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HomeMy WebLinkAbout236-0851-00-000 n(a O' n f/! 3 'v 0 e0 3 i A ° # -4 c O zz o-4 o m 0 cncl ?y o o ° CO c naw• C rr G 01 O fD N F1 CD (D CD G 00 W v d w Z a M y N p N 0) Cl) CD Dl N N N C CO CD CD i0 O CD .Z7 N O O O W (D -F-- I w n cm M Cfl ° 00 U) O rs `4' O C C n C qo 1 O IV ° "y (D b w 'o cnzD a°D (n <D am W (D n (o D rn a 3 m ° w a 3 rt Fr. W ° ao m rn rt 0. C O 01 C d W O O v m F~ 0 rt 0 ~ co c0 O Q N ° y co co tm N o c O (D C CA 0) _ 3 M C Y +4 a a ~n o c ~I 000° °r. v° c ~ 0 S gg C CO) (A CD ° a13 0 c y~j G, O O O^ CD CD 0 rnI 0 s D ° m I ~ y a 00 a a z N W F3 M o Z Z O O I tai CD cn o ~ h • 0 CD CD U) ;o CA -0 CA CD CD c xi N c 0 cc ca m c N P, rt I ° w a m N. 3 a 3 g 0 0 I ICD (6 I o N. a a A Z O n a 10 CD -4 rt I 0 CD w ~ a 0 3 a z U) z y m C, z I w~ I CD I A I I w m a - y T a C a a o y o (D d a m c ID d C°D °Z a co n CD IU) C CD 3 CL a 7 CD w' I ~ 4 N I I N ~ d ~ Q o I ° I ti I ~ I a o N O V w 0 CD A O CD DQ V p 0 o 0 oN Parcel 236-0851-00-000 01/26/2007 05:02 PIA PAGE 1 OF 1 Alt. Parcel 236 - CITY OF HUDSON Current X'', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner MARY LATUFF HIRSCH O -HIRSCH, MARY LATUFF 585 MALLALIEU DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 585 MALLALIEU DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE PROEHL'S ADD L13 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) Notes: Parcel History: Date Doc # Vol/Page Type 2006 SUMMARY Bill Fair Market Value: Assessed with: 188902 367,500 Valuations: Last Changed: 12/20/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 225,000 150,200 375,200 NO 05 Totals for 2006: General Property 0.000 225,000 150,200 375,200 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 90,000 113,000 203,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 c t Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT c ~y OWNER ~iJ~y tii Uj3~° fUs TO IP 110pse SEC. 2,7,1 T Z~ N-R _2'~'W ADDRESS /''~~~~,jGi~zc ~J•~iy-~ ST. CROIX COUNTY, WISCONSIN ~fUDSo,~J" wl'S r~ TA, SUBDIVISION LOT' co 1 V r I'P PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM l*'"►-L- wd7 ',N f n _ I ,i SST Sc! y0 / pel S 1 tk4 JWP / 1 iieosT ~f /ERIN ov7 s/,PPv tQ cK S'4 YO rX r~~8 S INDICATE NORTH ARROW A6-a%e 7f" BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /O D Proposed slope at site: SEPTIC TANK: Manufacturer: -oleSE/` / quid Capacity: ~v G,f/-r Number of rings used: ~ouJ2 Tank manhole cover elevation: Tank Inlet Elevation: 9~ O Tank Outlet Elevation: ?16 Number of feet from nearest Road: Front ,OSide 10Rear, Q 12-3 feet From nearest property line Front, 0Side ,ORear, 0 /e feet NO. u WIR- Number of feet from: well ~ua?TE4 building: /y fT (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE <.:M c ~ • PUMP CHAMBER Manufacturer: Liquid Ca ty: Pump Model: Pump/Siphon ufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevat Gallons per cycle: Alarm Manufactu r: Alarm Switch Type: Number of eet from nearest property line: Front, O Side, O Rear, 0 Ft. . Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Y Trench: Width- Len th• Number of Lines: 2- Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, 0 Side, © Rear,O Ft . Number of feet from wtr~- Number of feet from building: (Include distances on plot plan).'~'~ SEEPAGE PIT Size: Number of pits: Diameter:- . ~„r.--- Liquid depth: Bottom epage pit elevation: Area Built: Has either a dro ox O or distribution box O been used on any of the above soil absorbtion tems? (Check one). HOL G TANK Manufacturer: C y: Number of rings used: levation of bottom of tank: Elevation of inlet: Number of fe 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. DDated: CJ(~ Plumber on job: License Number: HOMESITE SEPTIC. PLUMBING CO. RT. 3O'NEIL RD.; HUDSON, WIS. 54010 ROBERT ULRRICHT WIS. MASTER PLUMBER LIC, N0.330) M.P.RS. MINN. INSTALLER & DESIGNER LIC. NO. 00663 3/84:mj 1 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LAB,OR & HUMAN RELATIONS P.a. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, Wf' 53707 BUREAU OF PLUMBING f2 CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSP TION ATE: Rollie Rubertus 2400 Walnut Avenue, New Brighton, MN J. J49 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. F. P LEY.: CST REF. PT. ELEV.: SW NE, Section 24, T29N-R20W, Town of Hudson Name of Plumber: MP/MPRSW Nu.. County San,tary Permit Number: Robert Ulbricht 3307 St. Croix 79200 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER J PROVIDED. PROVIDED ❑YES ❑NO ❑YES ❑NO BEDDING: VENT D A VENT 71 , WATER INUMBER OF ROAD: PROPERTY WELL. 1 BUILDING: VENT TO FRESH ALARM FEET FROM LINE. AIR INLET: ❑YES ❑NO ❑YES NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING- LIOUID CAPACITY POMP MODEL PUMP; SIPHON MANUF ACTORER WARNING LABEL LOCKING COVER PROV IDED. PROVIDED ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PERCYCLE: UMP AND CONTROLS OPERA T IONAL-- NUMBER OF PROPERTY WELL BUILDINGIVENT TOFRESH (DIFFERENCE BETWEEN FEET FROM NE AIR INLET PUMP ON AND OFF) P ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing WANE TER MA7ERInE AND MARK vG 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 111TH PIPE SPACwG COVER INSIDE UAA -PITS LIQUID TREN' ES MA .ERIA L: DIMENSIONS PIT DEPTH GRA r; EL UtPTH FILL DEPTH UISTR PIPE DISTH PIPE DISTR PIPE MATERIAL NO STN NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BE LOWED.{ ABOVE COVER EI EV INLF T ELEV. ENE) PIPES LINE AIR NLET :cr t a L FEET F 2, NEA_RESTO-_► t N 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PF HMANf NT MAHKI RS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEU TTH OF TOPSOIL SODDED SEE DFD MULCHED CENTER EDGES ❑YES. ❑NO ❑YES NO [:]YES ONO PRESSURIZED DISTRIBUTION SYSTEM: BE WIDTH LENGTH NO OF LATEHAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO UISTR UISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.. ELEV. DIA. ELEV. PIPES DIA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING; DRILLED CORRECT LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLAnIs ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: ='F UMBER OF PROPERTY WELL: BUILDING: EET FROM LNE❑YES ❑NO ❑YES ❑NEAREST 10 Sketch System on .,Retain in county file for audit. Reverse Side. - SIGNFyFNM . TITLE DILHR SBD 6710 (R. 01/82) wweconsm APPLICATION FOR SANITARY PERMIT / ' .D I L H R (PLB 67) 5ry~01s COUNTY inouS oEPRQ T TRY, LRB LgB UNIFORM SANITARY PERMIT # rlOUSOq 6 HUmgl"1 RELRTIOr75 7ZO 0 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in, size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS v//r- !J%EiP%ZfaO " v v Aae. At4J 4406474 PA.; PROPERTY LOCATIO CITY: t, Sly 1 /4 /VE1 /4, S , T 21, N, R ZOE (o W T /T ~J~fOit/ LOT NUMBER BLOCK NUMBER SUBDIVISION NAM ]NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER All TYPE OF BUILDING OR USE SERVED z 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: X New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: N OC IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump /Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): ,O- PROPOSE (Square Feet): y.3 XSL/ ~D 27 Private El Joint Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: [MP/MPRSW No.: Phone Number: _ p HOMESITE SEPTIC PLUMBING 0. G%KX~ 330 (~/S )Se cTI~S Plumber's Address: ROBERT ULBRICHT Name of Designer: 9MIS. MASTER PLUMBER LIC. NO. 3307 MY R,S. 23 23 COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: D te: [0 c~ Disapproved 01~~ dp V ❑ Owner Given Initial Approved Adverse Determination Reason for Disa ov Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber f ! • INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN REtATIONS 1 / MADISON, WI 53707 • (H63.0911) & Chapter 145.045) LOCATION: SECTION: w-JT@WN@4UWMUNICIPAL1I TY: LOT =]7BDIVISION NAME: 1/ 2y M-IN1111oE(o tiUP'reAJ COUNTY: 0 Sf '51190-1 7up NAME: •P~B~-.~rv~' 2yDOADCU~f/,vvi USE DATES OBSERVATIONS MADE NBEDRMS : COMMERCIAL DESCRIPTION: PROFI E 71 U. RIPTIONS: PE OLATION TESTS: Residence i11 New ❑Replace J RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) FS oU as ou ~s [:]U os Qu os EP ~ Xs)., If Percolation Tests are NOT required DESIGN RATE: If an s~ C/ ~+s •r"" Y Portion of the tested area is in the ~/[_C~J under s.H63.09(5)(b), indicate: L Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) "qt Qo - > P6-, /T A/. s 1.4' 4r . S toi1A4!, . -5-7p- 6 CS Gv i ire i 7,76 B-,2, S 93- /o s 6(o aN . ~s ti . 9 ,bv Ls w~d~ no~P,~d C'S wrc~k'~af,.~ (rR . B- v O 92 ' / J s/ t!/♦~' 90 ' - ~O ` s~ U~t7 .S) s~~ IV S 4f 1 6;1.4e- -r Pq o v cs j 6W - B- 4P /i~~ 4- B- foe g`TF~ .+r-£- - ~►s r?-T7- B- c sr 3yy CO /f.7-'r4a-AQ. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERT D 3 PER INCH P- • 3 ` L C t, SE P- /N .P / V.1!5iie 0' c pt~t P t P-- / 61 P-- 10q a> l> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. New *~/F Zli IX&I. SYSTEM ELEVATION. Cda ski ver/0.v E I XC S/T l,IDD~DS E r a 3ti cs7 T- , 3N~f7 , Ail ,r ~dU`-mac ~i9f - r Cs &p , i 3 yon I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS ERE COMPLETED ON:/~ HOMESITE SEPTIC PLUMBING CO. GS/.( ADDRESS: ROBERT ULBRICHT CE,,TIFICATION NUMBER: PHONE NUMBER(o tional): Will MASTER PLUMKR 1 . NO, 7 M.P.Rl 1J ' fz MINN. INSTALLER & DESIGNER LIC. NO.00663 CST SIGNATURF-A DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR O PLC__6_ ~ SB - fm -urate sail test, your rp.b, 1. ly ALm L_ 6. 10 Xe E a. s 30 ~fw 3 ")o M 6oA;5we&c71- d ,p OWE st~~w D~ ~ f Ofivt NIP 111.77(3) efflocAe- `-z5- w ll coPi5S c.PaSY oAmk 1 ° k^e ~ovu fcTloUS s'L % l t d/~ Tsl v T -{i&OM 1 ev.4 71W j',6e&1eE J O / I 1;: I , ~ S~g7t- *1i~ifbut~ I ' V FiPOsr✓,14xF ; 6' 1 ~ I l~ b 4V pr v "if- v = X00, 0 ~s - ~ 1 . /A WA (/ku l.~ i V C-40, Fresh Air Inlets And Observation Pipe ~t h ~ Approved Vent Cap Minimum 12° Above Final Grade Above Pipe - 4" Cast Iron Vent Pipe -to Final Grade 140MISITE SEPTIC PLUMBING CO. Synthetic Covering RT. jO'NEILRD., HUDSON, WIS. 54014 ROBERT ULBRICHT Min. 2" Agregate MvAS. INN. IINSTALLER & DESIGNER LI NO. P®06~i3 Over Pipe' Distribution Tee - a Pipe 1-00-0 0 0 )UV SO1 ~~S7f Aggregate o Perforated Pipe Below Beneath Pipe o Coupling Terminating At fT Bottom Of System 0 0 o IZ) > O -a C to G? a. E O C a) C Rf d p O N O j _ L A > N O N O 0 cm O C 'D c 0 O a) v O ~ ti- :3 O _m V v) a) N O C O O m i to L ' ~ _O i (n C7 C u) (D -0 :2 "a O p O (a 'a m 7 W 3 O -0 W C3 (-°30°~ c -tv VO C~ Na(ni~rn:~ =oU) c Q _ U T N O O I CM'o G U O ca N C O _O N N ai~ 4) CL L :3 jp CC f- •C (C ca N w o N E O aW N ~3VO~ M_~ m C C U_ O 0)07D CC W U° 3 t o 0 Ln r•~~(n 0 a) -0 3 4):E (D 4,Nr m c Co 00 3 a) U) ~ c W L'1 Q N 3 0 .Z N cd O 0 vi O m y O rL~ O " U to U L O U V O a V 0 j ° (D Q O L M a) c7 L- O .0 CD U) (D 4) ~l L ir c a CL L 00 a) Q C a) 'a 0 O (D cL° O 0 3 C L 7 0) Z C N C O 0 O E > O~ C C L L C C O ca O a) O (j L CM 0) :3 L co a) a) O U O E v Y L C D V L Of Q T _ Ca CD C O (n >1 N (D a. a) O_ 0 - ca CO a) N 3 N d m~o T3N(n 0 3: 0- a) (1),o Q j Q c O w a c 0 j O w Y cn 0) E v co w ca CO (d L L C 0) E .o 1- O O D U ~C a) 3 A C O 0 Co m G 4 7 C H p O N (n (n N .ell J c cc ~ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR WHUMAN RELATIONS SAFETY & BUILDINGS P:d. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, V."I 53707 BUREAU OF PLUMBING MOONVENTIONAL ❑ALTERNATIVE State PlanLD.Number: ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound of ass9neal NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Roland Rubertus Mallalieu Drive, Hudson, WI y BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: F. PT. ELEV.: CST R .ELE Na SEP NE, Section 24, T29N-R20W, Town of Hudson,Lot#13, Proehl's Pt. MP/MPRSW No.. County: Sa tary Permit b r Richard Hopkins 75,047 St. Croix 7 SEPTIC TANK/HOLDING TANK: I MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELE WA I LABEL LOCKING COVER PR D: PROVIDED: BEDDING: VENTDIA.: ~VEATL.. ]HIGH ATER ES NO ❑YES ❑NO NUMBER OF ROADPROP rBUILDINGVENT TO FRESH FEET FROM LINEAIR INLET: ❑YES NO YES ❑NO NEAREST DOSING CHAMBER: :M:A:NUFACTURER. BEDDING LIQUID CAPACITY PUMP MODEL . P UMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER ❑YES ❑NO PROVIDED: PROVIDED GALLONS PER CYCLE: PUMP AND CONTROL SOPERgT oNAL: ❑YES ❑NO ❑YES ❑NO (DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BUILDING VENT FRESH - TO FEET FROM LINE' AIR INLET PUMP ON AND OFF) ❑YES ❑NO SOIL ABSORPTION SYSTEM. Check the soil m oisture at the depth of plowin NEAREST g NE H 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 TRENCHES. INSIDE DIA.. $pITS_ LIQUID DIMENSIONS MATERIAL' PIT DEPTH: GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. BELOW PIPES. ABOVE COVER. ELEV. INLET. ELEV. END. NUMBER OF PROPERTY WELL: BUILDING: VENT LE FRESH PIPES: FEET FROM LINE: AIR INLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM 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. SOIL COVER rexruRE PERMANENT MARKERS. ]OBSERVATION WELLSDEPTH OVER TRENCHBED DEPTH OVER TRENCH/BED YES ❑NO YES ❑NO CENTER. EDGES. DEPTH OF TOPSOIL: SODDED. SEEDED: MULCHED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF ::TATERALSPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. DIMENSIONS TRENCHES: MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. EI.E V.:. ELEV. DIA. EL EV.. ELEV, PIPES: DIA.: DISTF FO RUBERTUS; ROLAND SE NE, Section 24 VER T ICAL LIFT CORRESPONDS TO APPROVED . PLANS: COmm, Mallalieu Dr. 17 9N-R20W, Town of Hudson PR❑ R ES WELL: ❑BIUIILLDING. NUMBER OF Hudson, WI 54016 FEET FROM LINE: of 13, Proehl's Pt, NEAREST San.Permit#7504 4-17-86 R. Hopkins Conventional, N Sketch Reverse Inty file for audit. TITLE: DILHR S B D 6710 (R. 01182) wlsconsln APPLICATION FOR SANITARY PERMIT COUNTY DILHR a , (PLB 67) ~ OEPQRTTEI-IT OF UNIFORM SANITARY PERMIT # - InOUSTRY,LRBOR6NUmRn RELRTIOnS ~say7 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER I MAILING ADD)RESS,_ ti PROPERTY LOCATION r } ; ) f f a 'A' A' _ CITY: VILLAGE: r 1/4 h1/-=`1/4, S , T2- , N, R10 (or) W TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISI N NAME NEAREST R AD„LAKE OR LANDMARK STATE P 4.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): 0 f THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Con ete Constructed Steel Fiberglass Plastic Septic Tank Capacity 1006 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 3 615 09 ❑ Private ❑ Joint Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Na of Plumber (Pri tl: Sin e: MP/MPRSW No.: Phone Number: e 9 R) f, a r P k j'n -s ),_4 I J 40 13' 1 (71k) Plumber's Address: Nam f Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ' 00 ❑ Owner Given Initial • V v RD 41Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBO-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.) ; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PEIUIIT S '1' C - 100 This application form lit t:o be comp.let,ed in full and signed by the owner(s) of the property being developed. Any inadU(Itiaci.cs wi]_1. only result in delays of the permit issuance. Should this development 'be Intended for resale by owner /con tractq-C, ("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 P-C- •,A-.D uDiT"Irf U 13 (z u5 Location of Property ~S\N Section T 2) N - R ZO W Township vP;5C>-a;.o Mailing Address M AL-k,..PL 1CU -DP1U 6 Subdivision Name C.> t-}-L Aoot-nor--- Lot Number Previous Owner of Ili opi+: ty A l e,-) ~ ~t21~`rb~~t=25~ Total ,;lre of Pat c:i+I S~2. EA-- beffaw &X- 5tt~+.P>r Date Parcel' way Are all corners tend .1 ill I. noii :1di!iil I I I+ 111-7 Yes No Is this property bel.n} developed for ii+»aIe (spec house) ? Yes No Volume ,:nd I'iil;ts PJumlrer 2Z~ ti:. recorded with the Register of Deeds 1NC1.11DE, WITH THIS Al'1'LICATION ONE, OF THE FOLLOWING: 1. Warranty Duct] 2. Land Contract 3. Other recordingd filed with the Register of Deeds Office In addition, a certified survey, if iiv;:llabLo, would be helpful so as to avoid delays of the reviewing pr.ocetai;. If the decd description references to a Certified Survey Map, the the Certi.f i ed t;tlrvey Map ,flea l l a I :;o be required. - - - - - - - - - - - - - - - - - - - - - - PROP! RTY OWNER CERTIFICATION I (We) ceAti-6y that al't' b.ta.temen.te orl .th.i,s 6o,ltm cute tAue to the best o6 my (ouA) hnowtedge; .('hat I (we.) am (cute) the owtic (s) 06 the pItopenty dedcAi.bed in .tW .in6oAma ion 16onm, by v-tvutue o6 a wcvuian,ty deed &CCO/tded in the 066ice o6 .the County Regtie.ten o6 De(-(16 as Documert.t No. and that I (we) pnesentty oun the pnoposrd .64.t.e 6on..thc aeiuagc clceposa ays.tem (on. I (we) have ob-ta,%vte.d an easeme.)nt, to n.un tc,Lth the above desuubed pnopeAty, bon the cons ✓tuc,tior, o6 sc(.id system, and :the scone has been dUty aeconded in the 066ice 06 the Coun4y Reg.Lst:e)t o6 Deeds, as Docanicat No. 3` ZA:31 ) SIGNATURE :F OWNEI SI ATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED , H N rJ S T C - 105 r SEPTIC TANK MAINTENANCE AGREEMENT y H St. Croix County ° 0 y OWNER/BUYER ~OL~4~O1J1~1~ ~y E~:tyS rn ROUTE/BOX NUMBER MaLLAL1FL) -DeAye Fire Number CITY/STATE_ Wr _"LIY `J O ( - PROPERTY LOCATION:' '--g, ~_AE Section--Z-4-, '1'Z-'9 ~1 RZo W Down of St. Croix County, SubdivisionTQ0 C'4 t_5 A"PpMiDti), 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, i_f n_ee-ded, by a licensed septic tank pumLer. What you put into th system can affect the function of the Sceptic tank as a treat- Stage 1n the waste disposal system. County residents maw be eligible Lo receive a grant for a r-.ximum of 60% of the cost of replacement of a failing system, :n_J_-h was in operation prior to 'July 1, 1978. St. Croix County ted this program in August of 1980, with the requirement that ~w==ers of all new systems agree to keep their systems properly z iaud. - Lperty owner agrees to submit to St. C r u i x C0utlty %oii ing a --s___icatiun form, signed by the owner and by a muster plumber, = -cyman plumber, restricted plumber or a licensed pumper veri- that (1) the on-site wastewater disposal system is in proper operas ing 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. I/WE, the undersigned, have read the above requirements and agree G to maintain the private sewage disposal system in accordance with x Elie-standards set forth, herein, as set by the,Wisconsin Depart- c 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. S I C N E DATE St. Ctioix County Zoning Office. P..0 1.ox 9S Hammor d- WI 54015 y4 715-7c 6-2239 -or. 715 425-8363 ~K;a a Sign, date and{icturn to above `address -'6c'{n" 75'~F ' RM..,.-:' _'•r"^K'£.'3jaT~. S"= H r 019 g w w ^ D to W M w C C N o m N ° Fwa CD w`< M C O~ 0,0 c O a m z 2M_c p p O m- (D 'D O tD CD 0 g? to y 0 ~ M CD to wv oNavw,~' _ co -N ~ ? CD Z ~ cc a o o ° o o co A n - w j = S c c O w O-, w n ? O w C O O L. c N S.' 0 Qm 0 O Z c`G w.-. w w c~D w w v, w CD p 0 a o m ~ 37 o w co f~D O C N tp Q O ~q N NCO A O>S.-.m O _ w O A ~ O 0) 'N 0 Q. cr O CL - m ~NCo :3 -7vwwv, C ~ a,co p D wow -+w=-~ :3 Z CLM o 0 0 M(D ?a j o D cD CCD O cO o a ~ n w m a w ?o ?0 ITf Cr vai N _T a oNn w S atw w a c o f M y c oo o fpNwwC It1 c a~ 3- 0 ~ MQw Z m 0 rma 3 Q o ~ agcc~a' n Cl) O a w o 0 of w O w - O a"o ° a° O y a~ cr w O` 0 co (D a C c d a O Co n (Di ° ' g f` a mc0w =@ 0=o aa3 00003 °i C. ° o o 1 3 o w a o < o (D z \V "c IN DUS TMF•NT OF., REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DV5TR1~`, - DIVISION PERCOLATION TESTS (1151 P.O. B°X7969 LABOR ANQ ~UR/IANIRE LATIONS \ / MADISON, WI 53707 (H63.090) & Chapter 145.045) TI )N- LOCATI 9'/ S ,C 1TV1 (or TOWNSHIP/ UNICIPA LOT lyO.: BLK. NO.: SUBRSQON NS E COUNTY: OZ R'S ;UY7 'S NA MAILI ADDRESS: /{o:!( /(J 1 iJ7 I &,Crolw Ole. AA /41) USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI E DESCRIPTIONS: PER OLATIO T77STS,* Residence n New ❑Replace RATS= Site suitable for system U= Site unsuitable for system CON ENTIONAL: MOU D: IN-GROUND PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) S ❑U S ❑U S ❑U ❑ S U ❑ S U 4 ve f-/Dna / &ed - ,3(0 If Percolation Tests are NOT required DESIGN RATE If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplainelevation : PROFILE DESCRIPTIONS BORING TOTAL ft. ED PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHI OBSE VED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) /ft > q./ '57 401~F 7 C b tv 9'F3~ F c o b.1 7 teoi B- F N Ii r w ~S"+. B q ~ Sg 1 e o I 5-,' s ~ yi✓ w j2i o cob F S~- •5- S' S 4- r B- 3 ~,5! b > ?151 ,S"Al 45' r1.0 c0 , , a so -s - M co s 41. a f3~ S r B- g- 58' 9'q~ J ~O g, 59,5-9 5-S' > 9/45, , 9~ g~is f rw f yob y~'~n s Lo m rti c I.- to *7 S. s. > 110001 ell -wb c-eh / . 5,p -e,7 S ~i s s B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI D2 PER O PER INCH P_ ? it 3 G 3 P , 3 cS G P- Ir L P-- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. p SYSTEM ELEVATION cc 3 ` , Ai4 133E lka5 e- e i a F A E •i v _ / ~ 'I, ~ i K ~yy~ ( 3 j L i I I E ' V t t 'LA 4 i i - I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE OMPLETED ON: choce j ' . UCL r\W t--~ 9 fi'(v ADDRESS- CERTIFICATION NUMBER: PHONE NUMBER(optiona1): ~°x 33 Son u' 6~ 3 ~7 3. CST SI N DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - L INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 • To a complete and accurate soil test, your report must include: ienal description; on must clearly indicate wh or commercial project; r urns: + of hedro ; or comr re use pla in 4. r A 13 SUIT/ ')R A N TANK ONLY IF ALL ON SUI' _ TI 6 riting profil ing the plot plan; 7 test locatio preferr A Ca point ar - t; to load plc p- 10 as flood plain, E Y, a,, i the apj < E ;x„ 11. curre t 12. distribute as r FILED /ITH THE LC - 4THIN 30 DAY ~T ABBREVIATIONS FOR CERTIFIED SOIL TESTERS ctu res r,~n pt - Peat - rn - Muck HWL Point e ~f any eon ' J 6 7 PLOT r --.I--) 0 S E C: T I ON h-tuaLm, PROJECTE3LUMRE NAME n, _ Ill AME L 0 CAT 10 N.__L'~I E ICI S E =f f , C_)ATE ~'.L U i M A_P s, A = g S°~ee~ P~ ~e r N r) C P, PC, 5, x. P a oc4 P3 y( r 1 ,t By t < I t ~ 1 - 47.5 ~dqe oar kTo_ - rFRESH AIi: INLETS AND OBSERVATION PIPE CROSS SECTION A~ Approved Vent Cap min imum 12" Above / rNA I Final Q): 1 ),A h% 41' Cast Iron Abov Pipe Vent Pipe To Final Grady----- Marsh Hay Or Synthetic Covering Min. 211 Agg:reg,a l _ Over Pipe Distribution, - Tee Pipe w ' Aggregate Perforated Pipe Below 9y- ~V Beneath Pipe 4 Coupling Terminating At Rottom of System