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040-1117-60-200 (2)
St. Croix County Planning and Zoning n,,,n,,«,,Jury ro,zoon.etv:ns:aiAM Detail Sanitary Information Page 1 of l y Computer #: 040-1117-60-200 Sub/Plat: NA Section: 30 Parcel #: 30.28.19.479C Lot: 2 TNIRNG: T28N R19W Municipality: Troy, Town of CSM: Vol. 09 Pg. 2612 1/4 114: SE 114 SE 1/4 Owner: Harrington, Tim 393 County Road MM River Falls, WI 54022 State Permit: 199878 Issued: 10/08/1993 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 10/20/1993 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Jim Thompson Yes Fogerty, Dave file both permit together in archives $0.00 Jim Thompson Signed Off: Yes Maintenance Scheduled Pump Date Pumped 1 st Notification 2nd Notification 3rd Notification 10/20/1996 6/9/2005 61912008 Owner: Harrington, Tim 393 County Road MM River Falls, WI 54022 State Permit: 193515 Issued: 07/14/1993 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: POWTS Detail: Trench - Seepage Bedrooms: 2 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As guilt Plumber Other Requirements Additional Notes Money Owed Not determined NA Fogerty, Dave apparently not used and issued a new permit for $0.00 Not determined Signed Off: No different tested area? S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 17a1r Ile ADDRESS (I lk- 1110-01 Of SUBDTVIS ION CSMW LOT SEC"TION. �ci -T-,.?Y N-R W, Town of 7/70Z 3 _'I L4 I 41c, ST. CRO I X COUNTY WISCONSIN ,70-A PLAN VIE SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 'r2*y- I \'I I INDICATE NORTH ARROW Provide setback and elevation information on reverse of this fore`. Ilrovide 2 dimensi-ons to center of septic tank manhole cover- /l BENCHMARK.' - ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING. -TANK INFORMATION Manufacturer: Liquid capacity: Setback from: Well > House 1A other ---� Pump: Manufacturer Model# 1a1►1 Size57 a� Float seperation fA,y Gal lops/.cycle : / ,7 Alarm Location 77 `:SOIL ABSORPTION SYSTEM Width: �' _ Length _. z Number of trenches -------- Distance & Direction to nearest prop, line: Zj ' w, v Lj Setback from: well. 7 /od f House } Ioo Other - - f � - �'ELEVATIONS )4;qcs r r _: Building e ST Inlet. u PC inlet .�P�ottom ,��� _ jr,off 4F'?.40 � 6 -- Bot --crEsystem t.. Existing G ��"E� p Final grade�' DATE OF INSTALLATION: /s 3 PLUMBER ON JOB: LICENSE NUMBER: j� .A_ df INSPECTOR: 3/93:jt LQAAWjAWp�artrF99Q* 44tt?, 8 -a 19,b SE , %WTE iEVROG A4SA% Labor and Human Relations INSPECTION REPORT Safetyand Buildings Division -GENERAL INFORMATION (ATTACH TO PERMIT) Permit HoldeL's Name: E] City Village Town of: I f y E] R ]a rp M TROY 'ARRINGTON-T Insp. BM Elev.: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aerati06 Holding TANK SETBACK INFORMATION TANK TO P 1 L WELL BLDG. ventto Air intake ROAD Septic NA Dosi ng NA Aeration Holding PUMP N F 0 R M AT 10 N Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Hegd Dist. �.� Forcemain Length 721 Dia. t. To Well FLFVATION DATA County: T CROIX Sanitary er Fn It 19 5 7. 1 QQ197A -- State Plan I 15- No. - Parcel Tax No-- 10 4 0 ---j- 3 1-7-- 6 0 0 OL A9 3 0 0 17 3 '/.A // �,i /9--� STATION BS HI FS E LEV. Benchmark A�L o. 67 Bldg. Sewer St / V1 Inlet St/Rf Outlet Dt Inlet Dt Bottom Header-p*�� Dist. Pipe Bot. System Final Grade Owl — SOIL ABSORPTION SYSTEM BED / TR04CM Width Length No- Of Trenches PIT No. Of Pits Inside Dia. DIMENSIONDIMENSIO Manufactur 21"It- lct-!4� Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE 1 STREAM LEACHI><�-' CHA CA � ill M o elm be r: INFORMATION Typeofi? -A-) OR UNIT System Yl DISTRIBUTION SYSTEM Header / ma-M 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 "bnly Depth Over Depth Over xx Depth Of xx Seeded/ Sod&d Bed / T-knth Center Bed / Tnci Edges Topsoil No 0 Yes E] No COMMENTS: (include code discrepancies, persons present, etc.) LOCATION: TROY -30s28.19,SEISEILOT 21 CO, RDw MM /* 4F inspector's Signature/ Cert. No. llllf�.2 0AL111rAl2V 12CORAIT ADDI lit ATIfIkIl %ov-solus 0 8-1%5 a § 0 �w am WM0 M 0--am 0 � a Wff S W 0,." 0 W COUNTY � 12C3101LHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITA YMIT —Attach complete plans (to the county copy only) for the system, on paper not less than t 761 �Check 8% x 11 inches i n size. if 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. PROPERTY OWNE PROPERTY LOCATION VNE 1/4 Y,49 S T z)Pq N 9 R (or PROPERTY OWNER'S. MAIL ADDRESS LOT# BLOCK # Z_ CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER er I I F r AW [3 11, TYPE OF BUILDING: (Check one) CITY NEAREST ROAD El State Owned Ej VILLAGE: as JOWN Q[: 1 or 2 Fam. Dwelling--# of bedrooms PARCEL TAX NUMBER( ) 111111. BUILDING USE: (if building type is public, check all that apply) Y 7 1 El Apt/Condo xv 2 El Assembly Hall 6 El Medical Facility/Nursing Home 10E]Outdoor Recreational Facility 3 El Campground 7 El Merchandise: Sales/Repairs 11 1:1 Restaurant/Bar/Dining 4 El Church/School 8 1:1 Mobile Home Park 12 El Service Station/Car Wash 5 El Hotel/Motel 9 El Office/Factory 13 El Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1 New 2. ❑Ee3. ❑El Replacement of 4. ElReconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # If Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 0 Seepage Bed 21 ElMound 3o F� Specify Type 41 ElHolding Tank 12 El Seepage Trench 22 El In -Ground 42 ❑ Pit Privy 13 1:1 Seepage Pit Pressure 43 ❑ Vault Privy 14 F-1 System-ln-Fill V1. ABSORPTION SYSTEM INFORMATION: ABSORPTION 1 1.GALLONSPERDAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5-PERC-RATE 6. SYSTEM ELEV. 7.FINAL GRADE GA C REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 720 Z Feet r4m�',O le Feet ill. TANK V V.. T I, INFORMATION CAPACITY in gallons Total Gallons # of Tanks Manufacturer's Name Prefab. Concrete Site Con- strutted Steel Fiber- glass Plastic Exper. App. New xisting Tanks Tanks IL Septic Tank or Holding Tank 47O lAp Z, F1 Lift PumTank/Siphon Chambert 1Z I El L] F El p Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsiteywage system shown on the attached plans. Plu ber's Name (Print): Plumber's Signature: ta s) W/MPRSW No.: Business Phone Number: lu er's Address (Stree , City, StaYe, Zip Code): .46 e.. k 1170 X , IX. COUNTY111tPhRTMENT U6E ONLY ❑ Disapproved Sanita Permit Fee (includes Groundwater Date Issued issuing Ageat Sign re (No St pproved ❑Owner Given initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. r 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 li;lensed 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. Il. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwellilg. 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, last the total gallons, numb,ar 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. Vlll. Responsibitity statement. Installing plumber is to fill in name, license number with appropriate pre,;ix (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'/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, locatio-i of holding tank(s), septic tank(s) or other, treatment tanks; building sewers; wells; water nialris/water-ervice; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacemen -system areas; and the location of the buiiding 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 r)LImb4�,r of regulated practices which can effect groundwater. The monies collected through tht,-se sj rcharp��:s ��re .:red ��;r ���:�_ -i �i:�..-. � :.- � � r : water contarnination im.,fesTiga.tions and establisnrr,ent of S B D-6398 (R .11 /88) I LLMINC92rion I SANITARY PERMIT APPLICATION 7DILHR In accord with ILHR 83.05, Wis. Adm. Code —Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. i —See reverse side for instructions for completing this application. I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION /f .�e L/4 1/4,Toli krpli,6�_ AO PROPERTY OWNER'S MAILIWADDRESS/ LOT# - �_. P- r - ,.- CITY, STATE ZIP CODE PHONE NUMBER e ok wz: 1111. TYPE OF BUILDING: (Check one) ❑ State Owned E]Public El 1 or 2 Fam. Dwelling—# of bedrooms COUNTY TY STATE SANITARY PERMIT # ❑ C eck /frevisio to previ,ris application STATE PLAN I.D. NUMBER I,N,R BLOCK # SUBDIVISION NAME OR CSM NUMBER 4(- e_le�wg -ZO-5— CITY T NEAREST ROAD VILLAGE Tr)WKI r)F:: 111111. BUILDING USE: (If building type is public, check all that apply) 1 El Apt/condo 2 El Assembly Hall 6 M Medical Facility/Nursing Home 30 campground 7 ❑ Merchandise: Sales/Repairs 4 El Church/School 8 ❑ Mobile Home Park 5 El Hotel/Motel 9 F] Office/Factory 0 . 1117 — ZooO — > PC) 10 ❑Outdoor Recreational Facility 11 EJ Restaurant/Bar/Dining 12 ❑Service Station/Car Wash 13 ❑Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) 5. El Repair of an A ) 1. ❑New 2. ❑Replacement 3. ❑Rep lacement of 4. ElReconnection of System System Tank Only Existing System Existing System 13) Z A Sanitary Permit was previously issued. Permit# Date Issued 7ZZ YJ 1W-S V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution 11 Z Seepage Bed 12 ❑Seepage Trench 13 ❑Seepage Pit 14 ❑System -In -Fill Pressurized Distribution 21 ❑ Mound 22 ❑ In -Ground Pressure Experimental 30 0 Specify Type Other 41 ❑Holding Tank 420 Pit Privy 43 ❑Vault Privy V1. ABSORPTION SYSTEM INFORMATION: Ile AB' VI. 11. GALLONS PER DAY GALLONS 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE . I REQUIRED (sq. ft.) I PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 7 0 7 fir d Feet Feet Vill. TANK V11 T CAPACITY in gallons Total # of Manufacturer's Name Prefab. FF Site Con- Steel Fiber- Plastic Exper. App. INFORMATION New xisting Gallons Tanks Concrete structed glass Tanks Tanks Septic Tank or Holding Tank Z Lift Pump Tank/Siphon Chamber 1A00 pea I L Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamp MP/MPRSW 77 Business siness Phone Number: I'd 7Zg r /5r zri_; or 'r Plumber's Address (Street, City, State, Z p Code): To! IY47 .13 IBC. O-UNTYIDEPARTMENT USE ONLY — X7 [] Disapproved Sanitary Permit Fee (includes Groundwater Date Issued, Issuing ent Sign R1111pb] ppro ved —1 Owner Given initial urcharge Fee) lie Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ie 1 A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any itewr criteria in the Wisconsin Administrative Code. will be applicable. 3. All revisions to this permit must be approved by the per.rni! ",;suing authority. 4. Changes in ownership or plumber requires a Sanitary r;3`)(9 io bE-0 .submifted to the county prior to installation. 'T h c p. t i. 11. nkq` -s M L4 e b,- 5. Onoite sewage syC;t-,,ms rnust be] properiiyrnamtar�-ed_ pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local Code administra,or 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(->') of where the system is to be installed. 11. Type of building being served. Check only, one and complete # of bedirc.-forns if I C)i- 2 j�am;'Iy Dwe;.Ihlng: Ili. Building use. If building type is Public, check all appropri.ate boxes that apply. IV. Type of, permit. Check only one in line A. Complete line B if permit is for tank replacernent, recorin,!cfion, or repair V. Type of systowl. Check appropriate box depending on system type... VI. Absorption system informat., or.. Provide all infi-.,rrnatm, Vl!. ird(ormation. Fill in the capacityof ever,_., tankti and 4-nanufacturc-, -s narr,-e� ;'!--(dic3 ' � , M a .: r ' - ' . ' ate p it C P46.0, rn pffsi Ph o n and hinl&ng tank- lor i�' te f Check 33 r o, -r i D I H R. -F. k r. in,,r_--J.aihnq piurnber �o f Mp, etoc-)', address anf..-J" phone number. Plumber must sign; a p p G a t n f, c.; X County/Department Use Only., X. oun#y epartt ent Use Only- j - 7, 0C plan,,:- L A I s rr, a r th a mA V, P g 3. ank rr -e as , xc . . ..... y ff e 0 r t i C, i s P fe t e s pfzc "r' ca tj or -is foir punrips and e, performance ctjrve; pump model and pump manufacturer; D) cross sewt!on of e Soil absorption s y 3e r r-; 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 creati 0�l Of for a r.10 cpn p ject groij 4. ff . ndwater. The monties co"ected thrg'the,es,rh Ir Qe f r �oa3"gsau.d ;,uw water contarn'nation inve'sJ-9atiorts -and estabhshmt ��nof t "Al, SBD-6398 (R. 11/88) Wisc6nsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page—z of Labe; and Human Relations Division of $afety & Buildings in accord with I LH R 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCEL not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned' n6rth arrow, and location and distance to nearest road. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWN PROPERTY LOCATION GOVT. LOT /4 1/4)S T N, R E (orL�r PROPERTY COUNTY PARCEL I.D.1. D - # REVIEWED FEWED BY PROPERTY LROPERTY OWNER'-S MAIL ADDRESS LOT # BLOCK# SUBD. NAME OR CSM # 41 fop ?.o CITY, STATE ZIP CODE PHONE NUMBER OCITY [:]VILLAGE GOWN NEAREST ROAD e, - L New Construction Use [X] Residential / Number of bedrooms [ ] Addition to existing building Replacement j Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft�.T, trench, gpd/ft2 Absorption area required 7,2-,o — bed, ft2 , trenchft2 Maximum design loading rate bed, gpd/ft2• trench, gpd/ft2 7.7 — Recommended infiltration surface elevation(z) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system El S El U Os 0 U Z S El U OS E1U El S 0 U 1:1 S OU SOIL DESCRIPTION REPORT Ground elev. ft. Depth to limiting factor Ground elev. ?� ft. Depth to limiting factor Horizon Horizon 0 Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Bounday Roots GPD/ft Bed Trend t A, 9_� 2- ;^e- Z V_� . 5- A-!j 7 Ll e�,"L __0 Remarks: zel t 7 0 S;11Z 10ep 41A ,/2- T� 144 V U le Ile - 27 C A) ILI 14D Remarks: ST Nam y.—Plus Print Phone-. 5- ddress- I)o 7a ;ignature* Date. CST Number: / .,d ..� t 1�p PROPERTY OWNER 4&4 SOIL DESCRIPTION REPORT Pageof a 4 � PARCEL I.D.' i � f J� Boring # 9 G P a/f t 2 Horizon Depth Dominant Color Mottles Texture Structure Consistence BoundaryRoots in. Munsell Gnu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench •...... C, Ground ". elev. IF ft. Depth to limiting factor Remarks: `l r� �- �`� c., Boring # 42 `w o hf V 4'-w Ground 3dd e-S or elev� 0 ft. v Depth to limiting factor Remarks: Boring # :SSS ••. y �' .S � rye, Af ` ! Ground zlz , elev. ft. Depth to _ e limiting factor Remarks: Boring # s•. :iti ....... S l is y� �S l Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05192) 74',P Y �,, p. -(0 je L• � f f (,Oqr .,4AVE FOGERTY PLUMING Licensed PlOrk Tester & Plumber #3233 #3289 Fogerty Heights RoS4p2 ROBERTSl MSCONSIN Phone 749.3656 FA :Llj %J "> / �) I A I�M • �o#I o./it-.,•,�u ��,• Otis �/ ■ Z4oJ P kf 11� 1' 7 it ./0,1 a$,? _ J, a 'PAP 0 (I ,A 19 d. awl � s�, �►�sr J a� . ?/, 70r. 1s` 31 P'9 I N V V rr vY PUMP CHAMbER CROSS SECTIOW AkJD SPEC-IFICATIOUS � 1"C-l. VEt'JT%.Plpr 2,5' FROM DOOR, wiUCOW OR FRESH AIR ItiTAKE 18 timim, APPROlEC JOIN? ,s//C.T. FlPF EX,7'EN0(KJ(- 3' )BTU SO',.10 SC,'.. VEWT CAP WEATHER PROOF— APPROVED LOCKING ------- JUWC.TIOIkl BOX TMAWHOI.E COVER I 1z"miu. GRADE COWOUIT—/ PROVIDE AIRTIGHT SEAL I rl� ALARM ON PUMP OFF COkICBETE 5LOCK 4" MI?J. APPROVED .JOINTS w/c.l. PIPE E.-ATLmolmG 3, ONTO SOLID S011. RISER EXIT PEKMIlrED ONLY IF TAQV. MAKIUFACTURrs-F, HAS SUCH APPROVAL -3) s�+��.����AT�o�� TIC AND TA,,QKS MAWLIFACTUREC. WMBER OF DOSES: P E K DAB - �. /-7 TA�Jlk !�IZC GALLOhJS DOSE VOLUME - - 9 f � IMCLUDING 15ACKFI-OW: 2 ?k;�LL ON S ALARM MAWU FACT U K E R MODEL QIJIMBER: CAPACITIES: A= —IMCNES OR Vj� GALLOWS SWITCH TtiFE: Z& 2— CHEOft GALLOUS MIS PUMP MAKIIJIFACTURKRO. C. = i-� IWLHE5 OR / GA L L 0 U S D w MODEL kJUMBEFUR 7 —INCHES OR /01 GALLOMS SWITCH TAPE.' "jag MOTE:, PUMP AMD ALARM ARE TO BE �(,T 2 INSTALLED OW 5EPARA�TE CIRCUITS PUMP DISCHA-RCoE KATE G PfA e VERTICAL DIFFEFLEMCE 5V:?V9F-lJ PUMP OFF AUD DISTRIbUTIOW PIPE.. —FEET + MIUIMUM METWORK SUPPLy PRESSURE FEET FEET OF FORCE MAIM Y, , � 37 Fyo FT.FRICTIOIJ FACTOR... FEET + Z -2-L-L , e 7 jo e,) TOTAL OtdWAMIC. HEAD FLET IMTERMAL DIMLWSIOMS OF TAWK: LEKIC7TH ;WIDTH ...4bLIQUID DEPTH ? DAT E:. MUMBERt LICEMSE z 0 Cr Uj Uj LLJ LJCAnl I— U. w 34 CAPA-CITY 32 30 28 26 EFFLUENT 24 and 22 DEWA TERING LL' 20 z 18 16 0 14 12 10 8 6 4 2 0 SEWAGE and DEWATERING 24 22 20 18 16 14 12 10 8 6 4 2 0 GALL( 115 MODEL 189 110- _100- 95 90--_ -so- 75 MODEL 165 7065- _60- 55- MODEL 163 MODEL 188 50- 45- 35 MODEL 137, 139- -*----MODEL. 185 30 25 _20 15 14 MODEL 97 I 'MO DEL 161 MODEL 53,55, 57,59 5 — ------ LONS i 10 20 30 40 50 601 70 80 90 100 1110 80 160 240 320 400 FLOW PER MINUTE Zff4 AIZJFjff ZaAff 3280 Old Millers Lane P. 0. Box 16347 Louisville, Kentucky 40216 LITERS 0 80 160 240 320 400 480 560 640 720 (aw 10-'C" I FLOW PER MINUTE r-� 498305 FILED APR 3 0 79931`. DAMES O�ONIL �1lster vt3 ,S �& cr* (;D,, Wi CERTIPIED 1 �► MAP' Located in part of the•SURVEYSEA of the SE4 of Section 30,' T28N, R19W Town of Troy, St. CrOIX County,'Wisconsin. ► .Our ve . !Vo•',' RadIus Length Central Chdrd Chord Are Tangent Awe Bed � ' Tangent "— � � � 05.961 Len th le �_—, _ Bearing Bearin 2�+°I6t55rt 954004/20 5ItE 259t251..���'��;���� 11�1:,N n Sbi 5�ta�+�� 1-2 S�t3°i3���+►� 605.961 2201315911 S53002+01.511E 233.66, 235.141 a. 605.961 200415611 S6501112911E 22.021 22.021 E �4 CORNER OF SECTION 30 \ c ' UNPLATTED LANDS s ' : U:? (0 - �,� A PPROVEDP*" . n Zr -„ a is �' ,�— ,� APR I oho n `►r `'' \�' ST , CA0jx Co M rt ' IC \��u ZorJnq e �y C o o ' Parks Co+�x t' ► © m o Ir 0 �n - . F �.9 N 37 i. - ,� N ' . �.�, if not i,"6 ,4 WilhW 'W 0O o n �. 30 4 " y I rn Fdf a} arbv��"de er' rn aval.0*90, � 'S ,,old LOT Q IC R I � �Z110— Q) 2 2.o I ACRES INC. R/W `� 87,726 SQ FT, w Ca IQF\j n'j 2 . ©87,165 S S xC, R/W � .� I� ®,FT, � N Id n�i ACCE99 EASEMENT VOL.731 P4, 57 �, SOO°04'27"W Ns9°al'$3"E I' S00b04'27"W © 23,51' 417.34 32,79 Nee 49"41"E 2194A' S8S°51'53"W' 437- 34' �� CORNER SOUTH LINE OF THE SE �4 20.00' 2 t.3A' WSy SECTION 30 SE CORNER. Sk4 CORNER OF SECTION 30 Ohs SECTION 2-9 I LEGEND V, I -P ! • -- WN E R 10Z Aluminum County Section Paul Johnson I(..t) Monument Found 382 C. T, H. I+MM++ l 11 +1 Pipe 'ri ' '; ; ,' Falls, s , I� i '� x 24 Iron Pip Set, ' �,' • l aver F , weighing 1.68 lbs. per'�•,`4' 54022 linear foot LLON C. 1001 Roadway -Setback , 1' Fence tine .r "� � i'� S i i ' •'; f� la �r J iti•fL•. ' `' i ` 1. e' SCALE IN FEET d`7��{'r�`'�, 41• 't.' y, O 50 100 a i �r/r� / VOLUME 9 PAGE 2612 SURVEYOR'S CERTIFICATE 1 Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify that by the direction of Paul Johnson, I have surveyed, mapped and described the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows. A parcel of lanai located in part of the SE1/4 of the SE1/4 of Section 30, T28N, R19W, Town of Troy, St. Croix County, Wisconsin; further described as follows: egnn1ng-et 589° 51' S3"W, along the south fine of SE1/ 4 of said section, 437 . 34 feet; thence N00n04' 27 E, 430.62 feet to the southwesterly right-of-way of County Trunk Highway "MM", thence S41055' 02"E, along said right--of--way, 344.47 feet to the point of curvature of 9 a 605,96 foot radius Curve, concave northeasterly, whose central angle measures 24018155", whose chord bears S54004 29.5 E and measures 255.23 feet; thence southeasterly, along the arc of said curve and said right---of-way, 257.16 feet; thence S00°04 27 W, along the east line of the SE1/4 of said section, 23.51 feet to the point of beginning. Above described parcel is subject to access easement as shown on this map and all other easements of record. I, also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land , and Subdivision Ordinance of the County of St. Croix in surveying mapping same. ,A` Each parcel shown on this map (plat) is subject to State and County laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.) Before purchasing or developing any parcel contact the St. Croix County Zoning Office for advice. 0 VOLUME 9 PAGE 2612 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County --QWNFrR/BUYER ADDRESS -FIRE NUMBER--03 CITY/STATE LCX zip PROPERTY LOCATION _S F,_1/4, �1/4, SECTION T N-R W TOWN OF St. Croix County, SUBDIVISION \J LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St, Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978, St. Croix County accepted this program in August of .1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St, Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber! restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and ( 2 ) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR, Certification stating that your septic as been maintained must be completed and returned to the St. Croi L on ng officer within 1b Co., JZ_o, n 30 days of the three year expiration te, SIGNED** Qs 1'� / Y, r, DATE: St. Croix co. Zoning Office 911 4th St, Hudson, WI 54016 4 STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the pOrmit issuance. Should this development be intended for resale by owner/contractor,(spec house), then ia second form should be retained and completed when the property` is sold and submitted to this office with the appropriate deed recording. -----_-_---------------_-_--_----__-_--_---_-_-------__----_-___----_--- owner of ro ert—- p p Y _ _ , 1 I Location of ' property`"---1/4 � � 1/4 , Section ) Q , T Lam- N-R `' W Township �j Mailing address Address of site Subdivision name Lot no, ! Other homes on property? -yes Previous owner of property Total size of parcel L Date parcel -was created% l Are all corners and lot line ? '` s identifiable. Yes No Is this property being developed for (spec house)? Yes No Volume tD/Fand Page Number 1 0 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION TIIE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in, the Q. fice of the County Register of Deeds as Document No. Cal and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly reco d, in t e office of County Register of deeds as Document No. 7 c J --�,-- Signatte`of applicant Co -applicant Date of Signature Date of Signature 't TMIS S15ACt RCSERVED FOR RECORDING VATj DOCUMENT NO. STATE BAR OF WISCONSIN F(,R.td WARRANTY DEED 1 J �i.L��� VO, L 1 UJL 0 PAGE 4 U REGISTER'S OFFICE This Deed, made between ... F.a!j1JL-._.JQhns_o.n ... and ......... ST. CROIX CO., W1 ..D.elp_hine,.R- _.io,hn.sQa. ..h u.s.b a-n d. -.a ad _w i f e ..................... Rec'd for Record ........... . ..... ......... .. .. .................. ...................... ------ ........ r .... ..... .................................. ....................... ........ .., Grantor, JUN 2 9 1993 and ....Del to -Cons t-ruc-t ion- CQ.9.1 .... a M i ]a LI.Q s.Q t -a -----------------_ 10:45 - A. ....corporation . ............................................ at 0. ij . ..... .... . . . ...................... ........ ....... . ...... ... I ............. ------ Grantee, Reg1ster of DOW$ Witnesseth, That the said Grantor, for a valuable consideration.. 17.17.7- 77. i 7 ................... ..... I .......... RETURN TO conveys to Grantee the following described real estate in S L... -C.ro!X ........ County, State of Wisconsin: Lot 2 of C.S.M., recorded in Volume Nine (9), Page 2612, as Doc. No. 498305, Register of Tax Parcel No: Deeds' office, St. Croix County, Wisconsin being located in part of the SEk of the SEk of Section 30, T28N, R19W, Town of Troy. Also granting to Grantee an access easement as shown on the above described C.S.M. and subject also to all other easements of record. This .... i.s , n , o t ---------- homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And — ..Paul H... -J-o-hngo:n..-a-..- ndI).e.. 1phine. . R ----- - ..Jo.hn.s.on ......... ... .. _ .............. ................... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and rights -of -way of record, and will warrant and defend the same. Dated this ... Tt h.. .......... day of _._-.....Kay------ ... ........ .......... 19. 9-3 ..... ......... . ..... ........... I ............ ....(SEAL) - - - -- ------------------ (SEAL) ............................. ------------------------------------ ....P aul.A. .6 h.n san .................. V ....... ...... .................................................. — (SEAL) ... ....... ... EAL) ....................................... — ......... -------- D.e. I P.h i.n.e R.-...JQ.h n's• o P.. I — --------- AUTHENTICATION Signature(s) -------------------- ...................................... ................................................................................ authenticated this ________day of__________________________: 19 ...... ---------------------------------- ' ----------------------- ------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not- ......... .................................................. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Gaylord, — A t1_9 K X! P Y ....................... River Fall.s,.WX ..... 5.4 O�2 2. --------------------- — ----------------- — .. .... .... I (Signatures may be authenticated or acknowledged. Both I nre not necessary.) ACENOWLEDGMENT STATE OF WISCONSIN as. ......... PA e.r c.e ...............County. Personally came before me this .101 ...... day of ................... MBLY .............. . 1 19 ... 93. the above named ................... Raul -IL. _J ohns.o n.. and ................ ................... D.e1_ph_in.e,..R_....J.ohns_an ................ ........................................................................... 0 ...... ................ ..................................................... to me known to be the person 5 ---------- who execood they Dreg ng instrument and acknowl dge the.-i reg ng Low, ag je, C) —Ka_a .e n.A,.._En9e1 ........... ........ ce !4:)tarV Public .......... __ ----P---i-e- r--- ------ r ou Titil Afy Commission is permanent. (If not, stk' "expir ar-,� date: ......................................... 7-14 ....... 'Names of persons signing in any capacity should be typed or printed below their signatures. L STATE [1AR OF WISCONSIN FORM No. I — 1982 Stock No. 13001 Em"EMMM uAscmumn [31L.l.R SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code [ COUNTY -Attach complete plans (to the county copy only) for the system, on paper not less than 8Y2y. 11 inches In size. -See rev'erse side for instructions for completing this application. I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION r, 4041 'Y44 5�5 Y4t S 410-PERTY OWNER'S MAILING ADbRESS LOT # ( 6) /101 1k4 —1 — CITY, STATE ZIP CODE PHONE NUMBER " �11 111. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ Public El 1 or 2 Fam. Dwelling—# of bedrooms SV09tVf&Eft14AME OR CSM NUMBER CITY VILLAGE TOWN OF: 111111. BUILDING USE: (If building type is public, check all that apply) L 1❑ Apt/Condo 2 El Assembly Hall 6 0 Medical Facility/Nursing Home 30 Campground 70 Merchandise: Sales/Repairs 4 1:1 Church/School 8 D Mobile Home Park 5 1:1 Hotel/Motel 9 ❑1:1 Off ice/Factory IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. Z1 New 2. OReplacement 3. ❑Replacement of System System Tank Only 13) DA Sanitary Permit was previously issued. Permit# wv� V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution 11 ❑Seepage Bed 12 Seepage Trench 13 ❑Seepage Pit 14 ❑System -In -Fill Pressurized Distribution 21 ❑Mound 22 F-1 In -Ground Pressure V1, ABSORPTION SYSTEM INFORMATION: 1, GALLONS PER DAY 2, ABSORP. AREA 3. ABSORP. AREA REQUIRED (sq. ft.) PROPOSED (sq. ft.; Vill. TANK CAPACITY INFORMATION in gallons Total Gallons # of Tanks New xisting Tanks Tanks STATE SANITARY PERMIT # ��n -e- ❑ C /.: y_-55 Check if revision to previous application STATE PLAN I.D. NUMBER v N9 R E (o6"W1 BLOCK # NEAREST ROAD 10 ❑Outdoor Recreational Facility 11 ❑ Restaurant/Bar/Dining 12 ❑Service Station/Car Wash 130 Other: Specify 4. El Reconnection of Existing System Date Issued Experimental 30 ❑Specify Type 4. LOADING RATE (Gals/day/sq. ft.) *, T 0 Manufacturer's Name t Septic Tank or Holding Tank r Lift Pump TankJSiphon Chamber V111111. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage Pi ber's Name (Print): Plumber's Signature: (No St4glips) D, .o4-- —4 /.7. e2 Plumber's Address (Street tate, ZiD Code): 0001� L 7 IX. COUNTY/DI#P ARTM ENT USE ONLY F� Disapproved Sanitary Permit Fee (Includes Groundwater VApproved Owner Given initial k Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: 5. ❑ Repair of an Existing System Other 41 ❑Holding Tank 42 ❑Pit Privy 43 ❑Vault Privy 5. PERC. RATE S. SYSTEM FLEW 7. FINAL GRADE (Min./inch) /r, e7, -.5"- ELEVATION if 01 2- 91 Cl Feet.] Feet Prefab. Site Fiber- Exper. Concrete Con- Steel glass Plastic App. structed, tem shown on the attached plans. "IC /MPRSW No.: Business Phone Number: L_ 71 Date sued Issuing Agent Signature (No Stamps) SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any r'eve' 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. Ohsite sewage systems Must b6 properly maintained. The septic tank(s) must be pumped by A'Iic.ensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning yotAr.,WSAQj5Qwage 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 nurnherfs) of where the system is to be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelli Ill. 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. VIL 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 eceived experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 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 tanks), 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 c;ystem 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, ground, - water contamination investigations and establishment of standards. SBD-6398 (R. 11/88) LQQTs1QNp;rtrWPAQ)( On JiPtry? 8 - 19 , SE f%4*JRTE i E VFRG E W S Tel Labor and Human Relations INSPECTION REPORT Safety arrd Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name: ❑ City E] Village Town of: ti eve -T-I-nsp. BM Elev.: I BM DescriptiorF TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosi ng Aeration I - Holding I TANK SETBACK INFORMATION TANK TO P / L WELL BLDG. Vent to Air Intake ROAD Septic NA Dosi ng NA Aeration NA Holding PUMP/ SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft I Loss Hff Forcemain Length Dia. I Dist. To Well ELEVATION DATA County: S a n ita r P47r on it WJKV I A State PWIDkRA D Parcel Tax No.: —060-200 A9300173 STATION BS HI FS ELEV. Benchmark Bldg. Sewer St/Ht Inlet St / Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches I PIT No. Of Pits Dia. inside Da Liquid Depth Liclul DIMEN51ONS I I I DIMEN51QN5 , Manufacturer: SYSTEM TO P L BLDG WELL LAKE / STREAM LEACHING SETBACK INFORMATION CHAMBER Model Number '. Type Of System L 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 0 Yes El No ❑ Yes ❑ No COMMENTS: (include code discrepancies, persons present, etc.) LOCATION*. TROY ,30v28,19*SE,SE,L0T CO , RD, MM owl 4 CO 4 C/ i� 0-061 C 0 04-111 t-se 46P "411�,o Plan revision required? [:1 Yes E] No Use other side for additional information. SBD-6710(R 05/91) Date Inspector's Signature Cert. No. RANITARV PERMIT APPI MATMN In accord with ILHR 83.05, Wis. Adm. Code -amATmin COUNTY STATE SANT1TAR-_Y"PER9I'r# —Attach complete plans (to the county copy only) for the"%ystem, on paper not less than ,ram 8% x 11 inches'in size. 4 ❑ Chec if 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. PROPERTY OWNER PROPERTY LOCATION 41 1040 '/49 S N, E ( ^J 1/4 0 LOT # BLOCK # PKOAEhTY OWNE SeA41LNG APORESS CITY, StATE ZIP CODE PHONE NUMBER %"J%a 13 19 6- 1 ON N OR CSM NUMBER beqpnwwff� 2i& 4A y 4? 9 4:7 11. TYPE OF BUILDING: (Check one) ❑El Cl NEAREST ROAD State Owned VILLAGE : i TO N OF. 7�OZPV M E] Public Z 1 or 2 Fam. Dwelling—# of bedrooms —2-- PARCEL TAX NUMBER(S) 111111. BUILDING USE: (if building type is public, check all that apply) 1 El Apt/Condo 2 E]Assembly Hall 6 El Medical Facility/Nursing Home 10 Outdoor Recreational Facility 3 D campground 7 El Merchandise: Sales/Repairs 11 El Restaurant/Bar/Dining 40, Church/School 8 El Mobile Home Park 120 Service Station/Car Wash 5 El Hotel/Motel 90 Off ice/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. Z New 2. El Replacement 3. El Replacement of 4. El Reconnection of 5. El Repair of an System System Tank Only Existing System Existing System 13) El A Sanitary Permit was previously issued. Permit# Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ seepage Bed 21 El Mound 30 El Specify Type 41 El Holding Tank 12 Seepage Trench 22 EJ In -Ground 42 El Pit Privy 13 El Seepage Pit Pressure 43 El Vault Privy 14 1-1 System -In -Fill V1. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEy/ 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION I # 're I 14z. r9t, OF*eet /&0 0 Feet Vii. TANK CAPACITY Site INFORMATION in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper., New xisting Gallons Tanks Concrete glass App. Tanks Tanks I structed Septic Tank or Holding Tank 1420 ZI Lift Pump Tank/Siphon Chamber M Lj Lj El Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage stem shown on the attached plans. er bDPI 's Name (Print): Plumber's Signature: (No Starn /1 W P/MPRSW No.: Business Phone Number: 1101�� 1`111 :z I I e r 1-03f P14U`er's Address -(StreetrCity, $fate, Zi r1kAde): I Z oe- I OUNTY/DitA_;tTMENT USE ONLY ❑Disapproved Sanita Permit Fee (includes Groundwater Date Issuedd Issuing Agent Signature (No Stamps) Approved F-1 Owner Given Initial Surcharge Fee) I Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any dew, criteria in the Wisconsin Administrative Code will be applicable, 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit TI-ansferlRenewal'Form (SBD F7199) -to be submitted to the courtly prior tG installalion. r1%,, JI - - - j -11' . . ., 5. Onsite sewage system:sr must bo% properly' rhaintairted. The septic tank(s) must be pti "' e'd- by'ac MP pu m-per whenever necessary, usually.every 2 to 3 years. 6. If you have questions concerning yo'u'r onsite sew , e system, contact your local code adminiskiat'Or or the ,Stata,of Wisconsin, 5afety. 8 Buildinjas Division, 608-266-3815. To be complete afid accurate thi,%,k$apj-jary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax Mjrnber(f.-O of where the system is to be installed. 11. Type of buildihg-be'lng sd'r%Yed. Chteckonly one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. 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- 3 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 fo- all septic, pump/siphon and holding tanks for, this system. Check experimental approval only if tanks received experimental product approval from DILHR. Will. 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 81/2 x 11 inches must be submitted to the couniy. 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 ,.c;ervice- 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) cqmplete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performarnc4'cur'v*� pump model and pump manufacturer, D) cross sizing section of the soil absorption system if required ,by cottl9ty; E) jajI test data on a...T'15, dorm; and F) aft si i information. dNWJ46*At& S LfR C H A R G E 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater,.*-,--,. The rpofuic ;A.ected througt, t� e* &-,.surcharges are used for, _rQapitorj-ng groundwater-,Q!otjnd- 1411 wafer-Wlarnii'i'atit)n investigations and estabIishm&Wof-t%h'4rds. A S B D-6398 (R. 11/88) N� Z3 DAVE FOWIry PLUNMN(� LWOnsed park Tester & Plumber, #3233 03289 Fogerty Hai" R*W eft. wiscomm 5Q23 Phone 71�� All 14� .164 4y Ole r. p ep4- 0 @ tv ell g4b '�i►�-mot �.►�"�,� �IL zo Ore #4 14cP4 ;7. r 00, zelee _5 W YY I 14crf m4uminum county Section I Paul Johnson Monument Found 382 C.T.H. "MM" AM 0 x 2411 Iron Pipe Set, 4 fiver Falls, Wi, weighing 1.68 lbs. per �►� , '`�'•"' ,', a. 54022 linear foot 1001 Roadway -Setback Fence Line SCALE IN FEET j 0 0 50 100 VOLUME 9 PACE 2612 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County -4DWNER/BUYER_tL.',�� t M ADDRESS FIRE NUMBER C.92 M- zip A-yo CITY/STATE PROPERTY LOCATION: 1/4,�...�-S_E.1/4, SECTION T N-R (TW TOWN OF St. Croix county, SUBDIVISION LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the Cost of replacement.,.. of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August Of .1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and ( 2 ) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and SCUM. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance as set by the Wisconsin DNR. with the standards set forth, herein, 1 Certification stating that your septic as been maintained must be Zoning Officer within completed and returned to the St. Croi CO1-4, U 11411 W J- A- 30 days of the three year expiration te, Y SIGNED; 't/t_4 / DATE: -7 St. Croix co. zoning office 911 4th St. Hudson, WI 54016 Signatti4elof applicant �7_' l V — e7 7 Date of Signature Co -applicant Date of Signature DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION L,ABOR -AND PERCOLATION TESTS (115) MADISONP.O. BOX W1 537790769 HUMAN RELATIONS , (ILHR 83.090) & Chapter 145) OCATION: EC ION: qDM_%5aweMUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: E'/4S E"/ /T,?FN/V 0E (or*'f —Tr6 If OUNTY: QOWNER BUYER'S NAME: MAI LIN$ ADDRESS: 0 USE DATES OBSERVATIONS MADE NO. BEDRMS.- COMMERCIAL DESCRIPTION: _�Ne PRAF E DESCR�IIPTIONS. PERCOPTION TESTS: Residence vv 7-1 Replace </ 4 RATING: S= Site suitable for system U= Site unsuitable for system M CONVENTIONAL: IN-GROUND-PRESSURE: SYSTEM-IN-FILIIN LHOLDG TANK: RECOMMENDED SYSTEM-(o tional) [2 S EU IO QS EU [AS EU ❑ S ZU ❑ S ®U-- 7� ` r C If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the enders. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevatiopr—. _J PROFILE DESCRIPTIONS BORING NUMBER TOTAL DEPTH IN, ELEVATION DEPTH TO GROUNDWATER OBSERVED -INCHES I EST. HIGHEST— CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK,) 7 Z, B B- & 4� PZ d "S B- /'P ell/ r'7P B- 6 r 12T PERCOLATION TESTS TEST NUMBER DEPTH INCHES WATER IN HOLE AFTER SWELLING TEST TIME INTERVAL -MIN. DROP IN WATER LEVEL -INCHES RATE MINUTES PER INCH PERIOD 1 PERIOD 2 PERIOD 3 P- 20 P_ 0 _7 P_ L19 j P_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings, and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference ppintS�4'cNj the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. ) '4 q, 0 #q 0, 6 , q$ - � SYSTEM ELEVATION X, A Imo. ;Am To!p "'Tren S. �_)' P L. Corn(T le 770 /0 it 00 . ec fill; 61 C) 12 e A All 1, the undersigned, hereby certify that the soil tests repo this for ad in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the loc n h sts are c c t he best of my knowledge and belief. NAME - 10:6d TESTS WERE COMPLETE9 ON: I ADDRESS: CERTI F I C NUM�ER: PHONE NUMBER( tional): 0121 CST S I GKA\W RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) OVER ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET * HUDSON, WI 54016 (715) 386-4680 April 291 1993 Paul Johnson 382 C. T. H. IfMMii River Falls, WI 54022 Dear Mr. Johnson: At the April 27 meeting of the St. Croix Co t Development Committee Y Planning & approval. The Condit' given conditional , Your minor subdivision was NW corner of the lotIons are that the driveway be 75 ft. that (per St. Croix County Highway Departm f rom the the map. t) f and the Surveyor make some minor additions and/or corrections to The driveway permit should be obtain.. Highway Departmentl and ned through required map changes. I have notified the N Surveying of the When these conditions have been met, the ma the Zoning Office for final approval. y presented to Should You have any questions, Please contact e. Sincerely, Mary J. Jenkins Assistant Zoning Administrator cc: Clerk, Town Of Troy