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Parcel 020-1326-30-000 01/12/2005 AM
PAGE E 1 1 OF 1
• Alt. Parcel 12.29.19.1695 020 - TOWN OF HUDSON
Current ❑X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* SOLTYS, DANIEL P & DAWN D
DANIEL P & DAWN D SOLTYS
832 MOON BEAM W
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 832 MOON BEAM W
SC 2611 SCH D OF HUDSON
SP 1700 W ITC
Legal Description: Acres: 2.530 Plat: 2534-TANNEY RIDGE SPECIAL 2ND ADD-N
SEC 12 T29N R1 9W PT SE NW LOT 66 TANNEY Block/Condo Bldg: LOT 66
RIDGE SPECIAL ADDITION 2ND ADDITION 2.53
AC Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
12-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
12/01/1997 569217 1279/584 WD
2004 SUMMARY Bill Fair Market Value: Assessed with:
49719 254,400
Valuations: Last Changed: 10/30/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.530 55,300 141,500 196,800 NO
Totals for 2004:
General Property 2.530 55,300 141,500 196,800
Woodland 0.000 0 0
Totals for 2003:
General Property 2.530 55,300 141,500 196,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 148
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
Special Assessments Special Charges Delinquent Charges
00
Total 27.00 0.00
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
uman Relations
vio#stafety s Buildings in accord with ILHR 83.05, Wis. Aden. Code
COUNTY
^:,St. Croix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but.
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or LLD. #
dimensioned, north arrow, and location and distance to nearest road. ,k`~__.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R Vl!< ED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Sam Miller GOVT. LOT 1/4 ;T4 12 T 29 N,R 19 E (a) W
PROPERTY OWNER':S MAILING ADDRESS L T BLOCK # SUED N~ME OR CSM #
_I I
Trout Brook Rd. g~ - 2nd-'Addn to Tanne Rid e
CITY, STATE ZIP CODE PHONE NUMBER []CITY all-LACE E TOWN NEAREST ROAD
Hudson Wi. 54016 ( ) Hudson Tanne Lane
[ J New Construction Use [ ] Residential / Number of bedrooms [ J Addition to existing building
j J Replacement (j Public or commercial describe
Code derived daily flow gpd Recommended design loading rate O.5 bed, gpd/ft2 0.6 Vench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate a.I bed, gpd/ft240.1~ trench, gpd/ft2
Recommended infiltration surface elevation(s) - - - - - ft (as referred to site plan benchmark)
Additional design/ site considerations Soil evaluation done for plat approval.
Parent material Flood plain elevation, if applicable It
S = Suitable for system iVENTIONAL MOUND IN- ROUND PRESSURE AT-GRADE SYYST2A IN FILL HOLDING T K
U= Unsuitable fors stem LJ9 S D U 0S D U VS ❑ U S❑ U XS ❑ U 13S 9111
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BauxJay Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tte &
0~1~23 3 -r ! rr, sbk, ~'I~i r s
926 6Yk 4 s, 1 M sio< 4r s .3
Ground 3 /p-/?, 414 s ®~►'I r M CS ok
elev. ft. 3 CZ7 /d `~,2 4 5 m ru-t
Depth to
limiting
factor
>
Remarks:
Boring #
A p,-/ L l r~ 5bK m !Fr cs 1 QA os
-/e 414 s 1 m sk /h t S a.z 0.3
;WKk;
JZ 72/4 4/4 S ru r- M s C3.~ 0,6
Ground /
elev Depth to
limiting
factor
Remarks:
CST Name:-Plea H3rve G. Johnson Phone: 386-4080
Address: p .0. B 91
Signature: Date: Oct. 96 CST Number: 3484
PROPERTY OWNER SOIL DESCRIPTION REPORT Page
PARCEL I.D. # C~l~ Y
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rench
a/o o~/t23 _ L / rn sbK m cs / 6,4 .S
gl ib-36 >La`12s~~ 5;L 1 ),7, Sbg CS - ,Z 0.3
Ground $Z 56 7•Sy~ q /4 5 eh /n S 0. S C),(,,
°Ll~ ft. $3 /3~ W1441 S /h M 62 :61
Depth to
limiting
factor
Remarks:
Boring # L.. 1 th516k /hji~- c5 Q , Q.S
,M14,~y Y.
441 1 /ovk
i1.t•:`v.S:i. .}i~~
B-z 21-q 7 S`fi24 4 SC j rh r M GLJ p,S 104
Ground
elev. g3 °1Z
r 16M, 3 077 1 I
O,Qft.
Depth to
limiting
factor
Remarks:
Boring #
/3A IQY S, L r►, Sb rn- r W Z i0.
g -~Z Y.,4/4- - SL n1 r r Cw
Ground
elev.
ft. 2-135 4/ S nit r ►'h.
/ate
Depth to
limiting
factor
Remarks:
Boring #
• tM•. ~4'Z
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
COi1. 0'70/1/q (1F/071
~Jokona
SCALC
I h qd_ 2P i
cl)
~ I
4i
\1
$s l~ M alek- 2'iP ELF-\j =ion, o( O' /
Aci.JEQ
~N
sr~
s
AS BUILT SANITARY SYSTEM REPORT
OWNER ~ AA i , I t. C ,f
ADDRESS U t t
SUBDIVISION / CSM
SECTION 1 1 LOT
---__T N=R W, Town of .
ST. CROIX COUNTY,
WISCONSIN
PLAN
SHOW EVERYTHING VIEW
' ~N 100 ET OF S EM
{
1 - - A,
y
^~t ~R,> ,
AL'".
A41 E
VIA "T ~oo,oa" sra' ~ D
103,1
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: 1~....f' < -4 'n, I 1
ALTERNATE BM: _t- j C.~ -
l SEPTIC TANK /PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: t_K r P ` Liquid Capacity
Setback from: Well House .3 ,G. Other 0 0
u
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House Other
ELEVATIONS
Building Sewer ST Inlet: 61,77-^c/ ST outlet:10i()7=
PC inlet PC bottom Pump Off '
2 C,
Header/Manifold Bottom of system-,-' N f*d. r~= T?,
Existing Grade-/, Final grade
J ,
zJ
>311_441 c_ I z 5 S
DATE OF INSTALLATION:
PLUMBER ON JOB: w\.,. -0,, t 1 ~ ~ II .~/II.~p.CS
LICENSE NUMBER: N( V4, e*,
INSPECTOR:
3/93:jt
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count
yST . CROIX
Safety and Buildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitalmtll~-:
Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)].
PTV golder'sslame• L*fjb~ jWIlage ❑ Town of: State Plan ID No.:
CST BM Elev.: SAM Insp. BM Elev.: BM Description: Parcel bi2bo-;1326-30-000
AAA _j
TANK INFORMATION ELEVATION DATA A9700186
TYPE MANUFACTURER CAPACITY STATION BS HI 4FS ELEV.
Septic d-tt*j Benchmark o~ 7d Dosing s
Aeration Bldg. Sewer CcT~%~ .
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic 7-a b NA Dt Bottom
Dosing NA Header / Man. r o' e z4 ° ,
310.
Aeration NA Dist. Pipe /~,3a~ • 7
o G.P.
Holding Bot. System qs".,a
PUMP/ SIPHON INFORMATION Final Grade , a p ' ioo s
Manufacturer Demand ja ,f~ -z/ /va y
Model Number GPM
TDH Lift Friction System TDH Ft
hi
Forcemain Length Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS (PD DI MEN 1 N
LEACHING Manufacturer:
SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM
INFORMATION TypeO 11 ~ CHAMBER Model Number:
System.q,2,2,y9~ 5c 5 > OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia- Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only __J_
Depth Over TB pth Over xx Depth Of xx Seeded /Sodded xx Mulched
Bed /Trench Center U ' d /Trench Edges a P Topsoil E] Yes C] No E] Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HUDSON 11.29.19,SE,NW 832 MOON BEAM WEST LOT 66
Plan revision required? ❑ Yes ❑r'No
Use other side for additional information. '7 a
Date I spector's Signature Cert. No-
SBD-6710 (R.3/97)
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
Vistonsin SANITARY PERMIT APPLICATION 201eE.W and shnlgtonAve sion
P.O. Box 7969
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 81/2 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide maybe used by other government agenc programs Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. pr)
State Plan I.D. Number-
MOL / V
1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N
Property Owner Name roperty Location
S/ A` L L0 Q.- 5 e. 114 A/01/4,S I/ T Z q, N, R/ 7 E( W
Property Owner's Mailing Address Lot Number Block Number
P_ 2 -4,
ZQ)f
City, State Zip Code Phone Number Subdivision Name or CSM Number n d
~DsoN W 1 5ya/C. (g )z q N t4 r. D E
11. T PE ILDING: (check one) ❑ State Owned ❑ ityge Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms 3 E] Villa Town OF t,,! OOpN BEAM UA
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 E] Apartment/ Condo 4=> Zen 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 if 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_ ❑ Reconnection of 5. ❑ Repair of an
?-'System System ___________Tank Only ______________Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
1 Seepage Pit 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 stem Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) S•1~, Elevation
I Sa S"G. . l I 2. Feet '71.400 Feet
VII. TANK Capacity gallons Total # of r Prefab. Site Fiber- Exper.
INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete st Co - Steel glass Plastic App
Tanks Tanks ~y
Septic Tank or Holding Tank vo V) E 1-sr (L 9 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
Vlll. 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:
,lG i t =-f LEL o S -a .t 3 IF- Flo
Plumber's Ac dress (Street, City, State, Zip Code):
~7U r~~p ~D v w yam!
IX. COUNTY/ DEPARTMENT USE ONLY
E] Disapproved Sanitary Permit Ese-lincludes Groundwater ate SSUe Issuing Agent Signature (No Stamps)
jA roved Surcharge Fee)
pp ❑ Owner Given Initial ~
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R 11/96) 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 m ust include:
1. 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 Et 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 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.
N*66onsin Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Department of Commerce Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size. 1~7L - cr" o
• See reverse side for instructions for completing this application State Sanitary Permit Number
2 43
The information you provide may be used by other government agency programs E] Check if revision to pre sous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION
Property Owner Name Property Location
/ .E 1/4 &J/4, S T Z? , N, R/ E ( W
Property Owner's Mailing Address Lot Number Block Number
k7 Z e
City, State Zip Code Phone Number Subdivision Name or CSM Number
we,,, c t,c,.,/ f _S%4 (3 % ) z 7 NNE oe / O 6
II. TYPE B ILDING: (check one) ❑ State Owned ❑ it~ Nearest Road
Public 1 or 2 Family Dwelling - No_ of bedroom ❑ Vila Townge OF 1/$0 104nOW&WIll IMe
111. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo
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. ❑ Reconnection of 5. ❑ Repair of an
System --------System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21171 Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12,Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 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,
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft_) (Min./inch) 99:n~; N Elevation,,,o °
tsr ~ r~
q,s 00
ySd SQ e'1 0; -5- q y. so «L..,Feet Feet
VII. TANK Ca pa "I
in alto s Total # of Prefab. Site Fiber- Exper.
NFORMATION 9 Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing strutted
T nks Tanks
Septic Tank or Holding Tank /too / LtJ~ /~F ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
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: (No Stamps MP/MPRSW No.: Business Phone Number:
/k 0 L4 S a~.t'ao 386-82.
Plumber's Ac dress (Street, City, State, Zip Code):
0 7® 4.-'41 40Je/ DGf
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sana ry Permit Fee (Includes Groundwater ate ssue Issuing gent Signet
Approved ❑ Owner Given Initial L,yQ~ Surcharge Fee) G~/3
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R.11/96) 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:
1. 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 E! 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 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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Wisconsin Department Relations Industry, S
Labor rx~Human Relati OIL AND SITE EVALUATION REPORT Page Lof
• a~
6ivision oiSafety Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY O NER: PROPERTY LOCATION
f A la to GOVT. LOT'S L", 114 f~JW 1/4,Sj T"29 N,R I E (or) W
PROPERTY OTWR':MAI IIGADDRESS L9T, BLOCK# BDL\NAh1E 0R ~M # -&v
CI . STATE P CO PHONE NUMBER ❑CITY ❑%LAGE OWN NEAREST ROAD M-001,41394011
New Construction Use Residential / Number of bedrooms 14 &)1o'- [ ] Addition to existing building
j ] Replacement [ Public or commercial describe
Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 6.7 bed, gpd/ft2a .K trench, gpd/ft2
Recommended infiltration surface elevation(s) n ~&r ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT- RADE SY TEM IN FILL HOLDING TANK
U= Unsuitable for s stem ❑ U ❑ S ❑ U WS ❑ U S0U.1 WS ❑ U ❑ S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr&
JDO A&
Ground e} -dl;!~ Ai
6 O,~
elev.
/"4243 ft.
Depth to
limiting
factor
>9 ss8
Remarks:
Boring #
r
Ground
elev.
Oa, ft.
Depth to
limiting
fac r
Remarks:
CST Name e se r* ` tJ Phone:
Address: 106 0 6so )
Signature: ~ Date: ~ /r CST Number:
PROPERTYOWNER '!!~W3 M/LCD SOIL DESCRIPTION REPORT Page of
r ,
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed ranch
$r 1 '37 1 [ S yM fh r t.J Q. Z
Ground 6 a 4 SC„ r"40r- ~r W S ,6
elev. L
ft. )2~ 1 y ? s rh r I 0• 0$
Depth to taC? to
limiting
factor
Remarks:
Boring #
16YR L-,~ 10 12
y- !0 5 ^r M w O.
Ground
fill
elev. S m r A
/(6 •S ft.
Depth to
limiting
factor
7 %00-
rJ ►S ~d££ 5i k~L)La t:
Remarks: j"~L di- R,
Boring # n
E~l 43, 3 ZS /dYre I s b, n ~r - 3
q L,) ®,k
Ground
~-/lr6 yQ r M, 7 X
elev. f
Depth to
limiting
~fac~~
tor
? 1V
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PALE 3 oP 3
f~o~c a
I ~ ADS
LET ~S
aZ
1~E[~m~ s l~ ►M E~ tv~~ tiU i ` g•Z
' Q~mmcNn~d .~JSTEM
T~r►~c v.- wL17T~caxN - 94 .I
E L.~VAT ~ a~Js -
~~G~ss TreE~~~a W6 NJ 114P, I
i
~G~1ti►~Rl~ ~ 2 "n~
Eu -mrow = mb,oa
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT rage t of 4
-Labor an& Human Relations
D4Won of t iSety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
St. Croix
Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but PARCEL I.D.
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
PROPERTY OWNER: PROPERTY LOCATION
Sam Miller GOVT. LOT ff F_ 1/4 54.,J 1/4,S 12 T 2 9 N,R 19 E (or) W
PROPERTY OWNER':S MAILING ADDRESS 4e iLOCK # SUED. NAME OR CS!~4
Trout Brook Rd. 2nd Addn to Tanne Rid e
CITY, STATE ZIP CODE PHONE NUMBER ❑VILLAGE ETOWN NEAREST ROAD
Hudson Wi. 54016 ( ) Hudson Tanne Lane
New Construction Use Residential / Number of bedrooms [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code deed daily flow gpd Recommended design loading rate 0 bed, gpd/ft2 1~. trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate j bed, gpd/ft2()." trench, gpd/ft2
Recommended infiltration surface elevation(s) - - - - - It (as referred to site plan benchmark)
Additional design/ site considerations Soil evaluation done for plat approval.
Parent material Flood plain elevation, if applicable ft
L S = Suitable for system c~IVENTIONAL MOUND IN- ROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING ,T K -7 U= Unsuitable fors stem ® S ❑ U 0 S El
U VS ❑ U %S [I U 20 S❑ U ❑ S rX U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerrft
sty" pn~y_
l 11- A In-1 (S A 16.5
Q o~1R3 3 L
r, sto< Mir
Ground Z6-4-31 16,-14 A-14-
elev. t r /'!'I I p.~ D.~ 8z? S I / v►
os
/D~ft."r'2~ Jd y 4
Depth to
limiting
factor
>
Remarks:
Boring #
A 0.4 r /o~/,e3I3 - CIA:
"h -s
s 4, ~ :O.rj
- S n
~z - 7-sye 4/4
Ground ` S /YI 1
elev . , /b /+Q 4 ~'!j r
f O2. ft.
Depth to
limiting
factor
F-T-1
Remarks:
CST Name-.-Plea ~pnnt Phone: 3 86 - 4 0 8 0
Harve G. Johnson
Address: P1. O . B 91
Signature 9,7 Date: Oct. 96 CST Number: 3484
:
PROPERTY OWNER SOIL DESCRIPTION REPORT Page of
PARCEL I.D. # 66,
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bajxbty Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed iench
1,3-/Q L / rn sbK rh CS
9, ib--3( w/L s/'4 S , L ) r, sbk rn 'Fr CS - ,Z .3
Ground $2 7.S`/~ /4 s /►1 r m/ S 0. S 6,C
9l 3 ft. I3 5 M 62 of
Depth to
limiting
Remarks:
Boring #
A o-~ id`ie L 1 th-s cs I o, o.s
Rxa4
Ground gz V-4 7.SY(Z4/4 r G~ 0•S 0.~
elev. 3 s a^ rn 0 :7
ion ft.
Depth to
limiting
factor
Remarks:
Boring #
w 0-13 /~`/e 3 L 5~ rn r GS 10A
S~
'S, L
Ground g 61~'~2 7. S Y.2 4 _ S L n~ r- r C W O.S 0,
elev.
/w ft
Depth to
limiting
factor
7 z5
Remarks:
Boring #
h
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
PROPERTY OWNER SOIL DESCRIPTION REPORT Page of~
PARCEL I.D.*#LaN"T 6
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Barxiary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw&
'AN
-!2 e Y L 0ia r G / ,4 S
`JC-' rv► b r fa.~
f. 12-44 i6V414
Ground _ y r /h 0.7 3
elev.
eo9-3 ft.
Depth to
limiting
factor
Remarks:
Boring #
0-0
16-4-3 16 YP,414-
AVP-4-1-2 (3 rwir- n, 16.7 :0.
Ground
e~lev~
/Z" . r ft.
Depth to
limiting
f~YrZ
Remarks:
Boring #
A 6-a
jz)Ys0- AA M I r
Ground
faft. 3 rz~ Od`v 5 r n. a .7
Depth to
limiting
factor
~ fafl
Remarks:
Boring #
01
in
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
t'/ZL►~ q ar ~ ~oR~cK
b. 65,
p,- Y
1°k
6I' ~ac~►+R1d-im,
P&nafAM1GNpE~ S%ISTE(h ELf.J
n
3sSvSTEr~ riot ~s' , r s 5 B E.,99.q aua48.o.
2 9
61' -
M ~
29
S T C - loo
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/ contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property s',q
Location of property 5C 1/4 N U-) 1/4, Section I -t , T '2_9 N-R !
Township (-t-,_3j0_.SL-)K Mailing address ae) Y 2-
I- UZ-S®N W , S-'(LnI<.
Address of site '22 Z 1lt4n~ N
Subdivision name T,4 q 911 Y M to c,4 Lot no. (oG
Other homes on property? Yes No
Previous owner of property A4 kA4L L- ZX&,4,k/
Total size of property 'Z . tr 2) 14 c-.
Total size of parcel 2 , S 3 A,-
Date parcel was created % - i 9
Are all corners and lot lines identifiable? V Yes No
Is this property being developed for (spec house) ? .-'k'' Yes No
Volume /0,3/ and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Soy~S~
Sf Applicant Co-Applicant
Date of Signature Date of Signature '
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER t j,1 ti' r 1, c ,
MAILING ADDRESS s Y ry; F..,
PROPERTY ADDRESS c ;1:'<l ?
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION:'- 1/49 ! 1/4, Section T ' N-R_ W ,
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP S S~~ 3S , VOLUME PAGE , LOT NUMBER L.
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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
VWe, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year ex iration date.
r
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, W1 54016 11/93
r~
DOCUMENT NO. I STATE HA F WISC0NS1 ORS[ 1-1961 rN19 ,rAC9 0999MV60 ,ON e9COee1Ne 9AT4
ARR% 0 D
504855-0'l 103iftGE 456
r:'-CJSTw4'S OFRCE
I This Deed' made between ,
Randall W. Synan and Patricia E. Synan,_._..._..• ~eC forCORecvN
.
hu sband ...and ..Wife-• t
Grantor, SEP T 1993
and
.....Sam ......M(1-:er...-a sIngle person ~t c~►~1'0~:4-5 - A.-PA
-4 one&
L a.rh~e,
• Grantee.
Wit~leSSeth, That the said Grantor, f r a valuable consideration......
Randall W. S nan and Patrycia E. S nan
conveys to Grantee the following des cribed real pLte in . St • CroiX aarueN TO
County, State of Wisconsin:
y~
Tax Pued No:
,
" The SE1/4 of NE1/4 of Section 11; the SWi/4 of NW1/4, the N1/2
of SW1/4, and the South 53 rods (874.5 feet) of the SE1/4 of
NW1/4 except the East 74 feet thereof, all in Section 12; all in
Y' Tovnship 29 North, Range 19 West, Tovn of Hudson, St. Croix
County, Wisconsin. FF
a AND ~i
A parcel of land located in part of the NE1/4 of SE1/4 of Section
11, Tovnship 29 North, Range 19 West, Tovn of Hudson, St. Croix
County, Wisconsin further described as follows: Commencing at the
E1/4 corner of said Section 11; thence S89 30100"W, along the
North line of the SE1/4 of said Section, 1212.32 feet to the point
' of :.eginning; thence continuing S89 30100"W, along said North line,
66.00 feet; thence S00 28103"E, 500.00 feet; thence N89 30100"E,
along the North line of Certified Survey Map filed in Vol. "3",
Page 722, 38.08 feet; thence N00 11133"W, 150.00 feet; thence
N03 58134"E, 351.07 feet to the point of beginning.
This ..........1A..ARt.... homestead property.
(ice) (is not)
Together with all and singular the hereditaments and appurtenances tuereunto belonging;
And..... ftnd.4.11..Vf....SY.RaO..and-•Patr.icia..E Synan
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements, restrictions and rights-of-vay of record, if any.
and will warrant and defend the same.
Dated this ................1............................. day of AW.Ust%...................................... , 11..91.
~ll?lrlLl4!!! !~ie.✓ ...........................(SEAL)
...(SEAL)
a~nc~ W A-*u. E'
n
• Randall W. Synan Patricia . Synan
~a
(SEAL) (SEAL)
r• AUTHENTICATION ACKNOWLEDGMEINT
I
Signature(s) STATS OF WISCONSIN i
St. Croix ..........Coaob.
j authenticated this ........day of . 19
-_--.sooa 7 ca =e before me ...C. ........day of
1 i August _ ts.. the above named
. Patr icia-...'..........
ltandallW.- Ay
TITLE: MEMBER STATE BAR OF WISCONSIN Synan
(if not.. Ar . ..!pY LrOAMI'J ;
authorized by 1 706.06. Wis. State.) to ma known to be do person Jq..... AN a ~I