Loading...
HomeMy WebLinkAbout040-1022-90-100 0~p., 3d -0 0 o ty 1 CD CD 0 -0 a T m to 3 2 v Z ° 00 m 00 c°n C 0 A IV aD • ICI 00 - CD p N C 1 w N :3 N N = v ~p 00 O p, cL° 7 & n N p D° ;f O H A ° °o ~ o CA O1 U) G D m ° f ro cn (n co C a C ° 3 p ° v 0 co to o r N ro o w O y -4 rn o° a (D ? O H. :;-7 O H '0 fl: • Z O O O N H ((D tr-+ ° v 115 -04 OIQ pp cn co ul w v W W y D 4- d cr v o z o o 0. ci c v J w m _ m ca Z rn r 3 A :3 -4 a N N I Z H D~00 O o a~ w ? CD N H• (D ~ m m Q o `I W c m m a H H a O N Z~ Z P., Z -4 co m . 00 p N c ' X =3 z ~i a G) ~ J 0 "o cn p R\ ~ Z -1 al N o rt a 3 P A !U ~C W 0 b G m P3 vl y Z m CA) I co a 0 oo n=i c ° pz a m I m ~ wZ ti ti O a w 0 O CD op D ti 00 69 0 p ~y ti • Parcel 040-1022-90-100 12/28/2005 09:07 AM PAGE 1 OF 1 Alt. Parcel 05.28.19.78A-10 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner WALTER D & SUSAN D WOODCOCK O - WOODCOCK, WALTER D & SUSAN D 475 TOWER RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ` 475 TOWER RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.000 Plat: 4472-CSM 17-4472 040/03 SEC 5 T28N R19W PT NW SE CSM 17-4472 LOT Block/Condo Bldg: LOT 03 3 (3.000AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 05-28N-19W NW SE Notes: Parcel History: Date Doc # Vol/Page Type 12/23/2003 749960 2480/128 TD 02127/2003 711460 17/4472 CSM 10/06/1999 611715 1461/539 QC 10/06/1999 611714 1461/538 QC more 2005 SUMMARY Bill Fair Market Value: Assessed with: 102180 215,300 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 48,000 159,200 207,200 NO Totals for 2005: General Property 3.000 48,000 159,200 207,200 Woodland 0.000 0 0 Totals for 2004: General Property 3.000 48,000 159,200 207,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 040-1022-90-100 04/20/2005 02:35 PM PAGE 1 OF 1 Alt. Parcel 05.28.19.78A-10 040 - TOWN OF TROY Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner WOODCOCK, WALTER D & SUSAN D WALTER D & SUSAN D WOODCOCK 475 TOWER RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 475 TOWER RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.000 Plat: 1652-CSM 17-4472 040/03 SEC 5 T28N R1 9W PT NW SE CSM 17-4472 LOT Block/Condo Bldg: LOT 03 3 (3.000AC) - Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 05-28N-19W NW SE Notes: Parcel History: Date Doc # Vol/Page Type 12/23/2003 749960 2480/128 TD 02/27/2003 711460 17/4472 CSM 10/06/1999 611715 1461/539 QC 10/06/1999 611714 1461/538 m29 2004 SUMMARY Bill Fair Market Value: Assessed with: 26283 206,800 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 48,000 159,200 207,200 NO Totals for 2004: General Property 3.000 48,000 159,200 207,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~✓~yE,2 ~ ~~;P~r-GfJ ~oPi~oti •Wiscons n D partment of Industry, SOIL AND SITE EVALUATION 3 Labor' and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis { Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Coura , , , b j x' tad include, but not limited to: vertical and horizontal reference point (BM), direction and 57` e / Y_ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. z, P'arcell.D. # APPLICANT INFORMATION - Please print all information. ReXved r Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). u _0 Property Owner Property Location sh;/~~~y ,4 • E,~Lo Govt. Lot NF V45k/ 1/4,S T 2-8 N,R E (or)o Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# `0 ~I 6 ~7~ ?Owl ;eD z p,-,Vp/,V(rC'W City State Zip Code Phone Number Nearest Roa Er- #ORSo n/ 1,015 . 5401& (3 V-,,) 3 5913 ❑ CityZ El Village AfJAG 7- )D - Town Tlo 2<1we Construction Use: esidential / Number of bedrooms 3 - Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: AlOr yso - Code derived daily flow &00 gpd Recommended design loading rate - -in bed, gpd/ft2 lf9 trench, gpd/ft2 Absorption area required JV~_bed, ft2 750 trench, ft 2 Maximum design loading rate bed, gpd/ft2 ' B trench, gpd/ft2 Recommended infiltration surface elevation(s) _ Szc f~G •.3 ft (as referred to site plan benchmark) Additional design/site considerations u5C T L i w % Jk PA0 9D )L D / ST,ei/f U T/oti Parent material al~5 77 13veeA7fvR J~ Flood plain elevation, if applicable ~ ft S = Suitable for system Conventional MMouunnd In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system P-9- ❑ U gt ❑ U ID-S ❑ U 21--El U 0,9-' ❑ U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed Trench I o-& i © yP- 3 s. o, 5 .7 .8 2. /o Ae z/Z. ,ter-/,e Ground 17-52 3141 elev. 10.11-30 ft. /0YX -7 Depth to limiting factor - Remarks: Boring # 0-7 ;o ye 3/a- cs 7'.9 2- 2 14 V 16 '33 S 3 e e- 1:V: 1-3 /0 3 S/ ~f'sde s 4 7 3 ,11 Ground G.s 0 s 7 elev. Gt $ lv7'ft. Depth to limiting factor In. Remarks: CST Name (Please Print) Signature R06~ f 7- ~G"/ n~/ GAT- Telephone No. 7/S 386 - /86-- Address Date CST Number Ulbricht 8 Associates Private Sewage Consultants 655 O'Neil Rd. -~o Hudson, Wis. 54016 PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of PARCEL I.D.# ~/'LtJ /OT CS~•1 ~~.vUly Boring # Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 i 16W 3/3 /s llp~f e,57 7 .9 Z -.30/6 CS OS ~p c 7.8 Ground d 141 lo S K2 S GC - • O /elev. Depth to limiting factor 7 7' Remarks: Boring # o 16 yle 3/3 /S / G~.Q GS 3 a lo Ground eleev l/~• f L , Depth to limiting factor in. - Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Boring # 0-8 /6 yl2 7 iw GP$• GAS Z-F 7 .g ]r- W2- /o y/~ 3/ /74S:, f ,w►4 ioy S. A s 564 c .-7, 8 Ground 16 J~ Cs ai • 7 ' . g elev. 1/bin. Depth to limiting factor f$ ln' Remarks: Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) k a y - E vAT'I o ~S r `~3 \ ~°y 3D /G7 (32- I' SG.4 Lt= ~ ' S pia , z5 ' e W ES T- 1--V T Ulbricht & Associates Private Sewage Consultant/ 669 O'Neil Rd. Hudson, Wis. 54016 i i \o 0~ f f © • G~i cEoq~S 4~ 4~ c~flfl~5 i ~ O • 0 v~' Sy So L a r- t, , /3M. ~ovvp: T6~ of Sv~PV~yole A- 7- SW L ~ 7- v ~ . /0 0 0 L _ ~ ~ . 3 o-F 3 Form-STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP / SEC. .S T N-R__LZ W ADDRESS ST. CROIX COUNTY, WISCONSIN L_'0 1- 3 SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~w~~c /Q,o. DvE~ yc~' 7"0 /V~a~c7'N /~FSl4l}NCE l'rpoAosE,d TL ~ ~RoPoSFD 1~rprvEw~ • Lt)"RoARTy 4,1Ne_s goo ' 5?, J~Nt /V O C ~4LL ' INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used /sue Elevation of vertical reference point: 00, DD Proposed slope at site:_ SEPTIC TANK: Manufacturer: W1,es )y Liquid Capacity: /000 ( ,Ai_, Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: o. 4/ Tank Outlet Elevation: /d%- 13 Number of feet from nearest Road: Front, Side ,ORear, O ©Vf,< 4/O feet From nearest property line Front ,C~rside,ORear,O Oye-le 'yao feet Number of feet from: well sJ building: 3(" (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 1_. • PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM i Bed: fbS - 6 ,5yrVTrench: Width: /V? A. Length:_S Number of Lines: 4_ Area Built:~~f Fill depth to top of pipe: Number of feet from nearest property line: Front, ide, O Rear,0 Ft. 400 Number of feet from well: 55~ v Number of feet from building: 7 (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 a 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: ~ ~~pO License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS 'LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 KCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number- F-1 Holding Tank ❑ In-Ground Pressure El Mound (1f assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: William Enloe Rt. 3, Tower Rd., Hudson, WI 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.'. NW SW, Section 5, T28N-R19W, Town of Troy Name of Plumber: MP/MPRSW No.: : Sanitary Permit Number: Gary Zappa 3300 To'"S't. Croix 88403 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELLEE~V.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER /100 /0 V/ PROVIDED: PROVIDED: / (Q YES ❑NO ❑YES C10 BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH /1 LINE: AIR INLET. r JALARM FEET FR 4V ❑YES %NO l I ❑YES NO NEARESTOM o o ()t DOSING CHAMBER: MANUFACTURER: BLIQU ID CAPACITY: PUMP MODELJPUMP/SIPHON MANUFACTURERWARNING LABEL LOCKING COVER PROVIDED: PROVIDED❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WE LL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 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: WIDTH: LENGTH'. NO. OF DISTR. PIPE SPACING: COVER JINSIDE DIA. #PITS. LIQUID BED/TRENCH TRENCHES MATTAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH 1'%', RPIPE DISTR PIPE DISTR. PIPE MATERIAL: NODIS7 NUMBER OF PROPERTY WELLBUILDING: VNT TO FRESH 4 BELOW ABOVECOVER INLEETELEV END: PIPESLINEAIR ET FEET FROM 21 q5, 1 o.Sa NEAREST-----9o- CJ ~7 J! MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED IMULCHED. CENTER. EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.'. ELEV.: DIA.. ELEV.: PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY 7R MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: if-I ❑YES ❑NO ❑YES ❑NO NEAREST ld~ ►o,I"I ~ Sketch System on in in county file for audit. Reverse Side. SIGNATUR - TITLE. DILHR SBD 6710 (R. 01/82) SANITARY PERMIT APPLICATION COUNTY 70ILHR 57 , c26~ 1C In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # ~ O~ -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PUJL~A=N I.D. NUMBER 8% x 11 inches in size. N~ If_ . -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES nr%7dl NO PROPERTY OWNER PROPERTY LOCATION a 0~ • ENG E_ PW Y. J4d%, S S T 2- N, R / ! E (or W PROPERT OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY, STATE ZIP CODE PHONE NUMB"ED" O VCITY ILLAGE : TjeD/~ NEA EST ROAD, /-luOSov w/S rV & 3d'lQ 3 3 ?o~ to ;Zo II. TYPE OF BUILDING OR USE SERVED: liE wed)(, d X, S i ✓r b Q f S Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): 1 III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. N New b. ❑ Replacement c. ❑ Replacement of d. E1 Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in ##2) 1. a. % Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. E1 Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: Ch Z L_iAw5 Co F-1- A PAP-+- 1. a. ® 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): Y3 /,f-- G yo d ~x80> 1~ S ~9 01 Feet private El Joint ❑ Public VI. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete strutted glass App. Septic Tank or Holding Tank Tanks Tanks ~?7~ ~ ~+~SE/e ~C ❑ ❑ ❑ Lift Pump Tank/Si hon Chamber 6, ❑ ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT 1, 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) AAA/MPRSW No.: Business Phone Number: 4,+Pq 2A/I'A- 337o v Plumber's Address (Street, City, State, Zip Code : Name of Designer: Hwy. 3 s N oeolr-_ /(v 1fdAj VAIN. SOIL TEST INFORMATION Certified Soil Tester (CST) Name RT. 3 O'NEIL RD.: HUDSON: WIS. 54016 CST # Z D~ G CST's ADDRESS (Street, City, State, Zip Code) ROBERT III HT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. Phone Number: MINN. INSTALLER & DESIGNER LIC. N0.00663 ~OJ7 IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee Groundwater Date Issuin gent Signature (No Stamps Approved d O wner Given Initial Surcharge 0 / Adverse Determination P!L7 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 necessary, usually every 2 to 3 years; 6. ?f you have questions concerning your private sewage syste: 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: Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 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'/2 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 publi debate. The groundwater bill GroundwIaler - - included the creation of surcharges (fees) for a number, of regulated practices which Wiscorsin's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried treasure is used in your building is returned tc the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. '(7~) The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the `department of Natural R-sources. These funds are used for monitoring ground- Vona f water, graur+dwater contamination in°:estigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (8.03/86) 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - C G' Owner of Property Location of Property Section , TJ N-R W Township Mailing Address Address of Site Subdivision Name 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 No Volume 4 and Page Number_ 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFRTV OWNER CERTIFICATION I (We) ceAt i.b y that at t statements on this bonm cute tAue to the best o6 my (ouA) knowt edge; that I (we) am ( cute) the owneA (,s) o j the pno pW y dens ut bed in this .inbonmation bonm, by vi tue ob a waA&anty deed neconded in the Obb.ice ob the County Reg.usten o6 Deeds as Document No. __I 9 17 5 and that I (We) pneesentty own the pnoposed site ite bon the sewage dis'pops system , •(on I (we) have obtained an easement, to nun with the above deschi.bed pnopenty, bon the con.6t uction ob said .system, and the same has been duty neconded in the Obb,ice ob the County Register ob Deeds, as Vo No. 6 _!2 7 yy~ 4119L SIGNA 0 OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) l DATE 'SI ED DATE SIGNED H z . cn 9 ST C- 105 r -a H SEPTIC TANK MAINTENANCE AGREEMENT o Croix County z tv a OWNER/BUYER </'✓r ~/~'L r~ ROUTE/BOX NUMBER Fire Number CITY/ST ATE zip6 M16 PROPERTY LOCATION: IV G' 34, /i1134, Section S T~N, R~W. Town of St. Croix County, Subdivision Lot number 7 %(.C.. 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. 0 Z. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- I'd ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office w'thin 30 days of the three year expiration date. 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. R_X&t_' / ate `3 QERARTO~NT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IIVDU TRYY, , - DIVISION AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELA ONS \ / MADISON, WI 53707 (H63.090) & Chapter 145.045) LQ~',~ 10 S rIO~TN R E (o )W TOWI/PDY: LOT NO.:BLK. NO.: SUBDIVISION NAME: 2S' I /~/~'V J y T COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDR SS: S/~"oi X M,es• 110ftj . ZiVl o~ Rf. 3 T060&10 4vI s .Syol USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS Residence New ❑ Replace l 5? '/P7oC, /Z.- 19- RATING: S= Site suitable for system U= Site unsuitable for system 7 CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ©S ou S au S ❑u EIS ®u EIS ou ..~,eoQJ1 y 14 'wip, 77 40--J If Percolation Tests are NOT required DESIGN RATE: If any portion the tested area is the under s.H63.09(5)(b), indicate: G`,.~SS Z~ Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) pfoc , Iwo 116 ' All , /..0 ' 0AI • r•', ~/G ' N• ) • 3 N . S B- '77,60 yo /a,s'o" I ~Is4 aR KUfS Sd>' 7.f 'V OFip cs B-2- ~~O• ~O• D GA 7 T?. A.-* CS . i PFrLrD icy' W.sf o,e.,o s B d f0 y! 7 y Boop lvzi l /V#-" s .3 , 6 p '»%v VOP C .F j,-0o< o a F 7_f y.,~ o ' /o" w r DE o/' y WO c Ea o 4Af yo ' B- ? ,V v c X . 4 0 1 4 ILIMK 5;~ .,P,? :k' ea. .6, .f,u B- 42.0 >.o' cs *01'04. f.¢ar- su ll ours 'of ,F G,ey C1*1 ' 04-, ( .KO~ WED) . B- PERCOLATION TESTS vEAy CS S7,e,,f ,0 TEST DEPTH, WATER IN H LE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWEL ING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D 3 PER INCH P- / D Z P- P- . / Z i P_ P_ _J 7 3 Y? 113,51 z 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~r.• ~ ~ ~ SYSTEM ELEVATION ~ i . i 3 i r I i f i 3 t I i T I ~ I E ~ t Y ~ 4 3 ~ i t ! lve're- Tb soi L S T~-' V C,7V ~9 T r f0~bs/ AS1 ' /N riLS Gov S ' fo}v G a ifll~T- f} e~1_ S/f-~~w~ ucQ-- 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 data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON: RT. 3 O'NEIL RD., HUDSON, WIS. 54016 . ,Or, 2- ADDRESS: ROBERT UULBRICK CERTIFICATION NUMBER: PHONE NUMBER (optional): 1118. MASTER PLUMBER LIC. NO. 3307 MARS. yd 2-- MINN. tNWtttR Si DESIGNER 1:10. NO. 006W CST S NATURE: ZC/ r c~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - _7 F 1I IC ACS C7r - 115 - S - -rte it to - 1. 4, C ~ LY IF ALL the p -re sd. A rit; tic ~cernp X, ED ' !TH THE "l%9L TESTERS a K - Y i " T INPEPARTMCNT DUSDUSTT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , - DIVISION LJABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS 1 1 MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION. SECTION: OWNSHIP LOTNO.:BLK.NO.:SUBDIVISiONNAME: 1W 1/ 1/ _r /T z4'N/R 19 E ( ► W 1;400 /V o .f c f' COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: ~SrG,E'0/X Ae f1.Q.f • ~ti/oE- 3 Tacv,~ T~~ . ~f v~so,v war - USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMIV~~AL DESCRIPTION: A New DESCRIPTIONS: ~R OLA ~ N T~TS: Residence 3 New ❑Replace ✓,Lj7i P6, RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: a~ IN G~ PRESSU RE: SYSTEM-IN~FILLHO~LDING©(V : RECJ`OEND~D SY~EM:(optional) 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: C/ xi Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATE -INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) s. - r4AI C S s6 90 S9 Fo ka1y4&~ 7, _7AAJ S11. /.v' cs /07.6 y ~k - > ~~f 67' yo ' D04' a,; . S; 4A) s, S ti V GJ w 0 G~ 7 S ~ B- , B-d IeA eU ~?e ' G 401-r t w- Jim,t-/l ~ S B a c fr ~,Pgy.;r T~Gv /o-4M . 5 D/oi. Tc~r- ,rye .~v~v PERCOLATION TESTS TEST DEPTH . WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- P- P- 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. SYSTEM ELEVATION I i E E o v vT5 4) b 1) 496 74 `rqN - N S Id, e _l,..SrzL-- R- ' f o-v a 3 (_Gr"xo pisl.csr _4 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: HOMESITE SEPTIC PLUMBING CO. O'NE1111 RD, HUMN, WIS. 5011 ADDRESS: ROBERT ULBRICK CERTIFICATION NUMBER: JPUDNE NUMBER (optional): WIS. MASTER PLUMBER LIC. N0.3301 M.P.R.S. J'y~Z..►~ MINN. INSTALLER & DESIGNER LIG. NO, OU60 CST SIGNATURE- DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - I r 4, ( STRU 'T - -CAF OMPL,E T- FORM 115 - S BD - ' hn l test, your rep TESTERS - Pt ffi - P, HWL - T REPORT ON SOIL BUi INGS & P~ICOLATION TESTS 115 PLOT FLAN . Z 1 Pl''oj-ect.I.D.__-~~.N OJT ZIf &-xe-s 540'f' ~f HOMESITE SEPTIC PLUMBING M LEG 'ND 11.1 WNEIL RD., HUDWN, WIS. 5" ROBERT ULORICHT o = Ba c kh o e its WR MASTER PLUMBER UC. N0.3307 M011 MINN. IWAUEA & DESM,NER UC. w mu X = Perc Locations C.S.T. 2482 Q = ,xisting Well Vertical Reference Point : ~Op 4F /pvL S~ CSC l I'_evation of Vertical Reference Point F?- - .Lot Line SCA =30 . EIILOE ~/OM E csA G ~1 ~ ~ ~'~oPas'E•~ C ~ D ~ h~o~rE k/ P I '3. is * (D x ~ 5'v ,e veyoR s - - - I" pipf. S YS TE.A i S w r-OR.Jc R ~i------- P J ~y of Chuck ~ • - S~ ~ x 07 S~ ~ r Ea10c LOT. J ~ - ,PE'PIAGE,uE.JT y' - A'iPE4 --w~ y o1;z) y~ a I ~ AVO y3 i 7 . ~voiv ~~s I ~I i Rip . s 0 !33 o Gt! -140 C,-Art, OF jeD, )PW of Z Ac~rs W ki 06 60 S C A L E: I30 APPR6X , P~~Pos~ ti lfbtir ~~J(~d~ ~~Ai~NfiELD - vr~( tlN~'~d~p~y - ~ Fr. SiDEtuA//S GYo sa ff T io' D 2--------_~_ VA i 13 Y - - - - -i a y4~ ~/y X 2 l/ h i I~~p/~1CEHEvTIPEq- , y6 A 50 $3 ~ .tea s, F ~ yo fo o PEA so;~ rESr: 16 M w ;s ?op of y3 PrP~ Pv ° ElEv~rroU = /00,60 v Fresh Air Inlets And Observation Pipe e 0 L Approved Vent Cap Minimum 12 Above F i n a l Grade ,x4pe r~~iHUrt off, 1/2, "Above Pipe _ 4" Cast Iron Vent Pipe -To Final Grade Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee Pipe 1-00 0 0 0 7~sT l0 "Aggregate o Perforated Pipe Below / Beneath Pipe 0 Coupling Terminating At i t~ Bottom Of System