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HomeMy WebLinkAbout030-1031-80-000 (2)St. Croix County Planning and Zoning Tuesday, May 08, 2007 at 5r05: SI PM Detail Sanitary Information Page col I Computer #: 030-1031-80-000 Sub/Plat: NA Section: 8 Parcel #: 08.29.19.111 H Lot: 17 TN/RNG: T29N R19W Municipality: St. Joseph, Town of CSM: Vol. 05 Pg. 1266 1/4 114: NW 1/4 NE 1/4 Owner: Goldberg, Mark 470 Nelson Farm lad Hudson, W 154016 State Permit: 175649 Issued: 08/21/ 4 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 08/24/1 9 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: N tes POWTS Pretreatment: NA c Issuerllnspector As Built Plumber Other Requirements Tom Nelson Yes Powers, Calvin Jim Thompson Signed Off, Yes Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 8/24/ 1995 10/5/2004 10/5/2007 8/24/ 1997 Owner: Goldberg, Mark 470 Nelson Farm Road Hudson, WI 54016 State Permit: 171442 Issued: 06/03/1992 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: POWTS Detail: Bed- Seepage Bedrooms: 3 POWTS Pretreatment: NA Dotes Issuer/Inspector As Built Plumber Other Requirements Jim Thompson NA Powers, Calvin Not determined Signed Off, No Additional Notes Money Owed data from notecard - file permits together n 1994 $0.00 WI Fund: Additional Notes Money Owed Filed with 175649 permit in 1992 $0.00 DErPkRlIIRENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTR",", DIVISION LABOR HUMAN RELATIONSPERCOLATION TESTS (115) MADISON WI 537P.O. BOX 07 6(H63.0911) &Chapter 745.045) C LOCATION: SECTION: TOWNSHIP �MMY: LOT NO.: BLK. NO: .UBDIVISION S NAME: T111 1�4� 1/ 8 /T29 H%RL9xE (or) W St. Joseph 17 1 n/a Schettle COUNTY: OWNER'S/BIAME: MAILING ADDRESS: St. Croix Orville B. Schettle R.,R.#l, Pox 32, St. Joseph, ITi. 54082 UJt UA I ES U13SF-KVA I IUNS MAUE XX NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 n/a lew ❑Replace 5-28-92 5-28-92 RATING: S= Site suitable for system U= Site unsuitable for system 6 �' 2 CONVENTIONAL: MOUND: IN -GROUND -PRESSURE: SYSTEM-IN-FILOLDING TANK: RECOMMENDED SYSTEM: (optional) D SEA ES-ElUlEiSElU EISR�U�1" HU conventional If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: n/a, Floodplain, indicate Floodplain elevation: n/a decimal" PROFILE DESCRIPTIONS rn n1773 BORING NUMBER TOTAL DEPTH IN, ELEVATION DEPTH TO GROUNDWATER -INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) OBSERVED EST. HIGHEST B-1 84 97.16 none >84 -14, 7.5yr3/2, s.l.; 14-28, 10yr3/4, s.l.; 28- 36, 10yr4/6, l.s.; 36-84,10yr4/4, co. S. B- 2 84 97.15 none >84 -12, 7.5yr3/2, s.l.,; 12-28, 10yr3/4, s.l.; 28-3 0 r4 6 l.s.• 34-84 10 r4 4 Co. S. g_3 g4 96.35 none >s4 0-12, 10yr3/3, s.l.; 12-22, 10yr3/<<, s.l.; 22-29 0 r4/6 l.s.• 29-84 1 r4/4, Co. S. g-4 84 95.85 none >84 -20, 10yr3/3, s.l.; 20-32, 10yr3/4, s.l.; 32--38- B-5 80 95.35 none 0-13, 10yr3/3, s.l.; 13-23, 10yr3/4, s.l.; 23-35 B- rlcnr-im_ql r 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 1 PERIOD 2 PERIOD 3 P- 1 4.00 none 3 6 6 6 < 3 P- 2 3.99 none 3 6 6 6 < 3 P- 3 3.19 none 3 6 6 6 < 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. �A_J'"! SYSTEM ELEVATION �3 • l � 0 In, is I, the undersigned, hereby cer Administrative Code, and thj tN � • l� 1 ed on this form were made by me in accord with the procedures and methods specified in the Wisconsin 4ktion of the tests are correct to the best of my knowledge and belief. DISTRIBUTION: Original and one td LGnc`al ority, Property Owner and Soil DILHR-SBD-6395 (R. 02/82) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete an(I accurate, soil test, YOW 1,f-.!po1,t, 111LISt HICILJCI(x: 1. Complete legal ( 1 1011, -Jescriw' 2. The use sectiorl must clearly Indicate �-vhether this is. a resld,t,nce or commercial woJect; 3, MAX I MUM number of bedrooms or commet chal use planned 4. Is this a nev,; or re;-)Iacerment syslem; 5. Comp p*e the Witahility 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 ah'Dreviations shown hei,e for vvritlng profile descriptions and completing the plot plan; 7. MAKE A I-EGIBLE diagram ac,"',uratedy locating your test locavons. D;avving to scale is preterred. A sepal ale Sheet may be used if desl -ed; 8, M�Ilke SLPe YOM l)e!,ichrn<ark and veitical elevaw"r) point. are clearly shovm" Jill we 9_ COMplete all appropi'late boxes as to dates, mirnt-,,,s, addressc-s, flood plain data, p(ncolzriiorl t,(-A excl,-Inp- tion, if appropriate; 10- If the 11"forn-lation (such as flood jilain, elevation) dc)(-!,, not: apply, placo N-A, in the <Ipptoprlafc box; 11. Sign thc� tot r1l and plac;,� your cirri ent adciress and YGLIf 1CJ1 1011 1') U I'll ber; 12. Make leglbkl copWs aind distritmte as rcqwreri. ALL SOIL TESTS MUS- Tl- BE FILEI-1 VVITI-1 T[JE LOCAL Al-fl"HORFIFY WITHIN 30 DAYS OF COMPL-ETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Tex1LJt-eS Other Symbols St wvct 10" P, R Bed t ock coh -tome r Gtavei (under 3") L'S L i i)- i est o, t c Sand 1 G Vv' Hl�jh S""IC)d p e c p "! I c o 10 t I o; n 13 a le 1!V II!,v, i (3 "h L� ein I k S I C!a'v 'Lnar-n- y S;�Iv J. 11,01,/ L w J il Six s, w x !(,,.i n m L I V, 11 13 M [I fV k V 3 P F it i TO THE OWNER: it� t t �i, ITlay t.I,OU :(,j lsrr 1 0 Sl ci n I e f M r t4c) dw LL �- rf C/) i WILLOW _ ___ _ RIVER STATE -PARK NI/4 CORNER f � `l� v SECTION 8 4 � � � U N P L A T T E D L A N D T29N, R19W �Z -- ____-___— —. z� 1 �� QI Q i NORTH LINE OF NE1 /4 Of W N 89052'E �� N 89052'E 1590. 70' 921.36' 522.70' 355.81' 178 19' w z (D w z 2 w z m w w i-- z w O z N s� z00 zz I— O z I- w Lu Luul) }.- uQ � I i r Ow J z 66' w 5 3 4' - I " LOT 17 3. 01 AC+ LOT 16 3.00AC._ ( 4 pi raj , 131,159S.F.± NLn NDI O �- o na 1 3 0, 8 2 9 S. F.± O cN I-- _ I� LLI `n r j Z o z 5 3 4' o z I I 548' 355. 81' 1 78. 1 9' r�- I DI Z1 zl ZI EXISTING S39°52'W 1616.00 �I JI OI CIO -I NORTHI RIGHT-OF-WAY LINE I z 66' i r I t I I U N P L A T T E D I L A N D S SCALE IN FEET LEGEND 0 200' 400' _ (n J •v �mzs� _ Drafted by Walter J . Gregory. Q W NE CORNS-R SECTION 8 T29N, R19W POINT OF BEGINNING 5 3 4' Lu 1 3 8. 611 89°52'W LOT 15 45- a 3. Ofl AG+ N (N 1 30, 82 9 S.F. ± c UNPLA_T_TE_D_ - - -_LANDS 534' Ln 1 80. 44' ROAD N G% a. 0 710 ST. CROIX COUNTY SECTION MONUMENT, FOUND. � 0 1" IRON PIPE, FOUND. O 1" IRON PIPE, SET, WEIGHING 1.68#/LINEAL FOOT. -- FENCE co y f.L. ck.. O z o CC. uj V N AS BUILT SANITARY SYSTEM REPORT OWNERm�rKC ka b¢,r_TOWNSHIP NJ SECTION T �N-R 0 W ADDRESS Ll ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM cr, Cr INDICATE NORTH ARROW BENCBMARIK:Elevation and description: t o r, rie r Alternate benchmark - SEPTIC TANK: Manufacturer : Liquid Cap. Rings used: Manhole cover elev: U-3 7Final grade elev: 700 Tank inlet elev.: 9*,,X Tank outlet elev.: 20 No. of feet from nearest road:Front.,)< j, Side_, Rear Ft. From nearest,prop. line:Front Side Rear Ft../�.5 No. of feet from: Well 70 Building: CZ15 11-0 -1 (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: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front F Side—, Rear Ft._ Distance from: Well Building SOIL ABSORPTION SYSTEM Bed:— X. Trench: Seepage Pit: Width: l� - Length_ <E � Number of Lines :—c>? Area Built A)51,-=, Exist. Grade Elev. 9 S. Proposed Final Grade Elev. g S 4='>Q Fill depth to top of pipe: YO No. feet from nearest prop. line:FrontX Side Rear Ft.-S No. feet from well: /0-0 ­0­—No. feet from building HOLDING TANK Manufacturer: Capacity:_ No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front No. feet from: Well building Alarm Manufacturer: DATE: g - 0) 'el- 6 / 9 0 : c j Side—, Rear Ft. nearest road INSPECTOR: PLUMBER ON JOB: LICENSE NUMBER:- G.- 3 -_ 1 LOCATION: ST o f Industry, 8.2 9.19.111H NW NE NELSON FARM RD Departmenty PRIVATVSEWAUE SYSTEM Labor and Human Relations INSPECTION REPORT to Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village [Town of: ;OLDBERG, MARK S & SANDRA L ST. JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: C ail . � J- TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosi Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. Ventto Air Intake ROAD Septic ' �' �?3 ,� NA Dosing NA Aeration NA Holding PUMP / SIPHON INFORMATION M a n u f a c4orer Demand Model Number GPM TDH Lift Friction S s TDH Ft ossI Forcemain Length Dia. Dist. To e SOIL ABSORPTION SYSTEM ELEVATION DATA County: ST. CROIX Sanitary Permit No_: 175649 State Plan ID No.. Lel Tax No.: 030--1031-80-000 A92VO:3U% V/�.� STATION BS HI FS ELEV. Benchmark t I 2- ,40 r Q 41 �. , �(o r , Bldg. Sewer St/ Inlet � ,;3 � St /X Outlet dF Header .� Dist. Pipe Bot. System 10,A5, 91S5 Final Grade77 �yf//zpe �. BED/TRENCH Width , /C� Length �8 No. Of Tenches % PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS- DI I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHIN Manu acturer: SETBACK INFORMATION CHAMBER OR UNIT �� -_ --I TypeOf Co-op,-, p,-, _ tf 5L� ,.. I �5 }�� Model Nu S stem: y DISTRIBUTION SYSTEM Header .4.0lanii Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia_ � Length Dia. Z Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over ,. Depth Over y xx Depth Of xx Seeded / Sodded xx Mulched Bed / Trench Center Bed / Trench Edges - -36 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include c de discrepancies, persons present, etc.) Aa tAko Z &A- r -j 01 Plan revision required? ❑ Yes o Use other side for additional information. rf "-d SBD-6710 (R 05/91) Date Inspector's Signature Cert_ No_ RANITARY PFRMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUN STATE SAN I PERMIT AL —Attach complete plans (to the county copy only) for the system, on paper not less than 417 1:1 Fifrevision & 8% x 11 inches in size. C/e�ck if to prey us application —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 M 6, . "K L O\A)p 1/4NEI/49 S T N, R fi r) W LOT # BLOCK # PROPERTY OW 'S MAIL*IADD S 7 44 ni/Ig CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER If kA.65 2n WT.., I 5-f(w L ) ; -u,, F�1, V% Vw-, NJa II. TYPE OF BUILDING: (Check one) 0 CITY NEAREST ROAD El State Owned 0 VILLAGE : IF 0 5-t '2W E]Public 04 or 2 Fam. Dwelling—# of bedrooms — PARCEL TAX NUMBER(S) 111111. BUILDING USE: (If building type is public, check all that apply) 1 EJ Apt/Condo 2 F] Assembly Hall 6 R Medical Facility/Nursing Home 10 El Outdoor Recreational Facility 3 1:1 Campground 7 El Merchandise: Sales/Repairs 11 El Restaurant/Bar/Dining 4 1:1 Church/School 8 0 Mobile Home Park 12 ❑ Service Station/Car Wash 5 El Hotel/Motel 9 El Office/Factory 13 ❑ Other: Specify IV. 'TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1 New 2. 0 Replacement 3. El Replacement of 4. El Reconnection of 5. Repair of an System System Tank Only Existing System Existing System 13) L A Sanitary Permit was previously issued. Permit# Date Issued 6 V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 J?-; Seepage Bed 21 El Mound 30 0 Specify Type 41 El Holding Tank 12 El Seepage Trench 22 El In -Ground 42 El Pit Privy 13 R Seepage Pit Pressure 43 0 Vault Privy 14 El System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: ABSORPTION 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE LLONS GA r1G REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION Feet Feet Vill. TANK INFORMATION CAPACITY in gallons Total Gallons # of Tanks Manufacturer's Name Prefab. Concrete Site Con- Steel Fiber- glass Plastic Exper. App. New xisting Tanks Tanks strutted Septic Tank or Holding Tank L68!E.� fey. _F Lift Pump TanIUSiphon Chamberl Lj I El F-1 El Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signa No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code)- 9P42 Ik IX. COUNTY/DEPARTMENT UbE ONLY 0 Disapproved ftnitary Permit Fee (includes Groundwater a eIssued Issuing Age hat S ps) --- % Surcharge Fee) 4Approved El Owner Given initial J14 Ld Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber APPLICATION FOR SANITARY PERMIT S T C - tOO r This application form is to be completed iri full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,("spec Rouse"), then a second form should he retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property IUA& 1, Cam? O LZ Location of Property IVW -� _Y,,, Section T 241 N - R 9 W Township Tw Matting Address � Subdivision Name KAEUS 0 /JP�K2M Lot Number IOT1 CS M s /o?660 Previous Owner of Property 0r41'eL'Lc, r- Total Size of Parcel Aevem -f -, Date Parcel was Created 9ZZ- " 1 ) I 1 Are all corners and lot .lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes X No Volume 6 U4 and Page Number 5ok as recorded with the Register of Deeds TNCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: Warranty Dee 2. Land Contract 3. Other recordings filed with the Register of Deeds Office Tn addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) ee_ntif ff that aH statements on tki/s 4ohm cme..thue. to the. best oA my (ota) hnowt dge; -that- I (we_) am (are) the, owner(s) of, the. phopekty descic i.bed in .thus -inAwt-coati on 4o4_m, by v-cVue o f a wa,"an.ty deed Aecotded .in the. 0664-ee oA the. C%+(!Y!tr, Rp.qi_A_f'eh (14 poorfA nA norr1mvh.t No. 7 6 -- 83 s : and tho-t I (we.) ph.e s en t f'..y own .the p o poh e d site A wt Vie s e.wag e. di6posat. 5 ys te.m (on I (we) have obtained an easement, .to han with. the above dens eAibe.d pn.opeAty, Kon the co nos thud io n o 6 said A yA xem, and the same l tag been u,P y ne.co:�de.d .in the 0 4 4 zce oA .the ounty Re_g-usten oA V(�e_ds, aA Document No. to-43S ) . SIGNATURE OF .,R SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DArrE SIGNED DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1--1982 WARRANTY DEED 47GS35 V0-0 . 26PAGE506 This Deed, made between --Orville B------ . Schettle an - - - - -------------------------d ---------- --------------------- Mary A�._--Schettle,_,_husband__and--wife and__each------ ­ � _-__in_ their--own__separate-_right____--- ------------------------------------------------- -- --- Grantor, and - - - Ma_rk. - S- 9.. ... ---a-ud__wi.f e__a,$._.9urvivorahip__marital--property---------------------------- ----------------------------------- , Grantee, W1tneSSeth, That the said Grantor, for a valuable consideration_._.__ ------ -------------- ------------------------------------------------ --------- - --- ------------------------------------ conveys to Grantee the following described real estate in St..__CroiX--______________ County, State of Wisconsin: Part of North One -Half of Northeast Quarter of Section 8, Township 29 North, Range 19 West described as follows: Lot 17 of Certified Survey Map filed March 31, in Vol. "S", Page 1266. THIS SPACE RESERVED FOR RECORDING DATA REGISTER'S OFFICE ST. CROIX CO., WI Rec'd for Record Dr.Cl G 1991 at 10:10 A. M Register of Deeds RETURN TO Tax Parcel No: ----------------------------------- 1983 This ........ is -.not-------- homestead property. (0) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And ---------- grantors- -Orville- .B...Schettle. -and _-Mary.-A...Schettle---------------------------------------------- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except any easements, covenants and restrictions of record and will warrant and defend the same. Dated this - --------- - ----- 19-9-�- 2-2-- --------- -day of - .... NQvm�ez - s - ------(SEAL) ll-�- ------(SEAL) Orville B. Sc ettle - -- - -- - ------------------- -----------------(SEAL) /�- - ��� �- `�` J............---(SEAL) MarySchef fle------------------------------------------------------------------ * ------------------------------------------------------------------ AUTHENTICATION Signature(s)------------------------------------------------------------ -------------------------------------------------------------------------------- authenticated this -------- day of -------------------------- - 19 ------ ------------------------------------------------------------------------------ TITLE: MEMBER STATE BAR OF WISCONSIN (If not- ------------------------------------------------------------ authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY HEYWOOD & CARI -------------------------------------------------------------------------------- by Samuel R. Cari ,1I------- 5441b---------------- (Signatures may be authenticated or acknowledged. Both are not necessary.) ACKNOWLEDGMENT STATE OF WISCONSIN ss. St�__Croix-------------------- County. 2-Z Personally came before me this ----------------day of ------------------ MD-vembex--------- 19-91--- the above named ------ Qruille_.8, ..Schettle--and--Mary-,Pmicbet t le --------------------------------------- --------- 1�,4. ---------- ------------------------------------------ to me known to be the person S--_-_ W_� wh(!) U . �'the: c foregoing instrumentFS ledge`tie,cazY►e. v c •' _ - -- -- ------------------------- -- ----- ��•Notary Pu is ._._-_._ ix_-- --------- County, Wis. hly Cominiss permanent. (If not, state expiration date- ----------------- --------- ---- 19------- ) *Names of persons signing in any capacity should be t�'ped or printed below their signatures. I'!ARRANTY DEED STATE. BAR OF WISCONSIN FORM Nn_ 1 - 14R2 Wisconsin Leval Blank Co. Inc. DEPARTMENT OF REPORT ON SOIL BORINGS AND INDUSTRY, HUMAN RELATIONS PERCOLATION TESTS (115) (H63.09(1) & Chapter 145.045) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 LOCATION: 114 SECTION: /T29 N/RL9xE(ar-) W1 TOWNSHIP=3fXp {)TY: LOT NO.: HLK. NO.: In/a SUBDIVISION NAME: NTT 1E1/ S St. Joseph 17 Schettle COUNTY: OWNER'S BEDEERMNAME: MAILING ADDRESS: St. Croix Orville B. Schettle P.,R.ffl, Box 32, St. Joseph, 11i. 54082 uJC _ _ UA 1 t5 UBNE K V A I I UNS MAUt NO. BEDRMS.: COMMERCIAL DESCRIPTIONS PROFILE TUFSCf�IPTIONS: PER OLATION TESTS: Residence 3 n/a ew ❑Replace 5--.28-92 5.-2 P_92 SEPT. TC "ANK `'tA rNTT'--NA:10E AGREEMENT St . C r o Lv Count,{ 0 W N L R/ '3 U Y Z :t MA9,K. 670 r25c._-P, ROUTL/ 30v NUMBER �'% � � � • Fire Number C LTY / STL ATZ GOT- ZIP 5yo/ P 0PLR_'L L0CAION : JVc *' -" • r Town or 5 St. Croix Councy, Subdivision c'Z-aSOAJ Lot number 7 Improper use 9nd maintenance o F your septic system could result in its premature failure co dandle wastes. ?'roper maintenance con - gists Of pumping out the sen c is tank every three years or sooner , if needed, by a 1 icensed seo c is cask oumoe r . What you put into C:1e sysCem can at:ect clle-unccyun oC the septic tank as a treat- menc stage in the waste disposal sysce`n. St. Croix: County residents may be eligible to receive a grant for a maximum of 607. u t the cost of replacement of a failing sys cem, which was in operaci.on prior to . my 1, 1.973. St. Croix County acceoced this orogram in August of 1980, with the requireme-nc that owners of all new systems agree to keen their systems properly maintained. The prooert7 owner agrees ro submit co St. Croix Councy Zoning a cersificacion form, signed by the owner and by a master plumber, journeyman plumber, restricted alumber or a Licensed pumper veri- fying that (?) the on -site wastewater disposal system is in proper operating condition and (L) at'c'ar inspection and pumping (if nec- essary), the septic tank is Legs than 1/3 full of sludge and scum. Certification form will be sent aporoximacely 30 days prior to three year expiration. I/T;E, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system to accordance with the standards set forth; herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form crust be comoleced and returned to the St. Croix Councy Zoning Office within 30 days of the three year expiration date. S t . C r o = x Counts ;:oniri 'J E f ;ce 1'.U. 3o�c Z2" Hammond , '.JL �<+OT 5 Aar-'- :in({ jhl)vc address. DISTRIBUTION: Original and nnr, copy to Local Authority, Prnt)erty Owner and Soil Tester. � n i i i i n � nn t;";fati (R. ( ?m,,) Nryy Stifr- Ia9AlOZ19� � R ' + � 1 �C) L)�, fifth Air 1r,1s1► And QbLr(,rallan Pips r14r►I Cud 4r d. • 20. 42 Above. rip ♦� Ciron �o Flnil Or a Vsr%l flip ua'sh lie! Or SrAI1+.lk Co.J$Iny lien 2' J1 v pr q l l 0141 Pips I_ Olslllb,,llon 1 -• �9of6941a Osnirlk Pips o 0 • Tit Pit lof0is43 P1106 U#low • Cof4ln1 1 •fOnlneling AI 0 11aon Of S j t I s m i ciR POP L)) Ins-� C C ri., clIr c. J o rl SOIL FILL *015TR113UTI01.1 , '; `TIC CGV . i=. „ r� � L E V. OF ii E ; r , OF ��Z - ZI/z AG Git CGAT C V •Vw n >a'P Uri �� �•,. F D- _ . y��� �f•, . D15-rRI6'JT1(ou PIPE TO bC AT LCAS'C ,. IIJCHCS (1CLOW 0n1G1WkL AQU AT LCAS'r zo wcviCS BUT k10 MOnr_ TI•-M)i 42. 1»C1tCs Or-LOVI F1INJAL 1 U-iuM Dkpr� OF F-XCAVAT100 r-XOM O 06V\JAL 6k1\VF- wILL BE :_.�__ 1'MitIUM pCf- ni OF CXCAUATIOW r-1f 01`\ wtLk_ bC s1G�Jco.• -� LIG C IJ S C LJUMrj 11: 5 3 OAT[ . �. A rr' rt n�jt - of IqP u§EPH 29. 1 ItW%tj a ry, c T 1 Labor and Human Relations INSPECTION REPORT Safety ana"Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) PerrInit Holder's Name: E] City E] Village E] Town of. X CSbft'tYBERG,, o�o I llgle& SA IgMeLriptionST JOSEPH I fI I TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosi ng Aeration Holding TANK SETBACK INFORMATION TANK TO P / L WELL BLDG. vent to Air Intake ROAD Septic NA Dosi ng NA Aeration NA Holding PUMP / SIPHON INFORMATION Manufacturer D �; mand 1 Model Number ZVI d M N TDH Lift Friction S)jstem TDH Ft Loss Ff 6-a d 4 Forcemain Length Dia. Dist. well SOIL ABSORPTION SYSTEM ELEVATION DATA County: Sanitary gy" It 6�0 I X State Pla I �Ipa_* 2 Parcel Tax No.: 030-1031-80-000 STATION BS HI FS ---------- 7 ELEV. Benchmark Bldg. Sewer St/ Ht Inlet St / Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bo System Fina) Grade- BED/TRENCH Width Length )No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE STREAM LEACHING Manufacturer: SETBACK INFORMATION CHAMBER Type Of Model Number: I 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 D No [] Yes ❑ No COMMENTS: (include code discrepancies, persons present, etc.) Plan revision required? E] Yes No Use other side for additional information. SBD-6710(R 05/91) Date Inspector's Signature Cert No --ram RANITARV PFRL41T APPLICATICM In accord with ILHR 83.05, Wis. Adm. Code WICRAWrW LJ A PaxwoRn A COUNTY STATE SANITAIfY PERMIT# -Attach cornplete plans (to the county copy only) for the system, on paper not less than 0 81/2'x 11 inches in size. Chlk7rvision s application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 1/41S a 4WY4 T,. 97NqR 1' (or)w PROPERTY OW ER S MAILING ADDRESS LOT # BLOCK # 7 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 4.S 0/v Li 11. TYPE OF BUILDING: (Check one) El State Owned 0 CITY NEAREST ROAD VILLAGE OF: 5r TOWN E]Public [R 1 or 2 Fam. Dwelling—# of bedrooms PARCEL TAX NUMBER(S) 111. BUILDING USE: (it building type is public, check all that apply) /0 3 --DO 1 El Apt/Condo 2 El Assembly Hall 6 El Medical Facility/Nursing Home 10 F1 Outdoor Recreational Facility 3 El campground 7 0 Merchandise: Sales/Repairs 11 El Restaurant/Bar/Dining 4 ❑ Church/School 8 1-1 Mobile I e Par 12 0 Service Station/Car Wash Mobile k 5 Hotel/Motel ic actory 13 El Other: Specify 9 E:] off r IV. TYPE OF PERMIT: (Check only one in line A. Cheek lineB pplic le) A) 1. 1y\1 New 2. El Replacement 3. Replacerne of 4. F-1 Reconnection of 5. ❑ Repair of an System System nk Only Existing System Existing System B) El A Sanitary Permit was perj;io�usi ued. Perms # Date Issued V. TYPE OF SYSTEM: (Check only ne) Non -Pressurized Di ibution Pressurized istribution Experimental Other P D i i bution Pressurized d zed 11 Seepage Bed El M n d 30 ❑Specify Type 41 [:1 Holding Tank M nd e B e 7 12 Seepage Trench 22 n-Ground 42 ❑ Pit Privy L it Privy 13 Seepacm�Pit Pressure 43 ❑Vault 14 El System -In - VI. ABSORPTION SYSTEM I.N ION: '�G T" 1. GALLONS PER DAY 2. ABSORP. A 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE ORP. A 41SC) REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) /-1K ELEVATION 4/ _7o20 07 1 al 4) t I Feet Feet Vill. TANK V11. INFORMATION CAPACITY in gallons Total Gallons # of Tanks Manufacturer's Name Prefab. Concrete Site Con- structed Steel Fiber- glass Plastic Exper. App. New xisting Tanks Tanks Septic Tank or Holding Tank t-te h, tF] Lift PumE Tank/Siphon Chamberl quo ��L Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Pr P4� Plumber's Sig re: (No Stamps) I MP/MPRSW No.: 1 Business Phone Number: Oct i U I h— LA) 7 c2 Plumber's Address (street, City, Sote, Zip Code): f %0 & It -A. fz 0 r ;> IX. COUNTY/DEPARTMENT USE ONLY TApproved Disapproved Owner Given initial itary Permit Fee (Includes GroundwaterDate Surcharge Fee) Issued Issuing A nt SignaLure (No St 7 :L4 2L, Z Adverse Determination 1 - X. CONDITIONS OF APPROVAUREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) 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 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 cbhcerni*ng 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 repair. 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 it 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 814 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks, building sewers, wells, water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. r 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) ":% /7 305ep\r\ /Ju d ti/ I � OL 7 i f a 1 a I oqlv�( 19et'\)C.14 R)ARV\,o- &'so 1--o! -r �s il? 41yo " � I , C) L L 3 -LV(3 S T— • -30V�9 MN NullVl\'VD�3 :J(D VU J3() W f) t4l)4 V Ab �a\v?g wOy,,4 MPIIVAY�X:l jo hid?o wni4m 30V10 -ilvnij Mo13© 33tj-)rjj -Zk NVHj_ :3vOW' 01,j i-nu 'J"3H-)M 07.LSV31 IV r1ply O-L 3did riolixglb-LSIG 6 0 1\i I Y t4 d)AO-) 7113VdAS G3AO'Uddl 1�3�h+ �o 'A3-1-3 �LY93 b99NJ jo z tj 0 %,j Od o\jd +Uollfs to wallag ly aulleviukillL avloo:) ^aloq Iffid PlID101"d o OdId llsouga , y q "" 0 0 0 ld )OAO did - 01950faby z VIA. )o "14 IvtA•pDaQIvvjj al uOil Ito:) Wdld 1,ROqY Z► -OZ Ul *AO(ry do:) IYSA P�A()--ddy OdIj uojjoAjjjqO pvy 1101-vi ily /7 I�'v� un.s�? nf� �5 y,L REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1 08/21/92 14:00 REQUESTS FOR INSPECTION WORK SHEETS FOR: 8/24/92 AREA: JT r Activity: A9200307 8/24/92 Type: CONVSEPT Status: PENDING Constr: Address: ST. JOSEPH 8.29.19.111H,NW,NE, NELSON FARM RD, Parcel: 030-1031-80-000 Occ: Use: Desdeiption: 175649 Applicant: GOLDBERG, MARK S & SANDRA L Phone: Owner: GOLDBERG, MARK S & SANDRA L Phone: Contractor: POWERS, CALVIN Phone: ��---r-wry--rrrrrw��--rrrrrrrrrrrrrrrrr�-rrrrwwr����+-rrwwrrrr-rwr-rrrrr��rrr-�- Inspection Request Information..... Requestor: POWERS, CAL Phone: Req Time: 13:08 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION rrrrrrrwrrrrrrwrrrrwwrwwrww-rrrrrrrr--rrrrrrrrrrrrrrrr+rr-w-r-w-w�-rrr�rrr�rrrrr�-rr-r--r Inspection History..... Item: 00012 FINAL INSPECTION