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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS
SUBDIVISION / CSMJ_
LOT
G;
SECTION T v2Cl c~ N-R W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIER
SHOW EVER THING WITHIN 100 FEET OF SYSTEM
o/a
yak S ~
W~
A
1
I
INDICATE tdOPTH I+RRO~'
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole (-over.
Y
r
BENCHMARK: 5,0- hn- V_ ex- $
ALTERNATE BM: fj
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity:
Setback from: Well O House Id ` Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length 3'Qr Number of trenches J'
Distance & Direction to nearest prop. line:
Setback from: well: _~^D House ?S~ 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:
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:)L
Wisconlf Department of Industry, PRIVATE SEWAGE SYSTEM County:
LaboY and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings. Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION
p Jkl.ENN i N%4 ❑ City ❑ Village IR Town of: State Plan ID No.:
CST BM Elev.: 1U Insp. BM Elev.: BM Description: Parcel Tax No.: Hiid-grin 46c) /(Jo A9
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark p ~u doo ,
Dosing~61~~-
Aeration Bldg. Sewer
Inlet X0,5 9v.'~y'
Holding St/ IM L
TANK SETBACK INFORMATION St/ FFX Outlet
Verit
TANK TO P / L WELL BLDG. Airito ntake ROAD Dt Inlet
Ai
Septic ' b 3 ' yU ' ~aJ NA Dt Bottom
I1_32- •Oz
Dosing NA Header/Man. 'a.36 q3 98
11. L7 qq.P'_
Aeration NA Dist. Pipe v 'If q %-I
v. 3 (6 9(, It 9
1,~! ' 3'1 4 3 -
Bot. System 13,35 `?11
Holding 3 81.04
PUMP/ SIPHON INFORMATION Final Grade 4 3 gg:
Manufacturer Demand
Model Number GPM
I Loss Friction System TDH Ft
TDH Lift
Fie
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 0 DIMENSIONS
LEACHING Manufacturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
INFORMATION Type O CHAMBER Model Number:
System:AZPLC 5 C, * S }as 1,A 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
Depth Over Depth Over ~ i / xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges LI Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Hudson.27.29.19W, SE, NE, L~qt 44, Oriele Road )J, 72 0
L! II „ /
I w't t
,J-
t - /v,15-
; r =
Plan revision required? ❑ Yes 12( No / Use other side for additional information. (P y CQ /1 :1Zc - J~J~t~ 14,
SBD-6710 (R 05/91) Date pspector's Signature Cert No
SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY A C~O/'
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ a a 3 3 ~
8% X 11 inches in size. Check if revision to evious 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
Orj 5,!~ % N r_%, S 2-71 T 4, N, R 1 `F E (o W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
2 3 3 'tom.
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
~un(31IQ17 I'~I5
uOSo~ ~JI. ~ot~ ILINP) (171
II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD
❑ State Owned 0'V AGE '
❑ Public LJ 1 or 2 Fam. Dwelling- # of bedrooms ~ PARCEL TAX NUMBER(S)
111. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
20 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. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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 Ell Seepage Trench 22 ❑ In-Ground 420 Pit Privy
13 ❑ Seepage Pit Pressure , 43 ❑ Vault Privy
14 ❑ System-In-Fill 3 't R ~,u Gl.(S N - S X .S D
VI. ABSORPTION SYSTEM ]INFORMATION:
1. GALLONS PER DAY 12. 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) S. p ` E)b
& 75-0 71-0 Feet • O Feet
VII. TANK CAPACITY Site
in allons 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 Holding Tank 1200 12-00 /~l~fl~ES7" 2 1 El 1:1
~IF.S r ~O
Lift Pump Tank/Si hon Chamber 1 El
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/MPPRi6"o.: Business Phone Number: )3,P6 - 3
Plumber's Address (Street, City, State, Zip Code):
Serb •tf 9P. ffVPso,,) cv s . S 4 o c 4
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanpry Permit Fee (Includes Groundwater Date Issued Issuing A nt Sig ture (No m
~f/Surcharge Fee) /
Approved ❑ Owner Given Initial /~r6 L1
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(R.08/93) 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 the 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 & 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.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
111. 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 replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system,type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/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% 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, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
ULBRICHT & ASSOCIATES CO.
,655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems
715-386-8185 Private Sewage Consultants
PROJECT INDEX
DILHR Plan I.D. # A/ Date
Owner T0l9 ~ivNES Phone 3 F(~
Address !2 33 1 FI vOSo"D t4-) S • 5L/O 1 (.o
Legal Description Ld l -ft 11v,4/13i1?D /6115
Se P E i7 -T' ~q R 19 to
Town of tf U DSO••, County S'j' • c p-o &
C . S . T . i ct - C S 2q Q'L Installer
~,trl S tiN ~4.1~E2
Local Authority/ Supervi si on !ST- , C P X ZQ 6 6
PROJECT DESCRIPTION
,vim ' CD,v S 770 VC 7-1? . ~ - • `~v
o ~ . Cv O a ~Q ~ p~ ~cJ r1-s T~~/o r-c~ .
oco
Pg.l PLOT PLAN VIEWS
Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS w
#450095
Any use of this POWTS design ty any licensed plumber, or any
related unlicensed parties or persons (excavaters, laborers)
shall not be construed as an assumption of responsibility by
the designer for the workmanship, construction, placement,
substitution or selection of any components not specified, or
any assumptions by the plumber that any unspecified components ,
are state approved or proper, or the effects of poor judgement
if working under adverse damaging weather conditions (wet/frozen
soils) by any such parties or persons.
ivy
s
\ C76-
VA WIN
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All
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Fresh Air Inlets And Observation Pipe
Approved Veal Cap
n rr Minimum 12' Above
_ 111 Final Grade
T~P~ ~tl C f f -~1~ ~ ~
~0 Cost Iran
. 3& ~ Above Pip. -vent "e'
• ,to Final Grade
i
1\ tynlhollc CoverMa
Min. 2' Aggregate
Over Pipe
Distribution - Tee
P1pe 0 0 a0
q (o 1 Aggregate b Perlbreled Pipe Below
Beneath Pipe -Coupling Terminating At
Bottom Of s.rslew
~ 5yo
3 Fresh Air Inlets And Observation Pipe
\J\ ~«---Approved Vent Cap
Minimum 12' Above
11 Final Grade
rl rJ l5 h~ D ~rR~4-f~ E-
_ TRE0c tr1 F70 '
"Above Pipe _ 4* Cost Iron
'to Final Grade Vent "t
'
$ynihellc Covering
Min. 20 Aggregate
V Over Pipe
010ribullon - Tee
Pipe 0 0 0 0 0
~i Aggregate
o Perlbraled Pipe Below
Beneath l 0 -Coupling Terminating At
' s y$ TC c I~U. ~l~iN1.Ar 4dM
Bottom Of S.yelam
o 13.0
Fresh Air Inlets And Observation Pipe
\ Approved Vent Cap
Minimum 120 Above
G I~/ Final Grade fi~~s. ~E~ yiP~O~
TR EAJ c H- 1 D
- g' Cast Iron
v 3 G 'Above Pipe Vent Pipe'
J to Final Grade
Synthetic Covering
Min. 2" A ggregale
Over Pipe
Distribution _ - Tee
pipe 0 0 0 0 0
aC Aggregate o Perforoled Pipe Below
V Beneath Pipe 0 --Coupling Terminating At
/;vitidM Bottom of system
9/• o '
4
ENa a,~ T a 0,P/ 67%,&64-G. OP AO-2 T-
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page l of Z-
Labor'and Human Relations
Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
)c
ST Ctzo
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 PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
-ro R E + C A"~ FS GOVT. LOT 5, 6:- NP_ 1/4,S z1 T 2-f N,R OF E (o (W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [.~{~WN NEAREST ROAD
[-fuPS dam' `4-~ 540/(0 (firs) 3 P6- It77 h~uDSoa ~kl`~•
[ t)'C:lew Construction Use [ Residential / Number of bedrooms Addition to existing building
[ ) Replacement [ ) Public or commercial describe
Code derived daily flow (000 god Recommended design loading rate bed, gpd/ft2 trench, gpdtft2
Absorption area required IV4- bed, ft2 73~-O trench, ft2 Maximum design loading rate bed, gpd/ft2 ' 00 trench, gpd1ft2
Recommended infiltration surface elevation(s) S-eA- Pca . -2 ft (as referred to site plan benchmark)p
Additional design /site considerations uS1 T le cOcis S OAS S 10 hm - w d'~ "D (20 (P o A- 'D t s T .
Parent material Sef Co Co - (3 U e-K k k eD T_ Flood plain elevation, if applicable 41,4'" ft
S =Suitable for system C-ONVWIONAL MOUND IN~-GR PRESSURE AT-GRADE SYSTEM IN FlLL HOLDING TANK
U = Unsuitable fors stem CC'S ❑ U ❑ S Er LA'S E U 11 S 91-0 U ❑ S Cam'
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Ekxrtdary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trtnch
Co / 0-12- t0 VR 3/7-- - S 2fSbk t,%ufP_ S 2 nr • S .C.,
2 2-2.b /0 VP' y /'?f s/ 2-Sid A% f12 4s IA, $
Ground 3 -1/2- 7• s ytz S/ G 5 O'S5. 'R k G s
elev.
90 -U ft. kj_- O /O y/? S/ C S S GQ 7 .8
Depth to
limiting
factor
^7°-
F-7
Remarks:
Boring # S Z S
/6 the 51 2-,." y fR
fi
3 ?•s vie y
Ground
3•elevv.. ft. 7•S!//~' y . S .
1
Depth to
limiting
factor
Remarks:
CST Name:-Please Print PO Q;E e T- ?4 tR R cA T- Phone: r71_1-`- 3 "/cf S
Address: S S O t pA iL kOD AP SOA_) ,S'~(`jl(A eIT Z 4.100 L-
Signature: Date: CST Number:
121F~ Y3
PROPERTY OWNER SOIL DESCRIPTION REPORT Page of
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tiench
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
;s~scxo::
.•+ty. Z r
Ground,
elev. r . ,
ft.
Depth to
limiting
factor
Remarks:
con 077n/D nClnn\
~ w. G oT _
G
71
w o~ ~
n ~
V4 "
o ~ ~ rtl
9
0,
I a
~b~ t3 N~ 3
A\' X
71
-7
mFri Am iCSI i r ITJ
l ~I
M Co LA M
Z r)
m t
~ jp z z D I O
t N ,00 h1„b I,00 OOS
( 0.162 .00,99
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(1 ID N
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co D (a'
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3 \ A / 1 N/Jo
:u C)
01
M ^ v
-n
0V \ 961-2 N s
0't ~3 £o.cO~SO 30o
9 0~.
i
1 F of _ _ _ % / Fri r I \
~ I r
p Q1 N Il r N 70 I
cn r o m
-1D 0
ILn
r
h
z
LOT 39 0
3.68 ACRES 0 ~L1 1.=1EC J1J;~✓C~~ wl,'~~,
\ 160,279 SO. FT.
- - - - - - - -
N
tiT F o 2. V01 . ~J
'o ~o tK N
-4 .N89043~55W 434.18
00 `
~0
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cDLOT 38
7 0, \ ph' W 4.64' ACRES
201,997 SQ. FT.
\SSio c'SS°9' 4 PONDING~
3), BEASE.MENT
S~, , \ \
F 6 N89°43'55"W 555.67'
oil S)e i' \
it ~ •
LOT 37
h LOT 44 2.69 ACRES
1 116,990 SQ. FT.
/ 2.27 ACRES 1
PONDING 98,742 SQ. FT. 1
o •
y9 J 1 '
EASEMENT N89°43'55"W 473.39'
EL. = 961 3)
2
~ I
LOT 45
2.27 ACRES ,yA
98,740 SQ. FT. h• p~
\ 9y /
CP / F
0~ 14W
0.00, w
2049'46 E'
66,00'
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNERBUYER ;I /ln fry,-fieS
MAKING ADDRESS %Z 33 T~'h Sf A)CIsely Id, S-`/,11/6
74;0; 0)-"e 4e_ l- a- we-
PROPERTY ADDRESS ZoT _7V 41 A),YS61U, Zd l-
(lo/cation of septic system) Please obtain from the Planning Dept.
CITY/STATE / / l UI~6~ A i. SyD/(o
PROPERTY LOCATION SE 1/4, /UC 1/4, Section 2'1 , T 2 9 N-RW
TOWN OF /7 yl,156A) ST. CROIX COUNTY, WI
SUBDIVISION flulnhmf1i/~S LOT NUMBER yV
CERTIFIEDSURVEY 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: / 7/SSA
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 /D ~J
~4 4eS
Location of property SC 1/4 A; 1/4, Section 217 ,T ZL N-R /y
Township OdG 61/ Mailing address iZ33 7A S
nu /t)/ ~%0
Address of site Lvr /'/e%- /T~C1~SDh. Aj"'
Subdivision name f7U~6j~// AA Lot no.
Other homes on property? -Yes X No
Previous owner of property /~l~• X /~acl
Total size of property
Total size of parcel 2 7 pete<.
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Yes _X_No
volume 1117 and Page Number 6-j;j5> 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. S-0 72 F0 , 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.
_5,2-7 '7 r
Signature of Applicant Co-Applicant/
Date of Signature e of ign<,
_ ~ f~Nss'~yoo~S
~t 52 `780 State Bar of Wisconsin Form 2 - 1982
WARRANTY DEED
DOCUMENT NO. VOL L .T;l;: JUV 04TWS0i'ftE
- - -----------ST. CM CO, Va
Rla V for PACZM
it Humbird Land Corporation, a Minnesota APR 17, 1995
it
-_Corporation,
at .12:~,4~`5",P~A.Ni
conveys and warrants to - Thomas M. Hennes and _ Reglater of Deeds
Barbara J. Hennes, husband and wife,
THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN ADDRESS
the following described real estate in . S t . Croix
11 County, State of Wisconsin: vA
l l
I -
(Parcel Identification Number)
I~
Lot 44, Humbird Hills Second Addition, Town of Hudson, St. Croix
t County, Wisconsin.
I
This is not homestead property.
XXX (is not)
Exception to warranties: Easements, restrictions and rights-of-way of
record, if any.
Dated this 14th _ day of April 19 95
Humbird Land Corporation
ii (SEAL) By. t (SEAL)
it Austin J. aillon, its President
(SEAL) (SEAL)
i
I,
I
!I
~I AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ss.
I I
St. Croix County.
authenticated this day of 19 Personally came before me this 14th day of
A nr i 1 19-C j- the above named
Aust p J. Baillon, President,
ill Humbird Land Corporation
TITLE: MEMBER STATE BAR OF WISCONSIN
I
(If not,
ii authorized by §706.06, Wis. Stats.) to me kn9. o be the person,/ who executed the
i% foregoing i trument a d a owl ge 1he same.
THIS INSTRUMENT WAS DRAFTED BY /V
_ Kristina Ogland Br6g a Poulin
'I Attorney at Law Notary Public St. Croix county, Wis.
(Signatures may be authenticated or acknowledged. Both are not My commission is permapt. (If no_t, sSatoonemiration date:
Bt'enas
necessary.) Nov. 24 Nay pubile 1996 )
Isconsln
Stata c
~ - my Commlas on Exptre
'Names of persons signing in any capacity should be typed or printed below their signatures.
I
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.
FORh4 No. - 1992 Milwaukee. Wis.
r `
i, .3
wK~onsin Department of Industry, SOIL AND SITE E V A L U AT 166"' R E P~l:R T ,1,." Page - of
Labor and Human Relations
U
Division of Safety a Buildings in accord with IL.HR 83.05,`W3. Adnf ,-Code IX NTY
~ sr c~orx
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must iTx~udarbul' PARCEL I.D.8
not limited to vertical and horizontal referenoe 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
B % o N GtiA/.Pti y GOVT. LOT S~ 114 N~ 1 /4,S 2 7 29 N,R E (a) W
FPR(0PERMYO,WNER' NER: O /d • PROPERTY LOCATION
BLOCK 8 SUED. NAME OR CSM 8
:S MAILING ADDRESS P S B a i R17 N I' l ~S (Pti /1S
.,~oB~'TS S7'
CITY, STATE 11 P CODE PHONE NUMBER []CITY QVILLAGE N NEARE ROAD
G Af S5lD/ lGri► ~i2-5SS5 ii uDSo, )
New Construction Use (k"esidentlal Number of bedrooms ` °•P 3 ( 1 Addition to e)dstlng building
( 1 Replacement ( 1 Public or commercial describe
f Sa -
Code derived daffy low ro°a 9pd Recommended design loading rate bed, gpolft2 trench,
71D
Absorption area required ,bed, ft2 7 french, ft2 kt*num design loading rate bed, gpol(t~ - d ~er>dl, gPd,12
Recommended infiltration surface elevation(s) S~ P1 4 • 3 it (as referred to site plan benchmark)
Additional assign site considerations S~'T 8 rOX 40A' 'OA
Parent material SAS 614 I3Vh' k' ~f 4e D / fZ Flood plain elevation, if applicable 414- ft
S- Suitable for systern MoU*- O U [al Q U PRESSURE V-Wo U SYST~Id U ML I IM TAM(
U - Unsuitable for system Ot O U l l~ S ❑
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consist Boumcsly Roots I
Boring # Horizon In. Munsell Qu. Sz. Conl Color Gr. Sz. Sh. 0-13 io 3/Z-- S /f see ~ orl ' ~z s 1 3 -f'// s 2-,m At es-
/417C Is- 6"
Ground Z 13 3Cv o Depth to e. Y.
d , S •
limiting
factor
y This test tie MIL200VED
Remarks:
Boring 8 / /G ' 3/i s~ 2 f SG,~ CS z f M
Z Z 56,e lw~~ s 17c-' 3 31
Ground elev. A0
S/
1Y
/0a, it.
Depth to
limiting
face
y
Remarks:
T Name.-EFIePr nt Q EgT Phone: : 3 rasa: C¢O' Jet Lr ~ 0 • 4 U'DSOA) W ~S ersr- °f 1 y8z
Number:
Signature: Date: CST q ~l
ORIGINAL
e ~
PROPERTY OWNER SOIL DESCRIPTION REPORT
Page L of
PARCEL I.D. # GOT yyi~1~/.~v ff/~~S
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounfty Roots GPD/ft
In. Munsell Qu. S Q)nt Color Gr. Sz. Sh. Bed krah
/ a -/0 /D 3 z S/ J&- vj~f es 3 s
Z o .zo /a Yle y 1ZJ - s/ Z~s6.C 1w
~s /Ic .s
Ground 3 J~ 7 s1le ~t`' q 4' S
elev.
/Gy fT h. t y,Q S/
Depth to
limiting
facto(,~
t
Remarks:
Boring #
loft, m WW1 q S -2
f v ti
.
Ground Z , S - 1.7
elev.
/0 7~ ft.
Depth to
limiting
facto
3
Remarks:
Boring # ~
a- 10)YX 2/2- S! z~sd,~,e ~s 2f
2 " ).,o 0Yle 313 sl z f s6,C 4,-I w ~s /-f
S
Ground '31- /D le 3Y6P
elev
/y-
Depth to
i
fmiting '
facto
Remarks:
Boring #
i
Ground
elev.
tt.
Depth to
limiting
factor
Remarks:
con e•fnn,D ncm~7
_ T5 3 A 3
I;E uAT(oQ s -
~3z.. ioo,y~
13
8 y to
/ - 3d
/3 S sCAIC-
I}i c~ T re~~ af.~- goo - o '
Lo r,~f ti 7' -7, o '
33
~1 By
e
~ L
gs
SO . LU T
~2 . l3~
Zo '
0
(3M . Top or s~ l
Lo T' I R-o^j C("z r /
V ~4 T I' OQ
LOT yam) l
p9, 9 ~ 7
1~14411 Air :"4-
F _ 6 ;F N69°435
LOT 5 W
v Y ~~s' ~~4 r
~t p 43 A
..34 ACRES
SQ FT, 'ti
~ ,33t~ ~ „ 411 ` ~
14
L
ti~~_`s ~'4 4~-,,, r„k j x~. 'f
1 N
t
M_ BASEMENT F~
_ V ' EL. = 961 _
9
LOT 45 % Zs
/ 2.27 ACRES
98, ,740 +O~ 5
SQ. FT
90
O ~ 99
P
S37°10'14 "W
8000-
S52049'46"E"
66.00, - ;
a
ei