Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
020-1166-40-300 (2)
Wisconsin Department of Commerce Safety and Building Division (ATTACH TO PERMIT) Personal information you provide may bi: used for secondary purposes [Privacy Law, s.15.04 (t)(m)]. Permit Holder's Name: City Village Township Hen ,James Hudson Townshi CST BM Elev: '~ ~ ~ Insap. BQM Eglev: l i ` 1 ~ BM D cr/i~tio :: (~ ,~•~ l ' l~'~'l '~ TYPE MANUFACTURER CAPACITY Septic ~ /, ' [~ ,~,,,, ~(,(~ x-(00 Aeration Holding TANK TO , - ~/L W~S~ WELL ~+ BLDG. Vent to Air Intake ROAD Septic ` ~ ~ J ! t ~ I ( sin S , ~~ ~ ~-~y s~V ( n ~''O/ "_ 0 ! . ~~ Aeration Holdin g r Manufacturer Demand Model Numb --. / TDH Lift Loss System Head TDH F Forcem Length Dia. is . e a g ~ ~ + Length ~ ( No. Of Trenches 3 g'-.S y TEM TO P/L BLDG WI Of System: ~ /1 ~~~- {~ n-~1;. County: St. CroiX Sanitary Permit No: 430180 0 State Plan ID No: Parcel Tax No: 020-1166-40-300 Section/Town/Range/Map No: 17.29.19. P1027 STATION BS FS ELEV. Benchmark ~ D ~j Alt. BM f BI ~u er ~f!~ ~ ~C 7.~7i ~ - J t Inlet ~.~ ~ya~ S Ht Outlet g•27 ~3- ~ Dt Inlet J Dt Bottom ~ Header/Man. .~~ ~~, ~~ Dist. Pipe O 6~1 8~~~ c~3 3~' Bot. System .~ ~ a. ~ Final Grade ~X ~ i- T f ~ G l ~~ ~ ~.~ st c~~ v~, ( 3ZJ f ~/ l a C~~'~f~~/~t ' ~ h~~ / INo. Of Pits Inside Dia. a 1' ~ 'J ~fd Hea anifold Length Dia Distribution Pipe(s) I ~ 1 ~~ ~ ~ Length Dia pacm x Hole Size ~.._ x Hole Spacing ~- Vent to Air Intake ~ ~ ~~ ~ Depth Over r ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ,~ Bed/Trench Ed es g To soil p ~ Yes ~ ; No ~i Yes No (Include code discrepencies, persons present, etc.) Inspection #1: / ~ Inspection #2: / / 451 Brookes-oo~d Dpr udson, V`JI 54 16 (NW 1/4 SE 1//4~17~T~29N _R-19nW)- Park View Es ates ddn. VI Lot 110 - )' / _17.I29.19.P1027 1.) Alt BM Description = t v t ~ ~~~~~ CJj 0 ~ 5t7"C..l'/~ / ~~G~'~ ~'~T11-~ ! a~~ 2.) Bldg sewer length = ~ h~~,~ /,hey ~G(.~ S-~]1l ~~~-~ 3tp J~ "°"~w~~^~-• - amount of cover = "~' ~-I' ~e~~U' Use otherls de for additional Information. No ~_~ ~ ~_-- _ ~ _ _ - ---~ Y1L~ ~ ~ ~ '1-~~__ SBD-6710 (R.3/97) Date Insepcto Signature Cert. No. Sanitary Permit Application Safety & Buildings Division 201 W. Washington Ave. ~p Po B `~seonsin In accord with Comm 83.21, Wis. Adm. Code ox 7302 Madison, WI 53707-7302 Department of commerce. Personal information you provide may be used for secondary purposes (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)J state owned. Attach com late tans to the count co onl for the s stem on a er not less than 8-I/2 x 1 I inches in size. County n (~ ^ State Sanitary P~rrnit Number ^ Chec evision to previous application State Plan I. D. Number O I. A Iication Information -Please Print all Information Location: Property Owner Name ~ ~ ~ `Properly Location r a Q `-" m F ~'(7, ~ IV~I/4S ~1/4,S I T~ T,N R) lE or W Property Owner's Mail~Addre Q~~ Lot Number Block Number i ~~ r ~ ~~, ~; ~~~ City, S to ~ Zip Code Phone ~~ F/~,f, ~ Subdivision Name w CSM Number , ~~ ` f II Type of Building: (check one) 1 or 2 Family Dwelling - No. of Bedrooms: ~ ^ City ^ village _ Public/Commercial (describe use): ~~° "j"'~ / O State-owned , I~P~CGl.S` III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest R d t ~ V tZUV ~"~ A) 1. ^ New System 2. Replacement 3. ^ Replacement of 4. ^ Addition to _ Parcel Tax Number(s) S tam Tank Onl Existin S stem _ t~ - / - ~ ~ Qa B) D A Sanit Permit was reviousl issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply) '~INon-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank D Single Pass ^ Drip Line ^ At-grade 2 tx ~ 1 Aerobic'freatment it ^ Re irculating Ot r: - ~ Z8 S --' V Dis ersaUTrea ment Area Information: - ~ C , I. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application S. Percolation Rete 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min.linch) EI ation VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing ~K~'3'~''^°j l~O}' crate structed T ks Tanks (.~E~E{c- ~1---- ^ ^ ^ D C.~~ U~ D ^ D ^ ^ VII Responsibility Statement. 1 the undersi ned assume res onsibilit for installation of the POWTS shown on the attached laps. Plumber's Name riot) ~~~ ' Plumber's Si Wpe(no eta ): ~ ~ MP/NtPRS No. Business Phone Number ' e a ~ t b~ ~~~ 9~ i~ -~ ~ Plumber's Ad dress (Street, City, State, Zip Code) /y ~ /~ / L~f ~ ` VIII County/Depart nt Use Only ,Approved ^ Disapproved ^ Owner Given Initial Adverse Sanitary Permit Fee (Includes Groundwater Surcharge Fee) ~ _ Date Issued I uin gegR Sig~rature o stamps) . Determination 2~~ Z~ ~IR. Conditions of Approval /Reasons for Disapproval; ' ~ l~ ~ C'~~ ~~ (r^ I _' . (~ ~ f JlU .~" ~ r/ ~J a/kl _5 ~ ~ cl ~. uJ ~ nc(e rs~ . .,~~.:f _._ ._.__.........___....._ - -- - .l~1. .~. _..... _.._..-- ----- ~a.._..~Gei~.r. _...__.._...._. _.. _. _. /.II~N~I-" ... _ :'m. _. ~uu.m~.es lea': . _.y._._-~--~---......--~-- -- ..._ .t~~ ._ .. _____....,.... _ ~ ~ ~ 7~ _ ~~ .. (,5' t33 y~ ~Xi S~IN4 ~rilt~sy)~t~ ~ ~ .5u - ~u11 ~4Nyo~uc ~ xv ,~~ w~oy~~ ~~ a~ ~ ~~~ T Q IZr nr~ 3s~ a -T~N~~S 3x 87-Sa a' i t~ ~~- ' ~ 7 ~o Prec~Ur~ -~ ....~ }{Ur~,e, ~/ p d~w~ ~l~l ~ .~.~_c A1fi Q.i~nwX~~.~_ o~ o~ -~r S~'~oY~+(~'! SIbINy CI-ed= Joo.~ .. , , . ~' t~ ~ . . ~ / /~ ~'lv t / ~/ ~ ~ u~kL _S ~ ~ cl e. cc)~ ncl e. rs . ~L'L'.~ _.___.---. --. _...___.-_..-- - -~l .~. _..... _.._..-- _.___ - . ~n._..~~e~a.r. Iy/j(-- -- --..._. -_ . _.. _. _._ %l~~%N!'L-" .._. _ :'m. _ ~~u.m~~ der.''. . ~ ` ~ • (,S' ~' `XI S~INh f~ ,~ ~ ~ ~~J>~ tin., -5~ - a' C3u11 (~uN~~~~t n £~v~`~HS -o~oy~) ~+~ y ~o~ ~{~r~~e 3x87sa pddiw~ Ala) a .~~i(. Al ~' Q, MpwX Ivp o~ r~A~ok ci.(~; 9.93 B~'~OYhG'{ ~Ip1Nt~ CI-ed= loo•~ l ~Q ,~-iao Wisconsin Department of Commerce Division of Safety and Building SOIL EVALUATION REPORT in accordance with Comm 85. Wis. Adm. Code County Attach complete site plan on paper not less than 8'/ x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and D Parcel I percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . . 020-1166-40-300 Please print all information. 04 (1) (m)) CPrivac Law s 15 be u ed fdr ui P l i f ti id a os R v' By Date I ~ ~ (2 . y , . . p ersona n orma on you prov e ay @~. s Y p p 3 "ii Properly Owner Property Location Jim & Barb Henry Govt. Lot NW 1/4 SE 1/4 S 17 T 29 N R 19 W Property Owner's Mailing Address ~ Lot # Block # Subd. Name or CSM# 451 Brookwood Drive ~ 110 Parkview Estates 4Th Addition City ,State dip Code ' Phone Number ~ ~ City JJ ~Ilage t~ Town Nearest Road Hudson ~~-V~VI` "`541?'Iti ~~~e • .71.5.-~86-1 20 Hudson Brookwoood Drive \~ ~{ New Construction 0~: ~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD /_] Replacement Public or cemmercial -Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install 2 trenches at elev. = 93.00' using 28 l eaching chambers. Each trench to be 3' x 87.50' using 14 chambers per trench. Boring # J Boring ' 121 ° ~++" Pit Ground Surface elev. 98.27 ft. Depth to in. limiting factor Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 1 0-12 10y2/1 noone sit 2fcr mvfr as 2f 0.5 0.8 2 12-22 10yr4l4 none sl 2msbk mvfr cs - 0.5 0.9 3 22-27 7.5yr4/6 none gr Is 0 sg ml gs - 0.7 1.2 4 27-53 10yr5/6 none gr s 0 sg ml aw - 0.7 1.2 5 53-121 10yr6/4 none s 0 sg ml - - 0.7 1.2 ~ R3 •o / ~ ~3 L[ ( ~,p, 21.~ H #3 contains approx. 15% gr., #4 Mains approx. 10% gr. -~7 "r 1. I __ Boring # ~ Boring 1~ Pit Ground Surface elev. 97.88 ft. Depth to limiting factor >118" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-19 10yr2/1 noone sit 2fcr mvfr as 2f 0.5 0.8 2 19-33 10yr4/4 none sl 2msbk mvfr cs - 0.5 0.9 3 33-40 7.5yr4/6 none gr Is 0 sg ml gs - 0.7 1.2 4 40-58 10yr5/6 none gr s 0 sg ml aw - 0.7 1.2 5 58-118 10yr6/4 none s 0 sg ml - - 0.7 1.2 • q'f 5 ~ Hen his~prox. 10% gr., #4 contains approx. 10% gr. * Effluent #1 = BOD y> 30 < 220 mg/L and T >30 < 150 mg/ ffl nt #2 = BOD <30 mg/L and TSS <30 mglL CST Name (Please Print) S ature: CST Number James K. Thompson Z- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceola. WI 54020 6252003 715-248-7767 1 Page 1 of ' D A.C.E. Soil & Site Eval ns Properly Owner ]im & Barb Henry Parcel ID # 020-11660-300 Page 2 of 3 Boring #~I Boring , /j Pit ' Ground Surtace elev. 97.63 ft. Depth to limiting factor > 119" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-16 10yt2/1 noone sil 2fcr mvfr as 2f 0.5 0.8 2 16-27 10yr4/4 none sl 2msbk mvfr cs - 0.5 0.9 3 27-34 7.5yr4/6 none gr Is 0 sg ml gs - 0.7 1.2 4 34-80 10yr5/6 none gr s 0 sg ml aw - 0.7 1.2 5 80-119 1 0yr6/4 none s 0 sg ml - - 0.7 1.2 p l~~ . J/ H #3 contains approx. 15% gr., #4 contains approx. 10% gr. 55-~0/q l • S(o ^ Boring # ~ Boring Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring # .~ Boring Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mglL * Effluent #2 = BODS < 30 mglL and TSS < 30 mglL The Deparhnent of Commerce is an equal opportunity service provider and employer. ff you need assistance to access services or nced material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. ~~oo~W~ .~r~v2 e 3 c3. M 8~ S,a[,- wed f{ SS tt.~'+1ec~ a l~ ~O~D.fl'J' fS nt /~ 1 ~ ~ 10 • 5 7- __ _ _ E)ri~~i~g ~ 6 edffxkn ~ ~ Ga.ra9rr , . . , e 3~dsnct ~ , hd/e L'v~K+'. ¢~: = 98.9.3' +----^ d ~c- ~-~ ~ d ccK ?~ ' eX; Ski ~, ctA~cfo R --~ p„~ C.o~crs S,i: , 4i L'(eJ: a~ oc~ItL~ -'~ ~9~9T=G~a6 99 m e~ ~~ 9 . Sy sty.„ ~ eH ~,~~ ~ 93.x. m 1D~ ~ .~ ~~ ~~',~ ~ L ~~ ,~ a~ n ~' ~`, ~- a~~ ~ ~ i J ~ ~ 43 v N ~~ ~ So,! ~lcca-~i'on P,•t Scale : / " ~'O' i ~ 11o ct~p~e.c.;able Slope -t~.rok.~ 1~ `,~, s-ta.,, A*ea. P~. 3 ~'.3 ~ .. Private Onsite. Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number o D Number of Bedrooms Desi n Flow -Peak (gpd) O Estimated Flow -Average (gpd) Septic Tank Capacity ( al) ~ to Soli Absorption .Component Size (ftZ) 8 7 (~ Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Com onent Desi n Flow -Peak (gpd) 7_.,lp ~ (.7 Maximum Influent Particle Size (in) ' i3 1/8 - Maximum BODE (m /L) p 220 Maximum TSS (mg/L) ~ 150 Table 3: Maintenance Schedule Septic Tank inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once eve 3 ears Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the s ~ Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. j Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason wfthout being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absoration Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by ail occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component, should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ~ ~ Management Plan fora Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office 386-4680 Boumeester & Sons Excavating 386-9020 BOUMEESTER EXC 7153779620 07!14!03 09:40am P. 001 S'I' CItUIX GUt1N'1'X Sl3i''i'lC "TANK MAIN'1'GNANCf~ A(;1t131?MIsN'1' ANU OWNG~ItSllll' C;f3RTIIaCA'I'lON 1~ORM Owner/Buyer . 1. F-7 M ~ ~ _ ~ __(3~f~~d~l~t-r G~V ' - - -- - --- -- --~-=---_t~~-_-___ Mtuling Address 5 / _~~~ rites ~C~f7___ ~7~---`__ Property Address ~~ f C~ ~ w fl p~ .~ (Verification required from Planning Ucpartrneni firr new construction) cityistate - .~ v r~~ory~wt ~ --~ ,~._ i steel ldenlificalinn Number - // ~ _ ~ - 3 -~ - _ Property L.ocalion ~~ %,- %,, Scc. _ , '1'_.._._N-It W, 'town of 3ubdiviaiorr ~~~ .~_-~~' ~~-~-r- ~- CertiOed Survey Map # ~^~-_ ~-- ~' Voluutc ~~_.~____..,, Page # .1 Warrs,oty Deed # /2S~a ,Volume ~-l~ ,Page # ~g~ ~ y~~ °O Lot lines idetttifiabie yes ^ aio IsOPr~ ~° wd msh>tenanceof your septic system could result in lie premature failure to Irandte waslee. Proper snvuatewaee eoasisEs of ~~ oat ~ ~ tank every three ycan or sooner, if needed by a ticeased pumper. What you put into the systeos G1° afrecl ~ ~Me o[ the septic tank ar a tresdnent sUge io We waste disposal system, T~ icy owner agret:s to sabrxtit to SI. Croiz Zoning pepanmonl a certification form, signed by tho owner sort! by <t ~~1a~~i~l, rostrictodplwnberor a licensed ~ ~ P~ epetxtttag eoadlNoa tttrdlor 2 ~~~.,.,.~ i~"t~ verifying that (1) the oa-site wtutewuterdirpopl aya1~ ()i ~ loq~ectiop and ptuuping (lf necessary), the septie tank h lap Wsa U3,iA~1 pr ~, I/we~ the ymdersigned have road the abav ~~ ~swd agreo la twin4in qte private sewage dlsposai ~ ~~~~ ~ ~ hesela, as ttet by the Department sn41~1+~! . stttodssds ~~ q~ y~ sritem ~ been ~ and the Departmortt of Nahtral Retoarces, Slste of WlttoooaMOestlligrdon ~ri of Ihnee year eapinNon date.~,p~trst bo copgtieted and reluraed to the SI. Crolz County Zanh~ taf,Xioe withla 30 SI ATURg OF APPLICANT ~ ' ~ ~ 7 ~ ~ ~/ O • DATB ~ ;; '~,~';' 1,;: I (we) ta~dly Ntst ap tip temerrts on tlti~, ~ aro truo to the beet of my {our) lutowledge. 1(we) am (sins) the owner(s) o[ ~e described abovo 6 virtue of a,Wruropty dtxd recorded In Ragiatt:r of Ueede Uflice, I ~ ~~~~ TIlRl3 Oa APPLICANT • ~`~',`. ~r., '!: ~ r' UATB An information that le mis-reprotts~,gayttesult in tiro sanitary permit being revoked by the Zoning ~'?~' Deparbneat. o•••aa i +i " Inclttdr wlih this e;pplicatlon; a eta ~IY,.~ ~0~~~' mPsd.'y~n>,pty deed tirom the Regieier of Iliad! ofliee " C°PY of dre eertllied survey map if reference is nrsde in the warranty deed iww ~ ~ ,~ ~ . ~~ f' r ..Y 1~s.~,q~': ty~i •ay i. k ~ y.- y~ d'. F1." te4 a.i t'~[~} ~ F ' i'a? ~~ ~ 5 '=~ ~- ' ~'~ ~s ~ ~ ~~ ~~: a m:~ ~ ~1~PWje. ~[~ . ~~ ris.~ Z.... w. ..ai.. .ry.hl....w ..'{p.va~ c ~x. h ~ ,+.r 7 ~ ~ ~, ~ a ~' '~ ....~ ^~+~' ~~~~ •... rLf.rq.4i9~ Wy. M .h?~_t»+r..t 'r.~t ~M~ »..r..w ~r ~' Sys ~.rs j~,1.1~.,, + - . i ....r..yM ..y....e'.~Y~»,I •- r H.1., ~... v.~ . `c=s~ .` _.. - . ~ ~Y,: ~ a ~d' .erutae4 0!.` :,~ipR~.~e....ilA~..811IZ1~l~j...~i.,.~ltnt~,.. ~~iv~eb~aad..aa~d,.~rtfat.~t.~ :-. aats,. ;„» s ,~ s ~ ~ . rt _ 3~ ., .: :'~,rl -.-~ ~ .r;~.r.a~r~M .+ x-E*.x+~--.-~-.••~•-^.- ~ -+-x~~ ~ • _ ~ ~,.g~. x '~~y`~~. ''~SM~ 4. f .A~.Y X...q ..~y .~..:,,a~.. ~ .-,..» r.. ..+'a~i v....ax.....wv~ ~,~sYIP' y. ~ ~'£,~~ that tadiowtnc daaribii tact estabr ~' ,~t _Croi~c _ .._ _ . »CoontT .,' ~ S{lEtr of Wiseoasiu ) ` ~ ~ :' ~ '.. r x~: ~, .~ _ ~ ,~ ~ ~ z . '+~iP _ z ~ u- ?~ T~arosi Neu ~ +,.~ ... r i~o "lt x; ~. r ~~ ' ~' ~ ~ Lot 110 arltvieW Eatat s Fourth addition q the Tom o~ -y~r i'~ -~, F ~ - ~ h ~ ~ ~ r; ~ _ '{alyupun'j g ~ r 4 ' ~ .1 .. hid i.--RYf ' ~ y .,;Y' ~. f ~ a - TOGETHER WITS.AtJD SUBJECT TQ easements, covenants, reservations,' Y~ and restrictions. of record. - ~ `` _ ~~ - t - -fi _ ~~ _ ~~ - ~ Thu 3a..not homestead ro ~~ ....... .._..... y party. k ,~ - (tsy (ts not) , ~ ~ { , Ezce tton to wan tier l an _ t '' ,. ~ _ ! Dated this .....................12th ... .._ da of .April _ ......... ... ~......---...... 1985.... k T .. - i ....... ........................_.._......... .. .(SEAL)..: ..`.~~~.~ ~1:r.LX~!.V.... ................(SEAL) f4 • ~ -, • Sam S ~ k _.. ..... ... ................. ..».... .. ... M=~~43F. .. ... ..............._... .... b . ....... ........ .. .. ..(SEAL) .._.. ......... .:..... ..-- -----.... ..,....(9EAL) ,~ ~ ' ~ ~ _ ;, ' LV?STS It?!DA?lOlt ACEIi<OWL1•Dti1[sN? 3'~_ ~ Sp(a) Sam.L_ l~ti2ler..._...~ ........ ..... STATIS Ol- WISCONSIN . ar. ...»......».......»» ........... H as trt thb .22tI~ ~ April....... ,1~ ..85 P~awnatty camr Miora mgr thu ... ..........day of %~aF/L~ ~~~_ ~ ~G »lt.w~C ~G~c~s~.~ec ..- ._.....» ...................... ..... is...»... tt-t atro~o named i? «..ttristins 0$Iand Lundeen .........»......... --••---..» .................... } ~~ TITLEs.YEYBEIi STATE BAB O! WISCONSIN ........ ~.~... »..»....... »».»........» ~. --.~...~• ..... I . .» .i '~k (awt~ho~sisd~trY ~ 7t16.OR„~Wit. Statr.) ....... ............ to mr ttnown-to M thr persoa'...•. _ who.esecnted the i fore`oins instenmant and achnowted~r the same. nua iHSn~uMarrr wns onar*eo ar i ~ ...,.~E~lE1i~I~..4?Sx~t!i~..k!?n~gen .......» .................. -----..............---.................... .....».....---... Attoraep at Law e. ~ ` Notarryy Pnblu .. .............. ... .. County. Wis. ~ ~ ' ` (8fsnrtares icay br snthenticated or•acl~noMedged. Both Idy- Commisalon- is~ permanent. (It ~!, state expiration ; ~ art sat n.oes.ar~-.> dates .......................... ... ......... is:..,.....y ! OOKWO~D 3,---------- 107 10 ACRES 97 S0. FT. ~~ 0 a a N ~ -------243.00' --- -- -- - i ~ 8 I ~ ~ i N - ~ ~o - c .N ~ 108 rn ~ n 3 ~- 1.071 ACRES - 46, 651 S0. FT. N I ~ ~ ~~pp O ~ M / ~jp~ I w~." _ i In ~ N89°15~ 14" E 243.00' -36''06 s ~6~g ~o -~=-_ ~ ~ " f0 0 0 ~-~ ~~~ 0 2 U) ._ ~\ yw ~~ ss '°8 Flo ,o S89°15'14"W 412.04' i,~ - - ~..-~T - - - - - - - - - - - Zos-o2' ~ fs~ b O 1 °D ' 3 M ~~ 112 ~$ ~ 0 113 W ~ ~ 1.031 ACRES N ~ 1.031 ACRE: b t~ ~ 44,908 S0. FT. i ~ N 44.908 S0. F ~ N o ~ e"~~ -•- 412. -- 206.02' 206.02 . N89°15~ 14~~ E 478.( SCALE IN FEET o loo 200 3oc Z LEGEND SECTION CORt~R MONIMAENT~ BERNTSEN ~ ~ 2coRNERS ARE (STAKED WI~TH31~x24~IR0 ' ~ 2" IRON PIPE FOUND ~ • I" IRON PIPE FOUND -'-'~ UTILITY EASEMENTS 10' IN WIDTH NOTE ~ ALL PIPES ARE ROUNDS DIAMETER C ^~ ,~M~ ~MEASUREMENTSAHAVE BEEN MADE ~O T'HEN NEA ESTOT ~~~~`C~G~JN~+~~~,y, 'UTED TO THE VALUES SHOWN. ~ ,lAIWI`S E. ~- , 19 84 ~ ...~.. ~ ~stam ~ ~ ~~~~ `~' ~~pa 6 ~ A ~ ` I ''~,~o~hs ~ R 4;~•s 5-13?b ~ DRAFTED BY NANCY KING r i ~""' w '~'~" ~ Form - S T C - 104 ~ ~/ AS BUILT SANITARY SYSTEM REPORT OWNER ,~ a ~'I / ~l t l (P ~" TOWNSHIP ~ u ~ s p !~ SEC . ~ / ADDRESS ~ ~ ' ~0 k ~ S~' ST. CROIX COUNTY, WISCONSIN ;~~uGls~r Wtscohs~n 5' 9- G ~ G ~~b T 2 I N-R ~ "1 W SUBDIVISION ~,db P n V P/ w LOT LOT SIZE ~5'~afc~i PLAN VIEW Distances and dimensions to meet.. requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM. .~ r~oK waa ~ ~r! u~ ;.,. I .~---- Nap 7 h G~ ~ t L t n t~ ~~ s~ ~ a r 7 ~ p - 5 ~ ~ F G c.rn~r ~m~ a ~ ~= ~ ~,, ~t~~ ~ lz~, E®~~- ~ ii z /U~ HOU7P ~ T /D ~f 3 z ~ ~ ` Z. ~ #' ~~ 9 2 . _~ ~O~ ~ ~ 2G k~ ~-F ~ 3c.' ~ INDICATE NORTH ARROW BENCHMARK; Describe the vertical reference point used /~C ~~ f c vehp r ! ~~~ !r t" -p-r-- Elevation of vertical reference point: r GO, DU proposed slope at site• 2 ~7 ~ ~ C~L~TTTl~ TALTT.~_ 1l__ L__~ ______ ~A/n ~~ r~ . r .. ///V (~ ~In/ PUMP CHAMBER Manufacturer: ~~ Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Elevation of inlet: Botto of tank elevation: Pump off switch elevation: allons per cycle: A C ~r ~ ~,r; Pump Size 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 ABSORBTIO,N SY/STEM Bed: V Trench: Width: Length:~ G ~ Number of Lines:~^ Area Built: ~ y% ~~ Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, O Rear,O Ft. ~ ~i i 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 o~ syeepage~ pit elevation: Area Built: Has either a drop box O or distr ution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity:' Number of rings used: `_ E1 a on of bottom of tank: Elevation of inlet: Numbar of feet from nearest property line: Number of feet from well: Number of feet from building: - Number of feet from nearest road: Front, Q Side, O Rear, O Ft. Alarm Manufac~urer: DEPARTMENT OF~INDUSTRY, INSPECTION REPORT FOR V, f SAFETY & BUILDING; LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS Dlvlslor P.O. BO?4 7969 BUREAU OF PLUMBIN( MADISON', WI 53707 „ L~CONVENTIONAL ^ALTERNATIVE State Planl.D.Number: (lf assigned) ^ Holding Tank ^ In-Ground Pressure ^ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTI N DATE: Sam Miller Trout Brook Road, Hudson, WI ,~.5 = ~%Od BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELE V.~. NW SE, Sec.17,T29N-R19W,Town of Hudson,Lot4~110,ParkView Est. IV Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number: Douglas Strohbeen 5432 St. Croix 54966 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ~ LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET F~LEV ('~- WARNING LABEL P OV DED: LOCKING COVER PROVIDED: p ~ ~ ~ ~""~C/L/ tf ~ (~ , / ~~~J YES ^NO ^YES ^NO BEDDING: YES ^NO VENT DIA.: I~ ~ VENT MAT // ~%C~ HIGH WAT R ALARM. ^YES ^NO NUMBER OF FEET FROM NEAREST ROAD: PROPERT LI E ~~ WELL: BUILDING: VENT TO FRESF AIR INLET: DbSI'NG CHAMBER: MANUFACTUR ER. BEDDING: LIOUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACT UR ER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATION AL: NUMBER OF PR OPERTV WELL. BUILDING: VENT TO FRESF (DIFFERENCE BETWEEN FEET FROM LINE I AIR INLET: PUMP ON AND OFF) ^YES ^NO NEAREST--~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ~er~~,rH DIAMETER MATERIAL AND MAR K wG or excavation. (lf soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CAN\/FNTICINAI SVSTFM• BEDlTRENCH DIMENSIONS WIDTH. LENGTH. NO. OF TRENCH DISTR. PIPE SPACING: ~ COVER M L: PIT INSIDE DIA.-. Sk PITS: LIQU10 DEPTH. GRAVEL DEPTH FILL DE H DIST .PIPE DISTR. PIPE DISTR, PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESk BELOW PIPES ABOVE C VER: ELEV./INLET 9~.y~ ELEV. END- ~• ~ ~ ,C, PIPES FEET FROM NEAREST-- ~ LINE: ' AIR INLET: muurvu moral em• 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. ^YES ^NO SOIL COVER TEXTURE. PERMANENT MARKERS: OBSERVATION WELLS. ^YES ^NO ^YES ^NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCHIBED DEPTH OF TOPSOIL: SODDED. SEEDED. MULCHED. CENTER EDGES: ^YES ^NO ^YES ^NO ^YES ^NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PIJMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DIS~rR IBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.. ELE V.. PIPES. DIA.: ELEVATION AND pISTRIBU7 iON INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ^YES ^NO ^YES ^NO COMMENTS: PERMANENT MARKERS : OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ^YES ^NO ^YES ^NO NEAREST Sketch System on Reverse Side. DILHR SBD 6710 IR. 01/82) r Retain in county file for audit. ~'~ w'St°nem APPLICATION FOR SANITARY PERMIT _ ~', ~ D 1 L H R (PLB 67) OUNTY - OEWiRrmEnT OF UNIFORM SANITARY PERMIT # ~ 1n°USrYiV,LgBOR 6MlJmrin RELPTIOnS -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATION ti ~~0~ ~~ •S U/1/45~/4, S , Ta , N, R >S(or) TF~ ~ 5°p/ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER O ~r ; c.w ~Sfi ~ ~/o TYPE OF BUILDING OR USE SERVED ~j~~f~r ~ ~~-.`f 1 or 2 Family Number of Bedrooms: Public (Specify): PHIS PERMIT IS FOR A: New System ^ Tank Replacement ^ Repair Replacement Soil Absorption System ^ Revision ^ Privy ^ Alternate System ^ Reconnection ^ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ^ Seepage Trench ^ Seepage Pit ^ Holding Tank ~ System-In-Fill ^ In-Ground Pressure ^ Vault Privy ^ Pit Privy ^ Existing, For Which A Previous Permit Is On File, Permit # issued ^ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Tota{ Gallons # of Tanks Prefab. Concrete Site Constructed Steel Fiberglass Plastic Septic Tank Capacity ~ ~~ Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer. `~ IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ^ Mound ^ In-Ground Pressure ~I/~ Total Gallons. #of Tanks Prefab. Concrete Site Constructed Steel Fiberglass Plastic Septic ank Capacity Lift ump/Siphon Chamber PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: / (Minutes per inchl: REQUIREDr(Square Feet): PROPOSED (Square Feet): 1 rig ~ ~ ~ Private ^ Joint ^ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Printl: Signature: MP/MPRSW No.: Phone Number: Do I S ~. ~ MQ- 3 z (L y~ 3 Z 3 3 Pl/u~mbe Addr~e/ss: n Name of/Designer: OC !~'#'~ l UQ,~U ~~ i~ n~! n it i1~ ~a'r S - s~/) / 7 /~/i,C~ ~ ~~/9 COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ^ Disapproved ~ j ~ ~ ~ d ~ A ^ Owner Given Initial ~ / pproved Adverse Determination rseason for uisapproval: ~ r Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398- To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.1; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipes-. 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. ` APPLICATION FOR SANITARY PERMIT S T C - 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 ~ {4 ~___ wl , ~ ~ ~ Location of Property ~~ S,~~i, Section ~_, T ~_ N - R l W Township _l7' c~._U S o ~ Mailing Address ~,~~/ /~'~ X 2~ Z_ // '' /' /~ Subdivision Name ~~ y~ y'~cci ~~~~~t 5 ~- Lot Number ~~/O Previous Owner of Property ,/~c~y`'~ lJa~7- Total Size of Parcel /,07 ~ f~L',~c 5 ~~, ~~~ Sg ~ f' ~- ~-- Date Parcel was Created 3~~~~ Are all corners and lot lines identifiable? ~^ Yes No Is this property being developed for resale (spec house) ? X Yes No Volume ~ ~ and Page Number ` ?i as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROP~RTy OUINFR C~RTIPICATION 1 (Gle ) cen~i.b y ~h.a~ a,Q,Q, b~atemen~ an .th,%d banm ane ~`nue .ta the beh~ o ~ my ( aun ) fznaw.~edge; ~ha~ I (we) am lane) -the awne~c(~) ab xhe pnapenty de,~ch,%bed ~,n .thi,a ,~nbo~rma~.t:an banm, by v-vitae ab a wcvvcanty deed necanded ~.n the Obb.tce ab the Coun.~y Reg~~e~c ab Deeda a~5 pocument Na. ~~ Z ; and zGi.a~ I Iwe) pne~ enemy awn -the pnapab ed a-cte ban the e ewage poe ~s yb.tem ( an I (we ) have ab.ta,~.ned an eabement, ~a nun w.cth .the abave debe~r,%bed pnapelety, bon the eans~.uct%an ob ba.i.d dyb.tem, and the game hab been duty neeanded .gin the Obb~,ee ab eke Caun~y Reg.i,d~vh ob Deede, ab Document Na. ~' ~ ~! ~'~ . .F -;~, ~--~-.~. • ~,.,... ,."+, 4 Y! ~.~~.7V~LJfYT.~~s+~*-~~ ~~ ~~'+sNln_~~p~',g11y~g,,;~+~^~y,~7~,,~gt ik,[S t~ 1i ~1.L36X- ~~~~, ~VP= ~t ~ ~~ S~'Tj 7 7 j,~#~t~r~1~ ,• s.:.. . _ L~ CiER7I!'lCd1TE er'1'C~It~ TkYA~tJ>eER- I,. Srra~slle A..TtillpaOe~a b'dai ~r-daiT siac4ad{ e}tnFliElad sad iatiad Tvwa Tsaasaast3 O! tla Tb*!a 4~' L~ada~, d1 t$at 3a ~ s fr- _ ~ OEf$Crs tit~!!!~ 03'LMpr~'ti~i+ti~YK M1i~ aaaeass4eaR#.ws rf...,,,,,~~ ,,,,~ nn iAj' ii6gel Eha ala# e! Dark ~.aR~i~~-,~.-~O!r~ii't~ ((//'yyt,, , i .+swa; i /0~301r~ ~IMlit?~ TO1-lt BOARD RESOLUTSO?i- A1CSOl:.YEIl, that thr Plat at PasicYdew Eststat Fottrih Addition in for ?own ai l~iadaob, Darrel. E_ Wart uyd Br A, Writ. owness, is ha:eby approved by thr T own own /~~o~ _ f t 9~'f~ ia+~ awQ a a hereby certify that tiu foreSoing is a copy of a reaolutioa adopted by the Town Board of the ?oven of iiudsoa. t 1)tte ' ~1own Clerk O~;ViCRSt CSRTIFIGATE OF D14:D3CATIOit Ae owners, we hesrbY that ws caused the Land described on thi. Prat to br surveyed, divided, mapped anda~+-ated as represented on this Plat, VPa also csxtldy that thla Plat Le regalrrd hp S. 136.10 or S, 23b, 12 to be submitted to the doilowing for tappsoval ar objection: Degartrtarat of Developmeat Deprrttaeent of IadKetst,, Labor and Human Relations, Town of Hmdeon, Cite ofliwisoa and St. Croix County. VPiTNESS the hand end rral ~ said owners thls /- 'a dsy of _ l" `I,,.,_t'f ~, Ia presence o!• /'~ ~ ,/ ff, , J ~, l~ srsl err ^ ~ - /Y ~ l ~' ' :.ice. Brverly A, VVr, STATE OF WLSCONSIN 1 SS ST. CROIJC COUNTY ) Peosonally cams beforr me this /~ '" day of /; ;.~... „[ ~ ° y the Above named Darrel E, Wert anti Beverly A. VPs: t, to me known to be the parsons wha exetutsd thr loragoing inst:umoat and acknowledged rho cams, # s< Notary Public .~~„`, +,yl ~,~, Wisconsin My eommission expires ~4~~ ... ~~~~" Mary 1l~sch, Notary Public _, f • CEixTIFLCATE OF TOWN CLERK i STA?iC OF' LYI5GON3IN} ST'.,GROIX COUNTY } I. Rita 1°Pasna, being tba duly aPPolt+t~dr qualified and acting Tow+a Clrrk od the 'iawa od :svdsor., do hareby.,c that. copier oflthir Plat wets doswsxcied a• regwi:ed by .~. «36. 12 as ths~ dsy of ~S~( 1$8~i, and .that withs"n the 2>i-day li:ni: sei by s, 23S.i2'(3} (no objscti ns to the plat have boen filed) {,ail obje^t!ans to ±he plat have been met). Irate Rlt Herne, Town lerk eiiRiiC~ ~_ ~~~ ..~.i+9u.~i.'.. 3..: c ~..c,c.y~.,~;,~ . loo , ~~.~y+ay~ ~~ w _ ~ ..•z .. _.. _ ._ . 1 1 f -, .. ,. ..,. , .. - ',-y iwas~~.lossar~i~errsi.e~S.~wi8a~.ra~,< h~s~i9r ~ ~~. 1~rst of ayrl~ai+^r~E ~~t-. ~srd trs}s¢= Tir1~3#sre~m'~a dind~i Est ~te.Yssa Ssawes..go~est~ Admen,. la~aa~+Ris~Gr4~i~s~tlf~wdtiAa~tll~eteYrStlI4aE.3~+~ow lT„ T~9Pi~ Tluit-1 siri~Cr ~rM~+u~+~Pr-Salt ffivsle~ Rsi 1M1M tr'TaJw a'3r+ttioa ui L~.g~e! P.`.:.` ~a~~~.~.~~'y;a~~se[~a~ ~ ~ses~ieda+ste~t~a~ss -~.. , '!1/# s~rsr ~d. ~ii~siiss !it t~oa~ 5~~t: isa~+ !1!4.~tww~AwbiiJ1~!`~Ei~t~tE~elleat~-sd[-7~lsenl7r ~1R"M~ dr~s~ ws~,~!"~tMO"1[ es=1W Qi1i@+d, fs~ ]tayr - . ,_ .,u~:--~.~+~+y~~dE:rt+~a~r:.wzs~t~a.~lee ih.~ tb..~.c _ =ta1s.:~~i.t~sC Ewa. Ditrt32+~ri*'ll~~r2a~z lAaec..:. _: --:_- rr~!~tAe:~a~.~..r~ :~~:. ~owrar~.ciwf nia~aaa r a .. . , yt,~,, ,. a; ~, ~ . ~. IQ~6N~F teas al3"!33~ ~ •I _.` ~: _ !~'~?aSf^1~'~i'l~3iMee:~614'7.~:. - ll~tncr .-. ~ ~ ;wlraa cboedo A!'+~0~ 6~ ~ ~~ i+iri~'1'lei~ iTa~i~ ~I3L,,3it a_3:.Ia61~:Yk10l~stra nM1 L ~ Yf~4°'~~~~ ~k~~"r . ..-. °tLissa~lw~' a 'sn.~s 30~~00~`. , . s~f~~sl~irbese c#psd~owrta~ ~ ~ `'!€.D9~: tM~ 11IOL~60rsE~s ffiwewa lEI! 2~sy~X ~#s~aeiae , r: a~&th~sautas4~am~ioarlsaias e~the- Sa*dwiew~w6lii'..~rrae~maia'k~..: ., '` ~ .~~ , °:'iyieti~i~arti ~.~++.iakliia~tea+i,8.oa.l,,zs+C~iL~-~lse'ossin . .lt~~soeze.E~s'. .cal. cratxco,mcr uf~ Torru ut :. f&+~r ~ sra t9~s~lit«,.. 8~cbdfi'rk~ioo- aa¢-E.C~rdi< Y,: .~ ice. ~ _ a~+~. ~5 421 aRSOai ~owo'. ..~ i~ -. l3w~oMt~ la+ ,"~i~3~ , __ ~' -k ST. C~CCI~Y: ~ ~ ., ~, 2,3c~ E.is~asse. bsfat duly eioot~.~ '~as2lBed° aei aari+yt Zx~~t+c+€~or at aa. Cseiar Goa da akst tl~arsaassla ~ ~ efl~ w~s~Qssnred tau ssis+s a~i ~ ar~~s K poe4st ear~sf+s ss of /1-.ilk- .. - sNMe1~ tM't~ Ssialat~d ~ tbs Plyl ~t P1~6 Y3rr ?tNatst Tonsel .. , .~ .-.. , .... .. .h p• .,... , ~, Dsi~ ?sarws _ ,, , :: "=s - ~ 2~OC' CA~tdlffaY YZ,~ SEE~it2?S~FS ?lrla Fiatls beasb7r spprswd b7rlbe &. Ceoix Couatr Comprabea~w Psaka, 3'lraaaix~ sad Zoaia~ Cosueid!lee. a J'~"" ... c.12,tO Cta$ -~.~..1-~-.~-,. .. sje. wamt~tcr,~r _ .., ~'.__ :,: S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER SrSr`lil ~,ZrLL F~ ROUTE/BOX NUMBER~~~1 ,~o,~~Z$ Z Fire Number CITY/STATE/~ti~~oh f,~/,~5 ZIP.S-~fD/~ PROPERTY LOCATION:~'~,'S~ '~, Section~_, T Z9 N, R~~ Town of ~4-soh St . Croix County, Subdivision,. V.[u/L~f~s ~ Lot numberl~a 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 tt~e septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents m_~y 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. '• I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with 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 'toning Office within 30 days of the three year expiration date. SIGNE 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. - ~ '--- ~ C~IL~~ ~~ OlPFR'tTT1iIlT O/ ~~~ If10lJiTFl4, ~.FY9C]giFMMIMflNtL1/flOllf~ SANITARY PERMIT GROUNDWATER SURCHARGE calory ~~ 8~rnltrry Pormlt No. .Sy 9~6 On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com- monly 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 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to the groundwater through your soil absorption 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. ~qn turo of Issuln AB~nt: Oro ndw~br Fes: Datr. _Hrt 88D-7289 (N. OSI9A) •r. f '" '~ ~ ': ~} DEPARTMEN~`OF ' ~?,~~,~~ F.~ PORT ON SOIL BORINGS AND INDUSTRY, ~ -.,, ~, ~.. , LABOR AN '•'•-i• ~'G~ 1,'~~FG ~: ERCOLATION TESTS (115) HUMAN A~ ~IONS'j~a/~r~ 198 ~~ (H63.09(1) & Chapter 145.045) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 LOC~'/~~ -' SECT ~ ~(o ~ TOWNSHIP/AW.LPdiCi~P,gtH'Y: OT NO.: BLK. NO.: SU DI/VISION NAME: COUtNTY: ~ ~ AME: MAILIN ADDR SS: D/ S`~D/ / ( C ~ ! ~ CS ~ t Ev /?~tL ~Cd you ~ 11SE Residence NO.BEDRMS.: ~ COMMERCIALD SCRIPTION: /'/~ New ^Replace ,Sv: ~~~' RATING: S= Site suitable for system U= Site unsuitable for system .- .T'.~ DATES OBSERVA'T'IONS MADE IPROFI E DE CRIP IONS: ER OLATION TESTS: ~-~y ~- - Y CO NVENTIONAL: ~1S ^U MOUND: ~.S ^U IN-GROUND-PRESSURE: ~ S ^U SYSTEM-I -FILL D S 1~U HOLDING TANK: ^ S ~U RECOMMENDED SYSTEM:(optional C6,w~.~~w,-/ _ x36' If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5-(bl, indicate: ~[,` ~ Floodplain, indicate Floodplain elevation: ~/~ PT•i~F11~,E DESCRIPTIONS BORING TOTALS D PTH TO GR UN DWATER-IM8fi1i"S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) B- ~ ~-~ i J q •~ i ! /~ ~ ,, ALG ~~~ l oZ ,61 Sly . '7 ~Bn .f/, . S ~$~s /fj ~•~o ~n C+-~'taVt,J S r Ccy B-•Z ,.5~ ' 7 ~. ,r' /..Z 8/s~, ,6ht/~ . 7 Ba !f, 3.sBn CS~rJ S r B- ~ $' ~ C 7 r .~ ` . 3 6/ s/, ~ '~ ~i s /~ ,~, f 8n ct •~~'~.~ 1, o h c ~ ,r- r. ~- ~ B-v r J r ~1 ~ ` ~r- / r ~ ~ /i ~ ~I ""T /J f / - ~ ~ /~ ~ d /~1f ~f~ l` / ~1 C.i T~~~'i B- PERCOLATION TESTS TEST DEPTHS WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I~AiGkIES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 P R PER INCH P- .s' o r2 ~ ~ p_ ~ / ~ L ~ P- ~ O L -~ 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 ~aZ~ 7 ~ ,Ce G ~,~ E __ ; _ ___, 3 c iM i ~ ~ [ i r E i _- _+__ E ~ - ' i _~ r3_ _ _~ -p-- /~0~~ _.,...... L ' /~ Ll~/''`^ I + ~ 3 ,• ~' ~IV4? t E~@. $. 3 $s I ~Cd1~43 '~X 4,n A.79YIi~ ~~ F ~~~ ~ i.d~~110 H Os.} a3 C.~S/ - s7i.~~ • , ' C~o Ise a co~~r~rletr~ . a~;curat ,rt~ur re~>y uluc:le: 1. Ccrr€rpl ~ ~ d_ ~' rn; 2. Th ~ ~ rly ;~~cJi~ ~~~~ther ihi ~c,, or comn~c~rci~d pr~csject; 3, ,? ~~mf cial ~ , .-fir '_ SITE fS `"` "`,C3LE FOF~ A NC~L~3ti~1C TANS ONLY C ALL _ ~ ~~~ BASES CF~'J ~_ .L ~C~NDI"("IC~NS; ~~ =a( , harp for Uvritie~E ~ ~ ofile descriptions a e ~(ot plan, ~. ~: ~ .. ; ~:~',t l~Ci'1tl~1(~ jrC zP„St loE6rtrQns. ~' ~.') S=' 31 P., 1S ~rP,ferr~C~. A ~ _. - ,` BleUe~tt(?rl ':`€~' ~]Q1[lt ~?Yi :~7GV (l, 8i"t t~ iiT-e pe("t77~tl E'P1t; kaoxes ~ > c'iates, seam =s, flood plai ~~aa, percolation test exemfa- ..~,__~ ~r~~i° e! :ot aPPIY, K~rln~ ~ the ap~r~c~priate hox, ~ 1C ~.. .. i'.! ,"gt-[If (C~ItIOC3 i .~ `. ~~ ..Y ' t~ttP,er Sy:~a€aols FHB - Bedrock - `°~ LS - Lir _. ~~V~ - F P~~ rc; -_~ f ~jv __ Bldrr ,. -- ., ~ B~~ Uk -' l~ ~ -' - E - I7~ i ~; ~; - ~ ~. f (; _ ~a , y }Y7 _ farm ~~ € _ ~ ~ d ~ ~tf L ' .r, _ E3( '~ .... ,.-.i '~' ~ ~ 4 y _~ . - - - ~ .Cl ~, r- ~ ~ r- -~ V1 A p ~ o ~ p ~ ~ ~ ~ p ~ ~ o ..~., ~ ~ `~ # ~ ~ ~ U f o ~ ~ ~ ~ I~ 'ql N ~ '~ ~ ~ R ~ ~ -E ,~ t,zP m i, ~ E ~ - 0 6' ~ A $ ~ '~ r~,-~ 0 ~ rit ~ N U ~ G ~ ~ ~ ~ A O~ ~ O ~ t P ( ~ ~ 0 p ~ ~ U ~ o ~ ~_ J o ~ ~' ~ - F ~ ~~ --r- s; -~- ~ i ~ `fl !~; o s i v -n `~' ~~ ~' ~a k; N 1 ~`-Nom-----~-N-~ r p ~ W n~ ~ ~~ -~ ~ ~~w--o.~. ~ N~ .~ , -~-- ,~-: J _ --Cf _ ~ ~ r ~ r ~~ a 0 I ~ ~ ~ .~ 1 ~ R pti U. ~_ ~__-, --=1 +~ q L"~ a 1~ .I, ` B'AS'/a ~" /,':. ~. _ __ _ ~ t ~~ ~~ ~ f~ t I ~. _ ~~ ~~~^ -.I ,~ i ~~ ... .` .~.. o~ z P I ~~ Q i°ar ~'~ e c,~t~~~ , COj \ ~, ~, i [ ~ "~" I I ~ ~ 1 f ~ I i, I '~• 8 ` 'E -.~ ,. R ~ s C ~--'~ ~~ N ,y s I~ ~~ ~n a O __~ c_ P ~\ a u `o `'±- ~ z ~: ~- ~ r \~ r (ate Cd`~ ~- M c e S P - "~ ~ 4- O a- ' p~ P ~~o A a <' ~ -~ ~ ~ ~-~ `~, P ; ,~.;~ 'C n'1 f -, ~~\, ~~ ~ `~ '~ ~~ A X~ ~ -__~ -- ~ ~ - -~ . _ _ W. 1i i ~ ~ i ~ I I l ~ i I ~ '~ , R -n ~ I ~~~ ~ ~ ~ i ~ P ~ -~ - -- ¢ x ~. ~. w ~•t ~ w- .. `V l ~ _x; ~ a .. _ ~^ ~ ~ j. %~f° a'` ~ ~ l~~ ~^ F .'° ~~ ~ o A N ~~~LQZ STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County WNER BUYER ~a~ vv~ ~ ~ Q-~ ~' l/ ROUTE/BOX NUMBER ~ (~s ~ ,[~d^pd ~ ~~©~.~ o(`. Fire Number CITY / S T A T E C't u~c1~ S c~ ~ (,~ ~ , Z I P ~ ~ ~ /~_ PROPERTY LOCATION:~(,~~,~_~, SectionLZ, T~N, R /,~W, Town of~~4~s„~~,-~ St . Croix County, Subdivision~j l~i~. • Lot numbe~. 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 m_~ a maximum of 60% of the cost of which was in operation prior to accepted this program in August owners of all new systems agree maintained. be eligible to replacement o July 1, 1978. of 1980, with to keep their receive a grant for f a failing system, St. Croix County the requirement that systems properly 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. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with 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. SIGNED St. Croix County Zoning Office P.O. Box 98~ DATE Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. .' 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/contractgT,("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 Location o'fr Prroperty~_~ ~~, Section /,7 , T ~ N - R ~~ W Township ~~~~ S O ~ Mailing Address ~ ~ (e ~ ~ ~ ® ~t . 5 ~,, ~ c ,(~, ,, Subdivision Name ~r. ,l ~ l) „f;,~, ~ c ~-~~~-~ K ,~ Lot Number ~ l /Q Previous Owner of Property ,~~ ~/'~ ~ (,~~,,- ~_' Total Size of Parcel ~ ., ©7 Date Parcel was Created S ~ ~ -3 ~ ~ ij Are all corners and lot lines identifiable? ~_ Yea No Is this property being developed for resale (spec house) ? Yea ~- No Volume and Page Number.__R__~ as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty .Deed 2. Land Contract .~,~ 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. • PROPERTY OUINER CERTIFICATION I (GIeI eenti.by .that a.P.e etatemente on th,ia bonm ane tn.ue #o .the best o~ my (owe) , hnow.Cedge; .that 1 (we) am (cute) the ownen(d) ob .the pnopenty de,~ehi,bed ~.n th,i.d ~.nbonmcLti,on bonm, 6y v.chtue ob a wa~.anty deed necanded ~.n the Obb~.ce ob the Cocuaty Reg.edten ob Deeds a,e Doeecrnent No. •• / "~ and that I (we) pneaent,~y own ,the pn.opoaed a.cte bon .the sewage pod ayb.tem (an I Iwe) have ab.tai.ned an eabemen.t, .to n•un w•Lth the above dede~.i.bed pn.openty, bon xhe eonefihuc,Lion ob aa~,d dyetem, and .the bame has been duey neeonded ~.n .the Obb.~ee ob .the Cow~.ty Reg<.aten. ob Oeeda, as floeeunent No. ~/~ ~Z. j°-~ ) .