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PUMP CHAMBER
Manufacturer: I Liquid Capacity: er s
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, Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Ze x t k Trench:
Width: Len the 3 G 10 Number of Lines:_ T Area Built:G'/F r
Fill depth to top of pipe:
i
Number of feet from nearest property line: Front, O Side, O Rear,0 Ft .LZ
Number of feet from well:
Number of feet from building:
(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 0 been used on any of the above soil
absorbtion sytems? (Check one) .
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job: ~tz
License Number: Al
3/84:mj
- 7
Form — S T C — 104
AS BUILT SANITARY SYSTEM REPORT
s +�
OWNER c TOWNSHIP y ti- 41_50 r1 SEC. T -_N-R��
ADDRES ST. CROIX COUNTY, WISCONSIN
t
SUBDIVI IONP„jf �j'�t LOT �~ LOT SIZE • 3CGLr i
PLAN VIEW
Distances and dimensions to meet requirements of I•LHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
4
}
a' N
1VI
INDICATE NORTH ARROW
Sa e
BENCHMA Describe the vertical reference point used a 41 O (61MQ f
Elevation of vertical reference point: 100.0 Proposed slope at site:
SEPTIC TANK: Manufacturer: Lkk,i `s(I Liquid Capacity: Iron A&A.
Num)er of rings used: Tank manhole cover elevation: ,Q Z -Y�
Tanc Inlet Elevation: Tank Outlet Elevation: /
i
Num)er of feet from nearest Road: Front 10 Side, Rear, O J �O feet
i
From nearest property line Front,O Side,O Rear ( 6/ feet
Num er of feet from: well �p� , , building:
(Includ this information of the above plot plan) ( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
I
LABOR&HUMAN R DIVISON
CATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING
P.O.BOX 7969
MA819@N,*1 53707
NW,SE, Sec 17 T29N-R19W 'CONVENTIONAL ❑ALTERNATIVE State igned)D.Number:
III assigned)
• Town -of Hudson ❑Holding Tank El In-Ground Pressure El Mound
Lot 93 ParkView state IV
N Sam PERMIT
MillerER. fil-vl A RoutePE1'IT BO HOLDER:282, Hudson, WI 54016 INSPECTION DATE �`^J
BENCH MARK(Permanent ref ence point)D CRIaE IF D FERENT FROM PLAN: REF.PT.EL
E V.: CST F.PT.ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Doug Strohbeen MP 5432 St. Croix 88480
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK TLET LE WARNING LAB L. LOCKING COVER
PROVIDED: PROVIDED:
YES El No DYES Q40
BEDDING: V NT DI VENT MATL.: HIGH WATER F ROAD: PROPERTY W BUILDING: VENT T FRESH -
NUMBER O AIR INLET,
ALARM: LINE: „EET FROM � I
❑YES O ' ❑YES NO NEAREST .x
DOSING CHAMBER:
MANUFACTURER: BE DING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
YES ONO ❑YES ❑NO DYES ❑NO
GALLONS PER CYC E: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING:JVENTTOFRESH
(DIFFERENCE BET EEN FEET FROM LI NE AIR INLET
PUMP ON AND OFF) 1:1 YES ❑NO NEAREST
SOIL ABSORPTIONS STEM.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 m continue.) MAIN
CONVENTIONAL SYSTEM:
WI TH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE CIA. YPITS LIQUID
BED/TRENCH TRENCHES: /_ MATERIAL: PIT DEPTH
DIMENSIONS I 117 «1 -LR'""
GRAVEL DEPTH F1.1,L DEPTH JOISTR.,PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL. BUILDIN . V NBELOW PIPES A V COVER E EnnT E V ND- ""� '.. PIPES: FEET FROM LINEI 7 C, u AIR L
Lo C. �,. 1 0 , Z_ ( .� NEAREST---► / L J /
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrcwn upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
1:1 YEE ONO
OIL COVER TEXTURE PERMANENT MARKERS OBSEH NATION WELLS
DYES ❑NO :1 YES ❑NO
DEPTH OVER TRENCH/BED IDEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SSD MULCHED
CENTER: EDGES. ❑YES ❑NO
❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES:
DIMENSIONS
M NIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. ID ISTR.PIPE DISTHIBUTION PIPE MATERIAL&MARKING
ELEVATION AND
E EV.: ELEV.: DIA,'. ELEV.'. PIPES DIA.'.
DISTRIBUTION
INFORMATION HI ILE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL. VERTICAL A PLANS LIFT CORRESPONDS TO APPROVED
❑YES El NO ❑YES I ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
r 1
DYES E NO DYES ❑NO NEAREST
t °�
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_7 .��
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE: - TITLE:
DILHR SBD 6710(R.01/82) 1'..1'1_'_
Zoning Administrator
Thomas C. Nelson
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 syste,�i, 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:
1. Property owner's narne and mailing address. Provide the legal description where the system is to be
installed;
11. Type of building or use served: If public is checked, :ndicate 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,
Ill. 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'h 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-110 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 Ater
included the creation of surcharges (fees) for a number of regulated practices which Wisco
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reastlt0
is used in your building is returned to the groundwater through your soil absorption u
system or the disposal site used by your holding tank pumper.
0
The monies collected through these surcharges are credited to the groundwater fund adminis.
tered by the Department of Natural R.*sources. These funds are used for monitoring ground- t
water, grourclwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
SBD-6398(R.03/86)
(—� SANITARY PERMIT APPLICATION COUNTY
U D'L R In accord with ILHR 83.05,Wis.Adm.Code x
°
STATE SANITARY PERMIT##
-Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8%x-11 inches ir 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
s -; 11e_r IVGV%5,F- '/a, S/ 7 TZ9, N, R /9 E(or
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
,4e)e# go y Z Z 92 /k V%tw Fu-ta-fe,
CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK
S VILLAGE: k S �/ O W a/� Pf V TOWN OR
11. TYPE OF BOIL ING OR USE SERVED: d010_ 11&6--6C1-00G
Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable)
1. a. Z New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanit try Permit was previously issued. Permit## Date Issued
3. ❑ An Exis ing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The SyE tem 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. ®Conv gntional b. ❑Alternative C. ❑ Experimental
2. a. ❑Syst m- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fil Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. ® seepage Bed b. ❑seepage Trench c. ❑ seepage Pit
2. PERCOLATIO14 RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): / � O/
6 /S ( T S r Feet X Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in allons Total ##of Prefab. Fiber- Exper.
INFORMATION
New xisting Gallons Tanks Manufacturer's Name Concrete stCon- Steel glass Plastic App
Tanks Tanks
Septic Tank or Holdinc Tank
Lift Pump Tank/1122= Chamber ❑ ❑
VII. RESPONSIBIl JTY STATEMENT
I,the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Prin): Plurber's Signature:(No Stainps) MP/MPRSW No.: Business Phone Number:
Plumb 's Address(Street,City,State,Zi Code): Name of Designer:
VIII. SOIL TEST IN FORMATION
Certified Soil Tester(CST)Name CST##
CST's ADDRESS(Stre t,City,State,Zip Code) 1/ ' '/ [' Phone Number:
Mc L Kra / /f !/ C i'7�Q SGh w� cj ) � �1 � � L
IX. COUNTY/DEP RTMENT USE ONLY
❑ isapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
Approved ❑ caner Given Initial S charge Fee y L
verse Determination ��d. .�a �� g/ `►[�ww 0•&� ISM
X. COMMENTS/R ASONS FOR DISAPPROVAL:
SBD-6398(formerly Plb 7)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
I
1
. 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 x,212 ZL'�l�r
Location of roperty __,&V _1p 114, Section -7 T �N-R�
Township 114CLOZZ
,p
Mailing Address �,p,Y 2$Z
Address of Site 4e, P
Subdivision Name k�'' Gt/ C_1ZA74°t .S
Lot Number
Previous Owner of Property
Total Size of Parcel 3
Date Parcel was Created
Are all corn rs and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? 1� Yes No
Volume S and Page Number / Z 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 a to avoid delays of the reviewing process. If the deed description refer-
ences to a C rtified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (We) eenta, y that att statements on this bonm cute true to the beat ob my (ou,%)
knowtedge; a t I (we) am (are) the owner(s) o b the pnopeAty des eh ibed in this
s
inbonmation onm, by viA tue ob a waAAanty deed teco&ded in the 046ice ob the
County Reg.cz en o Deeds as Document No. 3 3 Sz ; and that I (We) pnesen ty
own the prop s ed site bon the sewage d i b po.s system (on I (we) have obtained an
eabement, to nun with the above descAibed pnopehty, bon the eonstnucti.on ob .said
.system, and a dame hab been duty tecmded in the Obb.ice ob the County Regizten ob
Veeds, as Do ent No. 393ySZ ) .
r l'•, i
SIGNATURE 01? OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
i
S
3U RittT(M33 CERTLFtCATZ::
I.AMX"-t.AVOW1,.Registered Wisesa.sia I-ad 3uxvsyor, hsseby certify to the
best of my profesaie"I knowledge, undsrsbzad),ng and belief:
TUS 3 hmmw sss+wyeais divided mid mapy44 Park View Estates Yourth Addition.,
locateA in the NSI14 et the SW 1!4 and the NW-11 4 of the SE114 of Section 17. T29N,
It 141x. Tow of Ha4&w4 9t. Croix Cossty. Wiacessin;
That I have n uWo such survey. land divisloa sad plat by the d a*::tios of Darrel E.
Wwrtand-Boverly A.Wart, awaews of said land, described as follows:
Coenncoaeisg at this EI/4 corner of said Section 17.these&S896ZZA:'8'W (asstttn&d
beasiiW zedwoweed to the vamatneuted LAST-JEn 1/4 3eetioa Lisa cf.'Section IT.
b0*31 A ssaanrstl 314'22'08"W)(reoozd*d as 3W 2I140"Al on tint Certift-id S%tzrey'lap
reeariet to Yotrmw I,,Page id 184). 1332.916 along sa EAST-W EST'114 5aetion tines
to . %w%A3*oW-217.73 to the point of beginning;theses NW32040"W 412.001;theses I
NOW30"=2.12.00+is tie SoWborly right-of-way line of Gress Hfu Laos,theses I
?Z39•SZ.140-We, 6d.048 along said right-of-way Lice: thence W0411301W 251.001:!he�cr
579'36'S2-"Vf 194.351,-tieo¢a SWI5114-W 236.70;thence`(7S•37106 1W /42.171;theses
'5WI s14-W 558,.SOt;.tltemc+MWD6s30"L -04.00'.,Uwace S89'13s14"1k 3#4.00';tlrrnt:a i
PI0°!vr30"TZ iSSAW,tbeeeo Si9'151I4"lls 56.0111 theses SO'060"Iw 316.tW;theses
SWI5914M'15I.00t;thence N0137151"1f 54.IS:'these-389'221091W 14t..'}W,thence
:W*03"M 204.481;tbsoes NW13114"S ISO.004.tbsnce 30MOis36'W 31$.9712 thence
^t3!'-1SsI4"L 1Sd.001;.thawcs Soathrste:ly 66.151 aloa�the ssa.ot:;183.001 radius �
cnsweoaettri:l4ortissets:l7 who-a chord DanrsSi"50150"E 66.77,1;L5�sacw N6�YlStl4"E
0.01s;iksaco,3uuthsastexly_13b.S61 ajang%bs&i s of a 317.0019'radiae Cara&&octave
:lovtboa wterslyy whose,abovd bears 324 43102"I't M.511;those*336'231301 143.141: j
theses It F36230"E 160.961;these*N89'150 WE 243.00s;then *W06°3!'0'8r 108.001; �
&hence 38x!36130"re,259,161;theses Southeasterly%.141&lost the are of a 217.001
rat[aatFeM .000eave Wortheasterip wiles*ehord hears S78'O3•16"E 4S.Z+1';t4see
NAT,W14M,,.920.00;;thence Nortboasterly.91.214 along tae*"4.09 s 300.fh7+radius
• esur�i•sonaavrt lFostl;wrtaiy weoae e4erd bnszs ji80►32�f0"$9Q.85tf theaese;larth-
vpestswPy,91,444 along the arc of a 309.00s radius carte coucoww Northsaaerl y whoge
chords Iwwrs*.10137026181 91.091;thence N0.04130"E 150,000.these&N89''1Sk14
478.061ti*an to XV06SU"Z 834.551 to,the poW of beginning.
That•steak Riot is a correct repre&eatation of all tba exterior boaodeaies of the
I"survey"and the subdivision thereof made, and
Tbsa I have f oily oornpUed with the provisions of Cbapt&r Z36 of the Wiseoasin
Stat"It",the$04ITtaioo am Zoning Regulatto"of St. Crclx Comity,tb,e 7"s of
1'?rdsea 9ai4irte1oa OrdLsax&.atc3 the City of Hadeoa`obdivislos and-lsat7.ing,9741-
uaacsr in surveying.dividing and wALpping the sane.
Dated tbla' _, day of M9iw e . 1934 1
R sod 15th d' of April. 1984.
}'times i>.LRoseh - �:3�-f#"fZ 6
421 ak zmw 3traet .: : &news
14adeos.Wisconsin 54016 O ."".
COMM TAEASU11ER13 CERTIFICATE
STAT£Olr wi.9CONS171)
ST..0097[COUl47-Y ) 53
1. Meory Sass Livermore, being duly slatted, qualified and as►ing 2r,maurer of
St. Croix County, do hereby certify that the,records in my office show no uarsds*med
tax soles sod ne unpaid taxes er special assesernsots a&of
aUeeting the laada included in the Plat of Park View Renate. Fourth A&Mon.
Date sty Txa-sower
f �
_ 1
70NING COMAITTZZ RX30LUTION
TMs plat is hereby approved b7 the St. Croix County Comprehansivo Parks,
Pia►aafng gad Zoning Corsmitt.e.
r �
Usts Gtui!!tw -_
Det& Admisl et rat or
x'
tfMSTffYS ;;i;#�,
WK
1,4Mwq lift
n
�-• rate,_-1_k__ E �
r v't &wIM/'Jmi
c i
s
a a•, }' i
n, £s:, «•fit - -
F,ARK �- tr W ESTATE FOURTH ADDITION
A R URAL 9J6D'V1 1CN t t,,CATtb 1N�fiHE%E'W"S A a NWV*SE*,SECn0N 17, T29N., R.19W,
t s GYN Cr°Vii, ST. GROX CgUNTY, WISCOP N
C3'T.12ICAT OT TOWN'TI ASLT M
STATZ OY a as-
I, B 6TV,rly A.30haaon,.pfl"the duly eiactedo qualMad'aad acting Tawo Treasurer
of the Town o Hudson, do hwrebf csstify that in accord&= r rda in ury office,
V2420 are*a paid taxes or Spacial asee•srnests as of oo any Iand
inolaaied to t Plrt of Park Viatr-Zstataa Fourth Addition,
coke
Beverly.V,.ohnsoW Town reasurer
i
TOWN SOARD RESOLUTION
RZSOL'v ED, that the Plat A Park View Estates Fourth Addition in the Town of M
Hudson, Darrel E. Wart and Be ve A. 3V*trt, owners, is 12oreby approved by the i
L'a • pprovvil own rman
f% ig I ad A own t.n.a.rman dd''
i aerebv certify that the forrgoinq :s a copy of;- remolution adopted by the Town
Board of the Town of Hudson.
Dale own Clark
OW,'4ZRSt C rM T3=ICATE OF DEDICATION `
As owns a, we hereby earthify�that we caused the land described on thic 'Plat to be 1(I
rurvsYnd, ?='. ad, rrapped and drd(rated as ro?revent"d on this Plat.. W-1 Also certify
tart this Flat if requirad by S. Z36.10 or S. 230,1 to be submitted to tiie following for
approval or ob action:
Dspart nt Lf Development
l ecazt-n ont of Industry, Labor and Human Ralatio•tm,
Tcwn of Judson. City of Hudson and St. Croix Co,,nty.
W;TN the Lund and seas of said owners this—I- 't _ day of
In prasa ce ot: /�/j ��
�17
I)arre! art
/1
Beverly h 'Nei
STATE Or W CONSIN ) SS
ST. CROIX COLI.wry )
Pstscnal y came before me this " Jay of_ /�-�i /, _the above
named Darrel E. Wert and Beverly A. Wert, to me known to be the peracns who executed
the foregoing instrument and acknowledged the same.
Notary blic
Y .5,... ,.v6' '�4., Wisconsin My commission expires
b1ary iscary Public I'
.I
--CZRRTIFICATE OF' TOWN CLERK
'-.STATE OF WI ONSIN)
ST. CROIX CO JNT Y )
I, Rita;ior.e, being the duly appointed, qualified and acting Town Clark of the
Town of!!rdso , do herebj'e if that copin's of this Plat were forwarded as
required by .1. 230,12 on the3 day of--en e to 1994, and that within
the 20-day lirni met i•y m. 236;12(3)(no objecti n the plat have been filed)
{all ::hjnc:4nv o•h.n �;at have been
Date
AitX Horne, Town Clerk
.JAMES E. RUSCH
SURVEYING & MAPPING
HUDSON, WISCONSIN
TI03 INSTRWCNT (RAFTED 81
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• SEPTIC TANK MAINTENANCE AGREEMENT H
St . Croix County z
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OW ER/BUYER
RO TE/BOX NUMBER A6 Z g' Z Fire Number
Cl Y/STATE /ftsA.3p/� �L ZIP Sy0/G
PROPERTY LOCATION : , ,SG 14, Section 17 , T Z N , R-_Z1—Z
Town of St . Croix County ,
Subdivision k F,STf4YLot number.
Im roper use and maintenance of your septic system could result in
it premature failure to handle wastes . Proper maintenance con-
si is 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,
wh ch was in operation prior to July 1 , 1978 . St . Croix County
ac epted this program in August of 1980, with the requirement that
ow ers of all new systems agree to keep their systems properly
ma ntained .
The property owner agrees to submit to St . Croix County Zoning a
certification form, signed by the owner and by a master plumber ,
jo rneyman plumber, restricted plumber or a licensed pumper veri-
fy ng 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
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I/ E, the undersigned , have read the above requirements and agree Cn
to maintain the private sewage disposal system in accordance with x
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the standards set forth, herein , as set by the Wisconsin Depart- ro
meat of Natural Resources . Certification form must be completed
ani returned to the St . Croix County Zoning Office within 30 days
of the three year expiration date .
SIGNED , �` �VI,
�°�\���
DATE
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 .
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS
INDUSTRY, G DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN 139LATIO
(1-163.0911)&Chapter 145.045)
— N: OWNSHIP OT NO.:BLK.NO.: SUB DIVISION NAME:
,A/U/'/4 S ' l /Ta9 N/R/q Q(or t 0
COUNTY: O ER'S B R'S NAME: 'MAILING ADD S:
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USE DATES OBSERVA IONS MADE
O.BEDRMS.:ICOMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence 3 141,14 �New ❑Replace I .2-1747 2�7 j 7/-1,4
RATING:S=Site suite le for system U=Site unnsuitable for system Sv, x-j. �r a 64,k 19r'e( -r/f,-- Idd/'L
rzs ONVENTI NAL: M UND: IN-GROUND-PRESSUR : S STEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional)
❑U S ❑ ®S ❑ ❑S �U ❑S ®� eoa e� :om4 eJ /d"X36`
If Percolation Tests are NOT required DESIGN RATE: lFloodplain,If an q y portion of the tested area is in the under s.H63.09(5)(b),i dicate: �/ indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTALS i DEPTH TO GROUNDWATEI`14N61l+E3 CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER DEPTH14W ELEVATION OBSERVED EST. l" HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- / ,Q ' off. ' 6,e,, > d, o' .2. o fl/s/ /. - gn /r
B- 3 o rV' )0d-(*"
'tle /2- 7 O,v ' .7• s�
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.0, 10.3j A16AZe_ 7 0' X l S 1 S_ i5n is 6, C a10z r S
B-
PERCOLATION TESTS
TEST DEPTHS ATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER 44G -ES AFTERSWELLING INTERVAL-MIN. PERIOD t —PERIOD 2 PER1003 PER PER INCH
P-
P_
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 760. 00 Le em J
1
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To rULA�c�,_t .
1,the undersigned, her by 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,aid 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:
DC'lu,,u.`s -5 a-1 7 -8 7
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
CS TUBE:
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DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 2/82) —OVER —
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