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HomeMy WebLinkAbout040-1019-40-000 n CO) p n CO) 0 3 b n d o A ... (A T, - +n Z O W S S y Z N -i O O r f O OD C11 d. > > N N CO y d a CCD N CIt 7C -� W `A\ c Cp p CD "'� -' ° *% 1 l o o n cr CD y o Q a N °' o rn b t Cl coi m m m p C =' o w Q I 3 o ^' 3 N 7 y j O C y lCD UI y CD CD cn a co co (D W N w S ] N c S CD CD N 3 n • ' cs ? COO `G o CD W W w O L OD O p7 j 0 N o o a y o o a N N j Z 0 0 0 0 0 0 M � ' o z a o C n cn N a < z Fr CA Ch Ch Or o ry o a v v v rn 3 07 v v v rn O tai Ln t'p - O e�D cn CD 3 .. m o :3 m > > N N z z z w z 0 0 D D Q 3 . o C +�� 0 1 y (n M m m m :3 c c CD w �' n n a n 3 F 3 z m CD - Cl) y c w o a ?' G j. co � w ao CL a z c 3 c 3 o " o rr co y y z ! m zt D CD ? C4 m w CD D 3 D CD CL CC CD CL C O G j fl. G v CD �', c v CD Z a 3 z a CD N F, N CD S N y CD n A CD �C 3 N CD CD ti CD ti 0 ~ ti o 0 a I I ti I o o CD ro a v �» O o O o ° CD g a o o CL ° o s Parcel #: 040 - 1019 -40 -000 07/18/2006 08:09 AM PAGE 1 OF 1 Alt. Parcel #: 04.28.19.631 040 - TOWN OF TROY Current X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner NANCY L PRAUSE O - PRAUSE, NANCY L 515 OLD HWY 35 S HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description " 515 OLD HWY 35 S SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.480 Plat: N/A -NOT AVAILABLE SEC 4 T28N R19W 2.48 A IN SW SE LOT 1 OF Block/Condo Bldg: CSM IN VOL III PAGE 812 ORD Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 04- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/29/2005 801738 TI OT/23/1997 820/130 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.400 54,500 125,300 179,800 NO Totals for 2006: General Property 2.400 54,500 125,300 179,800 Woodland 0.000 0 0 Totals for 2005: General Property 2.400 54,500 125,300 179,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 304 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 -AS BUILT SANITARY SYSTEM REPORT OWNER 4!„'. �� ' TOWNSHIP aC SEC. T N, R W ADDRESS ST. qOT CO UNTY WISCONSIN. SUBDIVISION i 4 7 LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Tv FT I 1 1 I ,i 7 E Iindftade No thj Arrow 1' S CAL " = y�L� ' i —' SEPTIC TANK(S)MFGR. /�` CONCRET STEEL NO. of rings on cover z Depth PUMPING CHAMBER SIZE PUMP MFGR. _ MODEL NO. GALLONS Per Cycle TRENCHES NO. of widtri length area BED NO. of lines `, width �, Iength E area e; depth to top of pipe NUMBER OF SEEPAGE PITS Outsige Ji ameter total pit area AGGREGATE 1 �2 PERK RATE AREA REQUIRE AREA AS BUILT y Disclaimer: The inspection of this system by St. Croix Cbuhty does'not imply mP complete compliance with State Administrative Codes. There are other areas thn P it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. Vcause if failure is noted the County will make every effort to determine failure.. GREASES AND OILS SHOULD NOT BE DISPOSED THRSYTEM. INSPECTO � DATED PLUMBER ON JOB � LICENSE NUMBER ���s REPORT OF INSPECTION - .INDIVIDUAL SE(AGE SYSTEM Sani taty Pe'.nmit State Septic AMr ME& Town4htip ' St. C n a.LX County' ov s 4t) .S �' S e cxL c o n L u t L S ub di vi,6 i o n I:PTIC TANK S i, ze gatto Numbers o S eampa4xmen-t4 1 i t anee. 6 4om: W lv 0 B u-i t ding L 12% 4 t ope Highwa,ten �- (IMPING C HAMBER S 4- z e. ga nb _ . .Pump Manu 6actunen Mo det Numb en ,)L.OlNu I ANk Size gatton4 Number ob Compaktment,a Pumper A Sy4tem r d tance bnom: W ett Building 12% 4tope_ H.ighwa.ten iisORPTIO SITE A•.� / 4 Be d ' Tr e nch r rtitance 6nom: Wett k o Bai4ding 121 6top,e, H.ighwa-ten -- 1 1`�;OR1'TIO SITE DIMENSIONS Width o j .tneneh L E 6t Re u-i.ned{ anea (o / S >S Length o6 each tine � ® 6t Depath a nacft b etaw x�to /� in Nurnbe.n o6 ti-ne4 Depth o6 rack oven Cite in Totat te ng.th o6 Zinea 6.t Depth oS tite betow g r ade i Dis lance between Zine4 It 6t Stope o6 trench Z in. pen 100 6-t y V� T u tat ab4 on .t.ion anea Q R' b p >S� Type a� Caven: Paper an raw.. 3 • If DIME NSIONS Number ob p.i.t4 Gn.avet around- pi-t4 ye4 no Ou.taide 'diame.te4 6.t Dep-th below intet 6t To,,tat abb onp-t.ion anea 6t An.ea &equi&e 6t N.tiP1 CTED BY TITLE 1 DATE 198 t J1 CTE.D DATE 1 IASON FOR REJECTION u 1 X477 - REPORT ON INSPECTION OF SANITARY PERMIT # c;L9Z_5 (1) Name and Address 9f Permit Holder Person /Persons at Site (2 )Date of Inspection / Time of Inspection ame, Aaaress, LIcense No. 01 In a ing plumber Z�cJWi�� (3 )INSTALLATION CONSISTS OF: ❑ Septic Tank [] Seepage Trench []Dosing Chamber F - l Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System B ENCHMARK: Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? []YES ❑ NO 8 HOLDING TANK: Manufacturer of gallons ; construction ; depth to the cover ft; If septic tank is being used are baffles removed? YES []NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? [ ❑ NO; Wired? []YES ❑ NO; Locking device on cover? []YES ❑ NO; Diameter of vent and material Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe - elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? []YES ❑ NO Floodplain? []YES ❑ NO DILHR -SBD -6095 N.0 /8 Signature of Inspector p State and County State Permit # �� Permit Application County Permi # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: I rL T � s � c.�� c , . B. LOCATION: 14clu '/ Section 4 /, T.."N, R E (or) Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township v C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance ' Single family X _ Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY ' 1 4 0( (A Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concret Poured -in -Place Steel Fiberglass Other (specify) New Installation _ Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLU NT DISPOSAL SYSTEM: Percolation Rate - Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: Length 3 Width_ fk_ Depth =_Tile depth (top) f ` No. of Line �3 Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of lan Z Distance from critical slope WATER SUPPLY: Private I,PO Joint ❑ Community ❑ Municipal ❑ O nam a Ii on EH 1 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified Soil Tester, _ NAME 4 C.S.T. # , �j� �J �� and other information obtained from owner /builder Plumber's Signature ' MP /MPRSW# U �� Phone Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. 4` 3 , -. e rr i , a , , _ x e` r _._ s r i E E u z k r , i 3 e , i E ; • 3 s , r Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONE Date of Application 9'30- ff& Fees Paid: State .,,_ County J Date � 3 Permit Issued /R ed. (date) 9 3d -ee Issuing Agent Name ,[ / Inspection Yes No State Valid# Date Recd 1. county (whit copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4, plumber (canary copy) Revised Date 7/1/78 6— -- EH 115 (11 -74) ROT-E; 71-� /5 'VVi9-S DONG' M WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES eeomg MI?,KET'0 7 y �DIVfS10N OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 /`JO fII40 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS N PERCOLATION A D T.E�STy�S� LOCATION: �.� Y4, C' /4, Section � T , R�1 CAW, Township ty 1 �� +� I �V M A-P YOt_ � Lot No. __L___ Block No. � t O /�� Sub 'vi ion Name Owner's Name: P / I G SO k9 ' w V O SO AJ ,� A& Mailing Address: T. � 3�S TYPE OF OCCUPANCY: Residence N of Bedrooms ��it' �S 80 /'�► ��. o. Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS 7 90/76 A PERCOLATION TESTS A SOIL MAP SHEET �21 SOILTYPE N SOIL( 02 I t) — PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P -1 AM45 l'� i*r* /Z vuE 3 7y S P Z ��, s— Out P 3 34 �v % z % 7 ,7�� 3 y SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B _ 1 /l!C/�/C ?8 L 3 'D., B - 3 89 t_%, Sgj T3 S� - 5d;, rjI1 7 V_Qo Z- S 1 Only t > $ 1_-5,S O 2_4-" �P 8 ONE ;*8 LS - 3 G3 n S ,' t e` L� PLAN VIEW (Locate percolationtests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. 3600 SQ. F:r, S <T AIdg. 4r' Indicate scale or distances. Give reference point. Indicate slope. 3 5 ¢ P P J-4 N _ It Ail or P Q P N � N neg.. d 10 4-C c. 1 � 6 w V AI � Iq z t N r o' ro a - Z 2 Z � 2 L 0 0 I, the undersigned, her y certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) JAMM �-_• 1ZLro4 Signature Certification No. Name of installer if known Copy A - Property Owner : i 1 f 1 t _ , ; • 30 f i t , f d - / . t r i f i, 7 S y�p� /Gi 75*!!'��/ I ' OAF i , i : I I I • • f , a _ < r r ! , i , i �j E , / { E� i 1 I rI JIV , 1 - ; — r „ e , , f • h _ . 1 r a a _ P - _ f r j x. i i I r., : _ I I ' .L. I � 1 h - I Y 357297 S ST CROIX COUNTY URVEYOR'S RECOR CERTIFIED SURVEY MAP PART OF THE SW 1/4 SE 1/4 1 SEC. 4 T 28 N - R 19W TROY TOWNSHIP ST. CROIX CO. OWNER : BERNARD MC SORLEY HUDSON WISC, SURVEYOR: MARTIN HALVORSEN HUDSON WISC. 4 FILIED JUN 4 1979 AWN of ODOM of N �, BEARINGS ARE ASSUMED AND ARE � REFERENCED TO THE EAST LINE OF THE SW SE, SEC. II E E NORTH 200.00' 1/16 TH LINE ..�..�.__. O 19 0, 00� " x.10, p p' 9O O N w 0 Q: 0 It Q ° to In 0 co � SW SE �a�taa u, 10 c 45'X 85' a W. ROAD EASE:* w HAL 01 0 T k WSONI 5 -t3p2 z SOUTH �S 0 � ` �i kD SUR ` 0 1 4 C 1 OO.00h co Ilar��i s� o� s MI I, JULY 28, 1978 U)l i , w 0 REV. OCT, 12, 1978 33' I ' a - z REV. OCT. 25,1978 v0 0 - LEGEND — 0 - - --- EXISTING I" DIA. ROUND IRON PIPE 33' --4-' `" 0-N 0----3/4"X 24 ROUND IRON BAR SET, 66,00' 'PRIVATE —�►; i WT. 1, 50 LB: / LIN. FT, ROAD R/W 1 0 0 do 0 200' 400' 600' (EXISTING ROAD); c0 0.. f i O3.65_'� po 8. SCALE: I"= 200' 66' ACCESS EASE 89;1 5�op E 00 0 N S _ - _-•10• 8 MENT 66 9752 5 , 5$ E .�— -4 19 , /�, 0 '` --- T". 35 SOUTH 1 /4 CORNER SEC. 4� T 28 N R 19 W 4: COUNTY SURVEY MONUMENT APPROVED APPROVAL OF THIS MINOR SUBDIVISION 07Y 17 19 DOES NOT MEAN APPROVAL po ..,�� BUILDING SITE OR SEPTIC SY6TEM. R ST. CROIX COUNTY REFER TO H62,20. COMPREHENSIVE PARKS PLANNIN4 AMC AGMING GGM (OVE R) Volume 3 Page 812 I D qU lU! 9 - o --6o 0 STC - 104 AS BUILT SANITARY SYSTEM REPO# �W ��Q Usk j > , ' f y FCEIVE& OWNER A /" 1 r° j ADDRESS 5 (S rol- ST PO � # saw to tf * SUBDIVISION / CSM# `�" ` LO SECTION "( T 2 9 N -R / W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �'�.. 7'� A P014).V -�7 7E4� h��1 P ? E x-e- 4� go poc INDICATE NORTH ARROW rovide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic .tank manhole cover. ` ORIGINAL I ' r ♦ " w 7- or ,s - F4 , .;& 4 •ti s� G7% o,�J BENCHMARK • P/ Q • 0 ALTERNATE _BM: T OP "I SEPTIC TANK / PUMP CHAMBER / HOLDING.TANK INFORMATION Manufacturer: /�5� ( ?� Liquid Capacity: / Setback from: Well ?,S House 3 (j Other Pump: Manufacturer Model# Size Float seperation Gallons /cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: 3 Len th & O p Number of trenches r 2. g Distance & Direction to nearest prop, line: 3 7'� SO t9, Setback from: well : y /d D House l� Other 7-1A) ELEVATIONS G Building Sewer N ST Inlet; ~/4- ST outlet ! S Z PC inlet PC bottom Pump Off Header /Manifold Bottom of system SE"t� C PC a�- Existing Grade Final grade DATE OF INSTALLATION: / �'f 4 � - f/ PLUMBER ON JOB: �� EEI` 24 LIS R ( Ct LICENSE NUMBER: ZZ U S INSPECTOR: �� U 1'A) 6 � ed 7,( 3 / 9 3 : j t /� C • r P607 RL1,4A,) L O 1 f3M 7vp /fk /fit Cos 7 �,vs ` r J- 00-f�,rr,� O t i�TijcT` �� , y , /y01��� k V1,4 v.¢ f �a �E car -- - - - - - - - •�' �� ���, g� �/� I s c I 1 i ° i.� sa�`� � o /l� �►� o vT�� rS - i �y.S s STS M W. � fo, l I 10 m 5Y,57 a YS T y34� OA r� I3 �RD� Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitai fln teo.: Personal inf °oration you provice may be used for secondary purposes (Privacy Law, .15.04(1)(m)). V JiSJ 4 rause, Howard ❑City [] V�I % lim "ghip State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel 6WA- b19 -40 -000 1 00,0 uo • ' Csr r-c* ( IJ�+V I TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W E( ��y 000 Benchmark 3 -(2- 1b ; a-p , D Dosing Alt. BWI Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION 01 Ht Outlet 8.1 9S. 3o TANKTO P/L WELL BLDG. ventto ROAD Dt Inlet Air Intake Septic O r -'S r 3 S NA Dt Bottom Dosing Header/Man. Aeration NA Dist. Pipe �. ca 9Y• r Holdin Bot. System , 31 Cl 3,0 ' PUMP/ SIPHON INFORMATION F'na Grade M ufacturer �nd Model mber TDH Friction System TDH Ft gQ •3L 9 S% to r 4-L S Head Length Dist. To W ;;{• p , g0'K 42 rorcemain SOIL ABSORPTION SYSTEM ffi) amx ai j, BED/TRENCH Width i Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufac�rer. S SETBACK CHAMBER bk INFORMATION Type Of ► r f o e Num er.� System: epwV. 1 3 t5 4) OR UNIT DISTRIBUTION SY EM L0-6 S• PlL Header an old S Distributio e(s) x Hole Size x Hole S Vent To Air Intake L 0 ia. - Iii ength Dia. Spacing OIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over � �f Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center (o Bed /Trench Edges Topsoil Yes ❑ No Y No /CO MMENTS: (Include code discrepancies, persons present, etc.) of Location: 515 Hwy 35, Hudson, WI 54016 (SW 1/4 SE 1/4 4 T28N R18W) - 0428196 -Lot 1 1.) Alt BM Description = /1/f A , 4 2.) Bldg sewer length = ? -� �,� 36 ",, - amount of cover = cam- s+.- A I* 2oc� 4t? & j • -. C& wig• S.:Q stt5 c alf A ( It 2 06 1 Plan revision required? ❑ Yes K No tM� Use other side for additional information. 14��J gnatur Cert SBD -6710 (R.3/97) Date Inspector's Si ' Sanitary Permit Application S ety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for co this a ation lVisconsi p PO Box 7302 Madison, WL53707 -7302 Personal information you provide may usddfor secondary oses Department of Commerce [Privacy Law, s. 5,0 x )] (Submit completed form to County if not �.., 1 m ti state owned.) Attach complete plans (to the county copy only) f system t less.tham8 -1/2 x 11 inches in size. County State Sanitary Permit Number ❑ if revision to previous application! State Plan I. D. Number I. Application Information - Please Print all Information Location: Property Owner Name - ' : 6FJ &X ! Property Location OW ?� COUNTY /lI � ZONiNGOFFiCE S S T 1/4 1/4, S N, R E (or W Property Owner's Mailing Address ; ., , /' Lot Number Block Number S/S City, State Zip Code Phone Number Subdivision Name or CSM Number v pso.✓ Gtl� 510/ ( 3 -81 II. Type of Building: (check one) ❑ City Cj 1 or 2 Family Dwelling - No. of Bedrooms : ❑ Village Public /Commercial (describe use):_ RITown of 7k O v ❑ State -Owned Nearest Road 3 S Parcel Tax Number(,) III. Type of Permit: (Check pnly one box on line A. Check b ox on line B if applicable) L e, Z 3 , A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) K Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: Z Z I. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade ✓ Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) F , Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks o ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the under signed, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no stamps): JMPRS No. Business Phone Number �Ow-r 3 2 1 1 1 - ;�P6 - (�N -S Plumber's Address (Street, City, State, Zip Code) CUSS O' y� <l�li� fD lam/ . S��j IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issum gent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) }� L Determination ;` 4 a X. Conditions of Approval /Reasons for Disapproval: -7o, c C j: a � ��r✓ �C ins�4l /�� 4f1Gl('07 11 "V X1 Gin Lc � SBD -6398 (R. 07/00) LBF1ICI-i1 & ASSOCIATES CO. ' 655 O'Neil road • I Judson, WI 54016 fieg..nestgners �� F.ngineerin9 Sys Private sewage consultants ' 715 -386 -8185 PROJECT INDEX PLAN ID # DATE OWNER PHONE l �� ADDRESS S/5 LE GAL DESCRIPTION Z-0 7 �'S'iy 3 S a f 7 TOWN OF � T/2D _ COUNTY CSTM R 211164164 % ZZCe 3 � S LOCAL AU'TIIORITY/ SUPERVISION ,ST• �j )( GJ`� � v/ PROJECT DESCRIPTION! 4y, Yo /S ae l e-e- - 2ef( 1,5tZV S7�p_� S . Gv, / Ik ' tee . ` 6, 7', SYS Fr - Ulbricht & Associ Private Sewage Consultants ates ®66 O'Netl IS. 54016 7a;�4 , _s , t� 315 Pg.l INFILTRATOR SIZING WORKSHEET P9.2 SYSTEM PLOT PLAN P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. ZIP Pg . 4 11 to It It " It P9.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS P9.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS. 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. rn� kA Ix cnm o � � Ll\ Rr �. p w o ��, �►1 2� I T� Ot . , a � /D� �7� I iNS���TI a,o, o f i t fAW ( 30 , o ��N JM� � 70 gel S Y57 5 gall 13 C.0 t f3 i feo�► /5'6'0 , � I N i ' er • P`Pet � gl S �3 3 x 0 \ i O 13 z tp r b ri 57 o b ,3fff3 O jA PP iff N _ L 13. c S TA M y �i,�v, 9'a • O Ciao SS S�� TioA) w SQ. FT, rf mov � � �i i! T y� U v off �. "2� f iivi S fiED 9 A Tim OVER: See Reverse Side for Vent/ Observation Pipe Details. An observation pipe may serve as a combination observation/vent pipe providing it terminates in ` the same manner as required for vent pipes. See Figure 6. - Vent cap. Relurn bend / Cap r - j 12" n►in. 12" fill". — Final grade Aggregate Distribution lateral i h►p typ. \ System elevation Figure 6— Vent and combination observation/vent pipes Leaching chamber tops are at or below the original grade. Leaching chambers are placed directly on the bottom of the distribution cell. The locations of leaching chambers are in accordance with Table 3 of this manual. I Observation pipes are installed in the distribution cells and are provided with a means of anchoring to prevent them from being lifted up. Observation pipes extend from the infiltrative surface for stone aggregate systems or from the inside of leaching chambers to a point at or above finish grade. The portion of the observation pipe below the distribution pipe for stone aggregate systems is slotted while the portion above the distribution pipe is solid wall. Observation pipes for leaching chamber systems are attached to the chambers in accordance with the chamber manufacturer's printed instructions, extend from a distance.' flinches above the infiltrative surface through the top of the leaching chamber up to or above finish grade and terminate with a removable watertight cap. All observation piping has a nominal pipe size of 4 inches. See Figure 5. Water tight cap Top of 4" min. dia. leaching Repair couplings chamber �- Slot 6" min. 6" min. Intiitrativo surface d" min. Water Closet Collar Haw Ps' min. dia ) Figure 5 - Observation pipes Vent pipes, if installed, connect to the upper half of the gravity flow distribution laterals and extend up to at least 12 inches above finish grade. Vent pipes terminate with the vent opening facing downward by the means of a vent cap or fittings. Vent. caps must allow a free flow of air between the distribution lateral and the atmosphere. All vent pipes has a nominal pipe size of 4 inches. ' PAGE 6 REVERSE SIDE OWNER's MAINTAINCE OF SEPTIC SYSTEM N= POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic g p o is 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 5 * Governmental authority/ n y/ spectors: 3 �� g * Licensed installer, responsible for providing an operation/ maintenance "Users" manual: X20/3 �� �� i3/��' i 3 �'� • /�5 * Licensed servwce / inspection agent other than installer: Al 3 S>6 ' /3 a * Electrician, for pump, electric controls, wiring units: IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic (sledding, shoveking, etc.) across the area shall not be permitted, or frost can /will penetrate into 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 [��-� 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 J 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 t0 maintain a grass cover. 6. Periodic inspections by 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 tip - for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly qualified person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. A,t&e-1 7 C t , & Ile- /;n 0 ,eZe 0 l f I I F OO r • Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code - Go Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must s T Gt,.o /' K include, but not limited to: vertical and horizontal reference point (BM), direction and Parce.11 ,. Q(�a percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. R r by Date Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.04 (1) (m)). /,"17 revNALU 4.&;L 3 Property Owner d q ,Q ProQertyAjxation - Q ��u)/t; ? /(� I � IS� Govt. Lot 1/4 Sv1 /4 S T Z Y R // E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# Sl S • 3.5 / GSM 3 5 72 47 0 0 City State Zip Code Phone Number ❑City ❑ Village [,Town Nearest Road wi. s ya / � ( -71S 3196 ' 6 �Y "o #WV 3 s ❑ New Construction User Residential / Number of bedrooms ,3 _ Code derived design flow rate GPD K Replacement ❑ ��P,u�blliicc or commercial - Describe: Parent material 1D ESS OyCiE' 5,412 W Flood Plain elevation if applicable it. General comments �J and recommendations: A& S ©�(� / y -- �� /S 7`/�� 5����yLL C 1��� �� eo. WT /ze • - ;Yf-C /' © Boring # Boring r Q D� N .-Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 ;E;f 2 i ' /3 - /O / y / L / fS,6t�C .h t � S 2- - 2- L / • L3 6 YA 31 / L Im f• CS / - S 3 • z -/o M f14 /fJ11le /;m7-" c5 y oC l• 2 Boring # Boring Zo Z ❑ Pit Ground surface elev. I ft. Depth to limiting factor /S D in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 � o'�y- /o /� S/L /ff �t�' s Z� • z • 3 Z 3 4' z xh, /7c . S 2z•3 3 1 /o SL / tm- _ o /0 •S O, S • 7 q 2 - 0 6Z Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L ' Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg/I. CST Name (Please Print) Signature CST Number Address Date Evaluation Conduced Telephone Number 7 rS 30G '� /�S Uibricht & Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 0 Property Owner Parcel 10 # Page of F-31 Boring # ❑ Boring j7,6& '// L9 In. , Pit Ground surface elev. ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 / p - /S_ /old Sit' /-fs ��' �,,� Z . Z • 3 7 13 V�- 5 Z- 17 I 9 s e s • D, S • ? �• FO Qz -o Boring # ❑Boring � Q y Pit Ground surface elev. ft. Depth to limiting factor �` y in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2 � o •,� . is -- / ifs �►�`� w 2 . Z . 3 y 2f /f S D 01 L / n3� �' G _ • Cr Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L ' Effluent #2 = BOO, < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.6/00) i O ' 27 -rot of yea WS1� S p r fAi 3 Li � �5� � 7_ � (30 ,► s y feo� rs8o VC-Q r ------ - - - - -- l y J3 ' o ' JO 4 j 57 .0 r I / r P Of F� ,3of 3 — ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I/Jehave inspected the septic tank presently serving the �/ Q /�/I� C � s residence located at: .S 1/4, SE 1/4, Sec. T Z Ip N, R l� W, Town of _ 7 i Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. goo / Last time serviced /wOr ` doo Did flow back occur from absorption system? Yes X No (if no, skip next line) Approximate volume or length of time: 0�0 f gallons minutes Capacity: Sa Con struction: Prefab Conc rete Steel 11 //Other Manuf,acurer (if known) : 4V /"_ ti A'S � Age of Tank ( if known) : �,O , �f�l D/e G T�/� C•x. (Signature) (Name) Please Print iV o i uS� (Title) License Number) ber) (Date) Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR -83, Wis. Adm. Code (except for inspec opening over outlet baffle). / Name oSiE - R ?1z-M1a7 ure ,3 /MPRS 2 ' 2 0 3 7S r � 5/88 � ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT .-- --.. -T AND " OWNERSHIP CERTIFICATION FORM Owner /ice Mailing Address sus 3 S , �OS�� LU %.S • S ��` Property Address (Verification required from Planning Department for new construction) City/State Y Parcel Identification Number LEGAL DESCRIPTION Property Location . y S y, Sec. -( , T 2 1 N -R W, Town of Subdivision , Lot # Certified Survey Map # 3S'747 , Volume 3 Page # Warranty Deed # j�� 5 , Volume 9)-0 , Page # Spec house El yes O no Lot lines identifiable Kyes O no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system 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 e g Department a certification form sig b t h e w t; P g y e o ner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNAI F APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) 9m (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. _ / fit/ Q� SIGNATURE O LICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * "" ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed t I 9K 820 PA"E 130 f y! , '! STATE TWO $PACg RLatRYgD FOR MCORDINe DATA II ;1 DOCUMENT NO. ; BAS OF WISCONSIN FORM 1 —!ice WARRANTY DEED i REGISTER'S OFFICE Ws Deed, made between . 't�:S. R. Wli�xi{ ..a[ld.............. ST. CROIX CO., W CA I.it,...WWUM,..husk ed_arld_Sri eA .......................... Recd for RRCOrd ...., Grantor. y(l(: IJQV and -. H3ih Q.R....PRAUSS.and. °NL. PRAUSE,..husband and..Wi e as sucviarshia marital.., of 10:30 A M - .................... . .. ........... . .. .. .....I......_ .. -- . ....................................... - 0 & , .A ............ ............ .................... ... ..............I..............., Grantee, Register of Deeds Witnesseth That the said Grantor, for a valuable consideration...... of.. Sevventy :-flve. Thousand , Hundred . and - na/100..4$75,.900,j ----- - - - RtTIUN TC conveys to Grantee the following described real estate in St.. - Croix - .. .... ......... County, state of Wisconsin: Parcel 1 of Cerafied Survey Man filed June 4, 1979 in Volume 3, Paqe 412, Document Number 357297, in the Tax Parcel No: ................................... office of the Register of Deeds for St. Croix County, Being a parcel of land in the Southwest Quarter of Southeast Quarter of Section 4, Townshin 29 North, Range 19 West, Town of Troy, described as fol�ows: Cmnencing at the South Quarter corner of said Section 4; thence North 8 °55'00"E (assu►red bearing) 975.20 feet to a 3/4 inch iron bar located on the Easterly right- of-way (R.O.W.) of State Trunk Highway 35 (S.T.H. 35) the point of beginning of this description; thence N89 0 15 1 00" East 518 feet; thence North 200 feet; thence S99 0 15'00" r4pst 559.40 feet to the Easterly right of way of State Tank Highwav 35; thence along the Easterly right of way of State Trunk Highway 35 on a carve deflecting to the left, having a radius of 2,794.93 feet and a chord bearing s ut`1 11'45'00" East 203.65 feet to the point of beginning. Subject to a roadway easement over the Westerly 66 feet of the above parcel. 7)GL17IM : 4TnM and SUBJECT TD an easement 33 feet on each side of the North line of the above parcel and all of the rights and obligations of that certain Roadway Agreemit which covers that easement, dated February 19, 1979, recorded March 7, 1979, in Volume 590, Pages 465 -469, Document Number 355517. SUBJECT TO easements, reservations and restrictions of record. This -- ....-•�-- .... -....... - homestead property. TRANSFER (is) 4" not �10 Together with all and singular the hereditaments and appurtenances thereunto belonging; And .... J�S..R...WidikQr.. and -. Sharon. K-.-- liiTidilcer _.- ------ .. ... ........... • - - - -•- -- - ....... ............. . -- - -- warrants that the title is good, indefeasible in fee simile and free and clear of encumbrances except As set forth above. and will warrant and defend the same. Dated this .. ...........15th........... -- -•- ... day of ......... S-- ----- ----- 19.88.... ----------- -- ------------------------- (SEAL) s....rc v ...--- - -•... (SEAL) -• --------• ......... ............................. .. ...... . James R. _ Widiker - - - - - -- --- •- •.... -- .(SE,AL) _ ................. (SEAL) yQ/�Q7tJ 7T. - • ,Sharon K...YiidlkPr__ ---- - - - - - C .• v AIITHBNTICAT]ION ACHNOWLZD(}� —s to lNT Q ! t,l C) S < J ---------- STATE OF WISCONSIN .. • CADIX County. S j n� authenticated this ...,..-._day of•............. ..... .. .... 19. _... Personally came before me thi .• 15th - of August lg 58... the above named James R. Widiker and Sharon K.._. Wid er TITLE: MEMBER STATE BAR OF WISCONSIN .......... .............................. . ......•••••• I ........... (If not, ............................................................ ........................ ..................................... -- ............ authorized by 1 708.06, Wis. Stets.) to me known to be the persons ----------- who executed the foregoing instrument and ack / nowle t e same. THIS INSTRUMENT WAS OR4FfED BY /- William. J. Gilbert ........... .. . •_.._..._...... -- . Marlene M. Peterson GILBERT, MUDGE, PORTFA & UMEEN ...... .. . .... .. ..... . ...... - - St Cro ix ---- County, Wis. ...... ... . ...._.. . -- -- ... ( Sign a t ures ures m Streets Htxx or ac kn ow ledged. Notary Pablic ... Bo My Commission is permanent. (If not, state expiration (Signatures may be authenticated or acknowledged. Both are not necessary.) date: .. .......... 4 -5— --- ---- - -, 19.9 er( of peeaona signing in any capacity should be typed or printed below thoir signatures. CTATC RAR OR WISCONSIN K iecon,in Leval Blank Co. Ino. WARRANT! DBED F0I475 Nov i --1982 Mil —skee. Wig. 357297 . CERTIFIED SURVEY MAP PART OF THE SW 1/4 SE l/4 , SEC. 4, T 28 N - R 19W r TROY TOWNSHIP ST. CROIX CO. OWNER : BERNARD MC SORLEY HUDSON WISC. SURVEYOR: MARTIN HALVORSEN HUDSON WISC. FILED JUN 4 1979 am of Gomm how ro �� _ BEARINGS ARE ASSUMED AND ARE a9:0�c�, REFERENCED, TO THE EAST LINE Wbm"b OF THE SW SE, SEC. 11 E NORTH 200. 190.Od 'a.I0.00' 1/16 TH LINE .9 O o Nw o 0 o J Q o In I �r $ W o ti o _ v Q �; SW SE ian�pai cu Ki r''g0 < L CL w ROD EASE W HAL 9 MEJVT _ _ k .UDSON# O' o h $ O O &i S -t302 - ;Win Wi& off ` o q �+ SOUTH �i O suit ' aoI ; 200.00' m hi t I e ah iN �i + '�S• ° JULY 28, 1978 $� i -- Ul o REV. OCT. 12- 33' '+- J Q - Z REV. OCT. 25,1978 I 0 UCO o — LEGEND- - ci N °0 0 - - --- EXISTING I" DIA. ROUND IRON PIPE 33' --• - - a- 0 - -3 / 4 " X 24 ROUND IRON BAR SET, 66.00 PRIVATE- --0J, ��- / �\ WT. 1.50 LB. / LIN. FT. ROAD R/W ��0 h� 0 200' 400' 600' (EXISTING ROAD), i � O. p 9• SCALE : I"= 200 6 5 66' ACCESS EASE- 0 p'E MENT 66' IS 8 9 . 1p. 00 N 8'55' E - ---- -- -4 193. — 20' O —�: ""' STH• SOUTH 1/4 CORNER SEC. 4 T 28 N R 19 W COUNTY SURVEY MONUMENT APPROVED 07 u-- APPROVAL OF THIS MINOR SUBDIVISION Y 1 1�1� DOES NOT MEAN APPROVAL FOR BUILDING SITE OR SEPTIC SYSTEM. ST. CROIX COUNTY REFER TO H62.20. COMPRIMENSIVE PARKS PLANNING AMD 10MING GOMwnn Ave e t Volume 3 Pave 812