, Document #334002, which parcel contains 20.48 acres. f !RWA~r This is not homestead property. 4i*+ (is not) Together with all and singular the hereditanu nts and apparten:utce.; thereunto belonging: AIll Kenton P. Stewart and Susie Jo Stewart o:u•rants that the title is good, indefeasible in fee sImT,1e and free and eloa r,f encumbntmes excvpt easements and protective covenants or restrictions of record and-existing highways, if any, and will warrant and defend the shine. Dated this 7th da;: ,a April 1992 A1,I (SEAL.) Kenton P. Stewart IS A :1,) (SEAL) Susie Jo Stewart AUTHENTICATION ACKNOWLEDGMENT \~'1•?(1\<lti ~ilrnnli;re(,.t Kenton P. Stewart And 'TtTr (IT.' Susie To :~tewart 1 I'•„Int,. 7 th Al,r l 1 tl.'- Ixr 1 - c:1!i•• .0- l,. l n Ire this day of 1`.r tilt' abo%c nann' I John 1). Ileywood 1'I'1'i.li \1 I?\111(•;1: >•I' \"I'I•; It \ C rtl~ 1:=' 11` ~ ` - I I i not. I I,. u.. V, n:,. j,. , t.. I r' ti t• ...n, \ch , v crated 'Ire n'-. ~ ~;tr;n~n r ~tn,l :,ri.nu•~~lc,l~e itr re Ilovwoml S ('ai i by John D. Ile) wood 1t- 228, Iludson, Hisconsin 5401h I''!'i. f'„unr}• tt'is. I!T' w...,t I~ not. st:,te cxltirati-i F I'~ir ii'Ji ~~I IYI•.a♦ W, 1..•'I Innnk("'. Inc. - \111 I'i Ilr.l 11 11111 ~i ".n 1 - r. ill ,~I~w,•, w,x. s FILED 2 AUG 3119920- JAMES O'r,~"'NELL 3 48'7909 ti Re9istercl SL CW CO., WI Q d CERTIFIED SURVEY MVP s~ y Located in part of the NE4 of the NE4 and in part of the NW4 of the NE4, AT all in Section 23, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; 1~ N being Certified Survey Map recorded in Volume•1, Page 271 at the St. Croix 0 o County Register of Deeds office. LEGEND W • - 1" Iron Pipe Found 5fx. ,t"~~a 't 9. = r. ,lam 0 e o - 111 x 24" Iron Pipe Set, weighing 1.68 lbs. per linear food n I~;}~ yi p C- = N Existing Fenceline 1 4)7 o -Roadway Setback Line ! (7, S ro z -Aluminum County Section Monument Found co 4. L • - 3/4" Rebar Found - ` t%•~ ' µ W a - - Drainage Gully ro c ~L:v •..1,_~ mss. N •N O ! 4r N} Corner of North line of the NE} NE Corner of Section 23 N89056101"W 2605.861 Section 23 I ~ 1805.84' 800.02' ' I -r -r v I_ a;~'v UIN 1 OWNER S850201424 4 22 Sam Miller P.O. Box 282 U) I W W Hudsorl,.,~$3r(5t "8: CJI~+ z z ~~~~~~`jjj fi l U; po +c+ ( of >4 . tea. i~ •4 < 71 N 3 -44 -14 U•) CJ I® 6.35 Acres = a s Z ;;,y d Ld 276,545 Sq. Ft. N -JI °c v S8501315011W \ `y= (e'.,.,.2,,.,.••••~ LL I SS2~r 255-621 L \ ^ Vii 1(1'x..{V y W \Y' :.1L4S • ` ~I o~°' hw ~ NV. 2 N ~o 3.30 Acres ROVED o 4 +00 t~•, 4 143,956 Sq. Ft. C"i I o ao "0 3.47 Acres aQ o'o = 151,232 Sq. Ft. Vzo °y ROADS 19119„ CJ o S7? 1fig" 0ZCATEO,~`1 TO 444•?$► ho :ROiX COUNTY o o`oy by T zQ °o, :oraw honsive Planning S90.00, oning and IC Per s Committee 13? 5 OD, 5.32 Acres 11t recorded SOo 48 231,925 Sq. Ft. in 30 da 1 3001 348.10, pL0 CONCRETE, Wi . y3 Of rI) I T©480.10, 124.46r a Proval date CJ C n 1? ?6`~ o- X SRIOGE 103.68oval gh-,30 0 N8600911711 9 9f 9d/ 405.66' , &390011W ® ?S ~4i \ 482030' 231 5THE34 PUBLIC 43.23' o DEDI M82030' 23' <g; 488-451 o N0702913711W SO7029131111E 50.001 33.001 11 11 i ~~~~,rrAY nT 11 SCALE IN FEET I L• S. 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CURVE DATA CURVE LOT RADIUS CENTRAL CHORD CHORD ARC TANGENT TANGENT NO. NO. LENGTH ANGLE BEARING LENGTH LENGTH BEARING BEARING @1 - Q 2 233.00' 43°33'09" N50032'44.5"W 172.88' 177.11' N28046'1011W N72019'1911W Q -(D 2 80.00' 65038'17" N39030'10.511W 86.72' 91.65' N72019'1911W N06041'0211W G- Q5 - 80.00' 245038'17" S50°29'49.5"W 134.46' 342.98' N06041'0211W S72019'1911E 2 80.00' 48059'25" N31010'44.5"W 66.34' 68.40' 3 80.00' 86032'47" S81003'09.5"W 109.68' 120.84' 4 80.00' 82051'33" S03039'00.5"E 105.87' 115.69' 5 80.00' 27014'32" S58042'0311E 37.68' 38.04' (1-0 5 167.00' 78°48'00" S32055'1911E 212.00' 229.68' S72019'1911E S06028'4111W PREVIOUSLY RECORDED DIMENSIONS. LINE BEARING LENGTH N29053100"W 743.301• © S8400710011W 256.00' ' © N0603010011W 475.25' < S84013'0011W 522.35' < S0001210011E 530.00' OF S0001210011E 380.65' S0001510011W " © S71°57'00"E 481.15' a3 OH N8500110011E 124.50' OI S59°31'00"E 155.60' IL~~~u II APPROVED OJ S0803510011E 33.00' " N81025'00"E 488.00' ' "..~.,C,c''-~,.,~,,,,,..•..•• © N08°35' 00"W 50.00' AUG 4 s r CROIX COUNTY ornprahensive Planning Zoning and Parks Comrnittea If not recorded within 30 days of approval date a0provel shell be ,-++Ii & void' VOLUME 9 PAGE 2535 SHEET 2 OF 2 SHEETS 1 V 5£5Z 39Vd 6 3wn10A •90Tnpe 20; 90T;;o buxuoZ Xlunoo xxoj0 •1S aql joeluoO 1902ed We buxdotanap .7o buxsegoand aao;ag *(*Ole 11902ed of ssaOOe 'azTS lot wnwxuxw 'spuejlaM -a-T) suoxletnbaz pue satna 'sMej dluno0 pug alelg'ol 4oaCgns sT (letd) dew sxgl uo umogs taoaed goes .-lea ~ - Na aTO a •paeog uMOy uospnH agl Xg pan dde sT deW Aanang pax;T4ja0 sTgl legl X3i1aao Agaaaq I sivoialyuH0 NOSanH 30 Nmol saaxdxa uoxssxwwoo XW f 6GI '6c` 7daS s8jidx3 uorssiwwo3 AW u o T qnd /C e O N A -M003 A3SWVa VIOSj Mil-0119nd A ION i AVW 'W 3NNV0f Y~ awns aql pabpolmou{oe pue luawnalsux buxobaao; eql palnOaxe oqM uosaad aql aq o umouX ow o; 'aatjxw wes paweu anoge aql L6-~-6T ' ;o Xep sxgl aw aao;aq aweO Xlleuosaad 0 A4uno0 S SS ( ;o 9424 of nxT y i w a TW Wes s au1T "IT Nls;~ . kv?z ? .W6T 1! 97~ - ;o step stq; Aaumo ptes ;o teas pug pue ago ssaugTM yVI' YJC . •uoxgoaCgo 10 jenOadde ao; 9944xwwo0 buxuoZ A4uno0 xxoa0 '1S aql pue uospnH ;o umol aql 04 pallxwgns aq o; pajTnbaa sT deli danInS pat;x1190 sxgl legl A3Tlaao osje I 'dew sxgl uo palusseadaa 91 PSIVOTpop pug paddew 'pepTATP ,paAanjns aq of deli AananS pax;xlaa0 sxgl uo pagTjosap puel oql pasne0 I legl XIT4aao Agaaaq I 'aaumo sV NO I vo i asa 30 HSv0I a SH30 S , unm6 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 54.,01 ADDRESS_ FIRE NUMBER CITY/STATE _z e ZIP PROPERTY LOCATION:,&,/_V/4,lyllr114, SECTION Z , T05' N-R Zf W TOWN OF St. Croix County, SUBDIVISION 2 i'LOT NUMBER S 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 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 Co. Zoning Officer within 30 days of the three year expiration date. SIGNED' DATE St. Z Z~ St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY I k Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 4sr~e6 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 Q A At 1t'! 1LL&k GOVT. LOT NW 1/4 E 1/4,S23 T 19 N,R 19 E (or) W PROP TY OWNE ':S MAILING {DRESS LOT BLOCK# SUBDD..N OR C M-# CITY, STIATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OWN NEAREST ROAD N U 1~SaiJ w t ( ) 1~uD54 -,`T14 J New Construction UseK Residential/ Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow A gpd Recommended design loading rate 0.7 bed, gpd/ft2 a. trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate O. '7 bed, gpd/ft2 Qg trench, gpd/ft2 Recommended infiltration surface elevation(s) (4-3-00 ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable - ft S = Suitable for system CONVENTIONAL MO IND I~t ROUND PRESSURE T RADE SY TEM IN FILL HOLDING T K U=Unsuitable for s stems ❑ Ui S❑ U i~t S❑ U WS 1:1 U S❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench . a?~i3J~etis~a. I A Ground $Z -44 oy re 3 elev. p A:5 ] 0.7 161 7. 9ft. D3 $O" /U oS 4 Depth to 44liao d /D limiting factor 16,41 Remarks: Boring # ~g 7-0 InYi 4 3 5~ L ! cl~y, rtiss ~ e t 5 0, 'J::L~Ct`iititi0 $z -7~ 43 3 S ~"r G ! :7 Ground elev. g3 'S~~' Y 5 S ! 0.7161 6, Depth to ~ limiting 1_%f Remarks: CST Name: Please Print dQ~ N J pN•.~Sa~ ~!j y ~N Phone: 46-t6 Address: ~S0~.1 LJ ! 1 G Signature: Date: 4Z CST Number: I I I I I I I I I I l 1 Remarks: SBD-8330(8.05/92) { I cr, C7 y RQZ y r ~r I At r c wz ~ on 'A w w , • 2 4'QS~- a ti~ H ~Fi y P s- , r As . o\ AN F 0 n P R~ Y u C Y ^ 1 L a I I ~I N I N o ~ c I P n l Q W do n r in J s C " I ~ ~ I ;u n ' o o ` J• I a1 i 21, ~ R Y 1 T-o Cl z cn ! -n 1 i -v I p it { ~I I i i rn P ~ (11 K ' ~I 1 ! >r i ~ 1 I ,1 1 1 (-70~ ~ ~ii I ► -v c,, I L4 1 1.~. L4 i na? ! s 'l+ I ri y 4$ R° x A~ `l7 REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1 10/28/92 09:43 REQUESTS FOR INSPECTION WORK-SHEETS-FOR: 10/28/92----AREA: -JT-- A,ctivity: A9200351 10/28/92 Type: CONVSEPT StatusV PENDING Constr: • Addressn HUDSON,23.29.19,NW,NE,LOT 5, TRAIL TWELVE RD. Parcel: - - - Occ: Use: Description: 180272 Applicant: MILLER, SAM Phone: Owner: MILLER, SAM Phone: Contractor: STROHBEEN, DOUG Phone: Inspection Request Information..... Requestor: STROHBEEN, DOUG Phone: Req Time: 13:10 Comments : !(JO Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION i