Loading...
HomeMy WebLinkAbout040-1069-20-100 (2) y N o M 0 U y o C c O C cm N n 3 ~ tF X O N ~ I y O N I 6) 65 -C m u Q I rc C 6) o w i w o c o N N ~2 N (D .L. 0 CD c z ~ RS - L LL c m O 0)- C:> CO E Q x ~ I m ~r a a~ rn w 0 o o 0) 0) n oy W IL m c H Z 0 o z : y z a ° o N F- m z O m` (D CO N a N C ~ c • Ai g C C O U O 2 Q I Z F- Z o N z c U-)I 04 C N ~l N 4 _ I N _ CL y L MO O L N 0 0 0 o a E > o N N to (D _ o N Z > i- I- t- EL Z O O O Z° • rv a a a a c a g ° rn N rn N U= o '0 rn J U i Z rn rn LO co N co ) ti o o o E y 2 N O CO U 'C W Q c66 W 7 w O ~5 E LO 00 O L"r ° O Ili N C C 4J !l 0) °0 r Fw N C C V 0 C\'• 3 m c c m a) 0~ O O'. L C N 6) C (O V O H U 60 t ) 2 'aO ° i..l O' N N ` T N° - 7 Z' Z' D d CL a A L) a 0 in V 4 y~ I~ AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SECTION l 7 T V 9 N-RW ADDRESS- _'Y'Y~ C?~. /GQ~: ST. CROIX COUNTY, WISCONSIN I • ~I SUBDIVISION LOT LOT SIZE i PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 74, I P A 53, Drop Box ~ i INDICATE NORTH ARROW BENCHMARK:^Eleva ion an descrip~n: stye ~,~t X ~.(:~r A&- ~T _ ,rt~ i Alternate benchmark --jr"A04 e- J► 7 SEPTIC TANK: Manuf acturer Liquid Cap. nQ Rings used: a Manhole cover elev: Final grade elev: 7 •7 Tank inlet elev.:?/7,9T'-Tank outlet elev.: ~7 • J' No. of feet from nearest poad:Front Side Rear Ft. I S/ I J • From nearest prop. line:Front i,"" Side , Rear Ft. No. of feet from: Well. Building: (Include this information in the above*p'lot plan) •(2 reference dimensions to septi6,tank) ? SEE REVERSE STDE 1 d r PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front-, Side_, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM ~~/Q~ Bed: Trench: Pte'" Seepage Pit: Width: Length_ 2 _7 S' Number of Lines : j /dill Area Built 9 X g- Exist. Grade Elev,Yiwd 9~~ Proposed Final Grade Elev. 7rrc n.~ 9 3 , ® ' Fill depth to top of pipe: q d, uy / 'l2 ~ No. feet from nearest prop. line:Front , Side Rear Ft. %7 0 No. feet from well:-'>- i6. feet from building HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from. Well , building- , nearest road Alarm Manufacturer: i INSPECTOR: Aj d) DATE: : ~Llaa~- LICW4,SE PLUMBER ON JOB• NUMBER:-, 3 ~g 4 6/90:cj t k Parcel 040-1069-20-100 05/02/2005 04:50 PM PAGE 1 OF 1 Alt. Parcel 17.28.19.264A-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): * = Current Owner * TSCHUMPER, GREGORY J & RACHEL L GREGORY J & RACHEL L TSCHUMPER 441 E COVE RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 441 E COVE RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.760 Plat: N/A-NOT AVAILABLE SEC 17 T28N R1 9W 2.40A IN NE SW W 290 FT Block/Condo Bldg: OF E 580 FT OF N 360 FT OF NE SW BEING LOT 1 OF CSM 3/625 ALSO TRI> STRIP ADJ W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) LN AS DESC IN 588/417 (MINERAL DEED 17-28N-19W 889/640) ALSO COM W1/4 COR SEC 17;TH N 88 DEG E 2016.95'POB;TH S 00 DEG more... Notes: Parcel History: Date Doc # Vol/Page Type 11/10/2000 633357 1558/160 QC 07/23/1997 1132/597 WD 07/23/1997 761/313 2004 SUMMARY Bill Fair Market Value: Assessed with: 26674 237,200 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.760 66,000 171,700 237,700 NO Totals for 2004: General Property 2.760 66,000 171,700 237,700 Woodland 0.000 0 0 Totals for 2003: General Property 2.760 66,000 161,800 227,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch 216 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • ~ 3 • FILED F p C JUN 26 1978 JAM o, coMaL 349702 Wbura„ V ST. CROIX COUNTY s 8 SURVEYOR'S R CERTIFIED SURVEY MAP DESCRIPTION` A parcel of land located in the NE 1/4 of the SW l/ 4 of Section 17, T 28 N, R 19 W, Town of Troy, St. Croix County, Wisconsin, described as follows: Commencing at the W 1/4 of Section 17; thence N 880 40' 11" E (assumed bearing referenced to the North-South 1/4 Section line, bearing assumed North) 2061.10' along the East-West 1/4 Section line; thence South 33.01' to the point of beginning; thence continuing South 327.00'; thence N 880 40' 11" E 580.001; thence North 360.00' along the North-South 1/4 Section line; thence S 880 40' 11" W 16.73' along the East-West 1/4 Section line; thence Southwesterly 100.77' along the Southerly right-of-way line of Cove Road North on a 148.00' radius curve concave Northwesterly whose chord bears S 690 09' 52" W 98.83'; thence S 880 40' 11" W 470.87' along said right-of-way line to the point of beginning. I,. James E. Rusch, registered Wisconsin land surveyor, do hereby certify that I have surveyed and mapped the above described property; that such plat is a true and correct representation of the exterior boundaries of the land surveyed; and that I have fully complied with the pro- visions of Chapter 236.34 of the Wisconsin Statutes and the Subdivision Ordinance of St. Croix County to the best of my professional knowledge, understanding and belief. James E. Rusch June 7 1978 !'~11""~tv' N I/4 Wisconsin Land rveyor - ~`~'S,~i►~~,~CORNER Stevens Engineers, Inc. Ilr r 1409 Coulee Road JA NaiE~ Hudson, Wisconsin 54016 W I/4 CORNER I SECTION 17 M 13?,' w ~z T 28 N, R 19 W diver Falls, i / Wis. ♦d~ ~ ~ w c0~ ? UNPLATTED LAND NeeK~~~ %16.73' ' ' - - - - NORTH - COVE ^ROAD 2061.10 _Q 40 W ~$900, . ® 01 ujl S 880 40' 11 W I 470.87 - / rn a ~j SOUTHERLY '9/0/ 290.00 176.04 i / CO 6 CD RIGHT-OF-WAY 9' o N 180'11' 4.8i V 0 st / POINT OF ` BEGINNING 0 M 0 o00E %~aOEMEN~ / m N13 CV 5g EPS / EXISTIRG NC i/ HOUSE GRAVEL DRIVE OR \_0Z 00 o of F 0 E 0 zl of \ ~ T M Q1 ZI ® - __11 QI O t~ _ v 1' 0-0 of M Q 2.18 ACRE$ 2 2.19 ACRES = W w, fV L_ - F F-1 '15 EXISTING PROPOSED SITE c vii a H F-1 Q' BARN FOUNDATION FOR NEW HOUSE z JI x CD a, w z l a' z ~I O F- N J N cr - W NE -SW z 19/0 /9 oto g19 h 00 290.00' ~RE90.00' N N 88040' II° E 580.00' o z WWI. W ~a UNPLATT~D LAND 00 ,qpROVAL OF ST. CRC3tX '1Y 1 Z F DOES TF►I$ AAINOR `'0Mjgt2KWSIVL PARKS PLANI*4"O J1ND ZONING COMMIT L BUILDING S TE MAN APP p~lS/Op 1)v ~\o REFS TO SEPTIC S Y;: Vq FOR CS 1/4 ORNER I _Z H62-20., t F~ zz? '4 SCALE (I" = 100') '4 W< ~V 100' 0 100' 200' volume 3, Pago 625 TYIC 1WQ'r ffftlACrAiT -*WAa f%QACTCf1 QV-a#,ATT o 1 nWUAki - -wisconsin ue runent or inaus , SOIL AND SITE EVALUATION REPORT Pa e / of Labor and Human Relations 9 - Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 5r, CA401'X 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. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIE EDBY DATE PROPERTY OWNER: PROPERTY LOCATION e11AQ O ~?`E- ~i4 ! GOVT. LOT /VE 1/451k)1/4,S/1T Z o N,R / 9 E (o W0 PROP R OWNER':S MAILIN ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # ~ ' rdAAW s ~ /1, ~P CITY, STATE DSO ZIP CODE PHONE NUMBER QCITY []VILLAGE MOWN NEAREST ROAD S yOSG (~/.s) 3 P4; - 372 -1 Po y- wsr & i E cot-E RIP . [ Use [ X] Residential/ Number of bedrooms 3 [ ] Addition to existing buikfine,-.,, te eplacement Public or commercial describe deriv flowgpd Recommended design loading rate X bed, gpd/ft2 trench, gpd/ft2 Absorption area required IV* bed, ft2 76 t9 trench, ft2 Maximum design loading rate N4" bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) 'ti6~rtl~ s oucy . ZfSE . G G/o~ / F.E :g~ ~ti /~7D~o' /gi►T~' Additional design/ sites cgns4erations Parent materials SZ By~PkhtRVT - y,9ci~/ ouTw~9s Flood plain elevation, if applicable N ft S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem c'S ❑ U 13S ❑ U S ❑ U S❑ U ®S ❑ U ❑ S au SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed re & 14- o-lO /O e 312- /o,1,1 /j sb~C n..,f2 s ff1h / . S -7~ eS if"Z1 Ground 13 X~y . 100 95.180 ft. C 00 . Depth to limiting factor This tot site APPROVED nri[~IKI ft'l for a cony ntional septic systm Remarks: Boring # f f 312- A 2 ii /o ye vA/ s/ Z,f, 5,6& fie C-5 fFtlrr y ~L 7.s Yoe y - s/ 2-,-(l sh/c' s t , c Ground elev. /0 ye 516 - -f S D vf, fe 4*vf,E ft. Depth to limiting ~6 7 ~y fact y rte) i1j Remarks: five- S .u AolPiZoti ST Name:-Please Print HOMESITE SEPTIC PLUMBING CO. Phone: 655 O'N 11: RO., HUDSON, WISS. 54016 Address: ROBERT ULBRIGHT Signature: 3 Date: CST Numbe :Z r `6d' i t`r' , rQt LEF+ & DESIGNER LIC. N0. 00663 7- 2so f Z Z PROPERTY OWNER C' ~'9Y SOIL DESCRIPTION REPORT Page?,of PARCEL I.D. S Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed TreiO b-/O /o yk 3;1;-7 /v~rn f s h~ fR s If * / . S o-X> /,,-q !,e sb,e ~ie cS aftz . G, y"e y~G S~~ l f s6~ nrfR e5;7 zt Ground °"z, elev. 7,S %~e ft. 7-Y Depth to C ~'1Q /0yie limiting ;r factor „ 7 i Remarks: Boring # 4 Ground elev. ft. Depth to limiting factor Remarks: Boring # A~Avt..'.''•sta i t Ground i elev. ft. Depth to limiting factor E F-F i Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: SBD-8330(8.05/92) .71 Go M. PL- 0 T '(ALAS I ze,vE' cuAy sysTt,4 ffca«' 3. S~ y2 i i 23, m, = TO p of ~ ~/Z y cv~ ~ ~ ~ S,n 'tea ca-,c/etrz- P,lTia ~0 ' 'f IPCNGG, I-RyoU7 KS/NG-- T3 2 p 120 r /So v •Pi57~i RuT~v,~ 73~ ' 1 S 8~ ~ CvI2VED ro 2 I l 5-~' D C h 0 13 3 U~7T SE/0r/-c T1,k ~7 37 This test site APPROV.M for a con vw- tic aj sepW jW'jWM SuGGE51" A SYS-T -r G~-~iflT/©ti5 ~i y~C ~~'E•v~~. 9/- fi~S -60 9<?, Q HOME-SITE SEPTIC PLUMBING CO. 49 655 O'NEIL RD., HUDSON, WIS. 64016 ROBERT ULBRIGHT VIS. MA3TER PLUMBER LIC. NO. 3307 M.P.R.S. 'NNI. IN-1 TALLER 6 DESIGNER LIC. NO. 00663 I II I SG.4Lcs" % / 3~ IQCAT op: RYI a1.7.28.19.264A NE SW E. COVE RD. sconsin epart mento In ustry, PI~tIVl4TE SEWAGE SYSTEM +abor and Human Relations Safety County: and Buildings Division INSPECTION REPORT ST. CR IX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 180281 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: DAY CHARLOTTE TROY CST BM Elev.: Insp. BM Elev.:, BM escription: Parcel Tax No.: lDO qtr(' S t~-~~ d~f~ 040-1069-20-000 TANK INFORMATION ELEVATION DATA A9200360 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ! Benchmark r Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Airi to ntake ROAD Dt Inlet rl Septic b 15 b o r (o, NA Dt Bottom t Dosing NA Header/ Man. lib 90 y Aeration NA Dist. Pipe 4- - s Holding Bot. System l o, aI Q i 9 . ;J PUMP/ SIPHON INFORMATION Final Grade - ~-r S Manufacturer Demand Model Number GPM TDH Lift Friction . System TDH Ft oss Forcemain Length Head I Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Widt 4"th No. Of Tfenches PIT Nodf Pits Inside Liquid Depth DIMENSIONS ) Vl~ 'v DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHI ' Manu acturer: SETBACK INFORMATION Type O CH ER Moe Number: System: I I l o )7o 7 7 UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/Tr nchCenter Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) I,QATION: TROY 17.28.19.264A,NE,SW,E. COVE RD.._... A ~ r Plan revision required? ❑ Yes ❑ No / Use other side for additional information. 0 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 1 SANITARY PERMIT APPLICATION COUNTY rDILHR In accord with ILHR 83.05, Wis. Adm. Code STATE ANITA ERMIT# -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ / p,~/1 / 8%z x 11 inches in size. 6 ~ c~ I Chef if revis n previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION t-1 g, I- In Pce 'I, A9Y.S0K,S 17 TA9,N,R E(o PROP RTY OWNER'S MAILING ADDRE LOT # BLOCK # l '6 r oQ CITY, TATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER d N o L~ .3 86- 72y' 1 91 'n II. TYPE OF BUILDING' Check one CITY NEAREST ROAD ( ) ❑ State Owned ❑ Ler TOWN OF: ILLAGE Tklg V G®a ❑ Public Yor 2 Fam. Dwelling-# of bedrooms-3 PARCEL TAX NUMB o o Y6 - _'2' 111. BUILDING USE: (If building type is public, check all that apply) /d 6F - 1 ❑ Apt/Condo Y 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 130 Other: Specify IV. TYPE OF PERMIT: (Check o y one in line A. Check line B if applicable) A) 1.E1 New 2. L~l Replacement 3. ❑ Replacement of 4.E1 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 ~ ySeepage Bed 21 ❑ Mound 300 Specify Type 41 ❑ Holding Tank 12 IT'Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 130 Seepage Pit Pressure 43 ❑ 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. SYST M EL 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals//day/sq. ft.) (Min./inch) ciW."A .3 P, 6-0 94 9 5 VW N j " -75-0 570 r C~ Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New P-xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank /coo N N# m Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, 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 M SW Business Phone Number: 1~~NF C44 1, / I I" el!_~9 1 3 713- -7YP- 3 Plumber's dress Street City, State, Zi Code): © G 11W S a 23 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss 'ng Agent Signature (No Stamps) Approved ❑ Owner Given Initial 1►R~ l Surcharge Fee) Adve Determination U X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber L 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 codeadministrator or the State of Wisconsin, Safety & Buildings Division, 608,266-38.15: 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. II. Type of building being served. &f6ck 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) complgte4specifications 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 fbrm; and F) all'sizing information. GROUNDWATE1111 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) a 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 h Location of property-A/f 1/4 S w 1/4, section Q , TAN-R_Z2_j0 Township Mailing address E Co Z., E 4T o aa( Address of site Scc h'J Subdivision name__ Lot no. f Other homes on property? yes No Previous owner of property Total size of parcel Date parcel was created / Are all corners and lot lines identifiable? y Yes No Is this property being developed for (spec house)? Yes ~No Volume 76 /and Page Number 313 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 y~ references to a Certified Survey Map, the Certified Survey Map -~~P ds~hall also be required. do 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. f P? 7 © X , 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. /C , Signature of applic t Co-applicant J1 4? IrA Date of Signature Date of Signature L~ S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER- C a to f` ADDRESS .41 Al C-. FIRE NUMBER CITY/STATE ZIP (5J'y D / L PROPERTY LOCATION:~l/4, ~1/4, SECTION 1-7 , T,~ N-R_L2_Q TOWN OF Thn v , St. Croix County, SUBDIVISION , LOT NUMBER_L_ Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic 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: j.,. . DATE : D - 9Z- St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 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 Pa~l residence located at: ~1/4.~. t] 1/4, sec. / 7 . T.e?$N. R,e-W~, Town of 711(4 Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes " No (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: /000 Construction: Prrefa'b Concrete Steel Other Manufacurer (if known): Age of Tank (if known) : 19 7 3 ( ignat re (Name) Please Print 'awsw 3-,7 S$ (Title) (License Number) (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 VSignature 2~~, M /MPR 'Q 5/88 W _ abo. sSlh tSApaifiSrS6riC8t lrldustry, _ . _ Labor andHuman Relations SOIL-AND.-SITE EVALUATION REPORT Page_(,_of • Division of Safety Bujldings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. sT C~°0/ x Plan not limited to vertical and horizontal raference point (9M), direction and % of slope,sstaleuor but PARC L I.O. N dimensioned, north Wrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY GATE PROPER OWNER: PROPERTY LOCATION /~A~2 O f'?'~ ~f} Y GOVT. LOT /VE 1/45k)1/4,,S/1T Zoo N,R / 9 E (o WO PROP R OWNER :S hMILIN ADDRESS y 6 C p d LOT # BLOCK r SUBD. NAME OR CSM V, fit- CITY, STATE ZIP CODE PHONE NUMBER vDSa C~J S S yoOG (71S) 3~~ _ 37z' OCtTY []VILLAGE V-]I OWN M!ST ROAD TiPOY- GvPST T GbtiE.~D ( I New Constructiop ' Use (Al Residential /Number of bedrooms 3 (j Addition to existing bui ft.--_ (x] Replacement ( j Public or commercial describe Code derived daily Aoyv /5+D and Recommended design loading rate X bed, gpd/ft2 tr ench, gpd/112 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate N/i' bed gpd$_ • f 2 Recommended infiltr surface elevations , trench' gpolh It (as referred to its plan benchmark) Additional design / sitg adons 'tis~~►i/ - s o-~cti -iv . G bPv ~f.{ X - Parent m4lerial SGS 8Z f3y~Pklr~,eDT - y/*-W ou7-w-IS 1t Flood plain elevation, if applicable f4,•-4` • It S - Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem as O U as O U W S O U MS 01.1 ® S' O U O S O U •;4 SOIL DESCRIPTION REPORT Boring # Horizon yepth Dominant Color Mottles structure GPD/ft in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh.iste Roots Bed Ierrtt -io /0 e 3/2-E 0-.30 /o y/? Y y .5/ Sb,f- i,.►~~'.e GS /ft~, . C, Ground 13 D".5j2 71%e y,7 .e ~S elev. Depth to limiting factor ] ~~oo This t St site PR~V D I for a cane .ntion• SeP Ic s s ` . Remarks: Boring # /0 ye y f/ s/ Z.f sd,C n+,fe cs ` s z 75 YR y 5/ Z, ,rid/C ve Ground S f- G elev. G J" q~ /o'e _IV6 f S v1, ye nwv71'e i/• 1h It. Depin to limiting .Sf/Sr~~? Lo.~ID/;v(r tom` f// ~C 'L-~frc:;6' 7a-2 factor ic) i (~L Remarks: fi~~" Sg vD elz-o,v 2... ~ 4 v APE T Name:-Please Print HOMESITE SEPTIC PLUMBING CO. Phone: Address: I&b4W6 71$'- 3 ROBERT ULBRIGHT Signature: .1903107"." S__ Date: CST Numt> _ arc 7, 0 ;n Mn DORM PARCEL I.D. 0 , ~,x>dZry Roots Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence p GPDIft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed -.0 I,f 5 b& nhfR -s ' If ..S b-/O /o ,e 3 z °A-y 3 ✓r s nh Sb /;14 ~/e Cf 3f~1 . (4 O -~0 0 die ~ ~ x -F ~ c S 2 f ,i • 3 Ground 131 O - 2"? ,p y/Q y/G 5.11 s h-C to elev. It. 62- 4JAY Depth to limiting factor Remarks: Boring # •i M:Z Ground I elev. limiting factor ~ J Remarks: Boring # `s 1, • f ' ~ Ground y elev. IL ! 'Depth to limiting tactot Remarks: Boring # • .S I Ground elev. Depth to limiting factor Remarks: I cBD-8330(a.05192) PL-0 T Pz.AA 7 ze: ve-u~Ay 3 ' ~ARW ysTEM 9/.P~', SyfrtM 's6..... ~3` .S~ fxlST/.V 6- B.M. = rOf of CO,u L & TS R P~tTio So' i~y.4riot/ : /OC) o' ' SOWSTED 132- p(2op 601C t DtS714Qu-r(oO cvruEo ro C~ c v hilt S~oc all N 9737 vv7-`,~ r of S~~T~ c r4A--& -~uGGESr~D -57Y -r ELF 414rl,:9-v -5 I 4* lv Ti~F•t~Gl, Q ' I COPY for a his test site APp)70 conventional Septic system. REPT131 TROY ST. CROIX COUNTY ZONING PAGE 1 10/05/92 T#" EQUESTS FOR INSPECTION WORK SHEETS FOR: 10/(,/92 AREA: MJ Activity: A9200360 10/ 5/92 Type: CONVSEPT Status: PENDING Constr: Address: TROY 17.28.19.264A,NE,SW,E. COVE RD. Parcel: 040-1069-20-000 Occ: Use: Description: 180281 Applicant: DAY, CHARLOTTE Phone: Owner: DAY, CHARLOTTE Phone: Contractor: NECHVILLE, HENRY Phone: 749-3322 Inspection Request Information......y Requestor: HENRY NECHVILLE P'~ Phone: Req Time: 09:10 Comments:Q Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION ~~U~, Inspection History..... Item: 00012 FINAL INSPECTION 4~~~ V 1