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HomeMy WebLinkAbout020-1356-18-000,. %. 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 ^ T4yvn of: Bast, Kernon Hudson Township CST BMElev.:- Insp. BM Elev.: ~ BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~ Z~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. Vent to Airlntake ROAD Septic ~rj-p Z t '-" NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION rer Model GPM TDH ~i~Ft~ ~ Frict~A~ I S~rstem ~ TDH Ft fouemain I Length I Dia. SOIL ABSORPTION SYSTEM (l2~ ~ '/D~) ist. To Welt Yh ~~~ O ~T ' `~ RENCH Width r Len~tf~ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM , '~~. ~ DIMEN I N SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: ~~ ~ ~.~ u.~ INFORMATION TypeO "` ~ r ' ~ '-' CHAMBER o elNumber: ~ - C System: ''~ ~ ° -- OR UNIT y~P-ti-c., f~ - DISTRIBUTION SYSTEM Header / anifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake ~ Lengt Dia. ~ Le `----` 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 ~ f Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: fit°/ ~'/~ Inspection #2: / / Location: 704 Paul Burch Drive, Hudson, WI 54016 (NW 1/4 NW 1/4 14 T29N R19W) - 14.29.19.2080 Grass Range Addn. II -Lot 18 ~ ~ ~~~~ ~ a,~,i'ay2._ l.) Alt BM Description = U ~ 2.) Bldg sewer length = v 3 ~ ~ ~ ~t ' 1- -amount of cover = ~ 2 `~ ~ ~~ ~ ~- ~"~°"0~-~ ~ K~- °``~~""'-- ~"~- Plan revision required? ^ Yes (~ No K~^y Use other side for additional information. 04 ° ~' cst~ ( (O SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. ELEVATION DATA County: St. Croix Sanitary Permit No.: 363862 State Plan ID No.: ~- Parcel Tax No.: 020-1356-18-000 STATION BS HI FS ELEV. Benchmark ~~~oZ 8.62r t5'D•c7 alt. BM ~ (~ " ~ eq. r 2 Bldg. Sewer • ~p X03, q2~ St/Ht Inlet ~~D o2.92~ St/Ht Outlet ,~(p cZ-~. ' Dt Inlet -~- Dt Bottom _ Header /Man. H' ~ (Do . Dist. Pipe ~ q.oo o•o' Bot. System ~ 9 ' fO z' 0 Final Grade ~ St cover ,2~ ~b p (~ . Z2- ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~~~~ ' ;~~ E ~ ? r ~ ~ ~I E ~ ~ ~ ~ ~ ~~ ~ ~ ~.... I ~. ~. - I ~ ~ ~I ~~ ~ ,~ _ __m~. ~. ®. ~.... ,~ . ``~~~ ~~isconsin Department of Commerce ~{ ~,~V (r ~t ~ r( SANITARY PERMIT APPLICATION In accord with Comm 83.05, Wis. Adm. Code Safety and Buildings Division 201 W. Washington Avenue P O Box 7302 Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the syst (~ a ~r n t, / County ' than 8 v2 x 11 inches in size. Y ' " ~ ; ~ ~, , .~ • See reverse side for instructions for completing this app 'C3f~ yon '~ s R ` . tale Sanitary Permit umber F~F - ~ ~~ ~ ~p __ Personal information you provide may be used for secondary purposes ' ._ /".~q ~ - 3 heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. ~ ,-: ~: .~ ~ St to Plan I.D. Number ~- I. APPLICATI N INF RMATION -PLEA E PRINT t NF ~ ' Prop rty Owner Name ~'~ It/dLf/ i9-,S'~ rty LocaY ri r~~ T2 f , N, R E (or f~ Property Owner' Maili Address ~ of Number Block Number b O City, t to 41~ Zip Code Phone Number ( ) ame o>{SkHdsrntber II. T F ILDING: (check one) ^ State Owned ~ ~ It~ ~ Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms rows of III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ^ Apartment /Condo -. S ~ - ~ 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Mer ndise:Sales/Repairs 11 ^ Restaurant/Bar/Dining 4 ^ Church /School 8 ^ M bile Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1. ~ New 2. ^ Replacement 3. ^ Replacement of 4_ ^ Reconnection of 5. ^ Repair of an -_____System ________System _____________ TankOnly______________ Existing System _ Exlstin~System B) A Sanitary Permit was previously issued. Permit Number ~6 L Date Issued g'_yl-eo V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution .Pressurized Distribution Experimental Other 11 Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 Seepage Trench 22 ^ In-Grown Pressure ~ 42 ^ Pit Privy 13 Seepage Pit ,2 - 3X7 43 ^ Vault Privy 14 ^ System-In-Fill ~ ~ Lam' S S VI. ABSORPTIONS STEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System E v. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ~l JQ10~ Elevation D L ,d Feet p ,D Feet VII. TANK INFORMATION Ca aclt in altos g Total # of Manufacturer s Name Prefab. Site Co"- l Fiber- Plastic Exper. N E i i Gallons Tanks Concrete stee glass App ew x st n strutted Tanks Tanks Septic Tank or4leidewe~T.ink ~ ~ ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installatio the onsite sewage system shown on the attached plans. Plumber's Name: (Print) .-~ Plumber's Signature: N tamps) #AREMPRSW No.: Business Phone Number: © ~- ~ ~ PI er's Address (Street, City, St te, Zip Code): 3v ~ ~ IX. COUNTY / DEPARTMENT U E ONLY ^ Disapproved Sanitary Permit Fee (IndudesGroundwater ate ssue Issuing Agent Signature (NO Stamps) Approved ^ Owner Given Initial Surcharge Pee) ~ ~~~ 266 Adverse Determination X. CONDITIONS OFAPPROVAL /REASONS FOR DISAPPROVAL: ~ ('.~ SBD-6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSYRUCTION5 1. A sanitary permit is val id for two (2) years. 2. Your sanitary permit may be renewed before.the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD-6399) to be submitted to the county prior to installation ~+ Y~~ 5. Onsite sewage systems must be properly mairitained.V The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years, 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings•9ivisio-~, 60&2$6-3151. ~ ~ - ~ -- -~ y ~ • ~ ~ -~ To be complete and accurate thissanitary~permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed: ~ ' II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VIL Tank information. Fill in the capacity of every raew/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Instailing,plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Piumbermust-sign application form. - IX. County /Department Use Qnly. X. County /Department Use Only. Complete plans and,specfications not smaller than 8 1/2 x 11 inches mustbe submitted to the county. The plans must include the follovuing: ~Aj plot plan, drawn to scale or with complete-dimensions, Iocatiori oT holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump per#ormance curve; pump model and pump manufacturer,_D)-cross section of the soil absorption system if required by the county; 1=j soil test data orY a 115 form; and'F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 41b~included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. _ _ _ , , , The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. GD/ # /~ ~ JCL / ~. -` ~ ~ .~- / -- ~, ~ Tf'P off' S r~~ E , wo.p ~ ~~ ~1~Z ALT d/N ~ TD ya 0J~ ~ ~~ ~ v G f~t~~' ~03.a'. / x =,~~~ = ~v~GG • . {vr~,v.~ DoT ro,~rri~rt ~~c,r~r/,eo As' O = /,. mad ~ cv~~s ~'.i ' E y3s I~ys ~t P~ ~wr \ r ~ ~ f ti ~( /~~l~ #si ~~ Feg~ Plumbing #221180 28288 McKenzie Rd. Spooner. WI 54801 (725) 635-9609 ~~ .~ ~~j 3 L°~ ~ ~, 2 7~r/c-7L~' fhtEGGS #~ / ,Z - 3 X > ~ ~ T,C~%rC/S~ES . -~ ~-~ ~ PAL ~~.~~- ~J~- `~SC011S%11 SANITARY PERMIT APPLICATION Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code • .Attach complete plans (to the county copy only) for the system, on paper not less than 8112 x 11 inches in size. • See reverse side for instructions for completing this application Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1) (m)]. Safety and Buildings Division 201 W. Washington Avenue P O Box 7302 Madison, WI 53707-7302 county State Sanitary Permit Number ~ f~ ~ ~ ^ Check if revision to previou plication' State Plan LD. Numbi I. APPLI A N INFORMATION -PLEASE PRINT ALL INF RMATION Pro erty Owner N e Property Location 1 is t ia, S / ~ T ~ , N, R E (or~ Property Owners Maih Address ~ Lot Numt~pf Block Number City, State Zip Code Phone Number Subdivision Name or r 1 . TYPE F LDING: heck one) ^ State Owned o !ty Vill Nearest Road Public 1 or 2 Faml Dwellin - No. of bedrooms ^ age Town of !~ ,~ III. BUILDIN USE: (If building a is public, check all thatapply) Parcel Tax tuber(s) , V 1. /~~ ~~~ 1 ^ Apartment/Condo -/3~~ '~~ ~ I~ID~ 2 ^ Assembly Hall 6 edical Facility/ Nursing Ho 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ rchandise:Sales/Repair 11 ^ Restaurant/Bar/Dining 4 ^ Church /School 8 ^ Mo ' e Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Offic Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one box o ine A. C ck box on line B, if applicable) A) 1 ~ New 2. ^ Replacement 3. lacement of 4_ ^ Reconnection of 5, ^ Repair of an -_____System -___--__System ankOnly______________ Existing System ____-___ Existin~System B) ^ A Sanitary Permit was previously issue P mit Number Date Issued V. TYPE OF SYSTEM: (Check only one) ~~~~~ Non-Pressurized Distribution Press ized Distributi Experimental ether ~l/-/ad•9 11 ^ Seepage Bed ~~~ 2t Mound 30 ^ Specif Type X41 ^ Holding Tank 12~Seepage Trench S~iC~s ^ In-Ground Pressure Z~- 3'~ 7s'~ '~'~'~~= 42 ^ Pit Privy 13 ^ Seepage Pit 43 ^ Vault Privy ~ S ' '~ ' ~ 14 ^ System-In-Fill~,S S J(~(.2 o /J ~ . s/s/7~ VI. ABSORPTION SYSTEM I RMATION: / 1. Gallons Per Day 2. Abs p. Area 3. Absorp. Area 4. Loading Ra 5. Pert. Rate m Elev. 7. Final Grade Requ' d (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft. (Min./inch) Elevation i ~ S~t3 2-S , d ~ eet 1~ p , eet VII. TANK Ca aut INFORMATION in gallons Total # of Manufacturer's Na site con- l Plastic Appr N E i i Gallons Tanks Concrete stee g ass ew x n st strutted Tanks Tanks Septic Tank o -~ / 4j `~ ^ ^ ^ ^ ^ L ^ ^ ^ ^ ^ VIII. RESPO IBILITY STATEMENT I, the un rsigned, assume responsibility for installation of onsite sewage system sho on the attached plans. Plumber's N e: {Print) Plum er's Signature: (No St s) 1CIPfMPRSW No.: Business Phone Number: Plu er's Address ( treet, City, State, Zip ode): o ~' O~ IX. C U TY / EPARTMENT US ONLY ^ Disapproved Sanitary Permit Fee (IndudesGroundwater ate ssue Issuin Agent Signature (No Stamps) Approved Surcharge Fee) ^ Owner Given Initial Za S ~ p - `G~ - . Adverse Determinatio o 0 X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: $BD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, plumber INSTRUCTLONS A sanitary permit is valid for two (2) years. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Admjnistrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. ~t 4. Changes in ownership or plumber requires a Sanitary Permit'Trarisfer/Renewal Form (SBD-6399) to be sub ' ted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed~mper vvheneVi:r necessary, usually every 2 to 3 years. ,r~ `~. - . 6. If you have questions concerning your onsite sewage system, contact your local code administratoX^br the State. of Wisconsin, Safety and Buildings Division;=808-266-3151. - ~ .%~ - _ ., ~`f To be complete and accurate this sanitary permit application must include:. ,f ' I. Property owner's name arid~ mailing address. Provide the legal description and pars tax number(s) of where the ~, system is to be installed. ~ II. Type of building being served. Check only one and complete # of bedrooms i~7j or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that app)y. IV. Type of permit. Check only one on line A. Complete line B if permit is fasi• tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, Fist the total gallons, number of tanks and manufacturer's name,.indicate prefab or site constructed and tank material: Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement: Installing plumber is to fil{-in name, license number with appropriate~prefix (e.g. MP, etcJ, address and phone number. Plu.mber,must sign application form. IX. County /Department t~se Only. ::. ": ~: County/Department Use Onty. t: Complete plans and; specifications not smaller than 8 1/2 x 11 inches must be submitted tq the county. The plansrrtust include the following: A) plot plan, drawn to scale or with complete dimensions, location ofi holding tank(s),septic tank(s) or other treatment tanks; building sewers; wells; watermains/watersevvice; streams atad lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of.,the building served; B) horizontal and vertical elevatior+ reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss'; pump performance curve; pump model and pump manufactureF,. D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizin"g information. .. . ,,~ >~ ~- '~ GROUNDWATER SURCHARGE '~, ,. 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which-can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. . _ ~ Fey piwnbing for ~/~ #221180 ~ 28288 McKenzie Rd. ~S'~!¢~C / ~~= Yo Spooner, WI 54801 o Of H+~l~ (715) 635-9609 d ~4E / =- ~~~ l Go7' saRV,E+~ tr~i~, iaav ~~ / `/ ll #~ _ /fCT• ~~r 1 ~~ of ~z '~ ~. t~ po ~ = g~,et~v~' ~p _ ~w~~ ~uw~ ~T cga~ri~ s r~/i~o~s Gdr~~ .~ ~r sK'- y,, t ~ , : . ~- I J~ T /7'y~ ~ ~ ~ ~ 7~~ < t ~f 1~ , k y3•> --~ a~ ia' YS ~ -t--- -yo, Wisconsin Department of Industry, SOIL AND SITE EVALUATION R E P O R T Labor and Human Relations n:. ....t C..t..w. >t. G~ x:1.1:.... Page 1 of 3 ' III ClliliVlV Wllll ILrIR OJ.VJ, •~IJ. r'~aJi i~. vvaiv ro' I~ V V but Plan must include ii ahes~i i~ th fi ~ i l 2xi i l St. Cr , r s B~., ess .~ 1, .. n an on paper not an $. te p Attach complete s ~ not limited to vertical and horizontal reference mt,(~1M) direcyon and °lo o~slope, scale or ~~` •r ~ PARCELLD.# p ~ oa . dimensioned, north arrow, and location and di,Stano~ to nl~l~~ 020-1021-00 ~ APPLICANT INFORMATION-PLEASE PRlN1T ALL IN~DR`1~ATION-`=-~ `j RE EWED BY DATE PROPERTY OWNER: - •' F~~r~ P$. PERTY LOCATION Kernon Bast ' C~Jix +"~ .LOT Nod 1/4 ~ 1/4,S 14 T 29 ,N,R 19 ~ (or) W i PROPERTYOWNER':SMAILINGADDRESS ~.O+V~NGOFFiC£ ~ L # BLOCK # SUBD. NAME OR CSM # ~ ~~ 948 LaBar a Rd. STATE ZIP CODE PkiOtJE Nu CITY ^CITY ^VILLAGE ®fOWN NEAREST ROAD , Hudson, WI. 54016 (71 z'36~7 '~ Hudson Cu he [x] New Construction Use [ x] Residential / Number of bedrooms 4 [ ]Addition to existing building j ]Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate . 7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 102.40 ft (as referred to site plan benchmark) Additional design /site considerations trenches spaced to code 3/50' below surface el . 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 ~S ^ U SYSTEM IN FILL ~7 S ^ U HOLDING TANK ^ S ® U U =Unsuitable fors stem SOIL DESCRIPTION REPORT Boring # .................. <': 1 Ground elev. 103.Oft. Depth to limiting factor +R4" Boring # 2 ..~~:<« Ground elev. 103.Oft. Depth to limiting factor +82" Depth Dominant Color Mottles T t Structure C n istence Bax>da Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. o s ry Bed Trer~ 1 0-8 10 r 3 3 none 1 2msbk mfr cs 2f .5 .6 2 8-12 1 3 12-65 7.5 r 4 6 none ms os ml 4 65-84 7.5 r 4/4 none cos os m na na .7'• .8 i o~ 3~/~ Z- Remarks: 1 0-15 10 r 3 2 15-29 5 r 4 6 none 3 29-8 7. ~~«~~ `~rp ~2 Remarks: PROPERTY OWNER Kernon Bast SOIL DESCRIPTION REPORT Page? of 3 ~~ PARCEL I.D. # 020-1021-00 Boring # Tn4::::::•: `''vii: 3 Ground elev. 104.2ft. Depth to limiting facto+84 ~~ Boring # Ground elev. 105. R. Depth to limiting factor + ~~ Boring # ... 5 Ground elev. 105.9. Depth to limiting facro80 ~~ Boring # .................. ................. .::: Ground elev. ft. Depth to limiting factor H i Depth Dominant Color Mottles Texture Structure Consistence Baxxiary Roots GPD/ft or zon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh 1 1 2 2 10-25 10 r 5 3 25-84 7.5 r 4 6 none ms os ml na na .7 .8 Y 34~~-z -~ ~~Sy„ ~~:6 is 6 Remarks: 1 0-8 10 r 3 3 none 1 2ms m 2 8-14 10 r 4 4 none sil 2msbk mfr w if .5 .6 3 14-82 7.5 r 4 6 none ms os m na na .7~ .8 2 ~f /~•~ ~D~q~o ~ Remarks: 1 2 12-27 10 r 5/4 none sil lcsbk mfi if .2` .3 3 27-80 7.5 r 4 4 none cos os ml na na .7 .8 '3 G 't L o . ti 6m /;~~ , Remarks: \ Remarks: SBD-8330(8.05/92) . ~~ STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. Kernon Bast CSTM2298 New Richmond, WI 54017 MPRSW-3254 ~4NW4 sl4-T29N-R19w (715) 246-6200 town of Hudson lot #18-Grass Range second Addn. Zlzis soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test mayor may not be as shown as permanent lot lines were-not established at the time the test was conducted. N ~-~ ~ , BM.= top of mid lot survey stake C el. 100' ~ ~,.~ L ~ y Alt. BM.= top of 2" pvc pipe C el. 103.00' ~ ~ ~8 ~~ 3 y f 5` ,~- ~ p ~' ~YS~- a5 ~ ~3 g.~ ~t F ~ ~~ p ~/~ ~ / ~ Gary L. Steel 8-19-98 ~. 6 .~~- ~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ~ ~ AND OWNERSHIP CERTIFICATION FORM OwnerBuyer _ __ 15~,cGd/ 1~,5~ Mailing Address Q 5c~ ~ ,~~~_~ ~ w~- .~ yeff Property Address (Verification required from Planning Department for new City/State ~_ c~1s- S`~/OlG Parcel Identification Number ~D -/.~56 - /~- ~a LEGAL DESCRIPTION Property Location ~~t/ 1/,, ~(~/ 1/4, Sec. [~_, TAN-R~Vi~, Town of ~S~.k71y Subdivision Lot # ~~_. Certified Survey Map # _ ,Volume ,Page # Warraaty Deed # ~~? S I Volume / ~ ~/~ ,Page # ~'~ Spec house ^ yes ~ no Lot lines identifiable rd yes ^ no SYSTEM MANTENANCE 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 subunit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, joumeymanplumber, 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 days of the three year expiration date. vi ~ / / SI NA RE OF ICA 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 abov by virtue of a warranty deed recorded in Register of Deeds Office. ~~ / / SIGN TURF OF PLICANT 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 warrarrty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed •.. ,,: , ~: II „i ;~ :$ ., . MENT No ;~ WARRANTY DEED ! ~~STATf; BAR OF WISCONSIN FORM '1-1982 ~ / / 5602;1 ~ , o ,/t.(IJ ' - Y1~ ~ ~~1~~FMrc a~~ _ ~ i Ray G. .Sf^Own and. Eleanore Brown, husband and. wife, ~ ` •„ ;~! _ _ ... _ ..... ..... .. ~ JUN ~ 1991 _. ........ ........... ronvcys and warrants to ....... _._ , .............. 8:30 A. Kennon Bast and ~onalda .Speer-Bast,a/'c/a_Donalda_J... S ee~ - '~ husband.. and ~t.ife ........... ~a ~,~ ~ •~ ~-c •: ~ :+<. ..... ~~ .•.:.t~atm .,t Dtle.:3 for $1.OQ and.ather...ualuable consideration ... ... '..-.~ .. ~ Y ~ -- ~..`~ .. ... - ~~ ~'. ..... tho following described real estate to ...... St • Croix ~ ...... ............... Cou nty, titafe of ~{%tsconsin: Part of jr Taz Parcel No:..Q~0-102_-n0._.._. ; ?art of N'rI 1/4 0: NW 1/4 and Part of .IE 1/4 of ivN 1/4, A;.1 in Section 14, ~' Township 29 North, RangA i9 West, St. Croix County, Wiaccnsir., described as follows: B~ginnirig at ;he h'W cc;rner of said Section 14; thence ~I29°43'45"r: along ;he North :.ire of the NW 1/4 ci said Section, 1387.25 feet; thence S00°23'09"~ 91a.i5 feet to the Point of &eginning;hence S89°32'31"W 558.46 ~ee~; thence 500'07'20"W 105.90 feet to the hZV corner of that parcel of land recorded and described in Vol. "352", Page 382 at .re St. Croix County register of Deeds O~fice; ther:ce N89°24'30"E 157.0 line of the parcel of land recorded and described 0 feet along t:te Nort the NE corner of said Vol . "952", Pa a 382 • t1:ercoVc,1 . °' 952 ~ Page 3d2 to East line cf said Vol. "952, g 500 07 17 W along the 405.C5 feet; thence N00°23'09"W 05 003feet toy t e 'r'out of BEginNdrg24'30"E This deed is given in partial performance and satisfaction of a Land Contract dated July E, 1992, recorded July 10, 1992, in Vol. 958, Page 577, Doc, iVo. 485728, ' in the office of the Register of Deeds for St. Croix County, Wisconsin. The above- ~ described ,parcel is to be reconveyed to an adjoining landowner, Thomas I. Wfiey, to ~! be merged into and become part of his existing cor_tiguous parcel, and shall not ' thEreafter be conveyed or encumbered separate from said Conti uous ~~ it is to be merged, unless subs g parcel into which equently subdivided pursuant to applicable state, county and town laws and ordinances. ;~ This is not__ ....... homestead property. The real estate transfer fee was paid at ~i (is) (is not) , , _ _ ~~ i it Exrcption to warranties: Subject to town road right-of-wsy over the southerly side. ,~--- ~ ii Dated thi ~~ .. day o[ ... Mdy 19 97 I~ y'~ V (tit,U.l i Ray_G.,.-Brown;.- f .... .Eleanore Brown _... ......... .. _... _(SEAL) ~ _ Isr,At.~ , + I~ AUTHENTICATION t ACKNOWLEDGMENT 1i '~ Signature(s) ........... II - -.........-•---•--.......--• ................... I~ STATE OF WISCONSIN I~ ........................................... ..................................... ~ SS. .I ST CBOIX +I authenticated this ..-.....day of ......... 19 .. .... ------•--........County. a 5 !~ ... .......... ...... ---- ' Personally came before me this ......day of ! :...............••------ ..........-.........May..-----........., 19..97.. the above named ..................................... TITi.E: DiEMl1ER STATE BAR OF WISCONSIN ..Ray. 0....8xo~!n..a.nd ..------................ ....... ..l+~eanore Brown, (lf not, ....--- authorized b ................................ $renda-Poulin y 3 7oc.os. wis. stats.) . ............... .... .. - .... ..husba.~d.-and-wi_fr . '~ ~