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HomeMy WebLinkAbout020-1037-10-000 (2)Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT Y GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m}]. 'ermit Holder's Name: City Village X Township Bonne rise, Michael Hudson, Town of SST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION r, TYPE MANUFACTURER • CAPACITY Septic ~~ ~;•~ P lak. Sz5 Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. J~ ~O vent to Air Intake ROAD Septic 75~ / 7 ~ G Z-/ / M r i.~IM~wt+~ "_ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift riction Loss System H TDH Ft Forcemain Length Dia. Dist. to well Cull ARRnRPTInN SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 515092 0 State Plan ID No: Parcel Tax No: 020-1037-10-000 Section/Town/Range/Map No: 18.29.19.157F3 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer //. 9'a. 9 SUHt Inlet SUHt Outlet l~ ~ e,Q~ 3 Dt Inlet Dt Bottom HeaderlMan. Dist. Pipe Bot. System Final Grade St Cover ~e ~.~-,,.~ ~~ cz. 2. a ~~ i ~ ~1 BEDITRENCH 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: IIISTRIRUTI~N SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing Coll r:OVFR ., o.e~~...e c..~•e.,,~ n„i.. ,.,, Mn~~nrl nr Af_(:rarle SvcTems Anly Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center BedlTrench Edges Topsoil ~ Yes 0 No ~ Yes ~ No COMMENTS: (Include code discrepencies, persofrs present, etc.) Inspection #1: / J {nspection #2: / Location: 349 Casperson Drive Hudson, WI 54016 (NW 1/4 NE 1/4 18 T29N R19W) NA Lot 1 Pa/r~cel No: 18.29.19.157F3 1.) Alt BM Description = ~~~ ~~ ~~~, i*~ (~ J 1«A~~ ~ ~`J 2.) Bldg sewer length = ~ r, E~x~ - amount of cover =~~~ ~5 ~, ~ ~v~ -~ Plan revision Required? t Yes ~ No ~ ~ ~ ~~ Use other side for additional information. l0 Date Insep or's S' lure Cert. No. SBD-6710 (R.3/97) 1 ~~ ~~ 1 commerce.wl.gov afety and ~ 01 W: Washington Ave: Box 71G2 P O County (' J fi ~ ~ ~ ! ,, , . _ , U7 i s co n s ~ n ~ " ` , Madison, W 3707-71 G2 OeparttrteM of Cotnnre ~ Jl{l~ 3 0 2009 Sanitary Permit Number (to tx fiikd in by Co.) rca ~, 5 jS pg Sanitary Permit Applieatial>GR~O~fxp cyo~uNTYF In accord i h C l State Transacti n Number ~~ ance w t s. omm. 83.21(2), Wis. Adm. Code, submission of this~~i ~ ~ aPProPr~~ ~ve~tf~ttental unit i i d i s requ re pr or to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Commerce. Personal infiirmation you provide may be used for secondary u ses in accordance with the Privac Law, s. 15.04 I m , Slats. Project Address (ifdiffercntthanmailingaddress) nf~ ~ 3f1 ~ / 1. A tication Information -Please Print All Information ~~ ~ // (~, U1 - Propeny Owner's Neme ~~~1.,b ~1 ~ b ~~,~ e Qeiv u~~e rii Parcel A oZo • ~ 7.. /d - cx~~ Property Owner's Meiling Address x 3y ~ c.Jbs ~~(,~ p~,~ Property Location / ~~ (J, • Govt Lot City, State ^( ~ Zip ('ode Phone Number _ . ~~ Y., ~~ Y., Section ~ 8 ~~ . ~ U wl ~ U ~ _ ^ _ 4 ~ (circle one / ~ ~ 11.T ype of Building (check all that apply) Lot ~ T ~E -N; R ^ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name ^ Public/Comm i l D ib ~ Block # erc a - escr e Use __ ~_ ^ City of ^ State Owned -Describe Use CSM tuber ~ ' + ~'3 ^ Village of T r LLd 5 7[ j 7~ , own o t , J 111. T ype of Permit: (Check only one box on line A. Complete line B i applicable) A. ^ New System ^ Replacement System ~ Tank Replacement Only S ' ^ Other Modification to Existing System (explain) e ~ Tc.. evious Permit Nutrtber and Date Isaued B. ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Pr g Before Expiration Owner 4/ ! Y~5 IV. T e of POWTS S stetn/Com onent/Device: Check all that a I ^ Non-Pres§urized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. ofsuitabk soil ^ Mound < 24 in of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) V. Dis etsal/treatment Area Information: Design Flow (gpd} Design Soil Application Rate(gpdsfj Dispersal Area Required (st) Dispenal Arca Proposed (sf) System Elevation S ~ ~ ~ -' Ex- bit` Vl. Tank Info Capacity in Total p of Manufacturer Gallons Gallons Units ~ ~ New Tanka Exiat~ Taakt ~ ~ ,~A„ ` ~/ / O /d h 1"i I „ Septic or Holding Tank ~,. ~ i)~ ~ Dosing Chamber VII. Res onsibility Statement- 1, the undersigned, some rapoafblUty for installation of the POWTS tahown on the attached plaaa. Plumbe 's Name (Print) Plu 's Si MPlMPRS Number Business Phone Nu r ~ ~ >~ ~b . ~ l~ ~ L . aa~ 9 ~ o~ ~ Plumber's Address (Street, City, State, Zip Code) ~~~ ~ ~~ 3~ ~ ~,~s~~- ~~ s 1- ~~ ~l VIII. C unt /De artme t Use Onl Approved is Permit Fee. S Z$ ~ Date 1 ued ~ Issuing Ag ignature Ow iven Reaso enial a ' ~ ~ ~ / r IX. Conditi~~~/>Qeasons for Disapproval 3 O~ /i ~~ ~ t dL 1,pQ 1. Septic tank; effl(uttt 8ker and ~ dispersal cell must all be serv)t:es / maintairttad ~,~a t~ ~ as per management plan provided by plUrriber. 2. All setback requirements must lie mauttained Atrlrh In mm~nle~. nlw... r... u...........-..«..~..._ ,._ . _._.•. _..-.--.•.•. ... .... ..vuo.. vm• m. paper nv~ ~ws .wwn o vs x ~ ~ mrne: In SR! SBD-G398 (R. (11/07) Valid thru 01/09 o a P mees-~ ~ . ~, ~ G, Geese a!~dQo ~ ~~ 1 U~~ ~~ ~-i ~~, Pc~ ~V~C ~~ ~fi~~ ~CppY S ~,~ R~~l~c~~.~~ ~-~~~`~C. ~T"~Nk o-~~y ~°Nk Cod ~p ~$ r~ M~ o a~ ~e rn~~~~ ~ ®~~~~ Q®~~F ~~ ~ 1 m ~~ u ~e P mees ~ L' ~o~ 314 Cis nso~ Oo~iv< G~Ge~tse O ~ a'~Q ~ ~~'s~'~~c~ f$k~~ ~~f S ~~ I U ~U gal , i~i'CZ, Pal ~U~C ~y ~~ p~ Rc' ~' c~ S ~ ~~"; L ~e 1~~n T~N~C o~~ d 9, '~ ca~~ mtfia~ --------~ ~~ T°"k Col to pS'~ -~ w~ 1 l ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ovmer/Buyer ~ ~ G~ ~ t c~ ~ o N ti Mailing Address 3y ~' C Property Address ~ Cis a~ ,~" (Verification required m Planning & Zoning Department for new construction.) City/State ~ubSo1.4 UNIS ~. Parcel Identification Number LEGAL DESCRIPTION Property Location N ~ y4 , ~)~ r/4 ,Sec, ! Eb , T ~ 9 N R~W, Town of ~ u as ~~- Subdivision Lot # ~. Certified Survey Map # _ ~ ~ ~ ~ b ,Volume ~ ,Page # 3 Warranty Deed # ~T„~/a~c~,c~- ,Volume ~~~, Page # ~ -T Spec house yes O~.i v~ Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 leas than 1/3 full of sludgy ;., •,~; ,ti Uwe, the undersigned have read .~ is and agree to maintain the private sewage disgRMal •ystem witty the standards set forth, herein, as set by the ce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system lots • „ ' ed must be completed and returned to the St. Croix County Planning & Zoning'Department within 30 days of the threq ~` ,h on date. Re i ; . ~, Uwe certify that all statements on this fob tau to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a wamuity ~~~ded in Register of Deeds Offices ~. Number of bedrooms ~_ SIGNATURE ~PLICANT~S ~~ ~:_~ -- C) DATE ***Any information that is misrepresented may teutiha sanitary permit being revoked by the Planning & ?,otuug Departtent. "* r ,~, t, u • Include with this application a recorded watYyipty dot lrpm the Register of Deeds Office and a copy of the certiSed survey map if reference is made in the warranty deed. ~ '"'~ ~~' (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION Owner Permit # DESIGN PARAMETERs MAINTENANCE SCHEDULE Service Event Inspect condition of tank(s) At least ~ Pump out contents of tank(s) When co Inspect dispersal cell(s) At least c Clean effluent filter At least c Inspect pump, pump controls & alarm At least c Flush laterals and pressure test At least c Other: At least r 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 tank(s) 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. SYSTEM SPECIFICATIONS _ Septic Tank Capacity ~ Q U Septic Tank Manufacturer ~Q~l~, r Effluent Filter Manufacturer p~,,- t, Effluent Filter Model Pump Tank Capacity Pump Tank Manufacturer Page of ^ NA ^ NA ^ NA ^ NA NA NA Pump Manufacturer NA Pump Model NA Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfectior- ^ Other; Dispersal Cell(s) ^ NA ^ In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other; Other: ~ __ DL) N ~ l ~ pN ^ NA Other: d N_' ^ NA other: ,J ^ NA Service Frequency once every: a 8 earl Ilsl (Maximum 3 years) ^ NA mbined sludge and scum equals one-third IY31 of tank volume ^ NA once every: ^monthls) (Maximum 3 years) ^ year(s) ^ NA mce every: ~' ~ monthls- ^ yearls) ^ NA -nce every: ^monthls) ^ yearls- NA mce every: ^monthls- ^ yearls) NA mce every: ^ monthls- ^ year(sl ^ NA ^ NA vewes cyprcar ror domestic wastewater and septic tank effluent. Page of 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 cell(sl. 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. fio 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. ~ `Y'M1i iiiMriw+r tlf III t1YMNi MF1M AhM Mr1~11 M• MwrMMVMM f111N pr~MMr1~i +~~a~+WsMN er wv w •aMi!W'r+~ wNF~irmfl apwrwlrrr~ • 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. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ 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; i~r,~< ;'~ < <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 ~ s,~ ` ` ~~ POWTS INSTALLER POWTS MAINTAINER ., ., Name ~ v~, U~ Phone ~~' g~' ' ~~ ~ ;, . ; SEPTAGE SERVICING OPERATOR (PUMPER) Name A'(l. ~ ' Phone ~ ~ ~ ~ IJ ~ ,y Name ,;,,,, Phone ~ ~_~ LOCAL REGULATORY AUTHORITY `' ~ Name ` S C~bl D k'),r=' Phone 3 ~ ~ ^ ~ "$ (~ . , This document was drafted in compliance with chapter Comm 83.221211b)1111d1f91f- and 83.54111, 12- & (31, Wisconsin Administrative Code. START UP AND OPERATION Page of 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 cell(s-. If high concentrations are detected have the contents of the tank(s- removed by a septage servicing operator prior to use. Systam 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 surtace discharge of effluent. zTo 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 calls. 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. ~ `t'Hfii iilti'IIIfI9Mr 1/f MII yA-1Ka MFIM Ntwi ilriiill Mfr h«eHWVNM W11i1 Wf~FtM1`IV MtAiiwYfMM A7 MY M ~MI~Q(iilii wMhi11w1-1y ~1iwwMlNPi • 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 wets. 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. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area: If no replacement area is available a holding tank; may be installed as a last resort to replace the failed POWTS. ^ 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: ±~=~!x - - < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND10R 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 ' ` R'` ~' '" POWTS INSTALLER POWTS MAINTAINER . ,, Name ~ rr. Ulu; Phone ~5.. g~' , i~\ ~ .;, , ; SEPTAGE SERVICING OPERATOR (PUMPERI Name bbl ~ ' Phone ~.~ ~ > ~ ~ ,~' Name ,. ~;ti~~, - Phone '~ ~ ~:~ LOCAL REGULATORY AUTHORITY `' Name ' ~ ~~R.,O`l D 1i''k~' Phone ~ ~~ ^ ~ ~ This document was drafted in compliance with chapter Comm 83.2212-Ib1111(dl&(f) and 83.54(11, (2) & 131, Wisconsin Administrative Code. DOCUMENT NO. ~~~~~ WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2 -1982 _ -_ SISTERS OFFICE -_,-___THOMAS _ G . F . MC COMBTE III and HELEN M. S~'. CRC)9X CMG;, WAS. MC COMBIE hus ~ - - ---------------------- _________~_________ band and wife as oint tenants d. '~o• R~~ $h!s 19th ------ --------------- - ~~ ~f O_,___-. t'.__~1.~. iF87 _ Grantors ,_______-____ ___ __ _ ~~ 9:40 A - - - - - conveys and warrants to _P$ICHAEL J. BONNEPRISE and DONNA- - ------------•-----•----------•---------------------------- ._.___.I~~...H4NNEP?31,SE.,__.]aush~.zlc~_._and__~r_i.f e _. ~~__.j_o rit__•-__-•-- -------kenant~~------------------------------------------------------------- --------_ a~~i~ o~ ~o~. ----------------- -------G.xa.nt.~es..---------------------•---------------------------------------------------•--- - ............................._.._____._.__.____._._..__.____...____.. _.__.. ____. _.___-._. ... _._____. RETURN TO at. Croix the following described real estate in ________________________________________________County, State of Wisconsin: -Part of NEr of Nf~ and NGV4 of NFr of Section 13, T29N, R]9W, fia: Parcel No_ ______________________________ Town of Hudson, St. Croix County, Wisconsin, described as follows: Lot 1 of Certified Survey Map ~i1ed November 21., 1983, in Vol. 5 of GSM, Page 1370, Doc. No. 389310 in the Office of the Register of Deeds for St. Croix County, Wisconsin. TOGETHEP. WITH and SUBJECT TO non-exclusive private road easement 66 feet in width, being 33 feet on each side of the following described centerline thereof: CorrYnencing at the section corners of Sections 7,12,13, and 18, T29Pd, R19W; thence North along the West line of said Section 7 a distance of 474 feet to the centerline of an existing town road known as Krattley Lane; thence N62°21'E 240.0 feet along said centerline of the town road; thence N86°37'E 290.0 feet along said centerline of the town road; thence S81°20'E 197.0 feet along said centerline of the town road, to the Point of Beginning of the centerline of said 66 foot wide road easement; thence S15°09'E 276.0 feet; thence S63°24'E 411.7 feet; thence S43°55'E 156.9 feet; thence S53°09'E 352.6 feet; thence S34°33'E 341.4 feet; thence S20°40'E 139.2 feet; thence S76°23'E 72.0 feet, more or less, to the NW corner of Lot 1 of Certified Survey Pap filed .September 28, 1978, in Vol.. 3 of CSN[, page 702, Doc. No. 352047, in the Office of the Register of. Deeds; thence continuing along the North lines of Lots 1, 2, and 3 of said C.Sn4 in Vol. 3, Page 702, which is contiguous with said private road cen- terline, on the following bearings and distance; S76°23'E 166.0 feet; thence S54°04'E 103.6 feet; thence N66°02'E 254.13 -f_eet (Previously recorded as 255.2 feet in a certain Quit Claim Deed recorded in Vol.. 499, Page 439, Doc. This ___.___~s_________________ homestead property. (*** roN7-'INUED ON REVERSE ***) (is) (is not) Exception to warranties: Subject to easements, reservations,, restrictions and rights-of~aay of record, if any. Dated this --------•---__---1.`~_~s-..~---------------- day of -- ---------------------------------------------------------------- (SEAL) -------------------------------------------------------------------- (SEAL) * ------------------------------------------------------------------ AUTHENTICATION Signature(s) ----------------------------------------------------• authenticated this ________day of___________________________ 19__.___ -------------------------------------------------------------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN `~~•~W~ ,,, -----------September-------------------------~ 19._87... ~,~, ... i ~ f X--- ------------ ~~--fix- -_ -~-'-•-- (SEAL) * Thomas G. F. P~cCombie I I I .x ~2~1,~l1-~--- V"= "-V~'vL4~1s~Z~.----•--------------- (SEAL) * _-lie.]-.e3?•--n'~----1`!~cComba.e----------------------- ACKNOWLEDGMENT STATE OF WISCONSIN S__t_ _. Croix _County. I ss ``// Personally came before me this ___l~l.~~_day of ________September____________~ 19__87__ the above named __ Thomas__ G ,__ F_,___McCombie_,_I II__ and_______ __ Helen__M . __r?cCombie,__ hi_s__wi~e____________ ~~~~' .; ~ a~ ry V {~ ~ r~ Legal Description (continued) `~G! ! 9~PAGE~~1 ~~ ~~ afi-P~ k.':. F~ No. 316964); thence N81°45'E 89.42 feet to the NW corner of Lot 3 of said CSM in Vol. 3, Page 702, being also the NLa corner of Lot l of CSI in Vol. 5, Page 1370; thence continu- ing N81°45'E 323.54 feet to the NE corners of Lot 3 of said CSM in Vol. 3, Page 702, and of Lot 1 of said CSM in Vol. 5, Page 1370, being alsorthe NW corner of Lot 4 of said CSM in Vol. 3, Page 702; thence South 295.0 feet along the E line of said Lot 1 of said CSM in Vol.. 5, Page.137.0, being the parcel conveyed herein as described above, and also being the West line of said Lot 4 of Cam! in Vol. 3, Page 702; AND also including all of the cul-de-sac shown on said CSM in Vol. 5, Page 1370. SUBJECT TO the restriction that Grantees, and their heirs, successors, assigns and personal representatives, as owners of said Lot 1 of CSM in Vol. 5, Page 1370, shall be obligated to share pro-rata with other property owners in the maintenance costs of said private road as long as it remains a private road. Grantor reserves an easement over the same private road easement described above, includ- ing that portion on the parcel-conveyed herein, for access to, and running with Lots 1 and 2.of said CS.~~! in Vol. 5, Page 1370. ;.~ .. .. Parcel #: 020-1037-10-000 01/07/2005 10:40 AM PAGE 1 OF 1 Alt. Parcel #: 18.29.19.157F3 020 -TOWN OF HUDSON Current ^X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ` =Current Owner * BONNEPRISE, MICHAEL J & DONNA L MICHAEL J & DONNA L BONNEPRISE 349 CASPERSON DR HUDSON W1 54016 Districts: SC =School SP =Special Property Addres ' =Primary Type Dist # Description * 349 CASPE ON DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.080 Plat: N/ OT AVAI LE SEC 18 T29N R19W NW NE & NE NE LOT 1 OF Block/Condo CSM 5/1370 THIS ALSO KNO AS _ WN PRT OF CSM 3/702 -- Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-29N-19W Notes: P i tory: Date Doc # Vol/Page Type 794/1}0 07/23/1997 ,Q 1 1 C (a~'1 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 47884 213,800 Valuations: Description Class RESIDENTIAL G1 Last Changed: 06/06/2003 Acres Land Improve Total State Reason 2.080 40,500 124,900 165,400 NO Totals for 2004: General Property 2.080 40,500 124,900 165,400 Woodland 0.000 0 0 Totals for 2003: General Property 2.080 40,500 124,900 165,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 136 Specials: User Special Code 018-RECYCLING 001-WATER Category SPECIAL ASSESSMENT SPECIAL ASSESSMENT Amount 27.00 0.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 r • ~ ~ ;, 1 ~.~_. 44 ,. j ~ ~( '.~ ~ ~ ~ Sr 3893~.~ CERTIFIED SURVEY MAP LOT 3 C.S.M. VOLUME 3, PAGE 702, LOCATED IN THE NE 1/4 OF THE NW 1/4 AND THE NW 1/4 OF THE NE 1/4 -0F SECTION 18; T29Nr R19W; TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. I OWNER WANDA MILLER LEGEND ' RT. 2 ~. ~ ST. CROIX COUNTY SECTION CORNER MONUMENT KRATTLEY LANE ~ ~ .WITH BERNTSEN CAP, FOUND. HUDSON. WI. • 1" IRON PIPE, FOUND. NW CORNER N 1/4 CORNER • 3/4" IRON PIPE, FOUND. SECTION 18 SECTION 18 ' S88°57'03''W 1"x24" IRON PIPE WEIGHING 1.68 LBS./ ~ LINEAR FOOT, SET. 162. 2' W rn +n rn O I-' C w x CTS ~ BALI, TRA_____ ~..~ . -- -_ 323..54' E R©AD EASEMENT io IV AT ~ I y Fg -~~~ ' 290 Z ~ r 0 ~ i~ w ~ F"' H 13 CURVE DATA ~~ ~ = 105°49'10" ~ PRIVAT R= 80.00' / ROAD ~ L= 147.75' N C= 127.63' EASEME T ~ BB O ~ ii W 7 09 5 "4 V TB= N 9° ' 127.23' x S05°44'19"E 321.81' S89 15'41nW ,o ~ CURVE DATA o ~= 1214' 22" ~ R= 80.00' u' L= 167.89' ~' C=138.73' CB= S65°51'30"E TB= S05°44'1.9"E ~ LOT ~ N x ; < ~ APPROVED .~ 90,434 SQ. FT. ) INC . ROAD ~ o V w t co r Ip ! i r 2.08 ACRES ) rn N ,rte 64 877 SQ . FT • ) ~ NOV 181983 , EX. ROAD I ~ ~ 1.49 ACRES ) - o i~ J - - I 0 .~ N n C 0 r w ro i~ ~ t~ iv IN w' IN ~I c~ N ALL BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE NW 1/4 ASSUMED TO BEAR S88°57'03"W. n c 1 ST. CROI~C C•...: ;; .TY COMPREHENSIVE PAK1:5 i'LANI ANP ZOMNG COMMITTEE ~~ F1LED N OV 211983 JAYES O' CONNELL Rpbl et ~~~d~ A Caoh. ~ w.ow. ~(+ 2~ S88°45'05"W 322.2$` 289.27' -33~~01' CURVE DATA ~=54°01'19" R=80.00' L=75.43' Z 0 i C=72.67' ~ ~ CB=N27°00'39.5"E ~ TB=N54Q01'19"E ~ NORTHr ~.-" N ~ i I I ,p LOT 3 0 ,p ~w 130 426 SQ.FT.) INC. ROAD 00 ~ I`~ 2.99 ACRES ) 128,942 SQ.FT.)Fx unAn N54°01'19"E LOT 2 127.323 SQ.FT•)INC.ROAD .g 2 ACRES 118,975 SQ.FT•)EX.ROAD .7 3 ACRES ) ~j / J _ rz wr ~o ro o~ o r i.~ x v ao r wo - • 3 4 • ~~ ~ D S ~: FILE ~ D ~C~C~~d~ "" sE? 2s 1978 ~ o' co~~~ ~ ~.o~ of c..a~ - _ r ~w .~ 3 5 2 0 4'~ r ~~ ~ _ ST._ CROIX. COUNTY NORTH Bo As, °so ~~ /'' NORT 384.81 m o~ c~ mZ Gy ~~ v t^ ~ y O N O en v ~ N WW ~ ~ W 656.50' ~n << w. p O • ~ / .622.55' ti ~ ~ ~ v ~ o `*~ _ Z op .jS I z -°~ ~ ~m1 .~i/ ~ ~ i m ~ z 1 mr NORTH 186.4' 6' ~~~' ~ O N r ~ m ~0 150 t-' ~O dp Z ,gyp ~ - - - -,--~ c~ ~ ~ s m m ~ ~o ~ 9 0 N ~ ~ o ° °\~ o\~ ~' ~ ~1 ~, j D N ~ O:~ ~1 ~ I ~' ~.. ai g\ ao~ ~ i ~ n'I y\"o ~I .p ~ 661.38 ~ ~ NORTH 660.35' p0". ~I N_ .~' Q ,j~ o ~- s 7.01' ; t w I °= ~ ~ ~ 1 SOUTH ' `.p 1 ~ ~ ~ N ~ ~_- w N ~ T w } w w ~I a+ Sp - _ ~~ w~ 1~_ ; ~ n. -1 cn ~ I ~ ~ C l.p -~ o°nz _ z -~ w `~J I a'° Im o m ~ ~ U .t f w l _ I ~' ,p I~ z ~.p ' ~ ~o ~ --- ----..Q"' ~ ~ Z ~ ,~ - ~ NORTH 295.0' ~w++ ' ~ ~. II m m f-i Z ~ W 261.66 u' 'I ~ ~~ ~ --------w ~bW ~ \ umi w ~ ' 0 15fi 02~-00 ~~ ~ N "'~ o - /' b ~ ITI °~+~ N r / ~. / n N (n :O ~ ~ ~ / GI / - ~ _ ~ O ~v / OD ~ Z N \6 'V~ ° ~ ~ ~ m u' ~~ s of/ y V/ o l THIS MINOR SUBDIVIS ' ~ ~ ION ' 4 0 4 80' ~'. ~ ~ / 0 ~ / ApPROVAI OF N07 MEAN APPROVAL 8-' / FOt,Z c m . ' • 18 9.87 0 n DOES DING SiTc OR SEPTIC 5Y~TFJ4k ~ ~ SOUTH 628.95' 224.15' ~ ~ gUit ~ ~p ~tEF~R TO H62~ ,_„ c0 C N N ~c D -i ~ ~o ~ 2~ ~ ~~ O w ~/~ / •O ~~ ~ - o O ~ s ~n O / O O ~ Y z -n ~- Z a/ dg' 0 70 ~ CJ ~~ ~ ~ ~ o ~ W - '+ ~ ~ i ~ 1 '~ I ~ CD 3 ~ S~ 2 i o A~ S ° • ~ ~• N ~ c 3 ' ~ C7 y IV Q ~I C 7 O Z p_ ~ V! U1 ~! 7 C•~D O M W ~ ~ ~ Q 3 O v y ~ ~ ~ ~ ~ C A 7 ~ n p I ~ T p ~ O ~ ° y 3 ' ~ 4' ° p ~ ; N fR W o ~ v I U~ ~ D C A ~ a m ~ ~ ~ ~ ~, O N W a ~ y ! C a C ~ O O (D ~ i ~ ~ O O L ~ ~ ~ O ~~ v! (/1 ? N I 3 w ~ C 0 0 0 I O ~ ~ ~ a -' D `~ I ~i x ~ ~ ~l .. Q ~ ~vv_ ! O o O y ~ ~ Sl 'O ~'I A ~ O ~1 n ' ~ M .. y lr N ~ ~ ~ ~ V a a .3. ~ ~` z ~ Z W o O =~ O c O D a ~ ~r ~ I ~ ~ ' ~ ~• I ~ ~' l~l I `° C m ~ C N N a I W ~ I ~ y o ~ A Z ~ C ~_ ~ ~ d O- ~ A (~ ~ = .. ~ ~~ a~D I ~ z a A c z co I ~ ' m ~ z I I F W A I m v a ~ a ~ I o xn ~ ~ o ~ - ~ I ~ z n ao W o i I x ~ ~ o ~' N I y cN ` 3. A O' O A 7 y N ~p b d A ~ 0' y ~ t ~ N ~ O a O Q I ~ o ~ w I ~ do ~ Fn O ~., ~ ° ~ ~' - MC COMSI~, TOM N~ NGI, Sec. 1~ ___ 2crrm~- h~ ~ ~ (m ~~1 Y ~ ~CS"5 La~# 1, w, M~i,.?.2eh Sub . HucGson, GII T29N-R19w, Twn.o~ HucGson San. Penm.%t #49415 2-7-~4 R. Haph.iws Canven,#,%onae, New _. INSTALLED 3-15-84 ' ~ Parcel #: 020-1037-10-000 Category Alt. Parcel #: 18.29.19.157F3 020 -TOWN OF HUDSON Current ~X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-owner MICHAEL J & DONNA L BONNEPRISE O - BONNEPRISE, MICHAEL J & DONNA L 349 CASPERSON DR HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description " 349 CASPERSON DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.080 Plat: N/A-NOT AVAILABLE SEC 18 T29N R19W NW NE & NE NE LOT 1 OF Block/Condo Bldg: CSM 5/1370 THIS ALSO KN WN S PRT OF CSM O A 3/702 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 02/21 /2006 818927 EZ-U 07/23/1997 794/140 9AAR SI IMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05(30/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.080 69,500 158,900 228,400 NO 05 Totals for 2006: General Property 2.080 69,500 158,900 228,400 Woodland 0.000 0 0 Totals for 2005: General Property 2.080 69,500 158,900 228,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 136 Specials: User Special Code 09/19/2006 03:23 PM PAGE 1 OF 1 Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~~ AS BUIL`T' SANI`T'ARY SYS`L'EM REPUR'1' ~~-~ owNER ~U~'`~l ,~ C C___!~~- ~ ~ruwNSrllr~~UtGI~ ~ i' ~, _sLC .T~9N-K~w; ADDrtESS S'T' . CRO1X COUNTY , WISCONSIN . SUBllIVISION~b~(~ ~~! ';:~;;~ LU'1'__ ~ LU`P SI'LE PLAN VIEW llistances and dim~:nsions to ul~c:t requlremeiits of H63 SHOW EVERYTHING WITHIN lU0 FEET OF SYSTEM ' y~~ o' --- Ir di at N r h rrc w .~ BENCHMARK: (Peru-anent relcr~u~~, r~,. ~ ) 1)ebcri!,_:: ~Q,(,Q,, YUMY CHAMBER Manu~'acturer :___ .__ __ ____________Nuuiber of gallons Number of gal. pump r~et fur a cycle__ ____ gallons; Total capacity of distribution linen ___ };allure: bite of pump head; gallon per minute _ ____; horsepower ;brand nave of pui and mode 1 n u u~ b e. r ___ .__-_-- - ' Type of warning device __ HOLllI~iG TANK: Manufacture r_ Number of gallons El~uation of manhole cover > Type of warning de~`~ice SEEPAGE P"iT SILE; Number of pits feet diameter fe~~ liquid depth' _ seepage pit inlet pipe-elevation bo~,tom of seepage lit elevation feet. SEEi'AG~. BED SIZE: nuiiber of lines width _length~,~tile de Elevation of va~rtical referuucu p~i~1t:~~"~ ~'~"" Slope at site: SEPTIC TANK: Manu.facturer:_~~S~Cr~~ _______ Liquid Capacity: r' ~~ Nuiaber of r1n.b on cover lank manholo cover elevation:~~ b • __ -_- _ -- ----_____ 'Dank lnle[ Elevatluu:____ C'~~~ gg__ 'l'ank Outlet Elevation:~'Aj +~ -- - - G ~ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS ~ PRIVATE SEWAGE SYSTEMS DIVISIO P.O. Bbk Tp.69 M~i D IS~N, qIV 153707 BUREAU OF PLUMBIN C~CONVENTIONAL ^ALTERNATIVE State Plan l.D. Number: ^ Holding Tank ^ In-Ground Pressure ^ Mound (If assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Tam Mc Combd,e 20G Secand, fiud~on, wI 5401G -s ~5/ - ~~ 00 /h BENCH MARK (Permanent reference point) DESCRIBE IF D IFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. E EV.. NE NGI, Sect,%on 18, T29N -R19G1, Lod#1,G1. M,%?.enJc pub., Tawn o~ Hud~sa~. Name of Plumber MP/MPRSW No.: County: Sanitary Permd Number: . R-t.chand Ha~fiin~ 1059 S~. Cna~.x 49415 SEPTIC TANK/HOLDING TANK: MANUFACTURER: 1 LIQUID CAPACITY: TANK IN ,ET ELEV.: TAN (IMIT LET ELEV.: W RNI G LABEL LOCKING COVER ` / ~ ~~ ~' ~j ~ ~ P V ED: PROVIDED: ~. G''~- ~Z"Z~ , ~r / YES ^NO ^YES ^NO BEDDING: VENT DIA.: VENT ATL. HIGH W ER NUMBER OF ROAD: PROPERTY. WELL BUI DING' VENT TO FRES L ALARM: FEET FROM '>~ LINE~O ~ ~ AIR INLET: ^YES ^NO ^YES ^NO NEAREST ~ ~ ~ I DOSING CHAMBER: ' ' MANUFACTURER: BEDDING: LIO UID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER: W G LABEL LOCKING COVER P IDED: PROVIDED: ^YES ^NO ~ ^YES ^NO ^YES ^NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER PER - WELL- BUILDING: VENT TO FRES (DIFFERENCE BETWEEN FEET F INE AIR INLET: PUMP ON AND OFF) ^YES ^NO NEAR SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE I F~~c~Tl, DIAMET R MATERIAL AND MARKING or excavation. (lf soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) MAiN_ i CANVFNTICINAI SV CTFM• " BED/TRENCH WIbTH~ . j ~ LF~GTH- 1 ~+ NO. OF TRENCHES DISTR. PIPE SPACING. f COVER ~ MATERIA~•~y~C P~-r INSIUE DIA.. #PITS: LIQUID DEPTH. DIMENSIONS ! ~ `! jV, _ GRAVEL DEPTH FILL DEP DISTR. PIPE DISTR PIPE DISTR. PIPE MATERIAL: NO. DISTFL NU ER OF PROPERTY WELL: BUILDING: VENT TO FRES BELOW PIPES. ABOV COVER ` ELE V.INLET ~ EL€V.,~NU.~ l G ~ ~ ~ ~ PIPES `FEET FROM ' ,LINE I~ ~ f /,~,/ AIR1~1tiF~- f L, a "~~ ~ , , Z NEAREST- -i. cf" ! 0S/'r MOUNDS SYSTEM: Mound site plowed perpendicular to slope ~ Check the textur e of the fill material for PROVIDE A DIAGRAMOFSYSTEM and furrows thrown upslope: ''! mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- - ~ meets the criteria for medium sand. TIONS MEASURED. ^YES ^NO SOIL COVER TEXTURE: PERMANENT MARKE RS: OBSERVATION WELLS: " ^YES ^NO ^YES ^NO DEPTH OVER TRENCH;BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. ~ ~ MULCHED. CENTER. EDGES. -, ^YES ^NO ^YES ^NO ~ <^YES ^NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.$F TRENCHES LATERAL SPACING . GRAVEL DEPTH BELOW PIPF. FILL DEPTH A$OV COVER: DIMENSIONS : , MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELE V.. PIPES. - DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORK TLV COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: ^YES ^NO ^YES ^NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: L1 ^YES ^ NO ~ ^YES ^ N 1 FEET FROM LINE: NEAREST 4 ~ ~ ~ ~ G~ 1 • ~ \ Jr, , r r \ r 4 ~ ~- ~ ~~ ~~ ~ ~ 1 ~~ ~ 7 h ~ ~ ~ ~ ~ Sketc System on . 1 ~ Re y file for audit. Reverse Side. ~~ SIGNATURE: TITLE. / ~` DILHR SBD 6710 IR.01/821 ~" ~- ~ - wls~°neln APPLICATION FOR SANITARY PERMIT ~+ ~~°EPRFiTR1EnT °F `PLB 67~ UNIFORM SANITARY PERMIT # ~ InOUSTRV, LriBOR6NUTFln fiELfiTlOnS ~ ~~/~ - -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT ~H{S PERMIT IS FOR A: New System ^ Tank Replacement ^ Repair r Replacement Soil Absorption System ^ Revision ^ Privy ^ Alternate System ^ Reconnection ^ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. '~ Seepage Bed ^ Seepage Trench ^ Seepage Pit ^ Holding Tank ^ System-In-Fill ^ In-Ground Pressure ^ Vault Privy ^ Pit Privy ^ Existing, For Which A Previous Permit Is On File, Permit # ~~ ~ issued ^ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total Gallons #of Tanks Prefab. Concrete Site Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEPJI COMPLETE THIS BLOCK: ^ Mound ^ In-Ground Pressure Total Gallons #of Tanks Prefab. Concrete Site Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per~nchl: REQUIRED (Square Feet): PROPOSED (Square Feet): ~ r--- ~ ~ ~ ~ 3 Private ^ Joint ^ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Printl~ Signat re: RAP/MPRSW No.: Phone Number: Plumber's Address: ~/ ~ Name of Designer: - COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ^ Disapproved ~~~ ~ -~ ~_/7 , ~'y / ~yy /~I Approved ^ Owner Given Initial Adverse Determination rseason for Disapproval: Alternate coursels) of Action Available: OILHR-SeD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 ~ ' To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. Anew permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 5, 13. Horizontal and vertical elevation reference points that are permanent and clearly sh~nrn. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. corm - S T C 100 Owner of Property R Location of Property ~` ~~~, Section~,'T~~N R~W ._ Townehlp Ma111ng Address ~20tp o2 ~,r -~~~~ ~ ~~~~~ Subdivleion Nawe_ ~d ,~ Cf~_~, ~fpy~ Lot Number e Previous Owner of Property /~/t~ Total Size of Parcel ~~ Q Q /~ E'rr~c S Date Parcel tae Created Are all corners identlflable? ~_Yes No Jude wlth this application o~--~af_the following: .Certified Survey Map V .Deed .Land Contract, or , .Other Legal Document which describes the property PROPERTY OWNER CERTIFICATION 1 (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are- the owner(s) of the property described in this information form, by virtue of a warranty deed corded in the Office of the County Register of Deeds as Document No. ;and that I (we) presently own the proposed site for the sewage disposal system (or 1 (we) have obtained an Basement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ). -.a~ `~G SIGNATURE OF OWNER SIGNATURE OF COOWNER (IF APPLICABLE) ~ ~- ~ - gy GATE SI~NEO GATE SIGNED G!//.UTE~P TFv~T Co~vD~T~ovs ; suuvy ~ z ?°F ~ ~iPosT `DETsARTMEIVT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, . DIVISION L'A~OR AND ~ PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 ~~~~I (H63.0911) & Chapter 145.045) /w/A,vDA /Yi/~F/J S~U/~!~/V LOCATION: ' ' SECTION: T z9 N W Rl~ E TOWNSHIP/MUNICIPALITY: LOT NO.: / BLK. NO.: C SUBDIVISION NAME: 70 ~ l 3 P ti~ /a /4 (or / l8 / fiuoso.y SM o . ~ .. COUNTY: 5 f • C~Po/X OWNER'S BUYER'S NAME: ~ ToM MC ~'oM/~ ~E MAILING ADDRESS: p(o Z,VD % f/~iVSE•v ~siGill Z o,J W ~ s- S o i ~o I ISE Residence NO.BEDRMS.: 3 COMMERCIAL DESCRIPTION: N~ New ^ RATING: S= Site suitable for system U= Site unsuitable for system ~~7 ~7 DATES OBSERVATIONS MADE P FILE DESCRI TIONS: ER AT ON TESTS: Replace- - F~~ / ~~~~ li~/~~VEv ~MME,PT ~s - L'S .SuB-~fo,f'iz-s.cJS CO NVENTIONAL: ~s^u MOUND: as^u IN-GROUND-PRESSURE: ~s^u SYSTEM-IN-FILL as©u HOLDING TANK: osou RECOMMENDED SYSTEM:(optional) ~ °,~v/~_~,-s . T ~~X3s' If Percolation Tests are NOT re wired DESIGN RATE: °,SS~i'fT ~~_ A Z I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: ~ M Floodplain, indicate Floodplain elevation: ~~~ yf PROFILE DESCRIPTIONS BORING TOTAL p PTH TO GROUN DWATER-IN F CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED ES IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. O BACK.) B-~ /D,D~ 13.Z,~ ~ ~/O.p~ ~, 0; l3,v, sc. ~J'Lf~/3a- s~ z.i7'o.P.eS B- 7 ~ ~'~ 9r, ~5 ~- ~ ~ o •S' BN• /5, /, o' G~ Qa. /s~ /, 0' o,P. Cs ~ G.e~ .S:S' o cs . ~ i . S- ' ,Ba . L S /. (~ ~ ' L/• Q.o . ~s~ 1, Q ' Oaf? ~RcQ. S - B- G~ .(I ~Pf = ~tSE ~i o z ~it'~~fs ©•t'~(riv~t/ TES~`~D B- ~ ,~~- ,~ ~-v S PT z~ ~ y~3 . ~y ~;s so;G T~sr~-.e . B- ?! 'S ~Pt T ~ ~VE~1~ i o t.v ~,pE ~ ,~tv i~ f /a w S ~~~ PERCOLATION TESTS `~ ~S~SE~'lE-VT• TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 P RI PER INCH P- so ' o S ~i(s SS ~fuJ S y" £"VE GS P- O ~ L V V~ ~'! - F BPD ~/3 /Ei P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. ~OTToM OF /,3E0 ~XC~'JUAT/D.U .SLi~// LiE- ~j/, Q ' ~~l8eer- SYSTEM ELEVATION ~op~ ~. ~ /s v.~ri o ~ _ ~7 7 a_ I ~ ~ T ~ i ~ I i ~ E ~ E -- _~_.~ _ ~ _ _ ~~ ~~ ~.~~..w... .. ~___ ~_ ~.._.. __ _ ~ ._, TN _~ ~ __~ ~, __ _ ~r ~. i` + ~ 111~STRL~TIONS FOR OMPLETINC~ FORM 11a - SRC - 6395 ~. ~~ , T~~ F ~~~plete and :~_d~~rtate soi! test, yor~r report must inolude: , ~° ~ .. 1. Cr~r~p3~.,e Iccfal descr` .` , 2. Tl e tase.section must ' =arty indicate whether #h idence or commercial project, =r~ .It11UM number of bedrooms or co[n~~rercial use ;Manned:. ._ 4. is th~ss a nevv or replacer-nnt system; ~_ '~~.`Con~pEete i'~e surtab. :ing boxes. A SITE-1S S~k:PlTABLE FC)f~ A }~9(~LI~tNG TANK C)NLY !F ALL . - C7Tl~ER SYSTEMS ARE RULED C3UT BASED C3N SQiL CONDITIONS; _ - ~ F. PLEASE use the afah~~i t:ions sho~irnhere for ~rriti~~g profile descriptions and completing the plot plan; _ 7. MAKE A LEGISL`~ ~ ~=~' -n accurately locating your test locations, t3rawing to scale ~ preferred. A ~sapnfnl dcr'rec,3; 8. ~•Mai< t ~ ertica! elevation referenc e point are clearly shaven, ar~~ ~ ~;.~ permanent; o~- . ~~ Foxe as to dates names addre~ e flood 1a"n ~a erc la ' ~ - ~, ~ s .s s ~ dot o tso i test exem ~ i i ! p , !~ F ~Isriate; 1t3,, ~,rmati«n (such as flood plain, elevation} does not apply, Plane N.A. in the aplaropriate box; 11 ;,;~ ,~e form a~~d place your current address. and your certification number; 12. Ma( legil~ir copies and distribzate as rectuired: ALL SO1L TESTS MUST BE FILED iN1TH THE LO~:AL AIiTH~7RITY i`VITHIN 3Q DAYS_C3F C~MPLETIQN. - - ~ .-, ,. ARRREViATIC~NS FQR CERTIFIED SOIL. TESTERS . . , ~ '.. I . _ tes and Other " mk~ols ~ ' ~ ~ sC .- ~.. _~~ {,over ft~` ~ BR _ ~'.< ~ i . ' ~_ ~ ~ .. ' col: -Cobble i3 - 1 S") _ SS - _S ~_a~tone _ _ ~ gr - G~ ,vca! (under 3")~ LS - .t~irrastc~ne "s ,l NGGV - 6-`~:,h Ground4vater~ ~ , _ .. cs _, ~ ; ;.:~ Sa~~d ~ ~'r.~rc - P ~la*ion Rate x7ietl s - ~. .~um Sand V'U _ ~ ~, rs ~ci Sldg Is ny Sand ~ Ti~<~an rs~ _ ~.y Loam ~ - 7':a17 ~`I - ~ =m Sn ._. L n "sii -- ., Lo~~n~i Si - ~s'aek si - Si'~ t.~y - liras; cl - C Y _. Y ~~~:,ti~,t - _ rn mcat _. Zvi - vd _ sic, - ~'.~y fft - f~r~,v, Y t,~ _ ~ ~ rrzi;~ - PJi,. ,,, -a m - k d - disti~'r:' p -~ prnc~r',... ~. Six :.,~ sQil tex ~ fog I !id ,paste ais . , s; BM - [' . ` Vf?P - V ti ,:' ,.,ice Paint Y .ig~G 6 ~ ~~ Y~, _ r f l~ ~ _ zA ~ ~~ . , ~,Aww~•^ -,xn^.....,;,:~ r,,,~r.;N, ,Pr ..F.-..__.,.. ,,... .._....._.. ,~., ..T-._, .,_.,,d_,.- .~.,.__ ,.,~y~..-..,.._._.....,.~~.,.,--......r.-.-.~;..,...,.--,v«~,-r..~«-wnu,~!wris~'~""''^="^P-^r-,..,-,...w~~ :~, ~. RE~oRT ~N SQL. C3nRtNG-S ~ PE~Cat~ATI~N T'~5T5 II.S Per Pc.,gN pi~n~-1Ecr t. a. DA T'E ~~- - / / ~~/ 'v~ ~~ Al w %/, c I ~, .~'i~ ~~t1 ~~' ~iOM~SiTir TESTING CCU. tt~',3, O'fllEiL RtaAD BUB III,~'I~dG';~.~ ~iu~~r~iv, wis...._ s4o~6 C5T S.l~-~ a2 y~.Z ~ ~ l~ Fr. of MD,rE F~PO•ti- ALc TEST ~,PE~4S. PROPoSEA_ N+ot~Sf Mt~sT CIE 2 Rv RASE © WL t~t M U5T LI;E . P ~+~'`~' a~ ai~l~f` F~PdH Acc TEsT ,.q,PE~)S, • = L•3gc~('~,~' ~iTf a = EXi3T/•U y~ ~CIEL~. X t ~E4G foGg7"/A~f ~ ~ f/A~l~ R~9E~ED o,Q 5~4~1EL ~~ES s ` ~~,~r'Z • t3M ,~~®~~ VE/?1`%CAL k'ffERt~tIfE' /~t~~1T ~°~° ~~ ~IP~'~.~c! ~~ ~- ~/EV~~ov of t/..,~r ~E~ Pr. ,~Q t~. LE GE N p 1 ~ .. j ~.. n... ~ ~S ~{ f. 1 ~ .. t. ~. .2 ~~ ~ ~ ~ ~ ti ~ ~° ~ ~ti ti "~ / ~[ ~ ~„~~ i ~~ ,ti ~ ~ ~,~~ ~.~o ~Y' ~ mss,, '~ r'' '/ ',. ~ ~- ~~ '~.~~-~' ~G f~t~ t~ ~ o ~ ~. y ~ ,~ ,~~, ~; ~ ~ I ~ , .,+ ,. • ~' ~_~ ~ ,• ~, ~`~Z.~~~ ____.~- ~ CERTIFIED SURVEY SAP LOT 3 C.S.M. VOLUP~tE 3, PAGE 702, LOCATED IN THE NE 1/4 OI' TEIL. NW 1/9 AND THE NW 1/4 OF TIIL Nl; 1/~l OF SECTION 18, T29N, R19t9; `f'Ot^dN OF IIUDSON, ST. CROIX COUNTY, N WISCONSIN. O~IfVER 'f 41JA~i[lA MILLED LEGEND RT. 2 ~ ST CROIX COUNTY SECTION CORNER MOi~1UhtENT KRATTLEY LANE WITH BEfZN`1'SI;N CAP, 1~'UUfvu . ~`. HUDSON, WI. e; O 1 " IROP~ P 1 PE , FOUND . F'; ~,. NW CORNER N 1/4 CORNER ° 3/4" IRU1~I PIPE, FOUND. t SECTION 18 SECTION 18 S88°57'03"W O 1"x24" I£20N PIPE WEIGHING 1..68 LBS./ r ET. + LINEAR I OO P, S ~-~ 162. 2' ~V E rn ~ ' rn O ~' ~ ALL BEARINGS ARE REFEP.ENCED TO w x TS THE NORTH LINE OF THE Nt7 1/4 ~ gJ}pLL TR~C_..- ~.,.-- -''~_ ASSUMED TO BEAR S88°57' 03 "W. 3 2 3 • 5 4 .,.-= w R EASEMENrr ~ i o ' OAD E --- RIVAT ----' i ~ _ ~ P ,,.,_ ------'"_,._- 290.20 ~ ( i ~ ~~7 `°' LOT 1 .n ~ ~ 'k~ ~ N ~ ~~' y I (,~ i ~ r' 90,434 SQ. F'1'.) iii 0.1~ li I PJ C cuN o a r IC i~ 2.08 ACRES ) . rn rv I. J ~ `J' ~ 64,877 SQ. FT.) !i(_II~~D EX iv ~ 1.49 ACRES ) . o ~_ o I r~ URVG DATA C --~"'-" i o _ p- 105°4g'10•~ PitIVATE ~j IN ~~ R= 80.00' ~~ ROAD ~ L= 147.75' N I -- 127 63' EAS~i<9FNT ~ „ _ 1 ~~ 100 50 0 100 2 ~~ a CBS s~,7~io'16"U~ S88°45'05"W 322.28' , y TB= N19a55' 09"t^J 127.2.3' ' IU' _x ~ 505~44'19'B w ~ s 289.27 i - ~• • `" ~ ++ 321 .81+ Iv ~o 1 W ' ~ 33. O1' ° 4 S8`3 1`~ ° ~ ° r ~ o a - - CURVE DATA rn j rn CURVE DATA --- o +~ p=54 O1 19 I w I o ~ ~ ,~ p= .120 14 22 ~J R=80.00' I'0 1~ w R= 80.00+ ' L=75.43' I~ t~ ~' L= 167.89 C=138.73' C=72.67' ~ CB= S65o51'30"E CB=PJ27°00' 39.5"E o TB= 505044' 19"E TI3=N54Q01' 19''E I N PJ54~01' 19"E l NOR1'I~ LOT 2 0 127 32.3 SQ.FT.)IIiC.ROAD n ^..~ 2 ACRES ) ~ 118,975 SQ.FT.) \ ':.7 3 ACRES ) EX .ROAD t Z W 1~ r O [~ o O 'b O T ,~ . N ~. ~ w c. o~ o LOT 3 130,426 SQ.FT.) 2 .99 ~1C;RE5 ) I IJC . ROAD 128 , 942 SQ • FT •) EX . }iU11U ~ nr nr^oa•c 1 z O ~-] x .~ a W 0 Iw i> Ir Ir I I ^3 I ~ in i C!~ ~ •. y. • ` 1 '~® ~j /SIG C- 0'~1 h~ °~ ~~ ~M' ~ °~ v~ p ~'~i N.IL Sao E L- qo,7~~~ ~~-, ~~~- ~//~~ ~i~~w ~~~ ~ ~ ~i P ors w ~os~ 6~ y, ~hcu~ ~~...a..~Zr,~ sh'o ~~