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040-1084-80-140
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420665 0 GENERA!_ 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: Kasten, William I Troy Township 040 - 1084 -80 -140 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 21.28.19.334A40 TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing ��G� It. BM Aeration 2� V 1 Bldg. Sewer Holding W SUHt Inlet �� �ti TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing 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 Ed es To soil g p P-11 Yes No E Yes � No COMMENTS: (Include cod iscrepen ies, persons present, etc.) Inspection #1: �o / - u� Inspection #2: , A 1.( 4 Location: Townsvalley Rd Hudson, WI 54016 (SW 1/4 SE 1/4 21 T28N R19VQ Country Oaks Addn. I Lot 3 Parcel No: 21.28.19.334A40 1.) Alt BM Description = , 2.) Bldg sewer length - amount of cover 3.) Contour = Plan revision Required? . Yes � No Use other side for additional information. SBD -6710 (R.3/97) Date Insepct s Signature Cart. No s Sv C, r 5 o u el " 'o ) / ° p DY, - t u -A o LAA -1 �'� OPow +(2 Safety and Buildings Division County 11 _ 201 W. Washington Ave., P.O. Box 7162 T C Q. 0 h4 cvnsin Madison, WI 53707 - 7162 Site Address Department of Commerce Z Caukl/ty Sanitary Permit Ap p lication Sanitary Permit Numbrr In accord with Comm 83.21, Wis. Adm. Code, personal inf 15.04bfi y" ou vide 4zo 61 ❑ Check if Revision may be used for second purposes Privacy Law, 15.04(t)(44 I. Application Information - Please Print All Information State Plan I.D. Number - 2 9 f 33 Property Owner's Name { Parcel Number '54 1 0Y0 A) IKQ Property Owner's Mailing Address Property Location Z o GO u © A-K 'A Q �� % �k ) p ; S Z TZ f N, R ( 1 UV City, State Zip Code t Y Phone Number Lot Number Block Numbe_ `r Subdivision Name CSM Number r�?ttf w ��a 2- L C " Mtn Y aR-/f, H. Type of Building (check all that apply) ❑City 1 or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public /Comm 'a - 'be JxTownship 4 vy El State Own �' Nearest Road -�- �( z. ,ouq erg D. . • . -ou iv -f-n y AA III. Type of mi • me e o se). Complete line B if applicable) A. 1 ❑ New 2 ❑ Replacement System 3,X Replacement of T6 ❑ Addition to For County use System Tank Only 2tin System B • Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 ❑ Non - Pressurized In- Ground 21R Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Z� J Z dV Dosing Chamber /,rn VII. Responsibility Stat ement- I , the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum 's Name (Print) Plumber' Signature MP /MPR3'Number Business Phone Number Plumber's Address (Street, City, State, Zip C e) VIII. County Department Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse Determination Co S itions of Appro aso isapp I � L� w •Q�tJ�j .,=., CB H,►, +..i� .:ti .�tcne� ws � �Q JA wwt.:t � e3 —d 4 LaM v AtPachromplete plans o ON Coputy,only) for the systeip ogpape pot less than 81/2 x 11 inches in size V 01 SBD "(. 1) P -L -t fs t 6e `'fi�� , 1 � `� LO ���e•� 1 3-45 j 30� � Eli M yaM6 � ��flGE I � I , Z . qi3O R cc i w � o I n I o � • o 70 � n � � M - I t p 33 ,' tAN piS /n D jb sc nor � 6P k/ 2--r 02- -Z 1A v , n : Safety and Buildings N v isconsin 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 www.commerc .wis ons Department of Commerce www.wisconsin.gov James Doyle, Governor Corry L. Nettles, Secretary January 22, 2003 CUST ID No.226497 ATTIC• POWTS Inspector ZONING OFFICE ROGER D NELSON ST CROIX COUNTY SPIA 122 E SUMMIT AVE 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL j PLAN APPROVAL EXPIRES: 01 o O SITE: William Kasten 208 Country Oaks Rd Town of Troy, 54022 St Croix County / SW1 /4, SW1 /4, S21, T28N, R FOR: Description: Four Bedroom M ( j� Object Type: POWT System J Yp Y The submittal described above ha; and Wisconsin Statutes. The subr chapter 101.01(10), Wisconsin St The following conditions shall be met during consu u�.._ • Comm 83.03 (1) (b) The existing private sewage system (mound) on the property, should be evaluated for code compliance. • The existing septic tank must be inspected for structural soundness, size and baffles, and must be brought into conformance with the requirements of chapter Comm 83, Wis. Adm. Code. If it does not comply, a state - approved septic tank shall be installed. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required Condit A copy of the approved plans, specifications and this letter shall be on -site during construction and open to APPR inspection by authorized representatives of the Department, which may include local inspectors. All permits DEpARTMENT< required by the state or the local municipality shall be obtained prior to commencement of OF WV construction /installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should SM CORRIJ conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. ROGER,D NELSQN Page 2 t(22l03 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz n commerce. state. wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 t��+ f•y R 19w w fc c, � � � � � a s� E�✓ 'Q�� 9 C tt / ll II C© u k2 y o 5 2 b, ti f�<C`/ ��5 wt J c�{o Z Z ��� V .0101 3 ,J K rdZn SEG. S INK S pG k pEG 7 fNhP RayPoR q s r gu4 >oG�f _ r\ 1 — _1 (7– e �' r` -TT By i= COMMLpRCC rA�IU DING Al 0.^1 � u- atd�l1✓ b �PpNIp C f 2 2 6 5 ---% r f- ,q-�/E � c r,5 a) &..4- +/ t-j t 5! o') 7/5 Z ? 3 '�Y V 4 6 _.•- Mound � �:•r� � _ /LJ `y.t:rn Ivlanagernent Plan Pursuant ro Corrtm 83.54, Wis, Adm. Code The septic tank shall be maintained U un in ry Ou tank shall e disposed of in accGrdance with ilVFtr11l3�Wi9 �adm. �od ape aCng�ol dit,vn of s ee repU l) ;�n an en filter shall a a ion, - r d at least once every 3 years by inspeclipn, The pullet filter Shdil be c;eanea a$ nepeyser rc ensure proper operation- me filter cartridge should not be removed unless prpvisiona are made tW ;stain solids' in the ln,� that may Stough Ott the filter when removed from i e.;,ure. If the filter is wquippad with an flare[", ttie filter shall be the is nclo alarm is activated conGnuausly. Interrnitient filter alarms may Indicate surge flows or an i continuous a ann. 'rhe septic tank shall have its contents remc,ved when the vo(utne of sludge and scum in the tank exceeds 1i3 the tiquldolu,ne of the tank.. It Gta contents of the tank era not removed at the lime o mainter,s,r,ce personnel shall ado f the owner of when the next seNica neEG f a thenniai assessment, s to be perfprmed to maintain less than rnaximurrt scum and sludge accumulatio in the tan. The addition of blglo5icai or chemical additives to enhance septic tank performance is genarally riot required. Mo Id I k ngs if such products are used they shall be apy� roved for septic tank us® by the gmpartrnent of Commerce, Safety and Buiidtngs Divlsian. Pun^ T• nf� "lie pump (dosing) tank shall be lnspectaC at least once 8v � � vent'! peeper apgratlon. If an effluent filter k-) installed wiq,in tank it shall 6e Inspected anq Sean 9 p e necese�ry fed to Mo �n and Pres sure Dlstribut'nn No tease or shruos should be meted on e , t , ound. • mpg be ,Wade around the rrl0untl'� shall bd seeded and mulched a•s nece Plantings ssary td prevent erosion sand to provide soma protection from !rant (other than for v ®gelatine mdlnttr8nCe} on the rnourtd ie, no, rer,� d to Pr d 3 sell compactio lil SOn marint P er, and :ha rnnund inlSl"Uve surface within the mound anrd snpw contp3ctian i 7 the winter wit( promote feast t penttt rea rrs, ho ineta llatioigUctober.Feb rua tl/ hinder aeratrOn tt the ry} dictate t;1at the rTtaurtd b heavily muicherJ for frost protection,raUCn, i,atd weather Influent quality into the initial test when the en ttheh mound system Maly nc)t exceed �J my /L 8005, 150 mg/t, TQS and 3Q not t exceed maxlrnum d ®sign flow specified in the permit fo,• this ir1st�,liation. rrgrt, FOG. Inllcent (loon rti�ty They pressure distribution system is provided avitJ7 a 11tsshin lateral be flush+ d of accumulat ®d solids at Iwast once eve 18 months. When a pressure tact is error g paint at the d of.each lateral, and it is re�ca +nrnend,�d that each compares fCr system was (nstttiie:d to determine if orifice G:ogg(ng has occurred and if arl re9ulret! to Maintain et;u�al distribution +^dthin Chet disper�;al cult, p mad it should he .e cjegniny 13 Observadon pipes within t1 • le dispersal Celt S11a11 be checker' for e and any tenets above g ffluent Llqnar4f Inches WrIsldered as an Ito pending. Ponding levels shall rya reported to U1e owner, pending !' fail>)re requiring additional, ["tore hequent H16—Moir,.. 1- his 'Ysteni sh:itl b operated in arcordartoe wikh C t mean ®nt manual (SBp.- 14572�P C, G o °�' ' 94 �(ls, Adm. c ode, and shall maim i reporting, , ( grid local Or Suite rules pertaining to system maim a Wed In pie ccrdcnr:e with Its' snarrQe •and mainteirance No one should ever enter a sa�ptlC or purr,p tank since dangerous gases ma r pu+np ink mp n en s, i shill ge, n with Comrri 113.83, SOS Adrrt. Coda when the tan .� pOWY�g co ) 179 present that could causra death. Sel:fic and compone k,. ar,� no longer usbd as SepZ1.;; orpun•,p tank rnar�itoie rlse,rs Q used for s4'rvice and . 4ccess risers ar rd wvers snauld be inspected for vratar Ugltt ass and soundness ur1:5ovnd, defective, or su asses5merit shall be soap d Watertig open the completion be secured b Ufeot to ferilure must be replaced [Apasrd access openings r Aacess 9 of service. F,r,y opening ries,ned y an etfective cocking device to prevent accj ' C-¢r or una access ed entry ir±to a tank or co g eater thcrrt J - in,;�es In dian;etyr shall Cc tin Bn Plan rripon8nt. It the septic tank cr any of its Components yygtem in proper operaU once defecuv n9 condition. 0 ulc tanit or cumporrerlt shall be ra airs , If the dostn p d or replaced to keep the immediateigrenk� pump,. Pump controls, al3nrl or purred or replaced wltfl a elates wiring betAinfr9 defective the det�cUve 4ornpGnent shall bt, cx�rrtprJrlant of U)a 3 mrt pr equal performance, If fife i�', ®und corTtpenent fails to e CClp ter oaglny tC disc ter e w aste wate r ar' t•eplaced In its' pres+ertt tocaU0an G by Incre t we32 & wa ter O r b eras if cue IB �ka and dispersal medig and ref to the ground surface, it will bd rdpaired ope ratfnq cttnditian, �itsd piping and reptacirig Said Cemportents as de med r �c MQ /iri to iol gical cl 3ystc ogged ae.orpt��n Quecio �. •.._. �_.__.� ._ �. > ir, into p,upur abotct she atieras or� malt% -�� ---- ..�.- _. A'he Coon[ rttenarc� r,� t,his ?S Y �onirt�r — Ua�i'i,ce sr. tJ�—" tam sktpvl�:' be diz•ectac? Co: The ex;iteer teatal,l,r aC _ 54 orx V itt tz - e�tuz- ��::i>: The effluent filter rnanufaet:up al +u�S PU T h r. e rnp martufac t ur at pct .t` r I / =30 Ex t s�l� 6 st, o to p -,o i �r-PLA CE /o p -, ! I i 1 l : � O l C n ( 0 i ' 0 / \ 7 r n F V 133 N pi5r � -vt �X J ff ( AIb �UAlb sc DoT i,Pav �2- i I t 32__� r/E C7 7' C i.Po,v r j • PUMP .CHAMBER C K055 SECTION AND SPECIFI �- --VENT CAP VENT PIPE _ WEATHER PKOaF ^,II.Ii,() —' f iwir-TIOW 6OX � , :N(.; . FROr1 COOK, v'l;l' �n'a1FN.1 wiQJDOW UK FRESH 12 "M4LS. AIK iNTAKk 1.- GRADE I PROVIDL AIRTIC,tiT SEAL APVKOVCO JOfl�YT A Tank construction sliall compi lid APPKOVI Iii th approved �a:i Ch IL1-1R 83. 1.5 ar�d ILHR 83 o pipe e. xtena ng I ` ALAKA 3 feet or.tc, n 1 , 5 4) �/° A H i solid soil. I �N Goth sides of C t.anlc . I I CLEV. L ..' FT PUMP -_- D CCNCREi "E dLUCK KISLK EMT PERMITTED OIJLJ IF TAWK MAKIL1FAIwTURCK HAS SLJC.FI fk.PpKk)VA.I.. S SPCC_IFICATI0QS TA►JK� MAW U FACT URFAA.. )C UUMU K OF U 0 5 E S : _._. , r.. , ., _ P E K Uky TAWK CIZL: GALLO►JS D05G VOLUhhE ALARM MAWLI FACT UR,ICR: `�?_T 19 IMLI LIDIN5 6ACI W: _.,�.. � ' - � ._ GI MODEL M.SE.lMbE:K*. )' 77 CkPACITIES: A= �: �_d 'AJCH6:S Uh. / . GJ R 7 - IJCHES Cftl �, l ct PLIMI, MANUFACTURWR: A f't I o e; MODEL IJUM15 EK: SWITCH TJPE: �Gl�414 OTE PUMP Ah.1D M-AKM AR L r0 elf; MIMIMLJM DISCHARGE KATE �►�� s IN5T G'J 5i_{�i�,H.ftT "C ClFLL'lllT VCKT LIFFEKLWLE DETW> L)J PUMP OFF A►JD,.p15 (RItSuI{Ull PIPE- a= br -t- -i- MiAJIMLlM ►OETWORK SUPPCy PI�E:5SuKC , ,� � � ��,��s_ F "L_LT + — 3 0 u FEET OF FORCE MAj Y, [t . �J !_ ioorl,FRICTIVU FALTOR..�h Ft ET TOTAL 0tJLAMIC. HEAP IUTERAJAL DIMEW OF �AA� t_LNCr7 } {___ 'WIDTH 61" 86" 39" o m m n (n 45j" I ; D rri 0 I rn i � 5 � rn I i N � .� Z r 42 - i r- r D O O p c m m 0 0 o m O " - (--i OH O O Os:OT'ZOZ< o z Z ( DMz n Ac)O mow0 =•- I��T3:.1O- 0 : " Z5 R C -1 C r— r N ix �--i m --{ m CO z m� I Z Do., �zr n r <r rn�rn _� m m m O z O W J Dm v �'m 'N{�� Or -1�•P0 - �� - 1 ' U . C Q m�_� O n 0 Nm y I r P � O p - Zn MO D C ' � C ((A (n O m I --A �� N o p G7 i �{ m� �� Z - 0 G mom (nom V O cnW QO M o V N n� I� D N � a:F F-0 0 p = 0 o U L1� {' Z �p y► O O Q �p Ord > 0 CJ > 1 D y ` OC ;o m �T O c> In z v/ oz Z C 0 O � m� D x r O ,A m Q) �� m T ➢ V/ z 0 0 O o 0 2 0 3 1 P 6 1 9 6 S'rATL BAA 01: WISCONSIN FORM I - 2000 WARRANTY DEED 6 9 4+ 6 Docurnent Numbor KATHLEEN H. NALSH This Deed, m REGISTER OF DEEDS ade between Robert C. DeLeo and June Ann ST. CROIX Co., wI DeLeo husband and wife - RECEIVED FOR RECORD ___� Grantor, 11 -01 -2002 9:10 AM and William G. Kasten and Karen E. Kasten, husband and wife as survivorship marital property EXEAPT DEED XET�PT 1 REC FEE: 11.00 Grantor, for if valuable consideration, conveys to Grantee the following TRAYS FEE: 998.70 COPY FEE: described real estate in St. Croix _ Coun> t State of CERT COPY FEE: Wisconsin (the "Property ") (if more space is needed, please attach addendum): PAGES: 1 Lot 3 of Certified Survey Map recorded in V,lucne 8 on page 2312 as Document No. 4655 16 being a part of l) the Southwest Quarter of the Southeast Quarter (SW'•7 Itccurding Ana of SE' -i), Section 21, Township 28 North, Range 19 Mutic d Rew West, and part of Lot 4 of Certified Survey Map Titl e One Title ess Premier Group, Inc. recorded in Volume 4 on page 1157, Town of Troy, 706 19th Street South together with an easement over and across the Hudson, Wisconsin 54016 existing town road as shown on the Certified Survey Map in Volume 8 on page 2312. 040- 1084--80 -140 ParcclldentiGcationNumher(I'IN) 11 :)ethrr With all appurtenant rights, title and inlclests. I'his is homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, and Restrictions of Record. Dated dtis _ 30th _ day of -- October 2002 i t * _ * 7te Ann DeLeo _ ,UTIICN1'ICA'Fj0NT� ! ^T ACKNOW'LEDGMFNT - -- STATT OF WISCONSIN ) SIgnanlIv(s) ) ss. - -- �� ; •f ' 17 t `� .County. ) authenticated this clay of --: O:Eify U Personally canto bclore file this 23rd day of October 2002 the above named rs Robert C DeLeo an - June Ann DqLeo FITLE: MEMBER STATE BAR OF WISCONSIN (If (lot, to me known to be the person _ s who executed authorized by70G.Q6, Wis. Slats.) the fooing,' rut at acknowledged the same. I'HIS INSTRUMENT WAS O10I Bl' * Palm 'i Michael H Fu raeki , Attor N taly oblic, State of Wisconsin Eau C laire� Wisc onsin _ _ _ My Commission is permanent. (If not, state expiration date; � 11 "n Hurts m,t�bc uudx•nti ¢ I x Fick tuwludecd Both arc n ncccssmv 1 Dece r 12 _ 2004 N un of person �igwng m any capaury mull be q ped or printed below their signariuL tv 1RRr \N "1'Y DEED S'I'A I E BAR 01" WISCONSIN FORM No. 1- 2000 \nnrney Mlcbncl h1 Forccki 1X30 Dnrckcu Avc, Eno Claire WI 54701 -4627 Phona:(715)835 -3029 htx: (7 1 >) 835-4 112 Michael H. H=r ki T;Itt,90 ?.ZPx Pioducen with Z1pf-nm by RE Fom,yNei. LLC I6025 Fifteen Mile Fined. C]0- lownsh p MV1 48035. IB0.) 983 9005 TROY 21.28.19,.3 3 4A40 , SW SE LOT 3 , COUNTRY OAK &rjc ' ''17V C6r53tAT3 art> enfCfln�ustry PRIVATE SEWAGE MUM County: Labor and Hriman Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 180280 Permit Holder's Name: City C] Village Town of: State Plan ID No.: B OB DE LEO TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: �1 , 040- 1084 -80 -140 TANK INFORMATION U ELE TION DATA A9200359 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic !' v d p Benchmark /00, Dosing_r� Aeration S Bldg. Sewer Holding J — St/ Ht Inlet R V TANK SETBACK INFOR ATION �' 1 StJ Ht Outlet �S,o�r 8� 7 WD TANK TO P/ L WE BLDG. ventto ROAD Dt Inlet q Air Intake U 6 Septic >5`o p� a5 )a $�J NA Dt Bottom Dosing > L r S"0 .S NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System 3,5� q� l � PUMP/ SIPHON INFORMATION Final Grade 03 Manufacturer , Demand S� � lo,6 iP Model Number Of,D GPM TDH Lift 1�,� Friction2,i,4 System �5' TDH a3!'! Ft Loss d Forcemain Length /N Dia. J-V Dist. To Welly" SOIL ABSORPTION SYSTEM BED/TRENCH Widt Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth I 1 � / DIMENSI SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manu acturer: INFORMATION Type CHAMBER Model Number: System: 1"Ltk (pD I � U - 7 14- OR UNIT DISTRIBUTION SYSTEM Header/Manifold I Distribution Pipe(s) /� x Hole Size I x Hole Spacing I Vent To Air Intake Length _�,_ Dia. a Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over q Depth Over i �� xx Depth Of 1 xx See � i Sodded xx Mulched Bed /Trench Center U Bed / Trench Edges � � Topsoil L ( 0 Yes [] No E-3 C] No COMMENTS: (Include code discrepancies, persons present, etc.) r> L CATION: TOWN OPTROY 21.28.19.334A40,SW,SE,LOT 3, COUNTRY OAK' .fie lr l _ �°�� < Cc. LjLtt 1 q- 1' ' ,tom Plan revision required? E] Yes [�/ No Use other side for additional information. �4�i nspeclor's_ , Signature SBD -6710 (R 05/91) Date Cert . No. SANITARY PERMIT APPLICATION 3 ,15- In accord with ILHR 83.05, Wis. Adm. Code TT" C 0 t X STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than a l P 9 Q, )Nn 8% x 11 inches in size. check revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. r7 - c3 1 PROPERTY OWNER PROPERTY LOCATION z c e1i 5 e '/ ' /4, S T ff, N, R E (or Pf4dP&TY OWNER'S MAILING ADDRESS LOT # BLOCK # zd y v CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 4b 4lrV. 11 TYPE OF BUILDING (Check one) ❑ State Owned VIL GE : NEAREST ROAD ❑ Public ILLI 1 or 2 Fam. Dwelling -�# of bedrooms ' PARCEL TAX N 111. BUILDING USE: (if building type is public, check all that apply) 1 ❑ Apt/Condo O (� 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 in line A. Check line B'if applicable) A) 1. P. New. 2. ❑ Replacement 3. ❑.Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## _ Da Is V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pres Distribution Experimental Other 11 El seepage Bed 21 99 Mound 30 ❑ Specify Type "41 ❑ Holding Tank 12 ❑ Seepage 'French 22 0 In -Ground 42 ❑ PIt. Privy 13 ❑ Seepage Pit Pressure 43 0 Vault Privy 14 ❑ Systeat in -Fill ` VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY '2. ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE: 5. PERC. RATE 6., SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) . PROPOSED (sq. ft.) (Gals /day /sq. fL). (Min. /.inch) ELEV XION �f �+ '-7e7- .- Feet 70 Feet VII. TANK CAPACITY Site in Total # of Prefab. Fiber- Exper. INFORMATION._ Manufacturer's Name Con- Steel Plastic New Tanks istin Gallons Tanks Concrete strutted glass App' Tanks Septic Tank or Holding Tank Y I I W A Lift Pump Tank/Siphon Chamber a 1 Vlll. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation o f the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP PRSW No.: Business Phone Number: umber's Address (Street, City, State, Zip Code): d k IX. COUNTY /DEPARTMENT USE ONLY El Disapproved Sspitary Permit Fee (includes Groundwater Fate ssu d 1 i g Agent Signature (No mps) Approved C1 owner Given initial DO Q Q surcharge Fee) 1 /0-1 ` 61n - - Adverse Determination F a X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SRn -&1M /fnrmnrly Plhai7l IR 11 /RAI MATRIM MON• nrininai to Countv. One Coov To: Safety & Bulldinas Division. Owner_ Plumber 9' 15 AS BUILT SANITARY SYSTEM REPORT OWNER U2 '4-6.6' r TOWNSHIr T SECTION T N - - W ADDRESS -� ��,� � ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE Aa-z-p PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM AK , /t oll- Y� � V /al lei~ J d INDICATE NORTH ARROW BENCHMARK :Elevation and description: -� 3 l lS Alternate benchmark SEPTIC TANK: Manufacturer: 7 Liquid Ca /4G Rings used:. ,Manhole cover elev: Final grade elev: • t I gars ss�tsnsx ��s (xuvq oT4das o4 suoTsusiuTp aouaaa ;aa Z ) (uuTd 4oTd anoga 994 UT uoi49nzao ;ut S T94 apnToul ) :bUTPTTna "+ —TTaM :moa; 499; ;o 'oH apTS ' quoag : auTT • doad 4saavau iuoaa apTS ' X 4uoaa : paoa 4saag9u nzoa; -4aa; ;o • oK : 'A9TO 4014no Xu -- : -AaTa 42TUT xugy r S 49 (J ...I.L.H.R. 83.08(2 PROJECT INDEX SHEET Owner: r e ��� 7 13 -- 3 5 - 3 Address: 0D,P Site Location: Go -7' 5 w SE S T. z - 0 Project Description: 577 G� CouvTt' /VE6tJ CU,cJSTUCTi4,c> N 5- 7-1;,,ir¢ 7 D.¢i4 STEW /�4> ._ 31 Page 1. PL P LAN VIEWS Page 2. MOU CR OSS SECTION & SYSTEM PLAN VIEWS Page 3. PIPE LATERAL LAYOUI Page 4, DOSING CHAMBER CROSS SECTION Page 5. PUM PERFROMANCF. SPECS PLUMBER: MP 972, - DATE: t y SITE EVALUATER/ DESIGNER SIGNATURE PO ESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT C5 7— Z �' VIS. MASTER PLUMBER LIC, NO. 3307 M.P.fta " NN. INSTALLER a DESIGNER LIC. NO.00668 OR IGINAL PLOT PLAQ S. g2 ,- 0 313 9 s 30 o W ally p� C olt Se P A PpN� w �� o �z�•�rf' y �� i /Ea�ti�tir of 13 fd, . Se _W1`R I io 9y ,0 i � oP i p D I o W Prior To Plowing- Installer will carefully v1 � shift or-orient mound position ( toe line „ n�1or hpri aporeeare) So grQW1U, 9fi�o rE SPA 45 9 �. Sfl /✓D .� D �� �N 7"E � 'fit � �' 18 0 0 1 9 Page Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand -, HG Topsoil F u 0 j E S l o pe 97. o % to e Trench Of x- 2 2 Force Main Plowed - ----�" Aggregate Layer Undisturbed D /' O Ft. E 2, Z Ft. pRNP�� 'na s Section Of A Mound System Using F • 8� Ft. � C anes For The Absorption Area G Ft. A y Ft. N A S Ft.' o B 4 3 Ft. t ay�'Ctof s* G Ft. r • vts�o� cE R � g � N pEN K 2 Ft. CAR L Ft. Ft. Alterna a Position of Force Main I Ft. W 'Ft. L ---- -- ---B K C W Observation E Permanent Pipes ; Markers j Trench Of 2 ~ _ 2 2 N I Aggregate Mound Using 3 Trenches For Absorption Area ....•. t ... i v,/ -415 Pagd3 Df /S • V t?l �? V 01Uq.E 4 �"Ok 130 2 z , yap �f+l s r 1 o le- S m V 3 i 39 Perforated Pipe Detall Z jl RiGti T Foe VA f a-Al r vA End Vlew ) Perforoted End Cap \e• y� PVC Pipe Jo o� °e D �a Holes Located On Bottom, Are Equal Spaced R Qty gOR0 Tie s . • ally co 0 V P PVC C Manifold Pipe'$ OF Distribution C � Pipe S Hole Should Be Next 7o End Il Distribution Pipe layout P 60 Ft. R /0 Fo�Pcf• �''1.4�;IJ Fr of �'UG X Inches Inches Signed: Hole Diameter �� Inch Lateral Inches) License Number: Manifold " Inches Date: Force Main Z Inches # of holes /pipe 13 Invert Elevation of Laterals 77 ,90 R. P15'C ,4A E � 476 , rO,e � �1 �!� 14 TER �t / 15,2 'PAn. DT ti S Z 7 • To r� l �S T R i /3 U T /p�J 17 is Gh A�' GE %�'fl TE �(' ,UC �IvO,P/� 3 0, y �`� ' /'►"`c 92 9 �I PUMP CHAM6ER CROSS SECTION AND SPECIFIC LT" OAIS VENT CAP 4"C.I. VENT PIPE APPROVED LOCKING 1� WEATHER PROOF MAN HOLE COVER JUNCTION BOX 1A I z5' FROM DOOR, M w�tv,li(N 1 A) Cie- 1 wwoow OR FRESH AIR INTAKE I Vit 7- /0IV GRADC f l � 15 Mim. 9 y r co►JDUIT — ---- - - - - -- j.�IEU Oti g 3 o PROVIDE { I - li INLET ` - -- AIRTIGHT SEAL. - 7 APPROVED JOIIJTS APPROVED JOINT A IN �NK I II W /C.I. PIPE W /C.T. PIPE'V� I II EXTEWDIWG 3' { CXTENDIN6 3' to I ALARM ONTO SOLID SOIL li. OVI SOLID SOIL Z 8 ELCV. FT. ;� PUMP � OFF i 0 �a BLOCK rlo 1 x- RISER EXIT PERMITTED GWLLJ IF TANK MAWUFACTURF HAS SUCIi APPROVAL_ E SPEGIFI'CATI0Qs S EPTIC 6 DOSE M IOG�EST��N /�Ip���JrT PER DAB I ' ►JUMBER OF DOSES: i TANKS MANUFACTURER: /s !" 7 - 0 G ALLOWS DOS /7 TAWK 51ZE: ___��. E VOLUME GA Z ' INCLUDING OtCKFI OW: GALLONS - - ALARM MANUFACTURER: Z y� CAPACITIES.' A = ' f INCHES OR GALLOWS MODEL N UM E B R: Z u SWITCH TYPE: Al`RcyRy ��a�T B= 11SCHE5OR 38 — .-- ....GA4L0 S PUMP MANUFACTURER: _ I W CHES OR X72 GALLONS MODEL NUMBER: D= INCHES OR iy GALLONS o b1eec4 R/ 66 1'1047- NOTE: PUMP AND ALARM ARE TO BE R SWITCH TYPE. y ( MINIMUM DISCHARGE RATE 3� GPM INSTALLED OW SEPARATE CIRCWTS VERTICAL DIFFERENCE 9ETWEEN PUMP OFF AND DISTRIBUTION PIPE. � Z FEET - rA#j k SPeGS + MINIMUM NETWORK SUPPLE PRESS .. . . . .. . . . 2.S FEET 6A et 0 2 �' �} P � 1 ' .0- �F T. Z 7 D + :,,� -_ FEET OF FORCE MAIN X r oo FY.FRICTION FACTOR.. FEET Z'40A) S �Q • 75 � z �r I; = TOTAL O'JWAMIC. HEAD FEET i INTERNA DIMEIJSIONS OF TAWK: LENGTH ;WIDTH - ,LIQUID DEPTH SYSTEM y? pR1yATE S f Co n i tionallY ` �CI,A110N R HUB 1 of t ptySj'�'t BAFtTYD ION 0f EE CORRESPONDENCE" �l 5 92 - 03139 3885 AVAILABLE CERTIFICATIONS ETA LISTED SUBMERSIBLE PUMP AND 11 ��• CLASS I DIV. 2 AND 4 CLASS III DIV, 1 AND 2 ETL TESTING LABORATORIES. INC. CORTLAND. NEW YORK 13045 61086171480 CANADIAN STANDARD ASSOCIATION S P APPLICATIONS • Shaft: threaded, 400 series protection. Balanced for Designed for Continuo!. Specifically designed for t h e stainless steel, smooth operation. Bronze Operation: Pump ratings following uses: • Bearings: ball bearings, impeller available as an option. within the motor manufacl • Homes upper and lower Casing: Cast iron volute recommended working lin • Farms • Power cord: 15 foot type for maximum efficiency. can be operated continuoL • Trailer courts standard length (optional 2" NPT discharge adaptable without damage. • Motels lengths available), for slide rail systems. Bearings: Upper and • Schools Single phase: /3 and through 1 /2 /2 HP- HP -14/3 s. carbon sealing • I tais 16/3 SJTO with 3-p Mechanical Seal: Ceramic Lower heavy duty ball bea • Industry Plug. /4 3 1 vblin faces. construction. • Effluent systems STO with bare leads. Stainless steel metal parts, Power Cable: Severe dL Three phase: 1 /2 through BUNA -N elastomers, rated, oil and water resista SPECIFICATIONS 1 Y2 HP -14/4 STO with bare Shaft: Corrosion - resistant Epoxy seal on motor end leads. On CSA listed models, stainless steel. Threaded provides secondary moisti Pump: 20 foot length SJTW and design. Locknut on three barrier in case of outer jac • Solids handling capabilities: STW are standard. phase models to guard damage and to prevent 3 /4" maximum. against component damage oil wicking. • Discharge size: 2" NPT. FEATURES on accidental reverse rotation. 0 -Ring: Assures positiv • Capacities: up to 114 GPM. Motor: Fully submerged in sealing against contaminai • Total heads: up to 123 feet Impeller: Cast iron, semi- high grade turbine oil for and oil leakage. TDH. open, non -clog with pump out lubrication and efficient heat • Mechanical seal: carbon- vanes for mechanical seal transfer. rotary/ceramic - stationary, 300 series stainless steel metal parts, BUNA -N elastomers. METERS FEET • Temperature: 160° F (71° C) 90 maximum. • Fasteners: 300 series 25 80 MODEL 3885 stainless steel. SIZE 7 /" Solids • WE15H Capable of running dry ry 70 without damage to 20 wE10H components. 60. 5GPM 0 Motor: _ WE07H 5 Fr • Single phase:' /3 HP, 11.5 or Q 15 50 230 V, 60 Hz, 1750 RPM; o ' �!! W '/2 HP, 115 V, 60 Hz, E0f►! 3500 RPM; ' 12 HP through 10 WE03M 1 %2 HP,230 V, 60 Hz, 30 3500 RPM. Built -in overload with 20;' .weo3L... automatic reset, class B 5 insulation. 10 • Three phase: 1 /2 HP through 1'/2 HP 208/230 V, 460 V, ° o 0 10 20 30 40 50 60 70 80 90 100 110 120 f 60 Hz, 3500 RPM. Class B insulation, overload ° 10 20 30 protection must be provided CAPACITY in starter unit. 8 Parcel #: 040 - 1084 -80 -140 01/05/2006 11:09 AM PAGE 1 OF 1 Alt. Parcel #: 21.28.19.334A40 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 WILLIAM G & KAREN E KASTEN O - KASTEN, WILLIAM G & KAREN E 208 COUNTRY OAKS RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 208 COUNTRY OAKS RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 3.360 Plat: N/A -NOT AVAILABLE SEC 21 T28N R1 9W LOT 3 CSM 8/2312 3.360 Block/Condo Bldg: AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 21- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 11/01/2002 696684 2031/619 WD 07/23/1997 971/520 07/23/1997 940/192 07/23/1997 902/141 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 102697 379,300 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.360 62,500 302,600 365,100 NO Totals for 2005: General Property 3.360 62,500 302,600 365,100 Woodland 0.000 0 0 Totals for 2004: General Property 3.360 62,500 302,600 365,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 306 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 U FILED g t? JAN 0 9 1ngl a... 0 JAMES O'CO,NFLL "` R egiste r of 1)eoos /I 4 G 7 5 f Croi Co., WI .` OI CERTIFIED SURVEY MAP �. NORWOOD ECKLUND, RAY GALEP, ROBERT MACKEY, LAURENCE MURPHY �I 41 I Part of the Southwest 1/4 of the Southeast 1/4 and a roadway easement located J partially in the Northwest 1/4 of the Southeast 114 of Section at, Township 28 J Q` North, Range 19 West, being part of Lot 4 of that certified survey map recorded in Vol. 4 Page 115'7' of St. Croix County Certified Survey Maps, being located in , �I the Town of Troy, St. Croix County, Wisconsin. 3 O Indicates 1" iron pipe Found. Q$ Mailing Address: Murphy Land Surveying C Indicates 1" x 24" iron pipe Route 1, Box 36 A weighing 1.13 lbs. /lin. Ft. set. River Falls, WI 54022 R ( ) Denotes previously recorded tp data . , C.S. M. LOT 9 VO L. 4 . PAGE l 5 �.._� Indicates watercourse 3 0 A _ SCALE /' 200' \ 64 • 3 .0 0 _ �- - O 30' /00' /30 200' 300' 400' 300' 600' M \ 10. ' 00 o �'` 'it�� GOl�sh'y \ r 66� PR /VATS ROAD ��d \• \ a :3o a o o� ���`,.�•`.�• EA S_EMENT N X33 �Lgri ;l % ( FUTURE 7" OWN ROAD) Dated: 8- 3 -19!5)0 _ m W 6 Y �' °C w \ \ AS RECOROEO /N " Revised this • /� 1713 \; y �v� VOL, 890, PAGE ? 2 N RIV.FR FALLS.. y ,� / 7 / , Ooc - W k p 9th day of fi f� ., wISC �, 483 390 OF Sr. Q January, 1 1 �,� •• ... . ......... �� ' • �Q � cROI x Crr, w 1 LANG S ,`,,t , `' T : REC. a1 2 h Q Laurence W. Murphy 0 1 0 Registered Land Surveyor .�• a I W W 4 PA� ^ I oN w x1 J o `.�- I �M V1 b C•S•M L 6/8.g ^ $ C /© � m Q o m J ti p4 30 484.2 ` h j Zt 2.77 ACRES �4 74 b 120,893 SQ. fT. 3 b Z.633ACRES NET 331 1, 3 L0T / //4,7/3 SO. Fr. �1` / i �� W W 1 Ir' , 1 O W Z �3r �b 83• /4'/3 " E 660. . 6 /6 ` W �, W (� y h 10 N 6 27' // N I V, I - O - t1 �1 6 Q � I �� 3./38 ACRES 133 ^a�< /- •, �1 174 q /36, 682 QI Q ; li h 2. 986 ACRES N£T L O T 2 130, 079 so. fr. y . �p\ti 1 V - o , So„ I E 7(8. __� n ° ` N 4ll �.I I ' N p3 • 19 683. 2Z tD m o UI I2 t O 3.360 ACRES P'_ I r. % g_ I.fi:> w J • V 146,362 SO. r QI QI 8 331 20' ^Q 3.210 ACRES ^ " `N o `o �` - LOT J /39, 83/ S0. Fr. �' _ O i Q tr)I I q i� Ih N 4 �O „! 761. N 83. 23 42 = 9 0 /3 72 �I I3 O 3.382 ACRES �u ''` "' i / SEE orrA!L 4 K 3 99l N /47, 333 SO. fr. t,; M \� CUL ON PART /�L LY 1 N I p IR O L O r- 4 3, 267 ACRES NET OOWN£{� FENcc ��, 1 33, N SHEEP 2 (p N h /42, 332 SO. f r. 33 c, /394. BOB. 00' 202.20' I o n 133.0 /' 29 7�6� 1 1 774.99' LLL--- aaa�dll Z 5 S 88.57'03 "W 2672.94' R(2671.969 5 £ COR. S£C.21, r28N, R l9 w, S1 14 COR. SEC•2 /, r28N, R /9WI S LINE SE 114 (COUNTY SURVEYOR'S MONJ (COUNrY SURVEYOR'S MOH-1 UN PL A TTED L ..� � •�.; Vol. 8 °age 2312 Certified Survey Maps i 1 St. Croix County, Wisconsin SHEET /OF 4 AS BUILT SANITARY SYSTEM REPORT OWNER )-$O TOWNSHIP Try SECTION T N - ADDRESS /.v C ST. CROI X COUNTY, WISCONSIN SUBDIVISION a- y / LOT t/.-- LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �� 4 v v D INDICATE NORTH ARROW i BENCHMARK:Elevat' � � l ion and description: �u� � j -� Alternate benchmark ,tiuic/� 4/4a d �o — SEPTIC TANK: Manufacturer: 1 �s 7` Liquid Cap. / Rings used: /' cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road : Front X , Side Rear Ft. /d From nearest prop. line:Front , Side , Rear Ft. No. of feet from: Well 40 , Building: ;2,5 ,5 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE I PUMP CHAMBER Manufacturer: Liquid Capacity: 75e�� Pump Model: Pump /Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: lons/cycle ��a✓ Alarm: Man. Switch Type: Ae Location - 7D Distance from nearest prop. line: Front_, Side_, Rear,_,_Ft. Distance from: Well l6 Building S6` SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length Number of Lines: Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: /I `. No. feet from nearest prop. line:Front KC , Side , Rear Ft. 4 ` No. feet from well: feet from building l cl' HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: DATE: �O Z PLUMBER ON JOB : 'e�/ � LICENSE NUMBER: 6 /90:cj �1�.1 -IR SANITARY PERMIT APPLICATION CoUrA In accord with ILHR 83.05, Wis. Adm. Code J C Vo I STATE SANITARY PERMIT # - Attach complete plans (to the county copy only) for the system, on paper not less than ❑ I y9 � PO 8% X 11 inches in size. Check i revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. - 031 PROPERTY OWNER PROPERTY LOCATION Y4515 S it T99N, R le E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # t+J W .r CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: Check one CITY NEAREST ROAD nn ( ) State Owned VILLAGE ❑ Public �1J 1 or 2 Fam. Dwelling-# of bedrooms AR LTAX N ) 111. BUILDING USE: (If building type is public, check all that apply) /,)Q lDP-y QO 1 El Apt/Condo CJ v 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 in line A. Check line B if applicable) A) 1. 5. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # — Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 El seepage Bed 21 Pd Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) I (Gals /day /sq. ft.) (Min. /inch) p ELEVYIION Q G � �, Feet 7p e ��j Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Co ncrete Con- Steel glace Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank 09,10 L Lift Pump Tank/Siphon Chamber l ,Q Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP PRSW No.: Business Phone Number: umber's Address (Street, City, State, Zip Code): w IX. COUNTY /DEPARTMENT USE ONLY Disapproved Permit Fee (Includes Groundwater a e ssue I i g Agent Signature No S mps) Approved El owner Given Initial 0 0 surcharge Fee) Adverse Determination itary X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1. -A sanitary, permit is valid for two (2) years. 2. Your' sanitary may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. , All revisions tp 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. 5. Onsite sewage systems must be properly'maintainea. 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 & Buildings Division, 608 -266 -3815. 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 in 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 in ##1 -7. VII. Tank information. Fill in the capacity of every new and /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. Vill. 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% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; 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) aU sizing information, GROUNDWAYER 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, ground- , water contamination investigations and establishment of standards. - SBD -6398 (R.11/88) REPT131 TROY 0 ST. CROIX COUNTY ZONING PAGE 1 10701/92 k 9 REQUESTS FOR INSPECTION WORK SHEETS FOR: 10/ 2/92 AREA: MJ .Activity: A9200359 10/ 2/92 Type: MOUND Status: PENDING Constr: Address: TOWN OF TROY 21.28.19.334A40,SW,SE,LOT 3,COUNTRY OAK,MM Parcel: 040 - 1084 -80 -140 Occ: Use: Description: 180280 Applicant: BOB DE LEO Phone: Owner: BOB DE LEO Phone: Contractor: SCHUMACHER WILLIAM C. Phone: 386 -3121 -------------------------------------------------------------------------------- Inspection Request Information..... Requestor: BILL SCHUMACKER Phone: Req Time: 09:10 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION -------------------------------------------------------------------------------- Inspection History..... Item: 00012 FINAL INSPECTION I GOn3irZSeNpartmeOnfC ,r tn�uFtrTROY 21.28.19.334A40,SW SE LOT 3,COUNTRY OAX,V • 1`� PRIVATE SEWAGE MfEM County: r Labor and Hyman Relations INSPECTION REPORT ST . CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 1 80280 ` Permit Holder's Name: ❑ City ❑ Village EXTown of: State Plan ID No.: BOB DE LEO TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: �G( �. �n ,� 040- 1084 -80 -140 TANK INFORMATION EL61ATION DATA A9200359 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic m I , -./1 Benchmark &0,7 Dosing Aeration Bldg. Sewer Holding St /Ht inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Air to I ntake ROAD Dt Inlet q Air Septic X5`9 V ol a5 i S� NA Dt Bottom Dosing >• d ! S -S PS ' NA Header/ Man. Aeration NA Dist. Pipe 3,0 I Holding Bot. System 3,SF al,j� PUMP/ SIPHON INFORMATION Final Grade / ,q15 Manufacturer ���Oeo Demand s in t Gt lo,6 Model Number " kI GPM TDH Lift F Friction 2 , 4 System ;' TDH A�, Ft H Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Widt F Length ; No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth D IMENSIONS l / DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manu a SETBACK CHAMBER INFORMATION Type O , Mo Number: System: tV10 &0 ZO OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipes) x Hole Size ` x Hole Spacing Vent To Air Intake Length L_ Dia. 02 Length _ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over q , Depth Over J xx Depth Of / `/ xx See /Sodded xx Mulched Bed !Trench Center u Bed /Trench Edges / Topsoil ` r [Y]" Yes ❑ No [Yes [3 No COMMENTS: (Include code discrepancies, persons present, etc.) t; L CATION: TOWN OP 21.28.1 3,COUNTRY OAK,,M* $ .v� �� - � 7 • h � Q t t fC] [T t; ._ CJ "(k( Plan revision required? []Yes [�No D Use other side for additional information. � �. � � I d d SBD -6710 (R 05/91) Date inspector's Signature Cert. No. 1 4 ADDITIONAL COMMENTS AND SKETCH 10 r � SANITARY PERMIT NUMBER: ` �j 1.1 5 �1L `r ,_.45` Icy k 1031 S . V 3 3 tq I.L.H.R. 83.08(2) PROJECT INDEX SHEET' Owner: ,E`�o/ 7 1.5 2 - _5 i Address: �p T Z Site Location: G o f 5 T' z Project Description: /V�6v COAc .STP T/o,J /l/`i`! 6 S 7 TZ-- Goy GG� r Page 1. PLOT P LAN VIEWS Page 2. MOU CR OSS SECTION & SYSTEM PLAN VIEWS Page 3. PIPE LATERAL LAY OUI Page 4. DOSING CHAMBER CROSS SECTION Page 5. PUMP PERF ROMANCE SPECS PLUMBER: / lsyvt . j U�? /< MP6 DATE:�y ��. SITE EVALUATER/ DESIGNER SIGNATURE F'O 4ESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT C$ T Z `fgZ '/IS. MO.STM PLUMBER LIC. NO. 3307 M.P.Rt INSTALLER & DESIGNER LIC. NO.00695 ORIGNAL C ; P o -s PLO PLA S92--03139 o 30 A P lly •ona 0 ti N 0� Og �1 �• v SAN � � PRo�oseD % /3�,�'� E oR S poNO w �� o yoME y SEE G is I i � /Et/�lTio,� of O 1 � 13 /d5. io 9 y ,0 j I ' o� Prior To Plowing- Installer will carefully i shift or- orient mound position ( toe line I !� and area under bed ageregare) so gruwiu elevations across slope are as uniform as possible: Suggested elevations (staked on I site with lathe markers) are shoim herein and on pg. 2. I , o p i i ti • i st ioT 13z j i3O 2, -- -- Y o tiE /-or 3 3 ELf!/��io -�J r /d O • O c c, yGrv'�TGti� � Or 99'��G AT 9�F �� 0 / 2 /I - ra OeA Ls 9 �. S��T��1 SAND OG� !,v TE k' fit C 5 5 +r d 1 e7 9 Page Z Of �, 92 3 Straw, Marsh Hay, Or , Synthetic Covering Distribution Pipe Medium Sand H _ a G F Topsoil 3 E D a � /ST /•� yiP��� 97, a y % Slope Trench Of 2- 2 Force Main Plowed Layer Aggregate Undisturbe�11 D / ' o Ft. GS E Z , Z Ft Z S�P ' VP E • ' nail r s Section Of A Mound System Usinq F • 0' Ft. C0 114 t e rption �''° nches For The Abso Area G O Ft. $ v A y Ft. H A Ft a OMB S 0 X07 B Ft. �� pF Sp C Ft. 1 61i ' ,V1g10N NGE � Ft. R��Sp�NpE L 9 Ft. J 8 Ft. Alterna a Position of Force Main Y . Ft. 5 '� W Ft. �-- B K Q ! C yy Observation f Permanent Pipes Markers Trench Of '2 — 2 2 1 Aggregate Mound Using 3 Trenches For Absorption Area C Page 3 Of -� • �� (/ o /v,�t.E � o,� 130 ���� 2Z - / r!� Perforated Pipe Detail 892'O3139 u� ,ei Gti T �o�' tJi} l tlyr E v/)C v A 7 w 0 End View Perforated End Cap ae•y� PVC Pipe Holes Located On Bottom, ' A � A Spaced ` G ally a,i6 , ® V � pp� w � � V S g4� PAD � u'T Q PVC p1 OF C Manifold Pipe � Distribution CO R Isr Pipe 5EE Hole Should Be Next To End 1 , .. MgNfolD / Distribution Pipe Layout P (�0 Ft. C f� C N� 5 �JifI�S) R /O X 60 Inches y G Inches Signed: Hole Diameter �� Inch Lateral " 1 2- Inches) License Number: Manifold -2 — Inches Date: Force Main Z Inches # of: holes /pipe 13 Invert Elevation of Laterals 97 YO R. . U r /0AJ 5'e 4AO 4 TE IrO"e � �1 t �L 14 TF/c' 5 t,,.L, • -off/ T157R 18U r1o�, a/sC AR GE R Ao 3 i, 'i tl � 4 t �+ :II �tl ' 4 92 ., - 0 ,3 139 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 8,4 E OF 5 1 ' I VENT CAP 4`C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING LIGTIOIJ BOX MAWHOLE COVER .IU ; l 25` FROM DOOR, G'w'01'p(,��A�E� WINDOW OR FRESH 12 "MILL. AIR INTAKE ' 1147 IV GRADE I y�MI1J. pp 19" MIU. r1 oti Q PROVIDE I -- INLET - -- AIRTIGHT SEAL I \/ I DIFi I II APPROVED JOINTS APPROVED JOIWT °' IN N I I (I W/C.M. PIPE W/C.I. PIPE I M I II ALARM ONTO 3' EXTENDING 3' ONTO 501.1D SOIL OWTO SOLID SOIL. s l q,l4 3 3 I I oN qo , r LLCV. FT. PUMP --� OFF K BLOCK �fEV�fio�! y ` 1 I' RISER EXIT PERMI1fED GWLy IF YANK MANUFACTUR<R HAS SUCH APPROVAL 5PECIFICATIDMS SEPTIC E DOSE M /OI)EST4�°N pf, e,+57- WMeER OF DOSES: PER DAB � TANKS MANUFACTURER: 1$0 'd TANK SIZE: 75'0 - GALLOLIS DOSE VOLUME 172 GALLONS INCLUDING 9ACKFI,.OW: - ALARM MANUFACTURER: S' E�C720 2Z EL LIUMBER: CAPACITIES: A= - 2-1 IAICHES OR y � GALLON5 MOD M�,pcvey /O.g T g = Z INCHES OR _ GALLONS SWITCH TSPE: q �pVLQS C= . L IAICHES Oft - GALLOWS t; PUMP MANUFACTURER: /�n MODEL WUMBER: D s INCHES OR —L=- GALLONS SWITCH TYPE: yE�C f�' GGrlj�scK F�G9T NOTE: PUMP AND ALARM ARE TO 9E I 6 INSTALLED GPM INSTALLED OW SEPARATE CIRCUITS MINIMUM DISCHARGE RATE �8 Z -rA SPf VERTICAL DIFFERENCE Di:TWEEkl PUMP OFF AND DISTRIBUTION PIPE.. FEET 2.5 FEET EAR. Of' .Y P ►"L !'. -4- MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . • Z. , FEET FT. + _ FEET OF FORCE MAIN X 00FT.FRlCT10N FAC (�orIS • 7 5 I L 3 J i } TOTAL Dy1JAMIC HEAP FEET ' IIJTERNAL DIMEWSl01JS OF TANK: LENGTH - WIDTH � LIQUID DEPTH .�- -- k, �E SSwAGE SYS'TFM v � c i i . 1LU N%us ON® ENCE EE Gd,RPES� 992 3885 AVAIL48LE CERTIFICATIONS ETL LISTED SUBMERSIBLE PUMP G CLASS I AND 11 DIV 2 AND CLASS III DIV 1 AND 2 - ETL TESTING LABORATORIES. INC. CORTLAND. NEW YORK 13045 G1086131480 CANADIAN STANDARD ASSOCIATION SA i APPLICATIONS • Shaft: threaded, 400 series protection. Balanced for Designed for Continuous Specifically designed for the stainless steel. smooth operation. Bronze Operation: Pump ratings are following uses: • Bearings: ball bearings, impeller available as an option. within the motor manufactures • Homes upper and lower • Power cord: 15 foot Casing: Cast iron volute recommended working limits, • Farms type for maximum efficiency. can be operated continuously • Trailer courts standard length (optional 2" NPT discharge adaptable without damage. • Motels lengths available). for slide rails stems. Bearings: Upper and 16/3 SJTO with h 3-prong • Schools Single phase :' and HP- Mechanical Seal: Ceramic Lower heavy duty ball bearing • Hosptitals 3/4 , vs. carbon sealing faces. construction. • Indust plug. through 1 HP -14/3 Industry STO with bare leads. Stainless steel metal parts, Power Cable: Severe duty • Effluent systems Three phase: 1 /2 through BUNA -N elastomers. rated, oil and water resistant. 1'/2 HP -14/4 STO with bare Shaft: Corrosion - resistant Epoxy seal on motor end SPECIFICATIONS leads. On CSA listed models, stainless steel. Threaded provides secondary moisture Pump: 20 foot length SJTW and design. Locknut on three barrier in case of outer jacket • Solids handling capabilities: STW are standard. phase models to guard damage and to prevent 1 /4 " maximum. against component damage oil wicking. • Discharge size: 2" NPT. FEATURES on accidental reverse rotation. 0 -Ring: Assures positive • Capacities: up to 114 GPM. Impeller: Cast iron, semi- Motor: Fully submerged in sealing against contaminants • Total heads: up to 123 feet p high grade turbine oil for and oil leakage. TDH. open, non -clog with pump out lubrication and efficient heat • Mechanical seal: carbon- vanes for mechanical seal transfer. rotary/ceramic- stationary, 300 series stainless steel metal parts, BUNA -N elastomers. METERS FEET • Temperature: 160° F (71° C) 90 _.. _. maximum. MODEL 3885 • Fasteners: 300 series 25 80 SIZE 3 /" Solids stainless steel. wE1sH • Capable of running dry 70 without damage to 20 WE10H - components. 0 60 —► 5GPM Motor: i WE07H 5FT • Single phase:' /3 HP, 115 or a 15- 50 230 V, 60 Hz, 1750 RPM; o WE05H '/2 HP, 115 V, 60 Hz, 40 ........ _. _... 3500 RPM; 1 /2 HP through 10 WE0_3M 1 %2 HP,230 V, 60 Hz, 30 3500 RPM. 20 WE031_11 Built -in overload with 5 automatic reset, class B 10 insulation. • Three phase:' /2 HP through o 0 1 1 /2 HP 208/230 V, 460 V, 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 60 Hz, 3500 RPM. I I I , Class B insulation, overload ° 10 20 30 m /h protection must be provided CAPACITY in starter unit. 8 l " DOCUMENT NO. ii WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA f! STATE BAR OF WISCONSIN FORM 2 —1982; VO L ,_521 4 8 919 _ `' !I Country Oaks, a Wisconsin Partnershi b .. Laurence �' C — i Murphy - and Norwood Ecklund- -- -------------------------------- - ........... �i ST. C1010010Wi - - - - -- -------------------- •---- - - - - -- -------------------- - --------- •• ---- - - - - -- - - - - -- ... Redd for Roord - -- 192 i c onveys and warr wif e_.as.. survivorship .-max�talnpr.opexDyLeo SEP 29 9 at 11:15 A. --- - - - - -- ..... - - - - -- ---- - - •--• -- ----------- _ . . . . . .. .. .... ...... �� .... ................. ----- - - - - -- - ---- - - - - -- ........... - - -• -- - Registero� Deed3 -- li RETURN T --------- .----- ............................_ .................. .......................... .------- . _........ .. ------ St Cro ix the following described real estate in ... .......................__.._- __......_._.__.County, - _- _-- _ -__ - -- _—_- State of Wisconsin: Tax Parcel No: ....................... ...... Lot 3 of Certified Survey Map recorded in Volume 8, Page 2312 as filed with the St. Croix County Register of Deeds office on January 9, 1991 as Document Number 465576, being part of the Southwest 1/4 of the Southeast 1/4 and a roadway easement located partially in the Northwest 1/4 of the Southeast 1/4 of Section 21, Township 28 North, Range 19 West, being part of Lot 4 of that Certified Survey Map recorded in Volume ` 4, Page 1157 of St. Croix County Certified Survey Maps, being located in the Town of Troy, St. Croix County, Wisconsin. Together with an easement over and across the existing road as shown on the Certified Survey Map in Volume 8, Page 2312. Seller shall maintain this road, including responsibilities for snow removal, until said road becomes a public road. Seller hereby reserves a drainage easement over the Southerly 10 feet of the above described Lot 3. �I Said deed is given in satisfaction of the Land Contract between the parties dated �I March 6, 1992, recorded March 17, 1992 in Volume 940, Page 192 as Document Number 480588. a !� W, .00 P I I �I This ------- 1S-- nOt _-- - -_, -- homestead property. !KX)K (is not) Exception to warranties: easements, restrictions and rights of way of record, if any. GG Dated this -- - - - --- ---- --6_.1-------- -•--------- - - -- -- day of --------------------Septembe - - - - - -- ----------- ... , 19- - -92.. � COUNT OAKS: t1� ---------------- •-------- - - - - -- - (SEAL) By* --- - - -- --- � - ---- .. - - - -- -- - - - - -- (SEAL) --• - - - - - - - - - -- -------------- Murphy B y?or:wood � I_ /.._(SEAL) - (SEAL) � `�'"� Ecklund AUTHENTICATION ACKNOWLEDGMENT Signature (s) -- -- -- - - - - --- --•------------ •--------- •--- ----- ---- -- - - -• -- STATE OF WISCONSIN ss. ------------------ County. authenticated this --- - ---- day of -------------------- 19 ...... Personally came before me this .... -- ___day of - _September __ _, 19_.__92 the above named -- ----------------- - - - - -- - - - - - -- - - - - -- ------------------- * Laurence Murph,y -•-- - - - - -- --------- ------ - - - --- - -- ---- •------ - - - - -- --------------- - -- TITLE: MEMBER STATE BAR OF WISCONSIN Norwood Ecklund -•- -••----- -------- - - ---- ......................................... (If not, - ---- --- --- ------- - --- -- ......................... authorized by § 706.06, Wis. Stats.) g ,�+"" , to me known to be the person ._• __,.._ yjho exeht�d the foreg ing i strument and ackno let) ,t sar4j.� THIS INSTRUMENT WAS DRAFTED BY Joseph D. Boles (Attorney at Law) • ` JA3 .e ,n o co River Falls, -- - - - - -- ----- - - - - -• ------------- --------- - --------------------------------- Notary Public j CL_ t f>.._Com'�t �4is. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (ifna$ expiration are not necessary.) Z '�,y ••, ;•'° I� a- .... ` > date: ----------- --------------------- ll -� 19. 'f •Names of Dersons signing in any capacity should be typed or printed below their signatures, I •� �RRn`•'T'V r � n...� tNiscnncin I.Pna1 Blank Cn. Inc APPLICATION FOR SANITART PERMIT • 9TC -100 This application form is to be conplatod In full and signed by the ovnet(s) of the property being developed. Any Inadequacies will only tesult In delays of the pztmlt Issuance. -Should this development be Intended Cot ttsale by owner /contractot,(spee house), than a second Iotm should be rttalntd and completed when the property is sold and submitted to this office vlth the apptoptlate deed ctcordinq. ---------------------------------------- Oirn • oE property Kbber 6 Location of property 5 _ w 1/4 S 1 /I Section a T �1 •R � Y Tovnthtp T76 Ha l l i n g address 5 S (.j Li 0311 A Y L J L.��.�1�.� `� �^ �� � g (� I S C. Address of site /abdivislon na*Q C IC 3 2 • Lot number Previous owner of property _ �iGl�rt� e kh uo 6 IVU ,r celac c l4., Total slit of petrel _ O Date parcel vas created At* all cotnsts and lot lines ldentlflablt? �, - „Yas x o is this Property being developed foe resale (apse houatl?_Yes C_1 H o Volvwe and Page Number `��� as recorded vlth the Register of Deeds. -- ------ ---•- -----• -------------ww--wr-rw----------------------ww---------'--- INCLVDg VITH TNI9 APPLICATION Tllii FOLLOWINCt A VAARXXTT Dit[D which Includes a DOCUMENT HUMBQR, VOLUME A D PAGE HVHI[R, and the sKkL OP Tilt AROISTRR OF DRBD9. In addition, a certified survey, it available, would be helpful so as to avoid delays of the tevleving Process. It the deed descrlptlon references to a Csttltisd Survey Hap, the Cattltled Survey Hap shall also be required. ----------------------------------------- -------------------------------------- PROPURTY OWNER CERTI►ICATIOH I(VI) Cectlfy that all statements on this form are true to the best of my (out) knovledgel that f (ve) am (ate) the ownet(s) of the property described In thls Infotmatlon form, by vlttue of a warrant�j recorded in the Office of the County Register of Deeds as Document No. ` Q/) Q� . I and that I (We) presently own the proposed alto fox tho sewage disposal system (or I (we) have obtained an easement, to tun wlth the above described propectr, roc the constcuctlon of said nyalemp and the same has been duly recorded In the Oftice off- a oYhty Aeqlatec of Deeds, as Document o. J . signature of 7 Al nature of Co -owner (11 Applicable) Date of signatuts Date of algnatuc ST. CROIX COUNTY aA. WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE .6' 911 FOURTH STREET a HUDSON, WI 54016 (715) 386 -4680 September 2, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite soil investigation of the Larry Murphy property, which is currently owned by Robert DeLeo, located in the SW1 /4 of the SE1 /4, Sec.21, T28N, R19W, Town of Troy, St. Croix County, WI., has been conducted with the assistance of Bob Ulbricht, CST# 2482. This onsite revealed suitable soil for onsite sewage disposal to a depth of 30" while meeting the requirements of the A + 4 rule. This site should be suitable for a mound septic system having 12" of sand fill. Should you have any questions, please feel free to contact this office. inc ely, J es K. Thompson Assistant Zoning Administrator cc. file SEPTIC TANK MAINTENANCE AGREEIIENT w St. Croix County rt OWNER /BUYER Qe Leo 0 0 ER .. Fire Number 0 ROUTE /BOX NUMB Fe. i Lj s l 5c zip s�� n ' CITY /STATE � ( �� • +° —'� PROPERTY LOCATION :' S W k, k , Sectio TAN ► R W • Town of ern St. Croix County, Subdivision Got. ^y aG , Lot number 3 Improper use and maintenance of your septic osystem could r in its premature failure to handle wastes. soon sists of pumping out the septic tank every three years ut into if needed, by a licensed' t*ic tank um per. What you p the system can affect t e .unct on o. the—septic tank as a treat- ment in the waste disposal system. St. Croix Count residents'-may y be eligible t eve a a maximum of 601. of the co t P l whl was in operation prior to 1, 1978. St. Croix County accepted this program August of 1980, with the to keep their system g properly that owners of all new stem g maintained. The property owner agrees to.submit to St. Croix County Zoning certification form, signed by the owner and by plumber, journeyman plumber, restricted plumber or..a licensed pump er fying that _ (1) the on -site wastewater disposal system is i3.fproper operating condition and •(2)•after inspection and pumping essary) , the septic'•tank is less than ful 30 days sludge prior to sent Certification form will be approximately three year expiration. y I /WE, the undersigned have read the above requirements and agree 0 to maintain the private sewage di as.set bys accordance the Wisconsin Depart- the standards set forth, ment of Natural Resources. County Zoning office Certification o_ twithin completed and � and returned to the St. Croix of the three year expiration.date.,_____ SIGNED DATE St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386 -4680 Sign, date and return to the above address. DEPARTMENT OF REPORT ON SOIL BORINGS` S AFETY INDUSTRY, Y, DIVISION LABOR AN D P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: OWNSHIP /MeWCltfi'CiT9: OT NO.' LK NO.: SU801V1 1 N NAME: 6 � 2. / /TaN / R I ?E to ► T'p-oY ,3 cs 4 ArVA/:vcs- COUNTY: AAWY *r/,P lly _ MAILIN ADDR 5 : 5 ><e 2o /�' •�rak G�ttiO Sv�+v ram 1 9T. I 73 o x 3 A R; uFi2 Sit c IS. k) r S. s5% z z USE DATES OBSERVATIONS MADE NO.BEDRMS.: JCOMMERCIA LDESCRIPTION: : Residence 3 �- 4New ❑Replace $c S I l RATING: S= Site suitable for system Ua Site unsuitable for system z - - 407 %f CO S.4T X y y ONVEN IONAL: MOUND: IN- GROUND•PRESSURE: SYSTEM -IN -FILL OLDING TANK: RECOMMENDED SYSTEM:(optional) DS U ©S ❑U [IS 011 [IS FM ❑S ©U m o u v 5r r e If Percolation Tests are NOT required DESIGN RATE If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: CG� -rs Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H 0 GROUP DWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION RV ED EST. HIGHE TO BEDROCK IF OBSERVED SEE A8BRV. ON BACK.) & r �7 1 y ! . 33 ` 8N -Sy. S"/ /, 33 �. fY s i/ (4 I - S' 'G � () — l � 2 . G 5f1V �ioc,t'y -t; /' 3. $ B- �, � ' � , I . /6� <<Y s,' /o B- Z �n.0 D 3. Z V FI,P.K X31 n r:Ky / R .j. S 3. P,AO R,J 5 w/ , is , 0t•6 o ' Y. -to -t--s B- MM L� � - 3 3' 19i-Qj Si/ 7S G�j- �f.3w. Dloc.KY J"/ Z,ae V , 9 / 0 / p�/ G1 'W Q a - l/ r S S, 2 P*., s✓c sC,1- pis T- ok aY "-f PERCOLATION TESTS TEST DEPTH . WATER IN HOLE TEST TIME DROF IN WATER LEVEL-INEHIS RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. p PER INCH P . 3c ? O P. 3 0 <* G Q P 1-/ '7 P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or disunces. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the j &oction and percent of land slops. SYSTEM ELEVATION � i�fi, rd.,,, .- w ` e� i� " s �N ° c," , ( _ !' %S TiE �%3 v Teo.✓ L/r T� - A'Ir l S 7• 3 .S SEE, C - . ��lJ ,.5: T� , �/ �ipy,���G�Tic9.s;� 6tJ ice: � r'�t �Otir d s D.✓ f i 1 . 4 . ... .i..�... -.. {._....�.6...... -. 1..... -.L- ..�1.. _�- .1.._.x.1.. J _. ` _.. -. . . . 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: HOMESITE SEPTIC PLUMBING CO. S E p T. 1+ I V ADDRESS. 6550'N I .,HU193SWO ,VhIS -548tS CERTIFICATION NUMBER: PHON NUMBER loptional): ROBERT ULBRIGHT ZIT 2 CST SIGNATU E: 246/4 /C A_ •'lNN, INSTALLER & GESIGNER LIC, N0.00663 DISTRIBUTION: Ottginal and one copy to Local Authority, Property Owner and Sod Tester. DILHR -SBD -6395 IR, 10183► - OVER - � Lh � P oT P Lo -t- 3 l i v f V 0 �3 fo ZZ� x P3 S-9 . 0 5 0 3 - - - -- a� • �2 2- E�S7' Al op �7�04TOA) I SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 BOB ULBRICHT Owner: BOB DE LEO 655 O'NEIL RD RT 5 58W WOODRIDGE OR HUDSON WI 54016 RIVER FALLS WI 54022 RE: Plan Number: S92 -03139 Date Approved: September 9, 1992 Gallons Per Day: 600 Date Received: September 9, 1992 Project Name: DE LEO, BOB - RESIDENCE Location: SW,SE,21,28,19W Town of TROY County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. Tisa approval ppro ai will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50 -64 of the Wisconsin Administrative code. This approval is for the following components only: - NEW MOUND Inquiries concerning this approval may be made by calling (608) 266 -8230. ORIGINAL SBD -6423 (R. 01/81) Amon SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations BOB ULBRICHT Page 2 Sincerely, J KENN TH STIEMKE Section of Private Sewage Division of Safety and Buildings PPP016 /UUU9n/ 8 cc: BOB DE LEO _Private Sewage Consultant County UW -SSWMP Plumbing Consultant Owner Plumber Environmental Health i SRD•0433 (R. 01/91)