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HomeMy WebLinkAbout040-1144-80-200 0 > 0 0 z LL '0 'a 1 <1 \ _ 04 cn Z i IL co �2 .2 2 m 0 z c 0 0 z 7 2 ce) a cm 0 N CL (D :3 a) Cl) § t ON co o 2 < z z z c') 0 c 04 CN, E 6) I ' D Q- CL M La 0 I co 0 a .0 72 CL E U) Lo CL :D yab • k 0 0 0 IL IL IL 0 0) 0) 0 0 CO) 0 a> V) _3 0) m m cq cq 0 ;3 E (D ( > 0 2 -6 0 < z U) (n M (D 0 3: w a 0 04 E < . i CO U . ) C> 0 r- m 0 CL o o 00 - i .0 to r 2 (D = C%j 0 OD - 5 00 6 C14 C 04 "t 0 CD 0 C) M C:) z Z CL 4) IL 0 CL Z 2 i� 0) » *Ai 0 - 0 C Q u E r = 0 (0 1 a. 2 0 3 ti O U � N ti 0 Y 0o a 0 � I h o I O ' N N I � I d I I Q Z N z LL c O 3 E a 0 °- I r O N N W 0 w cn 0 z N € ° a 0 O z d co 0) z 2 0 N F- r c Z s E � Ch N CL 7 N N y .MM a L O 4 C C @ C Y U z w Z N d N N N 0� n + G m c co G G a z� > 0 bQ Z �aaa �, I IL o 0 C } U) J U = rn rn N 0 N N _ 0 O O w p p 7 Op E N O O m c Co O Z Cl) co � V; ° ° H C E 04 CO O o Lo o `r m u a ° ° V 0 3 N m N N 0 m- 7 N N i N T CC d N C C N OJ CO ° 0 e O N m' m 0 O y am ', o 1= F M o Z c Y cn ., 6 #t a a `I�i rte+ E C L '2 c w r Q u IL O N V Parcel #: 040 - 1144 -80 -200 01/25/2005 08:16 AM PAGE 1 OF 1 Alt. Parcel #: 12.28.20.575A -20 040 - TOWN OF TROY Current I X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): " = Current Owner * TILTON, WILLIAM L WILLIAM L TILTON 101 E 5TH ST #2220 ST PAUL MN 55101 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 278 W GROVE RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.000 Plat: 0376 -CSM 0712023 SEC 12 T28N R20W SE1 /4 LOT 1 CSM 7/2023 Block/Condo Bldg: INC PT OF P1014 (RW EZ) ALSO PT OF LOT 2 CSM 7/2023 DESC AS COM SE COR LOT 1 SO Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) CSM;TH S 01 DEG E 33';TH S 89 DEG W 12- 28N -20W SE 652'MOL; ;TH NELY 43' MOL;TH N 89 DEG E 624' POB ALSO COM NE COR SEC 13;TH N 89 more Notes: Parcel History: Date Doc # Vol /Page Type 04/01/2002 675114 1865/90 WD 04/01/2002 675112 1865/85 WD 01/03/2000 616334 1481/325 QC 01/03/2000 616329 1481/312 WD more... 2004 SUMMARY Bill M Fair Market Value: Assessed with: 27251 844,400 Valuations: Last Changed: 07121/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 517,000 329,100 846,100 NO Totals for 2004: General Property 5.000 517,000 329,100 846,100 Woodland 0.000 0 0 Totals for 2003: General Property 5.000 470,000 301,500 771,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 1210411998 Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 040 - 1144 -80 -100 01/25/2005 08:16 AM P AGE 1 OF 1 Alt. Parcel #: 12.28.20.575A -10 040 - TOWN OF TROY Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 2 Tax Address: Owner(s): ' = Current Owner RETIRED TILTON " TILTON, RETIRED Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 278 W GROVE RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 0376 -CSM 07/2023 SEC 12 T28N R20W SE1 /4 LOT 1 CSM 7/2023 Block/Condo Bldg: INC PT OF P1014 (RW EZ) ALSO PT OF LOT 2 CSM 7/2023 DESC AS COM SE COR LOT 1 SD Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) CSM;TH S 01 DEG E 33';TH S 89 DEG W 12- 28N -20W SE 652'MOL; ;TH NELY 43' MOL;TH N 89 DEG E 624' POB ALSO COM NE COR SEC 13;TH N 89 more Notes: Parcel History: Date Doc # Vol /Page Type 04/01/2002 675112 1865/85 WD 01/03/2000 616334 1481/325 QC 01/03/2000 616329 1481/312 WD 12/12/1997 569820 1282/306 WD more 2004 SUMMARY This parcel will not get taxed. It exists soley Assessed with: for parcel history tracking purposes. Valuations: Last Changed: 07/24/2002 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 040 - 1144 -80 -000 01/25/2005 08:15 AM PAGE 1 OF 1 Alt. Parcel M 12.28.20.575A 040 - TOWN OF TROY Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 2 Tax Address: Owner(s): * = Current Owner RETIRED TILTON * TILTON, RETIRED Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ` 278 W GROVE RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.093 Plat: 0376 -CSM 07/2023 SEC 12 T28N R20W SE1 /4 LOT 1 CSM 7/2023 Block/Condo Bldg: 3.808 ACRES INCLUDES PT OF P1014 (ROADWAY EASEMENT) ALSO PT OF LOT 2 CSM Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 7/2023 DESC AS COM SE COR LOT 1 SD 12- 28N -20W SE CSM;TH S 01 DEG E 33';TH S 89 DEG W 652'MOL;TH NELY 43' MOL;TH N 89 DEG E more Notes: Parcel History: Date Doc # Vol /Page Type 01/03/2000 616334 1481/325 QC 01/03/2000 616333 1481/323 QC 01/03/2000 616329 1481/312 WD 02/15/1999 597784 1403/455 WD more... 2004 SUMMARY This parcel will not get taxed. It exists soley Assessed with: f for parcel history tracking purposes. Valuations: Last Changed: 07/24/2002 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 �Wiscon&:n Department of Commerce PRIVATE SEWAGE SYSTEM County: a nd Buildings Division Safety a 9 INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST. CR IX Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 344645 Per itH We 'sNamee: E] City ❑ Town of: State Plan ID No.: TIE, BILL I CST BM Ele� Insp. BM Elev.: BM Description: Tj Parcel Tax No.: 040 - 1144 -80 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding i St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG_ Airi to ntake ROAD Dt Inlet irl Septic NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft m ead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type 0 mod Numb System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake 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 Edges Topsoil El Yes [I No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 12.28.20.575A 278 WEST GROVE ROAD U ;� - �/_ Ig- Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3197) Date Inspector's Signature Cert. No. Safety and Buildings Division SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue N-Visconin P O Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 r3 • Attach complete plans (to the county copy only) for the system, on p eT� ` I y r utsty T _ . than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application to Saniiar� Permit Nu mber *5 Personal information you provide may be used for secondary urposes S ' p De n ck it rev to pr evious application [Privacy Law, s. 15.04 (1) (m)]. 1 1 ?SC���T ate Plan'I:D: umber I. APPLICATION INFORMATION - PLEASE PRINT ALL INFO Property O er Name f pert !ion kI�4, S , N, R * (o r W Property Owner's IV1 il ing Address Lot / Block Number City, State Zip Code Phone Number Subdivision ame or CSM Number ssiotJ� 1(63 a y- aa/ - a 12 It. TYPE OF DG: (check one) ❑ State Owned [I City Nearest Road E] ge Cr�.t�•cli= Public 1 or 2 Family Dwelling - No" of bedrooms T T o Vi of 7 III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) I j2 .2Tr. -ij . c5 A 1 ❑ Apartment/ Condo 114/0 0 - Wo 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_ X 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 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 ((Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 []Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill 3 3 0 - Z 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/d /sq. ft.) (Min. /inch) Elevation 6 9 — Q Feet Feet Capacit VII. TANK in allots Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks M anufacturer's Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank host adbo i ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber /6001 1/0 l ❑ I ❑ ' I ❑ ❑ ❑ VIN. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb 's Nam (Print) Plumbe ' ignatu e: (No Sta s) /MPRSW No.: Business Phone Number: 3� U O?e s .- Plumb r' Address Street, City, S Code 6 V IX. COUNTY DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iping t Sig nature (No Stamps) Approved 171 Owner Given Initial Surcharge Fee) SC Adverse Determination /� X. CONDITIONS OF APPROVAL / REASONS FOR ISAPPROVAL• "r- t= a SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM h filing k+.: t ess P� erty Ad 9ress � / o. P , (Veri fication required from Planning Department for new construction) (Jy /State 0.\j Parcel Identification Number L. T, L ['sir, 1' ° operty [:o ration _ ' /., '!,, Sec. a . T 3 N - R W, Town of Si bdivisioi-i \L � 1Oc� , Lot # C ;miffed ,yt. :!rvey Malt # L A � 51� , Volume , Page # 00 � . N1 arrant 1'iieed # � a 0 , Volume o� a , Page # 30 _. St = horns .-, yes no Lot lines identifiable �6 yes O no 8 STER ;v L AINTEN ; ANCE Ir tp v ; ter use and tnaintenanceof your septic system could result in its premature failure to handle wastes.- Propel v aintenance cis isists of pw-rping out the septic tank every three years or sooner, if needed by a licensed pumper: What you put ins w the system cn 1 affect tb 4 I anetion of Vie septic tank as a treatment stage in the waste disposal system. Tae (l ovm�sr agrees to submit to St. Croix Zoning Department a certification form, signed by the. ow�aer and by a rr , ver pitnul, i i i., journeymaa plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewatcrdi sal. system is n proper i lip: rating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 fizi' of sludge. [! c, the u.;tu. G igned have read the above requirements and agree to maintain the private sewage disposal system with. f.,:. standards se firth Y ir4, as set by file Department of Commerce and the Department of Natural Resources, State of Wisconsin. 0trtifieatioc str ti th y pi : septic systc.m has been maintained must be completed and returned to the St. Croix County Zoning U within 34 dt s th[f t h� year ex d te., S 314ATU I: IF APPLIC 4Nt DATE _G: NEF a`;:t;' ;RTIFICATION I !'±certify. that al tatc:ments on this farm are true to the best of my (our) knowledge. I (we) am (are) tha 2wner(s) of t}+ p (I scribed e ; '`by v' ue of a warranty deed recorded in Register of Deeds Office. 1% INATCR. IF APPLICANT DATE An) :a iformation t;tat is mis- represented may result in the sanitary permit being revoked by the Zoning Departtri ,:at. Include Npi.rh 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 Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)J. 344645 Permit LTO'S1Namee- ❑ City Town of: State Plan ID No.: CST BM Elev.:- Insp. BM Elev.: BM Description: R Parcel Tax N .. �, O► 0 � � � 5�� � 0- 1144- 80 -000 TANK INFORMATION ELEVATION DATA ( -2- TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1.�Jts v •5O Benchmark &Z) , d Dosing A4.V D -*. n. Aeration Bldg. Sewer 9(,, 4-1 Holding St /Ht Inlet 3,g0 qj (, TANK SETBACK INFORMATION St/ Ht Outlet N, 0: - t 73 , 9 TANK TO P/ L WELL BLDG. Ai Intake ROAD Dt Inlet Septic tarp 5 1 gi , NA Dt Bottom SM 3 / Dosing >.(M ��ZI oZ3f NA Header /Man. 5 I o2. 2. Aeration NA Dist. Pipe Holding Bot. System �" b.Y2 t oo :1 PUMP/ SIPHON INFORMATION Final Grade &14 ou (_ Manufacturer c Demandf Model Number 74 GPM I to T Lift , Friction , L$ System ^ TD4 "Ft L H ead Forcemain Length `6 Dia. a u Dist. To Well �sZ, SOIL ABSORPTION SYSTEM a� w 6 3'7f4,,, -= 736 BED/TRENCH Width f Len t No.O r ches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3.3 D IMEN I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manu a t rer: SETBACK CHAMBER INFORMATION Type O I r r M e Number: System: V 6 �I� �/� �/� > ( OR UNIT _ /0, DISTRIBUTION SYSTEM Header/Manifold of Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length_e Dia. Length Dia. Spacing I I I > rs 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 P P P Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: TROY 12.28.20.575A 278 WEST GROVE ROAD ,F't 3�.r7 � �.�'� �w ��� • 5�✓ r.-� -- •� �g" •y�::Q, tee,«. � 4, Plan revision required? ❑ Yes No Use other side for additional information. 1 0,5 - 'LZ aD r SBD -6710 (R.3/97) Date Inspector's Signature Cert. No Safety and Buildings Division Visconsin S ANITARY PERMIT APPLICATION 201 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code w Madison, WI 53707 -7302 n • Attach complete plans (to the county copy only) for the system, on p e I v f 11 y :> than 8 vi x 11 inches in size. • See reverse side for instructions for completing this application to Sahitar Permit Nu mber�� r Personal information you provide may be used for secondary purposes Lo El eck it idyls n to pr evious application lPrivacy Law, s. 15.04 (1) (m)]. c ,S'� J 1 � —e 4� f�J 4 ,. ate Plarti +:'D:. umber I. APPLICATION INF RMATI N - PLEASE PRINT ALL INFO Property Owner Name r pert tion 'S ` ° r , N, R Property Owner's M ilin Address Lot / �, Block Number City, State Zip Code Phone Number Subdivision ame or CSM Number �o ss�o�� I (63 - 1) aaV_0071 - o II. TYPE OFULTI (check one) ❑ State Owned its age C_44r 4� Nearest Road Lj Public 1 or 2 Family Dwelling ❑ VII - No. of bedrooms Town OF III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) I 12 . ZTr. , ia . Gj — z P j A 1 ❑ Apartment/ Condo y©- a - 0 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. K Replacement 3, ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ______System System Tank ank Only stem ______________ Existing System Existing 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 [W Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill © r— S- 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/da /sq. ft.) (Min. /inch) Elevation 7 ,5 ' 0 7 Q Feet Feet Capacity VII. TANK allo in Total # of Prefab. Fiber- Exper. INFORMATION g Site Gallons Tanks Manufacturer's Name Concrete con Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank /6,<6 r 1:1 El El 1:1 1:1 Lift Pump Tank /Siphon Chamber 1 boo 1/ 0 001 / ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb 's Nam (Print) Plumber' ignatu e: (No Sta s) /MPRSW No.: Business Phone Number: Plumb r' dress Street, City, S Code�t, �� 5 CFO L C SL Tx DEPARTMENT USE ONLY []Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Is In Pf1 Su (No Stamps) raclfd �-_,. [�pproveci ❑ surcharge Fee) Owner Given Initial Adverse Determination /� X. CONDITIONS OF APPROVAL / REASONS FOR ISAPPROVA - z> �pe4- SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: 5 afety & Buildings Division, Owner, Plumber 1 INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be 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 5. 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. Ill. 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. V11. 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 into 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 81/2 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) 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. , ,l•JT. 70 If • N i/ ♦ Ele�lat: on S� N ✓ r o fd L. o lU 5 /4 4 R Sid:nq. Fl GIO.�• Rio. 90 ' Ex. sfr„J rrs�dc,�ce 0 buried jaI /, f(dt- M wit �+-�,i�• El tr: ; 96. sa; Gp prdy. /ocaiion o f b4ricd elit e. line ' I C'7 wn �!�• � o Ca �,� 8�lE Gav f.lot2,Sec • iZ, -r * /9S q.y-s "7rltl Sf . /2. 20 W 7 O'To y , Sf. A uC� of SSjoS s{. C.roi)f �o•� Wt. as - 7 y ""--�— ^ °�• BOSS SECTION AND SPECIFICATIONS 4 " CI VENT PIPE 12" MTN. ABOVE GRADE & ?"25' FROM DOOR, WINDOW OR WEATHER PROOF FRESH AIR INTAKE JUNCTION BOX APPROVED FINISHED GRADE 40 CI RISER WITH CONDUIT MANHOLE l 6" MrN. W/ PADLOC ABOVE G ADF "'WARNING i 28 IN 6" MAX. INLET :� ** WATER TIGHT SEALS H ' ?1 A • 4" /'' TIGHTs ' CI PIPE BAFFLE --./ A SEAL � APPROVED 3' ONTO -j— OV ED B LM JOINTS W/ SOLID 'i`" ! ON PIPE 3' 0 SOIL C SOLID SOI PUMP OFF ELEV. _AFT. - OFF ** RISER ® D PERMITTED IF TAyK MANUFACTUi 3" APPROVED BEDDING UNDER TANK HAS PPRO' SPECIFICATIONS CONCRETE P EPTIC 1 DOSE - - ._... - - •.......... .... . TANK MANUFACTVRER : NUMBER DOSES PER DAY: I TAN SIZES SEPTIC /�oS�U GAL --- - DOSE DOSE VOLUME GAL. INCLUDING OUr Q ALARM MANUFACTURER: FLOWBACK: ?-I GAL. MODEL NUMBER: CAPACITIES: A = SWITCH TYPE �aINCN£S jj" -� ,y e = .,_,? INCHES �p�$a,,�P r'UMP MANUFACTURER: �-t 7 MODEL NUMBER: —'�'-' C = �INCHLS _ �7 SWITCH TYPE: D ° INCHES : - &�j KEpUIRED DISCHARGE RATE �� GpM PUMP � ALARM WIRING AS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PER ILHR 16. 23 MINIMUM NETWORK SUPPLY PRESSURE PIPE + ( O FEET ` -L FEET FORCEMAIN X ��FT /200 FT. • FRICTION FACTOR '— FEET TOTAL DYNAMIC HEAD _ --� FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH f - ��FeeT t �r WIDTH Z ` : DIAMETER LIQUID DEPTH i / �tl LICENSE NUMBER : Goulds Submersible Effluent Pum 3 871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. y components. ■Motor Cover: Thermoplas- • Homes Available f tic cover with integral handle •Farms Motor; or automatic and and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, manual operation. Automatic points. z • Water transfer 115 or 230 V, 60 H, 1550 models include Mechanical RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty • Dewatering automatic reset. preset at the factory. rated oil and water resistant. SPECIFICATIONS • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- construction. • Solids handling capability: automatic reset. 3 /4 maximum. • Power cord: 10 foot plastic Semi -open design AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO with three with pump ou • Total heads: up to 24 feet. prong grounding t vanes for mechanical seal protection. Q median standards Association • Discharge size: 1 plug. Optional 20 foot N EP05 Impeller: Thermo - pl enclosed design for (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with improved performance. end in "F" or "AC ".) rotary/ceramic - stationary, three prong grounding plug BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running + dry without damage to s 30 components. Pump: EP05 8 -2.5Ft • Solids handling capability: c 25 Y4" maximum. a 3� • Capacities: up to 60 GPM. s 20 • Total heads: up to 31 feet. g • Discharge size: 1'/6" NPT. = 5 • Mechanical seal: carbon- o --ir, - F rotary/ceramic- stationary, s BUNA -N elastomers. o 4- E • Temperature: 3 10 104 °F (40 °C) continuous 1�.� as riti- EPW 140 °F (60 °C) intermittent. 2 5 Q �, l�+► 0 00 10 20 30 40 50 GPM L j- 0 2 4 6 8 10 12 math CAPACITY (t) 1995 Goulds Pumps Effeclive May. 1995 8 3871 �VVisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code A.C.E. Soil &Site Evaluations Attach complete site plan on paper not less than 8' /s x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reef n direction and St. Croix percent slope, scale or dimensions, north arrow �� I It d diets to nearest road. Parcel I.D.# 040- 1144 -80 -000 APPLICANT INFORMATION - p rint ll " ormatib► R w Date Personal information you provide may be used ndary p , ,ri oY Law, s.'15.04 (1) (m)). .� L y Property Owner -P perry Location Tllton, William L. { � G K Lot 2 1/4 1/4 S 12 T 28 N,R 20 W Property Owner's Mailing Address ST COAX # Block # Subd. Name or CSM# 195 Chatsworth Street Z NrY ! 1 NA CSM Vol. 7, Pg. 2023 City State Ph0 tfrt9�r City ❑ Village ❑Town Nearest Road Saint Paul MN 5 -224 - Y Troy West Grove Road ❑ New Construction Use: N Residen bedrooms 5 ❑Addition to existing building ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 750 gpd Recommended design loading rate •7 bed, gpd/ft .8 trench, gpd/ft Absorption area required 1071 bed, ft 937 trench, ft ,2 Maximum design loading rate .7 bed, gpd/ft .8 trench, gpd/ft Recommended infiltration surface elevation(s) 101.00' ft (as referred to site plan benchmark) Additional design / site considerations Install trenches using high capacity infiltrators. Dosing required to reach system location. Parent material _Outwash s & gr. Flood plai n elevation, if a livable NA ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system N S❑ U ® S❑ U ® S❑ u ❑ S❑ U ❑ S® U ❑ S u SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure Consistence Boundary Bounds Roots GPD/ft2 Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Bed Trench 1 1 0 -5 10YR3/2 None sl ?Imsbk mvfr cs 2f, lm 0.4 0.5 2 5 -14 10YR4/2 None sl mvfr cs 2f &m 0.4 0.5 Ground 3 14 - 39 10YR4/4 None s 0 sg ml gs if &m 0.7 0.8 elev 105.00 ft 4 39 -68 7.5YR4/6 None s 0 sg ml gs If 0.7 1 0.8 Depth to 5 68 -109 10YR5/4 None s 0 sg ml - - 0.7 0.8 limiting ' `� factor �1 >109" Remarks: 2 1 0 - 10YR3/2 None A Ifgr mvfr cs 2f, Im 0.4 0 2 6 -20 10YR4 /2 None A lmsbk mvfr cs 2f &m 0.4 0.5 Ground 3 20 -39 10YR4 /4 None s 0 sg ml gs 1 f &m 0.7 0.8 elev 105.82 ft 4 39 -68 7.5YR4/6 None s 0 sg ml gs if 0.7 0.8 Depth to 5 68 -115 10YR5/4 None s 0 sg ml - - 0.7 0.8 limiting factor 'l >115" �� $ Remarks: CST Name (Please Print) Sign re: Telephone No. James K. Thompson 715- 248 -7767 Address A.C.E. Soil & Site Eval ns Date CST Number Ref # 340 Paulson Lake Lane, Osceola, WI 54020 5/14/99 3602 1031 PROPERTY OWNER: niton w dliam 1.. SOIL DESCRIPTION REPORT ,os, Page 2 of 3 PARCEL LDJ 040- 1144 - 80-000 A.C.E. Soil & Site Evaluations Depth Dominant color Mottles Structure GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. nsistence Boundary Roots Bed Trench 3 1 0 -5 10YR3/2 None sl Ifgr mvfr cs 2f, lm 0.4 0.5 2 5 -17 10YR4/2 None sl lmsbk mvfr cs 2f &m 0.4 0.5 Ground elev 3 17 -25 10YR4/4 None s 0 sg ml gs 1 f &m 0.7 0.8 103.87 ft 4 25 -53 7.5YR4/6 None s 0 sg ml gs if 0.7 0.8 Depth to 5 53 -98 10YR5/4 None s 0 sg ml - - 0.7 0.8 limiting factor >98' - -�o,� Remarks: - - -- Ground elev Depth to limiting _ factor Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: _ S ■ .�.: l Dbs�ru�en v ' ♦ E!Q ✓A on A �7 9S S /44C A lt. &A.: &t to e B - 3 ■ I A EX %S�inq ___ ■ � res�denee 0 wel.� 9SS °� Q �o caf,•c» G�' d^��'t app,-O-. hcatcn Or burred elect. /ine T 2, See, /Z, x28/1., � l ,--d s { . Q . Zo W." 7n. anToY, St- P h?n. Ssl SE. Cro Co•, w �. �./ `7°� r ST CROIX COUNTY SEPTIC TANK. MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM C vner[B E h i ing `� 1,;: Tess ._ ` `. / f_ .. 1'r u,ertv . ,i 3,ress � (.J Sl 6, � �`�� �, l^ "Z s urV 1 - (Verification required from Planning Department for new construction) C ty /Stat+ w .. �'�J `�� �. Parcel Identification Number 1. L. I fIE; SCRIPTI ON P' op erty E io Nation ! '/4, ' /4, Sec. J a , T N -R 2 W, Town of �o� � . Q� � a?) Lot # S bdivis; _ . ti; ;rtifierli ,;j.;!rvey Malt # �i ``� `��� , Volume ] . , Page # 00 D 41 arrant,Ry "Fl eed # , �! () a Q , Volume I a a , Page # S, tec hou.s�;. 'I yes no Lot lines identifiable )� yes 0 no ST D �fji,( AINTEKkNCE Ir l- t oer use and maintenance of your septic system could result in its premature failure to handle wastes. Proper traintenance co isists of p ,i. rping out th s septic tank every three years or sooner, if needed by a Iicensed pumper. What you put inic. the system c:, ► affect tlr,:,l'unetion of t'ie septic tank as a treatment stage in the waste disposal system. i operty ovrn,-r agrees to submit to St. Croix Zoning Department a certification forth, signed by the. owe 1tr and by a tr ; seer plwnl iiir, joutneyma,ii plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdi, fc aal system is n prope r i lit i °ating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 &4 of sludge. li - 'e, the u;tu c-/.signed have read the above requirements and agree to maintain the private sewage disposal system with ti +, standards sc fi rth , h44-! ip; , as set by t':re Department of Commerce and the Department of Natural Resources, State of Wisc;onsrn t' rtification str dA th y thi :r septic systrstn has been maintained must be completed and returned to the St. Croix County Zoning.'Off tt: within 30 61 s thK 1'0 :e year ex j rid te. ; S sNATUR :i )F APPLICANTr DATE C A rNER 1 11 ;RTIFICATION I `certify that al tatcsments on this form are true to the best of my (our) knowledge. I (we) am (are) tha - wrrer(s) of tt< p t rl+ °'scribed c by v' ue of a warranty deed recorded in Register of Deeds Office, 77 S`: itJA at ] ')F APPLICANT DATE Artj ii cFormation twat is mis represented may result in the sanitary permit being revoked by the Zoning :Departs ±o.7t. N rr «w Includo ii! I h this appli cation: 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 i I � , ?"001 ` rot 1:_s F- 1) -nt l7u m bcr __. I)a'amrn' Tlf __. 9:30 A Rocotding Area Name and R-turn Addrtu 7'77 ti' • , t • ; s,tE. Et�n4A,'VIN 55439 H LA g Pared IdmGSutioa *Ir�bcr (PIN) TRANSFER FEE 1 "TUIS PAGE IS PA£T OF THIS LEGAI, DO(.UW':N't -- DO NOT r MOVE" TLis idOl-,-600 crun be cotatpl ud by wbcc:i : Aon mo adc ar the tinn+int ela cx, letal der _.... rvsme h renc ufAr - P!N rlf required). Od— irtformarion " c"iP'OJ^. 4.. "'Y br Placed on rhir fCrir Pate of the doc�an , or 7 be placed ai ad6aonal par" of the docwnrnt Note: We of thir curer pare a!ar me Par. - w your do,, , -a Qp rn dr recorsLn r fee. }Pucorvin Stao.* s, 54 517. WRDA 2196 v 2 2 , < ! r L'J: Uh1GNl ,.4. STATE 11,\R (11 11'ISCONSIN FORM I-- 1032 Y ' s ""Act RiS[RVCO roR atCoROINO OAM WARRANTY DEED ` !� V OL 1282PACEIM) GEORGE K. LINDEBERG T LN e m, a betivicel, ... ... .. I Y �`O I N HUSBAND.. AN.Q.. W.I F .E ............................. f ....... ............................... . .................. ..................... -- ................ Grantor, jand... WILL[. Ill t l.. h•... TL I- T. ON ..................................... ............................... .r : :: : :: : :::...::::..... - ......:: .- '. ::: : : :::: : :: : :: : : : : : : : ::: 1 _ .................. ........ _...... ................ Grantee, W 11:leSSCLII, That the said Grantor, f,,r r valuable consideration...... conveys to Grantee the following described rcnl estate in S . .. . CROI X ...................... j Cowlty. Stale of Wisconsin: i( PART OF GOVERNMENT LOT 2 OF SECTION 12, TOWNSHIP 28 - RANGE 20, ST. CRO I X COUNTY, WISCONSIN, 'Pax Parcel No:. 040_ . 1 144 80,__,,,...... DESCRIBED AS: ` LOT 1, CERTIFIED SURVEY MAP NO. 108, FILED SEPT. 29, 1988 1N VOLUME 7, PAGE 2 023, AS DOC. NO. 141515. TOGETHER WITH AN EASEMENT FOR ACCESS PURPOSES OVER LOT 2 OF C.S.M. NO. 108, V.L. 7, PAGE 2023 AS SHOWN ON SAID CERTIFIED SURVEY MAP. AND TOGETHER WITH AN EASEMENT OVER AND ACROSS OUTLOT 3, WEST GROVE ESTATES, ST. CROIX COL.NTY, WISCONSIN. 7i: 1 � -7 l� to — : 1 tcq "1 �1 This *......... homestead property. (is) (is not) Together with all and singular the hereditanienta and appurtenancea thereunto belonging. .... ...... ... ............................ ............................... warrants that the title is good, indefeasible in fee simple and free and c'e • of encumbrances except and will warrant and defend the saute. 24th nat�a thin .............. ........ :.. .... .............. ., -- day of .' VOV. E. M6LR ........................... . ....................... 19.. i 1... .... f.:.... L....Y .... -t EAL) �. ?G.. d .,.3 :.�t..:.`.` .. ` i . ......................... (SEAL) .. J .. GEORGE K. .......................... MAR` JO..EI. G ............................... It ................. I.... (SEAL) ............ .............. (SEAL) • ................................... ............................... ' ................................. ............................... AUTHENTLCATION ACKNOWLEDGMENT MINNESOTA I ` Signature(s) ............................ ............................... STATI -' OF V(4$180IIQ$IX as. ' ...........................•---•...-•---......... ..•- ••---- •--- .......••-- •• - -•• RAI,SEY C 7 24th y 1 authenticated this ..... -..day of ........................... 19...... Personally cattle before e nie me this ..............do of . NOVEMBER NOVEMBER ................. 19........ the above named - .......... ----- ...- •----- •......... GRAIVTUP, GEORGE K. LINDEBERG AND *... ---- •-- • ................. ......... ............. ............ . ..... _ �O HUSBAND_- AND..�iZFE....... TE BAR Oh TITLE: MEMBER STATE WISCONSIN ............. ............................... (If not . ................... ....- ... ..........-- ................... ............... ........ ................ .................................. ....... authorized by $ 706.06, Wis. Stats.) to mo known to Le the person 5.......... who ex_,:utcd the foregoing instrument and acknowl e the sane. + THIS INSTRUMENT WAS DRAFTED nY UNIV;K�Al- TITLE ...... �.�_.::'�,..�.c. :.kJ; . ........ .. .... ......................... ..................................................... KELLY � LUADTKE 2065 N. . -_ RICE ST., ROSEVILLE, MN 551 3 Notary " Public - ... AMSEY ....•-- ---------- - - - - - -- - County'' lys. MN (Signnturrs may W authenticated or uck;:.,e.; li; ed. I)uth M Commission is permanent. (If not, state cxpiratioli { arc not necessary.) date: .. .. ......... ) 1 KELLY M. LUADTKE •Nsm,s ur J."N n., hd'- 1:,..t- eiR„nlnn.• ` it s NOTAA D AiNNESOTA ...... ,........ RT.%m !!kit nv wigrY1N5IN S �M• �S, ..:n;S ii 9.M• ��7N YK`7 1 (0 V' 441515 CERTIFIED SURVEY MAP c c19B8� Located in Government Lot 2, Section 12, LEGEND T28N, R20W, Town of Troy, St. Croix County, Wisconsin O to COUNTY SECTION CORNER N\ BERNTSEN CAP C $ m N • I" IRON PIPE'FOUND \ ���-f' o O i" X 24" ROUND IRON PIPE WEIGHING 1.68 LBS. /FT. SET *—I- EXISTING FENCE t" w coil o I � 8 rn + �'i N ~ �mcn 24.76' 0 10 o o co - • o 00 cD b2so � N z z i N 00 z z rn .r En Q' ON E z M I- R• �Ic�DO cD w 0 3 0 , o • o m o (D w a'� cn _ l 0 x' O p w -4 0 w 0 n rn 0 o �� ' 11 EO Ln aD m NI 6'43 ' W1 p (D N I° 36'43"W 3 23.06' 92.72 92.44' W _ 290.06 185.43' �� a cn IP w N I-• 0 o S N I° 36 43 90.75 n C �• C o� � 40 OHO N t-+ ►-� ► -..I -+ N Z m cD \ \ \p � SB �Ly 4 ' w W O �a ►-• v� �n o w o w s i� o ti s; ro 'C OD 3 G\ b OOO JOO N C .pro a' v p F Ste �`� - CAL -J 00 N Ia 00 a M V p1 V z O z N l7i ,P9 ax lJt N O •C 0 C �' 4S4. tD o OD OD O N Olnln�lnO�! �''. C � N1N .4 .N � 0 ti OQO000~ MaD � �� 0 U 4 . (D tk -° a d M Iv M N 0) aQ co cn �, v 1pc (A 01 r- T�.' (D Cr 0 w ... o o �.. p N ' a w fD ` O Op0 wA m -1 ca N e w �n m w R• o` o O � O � o 4''� t— w v rt .O -4 Via' ro 0� pv a o a ��� J"'o°,�' - - CL !2 O O r• n N zz�7ZCi ° zz� �c p�i /`� i��` Q, (D v 00 ; 00 •4 0 -I O C' 0) � ,' R• U row°o`�wv,R' Z � JWNNWO fir" Z NNO2 O NN N A (D (a fD a ° Cr D Z to � N P! P V n D ( W � W GC���� C►IW I � N.� O n CA . ►-. ».:� �., a� N ° n?A u a ' M �' m N I 50'45' m �cnrnoov P' o I z 198.00 �w �o W ►- 00 O O 0) �' �, G 1 p pi O (A o O D 00 �+ N Q In �I �- to ' fD 11 Iv b 1 1 �. o ra a 0 OD t0 v M C (D R, W ; - u � O O 24.77 (D 10 z y ` rr �NI § "W .q K 1 ° �• v, l III 50 45 " W 208.00 rn C ::r -i (n (If ()--- A1 W M — 3T2 - 0 .7 8go (D '+ °DO - S I 50'45" E 577.50' 40 t 4"0 (D �' -1 Z0 for: George Lindeberg m oo Rt.3, C.T. "F" oNz Hudson, WI 54016 AFW VOLUME 7 PAG8 2023 S, / ��//JJ m tHIS INSTRUMENT DRAFTED BY -4 7