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Wisconsin Department of commerce SOIL AND SITE EVALUATION
Divisiaa� and Buildings Page I of 3
in accord with Comm 83.05, Wis. Adm. Code
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must Environmental By Design
Include, but not limited to: vertical and horizontal reference point (BM), direction and County
percent slope scale or dimension, north arrow, and location and distance to nearest road. St. Croix
Parcel (.D.# _
APPLICANT INFORMATION - Pleas information.
Pe►sorwl infonrgtion You provide mey be used for plo�slt( r y Law, s. 15.04 (i) (m)). R Date
Property Owner Property Location
; r� - . ,CQ Govt. Lot SE 1/4 SE 1/4 S 21 T 29 KR 19 W
Property Owner's Mating Address - Lot # Block # Subd. Name or CSIM
Tr outbrook Road 10 Unnamed
Crly V ta,(e Zip Code ho r I I [] City [] Village ]Town Nearest Road
Hudson 54016ST CR04,�
Hudson CTH UU
New Construction Use: ` rooms 3 []Addition In existing building
❑ Replacement I ribe
Code Derived daily flow 450 I
Recommended design boding rate 7 bed, gpd/f trench, gpd/IP
bon area required --W— --- bed, fe 56 3 _ trench, ff Maximum desi n In rate .7
Recommended infiltration surface elevabon(s) g bed, 9Pd 8 fr ench, gpollla
ft (as referred to site plan benchmar
Additional design / site considerations
Parent material LOESS OVER OUTWASH SAND Flood Plain elevation, if applicable t}
S- - Suitable for system Conventional Mound I In -Ground Pressure AT -Grade System in Fit Holding Tank
U= Unsuitable for system f us El U El S O U El S U I ❑ S U ❑ S❑ u El S U
SOIL DESCRIPTION REPORT
Horizon Depth Dominant Color Mottles Structure
Bonng# in. Munsell Ou. Sz. Cont Color Texture Gr . Sz. Sh. Boundary Roots --- GPDJfIa
Bed Trench
1 1 0 -10 10YR3/2 - sil 2msbk mfr cW 2f .5 6
2 10 - 1Oyr4/4 - A 2msbk mfr cw+ if 5 6
Ground 3 27 -38 7.5yr4/6 - s Os nil elev 8 cW
102.8 ft 4 38-48 7. Syr4 /4 cs i;z::: nil
cW - .7 .8
Depth to 5 48 -98 7: .
limiting — .= - - s ml - - .7 .8
factor �' 10 1
!�
Remarks: 1 z
2 1 0.9 10yr3/2 - sil 2msbk mfr cW 2f .5 .6
2 9 - 19 10yr4/4 t of ,o sil 2msbk_ mfr cW if .5 .6
Ground 3 19--54 7.5yr4/6 -1, s Os ml
elev 8 cW - .7 .8
4 .05 ft 4 54 -67 7. Syr4 /4 3 - cs 0s8 45-- - - ml cW - .7 8
)e f V 5 67 -93 7.5 s ' Osg ml - - 7 8
imting — �� (s
actor >93 �
Remarks:
CST Name (Please Print) Signature:
Thomas C. Nelson � �—G� -- Telephone No.
_
Address Envirwmiental BY Design 715- 246 -2454 Date CST Number Ref #
1432 120th Street, New Richmond, WI 54017 11/5/98 26 ST -72
8M OEWRIPTION REPORT
--- �� Page 2 Of 3
milli
Enviraune W By 'an
HorizM s flu. Sz Color Texture G Structure
Sh. nsisfe Boundary GPDfiF
Roots
Bed 'Trench
3 1 0-7 10yr3/2 - sil 2msbk mfr cw 2f 5 ? 6
1 7 -16 1 Oyr4 /4 - sil 2msbk,
kound y _ __ _— - - -- _ 1 f .5 .6
lev 3
1l►41 7 Syr4/6
- s Osg �
101.1 R cam' - 7 : 8
w � 1 r
� b "� �"._ q Osg cw - .7 .8
n6v s 7 Osg ml - - 7 i 8
.3
Remarks:
4 1 0.9 10yr3/2 - sil 2msbk mfr
cw 2f .5 .6
2 9 -25 10yr4/4 - sil 2msbk mfr cw if 5 6
ound
N 3 25 -90 7.5yr6/4 _ s 08 8 ml -
)3.70 ft
7 .8
Pb b
�9
br
>90
Remarks:
5 l 0.9 10yr3 /2 - sil 2msbk mfr cw 2f .5 .6
2 9 -25 10yr4 /4 - sil 2msbk mfr cw if 5
and . 6
3 25 -92 7.5yr6/4 _
s OS8 ml - .7 .8
1.75 ft -
Ih to
b9
rc
92
Remarks:
to
9
Remarks:
EM19 ONMENTRI BY DE51GN
1432 120`h STREET, NEW RICHMOND, WISCONSIN
715 - 246 -2454
SAM MILLER PAGE 3
SE % SE Y4, SECTION 21 T 29 N, R 19 W
TOWNSHIP HUDSON COUNTY St. Croix Wisconsin
P r d posep �d-�- ��
4 i � s lap e.
• 2
01$
SCALE 1 =40' Tom Nelson
BM 1. " pvc pipe set on lot line 100' CT VA k Lk 227387
BM 2. Spike in tree elevation 102'
r L4-
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% 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 INFORMATION - Plrffit aft information. v' By Date
Personal i bffr ation you provide may be used purposes (Privacy law, s. 15.04 (1) (m)). 1 r1
Property Owner ! Property Location
Miller, Sam j/ Govt Lot SE 1/4 SE 1/4 S 21 T 29 N,R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
Troutbrook Road _ `' "y '� Plat Home Place
CitySt e',,�ip Code'�htii�Urnber City Village ®Town Nearest Road
Hudson 4 '.�3 O 1 r r -'l; �° Hudson I CTH A
New Construction Use: , , I / Nu ooms 3 ❑Addition to existing building
Replacement
It ® ribs
Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpdffe .8 trench, gpolf
Absorption area required 643 bed, fls 563 trench, W Maximum design loading rate .7 bed, gpd/ffz .8 tr ench, gpd/fts
Recommended infiltration surface elevations) NA ft (as referred to site plan benchmar
Additional design / site consideration B ORE HOLES ARE FOR PLAT REVIEW
Parent materia LOESS OVER OUTWASH SAND Flood lain elevation, N app licable NA It
S- - Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holdin Tank
U= Unsuitable for system ®s E] u I ®s ❑ u ® s❑ ❑ u I ❑ s ®u 0S 0 u
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ftz
Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
1 1 0 -12 10yr3 /2 - sil 2msbk mfr cw 2f .5 .6
2 12 -34 10yr4/4 - sit 2msbk mfr cw if .5 .6
Ground 3 1 34 -90I 7.Syr4/4 I gs Osg ml 7 8
elev {-
97.82 ft
Depth to {I
limiting
factor
>90
Remarks: Bore hole for plat review
2 1 0 -12 10yr312 - sit 2msbk mfr cw 2f 5 6
2 12 -38 1Oyr4 /4 - sil 2msbk mfr cw If .5 .6
Ground 3 38 -90 7.5yr4/4 - gs Osg ml - - 7 8
elev
98.28 It
------- T — T7- 1 1 1 1
Depth to
limiting
factor
>90
Remarks: Bore hole for plat review
CST Name (Please Print) Signature'. _ Telephone No.
Thomas C. Nelson 715- 246 -2454
Address Envh'ommcetal By sign Date CST Number Ref #
1432 120th Street, New Richmond, WI 54017 2/15/99 227387 212
I
PROPERTY OWNER: Miller, Sam SOIL DESCRIPTION REPORT zf 'z I Page 2 of 3
PARCEL I.D.# Environmental By Dft-ign
Depth ' Dominant Color ' Mottles Structttlre GPD/ft�
Horizon in. Mansell Qu. Sz. Cont Color Texture Sz. Sh. �onsisten� Boundary Roots Bed ' Trench
3 1 0 -11 10yr3 /2 - sil 2msbk mfr cvr+ 2f .5 ; .6
- 2 11-40 l 0yr4 /4 - sil 2msbk mfr cw 1 f .5 .6
Ground , , , , , , ,
elev 3 40 -88 7.5yr6/4 - s osg ml - - .7 .8
91.88 ft
Depth to
limiting
factor
Remarks: Borc hole for plat review
4 I 0 -14 ' 10yr3/2 - sit 2msbk mfr cw ' 2f .5 .6
2 14 -45 10yr4/4 - sil 2msbk mfr cw if .5 .6
Ground
elev 3 45 -88 , 7.5yr6/4 - s , Osg , m1 7 8
95052 ft
Depth to
IimiUng
factor
48
I
Remarks: Bore hole for plat review
5 1 0 -12 10yr3 /2 - sil 2msbk mfr cw 2f .5 .6
2 1246 10yr4 /4 - sil 2msbk mfr cw if .5 .6
Ground
elev 3 40 -90 7.5yr6/4 - s Usg ml - - .7 .8
95.64 ft ,
Depth to
limiting
factor
>90
I
Remarks: Bore hole for plat review
Ground
elev
Depth to
limiting
factor
Remarks:
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ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT:
Owner SA
Propert Address t 711'
City /State L) P S 9D N W ! .•; /' / t�uri r =' rt
�)hI6Ci(��F
Legal Description:
Lot /D Block " Subdivision/CSM # H OM E '
I - L PIN # U
/4 S ec. � T Z� N R Town of J'
(SEPTIC TANK -"� DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer LL) E (S F ( L Size ST/PC / `7�� �_etback from: House 3 Z Well `d y P/L 1 3
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: T2F- ► Ic Width 3 Length .S6 ZS Number of Trenches Z
Setback from: House 4 Well a �• PT 3 3 , Vent to fresh air intake "7 2
ELEVATIONS
Description of benchmark Z � PVC o /-07 L N
�F 4 � M, #/ �, o s Elevation
Description of alternate benchmark T c OF Qlbc - Foy N40T - N Elevation S•
i
Building Sewer ST/HT Inlet S•9s% ST Outlet �' 30 r PC Inlet
PC Bottom — Header/Manifold 6 (� 9 �� 3 Top of ST/PC Manhole Cover 3,
y9oS
Distribution Lines �) �7� °O = g9,oS (� 7,0e ( )
Bottom of System ( �� 2 5�= 9 7, 8 (� S; Zsr 9 �� 8 ( )
Final Grade ( ) 3 • �° )o 2 � 3 ( ) '� 7 ,s l0 3 ( )
Date of installation /Z /S / Permit number : �Z `l 7 0 State plan number
Plumber's si nature License number ` R �1 �D 3 :P0 Date F
Z /
Inspector
Complete plot plan
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
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2 s .
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INDICATE NORTH ARROW
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County
Safety anti Buildings Division
INSPECTION REPORT ST CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. 324709
Permit Holder's Name: [I City ❑ Village $] Town of: State Plan ID No.:
MILLER, SAM HUDSON
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
ICE> (� Z� f 020- 1056 -90 -100
TANK INFORMATION ELEVATION DATA wo 6qq
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Vv 1 Benchmark /oa - JCV6
Dosing All's Us.. --N
Aeration Bldg. Sewer ,� �ild•92
Holding St/ Ht Inlet 3Z Ld0.2
TANK SETBACK INFORMATION St/ Ht Outlet °) 9
TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet
epti� 32 3�� NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe Q - �°t • 2c/
Holding Bot. System IpRS X 1'7. &
PUMP/ SIPHON INFORMATION Final Grade 6.77:) "2..5
Manufacturer Demand 12 9 SS' C) 9 0 /
Model Number GPM -2. �s» s',d / 3.
TDH Lift F TDH Ft oss
Forcemain Length Dia. Dist. To
SOIL ABS TION SYSTEM
BED Width Length No. Of Trenches PIT No. Of Pits ia. Liquid Depth
D IMENSIONS DIMENSION
SETBACK SYSTEM TO P / L I BLDG WELL LAKE / STREAM
LEACHING
INFORMATION Type O Q �d CHAMBER mod Number:
Syste WA j (, ' 7/�' �— OR UNIT
DISTRIBUTION SYSTEM �,�, ,, �, 1'71� � 4 3 / - &S. ,-�'f.
Header /manifold Distribution Pi e(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length, D'Z� ia. - 3 _f Spacing q
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.)
LOCATION: HUDSON 21.29.19.213A,SE,SE 594 COUNTY ROAD "UU" — LOT 10
( 4(4.801 - T 05 bla.c lc
C OX kU
Plan revision required? ❑ Yes ® No
Use other side for additional information. a
SBD -6710 (R.3/97) Date Inspector's ignature Cert. No.
I
ADDITIONAL COMMENTS AND SKETCH z ,
SANITARY PERMIT NUMBER:
I
SANITARY PERMIT APPLICATION Safety Washington l Ave Avenue
Vi sconsin 201 W. r . q m. P O Box 7302
Department of Commerce accord with ILHR 83.05, Wis. d Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8112 x 11 inches in size. 5�- C& — 1 1I`
• See reverse side for instructions for completing this application State Sanitary Permit Number
Personal information you provide may be used for seconds ���
I secondary � purposes � � ❑Check if revision to prevlou application
[Privacy Law, s. 15.04 (1) (m)]. /� f/ State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINf ALL INF RMATI N
Propert y Owner Na LZR. ` p roperty Location
c7E 1 /a S F 11 12, S Z/ T L.' , N. R /' E (or) W
Property Owner's Mailin Address Lot Number /0 Block Number
AWL ' !
City, State 1 Zi Code Phone Number Subdivision Name or CSM Number
U S4 �U� 5 0 r > 74 ,l
II. TYPE OF BUILDING: (check one) ❑ State Owned o c it a Nearest Road
Public or 2 Family Dwelling - No. of bedrooms 3 Town OF SON U lf
III BUILDIN SE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 0 Z d - 10 .5-
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
S ❑ 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 n[ New 2 E] Replacement 3 E] Replacement of 4 E] Reconnection of 5 E] Repair of an
System ^_____ System Tank Only Existing System _________Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench J N FI 4t�+ 4 42 ❑ In- Ground Pressure ' / 42 ❑Pit Privy
13 ❑ Seepage Pit 5/GCt#0 �-K 3 X S �e .2$ 43 ❑ Vault Privy
14 ❑ System -In -Fill .�
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
R ired (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) q Elevation
; F eo
�d 3 V 7 t,, - g `7 Feet 1 2. Feet
Capacit
VII. TANK in Ca allo Total # of r Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete con steel glass Plastic App
New Exist in strutted
Tanks Tanks k)
Septic Tan Ing I ank l 00 0 ❑ ❑ ❑ 1 ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ ❑ 1 ❑ ❑ 14—
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: ( Stamp MP /MPRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
o m 1 O F Ka H oo so N
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groun:: ate Issued Issuin Agent Signature (No Stamps)
+,Approved El Owner Given Initial Io Surcharge Fee) r � /j1
A dverse Determination 1 0 *� 164) ( � K
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 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 bq 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 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% x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal r{aol� (BM), direction and St. C
percent slope, scale or dimensions, north a ` WooOtid'1r, pry} c)istance to nearest road.
Parcel I.D.#
,'___ oz � S 90
II I APPLICANT INFORMATION - ?p nt I inform ion. o e
Personal irrfarmatiori you provide may be u r l�econda J (Privacy �aW s. 15.04 (1) (m)). V wed By Date 7 , rn
Property Owner Pro Location
r _ party
Millet', Sam Govt Lot SE 1/4 SE 1/4 S 21 T 29 N,R 19 W
Property Owner's Mailing Address -. ; Lot # Block # J !t Name or CSM#
Troutbrook Road ` - A � acr� 10 Unnamed
City Stat Z�ip,Co f�ltdlt's(�nber. E] City ❑Village ®Town Nearest Road
Hudson WI ' x'16 .. ;' Hudson CTH UU
❑ New Construction Use: ❑ Res ` ' Nw*wWr Of bedrooms 3 ❑Addition to existing building
❑ Replacement ❑ Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/W .8 trench, gpolfts
Absorption area required 643 bed, ft 563 trench, tt Maximum design loading rate .7 bed, gpd/ft .8 tr ench, gpd/ft
Recommended infiltration surface elevation(s) 99 it (as referred to site plan benchmar
Additional design / site consideration
Parent material LOESS OVER OUTWASH SAND Flood plain elevation, if app licable It
S - - Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system M S❑ U ® S❑ U ® S U El ®u ❑ S ®U ❑ S® U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/fF
Boring# Horizon in. Munseil Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
l 1 0 -10 10YR3 /2 - sir 2msbk mfr cW 2f .5 .6
2 10 -27 10yr4 /4 - sir 2msbk mfr cW if .5 i .6
Ground 3 27 -38 7.5yr4/6 - s Osg ml cW - 7 8
elev
102.8 ft 4 38 -48 7.5yr4/4 - cs Osg ml cW - .7 .8
Depth to 5 48 -98 7.5yr6/4 - s Osg ml - - 7 8
limiting
factor
>ss° 4s n
Remarks:
2 1 0 -9 10yr3 /2 - sil 2msbk mfr cW 2f .5 .6
2 9 -19 10yr4/4 - sil 2msbk mfr cW if .5 .6
Ground 3 19 - -54 7.5yr4/6 - s Osg ml cW - .7 .8
elev
101.05 ft 4 54 -67 7.5yr4/4 - cs Osg ml cW - 7 8
Depth to 5 67 -93 7.5yr6/4 - s Osg nA - - 7 ' 8
limiting
factor
>93 3v
Remarks:
CST Name (Please Print) Signature: Telephone No.
Thomas C. Nelson "` 715- 246 -2454
Addres Enviromnental By Design Date CST Number Ref #
1432 120th Street, New Richmond, Wl 54017 11/5/98 2605 -72
PROPERTY WMER: Wier, Sam SOIL DESCRIPTION REPORT Page 2 d 3
PARCEL I.D.# Environmental By Desi
Depth Dominant Color Mottles Structure GPD/I�
Horizon in Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. nsistence Boundary Roots
Bed ' Trench
3 1 0 -7 10yr3/2 - sil 2msbk mfr Cw 2f 5 6
2 7 -16 10yr4/4 - sil 2msbk mfr Cw If .5 .6
Ground
elev 3 1648 7.5yr4/6 - s Osg ml Cw - 7 ; 8
101.1 ft 4 48 -58 7.5yr4/4 - cs osg ml cw - .7 .8
Depth to 5 58 -98 7.5yr6/4 - s Osg ml - - 7 8
limiting
factor
>98
Remarks:
4 1 0 -9 10yr3 /2 - 0 2msbk mfr cw 2f .5 .6
2 9 -25 10yr4 /4 - sit 2msbk mfr Cw if .5 .6
Ground
elev 3 25 -90 7.5yr6/4 - s Osg ml - - 7 8
103.70 ft
Depth to
limiting
factor
>90
Remarks:
5 1 0 -9 10yr3 /2 - Sill 2msbk mfr Cw 2f .5 .6
2 9 -25 10yr4/4 - sil 2msbk - mfr Cw if .5 .6
Ground
elev 3 25 -92 7.5yr6/4 - s Osg ml - - .7 .8
103.75 ft
Depth to
limiting
factor
>92
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
I
E BY DE51GN
1432 120 STREET, NEW RICHMOND, WISCONSIN
715- 246 -2454
SAM MILLER PAGE 3
SE 'Y SE %, SECTION 21 T 29 N, R 19 W
TOWNSHIP HUDSON COUNTY St. Croix Wisconsin
\ \ 4cres
4% laps
Z1/-
SCALE 1" =40' Tom Nelson
BM 1. 2 " pvc pipe set on lot line 100' CT 14 k LAI 227387
BM 2. Spike in tree elevation 102'
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer S 3q M Aj Q_ L f— lA—
Mailing Address Ck " 1
Property Address --9 0 G Y o' V L 1,
(Verification required from Planning Department for new construction)
City /State D S d Al t.rt.a 1 Parcel Identification Number m �„�,,.. 10 O
LEGAL DESCRIPTION
Property Location `S E ' / <, � E '/4, Sec. ' , T N -R W own of d? 1N
subdivision rV Lot tf
Certified Survey Map # Volume , Page #
:.Warranty Deed # S$ � � � �-/ , Volume ,3 (o 3 , Page
Spec house yes 0 no Lot lines identifiable ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper mail',.
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, signe the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wa. :., aterdisposal 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 shin,
Itwe, 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 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 exilira ' n date.
SIGNATURE APPLICANT DA
; VWNER CERTIFICATION
-' , j {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 1'* ~described above, by irtue of a warranty deed recorded in Register of Deeds Office.
Z 3 'M
JRE V� r►f °I'L�ICANT DA/
* ** 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
F ,•
Document Number WARRANTY DEED
- Y
This Deed, made between.
Robert L Rohl ow
Grantor,
'
and, Sam E Miller REG ISfiER` 5^ O FIC
ST. CROIX CO.. WI
a single person Grantee. Rss'/ fw IheoN
r Witnesseth, That the said Grantor, for a valuable cons"eration of one dollar and c QQ
other valuable consideration conveys to Grantee the below =escribed real estate in OC 0 f 1998
St. Croix County. State ofVfta - rsm
�7
This is not homestead pro 9.
�"
Together with all and singular hereditaments arc appurtenances thereunto
belonging;
+e And Grantor
warrants that the title is good, indefeasible in fee srrpie and free and clear of
J; encumbrances except Recording Area
Name and Return Address A
easements, covenants, and restrictions if record,
and will warrant and defend the same. Sam E . Miller r
`• ;Parca dentification Number) PO Box 151
020 - 1056 -90 Hudson WI 54016
A parcel of land located in the SE '/4 of the SE '. s of Section 21. - 1 - 29N, R 19W, Town of Hudson, St. Croix
County, Wisconsin, described as follows: beginning at the SF. comer of said Section 21; thence N 89 °23'5 1 W
'„
13 19. 10 feet to the monumented West line of the SE '/4 of the SE '/4 of said Section 21; thence N00 °51'33 "W
4
980.09 feet along said monumented West line of the SE '/4 of the SE '/4 to the North line of the South 30.80ths of
} the E '/ of the SE "A of said Sep ion 21 as calm owt in that documentation found in Volume 838, Page 252 of
the St. Croix County Register of Deeds; thence S89 °37' 19 "E 626.85 feet along :aid North line of the South
30 /80ths to the intersection of the monumented 4*uth line of the Certified Surse% flap tiled in Volume'_, Page
484 and the said North line of the South 30.80ths of said E '/: of the SE '/4; thence S89 °23' 10 "E 31.88 feet to a
found 1" iron pipe being the SW Corner of said Certified Survey Map, thence continuing S89°23'l01E 660.24 4
feet to the East line of the SE ' A of said Section ' 3 : thence S00 °5 1'50"E 982.41 feet to the point of beginning.
containing 29.725 acres including rigl -- of %%a% t 28.006 acres excluding right of %%a
Y.. Dated this _ day of 199_ T AJ FER
Robert L Rohl,
.s.
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
COUNTY ST'. CROIX
Personally came before me this Z day of GcT �� the t
above named Robert L. Rohl t
authenticated this _ day of to �t
me known to be the person(s) who executed the foregoing
i ins ent and acknowledge the same .
signature
type or print name spnatwa J
type or print name v�/1Qt�
TITLE'. MEMBER STATE BaR OF WISCONSIN tary Public County,
(If not. a A Y PV om ission is _ permanent (if n ot, state e xpiration date
authorized by 706 06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY 2 'N a rsons signing in any capacity should be typed or
r their signawres
W
i Robert F. all
(Signatures may be authenticated _: acknowledged Bo are Aid E "
necessary.) 2• '
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