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NOTICE Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
�ousF ,
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To d
---- - ----- F r �
a ��r 0
INDICATE NORTH ARROW
ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
Owner S A ►'k "
Property Address 10 / S 4 A P A k (o F_ kC , 0 - 0
•.,.y� era
City /State 14c> DSc"a N
t , f . Y
Legal Description: 6
Lot Block Subdivision/CSM # It/b Allf
'L t/45 c& t /4, Sec. 11 , TAN- RL5„4QTown of A-L, DS ® Al PIN # 6 - 1J51 - $ o - o v - a
491jiE �TAN—OSE CHAMBER — HOLDING TANK INFORMATION:
Tank manufacturer W K Size ST/PC/ Setback from: House ZS Well P/L a 0
Pump manufacturer — Model
Alarm location --
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: Width 3 Length "?-S , Number of Trenches Z
Setback from: House 99 Well 156 P/L 7 3 • Vent to fresh air intake 1 i
ELEVATIONS
Description of benchmark To P o F � NoN E - }'FO ak LI R4 9osy 12-- Elevation 106 o o
Description of alternate benchmark To P of $ (o - a #) tk' L d NN '. $1 Elevation 104
�.2 1 101 -cal ` 101 -LI g�IL 101
Building Sewer S ST/HT Inlet 7 • ?Z- ST Outlet PC Inlet
PC Bottom -- Header/Manifold ` % 1,00, Top of ST/PC Manhole Cover �--
Distribution Lines loo • z 4 () 4 = loo , 21 ( )
Bottom of System ( �seU =`�$ S� (} ! =4D = 5Y, .C& ( }
Final Grade () " : �02,� Z () �R (D , L? )
Date of installation ± /I Permit number -33W7 2_. State plan number
Plumber's signature License number ZSb Dated 0 lI Ll 9 9
Inspector Complete plot plan a
Wisconsin Department of Commerce Count
PRIVATE SEWAGE SYSTEM
Safety and Buildings Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 6 CRUIX
Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). 338882
Permit Holder's Name: ❑ City ❑ Village Pg Town of: State Plan ID No.:
MILLER, SAM HUDSON
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
�d t46 0 020 - 1346 -50 -000
TANK INFORMATION to /17-1 f ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ✓ 'Z�v Benchmark Z
DQ � j n q 2 -Y to• Vi
Aeration Bldg. Sewer
Holdi St/ Ht Inlet 5 /a .
NK SETBACK INFORMATION ; c St/ Ht Outlet fo o Z z
TANK TO P/ L WELL BLDG. Aentto e ROAD
Septic Q / Z / f ? 3/ NA
Qai ng NA Header / Man. Z
Aer n NA Dist. Pipe '-T �•qZ /•►v
? - , ?7 1000 Z
/ ,
Holding Bot. System G - /o.� t d Z
PUMP/ SIPHON INFORMATION Final Grade r►, I
nufacturer Deman U 0 e Z
Model Number GPM
TD I ft Friction S stem TDH F
L oss
Forcemain Length Dia. Dist. To well
SOIL ABSORPTION SYSTEM
BED / J41ENCO Width Lenqtb No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIME OSTON 7 S 1 7- DIMENSI
anuf t
r r:
SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING M d
INFORMATION Type O CHAMBER Mod Num e
System: &f& I/ �3 9 / OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length � Dia. Length 3 ?5�! Dia. A/f Spacing L 16 Z
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
&6
LOCATION: HUDSON 11.29.19.185 1018 LABARGE RD- HOMESTEAD LOT 15
►r, % V kt&)&- Law, : r- X t4cr6j area
All +� z X77' (NQS tea Wj 6 4 r,�iA
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. (p Z ff ( �, � 46�
SBD-671 0 (R.3/97) D to nspector's Si u Cert No
ADDITIONAL COMMENTS AND SKETCH y
SANITARY PERMIT NUMBER:
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9 1p Safety and Buildings Division
SANITARY PERMIT TI 201 W. Washington Avenue
N*6 con� i n In P O Box 7302
accord with ILHR 83.0 �0! Ad I
Department of Commerce 8 �O Madison, WI 53707 -7302
r
• Attach complete plans (to the county copy only) for the sys eta, on paper nc�t I@ Co
than 812 x 11 inches in size. d'
• See reverse side for instructions for completing this applica 'tin SUN�y St nitary Permit N umb er
Y P Y seconda purposes ZINOQEF� d eck revision to previous application
Personal information y ou p ma be used for seconda if
[Privacy Law, s. 15.04 (1) (m)].
to Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF R1bFA
Property Owner Name Property Location G
4 5441 )h
L E 1/4S 1 /4,S T .NrR /! E( �
Property Owner's Mail' Address Lot Number _ Block Number
9 40 V ..�..;
City, State Zip Code Phone Number Subdivision Name or CSM Number
w 1 ( - M % 74 /4-041E AQ
11. TYPE OF BUILDING: (check one) ❑ State Owned " Town It Nearest Road
Village
Lj
Public 1 or 2 Family Dwelling - No. of bedrooms OF v0 N LA' >D,
III BUILDIN U E: (If building type is public, check all that apply) Parcel Tax N umber(s)
1 ❑ Apartment/ Condo 5/ ( — QO Q
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. /New 2. ❑ Replacement 3, ❑ Replacement of 4 E] Reconnection of 5. E] Repair of an
7%6ystem ________ System - ___________ Tank Only - Existing System ________ Existing System ---- --------
B) ' ❑ A Sanitary Permit was previously issued. Permit Numl5a Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
1 Seepage Trench C E A(, 4 22 E] In- Ground Pressure r 42 ❑ Pit Privy
13+3 Seepage Pit p� �� )� Tb�. a� J ?S" 43 ❑ Vault Privy
14 ❑ System- In -Fil �(
VI. ABSORPTION INFORMATION:
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. ft.) (Min. /inch) Elevation,
Q 1 — S` O o ft , r Feet O Feet
acit
VII. TANK in Cap llo s Total # of Prefab. Site Fiber- Exper.
New fxistin
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App
Tanksl Tanks strutted
SepticTank Holding Tank Z ❑ ❑ ❑ ❑ ❑
ump Tank /Siphon Chamber ❑ 11:11 ❑ ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumtkr' Signature: Sta p MP /MPRSW No.: Business Phone Number:
/IG e LG. L O
Plum er's Address fStreet, City, State, Zip Code):
Cy X0 H0114 R..J� D �vp t✓l!
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuin Agent Signat a (No Stamps)
Approved ❑ Surcharge Fee) Owner Given Initial �
Adverse Determination l — U
X. CON ITIONS OF AP OV / R FO PROV
SBD- 6398 (RA 1/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
r
r
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 by the permit issuing authority_
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608- 266 -3151.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 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.
V111. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber 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 by the county; E) soil test data on a 115 form; and F) all sizing information.
----------------------------------------------------------------------------------------------------
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
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Safety and Buildings Division
SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue
Vi sconsin of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302
6 Attach complete plans (to the county copy only) for the system, on paper not less County C /
than 81/2 x 11 inches in size. J`('• /O %h
• See reverse side for instructions for completing this application State Sanitary Permit Number
Personal information you provide may be used for secondary purposes ❑ Check if revision fo p e �vlous ap Icarion
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION
Property Owner Nam Property Location
S Ati - I All l(� -E�. 5 1/4 U) 1/4, S I T 7-9 r Nr R E (orl
Pro erty Owner's Mailing Address Lot Number Block Number
Y n .1-1 "�`"_
Cit , State Zip Code Phone Number Subdivision Name or CSM Number
S ON W 0/ (3 G) z 7�9 O 5'T /
II. TYPE F B ILDING: (check one) ❑ State Owned o it Nearest Road
Public 1 or 2 Famil Dwellin - No. of bedrooms 3 ° ro w a n OF c.1 D�SOI'Ie 1 -4844 G if 2 p�
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) I , ?,1. 1 125y
1 ❑ Apartment/ Condo :::�) 20 3 � - . 000
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 F PERMIT (Check only one box on line A. Check box on line B, if applicable)
A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an
- _____S� stem ________ 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 ❑ Specify Type 41 ❑ Holding Tank
12X Seepage Trench L EACoW 22 ❑ In- Ground Pressure ,. a 42 E] Pit Privy
13 []Seepage Pit - /NF /X7'X *7b a S (err Z.s" 43 ❑ Vault Privy
14 ❑ System -In -Fill /V— A/ 1C4PAC17 - . V 3 1,8 3 C21r7 AC.aH 4H4AXD E
VI. ABSORPTION SYSTEM INFORMATION:
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. ft.) ( /inch) Elevation
-- 1 6 S7 2_. f k i.l�_ Feet /0 2, S Feet
VII. TANK Capacit allo s Total # of r Prefab. Site Fiber- Exper-
--0 75y INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete st un Steel glass Plastic App
Tanks Tanks
eptioT140f[lFng�et+k 00c w S ❑ I ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ I ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (N tamps) MP /MPRSW No.: Business Phone Number:
daye4u. �S -d3SS 3g� -SG9 Z
Plumbers Address (Street, City, State, Zip Code)^
IX. COUNTY / DEPARTMENT USE ONLY
/ [] Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A t Signature (No Stamps)
❑ jKpproved E] Owner Given Initial �) Surcharge Fee) �)
V Adverse Determination / 10t� ! `
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
- n- 6398 (R.11 /97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit 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 septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 - 266 -3151.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 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 number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County / Department Use Only.
Complete plans and specifications not smaller than 81/2 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 by the county; E) soil test data on a 115 form; and F) all sizing information.
----------------------------------------------------------------------------------------------------
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
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.Wisconsin Departmdnt of Commerce SOIL AND SITE EVALUATION Page 1 of 3
Division of Safety and Buildings in accord with Comm 83.05, Wis, Adm. Code
Enviromnen By Design
Attach complete site plan on paper not less than 8 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal r e point (BM), direction and St. Croix
percent slope, scale or dimensions, north dl 19 nd distance to nearest road. Parcel I.D.#
APPLICANT INFORMATION Se ' t a �� y ation. Revi ate
Personal information you provide may be r ry'�h (P ' , c s. 15.04 (1) (m)).
Property Owner Property Location
MILLER, SAM `' r Govt. Lot SE 1/4 SW 1/4 S 11 T 29 N,R 19 W
Property Owner's Mailing Addre —1 " Lot # Block # Subd. Name or CSM#
TROUTBROOK RD ' = "� ST ` ' 15 Homestead
City aCe,\�ZW.iopk r, [] City [] Village ®Town Nearest Road
Hudson 386 - ' 86 , 0 Hudson Labarge
eh I r of bedrooms 3 ❑Addition to existing building
Public or commercial describe
gpd Recommended design loading rate .7 bed, gpd/ft .8 trench, gpd/ft
bed, T 562 trench, ft Maximum design loading rate .7 bed, gpd1ft .8 tr ench, gpd1W
vation(s) 98.5 ft (as referred to site plan benchmar
Flood plain elevation, if applicable NA ft
S= bultaDle nir bya«i, ntional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank
U= Unsuitable for system ®S ❑ U El ® U ® S ❑ U r] S ® U EIS ®U ❑ S ® U
SOIL DESCRIPTION REPORT
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Bounda Roots GPD/ft2
Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 1 0 -13 10yr3 /2 - sil 2msbk mfr cw 2f .5 .6
2 13 -31 1Oyr4/4 - sil 2msbk mfr cvtr if .5 .6
Ground 3 31 -90 7.5yr5/6 - s Osg ml - - 7 8
elev
102.1 ft
Depth to
limiting
factor
>90
Remarks:
2 1 0 -9 10yr3 /2 - sil 2msbk mfr cw 2f .5 .6
2 9 -92 7.5yr5/6 = s Osg ml - - .7 i .8
Ground
elev
102.55 ft
Depth to
limiting
factor nn
>92 �U
Remarks:
CST Name (Please Print) Signature: � Telephone No.
Thomas C. Nelson 715- 246 -2454
Address Environmental By Design Date CST Number Ref #
1432 120th Street, New Richmond, W1 54017 9/14/98 227387 -15
PROPERTY OWNER: MILLER, SAM SOIL DESCRIPTION REPORT -1e Page 2 of 3
PARCEL I.D.# Environmental By Desi
Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPDI'fl?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ! Trench
3 1 0 -12 10yr3/2 - sil 2msbk mfr cw 2f .5 .6
2 12 -19 1Oyr4/4 - sil 2msbk mfr cw if .5 .6
Ground
elev 3 19 -90 7.5yr5/6 - s Osg ml - - .7 .8
102.35 ft
Depth to
limiting
factor These are additional borings to a test that was completed on 8/19/98
>9 6 .
Remarks:
4 1 0 -9 10yr4 /4 - sil 2msbk mfr cw 2f .5 .6
2 9 -96 7.5yr5/6 - s Osg ml - - .7 .8
Ground
elev
103.85 ft
Depth to
limiting
factor
T
Remarks:
5 1 0 -14 10yr3 /4 - sil 2msbk mfr cw 2f .5 i .6
2 14 -89 7.5yr5/6 - s Osg ml - - .7 .8
Ground
elev
102A5 It
Depth to
limiting
factor
>89
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
.r r
ENVIgONMENTHL BY DE51GN
1432 120`h STREET, NEW RICHMOND, WISCONSIN
715 -246 -2454
PROJECT NAME HOMESTEAD 14T PAGE 3
DESCRIPTION SE 4 SW %, SECTION 11 T 29 N, R 19 W
TOWNSHIP Hudson COUNTY St. Croix Wisconsin
,� ate►
4r— ���
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SCALE 1 Tom Nelson
BM 1, 1 0 o i - r a p "'I a 22738-7
BM 2. dose pF 'rte w/ r,66orn
Wisconsin Department of commerce SOIL AND SITE EVALUATION Page 1 of 3
Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmental By Design.
Attach complete site plan on paper not less than 8'/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.#
APPLICANT INFORMA'T'ION - P qr„ t formation Reviewed By Date
Personal information you provide may be AFkivacy Law, s. 15.04(l) (m)).
i
Property ner ' `' ' Property Location
fi� , ; �� `' Govt, Lot SE 1/4 SW 9 1/4 S 11 T 2 KR 19 W
, SAM
Pro wner's Mailing Add , _ Lot # Block # Subd. Name or CSM#
RD i a� i 15 Homestead
City ' ..Sate Zip ode ,�)ioneRfumbet it ❑ City ❑ Village Town Nearest Road
Hudson r � ri , , 6 -869 / Hudson � Labarge
r New Construction `�; ,'Residential L 1O'ber ta'� bedrooms 3 ❑Addition to existing building
Use.
Replacement t0trcmme describe
o lion Recommended design loading rate �• Z bed, gpolft� 2 trench, gpolt
450
Code Derived daily flow '�p�. � ench, gpd/ftz
Abs area required — bed, W 7 f trench, f 2 Maximum design loading rate -2- bed, gpolfl
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmar
Additional design / si�consi
Parent material Loe lacial out a Flood lain elevation, if a livable ft
S= Suitable for system Conventional Mound In Ground Pressure AT Grade System in Fill
Hing
U= Unsuitable for system ❑ S ®U S El El ®U [I s ®U EIS ®U s ® u
Tank
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPDIfF
g F __ in,
Texture Consistenc Boundary Roots
# Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ` Trench
Bonin
1 0 -19 10yr2/1 - sl 2msbk mvfr cw 2f 5 6
19 -34 10yr4l6 - sl 2msbk mvfr cw if 5 6
6 _ s Osg ml cw
elev - 7 8
Ground 7.5 5/
3
4 79
yr
_ - -- _ --
/� 4 79 -84 1Oyr7/2 c2d7.5yr5/8 cl lfpl mvfr -
Depth to
limiting
CtOf
"7 to
Remarks:
2 1 0 -10 10yr2/1 - sl 2msbk mvfr cw 2f .5 .6
2 10 -17 10yr4 /6 -
sl 2msbk mvfr cw if .5 .6
Ground 3 17 -31 10yr5 /3 - sil 2msbk mfr cw if 5 6
elev 6
- 5 5
4 31 -46 1 Oyr5 /4 - sil 2msbk mfr Cw - -_
Depth to 5 46 -51 10yr4/4 c2d5yr5 /8 scl 2fpl mvfi cw -
limiting _ cs O ml - - 7 8
f 6 51 -90 7.5yr6/4
Remarks:
CST Name (Please Print) Signature:
Telephone No.
`� 715- 246 -2454
Thomas C. Nelson
Address Environmental By gn Date CST Number Ref #
1432 120th Street, New Richmond, WI 54017 8/19/98 227387 64
1
I BY D
1432 120 STREET, NEW RICHMOND, WISCONSIN
71S- 246 -2454
PROJECT NAME HOMESTEAD LfIT PAGE 3
DESCRIPTION SE 4 SW 1 /, SECTION 11 T 29 N, R 19 W
TOWNSHIP Hudson COUNTY St. Croix
C)
43
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Lo f
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t
1
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SCALE }" Tom Nelson
BM I. G., 0- 0OL n M j af of , ry n .0 CSTMO 2605
BM 2. n a. ; ��
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 5 r`t. ,V & e- 4E5' -4__.
Mailing Address ZC X -.# /' ; /
Property Address ( 0 / S L /4 Sf f �L jz 0 4 D
(Verification required from Planning Department for new construction e
City /State N U 1) :5 2 N LL) Parcel Identification Number CaO - 134 1 6 - S - 0 - 0 0 0
LEGAL DESCRIPTION
Properly Location �' l "" ' /4, ) ' /., Sec. , T_2 / , Town of I J
bdivision
110 ✓ T/� , Lot # �.
Certified Survey Map # Q /j/ 3 . Volume - , Page # 3
Warranty Deed # S� l 3 , Volume / . Page # + 9
Spec house yes ❑ no Lot lines identifiable 0 yes ❑ no
SYSTEM MAINTENANCE
Impraper 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 wastewaterdisposal 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 St. Croix County Zoning Office within 30
days of the three year expiration date.
ATURE F APPLICANT DATE
"i' VO WNER CERTIFICATION
' I'(we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the rop6itydescribeglabove, by virtue of a warranty deed recorded in Register of Deeds Office.
ATURE OF ' PLICANT 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
NI ST'v't. 1s.aR (IF WISCONSIN V0101 1 19132 H • ,•• \ HI'EM.e "- olk
This Deed. Inde b, twcen
�IIie and
;•
Nao,ni. R. �.il l ie, husband and
IV� R '
Grun:.,r,
10 30 r1.
.,fill yam C. `tiller, a single person ,
Gr•tntee,
W itnesseth , That the aid Grantor, for a valuable conslderat.un
:o.fc.•,x t„ Gr,uttce the followu.,; dcs,:rlbcd real estate in J.t,.
Croix
C,Unt), State of WISCLnsul:
See attached description.
Tax 1 &reel No: ... ............................... .
TRANSFE
This is not.. . homestead property.
(ib) Us not)
Together with all and blngul,.r the hereditament& and appurten -races .::rreunto bt. ,nging;
And Ronald L. Willie and Naomi R. Millie
c.arrunts that the title is good, ,ndefe,...lble in fee simple and free alit dear „f cncumbri.a.es except
easements, restrictions, and rights -of -Way of re,;ocd,
:,nd N III tkarl ant and defend ti ante.
hated thl. day of M 19 96
(SEAL) , Nt'T 1 r (SEAL)
. Ronald .Willie
(SLAL) `/ jscryr�« .`/ <G Lee. (SEAL)
. :Naomi R. Willie
AUTHENTIC:1'rION ACKNOWLEDGMENT
3ibrnature(s) ..... STATE OF V ISCONSiN
.... .. ....................... ........ . ..............I..
. . . ..... St. Croix ...... Ibunty. „
authentic ;ucd this - .._ da of 19.... Person ",.: came before file this .�1 .....day of
y
..AarGh., 19 913_, the above named
... ... ............ ........... _
...... .....Ro.na 1d...L.,..w i l 1 -ie -..axe .............. . .. .
• _ .. ........... ............ N.a.am i ..ft,...l? i 1.1.l.e ...............................
TITLE: NIENIRER SPATE B.\ It (,F WISCONSIN ............. ........ _ ................ I ... .. -.....
(If nut. -. .
authorized by ; 7(16.C 1Vc;. Stet.,.) to me known t„ i,e the persa .S.. .... who executed the
foregoing instr aucnt and.4}Lgowlcdge the same.
THIS 'v,TRUMENr WAS C,,'.F:EJ HY
C. L. Gay. lord,- A.tto.rne -y
River Falls W1 54022 , �. .$ ,���
_. ...... .. NoUre F ;tl., , .i . k. "S County, Wis.
:wtf:cntic:,u d r :,al.ID,uh 3 ed, Il ,tit 3fy Cunlnli Rion iy, plzrnipni fit. ll f ` nt3t, Gate ccpirution
ra cot I'%
r,.:ary.) > �` . - 19 ��;)
date: �...
1,.. th, ., ,.H—t .r,
NAhAA%TY r)k:}U It O F
11'I�,'U \SIN ' N. I L. :.t L';....6 C.. L•c.
t Vk31 .%•. I — 1'jtl: �i,..a •,.err. 1. ,.
parcel of Iano located in the 51 -1 /4 of the :W_ /4 and in part cf
the Si; -1;4 of the Si,' -1/4 of Section 11, Township 29 North, i,r,ntc 19
Vest. lawn of Hudson, being further described as follows:
beganr,ing at the S -1/4 corner of said Section 11; thence
X69 29'43 "1; along the S uth line
2376.39 feet; thence NO2 2E'06 "i; 1322.62Sfeet, o
to the d N'crth l line l,
of the 5 - 112 of the SW -1/4 of Section 11; tF -ErCc S�'9 ° :�5'�C "L, alcrq
said North line, 2446.:, feet to the North - Scuth 1/4 line of said
Sectior, 11; thence S00 34'16 "v, alon6 said North -South 1/4 line,
1325.65 feet to the point of beginning. Parcel contains 73.31
acres (3,173,674 Square feet) and sut)Ect to all ease -,eats of
record.
Together with and subject to an easement for ingress and egress
located in part of the fW -1/4 of the SV -1/4 of Section 11 and in
part of the SE -1/4 of the SE -1/4 of Section 10, all in Township 29
Korth, RanFE 19 West, Town Of Hudson, being further described as
follows: CorrimencinF, at the 5 -1 4 eon
- -,,, / corner of said S c E
0� 6, a lion 11; t ncE
hey 29
along S 8uth ling of the S
f the
23 76.37 feF F . L; -1 /� of said SEC:__..
t; thence K02 26'06"V 1256.54 feet to the point of
bcF.innini; thence continuing K02 66.06 feet to the Korth
lint of the 5-112 of the SW -1/4 of said Section 11; thence .
Kb� 35'50 "h', along the Korth line of the S -1/2 of the SW -1/4 of
said Section 11, 179.26 feet to the NE corner of the SE -1/4 of the
SE -1/4 of Section 10; thence N59 41'39 "1;, along the North line of
the SE -1/4 of the SE -1/4 of said Section 10, 1318.24 feet to th
Wes line e
ne of the SE -1/4 of the SE -1/4 of said Section 10; thence
S00 25'39 "1,', along said test line, 66.00 feet; thence S69 ° 41'39 "E,
on a line being 66 feet distant Southerly and parallel to the Korth
line of the SE. -1/4 of the SE -1/4 of said Section 10, 116.32 feet
to the f line of said SE -1/4 of the SE -1/4; thence 569 "E; or.
a line bcinz 66 feet distant Southerly and parallel to the Korth
line of the S -1/2 of the S1: -1/4 of said Section 11, 162.54 feel to
FEE t� of beginning. eginning. ParcEl contains 2.27 acres (95,9..6 Square
Fe and is sutiect to right-of-way c
E )' for :oar. road (_colt F.oaC) and subjEct to all eascme
nts of record.
i
590143
'' HOMESTEAD
THE Wl /4 OF THE SWI 14 AND iN PART OF THE SWI 14 OF THE SWI 14
11, T29N, RISW, TOWN OF WD'OUV, ST. CROIX COUNTY, WISCONSIN.
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, dolU ut T111C01
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14'419 plhl'41'1 1$173' 41).11 N102r41
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