HomeMy WebLinkAbout020-1374-17-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 556306 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Barber, Thomas & Mikki Hudson, Town of 020-1374-17-000
CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown/Range/Map No:
12.29.20.2250
IS l 6s T-
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER S CAPACITY STATION BS HI FS ELEV.
~•~1
Septic 0 , Benchmark
(.~)~cser F,t,,. z.s > 9.5 02.9
eenv 6 I o 1 a I~ 5 Alt. BM L.1A I 3 •
Aeration Bldg. Sewer S $ /Q7 /
Holding St/Ht Inlet
G .95 /o5.9S
TANK SETBACK INFORMATION St/Ht Outlet 7.3 105 . ,
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
01- D ck-'
Septic 5 / Sip 36 , 5-71 Dt Bottom
Dosing Header/Man. 2 gs /DG 6s
Aeration Dist. Pipe
59-$
Holding Bot. System Ty,
Final Grade
PUMP/SIPHON INFORMATION /03 .
Manufacturer Demand St Cover
GPM t-,'Its.. Lo x,35 / j~cf J~f
Model Nu er 61 Co. A- L.J
TDH Lift Friction Loss System TD Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ✓ &o I Z le
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: II
INFORMATION CHAMBER OR ~i^ I ~o.~~_
Type Of System:
Gov~Jt. o :22' 57 7 /00 4jk UNIT Model Numb
DISTRIBUTION SYSTEM A) f 4/ Z 1_..4,,
Header/Manifold , ( Distribution x Hole Size x Hole Spacing Veqt tp Air lpt~ke
/ Pipe(s) \
Length i. O r+-~t ~J
Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over \ xx Depth xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges \ Topsoil Yes Ej No C s 0 No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / /
Location: 237 Starr Wood Hudson, WI 54016 (SE 1/4 SW 1/4 12 T29N R20W) Starr Wood Lot 17 Parcel No: 12.29.20.2250
1.) Alt BM Description = " a[ k/.. o Ul for 5"11 Loe_
2.) Bldg sewer length = q Z
R~ 1 t,~ u rem
- amount of cover = / g ,1
Plan revision Required? ❑ Yes o ~c~ 71 S'
Use other side for additional information. I l Z J o~
SBD-6710 (R.3/97) Date Inse is Si ure Cert. No.
_ CQ~~.c- -~Xoil~,_ ~~~L _--~LS~I~-. _ _ - i✓eLsanJ . _
we
County
Safety and Buildings Division Z
5' 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Nume~to be filled in by Co.)
;0. Sp Madison, Wl 53707-7162
55 W a (,o
AUG 4 2 701?
K~;~ to Transaction Number
FL,NN8 'h'ermit Application
Wis. Adm. Code, submission of this form to the appropriat v I uni
In accordance with SPS 383.21(2),
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned PO a sub ' to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be secondary
u oses in accordance with the Privacy Law, s. 15.04 1 m , Stats.
1. Application Information -Please Print All Info ation
Property Owner's Name -Parcel #
f `-LZ /100
Propeity Owner's Mailing Address Property Location / ZZ G a
S Govt. Lot C J
City, State Zip Code Phone Number y., y., Section
(circle one
c T N; R E or&)
II. Type of Building (chec all that apply) Lot #
Subdivision Name
Q. 1 or 2 Family Dwelling - Number of B rooms r~~ _
Block #
❑ Public/Commercial - Describe Use +%4e, / ❑ City of
90 al~ 41 A
t:O, n r~ CSM Number ❑ Village of
❑ State Owned -Describe Use 1 J 7
Town of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. 19 New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. El Permit Renewal Permit Revision Change of Plumber 11 Permit Transfer to New List Previous Permit Number and Date Issued
❑
❑
Before Expiration Owner
IV. Type of POWTS System/Component/Device: Check all that apply)
19 Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Tre ment Area Information: k S
Design Flow (gpd) Design Soil Application gpdsf) Dispersal Area Required (sf) / Dispersal Area Proposed System Elevation
VI. Tank Info Capacity in Total # of ✓ Manufacturer y
Gallons Gallons Units
New Tanks Existing Tanks n /a I ' 00
00 :2 2 rR
U H y ?6 _3 w` U W) V5 U. E5 a
Septic or Holding Tank / - 7
Dosing Chamber
VII. Res o sibility Statement- I, the undersigned, assume respo ibility for installation of the POWTS shown on the attached plans.
Plumber' ign MP/MPRS Number Business Phone Number
Plumb are Print X12
F9/- 2217
Plumber's Address (Street, City, S te, Zip Code)
VIII. Coun /De artment Use Only
Approved 0PjsaPPMXq4 t Fee Permit Fee Date ssued Issuin gent Sign ure
Ob
rven Reason nial s q75-
IX. Condm11jt1~$'( 4,
4: e{>tic t easons for Disapproval ~rJ O f`/ti; f~ G`- 50
ank, imubht filter` and 3 Ilea (J t~
dispersal cell must all be servlaes Imaintalnad
tlis.per management plan provided by plumber. T'1
2 F regt ®mertts must be M lr"Wd e ~ ~a,/ f b✓~~
as Per 1!"Code % ord~ u
size
Attach to complete plans for the system and submit to tie County only per ess tie 8 12 x 11 inches y~
0 IT Mzw ID oa ks t,•~~ s 4.
CONVENTIONAL COMPONENT DESIGN
Residential Application
1
INDEX AND TITLE PAGE
Project Name:
Owner's Name:
Owner's Address:>
Z4~ !Z2214
Legal Description:
Township:
County:
Subdivision Name:
Lot Number: /
Parcel ID Number: 22 gyp
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing
Page 4 System Cross-Section
Page 5 Filter Specs
Page 6,Maintenance & Management Plan
Page 7 Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Designer/Plumber: Z~? I~Ml
✓ License Number: Date: Phone Number y~j - /y
Signature `
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
~oTl~ t G'xoJ~ 5'~s'D/G 7w6s-,,-- A)
I
1
•l
~ ~7euS~
1 ,
3 All
z
Soil Absorption System Cross Section
ft
4" Schedule 40 final Grade
PVC Vent Pipe c~y
With Vent Cap l 1 ft
Leaching
Chamber _ft
System Elevation
,3 ft ft
Soil Absorption System Plan View
ft
ft {
ft Leaching Trench 1
Vent Or Observation Pipe ~ Chambers
• ~',E~,,fos .
4° Dia.
Trench 2 Header
Leaching Chamber Specifications
Manufacturer And Modell
EISA Rating sq ft per chamber Soil Application Rate gpd/sq ft
Z ef--)_ gpd Design Flow : 7 Soil Application Rate : 2 EISA Chambers
2 rows of chambers each.
Page of
INSTALLATION INSTRUCTIONS
knMu"sinPrecast,DraLw ® Zabel-
&WasiematerFrodugs AOlvlahnotPolybkYc
PL-525/PL-625
FILTER
INSTALLATION INSTRUCTIONS
Center filter
U with opening
k p
r
~~,E4F:_ e ~ ~ r r
Step is Step 2: Step 3:
(A) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the
(B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe.
if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the
is positioned so the filter can be housing, making sure the fitter
removed from the tank for cartridge is properly aligned and
maintenance and service. completely inserted in the housing.
MAINTENANCE INSTRUCTIONS
i'k ~
3
WIN,
tee "1 v ixi ~ ~ i
Step 9: Step 2: Step 3:
Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back
if necessary. into the the housing making sure
DO NOT USE PLUMBING WHEN FILTER IS REMOVED (B) Pull the filter out of the housing. the filter is properly alighed
(C) Hose off the filter over the septic tank. and completely inserted.
USErRUBSER G;tOVES Make sure all solids fall back into the (B) Replace septic tank cover
WHEN GLEAWIJG_FILTER Rnntir tame
I
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page or~
FILE INFORMAT N SYSTEM SPECIFICATION
Owner Septic Tank Capacity al ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
Effluent Filter Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Model ❑ NA
Number of bedrooms ❑ NA Pump Tank Capacity al o-NA
Number of Commercial Unit ❑ NA Pump Tank Manufacturer a NA
Estimated flow (average) aUda Pump Manufacturer a NA
Design flow (peak)., (Estimated x 1.5) al/da Pump Model Fe-NA.
Soil Application Rate gal/day/ft' Pretreated Unit
I Influent/Effluent Quality Monthly Average* ❑ Sand/Gravel Filter ❑ Peat Filter
f Fats, Oils & Grease (FOG) <30 mg/L n Mechanical Aeration ❑ Wetland
Biochemical Oxygen Demand (BODs) <220 mg/L ❑ Disinfection ❑ Other:
Total Suspended Solids (TSS) <150 m
Manufacturer
g/L
Pretreated Effluent Quality ❑ NA Monthly Average** Dispersal Cell(s)
<30 m t~In-ground (gravity) in In-ground (pressurized)
Biochemical Oxygen Demand (BODs) g/ ❑ At-grade ❑ Mound
Total Suspended Solids (TSS) <30 mg/L ❑ Drip-line ❑ Other:
Fecal Coliform (geometric mean) <104 cfu/100mL
Maximum Effluent Particle Size inch diameter * Values typical for domestic (non-commercial)
wastewater and septic tank effluent.
Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once ever ❑ months 6a' ears (Maximum 3 rs)
i Pump out contents of tank s) When combined sludge and scum equals one third 1/3 of tank volume
Inspect dispersal cell s) At least once eve ❑ months ears (Maximum 3 rs)
Clean effluent filter At least once ever ❑ months 5rear(s
Inspect um tun controls & alarm At least once ever ❑ months ❑ ear(s) .KNA
Flush laterals and pressure test At least once ever ❑ months ❑ ear(s) o-NA
j Other: At least once eve ❑ months ❑ ear(s) aLNA
Other: At least once ever ❑ months ❑ ears ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator.
Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any
cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the
ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to
check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a
failing condition and requires the immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (%3) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113,
Wisconsin Administrative Code.
The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other
maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of
painting products or other
chemicals that my impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have
the contents of the tanks(s) removed by a septage servicing operator prior to use.
Owner: Page _of _
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater
will be discharged to the dispersal cell(s) and may result in the backup or surface discharge of effluent. To avoid this
situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent
pump or contact. a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact. The
area within 15 feet down slope of any mound or at-grade soft absorption are.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of
the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants;
fat; foundation drain sump pump) water; fruit and vegetable
( peelings; gasoline; grease; herbicides; meat scraps; medications;
oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONEMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system
is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage servicing Operator.
• After pumping; all tanks and pits shall be excavated and removed or their covers removed and the void space
filled with soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed
upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the
replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area.
Replacement systems must comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding
tank may be installed as a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at the time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND/OR
INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY
CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE IlVTERIOR OF A TANK
MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
I'OWTS INSTALLER
POWTS MAINT
Name AINER
Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name
Phone Name
Phone
START UP AND OPERATION Page 4- of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< WARNiNG> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
I
4DDITIONAL COMMENTS
i
"OWTS INSTALLER/ POWTS MAINTAINER
Name Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
J J
Name Name
Phone Phone
-his document was draftst ::_-:"ance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer TV10 rnQS S 1 p
er Y1'\ i Ir, Iii (3a r b e f J'(
Mailing Address
vt2. C~.S'C `Tirct,i ( S
Property Address ~3 - `J k-ar,r wood S-L40 ((p
(Verification required from Planning & Zoning Department for new construction.)
City/State ~M~ Parcel Identification Number
O-/37~ / 7-DDD
LEGAL DESCRIPTION
Property Location 5~r Z'14, Sec. (2 , T aq N R aO_W, Town of N vr( soVI
Subdivision Plat: `j }Att. Woo
Lot #
Certified Survey Map # , Volume
Page #
Warranty Deed # (before 2007)Volume Page # _
Spec house yes no Lot lines identifiable yes no
SYSTEM MAINTENANCE
AND OWNER CERTIFICATION
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 a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on th' form are true to the best of my/our knowledge. 1/we anvare the owmer(s) of the
property described above, by virtue of a wa anty deed recorded in Register of Deeds Office.
Number of bedrooms
SIGNATURE OF APPLICANT(S)
DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 09/07)
? II I III III I I
AA447
Tx : 40 9624
STATE BAR OF WISCONSIN FORM 1 - 2000
~ 947402
Document Number WARRANTY DEED BETH PABST
REGISTER OF DEEDS
THIS DEED, made between Henry Hanten and Ellen Hanten, husband ST. CROIX CO., WI
and wife as survivorship marital property , Grantor, and Thomas J. Barber 12/16/2011 2:37 PM
and Mikki Barber, husband wife, Grantee. EXEMPT#: NA
t REC FEE: 30.00
Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 374.70 t'
described real estate in St. Croix County, State of Wisconsin (the PAGES: 1
"Property,,):
f
Lot 17, Starr Wood, Town of Hudson
3
1
Recording Area
Name and Return Address:
i Title One Premier Group, Inc.
g File #17073
1 a`
"
I
Together with all appurtenant rights, title and interests. 020-1374-17-000
( Parcel Identification Number (PIN)
This is not homestead property.
i
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
easements, restrictions and reservations, if any, of record. 1
1
Dat i ' y of Orce E
2011. 1
3
~/d Z-,
i * He ant len Hanten
1
i
AUTHENTICATION ACKNOWLEDGMENT
/Signature(s) STATE OF WISCONSIN )
i COUNTY. ) ss.
authenticated this Personally came before me this day of
~r1C~- t l the above named Henry Hanten
* and Ellen Hanten, husband and wife to me known to be the
person(s) who executed the foregoing instrument and
TITLE: MEMBER STATE BAR OF WISCONSIN acknowledg he same. c
(If not,.
authorized by § 706.06, Wis. Stats.) f.
THIS INSTRUMENT WAS DRAFTED BY * P
Notary Public, State of i consin 1
f My commission is permanent. (If not, state expiration date: {
Michael H. Forecki, Attorney at Law 8~ )TO 1 y
S (Signatures may be authenticated or acknowledged. Both are not necessary.)"' t
j 'Names of persons signing in any capacity must be typed or printed below their signature JAY P. PENFlELD
1 Notar
State of Wlsc
i k
WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000
1 of 1
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Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Vvision if Safety and Buildings Page / of 3
Bmreau fttegrated Services in accordance with Comm 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
zo 0-7q-1- God .2ZS`6
APPLICANT INFORMATION - Please iii' iitk4n,. Revi ed b to
r
Personal information rovide may be used for secOndar~~urposes (Pacy Law, s. 15.'Q4 (1) (m)). -
Property Owner w,~~~4 P perty Location
0o t. Lot SE 1/4'S01/4,S T N,R E (or) W
Property Owners Mailing Address (a tnt # Block# Tubd. Name or CSM#
A/d2 S7 Ct3 t. 71
► r1r21,~5ZSa~
City State Zip Code fh
a RCE ; City q village Town Nearest Road
l~New Construction Use: ® Residential / Number of bedrooms Addition to existing building
Replacement ❑ Public or commercial - Describe:
Code derived daily flow !(n Q gpd Recommended design loading rate .bed, gpd/ft2 O,,do trench, gpd/ft2
Absorption area required ASW bed, ft2 ?SV trench, ft 2 Maximum design loading rate 0;2bed, gpd/ft2 Q, ? trench, gpd/ft2
Recommended infiltration surface elevation(s) 3y ft (as referred to site plan benchmark)
Additional design/site' considerations kVAQU4-rf bn1 &6~ 1 6to~ L,~ A if f 'ka y dL
Parent material Lk t / 1 L L Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system S❑ U fly, S❑ U S❑ U Q S❑ U K S ❑ U ❑ S [W U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
S e) -t i0w o V/ 5C, /1i <r- C __S &S
//-6 4F? SC 1Y)S C5 0 -7 6,K
Ground 8 t~ s 'l ay~
elev.
Depth to
limiting
f~,ctlor ,
? 2S~ in.
Remarks:
Boring #
to rkl<r- cS o A ; v.S
tb'5 rn 03 61
Kt. IQ4 4 Se M5 fy)
a
Ground
ley,
p ,
Depth to t)-6 I
limiting
foctor
>/6! in. Remarks:
CS34RV'tn1 me (Please Print) Signa re Telephone o.
J 6 ijNsa 3 ~a
A ss Date CST Number
~ZZ 7S7
O Q f~0 6so?v S,4 I &-/2-00
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Structure 2
g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed Trench
o /Ay'at 3 I 5 U 1~I cr CS 2
e 4 3> s~, nos r~ es P, 6 7 ;o,S
Ground gZ I"~~' / 16\14 ~ th
elev~
o,S o~>
-9 /by?, 3 s~ q;:5
Depth to
limiting
or '
in.
Remarks:
Boring #
A -3 /~y~23 'Sc ~,cr n, c o :4 Q ~5
346 ~o X24 - SG (1n5 6
lvls M 1 o,~
Ground
e v ft
Depth to
limiting
>1 1 r
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # 5 /Q k3 / JC /h <r M C ~,S
'7 !og
'3 o,
-~1 i~ >24 4 54 s 6,361
Ground
Gr~
Depth to
limiting
far or
? in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
SBD-8330 (R.9/98)
• Nov-28.2011 11 13 AM St Cralanty Plan/Zoning 715-386-4626
1/1
PROPEM MUM WIL DESCRIPTION REPORT Page Z of -7 .
PAFICBL I.D.#
Boring # Horizon Depth Dominant Color Molnar Texture Structure Conalstanoe Boundary Roots
I wq p- In. munsell Qtr. 62, Cont Color Or. 6z, Sh. Bed .'french
-Z , 3 S4 e5 o
-91 rn
-LP, .0 77 Ground 9 A. j 16%/( Cr 1115 j GS 71 ,(y
ejew,
fL .97 14VA 413 54
Depth to
fi►»Iting
in.
Remarks:
Boring #
M rA M '66
Z R SCE ~s m) f
around
Olt
Depth to
limiting
imt i~
I
n.
Remarks:
Mortzon Depth Dorrgnant Color Mottles Texture Structure Conelctence Boundary Roots
In, Munseil ctu. 62. Cont. Color Gr. 8z. Sh. Bed , Trench
Boring # I P,3 1 ,n r rn
B+ -3~ 3 ~ m5 n~ s o. ,a
SC 6,-7 6 1
Ground
Depth to
limiting ,
~f pr
7 tn, Remarks:
Boring #
13
Ground
elev. .
•~ft.
Depth to
limiting
factor
n' Remarks:
BOD-8330 (8,9198)
loz~
ELL. q9A
i ,
i
o I ^ An'
5 N n
3s' Al
I LEV- `
67 0!
ELI N
. LLEJ - ibs s
3C
C U~V-
99,2a
C h~
M1 r
t4,sTr : Nfo Lbw C~~z~~~s Dec v
Parcel 020-1374-17-000 01/12/2005 E 1 OF A 1
PAGE 1 1
a Alt. Parcel 12.29.20.2250 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
* ROBINSON, STEPHEN A
STEPHEN A ROBINSON
8762 PINEHURST BAY
WOODBURY MN 55125
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 237 STARR WOOD
SC 2611 SCH D OF HUDSON
SP 1700 W ITC
Legal Description: Acres: 1.133 Plat: 2506-STARR WOOD LOTS 1/25'00
SEC 12 T29N R20W PT SE SW STARR WOOD LOT Block/Condo Bldg: LOT 17
17 1.133AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-29N-20W SE SW
Notes: Parcel History:
Date Doc # Vol/Page Type
01 /21 /2002 668778 1818/591 WD
09/11/2001 656321 1716/619 EZ
09/13/2000 629839 1542/355 WD
09/13/2000 629835 1542/324 WD
more...
2004 SUMMARY Bill M Fair Market Value: Assessed with:
50149 92,300
Valuations: Last Changed: 10/30/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.133 71,400 0 71,400 NO
Totals for 2004:
General Property 1.133 71,400 0 71,400
Woodland 0.000 0 0
Totals for 2003:
General Property 1.133 71,400 0 71,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00