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HomeMy WebLinkAbout030-2082-10-000 C t m ° c c a�i o 0 3 Y y « C Q N N t ; N 1 y U ° O L N U O C Co N C O) y y a) W L Q co 0 t 2 a y - 2 V U > OU Q� y o o + CA ° �a o - - + z E ° 01 0 v o a ° o rn ° z _ c L � L 0 0 @ C c O 01 C o U N C� Zj O N N C E Q ca) too a� U a1 � 0 O z J O � N a � z v 1 CD m N F Z d m c o Z d c y m o U N o v� h rn o Z c cc E N _ N o N N � a w O o z s z o N � ° z N i 7 .. a) N z _ N E m Y 'C > d Q .@s O C C, @ O N 0 i a) C ® O O a .0 Fz o 0 I _ o U ° O 7 0 0 0 z •MV iQ U m m d Q 0 g C CO 1 O N N O M = a) O O `d Lo - E O O J _ m d M 'C N N us1 N C' o m a O m OI E M co L N cl ? co N V O 0 ° O C - M O C p E M N> > t o N cA Y m° N Y Y cn ✓� d a a a >, � •� Q w :u � �zo E c M U a E O N U r ,COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800 - 962 -5227 ST, CROIX ZONING REPORT NO.i 05012/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 5 /14/90 COURTHOUSE DATE RECEIVED: 5 /11/90 HUDSON, WI 54016 ATTNS THOMAS C. NELSON a 2- OWNERS William & Kim Gleason � 36 2-6 PL LOCATION: 1394 Woodland Ct., Houlton COLLECTOR:; M. Jeer€ins z.. , SOURCE OF SAMPLES Kitchen faucet COLIFORM'. 0 /100 ml INTERPRETATIiN$ Bacteriologically SAFE NITRATE -NS < 1 ppm ` Under 10 ppm is safe f or human consumpt i on. Coliform Bacteria /100 ml Nitrate- Nitrogen, mg /L I i- LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 OF . \N�FVFNp < Means "LESS THAN" Detectable Level Approved by'. Z o ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CIZOIX COUNTY ZONING OFFICE' St. Croix County Court-house 911 4th Street d Hudson, WI 54016 C /OL�� Telephone The St. Croix County Zoning office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Comple of this form is esse a_1 so that tt�c— pi= o�?ci-t - can be loc ated. Please provide the following infQ,rriation, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address'. Testin will be done as soon as possible after fee and formi dare received. WATER TESTING- -------------- - - - - -- � -; - -- - FEE: $ 25.00_ (For nitrates and coliforn bacteria) WATER TESTING '' FEE: $175.00 (For VOC'S) l SEPTIC SYSTEM INSPECTION - - - - -- - - -�� *- - - FEE: $25.00 X Determines if system is )ro ea l functioning at time of ( Y I P ,Y g inspection) Property owner's name k4l Property owner's address Legal Descrip 41 on /V�1/4 of the )C- 1/4 of Section 1113 r�T_ .3D N - RaD Town of — Lot Number Subdivision Name ?�r��u�+.� I Z;�- �ctid FIRE NUMBER - 3J4 -- L OCK BO X NUM131;12 Color of house Realty' s',ign by house ?:�LIf so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential 4:ater requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the �•:ater for several hours before the test can be conducted. WINTER TESTING: Many times ..:ater line-s are turned cff, or sill cocks are turned off, making access to the home n0cessar_y. If this is the case, please make proper arrangements; With this . office to ensure time when entry may be gained. Firm or individual requesting services: Telephone Number ,3 4 REPORT TOZB SENT TO: Closing date � �w_ Signature r " Rlve • / n a , •,\ HA ST. cx 10 2 2% ♦ exxs r - PI / IK 1aTH ST. TH or N TH O == a o T o 0 r Q D ' i r a r O 0 - � o Ruarq o 8T (TROUT SRO OK RD.( I Q s T a r ar � O � I O p 0 17TH ^ I - 48TH II ; e3 0 0 Q r o x 0 T. > iI? C 8T Q T O > 04TH ST • z b QL 0 0 u f ° m c` lb ' N V v � r ST. CROIX COUNTY 7 WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE x - 911 FOURTH STREET • HUDSON, WI 54016 -_ (715) 386 -4680 May 11, 1990 i i Carrie Johnson Edina Realty 700 Second St. Hudson, WI 54016 Dear Mr. Johnson: An inspection of the septic system of William & Kim Gleason property, located at 1394 Woodland Court, Town of St. Joseph was conducted on May 10, 1990. At the same time I also obtained a water sample for testing. The results of that test will be sent to you as soon as we receive them back from the laboratory. At the time of the inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance of the system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator cj 05/28/93 08:50 FAX 612 636 7178 SERCO LAB. 444 S.C. CO CRTHOUSE 11002 SERCO Laboratories 1931 West County Road C2, St, Pout. Minnesota 65113 PMne (612? 636 -7173 FAX (612) 830.7178 LABORATORY ANALYSIS REPORT No: 31586 PAGE 1 of 3 05/28193 St. Croix County Zoning DATE COLLECTED: 05/12/93 911 4th Street DATE RECEIVED: .05/13,/93 Hudson, WI 54016 CALICTED BY : CLIENT DELIVERED BY CLIENT SAMPLE TYPE SING WATER Attn: Mary J. Jenkins CLIENT'S ID: PECH SERCO SAMPLE NO: .37183 SAMPLE DESCRSPTIONs PECHE ANALYSIS: --- - - - - - -- Benzene, ug /L _<1,0 Bromobenzene, ug /L _<0.2 Bromochloromethane, ug /L <0.4 Brom.odi.chloromethane, ug /L -<0.2 Bromotarm, ug /L <0.5 Bromomethane, ug /L (Methyl bromide) <1.0 n- Butylbenzene, ug /I, <0.3 sec- Butylbenzene, ug /L <0.4 tart- Butylbenzene, ug /L <0.5 Carbon tetrachloride, ug /L <0.2 chlorobenzene„ ug /L <1.0 Chloroethane, ug /L (Ethyl chloride) <0.4 Chloroform, ug /L <0.5 Chloromethane, ug /L (Methyl chloride) <0.6 2- Chlorotcluena, ug /L (o- Chlorotoluene) <0.2 4- Chlorotoluens, ug /L (p- Chlorotoluene) <0.2 Dibromochloromethame, ug /L <0.4 1,2- Dibromo- 3- chloropropane, ug /L <1.2 1 1 2- Dibromoethane., ug /L <0.2 (Ethylene dibromide) Dibromomethane, ug /L <0.2 1,2- Dichlorobenzene, ug /L <1.0 (o- Dichlorobenzene) 1,3- Dichlorobenzeane, ug /L <1.0 (m- Diehlorobe"zene) 1,4- Dichlorobenzene, ug /L <1.0 (p- Dichlorobenzene) < means "not detected at - this level ". 1 mg 1000 .ug. 05/28/93 08:51 FAX 612 636 7178 SERCO LAB. S.C. CO CRTHOUSE 009 I SERCO Laboratories 1931 West County Road C2, St- Paul. Minnesota 55113 PA"... (61 P) 636.7173 FAX (612) 636 -7178 LABORATORY ANALYSIS REPORT NO. 31586 PAGE 2 of 3 05/28)93 i SERCO SAMPLE NOz 571$3 SAMPLE DESCRIPTION: PECHE ANALYSIS: -------------------- - - ---- _..__....._ Dichlorodifluoromethans, ug /L (Freon 12) <O.5 1,1- Dichloroethane, ug /L <0.1 1,2- Diehloroethane, ug /L <0.2 (Ethylene dichloride) 1,1- Dichloroethene, uq /L <0.2 cis- 1,2- Dichloroethene, ug /L <0.1 trams- 1,2- Diahloroethene, ug /L -<0.1 1,2- Dichloropropane, ug /L <0.1 1,3- Dichloropropane, ug /L <0.2 2,2- Dichloropropuns, uq /L <0.2 1,1- Dichloropropene, ug /L <0.2 cis- 1,3- Dichloropropene, ug /L <1.5 trans- 1,3-Dichloropropene, ug /L •<0.9 Ethylbenzene, ug /L <1.0 Hexachlorobutadiene, ug /L <0.3 Isopropyibenzene, ug /L, (Cumene) <1.0 4- Isopropyltoluene, ug /L <0.5 (p- Isopr,ppyltoluene) Methylene chloride, ug /L <5.0 (Dichloromethane) Naphthalene, ug /L <0.2 n- Propylbenzene, ug /L <0.4 Styrene, ug /L <1.0 1,1,2,2- Tetrachloroethane, ug /L <0.2 1,1,1,2- Tetrachloroethane, ug /L <0.1 Tatrachloroethene, ug /L <0.2 Toluene, ug /L <1.0 1,2,3- Trichlorobenzene, ug /L <0.2 I l i 1,2,4- Trichlorobenzens, ug /L <0.2 1,1,1 - Trichloroethane, ug /L <5.0 1,1,2 - Trichloroethane, ug /L <0.1 di < means "not detected at this level". ;i - mg = 1000 ug. s i — 05/28/93 08:52 FAX 612 636 7178 SERCO LAB. 444 S.C. CO CRTHOUSE 2004 rM i SERCO Laboratories 1931 West County Roso C2. SL Paul Minnesota 55113 Phone (ei 2) 636.7173 FAX (612) 638.7178 LABORATORY ANALYSIS REPORT NO: 31886 PAGE 3 of 3 05/28/93 SI&RCO SAMPLE NO: 57183 SAMPLE DESCRIPTION: PECHE ANALYSIS: Trichlorcethene, ug /L <0.4 Trichlorofluoromethane, ug /.L (Freon 11) <0.7 1,2,3- Trichloropropane, ug /L <0.2 1,2 Trimathylbenzene, ug /Z <0.2 1,3,5 Trim ethylbenzene, ug /L <0.3 (Mesitylene ) Vinyl chloride, ug /L <1.0 Total Xylene, ug /L <1.0 This sample's analytical results a �--n t. below the U.S. EPA's snwA maximum contaminant level of 1 /3o , 15 Nor those requested compounds which are also on the SDWA McL list. All analyses were performed using EPA or other accepted methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, Diane J. Berson Project Manager I < ueans "not detected at this level " . 1 mg = 1000 ug. �l r�'• COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 ST, CROIX ZONING REPORT NO.'# 41305/01 PAGE 1 ST, CROIX COUNTY REPORT DATE: 5 /18/93 COURTHOUSE DATE RECEIVED. 5/14/93 HUDSON, WI 54016 ATTN'# THOMAS Co NELSON OWNER'# Rudy Peche LOCATIONS 1394 Woodland Ct. Houlton COLLECTOR: M. Jenkins DATE COLLECT04 5 -12 -93 TIME COLLECTED: 1S30pm i! P faucet SOURCE OF SAMPLE. Outs 1 DATE ANALYZED25 -14 -93 TIME ANALYZED211100am COLIFORMS 0 /100 mt INTERPRETATION'# Bacteriologically SAFE NITRATE -NS { 1 ppm Above 10 ppm exceeds the recommended Public Drinking Water. Standard. Conform Bacteria /100 ml Nitrate- Nitrogen, mg /L 11 co A �A Y 2. F �HOrh V IN OF CE C, y O ,.NOEVfNOF Hj LAB TECMICIAN! Pam Gape 9 � J �O WI Approved Lab No. 19 { Means "LESS THAN" Detectable Level Approved by*. ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 I j VOC, te&r' ��JZ,SoJ / S-Q . 5'6 t ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE g 911 FOURTH STREET a HUDSON. W1 54016 .. (71j co` yr _ 3 iG3 SEPTIC INSPECTION / WATER TEST REQUEST FORM desired test(s) & remit appropriate fee with application. 'de water lines are often turned off during winter months, g Ing access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. .. ater (VOC's) $ 35 .00 Vival 1H Water (Nitrate & Bacteria) ` own( r: Requested by:A Address: rm Address City &State: l City & St. . L - Zip Code: 64C)e;�) Zip Code: ' Tele hone N Telephone N°: c! - gU /j �f� P D aA"A_E� - ��P �a j 7 S5 - / � 6 441--1 C Property address (Fire N &Street) : /3� LU07�dQ Location:�h, � h, Sec. , T -3o N, R2L W, Town of t. St. Croix Co., WI. Tax ID N 68�° Parcel ID W V House color: /bAd1cm .Realty firm: e4_ &t Lock Box Combo: `M4 Water sample tap location: TO BE COMPLETED BY PROPERTY OWNER * PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM Is the dwelling currently occupied? ©'Yes 0 No If vacant, date last occupied: Septic system installed by: Year: Septic tank last serviced b G,��,,�/ lr/a�fG Dater 9 ' y: �we.�s Previous Owner's Name(s): vie'- Have any of the following been observed? OY QP Slow drainage from house. OY GO Sewage Back - up into dwelling. OY WK Sewage discharge to ground surface, road ditch or body of water. OY eif Slow drainage from the dwelling. OY UK' Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge SIGNATURE: �� DATE: ��G`� G� ' P LC eX)V kA_zC cA C 4/93 r , i OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION / F N y _ P �S u �� TO BE COMPLETED BY INSPECTION AGENCY System design & /or permit on file? OYes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system OBelow grd []At Mound Approx. size 'X OGravity Mose OPressurized Ft.= OBed OTrench ODry Well Molding Tank OOutfall pipe OBSERVED DEFICIENCIES 00ther OUnknown Septic tank Setbacks: OHouse OWell OProp. line 00ther Dose tank Setbacks: OHouse OWell OProp. line 00ther Mocking cover OWarning label OPump /Floats OAlarm OElec. wiring Soil Absorption System Setbacks: OHouse OWell OProp. line 00ther OPonding: ODischarge: General comments INSPECTORS N ECTORS SKETCH OF SYSTEM LOCATION N 1` I I Inspector Title: • • - • S "A Family Tradition Since 1955 Hudson Office 700 Second Street Hudson, W154016 Office (715) 386 -8236 Metro (612) 436 -7072 FAX (715) 386 -1502 P c a 0 J� {' p ' N A Meaupolitan Financial company. 13 Ml$ 1� ST. CROIX COUNTY WISCONSIN ZONING OFFICE `- ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - - - (715) 386 -4680 May 14, 1993 Kathy Smith Edina Realty 700 - 2nd St. Hudson, WI 54016 Dear Ms. Smith: An inspection of the septic system on the property of Rudy Peche, located at 1394 Woodland Ct., Houlton, WI was conducted on May 12, 1993. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact his office. S' cerely, � f Mary J. Jenkins Assistant Zoning Administrator cj ST. CROIX COUNTY ZONING DEPARTIVIE14T" AS BUILT SANITARY REPORT Owner J X1 19 Property Address > ` City /State j Legal Description: Lot Block S ubdivision/ CSM # - P V4 t / 4, Sec,-2,z -, TAN -R Town of SEPTIC TANK -- DOSE CHAMBER -- TANK INFORMATION: Tank manufacturer Size�ST/PC /�� Setback from: House We11j P/L _,/_a22 Pump manufacturer Model A)�� /,L Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM , 3 �G.S Type of system: zj;& Width = - Length Number of Trenches _ Setback from: House ,_--y Well P/L }_ Vent to fresh air intake ELEVATIONS Description of benchmark - Elevation Description of alternate benchmark Elevation Building Sewer ST/HT Inlet ST Outlet RG,3. PC Inlet RS's" PC Bottom 6-, 7 Header/Manifold 9� 3 Top of ST/PC Manhole Cover Lines (/) ,!5�7. R (�) .:27, R Bottom of System () 9z,:5 Final Grade Date of installation -i Pe it number S7 State plan number Plumber's signature - License number -�7 Date �/3Inn Inspector Complete plot plan Or tx I NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW ��, /JD o�� ,rce �n�•nJ �r L' y ati s.� �r�ch Lt'a /& o,;r INDICATE NORTH ARROW t ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I hav inspected the septic tank presently serving the residence located at: Section T N R W Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Did flow back occur from absorption system? P Y Yes - X_ No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concret Steel Other Manufacturer: (If known) : �i(J,Tr9C�s Age of Tan (If known) : ( igna ure) (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 L83, Wis. dm. Code (except for inspection pening over outlet baff _Z Name ,) fl' S ignature MP /MPRS II -- v Wisconsin,DepartmentofCommerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Count Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Saniti0y tNo.: Personal information you provice may be used for secondary purposes [Privacy Law .15.04 (1)(m)]. Permit Holder's Name: ❑ City ❑ i la e T °)"ow n of State Plan ID No.: K emper, Donald W., Jr.�. �oshriship 1 � CST BM Elev.: Insp. BM Elev.: BM Description: I Parce6T f�1o,82 -10 -000 .C) , CEO •0/ ` Cs l 1 vow LV TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S (ZA70 Benchmark SD 10 -7.50 v0 , 0 Dosi ng t. BM — Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMA ON St/ Ht Outlet 2,(.(S 32' TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet � - (,(a0 Air Septic ' y S'D ' 3 r NA Dt Bottom Dosing 7 - p r > a 9 ' NA Header / Man. Aeration NA Dist. Pipe see Holding Bot. System see �Q6W PUMP / SIPHON INFORMATION Final Grade S j �• ©' Manufacturer 0.9S Demand St cover Model Number WE ©3 t l GPM �c; �e TDH Lift \y,1b Friction q . 3i System TDH �R�Ft i Forcemain Length p I Dia. H " Dist. To Well SOIL ABSORPTION SYSTEM �� s �° .s RENC Width r Length N . Of Trenches PIT Inside Dia. Liquid Depth DIM 3 spa DIMENSION Manufa re SETBACK SYSTEM TO P 1 L BLDG WELL LAKE /STREAM LEACHING ,, _ sg INFORMATION Type O CHAMBER Model Number: System: (tp••nn) > 10D 2 5 SZ OR UNIT DISTRIBUTION SYSTEM 4 3 - Header / M nifold Distribution Pipe(s) x Hole Size �xHole Spacing Vent To Air Intake � Length •�C Dia - Len ia. Spacing 7 (d0 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, p ersons present etc. Inspection #1 cD nsgection : Location: 1394 Woodland Court, Houlton, Wl 54082 (N�V 1/� NE 1/4 25 T30N R20W) - 25.30.20.698 Woodland Hills -Lot 21 S'r 1.) Alt BM Description = a:.gD 2.) Bldg sewer length= - amount of cover = �z 46 3� � q.�s 95�= ss Plan revision required? ❑ Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert No. X ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ° ° l s A e i } f mm$ ° t y F ' € � E a [ [ I i i E t t a j a t j } a m. 4 . ( j M , s } i fl y Ea f t m� } a }m e a A 3 3 } } i t P fi 1 � { e r( Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Nl isconsin P O Box 7302 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 8112 x 11 inches in size. .1 L �/, 6 � 1 Z • See reverse side for instructions for completing this application State Sanitary Permit Number - 35 - 3 3 9� Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Propert wner Name Property Location 1/4 1/4, S 2< T_ 9 , N, (or Property Owner'; Mali g Address Lot Number Block Number City, t e .� Zip Code Phone Number Subdivision Na a or CSM Number u ( ) 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ !t� Near t Road _LAE ❑ VII age 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) • n O �q 19 1 ❑ Apartment/ Condo - .2— 'J t 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. ❑ New 2 ig Replacement 3_ ❑ Replacement of 4 ❑ Reconnection of 5. ❑ Repair of an ------ ------- _ 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 ❑ Seepage Bed 21 []Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ®' Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 E] Seepage Pit � � 43 ❑Vault Privy 14 ❑ System -In -Fill 62� VI. ABSORPTIO SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /i ch) Elevation 1=r Feet Feet acct VII. TANK in Ca ga llo n s Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank — ❑ ❑ ❑ ❑ 1:1 Lift Pump Tan iphon Cha er 6C 6 El 1:1 1:1 1:1 ❑ ❑ VIII. PONSIBILIT ENT I, the undersigned, assume responsibility for instpliation of the onsite sewage system shown on the attached plans. Plumb is ame: (P nt) Plumber' Sig tur . (N Sta I MP/MPRSWNo.: Business Phone Number: Plum er's A dress (Stree , City tate, Zip Co IX. COUNTY / DEPARTMENT USE ONLY []Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) Approved E] Owner Given Initial �s�s ; Surcharge Fee) �] Adverse Determination (O-20M X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 4/99) 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 - licensed'ppmpe 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 8uildingsDiv45ien•; 608 -266- 3151. - To be compl ete 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 pfan; drawn to scale or with complete dilensions, location of holding tank(s),'septfc 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 the county; E) soil test data'on a 115 form; and all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included t}ie creation of surcharges (fees) fora 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. � JS o��'frcr /�nnl � 5 [7 G�K� f W}s��co n' rtmentofIndustry SOIL AND SITE EVALUATION REPORT Page 1 of 3 L'4'5r and Human Relations Division of safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 ih �m size. Plan must include, but St. Croix not limited to vertical and horizontal reference point ( ection And % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distanc arest ro a;� APPLICANT INFORMATION PLEASE PRIN L III MAW R E BY DATE PROPERTY OWNER: Sr PROPS LOCATION Larr &Barbara Last .9 ' 0 NW 1/4 NE 1/4,S 25 T 30 N,R 20 ;� (or) W PRO 394 Wo dlandlLC AD 4 ar /C � B S Woodland Hills CITY, STATE ZIP CODE PHONE QVY ❑VILLAGE [KOWN NEAREST ROAD Houlton, WI. 54082 (715 54T�.• St. J222 ph W oodland [ j New Construction Use [ 14 Residential / Number of bedrooms 4' [ ] Addition to existing building [X] Replacement [ I Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .4 bed, gpd /ft .5 trench, gpd /ft Absorption area required 1500 bed, ft 1200 trench, ft Maximum design loading rate _ bed, gpd /ft 5 trench, gpd /ft Recommended infiltration surface elevation(s) 96.60 ft (as referred to site plan benchmark) Additional design/ site considerations hill to be cut to obtain sufficient area for system Parent material crlacial drift _ Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem 0:S ❑ ci 01U as 0 EIS ®U 0 ®U ❑ ]U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -6 10yr3 /3 none 1 2msbk mfr cs 2f .5 .6 2 6 -24 7.5yr4/4 none sicl 2csbk mfr gw if .4 .5 Ground 3 24 -84 5yr4/4 none sl lcsbk mfi 9W na .4 .5 elev. 1 03.1 ft. 4 1 84-114 7.5yr4/4 none is sOg mvfr na na .7 .8 Depth to limiting factor o +11 4" Remarks: Boring # 1 0 -8 10yr2 /2 none 1 2msbk mfr cs if .5 .6 2 2 8 -28 5yr4/4 none sl lcsbk mfr gw na .4 .5 3 2 84 7.5yr4/6 none ms sOg ml na na .7 '.8 Ground elev. 1 00.1 ft. Depth to limiting kA p r factor +84" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715 246 - 6200 Address: 1554 200th e. New Ri4400d, WI A4017 Signature: Date: 6 -16 -98 CST Number: m02298 i PROPERTY OWNER Larry last SOIL DESCRIPTION REPORT Page 2 3� PARCEL I.D. # 030 - 2082 -10 -000 Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench <: 1 0 -8 10 r4/3 none 1 2m r mfr gw if .5 .6 2 8 -27 7.5yr4/4 none sicl 2csbk mfr gw if .4 .5 Ground 3 27 -80 5yr4/4 none sl lcsbk mfr gw na .4 .5 elev. lfs Os mvfr na na .5 :.6 4 80 -12 7.5 r4 6 none g 1 03.1 ft. Y / Depth to limiting factor / I +120 i Remarks: Boring # I Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting I factor Remarks: Boring # I y Ground ..•• elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Larry Last New Richmond, WI 54017 MPRSW -3254 NW4NE4 S25- T30N -R20W (715).246 -6200 town of St. Joseph lot #21- Woodland Hills � N 1 =40' BM.= top of well @ el. 100 Alt. BM.= top of cement slab by storage shed @ el. 98.40' V 2� o � r I 4 � I Gary L. Steel 6 -16 -98 - PAGE or PUMP CHikmB[R CROSS SECTION AN _ V E WT CAP �7 r VEIJT PIPE WEATHERPROOF APPROVED LOCKING - JUWCT IOAJ BOX MAWHOLE COVER WITH 15' FROM DOOR. WAIWING LAeLL WINDOW OK FRE3H IL�MIU. I AIR INTAKE I GRADE I y" MI►J. Ie•MIU. COW DUIT 16"AIW. PROVIDE tAILET AIRTIGHT SEAL II v APPROVED JOIIJT A I I APPROVED J01►1' I I W/ I PIPE W/ PIPE EXTENDIM6 3' I I I ALARM ONTO SOLID OWTO SOLID SOIL i II Souo S oI. D I I OW C CLEV. FT. PUMP - -� b OFF D COWCRETE DLOCK RISER EXIT PERMITTED OIJLH IF T AWK MAIJUFACTURCR HAS SUCH APPROVAL j" APPAoVE4 6EDDIn+G "ndcr T►'a► -1K 5EPTIC E 5PECIFICATIOfJ5 DOSE I �;� TAWK MAWLIFACTURER' IJLLMHCR OF OOSCS: PER DAy TAWK SIZE GALLOWS DOSE VOLUME ,✓ IWLLUUIWG DACKFLOW: - A GALLON ALARM MAWUFACTUKER: MODEL ►JUMDEK: __.� ICI CAPACITIES: A= 2?, 49" IUCNCS OR � SWITCH TtlPC: B _ 1�2 _ IAICHES OR GALLOWS PUMP MAIJUFACTURCR: C. V2, INCHES OR GALL0Wc. 1 MODEL UUMDER: D + — _INCHES OR GALLOWS SWITCH TYPE: r MOTE' PUMP AWD ALARM ARE TO DE IAJSTALLEU OW SEPARATE CIRCUITS MIAIIMUM DISCHARGE RATE _� — Gv�"� VERTICAL DIFFEKEIJCE DETWEEIJ PUMP OFF A1JO 015TRIBUTIOW PIPE.. FEET + MIUIMUM M ETWORK SUPPLY PRESSURE . . . . . . . . . . . 5 FEET ��qq�� FT,/� FEET + _ FEET OF FORCE MAIM X sdL2GL Ion rt. FRICTlO►1 FAC7GR.._L TOTAL OtiWAMIC �H1EA[) _ �g FEET 1UTERMAL DIME►JSIOWf- OF TAWK: l.E1JGTH 'WIDTH iLIQUID DEPTH SIGIJED' LICENSE NUMBER: PATE: rut 1ul 1114311(.;u w.� •-• , .. ,r M v t , u 1, , Curves PUMPS � METERS FEET 00 - i - MODEL 3885 25 iSiZE 3 /4" Solids WE15H — - Z 20 Q 15 — 40 10 30 WEGam WE031 0 0 0 10 20 30 4 D 50 60 70 60 w 1 C4 110 120 GPM 0 10 20 :4 ml/h CAPACITY ,t ` Ri jam•. f �,•�Y���' VOU�D-) IN >' PUMPS. C METERS FEET 120 MODEL 3885 35 i — T — SIZE 3 /4 Solids 110 WEiSN�— 100 1_ __ 30 90 T_ r — BO i 20 C -� 60 { j - -- ,- Q — -; — _ -- , WE05MH 10 20 10 0 10 20 30 50 w 70 60 t W 1 10 120 GPM 0 10 N _- — 30 m'/h CAPACITY 1 •19" 0910. Pumps. Inc. E I C) 1A` ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Do n4 ?V to .e mv Gr 3r Mailing Address 13 W'o c lax Co No A n W -L --- i0 f ,2 Property Address / 99 10da l a J edce'r� e 77In 6LLr- ;S yaej (Verification required from Planning Department for new construction) / City /State AO'An ./-E Parcel Identification Number Id LEGAL DESCRIPTION Property Location A) 0 V4, A) F, %4, Sec. Q 5" T _ 10 N -R off© W, Town of S4 &s . Subdivision l./,4r��a .d A //J Lot # � J Certified Survey Map # , Volume , Page # Warranty Deed # T1 Q , Volume / Page # U ° f Spec house ❑ yes 90 no Lot lines identifiable M yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. / J SIGNATURE OF APPLICART DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLIC DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed VOL 1`39:3 PACE Ufi.9 � Seller: LAST Data 1D; 1111144 595096 Order No.: 109818 Job No.: 1278 KATHLEEN H. WALSH DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 -1982 REGISTER OF ➢ ST. CROIX CO., , WI WI WARRAN'T'Y DEED RECEIVED FOR RECORD This Deed, made between LARRY A. LAST AND BARBARA J. 01- 05 -19% 10:45 AN LAST, HUSBAND AND WIFE (hereinafter referred to as Grantor, WARRANTY DEED whether one or more), and Donald W. Kemper Jr. , and EXEMPT N Elizabeth A. Kemper, husband and wife. CERT COPY FEE: COPY FEE: TRANSFER FEE: 570.00 (hereinafter referred to as Grantee, whether one or more), RECORDING FEE: 12.00 PAGES: 2 Witnesseth, That the said Grantor, for and in consideration of the sum of Ten and No /100 Dollars and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, conveys to Grantee the following described real property in St. Croix County, State of Wisconsin, to-wit: LOT 21, WOODLAND HILLS IN THE TOWN OF ST. G JOSEPH, ST. CROIX COUNTY, WISCONSIN. The above legal description includes memberships and/or ownerships of non - municipal water and/or sewer systems, if any. Tax Parcel No. 030 - 2082 -10 oi ry - 0,30 Together with all and singular the hereditaments and appurtenances thereunto belonging. This /S homestead property. (is) (is not) Property Address 1394 Woodland Court Houlton, Wisconsin 54082 This conveyance is made and accepted subject to the lien for current taxes and other assessments and all valid and subsisting restrictions, reservations, conditions, limitations, encumbrances, covenants, exceptions and easements as may appear of record, if any, affecting the above descnbed property. TO HAVE AND TO HOLD the said premises, with their appurtenances unto the said Grantee, their heirs and assigns forever. And the said Grantor does hereby covenant to and with the said Grantee, that they are the owners in fee simple of said premises; that they are free from all encumbrances except as described herein, and that they will warrant and defend the same from all lawful claims whatsoever. The singular number shall include the plural, the plural the singular, and use of any gender shall W applicable to all genders. Q p Dated this 3Qik day of �— 19 to a � (SEAL) a — (SEAL) LARRY A. LAST— Grantor BARBARA J. LAST -- Grantor DARLENE V. MANN Aft NOTARY PUBLIC - W INESOTA STATE OF } DAKOTA COWM }sS. Mylaettra til�trM.Mn 31, COUNTY OF } �k+ Personally came before me this _30 day of 9 441rk '199 f the above named LARRY A..LAST- to.me-knnwn.tn be -the. person who executed the foregoing instrument and acknowledged the same. Notary Public County, I=1721f My Commission is permanent. (If not, state expiration date: 1 -161 ss� 'Names of persons signing in any capacity should be typed or printed below their signatures. I [Acknowledgments Continued] Seller. LAST YOL 1393PA 470 Data ID. 01044 Order No.: 109818 STATE OF } }ss. COUNTY OF } Personally came before me this .10 day of 19 q44? the above named BARBARA J. n who e, tted the foregoing instrument and acknowledged the same. lo DARLENE Y. MANN NOTMflY PURJQ - t,1INNESOTA OAKOTACOUNTY wdnm1t�IlMJY491,UOD M jr L Notary Publi�� County, '%V. My Co mmissi on is permanent. (If not, state expiration date: J "Names of persons signing in any capacity should be typed or printed below their signatures. O \ N x Z oar OD N 0 O 0)_ X p 0 '� P z o z m m 0 v _ t S OD_ 0 -4 - n z ` �v 0 N = N w �_ cn m ` ✓ N O. N O -i to m (1) w m I � o z m o n - ` ' Y/ z A 2 .9, O 413.82' ��O - � - 0 z iD -I aD o o o - n N O CD 0 m � N - m 0 N / /6o ?.o_ Z iC 0 m 3 4�' Z I N i m (D ;� D m c � \ ;u v Z Cl) m m cn O 00 °L i� D -i V D iD i� Z �O11 OD ' Q U Z - n N OD D -I D Ul � 0 m c� m WoZ N N aD 0 :Ll p _ cn rn C Z D (1) w Ln Ul r cn A m N r' D c 4 �U 0 DZ �_ p D O N r ; _ cn O _ c m -4 D D BF �� m vim 6 i p /S 9 32 / O i C) < -j m D 3 (n � = Z C = i m N � w 0 < m r z = v / w Z N r- D 68. °D m 3 mm� O w -n Dv N U v N 00 °92\ z m = m m m "i *Km N 4s -i z D = v � o m m m o_ o • ..% m -1 0 5z ' 430.00' T EAAST LINE OF NW 1/4 OF NE 1/4 DS _ N W m CD_ O 0 I Z Jo Z Z