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020-1285-70-000
0 to p 0 to p K 'v h r w O m F O v c 41 O n �1 m 3 � z in z O W Cn in z C: , M tQ p • o 0 0 0 (o m d N o w °� c 0 C V N cn a 0 j N Q --I fb W N ~ a O N bt a L? tt (O O (D M co 7 N q N O N O O O W � N N a (D 3 77 111 O O U �' 7 O C7 < N O 0 cn �� WW OV � O V A 3 co CL O = O W O A 00 . C O N C 0 O :7 cn D7 O fl? S o sJ v D a Q (n CD a a 3 0 N 3 o � s 0 V N t1. 3 0 0 41 r 00 (D OZ (, W N -� a) m I.I A Q. �y CD I cn (CD 0 0 w ( ( C � (q 0 C w co CL C 0 0 0( o o o N 'D =O N E L` 2! �o c 0 y N d N N N Cn rl S p m a 9 O O o b 0 0 C) (D A N N U7 N CD CD fD 0 p O C7 Cf -0 j z d DD x \y w N m N 01 f/i a 3 w 7r 3 °' c M N � s� Z ._�. 0 D? 0 O D O O W m p N N �• O m O _ CD 0 l CO CD 0 y c ? O O N CD ro' a (a a C7 _ � 0 N K G N Oc 'P O =3 A z 0 N O Z N oo -o 0) v m G O. i t Z o m o 3 c 3 A O o =� z 3 3 m � N Z N z A n 0 a° C D CL (D CL o na. CL D) C o (D O A7 C p Z O. N O 3 z 0- O O m 0 o X3 CD a3 Sy CD N � N O (D CD N 0 0 3 a O S fo -0 JW 0C3 0 y N X O O S Q m <30 O c O O 1 O (p a 0 O w _ 3 0 ti m w 0 0 I � 0 00 o b r CD II I 0 ° 0 0- Parcel #: 020 - 1285 -70 -000 12/31/2008 08:13 AM PAGE 1 OF 1 Alt. Parcel #: 21.29.19.1384 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 O - SAVADGE, WILL D WILL D SAVADGE 900 WILLOW RIDGE I HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 593 SCHOMMER DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.010 Plat: 05- 088 -ST CROIX INDUSTRIAL PARK SEC 21 T29N R19W PT N1/2 NE1 /4 LOT 7 ST Block /Condo Bldg: LOT 07 CROIX INDUSTRIAL PK 2.01AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 21- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1213/532 QC 07/23/1997 1196/184 QC 07/23/1997 1138/310 WD 07/23/1997 1000/292 WD 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 257674 720,500 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 2.010 96,000 573,100 669,100 NO Totals for 2008: General Property 2.010 96,000 573,100 669,100 Woodland 0.000 0 0 Totals for 2007: General Property 2.010 96,000 573,100 669,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 n o 0 g? 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CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Property Address dQi v, City /State /Vu i 4-5"5 16 Legal Description: Lott er Block Subdivision/CSM %4 2/ 1 /4, S ec. , T N -R 9,_EW, Town of A4f Q5aAJ PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer 4JI e S , dl? Size ST/PC O / Setback from: House Well P/L , � 1 3 ' Al Pump manufacturer Model Alarm location r—.-• (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: T,Pr. k 14 Width 3 � Length Number of Trenches � Setback from: House ? o' Well P/L 3G Vent to fresh air intake ELEVATIONS Description of benchmark -:; , P0 �i P-- .4 Ali 4+ r Elevation / 0 b , 00 Description of alternate benchmark > i��� I AJ,6"w A,00,20,J Elevation 'F ` Building Sewer 00- ST/HT Inlet c ST Outlet 7 PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover /Ol- /S Distribution Lines O Phi ( ) . ( ) Bottom of System Final Grade Date of installation /-?o Permit nu er State plan number l3 t Plumber's signature ense number Date Inspector Complete plot plan Ar NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW /� �/2 �o� Ar et-Ob I ne'P bel VLF Nn� �kolod'7zY ��.v� Y 3 �750 44c w1 4 P 4zwc I;wx NJCW W r TIE zx e /aco ;c � 1 4 0 , Awo ScN 00 1 L /iva ' � LY�AeH`!J�IPK — �71�I15� -F e� e►D rn1 A' �>< r5 fi GJC1c P w� /5 'rio/G AS P! h4 tT 1, Mid INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division • INSPECTION REPORT Sanitary Permit No: 395112 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Savage, Willis I Hudson Township 020 - 1285 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: Lad 1 10 rah N TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark y( 1ot.itt Alt. BM Aerati Bldg. Sewer p Holding Ht Inlet 4 TANK SETBACK INFORMATION Ht Outlet 9. O f f .3 Z TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Qt Inl Septic / _ O Dt Botto osing S Header /Man. ion Dist. Pipe /D < Holding Bot. System PUMP /SIPHON INFORMATION Final Grade la.zZ nufacturer Demand St Cover Model Number TD Lift Friction Loss System Head TDH t Forcemain Length Dia. Dist. SOIL ABSORPTION SYSTEM BED/ Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME0110W 1 11 1 / - ?- J /' j SETBACK SYSTEM TO 7 P /L JBLDG IWELL IAKE/STREAM NG Ma ufa re INFORMATION CHA R OR� Type Of System: i O / I Z UNIT Model Number: 3 < DISTRIBUTION SYSTEM Header /Manifold Distribution T ole Size x Hole Spacing Vent to Air Intake L Pipe(s) > Z r Length �� Dia Lengt Dia ' _ Spacing SOIL COVER x Pressure Systems Only x Moun Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bedrrrench Center Bed/Trench Edges Topsoil IN Yes �� No Yes [] No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: I /Z7/o/ Inspection #2: Location: 593 Schom Drive Hudson, WI 54 (NE 114 NE 114 21 T29N R19W) St. Croix Industr Parcel No: 21.29.19.1384 1.) Alt BM Description = `t�hi5� ��op✓ Otw a�ti<tA. 2.) Bldg sewer length = Q - amount of cover Plan revision Required? Yes FNJ No 3 Use other side for additional informatio . Date Insepctor's Cert. No. SBD -6710 (R.3197) Safety and Buildings Division County © 3 201 W. Washington Ave., P.O. Box 7162 ,SC o ff Madison, WI 53707 - 7162 Site Address Department of Commerce J V _ Sanitary Permit Applica ' 12 1 Sanitary *3'75-112- ` r In accord with Comm 83.21, Wis. Adm. Code, personal' you rovi e 1 m ❑ Check if Revision may be used for secondary purposes Privacy Law 1 I. Application Information - Please Print All Information rate Plan I.D. Number \� r Property Owner's Name arcel Number Property Owner's Mailing Address N, Property Location �% TT Vi a. '3 A/ l' -A ,V -A. S A/ T N, R E City, State Zip Code fie Numbei - � �? ,,q Lot Number Block Number Subdivision Name CSM Number Y � L II. Type of Building (check all that apply) ❑City ❑ 1 or 2 Family Dwelling - Number of Bedrooms ❑Village g[ Public /Commercial -Describe Use XT-w-hip Li ❑ State Owned Nearest Road 3 x 3. :5' CAU III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) Lf `�' 1 19 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use oZ (_ ;t(?, 17, J 3 $' System Tank Onl Exis ' stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 Non - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30110 r V. D' rsaU'I4eatment Area Information: - Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Perco 'on Rate s - m evasion rade u So Required Proposed Rate(Gals./ Days /Sq.Ft.) (Min.flach) Elevation 9 ?. � VI. Tank Info Capacitf in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' Signature �/MPRS Number Business Phone Number PiumbeY Address (Street, City, State, Zip Code J s� VIII. Count /De artment Use Onl Sanitary Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issu' Agent Signatu (No Stamps) IK Surcharge Fee) ❑ Owner Given Initial Adverse ', Determination ZZS - ` wv( IX. Conditions of Approval/Reasons for Disapproval -� A�,l � - s vv� b.� �., �", a�,Q�`�u.�lr2� c�d1s� �o1e�,t�.wc -ems• wn Attach complete pEffis (to the County only) for the system on papa' not less than 81/2 x 11 inches in sae SBD -6398 (R. O5/01) rJ ~ d Z hh V v`I o 1.4 v `C 3 INC �" 4c • p �v k l I � Ar a 4 ,? 4t z Na M r + Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 _ TDD #: (608) 264 -6777 ,�consin www.wisconsin.gov .wis c ons .wisonsin.gov Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary July 02, 2001 CUST ID No.224757 ATTN: POWTS Inspector ZONING OFFICE MARK E STAHNKE ST CROIX COUNTY SPIA 715 6TH ST N 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/02/2003 Identification Numbers Transaction ID No. 656132 SITE• Site ID No. 631924 Willis Savadge - 593 Schommer Drive Please refer to both identification numbers, St. Croix County, Town of Hudson above, in all correspondence with the agency. NE 1/4, NE 1/4, S21, T29N, RI 9W FOR: Description: Commercial Non - pressurized Leaching Chamber System - 97.5 gallons per day Object Type: POWT System Regulated Object ID No.: 799091 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Conventional Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10567 -P (R.6/99). • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Aden Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. The owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the conventional component manual are complied with. A copy of this letter including instructions and information regarding proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the fitter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stars. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. i MARK E STARNKE Page 2 7/2/01 • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section Comm 82.20, Wis. Aden Code, to determine if plan submittal and approval is required. A copy of the approved plans., specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 �!/�• BALANCE DUE $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services 608- 789 -7892 Mon - Fri 7:15 AM to 4:30 PM WSMART code: 7633 jswim@commerce.state.wi.us cc: Willis Savadge `ZD CO LA3 �, `n IV \ ILA LA e y 0 0 G�G � � P r AN - AIG SOUIS 'R AU tooz s T Nnr 03RI333H a R z a - y k � t 1 low oil rIN to WN N3 k i RN r W e i � � I e a 0 O A o a x � 1 2 l n b Z' o M 5 r O N L � Invert 11' 1 � L4 m W � a � Vi 0 Zappa 31rothqors Inc. T15 sixth St. Mo., Hudson, WI 54016 -1074 Of f icit: 715 -386 -2850 fax: 715 -386 -0323 NPO Out Building POWTS POWTS Operation, Maintenance, and Performance Manual OWNER: Willis Savadge 900 Willow Ridge I Hudson, WI 54016 c Contact: Willis Savadge 715 - 386 -9121 RECEIVED " u DESIGNER: Zappa Brothers Inc. JUN 15 2001 715 Sixth St. North SAFETY & BLDGS Bill* Hudson, WI 54016 SAFE Contact: Mark Stahnke 715 - 386 -2850 Fax 715 -386 -0323 INSTALLER: Zappa Brothers Inc. 715 Sixth St. No. Hudson, WI 54016 Contact: Mark Stahnke 715- 386 -2850 Fax 715- 386 -0323 GOVERNMENTAL AGENCY: St. Croix County Zoning Department 1101 Carmichael Road Hudson, WI 54016 Contact: Rod Eslinger 715- 386 -4680 Kevin Grabau 715- 386 -4680 John Sonnet tag 715 - 386 -4680 715 - 386 -4886 In the event of component failure or malfunction notify Zappa Brothers Inc. or Tri- County Sanitation, Hudson, WI Contact: Ben Morgan 715- 386 -2130. f ` Page J of MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has, been designed, and is to be installed and maintained-ia according to Comm 83, Wis. Admin. Code, the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems (SBD- 10567 -P; June 11, 1999), and the Marathon County Private Sewage System Ordinance. 1. This POWTS has been designed to accommodate a .maximum daily flow of gallons of domestic wastewater- per day. The quality of influent discharged into the POWTS treatment or dispersal component shall be equal to or less than all of the following: monthly average of 30 mg/L fats, oil and grease. . a monthly average of 220 mg/L BOD5. •i.�-v ^.;/z a monthly average of 150 mg/L TSS. Wastewater shall not be discharged to the POWTS in quantities or qualities that exceed these limits or that result in exceeding the enforcement standards and preventative action limits specified in ch. NR 140 Tables 1 & 2 at a point of standards application,'except as provided in Comm 83. 4 p 03( ), Wis.:Admin. Code. 2. The owner of this POWTS is responsible for system operation and maintenance. The following maintenance shall occur within three (3) years of the date of installation and at, least once every three..years thereafter: 1. The septic tank shall be pumped by a certified septage servicing operator, licensed under s.281.48, Wis. Stats, unless inspection by a licensed master plumber or other person authorized to make such inspection, finds less than one -third (1/3) 9f the tank volume occupied by sludge and scum. More frequent pumping may be necessary to prevent solids from exceeding one -third (1/3) of the volume of the tank. Wastes shall be disposed of by the pumper in accordance with ch. NR 113, Wis. Admin. Code. At each pumping the pumper must visually inspect the condition of the tank, baffles, rizsers and manhole cover and verify that any required locks are present. 2. The soil absorption component(s) shall be visually inspected by a licensed master plumber, certified septage servicing operator or POWTS inspector. Inspection shall check for evidence of discharge of sewage to the ground surface and for ponding of effluent in the distribution cell. 3. The tank filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. The filter cartridge shall not be _ removed unless provisions are made to retain solids in the tank. Cleaning of the { filter at more frequent intervals q 1 may be necessary. 4. Any pump, alarm or related electrical connections shall be visually checked for defects and tested to confirm that they are operating properly. 5. Reports for all system maintenance shall be submitted to Marathon County in accordance with Comm 83.55, Wis. Admin. Code and the Marathon County Private Sewage Systems Ordinance. 3. Defects or malfunctions identified during maintenance described in item #2 above shall be repaired in conformance with Comm 83, Wis. Admin. Code,, and the Marathon County Private Sewage Systems Ordinance. The User's Manual, provided to the owner of the POWTS includes the names and telephone numbers of the properly licensed individual(s) to contact for such repairs. 4. Anytime a failure or malfunction occurs, it shall be reported to the person(s) identified in the User's Manual for this POWTS. Repair or correction of such failure or malfunction shall comply with Comm 83, Wis.. Admin. Code, and the Marathon County Private Sewage System Ordinance, 5. No one should enter-a septic or other treatment tank for any reason without being in full compliance with OSHA;standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 6. No product for chemical or physical restoration. or chemical or physical procedures for POWTS may be used unless approved by the Department of Commerce in accordance with Comm 84, Wis. Admin. Code. 7. In the event that this POWTS or a component of this POWTS fails and cannot be repaired, the following contingency plan is proposed: / O!2 � •ri ; i� U�= ��r L /Q r /2.^�7 � Ury �l s y w n L.�7` 7ivrr��t.� /YFG✓ .DMZ 1 '1'7 - Z-'v /VLT51L✓A7L- -V AZ - A lvN�/� .1'ur � u vTLory L ✓'IS iw .or`/L c>/ZCzrr✓rvL / ,D�.�7�ry / . Fib l�tL. ll7/Y'1= /2 1 - /J7Lti2rr !� /z /�/fJLFu r� 136 __ 7,v /� C• Ur2/,)/Trv�' (.✓ST7Y G U/�)/� , �3.33� / ��� • r'�GYnTiV. C�OE S. If this POWTS is replaced, or its use discontinued, it shall be abandoned in accordance with Comm 83.33, Wis. Admin. Code. i COPY Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ~ include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. p Q percent slope, scale or dimensions, north arrow, and location and distance to nearest road. , z / / , 1 Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 1410 1/4 A( / IE1/4 S Z) T - Z 1 N R�� E (or) W Pro rty Owner's Mailing Address Lot # Block # Subd. Name or C�SM# n OP 5i!!r2U.x v 112141- 1 A�� City State Zip Code Phone Number ❑ City tillage XTown Nearest Road c5' 0� 6 I (r ) - Nul SO rJ. ❑ New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement M�444* -or commercial - Describe: __— Parentmaterial 61LACioc 0Lf' W)0'y4 Flood Plain elevation if applicable _ MA ft. General continents and recommendations: r SS I LS 8 vk►-..iu A LAT Boring # Boring Pit Ground surface elev. /10 ft. Depth to limiting facto 9 6 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 L sbt V - /aY� — S +L Z A m r y _ .S A .g v Iris SG M f — Z Boring # Q� Boring WI pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 j b g 3 I L 1 Wr 5 >ax, r) r 6 -S j 6. • Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 < 150 nN& Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST ( Please PrintX Sig atu CST Number A KJE Y 2 �22 75 7 Adder Date Evaluation Conducted Telephone Number P i Property Owner _ Parcel ID # Page _ of 181 Boring # Boring Pit Ground surface elev. �Q1 ft. Depth to limiting factor >116 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 - 2< L 1 M.56K 1 Y' G5 6 6. C- S' dY 3 5 r L 'zrh a k r- C..S 412//b 16Y+ -4 4 Iy5 SG r Boring # ❑ Boring Q kIJ pit Ground surface elev. ft. Depth to limiting factor)/ �Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 'Eff#2 z -4 ( mvie 3 '�) L Z oi r n, r K -iiz nos 54 , 2 F-1 Boring # ❑ Boring 13 pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/l- ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD4330 X60)) f�1 U ' � e n r) Db Z c z > f� LN r � N r. r r. �10 N r! I r c -- r i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page f of Division of Safely and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.. / Q percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information R 'awed by ` Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).� Property Owner Property Location vi Q O E V f Govt. Lot / 1/4 AJC1 /4 S Z) T 1? N R I/ E (or) W Property Owner's Mailing Address Lot Block # Subd. Name or NW ! AtQ� I 5 i CteC� Ix f�l�U S r:l�l City State Zip Code Phone Number ❑ City q Y diage AV Town Nearest Road ( ) N ul . 50 Yj. I 'l / ! ® New Construction Use: ❑ Residential /Number of bedrooms Code derived design flow rate 6S' GPD ❑ Replacement 1� 42wbk or commercial -Describe: os+r Parent material &LAC i AZ d arwlasN Flood Plain elevation if applicable . A[A ft. General comments and recommendations: F—i Boring # Boring Q Pit Ground surface elev. ,tQL� ft. Depth to limiting fa _] b in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2 -1Z / / L l r►o sb 5 aC. Z rh .S cif. •�� s9•f �r. � F --zl Boring # Boring pit Ground surface elev. /Q�,4 ft. Depth to limiting facto r in. Soil Application Rata Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 p -z y 3 1 L 6.4 6 8 , Z1k, 0 S I OS 1 %Q o S S /Yi . :8 R Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 nVt Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST S P � lease Print Sig atu CST Number ,d KJ AjNS6N 2 ZZ 7S7 Add ress Date Evaluation Conducted Telephone Number P" 8"" 9 1-1300( 3v*g6 Property Owner _ Parcel ID # Page of a Ong # ❑ Boring pit Ground surface elev. 16 1 . 1 ft. Depth to limiting factor >116 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 A -is ib ° l L 1 M.SbK r G5 6. s' � �.d 6, &/ _" 5 f l_ zyh a k GS ® Boring # ❑ Boring 4 It pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 A -2i i b w3/� --- L, I l 4 Q •� z4-46 Q 4 3 '� ) L- Z m r A t C5 ,g MS 54 62 A Z 7 •S •Q Boring # ❑ Boring ' Ground surface elev. ft. Depth to limiting factor in. Cl Pit Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD4330 (R.6100) i 1 N �6 n r) m � C r � 1 r m _ 3 m c � r � w 3 i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 5-: �k o 1 o Property Address r J ` `.mo o wt +'r�J'' �id Lot 5 `m k 11 (Verification required from Planning Department for new construction) City /State AA "tn Parcel Identification Number D � 8S . '10 - o a co LEGAL DESCRIPTION Property Location '/4, '' /4, Sec. Z I , T 29 N -R 1Lc _ W, Town of Subdivision ���" C Cuk x �tiAv SA-r\a� ��;� , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 5S3 27-1 , Volume 1 � 1 3 , Page Spec house ❑ yes 8 no Lot lines identifiable ig 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Comrherce and the Department of Natural Resources, State of Wisconsin. Certification stating "-Your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the dkp a yea ration date. C _ Qo ./ G � SI A OF APPLICANf DATE OWN ER CERTIFICA (we) certify that all statements this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr rty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIG ATURE OF A PLR 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 5533'79 DISTRICT DIRECTOR'S QUIT CLAIM DEED I (Domna tN nba) THIS DEED, made in the city of Milwaukee, Wisconsin, on the I SL �v c0., � 41h day of D- ccmber, 1996, by and between ROBERT E. ( � BRAZZIL, District Director of Internal Revenue for the Midwest District, Milwaukee, Wisconsin, the authorized delegate of the I 4 EC I T 1996 Secretary of the Treasury, Grantor, ir, d Will D. Savadge, I at 8:55 A. Grantee; and, I • -W— .4 1-41-41L � M i fit•► a c.ecs WHEREAS, pursuant to the provisions of Section 6331 of the Internal Revenue Code of 1954, as amended, the hereinafter 1 described real property was seized from Mark W. Matz, for aso AND xETMN ADD RESS nonpayment of United States Internal Revenue taxes, which I N 1 l ` 4 were duly assessed and remain unpaid; and, (q 0 0 W , (( ki t WHEREAS, the time, place, and manner and condition of sale of said hereinafter described property were duly advertised in accordance with the provisions of Section 6335 of the Internal Revenue Code of 1954, as amended; and, _ Parcel Identification Number WHEREAS, said property was sold at public sale on June 3, E -46, to Will D. Savadge for the sum of $40,000.02, which '.( E amount was the highest bid received; and, ° v WHEREAS, the redemption period as provided by Section 6337 of the Internal Revenue Code of 1954, as amended, has expired without action to redeem having been instituted by the owner of the said hereinafter described property or by their executors, administrators or any person in their behalf, or by any person having an interest or lien therein, and, WHEREAS, Certificate of Sale of Seized Property, as executed and issued by the authorized delegate of the District Director of Internal Revenue, Midwest District, Milwaukee, Wisconsin on the 11 th day of June, 1996, which describes the hereinafter described property which was surrendered to the District Director of Internal Revenue, Midwest District, Nfilwauke--, Wisconsin, in compliance with Section 6338 of the Internal Revenue Code of 1954, as amended; and, WHEREAS, the sale was conducted in compliance with all of the requirements of Sub - chapter D, Chapter 64, of the Internal Revenue Code of 1954, as amended, and the Regulations thereunder. NOW THEREFORE, said ROBERT E. BRAZZIL, District Director of Internal Revenue, Midwest District, Milwaukee, Wisconsin, by virtue of Section 6338(b) of the Internal Revenue Code of 1954, as amended, and in consideration of the surrender of the Certificate of Sale and the sum of $40,000.02, receipt of which is acknowledged, does now hereby quit claim to Will D. S.:vadge, Grantee, his heirs and assigns, all of the right, title and interest of Mark W. Matz, in the real property situated in the County of St. Croix, State of Wisconsin, described as: VOL Part Of the North J,2 of the NE 1 4 of Section 21, Township 29 North. Range 19 West, known t 7 of St Croix Industrial Park in the Town of Hudson. St. Croix County. Wisconsin, being 2. acres more or less. IN WITNESS THEREOF, the Grantor has hereunto set his hand the day and year first above written. ROBERT E. BRAZZEL District Director of Internal Revenue Midwest District Milwaukee, Wisconsin 310 West :Wi Iscon i Ave. Milwauk�ee* o BY: Q Bruce Dethm Manager, General Advisory In Presence of. Dal, R Veer z -� 7 'A Moss Bruce Dethmers, Manager, Gen" Advisory of Internal Revenue, Milwaukee, Wisconsin, having personally appeared W ore me, and known to me to be the perscn described in the foregoing instrurnent, acknowledged that he signed and sealed the same as such Manager, General Advisory for the uses and purposes therein set forth. ?I - GIVEN under my hand and seal this 4th day of December, 1996, A.D. Paul Schmidt 0 Notary Public Milwaukee County, Wisconsin My Commission Expires o.3-ai-'M This instrument was drafted by the Internal Revenue Service, United States Treasury Department. ............ . . . . . . . . . . . . . . . . . . . . % . . . . . . . . . . . . . . . . . . . . . . . . . . ............... ......... - 'rOl LeT ............ . ....... ... ..... ........ ;15 - .......... F. Le ............. .......... ........... -3 %2 . .... .......... .......... .......... .......... . . ........ .......... .......... .......... �e,.r 014 PVr.A ...... . ... �_.. .......... .......... . .. .... ............ ........... El .......... .......... ................. .............. ........... ............ .......... O X IQ C: %4 (n z o .............. z wcn* .......... U-1 fA Z 4:b rrl 0) M 4pt ........... O co > rn 2 M m Z m . I -A ............. .FT. t0 W a Certified this ...day of. � �. e 3 IM 11 i .....19. o - 0 ti 901 O „ .............. 0 z t DePartlwent of Agriculture, Trade & Cons umer Protection ° ' 0 0 PART OF LOT 1 Z :a CERTIFIED SURVEY MAP 1 M T NQ ;�g640 VOLU QQUY 3 PAGE 71S N89° ( AS N89°50'W) c 00' 43 39 E 623.96' ................y N89043' E1 903.52'— -- 3 - ...••... • N .......... -..... _.......: 420. oO I; 3 ; v $ 0f- W ' O p 0: N; o _ p rn IO a SO. FT. O N 0 0 ^: Z 108, 159 SO. FT. N 0 N RES ' 2.48 ACRES I:Z ' 121,788 S0. 2.80 ACRES UNABLE TO MONUMENT LOT cORNI RIPRAP. SET I" X 24 IRON PIPE 3' 39 "W 00' 1 • 10.76' \� CORNER. 3' 373. -- FROM LOT 1738.95' _ -- 420.00' DRIVE - 3'39 "E 1739.87' 404.00' -----— 4 52.00' 3 3 in 0 t 7 0 N 8 Z N 2 OI 8 ES FT. Z N 87, 453 S0. FT. 2.01 ACRES 1 8.76' — 404.27' 452.30' ' 41'17"W 1718.79' RAILROAD STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER :? ADDRESS s S� h� •�ly/Ego �Q SUBDIVISION / CSM # �iC t(o /X V�u�PESgcrSi�.ft�P�' LOT SECTION -_ T N -R / W, Town of 1445o.-V ST. CROIX COUNTY, WISCONSIN S f/�vrT1ME ,p Q�p PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ,E.vcNN1AiPK a,PtN �Pr' E oP y �ti l �iPa� vi S Ar Al_ w �� � .P.t V�t �iP� ✓mss '��n,p,cfc� I /� I I ; , / �FFa t, (. "O/Pi!/C'� - 1-T �U�c'�� � � `i fin/ YV / .ul. C V A "Po 0 GJ�u l��fc. D�srR,3urov s �, INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: / cw /i PF � -r /J, (�.. &j&*-I'Y C�P�yfi E4 EIS 9/0 - 9 3 ALTERNATE BM: r -04J)SN CLEV . 9 /6 -sn SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: 6- ile5zP Liquid Capacity: Setback from: Well 9. Hie /n' Other Pump: Manufacturer Model# Size Float seperation Gallons /cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: s Length 51' Number of trenches Distance & Direction to near est prop. line: A" -o 30 /h Setback from: well: / /O' Heae a9' Other ELEVATIONS AT ?v ✓ - S Building Sewer 9/3• 17 ST Inlet, `; /,? .°jS/ ' ST outlet 9/•�• �� PC inlet PC bottom Pump Off Header /Manifold 91.?. a 9' Bottom of system 9 '// GO Existing Grade f 15. 46 ' Final grade 91 4 1 - '?S' DATE OF INSTALLATION: PLUMBER ON JOB: � � �,9D P/31, ebs Z,c,c, LICENSE NUMBER: INSPECTOR: 3/93:jt E PI�I AT� ` d 5Y5� L 4�cn�in+Iparr �11ius�r • 29.19 , N DR. County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST_ CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID No.: E e V .: Insp. BM Elev.: BM Description: Parcel Tax No.: t ? "' ,TY3 �i ,� Lc� O ( .1Gf0 2 —1 5 -70 -000 TANK INFORMATION ELEVAf ION DATA A9300054 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � .t� - Benchmark �q l y Dosing Aeration Bldg. Sewer Holding St / Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Air to I ntake ROAD Dt Inlet Air Septic �1d0' 9a /0 ' //o NA Dt Bottom Dosing NA Header / Man. �� p� e? ( f Aeration NA Dist. Pipe Holding Bot. System 9, 7 4/ 9 G p PUMP / SIPHON INFORMATION Final Grade 5 75 Manufacturer Demand _,6 Model Number GPM T Lift Friction Syetem TDH Ft Forcemain Length Dia. Dist. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS J/ DIMENSION SETBACK SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of n/r - j, , � CHAMBER mod Number: System YTi f: t)6 U r / 0 0 �� OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. 14f— 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 7 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Os�� LOCATION: HUDSON .29.M NE,NE, LOT 7, SCHOMMER DR. 4 _ Y � Plan revision required? ❑ Yes ❑ No Use other side for additional information.) fir' SBD- 6710(R 05/91) Date Inspector's Signature Cert.No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I ; :7Z = SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code couNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than El / Z jl. ion ?) � l 8% x 11 inches in size. check to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 3 PROPERTY OWNER PROPERTY LOCATION �} 1,4TZ AM' Y. /1/� %a, S al T , N, R / E (o PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 93 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME qq R CSM NUMBER ,os S5 C'?oIX ti/E�1TCtRES �.v/J�tsT 0.1CK II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD State Owned VILLAGE �ostav j W -0 OWN % Public 1:11 or 2 Fam. Dwelling- # of bedrooms — III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/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,IRL Off ice /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. xNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## — 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 12,9—seepage Trench 22 [1 In-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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION 911 6 , V y� Feet Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name C oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 1 565 I GJ C Ll Lift Pump Tank/Siphon 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' ign ure: (No Stamps) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 4 ;;r/S 6 TA' S . Al - fz/ /�So.V �-✓ S4/u/ IX. COUNTY /DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater a Issued Iss ' Agent Signat o Stamps) Approved El owner Given Initial Surcharge Fee) X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary.permit is valid for two (2) years. 2 Your 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. (Dnsite 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 focal 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. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one 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. VII. 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 tar;k(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 foss; 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 1993 Wisconsin Act 410 included the creation of sut charges ;fees) for a number of regulated practices which can effect groundwater. The r,:onies collocted through these surcharges are used fu r oroundw,ater, ground- water contamination investigations and establishment o11 standard,-,',-. SBD -6398 (R.11/88) ' S STC 100 This application form is to be completed in full and signed b the O"ct(s) Of the property being developed. Any inadequacies will only result in delays of the development be intended for resa by owner /contractor,l(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 Yj Mk—\ Location of property tCl /4 - 8. 1 / 4 Section 2 ) Township pp S'T C ) l CO( rT" Itailing address _Z3 et-Ay -e, PAL M r3 Wit l C) 3 Address of site -�5 / 3 Sc-H C) M Subdivision name G?- 0 � Y NQ� �L ?A� *Lot no. Other homes on property? es Y No Previous owner of property 4 257 X � 5 Total size of parcel 2,L) I A > Date parcel was created Q q- V—\t - 2 , (�Gi Are all corners and lot lines identifiable? / V Yes No Is this property being developed for (spec house)? Yes ✓No volume and page Number . as of Deeds. recorded, with the Register INCLUDE WITH THIS APPLICATION THE FOLLOWING: A 11 ARIWITY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE, 11UMBER & THE SEAL Or 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(Wc) certify that all statements on this form are true to the best of my (our) knowledge that I we am the property described in this information form th owner(s) of warranty deed recorded in the office of the County Regis of a Deeds as Document No. Y Regis of of own the proposed site f sewa , di p sal system) =resen (e) obtained an easement, to run the above described property, for the construction of said system, and the same has been atiiw recorded � n the off i ..F _ DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 - 1982 T HIS S /AC[ RESERVCD IOR RECORDING DATA a WARRANTY DEED 14 VOL 10 This Deed made between ...Saint Croix Ventures, L i 6 LN S OFFI a Minnesota.,.eneral p va ....................................... ............................... ............................. 'S=,d for Reebrd . Matz and . Ma rk W ' ......... ........... ............................... Grantor, PR 5 1993 .........:.. : a single Person .......... :45 ............. ............................... ........................... ....... ....................... .. .......................... Grantee, A . Red; ter � . .. ....., off D� W That the said Grantor, for a valuable consideration...... ................. .............................................. ............................... conveys to Grantee the following described real estate in _ St . Croix RCTVRN TO The First National Bank County, State of Wisconsin: _ 0 . Seco � j S 1 Lot 7, St. Croix Industrial Park , Township of nn Hudson, St. Croix County, Wisconsin Tax Parcel No: .... ............................... I � l" ANSF Eb $ i I i This ......... not homestead property. 00 (is rot) Together with all and singular the hereditamenta and appurtenances thereunto belonging; And........ St. Croix Ventures warrants that the title is .. I good, indefeasible in fee simple and tree and clear of encumbra ...- exc IIIJ i � i i and will warrant and defend the same. Dated this ....... ............. day of .......:..Ap 93 .. 19......... ...........(SEAL) Saint Croix Ventu es r — _ (SEAL) ................................... ............................... • � ..��. y, `__� ........................... Donald L Har (SEAL) ......... .. .... .� ..................(SEAL) • ..................... • Chr .. ' istensen AUTHENTICATION ACSNO W LBD GMENT Signature(s) ....................................................... STATE OF MINNESOTA I ......................:.. ............................... t es. .................. tienne in P ..................... Cou authenticated this ........day of ........................... 19...... Personally came before me this .... day of .......JUX4 ......................... 19- .. the above named Donald L. Harvey and ............................... ' .. ................. ............................... G. Craig Christensen TIT MEMBER STATE BAR OF WISCONSIN......... ................................................. ............................... (If not, . authorized by' §' 708.08, Wis. Stats.) ................... .......................................... ............................... tht person 5 ........ wh o exeeutPd tha S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWN ER /BUYER ADDRESS S I �MM'�� �D FIRE NUMBER CITY /STATE O F �uObCN VQ I ZIP �� �l Co PROPERTY LOCATION: t4*/1 /4, t 1/4, SECTION 2_I , T_Z2_N -R_j_ TOWN OF St. Croix County, SUBDIVISION G \� V LOT NUMBER 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 septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certif ication 'form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)• the on -site wastewater disposal system is in proper operating condition and ( 2 ) after inspection and pumping ( if necessary), the septic tank is less than 1/3 full of sludge and SCUM. 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 DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration date. SIGNED: 7Vlo DATE: St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 Wiscongin Department of Industry SOIL AND SITE EVALUATION REPORT Page of S Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but J' 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 PROPER OWNER: PROPERTY LOCATION 4T'�& emm=af N E 1/4 t4 E 1/4,S Z I T 29 ,N,R E (or )9 PROPERTY OWNER':S MAILING ADDRESS LO # BLOCK # SUBD. NAME / R CSM # IN S 3 �� SrQb Y��UT(rlPl{s &OS 7. �A�k CITY, STATE ZIP CODE PHONE NUMBER ❑CITY CC� VILLAGE OWN NEA ROAD, i vtJ w, Sy �iy t ) �lu t15a Sc (� New Construction Use (J Residential I Number of bedrooms (} Addition to existing building j J Replacement Public or commercial describe 1 19f �ifc7r�PY Code derived daily flow gpd Recommended design loading rate ():7 bed, gpd/ft ."3 trench, gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rate j.2-- bed, gpd /ft Z trench, gpd/ft Recommended infiltration surface elevation(s) �} / /. 6 Q ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable It S = Suitable for system CO VENTIONAL MOUND IN- ROUND PRESSURE A T - SYSTEM IN FILL HOLDING TANK U = Unsuitable for stem lS U S ❑ U IS ❑ U I�! S ❑ U HJ S ❑ U C1 S �U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench w E ZC)Yr2 i 7 s b K C- a t Ground � 6- q , /OYre elev. / 14 411 16Y 3 r S ✓h ! (3-7 d Depth to limiting factor 1 �2S Remarks: Boring # „ - z- L S b c rJr 0, Ground S 1 I 0.7:0.8' elev. 9 .9l ft. Depth to limiting factor > /Q.80 Remarks: CST Name:— Please Print f J '4Rgr � Phone:_ Q �� Address: / n , JL) A�ry )_ w /+ Signatur Date: , � /t CST Numberao e. PROPERTY OWNER '" n�S b SOIL DESCRIPTION REPORT Page Z of 5 PARCEL I.D. # t r Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench Ground $ -// �lOYr2 rv, n� 6 6 `D 4 elev. gti6g ft. Depth to limiting f or 7 7 Remarks: Boring # 7 'z � .� �• 5 :4 $f g --2 Gov �- 1 sl, fir a Z w Ground 1 9 /0- 0 ft. =i l6 Y e 4 3 �f M n, 1 o . Depth to limiting Remarks: Boring # 4 / ®YP z L. Z sbii c lo x Ground P 4 — S o ) r I ► ©.� 6 9 1 6. e ft i -�!S P Depth to limiting factor Remarks: Boring # `3 : 4 Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) ' P r�ti� 3 of Z I � , CID J / REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1 05/04/93 16:39 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/ 6/93 AREA: MJ Activity: A9300054 5/ 6/93 Type: CONV93 Status: PENDING Constr: Address: HUDSON 21.29.19,NE,NE, LOT 7, SCHOMMER DR. Parcel: 020 - 1285 -70 -000 Occ: Use: Description: 193390 Applicant: MATZ, MARK Phone: Owner: MATZ, MARK Phone: Contractor: STAHNKE, MARK E. Phone: 715 - 386 -2850 -------------------------------------------------------------------------------- Inspection Request Information..... Requestor: ZAPPA, GARY' Phone: Req Time: 09:05 Comments: q;06 Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION -------------------------------------------------------------------------------- Inspection History..... I I j SAFETY & BUILDINGS DIVISION I State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 A ZAPPA BROS Owner: MAR K M TZ 715 6TH ST N 593 SCHOMMER DR HUDSON WI 54016 HUDSON WI 54016 RE: Plan Number: 593 -40132 Date Approved: April 5, 1993 Gallons Per Day: 600 Date Received: April 2, 1993 Project Name: MATZ, MIKE Location: NE,NE,21,29,19W Town of HUDSON County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50 -64 of the Wisconsin Administrative code. This approval is for the following components only: - NEW CONVENTIONAL NOTE: The plumbing for this project discharges to a private sewage system. The approval covers only the domestic /sanitary wastes directed into this system. The Department of Natural Resources must be contacted regarding the treatment and disposal of all industrial wastes, including those combined with domestic /sanitary wastes. SBD.6423 1 R. 01/91) SAFETY & BUILDINGS DIVISION i t State of Wisconsin Department of Industry, Labor and Human Relations ZAPPA BROS Page 2 NOTE: The discharge of hazardous wastes to a private sewage system is prohibited by state and federal regulations. Accidental discharge of any hazardous substance to a private sewage system must be reported to the Department of Natural Resources or the Wisconsin Division of Emergency Government. Inquiries concerning this approval may be made by calling (608) 785 -9348. Sincerely, r 3RA e R a DM. SWIM Section of Private Sewage Division of Safety and Buildings PPP039 /0009n/21 cc: MARK MATZ X Private Sewage Consultant sun -6423 (u. ui/su Z ♦'O" Gv`vcr q3 I gZ N U U 111 U � r7SO�j.F. gw`o�Nc-v / a 1 � Q��I�INC -T' N9 m i m co c v \ o m N � N O � 2 ,ebb 1TIC "TYPE � Y l �. J _ U L v i= C.- scQ'P ���. t r+ F► E` a �!� 1 �� max• -' 1.920 Sgjt Of5c- S pacc 0 rl I li .rte= �tZ 0 N N ck rirmT 7:5 coo g5f SST 5.280 sq:i2. ct=ing Space .430 sq. ( I Cold Stor q8 41 oq SITE PI TEL -?