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030-1063-30-000
0 to O 0 cn O C v 0 � w c v ° m c O O � N I � N n /D • O A'! • T T z d cp A m 3 � m 3_ - rr �_ • • 0 Cl) O r cn Iv O a r Cn a o 1 • �- '„ m Q 3 N N C N Q L W O @ @ @ 7 7 @ @ p O 2 O OS � N O d a co v v @ O O O . N O. 3 3 N N la 1�{,�N.. 7 0 N " O (0 _0 �R N - N @ M . 00 - p fQ fQ '" cn O �"� O O C7 C C: A7 Z J U :3 3 O C0 � 7 N� 3 > > O 7 N� � O r. S S O O y i. C @ y + c C7 �! N O °—� m C - CD a CD c? fD m C CD u" ? N 0. A N m c OD a _ j j 0 N 3 0 � OD o O O W < N N (n Z C Z O O O Q O O O �y'��i • O p * * * S C * `2 * `ice on 3 y N y 3 a 3 N N 3 m M c r v 0 cr v_oo C p 7 f� f N d �y .d► d C (D 7 3 - cn A w c> N w O Zco Z z z o @ o D a o O D o O @ Cn CD v c '@ M. c m CD F' m O. @ A a CD id � a t° y; Z m do N c A a a �' C/) w a W m M m o zt CL Z 0 3 0 3 Z 3 - 0 z "O fd "O A W N W N CD @ D 3 F= 3� N '> 3 COD 3 7 d �. 0 N° =r 0) @ ° 7 3 M 0- j X 0• T CL CD =X p T -• O a N c . y E N C N C) '0 =r Z d @ O N 7� (O p C. CD O S X =@ O 0 @ CL g N @ O= J- N N@ X @ 'O N @ O Cn 77 O w @ N n N N m N 61 V w @ 0 O o m N o @: a K nO m v c 0C DLo 3 u CD CD 'o -@ a N m °: c N C @ m o ' � a � c. a• o co c v p 7 @ (� �_ _ 7 p cn< t� @ CD 3 N O N (O p) �O F < N a 0 N • @ O S co 3 N O N � @ W 3 A N =3 =1 I b O 6n O 69 O w o @ O @ L' O CL 0 CL f Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division • ,, INSPECTION REPORT Sanitary Permit No: 499236 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Libbe , Chris I St. Joseph, Town of 030 - 1063 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 19 � t GS ( 24.30.19.225D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing 5 Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet J TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing t Header /Man. Aeration Dist. Pipe q. 9 9 Z • 77 Holding Bot. System .�j 7 1 Final Grade 77 1 7# PUMP /SIPHON INFORMATION �P .75 55 q Manufacturer Demand St Cover i 6�t Model Numbe V" We_ nje, J 0 t' S. Z 9b- %7 TDH Lift Friction Loss Syst ad T DH Ft D�� vaaJY S9Z Inc - Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width i Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid De tp h DIMENSIONS 3 ��� �— 116 Z `1 e G �- �_ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer— INFORMATION CHAMBER OR 1 -✓��"` I � I J Type Of System 36/ —71 > / 3 z t Lo� UNIT Model Number: -'4c- DISTRIBUTION SYSTEM 3D -}- Z9 = 5 4b4,Q, Header /Manifold // Distribution ` x Hole Size x Hole Spacing Vent to Air I ake / [, Pipe(s) \ �. \ Z✓� Lengt Dia `f Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded!Sodded xx Mulched � ` Bed/Trench Center Bed /Trench Edges \ Topsoil Yes No -Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / \ \ \ \ \\ Inspection #2: Location: 1468 85th Street New Richmond, WI 54017 (SE 1/4 NW 1/4 24 T30N R19W) NA Lot Parcel No: 24.30.19.225D D 1.) Alt BM Description = k eJ2A1.- I e,r5o 2.) Bldg sewer length �0 - amount of cover = � Plan revision Required? Yes No Use other side for additional information. Date Ins ctor's ature Cert. No. SBD -6710 (R.3/97) ` 11/04/05 FRI 11:34 FAX 715 386 4686 1@001 Safety and Buildings Division Cann 201 W. Washington Ave., P.O. Box 71 62 �� 1 X � �� A� Madison, W 1 53707-7162 T � S permit Number (to be a ed in by Co.) (609) 266 ., g C1 Z-3 1p Department of Commerce Sanitary Permit Application an I.D. Number �- in amrd with Comm 83.2 1, Wis. Adm, Code, personal gtrormation you prov' may be used for soeondary purposes Privacy Law, s 1 5.040 xta) Projeci Adds' l 1 tmnf d IY t th n mailing address) : 0 /#& -g s5 41, St I. Application Information Please Print All atiun REC & _ Parcel M Block Properly Owner's Name l.or h X J #5 / ' r e, cT 2 7 200 10.6 000 - � via � Property Owner's Mailing Address Property Location ' / �✓ - J r ST. CROIX COUNTY Si z�l d yi, A'42 /..8eetirn City, State /die ne Num�bber / [� / 1� 5 7Q / r Circle 7 7/� 7 -5 M I `3ON; R�l._LRW 225 U 11. Type of Building (check 211 tha A pp l y ) Subdivision Name CSM Number 1 or 2 Family Dwelling - Number of Bedrooms L C A. — Public/ - I] iCommential - Describe 11se [3 Sw l e Owned - Describe the . .T t 3 G G �"t 1��' -� ❑Ciry'. ❑Yillagel ownshi f-7 �r tJ^as@� t lit. Type of Permit: (Check only one box on line A. Complete line R if ap A ' L) New System Kcplaecmcin System ❑ Treatme- ot/Hoiding7'ank Rcplt=nwnt Only ❑ Other Modification to Exis 1 ? System rmit Number it I'Mic Issued B. 0 Permit Rgtewal ❑ Permit Revision ❑ Chanp: of ❑ Permit Transfer to New Li ° ^vious Pe: ( Before Expiratran I'{umhcr Owner IV. T e of POWTS S tem: Check 211 that a I - Non- Pressurized lit- Ground C) Mound 2:24 in. of suitable soil ❑ Mound <24 in. of suitable soii ❑ At -Grade ❑ Single PASS S u d Filler Constntctcd Wetland ❑ Pressunred In -Ground ❑ Holding Tank u Pcat Pillcr ❑ Aelob Treatment Unit ❑ Recirculating Sam I il ter ❑ RxirculatinP,. Synthetic Medid Filter ❑ Leaching Chamber (� Drip Line �� Gtuvel•I�:e Piper ❑Other (explain) V. lais ersaUtYeatment Area Information: - 8 ! Design Flow (gad) Dcsiou Soil pli ion Ra gpdsf) Dispersal Area [red (s-9 Dispersal Area cd (s ystem Ele *lion �/ (nc Vt. Tank Info capacity in Total Nu,nhcr Mmwfacu,rer Prefab Site S . t 0h Plastic Gallons Gallons ofilnits f / / Concrete Constructed 41 ss W, �CSC.� New Rxidins � G P �p � - Tm,ks Toni= Septic <x Holding Tank 000 / 000 / Aerobic Traxrrmnt Unit Y Cluntl,ti O� L�e r � Yom. _. - —T- VII. Respomsihility Statement 1 , the undcrAtned, assume responsibility for ins tallation nr the POWN show on the attach plan _ Plumber's Name (Print) Plumbcr's_SiiRnature MP/MPRS Number Business Phh(o�rL:�Jt- unbber / a�f Plumber's Address (Street, City, State. 'Lip Code) o VIII. Count y /Dc artment l)se Onl Sanitary Permit Fee (ittcludcs Ground vale i su Issuin gen : i oat ( Stamps) Approved ❑ Di Surcharge hee) % DD 0 6 l 3 nl Q en Reason fo ill / � —� 1X. Conditions of Approval /Reasons for Disapproval SYSTEM OWNER: `da dC �✓tt^ 4 1. Septic tank, effluent ftfter and 3 � 44 dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code / ordinances. Attach eompkte Pt.m (lo t11t Ceun7 mob) the system en pupa sot kse than 31/21111 lack$ in sire �ccat� SBD -6398 (R. 01/03) -5ca le- 3 � • 17 rvcr f 'e,- Valve. (NE O) 1 Jim Tr cK I 3' p prof ose 1Y'er c he's �Z"� -� n C, V erl � n p�,'✓L A r �GL RECEIVED Wisconsin Departme it of Commerce OIL EVALUATION REPORT Pagel of L Division of Safety ani I Build br T 2 7 r1 C UL ���Igcordan with Comm 85, Wis. Adm. Code County CY 6 1 Attach complete si lar,4n p� r Qqt 81 x 1 inches in size. Plan must include, but not lim ed to'VertlC�1 �h'd firiz�on al refe ence point (BM), direction and Parcel I.D. percent slope, scat ocation and distance to nearest road. D 3 0 /Ox's — Z a — 0040 Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ory , ex e- �� Govt. Lot 114AW1/4 S T -5DN R 114(o W Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village own Nearest Road 1veW d 1m onwi bd' S' (7�.� ❑ New Construction UseA Residential / Number of bedrooms Code derived design flow rate 50 GPD Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments —}— / and recommendations: �� e /�0 �f . �{1 Ch �S /,J r�� l�r 1/G�''/ GY t/GI ltlC F] Boring # - orin g �G • ��j [2r pit Ground surface elev. ft. Depth to limiting factor &'I/ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 0- 6 110 E / ��� C �(0 9 -22 SY-9 Sy n /- s L /n e c..-11D 0' 112 A .Z Z• 5 YA 4 y o r) e- Sc /;7( c iJ /Y) ®! 31 '7 17 0 �e, 51 -rte f •s `� ,A / Fz—� Boring # Boring pit Ground surface elev. - 1 f ' 0-7 ft. Depth to limiting facto /c in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff #1 *Eff#2 6 -� /o In e /C's Tr A 1Z --y ,5 s r119 t s Cl) In � Vi Zq 7,5 s !� ✓'�bltZ �✓ r �� ,� / * Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/l * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature / CST Number / Address Date Evaluation Conducted Telephone Number 7z A a Id 337'? nnr� min inns inm M. I Property Owner Parcel ID # t>� ����G " Page of F3 1 Boring # [ oring � �" pit Ground surface elev. R ft. Depth to limiting factor in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDflf? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 pp ^ l d z1 A9,YR S u 13� 11 s rrp e, s Airs I - > s F-1 Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil W Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 ❑Boring a Boring # Ground surface elev. ft. Depth to limiting factor in. El pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2 ' Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 150 mgA- * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -6330 (807/00) _ INDEX SHEET GRAVITY FLOW CONVENTIONAL SYSTEM BOLDTS PLUMBING €- HEATING 820 MAIN STREET BALDWIN, WI 54002 715.684 -3378 Property Owner C h r , s -P �a f �� �. z l 4 y Adress:. I / y,/ 5 . Phone.. ") C A m Site Legal Description: lt Se- C . Z4 Contents. Page 1 Index Sheet Page 2 Plot Plan Page 3 Data Worksheet Page 4 System Plan View, Cross Section, & Distribution Network Page 5 Tank Cross Section Page 6 Filter Specifications Page 7 Management and Contingency Plan Page 8 Quick 4 Infiltrator Specifications Page 9 Soil & Site Evaluation Page 10 Soil & Site Evaluation Continued Plumber. - a�C 14M a/so Creditial # ZZ O$ 5 Signed: Date: Designed Persuant Component Manual SBD 10750 -P (N. 01/01) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND / / ) OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address JL) /�, /l h u 11 a (Verification required from Planning & Zoning Department for new construction.) City /State //ekJ ; C4 gy)� 4/1' Parcel Identification Number 6-3 0 -10, 3 —ZO — 000 LEGAL DESCRIPTION /V /(,/ J 7 '/4 Property Locatio 1 /4 If , , Sec. �� , T R W, Town of st- U A Subdivision 10 , Lot # Certified Survey Map # /V� , Volume , Page # I Warranty Deed # --?Z5 7 / O , Volume 5 � , Page # 2 7 Spec house yes 0 Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Irrproper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNAT OF AP ICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) Chy- ('-5 I,, DATA WORKSHEET Estimated Waste Water Flow (gpd) 300 gpd Peaking Factor 1.5 Design Flow 450 gpd In situ Soil Application Rate , System Area Required (300 gpd /.5 gpd/0) 9 q ft EISA Rating for Quick 4 Infiltrator 1 9.1 sq ft EISA Rating for Quick 4 Infiltrator End Cap Pair 5.8 sq ft Proposed System Two Trenches — 2 pair end caps — (5.8 sq ft x 2) 11.6 sq ft End cap footage minus system area required (900 sq ft -11.6 sq ft) 8 .4 sq ft 3 Remaining system area required divided by EISA rating For Quick 4 infiltrator unit �sq 19 .1 sq ft) O(units (rounded) 1 VD 51 Total sq ft of proposed system { (K units x 19.1 sq ft) + 11.6 sq ft} 9W3 sq ft ls� Two trenches Z c 1 One trench M units long (9V 5') One trench Z37 units long (95') 3d �2� • � vim.•. ac-,� �v'8 '?z'3� -'+7� � 8a3 3vftd • : • fi -,�f ;� v ��.! � � � � M hh A� Y YvY °ri )1 rl h Y aa9- ��e� -�• a9Y���43� VN POWTS OWNER'S MANUAL & MANAGEMENT PLAN paw or FILE woRMATION SYSTEM Owner e - 1:5 O ^ Q Z e, Ta*M hwulwll - 4✓S¢�(. ©NA Permit # Septic b Dose fl Holdnug Volume: ptgp (9s!) DESIGN PARAMETERS Tank i uufactert�r o NA ' Q.me- � Number of Bedrooms: D NA fl Septic fl Dose fl Holdng volume i S (A Number of Public Facility Ikats NA Vertical Distance Tank Sot6orn(s) to Service Pact g pq Estimated ( average ) Flaw: ( HwzmW TaWS)to Service Pact . JZDC> (10 Design (peak Flow =. ( estimated x 1 -Mr CO t y is >130 � to WvwIaea on In Situ Sod Wca6an Rate: r ( B&wntFirMawftcfuw Qpj yLcj< p NA Standard (Domestic) f rfluenttEfll mt ice/ averaw t Fd6er Modet L Fats, oa a Grease T4)G) sso walL Pump Manufachuer_ l Wdmr W Oxygen Demand (soDs) 4=o BVIL D NA )(NA Total Suspended Surds s150 nWL Pump Modet tfigh Strength lr Effluent Mord* average Pndrealnrent Unit (;OG} 2-30 n1dL 2-220 ° rNA � [] MedrardcatAerAd= 0 Pant Fitter WWR > n & Q Diiswecam 0 Weiland Pretreated Effluent Mon#* areraw. 13 sa nir-rnsel Filer ❑ Omer- morn Fecal Coliorm eomeb= r n (S1 Y} ❑ "round (pressure) DNA MaAmum Effluept Partide Size 16 1n (Jim ❑ NA � Q Mound . Outer Q NA Other D NA MAINTENANCE SCHEDULE. Service Evers Service Fsequency Pump out conten of tangs) 0 When combined midge and scum equals one-lttird (15) oflamk volume © When the high water alma is acti valwi EGu Inspect condition of tanks) At least ionce every fl r1°0r mum 3 years) 0 NA Inspect dispersal cetl(s) At least once ew - Y ts}) pohntnt 3 Years) 0 NA Clean effluent filter At least once evnrcy f } 0 NA Inspect pump. Wmp controls & alarm At Est once e++ery_ 2-3 mom) I fl yearw Flush laterals and pressure test AtleeA once every_ 13 rnontl*) Q Yearts) cow- g (�. At least once every fl }. Q NA ort>er S 0 NA MARMHANCE MS TRUGnONS hrapec imm of tuft and sots dmoq*m cyst wm stM be made by an mdvidud cerrpM one, of the iv m* g ftenees or oertifimoons Master Phxnber, Master Plumber Restilcied Sewer, POW TS inspector, Pd4N1'S &uktai rer or Septage Servk ft Operator (Pumper)• Tank Inspections must include a usual kgxm w of the UWs) to identity any =sslrm or broken twdwarrw identify any c radm or leaks, nteastna the volume of combined sludge and scum and a check for any back up or pondrrg of elflusrt on the ground surface. The sod absorption system Strad be visualy inspected tD clreu3c the eta IeNels in the observation prpes attd ip dredk for any polx rg of dluent on the ground surface. The porting of ellbent on "the gtaould staface may a faTirg condition and meow ft immed ft rte' rption of the total regulatmy authority When the combined accumulation of and sawn in any tealawt tank equals one4wd (V or more of the tank volume the entire contents of the tank shall be remow d by a Se~ Servift Operator (ptnrpeo acrd ktisposed of in P - r n wirrAwthidupterNI1113, VVrsconsin Adh nuistrafive Carle` Ad other services, indearg but not knked to the sarvidng of effluent Ows. medtsrtcal or pressured components„ O'drestawnt units, and any servicing at b*rvals of s12 nwrft shad be perf mwd by a certified POIY1'S Makftinet- AserAke report shag be provided to the bcn dory aulhO* withln 30 days of cmnpletion of any service event GMW-005 (02" - pap ' , - oe START UP AND OPERATIWy :. .. Fof new construction, prior to use of the -POWTS treatmett tamk(s) for the Presence of Pak&V products, solvents or obw chemicals or sediment that may Impede the treatment process mWor damage th soc7 absorption system- if tiogh corroentroations are detested have the contents of the WXs) removed by a Septage Servicing Opeirabor ( ) PnW to use Pump tanks may fill above normal tf wrAer ie%i prior to sbarttip or due to pump fa lurm. Stars up or restorafion of power under these conditions is riot recommended, as the excess wastewater wftl be disctaVW to the std absorption system in one large dose causing an overload that may result in the bac or surface doge of effluent and damage to the system. To avoid this situation have the contents of the pump #ark removed by a Sq age SesvcM Operathr &Xnper) prior to reswnng power to.the pump or contact a Plumber . or POWTS Alairtainer to assist in manually opeafnig the Pump controls use moral effluent Levels are restored within the pump tank. System startup shall not ooc urwtien sod =vSkmars fioeen atihe it re surfaces Do not drive or park vetoid>s over tanks or Rse sod absoOm systn_ Do not driva or park ova or otherv4se d simb of corrWA the area within 15 feet down slope or a ny miud cr ag area. Reduction or eWmation of #* fb&xft fr+am The wastewater sheen may ftrowe the perkrmance aed prolong to We of the beatimermt Tanks and sail absorption system acids. antilmlim baby wiles. bigaretle Uft c0ndo m union swabs, a q e s, dental flos% diapers, dosiMectart3s fats. kuWation obi bump tip) &scharga, Auk and vegetable peelings, gasoline. Wises. turf, meat scraps. medications. als. painting rxoducts. per. sanifty nwkim solvants, Urripom and water softener brine Grad 9a ABANDONMENT When the POWTS fails anOW is perrnaser* talm % t o fservioe the lblbwkV steps shall beiala i th imsegiatfla systern is properly and safely abandoned in compliance with s. CUM 83,33. VW3cosssin AdMinisbafte Code: • AN piping to tanks, pits and affww l atssorption sysi3ww sW be dr;soonrwcted and the ab�d me sealed. a The ooreerits of all tanks and pits shaft be mmoved and pwpedy ofsposed of by a Sq*ige Sm iding Operator (Iwmp 4 • After pumping, all aaift and pr"L shall be e=am+alled and rerrwved of their covers removed aril the void space tiled with soli, gravel or another inert sold rnakdat_ CONTINGENCY PLAN tf the POWTS fails and cannot be rgok d to lb&xiV measmes love been, or must be takert, to pievae a Come compliant repboament"ider►s= 0 A suitable reptaeemwt area ties bem eialuated and may be utiliaed for Re loc alior: of a replacermt at absarpeop sysh3x The replacement area stxxdd be protecSed burn ftUbance and compachm and s xxM riot be infrgige¢ t4m by reqn!s3d setbacks from ousting and proposed struaLM iot.lirm an d wed ire fo pruned the repbcem� afta vA result in The need for a new soil and site evaluation to eeta> URh a SUV21319 feP19CER10t are. Replacennxt systems must Com*Va io rules in effect#theGmeoftTseir _ ,. Partra'EiEc>oa ❑ A suitable replacemert e P is net available due to it Ift ardlbr sod limitations if the sod absorption system cannot be rehabilitated Ord bamW edvences in l 0WTS# ogy, a hokft tanl ma:► be issued as a last msorL The site has not been walualed to Iderstify a suitable placerniert area. Upon ft of ftse POWTS a soft and site evaluation must be perfbnned to.locate a Suftabie 18PWMMXA area If no repbameit area is avai#able a Wing tank may be installed as a last resort to replace the faded POW r& 0 Mound and st grade sod absm l*m system ajay be reconstruchad iii piece foil~owatg reneowd of the biorra"at the inililtrafive swiam of v1sterns must coffVjy vrVj fo lutes in, ifectat thatem m/VARt+BDlG TRFATMENT TA JCKss, PUMP TAWS. ADD *XXMHdG TAMS M^Y CXWAIN POtSOtiOUS OASMS OR. TACK. SL WFICIENT OXYGEN TO SUSTAM L§M NEVM ENTBt ANY TANK UNDER ANY CfiWVMSTANM DEATH MAY RESULT, ESCAPEORRESCUr= FIBDIItI'IE*InBWROFATAIREWAY#MlidPOSSDLF- ADDITIONAL INSTRUCTIONS: POWTS INSTA FOWIS MNKTAINBt SEPTAGE SERVICING OPERATOR LOCALaUtA7y3RYALi ; tY' N*e, Name -i/ -. - Phone - rtes d=rnent was drafted by the A ft d the teen L8k-- IMAwgumeftne sand WazhwabwWFC6rS mquW ry Vs awoiams wo s Cam 83- =(bXI) fd)&M and S3.ss(tL 0 & M Wft=%Sk Adm*rat w code. VieA 4 SMAOMMAAWN �l Quidc4 Starxhird Chamber (E Mr e e• smvm sEC:rior MEW MuftWo t End Cap a te' it SIDE W TWVEW FFKWVMW S ; S v A „��, �• °X �2� � 3 -+' x � _ �� r _ .,,,x f r:. - ". -.. y � � ��� � T 1! ipura�rblpiydaarl dblderrpJ r��a�aaol atrraeearorratllaaa0yrbarer l'Iahfl�AnbribASOaprr.p h � Yrl iitld�ne���y�rA e�WaIY�aYYYSa�tiY�RY�brrdbl�aa��alR�CE�I�� �rhAibdOM al�r 4tras�fa�O�d rf�t/��iY= P�YYrdtrNOOre��mstl�3p� / rtl a+ �Ol eD�Yaetw0�4� 17f�be7r�w0�br1r061��MC�bsrc Yro `44safm bebl'INS+�tly ltll rwrtwfljfilOer1 as! WaWllbOI 11e Cllly1 11.07q �ilsllel� Y��IOA.prielb�dd.rb edidlor YlrYU14Ml6�bO�ew�w601 S UMM VAVFAWYND . . s ue 1 %VMFIMWT SY STEMS INC q thurwrroJq rare.. aal aJyr pRdMd�Orq�mb6y�yrrderLpYeoc iliilMY�rAer . e<. rrobbe aanitm.gv..w.o.a+vbs.eeu.s.el arer r. mca .wstro.+.ans+aJbaen.a.RY�eo�,..d & 'no - a1Q11vItMir611aNrS0�Opr ormdaa�eadY�Yeor,. e... rr. a. u. smaQarYn .a.osaa..aaarrY�Y.Qartira� s�rao,lir acfedtao Iid�slAr. rJ yow�pawdinq�bMlartA lOacarlwbfaa011taYrtlaa aodd�Rw�1RaE�v d b1M�MIYitMiVatEr/ dbvrid�fiCOrd�lrm�r�tltLirOelO�trdelf�irr lrmdo�itilwb�aY�bbt� B Bt *less ilk FiDed • P.O. B a K 788 dia�ywrawasrt YA�hOrYMrungMeael r�riwetdlepaptmr�rYYbfrgrlrmrioi4frU�ii��d Old S"bWk Cr OB475 tr .l�rr�drbYpgrali9b��V.����b Yp�r4rrA4er1.E[i�pa�pcapW7COr drfue14w04hl P+ MOC' Yitt bidlltrrhMnl bvaisl bltil/ ilbCe�y#�dtl/bins�IHeiesbbistbid BOO-7T -7000 FAX BOD-M -7001 jummmt aadarrb trrlbos bM / f ldpay iawi�e6sv $00 221 �Mri�m� dm �i0 ~ 0n l it D ill ilarlir h+thraAeiroet M wRlwiW�6baomdtr.� W{tLG, �q m ol"d�iYrOslrbAadybWrMdYYM /ilMtllAlsrpc Ib�rs4�ldrbsi/f�rd�alih/rHJOadF swift �rtlstr�dli�Yd w kmm rOD1M&rs A6eiQwhrdaYYtadmeMlw bwpiF arra MA�dtlabr�wtlmtrtY lOS'aLYpu�Mr�r�bpOBiR�ek RPYr4srtAPue�babWna - C[ pydf��PtdY+ �r�alddddodyMtlLrw�YPdorbl l�p�elrrdWa . f DOCUMENT NO. STATE BAR OR 9 ONStX- HORN T 1111 BQQK 520 PA" WARRANTY F DEED THIS SPACE RESER FOR RECORDING DATA 325715 T _ NEG ;STrR BY THIS DEED, Ramona J unkm an S OFFICE ST. CRCr1X CO.. WIS. i Rec'd for Record this__jL�—h day of_F_e�?'u_a_U__A.D.I0 —i j Grantor conveys and warrants to ChristoQher J. Libbey and � Lorraine C. Libbey, husband and wife, as t___1jIjo__ A-; M. j Join tenants � -- s R N of De«IsW F Grantee for a valuable consideration IaETUR To the following described real estate in St Croix County, StsteofNisconsin: That certain parcel of land or tract of real Tax Ke + estate located in the Southeast Quarter of the This is not homestead propert Northwest Quarter (SEj NWj) of Section 24, Township 30 North, Range 19 west, Town of St. Joseph, more fully d.- scribed as follows: From the center of said Section 24 go North 00 :.0 hest $1 along the north -south quarter line of said Section 24 a distance of 660.0 feet; thence S 89 29 W along the centerline of a road a distanci of 970.0 feet to point of beginning for parcel to be herein described; Thence S 00 30 B a distance of 360.00 feet; thence S 89" 29 W a distance of 361.45 feet to the west line of said Southeast Quarter of the Northwest Quarter; thence N 00 45 W along said west line a distance of 360.0 feet; thence N 89 29 E a distance of 363.03 feet to point of beginning, the above described parcel containing 2.994 acres, more or less, together with a non - exclusive easement for ingress and egress 66 feet wide, the centerline which shall begin 660 feet North of the Southeast corner of the Southeast Quarter of the Northwest Quarter (SEj NWj) of Section 24, Township 30 North, Range 19 west and run parallel; to the South line thereof West to said Southwest Quarter of the Northwest i Quarter. x�i�iplc4f�fnvwnX'�c This deed is given in partial fulfillment of that Land Contract between j Grantor and Grantee recorded in the Register of Deeds office for St. Croix County on 12-14-73 in Book 506, Page 195, Document #319795. !� Executed at ��lf[e _ wi A- _ thi 1 7th day of 1 '' BbnaXY 19 i ti �I 1 SIGNED AND SEALED IN PRESENCE OF (SEAL) N/A -- Ramona - Junkman_ - (SEAL) I N/A \ \\ ( SEAL) Ij (SEAL) t Signatures of __ - ._� — N - - -- - - -- i authenticated this day of __ 19_. N/A Title: Member State Bar of wisconsiu or Other Party r Authorised seder Sec. 706.06 via. s y, *TAT* OV wl>1C011EIIt 1 i at C lx County. rik Personally caste heron use, skis 17th day or Febr_mAa , .[iui� i9? k. on above named -_ �ona Junkman ,•�`�G to so known to be the person_ who executed the foregoing instrument a nowled`ed the This instrwaent was drafted by J Z : OI]fl It ` Hugh F. Gwin, Attorney �•..•. + s _ Hudson. Wiscons Notary Public • ount Wis. ., 7VA use of witswsees is optional. My Commission (Expires) ( 7 _ 8s 1977 fuses of persons Signing ht Say eapacity should be typed at printed below their sigaat•res. _ ... Parcel #: 030 - 1063 -30 -000 10/30/2006 11:28 AM y PAGE 1 OF 1 Alt. Parcel M 24.30.19.225D 030 - TOWN OF SAINT JOSEPH 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 CHRISTOPHER J & LORRAINE LIBBEY O - LIBBEY, CHRISTOPHER J & LORRAINE 1468 85TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description " 1468 85TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 3.000 Plat: N/A -NOT AVAILABLE SEC 24 T30N R19W SE NW COM CEN SEC 24, Block/Condo Bldg: TH N 660 FT, W 970 FT TO POB: S 360 FT, W 361.45 FT TO W LN SE NW, N 360 FT, E Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 363.03 FT TO POB 24- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 520/270 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: ' 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 60,200 147,300 207,500 NO Totals for 2006: General Property 3.000 60,200 147,300 207,500 Woodland 0.000 0 0 Totals for 2005: General Property 3.000 60,200 147,300 207,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 124 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 4 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP r SECTION -R f W ADDRESS `'�' ST. CROIX COUNTY, WISCONSIN - hl"--4'L��- l J SUBDIVISION � LOT LOT SIZE PLAN VIEW N SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 3 0' s�/,E✓0 / � S T7 ' INDICATE NORTH ARROW BENCHMARK: Elevation and description: Alternate benchmark SEPTIC TANK:Manufacturer: J✓ Liquid Cap. Rings used: Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: 'j No. of feet from nearest road:Front_,X_, Side , Rear Ft. From nearest prop. line:Front , Side , Rear Ft. No. of feet from: Well ,Z7� , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons /cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front,_, Side_, Reak_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: _ Length 7T' Number of Lines: Built Exist. Grade Elev. - -y Proposed Final Grade Elev. Fill depth to top of pipe: = No. feet from nearest prop. line:Front k , Side k , Rear Ft. 7 No. feet from well: /38 No. feet from building /Oa HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well building , nearest road Alarm Manufacturer: INSPECTOR: DATE: ��- 90� PLUMBER ON JOB: LICENSE NUMBER: 6 /90:cj LA�c` ir�artr`�'trofh��is�lF'H 24. 30. ��S,y,Al�jj�,S`$�ST. County: `Labor and Human Relations CvY c7t T REPORT REP Safety and Buildings Division I O ST- CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: 18 Permit Holder's Name: ❑ City ❑ Village EkTown of: State Plan ID No.: T OPHER J ORRAJEST. J OSEPH CIS BM e Insp. BM Elev.: BM Description: Parcel Tax No.: /G 030 - 1063 -30 -000 TANK INFORMATION ELEVATION DATA A9200403 11// z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C��. s ( � Benchmark o, le d�.G) Dosi Aeration Bldg. Sewer Holding St /Fy Inlet � CC t� TANK SETBACK INFORMATION St /V Outlet 56' 9 TANKTO P/L WELL BLDG. Ventto ROAD D Air Intake Septic 3�v NA Dt B Dosi NA Header /' Aeration NA Dist. Pipe Holding Bot. System Z $'' PUMP/ SIPHON INFORMATION Final Grade Manufac Demand Model Number GPM TDH Lift Lriction Syste TDH Ft Forcemain Length Dia. H Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S I I DIM N I N SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHIN Manufacturer: SETBACK INFORMATION Type Of Mo e System: ( y /� / '- /3g CHAMBER OR UNIT DISTRIBUTION SYSTEM Header / 11AOFM+E#d , Distribution Pipe(s) 7 x Hole Size x Hole Spacing Vent To Air Intake Length CO Dia. Length � Z Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over „ Depth Over U3 xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center `8 �,7i Bed / Trench Edges �, Z_ Topsoil ❑ Yes ❑ No E] Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 24.30.19.225D,SE,NW, 85TH ST. I �Ia �tl, , 1; O � � Plan revion required? ❑ Yes [Q-ft' 6 _ other side for additional information. SBD -6710 (R 05/91) Date Inspector's Signat re Cert. No. I ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY ,^ STATE SANIT R 1 -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ / fi /r revision to 5-1 8% x 11 inches in size. Ch if previous application —See reverse side for instructions for completing this application. STATE PLAN I . NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNE PROPERTY LOCATION 40e"�& =2&&a '/a '/a, T , N, R E (or� PROPERTY OWNER'S MAILIa ADDR SS LOT # BLOCK # Cl STAT hh ZIP C DE PHONE NUMBE SUBDIVISION N E OR CSM NUMBER III. TYPE OF BUILDING (Check One) ❑ State Owned VILLAGE NEAREST ROAD�� El Public 4 or 2 Fam. Dwelling of bedrooms P R AX N III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. Z Replacement 3. ❑ Replacement of 4. ❑ Reconnectio.n of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # — Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ® Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min /inch) , ELEVATION a S Id Feet Feet VII. TANK CAPACITY Site in a alIons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for install ion of the onsite sewage system shown on the attached plans. P Name (Print): Plum is �gnature: (N ps) MP /MPRSW No.: Business Phone Number: it /' Pi m Address ( reet, City, Stlite, ip CoZ IX. CO NTY /DEPARTMENT USE ONLY ❑ Disapproved Sa 'tary Permit Fee (Includes Groundwater a e ssue Issuing A nt Signat No Stam s) Approved El Owner Given Initial �� >t 60 Surcharge Fee) Adverse Determin tin �v 0 j I S X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD -6398 (formerly Pib -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A 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. 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. Onsite sewage systems must be properly maintained. The septic tank(s) must pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 -266- 3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlll. 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. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8% 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; pump or siphon tanks; 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; and F) all sizing information. GROUNDWATER'SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground - water contamination investigations aiid establishment of standards. ' SBD -6398 (R.11/88) 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 c Location of property L� 1/4 /yLt: /4, Section N -R (2 W Township Mailing address Address of site Subdivision name Ze Lot no. Other homes on property? yes Previous owner of property _ s V1,1,0 r Total size of parcel _ 2 o C L' (Z Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes ,,�No Volume '` j and Page Number ,�17�; 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 & 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 references to a Certified survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. �jJ - 7�,5 own the proposed site for the sewage disposal and t system ) or I e (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No. Signature of licant -appl cant Date o Signature ate of S gnature 1 -,.. _� `�-._ . �: _ � =�' ` `�- ' ti ;,, .�- f �'�''' 1 J.n }.. _? SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER " o - ADDRESS: — /� �S`'� FIRE NO: LOCATION: 1 /4 1/4, SEC. ? _ TOWN OF: ��'` n �� �° ST. • CROIX COUNTY X SUBDIVISION: -lA LOT NO. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists 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 treatment stage in the waste disposal system: St. Croix County residents may be eligible to receive a grant to help with the cost of the 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 re quirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman. plumber, restricted plumber or a licensed Pumper verifying that (1) the on - site wastewater disposal system is in proper operating 'condition and (2) after inspection and Pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification from will be sent approximately 30 days prior to three year expiration. I /WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system-in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED :\ - ' t I. DATE: St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page / of Labor and Human Relations -/- Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach obmplete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but qj •not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. C_. o APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWN R: PROPERTY LOCATION / - - GOVT. LOT 114N 1/4,S T f6 ,N,R E"(ocev PROPERTY OWNE ':S MAILIN AD RESS LOT BLO K# SUBD. NA OR CSM # f CITY, STATE ZIP CODE PHONE NUMBER ❑CITY VI LA E [gOWN NEAREST ROAD4 [ ] New Construction Use [)4 Residential / Number of bedrooms _3' [ J Addition to existing building bQ Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate , .S" bed, gpd /ft trench, gpd/ft Absorption area required ?,�Q— bed, ft trench, ft Maximum design loading rate , _S' bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) ��_-,/ ft (as referred to site plan benchmark) Additional design / site consider tions Parent material _ Flood plain elevation, if applicable A tlA ft S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem I� S ❑ U S ❑ U ®S ❑ U ®S ❑ U ❑ S LOU 11 S �I U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench } - Ground lev. ft. < _ S Depth to limiting fact Remarks: Boring # A1 Ground - elev. _ ft. - Depth to - ' limiting fact Remarks: CST Name:— Please Print ' r) 1 Phone: / i Address: Signature: Date: CST Numb v PROPERTYOWNER SOIL DESCRIPTION REPORT Page,,? 6f PARCEL I.D. # C& 6 - 11 - 7, 1 , f- -M Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Baxxiary Roots in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. Bed Tmrdi Ll` / - Ground -3 �Z, ZIn �Z !3 elev ft. Depth to y S C limiting factor Remarks: Boring # rik Ground elev. ft. Depth to limiting factor Remarks: Boring # i Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) F - - - -� -- I i � �- I I I � I � � I � Sr� � I I I i I I I � I ' � I I f- i I '.- i j i I -T--_ r_ � I 1 _ j - I ' _ I , 30 f i I I , X) x -- I 6 --- - ------- 0 0l - T - t I T -r 7 16 I I I - i� - --T I r- I I I ; -- -_ -- -i - ; 1 , , I , I ; I I I i I I I I I i : ; -_. - - -- I j , - I r i { j i j t I 1 , _ 1 I I � I /,y I �� / ' � _' I I --- T I _ ' — '� I I - �'� -- 1 .�-l��lt���_.SCG' ����I � X211_— i � � -- i �- A4 ! _ w_ I � ' rv�cz "`� �"'_:`` —. I -- i . - _ -!� I i - -- , I � -- I I __ ! ! I I I I I '5�.. - '�PL -= I 1 � LLL�,GL{� � � I L - � � ' � � I , .J/� I � -- l I _ __ _ _ j _ T _ T � r---�— Tr—T —�-- _ rte I I -- � � _ I - I - -- � — � ---� -- � - � I L� I - � = -- ` -- + - - I ! —� —� I I T — 7 -- ' i 7 le zs 1 - F -- T � I —� i j I I I I I I i I i I I I I I I I I I I i i I I i I i i I I I I I I i I ' I j I I I I _ � T _ T • i , '� it � I j I I I j I I I i i . 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CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the J - residence located at: _ 1/4, Sec. , T N, R_22 W, Town of Upon inspection, I certify that I have found the tank and baffles" 'to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No„2�_(if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacurer (if known): Age of Ta k (i�f n wn) : /g7� J (Sig a ure (Name) P ease rint �� / L4 (Titl /e) (License Number) (Date) Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform o t e quire ents of ILHR -83, Wis. Adm. Code (except for inspecti o e 'ng over outlet baffle). Name Signature MP /MFRS �? r - 5/88 REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1 11/113/92 14:11 REQUESTS FOR INSPECTION WORK SHEETS FOR: 11/19/92 AREA: JT L� Activity: A9200403 11/19/92 Type: CONVSEPT Status: PENDING Constr: Address: ST. JOSEPH 24.30.19.225D,SE,NW, 85TH ST. PFarcel: 030 - 1063 -30 -000 Occ: Use: Description: 186518 Applicant: LIBBEY, CHRISTOPHER J & LORRAINE Phone: Owner: LIBBEY, CHRISTOPHER J & LORRAINE Phone: Contractor: O'CONNELL, KIM A. Phone: -------------------------------------------------------------------------------- Inspection Request Information..... Requestor: O'CONNELL, KIM Phone: Req Time: 10:11 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION -------------------------------------------------------------------------------- Inspection History..... Item: 00012 FINAL INSPECTION