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HomeMy WebLinkAbout020-1402-07-000t Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page ~ of m acccxoancx wnn ~.omm oo, vvis. r~arn. wue _ County ~ , Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan must ~ ~ t . include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal infonnaGon you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). Property Owner Property Location S Q SU ~ Sv ~~ O~ Govt. Lot F 1 /4 5~ 1 !4 S r' l T Z ~' N R E (o W Property Owner's Mailing Address / Lot # Biodc # Subd. Name or CSM# ~ y ~~cir ~'l ~ ~^ew . City State Zip Code Phone Number ^ City ^ Vilage ~ Town Nearest Road ~Scs kJ S~~I to ( ) / uc~sa S{~ ^ New Construction Use: (~ Residential /Number of bedrooms _~ Code derived design flow rate ~G GPD Replacement ^ Public or commercial -Describe: __ __ ___,__._ Parent material nU ~-w u S ~ Flood Plain elevation if applicable ~~ ft. General continents and recommendations: / _ / ^, ~~~ Ong # ~ Boring ~ pit Ground surface elev. ft. Depth to limiting factor ~- in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 b` L Z `- ~~ Zvn .6 r- C V .~ a S Z Z5 -Y6 o r `_- s~` ZwtS r C S i Ho-~N o ~~/ ~ .s ~~~ 3m ` ~ v~-~r' c ~ - c lo~l- v .o -- as -- - - ~ ~- , Z Z ~r;ng # ^ Boring _ / [~ pit Ground surface elev. ,~ ft. Depth to limiting factor ~ in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I G ~I 8 G 3 Sr ~ m 5b ~ C,S ) v-~ ~ Sr f ~ z 6 - ~, ~ / ZrvtS r ~ - ~ ~ 3 3a J~'5 0~ 5/ - 5,'~ ~~ ~ F y 5 5'~ u 5/ 3 7, s iy <i C 3m 5 ' ~` w o , ~i i~ -l3 ~u. - 5 -- - - , ~ 'Effluent #1 = BOD > 30 < ~0 mg/L and TSS >30 < 150 mglL ` E uent #2 = BOD < 30 mglL and TSS < 30 mglL CST Name (Please Prti~t) lure . - " CST Number `.~c~iLtJf~2~/ L 5330 ress Date Evaluation Conducted Telephone umber ~Ir ~D ~,~,~ ~~~~-~ ~1<, syoG .s"" ~~~ ~ y 7~s- 7~0 -oz ~ y ,. ~ r wrsoonsin Department of Commerce SOIL EVALUATION REPORT Page ` of Division of Safely and Buildings in arxoraance wrtn Comm ts7, vns. Aam. woe County ~ ~ Plan must r not less than 8 1/2 x 11 inches in size Attach l t it l f ~t . comp an on pape e e s e p inducts, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal infgmation you provide may be used for secondary Purposes (Privacy t.aw, s. 15.04 (1) (m)). Property Owner Property Location SQ d ~ SUrI ~ p~ Govt. Lot F 1/4 51/4 S ~( T ~~ N R E (o W Property Owners Mailing Address / Lot # Block # Subd. or CSM# " ~ ~ ~ (~a r ~l ~ e 4J ~ ~ City State Zp Code Phone Number ^ City ^ VRage ®Town Nearest Road ~.~~ w sYo1 b ( ) / ud~ ^ New Construction Use: (~ Residential / Number of bedrooms L~ Code derived design flow rate ~G GPD ~Replaoement ^ Public or commerdal -Describe: _ ____.__ Parent material Qy-~c~.r~ S ~ FbodPlainelevation'rfapplicable ^i ft. General comments and recommendations: © ~ # ~ Boring 1-- ng Pit Ground surface elev. ft. Depth to limiting factor > y 6 in. Sal iration Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Raots GP D/ft= in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 D-L Z `_ st ~ Zrn ~ ~ C v .~ , ~ Z Z5 -t(6 o f `- ~~~ Zyns r C S -~ ~ NO-lo`1 oYl~l C ,s ~` - 3m- r v-~-4~' e 4J a Boring # ~ Boring Pit Ground surface elev. _~ ft. Depth to limiting factor ~~ ~• Shc lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fg in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ~ ~-~ ~ ~ 3 - s. i Msb ~ cs ~~~ ~ ..sr Z 6 - ~, ~ Zm5 ~' C - ~ ~ -13 fog - 5 -' - - ,~ r~ • Eftluertt #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mglL • E ueM #2 = t~vu < :iU mgrt_ and i ~ < su nxy~ CST Name (Please Prvrt,' ), ~~ true 5c~tn~~ _ Z~ 30 Date Evaluation Conducted Telephone txnber ZIP ~~ ~'~-~~ ~ y-.~~~-~ /,t l~. SyDz .~ ?~~e o y 7,s_ 7~,0 -oz ~ y- ~. ~ v ~~~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PER Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 1)(m)] Permit Holder's Name: City Village Johnson, Jason ~d Townshi CST BM Elev: In~ BM Elev: BM Description: { ~ ~~ ` TANK INFORMATION Ci • ~1 Z- (llir . f3 . ~ , was-tom o~.. G~r.+~ a Q ~ ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing _.~.__.__._..._... Aeration Holding -- __,,,_ TANK SETBACK INFORMATION ~~0~ TANK TO P/L WELL BLDG. Vent to Air intake ROAD Septic . S ~~ ®..--• - Z l -v ~ Dosing no-~ i,-.~o ~ Aeration ___._ .__. Holding .___ ._-- .___.._.~___.-_ ..... ~.. , PUMP/SIPHON INFORMATION Manufacturer Demand PM Model umber TDH Lift ~ lon Loss System Head TDH Ft Forcemain L ngth Dia. is . o well SOIL ABSORPTION SYSTEM County: St. CrD1X Sanitary Permit No' 430203 0 State Plan ID N Parcel Tax No: 020-1402-07-000 SectionlTownlRange/Map No: 11.29.19.2518 STATION BS HI FS ELEV. Benchmark Alt. BM S-[JO ~p~, S,a~ 9~,9 Bldg. Sewer SUHt Inlet St/Ht Outlet -7',~ 57.2 Dt Inlet Dt Bottom Header/Man. Dist. Pipe /0 . ~V •I 7~r Bot. System ~ _~s fi. a 3 3 Final Grade c~i.~~ St Cover l..Z--!•S ~ ~ >,,.~ pe -- f ,tea -~5a-~ O , --t~ ~ BEDITRENCH W Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ I` ~ ~ '~ _ _-_. . SETBACK ATI N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ~~~ ~ ~~ • INFORM O Type Of System: u ~ v , •~ (d r _ UNIT Model Nu er DISTRIBUTION SYSTEM Header/Manifold e ~~ Distribution --., ..-•- t Pipe(s) ~ .-~- x Hole Size - x Hole Spacing ~_~ _,___-••-- Ventt~ it Inta~e „"? ~,~ ~ Di ~ th ."'"""` Di • '" - °- ~ m L Length a g eng a -•-- pae SOIL COVER v Drcccnrc Svetnmc n.,t.~ YY Mnund nr At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center ~ ~./ ~ Bed/Trench Edges ,~_ . Topsoil 'Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / 23 / ~~ Inspection #2: / /__ Location: 799 Starlight Ave Hudson, WI 54016 (SE 1/4 SE 1/4 11 T29N R19W) Misty View Lot 7 Parcel No: 11.29.19.2518 1.) Alt BM Description = l~.~Ko~~ ~aLi-c~+G~ • r ti ~,;~~ 2.) Bldg sewer length = ~ '~~ ~'~•'~ - amount of cover = `~ ----- - - ---- Use otherls de for additional • _ Yes No I'_ ~ ~T y I - ~~ p rnformati n1 ~ -~ ( ate r-_-/r/. /"'' Inse tor's ignature SBD-6710 (R.3l97) ~R ~G AC, ~ • ~~ ~,~' ~nt • ~~jCY i~ ~ Sew 1 S lisp- i. __ ~~ ~- ~5 ~ _ J' Cert. No. a~ ,~~, ~ ~~ ~ Safety and uildt s ' ~~ CO1101y 1 201 W. Washin on A -~tr~1;~~L P ~ ~ n n , Madison, WI 53707 - 7162 Sa nary ennit Num er to e filled in by Co ) s~ ~seo (6 ) 266- x51 [13D '1 ~~ Department of Commerce Sanitary Permit Applica ion S to Plan I.D. Number ~ personal info ation golf ~ovidra )~ 1~. ; ~ Adm Code 21 Wis In accord with Comm 83 , . , . , . may be used for secondary purposes Privacy Law, sl i ~ ;_' t,, , ,~ ;. oject Address (if differ t than mailing address) i 1. Application Information -Please Print All Information ~7 Property O+vner's Name Parcel # of lock # X20-~ X1.4 i Property Owner's Mailing Address Property Location ~ ~r/~ ~ ~'/<, ~'/., Section ~~ er City, tae Zip Code Phone Numb ~ // ,'I "~~--44-- t l k ll h a app y) a t I . ype of Building (chec S.~x Subdivision Name CSM Number v ~ 1 or 2 Family Dwelling -Number of Bedrooms / / (/ ^ Public/Commercial -Describe Use '' ,, // _ / ^ State Owned -Describe Use oS ~l $?% ~>GC,l.._) W>I ~y[~?~l'~~~~~~ ^City_^V' lage o++mship of lil. Type of Permit: (Check only one box on line A. Complete line B if applicable) `~ ~ New System ^ Replacement System ^ Treannent/Holding Tank Replacement Only Other Modification to Existing System B. ^ Permit Renewal ~Pennit Revision ^ Change of ^ Permit Transfer to Ne+a List Previous Permit Number and Date Issued Before Expiration Plumber Owtter 30 - O ~ O~ O IV. T c of POWTS S stem: Check all that a I - Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constnicted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter in Chamber Drip Line ^ Gravel-less P'pe er (explain) V. Dis ersaUTreatment Area In ormatton: ~' • ~ Design Flow (gpd) Design Soil Application Rate(g d f) tspersal Area Required (st) Dispersal rea Propose (sf) System Elevat p., VI. Tank Intit Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Bolding Tank / /.1 C/ / ~ / ( ~ Aerobic TreaU»ent Lh»t ~r ~2 n ~~ r~ Dosing Chamber ~TII. Responsibility Statement- 1, the undersigned, assume responsibility for installation or the POWTS shown on the attached plans. Plumb is Name (Print) Plum s Si ture MPRS Number Business Phone Number T ~~ ~ Plumber's Address (Street, City, State, Zip C ) _ v ~ ~~ o L . . c VII 'ount /De artment Ilse Onl Approved ^ Disapproved Sanitary Permit Fee includes Ground+ er Surcharge Fee) ~ ~ Date Issued y Issuing Ag t Signatur S amps) ^ O+vner Given Reason for Denial ~~ ! %,~~ 1X. ondition~s of ApprovaUReasons for Disap~Arov I L'~^ . ~ ~~ ~~/!~/ '~/ f~lZ~j~Gyl~r-~ic~Gl'LG¢~ C ~ 3 ~ ~Z:~d ->~ t~ effluent filter and (.U YLt~'h ~ ~• S D S USeptic tank , ~~~ ersal cell must all be serviced /maintained ~ ~~ d s ,, ~~~ ~ a~ i p lmS plumber rovided b nt lan . y p p as per managt;me ~ ~ AIt setback requirements must be maintained--~-- ~~~ ? . i d' ~3 ~ r-OLR- ~~ i~ as era licable code or Inances. Yhil'y,. - ~ Attach complete plans (to the County only) For the system on paper not kss than 8112 x 11 in sin sin ~~ q~ ~ / S ~ l,~ ~li~/~61/ ~ r~ SBD-6398 (R. 01/03) ~/ ~_~= 9sao ~ ~-a = 9y so d 6/k-/ .goo' ~~ ~ ~~ ,3rh-a = ~z~o' T~ ~ti~ r i ~ yo ~ ~` 7 ~V ~ G- ~ ~~5~ ~~ ~'~~~ ~ ~ a-~ ~sy 3Z _ ~ X- _ _ .1 _ ~~, ~ ZZ c~ b~ G 13 ~'a-~ ~,~' a r ~,,~v`' ~uS-1~" _. ~Q"aa03sa Wisconsin Department of C~.ommerce PRIVATE SEWAGE SYSTEM Safety and •Bui;~ ing Division INSPECTION REPORT GEIdERAL INFORMATION (ATTACH TO PERMIT) Personal information ;rou provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Johnson, Jason Hammond Townshi CST BM Elev: Insp. BM Elev: BM Descri lion: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~~ asa Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO /L ~ WELL BLDG. Vent to Air I take ROAD Septic \ ~ t ~ ~ f Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand M Model Number TDH Lift Friction Lo System Head TDH t Forcema' Length Dia. Dist. to We SOIL ABSORPTION SYSTEM i u rln ~__. ~, o.~d / •.~-i.,n ~,~. ELEVATION DATA County: St. Cf OIX Sanitary Permit No: 430203 0 State Plan ID No: Parcel Tax No: 020-1402-07-000 Section/Town/Range/Map No: 11.29.19.2518 STATION BS HI FS ELEV. Benchmark ~ ~ 10 D D ` ~ Alt. BM dom. tv ILL ~ ZY j _ ~ Bldg. Sewer SCM1 ~ ~: ~S / p y~ ~~ St/Ht Inlet ~. ~ ~ ,~ ~~ SUHtOutlet ~. ~ ~YS Dt Inlet ~ Dt Boo / / Header/Man. 7• p 3 q~, I '~ Dist. Pipe I / v - i/ ~. Bot. System ~ • gp ~l l'o • `~ Gra .~ ~ b~ St Cover ~ ~iG~ Vlft~ ~ / BED/TRENCH DIMENSIONS Width ~ ' '~ Length I (~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth 3 1 a SETBACK INFORMATION SYSTEM TO P!L BLDG WE ~ 1 LAKE/STREAM LEACHING CHAMBER OR anufa~ er: I ~ /^•' L L_ CL ~-j 71rD(,Tv T e Of System: ~~ ^~ ( ~,/ / UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold / i I Distribution Pipe(s) t ~ ~ ~~ ~ r / x Hole Size ' x Hole Spacing ~./ Vent Air Intake t Length Dia Length Dia S~acing~_ 3~ 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 / -~ 3 Bed/Trench Edges Topsoil [J,j Yes No ~~',I Yes I ] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~~/~ Inspection #2: / / Location: 799 Starlight Ave /H/udson, WI 54016 (SE 1/4 SE 1/4 11~1',T~9N R19 )Misty View Lot 7~/~ ~ ~ ~ Plarcel~Noo,:C1Q.29.19.2~51(8,,,, 1.) Alt BM Description = In~Cc ~t~~,(,~ -~(~,. r/l~(,tef I `~ ~" ~~ ~ ~ ~S'hCJC-~~° ~Qi4/ ~f~r ~~1j-v7~+~ L~ ~ 2.) Bldg sewer length = Z 3' S 0 1~(~`~~ ~~,~~~~ C'.~~Z Q/4.2J~ ~ ~j3 ~Z/ -amount of cover = ~ ~ Z -~,,P,t,~ S ~o j~ - Plan revision Required? Yes Use other side for additional information. SBD-6710 (R.3/97) __T __ ~, ',6 i G!-~, ~~_'Z~---~3 Date Insepctor's S' nature Cert. No. Aug-19-03 03:OOP OwnerBuyer Mailing Address ST CROIX COUN'T'Y SEPTIC TANK Iv~iADd'1'ENANCB AGRBBMSNT OWNERSHIP CERTIFICATION FORM ~-__.___~..~.~____~_...~.~., AND ~~.;~~~~ P_02 Properly Address l~! - `'~ (Verification required from Phutttiag Department f new constrtretion) ~-e~ t~~~G~,~i-v~ "~~~ City/State ,/1 G~~ ~~T Parcel Identification Number QZ~ ~' ~~~ a'"~~~ -~D I LEGAL DESCRIPTION property Location ~, '/., ~ %., Sec. ~, Subdivision . z sip ~-~l~ T~~N-R,~W, Tows of .Lot # ~!r_ Certified Survey Map # ~ .Volume _ _. ,Page # R/arranty Deed # jp 7 ~ 3 ~ ~ .Volume ~,.~_, Page # ~ Z Spot house ^ yes ~ no Lot lines identifiable yes ^ no SYSTEM Improper use and maintenance of your septic system could result is 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 prnpcrty owner agrees to submit to St. Croix Zoning Department a certification form. signed by the owner and by a mastsr plumber, journeyman Plumber, restricted plumber or a licensed pumper verifying that (1) the on site wastewaterdisposal system is in pmper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is leas than 1/3 full of sludge. Uwe, the undersigned have read the above tequirementa and agree to maintain the private sewage disposal system with the standards cet forth, herein. as set by the Department of Commerce and the Department of Natural Resources, State of Wiseotsia_ Cepcation stating that your septic system bas bees maintained must be wmpletod and returned m the St. Croix County Zoning Office within 30 f the three ye icati n date. $ ~3 S OF ICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form arc true to the best of my (our) knowledge. I (we) am (are) the owner(s) of t'oPertl+ descrrbe bove~ by virtue of a warranty deed recorded in Register of Deeds Office. S ATURE OF ICANT D TE *•*••* Any information that is mis-represoatedauy rc:ult in the sanitary permit being revoked by the Zoning Department.'**"` *• Include with this application: a stamped warranty deed from the Register of Deeds otfiu a copy of the eerbified survey nup if reference is made in the watraaty deed a =1y ~- NU o~ s~ a~r. 9 -aso ~'" 39~ ` ~ ~l y a` ~~ 7 ` v~- ~. g~. ~ o ~.~ ` --- ~/ ,Bra- _ ~ I "'' d F ~. ~~~ ~~ $.a ~,~ ~ x`i ~° r ~ ~~, ~- ~r• H%o ,S~ ~f7,(,c~ ~~ ja , ~_~o '~` U ~Paao3s~ • Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7082 ~~ ~ s ` ~~~O~S~~ Madison, W 153707 - 7082 Sanitary Permit Number (to be filled is by Co.) (608) 261-6546 3 (-~OzD De artmertt of Commerce . rate Plan l.D. Number Sanitary Permit Application asoaal information you provide ~q' Adm Code d with Comm 83 21 Wis I . , p n accor . , . . t-uy be used for stecondary pttcposa Privacy Law, s I5.04(I)(m) ~ roject Address (if different thaa mailing address) f ., I. Appllcatioa Infor lion -Please tat All Information }` -~ • ,: ~ ~-,,- Property Ownu's N r Parcel # Block # 7 ' -o , fO2 ~- di V2o-1 ? property Ouver's Mailing Add , ~ , ~ Property Location ~~ ~ ~/., ~/., Section ~L City, State ip Code ~^-,.., Z baaeNutt~}sor P - ~ C S ~ - 7 /~~~v - ~ T,~IJ~ R~Eoai~) l II. Type of Building (check aU that app y) ~ ~ 54- ,,,,,,~ CSM Ntunbu Subdivision Name S ~l or 2 Family Dwelling - Number of Bedroottts , ' ^ publi~JCommercial - Dacn be Use ~j /~ " -~ Y~ (2 ~ 3 t < ^City ^Vi g ownship of w~ /~p~1AR• • O 1! ) ^ State Owned -Describe Use C.Yw" ~ III. Type of Permit: (Check only one box on line A. Complete Tine B if applicable) 1rJ- pQ A' New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System List Provious Permit Numbs and Date Issued B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a 1 (~ Non -Pressurized [n-Ground ^ Mound > 24 in. of suitable sor ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Prtxsurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculada Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaVTreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System $levation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Stcel Fiber Plastic Gallons Gallons of Units Concrete Conswcted Glass New Existing Tanks Tanks Septic a Holding Talc / ,.,,r { © ` ~ Auubic Treatment Unit posing Chamber VII. Res onsibility Statement- I, the undersigned, assume responsibility for in allation of the POWTS shown oo the attached plans. ess Phone Number i B us n Plumber's Name (Print) Plumb 's Si lure PRS Number u ~G~~ aao 3s~ ~i3 • ~8^ ~q Plumber s Address (Street, City, Stat rp Code) VIII. Coun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee includes Groundwater Date Issued Is uin Agent Signature Stamps) Surchar e Fce) ~ g ~D~ ~ 2~ ^ Owner Given Reason for Denial IX. Conditions of ApprovaVReasons for Disapproval s~e'"" ttiS~~ Q~m..~t~ • ~ei-~ cQ,S'~`aKC.es ~(e .,~~+~. (~;-{~. ~ S~ ~ ~~ ~~ j ~. .at., ',~ ~~';~. "n~~~l.vtn,~.u~ ~ ~ . Attac4 coin kte leas to the Coun onl ror the s stem on a r aOt Ilff than sII2 I t I Iochlf Ia the ~'D 25l' y- ~• T N ~' o~ s~ ~,. 9 aso ~" C~,~r~ a = Ty~~ I `` ~ d ~~ ? , ` V~- ~~. ~ ~. -- ~ ~~~ ~~ ~~ __ 397 ' ~. ,~ . r~~ ~~,,~ , (r. ff %o .S ~ ~j7,(,c~ ~~ ~~, o .~ ~a '~~ U _- Pd 6~zs~L l ~ ~ lzq~ 3 tn~COnsiri Department of Canmeroe SOIL EVALUATION REPORT _ Page ~ of pivision Af tfr andBuildings r in aocoMance with Comm 85, Wis. Adm. Code , County C 'Attach cromptete site plan on paper not less than 81/2 x 11 inches in size. Plan must t indude, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. d Z l~' / ~~ 2 ' ~ ~"-~ Please print all infonnation. ~ by Date Personal inrormation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ Q Q ~- Property Owner Property Location ~~~ Govt. Lot S /~ 1/4~ 1/4 S ~/ T Z ~ N R / E (or)Q Property Owners Mailing Address Block # Subd. Name or CSM# I35 ~! e Trcr;l ielnl City State Zip Code Phone Number ity ^ village [Town Nearest Road ® New Constnu;tion Use: (~ Residential i Number of bedrooms 3_ ~ Code deri~d design flow rate •~ ~G ~ 0 GPD ^ Replaoarrlent ^ Public or commeraat -Describe: ~~ ' ~' 'Parent material O ~ ~~ 5 ~ Flood Plain elevation if appli r~ \,.; . .__ ~ , ,., ft: General comments ~i m '~ /-t ~/ • QG • -~~ ~ ; ,~ ',, and recommendations: ~Y ~L~. C/CJ • ~S• S~ ~\~ ~ti~'~~'"s °°~ .'`~ ' Borng # ~ ~~ Ground surface elev. 99 ~° ft. Depth to limiting factor ~'~. ~{RC O~FtC~ ~ ~~ Rate Horizon th De Dominant Cobr Redox Description Textun= Structure Consistence tad ~ ;, GP D/f~ p in. Munsell Qu. Sz. Coat Color Gr. Sz. Sh. ~ "Eff#1 `Eff#2 ~ o- I 3 3 Zmalrak m ~-5 ~/~ .5 .9 apt' ~•~l Boring # ^ BO""g ®pit Ground surface elev. ~d ~ tt. Depth to Itirliting factor in. Sod Pion Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Rook GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EN#1 `Etf#2 ~ p- / 3 SL- r cs ~.~ . 5 ~ Z / - ~t ---_ LS ~ m m-~ r ~ S - . -7 /. 2 3 ~/~ ti~~ -- mS Q ! - - . ~7 1.2 2 ` Etfltrent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L Effluent ~ = f3tJQ < ~ mg/t_ 8rltl (~ ~ JU mglL CST Name (Please Print} ignature CST Number h Z Address Dam Evaluation Conduc~,ed Telephone Number 21 t `30'5 5y0 /o -/~ -~/ C115~ Z4~ - yov $ Property Owner ~ ~'Ttlt 1 ~ Parcel ID # - ` . h Page ~ of 3 U Boring q Borirx3 # ®P)t Ground surface elev. q9 Z o ft Depth to fimitirxJ factor ~ ~ / in• Soil ication Rate tion x Descri R d Texture Structure Consistence Boundary Roots GP D/ff Horizon Depth in. Dominant Cob Mansell p o e Qu. Sz. Cont Color Gr. Sz Sh. "Eff#1 "Eff#2 I Z O-~3 /~- 3 I~ 3~2. ~ Sc'( ~ f~r ~r c5 c ~ v - . 5 5 .8' ~ 3 ~3-~ r`I~~a -- nnS s ~ - - -1 /.2 Boring # U Bonng Pit Ground surface elev. ft. Depth to larrilmg factor m. Soil lication Rate Horizon Depth Dominant Color Redox Descxip6on Texture Structure Consistence Boundary Roots GPD/fft' in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. "Eff#1 "Eff#2 ^ Boring # ~ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil licatbn Rate i H De th Dominant Color Redox Desrxiption Texture Structure Consistence Boundary Roots GP D/ft? zon or p in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. "Eff#1 "Ef(#2 'Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mgJL ` Effluent #2 = BODS < 30 mg/L arxt TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-2GG-3151 or TCY 608-264-8777. SBll-8330 (R.07/00) Property Owner ~`lT(1~ 1 t Panes ID # Page Z ~ 3 3 Boring # ^ ~ q ®Pit Ground surface elev. 99. Z 0 ft Depth to limiting tailor ~ o / in. Sal ~ RatE Horizon Depfh Daninant Cob Redox Descxiption Texture Structure Consistarroe Boundary Roots GP D/ff in. Mansell Qu. Sz. Cart Cobr Gr. Sz. Sh. 'Eff#1 'Effff'2 o-13 ~ 31Z Sf'( ~ cs I v ~ 5 -8' 2 ~- 3 ~ ~ -F"r c -- 5 ~ 3 ~3-l r`t~i~ nnS s ~ - - -1 /- 2 s~ l ~~ # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil lic:ation Rate Horizon Depth Dominant Cob Redox Description Texture Structure Consistence Boundary Roots GP D/ii? in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 ~9 # ^ ~~ ^ Pit Ground surface elev. ft Depth to limiting factor in. Soil lication Rate Horzon Oepth Dominant Cobr Redox Description Texture Stnx~ure Consistence Boundary Roots GP D/fF in. MunseN Qu. Sz. Cont Cobr Gr. Sz. Sh. •Ett•#1 'Eff#2 ' EtlweM #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgJL ` Effluent #2 = BODS < 30 mg/l. and TSS < 30 mgll_ The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-2G6-3 t 5 I or TTY 608-2G4-8777. SBU-8330 (R.07/00) 1 ~ ~ ti a PAGE 3 OF 3 ~TA A~iF S ~~ T C~T# ~ LEGAL DESCRIPTIONS ~- ~S~'La ,S // T Zq .N.R. ~ 4 E(Q~ U) SCALE:1"= y0 BM 1 ELEVATION lGV ~ O BM 1 DESCRIPTION ~,P o -~ ~ ti ~, Z " (•(; ~ (~ BM 2 ELEVATION `l `~ • Co U BM 2 DESCRIPTION daP a.~ ~g-F. t1 (~~ i~•.'u ~. SYSTEM ELEVATION qG • sU ALTERNATE ELEVATION 9S• 5'a CONTOUR ELEVATION 99 cw, loc?o 0 N SQC. ~ 1 1 ^--- -fi -- I x q o~d o~ 5 2~ ~~s- -~a~m s lay ~a~ ~ , /ocs+,~zai~ ,au. 4.~ ,~ l q g 2 Giht -no a- ~ g,~.l g-( n :ntL e t 4 t ~~'~ h -r ~ ° (3 Z r ~I' -3- ~Sf ~ „ i ~~ `f ` ~~ ~~~ G (~~ ,~ o, ~ ~ u, ~" 3 SIGNATURE i~n~~c~-= /~ ~ DATE /G: - z/ -~/ _ _ ~'~~ Z as an cis p e ~ A -~ i ~a i+ ,++.*oaw~wo~mxre Z 2 i J ~ x i ~ I ~ ~ ~ ~ ~t~~i `~~ ~ ~ ~~~~ ~ ~ ~ ~~ a~E~ ~ ~~~~~~~ ~~~ s ~ ~ ~ 8 ~~ ~~ ~~ ~ ~$ ~ I~ ~ ~ ~ § ~ ~ #~~. ~~~l~ ~~~~~ ~~~~ _~~~ t~- ~~~ ~~ ~~ Z~ ~+ $~ ~~ ~a~~~~a~~~~~ ~6 94~ o~ Z :o¢~ O~ •~ ~ O O ~ ~~~ r S ~ ~r~ 1 1 1 1 1 gS FILE INFQ Owner Permit # POWTS OWNER'S MANUAL & MANAGEMENT PLAN TION J~a7tl ~~ ~ Zo 3 DESIGN PARAMETERS Number of Bedrooms t" ^ NA Number of Public Facility Units ^ NA Estimated flow (average) ~ al/da Design flow (peakl, (Estimated x 1.5) al/da Soil Application Rate al/da /ftZ Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Ya in dia. ^ NA Other: ^ NA 'Values typical for domestic wastewater and septic tank effluent. ruerNrcr-reNr•_F cr•_W~nrri F SYSTEM SPECIFICATIONS Page ~ of Z Septic Tank Capacity Q al ^ NA Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ~- - ~ ~ ^ NA Pump Tank Capacity al )~ NA Pump Tank Manufacturer ~A Pump Manufacturer ANA Pump Model ~ ANA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: l2FNA Dispersal Cell(s) ~In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tankls) At least once every: ^ month(s) (Maximum 3 years) ear(s) ^ NA , Pump out contents of tankls) When combined sludge and scum equals one-third (Y31 of tank volume ^ NA Inspect dispersal celllsl At least once every: ^ month(s) (Maximum 3 years) year(s) ^ NA Clean effluent fiber At least once every: ^ monthlsl earls) ^ NA o y Inspect pump, pump controls & alarm At least once every: monthls) ^yearls- ^ NA Flush laterals and pressure test At least once every: ^monthls) ^yearls) ^ NA other: At least once every: ^monthls) ^yearls) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal celllsl shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY,1 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressuri¢ed components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Pape Z of 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain {sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ~~ T alua ' a o ing tank b e ai ~fZD}~1877E~ ~C~ ~~ L'DNS"?7ZfJ~TtOr~! ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE, ADDITIONAL COMMENTS POWTS INSTALLER Name Phone ~ _ ~ ~ .. POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ST. C ~ Cj ZD~Jl~cJ Phone ~lS- 3~(p- (p (~ This document was drafted in compliance with chapter Comm 83.2212i1b)11-(d1&Ifl and 83.54(1-, (Z) & (3-, Wisconsin Administrative Code. ST CROIX COUNTY ' SEPTIC TANK MAINTENANCE AGREEMENT ` AND ` OWNERSHIP CERTIFICATION FORM saP/-~ OwnerBuyer ~~~ ~~~~ Mailing Address 9~~ ~~~~ ~• . ~~~~,, ~" ~`~d /-G ~ Property Address (Verification required from Planning Depatimenffor new City/State Pazcel Identification Number - LEGAL DESCRIPTION '' // Property Location ~~ %4, .~'/., Sec. ~ T~-R~W, Town of /7' Subdivision /~/5T9 i/iCz~ .Lot # Certified Survey Map # `~~ ,Volume '-- ..Page # ~~ Warranty Deed # ~~ % ~ / ~ ,Volume ~ ~~ Page # Spec house y~ ^ no Lot lines idenrifiable~yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance vonsists 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 mastorplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on :site wastewaterdisposalsystern is in proper operating condition and/or (2) aRer 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 days of the three year expiration date. /~~:~'' S GNAT[JRE ~ PLICANT -7,z~ ~ 3 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 the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. _7 23/3 IGNA OF PLICANT DATE «««««« Any information that is mis-represented may result is the sanitary permit being revoked by the Zoning Department. ****** ** Include vrlth this applicaflon: 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 e 'J 1B93P ly2 ~ STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED Document Number - This Deed, made between _ __ RICHARD O Smnnm and TANFT v Smnrrm hV.sband and wifaa '- - --'- _, Grantor. and _JASnN R _ .TnHNRnN ~nA nAVNA iti Tnpn~en~r -husband ~~I_ wi fp, -~~- '-" -- Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following descri al estate to _.S~ ~`r~i x County. State of Wisconsin: Lot , Plat of Misty View, Town of Hudson, . Croix County; ~fisconsin. ~ '~/.'t--C~t ~ ip"~~ (SEAL) Janet P. Stout 020-1013-30-000 ozo_~n1a_1n_noo Parcel Idenlifieation Number (PIN) This 1S nOtltomestead property. (iS) (IS nVl) Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. Dated this 1 Sth day of May ~nnz . -""t~~ • \, `o ~i (SEAL) Richard 0. Stout Signantre(s) authenticated this AUTHENTICATION (SEAL) aay of TITLE: MEMBER STATE BAR OF WISCONSIN (If not. authorized by §706.06, Wis. $tats.) THIS INSTRUMENT WA$ GRAFTED BY Janet P. Stout _1353 Awatukee Tr. Hudson, WI 54016 6 HLE H x ALSH REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 85-17-2002 10:00 AM NARRANTY DEED EIfEMpT t REC FfiE: 11.00 TRAMS FEE: 200,70 COPY FEfi: CERT COPY FEE: PAGES: 1 R.a. ., ~;,I ~ .,, Name and Return Address /~f iva~.2 Cho" ~c ~ g~ ~ca.d~O~r-, YU~ SYO~o ACKNOWLEDGMENT (SEAL} State of Wisconsin, lI J ss. St. CroiX County. Personally came before me this 1 5th __ day of Md~r 2 0 0 2 , [he above named RirharA n $ ni- anr] Tanct P Rtnttt _ to me known to be ~t+he C r r"~fteabk6(uted the foregoing instrument d aAaTt Qt~s~I~CONSIN NON J. BAST Nota Public, State of c nsin My commission is gg(cI`man~gt^(If ot, to explrauon date: (Signatures may be authenticated or acknowledged. Both are note ~_ ~- ) necessa ) ry. Names of perwns signing in any capaary must be typed or prtnted below tbek signahlre. WARRANTY DEED STATE BAR OF WISCONSIN Wisconshi uegal Blank Co., inc. FORM No. Z - 1998 Milwaukee, Wis. - ~' LV 1 4 -2.001 /-,CRES ~ . 8T,143 so FT ~i t: _\ ~F cD r m 1 ~~ Vt ~ w 1 ~1 ~~ 0 1 °- a 1 1 1 1. ~ LOT 8 1 1 1 1 2.000 ACRES m 87,121 So FT ~ \ .W~ \ ~~ \ ~` /~ \ • ~ ` ~ .._.. ~~ ~ o `; ~? ~ ` . '-.-.- eon -. . ~aa~„w ~ ~\ ~ ~ ? ~ j ~ `.\ S 9°39'33"W 187.30 '~---_^_~`~\ ~ ~~~ ~ ~ \\`~~ N89°°39'33"E 187.30 ~/ D~ ~' ~~ g~ 6~ ~3 903 00 \ r~~a LOT 5 \ ~ 2.536 ACRES 110,489 SQ FT I I I i ~ ~- L - ~- ~ ••.L .. I ~ Mss' O N ~ a N O O r `~ ~ ~ MIN. FLOOR `~ i ELEVATION OF ~~~ ~i 905.00 ~~--~' S89°26'S9"W 368.72' LOT 6 ~ 2.214 ACRES 96,450 So FT 252-07' 398.46' ~ a~ 2.07' ~ ,~ TN LJNE OF THE SE1/4 d04 4 OCR ~o~o~o ~~ dOdo ~ 00 Q G°?LaC~aC~ X77 ° ~ a~ ~I a' CENTER OF 80' R TEMPORARY CUL-DE-SAC EASEMENT TO BI EXTINGUISHED V' ROAD EXTENSIOI r W W I H 0 W Z J -BENCHMARI - ALUMINUM ~ MONUMENT 926.15 M[~p~44f~i SE CORNER SECTION 11 . ~t'~`X Cocx+~y ~`~~t~t~ ~,~ " ~~~ NOTE NO LOTS OF THIS SUBDIVISION MAY BE FURTHER SUBDIVIDED UNDER CURRENT TOWNSHIP DENSITY REGULATIONS. NOTE MIN. FLOOR ELEVATION IS THE MINIMUM FINISHED FLOOR ELEVATION OR THE LOWEST BASEMENT WINDOW OR DOOR ELEVATION NOTE NO OWNER OR RESIDENT SHALL DO ANYTHING WHICH WOULD INTERFERE WITH OR CHANGE THE OPERATION OF THE APPROVED COMPREHENSIVE WATER DRAINAGE AND SOIL EROSION PLAN FOR THIS PLAT. THIS ~ ~_fsSUREMENTS INCLUDES BUT IS NOT LIMITED TO BUILDING UPON, OBSTRUCTING, ALTERING, FILLING OR EXCAVATING, OR PLANTING IN ANY POND -• ~ ~^ 'rn Gec~nnFniTC ~nieTFR nRA~NAC=,F HITCHES. LOT 7 2.002 ACRES m 87,198 So FT t'9 259.61' SURVEYOR: DOUGLAS J. SB~N LAND S 2920 ENLOE SUITE 101 HUDSON, w (715) 386-2C ENGINEER: AUTH CONS 2920 ENLOE SUITE 101 HUDSON, W (715) 381-5: OWNERS RICHARD O. i .IANET P. ST