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HomeMy WebLinkAbout040-1017-80-000 n cn p 3 -0 n = w o ID -0 ! CD m m 3 (n -4 2 to Z O 0) W A 0 C) A H• 0 w O w O O o N O w : CD CD 01 A O O O Co O 0 O (D v ~ O N N N N N n O w W w 7 O CO 0 0 0 0 00 0 :3 N CD U ° D° y O -.4 V C.Ji CJi O N O O 7 W O O d O w m w Cn ~ D G = (D 0 N O cn W cfl O -u 7 W Lrl N N N N~ O O O O 00 CD', O W O 404 A A N co C (p (o =r o r- cn l C" CC) (n 0 bi coi is _ a c 3 CL C rf FT C/) (n (n cn s c v v C) a v o m N cD W rn 90 O CD U a- 0 7 3 fl W N z O A ° D D o o W.O O N w w w S Q N• l N O O O 7 A O) = 3 - N O - W CD c 3 o o o- m cn 1 (n w c A Z n d W w ~a 3 N A ~ O O (n O CD Z -I A n co -0 C M, Z n ? x w O ' (n CO W 3 m w to ~ _ ~ A A p~ 0 (D ^ 7 O C D 3 N 0- Q o_(31aX O T ~co rp m C w m N Z W - _ o 0 CL o ° o CD c o ~a~°o D o -A o (D s (n w Iwo- CL (WD sz m -w ~o a c Q co m IF Q W N X Co a - W § c - c x CD D ~ O N (7 N 53 C O F O 3 > C A (D O_ O n A O A O b (D q W EA O r O O CD y~1 C:) CD Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP 7;001V SEC. T Z N-R W 2 ADDRESS 3S ST. CROIX COUNTY, WISCONSIN ,E'61' 7- SUBDIVISION LOT LOT SIZE W/(~s • U PLAN VIEW 560 Distances and dimensions to meet requirements of H 63 "UMESITE SEPTIC PLUMBING CO. SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM RI. 3 O'NEIL RD.; HUDSON: WIS. 54016 ROBERT ULBRICHT V S. MASTER PLUMBER LIC. N0.3307 M.P.R.& 'INN A8 No• Zo7- L iNsPEer'oA.) y ~ s r~Ei ~r~Q~/5 3 8 ~ ~ os~ c~- STO' eg Re(- (9s ~fir. /o , ~ n o 'vEw 7S'o 55 3 sr tio~ /POti p [,t~ i~sE~ Gs e 30 w/ /o c,~~;u4 -7 5' o coin lwl eloP Co.cx'va (e G-- Ca-. F'FiSTi~v tc~ l/ 1F 0-0-. t SCp T/c ~l e-A-X PUS INDIC TE NORTH ARROW /A) ,¢.J'r - illy tJ 4 s rE~/ ,6 sE-T N~Xr To /~,sT' BENCHMARK: Describe the vertical reference point used 1006,0 Fe c,- 100S7- Elevation of vertical reference point: Proposed slope at site: ✓r -/6 90 FX,fr~~ ~ loan ~ . SEPTIC TANK: Manufacturer: Liquid Capacity: 7s 0 04-P, o'L oz.'o /077 Number of r:.ngs used: w Tank manhole cover elevation: New = /U<c•2 fT 0 4,9 g OGD a O(o' Tank Inlet I levation: 103.7 ' Tank Outlet Elevation: Nfw /03.3 New Number of ff et from nearest Road: Front,@ Side,0 Rear, O 1 / 00 feet N0 • From nearest property line Front, 0Side, ©Rear, O > a 00 feet of NumbE r of feet front: well X building: > /00 F7 //°Uj~ (Include this information of the above plot plan)( 2 reference dimensions to septic SEE REVERSE SIDE r PUMP CHAMBER • Manufacturer:` ~j L Liquid Capacity: Pump Model: J ~f' //off Pump/Siphon Manufacturer: "Pump Size r~ Elevation of in1eBottom of tank elevation: Pump ff switch elevation Gallons per cycle: .2-1 Alarm ufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: 06;c-'e 160 FT C" ' 70-5- Number of feet from building: (Include distances on plot plan). SOIL ABSORBTION SYSTEM ,(o U,, Bed: Trench: ST~FT~ Width: 3 Length: 711- Number of Lines: Area Built: Fill depth to top of pipe. Number of feet from nearest property line: Front, O Side, Q Rear, O Ft Number of feet from well: Ui~~ a O b F Number of feet from building: 7o F r- (Include distances on plot plan). SEEPAGE PIT e; Number of pits: er: Liquid depth: Botto seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on 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: HOMESITE SEPTIC PLUMBING CO. Inspector: RT. 3 O'NEIL RD., HUDSON: WIS. 54016 SL / Z /l ' j WIS. MASTER NSTAI I FR F. DES NF NO. X307 M.0663 Dated: ~ Plumber on ob: MINN I NO 00663 License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & F(UMAN RELATIONS SAFETY & BUILDINGS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING ❑ CONVENTIONAL ❑ ALTERNATIVE state Plan I D Number. Of ass;gned) ❑ Holding Tank ❑ In-Ground Pressure ~p~,OUnd 8505213 '~"1'FVI NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPEC ION DATE: G „j Q Clay Barrette R. R. 3, Hwy 35, Hudson, WI 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.. CST REF. PT. ELEV SW SE, Section 4, T28N-R19W, Town of Troy Noma of Plumber. MP/MPRSW N... County Sanitary Permit Number. Robert Ulbricht 3307 St. Croix 69657 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY: TANK INLET ELEV.. TAN %Ot'U T6,LJF~T EL/E V.. WARMING LABEL LOCKING COVER VI DIED r" d'W'7 J~ J y rr~~ PROVIDED : BDDINGVENT DIA VENHIGH WATER EIIATL DYES NO ❑ Y S E ❑NO ALARM NUMBER OF ROAD: PROPERTY WELL. BUILDING: VENIT TO FRESH FEET FROM LINE LAIR NLEr ❑YES NO 17 YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPAC ITY PUMP MODEL PUMP/SIPHON4MANUFACTURER. / WARNING LABEL LOCKING COVER ~V ❑YES ~Z , PROVIDED: PROVIDED. LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERAnoNAL ❑YES ❑NO ❑YES ❑NO (DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BuILOwG VENT -TO FRESH PUMP ON AND OFF) FEET FROM LINE AI wLET ❑ YES ❑ NO NEAREST ~.5~. s SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LFNGTF{ 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 P~ 4 CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO. OF DISTR. PIPE SPACING COVER DIMENSIONS TRENCHES MATERIAL: PIT NSIDE DIA :PITS DEWY GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO DISTR. NUMBER OF BELOW PIPES ABOVE COVER ELEV. INLET ELEV. END. PROPERTY WELL. BUILDING. VENT TO FRESH PIPES FEET FROM ~ LINE. AIR INLET. NEAREST-s 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- C meets the criteria for medium sand. TIONS MEASURED. ~'ES ❑NO SOIL COVER rexruRE PERMANENT MARKERS OBSERVATION WELLS DEPTH OVER TRENCH BED DEPTH OVER TRENCH/BED ❑YES ❑NO ❑YES ❑NQ CENTER EDGES DEPTH OF TOPSOIL ISODDED SEEDED MULCHED ❑YES ENO ❑YES ❑NO YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH 3 R TRENCHES DIMENSIONS - 3~ G f" MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR . DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEVATION AND ELEV ELEV DIA Z ELEV PIPES DIA DISTRIBUTION ~ ~ ~ ~ q INFORMATION HOLE slzE HOLE sPAaNG DRILLED co RRECTLv COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS YES ❑NO ° YES ❑NO COMMENTS; PERMANENT MARKERS: OBSERVATION WELLS: NUMBER LJJ OF PRjPERTY WELL BUILDING FEET F YES ❑NO YES ❑NO N EARESTOM Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: yr• ~~^.r TITLE DILHR SBD 6710 (R. 01/82) > " ' Wisconsin APPLICATION FOR SANITARY PERMIT COUNTY ,(IDILHF~ s~ (PLB 67) OEaRRTmEnr OF UNIFORM SANITARY PERMIT # InOUSTRV, LRUOR 6 HUR1F1-1 RELRTIOnS -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNE MA LING ADDRESS CG/f iE'iP~ T7- ~T 3 rj~w 3 5 D1 o,J 4J s . S ya PROPERTY LOCATION Ctffo~'- q ~ E: .q sr SW 1/4 SE1 /4, S , T , N, R / E (or)~ TOWN OF: Tits / ~9iPT' LOT NUMBER BLOCK NUnE BDIV ISION NAME NEAREST ROAD, L AKE STATE PLAN I.D. NUMBER 3s ~S-oS2/3 TYPE OF BUILDING OR USE SERVED X 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair Replacement ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Bed ❑ Seepage Trench El Seepage Pit El Holding Tank -Se pa4e System In - Fill ❑ In-Ground Pressure ❑ Vau vy ❑ Pit Privy ❑ Existing, For Which A Previous Perml File, Permit # issued An Existing System That Has Been Inspected An liant As Far As Soil Conditions. Total #of fab. Site Gallons Tanks Concret onstructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Sipho amber Holding Tan pacity acturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BjTa : Mound ❑ In-Ground Pressure Total f Prefab. Site y Gallons ks Concr ete Constructed Steel Fiberglass Plastic Septic Tank Capacity a X Loft Pm pr Siphon Chamber 7S j) X Manufacturer: W1ES•4,P C'OA0cn,eX{e 141/*/I)e-c7 © Cee- 4:) S PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Private ❑ Joint ❑ Public I, the undersigned, hereby assENE e responsibili I eUrstallation of the private sewage system shown on the attached plans. Name of Plumber (Print): Onf~s/MPRSW No. Phone Number: RT. 3 IL RD.: HUDSON L ROBERT ULBRIC T 13,? o 7 ( 71. ) 3A. ~(f1~ Plumber's Address: wl$ MA$STA PLUM Name of Designer: i A MINN. INSTALLER & DESIGNER UC. NO, 00663 ~ COUNTY/ DEPARTMENT USE ONLY Signatur of Issuing Agent: Fee: Date: ❑ Disapproved 00 ? ❑ Owner Given Initial tr - Approved Adverse Determination eason for Disapproval: r 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 percolatton ~is•~i on the "115 soil ;est_ 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. H z ST C- 105 r a SEPTIC TANK MAINTENANCE AGREEMENT H 0 St. Croix County z tz) OWNER /-B'17rER ROUTE/BOX NUMBER_ /e/' 3 357 Fire Number CITY/STATE h4vP roA-) Lc'/ ZIP ,J- Vo PROPERTY LOCATION: 50 14,se Section 7 TJvp 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- I sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into i 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. 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 P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of t property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractgr "spec house"), then a second form should be retained and completed when the pro ert,( i sold and submitted to this office with the a p y s ppropriate-deed recording. Owner of Property Location of Property S~ 14 (5 ~ lt. Section T Zd N _ R ~/q W Township s7- 7- Mailing Address /C j . J y6~ Subdivision Name Lot Number Previous Owner of Property ? 1~cQc S Total Size of Parcel T Date Parcel was Created Are all corners and lot lines identifiable? Yea No Is this property being developed for resale -7Q (spec house) ? Yes /~L Volume C~ G" L No and Page Number 61✓ 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 of the reviewing process. If the deed descriptionreferencesutosa Certified avoidSurve Imp, the the Certified Survey Map shall also be required. y PROPERTY OWNER CERTIFICATION 1 (We) eenti,b y that a,Qt e.ta-temen,te on know~.edge; that I (we) am (ane) the ownen(e~oo ~e ' `oe to the best o~ my (owc) in6o4matl on bourn, by viA tue o6 a wak.anty deed bneeo4dedp~~the 066iced ~ n he a County Reg.c.e.tea ob Deeds ad Document No. 3 7 6~ e the pn ee entt y own the pn.o poe ed e.-te bo& the a ewa e 3 Z Z and that I Iw ) obtained an saeement, to hun with the above dedc4-ibed noyezem (on I (we) have 04 cone.ta.uction ob eaid eye.tem, and the same had been duty neeo4dedbin the 066.iee o6 the County Regicd.ten ob Deeds, ad Document No. 1. .00 SIGNAT RE OF OWNER SIGNATURE OF CO- R APPLICABLE) DATE SIGNED DATE SIG /V. oe /V-f. ckll y L1 ®fLHR PLAN APPROVAL Safety and Buildings Division Bureau of Plumbing P.O Box 7969 ❑ General Plumbing Plans Madison, Wl 53707 ❑ Private Sewage Plans Telephone: (608)266-3815 Plan Identification No. Gallons Per Day PRIORITY PLAN REVIEW ONLY Plan Review Fee Received Petition for Variance Fee Rec. Project Name Project Location - Street No. or Legal Description Count 11 City El Village ❑ Town of: The plumbing plans and specifications for this project have been reviewed for compliance with app le code requirtmuent : is 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. 1-1 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: Bv: James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact cc: 1_1 Private Sewage Consultant ❑ Plumbing Consultant ❑ Environmental Health !L- I County ❑ Local PI Cl Facilities Need Analysis Section 1_I UW-SSWMP ❑ Plumber ❑ Department of Agriculture DH HK-WD-6099 (R. 0-1,185) n Owner ❑ Other v w m oNO _ ~ m j w ~c c 3 N w (D CD X, n n fD 7 7 a3 ~(a ~•~p1 ~ =T ol C3 0 z - ? m° o ° g ; o m~ M CD aNA ~N~ 0 SD -0 CD CD =M C, 0 3 CCD 0 n ° ~ w ° o O CD coO r... ° ° w c 0) 0 0 c: 3° o c 3 0 =a o 3 Z1 c C Q ° ° . w C ~ U) -w S*M j O CD ~0 a~ CD W O W CD Q7 t V n < rw O r. C G 5CDD L I °'o °D Ono C) cn f$S 2 w°o..aQ°w N C fki* 0Nm °m.0~w~ Z D 10 Cl) m g m ai -1 (A n co O Z =r SI) U) m ~CCD m CD CD CD CA D CD m o? Rt c a o w °a Er ? a E N a CD N 0 ~ > a > cog w U) aw o va, c N w w C O (D O O (D r CD (°A Q. CD N l / 1 CD w 3 Qw _ a9 -,n- c D 6.0 u, ° CCD N m 1 cm "m c~32 CO O CD 3 0, v1 CL ccncccaa2i0 m (D - O CD N O w w ' aaaCL Q~ ~Cl' 5.~, ?CD 3 H n r m o cD u► 0 ~c o 7 ovi~ncD° a o m Ono ~m--1 mcm ° Ba 0 o =r c a c O r- CD = O O M aR ~n3' 3 CD °O CL 3 a o < _1= 0 0 PROJECT INDEX SHEET otivNER: ,L3~j/c'h'ET7- iPr3 f~wy 35 • ~ uDlo,~ wiS. S %oi~ 2~/V SITE: 7 5 ~.lS. S s~ ~/Y s>e f. y 7- Tipoy 70r~l vS~i/d S~• ~;X . PROJECT DESCRIPTION: ~ ~e~P,~•y . /~o-~rE' . .,~tcE.~ ray r-~ . . ~ (~s . 7-lk- l Sys'r'e* ✓ 404 s 'Oes-~~ 3 kM s . ~/1iL~iVy <Sv.p fi4c.~. DiS ) Soil /3~iPi'.U(rS ~NO~'cq-T~ 19 0E Ixf Jv w-,fG/ SsITvel7-&o ` Jrtt L Y w~4 S T~/o~90s = 600 S%OX dAv 1l p U.vI) 115 o X . PAGE 1 . PLOT PLAN VIEWS PAGE; 2. MOUND CROSS SECTION & SYSTEM PLAN VTEW-)' PAGE 3. PIPE, LATERAL LAYOUT --PAGE -B8SI G H- SIPHON CHAMBER CROSS SECTIONS PAGE 5 .--FijMP PRRFnRr r N44 ~n oR SIPHON SPR' C S PLUMBER: SITE EVATUATER or DESIGNER HOMESITE SEPTIC PLUMBING CO. HOMESITE SEPTIC PLUMBING CO. RT. 3 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRICHI RT. 3 O'NEIL RD.; HUDSON: WIS. 54016 WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. ROBERT ULBRICHT MINN. INSTALLER & DESIGNER LIC. N0.00663 MINN. WIS. INSTALLER & UESIGNER L IC, NO. U0663 DATE : SIGNITURE 3 3 a 7 RECEIVED 71 AUG 19 1985 PLUMBING BUREAU p~ o 7.5 Anets CG,4/ A1/& 77- { a /14 _?ARTMEN " e REF .,o T To v _ _ R P ~b A~' .BEST 5eT pST ~N 190.0 • - S147 SL 3 r s/ ~ 5 6i ' /07~ of y fGyPCE' /y/1%N RECEIVED SCA. 303 r " (k low f, X012 AU G 19 1985 9~eAn~ PUM ING BUREAU Cs` cs. ' FA UM OeQ tl*Ze-D - 1 y rl Ak'E~ . ~xr'STi%v~j /po0 (~Q, r 00 ' ~ r• c sca~k ~cri~ul.,w. r C oN~.a.~.7~.C / pRo pos~v cv:c • NE w ISO ADDi TIOW.4~ COAX S rif 7E q p~o~0 UE"~ am 0 gaga Si pho,,, Sltp4'*c ISO ~uP•) p spa►~ S . 5TA`tF- APPOvED w )ESCR ~o u G cf . Try K. . Page Z Of S Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand Topsoil - 3 E p 6 % Slope -XV Bed Of 2 Plowed Aggregate - Layer D Ft. Cross Section Of A Mound System Using E Ft. A Bed For The Absorption Area F • 7.5 Ft. • G /,S Ft. A /0 Ft. H 1-5 Ft. Signed: VB F t . License Number : Ft. Date: Ft. Ft. Alternate Position Ft. of Force Main Ft. d Observation Pipe---., B K A I----------------------- -----------------I W I•----- Distribution Bed Of z Pipe Aggregate I " Observation Pipe Permanent Markers 44415 ~ Plan View Of Mound Using A Bed For The Absorption Area G~rWcr E RECEIVED AIJG 19 1985 PLUMBING BUREAU Page -Of 3 jE sE s~ Perforated Pipe Detail u 39 0 End View Perforated End Cop) bye a. PVC Pipe i Jo~\o `o~oe ~a Holes Located On Bottom, S Are Equally Spaced e S ~ Ev MAtN SO ~bOC ow W~l~ a4w ,,vE p PVC VAGN(r Manifold Pipe fR~~ FR~~2f Distribution Pipe Force Main Lost Hole Should Be y" se-,,Q• 3033 0,-e 303 Next To End Cap End Cap Distribution Pipe Layout P -2 Ft. R s 3 ' X 30 Inches Y 3 9 Inches Signed: Hole Diameter r~ Inch Lateral / Inch(es) License Number: Manifold Inches Date: Force Main Inches # of hol es/pi Pe /U ~ST%''r,tTED Df/cy 4tJ.q~E/otD ~o~Q G~~~pys Invert Elevation of Laterals -S~Ft. ;S (pao Sap, IAC~ &o. of sc A c dabk j?asEs vli4 u y/` s 3 Av ors 5A & .2 zs ~ps. `.Di ST R1 B 0100 ? * 12 s d-,c, R Ti At eS (e L 4T-cAa s _ "I w n 1~ ~vUrvc RECEIVED ~D AUG 9 1985 ` PLUMBING BUREAI. . SIPHON TANK S7ATE ~,~P,PDU~D 'S~ ~ p - Mqv ~fAc TvpE,(' : ~u iESE.~ (J~ ` ro/V61Pf,k- eO'-. SLiD~NI~ AGII.HiNf/~l 7,4 7~5 1~416 61!~, 1 /CUD to ,Pr y iSTE,P / ~ ~V oT.~ Sid 7~ 1 4" Cast Iron Hub 10 i 24" dia v~NT / NOTES: - I. All reinforcement Grade M J 'Al vM 40 steel and 6x6 - 10 yi - u welded wire mesh lu Yi r ' k~/ V~ 2. Concrete compressive G/?ADE strength 4000 psi minimum L~ F r. LC /h: /0 3. Inlet: 4" Cast Iron iiub Discharge: 4" Cast Iron !{u 4' 4. Siphon: NLI[er 3" 4" C.I. Vent. Automatic Siphon i water line 5. Stor_a 21.47 dal/in Fio'r 13' Discharge: 279 Lwater line charge / 4ri0w 42-(3.5 ' G z~° 4° c.s /i/T /N!/EiQ r j3 SG ~ - ~S 3o j~ 84` DIN. - Obl-w 4uwo RW Nr G MAN►F N ltP'Sol Si(~ffov T~Nks ~.s•' PV v vT~er i, r RECEIVED 3~ Yi1 L: I«, f AUG 19 1985 r,.--~ PLUMBING BUREAU 3", 41#, 5", 6", 8" Standard Design Single Sewage Siphons • o" v NIGH WATER LINE a , V , 4" LOW WATER LINE Y P; 4 "J A- o a ~v ( - L. Reducer, discharge pipe, and t ~rrr c o o back vent and overflow, are not furnished or sold by Rex - ~I o o PFT Division. Vitrified tile { p ? pipe and fittings are generally ! o v- c used for this purpose. n_ _v 1 p- Approximate Dimensions in Inches and Average Weights in Pounds Diameter of Siphon , , , , , , , , • • • A 3 4 5 6 8 Drawing Depth D 13 .17 Diameter of Discharge Head , . , , , . , , , • • C 23 30 35 4 4 6 8 8 Diameter of Bell . . B 10 12 15 19 21 Invert Below Floor E 4% 5'/2 7,/z 10 9 Depth of Trap F 13 14%4 Width of Trap 23 30'/4 40 G 8-3/8 11 14 16 25-5/8 Height Above Floor H 7'/4 11-3/4 9'/2 11 16 Invert to Discharge=D+E+K , , , • J 20 251/2 33% 44 47 1 Bottom of Bell to Floor K 3 3 3 4 3 Center of Trap to End of Discharge Ell L 12'/2 14% 17 19 25 Diameter of Carrier S 4 4-6 6-8 8-10 8-12 Average Discharge Rate G.P,M , • • • , 72 165 328 474 950 Maximum Discharge Rate G.P.M......... 96 227 422 604 1400 Minimum Discharge Rate G.P.M...."*.. • 48 102 234 340 500 Shipping Weight in Pounds • . • 60 150 210 300 800 Detail Drawing 1F • • • 373 374.2 375 376 378.2A Note:-Two single Siphons of this type set side by side in the same tank will alternate,,See page 4 for discription of operation. The draft "D" will be 1 " to 2" less in this case. Siphons listed here are carried in stock'and can be shipped promptly on receipt of order and payment. I The dra4OW depth "D" may be reduced in certain cases by special air piping. Contact the manufactUldr for these special applications. _ ~ `~:~>*1vED _ 9 1985 PLUMBING BUREAU f {A.w ST. CROIX COUNTY sh WISCONSIN f7 k; zf` ZONING OFFICE 796-2239 (HAMMOND) -fir Y ~^M 425-8363 (RIVER FALLS) • HAMMOND, WI 54015 August 13, 1985 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An onsite investigation for the Clay Barrett property located in the SW4 of the SE-4 of Section 4, T28N-R19W, Town of Troy, St. Croix County, revealed suitable soils at a depth of 2.1 feet, be- low which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, nc/ _ _ l ~-1 'ol'/~.~ 1~ . Thomas C. Nelson Assistant Zoning Administrator mj STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Townshi0 "MX* XW SW SE S 4 T 28 N/R 19 XUUW Troy St. Croix Street Address: Subdivision: County Landowners Name: Mailing Address: 'Clay Barrett R. R. 3, Hwy 35, Hudson, WI 54016 I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DILHR-SBD-6413 (N. 05/81) My Commission Expires: WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status fojr an Alternative Private Sewage System In the County of t. Croix Location sw 1/4, SE 1/4, Sec. 4 T 28 N, R 19 p4m) W Town MAhXftJV_JT3}CktK Troy Street Address Lot No. Block Subdivision Landowner's Name: Clay Barrett The application for this site is for: ❑ new construction use. [Xkreplacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota num ers i ssueU - toyou.) ]one of the applications needing a quota number. The quota number assigned to this application is D for one additional homesite on a farm to he occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. [...]for an application on file prior to February 1, 1980. L.lfor a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: a failing conventional soil absorption system. L] a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here.[:] I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Si9off County Official Title Assistant Zoning Administrator _ Date August 13, 1985 DILHR-SBD-6158 (R 12/82) IND ' ARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ~h6TRY, DIVISION LABOR AND PERCOLATION TESTS P.O. BOX 7969 HUMAN RELATIONS (115) MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP 1 LOT NO.:BLK. NO.: SUBDIVISION NAME: sub 1/ '/a /T N/R E (o W -000 JV I• s7- 4109r - COUNTY: O NER'S/Rki-F!M S NAME: MAILING ADDRESS: ~i~• ~o/ X V. hR s . CAA ,QMr r- R77,3 , 11w/. 3S , 110 DSoA-) w/s • S~41(~, USE DATES OBSERVATIONS MADE ::rNO.BEDRMS,: [CC7MM;MMRCIAL DESCRIPTION: 7A%) OFILE Reside DESCRIPTIONS: PERCOLATION TESTS: nce Q ❑New ,Replace I ' 99S ^ rlu f ] y RATING: S= Site suitable for system U= Site unsuitable for system CONVENa., MOUND: IINF ILLHOLDING TANRECOMMENDED SYSTEM:(optional) s os ❑u ❑au ❑s aU MouA)D sysTEh OP-11 -Y I 1- C oo f'o cL,gss _Zr o~► 7- sroeE /~o.Q ANS. 0I i9*e,+ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS Iws ')ECi.,I Fr. ;A BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION 1 OBSERVED EST. HIGHEST TO E3EDROCK IF OBSERVED (SEE ABBRV. ON BACK.) , ZhF' 3 (1 V3 1.0 B- ~.Q /OZ .O -t%- > (f.0' /•la' , 3-33 • 'DENSE 1704 Sil MASC;VE' Na r7ftfTUAW , c B_ Z . o y3. N g3'2j~- (3v .'GRAy Sid TS , A P RA3- SW 6 74V y r/1 3. 60 (V 13AAW-Age toe r B s/ (wE'T it Ole ,Gy. h01S A7^• • 25y ~,l +r,~• g •Q 73. A) [~(Dr A33 A 134.-G,E.tr 1.4+ Si/ 2.33 747) 54-vD 1.83 0A1JDEr-> 7A*tjt <o B s► cards, -F o v_ { oR'!sY mats mr YG' . p A ~ ; • -c1 I PL a y. B G. o ?2.361 3•9' IJAI , fi 9 , y ~ p' OR. S/ i.o/dH.. C MMp,J L9. ~~sTi'~ucT PA - nR 1+cf 14 a. we'r r ~ SvRFACE elkw#ONS Of PEre' s PERCOLATION TESTS 340 TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES V1 NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- z y3- 30 S - S S WN P_ P Z „s p i P- 0 P- PLOT PLAN: Show locations of percolation t ts, 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 borriiinngs and the direction and percent of land slope. Sri) I30 nom C A0C- 1j`.4UQ 1,S -44^,-rAC&✓ ) 9T S-U P) SYSTEM ELEVATION LATE~Pi4L &I E,p7-s _ 95• D F+ r I I I t i V I 'This icas PP VED E for a cflnventionai s ® 3 ; ptlC system. Sec explanation. 3 f i R 24W,%.Soil S lj/pE ~EifSvAJr1/~,j~ I , 90 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. J~ , • 8 I S ADDRESS: ROBERT ULBRICHT CERTIFICATION NUMBER: PHONE NUMBER (optional): WIS. MASTER PLUMBER LIC. NO. 3307 MP.R, . 5S" O 2 110Z MINN. CPS INSTALLER & DESIGNER LIC. NO. 00663 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER v "J t, w0- MH . A" a st'aJi ~i3P:..+c~ E 34r. t€("C}}.~>€1 f-; € [ s ~.~!I 1-. ~a THER YS T F-, 1lSA;,i ,tL"LEA T: €.k -N SOIL ;ONIMTa 01 k se-,- ~r-., >t,£1a!,.,,. 5hov ,sR € ovrk € ,1do descE ,IR_.{ vo°.; i" { .4$ 3v i~FFIS. u _ .•t - , a~,e,{i, 3,€ { -s v i > v a°;,C{ PW nc [".C"{; . .>{v=a.arly "~°oo C;, an ell ;r",€; ."1aiI, a f 3t' j at3ts _ d ~,c na.€=od> 4 E, 1 o `a a ,a"k'! of aile; tj, i. .3ts~ box • C isddres., "al"l {/a a.k Sand 16- Vv, ~ii~ ih 0 >t Vb I~ 3~ ei; _ f rC ^r ~ , € ,r 4s. ':,s? ;a P~:f`~a {C3 Er}i Jt1~{'a ioc"."(i aulholgq }gb C? t';P REPORT ON SOIL E30RINGS t PERCOLATION TESTS 115- PLOT' PLAM PROTECT I'. D. 04111 19,4tf~ec rr DATE HOMESITE TESTING CC). R's • 3, O'NEIL ROAD BOB Uf1;1,'~L'., liuus Nr WIS. 54016 X 57.- SS GZ yr2 yo PROPOSED HOUSE MUSS' L!E Z~ Fr• a~ Mc~,PE F~POM .qLL TEST PRo POSE O WE'LL M vsr LIE 50 Fr o~ t~o1QE' Fxo"., ,9LL TEST E • = 13,q ffoE Pi7"S rXiS rl V 6- CvEGL- X PEG /DCgT/D~Uf = y,4,VP i}v9EooPED ok S~odEL 13owE5 • ` Moriz . BM V£Rric~c ~~FERt~vcF Poi,JT" TbP s~E~c ~ ,,vim I /o w oe E•VCE Sir Nex r To w oo D E.vo 7.-s w /4~S T' IDOS 77 LE GE N p ~~EV~rd v OA vlPr Pr /00. o ¢4 To o ~ p POST' /0 3. y -e-4. (3M . ' vE,er ,PCf Pr 1 i ,.;,o t5 of ~,p'vEwy 7-1 33o' 4~5 1 13 i3 20 % t CIG x sXISTI.V Z~ S~- Tic ~ ! Z• 1 " P3 I t t ~ I ~ B3 1 ~ hbA4 d- 6/EU. Df 5EPT!'c c•~• ~ 1~ eda` 6t9TLE7' ?5 /0 o f¢. v f Parcel 040-1017-80-000 01/24/2006 04:15 PM PAGE 1 OF 1 Alt. Parcel 04,28.19.62A 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): O = Current Owner, C = Current Co-Owner JOEL C & CHRISTINA A DILLINGHAM O - DILLINGHAM, JOEL C & CHRISTINA A 529 OLD HWY 35 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 529 OLD HWY 35 SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 7.500 Plat: N/A-NOT AVAILABLE SEC 4 T28N R1 9W 7.5 AC IN NW SE COM Block/Condo Bldg: 1421.4 FT N OF SE COR W 1/2 SE 1/4, TH W 1245 FT TO E R/W HWY 35; NWLY 162.4 FT, Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) W 10 FT, N 107.7 FT, TH E 1266.5 FT TO E 04-28N-19W LN TH S 270 FT TO POB Notes: Parcel History: Date Doc # Vol/Page Type 12/20/2004 783022 2718/506 WD 08/03/1998 584149 1345/121 WD 07/23/1997 704/505 2005 SUMMARY Bill Fair Market Value: Assessed with: 102140 217,800 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 7.500 34,000 175,600 209,600 NO Totals for 2005: General Property 7.500 34,000 175,600 209,600 Woodland 0.000 0 0 Totals for 2004: General Property 7.500 34,000 175,600 209,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 CLAY SW SE, Section 4 BARRETTE, T28N-R19W, Town of Troy R. R. 3, Ham' 35 Hudson, WI 54016 !o / 7 ~0- 60V. (1,2A 9-13-85 R. Ulbricht San. Permit#69657 Mound, Replacement INSTALLED - 9-16-85