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HomeMy WebLinkAbout030-2001-95-000 f o i f 3 w d ~1 10 0 o m o > > D M v CD m cD ` 1 y rT cJ~ O C/) z z C,3 (D ? d N N O O c~ O y O O A W ca ca °C • (p < O (D CO CD c a O ~ O CA V1 ~ Z COi y N 7 i N O NO '►7 lA\ O O N N (D O W y D V O r.: N CL 0 O O ? O 7 C O COT N O O C N O 0 O v 3 0 E O .7. O 7 y CO 7 y' !i 7 O Q C C ! O r7 cn Z D CD X cn D a (D (n CL o =3 ao m (D CD C: ;0 W a W W a O a O m 25 , CD a; N N F~ i C N fT = N N C y A W y A A O N .O. Q 1~~i1 m lV • 0 00 cS0 CS0 -M 000 W y y y (n -_R o N OIQ a to fn ca 3 rn 3 v v y 0 =r vi. F Er -0 0 ;g - CD CD 0 ju :3 O N = 3 m m 3 a CA N z Z W Z Z co Z 0 D o o D a 0 0 v o o 7 0 , "W• EY CD D CD X m e 0 c CD CD N O M. C O C CD O w m n n 3 v ~ ~ ~ CD -1 N CD N D N °c v d CL A ~ 3 o. G~ w w CD A lD < O CL c 3 3 3 CO D7 x (D y W "a ' A W co 0 O Q'mm CD 3 3f:3 < CL m 1 CD o CD N 3 CD T 3 T N> p y 41 C O y N C X d CCD N W Z G O O O Z O M O D7 O W [D =r N) a r y a T N y x o- O0 ~'.n M. 0 0) c = a =r .am m 0 0 o a °a 0 c 8C:) ~D-Em 3mo F N ° m O - ! y O N O S N CD CD CD 3 (DD ti N o -3 N y N =r O O f O a O O CO j H 7C A < w (D O d0 O N fA O 69 O v -00 C) CD C) CD O O a N y Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix &~,etyand Building Division INSPECTION REPORT Sanitary Permit No: 429950 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: Dunn, Brian St. Joseph Township 030-2001-95-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 1 3 13 (4. e.t"', . or-~ x'57 33.30.19.362C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 9 -7 -5 Dosing Alt. BM Aeration Bldg. Sewer Holding SUHt Inlet 2st~~ ( W TANK SETBACK INFORMATION St/Ht Outlet ' I 9 13 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom > Dosing Header/Man. Aeration Dist. Pipe -r- t 9 • P,,7 76 Holding Bot. System -r - 1 /0.7- 64-7 Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM 93,70 Model Nu er -O.`~ TDH Lift ion Loss System Head TDH Ft Forcentain Length IDia. Dist. to Weu SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS .3 (19 Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manuf cturer: INFORMATION CHAMBER ORj r 1 Type Of System: z U 16 i (U Model Number: C.~hUt n 1 crc UNIT 'z / t~, 5 4- DISTRIBUTION SYSTEM > p eJ. c , G- Header/Manifold Distribution x Hole Size x Hole Spacing V r ntake ,I Pipe(s) -71 r Length-""/?- Dia_ _ Length Dia Spacing ~ I SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Seeded/Sodded xx Mulched epth Over Depth Over xx Depth of T Be rench Center Bed/Trench Edges Topsoil r., Yes [ ] No L Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 / 0'( Inspection #2: paw r Lo tion: 518 Cty Rd E Hudson, WI 54016 (SW 1/4 NW 1/4 33 T30N R1 9W) NA Lot Parcel No: 33.30.19.362C v, S`ic. l~ c . r, rJ 6'b Alt BM Description = Pj o -4 ct" 5 i C(• ^ k ah o v ¢ S c c+-> [ 8 U r SG - 2.) Bldg sewer length= - amount of cover = > / $ Plan Use other side for additional information. i 112 r - ID-6710 (R.3/97) Date Insepctor's Signature Cert.' -•-••q uuuwn a 1.0"1~lvu t_oun Nvirscont~S ?Al W. Washington AveP.O. Box 7162 _ s,~ Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 112, qq Sanitary Permit Application She Plan I.D. Number/ / In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if differen than mailing address) 1. Application Information - Please Print All Information C- -R O is Na me Parcel mac EI VEp Lot >Y Block # r2 0, ~w ✓t Y~/ 030 -boo/- ~S~yjd Owner's M ~ailing Addrgs L 2003 Property Location ~k5 C 3-q S City. State zip e 'S'e lion 3 3 ~ Z NI OFFI ' d ~ D (cirri 0) O 3~O7i~ . Type of Building (check all that apply) N; E a y or 2 Family Dwelling - Number of Bedroo (S~j~ Subdivision a CSM Number ❑ Public/Commercial - Describe Us N A ❑ State Owned - Describe Use W - ❑City_❑Village wnship of's I _)0. M. Type t: (Check only one box on line A. Complete line B if applicable) rA7ffNew System eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System L. B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner V. Type of POWTS System: (Check all that a ly) l Non -Pres Udged In-Ground ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter thing Chamber ❑ Drip Line ❑ Gravel-less Pipe Other (explain) _ it p cj ; 3i / 9 3_ V. Dispersal/Treatment ' Area Information: S r 10`1~ 1, 1,7M& Design J C)w (gpd) Design Soil Application Rate(gpds~ DispersalArea Required (sf) Dispers~ oposed (s✓ System evatio VI. Tank Info Capacity 7, _5 in Total Number Manufacturer Prefab Site 1 Fiber Plastic Gallons Gallons of Units / ,l Concrete Constructed Glass New Existing .-1QCJ Tanks Tanks'` ✓ Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statemen the mid , assume cesptinsibility for mstanat' a POWTS shown on the attached plans. PI he me (Print) Plum i gnature MPfM tuber Business Phone Nu her J-- Plumber's Addre ss (Street, City, State Code) 2- 1,J c-tIA sal l VIII. otmt /De artment Use Approved ❑ Disapproved Sanitary Permit Fee ( ludes Groundwater Date Issued ing A t Signature ) Surcharge Fee) ❑ Owner Given Reason for Denial '~~~777 S/~ 0, 3 LX Conditions of ApprovaUReasons for Disapproval _ 3 ©u~nQ,tJ h'~~~~U~-vn ~~Nt Gin T 9_3, 3 D A plete (to the County nty) for the system on paper not less than 81/2 x 11 inches in she ~BD-6398 (R. 01 / c p,1e,1t ~,rerrerca SOIL EVALUATION REPORT Page of Division of Satiety and Bungs in accordance wish Comm 85. Wis. Adm. Code . Attach complete site plan an paper not less than 8 iR x 11 inches in size. Plan must Corny iz_; inckift but not trotted to: vertical and horizontal reference point (BM), direction and parcel t.D. percentslope. scale or moons, north arrow. and location and distance to nearest road. d 0) S . Please it an RebE D Daft Pasant Womation You provide may bow for secondary purposes (Privay . s.15.04 (1) (m)). 7 0/ Property Owner A P 14 2003 Property Location 1 bq) Govt. Lot SU A S3_3 T30 N R E( W o n PropectyOwneesMaftv Address, ST. CROIX COUNTY Lot# Block Scrbd. Name or ZONING OFFICE zip code Phone Number --S b OCKY ~ O vap ~ TNearest Road Q, New Carmtrurction Use Residential 1 Nixriber d bedrooms code derived design flow rate J" O GPD Replaoerrrert ❑ Pubic or commercial - Describe: taarent note" i .cJct~ Flood Plain elevation N applicable 114 fL ° and en°rai°°'""errts ~y 5,4~ Q le ►,~,c.~~iv8~'' q87, ~bb I )3 1 taz.J err ` a ,3arirg # ❑ F I pit Ground surface elev. R Depth to Brining factor _1. in. ~ Ankeflon Rats Had= Depth Dominant Wor RedwcDescfloam n Texkxe Sbuclu a Consistence Boundary Rods GPOW ir. Munsell QU. SL Cont. Color Gr. Sz. Sh. 'EfWl 'Eff#2 1 4 O - !n -r D~iw S S ^/0 Ally ` ? /.z Boring ~z ,C! Pit Ground surface elev. ft. Depth b 6ntiting factor in. ~ Appocalion Rate Horizon Depth Dominant Color Redox Descriplion Texture SUudur) Consistence Boundary Rods GPDW in, Murael (1u. SL Cont Color Gr. SL Sh. -MI 'Etf#2 a -7 n J^ / 01 • EMuert #1 = BO(k > 30:5 220 mWL and TSS > 50 nVL • EIkrent #2 = BCo < 30 mg& and TSS 130 nrg1L CST Name (Please print) CST Number ut,3Mic~ zU 00 Adniress Dale Evaluation Co xkxftd Tekeptane Number ~~f~ ~ G✓1 .S~' Ql ' a 3 7I~ - ~ ~ ~ ~ / 1 J ' V PW*al ID, Page of Rmpedy Owner Hodmoo Depth Danimt RedoK Description TOM" Strochre Corrsslence Boundary Rook GPOHI: In, CkL Sz. Carte color or. sr. sh. • F-1 2 s 3 ❑ pit Ground seW►_ tt Depth bra tactor in. Sol Appicagon Rab ppminsid Redcrr Desaip5ort Teztine Skckm Cambl nce Boundary Roots GPI Horixort Depth amsea Qer. Sz. Coal. Color Gr. sr- Sh. OEM •i~k2 ❑ Bor"sto s El 11 pit Ground surface elm. Depth In i In g Sail ApiolicallOll Rolle tlorizorr Depth Dominant Red= Description Te~drae Sh oclure Consistence Bouhdary Roots 013mv Mrn'rsell am Sr_ Coat Color Qr. Sr_ sh. 1 ' • S&mt #1 = 9t7Ds > 30 < no molt. and TSS >30 < 150 we& • lint 0 = BCD, < 30 mo& and TSS <30 moll. The DepuMznt of Coerce a an coast oppmftnty mMm pwn&w and empl"a Hyon need asusbaee to access se vv= or wed material in an ab mate fmmat, please contact flee ftuwxmt at 60$-266-3151 or Tff 608-264-8777. s~as~otROaodl r Soil Test Plot Plan Project Name Brian Dunn Sha ird Address 518 Cty Rd E Hudson Wi 54016 TM #226900 3Y'3 Lot Subdivision Date 4/8/03 S W 1 /4 N W 1 /43 33 T 30 N/R19 W Township St. Joseph ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 88.8/87.5/86.1 *HRpSame as Benchmark Alt. BM Top of Steel Fence Post @ 97.3' Cty Rd E a~ 0 Id syste Existing location house to be unknow tom down 0 00' 180 Well 03 Bedroom 175' 95' House 93' 20' B-3 B. 453 91, 35' 0' B-1 ~ 11% Alt Slope B-2 PLOT PLAN y2~ PROJECT Brian Dunn DDRESS 518 Ctv Rd E Hudson Wi 54016 SW 1/4 NW 1/4s 33 /T 34 19 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5/1/03 BEDROOM 3 CONVENTIONAL X00( IN-GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100° Filter Zabel A-100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 88.8/87.5 Alt. BM Top of Steel Fence Post @ 97.3' C Rd E Vent Standard Biodiffuser Old system house to to Existing be of >6 Cover Leashing Chamber a location unknown torn down with 31.1 ft2 of Area 0 Plans Designed Using 6' Long 11" Conventional Powts 3 411 Grade at System Elevation Manual Version 2.0 00' 180 Well 10~' o3 T Bedroom Z 175,, t S°'Y ~°'r9 use Ven , 10 20' *B.M. B- 35 i Vents i 11% 2-3' X 69' Cells with 3' Spacing Alt. Slope 51 Ko...~~z B-2 ~'vkl~C S-~L Y cupy PLOT PLAN -#412q q,!~z PROJECT Brian Dunn DDRESS 518 Ctv Rd E Hudson Wi 54016 SW 1/4 NW .1/4s 33 730 19 W TOWN St. Joseph COUNTY ST. CROIX i MPRS Shaun Bird 226900 DATE 5/1/03 BEDROOM 3 CONVENTIONAL )XX IN-GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A-100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 88.8/87.5 Alt. BM Top of Steel Fence Post @ 97.3' C Rd E Vent Old system Existing >6" Standard Biodiffuser house to be Leaching Chamber location of Cover unknown tom down with 31.1 ft2 of Area c 11" Plans Designed Using 6' Long Conventional Powts 3 411 Grade at System Elevation Manual Version 2.0 00' 180 Well 10' 10' 03 T Bedroom 175' House Ve 10' 20' * B- B.M. 35' 3 Vents B-1 11% 2-3' X 69' Cells with >3' Spacing Alt. Slope C_ 5' B-2  T I I ~ZR~S"a Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2.Replace other any ailing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shan Bird u #226900 ST CROIX COUNTY MA24TEliIANCB AGREEMENT' - SEPTIC -TANK : - AND OWNERSHIP CERTIFICATION FORM Ljot zl ! )L n- owner/Buyer C Mailing Address S/f property Address" - - - (Verification required from Ph o ng Department for new construction) City/State Parcel Identification Number 0 3v'.26 6 S~ - ~ LEGAL DESCRIPTION • ~ _ 3~2 Property I,ocation~ 2 Sec. N-~~w9 Town of Lot # Subdivision Certified Survey Map # . Volume Page # _ Warranty Deed # 5S 9 jr/ S , Volume jj~ ~ Page It Spec house ❑ yesAno Lot lines identifiable)4 yes ❑ no SYSTEM MA-MTENAN Impmperuseandmai xofyoarsepticsystem if nooded by a licensodpumpez What you 1 into the consists of pumping cut the septic tank every three years or sow can affect die function-of the septic tank as a ftutment stage in the waste disposal systM-property owner to submit to St. Croix Zoning Damtricut a certification form, signed by the owner and by a The agrees master ptumber iouraeymanplambe4 metedpiumberoralkensedpumtper verifying that (1)theera-sifewastewater disposei system is in proper operating condition and/or (2) after inspection and pumping (if nary), the septic tank is less than 1/3 fan of studge- Uwe, the undersigned have read the above =qfteMMft and agree to maintain the private sewage disposal system with tfie standards set forth, he rein, as set by the Department of Commerce and the DeparlmoUt of Natural Resources, Sbft of Wisconsin. Cat cation stating r!4 =y= sqok_-s~ztem has been maintained must be completed and returned to the St.-Croix County Zoning office within 30 iration date. SiGNA OF APPLICANT DATE OW~[L' R CLi RTIFICAf I'ION knowled e the owner(s) of ,Uwe) that an statements on this form are true to tie best of my(our Office• • I (we) am (are) above, by virtue of a warranty deed recorded in Register of Deeds y~ A OF APPLICANT DATE Any information that is mis-representedmay result in the sanitary permit being revoked by dw Zoning Department Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed teQL 1:~~4PACE4~5 /rim STATE BAR OF WISCONSIN FORM 5 - 1982 588815 i' PERSONAL REPRESENTATIVE'S DEED A DOCUMENT NO. Al G. Bliven REGl~1~1`Il~.t ST. CROIX CO., wl ------~-onzo Rat:'d for naoord as Personal Representative of the estate of OCT 4 9 1998 na iven 9'30 ,qM ("Decedent) -4, for a valuable consideration conveys, without warranty, to Re bt~r of Deadr Brian J. Dunn, a single person, Grantee Count THIS SPACE RESERVED FOR RECORDING DATA . the following described real estate in - Y State of Wisconsin (hereinafter called the -Properly"): NAME AND RETURN ADDRESSTS TO' ~i1c fI I,Z7`l DOC 31"'i LCtCon1pany AI)SU ~o tlrrvt.rstl` Hvcnue WCS1 .f. 1 t ,~nnt 55114 Mat',=01 •vlinnCSOCa 030-2001-95 ll PARCEL IDENTIFICATION NUMBER .l l A parcel of 3.9 acres located in the SWi/4 of NW1/4 of Section 33-30-19 further described as follows; from the NW corner of said l: Section 33 go S20201W 1313.9 feet, thence S10151W 175.2 feet, thence S76032'E 641.2-feet to pt7Tnt- of beginning for parcel to be- conveyed herein, thence N110111E 338.0 feet, thence N89025'E along the N line of said SW1/4 of the NW1/4 426.0 feet, thence S10007'W 436.5 feet to centerline of CTH, thence N780191W along centerline 94.0 feet, thence N760321W 332.0 feet along centerline to point of beginning. TRAtiSFER EE !,I Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the Personal Representative has since acquired. Dated this I;(D~ day of June 19 98 (SEAL) (SEAL) Alonzo G. Bliven E Personal Repre a ! Personal Representative tj JULIA A. DAVIDSON NXARY PUBLIC - WNlESOTA AUTHEN I TjQtjnwtt4sbnEzpiet,len9t,2W0 ACKNOWLEDGMENT Minnesota State of)V=K40}5Xn, Signature(s) ■ ss. Wg JW RAMSEY County. q authenticated this day of Personally came before me this day of , _tT X- C_ 19- the above named ' - Alonzo G Bliven, Personal Repre-d sentative of the Estate of Edna TITLE: MEMBER STATE BAR OF WISCONSIN r Bliven, (If not, D authorized by §706.06, Wis. Stars.) to me known to be the person who executed the foregoing I Y N instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland 8lwy f Hudson, WI 54016 ry Public, County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiirraoooat). necessary) - _.j, ` Names of persons signing m any capaiily should be typed or printed Belo SLATE (BAR OF WISCONSIN Wisconsin Legal Blank Co_ Inc. Form No. 5 - 1982 Milwaukoe. Wis. PERSONAL REI'RESF.VTATIVE'S DEED I Form- STC- 104 AS BUILT SANITARY SYSTEM REPORT e OWNER TOWNSHIP TQ SEC. 33 T30 N-R__LLW ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r ~i fk 1IG 5 P ~ e se~p•~ ~o° f?49V 1r ` ~ fps • ~~t' r'!. 99. J M i tel. Pee Top, e4 /oo: C Ty INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used TQp jCL Elevation of vertical reference p int: ~a Proposed slope at site: 3 ~s go SEPTIC TANK: Manufacturer: Liquid Capacity: /Q o o Number of rings used: _ 3 Tank manhole cover elevation:,~~ Tank Inlet Elevation: J' Tank Outlet Elevation: 9y Number of feet from nearest Road: Front, Side, Rear, c O feet From nearest property line Front,OSide,ORear, feet Number of feet from: well 6 I building: al (Include this information of the a ove plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: tom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSOR=PTION SYSTEM Bed: - yfS Trench: Width: Z841 Length: ` Number of Lines: 3 Area Built: __4& o Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,(VNFt. Number of feet from well: 77 ~YY Number of feet from building: pA (Include distances on plot plan). SEEPAGE PIT Size: Number of t Diameter: Liquid depth: Bo t Aeepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: E1 a i of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, n Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: I Inspector: Dated:. 7 Plumber on job: L`___^qe Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 • . ONVENTI NAL ❑ALTERNATIVE State Plan I.D. Number: (If assigned) D Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT OLDER, $NSP C ION DATE: Art Be,%ven, St. R. R. 2, u6on, W1 py - o?: Oa BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: SW NW, Section 330 T30N-R19WJ. Town of St. Joseph Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number: Don schmitt 3205 St. ctoix 54902 SEPTIC TANK/HOLDING TA K: MANUFACTURER: LIQUID CAPACITY : TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKIN OV tj o /J -27 YES ❑ NO NO H BEDDING: VENT DIA.: VENT MAT HIGH WATER NUMBER OF ROAD: PROPE RT WELL: B ALARM. FEET FROM © LIN AI IT-INLET DYES ONO OYES NO NEAREST 1 _515 DOSING CHAMBER: MANUF AC C URER HAMBER: BEDDING: LIQUID CAPACITY PM DEL. PUMP/SIPHON M ACTURE WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ONO OYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL ER OPROPERTY WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN LINE AIR INLET: PUMP ON AND OFF) DYES ONO 7FROMF EST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth f plowing IVrJ(, H DIAMETER MATERIAL AND MARKING or excavation. (if soil can FO CE be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF DISTR PIPE SPACING. COVER INSIDE DIA.. #PITS. LIQUID BED/TRENCH I J TRENCHES MAgfi L' PIT DEPTH: _3 DIMENSIONS GRAVEL DEPTH FILL DEPTVH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DI NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW P PES: ABOVE COER ELEV INLET ELEV. EN PIPES. Llf..y AIR I ET: !~/I FEET FROM `Jl 2,,, dd NEAREST-i MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- D meets th criteria for medium sand. TIONS MEASURED. YES ONO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOP OIL. SODDED SEEDED: MULCHED: CENTER. EDGES. DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATER L SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. JNO. DISTR. ID ISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.: ELEV.: CIA.. ELEV.. PIPES. CT: ELEVATION AND . DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: DYES ONO DYES ONO BUILDING: COMMENTS PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL FEET FROM LINE: OYES ONO OYES ONO NEAREST 6. a ills ~.72 Sketch System on in ' county file for audit. Reverse Side. SIGN URE- .~4 TITLE: DILHR SBD 6710 (R. 01/82) wlsconsln , APPLICATION FOR SANITARY PERMIT DILHR COUNTY - OEPRRTmEnT01 UNIFORM SANITARY PERMIT # - InOLI5T94Y.LRBOR6NUTRnRELRTIOI"IS 5y 9D _ -Attach complete plans in accord with s. H 63.05, Wis. Ad . 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 OWNER MAILING ADDRESS T L U ` " N d~1r m&Z PROPERTY LOCATION CITY: V1 1/4 10/4, S , T Q N, R/ E (or wlv of r LOT NUMBER B T LOCK NUMBER SUBDIVISION NAME EST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER 2 TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: ❑ New System Tank Replacement ❑ Repair 1. Replacement Soil Absorption System Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity X ffA &A &A Lift Pump Tank/Siphon Chamber Holding Tank capacity manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallo Tank Concrete Constructed Septic Tank Capacity Lift Pump Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 3-3-3 Z/00 LK Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewag system shown on the attached plans. Name of Plumber (Print): Sign re M MPRSW N Phone Number: 11-1A1 1 mzlvs N5 04 Plumber's Address: Name of Designer: c2 ja l~ ~k 5-1 D e. T .jE COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved / 0 ❑ Owner Given Initial b Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PERMIT S T C - 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. - - - - - - - - - - - - - - - - - --1- - - - - - - - - - - - - - - - - - - - - - - Owner of Property A~~J7~ Location of Property Section, T N - R W Township ~OSe12& _T Mailing Address 6 Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes ~ y No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTV OWNER CERTIFICATION I (We) ce4ti4y that att statement6 on this 6otm cute Uue to the best o6 my (ouA) k.nowtedge; that I (we) am (aAe) the owneA (s) o6 the p4o pehty deb cA bed in thi6 inSoAmation 4oAm, by vixtue ob a wakAanty deed %ecoAded in the Oj6ice of the County Registea o4 Deeds as Document No. tj / ; and that I (we) pAesentty own the proposed site ion the sewage dizpozat system (on 1 (we) have obtained an ea6ement, to nun with the above desc& bed p)Lopen ty, bo,% the consth.uctc.on o4 said system, and the same has been duty Aecohded in the 046ice of the County Regizten. o6 Deeds, as Document No. 3&54v7/ ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED irnlRRw~ oocuawtllT ho. STATE BAR OF •1KON51N-FORM 2 r VOl.. 1;~ :149 wAtau►NTr DEW 3656'71 THIS SFACI a/SINVIO rOa RICOROING OAri ~j ~1 - REGISTERS OFFICE DARREL E WERT and BEVERLY A W£RT, his wife, ST. CROLX CO., WL% Rix'd, fix W--.Ord eiis bth duy ct_;ucust A. D. 190 conveys wnd warrants to _ ARTHUR RT.TVF.N SR and \G2 ua A £DidA,BLIVEN. husband and wife as joint tenants, ~ $Q a4d J0 cgnnidprat-inn nf the sum of i« of pe.dr -$15,000.00, ~ atTUaN TO the following described real estate in St CroiX County, s State of Wisconsin: Tax Key No. A parcel of 3.9 acres located in the Southwest Quarter of the Northwest Quarter of Section 33, Township 30 North, Range 19 West, further described as follows: From the northwest corner of said Section 33 go South 2020' West 1313.9 feet, thence South 1°15' West 175.2 feet, thence South 76032' East 641.2 feet to point of beginning for parcel to be conveyed herein, thence North 11°11' East 338.0 feet, thence North 89025' East along the north line of said Southwest Quarter of the Northwest Quarter 426.0 feet, thence South 10°07' West 436.5 feet to centerline of CTH, thence North 78°19' West along centerline 94.0 feet, thence North 76032' West 332.0 feet along centerline to point of beginning, subject to highway easements of record. (This Deed is given in full satisfaction of a Land Contract dated December 21, 1971, recorded September 13, 1972, in Volume 489, page 190, Document No. 312360.) t•T This is s not homestead property. S, Q D (is) (as not) Exception to warranties: Dated this 15t day of - August 19 80, 1 (SEAL) (SEAL) Darrel E. Wert - - -(SEAL) ' (SEAL) C ~n - - - - - Beverly ~i Wert AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this 1St tay of STATE OF WISCONSIN August 19, 0 ss. ,L L/ NJA _ County Personally came before me, this day of l Hugh F. _Gwin the above named TITI.F. MEMBER STATE BAR OF WISCONSIN authorized by ;;06.06. Wis. Stars.) This instrument was drafted be Hugh F. Gwin, Attorney Gwin, Gilbert, Gwin & Mudge to me known to be the person who executed the fore- 430 Second Street going instrument and acknowledged the same. Hudscn,_Wisconsin 54016 N/A (Signatures mac be authenticated or acknowledged. Both ' n.•cessuy. i Notary Public --County. Wis. My Commission is permanent. (If not, state expiration date 19 ~I: cTATE BAR Or WISCONSIN FORM NO 2-1977 z • H a ST C- 105 r ' a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a OWNER/BUYER ROUTE/BOX NUMBER Fire Number CITY/STATE -zip _ ve j Section,- ?,3 L 0 N R / W, PROPERTY LOCATION: WI s- Town of , St. Croix County, i Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 606 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this.program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly .maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-eite wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 E I/WE, the undersigned, have read the above requirements and agree Cn to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ~n 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. f~ S I G N E Di~yi(~y`~~ , ~c CG? DATE St. Croix County Zoning Office P. 0. Box 98• Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DEPARTMENT OF RLRORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION P.O. BOX LABOR V RELATIONS PERCOLATION TESTS (115) MADISON W 53707 (H63.0911) & Chapter 145.045) L CA I / E TION: OWNSHIP/~: OT NO.: BLK. NO.: SUBDI VISION NAME: SiV '+w4/ 33 /T3 oN/R1 D(o s i J,-,, - COUNTY: WN Ant ER'S BUYER'S NAME: MAILIN ADDRE.S,SS: / A ♦ V~r X A4-teem J J Y A. r I .fOf/ 4! VCY6j USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: 1PEFICOLATION TESTS: Residence El New Replace _ /3 A<0,0 rAR RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-I -FI OLDING TANK: RECOMMENDED SYSTEM: (optiona ) ® S DU L9S ❑U XS ❑U ❑ S [9U 0 S ZU C-o-w( i , A J CaZlg If Percolation Tests are NOT required DESIGN RAT If any portion of the tested area is in the under s.H63.09151(b), indicate: Floodplain, indicate Floodplain elevation: PR FI DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-IM9MC9- CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTFfrMh ELEVATION OBSERVED EST. HIG H S TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- l a ' v ' OK S.0 8 /s` / ,3 efn I .3 . G n .ft B-oZ ,0 _0' . d n I Span S/ . 7 A St r B-..3 6'U ' b3,401 .7 h 9/ S B- B- B- PERCOLATION TESTS TEST DEPTH# WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 149A66- AFTERSWELLING INTERVAL-MIN. PERIOD RI D PER INCH P- / 0 3 C' 6 G P- o P- -3 2-if me P P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. , e = b•r/~a~~ E~- ~a3 I' SYSTEM ELEVATION 9• ? I I f ff 0000 d ~ i i 4 ' ~ l j ~ lZC',>c jr~~~ ~e- 3 p - 78, o iT 1 f t " Y9!► 4 ,100.0 Fr t 1 YmP tell t 7 Ii ~ ~I t✓t_ Ar 44 , -5- 66-44, 10 { f wes f. D il~ I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods s cified 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 (pr TESTS WERE Z50MPLETED ON! 6 -13 -f q ADDR S: CERTIFICATION NUMBER: PHONE tjUMBER(optional): Joy a ~s= - CS AT RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - : , . I , i t , Ll" ys mv~ s`f ?gr : C I , Top- n - , i +a~ i I n /Raw VF p, N" p ~ t~NE : a~2 ~ a p~P -ypA n-O." , I t1R~cvcw~- ~l~R' ~-1 y-8y ~ Acr~~Nrr II ssc I. , , , r : ~furD~vN_ l.~✓_~ -~~~h<,'~ . _ : ~,~-r~2s~7` Gtr` ~d~S1 - , I , i _ Y . _ . . ~ . ~ _ - ~ - _ _ . _ _ _ . _ , _ i ~ i f I ' ~ i II, I y ~ ~ ~ ~ j ~ ~ ~ } i 1 , , ~ ~ , _ - i 7 i - - ~ ~ ' ~ i j I ( ~ ' , ~ I ~ ! ~ i i i 1 i i i i i i ~ ~ _ _ , ~ , 1 ~ 1 i 1 ~ ~ i I , ~ ~ i i I ~ I j ' , i i, I ~ i i ~ ~ I ~ I i i I I ~ i ~ _ _ ~ _ { ~ ~ i ~ ~ ~ 1 i ~ 1 i. i ~ ~ _ _ _ _ i 1 _ ~ I ~ ~ i ' ~ ~ 1 i 1 i { i i i ~ i i J ~ ~ I i I , 1 ~ ~ I. i ~ ~ ~ ~ ~ I 1 1 1. 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