Loading...
HomeMy WebLinkAbout020-1037-80-200 -0 CD O N o N r Q 609 N O 0 ti ~ m C O O Z N 4) (D _ r- CU ~ p t N N N p V m C (p 0 o a°iY a y-~U) c (Doc;ga c c -r C p m O (nn.- m i m0V50z mZ c o~ o ~ o N y M a CO O O O N Z' O C z r -acc O ti c cep a ~j !n o c~ y cc 3 a of c> E d ~ of m p _m CL C) of fl! rn W O z m d co a co C O C C7 m o Z w m - a0i 2 p fq H r N z E N M Y N m CC C C O C O v Y O o Q c - 2 z D 1o z co m c N H E N ~ m O Q. (D O. 'W p M p H d E N L O O C e a U m z~> d o 3 hw c O O O Z o a a a IL v 7 p fn S O CD U) tq J V m rn } O Y co (ten N w 0 N m o o Opp E a o v m F- U) Q (D O o w y Q o O' 3 ? (n a [ l cQ p a c- C3) v 4. Cl) 0 O 0M0 N cU L w ) n cl) O' N co 7 U O V) E m U N O 2 (A O Z - c L L (n V1 `m E a L: a • a m d E c c r A U a U) U ' Form -STC - 104 T , AS BUILT SANITARY SYSTEM REPORT OWNER ~ A) -ga TOWNSHIP" 4'0 D So-J SEC. ~ T ~LN-R 20W ADDRESS J90 4)4442 S7 ST. CROIX COUNTY, WISCONSIN ~ s H upEio ) Gc'j S. S40 SUBDIVISION LOT LOT SIZE PLAN VIEW j Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I ' I i -OT P INDICATE NORTH ARROW 1V'4iL SST i•~ ~nOw~ 1 BENCHMARK: Describe the vertical reference point used ~~r Syle ld Elevation of vertical reference point: 702, o Proposed slope at site: 0 ( SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover ele Tank Inlet Elevation: Tank et Elevation: Number of feet from n Road: Front,O Side 0 R N , ear, O feet Vr6 m nearest property line : -Front10 Side,O Rear, O feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to,septic tank) SEE REVERSE SIDE e r, 7 f PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufactur Pump Size Elevation of inlet: Botto of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearer property line: Front, O Side,, O Rear , Ft. Numb of feet from well: T Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Lenffit Number of Lines: Area Built: Fill depth to top of pi Number of feet from earest property line: Front, ,O Si , O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distanc>of an). SEEPAGE PIT Size: NDiameter: oe' Liquid dept h: of seepage pit elevation: Area Built: Has either a drop box or distribution box O been used on any of the above soil absorbtion sytems/ (Check one). 9E744~t 70t,,) k- add o HOLDING TANK 3 Tn A:~'S /a S 1°~S Manufacturer: Capacity 36b6 Number of rings used: (3-_____ Elevation of bottom of tank: f3- so ' Elevation of inlet: ( F-7, O SST Number of feet from nearest property line: Front, O Side, O Rear, 0Ft..S Number of feet from well: DVS, ~flD Number of feet from building: 7 / /D Number of feet from nearest road: Alarm Manufacturer: Inspector:. p Dated: 1 f0 Plumber on job: H'RE License Number' • 655 O'NEIL RD., HUDSON, WIS. 54016 --TV^o~,T d64RIGHT N0.3307 FA.P-A.S. MASTER PLUMBER LIC i+ "JVTALLER & DESIGNER LIC. N0.00"3 3/84:mj A' X15 - (3 c.~i LT PLo-r ~ (.A~ T2 E for. t 1 Sfi/Sov~► L 44q7" U%CE 70 Ykvwe OFF to lt-~ iaTS12 ~24 ,v-hFE~TED1 i is Eve," 3 S E1 SO,dAC O ,gf N9 G ~ 0 of E 1~ h SAgooE ~ R~p~'. /0~.d a 4 v ~ -r 0 M 1 ~c.r• A'/''c C.o~~.O r J LE r EIEVAT J S of E f~tlTPOa S , T6 L) E.JTS c.r . ~ovvrcTic us -le q___ - y ?ay. S - 0 .i ~C O 3 ~il t>it5 - All /gi'TU.~t v.vipv S S~9C- ~o~tTtD F,tcTo (Q y W410- T4etr Lips s~~r/ D lf7- ~if~TO~y. R% as_ 3 tou" 5 ) fir-4X ti07 DER,ARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR &I-iWAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION SIy1QDl$QN~WIec 18 , T29 ^R20 State Plan I.D. Number: + NN~~+ If assigned) Town of Hudson, ❑ CONVENTIONAL ❑ ALTERATIVE X1 Holding Tank El In-Ground Pressure El Mound Nord St. NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Dr. Ivan Schloff- 59 W. 4th St. 22A St. Paul MN 5 102 , CH MA/R/nK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: T RP . ELEV. s Name of Plumber: MP/MPRSW N15.: County: Sanitary Permit Number: Robert Ulbricht 3307 St. Croix 11196-01" 45R;IQ20W/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: a TANK INLET ELEV.: TANK OUTLET ELEV.: PRWARNIOVIDNG LABEL LOCKING COVER ED: PROVIDED: 6C)0 aJI YES ❑ NO YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WAT rR' NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT FRESH q ALARM: FEET FROM w LINE / / AIR INLET- ❑ YES NO C0_5 YES ❑ NO NEAREST DOSING CHAMBER: LOCKING BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: E MANUFACTURER: M OLABEL pROVIDED:OVER PROVID ❑ YES ❑ NO YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: N_ ~ [ I UMBER OF PROPERTY WELL: BUILDING: VER TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: PUMP ON AND OFF ❑ YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST MOUND 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 TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: TRENOCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: A5 L /1/ ❑ YES ❑ NO ❑ YES E] NO NEAREST .99 6~V lr,- 7'leb~ in county file for audit. Sketch System on Reverse Side. SIGNATU / TITLE: SBD-6710 (R. 06/88) SANITARY PERMIT APPLICATION 701L R In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PER IT # -Attach complete plans (to the county copy only) for the system, on paper not less than 35 C( 8% x 11 inches in size. ❑ Check if revision totous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 157 fo ' 4O PROPERTY OWNER PROPERTY LOCATION n ~ R ,J sC Ct f F_ SE Y, /VC-'/., S /d T q, N, R E (or) W PROP TY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, ST TE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Z 2- f/ 71/ S'* II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ❑ State Owned / ❑ VILLAGE ~U~ SO,✓ 4/40A 42 , . ~ ❑ Public ❑ 1 or 2 Fam. Dwelling- # of bedrooms - PARCEL TAX NUMBER (S) 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 80 Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2./KiReplacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSO, AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) /(Min./inch) ELEVATION A/- A "(-114 Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Beetwe To it or Holdin Tank 4WO Lift Pump Tank/Si hon Chamber . +R+0 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Business Plumber's Name (Print): Plumber's Signature: (No Stamps) P/MPRSW No.: Phone Number: V6 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuing Agent Signature (No Stamps) Ldl Approved ❑ Owner Given Initial Surcharge Fee) 15 7~ 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 ' 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 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. ll. 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. Vlll. 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'h 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; (Jose 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.11188) o 9 x►SrlN& Well I UE,~P ~Pt~ P01;u7 RclriST£RED Supo yORTs F/000 61CUAT'" r;,3 "BF,u~ ~1 1~ (c ~,9q 3y I 13 0PR A 715 ► _ I ~i hOw FovaO: _I pi kE i rJ e --7r' sekSov,4 L RAVER T left 4-y RED ~ 6►a / f OF Spite ; 070. 1,0 _ ~ST~13Li$ t4QD F100D Plh,%3 0, CUeFACS' ASSuMEO EIr1'STraG- 2 F/?il.iJ(T C ie2d . S-ew.e~ j ~ Ct ss Poe 1 ~ TO Oft oz = CoQ$.O 0 QT/1NKS - 4~ Ii Tp t ,4 6A aOc.OeD m l pe,~ r ~ ff R ~ ~~ku F~o til P3,03 (2) t Bz I i / ~1NLET t lEV►Tie,J 700- y~ A Co97.o' i Sp e r ~Q O O 3 FIooD PRooF£D d HoIDi+~(r T.1akS. I giTUylvNpUS f0RM0 T F. 17 1. PLOT- PL-AtJ V~~wS ~ E EIV U APR 12190 *00 0 OFFICE OF DIV! r^ -on i-11- y,,., 1 rrr 5c A LE Z O I = d ~ c A elfoE 13o,010 G S Exis71,~6- foe-jo - /EV~Tiovs II` W 0 R'1 ~ LOT L, F I t I 4Y ~ al I State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL SAFETY & BUILDINGS DIVISION Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 I HOMESITE SEPTIC PLUMBING CO. Owner: DR. IVAN SCHLOFF ROBERT ULBRIGHT 655 O'NEIL RD. 59 W. 4TH # 22-A HUDSON, WI 54016 ST. PAUL, MN 55102 RE: Plan Number: S90-00682 Date Approved: April 23, 1990 Gallons Per Day: 150 Date Received: April 12, 1990 Project Name: SCHLOFF DR IVAN Location: 970 NORD ST. Town of HUDSON County: ST CROIX Fees Received (Priority Review): 110.00 The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - REPLACEMENT PETITION - REPLACEMENT HOLDING TANK Inquiries concerning this approval may be made by calling (608) 266-3937. I SBD-6423 (R. 08/88) State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION HOMESIIE SEPTIC PLUMBING CO. Page 2 Sincerely, OZ~ JAMES QUINLAN Section of Private Sewage Division of Safety and Buildings PPP012/0009n/ b cc: DR. IVAN SCHLOFF -Private Sewage Consultant -County _UW-SSWMP -Plumbing Consultant Owner Plumber Environmental Health ii I SBD-6423 (R. 08/88) State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION April 19, 1990 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 Dr. Ivan Schloff 50 West 4th Street, #22-A St. Paul, MN 55102 Petition No. S90-00682-P Dear Dr. Schloff: Re: Dr. Ivan Schloff - Residence Onsite Sewage System SE,NE,18,29,19W Hudson, St. Croix County, WI The petition for a variance requested to section ILHR 83.18 (8)(b) of the Wisconsin Administrative Code was considered on April 13, 1990. The petition has been conditionally approved. The conditions are that an 8 inch pump out port be installed in the manhole cover by the tank manufacturer, and the tank manufacturer must have approval for this fabrication from the department's tanks must be adequately anchored product approval section. Also the holding to counter the buoyant forces in the event of a regional flood and high groundwater. The rule requires that there be 2 feet of freeboard between the top of the service manhole of a holding tank and the regional flood elevation. The variance requested was to install three holding tanks with watertight manhole covers and watertight service ports terminating less than 2 feet above flood elevation. All of the data and statements submitted on behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. Si n ely, *d"- charrchitect Director, Office of Divisi Codes and Application (608) 266-3080 RM:JQ:0190e cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County SBD-6928 (R. 10/87) Robert Ulbricht, MP L ~ I.L.H.R. 83.08(2) PROJECT INDEX SHEET Owner: ~R. zvSCt, Laf p Address: S9 tl'` tw, 4tL• ST. 5T' PA uc. iAJ a, SS~~L Site Location: l,d 'T Acs i-or- S c me 1 SEAT ! T 2 y w -row, o f HuO.f0^-3 ST-.CR0I'x CbvaTY Project Description: < crt,B~,J Li r1 S f1 ~~fiL i.v G- So , ),I L C.eSS/° oo - v.e y~v~~~s 1 5 r cU'v UE•u TiOw> >t L- S y S y"E.~l W 4 76 e , 144L P o 1.u s ~v ~ ~ ;.v ~,c say s i/ I Lor k6i.47JV,641 V-0 s/oPE - FlAr YAK P> APE- Ap?0a0-0lA`TE(-y Be LO") `41-C EST~1 IQL~ S HED (»A Li S H E 0 4(6,t, F1oop pl.Ai.J E (c-v~tTi~ v5 70 2• U . "C) T-l PE o f SEPTIC 5 YS rE41 Ntv~~ aR ~o vE,~T~a AL IS Al/owA6ie' 00t To Q0tt..,.. F Ioov pLk /'J ~ ft: UhT i v.~S -=~,-ohs o~~~c~ SwTu ~'~tT t ~ Soi~S , p-opost v 1NSfh/~ 3 ~/vt~~~y fioov -~,~oofEl~ p1g t.tf r T~1 ti ~S .4 io o O , C0.I)kt f-t.. 1101,01A A6, PAGE 2, 4-1 (OL.~I•J(r T~►~k THOS S StcT~o~S PI,UMB.M : HOMES S8 T; DESIGNER 655 O'NEIL RD., HUDSON, WIS. 51016 ROBERT ULBRIGHT WIS.BING CO. VIS. MASTER Pt41MBER LIC. NO. 3307 M.P.R.S. H H OMNEILOMESITE RD., SEPTIC PLUMBING CO. iINN. INSTALLER & DESIGNER LIC. N0.00663 655 ROBERT ULBRIGHT 54016 WS. MASTER PLUMBER LIC. No. 3307 M.P.R.S. SINN. INSTALLER & DESIGNER LIC. NO. 00663 0 DATr ; SIGNATURE: w r VGElV t.U APR 12 1990 OFFICE OF~n>>ITS% r+Cnr" ^.~Ail L tau - o v Q Qo 13- z 06 - w ac 3 Ir q 2 V5 W r_ z~ W O :'x C mmCj= 3 _ 41 Po ti ~ ~ c ° T .r C 4 m V 06 O d b " C1 i o' r-+ CL b J v p J V , co L m A! W QU V c 41 N CL 4- 1 1 cl: so so o. M x L L 4:3 60 'k V Z~ b Z .G O G 0 10 U O MCA wr U W ' . c U Q ~ H > >L c Z IV 4J CO v" W vI U r-b \6 Q scc bos It a 0 4J L) 6-4 Ln .3 = 4J Q N W p4 ~r~• W qJ n U w C~ 4 N F-( Z L'1 Jx C -y V y~c •r 'u tm h v J •r r-I Q S O C-1- tn °om ; a ~3 8i~ ~ N 303 3 ~ ~~s 3 a V) n o x •r m L O sr 1 = 1 N 0~ p ~ ~ l~ .G4J Lt w ` 41 v to c 43 h = ¢ P o o. a Q r •r W C 3~ s- u z 0 a".ti c~ u w so :3 ~ S O ~ r V Z • • yN. p. ~ Z o APR 12 190 G j _ =1 1-00 r- W pwn Rf C lIJ r• €~s ACE 1s40 a b G G W W to OO a "on Anne.,S ~:S,doo 0 C J R! W W . I QJI-V A. N~JG L 1 r o' o c\W -'I i'' rq v1 C Q o r i W' to C T G '4 n I`1j I"' d y Z tvv cl) R 4' U C nicnM Go n' 20 > ~.po z G rn CA (A rQ H a .o k ~ m 1 L G ~ tt~ n n < o S 70 ig~ 1 98 N fA 4 Y 1 C o fi n G ~y ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 19 pi'w [9, F9, 114 911 FOURTH STREET • HUDSON, WI 54016 19 56a pwijk _ (715) 386-4680 May 8, 1990 State of Wisconsin - DILHR Division of Safety & Buildings Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To Whom it May Concern: The percolation test has been waived because of high gound water and Riverway District. Thomas C. Nelson Zoning Administrator cJ STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~`~'~^l ~ 7 CE ROUTE/BOX NUMBER / 20 1,U0A 9 S- FIRE NO. CITY/STATE ),2S ~ l S ZIP 7 PROPERTY LOCATION: 51-.:~_1 4 1V~ / 2~ 20 / 1/9, Section , T N, R W, Town of ffyl~Sy,.~ , 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 ¢ DATE /.2 St. Croix County Zoning Office St. Croix County Courthouse 911 9th Street Hudson, WI 59016 (715) 386-4680 Sign, Date, and Return to above address 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 o'f 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. 7-P Q Owner of property y4A,1 .sc /0f Location of property 1/4 N G 1/4, Section T.Y-! N-R ! W Township #'Z PS40A---/ Z 2^,` Mailing address ales ~ y 5 f ' P~vG ~I Address of site a !yd /e r A-4 P d CJ! S SS/Q~ Subdivision name Lot number Previous owner of property / y106=- Total size of parcel U Date parcel was created Are all corners and lot lines identifiable? x Yes No Is this property being developed for resale (spec house)? Yes No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, 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 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 constructs of said system, and the same has been duly recorded in the Office of the C ty Regis of ds, as Document No. Signature of 0460 Signature of Co-Owner (If Applicable) 02 0 Date of Signature Date of Signature 'l 2 r v fi i /fr, LDINGS INDUSTRY, NT OF REPORT ON SOIL BORINGS AND SAFETY & B DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 • (ILHR 83.09(1)& Chapter 145) ~jP/~~dX . d ,~{(~.5- LOCATION: SECTION: TOWNSHIP/AbUNI-CMALTTY: OT N0.• LK NO.: SUBDIVISION WA-0.7 NE 1/ NE y ig IT O N/R I q E (01 W NVvSo~v COUNTY: MAILING ADDRESS: y~.c,~r~i x Dom to 1133 AV"Ve~ef 4AE. Sv~TE yi0 sue' y b1i;vc~. SS// USE C41/3/ p 3P6-j`?/ DATES OBSERVATIONS MADE NO.BEDRMS.: COMM R IALDES RIPTION: TESTS: QResidence 2 ❑New %Replace A //,V ~ /Z_ r r RATING: S= Site suitable for system U= Site unsuitable for system SCS J 7 ^ ~~/~V~tirs SD~~S ONVENTI NU MOUND: JIN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDINGTANK:RECOMMENDEDSYSTEM:loptional) DS [DU OS DU ❑S ©U OS ©U ®S ❑U NOGD1a6r f"e ON1-1 If Percolation Tests are NOT required DESIGN RATE: NOT If any portion of the tested area is in the 01 under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: / PROFILE DESCRIPTIONS BORING TOTAL DEPTH T GR UNDWATER-INCHES CHARACTER OF L WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. H TO BEDROCK IF O SOERVED (SEE ABBRV. ON BACK.) B- B- /VOT B- (S,Rk /0 0 TI` 5 Q L Lo t.c.~ B- i B- . PERCOLATION TESTS L TEST DEPTH _ WATER IN HOLE TEST TIME DROP 1 WATER LEVEL-INCHES RATE MINUTES f NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD PER INCH P- P- P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the /surface elevation at all borings and the direction and percent of land slope. 'iII PD/Nrs /4Gt(~fS SI'1411 1d r C Vp&,0y SYSTEM ELEVATION. /3E/bw D• a~ R . RE6-; s?_>=--ee D FLooo Lit; AJ /&.u i 0AJ . 41 A_ .v r j _ I i ~ I i I I i CCU _ f - UN ONI G F ~u 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print : TESTS WERE COMPLETED ON: 3 _ HOMESITE SEPTIC PLUMBING CO. f a5ip' II R „ HUDSON, WIS. 54016 1 If JMBE ADDRESS: ROBERT ULBRIGHT CERTI ICAT ON NUMBER: PHONE NI. R(optional): WIS, ASTER PLUMBER LIC. NO. 3307 M.P.R.S. 2 4 82 3 - PIP S `!INN, fNSTALLER & DESIGNER CST SIGNATURE: ~`~L►l7r~l/` ~i~.Q~/~ I (NCO DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. -7 'Jig-7 1s~3 4 a' 1 0 r o o 4 I 4 •Z ~ 0 ~ - ~ ~ ~ Z u I r te -I ~ Y► u 3 ~W W N CD V C. 0- C~ "0 4 CIO M r 4 rt`~ ~L2 Z 1 (li ° a o 0 0 ~ O o ~ ci N 83 ~ co3xoac to ? z W p nJ. ~ v `t ~ fr e~vN - Mm'f iE' ~!>1~tc 1jVisconsin Departrnent o~ Industry, SOIL AND SITE EVALUATION REPORT Page of 3 1.ep, and Hunfan Relations Jivis,on of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ~1 • COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER PROPERTY LOCATION DIZ• =Vh°U SL lc-~-f- 130 Yc~e GOVT. LOT sE 1/41/4,S1,? T N,R 19 E(or)W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. AM OR M # 5f W 4 ST- aZ / ,J~~ v / N CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [MOWN NEAREST ROA e v f04 MN. ssioZ (&12- )L91- 7yS7 rJ~sa~. T~PDIUt Bed "ax KI New Construction Use [Residential /Number of bedrooms 2--6 3 Addition to existing building j [ Replacement [ J Public or commercial describe 30~ - Code derived daily flow ySo gpd Recommended design loading rate bed, gpd/0L d trench, gpd/112 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 , trench, gpd/ft2 Recommended infiltration surface elevation(s) s-~ Pte} 3 it (as referred to site plan benchmark) Additional design / site considerations Parent material 6G5 S7 A" f3 ovTltis fl` dlyivs Flood plain elevation, if applicable 70 ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ®S ❑ U ©S ❑ U QS O U 8 S ❑ U 8 S ❑ U ❑ S FlU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence rBw-day FRoots GPD/ft in,. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ,4 Oe 3/3 o 2 30 /0 t'4 316 /s , Ground Qz Sy /d yR y/y 5 yje nr►,~ S' . 7 711, f ft. C Depth to ~~PAvE9' limiting factor ff Remarks: Boring # D_ ~0 14 313 ~s O, f, S6,C /;,t d f2 ~ S S•'•. , 61 z (3, - 22 75 Is OTC, %e -2 L 3 f 0' ~3z 2-56 7,s y,e s/lp ~►.e e s • 7 Ground r elev. C 5G - /o /D rg 711"Y 7 ft. . Depth to limiting factor a ~ /op Remarks: p CST Name:-Please Print Phone: 7~S _ 3 a l J~- I SEPTIC PLUMBING CO. Address: 655 O'NEIL RD., HUDSON, WIS. 54016 Signature: W%. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. Date: y- 21- 13 CST Number' 2 y~ Z ' t,A?NN. RdSTALLER & DESIGNER LIC. NO. 00663 f~ad0 f ~ir~-v E/c v~T~o,~ - /1P~o~~l Tv /3t' zo-v, v~ f 1000 141l,~O S 0 r Q~ 6-, This test site APPROVED ORIGINAL w' i::Zi v for a conventtonAl septic system. Z i 130yj!De PROPERTY eWHER SOIL DESCRIPTION REPORT )Page. fL .3 PARCEL I.D. 8 LOf ' CS Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rends D ~O /O R 313 S 3n 31 la F / 0 Y4 3/4, Ground Bs 33 7 5 elev. 7712. R ft. 3~ (r0 -S y/e `SSG s , C, S CS 7 Depth to t^~ /0M s1 s Z _ , 7 limiting factor „ ~/OD Remarks: Boring # a~,~ s~ 3 - ~s• 0, f Jamie vfle S S y -2C0 /0 3/~ D 7A iw,'t B, s S Val 131, •3y 7,5 yk 5/6 , P Ground s y,2 5 /S ~Y ~S ~ iw► of c-S • s ~o elev. 8,3 - /a rR 5 y y /2-37 7 ft. C 3 I~ Depth W litin9 C 1~~ /a y/e S/y S C , s i►.., '7 i Remarks: I Boring# m. vtk S 2~ . S , re 10,00, 316 Ground //,!e, evC 7- m 75 yiP. S 4 - .S' Depth to limiting factor 7/OD Remarks: Boring # Ground elev. ft. Depth to I limiting { factor Remarks: COf~ 017A/D AC Mn\ I I 4 I . w igcn c ~o~y~ 0~9 ~ ti b t~ N O o e~ N ~ N o N h N . lp a ~ ~ r- Ul o v 1'h m n1 O ~ b w ~ o ° ~ L w H o N / n -n - f -v zv R ra. OM )F U% a Z c 70 n s L Wk fTl rn T~~GT JO Z 39bri ~wn~On O p N O6 o~ z O w Oz z LL ~.LyL • Q1 w z Ld z O cnV w c o ui L.L_ rn m Z Cry a N z r N J U Lu 3 ao - ij C) . w C4~ a 2 P ui O O\ • 'P 00 f►~ ~ ~ 1x .J s o m "ro c. d uz OO = V/ O 2 w (V W - w V O ai F-I V) N w a- z JI J1 O NU W d 010.1 w Q C.) z w1 ( In . - 1 w F- ~ 4T is Mr N Z w °'m 0.i of 1 m CID O I- O w w 0. ZI wl m z~ z ~lol z z x W N c) 5 CAI 2O Z m d• w r-li -0 0 ai _ o C~ J LL X L!J F- X w 1 ''36 t co W I N 'S = Ll. , Q3,, E ~p 5 2 0 1 00 U W d) O e ap0 < 3 0. i J g Zy00q 0. :t1 a l zI -JJ i l - 20 a~00 'iq' O N r~z~ `E 1 Q Zd 06 Q3 N m 2g 0 Z = ` `QQ 99 5 M m i.] U- t4- 00 0) V J N w I V 2yh\ N O~ z w i4d, ~ • la Og • 09 ~ r Q om, 6+6 s~ ~9 0.2 z N Nick:l o p ~ ` ox. ~Ial co Q J~ a wl}~ w Y z F-i m i Q al of O Z n.l z 1 0 0; p zl z i F- CO - Wg V X101 z Lv m z . o~~ oZ ~ LL L- ~0 W 'M „91,08 oss s 8V38 v Z ~ Ol 03wnssv b/I 3N 3Hl 30 3N1-1 Hinos w O ~w z Q 3H1 Ol 030N3a3338 38V SJNI8V38 YIV 3 to w = 3 H x„ •t ~ r It? 1 A~Pl ~c~ /598 FILED p 0 J U N 2 2199380- I JAMES O'CONNELL Register of Deeds 6 St. Croix 50119r 9 G •,L , C~o • wt s CERTIFIED SURVEY MAP '11 0 Located in part of the SE'h of the NE; of Section 18, T29N, R19W, .Town of Hudson, St. Croix County, Wisconsin. t• n co N r a c v o a d o O Bearings are referenced to the N a W M .0 M m South Line of the NE} of Section D r- w Loo H a 18, assumed to bear S88o50115"W. M rt a n + M c- o rr M m o o~ \ M ~ o rt g o y 1 d OTC (Mn -4O zm o ~~\v fro CO ti3 0 \ ds \ v/ ~ y N g W g tp w S 0 / / ^ U~ o \ \ Jl \O~ rt 0) 4 \ d 2 L \ LID • \ 'X 0 '40 IZ 1D ~ \ 2 -D M In N 0 It I r N 1 OD N rai n co -1 00 rt D 1 I(n 0 Ln N a d z I ~ Icn ~ W ~ d G.• o CD tr I -I M O-4 d 5 a, IM ro IM - 0 2 w Ip W ID Ln M 90 'co A 2 el- 6g2 ~,qlv ~66' ID iz i IZ m 10 co 0 E 1, o COD m iz S E C~ I< M a; Ip o z S 1 I m em 0 1 Q~~ I Cb ' I I L11 0 \ w o • o V r ~O I w o c rt > > W. . C t:lj Q r " ° o o -3 N a x w i zi r w rt rt 7 1r• lG r rt! 1.4-1 V (D 0 -n c) C-1. -7 0 0 eD 10- (D 00 O O l< °c o• o e C/) C4 H C/) CD 0- m rt 'r v re rt v 0 h o d X 0 X, m z m ED ro VOLUf4E 9 . PAGE 2632 . . PIRA I •q rNs Pwo,Ise *Itp FA*A f1t popw26A IOU N Ptm eupZ &wueld gmswwduw, Altmo MWO ' ! S U f a Mnr a3AOUddw Z£90 SOdd 6 SHMOA •aOTnpe zOT aOT;;p buTUOZ AqunoO xTOaO •4S aq4 goaquoo Taoied due 6UTdoTanap 10 6UTSegOZnd azo;ag •(•oqa 'TaOZed oq ssaooe 'azTs IOT wnwTuTw 'SpUeT4aM '•a•T) suOT4eTn6az pue saTna 'smpl A4unoo put a-4egs 04 joacgns ST (4eTd) dew sTgq uo uMogs Taoied gosg III z£9z 3OVd 6 MMOA ,awes butddsw pue 6UTAanznS uT x7OZ3 -qS jo Aqunoo aqq 3o aoueuTpIp UOTsTnTpgnS pue1 aq4 pue saznieJS UTSUOOSTM aq-4 3o 17£•9£Z zagdego go SUOTSTnOZd yuazzno aq-4 74ITM paTTdwoo ATjnT aneg 14eq-4 .pagTiosap pue paAanzns Azepunoq JOTZa4xa aqq go aTeOS 04 uoTIequasaidai 13azzOO P ST deW AanznS paT;T41a0 SIg4 4egj A3t-4-iao osTe 'I pzOOaz $o sluaulasea TTe 01 gDaCgns ST Taoied pagTZOSap anogy •aUTT zapueaw To pua pees woz; M„£6,90o4;ZN buTaeaq au-IT e T.o uoTsuaixa aqq pup auzT zapueaw go 6UTUUT6aq pTes wozl M„60,Zb-6£N 6u-,rZeaq auTT a go UOTSUagxa aq-4 UaaMlaq IanT~j MOTTTM aOe8 aq-+ To abpa S,Iagsm aq4 pue auTT japusaw pagTiosap anogs uaaM4aq buTAT spueT TTe 6UTpnToul uruur aq go ;UTO3 aq4 04 4aa3 OL'£SZ 'M„ST,OSo88S aouag4 :4aaT 9L•V£~ '21„£V,900SZS aOUag4 :auTT aapueaw pies 30 pua ago buTaq 'abpa s,aageM pies wo.z3 ssa,T Jo aaow gaaT 6Z quTod a o4 gaa3 86•STT 'auzT Iapueaw pTes 6UOTe '3„TT,9TnZSN aouag4 :abpa s,lageM pTes aq4 woz3 ssaT io azow laaT ~Z auTod e of laag L~'L6T 'auTT iapueaw pTes 6uOle '21„6S,617o9FN aOuaul 'auzT zapueaw a 3o buTuuTbaq au1 buTaq ' zanT-6 Mo T T TM @OPe l a. l 3o abpa s, aa4Pm aq4 woz; Ssa T 10 aloes laaT LS UTod e oq gaaf S9'OZZ 'M„60,Z6o6£N 6UTnurluoo aouagq :.b-uruv-rbaq-";o" ~TfTOa aqq of gaaj 8£'68 'M„60,Z~o6£N aouaga :4993 66'66S 'uOT43as pTes 40 auTT 6/T 4saM-4sea ago buOTe 'M„9T,OSo88S aOUagi :8T -IOT43GS pTes 3o IauzoO 6/T:g aq4 4e 6uT3u9wwo0 :sMOTTO; se pagTiosap zag4;cnj :UTsuoasTM 'Alunoo xTOZ- *is 'uospnH go Umoy 'M6T2l 'N6Z,L '8T UOTJOaS ±O 6/T3N aqi 30 t,%TSS Gq-4 To lied UT paIPOOT pueT 3o TaOied V :SyOTTDI e ';-agTzOSap ST paddew pup paAanzns Taozed pueT ag; To Azepun,oq zOTza4xa 9q4 4egq :dpW AanznS paT;T4aa3 STg1 Aq paquasazdaz sT TiOTgM Taozed pueT aqq pagTaosap pue paddew padanzns aneq I 7ToTU0S uenl To uoijoazTp aq4 dq leg4 d;Tgiao Aq@Iaq 'zodanznS pueg UTSUOOSTM pazajsTbaa 'uabegAN •0 uaTl'd 'I ~ZFIO I3I S?I~~ S , xoa~nxns