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Department of Industry, SOIL AND SITE E V A L U A T Page 1 of 3
.a r and Human Relations
Division of Safety & Buildings in accord with ILHR 83.0 m. Co
~o OUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in siz n mus~eyd CEL I.D St. Croix
not limited to vertical and horizontal reference point (BM), direction and Oope,,,sc `_gr I.D. #
endin
dimensioned, north arrow, and location and distance to nearest road. p
g
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATI IEWED BY DATE
PROPERTY OWNER: A'OPEF W LOCATION Jerry Lupke , 1I 1/4,S 27 T 30 N,R 19 for) W
PROPERTY OWNERS MA!I.ING ADDRESS LOT C BD. NAME OR CSM #
880 C.T.H. #E 3 na csm pending
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE AWN NEAREST ROAD
Hudson, WI. 54016 (71~ 246-5565 St. Joseph 132nd. Av.e
New Construction Use [x] Residential / Number of bedrooms 3 Addition to existing building
[ ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 QDd Recommended design loading rate • _5 bed, gpd/0 .6 trench, gpd/ft2
Absorption area required 900 bed, ft2 750 tren&1,112 Mweimusm design loading rate • 5 bed, gpd/fL2 anct, ypd/`?
Recommended infiltration surface elevation(s) 95.87 ft (as referred to site plan benchmarlc~
j _
Additional design / site considerations alt. site trenches C 95.621-93.391
Parent material outwash 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 for system (D6 ❑ UI )-0 S ❑ U ® S ❑ U ®S ❑ U ❑ S :K7 U ❑ S :au
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence lBotrdary Roots GPD/ft
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trltctt
1 0-13 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
2 13-38 10yr4/4 none sil lfsbk mfr gw if .2 .3
Ground 3 38-48 7.5yr4/4 none sl 2msbk mvfr gw na .5 .6
elev.
96.92 ft. 4 48-88 7.5yr4/4 none 1 fs Osg mvfr na na .5 .6
.
Depth to
limiting
factor
+88"
Remarks:
Boring #
1 0-10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
2
2 10-28 10yr4/4 none sil 2msbk mfr gw if .5 .6
3 28-48 7.5yr4/4 none sl 2msbk mfr gw na .5 .6
elev. Ground 4 148-88 7.5yr4/4 none S Osg mvfr na na .7 .8
99.9$.
Depth to
limiting
factor
+88
Remarks:
CST Name:-Please Print Gary L. Steel Phone. 715-246-6200
Address: 155 200th. Ay.,
w Richtniind, WI. 54017 8 1995
Signature: Date: - CST Num
PROPERTY OWNER Jerry Lupke SOIL DESCRIPTION REPORT p 3
PARCEL I.D. u pending
Boring # Horizon Depth Dominant Color Mottles Texture
I ( Structure Consistence eotixtary I Roots GPD/ft in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed iTmr&
1 -12 10yr3/3 none 1 2msbk m r gw
3
I
2 12-32 10yr4/4 none sil lfsbk mfr gw if .2 i.3
Ground 3 2-80 7.5yr4/4 none is Osg mvfr gw na .7 .8
elev.
98.62 fr 4 0-90 5yr4/4 none sl M na na na .3 :'.4
Depth to
limiting
factor
+90"
Remarks:
Boring #
1 0-10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
4?- 2 10-24 10yr4/4 none sl 2msbk mfr gw If .5 .6
3 24-63 7.5yr4/4 none is Osg mvfr gw na .7 .8
Ground
elev. 4 63-70 5yr4/4 none sl 2msbk mfr gw na .5 .6
99.9 ft.
5 70-94 10yr5/4 none fs Osg mvfr na na .5 .6
Depth to
limiting
factor
+9411_
Remarks:
Boring # 1 0-17 10yr3/3 none 1 2msbk mfr gw 2f .5 ` .6
5 2 17-46 10yr5/4 none sil lfgr mfi gw if .2 .3
3 46-88 7.5yr4/6 none is Osg mvfr na na .7 .8
Ground
elev.
97.28.
Depth to -
limiting
factor
+88"
Remarks:
Boring #
Ground
elev.
ft.
I
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Jerry Lupke 1554 200th Ave.
CSTM2298 SE4SE4 S27-T30N-R19W New Richmond, WI 54017
MPRSW 3254 town of St. Joseph (715) 246-6200
lot #3
N
1"=40'
BM.= top of 1" steel pipe C el. 100'
Alt. BM. top of steel fence post @ el. 103.80'
32 Ad , Nr'
a - 72 , b
- 3 c~7 p~M g A
1 'C
h 3a'
V
Gary L. Steel
8-20-95
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER r1 ~D r'/1
ADDRESS
SUBDIVISION / CSM# LOT #
SECTIONT 30 N-R~W, Town of ~o Pk
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 E'T OF SYSTEM,.,
0
044
490 , ?-1 16 t
ID
I~
G/5 P'
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
1
BENCHMARK: , j~'/ ~~•S r G~i, /-t°„rzC~
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: C(lG+Se r~ Liquid Capacity:
Setback from: Well /&p House Old other
Pump: Manufacturer Model# Size
Float seperation G o itY-cycle:
Alarm Location
;SOIL ABSORPTION SYSTEM
Width: 12- t Length ? .1
7 Number of trenches c2
Distance & Direction to nearest prop. line: 7J S
Setback from: .well: House 14 Other
ELEVATIONS
Building Sewer ~t 3 - ST Inlet, b F ST outlet
PC inlet PC bottom Pump Off
/ 0 1 4 Bo 7 i 3 e-" a ke.4,& - ~c /g
Header/Manifold ttom of system
r` c7
Existing Grade JiFinal grade ,
DATE OF INSTALLATION: ~YP SQ 3 O 99
PLUMBER ON JOB: is, /o
LICENSE NUMBER:
INSPECTOR:
3/93:jt
h
` Wisctnsirr Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village X Town o : State Plan o.:
TORNIO, DANNY P.
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELIVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ~~1'`~ Benchmark ~OC~.~JO
Dosing O 3,3y
Aeration Bldg. Sewer sw l
Holding St/ Ht Inlet zo
TANK SETBACK INFORMATION St/A kt Outlet/
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic y 'VDU' olr7 >a NA Dt Bottom
Dosing NA Header / Man. s" cJg
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
ystem TDH Ft
TDH Lift Loss Sr
Forcemain Lengt Dia. FDist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Lengt~j , No. Of Trenches PIT No. Of Pits inside Dia. Liquid Depth
DIMENSIONS a DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
Model Number:
INFORMATION Type
ystem: >`jU r 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 txx 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/:: Sty/~. Joseph.27.30.19W, SE, SE, Lot 3, 132nd Avenue
®
Plan revision required? ❑ Yes ❑ No ~t
Use other side for additional information. 1/0 1.)5- 7 ~i v2 ~p
SBD-6710 (R 05/91) Date ~r~f kc- s r-s Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH s
SANITARY PERMIT NUMBER:
Safety and Buildings Division
■ ■r+
SANITARY PERMIT APPLICATION Bureau of Building Water System
~~■~r■r.
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, W1,53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
C
than 8 112 x 11 inches in size. Sr.
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency programs ❑ Check it revision to previous application `
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location 13 r1i4 SC 1i4, S ~7 T -70 , N, R,/ E (or) 10
Property Owner's Mail g Address Lot Number Block Number
gT.9 TK r- -
City, State Zip Code Phone Number Subdivision Name or CSM Number
5, ya; 6 Z. II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ city Nearest Road
Public or 2 Family Dwelling - No. of bedrooms vlllwg of .Sr sT 2~~v
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo O - o
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..Ija~w 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank OnlyExisting 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.JEFyeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ 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
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
/ S` t~ 957 5F_? Feet % Feet
VII. TANK Capacity
in gallons Total # of Prefab. Site Fiber- Plastic Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App.
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank )L Oc~O L✓ r G1' f' ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon 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) C- Plumber's Signature: (No Stamps) PRSW Nory.:p BPhone Number:
G -e C . rw/r-tX0,", r f__ tea/ Ir -:7 D` d C-- -2
Plumber's Address (Street, City, State, Zip Code):
Lf / O S R G ,I ~ Cr ~Jr S' yov
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Age t Signature o Sta s)
Approved E] Owner Given Initial Surcharge Fee)
$ t1~J~
Adverse Determination O CJ
CONDITI NS OF APP V LEAS C-F7 ISAPPRp
SHD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a 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 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. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on 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 for numbers throuq ! 7_
VII. T, nk: irifci-rno tion Gill in the capacity of every new/or existing tank, list the !oral gallons: numb,:?r of tanks and
manufacturer's narne, indicate prefab or site constructed and tank material. Cor)plete for alt septic, pump/siphon and
ho!d ng 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 wish 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.
ns and specifications not smaller than 8 1%2 x 1 1 inches must be sul; .it+e;. t: €`?f my The plans must
r"
oilowin~;: A) plot plan, drawn to scale or with compieie C1rner.sit,~ .o:diny tank;,), septic
~`_he tre,ir.rrrent tank,~ bui';dingsewers, welly,; water ma;r~shtiat.° ~e tit- akes; pumpor siphon
a ion boxes, so, I -.;sorption systems; replacement syst !a__~ the building served;
aJ;"Ccl any) varrdl el~J<or'r( ference points; C) COmplete<I?t' f ontrols; -_~o,evolume;
)fi lifrerences; fri(tio oss; pump performance curve; pumr rii del r~, r. urns) 'r, ,arer D) cross section
It -.)bso., t on system if required by the county E} soil 1estdaLa cHn a -n or a a!' sizing information
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of rec_r.ilated p- actives which can
effect groundwater
The monies collected through these surcharges are used for monitoring groundwater :ontaminatior: investigations
and establishment of standards.
rs~v i•
SEkSE'k S27-T30N-R19W In P• To
town of St. Joseph ~v k ar)
4 lot #3
i
N
1"=40'
EM-= top of 11, steel pipe @ el. 100'
Alt. BM. top of steel fence post el. 103.801
1-32nd
v
wi CS~r! I. AO
LO
71
0 YIAP t
~ v
{
~ So: ~ 4 a
S G'~i c( 0
C~veri~f pvc o`
Z rv~%
v~
S s C
y
-AxonsinDepartment oflndustry, SOIL AN.D SITE EVALUATION REPORT ~ 1 of '
Labor vrui Human Relations
Derision of Safety & Buildings in accord with ILHR 83.05. Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 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. If
dimensioned, north arrow, and location and distance to nearest road. pending
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Q"ih h O / /7r GOVT. LOT SE 114 Se 114A 27T 30 N,R 19 )ftor) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
880 C.T.H. #E 3 na csm pending
CITY, STATE ZIP CODE PHONE NUMBER QCITY []VILLAGE MAIN NEAREST ROAD
Hudson, WI. 54016 (71~ 246-5565 St. Joseph 132nd. Av.e
[x New Construction Use (xi Residential / Number of bedrooms 3 [ j Addition to wdsfing building
I 1 Replacement [ I Public or eDrnrnerc ial describe
Code derived daily flow 450 gpd Recommended design loading rate • -5 bed, gpdM' - -6 trench, gpd R
Absorption area required 900 bed, ft2 750 treneh,112 Maximum design loading rate • _5 bed. gpd/112.6 trench, gpdrfl2
Recommended infiltration surface elevation(s) 95.87 It (as referred to site plan benchmark)
Additional design I site considerations alt. site trenches L 95.621-93.39'
Parent material outwash Flood plain elevation, if applicable na It
MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
S a Suitable for system CONVENTIONAL
U- Unsuitable forsystem i IM6 ❑ U 9 S O U ®S o u ®S o u O S Lj U O S U
113 1
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Sere Consistence BOlln * Roots GPD/ftin. Munseil QU. SZ. Cunt Color Gr. Sz. Sh. Bed ternctt
ti: Y~{C
1 0-13 10yr3/3 none I 2msbk mfr gw 2f .5 .6
v
F~ 2 13-38 10yr4/4 none sil lfsbk mfr gw if .2 .3
Ground 3 38-48 7.5yr4/4 none sl 2msbk mvfr gw na .5 .6
96 92 ft 4 8-88 7.5yr4/4 none 1 fs Osg mvfr na na .5 .6
Depth to
limiting
factor
+88„
Remarks:
Boring #
µ 1 10-10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
2 ,.yM, 2 110-28 10yr4/4 none sil 2msbk mfr 9w if .5 .6
4:'..
3 128-48 7.5yr4/4 none sl 2msbk mfr 9w na .5 .6
Ground
4 48-88 7.5yr4/4 none S Osg mvfr na na .7 .8
99.91
Depth to
limiting
fac+88
Remarks:
T Name:-Please Print Gary L. Steel Phone. 715-246-6200
Address: 155 200th. !y-, w Richtrncnd, WI. 54017
e n..... - PcT RL~
PROPERTY OMER Jerry Lupke SOIL DESCRIPTION REPORT Page 2` -of 3
PARCEL I.D. a pending►
s.
Depth Dominant Color Mottles Structure ~j j I GPD/ft
Boring # Horizon Texture Consistence Barclay Roots
in. Munseli tDu. Sz Cont Color Gr. Sz. Sh. Bed iTmnch
1 -12 10yr3/3 none 1 2msbk r
2 12-32 I0yr4/4 none sil lfsbk mfr gw if .2 j.3
Ground 3 2-80 7.5yr4/4 none is Osg mvfr gw na .7 1.8
elev.
;'8.62 ft. 4 0-90 5yr4/4 none s1 M na na na .3 '.A
Depth to
limiting
tacl~
+90"
Remarks:
Boring #
1 0-10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
v4>
?mt
4 2 10-24 10yr4/4 none sl 2msbk mfr gw If .5 .6
3 24-63 7.5yr4/4 none is Osg mvfr gw na .7 .8
Ground
4 63-70 5yr4/4 none sl
ft. 2msbk mfr gw na .L5 .6
5 70-94 10yr5/4 none fs Osg mvfr na na .5 .6
Depth to
tartiting
factor
+94"
Remarks:
Boring # 1 0-17 10yr3/3 none 1 2msbk mfr
gw 2f .5 ' ,6
2 17-46 10yr5/4 none sil lfgr mfi
gw If .2 ,3
3 46-88 7.5yr4/6 none is Osg mvfr na na .7 ;~.8
Ground
elev.
97.24.
Depth b
limiting
factor
+88"
Remarks:
Boring #
"IN
Ground
elev. fL
Depth to
limiting
fLtt)r
Remarks:
' h
STEEL'S SOIL SERVICE
Gary L. Steel Jerry Lupke 1554 200th Ave.
CSTM2298 SEQSEk 527-T30N-R19W New Richmond, WI 54017
MPRSW-3254 town of St. Joseph (715) 246-6200
lot #3
N
1"=40'
BM.= top of 11, steel pipe @ el. 100'
Alt. BM. top of steel fence post @ el. 103.80'
j'3
pk ~
• e
h 7" a.
Gary L. Steel
8-20-95
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor `and Relations
Safety fety and Buildings Division INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI
TORNIO, DANNY P. X
CST BM Elev.: Insp. BM Elev.: BM Description: St. ffoseph 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
Vent
ir Ito
TANK TO P/ L WELL BLDG. A
ntake ROAD Dt Inlet
Air
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 System TDH Ft
oss mead
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING manufacturer:
SETBACK CHAMBER
INFORMATION Type Of Moe 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/Tr nchCenter Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: St. Joseph.27.30.19W, SE, SE, Lot 3, 132nd Avenue
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:
i
1
Safety and Buildings Division
SANITARY PERMIT APPLICATION Bureau of Building Water System-.
201 E. Washington Ave.
In accord with ILHR 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. 51- C.•
• See reverse side for instructions for completing this application state Sanit ry Permit lyumb r
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Cevt n 7 P. 7-c-) Property Location
r' p O-1 /4 S`(T V4, S T 3 G , N, R E (orm
Property Owner's Mailing Address Lot Number Block Number
City, State Zip Code Phone Number SM Number
II. TYPE F BUILDING: (check one) ❑ State Owned D !ty Nearest Road
❑ village
Public 1 or 2 Family Dwelling - No. of bedrooms J~ own OF . Tp ,04
l3Zr=-~~
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo b z o 107 7O
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 Existing System Existing ----yytem
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
111~4-Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ 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
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
1511-C-0 6 y 3 G 5/ 5V 7 ~J . /S' Feet S$', .-3-Feet
VII. TANK Capacity
in gallons Total # of r Prefab. Site Fiber- Ex per.
INFORMATION New ExiGallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App-
sting pstrutted
Tanks Tanks
Septic Tank or Holding Tank /O!~ / ~✓~'~S~vj ❑ ❑ ❑ ❑ ❑
lift Pump Tank /Siphon 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) Plumber's Signature: (No Stamps) MPRSW No.: Business Phone Number:
F
Plumber's Address (Street, City, State, Zip Code):
y16' -Tr A J YG ,W~ ram
IX. C NTY / DEPARTMENT USE ONLY
❑ Disapproved Sa ary Permit Fee (Includes Groundwater ate Issue sluing Agen Si ature (No amp )
pp roved E] Owner Given Initial tD Surcharge Fee)
Adverse Determination $~6
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SRO-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS c
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed before the expiration date, and at a 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 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, Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on 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 for numbers I through 7.
VII. lank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
rnanuf;~zctur+_r's oarne, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding Um,:<s forthissystern Check experimental approval only if tanks received experi-nental 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.
Con+piete plans and specifications not. smaller than 8 1,2 x 11 inches must be su` (Tined t::, thy: county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensio log of n of folding tank(s), septic
~J or +e,' treat neat tc,nkbuilding Nelvers vvel s, water ma nsi:Ja~~:: +ce >ir.3 i i IaE Ls; pump or siphon ~
~us:r,ou~ior, ;,ones; so.l o5sorption systems, replacement sy,-en 3re.~:, s th- Ic f th ~ building
served- and ver<ical el v<_>.t.ion rofere-ice points; C) complete sp( `Or ;u- (ontrols; dose volume;
f`erences: frictic:'~ `oss; pump performanc c curve; pump m 0_',11 n,l. "u _~rer; D) cross section
absorption system if required by the ~_ounty, E) soii test data un all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of re_julated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards. .
Jerry Lupke
SE4SE4 S27-T30N-R19W
town of St. Joseph
lot #3
N
1"=40'
BM.= top of 1" steel pipe C el. 100'
Alt. BM.= top of 1" steel pipe el. 97.71' y0 17v~Z
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@
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r' ProP°f~ ~ tFN~?G
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
L:abr r and Human Relations
1ivision.tifGafety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
St. Croix
Attach complete site plan on paper not less than 8 I size. Plan must include, but
not limited to vertical and horizontal reference n i °o of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and slo nearest ro pending
~
APPLICANT INFORMATION-PLEAS e CO NT ALL I A REVIEWED BY DATE
"kP711
PROPERTY OWNER: ROPERTY LOCATION
Jerry Lupke :J : CPOVT. LOT SE 1/4 SE 1/4,S 27 T 30 N,R lg ]E(or) W
PROPERTY OWNER':S MAILING ADDRESS OT # BLOCK # SUED. NAME OR CSM #
880 C.T.H. #E 3 na csm endin
CITY, STATE ZIP COD PHON` NUMBER 3 ❑CITY ❑VILLAGE (MOWN NEAREST ROAD
Hudson WI. 54016 (71.5)24b-5-565 St. Joseph 132nd. Ave.
[ New Construction Useitx] Residential / Number of bedrooms 3 (j Addition to existing building
j ] 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, it2 Maximum design loading rate • 7 bed, gpd/ft2 - 8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 94.15 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material outwash 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 13 S ❑ U INS ❑ U ®S ❑ U ® S ❑ U ❑ S ®U ❑ S ® U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundaly Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmr&
1 0-8 10yr3 3 none 1 2msbk mfr gw 2f .5 .6
2 8-15 10yr4/6 none sil 2fp1 mfr gw if np .3
Ground 3 15-3 10yr5/4 none sil lfsbk mfr gw na .2 .3
elev.
98.05 ft. 4 30-8 7.5yr4/6 none co s Osg ml na na .7 s .8
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0-8 10yr3/3 none 1 2msbk mfr 9W 2f 1.5 .6
2 2 8-18 10yr4/4 none sil 2fpl mfr gw if np .3
3 18-3 10yr5/4 none sil lfsbk mfr gw na .2 .3
Ground
elev. 4 34-8 7.5yr4/6 none co s osg ml na na .7 `.8
98.35ft.
Depth to
limiting
factor
+88"
Remarks:
CST Name:-Please Print Gary L. Steel Phone' 715-246-6200
Address:
1554 00th. Ave. New Richmond, WI. 54017
Signature: Date: CST Number:
6-27-95 cstm 02298
4 olr'lldm~'
PROPERTY OWNER Jerry Lupke SOIL DESCRIPTION REPORT Page`2 of -3
PARCEL I.D. # pending
Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft
. Consistence Boundary Roots
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh Bed iTren ch
1 0-11 10yr3/3 none 1 2msbk mfr gw f .5 6'
3
2 11-1 10yr4/4 none sil 2fp1 mfr gw if np i .3
Ground 3 16-30 10yr5/4 none sil lfsbk mfr gw na .2 .3
elev.
97.15ft. 4 30-82 7.5yr4/6 none Co S Osg ml na na .7 ~.8
Depth to
limiting
factor
+82"
Remarks:
Boring #
1 0-7 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
4 2 7-17 10yr4/4 none si 2fp1 mfr gw if np .3
3 17-26 10yr5/4 none Si lfsbk mfr gw na .2 .3
Ground
elev. 4 26-80 7.5yr4/6 none Co S Osg ml na na .7 .8
95.82ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
1 0-6 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
5 I> 2 6-16 10yr4/4 none si lfpl mfr gw if np .3
Emm
3 16-34 10yr5/4 none sil lfsbk mfr gw na .2 .5
Ground
elev. 4 34-80 7.5ry4/6 none Co S Osg ml na na .7 .8
95.56 ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Jerry Lupke 1554 200th Ave.
CSTM2298 SE 4SE a S27-T30N-R19w New Richmond, WI 54017
MPRSW 3254 town of St. Joseph (715) 246-6200
lot #3
N
111=401
BM.= top of 1" steel pipe C el. 100'
Alt. BM.= top of 1" steel pipe C el. 97.71' A10 ~7P~Q
~PN@G7
1 y.
~ M
~70 8~2 25, ~A
alv
C7
ZS ~ O
V)
o
Gary L. Steel
6-27-95
m C5
FILED
JUL 5 1995 ►
Ka1~r K w,acsti
53086
r
x aoi f Z
° ° c ~1 Bearings are referenced to the
y -Ir East line of the SE1/4 of Section
ME= 0 I'b 27, assumed to bear N00°03'33"E
o x _ ti
o d
:E -n 0
'o mw M 0 > > 1" Iron Pipe Found S02°55'01"W, 1.69 feet
- v C a~ from computed position H t' Ct. o II iv . N d 0 ® 1" Iron Pipe Found SO0°54'48"W, 1.49 feet O Q
c `s 0 ~ from computed position
°w - ' C* I ° O CD
C)
m
I UNPLAi iCC' 1 ANTS MP'
-')I 4 110
84 C.1 a
West line of the SE1/4 of the SE1/4 N rr
o -`S00°15' 59"W , 1086.•26' O
'.3' hh
N N N T"- _ rt
S0
0°59'51 "W 1075.00' ° rah N
00 V 616'
%D 0
`o p O ~
F-to~~iA $e ~t 4~ n o k. 606
r ..a F y
w ~w w m y 1~ V O -'I
N a). CO .
w W ism O m w b o O T
V W
m> w~ z- Z I✓ rt 00
Ct :1 • L s, o o 'm o 1; fi t(D d
ter"':. y 1 I z 1 C
s 4 y
Off' ;0 9„ ' ~ > et x eft I I , t9i C
.17 X w I y N rn
ME ZE -h
. n
(t rn
S00°03'33"W 626.33'
I -I 612.47' r 13.86',-c) ~I M :J•
(1611 i
00 0
IV r
y 1
w i 0 0 I~
230.03' 230.03' u, - IC)
437.32' w 14..89'- 1 I_ IG~
N00°59' 51"E
460.06' co N00°03'33"E It,J •
kD m o z I T452.21' II,
1 H
!=A NDS to °o w ~ IGY I` If- IU w
° IN IU ICS IU o
ca ~ ~ ILA p~' ~t~~ 1-f I ly Z
1 _ -
-+w -•wr r -err N v y p N I Its. I~ I Ir '.d
O Vf O _
0 -P ow Ln -P
4:' w 3S33 ` IL 2:
-w> -4 N0> 8' ON wo :z S00003'33"W IM
0 -0 C, ay ~H aw ~N mw 453.57'
c0 ` J 437.12' 16.451 - 1
0
-n P Ctt0 Ctte0i K0 Ct0 M z
o r. NC NO
APP-h
f f g Lnn o O O N O O
JUL 00
L rJ N00°0 33"E 608.58' N 17.85' I 000°0313311E
ST.CPOrt Cm 711.V' - -Z
271 N0 0°03'33"E 626.43'
1337.70' cc." { r~c~CK9iter~si $ r,>+uf c o East line of the SE1 /4 ZD 0 f
b- m o
k*kb 040e
r - v?
%
% f
+avitt
arI: 184
This i,pUr melt drafted by Ed Flanum Job No. 95-22
VOL. 10 PAGE 2948 / '
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 0 A IlMv 1( a yY~ ~2 I a_ • I b e-M _h
MAILING ADDRESS 14 S H w 1i r -/'P Ak e /All
PROPERTY ADDRESS 13 :~N'OA-V I't LA~ Soh
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE 58 A
PROPERTY LOCATION ~E 1/4, S E 1/4, Section, T_30 N-R_LgL_W
TOWN OF S ( , ~So S e 0 ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIEDSURVEY MAP ~J~~ 5' , VOLUMEL D , PAGE qe , LOT N `MBER
Juvwijt
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 expiration date. SIGNED:
DATE: 0 $ I a I v'
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This application fo is form i 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 v PA-M0JA (T, 70AA)/U
Location of property , 1/4 Se 1/4, Section A7 ,T3 0 N-f~W
Township 57"t 3®Se Ptt Mailing address tAr +i I 9-3?'gf
106 4~- GAS HWY 63, -rU pfly 1„k. , 1,0,1- -1501-1,YO
Address of site _(~S 11`,~~ F,q~(So~ ( T j COI
Subdivision name ( C&Pl Xiod Su v~~. Lot no. _
Other homes on property? Yes-x--No
Previous owner of property Tecry (o er~I~(iu~ /,,ud OKc
Total size of property q-CRr 5
Total size of parcel 3'1-17
f~c r' S -
Date parcel was created 'Jq l <',W
Are all corners and lot line identifiable? Yes No
Is this property being developed for (spec house)? Yes 2( No
Volume It) and Page Number 91fK as recorded with the Register
of Deeds.
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. / SS5 , 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.
Signature App icant Co-Applicant
OIL
Date of Signature Date of Signature
AUG 02 '35 08:43 RIV VAL ABSTRACT 3867664AAAAAAAA P.2i2r"'""-
VOL 1131FAGE 61'7 ~ i
OOCUMEW NO. THIS SPACE ReeMIM FOR NUOaeNle "YA
WARRANTY 0990
531599 T `F~ ;
e.w..~._~Ierry..Lue Land 3 U L
p 1995
. iftTl tblf. !1~ Q>. us..8-nd:atlUd .!0
8:00 A. r
13r0tw.
aad..,Danny.P Tornio.aad.P.amela.J Toralo,.husban,l..._-••-- ; t~~'•~
,and.wifie,as.sur.vtyorslllp marital.proptrty..
With the uab~ vs)a~bto coasidaradon.~
_
Of one Ta ana o cowm; eration
eoavvA to 4rentae the foilovAng dweribd teat Estate is D D
. SL.Cralz ISTu" To FSISO/
.f ,f G,f
Tax Parcel No:.._
A part of !tile SE 114 of SE 114 of Section 27, T30N, R19 W, Town of St. Joseph,
St. Croix County, Wisconsin described as follows: Lot 3 of the Certified Survey Map
filed July S, 199in Vol Lime 10, page 2948, as documer t number 530869.
0
S~--•-"
FEE
This . j*AOY........... hoawateEd property. ,
Zbpet with ail aad singular the hcreditamenta sad ap rur' nevi that•uato bdon&r; i
veal.... JeraLlAwk ms~.G~ 1 G,AIJAcp1m
war:raats that the title is good, iAd:,fas ibio in tq simple and free and dear of sacursbran(aa empt
easements, covenants, and restrictions of record, if any,
and will varraat and dafend the aanwL
Dated Lha day of Gr . t9... I
leg
_ (tfLrlll.) ...........(SEAL) l
r & . .
..(SiAL) . . ICAL} I
• • ..Geri d.(H=.AA;ieg4
AUTEXNTMATION ACKNO W 36300UXMT
alssataue(e) sTATX )1r Wl,3C0NS1N
_ v..- _,t,..~J:S)!~►...............conxtr. g i
astheotIc" 0" .._..day of 19:.•... caa:e beiasa
.me19Y..~} ie l day of ~
f
.....pr.Tt>te above aamed
_ - 74 ke.and.Oiral4lixe. A-Luetft
TITLE: UZURETt STATE SAI OT WTSCONSTN - !
(If VA
authorised by; 706.06, Pig. S/Mtaataa..)~+ me kal a two het who executed t1:1
U. D ~~"lorei}rol Xesa d athnowtadse the same. '
T,us 4NSTRUNCHT wwa Or..Freo 6NOTARY PUBLIC i
Robert F.Wall STAIR OFYf=NSIN.._.... ;
on ree , .
11d>joa,V1..4016 Notsrv Piblk ...County, Wis. j
(S+=Atura may he suthentiwed or *AaawledpPd. Both %t romr-liasion is pEr:►;SAW. t l not, state ox1, 1 )
sre not :*cratary.) date: .?-J/({J T . 19..J....._.
•]t~~ .t r•re... +.a•IIe yr 4%r&rAT 4W.:4 1» q-Dwl W wtow h.r..r th.b Lstr~ i
I