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040-1106-90-110
St. Croix County Planning and Zoning Tuesday, April 16, 2013 at 11:02:13 AM Detail Sanitary Information Page I aft Computer#: 040-1106-90-110 SublPlat: NA Section: 27 Parcel M 27.28.19.426A10 Lot 1 TWRNG: T28N R19W Municipality: Troy, Town of CSM: Vol. 08 Pg. 2136 114 114: SW 1/4 SW 1/4 Owner: O'Malley, David 608 County Road MM River Falls, WI 54022 State Permit; 128612 Issued: 08/11/1989 POWTS Dispersal: Non -Pressurized In -ground PermitReconnection County Permit: 0 Installed: OB/11/1989 POWTS Detail: Seepage Pit Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Tom Nelson No Ulbricht, Robert None Signed Off' No Other Requirements Additional Notes Money Owed Explanation by plumber - wanted to connect to an $0.00 existing system with unknown size septic tank and one drywell. Permit application specifies this is a 3.7 acre parcel out of 160 owned. See 1989 CSM drawing that shows "existing septic system in NE portion of lot. File this permit with 1994 replacement permit Owner: O'Malley, David 608 County Road MM River Falls, WI 54022 State Permit: 218960 Issued: 10/0311994 POWTS Dispersal: Non -Pressurized In -ground Permit: Replacement County Permit: 0 Installed: 1010311994 POWTS Detail: Trench - Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Jim Thompson Yes Schumaker, William 1000 gal. Midwest septic tank to 3 -5' x 75' SO.00 trenches Jim Thompson Signed Off Yes Dave O'Malley also had permits for a parcel in Sec 26 on Radio Rd - there was confusion over 2 permits issued in 1989 Maintenance Scheduled Pump Date Pumped 10/3/2005 9/1/2010 9/29/2006 9/1/2013 9/24/2012 9/24/2015 I r 7k � .. �G. Xa blt- IN, riu,-Cl, i. c 9 YtA PA 19 x 9/ `30 P. Vn. St. Croix County Planning and Zoning Friday, September 07, 2007 a/ 4: 06: 28 PM Detail Sanitary Information Page I aft Computer #: 040-1106-90-110 SubtPlal: NA Section: 27 Parcel #: 27.28.19.426A10 Lot: 1 TN/RNG: T28N R19W Municipality: Troy. Town of CSM: Vol. 08 Pg. 2136 1/4 114: SW 1/4 SW 1/4 Owner: O'Malley, Dave 608 County Road MM River Falls, WI 54022 State Permit: 218960 Issued: 10103/1994 POWTS Dispersal: Non -Pressurized In -ground Permit: Replacement County Permit: 0 Installed: 10/0311994 POWTS Detail: Trench - Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Jim Thompson Yes Jim Thompson Yes Maintenance Scheduled Pump Date Pumped 10/3/2005 10/3/1997 Plumber Other Reouirements Schumaker. William 1st Notification 2nd Notification 3rd Notification O>ro -iipb - GD —/i D O'Malley, Dave SW4,SW4,Sec.27,T28N-R19 403 Wasson Ct Town of Troy, Cty Rd MM Heritage Square ` River Falls, WI to ff address of site Permit No. 128612 8-11-89 Robert Ulbricht Reconnection of existing system k Additional Notes Money Owed Dave O'Malley also had permits for a parcel in $0.00 Sec. 26 on Radio Rd. • there was confusion over pemits issued in 1989. 1000 gal. Midwest septic tank to 3 -5' x 75' trenches O'MALLF.Y, Dave 608 County Road MM River Falls, WI 54022 SW4, SW4, Sec. 27, T28N-R19W, Town of Troy Address Site: Same as above Permit No.: 218960 10/3/94 William Schumaker Replacement System - Trench Parcel #: 040-1106-90-110 09/07/2007 03:58 PM PAGE 1 OF 1 Alt. Parcel #: 27.28.19.426A-10 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner DAVID & RUTH OWALLEY O - OWALLEY, DAVID & RUTH 608 CTY RD MM RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description ' 608 CTY RD MM SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 3.720 Plat: N/A -NOT AVAILABLE SEC 27 T28N R19W PT SW SW LOT 1 CSM Block/Condo Bldg: 8/2136 EZ-UT-1505/96 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 27-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 853/62 ZUU1 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class Acres Land RESIDENTIAL G1 3.720 64,500 Last Changed: 07/20/2004 Improve Total State Reason 186.900 251,400 NO Totals for 2007: General Property 3.720 64,500 186.900 251,400 Woodland 0.000 0 0 Totals for 2006: General Property 3.720 64,500 186,900 251,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 136 Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00 Parcel #: 040-1107-20-100 09/07/2007 03:59 PM PAGE 1 OF 1 Alt. Parcel #: 27.28.19.427C 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Ownei KEITH T O'MALLEY O - OWALLEY, KEITH T W9962 HWY 29 RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 43.000 Plat: N/A -NOT AVAILABLE SEC 27 T28N R19W E 1/2 SW 1/4 BEG S 1/4 Block/Condo Bldg: COR SEC 27 N 88 DEG W 1003.02' N 14 DEG E 17.95' N 43 DEG E 98.19' N 2 DEG E 240.73' N 33 DEG E 249.92' N 15 DEG E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 453.07'N7DEG E254.13'N25DEG E 27-28N-19W 280.02' N 89 DEG E 751.28' S 114.60' S mon... Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 729/323 cV V / JUIYIMAKT Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 5.000 27,500 0 27,500 NO MFL BEFORE 2005 OPEN W7 38.000 199:500 0 199,500 NO Totals for 2007: General Property Woodland Totals for 2006: General Property Woodland 5.000 27,500 0 27,500 38.000 199,500 199.500 5.000 27.500 0 27,500 38.000 199,500 199,500 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0,00 0.00 0.00 St. Croix County Planning and Zoning Detail Sanitary Information Computer 0: 040-1106-90-110 Parcel #: 27.28.19.426A10 Municipality: Troy, Town of Sub/Plat: NA Lot: 1 CSM: Vol. 08 Pg. 2136 Section: 27 TN/RNG: T28N R19W 1/4 114: SW 114 SW 114 Owner: O'Malley, Dave 608 County Road MM River Falls. WI 54022 State Permit: 128612 Issued: 08/11/1989 POWTS Dispersal: Non -Pressurized In -ground Permit: Reconnection County Permit: 0 Installed: 08/11/1989 POWTS Detail: Seepage Pit Bedrooms: 3 WI Fund: POWTS Pretreatment: NA IleindaP. September 10, 2007ar 3:40:13 PM Page I of I Notes Issuer/Inspector As Built Plumber Other Reauirements Additional Notes Money Owed Tom Nelson No Ulbdcht. Robert Explanation by plumber - wanted to connect to an $0.00 None rff No existing system with unknown size septic tank and one drywell. Permit application specifies this is a 3.7 acre parcel out of 160 owned. See 1989 CSM drawing that shows 'existing septic system in NE portion of lot. File this permit with 1994 replacement permit Owner: O'Malley, Dave 608 County Road MM River Falls, W 154022 State Permit: 218960 Issued: 10/03/1994 POWTS Dispersal: Non -Pressurized In -ground Permit: Replacement County Permit: 0 Installed: 1010311994 POWTS Detail: Trench - Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Jim Thompson Yes Jim Thompson Nt. Yes Maintenance Scheduled Pump Date Pumped 10/3/2005 10/3/1997 9/2912006 912912009 Plumber Other Requirements Schumaker. William 1st Notification 2nd Notification 3rd Notification Additional Notes Money Owed 1000 gal. Midwest septic tank to 3 -5' x 75' $0.00 trenches Dave O'Malley also had permits for a parcel in Sec. 26 on Radio Rd. - there was confusion over 2 permits issued in 1989. St. Croix County Planning and Zoning Thursday, August 17, 2006 at 5:07.43 PM Detail Sanitary Information Page 1 of Computer #: 040-1107-20-100 SublPlat• 40 acres Section: 27 Parcel 0: 27.28.19.427C Lot: TN/RNG: T28N R19W Municipality. Troy, Town of CSM: 114114: E 112 SW 1/4 Owner: O'Malley, Dave Cty. Rd. MM (no fire #) River Falls, WI 54022 State Permit: 128612 Issued: 08111/1989 POWTS Dispersal: Non -Pressurized In -ground Permit: Reconnection County Permit: 0 Installed: POWTS Detail: Seepage Pit Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuerlinsoector As Built Plumber Other Requirements Additional Notes Money Owed Tom Nelson No Ulbricht, Robert This permit proposed to move a 3 BR house onto $0.00 None Signed Off: No property - verified with mete & bounds description in WD 7291316 owned by Dave O'Malley. There is no structure on the parcel at this time PQ - 2006 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNERg%a d C O^a//&✓ ADDRESS CaF4e kdf & A2 SUBDIVISION / CSMA eSM ✓Pi . LOOT � SECTION7 TN-RZW Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i/44 4 ,04J, DICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Avide 2 dimensions to center of septic tank manhole cover. BENCHMARK: �,�� Qs //SS ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /ddd Setback from: Well House Other Pump: Manufacturer Model# Float seperation Alarm Location Gallons/cycle: SOIL ABSORPTION SYSTEM Size Width: S Length 7 S Number tr s ,3 Distance & Direction to nearest prop. ine: O' 0 Setback from: well: House Building Sewer PC inlet Header/Manifold Existing Grade ELEVATIONS ST Inlet. PC bottom ST outlet Pump Off Bottom of system Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: ,%-,;�' 3/93:jt •WiscoNsm Department of Industry, Labor and Human Relations Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) ST. CROIX Permit Holder's Name: City Village ❑ Town o OrMALLEY, DAVE }� CST BM Elev : Insp BM Elev.: BM Description: 1d4 Ide) , a) mrr, a TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic���/� C Ca Dosing Aeration Holding TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Ventto Air Intake ROAD Septic SO 65 11f 74 NA Dosing NA Aeration NA Holdin PUMP / SIPHON INFORMATION Manufactur Demand Model Number GPM TDH Lift Frictio S s TDH Forcem ength Did. Dist. To Well SOIL ABSORPTION SYSTEM ELEVATION DATA STATION BS HI FS ELEV. Benchmark a' Bldg. Sewer St/O Inlet St / lof Outlet (o Dt Inlet n Dt Bottom Header / S Dist. Pipe Lp Bot. System i Final Grade BED / TRENCH Width L Lengt 's 1 No. Of Trenches PIT � �-_ No Of Pits Inside Dia. wd Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHIN INFORMATION CHA R ype I A Model Number: ¢yr System: - 1 >/s-a �,4 O NIT DISTRIBUTION SYSTEM Header / Mani odd „ Length . Dia Distri utron Pipe s , „ Length L Dia Spacing x Ho_ a Size x Hoe Spacing Vent To Air Intake sN SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Syster s B y Depth Over l� - Depth Over xx Depth Of eeded7Sodded xx Mulched 81tVTrench Center BgLJ Trench Edges Topsoil ❑Yes ❑ No ❑ Yes ❑ No N COMMENTS: (Include code discrepancies, personspresent,oa)� (CATION: Troy.27.28.19W, SW, SW, C unty Trunk MM 0 C0/1u ��ta1i7 Plan revision required? ❑ Yes No _ Use other side for additional information. SBD-6710(R 05t91) Date Inspector's 6- Cent No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _ ko-wLv- d�—_ s�� k, y�r mod. (93.00) g:�,y' 73 j3 v— ^�i�us>< SANITARY PERMIT APPLICATION Y r In accord with ILHR 83.05, Wis. Adm. Code ColprxCf i -Attach complete plans (to the county copy only) for the §yytem, on paper not less than STATE SI�(dITrRy.Pfrfj g ((iiJJ{{//(�/.•jjlVA 8% x 11 inches in size. OO''��)) CCyy11 ❑ Chsdr it ravlslon to previan applkadon -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 A e Sti YWLV %, Sal T.2r, N, R/5r E or PROPERTY OWNER'S MAILIN ADDRESS LOT III BLOCK # 12 �— �— CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NWII ER CC� II. TYPE OF BUILDING: (Check one) 1-1StateOwned VI NEAREST ROAD AGE ' ❑ Public ((�� �QWN% a CT IL-1 L^� 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NU ( ) 111. BUILDING USE: (If building type is public, check all that apply) 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 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check litre Bit 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 # Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 & Seepage Trench 22 ❑ In -Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAI 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 15. PERC. RATE SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq.ft.) (Min./inch) 16. � 9 V9� Oe�et G- Feet 9" 3 VII. TANK CAPACITY ' in gallons Total 001 Site INFORMATION Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. New isu Gallons Tanks Concrete Tanks Tanks strutted glass App. Se tic Tank or Holdin Tank / t Lift Pump Tank/Si hon Chamber Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system show on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) P PgSW No.: Business Phone Number: r.--. Plumber'a Address (Street, C ty, te, Zip Code): C ° a IX. COUNTY/DEPARTMENT US ONLY ❑ Disapproved Sant ry Permit Fee (Includes Groundwatx Dare eau IesuingA Ignoture( Stem Approved ❑ Owner Given Initial Surcharge Fee) /�i) Adve ((�� e D t rmineif X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber INSTRUCTIONS s 1. A sanitary permit is valid for two (2) years. 1 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. 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: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) 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) � � � � �,�G3�2 id/a�9i� W in Department of Industry. SOIL AND SITE EVALUATION REPORT Labor and Human Relations flw�ieinn of A.I.W A Page N of 3 41 pWVIV n141 ILI 11 W.V V, .. W. llV.l •. WVV ^^11�(�'�/ COUNTY sY. e�io Ix Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D. A not limited to vertical and horizontal reference pqint (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY DATE AOPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION \�p1V \b O, G&fl-tM SW 1/4 SW 1/4,S27T Zb ,N.R 19 E(0 3 PROPERRT(Y� OWNERS MAILING ADDRESS LOT If BLOCK I SUED. NAME OR CSM t 'y 6 V U d_0QktN '' . 1",1 CITY STATE ZIP CODE PHONE NUMBER 'A1UNR FIMQ,1,01 S402-Z (-)IS)L12S- 67-68 ❑CITY []VILLAGE OOWN TtZU`j NEAREST ROAD C.'T?} A' "' I 1 New Construction Use pq Residential / Number of bedrooms 3 (J AdditiQn to existing building D4 Replacement [) Pudic or commercial describe Code derived daily flow 4 SO gpd Recamtended design loading rate - bed, gVW a' y_tendl, gp W Absorption area required bed.112 t i Z 5 tend,, ft2 Maximum design boding rate 0-3 bed, gpolft2 0 • V trench, gpdM2 Room ynaW d Mlt ton surface elevations) S e-e- PAGE 3 R (as referred to site plan benchmark) Additional design / sibs atians 3 ENV \W Ns - LXpcc H S ' X -)S' 1-'0^J G Parent material stub outg t WH1M ouZw* s41 Flood plain elevalion, if applicable " - A. it $ = Suitade for system U = Unsuilable for system CoNVENTRINAL ® S ❑ U MOUND ®$ ❑ U N{�Yi M PRESSURE ®S ❑ U AT -GRADE US ❑ U SYSTEM INFILL ❑ S ®U HOLDING TAN( ❑ S I$U Ground elev. cl 4q -I it Depth lo limiting facbr 7—x13�' Boring # 2 Grand q b 0 tL Depth tD factor 16* SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell Mottles t]u. Sz. Cont. Color Texture Structure Gr. Sz. Sh. C.onsisterm 9ouxt3y Roots GPD/ft Bed tarKh ` -a \-,.Mt M Fh Q S ZYr1 a • S o. b Z —I_zV 10`t2 ��6 - s►� Zfs S o-I, '11Z Y/ - - o' 3 o'y s 1c ehyow. wv r 3 Gt-�'j Y S LA uQ_� Of= S c s Remarks: o_ 9 \o%A\Z -?-I I - s i 1 Z �'s�k VA Q- S Z o. S o. 6 Z 9-Z8 LO`L2 3/6 Si l Z gS1�h Vol Cw \� o• S o. 6 VA\ 9s � o•',a V y L1$ 76 to'1 IL V /y M u f►._ , , - r� o•�( o•S s (:E7 A✓u_ As kr al ; Remarks: ..-A Arthur L. Wegerer Li5 er Soil Testing & Design Service-P.O. Box 74 River JF`Pk Date: q- ZO 65 Number: M00576 PROPERTY OWNER SOIL DESCRIPTION REPORT PARCEL I.D.# page 2- of Z Boring # 0 Ground elev. cloo - % ft Depth to lr*ng factor -) 1)16 Horizon Depth in. Dominant Color Munsell mottles ou. Sz. Cont color Texture $tructu'e Gr. Sz. Sh. Consiswice Boundary Roots GPD/ftZ Bed Trench S zl� O's T L'i 3 10 ir WL C) S S o. L �4 o.S ------------ Remarks: Boring # 13 Ground elev. ft Depth to limiting factor Boring # 13 Ground elev. It. Depth to Uniting facto Remarks: Boring # E3 Ground elev. It. Depth to limiting factor Remarks: SBD-8330(R.05/92) PLOT PLAN SCALE 1"= 40 ' Page 3 of 3 n S-z X cquep w 5��71 e �`Pp.�hc LO ekTo+J 3 6 O X-r-1H Rr910EKjCe l. wEL L 111u.0 ON DOOR S%\-L (715 ) 4M-01 h5 — Id 00 576 CST Signature Date signed Telephone No. CST # Wisconsin Uepartmentoflndustry SOIL AND SITE EVALUATION REPORT Labor and Human Relations Division of Safety & Builddngs in �,,, ,A ..Afk HUD oq na Ufi, Anl . n_A_ Page ? of 3 COUNTY sT. e\ao Ix Attach complete site plan on paper riot less than 8 1/2 x 11 inches in size. Plan mull induce, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION ARV \fl Cyr f 1A�LETi Geff-M SLJ 1/4 SW 1/4,SZ 1T Zb ,N.R l9 E(o4W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK 91 SUBD. NAME OR CSM # 605 '!_*0QQ' 1 " 1" I"° - CITY STATE ZIP CODE PHONE NUMBER {k1UM �YCLlj,itiJl ❑CITY []VILLAGE G� R0A ' Sk/oLZ (-)lS)LlZ$_ 6L68 � ( I New Construction Use PQ Residential / Number of bedrooms 3 [ ] Addt on to existing builtt V bd Replacement (] Pudic or comnerdal desaibe Code derived daily flaw y S0 gpd Remmmended design badrg race --!--bed, gpol112' ` Will, gp * Absorption area required bed, ft2 J 1 ZS trench, rt2 Mann design kWng race 0-2 bed, gpolft2 o Y trfJnc�h Reim mhended infiltration surface elmetion(s) S e-g- p Pt Ge- 3 rt (as retelred to St plan bendrnarW Ad(150nel design / Site corsidera6ors I�WD _: ., es - H S ' x -)S ' L.LX1 G Parent material S tk-`(mil ovte V ro.nNy oub,vn S4{ Flood plain elevation, if applicable N - A. It U=U letor Os❑u ® ❑U I E USS 0U ❑S ®U ❑S IBUK Ground elev. q4_-I It Deplh to In4ng fMes% Boring # Z Depl h to kn&9 bw 77& SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell moft Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Bard3y Roots BG�PDi (.')--7 10` 1\Z z! 1 - S t 1 Z` '4 \.bh 0. S Q. 6 Z �_zt� �u�tcz �l� - rt l Z'f'sbk 3 2y-�e-t.5ti\ v/y - s o S -5 wt 1 — 0•3 o.y s �� e>z-ow .,., r 3 G tom.. y S 1 0001-SnR 017 S e S Remarks: 3 28-Y8 i•S` R- V(y s o 39 w,\ 9 S o, N la V st \eSllz-u� v„� o'q `0-S s t 1vU A s prr e l Ramarlm- STNwne. ePrm Arthur L. Wegerer Phone. 715-425-0165 wdrftt- e rer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 4r& Date: CST Number: 2Z7 q- Zo-qY M00576 PROPERTY OWNER "fV SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. 8 Ground elev. g8•%it. Depth to limiting faolgj b y Depth Dominant Color Horizon in. Munsell � o-�S �o`t.ciz.l) Mollies Qu. Sz. Conti Color — Texture Stl Structure Gr. Sz. Sh. 2'f-5`o Consistence wL`FH Bound2ry es Roots z,�, GPD/ft Bed o•S rends o.6 Z 1S-39 �0`123/b rLl Sbh wt(� °�S �� o.S o.6 3 V/y - C,tig) �C3�1t w, \6 0•�l 0.5 1 Remarks:. Boring # E3 Ground elev. fL Depth to limiting factor Ground elev. fl. Depth to limiting factor Boring # 13 Ground elev. IL Depth to limiting factor Remarks: SBD•8330(R.06/92) PLOT PLAN SCALE 1"= q0 ' Page 3 of 3 z r ts. 9 d c U 1=1�\STlN6 —• X aati ur%L k �•AUea \N Sell Q _rfovh LUChi�aJ 1 , O v v' �uu.ti ors b00R SILL 3 lava \t-m RC9IDEUCe k w EL L �-4 ten, �y.zz7 �� Cl �--�1V (715 ) 425-0169 1400576 CST Signature Date Signed Telephone No. CST # Wiscons nt of Lab" and SOIL AND SITE EVALUATION REPORT P � tabor and Hurtw, Relations age _. Of Division of Safety 1t Buildings in accord with ILHR 83.05. Wis. Adm. Code Attach complete site an on plan paper not less than a 1/2 x 11 inches in size. Plan must include, but COUNTY S%- not limited to vertical and horizontal reference pant (BM), direction and % of slope, scale or PARCEL I.D. 8 dimensioned. north arrow, and location and distance to nearest road. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: '2)JUE 3 Rv � �/f116y PROPERTY LOCATION GOVi.LOT $W 1/4 SU 1/4,s1� TIP N,R If E(q OW PROPERTY OWNERS MAILING ADDRESS &6 8 OW xM LOT t 1 BLOCK i SUBD. NAME OR CSM If . 3 AqLZ5 PWT OF iy2 4C4e5 CITY, STATE DP CODE PHONE NUMBER R(UIER FAILS W1. 51402z (r5)y2.5-62G8 ❑CITY ❑VILLAGE &MN -rRc -Ehsr PART" INEARESTROAD /% • A41V [ 1 New Construction Use ( Pr Residential / Number of bedrooms 3 j I Addition to wdssting building [�j'Replacenment [ I Public or commercial describe Cafe derived daily low y3'O gpd Recommended design loading rate L bed, 900 ' S trench, 9PdVft2 Absap6on area required bed, ft2 trench, 112 Maxim design loafing rate �% bed. 9pftl . S trench, W012 Recommended infiltration surface elevation(s) szc p y 9 9 l (as referred to site plan benchmark) Additional design / SO Wnsideralons it// S— T vi T�i� oy c y Jo oe to v c�� SySTE�s S Parent material Sf &A)5 iv--oAe& CT 'C..Sc 5 O '+ Rood plain elevation, if applicable A/&- it $ : Suitable for system U • Unsuitable Ior stem CONVENTIONAL ❑ S E'U I�IO N Ef O U N-GFIOUND_PRESSURE ❑ S 2t7 A❑7ZDEE Q N � HOLDING TAN( ❑ S car - Boring # Grouts 7Zn Depth to limiting bee ' a7 �r Ground f7.�ft Depth to limiting bw a5„ O•Je SOIL DESCRIPTION PPPnRT Horizon Depth in. Dominant Color Munsell Mimes Ou. Sz. Cont Color Texture Structure Gr. Sz. Sh. Cosistenoe Bouncl3y Roots GPD/ft Bed tendm 1 072 / O i/ 3/ $/ 7 wt(' C S 3�r S G Z /)-27 /o/R s/P �s /f s1& Asti w I ,8 / ye I N N 7,5 Remarks: l 0-(n /O t/jf? �/Z Si/ / F s6� FiP c5 2of 2 - 2 s 2, 5 Vie 31 — S/ / f f.P vfR C$ /uF , Y S 3 .25--60 io ye �/00 z 4A> ono /s IV I N y Cf, �07-Ev DE.P; E 1% '��o.�-r �Y.v f> 7�o c�� q't 6' ,el , 15' . vorvuw fJ f/o�vs �y/ / �PfST� rTEv C Y� 7� Remarks: rZVrr zo.0 S Of- {a. P I.S. Pleass Print -R o l3rE e r ZA L 8 f� m C (n T' Ph": 7/3--3 P6 - F1W 5-- 4SS o` 5'k-pr/-9y cst.H2�� )� Q Date: CST Number: SEE .t T T�`f at-f-� eo' GL PROPERTY OWNER �IUF O,ti�� SOIL DESCRIPTION REPORT PARCEL LD.I Ground elev. 95.12 h. Depth to limiting Boring # M Ground ft. Depth to limiting lactor3%, Boring # Ground' 9S. elev. It Depth to biting factor N WAA Boring # El Ground �G '? ft. Depth to limiting factor ,� A,0h14ppli{ Page 2- of ! Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boutdary Roots GPD/ft Bed JTrench i o i /oYl( z/z s G 2- y /9 & y/ S�/ 7` f6,f V z f . Y . S 3// Lp yU/orR yy s/ /f ,t' AIX -v s 5rR yG D, nN 2 ti Remarks: 5 t 7-r4 e- mot[ - . l o-,Z 1 %YR 3-// s 2-F Z a-zZ /d yie 3/ /o�rr, 2 .a, 56,�- .w f2 C-s If S kip Remarks: I31W-6P 1"7-4,f%4/5 I-✓ 1foe/'Zo v �/— C'E�lE c�T,^ y - ' SS /O / S Z -4- l ,P c'S 15 .G 3 7- y1 /s / vj__ G /o,91 G/ t�v} voFIJ v. s,� CJ, s oQ� '� S k . Remarks: Luf' 1Lpv y — 6yt•'r,'c Y SS MMM =®Mmw MIM, • i M� ,C MS --- ___MM� mm— -__-..■ / Remarks: iyO,c7 5-5-10E S,�uOI/ con anen.o nc nm �o4�TS G "� �2 S7,�EnX`5 aF /oo.s� �;ve .S �4Q v4h' y S7V &e71uXe /-ess feel4w&4--� s/, /307- &,0 /;a tT� � > 5'0 % ) TEX-7e , , S S' "a y c/�i � Szt f 1--e 71-e4—) PROPERTY OWNERS CO SOIL DESCRIPTION REPORT Pape got PARCEL I.D.! Boring # 7 Grout elev. y'S, i8 ft. Depth ID b*N bow zl, , Boring # Depth to Ground' ele+r. R Boring M Lj Ground elev. It. Depthb lMng few Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Cortsi,X= Boundary Roots GPD/ft Bed Tmnch y s/Z 5"1 .2411 shf S s - C- Z 9-z6, /oYR s./ /f.4& dvti a — `/ S 3 -7 ,o le y 4 sc, p �,, ��ti — - ti Ao ^4 S S 3 i t iv iYcnf.I S 7-i / — .n•/!cS 7' 45 7 w S 0 - Remarks: Remarks: Remarks: con 0e9ND ncnm Wisco of Labor ndHu angel tiondusay, SOIL AND SITE EVALUATION REPORT � Labor and Human Relations Division of Safety a Buldngs in accord with ILHR 83.05, Wis, Adm. Code COUNTY Attach complete ate plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to verticai and horizontal reference point (BM), direction and % of slope, scale or PARCEL I D. # dimensioned, north arrow, and location and distance to nearest road APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION REVIEWED BY PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT 1/4 1/4,S T PROPERTY OWNERS MAILING ADDRESS LOT I BLOCK t SUBD. NAME OR CSM ft ar Uuut PHONE NUMBER I ) [) New Construction Use[ ) Residential / Number of bedrooms () Replacement I I Public or commercial describe Page _ of — ,N,R E (or) W I I Addition to existing building Code derived daily now gpd Recommended design loading rate bed, gpd/tt2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem I El ❑U ❑S ❑U ❑S ❑U 1 ❑S ❑U ❑S El ❑S ❑U snit nFSCRroTrnu ocnnnr Boring # M Ground elev. ft Depth to limiting facto Boring # Nail Ground elev. Depth to limiting factor Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Bc rid3y Roots GPD/it Bed fiijdl neman(s: Hemarks: _ CST Name: —Please Print Address: Signature: Phone. Od ac./o.2 d'�;Pe'17?S -9o791 key -m/o �d/OA , S6 s�i� � � : --:7 Z 46t 41f/ m o - P�9 *'Y6 {�lI3/ 3 ��15/� S OIr�IOLy iSZ rvd'df� I # i •� A19 *7, X 1 0 4d, z� Z� �8h Of n ' oV Gs Q' I , n / - 1_ I cs ,I Sw&77G !F s 9g• /,vi � Z S� �' rt% all , Z * Mol 1S 7i��$ ri O-7nl'J OL y d 5 � cl,4 :cl S �i 014 �f/ a N l]LBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 715-386-8185 pg.5 of 5 Reg. Desgners of Engine^ng Systems Private Sewage Gorsultanrs Sept. 3,1994 Regarding soil evaluations at the David O'Malley home located at 608 Hwy. MM, River Falls, Wis. 54022 : The area outlined by B2-B4-B5 is suitable for a replacement mound system. The upper 241, are permiable with weak structure (design loading rate .4GPD/ft2) with soft consistency. Underlying horizons,however, are continuosly banded (abrupt alternating bands of fine sands and ls). These bands are weakly to firmly cemented. A soil knife can penetrate the horizons only with considerable force.When scraping into the pit walls, fragipans, firm and brittle, can be clearly isolated and removed by hand in long firm shelves. These cemented classes of soil are causing a downward permiability restriction. Per ILHR 83.09 (4)(4m), such soils are suitable only for a mound type system, using 18" of sand fill. This area is not suitable by code for an in -ground type conventional type system. The area outlined by B3-B6-B7 warrants extensive further descriptive detailing. This area, after further field testing analysis was determined to be suitable only for a mound type system. When dry hard massive soil samples were chiseled from the pit walls (with force) hand texturing APPEARED to indicate that horizons 3 & 4 consisted of sandy loam. Even if massive, sany loam textures a re suitable soils for inground type trenches using a design loading rate of .4 GPD/ft . However, when soil samples were moistened and brought to plastic moldable conditions for ribboning analysis, strong long ribbons well in excess of 5 cros. were consistently formed. This is apparently not a sandly loam textured soil, but a sandy clay soil. Sandy loam soils, without a high clay content, will NOT usually form strong ribbons 5 cros. long; sandly loam ribbons are weak, and disintegrate between fingers at 2.5 cros or less in lenght. It is not code compliant to install in -ground systems in massive or weak structured sandy clays or silty clays. The most likely, least disruptive area for a replacement mound system probably is in area B2-B4-B5. See plot plan. Sincerely, Robert Ulbricht CSTM 2482 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRI PROPERTY ADDRESS Dr_ G p A71?'I & I oK r A—d 145 (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION _SA) 1/4, ,574% 1/4, Section 97 , T -2r' N-R le W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE a�3 , 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 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 I/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 has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the SIGN] DATE St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 I1/93 Furor - S T C 100 Owner of Property qUe 04-vatYe4 _ ,Location of Property G✓ tty� ttSection 97 ,If 4FN K -W Township__ %roe/ Hailing Address_ 64 cf /�� /oo? Subdivision Name Lot Number / (ISt-n F/.;2 p Previous Owner of Property Total Size of Parcel -�? 7 P Date Parcel yas Created Are all corners identifiable? Yes _)� No Include with this application one of the following: .Certified Survey Map .Deed .Land Contract, or .Other I:egal Document which describes the property 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. ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of mid system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ). SIGNATURE OF OWNER SIGNATURE O CO-OWNER (IF�APFLI E) DATE SIGNEO OAT& SIGNED (DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION �7,�7pDL�/N' ss•ZT�SZ� A RECONNECT EXISTING SYSTEM S•` i � r r 17W (SttaslugnedD Number TOWn of Troy ❑ CONVENTIONAL ❑ ALTERATIVE Ctv Rd MM ❑ Holding Tank ❑ In -Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS F PERMIT TWUNCR: INSPECTION DATE David O'Malley •403 Wasson Ct. Apit.21 River Fall BENCH MARK (Permanent reference point) DE I I N M PLAN' EF PT ELEV.- T REF PT ELEV. ©� /'n 7 kiru Name of Plumber IF MP/MPRSW No County U Sanitary Permit Number Bob Ulbricht 3307 St. Croix 1128612 SEPTIC TANK/HOLDING TANK: MANUFACTURER' LIOUID CAPACITY' TANK INLET ELEV .r TANK OUTLET ELEV.'. WARNING LABEL LOCKING COVER PROVIDED- PROVIDED - YES ❑ NO ❑ YES ❑ NO BEDDING' VENT DIA' VENT MATL' HIGH WATER NUMBER OF ROAD' PROPERTY I WELL BUILOING VENT TO FRESH ALARM: FEET FROM LINE AIR INLET - ❑ YES ❑ NO ❑ YES ❑ NO I NEAREST DOSING CHAMBER: MANUFACTURER BEDDING LIOUIO CAPACITY' PUMP MODEL'. PUMP/SIPHON MANUFACTURER- WARNING LABEL LOCKING COVER PROVIDED- PROVIDED' ❑ YES ❑ NO I I I ❑ YES ❑ NO ❑ YES ❑ NO 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 ❑ YES ❑ NO NEAREST --- 1111� SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH' DIAMETER I MATERIAL AND MARKING or excavation. III soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) rnNVFNT1nNA1 RVRTFM- WIDTH LENGTH: NO. OF DISTR PIPE SPACING- COVER INSIDE DIA.' >Y PITS: LIOVID BEDITRENCH TRENCHES: MATERIAL PIT DEPTH' DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE I DISTR. PIPE I DISTR. PIPE MATERIAL. NO DISTR NUMBER OF PROPERTY WELL BUILDING VENT R H BELOW PIPES' ABOVE COVER ELEV. INLET: ELEV. END' PIPES' FEET FROM I LINE- AIR INLET - NEAREST MOIINn SYSTEM' Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE- PERMANENT MARKERS OBSERVATION WELLS: ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCHIBED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL SODDED SEEDED- MULCHED' CENTERS EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PIRFRRIIR17Fn nIRTRIR11TIOM RVRTFM- BEDITRENCH WIDTH- LENGTH NO OF LATERAL SPACING-. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER' TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL' NO. DISTR DISTR PIPE DISTRIBUTION PIPE MATERIAL a MARKING ELEV.' ELEV.: DIA.' ELEV. PIPES DIA.' ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO INFORMATION 1 APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS OBSERVATION WELLS- NUMBER OF PROPERTY LINE WELL BUILDING FEET FROM I ❑ YES ❑ NO ❑ YES ❑ NO NEAREST-1 Sketch System on Reverse Side. SBD-6710 (R. 06188) Retain in county file for audit. SIGNATURE' TITLE Zoning Administrator Thomas C. Nelson SANITARY PERMIT APPI MATIIAN U ieea�`ia'i�"I< In accord with ILHR 83.05, Wis. Adm. Code COON / STATE NITAAY PERMIT v�2 Y(1/� / PL_� -Attach complete plans (to the county copy only) for the system, on paper not less than 8'% x 11 inches in size. check 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. PRKERTY OWNER E 4 M PROPERTY LOCATION �tJ'/• S W'/a, S L? T, N. R �f E (or nW P. QO 3 TY 9 Si MAILING I,DDRESS 76�ar_ �q . (!+v 7F LOT M BLOCK fill(CITY, STATES ZIP CODE s yoz Z PHONE NUMBER � u 6' SUBDIVISION NAME OR CSM MBER o � 4 �l II. TYPE OF BUILDING: (Check one CITY �j� ��O NEAREST ROAD State Owned VILLAGE il4 ❑ Public X 1 or 2 Fam. Dwelling-# of bedroom93— PARCEL TAX O C ( , / u 111. BUILDING USE: building is 2 7• Z6 ' ! �LS Ar 7 (If type public, check all that apply) 7 j / t 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 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System 8) ❑ 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In -Ground 42 ❑ Pit Privy 13 Seepage Pit Pressure43_❑Vault Privy�y %Ep�CTSEE�E�e%- >F14 System -In -Fill L 5--Z3 VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER ABSORP. AREA 13.ABSORP.AREA 4. LOADING RATE 15. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE 12. y REQUIRED (sq. ft.) PROPOSED (/sq. ft.) (Gals/day/sq. ft.) (Min./inch) D7 ELEVATION f- �0 S s f��`OW IV S r" Feet /• o Feet VII. TANK INFORMATION CAPACITY in allons Total Gallons # of Tanks Manufacturer's Name Prefab. ncret site Con Steel Fiber- glass plastic Exper. App. New istin Tanks Ta ks strutted Septic Tank or HoldingTank Litt Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned• assume responsibility for installation of the onsits sewage system shown on the attached plans. Plumber's Name (Print • /6,C/CST Plumber's Signature: (No Stamps) �'�I3, MPMPRSW No.: Business Phone Number: 66v- 0 7/5' Plumber's Address (Street, City, State, Zip Code): S S 6 ,u tip IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved El itary Permit Fee (Includes Groundwater Fes) Date Issued nature j�0ast_ ps) , pproved Owner Given Initial �� fJ / — //7'�..�-v+-✓ Adverse Determination �j X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-87) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety Q 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. 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 aanita4Lpermit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill, Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service, streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) 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-6M (R 11188) 3 APPLICATION FOR SANITARY PERMIT 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), 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 1/4 /4, Section T_2S N-R'TW Township I/pp Mailing address I��J It f �� ✓� �r «�� i�5 Address of site 5 I1A Subdivision name Lot number — Previous owner of property X�. Total size of parcel -:5 ('0LA T) o dc / Date parcel was created i a )3) 7S Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes 4-- No Volume .and Page Number / 6 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, 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 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 de recorded in the Office of the County Register of Deeds as Document No. ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ). ( ) _ ') — /1 . .I ,9 Signature of.Owner o Signature of Co -Owner (If Applicable) /r? Dof Sigriature Date of Signature STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER pi ROUTE/BOX NUMBER I\ 3 FIRE NO. ! J CITY/STATE +1 i I, 0^ 7 afic?i Lcir 5 ZIP 5-10 L- t— PROPERTY LOCATION: 551 1/4 SG✓ 1/4, Section _, T�LN, R� _W, Town of `/ /O L/ , St. Croix County, Subdivision Lot No. 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 $3000 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 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. Certification form will be sent approximately 30 days prior to three year expiration. 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 Department 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�C��� drGC� DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address INS)US !'Y, REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSY�iY, DIVISION L�CBOR AND PERCOLATION TESTS (115) MADISO I W 53707 HUMAN RELATIONS (1L,HF;83.09(1) & Chapter 145) LOCATION: T NS UNICIPALITY: OT NO..BLK.NO.: SUBDIVISION NAME: w 1/ c'W 1/ ZaB It,N/R viE (orIli COUNTY: W R'SNAME: MA SZpU1� 3 Si - cc-kn vY. ORvtO & P'1 P%LL I Jq.I QeTL FALLS, W 1 Syo zZ. /SE NO. BEDRMS.: C EFICIAL DESCRIPTION:�?t \ Residence "'3 U , ^ 1 J New Replace e wT1.12. C- C:•-...:•-Al..w. ......... 11. C:•. u..eui•.1.1. /n• ew•.•n UA I CS UC611CM V A 1 Iuma mAVC lS_z3�B9 >v-q- (Z__T. (U®�S ❑Q M. ®S OU IN-G®� ❑� IL �� ❑� pLDINGTA�I:RECOMMENDED O S 91j SYSTEM: (optional) rx�s'noica, If Percolation Tests are NOT required If any portion of the tested area is in the DESIGN RATE: under s. ILHR 83.09(5)Ib), indicate: N . A - Floodplain, indicate Floodplain elevation: N PROFILE DESCRIPTIONS BORING NUMBER TOTAL IN, ELEVATION DEPTH T GROUP DWATER-INCHES HARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.I OBSERVED EST. HIGHEST B- 1SL{ 1 °11.0 F�Or�)E > \SL/ 0-18 BL C W111k -✓1) Sj I 1 18-3S 19N*-`'f %I\ 1p'l23/y sl I ' 3S-46 akRBn syR 3/y B L_ ) V6-63 oh-`t @>t tr 10 `1R V/Y� �sl 163- 10s' Ofa B to IL & w/ o c TS B- VOS•-NS4 `Oti-Yt3v%C►O"IR q/io '�S w/1S SPQrS B- i?tjS U %11 L30j2JA1G w e1L . N o S �u6 C� C_ CI Ft1'r, %oiL. CcPAJD1T)UA1 1)T E Exts7w Wj s w "Ni - - p wetc- w S B ORv[ - JWtb S eNTLY 1 iz stilt- woRtL0NG ce>vAli7�lJ. Tt1E F30r E- 4r a v1S l l3u� . El-C PERCOLATION TESTS he /- TL`I.L"3q.iBIC17a1�7 1►1T.u`i�al . -. • � - yeW9��`�7�yltli • . ��.iC•7•�•���l�a►•1•lrl• PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale o�ces. 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 +arndd the direction and percent of land slope. SOVTO" OF �RYw�Lt_ �h&e 90 S gst t wce %i 1 r Lelf\ t SYSTEM ELEVATION t-Leu • ate• s • ?1'l-►x al se Wne. Thwtl�•�ex lw%Vt LRL. Fot�e�eftiTlOnF xr I+V ELI. IBM- aL.1C3u•o I cw -O.P OF t�iLYwHLL. UST PIPE IS 1 TIE- w P2_RTtM ZSO' � • Or TtjE o F S t C9" 01\I ILI ZSoA►v, SW a4pW fR it TN _ C'fT1 � 1'1►'l a - StTE - X sc141F %".= LOOP C'rr1'nh'SC`C. Z7 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 Iprintl: F1RT8+✓R TESTS WERE COMPLETED ON: �. wE�ER�1t ADDRESS: P 0, %ox ' y CERTIFICATION NUMBER: PHONE NUMBER (optional): F21LILL W1 SVolZ csT oocs�b 11S-V25-o/6S CST SI ATU E: DISTRIBUTION: Original and one copy to Local Authority. Property Owner and Soil Tester. DILHRSBDS395 (R. 10/83) —OVER — I2E- (o4)atv4i0rj PLOT /'AAA) 7uC/� r p pf �J�ve U �ii1//E y F,n-sr j& SEpric . "V'e& Rhow--t e ------------- fS a [Ito R / �� '4ca- New 3 3t poem ' moot r� r7B HOMESITE SEPTIC PLLPABING CO 65•, C'NEIL RD., HUDSON. WIS. 50016 AMRT WRIGHT ,,,AS. MASTER PLUMVIM LIC NO. W M P R.S. „INN A 691ANFIR NA as ooua Parcel #: 040-1107-20-100 08/1712006 05:00 PM PAGE 1 OF 1 Alt. Parcel #: 27.28.19.427C 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - OWALLEY, KEITH T KEITH T OWALLEY W9962 HWY 29 RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 43.000 Plat: N/A -NOT AVAILABLE SEC 27 T28N R19W E 1/2 SW 1/4 BEG S 1/4 Block/Condo Bldg: COR SEC 27 N 88 DEG W 1003.02' N 14 DEG E 17.95' N 43 DEG E 98.19' N 2 DEG E Tract(s): (Sec-Twn-Rng 40 1/4 160 114) 240.73' N 33 DEG E 249.92' N 15 DEG E 453.OT N 7 DEG E 254.13'N 25 DEG E 27-28N-19W 280.02'N89DEG E751.28'S114.60'S mw.... Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 729/323 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 5.000 27,500 0 27,500 NO ENTERED BEFORE 2005 OPE W7 38.000 199,500 0 199,500 NO Totals for 2006: General Property 5.000 27,500 0 27.500 Woodland 38.000 199,500 199,500 Totals for 2005: General Property 5.000 27,500 0 27,500 Woodland 38.000 199,500 199,500 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 as Parcel #: 040-1110-20-000 09/07/2007 03:59 PM PAGE 1 OF 1 Alt. Parcel M 28.28.19.444B 040 - TOWN OF TROY Current X ' ` ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner O - O'MALLEY, ALICE FRANCES-ET AL ALICE FRANCES-ET AL OWALLEY 602 CRY RD MM RIVER RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 602 CTY RD MM SC 4893 RIVER FALLS p SP 0100 CHIP VALLEY VOTECH a a� _ P jx'' /1 �G Legal Description: Acres: 3.980 Plat: N/A -NOT AVAILABLE SEC 28 T28N R19W 3.98 AC PRT SE SE - S Block/Condo Bldg: 323 FT OF E 537 FT INCLUDES P426B EZ-UT-1505/137 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.800 76,000 122,000 198,000 NO Totals for 2007: General Property 5.800 76,000 122,000 198,000 Woodland 0.000 0 0 Totals for 2006: General Property 5.800 76,000 122,000 198,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 116 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 IN Parcel M 040-1106-60-100 08/17/2006 04:53 PM PAGE 1 OF 1 Alt. Parcel #: 27.28.19.424A-10 040 - TOWN OF TROY Current X . . ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 10/05/2005 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner O - VALLEY LAND CO INV PARTNERSHIP LLC VALLEY LAND CO INV PARTNERSHIP LLC 215 N 2ND ST STE # 102 RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.000 Plat: NIA -NOT AVAILABLE SEC 27 T28N R19W PT SW 1/4 & PT SE 1/4 Block/Condo Bldg: COM W 1/4 COR; TH N 89' E 1046.27 TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) POB; TH CONT N 89' E 2087.33FT; TH S 00' W 1263.98FT; TH N 89' W 311.95FT; TH N 27-28N-19W SE 02' W 114.60FT; TH S 87' W 751.28FT; TH 27-28N-19W SW N 00' W 218.88FT; TH S 89' W 1015.37FT; mon... Notes: Parcel History: Date Doc # Vol/Page Type 10/05/2005 808617 2903/387 WD 10/11/2001 658803 1735/578 WD 07/23/1997 1175/86 QC 07/23/1997 1136/567 FaZ mo ... 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Description Class Acres Totals for 2006: General Property 0.000 Woodland 0.000 Last Changed: 03/23/2006 Land Improve Total State Reason 0 0 0 0 0 Lottery Credit: Claim Count: 0 Certiflcation Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 040-1106-90-000 08/17/2006 04:53 PM PAGE 1 OF 1 Alt. Parcel #: 27.28.19.426A 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 10/05/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - WAHRENBROCK, RETIRED RETIRED WAHRENBROCK Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 27 T28N R19W SW SW NKA ALL THAT PT Block/Condo Bldg: OF PARCEL C DESC IN 1136/569 ASS'D Tract(s): (Sec-Twn-Rng 40 114 160 1/4) W1040-1106-70 (425A) EZ-UT-1499/276 NKA PT 040-1107-10-100 (427A-10) 27-28N-19W SW SW Notes: Parcel History: Date Doc # Vol/Page Type 10/05/2005 808618 2903/389 QC 10/11/2001 658803 1735/578 WD 07/23/1997 1175186 QC 07/23/1997 1136/569 .6C 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 040-1107-10-100 Valuations: Last Changed: 03/23/2006 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property Woodland 0.000 0.000 0 0 0 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00