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020-1315-00-000
.cousin Department of Commerce afety 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 Kirkwood, John Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: ~ ioo .o ,aa~a ST Gv~ To o TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing 0~ ~b~L. - ~' v- Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL / BLDG. ~- V~ Air Intake ROAD Septic , s r .~ ~/ Dosing ~ i Aeration Holding PUMP/SIPHON INFORMATION ~ //~/ Manufacturer Demand GPM Model Numbe TDH Lift Friction Loss stem Head TDH Ft Forcemain Length ia. Dist. to we SOIL ABSORPTION SYSTEM L L t ~- 'S =~ ~f''S 1 county: St. Croix Sanitary Permit No: 479446 0 State Plan ID No: Parcel Tax No: 020-1315-00-000 Section/Town/Range/Map No: 28.29.19.1596 STATI N ,,• ' X t/`~ B/S ~ ~ V r HI FS ELEV. Benchmark s ! 6~' ~O D ~ Z~ Alt. BM Bldg. Sewer /' ~-' SUHt Inlet ~~ ~ ~ ~ -- St/Ht Outlet /~' ~ v ~ ,1.3s ~s. Z~ //~~ B4~8ettorn I~o~ e ~ ~ ~ ~ • ~ ~ ~ s' U Header/ n. SI,d.Q., ~ ' ~ S. Dist. Pipe I I • S qS~ o~ Bot~tem y" ~' ~ ~ ~ $ ~ , ~ Final Grade ~~~~.- ~/ a ~aryr 7,(0 7 ~ ~~ ~ 1 St Cover &C/v '~ d BED/TRENCH DIMENSIONS Width r ~j LengJh~ ~ ~ (DD~~~~[[00 No. Of Tren~ PlT DIMEN~ No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WEL LAKE/STREAM LEA HING Ma act rer. r' INFORMATION CHA BER OR T Of System: r n ~2,S~f ~~i , Si ~ UNIT Model Number. DISTRIBUTION SYSTEM ~ ~ railt.el~.U. ,Q.f~2[ro Header mold ~ f Length Dia ~'1 4 Distribution r ~ ~ f Pipe(s) ~j p~y~, ll~I~ ~ "~ Length D e Dia Spacing x Hole Size ---~-- x Hole Spacing `J Vent to Air In e ~~ ~ SOIL COVER v v Procmirp Rvc4ame [lulu xx Mnund nr At-Grade SVStemS Only /~ Depth Over / h C t ~ ~- B d/T Depth Over Bed/Trench Ed es xx Depth of To soil xx Seeded/Sodded xx Mulched en er e renc g p i J Yes CJ No ~] Y s f ~~q No ~~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~~ Inspection #2: ! / Location: 521 Joseph Circle Hudson, WI 54016 (SW 1/4 NW 1/4 28 T29N R19W) St. Croix Estates Lot 10 ~ ~ Parcel No: 28.29.19.1596 1.) Alt BM Description =~8 t''o,+" "1 sl~~~" 'S S~S~j~y~ J ~ t~ 2.) Bldg sewer length = ~~~~ SyS ~~~~~~,,, !,o / 2 ~~ ~.' `~'~'~' -amount of cover = ~ 24 f-J f ~,yC~s p~. ,~3 GS T' 1~~ . ~ ~ ~ ~~ ,I .-- - -_ _--- - _ - -- - Plan revision Required? ~ ::] Yes f : ~ Use other side for additional information. ' __ ~__ i I _ - ~~ ~ ~i Date /~~~ ~ ~ ~ ~ ~ Inln ep~i atNure ~( Cert. No. SBD-6710 (R.3/97) CGti+{/ Wh q/ ~n. cS ` W 1'~ ~ ~Ty O~ ~ ~ ~~ ~ d / l~~zrs~ ~~ ~ Safety and B ' s/~~~s~t 201 W. Washington Ave. ~.~:~~1~'~. 6 County $'T. GRp 1~C ,~COnsi~ Department of Commerce Madison, WI 53707 -7162 `J~ (fig) 2bb-3151 ~ Sanitary Pe Ntunber to be filled in by Co.) G~ Sanita Permit A lic io r3' PP ~~~~~~~~ ~~ plan I.D. Number ,i /" In accord with Comm 83.21, Wis. Adm. Cade, personal info lion you provide may be used for secondary purposes Privacy Law, sl .04(1)(ngtj) / r roject Address (if different than mailing address) A ti L~ 17 »k 7F C. ~~ I 1 I. Application Information -Please Print AA Information ""' ST. CROIX COUNT O2 b /,3 /$ O a O O ./S9fi Propt:rty Owner's Na me IN OFFICE parcel ~ Lot y Block ~ tJoyN r: ~~. D - /O - Property Owner's M ailing Address Property Location 521 ~o l~'SPI~ ~ ~Rc.uE Q NV~ ZS $ ~' Ci Stau t '.i, !ii,Section Y~ Zip Code Phone Number , 1-t ~' nSO ~ ,~ W ~ 5~'O t b 115 ~ 3 $ j 37 9'4' (ci l rc e > Z ~ ~ 9 ~ II. Type of Building (check all that apply) T N; R E ot 1 or 2 Family Dwelling -Number of Bedrooms 'g" Su bdivisi On Name CSM Number ^ Public/Commercial -Describe Use A r S?• C Ro/x' ~T9~S . ^ State Owned -Describe Use ~City_^Village ownship of }j III. Type of Permit: (C heck only one box on line A. Complete line B if applicable) A' ~ ^ New System ~Repiacemettt System ^ Treatmettt/Holding Tank Replacement Only ^ Other Modiftcation to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owtter IV. T of POWTS S stem: (Check alt that a 1) y', ~~ Z S ~' Non -Pressurized In-Ground ^ Mourxl > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wedattd ^ Pressurized In-Ground ^ Holding Tank ^ peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. D' rsal/1'reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispe sal Area Proposed (st) System Eleva 'on ,~ VI. Tank Info Capacity in Gallons Total Gallons Number of Utti Manufacturer ,,si ~ 0.-~-e.Q ~ Prefab Concrete Site Constructed Steel •Fiber Glass Plastic ~ New Existing ,~~.~ 1 Tanks Tanks J Septic or Holding Tank 'tom 1 Ld 0 ~// ~ ~s ~ IQ+. Aerobic Treatment Unit ~ ~ ~ ~~ ~ tbsing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) tuber's Si lure 7~MPRS Number Business phone Ntunber Sos u~aR,c~+T ~ ~ ~~ 31~ ~~s• ~~z- 3~'2. Plumber's Addre ss (Stt~cet, City, State, Zip Code) 2$!Z. lO~'N AJE ~ SPtRtNiq Jgt.t•EY~t,.f i , ~6~i7fi'7 VIII. Cotmt /De artment Use Onl a Frmit Fee ncludes Groundwater Date Issued Issuing Agent Signature (No Stamps) ~' Approved ^ Disap ved S~ ~ ~ h ac ^ O n Reason for Denial g ) 3 ~ - 5 . o ~ 2eA~ 1X. Conditions o prov 3) bus ~~tx~c-az 13,~,,~ l,D n e. i ACi SYSTEM OWNER: ~"_- ~ i 1 Septic tank, effluent filter and ~~ ` r• n _ ~ ~~~~~ ~ ~~ ~ ~ dispersal cell must all be se V ~ -C1 ~ a t i - rv ced t ineintained as ~- per management plan provided by plumber. '' ~-n~ J -{~ ~$- ~ ~ 2. All setback requirements must be maintainp~ ~` 5 ~ ~~ °"""'~ ~ ~- >~ L t~ ds Ner applicable code/ordinances. u ~ ~~2~M ,A ~ `~ V'QSf ~~z s/ea/ ~s-~ ~~ -~ ~.Q~ ~ ~ ;~C IRJ'C!_~N p a 2 v 1315 0~ ono ~~£3oF3 NEW Qut.t V•4e.VG 93.`t j"~~ rc ' GPI' i Y ~ R. 8 n'~ ~ O R. F•~JST~~Ot 8Y57`~M 2 ~ 45 S*'S~N +Z. cL~t72' Z~~i' ~''r/ 2 kit 90 ~ ~-"~ y.4 F~t-~R ' C Z~~ ~ ~: - 99.31 ~ zz~ ~~ Z~ "' qJ1! 3 ~~ . '~ ~ ~' ExtsT~N ~ $• 3~ x 8~ .. i ~ ~, 12.0 0 '~ ti z SEP~r~ c. D B3 TgNKS C~R~~~. -To Q ~ ~ J ~ ~y _- M :... R~u~ J S~( ~,~, e eartc~ /~ `t3' Hausg , p wE~. ~ J ~ c---'. . . ~s, - a Ulbricht ~ A ss Private Sewa °Cjates 2812 1 Uth 9e ConsUl~n~ Spring uall V jW eY l 547E 7 50 u ~ AR o1'Frt - 'T+4'' ~~iv E $2 ~ R3.b1 a3 . 9q.3r ~ " ~~'`~ ~~~ 6 M 1• M eta rte ~, c cod 6 BM',Zs sOT R= IbQ,pO ~ SG~.LF ToM OF SIL~u~l~~ ~pr.S1 ~~~ = 30~ ~F`~vr~~a-r cs~~~~ q 5.8~ F ULBRICHT & ASSOCIATES CO. 28i 2 10th Ave. • Spring Valley, WI 54767 Reg. Designers of Engineering systems 715-772-3442 Private sewage Consultants PROJECT INDEX PLAN ID # DATE (,( I5 2[X~ OWNER JdyN hG/RK1.~}ND PHONE 7/'S- 3i81~5794- ADDRESSrj~ 2.1 .~ OE+E~1-L ~{ ~G L~ y N- [/,DSO ~1~ 1~ l Jr'9' Q ~ ~p LEGAL DESCRIPTION PlDS o20 ~3~SOV Oaa S E' ~/~~ NW 1/s+y 5 2L~- 'l' Z 9N~ R 19 W LOT /o $7 GQOIX 6S~"gTES TOWN OF }~ VD SO fJ COUNTY S-r• GTZp+X ' CSTM J Ef,fJ r u~~R.~r-r - ~'599~3~1'- LOCAL AUTHORITY/ SUPERVISION s 1 _ C' f2oV~ ~'Oc~--r Zp~.IINy PROJECT DESCRIPTION: IQEPt-gG~MI/'n/T <.SYS?'>EM Fv/L A '~ f3~A/Zoc~M S+i I~ Its l'-to.utS'. A. $G~.L V9LVL~ h/i~c. 13d ~tAv~/~ Fv+2. FuTuR~ NSE OF '~x~~7iNC~ SYSTEM PET. CST ~ GE27'F/a~'A SD ~G.TES'T~IQ~ ('U~ F/ R.M/~'f'+Vn) A "' ~ f}QPRoV~q L.. A Z aru5 $~!5/~! w +Tr/ q q." 2 A F3E' L ~ A! 1$pp) W ~ ~. ~. r3'lr ~1 P DFp D ~'F D F /EXiST~w1 (~ ?qN 1c. PR/v2 To ~ONNE'GTiv~ L~ltTiy /QEIOt-sIc-EM6nlT S YsTFM . Ulbricht & Associates Private Sewage Consultants 2812 10Th Ave. Spring Valley, WI 554A767 THIS POWT SYSTEM SHALL ~4~ ~ T_ v` ~ ~ ~ ~ C ~~ INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL ~ ~ ~ S ~ ZZ f!Q 3, S FILTER MODEL # ~ , ~ ~j O O g .~~- °S Pg.l INFILTRATOR SIZING WORKSHEET Pg.2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. s D c~ .~ Q ~~ m ti Z~ a (~~~ a ~i a~ 1 rn (~ ~~ y ~ ~. ~~ n \ G 0 ~ c y h ~ ~~ o ~ C ~ -Q m ~~ ~ ~ U ~... Q v~ -~.~ -,~.. Q ~ W W ~ ~ o ~ •. jv ~ ~ ~ ~ '' N ~ l /~ ^V A 1 1 ' V , N !~ t u A7 y ~~ 0 * o U b J ~' ~~ '~ `~~ ~ , 6` O ` 'k JRK1_A~N p c> 2 0 ! 3 15 o t5 000 P~ttq~3oF 3 NEW $uiJ_ Vq~v6 3 2645 f3~4'St+v 2 5' w/ 2 k~t+ ~'4 FJt'i~ 99.31 50' E?CISTJ N ~ t zoo ~EPTt L TANK3 'fc Q5 R~u~p Ulbrrcht & Associates Private Sewa 2812 10th A ee Consultants Spring ualtey, Wt 54767 Sour PR opC-t~t 'r`r ~~N E Bt. 93.~J B 2 - `i3 bt ~3 . `T 9.3J 6 /y t - NI Aa ~ ` c coy 6R= 1bO.pp BMZ: J3o-r7~pM pF. StaJnl~~ Ipr.St ~ F'F~- l.~'J;' t~'r ~.6J61.. ~ 4 5.81 • ' 8~Has>3e~Jaq~ ~ = ~oJJ TOu~ SGA-L fr /'• . ~ ~ O v~~r" ~c ~ ~~ i 1 ~~ .Uliv. ~ (., ~ ., ~~~ ~ ~/ ~ ~7 = -~~ ,.~ /9Pp~~~~ vim?- c,~i. d v~ ~NS~1 ~t T/ov ~3~~ ~rii - ~. ~~iviS~ED sue. ~o p~P,~~~- '-~--~dc q'7•o T~P~~ c~ ,A, ,, ~~_ _- :- //)) r, r - _ ~~ u~L ~P~9~~I~ ~.. s ysT~M ~/~v, q ~y . oc~ C~'©SS Sic ~'iav ©~ Tr~~"~v~~ls' ,~ ys, ~~ c~j~i4crry - __ s. ~ s ~ c,~-p~crry ~ s~-~ ,e~.~ c~,os ~- -f~ , ~~~ ~ SSG T~'o~ ~ ~ ~.v ivS~J~cT/o,,v ~/~,~, ~1i~v. i z ' r ~, 30 ,, Ar'.~~ /,vii ~7X~T4~ ~~ 12- ~ 1/// sc~. ~o ~~~c "'Z._.. - F/iV /SEED TiP~.t1 cif ,, ,, ~ - .. 1' . ._.... .- • OWNER ~ s MAINTAINCE..OF.SEPTIC SYSTEM • PON'1'S (landowner maintenance ~ is reponsible for proper operation and servicin °f this system, Regular periodic ins ections g is necessary for the safe health P and • systeAt. The owner is required b Y operation of;this ' maintenance/inspection reports toctde to submit all necessar he controlling ,authorities .. SPECIFIC CONTACT AGENTS * Governmental authorit ~~~~C~ C~~• Y/ inspectors: * Licensed ~~ 3 Ce ~- maintenances„staller, responsible for providin i7sers" manual; 9 an operation/ * Licensed service / in ~ r ~ ~ ~ ~~'~o ~ ~ S spectan agent other • T/Q! -' GT than installer: --s~4~J~'T~1f-T1D ~ f3"p *. Electrician, fog pump, electric contro ls, wiring units: ` /lJ / ~i \ . - ~, . IMPORTANT OWNER MAINTENANCE 1. Minter traffic- RE UIREMENTS ' area shall (sledding, shoveirin not be permitted g' etc.) across the the cell, freezin °r frost can/will winter, g uP the system. Penetrate into (a vacaction tri Discontinuos use lead to freeze ups, - P, resulting in no water-casein the • ) can a~.so 2 - Water conse rvat-ion needs~to be hydrollcally overloaded exercised! designed for a and destroyed. Thisrsvsstem can be maximum wastewater floes of }gem 'was 3• POWTS are ~d~ gals. daily, not des i -`.-'--"'- disposal unit fined to accomodate Any introd or any other wastes from a garbage , uctiott of unnatural sources of waste. destroy this such waste materials will overload and system, 9. If a power in a tem outage occurs •' porar °r a pump fails, it maYfresult cell, which mays °veri.oad of effluent bein recommended t Y adversely impact the cell Pumped into the. allowin hat a licensed pumper em t (leakkge), It is Consultg the pump to return to dosin P Y the dosin Your installer g the correct g tank, immediately for advice. amounts. 5. Neglect of t erosion he vegetative cover traffic preventive} can Lead (the Cells insulation also can destro t° failure. Compaction o & REGULARLY WATER THE y Y t he system, r heavy the EGETATION It IS NECESSAgy TO system beneath OVER A SYSTEM!! -~; `~cov~tr. IS MOT sufficient alone t0 Effluent in maintai;~ a 6. Periodic inspections b necessary. Inspect Y the owner i or hi s int on a o t i gent he s P Pes an s, is Ystem: d Ports o ha inspects n the mo ve been i u o n nc n d o b r a ~_t pinp,~1 ~,_ sal era„ ,____ poratoa ~-~-,.o~ ~: ~:~=Erg f ~ ~'0~~ ~.-~ ST. CROIX COUNTY ZONING OFFICE Wiso~rr$in Depararrent of Comrrrerce A?'!ON REPORT Division of safety and Buildings Page ./ of 3 ... ____. ..._........... , ..J..-~.,....,.....o ~aaa- complete site plan on paper not less than 81/2 x 11 inches in size. Plan must S 'r. C R o ~x u>r~ude, brit not lurritted to: vertical and horizarrtai reference point (BM), direction and Parcel i.D percent slope, scale or dimensions north arrow. and location and distance to nearest road. . C O 2v ft ~ 7 ~ a QOO P/ease print ail information. Re by Date Personarinforrnation ~+ provide mar be used for ascondary purposes (Privacy taw. s. ~ 5.04 (~) (m)). E-pT . D 6 Ply ~' Jb N ~~ R K vt/ooa property LocaNar GrnR. Lot SC 1/4N W 1/4 S i$ T 29 N R l `~ E (ar~j ms's Address 5 2 1 J o ~s Q .!.} G i 2c L_~. Lot # i o Block # Subd. Nana or CSMUI acs ~ State ~ Code N~tnsnn- w! ~b ~ Cdy ~ Ydlage Town Road (?i5) 381-579 /~ u,asoN cJ o~s~-/ CiRCc.E ^ New Constnx;tion use: ($' Residerrii~ / Number of bedrooms '`(' Code derived design flaw rate G~ O O Gpp I~RePiaoement O Pt~c or cortanendal - Desaibe• Parent material sA'~fl~ (/ ~ yrW /f-~. Flood Pfau, eevation if appNcabfe N / A ~ are Area Spot Tested suitable for ~oflventional inground system (P.O.W.T.S.) a# ~ ~~ ®Pit Ground surface elev. 93• ~0 / tt. p~ to ~~ ~ 92 ~. soil Rate i'b!'~ ~ Dorrrrrant Redox Description Textue Struch~e Consistence Boundary Roots GP D/il? in. Munse® Qu. Sz Corti. Coax Gr. Sz. Sh. 'Eif#1 'Etilf2 2 11,-32 lo~~'~ ~ scI Zmb~ m-~~i aw 3-t' •~ •~ " 2 -q loYR4/ - s p w~ / - 1 ~f I ®Pit Ground surface elev. 9.3 • (~ 1 ft, p~ ~ g factor ~ q ~ ~. a# ~ ~~ Sot rribion Rate Horimn Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GP Di'fC~ u>. MurseN Qu. Sz Coat Cobr Gr. Sz. Sh. •Etf#'1 'Et~2 i o- l2. io YR z z - .jL. 2m r m-i^-r C S • 4 2 -2~Z~ IurFZ3/2 - 2m bK m-Fr 3 .4 3 `~ 2~ - -'~l t o `t'ry `h~ i ~Y241~ - IBS S 4 5 i'Y) l m ~ Q W - a ~-F l of . ~ . "1 I•~ • EtiNien t #i = eaD_ > so < 2zo ~ ~ rcc man ~ ,c n ....,w . ~.a...,... ~ _ ~, , ~„ ~- _ ~ Name (please Pry j~ ~ f2.) ~, -T ~gn~e csT Nr.riber ndaress 5 9 93'S~ Da6e Evahretion Conducted Telephone Number 2$tZ lp~i'c-+ ~,,r= ~>?2caL-~ l~h'-~e~'z'.wt !o-ZZ-oS `7iS-`17Z-3~2 ( llhriciit R AssnciatPs ~;p< a KIRKWoai~ Parcel ~ # Page 2 d~_ 3 ~~ O Barg ~• ~ txaa~d srafaaeeie~-. ~ 37 ~. ~, m ~ > ~ ~,. ~, lioriaaw Depot Domioard Itwlox OesalpGon Texlus Stru~as Came Boundary Eiocts GP OM! ln. f~px~ tiu. Sz. Card. Color Qr. Sz Sh. 'Ei~i '~ 1 0 -17 I u~ 2/Z ' ~. 3 -•~ r w1-f-r C S 3 w, • 4 -8 2. I'7- 3 ~ Y23/ - . SC l rte b wl { l'' C S 3 -~' • 4 ~ I oY2~'-kr ©s vin ( GL w 3 v~-F .~ l . (o of 9`l~0 -.~ ~~~Y ~.y 5--z.y~ .~~~ ~ # ~ ~ Fiaiaort Depth Oomiterlt Redoes Deaaiplion Tea~ee ~ttcius Gartsislattoe ,Boutdaty Roofs t ftt. #ltatsel ~ ~ Cord. valor tl: S~. Sb. `B~1 ~ ~ ^ Borlr~ ~ Gronndstafaoselev fL Depth b ink factor is Sai Rafe ~fotiaort Oeplft Dontirtent fiadaet Desaip6att. Texture Stuottae Cor~efeetoe Botmdary fioo~s in. Mua~ tiu. Sz. Ooed. Color G1: Sz. Sh. `~ '~ a ~~ ~ t;totstdatataoeafev ft OaptltfoQrttllirfpiarAor in. got Role Hariaon Deph Dorttttertt Fiedatc DespripQoet_ Teedute ~tucfttre Oartsl~ttoe 8oudery iioofe in. tiu.;a`s. Oast t)ofor tar. St Sh. '~IF1 'C'~2 '!$1=BOD,>30<_?2DngfLandT5S~30_<15Utngn. 'Et~=BODs<~rrrglLand'I5S<30mg~t. ~klR1'CL~IND o 2v 135 00 0~~, P~IcC-~~'?,oF 3 NEW 6uit_ vq,. v~ w~~E ~,TK IJ O ~~ ~ ~~~ F~16T~~,t sYST'~'M ~1s rL~~72' ~ BI ~ 90' ~j- C •Z8J ~ • 3jFx 92' ~ z z~ ~~ t 8 3~"x~ ' t~ 3 ~: a7 3~ ~ q3.`~ 2645 ~~t^Sr,V 2 5' ''~/ Z ~~L A -tom ~ ~ 99.31 5`( _ S`(~ . D e q~ ~ ~~ '~' u5E wE~. ~ •~ rs, EXiSTrN ~q t z-o 0 ~P-r~ ~ Tqr~ Mc ~ '[c i3fr Rtz'Ut~fl Ulbricht & gssocjates Private Sewa ~8f 2 10th q ee COnsuitants Spring 1/alleY, VI/t 54767 Sou- pRo B t : q3.~~ B2~ `f3.bi ~3 . 9`1.3r BM! = MA~~Lc cc~6 S M'L : X30 -r--r R = to p, p~ ~M C R S tatnl E,~ = 1 ~. 51 E FFHtr~ r,-r Ls~s~. ~ q 5 . sl ~ pLD 5 YS'Ttr'M ~ 9 2.2. t • = coa•rou~ ScA-L (~ ~" ^ ~~~ r 1 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspe ted the septic tank presently /~~ serving the _ ~~~ residence located dt; S C 1/9, !`i W 1/9, Sec.?~_, T 29 N R I~ W ~~~ f~t c.d v sort 7'o w u Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. ~~~Ll __ Last time serviced Did flow back occur from absorption system? Yes No ~(if no, skip next. line) Approximate volume or length of time: ~ gallons minutes Capacity; , Construction: Prefab Concrete k Steel Other Manufacurer ( i f known) : (,v ~ ~ ,$~~~ CQ,J CL,~.~~ P~l~ . Age of Tank ( i f known) : lg~ ~ 2~ (Signature) (Name) Please Print (Title) (License Number) (Date) Farm to be completed by licensed plumber (s.195.06, wisconsln Statutes) oz Licensed bisposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-B3, Wis. Adm. Code (except for inspection opening/-over et baffle). Name ~ C~/t Signature 1'tP/MPRS Z~ ~ ~ S 5/88 ` ,. ©./ ~~ . ~ ~'" Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 sT cROix couN 5BPTIC TANK MAINTgNANCB AGRBBMENT • AND n~xnJUU carp [`RRTIFICATION FORM ~ ~r 3~ ~~ /.S • 3 ~~ ' •S7 9 OwnerlBuyer Ma~ung Address property Address (Verification required from Planning DCP~°nt for new construction) ~ zo • /3/ s-. c~ v • G o d CitylState Parcel Identification Number _ (, ~s96~ LEGAL DLGt~RIPTION Gi f y S~ 1 ~~ ~ q ~lv~s o..~ /4, Sec. Z T 2~ N-R ~ l ~1~I, Hof property Location /•, - - G/~ Oi'~ ~s T"-9-T~5 Lot # / O Subdivision ST _ Certified Survey Map # warranty Deed # 7J~7D 9 D Spec house ^ yes~no olume ~ _, Page # Zs3U, page# Z/y Volume . Lot lines identifiable Byes ^ no S~cTEM 11TAINTENANCE ~propcr use and maintenanceof your septic system could result in its premature failure to handle wastes. >p ~maintenanm out the septic tank every three years or sooner. if needed by a licensed pumper- What you put - consists of pining ,can affect the function of the septic tank as a treatment stage in the waste disposal ' a certification foam, signed by ~ ownea' and by a t0 submit to St. Croix Zoning f-ep~~ The property owner agrees v that (1) the on site wastewatexdisp°sa1 sy~n' Plumber, joumeymanpltnnber, restrictcdplumber or a licensodpumper ~fyurg the septic tank is Less than lf3 full of sledge. is is pmper operating condition and/or (2) aRer inspection and pumping (if necessary), to maintain the Private sewage disposal system wig the standards Uwe, the undersigned Nava read the above requirements and agree State of Wisconsin. Certification ent of Natural Resouroes, ~~ ~~ 30 set forth, herein, as sat by the Department of t ;ommerce and the Departm stating that your septic system must be completed and returned to the St. Ceoix County Zoning days of the exp• ~ ~ S CAS _. ~l - ~ DATE OWNER CERTIFICATION I (we) certify tha a the prs,~~~ a~ Y ~} ~ on this form are true to the best of my (our) knowledge. 1(we) am (are) the owner(s) of of a warranty deed recorded in Register of Deeds Office. '~ / ~~~'~ DATE oa i....~~ -- -- - «ss*# prey information that is mis-rcprescatedmay result in the sanitary permit being revoked by the Zoning DePartm~t- #***** «« Indnde with tlrls application: a stamped vvacranty decd from tbs Register of Deeds office a copy of the rectified survey map if nfer~e is made is the warranty deed U ZS30P 21y STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED Document Number ~~ This Deed, made between James G. Karras and Margaret R. Kar husband and wife ,Grantor, and John G. Kirkwood and Cheryl L. Kirkw_< husband and wife ,Grantee. c '-----" " -"-- Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of Wisconsin (the "Property"): ACKNOWLEDGMENT Area L~ `~'~ .. ,.L i L.it~ ('(~: Burnet Titte 7 5 50 France Ave. S. First Flooc Edina. ;~tl~ 55435 020 1315 00 000 Parcel Identification Number (PIN) This is homestead progeny. (is) (Is not) St. Croix Estates in the City of Hudson, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this ~ ~Q day of March, 2004. ' (SEAL) (SEAL) i~ ~ ~~ .)amjl;s G. Karcas Margay t R. Karra (SEAL) AUTHENTICATION Signature(s) WENDY SWATZINA authenticat~j!'!i~-€ g~ti~~,~ e ~N S 1 N . TITLE: MEMBER STATE 8AR OF WISCONSiN (If not, authorized by §706.06, Wis. Stets) THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet 1301 Coulee Road Hudson, WI 54016 4-21710 (Signatures may be authenticated or acknowledged. Both are not necessary.) WARRANTY DEED ~s~~~~ KATHLEEN H. tiALSK REGISTER OF DEEDS ST. CROIX i;Q., tfi RECEIVED FOR RECORD 03/19/?004 01:00Pit MARRANTY GEED EXEMF~T # REC FEE: 11.00 TRANS FEE: 1365.00 DOPY FEE: CC FEE: PAGES: 1 State of Wisconsin, (SEAL) ) ss. St. Croix County Personally came before me this~~day of March, 2004 the above named J Karra n M aret R. K rtes h e d and wife to me known to tie the person who executed the foregoing instrument and acknowledge e same , - Notary Public, Statelof Wisconsin My commissio/:~~p~~nent. (If not, state expiration date: UUZZ~~'' b ) STATE BAR OF WISCONSIN FORM No. 1 - 1998 Wisconsin Legal Blank Co, Inc. Milwaukee, Wis. '"~ _ ~ .~ a v _ 3. ~ S s L- - _ rn° ~~ ~ ~ . 1 ~ ~ ~ _ ~, D N w !~ 1 O w ao `• \ ~ # ~ ~ ~ y n ~ _ . ti~ ` ``~ 0 m ~ ~ ' ` ~ ~ o~ ~~ A -1 W I Z A ~~ r x ~~1 ~i 00 ~~ ~ i ~ ~ ~ ~- i ~e N, IV IV N N ~~ _ ~ N ~ ~ m ~ 01 4 X ~ ~ n ~ ~ ~.i tNA ~ ~. 3 ----- 1N3W3SV3 SS300bAlVM3A12l0 301M ,09 x x .00'~ili x x ~ / ~ ~ ,00'SZ I M~~Z~,S~,00S L~ 8Z N011035 ', ~NIMt 3Nl ~0 b/IMN 3Hl dO 3N1'1 15113 .$ ~~\ N \$ MME'' Z9 eO1N ~N N N W W W A yy ~ t~ ~ ~ OX C D ~ A O A ~ m y 3 N --- -,S£'£bZl - -k -- , 00' ~i I £ ~_ 1N3W3SV3 SS3~ f` n i i -i Jurvt ~ ~RBi~ ate . 5u~r~t~q sai~ a~ >~o~ has u~as; uoi~~ag 3o uoi~, ~aa~~s ~o auit dot ~ p-~tlo~- uo~~BZtE~su~ a~ ,, -> .::; ,~ ,..~., ~ y ~ / ~ AGE c ~ ~ ~ A ~ ~ ~ ~ 3 w •• n I O O ° L1 y ~ I ~ ) ur H N ~ c ~ ~ ~ w0 '" OD W 00 ~p ~ 7 ~ ~ CEO O CO ~ O C ~ N lO 00 N 00 ~ N I 7 y ~' ~ y ~ p ~ ~ ~ ~ I fJ) -C D a ~ m ~ y m IW .°.. ~ ~ ~ (.J C O. N N S n I ~ CO ~. ~ ~ ~ N N ()1 C11 d 0 r. I ~ O O O ~ I o ~ v ~ ~ 3 vi ~n o .. c ~ v _v, rn I ~ ° ~ ~ ~ ~ ~, N 3 m .. Q ~ N Z •• ~ C W Z 7 Ol O 7 O. 7 ? O N ~ I ' ~ ' ~ y ~ ~ C C ~ N ~ I ~,,~ ~ a a z 3 m ~ ~ N a C M I ~_ n O 7 ~ ~ a O '~ H I Z A ~ y Q ~ ~° fl? a ~ ~ a~ m c I o ° ' n~ • • X Ol N V N I a 7 N I n I 0 N I ~ I ro N d N I o N ~ 2 ~ O 3 d o ~ 9 n ~? 'a ~ 1 C .ONO N O. N O y0 c0 -~ 7 ~ ~ ~ ~ ~T ~ O ~, rn S ~ G v' ~ O C 3 ~ .. 0 0 X m N 01 y z ~ A ~ ~ CNp ~ .~ Z A ,"0 A d ~: !~ 0 O~ C ~1 O • O t~~ O N ~ 1 A b ~e o- ti C 0 ti b ~ p '"~ d0 tv re ~ ti N ti '- STC - 104 AS BUILT SANITARY SYSTEM REPORT _._.. ~.~ ~,~ l ~ 1''c'` ~! f~ t r'!'',1 ~;' ,, u OWNER ADDRESS /~ ~ ~fr ~`; -f~~ ,` r SUBDIVISION / CSrM~# SECTION ~~ T ~-^l / ST. CROIX COUNTY, W (,~.~ . -_ i ~~ ~ ,~y _ ~~ ~ l J rX ,~ ~ (~~t~C°~S~ LOT # ~~ _N-R ~% W , Town o f j~/G1 U~~~ ~) ISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ =~X 7) '~c~ SAD ' S ~~~~~~ ~ ~ ~n~ ~c INDICATE NORTH ARROWI Provide setback and elevation information on reverse of-this form. Provide 2 dimensions to center of septic tank manhole cover. v BENCHMARK' ALTERNATE BM• 1 t~~tis.. SEPTIC TANK / PUMPy CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~'~ ~iwC'`; ( ~~^~C~~i-~' ~ Liquid Capacity: %~G~ Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM r ~ ~ Width: / J Length ? Number of trenches Distance & Direction to nearest prop. line: Setback from: well : '~'SC~ f House ~ d 1 Other ELEVATIONS Building Sewer PC inlet ST Inlet. ST outlet Pump Off Header/Manifold Existing Grade PC bottom Bottom of system Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: J INSPECTOR: 3/93:jt ' v~• ^~sinDepartrnentoflndustry, SOIL AND SITE EVALUATION REPORT , ~ ;Paige-~~ of? .. ,..at+or and Human Relations ;r"~` ; /a ~ n ;!/~T r1 ewn of Csfely R Ruilrfirve i._~_ r'" ,. . n~ aV~.u~u wnn ~~nn UJ.VJ, .•~a..-.u,,,.......... COUNTY z ~'. ~ ,,~'~ ~t C~ta~~ y l but Plan must include i i 8 1/2 11 i h i l l l h . _ , n s ze. nc es ete s te p an on paper not ess t an x Attach comp # - = :: PAR p not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or . _ ,. . dimensioned, north arrow, and location and distance to nearest road ~-'~" . ''' ~n'@n i~g'- . ~" APPLICANT LNFORMATION-PLEASE PRINT ALL INFORMATION yEOBY ~ '' 'EE ~~""'~ REVI : , ~ PROPERTY OWNER: PROPERTY LOCATION `. , t ~: ,, , ,~~ ~., ~ N R " E T 2 John Rauchnot ) , I ~ ~ 8, GOVT. LOT ~ v4 ~ 1/4,S .29 , PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM #..: :' ; ~ ~~ f^ / 5?.7 Co. Rd. #W 10 na St. Croix Estates' ---=~" ZIP CODE PHONE NUMBER CI~~~T~b>~ WI ^CITY VILLAGE [MOWN NEAREST ROAD ~ • 54016 (715) 386-3052 Hudson Jud Circle [ ~ New Construction Use [ xj Residential / Number of bedrooms 3 (J Addition to existing building (]Replacement [ ] Public or commeraal desaibe Code derived daily flow 450 9Pd Recommended design loading rate • 5 bed, gpdm2 .6 trench, gpdm2 Absorption area required 900 b~, i<2 750 trench, ft~ Maximum design loading rate . 5 bed, gpdm2 .6 trertdt, gpdm2 Recommended infiltration surface elevation(s) 95.24 it (as referred to site plan benchmark) Additional design I site considerations na Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system ~ CONVENTIONAL ~ S ^ U MOUND ~ S ^ U IN•GROUND PRESSURE [~S ^ U AT-GRADE ®S ^ U SYSTEM IN FILL ^ S ~ U HOLDING TANK ^ S l~U U = Unsuitable br 5 stem SOIL DESCRIPTION REPORT Boring # «~:€< >': 1 Ground elev. 98.94 ft, Depth ro limiting factor +84" Boring # .,.~, 2 ~> .,. ~~ Ground elev. 97.74 ft. Depth ro limiting facror +80" Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Bour>c~ry Roots GPD/ft Bed Trertctt -12 10yr2/2 none 1 2msbk mfr gw 2f .5 .6 2 12-2 10yr4/4 none sil lfsbk mfr gw if .2 .3 3 28-7 10yr5/6 none S Osg ml gw na .7 .$ $ 0-84 7.5ry4/4 none 1 fs Osg mvfr na na .5 .6 Remarks: 1 0-10 10yr2/2 none 1 2msbk mfr gw if .5 `.6 2 10-24 10yr4/4 none sil lfsbk mfr gw if .2 .3 3 24-30 7.5yr4/4 none 1 fs Osg mvfr gw na .5 .6 4 30-80 7.5yr4/6 none S Osg ml na na .7 ` .8 Remarks: -Please Print Gary L. Steel PhOn•~ 715-246-6200 I"°°"'s' 1554 2~Qth. Ave. , New Richmond, WI. 54017 _ ISgnaturr ~~j,~,,,~ ~ ~~~~k~ ~aw~ 11-2-95 cstm 02298 T PROPERTY OWNER John Rauchnot SOIL DESCRIPTION REPORT Page? of 3 '` PARCEL I.D. tt pending Boring # ~<n~;:~? 3 ..:k«c:>~:>> Ground elev. 98.54 ft. Depth to limiting tacro82 ~~ Boring # i<_:;:> '4 .::a;:»> Ground elev. ' 99.6. Depth ro limitng facror +90" Boring # C: vb:~:~:~5: 5 ~i:::~4V\:iiiiii: Ground elev. 98.54 it. Depth to limiting facbDr +80" Boring # Ground elev. ft. Depth to IimiUng facror H i Depth Dominant Color I Mottles I Texture Structure I Consistence ~ Bourx~ry I Roots G P D/ft or zon in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed iTrench 1 0-13 10 r2/2 none 1 2msbk mfr if 2 13-2.7 IOyr4/4 none sil lfsbk mfr gw if .2 ~ .3 3 27-72 7.5yr4/6 none is Osg mvfr gw na .7 :8 4 72-82 7.5yr4/4 none is Osg mvfr na na .7' .8 Remarks: 1 0-12 10yr2/2 none 1 2msbk mfr gw 2f .5 .6 2 12-24 10yr4/4 none sil lfsbk mfr gw if .2 .3 3 24-42 7.5yr4/4 none 1 fs Osg mvfr gw na .5 .6 4 42-90 10yr5/4 none fs Osg mvfr na na .5 .6 Remarks: 1 0-12 10yr2/2 none 1 2msbk mfr gw if .5 .6 2 12-24 10yr4/4 none sil lmsbk mfr gw if .2 .3 3 24-80 7.5yr4/6 none S Osg ml na na .7 .8 Remarks: Remarks: SBD-8330(8.05/92) .-~ STEEL'S SOIL SERVICE Gary L. Steel John Rauchnot CSTM2298 SWgNW4 S28-T29N-R19W MPRSW 3254 town of Hudson lot #10-St. Croix Estates N 1"=40' BM.= top of 1" steel pipe C el. 100' Alt. BM.= nail in tree C e1.104.00' ~~ ~~ ~` ~ /yl`{`' ~ ~I~ /~ i 1 ' ~~ ~ ~~ ~' ~. ~~ ~~~ $,~ ~ v z ~5' ~o~o zz~ ~.. ~~ Gary L. Steel 11-2-95 1554 200th Ave. New Richmond, WI 54017 (715) 246-6200 r 1 w ~~ r Wisconsin Department of Industry, Labor and'i-luman Relations Safety and Buildings Division GENERAL 111lFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Permit Holder's Name: ^ City ^ Village ^ Town o KARRA$, JAMES X CST BM Elev.: f Insp. BM Elev.: BM Description: ~~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ; C,Gc~~c~`c~~l~ E? Z~ a.0• Dosi Aeration H ~ g TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic >S~ ~ ~ ~ NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION ManufacLure~_ . Demand Model Number TDH Lriction System TDH Ft F rcemain Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM ELEVATION DATA /~'/,.,~ .~'~ ~f STATION BS HI FS ELEV. Benchmark 3,~Qi Idv,~, ~~C~. ~ rY , /.~O/~ ~ s Bldg. Sewer St /y(t Inlet d ~' ~ St/ Ht Outlet ~D ~ a 3 / Dt Inlet Dt Bottom Headert-- ~~,33 ' 9 ~' ' Dist. Pipe 3 ~ ~ ~ Bot. System ~~~p' ~ ~ ~ Final Grade tn~io~t ~s~ ~a.5~~ ~v, d ~ BED /TRENCH Width , Length / No. Of Trenches PIT No. Of Pits Inside Dia id Depth DIMEN 1 N a DIM TBACK S SYSTEM TO P/L BLDG WELL LAKE/STREAM LEAC Manufacturer: E INFORMATION T e O CHAMBER M m e N yp ~ ~OI1 E ~ -'~~ ~ ~ OR UN T r. u o a System: , . ,~ I DISTRIBUTION SYSTEM Header /Manifold ~ Len th ~ Di Distribution Pipe(s~ 7~ / ~ L th ~ Di i CD ~ S x Hole Size ~'``~ x Hole Spacing Vent To Air Intake g a. eng ng a. pac SOIL COVER x Pressure Systems Onty xx Mound Or At-Grade Sys ly Depth Over Depth Over xx Depth Of x Seeded /Sodded xx u c e Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson_.p28.29.19W,~S/~W/,'_ NE, Lot 10, Joseph Circle J !/ l= ~- Plan revision required? ^ Yes Use other side for additional information. /~ SBD-6770 (R OS/91) Date ST. CROIX ry Permit No.: ax NO.: ~~ Cert. No. ~:~~~ SANITARY PERMIT APPLICATION Safety andBuildinggsDivisi y Bureau of Buildin Water S sten 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less -count - than 8 tiZ x 11 inches in size. • See reverse side for instructions for completing this application state sanitary Perm. Number a5~ The information you provide may be used by other government agency programs ^ Check if revision to pre~s application (Privacy Law, s. 7 5.04 (1) (m)]. State Plan LD. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Ow ame ~~. S ~~' S Property Location j ti4 ti4, So? ~' T p~Q , N, R` E (or~ Property Owner"s ~ iii g ddre~s ~~ (//- Lot Number~~ Block Number ^~ City~tate , Zip o~ /~ Phone Nu n Subdivision Name or C ~ ember ~ ~[ - II. TYPE OF BUILDIN (check one) ^ State Owned ~ ^ !ty ^ village Nearest R ad ~ ^ Public 1 or 2 Famil Dwellin - No. of bedrooms Town of ~ ~ (. lII. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ^ Apartment /Condo 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/ Repairs 11 ^ Restaurant/ Bar/ Dining 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 _ New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5_ ^ Repair of an ~ System________System_____________TankOnly______________ Existing System _________Existin~System ___ B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Mon-Pressurized Distribution Pressurized Distribution Experimental Other 11 ^ Seepage Bed ~ , 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12'~Seepage Trench a-S X $~ 22 ^ In-Ground Pressure 42 ^ Pit Privy 13 ^ Seepage Pit 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. Pert. Rate 6. System Elev.. 7. Final Grade Required sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ~G-'9~.0 E,,l,e//vation d " ~" ' ~ " S D b 91, g ~ ~ ~ Feet Y'~• Feet VII. TANK INFORMATION in gallo s Total # of Manufacturer's Name Prefab. Site Con- l S Fiber- Pla~c Exper. N E i i Gallons Tanks Concrete tee glass App. ew x n st strutted Tanks Tanks Septic Tank or Holding Tank nw 17~1J ~j,/(°,g f p/' ^ ^ ^ ^ ^ Lrft Pump Tank/Siphon Chamber ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibil'ty f r installation of the onsite sewage s shown on the attached plans. Plum is Name: (Print) PI a Signature: (No amps) P Business Phone Number: S o2 3 / -~ S~ P tuber's Address ( tregt, ty Sta e, Code): ,~„ t , ~ n O/ IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee (IncludesGroundwaler ate slue Issuing Agent Signature (No Stamps) Approved ^ Owner Given Initial d ~ Surcharge Fee) -'~J A verse Determination X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: (f v S' SRD-639f! (R. OS/94) DKTRIRUTION: Original to Cmmly, One copy To: Safety & fkiilJings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's Warne and mailing address. Provide th~a legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Cheek only one on line A. Complete lines B if permit is for tank replacement, reconnection, or repair. V. Type of system. Cheek appropriate box depending on system type. VI. Absorption system irformation. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or er:isting tank, list the total gallons, number of tanks and manufacturer's name:, indicate prefab or site constructe~~ and tank material. Complete for a!! septic, pump/siphon and holding tanks for thi;system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility staterrrent. Installing plumber is to fill in name, license number with appropriate prefix {e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Departmerr: Use Only. X. County / Departmen :Use Only. Complete plans and ;pecifications not smaller than 8 1/2 x 1 1 inches must be submitted to the county. The plans must include the following: A) plat plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other trea' ment tanl<s; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution byes; soil absorption systems; replacement system areas; and the location of the building served; B) horizor~~_al and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation difference;; 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 1 15 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected thrcugh these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. • ~ q, ~~ q~~,~~.1~~". ~ ~Y~~ ~~s~~ ~~Ne, ~T~~~~~ ~r~~~y~ ~~ ~V~ (~~' '~ 1~ c~ _~ ~. ~~~ ~~~ ~ J~~r ~v ~~ ~, ~~~ \ ~~, ~. ~ ~~- ~, ~r ~~ `\~ \ `. `~ ~ ~,,~ i ~~,d ~ M r• ~~ '`'D ~~ ~~' ~.. •~ ~J cry ~~ ~ ~ :~ '~ l/~ .-- ~ L~ l~~ ~S ~~t r~ a~~, s S c~ -r1W ~ S ~~'- r~~~ ~' ~~ ~, ~ ~'~j~ ~ ~ ~ Cry ~~x~ \~~ Wisconsin' Deparunent of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 ~. Labe,'and Human Relations Division of Safety ~ Buildings In I 3.05, Wis. Adm. Code t 9 COUNTY Attach complete site plan on paper not less /2 x 11 inc sin n must include, but St. Croix not limited to vertical and horizontal refere int (eq~$ der d ope, scale or PARCEL I.D. # dimensioned, north arrow, and location a ance to'~~etre pending APPLICANT INFORMATION-PLEAS _ 1 T ~~~rkl ~FAR10 =: REVIEWED BY DATE ~t. 4'; n r PROPERTY OWNER: ,..~ ~C?:.,"~;~,`4J -~?S: OPERTY LOCATION ',' ~''"~.. `'~ '~ OVT. _OT t/4 1/4,S T ,N,R or W James Karras ~ SW iVW 28 29 .1 ~ ) PROPERTY OWNER':S MAILING ADDRESS ' .; ' , ~ ,-a., LOT # BLOCK # SUBD. NAME OR CSM # 1.014 WI. St. ~~ ~ ~~- `• `' 10 na St. Croix Esta CITY, STATE ZIP CODE PHO E Nt•1MB~fd~ "` ^CITY QVILLAGE SOWN N OAQ Hudson, WI. 54016 (71~ 386-1.182 unr~Gnn T v Circle [~ ] New Construction Use ~ Residential / Number of bedrooms 4 [ ]Addition to existing building j ]Replacement [ ] Public or commeraal desaibe Code deraed daily Flow 600 gpd Recommended design loading rate .7 bed, gpdm2 •8 trench, gpd/ft2 Absorption area required 8S8 bed, ftZ 750 trench, ftZ Maximum design loading rate .: 7 bed, gpd/ftZ ~ >~ trench, gpdmZ Recommended infiltration surface elevation(s) area A=9~ . ~, B=89.00 ft (as referred to site plan benchmark) Additional design /site considerations trenches ~ 93.0-91.3' -90.8' -89.0' if used Parent material stream terrace Flood plain elevation, if applicable na h S =Suitable for system CONVENTIONAL MOUNO IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=unsuitable for svstem ~ ~l S D U I ®S ^ U ®S O U ~El S O U O S ~1 U ^ S ~1 U SOIL DESCRIPTION REPORT Boring # <' 1 Ground 92 e~~ ft. Depth ro limiting facto84 ~~ Boring # ~ 2 Ground elev. 96.5 ft. Depth ro limiting factor +84" i H Depth Dominant Color Mottles T re xt Structure Consistence Bounda Roots GPD/ft or zon in. Munsell Du. Sz. Cont Color e u Gr. Sz. Sh. ry Bed Trade 1 0-9 1Oyr3/2 none 1 2msbk mfr gw 2m .5 .6 2 9-20 10yr4/4 none sl 2mgr mvfr gw if .5 .6 3 20-65 7.5yr4/4 none is Osg mvfr gw na .7 .8 4 65-84 7.5yr4/6 none cos Osg ml na na .7 . .8 Remarks: 1 0-11 10yr3/2 none 1 2msbk mfr lm .5 .6 2 11-].8 10yr4/4 none sicl lfsbk mfr gw if .2 `.3 3 18-29 7.5yr4/4 none sl 2mgr mvfr gw if .5 .6 4 29 84 7.5yr4/6 none cos Osg ml na na .7 ~ .8 Remarks: Name:-Please Print Gary L. Steel Phone: 715-246-6200 ~''"""°"' 1554 20(~h. Ave. ,New ~2ichmond, WI. 54017 ~ 11 PROPERTY OWNER James Karras BOIL DESCRIPTION REPORT Page? of •3 PARCEL I.D. # ' s eariru~ # :: 3 Ground ~. 94.3 ft. Depth b limiting factor +96" Boring # 4 Ground elev. 92.00 fG Filing factor +88" Boring # " 5 t; ~.~ Ground elev. 96.4 ft. Ito factor +90" Boring # ,~~v :, <v :' ,~~>~> Ground eiev. ft, Depth to rr~tlng factor Depth Dominant Color Mottles Texture Structure Consistence Bour>dar Roots GPD/ft Horizon in. Munsell Cau. Sz. Cont. Cobr Gr. Sz. Sh. y Bed lTn~ 1 0-10 10 r3/3 none 1 2msbk mfr gw 2m °.5 I.6 2 10-27 10yr4/4 none sicl lfsbk mfr gw 'lf .2 .3 3 27-35 7.5yr4/4 none sl 2mgr mfr gw na .5 .6 4 35-96 7.5yr4/6 none is Osg mvfr na na .7 ! .8 Remarks: 1 0-10 J.Oyr3/2 none 1 2msbk mfr gw lm .5 .6 2 10-35 10yr4/4 ~agie sicl lfsbk mfr gw if .2 .3 3 35-75 7.5yr4/4 none is osg mvfr gw na .7 .8 4 75-88 7.5yr4/6 none is Osg mvfr na na .7 .8 Remartcs: 1 0-12 10yr3/3 none 1 2msbk mfr gw lm .5 .6 2 12-28 10yr4/4 none sicl lfsbk mfr gw if .2 .3 3 28-42 7.5yr4/4 none sl 2mgr mvfr gw na .5 .6 4 42-90 7.5yr4/6 none is Osg mvfr na na .7 .8 Remarks: Remarks: ti STEEL'S SOIL SERVICE Gary L. Steel ,Tames Karras CSTM2298 SW4NW4 S28-T29N-R19W MPRSW 3254 town of Hudson lot #10-St. Croix Estates N 1"=40' BM.= top of base of electrical transformer C el. 100' 1554 200th Ave. New Richmond, WI 54017 (715) 246-6200 1 ~~ lei ~~ ~~ ~~~~ ~~ ~~~_~ ~~ ~ ~ e '~ z ~~ ~'~ ~5, ~~ ~. ~ ~ ~ ~~ ,~ ~ ~ ~' ~ ~' ~ ~ -' ~ ~~ l~ ~,~ 8~z~ Gary L. Steel 10-30-95 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER -~I ~1 YY12 ~ l-~ • f-~ ~4 ~,2 ~5 MAILING ADDRESS /Ui~ '~/~ sCO h s ~ /1 ~~ ~ ~~o/s e ~- u~ S~IO/~ PROPERTY ADDRESS Sot / ~lo~e,o~ C~ rrL~. (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~i,c c'Y t o vim, ~ ~.t) ~ a~~w PROPERTY LOCATION 5 ~/ 1/4,11/ 1/4, Section 25~' T Z 9 N-R~~W ' / r H~v '/y s w /y , TOWN OF H ~~S O -'~-- ST. CROIX COUNTY, WI SUBDIVISION ~~ ~~ro ,•~L. ~~~ LOT NUMBER ~~ CERTIFIED SURVEY MAP ,VOLUME ,PAGE ,LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. UWe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: / /~~ o% St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 . 8 T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this ,development be intended for resale by owner/contractor, (spec 'house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property Location of property Sµ! 1/4 N W 1/~ ,Section Z$ ,T 2Y_N-R %Q W ~ ~iT'/y ..~~-~I Township ~~,~~s o vim- Mailing address /O/~ 1~t/i sin nsirl u So-ti ~ t,~~ SyO~~P Address of site ,S'oZ/ .S~~,n~_ ~_,;~~.le, ~/._„/~~,~ ,,rr c-un~h Subdivision name ~-~, (;.~c; ~C Estc~~"ZS Lot no. ~~_ Other homes on property? Yes_ ~ No Previous owner of property ~ ~ ct, A ,~~ Total size of property ~/j~.~y ,~,r.Q,S Total size of parcel z ~ ~~ ,Acres Date parcel was created // ~Z~' 9 S- Are all corners and lot lines identifiable? _~Yes No Is this property being developed for (spec house) ? Yes ~_No Volume //S'2 and Page Number ys3 as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLIIDE WITH THIS APPLICATION THE FOLLOWING: 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 5 ~ ~ ~ ?~~ and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. 5 ~~~~~. Si ture of Applicant Co-Applicant ~ '/3 0 ~9 S- Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 53'7220 vnl 1152Pac,:453 Brideeland Development Comn~y. a Minnesota corporation _ conveys and. warrants the following described real estate in St. Croix County, State of Wisconsin RCGISTER'S OFFICE ST. CROIX CO., WI Re~:'d for Record DEC 6 1995 atr z:oo P.M Reglstar of Deeds RETURN TO /~ o!' ~s- yysi 'l'AX PARACEL NO. Lot 10, St. Croix Estates in the Town of Hudson, St. Croix County, Wisconsin. This is not homestead property. (is) (is not) Exceptions to Warranties: s TF~R Dated this 5th day of December, 19 95 , .- (SEAL) /~ `'r'~LU~1-- (SEAL) * * (SEAL) (SEAL) * * AUTRENTICATION Signatures authenticated this day of . 19 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorised by 70G.06, Wis. Slats.) This instrument was drafted by ACKNOWLEDGMENT STATE OF MINNESOTA Dakota County Personally came before me, this 5th day of December .1995 the above named to me known to be the person who executed the foregoing instrument and acknowledged the same. *Darla J. Bauer (Signatures may be authenticated or acknowledged. Both are not necessary.) .a4ts. neRl s.1 Iw1A1 Notary Public _ Dakota ,County, MN My commission expires January 1, 2t>D0.