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HomeMy WebLinkAbout020-1128-20-000 n cn O ~ v n ~ I o d c g c ~' o ~ .O. O O C1 ~? 'O A~ ' ~ ~ 3 i d i : ~ ~ I _ r. ~ ~ i ^' ~ I ~,. Cn L O T~ rn ~° N m ? ',, '~, = -+ J O N "S `C ~ ~ o a 7 S o~ C m~ CD p j D. ' o N ~ ~ _' ICI ~ i _ ~ ~ ~ N ~ O N N CD N E ~ fD Q N < a ~ ~ D O 'S I O O ~ C ~ ~ F ~ J N O. ~ i CO ~ A ~~ ~ O C A 7 0 ~ N N O O C N d ~ d ~ ~ @ V A ~ C O ~ ~~ ~ . ~ ~ ~ CU • • ~ , I O` O ~= O O O O L ...T` O N O C O N N a ~ C I ~ w O O j ! f/1 O ' , ~ .. Q i C ~ ~ a v ~ ~ °' '~ O O O A , C ~ ~ ~~ ~ _ ~ ~ fA N fn rn m 0 n ? ~ ~ ~ O O ~ ~ O i-, cD N ~ ~. ~ , N .+ ~ d N ~ ~ - N i ~ ~ .. ! CD w I Z A p Z ~ Z CA Z ~ _ ,I "' ~» D ~ o rn ~ I o O ~~ N N ~ 7' N N ~ O i O O ~ fD y ~ ~ ~ ro ~ y Q O N O ~ + d ~. R: 7 ~ ~ ~ ~ 4 IU _ A C! C ~ ~ d 'A .. Z ~ O 7 W 'G ~ cNp J a ~; ~ ~ Z ~ ~ ~ '.. ~~,. C G N ~ N 'O A W N C ~ ~ ~ x ~ ~ N ~ Q " ~ ~ ~ ~ Q o ~ a ~ ~% - c ~- _ `D 0 ~ a < 7 f ('' N fD N N '~, ? ~ ~ ~ ' ~ j ~ N N ' ~ v; A c 7 a 4 ~ ~ I °° $ a D ~ ~' s m o m _ a o- ~ ~ 4 fD K N tv ~J N 7 d o w V A ~ • ti w ~ ~ ~ t~ O ' ~ ~ cn O N I `` O O Q, h .,, ~Wisconsln Department of Commerce PRIVATE SEWAGE SYSTEM safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Ihle, David Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic i c,5 / /j~/~ O (~V Dosing "-- _ Aeration mg s '~~M~ni if~r+n rar TANK SETBACK INFORMATION Head SOIL ABSORPTION SYSTEM ELEVATIC7N DA I A county: St. Croix Sanitary Permit No: 26 State Plan ID No: Parcel Tax No: 020-1128-20-000 STATION BS HI FS ELEV. Benchmark ,Z 0 aG- Alt. BM Bldg. Sewer SUHt Inlet Ht Outlet l/~ ~ 3. Dt Inlet Dt Bottom Header/Man. Dist. Pipe ystem inal~ St Cover ~ / q ` .~ P. l ~ ~ ~~ ~2•Z ~# ~ ~z,z yz, BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: ~ ~ ~ UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER v Prwcenra Svcfams only YY Mnund Or At-Grade SVStemS OnIV Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes ~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:1~/~/~ Inspection #2: / / Location: 472 Park Lane Hudson, WI 54016 (NW 1/4 NW 1/417 T29N R19W) Parkview Estffates Lot ~P(arcel No: 17.29.19.59_7 _/ 1.) Alt BM Description = ~, ~: ~~ ~e T W e etrl ~ ~ ~ ~ Ti.~ ~~ /M^~'~ 2.) Bldg sewer length = - amount of cover = ~r y ~.t/t` S 1~I4 S •rC~'~ 3.~ ~ at ~~C Goa ~ ice- ~Daa 5 e. Plan revision Required? ^ Yes o Use other side for additional informatio IS Date Insepctor's Si na re Cert. No. SBD-6710 (R.3/97) n~n~nrcrou~u~ u~rnoeenTrn~~ • County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER ` - (Privacy Law. S. 15.04(1)(m)] 1 1 ~' -- V "'__~ Hudson, WI 54016-77 0 y JJJ ooo (715)386-4680 Fax (715)386-4686 Attach complete plans for the system o t less than 8-1/2 x 11 inches in size. County Sanitary Permit # ^ C ,~ i 'o /pr us application O b ~-~P I I. Application Information -Please Print all Information ~• Location: Property Owner Name .,.• ,..~ ~ , ~..,. 1.J 1 /4 i /4, Sec l ~1 „ Property Owners Mailing Address ~ gT CN~X ~ Lot Number Block Number City, State Zip Code h e Number '~ Subdivision Name or CSM Number 11~ pe of Building: (c eck one) ~ - amity ^ Village own of 1 or 2 Family Dwelling - No. of Bedrooms: ~ ^ PublidCommercial (describe use): t,n -~ ^ State-owned N est Road ~ ~L ~ Check box on line B if applicable) Type of Permit: (Check only one box on line A II - ro - . . Parcel Tax Number(s) /7i ,) A) 1.~] R~pair ~ 2. ^ Reconnection 3.^Non-plumbing 4. ^Rejuvenation ` -'~ Sanitation / _ (~ ~ ° Z O ' O o O B) Permit Number Date Issued ^ State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other . Dispersal/Treatment Area Information: ~ 7,V (s E~~ST 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7.~ekGrade ~~o Required ys~ Rrefleeeei- 2 ~ ~RYw~S (Gals./day/sq.ft.) . ~ (Min./inch) ~ 9~ ~Q Elevation p8•sa VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic n r~vs ~ New Existing Gallons Tanks `~S~ Concrete structed glass Tanks Tanks Wi W~ ~ cY3 ~ / ~.IJ ~ ^ ^ ^ ^ II. Responsibility Statement I, the undersigned, assume responsibility for repair/reconnenctionlrejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non-plumbing sanitation system. PI tier's Name (print) Plumber's Si ature (no amps): ivtf'/MPRS No. Business Phone Number Plu ~~ cddress~reet, City,S~te, Zi~ ode) P ^ 1 f''v ~ / f~~ v v Q ~ J C /` 7 /(>~ VIII. County Use Only Disapproved Sanitary Permit Fee Date Issued Issui Agent Signa a (No stamps) Approved Owner Given Initial Adverse ~ ~ ~'2'~ ~ ~'~~ Determination IX. Conditions Ap I/Reason,`,for Di~,ap~rosv~l: , ~~ ~~~ ~ ~ ~~n~nM,..~~., .~e,p~,.- CS'~~~ wus rec-e~~ T° ~,~+~ `~S ~~~Td-o~ ~~ Uu p l~nllo ~o~.~i~r¢~.~. t~,6. t. ovT ~1c l~,~ Li'~v~•S ~~P®M 5~~17`c T. To ~. ~ic~'STi-~G-- v ~C 1` 1 ~~ 0 >~ it l~i Rl ~, li -~ O ~~ ~~~ ~ ~y ~ ~ L ~ a Z ~ ~ ° N ~ ~ ~ ~ 1 1 ~ m ~ Q q N N ~am~ ~ ~° N ~ m 'O w ~ 0 ' ~ ~i ~ ti J -~ ~ ~ ~ O ~ ~ ~ ~ ~ ~ ~ h~. ~ 11 ..._ ~ II o ~ y ~ ~ ~ o ~ ,o ~ ~~ ~ ~ p n .~ ~ r ~ .. T~ W • _ . ' o o ~, o - ~ ~ ~ _~ ~~. ~ ~ ~' I . o ~.-- -- ~ ~ _f J ~ ~ ~~ ~ ~ ~ ~. ~z ~y~ , ~` ~a~b .1 ~~ . ~. `'' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of 2' Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County $7; GiP O / X Att h I t i ac comp e e s to plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slo e scal di i rth Parcel I.D. n Q-~j ~~2 2 ~ p , e or mens ons, no arrow, a 2 d distance to nearest road. p Z. d • d - Please prfnt a t8' J R iewed by Date Personal information you provide may be us s ondary g~oses (Pri ). , s. 15.04 (1) (m)). ttuJ~tnn. '~ ~ C Property Owner • ~ ~~ V~~ ~~ 4E ~ roperty Loc'a`tion L t ~ ~~ J 1/4 ~r"~ ~ ~ ~J a I / ~' ` ovt. o /v 1/4 S T N R E (or W Property Owner's Mailing Address ~ - ~ s~r ct~x P~C 6N ~ x/72 Pfj' - of # /CQ Block # Subd. Name or CSM# P ~U~~ t ~`s'T.4TEs . - ; ~ • , - , i ~ r 1 City State Zip Cod~~> , _'~ Phone ~-C .~~ ff Uf~Soa~ ~ G~j/. , s~oib~~'i;~_) h 'J-~'~'~ ^ City ^ Village ~ Town HuvSo~ Nearest Road I ~r~i~~ ~.v . ^ New Construction User Residential / Numbe"'r'o~_„~ Code derived design flow rate 5'Sa GPD ^ Replacement /~ ^ Public or commercial -Describe: Parent material _ ~C~~r9`I~ Flood Plain elevation if applicable N/~ ft. General comments /DES.$ OU~~P S i'}ND y O l> r' Ltl/} ~, • and recommendations: D v, ~~, To ~t'~p/~}c~- G/o $5 ~n ~ ,t~~Po~~.~ /off ~E~~~ o~'sT ~..N~s ~.e ~-e~.,, s~ T ~ z ~ ~ywE~~~ . ^ Boring # ^ Boring ~~•~~ ~, Pit Ground surface elev. ft. Depth to limiting factor ~ O in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 p,(p ioy~ 3~3 -- ~s /.(rVf ~ did C S f . 7 /• 2 y ~ •r ~o yR 3 -- 5~ s s ,r ~ ~e cs ~ . s o io S S. D, s . ~ ~. `~2. ^ Boring # ^ Borin9 U 6$ •`f/ )O`{- ^ pi{ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 Elnuent ri'1 = BODs > 30 < 220 mg/L and TSS >30 _< 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number TZDt3ERT uL~RlGIn,'~ ~~ 224375 Aaaress Date Evaluation Conducted Telephone Number -- - ~a?-a y 3 ~ - n/ ~ ~ S • 3 8G • 8 ~8S Ulbricht 8~ Associates Private Sewage Consultants GD D~_ 655 O'Neil.Rd._ S yST~~I i ~S /,fl ~' ~ Property Owner ^ Boring # ^ Boring ^ Pit Ground surface elev Parcel ID # fl• Depth t0 (imifinn rarfnr Horizon Depth Dominant Color Redox D i ti in. Munsell escr p on Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence I I Boring # ^ Boring u ^ Pit Ground surface elev. ft. Depth to limirin~ ra~~n. Horizon Depth Dominant Color Red D ri ti in. Munsell ox esc p on Qu. Sz. Conl. Color Texture Structure Gr. Sz. Sh. Consistence Boring # U Boring ^ Pit Ground surface elev. n, Horizon Depth Dominant Color Redox Description Texture in. Munsell Qu. Sz. Cont. Color 'Effluent #1 =BODY > 30 < 220 mg/L and TSS >30 < 150 mg/L Page of _ in. Soil Application Rate Boundary Roots GPD/ftz 'Eff#1 'Eff#2 in Depth to Ifmiflng factor in. Soil Application Ra Structure Consistence Boundary Roots GPD/fl2 Gr. Sz. Sh. _ 'Eff#1 ~ 'Eff#2 ' Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L 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 departrnent at 608-266-3151 or TTY 608-264-8777. SBD-8770 (R.6/00) .~ WLCs 7- L o % L ~ ti~ ~V ~I -~ (~ O ~ ~ _~~~ ~ ~ ~~~~ oos ~ ~ ~ ~ ~ °° N N m o S ^ ` \` ` !O i m ~ b '^' V V C J J a ~ ~ W •. - ~- ~~ ~ 1 \ ~ CJ ~~ ~ i~ ~ I p ~---- ~ -~ ~ - -- f ~ ` ~ ~ ~. • ~ ~„ c ~ ~ ~,~ Z ~ a' `-~ ~ ~ o~ ~~ ~z ~~~ N ~ ~ ~ ~ ~~ ~e - ~ M ~~ ~^ \ol Q ~ A O ~ G `-' ~ ~ ~ ~ H ~. I~ ~ .~ ~ II 1 p ~ f o o ~ ~ ~~ O ~ ° ~ L~ ~~~~~ _ ~ ~. ~~ S'1' CRUIX COUNTY SEPTIC 'TANK IVIAINTENANCE AGREEMENT .,.....,..,r._ AND -- UWNERSIIIP CERTIFICATION FORM Owner/gayer .Df~U/ ~. ~~ LE 3~~ " !3S~1 Mailing Address y7~- ~~'/P~ LN • ff vD.SQ~ Let/. s ~O/ Property Address City/Slats' Parcel Identification Number D~'Q • rh ~'Z~ 'Dar7 LEGAL DESCRIPTION Property Location ~~'/., ~~'/A, Sec. /7 , T 2 ~N-R ~~ W, Town of ~~~`SD ~ Subdivision __ ~~'i~IC~V%~~ ~ST~-T~S ,Lot # ~ G Cet-ti[ied Survey Map # Volutne ,Page # -. Warranty Deed # (, 22 ~~f ,Volume ~S!© ,Page # ~~3 Spec )reuse ^ yes ~ no Lot lines identifiable yes ^ no SYSTEM MAINTENANCE ~ G 1 N AL OR Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. . The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewaterdisposalsysrem is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludg$. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set fotih, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification staling that your septic system Itas been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days the three ar expiration date. r / /Q~ SI NA1'iJRE OP APPLICANT DATE OWNER CERTIFICATION . i (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) 9m (are) the owner(s) oC the pro y descri a ove, virtue of a warranty deed recorded in Register of Deeds Office. / /~. SIGNATURE OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** s~~ie--- (Verification required from planning Department for new construction) ** Include with lids application: a stamped wattanty deed from the Register of Deeds office a copy of the certiCed survey map if reference is made in the warranty deed STATE BAR OF WISCONSIN FORM 3 - 1998 622SS9 QUIT CLAIM DEED Y.ATHLEEN H. WALSH kEGISTEk OF DEEDS 1 r1~- 1510 143 ST, CkOIX CO. ~ WI Document Number yl~•. PAGE RECEIVED FOR RECDRD This Deed, made between DAVID A. IHLE AND CLAIRE........- 05-1P-2000 9:30 AM IHLE, HUSBAND AND WIFE ___ _____._ ___________ QUIT CLAIM DEED _ _ _ _ __._ EXEMPT N 16 _ __ --~ - _ __ _ , Crantor. ---- - CERT COPY FEE: and DAVID A IHLE AND GL.ATRE E IHLE OR SUCCESSOR TRUSTEE. COPY FEE: OF THE DAVID A; IHLE AND CLAIRE E.-IHLE REVOCABLE TRUST TRAMSFER FEE: RECORDING fEE: 10.00 DATED MARCH 1, 2000. -..__-- ---------._____ flAGES: 1 - ~- - -----..-._..-- -• Grantee. Grantor quit cla ims to Grantee the following described real es[a[e in ST. CROIX County. Stave of Wisconsin: LOT 16 ARK VIEW ESTAES 1ST ADDITION, F HUDSON, ST. CRO.IX COUNTY, WISCONSIN. Together with all appurtenant rights, title and interests. n/ Dated this ~__,- day of _,. _ __-. (SEAL) + --- -- --- -_` (SEAL) AUTHENTICATION Signature(s) -_ authenticated this _ dey of _. -.__._ -.. TITLE: MEMBER STATE BAR OF WISCONSIN (If not. __ authorized by §706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY HEYWOOD & CARL, S.C., 204 LOCUST STREET P.O. BOX 125 HUDSON, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary) Name and Return Address - HEYWOOD & CARI, S.C. 204 LOCUST STREET, BOX 125 HUDSON, WI 54016 112.0.= I i ~ R-~ n-~IIO_----- Parcel identification Number (PIN) Thfs IS homestead property. (is) (is not) 2000 ~~(.Y •'~r`^~-- _ (SEAL) DAVID A. IHLE ~ -~~GTv! / ~.~L~O~ (SEAL) + CLAIRE IHLE ACKNOWLEDGMENT State of Wisconsin, 55 Y ST. CROIX _ County. Personally came before me this 21 ~ clay of _ -p4Ali61b ~~ 1~ ~ 20,OU _, the above named DAVID A. IHLE AND CLAIRE IHLE __ _ _ _ to me known to be the person who executed the foregoing instrument and ackn e.th sam6. -J=V1Li.~ -I~--~. Notary Public, State of Wisconsin My commission is permanent. (1( not. state expiration date: q -1 - OZ. .._ . _.) • Names of persoru signing In any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Le9ai eia~k Co_ mc. QUIT CLAIM DEED FORM No. 3 - 1998 Milwaukee, Wis. l~cii ~~~ ~~~ f 9 R19W TOWN OF F NW I/4 OF SECTION 17, T2 N, UNPLATTED LANDS OWNEC -- ------ 1.I LINE OF SECTION 17 N 89° 13' 09'E --"- 3` 200.00' 200.00' 200.00' 200.00' 1366.52 --' 0 0 18 0 - 17 16 _30 ~ 15 °o O O ~M O O O 1.80 ACRES M M 1.61 ACRES ~j 1.42 ACRES ~ 1.38 ACRES M N O M Z 400.0 .~ $. 3.08 0~,•, 0.00' _._.-- S 89°13~09~~W L 4 8 5 206,15 ' ,2T ~ N 8c ' ~i ~ O , 9 w -~ 3.08 575° 10.31, ~ ems.. . - - -~ ®79.94 2 20.00 ___ _ .~ a 212 T N m. ~~• `~ 75°10~ 59 ~' N, a 400. C -~ss: g'• N 183.4 cr ~''. °~,,_-____-' Q 28.84' ~ - _ ~ 1 .46 ACRES iA 1.46 ACRES O ~ 1.3T ACRES N 1.53 ACRE' ~ N °D 39 3 6 M 37 i N 38 N 300.00 239.46 199.46 220'00' S89° 13'09~~W 958.92