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Home My WebLink About030-2101-80-000 (2) ST. CROIX COUNTY ZONING DEPARTMENT 8.._. AS BUILT SANITARY REPORT (0 RECONJED Owner A R � P 4tg'� Property Address City/State 1101 S O lv- / - Loy , / ',�A ST cROO K cOuNTY � v Legal Description: '' Lot OZ Block YA Subdivision/CSM # e- o '/a _20 t /a, Sec. ,� �, TAN -Rj-W, Town of S i, r7n"yc o 4 P� # O SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer a,&E& :5 Size ST/PC /OG2J — Setback from: House 6 ' Well P/L Pump manufacturer Model __A Alarm location (HOLDING TANKS ONLY) Setbacks: ery nt to fresh air intake Water Line Meter location SOIL ABSORPTION SYSTEM Type of system: ��j'tE&C Width _3 Length Number of Trenches Setback from: House .2 C,' Well P/L Sn Vent to fresh air intake �S0 f ELEVATIONS Description of benchmark — o / Elevation g2:: Description of alternate benchmark 254 of �ASC/`%En�T �1Jf�� -�— Elevation 16 Description Building Sewer 5 3 ST/HT Inlet S ST Outlet — — ` PC Inlet - 1YA PC Bottom IYA— Header/Manifold Z O Top of ST/PC Manhole Cover Distribution Lines (1) 96 1/ (2) Bottom of System (1) U (2) f �• /��_ ( ) Final Grade (1) 9 7, ,5 -- 0-) 9 2 , 5- ( ) Date of installation 13 /v Permit number -7f:K2 7j State plan number IVA Plumber's signature " — 2L icense number �2 2 i 7 V I Date i Inspector rwi v (a� Complete plot plan * 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 N o R r# 1 L 3 4� G /+dAC 3 PaO v /�ar�SE 3X ?,5` /NFiIT/?ATO& T�E�vc�c —s INDICATE ORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. 353272 Permit Holder's Name: []City ❑ Village ❑ T(own of: State Plan ID No.: St. Joseph Township CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: a0 , r ,O u.l iw s4Jg- 1 030- 2101 -80 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark g ,1 �, 11 100 .0 r Dosing Alt. BM i0q.4 S Aeration Bldg. Sewer �.o (, 0 (. os Holding St/Ht Inlet g �. 2. 1 ,10 . 29 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air i to ntake ROAD Dt Inlet Air Septic y�e�p fi r' .-- NA Dt Bottom Dosing NA Header / Man. g, *0 cm, � I Aeration NA Dist. Pi p e Es� gQ,bg Holding Bot. System PUMP / SIPHON INFORMATION Final Grade •+. /02.0 Manufacturer Demand St cover ' Sib oZ .65 Model Number GPM TDH Lift Friction System TDH Ft oss Forcemain Length Dia. Fi Dist. To well SOIL, PTION SYSTEM 1 �C$/ RENCH Width r Len th r No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 3 $ DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION TypeO , , CHAMBER mod Number: System: y�1/, 5_ 2(6 -jE OR UNIT DISTRIBUTION SYSTEM Header/Manifold � Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length - r 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 I ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1. Of /VqI00 Inspection #2• I / Location: 462 Highland View �Hudson, �VI 0 (SE 1/4 SW 1/4 29 T30N R19W) - 29.30.19.827 Highland Hills I -Lot 27 1.) Alt BM Description = - 6f , �° �°"w'di1 °% 2.) Bldg sewer length = " V - amount of cover= X20 . 3 ) &\ � w� �s � Te+. Plan revision required? ❑ Yes tg No ( J Use other side for additional information. O/ 1 01f I DO SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division ��S�onS %n SANITARY PERMIT APPLICATION 201 Box Washington Avenue Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • . Attach complete plans (to the county copy only) for the system, on paper not less County t than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Per it Number 353 2: +-:-' 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 it Propert y O ner Na a Property Location R & SEv4 5 jA r- 1A, S a d l T 3 0 , N, R jq E (oe) Property Owner's Mailin ddress Lot Number Block Number City, St to Zip Code Phone Number Subdi ision Name or CS Number Ol(e ( a 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ C Pk4 Its Nearest Road ❑ Vil age Public 1 or 2 Family Dwelling - No. of bedrooms X. To' OF , 111. BUILDING USE (If building type is public, check all that apply) arcel Tax Number(s) ;0 1 ` T al 1 [] Apartment / Condo 0 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 Cam round 7 Merchandise: I R it 1 R r ❑ Campground ❑ Sales/ Repairs 1 ❑ estaurant /Ba /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 ill New 2 ❑ Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5_ ❑ Repair of an Syrstem ..... 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 12Rg,Seepage Trench 22 ❑ In Ground Pressure X � 2 E] Pit Privy 1 ❑ Seepage Pit ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM O MATION: cJ$� �p 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate m Elev. 7. Final Grade 45D I !:f5D 715-0 Required (sq_ ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) q��. Elevation f� . �o "�r�o Feet I Dct Feet VII. TANK Capaclt in gallo Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel lass Plastic App New Exist in structed g Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber L ❑ 1 ❑ ❑ ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) 4mer'sSignature:oosta ps)� MP /MPRSWNO.: Business Phone Number: 9- 6GS Plumber' ;Address (Street, City, State, Zip Cod IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate I ssued Issuin Agent Signature (No Stamps) K Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination s� X. CONDITI NS OF 6 P OVAL / REASO S FOR �S PPR VAL: S �0PM�0.' 7''�0 �° .d ct�tQS r 2 let o SBD -6398 (R. 4199) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, owner, plumber INSTRILCTlJONS k 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 Administrat ve- Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plum-ber 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 ticenSed pumper wtieriever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin; Safety and Buildings Dauisioi sp8=266=3151 - _ -- - -- 1 To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. ' II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone�number..`Plurnber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and _specifications not smaller than 8 112 x 11 inches must be submitted tote county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss, pump performance curve, pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data "on'a 115 form; and F) all sizing information. -- ----- ----- ----- ------------------------------------------- - --------------- ------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410included the creation of surcharges (fees) for a number of regulated practices which can ✓{ j ~� i � 3 effect groundwater. �� r ,r `J 4 6 sa The monies collected through these surcharges are used for monitoring groundwater contamination investigations 9 and establishment of standards. 7 / M i c i I { , i AWAr. t -- ?lI f R 1 1 F i _ _. -- — j AA// I 1 � t ; j J - - ` - - --- _ - jaa��Q r ' -- , _ lz 1 , Y _ 1/_ s i D/?Acvin[e- P0/1,' - -1 C-,q A y Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page i of _3_ Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PA dimensioned, north arrow, and location and distance to nearest road. INX h- �l APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION ,EDB S 9 PROPERTY OWNER: PROPERTY LOCATION Joanne Persico GOVT. LOT SE v4 SW S 29 9,► _o W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. 7 27 na Hi 1 co dn. CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE UFOWN �� Hudson WI. 54016 (71 386-9060 ST. Joseph E ' [x] New Construction Use [K ] Residential / Number of bedrooms 3 [ ] Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd /ft2 •6 trench, gpd /ft Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate • 5 bed, gpd /ft2 •6 trench, gpd /ft Recommended infiltration surface elevation(s) 98.87 ft (as referred to site plan benchmark) Additional design / site considerations alt area system el . = 98.40 & 95.57' Parent material pitted glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S ❑ U ®S ❑ U I ®S ❑ U 1E7 S ❑ U ❑ S CCU ❑ S L U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft I In. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 2 18 -40 7.5 r4 4 none scl 2csbk mfr gW if .4 .5 Ground 3 40_-,;.84 7.5 r4/4 none sl 2msbk mvfr na na .5 .6 elev. -- 10 ft. Depth to L 6 limiting factor +84 Remarks: Boring # 1 0 -8 10 r3/3 none sil 1 mfr gW 2f np.2 2 8 -17 10 r4/4 none sl 2csbk mfr gW if .5` .6 Ground 3 17 -40 7.5 r4/4 none scl 2csbk mfr gW na .4 .5 elev. 4 40 -84 7.5yr4/4 none sl 2msbk mvfr na na .5 .6 10 ft. Depth to limiting ,96 factor +84 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Me,, New Rich nd WI 54017 Signature: Date: 11 -12 -96 CST Number: m02298 PROPERTYOWNER Joanne Persico SOIL DESCRIPTION REPORT Page -of _3_ PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BouY Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench i....3....: 1 0 -13 10 r3 4 none sl 2msbk mfr cs 2f .5 .6 2 13 -24 10yr4 /4 none sl 2csbk mfr gw if .5 .6 Ground 3 24 -84 7.5 r4/4 none sl 2msbk mvfr na na .5 .6 elev. 1 Depth to limiting factor 3� +84 .3(, Z. " Remarks: Boring # 1 0 -8 10 r3 3 none sl 2msbk mfr cs 2f .51 .6 2 8 -30 7.5 r4/4 none scl 2msbk mfr 9w if .4 .5 Ground 3 30 -80 7.5 r4 4 none sl 2msbk mfr na na .5 .6 elev. 9 9.2 ft. Depth to limiting factor +80 Remarks: Boring # 1 0 -11 10 r4 3 none sl 2msbk mfr cs 2f .5 .6 2 11 -24 10 r3/3 none sl 2msbk mfr gw if .5 .6 Ground 3 24 -40 7.5 r4 4 none scl 2csbk mfr` 9w na A .5 elev. 4 0 -80 7.5 r4 4 none sl 2msbk mfr na na .5 .6 98.9 ft. Depth to limiting factor +2 ' Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Joanne Persico 1554 200th Ave. CSTM2298 SE4SW4 S29- T30N -R19W New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246 -6200 lot #27- Highland HIlls Second Addn. /1." =40' top of NW lot stake C el. 100' Ao-yo .. 3z1 5r Q^'v7 Gary L. Steel 11 -12 -96 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT . AND OWNERSHIP CERTIFICATION FORM Owner/Buyer G A)? — Mailing Address Y / . �zC C ��AF S • /fu/� 5 Property Address 46 2' k6:!�&',C,4 nin t'J, /C 46Z / (Verification required from Planning Department for new construction) City/State ia/) sa ,Al' Parcel Identification Number ./3 - 36 LEGAL DESCRIPTION Property Location E V4, 5 '/,, Sec. IT T�N -R W, Town of S%. Subdivision //>'GI-IL.,4/V h - S ic — A "A , Lot # 17 Certified Survey Map # Volume , Page # Warranty Deed # C Volume Iq?-2 - -, Page # 3'7. Spec house �( yes ❑ no Lot lines identifiable 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 masterplumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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 statin that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days f the three year n date A/ $161+A OF DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p erty described ab e'b virtue of a warranty deed recorded in Register of Deeds Office. l S A CANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed VI) I. 372 STATE BAR OF WISCONSIN FORM 2 - 1998 Es 15339 Document Number WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Highland Hills, a Partnership, 12 -10 -1999 10:30 AM WARRANTY DEED EXEMPT N CERT COPY FEE: Grantor, conveys and warrants to Gary Picotte COPY FEE: TRANSFER FEE: 135.00 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (The Recording Area " Property "): Name and Return Address 4U 11�Z �O 030 - 2101 -80 Parcel Identification Number (PIN) This is not homestead property. Lot 27, Plat of Highland Hills Second Addition in the Town of St. Joseph, St. Croix County, Wisconsin. S00 27 "E — —� Ln 155.00' A \ `J C-0 - - D \ VIEW Lit OD N ® r O N \ \\ D N O I W n I J O \ a O(x fJN N ' n -n N A M ri o I � I T1 iv n v \ I M O � W D cn � m 420.46' 117.86 505 °2951 1310.06' EAST LINE OF THE SWI /4 L -- ---- NORTH -SOUTH I/4 LWE 5256,3$ - MATC H L AN.L_ -7 SEE SHEE" (plat) is subject to State, County and (tions (i.e., wetlands, minimum lot size, )urchasing or developing any parcel contact 2e and appropriate Town Board for advice.. be placed such that the installation would . struct vision along any lot line or street BEARINGS ARf :ake b anyone is a violation of Section EAST - WEST y y ility Basements as herein set forth are for 29, ASSUMED - ivate public utilities having the right to