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030-1035-90-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538786 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No Cenex, Burkhardt Coo erative Assn. St. Joseph, Town of 030-1035-90-000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No /M G t)T' 10.29.19.120H TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER , CAPACITY STATION BS HI FS ELEV. •w S Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer S Z ?Q . 1 - 5 Holding St /Ht Inlet St /Ht Outlet TANK SETBACK INFORMATION TANK TO SL WELL BLDG. Vent to Air Intake ROAD Dt Inlet Li Septic Dt Bottom Dosing Header /Man. Aeratio Dist. Pipe Holdin Bot. System Final Grade T PUMP /SIP HON INFORMATION Manufacturer Demand St Cover t9 .6 Model Numb TDH L Friction Loss System Head TDH Ft Forcemain Leng r ist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia l iqui(I Deptn DIMENSIONS SETBACK SYSTEM TO P/L BLDG LAKE /STREAM LEACHING Manufacturer. �{ INFORMATION T — (I CHAMBER OR ype Of Syste Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 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 Vey N COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection Location: 1088 Cty Rd A Hudson, W 54016 (NW 1/4 NE 1/4 10 T29N R1 9W) metes jjj Parcel No: 10.29.19.11 1.) Alt BM Description I C� ice. :L..- '3 / 2.) Bldg sewer length = /d - amount of cover = P � u "e �� �`� 14 1 � Si A., I (ted dl-t)a Plan revision Required? 0 Yes No Z3 Use other side for additional information. _ Date Inse c 's Sig re Seri Nr SBD -6710 (R.3/97) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538786 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Village X Township Parcel Tax No: Cenex, Burkhardt Coo erative Ass City n. St. Joseph, Town of 030-1035-90-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No 10.29.19 120H TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet St /Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. 1 57t — to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution T ole Size x Hole Spacing Vent to Air Intake Pipe(s) 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 Bedrrrench Center Bedrrrench Edges Topsoil E , I Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2 Location: 1088 Cty Rd A Hudson, WI 54016 (NW 1/4 NE 1/4 10 T29N R19W) metes & bounds Lot Parcel No: 10.29.19 120H 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? [E Yes Fil No j Use other side for additional information. Date Insepctor's Signature Cert Nc SBD -6710 (R.3/97) commerce.wi.gov Safety and JuildwAs Division County 201 W. Washin P.d. Box 7162 i sc o n s i n Madis oa � 162? Sanitary Permit Number (to be filled in by Co.) Department of Commerce . ; ' ; j ' Sanitary Permit App ! state - owned yy r/ State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission o "fonns lEaemme tal i Q 3 . 75 -7 3 unit is required prior to obtaining a sanitary permit. Note: Applic POWTS re Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information used for secon ry / v g$ A& 1} p urposes in accordance with the Privacy Law, s. 15.04 1 m , Slats, 11 11 n ri I. Application Information - 'Please Print All Information w • g Property Owner's Name ST. C(�OIX COUNTY Parcel # PLANNING & ZONING OFFICE �% 3� " �a 3 qc ^ o o Property Owner's Mailing Address Property Location A&.` - / 2d r /,1 Govt. Lot t '/ City, State 14 �,� $ r t , • , � Zip Code S4a i S Phone"lA -- "(s . $3�$' tJ % +, Section (circle one / 9 H. Type of Building (check all that apply) Lot # T Al N; R E o1 ❑ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block # Public /Commercial - Describe Use 3iS ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Town of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. El + �y,, New System yUeplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B List Previous Permit Number and Date Issued ❑ Permit Renewal ❑Permit Revision El Change of Plumber El Permit Transfer to New Before Expiration Owner ? t IV. Type of POWTS System/Component/Device: Check all that appl ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVrreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation V?a 5 Q O p VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 2 o $ New Tanks Existing Tanks 6 � i s i Septic or Holding Tank r o 000 O f Oo 0 o y9 (yg r Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number to QLreP, NEc°N v-rLC E 1 L �' a�7 7 c o 7�s_ 7q 33.2 2 - Plumber's Address (Street, City, State, Zip Code) 910 1-4 t: s 4'O o13 VIII. Count /De artment Use Onl lg'Approved ❑Disapproved Permit Fee Date Issued Issuing Agent Signature/ /. $ auwAqzC Reason for Denial .�• # t =�� 1 ��` '� IX. C n on roy�1/Reasq s for Disa roval h �.t rqi� %� epLIC tar ' ' Mu ' a Tlltner antl pp J l' f✓ dispersal cell must all be serviced / maintained ���/ � l tr�' >,f as per management plan provided by plumber. 1 , " r e `, ' 2. All setback requirements must be maintained t� ='' -,,,, ° r • as per applicable code /ordinances. Attach to complete plans for the system and submi o the County only on.. per not less than 8 1/2 x 11 inches in size SBD -6398 (R: 02/09) Valid thr� 1 Top op Comca,4 , �J Dom Apftoa 1K.T w "y ��w D Np C ' cot cQf t4o� - rA k- EX 1'5rwj rA-i"A DRAiN 4 / p / APPRovEO 0 w y' 0 �0 �S w tt flmosr 13M At 1106, s� v5 d � 5 rDiu ms`s r s� 6 � ap , t Od W,4y/ � 13 I COAJV, 04/ pv / / av�KtirrRflT �� �r� i I E Top / G s pO�+ p A t2 ,q- ` � Sc AGE"% / = 30 e soil &, l v6-- I3,pDA?ock *r y -5 HOLDING TANK COMPONENT CHECKLIST 2008 F [J_VIolding Tank Component Manual SBD- 10855 -P(N. 03/07) GENERAL SUBMITTAL INFORMATION Y N/A 0 O O Plans and specifications must be complete and clearly legible and drawn in permanent ink or photocopied. Submittals must be on paper measuring at least 8 -1/2 by 11 inches. (' O All signatures are required to be original ink. O O Index pages require the owner's name, manual name and SBD no. and legal descri tion of the project. O O O tPlanspot� sing an index page are required to have every page signed and dated by designer /plumber. O O O Plans nyA -wing an index page require the name of the project, legal description and name of the manual shown on the plot plan. (A0' O O All designs shall be signed by an individual who posses a valid credential for designing a POWTS. SOILS INFORMATION f t.' O O O A properly co ted M must be included as per county policy. PLOT PLAN MUST INCLUDE: V O O Plans that are fully dimensioned or drawn to scale (scale indicated on plans) with all property boundaries clearly marked or parcel size shown. ®` O; O A benchmark & a north arrow. r� O , O Proper setbacks as established by appropriate code; (see Table 83.43 -1) (Y O : ' O The legal description of parcel /location information. O O All nearby existing s stems or well(s) Y g Y O ' O O O Reference to QgH_WM * when near floodplain boundaries or bodies of water. (ex. - reading of lake elevation r "d Xvation at/near the tank). *OHWM = Ordinary High Water Mark O' O O A service drive /pad located within 25 feet of tank service manhole(s) must be identified. SYSTEM SIZING: O O O For one and two- family dwellings the number of bedrooms must be indicated; (ex: 2 bedroom estimated = 200 gpd x 5 -day) = 1000 gallons; The manual requires a tank size of not less than 2,000 gallons. W O O Public building review require state review unless you are a designated POWTS agent; tank sizing calculations per Table 3 published in the manual, must be included. (ex: total estimated daily flow x 5 d - =min tank rN irPd The manual requires a tank capacity of not less than 2,000 gallons. O O O Sizing based on per capita occupancy or by meter - reading instead of estimated flow require that a deed restriction be filed with the county. 8 0 2 9 2 6 8 Tx :4020545 Document Number Document Title 937054 St. Croix County BETH PABST Holding Tank Agreement REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD J Permit Number - - -` '' 06/02/2011 2.52 PM Soli �itP4 E,� �9c� C��2rz EXEMPT #: REC FEE: 30.00 Name — (Owner) Type or p �/� ����� �Gm/1P PAGES: 1 being duly sworn , states, under oath, that: Q/1- 1. He /she is the owner /part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volulne Page 30 _ Document Number St. Croix County Register of Deeds Office: Recording Area A parcel of land located in the AIUJ 1 /4 of the AIE `/4 of Section Name and Return Address /U — ,T 2-1 N — R I q W, Town of a nSa 11 "At4 erg y Co -Op .Sr• - 7 St. Croix County, Wisconsin, being 1770 0)1 led- T duly described as follows (include lot no. and subdivision/CSM or -P-D. fS6)e 4 detailed legal description): 'b_ef'C" d ,rl 308 375 4 377 -- Parcel Identification Number (PI _ f1 fSO 'VVY13 �l ?,,e. t pa e l 4- Cv N wy 0 - 1 U 3 S- q0� 2& Agreement Date: `���.., C�2SCriIoLc7 rrt Vol. 733/4/ We acknowledge that application is being made for the installation of (a) holding tank(s) on the above described property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also. the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. Comm 83, Wis. Adm. Code, or Ch. 145, Wis. Stats. As an inducement to the county to issue a sanitary permit for the above- described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. Comm 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the governmental unit or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stats., the governmental unit (Town) may enter upon the property and service the tank Cr cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for curtenl services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 2. The owner agrees, pursuant to s. Comm 83.54 (2), and Comm 82.40(3)(e), Wis. Adm. Code, to have a water meter installed in the structure The water meter shalt be installed by a plumber authorized by the Department of Commerce to make such installations, with said installation complying with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to allow the governmental unit or the Department of Commerce to enter the above - described property on a regular basis to read and /or inspect the water meter. 3- Owner agrees to pay all charges and costs incurred by the governmental unit or county for inspection. pumping, hauling. or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding lank The governmental unit shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law 4. The owner agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to file • copy of the contract with the governmental unit. The owner further agrees to file a copy of any changes to the service contract. or a copy of • new service contract. with the governmental unit within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the county on a semiannual basis a report detailing the servicing of the holding tank. The governmental unit or county may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 6. This agreement will remain in effect only until the county office responsible for the regulation of private onsite wastewater treatment systems certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. Comm 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the pro Q, r�y tank is installed. Q wner(s) Name(s) - Please Print P • • T • bscribed and sworn to before me on this date: r e r �� Not zed Owner's Signature(s) =�. • N a oF ry p - -- �- ---- - -' " -" ' -- - - - UG �''O: •' �� -' • Governmental Unit Official Name. Title - Please Print YrrJ, "��; My Commissio xpir �' • re G u V 4 PJ L 0 �t r "✓i q Z � r, r n �i (72 (' +- overnment I Unit Offici nature Drafted by Persohal information you provide may be used for secondary purposes [Privacy Law S. 15.04(1)(m)1 "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" 1 f this information must be completed by submitler document title. name 8 return address and PIN (if required). Other information such as the granting clauses, leagal description, eta may be placed on this first page oft - he document or may be placed on additional pages of the HOLDING TANK SERVICING CONTRACT Contract Date 6 / This contract is made between the Holding Tank Own ger(s) Name(s) and Pumper's Name �'01? Sm )4444T P� nPr9 C o 1A V r We acknowledge the installation of (a) holding tank(s) on the following property: Provide legal descriptions:) See ahL4 -------------------------------------------- 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Comm 83.52(1)(c)1. Wis. Adm. Code and the approved Holding Tank Component Manual. This agreement will also be filed with the St. Croix County Zoning Department. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit that has signed the pumping agreement and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volume in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and sworn to me on this date: Today's Date Pumper's Name (Print) Pumper's Signature Notary Public Signature 1724 Ala Pumper's Registration Number V Commission Expiration j DAVID CROSBY Notary Publio-State of Wisconsin • fi -DOCUMENT No. �jSTATE BAR OF WISCONSIN FORAf 1 --1982 , T*ua SPACM RCBCRVMO FOR RLCOADINO owTw 789PAG€ CRI i � This D8ed, mares between --- __- .�°,�,g 1�.� .l;<_�T GLSJ.f f --- -- - _ •--- ------ =' 51. mix CO., Wi .. .............. . R*C'd. fw :, U =rd 24th 1 .. ; - and__ - Grantor. 6��) AuK. /�►. ��.}7 _i[ ` ►�LI rKY zer_3iiv a. r� �S UCaL3sx.,_ ............... C� __ - - -- V. Arj --- --------- ----------- .. Grantee, 4Vitnesseth That the said Grantor for a valuable ca nsideration....__ \ �! i ne AQ;C1�>i . �� _9U) and oi � ' . good_ _ xid- va�uable - _ c__aiz_sa 3e -a vi 1= conveys to Grantee the following described real estate in _ _ $' t - .. C ReTURR To County, State of Wisconsin: ' SEE LEGAL DESCRIPTION ON BACK li Tn.= PAr�a] Nn: -- - - ---- is i fvk ai 11 i This __.____zs_ ri_Ot _ ___ homestead property, (is not) Together with all and sjn I ?lAr the heredita;rlents and A� And_- ___- Les_lie Wa7_r�roff pP?xrtenances thereunto belonging; warrants that the ood, Indefea sibl e title is e "" B In fee si-n ]d free and clear of encumbrances except easements and zoning ordinances and e b restrictions of record, if an;/! i and will warrant and defend the same, IF { Dated this 0�-- day of I� JttZ)' ............................... 1 _.......(SEAL WJ y f .... (SEAL) i! --•- _ --- Waldroff .... .... �I ............. - -- (SEAL) i' .. .................. _... .(SEAL) !' AUTHENTICATION 1 ACK NOWLEDGMENT' 4~ Signature(s) e S lie j�T ] �j U f i - STATE of wISCQNSIN J -- -- -- .. oath icate3 is .-T• CRQIX ss. y County. ul -- - - - - -- -- ._ 2 Persona came b f t 12 a cxe --• --•-•- -------------------- - -•- - - -•-• ' ' pia S t - � s Do u la Zilz •- ...... , c� Wa1ar t�f¢ i'_......_. - - t i TITLE : MEbIB ---'- - _'.__..ay- o, it ATE BAR OF W]SCUNSt v !! !If not. ------------ --- --------- - ------- -- -- authorized b Y - 4 j66 - 6 ------------- - --- 6, Wis. Stats.] � �-•--- °-----"--- to me known to be the person _ h caccuted the THIS INSTRUMENT WAS �RAFTEO Sy fGTQgOjttjr, instrument and :icknotC]C:1FC the same. i' .. .LQU_GLAS__Ra Z i�Z ► t� t Col net[ a t Law -_. . . -- --- .. b. ('Signatures u.ay he autl:eixtjeate or a .. '- `%nta:• Public _ . :Ire not necessary.) At,- 3 ,tI 4h date C'nnnni.sjnn is nrrn,nnrnt. , if ,• nnt, wta:n c�: 1 � t. •Ns.^: es of pQ -son= <isnin 1 R in nnr Cw na�ir..- ch. hn is n.,.. ]q •) H.G Mil Co.npany'�/;l _._ + ?r rzeu nr ufcr,�t�ct?: Zktock No. I JUIl 1 AGE ^� A paerce of land Jocate'd • in pitrt 0f th �rq -s%. _ use - - - _ _ ►? of - St - _ sos.teph . St .. Croi s;o un Wiscos�sian„ further clescs Fsec as of s� Ws. , e - - coencing , at the cC3r I�X` of said Sct do 10;- E3aerice `: - 674 54 (bearings I4 ! are tefezeseged tg the Mast ling a the St3 tZOZ3 i4 are to bear CI& - a1= si m LL o . f 0 - t t4. a gc 3 art ca the , cente -rTl of G.T.H. - ?f- WhLi - re a lIne extended southeasterly along the Aiaxtheaaterlg wall 4f the sec feed - in *exts said centerline a.a escr bed sin a r err r3e Deed _ recorded Jn Volume 607, page 188 in the office of the fit. Croix __ . [..Qi3S1L,Y SSCL�3SL taS 1�CCR3i 77Q3.s.i ,L LiL -- +• :- .aa feet more ox less to the top of the st+ee� side of .the W p bank on the easterly :E1Iow giver, . thence }southwesterl.v along the p cf_ said steep Bank -to a point that is 54.02 at r_eet distant as measured right arsg7e€ to the previou described S43 line; t3:ence ° 39' 43 °E 2+61.12 feet more or less to said csriter13n8 of th said cesterline a 600.00 foot rred us curve concave nortrweamera - wria�e V hQza •. -- 732 w� . ,� -�L .. A! YY ��• _± - and wahose ffi o f t tangency; along the a� r 9f said CPrve , 6 _ 17 _ feet to the of s..gt rcy; thence M32�'j 7' 52nE along said point tG the p lnt of beginning. centerline, 49.51 feet Above described parcel contains 13,520 sq. ft. or 0.31 acres more or eeff and ? s m4l "ect to r-ictht --€a _ w. T. P. ° _ ... ++.m.:. - f -aav far g 7s," .and a.l�, a° ••�•�• r aa ze x men.t$ rae.r+rri Also sL)bjeL-t_ f_G H - 1„1@=U�`L�ula, „ �aBEISEitt for ingress and egress to use, repal_r, maintain and draw water frr�m an. existing well, all at easement holder's expense. Said _._ _easement ; =3Y= �iescx�ed -:-ae ��ollowsa Coetacig: at :;the .:northeasterly _ corner of the at describer? parcel on the cersterline of .fi.$..__ thence _;N43 39 along the northeasterly described parcel, I26. Z4 feet to the line of above point . of' bGgrnin3 of ttsis well easement de8cra'PtIon thence continu3.ng N43 3u.uo feet; thence. S46 20 "W 54.02 feet; thence S43 ° 39'43 "E 37.00 Feet; thence N46 9 17"E! $4"02 feet to the point of beginning. :above described parcel is to tie sold no an adjoining owner. r Safety and Buildings commerce.Wi.gov PO BOX 7162 MADISON WI 53707 -7162 i s co n s i n ww Contact Through Relay w.commerce.wi. gov /sb/ Department of Commerce www.wisconsin.gov Scott Walker, Governor Paul F. Jadin, Secretary May 18, 2011 CUST ID No. 226375 ATTN.- POWTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT & ASSOCIATES CO ST CROIX COUNTY SPIA 2812 10TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/18/2013 rabove, entification Numbers ID No. 1939573 SITE: 67276 Consolidated Energy Coop to both identification numbers, 1088 CTY Rd A correspondence with the a enc . Town of S aint Joseph, 54015 St Croix County NWl /4, NE1 /4, S10, T29N, R19W FOR: Description: Holding Tank Object Type: POWTS Component Manual Regulated Object ID No.: 1315192 Maintenance required; Replacement system; 1,905 GPD Flow rate; System(s): Holding Tank Component Manual, Version 2.0, SBD -10855 (N.03/07); Commercial System The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed: approved plans and with the component manual referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: => On page 1, t comp onent manual referenced can no longer be used as of January 1, 2011. Refer to the currently approved manual mentione ove. fiaveinc u c memorandum announcing this change. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of., 0 construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review t " shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. ROBERT W ULBRICHT Page 2 5/18/2011 � � 1 Sin r y [Balancc ee Required $ 90.00 ee Received $ 90.00 e Due $ 0.00 eter E Pagel Private Sewage Pla eviewer , Integrated Services WiSMART code: 7633 (608)266-2889, M - F, 0600 - 1430 Hrs pete.pagel @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www.commerce-wi-gov/SB/SB-BuildingContractorProgram. ULBRICHT & ASSOCIATES CO. 281210th Ave. - Spring Valley, W! 54767 Reg. Designers of Engineering Systems 715 772 -3442 Private Sewage Consultants PROJECT INDEX COVER SHEET DATE 2- 2 0ll OWNER (ONS66'.0 4 D <:FAAPr 4 v gyp - p PHONE 715. 7f6 - .53 2 S MAILING ADDRESS 1 770 cry. R y (-I AhMoiuv, W r, S y 0 .S SITE ADDRESS /p 1t ( ' 7 f�p - '� oR Q RK �� Z , MA MN` CR" ArFeoX . -, . / acu� yoiG SITE LEGAL DESRIPTION VIV %d w1 G yy ,S' f CT /0� T .L Aj , R (q GV TOWNSHIP Sr- T0SE(>k, C — UN I TY - r G Ro ! Y, CST N07 NEL--peD s A)OTJF5 INSTALLER NEckoiilt 6 7 X CAVh-TfM&— LOCAL AUTHORITY Sr. C PoPK CTS! tiek* y 3 ugh t--rC7 N EC In V I TIE- 2� S zourNG- �15. `flp�o AN & rjaG.. Ii�TEQNhI /,/ 1?1!!HdD&LED Im PROOED • A FAiIiN4 i 1 1� �cl NCA � J CDMP I1'4AjT-- itZJ Iz oc,NO PO WTS CUP -ReW7 .y 5�RU /,k) j t1it R ldI . i s Se iu rleAC7 L���s TO,�E- l3�ORocK P-� G:o ki No-- �xrsrs e �-r y � � ! — �lt � - y CO--( p t,• ,*N7— REPI ^cE mecx3 " AL- T�ICN/+ r VA /. /yQLQ�17�/ ;rrrrrrr�i, J y,, T�},u No s © /G % A� rvlr: - ) Repop � sloe,,�'' o F A y SPACE I S f L S . �1�iOS r --f�� `YS PG.! HOLDING TANK PRJECT DESRPTION,WASTEWATER CALCULATIONS. PG..LwIS DNR HOLDING TANK GREASE INTERCEPTOR RULES, Ne113.09 PG.3 PLOT ( PLAN b VIEWS/ DETAILS. SF���Cj PGA HOLDING TANK CROSS SECTION/ DETAILS E ATTACHED P NS AND S FICATIONS ARE BASED THE F LLOWING APPROV M r LS: "HOLDING TANK COMPONET M NUAL FO PRIVATE ONS STEWATER TREATMENT SYSTEM RSION d° SBD— 71— .6/990 ' W ,° i z 112 ,. A5 144" l/1 92 „ REQD m r z 3 -I D C D r - - - - - - -- r - -- - -7 -- X UP 37j" rn 1 4" C A S - - - - - ' J L--- - - - -.J L� -- J p r - - - -- - r --- - - - --I r I - - - - --i I I I I I I I m I I �;, I -4 I I I m w L--- - - - - ' J L'-- - - - - -J L)? - - - - - - - � 91, 94j" 9" r-- - - - - -7 r - - - -- I r�-- - - - - -- I I I I i n I I M I I I rn Q I L - - - - - - - J L - - - - - - - J L - - - - - - - J r --- --- - � r --- -- -- � r - - - - - - - - I I I I I I I I I I I n I 1T I I i L - - - _ - - - JI " - - - - - - - J L-- - -...J N S < A N rri w r - - - - - - - 'i r - - - - - - -- r - - - - - - - i I I I I I I I m I I I I I r --- - - - --i r --- - - --- r - - - - - - - - m 82„ 83" I I I I I I 1 I I I I I z LIQUID L VEL L_.- - - - = - J L - - - - - - - - L-- - -_ -.J m r - - --- -- i r -- ---- r - - - - - - - - i z 1 I I I I I m I I I I I I • I I I I I I r L - - - - - - - -i L - - - - - - - - r-- - -- - -- r0_1 r - - - - - - - - I J I II II I PP I - ?' r = r z D z D O A Z 1 0 m '� v 6 cam' -m m ` n ca �7 f7C �Z az A > z n << D X = Z m �id D �c�° n o =901c �1�*,r` C tAn rn T1 �{ v n m r -4Z n XNC �C - i 10���� F— m -D 1 co X Z N O= U) Z DO.. �Zm � w a I-- >m A a? N a m o R' M Z G 9 Oo D r*t N Dt PUP, W 0!. -1 09 I D (J► z i 0� Rol m Opoto• m 0 m c o 0 C/3 c _ m o �l X m 0 Do > �► P o a n D ° o r te,, ° ° m C7 C7 '' < 3 r O L v D z v y D D ID H m > 0 z �o '-1 � m � =-I C rn En o M Io � p D m o O > z° m z _1 z N o N (n z \ NECHALLE EXCAV. M BURKHARDT WI SCALE: 1/4"=l'-O" PRE -POUR: W1E ER DRAWN BY S. EBERT S 0-01CRETE REV. z PH: 715 - 749 -3322 2815 RILEY ROAD PORTAGE, WI 53901 DATE: 5/24/11 DATE:. POST -POUR: 800- 362 - -7220 PILE: \Segfic 201i \MR \Necirn7fe fxcawting - Burkhardf,dwg t pOCI�MENT No STATE Y BAft OF F- - WISCONSIN FORM . 1 loss � T >Il8 SP RCSRRVCD FOR RCCOADIND DATq '7819PAGE 80 ar _ t• li ar.a�TG n� This Deed, made between ._.._I.ex -- � „""•,,. Sr_ .er_Vft t - - - - - -- - i ter �C31X 1 d R�'d for '�� 24th Grantor. 4�Ay @� Aug- D. 1P,17 t and__ ►itlrKt l 3 LU.L._Cooper_ative -. i ,. �_C..... ii,................ t t t t:_ i.r)n II .... - r _ _ Wi _ Grantee, "�'"�,- tnesseth That the said Grantor, for a valuable cons deratio...___ ne n I?o�•a�_- C��._(9U and ,.ott•e - -• =- r •__- _good - -_aid_ valuable•- _cottsad'eat°iJrt t COnVCvs to Grantee the following described real estate in _- . ,5'.7c.. „CQ,7,. RETURN TO tt County. State of Wisconsin: -- SEE LEG?LJESCRIPTTON ON =BACK �1 Tax Par-1 N--- ----- - - -- - --- �i 1 � 1� 1:1 li 1 li This __ - ---- ZSIZOt__ -_ - -- homestead property. _ (is) (is not) Together with all and sin nlar the hereditaments and appurtenances thereunto belonging; And ------ Wa!q, f warrants that the title is - - ` ibl _' good, indefeasible in fee "' s- imple and free and clear of encumbrances except "" easements and zoning ordinances and building restrictions of record, if any,! and will warrant and defend the same, ? Dated this ` O I ..y 1 19.. ..... ............ -- ------ - - - - -- (SEAL) W J "A " SEAL) • i► ..... .._. .......( I� .Les.lie ... VaLIdro.f £ +' - --- • - - - -• - ---------- ............... -- (SEAL) (SEAL) Pi �{ AUTHENTICATION ACHNO W'LEDGrdENT 1R Signature (s) yesl_�__ Waldi_of_£___ 1 STATE. OF WISCONSIN --- -- -- -- -- --- ST. CROIX �I auth icated is - -- Gou ! —U / - _--- •- --__•. 29___ ] Personally came before me this of i a Tr�3 _Doug- Zilz ? p ` 1 ,. -.- 1P Walctrgf¢ r TITLE : 11�EILIB . ..... ................... ........... ATE 13AR OF W1SCONS(N ! I ! If not. - - ------ ------- --- it authorized b -- S Y § 706.06, Wis. StatsJ ----------•----•--•-- to me ..Hawn to be the person ____- who executed the THIS INSTRUMENT WAS DRAFTED BY fCTefralnQ i n strument and Who the sLmc. ---- - - - ------ -- .... - - . -4 p (Si.gnatures i;zay be aaL7:entiesLe�t or -° '- �oLar-• Public S t. Cro X _ .. are not necessar ac t "" �u� 3. .,.,Ll 3t C'nmmiasion is nermnnnn•. ITf Ilt "'"' ` •�ys•aes 'l of ate. j: P °: 9on9 Y " °>R'1IRR in ^A n1.•; t.e li � - ch.. hr f.: s,r.i ..r z. r�r.t i } ..•I. S TATE _RAA flC FORM loo- 1 — 1992 - JTOCI[ 131¢, 43VV1 -- araez or land .;acated in pare or nc� Ivix-+s /4 ar tn� -i/ of �e�9 n t* g s T29N� .7cas. pla , St C�Bi tYfr - - Wiscasaa gin; further described6 a �o13 rwsr r T _ M , —_ Q Cowzxa,encing at tare Nz ' corner_ Of sa ri SlactIOn 10; thsrrce �` fi74 54 07° (ben -rings ar referenced t the east line of the !M f O S l assumed to bear HOO - 0 HU[I - 51.1' 5Z'NJ 2L7 i�7s1.: fL t.Q is po =rat Qn t-Ie centerli of C..T_H. spa wacaxe a 1"a extended sotstt - asterly along - the northeasterly wall of the feet3 mill irste�csects said car= erline as described on a W- surranty De*d recorded In Volume 607, page 188 in the office of th fit. C _ _._ a ouaxz r gastr= c4z� Lye --= 3s saas.0 -..a - N �a� �3.�� _ � � � =i feet more c1x 3ess to the top � of the steep bank on the easterly side of the Gkil .loc+► River; thence southwesterly alan,4 the t�op of, said steep bank to a point that is 54.02 lest distant as measdred at o right angles to the provicualy described line; thence S43 39'43 0 E 2+61.12 feat more or less to said centerline o£ C.T.S. OA", said centerline being a 600.00 foot rr4dAus curve concave •,.. .. .31c _ z anid Feel. .northeast -erly along the arc of said - -- - - - -- c?�rxra_ 6 -17 _ feet to the point of targercy thence M32 7'52"B along said CO nterline, 49.51 feet to the point of beginning. Above described parcel. contains 13,520sq. ft. er 0.31 ;acres more or leeo _and is vub ec.t to right -- cif - ::say for a"... . ,. . a +s.e= a �+ F . a w. �rTer.�z. s.��. a.. `�3$ a ° •u.. tz Y raor�rsa Airzo for ingress and egress to use, repair, maintain } and draw water from an. existing well, all at easement holder's expense. Said _._ easeis:ent =is sieso_ bed >:as :fo.11s�ws: Comwenciug. at :the .northeasterly - corner of the abpve describedi_ parcel on_ the - cer_terline_. of C.T.i3._ . - " -A "s_, thence N43 39'43 "W alez3g the northeasterly line of above described Parcel, 126.14 feet - to the pckint cif' beg,�nning of this _ well easement dersaripti.on; thence continuing N43 39 *43 -W 3'o.uri feet; thence S46 2.0'17"W 56.02 feet; thence S43 "E 30.00 feet; thence N46020'17"R $4.02 feet to the point of beginning. Above described parcel is to tie sold to an adjoining owner. 0 £ o y O! 3 n d r1 v ` �° : 3 z Z r: 0 Q a G O n Z :1 CD j 0 D) O DI f O O j O W • O N y N X Q I� fD lD O U1 N (\7 N C �p fD d = y V X y (D �3 / \\ y co U1 A U1 V CD -� (D �p 3 Co N W 1 3 G N N N N N N O. y W O �. n 0 0 0 0 0 0 t0 n 3 . f p b ` O G N 3 O Q O 01 W 3 O N O O A� 7 N Q O' N o y C C7 o W y a 7 O �• (� A o o n ° C cn o N a s ° °' v? z D (D a °o c N ? O O O y �' N O G ... O Cn N 7 ".. _ � W O 01 ( O n < (n A m a ` 3 Q O O< (D I N N N N N N W W 0 D 0 0 0 0 0 0 N N l� Z s N O O O O d0 O 0- to y fD CO u O (DD cco O - ? n r- cn 0o o 3 CO co v v a I � 2 a `z Z 1 O O O n !I " lV � fp fA U1 D N i ri o f�A CO) N G! 3 O p !D w 7 1 y .. Ul W e•' D CD A D a 0 O O a O rn Z O N fR N• N G N y N N CD G O N O (D 3 - a m _ ( (D _ N O � c N p A? n a D A z O co m C � O. O A N 'I _< N O co 0. O O 9 L1 r! 3 A o :' y 3 Z Imc (D N N \ G O (D A � N O N O N Q N O N CD a O cn 0 OO. o' G (OD a C O T 01 X N O' S d 0 N j N p O (D N C Qa gm m z � m 1 o_ m � I 1 3'�co o en y iI 0 (D O y. 3 m f o y ow o a j OX !D pC VC a N O �. N (D I DO tw 69 0 •° 0 O r a ° o a O ♦ n N O n N O n O °' C °: f = d O r� 3 (D CD 3 1 3 3 (n Z S v Z ° p W o o N vwi CO cn �(D RL w a ° D =r a s N s O co r`v c m a m m m_ v ,e .� 3 CO a N a a cn t 1 a O c ? O ICT7 7 n O 7 7 n O C:) O O CD O 0. O ' a s O O 2 0 _ a g O 7 N CD 3 N CD O � N C N . . C d O T; Z D m fl- CD U Z D m a CD t co O 0 a D '0 O D! C co y l m W a, c a = O o = O O 3 C> co w 7 Q 4 CL Z Z O -4 -4 n O rn rn co co a �7 Zl o O O O D O O O D� p _ _ D * _ 1 0 N c N N y n ° o 3 ti� N C m 3 a- V O O p cr O O C C_ D A N N O W Cp CD N � N ry A .Tl lD A < 0 N co N N C) 3 A N 01 Ln fl. O O a O m a Xk :" 0) rn Z N I I o 0 D Q co z z D CD �y 0 0 0 w N CD CD -mo CD CD m c CD N c m w m CL m a a 3 F 3 E z CD (6 m m O N N O M c c "� A CL a ? O R 0 c Z -� W W V O a a z 3 A ° ° o o Z co �! Z Z CD CD _ O P N Cn 6 cn ' :3 D a N N CD D N N O a N (D O X 0 O N CD 23. T 6 p7 �• T 3 C) N N O' — 7 d z Q 7 0 a O� d O O p CD O (n N O N T j O N N rn N w N O W O O -Op CD CD cnn0 U3 C: o w 3 CD a e o n m o a e � n�oc - L CD CL CO to aoo -' 3 C CD m m n Q ° o 0 a in S;. O c, o -ate v zn N CD O DO n 0 0 b (D C bq O fA p 69 p CD CD O CD CD y a O p i O v Parcel #: 030 - 1035 -90 -000 03/20/2007 09:22 AM PAGE 1 OF 1 Alt. Parcel #: 10.29.19.120H 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner COOPERATIVE ASSN BURKHARDT O - BURKHARDT, COOPERATIVE ASSN 1088 CTY RD A HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description " 1088 CTY RD A SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.310 Plat: N/A -NOT AVAILABLE SEC 10 T29N R1 9W NW NE PART OF NW NE AS Block/Condo Bldg: DESC IN 308/375 & 377 ALSO 448/311 EXC PT TO CO. FOR HWY AS DESC. IN VOL Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 733/181 ALSO COM NE COR SEC 10 S 74 DEG 10- 29N -19W W 2298.81' -POB N 43 DEG W 243.51' TO TOP STEEP BANK OF WILLOW RIVER, SWLY ALG more... Notes: Parcel History: Date Doc # o /Pa a Type 07/23/1997 789/80 07/23/1997 733/181 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 2.310 116,600 246,500 363,100 NO Totals for 2007: General Property 2.310 116,600 246,500 363,100 Woodland 0.000 0 0 Totals for 2006: General Property 2.310 116,600 246,500 363,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Plb 6,7 APPLICATION FOR PERMIT Wisconsin State Board for of Health . PURCHASE OR INSTALLATION OF A SEPTIC TANK (sec. 1 44.03, Wis. State.) FA-OWNER OF PROPERTY T YPO MACK in* V" 7 �� _ g6 Address treet, City, Zip Code t to - B. LOCATION OF PROPERTY WHERE SEPTIC TANK IS TO BE INSTALLED Check 1. City Mail address one: 2. Village City 3. =/! / C. INSTALLER Wisconsinnse number he d: Licensed Restricted -- Plumber Sewer Name ame Address D. SPECIFICATIONS OF SEPTIC TANK Size in gallons; Check one 2. 5 00 gal. 4 . _ 1,500 gal. 7. 2 . 0 1�, 000 gal. 3 • - �0 gal. 5 . . _` 3,000 gal. 8' 5,000 gal 9. if over 5,000 gal. give capacity Materials: 1. Prefab concrete 2. Poured concrete 3..___ Steel FG- F OCCUPANCY Single family residence / Multiple family residence 3. Commercial establishment 4• , Industrial establishment IMATE NUMBER OF PERSONS SERVED DAILY S ATION TEST MADE 1. /Yes �/ 2. No Date ��', :✓� 2 �� (To be completed by County Clerk) Date application is filed and fee paid Permit issued (date) Permit Number County Clerk e: The application cannot be considered for filing until all of the above questions are answered and the fee paid. County Clerk will forward application, the fee of $1.00, and Copy (b) of the Permit (yellow copy) to the State Board of Health. Checks and money orders should be made payable to the Wis. State Board of Health. LOeATION street- highway - ._ g y city or township county OWNER _ (i'`,,�,v,� r /K� Mailing address - A€teHITEe'T OR- PNGINEER 67 Address -- - LUMBER� Address �- = v / it (;heck appropriate building usages) and fill in the infpr mation requested opposite Bach Lusage listed: csting building New building Addition If addition to e�cistinE( building attach detailed memo for each. Restaurant or dining room , r . , Seating capacity (10 sq.ft. /person) _. hotel (� Hotel Cottages , , Humber of units; Regular Housekeening - 0 persons unit 4 persons %uit n , ---- -- j . .. _ •._.�..._ '�'OTAL NUMBER OF UNITS { j' pr. poc�Ctail loun at ge r r r r r being rapacity (10 sq.ft. /person) Pa"ing Pr rgtiremetrt Jsoms r r r Humber of beds ebiie home dark r r r r r r r r Mlko Pf units a dependent r pondependent �5erviae ¢tation r r r r r r r r Number pf gars served (daily) �5ohooi , m mbar pf axaserooms Meals served Yes Nc P , r rs �. ��}.. !.. prgwldsd Yes No satory'or Pffioe building , r .Number of persona (total all shifts) O Residence • ........._ of bedrooms ( ) Other specify 2. Indicate whether or not the foil owing facilities are connected: Food waste grinder . . . Yes No Dishwasher . . . . Yeso�� AutOma 4 0t4es washer Yes No z / 3. dill in the appropriate information for the following as indicated: Faroe tank capacity planned Normal septic tank capacity raqu;rpd _ .5036. for FWG or Ail Total septic tank capacitygylred S ?praolation test results ATTACH PBF;COLATION TEST WORT SHEET Seepage trench bottom area planned width linear feet d epth e ' - -� d p Seepage pit planned outside diameter /� / 14 depth below inlet depth Seepage, trench bottom area required width A linear feet _ v A Seepage pit required p outside diameter p depth below islet /9•� ~ � d P� Signature of person completing form; STATE BOARD OF HEALTH, PLUMBING DIVISION ` P. O. Box 309, Madison, Wisconsin 53701 A dress: Approved: Ilk Date - � _. <, JUN �. -- Date - V TNS APPROVAL IS BASED ON STATE PLUMS• ([ • ING CODE REQUIREPAE14TS AND DOES Pi31 � 1` EXEMPT THE INSTALLATION FROM CITY, VIL• 1AGk TOWNSHIP Ott COUNTY REGULATIONS OR PERMIT REQUIREMENTS, �xy tzj a r g r a µ o w � �•� Cy z r ti j � H d Z W o f+ °' ' d y a e+ _ - - - ' d ca �ti roa v C/j rm IV )� En w a ° O N t7 H 92 1.4 o a -7 5� t' c C+ O b O 0 or v y r c O C!] ►� S trJ . O� z L ow p o H En 0 hF'� 0 P4 H pri y� ' tz1 O -Ti n Har rrj rz o zaa z ON ca 1 x 1 xo� A 8 l g O O C Z ) 0 cHn R+�Cj� O gz H o y �7 i �M _ ,`r z c i° i i _tit t 1 7. i0 ® Q �+ X N m O N ON W 8 C ! CA y A. 0. 8 CA En 63 Z j m tS :i a al tiO �] �d ►� ` W Z x cn V] �@ N , h � V 9 -a b H H 4'] 'L7 � c+ (7 �, 9 O a r 5�A N �o C] C m �C+ n µ 0O .. ,.r r En a «t d O R FJ �! ►►► H o > - - - c+ M Vff CD Co H sot' Co OA n O d 4 i H + o 9+ 0. lea ° . n c n C� H y ro � � i f f Q z W V9 z ° ► hw n ` ' x �' e �c �, �'� ,,,/ ,/ .� �� 1w �. �` 0 �, ,. ` n "� 0 +_ � r� /' (/^ �� mil s S ��"�' � � ���� � r�. .. � \� �ra� , . � �� � ` ;' \ , °° �" ;, � `; f �� C� '' ' �' J � a � r � � �� � '� ,, ��` �� f t %/ /` i j f x ) 1 J +w ell t• « , 0 0 ( .6 %ri k2 e■ z=/ z o e E§ E i\ E -4 t 0 % o \ . mac, 0) § i § / 7 / £; J / § o o 0 n ,,� n 2 q o »§® E 0 f o? o \ E E CD % o k @ z ƒ E % I ` ° � ƒ G = ƒ' e a S S {' lot CD k \ _; 0 7§ \' g E c z 000 § ƒ r \ \ m I S CO) CO) CO) E� i { 2 / J 0 7 k $ £_ � 0 } \ } 2' \ f - r a: > CD Q ° CX.M / ƒ C m 2 ; ° £ _ : C § Lo 3 / c ■ / Cl. z o 0 � § 2 CD CL $ z k CA E \J± 0 [ § 3 C) CD m&2 ƒ }D/ CD ' n 7 kEf ƒ k 'r f E$\ } a) _ a q §J7 / ( \ / � � ƒ � (D J \ _ o ` \i 4\ � s Parcel #: 030 - 1035 -90 -000 12/11/2006 10:04 AM PAGE 1 OF 1 Alt. Parcel M 10.29.19.120H 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner COOPERATIVE ASSN BURKHARDT O - BURKHARDT, COOPERATIVE ASSN 1088 CTY RD A PO BX 164 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 1088 CTY RD A SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.310 Plat: N/A -NOT AVAILABLE SEC 10 T29N R1 9W NW NE PART OF NW NE AS Block/Condo Bldg: DESC IN 308/375 & 377 ALSO 448/311 EXC PT TO CO. FOR HWY AS DESC. IN VOL Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 733/181 ALSO COM NE COR SEC 10 S 74 DEG 10- 29N -19W W 2298.81' -POB N 43 DEG W 243.51' TO TOP STEEP BANK OF WILLOW RIVER, SWLY ALG more Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 789/80 07/23/1997 733/181 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 168771 418,500 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 2.310 116,600 246,500 363,100 NO Totals for 2006: General Property 2.310 116,600 246,500 363,100 Woodland 0.000 0 0 Totals for 2005: General Property 2.310 116,600 246,500 363,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00 alb. 43 7 SEPTIC TANK PERMIT NO. R E P O R T O N S O I L P E R C O L A T I O N T E S T A N D S O I L B O R I N G S TO 199 0 DIVISION OF HEALTH • PLUMBING SECTION DEC P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code NAME 0 PROPERTY ADDRESS LOCATION (Check One) City Village Town . r, /o s et -p,&. County WATER SUPPLY FROM= Public Utility Cooperative City or Township - ---- -- P Private Well SEWAGE DISPOSAL INSTALLED By, i *L „y t� � e�(Ca }CJ dfss _ ) ,° r ,/t Data SEPTIC TANK SIZE 4477 0 Material _�9 -•ar,� � on } � Percolation & Soil Borings Test Dots EFFLUENT DISP.s Tile Size . _L_ No. Lin. Ft. Trenoh Width Depth of Tile Seepage Beds Length .?/, ! Width _ ,g�+ Depth of Tile Seepage Pits Outside Diameter Liquid Depth TYPE OF GCCUPANCYs 7; -t✓Z u ,, ! vs RESIDENCE: Number of Bedrooms OTHER (specify)k l �f4 <r Number of Persons LL�� FOOD WASTE GRINDER: Yes No 4 Dishwashers Yee No ,/ Automatic Clothes Washers Yes No 4 (5 eau Tu'gtw P E R C O L A T I O N TES T Test Depth Character of Soil Hours E ater Test Time Drop in Water Level Inohes Minutes Number Inches Thickness in Inches Since Hole Hole Interval Second to Next to Last To Fall 1st Wetted Example rn t in Minutes Last Period Last Period Period One Inch P- 0 36 To Soil 10 Cla 26� 25 or no 30 1 2 112 _ 112 60 Ain Y J /� ;j t RECORD DATA FROM MINI OF 3 TEST HOLES Compute size of absorption area In accord with H 62.20 Wis. Administrative Code. S O IL B 0. R I N G S - MinLnzm 36 Below Proposed Absorption S stem Test Total Depth De th to Ground Water Number Inches Observed I Estimated Example Characte of S oil with Thickness in Inohes B 0 72 72„ ack Top Soil 12" C1 18"t Sand 18 Gravel 2411 .._ 't . ti , t. RECO _ DATA FROM MINIMUM OF 3 TEST HOLES I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super- vision in accord with the procedures and method specified in Cho (13) a that the data recorded and location of test holes are correct to the best of , Wisconsin Administrative Coded and J� n my and belief. 9 .1 TITLE NAME V,"71 -� _� L 1 �� [� � Al ��// � Type or - Print} � T� `P`"� -- RFGTSTRATION N0. or MASTER PLUMBER LICENSE NO. ADDRESS / � � _ 4L DATE- I 7,0! SIGNATURE lb. 06i, Wisconsin Department of Health and Social Services 3/70 Division of Health SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK A. %Mn OF PROPERTY Name Address (Street, City, Zip Code) 7- I/w'.'FozI J-�_�. B. LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY Check One: CITY VILLAGE LEGAL DESCRIPTION TOWNS H a 1 " Ay - ,U Q z C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? _/� YES NO - ---2 PERMIT NUMBER D. SEPTIC TANK CAPACITY 9 D0_ Gallons NEW INSTALLATION X REPLACEMENT ADDITION MATERIALSs Prefab Concrete Poured in place Steel Other NUMBER OF TANKS TO BE INSTALLEDs E. TYPE OF OCCUPANCY Check One: One or Two Family Residents Commercial Industrial Other A Z p ,�00 Specify Number of Persons to be Accommodated _ Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES NO Dishwasher YES NO Automatic Potato Peeler YES NO Other (Specify) G. MASTER PLUMBER MAKING INSTALLATION Name: �r9k'� �f l- '/j7Ll LLc'' Ad dresss I©, ( ?'L License Number: D sa .r/ Mr .�7- Signature of Applioants _ �'� (9 -�CJ MP RSW Address: C ,�, r�, �"J Cy , ; )7 L_ 15/61 �fd.t� H. (To be Completed by Issuing Agent) Date of Application 7� Fee Paid ue0 Permit Issued (dat ) I Permit Number / 17 7 /} ^ Agent (Naas) ! For: Town, Village, Cit ,County, etc. (Specify) Note: The application cannot be considered for filing until all of the above questions are answered and the foe paid. Agents will forward application, the fee of $l.OU for each septic tams and the.tnird copy of the permit (canary) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED ACCEPTED BY RETURNED (Initials) (Date) See Corres. FEE RECEIVED VALID. No. PERMIT N0* es r Ro REVIEWED BY APPROVED DATE (Initials) Yes or No COMPLETE OTHER SIDE 4 Plb 60 / DEC 1 0 1970 NAWF OF BUSINESS ✓ /y Q� LOCATION V 1. Josep/s' V street o'r/ highway city or township county LEGAL DESCRIPTION $ K /7 /f/ L`�/ jQ 7 le /94 OWNER &,QK to ^ Q Mailing address H A ZIP ARvHITECT 072 ENGINEE7t 6 f ° C.p,L 4 �/Q/11�' ` /Vi�j���lJ/f Address / Ct! 2 �^ �} ZIP Q f� /0 /� PLUMBER / {o� b /' ��J tin i A/ 4— Address CO e //�G• - % 4 ZIP 1. Check appropriate building usages) and fill in the information requested each usage listeds Existing building New building Addition If addition to existing building attach detailed memo for each. ( ) Drive in restaurant . . ... • Car spaces ( ) Restaurant . • . . . • , • Seating oapacity 10 sq. ft. /person) ( ) Dining hall . . . . . . . Per meal served Toilet waste Yes No ( ) Motel O Hotel ( ) Cottages .. . Number of unites 2 persons /unit 4 persons unit TOTAL NUMBER OF UNITS ( ) Churches . . • . • Number of persons Kitchen Yes No () Bar or cocktail lounge .. Seating capacity (10 sq. ft. /person) ( ) Nursing or rest home . . . . . Number of beds ( ) Mobile home pant . . . . . . . Number of units — dependent (eamper trailer) - nonde dent (mobile home) t ^� X Retail store • . . . . . Number of employees Number of customers (10 sq. ft. /person) t ( ) Service station . . . . Number of oars served 4) ( ) School • • • • • • • Number of classrooms Meals served Yes No Showers provided Yes No ( ) Factory or office building . . Number of persons (total all shifts ( ) Residence • . • • . . • • . Number of bedrooms ( ) Apartments . . . . . . . . . . Number of bg4rooms 'sL .�..�L......��rr ( Other . . • . . • . . . . . Specify N.) � ZZ;7o;/ 2. Indicate whether or not the following facilities are oonneoteds Food waste grinder . Yes No Dishwasher . . . . Yes No Automatic clothes washer . Yes No 3. Fill in the appropriate information for the following as indioateds o Septic tank capacity planned 0 ? 00 Q TOTAL Septic tank capacity required / p Percolation test results ATTACH PERCOLATION TEST f&PORT SHEET Seepage trench bottom are a� p nsd � _ width linear feet T— depth v ems$ . ` je Seepage bed area planned J _ width Ot d linear Pest _ depth Seepage pit planned outside diameter depth below inlet depth Seepage trench bottom area ty-u� wi O / linear feet depth -C� Seepage bed area required width linear Peet depth V 6 Seepage pit required outside diameter depth below inlet Signature of person completing forms STATE DIVISION OF HEALTH, P SECTION L P. 0. Box Madison, Wisoon in 3701 Address: Ir7 4 Approveds ZIP 3� Dates 2 Date r JAN - ( 19 ._...�..�,� THIS APPROVAL SHALL BE VOID IF REVISED THIS APPROVAL IS BASED ON STATE PLUMBING WITHOUT THE WRITTEN APPROVAL OF THE CODE REQUIRFTiENTS AND DOES NOT EXEMPT THE INSTALLATION FROM CITY, VILLAGE, TOWN - DIVISION OF HEALTH. SHIP OR COUNTY REGULATIONS OR PEWIT (OVER) REQUIREMENTS. Parcel #: 030 - 1011 -50 -000 12/11/2006 10:04 AM PAGE 1 OF 1 Alt. Parcel #: 03.29.19.55E 030 - TOWN OF SAINT JOSEPH Current [K ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner COOPERATIVE ASSN BURKHARDT O - BURKHARDT, COOPERATIVE ASSN 1088 CTY RD A PO BX 164 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 3 T29N R1 9W PRT SW SE COM SE CO W Block/Condo Bldg: 486.5 FT, NWLY BY > OF 59DEG 167.8 FT, SWLY BY > OF 90DEG 33 FT TO POB, SELY BY Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) > OF 90DEG TO CO HWY A, SLY ON HWY TO S LN SW SE, W ON S LN TO PT 696.2 FT W OF 03- 29N -19W SE COR, NWLY BY > OF 57 DEG 57.5 FT MOL, M0re... Notes: Parcel History: Date Doc # Vol /Page Type 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 168547 12,600 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 0.000 10,900 0 10,900 NO Totals for 2006: General Property 0.000 10,900 0 10,900 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 10,900 0 10,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00 P1 %. #67 3/70 Wisconsin Department of Health and Social Services f Division of Health SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK FA* PROPERTY Address (Streat, City, Zip Cods) OF PROPERTY WN..RE SYS s TENDED C UNTY WILL BE CONSTRUCTED ALTERED OR EX Y VILLAGE LEGAL DESCRIPTION NSHIP C. IS LOCAL PERPIIT REQUIRED FOR THIS WORK ? YES NO _ J �/ �:L..� PERMIT NUMBER D, SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALSs Prefab Concrete Poured in Place Steel Other NUMBER OF TANKS TO BE I1(STALLEDs Q� E. TYPE OF OCCUPANCY Check Ones One or Two Family Residence Cozmercial Y industrial Jb OChsr Number of Persons to be Ao �mmo a't d, Specify Number of Bedrooms F. APPLIANCES, ETCs Food Waste Grinder YES NO Automatic Clothes Washer Dishwasher YES NO Automatic Potato Peeler YFS NO Other (Specify) YLS_ 4 NO G. MASTTR pU MBER MAKING INSTALLATION Names �L Addresss License Numbers Signature of Applicants C4 MP RSW Address s L! p L—��O .!'/ it r i C' / �F ! fYte /) � �/', ✓� H. (To be Completed by Issuing Agent) Date of Application — �G� �. Fee Paid - --- Permit I3'saed "(date) ' Permit Number Agent (Name) Ir:jA-r /� �C70 //_ For �� C "�, Town, Village, City, County, etc. Notes The application cannot be considered for filing until all of the above questions p are fy answered and the fee paid. Agents will forward application, the fee of $1.00 for each septic tame and the third copy Of the permit (canary) to the Division of Health. Checks and money orders should be = de payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED a ACCEPTED BY RETURNED FEE RECEIVED (initials) �/ �/� (Date) See C rres ) VALID. Noe PERMIT NO. REVIEWED HY APPROVED DATE (Initials) Yes or No OA COMPLETE OTHER SIDE S&PTIC TANK PERMIT NO. / R Z P O R T O N S O I L P s R C O L A T I O N T E S T AND S01L BORINGS TO DIVISION OF HEALTH - PLUMBING SECT164 P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code PZRC0LAT10N TEST Test Depth Character of Soil Hours Water Test Time Drop in or Level Inches utes Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall 1st Wetted Overniffm in Minutes Last Period Last Period Period Ono Inch Example P - 0 361* _ Top Soil 10" Cla 26" 25 Yes or No 30 1/2 / 1 2 _ . 1/2 60 13 0 RECORD DATA FROM MINIMUM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. S O I L B 0 R I N G S- Minimum 36" Below Prcased Absorytion 5 stun Boring Total Depth Depth to Ground Water Depth to Bedrock Number Inches Observed I Estimated Observed Estimated Character of Soil with T hickness in Inches Example B ' 0 72" 72" Black ToE Soil 12111 CM 18" -S 18 Gravel 24" 3 ;'6 RECORD DATA FROM MINIM OF 3 BORE HOLES PE OF OCCUPANCYS RESIDENCES Number of Bedrooms OTHER (Specify) _ e!';'t 1At w , 11 zllts 'l Number of Persons D WASTE GRINDERS Yes No Dishwashers Yes No X Automatic Clothes Washers Yes No EFFLUENT DISPOSAL SYSTEMS HEW X EXTENSION ADDITION REPLACEMENT „�;'s:o- .; - ,.. _ -.e . , ,.. _, .. r.. -ti,; =- . y / -° :�r'i� ::. �- : _.. ": �... .. -''" „'F+��,..• -• r j.. -:s.. _;; �:.: - ;. ' .. y — .. -.C'- =: ,3_�,.�., .. s .,c- -�_ ..,_ �:.e Tile Size i4 No.Lin.Feet Trench Width Depth Number of Lines Seepage Bed: Length �' � Width , Depth J- I Tile Size `, No. Lines 2 Seepage Pits Inside Diameter Liquid Depth 1, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super- vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAME ('. A /�� (PLC - , //� ZG Z L TITLE ( Type or Print / REGISTRATION NO.. or MASTER PLUMBER LICENSE NO. 3 ry ADDRESS 1/) -/ L•c���i? /yl P 0 Iq1_ i7 L/4 --) 4 DATE _ Al 3 SIGNATURE CA v,