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Z� Z co OCL ; .- *mi *0 . c A j S E 0 00 o co� A v 0 U) 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: (o h d6 '�; o ( Trench: ° -- Width: �R Length: (I Number of Lines: 3 Area Built•L Y8'3? 'f Fill depth to top of pipe: yC) Number of feet from nearest property line: Front, O Side, Rear, Ft . 70 Number of feet from well: 72 Number of feet from building: �9 (Include distances on plot plan). l� O SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one) . HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 7 3/84:mj APO Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT IIII a N-R� W OWNER o TOWNSHIP H c3�L o w SEC. T ADDRESS ST. CROIX COUNTY, WISCONSIN ;, �� �` Z• '2- SUBDIVISION LOT SIZE�I1-�.S�a `,,- LOT C PLAN VIEW Distances and dimensions to meet requirements of IT,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM North J.1- _ Q -- �„ /ot �,'� lot (o��t�►� Rio � /0 ' v o VC/ I V 72 cis 6 o1fXz! Ho�.S� a S�')r W INDICATE NORTH ARROW L BENC RK: Describe the vertical reference point used �ot � � N o1174r Elevation of vertical reference point: 100- D" Proposed slope at site: SEPTIC TANK: Manufacturer: 2✓ Liquid Capacity: 1 OD© QaL [. Nu ber of rings used: ( Tank manhole cover elevation: Tank Inlet Elevation: a S •Tank Outlet Elevation: 97.0:-i Number of feet from nearest Road: Front,O Side, Rear, ��� ' feet From nearest property line Front,OSide,�Rear,0 ADS" feet Nu ber of feet from: well SS , building: a fit- ico cow,1/1;ro�N 4✓o�54✓�S¢ (Inclu a this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI X53707 NET-4--, SwA',4,S17, 29N-R19W Ail CONVENTIONAL 1:1 ALTERNATIVE I State Plan l.D.Number: ❑Holding (Ifassigned) i Town of Hudso g Tank ❑ In-Ground Pressure ❑Mound Lot,, 31 ParkviEw Estates NAME 6F PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTI DATE:_ ,S 0 Mike Johnson 516 Huntor Hill )Woad #1 , Hudson, WI 54016 _q__1 O)l`J4 vL/o BENCH MARK(Permanent refer rice point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County Sanitary Permit Number: i t Douglas Stro been 5432 St. Croix 95987 SEPTIC TANK/HOLDI G TANK: MANUFACTURER: JILIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER �} PR DED: PROVIDED: �,{ J J 2� ' `�" YES ONO ❑YES -L^JNO BEDDING: VEN DIA.: VENT MATL.. HIGH WATER IN UIIIIBER ROAD: PROPERTY WELL: BUILDING. IVENTTOIRESH ALARM: FUM FROM LINE I AIR INLET. DYES NO q DYES NO FEET NEAREST ! /� �D DOSING CHAMBER: /G MANUFACTURER. JEIEDIIING. LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: EYES ONO ❑YES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF ':PROPERTY WELL BUILDING: VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing FORCE LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil c in be rolled into a wire,construction shall cease until MAIM the soil is dry enough to ontinue.) CONVENTIONAL SYSI EM: WID H: LENGTH. NO.OF DISTR.PIPE SPACING: COVER :INSIDE D1IA #PITS- LIQUID F�/ TRENCHES MATERIAL' PIT DEPTH: A d 3 C� s GRAVEL DEPTH FILL EPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO. TR UMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW P PES- ABO E COVER ELEV.INLET.ELEV END- PIPES. LINE AIR INLET:FEET FROM MOUND SYSTEM: Mound site plowec 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- ❑YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER ITEXTURE JPERVANCNT MARKERS OBSERVATION WELLS 1:1 YES ONO 1:1 YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED. CENTER. EDGES: 1:1 YES El NO 1:1 YES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: a � r WIDT : LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. TRENCHES: r:!MANI F OLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL jNO_D_1_ST`R____TD_1STR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELE ELE V.. DIA.. ELEV. PIPES. DIA.: HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. OYES ❑N ❑YES ONO COMMENTS: PERMANENT MARKERS: �E ATION WELLS: NUM y-+ PROPERTY WELL: BUILDING: PE_T FROM° LINE: ,D ❑YES NO ❑YES ❑NO NEAFIESt' 5, S3 3 S � Sketch System on Retai in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710(R.01 82) '' ✓ Zoning Administrator 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 tRthis 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: I. 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 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement 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 Ground aitef=- included the creation of surcharges (fees) for a number of regulated practices which Wisco ins can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure e 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- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COUNTY =ZM!n1 , STATEN PERMIT# In accord with ILHR 83.05,Wis.Adm. Code . , -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 INFC RMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE-❑YES No PROPERTY OWNER PROPERTY LOCATION Aka- Jo)A E'/4 w'/a, S T , N, R E (or PROPERTY OWNER'S M MLING ADDRESS LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME S6. uul r_ `� 3 � �Q✓ :ac,1 a 2� CITY,STATE ZIP CODE PHONE NUMBER CITY ��I NEAREST ROAD,LAKE OR LANDMARK A ISVILLAGE II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR E-1 Public(Specify): 111. PURPOSE OF A PLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. � New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an Syster i System Septic Tank Only an Existing System Existing System 2. ❑ A Sanita Permit was previously issued. Permit## Date Issued 3. ❑ An Existh ig System has been inspected and soil conditions meet minimum requirements. 4. ❑ The Syst m is shared by more thB+rone owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE rrO��IF SYSTEM: (Check only one in#1 and only one in#2) 1. a. ICI Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tafik V. ABSORPTIONS STEM INFORMATION: (Check one) 1. a. ZI Seep qe Bed b. ❑seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per i ch): REQUIRED(Square Feet): PROPOSED(Square Feet): 3 eo/j 6. Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name C Concrete str cted Steel glass Plastic App Tanks Tanks Septic Tank or Holding ank �� a-� ✓ ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,a sume 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: (� o u /�s f 6 ee ti 00 J � .�� 1►�1 1' - s 3 z 2 z 3 Plumber's Address(Str et,City,State,Zip Code): J Name of Designer: V o - 1e d co VIII. SOIL TEST INFORMATION Certified Soil Tester(C T)Name CST# -'.s'fo a v 5 �-, •�� CST's ADDRESS(Stree,City,State,Zip Code) Phone Number: 111r1 Z&4110-1 4a-. Sao/ 71S- b?G-,S"7 9 IX. COUNTY/DEPA RTMENT USE ONLY ❑ Di approved Sagry Permit Fee Groundwater Issuin gent Signature(No Stamps) ll Su harge Fee Approved ❑ O ner Given Initial jLy� /'� <4�1 6)l,� rzte A verse Determination w L/ Cl X. C07MENTSIREASONS FOR DISAPPROVAL: jQ h ;4e wpCI b y Thy 111� c . 1vl IS 0" SBD-6398(formerly Plb- 7)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 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. I - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property , o Location of Property &a_) Section Township L'-d-501 Mailing Address La'/ , � /I// �� L CA/ GcJ Address of Site O / � cc✓✓ �S/a�a.S 4F- 7"'1/ r. C4 D/4, Subdivision Name V I'C�v IC7 S�fe. . Lot Number / Previous Owner of Property Total Size of Parcel 2.r c Q ys 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 Dee4 which includes a Document number, volume and page number, and the Seal of the Re ister 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) ceAti6y that a t Atatement s on this 6onm cute true to the but o6 my (om) know.tedge; th I (we) am (cute) the ownen(b) o6 the ptopehty de�scnibed in this .tn6onmation 6o , by vi tue o6 a waAAa.nty deed neconded in the 066.ice o6 the County Reg c.at o 6 Deeds ab Document No. 35 3 S/-Z, ; and that I (We) phea enfiey own the pnopob d site bon the 6ewage dibpoa a yes em (on I (we) have obtained an easement, to with the above debcA bed pnopenty, bon the eonbtnuction o6 eaid dybtem, and th dame has been duty teco&ded in the 066.ice o6 the County Re9i,6teA o6 Veeda, ae Poemient No. SIGNA Old ER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED n., Y PARK VIII VY ESTATES FOURTH ADDITION � A ., a At .9-60.MSl N LOCATED.'*'THE .%0A--5V4A a NWY*S£4k SEC nCN 17, T294, R19%N., { '1'CWN:CR.Hid,.ST. C90X COUNTY, W15CA!WN C32TI21CATE r TO'M'RTUritsURM STATE OP W N=4)SS` ZT. CS=CO t..Y ti I, Bev"I A.Johak'".baiag the duly Elected. qual.Med'aad acting Town Treasurer of the Taws of udsen, do hereby certify tb"in lal seeordaaae r�pp��rda in toy office, 01426 are no un taxes or apee assessrasnts as of_ X...._.on any laird inatadad!a the at of Park Vi4w Lststas Fourth Addition. • Beverly. .ohns*W Town Treasurer TOWN BOARDR^SOLUTION HZSOI-V1 D, that the Plat of Psrk View Estates'Fourth Addition in the Town of Hudson, Dayrel E. Wart and Baveplf A. Wart, owners, is hereby approved by the To—n B"-d, �a s po ov6d own rman D ign d ' own Lnaarmsn a a4rabv a-tiiy that the feregoing is a copy of:a resolution adopted by the Town Board of the To n of tludst.n. Date own Clerk I OWNERS#Cii:.R 1FICATE Or DEDICATION As owner., we hereby certify that we caused the land described on this Plat to be aurwy.d, '_!•.z3 d, rrappad and dodleated as roprarented an this Plat. Wa also certify tSat s.4ts Flat is required by S. 236.10 or S. 236.12 to be submitted to the following for 4ppruval or ob; ctlon: Depaxt"it a Development' DoPArtme t of Industry, Labor and Human Ralatio•ts, Town of Hadmon. City of Hudson and St, Croix County. j W;TNZSS he load and real of said owners this_/'-•t day of In resan • of -- (� 7 aft ;, --1 —w at� ,, c rt� / Beverly A. Wsr � STATE OF WIS ONSIN ) . t' ST, CROIX COU ' Y 13ItfenAll same before me this " day of //,+ti, /' ••• the above nama7 Darrel E Wert .tad Beverly A. W art, to me known to be the persons who executed the foregoing in trumant sad acknowledged the same. Notary Pu lie 0 ��2, . Wisconsin My commission expires j Mary nsch, Notary Public I t CERTIFICATE F'TOWN CLERK �-:STATE OF WISCONSIN) i ST: CROIX COUNTY ) 1, RIta;'ben , being the duly appointed, qualified and aeting.Town Clerk of the 'Town of Ifndson, do harebj c. if that copie of this Plat were forwarded as required by a. 236.12 on the-YrW day of _ ,, 1964, and that within the In-day limit sat ly s. Z36.12 (3)(no objects ns to the plat have boon filed) (all uh)ec:ioni t. •h.a pat have boon m.t), Date Alt Horne, Town Clerk JAMES ire RUSCH SURVEYING & MAPPING HUDSONt WISCONSIN h THIS I"TRLWNT CRAFTEO Rt p. h r r N ., z x y •+ P t l C",�,yytz,y�s �1 f _ f StMv=(*2S CERTUMATS.: . I.Am%*&I .1twM%4 Rojiisterod Wiseasoia Land 3uxvayov, haw 94y certify to the best of wty pref•ssioaal knoe.tsdge, nnderrtaadtng sad belief: TW4I he"oerveyed.div-Aed sad raapp4d Park View Estatss;rourth Addition,. IoCASed is the NSI/4 et the SW 114 sad the W.M.114 of the SEI14 of Uotoa 17. T29.4, It 19w, Tows.of Hedsos. St. Craix Coaaty. Witcossia; That I have nmL4* such survey. land divialon sad plat by tka dlsarsion of Darrel E. we"a"Dsvaxly.A.Walt, owasra of said land, described as follows: Coawtueaelag al the VIA corns:of said Section 17;thence 539•fIZ"'"M (aseatned bawriags redoraaeed'to tbs ttwaneaeated Y.A3T:I E3T 1/4 3etxfoa llas cL'Section 17. bessfuy sasntsed 399wiot"W)(recorded as W21140'"M oa that C•rtn-A Survsy Uap rooeadadtoYet some I* FA Aare, 194). 1332.91;,along said 3T-WZST-114 Section 11set t eooei0e0i"A W-227.YJ tothe point of begiaaing.thence N9f3240"Y 412.OW;thence.. NO"oi'30"S 212.004 to the Seuthorlr right-of-wey Use of cross UJU Ls";tkenc• 1JSIPWO!'W 64.0411 along *aid rig kt•of•+.sy 13as;thence SO'O6"30"11 251.904;thence � STV26152"W 194.3511;th."s,S99'15914"W 236.744;themes 1473'371105"W 142.17t;theses 339°1 S1114r'TI 33840s;:UMuce N0'06830"L 104.0011 tbescs 339'15514"W 3f•4t.O W th ; ence NO!!v130"EclS3,0011;theses 341'13114"W 66.01111 thssee SO'0611300ltt`316.331;thsaCe 3i1'IS8I4wW_15I.0 .Alemc•No'37151"W 54.10;tboace,S39'ub9"W I4r..50tf thence 2W0030"W.204.4911;tb wo N91'15114S 150.0011;thence W"430"W 31L971;theses Ns!"1Sr14!'3s 130.00!pth.mce 3oeik�aitarly 66.23?alonmgg the era-of&:391.00"radius cuxv•eoaCSee:NerthereNrlr whose chord besxs S•4'S011S0"T 6i.l7!;themes'4g9Y15414"L 0.Wit SStonc•3omtheastexly_I36,541 along tbo arc of a 317.0011`radlas curve coocays Noxtbeaiftesiy whtwe chard boars 924 0110E 11E 13f4.51,;tLaaeo SW 130^ 143.141; ` theses 1471P36"W"E'160.961,tbeae•N99115014"E 243.0011;theac•30'06,3r"8� 109.001; th*"*.SST36130-W 259,16";theses SoutheistarlT 96.141 along he are of a 2 17.008 radi6asarvs.oeaears WorthoseWrly.,wiieoe chord beasa 373'03816"E 95.511;thane• NW.152140 920.00*;these*Northeasterly 91.21t,along the a"'.of a,300 fJO4 radius esr++toaesw lroxthwotexIy wbose chord bears It90r3E140'"1v 9Q.3S1f tbesrso North-. w+aterir92;44ra1esat�g thf arc of a 300.00,radius curve eaucsvir Nosthet.tnrl whot* Chord bears 470'3T"26"Z 91.09,;tbeoso N0104,30"1:' 150.008;thence NW1Sn144= ' 479.0 thence N0'06030"Z 634.56t to.the point of begtsulag., That seal►plat is a Correct repr•oeatatlom of aL the exteri0j b oeadtaie s of the t Iaa.I careered ant!the aebdfvieioe thereof sands, and Thaa I have fully,oormptied with the provisioas of Cbaptsr E36 of the if lseonain 3tsa loo,the Sobdivlslem and Zoalne Regmlattans of St. Crops Couaty,the:'owe of !ludsom Subdtvipfsn Ordinance,sad the City of Hudson Stsbdivlet•n and ettatuing OrU- _ name,to surveying.Olvidias and anapping the same. Dated this',Z'3 ' day of hWa , 1954 R sed t 11th ds of Apsil, 1984, �a' 7 �SnFes 1C. mseft- AML i j 42I&toad Street ..., 140 i hindeoa,wiscoasfa 54016 .4-04 K COUNTY TIIZASURSR,S CERTIFICATE tiQ STA719 Or WWCOH=4) �1iv4' ST.CROM COUNTY I. Moray Joan Livermore, being dtdy elected, qualified and acting 3rr.asuser of St..Croix County, do hereby Certify that the record•to my cities show as unredeemed tax anises and no aupald taxes er apectal assessments as of afteeti"the 3xadAL included is the Plot of Park Vl•w(:states Fourth Addtlon. s-Pelf 7 11•�:.,,�t.4, .. ; Date anty Treasures i - f I 7.OMNG COM)'AITTJ:R RESOLUTION This plat Is hereby approved by the St. Croix County Comprehanslve Perks, Funeing and T.oefnR Committee. F Date Ctisit �3 41_ Date, Admlaistrotor , L' rh) .r^ _ )J..�.�_.'r its�.i�•� r „`?t•='�t� ..� 't rsshJe sf Serve, C �rP'rV if Y �!°Sj, .14 y,*��:� ,. S •C,.• t+ 'L N H • �> ST C - 105 a H SEPTIC TANK MAINTENANCE AGREEMENT . o St . Croix County z d 9 H OWNER/BUYER -� 4't 0� ( /� ( M ROUTE/B X NUMBER S � (, -t �_ o � ,�� Qd ) Fire Number /4 CITY/STATE l-' 'LIP PROPERT) LOCATION :��, s� !4, Section_, T�N , R� Town of WA_dsah , St . Croix County , Subdivision/k -74�S , Lot number-'3/_. Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists o pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper. What you put into f the sys em can affect the function of the septic tank as a treat- ment at ge in the waste disposal system. St . Cro x . 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 ear expiration . H 0 F I/WE, the undersigned,, have read the above requirements and agree EA to maintain the private sewage disposal system in accordance with H the standards set forth , herein, as set by the Wisconsin Depart- •v ment ol Natural Resources . Certification form must be completed and re urned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED. i C✓� G DA'rE St . Cr ix County Zoning Office P . O. B x 98 Hammon , WI 54015 715-795-2239 or 715-425-8363 Sign , Jate and return to above address . � A M e•�d e-� �'e ..r- To F H //S- �.4-/e� S= 6-7� � DEPARTMENT CF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS 'T INDU$ RY, DIVISION LA. 6OR AND PERCOLATION TESTS 1151 / P.O. BOX 7969 U MAN RELATI NS / MADISON,WI 53707 (H63.09(1)&Chapter 145.045) 7 l 'f' ecl s• f o- S'.3 J L A I SECTION: OWNSHIP OT NO.:BLK.NO.: SUBDIVISION NAME: / / /T�9N/R/9�( ) uds� COUNTY: WNER'S BU ER'S NAME: MAILIN ADDR S: USE DATES OBSERVATIONS MADE NO.B DR 1COMMERCIAL DESCRIPTION: L S: A N T STS: Residence 3 XNew ❑Replace � �_7 �4-- RATING:S=Site suitable fors stem U=Site unsuitable for system J Sor Hid/' fI� CONVENTIONAL] ®�•❑� ING®� P❑� a� -I��L a�G®� .RECQOMMEp/SoYSTEM:(oonal If Percolation Tests re NOT required DESIGN RATE: [1f,ony portion of the tested area is in the A/under s.H63.09(5)(b ,indicate: odplain,indicate Floodplain elevation: /~/N PRRF,IV DESCRIPTIONS BORING TOTALS LEVATION DEPTH TO GROUNDWATER CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH W, OBSERVED EST.HIGH- EST TO BEDROCK IF OBSERVED(SEE ABBRV.�O^N BACK.) B- 2- [8 ` 00.4 r Alall e 7 ef, D ` 7 9,2-s-1, S. PERCOLATION TESTS DEPTH$ WATER IN HOLE TEST TIME DROP IN WATER L V L-IN HES RATE MINUTES NUMBER 'NellE6 AFTERSWELLING INTERVAL-MIN. p 1 t P PERIOD3 PER INCH P- •� ' N� -3 3 3 3 P- ly,10 Ala -.? 2 ,Z„ z P- 3 Ala -3 P _ -79 P- h� te O ` v 'LOT PLAN: Show Ic cations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori• ontal and vertical ele ation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent )f land slope. "YSTEM EL NATION t : l .0 fS / 0 i .� C �_ . ._ _. _ � �` (��r c� I Svf S ; I � ij- 4 I E 2 r � � I - - 7� af the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and et�ods sp2ified in the Wisconsin dministrative Code,a d that the data recorded and the location of the tests are correct to the best of my knowledge and belief. AME (print): ,(. TESTS WERE COMPLETED ON: .DDRESS- CERTIFICATION NUMBER: PHONE NUMBER(optional): Q G✓,`s 7/ -3 A 1'0. CST G TUR ISTRIBUTION: Origi al and one copy to Local Authority,Property Owner and Soil Tester. ILHR-SBD-6395 (R. 2/82) —OVER — REPORT ON SOIL BORiN1ii8 AM PERCOLATION TESTS . �WISpONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O.BOX 309,MADISON WISCONSIN 631EI'f �;, :'�► +�e'ction '�r� ,T�y N// Townsbip or ilAurlidpgllity►..,� IJ A, v t�s' ^l� r County (xe X a'; Nam bdivislon ?'�Il�IlI`'t�{P!ye $: tnr1 r `�ngPitiiagAd+ r X - COMMERCIAL ; TYPE AF.OCC ANCY:. Residence No.of Bedrooms ---'--' EFFLUENT DI' SAL.SYSTEM: NEW x REPLACEMENT ALTERNATE SYSTEM OTHER DATE$OBSERVATIONS MADE: SOIL BORINGS 5 ° f PERCOLATION TESTS 9,- P r,,... ' Plr' �,r SC1t�'MAP SHEE ter; NAME OF SOIL MAP UNIT n, PERCOLATION TESTS TEST CHARACTER OF SOIL HOURS WATER IN TEST TIME IN OP IN WATER LEVEL; CH . RATIS NUM SINCE HOLE HOLE INCHES THICKNESS IN INCHES INTERVAL PERIOD i PERIOD 4 PERIOV/3 MINOR BER 1ST WETTED SWELLING LING IN MINUTES P- P— - P— SOIL BORING TESTS TEST T TAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF>�IL WITH 7H{ NESS,COL6IR, TEXTURE,MOTTLING AND DEPTH TO BEDROCK NUMBER IN HES 'OBSERVED ESTIMATED HIGiHE3 IF OBSERVED IN 1NCHE8 X�z / .l C'i. «'S i<t" S R �D� J i�T r r � 6 PLAN VIEW(Locate percolation tests,soil bore holes and suitable soil areas.),Indicate on the an�the i ation rM square fleet of sui Ile am Indicate number of square feet of absorption area needed for building type and occupenc1' cvo Give horizontal d vertical reference points. Indicate slope. / ram f, r,vbifr fr _ _ .,_ ,,_. �r�-�i.� �r.� '/F {�� "1..,1.n./<'c_s r/''I s ..!it./rri' •fig[ YC'c.J e Id 4 y i ,, _ .... A t/Ar C .r j a # t y� ,� �e 4 I the u rsigtdr hereby'certify that the ae:•il tests repot tectol M!q ,, Berl! the Wisconsin Administrative Code.and that ttij 4 l Ip beliefyyy pw F"- ,AQdr!gIS� n 1 ,� P t�j. + F µ:_ y�..2 ,y � T1p"a J Ua 4 ! •At 4 ',!Y /,::� d f3 }'qJ y'n t f « Ft u vy a't e ,0 O � O � O d � Q lYj s o� �a ° , 1 r. o d � 1 L. s 1- o 0 — J vo < v =; h v C , K '� tJ� t , � 5 � v � d ID x 13 zr ti a vi ! I I \�}•jai�a Pc - . a �s } Z RETIORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.i.taxy Pexm.it State S P pt.i c /_2Z NAME rownahi1;, .: r- > St. Cxo.ix County A� / -_ Location SEPTIC TANK Size gatton4 . Numbers o4 Compaxtmente Distance Fxom: Wett 120 on gxeatex ztope 6t Bu.itd.ing it. Wettands H.ighwaxen DISPOSAL SYSTEM Distance Fa cm: Wett 12% on gxeatex Atope j t. Bu.i.Ld.ing ix. Wettandd Ft. H.ighwatex it. FIELD DIMENSIONS: .idzh -o6 txench it. Depth aj xock below tite .in. Length aS each tine it. Depth ob tack oven tite .in. Numb x- a6 tines Depth of tite below gxade .in. TotaZ tength a j tines it. Stope a j txench in pen 100 it. Distance between .L.ines_Lt. Depth to bedxack it. Toga abboxbt.ion axea jt2 Depth to gxoundwatex � . 2 Type a Pa et ax Stxaw - Requited axea �� yp � Covet: Pap et DIMENST NS: umbex o4 pits Gxavet axound pitzs yea no uts.ide d,iametex it. Depth below .in.tet 2 atat aba oxbt.ion axea it tea kequiked 2 INSPECTED B TITLE APPROVED ,DATE 197 REJECTED ,DATE 197 v EH115 Rev.9 78 r REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309,MADISON,WISCONSIN 53701 �1°� 4 /4,Section T N,R� (�,,.r, ownship or Municipality LOCATION:'/4, ' ��-Lot No. , BI ck No. /S �� "' l County ivision Owner's/Buyers Name: 73 4A7 es G' [c vA/ Mailing Address: 104 TYPE OF OCCUPANCY: Residence X No.of Bedrooms -� COMMERCIAL EFFLUENT DISPOS L SYSTEM: NEW x REPLACEMENT ALTERNATE SYSTEM OTHER r DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SOIL MAP SHEET NAME OF SOIL MAP UNIT PERCOLATION TESTS TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NUM- DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTEF INTERVAL MIN/IN BER INCHES THICKNESS IN INCHES 11STWETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- l �/ e 3 / 3 3 1 P- YP" see ors /1 12-- ,t(c: 3 d2 Z P— Ste A410 e 1P_ P_ SOI BORING TESTS DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEST TOTA DEPTH TEXTURE,MOTTLING AND DEPTH TO BEDROCK NUMBER INCHE S OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B— / / " axle. 7 •, �„7`s "�i� oZ" S D�C'-r B— ,� v /,4X e_ B— y 7,9g•r « S y n f 6 7 B— Y 7,9e v S 2— . S B— r. PLAN VIEW (Locat a percolation tests,soil bore holes and suitable soil areas.) ndicate on the lanthe location and square feet of suitable areas. Indicate number of quare feet of absorption area needed for building type and occupancy 0 X)610' InSlicate scale or distances. Give horizontal and vertical reference points. Indicate slope. i , &rc:s i c.l.,.... .._ i . Cj s _.__ E � I $ Q _ / Pe✓9 i3 I 1 ,/a 1 `v Ae ms , � .. a 3 � . � x .. _., m _ .. �.. . r E I,the undersi end,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 a d belief. Name (print) 1"11 t tr �/^S�✓ Certification No. Address G'e, .Name of insialler if known CST Signa e � Copy A—Local Authority PLB _� � State and County State Permit # Permit Application County Per i # Count.y��> ��ia'�'l�r for Private Domestic Sewage Systems *DENOTES STATE APPROVAL REQUIRED Date Approval Rec ived from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: Section 17, T"N, R JQE (or) Lot# _City Subdivision N me, nearest road, lake or landmark Blk# Village Township 57' i C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance Single family �_ Duplex No. of Bedrooms No. of Persons__ D. SEPTIC TAN CAPACITY l/�,W Total gallons No. of tanks HOLDING TAr I K CAPACITY Total gallons No. of tanks Prefab concret _ Poured-in-Place Steel Fiberglass Other (specify) New Installati n xReplacement 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 depth (top)—No.of Trenches Seepage Bed: Length 36 ? Width_1 Depth Tile depth (top)_. ----No.of Line- Seepage Pit: Inside diameter Liquid Depth No.of Seepage Pits Percent slope oi land /aJp Distance from critical slope WATER SUPPLY: Pr vate )C Joint❑ Community ❑ Municipal ❑ Owners name as listec 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 Adminis rative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified 3oil Tester, NAME / C.S.T. # —/6-379 and other information obtained from r/builder Plumber's Signatu e ` MP/MPRSW# �2QS_ Phone # Plumber's Address 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. t/ 3 . e x e s i yp _ 1 r .-. i s S �. : : 3 .a b r r e r e. 1 { g _s ar E P c Do Not Write ' in Spacg Below FOR COUNTY AND STATE DEPARTMENT USE ONLY �- Date of Application - ` - Fees Paid: State / ' c Cou ; , Da Permit Issu (date) 9°,2?4-7 2 Issuing Agent Name ­e Inspection YeXite -No State Valid# Date Recd 1. county (w copy) 3, owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink cop ) 4. plumber (canary copy) Revised Date 7/1/78