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HomeMy WebLinkAbout040-1009-90-000 h 03 6o hw a 0 C 0O X N C p n C DI L._ U y y cm N C OO M"O o oa w m mE [r 2 o y c U O 'C z .y O O)00 w co E LL c0 O 0) CL c 3 _ E EQ (1)ELo °v i U a T co N W a m M H (n it co O 2 a c _ U T O N 0 � O fA I- T it O1 N Z I C N O O N co N m y N N y C •�V d L O c c O O Z H Z O N Z C tv� CO c .. E � N 0 LO�i m 4a o CL ca .��. - c LO > y > y d O L O 0) c c a U N T %I � a5 00 = 000 Z •ti ; oaaa IL in 0 V 0 co co O t:: !,2) Z N r T w CO O O LO m � Q �i. ✓ y �_ 1^.l, Q O Q N O r+ O O W N C CC O w N O a) Oo U o c c d o rn • O O c N O c a N 0) 3 y0. OO '7 H T 00 y y T Z _ p ID N 0 a o N O c E L O p 7 CO N O V •O O O O Z .+ E d a L: a • c� a d .2 d w I Parcel #: 040-1009-90-000 04/07/20 PAGE 1 OFM Alt.Parcel#: 03.28.19.40C 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 "DOMIINO,TODD P&CARRIE D TODD P&CARRIE D DOMIINO 578 WHITE OAK DR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description "578 WHITE OAK DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.470 Plat: N/A-NOT AVAILABLE SEC 3 T28N R1 9W PT SE NW AS DESC IN VOL Block/Condo Bldg: 474 PAGE 442 ORD ALSO DESIGNATED AS 415 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 03-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 05/13/2004 762493 2571/130 WD 03/19/2004 757102 2530/289 QC 07/23/1997 983/52 WD 07/23/1997 821/425 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 26182 339,000 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.470 71,500 268,200 339,700 NO Totals for 2004: General Property 5.470 71,500 268,200 339,700 Woodland 0.000 0 Totals for 2003: General Property 5.470 55,000 248,800 303,800 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 208 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 t r Form S T C - 104 AS BUTJ,T SANITARY-SYSTEM-REPORT �il✓? �(ZA ` TOIJNSHIP T' ! SEC.- T`� N-R W OWNER 3 p I ADDRESS S70 �'` 14e4 - O*k- -Di' ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT _ LOT SIZES PLAN VIEW Distances and dimensions to meet: requirements of I•LHR 83 . SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM K ZF , /�s ,�iE✓f 3v/E', v w1 �0 ►�p�R ` s U Pvc y • C4A_L v to C p U l�Uh rraN S ro0 7c = /07.- ? V INDICATE NORTH ARROW T = 107- 66 lop o l= �yy �� PAC /0 ,'`.te S e-t- yo , o pf- BENCHMARK: Describe the verkicul reference point used CZtAieL dJF Thk To 1410 AiP"'L-e-- Elevation of vertical reference point:/60'd Proposed slope at site: 1=Xi STi 4 G- TiF.c)K - SE4_ •VO TES' A&U-C . C9 0 0 J p SEPTIC TANK: Manufacturer: w4 /CS' Cdh.0 • Liquid Capacity: 4 4°� Number of rings used: Ja` Tank manliv.1e cover elevation: / C1 l Tank Inlet Elevation: ) 0 (o,76 Tank Outlet. Elevation: Number of feet from neare;ae Road: Front,(D Side,0 Rear, 0 0'0 feet > .Z p 0 From nearest prof,^.):ty line Front:,oSide,O Rear,O feet Number of feet from: well > 5o buf l 'Liig: 50 E9900'ON'011 ONOISK V 831141°M,'NAIN S'a'd'W 10EB'ON'OIl 838W(l1d 831SVVY'SIM 11-10I88lfl 143803 N:h8/£" 9t01g'SIM`NOSaf1H''Qd 113N,0 999 '00 EJNI8lhnld OI1d3S kIS31NOa ` :aagmnN asuaayj :qor u0 a9gmnTd O :pe"(1 :ao3oedsul :a9an3oe;nueH maeTy :pool 399avou moa3 3aa3 3o aagmnN pTTnq moa3 3aa; 3o aagmnN :TTaA mo jaa3 3o aagmnN •ago 'a0ag O 'OPTS O 43uola .au �S3asdoad Beau moa3 3993 3o aagmnN TUT 30 uoT3enaT3 :xue3 3o mo33oq 3o uoT3en913 :Pasn OUT o as H :A3TsedeO n3oa3 eH �` ?INyZ ONI�OH qu *(quo xoag0) Lsma3eCs 7su­:2`Tr7 sqe TTOS Onoge Oq3 3o �tue uo pasn uaaq O xoq uoT T�3sTP ao O xoq doap 8 9 H :3TTng vaay :uoT3enaTa 3Td a8edoes 3o mo3300 77 :g3dep pTnbTl :aO3ameTQ 3o aagmnN :azTS lid aOydaas O S = ?Y4d'�z.S •(ueTd 30Td uo saoue39Tp apnToui) C1 :SuTPTTnq moa3 39a3 3o aagmnN S :TTOm m0a3 3993 3o aagmnN JQQ��341 0`avas0 OPT SO 43uo.z3 :auTT A3aadoad 3saaeou mo.z3 39a3 3o aagmnN :adTd ;o do3 o3 g3daP TTT3 :3TTnS eaay :sauT'I 3o aagmnN S s :ggSuaZ :g3PTM x :gouaay :pa0 s'S X s ���� — S3ry ��. WaZSxS NOIld�I0S0y 'IIOS •(ueTd 30Td uo saoue3sTP apnToui) :SuTPTTnq moa3 3sa3 3o aagmnN :TTOm moa3 3aa3 3o aagmnN • 0'avag O •OPTS O `3uoa3 :auTT Alaadoad 3sea moa3 3aa3 3o aagmnN :adAl ga3TMS maeTy :a9an3oe3nueH masTy :aTDAO aed suOTTeO /j :uoT3en9Ta g33Tms 33o dmnd :uoT3en9Ta Aue3 30 3300 :29TUT 3o uoT3enaT0 azTS dmnd ;"m oe;nuvK uogdTS/dmnd :TapoH dmnd :AZToedeO PTnbT'I :aaan3oe3nueH . XasMO d na i I Form - S T ''C 104 AS BUT.LT SANITARY SYSTEM REPORT E!(2,AQQ7 MC?RP SEC.3 T N-R W OWNER _ TOWNSHIP I ADDRESS 574 p W 414 D,*k -Die ST. CROIX COUNTY, WISCONSIN Hv� So � 4,c 1(e L LO SUBDIVISION LOT LOT SIZE 5 PLAN VIEW i Distances and dimensions to meet: requirements of ILHR 83 --- SHOW EVERS:THMIG WITHIN 100 FEET OF SYSTEM j I ' i I 57C � �4-TT�C4 4-07-- : i l i i :!5"t'2 F- s /f 67,+JV/P,-p w1 '�n.'"b�R ` S 'j'IPL G� 0 C''f 1 o 2 f�'t, W-Q Ca v OW-4 Ova X67- (�'h P l c ? lock, Div�'c�- Gv�}-S p v � I S ,',✓ .4 w o d v Q u i c. CO 06—le I Gv f Lle7r ID ,, 7 INDICATE NORTH ARROW 107, 6o op o t yy ruc /' si aP BENCHlMRKs Describe the vertical reference point used CjeAAiei- of Mk: „]Cb Altal'�L-e-- Elevation of vertical reference point:/0001 y Proposed slope at site: Ex� rte�G- Thar - SEA NoT&-S Aae4,-e . SEPTIC TANKS Manufacturer: W /CS Cd1tiC • Liquid Capacity: Number of rings used: la• Tank manhole cover elevation: / If. Tank inlet Elevation: rO �0•76 Tank Outlet Elevation: 106, 362 ' >� OO I Number of feet from nearczt Road: Front,O Side, Rear, O feet • From nearest- propcxLy line FronL,oSide,ORear,O feet 5 '' Number of feet from: well > .50 buf.l;'irtp: 0 1 f I j• JI PUMP CHAFER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer., Pump Size Elevation of inlet: Bott i of tank elevation: Pump off switch elevation: Gallons per cycle: . Alarm Manufacturer: Alarm Switch Type: j Number of feet from rest property line: Front, O Side, O Rear,O Ft. II Number of feet from well: I Number o�f feet from building: (Include distances on plot plan). I SOIL ABSORPTION SYSTEM I Bed: Trench: 7C _ i Width: Length: Number of Lines:_ Area Built: Fill depth to top of pipe: r Number of feet from nearest property line: Front, O Side, O Rear,O It /too Number of feet from well: 7 a TO j Number of feet from building: Z3 O ' (Include distances on plot plan). 54,piye = 570 SEEPAGE PIT Size: Number of Diameter: _ Liquid depth:�'� Bottom of seepage pit elevation: Area Built: Has sithe drop box O or distri ion box been used on any of the above soil O abs tion sytems? (Check one). HOLkING TANK i \ _ Me factu Capacity N or o ngs used: Elevation of bottom of tank: : I , Elevation of in Number of feet from near property line: Front, O Side, O Rear, OFt. I Number of feet om well: Number of feet from build j Number of feet from nearest road: Alarm Manufacturer: el Inspector:- /v E� Dated: Plumber on job: I License Number: a HOMESITE SEPTIC PLUMBING Cp. 655 O'NEIL Rb,HUDSON,WIS.K16 3/84:m j ROBERT ULBRIGHT WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. MINN.INSTALLER&DESIGNER LIC.NO.00W i s - p l=0 r y 13 En eM oc�l moRplfy Meksov- 0 0c-f . 10 PI 106 50 �<I'STi,uG- ' �'�F•c.4sr S�prt c tw� sAel► 30 M,4,,j /6- ?o i �3' .tiAv�o�F 13 Ntw goo ?3�4Ckf/oE ?eTs cc,A$cat' '` -b co it (,r.F'. SEpTrt � WEEKS � UEQT'• QfF- {�I. iS � SON�{,� � • � - -- I Top o F t=y pue- i II 220 `\ a^ oF-I&w �F S T- c-/0 I 3 W ►9 S4a4� ; o w , * r � y s fia w i 2 ? _�f S B F T6�S OF 2-'72--? P'p-k i J a �I L i! ? °t 3 a` y7.10 ?7.01 - -- - - - 5 '¢ 55 - - - --- EulGl ao 5)POP INLET _ y V7 f 9725' '--- - - -- -- --- -- -- --- L 9s.0' 116' M 1 o �i 9G o i t i�t 9 - - - - - - - ' �— S y £If v � 10 I - - - I►-'- - 5'K SSA--- - i O fa.. L ' - - - -s�14 - - - � � SYSTC- CIVVAT10J t P L o �y 9y.oco /b}ST if A-y�iP,EG�►7E XvDck PiST, prp,*s (•4 y-7zj Pvc � . v► 4 l o 'r`/p i2I o u E/Z HOMESITE SEPTIC PLUMBING CO. v i 655 O'NEIL RD.,HUDSON,WIS.54016 R G<< ROBERT ULBRIGHT CST �2 4041— i 3 i WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. ' MINN.INSTALLER&DESIGNER LIC.NO.4M ale De Bul pro 7" PI; Ak) 0G' MORplty H-o�t E MfksdRtz 0 DG-F I 0^�9 r oa o �«:2 SO � rCi's rw6- 1� Ii!r•chsr Scrprtc � ry ae s - � Mr{Nh0/E 7a 0 y+ � � c.s• So /E : � 30 13 ,vow boo ?3AGkHo� P�'TS lo eo Pe R c S lie S eo,v ca It to . = u R r Rf F �T, s 0. TOP OF I.-L 1--QUC M f f(EVAyao Bow POOOF CL i o - — y2• E/lbw p+sr G!o 3 IU it $-4 a apa r lu`ry r ( 5 too Aj cot P-k ,F Tb O O 10 ! L 9 7.of 3 y7.io a w b 1 10 H w `�L7-�o �20(� tNLFT �, 20 c'- C f301�E5 97.25 YST�M Eleu y(P•M _V - - - ---- - - - - - - - - - SYSTE ) 5l'EU• 5,/, lo 10 I , s'Ic op.. - - - - f SySTtr 'CIe�,4t►o,� iL P f3.f8 S PE cS 1 H W N :� • gr /8fSr % " �+ ys��wr r ��,o�,e �:s7; p; s %A I v 606r,— HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD.,HUDSON,WIS.54016 c ROBERT ULBRIGHT eST i-,XVe2 , i 3 WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. ' MINN.INSTALLER A DESIGNER LIC.NO.x0663 i i LOA i-Ir 04 41 DP • DEPAPTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,Wl 53707 ❑CONVENTIONAL ❑ALTERNATIVE state Plan D.Number: SUT 4,NW 4,Sec. 3 ,T 2 8-Rl9 W Ill assigned) Town of Troy ❑Holding Tank El In-Ground Pressure ❑Mound White Oak Dr. INSPECTION ATE NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: Dan Elizabeth IC-/off-� t�e`3o BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV. Name of Plumber: MP/MPRSW No County Sanitary Permit Number. kobert SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIOUID CAPACITY: .TANK INLET ELEV.. TANK OUTLET ELEV.. PROVIID ED LABEL PROV IDED COVER DYES El NO ❑YES ONO NUMBER OF PROPERTY WELL: BUILDING. VENT TO FRESH BEDDING: VENT DIA. VENT MATL. ALAERIV ROAD:FEET FROM LINE. AIR INLET. DYES ❑NO OYES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. JLIOUIDCAPACITV PUMP MODEL PUMP/SIPHON MANUFACTURER ACT UHER ROV O DLABEL PROVIDED OVER ❑YES ❑NO _ DYES ON O OYES ❑NO GALLONS PER CYCLE: 1111111P AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING AAERN N INLET FEET FROM LINE (DIFFERENCE BETWEEN ❑YES C}1t10 NEAREST PUMP ON AND OFF) 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: BED/TRENCH WIDTH LENGTH IND OF UISTR PIPE SPACING COVER INSIDE DIA tPITS DEPTH TRENCHES MATERIAL' PIT DIMENSIONS GRAVEL DEPTH FILL DEPTH IDISTH.PIPE UISTR.PIPE DISTR.PIPE MATERIAL. NO DISTR. NUMBER OF PROPERTY WELL. BUILDING VENT L FRESH BELOW PIPES ABOVE COVER ELEV INLET ELEV.END PIPES FEET FROM LINE. AIR INLET. NEAREST— MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES ❑NO PERMANENT MARKERS OBSERVATION WELLS OIL COVER TEXTURE ❑YES El NO ❑YES ONO DEPTH OVER TRFNCH'SED DEPTH OVER TRENCH BED UFF1H OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES DYES 0 N OYES ONO ❑YES ON PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE COVER ; WIDTH LENGTH. NO.OF LATERAL SPACING. GRAV LDEPTH BELOW PIPE ­.8E0/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV. ELEV. DIA. Ft EV.. PIPES. OIA tELEVATION AND V'aia■RIBUTION rZE NOLE SPACING DRILLED Cf`HHE'CTLV COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS `RRI/l��� ❑YES ONO EY ES ❑NO COMMENTS: PER NENT MAFlKERS: OBSERVATION WEt.LS: NUMBER OF LINE ERTY WELL: BUILDING. FEET FROM DYES ENO ❑YES ❑NO INEAREST— M YO z l.5��'`- >> �/0 > 9 33 S3 Sketch System on Retain in county file for audit. Reverse.Side. SIGNATURE: TITLE DILHR SBD 6710(R.Ot/82) ST. CROIX COUNTY WISCONSIN EMERGENCY GOVERNMENT OFFICE ; '.. ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 (715)386-4680 October 13 , 1989 QTv-IOh 6U� Elizabeth Murphy 2� ��. V6 C 578 White Oak Drive Hudson, WI 54016 pvrph Dear Mrs . 114urphy, On October 6 , 1989 I inspected the private septic system on your property at the above address . A wooden box-like structure was found, filled with effluent overflowing from the vent on the drain- field. The overflow of raw sewage is illegal by Wisconsin State Statutes (144. 235) and is cause to have the system declared a fail- ing system. Since that time you ahve received a letter of violation, with orders to replace the system. Should you have any question reagarding this subject , please .feel free to contact this office. Sincerely, `fit Mary J. Jen ins , Asst . Administrator St. Croix Zoning Office ST. CROIX COUNTY r WISCONSIN ZONING OFFICE r•?' ' ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 - (715)386.4680 October 9, 1989 Dan & Elizabeth Murphy 578 White Oak Drive Hudson, WI 54016 Dear Mr. & Mrs. Murphy: Enclosed is the violation on your failing septic system. Grant monies are available through the Wisconsin Fund to assist you in payment of the new system. I have also enclosed an application Y Y form, should you wish to apply. There is an income limitation for qualifying for funding, that being no more than $50,875 in the year 1988. You may check this from your 1988 Wisconsin tax returns. If you used Form 1, the totals of line 5 is your guideline, and on Form 1A, line 7 and on Form WI-Z, line 1. Should you wish to apply, please fill out the front page of the application completely, making sure to include the tax parcel number (from your property tax statements) , and the Register of Deeds Document No. (from your warranty deed) . Return the application, along with a copy of your 1988 WISCONSIN tax returns, and the application fee of $50 to the Zoning Office, and 't has been issued for application may be made as soon as the perms a y PP your new system. Should you have any questions, please feel free to contact this office. Sincerely, Y. Mary fi. enins, Assistant Administrator St. Croix County Zoning Enclosures cj SANITARY PERMIT APPLICATION In accord with ILHR 83.05,Wis.Adm.Code c• !;-4 STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than 8%x 11 inches in size. ❑ Check if revision to previous application –See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. N' PROPERTY OWNER PROPERTY LOCATION 70V ? /f o/eo/y sE- % A14>%, S 3 T 11� N, R 1 E(or(W BLOCK# WNER' # PROPERTY O s LOT MAILING ADDRESS CITY,STATE �,• 5¢COoi PHOI�E_NUMB��/ SUBDIVISION NAME OR CSM NUMBER ffvOSO.✓ 3� 11. TYPE OF BUILDING: (Check one) ❑State Owned CITY LLAGE: 7 R O NEAREST ROAD ❑ Public K 1 or 2 Fam.Dwelling,##of bedrooms AR EL AX NUM R( ©q _ _ (J III. BUILDING USE: (If building type is public,check all that apply) 03 _ ,21 f�l 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: (Ch A. Check line B if applicable)IVI A) 1 ,J New VNk 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) .3 S '" X SS Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 RrSeepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 M Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill Q0, Z- VI. ABSORPTION SYSTEM INFORMATION: Q 'L f d' 1.GALLONS PER DAY 12.ABSORP.AREA 3.ABSORP.AREA 14. LOADING RATE 5. PERC.RA)E 6.YaSTrEM ie:e EV. . FINAL GRADE &OO REQUIRED(sq.ft.) PR POSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch 9j( ELEVATION G o 2 s . 7 Z Co �; �' . Feet VII. TANK CAPACITY PACI s Total #of 'L�rvfC'v0&W..0✓ Prefab. Site Fiber- Exper. INFORMATION New istin Gallo Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank �Jlcl O VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): mber's Sign ure:(No Stamps) PRSW No.: Business Phone Number: 0 lg"T_ W13 P i Ck'T- 3 3 0 7 71S 06-BI95 Plumber's Address(Street,E I L State,zip code): t v ��'D ,J W I S . S /'D/ 4e 557 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(Includes Groundwater V(77pq Issued Issuing Agent Signature(No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial 0 0 Adverse Determination / X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: ion,Owner,Plumber SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Divis 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. 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 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if rec[ulted by the county; E) soil test data on a-115 form; and F) all sizing information. Y. 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) f r f III I e ' APPLICATION FOR SANITARY PERMIT 8TC - 100 This application form is to be completed in full and signed by the owner($) 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. --------------------------------------------------------- _�__ _ 'yiz'f" I ----- Owner of property , � N-R Section -3 , T= �W Location of proper�ty�S 1/4 1/4!� Township T F p!20 Mailing address SC Address of site �� ten! Subdivision name Lot number `n Previous owner of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? e Yes o Is this property being developed for resale (spec house)? No Volume 8�_and Page Number 41.e as recorded with the Register of Deeds. ------------------------------------------------------------------------------ INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBHR, 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 warrant deed recorded in the Office of the County Register of Deeds as Document No. V V1© ,?0 _; 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 co truction of said system, and the same has been duly recorded in the Of ce o t County Register of Deeds, as Document No. ) •�fdl/I ol gnature of Own6f Signature of Co- net (If Applicable) E Date of 819natu e bAe of Signature i a $ H„ . • - -., a-.R A?X .. .�.��yyllp: x fn �.QC���� �VQ. Y OaAial 1� R�aRyarwvs.� sVRm 1—n= �� ' x •.�I��uN��� PRE 425- 4:5�,, rte y + Y This ... Deed � -aJd . ... . ................. .. - yipxyl M. PetX 4*,.-h sbwawd ... • x k 4i . ....... ............... aD$.YtLf@., .• Grantor. AUGAI aed .��Hi<1£el J. anti:i x izabeth s M. .phy of 3:1 5 l� ta.1.pR!48e1rty_ (hat as survivorship marital - tx).... . .. .. ... ... ...... Grantee, q1M of t)M� f: witIIes•etl, That the said Grantor, for a valuable consideration RETURN TO eoaveya be Grantee the follvwing described real estate in _S t. C ro ix csulft, state of Wkeeesis: 'A paroal of land located in the SEA of NWT of Section ..w Town of Troy, described as follows: 4 f: ci..nq at the Did corner of said Section 3; Tax PuM No: ............. .-....;;. .....; # e °.0216162W (true bearing) 580.40 feet; thence S10391W 1565.91 feetf. ." heat -West" 33.01 feet to the point of beginning; thence West 59.2015 fe w?C . Vorth 537.16 feet; thence bLly 131.05 feet along a 667.00 foot > concave°SWly, curd nearing S66e371L•' 130.84 feet; thence SWS90S ., 65:.13 fret, thence Silly 356.50 feet along a 1110.34 foot radius curve + ! y� chord nearing 670.5018 355.69 feet; thence 5103911; k38.44 feet tWIN iasf of beginning. NO a temporary roadway easement located in the. =%,4 f'Section 3 (anti DIM of -, Wla of Section 3-28-19, Town of Troy, deacs3b#W 011dwot Commencing at the Nit corner of said section 3, thence 827161P. 580.40 foet= thence 31.39114 1280 feet to the point of beginakilfid canes all land,lying 33 feet at right angles each side of a line 1439114 834.43 feet to the centerline of an existing town road; sai4; ;ay. easement to exist until it is dedicated as a public road. b y � ► T A This ,i.Ef............• beelesbad Frooesty. (is) (is not) c, Together_with all aed singular this bervilksfmte and appurtenances thereunto belonging; Petrich And_ that the title is gesd, imweasbt in for simple and free and clear of encumbrances except easements and covenants of record a will .arrant and defend the sam& i this ._ .... .......... ........ �...�day of .. _August r .. ........ .. . . -, .. :-:(SEAL) - �- � {$ 0, Ward R. Petrich nt l .-. -. . . -.• . ......... - Cheryl Petrich . - ..... r 4 4 A0lsi�lfTIQAT><OIf ACENOWLEDG1g>iKT (it) .. ... ..... .....•.. ....,..--.............. .-......- STATE OF WISCONSI\ ....... ................ .................-•-•--' -------�----- S t. Croix ., _..--.County. i of......•.. ... ............ iq......` Personally came before me this Au-3uSt 1988 the a�iovd.F ... <.... .. ....:: .; ........ ....... ....... •- -.............. �iard R. Petrich std l .... : IM*BER STATE BAR OF WISCONSIN Cheryl J P . .'I�. •��� ��`) (It mot,..... - ..--.- .... lF , ii0tarixed by 4 706.K Wis. Stata.) "., .. .,,. to me ❑ to be t,.e Pl r nn fore„n,.._• ingtrum.•nt ;m I arknowl!d�t c+. c TM IftSUOUNEN, *A$OPAFTFDBY a e. t,a,rris MA" be authenticated or arknowrledged. Rath 11, ('� . u.sinn permunfeht_(tf note - r > -nggeWSry.) date: s , MEMEL -#*NNW to.W qaAkiq shw'I b.bL.x it pdple.t; STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT . St. Croix County � f �OX�� OWNER/BUYER - 57 7f ROUTE/BOX NUMBER 7s, 7 v 4,'e D4- ov FIRE NO. CITY/STATE li.So_') A..'/S - .S y0 /& ZIP Sc 1/4 Section _, T LN, R�W, PROPERTY LOCATION: 1/9 , 1/ Town of ©r , 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. 1/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. S I G N E f. .12 DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS . INDUSTRY, DIVISION � LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.09(1) &Chapter 145) LOCATION: SECTION: SE T N: TOWNSHIP/�: OT NO.:BLK.NO. UDIVISION NAME: 4 .3 /T1PN/pp I p E (or)W j Tlz 0 y COUNTY: OWNERS BUYER'S NAME: MAILING ADDRESS: 54 GRoI x b6AJ ? �l(2—6180_4% MvR{��►y S71? tO1 HE-OAk- -bR . µuDS o.J USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMM R AL DESCRIPTION: Ip1 'DESCRIPTIONS: PERCOLATION TESTS: ®Residence ❑New ,®Replace f dc� • - r 4 RATING:S=Site suitable for system U=Site unsuitable for system scs M VENTI NAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) S ❑U US ❑U ®S ❑U�S ©U I ❑S ©U IT R.e 4-c s'-- w -zRo QO x iS t3�rtl'o.J -� DESIGN RATE: If Percolation Tests are NOT required DES / = If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: C /j} SS Floodplain,indicate Floodplain elevation: W' PROFILE DESCRIPTIONS IIJ '>d Gi"4L T'fi. -4 BORING TOTAL P H TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH M NUMBER DEPTH IN. ELEVATION OBSERVED HES TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) C, .G7" r3u'SY s./ sr3 • 4K- /3 A, -Sy. s;� G7 ' L� ts'j B- 1 ,o' 1(v•78 �'ttj > r. Q qy. t3�o��j� SI.Y s .S�3 "R,5, 2 > S ' !'V S;/) I.S ' jf. B- 0 /OD, d D $ ' ?al:•• a . pl�rty I t -Sy .,,.r 2,0 f x B-3 $ 5 72y 6 s E//o w Co v lt S,- 5/ w .r . S, o '3 _ > B- cooRSE Sit --v N ' B- SvR-rACOL F("- aF L4 PERCOLATION TESTS cn ' TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES _ RATE MINUTES NUMBER INCHES AFTERSWELLIN INTERVAL-MIN. PERIOD t P RI D PER INCH m P_ 3. 8 ' 210 9G•�a ' /D I �/� '% I ' G P. P- I ! P- Q ti P- p I 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- 0 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. 41.6 4-IST IR€44, �� . 2p / Ili PDfC_ TP.CNet, fly ly �Q O SYSTEM ELEVATION Z 40 �S71 � - — --� C iE E I - _ ' r i • t � I � � ► i I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified.in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WE RE COMPLETED ON- r HOMESITE SEPTIC PLUMBING CO. Gf 16 ADDRESS: ROBERT ULBRIGHT " CERTIFICATION NUMBER: PHONE NUMBER(optional): PLUMBER WIS MASTER LIC.NO.3307 M.P.R.S. y'r Z 3 X 'PlPf MINN.INSTALLER&DESIGNER LIC.N0.00663 CST SIGNATURE: 4414 , DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R. 10/83) —OVER — PLOT- em QM ocrt J MORptfy sa R�E•c/FSr Sfprr c T.,w 'Sr2E: 06T O n CEofrfk) • = ?3gckHo�' �P�'TS 1 y cS 4EUT r Top O F y " PUc O- q elev.4vo& _ 160,0 2 Sb 3 J ►II9 $ 0 4 xp o w U. V1 v 0 p + . a � �a , H � w -- -- - - - 5 'x55 - - - - KP s ',o to 10 -- -- -- - -S,Kss., SYSTC- r- IeV,ITIOJ H � N � r N 12 V Z HOMESITE SEPTIC PLUMBING CO. v 655 O'NEIL RD.,HUDSON,WIS.54016 ROBERT ULBRIGHT eS'T le.2 ye,, 3 WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. � MINN.INSTALLER&DESIGNER LIC.NO.00663 611 i r OAS �,e. pL0T PLA-k) I y -- WE$ t3 my MORPffy _ sa - �6E r�0'5 ri,u6 (� P Rr-cm r S�prr c rw�D� 0 '57641e ; 30 Mc'fSveev 4cf•/D �y ,ve-w 80o' • - gckf{o� 'PeTS F el Wu y--c s va,�r °7 ouu�'ec�w, w��KS �.e � • �' ' UL-RT. RfF. Tod o � .y � pve -4- 1 j,-VArl'6A) = 160,0 2 b O Q 0— Q � ' W i H 7 Z 95 Z N ` v + O _ U, at e W 3b p 7, ul� N �o 5)pop _ . s -- - - - �-,>9 - c SYSTEM EleV. y(p. 2o M L \ L101-7� - `� - - - --- -9 _--o _ 5ysre'l tit u. ;o o ,- - - - -y�if--- - - -_ - 5yS'rtr EIEVATiou q340 r✓► u o t Fk cn � T r o HOMESITE SEPTIC PLUMBING CO. c� 655 O'NEIL RD.,HUDSON,WIS.54016 ROBERT ULBRIGHT of r -3 yeZ 3 WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. MINN.INSTALLER&DESIGNER LIC.NO..40663 'l-tfue w�i�� 0,4 41 .6e . - rr Fresh Air Inlets And Observation Pipe I l� - Approved Vent Cap I ,r • Minimum 12" Above Final Grade _ 4" Cast Iron Above Pipe — Vent Pipe' -ro Final Grade Marsh Hay Or Synthetic Covering Min. 2" Aggregate �i. Over Pipe 4 Distribution z? Tee Pipe 0 0 0 0 0 , Aggregate o Perforated Pipe Below V Beneath Pipe o Coupling Terminating At Bottom Of System Iv � III' v Fresh Air Inlets And Observation Pipe !4j Approved Vent Cap u , Minimum 12" Above Final Grade Q O A 4" Cast Iron Above Pipe Vent Pipe to Final Grade iq } ' Marsh Hay Or Synthetic- Covering Min. 2" Aggregate Over Pipe Distribution i�zy Tee a'. Pipe 0 0 0 0 0 , Co Aggregate o Perforated Pipe Below Beneath Pipe o Coupling Terminating At Bottom Of System • I Q vJ ' V) vFresh Air Inlets And Observation Pipe cx� h J p Approved vent Cap � ` Minimum 12" Above Final Grade _ 4" Cast Iron Above Pipe Vent `Pipe -to Final Grade Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution i1�g Tee Pipe ° ° ° ° Co " Aggregate o Perforated Pipe Below Beneath Pipe o Coupling Terminating At . G) 3, ' �y�,. Bottom Of System