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FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER I&VIdr TOWNSHIP R4,/_sor, _
SECTION 7 T N-R 117 f ZZ-7 9 3 V
ADDRESS-R,-x Z f, L ST. CROIX COUNTY, WISCONSIN
w -T- '!5 ')10
SUBDIVISION~Zrk U,'a-..,j F_51-cA6 LOT /-~RLOT SIZE ~ ~ 19eae s
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
`10
Ho ti
sxa~
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i
5~~1~-11y~=1OMEi~ 40
Ss" N
Got~i~"-
INDICATE NORTH ARROW
BENCHMARK: Elevation and description:
/ ~~~oT Pte. 5 . ~o t~~ ti Z~
Alternate benchmark 4ZL
SEPTIC TANK:Manufacturer:_ Liquid Cap. looo TQ0
Rings used: -2- Manhole cover elev: Final grade elev:
Tank inlet elev.: r_5` Tank outlet elev.:_10.(30
No. of feet from nearest road:Front Side_(X Rear Ft.-'TO
From nearest prop. line:Front , Side_.y , Rear Ft. To
No. of feet from: Well -575 ~ , Building:
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
t
o,
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front-, Side_, Rear-Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed• Trench: Seepage Pit:
Width : lSf Length 3 Number of Lines:_ -j_Area Built 6f«
Exist. Grade Elev. Proposed Final Grade Elev. / p
Fill depth to top of pipe: 'fz„
No. feet from nearest prop. line:Front Side , Rear)( Ft.s S
No. feet from well: 103 No. feet from building
HOLDING TANK
Manufacturer: /l/ ~l Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front , Side Rear Ft.
No. feet from: Well , building , nearest road
Alarm Manufacturer:
INSPECTOR:
DATE : PLUMBER ON JOB :
LICENSE NUMBER:
6/90:cj
{
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HUMAN RELATIONS DIVISION
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
,j~QQ~ISOfaI WI 5707 State Plan I.D. Number:
4 4, ec. 17 / ,T29-R19 9 (If assigned)
Town of Hudson LoE,12$ CONVENTIONAL ❑ ALTERATIVE
Wert Rd. Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Sam Miller Box 282, Hudson WI 54016
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. LEV.. CST REF. PT. ELEV
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Doug Strohbeen 5432 St. 128702
SEPTIC TANK v/! ->C~° ~vcr= s
MANUFACTURER: LIQUID CAPACITY: TANK INLET EL TANK OUTL WARNING LABEL LOCKING COVE
~ PROVIDED: PROVIDED:
e` / GZJo, (n 9 ~6 YES ❑ NO ❑ YES NO
BEDDING: V4fdT DIA.: MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT FRESH
C.o. 11 u, ALARM: FEET FROM LINE: AIR INLET-
0 YES NO ~ 4 1 & ❑ YES NO NEAREST -11110- ti n~. <5 7 r~
D
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 CQ S OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF ❑ YES ❑ NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTE . a e Le = 4 75Z
WIDTH: L O. OF DISTR. PIPE SPACING: COVER INSIDE DI # PITS: LIQUID
BED/TRENCH TRENCHES: MATERIAL: PIT DEPTH:
DIMENSIONS /13 i aO ~o
GRAVEL DEPTH bF~11 LDEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. I TR. NUMBER OF PROPERT7LL: BUILDING: VENT TO FRESH
BELOW PIPS: OVE COVER: ELEV. INLET] ELEV. END: PIPES: FEET FROM LINE:d / AIR INLET:
NEAREST~ ~J S
MOUND SYSTEM: ' '
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
ERVATION WELLS;
SOIL COVER TEXT PERMANENT MARKERS: OBS
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEP F TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
B DIMENSIONS ED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: VEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: TR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: AL LIFT CORRESPONDS TO
INFORMATION APPR
❑ YES ❑ NO ❑ YES ❑ NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
COMMENTS: FEET FROM LINE:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
® rci' / 'L.f ~ ~ lG.~ /Z¢,c✓-G~.-c;,.r ~ /y~'"Z2.~ , sue.. r .r , ~ y ~ rye,. d". / G I cF_'. / ' Ct~ ~C;J c~j by~+-r-, ~ uz a
~ U
F5 V Ir-111 C, t. V L,-
Sketch System on in in county file for audit.
Reverse Side. SIGN RE: TITLE: /
SBD-6710 (R. 06/88) ~'T1
E17EUILHA SANITARY PERMIT APPLICATION M ~..,..~..a
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 El Affi ! Q
8 % x 11 inches in size. vision to previ us application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
So- ~ -s Y4 S LL) Y4, S T 19 , N, R ! E (or
PROPERTY OWNER'S MAILING ADDRESS LOT # 01 BLOCK #
o Z Z
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
5~ 01(o 38~ a-1 ~9 a~ V
II. TYPE OF BUILDING: (Check one) VITM NEAREST ROAD
❑ State Owned VILLAGE * O 1~ w ~ f2 n Q
❑ Public 1ef" 1 or 2 Fam. Dwelling-# of bedrooms LT N B R
III. BUILDING USE: (If building type is public, check all that apply) 12"),7
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ~ New 2.E] 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 2 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
140 System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
Z_/ S 0 0,7 z G -Z 20 Feet 5.70 Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank D~ vv 4r
Lift Pump Tank/Si hon Chamber 1 L1 F-1 _Fj
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumer's Signature: (No Stam MP/MPRSW No.: Business Phone Number:
lAo
Plumber's Address (Street, City, State Zip Code): 7
Vi N / ,Nt, W' 7~ (s~0' a, J 5 3 1 U1
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued ng Agent Signature (No Stamps)
1"IVCI Approved F1 Owner Given Initial Surcharge Fee)
Adverse D termin tion le'l ~A=auu,
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; (lose 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)
. APPLICATION FOR SANITARY PERMIT
8TC-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 and completed ptrwhenr#theeCproperty Is sold second should
this officetawith the appropriate deed recording. _
Owner of property Ste- M
Location of property 1/4 _1/4, Section 1-7 T__aa_V-R_Lf_L4)
Township H rS o
Mall ing address J~o Z £f 2_
Address of site wm^'rt ~-oa 4 ~-~oLL)'j= S-/;D 10, .
Subdivision name ::4~ V It xTA.t C
Lot number 12-1/
Previous owner of property Z) ✓ f a t/t
Total else of parcel 1 zz l A r g-r5
Date parcel was created
Are all corners and lot lines Identifiable? ~_Yee o
is this property being developed for resale (spec house)?_~/'_Yes o
Volume 1-7- _and Page Number as recorded with the Register of Deeds.
I
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DIED which Includes a DOCUMENT NUMBER, VOLUME AND PAGZ NUMAno and
the SEAL OF THE REGISTER OP DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed descclptlon references to a Cestified survey Map, the Certified Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(Ws) cattily that all statements on this form are true to the best of way (out)
knowledge; that I (we) am (ate) the owner(s) of the property described In
this Information lotm, by virtue of a warranty deed recorded in the office of
the County Registet'of Deeds as Document No. ,39 3q--,, • ; and that I (We)
presently own the proposed alto for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, lot the
construction of sold system, and the same has been duly recorded In the office
el the County No 1 ter of Deeds, as Document No. 39 3~/~v
Signature of Owner Signature of Co-owner (If Applicable)
Date of Signature Date of Signature
i
3r:~~aii.: • p cl~,y1.LZyt;~}' /~O • u
' SURVZTORIS CERTT>:TCJITL ,
1. Jaatsw It. Resew. RejOstored Wtsesasta Lttsd Uxveyov, hstreby certify to the
10ee1 of ray paofoestoeal knowiedge. undere4odaag sad belsell
That I base etsveyo+l. div ded and mapyad Park View £statas ;f ousth Additions.
located Is tbo H ZI/4 e1 the SW 1/4 Alba the W-4114 W the SXI/4 of S•eHoa IT. T29.-f.
R 1911. Tow of Hadsoa. St. Croix Consty. Wiaeassla:
That I have made ouch surve7i I" dlvlston and plat by tks divor4lon of DurTal E.
Wart amid 'Beverly ,A. Wert, ow"Te of said lands ducrlbod ►s (ollows:
• . Comeaooeiag at the XIf4 corner of said Section 17; theme S89s22s011'W (►ssumod
be"Isas reforeoced to the mamumsated XA3T :y EST 1/4 3ectic , Use cl: 3ecttoa 17.
bmturistd assure" S&gr22t04" W) (regarded an 3W21040'"X os that Certki-04 Swrvey map
rwrded to Voluoae I;, Data IM). 1332,9111 alaag said EA3T-Wt 3T-114 Section Host
thence &0'041w-w 227.7'.1 to the point of besinainsi thence 71119.52144"Y• 412.00': thence..
' NO"O4139"S 212.00+ to the Swtth•rly rtaki-of-way Use of Green wU Lana; tkeoee
Ny1'%240'W 66.008 along said ri kt•of-way 11as; thence ^°dr'30" W 231.011; thane' l
579 36152"V1. 194.331; thence 3895114"W 236.761; thence :175'57905"0 /42.171; %homee
SW 1 S' 14"W 559.009;.lhence NO' 06830"It 104.0011 theaee 389' 13114'11K 30. 00st thence '
N0'!v130")C J33.ddt; tlteeao S 15114"yf 66.011t theoee 110`06630"W 316.431; thsace-.
SWIS814"W' 151.00'1 thence 140"37151"W 54.18x; theaaa 389.22b9"1P 141'."t; thence
89'061301^1. 264.448; thence N89'15914"S 15J.00s; thence W06830"W 311.978; thocee
MWISA114"=.130.0401.theace SoutJ a".0rly 66.231 alasst the are-of a 3&3.001 radiue
curw'concave'Northeastsrlr whseso chord hears!W50s541z 66,371; theme Nsee158Wit u
57.0111 tit ace' Southeasterly. 136.541 along ike ase of a 311.064 radlut curve concave
Noriheosterlyy whose chord bears 924 03102"E 1X1.511; thence x3023'30^: 143.141;
tbsnce T17P36!!0"t lbo.96s; thence NgIr15'14"L243.OOs; theac , 30`06131"8{ 108.001;
themee SS3`36130 W 259.161; thence Southe44iterlT 96.141 aloe the are d a 217.00'
rstlrrs:aagrie.oeaeata Northeasterly.' iese chard li"is 878'0316"E 9S.Ta0; tAan44
!4&9'!13714"X 920.009; thence Northeasterly 91.21, along the are'ol a 300Jh16 r*diu•
sus aooewvn (Northwesterly visions chord beare N80.32146"'M90.051; thoare North-
westortr 91;441 aloe` the are of a 309.008 radius curve eaueavs Northsartssl t~whose
chore{ bears 210'37126"7: 91.091- thence 140"06130"E 150.000. those* 4489'15"14 s. u
478.0S1y thence NW061300Z 834.560 to the point of "Sinning..
That "alb plot is a correct represeak"lon of all the exterlor bouodnaiss of the i
lead *"rw*ro4 nod Me subdivision thareaf raade, and
TUC 1 [save laUT oompUsd with the provisions of Cbaptsr 236 of the Vfistoesla
8tstatge, the JubdtvisLss am Zoning Regawtaas of St. CrCix Cousity. Vie V a"& ul
IIwAson %bdtvivisa Ordlnaoce, and the City of Hudson Subdivisigns and laming Or41-
nance., to surveying. tltvtdlns and rnapptng the same.
Dated this''
. ..113_..• day of MAi0cd1__, 1984
R vlaed t I 15th da of April. 1989. ~ ~'j'
JMM L
.'~mes >C. aesh - .t..s. {776 '
421 sewed street :ji M u 1
Hudson. Vleconoto 134016
COtMT TAWAMUnJrR03 CERTITICATE Ajp1r0
STATZ Ot WISCONSno
$,i
ST. CROM COUHTT y
1. bleary Joao Live... so, belag Judy etscted, qualUled and acing Iroasurer of
ft. Croix County, de hereby certify that the records in my ofnee show to uartdeomed
tax "legend no uupald taxes or epectal sonessm4rrte as of J/
Allectlag the Isads toalt ded to the Plat of Park View Estates Fourth Addtion.
' ~~,p-fig j 77! s1L8,~.,/
Date ant T:•nauror
7OMNG CO3ATATI Z16 RESOLUTION
This plat to hereby approved by the St. Croix County Comprthnnsive Parke,
inAaoln;t And 7ontng Commlttno.
1
%
Uste Chatr"hl
Date Admlalatratov
t,
.If~ITTf1YS ~t~. ~ i
• t....1Y. •r aslr'w 7th-~.i.~~.•.•.1"i`
thi
t .J ~ ! rfve.'~rfwat. 1b+1Fte ~ '
MOM%
R 741 ..:1 a 1. +
re ;)b
1
i ~
PARK VIEW ESTATES F0URTF1 ADD1110N {
A IMPAC SUEDMSICN l.C'CATEDAN THE I.1kA-SV,IA a NWY*SEW, ECTICN 17. T29N.. R1 9W. 1
TOWN : CF: HIL.C60% ST. C` CAX COUNTY, WISCONSIN i
C33tTI71CATE or TowN-TltvisusttR
STATZ OF -913CCN3L`t) '
LT. CZOIX COt:Tt:Y
I, Beverly A. 3o"&'On "a the defy slatted, quallned'and acting Town TTessurer I
of the Town of Hulee.a, do hoveby' Certify that lit seaordsaaa t r cords, in my officer
ibex* are oo unpeld taxes or special assessments as of . " V4,) 1 _ on any land
inaled.d in the Plat of Park View Letatso Fourth Addition. S yte 8ry . ahnso or.n sia~ arsY
TOWN BOARD RZSOLL•TION
Ni.SOLYED, that the Plat of Park View Estates 'Fourth Addition In the Town of t
Hudson, Devrel E. Vert and Hove A. Wert, owners, is hereby approved by the f
'Po~IS tlvyra. l' l.i
ya r d' own he rman
/ YA d
D Ijned owe t.natrman I
s a•r•br csrtliy that the forrigofnq !s a copy of it resolution adopted by the Town I
board of the Town of flud•c.n.
• bite own Clerk
01 NIM31 Cr.RTIFLCATE OF DEDICATION
As or•ners, we hereby certify that we caused the land described on thi: Plat to be
surveyed. d!-Ai•d, rrapped and de leated as rooro,srnted on this Plat. We Also certify
tbet -Ma Flat Is required by S. 236.10 or S. 23iI.12 to be submitted to the following for
approv+l or objection:
Depasteneat of Development i
Department of Industry, Labor and Human Relations,
Town of Hudson. City of Hudson and St. Croix County, I
WiTNfESS the luau and seal of said owners this _L'. •t day of
. -
In~eeancs at. I
10,
Beverly A. Wat
STATE OF wISCONSIN)
'
ST. CROIX COUNTY ) 53
I
Personally came before me this `stay of ,2. • the above
named Darrel E. Mort .end Beverly A. Warts to Ina known to be the pereane who executed
the foregoing Instrument sad acknowledged the same. i
Notary Public: • 1,r~~ Wisconsin My commission expires
1
Mary 1% Notary Public
f
CERTIFICATE OF TOWN CLERK
;-.STATE OF WISCONSIN) 1
53' !
ST. CROIX COUNTY )
• f, RIts, ;brne, being the duly appointed, ualllled and acting Town Clerk of the '
1 Town of :f:•dson, do herebj coq
if that eopie of this Plat were forwarded as,
'
r
t r•aquir•A by L ..16.12 on tMaL_day of 3• , 1964, and that within
I he 20•csy ilt:tlt met by e. 236.12 (no obI actlhns to the plat have been fitted)
(all 1n .canna to •1Iw )•t have born mat
1 r.)At
z, frp-l= Date iilt iiorna. own Clerk
t,
JAMES E. RUSCH
SURVEYING & MAPPING
HUDSON, WISCONSIN
THI3 1k$TitWENT CRAFTED Sl
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STC - 105
` SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
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OWNER/BUYER ,<7, ,,y,' a
ROUTE/ BOX NUMBERS Z_ Fire Number- o
d
CITY/STATE ZIP
PROPERTY LOCATION:*.S k,::~ wk, Section-U)Tom/ N, R / W
Town of w=~c St. Croix County,
Subdivision RtkV+ut) - ~ Lot number .
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Prover maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed 'septic tank pM2er. What you put into
the system can aFfect the function o he septic tank as a treat-
ment stage in the waste disposal system.
St. Croix County residents may be eligible to recieve 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 County Zoning a
certification form, signed by the owner and by a mater 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
I/WE, the undersigned have read the above requirements and agree o
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, as set by the Wisconsin Depart- W
ment of Natural Resources. Certification form must be completed b
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date. IL
SIGNE
DATE
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
r
INDUS
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, C DIVISION
HUMANRE 'RELATIONS PERCOLATION TESTS (115) MADISON WI 3707
HUMA
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/ivTttPoi~/: LOT NO.: BLK. NO.: SUBDIVISION NAME:
S6 ~/SW'/ ►7 /Tz9 N/1119 E (o Aso !z£3 - PdR%<4I&L,)
COUNTY: OW~,4 R'S BUYER'S NAME: MAILING ADDRE :
S-rCleOlx ) V M __eogr Qoo4 kt,
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: IIPROFI LE DESCR P NS: IIERCOLATION TESTS:
Residence ~NK I New ❑Replace t JULY ( I JULY Z 1990
~ Saps Il Ruk<'11 A QWT'
$
RATING: S= Site suitable for system U= Site unsuitable for system 4 S
JZS~
CO V NT:]U . IMOOUN ❑U I. PND Qu RE: SYSTEM-IN❑FILLHO0LDING T K: RECOOMMENDE~D~SIY~S~ p nal (T
If Percolation Tests are NOT required DESIGN RATE: ~J
If any portion of the tested area is in the A
under s. ILHR 83.09(5)(b), indicate: C~a Floodplain, indicate Floodplain elevation: NA
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH-M. ELEVATION OBSERVED S HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- / 9.75 9129 No-.ltf } q.7S 9" 1Z'' L ''$eN)MS 7 CS~G
B- Z ./7 900 h(o,vc > 9.17 zl "BLLTS L ►Z"$eNS~t 6 $2►~csi~r<_
B- ts G 97.04 N oN Ic > a, /O ec LTS gyp" L l~ ~$eu ri►S 70'1~~~. <S
B- 4 9.4Z % 3~ r40>,J1& >9.4Z /9'$cL~TS 9"IBRN L zz"$eN ~'~5 63"&eN cSfC~
B- S 33 97. ►9 0~ > 1.33 36'9,L4 rS 30"$a,i SL 46e>`►cs~ G~
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER lbbC=S AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERT D2 P R PER INCH
P- I 3.90 L_ ,10 >Z > Z
<
P- Nc~,A r 9'7.o6 3 > Z > > <
P- .9 ~,fejLr U .1 / 174 V/4 P- _
P- LE T
P_
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicat 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 eleva ion at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 92.ZU
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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:
Ae c, JO fr,JSe~ JoN N Sv ,si! ~UL 14 ~ o
ADDRESS: CERTIFICATION NUMBER: PHO E NUM ER(optional):
407 r co#•J l~ S~ U N S~ O I 34 :8~_ o
CST SIGN RE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
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