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HomeMy WebLinkAbout020-1353-31-000 J E , (0 2 C q -0 r i - c = • O ' c itt to, ] % '. § Do / } \ / { / \ 0 . \ \ o c ' j j E E 0- S@ g / / k \ ) k ¥ / 0.‘C.4 § 0 0 c 0 / / . § 2 / , z 0. ® (cn a 8 = E § 0 2 @ v > E l co u) P. c 3 4" 3 = E 3 \ § ■] al 7 .... ; / 0 K J 2 0 C c o s _ § 2 \ 0 0 0 -I �- � ) / { in \ � \ ' Il 0 ° 1 / { . £ q \ g . § \ Ni ; - _ 1 \ — cb e " . / > k 7 \ g / $ = { 7 a i • = s ° I N I C. of a 2 a) 5 . { m k a k 2/ / s « § i 7 E a 0 , I 5 .. 1 Z ® (4 1 CO m § « � § . z AI 7 ) \ { # o . \ ƒ § I f ƒ % I ° I / I K � ƒ I & \ 0 \ I Et / $ cti @° �t � § � Parcel #: 020 - 1353 -31 -000 02/09/2005 04:44 PM PAGE 1 OF 1 Alt. Parcel #: 36.29.19.2031 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * COLTRAIN, DOUGLAS J & KARLA D DOUGLAS J & KARLA D COLTRAIN 664 LOUISE LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 664 LOUISE LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.104 Plat: 0194 - COTTONWOOD RIDGE '99 SEC 36 T29N R19W PT SE NE COTTONWOOD Block/Condo Bldg: LOT 31 RIDGE LOT 31 2.104AC Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 36- 29N -19W SE NE Notes: Parcel History: Date Doc # Vol /Page Type 03/31/2004 758263 2538/416 WD 03/05/2001 639674 1595/287 WD 02/14/2000 618287 1490/028 WD 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 49939 475,600 Valuations: Last Changed: 10/30/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.104 54,300 313,600 367,900 NO Totals for 2004: General Property 2.104 54,300 313,600 367,900 Woodland 0.000 0 0 Totals for 2003: General Property 2.104 54,300 313,600 367,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch #: PRGRM Specials: User Special Code Category Amount 018- RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 S Wisconsin Department of Commerce SOIL AND- SITE EVALUATION + 3 Division of Safety and Buildings Page of Bureau of Integrated Services in accordande with's. ILHA `83� O8, Wis. Adm. Code . A County . Attach complete site plan on paper not less than 8 1/2 x 11 inctaes in size: ''lerrrnefgh include, but not limited to: vertical and horizontal reference /point (BM), direction a , C f t X percent slope, scale or dimensions, north arrow, and location a nd di ee to nearest road. ' l Parcel I.D. # s r 1 S7- cFia APPLICANT INFORMATION - Please print alldnformatiactkm "-1 R iewed� Date pp Personal information you provide may be used for secondary purpose s �3 ��tn)) ` / ,� 0 7 f 19 I l Property Owner , _, _ Pcopel�y lion R c\(\ - � f1`7l .‘-c:. �..•,: I r, U y ' 41E 114 1/4,S361 T L e t ,N,R / E(or),D Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 1 5 1? >, nAt �1�ee fir- 31 Co + rnwoc \ Q T) City State Zip Code Phone Number ❑ City ❑ Village f - Town Nearest Ro I aa)►\ 1 Wk. 15- cvko 1(15 )544 - 02-131 \ kr\SCyn 1 C._ Rd Ni New Construction Use: ® Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: G Code derived daily flow LoOD gpd Recommended design loading rate • 7 bed, gpd /ft • D trench, gpd /ft Absorption area required $51 bed, ft ISO trench, ft 2 Maximum design loading rate • 7 bed, gpd /ft • g trench, gpd /ft Recommended infiltration surface elevation(s) " QlaO Lowe 9TUO ft (as referred to site plan benchmark) Additional design /site considerations 44-/ . ufpe r 1 /•G 0 G•cr cJe ( ro.co Parent material ' \ (.0..\ ■., 1 1 Flood plain elevation, if applicable 4///4- ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system 11 S El U 00 S❑ U Il S ❑ U © S ❑ U El S (0 U ❑ S Y°' U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 i 0 10 yr 3/3 LS 1msri rni C,S ) -C -7 - g 2 15-12L Ja yr y ho rf"S 0 SJ ry), c S .1 • 8 Ground elev. 757 &Oft. Depth to ' limiting factor 1 Zb in. ' Remarks: Boring # 1 t) -lp \O y r 3)2- _ C.3 1 >l"1` 11 t cS l C. _1 . 8 E E 4 Z to--12 to 411y — t Cds m1 c.S — .`1 g 3 4-123 ib, `I Ito _ ,i-,s Osn in l c s — .1 , . g Ground elev. 9140 ft. Depth to , limiting factor 123 in. Remarks: CST Name (Please Print) Signature Telephone No. Ada SG it U vvv: ki.-e - / j 745 g 7 - yo 0 g Address Date CST Number i 4 7 /0 F liLde r SI . G � Sc rS-e -- J / s YGzS e/ X33° `l 7 ' SOIL DESCRIPTION REPORT PROPERTY OWNER S U 1 Page Z of 3 PARCEL I.D.# Boring # Horizon D Dominant Color Mottles Structure G Dlft g Texture Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 1 b -$ 16 y 3/ L5 ImS m CS 2- S - I ? 1, r y j4 -- 1Y" S C- S - i g Ground 3 iit )Z4 Ipyr yllp ms c.s 1 elev. 4 1 4 14 0 ft. Depth to limiting �y� factor � in. �" 1// 4.7 V/ Remarks: Boring # 0-lb Ipyr 3)3 — LS , mSc� ml C ? 1 y 1 Ip i21 in, y 1(P rns Cs_3 ml cs – : - Ground elev. gq•Zo ft. Depth to limiting factor 1.21 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # p_g IO yr L5 1 rn5,5 5 'Z 2 -14 ibyr 4j4 r os9 mI L_S 49-124 IOyr ��lo 'm '(', . $' Ground elev. - q ao ft. Depth to limiting factor i 2 in, Remarks: Boring # .......................... Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) e...0 4- 3/ - - SecJ I "= Cad Citil 1 elf /no.0 na: I t n le P No- 344 Z au% /oo. v uAr4 -renck g3.00 SySfwl etc). £.owes-- frin¢.h 9Z.00 36 4L¢. elev. Lvw +rerech *k. ° 4 M I . Alor4 • L L. y�'� alto r — _.1 � Qy anz. 53 • _ca., / • l C' — _ [SS ' n2 G cr • Wisconsin Department of Commerce SYSTEM Count y Y E PRIVATE SEWAG SS Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353306 Permit Holder's Name: ❑ City ❑ Village ❑ wn of: State Plan ID No.: Johnson, Jason I Tj�O Hudson Township CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: / b O /U U yka.j 1 ;14 aQ4-- 020- 1353 -31 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (A) ,acs (z 0 Benchmark / 0.1,5" -- //6,Z 5 , (0 o Doti na �- Alt. BM 101 /07-23 �. Aeration Bldg. Sewer Hol ' g 01 Ht Inlet '(, 3 / M 11 TANK SETBACK INFORMATION 9 Ht Outlet _11 O 9e S TANK TO P/ L WELL BLDG. Vent to ROAD 'Bt 1rrt t Air Intake Septic ±30 ± b0 / - 3(/ 3 ' NA -a Qosiftg—__ `— NA Header / Man. Aeration Dist. Pie < <w) / �, y y g3.acS3 Holding Bot. System CRS w, � T 2 / </- ' / 9° s' 9 3Sp, (,e PUMP / SIPHON INFORMATION Final Grade � P J •ufacturer - - - -- - mand St cover d d 3 /02 22 Model Numbe G TDH —"Cft Foss riction - S e stte e m TDH Ft Forcemain Length Dia. .is . • . - / SOIL AB • RPTION SYSTEM BED / ' Width Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN • NS . .- d •_ DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE /STREAM L MManu y ee TN r SETBACK f" INFORMATION Type Of ?� f � M System: (6, J - t ;U - r So - 747 / 0. NIT f ( y ,4 O 4 ( 1.4 P DISTRIBUTION SYSTEM CIS ht 5 7"' Header / Manifold r Distribution Pipe(s) , x Hole Size x Hole Spacing Vent To Air Intake (V' Length I ct Dia. -/ / I Length �.� D ia. N� Spacing �� - P r 1 Ail- Al4 >___S- SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over 1 xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Y ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #l / (3 /t,Olnspection #2: / / Location: 666 Louise Lane, Hudsn, WI 54016 (NE 1/4 NE 1/4 36 T29N R19W) - 36.29.19.2031 Cottonwood Ridge - Lot 31 1.) Alt BM Description = 1 of (*tiff 2.) Bldg sewer length = 3ef - amount of cover = > •t 3) 73 , y ht CQ� 4 4' CLc.{ Ov - 6fQ e4.r 7 ed -Ea ei /royae, Ca we- Plan revision required? 0 Yes 2 No a_ l SBD -6710 (R.3/97) Da Use other side for additional inform' ion. mein , � 6 Inspector's Si S u 1p 7‘,: i t re Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , i. 7 t s s ° 3 �.s Y e >a .. .. . »mmm 1 i E S 8 4 d .. >...„ A , ae.. . ,�...... ..,.E _ ,.,,, ..,,. ., .. _. . _�,... ,. ._,......., a ....... _... _ ._. ..... ..., .-.... , ,. .., ..... ... . _( 3 , I € t 1 ..�.€ i # r 313 5 - P [ S I F E °sA e�m ..... .: a.»mm -. °v.t m.� .mm, dm m »� b r q } . f i a 5 i 6.. ��. ._.. �� .d . °° we.. .� .... m. m., e, �° 1 9 ,.e.,.«.� .m.,�.. -.# ,° romw °m 1 . °m sa .. .�._, .._ _ . . .... ° NL- ..e... �...._..._ g e °. �-. ._ T - , s ° s9 .m.°._d °...,.d ....�.m..,...<.. i :8 € g 2 2 s f 3 y 3 5 € ] g , r < 3 s t !.. : 1 1 , , 1 i 5 s t 2 3 , 1 1 mm 1 ,. t .... € i {, } ° € € x °gee S £ € s = t i t ., e >..�..... ., ., c.. «..._ ......., ..........e .. _ .a _ .._. ...... ...«..ay....« .... a e t q 5 21 € 3 . E ° *--- 6 ‘;4, l& se_ L- I V.i., Safety and Buildings Division • S %11 SANITARY PERMIT APPLICATION P 201 W. 0 Bo W Avenue Department of Commerce In accord with Comm 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 8 1/2 x 11 inches in size. -� � 0, • See reverse side for instructions for completing this application State Sanitary Permit Number 3S3 ' :o(' 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 INFORMATIO — PLEASE PRINT ALL INFORMATION Prope fty Owner Name / � Property Location �,1i 1 SCA/ .!�l�'raiJ sDe.%oLrh (.-S ,Isc 1/4 j� 1/4, S3f T_ , N, Rig+ E (or� Property Owner's Mailing Address Lot Num er Block Number // City S : te Zip Code Phone Number Subdivision am: orCSM Number 1 • I. ' PE • c 1 LDING: (check one) ❑ State.Owned • Ity Nearest Road Public 1 or 2 Family Dwelling No. of bedrooms ❑ village ❑ Pbli ® y 9' p'Town OF 1s7Jd III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 3G .A .1 • ?03 1 1 ❑ Apartment/ Condo 0. 10 — 1 3s 3 -31 - 6 ©O 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. na New 2. ❑ Replacement 3_ 12 Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 • S. - ' Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure I I y , 42 0 Pit Privy 13 ❑ Seepage Pit - " "` 4 3 ❑ Vault Privy 14 ❑ System -In -Fill C3). = 8 VI. ABSORPTION SYSTEM INFORMATIO . 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. /sq. ft.) (Min. /' ch) Elevation � l /3.2 . ) tiro 9�i 9 Feet 9#„5? Feet Ca acit VII. INFORMATION in gallons Total # of Manufacturer's Name Prefab . Site Steel Fiber- Plastic Ex per. New Existing Gallons Ta n k s concret strutted glass App. Tanks Tanks Septic Tank or Holding Tank 4 I f9'I j / /1 )E"..";,V EA ❑ Lift Pump Tank /Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for insta lation of the onsite sewage system shown on the attached plans. Plumber': Plumber' Signa re: No fam .. / MP /MPRSW No.: Business Phone Number: Plumber's Address (Stye t, Cit , State, . • Code): -- Ird 3 0_ i �i0 i IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) 0,A roved surcharge fee) ^ AN pp ❑ Owner Given Initial Adverse Determination �� u— • .. 'l5—OD p a 1.�t vu J�OI X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 4/99) 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 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 septictaiik(sr 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 -SuiIdings.ivision, -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 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. 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, license number with appropriate prefix (e.g. MP, etc.), address and phone numbe must sign application form. IX. County / Department Use Only, - • X. County / Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must 'include the following: 'A) plot plan; drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required bythe county; E) soil test data bn a 115 form; and T) all sizing information. GROUNDWATER SURCHARGE . 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated prac which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. A;- 1 , 0∎, A- " - 4 - /) -5: d -76 - Tai,/ - A r M L) / ij A / 1. 4 - 1 4CtiJ P\ 11, 1 /Z .----- 4 ,a, �,�,�,- 4./,9 G' ,ee' - . 9.5;0 sr-"ie 7J - GJt.6;& /a40,, c?/ ; /ig - 3- 3G�'XS6 ,- 4510 j07-./..,),g ii i _ \, — '" te' , . i,4 \_.__. \ .,,s 1 it ,-? / / 1 i il r I I Wisconsin, Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page / of Bureau of Integrated Services in accordance with s. tLHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must'' County /J include, but not limited to: vertical and horizontal reference point (BM), direction and L ®i percent slope, scale or dimensions, north arrow, and location and distance to nearest road.` ParcellD APPLICANT INFORMATION - Please print all information. Rel4aed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1 (m)). Property ner Property Locat , +'` , ' 8 — � � T I ��.C�)S Govt. Lot a /, G 1/4 1/4,S ./.. �Q ,N,R J� E (orb Property Owner's Mailing Address Lot- #._'_ . # Subd. Name r CSM 7 ?/ ,s ,l,,Jmnn!Y r City State Zip Code Phone Number ❑ City 7/illage � Town Nearest Road I 1 I ( ) .<re/iJ , N New Construction Use: g Residential / Number of bedrooms 1 Addition to existing building Replacement El Public or commercial - Describe: Code derived daily flow r�/ G6 gpd Recommended design loading rate , bed, gpd /ft , dr trench, gpd /ft Absorption area required $<Tg bed, ft 7 V 2 trench, ft 2 Maximum design loading rate , 7 bed, gpd /ft , 8 trench, gpd/ft / Recommended infiltration surface elevation(s) ? 9 ft (as referred to site plan benchmark) Additional design /site consi erations Parent material design/site Flood plain elevation, if applicable , G - ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ) 2j S ❑ u 1Z S ❑ u 0 S ❑ U S ❑ U ❑ s ® u ❑ S KU SOIL DESCRIPTION REPORT Boring # Horizon De Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench / A / / '- ./I iv s/ c .a ,>‘A ,c , s . �? 4,A //', 45---A , Y/ /s- ,/,,��sJJ Id , ,3e , 7 , g Ground -.. , "��Q x4-- x'4/1/ ,f/- 61)," . />> / — L .7 •2 elev. ft- Depth to limiting ref 43.90 factor }.L-in. 40 .8 /;(...8 Remarks: Boring # - / _ . / ��. _ Ground elev. F- d'ft- _ . 5-g. gt3 Y.8 Depth to limiting - factor N _in. Remarks: CST Name (Plea• = Print) r 2 Signature 1 / / Telephone No. Sf Address < ' , Date CST Number � . '' 1�' 1 //e/ /4. - .� ri —/- 7, ,--;7-.2/--9., SOIL DESCRIPTION REPORT PROPERTY OWNER e l4i - ql..) Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont nt Color Gr. Sz. Sh. Bed , Trench 04-A z is h1 /s7 3c 7 _ Ground 5 .f,-12-1 7�'7S ��� '� 1 �it� /rl / — �< 7 ; elev. 2ft. Depth to limiting ¥5./8( C. factor Remarks: Boring # / 4-/? /,?r?1 . s „ [//, os . e 7� •/ /D 7sx A-4 s 01, — 1, Ground elev. _ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # • jAMIIIP,A= 111.11.1 Ground IMPAIPAP - IREIMM elev. Depth to limiting factor eV /4 in. Remarks: Boring # ........................... .......................... Ground elev. ft. Depth to limiting factor ' "' Remarks: SBD -8330 (R. 07/96) ` i 4s,"__? i` 5eiJ ,--1 -■/, .4F4 , /1, -�- .5:ze. Z — T�9� /iPA) II a25.5sJ u c9 .tl �.J r S`ievz 4 ,:4'1 / Ko? ,,a • /, (' ) s5 410 f /1— i k 7-1\i_ Alow,eo Ji l l 4 . , 8r I st 3 20 ' ' Ip- de ' /..78 \s , "J i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 'Owner/Buyer . .* Mailing Address Property Address �� � f/ Z (Verification required from Planning Department for new construction) /4 City /State , - O // • Parcel Identification Number 41o28 —/3s -3 —31—c49° LEGAL DESCRIPTION Property Location �/r 1/4, a 1/4, Sec.. N -R /9 W, Town of A‘ .,/ • Subdivision ., , Lot # � . Certified Survey Map # , Volume , Page # Warranty Deed # , Volume iTgO , Page # 02 Spec house f2z yes ❑ no Lot lines identifiable a yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, 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 sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must he completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. a OF APPLICANT DATE OWNER CERTIFICATION 1 (we) certify that all statements on this form are true to the best of my (our) knowledge. 1 (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. / / NATU F APPLICANT 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 map if reference is made in the warranty deed • STATE BAR OF WISCONSIN FORM 1 — 1982 6 18257 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT NO. VP'. 149OPAGr 2 ST.. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between RICHARD 0. STOUT and 02 -14 -2000 3:45 PM JANET P. STOUT, husband and wife, WARRANTY DEED EXEMPT # , Grantor, CERT COPY FEE: and Jason M. Johnson and Scott R. Johnson COPY FEE: TRANSFER FEE: 179.70 RECORDING FEE: 10.00 PAGES: 1 , Grantee, Witnesseth, That the said Grantor, for a valuable consideration • conveys to Grantee the following described real estate in Sf" _ Croix THIS SPACE RESERVED FOR RECORDING DATA County, State of Wisconsin: NAME AND RETURN ADDRESS Lot 31, Plat of Cottonwood Ridge, Town of Jason M. Johnson Hudson, St. CroiX County, Wisconsin. ''P.O. Box 105 ..Hudson, Wi 54016 020 - 1353 -31 -000 • PARCEL IDENTIFICATION NUMBER This i s not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Richard O. Stout and Janet P. Stout warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, rights -of -way and covenants of record, and will warrant and defend the same. Raced this IC) day of February la 2000 Richard O. Stout (SEAL) Janet P. Stout (SEAL) P (tilatan 6, (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix Count. authenticated this day of 19 Personally came before me this - �b�v0Lbday of February xpj200 above named Richard O. Stout and Janet P. Stout TITLE: MEMBER STATE BAR OF WISCONSIN NO fARY PUBLIC (If not, e nC authorized by §706.06, Wis. Stats.) to me known • ' x WISGQN tMd the foregoing instru - a NQMaaheBAST THIS INSTRUMENT WAS DRAFTED BY . S.. 4 :#•• • •1 Janet P. Stout 1 1353 Awatukee Tr. Hudson, WI 54016 Notary 'ublic, S ���. County, Wis. (Signatures may be authenticated or acknowledged. Both are not My c mmissio is permanent. (If not, state expir te: necessary) � 01 of persons signing in any capacity should by typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. .RRANTY DEF.0 Form No. 1 — 1982 Milwaukee. Wis. Jan 19 00 11.2Ga DREAMSTRUCTURE 7153967992 p.2 , ion: by: EDINA REALTY HUDSON 1t1ISCONS1N 71S 303 1502; JI /0/130 IU: )m1,1_4204 „ Pu 113 R6e":nlVw0* It 7 /00 70.1'N9{ ? ?} :SOU -0tSH6 -. s074A itEA'_TV iwLNonni K29coNarN Pg9a Y ltl /o7 /OO Flit 10:08 FAX 715 386 4868 ST CRX CO ZONING a 0 O3 WeitOrrstr Depttrtme;u al Commerci, SOIL. AND SITE EVALUATION D vision td safely arld ftuylGlr' C mewl ! 1 at tluradru of Intery:iten Eerviees in accordance with s. 11 MR 113.08, Wis. Adel. Code Attach onmremis grtc pearl co paper not liar trten $ 112 x i 1 rnrrvas rn via.' Mon Moot County u*J 00 ude, t rays Im e 1 ID tremolo nod n CQ ar@Antnl relefen pOlnt (BM), d4ac■ian site c • pv.pPr: sbpo• sc:Ie or a,rnecu,x;rtx, norm erroar and location and S;stsnca Iq �rosry� mud. ad. r• � � • - nta l :D. tr APPLJCANT RIFORMATKON - Plcwsry print WI hMoairst1Rn -.. R Qt/ Y L7uln iowud is Pmauwl ulrm uatiyn Fab i, o ce M &y DC uifd for sr/candies/ sr/candies/ ptonses (Pn., rail; "5 (l t ti(t , (,,n ji r Hem Ip”[ Pi optrty Ow ! , . Properly L stmx (` 7 1 { hr‘f( l i _`.) ILLKII _ . 41 F ii f 41s S� r z_ rr ,N, I+ V I 7 E (or 4} Proportyf'Owrinri, MBL:na Addross Lql a asks Setae'. Name sr C.'...$610 ' . ‘:?)177 .... —DAI I‘^. Tr' � ' . :t�'�tc c.Y 1 . : ' Cilyr ;ate lip t000 JPone Nembor 0 ary CD Wiog2 ' /own rswailkm mo t `t c� i -t a 1••�u 7 31 t t .: - <:'4 - ' g2...Now Coo...k . User IR Floorhe:nliel t Number or bedroom; 37'.±.. 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Conektenea Rounclsry floats Bad , Trench 1 y 4 4 } I N ' -- i t Lt f } ` L 15-11 j \ v r„ 11(4' —= r `� D. ;"- !. fil t t S — C • Cireuna /c iron. Owpthta _, limiting I j: I?in. i 1 —..±—--______ . Rernaryts: , _ . - -.._ coring u _ t r _ C'4 i/.r • :7f'- __ — tr 1 1 �[ i` ....- 3 t11 1 a. lb. t ' , -ii �_ .... _ _ PI') 1 <a i ' ,� t•,mrrn 910...it lending rat. »01 1L_9 in, Remarks: _._ ___ - _ _ CV Nattra !Pl�,ase Print/ — Slpnaturt Tetoprinnnc to mot. ,. _1: ,.._�_— _ G4","--- :"- r-C.:. ' - r'_ 45 "�+''Y - =� $` Acyrt.tml Data CST Number 4.�Se . ['. >?'- 2'_ j7 - r ,V,,..r : f ,..,1 j Ys: c �.. /5 ';. 5 3477 Jar 19 00 11 :26a BRERMSTRUCTURE 7153867992 p.3 • 5cnt by * NEA HIJIIION wISZOWSIN 71S 366 ' : 01/O7!00 10:22 jeLFnx #2C•3jf *Sige 2'` A9ce;_ved; 1, 7104 1 0; 1 0; 715 3aU 4Uat1 1 L+CINA R&ALTY tcUDSDN WXet ONS N: P.n. a 01 ; 07;00 FR( 10:09 PAX 715 3ad :cite ST CBI CO ZONING 4003 SAIL DESCRIPTION REPQRT r PAOFk11VY OWNER . ego of 3 . PAHGitt. r.P * _ . Bt'it>y it t edge' 4 V.Fitt Deoineaz -o:nr Mohloe Teems Slrvdrar Lursir,ebrtrn f)uvrrAtlry ROOM GrOm ig, U.milled O. 5 .s. Cent. Gat( tsr, Sx - Sd. Sal Trnnth 3. i 0 -$ EPIIMI . , .._ MO !rn ; .' !S inha - • ri Gmtmd 3 ! tY - 1 & • 4 'to -- . •r r% 1 e ms`$A. - -- n IIIIIIIIIIIIIIII alliiiiiiill. _ . /Depth — t�n - ... ... Mal.1111111111 nlmp • ta=r i,i• ' �7I 4. IIIIII 1111.11 rr — _ — — R emarks, -- _ _ - ---� Bolting u 1 ` r , , . o ki:..+1 „•. 1 - `t 1 a r I . . 1 . r ti i �1 its (_ _. .. (4 1, IL tzl i n Li L(o .. _.. rn s 4S _ 1 e . til0tx�o . ___. _.... _....„ #424...n. iiilljill . -- fader t'l en Remarks. - -... 1 Honzon t?ratxt, Done /wit Cot f Mnt1104 dnlutd Snr.eturc l onrsictttncw Ebtndaty Filaffr< SiPDJft en. P.16.,avY Ou. Si, CCnt CAitN {ter. Sz., $h Med . Y,e ortg 2, __ — LL.'3 i rr` M i k i3n M X1 • _ 'L • .. 02 ' ILA r Li_1 m S � '1 MI _ - 5 l Ground _ _ .... elev. .. __ ._ -- -- 1412•2-ft D411211 60 � . , ... limlurt9 MOO I 21/n. Remarks: T . e , 10 ... �.. �,.. - --. .- — -. .. ..._. - -. ...., depth m _ - - _ limiting tank • tn. Re , _ . _— ..--_...Y._ — BrkY `;dD•8890 'P. 07 tr+) • Jan 18 00 11:27a URERMSTRUCTURE 7153867992 p. 3crt tty: LUINA REALLY I- IUDS0 OS fN 715 :Mifi 'SO%; Oi /OIIf7D 1C,:23; Jetf k , '34; 3' 1 AOC814e0: 11 f10C) 10 :1O; 715 79ti AAR& ., CD1NA 1.1 HUmQM WTEC0$12N; F. 4 CL1U 1/04 fl 10:09 FAX 71$ 189 4946 ST CKX CO ZON1NC f , 7 -Z " _ er U —,...,:t : .1 ?Li x., .. ..�_ iiit Ullial 4 F r e i r $ ' C . 1 . y 3 ,Q t. S S. t . I.0L.k+.r 7r•aa i . Y t w ar 444 I T- 1 % 'too t Sri ° � I,. RA 1 r • t • re I { T t 1 I I I i i 1 1 L...._ _...f ---"' r Cam"., . Sent by: EDINA REALTY HUDSON WISCONSIN 715 386 1502; 01/07/00 9:51; tFix #i201;Page 2/3 1 W i _ ..31548= co i CI _ . _ 4185' X1.3-22 . _ r.... _, cti • 1 l o , N 1 • • • 1 *I H 1 50. � i : 50• 1 a ,... : !. ( 2.1 04 ACRES • • 1.. ( ! 91,673 SQ.FT. r 1_ ` \ •...• I t. 1 • 1 I R - 1 t • 1 L.. 1 1 • • ( • -• r - '� 1 . �- ---' " -�----- • ' ---- • 1 r'�� — r' r I mo/ r / r' / + / ' � � rte +.• � p ..- r i ----- '/ r r ` / / �• ` y I I �' 1 yr 0 1 1 1101 Carmichael Road Hudson, WI 54016 Phone: (715) 386 -4680 St. Croix County Fax: (715) 386 -4686 Zoning Department Fax To: Jason Johnson From: Glad Meyer Fax: 386 -7992 Date: February 14, 2001 Phone: Pages: Re: Septic Verification - Cottonwood Lot 31 CC: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle ST. CROIX COUNTY WISCONSIN � � ZONING OFFICE , i w 41" u u n n n u u M ST. CROIX COUNTY GOVERNMENT CENTER limn Puy 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 Fax (715) 381 -4686 February 14, 2001 Jason Johnson PO Box 105 Hudson, WI 54016 RE: Septic Inspection for Jason Johnson located at 666 Louise Lane, Cottonwood Ridge (Lot 31), Hudson Township, St. Croix County, Wisconsin Dear Jason: A septic inspection of the above referenced property was conducted on 07/13/2000. This property is located in the NE 1/4 NE 1/4 of Section 36, T29N R19W, Cottonwood Ridge (Lot 31), Hudson Township, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sincerely, Jon Sonnentag Zoning staff /gm cc: file