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030-1015-50-100 (2)
St.CrorCountyPlanning ' Tlr ursday, July 12, 104 at 9.00.23 AM Detail Sanitary Information Page, -of I Computer #: 030-1015-50-100 Sub/Plat: NA Section: 4 Parcel #: 04.29.19.65A10 Lot: 1 TNIRNG: T29N R19W Municipality: St. Joseph, Town of CSM: Vol. 09 Pg. 2445 1/4 1/4: SE 1/4 NE 1/4 Owner: Spangenberg, Jeff 526 River Road Hudson, WI 54016 State Permit: 171455 Issued: 06/15/1992 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 06/15/1992 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Jim Thompson Yes O'Connell, Kim permit number changed - relocated system area? $0.00 Jim Thompson Sj ; ie�_< CX - Yes Original Ken Bauer soil report for lot/CSM in 1992 found in active files - now with archive permit Maintenance Scheduled Pump Date Pumped 1 st Notification 2nd Notification 3rd Notification 6/15/1995 10/9/2006 04/20/2006 10/9/2009 Owner: Spangenberg, Jeff 526 River Road Hudson, WI 54016 State Permit: 149329 Issued: 05/08/1992 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Jim Thompson NA O'Connell, Kim not installed, see later permit $0.00 Not determined E ;>:.{ ft" No DEPARTMEIVTOF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, � DIVISION HUMAN RE LABOR DATIONS PERCOLATION TESTS (��J) MADISON WI 5370P.O. BOX 7 (1-163.0911) &Chapter 145.045) LOCATION: ' 1/ A/4 SECTION: /T29 N/R TOWNSHIP/111VTOMMITY: LOT NO.: I BLK. NO.: SUBDIVISION NAME: SE 4 19 or) W St. Jose h n/a n/a n/a COUNTY: OWNER'S/ Bt.NtZ3bnVAME: MAILING ADDRESS: St. Croix Kenneth Bauer 530 River Rd. lludson,wi. 54016 U5t DATES OBSERVATIONS MADE Y�esidence NO. BEDRMS.: COMMERCIAL DESCRIPTION: 3 n/alew ❑Replace PROFILE DESCRIPTIONS: 2-7-92 PERCOLATION TESTS: 2-7-92 RATING: S= Site suitable or system U= Site unsuitable for system �'L�- � 2 qws-- CONVENTIONAL: MOUD: IN -GROUND -PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) Qs E1.0 U SE] S❑ U ❑ S E U ❑ S Eul conventioanl If Percolation Tests are NOT required under s.H63.09(5)(b), indicate: DESIGN RATE: n/a If any portion of the tested area is in the Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 50, OnC2 BORINGI NUMBER TOTAL DEPTH ELEVATION DEPTH TO GROUNDWATER OBSERVED -INCHES EST. HIGHEST CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 7.25 99.7 none >7.25 .75l.1. .83bn.sil., 1.50bn.l.s., 4.92bn.c.s. B- 2 7.42 101.2 none >7.42 .42bl.1., .50bn.s.1., 1.00bn.s. 5.50bn.c.s. B_ 3 7.00 99.3 none >7.00 .58bl.1. .83bn.sil. .75bn.l.s., 4.83bn.c.s. B- 4 6.92 98.2 none >6.92 .83bl.1. 1.00bn.sil., .75bn.l.s., 4.33bn.c.s. B_ 5 6.67 98.7 none >6.67 1.00bl.1., .67bn.s.sil. .67bn.l.s. 4.33 bn.c.s. B- �r�rimal ' PERCOLATION TESTS TEST NUMBER _ DEPTH S WATER IN HOLE AFTER SWELLING TEST TIME INTERVAL -MIN. DROP IN WATER LEVEL -INCHES RATE MINUTES PER INCH PERIOD t PERIOD 2 PERIOD 3 P_ ? 2.70 none 3 6 6 h <' P_ 2 4.20 none 3 6 6 6 < 3 P- 3 2.30 none 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 97.00 ^� PZ � 4,J 7_k- -70 �6j tN I, the undersigned, hereby certify that the soil tests report NQc Administrative Code, and that the data recorded and the locatio 11 y me in accord with the procedures and methods specified in the Wisconsin rrq. 'to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: I Gary L. Steel 297-92 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. aVe. New Richmond wi. 54017 2298 715- 46-6200 CST SIGN E: 11 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) — OVER — r INSTRUCTIONS FOR COMPLETING FORM 11.5 - SBD - 5395 To be Ga complete and accurate sail test, your report must inc.lUde: 1. Cornplete legal description; 2. The use section} must clearly indicatQ whether ttlis is a i esicic.,m e, or cornmercial project; 3. MAX IMUM number of bedrooms or cc_arnrnercial use planned; 4. Is this a new oil replacement system; 5, Complete the stritahility 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 abbveviationc shovvn here for writing profile descriptions and com pletiray the Mot plant; I. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used it desired; 8. M-& e sure your benchmark and vertical elevation r € terenc.e point are clearly shovvii, and arcs pei nianeilt; 'j. Cotnlpletet all apptopriale boxes as to dates, dames, addresses, flood plaint data, perc:olaiion tc.st eXerTlll- tlor. it al_>propiate, 10. If f,he Information (such as flood plain, elf�v<ation) does not apply, gala€ e, N,A. iri the an-)ropriate box; -1 1 . SKin the for m arlc;i place your c ur rent address and yot.ar- certificatiorj 110m aer; 12. Make iegihle copies and distrit:lute as ret:luired, ALL SOIL... TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Sail Separates and Textures Other Symbols st Stolle (over 1 .") BR L: udrock co h Cobble (3 - 1 B„ ) ziS — �Je�r =El�tC3rt gi. ._..... Giavel (undei 3°' LS Lirrjeston s sand HG"VV -- High Gr otli'fdvvatt l y 7. t. ) p i f , In,e S a I i d B1(11 Bl.Jili_iitic; Is ___ L(-) amy Sand .,,.._ l.�i��;r��'.E' r 1 1iji) rs ......., Sb'ar,,dy Loam f� ( __._ Less I Than 5r1 gilt Loam B{ B (,—,k sr _ Slt C.y Gray c:l - Clay Lo Y -- Y�111 (arr, -gellc) sicl _... Silty Clay Loarn mot motlle: SC Sand\/ Clay w1i ,,:vitr; i _""` i l t y Ca f 6 ._-- (: vv, , i r r I {, r i {', r c May Ctc cur mon, . oar: e pi ..... . ea.tr ;nrrr I'vl"aoy, rnedi(arl) rn - Muck d distinct HVVL — HfCC:� !�"1cltf.',r lev€sI, u Six general syyorl[[�� textures C "1 } surface �li�f�aler for liquid vva"te disposal }'�``fp{ B Y! Bench Mark V RP Vertical Reference Point TO THE OWNER: This soil test report is the first step In securing a sanitary hermit. The county or the Department may request verification of this soil test In the field prior to permit issuan(T. A complete scat of plans for the private sev%latle system and ;a Permit ;application rnuSt be StAbrIlitted to the �i;ppwpritjle lc:)K.al authority it) order to obtain a permit. The sanitary permit must: be obttaineo and posted prior to the start of any constructicarj. Syslcm Eicvation r ; Wrttor►lln UtOJ'ir^orl of IrdUWY, SUIL ULyt-I%lr I IVts 1%LI Vt% 1 labor and Ftuman Relations (Attach Soil Profile Location Map • To Scale • On A Separate, Signed Sheet) Page1._-- t urrvys ww Kenneth,Bauer IM I VJ . OA r I 2-7-92 C UrvvWT Um L" V10 CCMW pasture r A"W ►+ A r I Ftv4 Tutwasn na► e/ASPIC t N-5% �• (Y-"o K.A" s a llltq-- ovo-le"`54016 5 3River Rd., Hudson, Wi. .tAtl�•tOLWY St. Croix gri t iC)Ao•+n a.aw a 450 LOW 41 SE NW 29 1 QM MlNI'1� 191S t Joseph t u1►MC It l�►� l R n / aDORM t�l . ` LOT 9LOCK 'n a -- CSFJr suevlvlslvN n/a -- NIw __ RlolAt7t • l Norleon Dtolh Dominant Color In Munslil Mottles u. St, Cont. Color 1txture ---�- �Slruclure Gr. St. Sh. Conittlenct Rovis Bounder Limiting Factor/ l wangGPO sp rt. Depth r'tnth B+d 1 0-9 10yr3 / 3 none 1 /m/ sbk mfi -1/f C none .3 •2 Elcv 9-1 10yr4/4 none sit. f sbk mfi 1/f C none .0 .0 9g•7 3 0-2 7:5yr4/4 none I.S. 1/f/s9 ml 1/f G none .8 •7 4 8-8 7.5r5/4 y none � C.S. /f/sg m1 1/f n/a none .8 .7 �� Harlion Depth OOmrnant Color In. untell Molllet u St. Cont. Color Texture St/u(tute Gr. St. Sh, Conittence Roots Boundar Llmftlnq Factor/ Lo &nq.QPbsa It. Depth ffencn Bed - ' 1 -5- 10yr3/3 none 1. /m/sbk mfi 1/f C none I .3 .2 �Icv `'►�"` 2 -11 10yr4/4 none s.l. 2/m/sb mfr 1/f C none .5 .4 101. 3 1-23 7.5yr5 /4 none s . /f'/sg ml 1/f G none 4 3-89 7.5yr5/4 none c.s. 0/f/sg ml 1/f n/a none .8 .7 B . � Hortton 3 Depth t?orntnanlColor In, Munsell 110yr3/3 Mottles Ctu. St. Cont. Color Texture Structure Gr, St. Sh. Consistence Roots Bounds limiting Factor/ Loadtrgc P1Dm ft Depth T►�nch !!ad ,1 0-7 none 1. 2 /m / sbl. mfi 1/f C none .3 .2 Elev 2 -17 10yr4/4 none sil. 2/m/sb mfi 1/f C none .0 .0 9.3 3 7- 2 .5yr none 1-S. 0 / f / sg ml 1/f G none .8 .7 4 F a 6-84 7.5yr5 /4 none C.S. c . 0/f/s g ml 1/f n/a none .8 .7 ' l . (Morison 4 Dominant Color Mun ill 7nn Mollies u. St. Cont. Color Ttriut .si uctu►e Gr. t, Sh. Contfittnct Roots BoundaryDepth Limiting F&clorBoo lo,o,rQopa+a. h. trtrncn Bad 1 10 r 3 4 none 1. 2 /m / sbl mfi 1/f C none _ .3 .2 EIt*v +� 2 0-22 10yr4/4 none sil . 2/m/sb mfi 1/f C none .0 .0 - 98.2 3 2-31 7.'5 r4/4 none l.s. 0/f/Lg ml 1/f G none .8 •7 4 1-83 7.5 r5/4 none c.s. 0%f/sg ml 1/f n/a none .8 .7 5 Morison _ Depth Oomrnant Color Mottles L-7. Structure - - -=, t.ImI11nQ Flttor Lotar+oQPDtq. h, OsPth /rsnth Bea In. Munsell I u. St. Con . Color Texture Gr. St. Sh. Consistence Roots 8ound�►Y 1 0-12 10 r3 3 none 1. 2/m/sb mfi 1/f C none .3 .2 LICv 0 _ 12- 10 r4 4 none s . s i 2 /m/ r mfr. 1/f C none .3 •2 20-2 10 r3/4 none l.s. 0/f /sg ml 1/f G none -.8 •7 .4 8-80 10yr4/4 none Cos. 0/f/sg ml 1/f n/a none .8 .7 Additional lttmarks: pie #50 Soil series OnC2 5+ plot on back, lot 2.33 acres Othtr Sttt IttatuVMS' Q� 2-7-92 f715 l 246-6,'O0 2298 97.2 - - --- tgnatuW bale Signed I'tlephont No Gary L. Steel, 1554 200th. Acve., New Richmond, Wi. 54017 CST unfit. (fAril) City Slate Zip RECOMMENDED SYSTEM T j (fr^�•4iJl 1 r 92-- Woscons,m otoa•trmort of Ir'(fuslry, SUIL UL :)+.l%ir I ivi 1 1%1-r V1% I Labor and Human Relations (Attach Soil Prolile Location Map - To Scale - On A Separate, Signed Sheet) ►.tad+ton, :,1 LJ.I" pi9e .r tutICA411arwa lotIVA& WE currerrUuouwvt4c r true R no►irwerwCl K000ruwd! Kenneth, Bauer 2-7-92 pasture utwas N-50 k/a 530 River Rd . , Hudson, Wi . c54016 •r,�r! �St . Croix450 ,vsr �a►o.,o o•oa w SE Lor j jNW 29 19�' St . osep� n/at� BC3 C S N r t.ot 9LOCK n/a sueolv'910" n/a NEW- REPLACE B - 1 Monson Otolh Dominant Color Mottles �Slructure Llmhlnp Faelorr LoaanpGMsq It. In Munsell u. St. Cont. Color Texture G►, St. Sh. Consistence Roots Boundary Depth trench Bed 1 0-9 1 10yr3/3 none 1 /m/sbk mfi 1/f C none .3 .2 Clt:v = 2 9-1 10yr4/1+ none ' sil. / f/ sbk mf i 1/f C none .0 .0 99.7 3 - 10-28 7.5yr4/4 none l.s. 1/f/sg ml 1/f G none .8 .7 4 P8-81 7.5yr5/4 none c.s. /f/sg ml 1/f n/a none .8 .7 13.2 Moreton Depth In. Dominant Color Munsell Mottles Qu St. Cont. Color Texture Structure Gr. Sr. Sh. Consistence Roots Boundary Umolln0 Fatroil Depth Lac0^9.GPD%4 n. Tench 9•d 1 -5- 10yr3/3 none 1. /m/sbk mfi 1/f C none .3 .2 Elev 2 -11 10yr4/4 none s.l. 2/m/sb mfr 1/f C none .5 .4 101. 3 1-23 7.5yr5/4 none S. /f'/sg ml 1/f_ G none .8 .7 4 3-89 7.5yr5/4 none c.s. 0/f/sg ml 1/f n/a none .8 .7 D _ ( Horston 3 Depth In, Dominant Color Munsell Mottles Qu. St. Cont. Color Texture Structure Gr. St. Sh. Consistence Roots Boundary Urnirin0 Fac1oN Depth LwangaPDsc� h. Trench Bed 1 Elev = 2 9.3 3 0-7 10yr3/3 none 1. 2/m/sb mfi 1/f C none .3 .2 --17 10yr4/4 none sil. 2/m/sb mfi 1/f C none .0 .0 7-2 6-84 .5 yr4 4 7.5yr5/4 none none I.S. c.s. 0 / f / sg 0/f/sg ml ml 1/f 1/f G n/a none none .8 .7 4 .7 d - 4 (H0111on Depth tn. Dominant Color Mun ell Mottles QV. St. Cont. Color Texlure Itructure Gr. St. Sh, Consistence Roots Boundary Um+ling Factod Depth Load1n913P(Y&4 M. Trench sell 1 ElElev a 2 3 0=1-0 1 r3 4 none 1. 2/m/sb mfi 1/f C none .3 .2 0-22 10yr4/4 none sil. 2/m/sb mfi 1/f C none .0 .0 2-31 1-83 7.5 r4/4 none l.s. 0/f/:g , ml 1/f G none .8 .7 4 7.5yr5/4 none C.S. 0/f/sg ml 1/f n/a none .8 .7 B. 5 Hodson Depth In. Oom�nantColor Munsell Mottles U. St. Con . Color Texture Structure Gr. St. Sh. Consistence Roots Boundarydepth 11m111ng Fecrorl Logan 3PD Tiench B,Q 1 0-12 10 r3/3 none 1. 2/m/sb mfi 1/f C none .3 .2 Elev � E8. 7 2 12-2 10 r4 4 none S.Si-_2/m/gr , mfr 1/f C none .3 .2 3 20-211 8-80 10 r3/4 10yr4/4 none none l.s. C.S. 0/f/sg 0/f/sg ml ml 1/f 1/f G n/a none none .8 .7 4 .8 .7 Additional Remarks: RECOMMENDED SYSTEM TYPE: trenc .2 age #50 Soil series OnC2 0 1!0� lot on back i ..�.� lot 2.33 acres ,= a Othtr Site Features: 97.2 2-7-92 t 715 .24 - 2298 Sys1Cm ElCvation 19nalu Dale Signed telephone No. CST it Gary L.(Steel, 1554 200th. Acve., New Richmond, Wi. 54017 CST Nnrne INIMj Cilr $late zip efn "-kw / 4 c4 a- �- 9L //t:�-'*lqcll�. a W J 11 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP - J. SECTION N-R-4q W ADDRESS � ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE -&,Z PLAN VIEW BENCHMARK:Elevation and description: - Alternate benchmark 10, SEPTIC TANK: Manuf acturer : _A2LeA� Liquid Cap. Rings used: Manhole cover elev: �-Final grade elev: /&?,? Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front , Sided, Rear Ft. From nearest prop. line:Front , Side , Rear Y Ft./ No. of feet from: Well , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: i Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front , Side Rear Ft.� Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width:' Length_ S� Number of Lines: Area Built_ _D Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: oele 4 No. feet from nearest rop. line:Front , Side , Rear Ft* No. feet from well:No . feet from building_ -3& HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building nearest road Alarm Manufacturer: INSPECTOR: DATE: PLUMBER ON JOB: f.q Z-' LICENSE NUMBER:,�S�9' 6/90:cj LOCATION: ST. JOSEPH Wisconsin Department of Industry, Labor and Human Relations ,afety artd Buildings Division GENERAL INFORMATION 4.29.1PRIVA�E �&AuSIIAVE. SY INSPECTION REPORT (ATTACH TO PERMIT) Permit Holder's Name: ❑ City []Village [Town of: JEFF SPANGENBERG ST. JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: cz, TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ' D Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. Ventto Air Intake ROAD Septic ' r 11,4 NA D NA Aeration NA Holding it PUMP/ SIPHON INFORMATION nufacturer Demand Model Number GPM TDH Lift FrictLossion Msteeadm H Ft Forcemai n Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: Sanitary Tre7rdit 171455 State Plan I o.: Parcel Tax No.: r A9200220 c,r//S/92 STATION BS HI FS ELEV. Benchmark Bldg. Sewer St / Inlet 9,:S-, St / FEE Outlet'J, fol ' Dt Inlet Dt Bottom HeaderL5�f,' O Dist. Pipe ' , Bot. System 7"�� ' Final Grade 6 J o 'l 5 % „ BED/TRENCH Width Length i No. Of T enches PIT Of Pits Inside Dia. Liquid Depth WMENSION i LAKE / STREAM LEACHINGVancturer: SETBACK SYSTEM TO P / L BLDG WELL INFORMATION CHAMBER Type O �i , , 4OR er: System: UNIT DISTRIBUTION SYSTEM Header PlMsnifeltl Distribution Pipes �Z !, x Hole Size x Hole Spacing Vent To Air intake Length _& Dia. Length Dia._,Z� Spacing _�.L 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.) "Oe,71 Z,4 Lin dw 3� Plan revision required.) ❑ Yes o Use other side for additional information. AZ SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. m;r�: _ _ ONITORV PFRUIT APPI MATMN AL �ap In accord with ILHR 83.05, Wis. Adm. Code s COUNTY ` /1 f ' STATE SANITA PERMIT # Attach complete plans (to the county copy only) for the system, on paper not less than 1Iq 78 x 11 nct�es I n slze. Check if revoe to previous application wee reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PRO RTY OWNER PROPERTY LOCATION �' -- ' % %, S , N, R E (orffl PROPERTY OWNER'S MAILING ADDR SS LOT # BLOCK # ZZ!ZA S S dz Ie CITY TATE zl CODE PHONE NUMBER SUBDIV SION NAME OR CSM NUMBER • 3 U TY OA II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLLAGE NEAREST R19 w i TOWN V. E]Public 1 or 2 Fam. Dwellin of bedrooms . v III. BUILDING USE: (if building type is public, check all that apply) 0201 0 %5�Q / OQ 1 El Apt/Condo 2 ❑ Assembly Hall 6 El Medical Facility/Nursing Home 10 1:1 Outdoor Recreational Facility 3 El Campground 7 D Merchandise: Sales/Repairs 11 El Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 El Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 El Other: Specify. IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. M New 2. ❑ Replacement 3. E]Replacement of 4. El Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 0 Seepage Bed 21 El Mound 30 El Specify Type 41 El Holding Tank 12 El Seepage Trench 22 El In -Ground 42 El Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 1. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min. nch) ELEVATION I I W��/) - ,/a //_ ? za,.9, Feet Feet VII. TANK INFORMATION CAPACITY in aallons Total Gallons # of Tanks Manufacturers Name Prefab. ConcreteCon-Steel Site Fiber-Exper. glass Plastic App. New sting Tanks Tanks strutted Septic Tank or Holding Tank lLi Lift Pump Tank/Siphon Chamber I F] I n I El 7111. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installs on of the onsite sewage system shown on the attached plans. Plumbe .'s Name (PrinV: Piurn 's na re• MP/MPRSW No.: Business Phone Number: 91 OOF P um 's Address street City, State, Zi ): 7,m 2000, .v, Id lur -3 4192ar to Z IX. COUNTYIDEPARTMENT USE ONLY /00"Disapproved ita Per it Fee (Includes Groundwater surcharge Fees SanL%c a Issuedissuing A nt Sign ure (No Sta s) Approved ❑Owner Given Initial Adve 12 alon. Ch 4 1 L X. CONDITIONS OF 1pPROV LIRE SO S FOR DIS PROVAL: .. - SOD-Ml (formerly Plb-67) (R.11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS • ' L sanitary ,permit is valid for two (2) years. 2." ''-Your saiiitdry porunit 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. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems -must be properly" maintained. The septic tank(s) must be'pumped by a'licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code- administrator or the State of Wisconsin, Safety & Buildings Division, 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 and parcel tax number(s) of where the system is to be installed. ll. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repai r. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/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. Vill. 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 84/ X 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) sooiLtest data on a 115 form; and F) all sizing, information. GROUNDWATEA SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations an establishment of standards. - - S B D-6398 (R .11 /88 ) S T C - loo This application form is to be completed in full ' the o��n�� (,) of the property ert 1 and signed by � � � being developed. Any inadequacies will onl y result in delays of the permit issuance. Should this development be intended for resale b own house), then a second form should be Y er/contractor, (spec retained and completed when the property is sold and submitted to this ' appropriate deed recording, office with the --------------- Owner of property Location of property^1/4 1/4 , Section =� T._N-R LLW Township Mailing address Address of site , Subdivision name- ,r Lot no Other homes on property? yes No Previous owner of property" Total size of parcel Date parcel was created Are all corners and lot lines identifiable? -_ A_ Yes No Is this property being developed for (spec house)? Yes 4 Na volume / ,V and Page Number / r' a --- /� s recorded . with the Re iste of Deeds. q r INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WAIUZANTY DEED which includes a DOCUMENT NUMBER VOLUME NUHI3ER & THE SEAL OFF' TIE REGISTER OF DEEDS. � in addition PAGE certified curve ton, a y, if available, would be helpful so as to avoid delays of the reviewing process. If the deed d references to a Certified Survey Map, the Certified Son u r shall also be required* rVey i Map PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are t best of my (our) knowledge that I (we) am are the rue to the the property described in this information (are) owner(s) of warranty deed recorded i the office of then C©unty virtue of a Deeds as Document Na --' .'> A� Y Register of own the proposed site for the ► and that I (we) presently obtained an easement, to run the above disposal system or I (we) the construction of said s stem aaOVe described property, for recorded in the office of Count ' Re n g the same has been duly No. Y g ter of deeds as Document Sig ur of p�licant Y I - Date of Signature Co-_. appl cant Date of signature DOCUMENT No. STATE BAR OF WISCONSIN FORM 1--1982 WARRANTY DEED 482975' voL 949PAGE171 KENNETH J. BAUER This Deed made between ---------- ---------------------------------------------•- Rt. 2, Box 530, River Road, Hudson, ----------------------- _11-1------------------------ I ------------------------ -- -----W i-s,c o_n s-i-n.-_5 4-0.1 6.---- ------------------------------------------ --- ----- ---------------------------------------------- Grantor, and �EF'FFE.Y H. and KRIS M SPANGENBER-G._. -- - --------707 __N_o r_t h- -E-i.g h.th--_S t_r_e e_t---Hu.d s_o n-,--------------- -------- ------- W-i_s- c-o-n -s-i n---54_©1-6-------------------------------------------_------------------- **h_u_ s_b_ and and wife as survivorship marital property Grantee, -- -------- - ------ ----------------------- Witnesseth, That the said Grantor, for a valuable consideration.d f - --__on-e___d-ol l a-r. a.nd..-ot_he-r_-v-al_ua_b_1 e-- c_on -s_i d_era_t__i__o__n . conveys to Grantee the following described real estate in --- s.t_..-.Cr_0 1-x- County, State of Wisconsin: THIS SPACE RESERVED FOR RECORDING DATA REGISTER'S OFFICE ST. CROIX CO., WI A. Rec'd-for Record MAY 0 6 1992 at 8 : 45 A. M 67 &rtlo�� Register of Deeds A parcel of land located in part of the SE 4 of the NW 4 of Section 4, T 2 9 N, R 1 9 W, Town Tax Parcel No: ---..-_______________________ of St. Joseph, St. Croix County, Wisconsin; being Lot 1 of Certified Survey Map recorded in Volume 9, Page 2445 at the St. Croix County Register of Deeds office; further described as follows: Commencing at the W 4 corner of said Section 4; thence S 89013129/1 E, along east -west line of said section, 2016.62 feet to point of beginning; thence N 05010'01" E. along the easterly line of said Certified Survey Map recorded in Volume 9, Page 2445, 268.39 feet to the southern line of Lot 2 in said Certified Survey Map recorded in Volume 9, Page 2445; thence west along the southern line of Lot 2 in said Certified Surrey Map recorded in volume 9. Page 2445, S 890 05108" E, 390.33 feet; thence south, S 00054'52" W, 267.00 feet; thence 89013129" E, 369.49 feet to the point of beginning. Grantee is hereby given an express easement of use to 66 feet of the private road adjacent to Lot 1; abutting said lot on the eastern side of the 1 of . This - - - i s_ _ n not . _ . _ _ _ . _ _ .. _ homestead property. (is) (is not) Together with all said singular the hereditamenta and appurtenances thereunto belonging; And----- K_e n n_e t-h-- -J- -----B a-u-e r---------------------------------------------- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances �x�eib� whatsoever and will warrant and defend the same. 92 Datedthis ---------. `�--------- day of -------- - ---May------- ------------------------ - ------------ 19_- — --------(SEAL) (SEAL) KENNETH J. BAUER JEFFRE Y H. SPANGENBERG ------------------------------------------------------------ --- --------------- ----- ---- (SEAL) ----------------------- -- - - ----------------(SEAL) * KRIS M. SP-------- ----- IANGENBERG------------ -------------- ....... ------------------- - ------- AUTHENTICATION Signature(s)-------------------- -------------------------------- -------------------------------------------------------------------------- authenticated this ----.--.day of--------------------------- 19 TITLE : MEMBER STATE BAR OF WISCONSIN (If not, ------------------------------I----------------------------- authorized by § 706.06, Wis. Stats.) ACKNOWLEDGMENT STATE OF WISCONSIN --------4/`��----------- County. { I Personallycame before me this ---.�� ---day of �r ------------------------- 19-1_- the above named Kenr%th J. Bauer and Jeffrey H . Spangenbe rg and Kris__M.__ Spangenberg_____________ ------------------------------------------- -- --- - -- -- ---=-` ------------------ to me known to beson•'s��.•',� who executed the foregoing ins eat a acki%pwle 6-.same. THIS INSTRUMENT WAS DRAFTED BY I :.� Robert R. Raehsler _____------ ------.----- - ----�--,�----:,�,--_------------------- L - • 3, = - * K nneth r ----------------------- Attorney at LawCounty, Wis. ' % '- Notary Public _ ___-_ , _ ------------------------------------------ �_ '• ,� � (Signatures may be authenticated or acknowledged. Both M�' Commission M � , bit. 'co�'\�state expiration are not necessary.) 0 sT A'� date- ------------- ------------ t �+f++i111�ti1 'Nantes of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Leeal Blank Co. Inc. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 'e 4��C_A ROUTE/BOX NUMBER Z42 2 FIRE NO. CITY/STATE z I P PROPERTY LOCATION: 1/4, Section N-1 R _W Town of !- � �St. Croix County, Subdivision , Lot No. 0 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 SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system, St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. S t - Croix County accepted this program in August of 19801 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 verifying that (1) the on -site wastewater disposal system is in proper operating condition and ( 2 ) after inspection and pumping (if necessary), 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 to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department 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, S I G N E D DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, W1 54016 ( 715 ) 386-4680 Sign, Date, and Return to above address ' F Aitlonlrn ottl3,1-orl of Irduitry, �PUIt_ Ut yirl%1r r 1U1 / W-I U11 I rj t^f �` J Labor end I+ur*►an RelJitont Wla(h Soil P.tolile lntatioii Map • To Stale • On A Separate, Signed Sheen .'.+ e1:t' tu>r�aww spa1M.oAl cv*M+�t"auw"acovwl r&^"wr "w Ka16MVccr nv�►vwae utwasii Kenneth, Bauer Z-7M pasture N-57, II/a 530 River Rd., Hudson, Wi. ` 4016 '1All CAM"y St. Croix I.tr 1^n•Rf O•t3w 45I) trxAlw SE W 29 �t 191• �o++MN t1C St. oseph 1A P nit" iA n�a N i csuf lot elocK n/a- gueorvl�IoN n/a �, haw �tt�lAr_1 U 1 Ho++ton Depth In Dominant Color Munllll gu. M0111t1 St. Cont. Color Teclure Struclu+t Gr. St. Sh. Conitltence Rooll Soundary LImItInO �aererr Depth ls+d^9 t3Pp'+o n. lunch bid 1 0-9 10 r3/3 none ]_ /m/sbk mfi 1/f C none .3 C:lcv 2 9-19 10yr4/4 none sil. /f/sbk mfi 1/f C none •0 99.7 3 0-2 7.5 r4 /4 y none 1. s . �1 / f /s�; ml 1/f G none .8 •7 4 Z8-87 7.5 r5/4 y none/f/sg C.S.c.s. ml 1/f n/a none .8 .7 -- Horrlon Depth Dominant Color '2 In. Mvntt11 lead^e OrD►n M. l�encn 9cd Teelurt Structure Gr. St. Sli" Convilence IIOol1 Soundery Um-11ne racier/ Ilepth Motilei Qu St. Cont. [olo( )-5- 10 r3/3 y none 1. /m/sbk mfi 1/f C none - .3 .Z Elev 2 101." )-11 10yr4/4 none s.l. 2/m/sb _ mfr 1/f 1/f C G none noise .5 .4 .7 .8 �: 3 1-23 7.5yr5/4 none S. )/f,/sg ml ,- 4 3-89 7.5yr5/4 none c.s. 0/f/sg ml 1/f n/a none Moreton Depth In, Dominant Color Muniell Mottles Qv. Si. Cont. Ca�or 17;t7url, Structure Gr. St. Sh. Contllt+ncf ROD Hound/ tlmitlnp Fraeterr depth l��nOQp04d tr+�h h. Md 10yr3/3 none 2/m/sb mf 11/f C none . 30-7 Ell:v 2 -17 LOyr4 /4 none si].. 2/m/sbl mfi 1/f C none . 0 . (� 39.3 3 7 ,5yr, none 1.s. p/f/sg ml 1/f G none .8 .7 rr �- 4 6-84 7. 5 r5/4 none C.S. 0/f /sg ml ] /f n/a none . 3 •7 4 Norrto+t Otpth 1n, Dominant Color MuM111 Moitlft Qu. St. Cont. Color Ttrture -- _ Structure Gr. t. Sh Conil tense II_ Dols sound I,Imtllna fleler/ p.gtti le�e•nq.t3Pd� h. 1 Q�}Q 1 r3 4 node 1 Z/m/sbl mfi 1/f C none Elev 2 98.2 3 -0-22 2-31 10 r4/4 7.5yr4/4 none sil. 2/m/sb mfi 1/f C none .0 . 8 - ,0 .7 -- 1 / f G none ml _ I.S. 0 / f / �g none 4 31-83 7. 5yr 5 / 4 none C.S. O,l f/sg nil 1/f n/a - none -- .8 .7 U - Np+tion Depth OvmrnanI Color 5 In, Muntell _ R0o11 Bounder �- Llmltlnl � OVI Depth le�dnaQPDttd fl, irenth Bsd Mollie% u. St. Con . Color Tefture Slrutture Gr, St. Sh. Conittttnct 1 0-12 10 r3 3 Y hone 1. Z/m/sb mfi 1/f C none .3 •2 Elev d 2-r10 r4 /4 Ile nol.s. s.si. Z/nI/ r mfr " 1/f C none .3 .2 .7 .8 1/f G none 3 20-2t3 .4 none-4 0/f/s ml 4 .8 80r4 / none c.s. ---- 0/f/sg m11/f n,'a none.8 - .7 -�--- Addtttonallttmatrki: ' RL;COMMENDED SYSTEM TYPE: trench #50 Soil series N�Z -., lot ' on back, lot ages 233 . , ,t plhtl Stte Ie�lurel: � Q 2-7-92 1715 1246-6100 97.2 tgneluK Otle t9nt -Te"Phont No Bf cjr% System E;lcvatlon W1• Gary L. Steel, 1554 200th. Acve. , New Richmond, 54017 c5T (Jl'lnrtt• Ir+lrt Cllr stale t ip L c, Iq Jt 1.6 t A el. 6r� -� �. 0 e,7 fE bra s •CERTIFIED SURVEY MAP Located in part of the SEI or the NWj of Section 4, T294, R19W9 Town of St. Joseph, St. Croix County, Wisconsin. OWNER Kenneth Bauer AREA OF LOT 1 530 River Road 101,589 sq. ftL(2.33 ac.) EXCLUDING ROAD R/W Hudson, Wi. 54016 106,684 sq. ft. (2.45 ac.) INCLUDING ROAD R/W ,• unplatted lands owned by others rr rrrr rwrrrrrrwrrrrrwwrwwwr rrww north line of the SEI of the NW 33't N89014106"W 752.70' 32'= . e c1 o a -'i A A • Ih t-+ 0 " OO IV • h • t•!' V! F+• — for lav n n Nire '` L 0 T 2 h 1ato . � S CA 653*201 sq. ft. (15.00 ac.) o r ' a• M A N89o22'3011W a R -� i � ►�5.501+ � � c� � t a r i C NO �go a � to � t� 1D IC P N ' . S890 1213911E �( 0 ;� : a �.� V v 330.09'W C dote: ��, r Put m r a a n�i . o> 1 w+ ra �"1 �_ -� Any additional-.lot,•aroune too existing house must a f+ cc 1 I CERTIFIED_ SURVEY_ NAP w minimum of 3+67 acres i�i : A l valuae_21_Qage_534 in size. 1 'P 1< 1 . ao - ra =o i= d A 1 p tom-• y Ir 7 O - IV *-, G r►-� existing hous5e ,�; 1 C7" L i rN 1 SCALF- I N FFFTI S89005108"E 1 io rye 390.331 2bo 160 . , 0 - 200 OD i7t _ 1 ,r V LOT 1 N 0 0 r i N 8 0 1 li r .,._._ 8�' 0 3"W 370.431 S89 east C west one -quarter section line p, S8901312911E 369.491 3216.091 W} col er - _____�_ Section 4-29-19 . corner ---- 1 Avenue Section 4-29-19: i}Q3'vy3t�3i��, LEGEND tA% G k ' P� Fvund Aluminum Cap in concrete. e found 1" Iron Pipe. a ,. �1.'1::• o Set III x 24" Iron Pipe weighing 1.68 LOS/linear foot. P $ i9 existing fenceline hZ3.t�_saC;:�s, this instrument was drafted by Douglas Zahler job no. 89-39 ' ! ..ti.'7t•.:..t • Surveyor's Certificate I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, do hereby certify that by the direction of Kenneth Bauer, I have surveyed, described and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in part of the SEA of the NW-4 of Section 4, T29N, R19W. Town of St. Joseph, St. Croix County, Wisconsin, further described as follows; Commencing at the A corner of said Section 4; thence S89013'29"E 1647-13 feet along the east & west one -quarter line to the point of beginning of this description; thence continuing S89013'29"E 369.49 feet; thence N05010'01"E 884.99 feet along the westerly right-of- way of a 66 foot wide Private Road; thence N89022'30"W 5.50 feet along 1.1he Sou.1--h line of Certified Survey Miap volume 1, page 19.8; thence NORTH 438.42 feet along the west line of said Certified Survey Map; thence N89014'06"VI 752.70 along the north line of said SZk4i of the NVA4, ; thence S00054'52"W 660.75 feet along the west line of said SE4 of the NA; thence S89012'39"E 330.09 feet along the north line of Certified Survey Map volume 2, page 534; thence S00054152"11 659.79 feet along the east line of said Certified Survey Map to the point of beginning. Subject to right-of-way for the Town Road as shown on this map and all other easements of record. Together with an easement for ingress and egress over the 66 foot wide Private Road shown on Certified Survey Maps volume 1, page 198, volume 2, page 535, and volume 2, page 405. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of he Colin y of St. Croix in surveying and mapping same. *tit. r 0 C. f3 k V IDSON, .0 % 4:1 ell 4'1%., -I Na 41Y nn Note: The roadway shown on this map is a Private Roadway. All maintenance costs of the Private Roadway, after its approval by the Zoning Administrator as a standard road, shall be shared pro-rata by the adjoining owners. If the Private Roadway is taken over'by a municipality as a Public Road maintenance costs thereafter would be a public expense. _fcfF 5�.�✓G�N,aE�� 7D7 8 �� S,� �P% 3 100, k), m�,�s,� 3�s� r � � PAGC OF • r F r o • � i C l� ,� '� c. n 4 l , f Ft4th All And Obtetwollon PIPS V a#j1 '' 1rin�l Clods • 20" 42' Above PrPr oCa61 iron To floral Graf• Vif11 PIP0 Of S ++IMIk Co.��in i Ufa 2` �V4ta�ala .. 4w.f pip • • • � Ol�rr II►�il�� Ns ~~`L9 9 o o a --- T o a a ' � ��gi�4a1• Isafoli Plp• ° P4110401414 Piya llalav O s ta�I1A� 11+1111IAa11A' As 0f i�alaaa f • C17- I Pro p r O' � ���� ���1DPi'� • / SOIL FILL. VISTKI UTl\ 1.1 PIPE f APPROO/C j + •��lT���710 COVC 2 -•-�'.�1,� AT F. fit! wcf hGGREOAIE� A,� 09, 9" o ��.�."J JE `- V• �. is 0 P «''t. - Z /,x Al G G R C G AT DlS'1"iZI6+Ji"Ir.3Q PIPE TU BE A7 L,��ST _ 11JCNCS BELOW R� 1 A A►�JV AT LOST 40► I1JGHE ; BUT •1.1C.) MOFLC THAN y 'G � � �. 2 11,.ICKES gE«LOW FINAL. rr�AOE • MX IMUM DaPfVi � C F EX AVIJ100 r4oil O�i6v4AL 6�1\vr. WILL 5� ,... L. N E 5 u K1 v O EF T1t OF EACAVA TI O W Ci,144JAL (3R1V. w i t.L_ BC II�CH�s • L I C C W S C AJUM5E 11:..,..r • OAT C moo* Ito LOCATION: ST. JOSEPH 4.29.19.65A,SE,NW,115TH AVE. Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM ' Labor and Human Relations INSPECTION REPORT 'Safety and Buildings Division 0 GENERAL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name: SPANGENHERG, JEFF ❑ City ❑ Villages] Town of: ST.JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P / L WELL BLDG. vent to Air Intake ROAD Septic NA Dosing NA Aeration NA Holding PUMP / SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Head I Forcemain Length Dia. Dist. To Well ELEVATION DATA County: ST . CROIX Sanitary Permit No_: 149329 State Plan ID No.: Parcel Tax No.: 030101550000 A) ZU U I I b STATION BS HI FS ELEV. Benchmark Bldg. Sewer St / Ht Inlet St/ Ht Outlet Dt Inlet Dt Bottom Header/ Man. Dist. Pipe Bot. System Final Grade SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type 0 Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold 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.) Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. U6NOMNINIn -QANITARV PFARAIT APPI MATICIN MW W 0 W W Im W 7 W ILHR In accord with �1L`HR`w8'm3.05, Wis. Adm. Code CW COUNTY !:// * STATE SAN IT PERMIT# -Attach complete plans (to the county copy only) for the system, on paper not less than / - 8% x 11 inches in size. ElChec/ifLrevisionto e;?iou7 'pplication -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION � 2-Z 1/4 1/4, S I Ajr NP R (or) 9) LOT # BLOCK PROPERTY OWNER'S MAILING ADDRESS Z rl Zz 3 _ZQ TE C= ZIP CODE PHONE NUMBER SUVBIV SION NAME OR CSM NUMBER AJ aiQ46 (/,-s Li CITY NEAREST R9,AD 11. TYPE OF BUILDING: (Check one) El State Owned 17-1 VILLAGE j-4 E0 JOWNQF: El Public 141 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(S) 111111. BUILDING USE: (if building type is public, check all that apply) 1 El Apt/Condo 2 ❑ Assembly Hall 6 1:1 Medical Facility/Nursing Home 10 El Outdoor Recreational Facility 3 0 Campground 7 El Merchandise: Sales/Repairs 11 EJ Restaurant/Bar/Dining 4 El Church/School 8 0 Mobile Home Park 12 0 Service Station/Car Wash 5 1:1 Hotel/Motel 9 El Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) V -1 Replacement of 4.1 Reconnection of 5.0 Repair of an A) 1 - unj New 2. El Replacement 3. F System System Tank Only Existing System Existing System B) El A Sanitary Permit was previously issued. Permit # Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 seepage Bed 21 ElMound 30 ElSpecify Type 41 F-1 Holding Tank 12 Seepage Trench 22 0 In -Ground 42 ElPit Privy N 13 F-1 seepage Pit Pressure 43 0 Vault Privy 14 El System -In -Fill V1. ABSORPTION SYSTEM INFORMATION: AB A SORPTION 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7, FINAL GRADE G A {Min. REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min. nch) ELEVATION -.7 4or Feet llo�'l /�q / Feet V11. TA Vill. TANK INFORMATION CAPACITY in gallons New. xisting Total Gallons # of Tanks Manufacturer's Name Prefab. Concretestrutted Site Con- Steel Fiber- glass Plastic Exper. App. Tanks Tanks Septic Tank or Holding Tank 11Z�o El El- El Lift Pump Tanklqiphon Chamber F-1 LJ Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum is Name (Print): Plum s Si nature: (No P/MPRSW No.: Business Phone Number: Plumber's Sta s) M Albm ber"s Address MFre-et.- City, State, Zip Code): Z w '0C r IX. COUNTY/DEPARTMENT USE ONLY Approved Disapproved F-1 owner Given initial Sani ryPermit Fee (Includes Groundwater Surcharge Fee) a e Issued I ing Agent Signature Stamps) %W Adverse Determination. X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: Cf SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS t 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expi, fion date of E;t'tLLticii ar- flaw criteria in the Wisconsin Administrative Code will be applicable. 3. All, rev;slons to this permit must be approved by the permit issuing autno, ity. 4. Changes in .2wn-�r—sh1p or plumber requires a Sanitary =ermi; T Forrn iSR,_D 6"g11) tr+� (: submitted to the county prior to installation. 5. Onsite sewage systems rnus} be properly malWained The aept'.� ta��l��;.,! :j�' be pu;�.r e�: by a ; c,f::; secs pumper whenever necessary, usually every 2 to 3 years. fi. If you have questions concerning your onsite sewage system, contact your local cede adr-nimstrator or the State of Wisconsin, Safety & Buildings Division, 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 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. 111. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in 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 in ##1--7. VI1. Tank information. Fill in the capacity of every new andlor existing tank. 41 "st the total gallons, num. ber of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Compete for air` septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. NIP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. K County/Department Use Only. 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; wel!s; 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 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) -- REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1 06/15/92 11:13 REQUESTS FOR INSPECTION WORK SHEETS FO►R: 6/15/92 AREA: JT Activity: A9200220. 6/-'-----.--.--- .-�---------�.�..------ .------____.-_...__-__ ._--___-_ 15/92 Type: CONVSEPT Status: PENDING Constr. Address: ST. JOSEPH 4.29.19-65A, SE,NW, 115TH AVE. Parcel* 030-1015-50-000 Occ: Use: Description: 171455 Applicant: JEFF SPANGENBERG Phone: Owner: JEFF SPANGENBERG Phone: Contractor: O'CONNELL, KIM A. Phone: ------------------- Inspection Request Information..... Requestor: KIM O'CONNELL Phone: Req Time: 15:06 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION ---------------- Inspection History..... Item: 00012 FINAL INSPECTION K''Vonlsr+ Otoa-tr^rrl of InOVIlry, Libor And Hvmjn Rtllt,ont WIL Uoi.m!" I IVte I%L1 V4% t (Attach Soil Profile Location Ma • To Scale • On A Separate. Signed Sheet) P u �o .,� 1::' P P 9 (.tadr�on, :.r c P4gt .i It�.sToi MAa� 60k i v*4 Dart �. _ CV�ff rail N�0 K�OAlfi /✓ , CT► ltatl IOCArpH � fO�rMW,yyrrGMK BQRA}G C g I // - L;5W/ LOT BLOCK SUBDIVISION l3 ' Hor'son Ototh Oominent Color MOItlt1 Structure In Munitll Qy t. Cont Color C ntltten e CIC++ [3 , l Nonlon Depth Oomimant Color Motllel StructurI I In Ow St. Cont. Color T Rture Gr. St. Sh. Contrtttnt Eley : (j I ►+onion Deoth Dominant Color Mottles Structure In MuntitllQy. 5t, ConA, Color Tw rf Gr, St, Sh• n i t Elty ram," wriAv� korwuw"t I A.= �1 GGLRY i +'Y t l Or0�4 O r b y a rAAPAKfttiM-64/A ' Maw alaLAt1 I.Inwiln0 Faclorr Lwotsg tip0 sq n R001 O n ar Oopth lrrrnth eta Roots 60vmdary Lpmw11np F acrorr 0.01h LO. O—q Tionch GPd %4 n �rQ Ll►Mrig Fcor, Laor.q GPI 04011 Trsr+th B+wCRoo ! und! n, 13 , ( Monson Depth 00mimanl Color Moults Structure In Mun tl1 QV. St. Cont. Color Tenure Gr5u Sh, onlitlfn f R Elev r. HOr�lon 0t01h OOmInant Color Motllet Slrutturf In Munttll . cont, col2r T e r r h Elty llrrnung Factor, I Loaanq GP Or q n nd ! 0001h trer-ch 841 1.1miing Faclorr Lw0.P%q,0Pp,,4 n ntf ROott d0 radar 00plh ga,d Additional Rtmarks: I II/0 RECOMMENDED SYSTEM TYPE: ' Other Srtf Ft�turtt: Sys(cm Elevation If r9r+aturt r� w - „4%_- CST Name ;P(k l) 9-2 ile rgnf tleRhon' No. , City state, tip LW | � { '-------------7) _ COUNTY 0 PLUMBER irn LIC. # a;4sc? TOWN OFaib na )CMW LOCATED yuj SEC q__T_Qq N;R W IV AND/OR LOT 0 N2 1 4S32___ CHAPTER 145.135 WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the application for permit. (b) The approval of the sanitary permit is based on regulations •in force on the date of issue. (c) The sanitary permit is valid for 2 years from original date of issuance and may be renewed for similar periods thereafter. Application for renewal shall be made through the county and shall comply with regulations in effect at the time. (d) Changed regulations will not impair the validity of a sanitary permit until the time of renewal. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought. Changed regulations may impede renewal. (f) The sanitary permit is transferable. A sanitary permit transfer shall be obtained from the county authority. If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. 'Rob i 44 AUTHORIZED ISSUING OFFICER - DATE PAN SO�-fAss,A 11,W, DURING CONSTRUCTION