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HomeMy WebLinkAbout020-1260-80-000S'~ : CRUIX CUUN'~'Y ZONING DEPARTMENT AS 6U[t,T SAlVtTARY REPORT - owner ~N a ~~t a. D ~ g ~,.~,t_t~t.ILL - ~~~ ~ ~ El E Cit},State ~trrso~ U .~. 5~(D/~ ~~ - - JUL 2 5 2005 i..cga! Description: Lot ~_ I31pCk SUbdIV18[orr/C$M ~ -r(.~ ST. CROIX COUNTY '~• S___~#,- 'f, U~., Sec.;Z~; T,~iV-R 19 w, Town of ~t~o~ PIN # SEPTIC TANK -- DUSE CIIAIVIBE~t IiOLDI,iiG TANK INFO ~A~,'IUN: ~ w J - /no Tank man>trfacturer ~! ~~ ~a Size 3T/PGr7~I Setback from: House 5` We11~7 5'~ P/L~ Pump rnarrafacturer Model Alarm location --• (nOLDt1+tG 7'A1YKS VIVL~ • Setbacks: Service mad Vent to fresh aic intake W~.~• ~~ Meter location Alarm location SAIL AB ORI'~ 'IUN SX EM: R~~ ~ ~~ ~rv.V ~ ~ •-~1 S (back system: Wlddi--`~- ~g~ ~~ Number ofaG~~ __~__r frsm: H se 2~1` WeII ~~ P/L .~3 _ Vent to fresh a><r mtake ELEVATItINS: Description of benchmark Description of alternate be Elevation ~00.0~ Elevation ~~ ; Building Sewer l~ocis~ei ST/fIT Inlet ~~ J`~ ~T Outlet ~ •~~ P~ ~~ FC Bottom _______`r I~eadet/Manifolcl r 2.• ~~ Top of ST1PC Manhole Cover q / • y~ Distribcx[ion Lines ~'} ( ) Bottom of System (~) ~ ~ '~ ~} ---~ - ~ i - ~ ,, I=inat Grade (~ ~~ ~) ~ } Date of installation ~~ermit Wombat C~'L~[.~ ~ State plan number - Plumber's signature License aumber ~ ~' ~ 3 7s Date / ! t Inspector~q,~„ C ~ in-~ (yes' - - 0 ] ~~ Ulbricht & Associate Private Sewage Con~~all~tt#6 2812 y 0th Ave, Spring Valley, W1547~~ b~-u~oN Wt 54pr? ~ ~, ~+' ~~~ ~~ 10 q` FjE~ ~c~oM ~~ SE 23 ~'~"~ 33` t .-~ a~~ ~E M S`( a ~~~ ~ 5~~ ~~ ~.'~' ~~ o Cop t~r-x~Mole. ~~~ ~ ~~ ~~ tiff S- ~ . z~`~' c, 1 b b~o ~~`~t ~.- titi° '~~ O -... '~.. .~ ... r .~ r ...r ~ 1 ~ ~ Vr` ~ Y ~ r r ~~ ~.. ~~~ .~+ i TQQ r Q~~lril~'r~~37 v~~- ~~.p ~,~_~ fr~ 1 p~~ S~S~~ J ~ Q'P~PtC N , r ~~ j o~. o ~~ TWIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # ^l~ t~ ~~~ ~' 4 Wisconsin 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 Klundt, Shane Hudson, Town of CST BM E{ev: Insp. BM Elev: BM Description: TANK INFO MATION ELEVATION A A ' TYPE MANUFACTURER CAPACITY Septic ~~ ,m O U V Dosing ~ ~~~ - ...y~~,~J ~ ~ Aeration Holding ~ ~d ~ ~l{ TANK SETBACK INFORMATION TANK TO P/L~ WELL BLDG. Vent to Air Intake ROAD Se f ~ i ~ ~~ ~~ I Dosing Aeration Holding PUMP/SIPHON INFORMATION Model Number to Well County: St. CroIX Sanitary Permit No: 479244 0 State Plan ID No: Parcel Tax No: 020-1260-80-000 Section/Town/Range/Map No: 21.29.19.1261 STATION BS HI FS ELEV. Benc ark Alt. BM O 5 n~` ~.~V Z Bld .Sewer -Q.c'l ~~ St/Ht Inlet ~ ; K.~,,~~ `~' ~ r ~ /D ~ 7 SU_ t Outlet a .'~" 2. 7 Dt Inlet / Dt Bottom ./~ Header/Man. ~-- ~/~°j5 , Dist. Pipe ~ / ~ Cl~ /"I• ~ ~'m y/. `~9 Bot. System 1 Z,<< Z l~' n l'~ tJi Final Grade -- ~•oQ 97.3 St Cover ~ n 2 ~- y ~.~ ~ ~ ~ f ~~,~/~ ~ Sell ~RSARPTIAN SYSTEM ~ G ~/" •7 ~ -- / ~/ .~ / BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ ~~~'~ •~ ~- ,.~ SETBACK SYSTEM TO P/L BLDG WELD G~( LAKElSTREAM LEACHING Manyta rer:% ri ) . ~ ril r C N CHAMBER O ~- f l Tye, •~ INFORMATIO Ty Of System: ~ ~ / ~/ ~ ~~/ UNIT Model Number: nISTRIRIITION SYSTEM !\ ~-l~l_ D~/~- Header/ anifold ~/ LI gth Dia Distribution ,,/ q ~ Pipe(s) Q~~ cr ! t; -~ / Length Il ~U i Dia Spacing ~J x Hole Size ~"~ x Hole Spacing ~'- Vent to Air Intake 1 ~~ i SOIL COVER v Proccura Svatams C1nly YY Mrn~nri (1r At-Grade Systems Only Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedlrrench Center Bedlrrench Edges Topsoil _] Yes No [~ Yes (~ No ~~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: (O /~/d~~~ h Inspection #2: / / Location: 556 Stagecoach Road Hudson, WI 54016 (NW 1/4 SE 1!4 21 T29N R19W) Prairie Vista 2nd Add Lat 22/~`'C) Parcel No: 21.29.19.1261 1.) Aft BM Description = s f C-efL~L-' 2 ~~/(it,p'1't-Q O~ 7'l~'~_'~ ~ ''~~f,,,~~0 2.) Bldg sewer length = . ~~f < ~"r ' Ql b~~'~-,~"`- ~~~/YI/Yy~ ~ ~~ ~ a~'L.~~~F'i- -amount of cover = '~- l ~~n t Plan revision Required? , :' Yes No `~ ~' ~ - ~ ~a Use other side for additional information. _~~ L - G2~~ ~C ~f- -'~'~ ---~ 1_----. ` _J Date Insepctors Signatur Cert. No. SBD-6710 (R.3/97) Safety and Braidings County S~'. GRD 1 201 W on Ave., .O. isconsin ~ - 716 ' ~8) 266-3 31 ~ ry P 't Number (to be filled ;n by Co.) [ f ~.q Department of Commerce .. Z • Sanitary Permit Application ~ 0 p Pl I.D. Number N In accord with Comm 83.21, Wis. Adm. Code, personal information y prov[~l~ CRQ1X CO tray be used for secondary purposes privacy Law, s15.04(1)( ZONING OFFS (if di an ~ k~ /J Sou~A. a I. Application Information -Please Print All Information O 2 d - / Z ~o~ 8Q . 00 d ~~ Property" Owner's Na me Parcel t # Block ~ Property Owner's M ail' Address ss Cv 5~~4 ~E ~-~ ~E- Tie~4j L Property Location /~ , J , r Sw 'v" '~' City, State ~()~So~ ~/~ Zip Code S `{ ~~ ~ Phot[e Number p ~~ 5' 377' ~ ~ u, 'i,Sectian a i Z l ( . / G c rc e / / / I II. Type of Building (check all that apply) E o W T N; R ~'1 or 2 Family Dwelling -Number of Bedrooms ~ S ubdivision Name CSM Number ^ Public/Comtnercial -Describe Use /~ 1> ,,,,[ I ~~l ~l ~ V ~ S / ^ State Owned -Describe Use ^Ciry ^Village ~T'ownship of _ U~~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ^ New S stem Y R lacement S stem ep y ^ Treatment/Holdin Tank g Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number atd Date Lssued Before Expiration Plumber Owner IV. of POWTS System: (Check all that a 1 ) ,, LXNon -Pressurized In-Grouts ^ Mout[d > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sar[d Filter '/ `` ^ Constructed Wetland ^ Pressurized In-Groutd ^ Holding Tank ^ Peat Filter ^ Aerobic Treattent Unit ^ Recirculating Sand Filter ^ Recit~ctilating Synthetic Media Filter ^ Leaching C ber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. D' rsal/Treatment Area Information: S Z T~ !~~ (gpd) U v Design Soil Application Rare(gpds 'l1 Dispersal Are^a~Required (sf) af, S / DispeQr~sal Area Proposed st) CT System Elevation GZ. O r 7 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Co~rete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank -1 d X000 ~ 1 S ~ Z ~S ' Aerobic Treatment Uni[ ~~ / ~ N.G tbsing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print} Plumber's Si /MPRS Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) ~.~i z to ~- ~~ . S~j~:,vG- v,4~/ ~iS . ~s ~-/ 7~ 7 VIII. Gotmt /De artment Use Onl Approved ^ Disapproved S~~-'Y Permit Fee (i Groundwater Dale Issued ing gent Signature o Stamps) ^ O r son or e[~at Surcharge Fee} .J ~ -'- ( ~ ~ 1X. Conditions ppro z ~ ~ SYSTEM OWNER: / ~ ~ C.t1D-~- - ~~ c C.@~'l. 1 Septic tank, effluent filter and dispersal cell must all be serviced / dnaint~ined ~ L ~S~ ~ gaX~ . as per management plan provided b~ plumber. 2. All setback requirements must be lri~intained 5~ ~ ~~ ~L ~~ ' as nor annlicable code/Ordlnatl~: ~ ~ ~~ ~--.-. •y '^~ s ~~~~ SCh1.Cz t'~-s20' w>c~~----may ~ 020--• t2dO-y ~o .~,,, e ~~ ~~ SET e~~ ~~ ~ `--~ ~ f -~ ~'$' ?-o -. ~pQ.L~M Z5' Hrovs'E .- 3M #~ t ~'~'"" ~`P t N ~fRC31~T"--__............_~s oP t~'c='o~. ~ ~XsST,waq- - i o0o C~ak~`o,J O TAaK ~F'taVtiFNT -- 0 ~ ~ ~Ev~~ - ~'3. i8 . ~. i~'~ pull vA~~'" R l~'7; i T~n1~ F3ED . 1 _ _ ~ 2 ~' $.'72 ~`1-OP pp ~ V ANT c~~~ i ~~ ia' • _ _~ , \~ ~ ~ - GthS ~.~~>E . ~°~°M sysr~ Hof ~- Zz c~ ~.$a-- .. I~terE 3~~ ,3 ~ t32 - Q~•~8 '~ ~_ i f ! b0' sy~.~r' qa.a n ! ; - ~s i a ! 1 ~~dSysTEJ~- ~'i' a~ ,,.; ~ , / qa.o ~ t 1 i ._..--_ i ~) t~ i~ ~i i ~ ~ 1 ~ f33= ~a9 1 1 ~. _ ~ 1 -----_' I qp ' ~ t ~ 1 1 ~3 s' iIJ Z i,N t1~ 1 i l~ ~C7 1 ~ a ! i ~c ~ 1 I X ~ ~t IIM 1 1 col ~~~/,9 1~- C~~ i Qr ~~ ~ A ~ -L-..._-t r ) -- St a q-~~.oo ~!1 ~~ ,o =' ~D 5~0~~ ~ R S G~~ R ~ ~~s ~R~~ I~LBR{CHT & ASSOC{AYES CO. - 281210th Ave. ~ Spring Valley, WI 54767 Rte. ~~~~ aE,~,~,-~ sysr+~-u 715-772-3442 P`"e~ s ~°~""~ PROJECT INDEX PLAN ID # DATE S~I'~'~'"''~ ~~ O S_ OWNER 5/fj4,v E" ~ ~,(~ i~ ~~L UiV~ ~ PHONE 3 7 7' Gy ~Q _._. ADDRESS ~ Sf~4(r~Li;~~- TSP. f~~So,~ cv~. S~6l,G LEGAL DESCRIPTION GO ~ # 2 Z "" {~ R~ ~ ~ « V ~'~5~,4,, TOWN OF +•I u DSa ~ COUNTY s~.~ C ~ ~• ~' C STM ~RNVw~ u j'~ R l C ~ ~".' ~ ~s f / ,7 y LOCAL AUTHORITY/ SUPERVISION SCI C RD/ ~ C 7 y ~ ~ (~ ~(~- PROJECT DESCRIPTION: ~d~ ~ ~~~ s~~,~~ SyST . w,~s DNS ~ ~s ~ 3 ~~M. __-- 75 ~ lc~ i,~ ~ S ~T- ~ ~ Posse M~ Ste- (3-2__ z~.~,e ~'~ ~~.~, s ysT. o ~~ sys~~ ~S~a,Ge /~ G ~~ Ga,~ti sec ~~ yr cam, ~ , -u c.Q 2 ~' r l~~ Ulbricht & Associates Private Sewage Consultants 2$12 1 Qth Ave. Spring Valley, WI 54767 M p QS ~- z-z.~ 3 ~ S e Pg.1 INFILTRATOR SIZING WORKSHEET Pg.2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. ~~ ~~ fl s G ~N~ ~~ N m ~~ c~ ®Ng~ ~~~~ N NO ~p CD Cam. ~ p}~N N Nei ~~ ~~ N c c R N O m 5 D c ci m m ~. m ti Z O ~\ v~' ~~~~ ~.~ ~ ~ ~~ ~ G b -fi ~' 1 y r v,^ ~~ C ~1 ~Q ~ G ~l ~1 ~'1 `Q ~~ [VV~\ `1 V _`Y~~ ~P ~~ ~ a ~ ~ 0 O W --C (,~ --C ~ e ,' x X ~. ~ ~ ` ~ ~ ~ r~ N ~ N 0 Q .--_ __~ • ~ ~o~~N ~ W~r_~--~ ii o20-- 12f~-Y pampa ~~. ~~ ,.~ ` SE? ~ s~,c.K ', ~~ t wr~~ s 1------~ ~~ 4s~ `', c~~-1~+-~E 11- . -. k3Ei~Q.c~otn f -~~ ~ -- l-4o vs~ 3M #~ l = t ~qp„~ =RotJ ~~ ~7tf5TINtT t o00 ~*~w,J d `T'A~1K .:~~ 2'Sa ~~ 1~t4-a~ 3d~ 3 • f32= q~.5$ ' T . f too' ~~r ya.a s~ 11 I I ~ ~ ~ t~ 5 ysrttr N- r f I ~ ~.s' ~ ~ f ~I ii .,_.._.__ ~I I I f ~ ~ f f33= ~'1a'1 . 1 A-D !• r,,,,' f ~ f~ 5, ~ ~ ~ ~ ~~ , f ?? J ~ r~ ~ f i ~c I r x r y ~ i 1 ' ~ f ~ ~ r If ~ I r iar ~°i r~ ~~ Q~ A , f.- -- Uti-~'I~T + ~J I LEvsr` = q3.1~~ k ~~ dull vA~~'" '~ ~ - - -i- -. - - - - - - _t f 1 i7tiSTtiN(~ h3ED p~ ! + ' ~~' C'T ~2 c1' 8.-12 ~~lS 1 oP aP ~~~~ V 67~1T G ~p~ . a°~M sy5-~ Hof ~ 22 ~P.~r~ ~~" U~Sf~ c~ ~.8~ ~_ e;¢ q~.oo ~ ~!1 10 2' ~D S~o~~ ~ R 5 ~ ~~Rp~ ~ ES ~R~~ i ~PPrE'aU~ iv.S~~cTrov c~ o~E' .mss?' y~ ~, ll/ .div. ~ 2 .. -- j ~- ~ /' (IVL~ ~ d ~~ - ~I~ ~ CA/cv~~F~'EP? l 'f~~ v~ ~.uS~otrc T/o,,v ~7~ . ~rii - ~ s~.~o ~~~~ 9~.~~~- 9~~ ` T~~~ ~~ n .~ - ~7' ~= S~'~T~M ~/~U, . qa.o. - -. Cho SS Sic ~io~ ©~ .. Tip~-ti~~.s ,, - G- 1N i G 7if'.q- TD S ::' . ~ U i f- k ~i~, c~i4crr~ wig, f ~ . ~ ,5'4~ ~j- ~i~®~D - ~ yam, . ~~~ 1 y~,~ ..1 ~y ys S~~T/'4 ~'~ ~NS~JEcT/o,,v ~1~,2 M ii ~ ,/// Sc~. ~o ~Z--p~c 9~~~~ T,~~,v~~ ,,~ ,, OWNER's MAINTAINCE OF SEPTIC SYSTEM POWTS (landowner) is reponsible fvr maintenance of this s stem proper operation and servicing is necessary Regular periodic inspections and system, The owner is requiredebsafe healthy operation of. this maintenance/inspection reports tocthe controllinall necessary. g,authorities. SPECIFIC CONTACT AGENTS * Governmental authorit s~ C~~~ x C ~~ Y/ inspectors: zD /~ ~ I~ (r „l ~ . * 3 ~~ ~ y~ ~ Licensed installer, responsible for maintenance "Users" manual: providin g an operation/ '* Licensed service / inspection-agent other than installer: TiP~ - G T ~ --5.4~.' 7~">9-T~i o.v T~U,~-f Electrician, for pump, electric controls, wirin . g units. 1. IMPORTANT OWNER MAINTENANCE RE UIREMENTS • Winter traffic'(sleddin area shall not be g' shove ring, etc,) across the the cell, freezin permitted, or frost can/will penetrate into winter. g uP the system. Discontinuos use (a vacaction trip, resultin in the lead to freeze ups, _ g in no water-use can also 2 3 9. 5. 6. • Water conservation needs hYdrolically overloaded and aestroreased! °r system can be designed for a maximum wastewater flow offs svsj~em was ~ D D gals. daily. • POWTS are not desi -~- disposal unit, or tined to accomodate wastes from a Any introduction of Y other unnatural sources garbage,. destro such waste of waste. Y this system. materials will overload and If a power o1.2tage occurs, or a in a temporary overload of effluenp beins~ It ma cell, which ma Y result y adversel g Pumped into the recommended that a Y impact the cell (leakage), It is allowin licensed pumper empty the dosin Consultg the pump to return to dosing the correct amounts. your installer immediatel Y for advice. Neglect of the ve erosion getative cover (the cells insulation & traffic preventive) can lead to also can destro faz]_ure, Compaction or heavy REGULARLY WATER T Y t he system, It IS NECESSARY TO HE VEGETATION OVER A SYSTEM!! the,,~Ystem beneath IS NOT sufficient alone t0 Effluent ~1 ~covQr, in maintai,1 a Periodic inspections by the owner necessary. Inspection ~ or his agents, is into^the system: on thAipes_and ports have been ;.,~„ ~~ o UyFsoorrsin Dep~artrrrarst of commerce SOIL EVALUATI PORT Page ~ of ~ Divi~ars of safi~y and ,Ma, corer, as. wry . ' ~ • C r0 i attach cxxrrpleta site plan an papas' not less tlra„ 81/2 x „ arches ~ size. C , ar~rae. but not to: vertical and harizorrta! reference poart (8N+1j, perc~t SlopB, SCBI@ ate. f10[til BrrOYl/, and IOC81iDn and distance ~ ~ ^ / ~ ~ V ~ O ~ ~b~ '~ Please print at/ infarmafion. ~ ,;~ ~' ~ Gate Pe~sonN Nfom~tion you provree my be used for +w ( ~ tso~~ ~ i l~~ (fl Y~~ Shuh•e 2ncl /Jehiese l~lvncl t Govt. roc c1~iy FF"c 114 S 21 T Zq N ft ~y E (orb Penpertl,Owner's tie 5~(p Sfia e Coach lc/'ai t_ >.~# 22 l~lr # scrod. Narrse w P/ZR-2iF I//~TfF Z ~D~,D S't2fe Zp code Phone Number ^ c itY ^ V~age Town Nearest Road ~'tl CI50 ~ W l ~'~l-O~ lP ~ 7l ~~ 377- 0988 u rT V ~ Qw~ S?lr6Ef01t~1 Tit . p Flaw Casstrrx~at Else: I~ R l Number of bedrooms code deriMSd desi~ flaw r~ <oD0 GPD (~ Repiacernesrt ^ Public or ~ - Desa~e: Parent material L b ~5 cy ~ O /TW,45 tf Flaod Plairs elevation if applicable ^~ / h ft. General oorrrrsersts and Area X Spot Tested suittl0irt bt Ij a conventional inground system (P.O.W.t$.~ . Q ~e ~ ^ ®Pn Ground sr,rfaca ele,-. 97 .ao >t. ~ m ' > 9 8 ~. - soar field Halton Oepifr Daminarrt IZedors Desaiptiors Texdse Stnxture Came 8orxsdary hoots in. t du. Sz Card. Cdor Gr. sz. S'is. 'E1~, '~2 I 0-13 IoYR~'~Z - ~ -f r mfr CS 3J~f .(o .. S 2 /3 ~3a iD Y~2 9/~ - S_ C ~ fr cc w 3 of 6 ~- 3 3x-98 ioYie ~l~t - s o s m ~ - 2~fi .~ .~ a7E" R2 •~ o 2 Q ®PIt Gramd stxface slay 9~ 's8 R Depth ~ frrd6g factor > 9 9 ta..., sail lie ~ ~ Hotb3on Depth Don~f Fiedoor Oesaip6ors Texftxe Sbucture Core Borardary hoofs GP [alfl< ar. Msnselt flu. sz Corrt. Color Gr. Sz. Sh. , 't~2 o - ~ i b YR2/I -- Q r 1'Y) f 7"' C $ ~ of . ~ . ` 8 2 tb-3y- ~bYQ`'~y- - /eI bk QW ~vf .~- . ~ ~ 'x--`19 1o Ye ~/g - S -'VI I - 2 Jf -7 l . (~ G~ • 9/r /oz .fib EtCluerrt #1= Bt]D: > 30 < 2?~ mdl. and TSS >30 <, 5o mdl_ ' Eftiuerd tit = t30D_ <_ 30 rnM_ and TSS _< 30 mglE. Cs~ lire (Please l'~rirsQ Sigrratsre CSTNs+ti~er J E ~ ~ `~ u ~ i3 2 ~ c ~ -r $~~93'S~ Address ais~ation eorrd~rcfed Tetepfrorse WuN+ar Z~ J2 I p 7rr ~/E S resin! V+tc.~~ tall' Q R-~•L as"-'Zod~ 7-5~-?'72 ~ 3-9i~Z ~~~ ,. .- K~ uN p T panel to a o 20 - ~ 2 (v o' 8'-00o a~ Z~ 3 a t# ~ ®pit Ground surface slay ~/ 09 n l~pth to s factor ~ 9~ ~,. saa lz~ ficriaon l~epllt Domina~~t Redox DesaipGan Te~m~re S6ucture Cor~istenoe l3ounriary Rods GP DAI' in. Mur~e9 Qu. Sz Copt Cola (~. Sz. Sh. 'Eflflt 2 l2.2$ »YR 4/4 - ~ e~ ~ w 3~f .~ . ~ 3 e• etas/a 6 mi ~ ~f -~ ~•~ .o ^ # ~ ~ _ ^ pn Gro~d surface elev. ft. Depth !Q ~9 fac6or n. Soi Raie Hori¢on Dept Dominant Redact Description Texture SNuaue Cooe Boundary Roots t~ OdRE in. Murrselt t1tt. Sz. Cant. Color Gr. Sz Sh. - 'E>f~'1 ^ ,~ Grarr-d surface elev. ~. l~(h to lirrr~irrg lador ~. a~~ sai Rate Horimn Depth Radax oesaQtiarr- TexWre strucGxe Cor>sis~,ae Barrrrdary Roots GpDIfF r,. > nr,. sz cant cabr Gr sZ sh. , ! z ^ ~ ~ > ~ ~ Groin sure elev. ~. oe~tn m facer ~'- soil Rate Hartaorr Deptl~ Dorrrirrsrrt Redooc Desafplion. Texture Stttrcttre CarsFstetree Botsrdaey Roots CPONE in. llAtxrsell ~. Sz Corrt. Color Cr Sz Sh ` Eflkierrf #1 a BOD_ > 30 < 2l0 ergll. end TSS >30 <_ 150 rtrgll ' Etlktent #2 = BODs ~ 30 mgll_ and TSS _` ~ ~ r ,~ ~ UN D T ___. _ _- - °~--. ~ = X21 N C~ SG~kLE !" =20' ii 020" 12~d^~ ~~~ 50 ~ `~ SE'r B ~Pec. K FRDM ~ w~~.L ~--~ WALL--y 9 i' 4 5' Ca~AR~[a~'E' ~ F3E'DR.doM ~ ~> ~4 o vs~E 8M +k~ t = Od.oo..y-~ -.----- oF ~~ EXISTItJ(a- I o0o ph~..wnl TArJ K E~F'FULE~JT t D'.rc -~ 1 2'3> S3oT'7'oM I o~ SYs-r~M q~•82 __3 ~ ~ ~ ~ ~ 2 ,. ~ -7.5 g A ~~ (Z~J ~ Ira 3 = `~O9 • A-O ~~ 5' L E~1 E1~- = ~ 3. 18 #~~ I i------- --- -- - -~ ~cw ~ ~7t ~sT~n1t~ F3~D Oi ,o, ~ I M*~2 ~1 $.-72 ~+~ C`Tos~ c,~ ~„~~ V ~r1T' c ~p~ gt=. q?.or5 ~--- ~o i' ~D' Zo' 0 5r'~~5 D ~ ~uRS ~~cRoss T~RE~ T ~ t I bD' lu Z ~- QI 0 A ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK Town of Upon inspection, I certify that I have found the This is to certify that I have inspected the septic serving the S~~NC /~GV'~~ ~~ residence l~ q 1/9, /y~ 1/9, Sec. 2- ~ Tom/ N, R~W ~ ps..o~ , tank and baffles to be in good condition, and it appears functioning properly. / Last time serviced M~`l ~D S to be Did flow back occur from absorption system? Yes ~ No (if no, skip Approximate volume or length of time: J~O~ gallons next. line) minutes Capacity: Construction: Prefab Concrete ~ Steel Other Manufacurer ( i f known) : (,~ 'i ~`SEI2 ~Oti(,~~~~_ Age of Tank ( if known) ; ~, /G~/ (Signature) (Name) please Print (Title) (Date) (License Number) Form to be completed by licensed plumber (x.195.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) ----------- Plumber (applying for sanitary permit) Certification: in accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle), i ~/' Name~Z(L~ IZ i C ~ 7`- signature 22Cp 3 ~k1P /MFRS ~~ 5/88 ~N~ /'S i N GoNr~~' r~. ©~ ~~ Cv~ ~ ~ 4~-~v~- ~ ~-~ Ulbricht & Associates Private Sewage Consultants 2812 1 Uth Ave. Spring Valley, WI 54767 tank presently located ~,t; 8T CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSIiIP CERTIFICATION FORM Owner/Buyer ~l7 ~'~E ~ ~~ i S E~ ~ C L l~~V 1~ ~- Mailing Address Property Address (Verification required from Planning Department for new construction) City/State [ T ~ D~ "~ Parcel Identification Number LEGAL DESCRIPTION ozo~/z~o~~o•~ Property Location -S ~'/., ~ ~ '/,, Sec. ?'' . T 2 ~ N-R ` ~ W, Town of ~ V ~~ O ~ Subdivision ~7't ~ ~ ! ~ 1, I S T' ~-~ ~~ ~~~ / T . Lot # 2 Z- Certified Sarvey Map # ,Volume p ~ ..Page # Warren Deed # ~ ~ ~ Lf 7 .Volume ~ ~ 6 ~ ,Page # 3 ~ ~'~ ~' Spec house ^ yes no Lot lines identifiable yes ^ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenancx c~sists of pumping out the septic tank every tLra years or sooner, if needed by a licensed pwnper. 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 agcers to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masbCrplumbor,lotnaeymanplumber,rest<ictedplumbtror a licensedpumpervarifSring that (1) the on-site wastewaterdisposal system is is proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sledge. Lwe, the undersigned Lave head the above ra set forth, herein, as set by the Department of stating that your soptic system has bee~- main ~3fs of the three year expiratipn dal I SIfiNA Q 3 ~ --~-5 DATE OWNER CERTIFICATION I (we) that all slat n this farm are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of property descn abov by a of a warranty deed recorded in Register of Deeds Office. ~ -~~ (y~~_ j SI OF APPLICANT DATE «««s«« Any information that is mis-represented may result in the sanitary permit being r+avoked by the Zoning Departmont. «'`'`*«« and agroe to maintain the private sewage disposal system with the standards and the IkpartmeRt of Natural Resources, State of Wisconsin. Certification be completed and rehuned to the St. Croix County Zoning Office within 30 «« Include with this applicstlon: a stamped warranty decd from the Register of Dads office a copy of the certified survey map if reference is made in the warranty deed Document Number STATE HAR OF WISCONSIN FORM 2 - 1995 WARRANTY DEED This Deed, made between Gart.23 N. G'hrist®nsoti. i Oi 1G sOn Grantor, and Shane M. Klundt acid T)stsis~ M. ICltsndt husband and wi~r ss avtrvirrorship aarital psotaatt~t _ Grantee. Grantor, for a valuable consideration, conveys and warratrts to Grantee the following described real estate in 8t. Croix County, State of Wisconsin. Lot 22 , Prairie Vista 8®oond Addition to the Torre Recording Area of Hudson. Es 1 X478 KATHLEEN H. IdALSH S7G;CROFXDCpDEE~i RECEIVED FOR RECORD 01-P6-2000 i!t30 PM n DEED CERT COPY FEEL COPY FEES TRANSFER FEEL 536,70 PIIMi FEE: i0. ~ Name end Return Address RETURN TC~' TtTLE G~i'•'' 70Fi 19TH STR`~~T S~'~r"' HUDSON, Wi ~~ti ib oao-laeo-eo-ooo 1'aroel tderaificatioti Number (PIN) This ie homestead property. (is) (is not) Exceptions to warranties: gaismnorits, roadways, grid rastsiot.ions of raoord Dated thi-~v ~ day of ~ ~ / ~( / Al3THENTICATION Sigtttature(s) authenticated this day of, TITLE: 1v1EMBER STATE BAR OF WISCONSIN (If riot, authorised by § 706.06, Wis. Stets.) TFi1S INSTRUMENT WAS DRAFTED BY Miahawl Et. Forac7cS At Sau Clai.ra Wisconsin (Signatures may be authenticated or acknowledged. Both are not necessary-) t:atrth 1~T_ Chriatorieoa ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix Cou personally came before me this day of above teamed to rte known to be the person who executed the f oing institunent and aclmowlodged the same. * Tr L . Tussaar Notary Public, State of Wiscor-sin PC7 Ik~l rs im t~ , (lf not, smote expiratior~d 'i'taay L.1lurter •Names of puso+ls signing ~ any capacity mint be tYVed or t~~d below their signature. Eitatie Of 1YIn STATE ttAR OF WISCONSIN WARRANTY DEBD FORM Na 2-[949 ~~~ IaeW ~~seos Pcod,loed+nilrl jipFOrm"' e'Y Wrtl~alt hle. 1e025 FetMn ttAllr (iCae. GYrlion To . i7 ~ F~c 1715) 7H6~631 Cmtley 2l Pmo.i~r GrauA 7(Ib I9k1+St 1~O^w13M16-3161 _ r 1 3 ~~y~/ ~ . 3'IZT ~ ~_ ~ f T ~, 1l . u .- ~~~ ~.. - ~,~. ~~~ NTH L1l~E t~~ Tim ~E I/+~ --~ .-. ~~ ~~ r2' l I ~ ~~ ~aat ~~ . 7 I I 1 !n a - ~ \\ ~ ~: i ~ ~ rte,. o' a = so' ~~" G.L.= t ~' L. s iL~~' C . d. _ $c~ ~ I I uE C.L.= i+t, S~~i~-l ~ iP. = 1167.!?O ~ ~ ~O 1Rf girth- ~~ 1 1~~. ~~~ f a,~i ~~.b3±b a~cre>>~~ ~0 1 ~9 i ~~~' a f ~~ I~' (~ . ~ ~~~~ a ~~\ ~ ~~~ ,. G~' } t7 /~ ,r ~t~. ~ :~: ~~~ ~E `A +-,. _ ~._. `s ~: r St. Croix County Map Output Page Page 1 of 1 http:l/72.21.230.178/servlet/com.esri.esrimap.Esrimap?ServiceName=StCroixOV &Client... 6/10/2005 ^,, ''"" ;,~ AS BUILT SANITARY SYSTEM REPORT ~~ OWNER_~Sa ss~ /fi,//~,,.~-- TOWNSHIP~~i~~, SECTION ~/ TAN-R /~ ADDRESS ~'ox '0`Z~Z ST. CROIX COUNTY, WISCONSIN ~~so,Fz W~ S`/P~/6 SUBDIVISION liar; ~ !/~'r~t_._ LOT ~J~LOT SIZE z.29f q<< PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM INDICATE NORTH ARROW BENCHMARK:Elevation and description: ~afi'~% Alternate benchmark_ ~ ~ m`,~Q~;1,, ~ ~ 7 SEPTIC TANK:Manufacturer:_i.,d; s Qr Liq Rings used: Manhole cover elev: ~, Final Tank inlet elev.:~.C. ~ ~~~ Tank outlet elev. No. of feet from nearest :road: Front , Side_ a'- Q`SELerhmrC-l =/oaov ^ ~~35 uid Cap. 00 grade elev: ~f.o Z x,90 _, Rear C~Ft.~ From ~ ~~~t cu~cr-r KOl9D PUMP C~IAMBER Manufacturer:/1~~ Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.:~Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front, Side, Rear_,Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM ; Bed: Co -fro,, . Trench: ~" Seepage Pit: -r Width: ~$~ Length ~a~ Number of Lines: 3 Area Bui1t~Z°s~~T Exist. Grade Elev. S-Zp Proposed Final Grade Elev. S zo Fill depth to top of pipe: `~ Z ~i No. feet from nearest prop. line:Front , Side , Rearx Ft.`t~~ No. feet from well: 8S~ No. feet from building 5~~'' HOLDING TANK Manufacturer:.1l/f~ Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front Side Rear Ft. No. feet from: Well building nearest road Alarm Manufacturer: INSPECTOR• DATE : PLUMBER ON JOB • ~~'`'~~ . ''' /~l ~ '" 7~ / ~7 LICENSE NUMBER: ~~ 6/90:Cj ~~~rg~~rtr i~~fo~lOni~ust21' ~~' 19' ~' pRI~AT~ 5E1lVAGE SYSTEMAGECOACH •; Labor and Human Relations INSPECTION REPORT Safety and Buildings Division GENE(~AL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name: ^ City ^ Village [Town of: ENOY VERLYN E & CATHERINE A HUDSON CST BM E ev.: Insp. BM Elev.: BM Description: _ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~`~oSe~~C.' , Dosin Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Airlntake ROAD Septic ~ a~ ~ NA Dosin NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer Demand Model er GPM TDH Lift Lriction Syste TDH Ft Forcemain Length Dia. H Dist. To well SOIL ABSORPTION SYSTEM ELEVATION DATA sin county: ST. GROIX Sanitary Permit No.: 175664 State Plan ID No.: Parcel Tax No.: e~ 020-1260'80-000 A9LUU~3Ll r1~~'/y,~ STATION BS HI FS ELEV. Benchmark (p•3S' /~, C~ r /d3. off' Bldg. Sewer St/yet Inlet $,6(0,~ ~ St/yrt Outlet ~ 9 '~S~ Dt Inlet Dt Bott Header~~lle-rrr. ~ Z'o 9 zo' ' . /S Dist. Pipe 9~ X32' , Q/ r Bot. System d,f/6 ~ ~ ~ ~ Final Grade ~~~~ ~ ~/,/!~~ ' Oil ~, j ~• ~ ~o2r o .33~ BED /TRENCH Width / ~ Length~/ / ~ No. Of Trenches PIT f Pits Inside Dia. Liquid Depth DIMEN I N ! 7` DI N 1 N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHIN Manufacturer: SETBACK INFORMATION Type O r . ,~ ~ ,y V CHAMBER NIT R Mode Nu System: ~, ~~ ~ ! (! U O DISTRIBUTION SYSTEM Header / 11A~an*ftrk~~ „ Z ~ ~ Distribution Pipe(s) ~ ,e ~ ~ x Hole Size x Hole Spacing Vent To Air Intake Length ~ - Dia- Length ~ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Z Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center a . ~Q ~' Bed /Trench Edges ~ - ~Q ~ Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) , - ~ Plan revision required? ^ Yes ~~ Use other side for additional information. 9 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH f -~~ ceN~TeRV a~RMIT OPPLICOTIIDN , _ ~-. O~~HR . In accord with ILHR 83.05, Wis. Adm. Code .e.~.,,,,e,. couN , -Attach complete plans (to the county copy only) for the system, on paper not less than STATE SANITA PE~R(~M~IT '"ZVC'~ 8th x 11 inches in size. ^ ~ ~!Y ch k if revisio o p evio s application -$ee r@VerSe Sld@ for IriStrUCtIOnS for Completing this appllCatlOn. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. PROPERTY OWNER .s /~/) .l L.L r 2 C ~1r~ ~ PROPERTY LOCATION ~'/a '/a, S L~ TZ~J , N, R / E (or PROPERTY OWNER'S MAILING A DRESS 1~ / LOT # Z Z BLOCK # A/ A /Y /T D L S Z CITY, STA E ~ ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER T~ T o (,c>T o/ a~ g E / A I 11. TYPE OF BUILDING: (Check one) ^ State Owned ViLTMLAGE ~ NEAREST ROAD STf16EtGWGf>< ©AD c~s cc o ^ Public ~ 1 or 2~am. Dwellings of bedrooms .3 R EL NUM 111. BUILDING USE: (If building type is public, check all that apply) d 2.0 - `L~Q ~-- ~!7 1 ^ ApUCondo 2 ^ Assembly Hall 6 ^ Medical Facility/Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/Repairs 11 ^ RestauranUBar/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 PERMIT: (Check only one in line A. Check line B if applicable) ®New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an A) 1 . System System Tank Only Existing System Existing System B) ^ A Sanitary Permit was previously issued. Permit # - Date Issued i V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 11 ~ 12 Seepage Trench 22 ^ 1n-Ground 42 ^ Pit Privy 13 ^ Seepage Pit Pressure 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE i ELEVATION REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) / // TSD 7Zp 7Zd ~', Z ~(~ / Feet ~ S ~ Feet Vil. TANK CAPACITY in allons Total # of rer's Name M f t Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks anu u ac oncret glass App Tanks Tanks structed Se tic Tank or Holdin Tank OtlO ~ Gc/~ ~S~ Lift Pum Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: St~~~b~~n D ~' ~ 2 z y~ 3z3 3 Plumbe s Address (Street, City, State, Zip Code): ~Z ~ ~ ~, f IX. COUNTY/DEPARTMENT USE ONLY ^ Disapproved Hilary Permit Fee (includes Groundwater Surcharge Fee) a e ssue Issuin ig o Sta ps) Approved ^ Owner Given Initial ~ ~~~ + ~ Advers Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/fib) DISTRIBUTION: Original to County, One Copy To: Safety ~ Buildings Division, Owner, Plumber INSTRUCTIONS 1.~ A sanitary permit is valid for two (2) years. 2.~~ four sanitary permit may be renewed before the expiration date, and at the 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. 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 & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provider 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 in 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 in #1-7. VIl_ Tank information. Fill in the capacity of every new and/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~ 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 5 T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then:a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------ Owner of property ~~l~~'1 /VF f3~~lDy~sA~l /(/j jL,c~,e Location of property~l/4 SE 1/4, Section 2 ~ , T~N-R /~ Township ~fudSD~ Mailing address ~3yX ~ ZFt Z l,F ~ ~l S o n 1~ ~ .s /o /~ Address of site ST~I~E ~oA~ N f20/~O Subdivision name •f~~~ll~r~. VI STi4 Lot no. Z Z Other homes on property? yes X No Previous owner of property ~ ~~ RO L A R S F N Total size of parcel Z• Z99 A~ ~ ~ S Date parcel was created 3~,3/ ~$ ~ Are all corners and lot lines identifiable? ~ Yes _______ No Is this property being developed for (spec house)? I~ Yes No Volume~Jand Page Number ~~ as recorded with the Register of Deeds. ----------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(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 recorded in the office of the County Register of Deeds as Document No. ~f o yz.~ and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No . ~f/O S~Z-~ r // i /J ;~ -. ~, rte;.. ~, ;~ , <~ `~ ~'i z ~ vW~+w.w .+~w~~{7eN A ~RlyK ~M ;fir , harry J. Stewart ...... .........._...._...... .._._.................._. ....~............~.._.~ ................... as Personal ReP='e~tative o! the.estab o! ~..,~.~tul.rAlslxQ .Mxx~>a..t.axa~:z+..a114/.a..>IAhu..B.1~d~cQ..I.,ax~~m._..._..... .....~/hL~t..A~t~xQ..1~x~~R ........................................................................ !os a valw-bie eondd~ntios~ ooavoys, without warranty, to .Vert DE ,,~B.--enQY ».$~. C.14~~4~F~4..~a..~~.4X~..#!~..~!}~~~Idl~ ~4~.w~:~g.8~.~4~Fi~a~. .._P7~RB.~7C~Y.~~h..JC~S~.t_ 4~..18!~JCY~YQ~~~I~E ....................................... ..---......» ...................................................................................... Grantee, the loDowinp described real elate in .. St..Croix ...........................County, { State o! Wiawnsin (hereinaltsr called the "Property") bleat Half of the South East Quarter of Section 21, Township 29, Range 19. ;,~~~0 F' .:9 a JSh _ - ~ ~Q ~_ ~' ~X'_ 1~ ~ ~~ „~ .;e _~i~ i r~ca o~HCE ~, <<~ . ~f. CR0lX C0.,1AoiS. "~, :::~.'~. for Roaond' M~is, 3_lnt 9.45 ~ `';%~ 1S~(I M YMS~ ',, ~,.~ •o Taz Parcel No :.................».....».... ,; ,~ :. ~: 5 Personal Representative by this deed doss convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedent's death, and aA of the estate end interest in the Property which the Personal Representative hu since acquired. Dated this .......~$C.h ...................°.--•-•-•-•-- day of ...........~aX~h.-•-•---•-•--•-•-•--•-•--.....-•-•-------••---.r 1>a..$~2... --•-•-•-•-•---••-•---.....---• .....................•--•-•--..._._.. (SEAL) ~ Penooal Repraeenbd~e I e AUTSSNTICATION Signature(s) ...............................................•--•--•----.. authenticated this ........day of ........................... 19...... TITLE: MEMBER STATE BAR OF WISCONSIN (If not ........................................................... authorized by $ ?06.06, Wia. State.) THIS INSTRUMENT WAS DRAFTED BY Lois A. Murray of HEYWOOD, CARI & MURRAY P..Q...Sox.22.9.,..]inrlenn,.-bIL.1"~QL6-.........- -•---- :, ~ ~ ;, -l ~~-~ ~vv`~~~" ---~ ,. . HNC>:Y..:I.....$.G~y!?1:C...._.. ..:..~t,_a *~•. Perwnal RepreeenLdve ~` ~ ~ ' ~ 4: ACHNOWLSDOD~~TD '~~~ ' ~. .o., J ~~ ri STATE OF WISCONSIN ~`~. Q `~ `~t ....Sk....GrRix----------------County, r• Personally came before me this .....2~>:h...day of 'r- ....MASS?~ ............................ 19.6... the above named ' ..~iaxxy...J....~>:~~raxz.,..al~..Pex:~sn~1..~~8x~$~~Cative `,,: ..fPx..l:h~-.~stax~..af...Iahn.A~dro.MYJC~D..b~x&~ne :. .-~/k/~,•John.•A1dro.,Larsen~••a/k/a._Aldro ~r ..Lgrsen ...... ........................•---•--•--•----....--............. to me k own to be the person ....---..-.. who executed the , foreg instrumegt and ack wledge the same. Z .- ..... -..- ...~..~- :r.........'. ~ ................... • u7.A ~ ~ ~? ~._.~ rvp~lzS ~ ~/--- ,. St._Croix Note. Y Puhlic --. ..............................County, Wis. , ~• ~~ ~ SEPTIC TANK MAINTENANCE AGREEPfENT St. Croix County OWNER/BUYER C,~jy,E~E'IN,E%ENDY1. ROUTE/SOX NUMBER~~Z .' CITY/STATE `/~/DSD • ~ ~wI- - PROPERTY LOCATION:•~'~', S~ Town ofrE~ Subdivision_ {. Fire dumber _ ZIP S ~/D~-6 ~, Section z~ ..• T~N- R~ ~ On/ St. Croix County, ~iP/-! I~~ E', Lo t number z Z Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every tfiree years or sooner, if needed, by a licens~ed~'s'e Cic tank um er. What you put into the system can a ect t e .unction o. t e•septic tank as a treat- ment~stage in the waste disposal system. , SC. Croix Count residents~~m~ be eligible to recieve a grant for a maximum of 60% of the coat.of replacement of a failing system, whic was in operation prior to-July 1, 1978. 5t. Croix County accepted this program in August of 1980, with the requirement that owners of all. 'new 's s't'ems agree to keep their system properly maintained. The property owner agrees to. submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber. restricted plumber or~.a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and •(2)•after inspection and pumping (if nec- essary)cationsformcwillkbessentSapproximately130fdaysdpriordtoc~~ Certifi three year 'expiration. I/WE, the undersigned have read the above requirements and agree to .maintain the private sewage disposal system in accordance with the standards set forth, herein, as .set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE ~.t,C~I~}~ ~1 ~z- St. Croix County Zoning Office 911 4th St. Hudson, WI 54016. 386-4680 Sign, date and return to the above address. • ,oo•oo I = ~1~~1 ~ . ~~11~d~~~ 3S lb'~d~d.loyXa~l„- j0 11~ Iad 1s3W9f ~l,-~~HU/ f17N3~1 I _ .~ - f ~1 O I ~ /fin - 4S _ ~/ ,~ ~~ ~~ • •t " ~ ~ 3 LbN ~ 311V i ~~h ,ah ~ i ~ I -8' i~_ _ _ _i ~-- oh D z -~ E- £-e ~g~~ ,, o I ,z~ ~ ~ ,Sa ~~ ' s~ nl ~:~ '~ S U'M ~~~ ~y J ~°~\ 5~~~ ~ m n ~ t_~ a "i ~Yrhr -s ~7i.o7 z Z 10 7 Y N y -, ss ~ z 10~ ~.b-~•~ Wisconsin Department of Industry, Labor,and Human Relations .jlivisiori of Safety & Buildings SOIL AND SITE EVALUATION REPORT .. r.d ...aF. II L.10 00 AG 1Al:n A.d... l~...1.. Page 1 of ... _---•........._.....,.,..,.,, ...,,............,..., COUNTY Attach camplete site plan on paper not less than 8 1/2 x t 1 inches in size Ptan must include but . , not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: Sid M ~ 1LL6+e PROPERTY LOCATION Q ~taT /y W 1/4 St 1/4,SZ ~ T ~~ ,N,R ~ I E (or) W PROP tTY OWNER':S MAILING ADDRESS ` LOT # BLOCK # SUBq-. AME OR CSM # ~ r 75~K -1 Qot~ 22. - ~4„Cr~ tSTA 1 CI STATE ZIP CODE PHONE NUMBER ^CITY ^VI GE OWN NEAREST ROAD New Construction Use (~ Residential ! Number of bedrooms ( ]Addition to existing building j ]Replacement [ J Public or commerdal describe Code derived daily 8ow~~b gpd Recommended design loading rate bed, gpd/ft2 ~~g trench, gpolft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate O ~ bed, gpd/ft2 O •~ trench, gpd/ft2 4 Recommended infiltration surface elevation(s) 6.f~0 ft (as referred to site plan t~enchmark) Additional design /site considerations Parent material Flood plain elevation, if applicable ~ ft S = $Ultable fOr System CO VENTIONAL S O MOUND ^ IN• ROUND PRESSURE ~ ^ T-GRADE ^ ~ SYSTEM IN FILL ^ HOLDING K ^ U=Unsuitable fors stem U ~ S U S U S U U [fit S S U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistence Bot~xia Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed tench g /6" io s ~ - ~ nos ,~-,,1 + a.~ ~3 76" ~ S +e 4 4 -- CS-~L~~ rn 1 C ! .7 0 FS Remarks: 1~ a / 3 /OY,e 1 ~-' L 1 ».t ab ~' n~ 1rr r ~ 0 .~ ~.S $ ~ 9" O Y 3 3 `- L 1-+. a b~ r>1'~~- ! 4 o.S 8 z?~ oy~e s 4 -- ~S~ rtil ~ o~ :off $3 S y 3 q. -- CS~fC,r~ w- ~ G ~ 0•? •O FS Remarks: CST Name:-Please Print ~~~/~ Ja>JN~ Phone: '~86 AQg.Q Address: ~as~ _ ~ 5AO 1 ~ `t PROPER'FYOWNER JaM,I~I Lc.C,~ SOIL DESCRIPTION REPORT Page? of 3 PARCEL LD. #~~ 22 ~/tv5r 21- Z9- ! g Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxi<ry Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trerxfi t7'' /OYr~ .4 3 L ~ b m ~r ) 4 S ~z ~.Z'' y~ 4 - s rh I ' :7 0 8 ., 3 s idY~ s 4 -~ ~h5 ~ 1 ~ 0.7 o Remarks: 3z,, y~ 4 4 - Ms wt I ) 0.7 ~ o.g ~4 3~"' /OY -- S w, ~ ~ O.? :off Remarks: )~~~ !0 ~ z) L. Q~~' ~'h~rr Z 49 ©S ,. $ l7" s ~- 4 -~ rtis~4 ~ 1 ~ a~ ~o.g ~ '' D re s 4 - ~s ~ l ~ 0~7 o. Remarks: Remarks: .R ~~ S~~L~ l ~'3a' 2~ ~~ ~cdPE +4c+aosS LNYI~ Aga ~s l~~' J • • \ ~ p~,,Mp~av ~~ ~ 1 1 ~~YA•oLIATL' $~cNMa~R.k- /~~GNE.S~c ~otnll- og 1 ~~,2oN {~ ~ Loy ~~N ~~, C~..1= lao .ao'. t'd V zZ fVws S~o~ 3$ $_. ~ i i 303 z--i9-l9 ~, c.~:R 2~ ~p~ Sp1~LUS Te C- p,p'~ Ac.~nTS" W ~~~ S ~ ~~ECoacw -Rb L~ ~ `. ~ ~a ~, , ~ 'v M -,- ~ ~ ~N~ ~ ~ ° ~~ o v ` \•t o. ~. v %t~ - i,~ ~i ~~ R Q ~ ~ ~ `` \ N p 'V L . ~. '' ' g ~Q ~~ ~~~ ~ o v > _ c3 R'd' i ~ ~J M ~' ~ ~; ~ i t---- ~. i! rry ~ G M ¢. • li ~~ ~~ i ' _~ ~, ! U ~*~ ~ ~fl cn LL ~ ~ w e~: Q ~~. C_ 2 v L~ ' ~ `_', a. ~~ . ~, ~ f- x ~o a~ 00 r 1G ~j s: tY ~- 4~ o ~~ z .._ C LJ Cl, 7 0 U w J Qz 1 ! J i 1 << 1 ~' i~ -- ~ --{ ~J± 'r~ i~ ~!~ Z ~ ~i~ U O ~ U ~ ~ ~ ~ ~, I ~x o~ o ~~ ~ ((~ I~ ~~ M F.„'1; U ~~~ ~- ~l wi '~ #r. ~~ ~~ w e_ Q ~~ ~ Z O ~ ~ w a, 0 w G1 REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1 09/2b/92 07:56 REQUESTS FOR INSPECTION WORK SHEETS FOR: 9/25/92 AREA: JT Activity: A9200322 9/25/92 Type: CONVSEPT Status: PENDING Constr: Address: HUDSON 21.29.19.1261,NW,SE, LOT 22 STAGECOACH RD. Parcel: 020-1260-80-000 Occ: Use: Description: 175664 Applicant: BENDY, VERLYN E & CATHERINE A Phone: Owner: BENDY, VERLYN E & CATHERINE A Phone: Contractor: STROHBEEN, DOUG Phone: Inspection Request Information..... Requestor: STROHBEEN, DOUG Req Time: 13:09 Comments: /;U~ Items requested to be Inspected... 00012 FINAL INSPECTION Phone: Action Comments Time Exp Inspection History..... Item: 00012 FINAL INSPECTION