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HomeMy WebLinkAbout020-1105-10-100 O 0 * \ ƒ 94 7 \ § ; < = G « :"I \ \ CD -I = , k \ f • 2 ® E O 0 ® & & w © ° t ƒ / 8 Q 6 E E e 9 _ P._ / } ± ± % / # g < ! P m E ` / / / ° k \ \ { $ § OD a e = o- 8 B \ @ $ \ \ ) \ ® E co E_: - S �2y 0 ? v > 2 E - \ ^ \ CO p- J § ) $ E @ m _ C 0 iv R3 r - Z / } \ \ J n r ] 8 G § ® ° ` \ F Cr } 0 0 0 13 E� E f• 0 0 0 } / / j j j ( / ^ > a / ° 0 ? \ \ �� � . \ en ` § (-71 \ ƒ • e « w & °° � ( \ 0 rojs a a \ § Ci \ E % I ca @ ; • o _� k \ \ c § Z = § % 2 CO -0 § ] « CD \ { ° \ } / i 4 \\0 § \ \ c ; / $ , / / , / 0 § ƒ ; \ * / a / . a 7 2 1 , . f m 0 \ / A } A o 0 . Z @ a \ f Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix SafQty and Building Division INSPECTION REPORT Sanitary Permit No: 479249 0 GENER 1L ) NFORMATION (ATTACH TO PERMIT) State Plan ID No: Persdnal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder`s Name: City Village X Township Parcel Tax No: Nelson, Michael Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description Section/Town /Range/Map No: 1�'fl ( it 1 34.29.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark LA- bSe . L z S` r 4 ./.,15 , -f.15> ) a0 . a r Dosing AI BM t . 3 0 S Aeration Bldg. Sewer r S 18.E • Holding St/Ht Inlet G. (may St/Ht Outlet TANK SETBACK INFORMATION t 9} 62: TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet _ Septic , UU t ( , 13 Dt Bottom ' Dosing iC l Header /Man. 1 Aeration . (Dist. Pipe (0.5 q - S ' Holding IBot. System 4 .SS. /o � .` S : s , 8U _-------.) '.3 - $ ® "`flflfl iii 30 Final Grade ( t7� P /SIPHON INFORMATION ) Manu - cturer Demand St Cover \ c D \ /07 GPM TJ Model umber TDH (Lift Fr'• on Loss 'System Head TDH Ft Forcemain ength • ist. to Well SOIL ABSORPTION SYSTEM ` 1 5 ) d5,,,- „,,hers. = �S / f p J-. RENCIJJ Width r Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. !Liquid Depth DIMENSIONS 3 Sao 6i (3) SETBACK SYSTEM TO /L BLDG WELL LAKE /STREAM LEACHING Ma fa4 gr: INFORMATION CHAMBER OR {'- Type Of System: / �' UNIT Model Number L i ).--6.06,3,4,,_ 5 b z >5 .) Gam,, k DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake V.■• Pipe( Length h' Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil g p r 1 Yes F] No r] Yes l_ No C :2 ANN S; (In u code discrepencies, persons present, etc.) Inspection #1 �a- dZ(ilnspection #2: 7% - - Location' 611 Northern Trail Hudson, WI 54016 (SE 1/4 SW 1/4 34 T29N R19W) NA Lot 4 Parcel No 34.2 .19. 1.) Alt BM Description = 6R-s ter- �'�e�- ✓ 5) ' rwee 1,f )��,Gv`! v'�” I` �7 2.) Bldg sewer length = -'- ZO / 2. e-.. � r / fi 1 UU - amount of cover = 1$ ��5 -Q ear. r f 'Plan revision qu ed? ]Yes No r/ I ..[ALL. Use other side for additional informati a t oz 1 = J L __ - -- 6t. 1 Date Insepc or's Signature Cert. No. SBD -6710 (R.3/97) I Safety and Bu ldings' : "Q�' d/ Coun 201 W. Washingto Ave., P.O. Box X16 �_ 45dsfl5Ifl Madison, W 53707 - 7162 Sanita Permit Number (to be filled in by Co.) (608) , 66- 315� 6 005 4[ / •-1 Department of Commerce / O ` Sanitar Permit A l icati t i., n � .. State Ian I.D. Number Y PP olx cOuiV i < G In accord with Comm 83.21, Wis. Adm. Code, personal informati ou pr OFFICE may be used for secondary purposes Privacy Law, s15.0 n t Address (if different than mailing address) ''' /\' 6// /111/1 I. A pplication Information - Please Print All Information / // y - Property threes Name a113 P ... 30) Parcel o v CO Lot # Bl c 4 T �� 20 -lao) Y Property Owner's Mailing Address , Property Location 75 / `J A-c- 4"-` oae S 4‘ 1/4, 5-141/4, Section 3Y City, State 11 � -w ,, w, � Zip Code Phone Number UJWv` W Z '� 70/ 77 - ?7 .5 - 2R / circ ) T22N; RI E II. Type of Building (check all that apply) (._/ si M a• ADD ' A •••....`• •••....`• X 1 or 2 Family Dwelling - Number of Bedrooms 4 Subdivision Name CSM Number ❑ Public /Commercial - Describe Use �� / Name 7 fy_ e-a ?0` ❑ State Owned - Describe Use ❑City_❑Vi lage o w ship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) n-/o0 A. kNew System ❑ Replacement System g Replacement Y Existing Y ❑ Treatment/Holding Tank Re lacement Onl 0 Modification to Existin System B. ❑ Permit Renewal Perm Revis ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ,i 4 412-(1-9 n-u""0- 1 i�t Zto- � 6 IV. Type of POWTS System: (Check all that apply) 7 9 ( , (.Z) 'Mute)" u tL O.0 ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Pro.osed (s A System Elevat40 r iv d r y g5- 7 .e , _.., 137(49 1— _ 1C* 1 VI. Tank Info Capacity in Total Number ' Manufacturer Prefab Site Steel Fiber Plastic ce._ Gallons Gallons of Unit /' ' ^ Concrete Constructed Glass New Existing 44 TA i. Tanks Tanks Septic or Holding Tank S© — _ SQ /ti"1~ ?�k ir /d 9 / �l Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) tilt/4 Signature 61/MPRS Number Business Phone Number il T'lumber's Add1ess (Street, City, State, Zi ode) #0 /U /r U t w,.4.` ,5 yo o /. VIII. County/Department Use Onl Y Approved ❑ Dis• Sanitary Permit Fee (i Ludes Groundwater Date Issued Issuing Agent Signature No Stamps) Iiit Surcharge Fee) / ❑ • - - Give Reason for Denial t0 ' — Al. • V z I ZLO IX. Conditions • Appro . • e SYSTEM *INNER: 3) o p,e-ve-Q 4 N.4i ,... ck 1 Septic tank, effluent filter arid t. r C SQC.ev . ba dispersal m rsal cell must all be serviced / maintained o as per management plan provided by plumber. 4 y ^-�S p AA,, 2. All setback requirements must be maintained 1 • tN °`^4 A_ CST as era PP applicable code /ordinances. P Attach complete plans (to the County only) for the system on paper not less than 81/2 x 1 inches in size SBD -6398 (R. 01/03) ..,. t .. 1 cL;(-c-- 2 ,_____________— (Aids( -(0 sca) ...., t vivo ..,,,, moor w ati_ . \ 4\ y l \' -..._\.— \ 1 L ( 1 1 1 -/' — Xt-eioot m Qi4,4, 1,,t Y cif. 1 / 1)' 0-- u-A-4-1/4-7 fi ._ /0 0 7 c...11^- veyt /1 P gy- 0 7 a I ) 5O / 5L'.. 7 7 ®,5" -/ - /60 - 7` ¥ fly "/tc, ' - r� ®,61k - ? -- 97,yo -- T' . 3 4, " U /3--3 \\ da vs. 6:-?, ; " 11- ,. LI 1111 ac-6_, lib di ow 7C. go ' 9 ,"Z / 1 1 1 / ois _--- /V - ,6.57 1 (21,0,4v. N 14-100 70-61 c �, (/o4 /1 yB7a 5y . 7` = %G ® ,!3/u- , / _ /co !- 7 e 7 /y •I laf/L (49 BA( - Ter 01 V • 13 -3 c \ \ 7 \ --k;\ f -c-6, lab _ t, go - , / - rJ �i ReGg ALU • ION REPORT #1750 Ital NVisconsin - Department of Commerce in accordance with s • m 85, Wis. Adm. Code Pag e 1 of 3 • Division of Safety and Buildings iA i( ?, 0 2.005 ) Steel's Soil Service, Inc. ...4 County Attach complete site plan on paper not .-ss than :' l• ► 10,1ip size. - • .t O St. Croix • include, but not limited to: vertical and h .rizor%l - . di -c i• • - percent slope, scale or dimensions, no arrow .51l� A 1- • _ _ to nea = •e - arcel I.D. 0 - 0- 1105 -10 -100 Please print all information. Reliiewed B, ) Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` - I / / Property Owner Property Location Michael Nelson Govt. Lot na SE1 /4, SW1 /4, S34, T29N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# < 9 • 1575 Quasar Ct 4 na CSM Vol 19 Pg4872 $t t rveyr7n� — City State Zip Code Phone Number City Village ® Town Nearest Road /Ci-Jay -p.. Lake St Croix Beach 1 MN 1 55043 1 651 - 998 - 0522 Hudson I Northern Lights Trail ® New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: na Parent material Pitted outwash plains and Stream Terraces Flood plain elevation, if applicable na ft. General comments Conventional system, system elevation 96.80ft. Trenches spaced and depth to code 3.00ft below grade. and recommendations: 1 Boring # ❑ Ground surface elev. 99.80 ft. Depth to limiting factor 110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * Eff#1 * Eff# 2 1 0 -6 l0yr 3/1 none sil 2msbk mfr cs lc .6 .8 2 6 -11 10yr4/4 none scl 2msbk mfr cs lc .4 .6 3 11 -110 7.5yr 4/4 none Is osg ml na na .7 1.6 2 Boring # ® Ground surface elev. 99.80 ft. Depth to limiting factor 110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -6 10yr 3/1 none sil 2msbk mfr cs lc .6 .8 2 6 -11 10yr4/4 none scl 2msbk mfr cs if .4 .6 3 11 -110 7.5yr 4/4 none Is osg ml na na .7 1.6 * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) � Signature /.- CST Number David J. Steel �� - 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 7/20/2005 715 760 - 0347 SBD -8330 (R.07 /00) . Property Owner Michael Nelson Parcel ID # 020410540400 Page 2 of 3 3 Boring # PP ® ❑ Ground surface elev. 93.70 ft. Depth to limiting factor 110 in. Soil Application Rate • Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -7 10yr 3/1 none sil 2msbk mfr cs lc .6 .8 2 7 -23 10yr4/4 none sicl 2msbk mfr cs if .4 .6 3 23 -110 7.5yr 4/4 none Is osg ml na na .7 1.6 Boring # ❑ Ground surface elev. ft. Depth to limiting factor in. ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # ❑ ft. Depth to limiting factor in. Soil Application Rate ❑ Ground surface elev. PP Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L * Effluent #2 = BOD 5 < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. SBD - 8330 (R. 07/00) Steel's Soil Service, Inc. STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel Michael Nelson 994 200 St. CST- POWTSM SE1 /4,SW1 /4,S34,T29N,R19W Baldwin, WI 54002 Lic. #248956 Town of Hudson, St Croix Co. Direct 715- 760 -0347 CSM, Vol. 19 Pg. 4872 Lot, 4 Fax 715- 684 -3449 '' P 9 _ - Legend N 1 " = 40' • = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe 7 _ 2 , 05 • = Alt Benchmark Ele. 97.90 ft Top of 3/4" pvc pipe ❑ = Borings Boring Elevations B1 = 99.80 ft B2 = 99.80 ft B3 = 93.70 ft 1 B4 = 0.00 ft 5,5'7. o ' / r 40 /,-. -� A, 9 3, 7ord- . I \ - - ____ ___________ _ / , e Oi- q 5 Yo \____ • t 6 t- g 0___- ��� / / I -/3I I R � s x J '--- ' ("3 ---1 \ 4 H 11 87/21/2885 15:53 7157491719 NORTHLAND SURVE PAGE U3 13 : 4.: 7 ' KATM 1. 487 ISTER or S T. CROIX RO I CO S I CERTIFIED SURVEY MAP 11/52/2104 R =roo b R LOCATED IN PART OF THE SE 1/4 OF THE SW 1/4 OF SECTION 34, T29N, R19W, TOWN OF HUDSON, g? EAP NW ST. CROIX COUNTY, WISCONSIN: INCLUDING LOT PAOCSI 2 55 OF CERTIFIED SURVEY MAP RECORDED IN VOL. 1; PG. 103 AND A PARCEL OF LAND DESCRIBED IN BOOK 512, PAGE 340. N1/4 CORNER :,... SECTION 34 OWNER SCALE IN PET 1' = 150 D ON FLATT 615 NORTHERN IJGHTS TRAIL 10 0 ` • 1 SO HUDSON. WI 54016 E a n�M �Ip n 1 EDWIN OR \ V OMT OF ©� WW U �UL:a4S NO RM SURVEYING, INC. A '1p 114 1 ROSEAU. VA 54023 49 i --- 810E 470.00) NORTH LMIE OF THE SE 1/4 OF THE SW 1 /4 • , - 463.72 �' 233.11' ° 230.61' i ©4L41. Mai 1 . Pao 9C3 i g ..,3$ p•� r. LOT 1 • • LOT 2 slag g i l -, ' 2.39ACRES INC. RAN , 244 ACRES INC. FIN/ FIN/ 3 103.899 SO. FT. 117 316 SO. FT. Sa fr 2 ACRES EXC. RAN 2. ACRES EXC. RAY ��e N •410 102 59590. Fr. 115,44090. Fr. • NOrliTIOW 355.37 I • 1 i see'1O'00'YI/ J -- 1i t W 47.00' Norm , 3R25 I g •-• a ' 1 1 ., ° ° N612252W244.91' g LOT 3 I u / i — �� c NT O 3JIOACRESINC.WW I 185.54730• FT. / Cry_._ I / ; 14 . H0 0 3. ACAS EC. RN ; le c ' ; r.'' \ : :' "• 150,19050. FT. ,R !t RI ' .3 - VENTS Q 5 RI It LEGEND / 434x! �' . , o L • 4 �. ' ° .•226 ACRESMID. R /+�A.. • COR MO NT FOUND ` �% o e 6 95.343 SO. Fr. • • a,� I i 1' O.D. IRON PIPE FOUND `` ' \ \ 2.01 ACRES �, S a o • • 3! �� A \ \ 0 117.597 E Si" x 111' IRON REBAR SET WEIGHING : \ '' 1.50 LOS. PER UNEAR FOOT \,, \\ \ ;Oa • ` 412• 50 ROADWAY SETBACK LMMIE ���,� t * � " Al 6 -x -= EXISTING FEJ4CEL9VE I 111 PERA4ANENT LM1FA m 177 ECM PROPOSED DRIVEWAY - � , \33 REC. IN VDL 2686. 007 20%> SLOPES 51 iti EVI i I ) PREVIOUSLY RECORDED DATA y w ^ t 1 31/4 CORNER • SO LBORING 14- SECTION 34 - CURVE TABLE — NUM9ER RADIUS CENTRAL ANGLE CHORD BEARING _CHORD LENGTH ARC LENGTH TANGENT IN TANGENT OUT 1 .00.00' 5 570O' SS93128e 77.51' 10.91• 855'3055E 3022002' 2 110.0 24•2217* S49•2554.5"E 33.77* 34.02 95r3600E S31•9451'E 3 80.07 339(53' 814'2724.5E 40.22 48.92 S31 S02'20ti2'1M - ' 715.20 18•0451' S24.4234.5% 225.0? '226.01' �S33M6!O E ,$154020E 5 maw 16'0502 S24'4273'E 23548' 236.4? 833•4500E 815'9454 E THIS INSTALMENT DRAFTED BY SAM ADAMS JOEI NO. 04415 DATE 545-04 SHEET 1 OF 2 SHEETS Vol 19 Pass 4872 • I • O • Safety and Buil+ . ision Coun 201 W. Washingto , • • 62 �S Ma 53 ° "� - �, Wisconsin 7 11 S�I1 , c rmit NumTer of Commerce (608) r 66 -315 er (to be 1 in by Co.) r Sanitary Permit Applicati i n JU Plan 1.D. Number In accord with Comm 83.21, Wis. Adm. Code, 2005 may be used for secondary purposes Privacy personal inform:.. you rovide — Law, s15. s (1X4 I - CROIX COUNTY . ect Address (if different • mailing address) I. Applicati. Information - Please Print All Information ZONIN —`'� Pro. Owner's /1 P10rTftCLN tfE C, 4.11i1 i / •t #. Block# 1 roperty Owner's Mai d. , .. - - .0' / r--- I` i 4t , 1 �C C 1 Property ; :aion Ci, ,State ( � r ������� Zip Code Phone Number , o • Y.(LL(L'A, Section II. Type of Building g 1 , /1 # 7 A ;2,,;' / N R circle one (check all • at apply) ° ' 4r W or 2 Family Dwelling - Number o t edrooms �L� • � / 7,_ �� y -- ❑ Public/Commercial - Describe Use e - Number 782 p � ' g ❑State Owned - Describe Use r "t ,T oz ' 1 Q ❑City ❑Village.�Town ip oft u III. Type of Permit: (Check only one bo on line A. Complete line 13 if applicab ill lik - al IIII System y ❑ Replacement New S �P L — ��� Sy- ❑ Treatment/Holding Tank R ent Only ❑ Other Modification to . II ❑ Permit Renewal ❑ Permit Revision Before Expiration , ❑ Change of ❑ ' it Transfer to New List ' Permit Number : .Date Issued IP • ; lumber • - er IV. T • e of POWT$ S stem: Check all that a .. Non - Pressurized In- Ground ❑Mound > 24 in. of suitabl it �� ,r �'� I ����• �����r�A` �l ound <24 in. of sub: e soil ❑ At -Grade ❑ Constructed Wetland ❑Pressurized In- Ground ❑Holding T:. ! � 'S Filter ■ Recirculating Syn Media Pressurized !i ri A P eat Filter ❑ • e • . is Treatment Unit a Leaching Chamber irculRting Sand Filter ❑ g ❑ D Line ❑Gravel -less Pipe ❑ OthBr (explai V. Dis • ersal/I'reatment Area Info ation: Desi: Flow (gpd) Design Soil Application Ra - .( i gPdsf) r spersa : Re quired (sf) • • 0)vl 0 t V -1 . - - o+ s J ev�tion� � /O VI. Tank Info Capacity Total 4 r � r te' tjt /O ` aci in tu ber = / Gallons Gallons F r.m b M anufacturer nil V/ refab - 4 AP O New Existing ' 4 4 - / n c../PA,, gif Crete , S teel Fiber Plastic Tanks Tanks A Il Cted Glass L� Dosing Chamber INN 11411111 11111._ --_ VII. Responsibility Statement- I, the , dersi , • '+ seta ' e �_ --_ I Plumber' ame Pri t) , .+. responsibility for installation he POWTS shown on the attached plans. �; I �-' MP/MPRS N �• ��� �� � ,'� " Business Phone Number Plumber's Ad. L • a a if , � or • Code) / I kagi' ., i ' me, � j se O . � - I . Coun /De .art X Approved ❑ r • - .rov Sanitary Permit Fee (i • lades Groundwater Date ; ued issuing Surcharge Fee) w r nt Signaturo ❑ Owner Given Reason for . / 0 _ (1do Stamps) IX. Conditions , ' ia / pprova s • - • ( .. •t iiE.�. `� SYSTEM OWNER: 1 b - 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintai as per applicable code /ordinances. nee Attach complete plans (to the County only) for the system on paper not less than 81/2 z 11 inches in size SBD -6398 (R. 01/03) . il--- si32—e)L 00 y ud-- ,,,,,L.-K—v 1 //1/45 9 it) i u I y A -/00 ,c,a.,. 0 3---0 7,-Q cam- c �s/u ' 87. \ 6 Y i'lar Nur i f / ^ 6,10 , w i r, \ r—, :I 9 6 . 8° f--- a /IP 1 f, ° - ' • Tc7; erig2 '6,/o ' /6. S 0 ( ' - 1 \ # Afi / 1 a _ ia y 7- (s /h " i, . / 1;'e- _____. 7 I4` ,\ // l'' / /:.- 116°9'-( ' k /371- a. \ / p -?.. / / AK /4/4 d O 35? � c 1 ' "Msa nsln Depatbuerttof • . '2 :.Le IL EVALUA ON REPORT Page 1 of 3 Division of Safety and Buitdi gs in acaoraanoe wuh Corrwn 45. Wrs. Adm. Code Attach complete site plan on . - , • not tesiE 125F1ft filches size. 02.0• //0 a7 • e O Dow • Da include. but not limited to: vertical . • Parcel I.D percent slope. scale ord'atensions, north arrow. and location and distance to nearest road. 0 e' • //05 • V>. O 0 0 Please print all information. 2et by Date Persona information you provide maybe used for secondary purposes (Privacy taw. s. 15.04 (1) (m)). , 1ZA J ) 4 1 2 0,1 5 — Property Owrter Property . D &) f AT T Govt. Lot Se 114 s T 29 N R / f OW) w Property " vo ;taring n) 4/ ' &Ats T.,4// ` hot I Bioa` .u o 4 , Eke State Zp Code Phone Number ❑ city ❑ Village ® Town Nearest Road 7 UPSo,J Sul 59o1(0 (7/5 386 *- UPso .voRtlt2i 3 . $ New Consbuction Use SO Residential / Number of bedrooms 3- y Code derived design flow rate `AC o - (p 0 0 GPD ❑ Replacement ❑ Pubic or cat - Desadhe: Parent material 5AVPy oa TW4 SIt - Flood Plain elevation if apps atbiee it Geneual oortrtteslts .arc : •4/g, -s 7"Fsren 4FI 5v/7 t 3 E f2R 4A/ icy #ovND rev 0 - laAi4 , 2 L). rs . see ❑ D•76 pit Ground erface elev. / D . ft. Depth to tirnitkg fa ›,..5- in. Soil Application Rate Horizon Depth Dominant Color Red= Description Texture Structure Consistence Boundary Roots GPM' In. PAunsell Qu. sz corn Color Gr. Sz. art G y • - -/ .• , o •,3 100e 3/y 51 fs/> if: U�12 J 3 7 2 X3•/2 /o ye 9/G -- sry /jcsb e 4t W"R es 2-f • 9 • 7 .3 /f43 7.5 /RS /4( GS 0,sl. Le c - .7. /•G . 1/ •Y3. S'S /o V/ 7/ , --- , #J. 3 v� .r 3 11. ....Z./. 2 Boritg ill ❑ j 03 . 8o - I Pit Ground surface elev. ft. Depth to intim fa > .2- in.. . .. , Sol Application Rate I Horizon Depth Donri>ant Color Redox Desatition Torture Structure Consistence Boundary Roots GPD1I in. Mussel Ou. Sz. Cont Color Gr. Sz. Sh. *Mil *Effie 010 /o y y ----- 4- if's i- •hj fir` act) 3 • y • 6 , 2 - 0 •2V /0yie ri 4 ----- sic " 21 ` s bi Aid' , cW . / f • (° • c3 3 Qs - r . � � l S tic. J �fi � y � oy�e ��, fs�6� � , - y y 6', 75y'.5/� _ 45 A ss. , ote cs -- . 7 /.G 5 ..o • 2, /o y/e % ---- ^ • S , d , sl eft , • 7 ./.. c. •• Effluent #F1 BOD > 30 < 220 mg& and TSS >30 < 150 mg&L • Effluent #2 = BOD <30 mg& and TSS _ 30 nut . CST Name (Please Address X o,3 Rr &aRic4T 2/.1-61 r .4-71,-2.0 3 J? o j� Date Evalusion Conducted Telephone Number sipr. 2.s - aq -NS • 772. 3 ¥42 Ulbricht & Aaauuictles Private Sewage Consultants 2812 10th Ave. Ce Bt , \ ! Spring Valley, WI 54767 ORIGINAL P , 44 r g — , i AJ /4G- N e CS 4 -! CV r °/`• . 010•go5•/0.00 d • 1,013 f/i TT' 010 .��a.5 •VO - ao Z 3 Property Owner Parcel ID # Page of 3 04 pit Ground surface elev. / OD • 9a Depth b l factor > 7 ice , ,Rye Horizon Depth Dominant Color Redox Desaiption Texture Structure ' Consistence Boundary Roots GPOIIP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 131111 'E1f#2 /. 0• / 2- /o we 373 1. /C54 fR c pw 3 y . c Z Pal . 2. /OYR y /6 ----- sit 2f s6►k w► f r' ccv t ' • c9 3 22.4 t /0 ye 5/', -- SSG / i ,S k •,► i as /f y • G .s R — LL5 O. S 4Q CS — / 6 3 5e. 27 /o yi . 7/ , — ,w4D. s 0. s 41 — • 7 a.+ g `l`9 Z 1 I f i 1 # ° Soling ❑ Pit Ground surface elev. ft. Depth to knifing factor in APPS Ride Horizon Depth Dominant Color Redox Desaipton Texture Strucbxe Consistence Boundary Roots GPDflF in. Mussel Qu Sz. Cont. Color Gr. Sz. Sh. - 't f1 1 7 I I Boring # 0 B(Iling r . . El pit Ground surface elev. ft. Deepth b in. Soil AppiraAon Rate Horizon Depth Dominant Color Redox Description. Texture - -, . Consistence Boundary Roots 1 GPDW in. Maisel Qu. Sz, Cott Color e . Sz. Sh. I I mo# ° Bwmg 0 Pit , , — ft. Depth to inking Or in. Soo Applea6on Raise tlormorr Depftu Donfiant Redox Damon. Texture Structure Consistence Boundary Roots GP!>II! in. Maisel Qu. Sz. Cont. Color Gr. Sz. Sh. ' 4 Effluent #1 = BOD,> 30 c 220 nglL and TSS >30 S 150 rug& ' Effluent f2 = BOD < 30 mg/t. and TSS < 30 nglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608-264 -8777. seoawtse.Sam • • Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 . „= 30 ` ,„-- r c K 11 PI 7-5 5 11 L _ CO Gl1u. XT; -,------------ _ . s feel pig \\* . . 1 d - 5/11 2-- Yop eP y ,\ , rob / A 6, / /f // \ A ( � / 0 3, A r . 6 Y /O i \ t Sz -� -y • r. O { �o • 1 1 1 \ r n / / .----P1 1 f\ I C / 52'. IjI • 3 CP -- -- s o, DoT 4 5 • • RECEIVED • OCT 1 2 2004 ST. CROIX COUNTY ZONING OFFICE CERTIFIED SU RVEY LOCATED IN PART OF THE SE 1/4 OF THE SW 1/4 OF SECTION 34, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN; INCLUDING LOT 55 OF CERTIFIED SURVEY MAP RECORDED IN VOL. 1, PG. 103 AND A PARCEL OF LAND DESCRIBED IN BOOK 512, PAGE 340. N 1/4 CORNER OWNER SECTION 34 SCALE IN FEET 1" = 150' DON FLATT 615 NORTHERN LIGHTS TRAIL HUDSON, WI 54016 \50 0 150 SURVEYOR w �vl MILL cri EDWIN C FLANUM p�4 Ole � u waLL W NORTHLAND SURVEYING, INC. \ EN \ \ P.O. BOX 14 - -- u 0 ROBERTS, WI 54023 0 NORTH LINE OF THE SE 1/4 OF THE SW 1/4 (S89 °35'10 "E 470.00) z — — _ _ _ _ N89°30'2' ' 463.72' II 233.11' 230.61' @O UEo iOda 1, pro 0 3 c a` lb N �. b� 1 ` • Ti gC� � � � � b L OT 1 • ( o �, � , m LOT 2 S il w o / ry "� 2.39 ACRES INC. R/W ♦ 2, 2.69 ACRES INC. R/W (V �_ z a �� C 103,899 SQ. FT. 117,316 SQ. FT. O o r b °ry o . 2.35 ACRES EXC. R/W Pp, 0' o• 2.65 ACRES EXC. R/W 0 r.0 z �c� 4i 102,538 SQ. FT. 115,440 SQ. FT. 7 c?) d �1l ' N86 °19'10 "W 355.32' Z 0° cc z LIJ 0) • S56 15 00 O ° c < cE D 47,00 1111 N86 1 910 'W 357.26' 0 N87 °29'59 "W 244.31' o z o N N87 °39'58 "W LOT 3 0 Rnil R / w M 80.00' CE WELL 3.80 ACRES INC. R/W / S p �o T DRIVEWq - y E - 165,547 SQ. FT. .. / \ P,i. � 3o HOUSE p 3.45 ACRES EXC. R/W • N 3� ® 150,190 SQ. FT. s ,n .. w a p C SEPTIC , ' c' � 6V OF VENTS M N co . 0 g ° �rn L R AV �IVE G% F S HE D N O 8 W. / t -co, • ro ' . N82 °38'33 W 587.09' ° o o co z LEGEND 43.80' a°o o LOT 4 5 4329' z • 2.26 ACRES INC R/W u ., ALUMINUM COUNTY SECTION \ 6 \ 98,343 SQ. FT. I (---) �A 6 CORNER MONUMENT FOUND .\\=- !� J 0,6 \O \ 2.01 ACRES EXC. R/W • 1" O.D. IRON PIPE FOUND \`� \ - ) \ \ O 87,597 SQ. FT. O 3/4" X 18" IRON REBAR SET WEIGHING \q� ` \ (D\\ • O cn 1.50 LBS. PER LINEAR FOOT o � \ 33 : O , ♦ 02g ' 3 i cc 50' ROADWAY SETBACK LINE � t ?4 0 " ` °Z N. 4 `15 I Z o N . —x —x EXISTING FENCELINE r. 1 g g1 ,i ■ PERMANENT LIMITED EASEMENT ; ----- PROPOSED DRIVEWAY - - - �N 0 g 3 \'3 3 REC. IN VOL. 2586, PG. 007 o I 20 %> SLOPES i 00 , z l ( ) PREVIOUSLY RECORDED DATA I S 1/4 CORNER • SOIL BORING I I SECTION 34 CURVE TABLE � NUMBER RADIUS CENTRAL ANGLE CHORD BEARING CHORD LENGTH ARC LENGTH TANGENT IN TANGENT OUT 1 80.00' 57 °57'00" S26 °38'28 "E 77.51' 80.91' S55 °36'58 "E S02 °20'02 "W 2 80.00' 24 °22'07" S43 °25'54.5 "E 33.77' 34.02 S55 °36'58 "E S31 °14'51 "E 3 80.00' 33 °34'53" S14 °27'24.5 "E 46.22' 46.89' S31 °14'51 "E S02 °20'02 "W 4 716.20' 18 °04'51" S24 °42'34.5 "E 225.07' 226.01' S33 °45'00 "E S15 °40'09 "E 5 749.20' 18 °05'02" S24 °42'29 "E 235.49' 236.47' S33 °45'00 "E S15 °39'58 "E THIS INSTRUMENT DRAFTED BY SAM ADAMS JOB NO. 04-86 DATE 8 -16 -04 SHEET 1 OF 2 SHEETS • S133HS Z AO 3 -L33HS ' 'uospnH 10 uMOj eq1 pue 80I110 6uiuoz Aluno0 xloa0 1S an 1o81uoo laaaed Aue 64olenep ao 6ulseio nd 9.10188 '(•O1@ 'paled of ssaoae 'azls lo! wnwlulw 'spue1l0M - el) suolleIn6aa pue sera 'sMel dlisuMol pue /(luno0 'ele1S of loafgns Si (1e1d) dew s1U1 uo uMOis !awed yae3 1 \\ \ N.11IWIIIIII/ / / q4 / i i SIM ' M3vw L817z WfNV1 J 70 .* '0 NIMa3\ , / � i S NOO S\ �\\\ tr "'"'IuMmnIIII " "\P‘' 'awes 6ulddew pue 6ul/(anans UI xlo10 '1S 1 i(luno0 eql JO 0OUeulpa0 uolslnlpgnS puei pue salnlelS ulsuoaslM ail 1 17E'9EZ aaldei3 to suolslnoad lueJano an 1.411M palldwoo A11n1 am" 1 1811'pequosep pue pe, eAJns kiepunoq aoualxe a11 1 epos of uolleluesaadeJ laaaao3 9 s! dew AananS paIUI1J s111 leg) /411a osle 1 'pima' 10 slueuanOO pUe Suoilou1981 'sluawasea Ja Ile pue,eM- to -ly6u (Heil s1-I61-1 waylaoN) peo1j uMOj of loefgns s! paled '('13 'bS 1701-'9817) same 171-' 1-1- suleluoa lamed paquosaa •buluuibeq 10 lulod ail 01 1001 E6'9M173„91,173017LN eouegl '/(auebue110 lulod eq1 o11001 1.0'9zz 'au!! /(ualsea pies pue amno pies 10 ale ay} buoie '/(uailnos email !Pal LO'9zz seinseew pue 3 „9'17E z17017zS saeeq pogo asoyM '„1.9,170.81, saanseew 816ue lealua° asoyM '/(ualsaM aneOUOO 'anana snlpea 10o1 Oz'91.L e 10 einlenano 10 lulod NJ , 01100100'99E 'au!! /(ua }sea pies 6uole '3000,9170EES 8 auail'ao!11O pies le 9L abed ' 1, awnloA u! pepaooei dew /(ananS pallilaa010 au!! /(ualsee an 01 1001 00117 M0091099S eouai1 '9910110 au11 Ulnas pies 0 11 88 16E' 1-1717 'au!! 1s8M pies 6uoie 'M „„z0,EZ017ES amain '99101 pies 1 au!! 1saM an 011001 L'E917 'au!1 ilaou pies Owls 'M„17z,0E068N 00 u 81 -11 '9910 pies 10 au11 y1.10u a101 osle pue eull 17/1. 1 -11n0S - i1. an ail 0 11 88 1917'86E '99 10- pies 10 au!' lsea 8141 6uol8 '3 „60,017010N eouail'aOI11 spaaa 10 aalsIbabl Aluno0 x10.10 '1S all le E01- abed '1, awnloA u! pepaooaa dew /(aAKIS Pe!111Je0 all 1 99 lo-1 1 eu!I Ulnas 8 14 0 11 80 18E'LLE M„8E, 1-001.0N eouayl '6uluuiOeq 10 lulod an 011001 9881.9 M„9i:1800z0N email '178 uolloaS pies 1 Jewo017/1-S all le 6ulauewwo0 :sMo11ol se paglaosap Jeglml'017C abed 'z 1.9 x1008 uI paquosap pue1 to 'awed 8 pue 00 1- abed ' 1- awnloA uI pepaoaaa dew /(ananS P 1 99 10-1 6ulpnIOUl'Ulsuoas!M 'Aluno0 x!0.10 '1S 'uospnH 10 uMOl 'M6LH 'N6z1'1 U 1 b/1- MS all 1 17/1. 3S 8 11 1 0 laed u! pa18001 puel 10 lamed V :sMO11o1 se paquosap s! peddew pue pei emns pue! 10 laoaed al; /aepunoq aopelxe ail 1ei1'den /(anmS pa1111aa0 slg1 Aq peluesaadaa s! yolgM pue110 paled all paquosap pus paddew 'peAanms en8i I 'llel3 uoa 10 uolloaalp ail Aq 1811' 1!laao i(gaaay 'aoAananS pue1 ulsuoaslM paJels! 0Hl 'wnueld '0 UIMp3 '1 31VOI311H130 Sild0A3A8f1S £30179 IM 'S1E13901:1 b 1- X09 'O'd 910179 IM 'NOSafH 'ON! 'ONIA3N1:1fS GNVIHl8ON IIVUI SIHOI1 Nd3H1EON 919 WnNV1 J 0 NIMa3 llVld NOQ HOA3AanS 1:13NMO 'OVE 3OVd `31.9 )1009 NI a39111093a aNvl 10 '1308Vd V aNV Co 1 'Od ` II. "10A NI a3a1:1003/A dVIN A3AHfS a31HI11:130 AO 99 101 ONI0n10NI !NISNOOSIM 9c1Nn00 X10 10 '1S `NOSanH AO NMOI `M6I.II `N631 `PE NO1103S AO WI- MS 3H1 AO VI L 3S 3H1 AO lidVd NI 031V001 ddw A3Aa ns a31A 11133 ' POWTS OWNER MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner lj,>?_, _, Septic Tank Capacity / 0 ga l ❑ NA Permit # 49_q Z �9 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS / Effluent Filter Manufacturer 2 �,...-t. ❑ NA Number of Bedrooms / ❑ NA Effluent Filter Model /4" /O0 ❑ NA Number of Public Facility Units -1.---"-. ❑ NA Pump Tank Capacity 1 aSn gal ❑ NA Estimated flow (average) 1 /06 gal /day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer JA Soil Application Rate . 7 gal / /f tz Pump Model FNA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit C NA Fats, Oil & Grease (FOG) 5530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 5530 mg /L eln- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 5_10' cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size 3/ in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency r Inspect condition of tank(s) At least once eve y .g ❑ month(s) ,� year(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 1; year( ,(s) f (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑month(s) ❑ NA Sryear(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At (east once every: ❑ year(s) ' ❑ month(s) Flush laterals and pressure test At least once every: ❑ year(s) ❑ NA Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of START UP AND OPERATION - For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. - System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. _ . _ - . a o • mg tank alua •• • �� nJ be ' e ai e • ?fZ D44113 Tie:. roe- A/>) coNS7RLJc 1 D ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name 01- 6..A.A4 Name Phone 7/ j- — o� 4, g Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY / Name Name sue(' G�.Q ()L (ou by 2oth'll- Phone Phone /S— 3 gCe,_ el(p SO This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Man 18 05 06:12p LISR 1911N KROLL 715 -246 -2444 p.1 • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT • AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ �/ ' 1. J .i • Mailing Address 41 111 4 ( AL <Dr; it , O, ' 1 4 .1t Property Address C/ ti _ `/ (Verification required from Planning D eat for new construction) City/State Parcel Identification Number 020 1 IOC' 10 -I p-p (.40 3 F - 30) LEGAL DESCRIPTION Property Location h,s /4, Scc� T,O9 N -R • 42111 Town of AlAdS001) Subdivision , Lot # Certified Survey Map # 728 2 S , volume l , Page # g ?at . cc Warranty Deed # Volume Page # - " . Z4 10 1'i ; Spec house nv Lot fines dentifiabl Ayes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature-failure to handle wastes. consists of pumping out the septic tank eve three years or sooner, if needed by a licensed Proper nto th system can affect the fimction of the septic tank as a treatment stage in the waste disposal system per. What you put indo the system The property -owner agrees to submit to St Croix Zoning Department a certification fo master plumber, journcymanplrmtber, restrictedplumber or a licensed . signed e by the owner and system a is in ,proper operating condition and/or (2) after inspection and pumping (if nec , the septic i the on -site less t a than 1/3 ull of system Pumping (if necessary), the septic tank is less than 113 full of sludge. I/wc, the undersigned have read the above requirements and a set forth, herein, as set by the D >� to maintain the private sewage disposal system with the standards stati th h your s t system Department of Commerce and the Department of Natural 3' ep ys� has been maintained must be completed and Resources ' State Zoning O c e n i � days of the three at expiration date. returned to the St Croix County o Office �tbi j,(�� SIG • ,oF LI DATE OWNER CER'r?LCAT1ON I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (arc) the owner(s) of the pro: . /. "bed above, by virtue of a warranty deed recorded in Register of Denis Office. SIGNA • OF APPLICANT % / 4) '5" — • D """ "` Any information that is mis- represcntcd may result in the sanitary permit being revoked by the Zipping Department " Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty decd it 79384 U 2 7 9 9 P 9 6 3 KATHLEEN H. WALSH REGISTER OF DEEDS State Bar of Wisconsin Form 2 -2003 ST, CROIX CO. , WI WARRANTY DEED RECEIVED FOR RECORD 05/02/2005 02: 00PII Document Number Document Name WARRANTY DEED EXEMPT 1 THIS DEED, made between Donald V. Flatt and Linda E. Flatt, husband and wife REC FEE: 11.00 TRANS FEE: 359.70 ( "Grantor," whether one or more), COPY FEE : and Michael J. Nelson and Molly A. Nelson, husband and wife; P FEE PAGES: 1 as survivorship marital property ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more Recording Area space is needed, please attach addendum): Name and Return Address Scenic Title and Abstract, Inc 220 Locust Street Hudson, Wi 54016 Lot Four (4) of Certified Survey Map filed November 2, 2004 in Volume 19 of Certified Survey Maps, Page 4872, as Document No. 778782. '71..8 # a5 - 7 Located in part of the SE 1/4 of SW 1/4 of Section 34, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin. 020 -1105- 10-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, Restrictions, Covenants, and Rights -of -way of record, if any. Dated April 29, 2005 • * (SEAL) i_1 (SEAL) * D . d V. Flatt (SEAL I ' ' '' ' 1C I (SEAL) * * Linda E. Flatt AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ss. authenticated on . St. Croix COUNTY ) Personally came before me on April 29, 2005 * the above -named Donald V. Flatt and Linda E. Flatt, TITLE: MEMBER STATE BAR OF WISCONSIN husband and wife (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: /3 ru ,ja-4 Wertheimer an d Associates "'"' -# "• `""' "" ` I rian Scott Eckholm Hudson W154016 - • ,( etary Public, State of Wisconsin • "Is ' y Commission (is permanent) (expires: 9 -11 -05 ) (S State of Wisoonsi tgIi f res may be au cknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 • Type name below signatures. . ' " ■?7 0 20' - / / -- io -10,0 71'7' 87' a � (. /3F — 3 / \ VOL 19 PAGE 4872 1 KATKGEEE H. WALSH REGISTER OF DEEDS RECEIVED FOR RECORD X � CERTIFIED SURVEY MAP 11/02/2004 12: 15PK LOCATED IN PART OF THE SE 1/4 OF THE SW 1/4 CERTIFIED SURVEY HAP OF SECTION 34, T29N, RI9W, TOWN OF HUDSON, REC FEE: 13.00 COPY FEE: 3.00 ST. CROIX COUNTY, WISCONSIN; INCLUDING LOT PAGES: 2 55 OF CERTIFIED SURVEY MAP RECORDED IN VOL. 1, PG. 103 AND A PARCEL OF LAND DESCRIBED IN BOOK 512, PAGE 340. N 1/4 CORNER OWNER SECTION 34 SCALE IN FEET 1" = 150' DON FLATT — _ ■ 615 NORTHERN LIGHTS TRAIL \50 0 150 HUDSON. WI 54016 \ SURVEYOR EDWIN C FLANUM \ PILA OF ©alLF212V G0fl D NORTHLAND SURVEYING. INC. c,� P.O. BOX 14 � 4 \ `0 0 \ Mil ROBERTS, WI 54023 NORTH LINE OF THE SE 1/4 OF THE SW 1/4 (S89 °35'10 "E 470.003 ___\_ N89 °302 • 463.72' 233.11' >Q 230.61' - I Oo�3DGu`�lt o 7OLLo 1, Pa. 90 3 N ,.... jo � ��� A R ai g iii ?�? d,4"4,4 `` LOT 1 g LOT 2 CO w ' ' ` ' 2.39 ACRES INC. RNV - 2.69 ACRES INC. RNV I o 2 103,899 SQ. FT. 117 SQ FT L9 3 f a h °ry 2.35 ACRES EXC. RNV 2.65 ACRES EXC. RN I V Q U S , 102,538 SO. FT. 115,440 SO. FT. e L f w T N86 °1910"W 355.32 Z 856 ° 15'001N N 19'10"W 357.6' I Q 171 22 47.00 0 2 o N87°29'59' W 244.3 X N87°39'S8W LOT 3 O 80.00' WELL U . ____ CE NTERLINE 0 3.80 ACRES INC. RNV __ 185,547 SO. FT. w b EWgY' HOUSE • / woa N ® 3.45 ACRES EXC. R/W • M \ ® 150,190 SQ. FT. §-, 1 °a --- / �� b 0 1 • vs •• CEjVT M (9 VENTS O P ^ ` % e, 041 /Ns S HEp te r ? g \ \\�\ o / -0'1, N 8'33"W 587. 3w M z LEGEND `.j 4 3.B o' 0, 2 rc� ' .g, LO '14 o " .o T ALUMINUM COUNTY SECTION 2'26 A - ' p w CORNER MONUMENT FOUND . \Q� �\v 0 ' a nt 1 ! = • 1" O.D. IRON PIPE FOUND \' \� \\ \\ 2.0 f. S EXC. RNV s SO. FT. 3/4" X 18" IRON REBAR SET WEIGHING \. \ \ O\ A 1.50 LBS. PER LINEAR FOOT �� o � �� \ \ 4A2 ,93 " S' N 50' ROADWAY SETBACK LINE \.�� � �\ \ c e2A - . A I 1 Z4 ~ aDI _x____. EXISTING FENCELINE ,� 0 `° ZOI PERMANENT LIMITED EASEMENT t J L PROPOSED DRIVEWAY 1 - REC. IN VOL. 2586, PG. 007 1 20 %> SLOPES \W ( ) PREVIOUSLY RECORDED DATA S 1/4 CORNER A SOIL BORING ` \ SECTION 34 CURVE TABLE - NUMBER RADIUS CENTRAL ANGLE CHORD BEARING CHORD LENGTH ARC LENGTH TANGENT IN TANGENT OUT 1 80.00' 5r5700" 526°38'28 "E 77.51' 80.91' S55 °36'58 "E S02°20'02`W 2 80.00' 24 °22'07" S43 °25'54.5 "E 33.7T 34.02' S55 °3658"E S31 °14'51 "E 3 80.00' 33 °34'53" S14 °27'24.5`E 46.22 46.89' S31 94'51 "E S02°20'02°W 4 716.20' 18°04'51" S24 °42'34.5 "E 225.0T 226.01' 833 °45'00 "E S15 °40'09'E 5 749.20' 18 °05'02" S24 °4229"E 235.49' 236.47' S33 °45'00 "E S15 °39'58 "E THIS INSTRUMENT DRAFTED BY SAM ADAMS JOB NO. 04 -88 DATE 8 -16 -04 SHEET 1 OF 2 SHEETS Vol 19 Page 4872 11 w 1