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P 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: Trench:
Width: t Length: Number of Lines: _' '.C.Ll='_� Area Built:_
Fill depth to top of pipe: �
r
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).
SE AGE 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
absVNNG on sytems? (Check one).
HOL 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: /Z/c-z Wy-C)
Dated: Plumber on job:
License Number: /141
3/84:mj
Form - S T C - 104
a AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP � f,�).J SEC. N-R W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION %Z. A
LOT /4- LOT SIZE /01
PLAN VIEW
Distances and dimensions to meet requirements of II- HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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[c0 ,c, rc�I
ry`
d AclZe'
CO 4#611CF/(Ffj j l�
2
zvkgF�98j INDICATE NORTH ARROW
D�jrkf ,..�
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: ` Propose3 slope at site:
SEPTIC TANK: Manufacturer: Lj', 4 --, Liquid Capacitl: r
Number of rings used: f Tank manhole cover elevation: 9z
Tank Inlet Elevation: �G/ Tank Outlet Elevation:
Number of feet from nearest Road: Front 10 Side 0Rear, O Z/&"e) feet
From nearest property line Front 10 Side 10 Re ir,,o Z90 feet
Number of feet from: well eW building: %� f
(Include this information of the above plot plan) ( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
—r
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
%rjk`ABO#&,HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX 4969 BUREAU OF PLUMBING
MADISON,W 1 53707 State Plan I.D.Number.
SE�,NW�,S23,T29N-4, UCONVENTIONAL ❑ALTERNATIVE State Plan I.
Town of Hudson ❑Holding Tank ❑In-Ground Pressure ❑Mound
Highway US 12 :&0 / -
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Calvin Burton 314 Pleasant Street, Roberts, WI 540 3 1 7
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.P LEV.: CST REF,PT.ELEV..
Name of Plumber. MPlMPRSW No.: County: Sanitary Permit Number.
Lyle J. Myers 6219 St. Croix
SEPTIC TANK/HOLDING TANK:
MANUFACTURER ACTURER. LIO D CAPACIT V: TANK INLET ELEV.. TAffi K OUTLET ELEV.'. WARNING LABEL LOCKING COVER
qq �j Q a -✓ PROVIDED. PROVIDED.
t > f •}' f t ! vF �,, ❑YES ONO —]YES ONO
BEDDING VENT DIA.. VENT MATL 1",E]YES GH WATER NUMBER OF RO D' PROP TV WELL. BUILDING. VENT TO FRESH
AIR INLET
ALARM FEET FROM („(� LI
DYES ONO O NEAREST U/V v
DOSING CHAMBER:
MANUFACTURER BEDDING'. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL IL OCKING COVER
PROVIDED: PROVIDED:
DYES ONO ❑YES ❑NO ❑YES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. U tBR PROPERTY WELL BUILDING VENT TO FRESH
LINE AIR INLET
(DIFFERENCE BETWEEN F PUMP ON AND OFF) ❑YES ❑NO N A
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH LENGTH NO.OF DISTR.PIPE SPACING. . COVER IN.;IUE CIA -PITS LIQUID
BED/TRENCH / THENC S MATERIAL: PIT DEPTH L�ro DIMENSIONS
GRAVEL DEPTH F I L L DEPTH DISTR.PIPF DISTR.PIPE DISTR.PIPE MAT ERIAL. NO.DISTR NUMBER OF PROPERTY WELL. BUILDING VENT TOFRESH
BELOW PIPES/ AB E COVER. ELEV.INLET E EV END° PIPES FEET FROM LINE�00 ��v / JA IR( (LET
i� 1 NEAREST--► Vti/ V Ld I
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
DYES ❑NO
SOIL COVER ITEXTURE PERMANENT MARKERS OBSEHVATION WELLS
1:1 YES ❑NO ❑YES NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES.
OYES El NO ❑ 11 NO ❑YES NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO.OF LATERAL SPACING JGRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MAHKING
ELEV.. ELEV.. DIA.. ELEV.. PIPES DIA.'.
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS LIFT CORRESPONDS TO APPROVED
OYES 1:1 NO DYES ❑No
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILOI NG
FEET FROM LINE:
f, C/ ❑YES 1:1 NO DYES ❑NO NEAREST
�/�
0
2 H-T
Sketch System on ty file for audit.
Reverse Side.
SIG TI LE. Zoning Administrator
DILHR SBD 6710 IR.01/82)
INFORMATION & INSTRUCTIONS FOR,COMPLETING A SANITARY PERMIT
APPLICATION
t
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 (riumber 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 ligensed
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 owners 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 ct9r
included the creation of surcharges (fees) for a number of regulated practices which Wisco tC1tS
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure.. 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 COUNTYY C
j DILHR In accord with ILHR 83.05,Wis.Adm.Code
STATE SANITARY PERMIT#
—Attach complete plans(to the county c0 PY only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8%x 11 inches in size.
—See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION—PLE SE PRINT ALL INFORf4A TION. FOR VARIANCE ❑YES 2"Sd NO
PROPERTY OWNER (,� e"7—L PROPERTY LOCATION
& '/4/(f d 114, S,Z3 T.2 N, R � E (or
PROPER�1'OWNER' M_ LING ADDRESS S— S� LOT NU ER BLOC MBER SUBDIVISI7/1 CITY,,STAT /!'J`/--c',,^rj'ZIP CODE PHONE NUMBER CITY ✓/`'r/f fl NEAREST D,LA OR LANDMARK
�S 7� j�
VILLAGE:TOWN OF*
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family 3 ,E3c�DlLb�J sDR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a. XNew b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑.Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4..❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2)
1. a.>�Conventional b. ❑Alternative C. ❑ Experimental
2. a. ❑System- b. ❑ Holding C.❑ Pit Privy d. ❑ Vault Privy e.❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMAT ON: (Check one)
1. a. El 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( are Fe PROPOSED(Square Feet):
� Pe Feet Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in oallons Total #of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holding Tank " Ow 1� �-T— ❑
Lift Pump Tank/Siphon Chamber Cam 7 ❑ ❑ ❑
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 Signatu e:(No Stamps) MP PRSW No.: Business Phone Number:
Plu er's Address(Street,City,State,Zip Co _ Name of Design : r
VIII. SOIL TEST INFORMATION
Certifie oil Tester(CST)Name CST#
CST's ADDRESS(Street,Cit ,State,Zip Code) Phone Number:
z a el f �y 3 i-a
IX. COUNTY/DEPARTME USE ONLY
❑ Disapproved S nitary Permit Fee Groundwater ate Issuin Agent Signature(No Stamps)
Approved ❑ Owner Given Initial '(�0 Sgrcharge,Fee /U/d,3-6/
Adverse Determination 1 7J11��V�cc
X. COMMENTS/REASONS FOR DISAPPROVAL:
SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
I
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
Owner of Property Cj 40
Location of Property Sb�, Section T—aLN-RLF— W
Township (A }�
Nailing Address
Address of Site
Subdivision Name
. Lot number
Previous Owner of Property L.eAvi I
Total Size of Parcel in sae_
Data Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? / Yes No
Volume _3 and Page Number `6) 22 as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, Would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
i (toe) eeAti6y that a-ft bta.tementts on thin okm ake tAue to the best 06 my (ouA)
hncwtedge; .that i (we) am (aAe) .the owneA(b) 06 the phopeAty descAi,bed in .th,ie
.in6olma-ti.on 6onm, by viktue o6 a waAhanty deed seconded in the 066ice 06 the
Colony Registers o6 Deeds ah Document No. and that I (we) p4uen.tty
aun •the Oopoaed bite bon the sewage di,6 h yew (on 1 (we) have obtained an
ea6 ement O
t nun with the above deheh,i.bed n.o ehti on
system, p p 1, 6 the eon,b.tJ�ucti.on o said
y .tun, and .the tame has been duty Aecohded Xn the 066.tee o6 the County Reg•i,a.teh o6
Veede, ae VocAmen t No. —
SIGNATURE 01? OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
1 D L� S-1 .
DAIS SIGNED DATE SIGNED
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an oic fly- aw"st 27. 1997, the entire bala tc% �
r = - of *17,6@0.00 shall be due and capable.
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irltlw�iM�t;M beksae abail be MW is fan on or
4itia�i PIMrR boomot`sMO awnw at do rou of... L-.% per aaw�a tM gNbre `n
x ' iMisil� lfafirWiwl�ddhWawt istarmlt and. a}as aoedormin sr Mbwft. M*
pri■r ••1iu ttttiw a lbrri aara b Fs*ebb to vsbr am...ft w!lirist ;.
ib1 %a�si/asr rsitr.ilw and e i basnrass Pmeim n win.has.To ty s w brae '
-g_ aA s affNr 9"'Mm ae 0 1 wbw a... Such aanaab romi"d by dw Vor�sr�e
{ + ff 006Ar is%M serew fmd or trerbe mmoo. but sb�il seE.
dWR AL AM sm Is IMMA M an=PON wdmw at ow tale ar dmW
aft nay fine
wtaRa e�.'Mb�wfASt NsY IM be erosta/ r Y itfidt witb rei"rt M
lMI M%W is s`& ease aeer"W iass ma frm`wmm* ! i1r
s �r isioif�km Ws m bf►ae be" b" *a ai ruby
4; .
M show
ar oniMa�sirt a lrrialn goeMs oaiaw M eeaatiaa�i/'ia wth�e n�m. K arealt of as �,
efwrar
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irullNwe a4�11 pp tM;awed»~ R1 _
A.M i�ae a /� IWtestt dad. V�Mr
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vendor.
ParMNarer �'
Py rrA W
# Ul�trrilla rai~4iR. '� �pt, oi�w�
«et't �eeira r����ar niMwa d the)?t�elif t � e n
;Dail�t�r wtle4s to`M awnsitssd on the r Mr" ►
MrW
-
f•eesspbAM�a Yew =�Scooting the PtaWsty
MOW hs arlM tY pried with interest nerd ethar now*awn
dA M tlr eat r m above • WadMr writ!M ,
.; Iw itipharte•• Atlidr 1Mt� d tM Property, frm and dear of all Baas
W► esaaNd b of Parobaseq except:
41r rR oe~halt ... .. ...»...
11�1tt oC
an
Vetarwn..tt!!t thee•-ar•e•riot..?�e4s..ct,an.. R.. � .: l�k �t9»�n .. eQ.A�.A ... .., .,..,.
encroachnent...:... ............................. ............. ......_.........-....-..•... .............�.:.,... .W
recd r*WSW tW per is of%f waded Mai (a) is the e�ad a dsf nk in tM Men*�1 ai4.
due deft or (b) in tea M�ent of tt
� bwleaert'trWeh aeatia�sas for a pored of .�Q».dsya idbw Mt the apoeifiM
Avasten at N'IWWElnr were continues tbe'a led of...��. t
Vawaet +s aw p liy+r atetiliai Maill.liwa antlna aiiMEba at>aaw x
ohm bdoww dw +od l��at Vaador'e option and.without notice �wbidi Pltlait#WNbe
endives).anti Ywddr MfijM elan sawn tea telYwiaR rights and remodia (subject to asy lileita�tiMUS`pusr►ldid�
*Adimsib to;Mlle d b how er M OVA*: (iy Vendor may, at his opp terminate th4 Ceatsaet.aaN
tltll/.a1d to do P Psurgrr y and r eeover the Property back throng
stsfet ddraeiowrw Mriw'
trrdteo a M cepditioaed 's full payment of.the entire owistandi bdiaeer write
the data at ddf�nit at the rate otfect ea such dateaadotheramonatedus>tareuader(iawMieMawnti�aasotgt{i
psi ip llpeVsse dwN be terafeitad as ligpidated damaues for failure to fulfill iMis Contract'
swd r
Hdpss$ K 7se�sses faits to redao)), or (ti) Vendor mw sue for speeitwe porto[afatlN of tl►is �r r
Yd fop payment of the satin Outstanding balance, with interest thereon at the rats its aR
Iai
other epaogats due hereunder,is which event the property shall be aectienad at MIND A" �
Nebid aq aefirl..dy•a< liii) Nemeses oWr sue at law for the rated onpaid par too dtt
thenofxar (tr) ender may;;I re this'CoatrWt at an end and remove *hie Canteadasaeleed laE A ,
action it tie Wpiteile interest of Purchaser is insignificant; and (w) Vendor May have Pwdlasar
of the peeparty and have a neeinrer a fed to Collect any rents. issues or nits darilt liea�aaM14)ir:
Under i) % Iv abon.N�ng.any oral or written stateme I to or aetialtib V Art
shall only be bindHsg upon Vendor if and when pursued in
tad of Vendor incurred to enforce any. remedy betwtader f
bey dad expenses of title evidence shall be added to priaeipel and pars
J, szkot net prohibited farad.and "I be inch"in any Judgment.
N)pea rite eomwnnesmmt er darie�W PNdoaey of anY action of loreelosnn of tWs
M tM ypotwtmMt-of a roeeirer of the Property. iaeiudin homestead interest,to collect tie riots.:
!hd dn:ia�tM pMaraeneq a! each action.and such rents.issues,and profits wrhen r"eDNsetdi „ }
applied ins the court shall direct.
a Purchaser sball.not Xrender, sell Or convey any legal or uyaitab►e interest in the Property (by
' et)Pruners sights under this Contract'or by option,lone-t-rml lease or-in snq other way) writhart
oeaeult of V unless either the outstanding balance payable under this Contract i. fisat paid M
;asrvW"is a p ga er assignment of Purchaser's interest under this Contract solely as adeurllp teE?
.lea the*rent of ear such trader:sak convey ante without Vendor's writga aonslpt.tIM
Rio adder Min Cootraet shall,become immediately due and payable to Lull,d V # f;
VeMor SWM make all pay�+ts when due under an. most ontatanding agd�teflw�
gaffe
Min Contract (except for any mortgage graMed bq Purchaser) or under any note Meenrod •
atM�ila tilsei�page eat of the among a then due under this Contract. f'uxhaser meY nnaka q
Cot ,if Vendor fails to do -) and all pad meats so made hy Purchaser shall ht pt41�t1
g
wtthont waiving day other subiequeat or prier daft vi
V+ISldw Mw. weive as►y defeat y��,
AV a�,mid @halt,ha biadin capon end inure to tl•a beaM>fts,of ft a#Y ?
l�wA oerierioe h e ad rigits ot an owner of the A%r tom M tlid dls1 i
�— !a the snbjed PenperEy
{ nlde Ns Mredl
May
' Dlod b .....
ea
da►y of
nk, "of St. Paul, b -
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Calvin
i >�Iit+cur t�awl i 9sc1 bef0ft_ar
r>. ipl ill r DA.P. of t+'ec* al
'ale 1M'1ftstxlein. . s
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=#MH�lf��MIME: t2!� NOitYO,
=, fnily described` os follows:
at the Mast 1/4 corner of Sec. 23, ?29•� 4
W-U $709 asap the Newt, line of the sM 1/4' of t1m =9 �.
` ;1 'l.95 fit to tha;Macth+rest oornrr of said m lji a!
q""2#'St"s aloe' the North line of said SO 1/4
h distaff of 1052.33 feet to a point on the jkmt line Ot
,Suswey recorded An Vol. 3 of C.S.M., page 6223' thence tl•32�
tit Meat 1100 got said;Certified Ivey a -distaste of 1 d4#sh
on the* centerline of O.S.H. 012'0= these:* SOVS4
t tlin�e_ * distances of 6N.90 feet; thence U10329 3SOR along
line of said
Certified S a.
} urveg a distance of 14.?4 feat to a
. North line of the SE 1/4 of the MN 1/4 of said Seetiae 23;
. 9"IV5a''1t aleng` said lines distance of 262.51 feet tb the:
ZMHtMC= ��
continuing Sa9'28'5S'0E along said lie a distaMrt of
**Aho Mortbeast eoemer of said St 1/4 of the Me 1/48
oo Sp'O,f►'Ot'M along .the Halt line of said Sd 1/4 of
ifatanc+� of 3312.7y 'fit to the meter of said See. 231
, •i.Y--
„009'42034OW along the South ling of said St _1/4 oC Ab
e . +dfatime o ilS*30_feet;
"*of*Oft ft'1#1!6.$a feet to the Point of Hegimtiag
it._aoces =snbt to 4,4t.H. 'I2• right-af�wt
lip
f2' aet.
for-,"I `eeasessest#s, sight-of-gays a" oo�twe3asea�t _
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STC - 105 a
H
SEPTIC TANK MAINTENANCE AGREEMENT Ho
St . Croix County z
d
a
OWNER/BUYER
ROUTE/BOX MBER��� ��s�(f��,J1`, Fire Number
CITY/STAT ZIP
PROPERTY LOCATION : .5E k, No -14, Section-c,-),3 , T �cf N , R_ZF W,
Town of , St . Croix County ,
Subdivision , Lot number�6_.
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes . Proper maintenance con-
sists of pumping out the septic tank every three years or sooner ,
if needed , by a licensed septic tank pumper . What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St . Croix . County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1 , 1978 . St . Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained .
The property owner agrees to submit to St . Croix County Zoning a
certification form, signed by the owner and by a master plumber ,
journeyman plumber , restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary) , the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. H
0
E
I/WE, the undersigned , have read the above requirements and agree
to maintain the private sewage disposal system in accordance with H
the standards set forth , herein , as set by the Wisconsin Depart- ro
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County Zoning Office within 30 days
of the three year expiration date . -
SIGNED
DATE
St . Croix County Zoning Office
P. O. Box 9S-
Hammond , WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address .
5, 4tz Aj aj 2-317--Zl Allefe /9 LXJ
pi
oa
Ivi
_
NbS
b,EPARTMEN OF
REPORT ON SOIL BORINGS AND SAFETY& B DIIV�ISION
P\IDUSTRY, P.O. BOX 7969
LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707
i1-�UMAN RELATIONS
-4 (ILHR 83.0911) & Chapter 145)
LOCATION: SECTION: TQW SHIP/MUN CIPALITY: LOT NRR.:BLK.NRR.: SUBD V S ON NAME:
S �/a �/ /T q N/R I RE (or W K I�
UNTY: OW R' BUYER'S NAME MAILING ADDRESS:
1(`1 DATES OBSERVATIONS MADE
USE T TESTS:
R C OM ER IA DESCR _I N: PRO I CR PT ONS: ER O
,,��,,//'� N .BED MS O 7
NResidence ? New ❑Replace
RATING:S=Site suitable for system U=Site unsuitable for system
CONV ATIO❑NAL: MOU �: IN-GR�OUNDPRES�dRE:MIS TEM-IN-FILLHOLption
U U SS ((E ��uu'' (tRU
DESIGN RATE:
If Percolation Test s are NOT required I If any portion of the tested area is in the
under s.ILHR 83.09(5)(b),indicate: Il Floodplain indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. I(jHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B, a 5�' > '7 " t a i Bjz 0 a vv , s I-
B:3 r1 >9a s 19 An vned<. ��a rr
0
B(� oZ oy �"l o� DKfans�. Q �,S 1 6.1 s 3 �. c r
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAPER INCH MINUTES
'{ NUMBER INCHES AFTER SWELLING INTERVAL-MIN. p D t PE 10 2 P
P 6) t
J P- 30 v
P-_3
P-
P
P-
' ,PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
kontal 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.
3
SYSTEM ELEVATION g
ELEVATION_ _ 'M ri ._JA-
_
i
/P _
�l --- �_ j--�
I _
.I
1315 g-
� 1315
i
6 .
3 W
:
131 4
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 Wisco in
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 MPL ED ON:
or ct .5 Y /�'7
' ADDRESS: CERTIFI ATI N NUMBER: PHONE NUMBER(optional):
CSTVrAT E:
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) —OVER —
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.1 CONIQUa o..a�
429911 ' w
CERTIFIED SURVEY MAP
LOCATED IN THE SEI/4 OF THE NWI/4 OF SECTION 239 T29N , R19W,
TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. OWNED BY:
^ NOTE: FOR MORTGAGE PURPOSES ONLY—
Y , Burton
THIS SURVEY IS FOR MORTGAGE CCalvin PURPOSES ONLY. ANY SALE OR NI/4 CORNER OF SEC. Rte 1
SUBDIVISION OF THESE LOTS MUST 23, T29N, R19W. 3-
FIRST COMPLY WITH ST. CROIX CO. (MONUMENT FOUND). ti Roberts, WI 54023
SUBDIVISION ORDINANCES.
N
NORTH LINE OF THE SE1 14-NWI/ O:M NE CORNER OF THE SEI/4-NWI/4.
O:
tip-.-H H. me -—
_ _ q _ 589.54' 15"E _686.30' — _ - - - __
O 619.30'
• 66.00' r1p. I7'
° _
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n � z
w v
66' WIDE EASEMENT (DDl In
1 6 6' Z d W m
O I 1 � Wa<
b ~ zxJ �
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IL M
Q Ip O z00:O F.O
N b LOT I �D z O2 pW
ED c NWI- Wa
J a I3 10.00 ACRES .r ''� mx°z z�
a a (435.592 SQ. FT.) m a y~o K W
4 Im 8.42 AC. TO R.O.W. a Z
O (366,988 SQ. FT.L S�/S!► ' O W<o kJ
. a O
J I D ~ • J ;)— ILI
"-1 Q: N ~ co). OOd it
'D 66' I N Q. - xLLC ay
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M I M 2• z z�-0 as
s ...1• 66.00' ? Q� ID (0WO air
• JJ' 0 1f
61 9.3 2' Z O x:) y)�
3 N89.28' 58"W 685.32' 0 1..z a (no
IA a0W
N
W �• W 0• Z 20p H
a W • CA W
z �...• /' a 1•'• m n a z
Z. 'O . 1- t
�• LL. .a y W
W Q . X
O ►- a J 1-
a a Q• )- WWa
a a . OD Go O a• } >.O O
N d Z. O O x Z. W
x F • Ip h iO >
Wax
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W E p cD )m
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'A m0
° O LOT 2
W
O O
10.68 ACRES I to. rn ►- �� S
e (465,390 SQ. FT.) • -�
O • z
APPROVED SCALE 1" = 200'
SEP 04 1987 0' 100' 200' 400'
ST. CROIX COUNTY
COMPREHENSIVE PARES PLiNN(NO
AND ZONING COWWW99, 4
N89° 8' 34"W 685.30'
�'EAST-WEST QUARTER SECTION LINE.
`��l1lI�N0�l�N', 2 5'±
O� 1/4 SEC-
lee
Ala_ i�nee TION LINE
'ie UNPLATTEO LANDS co
JAMESM. . . . . . ... . . . . . . . . . . . N
dV WEBER s I" �..
�i S- 1604 1"I.P. FOUND
C� SPRING VALLEY
w1s. SI/4 CORNER OF SEC.
Op��II® UVol���� MONUMENT FOUND).
iooilottt SHEET I OF 2 .
moo...._r.•..`�.;'--`=—
JAMES M. WEBER S-1804
WEGERER, WEBER AND ASSOC.
271 DATED 3*_Z 'N I �gQI
•;,� THIS INSTRUMENT DRAFTED BYC7►1�
VOLUME 7 PAGE 1878