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HomeMy WebLinkAbout020-1369-06-000~/* t Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ^ T n of: Bast, Kernon Hudson Township CST B Elev.; Insp. BM Elev.: BM Description: / 6U O Q v L .,... ~ r-wn uvr~nmr- i ww I TYPE I MANUFACTURER I CAP..AC1T-~J Septic Dosing Aeration Holding TA SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic f '~-~ t ~ r NA Dosing NA Aeration NA Holding PUMA /SIPHON INFORMATION Man acturer Model Nu ber TDH on I system il'rDH Ft F6rcemain ~ Length ~ Dia. ~ Dist. To Weli ELEVATION DATA County: "r St. Croix Sanitary Permit No.: 374936 State Plan IDID N~o` Parcel Tax No.: 020-1369-06-000 ID~7.a.lWrZ,~Qti STATION BS HI FS ELEV. Benchmark Z 9S (pZ, or Alt. BM 3.2 /b2 • ~3r Bldg. Sewer 2,SW l0o•6lor St/Ht Inlet (o ~ ao•o 1 St / Ht Outlet • (~; 5 ~ r Dt Inlet ~-- Dt Bottom Header /Man. `~• o q. O ~ ~(o , g ~' Dist. Pipe (0. L /~•p ~ ~s ~• /~ srp} ` Bot. System 11•~D If•o8 l(. t ~- • 8~- Final Grade St cover v b . Z r g w-.-~ ( S.~j ~- oS-k 1 ~ . ~ , SOIL~QRPTION SYSTEM ('I-pl ~ Q,~~._~,.sYS or~r~l.. L~.o.,.~~ / Width r Length , No. f T enches ~ PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N 3 `Z •~ DIM N I N SYSTEM TO P/ L WELL LAKE /STREAM LEACHING Man cturer: _ S SETBACK ^- ~ ~ INFORMATION TypeO ' r 1 CHAMBER e Number: System: yip ?!eo --~ OR UNIT - au DISTRIBUTION SYSTEM ~'--~->t-fl /1~. (,~" ~~ ~ Heade / Manifold N Distribution Pipe(s) x Hole Si x Spacing Vent To Air Intake Lengt 5 Dia. th ia. aang 7 fa0 f SOIL COVER ,~ , ~ x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ~ ~~2 Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center ~~ J Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No '.9~ COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1 ~ o-~/o I / o ( Inspection #2: `-f-"/-"' Location: 697 Old Hopkins Place, H-urdson,nWI 54016 (NE 1/4 SE 1/4 10 T29N R1~W) - 1029192196 Hoplcin's Prairie -Lot 6 1.) Alt BM Description = g~ewt o~~`~~ ~NE („At,y--c.~i ~ .~ C ~ 1 ~ ~~ ~~ 2.) Bldg sewer length = ~ ~ -amount of cover = ~ ~~ ~~ ~~' 3) ~5c r~. P:~~s ;,.. c,a.,,~~ ~ 2~c~o°^^~'-Q~ u,,, ~,,, ~r.~ ~e,~vQ. ~r.^^~,~. Plan revision required? ^ Yes ($ No OS' 0 I o 1 Us of eer sid fora dit~iorna~l in rmatioQn~. SB~~6T10 .3/ ~` `1A [~~~ °/~ a e Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: t , . ~ ~ e~n ~. ~~ . ~ __ ~~ ~ _ ~ ~ m. .. n mm. ,ma. a- -- _._ ~ ~ e ~ ~. a r ~ ~ ~ ~ ~~ ~ 6 9~ 61 ~ ~aP k ~~. s p~~ c e Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 Madison WI 53707-7302 department scaf,£ammerce Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)] , (Submit completed form to county if not state owned. Attach com lete Tans to the coon co onl for the stem, Eft ~ r not less than 8-1/2 x I 1 inches in site. County ~ State Sanitary Permit Number ^ Check if re ' ' n~e~pre 'o 'cation State Plan L D. Number C t I. A lication Information -Please Print all Information Location: Properly Owner Name ~ Prop rty Location e O ~~ ~ ~~C(v~" '~ ~ + /1/4 1/4,S T , Property Owner's Mailing Address _ ~ ~ r~ `,? J ~ 2000 t Number Bloc umber ~ L ,~. > City, State Zip Code PTio e Number~~~ ubdivision Name or CSM Number II. Type of Bu ding: (check one) t S Pe/ ~/ ~ C'ty ^ Village C . 1 or 2 Family Dwelling - No. of Bedrooms : ~~ ~ /~,5 ~ t ib je~Town of e use):_ ^ Public/Commercial (descr ~ ^ State-Owned ~ iV~e t Roa ~ ~' ~'~~ ~~ %= P '~xNum -~ - ~ III. T e of ermit: Check onl one box online A. box on line B ' icable /o Z 2 p) 1. New 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to S stem S stem Tank Onl Existin S stem B) Permit Number Date Issued ^ A Sani Permit was reviousl issued IV. Type of POWT System: (Check all that apply) Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At- de ^ Aerobic Treatment Unit ^ Recirculatin ^ Other: V. Dis ersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersa Area 4. Soil App tcahon 5. Percolation to .System levation T. Final Grade vation El e Required Proposed Rate (GalsJday/sq. ft.) (Min./inch) VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks IZ p ^ ^ ^ ^ ^ ^ ^ ^ ^ Ua VIII. Responsibility Statement I, the undersi ed, assume res onsibili for installation of the PO shown on the attached lans. Plumbers Name (print) Plumber's Si afore (no slam s): -I~'/IvII'RS No. Business Phone Number ~'r ~ ~~ ~ ~d 63 ~~ Plumber's Address (Street, City, State, Zip Code) ~ t z' rr p o l IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ^ Owner Given Initial Adverse Surcharge Fee ~ U U Z 2 D ~ Determination - r Disapproval: sons fo X. Conditions of Approval /Rea // / / C~/ G~ l~ ~FraGK ~ii lv.~ ~~ 06Sc<us.~,'a.~ ~Di~i f Sna ~~ N ih S~ ~ ~"s''~t` ` ~ Fl f < / c B bt L{~S{ur,6ca/GtwG~ S{ruG~<,~.-c s f~~ r'fN/~4.h A<.t.TS< L ca'e i"C,~,~%Or~ GL!/COc S~tal~KpT I~ Z., N (~' I ~ ~ 'k~ ~7 ~r `~0 6 i C th jiYl'~'/Pih ~ Q S ~Ov~-s ~ LoT * 6~ ~P~ivs ~,~yer~c Fogerty Plumbing #222180 28288 McKenzie Rd. Spooner, WI 5480 (715) 635-9 ~~~ l ,~~ ~s ~ ~~i G~ o ~~ ~- i/66 ~z.o' X = .dortrV~ ~y f~iKT o i= S~T/sr~ G = frZ~ ~'inC. S. ~rr~vD ~~- m.~.v~'iZ ~~ ~f ~f ~~ /1 ~~ ? X80 ~ /' ~' ~~ /~ / ~ .! i~ / \ © fa ~~ t__- ~{~vsF n' s~% -G I p I .~ Obf¢IV0.T:dr 1 ,p¢ COI - G2 - So ~ -!v ~ y, / B -3 l !~<Y% is ~^ ~r~jN~-, ~-S ~ ~-~/ ;~ Q/~ ~.cc ~ awl Wisconsin Department of Industry, SOIL AND SITE EVALUATION R E P O R T Labor and Human Relations nivisinn of Safa4ty R Ruilrlinne • _ _ _ __ _~ __a.~ ~~ ~ ~r, ..., ...- .,.~_ w~c-'S-n_~_ Page 1 of 3 - - n~ a~.~.v~aa ••~ui ~~~ i~ ~ ~.~.v.~, •.w ~s.y~t ~. .......... ,.. COUNTY ~ le k~t PI ~~t mcl n 8 1/2 x 11 inches in size a Attach c lan on er not less th l t it St. Croix ~ p p . omp e e s e p a # L LD PA1~C' not limited to vertical and horizontal reference point (BM), direction and % o sio~e, scale of ,.--~. " f . E 4 0 ~` dimensioned, north arrow, and location and distance to nearest road _ ~ 0-1010-7 000 ` --A APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATIO ' ` _~ '~ ~ °'--•~• ~'~ ~' REVIE ED Y DATE , 7 0 PROPERTY OWNER: PfO.PERTY ~" .~ Kernon Bast ~~~ L~~R¢~~F)~:. SE 1Y4` 10 T 29 ,N,R lg f(or) W PROPERTY OWNER':S MAILING ADDRESS Ld`f;# $LOCK # S1Jf3D. ~ E OR CSM # 848 LaBar e Rd. 6~' ;na , Hopkins Prarie CITY, STATE ZIP CODE PHONE NUMBER ^CITY t:A6E~ OWN NEAREST ROAD Hudson, WI. 54016 ~71~ 386-7775 Hudson Olk Ho kins Pl. [x] New Construction Use [x ] Residential / Number of bedrooms 4 [ ]Addition to existing building j j Replacement [ ] Public or commercial describe trench, gpd/ft2 Code derived daily flow 600 /gpd Recommended design loading rate .7 bed, gpd/ft2~ fQ~ Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate . 7 bed, gpd/ft2_~trench, gpolft2 Recommended infiltration surface elevation(s) A=95.60/B= 96.80' ft (as referred t site plan benchmark) Additional design /site considerations na Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system CONVENTIONAL ®S ^ U MOUND ~] S ^ U IN-GROUND PRESSURE CAS ^ U AT-GRADE B S ^ U SYSTEM tN FILL ®S ^ U HOLDING TANK ^ S ® U U =Unsuitable for s stem SOIL DESCRIPTION REPORT Boring # '1 Ground elev. 100.4ft. Depth to limiting factor +96" Boring # 2 Ground elev. 100.6 ft. Depth to limiting factor +g6" Depth Dominant Color Mottles Texture Structure Consistence BoLxl~lr Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y 1 -8 10yr3/3 none 1 2msbk mfr gw 2f .5 2 -28 10yr5/4 none sil 2msbk mfr yw if .5 / :6~ 3 8-96• 7.5yr4/6 none cos Osg ml na na .7,/ ~S~ S ,`« (1 ~.G~~~C~S Remarks: 1 0-33 ~ 10yr2/2 none 1'- lcsbk mfr gw 2f .4 ~ . 2 3-48 . 1 Oyr4/4 none sit 1 csbk mfr gw l f . 2 /~ . 3 8-96 7.5yr4/6 none ~~ Osg ml na na .7 / . RS ~ ~~ 2.Op ~~oS Remarks: CST Name:--Please Print Ga L. Steel Phone: 715-246-6200 Address: 1554 200th. .New Richmond WI 54017 Signature: n ~ _--~ Date: 11-16-99 CST Number: m02298 PROPERTY OWNER Kernon Bast SOIL DESCRIPTION REPORT PARCEL I.D. ~ 020-1010-70-000 Boring # 3 Ground elev. 100 . ~. Depth to limiting factor +96" Boring # 4 Ground elev. 100.4ft. Depth to limiting factor +90" ' Boring # 5 <' Ground elev. 100.8ft. Depth to limiting factor +90"` Boring # .................. ................. .................. ................. .................. ................. .................. Ground elev. ft. Depth to limiting factor Page 2 of 3 Horizon Depth Dominant Color Mottles Texture Structure Consistence Ba.~ry Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Be T 1 0-12 . 10yr3/3 none 1 2msbk mfr gw 2f .5 2 12-33 10yr5/4 none sil 2msbk mfr gw if .5,/ 3 33-96 ~ 7.5yr4/6 none co Osg ml na na .7 4.S! ~ ~ r d'' ~c6s Remarks: 1 0-14 10yr4/3 none sl 2myr mvfr gw 2f . 5' . 2 14-90 7.5yr4/6 none o Osg ml na na .7,~ . Remarks: 1 0-17 10yr3/3 none 1 2msbk mfr gw 2f .5 ,/ . 2 17-44 l Oyr4/4 none sit 2msbk mfr yw 1 f . 5 /'' . 3 44-90 7.5yr4/6 none cod Osg ml na na .7 /'~$ Remarks: Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Kernon Bast 1554 200th Ave. CSTM2298 NE4sE4 s10-t29N-R19w New Richmond, WI 54017 MPRSW-3254 town of Hudson (715) 246-6200 lot #6-Hopkins PraRIE This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1"=40' ~= top of 1" pvc pipe ~ el. 100.00' Alt. BM.= top of 1" pvc pipe 2 el. 102.00' r~,~- G~Z ° ' ', Gary L. Steel 11-16-99 • r s Wisconsin Department of Commerce f)ivisinn of Safety and Buildinos SOIL EVALUATION REPORT Page ~ of in accordance with Gomm 8b, wts. Aam. t,oae minty t ' Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan mus but not limited to: vertical and horizontal reference point (BM), direction and include parcel I.fl. , scale or dimensions, north arrow, and location and distance to nearest road. percent slope Z Q ^ f;1900 , Please print all information. Rev' wed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ' ~ ~ a' Party ~~ Property Location , Govt. Lot 1/4 1l4 S p T N R E (or~ Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# ~ ~ ,~ v. ._ City State Zip Code Phone Number ^ City ^ Village Town Nearest Road u ~ o c ) New Construction Use Residential / Number of bedrooms Code derived design flow rate _ ~~ GPD ^ Replacement ^ ublic or commercial -Describe: Parent material Flood Plain elevation if applicable ft• General comments and recommendations: 3 LJ Boring Boring # Ground surface elev. ~~~~ ~ ft. Depth to limiting factor Z, ~s in. Pit Soil ication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP 'Eff#1 D/f~ `Eff#2 1~ _ 3 L S -~ ' , r--- ' S- '- C S L _ ~' _ ,. ___._ CMS B ""_ ~' . Z yo ^ Boring # U Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 .___-~ _J TG.o ~ 7A ...../1 ' Effluent #1 = BOD > 30 < 220 mg/L and T55 >:tU _< i5u mgrL ~~~~~~~~~ ••~ - ~~~ . ~~ •••~•- -• - • __ _ __ __., _ CST a Iea~.Riint) ~S' at e CST Number - T Date Evaluation Conducted ~ ephone Number Address w~ ~y~~ Sent Gy:,EDINA REALTY HUDSON WISCONSIN 715 386 1502; _ - r }+w ii - ~7 07/21/00 8:37; tFau #965; Page 2i7 ", " ~~"~°~' SQIL AND SITE EYAIUATION REPORt nerd t9urrrar- Reladero - -- ~~ a ~ s s~roa ~--- irt a,~ J t~' Hpr¢pn Depth in. Dominant Color ftilunsel! Almttles ~. Sz. Copt Cdor Texture Sere Gr. Sz. Sh, CoriSisBgraCB 9pu'rl~y AoolS GPI;>'t tied Tierdt 1 B IOyr3/3 Hoare 1 ~nsbic mfg[' 2f .5 i .8 2 28 10yr5/4 Haase sit 2msblc Hitt yor if .5 ~ .6 3 -95 7.Syr4/6 tt~te # cos Otaq tai na ita .7 .8 I SOIL D>:SCAlP710N q~PCR7 i'lIIl ~ X61 TO. ~_ t3orirtg # ,:` i . Ground elev. 100.4ft. ~~ tanning factor +~N Boring ~ 2 ~~ Greund elev lOb.6 tt Depth b nag tBClpr i 1 33 loyr2/2 ><t~te 1 lcshk mfr yw 2t ^ .4 ' .5 2 3-98 10yr4/4 stone sf1 Icsbk mfr gw if .2 ~ .3 - 3 -96 7.5yr4/6 none cos Osg irtl na na . 7 ! . 8 ' , Remarks: CSTName:--t?tease Priru L. Steel gone: 71.5-246-b200 lwdreax 1554 ZOOth. .New W ~°~'~' x=11-16-99 CS'[ Ntunber: nat>Z243 ~~ Page 1 ~t 3 ., ...~..~....., ~...,,.,. .v..~.......,.... ,~. _ tx,t Attach oortrplate nits plan on paper not Ives than 8 i>2 z 11 inches in size Plan must include ~' ~~~ , . Eirrrited ~ veaticd end horizontal refsr'nce point (BM}, direction ar+d'6 of slaps, scale or P {.0. # •dimsnsioned, noRh mow. and bcation and disitnce to nearest road. 020-1010-74000 I- APPLICART INFORNA?IOt?i-PLEASE PRINT ALL INFBRMATION REV A~ t)ATE RR:OPt:~`! OWNER: PROPERTY LOCATION GotR. LoT ~ Ira ~ v~.3 IO T 29 ~•R 19 ~ttt~1 w PROPERTY OWNER':5 MAILING ADl3RES5 LOT a BLOCK a SUED. NAME OR CSM M 848 La Rd. 6 rid 'ns Prarie CITY, ATE ZiP COO PHONE NUM9ER ~ [jCiTV [JVILLAt3E OWN N EST ROAD Hte son, WI . 54016 t 71 ~ 386-77'75 ~Q New Corastru¢5at tJse pC ] Reslden~al / Number of bedn7onrs 4 E ] Addition ~ existing buildirtp •_ l Z ~t ~ J Punic or cOnrrlerp8l describe _ Coda decked daNy faDw 500 gpd Reconxrlended design baling rate ~„ _bed, 9AdAt2._s~bench, I Ab6nrplpn area regtAred 8'~ bed. RZ 750 )tench, ft2 Maximum deign Ioadirtg rata . 7 bed. gpd/l12 .8 trench, gpdJh2 Reaomrnebed tn6lbaoen surface ete~ation(s) A-95.60/~ 9¢- ~ ` A 4as reserved to si9a pta+i ber~hmartc} AddidOrlal design f tii19 OQnsiderdtiptt3 na Parent r-taterial otnrrash Flood plain elevxttiort, if epPficab~ na K $ ~ $ {~ ~(~ CONYtJVT10NAl MOUND IN-GROUND PRESSURE AT GRADE SY&TEM N FLL F10LOrNG :YAM( u= urtsuit~iolebr stem K~ e a u Ll s^ u y o u ®s o u ®s a u o s eau oEUTa Construction, Inc. 0, 206 Second Street • Hudson, WI 54016 To~ FLOOR COVERING Date Job # ~a Buyer(s) Home Phone Work Phone Job Address Floor Covering Allowance of $ Square Footage of Home VINYL in CARPET in HARDWOOD in CERAMIC in Sent by:,EDINA REALTY HUDSON WISCONSIN 715 386 1502; 07121/00 8:38; J~tFax !#965; Page 3/7 i PROPEH't'YOWNER K@I:TtOn )~aSt: SOIL DESCRiPT10N REPORT p~~_ PARCEL 1.0. ~ - -7Q"fl00 Boring ri 4. ? R 3' ~;;~_ . Groun$ elev. lOQ.~ m ~itirig lt~Or +96" 8otir~y s ~ '°~ '•°~ ti-Otmd elev. 100~4n m fipl~iAg laclnr + ~~ Boring ~ ~s ~: i, ~,,,~r ~Y,S G-aund eiev. .a0.an. ~~ ~~u~ tamer ~g ~- Horizon Depth in. 'Oorr+inantColor MunseH MoRles Qu Sz. Cmt. C.obr Texture Sere Gr. Sz. Sh. Cor>sis6snce 9ouidaty Rests Gp4it~ ~xt+ 1 0-12 IOyr3/3 none i Z>ssbk mfr gv Zf . 5 ~ 6 2 I2-33 ~OyrS/4 none sil 2ashk mfr gx if .5 ,.6 3 33-96 7.5yr4/6 nary co Osg ml r-a na .7 .,8 i Remarks: 1 0-14 IOyr4/3 nee sI 2mg~r mvfr gw 2f .5.~`s 2 19-90 7.5yr4/6 none co Osg ml na tia .7 ~ .8 _J Remarks: 1 2 3 0--Z7 17-44 44-90 20yr3/3 10yr4/4 7.5yr4j6 none nee none ]. sil co 2msblc 2msbk Osq mfr mfr ml - gsr ytrr na Zf if na .5 .!> .5 = .@~ .7 ~ .F~ - _,...~ r+ernarKS: Boring e ~~ g, - i ~~ ~- !t. i i~ (R1Ytli19 !actor , Copy Cat Digital Imaging Center 209 2nd Street, River City Center Hudson, WI 54016 VIRGIL FEDORENKO DELTA CONSTRUCTION 206 SECOND STREET HUDSON WI 54016 Invoice 34341 06/30/00 Ship To: < Same as Bill To > Pickup Acct.No Ordered By Phone Fax P.O. No Prepared By Sales Rep 649 VIRGIL FEDORENKO 381-1166 JENN Quantity Description Unit Price Price Thank you for the order. 14 Blueprints 1823.57/M 25.53 Paper Blueprint 20# Bond 18 X 24 1 Origs 1 --> 1 ~ 3.15 Copier BLUE/ZOOMER 18 x 24 ~ 22.38 i ~` Received: ~ Date: _/_i Terms Subtotal Discount Shipping Postage Tax Total Paid Balance Net 30 Days 25.53 -2.55 0.00 0.00 1.26 24.24 0.00 24.24 Pay from this invoice Copy Cat Digital Imaging Center • 209 2nd Street, River City Center • Hudson, WI 54016 • (715) 386-8400 (print# 1) Sent by:,EDINA REALTY HUDSON WISCONSIN 715 386 1502; 07/21/00 8:39; )etF~c #965; Page 417 ~'_~'-__-r ' ~-. • STEEL S SUIL SERVICE _ Gary L. Steel ~~ get 1554 204th i ~-ve. ~.1STM22s8 t~E~SE~ S10-t29N-R19W Alew Richmond. W! 5<~?i 7 n~RSw-tea o~ ~ t~~ s) 2~s-e~»oo lot #5-i~opkias PraRIE Zhie evil evaluation rae voe~dacted to eatis>Fy n zoning x+equizlaawrt, it ioay ar esy not be ~titaLie Fat your reye. brie ia~ica of the test a~ay at may »Qt be ae shoMrs as pecmanettt Iot ifnes care Aot established a-t the tame the test jtes coc~duCted. N LTi. - ~ ~ 1 " pViG' pipe ~ ei r 100. 00 ~ Alt. HM.= tvp of 1" pvc pipe 2 el. 202.Q0~ p~~ Gatry L. Steei 2116-99 a- < ~ Copy Cat Digital Imaging Center 209 2nd Street, River City Center Hudson, WI 54016 VIRGIL FEDORENKO DELTA CONSTRUCTION 206 SECOND STREET HUDSON WI 54016 Invoice 34286 06/26/00 Ship To: <SameasBillTo> Pickup Acct.No - Ordered By _ _. __ Phone Fax P.O. No _ Prepared By _ - Sales Rep 649 VIRGIL FEDORENKO 381-1166 Donna Quantity Description Unit Price Price ', ', Thank you for the order. 14 BLUEPRINT 1823.57/M 25.53 Paper Blueprint 20# Bond 18 X 24 1 Origs 1 --> 1 3.15 ', Copier BLUE/ZOOMER 18 x 24 22.38 24 SELF SERVICE Flyer 80.00/M 1.92 ', Paper 201b. White Bond 11 8.5 x 11 1 Origs 1 --> 1 0.53 Copier Full Service 8.5 X 11 1.39 i Received: Date: _/_/ Terms Subtotal Discount Shipping Postage Tax Total Paid Balance Net 30 Days 27.45 -2.75 0.00 0.00 1.36 26.06 0.00 26.06 Pay from this invoice Copy Cat Digital Imaging Center • 209 2nd Street, River City Center • Hudson, WI 54016 • (715) 386-8400 (print# 1) ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Steer ~iBNo~/ /~.~-ST Mailing Address Property Address (Verification required from Planning Department for new City/State l~ir~~e, ,~ ,~YOl~parcel Identification Number 4Z D -- /~~ 7~0~'-~' LEGAL DESCRIPTION Property Location, '/., SF_ '/<, Sec. l.U , TAN-Rf~_~~i~, Town of ~~~,~SDr~ Subdivision ~I~d~/c,~,jtrS .~j1~,~,~,E' ,Lot # _~. Certified Survey Map # '~- ,Volume T- ,Page # Warranty Deed # ~ .~.5'~6 ~ Volume l S~3( ,Page # ~~_. Spec house ^ yes no Lot lines identifiable yes ^ no SYSTEM MAINTENANCE 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department 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/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 d 1ys the three year ex iratio date. l~l / O b SIG OF AP ANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of he roperty describe abov by virtue of a warranty deed recorded in Register of Deeds Office. SIGN TURF OF LICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *****' ,~ ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ~a ~~1.1436Fnir 516 Document Number ' WARRANTY DEED phis Deed, made behreen, Jean M Hendrickson and,Kernori J Bast and Donalda J Speer-Bast Grantor, hushand and wife, as survivorship marital property Grantee. Witnesseth, That the said Grantor, for a valuable consideraton of cne dollar and other valuable consideration conveys to Grantee the below described real estate in St. CrOIX County, State of Wisconsin. This is not homestead property. Together with aU and singular hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except aasementa, covenants, and restrictions of record, and will warrant and defend the same. (Parcel Identification Number) 020-1010-70 Part of the NE'/. of SE'/, of Section 10-29-19 described as follows: Beginning in the center of Scott Road at the NW corner of Lot 1 of Certified Survey Map, filed in the office of the Register of Deeds for St. Croix County, in Vol. "3", Page 651; thence N89°48' 13"E 561.0 feet along the N line of said Lot 1 to an iron pipe mo^ument; thence Sly along the E line of said Certified Survey Map to the SE corner thereof; thence N89°48' 13"E 759 feet to an tron pipe stake; thence Nly parallel to the E line of said Section 10 a distance of 921 feet to an iron pipe monument; thence W 1320 feet to the center of Scott Road; thence Sly along the centerline to the point of beginning. Dated this day of ~~, 1999 G~ .'~~ h ' jr ~ f M Hendrickson AUTHENTICATION Signature(s) r authenticated this _ day of '~ S~ h ~ ~ type or print name TITLE: MEMBER STATE GAR OF WISCONSI G (If not, authorized byp70ti.lki, Wis. Stats.) ~ ~ ~ ~O THIS INSTRUMENT WAS DRAFT Robert F. Wall ~' ~ (Signatures may be authenticated or acknowledg ~ ~re not necessary.) ~~ 605x568 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR REt~RD ob-z~-im e:~o at tiAR(tAFITY DEED EXElP1 1 CERT COPY FEE: GOPY FEE: TRANSFER FEE: X50.00 RECORDINS FEE: 10.00 PAGES: 1 Name and Retum Address FIRST FEDERAL SAVINGS 201 SOUTH SECOND HtJD3ON, WI 54016 ACKNOWLEDGMENT STATE OF WISCONSIN couNTV ST. CROIX n, _ Personally came before me this ~Sday of ~`~"'~ S9 the above named Jean M Hendrickson to me known to be the person(s) who executed the foregoing instrument and acknowledge the s / ~ ,nn _ e t ~ro print name 1 Y C-~r -.)G~1 Yr1 ~c~ I Notary Public County, . S O ~X ~My commis~~ ~ permanent. ;If not, state expiration date: CJ D ~. . of persons signing in any rapacity should be typed or below their sgnatures. T•OW1K OF HUDSON, ST. CROIX ('OUNTY, WISCONS/N; ttC'l[vU Lug CERTIFIED, SURVEY MAP RECORIJED IN VOLUME 13, PAGE . EAST - wEST 1/4 UNE - C~itflalE OI1TA -- sn9•]rs7°E ,],e.zr _ lAT CENTRAL C1WR0 ARC NUYBER NUY9ER RA0915 ANGLE t71aR0 BFN9NG IENGTH I.ENG111 TANOENIS C7 21).00' 474506" 5 6741'35" E 169.31' 19343' S 9x31'39" E s 41'31'31" E C2 167.00' 4513'51" 56559'263" E 139.47 14039' S 41'51']1" E N 9x54'39'• E C} 233A0• 4533'17' S 654a'433•• E 164.16' 199.}2' N 9x54'36•- E 5 4J}2'05" E 9 233.00' 24'01'77" 5 79'04•]]3" E 99.99' 97.71' N 9x54'36" E S 650Y45" E 9 233.00' 22]1'40" S 34'47.33" E f1.0Y 91.91' S 9503'43" E 5 43']2'05' E C4 197.00' 4502'11" 5 653]'103" "c 130.60' 134.19' S 4732'03" E 9 6rN•16" E p 77.}.00' 46'02'11" N 953]'103'• w 162.22' 1021' N 6x34'16" w N 4732'05" W 5 23]AO' ]Ca9'SS" N 7210'30" W 1N.26' 141.44• N 69'34'15' W N 3{4724' W 4 273.00' 11'13'19" N 4x06'443" w 45.70• 45.7Y N 34'47'24" w N 47]2'03" W C6 10.00• 45]3'17" N 66'49.4]3" w 131.99' 1]5.69' N 43'32'03" w s 9x54'76" w C7 233.00' 4r1Y51" N 655e•263° w 190.40' 196.14' s e9'S4'J9•' w N 41.51']1" w 4 2]].00' 10'06.56" N 9501'54" w •IJ19' 41.14• 599'54•]9" w N 79'59'29•' w R/M. 2]3.00' 3506'33" N g54'S63" w 152.16' 155.00' N 7x39'26" w N 41.51']1" W BFNCFIYARK CO 167.00• {740'06" N 6541']5' w 1]4.97• 139.94' N 4151']1•• W N 95]1'39•' W U.S.G.S. DA7W 1929 C9 273.00• 3506'55" s 60.34.393" E 152.16' 155.Ox S 41'51'71" E S )x36.26" E -EIEV.- 913.15 VOL 981, Pr;. 9f T'OP OF 1• ,NON FIVE PARCEL !N N89'31'39' W 1278.92' ___________________ I 1242.99 -~ ~.w.L, - 9ta.oo ee,,.63• s39.39`~ ~_~ ~ ~ \ - EPTIC 511E . -]9.59' ~ \ ~ ~ ~ - 9 9r1E 2.603 ACRES ,8.31'39 '\ J~'/. 11],366 50 R 36.58' / Jr J, - I . zeo7 ACREST • ~11 1V u ~~ ~,... ~ , surveyed divided and moppe represents •the exterior boun surveyed: and that this plot SE1/4 of Section 10, T29N, L CORNER Wisconsin; being Lot 4 of C :TION 10 ~ $~" Page of the St. Croix Co, u ey~~ described os follows: Wge Commencing at the Et/4 C u W K abng the Cast Iirte of the F ~~~ Na9'31.39'W 5.93 feet to th ~ i ^ ~ beginning; thence continuing ' ' ' e ~ SOl ly 66.00 test; the 02 26 P ~ curvature of o 167.00 foot n 9 8 a eentrol ongle measures 474 - _ ~ L~ ~ N and measures 134.97 feet; 136 94 feat to the p curve ~ d m3 . , ~ ^ to the point of eurvotura of 'n 0 I northao9terly whose central o Sa0'S4'S8.5"E and meoaurea to curve, 155.00 feet; thence ! - Y 132.35 feet; thence S00'Sa'I \ feet; thence N00'25'44'E, p 39"W `~ SE7/4, 920.20 feat to the Desefitled pared COntaitq 1 f e< suDjeet to oll eoaemenls, r6 O ~ I W (/~ 1 W O~ ~I ~~ tl ~1 ~ N6r5a•3s'E 191x3 - ~ .` p\ (6'' W ai ?i Hgtg ~~~OLD KOPKINS PLACES ~l - 1 ~~ \~111~~~~~ •' I ,~ O~ OWNER'S CERTIFI /.OT 8 ~ 59x34'3R•Yr 19},33• ~ ~ - I • aa" Ihvl ~.~ r e v. v ~/ I N ornera, we 1 GS.J/. IN sEV1tG c ~~ 'rp, I ,t.'t" ~ Plot to Ds surv6 VOL 13 _Fl7.~M wE1L ~ ~ ~J~' -' _ ~ this plat. We ale --°~ - - - . ~~~ ssv' i^ '~~~. - -I ~ - - - - - - - `t - - C 5236.12 to be I --- V7 O ~ ~V°a'rb :\ \ I. ^ _.` . `- ~-T---- M d County Pla .--------------- - I ~ ` a 589'42'08"E - - -- -- ~ - a I b 132.35' 4 ® -$ ~ ~ ~ I t WETNESS the ha YN. I fp i \ ~ 112E 122 AAA ~ \ r '1 ' iq~o'I ix. i In the presence to aF% 9°'~iGN 1~IrrE r -~_ ` 2o.x9. -----~-2esp;-r. _' -~ Q~ ~i o ~ ~ ~'_/'_~ tiw ~ - - - .. _ 4 ~ 31 m . Kemon Bast v ~ETn. / t YI qi O O L,_ J H.w:L- 907.0 I I ~ I Z i f~S.rl/. /N vNi vNi \\~- ~I °ol p l State of Wiseor -------- 3 3 ~°~~ 5 ^~- ` i n' i ..aunty of St. _ _ - ~ , .-----------------------~Yn b 3.3}7 ACRES o -~ I I I ? i Personolly-eom~ O : 145.349 50 (i + \ i - ' I e ~ the above nom VOL. $~_PE_ BS7 o G ~` n '~ ' SI I C ~ thetaerrusrsona ------- v°N \ w, r \ 7.M6 ACRES ~ I I ! i Notary Public, LOq'-p ~< i ~, 12}.a7e so Fr I I 4' 61y Commiaaior i \ Resolved, thot the F --~ i~Ff.t-L- 915.0\-x_--~ C~ ~ ~~- 0.5' ~ /- Kemon Boat and 09 - -• - - - - 47s.3s• - 29s.O1 I Town Boord. C --- - ------ 589'41'39"E 780.35' a 1.3• «/ I t'OL 885, PC. 178 (N89'48'13"E 759') 'O I Jdtrq Johroon, Toi , --- ---------------- ;rlq'et'39"E 1318.24' I hereby certify the ~ SCALE IN FEET 1" 100' SOUTH IJNE OF THE NE1/4 OF THE SEt/4 by the Town Board SE CORNER ~ .. SECTION 10 JoAnn L Wert, Tot 100 0 100 200 300 y-t, CRO!X %CUNtt PLANNING, ZONING ANO PARKS COMMITTEE RESOLUTION 2T~IGTE Resolved, !"ot the plot of HOPKINS PRAIRIE in the Town of Hudson, Kemon Bast and Donolda Speer-Bmt, ownen, ;s hereby approved by the STATE OF WISCONSI St. Crnix County Plonning, Zoning and Parks Committee. ST. CROIX COUNTY ,sing the duly elated, qualified and acting Ronald Roymond Oats xmty, do hereby ceRity that the records in my Chairrt+an I, BaveNy A. Johns) ed lox sales and no unpaid taxes or special Town Treowrcr of ...- ._.... _. offectinq the land Steven 0. Fisher Oate with the records in my office, ,OPKINS PRAIRIE. Zon;nG Oirc^tor assassment9 as of Plot of HOPKINS PRAIRIE. Dote I hereby eartity that the foregoing is o copy of o resolution odopted by th9 St. Croix County Planning, 2on;ng and ParW Committee. Bevery A. Johnsen Town Treasurer Sue E. Nekton, County Clerk Data