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040-1016-50-001
cs o o g o m° 3 0 p 699 0 C C c o I 0 N , I I I i N In q 0 Z C Z C 7 S9 7 6 LL U. p O Cl) Z y o (n O z a m (L m N W v H cn C 0 o z d c c 7 7 +N. O w p tlvi 2 d c 0) Z E c E 7 _0 ` m O N N N C O N N N C `1 O N ~ O O O •1V 4. (n a N O N Q Q O N Q a.V-- Z co z Z Co z p N z d E IU N E E > c N T 4 d L O N 20 d i N O cD o c a .0 co O C a N Lo m Z N> O V1 N N _3I O t H F- I- O _ N 31 3: 3: O O a m i U') 0- LL O O O z° N O • w~ a a a a. a c. a C c O U) N U c_ 0) z = } 0 0 00 ^ E p 7 Q O a 7 L m Q 73 7 v) N co d Q z w ! m a N Q} T1 Q O #a U) O 13/1 H O l0 y C W C O "O V N N ° C C m 10 O it p~ -7 O O C C = N N U a p ooi p c aE`1 m o o co 71 N ° ~ ati oa a N a~ IL- Ft a~i C2 D " o N` rn o 0 0 0 7n E E rs v • O O 1- (n O N Z Z cn O rn (n E r r ik E d E d v ,a`; a Q W d • a d p (D C ~r``irwwrj E v~ c 3 i 3 w G `~1 A U a 2 0 in 0 0 U) 0 oo it Form - S T C - 104 A BUILT SANITARY SYSTEM REPORT OWNER r I TOWNSHIP _ 7!12K SEC. T N-R PI ADDRESS 0 1 It"-ge-d ST. CROIX COUNTY, WISCONSIN 12 SUBDIVISION LOT LOT SIZE 3 Q'CeGG~ PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 3J ~ 5~4' ~f , K-C INDICATE NORT ARROW BENCHMARK: Describe the vertical reference point used 31 ~o~ Sr ~1 r Elevation of vertical reference point: Proposed slope at site: rn?e SEPTIC TANK: Manufacturer: GUr-e&.S Liquid Capacity: /rte) Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: *Tank Outlet Elevation: Number of feet from nearest Road: Front, Side 0 Rear, O ,Z,vp feet -From nearest property line .'Front 10 Side 10 Rear, 0 7 r feet Number of feet from: well --1-_5_0 , building: j (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE . PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest- property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: ! L Length: 6 3 Number of Lines: Z_ Area Built: 75`4 Fill depth to top of pipe: 3d it Number of feet from nearest property line: Front, 0 Side, (D Rear,0 Pt. f Number of feet from well: 3 5-V OF Number of feet from building: ~ Zo (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box 0 been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• Dated: lrl~r «l Plumber on job: License Number: 3/84:mj WiscoY sin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor andHuman Relations INSPECTION REPORT St. Croix Safety and Buildings Division Lot 2 • (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Se4,SW'-,Sec. 4,T28-R19,'3auer Rd. 7 / Permit Holder's Name: ❑ City ❑ Village [R Town of: State Plan ID No.: Bill Seiffert Troy CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 60J TANK INFORMATION ELEVATION DATA 1/ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. r Septic Benchmark '`,GG, 4 Dosl ng Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet 38 r 42 I~ TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic Neljjt~ s~ NA Dt Bottom D NA Headed. Aeration NA Dist. Pipe ,287 95, o?/__ Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufa Demand Model Number GPM TDH Lift Friction tern TDH Ft Forcemain Length Dia. Dist. T_oVV0 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 63 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O 7 Moe Number: System: 20 OR UNIT DISTRIBUTION SYSTEM Header.a li.4 ~ fold, , Distribution Pipe(s) r / 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 o,o r~ xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ tr.".Center Bed / Tfe"rah Edges 10 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) /T i1j au~ t % Plan revision required? ❑ Yes I's ~o Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code CouN ~ sw.m~nv STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ o4 Plon 8% x 11 inches in size. ec f r vrevious 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 f f u t/a %a, S T ZJY, N, R/ E (oryOT) PROPERTY OWNER' AILING ADDRESS LOT # BLOCK # pl,ew-l Z CITY, ST TE ZIP CODE PHONE NUMBER CSM NUMBER '1-y O/ fa es gr's VA ljq. O 3 II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD I I` ❑ State Owned ❑ VILLAGE : D $ 'mil [U-TOWN OF: V ❑ Public 1P1 or 2 Fam. Dwelling-# of bedrooms _'L PARCEL AX NUM ER() ° 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 70 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. TYYNew PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5. ❑ Repair of an stem System Tank Only Existing System Existing System B) A Sanitary Permit was previously issued. Permit # /y f / k 7 Date Issued. 9W Z /V V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 L~ 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 DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (s q. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION ~d Z S ' Feet Feet VII. TANK CAPACITY Site INFORMATION in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. New istin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank 1 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 4AP/MPRSW No.: Business Phone Number: 4 1 IJ 3 t Plumber's Address (Street, Cityf , State, Zip Code): it /C 0 ~e 1- A, Wr- IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee (Includes Groundwater Date Issued Issuing Age Signature No Stamps XApproved ❑ Owner Given Initial do Surcharge Fee) Adve eD rmin tin X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11186) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber ? APPLICATION FOR SANITARY PERMIT S T C 100 This application form is to be completed in full and signed by the owner(s) of the, property being' developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended`'for'resale by owner/contractor, spec ' house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate' deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property L Location of Property S ~Ci S 1%, Section T_2zj N-RLL W Township Hailing Address Address of Site ~C) Subdivision Name .Lot Number Previous Owner of Property Total Size of Parcel .Sq Date Parcel was Created ! l 8 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume _ and Page Number 0-7 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: i 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 refer- ences to a Certified Survey Map, the Certified'Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . PROPERTY OWNER CERTIFICATION 1 (we) ceAti.6y that a t statement on tht6 6o,%m ane true to the but o6 my (ouh) hnowtedge; that I (we) am (cute) the owner(s) o6 the pnopehty desc,4.kbed in th.i,6 in6o)mati.•on 6ohm, by vdhtue o6 a waAAanty deed tecoided in the 066ice o6 the County Regi6ten o6 Deeds as Document No. ; and that I (We) pnebentey own the proposed z to 6o t the sewage d iz pos s ys em (on I (we) have obtained an easement, to nun with the above deacAi,bed pnopehty, bon the con6tnuc ion o6 acid .system, and the same has been duty Aeconded in the 066ice o6 the County Reg.i,.6.ten o6 Deeds, a6 Document No. 09/ ` v SIGNATURE OIL OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED J t~?c Litlt~FdN ~ k , S TE AK1'1Vi~~ T ' A r/y ' 1' `.Farr RESERVED FOR' RECORDI,PI b.,, hivI 11- 1s.1-"~ ' LAND CONTRACT • F' Individual nd C•orporate E UI}>♦13 FOR ALI. T iANISM 'NSiw}iFft 0\ Ett I , rV l f I~2Ii0 0 IS INANCED ANDWN 0'r l 1R'. NON-CONSUAIP7R , 1 t. i t ACT TRAWSACTIONSS u and bettwee JAMES H. FREUdD and + {qI Zgf;Uf P,3 r I Til, Afu (.rVendor. }0,1 ! I. whether one or more) and...... ILLARD...A.__•SELFEERT.._._--..._-_.. at 11:45 A. j~ A~f l Vr,,~.J,+G3C. ("Purchaser", whether one or more)' QegislerOf DeedS - Vendor sells and agrees to convey to Purchaser, upon the prompt and full p^r- formance of this contract by Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property''), " in St,._Cro,3x County, State of Wisconsin: RETURN TO I` Tax Parcel No. Part of SE4 of SW-4 'and SW-4 of SW14 of Section 4•-28-19 described as follows: Lot 2 of Certified Survey Map filed March 12, 1984 in Vol. "5", Page 1403. •1 r , This is not homestead property. ( (iwnot) I Purchaser agrees to purchase the Property and to pay to Vendor at -..--Hudson, .Wisconsin r the sum of in the following manner: (a) R5UQ.-OO..ak_.o.r.-prior-.to- Xsd the execution of this Contract; and (b) the balance of Q 24,0.0.0..-0-0.------------ td;<ether with interest from (late hereof on the balance outstanding from time to time at the rate of...nitte-.(^%) per cent per annum I until paid in full, as follows: li Monthly payments of $193.11 commencing January 31, 1991 and continuing for 59 it consecutive months with the entire principal balance remaining due and payable on or before five years from the date of this Contract. Buyer to pay additional $3000 principal payment due on June 30 of each year. i xxxxaYxx~dxe~x~tlc~t>xeaidre~bxDWO~xkailliies~~pxi!~xfx!~xxxoaxlxl:f~xx~tx~cxxxxxxxxx~R~t~4~ xxxxxxxxxxxxxxxxxxxgmUkxxxxttkommt=tk sllxxxxxxxxxxxxxxxxxxxxxXXXXXXXXXXxxxxxxxxxxxx Following any default in payment, interest shall accrue at the rate of...-.9..... per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). xxxx~•x>~xaixt~sscx~oxa~cb~ilt~e>>cd~xa~e~s~~x+iai~x4axY~xxR:~~IIxRx~€2tk~~4~~R~x4~~R*xl~~vkR~t5t4e?- ~,x4~lixi~s~xil:~xpncliokxsislll~slaseaol~7c~sca~x4[ +~7~xl+t~>sc~cx~c~{fiLRil}l:~~hlsmakcc~i!21x1~d>xxxk~oicxtxxi~xdcltRikiclrit~c, , ~'x>t~sc>I1asx6axa~nk~c~x~4lts~~t~4t~~sad~at>atx~'1?!x~~€x~x~xse~a,cnsxac*tx~xechcb~~x~t~x~xp¢xrxiltxrt ~eXxa~esxmlaafx>~IxvaA>:474R~ati~xrcQCa4cxaxt~xoe~axrt.~ta¢IC~atxims~ciaxotxl~mtkxa~c~ara~xaa~a~t ~ xx]>essttaa'm~txetpaiene>!tx>~x~l[7FX Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any (role, . ...............xxxX>tXxXx~ ]sitt~tac~xketa»sxpstie~aoe~okxnE~ca~ci4~txx~xlsxiffi>x xs~x~,~ixa~~c In the event of any prepayment, this contract shall not be treated 14 in default with respect to payment so long as the unpaid balance of principal, and interest (and in such cnse accruing interest from month to month shall he treated as unpaid principal) is less than the amount that said indebtedness would have been hnd the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herei'roln. xXXXV) xatmmxelxllexltkatxR=ck3a;ex3iKxxbiafn X)WXMYdgxsdeaxxxlsgxt xt4t4K,exldg=x;aioxftockkKf xmbxxx Xa~cas>4xtx~apsbt Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on.closing. X*Xkx...... •Crer-3 Out One. LAND CONTRACT - Individual and STATE DAR (I WISCONSIN Winconnin L,anl Illank Co, inc. Corporate FORM No. 11 - 1992 Milwaukee, Wis. •sazn)sut?)e arey) nwI.ol I,:I"pri .m pod it 4 Pin nl^ .ttCn;dv:, ;,rn n~ av!Itaix !anc:.,.,d Jn ""'I"N,C\ tt~6T •-----------•-••-kt rn-S~. :al13p . 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Rlaado.r,l atjl tit 1sa.10lut pin'. oll!l 's1t1,0•1 s.taFrtlaand pur joraluoD stgl alruttu.tal 'uotldo stq In 'Armt -ropuaA (t) :R1tnb0 tit 3n n',r.t Ril paptnoad Ds0111 of TIOMPPr tit (,,•rl Rq PaPtno.ul s11at1ti1tttitl Ru11 of laafgns) saipattn.l pnr. sJ112111 2tlim0lli,l 1111 nnrtl OFlp. 1111119 tOPuaA Pilr'(SDAII?m S(I010t1 aastigalnd gatgm) aatlou Inoilltm pun uotldo s,.zopuojk in 'llnj tit ,pi'Rr.d pur anti Alalr.tPatunu omoanq [11'149 1ar-tln0,) still Japun aanrlrq 2utpuulslno a.ttlua oil[ uagl'(1!rti1 pa!Jl1aD0 Ail paln'm u, Rlimimmad paaantlap) JOPu3A Rd Joan, nalloa ua1It1M 2111molloJ sRep b-6-- jo potlad a aoj sanulluoa il0!gm 11srilo-rn,t j0 no11r ►!Iq„ 0014[0 ,fort ;o aouruta0j13d tit llnrjap 13 Jo Juana aqI ul (q) J0 alrp anp patj!aeds aqI 211l molluj sRtip --06 to pol.tod r .1100 sonutluOD rlalgm 1simalut .10 pulmutad Rur jo IuatuRed aq1 tit 11majap r;0 Iuana Dill tit (r) put, 011110990 ngl jr, S1 mn1J [rill SDmIlit. aafmil.-n,l •asn TLuos.zad- jo3 A"Iaadoad 0140 $uTsBga-.znd-"--- iioszedsates a~e~sa p90TT B sT aai(..................................... slaUaS -----•---------•------•--------y yp g •aasegaand ;o ;tue;ap ao I0e aql Aq palroto soauragtunaua act suatl Rur Iftma `saauragtunoua pur quail tie ;o tsat0 pull aalj 'Rlladold 0141 ;o `atdmtq a3j ut 'paeR X;urxaeM it lxwimgaan j wil 01 19Atlat) pun eln0axe 'puvtuap uo ljtm aopuaA 'patjt0ads anogr, aauuetu oql tit pur wmml aql it, patu,oped Rllnj aq tl1349 suotl!Puoo file pus plied Alin; eq [lugs kauotu laglo pun 1sa.talut illrm a0tad aStiilO.tnd aql aSCa tit letll saa.t2r aopuaA -Apadoad aqI lurlrjte suotlrln9aa. pur, eawinulp-to 'smrl llr qI!.-A Ald1u00 of pus 'IaraluoD stgl ;o ustl aqI 0I zotaadtts suail tuna; aaaj Rlr+doad sill daml of '1!rda, pun uotltpuoa algrlurual pool tit Rlaadoad 9q1 daa>[ of 1R71ador j aq1 uo palltu6uo0 eq of OISCtA moll' 1011 RISUM 1!11111103 01 Iou slurnanol lasrgaan,T -...te{girvaT lterN+ aq of 1tCda, 10 uOlV1019aa agI gtuaap aopuaA aql paptnoad 'pa2murp Rlaadmi,t aqI jo 1trda, ao not Ca ilddit ail [legs spa;)-,load aauransut '9utlt,m tit 003213 astm,aglo -Tnpu,,,\ Put, aasrgoantT csDlull •.ir?s samr.dnto:) a,urausm oI ssol ;o 031lou an12 Alldtuoad Ilegq aastigaind •aopuaA ill m p3ltsodo) n fs?tt!t t-adoad Dill 2111.taAO:) sam;mlod ❑ti jo ltint2mo aqI Tutl!aes tit 900,213 astm,aglo JopuaA ssalun 'Put? PTIM Pill .11) -tonrj tit) asnr13 P.n?Purls eql mr.1u0D 1113,19 salarlod aqL enp uagm stuntutead eaut:an hugs aasegaand •IaviluoD still Japun pamo aoueleq aqj uegl aaoul lun6ut13 1113 tit 0293DA03 a, qs aopuaA Inq t Jo urns agI ut ',Opua,i Ail PDAC.'cidr oath `aour,nsut-03 Inogltm 'o•iynbo.t Rptu 10PaDA sr, 9P,rzrg .1Dgln gaps pur 91f31(1 121131AOD PIP11n1 •IuatuRrd galls 51mmogs sldtaoal p,IrunP uo JopuOA 01 19Attnp 01 Pur. 11 at 1 uordn Iro Allado-td aqI tto Patna[ sluatmassr pur saxrl lie anp uogAx Rrd of 9asttuoad aasttg0,nd _ MAR121884 Sao & cool" y of ftow i 3917.18 CERTIFIED SURVEY MAP Located in the SE 1 /4 of the SW 1 /4 and in the SW 1 /4 of the SW 1 /4 of Section 4,:' T28N, R 19W., Town of Troy, St. Croix County, Wisconsin tif rk.... Surveyed for: James Freund LEGEND Rt. #3 COUNTY SECTION CORNER ' Hudson, WI 54016 BERNTSEN MONUMENT • I° IRON PIPE FOUND O "X 24° RO :ND IRON PIPE 11 IG tifIG ~.68 LBS../LIN..FT. SET NOTE: FORMER ROADWAY EASEMENT 'h IS NOW A :TOWN,$HIP ROAD OADWAY- - - EASEM NT- `t - N 890 04' 486.00 - _ -16 Ex I, 9io 204.20 R /W LINE p "Zi~wDi gbZ 66 Ic rnrnrncn s ( N z a OT I ro 00 _ LOT 2` o *Mom 00 EXISTING HOUSE O. N°$ -4.4 P o ~-~i 00orn O.. c0 0 40 - Irn C I z Zo a''o 15.31 ` m 0_ w co z/ :s 1'V m o m A Z ~Z 5 ;r v m r rn A z 0 rn I O oq m fp C rn .A ~ `7S IN M o o 151°17.40 u- 1 rn ,p; - i4wN FEET, -200 ~D % DP o M. w 60 rn 0 50 100 2150 300 400 (cn $ 189.17 ~87 14 431.87' E NOTE: Access to Lot 2 shall be R e from the adjacent cul-de-sac. zPOINT OF BEGINNING. c w UNPLATTED LANDS THIS INSTRUMENT DRAFTED ,B v O Y C ~C /S '/4 CORNER SECTION 4 SOUTH LINE OF SW I/4 SECTION 4 / T 28N• R 19W 1437.51' _ S 89004 W DESCRIPTION .A parcel of land located in the SE 1 /4 of the SW 1 /4 and in the SW 1/4 of Mier, SW 1/41 of Section 4, T28N, R19W, Town of Troy, St. Croix County, Wisconsin, described as j follows: Commencing at the S1/4 corner of said Section 4; thence S890041W ( assumed bearings referenced to the South line of said SW 1/4, bearing S890041W). 1437.511 along, said South line; thence N0050140"E 438.00' to the point of beginning; thence continuing N0050140"E 462.001,- thence N89004'E 486.001; thence S0050'40"W 349.941; thence S2903 -31W 114.001; thence S870 1412011W 431.87' to the point of beginning, containing 218,01Z square feet (or 5.005 acres) more or less, and being subject to all easements, restrictions an covenants of record. Alsc,the roadvray easement as recorded in Volume 542, page 177, St. Croix County Register of Deeds, is now a Township (public) road. To eliminate any questions regarding access, said roadway easement is included hereid_by:refeZ8i0e. 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 eprrect representation of the exterior boundaries of the land surveyed;. and that I have 4 ]y;cozn lied with the provisions of Chapter 236.34 of the Wisconsin Statutes, the St.. Croix County Sub- ' division Ordinance, and the Town of Troy Subdivision Ordinance'-to the best of'my pro- fessional knowledge, understanding and belief. mes E. Rusch APPROVED r ti Wisconsin Land Surveyor S-1376 JAMESIE 421 Second Street RUSCH Hudson, Wisconsin 54016 R 12 1984 34% 8--ox 1111111114 COSY i~1111116 November 30, 1983 SL C" Vol. 5 Page 1403 PcCO MITre SEPTIC TANK MAINTENANCE AGREEMENT ;D St. Croix County OWNER/BUYER 0 ROUTE /BOX NUMBER Fire Number ZIP o / w lac i~ o CITY/ STATE n PROPERTY LOCATION:'_ .3-, Sections. T 2' N, R ( q W. Town of l/~~ _ St. Croix County, Subdivision Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Prover maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed' 's'ept'ic tank pumper. What you put into the system can a ect the-function of the septic tank as a treat- ment-stage in the waste disposal system. St. Croix County residents-may be eligible to recieve a grant for a maximum of 60% of the cost.of replacement of a failing system, whi.c 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 's s~ t•ems agree to keep their system properly maintained. The property owner agrees to submit to St.. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or.a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and .(2)•after inspection and pumping (if nec- essary), the septic-.tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year-expiration. F3 0 I/WE, the undersigned have read the above requirements and agree 9 to maintain the private sewage disposal system in accordance with 0 the standards set forth, herein, as set by the Wisconsin Depart- ment of.Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration. date. SIGNED DATE ` St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. LDINGS DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) L(5-CATION:ION: OWNSHIP/Nittw~Y: LOT NO.: BLK. NO.: SUBDIVISION NAME: /Tz; N/R/~9 E (o T o COUNTY: OWNER'S/ E AILING/ADDRESS: e-t er 441 DA ES OBSERVATIONS MADE R PROFILE DE CRIPT ONS: ER OLATION TESTS: USE NO. BEDRMS.: COMMERCIAL DESCRIPTION: ~lew ❑ Replace ~O 6 Hesidence 3 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSUR]S!~ EM INFILL NK: RECOMMENDED SYSTEM:(optional) Bs ❑u fls ❑u s ❑u ~s ❑u DESIGN RATE: If any portion of the tested area is in the Fun rcolation Tests are NOT required r s. ILHR 83.0915)(b)), indicate Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BOrr DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) _ ' f! . 2 / esf 7 Lc1 r Br / B- 9' cke_ ''4 ' r pjfk~ Y. ~ 2- rs~ c ~ B- y 7 i - B- pd 9 GG Ali e B- 3 7. lk~qfr 7 114 r3 / B- ` 1t. del -C > LfZ > ".svrt 6' ' PERCOLATION TESTS DROP IN WATER LEVEL-INCHES RATE MINUTES RTEST FDEPTHH WATER IN HOLE TEST TIME PER INCH AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER 3 7 P- 3 P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the At"PS ow thface elevation at all borings and the direction an percent of land slope. SYSTEM ELEVATION cGL ~ r / 3 3 a I ~ 3V Y~ A kw ~r - N Y f/va - E _ F I ~ ~/ate • ' . _~tt . _ _ n~-, I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accor ith the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: DAVE FOGERTY PLUMBING / 6 yi ADDRESS: 3233 X3289 CERTIFICATI N NUMBER: PHONE NUMBER (optional): Fogerty He' hts Road ROBE CST SIGNATURE: Phone 749-3656 (2 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - 1 °s m~ gbo Sip 1~ b c ~P 1 1 4 S~ I k \ h v ~ W •~II! ~~1 i • I n 1 i • . all ti r SANITARY PERMIT APPLICATION .LT .DILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ~Q` to 8% x 11 inches in size. C eck revision p evious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP RTY O ER PROPERTY LOCATION elF_ '/a_5 0'/4, S Ta , N, R 19 E (or) W PROPERTY OWNEPAS MAILING ADDR LOT # BLOCK # 'C r CITY STATE + ZIP CODE PHONE UM ER SUBDIVISION N M R CSM NUMBER Ds ON S V CITY NEAifEST ROAD 13 II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE MB ❑ Public 1 or 2 Fam. Dwelling of bedrooms *RCEl Ax l' III. BUILDING USE: (If building type is public, check all that apply) (,r 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. RNew 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 300 Specify Type 41 ❑ Holding Tank 12 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. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) P SED (sq. ft.) (Gal / y/sq. ft.) (Min./inch) "I/.so EVATION l ~l C~ p ti Feet ~ - eet VII. TANK CAPACITY Site in gallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks Concrete glass App. Tanks Tanks strutted Septic Tank or Holding Tank _ 6D D Lift Pump Tank/Si hon Chamber F1 11 El I Ll Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plum is Sigyatu (No Stamps) MP/MPRSW No.: Business Phone Number: -11 f"111 ON ryl*t. .1, Qll~ oy f 3a~ y~ Plu is Address (Street, City, Stat I Zip Code): V VA) &9 f6 ~j S~ N Io1i ,x_C %a IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Sign at o Stamps) / Surcharge Fee) /7 _q/ Approved Owner Given Initial El ~s 1~ I ~ Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS r 1. A sanitary permit is valid for two (2) years. 2. Your sanitarypermit 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 Sanutary 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. 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. 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 3% 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; close 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) 7 5Ts FAQ ASvsp/os/oA) D SAFETY & BU11 C,F_PA'ttT?v1ENT OF REPORT 011 SOIL BORINGS AN "1: Cllr' ~~ASOR AND PERCOLATION TESTS (1.15)1100% MADISON WI' HUMAN RELATIONS (H63.09(1) & Chapter 145.045) 9ECTIO - TOWNSHIP/MUNICIPALITY: OT BDl I 1 NAM ° S Y4 /T N/R 19 E I ► W •T~ po Of AIJUHI CO NTY: OWNER 'S NAM MAILI ~/S r • rs • C/Pa X _A 't"U~(I USE DATES OBSERVATIONS MADE _ ANN TI _jF NO. BE S.: COMM R L SCRI TION:Lrr D1°SCl{ rmr. Residence 3 4 AANew ❑Reptace J~3 ! C S I ~ 111/6 t - 9-VW-1,AAP7_ CoA) f;W 0457.1 RATING: S- Site suitable for system U- Site unsuitable for system .1 1 -.1 N\rENT10NAL: MOUND: IIV-GROUND-P~i l ST M-IN-FILL OLDING TANK: RECOMMENDED -SYSTEM: (optional) ~ouvEujio~l/~L cR 7/PE.v~~-s_~ ~SDU ~9S❑U ®SOU ❑SQU ❑ S ©U r t ssrE If any portion of the tested area is in the 4V If Percolation Tests are NOT required 77~ indicate Floodptain elevation: v under s.H63.09(6)Ib), indicate: Floodplain, PROFILE DESCRIPTIONS /U iA/ '01, BORING TOTAL P H TO W_ j DWATER-IN jFr CHARAC I ER OF SOIL WITH THICKNESS; COLOR, TEXTURE, AND DEPTH NLIMSER DEPTH ELEVATION OBSERVED ST. I H S TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) p , /.1~Ae, ► /Of'Bf/. S'/,` ./7' . 13"' 6'AA). ys3y . B-3 ~5 95• sO ~ > 9 ~'S 0;r I C r i Jf ' : • ,~.t/ , Si L , ko,? ,B.I/. Sit f ' B.v. S L / (o. 17 ~ A Ad At. 8N , tOA.A4 y . f .8,11 SL PERCOLATION TESTS MINUT TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEV L-1 H S RATER INCHES NUMBER IN AFTER SWELLING INTERVAL-MIN. PERIOD_t P.ERt D Z - - _ E T P' P. DUE' %i P eA 25 .3 P PLOT PLAN. Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are i :ontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction ~a/nd 1 . n of land slope. 130770M 0r- 13e-J) ok , e-AES $4AL Za trX4C;rj SYSTEM ELEVATION f l • /~ELo w U"r/ew- - ' J~0 fT ' tv 7ce- Tzsr eev T P S s• 7- 6 T. ..S ow Ldt-R 40JV1,,4 r/Uy 56;~~ Thies t-,,- t for Co»ver'iiranai PpROL7,y eptic system'~ J 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specifiad in the Wo ~k Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. 91 AM print): a 7rr T-ES-T S WERE COMPLETED ON- i 'OOB urivdliliHir '3W./ /f V 3 A DR S: CERTIFICATION NUMBER: PHONE NUM ER(opti(-.. 4. HOMESITE , ' CST SIG ATU ~ 074EIL ROAD t "WDSON, WIS. I DI>iTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Terror. I f REPORT ON SOIL (3UR~NC~S PERCOLATION TESTS IIS Pao r P I. AN PROTECT t. a D'A fee-. y T~ e ti, e'py q V3 HOMESITE TESTING CO. n'r.3, O'NEIL ROAD BOB ULliluc, a iiU USOH, WIS. 54016 C S T S.S-- 02 PROPOSED HOUSE mosr Cm 2~ Fr o,t Mo~'E F~PO.~ ALc TEsT ~9,PEAS. RoPosEO WLLL Musr Wf P So `T a~ tiO~PE /CiF'OH A[.L TEST ~iPE/f S, ~ • = DAC,('/yoE /~~TS O = EXifT/N !•tJEL~ i X ` ~E~G IOG~T"~DGt~f a yAgJO fjv9E.PE0 o,Q S~ovEL ~a~tES -rep o s llow;z . BM ~E~1Tic~►~ ,PEFEREwcE- Pour A~ijr s PaT ka. Pr. ,~oUUV Cv o o y r-,6 ~ r A 7- Co,PU£,Q LEGEND 61EVAroN o` t1al. kE,,~C Pr. /o o • fr . f3~-133 I► •~-j . t 40 P -S E PA S-7 L QE- for ie^ site A1~p a cQnveritional se ptic s ystern, fa.Ku, k~.,-tee 30 1 O 1- " - 13 s s 6 } V - - - - i I /ll.ltaag1E - ~ RAF. s E-- f3 s5 a .r~ 3 - SyS104 - ' ~.L ro CEN iE,2 S(c / 3~ 55r r I~ 3(n of RD S "sC • ---+t--- it-- ---~c- - - O _ O ~ P~~E ~~f£s pvAL 13 .a c E a Go f V~ S A , Fs so~ t°1,P) ~~(~s ynr~E~~D "PE60 ILE AR1219~~ M _ COVV4111 lb O F LEO sly, d0f LM a ela ow keg 'f .41 r<< CERTIFIED SURVEY MAP Located in the SF 1 /4 of the SW 1/4 and in the SW 1 /4 of the SW 1 /4 of Section 4, T28N, R19W, Town of Troy, St. Croix County, Wisconsin Surveyed for: James Freund LEGEND Rt. #3 COUNTY SECTION CORNER Hudson, WI. 51016 ® BERNTSEN MONUMENT ® I° IRON PIPE FOUND O I' X 24° ROUND IRON PIPE WEIGHING; 1.68 LBS. /LIN..FT. SET NOTE: FORMER ROADWAY EASEMENT IS NOW A TOWNSHIP ROAD RO_ADWAYr r _ EASE_ M_ENTT ~,I N ©9° 04~ 48G.00~ N~0.m I`V `9/0 204.20' R /W LINE p , z zcMN ps. Z V 66 1c M j; M W rn y M ~z Nzzc 0 L(gr 1 ~ ° LOT 2 1100 0 rte- gmmm ?ff Qctt ! 0 (D O D vvv EXISTING HOUSE I`t;p p o m -b of DOpm 0 1n o ut ~m °ot •nc...f z zcn 15.31 w io O v to .i z IT 0 DID - I m=mz ✓ Ir ° 0 ( c.!_ n N ~ .1 L:. v'.t f7 r Gt IDj O M. z O ' I~ p Z N cn o 0 151017'40'~ 1`~ ~y m , t~ y o - m s X220 - ti SCALE IN FEET I"=200' 1vz 6o'L'~ nt ~i9~ o l O 50 100 200 300 40o cn 189.17 PI 87614 20 E 431.8 7'-- POINT OF BEGINNING R-g0' z 0 4 UNPLATTED LANDS THIS INSTRUMENT DRAFTED BY14 l4 to 0 v 0 I Q /S I/4 CORNER SECTION 1 I m SOUTH LINE OF SW 1/4 SECTION 4 / T28 N, R 19W 1437.51' V^ S 89°04'W n DESCRIPTION A parcel of land l.ocnt:ed in the SL 1 /4 of the SW 1 /4 and in the SW 1/4 of the SW 1 /4 of Section 4, T28N, R 19W, Mown of Troy, St. Croix County, Wisconsin, described as follows: Commencing at: the S1/4 corner of said Section 4; thence S890041W ( assumed bearings referenced to the South line of said SW I /4, bearing S890041W) 1437.51' along said South line; thence N0050'10"E 438.00' to the point of beginning; thence continuing N0050'40"1-, 462.00'; tlicrice 1`4890041E 4136.001; thence S0050140"W 349.941; thence S2911-• 114.001; thence S87o 14'20"W 431.87' to t:he point of beginning, containing 218,012 sc1t1; feet (or 5.005 acres) more or less, and being subject to all easements, restriction:; covenants of record. Also,the roadway easement as recorded in Volume 542, p.-Ii c- St. Croix Connty P.egi3tcr ul Deeds, is now a Township (public) road. To eliminate ..111 questions regarding access, said roadway easement is included herein by reference. 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 cornpli~ with the provisions of. Chapter 236.34 of the Wisconsin Statutes, the St. Croix County 51111 division Ordinance, and the Town of Troy Subdivision Ordinance to the best of my pro- fessional knowledge, understanding and belief. ~j `,~~r11111111p11.1/jez % ~GGO,V sz fames F. Rusch ?f Wisconsin Land Surveyor S-1376~e1 PROVED 421 Second Street JAMES E. 's Hudson Wisconsin 54016 n RUSCFI~ All 1 1944 &1316 e Iludsm, November 30, 1983 VAL r iT. CROIX CO(IN1Y Vol. 5 1110) C0)Ar1IiIW11!IVii•I'LItr5 PV.N-141, o, O~'+.w..r• ~ V~ hull i- 111r, srl f flM0,111111i S LI VI _ J P L OTA(fli , \ N 67 P' cr,oss sECTIC P ~1 -r SID L. U M- is N M o , Te C AT 10 N Lic EN E. _ t:~ n P LL 0 I" M A P r 4 p► fie rzro' d •R " • tYl p o S • P3 . Qee • S-~ t SS 1 3~~ Yp~ LR~~ i cp Sa,~~l. I arr I ; e Ck SIa veo. Pf-f- VA . ~ I b o ~ Fn d r~ se ~'f' G O = y t n'~ • P~ P fi r- £ I-~y• too, ~ I ~ KWIZ W2 "s -f Pn ^6~ Wovt7 I'-crv ce Po f A WAX !L lot CUIL"p- IV FRESH AI1: INLETS AND OBSERVATION PIKE _ C10-S SECTION Approved Vent Cap Minimum 12" Above T j Np} GrPW f,. Final ,E de A" Cast Iron Above Pip Vent Pipe f To rinal Grade* Marsh [lay Or Synthetic Cover].ilg Min. 2" Aggrogl-if Over Pipe Distributi~~ Tee • I Pipe ._..__.._.I Aggregate ~Q Per-f.orated Pipe Below 9 ~~50 Bepcath Pipe Coupling Terminating i, I °~pA" Bottom of System _1x/fz- s ~•4 d 'r C t C m d w C m L °O E r {~I r y a o a o f M o Q c > - t~ ° c Qa E s > •m> r a N N ° m rn v c m E E `W N r N h ~ C r N'~ E o ° oL 0 0° > o H m`°' E a~ O m m Q p N m 'O ? a-°i ~ etc ~rn 'c N w- .0 f0 a m mw r Z O r y 'O m m 'O r 1 > ° c O Q Ir L" 2 -.2 E Cda m Y =m a ° I1W Ea N 3U a 01 L) CIL O ~ t CL ad > w E E E wt m`L 3c W CV) U d 'O m fp N r- N 4) d N W c Q tC r~ c~ dE~ 29 Y O V' O E ° v d o 10 a E I- m~ >o >~a~ o,L >2 r a o> °d m=w d p° Y. ~c W E _-0 O _ m m c E L d -o'5 c c 3 v v w d y m"'~o O C N c a _ 4m W U v _ Z N .c L 3 C m m N~ t 0, T H' W e ..lo V Y-_ H y w i v y O _ v E E Q G a ao _~o` ° m d v~ o wy n w z w ac z Z L U) F- O p U o o w z cr D ~n LAJ acc U (_9 o U) QU) D w oO ~ z w C2,00 d W cD L1,1 ° U Q z U oC • O D Li: LL w I U co W w cn Ir > X W CO#* O t LL .__I 2 co cr W m z - o U) cam _j 0 z = C103 0 CL < Labor and Human Relations Office of Divmon Codes and Application Safety and Buildings Division Onsite Sewage Section PLAN APPROVAL APPUCATION P . 201 E O. Box 7969. Madison, A S3707 (608) 266-3815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The reverse side of this form describes most of the required plan information. Further requirements may be contained in the Wisconsin Plumbing Code, which can be purchased from the Department of Administration, Document Sales and Distribution, 202 South Thornton Ave.. PO. Box 7840, Madison, WI 53707, Telephone (608) 266-3358. 1. PROJECT INFORMATION (Type or print clearly) Plan Number Previously Assigned Nap>o.of Submi ng Party (plans returned to same) Project Name c i^ I tre Address, P.O. Box IF r Rural Route Project Address or Legal Desrnption O d city or Village State Zip Code City ❑ County " 5-1/6-Z? Village ❑ of Telephone No. (include area code) - Town ❑ Designer Name of Owner Telephone No. (include ea code) Telephone No. (include area cane) _ ` Street dress, P.O. Box f or Rural Route Street Address„ P.O. Boat 0 or Aral Route J City oM State Zip Code City or Village State Zip Code Z Cr✓T o2 2. APPUCATION FOR: ❑ Experimental ❑ Mound System Q Now" Tank ❑ New Construction ❑ large System ❑ Convectional Gravity System I❑ Grourdwater Isilonnwing ❑ Replacement ❑ At-Grade ❑ System in Fill P<Petetow FOr Varaan0! ❑ Revision ❑ Pressurized System ❑ Sys" in Flood Plain tattach 580-6698; Q OtlWstternaiaves 3. FEE COMPUTATIONS (include existing tanks) FEE SUBMITTED i, MAKE All CHECKS PAYABLE TO SAFETY i BUILDINGS DIVISION. a: 750- 1,500 gallon septic tank S S000 O 3' b. 1,501 - 2-SOO gallon septic tank S 60,00 .D t z x c: 2,501 - S,000 gallon septic tank tr s 30-00 d. 5,001 - 9,000 gallon wptic tank S 100 00 O 9,001- 15,000 gallon septic tank S 150 00 d f- Over 15,000 gallon septic tank S2SO 00 ru 9 500- 1,000 gallon dose chamber S 3000 : z h. 1,001 - 2,000 gallon dose chamber s 5000 r i3mc i. 2.001- 1,000 gallon dose chamber S 70 00 J 4.001 - 8,000 gallon dose chamber S 9000 r R k. 8,001- 12,000 gallon dose chamber $11000 fl t R Z¢ 1. Over W= gallon dose chamber S 150 00 O ~ 1 O 2 M- 500- 5,000 gallon holding tank S 3000 s' 1 n. 5.001- 10,000 gallon holding tank S 5500 V, 0. Over 10.000 gallon holding tank S 100 00 : r s p. Revisions S 2000 Ti i f q Groundwater Monitoring - Per Site S 3200 AJ (other than a proposed subdivision) r. Petrbon For Vanance: Setback ~S ion S25 > Site Evaluat L ri Subtotal: . s Priority Plan Review: Enter same amount as Subtotal Total Fee: >S~i'+ 6/ .y SOD-6748 (it O&U) NOTE flees are Dvsuant to Wa s..-rr+ C1,4w, Char Ind hey. are subpect to change annaaity i~ 61P fa a HEALTH AND SOCIAL SERVICES -;i~- / 274-29 conditions at the depth of the proposed mtem and soil permeability is limits to the maximof m the class used or esign purposes and the soil condition is confirmed by the soil bore test data. The department reserves the right to require proof of the map findings or soil texture and resultant anticipated percolation rate. The exemption of percolation testa does not eliminate the required bore hole test data. The borings shall be distributed uniformly in the area of the proposed system. If soil pits are constructed they shall be located immediately adjacent to the area. cam. 2. Sod maps. When a parcel of land consists entirely of soils having very severe or severe limitations for on-site liquid waste disposal as de- termined by use of a detailed soil map and interpretive data, that map and interpretive data may be used as a basis for denial for an on-site waste disposal system. Nevertheless, in all cases the property owner shall be permitted to present evidence consisting of soil percolation test data, bore hole data and topographic survey data to support the conten- tion that a suitable site for an on-site liquid waste disposal system does exist. (c) R On each parcel of land being initially develops sufficient area o suitable soils based on soil tests and separa- tion and site requirements contained in paragraphs (b) and (e) for= replacement system shall exist. Where bore hole teat data in the replace- men system area are equivalent to that in the proposed system area the percolation test may be eliminated. (d) SeptiX tank I= ion. No tank s be lWted wi in 5 feet of ' building or is appendage. 2 feet o an of line. feet o an cistern 95 - feet of an well, reservoir, ow ground swimming or the i - water mar o any lake, stream, pond or flow!&e. wN~~ eptic tanks should be sooated to provsde acceeelblilty fm pumping and Mrvioe (e) Soil absorption site. 1. Location. The surfAce grade of all rptio-ni'disposial is systems shall be located at point lower than the su - ace Krage of any near water well or i e the Bite shall so lo- cated that surface w r rain a from the site is not erect toward a we or raw, an ass the we or reservoir site by several feet. The soil a on s tern shall located not less than 5 feet from an w 15 feet from an above ound swimmin pool; 25 feet from an l below grade swimming 1 or cistern.- 50 feet from an water we or reservoir and 50 feet from the i water mar o an a stream or other watercourse. Effluent disposal systems areas such as par lung o an drlvewavs are pro lte . Surface waters shaii be diverted away from the soilabsorption site. 2. Percolation rate-trench or bed. A subsurface soil absorption s - r rate for an one of the 3 tests is slower than 60 minutes for water to fall one iucli. The slowest Percolation rates used to etermine t e t4 absorption area 3. Percolation rate--seepage pit. For a seepage pit, percolation tests shall be made in each stratum penetrated below the inlet pipe. Soil ste&ter, January. 1979, No. 277 Health 1L'I'1 t0 N yonvV_A1 AUQI- AI'Y_LIMFION Wisconsin Department of Industry, Labor and Human Relations OFFICE E ONLY Safety and Buildings Division OFFI E USE ONLY Amount Paid 201 East Washington Avenue, P.O. Box 7969 Petition No. Madison, Wisconsin 53707 E-Number Receipt No. 608/266-3151 Nampa of Owner/Petitioner Building or Project Agen~,...A rchit ct or Engineering Firm Company Tenant Name, if any Street & Num er Street & Number Location, Street Number City State Zip Code City 1 State Zip Code Ci y County Telephone Number r 7 Telephone Number Plan Number, if known Named of Contact Person 1. The rule being petitioned reads as follows: cite specific 'rule number and language) 2. The rule b ing petitioned cannot be entirely satisfied because: / 4 ~tiy C. c'- 1~Zr C . 7i1 CF'~/~~ Cd /Gl /17v' v° u 3. T e fol owing alte nati4(s) and supporting information are proposed as a means of providing an equivalent degree of health, safety or welfare as addressed by the rule: ----~C~GU~t_ c.c~;r' ~_~-~~'c~• •t-- c ~ air~l>/~~ c r_ .t l~ _lt'~ t ` ~ GL-~ , t 7 - 4~ i a,-.ill r Note Please attach any pictures, plans, sketches or required position statements. VERIFICATION BY OWNER - PETITION IS VALID ONLY IF NOTARIZED AND ACCOMPANIED BY REVIEW FEE See Section Ind 69.15 for complete fee information Note: Petitioner must be the owner of the building or project. Tenants, agents, designers, contractors, attorneys, etc. may riot sign petition unless a Power of Attorney is submitted with the Petition for Variance Application. being duly sworn, I state as petitioner that I have read the foreaoina (NAME OF PETITIONER, Please type/print) petition; that I believe it to be true and I have significant ownership rights in the subject building or project. / Subscribed and sworn to before me this date: Signature of Petitioner My commission expires: ~ Notary Public SB-8(R.09/86) T n o ~ A m N m Ml c~ - A WF 04 1 ! 1 ~ ~Nin N CO V f `t cr, 0 ~ C r y\ l S W 1 I ~ I N 4 tJ -14 T-) ell I s I I s ~ v SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations February 1'1, 199? SILL }EIFFERT 508 DAIIIER ROAD HUDS01"I t! I 54015 Petition No. S92-00206-P Dear ►1r. Seiffert: Re: Pill Seiffert - Residence Private Sewage Systerl 508 Bauer Road Town of Hudson, St. Croix County, W1 Your petition for a variance to section ILHR 83.10 (1). loisconsin Administrative Code, has teen roviewed. The pot.ition has been approved. The rule being petitioned re(viires that a soil absorption system shall be located not less tnan 5 feet from any tat line. The variance requested was to allow an existing soil absorption system to rei;ain 2 feet from a lot tine. All of the data and statements suhmitted on behalf of the petitioner, were considered. This variance is specifiC. to the sutaject petition and cannot be used for any additional modifications. Sincerely, Richard !Meyer, Archl.:ject Director, Office of Division Codes and Application (658) 266-3030 RI-11: KS: 831wpn2 #8 cc:: Leroy ,1ansky, Pri vatA Sewa!le 'Consultant District 6, Chi npew Thomas Adel son, Zoning r~drsinistrat:vr - St. Croix County ti Dave Fogerty, P1u;:)her g c. ~---I o o~ ~ me 0 ~OL w v SRO 6928 (R. 01161) -