The URL can be used to link to this page

Home My WebLink About030-1079-20-250 ~ I o N ~ o° a e I I °o I I N ~ I I ~ I I I I I I I I I I I E (D z ° z 0 LL c 1i c o N o 3 L5 c 3 Q ~ I Q I Cl) M 3 3 v ! z E z E I U g o I ~ v V ° w co Cl) a m a m i 1- Z I ' c I o o z zt c c I d Z :!t ° ° 'o I to F- rn z a) Q) c c v I 4) cc ww v rn I 'o m M 1 c aai y c y o I `~+CJ o h U) U) to • `1 N ' O C N d L L O c O c O Q ° ° i`z z z ~z N Z V N t4 R m N Lo LO (~1 V R 7 ►y. t6 O CL CL M 04 04 1 0 y d d O O y d ` U:t~ _O p p C a .n 4) G G m E f¢ N N f/~ fn N N N N L v O O r r U N N Z N rr 0 I ZO I Y boo ° boo acn O IL IL IL CL CL CL N ~ c o co o co co y 0) 0) 0) 0) 04 (~R co ti~ (D cA w O N O cq O ml C m y C d y Q O y N O) d ¢zco m ¢>.cn p r 7 r r 7 ay+ C N C N m U 0 '0 'a E IV f6 c c U c 41 y d p O O _ Q N m w m N C c n- O O V O ` C C C N r- 4) O y .O y N N N p y -Z-- N 1 .C i' 04 .a: 7 O lid, 1~ O' M M Cj •d.. r, co co O 0 O y O O O W O U) O O t3 • ~^Vi O N U) N O Z Z Z N O Z N Z .E' (n 1 Q ee 2 v € E m 1 0 CL (L of a rrww• a d d r m y r 0 s 9z 0 (L 2 0 U) L) N uai E O z N ~ o v a Z_ a, .0 N `O l0 e0+ O -O O c7 V C Q. z co O ~ F O N c 0 O _ Z v O V- w O a ui d C z m 3 a o 1- y > a G N U fl~ c cs m ~ a CD CD, o 3 (!1 N > d Z U O 0 Q A I N E N N ~ a z a. C) 0 o N O y - c C m c C C, LO ca o d N n C) -0 Cn W N U) w U =$N fns in . 4J N Z o 00 J Q U 00 N V_ c ~ Z ~ c O U o o cm N C C N N 3 c ~ w o O o ~ c U N CV 30 F O ' O >>O N M N CO > O y E 7 N O O N O A C\l O = UJ N C C O O CO .n W Z N C 7 N C y: E3 -0 N co 2 C N Z ti > 3 N O'. O R1' U cL F) ' U cm O z z' z N m E .C 0 a 2 Parcel 030-1079-20-250 05/17/2006 04:09 PM - PAGE 1 OF 2 Alt. Parcel 28.30.19.284B-10 030 - TOWN OF SAINT JOSEPH Current 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 O - MOEN, MICHAEL E & MARGARET M MICHAEL E & MARGARET M MOEN 1340 60TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1340 60TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 21.750 Plat: N/A-NOT AVAILABLE SEC 28 T30N R19W PT N1/2 SE1/4 THAT PT Block/Condo Bldg: OF A PARCEL DESC AS COM E1/4 COR SEC 28; TH S 00 DEG W 300' TO POB; TH S 00 DEG W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 250'; TH N 88 DEG W 1853.10'; TH N 00 28-30N-19W NE SE DEG E 1855.88'; TH 89 DEG E 553.87'; TH S 00 DEG W 1307.99'; TH S 88 DEG E more... Notes: Parcel History: Date Doc # Vol/Page Type 02/04/2002 670250 1830/05 WD 09/24/2001 657319 1724/126 LC 07/10/2001 650733 1677/431 WD 07/23/1997 1098/366 WD 2006 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/31/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.530 96,300 178,400 274,700 NO AGRICULTURAL G4 16.000 700 0 700 NO UNDEVELOPED G5 1.220 1,500 0 1,500 NO Totals for 2006: General Property 21.750 98,500 178,400 276,900 Woodland 0.000 0 0 Totals for 2005: General Property 21.750 98,500 178,400 276,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/06/2005 Batch 05-29 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 a i i STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER~L ~JI/F ADDRESS[ 3 ® 7 S'l ell o~ '57 SUBDIVISION / CSMI /Vj~ LOT ~ SECTION_ T_30_N-R__a W, Town of ST. CROIX COUNTY, WISCONSIN SHOW EVERYTHING WITHIN I 100 FEET OF SYSTEM f3l"1- dos, fi r, I ,5CAL E ~o INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center nF a s BENCHMARK: _ ,a ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / BOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /600 Setback from: Well T t House Apr Other t Pump: Manufacturer- Modelf_ A(A Size_ it/d Float seperation Gallons/cycle,:, 4_ Alarm Location ~ 4 :SOIL ABSORPTION SYSTEM Width: Length 5:"2 Number of trenches Distance & Direction to nearest prop. line: & ?7-,c,( Setback from: well: NU--T House- Other ELEVATIONS Building Sewer S ST Inlet: ST outlet PC inlet PC bottom/ Pump Off A(A Header/Manifold r Bottom of system_ y Existing Grade Final grade Y5- DATE OF INSTALLATION- - \ PLUMBER ON JOB: LICENSE NUMBER: 3~6 s INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor-andHuman Relations Safety-ahd Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284208 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: DORWEILER, BLAINE ST JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION LEVATION DATA A9600464 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark s X00, Dosi ng Aeration Bldg. Sewer ? ' Holding St/Ht Inlet 'l.9 TANK SETBACK INFORMATION St/ Ht Outlet q 3 ? ' Vent TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Inlet Septic Y S~ NA Dt Bottom Dosing NA Header/Man. /0,0 ,S- 1 Aeration NA Dist. Pipe !p ~q/ q y.~j6 Holding Bot. System q, PUMP/ SIPHON INFORMATION Final Grade q Q, y5 Manufacturer Demand Model Number GPM TDH Lift Lric ' n System TDH Ft Head Forcemain Len Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS J' DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type Of model Num Number: System:,,Vz,, /Os j 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.) LOCATION: ST JOSEPH.28.30.19W, NE, SE, 60TH STREET s~ 44 Plan revision required? ❑ Yes ❑ No Use other side for additional information. f d 103 n ` 4 , 1 SBD-6710 (R 05/91) Date In ctor's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: y Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with II HR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County_ than 8 112 x 11 inches in size. -Z;) ` • See reverse side for instructions for completing this application State Sanitary Permit Number Vii The information you provide may be used by other government agency programs ❑ Check if revisi to revlous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name .Property Location C1/4 ,6 1/4, S 8 T 3p , N, R E (one Property Owner's Mailing Address Lot Number Block Number 80 0 City, State Zip Code Phone Number Subdivision Name or CSM Number ST&U44 .5-511 ( ) _ q' II. TYPE F BUILDING: (check one) ❑ State Owned o city Nearest Road ❑ Village Public 1 or 2 Family Dwelling No. of bedrooms •Town of Jf GTA T', 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo 030 0 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. 'New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Exi sting System Existing System B) A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 tR Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 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. 7. Final Grade Y50 A-41 3 1 5-70 .8 fly- 91-51, Required (sq- ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Feet Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site - Fiber- Plastic Exper New Existin Gallons Tanks concrete Constructed steel glass App. Tanks Tanks Septic Tank or Holding Tank 100 Er❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 1:1 El 1:1 1:1 1:1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewa e s em shown on the attached plans. Plumber's Name: (Print) PI b is Signature: (No S/MPRSW No.: Business Phone Number: 3 G23~ S Plum er's Address (Street, City, State, Zip Code): IX. COUNTY / DEPART NT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signa re o Stamps) Approved ❑ Owner Given Initial 4'j 1010 Surcharge Fee) P/ /d • `jam Adverse Determination " X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Ruildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new :.riteria 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 ii.censed pumper when -ever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815- To be complete and accurate this sanitary-permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling - III. B uilding use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line 13 if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site-constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for anumber of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. 0 Old y.~ BUG PJEicri/rvsp~cTio,/' ZyK APP&ve o C.ov~/1 0 Q ~ Co i ~ a ZAV T~ f- of 6074 s T e 13/7 SCALE / oo r Br! Ap 1-07' s TA-AE Our Z-or gyi4 al-' /CEO, -'2/-94 1106- b ~ .0 D r 611 ~ ~L-5X57 T/1F.rrcfrL',S o ~ i T. m NoTEt 19up7p LOCA7-aD /X flmusE Pnopose~ wec~ ~ l?C U~ 1QRAW11v6- rot. A ~Ml f 13Z-411V = O/1 GV E/ L LC Q 13 yD 6070 s?. 596 OAZZeY U/Ew ?/e. r ~bor „~,xl Human Relations o v r L- m r m v r i c r v m L U m l l l/ I V n r-r v n a rage 1 of Divr.:oivol[Safoty, & Buildings a in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11,ini%ptan Size I st'include, but St. Croix not limited to vertical and horizontal reference point (BM),,diceCtion and % o e ale or PARCEL I.D. # dimensioned, north arrow, and location and distance to hoArest road. APPLICANT INFORMATION-PLEASE PRINT LL INFORMATION , REVIEWED BY DATE PROPERTY OWNER: PROPE CATION Blaine Dortreiller d GOVT. LjQTj NE 1/4 SE 1/4,S 28T 30 N.R 19Qor) W PROPERTY OWNERS MAILING ADDRESS r "It 61, # OCK # SUBD. NAME OR CSM # 1809 S. Point Douglas Rd. na CITY, STATE ZIP CODE PHONE N _ • (:]VILLAGE (OfOWN NEAREST ROAD St. Paul, M. 55119 (614 7 4757 j1 Joseph s t. New Construction Use Residential / Number of bedrooms 3 [ j Addition to existing building j ] Replacement [ j Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 - 8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpat t` . 8 trencn, 9pdm` Recommended infiltration surface elevation(s) 94.45 ft (as referred to site plan benchmark) Additional design / site considerations system brought to code with extra rock Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANI U= Unsuitable for system i® S ❑ U I M0 U I E] S O U KIS ❑ U I ❑ S CCU ❑ S KJ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft, in. Munsell Chu. Sz. Cont Color Gr. Sz. Sh. Bed ITrer {j~YSvvCSCi:Gi:.} 1 0-13 10yr3/3 none 1 2mgr mfr cs 2ti .5 1.6 %s 1 w 2 13-51 10yr4/6 none sil lfsbk mfr gw if .2 .3 Ground 3 51-60 7.5yr4/4 none s! 2msbk mfr gw na .5 .6 elev. 99.45 ff. 4 60-10 7.5yr4/6 none cos Osg ml na na .7 .8 Depth to limiting factor +100" Remarks: Boring # K 1 0-16 10yr3/3 none 1 2msbk mfr cs 2f .5 .6 2 16-41 10Yr5/ 4 none sil lfsbk mfr gw if .2 3 41-52 7.5yr4/4 none sl 2mgr mfr CIW na .5 .E Ground elev. 4 52-10([) 7.5yr4,/6 none co s Osg ml na na .7 . t 99.30 ft. Depth to limiting factor +1001, Remarks: CST Name:-Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 00th. Ave. N Richmond, WI. 5401 '7 Signature: / Date: CST Number: ! 8-22-q4 rctm nm?qR PROPERTYOWNER Blaine Dorweiller SOIL DESCRIPTION REPORT Payne►~ 3 PARCEL I.D. I - I GPD/ft Boring # Horizon Depth (Dominant Color I Mottles I I Structure Consistence 1Bo=Wy Roots Texture in. Munsell . Qu. Sz. Cont. Color Gr. Sz. Sh. I Bed Mew 3 1 0-13 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 13-39 10yr5/4 none sil lfsbk mfr gw if .2 .3 Ground 3 9-47 7.5yr4/4 none sl 2mgr mfr gw na .5 .6 elev. 99.30 ft. 4 7-92 7.5yr4/6 none co s Osg ml na na .7 .8 Depth to limiting factor +92" Remarks: Boring # 1 0-12 10yr3/3 none 1 2msbk mfr cs 2f .5 .6 4 2 12-47 10yr5/4 none sil lfsbk mfr gw if .2 .3 3 7-52 7.5yr4/4 none sl 2mgr mfr gw na .5 .6 Ground elev. 4 2-90 7.5yr4/6 none co s Osg ml na na .7 .8 99.00 ft. Depth to bmiting factor +90" Remarks: Boring # 1 0-10 10yr3/3 none 1 2msbk mfr cs 2f .5 .6 5" 2 10-50 10yr5/4 none sil lfsbk mfr gw if .2 .3 3 50-56 7.5yr4/4 none sl 2mgr mfr gw na .5 .6 Ground elev. 4 56-10 7.5ry4/6 none co s Osg ml na na .7 .8 99.20 ft. i Depth to Wiling factor +100" Remarks: Boring # Ground elev. ft. Depth to limiting factor I i Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Blaine Dorweiller 1554 200th Ave. CSTM2298 NE4SE4 S28-T30N-R19w New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246-6200 l C q~~f&-- ZP~j A N (°S M~zl-4-Z 1"=40' BM= top of mid-lot survey stake at el. 100' v " X05 ,~,L~' 6 rde Gary L. Steel 8-22-94 4 33.7 O .x- n N N 511.20 726 E4 ~ &4-9 ~955!iz. Sa S. i31/0 6o~st. ° 284 A - SN ' LOT 1 1098, 366 1? C. S. M. 8 / 2142 t 7 26' 00-0 Y, 6i /I-f/~+ 8 -fJCG~;~1C 4. IJGi~L/ ---X` 7//4v0/~y,;139 N I' ~ u' ~oiL~S ~653.10~pi/ ~ YN1~ I 284 i i o~ I nQ I wicon i^ Department-of Industry, PRIVATE SEWAGE SYSTEM County: I 4alb-or art Human Relations ST. CROIX Safety and Buildings Division INSPECTION REPORT (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION PbbfhtM,: BLAINE ❑ City ❑ Village Q Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction Syestem TDH Ft Forcemain Length Dia. FFii Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM INFORMATION TypeO CHAMBER 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") LOCATION: St. Joseph.28.30.19W, NE, SE, 60th Street Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code St Croix STATE SANITARY PER!/MIT # -Attach complete plans (to the county copy only) for the system, on paper not less than o~ ~TT~ 8% x 11 inches in size. ❑ Check if revision to previous 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 Blaine Dorweiller NE % SE S 28 T 30, N, R 19 VIV PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1809 S. Point Dou las Road na CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER St. Paul MN 55119 612 731-975 II. TYPE OF BUILDING: (Check one) ❑ State Owned C : NEAREST ROAD St- !c)sP_nh 60th Street ❑ Publlc ®1 or 2 Fam. Dwelling-# of bedrooms 3 PARCEL TAX NUMBERO III. BUILDING USE: (If building type is public, check all that apply) 030-1079-20 200 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 H Seepage Trench 22 ❑ In-Ground 42 ❑ 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. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 450 563 563 •8 .7 Feet ~f Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank 12501 1250 1 Wieser I El p F1 Lift Pump Tank/goooged)EM 750 750 1 Wieser VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): P b is Signature- ( Stamps) Business Phone Number: Paul C.J. Steiner C 6780 715 425-5544 Plumber's Address (Street, City, State, Zip Code): IX. CW"N TY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing A ent Sign ps) / Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber i 2 INSTRUI'TIONS - ' 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 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: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. Il. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one 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 if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% 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. 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) Reo la~rl~ Dorwe;ller Scale J"~y0 M Porfk _Q - BIYI .purvey StQk4 ~/rev. /00.4 ~o ~ Co,~~r ~o O .8-3 • • V U/elser /a 50/70 7kW K _ Nome Well kocaflopt 6 1h7:: D j C-e ~S'~ PUMP CIIAMItF:R CROSS SECTION AND SPECIFICATIONS , . Vent Cap T Weathtr Proof Approved Locking Junction Box Manhole Cover 4" C.I.---- 12" Min ' Vent Pipe ; Final 4" Min Grade 18" Min Conduit-' 18" Min Approved Inlet Joints w/ C.I. Pipe i Extending Ap proved 3' Onto Joint w/ Solid C.I. Pipe A Ground Extending 3' Onto Alarm Solid Ground B On , C .Pump Off - Concrete Block D SPECTFICATIONS TANK • PUMP Manufacturer: Wetsef Manufacturer: ,er Tank material: Cpr-Cr&te Model Numbur: M -E sld. Tank Size: Ia. S0 7,,TD Callons Switch Type : } Total Dynamic Ilead 7!r _ _ Fr. CAPACITIES Pump Diacharge Race: GPM Total Daily Effluent: '130 Gallons A - " or 3aa.L Callons Numher of Doues : 3 Per Day B or 3a--~ Callons Dose Volume:' /fe 7 Gallons C~ or _z Callons Notes: 1. See pump curve for D or Y Callon additional pcrEorm~lncc ToEiiI Tank information. Capacity Required Cnllona 2. Pump and alarm are to be installed on ueparat,! circuit ALARM au per ILIIR 16.19 NAC. Mnnuf ncturer: i e 1 lei,ra Mori e 1 1:umbe r : Switch Type. er page of i ME40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 In 30 25 8 Z a+ 20 6 FF- 15 H 4 0 10 F" 5 2 0 0 0 10 20 30 40 50 60 70 80 90 100 CAPA TY GALLONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805-1923 419/289-1144 FAX 419/289-6658 Telex 98-7443 K3326 7/91 Printed in U.S.A. CROSS SECTIOM OF A BED SYSTEM fie6h AU 04#16 And 0011MV41100 PIP# Approved V4al Cop M►olmwm 12' Aoov4 Final Gf00• 20' W Above Pipe 4r Goof Gal To final G1044 Yang Pipe mwbn nay Of Syninflic CGvatng win V Auglogol4 Ova p►p4 Dulr►Dwlian - Tee Pips 0 0 0 0 0 $=o AyQr4Qal4 a Pulufaled Pipe B41ar is6u4aln pipe --cwwoiny 141minaling Al b~11um 01 Srf~lem SOIL FILL r OF AGGREGATG 013TKIDUTIOLI PIPL-1 APMOVED 5uWULTIC COVCK MATERIAL OF. V OF STRAW OK MAKSH KAy 9'~•`/~r ;k.., I~jIOP%i•Ai4 AG6KCG. ATL ELEV. OF_.._ FEET mss: `~%l►i~ev DISTKIAUTIOW PIPE TO nC AT LCA6T ~O lWCH1:5 BCLOW ORIGIWAL. GRADC ALTO AT LCAST.LO (WGHCS OUT WO MOKC THAN tit IMCUCS DQ-0W FILIAL GKAOC MAXIMA OLPT11 OF LXCAVATIOW FROM OKIGIWAL GKADC WILL DC 04C.HC6 MINIMUM OCPTH OF-.`EXCAVATIOIJ FKON\ OKIGIWAL GKP*09 W166 BC INCHES Wisconsir. Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 IC id Human Relations E~ivi~ on cf SafstS~ & Buildings • in accord with ILHR 83.05, Wis. Adm. Code COUNTY l St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 •fnohet ih sizig. 011w- st'include, but not limited to vertical and horizontal reference point (BM),,`d"Otion- and % ofS e ale or PARCEL I.D. # dimensioned, north arrow, and location and distance to44rest road. APPLICANT INFORMATION-PLEASE PRINT iLL_,INF*ftmATiON REVIEWED BY DATE PROPERTY OWNER: PROPE CATION Blaine Dorweiller GOVT. L;jr NE 1/4 SE va,S 28T 30 N,R 19 i&or) W PROPERTY OWNER':S MAILING ADDRESS OCK # SUED. NAME OR CSM # 1809 S. Point Douglas Rd. t'e na CITY, STATE ZIP CODE PHONE N , I (:]VILLAGE DOWN NEAREST ROAD St. Paul, MN. 55119 (614 7 Z-~75a ; t ! -Joseph h St. [ New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpdift` . 8 trench, gpd/tt2 Recommended infiltration surface elevation(s) 94.45 ft (as referred to site plan benchmark) Additional design / site considerations system brought to code with extra rock Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND I IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for svstem ®S [3U I MCS ❑ U E] S ❑ U 91S ❑ U ❑ S CCU ❑ S u U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence IBound3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend :?i•4W:•i:0ix;6: 1 0-13 10yr3/3 none 1 2mgr mfr cs 2f'•' .5 .6 :<:4 1 2 13-51 10yr4/6 none sil lfsbk mfr gw if .2 .3 Ground 3 51-60 7.5yr4/4 none s: 2msbk mfr gw na .5 .6 elev. i 99.45 ft. 4 60-10 7.5yr4/6 none cos Osg ml na na .7 .8 . Depth to limiting factor +100" Remarks: Boring # A' 1 0-16 10yr3/3 none 1 2msbk mfr cs 2f .5 ::.6 2::. 2 16-41 10yr5/4 none sil lfsbk mfr gw if .2 .3 3 41-52 7.5yr4/4 none sl 2mgr mfr na .5 .6 Ground elev. 4 52-10 7.5yr4/6 none co s Osg ml na na .7 .8 99.30 ft. Depth to limiting factor +1001, Remarks: CST Name:-Please Print Gary L. Steel Phone. 715-246-6200 Address: 1554 00th. Ave. N Richmond, WI. 5401,7 Signature: Date: CST Number: 8-22-94 cstm 02298 PROPEMOWNER Blaine Dorweiller SOIL DESCRIPTION REPORT Para. 2. 3 PARCEL I.D. # ~ Boring # Horizon Depth I Dominant Color I Mottles I Texture I Structure. Consistence lBourdary ( Roots GP D/ft in. Munsell Gu. Sz. Cont. Color Gr. Sz. Sh. Bed iTrench 1 0-13 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 3 v 2 13-39 10yr5/4 none sil lfsbk mfr gw if .2 i.3 Ground 3 9-47 7.5yr4/4 none sl 2mgr mfr gw na .5 .6 elev. 99.30 ft. 4 7-92 7.5yr4/6 none co s Osg ml na na .7 .8 Depth to limiting factor +92" Remarks: Boring # 1 0-12 10yr3/3 none 1 2msbk mfr cs 2f .5 .6 4 2 12-47 10yr5/4 none sil lfsbk mfr gw if .2 .3 3 7-52 7.5yr4/4 none sl 2mgr mfr gw na .5 .6 Ground elev. 4 2-90 7.5yr4/6 none co s Osg ml na na .7 .8 99.00 ft. Depth to limiting factor +90" Remarks: Boring # 1 0-10 10yr3/3 none 1 2msbk mfr cs 2f .5 .6 52 10-50 10yr5/4 none sil lfsbk mfr gw if .2 .3 3 50-56 7.5yr4/4 none sl 2mgr mfr gw na .5 .6 Ground elev. 4 156-10 7.5ry4/6 none cos Osg ml na na .7 .8 99.20 ft. Depth to limiting factor +100" Remarks: Boring # Ground elev. 1 ft. Depth to limiting factor i Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Blaine Dorweiller 1554 200th Ave. CSTM2298 NE4SE4 S28-T30N-R19W New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246-6200 N rn/ ~i-¢Z 1"=40' BM= top of mid-lot urvey stake at el. 100' 'Sw k-0 i 105 (b X - ` `Y yr 1 Gary L. Steel 8-22-94 c 33.p~ 0 t\ 5 .71. 20' E 4 CO 726 y1Woe I, 2; ~ iass!i Z- Sa c..~~-r S. GvA i~s~/ y 1.36o s-t . 284 A LOT I 1098 366 1 2' C. S. M. 8 / 2142 726'x} (,~/D /~{1'/%z34 //4 N 65 3.10' /6&11231 284 P' 00i i Y , STC-105 SEPTIC TANK MAINTENANCE AGREEMENT R St. Croix County OWNER/BUYER 13 1 m i 1^ e\ <,3 r w o i MAILING ADDRESS ~•:V+'s 00-=n '05 PROPERTY ADDRESS 60 s/ (location of septic system) Please obtain from the Planning Dept. CITY/STATE ruE .5 E_ PROPERTY LOCATION 1/4, 1/4, Section, TO N-R__L _W TOWN OF ST. CROIX COUNTY, WI -o SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP Y VOLUME , PAGE , LOT NUMBER 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 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 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater 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. 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 DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiratio dat SIGNED: DATE: /S - 1 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 r This application form is to be completed in 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 house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property. 6J A~ V)~( Location of property 1/4 1/4 Section 1,TON-R~W 5 s Township yjf Mailln(^address Nod Address of site 1- Subdivision name Lot no. Y_ other homes on property? YesX -No Previous owner of property I-- i c U S 42 04 , S Total size of property 3 S. a Ac r e S Total size of parcel + Date parcel was created c-F f `(9 Are all corners and lot lines identifiable? xYes No Is this property being developed for (spec house)? Yes No Volume /09r~ and Page Number 366 as recorded with the Register of Deeds. k. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In 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 Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. S5_._Q 2 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the constructior ^r said system, and the same has been duly recorded in the office the County Register of Deeds as Document No. r _ Sig ature of Applicant Co-Applicant 0C4- 1 5_ '7 Date of Signature Date of Signature r • `DOCUMENT NO. STATE BAR OF WISC;,%SiN FORM 2-1982 THIS SPACE RESEa,,ED F(A RECCRDINC DATA II • I WARRANTY DEED _FrirkamUb., Tnr., a Wisronsin rnrporatinn OCT 10 1994 i 8:30 A. ~..~,G. conveys and warrants to Blaine A. Dorweiler, a single ± f,r"" rY;~-v person > y II r I RETURN TO , the following described r€-: estate in St. Croix -County . I~I-- State of Wisconsin: A Parcel of Land located in part #030-1078-40 #030-1079-2 of the SWI of the NE's, NW's of the SE' and part of Tax Parcel No: 030-1079-10 the NE'I of the SE's all in Section 28, T30N, R19W describ,:d as follows: Commencing at the EJ Corner of Section 28; thence SO0°20'20"W, along the east line of the SEJ of said section, 300.00 feet to the point of beginning; thence continuing S00°20'20"W, along said east line, 250.00 feet; thence N88°53'47"W, 1853.10 feet; thence N00°32'55"E, 1855.88 feet; thence S89°06'46"E, along the north line of the SWI of the NE;, 553.87 feet; thence SO0°32'56"W, along the east line of the SWI of the NEI of zaid section, 1307.99 feet; thence S88°53'47"E, along the north line of thE: SE-'' of said section, 571.20 feet to the NW corner of Lot 1 of Ceitifi d Survey Map recorded in Volume 8, Page 2142 at the St. Croix County Regist r of Deeds Office; thence SO0°20'20°W, along the west line of said Lot 1, 300.00 feet; thence S88°53'47"E, along the south line of said Lot 1, 726.00 feet to the point of beginning. Parcel contains 35.00 Acres (1,524,654 Square Feet) and is subject to right-of-way for town road (60th Street) and all easements of record. This is not homestead property. t u R~• (is) (is not) Exception to warranties: easements and roadways of record. Dated this _ _ 7 day of Octob 19 94 ri csmith ;SEAL),, (SEAL) ' Dennis W. Erickson, President (SEAL) ' E 4L AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN " ' - County. f ti~ authenticated this day of , 19 Isonally came before me this day of 19 the above named TITLE: MEMBER STATE BAR OF WISCONSIN (It not, - to me known to be the person- who executed the authorized by § 706.06, Wis. Stats.) f~egoi g instre~f{~ent a ck o I dge the same. ` - THIS INSTRUMENT INAS DRAFTED BY ~~Q ``((fu -`T - ~I 00 m 0 lip n° 8 N0732'56"E 185588' I I i I I i I I I I - - ^ - - - - - - S00°32' 56"W 130799' ^ - • - ? CAST LINE OF THE SWI/4 OF THE NE 1/I4 %7Gf V pCD Ng A N U = W r A V F F m _v N m O a • I ' S00°20'20"W 300.00' I ~~F 1 1() Im 1?j I-I Ir 4i ior ~v m~ Irn Ij h ID 1-L+ t e g 8 - I S~24JN ~ - - - a0n00' zezs.es'