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030-1093-70-000
ti -o O y p q M O °uq~ ~ I h 4 h 0o Loi I N Y Y C N w~+ ~ L y, 3 rn N Q) J. C = r o ai c O ~ Y C N N Q) w (D y N N 'C Z ~0 -OO U. 3 3 c 20C) LO O O 7 E N II Q U f0 Q M N O Z O Z V/ M FC) W - U) d m N O L E O v W w a T ~cc w O Z r Q Z O E O E O N N ~ C O O z w z N 0 % O p E N N H . CL a. C: O j N y 25 '6 6 0 > c o a -0 a) d (A Z • = an. Z to > 'o IL c W U) J U rn rn z° U o o O ~ ~ = a tD m N ~ ~ I ~ m Q } in co I C.0 (2 O ~ w C E O O W d OR 'm 0 0 O N~ H 0 O p N N O N C O C C CO CO n W O to O Cl) v N, N O (O C O O C N N C O CD cc 4 O M U) N O Z c g O y i \ w a ~t Q L CL Q d ,V I d r.+ o ` C C o A U a 2 l 0 U) " vvisco''DepVtmentofIndustry, SOIL AND SITE EVALUATION REPORT Page ~of Labor' Human Relations ` Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # 7 dimensioned, north arrow, and location and distance to nearest road. 0 Q D l]'-` d APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION - - 02 ea Y A R L4 ki S 0-r-) GOVT. LOT 5C,) 114)VL 1/4,S 3 zJ 36 N,R J~ S(or) W PROPERTY OWNER':S MAII-ING AD SS LOT # BLOCK # SUED. NAME OR CSM # 1 11;11 5 ld rW-~ C - 4 /v ///4 Z'Or 3 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VIL GE MOWN N AR T ROAD 5 +--o r. (715) 5"-44,77S .SrrZ . s cp h ©l d 0-L i9 c .1 1 X New Construction Use( *Residential /Number of bedrooms 2 ( ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 360 gpd Recommended design loading rate _ , lv bed, gpd/ft2. trench, gpdift2 Absorption area required ©o bed, ft2 9 trench, ft2 Maximum design loading rate . 7 bed, gpd/ft2_ , trench, gpolft2 Recommended infiltration surface elevation(s) Z 7S ft (as referred to site plan benchmark) Additional design / site considerations ✓1Z d4' Parent material Flood plain elevation, if applicable rriig It 7SUunistuitable able for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK fors stem S ❑ U aS ❑ U RS ❑ U !P1--S ❑ U ❑ S i?jj- ❑ S S:U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bouird3y Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T r ch 62-13 /O /2 z/Z e5-r- S/ S2 rn r W 1144-- Ca LL) a , Z- 19- 3 / 0 rrL 3/ 12 0-72 Ground - 8 O K l2dr! S elev. 3 Depth to limiting actor Remarks: Boring # z/z~ ~2E S / a rh 5f2 5 . , to > n::::<:; 1 0 'Z6 /o pt, 3 CJ AZ' a 42 r rV! ~P G~ ~n F D r1'`/ n S l'Y/ d 't/P4- r v,4 Ground elev. _61ff %L Depth to limiting factor 2 Remarks: CST Name:-Please Print Phone: Address: vv o- /yG s S~4 7 Signature: Date: CST Number: Zz9~ J PROPERTY OWN ~t*"x YtSSOIL DESCRIPTION REPORT Page of PARCEL I.D. # Boring # Horizon) Depth Dominant Color I Mottles (Texture Structure Consistence Buxt try I Roots GPD/ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed ITm r& 2- zr~l i Ground elev. S Depth to limiting factor i Remarks: Boring # _ 3-3 :<::;>..:::<><> ~/Z i2 z~Z ~L ~-i%~ S/ Z rr/ r~ 1~~1 u~ ~•yt S / r2- 3 .51 nor v In eve / S Ground::: -~d 0 Y/ 5 D 5 % lev. Depth to limiting factor Remarks: Boring # 5,/ m f Z 62 Ground elev. S P -ft-- . Depth to limiting fa r 7 Remarks: Boring # Ground elev. ft. Depth to limiting factor I Remarks: SBD-8330(R.05/92) r STEEL'S SOIL SERVICE Gary L. Steel ~O 9@8 M. shul ve C.S.T. 2298 New Richmond, WI 54017 MPRSW-3254 SW K,'c, IV f/slc S' 3 z --f BOW- rz! 9 (715) 246-6200 17 (Cot+ 12-* r+e-r i 1 30 er Y~ ~T, 3 I~ Parcel 030-1093-70-000 02/28/2005 04:47 PM PAGE 10F1 Alt. Parcel M 32.30.19.342A 030 - TOWN OF SAINT JOSEPH Current ' X , ST. CROIX COUNTY, WISCONSIN ' Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner *JOHNSON,GEORGANNA GEORGANNAJOHNSON 465 OLD CTY RD E E HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 465 OLD E EAST - SC 2611 SCH D OF HUDSON f` SP 1700 WITC h 't Legal Description: Acres: 9.660 Plat: N/A-NOT AVAILABLE SEC 32 T30N R19W LOT 1 OF FORMERLY LOT 1 Block/Condo Bldg: CSM 3/856 N/K/A LOT 5 CSM 10/2788 9.66 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 32-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 701/568 2004 SUMMARY Bill Fair Market Value: Assessed with: 5568 363,100 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 78,900 197,300 276,200 NO PRODUCTIVE FORST LANC G6 6.660 81,000 0 81,000 NO Totals for 2004: General Property 9.660 159,900 197,300 357,2000 Woodland 0.000 0 Totals for 2003: General Property 9.660 94,000 158,700 252,7000 Woodland 0.000 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges 00 Total 0.00 0.00 ''~ORCSJ NO A85-A. y + i ~ r 'a NCMIMINCaiprM® ~ , S S~. GROIX C011 1 4 $URV~yfjw RE ORD 5:~293 FILED AUG 23 197 CERTIFIED SURVEY MAP $ LEGEND 9 COUNTY SECTION CORNER MONUMENT, FOUND. SCALE IN FEET • 1" IRON PIPE, FOUND. -*--K EXISTING FENCE LINE. 300' 200' 100' 0' 300' o I"x24" IRON PIPE WEIGHING 1.68#/LINEAL FOOT, SET. N 1/4 CORNER SECTION 32 T 30N , R19W • a'b ~o TTED LANDS ~ 00'L Aso uNPL? - - E 0&1 N TRUNK HIGH -~-ter so D COUNTY 0L WAY - - N 88 20' 52" E 615.97' N 78°ST*54„E 575.1 w, It' 300. 6' ® WAY LINE coo POINT OCCUPIED 16 N 8 °2052"E 25 00 M RIGNT'OF- 1 M z N88 202'E W BY CONCRETE cot N PAVED DITCH ao M N N Q0 - 6N#'' 2 o m 1 0 Vs C; U I 3,o ao 8.00 ACRES co N a m° o 01 12.66 ACRES a C? a Z I - a Z 06; 2; ; J1~ Q - 316.87' 419.92' W to to Z S8801 1 02" W of ~ 736.79' EXISTING W W J SE-NW 1 3 lP 3 SW-NEo to HOUSE CD W _ _ 1- = I M o 6.53 ACRES °o N oif) ° Q V CI (2) S 88°11'02'W N W a l WI Z I_ 688.61' 600.00' Z I f-1 J 601.67' _869# 218.92' 247.87' 133.61 H j1 0 1 ; S 88011'02"W 1288.61' 7- N al ~3 ASSUMED 4 o W R Rd ArPFIR _ O BEARING J M N o I~,.r M S. z S 880 11'02"W 1280.58 z 378.48' ~ 502.66' 399.44' 4 16 Q, SOUTH LINE OF THE SW 1/4 OF THE NE 1/4 269°460 POINT 0 it II UNPLATTED LANDS BEGINNING S 88011'2" APPROVED f- .M am 33.00' w 3.13 N N ~i 1303.71' AU G 15 1979 N POINTI OF U) ° BEGINNING ST. CROIX COUNTY O I h I COMPREHENSIVE PARKS PLANNING z I S I/4 CORNER AND ZONING COMMITTEE SECTION 32 T 3 0 N, R 19 W DETAIL APPROVAL OF DOES 1 HiJ M'NUk SudDiVlSi~ SITE NOT MEAD This instrument drafted by James T. Swanson. BUILDING APPROVAL FO volume Pak e 856 R f~R TO H6?,Z R SEPTIC SyST&& 96 ~Ygl, { i STC - 104 S7 AS BUILT SANITARY SYSTEM REPORT G,rX OWNER eny`&, twMd hAp c nti ~.1 ADDRESS '/6 6~ (91 C T p b w r 3y SUBDIVISION / CSM# / LOT SECTION 3 .Z T 3n N-RW, Town of ST. CROIX CO NTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET SYSTEM 3,B R M N6me, o X we .9M+ atI~.0' Q.r Top' Q f I'sns ~wrr Elec~ ~ I Aloolk, i sC C INDICATE NORTH ARROW 13.2 Provide setback and elevati information on reverse of this form. Provide 2 dimensions to cente of septic tank, manhole cover. s BENCHMARK: ~fa;t S ~ rMt ~Qy 7/e y. A0 fl0ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: U) eiser Liquid Capacity: Setback from: Well 70~ House 3 / Other Pump: Manufacturer A_ ey,S M F'Zb Model#A, V6 Size a, Float seperation-L;;L Gallons/cycle: / y/.g Alarm Location SOIL ABSORPTION SYSTEM Width: 5- Length 7 3- Number of trenches r Distance & Direction to nearest prop. line: /00 Setback from: well: 36 House Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: ~&r /'1 LICENSE NUMBER: 6 ~ eb INSPECTOR: I/ 3/93:jt i Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:ST. CROIX Labor tfnd Hroman Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 714 Pe b Fjp~dgr Na"~EORGANNA ❑ City ❑ Village R Town of: State Plan o.: rite Parcel Tax No.: CST BM Elev.: Insp. BM Elev.: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. IPF Benchmark Bldg. Sewer St/Ht Inlet TANK SETBACK INFORMATION St/ Ht outlet vent to ROAD Dt Inlet TANK TO P/L WELL BLDG. Airlntake NA Dt Bottom Septic NA Header / Man. Dosing Aeration NA Dist. Pipe Bot. System Holding PUMP/ SIPHON INFORMATION Final Grade . Manufacturer Demand model Number GPM tem TDH Ft 55 Length Dia. Dist. To Well gForcemain Lift Friction 96' SOIL ABSORPTION SYSTEM BED/TRENCH No. Of Pits Inside Dia. Liquid Depth Width Length No. Of Trenches DPIT IMEN I N DIMEN I N LEACHING SETBACK Manufacturer: SYSTEM TO P / L BLDG WELL LAKE/STREAM CHAMBER Model Number: INFORMATION Type o OR UNIT System: 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 Of xx Seeded/ Sodded xx Mulched Depth Over xx Yes ❑ No Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: St. Joseph.32.30.19W, SE, NE, Old County "E" East Plan revision required? ❑ Yes ❑ No Use other side for additional information. cert. No. obbbb, 9D-6710 (R 05/91) Date Inspector's Signature ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: w f s SANITARY PERMIT APPLICATION • . COUNTY In accord with ILHR 83.05, Wis. Adm. Code St Croix STATE SANITARY ERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than a 59 0 3 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. S95-41466 PROPERTY OWNER PROPERTY LOCATION Georgeanna Johnson SE 1/4 NE t/4, S 32 T 30, N, R 19 W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 465 Old Count "E" East CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Hudson WI 154016 II. TYPE OF BUILDING: (Check one) El State Owned ffimm: NEAREST ROAD ❑ Publlc ® 1 or 2 Fam. Dwelling of bedrooms ~ PARCELTAX NUMB R(S) III. BUILDING USE: (If building type is public, check all that apply) 030-1093-70 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.E] 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 ❑ 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 .3 95.0 Feet Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank 6htkjdkNjWk 125 1250 Lift Pump Tank/ ' 75. 750 Wiesc F1 El F1 I El Ej 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 m is Signat re: ( rpamps) MP/1 LNo.: Business Phone Number: Paul C.J. Steiner 715 42 - 5544 Plumber's Address (Street, City, State, Zip Code): N8230 945th Street: River Falls, WT 54022 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Iss ing Agent Signature (NO Stamps] Approved F-1 Owner Given Initial Al Surcharge Fee) Adverse D termination 9Q4W4~~ - X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: or V ZD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS • r 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'/s 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 establishmenit of standards. s SBD-6398 (R.11/88) SAFETY & BUILDINGS DIVISION consin Department of and Human Relations November 2, 1995 2226 Rose Street Ark _ i La Crosse WI 54603 to-r 1 rd_ WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 RE: PLAN S95-41466 FEE RECEIVED: 360.00 JOHNyON, GEORGEANNA SE, ,32,30,19W TOWN OF ST JOSEPH COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. ira cerel d M. Sw' Plan Reviewer Section of Private Sewage (608) 785-9348 3192R/ 1 SBDA-799718.10/84/ e Page of 6 MOUND SYSTEM FOR SQ C a c7 ft A 3 BEDROOM RESIDENCE 466 LOCATED IN THE SF' 1/4 OF THE NE 1/4 OF SECTION 3Z,T30 N, R 17 W, TOWN OF S`~' • S`o S ~~N S Y'• ,c_LWlx COUNTY, WISCONSIN. INDEX PAGE l 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION RECEIVED PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER Nov - 1 1995 PAGE 6 of 6 PUMP PERFORMANCE CURVE SAFETY & BLDGS. DIV. PREPARED FOR v~~Ef3u~ ~ ~'ott-ws 46S et-5'r, S Kjl wl SqO) (o PREPARED BY -.e rRe `J `k ~ G: 'Eg WEf3E:Z ER S; C3 I L TESTING 161 AND o, N J t_. ES I Gam! SERV I[ CE Bi L 915Pi Ke ^ , ` 6Ll t OF7Tii, e wr& F.O. BOX 74 421 N. KAIM ST_ ' ~ at FALLS. NI 54022 S' 1 CiN a► 715-4-c-0 c 715-4-2,-0 ® J to-_ 1'l 9 5 JOB NO. C1 S - 3 3 5 PLOT PLAN Page Z of 10 Scale 1"= GeoR6~"~~vlu 1y ~p 1~V S 0'N - ,o g' _N q ~ 3 BL7~Z,'M % ' x165 Pur x S e~lt c. `t'OJ'VL C Xt WE rttk&io OUP V' s pica. M4) x VON-ILL SO OF 2 4 PVC F.1"I . 1 S ~r ~3►~_ L-TL. luU.O v►.i Q 'Twp of Z t G>i f~ bo +I.~OT CAY~P~c-T 3~~ L -~TCi1C mx I oQ b 1sTvtze III I TN IS H t~"R . I Cr I y7J ~ Yly zs' ~ s i Page 3 Of ~o Approved Synthetic Covering ~S~t~ C 33 Distribution Pipe Medium Sand _ H G Topsoil F Elev-. C)\ 4 --J E D 3 b % Slope Force Main Plowed Trench of %2"-212" From Pump Layer Aggregate D \.0 Ft. Undisturbed Soil E 1.3S Ft. Cross Section Of A Mound System Using F O• b Ft. I Trench For The Absorption Area G N-n Ft. A S Ft. H i• S Ft. B S Ft. I S Ft. Linear Loading Rate= 6 -Q~ GPD/LN FT `7 Ft. Design Loading Rate= o • 3GPD/SQ FT K 10 Ft. L qS Ft. or W Z-7 Ft. Force g - K Main A 4~- W - L 2Y Distribution Trench Of 2 Pipe Aggregate Observation Permanent J Markers Pipes (Anchor securely) Mound Using I Trench For Absorption Area Invert Elevation of Laterals q'S.SQFt. 8x• k.\1_ q.a~ X I= 1~3 lZ Gp'"1 4 n Place lst hole from tee with succeeding holes at Sb intervals. Last hole to be next to the end cap. i TOTAL HEAD IN FEET V61 L 9LKN O Ul O Ul O CD O o O o ~ O (V ° O n I D D w C7 ° N n C) D. Jill n 0 O . N ~ - _0 C-1 m o N ~ Z O ~ -I H ~ ~Tl Z o c N m m ° CD O w N O co O W m O O O O - N (A P. (Jl 0) v (0 TOTAL HEAD IN METERS Wisconsin Department of Industry, SOIL AND SITE EV A L O R T Page 1 of 3 Latbr and Human Relations Division of Safety & Builings in accord with ILHR Adm. COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches' Plan ast it yt but not limited to vertical and horizontal reference point (BM), direct i} ~o of sb~cale"aF"'° ARCEL I.D. # dimensioned, north arrow, and location and distance to nearest ro 3 ; , > D 30 _ 1 D 3 - 0 APPLICANT INFORMATION-PLEASE PRINT ALL INFOR A~1~ONr f EVIEWEDBY DATE PROPERTY OWNER: APR TY LOCATION ~a G b Q Q R ASS ll.3 S6ft7 T 3T--~WF E 1/4,S 32.T 30 N,R 19 E (or) PROPERTY OWNER'S MAILING ADDRESS T t B SUBD. NAME OR CSM # cam{ It - _ L-t y b s CITY STATE - ZIP COgE PHONE NUMBER []CITY []VILLAGE ®fOWN NEAREST ROAD l vDSQUiWt 5~(Olb tS) 5y9_61n 8 S~.:S-US ~I v [ J New Construction Use [S¢ Residential / Number of bedrooms 3 [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow LISD gpd Recommended design loading rate - bed, gpd/90-3 trench, gpd/ft2 Absorption area required 31 S bed, ft2 _N1 S_ trench, ft2 Maximum design loading rate ° • S bed, gpd/ft2 0, trench, gpd1ft2 Recommended infiltration surface elevation(s) S • 0 ft (as referred to site plan benchmark) Additional design / site considerations w'lovtv~j w / S 'K "15 ' 11t4!%J0-H - `in ti- 1 r (~,r SfVkZ F-f LL. . Parent material S t\:" Y) L`-y V t % AM Flood plain elevation, if applicable ►y Nt • It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S O U ®S ❑ U ❑ S [au ❑ S ®U ❑ S O U ❑ S IOU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch Kn- ~Z Z l - s 1 Z h m y ~H c~ S- a- S 0.6 % 5 W1 Z-tl to`1~31y - S D s9 m ~5 1 o.U Ground 3 11-1 t3 I O'1 lZ 313 - s i Z ~s b k wr `F1- CS o S o. b elev. o(Z.5ft. l$-3`f t0 `-f R 31L - S O S9 c$ o-~ Depth to I b `t tZ 3 L .S I R S S s l oNn Cs 1 1 M `F 1-- - - limiting faclor L%I S S S t S- Remarks: Boring # o-y ~O~tQ-31z - L Z g~ Z_ Z_ t3 ~O R 31 y - S Zwt S b m y g- S o. 5 o. 3 \3 Z I O y tZ 313 - sit Z rrt S bk w~ Mfr ck. S - Q . S o. b Ground elev. u-3S ~U4 IZ3/6 - S S~ Yvl 0-S o.1 `o. YS 017- S fL ~j S--LZ vw-iR zlZ ~;.5`1tZ Sib sL C wi- Depth to limiting factor Remarks- CST Name.-Please Print Arthur L. We erer Phone: 715-425-0165 V egerer Soil T sting & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: r Date: 3 L - S CST Number. °1S-3 ~ S M00576 PROPERTYOWNER ::!~bt-P,336PQ SOIL DESCRIPTION REPORT Page'Z±of .3 PARCEL I.D.# b3c)- I Depth Dominant Color Mottles Texture Structure Consistence Boundary RoofG Boring # Horizon D/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Trends tFX.. 3 ~ 1 ~-b lo~~Z ~!Z - s~1 Zv►~Sb w►'l;~ c~ _ Ground 0 _ $ elev. R 2.1 Li ~Z- sip, Depth to L ft U N'~-A tS t t - limiting factor Remarks: Boring # 13' Ground - - - elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: sRn-q~aora os~o~~ 3 • PLOT PLAN Page 3 of s c~~, LL = Ll0 ' C-~~pR6~"`Prt~IIU'P~ ~'p ~V Sn'ty Q `p 03~, lOa3--10 --7 7 4.2 3 8D2,~ /r s~ ~l 6 5 ~x -1 S ePlt c `TrrNh x w~.L r ~4Z s Z.1, s.l----- z, s ToP of Z H- ~ G!1 ~ ~ .Yt~ VJ~T CAY-►P'~~-T 3~~.~~1 ls'L-~-TlZ1C Qox ~ oQ t, \sTvRe I I i `T1} L3 H u*k . I \ I Nt °ts I °i h N V&con*in Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and khunan Relations • Division of Safety & Buik# nys in accord with ILHR 83.05 Wis. Adm. Code ' COUNTY ST• 02111X Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 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. iJ 1Z), - I b °I 3 - 0 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION t j ztQ 6 tr I`1 (a A-skk f 3 S 6N GA1~f-E6T--S E 1/4 tQE i/4,S 3ZT 2,13 N,R 19 E (or)® PROPERTY OWNER'_S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM If ~ 6S t_~ c`R► E CITY STATE - ZIP COPE PHONE NUMBER E]CITY []VILLAGE RFOWN NEAREST ROAD ~V3OS01J1k11 S t(1c)l6 (7t.S) Sq9- 6178 S\ •:US'E~bI oLb Q%WtF y er*-T~T New Construction Use 14 Residential / Number of bedrooms 3 [ ] AddrtiQn to existing building [ Replacement [ ] Public or commercial describe Code derived daily flow 14 SD gpd Recommended design loading rate - bed, gpolft2 0-3 trench, gpdfft2 Absorption area required 31 S bed, ft2 31 S trench, 112 Maximum design loading rate o ' S bed, gpdtft2 o; t° trench, gp W Recommended infiltration surface elevation(s) °t S • 13, -ft (as referred to site plan benchmark) Additional design / site considerations w'1ov>v~~ w / S 'Y- '1 S' 'r~ mil{ • P~11 l r Ot= S hkz F~t_t_ . Parent material S XL`C`{ H L~- y V t u H1 Flood plain elevation, if applicable ft S = Suitable for system CONVE10ONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FU HOLDING TANK U= Unsuitable for system EIS IM U OS EIU ❑ S EXU ❑ S ®U ❑ S ®U [IS ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence BcurxJary Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerxtt 0_q ~O"12 z.l - s 1 Z 9\, Wi C.- - .0-S 0.6 Z ~-tt 1ovl~3ly - S a s9 m ~ cS _ Ground 3 ~1-Ia lpyLZ 313 sib Z ~sbk wI`F1- cS o S b elev. qZ 5ft l$Zq Ir) 3/6 - S o S9 V,\ cs o ~ ~ a Depth to S 34-c{c~ o ~t a 3 L 6 's y Sig s s 1 0NV, CSC ( -Tn - - limiting factor C7 s S a s- s 1z-~ r~ Remarks: Boring # C. - l 0 `t~- 312 - L Z 9 ~ Yn V 'rCb- S ~ , S p. Io < " , cLS 0.S p. Z Z _ t3 o `-t cL 31V s -v►n S b m \j 3 \3 Z 1 O 11Z 313 Z►n Sbl~ w~'Fh S - o S o 6 Ground 1 u elev. Z2-3S )c3-fI-L 3/f. S a S~ vh~ CS qZ. S It S S-LZ Lo\- iL zIZ a 5-18 s~ Ok•~ yyt 4 - - Depth to limiting S S \~4~ Sot f3S Remarks: CST Name:-Please Print Arthur L. We erer Phone: 715-425-0165 W gerer Soil T sting & Design Service-P.O. Box 74 River Falls,WI 54022 e Signature: Date: l 9 5 CST Number: M00576 PROPERTYOWNER ~~`rt'yUSUN SOIL DESCRIPTION REPORT Page 7 of 3 PARCEL I.D.# C> 1b~13- "?O Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 3 1 o--b 10~t2 ~1Z - s\ Zw~S1b w►'f~ c~. _ o.s o.~, Z 6-19 l0 y.tz 31 y ~ S 1 I Sblt m`~t- C 5 o. S o. Ground 3 ~°t-4 1o`'t 2- 3! 6 S O SS elev. S 6 q5. o ft. y,Z_6 1 o-t vL Z[ Z _1 4 2z s/~, S ► 01_\ W► Depth to L 0 L limiting factor AVA Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: . Boring # 1,3 Ground elev. ft. Depth to limiting factor i Remarks: Boring # Ground elev, ft. Depth to limiting factor Remarks: i qqn-q~~nlR (15io~i 3 of 3 Page PLOT PLAN sci~LL = Ll0 ' ~zoR..G ~~r.►l..J'R ~ 0 ~t'~v S O't~ A N x ' t ~J s z, s • ~ h'I - t-T1-. IOU, ll. V►v ~ TDP of Z ~ ~ ~ G H ~ ~ .-~t. ~p YJ~T crr-~P~~-T ~~~~N~ ~~-TIZLC Qox I o2 b ~sT~Re I I i Tl F 1.s ` I \ I ~t 9 S ° I ~ j l^ d I ~'Iv STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERIBUYER 0a MAILING ADDRESS PROPERTY ADDRESS L{ 1 (location of septic system) Please obtain from the Planning Dept. eJ CITY/STATE sit. ve ' PROPERTY LOCATION (~;F1/4, ' 1/4, Section, T_-30 N-I2 411 W ST. CROIX COUNTY, WI ~6 TOWN OF ~2E jl!?~ SUBDIVISION A)&*e LOT NUMBER CERTIFIEDSURVEY MAP ? 2 OLUME 3 , PAGE<~2e7 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 Me, 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: pZ 5 St. Croix County Zoning Office Government Center 1 101 Carmichael Road I i/y3 fiudson, Wl 54016 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 e0~~ \~1S~V -R- W l( Location of propertySE 1/4&E1/4, Section , T_:~o N yj r Township Mailing address Address of site Gf Subdivision name x Lot no. other homes on property? Yes No Previous owner of property r Total size of property ~T AL Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes \;::~No Volume_ and Page Number 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 ice of the County Register of Deeds as Document No. A'4~ , j~ , and that I (we) presently own the proposed site for he 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 f'c& f the County Register of Deeds as Document No. ;Z. -C 1Z S' a e of Applicant Co-Applicant Date of Sign ture Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 WARRANTY DEED 3sq V0: This Space Reserved for Recording Data ` THi-S E made--between - I Oliver E. Sassor and Helen R. assor, RI C44T84 pAW. husband and-wee as i no t tenants Gr ST. COX CO., WISE II antor 1 and-____ A"'I kv R%-0H !Ms 5th GeorgAnna Johnson -a 444y94 Dec A.D. 1914 T- Grantee, ~7;3i7 A M. W NE S H, hat the said Grantor., for 1 a valuable consideration bo" of Dow* conveys to Grantee the following described real estate in St. Croix County, State ot- Wisconsin: RETURN TO Part of the Southwest Quarter of the Cosmopolitan State Bank Northeast Quarter (SW# NE}), of 101 South Main Street Section Thirty-two (32), Township Stillwater MN 55082 Thirty (30) Korth, Range Nineteen (19) West, St. Croix County, Wisconsin, described as follows: Lot One(1), Certified Survey Map No. 116, dated duly 10, 1979, and filed in the office of the Register of Deeds for St. Croix County, Wisconsin, on August 23, 1979, in Volume '3° of Certified Surreys at Page 856, as Document No. 359293. Subject to highways and easements of record. lgfa This is homestead property. (is) is not F1=E Together with all and singular the hereditaments and appurtenances thereto belonging; And Oliver E. Sassor and Helen R. Sassor warrants that the title is good, indefeasible in fee simple an free and clear of encumbrances except: Municipal and zoning ordinances, recorded easements for public utilities located adjacent to side and rear lot lines, recorded building and use restrictions and covenants, and general taxes levied in the year of closing; and will warrant and defend the same. Dated this day of November 19 84 . SEAL ) L"~~ ( SEAL ) *J Oliver assor~ Helen R. assor AUTHENTICATION ACKNOWLEDGMENT. S-ignatures authenticated__~h~".iL~ STATE OF WdI392N'31ll )Minnesota _;day of November )ss. Washin4~ton COUNTY) Personally came before me, this 4th day of December 19 0 , Title: Member State ar of Wis. the above named if not, OLfiver E. Sassor and Helen a. Sassor, husband and .ri-e as Joint tenants authorized by VO6.06, Wis.Stats.) to me known to be the persons who executed the foregoing instrument This instrument drafted by: and acknowledged the same. John E. Joyce - Attorney - No 0., Wis. Stillwater, Minnesota My sD-E#.RA. VOTSO nt r - w NOT'RY PUE3IN; - F: tt l?:: SCTA _ ~ rflmmxs+flaExl?uati~i.23rtS~1.1~- D - S T A T E BAR OF AT S C WARRANTY D E E N T~~.~,~a~c«F oaarau~a+s ti -0 °o 3 0 Q ~ I c N o LO ~ I c o 0 O U) J O O N c c s a U) 3 o c ' ° to CO C O M o CCU CD rn B cn C•N o 0 c Z 'o6 ov- m Fci°> LL co 3 4 r_ c oo+CD - n c Co E 0 N N O c L E LL 06 U M p M O O Z m m o r d m C') U) o o o z a o ~ r w I w d Z c O N r I', E '2 O O) N CI E m LO N N C • -0 = A g o d.2~z o N LO Z I 00 00 N ! C R CD m d a CL b d c = G D IL 9 N Q E w w 0 Z in > w O O O a J Z •"Nil N maaa LO LO 3 c y (n J U Z 0 ml N c a I~T -6 0) CD .0 .2 1 c d S Q } v7 Q 1~ O f0 t!1 O O 3 1 m N E C) < o =3 co O dN' ~ N C 0. ~ S -0 r $r M c 'Y m N -j O to m RS U 0 C: *4 C) c) U) CIJ C) z O ~ III w I. nor i r~//~~ CC L Vl d L a #t a a r E v c L co~ w A cia192~,i,0 )u ~ ~ 0 0 0 3 m° \1 ° r a U) 0 on A N N N N O C O A W ''C • N tb A @ N ~r 0. v CD R N N O O O = Cn O. y CD ►+s x x ^ (o N N A CJ1 "S co C , N N n O W 0 co 3 O D F p n 7 M O O 10 0 Q d cn O !r CD C w a a CO ley N c co ~o cc s 3 CL ~I b O CL o CD v CD COo (po O '..1 co 0 c UI cn 3 Q (mil 0 N 0 o z 0C < 0C C A 0 co ti < G* Z C) n' a f~A t% N (.n o D 0 0 00 c v c N m o~y rn 0 0 m a cn N CD = (o L .di N I N 3 m cn W z 0 Z CW D D 0 O 0 n j 3 CD ( 0 D CD 0 cn a c C CD N a 3 3 z (Q -4 cn C N c :b Z (D O 0 a p z o 0 0 M w A 0o v m `D z a 3 .P ~ 0 z M (CD H z < ? (D W I U D 7 0 ~ on o' - n v c I N z c 9 0 0 I o n y N y 3 Q 0 A N 7 - Z I a cn (e O Q p 3 D Z cn s e 0 c o a o S V CD 0 .b v ba ~ • o CD C) Q 1 s STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER /Vt ADDRESS - g I7 r Syv SUBDIVISION / CSM# LOT # SECTION T_51 N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM !'Af s v 7s / 7 ' U INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: D i. ALTERNATE BM: SEPTIC T / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: d~'a Setback from: Well /y~~~House 42-, Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location .SOIL ABSORPTION SYSTEM Width: Length _5r'/ Number of trenches Distance & Direction Aye newest prop. line: Setback from: well: Ay ~House.6,2 / Other ELEVATIONS Building Sewer ST Inlet. ST outlet 1_:P3 PC inlet r PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade 9237 DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt 't Wisconsin Department oflndustry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX `Safety and`Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Pe~gµ~,l- c~r's Nat AL ❑ City ❑ Village Town of: State Plan I o.: lJVtc[e , YA CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: Z420 /W1 A9500410 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3, 36 ido , Dosing 1~6 Aeration Bldg. Sewer u~a3 qy _ Holding St/ Ht Inlet a/ r/G rf y' TANK SETBACK INFORMATION St/ Ht Outlet lPlo~~ 9 7,-1 Vent iritntaoke ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Septic o nom, NA Dt Bottom Dosing NA Header/Man. 7,0' Aeration NA Dist. Pipe Holding Bot. System OF ;a,' qS, /4/ ' PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 9 91171/ Model Number GPM TDH Lift Friction System TDH Ft Forcemain Len Dia. mead Dist. To Well SOIL ABS RPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /a /IS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type O $D , CHAMBER Model Number: System: y,,a 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 ~e Depth Over V xx Depth Of xx Seeded /Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges J Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Somerset.34.31.19W, SE, NE, Lot 1, County Road I 0 ~U- Plan revision required? ❑ Yes [E' No Use other side for additional information. D H6 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. w"so Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of BuildinWater 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 12 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number C'0-t `'t l 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 Ow r ame Property ation Gt ~c / ~C i^Cira. 1 /4 1 A, S T N, R Property wner's Mailing Address Lot Number Block Numbe Ci , State J Zip Code Phone Number Sub ivision Name or CSM Number II. TYPE 75F BUIL ING: (check one) E] State Owned ❑ city g Barest Road r ❑ Public 1 or 2 Family Dwelling - No. of bedrooms ❑ olwn of o0ii 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 0'3,'2-10q5_ 1 ❑ Apartment / Condo 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. ~ew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing 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 P4seepage 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 % o C~ 6) eq5'~ S - /Feet Feet ' VII. TANK Ca acit in allOns Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ 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. Plum Name: (Print r Plumb ignature: (No mps) MP/MPRSW No.: Business Phone Number: m is Address ( treet, City, State, Zip Code): tom'--~ f?~-~ d© IX. COUNTY / DEPARTMENT U ONLY ❑ Disapproved S nitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signatur (No Stamps) Surcharge Fee) #Approved F1 Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to eounly, one copy To: Safety & Buildings Divi ion, 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 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 foi ail 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 wi'.:h 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. ,rmolete puns end specifications n(-,,! smallerthan R 1/2 x 11 inches must hoc sc, 0ted t-, the inty The plans must ucie the foilowing: A) pint ,,plan, arawn to scale or with compiete dirner,si o. 1ocali _ n , cding tank(s), septic t ~i<;; or other treat!;,ent tonk:>; bw!ding sewers, wells; water mains/~,va.~ te; stre,: n r_fke;; pump or siphon ..,k, a s~;")ut.on i;or.es, so, .vrp!ion systems; replccernent system the building served; " d -a; el"r: points; C) corplete i of for pur,'t?.. fitrcda', dose volume; e.evati:Dn ' !ferences; frlction'Oss, pump perforf-,ante curve; pump mottei :t,lp m_tl; _ -er, E1) cross section system if fequired by the county; E) soil test data of a 1' or , a 1I 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 _ontaminat:on investigations and establishment of standards. x PLOT PLAN PROJECT A_ ADDRESS ~ ~--,"~`l SSG SE 1/4 NE 1/4S 34 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS BYRON BIRD JR. 3318 DATE 11/17/95 BEDROOM 3 CONVENTIONAL XXX IN-G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 BED SIZE 12'X 75' BENCHMARK V.R.P. Top of Steel Stake ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark VENT SYSTEM ELEVATION 95.1 12" GRADE TYPAR COVERING ' 12" 3' "(2), SEWER R K 12' County Rd. I * .M. 720' 0' -3 Note: May need to be cut to 42" \,101033' slope 18' B-5 27' 15' 60' CD 12 B-2 35' CD B-4 Vent 48 T 25' 20' Pro 3 B-1 Bedroom House Garage Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of wal r &i Human Relations Division of8afety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but i 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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. 0 1/4 1/4,S T N,R E (or)ffl PROPER OWNER':S MAILING ADDRESS LOT # BLOCC # SUBD. NAME OR CSM # i / CITY, STATE ZIP CODE PHONE NUMBER ITY VILLAGE ErOWN NEAREST ROAD b(] New Construction Use Nj Residential /Number of bedrooms [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow Ze)Q_ gpd Recommended design loading rate 5 " bed, gpd/ft2_'_,~Ltrench, gpd/ft2 Absorption area required ,a bed, ft2_ trench, ft2 Maximum design loading rate ~ bed, gpd/ft2_,_j~_trench, gpd/ft2 Recommended infiltration surface elevation(s) S?s el) ft (as referred to site plan benchmark) Additional design /site considerations - 1~ Parent material ,>44✓~,~r Flood plain elevation, if applicable ft ' S = Suitable for system CONVENTIONAL MOUND 71G'ROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ❑S ❑U ❑S ❑U ❑U ❑S ❑U ❑S ❑U ❑S ❑U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer'& 4~v / Pk/ • ...............v. Ground S-4 7 elev. - e6v Depth to limiting factor Remarks: Boring # n -2m Aw A1 4.101 Ground 1 - elev. „ - B73 71-1 ft. Depth to limiting factor 2 = C~ :lr Remarks: CST Name:-Please Print ~ Phone: Address: J n J ! t Signature: / Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Pagef PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr& 4 } 0 -42 ad/ Ground V 1A -7 elev. Depth to limiting factor 99 Remarks: Boring # All, A J-O,- e19 Ground elev. - - Depth to limiting factor Remarks: Boring # 4i, 42 Ground elev. _ "ft. _ ~ - Depth to limiting factor y7 Remarks: Boring # I Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) /8~ LiT1Il --;f- 1--, Ni ~r/~h% ,~~xaw ,x ~COG/t7/d~Jpp ®~SiTr ~7 ~o. ~ iUO,~iwcJs ~m ;tea S S ;S~C~,ES ~ r 39 !s 41o 4r -;7 o `f 1 96 .4 c vh-k-, ems /i r U to i1 Cry t"P'~ L~ 4~~ CA.) ' N STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER C/ t tt / ✓/k, ra ~r~/ MAILING ADDRESS mSq 5S`~ PROPERTY ADDRESS (location of septic system) Plftse obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION !5-~ 1/4, . 4~, 1/4, Section T~N-RW TOWN OF ST. CROIX COUNTY, WI SUBDIVISION GSI LOT NUMBER CERTIFIED SURVEY MAP 76 ' OLUME PAGE,zZ~ 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 expiration date. SIGNED: DATE: /~/o✓E...1~E2 ~99s St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S7-,2- /DO 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 Z4;L4*/ ~cL 'Z Location of property_~l 4 1/4, Section T 'Y/ I N-R~W Township Al- :!LDn, r '7 Mailing address 7 7 S Address of site ~15 Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Total size of property --~>!---~~_a J Total size of parcel Date parcel was created w . 3-IgZ -9 5 Are all corners and lot lines identifiable? _~Yes No Is this property being developed for (spec house)? Yes _ C No Volume //110 and Page Number 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 ofiQe of the County Register of Deeds as Document No. 5 and that I (we) presently own the proposed site or 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 theV~~qf-- the County Register of Deeds as Document No. Signature of Applicant Co-Applicant /I/i' 74w Date of Signatur-. Date of Signature FILED IPR 1 2 1995 ► :ov KATHLEEN H. WALSH Register of 52'765" St. Deeds V \ St. Croix x Co., Co., W1 CERTIFIED S Y MAP Located in part of the SE h of the NE k of Section 34, T31N, R19W, Town of Somerset, St. Croix County, Wisconsin. LEGEND NE Corner of .N Section 34 - Aluminum County Section Monument Found r o - 111 x 2411 Iron Pipe Set, weighing 1.68 lbs. per linear foot 41 CO O r - Marsh Area " ; - Roadway Setback Line v 4, - 0 d ~ 12' UTILITY EASEMENT c ~n o 9- ~ 9- k- o W o z v . L L1 L Uj W lC 2 d .-1 d N L d M iV L O .ti UNPLATTEV LaNCS W C.T.H. III II m A North line of the SE} of the NEJ N89028' 4011W - N89 .28' 40"W 731.60' _ ~I 1U 69 841 33.76' a - Q- --I I 292.31' 77-/ - 590.74' o N890161 11W i N89°1643°W ' 115.48' °0 0 33'133' 1 S0501311611W N0501311611E 88 12 117.97' N.•. 112.781; /1 u 1, N ; 11 0) co 100, 100, 7 o M N20°27' 3911E i 13 0' , 0 134.49' i S20 2Z 39„W * / `O hS / 134.49' n Z LOT 3 6 LOT 1 s - 14 L o ' ~ i 5.22 ACRES 0 M 5.19 ACRES O I 227,387 SQ. "FT-C~', i 226,149 SQ. F Tl W 15 !y °z ca J 41 LIJ 4) J1 Z", LJ 0111? 1-4 co t4) 0"10 a V N o J/ may.: ` Jr l s ti I to 2 N O l , .y n , _ •k~ LIJ W 1 Q ~~abl N y o An. 01 4 ' / 5-140 N \I6 I } N c ~_j 4Z 4J I X. 4- r- i N55038' 02"E I S. 66.00' Q W s _DI 3 1e S69056' 11"E APR n 107.20' y 1 2 19 (SEE SHEET 2 FOR .y TEMPORARY CUL-DE-SAC O~- OWNER ST. CR= COUNT DETAIL.) N69056' 11"W WILLIAM 'PETERSON 1;0MPrdMM1v*P3 LOT 2 113.48' . . C./O ZankVad ;j REMAX:%REALTY Pa*s CO MlXIM ^ 4.14 ACRES W SOMERSET, WI M 160,256 Sq. FT. ir> 54025 N not recorded n 0,9 within 30 d"s of M approval date z ir»oval shin be ovl A vo'd 963.76' ir S89037103"E 356.93' S89°37'031 'E I I 1 TTC~ South line of the NE} Q Corner of SCALE IN FEET vi~IPL_a 1 I ~ LANDS l✓ Section 34 0 100 200 400 SHEET 1 OF 2 SHEETS VOL. 10 PAGE 2903 J~653 State Bar of Wisconsin Form 2 - 1982 _ WARRANTY DEED DOCUMENT NO. VOL 1150PAGE 48r- r,EGIS~~rI s Ors-ICE S1 CROIX CO., W1 W. L. Peterson & Associates, Inc. RcedforRecord NOV 2 1 1995 'v ` ~t t .0 8: 30 A. ~ Paul C. Durand and Bar ara E ,►,-,-A- O id'. conve s and warrants to a 4'~ urand, husband and wife, Rpm+storof Deeds THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS /Q, DU the following described real estate in St. Croix N S 73 - 11~ V I.X~ County, State of Wisconsin: (Parcel Identification Number) Part of SE1/4 of NE1/4 of Section 34, Township 31 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Lot 1 of Certified Survey Map filed April 12, 1995, in Vol. "10", Page 2903, Doc. No. 527657. T SFER This is not homestead property. XXXI (is not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this 1 L~2- kAn day of November 19_95. W. L. Peterson & Associates, Inc. (SEAL) By: /UdA,'1 (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) A"y'' STATE OF WISCONSIN ss. St. Croix Count authenticated this day of Personally came before me this day of November , 19-9-5-- the above named f) L~Loky)J y T.. Peterson & Associates Inc. b TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland Attorney at Law Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary.) , 19 ) *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. FORM No. 2 - 1982 Milwaukee, Wis. c.oao-4~ co~oo~~ co•ao4~ c~oav~ cooo~~ c~~ c~'ao~~ c~~ c°•°a°~ copy~ F E r SF A G GOVERNMENT CENTER 1101 CARMICHAEL ROAD HUDSON WI 54016 DAB: d - TO: FAX N[R~EEt: 4-1 / - CO FROM: FAX NUMB R: (715) 381-4400 v NUMBER OF PAGES M=M OOVER SETT: . 0 IF COMME MM LEGIBLE UUMMAT M IS.LN= RECEIVED, PLEASE COMM- NAME: ;~w r 7ELEPROM NUMBER: c I ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road } - Hudson, WI 54016-7710 (715) 386-4680 TO: David Bracht Ap FROM: Barb Prinsen St. Croix County Zoning Office DATE: April 22, 1996 SUBJECT: Copy of Private sewage System Inspection Report Paul Durand, Part of BE 1/4 of NE 1/4 of Section 34, Township 31 North, Range 19 West, St. Croix County, Wisconsin described as follows: Lot 1 of Certified Survey Map filed April 12, 1995, Vol. 111011, page 2903. Attached is a copy of the Sewage Inspection Report requested by you this morning. If you have any questions regarding this matter, please contact our office at 715/386/4680. I