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HomeMy WebLinkAbout020-1141-90-000 c O 3" o d p N C ' ' ° 0 CD '0 3 l 0) v) 0 00 3 3 C fD a iV Q Fy cirl CD CD CL z N N A y = ' C (D y SL (D CD f =D O CC lA\ C) 0 j :-4 C) (0 N N 7 CD O 7 to Q7 C) C 0 U) C, 0 y CD cn C D C a m = N a ° a 0 m y 3 a ° o r v ^AVI p ~ = m c CD 0. 00 co C 0) 0 r fn rn 0 o c o 000 o, • ~ o rncn 0 ca v, y 3 1.31= OrQ v v v m (DD w 2) '0 o D CD m a CL RAI rr :3 Z z N D D o p c ° CD a I ~ t~l C CD I ~ w a 3 CD Cl) O A A z I C A W m < a z o' " x o M cn z CD C.0 I 0) CL a D ~d CD o o - v, v 3 v M3 m o a CL Cl) o5 hO fi co 4 cD ~i O a N CL zt CD A o w 0 a ! h O ti N 0Ap O o p oe ~ y CD CL y U) 0 0cn0 ! 3-0 n C`n o n m f' c d o O y lA\ ~ ~ ~ Z ~ _Z ° ~ = A N p> O y O ~ CD~ C j O. CD fD CD N IV O F1 tD N n yC O M n CD Z (D CD d. 7 y ~ I 0 p C j y N c. a s. ~ N co ON S11 n ° m CD ~ jZ N p N cc) co co or r ~ - t, C. ~ co) co fn p~ ~p rt Qa 3OIQ 3 vvv f cc CD W a' 3 01 i a ot - N z z 0 D D o a O a C CD c w ~a 3 o D -1 fn ra A ? A ci A 2 o p' A , Z M A o 3 - y Z F A W CL D a ~ i 3 v c 0 o a N m v m ' a A S =r =S C. O 0 n CD D ~ ti N O ti O O 0Ap 4+~a ° L O f Parcel 020-1141-90-000 10/10/2005 08:03 AM PAGE 1 OF 1 Alt. Parcel 34.29.19.729 020 - TOWN OF HUDSON Current XST. 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 WILLIAM J & KAREN A PETERS O - PETERS, WILLIAM J & KAREN A 655 EDIE LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 655 EDIE LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.950 Plat: 2514-STEWART'S ADDITION SEC 34 T29N R19W STEWART'S ADD LOT 6 Block/Condo Bldg: LOT 6 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 34-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 768/240 07/23/1997 756/491 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/27/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.950 39,800 154,600 194,400 NO Totals for 2005: General Property 3.950 39,800 154,600 194,400 Woodland 0.000 0 0 Totals for 2004: General Property 3.950 39,800 154,600 194,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 210 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form -STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ) k Pe, 415 TOWNSHIP SEC. T -J N-R/~_W ADDRESS k I ST. CROIX COUNTY, WISCONSIN SUBDIVISION G4j LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM All rL ~ tart ~-r`~. r _.e_- 20 i J r ~ We PeA N INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used e_40Y-Ajc -100, Elevation of vertical reference point: 140 Proposed slope at site: 6!9C SEPTIC TANK: Manufacturer: at"t M Liquid Capacity: lZ~e, Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,OSidejyjkRear, J` feet From nearest property line Front, 0Side 10Rear, O feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SFF. RF.VF.RRR GTnR PUMP CHAMBER Manufacturer: Liquid Capacity: ~d d Pump Model: -3`2 Pump/Siphon Manufacturer: Pump Size^ Z Cie LLO.- Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: A Y L Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear Ft. . Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: A Trench: Width: d Length: Number of Lines: 3 Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,Qltt. Number of feet from well: Number of feet from building: (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 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job:/ ~~'S License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL UALTERNATIVE State Ptanl.D. Number: (lf assigned) Holding Tank ❑ In-Ground Pressure Mound 8608503 NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION D E. William Peters Rt. 1 Hudson WI 54016 1-15-1987 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: NW SW Section 34, T29N-R19W Town of Hudson Lot #6 Stewart's Add Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Roger Timm I3224 St. Croix 88444 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER / ~f~ P O IDED: PROVIDED: ` Y 77,23 YES ❑NO ❑YES NO BEDDING: ENT DIA.: _ VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH /7~~/ JALARM: FEET FROM `Z s1 LINE: I AIR INLET. ❑YES ❑NO ❑YES ❑NO NEAREST- Z4 bOSING CHAMBER: MANUFACTURER BEDDING: JLIOUIDCAPAIITY. PUMP MODEL PUMP/SIPHON MANUFAC URER. WARNING LABEL LOCKING COVER PRO DED: O ED: YES ❑NO ' Z f' YES E] 37 f- YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENTTO FRESH (DIFFERENCE BETWEEN FEET FROM LINE A~NLE PUMP ON AND OFF) YES ❑NO NEAREST SO/ SOIL ABSORPTION SYSTEM. Check the soil moisture at t He depth of plowing LENCrH DIAMETER 1"A TERIAL 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 V CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH NO.OFHES. DISTR. PIPE SPACING COVER NSIUE DIA #PI75 LIQUID TRENC MATERIAL: PIT DIMENSIONS DEPTH. GRAVEL DEPTH FILL DEPTH UISTR, PIPE DISTR. PIPE DISTR.PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY TTO BELOW PIP E&. ABOVE COVER. ELEV. INLET. ELEV. END: PIPET` =AIR EN FRESH IPES: FEET FROM LINE. INLET. NEAREST-1 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- YES ❑NO meets the criteria for medium sand. TIONS MEASURED. OIL COVE TEXTURE , PERMANENT MARKERS JOBSERVATION WELLS DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED ❑ YES SEEDED ❑NO ❑YES MULCHED ❑NO CENTER. S EDGES: t• . / ❑YES ❑NO YES ❑NO *XYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS O S~ TRENCHES: ~j (/0 J_ MLAENIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR DISTR. PIPE UISTRIBU HUN PIPE MATERIAL & MARKING ELEVATION AND EW1.3 7 CIA E yb 1.33 ' LO PIPES / DlA/ L/ DISTRIBUTION V / (P 0 INFORMATION HOLE SIZE HOLE SPACIN DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS / O YES ❑NO ~ L1~CiYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL~:y~/ BUILDING: YES ❑NO YES ❑NO NEARESTM LI~O~ `y_/ Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. DILHR SBD 6710 (R. 01/82) DAL SANITARY PERMIT APPLICATION COON In accord with ILHR 83.05, Wis. Adm. Code SAT SANITARY PERMIT # ZEE ~ -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. 11>6 d X5 -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION PROPERTY OWN MAILING ADDRESS LOT NU BER JBV VER SUBDIVISIO NAME, &,r P 7 CITY, TAT ZIP CODE PHONE NU CITY NEAREST ROAD, LAKE OR LANDMARK VILLAGE : TOWN II. TYPE OF BUILDING OR USE SERVED: (,~o7O- /1 l-~ Aaxt- Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. ONew 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 blternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy ee---)Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Z Seepage Bed b. ❑ Seepage Trench c. ❑ seepage 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): Feet ❑ Private ❑ Joint ❑ 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 / Ll] ❑ ❑ Lift Pump Tank/Si hon Chamber p" ~'v ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPR~ Stab Business Phone Number: 2,41 ?L 3 2/ Plumber's d ess (Streit, City, St te, Zip Code): f S Name o Designer: I V 61 VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST Z411-1-LI'! CST's ADDRESS (Street, ity, State, Zip Code) / Phone Number: ` 2 IX. COON /DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee Groundwater Date Issuing Agent Signature (N .Stamps) Approved ❑ Owner Given Initial Surcharge Fee Advers e Determination ~ V r 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 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 Sanitary 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 n0Qessary, usually ev&y,\? to 3 years; 6. If you have questions concerning your private sewage systern, 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: 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed; ll. 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; Ill. 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'/z 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 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. 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 Gr ouhd~water included the creation of surcharges (fees) for a number of regulated practices which Wisconsin's can effect groundwater, The surcharge took effect on July 1, 1984. Ali of the water that buried ~reasure is used in your building is returned t the groundwater through your soil absorption o~ system or the disposal site used by your holding tank pumper. The monies r..ollecteO through these surcharges are credited to the groundwater fund adminis- tered by the Departrr=ont of Natu. al F sources. These funds are used for monitoring ground- t ,eater, groundwater contamination in est gations and establishment of standards. ;groundwater, it's worth protecting. SBD-6398 (R.03/86) WENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS fRY, DIVISION i 41.4AND PERCOLATION TESTS P.O. BOX 7969 iAN RELATIONS (115) MADISON, WI 53707 (H63.0911) & Chapter 145.045) / CA I N: SECT-ION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK %_LiUBDIVISION NAME: AjW 1/ 1/ /T 29 N/R 1y E (o W Hopsa,v 6 P10N T, 10i9Rr COUNTY: OWNER'S BUYER'S NAME: MAILIN . AnDR S : , S/ CA1 91,44, pETERS pr, z 13 c)( S 9 3f3 , B4 11-DW 6a /.S' S~bQZ USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: 7M-me DESCRIPTION IERCOLATION TESTS. Residence 3 p~7 N+ New [:]Replace pr ~D 9.i Q3 , UcT 0~7 RATING: S= Site suitable for system U- Site unsuitable for system MIJN VLNTIONAL: MOUND: IN-GROUND PRESSURE: S EM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) IS u ©sElul ❑sCRu ❑sNU ❑sZu Movvy o.o1-)~ If Percolation Tests are NOT required DESIGN RATE: [Floodplain, If any portion of the tested area is in the under s.H63.09(5)(b), indicate: indicate Floodplain elevation: I-V F/ PROFILE DESCRIPTIONS /a DEC~%tfAL Fy- . BORING TOTAL P H TO GR UNDWATER IN CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH EgLrEVATION OBSERVED S GHE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) /.3w f14 , -1.08' Cd%A `e OR. ~.7 L.~ . T t! L/~fESIOt1F IQ/Q . Y, oiv B_2, P.O •y~' R„-6y. s,L, <>< aA,. s.L1 -).&7' Y- < 4 3* n p h~ACP -5. 3. cJ Gil ?Z& > 3• 1,33 ' L1- /?tf- S,14 " 1.33 13,u S,-,c 0,4:1 17„ B-3 y. LS 3 barn, . S, .-f /X A 3 6i4rFSTav~ g' • D " V ` / "v_ 1 y O < • 33 ' ~-3AI -4y S,L LS , v sT 13g,0,00Cj< > / • 33 ' L?k yz R u . S, L r . 7 f C.P-,C~v Si- *r AC 8L > / Ji/ . &7 ' N -:1/ s. 33 ' 8,v S~ 33' Z• g.~ y~ . ace. s/ , 7sr 'o '-,e j C.Uie(~ s s K~x. ~r d y - vl9T/ON S PLR~COL ION ~ESfTS c,PEVicEO G~:~•ESfz~E a. ,e Saes SwE TEST DEPTH WATER IN HOLE TEST TIME D I WA L V L-IN HES RATE MINUTES NUMBER INCHES AFTERSWELLIN INTERVAL-MIN. p PER INCH P- P. 2- ZT -2 P- PTO A/CJTE: iPO Gt OM OF ,E.P Q~tG 7>~/'C /tl T /4 1.15 IC C04e- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and a direction and percent of land slope. s-9,v~l,ecr rN 7-" P5444er-.• /O O.70 / (a fr. of Iwo SYSTEM ELEVATION hu 0c,e i of D/STie1d &0 T/Q~v Al-tC 0 DoT ,CGS 5. ~l't Ck y _ e/~ s ~RA T y A fT~ P~ _ThT9 tW site NOT APPROVED for a'conventional septic system. E w E/~J D !rl Ay Le- 1e S . 57'4Tj6' C" f>ES /1 s u e. o~ ~iP~9C rviPEv k- 134,0 eUcK ; 4l" o FT I+Aj Go,v -u riovq Std iG /Sr i. _ 0 , o I~TS ~~e Aloy 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the or;gr~~,lq<jpn of the tests are correct to the best of my knowledge and belief. NAME print): TESTS WERE COMPLET D ON: Noll' / 3 -/fOO3 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): RT. 3, O'N EIL ROAD S =o L y~Q L HUDSON, WIS. IW1 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - Project I. T). /or 'tou S~~w~,~►f-fDDif. 13ve,r ee,~ 14f6Ps LEG7ND NOMESITE SEPTIC PLWNOING C+A EK/S TiN !r IT. 3 WAIEIL RD., NUOM, MMS. 501 ROBERT ULBRICNT /a , 2 F6 • = Ba c kh o e ''its . = sv,~f fcE 9w'4DEs MS. MASTER PLUMBER LIC. NO. 3307 M.P.RR X = Pe r c Locations `Ir/EU0rT1a 4 A X ) MINN. 4NNALLER & DESIr,~R ~►A.P,r~v woov /.tAEs C.S.T. 2482 dff = Existing Well WZ44 IN) Vertical Reference Point Al, 1-07- ro"%cl-e E -evation of Vertical Reference Point _ -Lot Line / 1. 0 "Sr- Lot G,;ve- 1 ~ o J ~ 4 I n o Q 0 u . A L Wa o IMF- qti / t1` i 1 31 / I / 115 i • 4 3 ~ I yl ~9N Pia t~~ ~ i -bob ?H C~ ~"1 Oro -1- t4) 10 = q T 7t r---------- - - - IQI i w lu V 3flQpQ' c z - v ~(Y/7~ 10.7 1s~nf - a ---y ~f5 GLh h 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 - /2j ~CC'C Location of Property ;4 ~ltJ, Section_ , T N-R W Township _g L Mailing Address? Address of Site. Subdivision Name Aly` Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created . Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes ~t No Volume and Page Numbers % 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) tenth 6 y that aU statements on this 6 o)cm ahe tAue to the best o6 my ( ouJc ) knowledge; that I (we) am (ate) the owneA (s) o6 the pnopen ty des cA i.bed in this ingoh.mation 6o4m, by vixtue o6 a waruranty deed hecokded in the 066ice o6 the County Regi(hteA o4 Deeds" Document No. 7 ; ,and that I (we) pnesentty own the pnoposed site soh the sewage disspob s y • (on I (we) have obtained an easement, to nun with the above descAibed pnopehty, bon the consthucti,on o6 said system, and the same has been duty keconded in the Og6ice o6 the County Regi6teA o6 Deeds, as Document No. SIGNATURE OIL OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) Z DATE SIGNED DATE SIGNED a I H z H STC - 105 r r 9 SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County 0 z a OWNER/BUYER H C+9 ROUTE/BOX NUMBER Fire Number CITY/STATE ZIP PROPERTY LOCATION:, 14, Section_ T. R~_W Town of , St. Croix County, Subdivision Lot number -6 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 I/WE, the undersigned, have read the above requirements and agree £ z to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b 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. r SIGNED DATE 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. d ST. CROIX COUNTY WISCONSIN ZONING OFFICE r;3sxc`;' 796-2239 (HAMMOND) ` 425-8383 (RIVER FALLS) _ HAMMOND, WI 54015 October 1, 1986 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the William Peters property, located at the NW1/4 of the SW1/4 of Section. 34, T29N-R19W, Town of Hudson, Lot # 6, Ron Stewart Addition, revealed suitable soils at a depth of 2.4 feet, below which lime rock was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Assistant Zoning Administrator TCN/mj WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St_ Croix Location NW 1/4, SW 1/4, Sec. 34 T 29 N, R 19 AXON W Town MK_1V=ftiT(UiVX Hudson Street Address Lot No. 6 Block Subdivision Ron Stewart Addn. Landowners Name: William Peters The application for this site is for: Elnew construction use. ❑ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: (.1 to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota num ers issued to you.) txl one of the applications needing a quota number. The quota number assigned to, this application is 59 - 17 - 7 ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. F ]for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. (Jfor an application on file prior to February 1, 1980. (_]for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: ❑ a failing conventional soil absorption system. El a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here. I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Si u-e County Official Title Assistant Zoning Administrator Date October 1, 1986 DILHR-SBD-6158 (R 12/82) STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township/Z&") P XMK-X NW ;4.1 SW S 34 T 29 N/R 19 $W Hudson St. Croix Street Address: Subdivision: County Ron Stewart Addn. Landowners Name: Mailing Address. William Peters Rt. 2, Box 59 BB, Baldwin, WI 54002 I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I a ree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the promises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DILHR-SBD-6413 (N. 05/81) My Commission Expires: PROJECT INDEX SHEET OWNER : MAP . M BPS • OAI • fET~~s ADDRESS: f j3aXs 9 33 3AL9wIa LUIS' , 5400 2., /eO d sTEW-4-0r AAPIrio,) 3, j 4uees SITE. LOCATION: 16 70' 6, swrys,? V T~ y, /y cJ, rw~ o~ ilvvso.), S~•Gioix SS>~,~y. y, , .10 PROJECT DESCRIPTION: Aekt) C0.vJ7AU, 10,J : NEW 40Vop oo . w Soil s o.✓ S~T~ ~/PF vii ~ f~E~'i ~•li ~tjQ/E' ~ v T~ C~~U/G~D W43 £at otJNTEXi eD purAl soil 12EpaRT" A-r of pdA S o>C -2. iN Aeej- ooor- plOo~ oSc-O --Yov,~,q Lo ~ /S 7D69/14 w 00,0EP 710 ii " `14/lPW00,0J /mwoX• / Z- f fie ACfO55 A401 z ,p 517 . T,eeer s11411 QE" t v vs A To PAGE 1. PTjOT PT,AN VIEWS PAGE 2. MOUND CROSS S7'(7TTO%l 84 SYSTEM P iAi'd VIEWS PAG7 3. PIPE LATERAL LAYOUT PAGE 4. DOSING OR SIPHON CHAMBER CROSS SITTIONS PAG2, 5sr PUMP PER F ORMIANC:I SPECS OR STPHON SPECS PLUMBER: SITE EVALUATiaR or DESIGNER 120&t-k T-14 Al . HOMESITE SEPTIC PLUMBING CO. 2 / ` 7 IT. 3 O'NEIL RD., HUDSON, WIS. 54016 RBEPT I 1 N /s • ~~S 7 Z~" NN3. MASTER PLOUMBE ULBRICKR NO. 3307 M.P.R.& MINN. INSTALLER & DESIGNER LIC. NO. 0060 DATE: SIGNATURE r..z oo rR, RECEan ~~G J M' OCT 211986 PLUMBING BURP", y~9sy kiN R Q I R.a ~OZ o I o r~ I t 8608503 l M r o_ ~F, c o ~ ~i•~~ ~00~ oy` OV o o ~00~ o_ C~ y~ c9 L s 1•~~L// AAk n _yJl) 4 kN, I t~ • ONG I t~ o i L A o ( OW H Z ~ ~ rn CIO RE EIV .p QCT 1 r, / V CJ PLUMBING BUR a, b / ~ I ~~~h n ' 9 Z $ Page Z Of kilo a ° 860 Synthetic Covering Distribution Pipe Medium Sand s y sreh a EIEVknw Topsoil F /00.70 ~ 3 1 E " D 3 , ~ 96 Slope Bad Ofr Force Main Plowed Aggregate Layer D ZZ Ft . 4. E G Ft. Cr ectig,`,)Of A Mound System Using 4 t,r F .7, Ft. ' . S ` For The Absorption Area G / Ft. A /d Ft. H 1 Ft. iCJ B .3'd Ft. K 1-3 Ft. Cv z L Ft. a~ J /D Ft. r 17 Ft. Force Main W Ft. L J Observation Pipe A - W ° --j------- M Distribution Bad Of i Pipe Aggregate Observation Pipe Permanent Markers y" PvG G~~PEI~ sf~~L ,boos Plan View Of Mound Using A Bed For The Absorption Area RECEIVED OCT 21 1986 PLUMBING BURFA Of Pdoe31 l,+sr me- ser u'pg yAr- ~orQ pve°iNb PMw AWN Perforated Pipe Detail /0 ~ End View )Perforated End Cap) ore PVG P pe Holes Located On Bottom, S Are Equally Spaced S \ P x PVC Force MaiK X , i / PVC Manifold Pipe I Distribution Pipe Last Hole Should Be Next To End Cop End Cap Distribution Pipe Layout P Ft. F s 3 ' 013G X 30 Inches Y Inches , „MI„t Hole Diameter VY Inch (l ~F Jl~ L Lateral Inch(es) Manifold L Inches SE Force Main Inches # of holes/pipe /d Invert Elevation of Laterals 1101.2- Ft. smog eoc k s ys` r)6A is i,,Auz 100.76 !)%5T0e&0ri0e ?1~0F 1A Tofa1~2_ ~~s~ R~ 6oTtvN I'' C6 IATE~'ot u~S~~""~`' ?ter` ` -72 (9 'Y MirJ. . Vah OCT 1 1986 Void PLUMBING BURFA f PAGE OF PUMP CHAMBER CROSS SECTIOIJ AMD SPECIFICATIO►US V iJ T CAP ~,p~,~ C/iPG oiT 0.I S'F,& E ~I~/u` 'i'C.I. VEA1T PIPE APPROVED LOCKING T WEATHER PROOF JUAICTIOIJ 90X MANHOLE COVER ~ 25' FROM I)OOR, WIKIDOW OR FRESH 12"MILL. .8 AIR I KI TA K E i 0 5~~ GRADE, I 9f I 40 MIN. 7 ISO mm, COWDUIT 18"MIAI. . K7 PROVIDE ' I IKILET ; - AIRTIG SEAL. I I I ( ri' I I I V i ~ 'I VVV APPROVED JOIWT A F III APPROVED JOIWTS /C.I. PIPE . (I ( W/C.I. PIPE W EXTENDIKIG 3' ALARM EXTENDIIJG 3' ONTO SOLID SOIL B I 1I ONTO SOLID SOIL ON c ELEV.~3•~ FT. siP~ 05F VAf PUMP + OFF • 0 ~A~k aEDnv~~ CONCRETE BLOCK z ya. yZ'~~ a~ • RISER EXIT PERMI1fED OAJLtI IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFI'CA'f IOUS DOSE WFE/~!s rljj t16 - P/pD0 . TANKS MANUFACTURER: IJUMBER OF DOSES: ER DAy TAWK SIZE: GALLOWS DOSE VOLUME ake%w ; 3,5' 54c, 0-200 ALARM MANUFACTURER: 6f vtz. 414 AM INCLUDING ISACKFLOW: 2 ;.Q GALLONS MODEL WUM6ER: ~'VL CAPACITIES: A= INCHES OR GALLONS SWITCH TYPE: /Elt~ov~ ~wAf 5= z' INCHES OR GALLONS PUMP MANUFACTURER: 20~`LE~ C= ILICHES OR 22 GALLONS MODEL MUMBER: 137 Y2 #p Ffft or-0T" Po-'Ip 1Z .2 p D s INCHES OR GALLOAlS SWITCH TYPE: Pilly "t MC CUIZy fJo*t,; MOTE: PUMP AND ALARM ARE TO BE MIMIMUM DISCHARGE KATE 12- G►M INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEN PUMP OFF AIJO DIATRIBUTIOU PIPE.. FEET 'J/1NK 9e6s • 444& JAVA- + M~IK~J-I-MUM NETWORK SUPPLY PREnSSURT,E/... . . " , . . . . 2.5 MET ♦ FEET OF FORCE MAIN X / ~ ? F/po nFRICTIOU FACTOR. '0 3 FEET „2 C~ S TOTAL DyWAMIC. HEAD = 1L' Q FEET • jt'DU~1~ 8/ ~O D IIJTERWAL. DIMENSIONS OF TANK: L H ;WIDTH LIQUID DEPTH 51GUED: LICELISE WUMBER: DATE: RECEIVED OCT 21 1986 PLUMBING BURFA~' r T D H H EAD CAPACITY CURVE im W 100 3O TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING SERIES 53-55-57-59 97 137-139 163 185 28 M LTRS LTRS LTRS LTRS LTRS 1.52 163 248 394 231 231 90 EFFLUENT AND DEWATERING y ` 3.05 129 216 300 231 2$1 26- 85 4.57 72 163 242 227--- 227 SEWAGE AND DEWATERING 6.10 loa 136 223 227 pA 7.62 30 216 223 24 8Q 9.14 206 220 ,:'40 12.19 172 206 T5 \ 54 15.24 125 191 \ ,7 19.29 s7 191 22 7021.34 114 TO 24.38 53 MODEL MODEL Lock Valve t 9' 24.5' 26' 66' 8T 20 65 163 \ 165 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE SEWAGE AND DEWATERING O \ \ SERIES 267 268 282 284 293 18 \ M LTRS LTRS LTRS LTRS LTRS \ 5 1.52 406 386 492 681 55 ` 10 3.05 227 273 360 598 16- vv 15 4.57 76 163 238 511 50 \ 20:: 6.10 30 125 401 25' 7.62 288 14 w ` X s.14 163 292 45 \ 95'4 10.67 zs 227 40a- 12. ,9 ' 174 12 40 45 19.72 106 1 15.24 45 t MODEL Lock Valve:18 21' 26' 35' S3' 10 35 293 \ 1 30 \ t MODELS \ 1 8 25 137 139 6 20 MODEL 15 _ 284 4 MODEL t MODEL 10 268 t 282 2 MODEL 5 S t\ 53, 55, MODEL MODEL 0 51 59 97 267 ' U.S. GALS. 10 20 30 40 SO 60 70 80 90 100 10 1x0 > ' LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE ii~ 3280 Old Millen; Lane 7", / P.O. Box 16347 Manufacturers of . (01) housing. - listed ' Browe motor and pump housing gy ~A//i.os Angeles roac Canaman Sianoaros Assoc 53 Series #SC-4425 d1ryq, ygr + " Cast Iron o#~ f ~ Series -Approval - iab Approval ava ieote 55 Series #SB-4415 "73.9" Bronze Series * • Automatic or Non-Automatic. ' • Automatic or • 1/2 H.P., 1 Ph., 115V, Non-Automatic. 200-208V or 230V • 11? H.P, 1 Ph 115V or • 112 HR, 3 Ph., 200-208V 230V or230V • Stainless steel screws, • Vortex impeller design. " s\1 float rod, guard, handle • Durable cast construction. and arm and seal assembly. Cast iron switch cft0EfVEQ • Vortex impeller design. and pump housing, base • Automatic reset thermal and impeller. overload protection. • Passes 5/8 inch QQcTs 2 1 q 19M • Float operated (sphere). submersible (Nema 6) • 1112" NPT "PLUMBING+ eURF I 1 1 1111 mechanical switch. • Float operated, submersible • Watertight neoprene °0° (Nema 6) mechanical ring between motor and switch. pump housing. • Stainless steel screws, bolts, • 1! NPT discharge. float rod, guard, handle and • Passes 1/2 inch solids arm and seal assembly. Isoherel r _ , . --1-