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HomeMy WebLinkAbout030-2065-10-000 n y O 3-0 n v1 o 02 C-D 3 52. S (D v 1 w {A7 Q = 3 v z o oD M%' cn w O • :T 0 "J c- 77 1 O cw C. 1.-0 -1 N O a W N C N = 7 g O CD 03 O m 7 N E O yy N a L 7 O cy) C) -0 R A N O n O OD O CA lD iH O • w 7 N ~1 r N N N rte. lr C p^ \4 % 9f 00 I t~` cn c8' ai I CL co vt W ro cv s ! d m o o m o N w 0 N "Rim d r~ A r CA dC~ y 00 0o a t L' N O c O N 3 w Q c~ 0 A O t~~1 Ur 3 to s a v O m ti coil 20 Q (ODD C N CL N z N z w z c 0 D a ~r CD m N• N N CD CD C (D N W N a a 3 7 z m ~p --I fA 0 a z 0 w Do T D (D O o cn a z B r C * N 3 C) I ~ z (D w I TO= D C<D N U) N7 a'. X Z a O O N C CD w z a o a N a O CD 3 N CD CD n a p (OD. N CCDL C 10, O . Cl co Cl c O) O'. 'C 3 CD 0 a ° 1 2)CDO ° 3 o- O b b Parcel 030-2065-10-000 11/24/2010 02:17 PM PAGE 1 OF 1 Alt. Parcel 35.30.20.605F 030 - TOWN OF SAINT JOSEPH Current ❑ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner DALE W HANDEVIDT 0 - HANDEVIDT, DALE W 1254 HWY 35 N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1254 HWY 35 N SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 5.190 Plat: N/A-NOT AVAILABLE SEC 35 T30N R20W E 573.55 FT OF GL 1 Block/Condo Bldg: "~~---c~ y nF SWLY RNV HWY 35 EXC PARCEL 2065-20-100 C 752/288 AND EXC A Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) S COM NW COR SEC 35; TH S 1 35-30N-20W DEG E 781.11'; TH S 51 DEG E 979.8 FT ALG SWLY R/O/W LN & NWLY EXTENSION more... Notes: Parcel History: Date Doc # Type 07/23/1997 1 /3 72 388 2010 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.190 198,800 108,300 307,100 NO Totals for 2010: General Property 5.190 198,800 108,300 307,100 Woodland 0.000 0 0 Totals for 2009: General Property 5.190 198,800 108,300 307,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 314 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Report for Parcel #030206510000 1 St Croix County, WI Page 1 of 1 2010 Property Record I St Croix County, WI Assessed values not finalized until after Board of Review Property information is valid as of 11123110 Years in red have delinquent taxes NOTICE: All payments received by County Treasurer will be posted the next day. Property Description Billing Information Parcel ID: 030-2065-10-000 Name / Attn.: DALE W HANDEVIDT Map ID: 35.30.20.605F Address: 1254 HWY 35 N Municipality: TOWN OF SAINT JOSEPH City, State, Zip: HUDSON, WI 54016 Public Land Survey: SECTION 35 30N 20W Ownership Quarter: QQ / Tract: Primary Owner: DALE W HANDEVIDT Plat: NOT AVAILABLE Secondary Owner: NO SECONDARY OWNERS LISTED Description: Deed Information SEC 35 T30N R20W E 573.55 FT OF GL 1 LYING SLY OF Volume Page Document # SWLY R/W HWY 35 EXC PARCEL 030-2065-20-100 DESC 752/288 AND EXC A PARCEL DESC AS COM NW CDR SEC 961 360 35; TH S 1 DEG E 781.11'; TH S 51 DEG E 979.8 FT ALG 728 388 SWLY R/O/W LN & NWLY EXTENSION THEREOF OF SWLY R/0/W STH 35; TH S 1 DEG E 81.23' ALG PREVIOUSLY MONU- MENTED W LN SD PARCEL DESC 491/624; TH Other CONT S 1 DEG E 303.82' ALG SD LN TO POB; TH CONT S Fair Market Value $.00 1 DEG E 6.84'; TH S 1 DEG E 149.44'; TH S 55 DEG E 124.33'; TH N 1 DEG W 133.98'; TH N 47 DEG W 138.74' Assessment Ratio: NOT AVAILABLE FOR 2010 TO POB Property Address: 1254 HWY 35 N Net Assess. Val. Rate: NOT AVAILABLE FOR 2010 Total Acres: 5.19 ACRES School Districts: 2611 - HUDSON Tax Detail Assessed Value Net Tax Before Lottery, First Dollar Credits .00 Valuation Date: 07/09/2004 Assessment Land Improved Total Lottery Credit .00 Type Acres Value Value Value First Dollar Credit .00 GS-Residential 5.19 198,800 108,300 307,100 Net Tax After .00 Totals 5.19 198,800 108,300 307,100 Amt. Due Amt. Paid Balance Installments Net Property Tax .00 .00 .00 Special Assessments .00 .00 .00 Please pay your 1st installment or full payment to County Special Charges .00 .00 .00 Treasurer, 2nd installment to the County Treasurer. Delinquent Charges .00 .00 .00 Period Due Date Amount Private Forest Crop .00 .00 .00 Total Taxes .00 Woodland Tax Law .00 .00 .00 Managed Forest Land .00 .00 .00 Tax Payment History Penalties .00 .00 Date Receipt Number Amount Interest .00 .00 Tota 1 .00 .00 .00 Specials Category Amount http://stcroixwi.mapping-online.com/StCroixCoWi/ParcelReport.j sp?keyword=03020651... 11/24/2010 . yr r t Vol" UUj FAIUA IJU.t. ,gal ~e~cription: The~t East 513.55 feet of Govt. Loot One, Section 35, Township 30 North, Range 20 West, Town n4' 0s T~,%W%1% lafiwn coud a"It► At 410 Atlf~T /OA~OM1tY Tti eTlit-of-way ; ' t1 1► 1,II 11V1 lit FvaJ yjly AY"16 tj Uw:Ir v1 t:U1V ►avuulrwtvtl~~r 14ryOf ~1~n$i" a w` Q1 'ax, ! EXCEPTING THEREFROM a parcel of land located in Government Lot 1, Seedon 35, T30N, R20W.. Town of St. _ dosenh. St.. Croix.. County, Wisconsin,_ and described-as _ Billows: 40 fkas AT.t,•~%,met fnrriar ..f onjd 'QanFin,~, Tq bhanna Q 1 A'~"Tx7~~ 7:Assisi" 4111111P%A1Vt11S qt uj%, 114 UhTryVOt LV111V1 Vl .~flt4 17LLL Vil ✓J, lrv11LV V L -J / irTd ar ...e a eatri at, Ol~SAO iOt~ referenced to the monumented West line of `said -Government Lot I as shown on that Certified Survey Map recorded in Volume 1, page 139, and also referenced to that Certified Survey map girded in Volume 5, page 1390, said line bang assumed S l0'31037'2011 E 7'11,11 few'; thence Q gl oU4 V 417*21 A2 faa# alnn than 1.1 tiliYli VV ALTyo EY AC- a r"61 . "bass, Aght_n ttr.iv l.ihip. JA-4V 41 AI./J. uayaa clay ~.vt.wanvyy~ra"bass, WA . T ~fl~ -11inrtl2l1/AQ1Arl1d N 7' a►..V b. , N..V .Y •-1 Vi M..r'Y.VIi' extension thereof, of the Southwesterly right-of-way line of State Trunk, Highway '35" to a 1•" x 24" round iron pipe and the p+3int of beginning; thence N 51028' W 113;01 feet along said tt fight-of-way line to a 1 x 24" round iron pipe, thence S 2041'32" E 497;06 feet to a 1" x 24" round iron pipe, which pipe is 35 feet, more or less, from the Water's edge, and on. a meander line of the St. Croix River; thence S 55009'28" E 107.19 feet along said meander line to an existing 3/4" diameter round iron pipe, which pipe is 41 feet, more or less, from said water's edge and at the end of said meander line; thence N 2x41'32" W 467.47 feet along the previously monumented East line of said Government Lot 1 to.iin existing 3/4" round iron pipe; thence continuing N 2041'32`' W 0.41 feet along said East line to the point of beginning, including all land lying between said meander line and said water's edge, AND ALSO EXCEPTING THEREFROM a parcel of land located in Government Lot 1 of Section 35, T30N, R20W, Town of St. Joseph, St. Croix County, Wisconsin, and described as follows; Commencing at the Northwest corner of said Section 35; thence S 1037120" E (assumed bearings referenced to the monumented West line of said Government Lot 1 as shown on that Certified Survey Map recorded in Volume 1, Page 139, and also referenced to that Certified Survey Map recorded in Volume 5, Page 1390, said line bearing assumed S 1037'20" E) 781.11 feet; thence S 51028' E 979.80 feet along the Southwesterly right-of=way line, and the Northwesterly extension thereof, of the Southwesterly right-of-way line of State Trunk High r;ray "35" to a V x 24" round iron pipe; thence S 1036'53" E 81.23 feet along the previously monumented West line of said parcel in Volume 491, Page 524, to an existing 3/4" round iron pine; thence continuing S 1036'53" E 303.82 feet along said line to -the point of beginning, thence continuing S IxV53 E 6.84 feet to an existing 3/4" round iron pipe; thence continuing S lo-M)53" E 149.44 feet along said line to an existing 3i4" round iron pipe, which ~Aei :e 1'1Q f a# 'a nr LIDA, frnwi Oka %e:nlar~a gsAma of tbia Qt fr''rniv F1 IMP #A"A ^n a maanrlaip INFV 15 2 a V IM 111V1V x,11 IWO, ttV41t 11tL TYa4Lt 0 %AAbw VA 111E ..76e +.1Vin A%aYLl cuaU Vu " sAsV~A%$VA line of said river; iiience a " 55 9 Soo '2~i" X 24.33 ieet along said meander li;ie to a i" A 24" round iron pipe, which pipe is 143 feet, more or less, from said water's edge and on the end of said maUAU%Or AA11W thanna RT 10,1411q,111 W 1'~Z 02 fiat to n 1" V 2d" rnnn iron nina• thanra RT litLGlllULt 111V, W1L1tVV All 1-JV ✓.1 11 A✓✓.IV aLV6 ay H a n Y4 mund as v.• paa.y, 47x43152" W 138.74 feet along the centerline of an easement as recorded in Volume 518, Page 403, to the point of beginning and 'Including all land lying between said meander line and said water's edge, St. Croix County, Wisconsin. t s ' Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~iP~G~f'5~N TOWNSHIP SEC. T go N-R -2va ADDRESS teT'l IPO! ' 3-,7 ST. CROIX COUNTY, WISCONSIN 6~/- JbueoOll- GU 1-5 SUBDIVISION LOT LOT SIZE 7t61--s PLAN VIEW Distances and dimensions to meet requirements of II,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ERICKSON JOHN } Goo - ~,y'_~t'# Rt. 1, Hwy 353s SE NW, Section 35 /~'j T3ON-R2 OW. ,e g' seph, WI 54082 Town of St. Joseph San.Permit#88417 10-24-86 R. Ulbricht Conventional, Replacement L0~ 35- INSTALLED 10-27-86 1 ~ 7 "CATE NORTH ARROW Tp~ o f A& L) i v: v~ ~UEY~. BENCHMARK: Describe the vertical reference point used M., 1;4J 0'- eltb 10i ( 7'kS7- Elevation of vertical reference point: X00' 0 Proposed slope at site: 16- /2 Pa 6v ~Fs~Q ~o uGQ~~ -,"0,00e-7-3; tAA iPe O `'R cc r- , uh 5 SEPTIC TANK: Manufacturer: Liquid Capacity: /or" Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: 96'0 V Tank Outlet Elevation: Number of feet from nearest Road: Front,@ Side,O Rear, O ✓ S feet From nearest property line Front,O Side,O Rear, O ss / feet 17 Number of feet from: well _6 building: j (Include this information of the above plot plan)( 2 reference dimensions to sentic tank) gyp.-~,1/,V,,rT/z.~ PUMP CHAMBER / Manufacturer: Liquid Capacity: Pump Model: Z-M ' Pump/Siphon Manufacturer: 'Z 7 Pump Size Yz Elevation of inlet: Bottom of tank elevation: a Z ---a- ShMt S 107'1'C 7-, Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line:- Front, O Side, O Rear, 0 Ft. i Number of feet from well: Jr- Number of feet from building: ,Z (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ^ Trench: Width: 12, Length: Number of Lines: Area Built: 3 " ip Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,O Ft. Z Number of feet from well: 37 Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: ~ Liquid depth: tom of seepage pit elevation: Area Built: Has either a dr box O or distribution box O been used on any of the above soil absorbti sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Num>ofrings used- Elevation of bottom of tank: Elenlet: Num from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: i ` Inspector: Dated: Plumber on job: License Number : i HOMESITE SEPTIC PLUMBINQ CA. IT. 3 OWEIL RD., HUDSON, WIS, Will ROBERT ULBRICH4 3/84:mj WIS. MASTER PLUM6ER LIC. NO. Allot 04111. MINN. INSTALLER & DESI11NXI2 Tlr'. "Vi v" T N ~iPi Gds dAJ i¢ S lJ%L HOMESITE SEPTIC PLUMBING CO. RT. 3 O'NEIL RD, HUDSON: WIS. 54016 ROBERT ULORICH4 WIS. MASTER ?LUMBER LIC. NO, 3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC. N0. OOriii3 Rb~jav INS 76f/ t y~,~ow I ~ ~1~ ~osf I S~ R y pow f N` 1101- to SNsv N OAl - $IA o f/cu ~3•Qo 1 l ~ -2 ~X sG ~ tsA TE Off f k// Of 201 2G ; 1 2l uD~ie j" tz, sT Pi~oES . Pv-h ' ~ 35 yi w P ► , , ' s ~,5 7( s y Sr~~ q3, p 3 ' s~ yo !'vc I I tev, iti y''~•r~ Pu ti~ Cti AE,e dE 30 f0 A/E/fiPF S r y'~ '~t, w/vOa w 700,11 of Tilt, P5.1~' - • - ~auEk 90.3 ~ ~L Sf~li~ f /,00 . 0 co vu,c f-2, 6)0.0 w/cJE,F ' ~y"17/ T" Ul/I S fiPoT" SGti 4/O f `S~ S re ,#Af,fd y Caw.vCC TipdS . ° 8cuv 3~~ ~r~~ " 00 l o~ 5 vTr"• Fl~~ 90.~1y, 3 r,,~ll T ~,a t,E sr a s a y. 90. ~'r J ~~s r ~ s. ~ /00 0 ~iP~ C>~~tf✓/~i~Ll~ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 799 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING IMCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (Ir assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: John Erickson Rt. 1, Hwy 35, St. Joseph, WI 54082 140-a 7 004 ~v°do BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: SE NW, Section 35, T30N-R20W, Town of St. Joseph Name of Plumber: MP/MPRSW No. County: Sanitary Permit Number: Robert Ulbricht 3307 St. Croix 88417 SEPTIC TANK/HOLDING TANK: ` MANUFA TURER: - LIQUID CAPACITY: TANK INL T ELEV.: TANK OUTLET ELEV.: IYW LABEL LOCKING COVER D: PROVIDED BEDDING: VENT DIA.: VENTMATL.: HIGH WATERjf S NO DYES ONO / NUMBE OF ROAD: PROPERTELL: BUILDING: VENT TO FRESH • ALARM: LINE IAIR INLET: Q FEET FR YES ONO OYES ONO NEARESOM y.~ DOSING CHAMBER: MANUFACTUR BEDD YESING: LIQUID CAPACITY. PUMP MODEL PUMP/SIPHON MANuI O TUBER. WARNING LABEL LOCKINDG COVER '~'7 PROVIDED: Pq OVIED: NO YES ONO DYES ONO GALL21661 -4 1 ON PER YCLE: PUMP AND CONTROLS J{/ ROLS ; OPERATIONAL NUMBER OF PROPERTY WELL UILDING VENT TO FRESH (DIFFERENCETWEEN FEET FROM uNE B„~ r PUMP ON ANFF) YES ONO NEAREST? J .G~ SOIL ABSORPTION SYSTEM. Check the soil moisture at t e epth 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 WIDT . LENGTH NO.OF DISTR. PIPE SPACING COVER INSIDE CIA -PITS LIQUID TREN RES. IAL: PIT DEPTH. DIMENSIONS 7yz GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR MATERIAL: NO R. PROPERTY WELL BUILDING: V NT TO FRESH BELOW PIP ABOVE COVER: ELEV. INLET. ELEV. END. PI MBER OF FEET FROM LINE A'y±ayL r. NEAREST-~ " MOUND SYSTEM: C16?o e2 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- D YES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DEPTH OVER TRENCH/BED DYES ONO OYES NO CENTER: DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED EDGES: MULCHED DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR DISTq. PIPE CISTHIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.'. ELEV.: CIA.. ELEV.: PIPES DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO DYES ONO COMMENTS; PERMANENT MARKERS: OBSERVATION WELLS: NUMB FROMER OF LINE PROPERTY WELL: BUILDING: FEET : OYES ONO DYES ONO NEAREST Sketch System on Reverse Side. Ry file for audit. SIG R TITLE DILHR SBD 6710 (R. 01/82) .i SANITARY PERMIT APPLICATION COUNTY DIL~HR sr. CPO X In accord with ILHR 83.05, Wis. Adm. . Code Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than / 8% x 11 inches in size. sr/V PLAN I.D. NUMBER -See reverse side for instructions for completing this application. I 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION FOR VARIANCE ❑ YES ~ NO PROPERTY OWN R PROPERTY LOCATION T fj .c) EiC~/ Clt: 0-4j O (o W SC % NO/a, S T ,30, N, R 20 E PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME w 3s CITY, STATE ZIP/ CODE [P715 HONE NUMBER CITY NEAREST ROD, V" L RK ' <lOS~j t~iC1f5 570 ~Z S~9 62700ED VILLAGE : $7 TOSE~D/~ 11. TYPE OF BUILDING OR USE SERVED Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): 0/a5-'jGtr two 3!5- III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. ❑ New bK 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. )N Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. E1 Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. See a e 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): /O O i G/ C/OO Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Con- Steel Plastic Tanks Tanks W /ES CON 0, Concrete structed glass App. Se tic Tank or Holding Tank rho 5 0~1+ @iuhl'~ Ole! Lift Pump Tank/Siphon Chamber CDH f/vM ~O/,a V~`+ EPRG ® ❑ ❑ El ❑ Li 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) MR/MPRSW No.: Business Phone Number: F-OB E-97- WZ-Gpi~ IV 330 7 715' 34prv 0/405 Plumber's Address (Street, City, State, Zip Code): Name of Designer: 'e-T-3 Q' A3E l L JZ D 14V Dso el W/ S 9ftWo VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # IT 3 O'NEIL RD., HUDSON, WIS. 54016 J ygZ CST's ADDRESS (Street, City, State, Zip Code) VAS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S Phone Number: MINN. INSTALLER & DESIGNER LIC. NO. 0060 7/f L?P(p -~j/EI! QD,5 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) 681 Approved ❑ Owner Given Initial Surcharge Fee Adverse Determination YAW &,lot cc 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 maybe 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 necessary, usually every 2 to 3 years; 6. If you have questions concernini, you p, lvat.- sewage syster i, contact yc=a r local Code administrator or thv 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 systern is to be installed; 11. 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; 111. 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'h 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 -110 was signed into law. This legislation is more commonly known as the groundwate protection law. This change in statutes was the result of over 2 years of steady nego- atipn and,p_tbiic debate. The groundwater bill Ground--ater - included the creation of surcharges (,`Aes) for a number of regulated practices which wiscorkil's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried ~i as ;re is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The -nonies collected through, these _lrcharges are credited to the groundwater fund adminis- tereo, by the Department of Natural r sso ce These funds are used for monitoring ground- g~ v;ater, groundwater contamination iir..~esr gat;ons and establishment of standards. Groundwater, - it's worth protecting. SBD-6398 (R.03/86) r HOM£SITE SEPTIC PLUMBING CO. RT. 3 O'NEIL RD.: HUDSON: WIS. 54016 ROBERT ULBRICH4 APPLICATION FOR SANITARY PERMIT WIS. MASTER PLUMBER LW. NO. 3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC. NO. 00663 STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate.deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Location of Property l&) Section , T 30 N-R ZO W Township .S • ~d ~~`P Mailing Address /el- "4 ~ S - Address of Site Subdivision Name Lot Number Previous Owner of Property 'POX, I3L ~ - Total Size of Parcel Date Parcel was Created e' Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume (06 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warrant 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) centi6y that at,t ztatement/s on this 6onm ahe tAue to the best 06 my (oun) knowledge; that I (we) am (she) the owneh (,s) o6 the pnopeh ty dens cAibed in this injonmati,on 4otm, by v-(ltue o6 a waA&anty deed neconded in the 066ice ob the County Reg.vsten o b Deeds as Document No. 3a - ;and that I (We) puz entey own the ptopobed z to 6o& the sewage d i 6pod s y~em (oh. I (we) have obtained an ea6ement, to nun with the above desehibed pnopeAty, bon the con.6t uction o6 said eybxem, and the same ha6 been duty teconded.in the 046iee o6 the County Register o6 Deeds, ab Document No. t ^ SI ATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED z ; . 'ycs y/ H • _ a STC - 105 r" SEPTIC TANK MAINTENANCE AGREEMENT H o St. Croix County z ~f d OWNER/~" H ROUTE/BOX NUMBER Fire Number CITY/STATE Leo ~Z ZIP ✓ PROPERTY LOCATION: 'Val 4, Section 3S T 30 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 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. SIGNED DATE St. Croix County Zoning Office HOMESITE SEPTIC wWN10.G CO. P.O. Box 98; RT. 3 O'NCL % H AEON: W15, 54016 Hammond, W1 54015 Rp9CRT l~LORIGH~T 715-796-2239 or 715-425-8363 MANN. AN3TALLERM& DESIGNER L IC. NO 00663 Sign, date and return to above address. ~ v INDUS DEPAR TtY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS Dt1STRY DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 HUMAN RELATIONS N WI 53707 (H63.090) & Chapter 145.045) LOCATION:VIV SECTION: TOWNSHIP/Mt1tfte P*tj-T-Y: LOT NO.: BLK. NO.: SUBDIVISION NAME: sE 35 /T3oN/R~E(o W sr- 7assPh~ COUNTY: OWNER'SAvr"z~S NAME: NT-1 LING ADDRESS: ~ceolx T.OHO 'ERACkrO~ vwy, 3s USE DATES OBSERVATIONS MADE Llg~ NO, BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTION PERCOLATION TESTS: Residence 2 ❑New Replace © IZZ^ RATING: S= Site suitable for system U= Site unsuitable for system SG s G'N/~c /s SToO71f- CONVENTIONAL: MOUND: IN-GROUMOU RE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) os ou os u Q11S ©u os ©u 11 49wi '"'OeAb w,8ev 1ZXs3 410 All, o sro If Percolation Tests are NOT required DESIGN RATE: I I'loodplain, f an Y portion of the tested area is in the under s.H63.09(5)(b), indicateindicate Floodplain elevation: PROFILE DESCRIPTIONS %p ~EG,r~lif~- fjL . BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST, IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- /0 ~ s G- 8-B-2- / • ~7, 0 D G.o /1 16 T v covARfe ?.I,cJ CS p! _ la cs' R_ O B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIO PERINCH P_ P- •Pd-~i G S 04/ .v Gam" P-_ P- T d~L 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. O SYSTEM ELEATION 1 T r- ~/po X i ~ I , u T - t t l _l , _ _ _ y , 1 I - k+ 6 '40 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 COMPLETED ON: Q HUMESITE SEPTIC PLUMBING CO. DC f a,Z / Q ADDRESS: ROBERT ULBRICHI CERTIFICATION NUMBER: PHONE _NUMBER (optional): WIS. MASTER PLUMBER LIC. NO. 3307 MARA .2 elJ0-- Qp qp MINN, INSTALLER & DESIGNER I CST SIGNATUR : T DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - r P OMPL "''r` ')T-W 11 - S6 - 6396 TC Eis test, yowl 2. C L A irient; 3t exernf)- 3 >x A THE fl, O T HI REPORT ON SOIL BORINGS & PERCOLATION TESTS 115 PLOT PLAN Project I.D. • J -6#,d HOMESITE SEPTIC PLUMBING CQ LEGEND IT. 3 O'NEIL RD., HUDSON, WIS, 5015 ROBERT ULORICHT • Ba c kh o e Tits WK MASTER PLUMBER LIC. NO. 3307 M,P.IRJ MINN. INSTALLER & DESIGNER LIC. No. No X Perc Locations C.S.T. 2482 Q = Existing Well !9 = Vertical Reference Point OF 40411 GfP))k Elevation of Vertical Reference Point /04' 0 -Lot Line N SCALE : ' 1 O y4/00 S r R/~ s' Lof" ~o~PN€~ \ N• E ap S i5 ( w/ SV~V~Y ~ .32 g i 7w Q1 1 Yo' 5'/0 I ~ I 3 ' tic; S h ~ r' pov A) S f 1o p .2/00,0 „~U owl , Y dos r N ~ N~• ~Ot LiwE„ J~ S 1 5z ' zs-- N E tot Y~S wise E pi? ~ iy,csZ aEv~ ?0r i j 3 a1 I i La r2- 1,7 oD 1 t B3 00 ~ w DI y h V / ii ~ ion 8~ X02 f c l c i v 56, VAP0 0 ~,r,5fir~ , /00 \_9 v Fresh Air Inlets And Observation Pipe a h 0 C~- Approved Vent Cap Minimum 12" Above Final Grade Gv~~f d~ ~pf L0 4" Cast Iron IN VGr ( Z Above Pipe - DF M~ ~ y Vent Pipe To Final Grade "'Synthetic Covering min. 2" Aggregate Over Pipe UI-Tee Distribution pipe - 0 0 0 0 0 ,e :5-011, T~"S7- "Aggregate Perforated Pipe Below Beneath Pi e 0k Coupling Terminating At Bottom Of System PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS &,eA7Yt. jAA0L,,0C JUoU6,Yt QiV DON VENT CAP---, Coi✓D~ t 4"C.I. VENT PIPE APPROVED LOCKING I MANHOLE COVER ~ 25' FROM DOOR, 12"MILL. WINDOW OR FRESH AIR INTAKE GRADE y" MIIJ. 3L V'-'` r (o ~18" /AIM. 13. ~ F 18"MIN. mil 5 , V) yot) PROVIDE INLET $~i~EAIRTIGHT SEAL APPROVED JOINT d AL W/C.I. PIPE APPROVED JOINTS I w/c.T. PIPE / P - pa,y EXTENDIN6 3' EXTENDING 3' ~dOQ ' c A,414 EX I ALARM ONTO SOLID SOIL B i I ( ONTO SOLID SOIL Sip t~C 1 GGIitM$f~2 ON LLEV.~i_ FT. PIMP-_ OFF D ~N S~DC~ $0 f~QM of b 5' 7 CONCRETE BLOCK A) $ ~D RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E ellA3iuiy 6.06) fit Ag5PEGIJFtGATI0K1S DOSE o1Es4X_ ~D41Gt L 7~-G- TAMKS MANUFACTURER: IJUMBER OF DOSES: PER DA.! TANK SIZE: /0" GALLONS DOSE VOLUME' /14 yd/S. -romL.% i~G•S M _,%Am8 A. INCLUDING BACKFLOW: S!59~~s GALLONS ALARM MANUFACTURER: LE~6L fl4WA4 3S 8 3oJ MODEL NUMBER: CAPACITIES: A= INCHES OR GALLONS SWITCH TYPE: G ' /v'~GV~ /~'?r B = Z INCHES OR GALLONS PUMP MANUFACTURER: ' C=~3'/Z, INCHES OR GALLONS MODEL NUMBER: co zZ_ ff C D= W INCHES OR GALLONS SWITCH TYPE: 'pi-6-6-.1 NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 7S GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 7 FEET Pv,4p CJhh/k/tT4_4' + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . 251L FEET ~ ~Z FEET OF FORCE MAIN X F/IOOFxFRlCT10N FACTOR.. FEET TOTAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF TANK: LCNCGTH ;WIDTH ;LIQUID DEPTH / SIGNED: LICENSE DUMBER: /l DATE: U~l~ ffW OAAr f 0 /p /a Ft df ,3 s~ Yo Pvc, 7 i yas HEAD a~ CAPACITY CURVE ` TDH W W` Y. , 00 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE 30 EFFLUENT AND DEWATERING SERIES 53-55-57-59 97 137-139 163 165 M hNM LTRS LTRS LTRS LTRS LTRS 28 163 248 394 -231-- 231 90- EFFLUENT AND DEWATERING 3.05 129 216 300 231 231 4.57 72 163 242 227 227 26 $5 \ \ SEWAGE AND DEWATERING 6.10 104 136 223 227 \ 7.62 30 216 223 ♦ 9.14 206 220 24-80 ♦ 12.19 172 206 \ 1524 - 125 191 75 1829 57 161 22 ♦ 70, 21.34 114 70 \ 24.38 53 MODEL MODEL Lbck Valve: 19, 24,5' 1 26' 1 66' 1 87• 20 65 163 ~ 165 TOTAL DYNAMIC HEADICAPACITY PER MINUTE \ SEWAGE AND DEWATERING \ SERIES 267 268 262 264 293 18 ` M LTRS LTRS LTRS LTRS LTRS b. 1.52 408 386 492 681 16 3.05 227 273 360 598 55 \ 16 ` Z 4.57 76 163 238 511 ` 20 6.10 0 30 125 401 5 \ \ 25~ 7.62 268 14 \ 30,, 9.14• 163 292 45 \ 3 10.67 227 \ t 40. 12.19 174 t 45° 13.72 106 12 40 t 15.24 45 \ t MODEL Lock valve: , e 21' 1 26' 1 35• 53 10 35 \ I 293 .t 30 MODELS t 8 25 E/--137 139 I i tn~ 6 20 MODEL 284 4 15 MODEL MODEL 10 268 282 2 MODELS I\ 5 53, 559 MODEL MODEL 57,59 97 267 U.S. GALS. 10 20 30 40 50 60 70, 80' 90 100 10 r LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE 3280 Old Millen; Lane Manufacturers of . Ozzz-zzj-ff oui Box 1entu Louisville, Kentucky 40216 (502) 778-2731 QL/AL/TY PUMPS ~iYCE IS,& 8 SEWAGE and DEWA I tKIwu PU1111ja `267" Series ' • Automatic or Non-Automatic. • 1/2 H.P., 1 Ph., 115V or 230V • Thermal protected. • Cast iron and stainless steel construction. • Vortex impeller design. • 2" NPT discharge. • Sleeve bearing running in bath of oil. • Switch case, motor and pump housing, base and impeller are of cast iron. is Passes 2 inch solids (sphere). 1 VI 1 listed I L°s Angeles co... de Sp Canavan Standards Assoc_ w'r, SC-2225 avwJaApproval available