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HomeMy WebLinkAbout020-1166-40-400 7 0 « Co g � 0w % 0 » . A ' Q� ) z m ■ ) 2 � § « � 2 � � a � z / U) o p k a m B z ¥ ) \ k k D z $ 7 7 N � ƒ A ) q ' 3 Q >_ } ) k $ ,, z ) R § i / » ■ LD © & a ) ) / k k c ' � U) U) � § R / { 0- K & & ® ® 7 0 / a a a 7 \ \ / \ _ \ \ § � . 7 V � . k \ § 4 \ e ] . � _ . . § m 7 4) § § k / \ / m § ( \ k k > $ U) § V) k \ � f i - § \ § o } / / 2 \ E { » J 2 . � kI — :3 EL k uIL w E k a § J v 0 U) 2 7 a PUMP CHAMBER PI Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pwtp Size Elevation of inlet: Bottom of tank elevation: ;S T i Pump off switch elevation: Gallons per cycle: t 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: r�ZVdj, 4 a,, Trench•___� r Width: / Length: 3 G Number of Lines: Area Built: y� Fill depth to top of pipe: 5lZ i Number of feet from nearest property line: Front, O Side, Rear, O F't .� Number of feet from well: / S�� Number of feet from building: r (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 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: License Number: 3/84:mj 1 ' Form ar S. -,--1 Q.. AS BUILT SANITARY SYSTEM REPORT T - - _/ R /q OWNER l d� TOWNSHIP SEC.��SOlit -1� C ADD�ESS f �D 2 �.ST. CROIX COUNTY, WISCONSIN t SUBDiVI ON G/r�w s �dS-MOT t l ( LOT SIZE PLAN_VIEW Distanc s and dimensions to meet requirements of II-HR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �iVolCfa 107- /;A � 3 0 5,1�C- l ,tiIL ftv u l�l �t t°zs L(, 12 s Zq r l6 3 W INDICATE NORTH ARROW BENC RK: Describe the vertical reference point used/ lo f r Q� vim- fy��e,.n yi✓ Elevat on of vertical reference point: 400, 0 Proposed slope at site: SEPTIC TANK: Manufacturer: W4-iS a r Liquid Capacity: /006 Tx / Number of rings used: �_ Tank manhole cover elevation: .�,,� Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,Side,O Rear, O feet f From nearest property line Front 10 Side IQ Rear,0 feet i N ber of feet from: well ZZ _, building: 2o/4 D3, 7ar, s•�Co��t�✓ (Inclu a this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF IN DUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RE LATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISQN,WI 5',1%707 S Plan I.D.Number: NW4,SE14, S17 T29N-R19W CCONVENTIONAL ALTERNATIVE (If assigned) Town. of Hudson ❑Holding Tank ❑In-Ground Pressure ❑Mound Lot 111 Pary ew, Estates NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Mille. Route 1, Box 282, Hudson, WI 54016 )6 A 11.'15 BENCH MARK(Permanent refe ence point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: 7.PT ELEV. Name of Plumber MP/MPRSW No.: County Sanitary Permit Number: Doug Strohbe n iMP 5432 St. i 102823 SEPTIC TANK/HOLDING TANK: MANUFACTURER: e' LIQUID CAPACITY: TANK IN _ V AN TLET ELEV.. WARNING LABEL LOCKING COVER 64)444*1 P O IDED-. PROVIDED 1 7ro ; YES 0 N OYES XNO BEDDING. VE T A.. VENT A L.. HIGH WATER NUMBER OF ROAD PROPERTY WELL BUILDING. VENT TO FRESH ALARM FEET FROM )_ LIN /� AIR INLET DYES NO ❑YES NO INEAREST �//V{lj/j 2 1 .20 DOSING CHAMBER: MANUFACTURER BEDDING LIOUID CAPACITY PUMP MODEL. JPUMP/SIPHON MANUFACTURER WARNING LABEL KING COVER PROVIDED: IDEDYE S ❑NO ❑YES ❑NYES ❑NO GALLONS PER CYC E: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL UILDING V NT TO FRESH (DIFFERENCE BET EEN FEET FROM LINE AIR INLET PUMP ON AND OFF) OYES ❑NO NEAREST IN 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 t continue.) MAIN CONVENTIONAL SYSTEM: WI TH'. ssss LENGTH NO.OF DISTR.PIPE SPACING COVE Au R INSIDE CIA -PITS LIQUID BED/TRENCH I 'q TRENCHES / MAr PIT DEPTH DIMENSIONS I GRAVEL DEPTH FIT L DEPTH DISTR PIP' DISTR.PIPE DISTR.PIPE MATERIAL. N DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TOFRESH BE O�J�PIP S AB V OVER ELgEV INLET E V PIPES pEET FROM LINE Q At E �. 5 NEAREST---- / MOUND YSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thro n upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES 1:1 NO SOIL COVER TEXTUR PERMANENT MARK EHS OHSEHVATION WELLS OYES ❑NO ❑YES ONO DEPTH OVER.TRENCH/BED DEPTH OVER TRENCH/BED [7PSOIL SODDED SEEDED MULCHED CENTER EDGES DYES ONO OYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WI TH. LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTHA V VER BED/TRENCH TRENCHES DIMENSIONS M NIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL IWO—DISTR DISTR.PIPE DISTHIBUTION PIPE MATERIAL&MARKING EL V.'. ELEV.. DIA. ELEV.. PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HI LE SIZE HOLE SPACING DRILLED CORRECTLY )COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ONO OYES ONO COMMENTS: PERMANENT MARKERS: O V 1 ES ELLS: NUMBER OF PROPERTY WELL: BUILDING (� FEET FROM LINE 4J / ❑YES ❑NO ❑NO NEARE T ✓ � � Q cl,�q Sketch System on etain in county file for audit. Reverse Side. SIGNATU TITLE � Zoning Administrator DI LHR SBD 6710(R. 1/82) INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT j 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: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. 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 .at@r included the creation of surcharges (fees) for a number of regulated practices which WisCO in$ can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasu#@„ a 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. o 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- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) {� SANITARY PERMIT APPLICATION COUNTY LI L RR In accord with ILHR 83.05,Wis.Adm.Code , CROP X STATE SANITARY PERMIT#/ /o a a3 —Attach complete Aans(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 IN RMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ONO PROPERTY OWNER PROPERTY LOCATION ,• ( 1._5� '/4, S 17 T.;?`, N, R / E (or PR ERTY OWNER'S AAILING ADDRESS LOT NUMBER IBLOCKNUMBER FN�EAREST IVISION NAME Z—CITY,S ATE ZIP CODE PHONE NUMBER CITY RLOAD,LAKE OR LANDMARK D/ ' =271: VWSO% 1.t10 00r i Vw 11. TYPE OF BUILI IING OR USE SERVED: Number of Bedro ms if 1 or 2 Family --S OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. N 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 San it try Permit was previously issued. Permit## Date Issued 3. ❑ An Exis ing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreementto County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. X Conv ntional b. ❑Alternative C. ❑ Experimental 2. a. ❑Syst m- b. ❑ Holding C.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP I n-Fi I Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. M seepage Bed b. ❑Seepage Trench c. ❑seepage 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): p 44, 3 &/S (0 4/$ 7 �� F Feet Private . ❑Joint ❑ Public VI. TANK CAPACITY Site in lions Total ##of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New xisting Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank X 000 ❑❑ ❑ Lift Pump Tank/Si ho 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: Plumbeits Address(S reet,City,State,Zip Code): Name of Designer: )e4: `/ A f,_c-,.) 12.'a�,owoh r o bIMcn VIII. SOIL TEST INFORMATION Certified Soil Tester( ST ame CST## Do-17n 3 7 - e Ar zzf 5P CST's ADDRESS(Street,City,State,Zip Code) f Phone Number: 4. _L � IX. COUNTY/DEFARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) urcharge Fee LPJ Approved ❑ owner Given Initial do Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly PI -67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber f A APPLICATION FOR SANITARY PERMIT STC - 100 his 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. Shouli 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 eo�'Xlar Location of Property /1Iw k `hr, Section / 7 , T N-R1�� Township ceq� Mailing Address d X Z Z Address of Site ro o Az Subdivision Name Lot Number TP Previous Amer of Property Total Size of Pi reel . 1, 0741 le aCr Date Parcel vas Created — S / Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume 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 ReRister 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 Cert fled Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (Wfl ceAti.6y that dtt statement6 on thus oAm ane true to the bust o6 my m o ' hnautedge; that I (we) am (ahe) -the owner(,s� o6 the pnopeh ty dm cA i.bedinthiA .Cn601mati.on 6o k", by viktue o6 a waAAanty deed neeonded in the 066.ice 06 the Cc�mtyy RegiAteA o6 Deeds as Document No. 3 ; and that I (We) pne�sen.tty Ac�un t1,e p�opoee a i.te bon the sewage di�spo3 a yes em (on I (we) have obtac.ned an ea.a"Ent, to Aun with the above de.aentbed pnopenty, 60h the eonAthucti,on 06 eai.d byete"+, and the came hae been duty kecokded in the 066,tce o6 the County RegiAten o6 aetdb, a.b Vocament No. p �,/l. VAS URS OIL E SIGNATURE OF CO-OWNER (IF APPLICABLE) do IGNED :� 1 �- ( �, DATE SIGNED . I • I nf 3ulily"Ca'3 CIXTU ATS.. L alttlewS.Ae*ats.Aojdsterod W'--sift Lad 3usysyos, 103re4y certify to the beet of my Psofeesioaal knas'"S68 amderstaedasg Sad belief: loeatsi In tiJwAt ham,* y the SV/1 4 and the N Mal 0l the 5Ll/£4toLr3oeKes T,+T ill K 19'W. To- -of Nods". St. Croix County' Wit<ersia; That I have mole ouch Surveys land dlvislot and plat by tba disarsion of Darrel E. Wast and 1!*v*r1T.A. Wert. owoere of said la,ai, described as foil*"-, C-0 u amdag at,the tl/4 eorsar Of said Sactioo 17;themes,S79WOOPW (assumed beosiW soiosanted'to the awsumeated EAST:II EST 1/4 Section,Use d1.3ecttoa t?. bsrLrty assun.ed 31r22""N)(recorded am 3W2lt40'"M on that Cert&,%d Sarv*y Map vaeaw4ad tn,Veln,ueo 4 A 184). 1332.91'along amid EAST-WZ2T'114 Section llael tb*MM 5*"6t39"W-237.rJlt%the Point of begleaimt;than**Nff$1 40'W 412.008.thence.. . NV96830"M 212.004 to the Southerly rigkt-of-.ray Use of Green wU Lame;theote rr3r32t10"1r 64.044 ale" slid rlrii4�h!•of-ay lime.thence S0104830"W 251.401.thane• 579r26152"W- 194.351;thwWo 341P 15814"W Z76.760;theme**47r3710S"W 14x.171;theme* S1r 1 S1 t4"W S8d.00s;.tbeaack N('06830"E 104.908;thence 319815814"W 3041.0081 thence NW M130"E'13S.OW;%home S19`Ist14"111 66.0111 themes,50106850"W'116.138;themee , 3WIS1WIff'131.00*;tbemce N0137t5 1"1/ 54.11%theme ,Str22%9"W 14f."Il theme* f 30'06'01''204.418;III --a W11814"Z 130.008;thence 3010683011/•31L 971;tbacce MWISS14PL•154.046pthaoce 30ethemsts:ly 66.231 along the aso.oi 6 31,1.001 radius 1 emrwa'ewtcsM:lrort►er+Mrlr wheos,chord boas 3-r5*1500E 64r17�i th*as.:IiY15114"t L7.0181 thetwe 3oeth mster1y.136.561 along 1146 use of a 317.044'sadime carve coeeave l Northeasterly Whose chord bears S24 0310211E M.511;Masco 336'23r30^: 143.141; 1 themes 1117P36830"X 160.961;thence N8?*15914"r-243.068;thence.SIV06IM-W 10!.001; theses,S3,Y36230'W.2".161;thence SoutheucesiT 94.14'AID" he arc of a 2 17.008 rrttw:wito.o*meav*Northedsterly.,WLs,m**hold bears S?r9P16"E 93..Stl t44nce NA .1'V14."lr 920.1W;thence Northeasterly 91-214410119 the Able'0f 1.300006 radium wr+o mooe+ivu Nerth-seterly-see*Chu:¢hems*K60r31840"L 90.S51f th&%"North-. v►eegrlr 91;44t along the are of w 309.008 endive curve eonsmve Northesdnslthese Cho"bens*.11/37r26I"itr 91.W.thence NO'04130"Z 150.001;themes Nil l5rl4 1 471.05x;thenoo NW06830"Z 634.561 to,the peLaa of b*gtmaing. s Th"i'v*b plot 10.a Correct repseeeat*tion of sU 04 smovies bosedsaiss of the Lama*srrmycd and MO sebdivlslom theread node, and Tboa I have fatly eoraPUed with the provisions of Chapter E36 of the!/tseossla StaMae.the Ssbdivtrbsa eed Zoming RojtUL"tens of 34. Crelx Co"Uty,the:e»a..f licdsea Subdiviels,a ordiasnae,and she City of Hudson Snbdlvlstes Abed 381sirim*Or l• ~, nnnee.L eeNreyitll.tUvidi*g end 1T1iPP171g the same. i Dated thlor. 004 day of MAfoc',lt , 1984 j It deed&I 15th do of April. 1984. s t. ueh - fit• 421 Stsomd Street ?'Puna" Hodso-.1lleconsln 54016 'COUNT?TIII:AAU11=13 CZRTInCATE XTATt Or WISCONS114) � ST.C3tOIx COt1NTT ) 33 I 1. Moi1'y Joe*Livosn,or*,being duly elactea,qualified and soling Iressaurer of St.,Croix Commye do hereby mestlfy that thr recordo in my since show no usredeemed tax*color end coo oupold taxes or special assosomeetm as of /-r-.f/-J/_ effecting the leads included in Plat of Park View Estates rourth Add,910n. »K• vlKy Tsessus*�� 1 1 ZONING CO%4),AITTER ALbOLUTION This Plat 1s hereby approved by the St. Croix County Comprehensive Pa Planning and T.onloo Committee. rks,, '.i Data Date Adsnlalstrator -' r 1 tEa'1Slflri �c�.� I 3' twill at,WK ertr. -..JatrLuae :;in,. ,••a..` ,� .-.,�4 1 r. �..: iii' fr'j. !� 18Men at 3MIft `•• I a I .. 11�.�:��111 4�;• ' i • I PARK VIEW ESTATES FOURTH ,ADDITION A i ' At 9-60"510N lG'CA { TED.IN THE ^a A-SwA a Nwy6-sEI4,SECT7CN 17, T29N,a RJ 91N.a ! TG°NPI:Cam.HLOSC N..ST C-90X COUNTY, VVISMON 1 CzATMCA Or To%wTXr'!A`SQRZR STATZ Or W B• ly A.•IO6teoiy b+aK the defy elected of the Town o Hudeen do n gualified'sad acting Tager Tratsursr syara are tw Apo �� l�tereby certify that!n accordance r rde!a any office, leotaled tat sy+sfal asaeesraents Sao( . _ on any land S'las of Park View ROW** Fourth Addirioat. to .,w�era . T• •.ohas torn :.a�:ar.s f . TOWN BOAR RESOLUTION HESOM ED. that the plat of park View E& too'Fourth Addition in the Town of Hudson, r:arr 1 E. Wart and Hove A. Warta awn•rr, le ber•by approved by the Town fiord. , r . 0, a •Ai roved own rman, 1 D is ad own t„iatrman� thereby eertliy that the toreloinK is a copy*1:a rerulutlon adopted by the Town Hoerd of the? wn of Hud°a,n, own Clark i 1 OWNERS'Ca•R IFfCATE Or DEDICATION As ve,ne a, we hrr•by certify that we caused the land described on thi: Plat to be curveynd, ::oi led, rrapped and dadieated as rooree.nt•d on this Plal.. W4 elso certify lSel 'WO Plat! required by S. Z36.110L or S. 236.12 to be submitted to(ire following for approv1 or ob action: j Departs at b(Development Geparttn Int of Industry, Labor and Human Relatio•aa, Town of ludeon. City of Hudson and St. Croix Co++aty. I W;T•"N= the luntl and aeal of said owners this t J, day of ,.r-�::—+•-__. _..r---- _ •�' 3L rra► erL ri ` 1 STATE OF WIS ONSI.V SS I ST. CROIX CO N'f Y personall f came before me this_,".fay of_ //,+_. / I the above narnwl Darrel E. Wert wad Beverly A. Wort, to no Anown to be the pereons who executed the foregoing In itrurnent and acknowledged the tame. Notary Pu Ile.-a' 1—d—, ./- , Wisconsin My commission expires lfl_�67 i A•lary R�.C,tsch, Votary Pub11c i _:CERTIFICATE F TOWN CLERK ' • i .STATL OF WISCONSIN) I SS'>:..fir•* - 1 ST: CROIX COUNTY I. Rica;tarn . being the duly appointed, qualified and acting Town Clerk of the y 'Town o.'frdson do hereh)r cser���iI that cop. of thla plat warn forwarded no required by a. 2fb,12 on th*%y day of 1984, and that within the 20•d3y lfrnit met Fy e. 236.12 (])in o obj..tlbna to the plat have boon filed) (alt JbJ,.c:Eon% t 'he Oat have boon mvr)• r l�7f �•..N ilyl Date itlt Horne, low G1erk eta NOIRES E. FI ISCH SURVEYING & MAPPING HUDSON, WISCONSIN THIS t►1STRWCNT CRAFTED at ir _N���•4i�.• ?. .. .lam r•�16,<.-f r�_'t + ' 4, , I, •I • H I z cn H 9 r STC - 105 r" 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d , 9 H OWNER BUYE ROUTE BOX NUMBER �� I /5n X Z 8 Z Fire Number C IT Y/ T A T E ?tt c/-SO s-1 Z I P PROPERTY LOCATION : 34, 14, Section T _N , R Town of /�c���p� 1 St . Croix County , Subdivision/��it uJ �s /a/dS, t t number Improper use and maintenance of your septic system could result rsin 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 . roix. 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 acce ted this program in August of 1980, with the requirement that owne s of all new systems agree to keep their systems properly main ained . The property owner agrees to submit to St . Croix County Zoning a cert fication form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fyin that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- 1/3 y) , the septic 'tank is less than roximate11130fdaysdpriordtocum. Certification form will be sent app y H three year expiration. E I/WE, the undersigned , have read the above requirements and agree x to Tnaintain the private sewage disposal system in accordance with ro the standards set forth, herein, as set by the Wisconsin Depart- 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 . r SIG Nz DATE -41 St . Croix County Zoning Office P . 0 Box 98- Ham ond , WI 54015 715 -796-2239 or 715-425-8363 Sig , date and return to above address . INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 ' Y a To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section most clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4- Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TALK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 5. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; B, Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; S. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If ti,e information (such as flood plain,elevation)does riot apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number 12, Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Sail Separates and Textures Other Symbols st - Slone (over 10") BR - Bedrock cob Cobble t3- 10"j SS - Sandstone gr .- Gravel {under 3") LS - Limestone "s - Sand HGW - High Groundwater cs - Coarse Sand Perc -- Percolation Rate reed s - Medium Sand W -- Vvr=ll Is .__ Fine Sand Bldg Building is - Loamy Sane( Greater Than sl -- Sandy Loam < - Less Than 1 - Loam: Bn - Brown "sii Silt Loarn BI - Black si - Silt IG2v Gra% c - Clay Loam Y Yell"ws sell - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles se Sandy Clay vv' v„ith Silty Clay fff ..-._ ferj, finer,faint Clay cc - common:coarse E - Peat matt - Many, [TWdiun) ri -- N'luck ' d - distinct p .— prominent H1VL - High water level, Six general soil textures swlace water for liquid waste disposal BM Bend, Mark VRP .__ Vert cal Reference Point TO THE OWNER; This so,F rest re part is ,-he first swp ill securinu a sa, nary permit. The county or the Department may request V.,, '; at .+:� ,of thi" s=aril test it) the; f.rsi(I prig :'o pf rrn,t. i,;ser_ncx�. A ,.omplete set of olans for the private i.l L7 t? sv� �„lE '1lea e f�'f3"�`iif ,3polical 4)n mils! hw c6abnnitt2d to he ,4,t'I lf�}Fi-7 cl tE' IOCaI £6i.�tFd C,E"i�`y in order t(7 oi3Ia i a r he aani a3 v Pernlil r j s. itr=oh, .E d 111d pr i«r to frtP start of airy C01',struction. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATION (H63.090)&Chapter 145.045) LOC U)I/ SEC ION: TOWNIP1� L// O.:BLK+�N( .: S�D VI�SAME: uJ'/a S '/a /tL COUNTY:O 1 OW ER'S BUYER'SiAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS:IPERCOLATION TESTS: Residence � �41ew ❑Replace. I '7—a S I�7 9,., v system � ~ P /t cl J /o RATING:S=Site suitable fors stem U=Site unsuitable for stem !tir" CONVENTIONAL: MO ND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) ®S ❑U S ❑U IS ❑U ❑S ZU ❑S CCU If Percolation Tests are IN OT required DESIGN RATE: 9 If any portion of the tested area is in the under s.H63.09(5)(b),indicate: iFloodplain,indicate Floodplain elevation: PROFI E DESCRIPTIONS BORING TOTALI DEPTH TO GROUNDWATER ING&&E CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTHyf. ELEqVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- / or rVr B- L r,8r r6� a� 7 B-3 1kof , _ ` d/WC— 3,y B S cs r B- d . J--'f ,01 9s s ,6 s c.s B-S 0 ' r 6 dA�Pi > go r �� f s4 r (0 is S B- PERCOLATION TESTS TEST DEPTH/ ATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER LAl4?Fli A TER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D PER INCH P_ / oZ L, P- Y._3' o 'Z L P- O ' //0 L P-_ I 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-,surfaoe elevation at all borings and the direction and percent of land slope. SYSTEM ELE ATION 9 ...... 6 I , , . I ` Ax -- I � N Na-► 1 _r s t t 3 0 ddls ----—-------- ------ r ( p 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: A,ymf l/r�l_'rj a h�hSP,ti - 17' d�I ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): t. 17� ercc -cJ�sr CST ATURE: DISTRIBUTION: Origina and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02 82) —OVER — No,-T (eT l;hL d z5a,m ' M k l� r dark Vi<-w �S a"4v-s g iat #Itl ` �Td. wn l �= �3 y•9 S t r � Q M i 5 'i•ha, VmFI' `(' l4e(i Z Q A ss rr ad 1V• = X00_`0' i �i4s� No�. 3�. C1 Bo �a.s � a.c� G,a�l � 24Xty' z�a"x so' ar c 5 C t sT '�ca'1�"o rn -- PV. = 4 f I&- A i 300 B iz '1ZadLvh'l CA- ANX wrt s . r B6 M � J ' 3 1 � t � y a I S`� d � T V yV 1 H - d t9� 9 V I I • d• s d N f � d ,,n a 1z d 01� V