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HomeMy WebLinkAbout040-1021-95-000 n v, 0 C m n o d: c d o d c CD m v y Cn co (D cs c \ Q p (D p p CO C N N (7D j v CO t °O T, p CD o w 3 a n o v C:) j N A ° t�rl1 N (0 d CL 41 0 °O (D �.""� Z co O p ' V i N N = v N ° ° fl. N p C D o o j a a O O O �• C , * -1* s A c y CA� ° D c , W ' CD T D1 Co ? A 3 N N z a? z z o y m 0 N O Z O N N �' 3 ly • m T m e N CD CD N c to a CD (D -1 fn o '�' Z C a a C I .. Z (n oov mPQ a Z " 3 � x C '. (n � C N C7 (D p O p� n (D U K � I 3 a) r. 2 O p — =3 T O N C Z p 0 o w (D R N S I r w N O O O 4� o D o p .,, Parcel #: 040 - 1021 -95 -050 12/1312007 10:01 AM P 1 O F 1 Alt. Parcel #: 05.28.19.73B -10 040 - 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 O - TULGREN, FERRIS R & KATHRYN B FERRIS R & KATHRYN B TULGREN 449 TOWER RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 5.643 Plat: 3642 -CSM 13 -3642 SEC 5 T28N R19W PT NE SW BEING LOT 1 CSM Block /Condo Bldg: LOT 1 13/3642 & INC PT DESC IN QC 2197/366 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 05- 28N -19W NE SW Notes: Parcel History: Date Doc # Vol /Page Type 09/05/2003 739006 2402/099 QC 04/07/2003 716253 2197/368 AFF 04/07/2003 716252 2197/366 QC 07/23/1997 922/251 more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 208437 234,600 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.643 67,800 141,400 209,200 NO Totals for 2007: General Property 5.643 67,800 141,400 209,200 Woodland 0.000 0 0 Totals for 2006: General Property 5.643 67,800 141,400 209,200 Woodland 0.000 0 0 Lottery Credit: C l a im Co unt: 0 Certification Date: 12/04/1998 Batch #: Specials: User Special Code Category Amount I Special Charges Delinquent Char Special Assessments Sec Ch es es D p p g q 9 Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division y St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT ) Sanita i No.: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)), Permit Holder's Name: ❑City ❑ V' a e ow of: State Plan ID No.: Tulgren, Ferris 1 ray owns` ip CST BM Elev.:. Insp. BM Elev.: I B4 Description: Parcel b N �- X021 -95 -000 d I . Z(, . 6 ®4 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic < p w P ✓c o f �U v Benchmark Dosi t. y Aeration - Bldg. Sewer cLl Holding V Ht Inlet TANK SETBACK INFORMATION (! Ht Outlet TANKTO P/L WELL B i LDG. Air to ntake ROAD Air Septic po / NA om Dosi �` — "" -- - -NA Header l Man. Aeration NA Dist. Pipe T1 9,i 4 o / i -4-& L b. 6 A P7- . Holding Bot. System �1 �l io. o Z Ala op v PUMP/ SIPHON INFORMATION Final Grade q q 9Y sS Manufactu Demand 5t cover Model Number — GPly TDH Lift Friction SYS TDH F ad - oss Forcemain Length Dia. H Dist. To SOIL A SYSTEM BED (TRENO W width Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM 5- 1 U Z I DIME SETBACK SYSTEM TO P/ L BLDG I WELL LAKE /STREAM L NG Man urer: INFORMATION Type 0 CHAM, I Number: System: (on,() Z f 39 LSD V OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) rr x Hole Size x Hole Spacing Vent To Air Intake Length C� — Dia. � Length Dia. _� Spacing k > `? Z rrj 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 /Trench Center Bed /Trench Edges Topsoil I ❑ Yes ❑ No ❑ Yes ❑ No C O M lu cd co s e a s r n a ns ec ion spec ion Location: 449ower ( �%� /4 5 T28N R19W) - •. 8.19.73B -Lot 1 1.) Alt BM Description = Fo IP o 2.) Bldg sewer length = 0 - amount of cover= /� N T t3 ' l� � 6 vev We a �lv y rrrl/ ���� p �� cal��sec� S ys /4,ttiQad--, y,� Y) SySll h UCQ z� hS�G b 5 e bw =A �� (�k�5><sa..a4'e Plan evision required? tres �[ /No L Use other side for additional information. 6D qA�l of SBD -6710 (R.3/97) Da a Inspector's Si ure Cert No. �k ADDITIONAL COMMENTS AND SKETCH i SANITARY PERMIT NUMBER: y r E .w� } 1 e na a s E n . W G E T�m k F a r j € s a } w r � . e a t w� i ...... _ .. .,m.m.....4, .. s t } w 1 �� 3 W s t � e.n t ,a �. m am u g � m 3 e E � f ^ e s I SANITARY P S afety and Buildings Division ' ESM T ARP CATION 2 01 W. Washington Avenue NV Iscons i n �y P O Box 7302 Department of Commerce ; 1n acdord w9 i 5, Wis. Alder. is ode Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) thiie sys Q- fi on 04 not less County than 812 x 11 inches in size. _F X ; r, : • See reverse side for instructions for completing th State Sanitary Permit Number r. Pel:sonal information you provide may be used for seconds pyrp4 ❑ Check revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLI ATI N INFORMATION - PLEA E PRI FORMA TION Property Owner Name Property Location F r rG 1i4 lJ 1i4, S �' T_� , N, R l E (or)& Property Owner's Mailing Addr@&s Lot Numb --- ---- - Block Number d City, State Zip Code Phone Number Subdivision Name or CSM Number 16 S arJ r lG ( G, q?d� fv C3 2 - 7 7Q /e/1 Z. II. TYPE BUILDING: (check one) ❑ State Owned o C it y Nearest R ad ❑ Public 1 or 2 Family Dwelling Village - No. of bedrooms Town OF V c✓ a s,- a ( 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number( 5 �, I '13G3 - 1 ❑ Apartment/ Condo a ' y a �,j 5 - 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office / Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------ System ________ Syr em __ _____ _ ___ __ Tank Only ___ ________ Existing System ____- ____ ------- System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 12 RSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit I r � � 43 ❑ Vault Privy 14 ❑ System -ln -Fill rj x S �Et VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) R/. 7 Elevation 0 ( y , ?PFeet ?S -5y Feet Ca acit VII. TANK in gallo Total # of Site INFORMATION Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Aper. New Existin Gallons Tanks concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tank 2 ❑ ❑ 1 ❑ I ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewa syste s h o wn on the attached plans. Plumber's Name: (Print) o Plumber's Signature: PO Stamps WPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): d' F 7_ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) (�j Approved I E] Owner Fee) Owner Given Initial (L , Adverse Determination 22-9. #D X. CONDITION OF APPROVA / REASONS F0 DI PPRO AL: SBD -6398 .4/99 , AS TRIB ON� Original to C G 0 a cppy To: LaWuiilclings Division, Owner, Plumber r INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation S. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches friust be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ful vc ., 3 L 46 or BAR o IA B;L rve e Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page ___ of Bureaa of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location e r : ` S Govt. Lot N4 114S47 1/4,S T�? ,N,R ✓ � E (or)6) Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# yY 7`6w e l,- d Gs /,-'I City State Zip Code Phone Number ❑ Ci ty El Village X1 Town Nearest Road e //Cr d s - Q ,r/ GJ �iQ/ (7< ) 3PG � �Y T e 7 W e r ❑ New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ® Replacement ❑ Public or commercial - Describe: Code derived daily flow 6 gpd Recommended design loading rate I bed, gpd /ft trench, gpd /ft Absorption area required bed, ft SG'g trench, ft r' Maximum design loading rate bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) �� ft (as referred to site plan benchmark) Additional design /site considerations f % y Q ✓ aYI �5 sib {p�1 f Parent material 45 /- Ccr ! p e� o 51 Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S❑ U ® S ❑ U KS ❑ U Xs ❑ U I ❑ S JO U EIS R U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground 3 G G elev. r Depth to i limiting q factor j`�in. 3 S Remarks: Boring # 0- . ..... .:: �Y 86 y r �, v" Ground G elev. Depth to - limiting factor & in. Remarks: CST Name (Please Print) Signature Telephone No. Address / Date CST Number PROPERTY OWNER T ic /or�,y SOIL DESCRIPTION REPORT � Page of PARCEL I.D.# ` Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground _ elev. �ft. Depth to limiting fow factor Remarks: Boring # ........................... .......................... ......................... Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # ........................... Ground elev. ft. Depth to limiting factor in. Remarks: Boring # .......................... Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) Ta ve, q e �%� /ofd cs�DQ�f < „o.`.v�/lJ..- /l.E'�eu�dD. / ' "fool-' ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer r l gzke,.) Mailing Address "'1'/ r�'w t' t— Property Address -S s� i -e (Verification required from Planning Department for new construction) City /State Parcel Identification Number D `f I LEGAL DESCRIPTION Property Location / -15� '/4, -t5"4/ '/4, Sec. T P` N -R W, Town of 1 Subdivision . Lot # Certified Survey Map # Volume , Page # Warranty Deed # Q- - 7 - 3 -� , Volume -2 >7 , Page # Spec house ❑ yes ,ano Lot lines identifiable JQ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance licensed r. What you p ut into the stem r if needed b a h umpe y p system of in out the septic tank eve three , Y P consists pumping P r5' ears or sooner, Y can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees Department a certification form, signed by the owner and by a 8m to submit to St. Croix Zonis g eP mastorplumber, 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. Uwe, 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. SIGNATURE OF APMICAM DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by-virtue of a warranty deed recorded in Register of Deeds Office. GNATURE OF APPLIC 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 DOCUMENT NO. VOL 3{]6 PQ�E WARRANTY 8991 J STATE OF WISCONSIN —FOAM 9 273389 TNI3 SPACE MMVM roe 113MOING DATA THIS i(NDEN'I'URZ, Made by Anthony J ZAVRIt and REGISTERS OFFICE Marguerite A Zezza, husband and wife, ST. CROIX CO., WIS. Rec'd for Record this_ 16th_ grantor - _ of _ St . Croix County, Wisconsin, hereby conveys and warrants day Of_ Au_9ust ___A,D.19 to Ferris R. Tulgren and Kathryn B. Tulgren, __ ,., M. husband and wife as at__ .�300 A __ joint - tenants, _ � Reg t of eds g rantee fi -- RET000 TO Of Qt . CrO� X County, grantee Wisconsin, for the sum of One Dollar and other good and valuable r•c pn the following tract of land in St Croix County, State of Wisconsin; A parcel of land located in the Northeast Quarter (NED of the Southwest Quarter (SWD of Section Five (5), Township Twenty - eight (28) North, Range Nineteen (19) West, Town of Troy, St. Croix County, Wisconsin, further described as follows: Beginning at the Northeast corner of said Southwest Quarter (SWI); thence South along the North - South Quarter line of said Section Five (5) a distance of 787.2 feet; thence West perpendicular to said quarter line a distance of 208.7 feet; thence North parallel with said quarter line a distance of 208.7 feet; thence East perpendicular to said quarter line a distance of 183.7 feet; thence North parallel with said quarter line a distance of 578.5 feet to the North line of said Southwest Quarter (SWI), said North line also being the centerline of the Town Road; thence East along said North line and Town Road centerline a distance of 25.Q feet to point of beginning, the above parcel containing 1.33 acres, more or less. The consideration for this deed is less than One Dollar ( ;1.00) and no Federal Revenue Stamps are required. IN TNESS W EREOF, said grantors__ ha MO_ hereunto set their hand and seal IB— this_.L___ day of , A. D., 19 SIGNED AND SEALED IN P ESENCE OF (SEAL) t Zezza (SEAL) Ke H.__Halres (/ Marauerite A. ezza (SEAL) Donna Olstad (SEAL) STATE OF WISCONSIN, - St. Croix B County. } Personally came before me, this 15th day of Aucdat A. D., 196 . the above named Anthony J. Zezza and Marguerite A. Zezza, husband and wife, to me known to be the person S who executed the foregoingl'n t and acknowledged the same. • t5 ' Kenneth H_ Hayes • wY' �A.i✓ i d This instrument drafted by 1Pe "�•,' N Public St . Cro otary County, Wis. a AttO1' r....••' b �, i MY Commission(Is) PB eta Bnt 'i) onsin 9 (Seetloa b9.51 (1) of the Wleeontln BMtnteq provider Its recorded shall have plainly printed inly prid or gperwri ten thereon the " names of the amnion, &ante*, witnesses and aetayy. - 1 WARRANTY DEED —STATE OF WISCONSIN, FORM 146:p; ' J IL e rau■ ca, ■neutu � 9 . S MAY 07 9 tl W d s k e l 0i Dews 6 02 770 '� �,6ro�cCo�W► > CERTIF111- SURVEY w N Kathryn B. Tulgren Part of the Northeast 1/4 of the Southwest 1/4 of Section 5, T 28 N , R. 19 W ,Town of Troy, St. Croix County, Wisconsin. r. I `j� al 1 °r^,�C tir ntr -`r�• nrlSrArCQ� I .� r -- —' —' -- /9 W =Nei • s /'oB E 5292.e2 - -- ;., , _ __J_ — � _ ROAD M T OW ER — =T „ E 288.00 - O �U 87 °5!'08 "E �--- . N 87 °5/ 08 - C-- 58 NB7°5 /'OB "E 234_2.24 _ ' - --� ''� : I N87 °39.49 ^•E 288A3 _ T � I — EAST -WEST I/4GlNE --- —" WEST //4 CORNER — r 1 ?2 v I EAST 114 CORNER SECT /ON 5, T2BN,R /9W I t NS' SECT /ON 5, f SET R. R. SPIKE/ T 2B N , I I R. i /FND.COUNTY O I I I SURVEYOR'S MONJ O_ WNER 9 ADDRESS ° 449 TOWER RD. I EAST L /NE SW /14 HUDSON, WI. 54016 �i /00'Bb /LO /N6 SETBACK L /NE 1 I ii LOT CONTAINS 245,813 S0, FT. I OR 5.643 AC. h = (240,719 S0. FT. OR O 5.526 AC. EXCLUDING O O O ROAD RIGHT OF WAY) I•F 6.3 WwQ I w ? Q EXISTING I I `4 GRAVEL W tl �t W DRIVEWAY QI. �00 I I I I ��O I I � =320 I i ~ I II W CO ' II d ap � 7. 4' SCALE IN FEET / /00 I/ 0 20 50 /00 200 3 t I N VY o L EGEND N g O SET / "X 24 "IRON PIPE o / N ' ( WE'LL DWELL / M ' Ot (MIN. WT. /.13L8. /L. F.) O W 1 CSI O o • FOUND I rr IRON PIPE F 1 1 � 4 I 4A FOUND I -//4 "RE -BAR --1F- FENCEL INE n I SEPTIC I VENT J EXISTING PARCEL `(AS PER PREVIOUS SURVEY) \ SG O lVS LAU CE m W RPHY I °C I S 1713 N. • IV R FALLS, / 288.00' i , 9� o • ' f „A � S 87 rp ' SECTIO 5 , COR A'ER /9W 1 � � .�.I�� i;T Lim �ii: �p fFND.COUNTY IItiY�s SURVEYOR'S MONUMENT! THIS INSTRUMENT DRAFTED BY ✓ERALD L. LARSON SHEET / OF 2 Vol. 13 Page 3642