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040-1067-95-200
.O O 00 Q o 3 0 0 M O E» h c p 0 _ ° c > e I U) N N) X N L ar Qo~ 'a 0 C .J c U Y p a) C Q) kr G L t 0 N N U a) E CU C O N y p cj N C E'O 3 > W i' y~LL m C0 co o20 c o E o~ aNi U~0 0 > Z T n c N o .6 Z I y U j, _ C Z a) 0 U- C _ NMI mN LL C O L Co _ p N E OZ~U co 3 g Q>z E ¢ N M a M U z VJ 0 0 Z ~ ~ 'C d d d a) ao am am H Z c o - o c C9 C ° Z c w . m ° Z o Z a 0 Z c toP ~ 0 c~ E N M Q> 0. N O O N O • a r d v C o Q O o Q z m z o z~-z z N Z (0 c o d N co I E N _ R (D I L ~i a `n CL 'M c H y aa)i o o o N d c C: Is 0 o a` E E N Q o c to w 0 ~ a ~ ~ N N N 0 z~> CL Z T a m Zo 00 0 M CL CL m (L CL m d co at r- oo V) LO LO N rn rn N V7 00 00 (D f6 O) W } fn J U rn rn } N_ N a3 a) N N 3 W O N G W O Y E F O~ ~p 'CS ? N O O! co C a rn m N O N n rn° ¢I 1 v d ¢ fn co 0 C7 0 N N o 00 o L H c o E m a c o v JE ,N ~ o rn c o EN ~ r- CD Q) r- M CO O 7 O 17 co w :2 a a) N M2 2 2 rn O CD co lL (D o ZN o z° z ~Ol ~ vt 2.' € ~ 1 E € I V 7 CL L: a te L: (L E v 'c c °r' 3 R ti► o m 3 o ° o c~a2 i0(nu nc~ ~1 A Parcel 040-1067-95-200 02/13/2006 09:43 AM PAGE 1 OF 1 Alt. Parcel M 17.28.19.257H-10 040 - TOWN OF TROY ST. CROIX COUNTY, WISCONSIN Current ~Xj Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - KRAUSE, JOHN R & JODELL M JOHN R & JODELL M KRAUSE 399 TOWNSVALLEY RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 399 TOWNSVALLEY RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.860 Plat: N/A-NOT AVAILABLE SEC 17 T28N R19W NW-NE 2.52AC LOT 1 OF Block/Condo Bldg: CSM 6/1564 ALSO COM N1/4 COR SEC 17;TH N 89 DEG E 457.77'POB;TH N 61 DEG E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 33.15'TH ELY 83.86;TH S 89 DEG E 17-28N-19W 349.08' TH S 00 DEG W 159.12';TH S88 DEG W 416.15';TH NLY 143.82' POB Notes: Parcel History: Date Doc # Vol/Page Type 03/23/2001 641154 1606/387 TD 07/23/1997 724/622 2005 SUMMARY Bill Fair Market Value: Assessed with: 102555 323,700 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.860 65,000 246,600 311,600 NO Totals for 2005: General Property 3.860 65,000 246,600 311,600 Woodland 0.000 0 0 Totals for 2004: General Property 3.860 65,000 246,600 311,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 133 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 lam" 8 i I~ FIL Evo a2a985 40422 81 C rt S S p N IO O n c rn O O co S z sd. .,T., p m r- rn 13 rm rt c~ r fm. C rC ti d rn 'l'1 o r H N YN Q q., i Z m c7 m p- Vito C.) r) Z g o a m y L CM o~ -°n C o ' u' rxn cr n rn N a l~~~ . w rn l< C7) 0 5C) CA C O Q F h• 6r~~ \n ~ N v O S r - F ...v m V o Co w Co N S m w - x T _ - m m - w z -7 w m r ,r `o• S03°3711211E 233.82' o CENTERLINE TOWN ROAD N -1 w N W r C7 cc ---0--7 Ln r S Q 1 11 Co 231.07' r • v I -r N 331 z I cm co y D In Ir Z co 0 d O co O 0 I Icwi• O ` p o let 'n 0 co jam" m rn ° co 1, is -c N oo OD C~ in 4.0 O V 0 t0 0 I C/) mc CL IN r 00 rn w 1 'co 0 N N N 0 0) 4.1 Co is 3 :V 17 A m.0 m N F-' z co Id O w N N - H X v r K 1H - N C* Co. Ifs ip rn I O Co jr• coin H cry r Ir m 1 - x z o cn Iw z Id' c) n - - Irr -a 1~ r r Irt -c c c 1~. O O I j~ g 0-4 O c~ czi N c"I. \ \ z VJ , - - z - m x H N o rn r Z N H ~ C I C) m Q -n APPROVE .a o . m v I AUG 0 7 1985 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 11AKt &A^ " ,t }' TOWNSHIP CE, ..) SEC. '43Tag N-R 19 4) ADDRESS ( t. 3 �ok,,035 AIR icisT. CROIX COUNTY, WISCONSIN AJSmr+.m SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM \Ac) r.'2 s0000 ' ? vg, 53 Bka IV INDICATE NORTH ARROW �?f BENCHMARK: Describe the vertical reference point used II Elevation 1 1 Elevation of vertical reference point: 'Q 0. 0 Proposed slope at site: SEPTIC TANK: Manufacturer: (,),.)�e.k S Liquid Capacity: ( J O V r Number of rl.ngs used: , J Tank manhole cover elevation: �`l•,y�c Tank Inlet Ilevat ion: I Oa,( q Tank Outlet Elevation: 101. S)0 Numb( r of f,:et from nearest Road: Front,Q Side,Q Rear, ' 50 feet From Iearest property line : Front,O Side,®Rear,O 135 feet Numbs r of feet from: well , building: 17 (Include this informatj.on of he above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: • Number of feet from building: (Include distances on plot plan). SOIL ABSORBTION SYSTEM Bed: Trench: Width: 1g Length: Number of Lines: Area Built : 5 Fill depth to top of pipe: tat Number of feet from nearest property line: From, Side, O Kear,O Ft Number of feet from well: .5 3 Number of feet from building: (4 ' (Include aistances on plot piaLL). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box() or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, D Side, O Rear, (1)Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• • A — Dated: / - ;f Plumber on job: License Number: (� 5 7 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ®CONVENTIONAL ❑ALTERNATIVE state Plan J.D. Number ❑ Holding Tank El In-Ground Pressure D Mound (If assigned) NAME OF PERMr, HOLDER: JADDRESS OF PERMIT HOLDER: INSPECT D E: Art Fe ereisen R. R. 3 Towns Valley Rd. Hudson /Do2~ ~S BENCH MARK (Permanent reference pomU DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV. SW4 of the SE4 of Section 8, T28N-R19W, Town of Troy Name of Plumber: MP/MPRSW N,, CountV. Sanitary Permit Number: Richard W. Hopkins 1059 St. Croix 69633 SEPTIC TANK/HOLDING TANK: IMANUFA TUBER LIQUID CAPACITY. TANK INLE LEV. TANK OUTLET ELEV.. WARNING LABEL JLOCKING COVER PROVIDED: PROVIDED: ID,~ OYES ONO OYES ONO BEDDING: VENT DIA.: .A VENT MAT[ JHI(dH WAT R NUMBER OF ROAD: PRO PE WELL. BUILDING. VENT TO FRESH ALARM FEET FROM LI LAIR I LET'. YES ONO OYES NO NEAREST 30 O ING CHAMBER: MANUFACTURER. BE DDING. LIQUID CAPACI TV PUMP MODEL PMP; SIPHON MANtIt nC TUREEt WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYE S ONO DYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING (VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) OYES ONO NEAREST 101 ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing jLi'l III JOIANIFTER IIIATIRIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WI DTH LENGTH NO OF IDISIR PIPE 'PACING, COVER [NSIDE DIA 'PITS LIQUID BED/TRENCH ~-V THEN s AL: PIT DEPTH. DIMENSIONS G KAVEL DE PT t1 FILL DEPTH IUISTH PIPE UISTH PIPE DISTR PIPE MATERIAL O H UMBER OF PROPERTY WELL BUILDING'. VENT TO FRESH BELOW PIPES j~ ABOVE VER El E INLET ELE ENU PIP fN E ET FROM AIR INLETEAREST► J MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- O YES meets the criteria for medium sand. TIONS MEASURED. O NO SOIL COVER TEXTURE PE HNIANI NT MAHKE HS OBSERVATION WELLS OYES ONO OYES ONO DEPTH OVER TRENCH BED DEPTH OVFH TRENCH HE 1) DEPTH OF TOPSOIL SODDFD JFF UFD JMULCHED CENTER EDGES OYES. ONO OYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIOTH LENGTH TOE NCHE$ LATE HAL SPACING JGHAVIL DEPTH HE LOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIIOLDMATEHIAL NO UISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. DIA. ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHEC1 LV COVER "AT TRIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES ONO _ DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: JBUILDING: FEET FROM LINE: DYES ONO OYES ONO NEAREST f 4W Sketch System on Ret ' in county file for audit. Reverse Side. SI N T RE. r' TITLE: ~j DILHR SBD 6710 (R. 01/82)' `~j~ 'a WISC°neln APPLICATION FOR SANITARY PERMIT UNTY ~-D1LHR I oeaRRTmenTOV (PLB 67) UNIFORM SANITARY PERMIT # InDUSTRM, LRBOR 6 HUMRn RELRTIOns -Attach corpplete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT \r ! Q PROPERRTY EJ WNE~_ ~ e 0 ~ MAILING • 33 ADDRE OWN . &351100 PROPERTY LOC T CITY: LACE: iDO <VMIL SW 1/45E , Td$ N, R E (or) LOT NUMBER BLOCK NUMBER ISUBDIVISAN NAr,~ NEAREST ROAD AI q OR LAN ARK STATE PLAN I.D. NUMBER r W A ~ lit TYPE OF BUILDING OR USE SERVED X 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): Cp1JVew n, d THIS PERMIT IS FOR A: LZ441-- -7 Z.4 //D 0 t New System ❑ T nk Replacement 77 pair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. 5Z I Seepaye Bed ❑ Seepage Trench F-1 Seepage Pit El Holding Tank Lf System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Conc ete Constructed Septic Tank Capacity 1000 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): lo l 7 9 5 J 't [9 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. N of Plumber (Prin Signatu /MPRSW No.: Phone Number: a: (4 1 rJ/1 T- 7/ 52 PL X Plumber's -ddres.. Nam#, f Desi er: 4~....r' / 7 r COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved r~.t3 f/~ ~f~~' ❑ Owner Given Initial a✓ Approved Adverse Determination ZZ,-ze, 6, I I Reason for Disapproval: 41~- Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. I? B. L, 6 7 P L OT A N 0 C., Noss sFc -nni\I . PROJECT PLU RE1-- . ., _ . \ A V E R id rtiicKei' '-i, d\J N AM E / rim= L 0 C AT I 0 N —6,61,,Nt, VAllej Kci, 1_ IC ENS Eli: 4 'C. , I..) A LE — s. — 5 S PLOT MAP he IN ,Fk(f0A Nt6s) 4, Lot iii\it . 1 1 I )1 1 50 13PItitrzt RR- , 1S TT • C,., 0f3/14'. Pipe 100.06Elt tY• ' . . . . c______: - (---- 40 ---------k-U- v-----5d -,---)* 57, > _ 1 /1* A, 0 1 ?- 3 . . YY' 715f, 831kX Be . . Qt.,. _ 1.....tr , • izz, I3X et_ yoi --*----1 1 a.? as- ..i .,.. cr. ,.,..,. ..,.,•,.. — IA 1 O1c Pk v. rh Mow Ka . . FRESH AIR INLETS AND OBSERVATION PIPE CROSS SECTION • --- , (.7) Approved Vent Cap Minimum 12" Above Fina] Gracie .I . k-iiIII fri kx 4" Cast Iron Above Pipe ( Vent Pipe To Final Grade Marsh Hay Or Synthetic Covering Min. 2" Aggregla [ e Over Pipe \ if Distribution 6 LI" I ,1 <, Tee ›- Pipe I i\- i__--1 . Aggregate (0 Perforated Pipe Below 91:40 Beneath Pipe 4, Coupling Terminating At v Bottom of System DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS 'INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATION \ / MADISON,WI 53707 l (H63.09(1) & Chapter 145.045) LOCATION:SE- SEC-/I4: TOWNSHIP/MUNJICIrALtTY: LOT NO.:BLK.NO.: SUBDIVISION NAME: Sw '/ ', 2 /T2PN/R/9E (oral 7 Qo/ ?4,ec�e 'fo /fie sa/,i.p 0/'oE,p . COUNT�,ii:� OWNER'S/1 UYLR'S NAME: MAILING ADDRESS: // 57{•aof ,4RT Fe -ye /el: 3 aw1 f/J ' /IP• i%UDfc1U, W;S . USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPT ONE J4/ f27- 4?J PERCOLATION TESTS: Residence 3. A/ • Aew ❑Replace 4/3e/ 1�15 RATING:S=Site suitable for system U=/I Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(option Lc. S lU [AS U kS U [ IS [x U [-IS x U eova )77:0t/,j/4-etee r,r 7 `, ' If Percolation Tests are NOT required DESIGN RATE: If any -Zj A portion of the tested area is in the /(tj under s.H63.09(51(b),indicate: C�l//f.S'.S - Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS in, .1.QC/sj.4L 'f-/'• BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-. CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST.HIGHEST—TO BEDROCK IF O SERVED (SEE ABBRy.ON BACK.) p b i /.Y ' d/X! fifi /sg '•B,v. SW, j.f_ -Aiarvx't o� 18,�.,. B- l , •S /pz •3d } O s- S/, B,v . s. , I S- ' //7 ' , /, ' s/, i s8 "ev• s,7, s.7 ,I;X. O f 8,v . BY 5 /o/ 9� " — >� 5/ (so 90) a•,J 7 t 9i,s S. (s o %) . 0 - ' /.0 8 /3/•F 5/4 /•7S ad. 5- ; ,5• GG ' Ai;x71 o-F B- 3 0 • J/ /0/.y0 4r ,f i ,v. s/ (so %) c<+rrQ 7-31.1 I eQ. S. s o 'I'o) . B d /00.3 -- 0 ' ' s' /i/,-- s,•/, 4 s ' o. .3 , -83 6a. 5 3. yz. , M/I. I3 QN, s/ CrO 'dd av1.Q 7'f, S,(.5 o c0. B-5 Y1.O /oO.30 > O ' Af ix/vac- 3/3., • s/(s o PPo) , 74,o . s(go 9,) B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES - RATE MINUTES NUMBER ' AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- / V. y 7�-- 3 0 2 'i,-, 3 iG 3 9 6 P-z y 6 ' 11- .f0 z 1 j 2 1K. z '%•; /e•7 _P-3 yo ' - .3O 3 324, 3 % FS' 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 points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION B0 ,F e-'i'e,414,-7-4 r 4 c y7ro F ART : FED I . • aDA1F A An ' I/E,er REF PT s �, �,t'o�osed 0 0 3 ' T P F ,y cc,vov;T f1,� NEty r ser /1Z No. LOT C.S.T �`/ELitTin� ' /b 0. p GiiVE PrPPRot ?bD 60We: , r t .- A P, 4 fl�€RN�Te p q y 8 . x3 sysre,/ id 2 p • a. s Yoe /3 2. ,t it h V4 POwCie Po/E /L "7-/8 , -2 -2-. This test site APPROVED • '` 1 o� -, P 7 . # z 3c Z " 4' for a conventional septic system. I,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): At 1 TESTS WERE COMPLETED ON: p HOMESITE SEPTIC PLUMBING CO. 2/ — / '4 j ADDRESS: RT.3O'NEIL RD.,HUDSON WIS.54U16 ��� • -T FI N NUMBER: PHONE NUMBER(optional): ROBERT ULBRICHT �.lk �/�F� , -O Z yF — 3, -89/j›- WIS.MASTER PLUMBER LIC.NO.3307 M.P.R., j0 J IGNATUR • MiNN.INSTALLER&DESIGNER LIC.NO.00663 �Y/ 9 - / /046 DISTRIBUTION: Original and one copy to Local Authority,Property Owner Tester. Sr,' DILHR-SBD-6395 (R.02/82) -OV - j' • APPLICATION FOR SANITARY PERMIT S T C - 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 permit issuance. Should this development be intended for resale by owner/contractor, ("spec house") , then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property Location of Property ,j L11/4 a t 1, Section , //!� , T.Z� N - R r < W/ • Township � z /�/V'" kiC e57 C� Mailing Address L��-z4,�� 22614 -cf Subdivision Name Lot Number C Th "//5‘/-/ • • Previous Owner of Property Total Size of Parcel Date Parcel was Created %7/./ Val. Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No y-• r Volume !� !C and and Page Number > 5 as recorded with the Register of Deeds • INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract - 3. • Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. • PROPERTY OWNER CERTIFICATION I (We) ce4ti.6y .that a.2 statements on th-is 6onm ane .true .to .the beat my (owe.) knowledge; .that I (we) am (are) .the owner(s) o 6 .the pro peh.ty des cA bed in this .n6onmatLon 6on.m, by viAtue 06 a wawtkanty deed recorded in .the 066.i.ee o6 .the County RegLs.tek o 6 Deeds as Document No. 6 q ,c1---, ; and .that I (we) pnesentty own .the p!eoposed site lion .the sewage disposat system (on I (we) have obtained an easement, .to nun with .the above descn bed pn.opehty, lion .the eons•JuLcti.on o6 said system, and the same has been duty recorded in the 066 ce o6 .the County Reg.i,s.teh (36 Deeds, as Document No. ) . 0../(/-44 SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED - H z H . a ST C- 105 r r a SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z z a OWNER/BUYER A -4 alll~ M ROUTE/BOX NUMBER Fire Number CITY/STATE f~.GiZ~l2 ZIP7~ (rj PROPERTY LOCATION: Section T ZY N, R 1 /W' I 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 con- sists 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 treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning'a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 ' E I/WE, the undersigned, have read the above requirements and agree z to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P. 0. Box 98. Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DOCUMENT NO. I..- eQ( 9r PA V~~, 4 _ MORTGAGE-To Corporatio"hort fond InSUr -~2 5 6 G- 4 2 [ of ~P► Pr jt~AI ace, TESOF WItSCONSIN FORM 20 THIS SPACE RESERVED FOR RMRDING DATA ' kE.GsiSI-E xS OFFiCIp. KNOW ALL MEN, That..Arthur..Feyereisen. & .Marilyn ST. CROIX CO.. WIS. Feyereisen, husband & wife Recd for Record this--.tb- mortgagor..., of.:..._St. Croix County, Wisconsin, hereby mortgage....... to day of_~I9vember- -A.D.19~ River F.alls State Bank at _q,;00____ A M, . ~ t a Corporation duly organized and existing under and by virtue of the laws of the State of Wisconsin, located at ............................UY..i<.r F.a11.5............................................ Wisconsin Re sta o eeds for the sum of.Thirty-one•...Thouaaa 31 000 00 - 0 _----------------------------Dollars, RETURN T the following tract of land in t QrQIX...................... County, State of Wisconsin: East Half of South West Quarter and South Half of South Half of South East Quarter of Section Numbered Eight (8) ; West Half of North West Quarter of Section Numbered (16); North Half of North East Quarter and South East Quarter of North East Quarter of Section Numbered Seventeen (17), all in Township Numbered Twenty-Eight (28) North, of Range Numbered Nineteen (19) West, in the County of Saint Croix and State of Wisconsin. This mort age is given to secure the following indebtedness: .....Thirty-One Thousand and no/100---------- ($31.00 - - ...........z ..................I.-.-......"............-........ Dollars payable. ..._MQtl.th 1n--- from date hereof with interest thereon until paid, at the rate of ..6.._384 per cent. per annum, payable AiFif n y, according to the conditions of............ 4 .............certain promissory note...... bearing even date herewith, executed by the said Arthur Feyez'•a Se11,_ &•-Mar . y}}_•.F~ya _~7uabaH~1•, &••.yi a••_••--••--mortgagor_.5...... to the said mortgagee. The mortgagor...... agree............ to pay all taxes and assessments of every kind, ordinary or extraordinary, which may be assessed or levied upon or against said described premises, or upon this mortgage, or the note............ thereby secured, or upon the mortgage interest in said premises created by this instrument. The mortgagor 5.... agree............ to cause said premises to be assessed as unincumbered real estate (and so long as the indebtedness mentioned herein, or any part thereof, remains unpaid; to cause the building..s....... located upon said described premises to be insured in some solvent fire insurance companies .........••--•-••----................•-_........................selected b said - - - - mortgagee, - - its successors or assigns, in the sum of..Thirt.y'five Thousand and no/100------- ($35x 000 0 .Dollars, ~ ) and the policy or policies of insurance issued thereon made payable to and deposited with said mortgagee, its successors or assigns;) and in case of the non-performance of any of the agreements herein contained, by said mortgagor S...... to be kept and performed, then it shall be lawful for said mortgagee, its successors or assi ns, to expend any sum of money necessary to preserve the lien of said mortgagee upon said premises, in payment of taxes, (insurance money or otherwise, and said mortgagee, its successors or assigns, are hereby authorized in the event of the non-performance of any of the above agreements, to grant, bargain, sell and convey said real estate at public auction, and make all needful deeds of conveyance to the purchaser thereof, pursuant to the statutes in such case made and provided, and out of the proceeds arising from said sale to reimburse itself for all costs, charges, taxes and insurance moneys, which it shall have expended in and about the preservation of said premises, or of any suit to foreclose this mortgage, together with a reasonable sum of money as solicitor's fees. It is understood and agreed by the said mortgagor...s....... that the agreements contained herein shall not be construed to in any wise abrogate or abridge any of the rights and remedies given to a mortgagee under section 2209 of the Statutes of Wisconsin, of 1898, and that this instrument shall have all of the force of an instrument drawn in the form set forth in said section. IN WITNESS WHEREOF, the said mortgagor s..........._ha...Ve.........hereunto set....... 9!AR hand ....S........... and sea] S......... this ....................5th............................................. day of................ Q.V. !.er.........._..........._......, A. D., 19...66... SIGNED AND SEALED IN P'RESENCE OF o,, (S EAL) Arkh4?r....eyeresen Donald W. Larson (SEAL) r' 1 n F ereisen (SEAL) Jane Petricka (SEAL) STATE OF WISCONSIN. 1 ; O c O p c C3 O O IL Vl O .2(D 7 t 7 'C YY> ` t` U= C7 t D p c > ~ O N F- O cu ~ O 'p p U to O r Vm.:. c ~1► O p C C7 O 'C E L O p C N cc c ca 0 cc W -s 0 0.0 m ~Ec U d .C O 7 a: Q O 0 W O 0 w Fc' = N OMB C O p)CD ~0. C V y t~n O p O N c~ W ~s c"oM00 mE c4O a 3rnoUM c 'ao CcH cc c U 0 ca c O c :3 -a = 'a t U ~3 c 0 m O w ~ a O '0 m L t U rO. y O U) C m Z 0 c~ ~(D y ` O O W Q Z NCd N cn c ~ N ' N O at c O O O cu c~.0 O vfp+ L.. C 3 O O. 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N CR m v o -n - - m to - w z ~ - w rn S03°3712"E 233.82' caw r O o T CENTERLINE TOWN ROAD w w w O N W r C7 Sga2= I It tr r O ' 231.07' a r co • V N 33' z • z I z IC °D CD O io ac r N I D N Ir Z w cco C" o d co Irt O N ~O M -n CR tO tO 14 r • m W O N n+ r~ CO ly K ° N O+ I U1 tO Z I ~n N N ► Of I N + w I -1 co m t O N Cf 0) co to trO 3 n (a rr, O N N C3. ONE I O N N ~ 1 as IN w r 1cr X 19 N rt rt V K y tp Ot Ira C7 C~l C 11 r' tJt ►-t to r+ I nt 1. >C 2 O N id a 1 ei f'f n Irt -1 1../. r r Irt < Z C Gf Gf n N Cl Z Z I N r- r- Z rn Na o m r Z z H M C) rn a v o c v a I M p a x a L" 33' o, o 0 CD N r m N r^ 212.12' 33.00 ' N01040'12"W 245.12' z m unQlattgd_lands_owned_by_Qlattgr T + z N m 1 - 2 5060'59" 577.61' 58.97' 58.95' S06°32'42"E 3 -•7f 3006'47" 610.61' 33.15' 33.15' S07029'21.5"E 4 5 2°18'46" 610.61' 24.63' 24.63' S04046'3511E 3 - 5 5025'33" 610.611 57.78' 57.76' S06019'58.5"E SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify that by the direction of Art Feyereisen, I have surveyed, described and mapped 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 land located in part of the NW 1/4 of the NE 1/4 of Section. 17, T28N, R19W, Town of Troy, St. Croix County, Wisconsin; further described as follows: Commencing at the N 1/4 corner of said Section 17; thence S52035'00"E (bearings referenced to the north line of the NW 1/4 assumed to bear N88019148"E) 696.19 feet to the point of beginning of this description; thence N81036128"E, 319.84 feet; thence N81050'28"E, 53.00 feet; thence N01040'12"W, 245.12 feet; thence 588019148"W, 416.15 feet to the centerline of a Town Road, said centerline being a 577.61 foot radius curve concave westerly whose central angle measures 5050159" and whose chord bears 506032142"E and measures 58.95 feet; thence southerly along the arc of said curve, 58.97 feet to the point of tangency; thence S03037'12"E, along said centerline, 233.82 feet; thence N81°36'28"E, 33.11 feet to the right-of-way of said Town Road and the point of beginning. Parcel is subject to a 33 foot Road Easement and an easement for Town Road purposes as shown on this map, and all other easements of record. That this Certified Survey Map is a correct representation of the exterior boundary surveyed and described; that I have fully complied with Chapter 236.34 Wisconsin Revised Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. !sr 11 60 6 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT SIN + vk- h 9a A s r t,. . Owner Address 3 4 u w w X V t City/State 14 Lk 0) 0;1 ,Ise - C401 (o rr . Legal Description: Lot Block Subdivision/CSM # Sec. % , T ab N-RAW, Town of P O PIN # SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer P wY- Size ST/PC (a Setback from: House Well 1~; P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road ___Vett to fresh air intake Water Line Meter locatioa-'' Alarm locat' ~m SOIL ABSORPTION S STEM: GuUV~►-~ )bUp Type of system: ZN ~ rin \ d~ Width 3 Length IS Number of Trenches Setback from: House ) I ~ Well P/L 21 Vent to fresh air intake 7,S& ELEVATIONS: Description of benchmark 1-0e A WO cr, S) n, r Elevation 10 U- 6 Description of alternate benchmark Elevation Building Sewer ST/HT Inlet ST Outlet (-P PC Inlet PC Bottom------' Header/Manifold a. y Top of ST/PC Manhole Cover Distribution Lines O 4 a O ( ) Bottom of System O j O d ( ) Final Grade O O f o J O Date of installation Permit number State plan number Plumber's signature License number a a Date Inspector T 1. u r s u u Complete plot plan Or r NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW 3 13.eJ RW rn X10 ~t ao° ~.S' d loud 9p) S~ p7 i ~,,%j° `may U 18x53, (3ed A1VP ~)c l S~ i .Sy 3 ~Pr. P ~ NRw ljl fY- 3X-I rr4tvc~s - T-W~',ITatoxf INDICA E NORTH ARROW N 4 ST. CROIX COUNTY ZONING OFFICE ~a t CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANi This is to certify that I have inspected the septic tahk;p sently l serving the N J o dV ~F.1~ 1A S-P residence located at: S I,J k, S r- k, section , T~N, R_B_W, Town of -f2v Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: U Did flow back occur from absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes capacity: ( O U 0 c p Construction: Prefab Concrete Steel Other Manufacturer: (If known) : W e.-e K S Age of Tank (If known) : ~.~n•-, ~oW~~. ~ VlR ~OId,YY1-G`~J~YL (Sig ture) (Name) Please print VnDA-((L i )k~\--Xek Vus ~r~-find a-~ 9v4 (Title) (License Number) ~U Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name 7 I m )90t4 rA-(F St49- Signature Q MP/MPRS X 21 7D Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor'and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299130 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: KRAUSE, JOHN & JODELL TROY CST BM Elegy Insp. BM Elev.: BM Description: Parcel Tax No.: 040-1067-95-100 TANK INFORMATION E EVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic L 1 Benchmark / .6 /pct Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet %S1 Z~ TANKTO P/L WELL BLDG. Vent to ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man.. y Aeration NA Dist. Pipe Holding Bot. System p g~ 90.6" PUMP/ SIPHON INFORMATION Final Grade Manufacturer - Demand 7 Model Number GPM TDH Lift Fr' Ion System TDH Ft oss Forcemain ength Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length/_,,,,, No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS a- DIMEN I N LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM CHAMBER Model Number: INFORMATION TypeO System: rvl ! r'/`'o 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 1 xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 17.28.19.257H,NW,NW 399 TOWNSVALLEY ROAD LOT 1 Plan revision required? ❑ Yes [/No Use other side for additional information. SBD-6710 (R 05/91) Date InS~ector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division v■~r■■. SANITARY PERMIT APPLICATION Bureau of Building water systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less Count than 81/2 x 11 inches in size. * • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs " 5 O ❑ Check if revision to previous application IPrivacy Law, s. 15-04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Pr Owner Name- Propert L cation o Co 1/4 1/4, S 1,7 T N, R /-c/ E (orj Property Owner's M g Address Lot Number Block Number City, St to (it.~J► Zip ode Phone Number Subdivision Name or CSM Number 6o A IF ~.ln (/j ) . vo C; II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ city Nea t Road ❑ Public Jjr 1 or 2 Family Dwelling - No. of bedrooms Tolag OF in. BUILDING USE: (If building type is public, check all that apply) Parcel TaxNumber( s 17.28. 19• a57h, 1 ❑ Apartment/ Condo 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 13E] Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an _____System ________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 11E] Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 (RSeepage Trench 22E] In-Ground Pressure 42 ❑ Pit Privy 13E] Seepage Pit 43E] Vault Privy 14 ❑ System-In-Fill 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 45 O Rea- uiirdd (sq. ft.) Proposed (sq. ft.) (Gal day/sq. ft.) (Min /inch) p Elevation ISO 1 ri. (PO Feet J Y. 9U Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION New Existin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App strutted Tanks Tanks Septic Tank or Holding Tank 1 (0 U U ( W ~j ❑ ❑ 1:1 1:1 1:1 Lift Pump Tank /Siphon Chamber El ❑ E El El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) P tier's Sipature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address ( treet , City, State, Zip Code): U, JT_ 7~J` C+ `ICJ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps) )(Approved Surcharge Fee) ❑ Owner Given Initial Adverse Determination ] U jaA( 9 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) _ DISTRIBUTION: Original to County, One copy To: Safety & Buildings Dive ion, 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 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, 608-266-3815. To be complete and accufate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be instaNed- II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type- VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material- Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches 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 contami: cation investigations and establishment of standards. • I-i. n. L.. . . ) ( I-) L U I A N il L. I U 5 .5 `...) I" L I I L.) 1\1 .,. ..: ., P R 0 U EC I P L U M.b E. k 1... 1 N A IM1E741 47,3-T4d1 KgwAls, NAME 31.,,,, 136-0A-cc1170- . :•, N.._ 0 C AT I 0 N 31-9 fb4.1d5 vio)k.... kel I_ I C N S...E WI_ . y.D. . . . :•; v i...) ;. •6 ..., _ PLO T MAP ...... .., • .i: ;•• • 3 BepRobt.„ . sOe•vvN • . . • • • • . '?., . . • r )o' . Top or . , . . WtO So r CAsob I' l-c . • •.. . : .. . . 4.e., 0 VAlv-P .: . ..H. — . . . • 19 I6)(S3 OP12 . • • N'rN) . . . •. . . l' . . . : • ..;:_i .3 tor 1 • ... • • • , .::'.0 . ., .. . 1 i • ... ( . i•--- •• ..•. I :!. T..' • I I 4' . ..,! (: • G.) . . t) 1-01.A.1.3- - • " : i . • . -')(7s • :: .:; • •,::-. ••1•1:: •• • •. ,. :. .. . '. . • . . . . . , . ' .. . . ' FRESH AIR INLETS AND OBSERVATION PI.PE CROSS SECTION • _ 47-- • (772) Approved Vent Cap /\ •-• e< Minimum 12" Above • • nw P ) GIC-442-c Final Grpcl? ., • ..• ' Lp,11 ill . • . -- „,„, 4 " Cast Iron Above Pipe (.7 Vent Pipe To Final Grade • - - - . . . . Marsh Nay Or Synthetic Covering . . •. .. Min . 2" AggregHo • . ' Over Pipe \I' \/.. ] ''' ' . .___ __ Tee • Distribution I it 1/ 0• __,-- . Pipe e \ : i Aggregate _T_ Perforated Pipe Below • 004" Trkr.bitf Beneath Pipe < Coupling Terminating P :. • ;415,J61 9 o i lob ____ v Bottom of System . • _ . ' , ✓ , /1-4t, /Yr ��� / Wisconsin Department of Industry, SOIL AND SITE EVALUATION � / 3 Labor and Human Relations (' Page of Division Of Safety and Buildings in acco 8i-s:1 .HR 83.09, Wis. ' ` County Attach complete site plan on paper not less than 8 1/2 x 1 'nth in size. n must:�? Sr ce o/include,but not limited to: vertical and horizontal referenct}p©int(BM f direoiorrfihd percent slope,scale or dimensions,north arrow,and loatlon .. and distance to nearest road p+, Parcel I.D.# APPLICANT INFORMATION - Please print' IU informstip11901x Reviewed by Date Personal information you provide may be used for secondary pu "se :(privacy Ltfvk SiNt.b4(1)(m)) Property Owner 3 _ '- ,' ' ' .- _ . ro �L�gcation '" O fv ,? J C7 �(_L r -� / 1/4 1/4,S Tz ,N,R E(o 3 Property Owner's Mailing Address # Block# Subd.Name or CSM# 3 ?I. row,vso,4i/Ey 1 csj1. va ► . co N . IS Co ci City State Zip Code Phone Number Nearest Road /7/!JPS0^3 Cc.)) • I S t{0/6 MS )3 ,/ Tel 73 ❑ City ❑ �ogey Town 1 7 (L'A)s 1'4//64/ /0-ee• ❑_Notw Construction Use: Residential/Number of bedrooms 3 Addition to existing building ff-Replacement ❑Public or commercial-Describe: Aydee = NOT'AECDAI41' %J &-- 7 Z Code derived daily flow /!!�6 gpd Recommended design loading rate /Vim bed,gpd/ft2 ' trench,gpd/ft2 Absorption area required it/M,„ bed,ft2 7.50 trench,ft2 Maximum design loading rate/V ie bed,gpd/ft2 ' Cv trench,gpd/ft2 Recommended infiltration surface elevation(s)S-e-1 • 3 ft(as referred to site plan benchmark) Additional design/site considerations *SE' Lati �dl}�j� !?Sc4.6 et)/ Di'op 40 . .D I S 7'le%8v 7'4 ) Parent material I of c5 6c.-e . "puo y O oT 4,/ii_ Flood plain elevation,if applicable Z/ ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system IRS—❑ U ❑ U I—❑ U `❑ U ❑ S IIU ❑ S 8 U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots _ GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench i. i i o-io /0YR 2/3 — I-- ifsk -Pita S l.j f ,4 ; is /6.2r &aye 3/y S,L lfsk Isk. •S , •Z: • 3 Ground 3 y g /©Yle y/C.P �'r/?A }Q°7 p,Jelev. `3 Q ,r�t/ 66/ ,'t E X 4 �/ S1�•n G,tQ X �t,( S , p� y G V ft. it u `10/, y 4 Ls- /4LY1 7/j /.t i it — . 7 : .C7 Depth to factorlimitin E'Kf'c?I-v(� sys7: iWE' S 7 O d-Q �9. 65 / 7 in. Remarks: 7/A-16- S75 •• /S /A CODE-�4/0/;4 4)-/SOi/S 1 C4 4 teq' t�1/4/(��� FX/3 Boring# - r o-I /ov,e 2/3 /fsh`C fit 'S /f • `f :5 z £ z. 9'.33 /o//R 3/ _----- 5,L /fSlk milt/ cS " z :• 3 3 3 3 -f,g /aye Y/ _ S /mi die d q-r' -- -) : .g Ground 1/ ig, /eel/, C X�/ '1 " - df I1�s 1 f y, ds 4.-4 r 5- : •( ?y.5O ft. ICVX s/ 5 2 �1�j d)2 ct,C•- . 1 : 'd Depth to d- limiting factor in. Remarks: CST Name (Please Print) �- Signature /^ 1 Tele hone /2o��,2T' Z1G/3iPir/ � 7/5 3v6. SOW Address Date CST Number Ulbricht&Associates Private Sewage Consultants 656 O'Neil Rd. Hudson,Wis. 54016 ORIGINF\L `e/e V�-� SOIL DESCRIPTION REPORT Z PROPERTY OWNER Page of PARCEL I.D.# 7 O /b 6 7 • <S •tern BoringHorizon Depth Dominant Color Mottles Structure G U/ft2 # Texture Consistence Boundary Roots P in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench 3 / o-q /e),e 2/3 /14,- k y s `f , 9 • 5/4- fShl< AvcfRC Iof -2- : • 3 Ground 3 3( -�2 /oyiie p/ M/: 7 t 6f- FS © S ;� �-( •S c elev � gs.2-6 ft. /or, D, - .. •8 Depth to limiting factor fg in. Remarks: _ Boring # — t� J Ground " elev. ft. Depth to - limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots L GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. LBed Trench Boring # Ground elev. ft. Depth to limiting factor —in' Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330(R.08/95) . -_________K • Ulbricht&Associates --4' I �k' Private Sewage Consultants 655 O'Neil Rd. ' Hudson,Wis. 54010 j.)i Ib / \ / ° T W 'S / I / ,5. 1;6,vaf r 2_,, 1 .i%t I log' / I filC�- vEti 7- 5 Sl/�S%„ _ /moo-Gout v��ce 95,Z5 I v aS� P�FOI 1- / - -- - -- - - -- - - PRO fl i i l�' XS3 I ,�i Sn I r (//sus) �. I , v.,t l6, 1 - - - -- ____-- - - _ ___- 4 e 3 C L sy' 717 5z pe 0A-7i o 4, 5 qo , a N ,-_______...., , SC,(LE ; / H= 2-O • _ 44cfitee4) P c7 3 1 �do,t,s /€1// 74 , ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the ,,SJ~~.► ~R14Ay~ t1 residence located at: SI,J Sec. 8 , TN, RI W, Town of 2U _ St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good conditio and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes N N (if no, skip next line. Approximate volume or length of time: _ gallons minutes Capacity: / Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): i ► ~ ~k Ytn-~~ ~ 1 n (Sign ure) (Name) Please Print Mro)-tr ~ X10 9 (Title) (License Number)' p 77 (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name I ►^h~,v,,~s~~~~ Signature I~,r MP/MPRS 3yUy im FIl E® 4UG 12;985 a ooh 404222 4 .~,.°i"",►, C=I ic~ n o co s o~ nPTI y f.. :t> p p O W c Z f'.FY' le ie f R 'm co i0 Z V 7t7 Z .'O rn rt rn m m cya cW d'A 1-+ " x o = T m . ua H a co m z a e 3°,'a z~ m Z co z x x rC 1" o d t-4 r 0 rn o r o Z .°i c~h ° c r ---I m -n 2 •'O mC to Cl) 40 . m IN O C7 N Z Z~. to r w o m O rn to tr C-3 r leg 3 to r to F z r 1-• N -7- R . V C7 O a o m o "n to x ' ~ N x a - T z r W eo m w -7 .r r N \ S0303711211E 233.821 c•' v. W O o "n W t0 N CENTERLINE TOWN ROAD W w - m o C-) _ H cco S03nV 1 ° ~cn °z 231.071 co 4 N 331 co I ~ I r to Z 2 ~ _ O co N ~ N Z Z W I d co let O O I -n ~ r Ito ~ O t0 F • 1 1►-• m W N C1D N O r CL D CC)_ 17 to CA N +o O Z I ly w 1w R1 1 rr, co CC) N 3 N I7 K9 m rn Ito CD N m O N N I W W ~ i It7' 7C 19 N eft fi ~I r K C7 1 a ;O ~ jo O 1~ tlt m H CT co I~ 1' C'~ n let In p p I j~ Z Iet H H H NE cn O • c') • O a x z \ \ I N .t me H M X H N O M r z tZt I H M v 10 r ° m z APPROVED M o ' H c m o Fri AUG 0 7 1985 I H S'1'('- 1115 SI;rTI(: 'I'ANI( MAINTE'NANCP. AGREI-'IN1ENT St. Croix Coullo, ONVNI-:10JUVrtt J_4hr, K-raUs e. MAl1.ING ADDRIsSS 3CH TOW h5 Val PROPERTY ADDRESS (location of septic system) Please obtain from the 1111nninf; Dell. CIT17STATE. H ud5Or .1 vil 5y O l (o PROPEIRTV LOCATION t 1/4, M15 1/4, Section N-It TOWN OF '"TrO~J ST. CROIX COUNTY, %YI SUBDIVISION LOT NUM13I?R CERTIFIED SURVEY MAl' 40q a19, VOLUME PAC E 156 1.01' NUM13(;it 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 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 I, 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. -Ilie property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a nlatcr plumber, jourileyrnan plumber, restricted plumber or a licensed pumper verifying Ihat (1) file on-site wastewater disposal system is in proper operating condilion and (2) aficr inspection smd 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 agice to maintain the private sewage disposal system in accordance with the standards set forth, herein, as sct by the Wisconsin Wit Certification stating, that your septic has been mainlctined must he completed and retunx•d to the SI Croix ('aunty %uning Officer within 10 days of the three year expiration date 0A 6/ 10-1(0 j q `I ('ruts ('a11111N, 7.un1111, ( )Ilict. (itlvl'1111nCI1) t't'tllel 1101 1'attttn•Ilac) Itoatl Ilnd"im, \VI '001li II/gt s T C - 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 permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property )ohs, ~ Jode I I KadsCi Local ion of property_w 1/4x_1/4, Section _J7 _,T 26 N-R-LL-W . Township _Iro Mailingaddress 3~iR ~ownSVa[lev Kd &'o r t~J L 54+01 Address of site Subdivision name Lot no. Other homes on property? Yes X No Previous owner of property Ar*1 .V- F 4C-fe1Sert Total size of property Total size of parcel 2. Ss2• ax-Ye-5 Date parcel was created 0 d1 q - $ Are all corners and lot lines identifiable? 1C Yes No Is this property being developed for (spec house) ? Yes X No Volume and Page Number 15(0' as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWINGS A WARRAIII'Y DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND 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 refs-,r•ences 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 office of the county Register of Deeds as Document No. 40 (P53.0 , and-that I (we) presently own the proposed site for the sewage disposal system or't (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register ot.. Deeds as Document No. S gnature o Applicant Co- plicant 11o - 97 I~.►1 cal i~iii: I ~Irr. Dat.o t,f signature ooRcuMENT NO WARRANTY DEED THIS SYAC[ RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 4op ISM I'%A 7Z4fkj;62Z offia Arthur Feyereisen and Marilyn Feyereisen,- husband-- - FT. Crim W., WIS and wife. M!'♦OCrd #6 29t Of/1.0. 198y _ conveys and currants to JOhn-R.. Krause. 3t1a-JOC1E11.M.._ICrdUSer... 9:15 A It wife.as Joint tenants...._..i.~ r hu:3and and. ~ b . - - - . RETURN TO . . . . . . . . the following described real estote in -St_ .11E ix - . ...County, state of Wisconsin: Tax Parcel No: Part of NW% of the NEh of section 17-28-19 described as follows: Lot 1 of a Certified Survey Map filed August 12, 1985 in volume 6, otx page 1564, in the office of the Register of Deeds for St. Croix, Wisconsin- Tax Ex,,-Wt 77.25(8) This is not homestead property-. (is) (is not) : TCNGETt1M WITH and ST,TECr To any other easements, covenants, Exception to warranties reservations or regtrictions of record, if any, but this shall not be deemed to extend any such other recorded encuftbrances beyond the term established by law therefor. J~ day of 1 1985 Dated this (SEAL) LiLGl/LP ~241~s" (SEAL) Arthur Feyereisen - -(SEAL) ~%1 /L~ 2L~[,'v ( 4Bt 12-~- (SEAL) Marilyn Feyerelsen AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN of.Arthur- Feyereisen-_arld_---------ss. iy yere se- --------------------------------------------------.county. Personally came before me this .....day of 19.8.S . ,-day of.. S.7- authenticated this . _ 42 19. the above named - • ~,..Dahle-------- - TITLE: MEMBER STATE BAR OF WISCONSIN - - (If not, authorized by § 706.06,Wis. Scats.) to me known to be the person who executed the foregoing instrument and acknowledge fire same.