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o `� o : 303 0 d 5't f c 9 A c .. � 7 C1 3 � r M (n .T Z Z F O -1 Z N Z O V I = V N O• fD O O y O= C c 4. m CD CA c N N O ' g y a O a p co N CD N C CD n c ro COD O d. 7 CD P A N A A� 3 0 0 0 o A o CD f f U. CD CD CD 'm O y a C n• O m y CL C :0 y O 9 W O W d C a c 0 0 a c _ O= ` CD O a I�1V to CL CD > > J O O T O y cn N Q Z OOOa 000 °'� gg o gg gg v co 3 �co N; s3 CO) N°' d Q v v Q v o 7 CCD e'D :: y m m y < CD CD (WD m m ? m ,�—�, !D f !r o v 0 m d O m y rn 3 C — N N a w Cl) w y o D o D(D o O �i O ?� O ° o m o Ns m � m � y ~ y O (D N O N R w c a m n Z m C -i N �_ ? N O N O A n n > A Z O a a O 0 Z -I m A m m m Z O O ? O M O :i fn -+ O ! to ;o y Z < m A Ca CA) 7 D CD 7 a PD a r c' m c � v c o o a ! v o a j• n N o a N m m I I n �. CD I a s o CL a cn 0 CD CD m 7 N a o' ON o o b v ! m m e O C» O w ° ° CD C) i CD CL COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800 - 962 - 5227 C: ST. CROIX ZONING REPORT NO, 08934/01 PAGE 1 ST. CROIX COUNTY REPORT DATE** 8/15/90 COURTHOUSE DATE RECEIVED** 8/14/90 HUr", WI 54016 / /} /� ATTN** TOW C. NELSON 7 ", OWNER** LEdw"ard y f Z. ` < Q 2 7i LOCATION** , udson COLLECTOR** M4 Jenkins SOURCE OF SAMPLE! Kitchen faucet COLIFORM** 0 /100 at INTERPRETATION. Bacteriologically SAFE NITRATE -N** 4 Ppm Under 10 ppm is safe for human consumption. Coliform Bacteria /100 ml Nitrate- Nitrogen, mg/L LAB TECHNICIAN** Pam Gane WI Approved Lab No. 19 Ot .NDEDE V0 V ' o` 4P Z o C Means "LESS THAN" Detectable Level Approved by** PROFESSIONAL LABORATORY SERVICES SINCE 1952 r ' 3 1 I t National Pa nk of Hudson 307 2nd �c t Hudson, W1 54016 ST. CROIX COUNTY ZONING OFFICE `7 / `� u! St. Croix County Courthouse 911 4th Street Hudson, WI 54016 e ephone - (715)386 -4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING--------------------- - - - - -- -FEE: $ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $127.00 (For VOC'S) SEPTIC SYSTEM INSPECTION---------- - - - - -- -FEE: $25.00 (Determines if system is properly functioning at time of inspection) Property owner's name Property owner's address Legal Description 1/4 of the 1/4 of Section , T N -R Town of Lot Number , O. Subdivision Nam /=r PS FIRE NUMBER LOCK BOX NUMBER Color of house Realty sign by house ? If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A C OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: F/V6 Z"7 Telephone Number :2-/!� 3 9,�, -55 // REPORT TO BE SENT TO: l — Closing date .5�9 Signatur of Hudson 307 2r:s `. i' i Hudson, IN 1 54016 }r h ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 -_ (715) 386 -4680 Aug. 14, 1990 Kathy Macknick First Nat'l Bank, Hudson 307 2nd St. Hudson, WI 54016 Dear Ms. Macknick: An inspection of the septic system of the Edward Kelley property located at 944 Wert Rd., Hudson, WI was conducted on Aug. 13, 1990. At the same time I also obtained a water sample for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspections. This not not in any way warrant or guarantee the continued proper functioning or operations of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance of the system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary J: Je kins Assistant Zoning Administrator cj C PJMERCIAL TESTIN k 52 BORATORY, INC. 514 Main Street, P.O. Box f Colfax, Wisconsin 54730 715 -982 -3121 800.982 - 5227 ST. CROIX ZONING REPORT NO.** 17387/01 PAGE 1 ST. CROIX COL14TY REPORT DATE: 1/30/92 COURTHOUSE DATE RECEIVED' 1/28/92 HUDSON, WI 54016 ATTN' THOMAS C. NELSON OWNER' Edward Kelley LOCATION** 944 Wert Rd., Hudson COLLECTOR** M.Jenkins DATE COLLECTED' 1 -27-92 TIME COLLECTED** 2'15pm SOURCE OF SAMPLE' Kitchen faucet DATE ANALYZED i 1 -28 -92 TIME ANALYZED **2'OOpm COLIFORM' 0 /100 ml INTERPRETATION' Bacteriologically SAFE NITRATE -N** 8 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria /100 mL Nitrate - Nitrogen, mg/L 8 9 N z0-, U-) p20 0 LAB TECHNICIAN' Pam Gane m co © . P1140 . WI Approved Lab No. 19 { Means "LESS THAN" Detectable Level Approved by' z PROFESSIONAL LABORATORY SERVICES SINCE 1952 a ST. CROIX COUNTY ZONING OFFICE St. Croix Count Courth use a' y 911 4th Street : , ., :•,'� Hudson, WI 54016 Telephone - (715)386 -4680 WI' St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion`of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING--------------------- - - - - -- -FEE: $ 25.00 zE. 0C) (For nitrates and coliform bacteria) WATER TESTING FEE: $127.00 ( For VOC' S ) pZ� SEPTIC SYSTEM INSPECTION---------- - - - - -- -FEE: $25.00 (Determines if system is properly functioning at time of inspection) Property owner's name Ed"-Ij Ca-4 -6 IR - L j LC Property owner's address q %4 H LUe- [4uj W /, Sc401 Legal Description 1/4 of the 1/4 of Section , T N -R Town of P,.t- yy Lot Number iqJ Subdivision Name j2,LEk-U ts&k,� FIRE NUMBER LOCK BOX NUMBER Color of house Realty sign by house? If so, list firm: l' PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting sere ces: t Telephone Number S5 1 _ Y REPORT TO BE SENT TO: - Closing date sA Signature ST. CROIX COUNTY WISCONSIN ZONING OFFICE r ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET a HUDSON, W154016 _ = - (715) 386 -4680 JW Jan. 28, 1992 Doreen White First National Bank /Hudson 307 2nd St. Hudson, WI 54016 Dear Ms. White: An inspection of the septic system on the property of Edward R. Kelley, located at 944 Wert Rd., Hudson, WI was conducted on Jan. 27, 1992. At the same time a water sample was obtained for testing. The results of that test will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. � r 8irlcerely, Mari" . Jenkins Assistant Zoning Administrator cj Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �.� TOWNSHIP ,ED V"\ SEC. ! 7 T c z � / N - R �g IL ADDRES ST. CROIX COUNTY WISCONSIN C'o SUBDIVISION �,, L E + / 6 �� LOT SIZE 4en � cc✓ S PLAN VIEW Distances and dimensions to meet requirements of 1,114R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM wC' ! I d - o oG /f i - o Al e a , I Ad I; DIC TE NORTH ARROW BENCHMARK: Describe the vertical reference point used ( ��`{' �, r)� E Co✓ A/af i Elevation of vertical reference point': /00 0 Proposed slope at site: a ** A in SEPTIC TANK: Manufacturer: (jj(r-� 5 Qr Liquid Capacity: t — T Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road.: Front, Side Rear, Q feet 71 x ".? From nearest-'property llie .;' Front, 6 Side, ®Rear,O feet Number of feet from: well j , building: �S��nr�, 5't-q . (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear Ft. Number,of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Ua c'J big g, Trench: Width: Length: �„ l Number of Lines: Area Built: y T. Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,( O Number of feet from well: 9 Number of feet from building: - (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, Ft. \ O Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: .Inspector':, 'C Dated: Plumber on job: OU License Number: / "l /" tr � 3/84:mj � 1 DEPART OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 000NVENTIONAL E:1 ALTERNATIVE State Plan l.D.Number: (If assigned) ❑ Holding Tank 1:1 In- Ground Pressure ❑ Mound NAME OF PERMI OLDER: ADDRESS OF PERMIT HOLDER INSPECTIO AT Sam Miller RR #1, Box 282, Hudson, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. NE SW, Section 17, T29N— R19W,Town of Hudson,Lot #105,ParkView Est IV app, 00 /llG Name of Plumber. I MP/MPRSW No ] Tnu my Sanitary Fermat Number: Douglas Strohbeen 5432 St. Croix 75023 SEPTIC TANK /HOLDING TANK: 9 fe MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED PROVIDED V /DDD ��� /p'�Q YES 0 N DYES ONO BEDDING. V DIA, I VENT MATL HIGH WATER NUMBER OF ROAD: PROPERTY W. VENT TO FRESH ALAHM FEET FROM l LINE AIR INLLEET ❑NO / C.. [:]YES ❑NO NEAREST !l DOSING CHAMBER: MANUFACTURER 7 1 NG. LIQUID CAPACITY PUMP MUUEL PUMPrSIPHON MANUI ACTIIHEH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED ES ONO OYES ❑NO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPEHTV WELL BUILDING JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) OYES ONO NEAREST ip SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I l f NLITII 1 1DIA1,11 TEH I IIATI HIAL AND MAHKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORGE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH I LIENGTH DISTH OF PIPE SPACIN('. COVER //J J INSILL DIA SPITS LIQUID BED /TRENCH 0 ` T NO O 'S n`Y�r�eyw PIT' DEPTH DIMENSIONS / (p � /� GRAVEL - DEP H FILL DEPTH UISTH PIPF UISTH PIPE DISTR PIPE MATERIAL NO DISTH I NUMBER OF PROPERTY WEL BUILDING: VENT TO FRESH BELOW PIPE /��f ABOVE VER El N ! EL E U PIPES ' LINE fJ AIR INLET. FEET /T (p P . (!' • �, NEAREST O - MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES ONO SOIL COVER TEXTURE IIItMANI NT MARK IHS OBSEH VATION WELLS DYES ❑NO ❑YES NO DEPTH OVER TRENCH BED I DIPTH OVER THENCH HEU DEPTH OF TOPSOIL S)1 I) SFFUFD MULCHED CENTER EDGES ❑YES. 1:1 NO ❑YES ONO 0 N PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TR EONCHES LATERAL SPACING J GRAVII DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV. DIA. ELEV. PIPES DIA.. ' DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT L COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLAINS OYES El NO OY ES ONO COMMENTS: PERMANENT MARKERS: J OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: OYES 1:1 NO [:]YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIG T R TITLE DILHR SBD 6710 (R. 01/82) �w'S`° APPLICATION FOR SANITARY PERMIT �rDiLHR COUNTY � DEPRRTTr1Er7T OF (PLB 67) UNIFORM SANITARY PERMIT # kinDUSTRV, LABOR 6 HUMRn RELRTIOnS 7 ` O .7-3 — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /2x 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS 15r l 4 2-13 PROPERTY LOCATION 1 /450 A S , T,?,9 N, R Iq E (or l OWN OF: L T NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE P AN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity ,� D c k Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic /�� Gallons Tanks Concrete Constructed Septic Tank Capacity /(/ Lift Pump /Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ❑ Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Sign a MP /MPRSW No.: Phone Number: Plumbe 's Address: Name of Designer: tan 0 a i 5 t) COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: El Disapproved _10P Q/1 ^ a y) ❑ Owner Given Initial Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR -SBO -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber 1 . INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. i Ir ! � P 7 4 T Z • 6' d U- o i a d �' �� d oho = I \V , �... J w + -s . LL' E.Ll I t � J � NT j dX ! I s . i ! i 1 i� t ! d - iw i n 7 j x T bo i ET u' .01 f, i R � i M G � •' V 1 1 I i I • � al � � d - I �� \ `` � 5 •�" it L Al -w• _ o DEPARTMENT OF REPORT ON SOIL BORIN D S AFETY &BUILDINGS •INDUSTRY, ,� :.. DIVISION LABOR,AND PERCOLATION TE. ° � 61 P.O. BOX 7969 HUMAN RELATIONS f MADISON, WI 53707 (H63.090) & Chapter 5) 4 LOCATION: SECTION: TOWNSHIP /fe4l"CIPALtT1i?S,M1 LK. S DIVISION NAME: COUNTY: OWNER'S /BUYER'S NAME: MAILING ADD C S 1 O_ r0 X J ���C /G�K�� �c �Lt W i �f . S 01 USE DATE RV TIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: DESCRIPTIONS: IPERCOLATION TESTS: Residence t / New ❑Replace _� _ /O _ �� p 5 0i , / I4!/!/ N r / v RATING: S= Site suitable for system U= Site unsuitable for system S C O CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM:loptiona1) 7 S DU (ES DU S ❑U 0 S ®U ❑ S ®u Ca,A61 36� If Percolation Tests are NOT required DESIGN RAT If an portion of the tested area is in the under s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: PR FIE DESCRIPTIONS ec BORING TOTALI DEPTH TO GROUNDWATER 'PIG' IE6 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH INW ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) C_ 7 9•S' BSI .3 B B- ?. .S' l . 7' �I�.KL '7• s' �t3 /S �. S /.. (o B s/ r ..s r . s S B- h X4 t S d A3A2 S or OF I B- PERCOLATION TESTS TEST DEPTH or WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER fW6#E3� AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PEIJIOD3 PER INCH P- 3,4 alo 6 •� 3 P _ 1- g r Ala .2 G L 3 P- c A/0 P -_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYS ELEVATION 9s y i , - -i• JN TF- i E I 8 I I o 113, o r �..�_ Q. 4 t ; 1, the undersigned, hereby certify that the soil tests reported on this orm were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: P ZAJ'Ad-> 0 11L, �, - L - 0 0 y ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST S A URE: � r DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SI3® - 6395 To be a cyplete and accr €rate soil test, your report must include. � 1. Complete legal description; 2. The use section rnust.Nearlyondicate whether this is a residence or commercial project; 3, MAXIMUM nurnber of bedrooms or cormYaercial use Manned; 4. Is this a nevv or replacement system; S. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HQrLDING TANK ONLY IF ALL OTHER t SYSTEM S ARE RULE40UT BASED ON SOIL CONDITIONS; 6, PLEASE use tFrr mbbreviations shown here for vvriting profile descriptions and completing Be plot plan; 7. MAKE A LEGIBLE diagram accurately locating ymir test locations. Drawing to scab; is preferred. A sepaarate sheet may be used it desired; S. Majk,e sure your benchmark and vertical elevation reference point are clearly shovAvn, and are permanent; fit. Complete all appropriate boxes as to dates, narnes, addresses, flood plain data, percolation test exenip- tion, if appropriate; 14 If Be hoormation (such as flood plain, elevaadon) does not apply, place N.A. in the appropriate box; 11 . Sign the forma and lalace your current address grad yo£n certification nurnher; 12. Make legible copi and distribute as required, ALL SOIL TESTS MUST BE HLED WITH THE LOCAL AUTHORITY WIAAN 30 DAYS OF COMPLETION., ABBREVIATIONS FOR CERTIFIED SOIL TESTERS y +. Seal Separates and Textures Other Syaobals r st -- Sr:aon_, lover 10 ") BR - E3edrr7ck W) — C1op31: h Q - 10 ") SS - Sandstarae plr — G ;vel (under 3 ") LS LirrvAorr `s — ssul € l4GV Wtjh Gnus ;as Ls C {;<ar= #': i,tf3 Pere, _ P:a,£r }lr? OU We 4 -- F i W Vii; ;id BMg _.. B i inq _ S and IN - rsf�r „jt `stand G rt:a,er IFtra _ s' I Sandy Loam Vh3,w, "01 5dr Loom 131 Flock Id - Clay Lo y -- y C a,.ar ,x c! ._- can G ”; { 1 'i'er wa ( --- Red _ s=cl _ Srl;b" Cle 1_r>arra n?£ar M ztle y "�",;,i3rav t '° ,ra�vf boy Ic_:i;. I "e f?t',Y Tx gemr al sot€ r ytumr , 5:1 faGf e .. r ;t;: of saw disposal l`-p =<rl - (3E,ra M fr "": VRP — WWI i TO THE OWNER, , This sail test report is the first seep in securing a sar °dtaary paernot. The co£arrty or Jm Department array re<luest vv itic<ation of t(tis sail test in the ter d prior 'a parrin i ky a acy A mmp by seat of pknn for the private _..arje ys€ rn and a pwmh appalicat,on lYuq b e 9L5r73Awd io O ap prophare vocal aWhoify in order to +YikSa"I „ ouraAL T s, ?"y perrnii nvw E.W E, lamed a nd p?fs5tod I for to I �_ ;tan of a cotlActlon. H ST C- 105 r H SEPTIC TANK MAINTENANCE AGREEMEN'1 0 St. Croix County z d 9 OWNER/BUYER SCE n ROUTE /BOX NUMBER �'� %o y 2g Z-- Fire Number CITY/STATE �c �.� J 7C� �° - -- -ZIP S{{Q PROPERTY LOCATION: 4, SGT 4, Section - / - T Z�N, R_� Town of N«c/S en r. I" St. Croix County, Subdivision - PalkV;,,vL�t'��` E _ Lot number 16? Improper use and maintenance of your septic system could result in its premature "failure to handle wastes. Proper maintenance con silts of pumping out the septic tank every three years or sooner, if needed, by a l icensed septic tank pu What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to receive a brunt for a ma 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 syste agree to keep their systems properly maintained. ^Y The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- ess "ary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. o I /WE, the undersigned, have read the above requirements and agree Cn to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- lid ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. —� S I G N El DATE St. Croix County Zoning Office P.O. Box 9i6 Hammood, W] 54015 715 -7)6 -2239 or 715 -425 -8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT STC - 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 S IM , 11 Location of Property /) jE It 1_1t, Section / 7 , T Z 5 N - R / 1 Township A r Z S e n Mailing Address (2 2 I go X -0 - 2 / Subdivision Name 1 �,r k V; : "a Lot Number Previous Owner of Property t.y C-,r Total Size of Parcel /• 0 �.¢ r 5 Date Parcel was Created Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? _ Yes No Volume ��_ and Page Number / Z-- as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 1...- Warranty Deed r' 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. --------------------------------------------- PROPERTV OWNER CERTIFICATION I (We) eeAti.6 y that aP.t 6 tatement6 on th,i a 6onm one t u.e to the but o 6 my (oun ) knowledge; that I (we) am (are) the owner ( a) o 6 the pnopen t y de cA i.bed in .th i,a in6onmati,on 6onm, by viAtue o6 a wanhmanty deed neconded in the 066ice o6 the County RegiA o6 Deeda as Document No. 3- q '-Z ; and that I (we) pnea en tty own the pnopoe ed a.i to bon the sewage pos system (on I (we) have obtained an easement, to nun with the above du ci i,bed pnopen ty, bon the eonathu.ction o6 ba,id dyatem, and the name has been duty neconded in the 066.iee o6 the County Reg-i.e.ten o6 Deeds, as Document No. 3 3 V C SIGNATURE OF OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ! DUR ION A RURAL URAL Sj6DV 510N ! _ TED 1N''TW- I. EA- a >tWWSE *, EC: T ION 17, T29 N. , R19 W. G'r +N tom Mtn, ST Cr:ROX C':Ot.iNTY 'WISGONS)N C3.stTI3'ICA T E OF TOVW T3tli/S[iftZR STATZ OS 71i3CCNSL4) . ST. atOf.TC04 - t ,Y ) 1, 2awwrly A. 3ohstsoa, bsfaR,LSe aaiq el+ciadi qualutad' and acting Town Treasurer ad the "Town of Hudson, do hsreby certify that in accordance r}.+o�rda in my office, iai Caere are no unpaid takes or spaa aasessraeats as ofI X as aay IjWA inaltaied is the ;Flat of Paris View-Zataust Fourth Addition. y y - LyA) �T 1� i Beverly . ..obns Town zeasarer � TOWN BOARD R ZSOLUVON RESOLVED, that the Plat o! park View Estates Fourth Addition in the Town of Hudson, Darrel E. Wart and Bev e A. Wert, owners, is hereby approved by the Town.B"rd. , :] / L'a a own rtnan _ p �r [> D ed own C- %airman A aerabY ca -tiiy that the forrgoinq if a copy of a resolution adopted by the Town j Board of the Town of Hudson. IDttO own Clark i I OWNXRSt CCRTi= ICATE OF DEDICATION As or•nern, we hereby certify that we caused the land described on thi Plat to be suzvsy -c', ?i' ri led, rrapped and dadirated as reprevented on this Plat. W,, also certify that shit Mat is required by S. Z36. ID or 5. 230, 12 to be submitted to the following for appro..al or objection: Dspartmeet "i Developmettt liaoartmant of Industry, Labor and Human Relatic•ts, 1 Town of Hudson. City of Hodson and St. Croix C*+.nty. Vf;TN 5S the hand and real of said owners this _ ' day of _, _ In pr'�'1 esence of: r r. / arr15 er fle"rly A. Wait i - j STATE OF WISCONSIN) 5S ST, CROIX COUNTY ) Personally carne I e before me this " ay n( _ _ the above named Darrel E. Wert and Beverly A. Wort, to me known to be the parsons who executed the foregoing instrument sad acknowledged the same. i Notary Public c'�' ,i,4, .2 „2, Wisconsin My / commission expires btar�R tsc�a Public ;- CKATIFICATE OF TOWN CLERK STATE OF WISCONSIN) ST'. CROIX COUNTY } I, Alta e, being the duly appointed, qualified and acting Town Clark of the. Mown of :!rdson, do hereby caZify that copies of this Plat were forwarded xs required by a. 235, 12 on th+ day of 1984, and that within the 20 -d2y litnit set k•y s. Z36' (3) (no objects ns to the plat have been filed) (all ohj c :inns to hr =;at have been mot). Dste tit Horne, Town Clerk t JAMES E. RUSCH SURVEYING & MAPPING HU SON WISCONSIN THIS i43TRWP.NT CRAFTED III 1 1 +r, t y% +� 3 _ i i j MMNIXTt281 CEATUICAM I. %Onozr X ltumvit. Roginteved Wtsessais land Surveyor, how 94y cartify to the best et 271)*'P6960eaforsl knowledge, amderetasdsrxg sad belsef: That -Ih vw sssow1v4. divedod sad roapp -t Pazk View Estatas:Ponrth Addition, . loca*ed is the= NZIA a* Mr SW 114 &" the NW 1 f 4 of the SE1 14 of Seatioa 17, T24N, R 1911. To" .*f 11640024 St. Croix County. wiacoasim; That I have raade each Survey. land divinion and plat by the dimaction of Darrel E. Wart aei Mort. owasre of said Lend, described as follows Cemmoncift at the El/4 corner of acid Section 17: tbenee 389 (assumed hessimps reEersste+d to the msaankmied (CAST -:!EST 1/4 Soe*ioa Ilan xW 34ettoa I7. boar"S:saaaesed SE4'22tOt "1YT (record" as 3W2I40 1 SC on that C•rtift od Srrny Usp reoaeistLs Yetrms 1,. A�r 194). 1332.98 along sold EAST - WZST - I14 3ectfon 11net tit oe iO w WW""W- 227.7'3 to the pains ad bwgianisg; thence I48f52 "a` 412.00 theses. Pt0 212.0@ to the Southerly rigUt -of -way Use oI Green BILL Lane; themes ?389 ".04 along said right•04 -way line; thence W04 231,00 ther•es j 579"26iSZN; 114.35s-thaaceS89"15 "W 236.74 thence NW57%5"W 1 4Z. 17 thence 339'15$L4MW 358.0Oe;':Uwte+ N006 104,00 those* 889'I8 3t#.OWi thence NVw. 1 r "Z 153,W; thsraet SWI3 66.01 theses SO'06 W 316.'13 theses 389"I5 W- LSI.00s; throes 1 40-37t5 1"W 34. 18 theme* 889"2269" W I4t.3 thence s0OPSOL R 204.48 thence N4+9'13 150.00$ thence 3006 _ 31L 97 thaeee N8!°1St14"l�- 1SA.00 thamei.Soathewstsrly b6.25s along the arm -of a.3&3.00t raAlua cpsyseomcsbe:ftorehesettzip whess chord Dears _'W50 50 66.27, thence, NW15 "1: 0. 01et theme Southeasterly-136.M along tba ass of a 311.00 Tadius eerve eoeeave `4ost1►asrter}1qq abose chord booze 824 03 "E 13.51 thence 836'23 143.14 threes N7PSds70" v 160.96 theme* N8r15!14 "1+243.00 thence 3e'o6ru -W 108.00 theme* 133 254,16 theses Southessterly 96.14 along th* arc of a 217.00 sndloa tetvM.oeoeevs Ltortiss[eteriy, whose shosd brasa S78'03. 16 "8 "_St; thane* WjWW14M 920.0A thmsee Northeasterly 91.21s along the &" of a,3o0.Ad radius csa00 4400 MII Nnrthwestesly Vaasa sherd beare It8032 94.85 thesteo North- Vostasiri 91 40 ado the s.ro et a 300.00 radius curve avocavn Pfotthessterly whose chord Sraus bT8'31 91.09 atone. rto.0 3tt "E I30.09 thaaea 1189'25 14 s 473.{13iy tkewco W06 834.56=1o.the poin* of begisaing. Thew such plat Is s, correct repzsoesdatioa of all the exterior botmdsties of the Is" warray" and the subdivisioe there" titads, sad Tern I have Sally oesnpllod with the provisions of Cbapter 236 of the WtscoesLn SUA%40#s the sabdivteirn am Zoning Regniatiers of St. Croix County, tae -'oven ui llt;ds,ea Sebditltsfaa 0WAI amee, &PA the City of Hatteoa Sabdivlsloa and 'nttriag t?rdi- Dance.. is marveling. dlvkUss and mapping the ram*. t Dated this' -� day of MMbQA_. 19 R ISth do of April, 1984, a*ro li. Deck - - I Mm 421 Seta" Street am Hodeos Wisconsin 54016 was . COtTD4?T T1tlCASU1tE1te3 CERTIlICA ?I: STA7X or VIVICONX20 ST,. CItCgX COUNTY ) sa I. Uaxy Sams Livermore, being duly elaetett, qualified and &cuing Tnmeursr of St. Croix County, do hereby certify the* the recouds in my office show as uaredastnod tax sales and ac trupaid taxes or special ameeesMante as of &Hoctiwg the leads included in the Plat of Park View lts*atee Fourth Addxlon. Date y Trezamurer 70NING CObi3.flT'.C,CF r4rsoixTion This Plat Is hereby approved by the St. Croix County Comprehensive Park., Fla"Ing and 7oning iornmitt". r A UAte Ghair'ft>:► Data Administ A. df6l STF�'S r # ;N�. S ; tiws 1 1 ✓t •� F *. C f w �ix` �,'� � � ��� �: �` � ✓ '.,d � dr. 'r= � � O ry) z m0 c : E o c 0:Ei moss I 0 = cc a0C co v vi E (D .0 >' cC7 0 U3 0 .c � � rn � '� •� vi C7 3 � c 0 c 0 0v_� --•- ;2on� a EC vE Q v�_Wcv> >g c .. cm 0 > N 4 ° w 0 Y 0 E o (D c 0 4 0 ._ o L t a C C U_ O (D Q O 0 O t - w - c c CC W N �Nw 0` �� a H Q E ON C m C ~ F— w cd «' L N t0 ti Q � rn ; ai� 3 '' N ~c m� — o 7 tv _ 0 Cf V O 7 ` Q 0 `' N N (7 O N a) > Q a a " co C O a) CC i C y 0 '0 0 O U) O O a) r ` 0 3 cm >.� rn c 0 C « `- O cC O y CO \` �� a i V 0 O E 0 v d co L C O Q . 0 a) C >, co O " 0 Co cc - �` 0 00 m �v o c° i V c 0 a in ; U) cn — 0 0 CD :3 o 0— 4) 0 -0n z cti cv c0 O O O p o� �T►.� C 0 0 0 Y CL E a) 3 C cm / C O >. > j a) C t N N m p O EN U, yam:° f- °' N C = N O SANITARY PERMIT APPLICATION Safety and Buildings Division Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. _S� - • See reverse side for instructions for completing this application State Sanitary Permit Number 2 The information you provide may be used by other government agency programs ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prop rtyownerName Property Location NEi /4 1/4,S 1 T ZC1 ,N,R /cJ E(or Property Owner , s Mailin� Address ` Lot Num be Block Number %t -u i_ Cit , Sta e Zip Code Phone Number Subdivision Name or CSM Number 5 1 'S'�}G) (D lls f3 — 7� a.t k i cw II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ C t y Nearest Road Z El VIl age ❑ Public &1 or 2 Family Dwelling - No. of bedrooms V Town OF \., ..1 III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo Z� ° �o �o — Z 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 ortly one box on line A. Check box on line B, if applicable) A) 1. ❑New 2 E] Replacement 3- ❑ Replacem t of 4 Reconnection of 5. Repair of an ----- System -------- _ Tank Onl _Existing System ______j_�__`E - xi sting System B) E] A Sanitary Permit was previously issued. Permit Num er Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 Koiss(eepage epage Bed 21 E] Mound 30 E] Specify Type 41 E] Holding Tank 1 Trench 22 ❑ In- Ground Pressure /�, 42 ❑Pit Privy 1 X `� 43 Vault Privy 13 E] Seepage Pit �3 ❑ Y 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation Go �, 8 Feet 9 7?:� Capacity VII. TANK in Ca allo s Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New ExIstin strutted Tanks Tanks Septic Tank or Holding Tank pC= -cr ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Ati be Name: (Print) Signature: (No Stamps) No.: Business Phone Number: 'S -t 14 Ire D % �,.� r� c� 6= 1 - 716 , 3496 - 213 0s Address (Street, Z - 9 City, State, Zip Cpde): ,54 / O '� :s* • �Cl b W �• IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued IssuiZgn4tsl nature (No Stamps) f'�' p []Owner Fee) Owner Given Initial �(C" � ! Adverse Determination JJ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Dive 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. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3815_ To be complete and accurate this sanitary permit application must include: 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 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7_ VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber 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 1/2 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 contamination investigations and establishment of standards. s r� D J i -' co ou w � s 0 � x � % V' P 41 f o� 1 �4 C S i f I i } x i to LN I a r' d A P p r � � P co U � • P -� I 6 iA f ti tA (T, + (n -+ p p rn P _ o - 0 tA V ►n P f P P p ? Q U N U _. 0 IM r' Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 2 Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code A.C.E. Soil &Site Evaluations Attach complete site plan on paper not less than 8' /z x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsiots, north arrow, and location and distance to nearest road. Parcel — 1.0.# APPLICANT INFORMATION - Pl"se print all information. R e t Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). e 4 Z ��' !f / Property Owner F Edward & Patricia Kelley NE 1/4 SW 1/4 S 17 T 29 N,R 19 W Property Owner's Mailing Address ck # Subd. Name or CSM# 944 Wert Road Park View Estates IV City State Zip Code PhoneNumber ❑ City ❑ Village ❑Town Nearest Road Hudson WI 54016 715- 386 -7662 Hudson Wert Road ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 ❑Addition to existing building ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ftz .8 trench, gpd/ft' Absorption area required 643 bed, ft' 0 trench, ft' Maximum design loading rate .7 bed, gpd/ft' .8 trench, gPd/ft Recommended infiltration surface elevation(s) Existing system elev. = 95.80' ft (as referred to site plan benchmark) Additional design / site considerations Soil evaluation conducted for Terra lift rejuvination of existing hydrohcally failed system. Parent material Outwash s & gr. Flood plain elevation, if applicable NA ft I S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fil Holding Tank U=Unsuitable for system ® S❑ U X S❑ u ®S ❑ U ®S ❑ U NS El U ❑ S® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft' Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bed !Trench 1 1 0 -10 10yr2 /1 No sl fill 2 10 -22 10yr3 /2 None A Ground 3 22 -32 10yr4 /4 None sl elev 99.70' ft 4 32 -50 10yr5/4 None s & gr - 10 r5 /4 None s !� 5 50 -90 Depth to Y P limiting Soil evaluation conducted with hand auger at request of property owner. Loading rates not calculated due to inability to determine structure of sal. factor Horizons # 4 & 5 would have 0.710.8 loading rates if a morphilocal evaluation were completed. >90" Remarks: CST Name (Please Print) Signatu Telephone No. James K. Thompson.— 715- 248 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, WI 54020 6/12/99 3602 1045 CggX99 — COV ,'` �VING )`V i • , ' �. 30'3 E d cc�orrd ;c; Lot oic - ecJ Es- 62,,*s So; ObS oo,6"on Ae / /ey /IEYYSc,>iy, 5tc. 17, 7 e /9W 9yy GJcr� �oa fi�K�Sav7 t c7 /. S�/O /G Tn' N '&cal d 0 [E• T,00{ ( r vc�' c�Ee F; e rac% ov = 99.l s' E/e �io t�le(o �� ocU. w 00 -� - -- 0 EJriS�.n9 0 . / �Ydfo n ,Y/d 5Auf4 4md. /'7,e 3ca.co �A:55LLM� • e ei - / M --f`oe D SAFETY & BUILDINGS OF BORIN. :- DIVISION �T EPORT ON SOIL 7969 R , � P.O. Box ,AND PERCOLATION TE MADISON, WI 53707 A RELATIONS & Chapter 1i�15 5) f 9 (H63,09(1) P DIVISION NAME: < TOWNSHIP Dp /f fdfCIPA[ '�E,�y, /, , /! yA I •/ 1/ E T O � T.Z`� N /n J� I to i � I� V 1 c F /�_ COUNTY: OWNER'S U R'S NAME: MAILIN ADD 6' "V( "s. SYvC i6 .r �.,• DATE RV TIONS MADE A N ESTS: USE I NS: d �j NO.BEDRMS: COMM R A DESCRIPTION: xNew Replace .��_ Residence Av RATING: S- Site suitable for system U- Site unsuitable for system S RECOM CONVENTI NAL: MOUND: IN- GRO UND - PRESSURE: S STEM -IN -FILL HOLDING TANK: MENDED SYS �M:(optional) ' ®S DU �1S ❑U S C]U D S ®U EIS ®U COA4 If Percolation Tests are NOT required DESIGN RAT If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PR FIE DESCRIPTIONS s BORING TOTAL ELEVATION P H TO GR UNDWATER HIAICi+E6 TO BEDROCK IF O S (SEE ABBRV. ON BACK jEXTURE, AND DEPT NUMBER DEPTH He OBSERVED 3 g . 75 p , '� ' ,t,l�.�` 7• S' ,C3 S , s . !o s/ r t r S" r� S ' hs h tit t Sd Ys 9. . B- PERCOLATION TESTS DR IN WATER LEVEL-IN HES RATE MINU CH TES TEST DEPTH WATER IN HOLE TEST TIME PER IN NUMBER ffi6iFCf3 AFTERSWELLING INTERVAL -MIN. P- , 6' - 3 P- A10 P- A10 aZ P -- P- P PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- cation on the plot plan. Show the surface elevation at all borings and the direction and percent zontal and vertical elevation reference points and show their lo of land slope. SYSTEM ELEVATION IsS -- - - - -- - i i i I -I I { -1-- -r -�-- i .._.. I, the undersigned, hereby certify that the soil tests eported on this orm were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. TESTS WERE COMPLETED ON: NAME (print 09 CERTIFI ATION NUMBER: PHONE NUMBERIoptionali: ADDRESS: — S'�o!6 S Y —3 6 CST S A URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) - OVER - ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �w c ��. tr ; c -, c- I'�-e. I t Mailing Address °� Property Address (Wrificatioa required from Planning Department for new constructioa) at3atate _ LA ti• cl -a o o, u 2 Parcel Identification Number U Z y- I 1 G - a_ v LEGAL DESCRIPITON Property Location del c %, S Q y, s ) . T z _ N RAW, Town of Subdivision _ ?c. 4 � 1�7 \,/ Lot # / . C rtified Smvey Map # Volume _ . Page # Warranty Deed # Volume . Page # Spec house ❑ yes ❑ no Lot lines idenffable ❑ yes ❑. no S3�S1EM��1�I�4�1"I',EN�INCE .. - ��ofY' o�s�icsysecmooaldres�tmitspeti�atucrfa�ca�etohandlewastes .PropermaimOcaaaoe Consists of pumping out 60 septic tank cvCry throe y,e= orzom if beedcd by a rreeased What you put -into 6u system Caa affoct6c fimeti= of ae, sep tic to &n.a ti�atm sbge is the wasteavosal-gstem I7rc. ProPerlY owner agrxs to :trbuznt to St Cbmc ?.cuing Departma t .ccdfiaadoa form, sigaod by tho owncc and by a p ] y�P restadodpbmberoriH =scdpumpervrafyingttLat(i)&eoa iGe is is Proper operating Condition and/or (2) after and pumping (If necessary), the septictanlc is less drag 113 fall of sludge. tom, ffic mdem4xdhue read the above requirements nerd agcue to maiadia the private sewage disposal system 6be standards at fords Lock n set by the Dgwimkad of Commerce sad the Departmcat of Idaftd Res oaa - State of W�oonsin.. Certification that YOM sePtic systemhasboccemaiatainedmastbecompldedandwWmedto St, Cmix. County ZoningOfficewithin30 f the &= year c#xfion data. '7 / SIGNATURE Ot APPLICANT DATE OWNER• C WMCATI<ON I (we) certify drat all statements oa this form arc true to the best of my (our) knowledge. I (we) am (arc) the owner(s) of descruxa above, by virtue of a warranty dood moor cd in Register of Deeds Office. SIGMA � =that CANT DATE «sR «s« A y is mis -rrpresc W may result is the sanitary permit being revoked by the Zoning Dgmttmeat «« Indude with this application: a damped warranty deed fiom the Register of Deeds office a Copy of the mod survey map if rcfacuee is made is the warranty dood i . D » I � : [ r .... ,,.. . -... .._ ._.. _.. . .. ......................- 1� S s. i k I 1 - c ' .n.., ,M- i' A I.t.i %il to LLrc (I �I '.i r � � Y ,i I� ii ,. E -�u:t wo war .+ *_ °�.� � ... t � • �g,�'�`; �_ .mss �a,,xa _ . i.t3 y,�. o 4.. _» „ .. ,.] �.. {. L p c; x 1 ,' , a... 1 , 5 o ,, z .r �i t31 $t1 x ]. c a iC?2 l d .t. � G3fj � ° ct �+�.'t�'k% �: ,_�.,- •..�.i. �.,>� #'a: ,.:. �.;.� .... °:a � ..�..'- �'ss�,+. +..-. 5�'-' 1:.,�. ,, i:,. T,.. .x a..._.i. ,, 5:1} �- .- .�� Fla" d grig day ,t P &_ ... i�...... I - `; __._ _.._ . .... .. .......__. ----- _, ------ .____ ..__. ... -. --------- ._ __. .... ......_..._..._... 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