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HomeMy WebLinkAbout020-1144-90-000 4 0 I ~°o I M 030 pe°a I h C a 4 O o h ov o a~ (D (D No" E f0 3 v m~ c:E Q T c f0w o ~ a) (D 06 O 5 1) 1 a" n 0- o t p c0 Y O. r $ co ~t> h o~ N N m o o04) h N N C O m C z -C C Z t C>a ID c` a 3 ~4 um It 7 N p IL c w' rn U. c c 0 O Y ET •2 O~ 3 ~2 3 -0 N V7 .t+ - -0 q? 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CROIX COUNTY, WISCONSIN Current X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - ANDERSON, JOHN V JOHN V ANDERSON 963 WERT RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 963 WERT RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 9.830 Plat: 2276-PARK VIEW ESTATES 2ND ADD SEC 17 T29N R1 9W PARK VIEW ESTATES 2ND Block/Condo Bldg: LOT 65 ADD LOT 65 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1082/516 QC 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 9.830 68,700 156,600 225,300 NO Totals for 2005: General Property 9.830 68,700 156,600 225,300 Woodland 0.000 0 0 Totals for 2004: General Property 9.830 68,700 156,600 225,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 149 Specials: User Special Code Category Amount I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 STC - 104 AS BUILT SANITARY SYSTEM RE ~b d~`' , OWNER ZrO 140 ~ Ist'I ADDRESS 963 WC-X- RD e SUBDIVISION / CSM# LOT SECTION / T N-R W, Town of iN ST. CROIX COUNTY, WISCONSIN y PLAN VIEW SHOW EVERYTHING ITHIN 100 FEET OF SYSTEM ?'/Is.~r1v I I ' 4 ~ i 1 , I W L. e_ fi € INDICA E NO ARR Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: 100 /d R lee-re ?.S' ~~e G ~B~4CfG SEPTIC TANK / PUMP CHAMBER / MOLDING TANK INFORMATION Manufacturer: " /,cF~~it1L Liquid Capacity: /2 my Setback from: Well House Other Pump: Manufacturer Model# Size Float separation Gallons/cycle: Alarm Location ~ I I SOIL ABSORPTION SYSTEM idth:_ Length_ Number of trenches i Distance & Direction' to nearest prop. line: 90 S. Setback frola: well: iVO House 7" Other r~-r mot' y0 ~N ELEVATIONS j ukding Se er ST Inlet : ST outlet /al. 73 C inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade_ fD3. Final grade DATE OF INSTALLATION: PLUMBER ON JOB: k- LICENSE NUMBER: to 4? ,f g :INSPECTOR: L-7( IA)S 3/93:jt Wisconsin Dopertmentof Industry, PRIVATE SEWAGE SYSTEM County: ST. CROIX Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-:. GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Town of: State Plan No.: ANDERSON, JOHN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: L z) U, 00 Waj d4 cJ - I A940 166 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark l~ Og L~ Dosi ng Aeration Bldg. Sewer a,3$ 05: Holding St/ Ht Inlet c/S I b3,~~ TANK SETBACK INFORMATION St/ Ht Outlet x/7_3 16313- vent iI to ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Ar I Septic has! ~NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe 3 Z/ J03, I Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand /o Z" /1~t 'YL ,r'uG~ Model Number GPM TDH Lift Friction System TDH Ft mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Leh No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM INFORMATION Type O CHAMBER Model Number: System: 4_e OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over rr xx Depth Of--I xx Seeded/ Sodded xx Mulched a~rw Bed /Trench Center Bed /Trench Edges ✓ Topsoil j ❑ Yes ❑ No ❑ Yes ❑ NoJ,4 ~ C TIr MENTS: (Include code discrepancies, persons present, etc.) - Lluson.17. LOCATION:19W, NE, NNW, Lot 65, Wert Road pz~ 1 is t+ Plan revision required? ❑ Yes ❑ No J ~r -1 1 Use other side for additional information. 1-4 y SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION Y U* D1LNR' In accord with ILHR 83.05, Wis. Adm. Code COU T SF, STATE SC II AlfR~I # -Attach complete plans (to the county copy only) for the system, on paper not less than ~G(~_ G6 'O G> 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNE ( PROPERTY L ATION t/a t/4, S T N, R t/E (O ING ADDRESS LOT # BLOCK # PROPEL OWNER'S MAIL q 4. AL 7- CITY, TATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR C NUMBER 0350 45Vjj::1j A if /Plgi,c II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ❑ State Owned ❑ ILLAGE ❑ PubliC 1 or 2 Fam. Dwelling--#~ of bedroom ~ PARCEL AX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that aW) O.P, c / t q q _ v r eej C) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 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 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 5 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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 REV IRED (sq. ft.) PROPO/SED (sq. ft.) (Gals/da /sq. ft.) (Min./inch) EL91ATION /00 ~ qcco 94 6,40 . 7 . O Z , ,3 Feet I' l • 'O(Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank 4945 Lift Pump Tank/Si hon Chamber Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system sho on the attached plans. Plumber's Name (Print): Plumber' Signatu : (No Stamps) PRSW No.: Business Phone Number: 9 G s-` Z_, 6 021 Plumb is Address ( treet, City, tate, Zip Cod A(2 &6K 7 a IX. COUNTY/DEPARTMENT USE ONLY 0 1 ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agen at r(Iro ps) (0 Surcharge Fee) _ Approved ❑ Owner Given initial ~~ff Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) ~t f/ S' Y /t1~ '7 Y -r, 9 ,v uI 2 G cf 1 ` S T ,4.Pr (DSe~ Oj &4 J. 7`d P e r4,t1 G ~ € lid it y y ~f ,ESL 'Pile PD s ,.ra ~'Z c Cp AL p `SST t COO C ©J ~-,Z p~ '1pLus y Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code - - COUNTY n must include, but Attach complete site plan on paper not less than 8 %nsize.OPI, ARCEL I.D. # not limited to vertical and horizontal reference slope, scale or P dimensioned, north arrow, and location and t o nearest 020-1144-90 APPLICANT INFORMATION-PLEAS NT OREVIEWED BY DATE PROPERTY OWNER: '`F,'~ROPERTY LOCATION ~ r. , $ OVT. LOT NE 1/4 NW 1/4,S 17 T 29 N,R 19 NE (or) W John V. Anderson r PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 2 t. Apt. A O 65 na Park View CITY, STATE ZIP COD ONE R ❑CITY ❑VILLAGE FROWN NEAREST ROAD WiiAcrin- WT_ 54n16 ( Hudson Park [ New Construction Use Residential / Number of bedrooms 3 Addition to existing building j I Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate __j bed, gpd/ft2_,$_trench, gpolft2 Absorption area required 643 bed, ft2 5fi3 trench, ft2 Maximum design loading rate _Zbed, gpolft2__$_trench, gpd/ft2 Recommended infiltration surface elevation(s) 102_'18 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem iaS ❑ U iaS ❑ U [3& ❑ U C3& ❑ U ❑ S jaU ❑ S jaU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rertdt 4•};M:•}hK 01 1 1 0-10 10 r3 2 none sl 2m r mvfr 2m .5 .6 v \v41}n b} 2 10-31 10yr4/4 none sl 2mgr mvfr gw 2f .5 .6 Ground 3 31-88 7.5yr4/6 none S Osg ml na na .7 .8 elev. 10.E -48ft. Depth to limiting factor +88" Remarks: Boring # 1 0-6 10 r3 2 none sl 2m r mvfr 2c .5 .6 $ 2 . 3 26-88 7.5yr4/6 none S Osg mvfr na na .7 .8 Ground elev. 10&. eft. Depth to limiting factor Remarks: CST Name:-Please Print Phone: Gar L. Steel 715-246-6200 Address: 1554 2 0 h. Ave., N w Richmond, WI. 54017 Signature: Date: CST Number: 5-2-94 s m 2298 PROPERTY OWNER John Anderson SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # 020-1144-90 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bwxbry Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITmr& 1 0-5 10 r3/2 none sl 2m r mvfr 2c .5 1.6 3 2 5-33 7.5yr4/4 none is Osg mvfr 9w lm .7 .8 Ground 3 33-96 10 r4/6 none S Os mvfr na na .7 ' .8 elev. t 1 Q3-,2-8t• Depth to limiting factor Remarks: Boring # 1 0-9 10 r3 2 none sl 2m r mvfr 2m .5 .6 42 9-78 7.5yr4/4 none is Osg mvfr na na .7 ~.8 Ground elev. 101.48 ft. Depth to limiting factor +7811 Remarks: Boring # h:=;~• : <:< 1 0-5 10 r 2 none s 2m r m 2m .5 6 vii`. 5?'; 2 5-33 7.5yr4/4 none sl 2mgr rnvfr gw lm .5 '.6 3 33-80 7.5yr4/6 none S Osg mvfr na na .7 .8 Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. i ft. I Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel John V. Anderson 1554 200th Ave. CSTM2298 NE4NW4 S17-T29N-R19W New Richmond, WI 54017 MPRSW 3254 lot 65-Park View Estates (715) 246-6200 1 town of Hudson N 1"=40' BM= top of Angle Iron at el. 100' alt. BM= top of mid lot survey stake at el. 108.08 06 40 20 do ~Z/ -102.38 ,B. 2, Yin ~ 12x54' seepage bed J.¢' \ if trench system desired el. to be 3.5' below surface )Z(~ level with step down design. area presents very limited working area. see attached survey copy for lot dimensions ~k Gary L. Steel 5-2-94 f;0551 Q1%,,94 12:49 HSD 0 S 2-2W-49 7156432457 NO. 161 Poo s . ~ trt ~6e ~ t~ ~°ve ~ Uv 55 ~ pia s c c~ Le , cr"S vy~ t. o c yc~. w 0-4 Y7 ..v . n. 65 1J2`2~ 00~ V j'uvv~cy his 9,43 ACRES o a T'yluy V~ Y, aI S'jaVlcP U ~~i9 90 N 89017 39' 1, LSOUYFI LINE OF THE NE I/4 OF TAE MW 1/4 ,PREVIOUSLY V N P L A T T E O LANDS g ~rav~P 0 1~ 'EUTM LINE OF 119 ~ , 0 NEL^ OF WV* LOCATION SKETCH o N w 1/4 r 1 /X v (Q n N 99.52'44' W 19o.oc' ,u SW 1/4 i SE 1/4 ~o M 66 p o_r L c fA fi 4 SECTION 1? 1.79 ACRES T29N,Risw S SCALE IN FEET W be 200' 100' 100' 200' * se 0+r o , 94 LEGEND 0' MONUMENT Four4o, J' ~s 9ERNTSEN GAP Zf ,.Tg ACRES 0 1' IRON PIPE WEIGHING 1.6$=/ LINEAL FT, FOUND 2" X 30' IRON PIPE wEIGwNG A9 3Z ~O W 3.65 tit LINEAL FT SET 2` IRON PIPE WEIGmiNG - 3.652/ LINEAL FT. F OuNO ~ 05 Wit, 94 G:33 ASD 0 S 2-2W-49 ► %5643245' f Itl. f~r77 } J t I t . •~o ~ ~ l,W~sT rt. c3au~ , j t~ I y1 j j ~ ; y ~ O j h cAboU s h ut~s c S-ka ~to . G! oV.no,,;r1 , o hu.1s.Q uvn. ' ~gdfuvr (Yl ~f ~t! 4 Wl s~ C~''~►~c p; -6 h e3 s .{.~1uH iY~u x. } aid; N i..r~ ~:Ji' 'C 9N ~-:Rtq. i STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County -OWNER/BUYER / MAILING ADDRESS i u -1 -S i X PROPERTY ADDRESS (location of septic system) Please obtain fromthe Planning Dept. CITY/STATE ~ ~ S > S PROPERTY LOCATION ~ 1/4, !C U4, Section N-R~W i TOWN OF 1~a n S'r,j J ST} CROIX COUNTY, WI SUBDIVISION c dl 4~~- 1--'d T NUMBER F X CERTIFIED SURVEY MAP , VOL'UME4g?gPAGE,2 T NUMBER S Improper use and maintenance of your septic system could result in its' remature 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 ' fimction of the septic tank as a treatment stage in the waste disposal t j St. Croix County residents may be eligible lo 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. ff 1 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 an (2) after inspection and i pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. ~ C j 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 y ex iration date. X SIGNED: t DATE: Z -c lc/ St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, Wl 54016 11/93 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 'j (j t 4J nom" e Location of property i 1/9 X1/9, Section l 7 , T,e?`! N-Rjj_W Township -D 13 c)n~ Mailing address q ~ i. X Address of site 163jbE Led A~ r, 1 (,ur S'qcj I( i'~'L ~C l% rz~ Subdivision name Lot number Previous owner of property I cl"_ ( Vl/ C'w 4 Total size of parcel T 6)3 f y eei Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes y No Volume 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 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 warrant deed recorded in the Office of the County Register of Deeds as Document No. S T $ 2.27 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office 1. of t e County Reglste of Deeds, as Document No. 32(:8Z2-7 Si tune of owner Signature of Co-Owner (If Applicable) Date of Signatur Date of Signature e OMUMENT No WARRANTY DEED Ta.e eeA._a o9senYaa P.M eseono,r.a 0414 STATE BAR OF WISCONSIN FORM I-NO 388227 WOL :674 =e : L-84 DARREL WERT, a/k/a` Darrel .E. Wert, and i5 Oft~~E !lEVEKLY 1►'ERY`, a/li/a Beverly ~l 'Bert, i~IX 00.1 W M D. 19.!3 eon..ds and w• nts nr P. and JUU ~f rf ANER50N, ►us~and„-diia- wi as..1oint 'tells is -dz30 A in consldeiitioa _C;r-Etie idw,dr,415;00.O:II0 - . St. Croi~c ` - r the following described sal mate in _ _ County state of Wimmin: Tax Pared Ne: i ~,wn Lot 65, Park View Estates Second Addition to the of Hudson. TOGETHER WITH and SUBJECT TO easements, covenants, reservations or -r• restrictions of record, if any, but this shall hot be deemed to extend" any such recorded encumbrances beyond the term established by law therefor. r LE Thii is not. homestead property. I 1 (ii) (is not) - - .Yet' ten ttaA -ran _ irr tha, -29th _ -dap of -September-93 (SEAL) (SEAL) .j Darrel We t tSEAL1 (T t~+ _ ~ ~I ~Z;-"2' (SEAL Beverly W t _..AVTHBNTIC-A?IOM- ` -A . ACtNOWLBD01[BNT Signature(s) VA STATE OF WISCONSIN _ St. Croix as 1 a .....................................County. authenticated this day of 19...... Personally came before me this ~a1.....day of i D...... d 19.8 3_. the y mama,, t .arrel ..Wert an Beverly Wert • TITLE: MEMBER STATE BAR OF WISCONSIN (if not + authorized by 170&06. Wis. States) Fyn I. he the Sion .S who uted Fhe O forft-nin¢ ' ~rnt . nowle,lse then »JEW 9 INSTRUMENT WAS pRAPT90 eY I- he Hugh F. Gwin Attorneyy 4 ` GWIN~ GILBERT --MI IN-- MUDGE i PORTER j~►y~iyS C ~ ~O.1J.~1~~11w......• Hudson, Wisconsin 4016 anti-... public St. Croix County. W;,. 18isnaturen may he suth..enticated or aekn.,wied_•ed. Itnth My ('nmmi-Ann is rermans %t.rIf net, state esr,iration are not necessary.) 1 19 .1 i z REPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM 4 Sanitany Penm.it State Septic NAME ~-'J township Cno.ix County i ~•5 Section - Location C X SEPTIC TANK Size gattonb. Numben o6 Compantmentd Distance Fnom: Wett it. 12% on gneaten ztope 6t Bu.itd.ing 6t. Wettandb 6t• H.ighwaten a 6t. DISPOSAL SYSTEM Distance Fnom: Wett 6t. .12% on greaten 4tope 6t. Bu.itd.ing 6t. Wettand4 Ft. H.ighwaten 6t. FIELD DIMENSIONS: Width o6 trench 6t. Depth o6 rock below t.ite .in. Length o6 each tine 6t. Depth o6 rock oven t.ite .in. Numben o6 tines Depth o6 t.ite below grade .in. Totat .length o6 tines 6Z. Stope o6 trench in pen 100 6t. Distance between tines 6t. Depth to bedrock 6t. Totat abe onbt.ion area 6t2 Depth to gnoundwaten. 6t. Requited anea 6t2 Type oj Coven: Papen on S thaw PIT DIMENSIONS: Numben o6 pits Gnavet around p.itzs yea no Outside d.iameten 6t. Depth below .inlet 6t. 2 Totat abdonbt.ion anea 6t A 2 Area %equ.ined 6t m INSPECTED BV TITLE APPROVED DATE 197. REJECTED P DATE 197. EH .115 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 Z- 7 LOCATION-& %A iE%, Section 1 7yn ,V_1_N,R~fe (or<jj?Township or Municipality ~ Lot No.Block No. County - Owner's/Buyers Name: s !,.i / lvell'•' 5ubdivision Name 1 v Mailing Address: COMMERCIAL j TYPE OF OCCUPANCY: Residence No. of Bedrooms EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 3r -7f PERCOLATION TESTS SOIL MAP SHEET S -IF NAME OF SOIL MAP UNIT !Ft PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- l 84 See; io,R- D :i Y j-- A/o -3 6 P_ Sr P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- dI II 414W 4e- it B- yZ 6 " a -r 3 " S 20 0 d. 57t, 21.s B_ 6., B- AJ e, PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of.suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy f rp~ „ Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. r~r res . E~ E E 5 ~s N E 3 N., q 74 I /149' L._ t LJ I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) r -W c' , I~ /0 S Certification No. ~ r Address ///c e SCAA f S-1vee-141 .Name of installer if known A Copy A -Local Authority CST Signatu A ' ~ ~ r y ice. ~ I ~ -i.~, ~ I _ _ ~ F ` ~ _ ~ ~ J, t j _ _ i i s J - ~ PLB 67 1 State and County State Permit # Permit Application County Per 't # j for Private Domestic Sewage Systems County low- *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF ~PROPERTY Mailing Address:/ I / /K d Jle' 14ud5^0, w SGGAs/?I B. LOCATION: '/4 Section, T N, R 7ff E (or) W Lot# City _tj Subdivision Name, nearest road, lake or landmark Blk# Village FQ K o ~aj`cs Township 'tlS o h C. TYPE OF OCCUPAND: Commercial *Industrial *Other (specify) *Variance Single family r'/ Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY ' d 60 Total gallons No. of tanks HOLDING TANK CAP~ITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depthjtop)_ No. of Trenches Seepage Bed: I/_ Length !Tx Width~_~_Depth Tile depth (top) 0 'r", No. of Lines 21- Seepage Pit: Insidejiameter Liquid Depth No. of Seepage Pits Percent slope of land ^ 7r Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the C rtified Soil Tester, .,t J -f NAME b A 4') u P C h /'y `a Arm C.S.T. # ~P" /and other information obtained from t (owner/builderl- _ Z Plumber's Signature M /MPRSW# 41, " ~l2- Phone I'7 3 A 3 / Plumber's Address o w PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. . 10 4cr~ wpi~ a Z ~ spa ale t t ~ a ~ E Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE.ONLY Date of Application - -/(Fees Paid: State ,00 Count 0 Date 7- Permit Issued/Rued (date) L Issuing Agent NUJ Inspection Yes X No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, Wl 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78