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HomeMy WebLinkAbout020-1268-20-000a~ o ~O I ~O I ~ ~ o ° I N ~ I e I ~' I °' I a 4 ~ I ~ I N I a ° I o I o ry `- ~~ w a Q- I ~ I a~ I ~ I ! v ~ ~ ~ ~_ 3 I ~ I C ' x ~q ~ ~ a ~ f p I ~ ~ ~ i ~= ~ m I rn N 4; N ~ ~'~ • O € • N O o Z I a Z ~ I i c a I i c m~ I ~ o ~ ~ o rno 3 ~~`-'€ I 3 ~o~ I m Q O a 1 ¢° `~ I ~' ~ M ~ M I ~ ~ ~ Z j ~ v ~ ~ a m I a m N~ c (9 O Z ~ ;, c f c 1 a~i z~ iI~ o ~ I o ' ~ I cn F- e- i ~ ~ ~ c ~ I N O N O O O ~ N Q N ~ • N N N O N N ~ a O I a ~ 1 ° ° I I 0 zz z mz z N ' ~° I ~ •• ~ I ~ ~ io ~yf d Y ~/+ t4 s U 'O ' ~~ ~ d d Q Q G N N ~ C W N ~ Q Q d N C d N . ~ ~ N Fy N N .D I Y 0 y I~ (!I FyN f~ l p a N - ~ aaa • ~ °aaa ~ I~ ~ v = .~ - I~ I ~ O N V! J V ao co ~ O O ~ ~ ~ c v v 1 ~ QOi OOi ~, ~ I O O = M M Z O O N~ N O N N C ~ V' O - .= -O ° ~ ~ tf) O O O O ... . -q CO ~ I O N Q 0- Y =I m C O d ~ 1 _ ~ N •p ~ _ V O Q n fn .•, m V ~ ~ 'O d N N O Q ~' (n .r N ~ O 7 .~ Q J 7 a~ Q v ly ~ .i.+ O '•- p C Q f~yA C M O p p ~ ~ N C f0 O c ~^ O O ~ O M p ~ ~ ~ ~~ ~ U D.. p I U N C N U d Qj p N I C ~- C _ V ~ CO ~ C I i H C f6 l6 C ~~ 'C C N O G O N~ t , D ~ of N' c ~ N c c Nd C N `f ~ p 0 CNi N' H C N O ~- i, ~{ ~ ~ . . m O N m E cC l • ~i ~ O N = ~ O .N- .Z N ~' d' ~ (n J N O Z N ~ ~ v rL (n O y c C~ ' V rn ~, a ~a I ~a I ~ • .:. ~ ~ •~ Q. d ~ a ~ d C I ~ a ~ N d C r~ ~ ~ 3 i O 7 O a `~.! A U a~ v i V i V , W~consin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes {Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Dul n, Thomas A. Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: Jay. / g p.-l- ~ a+n 0 ~: ~ ,.~ Foy TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding ELEVATION DATA county: St. Croix Sanitary Permit No: 126 State Plan ID No: Parcel Tax No: 020-1268-20-000 Section/Town/Range/Map No. 24.29.19.1321 STATION BS HI FS ELEV. Bp nc~h~ ark IDo tto,n~. ~ ~ ~ .Q; Z • ~ /DV ~ ~ ~ . J ~ Alt. BM Bldg. Sewer SUHt Inlet St/Ht Outlet ~' ~ 9 ~ • ~ a D Dt Inlet Dt Bottom Header/Man. 9, ~JZ 9L •$~D Dist. Pipe Bot. System Final Grade st Cover _.. ~ ~ C. Ia./V ,tf.J`~ 2 . ~ 5 J X03 . ~ 3 TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing 1, L ~' Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SClll ~RSnRPTI[~N SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P , BLDG WELL LAKE/STREAM LEACHING Manufacturer: RMATIO CHAMBER OR INFO N Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing S(lll rf1VFR ., o..,~~..... c.,~*o.r.~ n., i., ..~ Mnnnrl nr At-(Srarta Rvstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes No ~_ ; ~_~ sal Yes I ;~' No , COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /. Location: 812 Hutton Hill Rd Hudson, WI 54016 (SW 1/4 NW 1/4 24/T29N R19W) Sunridge Lot 24 1.) Alt BM Description = ~~ ~ (,,,C~,'~-- ~Td w- ~~1 2.) Bldg sewer length = 15~• '' //,,11 -amount of cover = ~ ~~ ' ~~•~1'l~ aJ ~- a~' Plan revision Required? Yes jNo ~ 3a ~q Use other side for additional information. C~ Date SBD-6710 (R.3/97) arcel No: 24.29.19.1321 r' la.~ ~/' ~. 3D3 ~, ~3 y ~ Insepctor's Sig ture Cert. No. ~t~i County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN ~~ In accord with Chapert 12 St. Croix County Sa Ordinance PLANNING & ZONING DEPARTMENT ~,+ b ~ Personal information you provide may be used fo and purposes ST. CROIX COUNTY GOVERNMENT CENTER + ~ $ ~ (Privacy law. S. 15.04{1}(m)] 1101 Carmichael Road ~~- Hudson, WI 540 1 6-771 0 (715)386-4680 Fax 715}386-4686 Atiach complete plans for the system on paper not less 8-1 /2 x 11 inches in size. County Sanitary Permit # ^ Ch i n a/Z(o 1. Application Information -Please Print all Information Location: Property Owner Name / T' APR 2 9 2008 S'cv,l4 ~/4, Sec L... ~ N, R E (or W Property Owner's Mailing Address ONI G OFFICE Lo Block Number u a 'L ~ ~ ity, S ate Zip Code Phone Numer Subdivision Name or CSM Number u~ © ~ S~-n ~i~ ~ II Type of Building: (chec one) " amity ^ Village T of ® 1 or 2 Family Dwelling - No. of Bedrooms: ~ ^ Public/Commercial (describe use): _ ^ State-owned Barest R d I ~ L f I. Type of Permit: (Check only one box on line A. Check box on line B if applicable) G- Parcel ax umbers ~ ~32a' A) ~epair 2. ^ Reconnection .^Non-plumbing 4. ^ Rejuvenation ©a ® "~/ ~ /p~ ~ ~~~ Sanitation , B) Permit Nuumber ~ State Sanitary Permit was previously issued pC D L~Q Z_ Date Issued "' IV. Type of POWT System: (Check all that apply) N on-pressurized In-ground ^ Mound ? 24 in. suitable soil ^ Mound 5 24 in. suitable soil ^ Mound A+0 ^ Sand Filter ^ Constructed Wetland ^ Peat Filter ^ Drip Line ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Other ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating . Dis ersal/Treatment Area Information: 1. Design Flow (gpd) i 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade ,// Required Proposed ~ (Gals./day/sq.ft.) (Min.lnch) Elevatio n ~ Q ~ 7 VI. Tank Information Capaicty in Gallons Totai # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks i~ 0~ /„ fd' ^ ^ ^ ^ ^ ^ ^ ^ ^ II. Responsibility Statement I, the undersigned, assume responsibility for repair/reconnenction/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A license is not re wired for terralift repair or the installation of non-plumbing sanitation system. Plumber's Name (print) Piu ~ i natu o sta ): PRS o. Business Phone N u m ber /11 _ / / , Plumber's Address (Street, City~tate, Zip Cod ~ ~ 6 i ~~ Z ~ ® s o , III. Coun Use Onl Di Sanitary Permit Fee Date Issued Issuin gent Signat (No mps) Approved ner Giv nitial verse d ZZ5 ~ ~ J~ '~ /30/d Dete ion IX. Conditlons of Approval/Reasons for Disapproval: 1 ~ 1 ~ w.rc.`. ~a ~'~1,~, ~ ~,.,~u.:,.~ 5 ~-t,,,,.`- c~ ~-~- ~J ~~ pa- . ~ I c..~ 1~ ~ , ^-~e. ,n~,,,~ ~ J ~~ ~ } z~ iC ~r ~en . ~-- ~ c l ~" ,~.- ~~2., Ga.b~ ilo,1 r GoYV..~ r. O J d~ 5~~,~. X12 . r i,d CJG,(.ad tli ~` ~' ETC.' ~' 1C)Q AE BUILT SANITARY SYSTEM REPC)Rfi OWNER _ • _ 1 [.' ~h,~ ~,L-~ C.-= ~/~ ~,~z j f'c A V V iiFiS~ ~~ "~- ~~ ~ }~Q >"~ ~.,,~g ~ f ~ i{~.-'Q' .„ SCt~BE?IVISION / CSM# ~/n. '~ i•'c~ TAT ~ SECTIOPi c~ ~T~N-R ~' 4 W, Town of ' ~ ~,.r ~,~5`es r1 ST. CROIX COtJNTX, WISCONSIN PLAX 'VIER OW EVERYTKING WITHIN 100 FEET~STEM dt?.~ ~ Re7`~i~i`[lU ~~ ~~ ~F~i ~,~ ~~ h 9y~ ~~y . /~~-~.. INDICATE NORTH ARR{)W _ Provide setback and elevation i.n£ardnation an reverse of this farm. Presvide 2 dimensions to center. of septic tank manhole cover. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer / v,n~•- n~ , ,~J ~ Mailing Address g1Z /'~y +~o~ /~~`/~ ,~~, Property Address ~ ~ z- ~-~ ~ l`To/~ ~~~- ~ ~ (~ (Verification required from Planning & Zoning Department for new construction.) City/State /~tJd~sor. (,,,) .L Parcel Identification Number 6 ZO ~- / Zlo~- ZCbo LEGAL DESCRIPTION Property Location St-/ '/4 , ~~'/4 ,Sec. ~, T Z~ N R 19 W, Town of /~y~sar~ Subdivision Plat: ~ v~ r; ~ Certified Survey Map # Warranty Deed # Spec house ' 'yes Lot # Volume ,Page # (before 2007)Volume Page # Lot lines identifiable~es .:~ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pwnper 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. 1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedroo -3 ,~ f `_ SIGNATURE OF APPLICANT(S) `~ /~/ ~ S DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) roc. ~ to ~_ R~e~ lf~ ^~-,~~~ ~F?+FE B:aR Or ~ISC0:~~9~: FT,R.~! ? - If3Et3 ~+j ~Vr~RR~ti~TZ' IDE[D~ _Richard :.. La>itbert and Sherri L _ Lambert, _ _ _ husband and wi f~: _-_ cun.-cy-a aru: aarr._nts to _ mt,o a n a .i n t. ., a ~.~_- husDand aced safEe as survivorship marital pragerty _ f ~ `~'',,~-~3 L ~+/~ ~T~~ x~'wc`c ~x A~rs~ 9:Sfl A '--- - - rw3s s~~ t=~:z~a~es rte ~s::;ga .~ Z.r,sa ____~ - --- _ +asscf ~rayp ~l-rara~ ssaaa~/ss the [.aldesztig drsrntrd n:ti tsute to _ St_CrOi7c ._nun_~: `!L! C~ ~p ~r ~"'~ ~atr of .~~onstn ~' 0~0-1268-20-000 _ Lot 24, Plat of StsnRidge, Town of Hudson, St. Oroix Oounty, Wisconsin. ~~~~~ ~~ a ° ~7...~ This 19 _ homrstta;l ~ ,~r,•;. (is) JG7Cti0~X Exception co.~•atrtnttn- Easements, restrictions and r:.ghts-of-way of record. if any. 16 t!i Mttd this _ day of July (SEAL) authemicated this AUTHENTICATION day of TITLC-: A1EMI3[R STATE BP,R JF ~VtSCOh'SIiV (If not, _ authorized by X706.06, Wis. Stats.) (SEAL) /l.CKNOWLEI3GIvIENT State o€ Wisconsin, ~_ -- St. Croix ss CUUntyc 19 Personally came before me this 30t day of Tune , !g 98 ,the abc~c : ancd Richard L_ Lambert an S errs L_ mbert, husband and _ wife Brand€~ Qu NOia~'/ oavn w be the ~ son 3 State of Wis~1~~ - instru nt and ackno ~ dge ~4e same. - _ :n'Fc e.•recuted the laregoing THIS 1NSTRV MENT `JVAS ORAFTEO BY ~l. L' .a.ttorney Kristina Ogland - renda Paulin _ Hudson, WI 54016 St. Croix _ Votan,~ Publtc, .__ wurtlg: k1%+s (Signatures may he authenticated or ac4nowledged. loth are not ivly comm+ssiutt is Txrmanent. rl( nut, state expireu+~n d~tr 11/19/.219fl0 _.i ti~_t~ry.) - ---- ~Ri hard L L mbert _ 'Sherri L. Lambert • tier..: s of (%'f50:15 slgn.ng m any caoaun~ sh~-~~ld 'x n•pce or pnnmd 6clou~ irzv <nziurec. ti TAT(5,6AR Of- GV15CC1tSlh' .••-~'~%~•~ : ~~^ ~u . r`- R'.titRAA%TY DE PD Form Ko. 2 - 1982 ehA'•aacc~°_N~: STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER fQ°~G ~ ~Gt, »y ~ +C+~ ADDRESS ~~ Z ,ri'v ~ ~e ti f~~ ~ /f ~0-a~ ~~ ~ s~ J 1 SUBDIVISION / CSM~ ~ FYI. '!~ y~~ LOT ~ SECTION_ o~ ~ TN-RAW, Town of ~ ~ ~ ~ ~e~ y~ ST. CROIX COUNTY, WISCONSIN PLAN VIER OW EVERYTHING WITHIN 100 FEET OF SYSTEM • ~1f ~! .. 9' S'GA : c b ,? ~ ~h 9y~ 9c~ ' 'z ! _.._.~ ~~~Y l~x-~, INDICATE NORTH ARROW ~~~"' ~ Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARR• ALTERNATE BM: 'y _ • SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~y~S Liquid Capacity: /,~d~ Setback from: Well ~e ~ , House ~ Other Pump: Manufacturer Size Float seperati Alarm Location -SOIL ABSORPTION SYSTEM Width: ' Length ~ ~ Number of trenches /3~c~. r ~' Distance & Direction to nearest prop. line: Q ~ T~'~i 70 ~ ~~ 'L- Setback from: well: House Other ELEVATIONS Building Sewer~c U 3 ST Inlet : s~ ~ ~ ST outlet s, ~~ PC inlet PC bottom PumpgOff Header/Manifold~~ Bottom of system ~f~ ~~ Existing Grade ~ ~ Final grade ~ry ~ DATE OF INSTALLATION : J~ `w7 ~ ~ 5~~~_ PLUMBER ON JOB: __ ~;I`D ~. ~ C~ Q~ S LICENSE NUMBER: ~ O ~~+ ~ l~a"r ~ Son INSPECTOR: 3/93:jt Ts~rtt~t~t~uSia~t . ~9 . ~ ~ - ~ =~R~V~~E~SEV~6~'~S~~Tv-, RoAn 'Laborand Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name: ^ City ^ Village ^ Town of: X Insp. BM Elev.: BM Descriptio ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~ / ~ ~~~'`;' Dosing Aeration H TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Airlntake ROAD Septic ~j~ ~ ~S ~ ~ NA Dosing NA Aeration NA Holding PUMP~SIPHON INFORMATION e ~. i,n~ . 131f Manuf ode/ Number ~~, TDH Lift Lriction Forcemain Length Di SOIL SYSTEM Demand GPM Dist. To Well ELEVATION DATA n Tax No.: ,,,,~- , , ~n-,,.-~.~..~ aae.nnl ~ti S?'~..7c/%r'~ STATION BS HI FS ELEV. Benchmark ~ ~' ~~j~ ~~~' ~~. 3 ~D.7d o ~~' Bldg. Sewer ~3l ~ ~ ~ St/J~Inlet S./5 9~ 33 St/ I~Outlet Sj ~ 7' Dt Inlet tt D B om o t Headed-], g,,~~ s /S Dist. Pipe 3 ;~~ ~ Bot. System ~? ~~ 3, 9~'' Final Grade ~ ~ ~~ ~ ,~a' , sG' BED /TRENCH Width / Lengt No.Of T enches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N ~ DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK INFORMATION Typeo ~ J- i~ ~ ' CHAMBER Mo a Num er: System: ~. ~a 7S OR UNIT DISTRIBUTION SYSTEM ~~~ ~°~ Header / Mani ~ Id ~~ Distribution Pipe(s~ „ ~ ~ ~ x Hole Size x Hole Spacing Vent To Air Intake Length ~ Dia. ~ Spacing Length ~ Dia. Depth Over ~~ , Depth Over ,~ ,~ xx Depth Of Seeded /Sodded xx Mulched ~ Bed/~r~chrCenter 37-~a Bed/ages ~ 7- ~~ T_ ^ Yes ^ No ^ Yes ^ No SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys nl COMMENTS: (Include code discrepancies, persons present, etc.) l'AC'ATTONt H~tJnSON ~4.~9 19.131 .RW.NF HIT ON HTT ROAi~ /-, o ~~ G, ~ ~`~%~ P ~~° e~ ~' -'-`~. G~X imp-r~-~ ' ,~~^,.1~-b ~-~°~-''r Q-,F' ' a ~i, ~ ~ ,~ ~ ~G" ~. ~ 1 X77 G C J~-~. f`~ ~ ~ ~' ~ ~L~~-`_"'r C~ ~J ~'Y/lj-~-~-,`~% ~ iYYY~~~'. Cl' l lah revis on required? ^ Yes [moo Q Use other side for additional information. O ~ g ~i,..~ ~~ SBD-6710 (R 05/91) Date c/ Inspector's Sig Cert. No. SANITARY PERMIT APPLICATION ~DILHR In accord with ILHR 83.05, Wis. Adm. Code -Attach complete plans (to the county copy only) for the system, on paper not less than 834 x 11 inches in size. wee reverse side for instructions for completing this application. couNTY STATE SANITARY PERMIT # ~~agoo2. Check if revision to previous application STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMA TION. PROPERTY OWNER PROPERTY LOCATION L S4+'/a w%a,S 2Y T.~4,N,R /9 E(or W PROPERTY OWNER'S MAILING ADDRESS L07 # BLOCK # ~- S' ~' C 7' d .~ ~ .~ CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER C Lv ' cns- 7es- u~ - ~ S ~, II. TYPE OF BUILDING: Check one) ITY ~ NEAREST ROAD F`/2 ( ^ State Owned ^ VILLAGE ~ _L ~ ' / ^ Public ~1 or 2 Fam Dwellin ~# of bedrooms ~ PA L N , g . ( ) III. BUILDING USE: (If building type is public, check all that apply) ©~ O ' / L 6~' 2- v 1 ^ Apt/Condo 2 ^ Assembly Hall 6 ^ Medical Facility/Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/Repairs 11 ^ RestauranUBar/Dining 4 ^ Church/School 8 ^ Mobile Home Park 12 ^ Service Station/Car Wash 5 ^ Hotel/Motel 9 ^ Office/Factory 13 ^ Other: Specify IV. TY PE F PERMIT: (Check only one in line A. Check line B if applicable) O ~~ ~~ 11 A) 1. I~t'New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an System System Tank Only Existing System Existing System B) ^ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11,®~Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 ^ Seepage Trench 22 ^ In-Ground 42 ^ Pit Privy 13 ^ Seepage Pit Pressure 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE ELEVATION REQUIRED (sq. ft.) .PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Q rS"a (/ 2..S'' / / 2 ~ ~ -- / Feet ~8 Feet VII. TANK CAPACITY in allons Total # of ' Prefab. Site S l Fiber- Pl ti Exper. INFORMATION New istin Gallons Tanks s Name Manufacturer oncret Con- tee 91ass as c App. Tanks Tanks structed Se tic Tank or Holdin Tank 000 / C~ f.t' r Lift Pum TanWSi hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) /MPRSW No.: Business Phone Number: !~; c E. c.,.iY h ~ E. , c.~~~_ ~ 3 8'I'' 7.r .zt9- r.37 Plumber's Address (Street, City, State, Zip Code): /d '~ ~~ E ~' G/i s~U 0 ~ IX. COUNTY/DEPARTMENT USE ONLY Disapproved S~}nitary Permit Fee (Includes Groundwater Surcharge Fee) a e ssu uing Agent Signat (No Stamps)- Approved ^ Owner Given Initial ~j ~ /~~ Adverse Determina ion y X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: U~ SBD-6398 (formerly PIb~7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. , 2. Your sanitary permit maybe renewed before the expiration date, and at the time of renewal any new criteria in the. Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfe=;'F?enewal Form (SfiD 6399) to be submitted to fhe ;ounty. prior to installation. 5. 4nsite sewage systems must be properly maintained. The septic tani~(5) rn~~t be pun,pe~:.` by a licensed -• pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions cancerning your onsite sewage system, contact your Ir~cal code administrator ar the - State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system;i~~to~Q,;installed. II. Type of building being served. Check orily one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type.. VI. Absorption system information. Provide all information requested in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and .manufacturer's name. Indicate prefab or site constructed and tank material: Complete for a!/ septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VI11. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. CountylDePartment Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8%z x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes;-pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if 'required by the county; E) soil test data on a 115 form; and F) all sizing information. ' - GROUNDWATER~SURCHARGE 1983 Wisconsin Act 410 included the creation ofi surcharges (fees) for a number of regulated practices which can effect groundwater. The ,monies collected through these surcharges are used- for monitorirr~ grorndwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) C fi ~ ca ~ ~ ~ ~ ~~~~ .t b ~ ~ ~ ~ ~ y 1~l~V'7 l~1 ~_W if+ ~ ~ y ~ ~ ~ O .q oo w • Z '`C `'~ ~ ' C r ~ ~' ~ ~ ~m A ~ P- ~ ~ ~ ~ ~. ~ O p C L r . ~,% 0~~ u u n ~ ~ ,~ . ~ ~~ C ~ ~ ~ w rw - o ~ y ~ .. ~, L ~~ ~ (' ~ O l ~ r ~~ ~ o r N ~ a o O ~ ~ ..: _ ~__.._ .. _.. .._...~._i_.__...wi..~ .~ i....___ ,..~:.~ _ ...;. .F / ANA r- .q • , ~.~~ • ~ ~ , r •~ D'; ~ C U -- ~ 1 f ~ ~ ~ ~ `, ~ S ? 1 S ~ ~~ p ~ 0 `1 h s ~ ti. t T ~ ~ r ~ ~. ~ ~ ~ ~ ~ r n A~ i~ ; a 1 •~ 1:4 ~ ~ 1 ~- ~o ~. W ~ ~ • O~ ~ ~-~ W W ~e ~, ~ ~ ~ w ~1 00 0 ~. ti ~ A o a ' 7. ~ ~ ~ : ~ \ t A A ^ ~ ^ Q ~ I ~ IL .c .r ~ ,t -~ o f ~ ^ ~ I~ ~ ~ i `f F f n- ~ ' ~ ~ ~ ~ I~ • ,, ~ 7 ~{ 1 `~ ; ° l I ~ ~ ~ o~ a _ ~ ~ ~ , - t~ ~ 11.. ~ 0. a ~4 ~ ~.- ~ ~ s ~ ;~ ~ o ~ d- r~ __ _ - _ __ __ - - P f . __ f " ~ I ; ~ ~ ~ ~ -y t ,~ ~ , H ~ - N u ~ , • ~ !~ M ~sconsinDeparOnentoflndustry, SOIL AND SITE EYA.LUATION REPORT Labor and human Relations Division of Safety & Buildings in accord with 1LHFi 83.fj5,aNis._ Adm. Code Attach complete site plan on paper not less than 8 1~2 X ~1 inchb~ irt;si2e. Plan must.Idclude, but not limited to vertical and horizontal reference point,/(Btu~, dir~~trorti.-slid % of slope~,~,ca a or dimensioned, north arrow, and location and distange ti3'neare~t road. ; *~ ~.. APPLICANT INFORMATION-RL'EASE PRIN~'A`L~. INE,O.RMATl0~N '~ a Page ~ of 3 couNTY S"'T G~PD/,X PARCEL I.D. # REVIEWED BY DATE PROPERTY OWNER: r ~1 C~' /.. ° S~E~Pl~l~ ~. LA , '~T r'- ~ ~ LOCATION GOVT:LOT W 1/4Nlil 1/4,SZ T 2- PROPERTY OWNER':S MAILING ADDRESS ~'~ f~ •`; ' zQY cr . ,c~0. ~~t~.~,~'. ~ LOT ~ ay 6LOCK # SUED. NAME OR CSM # Svv /v~-~-- CITY, STATE ZIP CODE PHONE NUMBER C6~tR G~-~E Gfli~ 5'yvas- (9isT zC~3--3~0~ CITY ~1(ILLAGE WN ~urJSo,.~ NEAREST ROAD Nurroa tl~ll ~D• [vJ'~lew Construction Use [ICJ Residential I Number of bedrooms f ~ () .Addition to existing building j J Replacement [ J Public or commeraal desaibe ~ r Code derived daily flow <oOO gpd Recommended design loading rate • ~ bed 2 ~ S gpd/ft trench, gpd/ft2 Absorption area required bed, it2 trench, ft2 Maximum design baling rate • 7 bed, gpd/ft2 • ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) S~ 3 ft (as referred to site plan benchmark) ~- Additionaldesign /site considerations u S E T 2~'.u S w ~'~ D t' S T • ~ c X E'S - Sic. ~v o T' F ~. ~-azc7 Parent materia~xS S'9 -5'~{TTip~ Flood plain elevation, if applicable Nf1- - ft S =Suitable for system U =Unsuitable for s stem ~~ O U L L•~'S MOI~DIB' O U ['TS IN GR~NaD U ESSURE L~1'$ AT_GR9DE^ U l~S SYST IN FlLL ~O U FIOLDING TANK ^ S SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell Mottles (~u. Sz. Cont Color Texture Structure Gr. Sz. Sh. ~~~~~ Y Roots GPD/ft Bed Trt~tcit O-/o /v YR z ---~ S,/ Z.-F Sde ~ ft' S Zf . S . ~ A z ~• 3a to yr~ `l/y --~ S~/ z .,r.., sbK ~,t.~F,' cs 3-F . S . ~ ~ , / 7.s yR 3/ ~... /s l? ~,, f~ yegvEUy c s 3f . 7 : , S GZ /-~~ ~5~lR S/~ s o ~.s ~Q.Q ~s - ~ ~~S' C ~- yp 7.5 yR y ~l - - S 1, f, s6K iw-f R -- . `z/ . S Remarks: V T~ i V 1~ V /"~ ~.. P _ g /o y~ ~(~._. ------. Sr'/. Z. ~', s 6~. nM f 2 ~.S Z-F- . S . ~ -,14 o y~e 3 /3 '`' S,-/. 2. f, s b~ nM-F~2 5 .z~F s • ~ z. ~ -~ /o y,2 y ~ ~ - Sr/ z, ~,- b~ n^--f,• c 5 3f . 5 ~ C, y y ~ s yR 3/y is ~- ~, y~ Mt v~'f2 c s ,- ? •~ rnt aQ cv rr~tiana! pt~c s em. Remarks: Namp--Please Print ~~~~~- ~~~~~~C~?-- ess: (.~j~~" D ; st/t~i/ /P~ • ~G~I~So.J ature: ^~~~ ~~GlJ~1 Phone: 7~.J^_ ,3 ~/ _ ~~~..5 Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT PARCEL I.D. ~I ~Of ~ 2f - fU~viP/D~L'~ Boring # ~:~:~.v >t .S <'a~:~; .~ Ground elev ~.~ft. Depth to limiting fac~ ,/ ~ ~~~~~~~w7-e-t- Page ~' o` 3 Horizon Depth Dominant Color ~~~ Texture Structure Consistence ~~, Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench A , v-! ~o yR 3/3 --- S~/, .2, -F, s bK .~r--F 2 s Lf . s • ~ A P o-~o Yo ye 2j~ 5~/, z.f, S6,e ,~-~,e ~S .2--F .s i~ ~ , o •~y D y~ 3/3 s.•% 2 . ~ shy .-.~, ~R ~ s z~ . s • ~ Z ~-~ ~o y~ ~ s,~ 2 i,--I , `~~~ ~I~ , ~ cs ~ ~- . ~s-. ~ GI 3 ~SyR 3/ is O e, ~E' ~,e cs .~ •? -~ Remarks: Remarks: . ~ f' ©- ~ to yR zlZ S1"/. 2,`F, sb~. nM-F ~ S Z~F . s ~~ A ~ - i ~ ,. s yR 3~ ~ ~~`~ S ~ ~, ~, sl~~ ~,~,-F I ~ c s ~ . y . s c, P,G ~ ~y~ S~ -----, s o, ~, s ~P~. cs .- . ~ . ~ eZ ~ ~ ~ ~- s/ l-~ sd~ ,~~~ ~- ~ y. s Remarks:. Boring # v;? v._h ~Uitil Fr y;~ Ground elev. ft. Depth to IimiGng factor Remarks: eon oonnio ncmn~ .~ ~. 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WARRANTY DEED THIS SPACE RESERVED FOR RECORDING D. S1SSS~4 STATE BAI~' W SCONSIN FORM 2 -1882 von 1~74~,~~T4 Greenwood Enterprises, Inc., a Wisconsin Corporation, - .. -__. - conveys and warrants to ..Richard L._ Lambert and Sherri L. __- - -I,am1~~r->r-,-_h~sband--as._wife__as--survivorship-.marital - - ---------------- property.---•--- -----• -------- the following described real estate in ._-S.t_..__CrOi„x_______________ _ _ State of Wisconsin: -County, `mI 1. P..'. :1.. ..7\ '~~` ;'; `,!I r l4bC~~G i~ ~.'sca_.t~ APR 1 9 1994 ,8.0o a. ~~... - ,: ~~1 ..~..... RETURN TO Heywood & Cari, S.C. P.O. Box 229, Hudson, WI Tax Parcel No_ ______________________________ Lot 24 of the Plat of SunRidge filed in the Office of the Register of Deeds for St:. Croix County, Wisconsin on September 22, 1989 in Volume 5 of Plats at Page 71 as Document Number 451750. `~'.~; o ~. b_.:a _-~ This .._.___is--not.--_ _-_ homestead property. (is) (is not) Exception to warranties Dated this ___________________ ~ r'~ .-:~_ James E. Rusch President - --- ---- ---------------------------------------- --(SEAL) AUTHENTICATION Si tare(s) ___J~~ ~__~,__~tus_cb.,___P.r_esi.den~___._ -authenticated this __/ da of__.~ LAG v' --- y ~'----------------- 19__94 TITLE: MEMBER STATE BAR OF WISCONSIN - ~Z~, ~SE~) .Q~ Mary ch, Secretar Tresb~r -1 y! ue~K; -- - ----. L ~ . e: -- -- - - - - - - - - --- --- - ---vim =y(sg~~,~,~ c~ ACKNOWLEDGMENT ~4 STATE OF WISCONSIN ss. ST. CROI?C .County. -- ------ personally came before me th~s _-__1~~___.day of ----•----~2ri1_____-•__R ---___---~ 19____---- the above named ________Mary__Rusch_,- .Secretary/Treasure r__--_-___ day of 94 ..,,,~ 1 ---- , 1 - -<~ ~I (SEAL) • ~ DQGI_JMFNT NO i STA.Tb; L'A1C OF ~VISCONti1N FORM 12- 1982I~I PARTIAL RELEASE OF MORTGAGE ~' i r~-- ------YOL ~O~4PAGE ~~`~ _- _ - '--__ - __ _._.- - -_ _rr__~.- f ll'. :~1-~A'.:;_ f. L'.5[RVI.D 1'(7R RL':~>RDING DATA The undersigned certifies that .. Verlyn_ E. Benoy,-- Arlyn L. ~.1,,,~1i~~ro~ ~s~J'.y ~4~ Benoy..and Wayne- A, ..Benoy, as .tenants in common- -_ _ 1<'.~`u" tiar~:'~r~ area tl,e present owner of a mortgage executed by .Grae~wood--Fnt.e.rpri.se.s,,~ APR 1 9 1994 Inc, ,_ a Wisconsin.Corporation V rl n T' Beno Arl. n L._ Benoy--and Wayne__A. Benoy, ~~ B.OU A. ,. to e.. Y. .~~ .. _.Y,.. Y ... ~~P~ as...tenants. gin, comm4[t._ ..... _.. ... . ...... ...._ -- .. _ ,~C hh~~~. r ~ . . to secure payment of ,^y.-..51, 366.88 __.. ... - ,dated ~ V ~`s~i's~r~'l~S:~ - Apri.J..-20 --- - ----------- --------- - _- - - ., 19..90.-, recorded in the ~ ~_ _,,,,~„ office of the Register of Deeds of ..-....St.- Crox..__-----------------_._-County, Wisr-onsin, on ....Apxi.l_30..__.._ ..._._. t9.9Q_ - -._ __,-._ __~,-_-_- RETURN TO as Document Number .4S89G7--..--_..-..._.. _.-----.--.----._ .............._ _-, in li ~~ s Ca-,.~ (Reel) 869 (Records) (Image) 247 (Vol.) ....-- - - -..-...... of (i`4ortg's) on (Page) . ................ _ ~'__--- has the right to release the same, and hereby releases from the lien of the above described mortfiat;e the follmvin~ described property located in .. St. CroiX _,-_--.Counts', Wisconsin: Lot 24 of the Plat of SunRidge filed in the Office of the Register of Deeds for St. Croix County, Wisconsin on September 22, 1989 in Volume 5 of Plats at Page 71 as Document Number 451750. The undersigned retains a lien upon the balance of the premises (not heretofore released) described in said mortgage. Dated this .. - ._ /~._ day of VerYyn E. Benoy O ~ 'l • ... ARLYII .L ..BEL~IO.Y ................_ -../....... ~~ ___ _ - , I9_ 94 . - liV ~ ..... •. ~~) . ~G ..~ ... - • --- •--•-- ----- ~ (SEAL) -.Wayne..A....Benoy .......... ...................... AUTHENTICATION ACi{NOWLEDGMENT Signature(s) Verlyn E. Benoy, Wayne A. Benoy STATE OF WISCONSIN and Arlyn L. Benoy ~ ss. -----------------•----------------....__.._---------- - - ------ St. Croix / ---•--•------•---------•-•-------•---.County. authenticated this ._J--.day of___..~~Lf.:~-_.__, 19,~y Personally came before me this ________________day of _.~G~o.__~~a~ ---...-----•-•-----------------•---•_•--.., 19._._..., the above named ~~l - --~ ...---•----•--'=~---- Verlyn E: Benoy....---•• - Walter liod nsk. ----------------------•.-----.._-.. •..._.....-------------.Y Y Arlyn--L-'--Benoy------------------•-----------------..._...-•---- TITLE: P/fEbfEER STATE EAR OF WISCONSIN Wayne A. Benoy ~"1 ~