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HomeMy WebLinkAbout020-1266-50-000 -0 0 (D C~ Q o a 0~ N y h O r. ~ ti C r. C C N N z, C -C ~ O X L y U C i N N O Y C U. b) a1 ~ O ~ O M r0)_v LL ~ I L O ) a ° N F z 04 C t9 O z !t O z ~ o c a c 0 m N a O yam} _ ~ ti O O O O C C O N M N N aw c (D O O O O Q O N z r z z o _E N ~ ~ N L O N C d i I -T O C) T) V C) a ~ -2 -8 W rn _ 0 0 0 •►~y R oaaa (V m Och N N y (n r U a~ ~ rn rn a ~ rn ~ E O O .2 -6 ) O LO ~ U1 C O O~o C O O (0 O~ 3 O C C d- m O) O O O I- cn C C N N O C N N N N N 04 C4 'a cl, '4 L) 4 E d Lw m L a a ` a • tej a d .2 d rr.~ £ L C C 1 D u( L 2 0 U) 0 Parcel 020-1068-30-000 01/12/2005 05:13 PM PAGE 1 OF 1 Alt. Parcel M 24.29.19.259C 020 - TOWN OF HUDSON Current 0 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner * THOMAS E & DIANE DANIELSON DANIELSON, THOMAS E & DIANE 872 BADLANDS RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 872 BADLANDS RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.740 Plat: N/A-NOT AVAILABLE SEC 24 T29N RI 9W PT NW SE COM SW COR TH Block/Condo Bldg: E 126.25 FT TO CL TN RD N67DEG E 1033.15 FT TO POB; TH N 285.76 FT E 175 FT S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 212.59 FT TO CL RD S67DEG W 189.87' TO 24-29N-19W POB- ALSO PCL OF 2.74 ACRES N 1/2 OF SE1/4 LYG ADJ TO ABOVE PCL AS DESC VOL C more... Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 WD 07/23/1997 Fad WD 07/23/1997 464/233 WD 2004 SUMMARY Bill Fair Market Value: Assessed with: 48183 247,300 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.740 58,400 132,900 191,300 NO Totals for 2004: General Property 3.740 58,400 132,900 191,300 Woodland 0.000 0 0 Totals for 2003: General Property 3.740 58,400 132,900 191,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 110 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP f~UO`So y SECTION 2 7 T L~ N-R W ADDRESS 63 -7 13 -t'~` `ST ST. CROIX COUNTY, WISCONSIN 111aso ti wiS. syo /G SUBDIVISION LOT LOT SIZE accts PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM INDICATE NORTH ARROW &Pe rf1 SST I'SY e's-7 7 ,V c BENCHMARK: Elevation and description: L©T Alternate benchmark 6v~~S ~alTb ~s' , SEPTIC TANK: Manufacturer: COv6tel (t CD Liquid Cap. Rings used: o Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: y'3; ~ ZOO " No. of feet from nearest road:Front , Si , Rear Ft. From nearest prop. line:Front ide %0 , ,vj u aXII 00'r I~VS-fA//E Z> Y---) - 70 No. of feet from: Well R4 7e-- , Building: Z (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE l ; f i PUMP CHAMBER Manufacturer: Liquid pacity: Pump Model: Pump/Siphon Man act.: Pump Size Elevation of inlet: Bot 'm of tank elevation Pump on elev.: Pump o elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from n rest prop. line: Front-, Side-, Rear_Ft. Distance f m: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length -7 S Number of Lines: Z Area Built 314% S Exist. Grade Elev. Proposed Final Grade Elev. 30 -{a yo " Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side 12- , Rear Ft. No. feet from well: N' No. feet from building y~ HOLDING TANK Manufacturer: SaVai-city:_ No. of rings used: Elevati of bottom tank: Elevation of inlet: No. feet/ from near t prop. line:Front , Side , Rear Ft. No. feet fro . Well , building , nearest road Alarm M ufacturer: C INSPECTOR: DATE: Z/~ / Z PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj NOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGFIT NIS. MASTER PLUMBER LIC. N0.3307 MY.R.S. INS!ALLER & DESIGNER LIC. N0. 00663 • ~l S -131>~'~T . ~G b T ~G~9~v 3 13-P,,~ 9N4 • ~'O T G ~~vE ~.PoS7- ~'Qaa/C G/v y Z 2 gEw,9 L Sad . ¢o Pvc 13 Saves Y O .v~cv /oao S~prrc T. ~cJ F S c vice~s7ir - , - - - s " 7P rvp of P.Q ,tr- f7 3, 4t -o-, -nof, P,P~ - - "Y S 7-&,,l V -7 ys r~.y 1,04&7- TO Tip °f P~pE 112 o,Pop do S( y7, 1/0 ' Torn of p~~ 97.9& -,2-- o CG~ST" 'E.v 73M ~ 7o o,~' (a ~E --*S&ST TO y&-,e r To SfeEL Nct- OVOST- 47- L15~ 2I~v,Dz 5a 21,2--1 eA04TioN = ~I'ST~~ t3U'rio.J Qi ~ iod•D ' T?64le i S l HOMESITE SEPTIC PLUMBINU CO. ON O'NEIL RD., HUDSON, WIS. 540% ROBERT ULBRIGHT W MASTER PLUMBER LIC, NO. 3307 KRA.S. MINN. IKTALLER A DESIGNER LIC. NO. 0069' 11R- La r*d Huartr~ed t~ st~y4.29.19.1~46.DT7~l99FVVk8E S?tTEMDIRMAID County: Labor aman Relations Safety nd Human and Buildings Division INSPECTION REPORT ST- CROIX ` (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 175632 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: JERRY SCHMITT, HUDSOY4 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: DD / 0 z, l tIP0C A) `L LD i 020-1266-50-000 TANK INFORMATION /3j- 10,90/ ELEVATION DATA A9200291 vr~s TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S p p 0 Benchmark ra-_. Dosing Aeration Bldg. Sewer Holding St/Ht Inlet ~Ct TANK SETBACK INFORMATION St/ Ht Outlet Vent TANKTO P/L WELL BLDG. AirIto ntake ROAD Dt Inlet Air Septic qb I NA Dt Bottom Dosing NA Header / Man. r ~r q~• ~ Aeration NA Dist. Pipe _ I Holding Bot. System ro , 8 PUMP/ SIPHON INFORMATION Final Grade !)1, a Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth 5 D DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO CHAMBER Mode Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Mani old 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 Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Incl code discrepancies, persons present, etc.) <r it Vii; it ~ &~.-r Plan revision required? ❑ Yes ENo , j Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 17UILHA SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than f 0254 3 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 xx Se AI41-~ t- ~V i<sw ~4, s 2 T 1-f N, R E (o co PROPERTY WNER'S MA NG A~~ LOT # 47 BLOCK # S_fJ016 (3p CITY, STATE 3 ZIP CODE PHONE NUMBE SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: Check one CITY NEAREST OAD ( ) ❑ State Owned ❑ VILLAGE OF: ~G ❑ Public NI or 2 Fam. Dwelling- # of bedrooms 3 PAR LTAX N III. BUILDING USE: (If building type is public, check all that apply) - LCe --S o "b 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 40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 50 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. PQ New 2.E] 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 /Ob 14 ❑ System-In-Fill L .2- f 6' 346j~t X 73- VI. ABSORPTION SYSTEM INFORMATION: 9(e ..l- 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) JELLEVATION 75nU 75"Y/ Ir-s " Feet / ! . Feet VII. TANK CAPACITY Site in allons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber [I I Ej El F1 F-I F1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu tier's Signature: (No Stamps) /MPRSW No.: Business Phone Number: Ai5a T 330 7 ?ice 30 ~BCP.5, ' Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater a e Issued Issuing Agent Signature (No Stamps) urcharge Fee) p RApproved ❑ Owner Given Initial Adverse Determination ~G 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 of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes 'in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior,to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage 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't'anks; 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 rpodel and pump manufacturer; D) cross section of the soil absorption system if . required by the county; E) coif 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) ~ r r. '7 m ~1J rr m Q m 01 wcm-co, cn ,o m 1 MM _Z ° rn ~ c 7-Z~,y mm ti 1711 y o v `NA ti ~ a y -zz L, co t o h p v A rn W k r.Aj b ~I t~t\ `O r, ~ 'A Fresh Air Inlets And Observation Pipe Approved Vent Cap { Minimum 12".Above Final Grade - - 7cINiS}~~D / 4" Cost Iron • 3 d ~•,7 Above Pipe r Vent 'Pi 8 'ta Final Grade pa' Marsh Hay Or Synthetic Covering min. 2" Aggregate Over Pipe Distribution z7zf Tee 0 0 0 0 0 Plpp c~ Aggregate o Perforated Pipe Below Beneath pipe 0 Coupling Terminating At Bottom Of S,yt►tem Fresh Air Inlets And Observation Pipe i i Approved Vent Cap Minimum 12" Above Final Grade 3- o Fr 4" Cast Iron "Above Pipe -to Final Grade Vent Pipe' Marsh Hay Or Synthetic Covering min. 2" Aggregate Over Pipe Distribution ).72-9 Tee Pipe CO 0 0 0 0 , " Aggregate 0 Perforated Pipe Below Beneath Pipe o Coupling Terminating At syJT~,, z Bottom Of System 4': wlth Il.lill 8 3.05, 4`Ji$. At71i,. I,JdE . COUNTY ST • ~~PG~ f Attach complete site plan on paper not less than 8 1/2 x 11 inches in -Ian must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. ii ; dimensioned, north irrow, and location and distance to nearest road. APPLICANT INF0,0MATION-PI.! A E PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER... a Q CA PROPERTY LOCATION O ~~~lQ y 00VT.1. 0T lind 1 /4 50 1/4,S 1 T 2- / N,R If / E (w) f PHOPEggTY Y R':4 MAILING ADOR SS y LOT 'iLOCK # SUED. NAME OR CSM M N I~7 .1696' 0 7 .57 _ _ y svti o~~ Xv p GITY, STATE ZIP CODE PHONE NUMBER - []CITY []VILLAGE INVIIE !BROAD ,Ql ov►►N 4;e Qr QZZ (7~sl4~s- New Construrbcq Use Residential / Number of bedrooms Addition to existing bullding ' f [ j Replacement (j Public or commercial describe__- _ i! Coda :'rived daily f1g? gpd Rxomrnended design loading rate .gybed, gpd/ft2 G french, ,W42 Absorption area rogui(ed K bed, 112 Uench, h2 Maximum design loading rate k bed, gpd/ft2 trench, gpcUft2 Recommended InQllrq. an surface elevation s) -Sy~ it (as referred to site plan benchmark) 7 ~ ~ - Z_r, 4 -VeA S D,v L y -,9vc~0 ,egrE'tO -V ~I Additional design/ s*0 iderations S NoTi~ Parent m4lerial~s Of-'rWisN 41A '.v r _ _Flood plain elevation, if applicable S - Suitable for system co"NENTIONAL MOUND II4-GROUND PRESSURE AT-GRADE SYSTEM IN Fell HOLDING TANK j U I-_ tAsuit Fatarsystem MS ❑u ~as ❑u CIS ❑u ®s ❑u QS ®U Ds M SOIL DESCRIPTION REPORT { Boring # Horizon (~epih Dominant Color Mottles Texture Structure Consistence Bourrkly Roots "Pr' ~tG in. Nitinsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed tench t j . o- % leTe 2/:2- l,f S6,C M, vf,e CS 2,r.. z fl L- t/l ~d IA ..3/ 2, f, s 6k f~ s . -F. X , 6 Ground 13 T'30 /O f/i~ /f X ,3 13 k' /'o xe '%m Am yx ~ /.r+ ar► DE' pIn 10 Kf- //0 14) M limiting _ - j factor Remarks: Boring # L > < V 1,01A,311- fit. GS x .G 2, s7h,4t ?c, 8, -27 /0 a YIK", ee ~ L 1 y0 /D jp 5-141 544: 'Itl 7Zi' G S ~UJ'c -S 9. it. - Depth to C b' yt¢ l D yjty y/ / 56,E ~w1~i~ CS X ~ s limitin lactorg n C v y~ /0 Y/- Remarks: CST Name:-Please Print 655 aNEIL RD., HUDSON, WIS. 54016 Phone: 3 Address: i- - w16. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. Sgnature: ~~n O , tN. ter a vEStcluEatte-NO eost;3 - Date: CST Number; r ; rpTYOWNER t~/E f l bOlL DESCRIPTION REPORT Page?- of " -PARCEL I.D. # Boring # Horizon Pepth Dominant Color Mottles Texture Structure Consistence Buund ry Roots GPDA1 - In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tryfi 0-4P /O/P 2. too 1/-0 Yle Ground '.2<J /dyi<' x^ ,V3(~tt. gz y /D Y/ 2,~►, s,6.C off c s ~u x s- S Depth to C ~byiP ~f/(v - s n~.•C ! limiting ' _ ' factor Remarks; C •/D~°/'~Q ✓ i S A ~'li,(~v~PE f _ .S/ r►"' ~F IP . 4 GP. Boring # A -f 109313 S/ co~~,~c~- 7J d5; 3'(- J1' INP /0 yie Of ,J,, 6m-t4l' e 5; .2 G round ,p elev. it k . i Depth to limiting factor ~Z ~f<J l ~llUj•' ~►.+.•~if mot-' .~t~' ~'~t d lJ • -.~f 70 5- S Z00- S Remarks: Boring . 3/ 2f /a -jX /Dy £ 101r /JI*17;1 13, la -30 5- /Uf Ground elev.2 ' y 7s Ye sb X /J►►.Q S x • r.~ Depth to v ' limiting facts Jl.~</"E7' 4 Remarks: ~A Boring # Ground elev. Deptn to limiting factor - - i I,t ~ h ~ k i~ r 'U 1 Vl , ~ i, 'lit I two.. 0 h, j 1 ' fill I }ti it f~ .j' ' r ' < I' r tA, yq~ ~ ~ I li d I' •J I I; • : +,i !Y a d .I,. 41 g '-n , v pie Vv1► S ~$f W W. W NN uj , w i 1 r r y a , v f - Qom' ! C? j DL t• , A, M~ 07 n j, i S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER /~'r~S ~C~IQ y 5~~ 7t 7~ ADDRESS NO ?O / le((,J I"` S7 FIRE NUMBER CITY/STATE /P/ 0" J-~eo 2 IP PROPERTY LOCATION : 4w 1/4 , ` ?V 1/4 , SECTION l T , T L` N-R zT W TOWN OF r/VASD1q/ , St. Croix County, SUBDIVISION 500V LOT NUMBER-f-. 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 fficer within 30 days of the three year expira on date. SIG DATE: (0 L St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 w I APPLICATIOH FOR SAHITART PERMIT 9TC-100 This application form Is to be completed In full and signed by the ovnet(s) of the property being developed. Any Inadequacies vill only result In delays of the parmlt Issuance. -Should this development be Intended lot resale by owner/conttactot,(spec house), thcn a second form should be retained and completed when the property Is sold and submitted to this office with the appcoprlete deed recordlnq. - - - - - - - - - - - - - - - - - - - - - • - - - - - - - Ovnet of pcopetty _Itfl 1-fX5• Location of property 1/4 's;•_1/1, Section T f It V Township V'VJ-40^" Mailing address A/ 9 7,9 T 0 ly` ✓;F Address of site /abdlvlslon nawe SUv Lot number Previous owner of pcopetty ' Total ■1:e of patcel C;2'L 4 l9Ct-CS ' I Date parcal was created Ate all cocnsts and lot lines Identifiable? as _tfo is this Property being developed tot resale (spec house)? as Ae0 Volume and Page Humbsr as recorded With the Register of Deeds. •---••------o................ INCLUDE WITH THIS APPU CATION Till; FOLLOWINCt A VAARAHTT DYED which includes a DOCUHRHT NUMBRR# VOLUIIR AX D PAOR MUHeRR, and the BULL OF Tilt RBOISTBR Of DEEDS. In addition, a certified survey, it available, would be helpful so an to avoid delays of the reviewing process. If the deed deactiptlon teferences to a Csitltled eutvsy Hap, the Cattitled survey Hap shall also be required. PROPBRTx OWNER CBRTIFICATIOH live) certify that all statements on this form are true to the best of my (out) knowledge that I (we) am (ate) the owner(s) of the property desctibed In this information form, by virtue, of a warranty ad t corded In the Office of the County Register of Deeds as Document No. presently own the proposed site for the sewage d sposal syste~nl(ocdltlwe)l have obtained an easement, to run with the above described Property, tar the construction of sold ■tem# and the same has been duly recorded In the office he coynty R Is or o Deeds, as Document moo I~ ;99"atute of Ownee sign re of Co-Owner p llcable) t p Date of Igna to Date of gnatute f i~ t r ~A S4 t b~ 4 „ t3: t~~n t ~ iti eo- r ✓ ~ . `ttl:l ~ s W.a R6 v1 Yr ••i. , 1 1 s* ~ ~Z9 • h .y R.t k~ jaw s nr FR •4'_ ~t iZv. :eilN a~~~5' ~ •NL l Af lS{1.:~' ~ - ~d` i9s~. _ REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1 09/21,/92 08:23 REQUESTS FOR INSPECTION WORK SHEETS FOR: 9/21/92 AREA: NJ Activity: A9200291 9/21/92 Type: CONVSEPT Status: PENDING Constr: Address: HUDSON 24.29.19.1306,NW,SW, LOT 9, MCDIRMAID DR. Parcel: 020-1266-50-000 Occ: Use: Description: 175632 Applicant: SCHMITT, JERRY Phone: Owner: SCHMITT, JERRY Phone: Contractor: ULBRECHT, BOB Phone: Inspection Request Information..... Requestor: ULBRICHT, BOB Phone: Req Time: 11:09 Comments: Items requested to be Inspected... Action Comments , Time Exp 00012 FINAL INSPECTION a S Inspection History..... Item: 00012 FINAL INSPECTION y., ;nsi Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & Buildings in a 1 3.05, Wis. Adm. Code ~ JO COUNTYS-T/ Attach complete site plan on paper not less t 2 x 11 inches in si must include, but not limited to vertical and horizontal referen t (BM),(*,wcti*nd °C pe, scale or PARCEL I.D. # dimensioned, north arrow, and location an, t oe tonekest r".t Rt T10N ti REVIEWED BY DATE APPLICANT INFORMATION-PLEAS IN% ,,INT PROPERTY OWNER: S G • PERTY LOCATION p q J~/rt/e n c-% VT. LOT IVId 1/4 $(~t) 1/4,S2 T a / N,R E ( W PROPE TY OWNER':S MAILI G ADDR SS y LOT # BLOCK # SUBD. NAME OR CSM # N F7 V /D D 57 / Z 9 sv~v :~iDG~ S041P . CITY, STATE ZIP CODE PHON E]CITY E]VILLAGE/UOWN N RES ROAD /U i ~if/~S ~/s• S'yp~Z (7/S)4~5~ X3100 vvso„> NV ~ ~-!ip P 1~ New Construction Use [,t'J Residential / Number of bedrooms 3 Addition to existing building j [ Replacement [ ] Public or commercial describe Code derived daily flow #;29 gpd Recommended design loading rate gibed, gpd/ft2 • G trench, gpd/02 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate X bed, gpd/ft2 trench, gpolft2 Recommended infiltration surface elevation(s) -5-ez . 3 ft (as referred to site plan benchmark) Additional design / site iderations Nd7'~ - Z~S - 7,e£-4J-,At S 4 -"l -J-fooi0 '6&-p r Parent material!5if37 ~y -1, - ovrW45 f ~014/:v S Flood plain elevation, if applicable N'14 - It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem MS ❑U E~S OU ®S ❑U ®S ❑U ❑S ®U ❑S 7U 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 2, f, shk fi2 s f x , G ~4w ~f { t f~ - YR 3/y Av, Ground 13 3D /o f/~ 5' f, sh/C If X , 3 elev. 1*3 a o Depth to C - !lD y y 1141- S O,,►+t, $ nM ,2 i )C , 0 limiting factor for conventional se ti mtams ~s~ OAS Gw ~ / G-- Remarks: fjglPil.U~ k C ~~~1j;J s ~~1~1b-~►~fTS o f S~ 1 / - G Baring # 21 f, Si k /J+f V Jail C S 1-4n X .G > 11" 2,111. ,s/ 2, f 5-h,4- ' s if X • G Ground elev. ~DY/, 4~1 -7Zi' S /uf x 1 -S ~9- L<, ft. Depth to s/ X fj sd e /W-/A 05 to 9 limiting C v y0 /0YX y s i~ S ~r►-~- x '0 factor n Remarks: CST Name:-Please Print 655 O'NEIL RO., HUDSON, WIS. 54016 Phone: 7~5 ,3 Rvo'RT-vLBR.~f~T Address: 7 , NIS, MASTER PLUMBER LIC. NO. 3307 M.P.R.S. Signature: Date: f2- MER tic. NO. CST Number: y~ PROPERTY OWNER SOIL DESCRIPTION REPORT Z ~c Page - off` ' PARCEL I.D.# Gof/~/ Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T--.vt 3 k o~~ /o Y/ 3 i. S' ~,f~ shy v ~s 1 x , ~Yle 2,{, sbr -F,e ~S Zf x , G Ground /sr /dyie y /03 2&ft. /3Z y io Yl y S/ 21) sb~ ,h, vie c s x Depth to C /b y,2 g~CP s limiting factor Remarks: ~fD,t'%7~-~/ /s ~lit'fy~E a f S/ • 4 GPI Boring # ...5F 10he313 S/ e 1_44 ry4 ::><:<::; r ~ 5 NP oyt' zf- X -S - C , ~DI~ 2- 'K Ground - - ele G'Z D /d !/-1 S , , S Q X /m, o ft. - Depth to - - limiting factor 'r E VSF' 60 a v 1~ . ' //L /fD l Za-uS' Ajl Remarks: Ate/ ~p.v /s rl / sDGF ~~G> ,i1 7'y~P~ ~t'~ S v~ Boring # / - A0 /w e:5~ 2 14C d -/1 /0 3Y S./ 3 , ShK f~ S l ~ x - 6 X S/ Ground / /DYle 517 e y~ 61~ Shl< -Z✓ C S h) F A- . 3 ev. 161,e1,3 & ft ~2 v"y 75yiE' f, Sblr /1v1.Q J i - Depth to Ye limiting /~~t°i 2lh~ G ri.~T•9iNS .~1il~ ~OC,f'f~` 4F factor 7. - ?l/~ O ~ . Gam; v~.e Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-e330(R.05/92) .f In r ~V` O 0 C...r ~ U O mr~-O~m odl N ~ ~ ~ J om~i~ o cmi~ t \ m oZc 1t r ~z n~~y47 ~ ~ ~ ~ $ 'ro l~rn 1 I 1 7---Z y o 93 n b v ca ~Ss a ~z z b 4 l - N o m y y ORIGINAL 'b ~A a c r m r o