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VVisconsin Department of Industry, SOIL AND SITE EV A VATI ON REPORT Pagel of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
rPARCEL Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but LD. #
not limited to vertical and horizontal reference point (BM), direction and % of slope, scawltr or
dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
PROPERTY OWNER: S 1f vp O VIRW ATION
E t /4 N~ 1/4,S 2 T 29 NR /,f E (a) W
PROPERTY OWNER':S MAILING ADDRESS / yyi8 /~ipu£~P ~~ty) CK / SUED. NAME OR CSM #
336 ~.xoB~TS ST C ~►UMRi R17 Hills (K ASF.2-
CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE N NEAREST ROAD
G IYA1. 35 /0 ((/ri) i22--5S55 +f u V-50tj /
New Construction Use [ kiesidential I Number of bedrooms ` 3 Addition to existing build'uhg
[ ] Replacement [ ] Public or commercial describe
Code derived daffy flow y~ao 91~d Recommended design loading rate s bed, gpo19 , trench, gpd/ft2
Absorption area required S~ bed, 03~1~ trench, ft2 Maximum design loading rate t S bed, gpdfit2 , o trench, 2 .
Recommended infiltration surface elevation(s) 5-~ • 3 it (as referred to site plan benchmark)
sl ' s&17A- ,s /E -cok liov v v TYA-C
Additional design I site considerations 7--fS T
Parent material 5255 Rood plain elevation, if appfibable It
'su RE I ~4
S = Suitable for system CONV MOUND IN-GR"D PRE
A❑T S DE a S N FLl Q SN4 TAM( -Tw U =Unsuitable ftN Stem ❑ S go ❑ U ❑ S 0 _-1
SOIL DESCRIPTION REPORT
Depth Dominant Color . Mottles Structure Roots MGPD/ftz,
Boring # Horizon in. Texture Gr. Sz. Sh. ~
d3Y Munsell Qu. Sz. Cont. Cola'
2 f 57,E aft 0- oyle 2-/2-- 7:51 cs f Ground 3 Z2 /t
slay. ft T, / I- • S'
/0,/t . 4 - o 7-5 ,e
Depth to
limiting
faclor
Sd
SSS . .
Remarks:
Boring # W7;7,2- ~ Sbr Mt 117 1,)m 74X 7c--
L?/ 16YX 31411
13 c ~3 P~ s// '2'* 1h, 7""f a 5 , 5-
Ground 3P
elev. 5 f%e y
/oo, w it. .
Depth to
limiting
factor
. l~
• 1 •
PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z ot3
PARCEL I.D. t
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bogy Roots GMT
in. Munsell Qu. „Cot color Gr. Sz. Sh. Bed iench
o-/Z zfsbk
2 /1 - /DYE
Ground 3 31 1,2,/e .6
elev.
~9,iv ft. 3 y-S /o L"? y/ Y10-
d -fe " cs • s . ~
Depth to s y 707- Y,~ , 7
Smiting I2
, y ~ ~ ,S'.
factor, Y/ BfJ~~ Sb~C nv f °e-
S.ss ~
Remarks: ,SA 7U/~it1~ Zo-J f1o7`~~7~ ~i9•yl~ .
Boring #
Ground
:.v.
elev.
ft.
Depth to
limiting i
factor
I
3
Remarks:
Boring #
Ground
elev. ~
ft.
Depth to
;
limiting
factor
Remarks:
Boring #
i
I
Ground
alav i
r
r a Z~ n, belor the dow~slope dp d b
the ~ e
sill ONON0111dimi
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116,
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00
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2.27 ACRE N.n ~':"i 0~0 C
98,- 7,40 SO T^O~
a J~ ~ ~ fist-.~.~ ;r
s~i9 • ~~-Y ~ , . a~ `ash ~ 5~ ~GC `
'099'
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80.:00 1
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS ; /r~~ 5'c- ✓ l
SUBDIVISION / CSM#_ LOT #
SECTION _7 7 T ;2 N-R /f W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
j t,U
G -
y ~
L
J r, /
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
1
BENCHMARK : G _5 S
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: 1~ Liquid Capacity:/,*c.11~
Setback from: Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length 5 Number of trenches 2
Distance & Direction to nearest prop. line:
Setback from: well: S-G House e f- Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: %Q/ 11Z y~
PLUMBER ON JOB: lam.. ,~,,y2~=
LICENSE NUMBER: INSPECTOR: T
3/93:jt
• Wisconsin Department of Industry,
Labor and Human Relations PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary 68661
Permit Holder's Name: ❑ Uty ❑ N Ilage Town of: State Plan ID No.:
WEISS RANDY ~j 1DJg0
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA A9600366 /a/-?/ y~
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 19 ✓&XS-1eey Cry r
CU Q Benchmark /co co
Dosi n /4 /l
Aeration Bldg. Sewer
H o I d i g St/ lnlet S. ' 35
TANK SETBACK INFORMATION St/W( Outlet S(a ads'
TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet -
Septic I
Septic NA Dt Bottom
Dosinq_ - NA Header/ Man.
Aeration A Dist. Pipe '
M11 117"
Holding Bot. System 2•1~ ~ 10s24r'
PUMP/ SIPHON INFORMATION Final Grade
Man rer Demand 7 I Zz' ~6 /9
Model Number GPM
EForce Li L ct ion Ft
main I I Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width I Lengt 7 No. Of Trenches IT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS S DIMEN I
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEA u acturer:
SETBACK
INFORMATION Type O CH R
System: +L-,rt'CL5 > 5- 1 yZS7 CD 74-- UNIT Moe Num er.
DISTRIBUTION SYSTEM
Header Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length __l L Dia. Length ~ Dia. Y Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx u
Bed/ Trench Center Bed/ Trench Edges TopsoA-' E] Yes 11 No ❑ Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HU~Dl1SON..2n7~..2C~99.19W, NW,, NE, LOT 45/,l HILL FAR)vI ROAD
~~L,L.?y1 ttylQiy! ~ V~''~~'/~~'~7 ` .A,LE'~,~,~ ~1,n,! t_~ i t ' J' . 'T ` / *,.T,•~~'"`. f `,!`,~~,/(i
Plan revision required? ❑ Yes No
Use other side for additional information.
1,3/ 190
SBD-6710 (R 05/91) Date Inspector's Signatu a Cert. No
ADDITIONAL COMMENTS AND SKETCH '
SANITARY PERMIT NUMBER:
r^~i~il,S~'n SANITARY PERMIT APPLICATION BureaSafetyu o oand ff BuiluildinWater Systems
ng Water 201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size. cele • See reverse side for instructions for completing this application State Sanitary Permit Number
o?O r66
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 INFORMATION
Property Owner Name Property Location
e .5Sy114 - 1/4, 5 T ;Zq , N, R / y E (ore
Property Ow is Mailing Address Lot Number Block Number
e- e. e, ill S-7- 3'
City, State Zip Code Phone Number Subdivision Name or CSM Number
I1. TYPE OF BUILDING: (check one) ❑ State Owned ❑ CitlIyy Ne r sa QC~
❑ Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Towann OF / M
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 0 i cl - /20'j/ - b 0
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. pl 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 &d Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1~SF ~3' fo e
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System E19y. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 31 Elevation
- 3-76 7 Feeti 1jjj%Wr Feet
VII. TANK Ca
in gallons Total # of P Site Fiber- INFORMATION Gallons Tanks Manufacturer's Name Concraete Con- Steel glass Plastic APpr.
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank /dd ( , ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber f ` r 2- ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No Stamps) /MPRSW No.: Business Phone Number:
W S" y d
Plumber's Address (Street, City, State Zi Co e):
,
le?ej _1506 IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sa itary Permit Fee (Includes Groundwater Date Issue Issuing A nt Sign ore (No amp
Approved ❑ Owner Given Initial Surcharge F ee)
/~f~ jP-51,?a Adverse Determination ~ (o ~,i~~--
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 015/94) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Divrion, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe 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, 608-266-3815-
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 isto 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-,of 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 carr
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
ffa ,'nom 17 11s'.5//
Y'z ZJ le ago-
p2
t
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pp-
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor aru:• Human Relations
Oivision of Safety 8 Buildings in accord with ILHR 83.0 5, Wde
49 COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in si I must i44cludeSt. Croix
not limited to vertical and horizontal reference point (BM), direction an slot stile o PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road fC'tl 020-1304-00
APPLICANT INFORMATION-PLEASE PRINT ALL INFORM 6 N ~Ir ((FEVIEWEDBY DATE
ea S" t ~d i
PROPERTY OWNER: PROREfiZY4.99ATION
Randy Weiss GOVT04Ty 1/4,S 27T 29 N,R 19 Mor) W
PROPERTY OWNER':S MAILING ADDRESS 'LOT-# 'BtU K # =S (J: NAME OR CSM #
323 Locust St.1'1 ,_..,..,M- ~v umbird Hills
CITY, STATE ZIP CODE PHONE NUMBER [31ZI. VIL rE OWN NEAREST ROAD
Hudson, WI. 54016 1715)386-].053 Hu son Oriole Rd.
[:I New Construction Use [x J Residential /Number of bedrooms 3 [ J Addition to existing building
I J Replacement [ J Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 .8 trench, gpd/ft2
Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 .8 trench, gpd/112
Recommended infiltration surface elevation(s) 105.3' & 103.5'trench ft (as referred to site plan benchmark)
Additional design / site considerations alt. area from soil evaluation of 5-3-96
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ®S ❑ U ES ❑ U ® S ❑ U )OS ❑ U ®S ❑ U ❑ S au
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxnlary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
1 0-9 10yr3/2 none 1 2msbk mfr cs 2f .5 .6.
':_._.1_..... 2 9-27 10yr5/4 none sil 2msbk mfr gw if .5 .6
Ground 3 27-44 10yr5/4 none sil lcsbk mfr 9w na .2 .3
107e15' ft 4 44-84 7.5ry4/6 none ms Osg ml na na .7 .8
.
Depth to
limiting
Qr4
fact
Rey„arks: -
Boring #
1 0-9 10yr2/2 none 1 2msbk mfr gw 2f .5 .6
2 2 9-38 10yr5/4 none sil lcsbk mfr gw if .2 .3
3 38-84 7.5yr4/6 none ms Osg ml na na .7 .8
Ground
109eV3 ft.
Depth to
limiting
factor
+84" ILL __j
Remarks:
CST Name:-Please Print Gary L. Steel Phone: 715-246-6200
Address: 1554 0th. Ave., New Richmond, WI. 54017
Signature: Date: CST Number:
ILL- 9-11-96 cstm 02298
PROPERTY OWNER Randy Weiss SOIL DESCRIPTION REPORT Page ?of-2--_
PARCEL I.D. # 020-1304-00
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
1 0-9 10yr2/2 none 1 2msbk mfr C1w 2f .5 .6
2 9-39 10yr5/4 none sil lfsbk mfr if .2 .3
3 139-90 7.5yr4/6 none ms Osg ml a na .7 .8
Ground
elev.
109.3 ft.
Depth to
limiting
factor
+90"
Remarks:
Boring #
ti
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Randy Weiss 1554 200th Ave.
CSTM2298 NWQNE4 S27-T29N-R19W New Richmond, WI 54017
MPRSW 3254 town of Hudson (715) 246-6200
lot #45-Humbird Hills
N
1"=40'
BM.= top of row survey stake C el. 100,
alt. site from soul evaluation of 5-3-96
drainage system el. 961.00 = 9.71 as el. of borings
1v
~o
ti
)6Ia
'-set Sy~Er~
115
J
n~ C9
Gary L. Steel
9-11-96 4
O 1
' LOT 37
LOT 44 2.69 ACRES
/ 2.27 ACRES t ' 116,990 SO. FT.
PONDING 98,742 $0. FT. t
~ I
7
Eby EASEMENT ~ J } ~ !
FF ry + ► t N9V43•59'w 413.39'
EL. •961 1 .
IER
LOT 45
/ 2,27 ACRES
/99.740 S0. FT. ~O a 6
ft-
O•p . / AO~ iys
/ - ~9 0 O SJ • Llli .
a~
t
S37°10'14"W ~P os h '
\ 60.00' ~V
S52°49'46
66.00'
FARM /
Each parcel shown on this map (pia
and Township laws, rules and requl
lot Bile, access to parcel, etc.).
developing any parcel contact the
and appropriate Town Board for adv
UTfLiTY EASENEIi~•S
No pole or buried cables are to be
installation would disturb any sur,
along any lot line or street line.
The disturbance of a survey .take 1
Section 236.32 of Wisconsin Statute
herein set forth are for the use of
SHEET I OF 3 SHEETS public utilities haling the right
V A
268.38' _ 9
7 o
~ O
L
4.
20
tiS~ s ~ \
2 <,q a
a `sS/o 509• Gy PONDIN
FT.
3~,, \ \ EASEMENT
LOT 43
2.34 ACRES ~°j
oh 101,995 SQ. FT. /
co II
LOT 44 1
2.27 ACRES ►
• 1
PONDING 98,742 SQ. FT. ►
oEASEMENT
i
O h F~ = ~sr - a 1 ►
/9
s
LOT 45
/ 2.27 ACRES
/98, 740 SQ. FT.
\ a tis2 ~P.
V9
9
9`S'F ro0 9~'F ~00~0 0~9•
Q
~ `~S7v, / ~ O 3
\ S37°10'14"W
\ 80.00' ~
S52°49'46"E' _
66.00'
FAc111
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER R" 1+LL D. W E 1 SS 39 ~N D ~6g;ccA W r--l SS
MAILING ADDRESS 323 LoWLL Si th .yy-y► , too 2ol,b
PROPERTY ADDRESS '751) H- is FARM iZD
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE RIAW M . W I
PROPERTY LOCATION NW 1/4, N( 1/4, Section 1 T Zq N-R__A q _W
TOWN OF "D.S-OA/ ST. CROIX COUNTY, WI
SUBDIVISION pf"M$ )121 A- "Ls LOT NUMBER
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 I/-~ ` ~o
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
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 rw'NDOnL t). LVI;ISe , JR 14 iiD R 6&-CCP A. WEISS
Location of property_PLW/ 1/4 t4E 1/4, Section 21 ,T Z'I N-R 19 W
Township 1+(AD--okj Mailing address -75q 14-lLl. FRRM 9-0
Z 39-3 lneu-&-~ tutf►' qce bu)ft
Address f site
subdivision name Rumbird N-i Its Lot no. 4S
Other homes on property? Yes_X_No
Previous owner of property "nOYL .
Total size of property 137$ SQ,
Total size of parcel 'A - All
Date parcel was created 1013
Are all corners and lot lines identifiable? _-Yes No
Is this property being developed for (spec house) ? Yes No
Volume 11014 and Page Number 5(o,2 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. y80-79 , 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.
SySo~q
Signature of Applic nt Co-Applicant
S'-N-U g-j4--qb
Date of Signature Date of Signature
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SrACE RESERVED roR RECORDING DATA
54 80 ryA WARRANTY DEED
f J REGISTER'S OFFlC
T. CROIX
This Deed made between ROCaId~
Rec'dfor
_Hunbi,rd-"Land-_6 rporation, a Minnesota Corporation
A
UG 12 1996
- Grantor,
.Randall D. Weiss, Jr and Rebecca A. Weiss,-' -
and
hu
at 1:00
sba nd a n d _ wi fe ,
. . m
4) Grantee, •a°il'o~ae+wua
Witnesseth, That the said Grantor, for a valuable consideration......
- - -
5t CrO1 X RETURN TO `
conveys to Grantee the following described real estate in ._.._.r....__...........
County, State of Wisconsin:
Lot 45, Humbird Hills Second Addition, -
Town of Hudson, St. Croix County, Wisconsin Tax Parcel No:
This -----.iSnot homestead property.
-Xiii 6s' not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And----- - -
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
Easements, restrictions and rights-of-way of record, if any
and will warrant and defend the same.
Dated this 2nd
day of -----..August. 6
-------------------------------(SEAL) HUMBLRD-LAND--CORPORATION--.... -..-------.(SEAL)
Austin J. Bail~on, Its President
(SEAL) ................(SEAL)
r ` -
AUTHENTICATION ACKNOWLEDGMENT
r : Signature(s) STATE OF OQ 101O(DQSK M I NNES9TA
ss.
Ramsey Count f
y'
authenticated this ........day of 19...... Personally came before me this 2n...--d -....--.day of
August t 19._96. the above named
Austin J. Bai 11 on Presi dent of
Humbi rd__Land_ CorRQfatl_Rn
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by 1 706.06, Wis. Stats.)
to me known to be the personn
foregoing instrument and ack w the~2~> A. BA' N
THIS INSTRUMENT WAS DRAFTED BY NOTARY PUBLIC MI ESOTA
Land ~A•.`
Humki.cd= ' tNGTON
OarRaratinn- PA C
*Paul A. Bai 11Q.r) . k n.
Ja 1,2000
Notary PubliWashin$... to X
fi_
Public
■
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.)
date : anuary.31..9...................... xazA00)
•Namm of persons sfruing in any cepaelty should be typed or printed below their sianatures.
WARRANTY DEED STATE 9AR OF WISCONSIN Wise-in Leyti IIlaok Ca. I.e. '
FORM No. 1-1982 Altimn,,I,.~ wt.
RT
SOIL AND SITE EVALUATIO PO 1
Wisconsin Department of Industry, .K ~ Page of 3
Labor apd Human Relations
i Division of Safety & Buildings in accord with ILHR 83.05/#6!.
4 COUNTY
St. Croix
Attach complete site plan on paper not less than 81/2 x 11 inches in si ,ain muRl,dq ,but` CEL I.D. #
not limited to vertical and horizontal reference point (BM), direction an x; slope; wafer- I ~ -®p
dimensioned, north arrow, and location and distance to nearest road. i IEWED BY DATE
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMA
RO }
PROPERTY OWNER: ION 1l4,S 27 T 29 N,R 19 Fir) W
Rand Weiss NAME OR CSM #
PROPERTY OWNER':S MAILING ADDRESS ` s Humb i rd Hills
400 S. second St. - -,.4
CITY, STATE ZIP CODE PHONE NUMBER CITY VILLAGE MOWN NEAREST Role Rd.
Hudson, WI. 54016 (711 386-3700 Hudson
Addition to existing building
F ruction Use [ ~ Residential / Number of bedrooms 3 [ ]
nt Public or commercial descriaily flow 450 gpd • 7 bed pd$ • -8 trench, gpd/ft2
Recommended design loading rate , 9
2 563 .7 ban be nc/ft2 .8 trench, gpd/ft2
Absorption area required 643 bed, ft 9tr ~h,, ft2 Maximum design ft (asgefeeed to site plan
Recommended infiltration surface elevation(s)
Additional design / site considerations na na ft
Parent material outwash Flood plain elevation, if applicable
S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE TSYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem C7 S ❑ U as ❑ U EIS ❑ U ® S ❑ U ®S ❑ U ❑ S I RU
SOIL DESCRIPTION REPORT
GPD/ft
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Bed Trench # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
2msbk mf r
1 0-8 10 r3 3 none i
2 8-20 10 r4/4 none sicl lcsbk mfr w if .2 .3
Ground 3 20-8 10 r4 4 none cos os ml na na .7 .8
elev.
99.98ft.
Depth to
limiting
factor
+84"
Remarks:
Boring # 2msbk mfr w 2 f • 6
1 0-13 10yr3/3 none 1
2 13-22 10 r4/4 none sicl lcsbk mfr w if .2 .3
3 22-48 7.5 r4 4 none is os
Ground
elev. 4 8-84 7.5 r4/6 none cos os ml na na .7 .8
100.58 ft.
Depth to
limiting
factor
+84"
Remarks:
Phone:
715-246-6200
L. Steel
FAddress: me: PleasQPPrint
m02298
200th Ave- , New Richmond, WI. 54017 CST Number:
re: Date: 5-3-96
PROPEWYOWNER_ Randy Weiss SOIL DESCRIPTION REPORT
Page ? df 3
PARCEL I.D. # C ?-0 ^ 13 0-f-00 Lot #45 .t
Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Bourxiary Roots
~~t::=.>h Bed Trench
3 1 0-14 10 r2 2 none 1
`2 14-29 10 r4 4 none
a l2cmssbk k mrnfr
sicl 2msbk mfr w
Ground 3 29-39 10 r4 4 none sl
elev. n
fr
cfw 99.98 ft' 4 39-80 10 r4/4 none
cos os ml na na .7 .8
Depth to
limiting
factor
+80"
Remarks:
Boring #
1 -6 10 r2 2 none
4
fit: G:4
*r 2 -26 10 r4 4 none
:~<~`i} sic 1 mfr 1 c s bk w if . 2 .3
Ground 3 6-30 7.5yr4/6 nons sl mvfr 2m r
w w .6
elev.
99.78 4 0-84 7.5 r4 6 none
ft. cos os ml na na . 7 . 8
Depth to
limiting
factor
+8411
Remarks:
Boring #
Y / '
.5 .6
ff7.5 r2 2 none 2msbk mfr w 2f
yr4/4 none '
sic 1 I f s bk mfr w i f . 2` , 3
Ground r4 6 none cos os ml
na na . 7 .8
)9.28 v. ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
:<.:<. 1 -16 10 r2/2 none 1 2msbk mfr w 2f
.5 .6
e 6
2 6-30 10yr4/4 none
sIfsbk mfr w if .2 .3
3 0-90 7.5yr4/6 none cos os ml
Ground na na .7 .8
elev.
X1.18 ft.
Depth to
limiting
factor
+90"
Remarks:
SBD-8330(8.05/92)
t '
STEEL'S SOIL SERVICE
Gary L. Steel Randy Weiss 1554 200th Ave.
CSTM2298 NW4NE S27-T29N-R19W New Richmond, WI 54017
MPRSW 3254 town of Hudson (715) 246-6200
t lot #45-Humbird HIlls
N
1"=40'
BM.= top of SW lot stake C el. 100,
~X
l08
1
A:7 j
tow
sz ~
100('4
Gary L. Steel
5-3-96
2 9 7 LO
~ \0 to i00
\ah rn 4.64
201,c
INI
h ~ 9 96
tG to \SSio 2SS°9• 4 PONDIN
S>' 'B'\ EASEMENT \
FT. 6 ,NW43' 55
F
2SS ro
LOT 43
2.34 ACRES cow / ►
o0) 101,995 SQ. FT. II
co ~0 1 1
LOT 44 1
2.27 ACRES 1 ►
PONDING 98,742 SO. FT 1
i '
EASEMENT
o I 11 /
.O ~ ss
O
(75
LOT 45
/ 2.27 ACRES
98,740 SQ. FT.
90 \ / y9 /
~60' i Fq ~~29 X00'0
0O
C:o
S 37° 10►14►► W
80.00'
S52°49 46
66.00'
FAR"A