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sconsn Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations Page of -
• "LWslon of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
4'
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
6' 41
Include, but not limited to: vertical and horizontal reference point (BM), direction and 57'
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel i . #
APPLICANT INFORMATION - Please print all Information. viewed by Da e
Personal Information ST CSC
you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). UqP _%1001 X Property Owner ZEeVViS ,aTOAPAJ57,-f,* .4.,,p Property Location
_ iNGO FiCE ':u^
r%o,'f,4'S Ni Q SE.V Govt. Lot EVE 1 /4 SC 1/4, S 2- , f r6
Property Owner's Mailing Address Lot # Block# Subd. Name or
City State Zip Code Phone Number 7/Jr_ Nearest Road
ttupSoA.) kola S4a11'o (3AG)-~z79 ❑city ❑~inoe Gown 1~R
L'J New Construction Use: u Residential / Number of bedrooms 3 - Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
y✓P- N/,e = No7- RECOftM4W u O
Code derived daily flow loOd gpd Recommended design loading rate /`/~e bed, gpd/ft2 ~trench, gpd/1`12
Absorption area required N
1/f bed, ft2 /.200 trench, ft2 Maximum design loading rate M- bed, gpd/ft2 ' S trench, gpd/ft2
Recommended infiltration surface elevation(s) 5-42 PA, (n w • 3 ft (as referred to,'si.4plan benchmark)
Additional design/site cons ions
Parent material SCS \7 flo' / 1 ~ieLiLVO ~lr,/ s~ S08S7Q/t7S Flood plain elevation, if applicable N/~ ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
u unsuitable for system [ ❑ u s ❑ u p s ❑ U 0_1 ❑ u El S p❑ s
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2
Texture Consistence Boundary Roots Bed , Trench
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
s
QA ~9_ /OyR z/z /k, -fe ~s - zl
a -/7 lo Ye 3// /1"-re CS i-F S' ,
Ground 3 1,7-3;1 75 Ye / 5`6e 1;,-6f C ZO / 5-, 6-
elev.
/02,519 ft. _7 7.5 V, e $ /fs~✓.~ ,e acv i Y . S
Depth to
limiting ;
factor
00 In
Remarks:
Boring # /0 Yp- 2/Z /f 56.E /l+~-F,2 S 3~c , y S
U 4~, 2 -W /o e 313 /f'sdC- 11„-6e s 2-F . y ; , S
3 is l ,w,fr es z f , s ; ,
Ground /D 5/ /Li -7
elev. C
l y Sift. J
Depth to
limiting
factor
> yQ ln. Remarks:
CST Name (Please Print) Signature Telephone No.
R 013ER T- -24L(3R i cA7- 7MA i% 71 3 9P6 - 918s
Address Date CST Number
late: 3 76 C5riy Zy PZ
Private Sewage Consu tan s
$55 O'Neil Rd.
-A491
PROPERTY OWNER SOIL DESCRIPTION REPORT ,
Page Z
PARCEL I.D.# LOT HA ~'T'Lhti►D
Boring # Horizon Depth Dominant Color Mottles Texture Structure 2
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots
0-7 10YR Bed Trench
Z f 11. It-V-F 2. s 3-f -3
Ground 3
~o$'elev. on. ~o I,p s s/ / f nti►-F
Depth to
limiting
factor
LLL]
0
Remarks:
Boring #
- -/o icy ye z f ars
3 sl,~ 4-w6e cs 3 f ~l • S
jO' s r~s,6x ~ie ccv Lf y ',S
Ground
elev. L1 ,S
Depth to :'3
limiting
factor
Remarks:
Horizon Depth Dominant Color Mottles Structure
In. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots GPD/
Boring # Gr. sz. Sh.
Bed Trench
~OY~ /f s,6,~ -~,e s 3-F
S 1 - o y / -z --F sbk l-rR cs -f . S . ~
Ground /0 5- r
elev. S v~ f I~'1 l~ y . S
/pS•33 ft.
Depth to
limiting
factor ,
Remarks:
Boring #
Ground
elev.
Depth to
limiting
factor
---In. Remarks:
SBDW-8330 (R. 08/95)
IMPORTANT NOTE TO OWNERS 8, TNSmnT.T_Vv. a,,
~s
5 ~Jo
~No
/a s
130,
AS
~ 61o LoT
~S
T. , of
To P
y .r y~ yob S S
s/00.0
,a
SP
SCALE:
1 = 30
IVA SAC
I-oT S
6teoATION $ LOT to
r►~S~/kll ~ ~U1l( 'u~~L AO cujpus-
~i f, SO T-PeN~.G~t s To SV i'1' co.34vues .
ULBRICHT & ASSOCIATES CO.
655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems
715-386-8185 Private Sewage Consultants
Re: Soil Test Sites, and Siting Your Home.
To Owners/ Developers, Please be aware:
All of the systems for lots #4,5,6,7,8 in Hartland
Subdivision (tested under winter conditions March 11th &
12th, 1996) will require very large TRENCH TYPE conventional
systems because of soil permiability restrictions.Conditions
across other parts of each lot can/ and may require entirely
different on-site treatment systems.
Also, as required by state codes, an equally large
replacement area has to be left intact UNDISTURBED with
proper set-back distances to the well, other structures,
etc. as deemed by code. Less space is required if the owner
were to install a mound type system (i.e. no replacement area
is required for mound type systems).
Please understand, that in the process or procedure of
selecting the actual homesite, if the owner will be using the
soil test areas as provided and recorded by the seller/developer,
the following is very critical:. The installing plumber you
select, or a registered designer or engineer should meticulously
layout and plot the system as indicated from the soil report..
And an equally large replacement area should be plotted out.
Further information to be supplied by the owner is necessary
in order to determine the actual exact size of the system.
The final size of the system is dependent upon,the gals. of
wasteflow to be generated from the proposed size of the home.
The County Zoning Dept. must review the owners final house-
plans; only then can the installing plumber determine the
final size of the proposed system.
All of this has to be carefully addressed before a
builder and owner can safely choose one's precise homesite.
Often times the original soil test.area, provided for
subdivision approval by the seller as required by County
Zoning Dept. ordinances, is not in an area prefered by the
eventual buyer, or perhaps the size of the buyers home may
require a -larger test area. New or additional testing may
be required, since a septic system by law has to be laid out
exactly within the recorded spot tested; it cannot be shifted
out of the area recorded with the zoning dept.
Finally, it is our recommendation (and of most
consciencous installers) that when soil permiability on
a site is very slow (.5GPD/ft2 or lower) to install a
presurized, dosed mound-type system. It is the concensus
of most officals that mound systems will generally outlast
in-ground conventional system (average life 10-15 years).
This is a very important option to cautiously consider.
Remember, the two most important systems you will be depending
upon for many many years to come is your well and the quality
of Vn17Y core i n cvo4-c-
✓1
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ! ,A- UOT-
ADDRESS 13,PA7VgQoAJ ' glV,'
A~6-50"Q w c. SSYo i'~ I
SUBDIVISION / CSM#ZLrhytn LOT #
SECTION T :?9 N-R_?OW, Town ofdSa^/
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
GJd ST j0? rH
~Qo~~PT'Y ORoQE~Prr
A iNLF
J~it/t~s E~
y JK
-e
I moo, ~o~~ 3
WELI.
cN M~~K - Qvui3Gt /OO' a
S , {~s i N OAK -rff C
R
~~SOR 3v3~1 LSFfalravT L....r
loco (rtz 6virscYr S~iT~c 'j`.tur~
rsc H 1/0
SdiuE'IQ i N~ n
sau-rH Y~PUildr~'+'/ 'Zi'"~ QQ,},vOo.,1
Id RM/~
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
aBENCHMARK: `ras 4"LEV, /OCR, oo '
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: WiZ.SeR Liquid Capacity: /Owo 16.fa,.
Setback from: Well O House /'7' Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length 9!5' Number of trenches -2
Distance & Direction to nearest prop. line: ~~-7-Al
Setback from: well: /dd' House 1/4' Other
ELEVATIONS
Building Sewer 9~•~ ST Inlet: 9~ ~3 ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold 'F.. O Bottom of system 7 3. 34
Existing Grade 991 Final grade 30
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: IS' g-
INSPECTOR:
3/93:jt
K
Wiscclnsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 284204
Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.:
FAUST, KEVIN HUDSON
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA ;27
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
r
Benchmark S! p2{ fG~, Od
Septic Gc~J < ~ra Cr , . , .
osi Z,/ -5
Aeration Bldg. Sewer
Ho St / Inlet 91 TANK SETBACK INFORMATION St /~tf Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic 0 17 A NA Dt Bottom
/
Dosi NA Headers J~~S
i
Aeration Dist. Pipe
i
Holding Bot. System 93,53
PUMP/ SIPHON INFORMATION Final Grade
Demand
" I
h~~ 8 : cv 9~, ~r '
Manufacturer
1
Model Nu GPM
TDH Lift S stem TDH Ft
Force Tength Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches No. Of Liquid Depth
DIMENSIONS S 7 DIMEN
G Manufacturer:
SETBACK SYSTEM TO P/L BLDG WELL LAKE/ST M
INFORMATION Typeo ✓a4,o- e-- i CHAMBER Model
System: `V0 51, 41~o OR UNIT
DISTRIBUTION SYSTEM
Hole 5 it Intake
Header / Distribution Pipe(s) x Hole Size x
e,
maxge4d Length Dia. Length A_ Dia. ___y Spacing _j~~
SOIL COVER x Pressure Systems Only xx Mound Or At-Gra ystems
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center -3 Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HUDSON.12.29.20W, NE, SE, BRANDON` DRIVE
Gam` ~ ~ ~ i 1 ~ ~ t,~~~.•:' ~ ~ ...A4
tclp
Plan revision required? ❑ Yes 4o 49 1
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: • ,
SANITARY PERMIT APPLICATION COUNTY
70ILHR In accord with ILHR 83.05, Wis. Adm. Code
-.e.,.,.a....,..~
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑
8% X 11 inches in size. Check if revision to pr sous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
k v N uST A1,15' '/45c '/4, S a T ?41, N, R o?o E (or,601D
PROPERTY OWNER'S MAILING ADDRESS LOT # 41 BLOCK #
p 1 VJ001Al b!r►VE
CITY, STATE ZIP CODE PHONE NUMBER SUBDIV~IS,ION NAME OR CSM NUMBER
psa"i w 0410/~ 14-Ar l'AV10
11. TYPE OF BUILDING: (Check one) El State Owned D VC ILLTYA NEAREST ROAD
GE fi/6[O5~1 ~P ~p~ QiP~u~
❑ Public1 or 2 Fam. Dwellingof bedrooms 3 PAR EL TAX NUM ER( )
III. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/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 in line A. Check line B if applicable)
A) 1. 0 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 # - 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 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 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) ELEVATION
-1lSO ~Sasa fr. r750 sq.r. - (v ~&-?'7" Feet 9P- ~O Feet
VII. TANK CAPACITY Site
in gallons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank 0.100 000 6c) / f f
Lift Pump Tank/Si hon Chamber I FT, 1:1 E] 1:1 1 0 11
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber' ign ure: MP/MPRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code
Aj 60,
IX. COUNTY/DEPARTMENT USE ONLY
X I ❑ Disapproved Sanitigy Permit Fee (Includes Groundwater ate ssue uing Agent Signature (No Stamps) r
Approved E] Owner Given initial 4 T Surcharge Fee) r)/J- Adverse Determination QQa.,u
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly PIb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
R
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the 1: ne o renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by [he permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Rerevw.al Form (SEQ 6390) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be p,umpe 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 & 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 cumber(s) of
where the system is to be installed.
II. Type of building being served. heck only one and complete of bedrooms if 1 or, 2 +=amily Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacernent, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all informalion requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total callor 3, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, purnp/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 approp!1ite 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% x 11 inches must be subrnittEd to ti,e county. The
plans must include the following: A) plot plan, drawn to scale or with romplele dirnenskr)m- Vocation of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; ~,,ater rna.in!! water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems *,ep arement system
areas; and the location of the building served; B) hc,rizontai and vertical elevifior ref-rencE points;
C) complete specifications for pumps and controls; (Jose volume; elevation d1e-arce:;; fric;rion loss, pump
performance curve: pump model and pump manufacturer; D) cross section ,:4 rhea so^l abso-:Rion system if
required by the county; E) soil test data on a 115 form; and F) all sizing irlforma ion.
GROUNDWATER SURCHARGE
1933 4aAiL.d,c>r~ +in Act 410 included the creation of surcharges (fees) for a number c i
regulated practices which can effect groundwater.
The monies collc,cted through these surcharge.s are aed for Grnr;nitrring dre~und~<<;"er, gro.md
I.
water contarnination investigations and establishment of standards.
SBD-6398 (R.11/88)
.PLB 57~"~ Bi PLOT & CROSS SECTION PLANS
ZAPPA BROS. EXCAVATING INC
- k Ala PW.MBING UNIT
~t°4t
PROJECT
'A Die/
oil*
~~nJffi g ~y ~ NEc.~ TLA)eol S
Q 3
l~ENc 11r~l! ~a~a gcaSoirE IN Dnr ZArr
T~£~ : E<E~ _ ~aa. oc' Y3 / Gov . D
3034PJ4~FFU~crrr (.,vim Y' 'o Pa-rT
~ ~ ~„>ttL
/GOO ~oit[ _5r pvC I A16
~/GuK /
Y
N
NO
~Q/4tilOp~l SCALE
I~'JVf
FRESH AIR INLET AND OBSERVATION PIPE
APPROVED VENT CAP
MAXIMUM 12' ABOVE FINAL GRADE MAXIMUM OF 42' ABOVE 40 4' CAST IRON VENT PIPE
PIPE TO FINAL GRADE
SIGNED. p s
MARSH HAY OR SYNTHETIC COVERING LICENSE:
MINIMUM 2' AGGREGATE DATE:
OVER PIPE
DISTRIBUTION PIPE
TEE SOIL STING BV-
ELEVATION BED
d' AGGREGATE •
BOTTOM PER SOIL BENEATH PIPE • PERFORATED PIPE BELOW
TEST 18
COUPLING TERMINATING
93•x7' F. AT BOTTOM OFSYSTEM
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Wiscbnsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page __L_ of
Labor and Human Relations
Div►sibn of 8Afety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. 14
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION WED n E
?10/4 Y
PROPERTY OWNER: PROPERTY LOCATION
GOVT. LOT /4 1/4 or) W
PP,0PERTY OWNE S MAILING ADDRESS LO A# BLOCK # SUB NAME R
Cg4STATE ZIP CODE PHONE NUMBER ❑CITY ❑VIL~AGE OWN NEAR 1
/JU &Sol) ICJ i S4a / ( ) d Sc~ ~i
(QC~ New Construction Use ( /f Residential / Number of bedrooms Addition to existing building
j J Replacement { ] Public or commercial describe
Code derived daily flow gpd Recommended design loading rate ; bed, gpd/ft2d , ~ trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate ~_bed, gpd/ft2 0.6 trench, gpd/ft2
Recommended infiltration surface elevation(s) It (as referred to site plan benchmark)
Additional design / site considerations
Parent material Flood plain elevation, if applicable It
S = Suitable for system ~~QQNVENTIONAL M~gLIND IN-GROUND PRESSURE T-GRADE RYYWS STEM IN FILL HOLDING TANK
U= Unsuitable fors stem EcJ S❑ U flyS❑ U NS ❑ U WS ❑ U ❑ U ❑ S U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Cu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
3 A ®-6 vR3 Z L /hc~ r C5 / 646,S-
16-1-7 /ovv, s-/4 - S L I sbK A 4'c s o.1- o.3
Ground OVA i S; rib s6 M r s j>, 2 Q:3
elev c~
tOf. ft. qS 90 0`1►2 4 4
Depth to d 9Q 7.5 ye 4 3 s t~ r°f'► r m O. S p .
limiting
factor
Remarks:
Boring #
FA Ili idy 3 Z L m c r C 2m 10,41
iD~ ~ layRs~4 5 n ni ~ I ~ 0• Zd.3
$ 6 X6210, 4A vrj-wrsb n -F, s - O.`Z a,3
t9- A
Ground
elev. 9 /by P_ 4 4 S /h s D. O b
/Ci• I ft.
Depth to
limiting
factor
Remarks:
CST Name:-Please Print Phone: _'~R& Anz~
Address: 1 6AS6-D W f
~qC~ I
Signature: Date: 4 9 9(/- CST Number:~4
PROPERTY OWNER I L~ SOIL DESCRIPTION REPORT Page of
PARCEL I.D. # '
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bwxlary Roots GPD/ft
In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed tench
Yoe-
9-l9 1 ypes- 4 s, c /A'sb>` rn s o.z o.3
Ground $ 9-S-3 e- 4
elev. ft $3 3-9/ 16y 4M S i t 5 ~.6
Depth to
limiting
factor
Remarks:
Boring #
Q Mc:r L~ 2/y 0.4 ` .S
Ground /d ye K - L m 5 b r! Al ~r s D. 2 Q R
elev. i2 2 24 s n, 0 .S" O.6
6 .4 / ZZ It
Depth to
limiting
factor
i ~'/D f7
Remarks:
Boring #
0-9 16"Ilplz L r~ C r rh r c5 2 a .q o.~
A
t 4.2 0.-3
13
Ground 16YR4 L6 sit 5LY rn~r 5 a .Z`0.3
IevZ It a r rh d,S 6.6
Depth to
limiting
(TtZ7
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNERBUYER~'~
MAILING ADDRESS 0(l\
PROPERTY ADDRESS 1-7-e 6r--Ao^ Dr-,,
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE FIu05o(0 H\f V-) iSLDNS V)J
PROPERTY LOCATION QE, 1/4, S ,E. 1/4, Section Z T 29 N-R 2y W
TOWN OF H u OSo0 ST. CROIX COUNTY, WI
SUBDIVISION Hc.,- ~LIAA LOT NUMBER H
CERTIFIEDSURVEY MAP Rr, ,o~~~~ , VOLUME Z , PAGE ~O W , LOT NUMBER Ll
('torcr. 19aG
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 maintain ust e c and returned to the St. Croix
County Zoning Officer within 30 days of the three n date.
SIGNED: L -47 IL02
DATE: Iyc ~(v
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 41~"' M L 4115
Locationofproperty IBC 1/4 5E 1/4, Section I"L T 21 N-R 20 W
Township HuD'~ON Mailing address h i I
MrJ Ssi2"~K
Address of site LIZ g t~ `br,\3- Hasson, IL-sy-t c,3S, E" o subdivision name tjoA1&A6k Lot no.
Other homes on property? Yes No
Previous owner of property ga t N APO DEWCL4 PIS Et►f
Total size of property I , L-i 3 ,-e-P--ES
Total size of parcel 12, bo ORES
Date parcel was created OCAA-6. Al' 1996
Are all corners and lot lines identifiable? v✓ Yes No
Is this property being developed for (spec house)? Yes =No
Volume and Page Number 3010 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 ff C of the County Register of Deeds as Document No.
Si 4n u e of Applicant Co'--Applicant
,c
Date of Signature Date of Sigha'ture
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State Bar of Wisconsin Form 2 - 1982
WARRANTY DEED
DOCUMENT NO.
B & N Land Development, a Wisconsin Limited
Liabtltty-Company,
conveys and warrants to Kevin M. Faust and Michelle L. _
Faust, husband and wife,
THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN ADDRESS
the following described real estate in S1•- Croix
County, State of Wisconsin:
(Parcel Identification Number)
Lot 4, Plat of Hartland in Town of Hudson, St. Croix County, Wisconsin.
I
I
This is not homestead property.
(is not)
Exception to warranties: Easements, restrictions and rights-of-way of record, if any.
Dated this / Sr day of April 19 96
B & N Land Development, a Wisconsin Limited LiabilZ,"-
(SEAL) any
BY' Y(SEAL)
Dennis M. ornstad Thomas K.Nielsen
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Dennis M. Bjornstad, STATE OF WISCONSIN
TI_ - v a- , 1 c.
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5'1w;I State Bar of Wisconsin Form 2 - 1982
WARRANTY DEED
` f DOCUtAENT NO.
- 1170m ~331- 'C.. C'
B & N Land Developments a Wisconsin Limited APR a 1996 II
-ltabilitp-Company, 8:00 A.V
conveys and warrants to
Faust, hasband and wife
n
r
II I t1PW5 SPACE RESERVED FOR RECORDING DATA
/D
- - f %ANE AND RETURN ADDRESS
- '0
the following described real estate in St Crai x - I
County, state of Wisconsin:
i I
~i tparcel Identification Number)
i r
I I
Lot 4, Plat of Hartland in Town of Hudson, St. Croix County, Wisconsin.
'i•
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TRA S ER
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II
r This 13 not
homestead property. II
X)= (is not)
I 1
Exception to warranties: Easements, restrictions and rights-of-way of record, if any. ii
~i II
I I t r 96
day of --11 - - 19--.
- '
Dated this
B & N Lard Development, a Wisconsin Limited Liability ny
I '
BY: (SEAL) (SEAL) I
• Dennis M. ornstad Tham s; K.Nielsen
(SEAL) (SEAL) ii
i
I
AUTHENTICATION ACKNOWLEDGMENT
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I
Signature(s) Dennis M. Bjornstad, STATE OF WISCONSIN
1homas K. Nielsen County.
authenticated this (*lt day of April peryo.aly cause before me this day of
19-- the above named
Kristina kland
TITLE: MEMBER STATE BAR OF WISCONSIN " '
(If no(.
authori.,ed by §706.06, Wis. Stats.) to me known so be the person who executed the
foregoing iusarsinser It and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY