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HomeMy WebLinkAbout020-1079-90-050 ncn 0 ~mn C7 0 m F m 0 744- C') M U] In o v 0 o v c co~ C • O P) rt o 0 3 0 c ro a) N - N° (D b b r' o m a- 0 N 0`- 0 w t \ (D CD n cn CD rt K x o D ° C) 0 F~ (D a A~ O ~ t d u? N ID I- ON UQ cn O ° N cn %.D Q4 (D `D C N H Ql ~-tl y a ' ' O p = r1~yl l0 td F1l O ? O a 0 ~ c o { co D c. tr- a Z y cn cc O n ° c d n i-h v e~. (D O Fit cr 0 (D 5 r• ooo I N (D ~T * * *m c = ~y~ o c `i ;T (D " CD 0 Ul D o (D m. CD In N O CD v °a !d O N [rJ C CD ci 0 o n C-~ (D O tai z z m 0 Z, F-1- H fi !d O D :3 r t-i w %lo cn (D c•+. n (D `D r+ i••i rt c a N rt r.> rt H r• c a n O O F-i O (D = -i (n (D F11 o A Z I-' O 00 Q a z 0 I- F-h N Co (D •D m co m z 0 3 o U) 3 m N CD ? O ~ 0 0 N cn = a N _v D c (D N 0 O (n Q N F Q O n a N CD (D p °0 O C p o~ ( =3 T Z3 r_ °n a3 5' Q C c0 O N (D C7 z Q a fl m _ v-.Q o o m m~ Co o o ~a N Co s~-o ac_0 ~o mm F,' RV (D C O~ 7L 0 d M1 N. N O C 3 CC (D A (D (D S n - S (n (D t0 (D (0n E c 7 0 Q• (A 0 L~ CD mX N0 0 -J u) m w C~ II ~ v (OD QO N v N X- N O. O a) CD Q X CCDD 0-:3 co ~ a A (D b 6s O O ° a Parcel 020-1079-90-050 02/01/2006 04:40 PM PAGE 1 OF 1 Alt. Parcel 28.29.19.325A 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner NKA HUDSON RODEO CENTER HECHTER O - HECHTER, NKA HUDSON RODEO CENTER GATEWAY LTD & FROELICH M C -GATEWAY LTD & FROELICH M Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 23.540 Plat: 1614-CSM 16/4430 NKA HUDSON RODEO C SEC 28 T 29N R 19W SE SE CSM 16/4430 LOT Block/Condo Bldg: LOT 1 1 (23.540AC) RONN HECHTER 50% HECHTER GATEWAY LTD 25% & MICHAEL FROELICH 25% Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) NKA HUDSON RODEO CENTER ('03) 28-29N-19W SE SE Notes: Parcel History: Date Doc # Vol/Page Type 12/11/2003 744859 9/95 PLAT 01/15/2003 705928 2111/196 EZ 01/15/2003 705926 2111/188 WD 01/15/2003 705925 2111/186 Rp mor 2005 SUMMARY Bill M Fair Market Value: Assessed with: I ~ v 0 q~ Valuations: Last Changed: 02/16/200 Description Class Acres Land Improve Total State Read Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 0 0 0 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 cow s~;~ Loc~► Ts ~~'~t c~sT.~i . T. 3 /may. u 0 So N , w S s-yrol r9 c~,pioyE~s P1,s ~'/vaK !~~'i9iN . C6~►SS PE,Pc ~'ATE-~ Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT N . G. G . ~diPpOrP~-Tiav OWNER E/,U /tJ,¢s f 7<' TOWNSHIP ffVDS a..) SEC. T 2j' N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT SIZE PLAN VIEW HOMESITE SEPTIC PLUMBING CO. Distances and dimensions to meet requirements of ILHR 83 RT. 30'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRICHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM MINN. INSTALLER & DESIGNER LIC. NO. 00663 ll ' EN~ d• ~ ~O.O•~ c~p.g~ X p~ ~ ~we w TR r lE U S , \ ~S' + ~P of TRcNq~ g r qa.~ Wis. Esr/rTt- p I ; ncN s O I e' x l0 /6 y8 k- ,k E I I ' ~ , ~ yiQvC£ Avo.C'r;'f R i' I' A O tea. of ;°P~ Irv. = 9a.~~' TES y") -76P pr, ~leVA yo . ~9 / 32 INDICATE NORTH ARROW V 71z A. 7ip 6- a -fa BENCHMARK: Describe the vertical reference point used ~ Uv,V 9,4T,•6v - P:LA= Soi( 7-e- ST. Elevation of vertical reference point: /00.0 Proposed slope at site: ~o SEPTIC TANK: Manufacturer: lug &J-6-4 ezvc• Liquid Capacity: /dz'e Number of rings used: 9to'•-Q- Tank manhole cover elevation: P / Tank Inlet Elevation: F760 Tank Outlet Elevation: / 7- Number of feet from nearest Road: Front,O Side,O Rear, O Oat'E' 106 feet so d t+, /.1 Cv From nearest property line Front, OSide,©Rear, 0 feet /OU Pf• Number of feet from: well building: !Z fl- . (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacit Pump Model: Pump/Sip Ma acturer: Pump Size Elevation of inlet: Bottom o k elevation: Pump off switch el ion: Gallons per cyc Alarm Man cturer: Alarm Switch Type: Nu er 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). Ne 7-91AJCr4 SOIL ABSORPTION SYSTEM C'm c-6` 7F • Bed: Trench: _'f f Width: S Length: Number of Lines: Area Built: Fill depth to top of pipe: 'fa , Number of feet from nearest property line: Front, 0 Side, O Rear,0 Pt Number of feet from well: 3 OZJ + Number of feet from building: (Include distances on plot plan). SEEPAG Size: Num f pits: Diameter: Liquid depth: Bottom of seepa elevation: Are i t: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOI Manufacturer: Capacity: Number of rings used: Elevatio ott tank: Elevation of inlet: N er of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: 0 Dated: Plumber on job: HOMESITE SEPTIC PLUMBING CO. License Number : IL RD OSON N~ S 54016 ROBERT ULBRICHT WIS. MASTER PLUMBER LIC. NO, 3307 MR..R.S. R Q, DFQ1CNFQ ! it mo Cf 6 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 PlanLD Number ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound $~~494 NAME OF PERMIT HOLDER. N. G. L. Corp • ADDRESS OF PERMIT HOLDER: INSPECTION DATE. John M. Nasseff - offic r 50 W. Kellogg Blvd., St.Paul, MN /0 - (S BENCH MARK (Permanent r,,fe,e-point) DESCRIBE IF DIFFERENT FROM PLAN: Part of 119 REF. IT. ELEV.: CST REF. PT. ELEV. SE- 1, Sec.28 T29N-R19W Town of Hudson, Commercial Acre Nauru ,f Plumber. MP/MPRSW No County Sanitary Permit Number- Robert Ulbricht 3307 St. Croix 69691 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. DYES ONO OYES ONO BEDDING: VENT DIA.. VENT EHI(j~H ATE R' NUMBER OF ROAD: PR OP ER TV WELL. BUILDING: VENT TO FRESH . FEET FR OM uNE AIR INLETDYES ONO ES ONO NEAREST 10 _ DOSING CHAMBER: _ MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL. PUMPi SIPH ON MANUFACTURER . WARNING LABEL LOCKING COVER PROV ILED . PROVIDED: DYES ONO DYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL--- NUMBER OF PFi r)PERTY WELL IBUILDIN(3. I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES ONO _ NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1 v(1,~ 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 LENGT JN FL7 DISTR PIPE PACTNG COVFH INSIDE DIA. -PITS LIQUID BED/TRENCH S TRENCHES MATERIAL: PIT DEPTH. DIMENSIONS yy V 1) P7 GHn FI f P UI FII DEPTH DISTR PIP" UISTIT PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF 1PROPERTY =ELLBUILDINGVENT TO FRESH BFLIA✓ PIP, ABOVE COVER ELEVINLET ELEVEND LINEAIR INLET11 - FEET FROM 1 ! / NEAR_E_ST_ ► Z' 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- D YES NO meets the criteria for medium sand. TIONS MEASURED. O SOIL COVER. TEXTURE PERMANENT MARKERS. OBSEHVATION WELLS DYES ONO DYES ONO DEPTH OVER TRENCH BED DEPTH OVFR THENCITBED DEPTH OF TOPSOIL SODDED SEEDED. MULCHED CFNIER EDGES DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LE NCiTH NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. TRENCHES. DIMENSIONS MAN( FO[ D PUMP MANIFOLD DISTR PIPE JMANIFOLD MATERIAL jNo. DISTR JD~STRPIPE DISTRIBUTION PIPE MATERIAL & MARKING E1Ev ELEVDIAELEVPIPES DA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS EYES ONO _ DYES ONO UMBER OF PROPERTY WELL: IBUILDING. COMMENTS:' PERMANENT MARKERS: OBSERVATION WELLS: IJNEAR~ EET FROM LINE U DYES ONO DYES NO ES T----fir _ 1 < l Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. DILHR SBD 6710 (R. 01/82) HOMESITE SEWER & SEPTIC CO. Route 3, O'Neil Road • Hudson, Wisconsin 54016 • (715) 386-8185 $44 COMMUNITY TREATMENT SYSTEMS • ON SITE COMMERCIAL TREATMENT SYSTEMS ON SITE RESIDENTIAL SYSTEMS - SITE -,TESTING & EVALUATION - PLANNING & DESIGN - COMPLETE INSTALLATION COMPLETE MAINTENANCE SERVICE UI 4z L c; c ~z R S 'e'er----- :~.~2 I ~ ~ Y M Of I I 2q 1l JO f P C-- h Z, k 777 Certified. Minnesota P.C.A. ,4 7- 3 S~TE LaG~ i ioti Gv~'S <o,v S~Jv L ~c~9T~-~~S ~~r~L ~'ST~tT~ o~fr~~ S~ yY 5~ %y SzP 7--) 9~~'1~~. ST Grpix To ccw N U D S o 19,5-5c ei1P7-10A 1 ryE- c-,fisr~'v y sEP Tic s ysT~ J~-~ ~~s ~i~~•/Eo fob' ,4- o,~ s 7-o~'r ~v oop F~~1~1 E- o~~i~~ ~~og . A ssu y~~ 14 f~~/moo s ysT~ 115 Z ~o,u TJ9-i,US 3 -SJ''lr¢ DF~i~S ~}No y~f'~'~1~ S rol~'~y'~ ft~PE~S . a-- J ~ iE- 6X1'sTS , o"'e o//) os,E- Z . ESri~1,~T ~ A41- ".'Ts- LGr,IP is -2- 3 0 s . rMX iZ X 3.1 S C3J Cc> • pzgo pc-o ABSoR p11'6,, A-• 75~ SQ. -F+, f,p CTo~b~~r;ov/( T2lm-4e-2s C Two il'Ajcs1 ~'oR cL,gss soli T-cST', Co,vUE,vTiacJrT~ T,C'~,v SySTM ~S h~oPOSEp ° ~2- J30X p%57-RI,1607-1oA) Cow S f~fic Pf46 PL-AAJ U IEcvS . 6,, z C,Poss s~~, o~ s y T~~ H~~ T~f~ .3. C,P~sS Sc-c i ~o,v o~ S' y sT~~ ~~owt,e r,~~ti~~) RECEIVED 10 19$5 6 4 9 4 PLUMBING BUREAU HONEST IE SEPTIC PLUMBING CO. 78 5O RT. 3 ONEIL RD, HUDSON. WIS. 54016 HOME;ITE SEPTIC PLUMUIfJG C.:ROBERT ULBRICHT R1. 3 O'NEIL RD. HUDSON. w'IS. 5rtilt; tiY(5. MASHER PLUMBER LIC. NO. 3307 M.PR ROBERT UL t4~L5 MASTER PLUMBER LICTC. . NOT NO- 3307 M MINN. INSfALLFR & DESIGNER LTC. NO. 0llhb NIINN. IfJ31ALLFR & DESIGNER UC.,,q) oii66,; ,17 s. 44- LA L r~- hew y PA STS ~ o 3 p~ HIV/mow / 0-1Z 0 ,t. /)f~G,K AJJWT CovU6Ajr1ovA1 $ jZC of / lg/PC~ ~i~r T",t'E.UCIti S~/STfy ~ lie W E~ o f ~k~OME $ToA O ffi'eE LDG c~Gt.ps~ WnOQ S IDlNG ME£T5 Y wEi'h"~+ `;r t~ a 11- u,kt~ Co,Q C P-+-e- S IEV1tTtp,~ OO • O fir' #okZ spit TEST) : VAVOOS EDyES y00 ur , a F (3 LOq qtr SAD o F go r/)~ C f R~?i K y('1 OE/ .moo SeT L vs-t /3 EfP SE,piE S ~J J / o!= GvooD o ~P S TE E~ t- + / ~E v cE 19o s T-S 7-0 y~eA Ur',eT fPEf /3LOCR TE'ifFFiG ovew %~fN~ off? ° n D e 9 ~ nfk5~ -o` .~-4!5 5 a 1O STATE- f1/~/~ip0[lE-p /000 SE-PTic. ul o U a Gt> iEsE,e to ,~c,..i ~2 ~ MAlof v ~Po c,~-~ GviS . i v of SL '601 RQoS o - y o P,PoPasep y,PAO,E,~T- ~ qo y s«e. 30-?y SritTE f}~i°,f'dU~l~ - t30(?E Oeolo ao x CC OC,,elP- euI'S . / 20' ` /1o A 1► TPf vGG~ Q 02 TiPES/C~,Q f__~' - - - - - - - - - - - - - - - - - To T loxopc,ery GiuF ~a 'x 72 3. 3 Pit 5 }~.G, caDE C, ril~Cr=1V~t7 U S 'E 1985 a 3 - .1,1PLUMBING BUREAU N -o A 850 6494 A I f f, P4 qp 2 0 0 O ~ PLUT&BING U f JiLD1~+GS Q ~ RRES~Ot`taEN C E SEE CO Q ~ v - T s H`/ / ~~'oE x '7F Z o.0 G- Fresh Air Inlets And Observation Pipe V ~ h 0 Approved Vent Cap Minimum 12" Above Final Grade 1 y F r 4" Cast Iron 02~ Above Pipe - Vent Pipe To Final Grade Synthetic Covering PLUIwISiNG BUREAU Min. 2" Aggregate Over Pipe Distribution - Tee 8506494 Pip© 0 0 0 0 0 , Aggregate o Perforated Pipe Below SoiL T~sr Beneath Pipe o' Coupling Terminating At Bottom Of System 13o 77'o M s J d li PL.UMS114G 1 _ U ~ ~ 3 t ~ a~, Nt;~,AAN RQA~KS v tNG~ = Q N pEi " T 00 J r ! c o a v o ~r ~ ~ fl t Fresh Air Inlets And Observation Pipe v Q a h r= Approved Vent Cap Minimum 12" Above Final Grade 73. d 4" Cast Iron 1(o Above Pipe 4 Vent Pipe `To Final Grade PLUMBING BUREAU r„ Synthetic Covering Min. 2" Aggregate 8506494 Over Pipe Distribution _ Tee Pipe 0 0 0 0 0 ?ER YoiL TES/ (o Aggregate 7"/P,Uc~,~ /3oT°i`'t Beneath Pipe Perforated Pipe Below 0 -Coupling Terminating At ~0.0 Bottom 0 f System F0 /'2 w APPLICATION FOR SANITARY PERMIT D ' L H R COUNTY RRTMEnTOF (PLB 67) UNIFOR///M''' SANITARY PERMIT # InOUSTRV, LRBOR 5 HUMRn RELFITIOns J / ; ~/J -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 , Cr. C SON MAILING ADDRESS .v /4► - Nf s s~ Fr- - '©Ff, c eti- S v Gv • PROPERTY LOCATION SE 1/4 Sr 1/4, S Tl, N, R 19 E (or) W TOWN F 14 uDSo~,3 LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, STATE PLAN I.D. NUMBER Pl1xT Ov - /iy ~o,~ exc•~/ f4_0s #U 9 - ~'S o 1 TYPE OF BUILDING OR USE SERVED or z amI y um [ Public (Specify): - 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 X 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 Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity w Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: ESE/•Z (~'6- • / Eti OGK ❑ 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): REQUI/RED (Square Feet): PROPOSED (Square Feet): I- 7 ~d C.o Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): HOMESITE SEPTIC PL Sigat ree: /MPRSW No.: Phone Number: _P664 7 RT. 3 O'NEIL RD., tltl ` 3 3 O 1 215 Plumber's Address: UERT UIBRICHT Name of Designer: WIS. MASTER PtUMBER UC. NO. 3307 M.P.R.S. COUNTY/ DEPARTMENT USE ONLY Signatur of Issuing Agent: Fee: Date: Disapproved ❑ Owner Given Initial A Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-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. REPORT ON SOIL 13ORiNUS PERCOLATION TESTS IIS ~viScoco siv LocI42-f,PS PLOT- PLAN P 'o-'Eci 3 DA rE- .SHPT' HOMESITE TESTING CU. R T.3, O'NEIL ROAD BOB ULI;RICt, auuSON, WIS...._. 54016 C57- .6-6,41E Z / - YO PROPOSED HOUSE M05T LIE 2~_Fr. oR MCt'E "OM 41,4 rESr ,PEAS. PRO POSED WE u MUST LIE 5o FT O~Q MOJ?~ Fieom Ac/- rE'sr A.pZ45. • = awellOE p1r3 O = EXIST/,J 6- G(>EGL- X = ~E~G IOC~¢1/D~Uf ~ = y,4,~~ f}v9ERE0 o,Q S~DdEL /jp,~ES s. . rrp of 8X05 . r° f/otiz . B m VE~1r1eA1_ ,PCFE,eiVei_ Pour c0H i,e E- cco o o 0 c06ti ,~~S 6F 5 i of o DS , ,~f EE ri;uG- co.vc,e~z S 8 LEGEND ~1~v~1%ov o~ !/E,P1' ~PEF. ~T / o o . o Fr. c~ o v£R 2 00 ' jo Eoy~ of= /~~y /Z of ic~-s/widL. VERT ff. l°T' 3S r o.w ~,,/SETp of 50' 30 ~QE1+ a Y.a Glli¢~ ~b0~s at s 730° X9.0 0 9P.3 ~'o a -A Zoo 4 a 77.2 9s. .L F a. 0 fr Px XPZ ~ 9y.s ~ P3 ~ 0 93a r !3c o ya.a 0 9 5 ~ 9/. o If s - Gt,J56 r 7 DILHR Safety and Buildings Division" . N W„ PLAN APPROVAL Bureau of Plumbing P.O Box 7969 ❑ General Plumbing Plans Madison, WI 53707 ❑ Private Sewage Plans Telephone: (608)266-3815 01 O,e~p'~y~ l9~ I s~ Plan Identification No. Gallons Per Day b[r t t' I 3 ( j ,........."f--i....,_. _ ~ f...~.. r..\.i_ 1 . . a ~.w, ...m..¢ PRIORITY PLAN REVIEW ONLY _ Plan Review Fee Received i $ 333333!!!!!! Petition For Variance Fee Rec. $ Project Name Project Location - Street No. or Legal Description Count ❑ City ❑ Village ❑ Town of: The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. ❑ FOR PRIVATE SEWAGE PLANS: (1) (2) (3a) (3b) (4a) (4b) (6) (7) This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for plumbing and/or private sewage code requirements only. All other system reviews must be submitted to the Bureau of Buildings and Structures. Comments: By: to -L74 j James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact ♦ cc: ❑ Private Sewage Consultant ❑ Plumbing Consultant ❑ Environmental Health ❑ County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber Department of Agriculture DitHR-sBD-6099 (R. 01/85) ❑ Owner ❑ Other E77 ®ILHR PLAN APPROVAL Safety and Buildings Division Bureau of Plumbing P.O Box 7969 rI General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-3815 Plan Identification No. ~CMC - Gallons Per Day C`NelI d, 1r( i s C 1 r PRIORITY PLAN REVIEW ONLY Plan Review Fee Received $ 10 Petition For Variance Fee Rec. $ Project Name Project Location - Street No. or Legal Description kJ1 C- C~-fle 6, ,2- County ❑ City ❑ Village ~ Town of: 4 ~ J S t4 CC." C The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. FOR PRIVATE SEWAGE PLANS: (1))(2) (3a) (3b) (4a) (4b) (6) (7) This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for plumbing and/or private sewage code requirements only. All other system reviews must be submitted to the Bureau of Buildings and Structures. Comments: By: James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact G .I (f Private Sew' Consultant Plumbing Consultant ❑ Environmental Health County ❑ Local PI ❑ Facilities Need Analysis Section J UW-SSWMP ❑ Plumber Department of Agricullurr' DII HR ',k:)-609') o1 8-, 1 1 Owner 1-1 Other O r:. Ul S m S ~ m N m ~ ~ -I W S fn u) N 0 ~ mm ~ t0 cD0 i~ j OR ~ 'D- 03 z cn co 0 3 o m ~c0T•m ~aom-.off' m a ~~cn( mF CD w co g a 0 a p n o CD w Co 51 , m ~ i~ w~ w -%A'< n 9r m n ID 7 (D P C.) 3a o0 CD CD 00 w = 7 > O cc C 13: =3 Zfa c c O a 0 cr =3 ww~ CD c CD 1 w w_ v, O p 2. ' O cD-~a~ D tD w ' (D 'CO , n cn Q (ra ~o~ °DCD o °e C o f~D a O F ~ ww 0 5a cn I o ~'ai C CD CD n ('D Z am o 3 w m cD ~a D 1 aD, c m n waa 2w0 a o ?aco N v, w m 0 a c o CD ~m boo vmCA m wc=r 0a 9) (D 0 CD cr A) n oar - ~ CD -1 0 -.0 CD 0= CA "I a m a0 0 c c caw w G) 0 ' w w 0 0 o 0. C, Q Now aa?c' ENO 0 =r CD 3 d n m 0 c p vi n cD O ~ aoZ o~° c~cm S ' a c ~i =0wa I c~0) o CL 3 0 p o i o "o W" :3 w ° (D o m N `°a °CD ~z e = 0 5 HOMESITE SEPTIC PLUMBING CO. RT. 3 O'NEIL RD., HUDSON: WIS. 54016 ROBERT ULBRICHT WIS. MASTER PLUMBER LIC. NO. 3307 M.RR.S. MINN. INSTALLER & DESIGNER LIC. NO 00663 APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Al ' V /(/4 5 N. Location of Property Section , T N - R W- Township /7~ V ~f Q•✓ Mailing Address y Subdivision Name PWl- Lot Number ? Previous Owner of Property Ll c, Total Size of Parcel r~ Date Parcel was Created C Are all corners and lot lines identifiable? ~r Yes No Is this property being developed for resale (spec house) ? Yes A- No Volume and Page Number ~P as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTV OWNER CERTIFICATION I (We) eet.ti6y that aU 6.tatement6 on th i,a ~onm ate true to the but o6 my ( owl ) know. edge; that I (we) am (ace) the owneh (6) o6 the ptopen ty dea cAi.bed in .th iA in6otmati.on 6otm, by vi4tue o6 a wavcanty deed teeotded in the 066ice o6 the County Reg-iA tet o g Deeda as Document No. ; and that I (we) p4e6 en.tey own the pnopo6 ed 6-c to Got the A ewage diApoA 6 y6.tem (ot I (we) have obtained an ea6ement, to tun with the above deAcAibed ptopetty, Got the conztth.uction o6 6aid 6y6.tem, and the Game has been duty teeotded in the 066.tee o6 the County Reg,i.6.tet o6 Deed6, a6 Document No. ) . I~GNATURE OF 0SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADIS ON WI 53707 HUMAN RELATIONS _ (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ AEI ~LK. NO.: SUBDIVISION NAME: SE '/a /T1-7 N/R I9 E (o W N Dso COUNTY: MAILINGADDRESS: j• wl'. IZ S T hz Z o C47-E.? s ,PE'7fL r y. M y D,S•o J, ~v I S USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL rDESCRIPTION: PROFILE DESCRIPT/IONS: 1PERCOL TION TESTS: ❑ Residence Sn f// o f f r'C CS New =~e I Pi Q a E''Yp zoyEE5 fl-04 ► ootZ jehrQ) 76 a SQ. ~Ft • -fo le T IP E U CA-C S RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) Qs ❑u E S au , ES ❑u S au [:1 S 2U T, Cvee .Us T 04 ~4X/ Fl. 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: Ck't-s -S --L Floodplain, indicate Floodplain elevation: > PROFILE DESCRIPTIONS IN 'De L_ Fr o BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH 76 NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1 611 - a B- r B- X0.0 / 5.7(~- S8' 1-tv aE--xy C5 GR. ~2._/a A4 e U / / • S f~- / , r B- , SV PFi4CE/EUifTo of P"-f S PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN AFTER SWELLING INTERVAL-MIN. PERIOD 1 __-_.PERIOD 2 PERIOD 3 PER INCH P- 2, 7 PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the horn zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all horings and the direction and percent of land slope. `j//. qA 4 T'ge'V a,- SYSTEM ELEVATION 1 o wTk sw a,,_ = 90 ~ FT r I I ~ i ; f f I I . r i l TN I _ ( r ,i i , i 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 COMPLETED ON FiOMESIfE SEPTIC PLUMBING Co. i~ RT. 3 O'NEIL RD., HUDSON, WIS. 54016 ~Q ADDRESS CERTIFICATION NUMBER: PHONE NUM ER(o tional): WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. 3& - ~ t~ ~i k`Iff~ & DESIGNER t PG. 943 ~ IS CS IGNATURE DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) OVER H H HOMESITE SEPTIC PLUMBING CO. RT. 3 O'NEIL RD., HUDSON, WIS. 54016 S T C - 105 r ROBERT ULBRICHT 9 WIS. MASTER PLUMBER LIC. NO 3307 M.P.R.& MINN. INSTALLfR&DESIGNERLIC N0.0066$EPTIC TANK MAINTENANCE AGREEMENT 0 L. St. Croix County /SlOati~ z G O W N E R/ B~'E R S AZ: U ~,1 ` T{.P S 14 i ROUTE/BOX NUMBER 'L~ h Fire Number Z n CITY/STATE ZIP PROPERTY LOCATION:Z__ 14,-52 ~4, Section 2d T Town of C>IDS'o'y St. Croix County, Subdivision AfA7- 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 stems 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. yA 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- ~d 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. SIGNE D A T E J 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.