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Home My WebLink About030-2032-95-000 O 0 Si 3 '0 0 d O A CD N A7 3 b Z w C oi N O ° Oo O w °w O• Q d d f CD °. w CD N t -� CO tD ,0. a n N c N y ° O o o m V N N 0 O 3 O f0 (�O Cfl Q n a' ? 01 C° Ul m o v O wI a � rn wI c p ca b wl d w ° ti m cn oz D A a -1 m cn -< D en m �i o y a CD! m c? y W a m ro m W 0 1 m c 3 a0 = wc I 3 O CL m CD CL c°I CD o CO) rn rn° y Q c I =I = 3 g o �• o � gg z ? I tv 0 3 3 C, co (a 0 M o Z a4 o' I(D W ;r I O Iro w O N O N I O A N{ c w 'm m 0 NJ a a rr N 0. 0 0 y m 0 o D ( c o , c o O o. M 0 O 0 !r I CD o CD m �• "0 v c CD 7. m c. C CD C CD l W CD a I W O, i a m 5 a m ' -1 0) o N a o N o I A ?0 c c I w a I w a f' z 3 I 0 0 Z - I N e W w I m w w CL c o a Z 1 0 I oFF z o 3 3 � tl! I H7 z 7 3 m 7 y '��v * 3 'm a a c� mom o R N _a N N O fD O y O o n '' N K ..« I ° = { voi :I- � ° off m m � � 7 � � -,,ci o;-.N m °� N0, 0 B y 0 c O g 0 nab n� O Cl 5'8 py W � ` 0 : �� Q o = y :� 0._ Oz C Z oho av m C O D %DOO�N ?�WIVO7�'N', o � coo) cD -low o rno o ?mo �O N V 7 is fD 'O g w 3 mo m o , o v S o G o m 0 0) 2m �C�5m CD p gam m m o yy a <��v e o�dNOa > >03. m0 CD -a o a W W O cn m O Q.O. N C A cD g o o.a e xgo o) a o -„ N Q M CD Z CD O0 >> He CD m o ° cv ai�g�� a w = a o �i { a o Q 0 o b :'� CD m c F o NO 0 y p L O CL N y Parcel : 30-2032 -95 -000 02/14/2005 04:40 PM PAGE 1 OF 1 Alt. Parc I #: 23.30.20.456D 030 - TOWN OF SAINT JOSEPH Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner MICHAEL L JOHNSON * JOHNSON, MICHAEL L 1383 THELEN FARM TRL HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description * 1383 THELEN FARM TRL SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.600 Plat: N/A -NOT AVAILABLE SEC 23 T30N R20W THAT PT OF SE SW LYING Block/Condo Bldg: IMMEDIATELY SOUTH OF CSM 2/348 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 23- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 07/2311997 1113/119 QC 07/23/1997 780/72 07/23/1997 728/583 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 5987 933,400 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.600 102,700 815,600 918,300 NO Totals for 2004: General Property 3.600 102,700 815,600 918,300 Woodland 0.000 0 0 Totals for 2003: General Property 3.600 60,200 648,400 708,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 127 Specials: User Special Code Category Amount I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 wsqp nsin gepartment of Commerce PRIVATE SEWAGE SYSTEM County: Safleiji and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sammy Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. cr)o 3 Permit Holder's Name: ❑ City ❑ Village ❑ Tov3rn of: State Plan ID No.: Johnson, Mike St. Joseph Townshi CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 030 - 2032 -95 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht outlet TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet Air I Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St cover Model Number GPM TDH Lift Friction System TDH Ft mead Forcemai n Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manu acturer: SETBACK INFORMATION Type Of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Mani old Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #i: / / Inspection #2: / / Location: 130 County Road E, Houlton, WI 54082 (NE 1/4 NW 1/4 26 T30N R19W) - 263020456D 1.) Alt BM Description= 2.) Bldg sewer length= - amount of cover = Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Ttr ( I I � t s 12Al2. .1 County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN �Q In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)j 1101 Carmichael Road F.4L. Hudson, WI 54016 -7710 (715)386 -4680 Fax(715)386 -4686 Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if revision to previous application 1900 3 1. Application Information - Please Print all Information Location: Property Owner Name 1/4 114, Sec �� T N, R k E (or Property Owner's Mailing Address V V of Number Block Number 13 0 �° i I City, State Subdivision Name or CSM Number Du` ! A A fI Type of Building: (check one) amity ❑Village ❑town of 1 or 2 Family Dwelling - No. of Bedrooms: / ` ❑ PublidCommercial (describe use): ❑ it: (Check only State -owned ,f („ Nearest Road _ II. Ty e of Perm one box on line G} h r 'arcel Tax Numbers) 2 3. D• L D ySG A) . ❑ Repair 2.09 Reconnection (� N Z O3O -X0 - U Date Issued �K State Sanitary Permit was previously is-c— IV. Type of POWT System: (Check all that apply) 0( Non - pressurized In- ground ❑ Mound E] Sand Filter Constructed Wetland • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At rade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min. /inch) Elevation A o� , '9 3 o 1, 31 VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass SErP Tanks Tanks TIC ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ II. Responsibility Statement I, the undersigned, assume responsibility for repair/ reconnenction /rejuvenationAnstallation of non - plumbing for the POWTS shown on the attached plans. A r not required for terralift repair or the installation of non - plumbing sanitation system. Name (print Plum Signature (no sta ps PRS Business Phone Number _ i 'S 6s Address (Street, City, State, Zip Code) 0ALcigy- VIA-fiv 7 SO ty Only Use Disapproved Sanitary Permit Fee Date Issued Issuing Agent Signature (No stamps) pproved Owner Given Initial Adverse Determination -#, / Z S0() q Z!� Z{7DU tions of Approval /Reasons for Disapproval: S lt s>< { «c��s�, /�a°c�t` �YS��, w�l� • OWNER y' r �'� TOWNSHIP �Sf� r �j�L /7 SEC. T N -R ADDRESS L1 �, I ST. CROIX COUNTY, WISCONSIN r f SUBDIVISION LOT LOT SIZE PLAN VIEW I Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �0 rn pCI.I� ` d 011 INDICATE NORTH ARROW !I 1! BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: _ zo o � Proposed slope at site: SEPTIC TANK: Manufacturer: �,(J��j� rs Liquid Capacity: 10eO 1014 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and ho ' d � int (BM), direction and percent slope, scale or dimensions, t n distance to nearest road. Parcel I.D. 2 Please info , a atr 030 032 - 95 Date Personal information you provi used ( s. 15.04 (1) (m)). Property Owner 7�� i Property Location Johnson, Mike Govt. Lot NE 1/4 NW 1/4 S 26 T 30 N R 20 W _5 9nnn Property Owner's Mailing Ad ss Lot # Block # Subd. Name or CSM# C IN 130 Cty. Rd. E C•, ST CROIX ^ nao City / IgWJgftm r J City _j Village � Town Nearest Road Saint Jose h 7 - 78 St.Jose h City. Rd. E 1 f/ New Construction Use: sel Resl - ' t•I4db6r of bedrooms 4 Code derived design flow rate 600 GPD J Replacement J Public or commercial - Describe: Parent material Outwash Plain Flood plain elevation, if applicable na General comments and recommendations: This boring was done to verify the soil for an existing drainfield. There is no evidence of saturation, high ground water, or bedrock. Boring # V1 Boring J Pit Ground Surface elev. C7 ft. Depth to limiting factor >110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Murrell Qu. Sz. Cont. Color Gr, Sz. Sh. *Eff#1 *Eff#2 1 0-8. 10yr3/3 none sl 2mgr mfr gw 2f .5 ✓ .9 ./ 2 8-24- 10yr5/4 none sl 2fsbk mfr gw - - - - -- .5 / s 9✓ 3 24 -78• 7.5yr4/4 none Is Osg ml gw - - - -- .7 / f, 4 78 -110• 10yr5/6 none ms Osg ml - - -- - -- .7 �d. � n * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <30 mg/L and TSS <30 mg /L CST Name (Please Print) Signature: ✓ CST Number Thomas J. Schmitt `rstny, �w i. 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number Somerset, WI 54025 8/18/00 715 -549 -6651 i I I I - i I I I I I 1 I I , I I i NO — b. ' d P _ i r- --� I a- i I I I i I C4 he floelh Nsx e Ao ao-" 4 e p" s /,C I hr1� �er�s � � t �o �/ �� i<in.C�► t'G�4[Jtk D ° y y � �+��"►txf -- I y ! I I I I I I , I : r i I j i ' I . I r ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the /`'l KC- residence located at: " Y., &J& %,, Sec. T _ N, R Town of ,$ j �. �T St . Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced s'r� , /999 Did flow back occur from absorption system? Yes No (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer (if known) : Age of Tank (if known): (Signature) (Name) Please Print (Title) (License Number) (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (exce t for inspection opening over outlet baffle). Name &ACg&IAf �C #/y/TT Signature MP /MPRS III 2!V I r ' v r S r ST C- 105 r 9 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER Michael & piane Johnson ' Fire Number ROUTE /BOX NUMBER Route 1 Bo$ 649 CITY /STATE St, Josep W'I ZIP 54082 PROPERTY LOCATION: SE 4, $W k, Section 23 T 30 N, R 2 0 W, NE 2 NIff Section 26 Town of St, Joseph St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its e remature 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 60% of the cost of replacement of a failing system, i which was in operation prior to July 1, 1978. St. Croix County accepted this program is ro in August of 1980, with the requirement that g owners of all new stems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I /WE, the undersigned, have read the above requirements and agree disposal s to maintain the private sewage sp stem in accordance with Y the standards set forth, herein, as set by the Wisconsin Depart - ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zonin,� *ffi n 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98. Hammond, WI 54015 715- 796 -2239 or 715 - 425 -8363 Sign, date and return to above address. i oo� "T DiLHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code f STATE SANITARY PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. —See reverse side for instructions for completing this application. PETITION I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. FOR VARIANCE F YES ❑ NO PROPERTY OWNER PROPERTY LOCATION %,S T , N, R E (Or)CW.•' PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME CITY, STATE ZIP CODE PHONE NUMBER CITY : NEAREST ROAD, LAKE OR LANDMARK O VILLAGE: II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. ❑ New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. ❑ Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b. ❑ Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Feet ❑ Private F-1 joint ❑Public VI. TANK CAPACITY Site in g allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holding Tank ❑ D ❑ 0 El Lift Pump Tank/Siphon Chamber ❑ ❑ I ❑ ❑ 1 ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # CST's ADDRESS (Street, City, State, Zip Code) Phone Number: IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) El Approved Given Initial Approved Surcharge Fee ❑ Adverse Determination X. COMMENTS /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608 -266 -3815. To be complete and accurate this sanitary permit application must include: L Property owners name and mailing address Provide the legal description where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; Vlll. Soil test information: Certified soil tester's narne, certification number, address, and phone number. IX. County /Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8' /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; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. -------------------- - - - - -- ----------------------------------------------------------- - - - - -- ------------------------------------------------------------------ GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground atria• — included the creation of surcharges (f3es) for a number of regulated practices which Wiscp 1r1`5 can effect groundwater. The surcharg -� took effect on July 1, 1984. All of the water that buried reasure is used in your building is returned t: the groundwater through your soil absorption o systern or the disposal site used by +,Our holding tank pumper. The monies collected through these :surcharges are crediTed to th a groundwater f_.:nd adrr?inis- tered by the Department of Natural Resources. These funds are used for monitoririg *ground- t water, groundwater contamination in and establishiment of standards. Groundwater, it's worth protecting. a 3EPARTMEN T OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LA11OR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION '.O. BOX 7969 BUREAU OF PLUMBING MADISON, WL 53707 ECONVENTIONAL ❑ALTERNATIVE state Plan TO. Numt— , (11 nargneA) O Holding Tank ❑ In- Ground Pressure O Mound NAME Of PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE Michael Johnson Rt. 1 Box 649 St. Joseph, WI 54082 BENCH MARK (Permanent reference polnll DESCRIBE IF DIFFERENT FROM PLAN FIEF. PT. ELEV: CST Hit PT ELEV NE NW Section 26 T30N -R19W Town of St. Joseph Na— of Plun.ber. MPlMPRSW No.. County Sanllary Pelmn Numlxr Donavin Schmitt 3205 St. Croix 1 88389 SEPTIC TANK /HOLDING TANK: �r MANUFACTURER LIOVlO CAPACITY TANK INLET ELE V. TANK OUT LET ELEV WARNINI: LAB L L(1CKING COVER PR VIDED PROVIDED 1 14 ?4 a % . ;e YES ONO ❑YES DNO BEDDING VENT OIA. VENT MAIL. HIGHIN NUMBER OF ROAD. 1 PROPERTY J WELL � / BUILDING VENT TOFRF S11 yj ALARM FEET FROM LINE / AH71 ET 4 YES ONO �✓ C" DYES ❑NO NEAREST J� �D /' Q DOSING CHAMBER: MANUFACTURER BEDDING LIQUID CAPACITY VUK+V MODEL PUMP. SIPHON MANUF AC TIMER WARNING LABEL LOCKING COVER PROVIDE PROVIDED DYES ONO DYES LINO DYES C)NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF Pl+t)l'f If 1 r 1 1111 LI 1 141111DINI, VENT TO F In S11 (DIFFERENCE BETWEEN FEET FROM LINE AIR INI f T PUMP ON AND OFF) I OYES ONO NEAR EST -----30- 1 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ( EN61" rnnM1 n It 1 11A I1 111,11 AND MnHKINI, or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH NO OF DISTH PIPE SPACIN6 COV II INSIOI IHn spill. 110010 BED /TRENCH iHENCHyy Mnr 1 L PIT Dfrlll DIMENSIONS I(;HAV LOIV ll FILL UE Pr /l UIS 111 PIP( UISTH PIPF ISTR. PIP A RIAL NO H NUMBER OF PHOVEHIY WELI HUI LDIN(, VE NI ID I lil Sn Hf LOW PIVES /n ANEIVE P E 1 I 1 V INI f 1 ELEV END PI FEET FROM , LINf '/ AIH INLE f `� Ol NEAREST 9 /D 'MOUND SYSTEM: Q ) 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 R EVE RSE SIDE. SHOW ELEVA- ❑YES ONO meets the criteria for medium sand. TIONS MEASURED. _ ggluqym It XIORE PI IIKIANI N I MA 14K I HS I H1SI If V A 114-N WI I IS DYES _OYES LINO Uf P111 (1VfN rHI N(.11 BED Uf VI11 DVIH — TRENCH 8E11 1.f VIII OF TO PSOIL tit II111F 1) StI DI I) -- &101( -1.111 CFN 1f 11 EDGES DYES ONO OYES D I DYES C_ PRESSURIZED DISTRIBUTION SYSTEM: BED /TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING 1 HAVi L DIP111 HI LOW PIPI -- 111 L OF PI it AHOVI (.OVI H DIMENSIONS MANIF 01U POMP OI.I) UISTR PIPE MANY (ILII MATt 1(IAl N") 1115111 (1151111'1 5M 15 H1111rINV11'I KIPIIHIAI An1A11KINI, ELEVATION AND ELEV ELEV CIA ELEV. PIPtS UTA ' DISTRIBUTION INFORMATION HOLE SIIF HOLE SPACING UIIILL LO COHHI C I I Y C(IVFH MATERIAL VIHIICAI 111 I(;OHHt SVIINUS111AVP1111VID PLANS OYES ONO DY ES ClNO COMMENTS: SERMANEN MARKERS: OB N SERVATION WELLS. NUMBER OF PROPERTY WELL BUILUING FEET FROM LINE ❑YES ONO ❑YES DNO EAR EST __ _— Sketch System on Retain in county file for audit. Reverse Side. SIC AT RE fI7LE DILHR SBD 6710 (R. 01/82) + • r i • Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER T ��„ L_ 9 Cif - N_I a�f TOWNSHIP �,�� ^��j - /''= _ SEC. �� T 3O -R_? a ADDRESS 1( �, / ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LAR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM � Ic"0 e ,- I I //} g- INDICATE NORTH ARROW 'Az v� I f, e'er I BENCHMARK: Describe the vertical reference point used If" Elevation of vertical reference point: , Proposed slope at site: ; SEPTIC TANK: Manufacturer: �(,1�L Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Ye Tank Outlet Elevation: Number of feet from nearest Road: Front 1 0 Sid ekDj Rear, O 300 ` feet From nearest property line Front 1 0Side,W( Rear, O feet Number of feet from: well & building: �))� (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERS SIDE PUMP CHAMBER ` Manufacturer: Liquid Capacity: Pump del: Pump /Siphon Manufacturer: Pump Size Elevation of et: Bottom of tank elevatio . Pump off switch elevat Gallon er cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest roperty line: Front, (D Side, oRear,(D Ft. er of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: Width: Length: Number of Lines Area Built: - t( Fill depth to top of pipe: 7 6 Number of feet from nearest property line: Front, O Side, Rear,O Ft. Number of feet from well: W Number of feet from building: 17 (Include distances on plot plan). EPAGE PIT ze: Number of pits: Diameter: Liqui depth: Bottom of seepage pit elevation: Area Built: Has either a drop box or distribution box O been used on any of a above soil absorbtion sytems? (Check ). HOLDING TANK Manufacturer: Capac Number of rings used: Elevati of bottom of tank: Elevation of inlet: >Number from neare property line: Front, Side, O Rear, OFt. N er of feet from well: umber of feet from building: of feet from nearest road: rer: Inspector Dated: :/ �� Plumber on job: I License Number. 1t%'I 3 /84:mj SANITARY PERMIT APPLICATION COU .7 0ILHR In accord with ILHR 83.05, Wis. Adm. Code •�� STATES I TARY PERMIT # 3t? — AYtach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION F VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION / _ '/a N114 e, S & T 30, N. (Or)( PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIV ION NOME CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK S `^ ) 7 -5 ❑ VILLAGE 11. TYPE OF BUILDING OR USE SERVED: I242,t&— • Cod Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public (Specify): 203a gS'- -� �• III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. � New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit ## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. N Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. seepage Bed b. ❑ Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): qq Feet ��Wt Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glace Plastic App Tanks Tanks structed Septic Tank or Holding Tank ,6 �E Lift Pump Tank/Siphon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber' ignature: (No Stamps) MP PRSW Business Phone Number: r e � lumber's Address (Street, City, S Zip Code). Name of Designer: -r p^ - r Vlll. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # C 72F , 61L Z2 CST's ADDRESS (Street, City, State, Zip Code) Phone Number: is IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved S itary Permit Fee Gr undwater ate Issuing Agent Signature (N tamps) Approved F Owner Given Initial D S r harge Fee lei i Adverse Determination X. COMMENTS /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Pib -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT j APPLICATION TO THE APPLICANT: , 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.),.depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to .3 years; 6. If you have questions concerning your private. sewage systern, contact yr•ur local code administrator or the State of Wisconsin, Bureau of Plumbing, 608- 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County /Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/ x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; dosing or pumping chambers; 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 it required by the county; E) soil test data on a 115 form. ------------------------------------------------------------------------------ - - - - -- ----------------------------------°-__..-•.----------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the r7� result of over 2 years of steady negotiation and public debate. The groundwater bill GroundyafAtBC- included the creation of surcharges (fees) for a number of regulated practices which Wisco in`5 can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried1re sure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. 0 The monies collected through the=se surcharges are credited to the groundwater fund adminis- ° !erecs by ihe Department of Natural R? sources. These funds are used for moniton, - .g ground - t - ater, groundwater contamination in;est"gations and establishment of standards Groundwater, i "s worth protecting. SBO -6398 (8.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, ( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property Mi chael Location of Property SE StiY , Section 23 T 39' N -R 20 W NE NW 4 Section 2 Township Sty. Jose -ph Mailing Address RQu t e 1 Rgx Q49 St. J o s eph, wI 54082 Address of Site Same I' Subdivision Name Lot Number Previous Owner of Property L,eQ Cagrmain Total Size of Parcel 20,1 G Ps Date Parcel was Created Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes x No Volume 2 and Page Number 348 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING A Warranty Deed which includes a Document number volume and page number and the Seal of the Register of Deeds In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTy OWNER CERTIFICATIO I (We) cent 6y that att statements on thi.6 6onm ane t to the best ob my (ours) knowledge; that I (we) am (ake) the owners) o6 the property descA bed in this .inbonmation 6oAm, by vi tue of a wa Aanty deed neconded in the 064,ice o6 the County RegZ6te>t o6 Deeds as Document No. - ; and that I (We) pnezentty own the proposed site bon the sewage dz6pas 6y6 em (on 1 (we) have obtained an easement, to nun with the above descA bed pnopenty, 4on the conhtnucti.on o6 said system, and the same has been duty tecoxded in the 04b.ice ob the County Regi6ten of Deeds, as Document No. ), I K SIGNATURE OF'OWNE SIGNATURE OF CO ER (IF APPLICABLE) DATE SIGNED DATE SIGNED Q . a' (') P b C hi c °,' m m C d b y o n o H O N• w 0 (D y y to V d (D rt N �' to �' CD G m A �• CD M M P" ~ 4 W CD •� ° m o O O - 20 go 0 rt Co w P P.. a �r t m cr C 'O M x o K co 7e' rt N N -• N, a , a. 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O N N z G 'O rt o a O m w is (D p O . �' ro w o W� 'u, m a rh cn •p rt o CL w O N rr �C > •C N A O N p m • z r � H STC - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT H 0 St. Croix County z ty a OWNER /BUYER Michael & Diane Johnson H t� ROUTE /BOX NUMBER Route d Boo 649 Fire Number CITY /STATE St, Joseph WTI ZIP 54082 PROPERTY LOCATION: $E SW 1 4, Section 23 T 30 N, R 20 W, NE 4 N?N SectXQn 26 - �- Town of St Joseph St. Croix County, Subdivision Lot number I 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 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new 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 -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. d I /WE, the undersigned, have read the above requirements and agree En to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart - v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County ZoninZ ffic 'th n 30 days of the three year expiration date. SIGNED Q_ DATE St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715- 796 -2239 or 715- 425 -8363 Sign, date and return to above address. �1 DEAA'RTM4!NT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION BOX HUMAN RELATIONS PERCOLATION TESTS ( \ MADISON WI 79 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP Y: LOT NO.:BLK. NO.: SUBDIVISION NAME: G )/ � k JON /Rg (or) W a� ? a 7 S'4 h A )4 COLIN Y: OWNER'S YER'S NAME: MAI LING ADDRESS: ) (o I 1 0 f ), USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: I PROFILE DESCRIPTIONS: ER OLATION TESTS: dence 3 9 New ❑Replace I �} //_ /� / RATING: S- Site suitable for system U= Site unsuitable for system r S.S. El 111 fAS M1 ONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) E]S 3 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS / , BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER BEP+F! -FPd, ELEVATION OBSERVED EST. HIGHEST TO BED OCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 5 ,� o 7 1? ,) .� 1. , . s B- Z. b.� l 05 /� 0 iJ Sy '�I.S.I.. aG �''�3n•S.l,,. Fjn• �. . B- 1p 9 Q B- -� / 79 /b 4 t T .s 8 1 �i3., . S . . {., . c� ° a .S, B - 4- 140 02 /VO f_ - 3 ; 1. 1. / , S• I. YN . %I. aft 401M • cr) A i PERCOLATION TESTS TEST D EPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER ll-NeH+ES AFTER SWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 P D 3 PER INCH P _ Z Sa Na P- 3 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. SYSTEM ELEVATION o r I — -- 1_4---- ------ � ©% - +"s 4 t 1 1 I 111 _ Ir ! ' i .J _ _ . _ _ ,y ,,,.�,. __ X39 i 1 � .. 1 t N 1 Sic d*- � t f I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print)• TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: GONE NUMBER (optional): Iv - L r. U i , 2. z 9 5"- z.4.1a -G Zod CST SIG E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include; 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4- Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; B. M,91<0 sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. (f the information (Such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11 . Sign the form and place your current address and your certification number; 12, Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st Stone (over 10 ") BR - Bedrock col) Cobble (3 - 10 ") SS - Sandstone gr - Gravel (under 3 ") LS - Limestones. * s - Sand HGW - High Grorin<fwatei cs - Coarse Sand Perc -- Percolation Rate coed s - Medium Sand W - thte(i f .._ Fiore Sand Bldg -- Building Is - Loamy Sand > -- Greater T =ian sl - Sandy Loarn < - Less Than "I - Loam Bn - Brown sil - Silt Loarn BI - Black si - Silt G - Gray * cl - Clay Loarn Y ..._ Yellow sci - Sandy Clay Loam R - Recl sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay vV,/ -- with sic -- Silty Clay fff -- few, fine, faint e -Clay t;e: -- cornmora, coarse pt Peat min - Many, medium m - Muck d - distinct — pvominen I-IVVL - High water level, Six general soil textures surface vv ater for liquid waste disposal BM - Bench Marie VRP -- Vertical Reference Point TO THE OWNER: This soli test report is the first step in securing a sanitary permit. The county or the Deportment €nay request verification of this soil test in the field prior to permit issuance. A cornpl ete set of plans for the private seti'age' syst�-rn and a permit: application, must be SWbrIlitted to the local aulhority in order to ohlain a perrynt. The sanitary permit must he obtained and posed is for to lh, start of any construction. Or f O -4 o f dap! AM n■ '■0n o q § m co� � 7 k ' � / i ƒ / o ° & \ @ § S Q ��° - 2 \ ¥ [ § B { o / k § it - 82; ; g 04\ k O ° 3 CA c k \ �i. M \ / / ƒ ou .. . o o E� 0 0 2 % 9 ' ° ® -4 Q - . � } \ 2 0 c M � ; § , � M z 0 3 0 09 o ® § % ) z / [ § (a CA @ 2 > E #/ 0 E2 \ f i /' z " 6 §k \ g M ° / CD ` (D k CL CD (6 � ca \ rL § K E " T M § § . E e _ � z § q z CD # G a ¥l (n o > j { = wz= m Wc $ 0 cylPi2 E / -n 0) p J c CL ch 0 % 0 . CL. S CD \ CD ID k tEnoa-0 7 'D faE o 9 m r (D M S f mcCD Ck '3 0 - 'A ' 0007 &� ; � ��±ca � $ ('-D q ••§ \�2 $ %OL 96 £ K o : » _o � /i � �7 c ti "�, 3 d O d cn C r c m m 3 Z 5 Z Z ° p ! 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O N C1 o xo ra CD n O O Fn �S7 O W O p 69 0 i Parcel #: 030 - 2043 -30 -000 02/14/2005 04:40 PM PAGE 1 OF 1 Alt. Parcel #: 26.30.20.497E 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner MICHAEL L JOHNSON * JOHNSON, MICHAEL L 1383 THELEN FARM TRL HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1397 THELEN FARM TRL SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 16.500 Plat: N/A -NOT AVAILABLE SEC 26 T30N R20W 16.5A IN NE NW COM N1/4 Block/Condo Bldg: COR TH N 89 DEG W 165' TO POB S 0 DEG W 866. 25' TH N 89 DEG W 827.14'N 2 DEG W Tract(s): (Sec- Twn -Rng 40 1/4 160 114) 867.42' TO N LN ELY TO POB 26- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1113/119 QC 07/23/1997 780/72 07/23/1997 728/583 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 6083 130,500 Valuations Last Changed: 07/09/2004 Description Class Acres Land I prove Total State Reason PRODUCTIVE FORST LANE G6 16.500 128,400 0 128,400 NO Totals for 2004: General Property 16.500 128,400 0 128,400 Woodland 0.000 0 0 Totals for 2003: General Property 16.500 64,200 0 64,200 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 � i Parcel #: 030 - 2032 -95 -000 02/11/2005 09:04 AM PAGE 1 OF 1 Alt. Parcel #: 23.30.20.456D 030 - TOWN OF SAINT JOSEPH Current X, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ' = Current Owner * JOHNSON, MICHAEL L MICHAEL L JOHNSON 1383 THELEN FARM TRL HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description ' 1383 THELEN FARM TRL SC 2611 SCH D OF HUDSON �— SP 1700 WITC Legal Description Acres: 3.600 Plat: N/A -NOT AVAILABLE SEC 23 T30N R20W THAT PT OF SE SW LYING Block/Condo Bldg: IMMEDIATELY SOUTH OF CSM 21348 Tract(s): (Sec- Twn -Rng 40114 1601/4) 23- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1113/119 QC 07/23/1997 780/72 07/23/1997 7281583 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 5987 933,400 Valuations Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.600 102,700 815,600 918,300 NO Totals for 2004: General Property 3.600 102,700 815,600 918,300 Woodland 0.000 0 0 Totals for 2003: General Property 3.600 60,200 648,400 708,600 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: 127 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 `+ Form -ST C- 104 AS BUILT SANITARY SYSTEM REPORT OWNER � L / fNS 0 1V TOWNSHIP SEC. v'` T N -R IFVW ADDRESS / �/ ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N I�ocL 54filV 103 AP 4 t- \ ` r INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used _ 11p eAl Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: l(�' Number of rings used: QNC Tank manhole cover elevation: 100 e Tank Inlet Elevation:____ Outlet Elevation: Z . / Number of feet from nearest Road: Front 1 0 Side IVY Rear, O IYO feet j From nearest property line Front,O Side, Rear, O � feet \Z) Number of feet from: well '0t N1 , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE S IDE /O 0 PUMP CHAMBER Manufacturer: _ (' /�� % S Liquid Capacity: , Pump Model: / Pump /Siphon Manufacturer: ZC2 C-- LLB Pump Size Elevation of inlet: 9 7, .3,y Bottom of tank elevation: 23,-3aF Pump off switch elevation: �, � Gallons per cycle: 13-2— Alarm Manufacturer: I-_ 66��- A(,4k &Alarm Switch Type: � T Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: 2166 f Number of feet from building: Vy (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Tre ch: Width: _ / Z Len "h:_ 3 Number of Lines: _ Area Built: 6 9 Fill depth to top of pipe: 3 9 J� Number of feet from neares property line: Front, O Side, ( Rear, O Ft. Number o feet from well: 3� ? Number of fe t from building: (Include distances on plot plan). EPAGE PIT ize: Number of pits: Diameter: Liqu depth: Bottom of seepage pit elevation: Area Buil Has either a drop bo or di tribution box O been used on any of the a soil absorbtion sytems? (Chec ne). HOLDING TANK Manufacturer: Capaci Number of rings used: Elevati of bottom of tank: Elevation of inlet: Number of feet from neare property line: Front, Side, O Rear, OFt. ber o feet from well: umber of fe t from building: Number of feet fr m nearest road: Alarm Manufacturer: Inspector: Dated %�� Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LkBOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P•0 9 BUREAU OF PLUMBING MADISON, WI 53707 NE %,NGI 4 -,S26,T30N -R20W CONVENTIONAL 1:1 ALTERNATIVE State Plan l.D.Number: (Ii assigned) Town of St. Joseph ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound County Road E NAME OF PERMIT HOLDER! J ADDRESS OF PERMIT HOLDER: INSPE TION DA �,chaet Joh"on Route 1, Box 649, St. Joseph, W1 54082 _ eq y - ' P BENCH MARK (Permanent reference Point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV e-5 - 7' Name of Plumber: MP /MPRSW No. Cnu� I Sanitary Permit Number: Donav,in Schmitt 3205 St. Cnoix 112787 SEPTIC TANK /HOLDING TANK: MAN UF AC URER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER I �D <? GJ pr P OV DED. PROVIDED. ®� ' / / YES ❑NO ❑YES O BED NG: I VENTIIIA. 11 VENT MATT H WATER NUMB QF. ROAD. PROPERT WELL. BUILUING: VENT TO FRESALARM FEET FROM. / ,(' ,LINE AIR ❑ YES NO YES ❑ NO NEAREST ! S i�/) I / / DOSING CHAMBER: MANUFACTURER J BEDDING. iQUID L CAPACITY PUMP MODEL PUMP: SIPHON MANUFAC.TUHEH WARN ING LABEL LOCKING COVER c PROVIDED PROVIDED: L YES NO 3 2l� 7, �` ❑YES ONO DYE ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL J BIJILDING J VENTTOFRESH (DIFFERENCE BETWEEN `,� FEET FROM LINE AIR INLET PUMP ON AND OFF) 1:1 YES NO NEAREST SOI L ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I F (,TI{ J OIAMF TE It MATE FRAIL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FOR the soil is dry enough to continue.) MAIN' CONVENTIONAL SYSTEM: WIDTH J ILINGTH I ND OF UISTH PIPE - ACING COVER J INSIUE Uln SPITS LIQUID BEDITRENICH I THENCr / w RIA PIT / DEPTH_ DI MENSIONS 0 3� G AVELD P - FILL DEPTH UIST H. PI DST PIPE DISTR. PIPE MATERIAL NO DI 1 NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BELOW PI S I` ABOVE COVER El EV. INLF T ELEV END PIP LINE IR INLET. g4Ea7- °1c., �� a� N EARS "" ' 130(.) asv Zs� 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- meets the criteria for medium sand. TIONS MEASURED. ❑YES NO SOIL COVER TEXTURE PE HAAANf N( MAHKFHS OBSERVATION WELLS _ ❑YES NO _ ❑YES NO DEPTH OVER TRENCH BED DEPTH OVERTHENCH BED j TTFTFT T TFT)PS0IL SUU1) F1) SfEDFU MULCHED r CENTER EDGES ❑YES. L1 NO 1:1 YES ❑NO ❑YES ONO PRESSURIZED DISTRIBUTION SYSTEM: B EDITR EN} H WIDTH LENGTH NO. LATERAL SPACING I GHAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENI[IN'S; MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH DISTR. PIPE DISTF41BUT ION PIPE MATERIAL & MARKING f ELEV.. ELEV. DIA ELEV. PIPES DI A.: ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED COHHEC7 L Y COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION, PLANS DYES ❑NO ❑Y ES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF '! PROPERTY WELL: BUILDING: FEET FROM LINE El YES 1:1 NO 1:1 YES El NO NEAREST .._.i � o � Sketch System on Retain in county file for audit. Reverse Side. -� S NATUR TITLE: DILHR SBD 6710 (R. 01/82) Zoning Administk ton � � ` � �I�VW � a {�, J SANITARY PERMIT APPLICATION co� .l] kQ/ � DILHR In accord with ILHR 83.05, Wis. Adm. Code / �'�.. STATE SANITARY PERMIT # 17 S *7 —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES 19 NO PROPERTY OWNER PROPERTY LOCATION PROPERTY OWNER'S MAILIN9 ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY, STATE ZIP CODE PHONE NUMBER 0 CITY NEAREST ROAD, LAKE OR LANDMARK i S i GS _ El VILLAGE : ,� 11. TYPE OF BUILDING OR USE SERVED: POLE 9,4I N" 000 -c9 c O — Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): -! 9 III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) O 1. a. X New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit ## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (C-heck only one in #1 and only one in #2) 1. a. VNI Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. X seepage Bed b. ❑ seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minute per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Feet Private ❑Joint El Public Vl. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank ) �.� _L�L_ Lift Pump Tank/Siphon Chamber S VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plum r' Signature: (No S m s) M /MPRSW No. Business Phone Number: j ° T .J �r�j - • P um er's Address (S reet, City, State, Zip Code). Name of Designer: s r Vlll. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # J g L lu CST's ADDRESS jStreet, City, State, Zip Code) Phone Number: 5'# 61 0 ,46 / ` IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee 4 a y Adverse Determination 2U. 40 ` - 2Z a X. COMMENTS /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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_ Private sewage systems must be properly maintained: The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VI1. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County /Department Use Only; . X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8%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; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ------------------------------------------------------------------------------------------------------------------------------------------------------------ GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2.years of steady negotiation and public debate. The groundwater bill Ground :atIer included the creation of surcharges (fees) for a number of regulated practices which Wisco CFZ' can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rep urO is used in'your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD -6398 (R.03/86) I APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, ( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property ,A L fee_ N2 4 Location of Property � 1 _ hti, Section �-(© , T H -R W Taimship a"�`� a-A aaL. Nailing Address /� dK Address of Site Subdivision Name .Lot Number Previous Owner of Property �� L Ce -13 VX � � nJ Total Size of Parcel ReizPc Date Parcel was Created , J ell 2 Are all corners and lot lines identifiable? ' Yes No Is this property being developed for resale (spec house) ? Yes x No Volume 7_ 2 8 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number volume and page number and the Seal of the Register of Deeds In addition, a certified survey, if available, Would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATIO 1 ((ve) ceUi.6y that ate 3 .tatements on thin own eAe. tAue to the bmt o m 6 y I ouh 1 hnowtedge; that 1 (we) am (aAe) -the ownen o6 the phopehty dmcAi.bed in thiA .in6olmaLi.on down, by vi&tue 06 a waAAanty deed keemded in the 0 66ice 06 the Count yy R¢g�,�s #eh o6 Deed's ass Document No. aun th¢ Ito owed s ite 1 7 L3 and that i (use) phehe.ntty p p bon the sewage di�spoa a y6s em (on 1 (we) have obtained an edAement, to nun with the above desc& bed pupeAty, 6oh the eonstnue.Li.on 06 aa,i,d s yd tun, and the aam¢ has been duty kecohded ,tn the 066ice o6 the County Regiateh o6 Dttda, ad Docume'n't No. ) , ^ _.__. SIGNATURE 0 OWN SIGNATURE OF CO -OWNER (IF APPLICABLE) 9 /9 r.a _ I DATE SIGNED DATE SIGNED x DOCUMENT NO. STATE BAR 6 Y WIS SI t F'0 11 1988, THIS SPACE RESERVED FOR RECORDING DATA LAND C NTRACT ' 407963 I Individual a d Corporate I (TO BE USED FOR ALL TR NSACTIONS WHERE OVER + a I � $26,000 IS FINANCED AND N OTHER NON - CONSUMER �. ACT TRA ACTIONS) REGISTERS OtfICE Contract by and between _. .]x... Gea~ma ..azl..d.11azi an...._.. ' , � ST. C"X CO., W iS ..................... ......................... . . . . .. .... ........... ( "Vendor ", R ec'& for Record this 20 - . 6 . whether one or more) and.... Di an e•A..__qulitkl.Aad .Miuh4e1.1 .... ......... y of ngg._ 19 S --- Jolinson-.... ....... .•..----- •-- •--- •---- •...... �7 ... ..................•... ..--- ..._._.__._...._.......... "Purchaser ", whether one or more Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- formance of this contract by Purchaser, the following pro together with the Isiaw el e rents, profits, fixtures and other appurtenant interests (all called the "Property"), St. Croix ------- Counly, State of Wisconsin RETURN 1 i .............. - ....._.. -- - -•- - - Part of SE 1/4 of SW 1/4 of Section 23 and Part of NE 1/4 of NW 1/4 of Section 26, ALL in 30 -20 described as follows: Commencing at the S 1/4 corner of said Section 23; thence N89 °38'23 "W on S line of said Section 23, 107.08 feet to the Point of Beginning; thence N89 °38'23' on said S line Tax Parcel No .... ............................... 57.92 feet; thence SO ° 31'32 "W 866.25 feet thence N89 0 38'23 "W 827.14 feet; thence N2 ° 36'58 "W 867.42 feet to S•liae of said ection 23; thence NO*0'14 "W 52.95 feet to Sly line of Certified Survey Map in Vol. I T' page 348; thence N57 0 30'26 "E on Sly line of =aid Certified Survey Map 222.65 feet; th nce N86 ° 23'06 "E along the S line of said Certified Survey Map 82.0 feet: thence S6 ° 08'14 "E along the S line of said Certified Survey Mare 49.61 feet; thence S89 ° 3$ 1 23 "E along the S line of said Certified Survey Map 638.05 feet; thencSO4 ° 13'05 "E 156.2 feet to the Point of Beginning. TOGETHER WITH a 66 foot access easement; the E lin of said 66 foot easement being the same as the W line of the above described parcel and n a true extension of said W boundary line, S2 ° 36'58 "E to County Trunk Highway "E ". This ..... is ........... homestead property. = 0) (is not) their residence at Rt. 2 Box 240 11, Purchaser agrees to purchase the Property and pay to Vendor at Wax ry...Rd,.. - .Rj.Y.� . - 1: �.; ,.• i..54o22 the sum of $...U7 000. 00 ...... ............................... ir the following manner: (a) $ .... 25, 000 _O Q.......................... at the execution of this Contract; and (bj the balance f $ ..35,QQQ.aQQ ................... together with interest from date hereof on the balance outstanding from time to time at the rate of.. �LQ.: 5 . .. ............................. per cent per annum until paid in full, as follows: $400.00 on February 1, 1986 and the same amount on the first day of each month thereafter, such payment to be applied first to interest on the unpaid balance at the rate specified, and thea to principal. Such payment shall continue w through October 1, 1990. — --- -.- __ with int t from Oct. 1 1990 Provided, however, the entire ou4tanding balance hall be paid in full on or before . ............... day of Q.CtQ)245 ------------------ 19..40.: ( the maturity date). Following any default in payment, interest shall accrue at the rate of ..1,Q&5. % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). 21 0 , 06 - excused by us-Aar, ftexaso te P Ip weath to 3 14 -d o g to pay a ams 0" r _ pated annual taxes, special assessments, fire and requirlid insurance premiums when due. y endor, Vendor agrees to apply payments to these obligations v un received by the Vendor for payment of taxes, assessments and in osl ed in an escrow fund or trustee account, but shall not bear interest Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any timeyiK IWX ............................. HK ...... (ex)[ f�sa[ ocXDmc7au�e7t➢ �' IWe >afasdc�ilriamci;mic�ifta0xt[ . omc7afc�be�a�o:x'�t In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less that; the alnount that sail indebtedness would have been had the monthly payments been made as first specified above; provided that monthly p yments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded hererom. Purchaser states that Purchaser is satisfied with the title as sl,, awn by the tit'e evidence submitted to Purchaser for examination except: the in. t:e-est of Henry J. Lentz, as vendor, under the land contract recorded in the office of the Register of Deeds for St. Croix County, Wisconsin, in Vol. 623, p. 33:, Doc. 368604. Leo M. ermain and Marilyn L. Germain agree to make all payments thereunder on or before their due date; that the balance owed on said contract will at all times be at least $5,000.0 less than is owed hereunder. If vendor does not make payments, these purchasers sh ll have the right to make them and to receive credit on this contract for the amount paid. Purchaser a€€►�fees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shalt be retained by Vendor until t!.e full purchase price is aid. Purchaser sht 11 be entitled to take possession of he Property on.. _......December 16, RS 'Cress Out One. LAND CONTRACT -- Individual and STATE BAR OI' WISCONSIN Wisconsin Legal Blank Co. Inc. Corporate Y'OR>I No. I — 1982 Milwaukee. win. z En H ST C- 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z a H OWNER /BUYER r ten ROUTE /BOX NUMBER /OA6 Fire Numbe CITY /STATE ktLTom W� ZIP PROPERTY LOCATION: qko 1 4, Section T_ N, R ZQ W, Town of St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you put into I ! the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new 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 -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 0 I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart - ro 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. 4 2 SIGNE DATE d St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715- 796 -2239 or 715- 425 -8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION LABOR AND HUMAN RELATIONS PERCOLATION / PERCOLATION TESTS ( P.O. BOX 7969 (H63.090) & Chapter 145.045) MADISON, WI 53707 LOCATION: ECTION: TOWN SH IP/ TY: OT NO.: BLK. NO.: SUBDIVISION NAME: NE ��4NW�� 26 / N /R 2U(or)w St. Jose h n/a n/a n/a COUNTY: OWNER'S AME: MAILING ADDRESS: St. Croix Michael Johnson R.R. #I, Box 649, St. Joseph, Wi. 54082 USE DATES OBSERVATIONS MADE NO. BEDRMS : COMMER IAL DESCRIPTION: PROFILE DESCRIPTIONS: E COLATIONTES TS: ❑Residence n/a factory New ❑Replace 3 -2 -88 RATING: S- Site suitable for system U= Site unsuitable for system CONVENTI NAL: MOUND: IN- GROUNaPRESSUR_E: SYSTEM -IN -FILL HOLDING TAN tional) ® S �U �U � S �U E S �U El S c F rcolation Tests are NOT required DESIGN RATE: If an y portion of the tested area is in the r s.H63.09(5)(b), indicate: Class 2 Floodplain, indicate Floodplain elevation: n/a decimal PROFILE DESCRIPTIONS a e 41 CoC2 BORING TOTAL ELEVATION PTH TO GROUNDWATER- INCHES CHARACTER OF S01L WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DE OBSERVED EST, IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B -1 7.51 99.16 none >7.51 .67bl.1, 1.17bn.s.sil. 5.67 bn.s.l.' B -2 7.08 99.05 none >7,08 .58 bl.l. 1.25bn.s.sil. 5.25bn.s.1. B-3 7.08 98.19 none >7.08 .58bl.1. 2.00bn.s.sil. 4.50bn.s.1. B - 4 6.84 96.36 none >7.84 .75bl.1. 1.17bn.s.sil. 1.67bn.cl.gr. 3.25bn.s.1. B-5 6.67 96.11 none 5; .67bl.1. .50bn.s.sil. 4.33bn.s.1. 1.17bn.mot.s.si I... - - F . B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RA NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PERIOD 1 TE MINUTES P- P RI D p PER INCH P- P- s4te des' m rte P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. In9i�,ate scale or distances. DI!9cn what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface Iay'ation at al rinps and the ction and percent of land slope. �_ r SYSTEM ELEVATION 95.19 f ; , T IL i V I t , T� T T Z tN 'i a - - - I , 3 f , , l 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. a NAME (print): Gary L. Steel TESTS WERE COMPLETED ON: ADDRESS: CERTI 3 -2 -88 F1 CATION NUMBER: PHONE NUMBER (optional): � 154946-6200 988 N. Shore Dr., New Richmond, Wi. 54017 2298 CST SIGNA E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. v DILHR -SBD -6395 (R. 02/82) — OVER — tlaAlr T . APaox 0 ' y p /IPPRoveo �y 3 p DRA ° 6 �. s ysr- -n r S1 ��e 1 ,0 NOTE: )VO w�ttS w i rNi� 50 ,203' r!t 0 /�OSL - wATES/t E,C /ST /N G- W El L 'g oo / r4WAY e /10 JA1 ef � s / �'' Sr Pr .1°' COO 13,5 ecoo C-AL- 9w " &4 i8 x 36 Sew ncA a �b �„ F dI�G E L IWE �Zt am 1, � B� N go Aaw; & zsL q h J C /''l P R S 3,9 05' 7-/b PR 0pe2ry irocA rlon/ X30 f,4GToi? � �PLAs��TYCS) S�EP�c� � z� G Z- Ass ,2 -, � LooR 1�I��1 %v k f D � -t /• 0 3 k 2 v5' G!S ,+o FT, b C TA X �C J8 DD 6-'A L 76 C 76'O mac, O o CA-11 9 - 0 O A4 = /ODO 6!A Z , 6 ,6 � 0 1 ; 7c 7 ,4,,v,� - 1 Y % J4 LA/1/"I Stv/ %ems 11VCh' a2 Err /lzv -- /00 C-Az, 3, ! r' Lon12 :5 6;, Z 1YI4/v �1TAC ]�Cf/�E2: /'7P/? 5 3,2 o S' • PAGE OF._� PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS' VENT CAP 4 C.Z. VENT PIPC WEATHER PROOF APPROVED LOCKING -T JUMMOM BOX MAIJHOLE COVER 25' FROM DOOR. IZ'MILI. wIM00W OR FRESH AIR INTAKE GRADE I M" MIN. 4L 00 I ,•` I .� id`N1tiJ. COWDUIT – – – – PROVIDE I –� INLE T AIRTIbNT SEAL I I II v APPROVED JOINT A I I' APPROVED JOI I I I W /C.I. PIPE I PE I w/ t. =. ► EXTE 3' I 11 ALARM ¢ x TT�lA0 11Ks 3 OUTO 60LIC %OIL ' I I I ONTO 30LID W6 s I 1 I I ON c 1 LLE V. FT. PUMP � � OfF 0 ' 1 CO N CRETE DLOCK r AaPRovED K15ER EXIT PERMITTED OWLd IF TANK MANUFACTURER HAS SUCH APPROVAL gEppl SEPTIC E SIDE C, I F I CATI OKIS ...•••..... _.___ DOSE TA W KS MANUFACTURER: �'�" .– NUMDER Of DOSES: q — PER 0" TANK SIZE' am GALLOWS DOSE VOLUME ALARM MANUFACTURER: - fAv& ACCT INCLUDING OAC1tffl ow: C3� GA LLONS MODEL NUMOCR: CAPACITIES: A= I?JCNE5 OR X61 WLLO►I6 SWITCH TYPE' ..L? 1: 15 = INCHES OR G(►LLOLIS PUMP MANUFACTURER: n k_ uma AN C r-- IU(NES OR 1 3 1 _ GALLONS M DEL NUMBER'- N M ER: l/' 0. ZZ INCHES OR - GALLONS SWITCH TYPE' Hot f3 MOTE: PUMP AND ALARM ARE TO OE MINIMUM D15CHARGE. RATE GPM INSTALLED ON SEPARATS CIRCUITS VERTICAL DIFFERENCE CETWEEN PUMP OFF AUD 015TRIbUTION PIPE.. 10 FEET + MIAIIMUM NETWORK SUPPLY PRESSURE . . .. . . 2 5 MET + FCET OF FORCE MAIN X F YottFRICTIOU FACTOR.. FEET ._ TOTAL DtIWAMIC. HEAD = T FEET n� Ua , � „ a. INTERNAL DI EwSION�4 OF TANK: LEWCsTH ;WIDTH ;LIQUID DEPTH t t Stt'sNED: LICEIJSE IJUMBER: 3C7� DATE:�S County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN �V In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER G [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road A _ Hudson, WI 54016 -7710 (715)3864680 Fax(715)386 -4686 Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if revision to previous application 0 I. Application Information - Please Print all Information 12 Location: Property Owner Name ,��y 114 1/4, Sec T N, R Q E (or > Lot Number Block Number Property Owners Mailing Address AA 0 r V City Zip Code Ph mer ne1ishu cgpi2�_ IC Subdivision Name or CSM Number tY � FFE i ZONINGO 140U1,7_0 A( 6 VV IVA 11 Type of Building: (check one) > amity ❑Village ❑'town of [K 1 or 2 Family Dwelling - No. of Bedrooms:,r e'^ ` ' ❑ Public/Commercial (describe use): [I State -owned Nearest Road _ Ii. Type of Permit: (Check only one box on line A. Check box on line B if applicable) G Parcel Tax Numbers) 2 3- 0 _ L 0. 1 1.0 Repair 1 2-09 Reconnection 3. ❑Non- plumbing 4. ❑ Rejuvenation Z _ '°`) Sanitation 030 _ , 0 S 0 Permit Number Date Issued 19 State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Non - pressurized In- ground ❑Mound ❑Sand Filter ❑Constructed Wetland 11 Pressurized In- ground Q Holding Tank Single Pass ❑Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other . Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Min.Anch) Elevation 3D0 ✓ 1 0 1, 31- 1 VI. Tank Information Capaicty in Gallons Total # Of Manufacturer Concrete S trutted Steel glass Plastic New Existing Gallons Tanks Tanks Tanks Sep p-/ 1 Idea / - ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement 1, the undersigned, assume responsibility for repair/ reconnenction /rejuvenationlnstallation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non - plumbing sanitation system. Plumber's Name (print Plum Signature (no sta ps PRS Business Phone Number _ 7/S 406A(AVjjV -1V17177 Plumber's Address (Street, City, State, Zip Code) ne r � Q VIII. County Use Only Disapproved Sanitary Permit Fee Date Issued Issuing Agent Signature (No stamps) Approved Owner Given Initial Adverse. / I Determination IX. Conditions of Approval /Reasons for Disapproval: nn l •, 2 .� /7�� StGliCH7csZT.f� %kG1'-e_ y�it5 ��/SJIt� lilll( t[cllG ors p / �o�r��. M e �y L d1�kw�bcr ( 1