HomeMy WebLinkAbout030-2073-40-100
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division., Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Co
oix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must i ut
not limited to vertical and horizontal reference point (BM), direction and % of slope, ~EL I. f
dimensioned, north arrow, and location and distance to nearest road. 030- 7 -40
a. Ev ~D B DATE
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION § i~3U
PROPERTY OWNER: PROPER %ATION ti
Earl Balzer GOVT. LOTS 4vima N,R 20 )(or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BL Ck f , ~UBD. NAM
5367 Jamaica.Ave.:LT. na nX = 9
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE NEAREST ROAD
Lake Elmo MN. 55042 (612) 779-1997 St. Joseph Cty Rd. V
[ ] New Construction Use [x] Residential ! Number of bedrooms 4 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 arid Recommended design loading rate • 5 bed, gpd/ft2 .6 trench, gpolft2
Absorption area required 1200 bed, ft2 1000 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 •6 trench, gpolft2
Recommended infiltration surface elevation(s) 92.93 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material pitted glacial drift Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem IN S ❑ U ®S ❑ U ®S ❑ U [3S ❑ U ❑ S ® U ❑ S C3rU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxtd3y Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
l 1 0-18 10 r3 4 none ql llmar mfr Cs 2f .5 -6
2 18-42 10 r4/4 none sl 2msbk mfr crw if .4 .5
Ground 3 42-67 7.5 r4/4 none s os mvfr crw na .5 .6
elev.
96.85 ft. 4 167-70 7.5 r4 3 none
Depth to 5 170-83 7.5yr4/4 none ifs lmsbk mfr CrW na .5`.6
limiting
factor 6 83-95 7.5 r4/4 c2p7.5yr5/6 sl lmsbk mfr na na .4 .5
Remarks:
Boring #
1 0-18 10 r3/3 none sl lmgr mvfr cs 2f .5f.6
2
2 18-39 10yr4/4 none sl 2mtsbk mvf r 9w if .5 .6-
Ground 3 39-72 7.5 r5/8 none is os mvfr crw na .7.8
elev. 4 72-90 10 r4 2 c2 7.5 r5 6 scl lfsbk mfr na na .2..3
94.3 ft.
Depth to
limiting
factor
72"
Remarks:
CST Name: Please Print Phone:
Gar L. Steel 715-246-6200
Address:
1554 200th Ave., New Richmond, WI. 54017 m02298
Signature: ` Date: CST Number:
5-13-96
16-
PROPERTY OWNER Earl Balzer SOIL DESCRIPTION REPORT Page 2 of3
PARCEL I.D. # 030-2073-40
Depth Dominant Color Mottles Texture Structure Consistence Bounclary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
: 1 0-8 10 r3 4 none
Z.-` 2 8-22 10 r4/4 none sl 2 r mfr cs if .5 .6
Ground 3 22-32 7.5 r4 4 none sl lmsbk mfr Cs na .4 .5
elev.
95.35 ft. 4 32-80 7.5 r4 6 none lfs
Depth to 5 80-10 7.5 r4 6 none s os mvfr na na .7.8
limiting
factor
+106"
Remarks:
Boring #
Us
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
10
011,
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Earl Balzer New Richmond, WI 54017
MPRSW 3254 SE4SE4 S36-T30N-R20w (715) 246-6200
town of st. Joseph
N
1"=40'
Bm.=bottom of house sideing C el. 100'
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GAry L. Steel
5-13-96
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, _ DIVISION
P.O. BOX 76
LABOR AND PERCOLATION TESTS (115) MADISO
N WI 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
OjV NAME:
LOCATION: SECTION: TOWNSHIPrGT_N0_.jBLK. SUBDI Z
JJ
C1/a S,61/ 3 4 /T)pN/R.v1(p . P A
/L ~
COUNTY:
'X OWNER'S /BUYER'S NAME: MAILING ADDRESS: Y ~ON / ]0v~ G(i l y'7 0
USE C^ Is DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMER AL DESCRIPTION: PROF[ D RIPTIONS: IPLHL;UXA II TESTS:
esidence New ❑Replace
RATING: S= Sites table for system U= Site nsuitable for system
❑
MP '4 D: ❑U IN-GROU~D-PRESS L'RE:SSTEM-IN-FILLIHOLDEIING TANK: RECOMMEND
IONVENTION#
NS:l SJ WSEIS
If Percolation Tes are NOT required p SIGN RATE: G 1, 6.5 any portion of the tested area is in the
under s. ILHR 83. 5)(b), indicate: Floodplain, indicate Floodplain elevation:
7 A
PROFILE DESCRIPTIONS
BORING TOTAL # DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IAQ.' ELEVATION OBSERVED EST. HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B-z l >.S
7.5
B-
ST A;7 -S
B- t
B- ,33 > i-0
B- > J-1, "
PERCOLATION TESTS
TEST DEPT WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER 4*00tgS AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI,QQ 2 PE PER INCH
P- 2,0
P_ z y y
P--3 :3
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. 1 SYSTEM_ ELEVATION ~~-q3 / 111111-1-, 1 3 t t p~T._~_
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INSTRUCTIONS FOR COMPLETING FORM 115 - S - 6395
Ter ` 2 mplete anti accurate s.3 Yong report rnust irlc:lude:
1. Co le, If description;
2. The ct:ion roust cleai ~k Lvhether this is a ~ddeiice or commer6al project;
3. M,4I nt :nber of be~. commercial w r, :1;
4. Is 11'--ernent
5. C): k,, ity ra.. A SITE IS S LE FOR A HOLDING TANK ONLY IF ALL
11 1
OTI-` RE RUL: T BASED ON L ~L CONDITIONS;
6. PLEASE L 'r for writing profile descriptions and completing the plot plan;
7. MAKE A I is-l,ting yo.,. <:est locations. D:,i ing to sc r,-.~ preferred. A
separate st -
8. Make sure y..~ and "at:i€3n r )oint are clearly ~rrmanent;
9. Complete all < )pr ialc boxes r, to es, names, i :dresses, flood pla; I I = :)h or test exemp-
tion, if appr ,
10, If V- s flood pI i, ovation) does not apply, place N .A the apt €ohriate box;
11, Sig ti . current, and your certification nurnber;
12. Make tribute, as I L ALL SOIL TESTS ML FILED WITH THE
LOCA ..1m. RITY 10 DAY (s COMPLETION,
MATI NS FOR CERTIFIED SCIJL'a RS
Sail Set: Texturesca4s
st. ~Dver, 10-1 BIR -
cob (3 - 10") S S ,1r e
gr Gravel iunder 3") LS L,,.s~
s - Sand Ir It VV High %,vater
c" Coarse Sa,-id z_ro P- i Rate
med s V: lirmn Sand w W
sti £11
- Gy
y Y_
Lown R
r;arr rnot - € Ies
sic; - Sil C ay fff - few, fine, `-int
'kr cc - (:omPIM, arse
pt mm Allany, me,
7l d distinct.
p prorniner
HVVL. Highs v-, Six g awes surf _
aI P Sen6
t" ;`attr. cc Point
~ ~ 68927
*Q)pE VOL 76 PAGE 4365
APp
KATHLEEN H. VALSH
REGISTER OF DEEDS
Plano!^Q Z~^'rO an 1 3 2002
AvG 1 2 2Q02 ST. CROIX CO., WI
RECEIVED FOR RECORD
if not rded wdtun so 09-04-2002
row aQPf pid 2:00 Ph
a22 , ;I Lin" al data
CERTIFIED SURVEY FEE: 17.00
Y FEE:
STEVEN AND THERESA JOHNSON PAGES: 4
Located in part of the Southeast V4 of the Southeast Y4 of Section 36, Township 30 North, Range 20 West,
Town of St. Joseph, St. Croix County, Wisconsin, being Lot 1 of that Certified Survey Map recorded in
Volume 2, Page 523 of St. Croix County Certified Survey Map records
s--~ NOTE- LEGEND
1220 COUNTY TRUNK HIGHWAY'V' AN EROS/ON CONTROL
HUDSON, WI 54016 S I PLAN WILL BE REOU/RED O INDICATES ATES 1' x 24' M20N PIPE SET
U" a BY THE Sr CRO/X COUNTY (MIN. WT. -1.13 LBJLIN. FT.)
ZONING OFF/CE PR/OR TO 0 INDICATES 1' RON PIPE FOUND
CONSTRUCT/ON ON THESE O SOIL BOOM MVPOSED SEPTIC SYSTEM)
BE4RI10S ARE DICED LOTS. 0 SECTION CORNER MONLIMENT (AS NOTED)
TO THE EAST L MIE OF THE x INDICATES FENCEUNE
SOUTWAST W OF SEC,•T10N 36,
T 30 N, R 20 W, ASSIMIEa AS (R-) RECORDED AS
N 00°0000' W.
ooSpo00004~~~DDpp EAST 114 COMER
SCALE W FEET 1' =159' NDATE OD: 8, 2000 ~GONg~~ oGp0 100. TSEC 30 NTK 36,
REVISED: o ° 4 (FOUiJD
v° °°0
APRIL 23, ?001 LAUREN I I eERNTSEN I
50 50 1 0 1 0 REVISED: ° MU r ~o
MAY I4, 200/ * • S 13 e * I MONUMENt) _ I
REVISED' RIVER O
MAY 24, 200/ e FALLS, °
SUBJECT t. .4 le 6'
NOTE: TO FUTURE ASSESSME
N FOR OCV7i9BER 4 200/ 0~~000'PEO ° w ° ° ° °9J~ I I
TOWN ROAD IMPROVEMENTS. 115, 3 50.1
UNPLATTED -LANDS
- - S 89030'37" E 652.02' z
122nd R -537.07- 65.ar, 50.ar 50. co
CERTIFIED (DEDICATED TO THE P"RZ') gi'Fy~ ~~o ~I I
MP t' IP - i~-S 89°30'37' E 325.81,_ , _ F3 "'I o Q~ I
r C
ELEV. E4s.91' DwvEwav Raaowar8- IL1TY.
(ASS I-EASEMENr 8 _ S!!)
I j eel a WELL NOTE - moaw /S A NON- " I m
LOT 1 0.0 O.ar (7tIJ CONFORM/NG 'i
ZED[ eE . _ . SETBACK o BaL • 0.00 I
SURVEY W s~Prrc EL+ M. I W o
''Q 75 j AREA o mss, ) . A
75
IN g SHl LOT 6 , _10 °
- \J N 210,231 SO. FT. OR 4.826AC. ( 1
S 90'00'00 ' W
O\ -'I al
LoT3 's i LOT ~•`b , 30.ar
~(R=VVM 3s
MAP 29 LOT 7 rt 80' 80' g
S`~•_ w 168,614 SQ. FT. ` I
lir `
i) OR 3.871 AC. W
/ to A90/NARY (130,719 SQ. FT. OR I g 1 a
LOT 3 M /NION WA 3.001 AC.EXCLUDMIG
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04 ~1G LEVAT~N AS Z 1 ROAD RIGHT OFWAYS)
V_ 13
F firmRN/NED BY 1 ~J ~~~r111 0 I ~
$ 1j i > &; SST. CRO/X COUNTY % POND $ t I
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S:. CROIX COUNTY
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER .5 ~E fEl1_ _ _C /GN~(~!
ADDRESS p r
SUBDIVISION / CSM9 LOT f
SECTION . C>_T 3a N-R Zo W, Town of -Dj
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
st
Fc lea o ~~pp Gh` Sr'f,
A/ t
~ X15r *
L
b?17. 0/5"1 5f olNG- lob- pO
EL. ~aoa _ S C CJ
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: 6 Tt7 Sid //1/ EL/OVA D
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: ptnpew ? ? Liquid Capacity: /;.On
F.
Setback from: Well Q' House- Other
Pump: RaT" rer Model# Size
Float seperation Gallons
Alarm Location
-:SOIL ABSORPTION SYSTEM
L/A1LCS o~.
Width: Length 11010 Number of
Distance & Direction to nearest prop. line: /(aaQ
Setback from: well: /0(~ f House y~ Other
ELEVATIONS
Building Sewer. 1ST Inlet. ? ST outlet F 7
PC inlet PC bottom Pump Off
Header/Manifold s Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: _'Z o -
PLUMBER ON JOB:
LICENSE NUMBER: &,e.dSa! '3220.-
INSPECTOR:
3/93:jt
Wis:onsin DePartmentof Industry,
Labor and Human Relations PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 262360
Permit Holder's Name: ❑ City ❑ Village 0 Town o : State Plan ID No.:
JOHNSON STEVEN ST. JOSEPH
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
A9600169
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. AirI to ntake ROAD Dt Inlet
rl
Septic >"),f-? - NA Dt Bottom
Dosing NA Header / Man. "q
Aeration NA Dist. Pipe
Holding Bot. System 9-C~ 9
PUMP/ SIPHON INFORMATIO Final Grade
Manufacturer Demand 7 6.`' a 9
Model Number GPM
TDH Lift Fri ion System TDH Ft
Forcemain Le th Dia. Fi Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Widtha Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS / /0o i DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer:
SETBACK
INFORMATION TypeO CHAMBER Model Number:
System: ~ 7V0j ` /j(5 ~/o o ' /1J 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 J Bed/ Trench Edges ! Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
i
LOCATION: ST. JOSEPH.36.30.20W, SE, SE, CTY RD V
Plan revision required? ❑ Yes O/No /
Use other side for additional information- i:) b )1y,v
( v
11
SBD-6710 (R 05/91) Date In pe6r's Signature Cert No
i
3 ,
w. SANITARY PERMIT APPLICATION
■
r.'~L■7R In accord with ILHR 83.05, Wis. Adm. Code COUNTY
-5t- r-O%
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for, the system, on paper not less than 300
8% x 11 inches in size. chec i revislon 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
.S E E /4 ,'t/4,S 6 T3N,R 0 E(odo
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
d
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBE
91" ?76 -3 t/ S a O ~ .5
Aabs OAC W/
II. TYPE OF BUILDING: (Check one) El State Owned O VILLLAGE ' NEAREST R D
-7 1
T
❑ Public X 1 or 2 Fam. Dwelling-# of bedrooms _Y_ PARCEL TAX NUMBER(S)
111. BUILDING USE: (If building type is public, check all that apply)
O d -.2-0 '73
❑ Apt/Condo d
2 ❑ Assembly Hall 60 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 in line A. Check line B if applicable)
A) 1. ❑ New 2. CK Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] 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 N Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ 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
600100 /a, Q 4 9 Feet 9Jr 85' Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App.'
Tanks Tanks structed
Septic Tank or Holding Tank /140 -1 L1 I Ll
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plum UhA`r'_A Signature: (No Stamps) M MPRSW No.: Business Phone Number:
D6 Mo C - - , L 7-M7 1 1
Plumber's Address (Street, City, State, Zip Code)'
IX. COUNTY/DEPART NT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue I ing Agent ]bmigntnjo Stam s)
O(Approved El Owner Given Initial Surcharge Fee)
L- ircmag
Adverse Determination
/
Z12 & Tfofi,
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(R.08193) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
e ~ , 3
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions 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.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one 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)
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Labor apd Human Rotation v v . r n • r v. • r r s n r v • . v a- -
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 030-2073-40
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Earl Balzer GOVT. LOT S t14 v4,S 36 T ,N,R 20 7~CO W
PROPERTY OWNEIT:S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
5367 JarMica `Ave. N. na na Cty Rd. V
CITY, STATE ZIP CODE PHONE NUMBER OCITY DVILLAGE :MOWN NEAREST ROAD
hake Elmo M. 55042 (61:0 779-1997 St. Joseph Cty Rd. V
New Construction Use [x] Residential / Number of bedrooms 4 Addition to existing building
[ ] Replacement [ ] Public or commercial describe
Code derived dally flow 600 gpd Recommended design loading rate • 5 bed, gpd/ft2 .6 trench, gpW
Absorption area required 1200 bed, ft2 1000 trench,1112 Maximum design loading rate • 5 bed, gpd/ft2 - 6 trench, gp"2
Recommended infiltration surface elevation(s) 92.93 It (as referred to site plan benchmark)
Additional design / site considerations na
Parent material pitted glacial drift Flood plain elevation, If applicable na ft
S = Suitable for system CONVEwnoNAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable for system ®S L] u ®S O U ®S O U C3S D U 0S ®U DS M
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consislience Boundary Roots GPD/ft
Boring # Horizon in Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rfto
1 1 0-18
2 18-42 10 r4/4 none sl 2msbk mfr if .4 .5
Ground 3 k2-67 7.5 r4/4 none s as mvfr na .5 .6
elev.
96.85 It. 4 167-70 7.5
Depth t0 5 0-83 7.5 r4/4 none ifs lmsbk mfr C1W na .5 ` .6
limiting
factor 6 63-95 7.5 r4/4 c2p7.5yr5/6 sl lmsbk mfr na na .4.5
83"
Remarks:
Boring #
1 0-18 10 r3/3 none sl 1 r mvfr cs 2f .5::.6
2 118-39 10 r4/4 none sl 2mtsbk mvf r if .5 .g
3- _
3 39-72 7.5 r5 8 none is os mvfr na .7:.$
Ground
dev. 4 72-90 10 r4 2 c2 7.5 r5 6 scl lfsbk mfr na na .2 .3
94.3 f1
Depth to
limiting
factor
72"
Remarks:
T Name:-Please Print Phone:
Ga L. Steel 715-246-6200
Address: 1554 200th Ave., Nev Richmond, WI. 54017 m02298
Signature: Date: CST Number:
5-13-96
1 4
PROPERTY OWNER Earl Balzer SOIL DESCRIPTION REPORT Page ,2 of3~ a
PARCEL I.D. # 030-2073-40 ,
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmsifty Roots GPDJftin. Munsell tau. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh
3 1 0-8 1 r3 4
2 8-22 1 r4/4 none sl 2mcrr mfr CS if .5 .6
Ground 3 22-32 7.5 r4 4 none sl lmsbk mfr Cs na .4 .5
elev.
95.35 ft 4 32-80 7.5 r4 6 non
NO ID 5 80-10 7.5 r4 6 none s 0sa- mvfr na n 7'' .8
Nmiling
factor
+106"
Remarks:
Boring #
Ground
elev.
ft.
Depth b
6ntiting
bctor
Remarks:
Boring #
13.
Ground
elev.
ft.
Deplh to
lilting
factor
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
facior
Rnmarke• _
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Earl Balzer New Richmond, Wf 54017
MPRSW-3254 SEkSE4 S36-T30N-R20W (715) 246-6200
town of st. Joseph
N
1"=40'
Lm.=bottom of house sideing @ el. 100' 4\
VIA
3Qt o 'd
6M
v
I
Sd
GAry L. Steel
5-13-96
345228
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`RECORDED IN VOLUME I PAGE 68)
N 0025'07"E G66.98'
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m -266.99' 400.00''',-- T
= N 0° 12' 3 5"E GGG.99' . 1 itJ
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R.O.W.... ti ...pj 345220
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNERBUYER ~4<-V 4 + We y
~ SO r
MAILING ADDRESS Z ZQ n (2j- V P u Gt,SOn w
PROPERTY ADDRESS co r.,
~ll- (location of /se'pttic system) Please obtain from the Planning Dept.
CITY/STATE T" 0 n . W (
PROPERTY LOCATION SE 1/4, 1/4, Section 3 T_30 N-R 20 W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP 3~t 2~8 , VOLUME Z, PAGE S 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.
UWe, 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 exp`iratio, t.
SIGNED: 'Y'd I 'Aj.
~r
DATE: (0 IO
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
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 ( G ~ J Tkne4a_
Location of property S E 1/4 SC- 1/4, Section , T*~ONDD-R /0 W
Township Join t1 Mailing address ' ZZU &0 ~ J
&Sor~ , W1 1/ I l
Address of site It 20 ct~~ &I V AIL[ A. W I
Subdivision name "O k3g , Lot no.
Other homes on property? Yes No
Previous owner of property
Total size of property (b A
Total size of parcel ~Q A-
Date parcel was created 140 1
Are all corners and lot lines identifiable? Yes No
Is tytseroperty being developed for (spec house) ? Yes _ ->4/-No
Volumj ~ and Page Number ~as recorded with the Register
of Deeds. 416V
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. S4,3gAjr_ , 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
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
5y
Signature of Applicant Co-Applic
6 _161f 4 6 --o-f6
Date of Signature Date of Signature
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
serving the '51 dg C,,~ M'eo h residence located at:
.~ZF 1/4, .SL' 1/4, Sec. T 3a N, R 90 W, Town of
, Upon inspection, I certify that I have found the
tank and baffles to be I good condition, and it appears to be
!lam y'~s°lute ~c%f /n P14~ Y,h-e, u6 p`~~~ a'rrv~hL~olt-
a functioning properly. G„11 V.-A, P
Last time serviced
Did flow back occur from absorption system? Yes No4- (if no, skip
next line)
Approximate volume or length of time: gallons minutes
Capacity:
Construction: Prefab Concrete Steel Other
Manufacurer (if known):
Age of n ( if known)
(S ignatur
(Name) Please Print
b c;2
Q~181e~ _6 ~ (19
(Title) (License Number)
6- -qC
(Date)
Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes)
or Licensed Disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tan}
condition, I certify that the tank to the best of my knowledge wil.'
conform to the requirements of ILHR-83, Wis. Adm. Code (except foi
inspection opening over outlet baffle).
Name Signature "MP/ PRS 3it10
5/88
SGAI'E BAR OF ~4'ESCtJ~Sty Fi1RM l - 1 52
WARRANTY DEED
DUCUMU'T NO. 1; 454 !
Sr C t`v 1)( C y
i
This Deed madehcnvecn Earl W. Balzer and Arles F. Balzer, husband ana wife, MAY 1 %
- r 1 {
Steven M. Jo~tnson ancT I`Fteresa K Johnson, 1
;InU - i
husband and Wife, as survivorship narita
-
property,
-
Witnesseth, Eh trite aidCrar.[or,fura~at:.~h;~ on~~~elau.xt 0- One
dollar and other valuable consideration- TH,ssRACERes RvEDFn~RECORDNCDnrA/jb3bt(51,~
nxtveys to Granter the lollowin~ described real estate in St. Croix -
NAME AND RETURN AC JPESS
County, Srate of ~~'iscuruut:
PaLt of the Southeast one-fourth of Southeast
one-fourth of Section 36, Township 30 North,
Range 20 West described as follows:
Lot 1 of Certified Survey 'lap filed in the
office of the Register Deeds for St. Croix 030-2073-40
County, Wisconsin on December 6, 1977, in ?AHCEL IDENTIFICATION NUMBER
Vol. "2" of C.S.M., Page 523, Document
Number 345228.
l
This is not homestead property.
(is) (is not)
Together with all and sin ular the hereduaments and appurtenances the-.euntu ielo. g1:1g;
And Earl W. Iralzer and Arles F. Balzer
warrants that the title is good, indefeasible in fee simple and fret and clear of enccr =a:. rs c:.cept
easements, covenants, and restrictions of record, if any,
and will warrant and defend the same.
Dated this 13 day of _ May [ y 9 6
(SEAL) (SEAL)
-
marl ld. Balz
n-
2r~1 , (SEAL) s
(SEAL) ~.f . r
. Arles F. Ba zer /
r
t
ACKNOWLEDGMENT
AUTHENTICATION
State of Wisconsin,
Signature(s) _ - ss
Pierce Count;:
s' i z ~".a fly came before me this +3 day of
authenticated this day of Iy- May 19 he above named
_Earl If. Balzer and Arles F. Balzer,
t -Husband & Wife -
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
s who executed the lore
authorized by §706.06, Wis. Slats.) to ^tt ti►~ :o be the peratt; gumh
/Iw
:7__ ---,j acknowledgeAhe sainG!
, n e