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HomeMy WebLinkAbout020-1342-10-210W, o , n B fD E CD k C f � } § B + % \ � § § -4 \ / ° ca ■ § k / 0 / k k \ � ■ _ § 9 q --I q Z k � ƒ � g � � § g � � § � § Lo� - � � � � � � � z Oro \ � / ƒ $ \ K � \ � w � # 0 o ? � c � � § ID J % 5� 4 q. � § § 0 °§ /� ¥ m 0 \ 2 ƒI 0 + C @ / 3 m E E a E E ~\ j k B @ / i _ § 2 ; @ 7 E E E C CD ° g E E 7 E) \ k m f / § ¢ §� o g / { £ ¢ § CD k c 2 � ] 03 k o o e $i 0 2 - � ƒ 4 / D 4 2 §�\ C § § 0 § E� 0 k [ _ CD C.) © CD I _ _ \ } 0 0 0{ 0 0 0 ) J § 0 = § \ \ c CD \ 7 / \ CD (n \ 9 / § E 9 - \ a V \ - \ § 2 a \ c� k CD ( § r \ \ z 0 \ § F / § 7 \ \ L � \ \ I ® / ) 1 3 / ( E� (0,0 I E E \ �\3 / z CD \ / c C / :2 $ k 0 k� kj ■ § ƒ \ 0 § k k ƒ \ £ E ■ = k 2�CL $ § ) \ § D \ ° ;_ � z o % @ z ��0 % ƒ f \IE. � f) _- C§ 2B � � (§ 0 � � � ƒ G ; _ CD / ? W, o , n B fD E CD k C f � } § B + % \ � § § -4 \ / ° ca ■ § k / 0 / k k \ � ■ _ § 9 q --I q Z k � ƒ � g � � § g � � § � § Lo� - � � � � � � � z Oro \ � / ƒ $ \ K � \ � w � # GENERAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR01 REAL ESTATE TOWN OF HUDSON COMPUTER NUMBER 020 - 1342 -10 -210 Parcel Number 32.29.19.1837 Claimed Date Re- certified / / Relate Number: WNSR HTS OWNER NAME: First ALLEN M & PENNY W Last LEPINSKI CO -OWNER Mailing Address 3597 ASHBURY RD City EAGAN State MN Zip 55122 - Type Vol Page Doc # Rec.Date Type Vol Page Doc # Rec.Date HISTORY W D 2051/ 258 698939 11/18/2002 / PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name- Type SD Apartment Post Office 520 CARRIAGE LA School District: 2611 - SCH D OF HUDSON Special District: (1) 1700 - (2) - (3) - W ITC Plat Code: Last Changed on: 01/13/2003 Book Number: 1 SECTION 32 TOWN 29N RANGE 19W '/4160 NW %40 SE Map Number: 00 - Sales Area: Parcel Control 0 TAXABLE Number of Units: ZONING: Permit Number: Type: Bank Numbers: F4 -Prev, F5 -Next, F6- Legal, F7- Value, 178- History, F10 -Exit, F12 -More Wisconsin Department of Comm PRIVATE SEWAGE SYSTEM Safety and Building Division— INSPECTION REPORT `' x ` 1 (ATTACH TO PERMIT) GENERAL INFORMATION Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: West Lake Builders City Village X Township I Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Vent to Air Intake ROAD Dosing ... 30 ' 15 ' 2 I Aeration 020 - 1342 -10 -210 Dosing Holding Bldg. Sewer TANk( SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ... 30 ' 15 ' 2 I _ 020 - 1342 -10 -210 Dosing 14 4 Bldg. Sewer Aeration SYSTEM TO St/Ht Inlet BLDG WELL / t0 .60 Holding St/Ht Outlet INFORMATION / Q ( t PUMP /SIPHON INFORMATION Manufacturer Demand GPM Model Nun TDH Lift n Loss System Head TD Ft Force n Length D PTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: FS ELEV. 420533 0 State Plan ID No: 7 - -SD Parcel Tax No: 1 S Alt. BM 020 - 1342 -10 -210 STATION BS HI FS ELEV. Benchmark � �r0 7 - -SD Liquid Depth 1 S Alt. BM 14 4 Bldg. Sewer 3 ,10 SYSTEM TO St/Ht Inlet BLDG WELL / t0 .60 LEACHING St/Ht Outlet INFORMATION / Q ( t Dt Inlet CHAMBER OR — � �^ Dt Bottom to -31 1 y 1 5- ! Header /Man. Model Number: Dist. Pipe .Bot. System I _ Fin Grade S over 3 . 011 RENCH dth 1 Length No. O Trenches Vent to Air Intake PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufactur r: INFORMATION CHAMBER OR — � �^ Type Of S stem J to -31 1 y 1 5- ! UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold, ii Di x Hole Size x Hole Spacing Vent to Air Intake Length `�— Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of x x Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection # . Inspection #2: t o R•�►G it Location: 520 Carriage Lane Hudson, WI 54016 (NW 1/4 NW 1/4 32 T29N R19W) Win or Heights Lot! Parcel No: 32.29.19.1837 1.) Alt BM Description = &� �' S •�, 2.) Bldg sewer length •) p ��(�'- - C I0?j. - amount of cover = «�1 �,. /,`,,,�t ,_ Q _ _.r, np/ � ®�. kye � � • v"� (C,) a (02.5 I Plan revision Required? Y ❑ No Use other side for addition in ation. SBD -6710 (R.3/97) D 1 _]„� / 4n or's Sign re Cert. No. T C� Attach complete to the Conn' only) For the a em on pap not less man al" z 11 mceea in SB D-6� 0510��1) At `tom v 137 4) Safety and Buildings Division County �r / �srd ` N VIsconsin 201 W. Washington Ave., P.O. Box 7162 5 , V Site Address Madison, WI 53707 - 7162 Dep artment of Commerce Jrd t4 D CA-eVAQb Sanitary Permit Application sanitary Permit Number �� In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ` s33 ❑Check if Revision may be used for wwndary purposes Privacy Law s15. 1 m) I. Application Information - Please Print All Inf State Plan I.D. Number Y Property Owner's Name Parcel Number nG ozv- 13 12- - X -z10 1830. Property Owner's Mailing Address Property Location I U/ d S T. Vk, 6Idik:S -? A T a N, City, State Z " Phone Number Lot Number / Block Number Subdivision Name CSM Number � Q,tJ GJ � s � . i'- �'— 7g' G✓�`�a�.�as� c,' �7' H . Type of Building (check all that apply) ✓ 6 PW yu,�vM+ ❑City ❑Village A1 1 or 2 Family Dwelling - Number of Bedrooms S . ❑ Public/Commercial - Describe Use . A ownship l7it� ❑ State Owned ��> S Nearest Road III. Type of Permit: (Check only one box oh line A (numbering scheme for internal use). Complete line B if applicable) A. 1NNew 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use System Tank Onl Existing System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use) .�_ .Q� -fob 44)(Non - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Welland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed L Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation f / VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plast Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _ � ` ,� G V A/ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assum responsibility for inst#Uation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature P PRS Number Business Phone Number Plumber's Address (Street, City, Code) ,Zii`pp VIII. Coun /De artment Use Onl Approved Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse /'/// O 2 - Determination IX. Conditions of Approval/Reasons for Disappro - Se P = 1 aw a - ) � 17P ec ` Attach complete to the Conn' only) For the a em on pap not less man al" z 11 mceea in SB D-6� 0510��1) At `tom v 137 4) A." a X/le J /ws� s y Z f6 X - P- 41to '6B% -;-n Lr�� �"� a/S'� ,�w!' la e�' ,s � o � .2� L✓�;!/ cQ.s o'er �Br G� �.� ak1,� B� .�1�.1�5 ®.y' _ ' iei� Wisconsin Department of Commerce ' Division of Safety and Buildings Bureau of Integrated Services II Attach complete site plan on paper not less than 81� include, but not limited to: vertical and horizontal ref percent slope, scale or dimensions, north arrow, an APPLICANT INFORMATION - Please pr Personal information you provide may be used for secondary Property Qwner , / — / / Mailing SOIL AND SITE EVALUATION �gt$a j e,vV th S. IL 83.09, Wis. Adm. Code Color 1 Munsell Mottles Cont. Color Ijfnche Lin must County D point and ion, d distance to nearest ULL Parcel I.D. # ' i inforF - - - o Re r ' - JPI d* Locati on Lot �� 1 /4A / /') 114, Lot # I Block# Ci state Zip Code Phone Number ❑ City ty Page —2— of 3 a K` /rE T - 2t;> ,N,R Iq 157/0 a New Construction Use: - 01 Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate -, S bed, gpd* / trench, gpd/ft Absorption area required 'Q_ bed, ft2 1e�919C trench, ft Maximum design loading rate _ � bed, gpol* —z l — tench, gpd/ft Recommended infiltration surface elevation(s) "Z 7 ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system I P S❑ U P S ❑ U JZ1 S ❑ U I El S ❑ U I ❑ S 5f U ❑ S O U SOIL DESCRIPTION REPORT Boring # Ground elev. ,/�, zft. Depth to limiting factor ->2p— Boring # Ld Ground elev. l Depth to limiting factor 00 Dominant Color 1 Munsell Mottles Cont. Color ml_ ! !r7' IL ►i s�WAMM� Remarks: in. Rema ks: CST Name (Pleas rint) , Sig�bure: r Telephone No. Address Date CST Number a PROPERTY OWNER / PARCEL LD.# SOIL DESCRIPTION REPORT Page of • Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 2 Bed , Trench -S za S / G s Wd. „ Remarks: Remarks: Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD /ft2 Bed , Trench -S L / G s `b" Remarks: Depth to I limiting factor ' Remarks: SBD -8330 (R. 07/96) L2 ,, -,. 1 s V6 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Des i n S ecifications Sanitary Permit Number 1 Z0 5 3 Number of Bedrooms Design Flow - Peak ( pd) Design Flow - Peak ( pd) Ze CT Estimated Flow - Average ( d v Septic Tank Capacity (gal) 12� Soil Absorption Component Size (ft) t 2 Type of Wastewater Domestic 150 Table 2: Soil Absorotlon Comnonent - Limits of Reliable Operation Table 3: Maintenance Schedule 4K. Septic Tank Septic Tank Component Soil Absorption Component Design Flow - Peak ( pd) Soil Absorption Component 1213 Maximum Influent Particle Size (in) V 118 Maximum BOD (m /L) 224 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule 4K. Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats, The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The utlet filte shall be cleaned as necessary to engV proper operatio The filter cartridge should not be removed unless provisions are made to retain solids nn olids in the tank that may slough off the filter when removed from its enclosure. If the Management Pisn for a Septic Ta are Soi: Absorption Comp a"I ent . -1- filter 1s equipped with an alum, the filter shall be serviced if the 618rm is activated COMInuoU&iy. lntemtlttent inter elerrlrta may Indicate surge flows or & A � ai scum end aiu ala � tank septfo tank shall have Its contents removed when the volu exceeds 113 the liquid volume of the tank. It the con t e nts n the � tonk am Of n ot when v MIA service time of an assessment maintenenrA personnel she needs♦ to be Womwd to maintain less than maximum scum and slu acoumu#atlort In the tok, Manhole risers, socsss risers and oovers should be Inspected for water tight and soundness. AoMe openings used for servlcs and assessment shall be sealed watertight upon the completion of seNla Any opening doomed unsound, defectivs, W WOO to falwre must be r«piaoed. , Exposed access openings greater then �- Inches to dI6M# w shah be secured by an effsoWo locking dwics to prevent aoddental or unauthorized antr'y tnto the tank. No one should enar a aeptk or other tnabnent or holding tank far any reason w0out balm In full plaso+ with ON" eande liar at>e ering a confined space. the stmaip om * tin the or odnr trMtsterant of hWng tank Wray earn flo fNm anal mcuo of a pertroa fto she Interl of die tank nay be dlOult or IWapasWW Tank abandonment shall be in a000rdanos with Comm $3,33► Ms. Adm. Code when th tank Is no longer used as a POWYS component, The soil absorption corponent serving this structure Is d"1Qn9d to accept domestic wastewater tram a residential faciitty. The limits of Wration of this Component are shown i n Table 2. The longevity of a soli absorption component depends grea* on proper and timely maaintenanos, and system use within or below the limps of reliable operation, Good water conservetltiort practices by all compants end the Inste#fatlon of water Cons>srvIng plumbing fixtures are key factors In extending the useful life of this component. The soll absorption component`s operation must be assessed by Inspectlon at least once every three years, The Inspecklon shalt include recording the ier+els of pwdlna, if any, In the obswetl n pipes, and a visual inspection for arty evidence of surface seepage or discharge from the component. On staply sloping eltes, arose of erosion ohcwId be Identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human hoolith hazard Tr ft around or over the soil absorption mn componard ahou loulaA lead during winter rtths, The compaction or removal of snow covet thbut e oo r difficu ar to hydraulic failure by freezing, This type of fallurs is usually temporary, lrhposs to repair until weather �nd1tlM jRto �� and dis� otrilmv,�hictionn�soy a�I to component win reduce diffusion o oxyg more intense" and earlier, organic clogging Of the soil, H Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep - rooted tress and shrubs directly over of within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Contingency Plan °*�- In the event of system failure, a new system could be Installed in an alternate area. With the installabon of a diverter valve, the existing system could also be reused after a period of three to four years. It is the property owners responsibility to maintain the alternate area free from any planting of trees, shrubs, etc. In case of failure of the original system, the alternate area will be needed. If any trees, shrubs, etc. have been planted on the alternate area, they will have to be removed at property owners Upense. 716 If alternate area is destroyed, there are other alternative systems that an be used, in which, could result in added expense to the property owner, Any tank abandonment shall be done in accordance with Wise. Cods 83.33. Any questions regarding this cam, please contact your local Zoning Office or contact the Installing plumber. Sent By: HEARTH AND HOME DESIGN CENTER; 715 381 5894; Oct -29 -02 11:12AM; Page 1/1 FFMl : 5ehua8ker PlmblM FPV NO. : 7153963121 Oct. 29 2002 10:30AM P1 ST CROIX COUNTY �+ra•,t Ph�,r,,... SEPTIC TANK MAINTENANCE AGREEMENT AND OWN] HIP CERnFICATION FORM Ow=A3uyor ltJ es7`�l�L a �`��evS' - - wIMAM� II...1 I ■ (Vasliloadom n qo red !i► PLtwift DeyatMM 5w erw aoa et�ara} v"�■ citylstate Favd IdentlBt:ation Number °z — / 3 qz —10 pwparty 1=ati m & V., 4 4La_ '' /,, S 3A . Tgf N -R W, Town of Slat vision `.Ji` di �$o�^ h�e.'�/s f . Lot # K A C lrti>llad Survey Map • Yoluame . - pw # Warrvrtp Deed 0 -5' as v o l ume Spec house Z yes 0 no Lot bra idtWXwbW 0yei Cl no lmpnoper tlas aad mdaaeaemoeof lops aeptu ayessm ward Mutt in � fsilun t haedla .vaetee. Popper asau►tepanoe ootteiea Of pwupi opt fife apw UA rMy doe yeam as eoataar, if aoedtd by a Wo oW VWVft WLat Y W >lto the system etet mat AM010 o!dw aeptw task"a v anow tttp is the waste thew eyetena. Rbs properly owner &VW to eab & to St. Atoht Zadq Depacm M a om061dW *M 4pW by *9::w= WA by a mutes pipauhre, pluaDber. rsrtdasadpitamber ae s 3icenaed vesil that (1) SO a 4*0 weluawatetrdiepoatl 12 is pt:oper opmew oaasdittan and/or (3) dw Wpclioa and pw*& (if geoee> Ma the tq& talc 1s lose tbam I/S W Of 11040. ea a have read dw abovs regakmenb ad � to ms�tain tbs Pdvate $ disposal 00W die maaards in the ttdestidptad of Naomi Rmas=6 8h to of Wfaaa W& CarwkMiod cec ibem. �t4r a0 by tied DopartcaNat of Camaaaera sad the D�paefansat em" 60 ym � arete�► l e. boo Mh tlwA=xt to eomp]a d sad era®ed t the St. Ccatx Coamiy Zatiiai � withia 30 11 Z WMAWn OF ABP DA'tB I (ar) co mw that som matia On tLia form are tMe to the beat of my (our lmowledp• I (wee) am {are) OW Owns*) of Lahnvmf by a warpLa y deed reaorded in R of Deeds testae. ?t}>RE Ol* APPI'.ICAN'1C DA1'S wa•r•a A imloe»oat3oa 11t! is mirrepseieated maY result izt flea IaoitatY penalt being revoked by tha Zoaiad De menu " "` *" ■e batude wttb fate 40HO 144= # N-wead wo=&W deed Meta the iteOar Of Deeds OMM a oopy of gat we" Wsy mtp if "i mee it match in to *Uxtty deed y X55130 STATE BAR W RANT T IDE D M 2 - 1982 DOCUMENT NO. VL � 1 PACE 06 Mary K Kral, a single person, conveys and warrants to W est Lifl e U ers, nC. , a Wisconain Cgi=ratinn, HEGISTES"i C. i ST, CRO CO., w1 FEB 3 1997 si 4C. 1% t.�1iti Rgsw d D,Bd1 THIS SPA RESERVED Foot RECORDING D A 1 NAME AND RETURN ADDRESS N the [oltowing tkescribcd real estate in St. Croix CountK f�/��I�` State of Wisconsin: 1 / 4 6 020 - 1093 -10; 020 - 1093 -60; ICA ION NUMBER (See Attached Exh ibit "A ") LIU rl z r ) Z;NSUR This ).8 homestead property. (is) Emptiontowartant" Fasements, restrictions and rights -of -way of record, if any. Dated this dal of January A.D.. 19 97 (SEAL) aL (SEAL) Mary K. Kral (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Sigauure(s) _ State of Wisconsin, S& St. Croix authenticated this dry of .19 Yets=4 came before me this _ day of Tarn ry 19V _. the above named Mary K Kral, a single Mrson, TITLE: MEMBER STATE BAR OF WISCONSIN (If not. authorized by 8706.06, Wis. Stats.) to me known tc be person who executed the fotegping inst kedg the same. THIS MiSTMIMENT W AS DRAFTED BY d tnrnav Krintina 0glarrl , titirkn WT 54016 Notary c. (Signatures may be authenticated or acknowledged. Both are not My o oa u etTnartettt. PL necessary.) • Nsmes of penom dSeinS In ury apecky shoeld try typed or printed below their ftwurm / STATE BAR Of WISCONSIN WARRANTY DEED tort• No. a — 19" Couro Wis. (if not, state expirsti y date: YYlstonsN lead Blstst Co.. tr: kameA . WIL z vK M) PACMA5 EXHIBIT "A" 921/4 Of NW1/4 EXCEPT the South 66 feet of west 66 0 fdot there of and EXCEPT the East 3-1/2 rods of South 20 rods thereof and EXCEPT that part lying Ely of O'Neil Road; The North 66 feet of East 678 feet of NEI/4 of SWI/4; Part Of SW1/4 of NEI/4 described as follows o u tl o t "lm of Certified Survey Map filed October 15, igeo, in Vol. "4", page 1001, Ek)c. No. 367079. All in Section 32, Township 29 North, Range 19 West, St. Croix Count Wisconsin. Part of NEI/4 of SW1/4 and part Of SE1/4 of NW114 of Section 32, Township 29 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Commencing at the N1/4 corner of said Section 32; thence S0 (bearings referenced to the N-S1/4 Section line of said Section 32, assumed S0 2698.18 feet along said 1/4 Section line to the point of beginning; thence continuing 50 35.40 feet along said 1/4 Section line; thence N89 678.01 feet; thence N0 132.48 feet; thence S89 647.66 feet; thence N0 19.24 feet; thence N89 660.06 feet; thence S0005105"E 66.01 feet; thence S89 12.09 feet; thence S0 66.00 feet; thence N89 678.04 feet to the point of beginning. TOGETHER WITH AND SUBJECT TO A non-exclusive easement for ingress and egress as described in Quit Claim Deed dated January 12, 1987, recorded January 15, 1987, in Vol. "716", Page 200, Doc. No. 421395. In ,69'6S£ M .. \/ rn EA rn I 0 ••• •123.99'v X61 � . 6 'v • by 0a., • %, D w N _ 14 D owl 01 Jm "� N Om PC Im 0 O-jo D C � Q C ;a O C ;R0 ZOO ZOO ca L4 IT1�N D O rj ZOO Zj m o0 �� 10 in m Z � D °3 �N `J Drria m � N 000 OR N D PMW m -n N N Dy ND p;u ' t n N N S 01'00'35" E W - - - — -- -• "'U ASS• 113113' I i n _ S ' � 3 ' 0 3'' S 00'55' 16" E S 0NEIL ROA W 1 15.93' - — - 3.4 o' _ _ — I-------- S00'55'16 "B 5291.73' -------- - ---- I LOT 3 i LOT 2 LOT 1 C. S. M i VOL. 4, i PSG. 1001 Im 0 O-jo D C � Q C ;a O C ;R0 ZOO ZOO ca L4 IT1�N D O rj ZOO Zj m o0 �� 10 in m Z � D °3 �N `J Drria m � N 000 OR N D PMW m -n N N Dy ND p;u ' t n N N T t Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m) !rmit Holder's Name: ❑ City ❑ Village Qg Town of: WEST LAKE BUILDERS HUDSON iT BM Elev.:- Insp. BM Elev.: BM Description: TANK INFORMATION Depth Over TYPE MANUFACTURER CAPACITY Septic Bed /Trench Edges Topsoil Dosing ❑ Yes ❑ No Aeration Holding TANK SETBACK INFORMA1V1N TANK TO P/ L WELL BL Septic Dosing Aeration Holding PUMP/ SIPHON INFORMATION Manufacturer Model Number TDH Lift Friction I Ister L Forcemain Length D' . SOIL ABSORPTION SY EM BED/TRENCH width Length DIMENSION SETBACK S EM TO P INFORMATION T e O stem: DISTRIBUTI SYSTEM Header / ManitoW Distribu Length Dia. Le SOIL COVER x Pressu vent to ROAD Air Intake I. NA NA / Demal GPN TDH Ft Dist. Tc*Vell No- Of Trenches BLDG I f a n �f Pits LEACHING CHAMBER R UNIT w I x Hole Size I x I Spacing xx Mound Or At -Grade Inside Dia. I Liquid Depth umDer: ent To Air Inta y Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 32.29.19,SE,NW 520 CARRIAGE LANE County: Sanitary Permit No.: 338822 State Plan ID No.: Parcel Tax No.: 020 -1 —10 -210 ELEVATION DATA Ayfyuu STATION BS I FS ELEV. Benchmark Bldg. Sew?,r St /Ht St/ Outlet t Inlet Dt Bottom Header / Man. Dist. Pipe Bot. System Final Grade I x Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert No. Safety and Buildings Division SANITARY PERMIT APPLICATION 2 O 01 W. Box Washington Avenue. 14wonsi Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. ,s'rC • See reverse side for instructions for completing this application State Sanitary P49 ,Nuffther � Personal information you provide may be used for secondary purposes [:]Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Property Owner Name �Ao l,e SEProperty Location 1 /4 1 ia, S T N, R E (or)� A i W Z ) a , Prop rty Owner's Mailing Address Lot Number Block Number 3 a City, State Zip Code Phone Number Subdivision Name or CSM Number 11: TYPE OF BUILDING: (check one) ❑ State Owned o it Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms p Village Town OF li o� !� .0 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ?JZ d 24 3ya► —t ° l O 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Out Recreational Facility 3 ❑ Campground 7 C] Merchandise: Sales/ Repairs 11 ❑ urant/ Bar/ Dining 4 ❑ Church/ School ❑ Mobile Home Park 12 rvice Station / Car Wash 5 ❑ Hotel /Motel Office/ Factory 1 Other: specify IV. TYPE OF PERMIT: (Check only a box on line A. Check box oZB,if cable) A) 1. M New 2. E3Replacem t 3, E3 Replacement oeconnection of 5. E] Repair of an System System ____ ___Tank Only_xisting System Existing System B) ❑ A Sanitary Permit was previously ued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurize stributio Experimental Other 11 ❑ Seepage Bed 21 E] Mound 30 E] Specify Type 41 ❑ Holding Tank 12YJ,Seepage Trench 22 ❑ In- Ground sure , 42 C] Pit Privy 13 ❑ Seepage Pit �"' s X 100 1 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. A rp. Area 4. Loa Rate 5. Perc. 6. System Elev. 7. Final Grade Required (sq. ft.) Pro sed (sq. ft.) (Gals/da ft.) (Min. /i h Elevation OU I'D ®Od 101.� Feet DS &Q 7 Feet VII. TANK Cap acct in allo Total # of P e Site Fiber- Exper. INFORMATION Gallons an Manufacture C to Con Steel glass Plastic App ' New Exis structed Tanks T Septic Tank nk QO 29, ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ I ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STAT ENT I, the undersigned, assume sponsibility for insta (at' ortoNe se age system sho on the attached plans. Plumber's Name: (Print) Plumber's Signatu No St imps) P MPRSW No.: Business Phone Number: t�. as Q -7 s. - si ,X Z Plumber's Address (Street, City, St at Zip Code): io IX. COUNTY/ DEPARTMENT ONLY Approved ❑ Disapproved ❑ Owner Given Initial Sanitary Permit Fee (includes Groundwater _ Surcharge Fee) oa ate Issued / pp Issuing Age ignature (No Stamps) GG /Ob "� Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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 - 3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Far(Dwelling. . III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on lipe A. Complete line B if permit is for tank re cement, reconnection, or repair. V. Type of system. Check appropriate box'depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list 0e total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank m4terial. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application farm. IX. County/ Department Use Only. X_ County/ Department Use Only. Complete plans and speciati not smaller.than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) Flo ra 'to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment f i wers; wells; water mainstwater service; streams and lakes; pump or siphon tanks; distribution boxes; soil lk> or y ems replacement system areas; and the location of the building served; B) horizontal and vertical elevatr e e of C) compI to specifications for pumps and controls; dose volume; elevation differences; friction loss'; pu erf rm c curve; pimp model and pump manufacturer; D) cross section of the soil absorption system if,.required t co y, El soil test data on a 115 form; and F) all sizing information. y ---------------------- - - - - -t' -------- - - - - -- --'-° 10 - - T - - -- -------- - - - - ------------------------- f GROUNDWATER $URC RGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for as number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. lea d0� 1 S e� oe-ol Q'1 \ p 40 `.hes (3- S"x k-r s 1 _ -tom 7? Q a 0 � �'� ,',p � C oil,".✓ ��' ST (. R OIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNFR.S1-I.IP (' RTIFICATION FORM, Owner/Buyer �)e a1-\C Mailing Address e V_ o X Sg D Property Address _ X9,K �r✓���S ��tn� —..r_ (Verification required from planning Department for new construction) City /State Id _o L--) 2 �` q Parcel Identification Number �G - F LEGAL DE SCRIPTION Property L l v oca tion W %4, ALA� /<, Sec. � , TZI. N- R.�NV, Town of p Y Subdivision ' 1 C�5_G r. M� Certified Survey Nlap # _ __._, Volume Page # Warranty Deed # _ _ _ . Volume , Page— �_,,._._w�_ Spec house )?� yes 0 no Lot litres identifiable IK yes ❑ no SYS TEM MA Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper ntainte;natace consists of pumping out the septic tank every tivee 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. Tlae property o m;r agrees to submit to St. Croix Zoning Department a certification form, signed by the owner attd by a rtaaster plttznber, jourtzeyttaan plumb restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and;'or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of shidge.. I /,ve, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, hereirt, as set by the Department of Conunerce and the Department of Natural Resources, State of Wisconsin, Cettification stab that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office % 30 dC► s the three year expi 8tio at . SIGNA'I'UR OI APPLICANT DATE O`VN_F_ ;R- CERTI FIC:'ATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) ant (are) the o���ter(s) of the orty de ctibed abo e, V a N arranty deed recorded izt Register of Deeds Office. /)57 SIGNATt_JI2.I~ P APPLICAN DATE •" *' ** Any information that is mis- represented may result in the sanitary permit being revoked by the. Zoning Department. Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey ntap if reference is made in the warranty deed 7 555tao i! DOCUMENT NO. Mary K. Kral, a MA STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED tii 4EGISTZ bT. CRM :.0., M single person, f4ed for PAUG FEB 3 1997 --- .-- 1 conveys and warrants to West Lake Build ersp nc- 1 1, 10:00 A . M a Wisconsin r-n roratjnn, THIS SPACE RESERVED FOR RECORDING 0A 0 RETURN ADDRESS 50 the following described real estate in St. Croix County, 10 State of Wisconsin: �i `+ " 020-1093-10, 20-1093-60; 4 iML7. N01b RR NUMBER (See Attached Exhibit "P) NSUR This is — homestead property. (is) )MM Exception towarranties: Easements, restrictions and rights-of-way of record, if any. A ,f Dated this day of January A.D., 19 AUTHENTICATION Signature(s) (SEAL) yyl . , � , I(". OL (SEAL) Mary K. L Kral (SEAL) (SEAL) authenticated this — day of —.19— TITLE: MEMBER STATE BAR OF WISCONSIN (if not, authorized Ly §706.06, Wis. Stats.) THIS ;NSTRUMEN't WAS DRAFTED BY Atrnrney Kri-,tina QjZI;and flichson. 111 54016 (Signatures may be authenticated or acknowledged Both are not necessary) ACKNOWLEDGMENT State of Wisconsin, St. Croix County Personally came before me this - 3 day of — January - -1 1941— the above named Mary K. Kral, a single person, to me known to be F person — who executed the foregoing inSat a wkedge the same. wn-�- Notary P*6c, County, Wis. j M.y,,",§.sjon is .jo _permanent. (If not, state expirati2p ate: Names of persons sigma i any capacity should by typcd,.- printed below their signatures. STATE BAR OF WISCONSIN Wownson LWA 9011, CO. 61C. WARILANI, DEED form No. I — 1982 Wwaukes, We iii . r VIL 1221 PACE 065 EXHIBIT "A" SE1 /4 of NWl /4 EXCEPT the South 66 feet of West 660 faet thereof and EXCEPT the East 3 -1/2 rods of South 20 rods thereof and EXCEPT that part lying Ely of O'Neil Road; The North 66 feet of East 678 feel of NE1 /4 of SW1 /4; Part of SWI /4 of NE1 /4 described as follows: Outlot "1" of Certified Survey Map filed October 15, 1980, in Vol. "4 page 1001, Doc. No. 367079. All in Section 32, Township 29 North, Range 19 West, St. Croix County, Wisconsin. Part of NS1 /4 of SW1 /4 and part of SE1 /4 of NW1 /4 of Section 32, Township 29 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Commencing at the N1 /4 corner of said Section 32; thence S0 (bearings referenced to the N -S1 /4 Section line of said Section 32, assumed S0 0 12 1 40 "E) 2698.18 feet along said 1/4 Section line to the point of beginning; thence continuing S0 0 12'40 "E 35.40 feet along said 1/4 Section line; thence N89 0 57 1 50 "W 678.01 feet; thence N0 0 16 1 48 "E 132.48 feet; thence S89 0 37 1 30 "W 647.66 feet; thence N0 0 05'05 "W 19.24 feet; thence N89 0 09 1 26 "E 66 feet; thence S0 0 05'05 "E 66.01 feet; thence S89 0 09'26 "W 12.09 feet; thence S0 0 12 1 40 "E 66.00 feet; thence N89 0 09 1 26 "E 678.04 feet to the point of beginning. TOGETHER WITH AND SUBJECT TO A non - exclusive easement for ingress and egress as described in Quit Claim Deed dated January 12, 1987, recorded January 15, 1987, in Vol. "716 ", Page 200, Doc. No. 421395. 4!E OF' E SE1 OF THE NW1 /4 66 —X 3 L27. X — X••N IQi N X w W.L. ro �-` • -• -•- - 4 U , 939 N rn / + co / 1.286 ACRES / U j v 1 . 56,014 SQ. FT. 0� of (L/i I' 1.190 ACRES EXC. R/W ui� I• / 5,829 SQ. FT. S 86-55-08" E 419.50' ' i i�1EMPORARY — _ _ _• 7.90 p /� 2 0 ' RADIUS CU L - DE -SAC RAD g r S , �^ 1.354 ACRES Z' N 0) - 0) t , •� S�, 58,961 SQ. FT. 1.312 ACRES EXC. R/'N I 57,127 SQ. FT. ; L . �. . • u' tom- �i .i i 'l.249 ACRES 54, 397 to , ' U' � Cp I Lo 1.141 ACRES 0 49,696 SQ. FT. tti O -� - -- � (n F r I ' I 11 N I I Oi O I °' N -----tz Z i ilk I Q t in n M E—,� I O Ul W w Lo w I o -- I O I cn I S 88'49' 43" W 12.50' I I I uj o I O I d' : O I j cv) O to I� I o cn c\1I Oi (j; I w i o i l 8'49 43" E j O 57.75' SOUT,H nF TMc X /4 TEMPORAi UPON EX NUMBER L1