HomeMy WebLinkAbout020-1113-90-185 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Fuilding Division
INSPECTION REPORT Sanitary Permit No:
515178 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Konkol, Gerald I Hudson, Town of 020 - 1113 -90 -185
CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range /Map No:
D�• v (��'� � 5 12.29.20.459125
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic &Xr rk
.oS 07.0 1 �- a
Dosing n _ / Alt. BM ,0 _ YS
Aeration Bld g�r I r /0 D
Holding t/H Inlet c� 10 j a v
SUHt Outlet y S
TANK SETBACK INFORMATION OD• ZS
TANK TO / � P/ L W�l� BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 22,f Dt Bottom
Dosing d Header /Man. AE/ Z �{ , 32
Aeration Y Dist. Pie c� (I j 7
Holding B S stem
Final Grade 03
PUMP /SIP ON INFORMATION T� ,.
Manufacturer Demand St ( v r
GPM _j q4 T�
Model Number 6'YL IMA
TDH Lift Friction Loss m Haad TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM 7j ( G
13EDITRENCH Width ) Length No. Of Trenches PIT DIMENSIO S No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM tHAMBER�O I M tur
INFORMATION T e Of System, L Y {r DISTRIBUTION SYSTEM / / — / Model b r. .
_ku i t�
Heade anifo 'L i tion / � � x Hole Size I x Hole Spacing Vey to it Int e
Length�� j Dia Leng { th �Q(/ Di JSpacing .
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth O I Depth Over xx Depth of xx Seeded /Sodded xx ulched fV
Bed ench Ce �' /� Bed/Trench Edges Topsoil Y M
es Ye
No s E] No
COMMEN S: (Include code discrepencies, persons present, etc.) Inspection #1:�/ /� Inspection #2: / /
Location: 908 Kirkwoo Wa y N Hudson, WI 554-0,16 (SW 1/4 SE 1/4 12 T29N R20W) NA Lot 2 Parcel No: 112.29..20.459125
1.) Alt BM Description = r Z ,, m k UWA,- � —2. - ` ( L/ A tjQ__ Aile
2.) Bldg sewer length
- amount of cover
Plan revision Required? [] Yes C No
Use other side for additional information. U J IO v
Date Insepctor's Signa ure Cert. No.
3BD -6710 (R.3/97)
in
.Wi gW Safety and Buildings Division County
`* 201 W. Washington Ave., P.O. Box 7162 S
tr k t a l Counwialve AV �Ro,
n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.)
515'17$
Sanitary Permit Application Sete T Numb"
In accordance with s. Comm. 8321(21 Wis. Adm. Code, submission of this form to *opp memmenial / vim' _
unit is required prior to obtaining a sanitary permit. Note: Application forms for state owned POWTS are Projed Address (ifdi.@'ereat than mailing address)
submitted to the Department of Commerce. Personal infornmation you provide may be used for
purimses in accordance with the Prn Law, s. 15. i )(m) Stats.
L Application Information - Please Print Ail ation secondary /RKa6d,0 .44)
Property ms's Name f Parcel #
z. o�x L OCT 2'2 2009 2a - ///3 - 7D
Property s /8
,,,A W UN 1 Y Property Location
� j,✓�,yq„/ PLANNING & ZONING OFFICE Govt Lot ZJ
City, State Zip Code Phone Number 'r4l_ Y., ..tE %. Section
ter ✓ l./ S - '/ - 7 - 8 99 (Circle one
H. Type of Building (check all that apply) Lot #
T _ N; R 3a
0 1 or 2 Family Dwelling - Number of Bedrooms oZ Subdivision Name
O k aD
❑ PubliclCoamancial - Describe Use .. eity of
❑ State Owned - Describe Use CSM Number V ❑Awasenof _
3 N,-A- Ce.� L./ �-1 5 T5 5 y5 Z- Town of u ,O.sa ✓
III. Type of Permit: (Check o one box on lime A. Complete line B if ap ble)
A- O New System ❑ Replacement System ❑ TmaomendHolding Tank Replacement Only ❑ Other Modification to Existing System (ezplam)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List PreviouSS Permit Number and Dot Issued
Before Expiration Owner rb J + „
N. of PO S Coe ent/Devicc: Check all that a I 0 J ` T7
cjc-
K Non-Piessanzed M- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound> 24 in ofsoitabte soil ❑ Mound <24 in. of �0 m
❑ Holding T �� Dispersal Componcnt (explain) ❑ Pretreatment Device (cTlain) Ll
V. Dispersalf1lireatment Area Information:
Design Flow (gpd) Design soil Application Dispersal Area Required (sp Dispersal Area Proper Sygem Elevation
Cap
.7 �/ 8s8 871.9 9y.? / 9L. J Y /
VL Tank Info Capacity in Total # of Manufacwrer
Gallons Gallons Units o o - .q o
New Tanks Exisft Tanks
4
aU w � � wCti O..
Septic- HWdisg -T-k
Dosing Chamber
VII. Responsibility Statement I, the i aderslIgned, asseme respondbliily for hisWlation of the POWTS shown on the attached plan&
Plumber's Name (Print)) Plurnb"Signature MP /Nil $ Number Business Phone Number
O �/ G'� L•�� '�� X3/.3 %G /S c - S.?4 G
Plumber's Address (Street City, State, Zip Code) �, ,
G.? 8 jr. wr, S u2A, w IJ_ SV7,?G Ck
VM Counilyffiepartment Use On
ved Permit Fee Date Issued Issuin emu Signature
❑ en Reason
IX. Condit a fQr Disapproval
1. � Se* tank,_effluent finer and
dispersal cell must all be services / maintained
as per management plan provided by plumber.
2. jAa ck requirements must be maintained
as per applicable code / ordinances.
Attaci to ceseplew plans for the system and wbmait to tic Cannty only on paper not less tbaa 8 in x 11 indes in sae
SBD -6398 (R 02/09) Valid thru 02/11
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings
in accordance with Cc Ad Code
County St. Croix
Attach complete site plan on paper not less than 81 /2 x 11 inches in size. ram t
include, but not limited to: vertical and horizontal reference poinT"4.d,irection and Parcel l _ r
percent slope, scale or dimensions, north arrow, and location and distance st road. - �► ��j -- / �/ ��' W� ,
-7/ _
Please print tion. Date Z
Personal information you provide maybe used jr secon�r� r� P 15.04(1)
Property Owner c.
Location
David and M HartJUN o Lot SW U4 SE IM S 12 T 29 N R 20 ❑ W
Property owner's Mating Address S T of # Block # Su lbd Name CSM# c�� S I �
1023 High 35 CROIX 2
City State Zip Ntrnber ouart Nearest Road
Hudson WI 1 54016 7j5 3 Kirkwood Way North Midson
E] New Construcbm User Residential / Number of bedroorns 4 Code derived design fbw rrle 600 GPD
Replacement Pubic or commercial - Describe:
Parent material good Plain elevation iF applicable J- R
and recornmandedws:
l❑ Boring # 0 Boring lob . Z.
El pit Ground surface elev. 100'5" ft. Depth to limiting factor 84 in. Sot Applicedon Rate
Hoitm Depth Dominant Color Redox Description Texture Structure Consislenice Boundary Roots
in. Mtrusei Qu. Si Cont. Color Gr. Sz. Sh. 'Eff#1 I 'E=2
1 0-6 10YR3/3 SL 2 M BK MFR CS 3M .6 1.0
2 6-54 ISM* LS 0 SG ML 1M .7 1.6
�l
2
F Boring 76
Boring Bori # 93'10" El Pit Ground surface elev. ft. Depth to limiting factor in. Soi Rate
Horizon Depth Dominant Color Redox Description Texture Strtxltre Consislience Boundary Roots GPDW
tit. Munsei Qu Sz. Cont. Color Gr. Sz. Sh Ei�l 'E1�2
1 , 10YR3 /6 SL 2 M BK MFR CS 3F .6 1.0
2 4-76 7.5YR4/6 LS 0 SG ML 2 F .7 1.6
7
* Etlluent #1 = BOD > 30 220 mg& and TSS >30 < 150 mglL ertld TS3 :5 30 dg&
CST Name (Please Print) Signature Number
Dale R. Stewart 220579
Address Date Teiephone N rMer
757 107th St. Roberts, WI 54023 05031/2007 715 749-0145
Property Oww Hart, David and Arlene Parcel ID # Page 2 of 3
Boring
❑ Boring # a Pit Ground surface elev. 100'4" ft Depth to limiting factor 77 in. Rate
Horton Depth Domnant Color Redox Desaip4on TeAm Structure ConsMerim Boundary Roots GPDAF
in. ttilunseM Ou. Sz. Cont Color Gr. Sz. Sh. 'E1f#1 I -EW2
1 0-4 10YR3/3 4 1 SL 2 M BK MFR CS 3F .6 1.0
2 4-7 7.SYR416 LS 0 SG ML 2 F .7 1.6
F-1 Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in. Rate
Horizon Depth Oorrinant Color Redox Description Tofte Structure Consistence Boundary Rods GPOMF
in. IUu nd Ou. Sz Cont Color Gr. Sr- Sh.
Boring
❑ Boring # Pit Ground surface elev. ft. Depth to limiting factor in.
Sai Rate
Horizon Depth Dorrrnank Color Redox Description Texture Structure Corrsrsterroe Borndary Roots GPM
in. M And Ou. Sz cork. Color Gr. Sz Sh. -SW 'E81112
" Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD, < 30 mg& 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.
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Private On -Site Wastewater Treatment System (POWTS)
Index and Title Sheet
Owner: L
Project Name and System Type .A
Location: AMxA,Jo&0 41 4r 4 r.4
Street Address
.S4/ STS pT9 T o?a / Lor a2
Legal Description
v a�r� .F �.�sa r. Cicoi Co
Township /County
Contents: Page 1: _.yicer
Page 2: l/G o r A4 . C.fe - Sl-c rte..✓
Page 3: you rs OcJ ,✓dn `f ire w/u.�L �~ /Y i.✓.n� .,«.ter �i..
Page 4:
Page 5:
Page 6:
Page 7:
Page 8:
.Page 9:
Attachments: Z a.o rro.✓ �a' /aa r
zAQ�'c � /L 1,✓fo
PlumberA 3@@iSner: .% o r„ � Signed:
Credential Number: 1 a?J Date: 1 / -.To -07
L/sE �6,✓d r�oa,,� Qo�JrS Lo„►oo.v�,rr�,v:�AC�
S44 16s-4 7
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 3 of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner & " 4Z41 L Septic Tank Capacity ,?60 a l 0 NA
Permit # Septic Tank Manufacturer El NA
G�JESEii Co.vG.
DESIGN PARAMETERS Effluent Filter Manufacturer A� ❑ NA
Number of Bedrooms !�! ❑ NA Effluent Filter Model �pV ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity a l JVNA
Estimated flow (average) 00 gal/day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) /Op al /day Pump Manufacturer ❑ NA
Soil Application Rate .7 al /da /ft2 Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit J'NA
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODJ 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 530 mg/L XIn- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L )rNA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. _ ❑ NA Other: ❑ NA
Other. ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. ref: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(sl At least once every: E3 month(s) (Maximum 3 years) ❑ NA
3 earls)
Pump out contents of tanks) When combined sludge and scum equals one - third (Y of tank volume ❑ NA
Inspect dispersal cells) At least once every: ❑ month(s) (Maximum 3 years) 13 NA
3 ($ year(s)
Clean effluent filter At least once every: f y months) ❑ NA
❑ year(s)
Inspect pump, pump controls & alarm At least once every: ❑ mo nth year(s) ) J�NA
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other. ❑ month(s)
At least once every: ❑ year(s) ❑ NA
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 tankls) 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.
STARTUP AND OPERATION Page Y of - -,
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 abandoped 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.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ 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 13E DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name .✓ ELK -�,3 .;t�6 Name o .✓ -, I'V- .rE Lar��i.Ji
Phone S G7.? - S.? / , Phone - L7.Z - .l L
SEPTAGE SERVICING OPERATOR (PUMPER) -- LOCAL REGULATORY AUTHORITY
Name Name � L olx Z o.Ji.✓6 Df'f /Gd
Phone Phone 11 / 4 -4l"
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.
START UP AND OPERATION Page 4 1 of
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; most scraps;'medicadons; 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.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ 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 OTH15R 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
EINam EL •?3 �t�6 Name
e J hone ,S G7.? - .4:?G Phone 121 ' s G 7.Z - 4.4
SEPTAGE SERVICING OPERATOR (PUMPER) - LOCAL REGULATORY AUTHORITY
Name Name
> oiX .. za.Jl.Ja Df'f /Cd'
Phone Phone
/ G - *" 80
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.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer "! e ret �( l yl Ko
Mailing Address _� 16y/ R1 w 1 , 4L t o SEA &�
Property Address ` ►'' Kwoo
(Verification required from Planning & Zoning Depa meni for new construction.)
City /State I �W c�tr l I.tOS o/l1 Parcel Identification Number n
,rl J 0 a0 w t1 - �O -
LEGAL DESCRIPTION
Property Location S&J 1/ , _ S� 1 /a , Sec. /, T,23 _NR ?0 W, Town of
Subdivision , Lot #
Certified Survey Map # o ®Q 1 , Volume 2 _ _, Page #
_
Warranty Deed # 7 3 7S , Volume , Page #
Spec house yes no Lot lines identifiable (yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & 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.
Uwe, 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 be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms '7
6; `2 l it of
SIGNATURE OF APPLICANT(S) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
Illllll IIII'" "'IIII IIIII lull IIII !11111 IIII IIII
* 8 ,I 0 0 1 4
860001
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
09/06/2007 01 :0OPM
CERTIFIED SURVEY MAP
VOL: 22 PAGE: 5452
CERTIFIED SURVEY, MAP REC FEE: 17.00
COPY FEE: 5.00
LOCATED IN PART OF THE SOUTHWEST QUARTER OF THE PAGES: 4
SOUTHEAST QUARTER SEC710N 12, TOWNSHIP 29 NORTH, RANGE
20 WEST, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN
OWNER:
The Bearings ore referenced DAVID & ARLENE HART
= to the South Line of the
1023 HIGHWAY 35
it Southeast Ouorter of Sec. 12- 29 -20,
zz assumed to bear N89 °1150'11, HUDSON, N9 54016
LOT 1 LOT - 2
C. S. M. I C. S. M. 1
O 7 7 VOLUME 6, I VOL UME 6, 1
PAGE - 1778 1778 I PAGE I
- -- -- - - -- - - - --
' Southeast �
`\ (N89- 0755'E 1 924.65) C orner +
S89 %6'06T 924.29
474.59 449.70
ZEast South Line of the CSM, rn L O T 1 Vol. 6, Pg. 1778 p 112, 026 Sq. Ft.
2.572 Acres 66 FOOT PRIVATE p U T L O T 1 C 1 GRESS do EGRESS
INCLUDING PRIVATE ROADWAY) ` -66.01 C EASEMENT
R291, 652 Sq. Ft. 6.695 Acres L3 of North Line of THE P.IDGES L C fhe GSM, o cip 49,453 Sq. Ff. 50 N 1912 2 1.135 Acres 00
715.65 - -- 316.78
- N89 0 12'36 V 11162 .32 - - - 1446.67
0 I Northwe n r 1 (N89 ° 15'09 "W 1162.33) SEE DETAIL -60 � o
Core o
1 LOT 1 I THE RIDGES CONDOMINIUM \ �LOr 3 \LOT 4 i LOT 5 I LOT _6 o LOT 9
- - - - - -- 1 THE RIDGES CONDOMINIUM \ THE RIDGES
c. M. 1 --- ----------------- ---- -- ---- ----- - - - - -- I I I
I VOLUME_ Z, I KIRKWOOD WAY NOR V
NOTE. SEE DRAINAGE
(PAGE 191_2 AND UTILITY EASEMENT
I I DETAIL ON SHEET J. Eas[ Line o/ the Sou[ haves[ ---{ o
Ouorter of the Southeast Ouorter 2
I I
L _ — - 1 32 6. 52 - - _ - , ' 1326.52
South 0 12-2 Corner N89 °1150 "W 2653.04 , Southeast Corner_
Sec. South Line of the Southeast Quarter Sec. 12 -29 -20
Found Aluminum num Monument found Aluminum Monument
��glln�llllttt!!i lfl kl� �.�.
200 100 0 200 1 DETAIL
SCALE: 1 INCH = 200 FEET � � MARK F.
316.78 69.77 ��
MAISTROVICH
LEGEND 3.17 ' - 63.43 3.17 y S -2624
Q Set 314 inch x 18" Rebor ` EXCtMNI
weighing 1.50 lbs./Iineor It.
0 Found 1 " (0. D.) lion Pipe t
L1 N89y4 42"W 138.53 tttilll,
■ Found 1 -114" Diameter Rebor L2 N18'b7'J4"W 9520
0 Found Section Corner LJ 389'14'421' 137.66
L4 518V7*J4T 7258
(S39 °3654 "W) Record Data Z d,/ I _F
Mork Moistrovi b, S -2624
50' Building Setback Line Posse Engineering, Inc.
2003 O Neil Rood
Ingress do Egress Easement Hudson, Wisconsin 54016
PROJECT NO.: 843 - 06 715 381 - 1150
1 Qf,7�1 WING DATE. JUNE 28, 2006
A 1491 BY- JAMES WEBER SHEET 1 AF 4 armm Dote: s o
Vol. 22 Page 5452
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State Bar of Wisconsin Form 2 -2003 7 G
J
WARRANTY DEED r
KATHLEEN H. WALSH
Document Number Document Name REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
04/29/2008 01:05PH
THIS DEED, made between David A. Hart and Arlene Hart, husband and wife WARRANTY DEED
EXEMPT 1
( "Grantor," whether one or more), REC FEE: 1 1.00
and _Gerald L. Konkol and Christine V. Lassa, ' TRANS FEE: 247 .50
PAGES: 1
( "Grantee," whether one or more).
Recording Area
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate, together with the rents, profits, fixtures and other appurtenant David J. Estreen
interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is 304 Locust St.
needed, please attach addendum): Hudson, WI 54016
That part of Southwest Quarter (SWI14) of the Southeast Quarter (SE1 /4) Section
12, Township 29 North, Range 20 West described as follows: Lot 2 of Certified Lo , - (753og_
Survey Map recorded in Volume 22 of Certified Survey Maps, page 5452 as
Document No. 860001 together with a 66 foot wide private easement for ingress and
egress as shown on the subject certified survey ma St. Croix County Wisconsin. Part of 02 0 - 111 3 - 90 - 17 5
I e
g J y p• Y Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Exceptions to w arranties: Easements, restrictions and rights -of -way of record, if any. /
Dated 1 f �'i l o f
(SEAL} (SEAL)
*
*David A. Hirt
(SEAL) 1` 9dX.( ii (SEAL)
* *Arlene Hart
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) David A. Hart and Arlene Hart, husband
and wife STATE OF )
authenticated on ) ss.
COUNTY )
*Kristina O land Personally came before me on ,
TITLE: MEMBER STATt BAR OF WISCONSIN the above -named
(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:
Attorney Kristina Og_land _ Notary Public, State of _
Hudson. WI 54016 My Commission (is permanent) (expires: )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003
" Type name below signatures. INFO -PRO' Legal Forms 800. 655 -2021 www.infbprofbrms.com
1 of 1
CERTIFIED SURVEY. MAP
LOCATED IN PART OF THE SOUTHWEST QUARTER OF THE
SOUTHEAST QUARTER SECTION 12, TOWNSHIP 29 NORTH, RANGE
20 WEST, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN
CURVE CENTRAL ANGLEJ RADIUS ARC LENGTH CHORD BEARING CHORD TANGENT BRG. IN TANGENT BRG. Our
1 71 233.00 289.21 N53 °41'08 "W 271.00 N18`07'J4 - W N8974'42 "W
2 71 167.00 207,30 S5.3-41 - E 194.24 589 °14'42'E S18V7
DESCRIP TION
Located in part of the Southwest Quarter of the Southeast Quarter of Section 12, Township 29
North, Range 20 West, Town of Hudson, St, Croix County, Wisconsin, more fully described as
follows:
Commencing at the southeast corner of said Section 12;
Thence North 89 degrees 11 minutes 50 seconds West, along the south line of the Southeast
Quarter, 1326.52 feet to a point on the east line of the Southwest Quarter of the Southeast
Quarter;
Thence North 00 degrees 24 minutes 18 seconds East, along said east line, 390.10 feet to the
POINT OF BEGINNING;
Thence North 89 degrees 12 minutes 36 seconds West, along the north line of THE RIDGES, as
platted and on record at the St, Croix County Register of Deeds office, 1162.32 feet to the
northwest corner of THE RIDGES CONDOMINIUM as platted and on record at the St. Croix Register
of Deeds Office;
Thence North 00 degrees 14 minutes 47 seconds East, along the east line of the Certified
Survey Map recorded in Volume 7, Page 1912 on record at the St. Croix County Register of
Deeds Office, 46.00 feet;
Thence North 32 degrees 23 minutes 48 seconds East 449.51 feet to a point on the south line
of Lot 1 of the Certified Survey Mop recorded in Volume 6, Page 1778 on record at the St.
Croix County Register of Deeds Office;
Thence South 89 degrees 16 minutes 06 seconds East, along the south line of said Lot 1, a
distance of 924.29 feet to the southeast corner of Lot 2 of said Certified Survey Mop;
Thence South 00 degrees 24 minutes 18 seconds West, along the east fine of the Southwest
Quarter of the Southeast Quarter of said Section 12, o distance of 429.78 feet to the POINT OF
BEGINNING and there teminating.
This parcel contains 453,338 square feet - 10.407 acres.
SURVEYORS CERTIFICATE
1, Mork F. Maistrovich, Registered Wisconsin Land Surveyor, hereby certify. That in full compliance
with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St.
Croix County Subdivision Ordinance and under the direction of David and Arlene Hart, I have
surveyed, divided and mapped the above described parcel and that such mop is a correct
representation of the boundary thereof.
`n an��uuuninan rrrr
SC0 I1dS
Mork F, oistrovich, -2624 D to MARKF
Posse Engineering, Inc. = MAISTROVICH
2003 0 Neil Rood = S -2624 -
Hudson, Wisconsin 54016 ° EXCELSIOR,
715 - 381 -1150 IVIN -`
Note.
Each parcel shown on this mop is subject to state, county,ond township lows, rules and regulations (i.e. wetlands,
minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County
Zoning Office and the Town of Hudson,
PROJECT NO.: 843 -06
2 W$W1NG DA TE: JUNE 28, 2006
DRAWN BY.- JAMES WEBER SHEET 2 OF 4 SHEETS
Vol. 22 Page 5452
r
CERTIFIED SURVEY. MAP
LOCATED IN PART OF THE SOUTHWEST QUARTER OF THE
SOUTHEAST QUARTER SECTION 12, TOWNSHIP 29 NOR7H, RANGE
20 WEST, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN
This Certified Survey Mop is hereby approved by the St. Croix County Zoning Office
A len Bic, &kbUv- on 7 — 27 -0
Dote
This Certified Survey Mop is hereby approved by the Town of Hudson
oir n Dote
This Certified Survey Mop is hereby approved by the Villoge of North Hudson
..Vdoge President Dole
V `3 /e h
Villoge Administrator Dote
Note:
Per resolution number 2007 -07 the Village of North Hudson is exempt from some of the
applicable Village of North Hudson requirements pertaining to streets, water, sonitory sewer,
and storm sewer moins in conformance with Article Ill.
66 FOOT INGRESS AND EGRESS EASEMENT,•
A 66.00 foot private ingress and egress easement for driveway purposes across the following
described property.
Port of the Southwest Quarter of the Southeast Quarter of Section 12,
Township 29 North, Range 20 West, Town of Hudson, St. Croix County,
Wisconsin, more fully described as follows:
Beginning at the southeast corner of Lot 2 of the recorded Certified
Survey Mop, thence on on assumed bearing of North 18 degrees 07 minutes 34
seconds west o distance of 72.58 feet along the easterly line of Lot 2,• thence
northwesterly a distance of 207.30 feet along a tangentol curve concave
to the southwest having a radius of 16700 feet and a central ongle of
71 degrees 07 minutes 08 seconds: thence North 00 degrees 45 minutes
18 seconds Cost not tangent to said curve to o point on the south—
westerly line of Lot 1 of said Certified Survey Mop; thence southeasterly
o distance of 289.21 feet along a non— tongentol curve concave to the
southwest having a radius of 233.00 feet and o central angle of 71 degrees
07 minutes 08 seconds; thence South 18 degrees 07 minutes 34 seconds East
along the southwesterly line of said Lot 1 a distance of 95.20 feet to the
southwest corner of said Lot 1; thence North 89 degrees 12 minutes 36 seconds
West along the south lone of OUTLOT 1 o distance of 69.77 feet to the
point of beginning. Ok/
DE TA
rr
NOT TO SCALE MARK F.
REAR LOT L)NE MAISTROVICH
- S -2624 -
- EXCELSIOR,
L � � MN
TYPICAL
DRAINAGE AND UTILIT
R)GHT OF Wa LINE
EASEMENTS ....,.• •
(UNLESS OTH£RIMSE SHOWN)
Mork F. Mois t ro vich, 5-2624
LOT LINE -� _ Posse Engineering, Inc.
2003 0 Neil Rood
Hudson, Wisconsin 54016
PROJECT NO.: 843 -06
715 - 381 -1150
NO WNG DATE: JUNE 28, 2006 Dote: b a
DRAWN BY. JAMES WEBER SHEET 3 OF 4 SHEF/5
Vol. 22 Paste 5452
CERTIFIED SURVEY , MAP
LOCATED IN PART OF THE SOUTHWEST QUARTER OF THE
SOUTHEAST QUARTER SECTION 12 TOWWSHIP 29 NORTH, RANGE
20 WEST, TOW OF HUDSON, ST. CROIX COUNTY, WISCONSIN
Stormwoter Management:
The Town of Hudson, or its designee, is authorized to access the property as necessary to
conduct inspections of the storm water management practices or drainage easements to
ascertain compliance with the approved Storm Water Management Plan on file with the Town
of Hudson.
Upon notification to the Responsible Party by the Town of Hudson of maintenance problems
which require correction, the specified corrective actions shall be performed by the
Responsible Party within a reasonable time frame, as set by the Town of Hudson.
The Town of hudson is authorized to reform the corrective actions identified in its inspection
report or its notice if the Responsible Party does not make the required corrections within
the specified time period. The costs and expenses of such corrective actions shall, in
accordance with Section 66.0627 of the Wisconsin Statutes, be entered on the tax roll as a
special charge against the Benefited Property and, if not paid within the time determined
by the Town Board, collected with any other taxes levied thereon for the year in which the
work is completed. Responsible Party shall pay any and oil such charges resulting from its
failure to reform its obligations under this Agreement.
This Long -term stormwoter management shall run with the Property and be binding upon the
successors and assigns. The Town of Hudson shall have the sole authority to amend this
agreement, including approving any physical modifications to the storm water management
practices and drainage easements described herein. The Town of Hudson shall provide o
30 -doy notice to the titleholder(s) prior to approving any amendments to this agreement.
ST14TE O W 1.SCUs r N
Co�NrY� S5
Sr'' .no
e r S PC , I G S sQ s s .«e. fT c u � �3 31. o"2bO `2 (4 4)
APPROVED y *�s s''''� %
ST. ?.� �4'
ftok aZW 0 ' MARK F.
MAISTROVICH
JUL. 2 7 1007 = s -zsza = ,I
EXCELSIOR,
If not worded vA tftt 30 deytl of
,
'N do* approval MaN be %, ^ � �' ,�' Mork F. Mais tro vvich, S- 2624
rwattdvold `-' ; Passe Engineering, Inc.
2003 0 Neil Rood
Hudson, Wisconsin 54016
PROJECT NO.: 843 - 06
715 - 381 - 1150
ORA WING DATE: JUNE 28, 2006 Dote z W 6 ')
WN BY- JAMES WEBER WEFT 4 OF 4 SHMS — t --
Vol. 22 Page 5452
- onstruction FAX NO. :651 628 0263 Jul. 27 2009 03:31PM P4
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