HomeMy WebLinkAbout030-2015-40-200 `Wisconsin Department of Commerce E SYSTEM Count
PRIVATE SEWAGE Safety and Buildings Division
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353308 -
Permit Holder's Name: ❑ City ❑ Village ❑ ToWn of: State Plan ID No.:
Kavaloski, David St. Joseph Township ---
CST BM Elev.; Insp. BM Elev.: BM Description: D ' N Parcel Tax No.:
wu *-1 030 - 2015 -40 -200
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 2. n4 7S LZ -0 r
Dosing Alt. BM � 10 2- - �1 r
Aeration Bldg. Sewer ((. Z q ct6 r
Holding St /Ht Inlet (3, du q„�-'
TANK SE CK INFORMATION St/ Ht Outlet 13. 3 I
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic > CU 3-5 ` ( r NA Dt Bottom
Dosing NA Header / Man.
R3
Aeration NA Dist. Pipe t 3 23 .73
Holding Bot. System ` SZ q .2 .1-3
PUMP/ SIPHON INFORMATION F' al Grade r
Ma turer and St cover
Model Number GPM
TDH Lift Fri S stem TDH Ft
Forcem Length Dia. Towel)
S IL ABSORPTION SYSTEM
BED TRCAF6H Width c Length 1 N f s PIT No. Of Inside Dia. Liquid De
D
ENSIONS 1 Z 3 2 ( S DIMENSION
SETBACK
SYSTEM TO P! L BLDG WELL LAKE / STREAM LEACHING Manu urer:
BER
INFORMATION Type O �/ �y r CH CH AM UNIT el Number:
System: /
DISTRIBUTION SYSTEM 9 O 4-
Header J nifold u Distribu n Pipe(s) .. t x Hole Size x Hole Spacing Vent To Air Intake
Q
Length Dia. � Length � Dia. Spacing 1 . > '
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 El Yes El No [j Yes C] No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 40 �Insnection #2: — — Y —
Location: 861 Willow River Drive, New Richmond, WI 54017 (SW 1/4 SE 1/4 36 T30N R19W) - 36.30.19.415A -20 -Lot
1.) Alt BM Description
2.) Bldg sewer length = 4?'
- amo of cove,�r =� 2 ssiJ� 6° rwL
r� S '&'W ,k� Svvc�
&A)I
Plan revision required? Y s No
Use other side for additio matron_ fl� lb rm 2
SBD -6710 (R.3/97) Date Inspector's Signature Cert No.
2 y �
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
n Avenue
t
Washin
201 W
Ai s ' consin SANITARY PERMIT . go P O Box 7162
Department of Commerce In accord with Comm 83. r jA(�s. drn. e" - Madison, WI 53707 -7162
• Attach complete plans (to the county copy only) for the s s ey/i, o k�014t less 'C91l my
than 8 1/2 x 11 inches in size.
e r.
• See reverse side for instructions for completing this appl c�t<ion St r ay Sanitary Permit Num
3 3
Personal information you provide may be used for secondary purposes s�_ f eck it revision to vious application
(Privacy Law, s. 15.04 (1) (m)). ". , ` Plan Review Transaction Number
I. APPLI
CATION INFORMATION -PLEA E PRINT ALL thif OR All
Property-O Name ` s Lp /' 5 T , N, Ra E (O
Property Owner's M ilin ddress Lot Number Block Number
,� ? ' S' —
City, to Zip Code Phone Number Subdivision Name or S er
11. TYPE OF BUILDING: (check one) ❑ State Owned !t(
Public 1 or 2 Family Dwelling - No. of bedrooms Town OF
111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 3 0 19
1 ❑ Apartment/ Condo C,?a S=
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 box on line A. Check box on line B, if applicable)
A) 1. IZ New 2 Q Replacement 3, Q Replacement of 4 Q Reconnection of 5_ ❑ Repair of an
------ SYrstem _- -_ - - -- System - - - Tank Only ------ -- - - -- Existing System _ Existing System
---- - - - - -- - - - - - --
6) A Sanitary Permit was previously issued. Permit Number 'j S3 30$ Date Issued y
V. TYPE OF SYSTEM: (Check only one)
Non�Pressurized Distribution Pressurized Distribution Experimental Other
11,J4 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit it 43 [] Vault Privy
14 E] System-In-Fill
VI. ABSORPTION SYSTEM IN
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc Rate 6. System Elev. 7. Final Grade
1 915 IT 1 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. nch) Elevation 9L 73 Feet Feet
Capacity
VII TANK in Ca gallons Total # of Prefab. Site Fiber- Plastic Exper.
INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete stru n- Steel glass App.
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ I ❑ 1 ❑ 1 ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for in allation of the onsite sewage system shown on the attached plans.
Plumb r' ame' (Print) I Plumber' ' at e: (No 5ta MP /MPRSW No.: Business Phone Number:
Plumber's ddress (Street, Ci y, State, zi ode):
OF �p
IX. COUNTY / nIPPARTMENT USE ONLY
Q Disapproved S nitary Permit Fee (includes Groundwater D ate Issued Issuing Agent Signature (No Stamps)
Approved Q Owner Given Initial Surcharge Fee)
Adverse Determination 0• - f6 Z
X. CONDITIONS OF A er / REASONS F R D _
G ` C t♦Iw ' _ v ` W A
♦ `'.,,&
SBD -6388 (R.12/99) DISTRIBUTION: Original to County, One copy o: 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 a 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 be 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 and Buildings Division, 608- 266 -3151.
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.
Il. 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 on 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 for numbers 1 through 7.
VII: Tank.information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks ands
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.
VIII. 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 1/2 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 1.15 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 contamination investigations
and establishment of standards.
s
Safety and Buildings Division
AiS ANITARY 5C0�1S%/1 PERMIT APPLICATION 2 W. Washington ington Avenue
Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size. '
• See reverse side for instructions for completing this application State sanitary Permit Number
35 308
Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION ---'�'
Prop Owner Name Property Location
SA j 1/a 1/4, T3 , N, R o
Property Owner's M in ddiess , Lot Number Block Numbe
Cit , tate Zip Code Phone Number Subdivision Name or CS MNijmhpr
�' W -� ( )
I ll. TYPE OF BUILDING: (check one) ❑ State Owned 0 !t� Neare Ro
Public 1 or 2 Family Dwelling - No, of bedrooms l T own o /
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s�5 p r
3�.�o.t -1. a
1 ❑ Apartment/ Condo 6
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 box on line A. Check box on line B, if applicable)
A) 1. jg j New 2. ❑ Replacement 3_ ❑ Replacement of 4 ❑ Reconnection of 5. ❑ Repair of an
______ Sysstem ________ System _____________ Tank Only ____+_________ Existing System _________Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 Q Seepage Bed 21 [] Mound 30 [] Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 []Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill 3 (Z' K ,7-Z
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.) (Gais/day /sq. ft_) (Min. /' ch) Elevation
Feet Qe, Feet
Ca acit
VII. TANK in gallons Total # of Site
INFORMATION Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Aper.
New Existin Gallons Tanks concrete structed glass App.
T nks Tanks
Septic Tank or Holding Tank 6aw 1 1 0 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ I ❑ 1 ❑ ❑ ❑ 1 ❑
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for in tallation of the onsite sewage system shown on the attached plans.
Plumber' Nam : (Pri t� Plumb 's Si at N MPIMPRSW No.: Business Phone Number:
P u ber's Address (eet, Ci , Z y, State ode):
C7
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved nitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signature (No Stamps)
%Approved ❑ Owner Given Initial ;U 1�� ev Surcharge fee) —oZ
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R. 4199) 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 a 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 be pumped by a icensed'puinper 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 -and Buildings Division, 608 - 266 - 34,51. _.
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 on 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 for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /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.
VIII. 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 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan; drawn to scale o'r with complete d'i'mensions, 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 ona 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 contamination investigations
and establishment of standards.
now,
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Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page —,/— of
Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and a
percent slope, scale or dimensions, north arrow, and location and di tance to nearest road. Parcel I.D. #
tk 0"'
APPLICANT INFORMATION - Please print all information. R viewed Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 0) (m)). h �.Z+
Property Owner Property Locatidn;
Govt. Lot j 17`4 1l4 ;$ T N,R E (or�
Property Owner's Mai in Address Lot # Blo k #f Sulad. Name orb M#
IJAIl"? loci_
City State Zip Code Phone Number , Y ' a -<1 Neares o
-: -_ -----------
. ..........
(�] New Construction Use: Residential ! Number of bedrooms _ Addiition'to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 6 ' 4 1 7 — gpd Recommended design loading rate gy bed, gpolft _ trench, gpdfft
Absorption area required bed, ft ft Maximum design loading rate 7 bed, gpolft trench, gpolft
Recommended infiltration surface elevation(s) 7 ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material s <.� Flood plain elevation, if applicable ft
S = Suitable for system I Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for systeml LAS ❑ U ®S ❑ U ZS ❑ U 1 0 S ❑ U I ❑ S [2 U ❑ S .® U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDlft2
1 Qu. Sz. Cont. Color Gr. Sz. Sh.
Bed Trench
i 0
JA
Ground
elev.
Depth to
limiting
fa
in. . o Z O
Remarks: -
Boring #
Ground 1 `
e lev. r
ft. ,
Depth to
limiting
factor
.;� In. Rem rks:
CST Name (Ple Print) j Signature Telephone No.
c0 V
Address �� Date CST Number
i 1
PROPERTY OWNER C�
SOIL DESCRIPTION REPORT Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench
3 S -
9,22 A
Ground
elev. '
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench
Boring #
r ,
. j
Ground
elev.
ft. '
Depth to
limiting
factor
' Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in,
Remarks:
SBD -8330 (R.9/98)
• �i�d�.o ���s,�,� -.�/� -sue/ - ..s,Ee .3� - T.�e.�/- 7t'i`�u/
Gtr 4 5 &1
71 ,
pr, JK� 3
-TI
b
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Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
La�-3r' and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
5 COUNTY
St. Croix
A a' oE — complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
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.
APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION RE IEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
John Leys GOVT. LOT SW%, 114 8L. 1 /4,S 36 T 30 N,R 19 for) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
12461 Arcola Trail 7 I n/a Vol #4 -page 1114
CITY, STATE ZIP CODE PHONE UMBER ❑CITY j]VILLAGE EITOWN NEAREST ROAD
Stillwater, MN. 55082 (612[39 -0641 St. Joseph 1 1 - 7illow River Pd.
}c New Construction Use Residential / Number of bedrooms 3 [ ] Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate . 7 bed, gpd /ft .8 trench, gpd/ft
Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate . 7 bed, gpd /ft .8 trench, gpd/ft
Recommended infiltration surface elevation(s) 95 .43 ft (as referred to site plan benchmark)
Additional design / site considerations n/a
Parent material outwash Flood plain elevation, if applicable n/a ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem nS 11 U 93S ❑ U nS ❑ U M ❑ U ❑ S MU ❑ S )CE] U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1
1 0 -12 10yr3/3 none L. 2 /m /gr mfr c/s 2/f .5 .6
2 12 -24 10yr4 /4 none scl 1 / f / sbk mfr g/w 1/f . 2 .3
Ground 3 24 -36 10yr4 /4 none ls. 0 /sg ml a/ na/ .7 .8
ele v. i
98.6 ft 4 36 -82 10yr4 /4 none co.s. 0 /.sg ml na/ n/a .7 .8
Depth to
limiting
>8 oK ��•
Remarks:
Boring #
:.............:..
1 0 -8 10yr3 /3 none L. 2 /m /gr mfr I f .5 .6
?`{ 2 2 8 -22 10yr4 /4 none scl 1 /f /skb gJ"cd` f' 2 .3
3 22 -30 7.5yr4/4 none Is. 0 /.sgt na /'`Y .8
Ground
elev. 4 30 -82 10yr5 /4 noen O.S. 0. /sg n/� ja .8
98 ft.
Depth to
limiting
in
factor 3 �• �Y ,k
>8
Remarks:
CST Name:—Please Print Gary L. steel 715 246 62 & ne:
A ddress: 1554 00th. th. Ave. ew Richmond. WI.54017
Signature: Date: T Number:
• 7 -21 -93 cstm229�
PROPERTY OWNER John Leys SOIL DESCRIPTION REPORT Page 2 of 3
4
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boy Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. g Bed ITw&
„3:, 1 0 -9 1 3 3 none L. 2 m r . f
2 9 - 21 IOyr4 /4 none scl 1 /f /sbk mfr g/w /f .7. .3
Ground 3 21 -31 7.5yr4/4 none Zs. 0. /sg M1 g/w na/ .7 8
elev.
98 ft. 4 31-82 10yr4 /4 none o..S. 0 /sg ml na/ na/ .7 r8
Depth to
limiting
factor
>82"
Remarks:
Boring #
1 0 -12 10yr3/3 none L. 2/m/gr mfr c/s 2/f .5 `.6
ti 4 2 12 -22 10yr4/4 none scl 1 /f /sbk mfr g/w 1/f .2 1.3
U
3 22 -38 10yr4 /4 none ls. 0. /sg ml g/w n/a .7 i.8
Ground
elev. 4 38-80 10yr4 /4 none co.s. 0 /sg ml n/a n/a .7 '.8
99. 103
Depth to
limiting
factor
>80"
Remarks:
Boring # 1 10-13 10yr3 /3 none L. 2/m /gr mfr g/w 2/f .5 .6
'.....5..: 2 13 -19 10yr4 /4 none scl 1 /f /skb mfr /w 1/f .2 .3
3 19-3217.5y4/4 none 1s. 0. /sg ml Cr n/a .7 €.8
Ground
elev. 4 32 -84 10yr4 /4 none co.s. 0 /.sg ml / n/a .7 .8
99. ft.
Depth to
limiting
factor
>84"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE 1 554 200t-h
Gary L. Steel
C.S.T. 2298 John Leys New Richmond, WI 54017
MPRSW -3254 ShT% SE% S36- T30TT - R19W (715) 246 -6200
town of St. Joseph
lot #7, Vol. A -page 1114
✓ Imo,
l o co
r�
1
3�
4 '
Gary L. ( steel
7--21 -93
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
Property Address
(Verifivation required from Planning [Departmant for new construction)_ _ _
City /State Parcel Identification Number 0 - ?.Fl
LE GAL .DESCRIPTIOrS
Property Location y;, '/, s ec. , , 1q. I'd -R W, Town of
Subdivision _ , Lot # �S
Certified Survey leap # �C1 -��/y _ Volurne Page #
Warranty Deed # / / l; l� , Volume .�Z .? .._, Wage #
- Spec house ❑ yes ,4 no Lot lines identifiable JO yes ❑ no
SYUEM MAINTENANCE
Improper use and maintenanceof your ;,eptie system could result in its premature failure to handle wastes. Propertnaintenance
consists of pumping out tl,e septic tank every three years or sooner, if needed by a licensed pumper. What you pat into the system
Gan affect the function of the septic tank as a treatment stage in the waste disposal system.
Tltc property owner agrees to submit to St, Croix Zoning Department a certification four, signed by the owner and by a
masterpNrnbcr, joarncyman plumber, resttictedplumber of a licensed ptunper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) rafter inspection and pumping (if nccetsgry), the septic tank is less than 1/3 fltll of sludge,
Ywe, the undorsigncd have read tits 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 Deparmtent of Natural Resources, State of Wisconsin. Certification
stating that your septic system h eon maintained must he completed and returned to the St, Croix County Zoning Off w within 30
day. rthe three. ye r xpirgt' data.
/ 4
a 2 117rcev
MG14ATURE 0 APPLICANT DATE
OMER CERTIFICATION
I (we) certify that all st4omtrits on this form axe true to the best of my (our) kno>w1cdge. I (we) am (are) the owner(s) of
the erty des 'bo above, virnte of a warranty decd recorded in Register of Dcads Office.
0 121
SIGNATURE OF APPLICANT DATE
Any information that is rnis- represented may result in the sanitary permit being revoked by the Zoning Department.******
Include with WS application: a stampod warranty deed from the Fegister of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
72•e3 -v8d; 8!18/99 8 =09AM' 7163668661 -> L RFALTY HUDSON WISMNSINp Page 2
AL;. 113.1%9 9=06RM CENTURY 21 HUDSON N0.245 P.2
i
AUK
w i se
W4964 ilgJ4
CER TIMED SUBVEYMAP
LrOOSted is the SW 'Y. OrWe SE Ya and We SE % of tk SW 0 of SoWan 36.730K
St. I St. Croix Cou n, being Lot gem (7" of that
KIM TOM oES oeNpAb, , W iaourdi
nh'
Volume 9 P e 26.74 as DOOumant NO. 50445th in t!m St
CertiCed 5ur+ray Map filed is Va e8
CWjk Coualy R"isLw of Deeds.
OWNER /SUODI'VIDER: JOHN LSYS
NOTg: far curve 12461 ARCUt.A TIL i
irforsutian am sbeR 2 at 2. STILLWATIM MK.55net.
LglrI I 1.Qir3 s LQ>3 + IQ—T!!
+ i Q.ERJiF„ R T U--9Y-=Y M/}�P ,
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e ........ � �
rt i�'e�,1 ' � (
ioee p t
r2 .2r) 1R 131,1,17 OL UME FEET at, 20 scow 1 # ++91.1 W 6`Ot1ARE tg7 �
�. Los
(3.01 ACRES) ( 3.01 AC RES 1
All
317 07a seal ,{�
aeg•o�olrw 1.1xt.oe .,��
yQE„tlA �L E'A.oE.; W
AFFROxINIATS
NORT H - V QU TI4
1/4 SECTION ZAN
N
SCALP INFECT 1" +800
a sw MO' t AOtJ e0a sOtmlur4EO >:1�gll+et*. 1MQ!'aR�riYlON11
31M CORNER OF SECTION 30 ° ° M M;r4M 2801.31' BE 6QRttER (?F . • ae,
T 30K Rjew ( ALUM. Ummaw I . jn 1 m )
Xftt6*s rsWencedlsthe S outh llgp 9f the 32 114 of
Swab is 36, previously recorded 43 *Ad 060101 to be
N39`23'45"$.
.aeon cow mos rs".
(w rNlgld )
,! >dId'It14Sp 1.• 4= PiM iband. 1 PF1 W.
*. Imbpao I" X ?q m *e
weibi!I; 1.05 tbs. / 1W. A. set. R 0
t A 996 s a* usly reewded PRIWARtED BY:
info�la {7
NEW RICt11]r110M. W1. 5411
PMM ( 711 ) 24411-7329 N
Joe NO. X16
rids IMS'1°lltiUllMT Pp AlrrED BY: 1t7SMI w, COA,NNMG. 91�R 1 GIr 3
' \!�1 T7 Dew.n pCG9
eYlt Uy, LUJIVA Mr.AL i Y MW 0#4*604b.04 i I U 4OU ; :JVC Vf Vf s nn I c. :IV�In7l4kl'lfll...fs"�sf�r�.ya cr
I X - * & Z06
tort
le t
Attn; Judy stainer
Th soil evaluation for John Leys shows the available area for
sbsorption system as 2736 sq. feet. A 4 bedroom home requires
1716 aq. feet of area. The Oytem as shown is suitable for a 4 bedroom
home.
'r
New
*a W wipu�wrnt M aqt
wand .. �41��M bpi
1 � �
STATE AAR CF WISCONSIN FORM 2 - Ion KATNtW N. 11AL5H
WAVRANYY DEEP RFt3I8TER 0 DE CDB
OOGUMkNT NO 7JQ{ !_?,P6�;L: V_L._,,.,. _ 4ECE190 FIA kECOR
John A. L et's i6- 251999 it�� aN
BEF6
CART EN"f FEE=
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—a—fag and warrarda EO
_ �pINe FEE; 14.44
MEBt l
i !� _.I.I ri ia' �'�lrl 1 n Fki A_nd I�E� � aa3
611rV�,a r5Yl1A
YNS MME RMOVEpFOR 1111 OWO DATA
—r I
MAW AND RITURN A"R£88
Iht jUllowiny, dE8CYiba4 real sa ran 1 , COUtU} {.7 N LAW FC 1$.C.
su orw ; SCOAliiil j 43D SECOND 9'I5 W
l
V sst part of 8'W k e: Of th 5Bk and the SE ;h HUDSON, W 5 4 W 1 510
i
I of the SW 1 4 of section 16, Township 3C North,
r of 7,CC 1 -- -- -- -- --
Rai a 19 West, bein4 P t !
l q
i Certified Survey
Mao zecorde4'in X01, "9" of 430- 2015 »44 -0 (PaLt CE) �;
`y Certified Survey Nlapr-, Pag4ge 2674 as
9RCE1 I0¢NTRICA710NNUN9E4Y �!
! Document zoo. 504459 daaccrxbed a9 follows:
j{ Lot 15 of a Certified Survey Map dated April
22, 1999 filed June 14, 1:999 and recorded �
:n vol 13 of Certified SurveY MaPsr Pat7e 3663
j ae nooument No. 604554 in the office of the
ttegfsbar o> needs for St. Croix CO>lntyr !
Wisconsin _ !` OD
TAiu homestead prnperry
t CW to rwt7
'j [f[ceplronlawsrcanttes Tb=Fi1rR WITH AND SUBJECT TO do Y 6tku3r any, tBx't ;
i covenants, reservations Or restrictions Of rc -
ecrd, if ang but.th39 shali
,tot be deemed to e.�ctend axty 9ueh otttes recorded %nct%marances beyond
w tha term established by law therefor. !?
i1
flared this ,�2mkl dRp Of
.'101�AT.
(SEAR (S @AIJ Il
�� pCiCNOW4knGM�N7 i,
�! AS]TIICAITI,CATYON I
Slate of Wisconsiti, (`
5ignatare{5) ^Y..f. Tnhn 7A LaYS 1 �. I II
Ciouniyt J
autheq ed t or Or , 19 Ntson0y ca !le rer Ne me this day of
at -0—be _. Tv —, the above named
X111.E ►g�j��@}�l5�Iv5tlS � �
. �N� rr51 Ic ,mt know+ W he rile person
11 who eaecdted the fortgt.Ing
no WTl in.Ltum£m and aeknowltdgt rile sane.
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Atty. Ebu It' S. twin i
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{ gnarvres may be s1ulrowic.Med ar rknnwled�d. t xh arC not My c,titWmissitNt l9 pe morwAt. {i( hat, slsk k2pirstItIn dolt:
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