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020-1304-20-000
I I I I J ~ W J O ~ O O O O (P I I V CT ? N W w ~ o N N N ~ COT W I I I I 1 I I I I I I I I I I I I I I I I I I I I ~ $ C_ L N ~ ? m ~ 3 y o N O ~ ~ ~ ~ 3 ~ ~ A ~ y '' ~ ~ m o o 3 3 ~ y tD ~ 000 C ~ j j ^n" 3 $ ~ N ~ N D CD cQ i U c y Q, W O L N N ~ I~ v o ~ ~ ~ m x m O s m m c m (D 7 N m °- a N O ~ ~1 N a to m Cp y CD 7 N .t CD O (D N m (] O Q O ~- ~ ~~ o ~ ~ ~ ~ ;, ~ 3 ..: o w l ~ y ~0 s 'v WC m` V ~ p a ro W N ~ C 3 o_ 3 N ~' 7 ITl ~ c N 7 fA ZT y y C. C. ~ i ~ O. fD rnl c rn ~ ~ N ~ ~ 7 ~. COD COD K I ~^ ~ r iv O O O Y o 'ovv~I ~+ ~ I ~p = N CT 3 °-' ° ~ ~ ~~ rn .. I D a ~ l ~ v m ~ m y ~ y °' ~ I ~ ~. a 7 to O C fl. ~ ~ I a, ~ I o' ~ c r: I 3 I y Z w ~ I ~_ I T C a i I I I I Z `< `< y O 7 7 ry y N N 7 ~ y f~ (Q f(1 O O p 0 tf) A IN ~ ~ W a O c o ~. O Z O m 17 y ~ c m a o ~ v y ., 0 3 O s m m c m N 7 N x c~nm D in ~ocD a co °-' ctOD ~~ CT fU o~~ Z O y co 0 41 y N N Cf 'O Cep _~ ~ n 01 ~ .+ d ~ O ~ ~ N W » d ~~~ N O Q N a~ v ~a m ~ n ~ ~ y o n - m () ~ O O ~ ~~f ~ m m ~ ~ ~ 3 r: 3 O O ~ ~ ~. N ~ w ~ N N eN~ fyR ~ y ~ Sp CD ~' a ~ fC 0 0 ,' A A ,y.' O O) N N ~ O O O w O O gOg m y ~ ~ovv~ m A a ~ y 3 °-' ~ ~ .. - .. ~ Z ~ Z ~ D _~ ~ ° ~ ~ ~ o ~ ~ I p ~ I ~' ~ I A ~ (A ~ I a O ~ C cD n y N !D a °o a~ N .Z1 m a cn ~ ~o m TI C 7 a 3 ~ o ~ 3 ci ~? v d 1 ,~ ?~ _ -+ N c O N N O ~ ~ 7 W ~ ~ O 7 O p 0 °, o y O C 3 °~ a .. ~ °: ~ ~ sv m Q m v m v n n -+ -1 N A Z tD ~ ~ w A Z O •• ~ 7 N "'~ ~ Ill N ...~ (D A Z m ~ A d 0 r~ O Q ~y' y A 'C A n 0 O A h q ~ q a ti Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safet;i and Buildfing Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Mifier, Geoffre K. & Mar aret M. Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: ,ob ate TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER .,n~ CAPACITY c Septic (,,~; ~~ `~ iova Dosing ~I y ~ l,J : 2 5.t.n. `75 a fle~atie+-ti- Vim- ~a l o ft- Ho{d'Ing TANK SETBACK INFORMATION TANK TO Sa P/L WELL 30' b~ BLDG. Vent to Air Fake ~~ ° -Ct R AD SeptA tic ~ /"u~.~ 7 5~ ~ 3b ~ Z~.S 7 ~5 Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand PM Model Numb TDH Lift Friction Loss System Hea TD Ft Forcemain Length Dia. Dist. to Well S(lll GRS(~RPTI(~N SYSTEM County: St. CrOIX Sanitary Permit No: 506123 0 State Plan ID No' Parcel Tax No: 020-1304-20-000 Section/Town/Range/Map No: 11.29.19.1510 STATION BS HI FS ELEV. Benchmark !I. d 5 111.65 /~ ~ Alt. BM F• ~. o 3.99 /a7, {P~p Bldg. Sewer ~c S StIHt Inlet .... ~~ SVHt Outlet bl ~ g• 4(i /D? • fc~~l Dt Inlet /l.L~ w %r. c/. oD / b Z . (o r7 ~ air" 9.1) ~ / /bZ.S7 Header/Man. /O,a~ /o/•v! Dist. Pipe Bot. System 1~ s•7 • Final Grade C7~Z ~ qp~ 1"-~ +o . 7o 0.~1 iao . 95 0. St Cover \ 35.9 / 07 • ~ ~ l~ ~ a i g.Z~s 1oz . 37 BEDITRENCH Width / Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 ~ 1 _ ~0 3 ~ f~~ ~. ~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer. r_ /~ / -L,n,d-~~ ~f ~a ~~+"~. INFORMATION Type Of System: t Go~~Il;~~ ~ ~~ ~ ~~ ...7 $ i ~ 1'\ YC' UNIT . Model Number. ~ o ~ tIISTRIRI ITInN SYSTEM / `/ ~- / 7 ~/ 7 = J ~ Header/Manifold ~~ Distribution x Hole Size x Hole Spacing Vent to p/,~~r In e ~ '/ ~~ \ Pipe(s) \ > ~ i S \ ~ a~ 3tdl S Dia T Length ng pac Length Dia S(lll C(7VFR ,, o.o«~.~o s..~tom~ n.,w YY MnnnH nr At-Grade Systems Only Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~,j C ~ r J Bed/Trench Edges Topsoil Yes ) No Yes <% No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 1060 Tanney Lane Hudson, WI 54016 (SE 1/4 NE 1/4 11 T29N R19W) Tanney Ridge SpeciallIAdd LolIt 5 1.) Alt BM Description = ~~ ~'~ ~OJ ~~ G~a,~ ti S '~ rt» G GtCS 2.) Bldg sewer length = ~; S ~;',~ - amount of cover = t I Plan revision Required? _:.' Yes tit No i1 !f ~ b Use other side for additional information. I I Date SBD-6710 (R.3/97) Inspection #2: / /_ Parcel No: 11.29.19.1510 O ~. ~~ ~ 3 Cert. No. commerce.wi.gov Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 7162 st. CrO1X ~ seo n s i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce CJ ~ ~' Z Sanitary Permit Application State Transaction Number ~ In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate gove Brent than mailing address) ject Address (if unit is required prior to obtaining a sanitary permit. Note: Application forms for sta =POWYS are b itt D d t th t t f C l i P f i i d f ~ ! D ( su m e e o epar men ommerce. o ersona n ormat on you prov de may be use or se . e~,~_ f ~ mod (a,~~g u ores in accordance with the Privac Law, s. 15.04 1 m , Stats. ~ same I. A lication Information -Please Print All Inf mation Property Owner's Name / EQ Parcel # Geoffre K. & Mar aret M. Miller 020-1304-20-000 Property Owner's Mailing Address Property Location / / C ~ Q (• J 1060 Tanne Lane ST. CROIX COUNTY Govt. Lot City, State Zip Code ber SE '/<, NE_ ~i., Section 11 (circle one) Hudson, WI 54016 (715) 386-0779 T 29 N; R 19 w II. Type of Building (check all that apply) ^ 1 or 2 Family Dwelling -Number of Bedrooms 5 R ~ 5 Subdivision Name ock # Tanne Ridge S eeial Addition ^ Public/Commercial -Describe Use Na ^ c;ty of ^ State Owned -Describe Use CSM Number ^ Village of ~wn of Hudson 3 p ~ ~-- Ce-`,~S w ! ? f' ! cl ~' / 9 ~' a III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ^ New S stem y a lacement S stem p y ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ~ ~~ 3 -- IV. T e of POWYS S stem/Com onent/Device: Check all that a 1 i B~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 Componen lain) ^ Pretreatment Device (explain) V. Dis ersaUTreatment Area Information 57 In ltrator " -4 standard" chambers 19 1 s .ft EISA / chamber+ 3 air end ca s 5.8 EISA = 1,106.10 s . ft. Design Flow (gpd) Design Soil Application R sf) Dispersal Area Required (sf) Dispersal Area Proposed (sfJ System Elevation / 750 gpd ,/ 0.7 in-situ soil ,/ 1,071.43 sq. ft. 1,106. 10 ft. / 100.00' / VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ~ o '~ ti o New Tanks Existin Tanks S ,(//J P ~ C ~' SZ5 f ~t '~ c ~ p O-~ C..) ~ ~ V] v~ y yN, V~ ~ Say C7 P. septic or xolding Tank 750 1,000 1,750 2 Wieser one. X Dosing Chamber VII. Responsibility Statement- I, the un ersigned, ass me responsibility for ' anon of the POWYS shown on the attached plans. Plumber's Name (Print) Plumbe s Sign MP/MPRS Number Business Phone Number James K. Thom son s-- 30021 (715) 248-7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola, WI 54020-5413 VIII. Count /De artment Use Onl Approved Permi t Fe e Date su Issuing ntSignature C~ ~ /~~ r ~ f $ ~ ~ / -7 ~ t0 b ive or Denial v • ! 1X. Conditions of ApprovaUReasons for Disapproval \ ~ \ 5 ~ ~ s~rsTEnn owrlE~ 3 1 ., ~ ~- ,,,,,~p~ r ~ J 1. Septic tank, effluent lifter and ~ ' ! ~ dispersal cell must all bebe servlces(~ ~ ""~~~~ as per management plan provided by pltmt~r. ^ 2. All setback requirements mast be rtainteirwd ~ ~~ ~wR- p~ n (~ s ~w`. ~-a ~ ~ ~.. t' o,r.~J•1 -- ~-• -rr••-~~cTi ta'tbdf~AR~l~ds'7or the system and submit to the County ouly on paper not less t)faa 8 1!L x 11 inches in size ~~ SBD-6398 (R. 01/07) Valid thru 01109 SOiI?r/Q~ua~%on~••E UV 5Ca/~~/'-slD ~a~'`~ZOlo7 ~f;I/cr~Oro,~/Ey, .3Eislh~ys%SPc. ~% T. a~,~u.dSon• SE. CrD~'X ~,,c.J~ /oE5 Tnnc~~'d,Q~S~OCGaF/~dd,"' /0~ ~ 014-:o3s/-zo•ct~? "zG E/ev : iod. ~a~~ ~~; dewy P'~'p° Sed c<l i eS e / CavrC, -~-- o~---Gt)2l( 7So~c..P 5ycfi'C.Ln~ w/ H,ly/o~'P~-szs 5 burr., p;ucrs;o~ ~ ~.~';' o ~ ~'~ J' %; • ~ ~ ~, '. L fan ~ ! ~ ~ ~~ ,. ~_ ' ~~~~ ` -, , , EiY/.J~i/!~ /B Xf~O ~~. /oS.B ~ ~ ~ \ \~ '• . _ o ~ '~ ~ ~. _ 1 ~ ' , - I '~ F~oPascd d,'s,~+'a~.(C~//. fob, p' ~ . Thrct (31 ~Ytnclits 4~ ; ~` ~_ ~S (;ne S~or+dai'd S-si~/t~o.6or ,! ~ r- C.l.a.r,6~s/ui'~c~~. ioso'8z ~e~D'cahfpur ~~ch rnas'~ : /o.~ o/ /off / ~- ~Q~Su x a/e -/Cb.CY~ . ~ °~_ ~3c1~~ 7~~~y ,C.~re I 4 • So;l eda/uaE%o~~a•~E • ~x/SEi'nrj G/'CLp~e e/w" a~e~~"-sl0 /Yj;//c~j0i'oc~c/Ey, 3Eis/~'/Gr~'s!.51c. /~ /oES, Ta~acy%•d'e~S~acciaFAdd, ~0 ~ p[ 020 - /a3 S~- Zo • ~. ~~ ~~y ~e , s c, ~an~l! , cwt/ e(e~=/o.Z.Bo - P~orostdd.SPcrsm.l'C~//. %o~.o~ ~L/'f C ~~ ~cu.l.ts aE ~awl~/s/a'/' ~CifG~. ~~ ~4~t ^ /OS,•OI ~ e n ~~ ~ ~. ~3SGc e d '~3~H Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance wish Comm 85. Wis. Adm. Code 2067 Page 1 of 3 A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8%: x 11 inches in s¢e. Plan St. Croix include, but not limited to: vertical and horizontal reference point (BM), di rcel I D percent slope, scale or dimemsions, rarth arrow, and location and distance to . . 020-1304- 000 Please print all information. Bevis y Date Personal information you provide may be used for secondary Purposes (Privacy Law, s. 15.04 (1) (m)). t~ ~ ~ 7 Property Owner RECEIVED ropertylocation Geoffery K. & Mar aret M. Miller vt. Lot SE 1/4 NE 1/4 11 T 29 N R 19 W Property Owner's Mailing Address APR 0 5 2007 of # Block # Subd. Name or CSM# 1060 Tanney Lane 5 Tanney Ridge Speciat Addition City State Z Code Phon Nu J City _J Village ~ Town Nearest Road Wudson ~ WI 01ti T~ (715) 380779 Hudson 1060 Tanney Lane New Construction Use: ~ Residential ! Number of bedrooms 5 Code derived design flow rate 750 GPD ~f/ Replacement J Public or Commercial -Describe: Parent material Glacial Outwash Flood plain elevation, 'rf applicable na General comments and recommendations: Site suitable for conventional dispersal cell at 0.7 gpd loading rate. Install trenches at 100.00'. I "1 I Boring # ~ Boring 11 II 1 ~~ 08~~ ~ Pit Ground Surface elev. 05.14 ft. Depth to in. limiting factor Soil Application Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots P Dlft' in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-27 10yr3/3 none fixed fill na mvfr as 1fm 0.0 0.0 2 27-32 10yr4/3 none sl 2fsbk mfr cw 2f,1 m 0.6 1.0 3 32-40 10yr4l6 none is 0 sg ml cw - 0.7 1.6 4 4p-61 10yr5/6 none s 0 sg ml clnr - 0.7 1.6 5 61-108 10yr5/4 none s 0 sg dl - - 0.7 1.6 ~ rt rr ti Boring # ~ Boring yfJ Pit Ground Surface elev. 104.77 fl. Depth to limiting factor >103" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots G in. Mansell Qu. Sz. Cont. Color Gr, Sz. Sh. 'Eff#1 'Eff# 1 0-13 10yr3/2 none sil 2fsbk mvfr as 1fm 0.6 0.8 2 13-30 10yr4/3 none sil 2fsbk mfr cw 2f,1 m 0.6 0.8 3 30-34 7.5yr4/6 none sicl 2msbk mfr cw 1fm 0.4 0.6 4 34-41 7.5yr4i6 none Is 0 sg ml cw - 0.7 1.6 5 41-52 10yr5/6 none Ifs 0 sg ml aw - 0.5 1.0 6 52-103 10yr5/fi noone s 0 sg ml - - 0.7 1.6 /-~ lob rt Effluent #1 = BOD5> 30 <_ 220 mg/L grid TSS >30 < 150 g/L 1 E nt #2 = BOD < 30 mgll and 7SS < 30 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson 'S---r 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, Wt 54020 4/2/2007 715-248-7767 Property Owner Geoffery K. & Margaret M. Miller parcel ID # 020-1304-20-000 Page 2 of 3 Boring # J Boring i~ Pit Ground Surface elev. 104.08 ft. Depth to limiting factor >98" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 015 10yr3/2 none sil 2fsbk mvfr as 1fm 0.6 0.8 2 15-27 10yr5/4 none sil 2fsbk mfr cw 2f,1m 0.6 0.8 3 27-41 10yr4/4 none sicl 2msbk mfr cvv 1fm 0.4 0.6 4 41-46 7.5yr4/6 none Is 0 sg ml cw - 0.7 1.6 5 46-98 10yr5/6 none 0 sg ml - - 1.6 -~ 7 ~ '~ Boring Boring # ft, De th to limitin factor in. _J Pit Ground Surface elev. p g Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # -~ Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) A.C.E. Sall & SItE Ev31UBi10n5 a/e~/~-slD, 0 ~i~~ZO~°7 X ~. , cJ! G'a.FfJd c/,~f n ~! ~~' .u-.+e . ~. 303 c~ o o vsac .Y1tF'r' : r Sw ~ r,.. t ~,, Js r+tcK_ a - tiIF ~`, .-(~jyam~~n. "~~'y~q~~ ,,~~yy~~ qh 0 S Y ~Jh fit ~7 i Y11.Y ~~~., t` ~ ~~ »--w aka ht.r+ax c~:fprw a ,~ r rr nvanfriwX~tieme~' - ;-- ~ .: E i i"' ~ ~ ;i r\_ 6 ~ .IMn rg~a er0le ~ 1 ~'iiC ~ ~ ~~ ~ '~-rK Apo ~ r~w'~snrwxuNc ~~_ ' ~ l.dT B ' ~ ~t I ~' ~ t a o ~~.r.~ s ~~ ~ L4T~ ~9 r~pw ~- i .x~w~eurr ~~ ~ ~~ +.w xn I ~ f' n~ wrh , i `F 1 ~ ~ uc: qua ~ -r *xmuntwwMr X ~~? 0 ~ r_.~ w:R ~ ,~,at a Ir. i~ ~ .. ~ Aga ~ ~ ~ Y ~.,~~, ~ I aa~r ~owrr ~ z F ~"'~~ ~ V~~4wdfw~ \`4 _ '`f ~ ter. . ___( W >~,. ~u~ JWa z v ,,~ ~ moo: .~.~^ ~- ^ ', ~s^ ._...^ T "".~~^ 3 ~ z ~ fir` ~' ~ Q ~ ~m^ ~, ~ _ ~ ~ ` .......a Z ~ ^ ~o~ ~ m ~ ~~~ ~ w I .~.~^ ~ 00~ ~ I ~~~ ~ z .~..^ F- ~ ~ Y 'J _. =-Y _.; a/~S °U~ 3 _w z 0 U W I1r III ~~I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/I~- Mailing Address ~~~ '~rcro~.s~r,, t.~/. S Property Address ~r>e (Verification required from Planning & Zoning Department for new construction.) City/State ~~~~. GJ~ Parcel Identification Number D10 ~/30~ ~O-CQ'~ LEGAL DESCRIPTION Property Location~~ '/a , /~~ '/a ,Sec. ~_, T ~~N R~~W, Town of ~~~~~ Subdivision ~Q/ I~:~/~ ~ ~~ ~"x'`'~~~ ,Lot # ~. Certified Survey Map # I'~n. ,Volume ,Page # Warranty Deed # ,Volume ~o ,Page # 7 Spec house ~s no Lot lines identifiable yes 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 [he three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of [he property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of edrooms ATURE OF APPLICANT(S) ~/O3/-°~ 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. 08/05) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the G'.Ao,~re~~/7~'~a~~ /yj;~/~/ residence located at: SE ',, /IE /4, Section ;1 ,Town ~- N, Range~_W, Town of w~scn , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service ~~~ ZCO7 Did flow back occur from absorption system? Yes / No (if no, skip next line.) Approximate volume or length of time: /z lii; gallons ~ minutes Capacity: ~ ~/y Construction: Prefab Concrete ~ Steel Other M ufacturer (if known):.~~ Gc~i~S~ ~oa~z,~'c~ Age o Tank (if known): ~bZ vP~a,~s icensed Plumber Signature) (Print Name) ~~~~~ . (Title) ~~~~ ~~~ (Date) 3~~ (License Number) MP/MPRS Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) _ ~~, - - __-_-- __ - ---- , L b I S I __ _--- a -_-_ - ~Ib 3„OZ,£Oo00N dog - - aNnow ~ - ---_ - ~H1 Ol ad 0 Ib M„OZ,EOo00S ~~1C1~IQ~Q N _ - - y 7 n D V P D bi13N 3H1 ~0 b/13S 3H1 ~O 3N11 1S3M --, S~'f~t', ~, ~ ,~ o-., ~~~ rt O ,R N C O t~ O ~ my~U ~ ~Ov~E >nvs > ..~ +~ ~ ~, r, m > ~ m u •.~ ~.~ a~ .t~ ~ ~.~ ~ otl R! 'L3 ~ v1 b .~ b tq v r0 ~ w (il O ~.•r U~ .Q O O .C A rr O ~ ~ O O M +~ +~ O -•-+ -.i UJ ~ O.x ~ al .A ~ trl .L2 1.a U -.-~ l0 O p i~ ~ ~ w ~ W O 10 ~ ++ .--~ -~ O O ~ O A. ..C: agar. ~,s~~v ~ va~ ~ O O 1b ~ O 8f b v O ~ ~ ~ td ~ -.i tb .Ll +> > •n t . rt .n N .x to +~ i . n~ r .r .C > e~ - ~ rd ~ w• ~, .1 \' \ ~ ~ ~ ~ o ~,, ~ ~ ,~ ~ ~ ' \ \~~~ ~ ~, ~ ~_~' -~ \~~ \ ~ ~ ~ ~ ~~ ~ ~ oUU N L :~ ~~ ~J! ! C~~Gr~~~ C r~ J~ Z -~_ - ~\ '-~ ~\ - ----~_ ip~, ~s ~-~ H L~ V ~ Q ~ O O r'~ V J N~ m • ' ~ 4 _16~OPA~s 4~4 I STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Marshall S. Sherman and Karen L. Sherman, husband and wife, Grantor, and Geoffrey K. Miller and Margaret M. Miller, husband __ and wife, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot S, Tanney Ridge Special Addition, Town of Hudson, St. Croix County, Wisconsin. Recording Area 645Es6~ I:ATHLEEN H. WALSN REGISTEF: OF DEEDS 5T. CkOTX CO., WI RECEIVED FOR RECORD 05-fb-2001 10:00 AM WRRRRHTY DEED EXElIpT ll CERT COY FEE: CDRY FEE: TRANSFER FE£: 657.30 RECORDING FEE: 14.00 RAGES: 1 Name and Re~ogN TO: TITLE ONE 70619TH STREET SOUTH HUDSON, Wl 5016 020-1304-20-000 , ___ Parcel Identification Number (PEN) This is homestead property. (is) ~~(t)Q Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. ~' 2001 Dated this _~~ day of May • * -- - ~~ ~ AUTHENT[CATiON Signatures} Marshall S. Sherman and Karen L. Sherman, ,_ husband and wife, _ autfienticated this ~ ~/ ~y of May 2001 s Kristina Ogland _~ • '[Vlarsfiall S. Sherman s Kareh L. Sherman _ _____ ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. County ) Personally came before me this day of __ T-_ __, the above named T[TLE: MEMBER STATE BAR OF WISCONSIN to me known to be the persons} who executed the foregoing (If not, instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS ENSTRUMENT WAS DRAFTED BY • J _ Attorney Kristina Ogland __ __. ___._. Notary Public, State of Wisconsin Hudson, WI 54016 __ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) } ' Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN WARRANTY DEED FORM No.2- 1999 ~, kdortnation Professionals Company. Fond du Lac, YVl eoosssao2t ~~ C~~~~ ~ c ~ ~ o I M ~ ~ p °~ I y M ~ c I N; 4 g° I c I n O O I N I N I ~ I ~ I I of ~ ~ i ~ ~ I I I ~ I ' ~ z° I c ~ ~ I o 3 a I a I 3 ~' I I ~ °' ~ z `~ E I z w °o I z ~ ~ ~ I a m I ~ ~ i '' I ° ~ O Z d' ~ ' ' ;i ' ~°c 7 ~ w r+ a r N Z~ m N c Z I ~ H r ~ ~ ~ I ~ ~ "' I ` - N O N ~ U'/N1 ~ I Q ~ I ~ N ~ C N ~ ~~ zmz .. ~' z I ~ ~ ~ I ~ m _ .. I ~ ~ Y N I I _ I ti .. N N ~ ( ~ I ' G 'R i ~ ~ ,~j T O N_ N d a. N N ~ O O O v C ~ ~ a 1 ~ U 0 ~ ~ ~ ~ r I ~~ 0 0 0 d ~ I in Z° •N ~ aaa ~ ~, I a I °N °~~ rn rn `~ I cn J U ~ ~ O ~i a N c co 00 .. ~ ~ O O E o ~ I , ~ J ° ° ~ a c~ c~ I ^ N ,~ m w Q O) O w n ~ ~?~ C Q z ~ o I ~ i ~ 3 .r~i I ^Y ~l 0 00 ~ ~ IA N ~~ ~ N C ~ j O r ~ ~ O O C O! ~ N ~ i 0 ~ ~ ay C ~ ~ UJ a0 (D a0 ~ U d 0 0 0 1 N N V O V' O~ C ~ c4 In N C ~ E O ~ N O O I~ O ~ N M N t" ~ rn v°, r ~ V m a~ W -o H c~ cD ~n ~ I ~ N N _7 - M O N O E _ ~ U I • N ~ O ~- _ ~ N O Z N Z =~ g~ O ~ + r I ~ I ~ ' L ~ I v ~ ~ ~ it a a f Law `~i :~ ~ ~ '~ ~ °7 ~ t t A tiag ,O inc°~ ~ STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER_SflyY) ~/L/ ~2 ADDRESS rj©~( ~ z ~ Z ~ v ns n nr c~ ~ ;'~~/~ sU~sDlvrsroN / csM~ rt~NU~~ ~ID6f. LoT ~~_ SECTION /~ T Z`1 N-R / Town of HC~~,$a J~/ ST. CROIX COUNTY, WISCONSIN ~JE ~~ NoTF ~ ~ s F ~(roJtis w~ ~~ N YET ~Nsl'A LEA ~ A ~r~~ - 1 I I Nay ~~.~~ ~5~~ ~~~ v ~bU j h C o7 ,~ Ohl K INDICl~TE tdORTfi hR120,~' Provide setback and elevation information on reverse of this form. Provide z dimensions to center of septic tank m<~nhole <-ovet ___ pr2iv~ wry ~ _ _ - - -_ , ~ ~ ' - \~~xso' ~ ti ,.v 75 \. PLAN VIER SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ,. BENC3B/LARK: -1"pS~' o~ / ~~ L o~ 7~/Pf /9T ,'~ CDR/!/F~ E/- I~, /~ = ID6.OQ ALTERNATE BM: -T61~' o ~ ~d Us F fg~KD~4T/D/~l E l . 2. /S SEPTIC TAN / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: wE~Sf/Z Liquid Capacity: (OQC7 6~4~, Setback from: Well 7 S ~ House ~ ~ ~ Other 85 ~ To Sa4~"~ Lo7" ~~jJrE Pump: Manufacturer Float seperation -~ Modell Size -~-. Gallons/cycle: Alarm Location -- SOIL ABSORPTION SYSTEM Width : / 8 Length y o Number o f trenches Distance & Direction to nearest prop. line: 37" 7`o Soo7'k Setback from: well : / ~ b~ House y S Other ~ a ~ ~b S.T, ELEVATIONS Building Sewer ~ ST Inlet. 7, ~JO ST outlet 7. 8s' PC inlet ~ PC bottom Pump Off ~H S. s z Header/Manifold Rµ g.1~4 Bottom of system 9,~5 Existing Grade -s~ S a Final grade 5~S 2~ DATE OF INSTALLATION: y~,, PLUM[3ER OIJ JOB: IV`(~ LICEraSE NUMBER: ~~~ S -Q~S pa INSPECTOR: 3/93: )t ,Wisconsin Department of Industry Labor and Human Relations Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) PP,E1AjLFipld,~r'; N~~;I M II~ll1,L~+2i ^ City ^ Village C1 Town of: : C T BM Elev.: CS Insp. BM Elev.: Insp. BM Elev.: ,~ BM Description: BM Description: - ,t TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic s~ ~ ~ i f ~ -Y' ~(~=t1-~: Dosing ~, Aeration Hotdil<ig TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Airlntake ROAD Septic ~So ~ ~ ~ l ,/a,L NA Dosing NA Aeration - -------- NA Holdin PUMP /SIPHON INFORMATION Manufacturer Demand Model er TDH Lift F I e m - t Forcemari'n Length Did. Dist. To Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: ST. CROIX Sanitary Permit No.: State Plan o.: Parcel Tax No.: STATION BS HI FS ELEV. Benchmark ' ~ c ~~' ~) .~ i' ~. Bldg. Sewer St/ H~E Inlet -~ ~, ~ ~ ~, 3 g~' St / Fjt Outlet ,%, ~ ~-' l0 3, ~O ~ Dt Inlet Dt Bottom Header /Man. ~?5 ~ ~Ga, ~sl ~ Dist. Pipe ~ :~ ~ /d~ (~ / Bot. System -=~ ~~ ' U d ~ Final Grade : ~j,~' D~ Q ~ ~~ BED /TRENCH Width Length No. Of Trenches PIT No. Ot Pits Inside Dia. Liquid Depth DIMEN ION ~ ~~ ~D DIMEN I SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHIN Man cturer: SETBACK INFORMATION Type O /.e~..~C~~~ ~ C~ CHAMBER Model Number: System: l~p~,~ ~~-~. S / ~ OR UNIT DISTRIBUTION SYSTEM Header ._ ~/ ~ Distribution Pipe(s) x Hole Size x Hole Spaci Air Intake Length ~ Dia. ~ ' / Length ~~ Dia. 5~ Spacing ~P SOIL COVER x Pressure Systems Only xx Mound Or At-Grade S em rr~y-_--.-~~ Depth Over 3 Depth Over ~ xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.ll 29.19W, SE, NE, Lot 5, Tanneane J~' -'" , - _ r` - ~ - ~ ~'LC, .t ~"` ~~_, ~~ . r . ',r C~~ee°y--r -s. ~, ~?sv1.~=] C ~ ~•y.::(, ' ~, /~ ' / ,~ ~ ; - ._ ; yr ,~~..~ -~-/ ,. 3 ,, _; _ Plan revision required?~~'^ Yes Ito Use other side for additional information. ~ // p SBD-6710 (R OS/91) Date Inspector's Signat a Cert. No. ,SAM MILLER IOlo0 TANK( LANE 7"ANNY R1D/oE LOTS • Q, M. Tod OF I~~ I ICON AT SE LOT colt NE12 ~/- _ /DD-DO i ~~ _ .. scq [ E l y - /o ~ ~ ~ ~ /~1~'ii~'r- v .3SO v SYSTE M EIY: ~p/s ~~~-'4 71 ~/~-~ WEST LOT L ~ N E 2 y7. So' Lr7Y 4 ~ L_ ~'I N ~t V 0' ~ WEB L f ' !_ ~Q -_-_._._. _...__~__-. -t !}ooSE G ~~`k as'xs ~~f~X 3G~ 7S A o " R o ~ is'~ ~ / _ _ _ _ _ _ ~ I ~ ~ ~25~ ~ ~ B-3 Soy y' ~ ----_ - - ~~I ~~ ACTFR /VATS I ~ ~I~~~ ~ I ~ i l r- ~ ,, Z ° ~ - , ~ e-s BM I /2o FlhT R-N - -sS_ ~ SE I.o•~' CoRNE~ z~ 2L E1=I~0.~o' ~ l TAN//y LANs O O M1M M w r 0 J 2 F r a z ~,~,.:~ .~,.E .• ~ ~~1~.i~r'T+- SANITARY PERMIT APPLICATION ' In accord with ILHR 83.05, Wis. Adm. Code • Attach complete plans (to the county copy only) for the system, on paper not less than 8 v2 x 11 inches in size. • See reverse side for instructions for completing this application The information you provide may be used by other government agency programs (Privacy Law, s. 15.04 (1) (m)]. Safety and Buildings Division Bureau of Building water Systen 201 E. Washington Ave. P.O. Box 7969 Madison, WI 53707-7969 Count~-~/1 /7 '" State S"aCni/t~ airy Pe(r"m'i}t' N~u~m`b"eer7-.' ~3~~~3 ^ Check it revision to previous application State Plan I:D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFO RMATION Property Owner Name SAM I LLI~ ~ Property Location E 1/4 E 1/4, S ~~ TL , N, R /9 E (or~ Property Owner's Mailing Address Lot Number Block Number o ~` z Z s` - City, State Zip Code Phone Number Subdivision Name or CSM Number vDSoN Wz SS/o/4 (38'6)z~{eq rc D~~ II. TYPE OF BUILDING: (check one) ^ State Owned ^ cit~ Nearest Road ^ Public 1 or 2 Famil Dwellin - No. of bedrooms ~_ ~ Town OF uDSV 1' NN ~' LaNE III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ~~-13~~-2c)- ~ 1 ^ Apartment /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 box on line A. Check box on line B, if applicable) ~ 2. ^ Replacement 3_ ^ Replacement of 4_ ^ Reconnection of 5. ^ Repair of an A) 1. [~ New System System Tank Only Existing System Exlsting 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 ^Seepage Trench ~ 22 ^ In-Ground Pressure 42 ^ Pit Privy 13 ^Seepage Pit 43 ^ Vault Privy 14 ^ System-In-Fil I 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 d=q. ft.) (Min./inch) Elevation /l ~~ Required (sq. ft.) Proposed (sq. ft.) (Gals/ ` 7 f,, ~/ Z. ~ Z O ~S(7 ~ /O /. S Feet / ~ Feet VII. TANK Ca acit INFORMATION in gall0 5 TOtal # Of Manufacturer's Name Prefab. Site con- l s Fiber- Plastic Exper. N E i i Gallons Tanks Concrete tee glass App ew x n st strutted Tanks Tanks Septic Tank or Holding Tank x ~d d ~ / / S ~ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber ^ ^ ^ ^ ^ 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: o Stamp) ~ MP/MPRSW No.: Business Phone Number: MIKE M4 Oi~ELL `~- %7~ a~.t-('C~! MPS 3SG1D 3qG- ~~~ Z Plumber's Address (Street, City, State, Zip Code): ~ 6~E K M L~ L14 E Ff p L IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved San tary Permit Fee (indudesGroundweter ate Issue Issuing Ag nt Signature (No St ps) Approved ^ Owner Given Initial /~~ Surcharge Fee) /~ ~ ~ Adverse Determination `~' ' /~ O ~-- X. CONDITIONS OF APPROVAL / REASONS FO DISAPPROVAL: ~ SHD-639H (H. OS/94) D6TRIBUTION: Original to Cmmty. One copy To: Safety & HuilJings Dim:ion, Owner, Plumber - INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. . '~ f 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 S. 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: I. 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 'I 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 number<~ 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 t~~nk material. Complete for al! 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 vrith 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 scecifications not smaller thar. 8 i/2 x 1 1 inches must I.~e sr~hmitted to the county. The plans must includa 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; weir; water mains/wa~~-:" s~.: vice; streams and lakes: pump or siphon tanks; distribution bores; soil absorption systems; replacement system area>; and tl-re I~~xation of the building served; B) s orizc: ~t~l and vertica~ elevation reference points; C) compete specifi~~:tio,~s for pumps and controls; dose volume; elevation di f f;;rences;'~riction loss; pump performance curve; pump modf~~ and pump manufacturer; D) cross section of the soil absorption system i f required by the county; ~) soil test data on a 1 1 ~ fonr; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Ozo 1011 ~a-~ ~.. LJ d a ~ ~Y ~~ X ~~ O 01 ~O X ~ Rte. z ,~. OD 2 w }~ F ~' ~j O = v O O ~ 2 w a Z O W a z Z a ~ a c~ z x U U 4 z .~z Q ~1~=-~ ~ YY O 1= O r- i i I ~ ~ M 4 I `a ~ ~ ~~ ~~ _ ~~ w a a v `~ H J ~ w 3 0 w m c~ z 0 d _~ VYisPonsin Departrnent of Indusvy, SOIL AND SITE EVALUATION R E P O R T < Labor and Human Relations Division of Safety & Buildings __J ._.:.~ n ~ ~r~ nn nc \A/:~ AJ~ /~~J~ Page ~ of .~. CIVVV.V •~Illl IVI ~. ~ VV.VV, •.V• /~V<<.• Vvvv COUNTY ~~~ /k 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 , . lion and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location a t ~, ~ d. ~~ ~~ APPLICANT INFORMATION-PLE S~?;PftlN jj AL IN TION REVIEWED BY DATE '~. T f?,„ PROPERTY/O/~~,W,,,NER: ~<<~'~' n' ~` S R . ~ `•>~. ~;~~~ N - PROPERTY LOCATION Q E(or)W N R 1/4/J~ 1/4 GOVT LOT S S f~ T Z~ ~ rtt 1ILZ~' - f 1 ~; ., , r , , , . E f I PROPERTY OWNER':S MAILING ADDR SS`~y i ~'~ ~„ LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE Z ,~E'~':='', UMBER ~' " - ~ ^CITY ^VI LAGE OWN NEAREST ROAD L ' - ( ~' ~jr.,; ~ ~ ~~N r4~ ~ Nay [OQ New Construction Use [E~'~ Residen f~irhb~ r ~ ms l~l ti,K [ ]Addition to existing building j ]Replacement [ ] Public or commeraal desaibe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations ~v~ai. yAT /~~. ~+~ ~ ~-oA ~c.~tr /4+°~`+~caYa ~.,, . Parent material Flood plain elevation, if applicable ft S =Suitable for system CO VENTIONAL S ^ U M UND ~ S ^ U IN-GROUND PRESSURE ~ S ^ U AT GRADE ~ S ^ U SY TEM IN FILL I~S ^ U HOLDING TANK ^ S ~1 U =Unsuitable fors stem SOIL DESCRIPTION REPORT Boring # ~~? hh 34;:2; +•C6 K.......~~. Ground elev Depth to limiting factor 7 ip 11 Boring # Z Ground elev. rob. ~ oft. Depth to limiting factor y ~S i H Depth Dominant Color Mottles Texture Structure Consistence Bot ~l Roots GPD/ft or zon in. Munsell Qu. Sz. Cunt Color Gr. Sz. Sh. y . Bed Tretxtt A 0~2~ IdY l - ~L t Y 5 Z ~-~t 0,4 d ~~ ~Q L~ - 5 Z ~ ~ ~ ~ j ~ ] i / /~? 10 1 f?~) C S I -z~i~.~ ~~ 4 4 _ ~ d m 1 0.~ ~ Remarks: -~ i a 4 4 - S M~ 0:7 ~~ Remarks: CST Name:-Please Print ~,f~aeJL JC~N SQ N Phone: ~6_ ~0~0 Address: ~.U, ~X ~7 ~ C.1 ~S~l N ~ 9 J 6 C~ Signature: ~~ Date: /// ~l /~ ~ CST Number: ~^ ~~ PROPERTY OWNER ~A,~'- ~"~/~C~'~ SOIL DESCRIPTION REPORT Page? of •PARCELI.O.~ Lar 5 `T,aN,v~y ~-~C,r Boring # ...~v ~ . Lx ~~< Ground elev. l04 ~'-ft. Depth to limiting fac r ~.~z Boring # ~~~~".~~ k,,,~,k:..: ~.•... Ground elev. /~~• Depth to limiting factor p. ~ Boring # S Ground elev. i0~ ft. Depth to limiting factor > iD.c~ Boring # k.'+3~' ~h !+~' Ground elev. ft. Depth to limiting factor Depth Dominant Color Mottles ' r T t Structure Consistence Bourdar Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color ex e u Gr. Sz. Sh. y Bed Trerxh /~ ~~-J 1dY~ 3 f S L i ~i Cr /Y~ Z Q .a{- .S $ i ~9 y 4 3 ~ ~, L ! n, sbK ~,-~ ~ ~ ! O.Z p,3 ~-gig ~~~~ ~ S 1 0.~ 6 Remarks: A ~-~a %OY~ 3 - L 2 M ~~~ /h'~r ~ S ~ rrf 0.'~ 0.6 $ o-~~ %d` 3 3 _' SAC. Z~ sb~ "~" C S 1-~ O S 0.~ $ t;-~ ion/~ 4 4 `"" ~ C~ r~ 1 tl 7 ~.Ft Remarks: $; 1Z- 3o d 3 3 -- 5; L ~, 5b~ r-~~,~ GS ~ o S O.b -12 1 Ail ~ -` $ ® J'h ~ ©,7 Remarks: Remarks: SBD-8330(R.05J92) i .. r R ,~ ~ W v V ~~ I f I 1 ~~ ~~ ~ , 1 6 pW ~ L ~ ~ m~ ~ '` ~' ~. ~ ~ ~ b r r~ 4 Z C ~ ~ ~ fl ~ ~ O t7 .s .~ ~~ 1 ~ y 1, ~ / 0 ,. ~p~ .jt- ~ ~ ~~ a, .. ~., ~ _ , ~P . N ~ ~ ~ ~ ~ ~~~ \ ~ ~ 'p~ ~a o ~ ~~ ~ I 1 Y~~ i 1 ~ °~ 1 N ~ ~ ~~` ~ ~ ~ N N '~An~N~`i LX1~ir' ~~ ~ \ C 1 r ~pp~l1O ~r wO rNr~^rwf ~ t M r r r~/~ A• rej E O O ~S~E,~S'~~83=~~ ~,..rSr.:~....:".• P e r D$ C r .• A r r 0 .ri ~v~a.,~~~igtio ag O~ YYOD 6Y ,O O ~ ~ ~' w ~ ~ 6 O O C •r• EE411NOf ML PlFEN[K[D TO TNL G2f-1YE M ya ~~ ~ n o n M N O V N r p Y IN IM[ QF KRNNI 11. •ff YYLO TO fl~N sffl2o'oo w. whyy v r`.. .-o o. i S O i~ i r r r C ~ C ~ • S • rrro~oii r~vi: _9 ~~,.e,... D o R ~3 8 • re°D ~ • s o uo~~~a~TED ~auDs --------- ----_ wEfT LINE OF TIK KIN OF TN[ M[W. fCCTION N a n sJ ~~ O ~ '~ ~ ~A mN~ ~~ J IVIm 0 N\ k Dac tOx ~a \ \ h~E40~ b'I/r n 0 m~ ~' ~t~ s_~. --~ z os~ r m ~s r ~ •w l G ` ` y `b o~R °' + ~ ~ xR ~ t Y~ O iN r r'~ ii r 8 ., •. p •,. ). \~~l\ •~01ry ~©Il:a' -12,..r-- .~ W at A' i x : fr 03 179.17 •. ~ r - - - ~ ~, .r..I.N, a I ~ :~ __ % .r.ua p/ -' ~ ~ ~ ~ / --' ~ E0ICATEO m Ia. PUB1.1C -~ 0 8I'~{ ...............~_. \\ ROAD TO T1# ~ ~ f. / ~ ~ ` , ~~ - -3q-MOUND - ROAD SOUTH - -g ~ y 0 ~} \ ~• ~ _ __ x1.17 ___ ----as1.»'--- x~ ~ ~ 0 ~ iRl If- l_......._....._.........._._........\._.....~..... I a e --,) ° ~~ 1 ~0 8 ~a ~ 8,0 / iNV/ ~~ m a wY/V ~ ,C8 O k ~ ~ I .fir 0 I ~ it s p to ~a / 1 w~ ~~ ~ w g .f, ""' N T a~ g '" ~ 1 \ ~/ 1 N '7 N ---~-~ ~. ~ V1 1 • ' a~k ~ 1 122.6' N V 1 1V / qo1 / I . ~ ~ ~ p D 9~ N w 504 4409E 240.24 ~~p y w2.17 141 / of ~ 6' •~ w 11 f=m*1 ro - tjl 11V I d + • ~I u. Im IFv' / / / solar 0 1 r 1 N _ ~ ~ ~ ~ / S00 03 20 W 491.72 no.ao 8 ,aa~ 'TI ~ IN / ~ .uR t ~ ~ tit / /~ i4) i` ~~~ 1f ~~ 1 - m > ° °>. ~ 4 1H 10 }t1 V 03F 1 / i~ ~! iy I-1 `~,, y0 O~ : r 4jQ92 // i~ o IlN IT• p g p 'o ( .r`~', 1•.~_w'!~ 0 I as~(~) ~ ~ D ~ +~g• tij of \~ • N 1 1° >• • ~ °J ~ g ~ 1 > r 4). 8"..; (:..~ ~±-, ~ «00'11'71'w a21.1f !~ ~ BG / 3,_ _,~ N g ..,.,;'" ~_aJ' w ° - ~--~---i i~ I ?o I 111 ` / ` o> '~ 8 r w ~ ~ s3 ~ ~ ~ F ~") i 4 a .......... g r $ ~ }~ i ' ~ J 0 $ R ~ /•/~// s3 ~' ~ 1 1 n ) {~ u a / .r" J6 k' Q / 1 0 i 0 W '` 8, ! - ~ - .4y i / ~ is d~ - -+ ~ I ~ I I ~ ~ Ca ~ ' tg N r' Og sJ :, `09 rINNn ~uu ~- y ID f ~ $ r ''6:. T /1 E ~ F ~ ~ ~ ~. ~ar~os 11/ S m ~ I - a I~ ~ 1 I 0. 0 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/I3UYER S~ l~ M MAILING ADDRESS QO X~ Z g Z ~ y~ 5 O N ~= 5 `~O ~~ PROPERTY ADDRESS I D(o~ TN NK ~ LANE (location of septic system) Please obtain from tl~c Planning Dept. CITY/STATE l~lr~ LlSC ~I Wx S'yD~` q PROPERTY LOCATION S ~ I/4, ~ 1/4, Section ~_, 1'~_N-R ~ / TOWN OF (-~ tJ D S O N ST. CROIX COUNTY, WI SUBDMSION `1`~1 N ~ ~ '~I~6~. LOT NUMBER S-` X CERTIFIED SURVEY MAP S2, ,S ,VOLUME ~o ,PAGE o2SLOT 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 tl~rec years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect tl~e 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. UWe, 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 tl~e 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. f ~~ SIGNED: _-- DATE: ~~ '"~ St. Croix County Zoning Office Government Center 1101 Carmichael Road [~udson. \\'I 5401 G (1/93 .* 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 ownerjcontractor, (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 5,4 /y1 /~ /L L E2 Location of property sF 1/4 NC 1/4, Section ~_,T~N-R~ Township fjyQ SO1V Mailing address BDX ~ Z~ L Address of site ~~(00 '~'A N N Y LfFJV~ Nybs aAI C,c11 ,f~/o/G Subdivision name "T~(N~' l~ I D 6 E Lot no. ;~ Other homes on property? Yes X No Previous owner of property ,p,4NDAL L SYNRl1f Total size of property ~, 01 ,4 C Total size of parcel 2 , 01 A L Date parcel was created ~-/- 9 3 Are all corners and lot lines identifiable? ~_Yes No Is this property being developed for (spec house)? X Yes No Volume /p~_ and Page Number yS 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. 50 y~ SS 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. .so Y8 ss ~. ' nature of Applicant 5 , S ~,--- Date of Signature Co-Applicant Date of Signature .,.::_. _ F' Y ~ ! ` f i ,' ~ DOCUMENT NO. STATE BA F WISCONSI ORM 1-1986 TNi[ svAC[ Rcec"v[D -oR R[CORDiNO DATA ' AARANTY D D .~ ~„`; SO48SS _ YOL ~~~-~GE 45V ._ T~718 D@@(~, made betareen --- - ------------------------------------------•--..... Randall--W. Synan and_Patricia E. Synan, -- ----husband---and wife - ..- -----•-- -----• ----- ---- ---------•----- --------- - -•-----•------...--- --------._, Grantor, ana---Sam E. M31aer, a single person - - --•-•------•-••--•--•-------------•--._.._..--•--- ---- •-•-----• Grantee, Wit @SS@tll, 'I hat the said Grantor, for a valuable consideration--.... Randall W. S~+naa and Patricia E. Synan conveys to Grantee the following described real ntata in _._St . Cz0 X County, State of Wisconsin: r:_CJST~4y',5 OF1C~ ^ec'~ fir Reoo~ti - SEP 1' 1993 ~t Io:4~ 0 .::'M L R~~~ R[TURN TO 6 f ,, Taz Parcel ao: •-------•-------------------------- The SE1/4 of NE1/4 of Section 11; the SW1/4 of NW1/4, the N1/2 of SW1/4, and the South 53 rods (874.5 feet) of the SE1/4 of NW1/4 except the East 74 feet thereof, all in Section 12; all in Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin. F~~+ AND ~~~ A parcel of land located in part of the NE1/4 of SE1/4 of Sectio 11, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin further described as follows: Commencing at the E1/4 corner of said Section 11; thence S89 30'00"W, along the North line of the SE1/4 of said Section, 1212.32 feet to the point of :.eginning; thence continuing S89 30'00"W, along said North line, 66.00 feet; thence S00 28'03"E, 500.00 feet; thence NSQ 30'00"E, along the North line of Certified Survey Map filed in Vol. "3", Page 722, 38.08 feet; thence N00 11'33"W, 150.00 feet; thence N03 58'34"E, 351.07 feet to the point of beginning. This .....-.-•-~-~-.n42.ti__.. homestead property. (is) (is not) Together with all sad singular the hereditaments and appurtenances ti.ereunto belonging; And___..A~~d7~~.- W-,.--Synan--and-.Patricia---E-.-.-Synan------------------ warrants that the title is good, indefeasible in tee 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 thia .--••-•----._.,./.~....-•--•-------•--------.. dsy of --- ~G~Y1dr~T GtJ,.~ .---~'•`~---(SEAL) Randall W. Synan -----.. ---A,ugust--------------------•----•-------•- ---• 19._9.3.. Patricia Synan ---...----•---------------------------------------------•------._.. (SEAL) AIITHSNTICATION authenticated this --.--.--day ot______________•---.-------, 19_----- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, .----- --•- ---•-----••-•--- ----------------------------- anthoriud by ¢ 706.06, Wis. Stata.) THIS INSTRUMENT WAS DRAFTED BY Rristina Ogland At-Forney--a-t._t a W ------------------•-------.... _ (Signatures may be authenticated or acknowledged. Both ----- - ----•----------•-------.....(SEAL) ----------------------------- -- ACHNOWLBDOMSNT STATE OF WISCONSIN ea. St . Croix ----_-__--..County. Au uSL nally came before me ypy ~ .___.___dsy of .... g ------------------•-•----•-------, 19.._y-.3.__ the above named Randall W. Synan, Patricia E-.-- Synan--------------------------------- ------------ •--------•--- •--------------------------••---• Alice---~- -- - to me known to be the person .~_.__..lYa~'l~z~tlthe going instru nt and a n wle~~e(~a~RfCO1LA7s Alice Joy o ors st-;---cr-a X .................... .. . Nota-y Publie ..-._____--•-------•--•------•-----•-----County, Wis. My Commission is per` neut. ~jf not, state ezp~ation