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HomeMy WebLinkAbout020-1165-84-000 00 ~ O~ oar O ~ t~ O~q O O tr 0. 0 0 C ~ N I n N O > c N U M; m i° y rn Z C r~ C E N m a ° s N N 3 I 0 0 o E z z ~ c c ° m 3 m C C ° U. LL _ O W O ' a N a ~ E a a~ U I co O M N > Z N N > C C (n jl E O ~ O ~ Z ~ i .6 I ~ .0 m m m m W a m a m n Z c o I c C7 • m O z •d' c C: v w d. 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CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM • ~Xs~i I-) eLl l7is A~....~c ~.r•n ~ we ( ~ \ ~ yss~-. ~ o 0 i £c /a o 10 `k~ f INDICATE tdORTh m Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole c'ove' BENCHMARK: ALTERNATE BM: _ ^f SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ,e=-i Liquid Capacity: 100 Setback from: Well -?o House v25/ ' Other Pump: Manufacturer Modelg Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length /,v Number of trenches d~ Distance & Direction to nearest prop. line: Setback from: well: House 3 'Z- Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: ✓ ltiw~ LICENSE NUMBER: INSPECTOR: T/93: )L Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations $T. CROIX Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI ELERT, GARY X CST BM Elev.: r Insp- BM Elev.: BM Description: Parcel Tax No.: / Gv, GU /Gl~ . 01) TANK INFORMATION ELEVATION DATA p~?'s TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark dv' Dosing/ AeratfeA_ Bldg. Sewer o ding St/ Ht Inlet TANK SETBACK INFORMATION St/W'Outlet g ' TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 1>5-0 NA Dt Bottom Dosing NA Headers Aeration NA Dist. Pipe %~%fl 9 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manuf r mand `may,°l Model Number TDH Li Friction System TDH Ft F Loss Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length s No. Of Trenches PIT No. Of Pits Inside D Liqui -Depth DIMENSIONS `O C12 a DI EN SYSTEM TO P/ L BLDG WELL LAKE /STREAM L ING anufacturer: SETBACK INFORMATION Type O e ry,Li 3 OR UM T Moe um er: System: U.v s 9 DISTRIBUTION SYSTEM Header /Manifold y Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length _Z12_1 Dia. Length !S77 Dia. Spacing ~a SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sy s Depth Over Depth Over xx Depth Of zx Seeded /Sodded xx Mulched Bed/ Trench Center Bed / Trench Edge Topsoil ❑ Yes ❑ o ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present,~_f * LOCATION: Huds/o~n.17.2~9._1~9/W, SW~,, Lot 99, Becky ircle ~~-C'~G";J~,s''""~"^"..'-' :,.-r j 1 s-~r Plan ion required? ❑ Yes /No Use other side for additional information. ~p 9 SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i SANITARY PERMIT APPLICATION Safety and i inter Division Bureau of of Building Water 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 Q_(_0( than 8112 x 11 inches in size- • See reverse side for instructions for completing this application State Sanitary Permit Numbe c>? 33 ~S The information you provide may be used by other government agency programs ❑ Check if revision to previo s application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Propert Lo tion /V91/4 3~i14, S )7T ay, N, R /ftork Property Own is Mailing Address Lot Number Block Numb I °7 ► d-a 74 City, Sta e Z Code Phone Number Subdivision Na a or CSM N mber 1(7142 aq - 011pej II. TYPE F BUILDING: (check one) ❑ State Owned City Nearest Road Village & E] Public 1 or 2 Family Dwelling - No. of bedrooms Town of ✓,Lk III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑Apartment/Condo ol)-o 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) A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only----- Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit 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 125aSeepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade / / Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 'M Elevation -7 5 '1 p 15 °717 , "7 r0o Feet f 7, Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank `eDo es er ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber El El El 11 -1 1 1:1 El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb Name: (Print) t Plumbe 's Signature: (NOS mps) MP Pao.: Business Phone Number: Plumber's A dress (Street, City, State Zip Code) _3j,;Z FT ;to 'L )6 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A ent Si nature (N am Approved E] Owner Given Initial 6,191-~ Surcharge Fee) Adverse Determination 161644 X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to Counly. One copy To: Safety 8 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: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 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. Absorpi:ion system information. Provide all information requested for number, 1 througi i. Vll. Tank information. Fill in the capacity of every new/or existing tank, list the lot" ;1a!lons, num!-)-.- of tanks and manufacturer's name, indicate prefab or site constructed and tank material Cc r !et.e fc, 1/..PptiC, Dump/siphon and ho ding tanks for this system. Check experimental approval only if tanks rct2 v experir'en, :i rod act approval from DLHR VIII. Responsibility statement. Installing plumber is to fill in name, license number wi _ii apnrc) :-r'a t? .-,;refi:c (e g MP, etc.), address and phone number. Plumber must sign application form. !X_ Cojrity! Depar ment Use Oilly - X. Cojr,t,- t~~partment Use 0-ily C _ nC suec ficatioiis nc, sma r thar 8 1/2 x 1 1 inch~, t r!ty ' he plans must ovvj*,.;, o wale or with complE~_E- t c,,,yl,. - :anh septic V:? pt_'IT1pors!phon tlP 1,N„III6 rlg <<_I'Ved; 0 1 T, k2 I O 5; p: ^f_ r a SssCt:!on by , . ll,`1'J, .j s r! c1 in' 'rrration GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a numoe,- re:-!.:lated f' ,st,, 4-, rvhi<_h can effect groundv:ater. I h~- 25' jL? Led thi, Ug'l Lhi-,se _urcharges u'e :;red 1Ci1 r! or,,itOnng gror.mdwate! :Oflt !T ?c iivest!gations arld est,: bh,'r mer,t of standards_ JOB ~4 r4 ErT y TIMM EXCAVATING SHEET NO. I OF 2 Route 1 Box 192 r- - WILSON, WISCONSIN 54027 CALCULATED BY DATE -s (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE yb SCALE i l 2 t~ :rz ~ .../L[ i 85 D . . . d5.... ~a-4. - u . ~~cca na~` . ryj~... `~a a0 1. \ C,: \ h1k ~1..... 2~ 6Iz s . \ . PRODUCT 205-1 Nis Inc., Groton, Mass.01471. To Order PHONE TOLL FREE I-8D0-225-5320 • JOB ~4/✓ ~le!r r TIMM EXCAVATING Z Route 1 Box 192 SHEET NO. - DA / WILSON, WISCONSIN 54027 CALCULATED BY---L~'~ DATE (0 7~S (715) 772-3214 (715) 386-5443 MPRS #3224 Wi MPCA #696 MN CHECKED BY DATE SCALE - `rl 9 z $ . 1 a PRODUCT 205-1 AMp Inc, Groton, Mass. 01471. To Order PHONE TOLL FREE 1-8*225fi380 Wisconsin Departmentof Industry, SOIL AND SITE VALUATION REPORT Page / of Z- t A r, and Human Relations EVALUATION uivisiorgof Safety a Wkrinp in accord with IL14R 83.05, Wis. Adm. Code ` COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but sue' C2o not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION T-HC 'CC E"'e_ Z- GOVT. LOT Ali_- 1/4 Sw 1/0 . l7 T a5 N,R (t E (or) ll PROPERTY NER~'J MAILING ADD SS LOT # BLOCK # SUBD NAME OR CSM # 3 /T~ CL TD l© (D G P/~ Q K Ve IF(,) CS723~ CITY, STATE ZIP CODE PHONE NUMBER ITY OVILLAGE 9rWN NEAREST ROAD C ro (SScv (7/31 SLy-ST S w' -'z> cK e,2ccK- . ( ] New Constructiat Use ( Residential / Number of bedrooms 3 Addition tD oAstirg bAding j j,,}~Replacement (j Public or commercial desaitle Code derived daily flow VY0 gpd Recommended design loading rate 7 bed, 9p(W ~b'encNWW Absorption area. required _~q3 bed,112 1'63 trerich, A2 MaArnum design bading rata 7 bed, gA412 b'ero qxd #2 . Recommended infiltration surface elevation(s) 9~: b~'' w~i ° K ft (as rabfred to site plan benfimark) Additional design/ site consideratforts_ys-r- 9 cow A`PqE_ /1 vh 01C 0,4B0il- EreL!r& Parent material Flood plain elevation, ff appl Wj* Al R S = Suitable for system eMONAL MOUND KGROUND PRESSURE AT-GRADE WIN IN FILL HOLDING TANK U= Unsuitable for system S O U EIS o u [Is o u 0S O u Lis 13U O S O U SOIL DESCRIPTION REPORT uring # Horizon Depth Dominant Color Mottles Texture Structure CoroMptoe Barrld3y Roots GPD/tt in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed tt3rtcft N.4 a- - ~V S "IJ Ground ) Zv-/iS Idyl? 114 N 14 )14 /L G bieV. G o ft. 10 `:~epth to limiting factor s _J_ M i l Remarks: fi~V-A r>-~ ,tip iN /ST # a.vv ff~/C(Z~f.-VS 3oring # 1'L~ .c c✓ S l a~/~ l R 2/~ N,4 At L 44/ ...»:i 3 ZS-o7 /o yR Y/3 dY h Cround e'ev. ~y-33 ft. Depth to limiting factor. Remarks: TJ ~U . CST Name:-Please Print Phone: Addrcass: too 5"7,d .7 Signature: LZ - Dat J - pip Numbor f. t W, PROPERTYOWNER e;A# f ~ECEei SOIL DESCRIPTION REPORT Page~otZ i PARCEL I.D., Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft 1 Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Boundary Bed Trench 44 Ground 3 (7-t 4 v K /Y y AI A- elev. Depth to limiting factor Remarks: 6AILS 7 Two W,, t e'-i Ac Boring # \h ]F:•: ~hGitiv~ Ground 17 elev. ft. 4r Depth to - limiting factor Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: Boring # k ::v:2tiv ii:.t~ zzs Ground elev. Depth to limiting factor Remarks: SBD-8330(8.05/92) • f T ` /06 i4 So. L .v v -5 - ~',~c .g v.✓ /P ,v, Z-- 1'~l<<,~/U,ab/1~s5 - 1378 h~o 7-d o c.✓A a h ff✓ a so -J ~/.g ~ t JlSc v~J {~i4r2K ✓~~v~-~ ~ST/~-T'~S~ ~f L'ST't/~vos6v 7 PH . 7~S-Y 8 ~r sS x Y , jk /Yj v5T r A2t,Ff A~ d3 AL~~ Noas j~7,~ 4,0, VC gr o TcP f~~ 9 V.43 ` r 97-- -'51.33 13 3 - boo, 13, , ,to ~ o ~ ~ ~o ~PUtrF~ rvx- - o(L ,Ex r.S7 f v&- /,-"v ""f J ~J Acoi lk~A A A A A, A A A A AL-A--A~ A AL-A~ A ~w 79 i 80 ---vi---- ~J 81 82 300-o d o- /Mp 09° I I I (0 o 80 S 11- z S89015~14W i Nr FT. a 58.00 S?p5 o°M r-75.00'-\9Z ---408-- .-00 -r - - , 300.00 ` 75. ry i i - 5'007 g `bb i I 7~ ~ ~ o I I I ' I I I :8 _ I~ y.~I I 4(/ C7 RES -g 981.498 ACRES h L v 65,257 S0. FT. 300.00 driveway ea ement 97 ? 1 M 1.196 ACRES 1.198 ACRES Ito 52, 166 S0. FT. cn i 94 L 52,097 S0. FT. 1 100 1% I 1.153 ACRES '.--5 50,246 SO. FT. 1 p 5-+ O IN O p 1 U') 0 EFT S82 09'22E Y> N82°3115E ; 181°4114"yi i g I o c) I 201,43' 205.7 7 300.00 1 1~ m I 31 ' 292032'05"\ - - - - - - /'292032'05" F I3 O 100 1 8 157027'55 157°27'55" 96 i0 95 RES I 1.036 ACRES -O I O 1.034 ACRES IN FT. 45,140 S0. FT. 45,062 S0. FT. uj 1.021 ACRES 1 ° 9N~ 1110 I 44,460 S0. FT. O Oo NI INS o9 30 _ 0.00- I 246.00 JA's" z~l 1~z e~ 246.00 249.87 546.0 0 N89°1514 E 495.87 rKWOOD - - - - S 89°15'1414 1484.05 243.00 156.00 156.00 156.00 1 ----141704---- ~ I ~i o c ° p c 7 IM 108 J 109 110 2 III O CRE. 1.071 ACRES 1.074 ACRES 1.074 ACRES 1.074 ACRES ff, • FT 1 46,651 S0. FT. 146,795 S0. FT. 46,795 S0. FT. 46,795 S0. FT. O d 3 o r N89°15'14' E 243.00;' o 0 0- M X0 ~ - P-0 _ N (0 156.00 156.00 156.00 DO 2~-- - - S89°15'14"W 468.00' A • j~ r E f R i' i' t4 Zabel Filter Installation The Model A100 Zabel Filter for residential septic tanks is installed in place of the standard outlet tee. Securely fasten the bell coupling on the side of the filter case by a solvent weld connection to the Schedule 40 PVC plastic pipe which extends through the outlet opening of the septic tank. The Schedule 40 PVC pipe extending through the outlet opening of the tank should be at least 12" k or more beyond the tank before being connected by an adaptor to the remainder of the system. This will suspend the filter inside the septic tank by the bell housing on the side of the filter case. The top of the tank must have an opening 12" in diameter or larger to allow easy removal of the disc dam cartridge for cleaning. If the tank opening over the filter is the only access to the tank for pumping, it should be large enough in diameter to allow the tank to be pumped prior to removing the cartridge for cleaning. BUTYL-RESIN SEALANT v OUTLET 12" DIA. MIN. CONNECT WITH PVC CEMENT ZABEL TANK Call 1-800-221-5742 or Fax (502) 339-8669 for further information. r r 0, ff Zabel Filter Resi'dential Maintenance The interval for servicing septic tanks is set by state and local code. Throughout the United States there is a wide divergence of opinion on what this interval ought to be, but most regulatory agencies suggest two to five years. The filter does not increase the frequency of servicing for the tank. To service the filter, remove the tank cover located over the filter. Pump the tank prior to removing the disc dam cartridge for cleaning to prevent any solids from escaping to the field when the cartridge is removed. Pull sharply on the lid handle and the disc dam cartridge will slide out of the case. In order to prevent contamination of the ground with septage, turn the cartridge sideways and lay it back in the opening. Now rinse off the cartridge with a garden hose or a fresh water tank hose from the truck, being careful to rinse all septage material back into the tank. It is not necessary that the filter be cleaned , "spotless". The biomass growing on the filter aides in the pretreatment process and should be left on the discs. On rare occasion then it will be necessary to dismantle the cartridge. If required, remove the nuts on the three bolts at the top of the lid and the cartridge can be easily disassembled for cleaning. After the cartridge is cleaned, and reassembled if necessary, place it back in the filter case. Be sure it is all the way in the case until it snaps into place. Replace the septic tank cover. E Easy to maintain • Ecologically Sound ♦ The filter is virtually self cleaning. The continued action of the anaerobic organisms on the filter discs causes lodged particles to disintegrate and fall to the bottom of the tank. K ♦ The filter only requires servicing at the normal inspection and pumping intervals required of a standard septic installation. ♦ The filter cartridge is safely hosed off back into the tank by a qualified septic tank pumper. i Call 1-800-221-5742 or Fax (502) 339-8669 for further information. INSTALLATION OF THE ZABEL, CONTAINER ASSEMBLY' 1. Dig a hole and remove a section of pipe as shown in drawing #1, below. t'44 = j .GRO{7ND LEVEL.\ 24 SEPTIC T.ANK a' :a . : v :~•'a . ,4' - _ _ - , ISTR IB UTIO N BOX 2 0'T CUT AND - I CLEAN -PIPE . DRAWING t1 s- 2. Install the pipe seals in the filter container. The blue seal is for schedule 49, 4" PVC, and the yellow seal is for schedule 35, 4" PVC. The blue seal is always installed on the-outlet of the filter container ( the outlet is 1/4" lower than the inlet). Use the yellow or the blue seal in the inlet, depending on whether the existing pipe is schedule 35 or schedule 40. 3. Cut a piece of schedule 40, 4" PVC 6 1/4" to 6 1/2" long. Cement an adaptor to one end of this pipe. The adaptor will be used to connect the schedule 40 PVC to the existing pipe. Insert the pipe into the outlet of the container, keeping the adaptor on the outside. •G R OtJ Nb gEp;r rc• CVEL 40 3 TANK OUTLET • • ' . o - \ _.S C .,4 0 R.V,C/, o= ADAP T OR' a 1 3/16" _ . 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CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify tha I have inspected the septic tank presently serving /Cs.r rciz & W -V or2 th/YIAoeK rQr; r ~r m <f AQ y ~cewl residence located at: %VC Sec. 17 , T -4y N, R /9 W, Town of ></~v so , St. Croix County, Wisconsin. Upon inspection, I certify that.I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced /2(~ 9 5 Did flow back occur from absorption system? YesX No (if no, skip next line. Approximate volume or length of time: bG gallons minutes Capacity: 16 oo Construction: Prefab Concrete Steel Other Manufacturer (if known) : 6.) 97- 5,014- Age of Tank (if known) : 0-7 S 7 (Signature) (Name) Please Print o T 4-)' - coy~, 17-70 (Title) (License Number) (Date) Form to be completed by licensed plumber (s.!145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) II - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). / Name 1° G Z -mot S ignature v MP/MPRS STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS C 7 ~T! e-L TU z>s / -d v L Ta.c/ 1A11 , SX01'Z- c ~ PROPERTY ADDRESS l C~ & ,C C C 'C' (location of septic system) lease obtain from the Planning Dept. CITY/STATE 4` i) &-)f . PROPERTY LOCATION IV 16 1/4, 5-41 1/4, Section J7 T_j f N-R a W TOWN OF PU b So ST. CROIX COUNTY, WI SUBDIVISION f-; (k) E5 4 I f-S LOT NUMBER CERTIFIED SURVEY MAP N1 , VOLUME /4 A PAGE/l, 4 , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 f S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property ~/.2 '676 t< Location of property A f 1/4 :5uj 1/4, Section FT , TAN-R ( W Township ff v y S Mailing address j 7$ f f t t_e__re P > (42 U c 7-,9,4J o fl .L-- Address of site O < t r l~ c /1 rf Subdivision name K y t F wl j5ST1j-Tr_S I Lot no. Other homes on property? Yes ✓ No Previous owner of property LC 6 1'c Total size of property A j j~ ,¢c,Q£ S Total size of parcel sr9~t _0_- Date parcel was created - 6- Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume 7 and Page Number G Y/O 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 th office of the County Register of Deeds as Document No. tf- $r,6 S ~ , 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. V Signat re of Applicant Co-Applicant Date of Signature Date of Signature t , DOCUMENT NO. - WARRANTY DEED TN IS SPACE RESERVED FOR RECORDING DATA ,i STATE BAR 0!'' WISCONSIN FORK 2-1M 786PAGE 640 _ - j REGISTERS OFFICE ' ST. CROIX 00 WIS. Sam.A....M .1.1erf... A.. single-man : Rec rd tN3 31st for Rsoord - of J~ my A.D.198.7 I 9:30 96 tonveys and warrants to Gary-. A... J-,.. Elert,._.husband .and-wife-as-marital..... survivorship-property. 'j 'f RETURN TO 1 I i~ . i fit C _ the following described real estate in ...roix ...........................County, State of Wisconsin: ,l Tar Parcel No:.......-• I ~j ~C Addition to the Town of Hudson. Lot 99, Parkview Estates Fourth i nw4 SF§R. EFS J 'j This ia._.TK?t..... homestead property. (is) (is not) f Exception to warranties: 'HM WITH AND SiIDJF7CT TO any other eaSH0P11tS, OOVendnts, TOGE reservations or restrictions of record, if any, but this sh311 mt be deal►ed to extend any such other recorded encumbrances beyond the term established by law therefor. Dated this -----.--"...30th. day of .----jU ,y 19_.87... (SEAL)- - ---....._..---(SEAL) Sam E. Miller . ......................(SEAL) ......_..(SEAL) • . AUTSBNTICATION ACSNOW LEDOMENT Signature(s) '~~A STATE OF WISCONSIN St. Croix •-•------.County. Is. authenticated this ........day of 19...... Personally came before me this 30th. ...day of uly_..____. 19.87.- the above named m E. Miller ' TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorised by 1 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowIddgi'the same. THIS INSTRUMENT WAS DRAFTED BY Hugh F. Grain, Gwin & Gwin R-Y--'_ • 1 . r Cori t 430 2nd St., Hudson, WZ 5407.6 rl. Notary blic et-, 0.1X ~ ~ y, Wis. (Signatures may be authenticated or acknowledged. Both My C mission anent„(It;ot, state expiration are not necessary.) date- ~F_-_%1- r? *Names of person+ signing is any capacity should be typed or printed below their signatures. ARRAMTT DEED STATE BAR OF WISCONS N Wisconsin Legal Plank Inc wo. Form - S T C - 104 k * AS BUILT SANITARY SYSTEM REPORT 1 OWNER ~ to 9i /L/ TOWNSHIP ~CA'Ses SEC. 7 T f N-R~ ADDRESS 010 'JpX aSz ST. CROIX COUNTY, WISCONSIN C 1&0 4 wz ~ ~ Ito SUBDIVISION P,;kVi,t u)ELae::~5y_LOT 99 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM u^ ~ro~ s;~1~ 8:~ Ion S~ Uo~ k I ti~ K-- 4 I . 1 - Z ~ ~ I i i /C ~t cx Lt i ✓ 2 ~~yJ d ~~'~5 1 1 1 I v \ //0 I/ffo C4 5 C' rLOAi► INDI: . CATK NORTi3 ; 10W , BENCHMARK: Describe the vertical reference point used UJCor,ha, ' Elevation of vertical reference point: L00.0 ~ Proposed slope at site: % SE SEPTIC TANK: Manufacturer: L!/i 5 a✓ Liquid Capacity: ~Q QQ 4i1 Number of rings used: Tank manhole cover elevation: 9(po Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front ,®Side ,O Rear, O feet i From nearest-property line Front, Side ,1'7~Rear,0 wS feet Number of feet from: well building: ~~r-2~ ~l~ti~r ItCCdvVlac~ (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 1 y 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, 0 Ft. Number of feet from well: i Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: 6,' yR'`kDn \ Trench: - i Width:. Length: 3G Number of Lines: Area Built:4 y8*~T Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear,O Ft. 00 Number of feet from well: Number of feet from building: (OO (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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: Or/ License Number: A4 /fi 3/84:mj DEPARTM.E!d.T OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS L413a7R & HUMAN RELATIONS DIVISION PRIVATE SEWAGE SYSTEMS P.O. BOX 7969 BUREAU OF PLUMBING -MADISON, WI 53707 ~ N04,SW~,S17,T29N-R19W XXCONVENTIONAL ❑ALTERNATIVE (ifassigned)D.Numben Town of Hudson ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound is" of 99 Parkview Estates IV NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Miller Route 5, Box 282, Hudson, WI 54016 "'7-0- 2-7 6c) BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber: MP/MPRSW No.. Counry Sanitary Permit Number: Doug Strohbeen 5432 St. Croix 96037 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPA Y TANK INLET ELEV.'. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER w 1 I, / PRO IDE PROVIDED: YES S ❑NO ❑YES [!<O' 65 J W BEDDING: VENT DIA. VEN MATL'. HIGH WATER NUMBER OF OAD: ROPERTY ELL: BUILDING: VENT TO FRESH LI 4-7 AIR INLET: r ALARM FEET FROM S~ P ❑YES NO ❑YES O NEAREST V / DOSING CH MBER: MANUFACTURER'. BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO TO ENT FRESH JV GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL'. NUMBER OF PROP ERTV WELL BUILDING. (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET : PUMP ON AND OFF) ❑YES ❑N0 NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing J[[ r,'4Tlr DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH INOOF DISTR. IPE SPACING. C INSIDE DIA #PITS. LIQUID BED/TRENCH THE NCHES M IA PIT DEPTH DIMENSIONS 19, GRAVEL DEPTH FILL DEP H DISTR. PIPE DISTR. PIPE DISTR. 11E MATERIAL: NO. DISTR. NUMBER OF PROPER V WELL BU} 06: VENT TO FRESH / : BELOW IPES AB E OVER. E' EV. INLET ELEV. END. PIPES LINE //0 n ( FEET FROM AI I`~n/ p LET v, NEAREST MOUND SYSTEM: 39 Mound site plowed p rpendicular 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. ❑YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. F ED SEEDED. MULCHED. CENTER. EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER'. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.'. ELEV.: DIA.. ELEV.. PIPES'. DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANSCAL LIFT CORRESPONDS TO APPROVED ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: Q,. NUMBER OF PROPERTY WELL: BUILDING: U FEET FROM LINE: 1 , ~1 ❑YES ❑NO ❑Y 0 C❑NO NEAREST CTI ~ s b4LA, A Sketch System on Re n in county file for audit. Reverse Side. IGN RE D ILHR SBD 6710 (R. 01/82) FTLE / Zoning Administrat C~ILHR SANITARY PERMIT APPLICATION COUNJY T61_HR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. I -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES f NO PROPERTY OWNER PROPERTY LOCATION .J/;& r'/45WY4, S T Z, N, R/ E (or .5;2 jW PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 9 9 .40- z g z -f 91 - PQ.k v ~w ~s74fi~s _1T CITY, STAT ZIP CODE IPHONENUMB / ER CITY NEAREST ROAD, LAKE OR LANDMARK 14 ,0 n I I 1-444d -50 Wr D 7/6❑ VILLAGE : 14 A& 4t Ill. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): Ill. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. ~ New b. ❑ Replacement c. ❑ Replacement of d. E1 Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2: ❑ A Sanitary Permit was previously issued. Permit # Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. ,tom Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. E1 Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) ❑ Seepage Pit 1. a. seepage Bed b. ❑ seepage Trench c. 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): C, C 3 c0 I S'Ser -7 'r'- S F-r ?3_5' Feet Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App ► I Ta`nks Tanks structed Septic Tank or Holding Tank i ~QO / Car- i S Lift Pump Tank/Si hon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plu ber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Bl stro4bcc 14P-~ 3 2 ~,,f et, City, State, Zip Code): Naof Designer: Plu iffdr ,2poe (Stre R u/ l 4 4 ~~l (w VIII. SOIL TEST INFORMATION Certified Soil Tester (CSTame CST # 1) -W/01 " S ) CA 1P / r` I© kCL 5N., h S 7 CT's ADDRESS (Street, City, State, Zip Code) Phone Number: [I ko Lau ro-k U) q o IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) 5fl Approved F-1 Owner Given Initial urcharge Fee Adverse Determination lloo `Go +~CU r a ct+ / ' ` X. COMMENTSIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) ':o be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped b./ a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If yoi have questions concerning your private sewage system, contact your local code adn ir'strator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owners name and mat ing address. Provide the legal description where the system s to be installed; II. Type of building or use served: It public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; Vi. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given whan application is disapproved. Complete plans and specifications not smaller than 8'% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement j system areas; and the location of the building served; B) horizontal and vertical elevation reference points; j C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump t 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the t - result of over 2 ears of steady negotiation and public debate. The groundwater bill' Y Y 'Groi r,d~,vater - included the creation of surcharges (fees) for a number of regulated practices which WiSCO_z t'S e can effec° groundwater. The surcharge took effect on July 1, 1984, All of the water that burl.-.- tzasure Al is used ir, your building is retjrned tc,_ the groundwater through your soil absorpticy9~ r o system or the disposal site used by your holding tank purnper. f The mon,es olie cted through these surcharges are credited to the groundwater fund adrr nis l recd by .he `7epartment of Natural Resources. These funds are used for monitor rg grourd- l _ iter, groundwater contamination investigations and establishment of standards -Arcundwatei, it's worth protecting. SBD-6398 (R.03/86) s4~-, m;11~-r k V w E 5rt s-KF No(tk 1o't l~n ~S' 4>rt ~ 99 Sys to rn1 E IV - = 9 3 , s L 5 C-K A B.M. s `fk, V~vrt 4 1'0•,'t A-T tk.. U.W. (oT Core o~n -tat v 2" 10-f- P" P' As5u.---r Ely, 0 ao f 4f- S j ~h C>3a~k hog) I I~ D y z C T` .T 3ortfc -vi f C-C - ' . a- YNA C) Q. c mt 1 K B3 -t"h EJ3 I 1 r i p slc. . 97 2 ~I 4: d 1 1 1 214-1 O 0 O y •S L a. f !a. ' asx~~ Fyn 3~ a 5 ~.c i I - .3 r P I kAl t 1 A • w jLA~; A 0 40 TIN f % I.Q ^ R _ C _1 Tip y D,EPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INOOSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W153969 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/1~+6WRALIZY: LOT NO.: BLK. NO.: SUBDIVIISIION NAME: N F_ w' / / N/R/ ' ( r) W c. ~s *A( A` 05 COUNT) : OW ER'S BUYER'S NAME: JMAILING ADDRESS: S). Croy )c .57#*, «at 1 ~3o d✓~~. ,T d! USE DATES OBSERVA IONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DES RIPTIONS: PER ATION TESTS: Residence XNew ❑Replace &ZI /o _x 7 6 ~3 ~7 sw Mme 9i- 16 RATING: S= Site suitable for system U= Site unsuitable for system P6- j- lfi y 0 RKS NVENTIONAL: MOUND: IN-GROUND PRESSURE: IS YSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (opti [:]U fps ❑u as ❑u ❑s ®u ❑s ®u Coev ,e,,4N If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROF! ,LE DESCRIPTIONS jr,000 BORING TOTAL$ ELEVATION DEPTH TO GROUNDWATE CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHJ* OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- / . 7 3 `ocr 7 8, v' / 18/sl s/ S Ni B-Z f. d' 1.8 B/sl 6 g4 S/ JO n A9 A*JS B-3 ~O' -78.6- / l pis s/ y s s/ had-S A&C B-1 .rv ' Q7 7 ' ~ ~lJ~ •Dv' r . l B/ S11 3, Gns / 3.5- '0 n_' ca SIX-1, S B-,57 .8 Q/l.s/ i A s 4 ? s B- PERCOLATION TESTS TEST DEPTH F WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 1Pl6FfCS AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH P- 1 3.8' 0 2 6 -43 P- ;L L1.21 AID Z Idl- __7 P- 9 o L-3 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. SYSTEM ELEVATION 73. s- /#1c V.4;-.4 B, " 1 sac- , &-f. s I E t i I Flo, 3 , E is ~ E . _ E Q 1 P Off, Z'~s f . . 3 . _ .d! 7o P f the undersigned, hereby certify that the soil tests r po~ted on tj j~e aw me in accord with the procedures and methods specified in the Wisconsin dministrative Code, and that the data recorded and t ~ation ~tb~~sts ~f'~cmor to the best of my knowledge and belief. E (print): j TESTS WERE COMPLETED ON: E S: CERTIFICATION NUMBER: PHONE NUMBER (optional): ATURE: r 01- ON: Original and one copy to Local Authority, Property Owner and Soil Tester. 395 (R. 02/82) -OVER - INS1 .TIONS FOR COMPLETING FORM 115 - SBD - 6395 , To be a cc '',I accurate soil test, your report must induce: ~ 1. Complete h iption; 2. The use sectic i dearly indicate whether this is a residence or commercial project; 3. MAXIMUM nr of bedrooms or commercial use planned; 4. Is this a new ment system; 5, Complete ,,y rating boxes A SITE IS SUITABLE FOR A HOLDING TANK,: ONLY IF ALL OTHER SYSTf " ARE RULED O! T F ON 501L CONDITIONS; 6. PLEASE use the abbreviations sl `Di-writing profile descriptions and completing the plot plan; 7. MA' E A LEG113L diagram a(.- ly locating your test locations. Drawing to scale is preferred. A te sheet n- u-:d if desi sure your, - - n__rk and ti alevation reference point are clearly shown, f, notmanent; 9, C: Mete all apl~ date boxes as to dates, narnes, addresses, flood plain data, p st exernp- f appropriate; 10. is formatiosi flood plain, elevation) does not apply, placr3 N.A. in the hx; 11. Si,;~- Lfle form and pl_ your current address and your certification number; 12. Mis'<e legible copies _ distribute as re(Juired. ALL SOIL TESTS MUST BE FIL `TH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Sepata Textures Other Symbols st - S,,„ s~ 10") B R - Bedrock col) (7, ~ 10") SS - Sandstone gr Gravel (under 3") LS - Limestor. s - S HGW Nigh C cs Perc - P meds - d W fs Bldg - E . l> - Lisa, 'v d sl - L s T~ i - - ] E3n B!,,tvi, stf BI Bi,~, ~r G",' - ( scl S y Loam R - Red sicl - ty Clay Loarn mot Mottles W S- dy Clay wi with sic ' y Clay fff few, fine, fai c { ce cmm-. pt: MIT) IV i. d p -p`. HWL - Hroh Six ger<<arai soil textures for liquid uvaste disposal BM - B, VRP Vart€ is Poi:-I- E OWNER: ')ort is ry pc TV,~- cou, L Pl. , T e0, i H z cn ' H 9 • r ST C- 105 r 9 ' y SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d 9 OWNER/BUYER tr' ROUTE/BOX NUMBER ke-#-1 A e 2 8 Z Fire Number CITY/STATE f&4e 14-1 ZIP PROPERTY LOCATION: 34, 5 W 1, Section 7 T a y N, R W Town of #AtAe_1^ St. Croix County, Subdivision Ae a~o.aj.&to' Lot number. I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. 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 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 systems properly maintained. 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- essary), 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. H 0 z I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- 'b 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. SIGNED =?5(1M~ .YyI DATE- 6 ^0 St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 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 /A Location of Property Section 17 , T --X9 N-R /2 Township 44 41.5 dc Mailing Address CL,4 / B oX ` ZS/ Z ~7 cc d sag `r/.~, ~~O /fo Address of Site ee o~ S Subdivision Name -ark v ;acv t S a sus _ rtt g .Lot Number Previous Amer of Property ~i.r/4. / W4 r 7- Total Size of Parcel 9G dY5 Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? X Yes No Volume _ -!r _ and Page Number / 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION i (Wel ceA i.6y that a t Atatement,6 on thin 6onm eAe true to the but 06 my (0un) hnowtedge; that I (we) am (ace) the ownen(b) 06 the phopeJcty ducAi.bed in thiA in6o"at.i.on 6onm, by vixtue 06 a wavcanty deed neconded in the 066ice o6 the Countyy Reg"teh o6 Deeds o Document No. ~ and that I (We) pheeentte own the pnopoded eite bon the ~6ewage didpos ayes em (on I (we) have obtained an eaeement, to nun with the above denscAi.bed pnopenty, bon the con tAucti.on 06 6aid eydtem, and the dame ha.d been duty neconded in the 066.Ece o6 the County Re9iAten o6 Veeda, ab Document No. e/ s 2.. ) t )'~j 4& TURF Olt OWNER SIGNATURE OF CO-0 ER (IF APPLICABLE) / D DATE SIGNED 1 . i PAf•••, •R^K VIEW 11rsIE~~ ESTATES FOURTH ADDITION c A RURAL StFaMS1CN l_CCATEQ IN THE lvcWS>, AaNWlf4-SE*,SECTICN !T, T29N., R19W. TOWN : tom. RJDStN.. ST: CROX COUNTY, W15COWN i C33TI14ICATE OT TOWN`TStrASU1tZ1t 1 STATZ OF'WI3CCbLSLY) SS:! ST.• QOIIr COIJ~ I; Y I, Beverly A. Jobaioe,..be;iR,ti<e daffy aiactsd, quallfied'aad acting Tuwa Treasurer f of the 'Yawn of R%Uioon, do ho<reby certify that in uco:daxe records is my office, theme are no un ttt:se paid or spacial ates, Froth sa ition. . r an any Ia,sd inaltsated in the Piet of Park Vioes• Lataias Fourth Addition, • Bovqvty V ohnso own Treasurer TOWN BOARD RESOLUTION RESOLVED, that the Plat of Park Vt... Estates )Fourth Addition in the Town of Hudson, Parrott E. Wert and Bove A. Wort, owners, is hereby approved by the j r J y 41 Date Approved p rman own D Signed 'own Laatrman i ;terebY certiiy that the foregoinq la a copy of.. resolution adopted by the Town Board of the Town of Hudson. DJte 1~"- own Clark 1 O` NZRSt Cc13Ti=ICATE OF DEDICATION I As owners, we htiroby certify that we caused the land described on thi: Plat to be survey-d, '_:•.-i3•d, sapped and do irated as roprov,ntnd on this Plat. We also certify tbat c:.is Plat is required by S. 236.10 or S. 230.12 to be submitted to tiro following for i approv+l or objaction: i Depa:ttruot t.f Dovelopmeat D.oartsnent of Industry, Labor and Human Relatio•t•, 1 Town of Hudson. City of Hudson and St. Croix County. W:TN85S the load and ual of said owners this 't day of „~:_,,,r~_„_,_~_ . i In presence of. -i/,F all rrel . crt. ri t yaKL~LC~_.~~~f`GZ.ssG1.( 1 Beverly A. Wort ` STATE OF WISCONSIN) SS ST. CROIX COUNTY ) Personally carne before ma this day of , / the above I' named Darrel E. Wert And Beverly A. W art, to Inc Known to be the persons who executed the foregoing instrument sad acknowledged the fame, j Notary Public _ / , i, • J Zr . Wisconsin My commission expires Mary tech, Votary Public I CERTIFICATE OF' TOWN CLERK ; A?~:STATZ OF WISCONSIN) 1 ) 38 bT: CROIX COUNTY } 1. Rita ;-Iorne. being the duty appointed, qualified and acting Town Clerk of the Town of I!rdson, do hereby c~ i~ty that copiol of this Plat were forwarded as required by a. 236, 12 on thea.y day of 1984, and that within the 20-day limit met ley 136.12 (3) (no objecti nab to the plat have been filed) (all anjerjt+ns to he plat have been mrt)• Date flit Horn., To-own Clark t JAMES E. RUSCN a+ SURVEYING & MAPPING HUDSON, WISCONSIN TM3 INSTRLW..NT CRAFTED 91 .4, ' ~ • t r w Vw~ii~.s.Jni i O ~~Z~7"' ~~O Li y aft f I I • SiT1t1t=0023 CERTIFICATZ. 1. 3amera-3i'. Aneely Rokiateved Wtaesaeta Laced Surveyor, hexaby certify to the hoot of my profeeeioud knawledges understaodiag aced belief: TAwt.2 horse wervoyr•4s divided and roappbd Park View Eats"& Xourth Addition,. !oersted Is the NZ I i4 at the SW 114 and the N'J1 J 14 of the SZ 1 / 4 of Srssiloa 17, T Z 9.4. It 1910. Tow .09 Hodson. St. Croix County. Wirceesin; Thst I have me de auth surve7. land di-Avion sad plat by tha diaactlon of Darrel E. We" and'fieverly.A. Wait. ovssrs of said lieu!, described as follow: CosiOtasdag at.the X1/4 corium of acid Section 17; tkeree S89sL`"'1* (aasamed bewxtase raiw evocad to the mosumeated EAST -1V EST 1/4 Section. 11ae c1! 3ectloa 17, bslttiy sasmmed 339122'0r'W) (recorded as 38f Z 1146"W oa th" Certift'+d Survey Uap reterdei to Volume, 1; Pale 134). 1332.968 alcag said EAST-WZ3T" 114 Section llaef them* g0s06230°W-227.Y! to the point of bo inoi ig; thence N8f5240'W 412.00'; thence.- N0'06230"IC 212.00+ to the Swtherly right-ol-way Imace of croaa hill Lane; thence NS9'S244-W 6,6.008 .Iona said right•of-oaf line; thence S4'06830"W 231.•004; thence ~ 579r'36152W 19.4.352; thence S89'15814"W 236.710-, thence N7V37%6"W 142.171; thence 389"if1213V'W Si8,001;:thsae+ W06830"L 104.901.1 themes 6WIS514-V 3t4.OW1 thsaea . NO'!.,h011E 555.008; thanoo Ulf 15114"ill 66.011t theaca, SO 6030"V 316.131; theses' . ' SWISe14"W,151.008;.thenea N01371S1"W 54.138: theaco 389.22b9"W 149..301; thence SWO66360V 204.488: tame NW13814"Z 1SA.00A: theme S~30"W 31L.971; thence !V89s13r1:/^1;.1Sd.00~;.the"* Southeasterly 66.251 alemny~: the ssa.of &..3836908 radius ! cnrw-eonease:lto:ihrreterl7 wrbeee chord bears 54'50850"£ 6i.17~i thence 3!E'Y'iS114"t i.7.0111413eaeO Sot3heasteriy_136.561 along tke arc of a 311.008'4adtas curve concave ! NoithoseterIy whose ckovd bears 924 03402"E 130,511; thence 83b 23130^ 113. l{t; the*" Mr36830"Z' 160.961; 'thence X89` 16114"ZZ43.OW; thence SO.0613Y'V 108.002; tbercaA33W3tt"x. 2S9.1i'. thence Southeutorly 94.141 sl the are of a 217.001 rsaii ;errvs.naoeave Xortheasteriy. wtiep ohord beasa S73P031.16"E 96.3S1: ttiance NA9!t;gll+' 920.008: themes Nertheaatarly 91.212 along the arw`bf si.300.fi02 radius tosM►sanarro Nerthwootarly whose chord bears XW32240"1G90.SS81 their. North- " sweir9l';4,46Monng~ that. are of w 300.008 radius evm.e eoneavr Nortbeaetmrly whose ehomdbonze, NW37026"`a► 91.09x; thence 1'4010613008 150,002; thence NWIS*14 4 478.0591 tlstwto NW06830"Z 934.561 to. the point of begiaaing.. TboW such'tet is a correct repmeseadstiou of all the extemier bouodaiies of the I&" inn rayed and the sebdiviefoa theread made, sad Thee I have fully oor gUod with the provisions of Chsptar 136 of the Wtseoasis SRSteboo, the SwbdtviaLow sad Zoning ReXutattaw of St. Croix County, the :own u1 Hadsan -Sabdivtstom OrdL lawo, wed the City, of Hudson Subdivision MW AnhAng 0r41- netreaR is rwr+veying. t0wMag and mapping the same. Dated this.. day of Maofiwl , 1964 1 ' R red f Iith dn. of April. 1984. cm `r . 1376 ~ . 421 fkt:ead Dtrest i liodeon, Zalfrtamafa 54016 Wt^ COUMTT TRWASUIMR1S CERTIFICATE 6TAT1e OBE' WISCON~ ST. CRO93C COUNTY ) S.3 1, Ma y Jean Livermore, being dJdy. elected, quallited and se►ing Ir,oasurer of St.. Croix Covell,, do hereby certify that thr records in my office show as unredeemed tax sales rod ao oupsld taxes or special sssessments aloof 1-'t- J'/-Ar/ affeetiag Om Isads laelodsd in the Plat of Park View Estates Fourth Addthon. Date unty Treasurer i - t 70NM COMIst1'1 CS RE41OLUTION This plat is hereby approved by the St. Croix County Comprehensive Potrks, Planing and ZuninR Committne. 1 ' ' Data Clmi i/ .a e,4_ Date Adminf etrator a- • IE61ST¢f1'S r;cam ~ , r . _ 517•''-'•!-'r-'---...fi y ' wYlt Rt(t 1*j 1 f ' lV. .41