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HomeMy WebLinkAbout020-1111-02-000 o O 3 m o d Lon r m - 1 (D M CD 3 CD 1 3 - 3 A SN C N O f (7 0 O O N O W N YI CCYII N a z 'o 1 C C 1 w sv (n CL O D n N ~ p 0 C) CD -oa D C) O A7 (n to 3 ° O p rn c w cn -C D m a w m (5 N (n co d -u W m Q o o ° W;o c o 00 C0a nra m i° 4~ ;l "WA CD CD Z z O O O a 0 (n N N N (C O' (D Cn O 'Y .Or y^ -p O 0 CD - CD A Cn o. a) I cr (A ° m CD m .N. O SD N Cl) CL 3 (D r Z N « C co z ' 7 CD O 0 O 7 O O O O N -b 7 j COD Cn ~I CD (D (D C D CD CD W CL 7 _ z CD A Z O o m _ E3 ~ K p Z O 0 ~ o' oov m~N CD z c z O 3 m 0 N z CD W A DQ (D O L2 O M CAD _ go C o= T tU C O 7 p a T N. w O cn N O_ W 'A N O ` N a O ~ n C CD p O V N N p CD qz~ (D y A 0 A D CD Oq W w O p r rv y~J O CD O CL y Parcel 020-1111-02-000 01/07/2005 04:38 PM PAGE 1 OF 1 r Alt. Parcel 12.29.20.450D 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 CLARK, PETER D PETER D CLARK 289 EDGEWOOD DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 289 EDGEWOOD DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.309 Plat: N/A-NOT AVAILABLE SEC 12 T29N R20W SE NE LOT 1 OF CSM Block/Condo Bldg: 5/1407 ASSESSED WITH P450E & P45OF Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-29N-20W Notes: Parcel History: Date Doc # Vol/Page Type 03/27/2001 641376 1608/122 WD 07/23/1997 1237/021 WD 07/23/1997 851/56 07/23/1997 796/75 more... 2004 SUMMARY Bill Fair Market Value: Assessed with: 48523 223,800 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.075 33,300 139,800 173,100 NO Totals for 2004: General Property 1.075 33,300 139,800 173,100 Woodland 0.000 0 0 Totals for 2003: General Property 1.075 33,300 139,800 173,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 138 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 t , ~K✓~ A \\_V~ PLB (o7 PLOT ai nJ CROS5 1 Suff-ICT1014 PIANS 70 A 3 lie d f, a ~ /OiPa J1156- T_ CW) pk~a 'e'p e; NED HOMESITE SEPTIC PLUMBING CO. RT. 3 O'NEIL RD., HUDSON, WIS, SQ15 Tom- - % '7 t ROBERT ULBRICHT WIS. MAS1iR_PLUMBER LIC. NO 3307 M P R S. t MINN. INSTALLU, $ DESIGNER LIC. NU. 06663 Fresh Air Inlets And Observation Pipe SOIL 7'E5r1)a5 Iy M..3, TE TEST N(, RT Approved Vent Cop RT.~3 HUDSON, WIS. 1+4016 Minimum 12° Above F i n a l Grade 7 FT' 11ayi.4v"i yi.' Above Pipe 4" Cast iron Vent Pipe To Final Grade i ` ~rD Marsh Hay Or SyntheJc Covering fOA Min. 2' Aggregate Over Pipe Distribution --Tee pipe 0 0 0 0 0 71, Aggregate 0 Perforated Pipe Below Beneath Pipe S 0 Coupling Terminating At Bottom of System Now- Parcel 020-1111-02-000 12/14/2004 09:23 AM PAGE 1 OF 1 Alt. Parcel 12.29.20.450D 020 - TOWN OF HUDSON Current X'i ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner PETER D CLARK CLARK, PETER D 289 EDGEWOOD DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es):. Primary Type Dist # Description * 289 EDGEWOOD DR SC 2611 SCH D OF HUDSON SP 1700 W ITC Legal Description: Acres: 0.309 Plat: N/A-NOT AVAILABLE SEC 12 T29N R20W SE NE LOT 1 OF CSM Block/Condo Bldg: 5/1407 ASSESSED WITH P450E & P450F Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-29N-20W Notes: Parcel History: Date Doc # Vol/Page Type 03/27/2001 641376 1608/122 W ID 07/23/1997 1237/021 WD 07/23/1997 851/56 07/23/1997 796/75 more... 2004 SUMMARY Bill Fair Market Value: Assessed with: 48523 223,800 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.075 33,300 139,800 173,100 NO Totals for 2004: General Property 1.075 33,300 139,800 173,100 Woodland 0.000 0 0 Totals for 2003: General Property 1.075 33,300 139,800 173,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 138 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 Parcel 020-1111-04-000 12/14/2004 09:23 AM PAGE 1 OF 1 Alt. Parcel 12.29.20.450E 020 - TOWN OF HUDSON Current Xj ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner CLARK, PETER D PETER D CLARK 289 EDGEWOOD DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.403 Plat: N/A-NOT AVAILABLE SEC 12 T29N R20W SE NE LOT 2 OF CSM Block/Condo Bldg: 5/1407 ASSESSED WITH P450D.403AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-29N-20W Notes: Parcel History: Date Doc # Vol/Page Type 03/27/2001 641376 1608/122 WD 07/23/1997 1237/021 WD 07/23/1997 851/56 07/23/1997 796/75 more... 2004 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/19/1993 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Marcel 020-1111-06-000 12/14/2004 09:21 AM PAGE 1 OF 1 Alt. Parcel 12.29.20.450F 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 PETER D CLARK " CLARK, PETER D 289 EDGEWOOD DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 W ITC Legal Description: Acres: 0.363 Plat: N/A-NOT AVAILABLE SEC 12 T29N R20W SE NE LOT 3 OF CSM Block/Condo Bldg: 5/1407 ASSESSED WITH P450D .363AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-29N-20W Notes: Parcel History: Date Doc # Vol/Page Type 03/27/2001 641376 1608/122 WD 07/23/1997 1237/021 WD 07/23/1997 851/56 07/23/1997 796/75 more... 2004 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/19/1993 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. ~L T 2-7 N-R ZC2 W ADDRESS 76 ~I~L IOC FST. CROIX COUNTY, WISCONSIN FD GO o oD / L SUBDIVISION LOT < < LOT SIZE / PLAN VIEW I)i,;tas~c~~s <iii'! 1iII1(~I1;ilUllti to ~n<~itl <<iru IiIt'IIt.~ Il 63 IIUW I,;VL:RY` HINC WLTHIN 100 FEET UI,' M'STEM well =5"7' r\7 r ~ /o /,C'ON 'S S (Ile INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used -0t) 9;,4SS7- /-O -Elevation of vertical reference point: /00 Proposed slope at site: SEPTIC TANK.: Manufacturer: Liquid Capacity: /0-z';V Number of rings used: Z Tank manhole cover elevation: 106' 0'? /0 -7 Tank Ir,,let Elevation: 10/~2- Tank Outlet Elevation: Number of feet from nearest Road: Front,~Side 10 Rear, O /00 ~cc1; feet From nearest property line Front, 0Side, 0Rear, 0 12- ~ root Number of feet from: well 7 7 building: Z (Include this information of the above plot plan)( 2 reference dimensions to ,optic tank) SEE I:EVI"NST': S I D1? r 4 r PUMP CHAMBER Manufacturer: L id Capacity: Pump Model: Pump/S' o anufacturer: Pump Size Elevation of inlet: Bottom o ank elevation: Pump off switch ele tion: Gallons per cle: Alarm Manufa urer: Alarm Switch Type: Number f feet from nearest property line: Front, o Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: _i3 Width. Length: 3 Number of Lines. Area Built: Fill depth to top of pipe: V"► Number of feet from nearest property line: Front, O Side, Rear, O Ft. Number of feet from well: "V Number of feet from building: S3 / (Include distances on plot plan). SEEPAGE PIT Size: Number of s: Diameter: Liquid depth: Bo f seepage pit elevation: Area It: 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 tank: Elevation of i et: Number of feet from nearest property line: Front, O Side, 0 Rear, 0 Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm 1anufacturer: HOMESITE SEPTIC PLUMBING CO. Inspector: RT,n„~uEIL RD V..o-HUDSoirWIS. 54016 /3 ROBERT ULBRICHT Dated: Plumber on job: WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S -IRi N. STAI YR DESIGNER LIC. NO. 00663 License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING MADISON, WI -53707 XXCONVENTIONAL ❑ALTERNATIVE State Plan DD.N-bar t ❑ Holding Tank El In-Ground Pressure El Mound Ilf assigned) NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. B 8 H Vevetopment, Inc. e/o U.Bjoltnstad,836 St. CtLo(.x St.N.HuAon 17-13 .91;,4 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV. SE NE, Section 12, T29N-R20W,Pa~tcets 1,2 9 3, Edgewood, Town o~ Hudlson Name of Plumber. MP/MPRSW No.. Count v Sanitary Permil Number. j~~ Robetct UZbtr%cGit 3307 St. Ctc.oi 49484 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV. WARNING LABEL IL OCKING COVER J /r PROVIDED PROVIDED 1t l IYI ~C ~r G 7~ ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.. VENT MATL HIGH WA ER NUMBER 0F' CAD: P PERTY WELL lauILDING. JVNT TO FR ALARM FEET FROM L.. /2 AR I r❑YES NO ❑YES ❑ NO NEAREST, 1/ J// DOSING HAMBER: Z-1, I MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMB R PH ERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET R LI IAIR INLET' PUMP ON AND OFF) ❑YES ❑NO NE E SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing v ,i + DIA ErEH MATERIAL AND MARKING 'ILE or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH NO. OF DISTR. PIPE SPACING. COV R BED/TRENCH ! Y11111 CIA uPlrs LIQUID DIMENSIONS TRENCHES M CT R A PIT DEPTH GRAVEL DEPTH FILL DEP H UISTR. IPE DISTR. PIPE DISTR. PIPE M ERIAL. NO. DIS NUMBER OF PR OPERTV =LB. VENT TO FRESH BELOW PIPES% ABOVE COV ELEV. INLET ELEV. END. PIPES. LINE AIR INLET. fir-. FEET FROM e NEAREST MOUND SYSTEM: 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 O REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. T ON SURED. ❑YES ❑NO z --4 SOIL COVER TEXTURE PERMANENT MARKE S ~BS RVATION WELLS l ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH 'BED DEPTH OVER TRENCH: BEE) DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ❑YES ❑ ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO DIS DIST IPE DISrRIBUTION PIPE MATERIAL. & MARKING ELEV.. ELEV.. DIA. ELE V. PIPES ELEVATION AND DISTRIBUI ION r INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERI L VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: MBER OF PROPERTY WELL. BUILDING. IZEET FROM LINE' ❑YES ❑NO ❑YES .l-❑NO EAREST C, `I 5 4 2 Sketch System on t n in county file for audit. C, l Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710 (R. 01/82) wisconsin APPLICATION FOR SANITARY PERMIT yam,.' OUNTY DILHR 'EnT (PLB 67) # nOUS In OUSTRY, LR~ Lg90q 6 HUTgn RELRTIOnS 1 UNIFORM SANITARY PERMIT -4147111,? -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS ~.73(~ S/ cpLdiX Sf 13 f! It oEL-o pme,,) T- 4 o- A To/evsrAv NoRdt- flvDSo J , CJi'S . PROPERTY LOCATION _ -LT V >e E 1/4Nt 1/4, S I 2- , T 2& R 20 E (or W TQ o: ~luDfoAj LOT NUMBER 11BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER ~ BPS ! 3 ~o~ cvv a~ Sf hwy. 35 TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. E j Public (Specify): THIS PERMIT IS FOR A: 4 New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System I❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill U In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total # of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity X Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: E~ S row ct-e .e CZJ / -owe I IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber IManufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED( are Feet): 3 s CO X 36 [ Private El Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plilmhar (Print): Signature: ~Qe,~ o pQ IbW'/MPRSW No.: Phone Number: HOMESITE SEPTIC P UMBING CO. (7/5 Plumber's Address: ROBERT ULBRICNi Name of Designer: WIS. MASTER PLUMBER LIC. COUN EPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved , ❑ Owner Given Initial :Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADIS ON WI 53707 HUMAN RELATIONS NE- (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ HldtPdt+ : LOT NO.: BLK. NO.: SUBDIVISION NAME: Sc 1/4 1/4 /2 /Tzq N/Rzo E (or HO-010A-1 AX s i z 3 E•~.e W00 LD COUNTY: OWNER'StROY€R'S`NAME: MAILING ADDRESS: S~. C RO14 )3 y -01.e L).e-26,K to -t- 41--c- . 10. Q S a R is 7A D P36 S{ 4o:,r s7(. /Vo,rd~ h/vvf ov USE DATES OBSERVATIONS MADE 4e-.)If NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 1+ New ❑gReplace RATING: S= Site suitable for system U= Site unsuitable for system OA 441 1 r/1N~/1_,_l0 CONVENTIONAL: MOUND: GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ©S ou oS our oS ou oS ©u EIS au -vvEvr/oA14L ~ /~y36 If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the ~~AI _-under s.H63.09(5)(b), indicate: 2-O! Floodplain, indicate Floodplain elevation: /V DeC/MiL ff PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) .112 ~WaN . s / . 9a ' 6'e. C's ow. CS 4,/ p-.%L Gee . 4N•s1 •67 0)e - N. oP'?ANga-~,e B l2.41006 /Z p' s B-3 1. 2, v /01 PP 4 13,v . v e S /J v. s 1. off'. S B- 7 12 0 750 s~' /3,). s/, . s , B- yo~ /613, 2v- > yv , A/V s, Z.01f' s, ss~ Q~ B- w j)rciA,aQ FT'• PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN, AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P_ 6.4- 9fe - < Z 2A s ca e k P P- 2- 6.7 L _574A-) P- p_ Z ' tc'Ol Pti. DIPAIA) D t PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- 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. ~T SYSTEM ELEVATION 13,f^~ I pox) S-A fr 6oT L • i0 32 ' 27 310 • = MC4d F- Pi TS P 1 51- 7- • a Z y E ~3 rs Top SE" k ez [33 as Lo7- ~RoN IR -WIC0 61 'y PIP-) I Sep 36 '"Ch 00\Jent~on ~f611,f7 , lot ' 13 =_l Uv • 0 G f fD,K~J l T" I Ro osEv I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): RO WS= 7TS TESTS WERE COMPLETED 0 i1 1V1 r. 1 1 J._'. 1 L 'r JLWR S. T IT 'NLUATIQNS WE RC TESTS' ADDReS i r F% CERTIFICATION NUMBER: PHONE NUMBER (optional): C ;r, 55-02482 RT9 38 ()IkJ L RD, HUDSON, WI 54016 CS GNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - , t . a o . . , _ it. S SO. bjy,~ i rf a cD bf,6 Qq0 and 1"mrate soil f, ; : yow b ynerq "Hint bye tndo 2h ua a sioct[£" n must c iew €y n lie ,:&eVwF W is is a i-esidencc; ni bc'}enmerci as pri iiect,; ,:z.. 1\11AX M11i, Pv'I i[une1 of I)i;[:i,octToS Cot c€:IInIyle1,'if i USE'. '}[a? i;<; 4, Is this z W of Y€ pl at o.n 4 i systann: 5. CE~ltwl ;fi; 1hq ~it,x.11€y r tir q Want. A SITE 3 S UI S rt~LE F )R A ~-$OLD!N(,, fi 4l 3F "L.~. 014F } S ARE RULE U BASED ON SOIL ,.1"rNOI I I1. NS; f Pl-f ASE ow, W eatAw iw w shown Vier. for vWting profOe (escriinions and urn pie Ong t1w 1 teat plan; l ,f t_r::=9Bi E f 3;s€aram i?i.ca :x y nw€n yon" lam _ .m(i?nk Di t ii',':I o scale IS pre ,io(7, ~s i -t of,3'r be nse £ if Ali':'.;€rc'£l; w, f P 4c _ w: br`ndwric"ii',` and ve w._, .(l atiotr7 whf ence point are clewly sh r q,s WWI are pa rtlancid; t :.,r.:-., . o IF „l;o:b;c prime hti xos e"" to dates, rya"a(1tes, ad'dl €%sses fio4?d tal i tr ?1;.'.ii4Jtl i~:.'S, £;Xc;r7i(7- Ql~ it al4molm we; I.F. t{ fo .w,Ani (01 01 as fl ! Pon, e .tail M) does not <apol , plat; , , ,ii ? E, box; S a . SN We #oi r Won 1 3wT your cur , ent af£hm and your mr e,'1, l icn3 manner; 2, Make legH 1P ow£:, am! da j ihw , as rf .p r'Ni. ALL SOUL TESTS IMUS-T 81,.. FILED VVI i H TV-IF L( ni.,if'i - L AUTHOR 1"i-,( VE> S . c-Nr ~Li Drb.'+-`~F3 Or it ;PL',.".. & tL)Eid. ABBREVIATIONS OR C E'RIFIF1 SCIH. FESTERS Sod °Eep malaw4s and ae""tfl M' OlPer Symbols S 3 e ova isl RR ~ W, cock on, C,)fbi.")fe 6, 1 0SS - Sl danne G wvl N : - 3"), LS i... e E -tune j x cs _ f Fb_ tse £7itod 4'em P 'Etb flt on Rate fn Fine Swul Bug Boldiruf Las Than So . i_ ani B1 _ is `ck S;: Cat y Gay - Coy i_ow y S r' Gov :w fry 1101 m ft, c wn, =mix ° - ? ' Sky co, t ,d UNY f. 1 Maly, 11 'D .iin", L ~ OT1 (oQZ -W of MIS Stilt € . . the Kid APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractql~,("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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9W 13oit-vEw5 (2or-0 or,1ZVt, 4te-.~ Owner of Property 'l Location of Property .SIC- ~4 Section /2 , T 2f N - R Z ~ W Township A10 PS0. n _ Mailing Address 3p Subdivision Name / Lot Number ~1t/P S j Z 3 7~-~~ 1,676 6,Lt S V Previous Owner of Property 14Total Size of Parcel 1. O7G0 S Date Parcel was Created Are all corners and lot lines identifiable? x Yes No Is this property being developed for resale (spec house) ? X Yes No Volume Ly _ and Page Number S as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (We) eeAV6y that a.P.C .6tatement6 on -thin 4onm ahe tAue to the best o4 my (ouA) knowledge; that 1 (we) am (ane) the owneAks) o4 the pnopenty dean bed in this in6o4mation 6onm, by vi4tue ob a wagAanty deed neeonded in the 066ice o~ the County Regi,6 te/c o6 Deeda as Document No. 139% i ; and that I (we) pne,senfity own the pnopo.6 ed site Aon the sewage po6 e ys tem (on I (we) have obtained an easement, to stun with the above descA bed p&opeAty, 6o& the eon6 t&uc tiov;, 06 said .6 y~s-tem, and the z ame has been duty &econded in the O j 4ice o6 the Couw.:y Regi~t--, olu •Deod,, 9--n imo"t No. - - 1- SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED S T C - 105 r y H ` SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County _ 13 U/Ll~r/ps ( J),e 0~ N ' CO WNER/BUYER c 11 M ROUTE/BOX NUMBER GOix S~ N0 Fire Number CITY/STATE M0 P- f+ 0~ ~1 "LIP 5Z ' A~ Section `T 2 / N, R 10 W, PROPERTY LOCATION: q Town of v~`Sa~J St. Croilc County, C'S./~t . Subdivision 2EVP1A)&- Lot number i 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 pumLer. 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 may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all newsystems agree to keep their systems properly maintained. 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. o I/WE, the undersigned, have read the above requirements and agree Un to maintain the private sewage disposal system in accordance with x r, the standards set forth, herein, as set by the Wisconsin Depart- lu ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED :.nom ~7}./.- c DATE ? `r St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. VII-ILACE BOARD RESOLUTION Resole c 6, that the Certified Survey Map in the SE1 /4 of "[)c N1:1, of section 12, T29N, RZOW, Town of Hudson, B. & IT, .Dcvclopment, l'c'; Owners, i- '1_,r.eby approved by the 1 ilia-g Board of i he Vil.la~c oi: ih Hudson. date appro\>ed Wallace Gregerson, President date signed '.\,Iaurine Brynildsen., Clerk C R i IN D ~URVEY rA Located in the SET /4 of the NE 1 /4 of N Section I2 , 129\, R20''.~r , N E CORNER LEGEND RIX), Town of Hudson SEC 12 ® Surveyed for: SECTION CORNER MONUMENT MF BERNTSEN CAP L Mro h& H I': C ti ~+.t? 21 z cy 3 M 836 St. Cro;,- St. \o~ O I"X 24" ROUND IRON PIPE WEIGHING 1.68 z om v LBS./LIN. FT. SET. m -i~ Hudson, Wl S69°09'47W TM? N=GZi w _ 407.11' o M m c z POINT OF BEGINNING o `J Gg SCALE: 1"=100' UNPLATTED M LANDS ZG3fl5 0°~ w - - - - - ° - - - ~J ° 6l_ p E 1/4 CORNER 20 SECTION 12 2 N 8515q'41"W p S 720 3 ~0°0p,00 T29N;R2OVV S16° '34"W 5 TZ°36 ~C'7/ ~O 'S 6 2L4 W " ~N°3330.. T I~ / 2p 9po00 ` n 00, ' ; ~ ti co N z 1 % 9 E 1 ° 131 6. "r 9, UNPLATTED LANDS o° N6~ e,80 S 8745' 56"W 54048'03" z15°11S7" m 5 Jr- w S60°02'07"E \ 2 }Z °i } O 5A 401 S ~ SCALE I"=100, A O to 0 25 50 100 200 300 0 ? 3 m 0 o s ° 150.00' V 0 N89°15 56 E DESCRIPTION A parcel of land located in the SE 1 /4 of the NE 1 /4 of Section 12, T29N, R20W, Town of Hudson, St. Croix County, Wisconsin, described as follows: Commencing at the El/4 corner of said Section 12; thence N1013147"W (assumed bearing referenced to the East line of the NE 1 /4 of said Section 12) 1321.97' along said East line; thence S89009'47"W 407, 111; thence SOo50' 13"E 359.94' to the point of beginning; thence S72036'20"W 263.85'; thence Westerly 187.48' along the arc of a 250.00' radius curve concave Northerly whose chord bears N85054141"W 183. 11' to the Easterly right-of- way line of State Trunk Highway "35"; thence Southerly 66. 6 P along said Easterly right -ef-way line on the arc of a 1975.08' radius.curve concave Westerly whose chord bears S16°52'34"W 66.61'; thence Easterly 187.06' along the arc of a 316,00' radius curve concave Northerly whose chord bears S83012'46" E 184 < 34'; thence 524050' 10"E 91.09'; thence Southeasterly 98.30' along the arc of an 80.00' radius curve concave Nortl.casterly whose chord bears S60°02'07"E 92,231; thence S5°14'04"E 155000'; thence N89015'56"E 150.00'; thence N1015'56"E 369.62'; thence \17023'40"W 66.00' to the point of beginning, containing 100519 square feet. (2.308 acres) more or less, and being subject to a. non-exclusive access easement for ingress and egress as shown ,on the face of the map, and also subject to all other easements, restrictions and cov- enants of record, NOTE: 'This Certified Survey Map is being created, pending municipal sewer and x,a.ter, per Wisconsin Administrative Code H 65.03 (4) (b), using lot combinations. Individual lots cannot be developed separately until this restriction is removed, in writing, by D.I.L.H.R., or the appropriate state agency, and not until municipal water and sewer are available. „ THIS INSTRUMENT DRAFTED BY i2d@LYd'`d?trd"wtis2fi]'lui~F50._MCPF.. sSw:Lxma5w1"77aC"LT.r .Sv::4YE ~r .n."ti .v fi'f-: un: 9k 5aTrav,ac[saev ~a ova 7• I, James F~', Basch, r.ecjstered. Wisconsin Ian(] ;.;urvE,yor, clo her'Chy certify tlia I have survr_-~Ted and mapped th(,, above describe.' p.-roperty; that such plat is a true, and correct representation of the exterior bounda.ries of the land surveyed; acid that I l;av(~ fully compli ed with tl')e provisions of Chapter 236.34 of 'tlze ~1 i.sconsin Statutes, the Subdivision Ordinance of St. Croix County and the Subdivision Ordi- nance of [`.,e Town of Hudson to the. best of my professional knowledge., under- standion and belie. % Tames E. Rusch~ "`disconsin Land Surveyor S--1376 JAi1~ESE. " RUSCli R 421 Second Street S-1376 i•~ .o a Hudson, Wisconsin 54016 ~ e Hudsa A' 6Yis ~7 December 19, 1983 Sun This map is hereby approved by the i Board ~C~~ata s a~~~' Date CABernaxd Kinney CURVE DATA TABLE Curve Lot Radius Central Arc Chord Chord Tangent No. No. Angle Length Length Bearing Bearing 1-.2 2,50.00' 42057'58" 187.48' 183.11' N85054'41"W S72036'20"~`y 2--3 1975.08' 1055'56" 66.61' 66.61' S16052'34"W S15054'36"W 3-4 316.00' 33055'00" 187.06' 184.34' S83012'46"E S66015'16"E 5-6 80.00' 180000'00" 251.33' 160.00' N65009'50"E S24050'10"E Boun-80.00' 70023'54 98. 30' 92.23' S60002'07"E S24050' 10"E dart' 3 80.0.0' 31012'54" 43.58' 43.05' N69°09'29"L 2 80.00' 52036'48" 73.46' 70.91' N27014'38"E 1 80.00' 25046'24" 35.99' 35.68' N11056'58"W N24050'10"U TABLE OF LOT AREAS Lot Square: Acres TOTAL AREA PER H65.03(4) (b) No. Feet 46859 Sq. Ft. or 1.076 acres 1 13478 0.309 2 17554 0.403 3 15827 0.363 CONSENT OF LAND CONTRACT VENDOR I, Anita Marty, Land Contract Vendor of the above described land, hereby consent to the surveying, dividing, mapping and dedicating of the land described on this plat, and further consent to the certificate of B. & H. Development, Inc. , Donald E. Bjornstad, President, and William C. Harwell, Secretary, Land Contract Vendees. WITNESS the hand and seal of Anita Marty, Land Contract Vendor, this day of December, 1983. witness Anita Marty STATE OF WISCONSIN) SS ST. CROIN COUNTY Personally came before me this. -day of December, 1983, the above named Anita Marty, to me known to be the person who executed the foregoing instrument and acknowledged the same. Notary Public, St. Croix County, Wisconsin My commission expires CORPORATE. OWNER'S CERTIFICATE OF DEDICATION B. &.H. Development, Inc. a corporation duly organized and existing under and by virtue of the laws of the State of Wisconsin,as owner, does hereby certify that said corporation caused the land described on this plat to be surveyed, divided, mapped and dedicated as represented on this plat, B. & H. Development, Inc., does further certify that this plat is requ`i'ed by s. 236. 12 to be submitted to the following for approval o objection: Town of Hudson, Village of North Hudson. IN WITNESS WHEREOF, the said B. & 1-I. Development, Inc. has caused these presents to be signed by Donald E. Bjornstad, its president, and countersigned by William C. Harwell, its secretary, at Hudson, Wisconsin, and its corporate seal to lt)e hereunto affixed on ttihis . , day of December, 1983. Corporate Seal Corporate Name President ST?_TE OF WISCONSIN) SS ST. CROIX COUNTY ) Countersigned ' Personally came before me this day of December,198' Donald E. Bjornstad,