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HomeMy WebLinkAbout020-1441-81-000 , o f E-130 / , = ; \ , 0 $ -I, , co 5 co A / § Ff « Q ƒ 0, 3 cp o ° t co c 0 IE 22« ry # . - on \ � \ = � � 3 o 8 2 ; S m AD o 3 I % \ 0 § 0 Z g $ § £ E co 03 1 m a - k « o o o o r ■ Z co o C � - § k �- k z cn 0 0 0 \ .. CO. § % . co n o _ § CA C A C A 0 � pp 13 41 § " ; k IV • I a a \ { .. " 7 % 7 { > 1 o) � 3 o 9 k o \ 0 0, , _. ( « R. E 8 co z i , 2§ k/0 co — , XI a: a § o / I co -0 m § m o CD k 2 o fr Cn 2 _ a* EEgm> ® -8 �R § % I� i c $� _a — = = EiE0 A ] § §§ ( CO CO i2§ f M. CA E« � _ k 2( 0 M. � B CD co k\¢ 0. # co iii ksa c o x, � ,• CD 0 k " 0. k 1 0 • § % • _o �§ � § k ■■ � Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division 1 " • *INSPECTION REPORT Sanitary Permit No: 430283 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No Personal information yoi 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 / cl/ Bast, Kernon Hudson Township CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /D/J • 0 /9 v0. 0 Rt.. 4 gi .4 /as tad a'n / Ice- pin /n i)14a— 36.29.19. TANK INFORMATION EATIdN DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark (� �, r-- a3 1 �1 C b/ 't'1" 1 I t 5 U / k • _1��,�: 71 i fit. vt r Dosing Al M ----- TL( It: , jCchh 3.5C 1 O ' Aeration Bldg. Sewer Holding / I St/Ht Inlet 'N. (pc ' 2,4,-...i. Lc' c. f �` g / St/Ht Outlet TANK SETBACK INFORMATION ' ,�' . 4 p c 1(0.20 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / Septic / Dt Bottom / Dosing Header /Man. Aeration Dist. Pipe /2 • / Holding, - -! B ot. System (f */ S I Z . yf, 12. Final Grade ..„, .., C' ra e c ` " -6 ( PUMP /SIPHON INFORMATION Ill .D WI -}v ICf(/ 5.66 Ifl,(3O Manufacturer Demand St Cover PM LI36 is .SO Model Number TDH 'Lift Fn ti n Loss System Head TDH Ft &m ill A J lb, ‘ A bai e 612,1PE Y* S /0.0 /00,0 Force n Length Dia — Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches p? p .f (.7 PIT DIMENSIONS No. Of P i _ _ Insid ' e Bie '�' of opts _ DIMENSIONS / ( . - — I J 1 ? ( ILi�w -1 v7 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREA LEACHING anufacturer: j� INFORMATION CHAMBER OR /.1 2: et/ t ) -t Type Of System: ('A11 )/4_,t !Al L ,A (5 / 7Z N �� UNIT Model Numb 5-(-2',. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Spacing Veo} t Air Intake , / / 1 Pipets) Length 1 Dia "I 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/Trijoet -Genter Se371 ench Edges ---Tnwil __ Yes __ No - Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: t J / k., / J / n i Location: 643 Leah Lane Hudson, WI 54016 (NE 1/4 SW 1/4 36 T29N R19W) Cottonwood Ridge 1st Add Lot 81 J Parcel No: 36.29.19. 1.) Alt BM Description = � 2((`u - ∎0.,v46,,k �_ '' „Jaw i . -f h,. (v- . t v"- ` t , Y �% 2.) Bldg sewer length = 7' I o v\ /, 7 , I ( ./ L' t i ` , 1,vhti" " � - amount of cover = c,..;\4 \ 1;\A ' iv . L t.ec1 b&. dam. - � . 3 S' a, sys- -. _ `(, 1 Plan revision Required? 11Yes El,r o r F -1 ,1 t/ � Use other side for additional inform tlon. L /a i 3 v _ _ ________ i ✓ / Date Insepctor's Signature Cert . No, di SBD -6710 (R.3/97) NJ \ \Yy��(� } { Safety and Buildings llrvtsron LUU 111y ( i /J [- � � 2 W. Washington Ave., P.O. Box 7162 ' er . f � Madison, WI 53707 — 71 62 Sanitary Permit Number (to be filled in by Co.) �S�i�l�Sji (608).266-3151 4 430 0 Department of Commerce State P1an I.D. Number Sanitary Permit Application , /y/ A In ac accord with Comm 83.21.. Wis. Adm. Code, personal information you provide pro ect Addres ifferent than mailing address) may be used for secondary purposes Privacy Law, s15.04(1)(m) 04 may J Application Information - Please Print All Information M I. App ' r ., 1 y j . r "t - 4 G 1:___ Lot Block # .. ..... •arcel � Owner's N me Property 0 8/ ;Prop I S , � J� I ✓` r'I�f� -�. � ' � �" `� ' � t 2. 0 3 Pro�e�_ Location Property Owner's M ailing Address 1 / F" . 4 `i 4 Section — ip Code City, State � � i 7 ( E II. ype of Building (check all that apply) s / j , Subdivision Name CSM Number / �, �J/ ' or 2 Family Dwelling - Number of Bedroom . /ALAI-. AO � ' O t /• 1 E puUltciCommercial - Describe Use JCXw �� --e..City ❑Villa,:- Tonship of '^! Stte Owned - Dcribe lise 1�T � .P / ' ! 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) System ❑ Replacement System ❑ Treaunenv'Holding Tank Replacement Only 1 ❑ Other Modification to Existing System e List Previous Permit Number and Date Issued B. a Permit Renewal [..:1; ❑ Chan of Li Permit Transfer to New Permit Revision g I Owner i Before Expiration Plumber IV. Type of POWTS System: (Check all that apply) ❑ At -Grade Single Pass Sand Filter n - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil !.J Mound < 24 in. of suitable soil i J Constructed Wetland El Pressurized In and Holding Tank E Peat Filter U Aerobic Treatment Unit E Recirculating Sand Filter , Recirculating Synthetic Media Filter '.teaching Chamber E Drip Line Soil A plication Rate(gp E _ r Gravel -less Pi.e ❑ Other (explain Dispersal /Treatment Area Information: ) D r i • • Dispersal Are 4i.a WV Flow (Qpd) Design dsf) j Dispersal Area Required (s I � roposed (sf) � / / • j 1 ; prefab Site Steel Fiber Plastic Gallons Ca acir in Total 1 Number / M nu Concrete Constructed Glass VI. Tank 'nfo P y 2_z t_e A— /o0 1 Gallons i of units New ( Existing i Tanks I Tanks - f i i Septic or IlolCin; Tank � 1 i r r i J Aerobic Treatment Unit - �I _ � t 11 1 r , Dosing Chamber i I 1 VII. Responsibility Statement- I, the undersi f a ssume esponsibility for installation of the POWTS shown on t he d p la n s. Number - * - tore ( MP /MPRS Number Plumber's Na me (Print) P ;umber' '�- � I . � � —„�� !!! � i cy' 15/ �� , / 2‘74tr 1 . Plumber's Addre ss (Street, City, State. Zip 'a ' >/ ) VIII. ount_y /De artment Use Only —_ i Sanitary Permit Fee (includes Groundwater , Dg a Issue Issuing Ag- t Si..? am,' Vs Stamps) Approved 0 Disapproved • Surcharge Fee) .y �� O , k U Owner Given Reason fir Denial � / !!// IX. Conditio i of ApprovaliRe sons for Disapproval a v -c E4q) 0 01).i sOE EkCot":' f(1(1 , 4 &A,„,.' -1- q 2 4 ) , i 1 Septic tank, effluent filter and erl m . 5 3 5 i � dispersal cell must all be service / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as.era..li <. - ..- ..•. . - Attach Complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size PLOT PLAN PROJECT Kernon B ast ADDRESS 948 La Barae Rd. Hudson Wi 54016 SE 1/4 NW 1/4S 36 /T 29 N/R 19 'v TOWN Hudson COUNTY ST.CROIX f MPRS Shaun Bird 226900 - D ATE $ /1 O/03 BEDROOM 5 CONVENTIONAL XV( IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1650 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1119 # of chamber BENCHMARK V.R.P. Top of 1/2" Steel Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 94.5/94.6 4.5' below grade a, Vent • >6„ Standard Biodiffuser Plans Designed Using Leaching Chamber Conventional Powts of Cover with 31.1 ft2 of Area Manual Version 2.0 n ' g n Grade at System Elevation B -2 �, 34" Q 1 72' kei B.M. #2 j� '0 0*(9"). 1 21 ., ii) ( l %;,t; � Bedroom Pro 5 20' ST 20 ? ( ents 100.76' �` I House ♦ 60' B-3 0411 30 , ■ • X A. U- 2 -3' X 113' Cells with >3' Spacing n ' V 80' V \91 . 1 4 ' T , : r.. •I �,I .. 4 0 � ^ B -1 Vents 20' / -44 Property Line V ` k ' Le r r Wiiscomin Department of Commerce SOIL EVALUATION REPORT Page / of ?- Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code n t County `� (',�29) Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel .D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. . / 34.247. % ei , Please print all information. - - viewe• b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). l `/ t,(!(/j"1/1": 1 I t� /2- 1) 3 Property Owner �( , Property Lotion / ' iN I �{ ` . I / j 3 ipv f 4.6 Govt. Lo � 4 S56 T 2 R / E (oy)'V1� Lot Owner' Mailing Address Lot # Block # Sys. Name or CSM# �/ S tate Zip C e Phone umber ❑ C ❑ '' rage !: • wn Nearest Road / iL ..04, - 1 0 ( ) /L_ i•,.. l /c • SG! r New Construction U se esidential / Number of bedrooms S Code derived design flow rate 71 ^'U GPD ❑ Replacement ID PPublic or °Ofn rclal - Describe: __—_ _ / ' Parent material �C ,! 9i1.�` Flood Plain elevation if applicable /w4- ft. General comments c ' ' and recommendations: (-1-7-C sy <. )1 RV - to S- r� 66-- 99 � b.e� •e-n c_62-go Li Boring # ❑ Boring 1-—Z it - it Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell � Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 �. 0 c it / EI ,ILNI WII Zf UWN 0 r rr. - b 4 �MI� RM PIP'' MNI 0 4101V q i • (/ / ..- g. .4 V / vi. 2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 • ' ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) S'.t,;:- re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address / Date Evaluation Conducted Telephone Number • 1008 192nd Ave, New Richmond, WI 540 , //7- c2'o 3 715- 246 -4516 Property Owner _ Parcel ID # Page of Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff 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, < 30 mg/L and TSS < 30 mg/L Department Commerce is an equal opportunity se rvice provider and employer. If The epartm of C q pp ry you need assistance to access services or p Y need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (8.6/00) PLOT, PLAN PRO Kernon Bast ADDRESS 948 La Barae Rd. Hudson Wi 54016 SE 1/4 NW 1/4S 36 /T� /R 19 W TOWN Hu dson COUNTY ST.CROIX // 8/10/03 5 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL XXX IN -G ' ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1650 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1119 # of chambers 36 ` BENCHMARK V.R.P. Top of 1/2" Steel Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 92.0 op Vent A >6 » Standard Biodiffuser Plans Designed Using Leachin Chamber Conventional Powts v g o f Cover Manual Version 2.0 with 31.1 ft2 of Area 6' Long ft 34" Grade at System Elevation B -2 Q 72' Pro 5 2 1ST 20' op. Q Vents 100.76' Bedroom I I House V4 60' �� 30' No- • 2 -3' X 113' Cells with >3' Spacing - � 80' 30' 0 oi 35' 0' B -1 Vents 10' M. #1* 20' Property Line y J PLOT PLAN PROJECT Kernon Bast ADDRESS 948 La Barae Rd. Hudson Wi 54016 SE 1/4 NW 1/4S 36 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 D A TE 8 /10/03 BEDROOM 5 CONVENTIONAL XXX IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1650 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1119 # of chamber0 ■ BENCHMARK V.R.P. Top of 1/2" Steel Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 94.5/94.6 4.5' below grade imo Vent A >6 „ Standard Biodiffuser Plans Designed Using of Cover Leaching Chamber Conventional Powts with 31.1 ft2 of Area Manual Version 2.0 6' Long 34" Grade at System Elevation B -2 2 ' 20' �Q Q Vents 100.76' Pro 5 �t ST I 1 Bedroom House 60' B -3 30' ► � • 2 -3' X 113' Cells with >3' Spacing a) 80' .04 lo ' OP r :' ' .o p •, e B -1 "e• 11 .1' Vents \ 1 ' • .M. #1 20' • Property Line V 0 /3u y Ot���a 072 : /'E/ p,� /3/ 5 r 3 vaN�4 5 P X3/1-.$ 1 — y vk LA BA -E RD • hivpSo Iv/. -5 e Wisconsin Department of Commerce SOIL EVALUATION REPORT page / of 3 Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 5T: Include, but not limited to: vertical and horizontal reference point (BM), direction and Paroet I.D. 5 ee. 4/6 Lc' *- percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all InforR€ IVED Re =wed . Da Personal Information you provide may be used for secondary purposes (Privacy Law. 1. 15 D4 ( (m)). / A, / Z ( " / 7/ 3 Property Owner PropAy Lora , ' aF 5 'v0 ,1J/'L w /LC0X5oit) JAN 0 9 2003 Govl Lot 5e 1/4/JV1/4 S [p T Z 9 N R /g E (or) W Prope rOwner's Mailing Address / ST. CROIX COUNTY Let B # Subd. N M# � me or CS Remit/ A.)6r- A . Ft le cry. Hwy. A/ - ZONINGOFFICE ��` (�! 71L.7r1�LCY-c.C� 642 .. 414 City State Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Read HUPSOA) Z0 /. 50/4 i (76)3rG•z2 2? MIPSO ,t/ i ' . ‘4.-New Construdion Use: (Xi Residential / Number of bedrooms 3 -y Code derived design flow rate y4 — C' 4v . GPO ❑ Replacement ❑ Public or commercial - Describe: ._......._ Parent material /'Es$ aUfR sA.uOY 6 !} Flood Plain elevation H applicable /1-1/ ft. General mmen comments • 517 - - sr /5 5"v /r4i '7L - �O 4 /mot ;9, v-2) and recommendations: CDmi ' p0. w. T. 5. — 131 ' d; x'41 cate S . . C see- P c . 3 ❑ Boring • I / 9 # ® Pit Ground surface elev. ` .S �ft. Der th to limiting factor y� in. So Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/?F In. Mussel Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 l p- i5 /D ye 2 2 - - --- L /fS h& /, fe ••4J Z l . y r . 4. z 15-..2.9 /00e 3`y _________ 5L. fAle1 9R . A t C I V _ / . 'i . 6 3 2 - 7 /L 5.' 5 t , 4 • • 5 — _S ' r • .s 6 S Le - .7/Z , g if. 4. • (00. 7 ,r 1 / 4 Z # ❑ � iZ > 2 I Ed Pit Ground surface elev. ft. Depth to limiting factor In. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf In. Mussel Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 / o - f2- /o /' z z 1- /7 ,), W Z *P , y • . Z /,2 •Z(e /D /3/ SL 44,0 fg , "1k' .C, 3 14' z 7.5 / --- �j i 4. 2 411 . F ' _ ROI 0 , M ,a• / .0 ,/ _/ 211 4 </6/ , . • Effluent #1' BoD > 30 < 220 and TSS >30 < 150 mg/L • Effluent #2 == BOD. < 30 mg&L and TSS _ 30 mg/l. • 30 CST Name� / 3 e ete T Zl /b/&/ GG T -" Signature ( X /�?�c�4 2 G CST Number ` S Address iC' Date Evaluation Conducted Telephone Number Ulbricht & Associates ' " I'fiC . 7— '.-D 0 2.. 7/S • 3 26 . ei/8S 655 O'Neil Rd. Hudson!, Wis. 54010 - PI Vg N ,� S o a 6 • //o y• yp • oa • s or o2n- / /ay . 2C9 - i 601102- r 1�. / 3 / 4T- per, oar Ne L Gt>i� o X So ,o o.p - //b 7 • �o • �' 2 3 Parcel # Page of 3 ❑ Boring , I � # t].J-Pit Ground surface elev. O R. Depth to limiting factor 0.7 in Horizon Sol Apps Rate Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/IP in. Munsel Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o i 3 /o ye zlZ L ifsb, ' fro •fe fw . y . C :27 /o • 3 SL /-le A i ,t4Afe C5 / • 3 2 711 -2• sp 9 /lam 5, c 2 frn 4 4 . mss . -- • • S y ¥2s4 7.5YR fi Ls / f ds C$ -= . . 2 5 )70 1.O /,9 R fe4 i • 5 p 1. 4 ---- .1 /. 2, 1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. SoR Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence 'Boundary Roots GPD/ff M. Munsef Qu. Sz Cont. Color Gr. Sz Sh. 'Efl#1 'Eff#2 I 1 Boring# 0 Boring El Pit Ground surface elev. ft. Depth to limiting factor In. Sol Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots ( GPDIfW in. Munsel Qu. Sz Cont. Color Gr. Sz. Sh. -- 'Eff#1 'Eff#2 I Boring I ❑ Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/W In. Munsell Qu. Sz. Cont Color Gr 'Eff#1 'Etf#2 • • • Effluent #1 = BOD > 30 .c 220 mg& and TSS >30 < 150 rng/L • Effluent #2 = BOD E < 30 mg& and TSS < 30 mglL 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. saw770 (1t.6/00) For issuance of permits and designing Contact: Ulbricht & Associates Registered private wastewater ater co nsuitant and plumbers 655 O'Neil Road Hudson, WI 54016 715 - 386 -8185 or 715-772-3442 /- 13 Z • 2 - o P -Fr yf ot) / " " ,20 A � cxle P'rs • p' a�/1U 33 *--( 6b • • —36 - A I� T 6 Z , v �` N0 .19:)7 )1 V (' J\ if))1/-C :, 'N) A API"an ?s- ,\,-\ '-i /"\ i) itli .4700 ,e-) AP -- , 1 r.„, c_-:, ,,,, ,,,,, (..., •,,, .,.._ ,,,, ..„, , \ , a t I i 4 p ) . .. -..... , 4,, 1 • /3 1 �' 0 % /0' - 0 1 �' �l 11/ se 7 Tor) of / ed L w yo i S ( GP - f - i p ) ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 1C &io ► S- 13A"sr Mailing Address G'► / Ate# ID. '4 "4s'aN Jt , Property Address (Verification required from Planning Department for new construction) City /State Nu0strd/ go tsCo s1J Parcel Identification Number JJEGAL DESCRIPTION Property Location 4 %,„40 Sec. 36 , T ?_N -R 19 W, Town of EIvOsi . Subdivision :.11' i .. _22. it ,_' r , s ,040 Lot # Sl . Certified Survey ap # , Volume , Page # 1 Warranty Deed 70 , Volume Z / 3 ' , Page # 35 Spec house Al yes ❑ no Lot lines identifiable J 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 wastewaterdisposalsystem 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, in, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification sta • that ur septic system has been .• • t : • . • s. ust be completed and returned to the St. Croix County Zoning Office within 30 ys of three year exp' / serhA._ SIGNATURE OF LICANT DATE OWNER CERTIFICATION `./ (, ) certify that all statements on ., • fo Si are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of r . - described above, ,• • r . F /1 arranty deed recorded in Register of Deeds Office. - S if /la3 SIGNATURE OF AP'. I ANT DATE * *t * ** 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 • Maintenance and Contingency'Plan for a Septic System 4t3 Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -45 St. Croix County Zoning 715 386 - 468 0 Pumper Tom Mondor 715 246 - 51 4 8 Shaun Bird #226900 J 2 1 3 5 P 3 5 5 708880 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., MI Neil L. Wilcoxson and Mary J. Wilcoxson, a /k/a RECEIVED FOR RECORD Mary Jo. Wilcoxson, husband and wife, conveys 02/07/2003 02:00Pn and warrants to Kernon J. Bast the following EXERT described real estate in St. Croix County, State of Wisconsin: REC FEE: 11.00 TRANS FEE: E 2880.00 00 COPY FEE: CERT COPY FEE: PAGES: 1 Exception to warranties: all easements and restrictions of record. This is not homestead property. Parcel Identification Number(s): 20- 1109 -40 -000; 20- 11 -9 -20 -000; 20- 1109 -10 -000; and 20- 11 -90 -55 -000 Name and R V i0: A parcel of land located in part of the Southeast '/ of the t ealty Ti tle Northwest 1/4 , part of the Southwest ''4 of the Northwest 400 South 2nd Street 1/4 , part of the Northeast 'A of the Southwest1/4, and part Suite #115 of the Northwest'/. of the Southwest' /., all in Section 36, son, WI 54016 Township 29 North, Range 19 West, Town of Hudson, St. �' 1$' .' Croix County, Wisconsin described as follows: Commencing at the South 'A corner of said Section 36; thence North 00 degrees 10 minutes, 01 seconds West along the north - south' /4 line, 1634.77 feet to the Northeast corner of a parcel of land described in Volume 526, page 259 at the St. Croix County Register of Deeds Office, being the point of beginning; thence continuing North 00 degrees, 10 minutes, 01 seconds West along said North - South' /4 line, 1977.22 feet to the South line of the North 350 feet of said Southeast '/ of the Northwest '/4; thence South 88 degrees, 49 minutes, 51 seconds West, along said South line and the Westerly extension of said line, 1324.14 feet; thence South 00 degrees, 09 minutes, 43 seconds East 2,096.73 feet to the centerline of County Trunk Highway "N" being a point on 1,999.00 foot radius curve, concave southerly, whose central angle measures 03 degrees, 00 minutes, 19 seconds, whose chord bears South 80 degrees, 02 minutes, 21.5 seconds East and measures 104.84 feet; thence Easterly, along the arc of said curve and centerline, 104.85 feet to the point of tangency; thence South 78 degrees, 32 minutes, 12 seconds East along said centerline, 712.54 feet to the West line of said parcel described in Volume 526, Page 259, thence North 00 degrees, 10 minutes, 01 seconds West along said West line 304.75 feet to the North line of said parcel; thence North 89 degrees, 49 minutes, 59 seconds East along said North line 523.00 feet to the point of beginning, all in Section 36, Township 29 North, Range 19 West, St. Croix County, Wisconsin. A 1 Dated this � day of JC. 2vtL , 2003. , a N s, &,t ' 'Wilcoxson Mary J. W' o on \ ACKNOWLEDGMENT ,,, COUNTY OF ST. CROIX ) tom . 0'% PVe� N` l w ,. Personally came before me this 3 4 day of ✓ ' , 2003, the above • -med Neil L. Wilcoxic d Mary . C 9( Wilcoxson to me known to be the persons who executed th fo oing instrum - , acknowledge the dmme A, * •. PRESTON j Nota Public _ 2 My commission expires: b 4 11 q/ 2 , OF W 61 1 , .z- This instrument drafted by Robert F. Wall. WilcoxsontoBastWD03 -1 '11411 nWIS � » ' K . i • LOT 79 d! •• • 2.85 ACRES • • , 115,337 SO. FT. . •• •\ •• ® L.B.O. - 1033.85 (VDU 00 • \® \ 4.. Ikgi - , .., ob a 4 % T-' -.40 .91. o a • _ / N ,'/ / !e NI 3 33' 1 j ° / / / / � 1 0) � 3 SECT ON 38 H I ,�� r / N88 "4TO1'E 2922.70 • I �89 °49' 9•W 118 • r------ 1 1 c a LOT 80 • 2.98 ACRES • g 1 M 1 z 124,559 SO. FT. LC Y7 CO w ,�.� I 1.8.0. - 1033.85 / ! $ 4% -. g o - / ii 81 i I o BI - Z 0, ' l� 47117' ______\„ 158.8r— _ _ _ WIL COXSON --� KSON DRIVE -- - - - - - - DRIVE -------.' 0 I 0 0 ( 1 I B EM-7:47 N P K NP N 'y 33' 1 33 ' r 0 1 ♦ • 1 I USGS DATUM 1929 .z 1R W 0 ,,,, TEMPORARY CUL-DE-SAC TO BE UPON EXTENSION OF THE PER E ROAD P HE PLAT ! p 4 OF COTTONWOOD RIDGE i 1I N s, N oi LOT 84 --6.1. °.1 i • Igir 5 2.18 ACRES I ( 1 LOT 81 94,285 SO. FT. ;: I • 6 1 6 • ` I : 2.08 ACRES • 90,839 SO. FT. ♦ •— .: A tY 1 - -- • • 1 • / 19 1 S • 116 : 1 • • 1 • • 5 1 n � N89•55'21•E 214.78' t \ / a N89 "55'21'E 205.13' Lam,© U `'3 • 1 • . o I •.• 18 ••• cI • --...%. r cg _ ____ ......._ 7 I