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Parcel 020-1306-10-000 02/09/2005 04:36 PM
PAGE IOF1
Alt. Parcel 27.29.19.1523 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
*
DANIEL D & LISA M KEMPER KEMPER, DANIEL D & LISA M
1 ~ lA
738 ORIOLE LA I~ 'f
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 738 ORIOLE LN
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 3.830 Plat: 2122-HUMBIRD HILLS 3RD ADDITION
SEC 27 T29N R19W PT NE SE LOT 46 HUMBIRD Block/Condo Bldg: LOT 46
HILLS 3RD ADDITION
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
27-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/02/2002 675172 1865/364 WD
11/17/1997 568616 1277/166 QC
07/23/1997 1152/295 WD
2004 SUMMARY Bill Fair Market Value: Assessed with:
49560 288,500
Valuations: Last Changed: 10/29/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.830 52,600 170,600 223,200 NO
Totals for 2004:
General Property 3.830 52,600 170,600 223,200
Woodland 0.000 0 0
Totals for 2003:
General Property 3.830 52,600 170,600 223,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 305
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
Special Assessments Special Charges Delinquent Charges
Total 27.00 0.00 0.00
ST. CROIX COUNTY ZONING DEPARTMENTf ti
AS BUILT SANITARY REPORT ~
Owner b i 4_4 J-
Address 111 u + S _ c 140IN"
h
City/State 1.4, r l t E o.l'v-r„
1 /
`
Legal Description:
Lot Block Subdivision/CSM #
1/4",'/4Sf , Sec. 2,2_, T N-IO W. Town of .j t dt 4, nt PIN # ,
SEPTIC TANK - DOSE CHAMBER. HC?LDINO TANI{ INFORMATION:
III
Tank manufacturer M# d w c; t" Size ST/PC Setback from. House 1 '1 Well 04/4- P/L
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.: s G Width . 12. Length y j Number of Trenches
Setback from.: House Y Well P/L Vent to fresh air intake
ELEVATIONS:
Description of benchmark r I xt. Elevation
Description of alternate bench m. ark Elevation
Building Sewer . qj, ST/HT Inlet . ST Outlet _ PC Inlet
PC Bottom HeaderiN4anifold , Top of ST/PC Manhole Cover
Distribution Lines
Bottom of System ( ) S ( ) _ ( )
Final Grade
Date of installation %ff2 Permit inkier State plan number
Plumber's signature License number A ate
Inspector
complew p10x plan
f 1
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 LJ
A
t ~
i
t
L _ o- J
INDICATE NORTH ARROW
1Nisconsin.Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and-Buildings Division INSPECTION REPORT 51C~rO(X
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)]. Nq 13 Z
Permit Holder's Name: ❑ City ❑ Village N Town of: State Plan ID No.:
CA161 kl M 4D qv
CST BM Elev.: Ins . BM Elev.: BM Description: , S Parcel Tax No.:
avrt~ as CS
(oo l acs ("I.S'w wIe OZo -130& -/o -000
TANK INFORMATION ELEVATION DATA X'F7 00el-l
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
eptic[rl,L[vie- + re_caSfi 0c) D 1 Benchmark
Dosing
Aeration Bldg. Sewer (D •o7 97 3b~
Holding (049~ Inlet G•z9 9 -7•/(.TANK SETBACK INFORMATION Q, Outlet S?P 9&. 647/
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
eptic vt (a b ` (Z' NA Dt Bottom
Dosing NA Header/ Man. •9~ 9Cv S/
Aeration -NA Dist. Pipe ?6-31
Holding Bot. System ~Ob gS-V q PUMP/ SIPHON INFORMATION Final Grade ~,-R S/9
Manufacturer Demand Si- erg I y 9?
Model er GPM At+ _ar
TDH L Friction System TDH
Forcemain Length Dia. Fi Dist. To Well
SOIL ABSORPTION SYSTEM
BE TRENCH Width l Length r No. Of Trenches PIT No. Of Pits Inside Dia. Liqui Depth
DIMENSIONS S DIMENSIONS
LEACHI ufacturer:
SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM
CHAMBE umber:
INFORMATION Type O7
System~i i, I Co LIZ-" ~l A OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Asir Intake
Length V Dia. q Length SO Dia. _~L Spacing rOr A gr WL S -H . 7 -7 Z
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth O xx Depth Of /Sodded xx Mulched
Bed /Trench Center Bed / Trench Edges _ ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepanciers, persons present, etc.) 7~78 C7 r'r.>(e ~a vzL
Zi h~ ~1~0✓ G~~i✓~ I h -~ke `idtva Is c tea, S~ (~~~c (ve~fua
4-& R,w t5 v4i1vx-IVU e, xCauit
?v`ovlG~ U,
otivUt i ~~o ~JLi f c t~'1.
t 4 k2-l 1~( a
Plan revision required? ❑ Yes ® No
l ~
Use other side for additional information. POW Cp/
SBD-6710 (R.3/97) Date Inspector's ignature
ADDITIONAL COMMENTS AND SKETCH r
SANITARY PERMIT NUMBER: Z G1
O
D we i
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Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 E. Washington Ave.
1,iscons►n In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
,partment of Commerce Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County n ,
than 8 1/2 x 11 inches in size. 5~- • ~I1
• See reverse side for instructions for completing this application State Sanitary Permit Number
a99~~
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION
Pro rtrImLr nerNa e~~f ICI 4ertyE Location
J 1/4, $ a T , N, R` 9 `(or~W
Prl perty lipg Ad i, Lott Number Block Number - L4 ('0 1
City, stale t Zip Coe Phone Number S b ivisio Namg or C M Number
in 3,? CL
II. TYPE BUILDING: (check one) ❑ State Owned E] City Nearest Rgad
❑ Village
on OF ~l 15r )61 Lane,
Public 1 or 2 Family Dwelling - No. of bedrooms - Tw
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 Apartment/ Condo d ~ U s s o 4
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 p Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1- ca New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. Repair of an
-----System ____--__System_____________TankOnly______________ 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 JE3 Seepage Bed 21 ❑ 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
I Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min./inch) EI v ion
`I (p4 „(p 1u `1 J Feet Feet,
otal # of Prefab. Site Fiber- Exper.
Cap HExistin VII. TANK in T
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New strutted
Tanks Septic Tank or Holding Tank X two I n1 I-err~ ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility r install 'on of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum s Signatu e: Stamps) r P/MPRSW No.: Business Phone Number:
ae mP a tot, I -X15.-~g8J~~1~~
Plumber's Ac dress (Street, State, Zip e):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Ag nt Si nature (No S
Approved Surcharge Fee) h
❑ Owner Given Initial f~~O
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: .
SOD-8398 (R.11/96) DISTRIBUTION: Original to county. 0 ne 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.
11. 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 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 of Industry, SOIL AND SITE EVALUATION REPORT P \ of 3
Labor and Human Relations -
Division of Safety Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
` Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but Ste[ GItz1
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 ne O 7,0 - 1 3 (0 . {
APPLICANT INFORMATION-PLEASE PRINT LIQ1', REVIEWED BY DATE
PROPERTY OWNER: =_TY LOCATION
C_2MCC' p~EIVEO M;:Z 1/4 SF 114,S-C) T Zq N,R tq E( W
PROPERTY OWNER':S MAILING ADDRESS tp LOT'„ BLOCK # SUED. NAME OR CSM #
111 e v~2cH s~-• 199"
141, - ~klMe,cD Ybuz 3
CITY, STATE ZIP CODE NE NUM@RRCROIX ❑ - VILLAGE [@TOWN NEAREST ROAD
WO~~VL~.L~ wI Sy.u2.$ ) 698 1~SOly oQlOl.~ LF\lJl~.
~Q New Construction Use Residential / Nu ~p rooms [ j Addifign to existing building
j j Replacement [ j Public or commerci i
Code derived daily flow q S o gpd Recommended design loading rate 1 bed, gpd/0`d trench, gpd/ft2
Absorption area required bq 3 bed, ft2 S 6 3 trench, ft2 Maximum design loading rate bed, gpd/ft2 • B trench, gpd/ft2
Recommended infiltration surface elevation(s) of S . S ft (as referred to site plan benchmark)
Additional design / site considerations 1-V X Ste)' C_Oki V~1'MLK4 _ t Lb _ CSTIE 1JCS S cyv -VNf6t
Parent material S f-\Vv\--34 o\.)" / 31r\ Flood plain elevation, if applicable M, A- ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem 12 S❑ U RS ❑ U DOS ❑ U LK S❑ U [a S❑ U ❑ S EIU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxxiary Roots GPD/ft
In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rer>ch
"11Z - l Z i 9h Y~i v~"- CS - - S
a` l 0 -8 10 2 2
1r_ K Z l9 `i I~ 3 l 3 s t Z.`F s W, LS , S .
Ground 3 19-U2 1-Still )IV S st+ o S~ y„> > 8
elev. - 8
019 ft. 1-11..98 LO `1 R y16 S O ~ ~ ~
Depth to
limiting
factor y
-798
Remarks:
Boring # ,
t :„Y ) ~-8 t0`tR Z t i Z `F~~. hn v'FF S , s
Z.•> Z 8-iS_ log-►ti 3)3 - sib Z`~ S~k Yn'~~r CS . S _ l
3 1S -3g S "I 31 - S G>, 5 c►,, ,
Ground
elev. L(- 3p_9Z )oyR y/6 - S CAS M
94.0 ft.
Depth to
limiting
factor
Remarks:
CST Name.--Please Print Phone'
Arthur L. We erer 715-425-0165
44
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: -Zq Dtite: CST Number:
~9 ~j'7 M00576
PROPERTYOWNER ~1,t312~Si}'I-SON SOIL DESCRIPTION REPORT Page -Z of
PARCEL I.D. # O Z O- 1'0'56-/0
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
oil in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
2 g-39 n-i m JC3 s1 \ 2 ~Sb~ E as - • 5 . L
Ground 3 39-bo 1-Sy ft 3lY s d 6~, O s Yvl 1 (`.I,J •-i
elev.
WL0ft, 4 bq_IL 10 M y/` - 9
Depth to
limiting '
factor i
Remarks:
Boring #
0-9 10`-1~Z,CL L Z~°~~ mv'FI~ C S
S'•L
3 s2~o '1•S`18-3/y Se16~, Os9 w► cw .1 .3
Ground
elev. o_ tts M\m 4A - S ~ S9 vh •1 . g
1"'a ft.
i
Depth to
limiting
factor
? l 1$'
Remarks:
Boring #
D~8 l0`'1 R ZL2 1, Z`~ 91, ~rav`F1r e'-g - .S
h
S Z $-~y S VL 3fy - S4 Gv 13 S9 f+1~ S '1
Ground
elev.
CO.3 ft.
Depth to -
limiting
factor i
7y,
i
Remarks:.
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PLOT PLAN Page 3 of 3
SCALE 1"= 3p '
WR- ZO PtiUV1p~ V'fr ue"T Zp' Td
S ~bpFs ~cc~s of ~i'l~ .
F I
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(715 ) 4 2.5_n i p s M00576
CST Signature Date Signed Telephone No. CST #
Wwonsin Departamt of Industry, SOIL AND SITE EVALUATION REPORT Page \ of 3
Labor and Human Relations
Division oY Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S'1" C.U
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
- i
dimensioned, north arrow, and location and distance to nearest road. O Z.0 - 1 3 (0
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
C Z M 6 1'f QRt6ttTZ ON 6A1FP.+= NF 1/4 S F 1/4,S 0 T Zcj N,R lq E( W
PROPERTY OWNER'.S MAILING ADDRESS LOT BLOCK # SUBD. NAME OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE MOWN NEAREST ROAD
Woo~v~~~~ bv1 Sy,uZ$ ('7ls) 69B• 2~6g `t~v~sorv o~.to~~. ~.RN~c.
[xj New Construction Use [xJ Residential / Number of bedrooms [ ] Addikn to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily-flow 'l S o gpd Recommended design loading rate 1 bed, gpd/ft2 - trench, gpd/1`12
Absorption area required bq 3 bed, ft2 S 63 trench, ft2 Maximum design loading rate bed, gpd/ft2 • b trench, gpd/ft2
Recommended infiltration surface elevation(s) q S - S ft (as referred to site plan benchmark)
Additional design / site considerations 1 Z Y_ S'_f ' C0►J I~C~J'tl Ly'(, ] CD - tr STE y3y'es cy j
Parent material S ~ I C) T J'I-~ S y\ Flood plain elevation, if applicable M- A- ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem 19S ❑U NS ❑U RIS ❑U OS ❑U [MS ❑U ❑S I)U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Corp Color Texture Gr. Sz. Sh. Consistence Barxiary Roots Bed nelch
Z $-l9 1D `!2 3/3 St 2`FS~~ Yn`F1 ~S • S
Ground 3 19 -QZ 1 S '-f fZ 31 y - S r~ s o S't
elev.
°19 --I ft. 1-11-93 1O'1 R- ~1 S 0 yn - - 8
Depth to
limiting
factor y
7 98
Remarks:
Boring #
) o -8 ! O `-t 1Z z 1 Z ~ Z `F ~ ~ `m U ~F ~ S . S • ~
Z-< Z-~S_ ►o`tti 3)3 - sib Z`F s~k m~h CS . S . L
3 ~S -3$ S `iR 31 - S ~ G►~ u S ~ >Y> ~ C4v '1 ' ~
Ground
elev. Cf 3P _9Z !~`tR y/6 S CAS w►~ _ ,1
99.0 ft.
Depth to
limiting
factor
? 9 Z"
Remarks:
CST Name.---Please Print Phone-
Arthur L. We erer 715-425-0165
Address: Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Sgnature: _ZC) Date: CST Number:
tiYL~~--19-°V7 M00576
r •
PROPERTY OWNER- 9~-%JXL6Cfi'1-SON SOIL DESCRIPTION REPORT Page _Z of
PARCEL I.D. # O ZO - 11036-1C)
De th Dominant
Borin # Horizon p Color Mottles Texture Structure GPD/ft g in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots
Bed Trench
3 0-$ )o L.Iz rnv~ cS 4S
.6
2 g-39 n IIZ J13 _ s1 2 Fsb1~ bn 1- as - S . L
Ground 3 39-bo 1•SyR 3ly
elev.
IoZ.O ft. %4 b0 _1L 10 `'1 R YA - S CJ S 9 M I -'1 •g
Depth to
limiting
factor i
I
i
Remarks:
Boring #
o-R 1o-i \zZLL - L Z~~~. rn~`FH CS - •S
13 Z -S2 lIj3 Si) ~-TA~~ v►~`~h ~S - .5~.~
3 s2~o ~•SYR-3/y SFcs~1 o s0~ M'i cw .
Ground
elev. -io_its LO`1R,+•L/(. - S ~S9 ~1~
1ot•S ft.
Depth to f
limiting I
factor
i
Remarks:
Boring #
1 b- t 10-1 1Z Z L L Z J w, V T~r` S - . s , O
S'` Z. $_Zy "~.SHR 3Jy 1 Sd G~. t~ s9 yh l ~S '1 i
Ground 3 Zy,~o to 1Z-y16 S O S9 ~ ~ ~ ; •8
elev. '
Q').3 ft. {
i
Depth to I
limiting f
factor
}
7 O4
Li I
Remarks: _
'Boring #
j
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PLOT PLAN page 3 of
SCALE 1"= 30 '
V V% ~ v i41 1Y►P z ,l i~t 1 ~1 `T?;t~ S
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER ro Q I ~r t ah ~Sc~
C
MAILING ADDRESS I, Church
PROPERTY ADDRESS / 3 C 10
L `r (location of of septic system) Please obtain from the Planning Dept.
CITY/STATE ~CI ~ t 'I k e, w a
PROPERTY LOCATION 1 JC- 1/4, L 1/4, Section T aQ N-R t CW
TOWN OF 1ll G15 al ST. CROIX COUNTY, WI
SUBDIVISION O u.mb rcl I15 ~ LOT NUMBER q~O
CERTIFIED SURVEY MAP VOLUME --,,PAGE , LOT NUMBER
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.
I/We, 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 expiration date.
SIGNED:
DATE: 0 8 q
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
04/25/97 FRf 10:17 FAX 715 386 4686 ST CRX CO ZONING Z002
0TC- 100
This application fora 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.
1 b r i_
Owner of property rC~i 4,,!s-&n
Location of 7roperty NE 1/4 5r 1/4, Section J7 ,`i' ag H-RI y w
Township f1UG~5L~r1 Mailing address OILLre-k
Address of sits ? 3 k' l?
Subdivision name FT 111 S ~ ~ Lot no . 14 b
Other homes on property? Yeses-No
Previous owner of property
S
Total size of property 3 :y 4 0 e-
Total size of parcel 3 a G
Date parcel was created
Are all corners and lot lines identifiable? -A-1 Yes No
Is this property being developed for (spec house) ? -Yes K No
volume 115 2 and page Number ~2?5- 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 ny (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. rh and that I (we) presently . L2.2 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.
S~3!7
A Co-Applicant
Signatu of Appli nt
Date of Sig tune Date of signature
QOCU10FfJT NO. STATE BAR OF WrscoNQ1Y //0 v
WARRANTY >Fn T - IMS,l s..ca RE![RYro Fee RCCORDINO DAM
537177 ~ - I ~ F~-G SitR'g o
1 C Q i
This v~ • 1 JzPAt":' 2J J ST CROIJ( (r~I
Deed, r,r-d, hetwee„ . Humb i rd- Land Corp&rri aier j R ,c d f O~ ~ !
A Mir:nesota Corporation • I or
F@COfd
a
DEC 6 1995
Grastur;
and Craig W. A]brightson - I
Fjt 1C: 15 A
i~
'•n
li _ ~awtee, J
I I ,
Witnesseth, That the said Grantor for a ralaable C.Ote s'.eia. I o r5I0fOfQ Jg
i
ii °nT'` "a to 17rnntce the following described real estate is St. Cre- f pO- IN
U
RETV RN TO
t'.untS. State of Wisconsin: i
Lot 46, Humbird Hills Third Addition,
Town of Hudson, St. Croix Caunty, Wisconsin
I!
Tax Parcel No:
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n
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This -.--15-nOt-..._. homestead
(ia) (is not) Property.
II Together with all and singular the hereditament and appeartrwatiftcm thereunto belonging;
And..Humbird Land-Corporation
«':u roof , that the title is good, indefeasible in fee simple asd free as.J
clear of encumhra m es except
Easements, restrictions, and Rights-of-Way of record, if any
I
i
I
~I and will warrant and defend the same.
hated this 28th.. day of November
95
I~ Humbird Land Corporation 18
i~
Ij (SEAL) Sy;
I
• Austin J. (SEAL)
aillon, Its President
_ (SF.AL)
I
I (SEAL)
I
i _
AUTHENTICATION
ACKNOWLEDGMENT
4~RnatTrre(s)
STATE OR IiY4(Qld(N]!M
NINNESC -A
i - ss.
authenticated this day of-.......... - - CoaRty.
i
1 ftsiraa11y came before the this 28th..... day of
-160vamber - 19.E--- the atop named
Austim _Bai-l-1.on,- President... ot...............
TITLE: MEMBER STATE BAR OF WISCONSIN 1kn butt-Ujxd.• .C9rp9r.ati-un..-_
(if trot, -
authorized by 4 7Q6. P" - -
I Mine, in to be the perion ltr,,~u,~^^'~''tf"~'~.v•
T!"s rNSTRumENr wes DRAFTED BY mlrlt and trc~CSOw1nd~'~f a L
Humbird Land Co p -r r ation
o. _ _ r, T F
T
. C.ClJt+
Pitt A. y C
- - - - ~ .n. 31 •1
I ....Aitivlela.~n:Mr.M~yyyK
9 i~natures may its W s
y be nrthent:,sted or acknowledged. Both is Permanent. (f not,'
t,' stateountyration MN
(ore not necessary.) 'RR+„}Rww is permanent. (If sot, state expiration
aster - January-31
u .x,02000.)
II •N.m....r ..r.-__ - _
Wisconsin Department of Industry. SOIL AND SITE EVALUATION REPORT Pagel of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY
ST. c~o~ X
Attach complete site plan on paper not less than 81/2 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
L % 0 A.' - GtiA/~t°.N ~Y ~ 1 /4 SF 1/4,S Z7 T 29 N,R /f E (or) W
PROPERTY OWNER: RG OCATION +j U V) so
PROPERTY OWNERS MAILING ADDRESS ~yi8 f~ip uf~P OCK # SUBO. NAME OR CSM #
331ST ) }{UMRi p/7 H IA-5 3
LN ,
PHUN S 22 R5SS5 I~ GE 96W-N N~ ES` ROAD
CITY, STATE CODE
T AfvG /f1N 55`
New Construction Use ( k"esidential I Number of bedrooms ' °'P 3 Addition to existing building
I Replacement ( I Public or Commercial describe
Code derived daily flow Leo gpd Recommended design loading rate / bed, gpolft` ` trench, gib
Absorption area required bed, 11:2 trench, 112 Maximum design loading rate bed, gpd/ftz trench, gpd19
Recommended infiltration surface elevation(s) _5500- • 3 ft (as referred to site p"l ~n bencitrrark)
~rvST ZrSE . G G~VI-R. /G AOiv A°Tc~
Additional design I site considerations i E " ~ 3 - y
Parent material ✓cC5 - 130 f Flood plain elevation, if appli6able It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSUREJ AT-GRADE SYSTEM IN ML HOLDING TANK
U= Unsuitable fors stem O S O U [IS O U [IS O U [IS O U ❑ S O U O S O U
SOIL DESCRIPTION REPORT
Boring # Depth Dominant Color Mottles Texture Structure Consistence Bourd3y Roots GPRt
Horizon D
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed 13 / 0- io Yie ,3/Z S/ 2- f . S z 100 is y "Ow 511 /~S//~ A." f R
cs ~ f y- S
Ground .3 'a .
elev.
Ida ft. .14Z
Depth to
limiting i
factor le
Remarks:
p
Boring # E)-
/CP /Q Y4 3/Z L JP5
Z 4 --13 /o Yee y/y 3 3 -3G 715 yle y cG
Ground (~G
elev. /0 v S/~ C', S.
.
20 ft.
Depth to
limiting
factor
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w
PROPERTY OWNER SOIL DESCRIPTION REPORT Page L of 3
PARCELI.D.! VH RIleD 4I l~s
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft
in. Munsell Qu. Sz. Cor t Color Gr. Sz. Sh. Bed TWnch
'5 2-f s be f R s t , S . 6
z a - io yR
Ground 3 /S - 3 7S R y/lam l c ,P ~,e S
,Do Ire rt. 9v /0 Ye Sly ~s d,s . S'
Depth to
limiting
factor
Remarks:
Boring #
0-~G 1610f 2-f 546,e * -F R
es . s
Ground
elev.
/oO, 2- ft.
Depth to
limiting
~
factor
Remarks:
Boring # 0-// ~D S~
::vivi::.•i •h.
Ground 3 7•✓- ye " .7 14
97- ello• It -2-90 /o rP . s~ S. D S aQ .Q - ` ~
i
Depth to }
limiting
fac
Lf~-
Remarks:
Boring #
Ground `
alav i
L
LIN
~~.l m ~ t/~ ~C la N . G
rm0 ~ fi m
o ~ •Q ti
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N
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