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July 14, 1998
Doug and Denise Heiman
144 Skyline Drive
River Falls, WI 54022
RE: House addition,Town of Troy, St. Croix County
Dear Mr. and Mrs. Heiman:
You have requested the Zoning Office to review your remodeling/addition project for compliance with the state sanitary code
(COMM 83). When remodeling or adding onto a dwelling you are required to examine whether or not the construction
involves an increase of wastewater.
As I understand the project, you presently have 1,538 square feet of total living area and you are proposing another 1,062
square feet of living area. The proposed constriction equals a 70% increase in the total living area and does include a
bedroom. The original house plans revealed a bedroom in the basement. It is my understanding that the bedroom was never
constructed and the space was used for a family room.
Section 83.055 (3)(b)(2) states: Increased wastewater load in dwellings results from an increase in the number of
bedrooms from construction of any addition or remodeling which exceeds 25% of the total gross area of the existing
dwelling unit.
Since you are adding another bedroom and the construction/remodeling does exceed the 25% standard as stated in the code
section above. The septic system will have to be evaluated to obtain a building permit.
The septic system serving this structure was evaluated by Carl Heise on July 8, 1998 and he noted that the system was
functioning properly at that time. Mr. Heise indicated in his report, if there is an addition onto the end of the house, there will
be no problems with setbacks or the replacement area for the septic system. The as-built report revealed that the septic system
is sized for a three bedroom dwelling. Records of the sanitary permit could not be located.
Since your proposal exceeds the 25% standard, you must have an affidavit recorded with the register of deeds indicating that
the addition may cause the existing septic system to become undersized for a dwelling of the resulting size. Also indicate
whether a replacement area is available.
To prolong the life of the system,remember to have the septic tank pumped once every three years or when the tank becomes_
full of sludge and scum. Other efforts to prolong the life of the system could be as simple as fixing or replacing plumbing
fixtures with water conserving fixtures, reducing shower time, washing dishes when the dish washer is full, avoid using a
garbage disposal, using a wash machine with a suds saver feature, etc. Therefore, the prolonged life of this system may be
dependent upon proper maintenance of the system.
Should you have any questions,please contact this office.
Sincerely,
Rod Eslinger
Assistant Zoning Administrator
0
VOL 11141 mi 05
1
=r S L`
SYSTWI MVIT
went Number F Hame & Re Address
OX
toe
art t-,,� �,� �el ale -1116 _ � �Pa cel I.D. Nam r
The eiist.ing septic system which serves the dwelling be ng added on to amst be aseri,Eie<d by
an acceptable soil .report or be Ian wted bV a Ucensed soil testex For cozpliance with bash
grounndvater and/or bedrock sepa:ratJo n requiremnts as set fortb in a. C%LM Chapter 93.10 (2)
W1. Adm. Code. 'The reavlts of that inspection muse be made ava la);?e to tbis office. lE the
existing septic .system meets these min.in requirmencs. and i- properly functioning. an
addition may be added to the dwe;2ing without ;;i;t.i¢n9g that system. This addition must mos,
however, encroach upon the required septic ayatta- setback-9 as Betfnr'th ir. s, CCK-4 63-IC (11 .
Proportyr Ownanr(.a) 14 44vtS i9
Pray*ty Wailkag .Addres m tY
S" o-Z Z
property boga.l Descriptions Lot I Cs"Ysubdivivion,+ ?�' Z V
I j-R Wr Town of 2
Comments. the existing conventional septic system was sized and installed for a three
bedroom dwelling.
Carl Helee (ID 9 22OSS4) stated in an inspection report on ;finely s, 19998, that the septic
system was :ueetion-ing properly and the addition will not affect the replacement area nor
encroach upon the canx-rent setback reyuiremi nts.
1, as the owner of the above described property, hereby affirm that the septic system serving
this dwelling meets the above referenced state private sewage systems codes. T realize that
this addition may cause the existing septic system to beczae undersized for dwelling of the
and r will malke this information a ziBable to any Eut,ure parties interested
In purchasing this a erty. � ,�^� p
Sigtnedc No axy Public Subscribed and
n ,worn to befpre, me on this date;
Date:i�
Ci
v..--•••• nar�efel�.tft�.+ 1 my commission arpireez
r
Approva l l LC= 'a"
soil ids
NOTARY� aan�.++.
sme of Vv1iSconslfl
- Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
(11 fi SEC. T N-R l " W
OWNER �L Q a � TOWNSHIP 3 a
t 4 _J� �_
ADDRESS J P t` F`" ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
I
Distances and dimensions to meet -requirements of 11HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
ti
j
A
Zr 1 lY air,}s
s �
0
Qry
tt
S
Q
N
WnoA�°� 3z`
F
i
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference w
oint used o
P _wool S��re.e. i►,� �t is ��.��`!•,Q r�„,
Elevation of vertical reference point: 4->5,,, 0 0 . 06 Proposed slope at site: f s
SEPTIC TANK: Manufacturer: Liquid Capacity: I Do n
Number of rings used: Tank manhole cover elevation: 32, 2 4
Tank Inlet Elevation: q T 04 Tank Outlet Elevation: 54 ,44
Number of feet from nearest Road: Front, Side 0 Rear, O
55 feet
From nearestproperty line Front,0 Side,O Rear,O 7 p feet
Number of feet from: well
nP,-. 3's building: � 8
(Include this information of the above plot plan) ( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
i
PUMP CHAMBER
Manufacturer: N 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, OSide, O Rear,0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: 11� Trench:
Width: o? Length: 4 0 Number of Lines:_ _ Area Built: q'/0
Fill depth to top of pipe: q p
Number of feet from nearest property line: Front, O Side, 0j Rear,0 Ft . 2 3
Number of feet from well: m o � V
Number of feet from building: 3 Z
g
(Include distances on plot plan).
SEEPAGE PIT n�
Size: IV Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O 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, OFt.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector: ?0 1r' tv-flso
Dated: `7 8 f 19f Plumber on job:
License Number:
3/84:mj
rv-0C
VOL 13411 pni 055
583157' EXISTING SEPTIC
SYSTEM AFFIDAVIT
Document Number
Name & Return Address RlrGIS ERR" !; Cffrr
�ib�•c
//2 51 ST. C R O I X CO,, uhf!
/�/� :S' L!/✓/a PEI. Recd ?ur Rvserd
vim' ��ru-s w/ sryo�2
JUL 16 1998
0410 -1116 1 :00 P
Parcel I .D. Number
Re iefer of Deeds
The existing septic system which serves the dwelling being added on to must be verified by
an acceptable soil report or be inspected by a licensed soil tester for compliance with high
groundwater and/or bedrock separation requirements as set forth in s. COMM Chapter 83.10 (2)
WI. Adm. Code. The results of that inspection must be made available to this office. If the
existing septic system meets these minimum requirements, and is properly functioning, an
addition may be added to the dwelling without updating that system. This addition must not,
however, encroach upon the required septic system setbacks as setforth in s. COMM 83.10 (1) .
Property Owner(s) �kci_lf S
Property Mailing Address: l�y 47-W/PA_
/Z/✓F� 65gzLS 4-yl- 5—Yo Z Z
Property Legal Description: Lot # CSM/Subdivision v /
1 y .,� Sec.3, T_ZgN-R 9 W, Town of
Comments: The existing conventional septic system was sized and installed for a three
bedroom dwelling.
Carl Heise (ID # 220554) stated in an inspection report on July 8, 1998, that the septic
system was functioning properly and the addition will not affect the replacement area nor
encroach upon the current setback requirements.
I, as the owner of the above described property, hereby affirm that the septic system serving
this dwelling meets the above referenced state private sewage system codes. I realize that
this addition may cause the existing septic system to become undersized for a dwelling of the
resulting size, and I will make this information available to any future parties interested
in purchasing this o erty.
Signed: Notary Public Subscribed and
Date: sworn to b r me on this date:
Zoning Depar t My comet' sion expires:
Approval:
Date: 7 /
Diane D. Miller
NOTARY PUBLIC
State of Wisconsin
.............F EXISTING SEPTIC
SYSTEM AFFIDAVIT
Document Number --
Name & Re urn Address
v o2 Z
c'0
d
Parcel I .D. Number KA!NG OFF ICk
The existing septic system which serves the dwelling being added on to must be verified by
an acceptable soil report or be inspected by a licensed soil tester for compliance with high
groundwater and/or bedrock separation requirements as set forth in s. COMM Chapter 83.10 (2)
WI. Adm. Code. The results of that inspection must be made available to this office. If the
existing septic system meets these minimum requirements,_ and is _properly_functioning., _an
however, encroach upon the required septic system setbacks as setforth in s. COMM 83.10 (1) .�
addition may be added to the dwelling without updating that system. This addition must not
Property Owner(s)_ 1�bz4Gz-/fS Z,
Property Mailing Address:_ 5)k1-1VL-1i16 �/✓A
Property Legal Description: Lot # —i—CSM/Subdivision 51'1 Z
.� /., Sec. , T
L7-&N-RAW, Town of
Comments: The existing conventional septic system was sized and installed for a three
bedroom dwelling.
Carl Heise (ID # 220554) stated in an inspection report on July 8, 1998, that the septic
system was functioning properly and the addition will not affect the replacement area nor
encroach upon the current setback requirements.
I, as the owner of the above described property, hereby affirm that the septic system serving
this dwelling meets the above referenced state private sewage system codes. I realize that
this addition may cause the existing septic system to become undersized for a dwelling of the
resulting size, and I will make this information available to any future parties interested
in purchasing this o erty. XQ I
Signed: Notary Public Subscribed and
/gC! sworn to b r me on this date:
Date:_ �� C! (L , /991
Zoning Depar t My comm' sion expires:
Approval: = :-L`/. /q99
Date: 7 /
Diane D. Miller
NOTARY PUBLIC
State of Wisconsin
I
� � 1
ST. CROIX COUNTY
G WISCONSIN
xxxxxr�a: ��
ZONING
OFFICE ST. CROIX
COUNTY GOVERNMEN T T CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
- (715) 386-4680
July 14, 1998
Doug and Denise Heiman
144 Skyline Drive
River Falls, WI 54022
RE: House addition, Town of
Troy,Y, . Croix x Count
Dear Mr, and Y
Mrs.__Nei-man:
You have requested the Zoning Office to review
compliance with the state sanitary code COMM 83).your remodel ng/addition
dwelling you are required to examine whether or not the When remo eling or adding ontto ar
of wastewater. construction involves an increase
As I understand the project
You are proposin , You presently have 1,538 square feet f total living area and
g another 1,062 square feet of living area. The Proposed construction
equals a 70% increase in the total living area and does include
house plans revealed a bedroom in the basement. It ism
was never constructed and the space a ding that. The original
y unoom. n ing that the bedroom
p was used for a family room.
Section 83,055 (3)(b)(2) states: Increased wastewater load in
dwellings
an increase in the number of bedrooms from construction of any addition or
results from
remodeling which exceeds 25% of the total gross area of the existing
y
Since you are adding another bedroom and the constructi ing does exceed the
dwelling unit.
on/remode
25% standard as stated in the code section above. The se
evaluated to obtain a building permit.
ptic sys em will have to be
The septic system serving this structure was evaluated b
he noted that the system was functioning Properly Y Carl Heise n
report, if there is an addition onto the end of the houhat time. Mr. Heise und8cated 8 his
setbacks or the replacement area for the septic system. The there will b
septic system is sized for a three bedroom dwelling. Records no problems with
not is located, as built report revealed that the
g ords of the sanitary permit could
Since your proposal exceeds the 25% standard, you must h
the register of deeds indicating that the addition may
become undersized for a dwelling e the r esulting size. Also indicate whether a
have an ist g s recorded with
replacement area e available. y use the existi g septic system to
To prolong the life of the system, remember to have the septic tank pumped once every
three years or when the tank becomes 1/3 full of sludge and scum. Other efforts to prolong
the life of the system could be as simple as fixing or replacing plumbing fixtures with water
conserving fixtures, reducing shower time, washing dishes when the dish washer is full,
avoid using a garbage disposal, using a wash machine with a suds saver feature, etc.
Therefore, the prolonged life of this system may be dependent upon proper maintenance of
the system.
Should you have any questions, please contact this office.
Sincerely,
Rod Eslinger
Assistant Zoning Administrator
JUL-09 98 10:30 FROM:NOR LAKE 715-386-6149 TO:715 386 4686 PAGE:03
07/09/1998 88:88 7154255287 CPA- FEISE EX PAGE 81
i MOVE THE EARTH
QM N= MQ^VAinma
1"2 GoWft "P
mr4im FAu& w, 54022 ZAB
(71 5) 42¢1175
CARL P. HEM
Owrw
V� Y
JUL-09 98 10:31 FROM:NOR LAKE 715-386-6149 TO:715 386 4686 PAGE:04
87/99/1998 MRS 7154255287 CARL I-EISE EX PAGE 02
From:Carl Howe bOW 22OSS4
cad 130ise Rocavath*
1042 Syfain 5t.
wvw Palls.wl Sd022
715-425-2175
Fax 71SAZS-5287
_ To Whom It MAy Con=M-
On July 8,19981 inspectcd the septic system at 1"Skyline Dtl"for Doug Selman. At the tame
of the iaspecdon the baffles wm intact In the septic teak and everything was in vAx*i g order-
1-he tank was pumped in 1997- Upon rasp ion of the vent is the dudn"dA was found to be
dry and Intact. V tbete is an addition onto the end of the house.there will be no problems v d*
oOback s or the replacment atom for the septic system.
O.W l
IK P R S a ss 9
JUL-09 98 10:30 FROM:NOR LAKE 715-386-6149 TO:715 386 4686 PAGE:02
DARRELL'S SEPTIC SERVICE, INC. ;
1547 1.8th Avenue
RIVER FALLS, WI 54022
(715) 425.1025
ttnD er
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COMPANY.- 61. Cro,-) ( 1010 N. Main
River Falls, Wl 54022
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Phone
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Fax Phone
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FAX
ST. CROIX COUNTY ZONING OFFICE
1101 Carmichael Road
Hudson, WW 54016
(715) 386-4680
DATE: 7/6 A
TO: Fax Number: ��� 7
Name: � ,(� jL1� e—
FROM: Fax Number. 386-4686
Name:
Number of Pages Including Cover Sheet:
IF COMPLETE- AND LEGIBLE INFORMATION IS NOT RECEIVED, PLEASE
CONTACT:
NAME:
TELEPHONE NUMBER:
14- 4tv ovi
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER i ltd Ga.?Z TOWNSHIP 0 SEC. _0 T _N-R#_W
ADDRESS ��vZ,,i,P ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I•1HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I b.
p Q�aQ v
I - IL
.4
N
w o�A q.kc
i
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used Ljool 57fa4,_ iu west�+ ,LL(L
Elevation of vertical reference point: *-)5,w /Oo.00 Proposed slope at site: °I 5v.
i
SEPTIC TANK: Manufacturer: l,J[ese,< Liquid Capacity: 1 0 O O
Number of rings used: Tank manhole cover elevation: 51,2 4
Tank Inlet Elevation: q�,O4 Tank Outlet Elevation: 9L.L g
Number of feet from nearest Road.: Front,®Side 0 Rear, O 65 feet
e
From nearest-property line c - Front,O Side,O Rear, ) O feet
Number of feet from: well building: 19�
(Include this information of the above plot plan)( y reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
I
Manufacturer: YV Liquid Ca acitys
Pump Model: Pump/Siphon Manufacturer: Pump.Size
Elevation of inlet: Bottom ofitank elevation:
Pump off switch elevation: Gallons per cycled
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side,O Rear,Q Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
_Width: ,7 Length: 4,0 Number of Lines: Area Built: QG o
Fill depth to top of pipe: 4 p
Number of feet from nearest property line: Front, O Side,�{j :Rear,O Pt .23
Number of feet from well: mew Soy
Number of. eet from building: 3 Z
(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 O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
i
Manufacturer: Capa4ity:
Number of rings used: Elevation of bottom of 'tank: '
Elevation of inlet: '
Number of feet from nearest property line: Front,O Side,O Rear, OFt.!
Number of feet from well:
Number of feet from building:
Number of feet from nearest 'road: *.iv �arf:F �?S i ja4vU
;ygb -to di;, .
Alarm Manufacturer:
r.:Insp'ecto
Dated: Plumber on14Job:,=
License Numberxao%n 33419,t,4,41 'if, -f,4dM aGJ
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Parcel #: 040-1116-30-000 03/31/2006 04:27 PM
PAGE 1OF1
Alt. Parcel#: 30.28.19.473J 040-TOWN OF TROY
Current j_X1 ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
DOUGLAS E&DENISE L HEIMAN O-HEIMAN, DOUGLAS E&DENISE L
144 SKYLINE DR
RIVER FALLS WI 54022
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description * 144 SKYLINE DR
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 3.508 Plat: N/A-NOT AVAILABLE
SEC 30 T28N R19W PT NW SW FORMERLY LOT 1 Block/Condo Bldg:
OF CSM 5/1247 N/K/A LOT 1 OF CSM 9/2493
EZ-UT-1499/272 Tract(s): (Sec-Twn-Rng 401/4 1601/4)
30-28N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 928/331
07/23/1997 845/294
07/23/1997 772/304
2005 SUMMARY Bill#: Fair Market Value: Assessed with:
102929 300,300
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.508 63,200 225,800 289,000 NO
Totals for 2005:
General Property 3.508 63,200 225,800 289,000
Woodland 0.000 0 0
Totals for 2004:
General Property 3.508 63,200 225,800 289,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 212
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING
LABA&HUMAN RELATIONS DIVISION
P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION
MADISON,WI 53707 State Plan I.D.Number:
NW, SW, SEC. 30 , 28, 19W RL CONVENTIONAL El ALTERATIVE (If assigned)
Town of Troy XX
Lot 1 Sk 1 i d Dr ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PER IT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Michael Bartz Route 2 ,Box 80 Roberts ,WI 54023
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:
Carl Heise 3378 St . Croix 119538
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES ❑NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER I NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM: FEET FROM LINE: AIR INLET:
❑YES ❑NO ❑YES ❑NO I NEAREST---
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO E:1 YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF ❑YES ❑NO NEAREST-�
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: I 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: LE TH: NO,OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID
BED/TRENCH BENCHES: MATERIAL: PIT DEPTH:
DIMENSIONS
GRAVEL DEPTH FILL DEPTH D TR.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 I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
[--]YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH/BED I DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: TE:1YES CHED:
CENTER: EDGES:
❑YES ❑NO ❑YES ❑NO ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING:
ELEVATION AND
ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
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:
❑YES ❑NO ❑YES ❑NO NEAREST-
� o
)- 3
o
Retain in county file for audit.
Sketch System on
Reverse Side. SIGNATURE: TITLE:
SBD-6710(R.06/88) Zoning Administrator
Thomas a son
I-DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05,Wis.Adm.Code CouNTV—'
STATE SANITARY PERMIT#
-Attach complete plans(to the county copy only)for the system,on paper not less than l 3�
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
1. APPLICANT INF TION–PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
IL � r t/4$ t/4,S T , N, R E(orw
PROPERTY OWNER'S MAILING A
7,ESS LOT# BLOCK,#
CITY,STATE) ober-b ( }s ZIP CODE PHONE NUMBER SUBDIVI ION NAME OR CSM NUMBER
CITY NEAREST ROAD
II. TYPE OF BUILDING: (Check one) 1:1 State Owned VILLAGE
❑ Public X 1 or 2 Fam.Dwelling-#of bedrooms 3— PARCEL TAX NUMB R(
Ill. BUILDING USE: (If building type is public,check all that apply)
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. Vu New 2. El Replacement 3. ❑Replacement of 4. ❑ Reconnection of 5.El 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 N 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 12.ABSORP.AREA 3.ABSORP.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
945 7 94 .7 Feet Feet
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Expp.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank 00 J000 l
Lift Pump Tank/Siphon Chamber
Vlll. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans.
Imams
Plumber's Name(Print): Plumber's Signature:(No Stamps) M MPRS o.: Business Phone Number:
Ci ens s 42C-20,757'
Plumber's Address(Street,City,State,Zip Code):
Ib a�
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved i ry Permit Fee(Includes Groundwater Date Issued Issuln A nt Signature(No Stamps)
/� Surcharge Fee) 0.
X 1 Approved ❑ Owner
dverse veeInitial )7/`
Adverse D rmin tion
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety 8 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:
I. Property owner's name and mailing address. Provide the legal description and parcel tax numbers) of
where the system is to be installed.
11. 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
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)
APPLICATION FOR SANITARY PERMIT D�40_ /fl& .30
STC - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
Owner of Property
Location of Property J l�1% � � Section , T_ZLN-R W
Township Tr n
Mailing Address / q e
Address of Site ) L/� S 4 ' ,o bj:,'vt l�7 .
Subdivision Name '" 106 r L-,Q �� ��1 S.` �� r►-�
. Lot Number '
Previous Owner of Property
Total Size of Parcel
Date Parcel Was Created F3
Are all corners and lot lines identifiable? Yes X No
Is this property being developed for resale r1e■sale (spec house) ? Yes _ Y_ No
Volume =- and Page Number 12_ �' / 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 refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
I (We) ceAti6y that aQC 6tatement6 on this 604m ane thue to the beat o6 my (oun)
knowledge; that I (we) am (are) the owner(.d) o6 the pnopW y dens ch i.bed in ,thiA
.i.n 6oAmat i,on 6oAm, by viA tue o6 a WaAAan ty deed recorded in the 0 6 6ice o6 the
County RegiAten 06 Deeds a6 Document No.
own the pkopod ed Aite 64 the a ewaq a d i s pos a ya ems (o dI (we)Ihave)obtained an
easement, to hun with the above dea6c i.bed pnopenty, bon the eone.tAuction o6 aa.id
eydtem, and the same ha,e been duty recorded in the 066.iee o6 the County Reg-ia.ten o6
Veede, ae Document No. ) ,
(� c� I
SIGNATURE OIL OWNER SIGNATURE OF CO-OWNER I
. ( F AP,ALICABLE)
DATE SIGNED DATE SIGNED
li DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
II
STATE BAR OF WISCONSIN FORM 2—1982
449501 II v� _=845PArr 295 - REGISTER'S OFFICE
--- ---- ST. CROIX CO., WI
scotr-t---R hole-s------------------------- --------- ------ Recd for Record
---------------------------------------------------------------------------------------- ------------------- JUL 071989
ji ------------------------- ------------------------------------------------------- .............................. of
3:45 P-.M
conveys and warrants to _. t
-__Michael-_L._• Bartz
8art.z,_...husbns3._and__ rife___as_..surviv.arsha --------------- ReghteefOs''eds
-mar ital..propertX- ------
j ---------------- -------------------------------------------------------- .........................................
---------_-----_-----------------------------------------------------------------------.-__._.--_-_--._._..-__. RETURN TO
the following described real estate in -------St,,_-Cr-OlX-------------------County,
State of Wisconsin: I�
Tax Parcel No: .............
ii
i`
Lot 1 of Certified Survey Map dated September 21, ,
1982 and revised on October 27 , 1932 and recorded
at the Register of Deeds Office for St. Croix County
on January 21 , 1983 in Volume 5 , Page 1247 , as
Document Number 382262.
�I
�i
' "5 �
`
FEE
�j
�j
This .___1S-_not----- --_------ homestead property.
(is) (is not)
ii
Exception to warranties:
Subject to easements, reservations and restrictions of record.
; Dated this ------------------------------------------------ day of ...........J.L11y---•--•---------------•---•--------
- --- 19..-89
�I
----------------------------------------- ------------------------(SEAL) ---------- -------------(SEAL)
--------------------------------------------------------
SCOTT RHODES
---(SEAL) -------------------- ------- ----- ------------------(SEAL)
-
--- --------- ----------------------------------------- --
-
j AUTHENTICATION ACKNOWLEDGMENT
'i Signature(s) ------------------------ ...............................
STATE OF WISCONSIN
ST. CROIX ss.
------......County.
li authenticated this ........day of........................... 19...... Personally came before me this ----------------day of
_Jul ......................... 19...89. the above named
--------------------------------------------------------------- --- Scott Rhodes
" ------------------------------------------------------------------------- ------------ -------------------------------------------------------------------
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not- ----------- -- ----------------- --- ----------- --• -----------•------------- ------------------------------------------------------
authorized by § 706.06, Wis. Stats.) to me known to be the person ____________ who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY Debra K. Vindal Debra K.Vlhdal
STEPHEN J. DUNLAP
--------------------------------------•--------- .............
Notary P bi(c
�i Hudson Wisconsin `- / -State-of% :wm*1
--------------------------------------------------- -----•------------• Notary Public ----------St.....C-rO.1.X-------.-_Count , Wis. II
My Co fission .is ermanent If not state ex it tion
(Signatures may be authenticated or acknowledged. Both /fie� /:� P
are not necessary.) date: -�X J 19-_�1�.
'Names of persons signing in any capacity should be typed or printed below their signatures. I -.
WARRANTY DE �xee�,�„ STATE BAR OF WISCONSIN Wjaeonsin c•u�In•-
,tf.::_... - �.x�:",.�..n:.J.S.5�uWevvCb.w- :o::N�..a,..•u.4...� t..:�_ .���..
------- M..Nn...7._ lUa9_.....
STC - 105 r
a
H
SEPTIC TANK MAINTENANCE ACREEMENT o
St . Croix County x
d
OWNER/BUYER r , C k q./ t0 i t ��rTZ_ M
ROUTE/BOX NUMBER 1qq Sk,41"UP l)LIS .0 Fire Number
CITY/STATE j F.,A, —ZIP
c
PROPERTY LOCATION :ML'A, 'S CJ14, Section , T N , RW,
Town of D�/ St . Croix County ,
Subdivision Lot number_.
Improper use and maintenance of your septic system could result in I
its premature failure to handle wastes . Proper maintenance con-
sists of pumping out the septic tank every three years or sooner , I
if needed , by a licensed septic tank pumper. What you put into
the system can affe— ct the function of the septic tank as a treat-
ment stage in the waste disposal system.
St . Croix . County residents may be eligible to receive a grant fur
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1 , 1978 . St . Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their 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 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 . 0
0
E
I/WE, the undersigned,, have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with H
the standards set forth , herein, as set by the Wisconsin Depart- Iv
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County Zoning Offkre within 30 days
of the three year expiration date .
SIGNED
DATE :2- 10
St . Croix County Zoning Office
P . O. Box 98.
Hammond , WI 54015
715-796-2231 or 715-425-8363
Sign , date and return to above address .
OF REPORT ON SOIL-�BORINGS AND SAFETY&BUILDINGS
IND DIVISION
LA PERCOLATION TESTS (115) P.O. BOX 3707
1.4UMAN RELATIONS \ / MADISON,WI 53707
LOCATION: t IPALITY: OT N LK.NO' SUBDIVISION NAME:
COUNTY: NAME: L ADDRESS-
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMM R AL DE RiPTION: P OFILE DESCRIPTIONS: PERCOLATION
c
Residence New ❑Replace
17— Z�— � Z RlnT ta-c..ou
RATING:S=Site suitable for system U=Site unsuitable for system
COONNVVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional)
❑U _RJS ❑U SaS ❑U ❑SOU �S ❑U ✓E� -��
If Percolation Tests are NOT required DESIGN RATE S If any portion of the lot is in the /
under s.H63.09(5)(b),indicate:,,,,c 7— J< �ygg ¢, 7 Floodplain,indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORINGI TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER IDEPTH IN, ELEVATION OBSERVED EST.HIGRE—ST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
B- �- o o. O .�o .v /0S, r / / /o ' ,C�'n /f /J 8
B-
�� p—) PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. RI D t PERIOD2 PERIOD PER INCH
P- rC P sC
P-
P- �c
P- 5
P_
PLAN VIEW: 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 slop. c s495 .' Soi.c-4 C—A&-ey.i� � L.-Y er '4 G GE,r-'r- A4 Y
SYSTEM ELEVATION � ¢. � sv,•c. ����,�`' '
�_ _ - ��
l
_. . ., -7 r _ .4.. ._. ... _ .
F � dja k
Zy �w
— w
undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
istrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
0: TESTS WERE COMPLETED ON:
e --5-- 8 Z_'
CERTIFICATION NUMBER: PHONE NUMBER optional):
�_¢Q CST SI ATURE:
ocal Authority,2nd page-Bureau of Plumbing,3rd page-Prope y Owner, page-Soil Tester.
J
P )OT
1
_ FINA G_M -__ __ __ __
PP VIB f- t rti2S 3
9 PE Fa A7 E P
1N "A G, L
O FOOD FF
4 �
t
3 3 0 WELL
G�
I Odo 6AI S v 1C
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r
0
SS U K 1 , too 00
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nj
- l
f
f
flURVEY MAP
MAURICL•' VORWALD
NATALTE Mi3ILM
Part or the Northwest 1/11 of. the Southwes L 1/h of Section 30, .I`Ownnllip :'8 North,
Ranre 19 Went, Town of Troy, SL. Croix County, Wisconsin.
UNPLATTED LANDS EW 1/4 LINE
5 87.51' 32"E
00. 230,00' II 46.00'
316.00. I
16'_- E 1/4 COR. SEC.30,
1/4 COR. SEC. 30, , 4 T28N, R19W,(000NTY
UNPLATTED LANDS SURVEYOR' S MON"
a". R 19 W,t COUNTY
URVEYOR'S MON.) ti
86.00' ROADWAY EASEMENT
O LOT 1 e 3.509 AC.
• n r+
UNPLATTED a 152,649 SO.FT. „
3 LANDS '► NET:2.555 AC. m v 1
It
ell,275 SOFT. I I
°C
i C.S.M: VOL. I
N o I PAGE 289 1
~ m 1
o I
M
u O S80'00'07•'E 316 00' I
kd „ 230.00' Id6.00' — -• — ---- ”--- —' !'ll Pr0 Y I..J
b-
JAN 131983
o w o LOT 2=3.090 AC. 9 '.I, C:OI!: COUy"f
3 0 0 134.616 So.FT. w I v o° 3 CC1 NPdE11FNSIV[ I'ARI;S PLANNING
w ° N NET%2.249 AC. t w , A1dD ZONING COMMI,TFF
= sJ p V 97,960 SO.FT• a I N a o
Oo o
In
n' n ,ti1/0E[Ifff/J>`Pr,
o O UNPLATTED LANDS
N _.._
See;; 07"E ' ?A,6.00'
W ° I ,=r; V'J MURPHY
W
w rc
1713
I
w
J "
a ° o Tom)S•1•.�CI.IV•'t'R I-ALLS
v+ u LOT 3 2.931 AC N c C.°
o: To°
v 127;664 SO.F . ......•• ��•.E
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(JAN 23rI L E'N 08.00'07"W 316.00' 21983 66' GLENMONT ROAD UNPLATTED LANDS Als O'CON11RE p14►lndicates 1" iron r,iy)e i'o ncl �� +lYo J:ndi.cates 1" x 2.11" :iron pipe wc�:ilrhing 1 .13 lbr,./l1n. ft. seL Wltoule3a
� !fir
State of Wisconsin)
County of Pierce)
:1 , l,nur r_nce W. Mu1'►)hy, fi�:•;�:i trLc•, r r1 1..nn11 :31,1rvc yor, do hereby co-rl:i.f.•,y that by (U-rre Lion of
Lhe Ownrrn, Mmlr:i.(e Vc,rw-lld m)d NnUil..i c• K1.I.^,'ilrk, :I: hnvc� .nurvey� cl <vul di.v i.c.leel l.hrt ]an 1^
shown hereon in accordance Wit-1-1 off:i.clnl rocordn, CI,,IpLer' "36 of lisconsin St;rtL!te, Lnd
the Ordinances of St... Croix County; mid that the above (nap and de^cription are a trio
and correct representation theroof.
bated: 21 SepLCmbeT' 1982
flevisod: 27 October 1982
Vol. `• Pal;e. 1?_117 L,lurenco 1,1, Muy-pIly
Ccr l..i 1'i eci Survey )hlpr, 1jrl�.i n Lrr+'d 1..rnlcl