HomeMy WebLinkAbout040-1002-50-100
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
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OWNER
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SUBDIVISION / CSM# `T YO M& YO/' ~ • 2- ~ LOT ~ 7L
SECTION. l T Z N-R /9 W, Town of 7-PO)/
ST. CR.OIX COUNTY, WISCONSIN
PLAN VIEW
-'SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
ORIGINAL
INDICATE NORTH ARPOW
Provide setback and elevation information on reverse of this-form.
Provide 2 dimensions, to center, of septic tank manhole cover.
.r
No I&EW P11i/-4P -/v A47-2--` z t~
lVo 1,6,zvo- /3 o&r
90 19 ~
BENCHMARK: IN, • ~/7~~c~ ~rg~~U19"TCd•J
ALTERNATE BM:
/ 25^v 7J`d Sid •
SEPTIC TANK:/,, PUMP CHAMBER J HOLDING..TANK INFORMATION
Manufacturer: A) ESER '~70A~ 64 k- Liquid Capacity: /2 S'U
No well erxV`5 ~O ~pIJSE~
l`
Setback from: Well House Other
-T
Pump: Manufacturer ZeEi1~ Model# 97 f~ Size k2
ii
Float seperation / Gallons/cycle:
Alarm Location ~~lJSi%~~ `i0•~1E" UiG 7
o UAJ r
SOIL ABSORPTION SYSTEM
width: y Length S ! Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: N/1~ House 'V14 Other
ELEVATIONS
Buildi ' ST Inlet: f ST outlet
'
PC inlet PC bottom N, • 12' ' Pump Off 12-
Header/Manifold Bottom of system , TOT.¢L
42. av~p Ic y p G Fr_
Existing Grade Final grade
9• o~
DATE OF INSTALLATION:
PLUMBER ON JOB: ~aI3T Z1~6'e/LLr~
LICENSE NUMBER: 1WIeS• 33 d 7
INSPECTOR: Alflk~
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a Wiscon Depart Re Department of industry, PRIVATE SEWAGE SYSTEM County: ST. CROIX
Safety and Buildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPermitNo.:
Permit Holder's Name: ❑ City ❑ Village nn Town of: State Plan o.:
ULBRICHT, ROBERT & DICK GOODE X
CST BM Elev.: Insp. BM Elev.: BM ;De~_,,,tion: Parcel Tax No.:
6)0 A9400174
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic -L. 1754 Benchmark i
/00.0,
101,21 5,,2 1
Dosing ~tJ/L~i 5a ~.3(o /o U. CD
Aeration Bldg. Sewer ,94' 83,50
Holding St/Ht Inlet g,n.-7 -v
TANK SETBACK INFORMATION St/ Ht Outlet
Ventto
TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet
Septic s , / NA Dt Bottom
Dosing NA Header/Man.
'
Aeration NA Dist. Pipe 9 3 ' q9, 613
Holding Bot. System 7/ 17q i'
PUMP/ SIPHON INFORMATION Final Grade .6(-1 01q, 76"
Manufacturer Demand
Model Number Cq P ) GPM a-
n .
TDH Lift '10 Friction System 5 TDH S Ft
oss Forcemain Length Dia. F + Dist. To We
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No-Of enches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION / DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION TypeOf ~2~ Model Number:
System: ~ 0-ya ` lI A/ A OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. / Length Dia. Spacing ~o / V 5(~
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over c~ Depth Over (4r xx Depth Of 4, xx Seeded / Sodded xx Mulched
Bed /Trench Center l 0 Bed /Trench Edges Topsoil Eres ❑ No 9?1'es ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Troy-1.28.19W, NE, SE, Lot 2, 90th Street
L4O CO L Y1 % ~+-~c c, G O1`~14, Q
J _ q t > > a#- ) 13 0
C1 SLR -
Plartfevision requi ed`f ? ❑ Yes [-Io
Use other side for additional information. Q r~ • , Ll
SBD-6710 (R 05/91) Date s e 6's Signature Cert. No
I
1
- SANITARY PERMIT APPLICATION
~ ■ COUNTY
~'~~-~■i In accord with ILHR 83.05, Wis. Adm. Code 5 T,
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than
El 181 -61 9 $'/z x 11 inches in size. t. ~ Check if revision to previous application
See,reverse side for instructions for completing this application. ~ STATE PLAN I.D. NUMBEA,~-
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. J` yo S 9~ r. p Z i 50\'
PROPERTY OWNER PROPERTY LOCATION -
Ro13eleT- Z4L(3Ri c(A7- 'DI•ck Gc~DDF,v NF '/4S~ '/4,S TZS',_N,R If E(Or W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
557 O' /PO . 2 PA RceSL 13
CITY, STATE 15ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER L s s
DSo~ . V3PG FI.P5 CSA1 41/707F6, 00/ f
rr7T
II. TYPE OF BUILDING: Check one) CITY NEAREST ROAD
❑ State Owned 92
92-TOWN OF VILLAGE . T (2p Y
❑ Public LJ 1 or 2 Fam. Dwelling- # of bedrooms L PARCEL TAX NUMBER(S)
Ill. BUILDING USE: (If building type is public, check all that apply) 0 7C~ ` 1 60 - Z - 0/-
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11- ❑ Restaurant/Bar/Dining
40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. a -New 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.0 Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 E` r ound 30 ❑ Specify Type 41 ❑ Holding Tank
12 0 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 430 Vault Privy
14 ❑ System-In-Fill 1
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
&00 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ~F7 S ELEVATION
5^O O 7'OU Feet d Feet
VII. TANK CAPACITY Site
in al Ions Total #of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank 2 5!~ /LSO /
Lift Pump Tank/Si hon Chamber -7 50 ,750 / C4 o-e
VIII. 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 Stamps) fv!P/MPRSW No.: Business Phone Number:
RbAc-rT 2111M~' 7- 1336-7 7j5 3~G'~~~'S'
er's Address (Street, City, State, Zip Code):
Plumb
695
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Si Stamp
Approved ❑ Owner Given Initial ~ ~~(06urcharge Fee)
Adverse Determination WW `
X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL:
SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
' t
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 Administ~ative''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 & Buildings Division, 608-266-3815.
To be complete and accurate 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 installed.
H. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
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% 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, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
L_
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application
201 East Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
HOMESITE SEPTIC PLUMBING
655 O'NEIL RD
HUDSON WI 54016
RE: Plan Number: S92-02150 Date Approved: July 21, 1992
Gallons Per Day: 600 Date Received: June 25, 1992
Project Name: ULBRICHT, ROBERT - RESIDENCE Location: SYSTEM B,NE,SE,1,28,19W
Town of TROY County: ST CROIX
The plumbing plans and specifications for this project have been reviewed for
compliance with applicable code requirements. This approval is based on Chapter
145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are
stamped 'conditionally approved'. This approval is contingent upon compliance with
any stipulations shown on the plans. All items that are noted must be corrected.
All permits required by the city, village, township or county shall be obtained
prior to construction. The licensed plumber responsible for this installation
shall keep one set of plans with the department's approval stamp at the
construction site. The installer shall notify the appropriate inspector when
inspections can be made.
This approval will expire two years from the date approved or if a sanitary
permit is obtained, it will expire the day the initial sanitary permit expires.
The Section of Private Sewage has reviewed these plans for private sewage system code
requirements only. These plans have not been reviewed for the code requirements
set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the
Wisconsin Administrative code.
This approval is for the following components only:
- NEW PETITION
- NEW MOUND
SRO 64231R. O 1 /91 i
i
• I
I.L.H.R. 83.08(2)
'I
PROJECT INDEX SHEET
Owner : R0 13
Address.
yCY G-
Site Location:
/lie' fy Sic I, 46) , 7-e v v e,4 a`
I
'BJec c iption:
4tltv
i.
Colt ~e®~ ENO
2,4 571 -,eV A41;~Y
d~' v
74-
zip
T3 OT - 5 '~4sel"I1
I~ sr c Ti ~iQ/f1zee,
T> 14- f r " 5~~ vG0 t4~ 71*
T, c--
C.- /Old f r I If A.1 e"'''''
VIE?- 0
Page 1. PLOT PLAN VIEWS
Page 2. MOUND CROSS SECTION & SYSTEM PLAN VIEWS
Page 3. PIPE LATERAL LAYOUT Co~S€1Pafiliu~""
Page 4. DOSING CHAMBER CROSS SECTION ~C•'~}D~.t~ j~-
Page 5. PUMP PERFROMANCE SPECS t> ~
54 W-/
PLUMBER:
S92--02150
HOMESITE SEPTIC PLUMBING CO.
MS OWEIL RD., HUDSON, WIS. 54016
ROBERT ULBRIGHT'
WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S.
MINN. IN)ALLER & DESIGNER LIC. NO. 00663
DATE: 7 SITE EVALUATER/ DESIGPIER
SIGNATURE
+ HOMESITE SEPTIC PLUMBING CO.
655 O'NEIL RD., HUDSON, WIS. 54016
ROBERT ULBRIGHT
N66. MP?7R PLUMBER LIC. NO, 1307 M.P.R.S.
~,'~tp+ na^rnl LcR & DESIGNER LIC. N0.00663
t
70
YS TEA1
f33 95:.3 ° 9?Z S'a ' 370
~ y y5". 5"0 , A
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. , X82
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0 V T LET
4 /00
G G Flr 4
I M
N
/
k -Oro
t
y Prior To PlovTing- Installer will. carefully RI
shift or orient , ?ound position( toe_ 1 ' #d
and area under bed aggregare) so gruui
elevations across slope are as uri:iform as J9 13g b
I possible. Suggested elevations (staked oi~j~
site with lathe marker:) are sho-in herein
and on pg. 2.`, o
/J.E'o~'r~s c tJ .f's ~v ~t f / U)
592-0215 0
33,
wed fh, Z,07- Li v4z-_
f /41 A)
6L O'C Z
fad
olx~
s T& 12 c 15
is I
Page z 0f
V,AI Straw, Marsh Hoy, Or
i' Synthetic Covering
Distribution Pipe
toedium Sand
G,%tl H o
Q Topsoil _
/1 • F
E - D
3
EX/ST/•u y yif'~lt~c ~
~G o
Z % Slope Trench Of 2- 21' Force Main Plowed
' Aggregate v~ Layer
D Ft.
Undisturbed
~ foil r ~ 5~ Ft.
Cross Section Of A Mound System Using F -Ft.
Ip > Trench For The Absorption Area G D Ft.
A y Ft. H A Ft..
j B Ft .
K /2 Ft. i
1 /f
L Ft.
J Ft.
Alternate Position of Force Main T 13 Ft.
W 2 8 Ft . , 1 of l-
i
J ~
A-
I
i
WI Observation i Permanent
Pipes Markers
Trench Of 2» - 2 2 M
l P~~ ~Or,Aggregate
Q~`J dot
0 v
ooa►, o
or Absorption Area
q ~G
592-02150
cs~• o~~`s ~~SQ°
page 3 Of S
t/ 0 ?VC
- Z
/,4 r le Pertorotca Fipu Dctah
Z(~ P'6A7 0VAI Pv lE
VAC U 4 ~ oN r~
End Vin.
Ferfuroled ~ ~
End Cop \e l PVC Pipe
~ ~o~o once
D~r~ Holes Loeoled On Bottom,
Are Equally Spaced
w
r~ PVC Forcu Mum
Oialripuli0n -
Pipe
LOSI Hole Should Be
Nexl To Eno Cop
End Cop Dislrioulion Pipu Luyuui P
~I.SFt.
PRIVATE S1=WA6 ga'r` a EM
O
Conditionally X x ~O Inches
y~
Inches
SigneA P OV'"r% Hole Diameter Inch
00t. OF MOUMVIV6,011 u 7S Lateral " Inch(es)
L i c e rMLO AFET NO 1 N6
Force Main Z Inches
SEE CORRE3 ENCE # of holes/pipe 1-3
Invert Elevation of Laterals Ft.
G i lip ~ 13 u T iQ.LJ 1'i 5e/ 1,,r1 7-2 iW 4 Z 5a
Y,kL. Q T
• 7,1l `r7/5 7:6'v7-1(9,) U~f~vo,Pl~ /w"A.
,,u~~ 111Q~2
592-02150
f
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nk y I
I ~
i ^
PUMP CHAMBER CROSS SECTIOM AMD SPECIFICATIONS flf}~~ ~f of ,C
t VEtJT CAP
`"C.I. VENT PIPE APPROVED LOCKING
7 WEATHER PROOF
-fr KJ 90X MANHOLE COVER
Z5' FROM DOOR, JUIJCTIO 1"'/ 4VAXU)'u6- 1A13E1
WINDOW OR FRESH 12"Mill.
AIR INTAKE
&Ur)T10 v GRADE I y" Mild.
COIJDUIT
9~,0
i
lE l~;¢ rr 0 ~v ~ ~~l
740 PROVIDE I
I&JLET r4,tp AIRTIGHT SEALAPPROVED JOINTS
APPROVED JOINW/C.z. PIPE
PIPE EXTENDING 3'
EXTENDING 3" ALARM ONTO SOLID SOIL
OIJTO SOLID SOI1
31" 3 I I onl
ELEV. FT. PUMP
OFF
N -
1
0 12
Sk ➢0I"d !r I Z BLOCK
AP
-x- RISER EXIT PERMITTED OIJLy IF TAIJK MANUFACTURER HAS SUCH APPROVAL
SEPTIC SPECIFI'CATIDKJS
f y
DOSE
/E.S CDcIGiPc ° ~UMBER OF DOSES: PER DAB
TANKS MANUFACTURER. L
r GALL0NJS DOSE VOLUME
TAWK 51ZE
G U L ~~/IiPM L~ tK1CLUDING BACKFLOW: GALLON
ALARM MANUFACTURER: - ZS
MODEL K)UMBER: CAPACITIES: A= 204 INCHES OR yo0 GALLONS
5WITCH TyPE% /y~PCURY J~10~~- B= q2- INCHES OR `38 GALLONS
t " PUMP MAKUFACTURER: 040E~/~~ G= / INCHES OR GALLOtJ5
MODEL NUMBER: 9,9 (~-oe."cw, # ~7 D= 7' 2 INCHES OR GALLONS
SWITCH TyPE: Pr 6,GY,6,16-r IqLO(,UXz----~ MOTE: PUMP AIJD ALARM ARE TO BE
INSTALLED ON SEPARATE CIRCUITS
I' I MINIMUM DISCHARGE RATE 3 S GPM S,
VERTICAL DIFFEKEKICE BETWEEN PUMP OFF AND 015TRIBUTIONJ PIPE.. FEET -1'ANk ~fG
' MIKJIMUM KIETWORK SUPPLY PRESSURE 2'5 FEET EACLA, 0rr J P
H- S FEET OF FORCE MAIN X 2.0s F >1/1 ofLFRICTION FACTOR.. 3' 0 FEET "::-40A
TOTAL Dy1JAMIC. HEAD = FEET
1 ~~OUuD 3"
IMTEKKIAL. DIMLWS►OtJS OF TAIJK: LENGTH ;WIDTH 8o ;LIQUID DEPTH
A
pNVATE SEWAGE SYSTEM
ndationally~ S92 -ft 02150
t,u E7. C ~
ovE
AP gut
~ ON a Hui 7 10
ABET
i ~
j
8EE LpRpESPO ENCE
i.:
it -
~ 1.
F W
W
+ PfEADI W ~
115
110
ACI 34
I
CAPTY
32 105
30 100 -
UR WE 95
28
90
26 85
80
EFFLUENT 24
MODEL
and a 75 MODEL 189
DEWATER/NG = 22 ~61
V 20 65-
Q
} 18 80
55 _
16 50 MODEL
Q 14 MODEL
45 188
12 40-
i
35--
10 MODEL
30 137, 139 - MODEL
SEW GE and 6 165
25
Dc er ~ TEN/NG 6 20- MODEL
15 -MODEL 161
4
10
l1gC MODEL . " r
W ( 2 5 53, 55,
57,59
0
GALLONS 10 20 30 40, 50 60 70 so 90 100
80 110 p
2 F4'
7LITERS 0 90 160 240 320 400 j' i
22 -
7f FLOW PER MINUTE i
20,. i
li
18 - MODEL
-
'A IF
4I 5!i i 295
Et
'fti t) 3 ftw El
1A, 45 MODEL JUL 112
35. 294 - !
~MODELA MP ~r1I- 'Y1 t~
C 10 293 MODEL ViAI~"H"ER VytoT f
N 30 -
284
8 1 ~ ~
26' - -
' MODEL t
° 20• 282
4
t
MODEL - -
ZffE L
2 287. 288
S
°
3260 opt MNlm Lena.
GALLONS 10 W! 3o aoi 50 80 70 80,1 90 100 I110 120 '130 140 "isP 160 170 /so 1»o P0. Box 16347
f-1~--~ -T-- LoUMvINA Kentucky 40216;
LITERS 0 80 ' 160 240 320 400 480 560 640 720 (50) 778-2731
ii
FLOW PER MINUTE
02150
I
3. r
' ~j yy~y r
r, V7 Cast Iron Se es MEAD CAPACITY
UNITS/MIN
l~
\ Feet Meters Gal. Ltrs.
• Automatic or Non-Autoratic. 5 1.52 57 216
~ • H.P., 1 Ph., 115V or 230V. 10 3.05 51 193
• Non-clogging vortex impeller design. 15 4.57 43 163
20 s.1o 27 104
• Passes',,!" solids (sphere).
f j Lock Valve: 24.5'
• 11ir" NPT discharge. ,
• Float operated submersible (Nema 6) mech-
anical switch. 97 Series
• Automatic reset thermal overload protection. U~ listed SC-2226
• Sta: nless steel screws, guard, handle and arm and
seal assembly.
• Watertight neoprcnc ''0" ring between motor and
Canadian SlanOards
pump housing. C A.-.-Approval
available
N97, non-aulomalic, available packaged with a piggyback mercury
float switch.
rrrrrrw
,t of
L'nsin D ' n Relations Industry. SOIL AND SITE EVALUATION REPORT Page f of
ahd
Division of Safety & Buildings in accord with ILHR 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
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # PA.P~ Z
dimensioned, north arrow, and location and distance to nearest road. D,v 57,'7-,F- 'DuAlf'-l> 1,4-D
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
U~° iii' ,t~loi✓~ S. -rk oM ps o /J sui y 7 - 9z
PROPERTY OWNER: PROPERTY LOCATION
TZ0 (j6k r V 1 b lLo l' GAT 3 T CC I~ PP CTO DDE~u GOVT. LOT NE 1/4 5; 1/4,S / T N,R l ~ E (or W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
BOSS `pf->. z (r-S M P tFAJ O .c~ 6r-
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE FrOWN NEAREST ROAD
u PSD-%.'; Lci/S S'1oi42" ('215) -f o IV Y
[A New Construction Use [x ] Residential / Number of bedrooms y [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe t~
Code derived daily flow (OQ y gpd Recommended design loading rate bed, gpd/ft2 • / trench, gpd/ft2
Absorption area required bed, ft2 ~OO trench, ft2 Maximum design loading rate bed, gpd/ft2 • CO trench, gpd/ft2
Recommended infiltration surface elevation(s) z S ft (as referred to site plan benchmark)
Additional design/ site considerations
Parent material 565 7.S - U/,asliTY S/- s.~1-7Y S~D•:~r ~ rs Flood plain elevation, if applicable /V ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem El S ~ ] U S ❑ U ❑ S J JU ❑ S U S FEW I ®S E 1U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bartdary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trer&
w o S t o y,Q 2l z S~ 2 5h& M► vf~ as
Ground 131 /5- z y y 5" l2 s Si f Sd k /f+^,t' s /7G" - , G
elev. 3 . P
~1'~ft. ,Y-y~ S 5G~ 1:2,'w►,5~~ n~,f-j" ' - •S
Depth to
limiting
factor „
15
Remarks: S''TE i`'/fTS A 7` /f't~/~ - Z~SE /o,~ f ~l/.yPd4~ 7i~' vC~ .l
Boring # „
14 \ 0-5 DY 2~2 S~/ Z nM, shy /hl v'4ie aS 1/04 ~ '6
Z E ~/2 /o yl 4/19 f slab vf~e,s /,~,1 - - G
h• :yvt\tii: /
~C'.. v'•.tOY.
1.2 s'2~e s/~ s1/ 2, f shK ,k,f~ s /f - ' . G
Ground
elev. .s1,/,S RP 5 S-
9 -7, glo ft.
Depth to oo% 8
limiting
factor N A; D I
/2~ v, c-
L01Z ("j
Remarks:
IRMARAII 1-1 , I,;;-
CST Name:-Please Print 655 O'NEIL RD., HUDSON, WIS. 5401 m co Phon
Address:
^--AANIS. MASTER PLUMBER LIC. NO. 3307 MR.
Signature: G _ ESIGNER LIC. N0.00863 Z CST Numb r:
u/6CrGtiT/SOD-~
PROPERTY OWNER SOIL DESCRIPTION REPORT Page, Zof4i-
PARCEL I.D. # ~f Z Si`4
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
< :3:....: o-/D /a ,e -2/2-69~ Y4
Ground 13, v'9- 16 / YR S/ Z,
O . S it'
70 ft. G 'Y ~Dyie ~r'3'V S.cC~ 1,f~S~i~' Gt!~ % i
Depth to
limiting
fact
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev. 4
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
F~w•r rioti = god . 0
C~i~ s r `o r .G . 3 5 ~
8 p' ~C,PES
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HOMESITE SEPTIC PLUMBING CO.
2 855 O'NEIL RD., HUDSON, WIS. 54016
ROBERT ULBRIGHT cs r # 25/PZ
33 70 NIS. MASTER PLUMBER LIC, NO. 3307 M.P.R.S. - ,
1 MINN IN 'f ?I1 f-,P ~ DESIGNER IJC. NO.00663 S G/}LE - / y~
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13R 61VbbE ~iTS
how'-'D
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y
-01 4 1
ST. CROIX COUNTY
WISCONSIN
r t ~ t FFr4 y tiJ,r~ + ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET f HUDSON, WI 54016
(715) 386-4680
July 14, 1992
Division of Safety and Building
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
To whom it may concern:
An onsite investigation of two parcels of land owned by Robert
Ulbricht & Richard Godden, both located in the NE1/4 of the SE1/4
of Sec. 1, T28N-R19W, Town of Troy, St. Croix County, has been
conducted with the assistance of Robert Ulbricht, CST #2482.
This onsite revealed suitable soils in the area of proposed lot #1
to a depth of 1811, with proposed lot #2 having 15" of suitable
soil. Both locations meet the requirements of the A+4" rule.
These sites are suitable for new construction with a mound having
18" of sand fill.
Should you have any questions, please feel free to contact this
office.
If's ' Os~ one dales pro jer-f
since ely, affer anof her.
/
mes K. Thompson
Assistant Zoning Administr;f~J! Gvl
c j Y
}a
ILED
3 01992► a
490 `86 (fZJAMES O'CONNF:L
er of DWAS
CEFITIFIED SURVEY MAP
RMER I W. 1L13iICHT AND RICHAF13 L. GOODEN r
Part of the Northeast 1/4 of the Southeast 114 of Section 1, Township 28 North, Range
19 West, Town of Troy, St. Croix County, Wisconsin.
•Indicptes 1" iron pipe found.
OIndicates 1" x 24" iron pipe weighing 1.13 lbs./lin. Ft. set. -
i
- 4 COR. SfC. r28 N, R /9 W,
/COUNTY SURVEYOR'S MON.)
~ o
3.91. OVERLAP 0
VOL- 501, PAGE 437 UNPLA TIED LANDS " o 6
N89.51'45"E 990•.26' R./EAST 990./5) 11•00' Z h
a 919.2x' g I w e
0
h / N/GNWAY SETBACK L
LOT /NE 1- I b t;
QI h - r b 339.40' 1`/00' 6 I DI b
v W N 89-38-03"E 600. 00' ( 40.6 ' Z
0 j 4.083 ACRES O 1 W QI
„ b /77, 959 S0. FT.
WI yr O W LOT 2 3.923 ACRES S I O 3 -
p
~ O 4.023 ACRES EXC. ~ /70, 880 SO. FT. I b' 80 1~ Q ~ 91
IrI t ROAD R.O.W. O
3.661 ACRES EXC. 0
7040R.O.W.4(4 W
v C 175, 259 SO. FT. C / 59, 3 / 7 SO. FTr 1 I Z~ f\I Z
q.1 Z. 00 599. 99' 1 Z ~ . v b N
I ~I Z ~
Z 138.89'
.7.91.78,
56/. /0' I Z
,I W v
S89'51' 4$"W 991.77' i W 0
~ t $ b r
VNPLATTED LANDS M e t o
Owner's Address: W w ° h
655 O'Neil Road o° a
Hudson, WI 54016 W N
Phone No. 1-715-386-9052 .-SC COR. SEC. THEN, R/9 W,
SCALE / " s zoo, /COUNTY svRVEYOR'S MON./
0 /Po., 200' 300' 400' 600'
,,,,tttt111111111h,,
si y
~~SC ON
Dated: September 29, 1992 y ' 40
"Revised this 28th day of October, 1992." LAURE E'
=~=WMU NY io~
This instrument drafted by Laurence W.•Murphy S ~3 a ~
A FICLLS,~~• i
J •
LAND
NO TE.'
Lot 1 of this certified survey map must access 90TH Laurence W. Murphy
Street at the center of the 66 foot corridor and a istered Land Surveyor
Lot 2 must access a minimum of 200 feet South of the
Lot 1 access driveway.
14ppOO V ED
Vol. 9 Page 2559
OCT, Certified Survey Maps
St. Croix County, Wisconsin ST. CROIX COUNTY SF•EFT 1 fF 2
'.,,mProheasive P c4
Zw** and
parks C0""Wtt"
• if not `Corded
w32iin days off
appr9k8i date
.
J -
I . '
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER Ra i' / ~t /,6~E'IYGLr 7- A4-xz,-) ~vfJl~~~y
ADDRESS &5 5' 0 IIA-)R FIRE NUMBER
CITY/STATE ffZ P_5-0 . ) S ' ZIP 5- CP
PROPERTY LOCATION : Ne 1/41 SE 1/4, SECTION , T ZF N-R ~ W
TOWN OF St.. Croix County,
Cs,A1 e15;70 7 2-
SUBDIVISION 1101.V n! • 2- 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, 1918. 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
I with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be
completed and returned to the St. Croix Co. Zoning Officer within
30 days of the three year expiration date.
SIGNED:
DATE• -
St. Croix Co. Zoning office 911 4th St.
Hudson, WI 54016 fl. `I~ y
Alp,
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 permit issuance. Should this
development be intended for resale by owner/contractor,(spec
house), thenla second form should be retained and completed when
the property' is sold and submitted to this office with the
appropriate deed recording.
A9g,cle F Zl1h1' f "4 T- rev bra yf>~.~
y
Owner of propert
Location of property NC1/4 SZ 1/4, Section , T ~ N-R L" W
Township V20 y
Mailing address &S-5 _0 'A)GC_ tiOPSo.J Cc' CIS. S~ot~
Address of site
CS1" . vsa 700 C- yoi 9 Ps Zssy
Subdivision name Lot no.
Other homes on property? yes No
~ y U/t~/4yv D
Previous owner of property ~41
Total size of parcel 3. 1- AC4l S
Date parcel -was created DL f • 3 O - y Z
Are all corners and lot lines identifiable? Yes No
Is this property 1peing developed for (spec house)? Yes Z::fft
Volume and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE 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 office of the county Register o.
Deeds as Document No. , 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
recorded in the office of County Register of deeds as Document
No.
I
i
Signature of applicant C applicant
Date of Signature Data of S ature
I")-UNIENT N0 STATE IJAP OF Wl'-,C') SIN FUlOll 1 - 1982 ~s •r.._. ee qt wve~ raw w.cow~:.. p.r♦ j
WARRANTY DEED
487GGIL vilt 9659A,E 442 REGISTER'S OFFICE
This Deed, matte between Dale Dura.t.l ST. CROIX CO., M
a Reed for Record
AUG 26 1992
GranWr,
and Robert W. Ulbricht and Richard. L. Godden, Cif 8.30 A.M
as tenants in common
Grantee, eae
Witnesseth, That the said Grantor, for a valuable consideratwn Rea Wet OfDeeds
M(rUwM T J 1
runve's to Grantee the following described real estate in St . Croix Fcr ~C
C ~~i rr!( It ii
County, State of Wisconsin: i ~`1 S J c? r ° ~
Part of NEk of SEk of Section 1-28-19 /1 ioC/~~/s' S7JL~)I
described as follows: Commencing at the i~
Tat Parcel No:
Ek corner of said Section 1; thence S00 00'00"E
along the E line of said Section 1, 308 feet to the
point of beginning; thence S00 00'00"E assumed bearing being along I~
said E lino of Section 1, 352 feet; thence S89051'45"W 991.77 feet;
thence N00 14'45"E 352 feet; thence N89 51'45"E 990.15 feet to point II
of beginning.
I
a
0
I~
This is not. homestead property.
(is) (is notj
I .
Together with all and singular the hereditament& and appurten:.nces thereunto 6clonging;
And_..Dale _Durand
warrants that the title is good, indefeasible in fee simple and tree and clear of encumbrances except
easements, restrictions, and rights-of-way of record, if any, li
and will warrant and defend the surne.
~
hated this 6th day of Au s _ 1992
(SEAL)
(SEAL) I
..Dale Durand.
(SEAL)
I"- A
( ~rv;'r 1fi$t -4CATION ACKNOWLEDGMENT I!
- , N uu~~1 rt p.•. ~
Sibrnit4 a-~ , j.....-..------.- STAT 'OF WISCONSIN li
f
• ns.
7 `
•T.. County. it % authent~b~Itttiljl S~~da of , 19...... Personally came before me this ....6 fh... day of
yrr'
~rr.rrn„n+a.,,r"' ...................Augu.s.t..- 199.2... the above named
_ I
..D.al.a.-.D.u.r.and...---
TITLE: MEMBER STATE BAR OF WISCONSIN
(if not, - - by 906.06, Wis. Stats.) to me known t
authorized b to be the person who executed the
foregoing instrument and acknowledge the a"e.
THIS INSTRUMENT WAS DRAFTED BY Betty Ug iI
C. L
RiVe ..Falls.,, WI , - 54022. Notary Public .~~.4 ui county, Wis.
(Signatures may be authenticated or acknowledged. Both My COM Ion Is permanent- (If not, state expiration
are not necessary.) 19 Qom)
Gate: ~ Zo /77
fUJ
•N.mM of Deraana siamna in any cap•ciry ahuWd he t)pr,l or printed Deloar th<,r a,a nawre>. i
1
~~.Rt•er FON11 N& I_ 1582 fst
a7ATF IIAR WISCONSIN Stock No. 13001
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
"r """N""~- r••.~ ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
January 31, 1997
Dean Albert, Chairman
Town of Troy
296 S. T. H. "35" N.
River Falls, WI 54022
Dear Dean:
On July 3, 1996, a sanitary septic system was installed on the property located at Lot 2. Certified Survey
Map 9/2559, in part of the NE'/, of the SE'/+, Section 1, T28N-R19W, Town of Troy, St. Croix County,
Wisconsin.
The present owners of the property, that has a mailing address of 540 90th Street, Hudson, WI, are Dirk
Linder and Marlys Jensen.
The mound septic system was inspected by this office, and found to be code complying for a four
bedroom residence.
Should you have any questions, please contact me at the above number.
Sincerely,
Mary J. Jenkins ,
Assistant Zoning Adm' inistrator
POWTS Inspector No. 4626
cc: Dirk Linder & Marlys Jensen
Robert Ulbricht, Plumber
File
i,
I