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030-1088-20-000
r Wisconsin Department of0ommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 68 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: Town of St. Joseph I St. Joseph Township 030 - 1088 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 30.30.19.3176 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM iquid Depth BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. L DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Di a 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 L] Yes ❑ No Yes r ''; No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1337 Cty V Hudson, WI 54016 (NW 1/4 SW 1/4 30 T30N R19W) NA Lot 1 Parcel No: 30.30.19.3176 I 1.) Alt BM Description = 2.) Bldg sewer length - - amount of cover = Plan revision Required? Yes E No — Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. '09/30 /,03 TUE 11:54 FAX 715 396 4686 ST CRC CO ZONING 001 C $T. CROIX COUNTY VASCONSIN in accord with 15.04 St. Croft County Sanitary CWnanee ZONING OFFICE Personal Information you provide may be used for secondary purposes ST. GROIX COUNTY GOVERNMENT CENTER 1POncy Law. S_ 15.04(lXm)] 1101 Carmichael Road Hudson, WI 540167710 711)3864680 Fax 1S -4686 Attach complete plans for the system on paper not less than 6 - 112 x 11 Inches in size. County Sanitary Penst # ❑ Check I revislon to previous application sT (P . Appgeatlon Infonnation - Please Pdnt all Information Owner Name 194 J 114, Sec d O 0 " 1 0 6 2003 S N. E (of Owneh's Mailing Address Lot Number � I Number ST C � t i Pl i'� ee City. State Zip Code Subdivision Name or CSM N 73�� < 3 1 Type of Building: (Cheek one) of ❑ 1 or 2 Family Dwelling - No. of 9"toome: PublWC rnmefcial (describe use)' �O`f C3 SUMKwawd NeMd Y I. Type of pennit (Check only one box on line A. Check box on &rw B if applicable) Parcel Tax be ) 1.0 Repair . ❑ on- plumblrQ . ❑ Rejuvenation J � anitation I tJ n 8) ❑ State SaI1i<afy Permit was previously issued Pehmf[ N Dale Issued tY. Type of POINT SysWrn: (Check aM that apW ❑ NOtiV4691frized If Around Mound (] sand Filler ❑ Constructed Wetiand ❑ Presswize:d In - ground Holding Te k �� 1/ ❑ Single Pass E3 Drip Une O At D Trea nt un ❑ RedreuWkhg ❑ other reabnent Area Information. 1. Design Flow (00) 2_ Dispersal Area 9. Dispersal Area 4, SOU Application Rate S. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals_lday(sq.ft.) (Min.Anch) Elevation . Tatnk Intone anon in torts o Manufacturer Prefab 31te Con• Steel Fiber- Plastic New Existing Gallons Tanks Concrete strutted glass Tanks Tanks ld ; ese r a o ❑ ❑ ❑ ❑ o ❑ a L Rosponslbllity SWOnwnt I, the undersigned. assume re5pon3Wity for repairlreconnenctionlrejuvenationCm $Wiation of non - }plumbing for the POWTS shown on the attad ed plans• A Icons Is not required far terralift It or fife installation d rim-plumbing sanitation system. Name (print) Plumbers Signet a (no stamps): P PRS No. 8uslness Phone Nuttnber ` " M s' a .c k > - 3i �1 s Address (Street, City. State, Zip Code) —17 A4 It. Coue Only Disapproved SarAs t Fee gate Issued Ksuing Agent i UnEl ( n>ps) ln/ AppMved Owner (Nven Initial Adverse -I1 3 Detornination )L Conditions of Approval/Reaaorm for Olseppreval: Pe I V� rvw: ry AGL REOLOZ" e Co N -M-r,vp'� , Olt 4, 4e V �. / L.0 ED > Cj Lu LLJ 2417 P 633 741 (D gg KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 09/23/2003 01:45PH Document Number Document Title HOLDING TANK AGREEMENT St. Croix County EXW # REC Holding Tank Agreement TRANSEF 11. COPY FEE: CC FEE: fate Plan Transaction Number- PAGES: 1 Town of St. Joseph Name — (Owner) Typed or printed being duly swom , states, under oath, that: 1. He/she is the owner /part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume 588 Page 424 Document Number 3 5 4 6 6 $t. Croix County Register of Deeds Office: Records Area Name and Realm Address A parcel of land located in the NW '/. of the ' /4 of Section 30 Town of St. Joseph T 30 N - R 1_ W, Town of 9t. Jncenh . St. Croix 1337 County Road V County, Wisconsin, being duly described as follows (include lot no. and Hudson, WI 54016 y- subdivision/CSM or detailed legal description): P 1 _ S t le , i3 i'. D 4 3 � s ) 1 - rte C S r l'N / r✓ 1/0 3 E 7) T 9 a , M n,;..+ f 030- 1088 -20 -000 Agreement Date: 9/2 03 3 j y L B Parcel Identification Number (PIN) We acknowledge that application Is being made for the Installation of (a) holding tank(s) on the above described property or that continued use of the existing premises requires that a holding tank be installed on the properly for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. Comm 83, Wis. Adm. Code, or Ch. 145, Wis. State. As an Inducement to the county W Issue a sanitary permit for the above described property, we agree to do the following: 1 . Owner ogre" to conform to all applicable requirements of Ch. Comm 83, Wis. Adm. Code relating to holding tanks. It the owner falls to have the holding tank properly serviced in response to orders Issued by the governmental unit or the Department of Commerce to prevent or abets a human health hazard as described in s. 254.59, State., the governmental unit (Town) may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the. tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 88.0703, State. 2. The owner ogre", pursuant to s. Comm 83.54 (2), and Comm 82.40(3Xo), Wis. Adm. Code, to have awater meter Installed In the structure. The water meter shall be Installed by a plumber authorized by the Department of Commerce to disks such' installations, with said Installation complying with State regulations and manufacwren spedllcstion s. The owner ogre" to be financially responsible for the purohase, installation, maintenance, and repair of ft water meter, and ogress to allow the govemmenW unit or that Department of Commerce to enter ft above-0e3eribed property on a regular basis to read and/or Inspect the water meter. 3. Owner agrees to pay all charges and costs incurred by the governmental unit or county for Inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank In such a manner as to prevent or abate any human health hazard caused by the holding ferric. The governmental unit shell notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event tits owner does not pay the costa within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 4. The owner, agrees to contract with a person who Is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to file a copy of the contract with the governmental unit. The owner further ogre" to Via a copy of any changes to t service contract, or a copy of a new service contract, with the governmental unit within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the county on a semiannual basis a report detailing the servicing of the holding tank. The governmental unit or county may enter upon the property to Investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank Is not being property maintained. S. This agreement will remain In effect only until the county office responsible for the regulation of private onsite wastewater treatment systems certifies that the property Is served by either a municipal sewer or a private onsits wastewater treatment system that complies with Ch. Comm 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the helm of the owner, and assignees of the owner. The owner shall submit this agreement to the register of dead&, and the agreement shall be recorded by the register of deeds In s manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank Is installed. Owners) Names) - Please Print Subscribed and sworn to before me on this trots' ' ' ' • , Town of St. Joseph September 22, 2003 �P�E.�•'chy� Note d rat Signature(& No Pub c m i `••/PUBLIC Governmental Unit Name, Title • Please Print My Expires ', 9T F /3i= oc T eC r )s r S4�t ays April 4, 2004 Governmental Unit Official Signature Drafted by: / L Personal Inffrmation you provide may be used (or secondary purposes (Privacy Law s. 1 04(1)(m)) r' "THIS PAGE !S PART OF THIS LEGAL DOCUMENT- DO NOT REMOVE" I This information must be completed by submifter document tltb. name 6 return address. and Pfd( (If required). Other information such same granting clauses, leagal description, etc. may be placed on this first page of the dccument or maybe placed on addldonal pages of the document. Note; Use of this cover page adds one page to= document and Wsoonsln Statutes, 58.517. FROM Schurnaker Plumbing FAX ND. 71531353121 Jun. 11 2003 05:21PM P1 06+03/05' TUE 13:21 FA% 715 366 4686 ST CRZ ce ZONING HOLDING TANS SleRVICING CONTRACT ttraa DAIS 4. a S - v 3 This contraot Is made between the H ; l ank r(s tne(a W Pu Ws Name fr - W e na on a dingy s err the o �8 e9� eaa bona .ai rho 3 C E /94 .) LO / �S/ 3 �7SS i1 i, Ths O wner ivies to file a c o py Cf this warty with the k xW iio verMOMI Unit 60 has 6IEd the paVisS mat taquized in Comm 8332(lx4 1 . Wis. Adn Code end the %Vmvad Robding Teals Cea$Q aW Muw&l. This aprwww will also be 5ted with the $t. Croix Connry Zoning MWtIllOnt 2• The owner agrees to have the holding tank(+) serviecd by the puapW and paaraatea 10 permit tifa Pumper to have ae=s and to easervpDt3 the property far the puposo otwvking the boMm teWk s). The owner ep vcs to mat 60 ages road or drive so brat the paaspe= M satriae the holding %W*(s) with des ixaampinp equipmea 1% owner flak egress to pay the pttttlpw fogy *2 oWgn incaazrd in at•ri*g 60 6vldir�g te+ilc{s) a: t:nttuaily apxeed stpon by doe owsar bad pusteper, 3. The pumper asrm to tatbmit to the kcal gavaxatawuW unit that ba signed the p mpima asmmezrt cud to ebe CotwW, a repon for the servicing of tba holding tattlol s) an a atsmiaMWA basis. Tlu ):nape+ fst�"ttter is"= to iaclude the follovzng In tba sam "anal repeat a. The name and address of the psmentt -pm .6 It for sefvioing the holft nark; b. The nun of the owes of the hokiing tank; c. The location of the pfopetty an which the hokiia® rank is imtallcd; d. JU "nitary percait cumber issued for the holding tank a The slaves an *loch the bolding twit was &&_wised; f. Tha voIwo is Vttvos of she oonftgs pumped froc the hokft tsttk for emab aervi8Lt , p. 'Che dispoaat situ to w}uch tiro cotta from the >SOlshug teak were delivered. 4• This agtroetaeti: will remain in effect Mil dw owner of pumpa k knifes this contract Is the evaot of a sheave is this cocoa 4 the owmr agrexs 10 Cc a swpy of tW ohasgoe to this sarvia contract or a copy of a new swrxe ax7traat with local goveramcnW unit and the CMWty abased above Wvitbua M (10) buahtees days tram 60 duce of ebaaga to thin serwrA canhut. er(a) Nafn e) (Prktt) CawnePe s tube and avrom to me on title date: 01 0 3 T.. Date �umpees Name (Print) Pula s signature Notary blic Siyneture ices r r Pumpers Regisuawn Number Comm Scion EWLfstian 1C 71 7/3 F A ' I ��A or •N AR • CP P UBLIC . '"OF WISE Z m Z Z ao m • X v O m O m r- :* x O U) m O 0 < X °`� - v � � K W 0 O m w o c C-10\ 0 o ;u c D J T r O m c 0O z� Cl) m n o (� m O ;I m *k N Z �,� z mD Z o C 17 � 1 m 65 w O C/) Z - z X cl# m o zZ m " O G) 3 Z I� --� -- m m° o m y a Q v = o y d a� a M 1 �o �� °� ��� mom_-+ r m w amy SL M. ;0-CD ��pp 1 O m 0 y M d f0 O p W j W wa (4 m V n 2 C 0 ^ j ~ fir lei% a% a� ?> ��� 0 X? X W .. �—. H 7 N N 7 = �� �. y v < O m "� a '�° m� °~ Aga o �� $_ ? �f_ m 3 m ro v_ 3 '9 m c'c D �c g ° y ?- CA m to O G1 N y A v, �� °� d ; o = =�. 3m m zo m mom 0 � 0 O z g d �' -� oai m m Z r Z ct R, m S r s ' o oz o m z zG) z SANITARY CODE 15.04(3)(b) . (b) Permits• Issuance of a sanitary permit shall be required prior to the start of Mork on any structure or facility requiring private sewage systems or prior to the installation, enlargement, conversion or alteration of any private sewage system. Procedures for application and is- permits shall be as specified in Subchap- of such p _ suance P c Privies 1. Privies shall be constructed and maintained in the manner described in DILHR specifications for a sanitary privy, which are available in the office of the County Clerk or the Zoning Administrator. Privies shall be maintained in a clean condition and shall be constructed so that insects and rodents cannot enter the vault. 2. Privies shall be located at the minimum horizontal distance of: a. 25' from dwellings. r12 e �� aYS b. 25' from lot line C. 25' from any 12% slope at the e dge of a water- course. d. 50' from wells having watertight construction more than 50' eefl. e. 50' from the high water mark of a watercourse. f. 75' from wells having watertight construction less than 50' deep. 3. The bottom of open pits shall be 3' above (any creviced) bedrock and the high groundwater level. All priv- ies In areas subject to periodic flooding shall be located and constructed to minimize any health hazards and the risk of water pollution. 15.05 MAINTENANCE PROGRAM (1) The applicant for a sanitary permit shall be provided written notice of the maintenance program at the time the sanitary permit Is is- sued. The records of this notification shall be maintained by the County Zoning Administrator. Upon sale of the prop- erty,,, the owner shall provide written notification of the maintenance program to the buyer. - 3- ST. CROIX COUNTY 10/01/66 N ' & il! N � 0 N , � • I _ W ,I I.I 1 L [ P I P "' IS ROD ST. JOSEPH `W' PLAT - 29 -30 -N • R- 20 -19 -W � r , (Landowners) so 'S' PAGE aj — See Page 112 For Additional Names. 100 A NDE R SEN SCOUT CAMP RO 200 2 3rd ST 150th AVE 400 j � ,$ 3 K & to Ro T anise $ Bce Linda Gloria � LN LN ctux IL HERON W tz amen u Moelter 4o Hinz Basel Ern�a - 46 E—ta ey Is 7 Singer '� ia. s 53 tr os N a _ 114 F rally E qu ' ed - queued ers N ARBOR G5 tp , h I 78 Q , HILLS I 145th T r ust I Ne 160 o rt"ae.. 19 t 74, SZdj . a DR 37 AVE 118 t� pY P d u tr 3 Patrkla go S tr g WNI° a Q DAa tr TRi t t - a Mmaama 144th 2 i f A TM AN 1� f r 9 4 3aao 1 DR LE n U) 3� Hen ) a >+aa°a.. sF ,E Oy o � tr tr AVE Edwa ° Dr b D. 8 GE p 4GM MCeadows I Trust balhoa Gknnr- gF: O sqs s r x 1 F `t' 9 i wan Inc 78 47� 11 173 +0 soo s d 1 _ _155 r lam. a coma IF.d�yrd M - OTman II - P o iy M$ F , MD 1x �i i[�d - ' I .'°. D a iwt ° n J xaL a,<. nar 'g Mary - 8 MLL 10 " Brown Etnmeck - �CA gg � � <' ¢ L std v x t a etas 90 I �s to LTON I A. t ..�`° tr ss Ur HK j > 3 Avam aT" I v,Nw laan 39' -a to 3:i lY 0 g �t t v Severson I 77§ r G t30 tr 3 I> 9 Laverne N Th Tn o m .q a tr aer a b A V d tr is I Anderson McCo I V I u cn F 6 zt 3 w,f a C 5 95' 80 • _ 10� m F, F9 - t --- - � I Eo `9�xt F 6 sp.n �r a t sm ttaM Wald- ca0 6. t tr 75 D,,,,a asm s t3 cm Z i �^ t 2 � m CPsGJ trr ST O,4 35 181 tr V Steven Mz ran a 10 34 %r 189 1 125th AVE Ericks Kim F A f C r 3 � 9/ &E TRose 113 P15 N 2 tr E B— g Lois 9 9 IPiord 8 dam +> tr a c RIVE W 3 41 5° B ^ 53 u ... v.• ° 161 u N ACRES "ta 41 z urwt Ernest fain 1 aaea etbe D12 n. M do L9a� buts s 4 HA tr Id T3ON RIVER EST ^ wtt 0 sdct 2 2 U L 14 4o Trust 66 1as 16 T29N RD t - �R&PH , 1 ` sa t P n, Tf Dubn 1 1 tr y d — nonawg 14 ttid� tr PaP 14 JdtD 18 BL 29 Ncstru6 AR DR t+ s 14 s 4 6 ~ tr z W 2 n s SS a . a• PB. R IOat tr ` < ° r Ir s ta'} 1`a Z Its 79 ia ' a rat 2 a'TM6 tr tr 10 6�. 30 9 i u rm tr xr.esa L tr Sr fo P•t a f M y Odleb W SO Z tr r N U Olm� 33 aldro�t W ^ R tt # m Mich ael ear oaM ` a: 0me tr f WP tr 32 I 37 Rsa ti . Nr P L7 s aw ° d3 I 35 GOLDEN ROUT L ALLS RIVER HEIGHTS TRL - OAKS LN BROOK IiUDSON'W' PAGE 26 RD LAKE We're right here - in this local area - to help you, your neighbors and our local communities. And because we're here, your deposits with us are invested in loans to benefit the local economy and local people. r RIVER FALLS PRESCOTT 104 East Locust Street 1151 North Canton Road �. (715) 425 -2401 (715) 262 -5000 Locally owned and operated since 1904 44 „a -'y 354628 .• CERTIFIED SURVEY MAP ao ' Ic M - � I> - X c: I Iz'r z m 145' 45' I O I. > .1 UNPLATTED LANDS ( I I I ---------------� __- _- __-- -- --� - -- 'a 'w`-' o� COUNTY TRUNK HIGHWAY "V" — � w S0 5 a10. 1 W o� w WEST LINE SW1 /4 w w C V1 w -I N _ \ °o n N 0 °10'20 "E CO r — — — Z --1 0 � 500.25' Oo T \ o w O �o w % 0 W ( N � _ m -+ O; EAST RIGHT -OF -WAY LINE m O_ O o c u'„ I Z Zz iC ml I Ofd � Iz A � , .vcNo I � IT t3�., z O cn cn I ;0 17 0 n� m I 100 I �° M --I Im 50 ' 50 ' I 1v "ti Ia o r34 �� � o I.. Z p ti `� m o, Q O Z I Vf d p, so ° 1 0120 11W C I �z m � to a 115.00' j -= I A j iD �.' Lri -0 < I O I 2 0° ;:' 'e I I-i cn N I , C� I IM C W N W ( D I IV Z O Q- I71 N Gn o � I AD C I Ir o cQ r- I ID 00 10 v y m z m I Iz 00 n ti NO °10'20 "E m - I 10 n' m 0 � 115.00' cn I I to co N A o °o I Ln ° M �D �O�o CO c o n ° I V ) M m 16 ° Z Ln 50' I 50' I o -n O M Oti ti = 0ti 40' 45' N C) p Ln I o° = o o co 8 5 w I O V m z Ic > M I M IZ I Ir r r I IY Z z I m rn I I Iv I 'r I � (0 I I Z ° 9 0 , ,v F ' �N 510.25' 9 4 8 5 S0 0 140 45' UNPLATTED LANDS I ---- - - - - -- - - - - -- Drafted by James T. Swenson Volume 3 Page 755 Safety and Buildings Division County + 201 W. Washington Ave., P.O. Box 7162 J % G . <r�{_ �gloansn } Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 Sanitary Permit Application State Plan 1. D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, si5.04(1)(m) __-_ Project Address (if different than mailing address) L Application Information - Please Print All Informatl ,j Property Owner's Na me 0 f_. O Parcel 11 Lot # Block M D J e —, ST �dSC Property Owner's M ailing Address " Property Location � -- ` .fi�c1 ��, SGV ii,Secdon 5e City, State Zip Code Phone Number (circle on II. Type of Building (check all that apply) T , �_ N; R _ /E or IkJ Al or 2 Family Dwell' y tng - Number of Bedrooms Subdivision Name CSM Number blic/Commercial - Describe Use rAl -ld A � �, t �7y 99TTTT ❑l ''�� State Owned - Describe Use ❑City_UVillage &Township of III. Type of Permit: (Ch on ly one bolt on line A. Complete line B if applicable) A. 0_New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System I B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and .Date Issued Before Expiration Plumber Owner IV. IM of POWTS System.- (Check all that apply) ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. pf suitable soil ❑ Mound < 24 in of suitable soil ❑ At- Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ` J+ , Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑Leaching Chamber El Drip Line ❑Gravel less Pipe X Other (explain) as /I' V. Dispersal/Treatment Area Information: — � Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required Of) Dispersal Area Proposed (sf) System Elevation VI, Tank Info Capacity in Total Number I Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatrstent Unit Dosing Chamber VILRes nslbility State I, the undersigned, assume responsibillty for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature P MPRS Number Business Phone Number Plumber's Addre as (Street, City, State, Zip Code) VIII, County/Department Use Onl ❑ Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Re ason for Denial J I IX. Conditions of Approval/Reasons for Disapproval Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF SAINT JOSEPH COMPUTER NUMBER 030 - 1088 -20 -000 Parcel Number 30.30.19.317B OWNER NAME: First %TOWN CLERK Last TOWN OF ST JOSEPH PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 1337 CTY RD V SECTION 30 TOWN 30N RANGE 19W %160 1 /440 Line Description Line Description TOTAL ACREAGE 10.000 PLAT LOT BLK 01 SEC 30 T30N R1 9W NW SW LOT 15 02 1 OF CSM 3/755 16 03 TOWN HALL/FIRE DEPT 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, 174 -Prev. Parcel, 175 -Next Parcel, F7- Valuations, F8- History, F10 -Exit C O g ' ° 2 $ % k ) ® B ® f $ ƒ 2 7 0 $ / $ / § , / \ \ � m i CD 3 \\ i 90 9 - § 2 K § E E /j / \ o C/ / c E / > £ % q w C g § 0 ■ o CD < @ § § < z § § k 0 r @ o c ° S S § ■, J T T \ • ƒ 0 0 0 fT Oro / \ \ 3 3 § §� 7 > o v o E CD / � A - / 7 2 0 \ ( / K R ;�� E m % � ƒ � \ \ cn = j K 3 / / m E 2 z m ca 0 f z 0 a 9 2 [ ■ 2 ) § E § z k 7 7 z C / ° ` _ -¥> \g 0 § § ® 3 ; c CDk z % = C 0 0 22 _ \ \/ ■ §§/ k 22= Efz % � Im a ?W 7 C 2 cr Q5 0 0 / m § f ? § 8� 10 o f r. 0) 0 � I a .. o� � 3 I o �o � I � � � » eo c � •^ .. 0 w 0 m 3 ° c co o o � I � °-' o o �� �� L co a 10 a m m m o CL CL CL 0 N a y (n o a v y y m I w N o $ ° cb� c� O y W O �' NI fD 7 y ! 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Oiti4 a2% s r -- ---- - o (a URSEKT EWENSON PLUMBING &HEATING 0 SO OV AS POSSIBLE 419 Second Street FILE NO. p No REPLY NEEDED MUl�S€)N, WISCONSIN 5016 Qna Id Alvin ATTENTION TtJ Phone 715 386 -3623 � suaJECT Se`�age system lns X�aWat1T3 Co. Ott. Joseph 'Down Hall g Monroe Street North ` St. Croix County jjiZdsQxa , wx 541316 Cir MESSAGE - :. Bear ' Don > This letter is to inform you that tale sewage disposal system at the Jc�aepb Tower must installed by liconsed master plumber, d ear our , can for JT 3 _ �.. the itch 3eeiteling crock unless they haves li rise; an r s SIGNED .. an On R$PLY t + ! I ' DATE OF REPLY � r SlGNf© - �.. ,, c .`-.> . 7°`.r, ` . ,.... " . .. .. . , = .. .mac' ".' •- r Z - ' ~ 'REPORT OF INSPECTION SEWAGE SYSTEM San.itany Penm.i� _ I State SQpt.ic / / NAME a ownah.ip S$. Cno.i•x County L ocati on ! S�' Sect�.on SEPTIC TANK y• Size g attonb. Numben 96 Compantmentb ViAtance Fnom: Wet 12% on gneaten mope it Bu.itd.ing o�7 Wettandb 3j` #. H.ighwaaten it. VISPOSAL SYSTEM Vi,6tanee From: (0 et 12% on gneaten etope Bu.itd.ing Wettand.a ��� F t. H.ighwaten t. FIELD DIMENSIONS: Width of trench l d it. Depth o6 rock below .tile _ -.n. Length of each tine it. Depth o6 noek oven , t•ite -- .i n. 1 Numbeh. o6 tine,a J Depth pi t.ite betow gnade .in. / Totat Length oS Una it. Stope" of trench .in pek 100 it. D.i d Lance between t.in.eA i t. Depth to b edna ek jt. Totat ab.aonbt.ion anea Depth to gnoundwaten .. D� ; t 2 Ty a e.= ox Straw Pa Requ.ined anea � � yp � Cav PIT DIMENSIONS: Hum I bea of p.ita Gnavet around p.ite yed no OutA.ide diameters St. Depth betow .intet fit. 2 Totat ab,6onbt.i.on anea it > Area nequ.ined it2 ^' INSPECTED L 1 TITL1 APPROVED _00� — ,DATE p.. 19 1': REJECTED ,DATE 191 1 • . ~ TRANSFER FORM SANITARY PERMIT 6 State Permit r # 11111111111T PLB Sanitary Permi County Sanitary Permit Transfer Date Original Permit Issuance Date A. Property Location: G✓ '/, 54 Section T _qQN,R_Z7_ E (or) W Lot s �# , �— City Subdivision Name, Nearest Road, Lake or Landmark BLK Village Township c B. TYPE of Occupancy:.Commercial Industrial Other (Specify) r Vl N -A r � Single Family Duplex No. of Bedrooms Variance C. SEPTIC TANK CAPACITY 1 : Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks . Prefab Concrete Poured -in -place Steel _ Fi;berglass Other(Specify) New Installation Replacement LIFT PUMP TANK /SIPHON CHAMBER Total gallons Prefab Concrete Poured -in -place —Other (Specify) D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate _ L " 'Total Absorb Area 7jft2 sq. ft. New Replacement Alternate (Specify) Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) � No.7renches Seepage Bed: Length Ya Width I& / Depth Tile Depth(top) _ ' No. of Lines_ Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits Percent slope of land Distance from critical slope E. WATER SUPPLY: J' Private ❑ Joint Q Community ❑ Municipal Present itary Permit Holder Phone No.7 — nitary Permit Transferred To: Phone No. VA- X V s9 Nam ° A Aj Name Address �Z�� Address w ` `y , Zip— Zip S�7 I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with section H 62.20,, Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH -115 prepared by the Certified Soil Tester and /or any additional soil to is that may have been required. Plumber's Signature MP /MPRSW # ' la 67 Phone Plumber's Address i Information obtained from owne r agent) PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include erection of slope and all distances in accord with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh- bor's Propert . If well has i indicate- Signature of Issuing Agent j A Aj, J 1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH 2. State (White copy) 4. Plumber (Green copy) P.O. BOX 309, MADISON WI 53701 PL8 6 � � State and County State Permit # 7 5 ' Permit Application County Permit .11 for Private w to Domestic Sewage e S stems County 9 Y *DENOTES STATE APPROVAL REQUIRED tt Date Approval Received from State if Required r 7 State Plan I.D. # U 3 y A. OWNER OF PROPERTY Mailing Address: 1 0, - ) , o : t P 6 B. LOCATION: h L-) % � '/4, Section 3� , T `30N R I4 E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township Sh 7?0 s E1J C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) �rian'ce _ Single family Duplex No. of Bedrooms No. of Persons ` D. SEPTIC TANK CAPACITY 1100 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured -in -Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area 7o b sq. ft. New t Replacement Alternate (Specify) Seepage Trench: _0_ No. of Lineal Ft. Width Depth Tile depth (t P )__ No. of Trenches Seepage Bed: — _ Length - f K Width — Depth 0 Tile depth (top No. of Line Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private ❑ Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than p owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certif So' Teste NAME e. � �C_ 9 � re 1.,0CL C.S.T. # (:;5 n and other information obtained from (owner/builder). Plumber's Signature MP /MPRSW# `fr y Phone # j —3 86 Plumber's Address -.✓ �. PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. �. .. . E ...4, ....� e� E i ! k } j 4 [ i e E E i r t .m+ .- c _,..,.. E . ...._, ,.. ...,.e _ .. m.e ...c. .,«. ...w.,.. e, as...e .... ,,, �.... ... ._.,. ,., .... ._. .. . „. .. ..... .).-.. ..,. .. .......A f m <s_ .. r _ t Do Not Write in Space Bel w FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application r 0 7 y Fe Paid: State 1_5 County Z Date 1 --jog 7I Permit Issued /Reject (date) L 2 Issuing Agent Name Inspection Yeso State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 711178 EH 115 ` • 4 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS Sheet 1 Of 2 LOCATION: NK ' /a, Section 30, T_ON, Rl� E (or) W, Township or Municipality �t Joseph Lot No. 1 Block No. - Certified SUnW Man V.3 P. 755 County St. Croix ubdivision ame Owner's Name: Town of St Joseph Mailing Address: oltmteer TYPE OF OCCUPANCY: Residence No. of Bedrooms Other Pin- Station EFFLUENT DISPOSAL SYSTEM: NEW x ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS 7/5/79 PERCOLATION TESTS 7 /S1 79 SOIL MAP SHEET 41 SOIL TYPE XXlK1KZ)MX COC2, OtB PERCOLATION TESTS TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL NUM- INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN BER P_ 1A 96" 24" BnL; 20" Bn S L; 10" Si L; 1 - 10 5" 5" 5" 2 27" S; 10" Si; 5 Bn S P 3 102" 30" Bn S L; 30" Bn L; 30" C Bn 1 - 5 6" 6" 6" 1 S &Gr; 6 Si; 5 Lght Bn S & Co P7 4 Bn Lf 20" Bn L��& S layered t � 73 Bn S; 9 Si; 5 Lght Bn SK ob 1 - 5 6 6 6 1 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B _ 1 110" ]110 48" Bn L; 60" Bn S; B_ 2 150" 7150 20" Bn L; 35" Sil,mottled; 55" Si $ S layered; 42 ILg ht Bn S & Cob B-3 .145" 7145 30" Bn S L; 30" Bn L, few faint mot; 30" Coarse I S & Gr; 6 Si; 48" Lght Bn S & Cob PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square fefbaf g to W areas. Indicate number of square feet of absorption area needed for building type and occupancy. �"tt Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. ' t N 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 location of test holes are correct to the best of my knowledge and belief. Name (print) Walter J. Gregory Certification No. 55 -588 Address Ogden Engineering Co 123E Elm Street, River Falls, Wisconsin 54022 Name of installer if known Job No. 79 -1154 CST Signature COPY A —LOCAL AUTHORITY EH 11'5 y WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 Sheet 2 of 2 REPORT ON SOIL BORINGS AND PERCOLATION TEST LOCATION: NW N., W_%, S6ction 30—, T30N, R 19E (or) W, Township or Municipality St. Joseph Lot No. 1 Block No. Certified Survey Mai V. 3 P. 755_ _ County Subdivision Name Owner's Name: TOW11 O Mailing Address: ASSembly Hail & KuraI_Vo TYPE OF OCCUPANCY: Residence No. of Bedrooms Other --Fire Stat ion EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS 7/5/79 PERCOLATION TESTS 7/5/79 SOIL MAP SHEET 41 SOILTYPE XCIMM COC2, OtB PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN P -1 64 ", 48" Bn L; 16" Bn S 1 - 10 5" 5" 5" 2 P— P— SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B_ 4 190" 7190 40" Bn L; 20" Bn L 4 S layered; 73" Bn S; 9" si; 48" Lght Bn S & Cob B- 5 130" T130 60" Bn L; 70" Bn S & L layered B- 6 170" > 170 40" Bn L; 15" S & Gr; 41" Si L & S layered; 14" 1► 11 PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. 700 Sri Ft Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. B- 7 1 0" 50 1 1 2 d 31 • 2 It " Bn SHE T CE DT ILDMAP. N R S( ED 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 location of test holes are correct to the best of my knowledge and belief. Name (print) Walter J. Gregory Certification No. 55 -588 Address Ogden Engineer Co., 123 F ELM Street, River Falls, W; s .onSin 54022 Name of installer if known Job No. 79 -1154 CST Signature COPY A — LOCAL AUTHORITY rry r , f ' � h `._,x '. , i, .: — •r $ 3r a:. j T 3 t '—�-.^ 4✓� f; y @@SS��,, �Y„ 4'.i — -� - " , � , ; � , � , .. -1—.1 - � � y rf r t. as fi" 4 Y .r C Ft n z �,' � * �' t +-1, . � � i , "AI. . , ��v 1 � �- . , - 1. "I � I I., : .. � I i , , . , � �� - , n r a , Yt - - ,,, .- - �.� , . 1. � 1 , �., � . , , -�- . -, , - 11. � , " : " , �� " �.,: � �—?� 'i, - .,It I �'-- � , ". � " ,, , -, ,:i -.! �,t, - I ... .c Y '' 2 e ,14T, .Y1C_" G a h t A �.. . 'YI \: -, fic y d' aY fi.. Y F ,� t 4 Y Y A Y' •t 6 ". ^� < » �: . fi �'r e t i y y � s 3 '; s s. . r a _ „. 4 1 S 7 F -,a,� .-Y e-f w - 4 t Y y- y y � C + � � wP *� - �{fi4 :�� C � ,: ; 1� I 1; — - — , 1 � I � 1. a Y y. J ` IL t * 'i" 4, _t i q `" J A' ' :YL *`{, ylZ� "F �"'Sr �TgR ;'yyTj. Y y 1. Z� �, Y,,. 4 3 3� .r �! 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