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020-1165-61-000
I Q ^ O °vy O °ul, M U ~ a 0 0 "r T2 x O _ N 0 O EO co 0 C CD 0 > (n in r' O O (0 O 2 C N C c0 L N Y 0) > _N ca c 7 C co N N .0 3 N 0 .0 C N 0.00 C) U M O. N C L 3 = a) •N N N O v) co - ~ E ~ a- m co C4 U N •O co . > O g O C N O aS O> r N U •O C M N N y 7 C p) '0 O c O. r COY 0) U w0 w (0 a O U N O° rn E 3 0 S? E 0 i> O) o)w O N N~O - In L C x o c c o LL ~ r =°LOa)a) w0 0 N N c lu E a)cn N CL) U `Q) o y aci O a) O F 4? ~ 3 a ti Z m Q))-C a Z C c E'0 c - w U C a)-0 ..0 c N Q) N C O 3 u m n u)a c E N . O _ c U ca o o E o c u. c ar a) Li - otS _ p ` N W V 7 '6 O cp c9 N c6 N w U N N t N O ~ co C ca - U 0 C _ N C c0 O 2 q? L) 0) 75 0. - N N C :3 zo E Q c ca cu a)~ `o Q o Vin- Fn co U I I c9 M M 0 N 0_ N z N rn w E E U) o = 0 :t ° o N! a m d m i- z 0 c C7 o is O z :t c U c 'U Cr e.. O N w O N O c fn F- ~ ~ EN U ~ ~ . N N _0 0) 2 CIA O 0 N 0) N j co N in CL N U) N N d N CO d N C O 0 z F- z z co z N N 00 aNi c m N R A w a w C O C d «0. CL CD T 4) ~i > G G a n CD 00 0 0 co N a i N N N c a m L d C) H H O U N o o LO H F F -2 o !►1 333 n co zavv 3~3 a_ •hi a a a N o 0 0 a as a o_ _ ! N ;j 2 N j Cl) 0) 0) (D co o o 0 N J U 0) 0) = rn rn z co N c0 '0 co O N 0) N N O N 0 = E D ~n w Lo 6) c1) O O - ca C co 00 '8 C ~ _ Q > O 0 ?j Q } U3 C o O U) C co c 00 N 0 -0 t LO G) (o 0 U) 9 ° 3 © E Q)) c c CL m °O °o °o v c CD 0 \ y = N Y Y 'O N N N E N E c v O Ln C c c C _N O In m O C N N (U '0 Z co 0 N 0 UO) c rn x Q) • 7a N 0 O O CY) O y N N f3 U - co O N O f0 O S 0 0 _ 2 2 (n co O N z 2 O ~ r.+ _ = r i U 7x w E E d CL a #a a L0. w a c° CL d °1 c m y 0 a~ O in c O in u A o r 4 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 10 1 ADDRESS SUBDIVISION CSM ~6 4 . , ; ~S I ~d! LOT` } SECTION. ( Tyr`} N-R1_W, Town of (66'1 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM . -3T I - n bull ~UQ ; z Valve - ,f ~ { n~ nr ~ IV INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover- 4 ' J. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING-TANK INFORMATION i Manufacturer: W P\1 Sc 6 Liquid Capacity: r, Setback from: Well House Other Pump: Manufac u Size Float seperation r'Gallons. e: Alarm Lo on SOIL ABSORPTION SYSTEM r_ a Width: ~ Length Number of trenches Distance & Direction to nearest prop. line: 90 Setback from: well: `P House - S Other ELEVATIONS Building Sewer ST Inlet; ST outlet J 11~ Header/Manifold Bottom of system \k<w a 1 Existing Grade Final grade p ~N 13,77 SS DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: of d9 N~ w INSPECTOR: 93.77 3/93:jt ~~`ipart+~~~us~r • 29.19.1 County: Labor and Human Relations IVATE SEWAGE SYSTEM Saf@ty and Buildings Division INSPECTION REPORT (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 1-99971 Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID No.: lev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 020-1165-61-000 INFORMATION ELEVATION DATA A9300329 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3 'I Z 0 © C t, IQ . Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet CJ3, gS TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header/Man. 33 9D,S y Aeration NA Dist. Pipe Holding Bot. System , 5 (0 PUMP / SIPHON INFORMATION Final Grade t Manufacturer Demand Model Number GPM TDH Lift Friction Syestem TDH Ft Forcemain Length Dia. Hi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS L DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type CHAMBER mo C / -74 ~ ti/A OR UNIT model Number: System: 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 xx Depth Of xx Seeded/ Sodded T xx Mulched Bed /Trench Center µ Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) IpCATION: HUDSON 17.29.19.1007 - i Q..l Y Plan revision required? ❑ Yes ❑ No R13 Us e other side for additional information. t,J fW b SBD-6710(R 05/91) Date Insp ctor'sSignature Cert.No - ADDITIONAL COMMENTS AND SKETCH R SANITARY PERMIT NUMBER: ILH a SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE 7rlzion -Attach complete plans (to the county copy only) for the system, on paper not less than 71T# 8% x 11 inches in size. / ❑ Chec ito previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PR RTY OWNER PROPERTY LOCATION Nut %a '/a, S f'y T oZ , N, R / E or) W PROPERTY OW 'S MAILING ADDRESS LOT # BLOCK # 9 041009 CI ,STATE ZIP CODE PHONE NUMBER Sy~q IVISION NAME OR CSM NUMBER 4-6 AJ air I_TVQ)6 EEsALles II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) El State Owned VILLAGE N Or PAW X NUMBER(S) ❑ Public 1 or 2 Fam. Dwelling-# of bedrooms 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo lJ 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 in line A. Check 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 # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 4 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 REQUIRED (sq. ft.) PROPOSED>4 q. ft.) (Gal day/sq. ft.) (Min./inch) ELEVA ION (0 -18 9 l1 . V Feet - eet VII. TANK CAPACITY Site INFORMATION in gallons Total # of anufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. M New lExisting Gallong Tanks oncr to structed glass App' Tanks Tanks Septic Tank or Holdin Tank 11 U,3 r ) N V I F] F] F] I F] Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: i-c-Aa --R611.Ty\jeE_-54Cr ~ " 13640 f2i3 38 - 6Wa6 Plumber's Address (Street, City, State, Zip Code). IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Qi~~j Adverse Determination w Lo, 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 reVsioris to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SRD 6399) to be submitted to the county prior to installation. 5. Onsite sewL.ge { yst?ms must be proper;y maintained. The- tank(s) must 19e pw,nped by`a Iiiiensed- pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code admirdstrator-ar• 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. 111. 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 e, <ery new and/or e; tank., list the total gallons. number of tanks and manufacturer's name. Indicaf.o, prefab or site constT ucted and tank material. Complete for all septic, pump/siphon and holding tanks to? this system. Check c: x erimental approva only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, iin:. rse number with a0p;ropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign app lcation form. ' IX. County/Department Use Only. X. County/Department Use Only. Compete t ; ;n and specification-„ not smaller than 8% x 11 ins fii r ru!_t be submitted to thf: r:ourty. The ' plans must Include the following: A) plo! v'an, drawn to scale ! y: iti• complete dirneri:,ions iccaticn of holding tank(s), septic tank(s) or (.aher treatment tacks; but _;s t: s: wells; water mair:s eater service; streams and lakes; pump or siphon ianka; distribution boxes, rt_iswption systems, replacement system areas; and the !ocatien of the building sec ed; B) hcrizont? mica: elevation reference points; C) complete specifications for pumps and controls; dose voiume, eiavatio'i 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 41st n ;tided the creation .E :_~i;rchar4les (fees) fc., a -uni 3+,r Gf regulated pr_' _es van ch ---.an, effect gi oundw The rnonies •c,:'.ecteE through ~>,~se•surchargt:; Lit,, t gro; -r;,n,ater, ,-,i::;ans - water contarm nation mveiiigafioos and establishrn giant of titarfa =+~us _ ; SBD-6398 (R.11/88) w n.w.,•.. -.-'..y. ii.s<.SaT~~"!`Y`MMYV'?aAiyiYN1~A4 '~v+'~#~IY~IbR'+.enwCN.,:' 'Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page l of 3 Labor and Hyman Relations Division of Safety d, Buikings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ST, C,f,°& X Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must inckide, but not limited to vertical and horizontal reference point (BM), drection and % of slope, scale or PARCEL I.D. If dmensioned, north arrow, and location and dstance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER- PROPERTY LOCATION GOVT. LOT ti' w 1145,E- 114,S17 T Ly N,R /9 E (or) W PROPERTY ER':S M41LING ADDRESS LOT # BLOCK # SUBO. NAME OR CSM # )3WOOeW 000 90 - low" n"eZI-1 --Lrr_- CITY, ATE ZIP CODE PHONE NUMBER []CITY []VILLAGE CYOWN NEAREST ROAD USo.,~ /S. ~S~b/lo (715) 3P6 ' 9!17 vOSo~ ~,E'oo~~v o00 O New Construction Use [ Residential / Number of bedrooms 3 [ 1 Addition ID ebstirg building VRepimement [ 1 Public or oorrt wcial describe Code derived dally flow y. gpd Recommended design loading rate bed, gpd/R2 trench, WW Absorption area required 3 bed, 112 J2o3 trench, 112 Ma)amum design loading rate bed, gpcW " trench, WW Recommended infiltration surface elevation(s) s-e-e- p ~ 3 It (as referred Io site plant benchmark) Addi*N al design / site oonsiderations 57rpaN6Z y Re o-yvE-vb o u~y 7x°fAACA1 S ZO/W4- D,Pv 13oX Dr'ST.ei n , Parent material 5e5 SY 'S Of&4F for fll"l cr-`rd454, Flood plain elevation, d applicable It S - SuitWe for system CONY MOUND D PRESSURE AT GRADE SYSTEM IN ILL HOLDING TAN( U- Unsuitable for system e1 o us ❑ U 21-11 U E o u E31 ❑ U a S Be- SOIL DESCRIPTION REPORT k Boring # Horizon Depth Dominant Color Mottles Texture SWcture Consistence Boundary Roots GPO/ rb in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed lends 1301k 11 / i0V s 10ryp71;07T0 q "-1-, u R Ground 3~-loy 0 SC/ /,f, 5& 4rl•i4k i Z elev. ft. hb~~ Doti , „ ,S A yX orpG 4.,/ c j /e'jEp7-i -vet / l f> Depth 10 fS&;e AORI- ,vs Ty/~i~7srt ti46"jF tilyx kA limiting factor / Nr~°.v 10+AEX07-1~S . 7XI's i No7- vl'TfD ae c ~G /--V-W. 00//!t,0 of SIOWS ) ae ,5' f/-e S STS 5 . Q Remarks. . fF ~ i/iN(- SI STE.H i'S 55717-6D /ti ~P i' zo-v O i/T I'-R41 ~ Boring # .3v4C' Io~ ~ 2- / .vTi 'sL TO IDi f / , 46/161A h. / ~/~ov o 13 i fi• Df deG 57,01- S, N Ground elev. .SOr~S ~ pV iV 0 T ~ -S 7~ w E" Y So it Depth to Gv~ limiting irau'li factor Remarks: ^1 Name.-Please Print Phone: tress: ASS o' RD ff~Dso~ ~s . s yo~(o io -i.~ - y3 csr~y 2-y002-- y ISignatitre: - , CtA_~ Date: CST Number: r 4ACfi -13 tA r-OR ~N 'N yiPo v-vv ro-v v -mar/ a~.~ sy sr~--~ PROPEMYOWNER 00/;tty S SOIL DESCRIPTION REPORT Pape?' d 3 PARCEL UX f `O T _ j`~ - f •~y~ Depth Dominant Color Motiles Texture Stnxoure co nsisiw noe Bwd3y Roots GPD Bo" # Horizon in. Munsell CAL Sz. Cont. Color Gr. Sz. Sh. Bed T*o A) t!p 77 X 7777 -51 *4 A) /0 Yle 17-11 b b- /a Yid 2,11 Aip Grond ,f, s l e /w f R S . y S /3 zz-zy /o V /s o f Cs 7 • d' Dept, to (!5 W /o Y sly S O ,w, timi6ng Remarks: Boring E O d yl( o e &f,-, 1 F 2 3 G zo /o 3 c, 65 Ground elev. 9SS~.tt t)" ID imi~n9 factor Remarks: Boring # 7 C s Zf . S .G o L)-/o i1 Z• , ,p 441 / J~ j3 /D -)o /a //e 3~3-- S~ .f Sbl~ v7r-1Q e S 5 G S S ,H - Ground ,77 31 tL Dep to 5Mng facta~ „ Remarks: -Boring #t E3 Ground elev. ft. Depth b ~rtatitt9 factor LL Remarks: con ooonio ncinlw~ v ~ 0 W 2 1j~4Clc~h DE TS W 13Af s A30777,0,44 OGE or y,~,~y wooo s,oa ~ ~ w v ~ h b toed s ~ w j W o Q , o 4s .41 3 13CPe lq . #OME V1 s y' ~ v o ~ t 30 53 361 114 I M 1yK1~ i3 y~R~46E 30~ ~ - Lys w~ESE~iQ~ ~ ✓r • Af eC~fs r rJ /P 1(36 93•Go ol~ 19 _ 13&,o 131 2 O CCnn ~ ~ 7d, M. ~ M oD 3 o 3 P; Q.L. ) 7 _ L ~T H , 1-10,S IS E C; T I I\l_ J EC N A M ET l N A M E ,ir, L 0 Cr.~v:.~r . . _ _ t......._ AT I M A_h _r PLO ~ , mss' 3 RRugoJ M d3 3 C) Roo o i By ~S fr 0 . ~ - !►~Prvl~i-P f . a - . UJ pots, WP1? FRESH A'il'. If.~LI:'I5~AND OBSERVA`PLON PIPE CROSS SECTION Approved Vent Cap Minimum 12" Above I V' }\j Final G ade___,._. Cast Iron Above Pipe Vent Pipe To Final Gradc!- I' Marsh Hay Or ~Synthetic Covering Min. 2" Aggr.cgl;il Over Pipe Distribut-i~ -Tee Pipe I r Aggregate Perf.orat:ed Pipe Below ilencath Pipe --Coupling Terminating P Bottom Of System. Y - S. T C - 105 r Y SEPTIC TANK MAIN''LNANCE AGREEMENT ' T St. Croix County 1-7 OWNER/BUYER G S Y } ,r1' ROUTE BOX NUMBER Fire Number 6---Y CITY/STATE(,( C A Z-IP PROPERTY LOCATION 4, 4, Section , ''r,2 N, R W, Town of /-,J' St, C County, Subdivision ,L-~ Lot number Improper use and maintenance of your suptic system could-result, in'- its premature failure to handle wastes. Proper maintenance curl-, sists of pumping out'the -septictank every three years or sooner; if needed, by a :licensed sL!1)tic' tank Lurn_Ler: WhJt you put into the system can affect the function of the uhtic tank as- a treat~-._ inent stage iii the waste disposal system. St. Croix County residents mu be eligible to receive a braat.,for- 1 ' a maxiwuni of 60% of the cost of replaceuient of a fai`linbsystem,~t; ' which was in operation prior to July 1, 1978 .$t., Croikt°Countyt4 accepted this - 1) robram in ,A"u'gust of.-1980, witli ..tl e rey'ulreill ent`:,.that owners of `till new system agree to keep their .systenis' 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 pLim per veri fyinb that (1) the on-site wastewater disposal' Sy p' pe stem is in proper 1 operating clondition'-and (2), after inspection and pumping (if :nec'-, essary), the septic"tank is less than,l/3 full of sludge. and scum. Certification form will be sent approxi,'mately'30 days prior to three year expiration. H 0 L IIWE, the undersigned,: have read the above requirements and agree, to maintain the private sewage disposal system in.acc-ordance with' x P::O. fox 98 ro~ H the-standards set forth, herein, as set by the Wisconsin Depart-_10 ment-of Natural Resources. Certification form must be completed; and returned to, the St. Croix `County Zoning Office within' 30:da of the three year expiration dste. 1 SIGNED / D AT E f O St. Ciaoix C_)Lin ty Zoning Office Hammond, .WI 54015' ~ - 715-7c6-1239 or 715-425-8363 Sign,- date and return to above address. - i ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the 4) ~y/1l4w`2 residence located at: 1/4, .5~ 1/4, Sec. T& N, R_Zf Town of 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 ct Did flow back occur from absorption system? Yes No (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacurer (if known): t Age of Tank (if known): Cq c~ 'r- ~~J M ~OUIrQjz A (Sig tune) (Name) Please Print rrnFsfieg- 3qo y (Title) a (License Number) I I )-d r (Date) Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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 7a0a lee~i4tL_Signatur 4'66/ MP/MPRS ~YOY 5/88 MINK AI'P fCA'I.'lON VOk SAt•ITAIZY PE11MI'i I S '1' C - 1UU ti, This application form In to ba 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 duvel;ojent'ba Atended for.resale by owner/contractor, ("spec Douse"), then a second form whould hu rutnUiud and completed when the property is sold and submitted to 1.IK affl.r_e with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property 6!/l'~~e > ~A , i P !4 Lf~(nc), Location of Proper t .S~ction T N R y W ,gv Township V . Mailing Address roo <(JOOd ~f )f 4 }N~`~P~ , 14~k 1 Subdivision Name Q6_~TCS l C~ S Lot Number Previous Owner of Property n( ~~1e('~ S Lol, 1. o~ Total She of Parcel c `e- s Date Parcel was Created - -2 ' Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number ~O~ as recorded with the Register of Deeds J4 ` tt ~4 A4 X-- INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: `s I. Warranty Deed 2. Land Contract 3. Other recordingd filed with the Ru ister of Deeds Office In addition, a curt if l ud unrvmy, If nva l l iihl u, would be helpful so as to avoid delays of the reviewing proc:um" I P thn d"od Wer Lptlon references to a Certified SurveyINJ I M FAY, Map, the the Cer't 1 f I ed Ili uoy Map "Im I 1 a I on h" ruquir.ed. J.i,`s'H r?, ah'` - - - - - - - - - - - - - 1 (we) c&t. Q that atf ota.(ementa un 11i.i.a 6oAm ate th.ue to the best 06 my (out) tb►i~5 hnowtedge; .that T (we) am (aAe) .tile, owneh Is ) o6 the p4onehty deseti.bed in ,0n60/Lmation i6o4m, by v.LA.tYae 06 a Wi111va"Q deed accoatded .in the 066.ice o6 the County Regla-ten o6 Peeda as Document: No. and .that 1 (we) a paeiaentty oun the p4opoSad a.i-fe 6o4 .(hv sewage UjApoaa system (on 1 (we) have obtained an ea.aeneh to hail wi..th the above. deamtbed ptopenty, 6oa the' conathuctior, 06 Md ayMem, and the some Itca:S been du,L'y ahcoaded in the 066.ice o6 the County Req.ts.2'.n 06 ME, as Vonunemt No. 3~~'3~h~ 1 • Y`~.' SIGNATUIIE (I OWNER SIGNATuE OF AO-.OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED k 004iJMENT NO. WARRANTY DEED l THIS SPACE RESERVED Foot RECORDING DATA STATE BAR OF WISCONSIN FORM 2-'as`P$, ' = -785PAGE -504 I REGISTERS OFFICE Sam E. Miller, a single man ST. CROIX CO., WIS. Ued. for Rocord this 20th day of July A.D. 19A7: conveys and warrants to ..Thomas- J.._.Quinn...and_..Margin._K t 1:30 Pty ~I 4ua z~n~_.-husband-_amd -wife.,-- aa-marxta~....su ...ProP~ ty---•-•••....._......••-•-----•-•............••• hamor . j RETURN To I the following described real estate in S.t_...Croix ...............County, ----__I State of Wisconsin: f _ . Tax Parcel No: ; I Lot 90, Parkview Estates Fourth Addition to the Town of Hudson. ~I M0 r it i i I 1 it I i This ...__._.lu._ home=teal property. (is) (is not) Exception to warranties: TOG 71M WITH AND SLMJECT TO any other eaSEmnts, covenants, reservations or restrictions of record, if any, but this shall not be deemed to extend any such other recorded encumbrances beyond the term established by law therefor. Dated this 16th day of July 19..8?... i - (SEAL) Sam E. Miller • II --••-----.....(SEAL) ......(SEAL) i • jl AUTHBNTICATION ACKNOWLEDGMENT li Signature(s) -----ht/A STATE OF WISCONSIN i ss ......at _---Croix County. j authenticated this ........day of. 19...... Personally came before me this .lfith..... day of July 19._81. the above. ed I; Ti f Sim .E Mz ller ` .,`'i:'` TITLE. MEMBER STATE BAR OF WISCONSIN (If not. I / _tii authorized by $ 706.06. Wis. Sta.ta.) iI tome known to be the person .............V):o eQcu&a -the foregoing instrument and acknowledge tV4am~. Q`~ THIS INSTRUMENT WAS DRAFTED BY - - _ j~ Atty. Hugh H.win~ Gwin .&..Gwin---• - . li 'e ~ 430 2nd St. Hldson, WI 54016 a ~ "e--- 1 Notary Public Co St.a...CYOlX unty, Wis. I (Signatures may he authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) / date: yt-.!-4?.......................... 19-ee..) Wamea of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATR BAR OF WISCONSTNI Wisconsin Legal Blank Co. Inc. FORM 71o. 3 - 1982 )f ilwan kee. Wis. r - Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Sct_ /J~ ~f~ ~~Qr TOWNSHIPGc d ~SOi'1 SEC. TN-R /T ADDRESS ,~p1C Z $ Z ST. CROIX COUNTY, WISCONSIN ~u ohs d ~ i GJ.Z ~ `yc/e. SUBDIVISION ~a(k ,'au) LOT * 10 LOT SIZE ~.O I 4 c Q ✓ 5 PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Sys'~Q~ EIY. 92,g' SG0.16- ,~y /Oi M, B- EIV = ►o0.o' d u ~ M /4o d ti ~ r aC~Lr o ~~`IX2.4 s~ 0 26 3S d 3 4 Zo( , .02'(A(O! ~ u ~•roc~~l ~ ~ r~~ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ~~/of p; p~ 4'f SF ~o/Iiac/ Elevation of vertical reference point: /yo'o Proposed slope at site: (0 SEPTIC TANK: Manufacturer: Wes; ~a Liquid Capacity: lQ0O Number of rings used: Z Tank manhole cover elevation: Tank Inlet Elevation: 00-W Tank Outlet Elevation: (0(),'/0" Number of feet from nearest Road: Front,O Side,Q Rear, Q) 7-:21 feet .From nearest property line Front,OSide,nRear, 0 ~Q feet Number of feet from: well 0-5- building: 30 +So-jf-71ory~ SECo✓µar6a~a (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE f ' 't* 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: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ~OAVd_Lti10 k 4 I Trench: Width: Length: 3 (o~ Number of Lines: _ Area Built:~oy~r Fill depth to top of pipe: y Number of feet from nearest property line: Front, O Side, O Rear, V Vt.-- ~ Number of feet from well: Number of feet from building: y0 (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 Capacity: Manufacturer: N', 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: ill 4 a License Number: Z44 17P 1 3/84:mj D LHR SANITARY PERMIT APPLICATION COU ILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY IT# -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. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ No PROPERTY OWNER PROPERTY LOCATION V '/a S T.P q, N, R E (or S -7 PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY, STATE ZIP CODE PHONE NUMBER 71 CITY NEAREST ROAD, LAKE OR LANDMARK T 4 VILLAGE : o ~t IAJ 'S II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family -3 OR ❑ Public (Specify): Ill. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. New b. E1 Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an / System System Septic Tank Only an Existing System Existing System r 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. Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. X Seepage Bed b. ❑ seepage Trench c. ❑ See a e Pit 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/ S 7- / K• If 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 Tanks Tanks structed Septic Tank or Holdin Tank a 00~ r GvQ ` G✓ 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): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumb is Address (Street, City, State, Zip Code): Name of Designer: ~L/ Afg-W 4, I / VI I. SOIL TEST INFORMATION Certified Soil Tester (CST) Na e CST # r A CST's ADDRESS (Street, City, State, Zip Code) Phone Number: - Gc1 o3'~D i,5" 3 ~6 OU 1114 06? U_ f, / All A- zzf~ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial ~Il V U ~l Surcharge Fee Adverse Determination 192~ X. COMMENTS/REASONS 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) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: Property owner's name and mailing address. Provide the legal description where the system is to be installed; ll. Type of building or use served: If 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 when application is disapproved. Complete plans and specifications not smaller than 8Y2 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 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. 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 result of over 2 years of steady negotiation and public debate. The groundwater bill Groundwater included the creation of surcharges (fees) for a number of regulated practices which Wiscorisin's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried treasure is used in your building is returned to the groundwater through your soil absorption o~ system or the disposal site used by your holding tank pumper. The monies collected. through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- 1 water, groundwater contamination investigations and establishment of standards Groundwater, is worth protecting. SBD-6398 (R.03/86) DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS "LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLDUMBING P.O. BOX 7969 ' MADISON, WI 53707 : `CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number (lf assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME Of PERMIT HOLDER: rRt. ESS OF PERMIT HOLDER: INSPECTION DATESam Miller 1, Box 282, Hudson, WI 54016?3C~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. NW SE, Section 17, T29N-R19W, Town of Hudson, Lot 90, ParkVieWEst. IV Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: *Mift Douglas Strohbeen 5432 St. Croix SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER 1 PROVIDED: PR VjDED. YES ❑NO YES ❑NO BEDDING: ..VENT DIA.: VENT MATL.: HIGH WA R NUMBER OF ROAD: PROPER WELL: B DING VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET. Y❑NO -]YES O NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING. LIQUID CAPACITY: PUMP MODEL. PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND Y FROLS OPERATIONAL: NUMBER OF PROPERTY WELL IaUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR wLEr PUMP ON AND OFF) ❑ES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH 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: BED/TRENCH WIDTHLENGTH IND.=FDISTR. PIPE SPACING COVE JINSIDE IA SPITS LOUTREMA PIT DEPTH DIMENSIONS RAVEL DEPTH FILL DEPTH UISTR PIPF DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING: V NT TO FRESH BELOW PIPES. ABO E COVER: E EV IP{LET. ELEV. END: PIPES - LINE AIR INLET r~ FEET FROM .fit IV L NEAREST I` ( 11 L 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. ❑YES ❑NO OIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED 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. N0. DISTR. jD:1TRPIPE DISTRIBUTION PIPE MATERIAL & ARKING ELEVELEV.: DIA.ELEV.: IPES DA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL P`ANSCAL LIFT CORRESPONDS TO APPROVED ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. . TITLE DILHR SBD 6710 (R. 01/82) r77 i -yN.V ~O 4SbY 9 3f I NIQ¢ I. i~~ 3 l' 0 i ~z V) ~r d N ko (Y) -P 40 ® ao o rj ~ ~ s a a~ ku 4 W IV) V) (3- .14 IJ t~ L4j All R i i ~ I Ya - nvl'1 ud. ~ + ~ d I I A~ I =T a, ~ i I j a Nv~ ~ I t- Vic. \1 tis . i - DEPARTMENT OF REPORT Q BORINGS AND SAFETY & BUILDINGS INDUS11W, DIVISION LJ!ROR ANO PER STS (115) MADISOP.O. BOX 7969 HUMAN-RELATIONS N WI 53707 63.~ hOte 045 L' I'/SS~ TIO/~?N/'1/ / ~lo NSHIP/ ! I LOT O.:BLK. NO.: SU~DIVISION COUNTY: OWNER'S BUYER'S NAME: I N%F D ~R E3115: / 5)k * Cad ' 10- 774ai AC a( / d~,u its' pvw C. USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMER IAL D SCR( ( (PROFILE DESCRIPTIONS: DILATION ESTS: Residence ❑Replace I F~1,2_ ,S QA O /.9 a RATING: S= Site suitable for system U= Site unsuitable for system of /,•t CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-I -FILLHOLDING TANK: RECOMMENDE SYSTEM: (optiona XS ❑u ®S E ®S ❑U E :]S Q0 E:]S Zu Coaveu If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the A/4 under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: A PR FI E DESCRIPTIONS BORING TOTAL( DEPTH TO GROUNDWATER '114@1 6 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHfiR. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) Mt B- / 7 r' /03.l ' axe- > 7.S' / z BIsJ f 2 Bh S S, l 18 S B- .2 9.0' /03.4f'~ 7 gw' . S~ S/ /,S0n sI 6.0 C S B- 3 s` 10.3' ~0ul1~ .S"' . a /0 3 8 ,Sy 'Y Ali Cs B- y 10 ' S/ N.3 406 cs l AS A3 BhCS B- S' 110 ' Q dxr< t, v ' . ? l S/ . 3 6h s/ S3 cS f d Bn S . 7 8h Cs B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER k"Q41E5 AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P_ / . 3' 0 2 3 P_ z Sd • A10 .2 6 6- 3 P- 3 o a2 .3 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. SYSTEM ELEVATION ,CeG e,,a 1 € I + 1'_ { I ~ ? 1 S E 0 0' il k' Tw E f ALL,& I, the undersigned, 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 the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: 4~"'jr ( e r`'S A6 - 3 - 4?'1( ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (o (optional): 0'a e, / f dial~u W Y , s-~wG I rf ?o - 8 CST SIG RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ~DILHR-SBD-6395 (R. 02/82) - OVER - • M INSTRUCTIONS FOR COMPLETING FORM 115 - S1> - 6395 To be a complete and accurate soil test, your must -+riclude: ~ • 1, Comp 1, ;tai description; 2. The use r i ;t clearly..im . e, whether this is, ace or comm oject; e 3. MAXIP " )f hedroc - r commercial use [.iw -d; 4. Is this __..,ent sy 5. Cc su;,ability ratio A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL C v >TEMS ARE RUL. BASED ON SOIL CONDITION 6Pl. a'. 'eviatior sere for writing. profile descriI completing the plot plan; 7. M °l F diagram ac- «~~y locating your test locatior' wing to scale is preferred. A sem if desl i'; 8. C-t : -k nd vertical elevation reference point are . ' y shown, and are permanent; 0 'k boxes as to (fates, names, addresses, flood pk data, percolation test exemp- ~i ;--Ach as floors 'a4m, elevation) does riot apply, place, lot A. in the appropriate box; 11 . 1 plaaa your address and your certification nut r; 12. M• pies anc di. re(1uired. ALL SOIL TEST T BE FILED WITH THE LCICA- _!I HORITY VVITHI )AYS OF COMPLETION, ARRREVI J NS FOR CERTIFIED SOIL TESTERS Sail eparatas and Ti Other Symbols st Stone (over 10 FAR - 1 frock cob - Cobble (3 - 10") SS - gr (under 3") LS - Li HGVV -H' - P c r c - P rne(: s - cl - L ~ Fan I t-o~,u) Cil Y - s • ,oli ~raStP t~ s' . z V. r :r M i t TO Thl° thr~ first step in securing a sari it 'y ;~^rmit. The county n° fhrDr . r .r --fuest f ti is soil test in the field prior to p, r ree_ A comp'- :t f to d a permit application must a mit. The sanitary nerrnit must be t :art of y_ i 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 :2.1 M Kl t U ci ky Location of Property Al U-) 14 Section , TAN-R W Township /4 J S -n Mailing Address l2 ( 3 d ~t Address of Site /ere('' Subdivision Name Lot Number Q Previous Owner of Property Da V W Total Size of Parcel f.0 Z_ c 4- V-~ Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? _ Yes 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) cer ttby that att .6tatement6 on this bou ane true to the be6t ob my (m) knowledge; that I (we) am (cute) the ownen(b) ob the pnopenty de.6cAi.bed in the inbo,rmation boAm, by viAtue o6 a waAAanty deed %ecmded in the O bbice o6 the County Reg.usten o6 Deed6 a6 Document No. 3 Vj: Z ; and that I (We) pnes entey own the phopo.6ed A to bon the .sewage dizpoz sys em (oft I (we) have obtained an ea6ement, to nun with the above de6chi,bed pnopehty, bon the con6tnucti.on ob.6ai.d hy.6tem, and the .6ame ha6 been duty %econded in the Obbice ob the County Regizten ob Deed6, a.6 Document No. Z, g L SIGNATURE 01.0 R SIGNATURE OF CO- ER (IF APPLICABLE) DATE SIGNED DATE SIGNED J I z En H STC - 105 r • > ' H SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County z d 9 H OWNER/BUYER ~!<y° 01 ROUTE/ BOX NUMBER ,gp)( ~2?~ Z. Fire Number CITY/ STATE J4 ZIP PROPERTY LOCATION:.~14. A~4 Section , TSA:JN, R~ Town of /7C~aS~t~ , St. Croix County, Subdivision A&V/;LQ) E,~ _IYLot number~10 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. Ho I/WE, the undersigned, have read the above requirements and agree En to maintain the private sewage disposal system in accordance with x r+ the standards set forth, herein, as set by the Wisconsin Depart- ~0 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 Q DATE l U 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. - .3935!,fL I MIRVITt1RsS CERTIF=ATS , . 1. Anne& it. Rueo34 Itojostrrod Wiesae.ois Laad Surveyor, hexetsy certify to the beat of st-rpratsesfoxal knowledge. Undarstaodtng and haitsf: Tbst 1 hamw on-o yowl. divided sod mapp,*d Park View Estates .i'ourth Addition. locatsi tai the NZ 114 s4 the SW It4 and the N11.1 14 at the 5X1/4 of 3+ation 17. T29P1, It 19W. Town.of fladaoa. St. Croix Caaaty# Wisconsin: That I haw toe" ouch survey, land divioion and plat by tha diawcdon of Darrel E. Wart and BevsAy..A. Wart. owners of said land, described as foliewt: Cotsacaaeiag ae the EIA corner of said Section 17; thence 389•Z! *.%S"W (asentned boariats sodsreseed to the vsodnaieatad BA3T-.4 EST 114 3ectioa Ilan a°i'. Section 17. bearia~:aastused 349'22105" Wj (recorded as 3SWZ1140"`X on that C•rtn-id Survey leap recori+t t- Volrmo I, PaSo ISO. 1332.95; alasg said EAST -W ZST - 114 Section lines thanes i01bis30" -227.733 to the poise of hoSianing; thence NS9SZ24011V 412.00+; theses NO'06s30"X 222.095 to tho Sou Nerly right-ei-way lies of Green Fled Lars; thanes NSIP522401W 6d.0018 slain said rigLt•ofw.ay line; thence :r0 04'30'W 251,.001; t"r_cs 5rrZ6152"W- 194.352 thanaea S$9.15124" Ile 236.741; thence N75'S7901W 142,171; thence 5d9";'.i114-V 539,,'301; theaco N706830"F 104.001.; thou,. 389'15414-W 3t4.004; thence NO°!.,f30"S 15§.00;; thence SS9'25114"W 66.0111 thence SO'0bs30"W 31k*31; theses 3S9'I5s14"W' lS l.00s;. thence N0'37151" 1f 54. IS: th•aes 889'22s"'W 141..x011 theaea S0'O6s9Q*' 204.48s; t' - N4WIS114"E 150.610+;. thence S0'06930"W 312.971; %Seces 48110'AV X 150..005;•thracwSoatheastorly 66.231 ale the sro-of &.383.001 radfue curvoceueave Atorthesetsri7 whose chord bsarsSd'50, .5'E 66.171: th*mm NeY1S114"E 7.0111 licence South" storly., 134. Us' along the arc of a 317.001t'iradius curve coeeave Norths •.11044 chard bears 924 43101")1 M.51 1; thence 53023130": 143.141: iheseam7P gII"L 160.961; thance N6!'15114"E243,00+; theneo.SV06131-v 105.001; these* 883 W30 W 259.161/ thence Southemssteriy 96.141 atoua tb• are of a 217.00+ sedlwa~lttve.oeseava No:tbeastoriy.viesss chord b•ara S7S'037. 16"E 95.3V; thanee Nw.I'V14"s 920.091; thence Northeasterly 91.21, along the &";of a 304M I r%dius ~ can It saaamisno blortltweiuly woose chord bears N50'32140j1249O.s51=tbeare North- weetaslr 91,4491 s1snngg the. arc of a 309.00s radlum, curve eaneava Northsasterl rwhose chord-bates ZdBr'371Y64 91,091: thanee "0643D"E 230.091; thence, N89'ISrl4 475.0511 theme XWQ6830"V 534.561 so-the point of beginaing. Thatr slush plat to a correct repryaeuatation of all the siderios bouods:tica of the land aarvayaC and the sabdivisios thersef made, sad Thar I have fatly otrnplied with the provisions of Cbapter 236 of the kf istoasin Saatutae, the 'debdiviaianand Zoning Rogalatiana of St. Croix Comity, the -'own ul Hcdsoa Subdirisioa Ordinance, gad the City ni Hwd'"n'.oWivlstoa and Ptssxiag Ordi- cs ace, is surveying, d1viding and mapping the came. Dated title' ",-6 day of Mmima , 1984 1 R sod mh da of April. 1954. ' titrsss Z. Stssch - ~ JrA*M 421 Sezoad Street r► liRtlH Hedooos Wiscoaala 540111 i11s4 C04197T TRZASUAERI3 CERTIFICATE 9 ~ STA7Z` Or Y'31.'fC0N=M SST.. CROIX COUNTY ) I, htakry Sean Livermore, being duly elected, qualified and acting Trlsasurer of St. Croft County, do horeby certify that the records in my office ahow no unrodmomad tax solos and no unpaid taxes or special assoesmaete as of /---.'J/-dA aifeetisg the lands included in the Plat of Ark View Rotates Fourth Addtian. J 6 Date ty Treasurer i f . ZONING CM*AT'XVz RESOLUTION Thin plat fs hereby approved by the St. Croix County Comprehansivn Parks, PLItnoln~I gad ZoninS Committee. Data Chair u► i Date Administrator K' S t ;.Rolf 211, WK -.S. • •''s~ t~ - . !'t1i:~.-f.--JIi.Ms1Mtllllf I~ 4 zc~ - , r PARK VIEW EST~k FOURTH ADDITION 1LRAL ` SL6DMSION !.ATE 3.iN:THE , *SW4aNWWSE*, ECT7CN 17, T29N., R19W, t OWN CF-. H 1, ST CROX COUNTY, I,fT-vCOWN - I I I C^: 71MCATE Or TOWW T'it=SlJ M STATY OY WISC.CNSL41 SS: , ST. c3tOINCou-"y ) I, Beverly A. 3olsttroe. b+ia~ the duly elected, qualifiad'aod acting TV %M Treasurer of the Town of Hudson, do hswblr certify that in accordaaea %~z,~° rds is my eifiee, teem axe no unpaid taxse or Special assess s as of R:L~ on any land iaeladsd is the Plat of Park Vie%*Z*Atan Fourth Addition, T J Qite, l Bswz g , .ohms owe zaasarer TOWN BOARD R =SOLUTION RaSOLVED, that the Plat of Park Vir Estates Fourth Addition in the Town of i Hudson, PAT-el E. Wart and Bev A. Wert, owners, is hereby approved by the 'Town .tJw1:_ L a Aporovadq(L own mangy D igned own l«c man f/ A hevsbY cartiiy that the foregoing is a copy of a reevlotion adopted by the Town I Board of the Town of Hudac.a. Date J-^ - Town Clark I OWNZRSf CrMTt_ ICATE OF DEDICATION As owners, we hereby certify that we caused the land described on thi, Plat to be survaY'd. ?.'•^-isd, rrap:+ad and docuexted as repreventnd on this Plat. Wa 412o certify that ?I&., is ;squired by S. 236.10 or S. 30.12 to be submitted to tine foltowing for f appro"I or objection: Dspartrneot of Development D,bartment of Industry, Labor and Human Rolatio•ts, I Town of Hudson. City of Hudson and St Croix County. I W; T NESS the lurid and seal of said owners thla _t .f- day of In prssance of: / Darre L. Y er~-~~ /1 I Beverly A. Wart STATE OF WISCONSIN) SS ST. CROIX COUNTY ) Perscnally carne before me this lay of the above narnad Darrel E. Wert .tad Beverly A. Wert, to me known to be the persons who executed the foregoing instrument and acknowledged the same. . •i Notary Public _s_~,~t• 2„Z, , Wisconsin My commission expires 1 Mary usch, Nottaary Public CEStTIFICATE OF TOWN CLERK ' STATE OF WISCONSIN) 1 )SS ST. CROIX COUNTY ) 1. Rita ;iorne, being the duly appointed, qualified and acting Town Cloak of the Town of'?r4son, do hereby c iify that copie of this Plat were forwarded xs required by 235, t2 on the 5W day o[ 1984, and that within the 7,0-d2y limit sot ry e. 235; 12 (3) (no obje t,, to the plat have been filed) fall oh,jtir:ic+ns to ")I r' ;at have been met),+y~ 'Dice Ait Ho ne, Town Clerk i %A ME E. RUSCH & MAPPING SlRV '1 to WISCONSIN H UDSO , THA I"Tt1UMF74T CRAFTED Dt " t t 31 1. Y