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HomeMy WebLinkAbout040-1045-60-100 ry, o -0 °o. I Q ° ao CD a 0. a m oo I b O O O Z o 0o N aEoLL 0 ti c E L rn2cp m O C O ` L O..O i C 0 y .N. (5•O O X �L F aN t a a•f0 U) N O W �c Tco < ,0� — N f6 V iT N N CD 0— y oco- N= CL Z ay po 6 U N m N y (6 U N IL c0 0Z C(D >- r @:2 a E ro Qn �Ua� m � � o I I rn z C o Z a m 0 o z d c v v o U) H O Z E -2 cc c �_ M a y I • Q) o N O N Q O U O = Z m Z Z N � co N II � .. E LL CL > a d c o E O m a� p co � 'coa j chi rN rNN '_y t�wvv�J m o O o o cn Z •A�rl io p a a a N IL a LO co co o w p N J V p00i rn Z 2 c _ � N 0 N 0 0 E f`0 m d c p N p O @ 'O _� Q Z fn tV q N 7 O 06 H N p E ,O O C> C ''I o Q> c C U d 0 O iw ?� N y C IC6 N V 1 O N 1 N N C 7 N I.C. ~ E W N Z ed+ 'C7 O *4 O' N T E N ad. E Z' = a)p O m O U • V O O N O r O H ! m O Z _ H O ►L it - E E m a CL • a - d c I ._ E v c c +� � Parcel #: 040-1045-60-100 02/15/2006 04:35 PM PAGE 1 OF 1 Alt. Parcel#: 10.28.19.150G 040-TOWN OF TROY Current XI ST. CROIX COUNTY, WISCONSIN Creation bate Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner DAVID G&SANDRA D BRUMMEL O-BRUMMEL, DAVID G&SANDRA D PO BOX 344 RIVER FALLS WI 54022 Districts: SC= School SP=Special Property Address(es): *=Primary Type Dist# Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 4.000 Plat: N/A-NOT AVAILABLE SEC 10 T28N R19W PT SW NW LOT 1 CSM Block/Condo Bldg: 6/1606 EXC PT TO HWY PROJECT 7200-04-21 HWY35 MANUFACTURING STATE ASS'D Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 10-28N-19W SW NW Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1133/83 WD 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 102364 105,000 Valuations: Last Changed: 10/27/2005 Description Class Acres Land Improve Total State Reason MANUFACTURING G3 4.000 32,300 68,800 101,100 YES Totals for 2005: General Property 4.000 32,300 68,800 101,100 Woodland 0.000 0 0 Totals for 2004: General Property 4.000 32,000 71,600 103,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 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 PAUL STEINER Owner: DAVE BRUMMEL ROUTE 1 BOX 138 ROUTE 3 BAY CI'T'Y WI 54723 RIVER FALLS WI 54022 i RE: Plan Number: 87-06000—S Date Approved: October 2, 1987 Gallons Per Day: 300 Date Received: October 1, 1987 Location: SW NW 10 28 19W Project Name: AVES STUDIO , i Town of TROY County: ST CROIX 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: NEW CONVENTIONAL Inquiries concerning this approval may be made by calling (608) 266-8230. Sin erely, KE ETH STIEMKE Section of Private Sewage Division of Safety and Buildings PPP016/0009n/23 cc: DAVE BRUMMEL ___-Private Sewage Consultant _ County _ UW—SSWMP Plumbing Consultant Owner —Plumber Environmental Health DILHRSBD-6423(N.04/81) DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 SW4, NW4, S10,T28N—R19W CONVENTIONAL ❑ALTERNATIVE (If assigned)D.Number: Town of Troy ❑Holding Tank ❑In-Ground Pressure ❑Mound HWY 35 NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPE TION DATE David Brummel Ro e lU���d BENCH MARK`(ssPer``rmanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF,PT.ELEV.. w �^v Name of Plumber W JMPIMPRSW No.: County: Sanitary Permit Number St. Croix 102788 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: ITANKOUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED PROVIDED sE �/ OYES ❑NO OYES ONO BEDDING. VENT DIA VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. (VENT TO FRESH ALARM. FEET FROM LINE'. AIR INLET DYES ❑NO OYES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: El YES ❑NO ❑YES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPE RATIONAL. NUMBER OF PROPERTY JW BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES 1:1 NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE SPACING COVER NSIUE DIA -PITS LIQUID (� TRENCHES / N TERIAL PIT DEPTH DIMENSIONS J GRAVEL DEPTH FILL DEPTH DISTR PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO. R. NUMBER OF 1PROPERTY WELL BUILDING VENT TO FHE SH BELOW PIPES.(1 VE CO ELEV.INLET ELEV.END. O '� PIP 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 OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. 1:1 YES ❑NO SOIL COVER TE%TURF IPERMANENT MAHKERS OBSEHVATIONWELLS DYES ❑NO ❑YES E NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. DYES El NO F-1 YES 1:1 NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR,PIPE M NO DISTR UIST R.PIPE ELEVATION AND DISTRIBUTION PIPE MATERIAL&MARKING ELE V.. ELE V.. DIA. ELE V.. PIPES DIA.. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED OYES ❑NO PLANS DYES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE ❑YES ❑NO ❑YES ❑NO NEAREST oil 4, i r \ 1, 4'.\ �. az',o a. 5 e� 3w.�_ Sketch System on Retain in unt f t. �LQi_ QV� Reverse Side. u 7. SIGNATURE. TITLE. DILHR SBD 6710(R.01/82) Zoning Admini i INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system,- 4. Changes in ownership or plumber requires a Sanitgry Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; --•- 5. Private sewage systems must be properly maintained.-The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete#2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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; dosing or pumping chambers; 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 modet.and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. -------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground &t', �--' included the creation of surcharges (fees) for a number of regulated practices which Wisco iF3!'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- f water. groundwater contamination investigations and establishment of standards. Groundwater, ....... .....>.......:......... it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COUNTY �.01LHR In accord with ILHR 83.05,Wis.Adm.Code STA E SANITARY PERMIT# M a y?9' —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. d l Q —See reverse side for instructions for completing this application. PETITION I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES I4 NO PRRERTY OWN PROPERTY LOCATION E ► '/a '/a, S T :2e, N, R P PE,RTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE ZIP CODE PHONE NUMBER NEAREST ROAD,LAKE OR LANDMARK L - II. TYPE OF BUILDING OR USE SERVED: e Number of Bedrooms if 1 or 2 Family OR El Public(Specify): /7 — III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. �New b.❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than,one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a.IN seepage Bed b. ❑Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): 42 0 d 9 Feet X Private ❑Joint El Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank /cot) e Lift Pump Tank/Si hon Chamber ❑ F-1 F__1 ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumb ignature:(No S mps) MP/NWRGW-Ne,.: Business Phone Number: A C S .e - � � �a 7 1,4- Plumber's Address(Street,City,State,Zip Cod : Name of Designer: _1 ' Uj VIII. SOIL FBiRMIATION Certified Soil Tester( )Name CST# O ✓K CST's ADDRESS(Street,City,State,Zip Code) Phone Number: f 7/ 3x -3 r IX. COUNTY/DEPART ENT USE 014LY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuin Agent Signature(No Stamps) Approved ❑ Owner Given Initial Su harge Fee C_/,{►,/, Adverse Determination /� �-ff �� - X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 14 i AVES STUDIO Hwy 35 Hudson, WI ) 00 Master Plumber Paul C.J. Steiner #6780 Table of Contents Title Page . . . . . . . . . . . . . . . . . . . . Page 1 of 5 Table of Contents . . . . . . . . . . . . . . Page 2 of 5 Calculations. . . . . . . . . . . . . . . . . . Page 3 of 5 Plot Plan. . . . . . . . . . . . . . . . . . . . . . Page 4 of 5 Cross Section. . . . . . . . . . . . . . . . . . Page 5 of 5 0600► Project Name: Aves Studio Master Plumber: Paul C.J. Steiner #6780 Signature : Date�,1 t _ page 2 of 5 • Calculations Step 1 : Sized in accordance with ILHR83. 12 Table 1 and table 2 Class I perc. Seepage trench 110 sq. ft. X .4 for each employee X maximum of 10 employees in 24 hours = 440 sq. ft. required trench area. Step 2 : 440 sq. ft. required trench area = bed 14. 5 ' x 901 . Note: Oversized as per owners request. Aves Studio page 3 of 5 PAGE'. OF CROSS SECTIOM OF A BED SYSTEM Fresh Air Inisle And Observation Pips L0--_--')m--Approved Venl Cap Minimum 12"Above Final. ad* 20.42"Above Pipe _4 M Coal Iran To Final Grade Vent Pipe Mares Noy Or syntnelte CoveimQ In 2" Aggrepal• Over Pipe Distribullon Too Pipe 0 0 0 0 0 8'- a" Aggi*gm* o Potluroled Pipe below 8eneoln Pipe —Cwryiiny TerminolinQ Al t` Ilultom Of Syvlam i Pier, 601L FILL eoF AGGREGATE DISTKIDUTIOU PIFE-1 APPROVED 6UMTHETIC COVER MATERIAL OR 10 OF STRAW OR MARSH N" 4:0F&•2t�s AGGREGATE CLE1. OF_._FEET"."_.. l ST C - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d J a OWNER/ ,�Q (? GI r u .ruJl',.e L t2i ROUTE/BOX NUMBER P-3 Fire Number /J ZIP 5yozz CITY/STATE lie/' J�rc6(� LIJZ PROPERTY LOCATION : 5 0Q Section, T 6�9 N , R W, Town of St . Croix County , Subdivision , Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists 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 treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their 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 . H 0 E I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- ro ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED ` DATE �Ah 7 St . Croix County Zoning Office P. O . Box 98- Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above address . DILHR wiscon*in Department pf Industry, INSPECTION Labor and Human Relations Leroy Jansky P.S.C. Satety&Buildings Division REPORT 13 E. Spruce Street Bureau of Plumbing Chippewa Falls, WI 54729 Inspection Date (715) 723-8786 ` =k .bra ;;)(, i Name of Premises AddoeswsLegal Description QWTownship County A V�.S 5 TI-', 5W - Ka. ,j - I o-7-S C,r-..� T-",(a, 11-1 C.),.( Sr. C Q01 X Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D.No. ()A-,A;,_ Bile=t+vF 12 t"%P (.78C.) 8-7 O&OCj i2t- 1 f ax 13EN Sanitary Permit No. 6" C)t�1 (AJ Sct�z3 Journeyman Plumber/Soil Tester Licensed Person's Name(s)and License Number(s) Owner's Name and Address rN_yc >D6A71C,^) __0 fit c �a�.s�t �,s cv, �PiA,"T /� v nC t�l�c FP-E4F1eit _ i,,lP `P lt'F- In+i3.1 AiFf rk ++T .TN17- S'YS ! ;y N�-.l'Z l.�'C t: _ *jiUpj U'= Ti4tz-& _ tN j!' 17;12 1 ?t�T t�F. Fk.0 Lt "AP ! ��!4��✓�� ��. _ b�.Ais _ T7y_ °77t Fl * 061 0I Tt1E 6Vt1L O-P-36 � 1t t ' j t' laA � t . ,l �'Jil''" r�iPrrJE.> r'�c <c �a7°fJ6 THE 6�,r�rl2 t `Tr+ems, Nqr: G(u'�AY"FIL ri�tu� TN1F- 11 L w.j Ehr-Lut:-r.+ [ r, ,~ t�j�� c LING A �anr �.c i l'Ut1 Ti i y U J 4)(7 i0 f= O„11� p1°J6 S�L�)r �f�NFtr=1�- t"t7 �S_ �' / r . l6Jil+j% C_.. ;rf A(,(,47DANCC i-jIrt+ ;cam `5 Z. 3a Ltt�:�b�° .tti�1{ � ,�Dt,rcrtr� a 1NSu sRcYD_ :0 At 'A-3t ri f r� -Ta t;= t 1:41 r t r�-. 1'5 / lP-E c3y //2F._.+J—V,� 'a o I A)C,6U± ic`- /!{ 1.. f 1(9a 1.z 6F J�=E,�� A I / 2 a s��A r_t;�+1�d�.' t�� � /N r i a4tL ti�`s% �-. )►J�1`../�i'+�'� , 7 N`sr..t L A71 0 awl 44 AL. � k,jll+ h4t-=- is tP-*1V!f3F;3 1 7VFC- U fi 0-16, 4)"'4"'1 eF_ A Y' Cf=. -57 ^Jx � Tf+![:K At--D � � �,rp> _ "rt- FHE_ `;f Vic- i t t E i M 54 t k-?-t i s aJ ` U/-_12 7 f�f. I�rF'Iw u c=c•t r -l�t%'i fA t L a� ve tC! T lFi G ''Q T T!)° n,,aVA ;,` 3L 6+1 r i-U; ✓�f 47 7 a r,,t.,AJ,A �, ti c f !v'aL_ .t r t+t - k 1 j Page—l—of Z""- Signature of Responsible Licensed Person(only one needed) Signatur of Plumbing Consultant;Private Sewage Consultant (Check all l`\ Coplesto: \thatapply/ i Original.• SBM192(R.11/85) District 0 DILHR 9 Plumber 9 Ow >r CoQ'ty/Local Insp. 0 Ot DILHR wisco n Departmentpf Industry, INSPECTION Leroy Jansky P.S.C. Labor and+luman Relations 13 E. Spruce Street Safety&Buildings Division REPORT Bureau of Plumbing Chippewa Falls, WI 54729 �P. Inspection Date (715) 723-8786 C/- Name of Premises egal Description Township County Avf-S S,o! U Sw CQev/x Master Plumber Name and Address Master Plumber irm Name and Address Plan I.D.No. PA,q t~- `ZJ'T-=t - E37 o cp c-.,o cj - $ Sanitary Permit No. Journeyman Plumber/Soil Tester Licensed Person's Name(s)and License Number(s) Owner's Name and Address € 4t,tit 4r Ptictrr3ER .s awexl-N.St ?IFS to L: i~ ,.� rt t,. F=�1'�c� _ �4 r-�� I w su i f�1 u,v ,517 4< t2IF— T14 f= (W 54 LA l�c!n! tNtlC. �c� C�'�Pc 1C� CAN 6C no6�s�_ 16 /r 8 {tt�1..— trt �`P@-T t1 PIS Flu t r,.lr" 1k T0-C PZ Lt k` �r?�Ny �' 0 t?41 5 er f°��/�'i A-,C4 5dz , s I _ RECEIVED On 0 4 Isar ., gT.GR01X n ` ^.AUNTY I I �)NiNG{3FFt�- I Page — Of Signature of Responsible Licensed Person(only one needed) Signatu of Plumbing Consul Private Sewage Consultant (Check all Original: Copies to: \that apply/ SBD�192(R.11/85) District ODILHR ®Plumber C?OWr Co my/Local P. her V i APPLICATION FOR SANITARY PERMIT 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 /�Q�i/� ru tLhia( Location of Property ANV hr, Section /0 , T c p N-R Z 61 Township I r o v T Nailing Address 3 i v ev Address of Site Subdivision Name A . Lot Number 41A Previous Amer of Property Total Size of Parcel _ Date Parcel was Created �� �lt _ Lj , f Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes X No Volume .lc.k-f-7 . and Page Number _LLF5_ 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) cvLti.6y that ate statements on thus fokm aAe t1Cue to the but o6 my (ouh) hnowfedge; that I (we) am (ahe) the owne&k 06 the phopenty dmcAi.bed in this .in6o"at.ion 6o4m, by vi tue o6 a waAAanty deed neconded in the 066.iee o6 the Count RegiAteA o6 Veed�s" Voeument No. - 'f 961 and that i (We) pnezen,tey own .the phoposed bite 6oh the -sewage di�spo�5 b yes em (on 1 (we) have obtained an easement, to nun with the above de%cki.bed ptopehty, bon the eonetnuction o6 ea.id ,6ote +, and the came ha.s been duty neconded .in the 066.ice o6 the County Regiaten. o6 Vee ab Uocment No. ) . L GNATURE Op OWNER GNATURE OF CO-OWNER (IF APPLICABLE) TE IGNED DATE SIGN r _ lea� CERTIFIED SURVEY MAP Nov 61985 " to CORNER SE G fly, SECTION 10, ,C 64 Wes* T 2 8 N,R 19\N) ''Q UNPLATTED LANDS N880 37'59"E N 0 0 4I7.42' 4 p m n 0 S O '1 D z 9� p i p Ste% � �i mm � G) Z IZ DoT I �p 0 -0 Z 4.0 ACRES MORE OR LESS z c- p m I� o (174,188 SQ.FT.) A 0 I� P m n � �� o r -1 M N ;J N ID N= I0 O N ,n car N O Im 0= 0 _ern m 1° 0 :r o O I� J Ir o, m _ z N _ I D n ACCESS �0 } I c m \EASEMENT 1 M m r- ^;Y CRt 'tti! 1 0 m O \17.62' Opp 900 LEGEND w \ o°O S9Sy'' �'COUNTY SECTION CORNER 417.42 BERNTSEN CAP 96.4 S 88 03759"W -— — • 1" IRON PIPE FOUND z� O I"x24" IRON PIPE WEIGHING 0 UNPLATTED LANDS VOLUME 501 PAGE 95 N — — — — — -- -- ---------'---- --- 1.681bs./LINT FT, SET \ ` N POINT OF BEGINNING Op I _ SCALE IN FEET �h N 0 100 200 300 (I"=I00') W.1/4 \ CORNER DESCRIPTION A parcel of land located in the SW 1/4 of the NW 1/4 of Section 10, T28N, R 19W , Town of Troy, St. Croix County, Wisconsin, described as follows: Commencing at the W1/4 corner of said Section 10; thence N0022'04"W (bearings referenced to State Trunk Highway "35") 174.26' along the West line of said NW 1/4 to the point of beginning; thence continuing N0022'04"W 417.42' along said line; thence N88037'59"E 417,42'; thence S0022'04"E 417,421; thence S88037159"W 417.42' along the North line of that parcel recorded in Volume 501, page 95, to the point of beginning; containing 4.0 acres (174,213 sq. ft.), and being subject to all easements, restrictions and covenants of record. Also an access easement across the driveway presently constructed at the southwest corner of said lot, being the 33' adjacent to and Northerly of said parcel recorded in Vol 501, page 95. I, James E. Rusch, registered Wisconsin Land Surveyor, do hereby certify that I have surveyed and mapped the above described property; that such plat is a true and correct representation of the exterior boundaries of the land surveyed; and that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes, the Town of Troy Subdivision Ordinance, and the St. Croix County Ordinance to the best of my professional knowledge, understanding and belief. 483-461 Vol. 6 Page 1606 THIS INSTRUMENT DRAFTED BY F. LECHNER r `C p� ti .LD7'�lri7., og x,o� ��'boi �at4niS No 1 1 1 — ► )pJ S ,biZ 1 fi� l b6$I S s7� NnQC ,�a�abr/ {. L 'VV d,lnAIl <�r�QltC18 9rv115►Y,3 73ni ..LVr1 vNv Ski ha Q 30bd3ld SCI "' hrIMaDQ 1 1 cillfl yVh1 �(i11�1�� iC�?T�f�H / J e� DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS iNPUSTR Syr. DIVISION PERCOLATION TESTS 115 MADISON,WI 5a of HUMAN RELATIONS fH63.09111&Chapter 145.045! YyN� NS 1 NICIPALITY: T NO.: LK.NO.: SUBDIVISION NAME:2 U YER'S V# 4 )Q N/R� %aow COUNTY: JM NAME: IL ADDRESS:�,c4ZA0 t s USE DATES OBSERVA IONS MADE 01saidence New ❑Replace I /d 114 RATING:S-Site suitable for system U-Site unsuitable for system G/ VE U R4 LL OLO IN TANK:RECOMMEND ED SYSTEM:loption al) o S ❑S �� CoN�/c x�7`TcJA r .s If Percolation Tests are NOT r equired DESIGN RATE: If any portion of the tested area is in the * ' under s.1­163.09(6)(b),indicate: N( I f�)s Floodplain,indicate Floodplain elevation: 1 ScltL, f--,- 74- PROFILE DESCRIPTIONS t3V> .,K 1} A,i�.UT o f L{� BORING TWAL AT R-INCHE CHARACTER SOIL WITH THICKNESS, OLOR,TEXTURE,AND DEPTH NL#/MER H IN, ELEVATION ' ! TO BEDROCK IF OBSERVED tSEE ABBRV.ON BACK.) B- ( it ldd�°� iV ©A1E `� $(.fir' 5L I-, /a�, % gn 5(L, 24� Y C$" SL w�G-,Ras C0% ,42; n M to C „ g t_ L /dj 3 n `- •,l./G,z. � c u 9. , /f"; r3,., �5 �,,,; ri.�, /(0/. 0 r3,.1 a 7" a K G. L, dr.' L .N C-R. C--i3. /4'") aw LS w/G,2, r di g.4 /ni,� 0,Va �u W\40 5 44„ L' 7 a� 13L L, /,O 3�r L ,-4 C-1rsr B- 5 �+ !d/ U MILT, S, 54)" f t rs %L L_ .N/&OL, ID ism L B- !d3.v ), (0 r, (i McQ 5 nz C-'L, PERCOLATION TESTS TEST DEPTH WATER IN H L ---T--E7ff T RA U YES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PER INCH P_ I / 7S I P. E /i P- ga z 3 -S P_ P- �SLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- !ontal 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 3f tend slope. 3 i~o_H PAA-r.K - s r-,4,-r.-I- SYSTEM .ELEVATION 98.0 --`"� 014 R_I s c• A. w - o /O I t r ,. s rTH t I , Et- l L T '. , __. •r,OUrM &o , Lrrv( 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, 4AME print : TESTS WERE COMP4ETED ON: 0.17 SSS: CERTIFICATION NUMBER: IftHONE NUMBER(opiional): C9 GNATURE: ASTRIBUTION:Ori*linal awi n"r+rnp;•to I_nrnt Authority,Prnpr,r t,/Ownnr and Snit Te>car. kr l JAMES E. RUSCH Jz.mes E. Rusch S-1316 isconsin Land 1376- Surveyor S •r Hudson. Y y�9 WIL ,r 0 421 Second Street �� ••.•''.� e�F Hudson, Wisconsin 54016 U 09 0 losses� This map is hereby approved by the Town Board of the Town of Troy Date Town Clerk March 31, 1983 Surveyed for: David Brummel Vol. 6 Page 1606 1 CERTIFIED SURVEY MAP NOV61985 do SAX*I NW CORNER a Dee& 40 SECTION 10,---�� � Sil 04b ows"' T2 8 N,R 19W, �Q UNPLATTED LANDS N880.37'59"E 0\M ' z 00 417.4 2 O N -1 *0 OO �m ED rn sue:, 0 (n � 0 D Z z LOT l m vi � M Iz -1M �A v I-0 z 4.0 ACRES MORE OR LESS c z C -n 0 m ID1 o (174,188 SQ.FT.) � iz U1 A M m cn -I N �, ory o m N f/) �� 0 `1 N �-D-I N? n Cdr N O �m 0= 0 jz - ,p O v = Om Ir m 1 Dto z D 0 \ v N m J � ACCESS ' .f ir � N z \EASEMENT ? m r . 62' `9p 0 LEGEND w S)�� COUNTY SECTION CORNER 417.42 __ _ BERNTSEN CAP 96.4 S88°37'59"W • 1" IRON PIPE FOUND \cy \,h z _ _ _ _ __ 0 I"x24" IRON PIPE WEIGHING 0 UN PLATT ED LANDS VOLUME 501, PAGE 95 N POINT OF BEGINNING 1.681bs./LIN FT. SET \ \ N- \ SCALE IN FEET N 0 100 "- 200 300 \�\ - (I -100) W.1/4 \ CORNER DESCRIPTI ON A parcel of land located in the SW 1/4 of the NW 1/4 of Section 10, T28N, R19W, Town of Troy, St. Croix County, Wisconsin, described as follows: Commencing at the W1/4 corner of said Section 10; thence N0022104"W (bearings referenced to State Trunk Highway "35") 174.26' along the West line of said NW 1/4 to the point of beginning; thence continuing N0022'04"W 417,42' along said line; thence N8803715 9"E 41 7.42 1• thence SO o 22 r 04" E 417.421; thence S88037159"W 417.42' along the North line of that parcel recorded in Volume 501, page 95, to the point of beginning; containing 4.0 acres 1 ( 74,213 sq. ft.), and being subject to all easements, restrictions and covenants of record. Also an access easement across the driveway presently constructed at the southwest corner of said lot, bein • g the 33 adjacent to and Northerly f said parcel recorded in Vol 501 y page 95. g I, James E. Rusch, registered Wisconsin Land Surveyor, do hereby certify that I have surveyed and mapped the above described property; that such plat is a true and correct representation of the exterior boundaries of the land surveyed; and that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes, the Town of Troy Subdivision Ordinance, and the St. Croix County Ordinance to the best of my professional knowledge, understanding and belief. 483-461 Vol. 6 Page 1606 I pop- C FS acs Q F Ni 4- W .G. J a Ia v 3 h it lz o � a O a {b ti v V) look ;r- s