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HomeMy WebLinkAbout040-1018-20-000 c m y1 `�° m CD P4 3 0 , L) R (D m o 1 o ° (D l< 3 m `° < N w ° c PD (O 0 ° D) CD po a) v y i a , ,try CD CL �C v W CD (D Lrl p ;"°' Z v O W N a) a O N N 5 O C CD .� O C=) O N CL 0 0 0 C n 3 S CD '9 O a N @ d '6 O QO �lr1 0 ( D 3 (D ? a !V cr CD a O cn W zwz0) D (D CD 0 :3 N CD Cn CD F y w Q N - �r C (D D a 3 3 (D a N p Z CO ;o 0 C ; a .. Z P (D w a 'I z o N 3 m `° m � � (D p n m CD m D CL m R 10 3 � ° � 0 O T G n = Q O N (n C i-. (D a y A Q O O = Ct O. Q CD N b a I o � b CD i COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800- 962- 5227 F - FAX - 715 - 962 - 4030 ST. CROIX COUNTY GOVERNMENT REPORT NO.' 54981/01 PAGE' CENTER REPORT BATE; 1 /03/94 1101 CARMICHAEL ROAD DATE RECEIVED: 12/30/93 I.RJDSON, WI 54016 ATTN*# THOMAS C. NELSON OWNER*# Bruce Oweas LOCATION: 559 Tower Rd., Hudson COLLECTOR: M. Jenkins DATE COLLECTED*# 12 -29 -93 TIME COLLECTED: _ 2*#34pro_ SOURCE OF SAMPLE*# Kitchen fauce+ BATE ANALYZED212 -30-93 TIME ANALYZEDt10200am COLIFORM,MFCC*# 0 /100 mL INTERPRETATION: Bacteriologically SAFE i;otiform Bacteria /100 m.l V /R J a'g10 I , ST ._ Imo, ,,:Y �•..�.,, j r a GN;N ti 'JFI -i� a LAB TECHNICIAN: Pam Gam RESULTS:_ WI Approved Lab No. 19 FAKI"? ON: - -J- , Llti" -- PHONED ON: CALL ET.. OF A DE O Z a t Means "LESS THAN" Detectable Level Approved by! 0 PROFESSIONAL LABORATORY SERVICES SINCE 1952 E 'COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 k Colfax, Wisconsin 54730 715- 962 -3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 ST, CROIX COUNTY GOVERNMENT REPORT N0.*# 54652/01 PAGE i CENTER REPORT DATE'. 12/27/93 :.101 CARMICHAEL ROAD DATE RECEIVED: 12/22/93 HUDSON, WI 54016 ATTN*# THOMAS C. NELSON OWNER, Bruce Georgia Dena f LOCATION: 559 TOWER Rd -, Hudson COLLECTORS M. � Jenkins DATE COLLECTED*# 12 -20 -93 i TIME COLLECTED*# 3*#00pm P SOURCE OF SAMPLE*' Kitchen faucet I DATE ANALYZED*#12 -22 -93 TIME ANALYZED 2200pm i 'f COLIFORM,MFCC*#TNTC /100 ml INTERPRETATIONS Bacteriologically , t_hNSAFE NITRATE-14 5 ppm Above 10 ppm exceeds the recommended Pub [,v6 `,° Drinking Water Standard. 1p;� ° *TNTC*# Too numerous to Count. Co l i f orm Bac ter i s /100 ml, �j° ;oumr? Nitrate— Nitrogen, mg /L GidiNGO�FICc RESULT S: - E FAX'D OIN: _ z7 L �xi PHONED ON: LAB TECHNICIANS Pam Gane CALLER: ---- - -- T f OF.NDEVfHOENl m WI Approved Lab No. 19 O i u F Z� 4A t Means "LESS THAN" Detectable Level. Approved by*# 0 PROFESSIONAL LABORATORY SERVICES SINCE 1952 T � sT' ��s7- !,t)/�S /rc� SSA- �l�t� -- ST. CROIX COUNTY - -.::' WISCONSIN ZONING OFFICE •v •'. / ST. CROIX COUNTY COURTHOUSE - d •HUDSON, W154016 (715) 386 -4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to,insure a time when entry can be gained. I- ktOA- l --- / / S. o v ❑ Water (VOC's) $185.00 ❑ Septic $25.00 t'(Natey. &- - "B'a,Cte $35.00 (Visual inspection) Owner: Ud' �� S Requested by: 1� 6iQA.-e�o ST Address : S Address : 7& ! s a '� S City & State: c-),0 OK0 t City & St. tot , Zip Code: gW, & Zip Code: Telephone N°: ( ) Telephone N Property address (Fire N & Street) : f0 0 Location: '„ ',, Sec. , T N, R W, Town of O St. Croix Co., WI. Tax ID N Parcel ID 14 i( House color &�v Realty rm:� Lock Box Combo: K.\77 B Water sample tap location. 1 K�tJ TO BE COMPLETED BY PROPERTY OWNER Wool', * PROVIDE A SKETCH - OF HOUSE & SEPTIC SYSTEM ON REVERSE. OF THIS FORM* - Is the dwelling currently occupied? ❑ Yes E No If vacant, date last occupie - Septic system installed by: LXW Year: V Septic tank last serviced by: -a Date: Previous Owner's Name(s): Have any of X ing be observed? ❑Y ON age om house. ❑Y ON k- into dwelling. ❑Y ❑N ar e to round surface g g o ody of water. ❑Y ❑N age f the dwelling. ❑Y ❑N s. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. Q OWNERS SIGNATURE: CS` DATE 0 gO-/0 I f - 2-0 610/1 (aZE OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION t I N TO BE COMPLETED BY INSPECTION AGENCY System design & /or permit on file? ❑Yes ONO Soil series per SCS Soil Survey: sheet # Type of soil absorption system OBelow grd OAt -Grd OMound Approx. 'X OGravity ❑Dose ❑Pressurized Ft . 2 ❑Bed _ OTrench ODry -Wel OHolding Tank 00utfall pipe OBSERVED DEFICIENCIES ❑Other OUnknown Septic tank ; Setbacks: ❑House OWell OPro T _ P� ine OOther Dose tank Setbacks_: OIiouse .OWell . ❑Prop. 'Line : OOther . ❑Locking. cover ❑Warning label ❑Pump /Floats " OA l arm OElec. wiring Soil Absorption System Setbacks: OProp. :line ❑Other OPond ng: ❑Discharge: General comments INSPECTORS SKETCH OF"SYSTEM LOCATION N I Inspector Title 01/03/94 12:15 $ COUNTY CLERK Z001 a • ssa��$es * *se�� *a�a�sss����s gas ACTIVITY REPORT TRANSMISSION OK TX /RX NO. 0924 CONNECTION TEL 93861502 CONNECTION ID START TIME 01/03 12:14 USAGE TIME 00'39 PAGES 1 RESULT OK COMMERCIAL TESTING LABORATORY, INC: Colfax, 514 MStreet, P.O. Box 526 Post R" brand fax transmittal memo 7671 # of pages . t Col, Wisconsin 54730 l 715. 962 -3121 To R 800 962 - 5227 co. ca { � FAX - 715 = 962 -•4030 s, -�• . ' ; I Dept_ h4nt _ 4 '. Fax M Faxw_31 — lsoa ST. CROIX 0MIM #T pA + 11011 CofICHpE1 ROAD Rk.P(�T ;BATE:. -12!27/93 ' DATE RECEIiI to 12!22/.93 Heim, RI 5441b f ATTN: TIIONi#S C. f l - ( l ' ! l�Ri $rlfCi �t Georg i a 0015 LOCATION ' 599 TOFF -Rd at Hadulk I , COLLECTOR M , Jenk DATE aXLMTED: 12-20-U TIME COLLECTED: 3 :00ps l SOLKE OF SAMPLE: " Kitoon faacet DATE ANALYZED: 12 - 22 - 43 4 j TI? E -AiiA *YZB:2i00Ps . i COLIFORN,IgCC:TNTG /100 sl INTERPRETATION! 8acter i a Ias i ca t ly �tw3AFE i • NITRATE —N: 5 pp■ -- _. Above 10 pps exceeds ?he recoaoended Pub[ " ��'•+ ! i 2.! �. Dr i ids i n9 Water Standard. tKAK . fit' Td � -"ovJ�e ©-e-f �r 3 A wy ,C[�A -y-S ST. CROIX COUNTY' 99 3 ,q WISCONSIN ZONING OFFICE / ST. CROIX COUNTY COURTHOUSE �. r CfVC •HUDSON, WI 54016 = - (715) 386 -4680 \ X13 SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. ❑ Water (VOC's) $185.00 Septic $25.00 A Water (Nitrate & Bacteria) $35.00 (Visual inspe Owner: c� � d� 61' l l)u.)r)s Requested by: 0, J / - 5( ` Address : CM Address: 00 0-y '-T'` City & State: At105o•J . , &_)t City & St. 0 � , i zO & Zip Code: Zip Code: Telephone N°: ( -- & M r Telephone N -: ( ) 396 -$a Property address (Fire N & Street) : S"�q /BLOB RL Location: ., 4, Sec. , T N, R W, Town of St. Croix Co., WI. Tax ID N Parcel ID N House color: Realty firm• Lock Box Combo: Water sample tap location: -/) TO BE COMPLETED BYPROPERTY OWNER * PROVIDE A SKETCH OF HOUSE & SEPTIC. SYSTEM ON REVERSE OF THIS FORM* Is the dwelling currently occupied? 12 Yes ❑ No _. __If vacant, date last occupied: - Septic system installed by: 04) 260 � Y ear: Septic tank last serviced by: t 1 7 t,4,n Date: Previous Owner's Name(s): Have any of the following been observed? ❑Y Slow drainage from house. ❑Y ZN Sewage Back -up into dwelling. ❑Y E1 Sewage discharge to ground surface, road ditch or body of water. ❑Y Slow drainage from the dwelling. ❑Y Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. 22 pp OWNERS SIGNATURE• DATE: /o�-� OWNERS DRAWING OF HOUSE & SLPTIC `SYSTEM LOCATION t I N TO BE COMPLETED BY INSPECTION AGENCY System design & /or permit on file? ❑Yes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system ❑Below grd ❑At -Grd ❑Mound Approx. size_ 'X f ❑Gravity ❑Dose ❑Pressurized Ft.Z ❑Bed, ❑Trench ❑Dry-Well _. Molding Tank ❑Outfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbacks: ❑House ❑Well ❑Pro _ P�- line ❑Other Dose tank Setbacks: OHouse : :❑Well . OP- rop:..'line ❑Other Mocking_"cover ❑Warning label ❑Pump /Floats " ❑Alarm ❑Elec. wiring Soil Absorption System Setbacks:- _i]House . _OWell ❑Prop. line ❑Other ❑Pondingi ❑Discharge: General comments INSPECTORS SKETCH OF'SYSTEM LOCATION N Inspector Title r ST. CROIX COUNTY WISCONSIN ZONING OFFICE �i r w s • momsi ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 _ (715) 386 -4680 December 20, 1993 Kernon Bast 700 Second Street Hudson, WI 54016 An inspection of the septic system on the property of Bruce & Georgia Owens located at 559 Tower Road, Hudson, was conducted on December 20, 1993. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact this office. Sincerely Mary Jenkins Assistant Zoning Administrator js -)rcel #: 040 - 1018 -20 -000 2U'o'3 CC�� 11/03/2004 09:11 AM U P A G E 1 OF 1 Alt. Parcel #: 04.28.19.62E 040 - TOWN OF TROY Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * = Current Owner * HARDWICK, ELAINE 0 ELAINE 0 HARDWICK 1568 FOSTER CT &tz/)'� G� RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 559 TOWER RD SC 2611 SCH D OF HUDSON SP 1700 WITC ?.Ua GL&ZQ. a Ps- Legal Description: Acres: 2.200 Plat: N/A -NOT AVAILABLE SEC 4 T28N R19W 2.2A IN NW SE COM 399.7 Block/Condo Bldg: FT S & 361.2 FT W OF NE COR, TH W 256 FT, N 371 FT TO CEN LN TN RD, E ALG CEN Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) LN 256 FT, S 371 FT TO POB 04- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/02/2004 767742 2609/269 WD 07/23/1997 1059/552 f� WD 2004 SUMMARY Bill #: Fair Market Value: Asse 222,900 Valuations Last Changed: 07 5/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.200 50,000 184,500 234,500 NO t oll Totals for 2004: General Property 2.200 50,000 184,500 234,500 Woodland 0.000 0 0 Totals for 2003: General Property 2.200 44,000 170,500 214,500 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 117 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 fNO 7 ST. CROIX COUNTY ZONING D E PAIVI'MEN BUILT SANITARY REPORT' J � H � C Owner 5 C�T / E�Q� 39( �, ��City /Slate Vk'S,O () 4 I.rgal Description: �P��i��i�'v � Lot Block Subdivision/CSM # M -C25� 'A N S, Sec., T N -RLW, Town of PIN # oYa • 101,P • Z o • a� v SEPTIC 'TANK -- DOSE CHAMBER -- BOLDING TANK INFORMATION 7S - Cv /tjs�'�? �°� Zr 715 Tank manufacturer Size ST/PC / 54 Setback from: House Well P/L Putrnp manufacturer _ A A Model Alarm location - � V (11OLUING TANKS ONLY) /(/ /�-- Selbacks: Service road Vent to fresh air intake Water Line _ Meter location Alarm location SU AI350It1' l'lUN SYS'T'EM Gr�.v fi,�a�v Ta 1 Pee • Type t,!' system: Width �. Length Number of Trenches Setback from: House Well „P/L Vent to fresh air intake ELEVATIONS Description of benchmark Top or . Y/// 1t' - Elevation Description of alternate benchmark 7 O 5.7- AtVA41 --'C -'0Y , Elevation - q0. 51/ Building Sewer ST/HT Inlet ST Outlet PC Inlet PC I3ottotn lleader /Manifold Top oC ST/ at sole Cover — Distribution Lines ( ) O (� • 13oltui- of System ( ) ) + Grade ( ) final ( ) O ( ) 0C•¢, Z 3 -. bate or installation / / Permit number � / State plan number Plumber's signnture �Licensenumber �"�' 3 �S Date / Inspector 4 •' fGY (�[, /�„ ff �� ' Complete plot pie" r► Ulbricht & Associates. 'C'et Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 -; 0RIG,i 1 p T.D r 1I fsrlu G-- 3 /vow 0 Fol N � Co 13A # _ Tll oF. e.r /DD • D 10 . 9 - OF 6 7 3• &4 i # I1S POWT SYSTEM SMALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # ,l7 -/Q A ssociates Uibricht & A SSOC Private Sewage Consultants 2812 10th Ave. Spring valley, Wl 54767 /3 /Z 7 7 AJ wy;consin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 69 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Peterson, James Troy Township 040 - 1018 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: I UD • Q 1 0 0 Mom Plaic 6e r&p oo v &2 1) 04.28.19.62E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS 7 HI FS ELEV. Septic Benchmark ID &m I 7L /4;c.7o Dosing Alt. BM Aeration Bldg. Sewer Y. Holding St/Ht Inlet cc 90,5 TANK SETBACK INFORMATION SdHt Outlet Z, V a 7, 9 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet /^ Septic r b �' r / Dt Bottom Dosing J Header /Man. vwto Aeration Dist. Pipe k: Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover �� .r►�, u tarot 1 106 93 - (1y Model Number J " , t 5f 411 TDH Lift Friction Loss tem Head TDH t 00[ Va l ve, For main Length Dia. Dist. to Well �r ' OIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches ) a PIT DIMENSIONS Liquid Depth DIMENSIONS R� 7 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LE4CHING 7 Manu cturer: INFORMATION CHB OR Type Of System: (_C"M T Dry "o C�YlNIT Mod tuber: DISTRIBUTION SYSTEM Header /Manifold 5 (i d 3t. Distributions A / x Hole Size x Hole Spacing Vent to Air Intake � Pipe(s) y l p g k I lLength j;j i Dia Length e Dia _LY I S acin SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/T J NO Yes ? No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: A- 1 36) 1 Location: 559 Tower Road Hudson, WI 54016 (NW 1/4 SE 1/4 4 T28N R19W) NA Lot Parcel No: 04.28.19.62E 1.) Alt BM Description 2.) Bldg sewer length = 1� _t" 1 O ' S 6q v►'1 4 e p ► lz' '{�' v �� -amount of cover= ;t �� I ►� (31 to — ate - — - - -_ Plan revision Required? [ O ] Yes [ No /O 3 �� = Use other side for additional information. J J _ � — LD 1 SBD -6710 (R.3/97) h , , Date Insepctor's Signature Cart. No. County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER (Privacy Law. S. 15.04(1)(m)) 1101 Carmichael Road Hudson, WI 54016 -7710 (715)3864680 Fax (715)386-4686 Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. County Sanitary P q n, t # ❑ Check if revision to previous application 5 r 1. Application Information - Please Print all Information Location: P ���NC' • ► ! �� /�-� N, �ri X 14, Sec T 2 N, R -4.4"( Property Owner's Mailing Address T Lot Number Block Number , l � J� a aLo�o I City, State Zip Code Phone Numer t 5 Subdivision are or CSM Nu r -if 6-S 0 fj tVE7 a �E 11 Type of Building: (check one) amity ❑ Village own o 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): ❑ State-owned Nearest Road 3� II. Type of Pe it: (Check only box on line A. Check box on line B if applicable) Parcel Tax Number (s A) 1. Repair 2. Reconnection 3. 01slon - plumbing ❑Rejuvenation 9 � v J � ✓ ) l Sanitation l/ / V 8) Permit Number _" , Date issued ❑ State Sanitary Permit was previously issued TO 0 Yt.O A IV. Type of POWT System: (Check all that apply) Non - pressurized In- ground � G Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground C�) ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At-grade ` J ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other V . Ofspersal/Treatment Area Information: ,S 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate Yystem Elev lion 7. Final Grade Required Proposed (Gals./day /sq.ft.) (Min.rnch) X3. Elexatio 1. Tank Information Ca0aicty in Gallons Tota #,6f Manufact er Prefab Site Con- Steel Fiber Plastic New Existing Gallons Tanks G71I ��Q Concrete structed glass Tanks Tanks / / p- ! G 000 1600 / ❑ ❑ ❑ F ❑ n ❑ ❑ ❑ ❑ VII. Responsibility Statement 1, the undersigned, assume responsibility for repair/ reconnenction /rejuvenaUonfinstallation of non - plumbing for the POWTS shown on the attached plans. A license is not required for teralift repair or the installation of non - plumbing sanitation system. Plumber's Na a (print) Plumber's Signature (no stamps): MP /MPRS No. Business Phone Number L2 - 715 7 - X22- - 2 Plumbers Addr ss (Street, City, State, Code) ill. County Use Only Disapproved Sanitary Permit Fee gate Is ued ¢suing A nt na o stamps) Approved Owner Given Initial Adverse 60 10 G� Determination 't Z D3 � J IX. Conditions of Approval /Reasons for Disapproval: YSTEM OWNER: //�� Septic tank, effluent filter and Cli1'✓% (, w - -f t-4' �vr dispersal cell must all be serviced / maintained as per management plan provided by plumber. I 2 All setback requirements must be maintained vrl�5+2 V _ Ntl R� ✓ �� . as per applicable code /ordinances. 93 . ( f3 r v 7'0 GUt'72 Z?D T° �E 3 wE O f To 10M - tj i 5j� NS T f l A ���E fo� , Ai� fit 40 I �F (� (31 , � I� 00 p- 0 8 A tuM DO v- 20 r� d Si1f s a -- ---- -- 1 o ho ° l3, /0 aa.5o 3. ��'� mop of rc.45 T" pRyW p //5 NoAfiNUvt a T s V 5AJ CIA p 1 pig CT' S g THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # A _ 16V 40 L /49,P 4,e e o 4 y r Gi v.Q 5 Safety and Buildings Division County -s� OF 201 W. Washington Ave., P.O. Box 7082 S / - e'/2OP X — Nvit's consin M adison, WI 53707 — 7082 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 261 -6546 Sanitary Permit Applicat' State Plan I.D. Number / In accord with Comm 83.21, Wis. Adm. Cod e personal -- inform yo ui maybe used for secondary Purposes Privacy Law, s15 ion (lx , ect Address (if different than mailing address) I. fiv c3�b Application Information — Please Print All Information l� t 0400 ro Owner's Name Ircel # Lot # Block # S �A M,ee f s ' A o v,vpS operty Owner's Mailing Address i roperty Location City, tate �V w Vs �� ' /., Section ty. Zip Code Phone Number Q I�SDA �tJ 1. ypl�Q 3 96 ' <0 Z ZV �QCcirc T N; R E o W l Z. z ` II. Type of Building (check all that apply) � � i r KJ or 2 Family Dwelling - Number of Bedrooms _ l" � S ✓�( Subdivision Name CSM Number ❑ Public/Commercial - Describe use ❑ State Owned - Describe Use ❑City -r►- ❑village Township of / d III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System ❑ lacement S Rep yttem Treatment/ifM� Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POW'I'S system: Check all that appl 0,N0n - Pressurized 1n -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Said Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis rsaUTreatnimt Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (so System Elevation 1 150 t 7 N / 1+ N/ + - 1 sE Pp44N VI. Tank Info Capacity in Total Number Man far /l Prefab Site Steel Fiber Plastic Gallo Gallons of Units � �c� )6 Concrete Constructed Glass New jE. i stiug Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- t, the undersigned, assume responsibility for installation of the POWTS shown on the attached plains. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number L -6 P I �'�a � • Z2 Ce 3 � S 7 15 •77 ' 3 40 Plumber's Address (Street, City, State, Zip Code) Z?1.7 /a FK. •due . �'•v �- U� /l &v /. sy�� VII oun /De artment Use onl Approved ❑ Disapproved Sanitary Permit F (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Reason for Denial �ti"E&ApprovaVReasons for Disapproval Septic tank, effluent filter and dispersal cell must all be serviced / maintained s per mama ement Ian rovided b lumber. All set ack requirements must be maintained as per applicable code/ordinances. —7-t�J l A b compkte pbas (to the Coeaty on the rys em oe p:pir a than 81/2 it 117iac is sin t ULBRICHT & ASSOCIATES CO. - 655 O'Neil Road • Hudson, WI 54016 ryes. Designers of EtV -eedW suer 715- 386-8185 Private Sewage Consonants PROJECT INDEX ' PLAN ID # DATE o3 OWNER Z 5 7 T4-r PHONE ADDRESS S .S 77. IVz:`2z ICJ/ 5 4® LEGAL DESCRIPTION /qg S - 18 0MI 5 - TOWN OF 1 O S7� • '�tdl f� COUNTY CSTM /?- - ?g0V M Ge4 - LOCAL AUTHORITY/ SUPERVISION 57 f C7 - y. PROJECT DESCRIPTION: ALL NON- CONFORMING TREATMENT TANKS SHALL A' 34 v O 1 0 BE ABANDONED PROPERLY PER COMM. 83.33. GO aeAV1 / &k-t _ f eD- A4 4 0 - L SVGS- cad Co''?/° /; ffk- -,— S� i f ,�l P/Zov w i a_ 6 Ulbricht & Associates THIS POWT SYSTEM SHALL Private Sewage INCORPORATE PER COMM 2812 1Oth Ave. C °nsultants 83.44(2)c A PROPER ZABEL Spring Valley, WI 547 ,67 FILTER MODEL # / ,f . /, r'1 l l X M AP S 0- 22_03 S P9-1 INFILT OR SIZING WORKSHE tq (,d ,)- o P9.2 SYSTEM PL PLAN P9.3 CROSS SECTIO SYST , WITH ELEVATIONS. Pg . 4 II II 11 If /I P9•5 OWNER MANAGEMENT L & ZABEL FILTER SPECS P9.6 (OPTIONAL) CRO SECTI AND SPECS FOR DOSING TANK. PG.7 (OPTIONAL) P P PERFORMAN PECS. The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Treatment Systems.' (Version 2.0) SBD- 1075- P(NOl /01. 7'D4Ue`�2 ;gyp i3 t i� 7° 04 : z To �r 5 f m ew TA �auJ 0 lot l p ° IVU-aT �jn 19 00 p- GD� � n Alu►MI^'v 060 r ° 10 50 p of uc VeA)T) �3 70 x•45 T � -T U�?- -- L pa CAP � AWE g � 3. _ 1 I 4/l�- �-�"(y (�C I lil THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # _ 440 p, / ZD �I PAGE 6 REVERSE SIDE OWNER's MAINTAINCE OF SEPTIC SYSTEM POWTS (landowner) is reponsible for proper operation and 'maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS 3 9 6 + 6 (? 0 * Governmental authority/ inspectors: /i_ jJ 2�9 4) � *.Licensed installer, responsible for providing an operation/ maintenance "Users" manual: R. Zf /�l/� >•Gli �____ API? - 7 • - 77 1 3 ���... Z (e 3 - Z S * Licensed service / inspection agent other than installer: 71 Ci y SAAJ P r, 0 A-) - 715 - 3,f6, l 3 v * Electrician, for pump, electric controls, wiring units: IMPORTANT OWNER MAINTENANCE REQUIREMENTS Z. Winter traffic (sledding, shoveling, etc.) across the area shall not be permitted, or frost can /will penetrate into r the cell, freezing up the system.- Discontinuos use in the winter (a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This system was designed for a maximum wastewater flow of y5 0 gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (leakhge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the system beneath IS NOT sufficient alone tO maintain a grass cover. 6. Periodic inspections P b the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, , at each h tZp for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly qualibied person should be performing this work which involves n o lves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. U I'-� Wisconsin €3epartrnent of Commerce SOIL EVALUATION REPORT Page / of Z Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County c / • eV of X_ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include. but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. , Percent slope, scale or dimensions, north arrow. and location and distance to nearest road. 77 0 ' Please print all intbrmatfon. viewed b Date Par —M InrormaWn You Provide may be used for secondary ides (PfivaY Low. s. 15.04 (1) (m)). P AM,ff5 J Pc el frec -- ?e Govt. tot ti 1/4 S9 Ira S T 2 '� ) N R � g ) or w Property (?wrists Mailing Address Lot # Block # Subd. Name or CSM# 55 G w&7?- + 13 o u NP City State Zip Code Phone Number 0 City 0 Village I@ Town Nearest Road Q New Constrcrction Use. -A Residential I Number of bedrooms Code derived design flow rate GPD Q Replacement 0 Public or commercial - Describe: _ Parent material Flood Plain elevation if applicable General corrnm is and recommendations: • ) if CE��•,c, T F 4 S�_p T7c 1, -,)A� 01UL)l -A- w Q Boring � .._ t--- -, Bating # Pit Ground surface elev. W 1. 3 4 // R Depth to Pmtiting fador _ soa Aniftatim Rate Horimn Depth Dominant Color Redox Description Texture Str Consistence Bowrdary Roos GPDVftx In. Munseff OU. Sz. Cont. Cdor Gr. Sz. S. - OW "Eff* a-� �byR 3 - s� s ti cs 3 f . • 3d io A t MIM r SL cs Z f D /o S D - l• Z. l og W 83 co no Borkg # 0 Booin dam/ • �' .' Pit G d ce elev. ft. tai err Rate Horizon Depth Dominant Col Redou Description Texture Structure Consistence Boundary GPDM dAA in. Munseil Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 "Eff#2 ' Effluent #1 = Bt?D > 30 < 220 "mg /L and TSS >30 150 mg& " EfBuent #2 = BGD 1 30 mg and TSS 130 ng& CST Name (Please Print) SQnature CU Add Date Evaluation Conducted Teleptxane Number oc • 715. 7 . 7A • 3S1� ' Stsuciates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 ORI 2 EX i S Tim G- PR / eve I/S I '45 C- iAje� /1�, 1�5 c i M,+5 p 10 1q1AS S oi l Te!r57 sS - its 4oP.A=_ /.v Slnle 7 7 G-- Ca,�p1• T id .J . oll�.[�gQS r4 -�f' 6GC ® ;v6- 9414Y �r j!�FrGVEkj 7_ Aft-Sa4-7 r /.v A-S or DG f /�o _ a�4y of 7 y�--5 7—. Property Owner Parcel ID # P of soft -P ❑Boring ❑ Pit Grotmd surface elev. ft. Depth to limiting factor Soil Application Rate Horizon Depth DorninanF Color Redox Description Texture Structure Consistence Roots GPM In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 Boring # . ❑ Boring ❑ Pit Ground surface elev. ft. eptfi to limiting factor in. So# Application Rate Horizon Depth Dominant Color Redox Description Texiur Structure Consistence Boundary Roots 6PDff In. Mtnseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'ES#1 '0192 �� # Pit Ground surface elev. ft. Depth to limiting factor in. -- ❑ Sol licafiiatt Rate Horizon Depth Dominant Color Redox cription- Texture Structure Consistence Boundary Roots EQM— in. Mansell Qu. Sz. Court Color CT. Sz. Sh. *091 'Eff#2 E Boring # ❑ Boring ❑ Pit Ground surface elev. if. Depth to Eimit N fade �. Sob Appkabon Rafe Horizon Depth Dominant color Redox Description Texture Structure Comistence Boundary Roots GP71tF In. Mnnsell Qu. Sz. Corm Color Gr. Sz. Sh. 'Eff#t 'Eff#2 Effluent #1 = SOD > 30 < 220 mgA.. and TSS >30:S 150 mgtl. " Effluent #2 = BOQ < 30 mgR. and TSS < 30 mglL The Department of Commerce is an equal ' orlunity service provider and employer. If you need assistance to access services or O PP neco material in an alternate format, please contact the department at 648 -266 -3151 or TTY 648 -264 -8777. SBD -0310 (R -6N0? . FIAL To �N yo u ye OA f 5 K sop rAAI f�- ° U ) ' to _ r p 0 tq A r� 20 0.0 j /09a 9a . 5o rf L VeA 3.7Q D ��' Top of IM5 r , 410AI IV EAvT /Od GA Ulbrich Sewage Consultants pnv 10th Ave- Sp ring 2 Valley, W l 5 167 Sp ST CROIX COUN'I'X SCPTIC TANK MAINTENANCE AGREEMENT .. AND OWNERS111P CERTIFICATION FORM Owner /Buyer 3i , ` f O �� Mailing Address ss g TO U x • Property Address (Verification required from Planning Department for new construction) Cit / St e il• Parcel Identification Number L ` �G C � ' LEGAL DESCRIP'flori /J q . 602 6 Property Location �� '1 4 4 s � y,, S 7 , T N -R �/ W, Town of � ^e d y Subdivision _ �� L �1J ,Lot # / Certified Sitt Ma # Z y I' — , Volutne , Page # WArrnnty Deed # / I , ��, Page # Volwne Spec house 0 yes kilo Lot lines identifiable ,o y es Cl no SYS'T'EM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failute to handle wastes. Proper maintena consists of putnping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the sysl can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Depatifft t a_cettification_fonw signed by the owner and b master plumber, journeyman plumber, testricted Plumber or a licensed pumper verifying that (l) the on -site wastewaterdisposal syst Is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludi i /we, the undersigned have tend tine above tegairements and agree to maintain the private sewage disposal system with the stands set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. CertiGcat stating that your septic Rystem ling been maintained must be completed and returned to the St. Croix County Zoning Office within days of the three at expiration date. CINA3URB APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this Form ate true to the best of my (our) knowledge. I (we) gym (ate) the ownet(s) the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. L J U�Bo PLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. *• *+ include with lids application, a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in lire warranty deed LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF TROY COMPUTER NUMBER 040 - 1018 -20 -000 Parcel Number 04.28.19.62E OWNER NAME: First JAMES T & REBECCA J Last PETERSON PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 559 TOWER RD SECTION 4 TOWN 28N RANGE 19W %160 '/.40 Line Description Line Description TOTAL ACREAGE 2.200 PLAT LOT BLK 01 SEC 4 T28N R19W 2.2A IN NW 15 02 SE COM 399.7 FT S & 361.2 FT 16 03 W OF NE COR, TH W 256 FT, N 17 04 371 FT TO CEN LN TN RD, 18 05 E ALG CEN LN 256 FT, S 371 19 06 FT TO POB 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, 1 -Next Parcel, F7- Valuations, F8- History, F10 -Exit I , 4 DOCUMENT NO. THI VACi N[ftRV[D IOR RLCORDINO DATA f WARRANTY DEED , , ' STATE BAR OF WISCONSIN FORA[ I— IOU 59PAU 55Z x REGISTER'S OFFlCE Riche );d..��..�n..>3ra.Gx &i�..A 9h!en,..h>�sba..and.wi�fe,.� ST.CROIXCO. i ji Reed for Record ....................................................................... ............................... .. .. ...............................................•---•....... ........................._..... JAN 1 1 1994 I conveys and warrants to ......James. T...Petersoa. and. Rebe = &.. ; O J . 8L 12.45' M r ..- Peterson,. : husband . and. wife, ....................... ............................... �' P'ti•�QJ�, i �i ........................................... ............................... ...... . • .... ................................................ _ ............................................. ............................... jl R[TURN TO ' ............. .......................................................... ............................... � I the following described real estate in ...... ...................County, • ''' State of Wisconsin: ' . i Tax Parcel No: ------------------------------ L Part of the NW Sec. 4- T28N -R19W, described as follows: Commencing at the Northeast corn er of said NW3f of the SEW; 7. #�R thence South on the East line of said NW% of the SE'A 399.7 feet; thence West 361.2 feet to the point of beginning; thence West 256.0 feet; thence North 371.0 feet to the centerline of a Town Road; thence East on said centerline =+ 256.0 feet; thence South 371.0 feet to the place of beginning. r 4. i ,'.' Q , This - ---- ._- -- _is .......... . .. homestead property. � 1 • Exception to warranties: Eagi?llieilt:g, rest � of record, if any Dated this I .2 / 3 ......................... day of ................. ember... ........, 19. _93.. x i dy .. .. ............... .......•.. ...................._.... (SEAL) __. ..t........... (SEAL) >; Richard B Owen SEAL) tic Lk. 4.e4 („�..1i L1�'l•K.. • t t ti , ( ....__.(SEAL) , ) _. Geo- is A. __. Owen ............................... L • t� ........ ............................... ......... .................. .- __..__.- ..- �......_.. ........ it •, AUTRUNTICATION ACENOWLEDOMUNT II * Signature(s) ------•----------- ---- --- --- ------•- --- ---- -• –•-•- ......_. STATE OF WISCONSIN 7 ,. sa, i . County. St. Croix • ' authenticated this ........ day of ........................... 19 - - -- -. Personally came before me this ' day of 1 f. �2CPJTk ------------------------- 1 , 19_x._. the above named ' ------------------------•------••---...--------•------ .......- •----- •-- ._..._._. .sharsi..R.e..Sh�!ela._,�zid. Georgia_ A.._ Q�rl, } -- -- --------- -------- •--------- •--- -• - - -• r � ;tea ��� _- TITLE: MEMBER STATE BAR OF WISCONSIN ___•.__• -• ---------••---_ .............•-------. .-- ._........__..._....._...... r (If notL -- ------------ • - - -• -- ----------------------•----------------------•------------------••--•---••---•-- authorized by 708.08. Wise Stata.) to me known to be the persons ........... who executed the ' fo ing instru t ataaled e the same. THIS INSTRUMENT WAS DRAFTED BY � B1 1�� r .a Kristina.O Y P oo ...... ....... .. ............. °••••• °--.._... ..... ..... Attorney.. aL. J-------- -- ---------- -- -------- -- - -- -- -- Notary Public ... unty, Wis. a sy be authenticated or acknow Both My Commission is �rot, state ex p tio+t date: (0 ......................, x. r eNamea of persons siaaias is any capacity should be typed or printed below their siinatures. i WABSANTT DEED STATE BAS OF WISCONSIN Wisconsin Lega181ank CO.. Inc FORT/ No. a — 19n Milwaukee, Wisconsin ° = m ° > �.. 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Of �n9 X27 4 ' 141 Troy 40 W _ ` F s ss -- — -- 80 —� - -- Corp 4o L_ 63 `° 6� 4 9 0 ^' 1 L &I& Rolling - - - - -- Dav(ddc -�----- — I 6. ib m, J & G 8 Hills 79 a �p, o 1 103 as f Moeller Dev Arno & 70 �C7 C3 AN xc n a 120 is Trust Inc Marion v was Rkb d s � 1 119 Birr 125 6 aN Inc TaR 20 117 17M 12 GLOVER RD g e s 13 3 Rki0e6t 41 60 6larose) D&C 5 j e I& Truut j� 2 Clair & Donna R I a R Allen & ` 25 rr �1 Moelar ry . Wilcoxson Christie x w 4s t David 133 ' Hanson I x O 14 Screaton M . I pp a 160 A E 3 0. R 11 IS 40 'off 146 42 — s 73 04 — 8 0 _ — y� _ y iuvene Ts f r — — 2 — —� R r E 19 amd — — — Dean & B der Donald —Hu I A 4 ` yyl1aann G s"„„°° T" ys 41 runt Ph `�6 lrust 81 35 Jensen Bros Inc �C = H NN OCK LN so s � 1 4 — ' f0 1 6 113 CHAPMAN � cRactes w a $ ` � �y DR =I a+ ` webs0" 14 C ` t0t t 1 N n � a 2 3 G Gladys TROLLING Guy & gyp 'd Chapman w r Marlene Trust 248 ME iDRADOW Du os \ dd 158 g o sal j 81 Orin & 90 Ram w^ r u se,a6ly a setae Donald No Brown rman ` m i e a E� f 165 Johnson 86 1 18_8 ea r naMr s An _ aniel Sue Carl 8 12 - — _ D • S - — - C & C111 - — < Romo a D wn Warren 4 KBkarn g�:e "� ° . 43 40 "` u 40 40 74 4 HB)s i 2 )aI 14 Larry Inc � � D" 4 i o L Bauer ( University 156 r 41 38 ' Of 155 a Daniel & 0 6 y� ^ BJERSTED Wisconsin nc l `vR 65 Teradta ¢ o , LN �a Philipp & o s i Pearson Ch w sl > m Patricia 1 N . ti b wae• � M p 65 ! 159 O>Ay+ O " eisen 11s 241 _ 147 57 1 — Orin & tr i '� David & PPatrida J hn on i w Cernohous z I Iiln & z I et - 20 Ch $Bross _J Er x 80 40 2 75I 54 97 \ loo 1 1O MM 160 0 010 R6 Q ¢ 9yx�s ta 33 Trust 96 g" M = 201 2 r b 194 LD u C U1 ry 25 2 7C I George q fd` RD M 3 � Nelson 188 135 TB 6 VGR6 -- 6 M o GOLDEN ACRES RD PIERCE CO. 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