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Home My WebLink About020-1014-30-125Wisconsin Department of Commerce Safety and Building Division GENERALINFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) ~ J Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Beer, Dan Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: /~ ~ ~ ~~"_ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic C~J.~, 7~-. / ZS O ~~ l Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ / ~ ~ a / 0 ~ ~' _ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CroiX Sanitary Permit No: 453236 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 12.29.19. STATION BS Hi FS ELEV. Benchmark Alt. BM 5 :` C.: z .5~ q8. ~ 5 Bldg. Sewer StlHt inlet 9 ,5 ~ Z SUHt Outlet ~ ~~ ~ ~ r Dt Inlet \ Dt Bottom \ ~, Header/Man. J ~d , Z / b , 9, < Dist. Pipe / O, L ~~ .~ Bot. System Final Grade ~ .3~ St Cover (~, b ~' /6~,G5 Z .5~ 9~~ ~ BEDlTRENCH Width Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~' Q ~ / ~ \ ~~ ~~ \ ~, ~_ ~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer•..~ j. , I ~ ,~ INFORMATION CHAMBER OR ~ ~-v~#~ Type OF System: ~» ~~ ~ Z7 ~ ~ ~ •' ^ IV F'Y ^ /t ~i-} UNIT Model Number:a , DISTRIBUTION SYSTEM Z3 ~.,~~.(,, ~ a~Q, Header/Manifold ~ / Distribution x Hole Size x Hole Spacing VentSo Air Intake, r - ' VJ ~ Pipe(s) ` \ ~ ` ~ ~ l/t-~/~.,~- ''~ - Length Dia Length Dia Spacing C~„ r SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Oniv t "`'d'r Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center ~` ~j'~ /l~J Bed/Trench Edges \ Topsoil ~ - - !Yes ~ No ~ , Yes ~ _~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 844 Moonbeam West Unknown (SW 1/4 NE 1/4 12 T29N R19W) NA Lot 1 1.) Alt BM Description = S~ P~-~ ~- ~v.1PJ~ C~ . ` ~ cti,• rte, 5 d- ~ a~ O v'~. 2.) Bldg sewer length = 5 - amount of cover = /a ~ j~ (_S~_ Plan revision Required? L] Yes No ~ (~~ Use other side for additional information. ~__ _ L -_J SBD-6710 (R.3/97) Date Inspection #2: / /. Parcel No: 12.29.19. L_ ~ ~~_.~ Cert. No. Safety and Buildings Division Cotmty ~ ~" ` 201 W. Washington Ave., P.O. Box 7162 , Q% iseonsin Madison, Wl 53707 - 7162 Sani Permit Number (to be filled in by Co.) (608) 266-151 3 2 De artment of Commerce 2 Sanitary Permit Application State Plan LD. Nnmber In accord with Comm 83.21, Wis. Adm Code, personal information you provide maybe used for secondary purposes Privacy Law, s 15.04(1 xm) ject Address (if different than mailing address) 1. Application Information -Please Print All Information,.,.:,, ..__.__ ......--,..-.m-- --~~-°- _ -°•--I Property Owner's Name Parcel # Lot # Block # - ~ ~ 2e ~ '~ - O~0 - /0/ - 30 ~~ ~~ r ~ ~ ~ F, ~ Pro perty Owa e r's M ai ]ing Address `' ,_ Property Locat ion ~~ // / p / 1 /~~! l..d. /~w ~ i.~..iUi~- r S~ ~/. /l~~/ Section ~i2- City,State Zip Code ~}ppp6 ~IGE , , /Yr~t~0I7 !~ /• S t~~G p ?/ 0 w// " ~ (circle one) T ~ N; R~'$Zr W 11. Type of Building (check all that apply) ~.,~ ~ ~'M' ~ SI-bdiuisiea-Pfaff CSM Nuurbcr Ill 1 or 2 Family Dwelling - Number of Bedrooms tMn C ~ ~~~~ ^ PublidCommercial -Describe Use ~t ~ ^ State Owned -Describe Use v ,,..__,,~~ _^Village Ls?1"ownship of ~SDn ~ ~e 111. Type of Permit: (Check only one bog on line A. Complete line B if applicable) a. New System ^ Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New last Previous Permit Number and Date lssued Before Expiration Plumber Owner IV. T of POW'TS S stem: Check all that a 1 Non -Pressurized ln-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized in-Crmund ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leachin tuber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis rsal/Treatment Area Information ~ ti'/>~~ Cl~ant~t/S /y k' fJ'CiK./+ a~ ,~/. / . ~ = 70 5~' Design Flow (gpd) Design Soil Application te(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sfj ' yttem Elevation S~ ' Gen .d. o. ~ d. s>r ~s7. /s sf ~0. ~o s~ Es, s 8 ~ ~ 89a Vl. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plasti Gallons Gallons of Units / ~~ ~,,, ~ ~ oncrete Constructed Glass Ncw Existing ~/~ Tanks Tanks Scp[ic or Holding Tank / Z ~ ~, / ZS~ ~/ ~~~. / Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the nnderslgned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pl 's Si MP/MPit9 Number Business Phone Number do 2~3~/7S 7/5 to ~~-S/lo6 Plu m be r 's Address ( t, City, Sta te, Code) ~/ J~ y ~ p~ /~ / 1 / ,V. ~ l0 W ~/~~? ~~ S~DZ/ Vlll. Coun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater h Date lssued s ' Agent Signatur (No Stamps) Surc arge Fee) ^ Owner Given Reason for Denial _ 25~ Z$-~ IX. Conditions pprova 21 p~-~ ~ C ~~ ~~~ J / r ~ a~~ l ~j ~~a~Q Q SYSTEM OW IVER: ~~ .. 1 Septic tank, effluent filter and ~, dispersal cell must all be serviced /maintained ~~ - ~' as per management plan provided by plumber. ~ t d ; ~ ~ i i b ~ ~ l~ ~ ,,. .~ . j ~,y, ,vy~ l e ma a ne n 2. All setback requirements must ~~'" "_ -~ as per applicable code/ordinances. Attach complete plans (to the County only) for the system on prat sntha 1/2~r1'o, chca io size L SBD-6398 (R. 01/03) r~ ~. J SLR' r,Z,.sl~ an t.~++N+ ~ ~~ ~ ow N ~ ~\ ~~ I ~ - ~ ~.~,~~ ~ 2 ~ao~ Wisconsin Department of Commer~ s ~. ci~o,x Couiv~OlL VALUATION REPORT Page of Division ofSafetyandBuildings r___- ZONING OFFICE mar:coraancewrm~ornnroo, vns. r~urn. ~.vua er not less than 61/2 x 11 inches in size Plan must Attach com lete site lan on a County ~~' ~~ i ~ p p p . p 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. Please print all information. Reviewed by _< to Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ \rI Y , ~ Prope er ~' ~ Properfy Location Govt. Lo~~{rJ 114 ~1/4 S J ~ T ~ N R E ( ) W P-operiy Owr~r's Mailing Addre ~~ ~ Lo # Biodc # Subd. Name or CSM# City to Zip Code Phone Number ^ Ciity ^ Village Town Nearest Road New Construction User Residential / Number of bedrooms Code derived design flow rate _ ~~ ~ GPO ^ Replacement L ^ Public or co/mmerdal -Describe: ,_.____. __- ________.v_ __- Parent material ~i~f.7-l.~/c:~/~~y Flood Plain elevation if applicable /'~/~ /~ ft. General continents v / and recommendations) fj, j ~. ~ ~,Pi 1/Ck./~~-c~'t~ ~\J ' ~ ~ !' ~p // c-~~ G~-~ PJ ~ ~~ # Boring pit Ground surface elev. ~ +~ : ~. Depth to limiting factor /~ b in. Soil lication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP DlfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 - ~s ____ ~ - l~ Boring # 4 Boring ~ I~ I ~C Pit Ground surface elev. ~ ft. Depth to limiting factor / ~ in. Soil ication Rate Horizon Depth Dtxninant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Z , 2 ~-~ ~ C s- ~ . 3 ~6_ ~ r ~ ~---- ~! S s Nl~ ~ ~? . z-- • Effluent #1 = BOD > 30 < 220 mg/l_ and TSS >30 < 150 'Effluent #2 = BOD < 30 mg/L and T55 < ;3() mg/L CST iYarne {Please Print) S' CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 , ~ '~~-,-- O ~ 715-246-4516 .~ ,2 •~ .~. .L .~ Property Owner Parcel ID # Page of Bonng # ~ Boring ~j ~^Pit Ground Surtace elev C 1 ~ , ft. Depth to limiting factor r ~ ~ in• Soi! ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIff in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ 0-~~f 0 3~z ~--- 5 ~ ~ ~ h'1 C' ,j-- ~~--~ . J . ~-6 ~ ..~ ~ r~ ~K ~ ~ ~^3 .o ` ~f- .6 ~ ~ ~ 3•G. n Boring # ~ Boring l~J U Pit vrounasunac:CeiCV. w. vnyui w unuuny iau~~ ~~~. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eti#1 'Eff#2 ~~ # O Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP DIfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mglL ' Effluent if2 =GODS < 30 rrrg/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 608-266-3151 or TTY 608-264-8777. Sa0.8310 (8.6/00) . {~ .2 .~ Soil Test Plot Pl Project Name Dan Beer ~ c Address 1119 Cty Rd A Hudson Wi 54016 Lot 1 Subdivision ------- Date ~I'M #226900 12/15/03 S W 1 /4 NE 1 /4S 12 T 29 N/R19 W Township Hudson Boring Q Well PL Property Line BM or VRP Assume Elevation 100 ft. County ST. CROIX Top of Steel Fence Post System Elevation 90.3/89.6 *HRpSame as Benchmark Alt. BM Top of Steel Fence Post @ 99.7' 11 lr u• v J e o ~ ~ ~.~. ~~ ~ ,~ ~~. ~ 97.e K 8/ ~ ti~ ^ 1 xs~y~s `. ~~~ `~ 101 s~~ . .~ r-'~.~~~~, Proposed c~resarCo,rc,~,-Fa ^ Sa'/ t/Q/ua+~~v/~oJ~ ~~ ~ ~ . 32 ~ F-XhS~i~~r~tde elegy ~ ~~l ~-/c0 c FF/cc~6 ~. i 63 ~ ~~~ ~ ` ^ `~~ ~•lF..~ a~ occ~lst . • d~orgo. sta~t't y, 4~i i ` . W~4' ~, . ~ ~ rZ°~LnEio+n ~ -. ~ ~ a~est. ~ ~ ~~'°• Proposed ~ ~ ~ ~tlw. a/~:Ao'~o'; 9so' ------- 3 bedr~.--, ~~ ~ ~ _,' res:dctiee j % ~~9¢ ~/oiosh;yL ~~ 1 i ~ S'/d• atds. ~~WeoLl std • jf l?0'~e: KCVO/QC~meA~ of p ~~o c~ ~/. ,v/ /~ L b A1~. B.M. ~ Tp dF.~'' /et S~t~. Elee~ o /o%G3' OPY ~' '' fi u ~b o ~' .~ . ~~ Q ~ ~ ~ ,~ ~- ~ i' 97.'0 ti ,•'' ~~ ~19•r/'Cer~~a/' k 8l ~ ti ti ^ ~~ ~s~~s ~., ~ "~ 1 9~ro' . '~, .~, s~~ ` 1~1 ``~ •~° B2 wLP-i2sar-'-Rsepb'c~~ y, ~ ~ ` O ~'' 1 \~ ~ ~ `~,, ` f~~' ern ~` 9G.ct9' 1 re~n~oY, ~ .. ~ - ~ ~ 1 ~~~• Proposed ~w. elev~-fW.ca ~ ~es;dtnec ~9 /oi.o h+ ~ ~ ~ 9 ~ . ~ did ates. .~ ~Fl-oposed i well ~~ b ,v/ Ate. gym. TP aF.~'' /off SzSrt~. ~/et~: = /o%G3' P10yoose. c~ /'Y(r.8n Q¢a-m ~,tae5 ~ -~ ^. • • doC>~.ead~orgA SaSa~G ~ r1o~Ee : ~yo/oca~„en t GlreQ co:/l/'~u:re ih5~//ctfi; ~...~ I.. • O \I ~• ~/ L / ~ - :. . . f , ~.' A O ~ ~ O ~~ ~ \ \~ ~ ~~ .; .. •., . ~ ~~ . O ~ ~ ~p •t n i 1 -y ` W ~ ~~ ~ .., / I ~ .. s~ ,,5.: O 'b n ~ - ~ ' F~ CA~ r £~ ~~ O ~, W QG 0 ~ ~ C1 (~ `t ~ O N C _ ~ ~ O N POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page f of 2 FILE INFORMATION Owner' ~~ D ~ ' Permit # 1..~,,C~2Z~?J~O DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ~IA Estimated flow (average) gal/day Design flow (peak), (Estimated x 1.5) ~p gal/day Soil Application Rate d _ al/day/ftZ Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand IBOD5) 6220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODBI S30 mg/L Total Suspended Solids (TSS) <_30 mg/L ^ NA Fecal Coliform (geometric mean) 5104 cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity /~ Z $T' al ^ NA Septic Tank Manufacturer ~c>`cQ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model _. ~ ^ NA Pump Tank Capacity al A Pump Tank Manufacturer ~AVA Pump Manufacturer A Pump Model ~ ~CNA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~A Dispersal Cellls) ~[In-Ground (gravity) (^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: A Other: q Other: ~q MAINTFN~Nr_F S(_HFI)111 F Service Event Service Frequency Inspect condition of tankls) At least once every: ^ month(s) (Maximum 3 years) earls) ^ NA Pump out contents of tankls- When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dis ersal Cellls) P At least once every: ^monthls) (Maximum 3 years) ear(s) ^ NA Clean effluent filter At least once every: ^monthls) 2- yearlsl ^ NA ^ monthls) p~A Inspect pump, pump controls & alarm At least once every: ^yearlsl r - - ~ ~1s) ,~A Flush laterals and pressure test At least once every: yea~js Other: At least once every: ^ year) Ils- ~NA Other: l}I~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 Cellls) 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 IY31 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 pressurized 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. Page Z of Z START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) 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 celllsl in one large dose, overloading the cellls) 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 r~lacement 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 ttank b e ai a ~Rullt8 rr~. x'02- /~/~1'/ LONS'T7eclc-~1.o*~ ^ 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 ~ ~j"r~J Phone ~ S- POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ST. C ( OU ZO~I~CI Phone ~/S- 3gC0- (O t] This document was drafted in compliance with chapter Comm 83.22(2-Ib11111d1&(f) and 83.54111, (2) & (31, Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAIN~'ENf1NCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/~~ ~c~, ~A.t, r' Mailing Address /~~~ eo • ~cc7 S/ .~ , ~,c~ S ~,-~ Property Address City/State t..~. (Verification required from Planning Department for new construction.) LEGAL DESCRIPTION Parcel Identification Number 02D -/d/~ ~' ~~ T ~S r gr ~ a 2G • ~ a•t~lt- i C U /2 Property Location ~~ '/a , ~~ '/< ,Sec Subdivision Certified Survey Map # Warranty Deed # ~c T LZ~N R /9 W, Town of ccolSO» ~~ ~C e{~7~' C~J °~ o ,Lot # ~ ~~ ~_, Volume ,Page # Volume ~{O ,Page # SC7 i Spec house (~s ^ no Lot lines identifiable ~es ^ no SYSTEM MAINTENANCE Ce~C Improper use and maintenance of your septic system coul result in its p mature failuyre 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 County 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 I/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 ent w' 30 days of the three yeaz expiration date. ~/ / `ice IGNATURE OF APPLICANT DATE OWNER CERTIFICATION I/we certify that all statements on this form aze true to the best of my/our knowledge. Uwe amaze the owner(s) of the property de 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. ~/ ~~',~/ SIGNATURE OF APPLICANT DATE ****** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. • .-... ...-. .. ~ - a ' i I ~ m CURVE DATA TABLE (ALL LENGTHS ARE IN FEET) ~ ~ m ~ N Curve Radius Cerlhal Chord Chord ArC Tangent Bearings ~ ~ Number/ Lot Length Angle Bearing Length Length Tangent In Tangent Out ~; a m C t 233,00 25°14'45' ST7°38'13.5'E 101.84 102.67 N89°48'24"E S64.58'51'E O Z T 1 233.00 19°14'21' S80°38'25.5'E 77.87 78.24 N89°48'24"E S70°59'15'E o~ m m 2 233.00 08'00'24° S67°59'03°E 24.42 24.43 S70°59'15`E S64°58'51"E ~ ~ z C2 187.00 47°37'51' S88'4T47"E 134.87 138.83 S64°58'S1'E N67°23'18'E ~ ~ m C3 233.00 18°47'36' $08°37'08"E 76.08 76.42 S19'00'S4'E $00`13'18"E ~ G4 167.00 18°47'38' N08'37'OB'W 54.53 54.78 N00°13'18'VV N18°00'S4'W ~ z O C5 233.00 35°53'31' N82°55'36.5"W 143.58 145.96 S79'OT38°W N64'S8'S1'W m ;~ m C6 187.00 25°14'45• N77°38'19.5"W 72.99 73.58 N84°58'51'W S89°46'24'W C7 292.00 29°08'36' S59°52'28"W 147.01 148.81 S74°27'1tiW S45°17'40'VV C8 233.00 17°32'54' S54°04'07"W 71.08 71.38 S45°i 7'40'W S82°50'34`W ~' UNPLATTED LANDS END ---------------------.-------_____ UN ALUMINUM COUNTY _ _ _ _ _ "- 589~46~37~~W 438.3 ~ '~- I N CORNER MONUMENT 319.85' 118.53' OUN 1' OUTSIDE r`°-~+ • t~ DIAM TER IRON PIPE i `, S 1' OUTSIDE DIAMETER BY ,,..-~ I !~ Q~ ~C' 1 LONG IRON PIPE, WEIGHING ~ tl J ~'" .13 LBS. PEA UNFAA F00T N ~~ I ~f T (50' F pM RIGHBT-OF•WAY) i n LOT 7 ~ z ; p i ~ FOUND 2"OUTSIDE ~--+ ; O 2.485 ACRES ~ Q ; C"' DIAMETER IRON PIPE ~ (108.252 SO. FT. ~ O ; ^ ~ ~, ~ ~n ~ , ~ EXISTING FENCE ~1 ~ Ct7 ~ d `O- ~ ~ ; ' - - 12' WIDE UTILITY EASEMENT ~ ~ ~ ~ LOT 2 ~ ; ~-- PROPOSED DRIVEWAY ' ~ v 2.434 ACRES ' , ' C>7 ~ z tJ1 I n ; a ~ (IO6.o44 So. FT.) -v ; N _ (~ ^'~ o ~ ; ~~~ o g a~ ;~ ro ~~' ~~ ~ ~' W 9°48'24"E ~ ~ r ~ ~ ~~~ '- ' Y ' r-~ ...... ~ ~ G t ~ .... ' ~' `' ` 1 ~ 1 Vi `1 ,~,y ~, O~z ~ ........ ~• - a~ SOT 3 '~,'d z ~ ~, ~ ~, , Z , ~ ~ LOT 4 ~ t~ ~ 2.419 ACRES ~ ,;~ - 3.252 ACRES ~'~ (105,370 SQ. FT.) •p `, +~ ~ ! C-` ' (141.655 SO. FT.) ~ I ~ ~;~ ` L.l ~ ~~~ / ~ el ~Gw •-r ~' ~ 33' 33' ~ °Q D~25~96.1 T 459.02' (N89°57'28'VV) ; 66 312.16 t 890.88' ~~ r V ~ - N89°a6~3~"E 837.1 \ EAST•WEST 1/4 ~ E1/~a COR. /ua coA. ~ LOT l ~ --~ ~~ I--s6' LINE LOT 13 sec. ,2 ---- ---- ~c.,2 I ---~------ ° ~ N89 48'37'E 5324,23' ~~ ,O I PLAT OF ~ i° ;z I MOONBEAM RID~L •p,Qg~~ ~'~ ~1~ ,~~~ ~. Hetchlera.,xusband ,ana ~..ht~~'~ ... .. ....... ..........................................a..................... eoasreyf sad warraab b~...AATi~~~...Rt...~'~4~..I~~~?berly,~A_s. ...... ~ ~ ° .:. Hee~,..hlisband..and..rife.,...s.~..lnar~.te.J...R1;A,Rlrh ~y...... ..:ariLh..rig;hLs..os..aurxivarship..........~ ................................ ' ..... f the following described real astab is .. St,!,,,CI,01X -.-,County. Stab of Wisconsin: SEE EXIiIBIT "A" ...: _. y~.- ~`~• FFF TN~e waea asssavse roR iaeaeoiRS a-*R ~'d ~Reooid Ili 6th ~- ~_~~.a t~B6 t~ ' i l - '~ ~c~u~N ro Tas Parcel No: `f This .~S..a'~G~...... . j` ....._ homestead property. ~~ (is) ('u not) i Exception to warranties: ~~ SubJect to Baser.:ent:.~, reservations and restric*.icns of reccrd. Dated this ..~.,k1~X'S~ .................................. day of .......Q.Ct~~er. ......----------•---- ...-...........---. Ia... EE. .....---•--•-• ......................................................(SEAL) .. ...Q.~~- - .. .- - -- - .... ... ...(SEAL) -.Roger--•.E=.. Hetchler---.. i .................................................................. ~ t ..............•-----•-----...........................---.....-.......(SEAL) •-- --- -- - -..` ..........-..........-..............(SEAL) Ma etchler AQTSBNTICATION antbentieated !.hif .._.._..day ot...____°-• ................ lsa...._. IE ~tt_ TITLE: MEMBEB STATE BAIT OF WISCONSI:~i (It not- ------------°--...---.. ... ....°-------°•---..-.._. t~ authorized by ~ 706.06. Wis. Statf.) ~~ ~ T'`'_ IN~fTRUM6NT, /WAa DRArTlD Sr j (Signatures may be authenticated or acknowledged. Both are not necxssar'.) ACHNOWLSDC~MSNT STATE OF WISCONSIN ss. --....... $t .,, CrO~X.---.._._.l:ounty. Personally came before me this .. 3rd...._._day of _....._.._BCtOb~r.-___-....-•------+ 19.86... the above named ........._Ras~r..E;~..H(:t~hl.er._and ............................ ......_._.Mary__.I.._.H~~~hlar ....................................... to me known to be the person 5_........_. who executed the foregoing instrument and acknpav a aspic. ,~ ~gpi !~ --- •----- -- --- -------- --~- 1---::-~:....... Notary public ..............~ ~ ;~r. -.... • CopirB,t; Wis. My Commission iqq perrnt. (IQn~, to .~ttation i t `' a~. ~`~ ~ ~ ~' s ~ ' ~. ~ - ~ a ~ ~ ~ rq _ _.r e ~ ^ t - ~'~"~ r 5~.~'~ 1-sue w'. ~~`- ~.~ x # H~ - ~ -, r .. ~ Y~~ .[ aF it •• ,_ .. f k '' ~ ~ ~i ~{ ~ ' ~/.r. J ~~' .A~':~ if ~ NYr ~.ti `K. .~ _ . ~- -~ ~ ~-~ ~ : Qom ~ 56~~` ~ 5~ ~ Y ~ ~~ . . ~~ ~. ~~~ s~ ~~~-~ EXHIBIT. A; t s- ~ +~ F ~` z ~,, The~W~ of the rSE}.' except fhe~ Bast 33 feet of the South. 264 Teets ,~~. w.,. :and. a parcel in the E~ of the SE}, described ass Comsencing -,::~~. 4, ~` at Che SouthwesE-'corner of Section 12, thence West 462 feet, thence North 264=feet; thence Weat Sgt feet to a steel post and the,Potnt.af'Beglnoing; thence West 27b fRet to the West line ,~ " of said E of SE}; thence North 2,367.05 feet to the North line ,~ t.. of said E~ of SS}; theace East along said North Iine 276 feet; - thence South Eo the Point of Beginning; and the South 53 rods- of the SW} of the NE} and the East 74 feet of the South 53 rods .:~. of the SE} of the NWT;, except the following described .two pa.rcelst ~~ 1} Commencing •'at the Northwest corner of t~{ a SF.} of Sec- ,~,,, `- tlon 12; thence East 763.1 feet; theace Soutn 1,98C' feet;: ~ • ,~'" ^ -,- thence West 103.1 feet; thence Southwesterly to a-point ~a ,~~~x - 165 feet'East of the Southwest corner of the SE} of said .' 5ectian l2; thence Weat 165 feet; thence North 2,640 feet I •, to the. Pointof Beginning,. together with a nun-exclusive ,_~., 33 foot vide right-of-way easement fro® this parcel to ~`i~~ I _ 4 the Towa Road. ~ - _~.. 2)~ A arcel of land located in the SW} of the SB'~ and ,a the SE~ of the SE} of Section I2, more fully described `° ~` as follows: Commencing at the South quartercorner of said Section 12; theace South 89°56'43" East (assumed bearings referenced to the'monumented East. Line of said . SE}, bearing North 0°05'01" East), 165.00 feet along the '- k, South line of`said SE} (previously recorded as East),. to '' the Point of Beginning; thence continuing South 89°56'43"' ~'~ East, 1,071.32 feet along said line; thence Easterly, 20.78 I ~ feet along khe Northerly right-of-way line of an existing.. Town Road on a 603.00 foot radius curve concave Southerly, - ,~ whose ehosd hears North 80°33'37" East,. 20.78 feet; thence ..North 81°32.'51" East, 46.72 feet along said right-of-way - ,- line; thence North, 253.55 feet along the Easterly right-of-way line of a proposed town road; thence South '~ 89°57.16" East (previously recorded as East.), 30.1.06 feet; ' ''i thence North 0°02'46" Esst, 475.00 feet; thence Nurth 62°15' West, 838.00 feet; thence South 16°08'29" East, - ~~. 499.45 feet;. thence North 88°32'38" West, 343.31 feet; thence South 36°55'27" West, 821.47 feet to the Point.o[ ' Beginning. . Together with a noa-exclusive easement for ingress and egress ' over the drive and cul de sac as presently laid out and traveled located in exception (2) above; and also an easement for ingresa._ '~ - and egress over a parcel described as follows: Commencing at - the South. quarter corner of Section 12; thence South 89°56'43" .East, 165 feet along the South Line of said SE};.thence North 36°55.27" East, 821.47 feet; thence South 88°32'38" East, 343.31 feet; thence South 16°08'29" East. 147.56 feet to the Point of ' Beginning; thence North 16°08'29" West, 147.56 feet; thence North 88°32'38" West,. 75 feet; thence South 16°08'29" East to - _ - the cul de sac above described; thence Northeasterly along the curve of the cuI de sac to the Point of Beginning. '~ AlI that part of Lot 4 of the Certified Survey Map filed and recorded in the Office of the Register of Deeds for St. Croix County, Wisconsin on~May 8,..1984 in Volume "5", Page 1417, Docu- . ment No.,3931I1, which lies North of the centerline of the 66 foot roadway easement,as si~own on said Map. _ Together with an easement to use the 66 foot roadway easement II shown on said Certified Survey Map as an acclss read and for _ utility lines located so as not to interfere with its use as a road. Sec. 12-T29N-R19W. _ `, _ ,. `~, 765'942 VOL 18 PAGE 4772 KATALE~A H. Y7~L~SA'-~ REGISTER OF DEEDS CT l~lIATV f•A YT CERTIFIED SURVEY MAP LOCATED IN PART OF THE SW1/4 OF THE NE1/4 AND IN PART OF THE SE1/4 OF THE NW1/4 OF SECTION 12, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. SURVEYOR: PREPARED FOR: DOUGLAS J. ZAHLER DANIEL 8, KIMBERLY BEER S & N LAND SURVEYING, INC. 1119 C.T.H. "A" 2920 ENLOE STREET HUDSON, WI 54016 HUDSON. WI 54D16 BENCH MARK: TOP OF 1"IRON PIPE, ELEVATION 945.9 'r 1 ' ~O ~~ iNi~ l i '~~n ~ ~ ~ ~ ~ ~'O _ ' 'zH V I ~~,a ~~y~H ~ ~ v ~ ~ 'rim Ig ' .o W w J .~ ~ ~'o ~,~ ' i r'te' ~~~ ' ~z ,~ ~c DRAINAGE EASEMENT "C LINE TABLE # DIRECTION DIST. C1 N89°46'24"E 30.00' C2 S00°13'31"E 102.62' C3 S24°59'25'E 56.1 T C4 S09°35'48'W 64.25' CS S52°04'28"W 53.81' C6 N00°13'31"W 249.84' --- - -------- ---- - ----- - -- S89°46'37"W 438.3' '--It ^~ read wllntn 3~W tlt~ rf 31 85' A5 118.53' #~ ~p p M~1 a FOUND ALUMINUM COUNTY SECTION CORNER MONUMENT FOUND 1. OUTSIDE ~ DIAMETER IRON PIPE SET 1. OUTSIDE DIAMETER BY 1 18" LONG IRON PIPE, WEIGHINCS 1.13 LBS. PER LINEAR FOOT ROADWAY SETBACK LINE (50' FROM RIGHT-OF-WAY) FOUND 2" OUTSIDE I DIAMETER IRON PIPE - EXISTING FENCE - 12' WIDE UTILITY EASEMENT PROPOSED DRIVEWAY ti ~~~~ N ~ ~ ~~ ~o DRAINAGE EASEMENT "A" LINE TABLE DRAINAGE # DIRECTION DIST. # DIRECTION DIST. EASEINENT'B' Al S75°40'S6"E 37.4T L13 N41°30'44"W 166.29' LINE TABLE A2 S56°25'22"E 79.98' L14 S19°01'47"W 24.41' # DIRECTION DIST. A3 N88°32'42'E 62.82' L15 S50°35'52"YV 30.68' 61 N89°48'24'E 30.00' A4 N05°22'54"W 52.76' L16 S76°30'55'W 30.78' B2 N00°13'31"W 88.10' AS N89°46'37"E 159.06' L17 N83°35'3T'W 35.20' B3 N88°02'25"E 44.62' L6 S17°1T18"E 71.22' l18 N26°41'08"W 117.4T 64 N09°00'06"E 81.90' L7 Sl9°01'47"W 44.83' L19 S88°32'42"W 68.32' 65 N34°56'38"W 82.32' L8 S41°30'44"E 169.99' L20 S64°15'04"W 26.88' 51.11' ° ~ D L9 S00°09'S7"E 257.50' L21 S41 °58'39"W 56.48' 268.66' " ' ° ' ° " ' ' ~~, QROIX OOUNTY L10 57 W NOO 09 ° ' ` 32.53 L22 S58 20 02 W 46.31 I~ I~ ~~ ~~ Ps*~ C°mnlNtee L11 73 15 N32 W 18.84' L23 N00°13'31"W 152.89' L12 N00°09'57`W 222.62' ~ U N 1 $ z~~4 UNPLATTED LA NDS , r Ivor °hva~ C OJ/ T 1 I .ID w1/4 coR. LO N E PLAT OF ~ ---------- ~ 11 ~ F SEC. 12 5324 23' -------------- i NOTE: ~;o D ;z~ NO OWNER OR RESIDENT SHALL DO ANYTHING WHICH WOULD i ~' ~ i W I INTERFERE WITH OR CHANGE THE OPERATION OF THE APPROVED i ~ COMPREHENSIVE WATER DRAINAGE AND SOIL EROSION PLAN FOR ~~ THIS PLAT. THIS INCLUDES BUT 1S NOT LIMITED TO BUILDING UPON, OBSTRUCTING, ALTERING, FILLING OR EXCAVATING, OR PLANTING IN ANY POND EASEMENTS, WATER DRAINAGE DITCHES, WATER RUNWAYS. WATER CULVERTS, BERMS OR GRASS SEEDINGS. THIS INSTRUMENT DRAFTED BY: WILLIAM KANE JOB NO. 6134-02 DATE: 01/06/O4 REVISED: 06/11/04 RECEIVED FQ8 ~tECORD 06/16/2009 08:00A11 CERTIFIED SURVEY MAP REC FEE : 15.00 COPY FEE: 4.00 PAGES: 3 SCALE IN FEET 1" = 150' 150 0 150 SHEET 1 OF 3 SHEETS ~~~ C A .., Wmx O O T ~~~ o, ,~~ ~',,~ ~~~ ~~~ ^~ ~`~ ``V m m ;, ,; ~~ ~~ ` E1/4 CDR. SEC. 12 ~ MOONBEA_ M RIDGE - -------LOT 13------------- Vol 18 Page 4772 Parcel #: 020-1014-30-100 Alt. Parcel #: 12.29.19.61 C 020 -TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 06/16/2004 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-owner O -SULLIVAN, DALE M & MARY L DALE M & MARY L SULLIVAN 3125 44TH AVE S MINNEAPOLIS MN 55406 Districts: SC =School SP =Special Property Address(es): • =Primary Type Dist # Description "844 MOONBEAM W SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.485 Plat: 4772-CSM 18-4772 020-04 SEC 12 T29N R19W PT SW NE & PT SE NW CSM Block/Condo Bldg: 18-4772 LOT 1 (2.485 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-29N-19W SW NE Notes: Parcel History: Date Doc # Vol/Page Type 08/17/2004 771922 2639/422 PR 08/17/2004 771921 2639/419 TI 08/12/2004 771508 2637/01 WD 06/16/2004 765942 18/4772 CSM ore.. 7(lA~ CI IMtUARV Bill #: Fair Market Value: Assessed with: 0 08/10/2005 08:58 AM PAGE10F1 Valuations: Description Class Acres Land Improve Last Changed: 03/10/2005 Total State Reason Totals for 2005: General Property 0.000 Woodland 0.000 Lottery Credit: Claim Count: o Certification Date: Batch #: 0 0 0 0 0 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00