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HomeMy WebLinkAbout020-1460-00-103~ o h N 4, C a O N O ti ~~ •~ N .~ • ~Z\. V r`I~i r i ~~ d C O ~~+ L G Fri ~I .~ e~ ;~ A a ~ Z 0.' 7 Z rn N I- Z C C7 O NZ ~ _LL r Cl Z ~ r N N d M O Z .- ~ m a ~ o cn (n J U M 0 O ~ C ~ ~ O ~' N ~ O rri ~ C ~ ~ N -p O N 2 dt ~ °Yl #a o. a ~ ;~ ~ ` c U a ~ 'O C 3 LL ~3 ~~ Q Q' y ~; O O a m Q to ~ ~ c of C 'O Y N ,U 7 7 to to `l O a m m co -_ Q Z ~ Z C 16 O rn ~ y L Q ~ ,. M ~ ~ d O f/1 fA (n N o ~ o 2 N tWp ~ N 0 0 r a~ ~ .a d c ~ y7 +~+ m Ill C J J ~ ~ ~ N M m v o . ~ ~ a d ~ a c :: ~ O N U ~ o 3 0 O ~ a~ c 0 M N M C M O 7 ~ ~ T t' O C ~ Q ~ ~ O ~a ~ a s 'a E y>~.In v a n. a O ~ d ~v; w ~~_ ~~~ o ~ v N ~ N f0 O O Q C N Z ~p ~ TN (0 ~` ~~~ O C ~ O V :~ 4 ~, ~ o~ao Q ~ ~ ,z w C Ql L ._ N N L O T 'O m ~ ~ ~ rn a ~ d .~ ~ ~ 0 Z .r o ~ '~ o m .= c m Q n in Q C O U ~ ~ C C c c '~ `m N } y N ~ C Z N a ~ a~i E a I ~ I 7 n V a q t6 ~ ~ ~ _ ~ N ~ O C N g ~ I I I 1 V d ~ rJ C J cr ` _ ~~ V' Ryan Yarrington From: Jansky, Leroy G -COMMERCE [Leroy.Jansky@Wisconsin.gov] Sent: Thursday, April 02, 2009 7:42 AM To: Ryan Yarrington Subject: RE: Three compartment sink That is much smaller and makes a big difference. We need to know how much water used cleaning up to add to his total. I suppose we should ask if there is any other water use we don't know about. Also find out what's in suite 101 and if there are other suites that are empty. If they're empty, inform the owner that anything besides a few more employees could be a problem. Then do the calcs for what's there and if it's under 585 gpd give the go ahead. Put your calcs and this e-mail in the file for future reference. Note: On the actual flows used multiply by 1.5 to determine peak flow (when they use the sinks or what ever more often than anticipated). So one sink is 6.06*1.5=9.09 gal/use. Leroy G. Jansky, RPSS POWTS Wastewater Specialist Wisconsin Dept. of Commerce Safety and Buildings Division 13 E. Spruce Street Suite 106 Chippewa Falls, WI 54729 (715) 726-2544 - Office (715) 726-2549 - Fax (715) 828-5902 - Cell From: Ryan Yarrington [ryanyQCO.Saint-Croix.WI.US] Sent: Wednesday, April O1, 2009 15:53 To: Jansky, Leroy G - COMMERCE Subject: Three compartment sink i spoke with rich about the sink. It is 1400 cu inches per compartment. If you divide 1400 cu inches by 231 cu inches per gallon that comes out to 6.06 gallons per compartment. Three compartments times 6.06 gallons equals 18.18 total gallons. which is a lot smaller than what we talked about on the phone. Ryan Yarrington Zoning Technician St. Croix County 1101 Carmichael Rd. Hudson, WI 54016 715-386-4680 ryany@co.saint-croix.wi.us<mailto:ryany@co.saint-croix.wi.us> I 1 , ® /~ } 7 / / ~ ~~.~, __ ~~ ~ ____ _ ~~ ----~ FAX MEMO ~ (o ~ `~ %S f ~- r sfa~ 1 r ~-tea''` DATE: 3~~~ ©~ ~~ ~ ~~ %~~`~- Code Administration -~V''"_ _ ~~ ~ 715-386-4680 FAX NUMB R: i15 ' ~7ZG:,•- Z55~ `~ ~~ , ~~ Land Information ~ n ~~ ~ `~ Planning FROM: K4~..ti. 715-386-4674 _ ~J .l-t.~ FAX NUMBER: 715-386-468 Real P,t~perty PHONE NUMBER: `7~'S - 38i~-- CSC ~z -~ z- ~ 715~~$6-4677 R >' ycling ~"~ 386-4675 NUMBER OF PAGES, INCLUDING ~ v RE: ` r ZZ~i ~ ,ne~S • ~~ ~~~ S ~~,~PCY ,~, ~ ~. R ~ 1 (~JS .~. /j I /t~~~n +tt iUv 51~~1~., ~r s~ ~J G1~~1~ ~ t~~e~~a~e~ ~.1 j,~ ~ ~ Aso ~, ~,.+ e n ~`z t~ ~ ~' 0 _ ~~ l ~- ST. CROIX COUNTY GOVERNMENT CENTER 1 lO7 CARM/CHAFE ROAD, HUDSON, Vi// 54016 7>5-3B6-4686 FAX PZ@CO,SAINT-CROIX. WI.US WWW.CO SAINT-CROIX WI US i' State of Wisconsin Jim Doyle, Governor Department of Agriculture, Trade and Consumer Protection Rod Nilsestuen, Secretary February 5, 2009 Rich Raley Raley's Pizza LLC 1116 1St Street Hudson WI 54016 Rich: Meat Safety Consultant Stephany Grossbier, Meat Safety Inspector Nicole Ryan, and I enjoyed meeting with you a# your establishment at 588 Outpost Circle, Hudson, WI on January 29, 2009. It is my understanding that this is the facility that you intend to have licensed with this Bureau as an "Official Meat Establishment". The purpose of our visit was to review the establishment for licensing acceptability as an "Official Meat Establishment" and to answer any questions that you had regarding the requirements to manufacture and wholesale various pizza products. In reviewing the facility that you intend to rent, we found the general interior to be of sound construction. However, there are some areas of concern that would need to be resolved prior to issuance of an Official Meat Establishment license and they are as follows but are not limited to: • At least one non-hand operated sink in the area of processing room will be required. The sink will be also be required to be conveniently located within the room. • Currently the floor is carpeted. Currently this is not acceptable and will be required to be of a material that is easily cleanable and prevent an insanitary condition from forming.. • The wall behind where the intended placing of a four compartment-sink will be required to be of material that is impervious to moisture and easily cleanable to prevent the creation of an insanitary condition. • Vestibule will be required were the outside doorway enters into the processing area. • Walls have holes in them and will be required to be sealed to avoid the creation of an insanitary condition and to facilitate effective cleaning. • All doorways are required to be tight fitting and sealed to not allow pests from entering facilities. • All plants are required to have a pest control program in place. You indicated that you would conduct these activities, I further explained that bait stations or poisons are not allowed it the production areas or in the interior of the facility. • A welfare room will be required for employee to take breaks and to leave personnel belongings. No food or drink is allowed in the production area. Agriculture generates $Sl. S Billion for Wisconsin 3610 Oakwood Hills Parkway • Eau Claire, WI 54701-7754 • 715-839-3851 • Wisconsin.gov This institution is an equal op ortunityprovider Raley's Pizza LLC 2/5/2009 Page 2 of 2 We discussed that the products that you would like to start out wholesaling are of the "raw, not ground" product category. All products that are intended for wholesale are required to be~ manufactured under HACCP and SSOP food safety plans. During our visit, we discussed the requirements of an "Official Meat Establishment's" HACCP and SSOP and how these systems are based on "prevention". These two programs are required for all inspected meat processing operations prior to licensing. All licensed meat establishments manufacturing wholesale meat food products are required to provide scientific validation and incorporate a process to achieve adequate lethality or a control measure necessary to produce a safe product. For this reason, it is the bureau's expectation that all meat food processors have attended HACCP training. The UW Madison's Department of Food Science Extension Office (Dr. Jeff Sindelar), conducts these one day Basic HACCP training and Advanced HACCP seminars at various locations throughout the state during the year. You may contact that office at (608) 262-0555 or email them at jsindelar@wisc.edu and inquire as to their plans for future training. This Department also is a great resource for developing your HACCP and SSOP plans as well with a website full of very helpful information. The address of the website is www. meath accp.wisc. ed u/. Meat Safety Inspector Nicole Ryan will be assigned to your establishment and will be your contact resource person to assist you with HACCP, SSOP, formulation, labeling, and other inspection requirements. You can contact Inspector Ryan at telephone number (715) 246-9743. A plant number has been reserved for you and will be needed for labeling and formulation requirements. As we discussed I have enclosed a Certificate of Sewage disposal for you to have completed by your local government personnel. Again, 1 enjoyed meeting you and I look forward to assisting you in the future. I will perform a final on-site licensing inspection with Inspector Ryan and formalize the process when you are ready with your formulations, completed Sewer Certificate, an acceptable Water sample obtained by Inspector, and your HACCP/SSOP plans meet basic compliance. I wish you the best in your future business endeavors. Feel free to contact me at (715)389-3851 if you have any further questions or concerns. Sincerely, J hua P. Knutson at Safety Supervisor ISON OF FOOD SAFETY Cc: Stephany Grossbier, Nicole Ryan, Rich Raley File (612) 328-2508 Enclosure Agriculture generates $Sl. S Billion for Wisconsin 3610 Oakwood Hills Parkway • Eau Claire, WI 54701-7754 • (715) 839-3851 • Wisconsin.gov This institution is an equal op~ortunitYprovider. Code Administrati~zrz 715-386-4680 DATE: `~/~ to ~ To: l-Gro FAX NUMBER: FAx MEMO 7/S, 7 zc~ - z5 ~~ Land Information ~ -m Planning ~ FROM: y q ,,~., 715-386-4674 U FAX NUMBER: 715-386-4686 Real Property PHONE NUMBER: 715-'~~6-4677 7~! _ 3 ~~O , ~f ~ •~b ,~ R "'` cling 386-4675 NUMBER OF PAGES, INCLUDING COVER SHEET: RE: ~. G rrb i P ~ I ~~ s,`~, ~b wcJe.~. l s,~,'cc ~-C,.,~ti ~. bte w,'Cl l5 ~o G `nom LJa ~~-d~ d ~., ~v a G ~ I/ c. ~. c~ c~ / ~ d J V~-ve 4, 2G~c~~ ~ a ~ ~J PAS V'~~~''~'S_ ST. CRO/X COUNTY GOVERNMENT CENTER 1 101 CARM/CHAFE ROAD, HuDSOAi Wi 54016 715-386-4686 FAx PZ@CO.SAINT-CROIX. WI. US WWW.CO,SAINT-CROIX WI US WIESER ._~_ ~ ~~ -~ , ~. __ -- ~ - -~ Celebrating 40 Years Of Excellence 1965-2005 oonoRFTE _. S E , _~__ ._ ~,~ _~ ,~ { _ ~~, ~_ ~ t Maiden Rock, WI (800) 325-8456 Portage, WI (800) 362-7220 _~__ Fond du mac, WI ('800$41-5937{ ~ rj Spooner, WI (800) 336-3416 27Z ~s~3~. Raley's Pizza Sanitation Standard Operating Procedure (SSOP) Responsible Employees The Plant Manager is responsible for activities related to implementing and maintaining the SSOP. Implementing and maintaining the SSOP involves: • revising the SSOP as needed, • doing the daily monitoring or pre-operational and operational SSOP procedures, • recording the fmdings of monitoring, • performing or assigning any corrective actions necessary, and • documenting the corrective actions The plant manager may assign responsibility for training or other specific SSOP duties (including monitoring) to other employees. Si~~ and Dating the SSOP The SSOP shall be signed and dated when it is implemented and anytime it is modified. The Plant Manager shall sign and date the SSOP. SSOP Record Storage All records pertaining to the Sanitation SOP will be kept on file at the plant for at least 48 hours. After 48 hours, the records shall be kept for at least 6 months at the plant or another storage facility. All SSOP records will be made available to DATCP personnel (within 24 h) upon request. Pre-Operational Sanitation All equipment and other surfaces that could contact meat or ingredients shall be cleaned and sanitizes at the end of the shift in which it was used These surfaces include smokehouse equipment such as racks and sticks that directly contact products. 1. Disassemble the equipment. Place the parts in the designated tubs, racks, etc. (Simple equipment and hand tools are cleaned and sanitized in the same manner, but they do not require disassembly and reassembly.) 2. Physically remove product debris by hand or with tools such as scrapers. 3. Observe equipment for missing parts or parts/surfaces that are worn to the extent that debris will accumulate and cause product contamination. Replace or repair parts/surfaces and document what was done in the Corrective Action Log. 4. Rinse equipment parts with warm potable water to remove remaining debris. Note: a potability certificate for water from municipal water, or a satisfactory well 02/01 /2009 version; supersedes all previous versions test report (done at least every 6 months) will be available to prove that the water supply is potable. 5. Apply an approved cleaner to parts and clean according to manufacturers' directions. 6. Rinse the equipment parts with potable water. 7. Rinse the equipment with an approved sanitizer that is mixed and used according to the manufacturers' directions, and, if required, rinse the potable water. 8. Check and reassemble the equipment. Note that some equipment surfaces will be sprayed with white oil (to prevent rusting) before reassembly. 9. All cleaning and sanitizvng chemicals shall be properly labeled and stored separately from food and processing areas. The Plant Manager will inspect the equipment and other food-contact surfaces before the start of production each workday to monitor the effectiveness of cleaning and sanitizing. The Plant Manager will normally rely on appearance, odor, and feel of food contact surfaces (an "organoleptic inspection"). Any necessary corrective actions should be performed and documented in the Correction Action Log. The corrective actions taken must prevent direct product contamination or adulteration. If new inspection procedures are adopted, the SSOP will be modified accordingly, signed, and dated. Although the SSOP regulations do not explicitly address potential indirect food-contact surfaces such as floors, walls, and ceiling, these surfaces can be an important source of microbial contaminants. We regularly perform the following steps to maintain sanitary conditions. 1. Cleaning Procedures a. Sweep up debris and discard it. b. Rinse surfaces with portable water. c. Clean surfaces with an approved cleaner, according to manufacturer's directions. d. Rinse surfaces with potable water. 2. Cleaning Frequency: Clean processing area floors and walls at the end of each production day. Clean ceilings at least once a week, and more often if needed. 3. If necessary, clean the cooler/freezer floors, walls, and ceilings. Shield or remove product before cleaning to prevent it from being splashed. Follow the Cleaning Procedures described in step 1. 4. If cooler/freezer shelves and racks are in need of cleaning, remove product and clean using the Cleaning Procedures described in step 1. 5. Pest Control is done by a Plant Manager. The Plant Manager will provide a record of his/her inspections, fmdings, and actions taken. These records will be kept on file. The Plant Manager will monitor plant entryways on a daily basis during production to assure that insects and rodents cannot enter the plant. Rodent traps will be monitored daily to ensure that they are properly placed. All pest control chemicals shall be properly labeled and stored separately from food/processing areas. 02/01/2009 version; supersedes all previous versions 2 The Plant Manager will inspect the potential indirect food-contact surfaces before the start of production each workday. The Plant Manager will normally rely on appearance, odor, and feel of indirect food contact surfaces (an "organoleptic inspection"). Results of the inspection will be recorded on the SSOP Inspection Form. Any necessary corrective actions should be performed and documented in the Correction Action Log. The corrective actions taken must prevent direct product contamination or adulteration. If new inspection procedures are adopted, the SSOP will be modified accordingly, signed, and dated. Record the inspection results on the SSOP Inspection form. If an inspected area, program, or piece of equipment is acceptable, enter the appropriate symbol (~ ). If a deviation is noted, enter the (I~ symbol in the SSOP Inspection form, and then describe the problem and the corrective actions taken to fig it on the Corrective Action Log. Be sure to date and initial these records. The corrective action may consist of re-training the sanitation crew employees as appropriate, changing a cleaning/sanitizing procedure, and/or repeating the existing procedure with greater care and re-inspecting. Operational Sanitation The objective of our operational sanitation program is to prevent contamination of carcasses and other food products resulting from employee actions throughout processing. 1. No person with illness, or open/infected wounds is allowed to handle foods or food-contact surfaces. 2. All employees must begin their shift wearing clean garments. Raw product processing employees must wear hair covers and change or clean/sanitize (or replace) outer garments when they become soiled. Ready-To-Eat (RTE) product processing employees must wear hair covers and single-use disposable gloves, and maintain the cleanliness of all outer garments. 3. Employees must wash hands properly after using the bathroom or handling any objects that may contaminate products, and before putting on disposable gloves. 4. Employees may not use tobacco, eat, or drink in slaughter or production areas. 5. Employees may not wear jewelry (other than secured wedding bands) or cosmetic items that could contaminate product. 6. Food, beverages, and medication must be stored in designated employee locker or storage areas. 7. Hand wash facilities and toilets must be kept functioning correctly and properly supplied. Processing will be performed under sanitary conditions to prevent direct contamination and cross contamination of food products. a. To avoid cross-contamination with allergens, one or more of the following steps will be taken: 1) allergen-free products will be processed first, followed by products containing allergens. In no case will a product containing a particular allergen be processed before anallergen-free product. 2) Products containing allergens will be processed separately 02/01/2009 version; supersedes all previous versions 3 using equipment that is not used for allergen-free products. 3) Processing equipment and other food contact surfaces will be cleaned and sanitized, and pass apre-operational-type inspection, after use with allergen- containing product and before use with allergen-free products. Clean and sanitize hands, gloves, knives, other hand tools, cutting boards, etc., as necessary during processing to prevent contamination of food products. b. Clean and sanitize equipment, tables, and other product surfaces throughout the day as needed to prevent contamination of food products. c. Take appropriate precautions when going from a raw product area to a RTE product area, to prevent cross contamination of cooked products. Change outer garments, wash hands and sanitize hands with an approved hand sanitizer (sanitizer is equivalent to 50 ppm chlorine), put on clean gloves for that room. d. Process raw and RTE products in separate areas. Do not cross-utilize equipment between raw and RTE products. If this is not possible, separate the handling of raw and RTE products by time and do a thorough cleaning and sanitizing of all food contact surfaces before working with RTE products. Note that cleaning and sanitizing can be done at the end of the previous day if RTE product is handled at the start of the next day. As a last option, keep raw and RTE products distinctly separated within the room. For example, raw products could be handled on one side of the room and RTE products on the other side. If this approach is used, do NOT cross-utilize equipment for raw and RTE products. e. Outer garments, such as aprons, smocks and gloves, are identified and designated specifically for either the raw processing rooms or the RTE processing rooms. Wear the appropriate garments for the task you are doing. Hang your apron and/or smock in the designated location when you leave a processing room. Keep your outer garments clean and sanitary and change them at least daily and, if necessary, more often. f. Check cooler and freezer temperature daily, as described in the SOP for Finished Product Storage. Coolers should be at 41° F or colder and freezers should be at 0° F or colder. 2. Monitoring and Recordkeeping of Processing Operational Sanitation a. The Processing Manger is responsible for ensuring that employee hygiene practices, employee and product traffic patterns, sanitary product handling procedures, pest control, and cleaning procedures are maintained. Make a visual observation at least once between each break in work (start, break, lunch, etc, Record results on the SSOP Inspection form at least once per processing day. If an inspected action is being done, enter the appropriate symbol (). If a deviation is noted, enter the (I~ symbol in the SSOP Inspection form, and then describe the problem and the corrective actions taken to fix it on the Corrective Action Log. The corrective actions taken must prevent direct product contamination or adulteration. Indicate on the Corrective Action Log the disposition of any product 02/01/2009 version; supersedes all previous versions 4 Ryan Yarrington From: Jansky, Leroy G -COMMERCE [Leroy.Jansky@Wisconsin.gov] Sent: Wednesday, March 11, 2009 2:44 PM To: Ryan Yarrington Subject: Wert Building Regarding the type of wastewater discharging into the existing system for the proposed pizza assembly operation, the owner will need to submit information to DNR so that they can determine if the discharge from the food operation may be comingled with the domestic wastewater. If DNR approves then we will need to look at volume and concentration (organic load) into the system components. Pretreatment might be necessary, but then again maybe not, considering what your have told me about the operation. The DNR contact in Madison is: Steven Smith (608) 266-7580. Leroy G. Jansky, RPSS POWTS Wastewater Specialist Wisconsin Dept. of Commerce Safety and Buildings Division 13 E. Spruce Street Suite 106 Chippewa Falls, WI 54729 (715) 726-2544 - Office (715) 726-2549 - Fax (715) 828-5902 - Cell 1 commerce.wi.gov ~ r isconsin Department of Commerce Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 Contact Through Relay www. commerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Richard J. l.einenkugel, Secretary March 13, 2009 CUST ID No. 231073 MICHAEL C DUNN DUNK PLUMBING INC 761 ORIOLE LANE HUDSON WI 54016-7675 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/13/2011 ATTN.' Plumbing Inspector MUNICIPAL. CLERK TOWN OF HUDSON 980 COUNTY RD A HUDSON WI 54016-7674 SITE: BBSJ LLC Multi Tenant Building 726 E Hwy 12 Town of Hudson, 54016 St Croix County FOR: Facility: 657964 BBSJ LLC MULTI TENANT BUILDING 1 726 E HWY 12 HUDSON 54016 Identification Numbers Transaction ID No. 1644951 Site ID No. 686416 Please refer to both identification numbers, above, in all cones ondence with the a enc . Tenant Name or Addn/Alt Description: Raleys Pizza Tenant AlterationPlan Type: Addition-Alteration; 1 Grease Interceptor; 1 Interior Fixture(s) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. Comm 82.20(8) The plumbing system shall be installed in accordance with approved plans. 2. Comm 84.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it is of a type conforming to the standards or specifications of chs. Comm 82 and 83 and this chapter and ch. 145, Stats. 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. 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M ~ ~S~oQQCO4~a Qom' ~~~~~ ~ ~~ Q ~ ~`^~'~DCO moo 0 ~g ~~ ° O O QO S~Q7.0 `G--~ 3-'~ (D 7~ O N Q l° " W ° -" = V _ i~ v~ 7'cD O n~ ~N Qr p A O ~ N 6-.Q ~'< w N Q 7 c ° 2~^ ~ rn = m ~ ~ D m 7 _ N y ~ W W Z ~ ~~..-\ __._- ' ~ N_ m Sao O ~ v, Oou, ~ _ - __ A- D '- G~ G) N J Z ~ rn D -~ m o .~ _~~ - J m rn N ~ - --- ~_. _- .- _' rn r O -~i N ~~Jc D cz ~ rn p p ~ ~ ~, _ D 3 ~ _ ~ "~' m T Q ~^ p m A ' y f ~ n -TryZ • 'I r ~y w r' Z o rn ~"~ C~ ~ m W O ~ I O -+ - D ~ z ~ a p ~Zrn Z A A •~- N ~m ~ m ~ _ ' rn n '~ L7 D in m < ~ -, ~ rnn~ D m~ ~ A ~ 1 D ~~~ `nm ~ ADD ~D \ - -I n~ ~Z ~ I -< O O o o - ~ ~..~L N N ~~ `~ f~ T O D -- D ~ 3 -~-awo ~ Z~ O m G ~ S~pp~ O T W ~~ ~ ~ QvVOOQ - Oy y A o-~a ~n Ccn a-'7 -N.•~.i mm ~' D o ~s`O~~ ~O m 3 ~„ ~ z z O _ o z _ ---- - - ' ~ ~ - --~ p ~ ^~ ~ ~ ~ ~o~ • ~ _ ~~ __ . ~m ~~~~ State of Wisconsin 1 DEPARTMENT OF NATURAL RESOURCES WISCONSIN ~-•-~ DEPT: OF NATURAL RESOURCES March 31, 2009 Mr, Rich Raley Raley's Pizza, LLC 726 Hwy 12 East, Suite 106 Hudson, WI 54016 Jlm Doyle, Governor Matthew J, Frank, Secretary Subject: Raley's Pizza, LLC Dear Mr. Raley: 101 S. Webster St. Box 7921 Madison, Wisconsin 53707.7921 Telephone 608-266.2821 FAX 608-267.3879 TTY Access via relay - 711 This is to document our phone conversation on March 2S, 2009 discussing the need for Department of Natural Resources (Department) concurrence for disposal of wastewater generated from your proposed pizza making business. You indicated that all ingredients of the pizzas will be frozen, with the exception of the pizza sauce. The wastewater generated by this business will result from cleanup of a sauce pan and ladle, an assembly surface, a stainless steel sink unit (equipped with a grease trap) and floor and other surface washing. Initially, the business will employ 1 person but could ultimately employ up to 3 people. The space is being leased in amulti-tenant building that is zoned for industrial use and is served by a single large septic tank and drain field. This private onsite wastewater treatment system (POTWS) was approved by St. Crow County Zoning on October 21, 2004. The wastewater that will be generated will be of low volume and of organic nature and is compatible with disposal in the previously constructed POWTS. Therefore, the Department has no objection to the discharge of the wastewater described above to the system. To minimize organic load on the treatment system, dispose of waste or spilled solid ingredients or waste sauce in the solid waste stream. Also, take care that any chemical cleaners used should be compatible with septic systems. If you have any additional questions, I can be contacted at 608 266-7420 or at tom.mugan@wisconsin.gov. Sincerely, Thomas J. Mugan, P.E. Chief, Wastewater Section E-cc Leroy G. Jansky,Wisconsin Dept. of Commerce, 13 E. Spruce Street Suite 106, Chippewa Falls, WI 54729 dnr.wi.gov wisconsin.gov i I I I I O t~/i ~ ~ N O I fD a cn z y a D W Z O ~~ ~p c N a ~ W m a lO ~m G (D (D N I I I 3 o a a o 3 0: ~ m m~.~ I w ~ z ~v o I ~~ ~ ~ o I c ~ I a ~' ~ ~ I `~ ~ O I m N_ i ~ 7 O O W O 0 C=D O O ~- 4/ M O O y ~ ~ C w 3 i ~ eo ~ it ~ ~ ~ 3 3 o ~ o0 r C7 J 7 N ftl y ~ C - a ~ a = o ~_ N ~ _ p C ? N 7 ~~~o~ ~~~~ W fn N ~ ~ A O ~ ~ ~ ~ ~ .. ~ ~ .. 7 w 7 -~-h O 7C ~-.. 7 O N ~ O N p N c ~ n N A a S G1 Q C (D ~ a W ~ a °o :' m A ~ N m c 3 a 3 d o ~ ~ 3 m v m ~ m C W N d IV Q O ~ ~ ~ "~ OO1 -.{ ~ N ~ W O W ~~g ~ O ~ O C 3 °Y ~. o D 0 W '0 cn rn N N A Z ID .a ~ en-, A ~ ~ `~ ~ w z ~ ~ ~ ~ d Ay N' ~n O M.{ • O ^ 1 "`~ ~• 0 ~~ ao w ti O~ O A ti b A' A ~ ~0 ;r ~ ~ y ti y Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 'ermit Holder's Name: City Village X Township BBSJ, LLC Hudson Townshi :ST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 3 ~, iz5~ Dosing Z 1~1.~:x.~ I Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ 7 /~(~ ~~ ~ ~ ~ ~ '~. Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufac rer Demand GPM Model Num r TDH Lift fiction Loss Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width ~ ~ Length ~ No. Of Trenches DIMENSIONS ~ it ~`1 1. SETBACK SYSTEM TO P/L BLDG WELL INFORMATION Type Of System: ~ ~~ ~ ~, i ~ ~~ ~ C~,~,t~e ~~-," ~ ~. DISTRIBUTION SYSTEM Header/Manifold ~/ Distribution (~) ~ [ J Pipe(s) Length '7 Dia ~7 Lenoth \ Dia \ Snarinn ELEVATION DATA county: St. Croix Sanitary Permit No: 453464 0 State Plan ID No: Parcel Tax No: 020-1062-00-000 Section/Town/Range/Map No: 23.29.19.2348 STATION BS HI FS ELEV. Benchmark z ~1l , $ ~I7 - cP Alt. BM °~-- C.o~+ 2 -°I yy, S~ Bldg. Sewer ~3.7o qy. 1 SUHt Inlet ~ ~ 90 45 SUHtOutlet 7.OG J ~~. .7~ Dt Inlet ` Dt Bottom ~ \ Header/Man. c~ 7• 1 ~~• Dist. Pipe ~. o ~9 • `~ Bot. System ~© Final Grade ~ , SS ~ 3 Z St Cover Z ~z ~~'~ PIT DIMENSIONS No. Of Pif\ InsideL~a. Liqui Depth LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ~~ ~ i i ~l ~~ 1' - n G~. c~ L J- d-+ n n - 1, h~ UNIT Model Number: r j u ~ c~ ~ 5 ~~... ~ r~ .. ~5 x Hole Size x Hole Spacing Vent to Air Intake SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Only Depth Over Bed/Trench Center !~ ~ Depth Over Bed/Trench Edges xx Depth f Topsoil ~ xx Seeded/Sodd\ed~~ ' xx Mulc ed ~ 1 I, \ Yes , No 'Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 726E US Hwy. 12 Hudson, WI 54016 (NW 1/4 NW 1/4 23 T29N R19W) NA Lot 1 Parcel No: 23.29.19.2346 1.) Alt BM Description = ~~~~+~ ~a~`Ien.. ~~~'~'~` ++-~La" C ~0~~+~5 ~ ~~`-~`~ d ~ 2.) Bldg sewer length = 7Li ~~~ ~ ~5 `7 5C'-.~- ~.j c~.~iZ... ~ d7 c ,r1 -amount of cover = Z ~ ~~~, ~ rev ~~,~ P , ~ J ~ (1 ~~ __ 33 ~, /~ ~; ~ Plan revision Required? 0 Yes NNo ~ ~ ~ 1 I ~; l ~I Use other side for additional informs iof n. ~ t ;____`_'_~__, i _ __KK___~__^_ __._._ ___ .._ ____--_____-__ ~ __._ _ __. ___J SBD-6710 (R.3/97) Date V Insepct s Sign re Cert. No. Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Cou ST ~ ~X nsin Madison, WI 53707 - 7162 i Sanitary Permit Number (to be filled in b Co ) seo (608) 266-3 I S I Department of Commerce State Plan I.D. Number Sanitary Permit Application ~~ p 2 G 2/ y al information you provide e so Ad d 21 Wi C 3 r n m. e, p , s. o . In accord with Comm 8 may be used for secondary purposes Privacy ~Y, slS.(14(.I):Lt~----.-~~-•• -~-M-~--~---t 7 __ ~m 'y ' ~_-: Project Addr (if different than mailing address) L Application Information -Please Print All Informatio `7 ~' (o ~ ~/~~{~ ~ ~.Z Property Owner's Name ~; t ~. - ; + ~ I ; : ! ~ cel # ~ ~ t # O ! y„Block # 2 0 - ~ - (ft~u ~~SS ~ L(° ~ Property Owner's Mailing Address i Prope Location C/ Z 3 ~' L~ t ~------~~--- , °- /., ~/ h, Section .3 City, State Zip Code Phone Number .007 (circle ASik.- ~~ ~Y°' 6 `7!S"7 T ZCC N: R~E W [I. Type of Building (check all that apply) Subdivision Name CS Number ^ l or 2 Family Dwelling -Number of Bedrooms i~1~~33 f G~ ,,sf ~OLOn'``'- 3 PA'`~ ~ ~ U^~JT DF-F le i ~trblicJCommercial-Describe Use ^Village ~'ownship of T~OSo N ^City _ ^ State Owned -Describe Use 0` -- d~Q ~ ~ ~ J III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' New System Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T of POWTS S stem: Check all that a 1 Non -PressuriDed In-Ground ^ Mound >_ 24 in. of suitable soil ^ Mowd < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter Recirculating Synthetic Media Filter Leaching Chamber D 'p Line ^ Gravel-less Pi ^ exp ~ ) V. Dis ersal/TreatrnentRrea Information: CJ Design Flow (gpd) Design S ' ion t f) Dispersal Area Required (sf) Dispersal ed (sf) t~m EI vati9n 7- 3, D8 ,- -7 ~ g 3~ ~' O -a = SOT- y o Vl. Tank Info city in ota Number Manufaceurer Prefab Site Steel Fiber Plastic Ga Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Scptic or Holding Tank ") Q 1X _ ~O ` Aerobic Treatment Unit I ,/ ` , W ~~x~/.~l Dosing Charmer VIi. Responsibility Statement- I, the undersigned, assame responsibility for i Ilation otthe POWTS shown oa the attached plans. Plu Name (Print) lumber' ign M PRS Number Business Phone Number ~- Y ~~~ ~ a 3s 7is- a~ g - ~ 9 Plumber's Address (Street, City, State, Zip Code) }~ ~+ /7 ~. ~r~~ J ~~ VIII. n /De artment Use Onl pproved ^ Disapproved Sanitary Permit Fee ncludes Groundwater Date sued Is tng Agent ~ natur o a s e Fee) ~ 7 C-7r Surchar ~ ~ Q + - ! ~ D g '*~ G J U ^ Owner Given Reason for Denial IJ-. C'onditions of Approval/Reasons for Disappro 31 ~ 1,~ f,Q^M ~ ' ~ ~ ` a ~ ~-~R-~ ' `~ ` 1/L~ WNER . : SYSTEM O i SQ~-~o Vy-~ ~-Z d ~ 1 Septic tank, effluent filter an ~ i9a~ ~ (/y dispersal cell must all be serviced /maintained ~ ~.~~ ,,~~~il,~},L„ Uy, ~~=f~i'~ ~ _ _ 2 rG~ ~~ Q h'' '~ - as per management plan provided by plumber. a " ~'~~ ~~,l~~.-e.._ All setback requirements must be maintained 2 . 7 as per applicable code/ordinances. -...1... rr..n !1R : tt ieehes ie fig .....~.. w...r...... r..-... p...........-...~ - + ~ -- --- -• ----- - SBD-6398 (R. 01/03) Y -~- - . ~~ _ _ p ~~ ~~ R- - /oo z ~--~- N~ ~-~ 0 13/~t I = Ion ~ ~` o-~j '' ~u~- ~° ~ ®,6m a - ~7 ~o , r~ ~ r 5 y .~. ~ I ~~ ~ ~ ~~ g8,5o 7"- 3 8 a r- `/ g7,~o l~r~~` ca. r.._.~ ~- 3' t- z 3 ~ 3 $q gg,sv' t , 88 1 yo, ~~o ~ ~ ~~ c..,~,~- ,~ ~ // s ~ ~ h~ ~- ~t3 ~ N~ ~ ~ ~lSo~ a~~r ~~r x ~_ 3 ~ ~ ~M 3~ ~r-y S } so ~~~ ~ ti~ S~ ~ --~ -_ • \ ~ - ~o ~ z o-G--~ N~ U~ ~_< < i ~ T $q SS~so, t_3 °-~ ~.~.-~ . s8 s y .~-~. ~ ~=l ~9 .~ ra g8,5o r- 3 8 ~ ~3 ,~ s ~p ti~ ~- - -~ ~~ \ , q3 ~ ~ - ~ ~ ~ lSo x ~_ a~~r ~,~~ ~ X ~- 3 ~ ~ Q~ ~~ 3~ ~r-y 8 Asa --=°~-~ ~~ sR,t ~& -___ P~ y~F ~ commerce.wi.gov isconsin Department of Commerce Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264-8777 www. commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary July 30, 2004 CUST ID No.220357 BRADY J UTGARD 110 KELLER AVE N APT 112 AMERY WI 54001-1034 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/30/2006 SITE: Brian Wert Commercial Building Hwy 12 Town of Hudson, 54016 St Croix County NW 1/4, NW 1/4, S23, T29N, R19W Identification Numbers Transaction ID No. 1026212 Site 1D No. 687037 Please refer to both identification numbers, above, in allrcorrespondence with the agency. FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 971322 Maintenance required; 585 GPD Flow rate; System(s): In-ground POWTS Component Manual, SBD-10705-P (N.O1/O1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. 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 "In- ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10705-P (N.O1/O1). Comm 83.02. This approval covers only the domestic wastewater directed into the POWTS. The Department of Natural Resources must be contacted regarding the treatment and disposal ofnon-domestic wastewater, including those mixed with domestic wastewater. 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. BRADYJUTGARD Page 2 7/30/2004 Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Thomas E Devereaux Plumbing / POWTS Reviewer II ,Integrated Services (715)634-3026 , 7:15 am - 4:00 pm Mon. -Fri. tevereaux@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WSMART node: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 CONVENTIONAL IN GROUND GRAVITY Commercial Design INDEX AND TITLE PAGE Project Name: BRIAN WERT Owner's Name: BRIAN WERT Owner's Address: 923 CLOVER LEAF CIRCLE HUDSON WI. 54016 Legal Description: NW '/4 NW '/4 S 23 T 29 NR 19 W Township: HUDSON County: ST. CROIX Subdivision Name: N/A Lot #: N/A Block #: N/A Parcel I.D.# N/A Plan Transaction #: N/_ A___ Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Index and title Sizing System cross-section Plot plan Tank cross-section Contingency plan Soil test * fl~~`~2q~ ~ b* r ~~ fr. N', pNrj u.--~ cam,-..~ ~Et 1G~ ,~"''~ ~Sp Oh Designer: BRADY UTGARD .License #: 220357 Date: 07/1 04 Phone #: 715-268-6995 Signature: Design Pursuant to the In-ground component manual for POWTS version 2.0 SBD-10705-P Page 1 of 7 CONVENTIONAL IN GROUND GRAVITY Commercial Design SIZING 30 EMPLOYEES x 13 G.P.D. = 390 G.P.D. 390 x 1.5 = 585 G.P.D. 585:.7 = 835.71 SQF. 44 Q 4 INFILTRATOR CHAMBERS 44 x 19.1 = 840.4 SQF. / 4-11 CHAMBER TRENCHES TANK SIZING FOR 3 YR. PUMPING CYCLE 585 G.P.D. x 2.088 = 1221.48 GAL. PROPOSE 1250 GAL. WEISER SEPTIC TANK A-100 ZABEL FILTER ~~~2~cF-y a ~~ m ~ _ a ~ - ~~ ~ >~„ o~~ JW~ = v ~ ? ~ ~ > n q 1. '~ g~~ N W ~ ~ pm ~^u1~C~ v an N ~ 2 ~~ ~ H 8 ~ q u N ti ~ L ' m ~ x m ~. ~~~ ~ A V d ~ ~ ~ in o .~ ~ ~~~ ®~ 3 W J ~ +~ ~ ~ W ti ~' W Q a _ U W ~ Q ' + U ~ ~ W ®~! V Z ~ ~~ '" Q ~"~ w o H O Q ~ ~ m a ~- ~ J U ~ ~ a C~ 3 w " o .. ., U W N M ~~ ~ ~~ - ~, p s° ~m ~; IS m N I~ --1 k Z N A .Z rn a A 7 C r n c 0 rn X n m m A y n i N ~ N I J m O C m m z I N n C a D~ z~ ~ p ~~ p' Z zx r~i . . c N IV Q 7. a P1 N m n O Z r+i D ~ ~ ~ z a m g ~~~ ~ z C ~'+ o y D ~g ~ ~o ~ ~r~i~~~;~p~ ~~~ g ~ Z ~ m ~p s~ ~ ~ n o mg ~~ = o~c>~ r, ~S~„ ~~o~~" = m O O n= ~~ ~ W ~ ~ , ~~ -~ j~ r, D-~ m~n~~~N~iv~ N C7~~ '~~N N~ .~r ~ N , rw~, n~- ~ <~ 7 ~ ~ ~ ~a, ~Oo ~ Q :~ T ~O w ~ ~ ~ \ A ~ O o v C Ov ~ ~ ~ A iV r z "fi r' ~ m g t~ ~ Q r z ~ WIESEII COtiGAETE ws1+6 us nwr+a u~ioE~ aoCK, w+ s~750 800-325-8456 p~ s~~ 52 ~" at' N ~~ i M1~ I o, 5~ qa' ~~ m~ b~O ro A ~ WO~ rn2p n ~ ~' 2 ~~~ N~r :0 r~\ /' i ~/ 1 ~1 // .w 4g ~' J9" ~I~ m Z --I -i s ~ vPrscansin Departrrrent .Commerce Division of Safety and Buildings . SOIL EVALUATION REPORT Page ( of rn accoroance wnn wmm aa, rrrs. ~prrr. was County dres b size n must 11 i Pl th 8 1!2 A f l e . x n a an ee plan on paper rat ess ttach complet s indude, but not arrtilsd eo: vertical and horizontal relbrence point (BM), diredbn and parcel ID. ~ Z U ~ ~(~~ Z '~ ~ ~`~ percent sbpe, scale or dimensions, north arrow, and locatlon and d nearest road. Please pr1M ail informatlon. t ~y ~ 04 1 )) P ~ R Date / - /l ~ ~ ~! l/ ( ) (m . , s. . Perswrd infomratbn you provide mey be used fa secondary purposes ( ~ ~ party Own ~ f ' --~-~ ~ ~ ~ ~ ~ ~ ~ ~ ~Locatbn 4 ~ T N R E { /~ \./ ( 1/4 1I S G (or Property Owners Mailing Address ° ~ L # Bbdr # Subd. Name CSM# ~-f ~ ~~ 3 ~ o - ~. 3 a~~.c~ ~f~~ a . C State Zip Code Phone Number City ^ ~Ilage ~ Town Nearest Road J(J~ ( )., . ~, ~~~ . ~ w ~ (~ New Construction Use: ^ Residential I Number of bedrooms _ - ~._-~ Code derived ign fbw rate ~ 6 ~ ' d - ~ S~ GPD (o ~{ u , ~Q ~~ ^ Replacement (~ Pubfic or commercial -Describe: ~ ran P ~! _ on if applicable _ va ti Parent material _ ______~ Fbod Plain ele ~/~ ~- ft. General oonxnerris Z 6 ~~~ ~ ` ~ l ~ (! - ~ j ( and recommendations: S YSf t "^ ~ `~ ~. ~ ~ ' 6-e, ~~ l/L~- "" (J ~S~in,~~~ Boring # ~ eonng p 2 [~ pit Ground surface elev. L /-~~ ft. Depth to limiting factor _ I ~ to in. Sod lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlt[= in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 o-i~ Z ~ SL ~, ~~ .5 lv CU Boring # ~ Boring ® Pit Ground surface elev. ~~~~ ft. Depth to limiting factor ~~ in. ~~ ication Rate Horaon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP DIft: in. MunseN Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 l O ~ +~ r Z _ SL ~ /~ ~ ~ v~ ~ ~ U _ ' Effluent !f1 = 80D > 30 < 220 mglL and TSS >30 <_ 150 nrg/L • Effluent #2 = BOD < 30 mglL and TSS < 30 rrrg/L CST Name (Pieege Print Si CST Number - zs-3 Address Date Evaluation Conducted Telephone N ber ~ ri 3 ~so~.s~ ~,~.~-~, wl• s~zs- ~ iy--o y 7is--~~ ~ --~z~; ~+ Page _ L of ~, Property Owner 3 ~] Boring ~ ~ !,//yn Borrng # 'i ' = l pith to tirrrii;n9 tac6°r ~~ in. Sob ication Rate ^ ev. ~ - Ground surface e Pit Texture Structure Consistence Boundary Roots GPDAF ff#1 •EH#2 •E Redox Descriptan Horizon Depth Dominant Color MunseN Qu. Sz. Copt Cobr Gr. Sz- Sh• ~ t . / ~ U ! , in S~ ~ ~~ sbl~ m ~~' ~ ~ q- y ~ r /~ _ - ,, c o s~, vvt -- Boring rn• So@ A ication Rai Boring # :Ground surface elev. - n• Deplh to limiting factor - - ^ Pit GPDfIf' Redox Description Texture Structure Consistence Boarirrdary Roots •Eft#1 •Eti#2 Horizon Depth Dominant Color Gr. Sz Sh. in MunseU Du. Sz. Cont Cobr Boring ft. ^ Borin9 # Ground surface elev. --- ^ Pit Depth to limiting factor _- - rn• The Department of Commerce is an equr-1 opportun~tty~s~ ~c ~e departmentrat 08-2t66-3151 oa TTY 608c264-8777. cervices or need material in an alternate form t, p SBD-ffi30IR.07/00) > c 220 and TSS >30 5150 mglt • Eiiluent #~ = 6005 <_ 30 mgll_ and TSS < 30 mglL • t~iluent #1 = BODS 30 _ n-9n- ., f ' J~ Cd6 ['AGE ~ OF~ ~~ ~ LO"I'JJ I LEGAL DESCRII''I'ION:~[{,~t~'}~1~~1,SZ3~l'~,1`J,It,~L(ur)~ NAME: ,G»' r SCALE: 1 "_ ~U ELEVATION: `` d BM l DESCRIPTION: ~~ o ~ ~ Qav~ ~"'a° ~' fi _ BM 2 ELEVATTION:_ -- BM 2 DESCRII'"1'ION:_ r~_o~_~-c~t~~_~~~ SYS"I'L'ivl ELEVA'I~Ic~N:__ - _______________ SYS'T'EM "TYPE: _ __ _------ SIGNATURE: ~ -'--~ ~I'L: ~- / OG+ 1 /Z r i • - v+iLsrartsinDepertrner-totCominerrra - SOIL EVALUATION REPORT Page ~ d~ Dfvisionoisatirtysnd8uld'nga . a7 ~f.LVRJffilW M/Y7 µw/w11 VJ, •1r7i. JNall. VW8 Courrty Attach cornptete stee plan on paper not less than 8 U2 x 11 inches in size. Plan must include, but not BrrrlOsd bo: vertical and horizontal re(eretir?e pofctt (BM), dtrectlon and Paroe! ID. percent sbpe, scale or dimensbns, north arrow, and bcatlon and distance to nearest road. Please print all /ntonnatlon. Reviewed by Data Peraonai tnrormadon yw provide may ~ usrrd for rreeardary pwpows (Privacy Lsw, s. 15.01 (1) (m)). Propert y Owner Property Locagon ,, //~~ 1> r t G r` ~,./ {E (~ ~ Govt. Lot .~ 1!4 !4 S Z 3 T ~ N R E (or) Property D ~ is Ma~ A dress Lot # Bbdc # Subd. Name or CSM# ~ City State Zlp Code ne Number ~ Clty ^ YI e tag ®Tawn Nearest Road l~~ r ( ~ ~J ~D .So New Construction Usa: ^ Residential !Number of bedrooms Cade derived design flow rate ~ ~~ _ $ ~ GPD ^ Replacement (~ Public or r~mmercial -Describe: ~ a! Parent material _~ Fbod PNain elevatlon if applicabl ~ ~/ / A-- R. General cammerrts and recommendations: s ys{'~'~` c ~`V• ~~• Zt~ rn _ . n ~a q3• ~ o~rn~y ff © Ground surface elev ft D lh to I! itin fact ~ ~v Pit ep m g or_ ,. SoA lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP OlfF Gt. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 •Eff#2 -. U ~ ~ >~ ~ - r ~ I Boring # U Boring /i J7r T(~ ® Pit Graund surface elev. ___ ft. Depth b limiting factor ~z in. Soo A lion Rate Horizon Depth Oominant Cobr Redox Description Texture Structure Consstence Boundary Roots GPD/f1= in. Munsell Du. Sz. ConL Cobr Gr. Sz. Sh. •Eff#1 •Eff#2 ~ Z -i2 io -- 5 o s ~-, m ! -- - ~ ~~ Z - trrirrent r!1 = epD > 30 < ZZQ mg/L and TS5 >30 < 150 mg/L ' ERhrent #Z = BOD < 30 mglL and TSS < 30 mg/L CST N (Plea.ve P ' Si re t„ST Number c~ryr ~~~2~~'~-~~-- -y S 33a ress Date Evaluation Conducted Telephone Number af,. Property Owner - W ~'~~ Pamel iD # Page Z' of ~_ 3 Baring # ^ Boring - ©Pft Graurta surface elev. ~i ~ R. Depth to 6neita-g fardnr ~_ in. Soi nation Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP DIfF tn. Munsed Qu. 5z Cont Cobr Gr. Sz Sh. 'Etf#1 •Eff#2 -y~ r/y -- ~ c~ i~r - l,v ~(o-~ !~ 05 vY1 1 ^ Boring # ^ Boring ^ Pit Grvtmd surface elev. R Depth to i'nniting [actor _ _ in. SoG A Ifcation Rate Horzon Depth Dominant Color Redox Descaiptbn Texture Sirudure Consistence Boundary Roots GPD/fF in. Mansell Du. Sz Cont Cobr Gr. Sz Sh. •Eff#1 'Eff#2 ^ Boring # ^ Boring - ^ Pit Ground surface elev. ft. Depth to limiting factor __ in. Sod A lication Rate Horizon Depth Dominant Color Redox Desuiption Texture Structure Consistence Boundary Roots GP DIfFF in. Mansell Qu. Sz Copt Color Gr. Sz Sh. •Eff#1 'EtT#2 ' ElSuent #1 = BOD, > 30 < 220 mglL and 7SS >30 < 150 mg1L • Etiluent #2 =BODY < 30 mg/L and TSS < 30 mgll. The Department of Commerce is an equal opportunity sctvicc 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. seo-esw tx.m~ool `fir .. C° rACE ? or•~ NAlv1E:~ ~ LO'I'1! LCGAL UL•SCRII'"I'ION:f[(.,ll/4~1/~t,S~~1~.N,R,~E(vr)~ SCALE: 1'L ya ~ ~~,,,~ ELEVATION: lDD '~ ''rt k ,. ohi 1 DGSCruP"riorJ:o~ ~o~~ w ~ ~ P° ~ ~' Bh12 ELEVATION: C( ~r ~P6 Bh12 DCSCRII''C1ON: {op o~+ -~-t~~n2 ~~, SYSTL'•ML•LL•Vn'I'!t)N:_~~/Z~ _____. SYS'1'Ghi "1'Y('f:: ~rl ~ rl'~/~ ~ .__ ~~ - ~fi ~ ~.L~ POWTS OWNER'S MANUAL & MANACatmtly I r~HIV Page ~ of FILE INFORMATION Owner ~ ~~ Permh ~k s ~s--3 L/lo' DESIQN PARAMETERS Number of Bedrooms O NA Number of Public Facility Units 3 ' ~ ^ NA Estimated flow (average) al/da Design flow (peak), (Estimated x 1.5) Jr' al/da Soil Application Rate ~ al/da /ft~ Standard Influent/Effluent Quality Monthly average• Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L O NA Fecal Coliform (geometric mean) 5104 cfu/100m1 Maximum Effluent Particle Size in dia. ^ NA Otfier. ^ NA •Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity at ^ NA Septic Tank Manufacturer O NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ~j ^ NA Pump Tank Capacity `"' al O NA Pump Tank Manufacturer ^ NA Pump Manufacturer - ^ NA Pump Model ~ ~_ ^ NA Pretreatment Unit ~7 NA O Sand/Gravel Filter ^ Peat Rlter ^ Mechanical Aeration O Wetland ^ Disinfection ^ Other: Dispersal Cell(s) O NA In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade O Mound ^ Drip-Line ^ Other: Other: O NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tanklsl At least once every: ^ monthlsl (Maximum 3 years) .6P ear(s) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y9) of tank volume ^ NA Inspect dispersal cell(s) At least once eve ry~ ^ month(s) (Maximum 3 ears) ~ year(s) y ^ NA Clean effluent fitter At least once every: ^ month(s) year(s) ^ NA Inspect pump, pump controls & alarm At least once every: O month(s) ^ yearls) ^ NA Rush laterals and pressure test At least once every: ' ^ month(s) ^ year(s) ^ NA Other: At least once every: ^ month(s) ^ year(s) ^ NA Other. ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third lY,l or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent fitters, mechanical or pressurized components, pretreatment unhs, and any servicing at intervals of 512 months, shalt be pertormed by a certified POWTS Maintainer. A service report shall be provided to tho local regulatory authority within 10 days of completion of any service event. P89e ~ of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tank(s) removed by a Septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 1 5 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or~their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN ' If tfie PO S fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacem t system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. p-~ T //'~i aluat' a o ing jank b ~ e ai a .'3404-~181Ti~ ~/Z- /~/~'/ ~NS7XCI~ DN ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDlOR INSUFFICIENT OXYGEN. 00 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDfTIONAL COMMENTS POWTS INSTALLER Name Phone - _ ~ r SEPTAGE SERVICING OPERATOR (PUMPER) Name Phone POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Name S C ( 20rJl~(.l Phone "'7(S- 34 C0- (O (~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~S ~' ~ L Z..C'. Mailing Address ~} Z 3 ~° t_o~'a2l.4A~ C i~ ~ f /vas o.~ , ~ S'~a~ b Property Address '7~ (o ~ ~~ bN~'~ ) Z ,~s,_ (Verification required from Planning Department for new construction.) City/State, (-}uoS~N t ~ Parcel Identification Number duo.- j06.~- on- ooc~ LEGAL DESCRIPTION .23~(l3 Property Location n!W '/4 , _~~ %4 ,Sec. ~_, T ~N R~_W, Town of l~u.aro-~ Subdivision ,Lot # /' Certified Survey Map # ~ / /~ ~ .3 3 ,Volume 3 ,Page # ~02~ Warranty Deed # ~ 7 7 7 7 ~ , Volume ~U ~ ~ Page # d~ Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Department within 30 d/a~ys~ of the three year expiration date. ~L,l/K.tr~ ~'l Z l~ SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the p~~pe~ty described ab e, by virtue of a warranty deed recorded in Register of Deeds Office ~~ ,-,-- ~ Ffl Zl o tt SIGNATURE OF APPLICANT DATE ****** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. Document Number U 1882P 005 WARRANTY DEED This Deed, made between M. LYNN BERG AND BBSJ, LLC Grantor, 67~-77'9 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO., NI RECEIVED FOR RECORD 05-02-2002 8:00 A!f WARRANTY DEED EXEMPT t1 a Wisconsin Limited Liability Company Grantee, Witnesseth, That the said Grantor, for a valuable consideration of one dollar and other valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of all encumbrances except easements, covenants, and restrictions of record, and will warrant and defend the same. PART OF THEN 1/2 OF NW 1/4 OF SECTION 23-29-19 DESCRIBED AS FOLLOWS: LOT I OF CERTIFIED SURVEY MAP FILED JiJNE 22, 1978 IN VOLUME " 3", PAGE 622. Dated thisk~ay of ' ~ 20~Z . ---~ i ` M. L ERG REC FEE: 11.00 TRANS FEE: 247.50 COPY FEE: CERT COPY FEE: PAGES: 1 Hugh H. Gwin 430 Second Street Hudson W I 54016 (Parcel Identification Number) 20-1062-00-000 AUTHENTICATION Signatures authe ~ ~ ay of ~Z signature ~ 1 J ) , type or print name TITLE: MEMBER STATE 8AR OF WISCONSIN (lf not, authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Robert F. Wall ACKNOWLEDGMENT STATE OF WISCONSIN COUNTY OF ST. CROIX Personally came before me this day of the above named M. LYNN BERG 20_ to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. type or print name Notary Public ST. CROIX County,_ My commission is permanent. (If not, state expiration date: •) \~ `Names of persons signing in any capacity should be typed or printed below their signatures. p 34963 4 CERTIFIED SURVEY MAP N ~Nw coR. 3 ,~ 3 W ! /4 - SEC. 23 ~ T- 29- N ~ R-19-W CO. MON SEC. 23 W Z_ J ~-- 3 ~ z W 3 .~i i FILED ,,,~ X1978 ~-~ "~ BEARINGS ASSUMED S00°-34~-50~~E ALON WEST LINE-NW I/4, SEC. 23 N 89°-27~- 44~~ E 660.0 0~ W O, ~ ~ M M ~NQS. 8 N 89°- 27~- 44~~ E ~-~//!0 &°2/-40„ 0 0 M M 0~ 3 ~o 0 pNQ~p~'C ~PNpS . HOUSE LOT I 5.0 ACRES ~N 0 ?~= P~. V PN~S ..y.. 9~0 38 ~ o 0 0 ~ M 0~ co 0- - N ~0 Z gP 3g.2a e8~2/,40~~ 3~ Y S 89°-27~- 44~~ W _. - . _'3~ r 660.00 LEGEND W I/4 0 = I~~ X 24~~ IRON PIPE WEIGHING CO. MON. 1.68 LBS./ LIN. FT. SEC. 23 -/~~~ =LINE NOT TO SCALE 1;-~ = 90° R/W WIDTH SURVEYORS CERTIFICATE: R/W CENTERLI N E U.S--- H-n 2 R/W..... . THIS INSTRUMENT WAS DRAFTED BY_G•C.S. JOB N0. 78 - 24 t5~ 100 50~ 0 t00~ SCALE I N FEET •l~~yGONSti ~ QENE C. SHAFFER rr S-1325 1 HUDSONCj I, Gene C. Shaffer, Registered Land Surveyor, hereby certify that ~ ~' in full compliance with the provisions of Chapter 236.34• of the ~qHD R~ Wisconsin Statutes a.rid Section. 5.4.2 of the St. Croix County Zoning ~a~ Ordinance and under the direction of John Currell, c~o Charles Kelly, owner of said land, I have surveyed, divided, and mapped said parcel of land, that such survey correctly represents all exterior boundaries a.nd the subdivision of the land surveyed and that this land is located in the NW 1~4 of Section 23, T-29-N, R-19-W, Town of Hudson, St. Croix County, Wisconsin, further described as follows: Commencing at the NW corner of said Sec. 23; thence S 00-34-50 E along the West line of the NW 1~4 oi' said Sec. 23, 1354.51 feet to the centerline of U.S.H. "12"; thence N 89-2'j-44 E along the centerline of U.S.H. "12", 1053.04 feet to the point of beginning of this description; thence N 02-10-36 W, 330.00 feet; thence N 89-27-44 E, 660.00 feet,; thence S 02-10-36 E, 330.00 feet to the centerline of U.S.H. "12"; thence S 89-27-4.4 W along the centerline of U.S.H. "12", 660.00 feet to the point of beginning. Above described parcel contains 5.0 acres and subject to easements of record. CERTIFICATE OF TOWN OF HUDSON: Parcel #: 020-1460-00-103 o2/z5/2oo9 03:40 PM PAGE 7 OF 1 Alt. Parcel #: 23.29.19.2944 020 -TOWN OF HUDSON Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 04/18/2005 00 0 Tax Address: Owner(s)' O =Current Owner, C =Current CaOwner O -BBSJ LLC BBSJ LLC 739 REGAL RIDGE CIR HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description * 726 HWY 12 #103 SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 01/100-HIGHWAY 12 BUSINESS CONDO UNITS 101 SEC 23 T29N R19W PT NW 1/4 HWY 12 Block/Condo Bldg: LOT 103 BUSINESS CONDO UNIT 103 & COMMON ELEMENTS Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-29N-19W NW Notes: Parcel History: Date Doc # Vol/Page Type 04/18/2005 792540 01/100 CONDO manna ci i~uaeeQV Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class COMMERCIAL G2 Totats for 2009: General Property Woodland Totals for 2008: General Property Woodland Acres 0.000 Last Changed: 05/30/2006 Land Improve Total State Reason 46,600 54,800 101,400 NO 0.000 46,600 54,800 101,400 0.000 0 0 0.000 46,600 54,800 101,400 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 o n~i vv'i o m' `~ m m ~ 7 N x (=q ~ O to 2 D ~p O H O ~ d ... Z 0 O ~ o m O s m fD C m m 7 N w ~ 3 a ~' y N a NN~ o n N ~ d am Z y O O1 ~ N > j N ° a ~ n 'O d ~ C N _. o O O ~ y. a~ o m ~ ~. N =. O ~p y (D a ~ 0 m o °o a L ~ F ~ ~ ~ ~-o~ v m m ~ 3 o m p ~ o ~ o~i 7 N 7 CI N ~ 'i ~ a m, a c N ~ ~ ; O N tD N rn = C ; a N ~ ~ ~ ~ Q Q 0 " SS CS SS N y N ~vv,o~ N -` 16 = ~m ~ ~ ~ I ~ .. 7 M Z ~ Z D m ~ y N ~ "O N~ co a m _. ~ I C n I 1 ~ m a~ c 3 v ~ w m ~ I C a I I m vyi O O ~ ~ a a 9W1 N O ~ N IN C~ 0 N y O ~ C6 N v m O m N C m m 7 N W o m, n ~ D of ~' ~~°= a ~ ~' ~' m ~~ yQ.^W~ ~ 7 tOD ~ N d N ~ d 7 7C N ,,,. Z N y O^^? O p ~ ~ N`~ y. N ~~ Q V! N ~ N ~n~DOxm~ ~ n m -;~ 2~ d ~ ~~ ,~ .~ v ~p N ~ N ~j N ~ ~ N c:~cN~~ -' ~ a m ~ c° o.a a a,tn ~o N ~ 7' ~ N C7~ ~ ~ N f0 ._. w o -~ 3 0 m 0 o° a o ~ ~ ~ ~ ~'a-! '.: o ~ v N O 7 J 7 N NN ? N G N ~ ~ m a c N ~ ~ A J J f0 f0 N °~ rn c d y ~ 'O ~ j Q SS SS SS y y y ~ ~ ~ O J ~' 7 M z. ~ ' ~ i D m ~ ~ ~ m N C fC d ~ ~ co O c n '. a °o ~* 3 fD a ~ ~ 3 fD ~ '^ a 3 m o ~ ~ 3 ci ~? v C W N y IV Q O ~ ~ ~ N "'I N o O 7 W O Ow O 3 ° g .. ~ d M ~ ~ 0 ~/.~ N N ~ ~ y A?n~ A Z O 2 ~ " A 17 ~ ~ A d I~ :: a C O 0 d a h a I ~ I O b c., I~ i ~o ~ w n v ~ m N O ~ d ~ N vOi O O~ N ~ O y O O w 3 ~ O N ~_ c co ~ p ~ ~ a ~ ~ ~ m~ w c. o ~~ m ~. o N O- 7 ~• 7 ~N a 7 ~ O ' p ~ ~ f0 O ~ ~ O ~ j 3 7 ~ (n Z~ Z D ~ cn Z cn Z D m co D cn D ~' m c= D c3' D W 3 a a 1W ~ n a ~ O O ` O O N f~D N N (/1 f~ N (A K ~ z z ° c c ~ ° c c ~ ~ ~ ~ = ~ ~ o. a a ~ o. a o. ~ ~ 07 ~ ~ W ~W ~ ~ ~ ~ a a z z 0 0 v O o~i O s r' ~, o' ~ ~ ~ ~ ~ C C W CD W (D n 3 0. ~ Z ~ Z ~ O N O N d v 7 m v~ cog D m v_v o g a Q33 v3 0- Q33 ~°~ a Ui N N `< fQ O N N f~D '~ O O S ~ ~ v ? ~ C), 4~ L y y !/i N Z ~ y N y N Z ~ ac ~v o ~ ac ~v o m d o m m m d o w m ~,~a ~ o v, ~~a ~O ~ ~ 3 ~ c ~ ~ ~ m c ~ ~'~ acn sp acn ~_' ~~ ~'~ cow N.~ ~ N.~ O ~' ~' m coo y m 7 O U7 7 fD N t~/l 7 ~ f3/1 7 -O+ ~ - ~ ~ ~ O ~ O (p W F fD W x ~ O~ O^^ O~ O N O N OW O O (D tD O O ~ O O ~ o °o o- °o °o o- e° ~ f ~ ~ ~ ~ ~ ~ ~ O N ~ ? L r n V ~ ~ m, ~ ~ N a a 0 oQ~o '' N ~ _ N N d O O O ? A 7 ~_ O gOg O ~ N ~oov, .. ocD+ ~ 3 m ~ _ .. ~ ~, o x ~ ~ o d ~ O y p N C C n N. ~ a S 7 3 `~ C y d W W Q A A N 3 m T C a 3 d o m_ ~ o C W N y IV O O O N -I IV O 7 ~ O -Oi. O y O C 3 ~ ~ .. M o ~ D 0 w A Z f~'1 s 'A rr A ~ ~ tNp W ~ Z A Z7 ~_ A e Parcel #: 020-1062-00-000 01/20/2005 10:26 AM PAGE 1 OF 7 Alt. Parcel #: 23.29.19.2348 020 -TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ` =Current Owner *BBSJ LLC BBSJ LLC 923 CLOVERLEAF CIR HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): " =Primary Type Dist # Description * 726 HWY 12 SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.000 Plat: NIA-NOT AVAILABL E SEC 23 T29N R19W 5 AC IN CENTER OF NW Block/Condo Bldg: 1/4 LOT 1 OF CERT SURVEY MAP IN VOL 111 PAGE 622 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 23-29N-19W Notes: Parcel History: l b~ ~ Date Doc # VollPage ~ ~ ' Type ~ I 09/23/2002 691364 1986/88 EZ 05/02/2002 677779 1882/005 WD 05/02/2002 677778 1882/004 GD 09/15/1998 587052 1357/092 WD more... 9AAd CI IMMeRV Bill #: Fair Market Value: Assessed with: -- - - - - ------- -- - - 48114 197,500 Valuations: Last Changed: 10/29/2001 Description Ctass Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 58,000 94,800 152,800 NO Totals for 2004: Gen eral Property 5.000 58,000 94,800 152,800 Woodland 0.000 0 0 Totals for 2003: General Property 5.000 58,000 94,800 152,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 130 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSM ENT 0.00 001-WATER SPECIAL ASSESSM ENT 0.00 Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 O N fyli O N '~ fcD ~ L ` N fD ~ 7 N ~' y n O ~p O N ~ W a O r. Z 0 m ~ c m ~ Im d c~D 0 C m m 7 l%1 d D d vro a ~ O. n N ~ iU am Z O 7 n• N O D. c~ n ~ a m c ~• o O O N N a~ o ~O _. y ~ O, ~p y N a ~ m o ~ o ~ °c ~ e ~ ~ A ~ ~ ~~ ~~ I O W O O ~ N ~ y ? d ~ m .°.~ m I a fO = I = I al 'o v ~ ~ O O O ~I ro ~ q o ~-'' ~ °' I d 3 °-' ~ W .. I A~ i I ~ I ~ y ,a N. I a I ~ I o I c a I I W ~ a 3 o° ,.-' ~ N ~ I v I ~ w ~ I ~ I m .r T C a I I I I I I I I I I I I 3 N Yii O O ~ A ~ a H N N N 7 ~ O N ~ ~ I~ a W O m N m ~ m v N 0 N C m m N ~~~ ~~~ a N n n y <N <p "~~ 7 ~ d 7 77C ^^N n' Z Np N O,Cly O ON a~NVi t~/1 ~~oxm~ 7, n ~ V 2 N v = ~ fO-,~ _v ~ ~ ~' ~ ~' f~D ~ 7 A N (~D ~ y ~ . _ w ~. ~ (gyp y ~ N C 01 ~ ~~~aa ao y ~a ~ ~ ~m m c~no ~ N ~ ~ . O, 0 m o ~ °o ~- ~ N o ; ~ ~ ~ ~ ~ ~ ~ ~ ;~. ~ o ~ ~~ ~ ~ ~ ~ ~ ~I K O ~ fV0 ~ ' O = W N c ~ ~ • 7 ~! 0- IV Q I~1 ,~ N fD ~ ,o ~ ~ ~ ~ N K n O W O ~ ~ O ~ W b A~ _ 7 U! ~ ~~''~ -Ow O ~ !~ a m •°•' ~ j ozi N N .~ (~ t0 A 'i f J i rn rn = ! c'~rt~ ° c C a ~ ~ 0 00~ '~ ~ I ~ g g N~~S`- j oD /y ~ `~~1 ~ ~ O1 °w ~ ~ ~ ~ ~ ~ fG N K ~ ~ ~ N •• ! N o ~ O A~ ~~ ~• .a N 07 fD ~ a N O ! 'p Z CO C a ' ~+ .~ ^~ ? Z O I : ~? .'. W ~ ~~~' a ~ Z ~ 'o ~ ~ 3 ;: Z ~ ~ v .P ~ _ d ~' 3 m _~ T !. C a i y A ~,C fi m a N I ~ a A h p ° nQ ~ o , A 0 ~ ~ w ~ C(?~IIMERCIAL TESTING LABORATORY, INC. 514"Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 a' ST. CROIX ZONING 'f~' ST. CROIX COUNTY C04JRTHOUSE HUDSON, WI X4016 i ATTN: TNOhiAS C. NELSON ~.. ,..1 ., ~, _ 1J411~ ~ I LOCATION: COi.LECTOR: DATE COLLE REPORT NQ.: 3pS74/Ot RFPORT DATE: 10!12/92 DATE RECEIVED: id/OS/92 PAG£ ~. Terry ~ Gina Nash 726 E. Ht+Y 12, Hudson `~~ G ~ -~'~ Tf. TED: 10-06-92 ~~~ TIt~ COLLECTED: 10:30am SOURCE OF SAhff'LE: Spigot in Pump house BATE ANALYZED:id-08--92 TIME ANALYZED:2:OOpm CtX..IFQRiri: 0 /140 m l INTERP'RETATTON: Bacteriologically SAFE NITRATE-N: 18 PPm Above 10 ppm exceeds the recommended Public Drinking Water Standard, ,~ Goi.iform Bacteria/100 ml Nitrate-Nitrogen, mg/t. 9 ~"` .~ ~~ LAB TECWNICIAN: Pam Dane WI Approved Lab No. 19 (~~Seans "LESS THAN" Detectable Level 2~ G29G .-;- ~ ~~ -°~'Z,~ ~ E Approved by: _~ ~~ ~ ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse ~p ~ 911 4th Street Hudson, WI 54016 ,~ nu-9d Telephone - (715)386-4680 ~~ The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of t 's or is essential sQ that t~ property can }fie located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along .with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 35.00 ~k (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00. (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00_ (Determines if system is properly functioning at time of inspection ) ~y~ ~~~ ~/~~ ~~~ PROPERTY OWNER' S NAME : , ~ //G~ , ` /~ PROP. ADDRESS: ~..~1 ,~ ~/~~G~i~~ ~~ CITY /7~G/J`~~ Legal Descri~t~' on f1~~1/4 of the _ 1/4 of Section ~_, T ~9 N-R /y Town of ./.f/~%/:~D~ Lot Number Subdivision: _ ~U~ FIRE Loc Box NUMBER/fG~ ~~L~~~yG-~+~- - C~~/"~ l-~'~l-~'~ /D~ Color of house ~ ,Realty sign by house?~If so, list firm: PLEASE INCLUDB, IF AT ALL POSSIBLB, A KAP,i.e,COPY OF PLi~aT HOOK, WITH LOCATION SHOWN, AND A COPY OF THB LISTING SHEBT. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual re uestin ervices:b- `/~~~ ~~~~~~ /'~~'~u Telephone Number ~ ~ -~ ~~ REPORT TO BE SENT TO: P- ~i~iv~ CLOSING DATE: Signature ~AST,~.,~~DSON PART T.29N-R.19W. _ SEE PAGE 4/ _ W/LLOW N~~ rc~' C/~/eePh,, C am<u~~< PPin rent n Gub, Inc. F r r r^ ~ ' ~~ `''Y ~ y~~` Pah/e s'2/ cha d 40 - s ~ 9 R I VER '~ ~ ~ 9~ 4„~ j t .r ezr~.s sv Pacfricie o.'.9. /A3 ~V I Ohen 2/4 /b~ /yna/] O.Y ,~ d. rls hf ~ S TA TE PARK ;~~' 7 ca'w~~ z z ~;`~,- s ;fin "`<^ks /aloe as ~aG ~ t5/Ole of'WisCCrLyin ~~~ . R~pnC 5k'v}h y~i~L~r~.n~~ 4o a.~° ~ ~~ D7n>R of Natural ° 58.z7 '34.e4' ,N~~i i/~ le9el'n 9o us re~Sabr~~. b ~ ~ ~ • Hr bb G1B6 - w.. • 8 ~ AVE.O Cq~.. y w 7'L~°z 4EJearrore 9 y R 4 ~ ~ ~ ~ F.: i§ .,: La. ~ Ruth w sirs '~ n `^~ Corert ~ a. ~ uo ao° Kat s~ o r brown _ '~Yi St Cr Va//ey l oq ~.~: 3 w,,Pd: • BO a ~/ •e 1 v • Gir/ a ~~ f^ m a s ~ ^ • ~. sr~i ~. ~ o o ~'• SCOUi Co/rr0.f J¢~ \0~ ~ SPURL/N tom-/' ryrys5ml ~ TRS : ~ Inc. ~`x~R "f° sr w, - a ~ '8aE'oz ~ F Y /73.2/ :: .a3~ O y ,.~ (B/J V ~ aca6.11 .:~~obe C\ \ l r/nur~ 2vep5 N c..c f Ke~fR a 2Bo b u o cob B4Be ~ afr2 ~kken o P tl 0 '~ ° ~ C x n v~ akken Doria/aa ~ Iv A ,•~ ro4 ~m C h ~ 3 0 ° ~ ~o ao °° ,S~ers o. rein . cneri ~ '~ l ~ ~ ~ /244 9B9 G f rh S/M. ~ ° a ~ .BQrbara ~ /47 /7 cerooyyy ewes 8i har/es ./ ~ ~ ~J~ FraneCS fDor¢Mae r n .y ,QiC ar¢g0r7 R• . Tm.3 /SB9 ~ R' °, /foray, ernes • / .iv A ,SYCroi - ork ~ Dci ile I i ht~ eo/ `py1'. to 8i!+?Re:. `e1~r'enGf tares • U zx. ~, g N• ouwdro{f ~i~c nos a s a n SS 39 ~. Py ~ > $ KI ~ a~ N He/'n7 P5 ?~ • ,k/ y:, Cj6/e D ' S - GE. ~ ~ 'y V W ~ Lumber Co- ~ nsz3 •N{Isabe// ~ 8~~etal V + 7707 'i .'•' 594/ ^ ° Cua//ry sr ¢ N- ~P/ U. F/t Balluln ! 2. ~~C 'OCE ~~~ (/.?.4L J J W z a°-. y~ ~ °~ :~ ~ Irene Y l:.rdd 4 iu. v zo a3 ss ~ q Genar r ~ '^ K y ~ ~< ~ o '^ er+o n°n 74 •Kennethf " r'een .I~ w- ~ .o oq. -37 d/ ~o J n.. ~ C/J 2i L> Co.6 <nb, 43f FBI H Sr". ~yl hP'~srA S FOh/~L E) N ~ Z y. o° ~ .. 5'aLL_Y D1a :: ~• ~. ~ `~ ~~ i5r nop L g ti ~d?1 C, ~~ i ~ ~ IK ~ .: ~ ri m ~ ~ _, /.3B 7 3,' Q.GY '~ ~. v Y ~ ~ersF T ACr6 ~ I•~ vn T45 6`< UU ~aerr nK ssi• vVe/s Hr vmn /lcrr fw Po/en s c,tyro, ~ 's eia/ f3er.Itrrd f r~ n 2 ap • Mar ~ K,nne ,Bernard /GO ' ~ m N m5l~d `9 ~ K hney ~ ' ~ ~ NG c Carp Land 2vc.37 b S Q 2 ~ `/ A R - /~ Corp / ~~ • 14 C C: w ... E Par" r'osimm /73 ,Berm r~ S°GOb-I uS Fis 4 o tl ~ c`a a .-/ A» F ti 1`/`e 3 awn 44 K nnry tcnr Q 'E ~ Lt(i/d1~ LENERTL R • T J N¢$Crl/ef fn-dS ~Bro In fsnf T~ A NG C. Carp. • J` \ J ausen 9 r,e,ioow a "i 243 /z.39s sAKa ,7 a 94Da... ~ , 35 /j ° o ~~n.~ cs r G/rnn s uyce//a .30 y ~ ~ ~v (/ ar/, ~l7 :~. s.,~.~qc • !'lrcL. an ,s f~a./e Wi%/arf 17anie/ ~ c ,,, ai . etn/ •DL v j avers f33~lB arbe A o/»J,' efa/ R Bauer 35.EE s • 73s C/aPP •rrG ~ .7r-t4l.L ~ e~ • /5) yvj '1Nti ~'~ 2 ~i$ ~~ /fO.SS 4 Ch. TRAC ~ •~5L N /~O/JCrf f • k Cflet a0 M Ep~.*Ur. s .l+ Sy/vesfc-r- ~i¢rbG ~^9a°a!' ~ U ~ q~ i, Q. w I .B¢,Eer RObCr¢ 1 ` q G Z o Christine 5 i v u 23227 2825 , u C ~ Waron J5 rr n " > ' ~a~ o ~ °,~ L w,rriir/r+ N~.~. 'f/a/mes ~ ~r. _ p ~Z `} ~`K sfC orx er.,~>/.Wi~.sre 01991 Roc ordr/aPP~ /s, r,a SEE PAGE 75 ___ M^ 500 600 700 27 I PREPARE FOR THE RIVER VALLEY ABSTRACT ~ ~ Fl!'fl1RE & TITLE, INC. 220 LOCUST STREET 1N ~ HUDSON, WISCONSIN 54016 I ~ '~ PI-TONE: (715) 386-7772 ~-==~ ROGER D. BEVERS ABSTRACTS • TITLE INSURANCE • CLOSINGS W 41 8 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 October 6, 1992 Lucy Gearhart Century 21 Premier Group 706 - 19th St. S Hudson, WI 54016 Dear Ms. Gearhart: An inspection of the septic system on the property of Terry & Gina Mash located at 726 E. Hwy. 12, Hudson, WI was conducted on Oct. 6, 1992. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. S' ncerely, ~~~1'"'"'~ c ~ e Mary J. Jenkins .Assistant Zoning Administrator cj r ~ .r AS BUILT SANITARY SYSTEM REPORT Form - S T C - 104 OWNER 6~Gy TOWNSHIP ~f~L,S~fn~t. SEC. .~3 T ~_N-R /rJ W ADDRESS ~~ / 2 ST. CROIX COUNTY, WISCONSIN ®~ ~a ~ ~. ~w~ ~ Z SUBDIVISION r-~ LOT --- LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILI~R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 9ra~H~ ®aM .~ ~ ~~ ~r A P no 300' -- a ~ ~ ~ ? S° ~ so ,~,~~/ !tea/C';re~~-- ~( ~i~uC'G~ ~iN fy !/~ ~ 2 i s S9 ~ ~M zr -=9 ~s # / s Yi __ __ _ _-- ~ / ~3~ ~ 2 ~ So - ~~_ ~s~ S'c a ~c I " . ~/O ~ mod' ~+~ INDICATE NORTH ARROW d~ ~ ~•-~, S . ,r.. ,- ,pia ~ma.o ~ -~ .s-r oK~~ BENCHMARK: Describe the vertical reference point used ~,J~~ ;,, ~„~,,,dd,,, .~is•~ ;,, ^v~ Elevation of vertical reference point: lmp.o ' Proposedd slope at si e• ~ ?o ~„ Ni. PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Pump Size Number of feet from nearest property line; Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: r/ (~C•d{) ~7 Width: ,S'' Length: Number of Lines: 2 Area Built: /100 pc It S f Fill depth to top of pipe: 3 ' / hn~~s ars 8S'! ? Number of feet from nearest property line: Front, O Side, O Rear,Ol~t. y~, Number of feet from well: ~~~, 0 Number of feet from building: > ~~ ~ (Include distances on plot plan). f~f~v~lr ~~ 9S'98 ~i~ ~~ fS.Yi ~ i y6'.o2 .~ i. fy. Qy SEEPAGE PIT Size: Liquid depth: Area Built: ~~o of 4Y. aY ,~ z y3, yY Number of pits: Diameter: Pump/Siphon Manufacturer: Bottom of seepage pit elevation: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Number of feet from well: Number of feet from building: Number of .feat from nearest Front, O Side, O Rear, OFt. road: Alarm Manufacturer: DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING; LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS Dlvlslon P.O. BOX 7969 BUREAU OF PLUMBING :AADISON, WI 53707 C~CONVENTIONAL ^ALTERNATIVE State Planl.O.Number. (If assigned) •~ ^ Holding Tank ^ In-Ground Pressure ^ Mound ~ ~ Q ~ /. NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSP CTION DATE: Ken Dolney 1476 Midway Pkwy. , St. Paul., MN 55108 ~~~,~,~~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: NE NW, Section 23, T29N-R19W, Town of Hudson Name of Plumber: MP/MPRSW No.. Cou nly. Sanitary Permit Number: Dave Fogerty 3289 St. Croix 79221 SEPTIC TANK/HOLDING TANK: -3: yS iT REF. PT. ELE V.. MANUFACTURE ~. LIQUID C.4~ACITV. 1 TANK INLET ELE V. TANK OUTLET ELE V.. WARNING LA PROV DED BEL LOCKING COVER PR V ' ~ ~ /~•~C•' ~ ^ S D~ ~ : YES ^NO O IDED ~-y ^YES L,esINO BEDDING: VENT DIA.: VENT MATI HIGH W ATER NUM BE OF ROAD: PROPERTY WELL: BU ILDING: VENT TO FRESH ^YES NO ALARM ^ FEET FROM ~ ~ LINE. ~ f I AIR INLET: -~ YES O NEAREST ~ DOSING CHAMBER: MANUFACTURER BEDDING'. LIQUID CAPACITY PUMP MODEL PUMP; SIPHON MA NUE nC7lIHEH WARNING LABEL LOCKING COV ER PROVIDED: PROVIDED: ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CY CLE: PUMP AND CONTROLS OPERATIONA L NUMBER OF PH OPEHTV WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) ^YES ^NO NEAREST-~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing _ E N(,n, IIIAME TEE; MATEHInL AND MARKING or excavation. (lf soil can be rolled int o a wire construction shall cease until FORCE I the soil is dry enough to continue.) , MAIN rnnlvcnlrfnnlel cvcrGnn• BED/TRENCH WIDTH LENGTH NO OF rHEN~s UISTR PIPE SPACING COVER MnrEHIAL: PIT INSIDE UTA =PITS LIQUID DEPTH DIMENSIONS ~ ~ / riRAVFL DEVT11 FILL DEPTH UIS7 H. PIPE UISTR PIPE DISTR PI MATE AL NO _1H NUMBER DF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES ~~ / ~ ABOVE COVER ~ f El EV INLE I ELEV. ENU PIP 5 FEET FROM LINE ~ I O~~ 1 VO.1 qIR INLET: (O ,~ S. Q 2 7 ~ NEAREST -- ~~U"7 MOUND SYSTEM: o Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAMOFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ^YES ^NO SOIL COVER TEXTURE PFHMANf Ni MAHKF HS OHSEE{NATION WELLS ^YES ^NO ^YES ^NO DEPTH OVER TRENCH BED DEPTH OVFH TRENCH HEU Uf PTH OF TOPSOIL BUDDED JEE UEU MULCHED CENTER EDGES ^YES. ^NO ^YES ^NO ^YES ^NO PRESSURIZED DISTRIBUTION SYSTEM: WIOTH LENGTH O LATE HAL SPACING GRAVEL DEPTH HE Ld)W PIPE FILL DEPTH ABOVE COVER BED/TRENCH CHES TREN DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO UISTR UISTR. PIPE UISTNIHUTION PIPE MATERIAL & MARKING ELEV.. ELEV. DIA. ELEV. PIPES DIA.'. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CUHHECiI V COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ^YES ^NO ^YES ^NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: ~~ NUMBER OF PROPERTY FEET FROM LINE: ~ WELL: BUILDING: ^YES ^NO ^YES ^NO ( NEAREST--- Sketch System on Reverse Side. DILHR SBD6710IR.01/82) sANITARY PERMIT APPLICATION °OU" ~ DILHR Code Adm 05 Wis fn accord with ILHR 83 . . . , ~9°°.~.,.,,.~..a. YPERMIT# STATESANITAR nn o~ -Attach compete plans (to the county copy only) for the system, on paper not less than sTaT PLAN I.D. NUMBER 8'h x 11 inches in size. • -See reverse side for instructions for completing this application. PETITION ^ I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. NO FOR VARIANCE ^ YES PROPERTY OW ER PROPERTY LOCATION '/4 '/a, S 3 T N, R/ E (or~ PROPERTY OWNER'S M LING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME G ~...~ CITY, STATE ZIP COD PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK l0~ VILLAGE : Z ~ II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family ,S'" OR ^ Public (Specify): ON: (Check only one in #1. Check # 2, 3 or 4, if applicable) 111. PURPOSE OF APPLICA TI ~ y 1. a. ^ New b. L.~J Replacement c. ^ Replacement of d. ^ Reconnection of e. ^ Repair of an System System Septic Tank Only an Existing System Existing System 2. []~A Sanitary Permit was previously issued. Permit # ~ 3 PS'd Date Issued ~ „ s, k ~+CIYP~ ~ ~ i i t i ^ ~~ ~ ~~ remen mum requ s. An Existing System has been inspected and soil conditions meet m n 3. ' ~ ~ ^ i t tounty Copy. i The System is shared by more than one owner/building. Attach Common Ownership Agre 4. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #~2) 1. a. Q~Conventional b. ^ Alternative c. ^ Experimental 2. a. ^ System- b. ^ Holding c. ^ Pit Privy d. ^ Vault Privy e. ^ Mound f. ^ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ^ See a e Bed b. See a e Trench c. ^ See a e Pit - 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ~ ~ y p ,~ F' ~ ,fi. z ~3, 9 Feet Private ^ Joint ^ Public VI. TANK CAPACITY in allons Total # of ' N Prefab. Site C l St Fiber- ti Pl Exper. INFORMATION New xistin Gallons Tanks ame Manufacturer s oncrete on- ee glass as c App. Tanks Tanks structed Se tic Tank or Holdin Tank J '~ S A / `~~ K/ Lift Pum Tank/Si hon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: .t ~ ~ ~o lumber's Address ( reef, Ci ,State, Zip Code): me o ner: VIII. SOI EST IN ORMATIO Cert' 'ed Soil Teste~ T) Na a CST # C 's ADDRESS (St et, Cit ,State, Zip Code) Phone Number: .t3 6Sx IX. COU Y/D RTM T SE ONLY ^ Disapproved Sa tary Permit Fee ~ Groundwater S charge Fee ate / Issui g Agent Signature (No Stamps) /t /J Approved ^ Owner Given Initial D ]~y ~ c ~ ~ _ ~ L ! _ / / ~i ~ Adverse Determination / / ~/ s e~- ' / r V d X. COMMENTS/REASONS FOR DISAPPROVAL: v SBD-6398 (formerly Plb-67) (R. ll3/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A'll revisions .to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in'your building plans, system i'ocation, estimated wastewater flow (number of bed- rooms, etc.), depth of system,.or type of system;... 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399} to~b~ ~ ' Submitted to the county prior to installation; _ 5. ~ Priuate sewage systems must`be~•prop~'rly maintained. The• septic tank(s).should be pumped by a licec~sed pumper whenever necessary, usually every 2 to 3 years; 6. If you have question; concerning your private sevaage system, contact your local code administrator or the State of Wisconsih; bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: !. Property owners name and mailing address. Pr~~~idc the legal description where the system is to be installed; ll. Type of building,or use served: !f public is checked, Indicate type of use (+.e. 10 unit apartment, 30 seat ' restaurant, etc:).' Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of'application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appr=opriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; .... X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z X 11 inches must be submitted to the county. The plans must include the tollowinc~: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tariKS; building sewers;'wetls; water mains/water service; streams and lakes; dosing or pumping chambers; 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. ~~ GROUNDWATER SURCHARGE On titay 4, 1984, 1.983` •Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwate~~ protection law. This change in statutes was the result of over 2 yearS~,ot;steady negotiation and public det9ate. The groundwater~bil~`•,, Gccrun, included the creation of surcharges (fees) for a number of regulated prac#ices which Wiscot can effecr groundwater. The surchar;e took effect an July 1, 1984. All of the water that buried is used ir, your b,~ilding is returned tc the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. T~~e rrZOr: es :;ollectec~ through these surcharges are c~edi~ed'::~ the graun::wat;r fund adminis- t~re;' by ~iie ~:epartment of Natural R_-'source:. These funds are used for r7onitoring ground- Y°=atF~ gr ~un:.iwater contaminaticn ir.<estigations and establishmEnt of standards. Groundwater, i°:`s wcrtr~ protecting. E~3D-E'98 ~RA3186y ,~ .~ , voter - irt'S a easure ~'~ ~~ DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) (H63.09(1) & Chapter 145.045) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 LOCATION:~f • SECTION: TOWNSHIP/Mtifi+6FP,'4thfiY: OT NO.: BLK. NO.: SUBDIVISION NAME: COUNTY: WNER'S BAKER=S#t4idlE: MAILING ADDRESS: S,>< Gam,` ~,~ ~ G R 1 ICF NO.BEDRMS.: COMMER IALDESCRIPTION: ~~ L7 Residence ^ New ~eplace - - - ~ ,•--- RATING: S= Site suitable for system U= Site unsuitable for system DATES OBSERVATIONS MADE PROFILED SCRIPTIO S: R ATI N TESTS: O y~~i -. I.n t,/ Z CO NVENTIONAL: ~s ^u MOUND: cis ^u IN-GROUND-PRESSURE: as ^u SYSTEM-IN-FILL ca-ss ^u HOLOING TANK: cis au RECOMMENDED SYSTEM:loptional) ~ ' ~ ~ ,~ ~3 If Percolation Tests are NOT required DESIGN RATE: If an y portion of the tested area is in the under s.H63.09l51lb), indicate: -- Floodpiain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GR UN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.1 B- B- z ~y e ~ ~ r :/ / P ~ ./ 54 B- B- ~ /p 9 d'. /tl e ~ m 9 ~ ' / --' -P y 18.3 PERCOLATION TESTS ~ ~ ~~~ TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERT D 1 PERT D2 P R PER INCH P- / 0 S' ~ P- i P-_ 2 3 J P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the horn zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. ~ ~ ~f; SYSTEM ELEVATION %r~~ z~i 43.9_ _~ __ _~~ r _ ___ _ . _ ._- - - } (€ , ~ E i t ~ 7 ~ ~ i ( € I r ~~ ~ ~ ~ ' _.___?.._.._. ~ ~ li s- '- ~ E ! i i _ __ _-_ ~~__ ..__ .1___ c_ _.~ ~ ~_~__ -_ _. _ _ ~__ i ~ ( 7 - ~ ~ - 777 ._. .. _....--""- E i ~ ! ~ r _ _ ____ ___ _. ~~ ~.. _.__ __ __ -~--- , - 7 i ( 7 e r ` ~ ~ ~ ~ +j . ~ E 7 ~ 7 _ a__ ~ __-1. 1 - t ~ ~ ~ t _ ~ ~ f ~ ~ ~ t ~ ~1 ,..........~ „~.~_ ..-'~----..- ......_._ _ _. .._ ,....,1E-~,. i 1 _ _ ..... ~ c 1 ~ ! t ~ _ E ~ _ _ ~ ~ ? ~, i .~ .~ i~ ._ I ~ i t ~ ~..~._. _. , _. aTRl.1T0lVS FOR OMPL"~O FORM 115 - IS3 - 6395 To ba a co5r;>efie and accurate soil lest, your report n~t3st include: ~ 1. Cc~mp(ete [_., =sc:ription; 2. Th ="e ust clearly i ;::ate, whether ~ a residence or commercial project; 3. I . of becirca+ or cr.>rrnner nned; 4. ' ~ ~ ~lacement ~ =n; ~~ : _ , re th ~lity stir . A SITE IS.,:iITr~BLE FOR A HOLDING TA(Li OILY I~ ALL O~ ER SYSTE ~ ARE RULED OUT BASED ON SOIL CONDITIONS, 6. PLEA sE use the abbreviations sho~lvn here for vtitriting profile descriptions aid con~pletinq the plot plan; 7. ''> -=:'<E A LEGIBLE diagram accurately (r~cating your test lr~cations. Drav~ring to scale is preferred. A sh~~t =-~~~~ be rased if desired; -e y it b tnehmark and vert€c;al elevation reference point are clearly sPrown, and are permanr~nt, opriate hexes as to elates, names, addresses, floor plain data, percola~tior~ test exemp- ~. such as fic~oca plain, elevation} does not apply, place N,A. in the apps"ot~riate box; ~ }. .; ~ ~ l ,ce your <,i.in~er~t address ~ri your certification number; .,~ies an<i distribute as r~ ALL SCJIL TESTS iV1UST BE E=3LED t~!tTH THE I ;' !U~°F(OI~~ITY 1<`trITHIN 3Q QAY,~ C ~MPLETIOd~I~ ~ .,~EVIATIC~NS FO(~ RTIFIEi~ aC3[L `FSTERS S<< ~ ~ ;lEl TBXtt11P,S Si - a~~r% Cpl) _ ~;? iQ") g~ - Urtli£;1" ~ 1 cs - iaru ..~ C _ Syl '. L{}a Zli Si -- silt ~.' :iy. E...~ r'j t .. ~' >91 _ `~~ .. ~:I ~tfi~r .. .'3 ~R SJ v LS - ~ NGVV - HigF~ ~': F' e t c: - P 5~ti~ - - f31~ig ~ _. .. i T' ~ _ pp l.tn ., Li E :. l . p,,. ~, (_ t'ti,` ~~1 _. ... '.'L ., : 4 V e... R ~~/ i n 0 4 z ~ V :~ ~ o ~ ~1 0 ~ - F 1 ~\ n N i~ °~ ~ ~ o o ~~ `~ ,~,~ n ~ ~ ~ ~ C r -~ ~ ~ ~ ~ ~~ ~ w ~ ~ H ~ ~d. w ~ w ~ ~ ~~.,, ~ ~~ ~,_ 1~ O \ i /V_\ N1 \~ s \~ ~ ~ O o ~ w~ N ~- ~~ 0 D Q 3~ ~o ~ w v ~ ~ ~ 4~ ~, ~~ b ~ ~ h c ~ - ~ h w ~~ 0 ~. ~ : v f _ ~' ~ .. ~ h \ ~ ~ ~ ~ ~~ ~ o ~~~ ~ ~~ ~ ~ ~ ~ ~ ~ ~, ~ ~ ~ ~ ~ ~ ~ ~ I ~ ~~ \ti ~ . ~ ~ ~ ~ O = z O C ~ ~. ^ U' ~ '~ ~ ~ m -o p Z o0 O JIJ ~ r p p J 1 m x • -n < ~o ~ to ~ n • 00 r • m ~ ~ ~ ~ p ~ p r ~ ~ ~ ~ ~ r ~ ~ - Z = _D-I C) p m o rn ~ ~~i 0 D ~ ~ C T Z ~ r Z ~ ~ Z ~ m m ~ r m O ~C m ~ ~ m 0 D -~ m N m 0 c 0 T rn m Cn O Z ~ • Sv of eo0~ 70. ? mOuNi~, m OQ ~``.~ 3 0• rf ~ 1p . C ~ ~ ~ ~ o m „ . ~ ~A ~~ c~ ~~ 3~ «~~ ~A m p 0 N C d 7' ~ A~ C~ m1Oey _ O m ~ S 3 0 O.m d ~ ~ p t7 C ~ ~.m ,,. ~ O' O. ~ "=<m , . oa a M ~~ ~. ~ty ~ ti~ 70 3 NN ~ 7 ~ ~m.. m0 ~~ 7 ~ ~ ~^ O l0 4~» S ~„ ~3 ~ ffi N ~ '3 s S N H „ ~ ~ ~ ~ W C ~ A C N m ~' W S~N 01 ~~ ~ . < ~ ~ ~ o ~ ~ O tt ~ ~ d ~ ~' ~ ~ ~ .Cn V C N 7 7~ ;»3 z _. ~ ~ 3 m ,~ ~ ~ c3 A o v m z •o Am $ $3 ~ D m B ~ ~ "~ -°, o .. ~ . ~ ~ a < , o S M ss ' ` c ~ .~ o. A Q Q 3 o < ,. oo ~, „ 3 m m:.o ~ 3.~ W N ~ ~ ~ ~ 3 m~ a 3D°- ° o V "~ < m . ~ 4_ ~_ i ~ N Q 7 ~ ~ 3 ~ N M . ? ~ `,.' ~' A ~ N ~~ ° ~ 3 sa°. ~ a , ~ a -.~ 0 x C Z ---~ x tAr J N A O Z y Z y 10 C T ~ W w O ST. CROIX COUNTY WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 September 24, 1986 Ms. Carolyn Haag State of Wisconsin, DILHR Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Carolyn: Permit~683850, issued on 9-2-86 to Ken Dolney, is being rescinded, and permit4~79221 replaces it. A new percolation test was done and the system is being installed in a different location. Permit~~83850 is attached. Should you have any questions regarding this subject, please contact this office. Si erely, .Mary J. Jenkins, Secretary St. Croix County Zoning Office Attachment r DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR sAFETY dl euILOING: LABOR a KuMAN RELATIONS PRIVATE SEWAGE SYSTEMS Dlvlslon ' P.O . BOX 7889 BUREAU OF PLUMBING MADISON, WI 63707 ' (CONVENTIONAL ^ALTERNATIVE 9uta Min 1.D. Numtier a III atargnetll ^ Holding Tank ^ In-Ground Pressure ^ Mound y.. NAME OF lERMIT HOLDER: ADDRESS OF PERMIT HOLDER. t NSPE ATE: Ken Dolney 1476 T4idway Parkway, St. Paul, MN 55108 ~ BENCH MARK (Permanent releren~e Pam() DESCRIBE IF DIFFERENT FROM PLAN . PT. ELEV.: CST REF. PT. ELEV NE4 NW 4, Section 23, T29N-R19W, Town of Hudson Name of Plumber MP/MPRSW Nn. Caunty. S anitary Permit Number: s Dave Fogerty 3289 St. Croix 83850 SEPTIC TANK/HOLDING TANK: MANUFACTURERS. LIQUID CAPACITY. TANK INLET ELE V. TANK OUTLET ELE V. W ARNING LABEL LOCKING COVER P ROVIDED PROVIpEO: ^YES ^NO ^YES ^NO eEDDING: VENT DIA.. VENT MAT( HIGH WATER NUMBER OF ROAD. PROPERTY WELL BUILDING. VENT TO FRESH ^ ^ ALARM ^ FEET FROM ' LINE AIR INLET. YES NO YES ^NO NEAREST DOSING CHAMBER : MANUFACTURER BEDDING. LIQUID CAPM:IrY PUMP MOUE I. PUMP,$U'NUN MANUI A(:IUHEN WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CYCLE: PUMP AND CON THOLS OPERATIONAL NUMBER OF PHOPFHTy WELL BUILDING V NT TO FRESF (DIFFERENCE BETWEEN FEET FROM LINF AIR INLET. PUMP ON AND OFF) ^YES ^NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE ` I f Nt, n( ~nAMf rF f( n,ATI Hlnl ANU MAHKINh or excavation, ilf soil can be rolled into a wire, construction shall cease until I the soil is dry enough to continue.) ..MAIN CONVENTIONAL S YSTEM: BED/TRENCH WIDTH LENGTH NO OE T E S UISTH PIVE SPACINI, COVFH ' INSIUL UTA apl TS LIQUID . ° H NCHf MATERIAL PIT DEPTH DIMENSIONS V L DE FILL DEPTH IHSTI( PIPE UISTH PIPE. DISTR PIPE MATERIAL N[) UISII( NUMBER OF PROPERTY WELL BUILDING V NT TO FRESI BELOW PIPES ABOVE COVER FI EV INlll ELEV FNU ~ PIPf$ FEET FROM LWF AIR INLET _ __ NEAREST----- MVVIVV .~7J1 tM' Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ^YES ^NO SOIL COVER TE%TURE rr^f HMANf NI HANK FHS URSEH VATION WE LIS ^YES ^NO ^YES ^NO DEPTH OVER TRENCH BED DEPTH OVFH TRENCH HEl1 U[ P11/ OF 10I'SUIL tiIIUUf U 5F E UFU MULCHED CENTER EDGES ^YES. ^NO ^YES [JNO ^YES ^NO PRESSURIZED DISTRIBUTION SYSTEM: BEO/TRENCH WIDTH LENGT/I TRENCHES LATENAL SPACING GNAVEL UFPT11 HF LUW PIP! FILL DEPTH ABOVE COVER DIMENSIONS . MANIFOLD PUMP MANY OLU DISTR, PIPE MANIFOLD MATT HIAL NO UISTH UISTH PIPE UISTHIBUIION PIPE MATERIAL S MARKING ELEVATION AND ELEV. ELEV DIA ELEV. PIPES DI4 DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING L`IiILLEU CUHHFCIIy COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ^YES ^NO ^YES ^NO COMMENTS: PERMANENT MARKERS ^YES ^NO OBSERVATION WELLS. ^YES L)NO NUMBER OF FEET FROM NEAREST PROPERTY LINE: WELL: eUILDING. Sketch System on Reverse Side. DILHR SBD 6710 IR. Ot/82) Retain in county file for audit. sANITARY PERMIT APPLICATION couNT ~ DILHR Adm Wis Code In accord with ILHR 83 05 . , . . ~....~„~.,.o.,. STATE ANITARY PERMIT# 3 0 -Attach complete plans (to the county copy only) for the system, on paper not less than sTATE PLAN I.D. NUMBER 8'h x'11 inches in size. -See reverse side for instructions for completing this application. PETITION ^ 1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. No FoR VARIANCE ^ YES PROPERTY OWN PROPERTY LOCATION / .c=vc- ~ '/a ~ ~'/a, S '~ T ' ~ , N, R E (or PROPERTY OWNER'S MAI G ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY, STATE ZI CODE HONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK LLAGE VI II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family j OR ^ Public (Specify): TION: (Check only one in #1. Check # 2, 3 or 4, if applicable) III. PURPOSE OF APPLIC A I ~ 1. a. ^ New b. U Replacement c. ^ Replacement of d. ^ Reconnection of e. ^ Repair of an System System Septic Tank Only an Existing System Existing System 2. ^ A Sanitary Permit was previously issued. Permit # Date Issued 3. ^ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ^ The System is shared by more than one ownerlbuilding. Attach Common Ownership Agreement to County Copy. IV. TYPE SYSTEM: (Check only one in #1 and only one in #2) F O r ~ / 1. a. LJ conventional b. ^ Alternative c. ^ Experimental 2. a. ^ System- b. ^ Holding c. ^ Pit Privy d. ^ Vault Privy e. ^ Mound f. ^ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ^ See a e Bed b. ^'See a e Trench c. ^ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ~-~/ ^ ^ 2 ,~ )`~ ~ C' Feet Public Joint L=1 Nrivate , _ VI. TANK CAPACITY in allons Total # of ' N M f Prefab. Site C t l Fiber- lastic Exper. INFORMATION New xisting Gallons Tanks acturer ame anu s Concrete on- tr d t ee glass App Tank Tanks s uc e Se tic Tank or Holdin Tank / S lC~ ~ !~/~ - l !'~' Lift Pum Tank/Si hon Chamber ^ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. P~u[_nber's Name (Print): ~ Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: ~ `'~ ~~ ~ tl % c 1 ~ ~, ~ ~ r 's Addr ss ( fit„ te,Zip ode): ~N~me of D ~~ 'r ~ 2 ~ ~~ L 5`Z C4_l ~ `~~ VIII. S IL TES INFO NATION Certified Soil Tester (CST) Name CST # ~~~ ' cs-~, ' 1 l r ~ CST' ADDRESS (S t re et, Crty, State, Zip Code Phone Number: , C ~ L ~ ~~ _ IX. COUNTY/DEPARTMENT USE QNLX ,may( ^ Disapproved Sanitary Permit Fee ~ ; Groundwater Surchar a Fee ate Issuing Agent Signature (No Stamps) J2S.1 Approved ^ Owrter Given Initial ~~ / D~ ~ `' ~~~~~ Adverse Determination [. / X. COMMENTS/REASONS FOR DISAPPRbVAL: ~ ~ (/ v SBD-6398 (formerly PIb~7) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORI~AATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licer;sed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: !. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair, IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; Vi. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a/I septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'h 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the ``'~ result of over 2 years of steady negotiation and public debate. The groundwater bill Groundyuater -`~~-~ included the creation of surcharges (fees) for a number of regulated practices which Wiscor~5in's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried ~reasure ~ is used inyour building is returned to the groundwater through your soil absorption (~ system or the disposal site used by your holding tank pumper. `R' The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural R<~sources. These funds aye used for monitorir:g ground- -~ water, groundwater contamination investigations and establishment of standards. Groundvrater, ._ __.. it's worth protecting. SBD-6398 (8.03/86) i ~ APPLICATION FOR SANITARY PERMIT STC- 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 /~i~/C~~~ ~i'~L/ Location of Property ~ // GGl ~, Section ___~ „_,, T, ~9 N-R l,/ W Township ~~~(;~ Mailing Address /~~lp /~/d~j~~ ~~/~lir/6t~ ~ ~~ /GCI~~ ~i` ~~~~ .:Address of Site ~,J~~/~~~ ~~~~/~ ~~~ ~" ~/~UJ~~//~~ GU~ Subdivision Name Lot Number Previous Owner of property ~ ~~,~ ~ ~~~/~,,,,, ~®~ :Total Size of parcel ~~d ,~~' Date. Parcel was Created /~~~ Are all corners and lot lines identifiable? _~ Yes No Is this property being developed for r~sale (spec house) ? Yes ~ No Volume e La and age N ber as ~~9~'3s'~ recorded with the Register of Deeds v . INCLUDE WITH THIS APPLICATION THE FOLLOW$CNG: -r-- A Warranty Deed which includes a Document number, volume and page number, and 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PRUP~RTy OGIN~R CERTIFICATION I (we) cenx,<,by ~hctt a2,2 ~s~a~emen~is on .thus banm ane fiJcue ~a ~l~.e be~~ ob my (aunj hnaw.2edge; xhcrt I (we) am (cute) the awneh.(~s) ab the pnapenty de~sau.bed ~.n ~h.i~s ~.nsonmati.an banm, by v-vctue ob a wa~vrav~ty deed necanded tin the Ubb~,ce ab xhe Cauwty Reg-i~s~en o ~ Veed~s ad document Na . ~'~~ ; and ~ha~ I (Gle 1 pne~ en~2y awn the pnopaded .d~cte ban the sewage d.i,~pod a y~ em (an I (we) have a6~ac:ned an eaaemev~t, ~o nun w.c~h the above de~schi.bed pnapehty, bon the can~sfi~cucti,an ab acrid t.ittnm nrn.d tlnn tn~n ~nnt hnnm .~lrrOrr NnnnNrln~ iu. tlnn f1LLinn nL tlnn (~nrrvrtri 4nnixtnh ~ s.~ Y f ~ h h } 3 r:, :. ~ . . , ~: _ , , , ~. wrtl~~s ' ' ~ . f ~~~~ ~` °~s ~erantsb 11e1(i ~uz#fifle ' ~ • : • O fiQ R!s a ~ .. ~ fi ei1~•Tt s ' T" - ~. r ~~~,~~ F, -- ~~ IIET{EMI T0~ ~., >' ~~ .,~ ; _ y ~;~ ~f!loflorrig0 pMari!>yd red e~.1n t s ;:. r0 x ~. `, ~~"; Bf#te pf WhooiMin: ', -"~.__Y_„--_... , .. ,: " ,,. a „~ :, , ~ "~ ;- - Tsi1t l1MrN Mq, ~"~ ~ A parcel of land ioC.atred In Northwest Quarter ~~~~ ~ ~ ©f 'Section 2~3, Township, ~9' Morth., Ran °~9.we~t,. .:4 -~. as dEscribed to tht`Certified Surva ~p ~, :ft ie and-of record ;n the Office ofythiR a,~i~s;- ~ _ - i J of Oeeds for. St..Croix County Wiscvnsln,~n =rf K Voiume "3", pa a 622 of Certified Survey Imps, ^~ ~~: Document No. 349633. ~~ Whirs Deed is s # lhlfilLdent ~ot a land oontracrt~ dtt~ 3u1~ ,16~ 4~;,#~ a recorQeQ July 21, 19A~ in Volume ~3g~ P1~e 554. a~s • -: ~3?dr. "~ ,~~ . ~ - - hr `'S,. - ti ~~,~+ R .~~s ,, i s ., ` This .,horr-gtead r art ~` (is! Pop Y. (is nol~- k ~ Eicce hon to ~~' P z ~7,': '~- .. .. - _..- . _~. day or __ December - ~ ~ ; ,. .- ~~:~ d`~~+ -_ --- ____ _ _ (SEAL! .- . - - ~ ~ v, ~ _:' - - - -- - --~- - - - _ _Jaune s ; 0 . Ha i v e r spit "`~~. ,. - - - - - ~ --- - - - - - - ~ SEAL I L~~ /'~-.- _ i. C/1/ ~~~s ter..-.~,' - ---~ ~- ~~ Judith M E - --;-_ Haiversan - ~: ---' At1THEN'tICAT10N ~. c~+~y~tLE`OGAit~llT ~. ,r Sig»~tor8/s-. _ _ Mi NNE50TA ,~, - _ -. __ . ._ STATE OFlX'~ v ~ autnenticaiea this_ - Wash -~ ~ ~ ~ ~-:. ~. - 'Aayot ~ ty-: 9~QtY_ ~ ' County. '~, ~ - PersoliallYCanb~}orsmsit~~ ~ . ~- e ~ QBC~er' ~_ ,_. - - - James , D .. ~ ~ HIr ~: _ Judith=i"~. Haivetsr~~ h T1TLE:'MEMBER STATE BAA OF WISCONSIN J _. _ L- ~. :? aY1~it~DriLed by § 706,Q6. Wis Sra;s. # - - - to me known to be ttte.pMypn ~'i `~ "~^-~~E~St~+~,=~una~+u~aa~wS~3Rw~rEAt~x for~~Gm~~g~nstr t~~j t~; ~ ~ ~~ ,~ ,~ b i I ~. -- • ~ n ~ ~. I~atunss ~n,,;y r,~ au~r~.~nr,caf~d or acknowledpsC.~gp{p NoCa~y Pupric _~ "C ~~Mf`necessa~y ; _ - M.y Comrg?~Gm- STC- 105 .. SEPTIC TANK MAINTENANCE AGREEMENT ' St. Croix County OWNER/BUYER ,~~~~ ~ ~ ~/~~~~G!/~G~ ~j~~~1 ROUTE/BOX NUMBER ~~~~ /~i ~{J~i~ ~~ Fire Number ~.~`T CITY/STATE ~G~~D/rN L(J~ ZIP ~~~w PROPERTY LOCATION: '~, ~3L, Section ~/ T ~/ N, R ~~ W, . Town of ~~~~~~ St . Croix County, Subdivision ~ Lot number ~ 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 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 treat- ment stage in the waste disposal system. St. Croix.County residents m_~ a maximum of 60% of the cost of which was in operation prior to accepted this program in August owners of all new systems agree maintained. be eligible to replacement o July 1, 1978. of 1980, with to keep their receive a grant for f a failing system, St. Croix County the requirement that systems properly The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master 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), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to 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. SIG DATE ~ ~ C. ~ -~ St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 H z r r H H 0 z d Y H t=] Sign, date and return to above address. ~~ ~ ~ n i &1: AI i "+r........ NIN CC Cq. Mt) IlEC. ;~ W a ~~ N.(• .a~ ~al~e~. r ~ ,- . ~ ~~ b fj ~ ~ ' ~ f~ r ~ ~ M N I ~ S ~a ,. (~ r ~,:,y~ '', 1~`~rU,, ~ s~ r~ta~ N 1 } r r ~ t~} - 1 t i! y I~ ~ : + '0 uN~ t• ~ ~ ~~1~.M V NA ~ ~k°~~~di~~ ti '~ ' ' ~~ , .. ~~- ~ ,~ ~ .. t w ;'a. s~ ~ ~ t0 F,h ~ i ' ~ j ~~~ _ ~ ~ i . N i ~ •w,~.,•.,.-, .. ~~ . - ~, . - ~~ ~ -~ w. r+t ;.ra .» ..r fir. !~'T'~@"' -- ~-- y~- is ~ .,. ~ tc,~a.o4 ~- _ ~- ^'X 6:, i ~' ?y'. ~~. ~ y~,, ~., A ~. ~:>wt ~ ~w s. v ',~:~:€ ,:,~~ ~~ t ~ ~ x r ~,. .i. ~ 1E ~_ ~ _ i~ }1 ~~.. r ~ i -, ~. ~~-. ~ -" f -- . " " ; d !`•~ ~~! +~ ~ O rlr t/•4 0 • 1 X 24 tRON 'Its wlI~NINS „ r ,: ;,, r ;,~ ~ w ~ • '~ ~~..... 1.S• LOS./ LIN. INT. ~ No. •• 2e ~I//- • LINE NOT TO SCALE ~~ ; 90° R/W WIOTH p .! ~iit~~I! IN FEET' ~ ~~ s :~:.,~ ~• dt?_:~ffer, ftegistersd Land Surw ~rz 1 u~ 1 c~umpl xance with the provisio»• ot~r~ hesyby oertiry that ~1~cac.s~in 9ts,t•utea and SscClop 5.4.2 of tatlo ' tp.Lrr~„yl- ot... Lfe.: 1 ~~'gi s ,s: at~a a»c3 under th© direotio» oP John . '~lntyr ?~oi~tld ,. ~ , .. cw~,ar ~,.f sald land 11,`l ,~ :. •"~~~ , I have surwyrd~,~ a~ I ~~~A.ccAl o~ lands that such survey Qp ~~ ~~;~ ,~ ar~.f .cr ~unct~risa and the aubdirilion oP ~ ~ ~ ~' , ~ ~' `~~ ~'~ ~ ~_~~ f ~., the NW 1/4 of r5~otio~rr 23, 'P-2galt ,;~.19w, '~!d arad ~tha ~,a , . , .x, ~.taconain further • Mfr '~'-~ of ,,~ ` ~: ..-~ ;,;~ at ~ d+~-oo»ibod as tolZriMl~ilrt ~ , ,; . ~. ~'~ ~- ' ~ ~ tho Nail corner of Maid 8eo. 2 , . .~ ~~, . ~4tlent» li da34~30 ~ , ulna c~' the dW 1 4 0! •aid Geo. ~ E -hsA1. °c~ - -4~G 23s' 1354.51, L, to alwl ~ , '~ d9 z? ~ alota~ thsr oehterline of 1.~1. ~ M12~" ~ ~~ ~`~f ~': H: t ;~rxitlg of thin descripti,o~ thence ~ ~. p,. s :10S3~O~ titan., ~:~-~ i<:, 6b0.00 testa thepce d 02 Q" c ~ ~'.'da•; ~ f.1 `• t.~ '"12"'; thsnae 9 8 2 _ -1 ~- ~34t~0 ~,'~~i"~~~~tiiielji "' g.. ? ty~ W alo»~ trllo ;oeni~t~± , o!'`v.a.~g, ," . ; ~: ~~ L to the point of bQ~i»g3~t. ~bo~114idoso aaxi ~ aL~aat to eaaelsenta of ~o~ t ~ ~l oIIMt . r3 17'~k ~ {t -^.-.+~sa~,..~,adM~,~~lr+,,,~a.~ ~, ' ~ 4~~. ~.f .~ ~ '„ yes rr i ,,.. , ._. 11,:e.~.33,... _ .. xa~ ,SOOt34'-Stl"E AtoN~, r wE~ 1.1 IME - NN t/4 ~ ~'; i` r' /.~ ~} .tea _ .,d. .~~i r ~,~fi,~ Q. , ~ .. z Y: ~ ~, • ~: . ~~~ r. ~ ,~~~ :~ .~ ^^,, ~ a r '_ J~.,, f' 3 ~` }*r l s',: ~r a •~, „ .. ,, .. ~;~: ~r .r~. ~ • : ~.~ {~9r~ __ __.__ _. .b .._~. ~''_ d.~ g~,ys.,'~ DEPT ~F REP4RT DtV ~C11L ~RlNGS AND INDUSTRY, PERCtK.ATIQI~ TESTS (115j LABOR AND HUMAN RELATIONS ~J63.oi~t~) gi Chswpter.146.1?~) 4Ele- toy 5®lL ~a~ 1 1 ~=) `" ~'~~ SAFETY & BUILDINGS DIVISION .., ;; P.~:'BOX 7889 MADISON, W1 63707 $~'~~8~ ~v ~ $ /~ ~ ~. ' 8 v ie., KH•~i~LDT V. SNII~~ -~i~ ~ - ELEVATION 1'RtCKNE88, COLOR, TEXTURE, AND DEPTH ip E A98RV. ON BACK g-' ~ ~, ~°, ~ ~a T 8 ~ Dl~ ~ ~ ~©•~,~ pIC Ilnl NI "~ N ~ To ^'O ,S N DR/aONs o.~,or ra o.~o' ~ 4.~0' ~.r. 'ate M ~0 5 g- ..; " q ' N J ~ as' ' 9 ~.~o' ,Q L. ~ T5 ~ I~ S"O' @bN ; 1.. ~ r.oo' $M R~ S j ' " g. ?„ .o~ ~-.s ~ ri a> , ~ 'DN S 5 • +, a, r~s' 6~ ~ 8- t ~ t.10' 8L i Tt j A,oo Lr $n/~ f. Sj I.To' 6..rMerp e-3 9.IO g- .w p~;um~pd... DCQMI ATI!"Iw1 TL:STA' 7t' pw~ . _. _ w - - - - - - ~ Es". T --- -----~--- sy rv v fWaHIF3ER D TH ~ A TER SW lUN 1 VAl-MIN. PER lNCH p. i O ~ ~. I L ~ `~" p. Y. . , O o o ~ ~' p. ~ .k. ~, . 1 n nilac i+ L a ~.~-.„ >•_G" ,_ ~ - "C, '3 ,,~,., _ .~.-.. ,._:.a.~..v~.,.~. _. .,.~_~ . J P- .._. P- P- PLOT PLAN: Show ioastions of perooiation testy, ail borings and tie dimsnsiom of suitebls ail ens. indices scale or distances. Daa~~e what aro tM hori• zontai end vertical elevation reference points end tFww their location on the plat plan. Show the surface eiewtbn at alt borings and tht dir~tion end parent of land slope. N O ftt-H `T~-~ w,~ 4 Fri ~~, ~. p wvw~~ rt ~ 1 ELEV A Tl~J N ~ ~ ~+~ 'r"2 .X: MGt a ~ ~ . ~o Sc ~~ .~ _ .... _.._ . ~._. , ~ __... ~ _ ...~ ~ .. fw. ~ ~ - - 1.... ...-_~ ~. _., _..._ ~ .-...... ...- .... .... _ .._..,.. ._._ _.-.. ..-.. ~......._ .... ..~s.... ~ ~_ E f __ 11 ` ~ - ~- _. a ~ ! i . .. . ~ ~ ~ ~ + _._ ~ ~ * - - ~ i - - I __ _. , ..-. . ~. ^'3' ,~ ~ - . _ T ~ . 1. i _._...j I ~ ?_ 1 i _ ~ .,. .~ S _ i _.. - ~.._ _ _. ._. ._ ~ _ . .. __ .. _._ ..~..~_ _ _ ~. . _.. ._,.. ~ ~ ~ . ~ ~ ~ ! I h __. ~ ~ ~_ ___ ___ _ .. _ _.. ..._ . _. . .._ . .... .. ._ i ~. _., { f ! ~. ~ ~~ T 1~" 1 F_ # i t 1 (~~ ! I , _; { { ' i if Psrcolatlon Te:t: era NOT required ,AA D 1 R T ~ e.~-~ if any portion of the fated erect b M the under s.Hf33.091411bi, indicate: ~ ; l1- ~„ (. ~S~~ ~i-~ Floodplsln, indicati fTiiaodpiein slevationc ~ ,' `~'-r'-ZS€c~:tl~Vl,h•L. TROfi1.6~ LrtESCiRIPTIONS NoT1G ~ $`~S 5iL ~""'°~. r ~ ~ ~ ~ Roow- a~ !" _~ _, "'~ ~ -~~ a %~~ ~ ~ ~ -~ ~ 7 ~~~~ 1r ~~~~/ ;~~ ~~ s X `~ ~~v /s x ~~/~ Sr~~ ~ ~~~~ ~~ r~~~ Ol ~~ ~L1 ~ S/_/ . p~~ ~~ ~ ~~~~ ~~ ~~.~s 08~ ~l`` ,jam s ~C ~ /r Q~~ i ~ i~ ~/~~T ~~ ~Jy ~' ~ a'`l ~ y~~' ~~-~ ~~ M ~~ ~ '~~4~~. f~ ~1,~~. ~^ ~- vH;~o~/~' l~r vP vi ec,v ~~ ~~~ ~ Qo ~~ ~ ~ ,J + A ~~ `~ 3 ~ J 3 3 J Y ~ ~` ~o ~ a .~ 1 ~~ ~l _...____.__. __i__.-___-_. - _- t~ a ~© ~ `Y z v L ~ ~~ ,~ ~~~ ~~ s ~ ~ 3 ~ ~ `~ ,, r ,i ~, d o J V ~ '., n 3 ~~ v i /% i ~ r ~ ~ ~ i - a ~ ~ ~~ p~ `a ~ ~ N p V "^ \ v o v M ~ \ ~ ~ M //~: ~~,\ _ o ~~ ~ i ~^ ` - ~ ~ \ ~- ,y ,. °° -` ' ~' ~ \ ~ ~~~ `< ,n. a r R ~ * M ~~ n v a °v I "c ~~ ~`1 ~' . ~ i ; r ~~•. f ~ • I "t .~ ,~ 4 ,~ l 4n ~~ 4 ~C ,~ h R ~1 `~1 v J i ~ uo @~ ~~ ~ -. J ~~ fp ~: , ~~~ 34963 T i . NW coR. 3 4 SCERTIFIED SURVEY MAP N I~ ~'co. MoN. c>, * W ~ /4 SEC. 23 ~ T- 29- N ~ R-19-W SEC. 23 w z_ J ~ ~ w ~ 3 i W 0 M i O~ N M FICED ~ J~ p' ~~78 ~ UNQ~P~t ~PNpS . °i . ~~~~i ~ Uj 6 N 89°-27~- 44~~ E 660.0 0~ ~NQ~P . ~NpS. N 89°- 27'-44~~ E - ~~~~~-~ 88c2/`4o,' p9~ `~ ~a y~ s ~' HOUSE / `~ LOT I ~ l f~ N 5.0 ACRES' °o, 0 M M 3' t0 M 0 z BEARINGS ASSUMED S 00°-34~-50~~ E ALONG WEST LINE-NW I/4, SEC. 23 ~ •yv 0 0 M ~ M o- m N t0 ~ B Zd 8 ° - .. :3~ - S 89° 27~- 44~~ W ~3~ 1053.04 - - - - - - - -- - - - - 660. 00~- - - - - - -- - -- - - - U.S. H..~ ~.~. R% W LEGEND THIS INSTRUMENT WAS DRAFTED BY G.C.S. --~_. - ~~ JOB NO. 78 - 24 W I/4 ° = I X 24 IRON PIPE WEIGHING ~ CO. MON. 1.68 LBS./ LIN. FT. 150 100 50 0 100 O"A".•NI~~ SEC. 2 3 ~tyG `r~/~ -/~~~ =LINE NOT TO SCALE SCALE IN FEET ~~ ~~-~ = 90° R/W WIDTH SURVEYORS CERTIF_Iys 0 ~° 1,~' ~QVP~~ ~PN~S~ - R/W CENTERLINE GENE C. sf+~~ ~ s-~~s, HUDSONC' ~- '~ Q' I, Gene C. Shaffer, Registered Land Surveyor, hereby certify that ~ ' in full compliance with the provisions of Chapter 236.34 of the ~jgND R Wisconsin Statutes and Section. 5.4.2 of the St. Croix Count Zonin ~ Y g Ordinance and under the direction of John Currell, c~o Char e Kelly, owner of said land, I have surveyed, divided, and mapped said parcel of land, that such survey correctly represents all exterior boundaries and the subdivision of the land surveyed and that this land is located in the NW 1~4 of Section 23, T-29-N, R-19-W, Town of Hudson, St. Croix County, Wisconsin, further described as followss Commencing at the NW corner of said Sec. 23; thence S 00-34-50 E along the West line of the NW 1~4 of said Sec. 23, 1354.51 feet to the centerline of U.S.H. "12"; thence N 89-27-44 E along the centerline of U.S.H. "12", 1053.04 feet to the point of beginning of this description; thence N 02-10-36 W, 330.00 feet; thence N 89-27-44 E, 660.00 feet; thence S 02-10-36 E, 330.00 feet to the centerline of U.S.H. "12"; thence S 89-27-44 W along the centerline of U.S.H. "12'•, ..660.00 feet to the point of beginning. Above described parcel contains 5.0 acxes and subject to easements of record. CERTIFICATE OF TOWN OF HUDSONs