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HomeMy WebLinkAbout020-1055-60-200WisconsintDepartmentofCommerce 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 ^ Tgyvn of: Miller, Sam Hudson Township CST BM Elev.:. Insp. BM Elev.: BM Description: U~ a S TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~`~ P Z ~ D Aeration Ho d' TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake -ROAD Septic )~~ Z-?-~ 3 ~ NA Do ' NA Aeration N Holding PUMP /SIPHON INFORMATION facturer ,~_ errand Model Number M TDH Lriction S stem TDH Forcemain Length Dia. Dis . ELEVATION DATA County: St. Croix Sanitary Permit No.: 363864 State Plan ID No.: Parcel Tax No.: 020-1055-60-200 STATION BS HI FS ELEV. Benchmark U ~ gb ~ O Alt. BM ~ "/ . Z 3 B{dg. Sewer Z ~Q~r-~ ~ , Ht Inlet `Z, ~ ~ / Ht Outlet ~~~ /0 , 3 ~ ottom Header /Man. Dist. Pipe ~~ ,~ ~~ ~ /~ i. 9 Bot. System f` iu " yt /d~ y~- Final Grade r z ~ St cover 3 (j a SOIL ABSORPTION SYSTEM , ~ _ ~ / _ _ _ . BED / CH Width - Length r ~ No. Of Trenches - PIT No. Of Pits Inside Dia. Liquid Depth DIME / ~"5 DIMEN 1 N SYSTEM TO P / L BLDG WELL LAKE /STREAM Manufa ur r: SETBACK ~~HA~h~ INFORMATION Type 0 3 ~ ~ 3 A OR UNIT Moe rm er: ' System: S y !` 6 DISTRIBUTION SYSTEM Header /Manifold ~~ Distribution Pipe(s) ~ x Hole Size x Hole Spacing Vent To Ai~ntake Length ~ Dia. ~ r Length ___L. Dia. Spacing ~ ~ 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 Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 'S / ~~/ 00 Inspection #2: / / Location: 521 Prairie Lane, Hudson, I 54016 (NE 1/4 SW 1!4 21 T29N R19W) - 21.29.19.206A20 -Lot 3 ~ bK= ~ ~: 1.) Alt BM Description ='{ep o~ ,,..~~~~ 2.) Bldg sewer length = Z ~~ -amount of cover = ~ 3' P{an revision required? ^ Yes No Use other side for additional inform tion. ~ ~ SBD-6710 (R.3/97) Dat Inspector's Sign t e Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: t ~~isconsin Department of Commerce ~SZi Pr~,~~ ~-~c SANITARY PERM ~AjT10N . ,.,~ In accord with Co 3^0 s: Adm. Code ~':k,, Safety and Buildings Division 201 W. Washington Avenue POBox7162 Madison, WI 53707-7162 • Attach complete plans (to the county copy only) for st~q},~~Ier not,t?~ county than 8 v2 x 11 inches in size. RC- y - (10 ~ C • See reverse side for instructions for completing thi licatior) ~ ~~ `v~~ ~r`'c' State Sanitary Per~~m~~it//Number / , ` r ~~~~ / ~~ ~ ~ G - ~w3Xr.r yI VJ C ~ Personal information you provide may be:used for secondary purpo ~T( ..,~ S~ evious application ^ Check if revision t O pr [Privacy Law, s. 15.04 (1) (m)]. ~~f~ ~ y,`i . State Plan Review Transaction Number I. APPLICATI N INF RMATION -PLEA E PRINT. MAT Property Owner ame 6 ~`,~ cation ~1/a, S Z, T Z , N, R E( W Pr perty Owner's Mailing Address ~ ~ Lot Number Block Number ~~ City, State UQ t~N t.~v t Zip Code ~ ~ Phone Number c3~b) 2.7~c Subdivision Name or CSM Number ,~ .~ CS l~} ~~~ I. T P F B fL ING: (check one) ^ State Owned ~ !ty Village HvoS N^~ea9res`t Ro/~ad d ~/ ~ ~ ~ ~~' -`1~ ' f Public 1 or 2 Famil Dwellin - No. of bedrooms o r" Town OF t CI [ 1~- T III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) ~ ~"~ ~ `~ S ~ `` ~° ~ ! ~~~ 1 ^ Apartment /Condo 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home, 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise:Sales/Repairs 11 ^ Restaurant/Bar/Dining 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE OF PERMET: (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 ________ Existin~System B) ^ A Sanitary Permit was previously issued. .Permit Number Date Issued 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 l,~R~,P~ 22 ^ In-Ground Pressure ZK 3 /x 7S i 42 ^ Pit Privy ~ . j Seepage Pit j~! /tKF/LT2AT0/~ 43 ^ Vault Privy 13 14^System-In-Fill 3~t$'SQ~T. SIQE,.4J/NIJE.fZ c ~HAw(a_/Z ~•j'!I-TL~I~~-- VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade ,r1 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) r a' 5,,, Elevation w '."' SO " ' S w '~ ...-mom. t `~C S ' o 3 Feet Feet o t VII. TANK INFORMATION Ca aat In allOns g TOtal # Of r Manufacturer s Name Prefab. Site con- st l Fiber- Plastic Exper. N i i E Gallons Tanks concrete ee glass App ew x st n strutted Tanks T nk Septic Tank rHoldingTank ~Zsp +,~ f ~(~>E S~ ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY 5TATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber' Signature: o Sta MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code ono ~ 2 ~a i~..oAD vos©N ~ ~ IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) pproved ^ Owner Given Initial d D i i (l~lD{^ Surcharge Fee) a ~ oZ~ S g'" ` A verse eterm nat on ~. ~~.v/n--uiee~~~/ww~ yr HrrrLcw~-~ i n~Hwn~ rurc u~~Hrrrc~ H~: D0 SBD-6398 (R.12199) DISTRIBUTION: Original to County. One copy To: Safety a Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2} years. 2. Your sanitary permit maybe 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 i~~suing 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 5. Onsite sewage systems must be properly maintained: 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 Division, 608-266-3151. To be complete and accurate this sanitary 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 isto be installed. 11. 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. VII. Tank information. Fill in the capacity of every new/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. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of 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 performance curve; pump model and pump manufacturer; D) cross section - of the soil absorption system if required by the county; E:) soil test data on a 115 form; and F) all sizing 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. ,. i , Act, i3, cLl. Tor' r F /,~c°~rr~~r~,E ~l/!~ ~G~,~~`,~~1 L~~~ ~ ~ ~'/'~ `' M.Top CAF i2au { -PE f~ +{r` r I RA1~ECt Ec~~~~.~-`.~ ~~7.~ 11 5" ~ l ~~ I ~. t ~.. L e~'~.., -~,~ ~. ~ ~ ~" QZa - r~ss ~-QOv ~ ~5-~~~ ~~~~: ~a~ ~~~ r ~..~~ ~ ~ i..= ~ V ~ ~ iwr , ~ ~ 1 r' r p'~ ~` J "~" ~ F .~ ' t ~ , ~/' ~"~ k~ ' 7s `~ ~ ,~ i~l c /-~ Tt~ AMC. H ( i ~ y - T c~ TA ~ + ~ v y ~ `` ~ __ ~'~ ~ ~ ~ 7d ti I l~k0a1$ E ® V1lF ~. L J ~~{ X~•^o' S ~ ~ I ~ ____...__ .._._.._.~...~._-- -~-~----_ _.._~_Z•F. 2 ~ e fl ! ~ ~ ~.1C ~ ~Q~ 4~ ~4 r2~ c. ~ ~ D R ~v ~. w A `~ ~~l' S p[ i ~ I zso SAL. 5T-'~ Wisconsin Department of Commerce SOIL AND SITE EVALUATION ~ 1 ~ 3 Dtv~xm of Safety and Burldmgs in accord with Comm 83.05, W is. Adm. Code AC.E. Soil & Site Evaluations Attach complete sitee plan on paper not. less than 8'f: x 11 inches in size. Plan must County include. twt rbt {urnted to: vertiea! and horizontal reference point (BM), direction and St. Croix percent slope. scale or dirnemsi~s, north arrow, and kx~ia~ arx#distance to nearest road. Parcel I.D.# APPLICANT INFORNWTION - Please prirrf all information. ~ t~ ofo20-loss-6o-o00 Personal informafion you provide maybe used for secondary purposes tPriwa w, s. 15.04,(1)`(m))- R vlelved By Property Owner / `_, ~.. r ~ L' rroperry2gGauon Miller, Sam ! Govf Lot =::~ NE 1!4 SW 114 S 21 T 29 N,R l9 W Property Owners Mailing Address <` , 3 1 ~ # + .. Block # Subd. Name or CSM# P.O. Box 151 ~ `=^~ C~~rx 3,' ~,~ Proposed CSM City State Zip Code`,.et?honeN ~ G .' ^ Village ~ Town Nearest Road Hudson WI 54016 7l 5 ~ -~~~a:1 s` `~ xudson Stagecoach Trail New Construction ~~: ~ Resxierltial I~ltise< oI t}edrr ` 4 ^Addition to existing building Replacement ~ Publ~ or commercia~I des -cn"6e Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/ft .8 trench, gpdfftz Absorotion area required 857 bed, ftz 75 trera~h, itz Maximum design krading rate .7 bed, gpolftz .8 trench, gpd/tt2 Recarlmended klfittration surface ~vatiort(s} ~- _ ft (as referred to site plan t>er-chmark} Additiorlal design 1 site considerations Install trenc es using High capac~ kct'drrators. Parent material Glacial outwash Fkxxi ain elevation, if a tcabte NA ft S=Suitable far system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitab~ far system ~ ~ s ^ u ®S ^ u ®S ^ u ®s ^ u ^ S ®u ^ S ® u Boring# 1 Ground elev 107.12 ft Depth to E'rmi6ng factor X141" Ground elev 1r1R 7Q A Depth to limiting factor >11s° Depth Dominant Color Moths Structure C i t B d Roots ~~~ Horizon in. Munseft ~. Sz. Cont. Color Texture Gr. ~. ~. en ons s oun ary ~ ,, Trench 1 0-11 10yr3/2 None sl 2msbk ds cs 2f 4.5 0.6 Z 11-28 10yr4/3 None sl 2m~1 dsh cs 2f 0.4 0.5 3 28-36 10yr5l4 None is Osg dl gs if 0.7 0.8 4 36-78 10yr5/4 None s Osg dl gs If 0.7 0.8 5 78-121 IOyr6/4 None s Osg dl - - 0.7 0.8 ~ O _ ~~yY eo3. `~ Remarks: 1 0-8 10yr3/2 None sl 2msbk ds cs 2f 0.5 ~ 0.6 2 8-18 10yr4/3 None sl 2msbk dsh cs 2f 0.5 '. 0.6 3 18-24 10yr5/4 None is Osg di gw 1 f 0.7 0.8 4 22-81 IQyrS/4 None s Osg di gs if 0.7 ~ 0.8 5 81-119 10yr6/4 None s Osg dl - - 0.7 ~ 0.8 Remarks: GST Name (Please Print] Signatu Telephone No. James K. Thompson ~_.__- 715-248-7767 address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, 4020 1115194 3602 1127 'arri!~: Maims sue, PARCELLD.# Dartof020.i055-60-000 3 Ground etev 106.39 f Depth to limiting factor >119' SOIL DESCRIPTION REPORT „z7 ~ 2 of 3 e (` F Cnil JPr Cite Rvalnatioas Depth Dominant Color Mottles Structure i t nda B Roots G~~Z Honzon in. Munsell Qu. Sz. Cont. Color Texture Gr ~ ~ ence s s ry ou Bed ~ Trench 1 0-8 10yr3/Z None sl 2msbk ds cs 2f 0.5 0.6 2 8-22 10yr4/3 None sl 2msbk dsh cs 2f 0.5 0.6 3 22-30 10yr5/4 None is Osg dl gw if 0.7 j 0.8 4 30-82 10yr5/4 None s Osg dl gs if 0.7 ~ 0.8 5 ~ 82-119 10yr6/4 None - s Osg dl - - 0.7 0.8 . (08 ~(. ~ Kemarlcs: 4 Ground etev 105.65 ft Depth to limiting factor >104" 5 Ground elev 105.93 ft Depth to limiting factor >108" 1 0-10 10yr3/2 None sl 2msbk ds cs 2f 0.5 0.6 ~ 2 10-20 -- 10yr4/3 - None sl ----- - 2thickpl -- dsh cs 2f ..,P o. 3 .9:4 .A:S 3 20-26 10yr5/4 None is Osg dl gw 1f 0.7 ~ 0.8 4 26-75 10yr5/4 None s Osg dl gs 1 f 0.7 0.8 5 75-104 10yr6/4 None s Osg dl - - 0.7 ~ 0.8 RemarKs: 1 0-9 10yr4/2 None sl 2fer ds cs 2f 0.5 ~ 0.6 2 9-36 10yr3/Z None sil 2msbk dsh es 2f 0.5 0.6 3 36-41 10yr4/2 None sl 2msbk dsh aw if 0.5 '~ 0.6 4 41-91 10yr3l4 None s 2msbk dh gs if 0.7 0.8 5 9I-108 7.Syr4/4 None s&gr. Osg dl gs - 0.7 ~ 0.8 KemarKS: Ground elev Depth to limiting - - - factor r i r-'fLt~..B : Top o{'~'ron~0~ a,'~ ~r~ .~ ~~ ,~ ~.3 s~aa~e,~,oac.~ T,-/ zso'=- T P ~{' irdn ID:~Oe . ,gssc~.ned el~e~t.-= ~~ cD• ay ^ Q/-, ^ ~ ~~ ~ h t k h cP ~ ~ ~~ ~ ~h'' Q ~~ ~ ~ @~ -/ Bs ^ ~' yo~.cd P~.3eF3 ~ .~,~1 Obscr~a.,~o~, P;~ ~lQda~a» {~' . /oca~Zc~p~oio. 1 ~1 ~ ~a.kt O~ne~= ~a.r+ rK; /ler I0 0. ,B~ /S/ sya~ r~ I`ot3 o~~O~oooslct' CS~r(~ /JEf'~Sca~y, See. z/, T..29d. Q %ycv,, T, of h~ic.olsan, ,5~•C.'~~XCv~ 275.98'• ~ ~ ~ own f'• !'~ ... ~~~~ V' :~~~• f'} ~'w ~ ~ ~~ V V Q ~. ~ • ~ N ~ ~ ,~ ~O tton .~ V, ~ ~ '. i ,~ S ~. y ~~ ~ ~ V .. __.. ~' ~ •1 ~ c~'f ~~ ~ . ': W: ~~ D ' .- Z -~ ~ ,.i._'` U ~ W W ~° ~ °- U ~~ ~ L C/~ U C ~ T o ~ ~ x E ~ o ~ ~n ~ ~_ _ V x 4 u4 J ` X • ~ N U ~- T E ::. ;. 1 •~ E - 'v ~ ~ ~ a ~ $ d d ~ a v, .. a~ ~ ~ ~ ~ ~~ v 0 ~~>°- rn ~ ^`` ~ C ~ W m ~ ~ ~N2 y ~ s ~ ~ W~ C ~ C ~ ~ _.. e ~ ~'v ~ ~ ~ •~ ~ Q T~ ~ ~ i ~ ~O~Z V~ ~ . . • • °_' a ~~ b W ~' ~ O ~~~.../// / V T zCi b W • .~ U `~w R w! ~ f ~J iEt f ~~ ~ ~ Z~ ~f ® ® ~ ® ~ ~ ~ ~ w ~ ~ ~ C .- ~ O ® `~ ® ® ~ ~~ a ~~ : ^ ~ ~~ U ~ ~~ ® E ~ a • U ~ ~ ` ~: • ~ '~ ~ ~ ~ E ~t ~ ~ ~ _ . ~ a ~ ~ c ~ ~ a ~~}} ° . j j a a ' ~S a . ~~ c ~~ , ~ a .~c .. ~ 3 X31. ~ ~ ~: ' t ~~ : ~ W . ~ ~ ~~ h- `° ~ T ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~- ~'f f'1'~ ~ L ., /.- ^. Mailing Address ~ ~. Property Address ~ ~ ~ ~''j~ ~} ~ /~ ~ ~,. Via. (Verification required from Planning Department for new City/State +'"~ '~ (~ ~~ ~ f Pazcel Identification Number ~ '~ ~~ ~ `~ ~ '""~~ ~ 2(•2R. 19. ZDb~ -~ LEGAL DESCRIPTION Property Location /Y~ '/4, ~ '/4, Sec. ~ ~ T ~ `"~ N-R ~ ~~ ~ Town of ~'~ ~ ~~~~ Subdivision ~ ~ ~ _ .Lot # ,~_. Certified Survey Map # ~v ~ 7 ~ ~° t ,Volume ~ ~ ,Page # ~ ~ `~ ~ Warranty Deed # ~ ~ o ~ ~~ ~ .Volume / y ~~ .Page # ~' ~ Spec house ~( yes ^ no Lot lines identifiable ~ yes ^ no .~~ SYSTEM MAINTENANCE 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 (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 standazds 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 5t. Croix County Zoning Office within 30 days of the three year expiration date. ~~ ~- p a ,~ , o© SI r AT[JRE OF AP ICANT 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 th~perty described above, by virtue of a warranty deed recorded in Register of Deeds Office. / A F APPLICANT 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 warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I' 1 r , I; ~) I • ooCUr„Er,r Nom. WF,fTT1r^•.`:TY GEE%- . ~STO.T-. isAa~,F w• c.,~,~::: r~GRLl z-~9ezl 6107~i~ Y~~ 14V58P~•,E s~ ~~ REG1~1Ek OF DEEDS HumDird Land Corporation, a Minnesota Ccrporat^:;n I~ RECEIVED FOR RECORD .......................... ................... .............................................. .............. . 09-22-1999 ~l:30 AM . RRANTT DEED .. ..... .. ................................ ............ ,. E?cEnPT N ... ..... t•onw•ys :u\d wnrrnnlr to ...........5~' E. Miller ................... CERT CODT FEE: ... .. ... .... COFY FEE: ..................... ........................... ........ ... ................... TRANSFER FEE: e17.50 ............................................... .................... RECuRDING FEE: 10.00 PAGES: 1 ... ... .... ....... ...........................-.- _..................- .... ncrunh ro ................. fF~ /D~ Cho folluwin{: described rc:,l eslatc in ......5.4,,,Crpix_._. _,..._ ,..,County, -- State of Wiscunsin: n•~. The East Half tE>~) of the Southwest Quarter (S'~) EXCEPT parcel Tat Parcel No: `'~!.~~~~~~~ conveyed to Alfr~rd L. Ekblad in :Diane 498 O O page 484; and EXCEPT ~ /D~-~6 parcel conveyed to Leslie L. Swe^son in Volume 438, page 504; and EXCEPT parcel conveyed to Donald F. Johnson in Volume 500, page 515; and EXCEPT parcel conveyed to Dc^ald R. Jordan in Volume 580, page 354; and EXCEPT parcel platted as we'.'s cargo Station, in a'olur! 5 of Plats, page 89, as Document 1478658, ALL in =ection 21 (?1), Township Twenty-nine (29) North, Range Nineteen (19) West, 'own of Hudson, St. Croi: County, Wisconsin. ~' I Subject to unrecorded agreement _ated October 11, 1491 by and between Donald R• Jordan, Cail Gordan, John A. Elbert and Eric J. Lunde+l regarding fut::re lano transfers and roadway conveyances. Subject to covenants, conditions, -estrictions :nd easements created by preliminary plat of 'Neils Fargo Station First Addition. Subject to easements, restrict~:~s, reservations, and r~;hts-of-way of record, if any This .......!.5...".ot........... ~:.restcad prorer!,:. (1d0 (is nnt) I•:xccl`timi to wnrrnntics: As ^oted above Dalai this .. .......,20th ................. ...... .. Jay .: ....__ .. _ ..................... .(SAL) AUTHENTICATION Signnturo(s) .............................- - a•,imer,ticnt~d 'skis ........, r".... ...._.... _? TJ'IIE: bfC~1llL•'RS'fATE BAii'JF'.VI~^:\`~;I`: (If nut . ............................. ........__ authariud by b 7OGAG,, Ws. ":,ta.) T/i15 INSTRUMENT `N.>$ URa F-FCJ 8'i Hu.^~bird Land Corpor;jti~.n (Signnturrs-.may Ee aat^.Cnt:'3'_~7 3Cii:`f\Vl 11~••- 'S ere not r~•r..~,. ., \ ' August..... .................... 19.99 HUMBIRD LAND CORPORATION ...... . ...... (SEAL) Austin J. Baillon, Its President . _......... ..................................(SEAL) ACKNOWLEDGMENT STAI'F OF XX.'r9i3ii~CjBfIQ MINNESOT ss. Ransey ...................County. f,~5.:r.:i:y :.,nw wioro me this ...'~th......day of a~.9N?t ............................ . 1:'39.... tha ubovo nnnlcd Austin J. Baillon President of '~.u;nbi-rA Lard..Cnrpncatino ......................................... ................................. ;c me known to Le !Le , erson ............ who ~r.ecuted the :,,r~~,t-.:~"nt :\n~ a,~~.u.+wlc~~arf~.R•Raluq Paul A. 311 ]r n - ~V COL+'::TY C,.r 1 l I t Nashi 9 ore ~•• ...C6U`htV,~~:~ N 1> '; ,, •i. lion 5 nr.,mnrent ([f r.ot, state exlurntion o r ~~•~ °°~ ~Zb~~ r i . ~~~~ `V ~~ 61`461 '.1 CERTIFIED SURVE''Y MAP Sam Miller, Don and Cail Jordan Part of the Northeast %, of the Southwest y, atiid part ~f the ,Sor~theast '/, of the Southwest f/. of Section 21, Township 29 North, Range 19 West, Town of Kud~orf, St. Croix C'oul/tV, Wisconsin, including part of Lots 2 and 3 of that Certified Survcv Map rerordeci in l~'nlunte 9, Page 2503 of St, Croix Couiily Certified Sun'~ti' Map records. G~ ItvC' ~ C_~~G ~~j r~~l~Vi~ ~T'r,~~ `~ I ~ WP. 1.13 iiBJ IlllRAi F~ ~S s• I "°' • FOUND i~ ~~ pl~ a:07"OB'oo .~:.~. L.. ~ : 27 H ~ ~` ~ / E' _.. . 8T ~q : 48 -- , _ -~ ~ , ~ ~ ` 1 CN~40,AB' 90' W 1 9U/L~ ~~ - _ ~ ~u S. L /NE STAGECOA H TR. ~E-iIE )~ T~]g l~ 1 ,pr i4.~ h ^ 74.87 .. ~?4Z 00 : 1~ ~ E.1 q O O gI~LOT ~ B .1~66..,j 1 r~ 3' his fBgQCON ' NOf ~~ r~C~C"/' 1, , ~ FOUND 2 ~1 P1FB t _c ~ o a, w ~ S ~~aq •• , ,~ . g. Ag.~i,: ~ ~F ~% //VVCC q p ~ ~ .. ,~? ~ , .. ~.,. , ~~ '^ hie S O ti. a n~ a , h 0 . ~ ~ of ----• ---•-- p 301!. BOWNOB 1 FLOW ~ O fxt ti ~ a. ~~~,~` 1; . ,I OI ~~I LINE wf a y~/60oG~`~Op'-g ~y '~~, in tap W"~i 2~ h ' ` '~ ` I EL EV.: v NOTE- 97.6' 619'02'P?"E A, 58.0 ~ ~ h0 ,~ ~q9 SEE SHEET 3 FAR ` 1 ~ ~N p NG h • 5 S 3 0~, No 'SOS ', ,~00 , AC.4EACE DET~/LS ~.1 aRa/Na,^,E o LET 2 '^ O4LOT3~ ,SS~p~ (J I ,fr157EMfNT O O ON ALL LOTS t,~~ ~ $ ?50.o0'~n ~ ae3.so' Nsae'36c0' , UII~~; ~ ~- SB9.0 '2 "W 633.50' J~3 3 , OWNERS AOORESS- ~;~-~ `~ w o a. M. swcoR.~coT/ M s '49•' t ~ S;,/.~v'c-y SAM M/LEER `., ~ ELEV._/oo.t~o'(ASSUMED! '""'--- P.O. BOX /5/ .~ o• ~ B HUDSON, w/ 54ois ~; ; `^ ~ RESERVED FOR ~ DON ANO GA/L /ORDAN 2!. ~J I a ° a i ` ,`•~s~~(',t01~/,a~~ i~ ROAD E TOWN i W N '~ 550 C.T. H. ~~UU ~~ ~j I ~ ° W ~ ~~, CJ ~~ I to HUDSON, W/ 540/6 % i i ti t ~+ ••~ f1~ ,,......., `S~ ~i~ I N o ~~ ~ ~ M vp ? ~ ~ •~' ••., ~ ~j I 166 O p ~1 ~'.'~ 'LAUREN ~ I i n~ ~ LOT 4 3a ~ Cm.'.W M R HY~ o ~ j ~9 v er ~ 1713 ~+ • - ; / f l~ j ~- h a ~ N~tR.fGER FALLS, . ~ ,~~I ~ / ' 1.^, a ~ ~~ ,~ ••. ...• J • ,,i U, oa .. S ~ -'•s h a 1`•I v ~ DATED: OCT. /2, /999 ! W t ~ ~ 1 ~~. 4i~i 406.58 ~ REV/SED: /A NU4RY /8, 2AD0 I ~ -Z. ° iy C:1 4.5'3• = -ac_«_ . ° ~ N ~: ~ REV /SED /ANUAR Y 20, I ~O g oho cal ~~ SB9°02 22 W 'p4 2000 i O~ . W a is ( ,~~ V a 0 - ~ ~ ~ W h c~ ( \~ ` ~ ~ ~ ' ~ • O B , ~T . 2 3 ~ ~ I 2 ' 255.74 %© ~ :r-a. ° ~ APPROVED S99°02 22 W x W o ST. CROIX COUNTY P ~~- ~ 3 ,~ ~ Fvl ~ Plsnnin n Parks Committee ~.~' ~ W ~ E,i ~1 SCALE /N FEET ~~ ~~~ `?~~~ ~ m O ~ `:I ~:~ ?~u~ z J 3 0 50 /50 300 60~oO" '~ ~y~'~ `i ~JI 3,~¢"E ~ QO' BU/LD/N6 ~TB~C,~/KE •~ O - ' 22 5 If rwt rooorded within 3ddays of O ~=!- 5 ~. ~ ~ "E I annrnvsi rfafa annrnval shall be ~ o 2?h 5 ., ~~ Q6 1101 Carmichael Road Hudson, WI 54016 Phone: (715)386-4680 Fax: (715)386-4686 Fau To: Tammi From: Shawna Moe Fax: 386-9281 Date: August 15, 2000 Phone: 381-5000 Pages: 2 Re: Septic Verification - 521 Prairie Ln CC: ^ Urgent x For Review ^ Please Comment ^ Please Reply ^ Please Recycle •Comments: ~\ ~~`~ r~ ~ ~~ 1~ .c~` INNNNNNNN -- nrri ~ ~~. ' i August 15, 2000 First Federal Attn: Tammi 201 S. Second Street Hudson, WI 54016 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 Fax (715) 386-4686 RE: Septic Inspection for Sam Miller located at 521 Prairie Lane, CSM Vol. 14 Pg. 3796 (Lot 3), Hudson Township, St. Croix County, Wisconsin Dear Tammi: A septic inspection of the above referenced property was conducted on 05/17/2000. This property is located in the NE 1/4 SW 1/4 of Section 21, T29N R19W, CSM Vol. 14 Pg. 3796 (Lot 3), Hudson Township, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. If you have any questions regarding this, please contact our office at (715) 386-4680. Sinc , Jon Sonnentag Zoning staff /sm cc: file