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HomeMy WebLinkAbout030-1057-50-000 4 STC - 104 1`L 2 AS BUILT SANITARY SYSTEM REPO OWNER ADDRESS C6 Ur~jy M~ L 9 1J9~ mss/ SUBDIVISION / CSM# LOT # SECTION N-R~~W, Town of _ Q6& °h ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM yo sc~l ,r3ul/~~ U,~~, ~u~ al~'sy~~•. ,,{Ju~' A~,w SyF~~ p x(, ss" ®~a Sir S ~"~h INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK • ALTERNATE BM: SEPTIC TANK /PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: f~s'e-'s Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location .:SOIL ABSORPTION SYSTEM Width: Length y~ Number of trenches - ------D-istance--& Direct-ion--to--nea-r-est-- r-o' Setback from: well : t/y.~_ House__44L 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: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, Labor and Hu n Relations PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: P LATNER, STEVEN I City ❑ village Town of: State Plan o.: CST 771 ev.: Insp. BM Elev.: / BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA a TYPE MANUFACTURER CAPACITY STATION BS I FS ELEV. Septic Benchmark Dosing 61, Aeration' Bldg. Sewer Holding St/0 Inlet TANK SETBACK IN RMATION St/,Ir Outlet TANKTO P/L WELL BLDG. Aiverntntake Ito ROAD Dt Inlet Septic NA Dt Bottom •-7 Dosing NA Header / Man. Aeration NA Dist. Pipe /P' P-7./7 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade (7, Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft H a Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length i No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~.~2 5 DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent Length Dia Length _73 Dia. X Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems O Depth Over Depth Over`-,,"\ } xx Depth Of xx S /Sodded xx Mulched Bed /Trench Center Bed/ Trenc*KEdges; Topsoil ❑ Yes ❑No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 4,A,-s (-'r,,~ y 7 LOCATION St. Joseph./2,3.30. ,19W, NE, NW, Lot 3, North Bay Rgad l ~ ;..1 ~ ..-i.= ~ 't?a i~ o n f, / ;-T~ ' ~ Q~ .-'r~"? _ r. U-K.. ~ ~ Y" ~i/'~...t<_.r' i Plan revision required? ❑ Yes 2 ll~o Use other side for additional information. SBD-6710 (R 05/91) Date - Inspector's Signatu a Cert. No SANITARY PERMIT APPLICATION ~ COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY P RMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than oC 19 (?09" 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. PROPER OWNER PROPERTY LOCATION '/e t/4, S T , N, R V(Or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # Zoo 12 ~)4 CITY, STATE ZI COD PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ielSjy` , 3 'gz,, V fz). . G/ 11. TYPE OF BUILDING: (Check one CITY NE ARE T R AD El State Owned VILLAGE ❑ Public ~1 or 2 Fam. Dwelling of bedrooms 3 PAgL TOWN OF: I-InIZA &-4, RCEL TAX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) ~aQ 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 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.E] New 2. [Z 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 # 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 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 Se tic Tank or Holdin Tank - F] Q F] U_ Q Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for install ion of the onsite sewage system shown on the attached plans. Plumbe s Na a (Print)- Plumber's g to r s) MP/MPRSW No.: Business Phone Number: lumber's Ad ss (Street, City, Mate, Zip Cod Ae IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved San~ary Permit Fee (includes Groundwater Date Issued Issuing A nt Signat S ~f~~ Approved F-1 Owner Given Initial Surcharge Fee) f~ 1416 Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS - 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number (s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete Vine B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) ~ ~~~q~~y~ T-.~~~✓, ~/per, mEiPS~~% /,Jz, S ~-Av/ S ~ r ~ a a • ~ C.r~s~. ~~.c~loi~ 0~• nn , Fie Ill. Ak Weis AAil 9664(vellm pipe . YWwru IDSADpvo-..T~+~ AtN••1~ V61so cool ; i 10• Akove /I~ t• Cool 1404 T~ ILN'or•~• VON I100 WrM 14, Or ir•nyrk C•.•rln• 000f Plot t4• -Too 4 • t' 4tr.t.~o . . I.H.1~ II~• • POIIWO1441 IIP• II.1•vl r • 1C~MI•I T•.nl,r•11.•! AI • t•11ji• 01 i/11.w Propo tD ~ink1 9r•,,clt - - _ &OIL ri1.L. • ©13TKIDUT101.1 PIPC • APPRO,rrp S'()lTl1E71C COVC 2'OFJNGrR~GJ1iE---fir ''MATER14 OP, 10 OF S7RAb OIt MAKs~. N.Ay ELEV. OFa-~-FEI<Y_~ "Or I.GGnCG^TC 1DI5TRi5UyI01J Plrc •YO D ~j AtJU AT. C A7 4CAtIT --•~1~ IuCHC3 LCAiT;p IA9C 6CLOW OR1CawA1, HCL OUT 1.10 MORC TH^N 42 IuCNCi gCI.OW II►JAl "?t^OC M~clrwM D4PTVJ OF EXCAVATI00 F OEF T11 OF EACAVATION iCon oKltrA>. 6 1~0~ WILL. BE 1 VNIr'1VJ~ IlJ c H e s H IOM, 04~16I14/jL GRnDr` Wla.l. BC INCHCS 51GIJC*v": - LIGCusC UUM5EIt: • OAT C : ,_,L•._ t Wisconsin Department Industry, Labor and Human Relations SOIL AND SITE EVALUATION REPORT Page of Divigiori 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 S' C (QC) ► X 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 Q I T 7' ►J GOVT. LOT N C 1/4 At LJ 1/4,S23 T N,R J E (or) W Pi 'E' "OWNED Tk ItSGY D 4 L03# BLOCK# SU . NAME Obi C M l4~ 1 CITY,, STATE ZIP CODE PHONE NUMBER (r r\/ M 00 St ❑CITY ❑VILLAGE OW TOWN NEAREST ROAD ( ) Jam,'c .0)4 cw kcr'/ l [ J New Construction Use Residential / Number of bedrooms 3 [ ] Addition to existing building ~f Replacement Public or commercial describe Code derived daily flow Sd gpd Recommended design loading rate 9 bed, gpd/ft2 6 6 trench, gpd/ft2 Absorption area required 9,06 bed, ft2 75O trench, ft2 Maximum design loading rate D,2-bed, gpd/ft2 ®.g trench, gpd/ft2 Recommended infiltration surface elevation(s) R C ~1cS ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system ggNVENTIONAL ►~IOUND IIN-GROUND PRESSURE AT-GRADE SY TEM IN FILL HOLDING T K U= Unsuitable fors stem tj S O U ® S O U S❑ U L1 S❑ U RS O U ❑ S W,u SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Boring # Horizon Texture Gr. Sz. Structure Sh. Consistence Boundary Roots Bed Tred ITm { in. Munsell Qu. Sz. Cont. Color nch a l # -3 /001 41 Z_ IS L 2 C S 0.5 -2Z IbY,~ 4 - SL- 0 M r eh ~ C W I O O Ground z2`3Z 7,Y 4 - CLL S~iK M~( C w elev 0,2, p.3 q ft. 63 32-4Z 16Y4, l 5 3 5~ rt tsi a.J d- z Depth to iB Z.12 4 © f limiting 'O.S fac r C q - ~aYtR Cd wt ! 4 L 1 a5 d.~ Remarks: 9 4AI' ~ of tJ~N00-r 4 ~A"IeQS Boring # j/ 161yk 4/Z c r'►~r C S 7 o.S d.tz 6" ~S V - S Jr CL -j Ground elev. $3 / 90216 ft. 16 4 A I o.7 d Depth to J limiting f ctor Remarks: L CST Name: Please Print Phone: ddress: 1 6x 9! 140 Wf c. Signature: Date: S, ftlumDee 0 91 PROPERTYOWNER ~ILV~C`~bic L~J7frNC SOIL DESCRIPTION REPORT Page Z. of 3 PARCEL I.D. # Boring # LA Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0.4 o- Ground -129 lOy~ Q' S Ih elev. °1g°L ft. Depth to limiting factor ~z A "S J d y~ g - S Q rn G d •S 0 Remarks: A / L4\164 S of Fi tit SAgQ -rgitoUC, Y6 Ur, i LAvC ks Boring # 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: SBD-8330(R.05/92) r 1 v t o~ Di $ ~ a 1 ~ I nl ~ ► C ah 1 u 70 ~nn ► C> d' C> L r 4 14 i d ---7? J ` b I r I ~ ► r ~ I 100 \ ~ D 6' A U L I "X r~~~11Nt1gN~ SET WT 310.168 LBSP/LIN FT. CURVE I- 2 DATA G4 RADIUS.--= 80.0 N CHORD------108.92' GENE C. CHORD = SHAFF£R BEARING---N18°-44`-55"W = S-~ Q ASSUMED BEARINGS CENTRAL S HUDSON V ALONG THE NORTH ANGLE----85°-48'-'29" W LINE OF SEC. 23 (S890-41'- 40" E) 20dQ 150' 100' 50' 0 15 0' APPROVAL A U u NOR SUBDIVISION DOES NOT MEAN APPROVAL FOIL THIS INSTRUMENT WAS SCALE IN FEET BUILDING SITE OR SEPTIC SYSTEM. DRAFTED BY GCS REFER TO H62.20. ,1os N0.78-49 voL. 3 PAIGE ~G1 SHEET 10 F 2 CERTIFIED SURV~'Y ihl1PS S'P. CROIX COUN'T'Y, wI. STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS _ ,11~~~ nAn PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION , 1/4,_ 1/4, Sections TW TOWN OF ST. CROIX COUNTY, WI SUBDIVISION ~s 1.~~6 3 --~~LOT NUMBER CERTIFIED SURVEY MAP9_~VOLUME -5', PAGELOT 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 the on-site wastewater (1) 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: Cy c- v DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - loo 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 jnten(~ed 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 //~Z L)Ee Location of property ,1/4(1/4 , Section, T_N-R_W Township Mailing address &a A Z: su s' Address of site Subdivision name 55-0 rK M- t) iQ0 OW I r Lot no. Other homes on property? Yes_ No Previous owner of property Total size of property 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 _ l No volume & 71 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 office of the County Register of Deeds as Document No. lc-~ 9 , 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 f Applicant r Co-Applicant I /r a V /,-i y - & /Z~ ~q, ~ - Date of Si nat re Date of Signatu e DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-198? 42 ~►rsC Cg ciX co., W1 Howard W. Pittelkow and Doris Pittelkow, husband and wife c~. .x.d f,r P-Cord MAR 28 1994 11-30 A ^onveys and warrants to St.emgn..L,. Lanz-rner._and..Kala-.T " e,r - ti La_t.tern.er.,._husband.-and- -wife„-.as_marital--survivorship........ ! { R °xsw of~ proper_ty................................................. 1 +b~" - I i RETURN TO the following described real estate in St. Crom ..........County, State of Wisconsin. 030-1057-50 Tax Parcel No- Part of Government Lot of Section 23, Township 30 North, Range 19 West, St. Croix County, Wisconsin described as follows: Lot 3 of Certified Survey Map filed September 6, 1979 in Vol. "3", Page 861, Doc. No. 359578. This ._iS-------------- homestead property. (is)~ Exception to warranties: Dated this 3-•------•-•-......._. day of March 19>..94.. (SEAL) (SEAL) Howard W. Pittelkow - (SEAL) (SEAL) Do s Pi tte k.. AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN St. Croix ss' County- authenticated this day of 19 Pe sonally came before me this 23........ day of N arch d. 1994... the above named -Howard W. Pi ttel. . kow. .and. .Dor. .i.s.. P.1 ttel kohr, . husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN R (If not, . 5 authorized by § 706.06, Wis. Stats.) to me known to be the person C4 e foregoing instrument and acknowledg the ' THIS INSTRUMENT WAS DRAFTED BY . _Title of Stillwater Attorney's -PU 1 935 Northwestern-Avenue-.------ . . o St-i-l-l-water)... 14----55092-------------------------------------- No ubl' $-t..Xr.0x....... eta#~ i' (Signatures may be authenticated or acknowledged. Both M. ommis on i permanent. (If not, state are not necessary.) date: • ~i *Names of persons signing In any capacity should be typed or printed below their signatures. ~i pgrq STATE BAR OF WISCONSI'd+e e- le Nn ,:Ana FOR ~.•4 ~ I 45:5' n` _FIE ED ~i ~s Sr.P Co 1 A..QES 0, CONMG[t J C E RTI F1 ED SURVEY MAP Ragtsfer Of Oo®da Croix Count GOVT LOT 5 SEG. 23 T30 N R 19W `'~°^'jY TT' UNPLATTED --LAND S66°-13!-23~'W - - - 62 IE S 89°-41'-40" E S89°- 41'-40" E 748.69' NORTH 2LINE 7 3.6 N.W. COR. 1317.87' " - 24'-04'-57 SEC. 23 00, I"I.P. FD. COQ, A42 O ~1 S38°-10=5•~"W LOT 1 114.12 / LAND UN?!-ATE~~ 4.3 ACRES aye "~6 ~~ohh o 2 - 20 a~ `69 g8 ' 618.26' 218°-2j-5d% S 89°-41'-40" E S88°-13'-14"W N89°-41'-4"W ° -174.61- - - - - 106.30' N5['155'-24"E 51 1.96' 67.25' PRIVATE Sc'0 51°-55=24"E EASE- 33.62 MENT ti1 ~ t V ry , ~ „ ~ ` 1 L O T 2 9s* on - 0 ryd` ^91 3.0 ACRES 3p 0 mw 6' N c td 59°-26'-56" S89°-41'-40"E Ri B Q S S 0 556.62 o; a v) to N03°59-07"E 13.35' ilg / 93.20', ` 1A _k ,o 01570 cv~ , L A K E CD' LOT 3 0t 0 3.0 ACRES oa _ 1 is 0157°-15-59 $0; pp \ ---a~ 66 ti A~S 89°-41'-40" E ~~%u`F~. - % s Flo 498.55' % p'i" S63°-03'-47"E yt~~ `c'p ~s •9~ 120.81' 66' PRIVATE % p, EASEMENT FROM Ss !y C.T. H. I TO u" F. LOT 4 g0 o CUL -DE -SAC A0'\ p \1+ S32 45-09 E •~,s3.0 ACRES \ 109.44 11 /pa \6 6 PRIVATE o, 8t S19°-30'-50"E / Oo \ , \ 50.38 EASEMENT Sp 65'! LEGEND `o- 88.52' N 89°- 41'- 40" W 505.74' o- I"X 24" IRON PIPE SET UNPLATTED L68LBS./LIN.FT. ----------LAND- WT. ---,~,~~{/fflfgH,I •I X30 IRON PIPE SET CURVE 1- 2 DATA 00 I'~. WT. 1.68 LBS. / LI N. FT. a®~ RADIUS 80.0' CHORD----108.92' N a ' GENE C. CHORD SHAFFER BEARING---N18°-44`-55"W S-1325 ASSUMED BEARINGS CENTRAL 5 HUDSON ALONG THE NORTH ANGLE -850-48'-29" LINE OF SEC.:. 23 <,q ( S89°-41 - 40 E) sua 20d 150' 100' 5d 0 15 0' APPROVAL OP~ OR SUBDIVIS mmmm~ DOES NOT MEAN APPROVAL FO THIS INSTRUMENT WAS SCALE IN FEET BUILDING SITE OR SEPTIC SYSTEM. DRAFTED BY GCS REFER TO H62.20. JOB NO.78-49 C vu. 3RTIFI61) a ~ Urt ~ 'J:;Y mjI ~~1 P5 SHEET I OF 2 ,if. CROIX CUUL~TY, vwi. -0 C) Q) 0 Z O ° 0 ° h ~ Q7 J N ev a O O O C N N w O tq N fd ~ ~ f0 S O N 0 (0 F l+i 'N M U) 'C i n ~n -o ~ ~ I v Z ~ c~ ~ y I (D 2 a~ N N M ~ -j E E x c y f0 f0 O m w N o ro- "D -6 C Z Z 0 to O C N 7 co ~ :s 0) 7 N LL O aN w LL O =O C O 3 3 0 om~ai aci _0 CL I Q J 3inin E Q V 3 Cl) a M (D N Z N N O) U E E O r. O O J 2 Z E ° € 0 4) 0) ° o a m a m N H C7 O E (6 O z a v to , ~ N z p 2 2 d w rn z N ° a c c E -o _ E v o co N d 7 m a) co N m vn 0 ~ •N fn s d U o U Q z m z z m rE w N o -~co LO 0) N E N 12 LO 0 M 4) CL m (n CD C~, La -a) ! 0 o E 04 zc)> a~`~0 0 'a ° Z C) c a` ` ol~~C'4, o C) a B (A J U) 0 O m O rn rn Z ce) C) 0 0 0 m O N V- 0 c) E M M_ Z m C m C E N O y m N N D rn O aM0 Q Q Z (n -O U) w 00 O N c N c E Q p 2 O a5 N c v d M co O p = -2 U) O O N L € O N N 4. O 0 Y O N U 'O E O W U N _0 p O S a O 0_ co w O O N O) N 00 • M CM ce) 0) O C m N O O U) 0 R U Q O N to a m 0 z- m J N C. Z U) as d m a a a 3 a a • 0. •0 (D d c 0) m c E t c c c 0 0 m 3 A Ua2 IOUV 0 U)L) Parcel 030-1057-50-000 03/02/2005 03:38 PM PAGE 1 OF 1 Alt. Parcel 23.30.19.201 D 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 * MCKANE, JAMES P & LINDA J TRUST JAMES P & LINDA J TRUST MCKANE 1483 NORTH BAY RD SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1483 N BAY RD SC 5432 , SCH D OF SOMERSET SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE SEC 23 T30N R19W GL 5 LOT 3 OF CSM 3/861 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 23-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 05/10/2004 762086 2568/199 QC 03/25/2004 757679 2534/414 TD 11/10/2003 746264 2453/411 QC 11/07/2003 746044 2451/530 WD more... 2004 SUMMARY Bill M Fair Market Value: Assessed with: 5212 415,300 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 270,600 138,000 408,600 NO I Totals for 2004: General Property 3.000 270,600 138,000 408,600 Woodland 0.000 0 0 Totals for 2003: General Property 3.000 171,400 130,700 302,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 113 Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 626.25 Special Assessments Special Charges Delinquent Charges Total 626.25 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT 'OWNER Lli parr l jP aQ 1.4 TOWNSHIP ~ SEC .T,3tN-RW ADDRES S y J 5 D t~ C~w~ ST. CROIX COUNTY, WISCONSIN. 3d~ SUBDIVISION L r l LOT LOT SIZE 2 PLAN VIEW /17 ~ Distances and dimensions to meet requirements of H63 6 3jj ' JOK-'-0- =THING WITHIN 100 FEET OF SYSTEM 760 ~STI AA 11 1 9 I di a e o th Arrow 1' I SC L BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: SEPTIC TANK: Manufacturer: \ L' Liquid Capacity: ~f Number of rings on cover Tan manhole cover elevation: 3 3 Tank.Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cyc a gallons; total capacity o distribution.lines gallon: size of pump head; gallon .per minute horsepower ran name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number o pits eet diameter feet liquid dept seepage pit inlet pipe-elevation bottom of seepage pirc-levation feet. SEEPAGE BED SIZE: number c'f lines__.2 __width length_j~_tile depth_4 SEEPAGE TRENCH: id h length PERCOLATION RATE • A QUIRED REA AS BUILT e INSPECTOR Af- DATED_ PLUMBER ON JOB LICENSE NUMBER IoA c~ y° O ~ -f- W a ~ a S ~ O ' I \ w ; _q a_ i i 'loll S I (I I r 4 AMI -Gnaw owylA r l , rr ~ j~ S('c ti u Lu-t M Sub 4c v46 c rrn 1 III I CI ANK _ _ yaYYune Numbers al( eornpun tmen t~ , l,cur ~ fl (,fit: weYY - o22- Bui fd/ ,Plq 12$ rope Hi ghwa ton )MVINi, CHAMBI R gaet'one. Pump ManuAae.tuh.e.h Modet' Numbers 01 VIN!; TANK ti_ gaetune Numbers uA Compa4tment.6 I'rcrnf,c h Atahm Sye tem ti tame Thom? weI f Buitding I ? o eYope Highwateh +10WI'TION SITE Ked Thench tunce chum: weer' Bu-itdi.ng_ -7~t2$ 6fope Highwaten 'WI'IION SITE DIMENSIONS Width 4,6 the.neh At Reyui ned a.nea At length oA each, At Depth oA hock beYuw t+4'e Nirmbe n c,6 Yined Depth o6 kook uveh (4 6, t n 1„l,cY Yen~fth u~ eir;rU 61 Uepth u6 #t4'e beYuw gnade - 4n d he l~crcrr between Yinee_ At S('upe oA theneh tn. t,en 100 At i a I, ,1 ~,1111~4UY1 a~cec .t Type ___L-~_ e (;4 Coven: I'apeh uh Ath,IW ► 1)1MINtiIONS y1 ll ,V cc nih c-c ofi I 1•i t6-•___-- - GhaveY anuund p4 to yeh nu OuttiIf ill' diameteh ~.t Depth beYuw 4ntet ~t Iut(cY nbeonption ea _,I(t Alien neyU4hed NtiI'I 0111) BV TITEI '~C I'1'Ki)Vf U DATE 19A ( I I CI 1 U DATE 198 I AtiON I OR R(JECTION ~P L B 6 7 State and County State Permit # Permit Application County Permit for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: p B. LOCATION: X 4! iW/4, Section _3eN, R_/!~p B (or) W Lot# _City Subdivision Name, nearest road, lake or landmark Blk# je4SS ~a/ftVillage 4 5 ~j ~c C~tqj 3 Township ` t~O~{ C. TYPE OF OCCUPANCY Commercial *Industrial *Other (speci ) 'Variance Single family Duplex -No. of Bedrooms 3 No. of Persons ~ D. TYPE OF APPLIANCES- ishwasher OYES NO Food Waste Grinder YES Z-Pl$- # of Bathrooms Automatic Washer YES NO Other (specify) E. SEPTIC TANK CAPACITY / t2n9 Total gallons No. of tanks 41~ *Holding tank capacity Total gallons No. of tanks New Installation t--' -Addition- Replacement _ Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) _ 2►_t 3) Total Absorb Area dl!sq. ft. New !r "Addition Replacement *Fill System _4eepage Trench: No. Lin,. Feet Width Depth Tile Depth No. of Trenches eepage Bed: Length, rWidth A;~ ► Depth Tile Depth ?a No. of Lines ~i Seepage Pit: Inside diameter Liquid Depth Tile Size y Percent slope of land D /O % Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certifi Soil Tester NAME Z G ~i 9/• a j W . /q& gh~ / C.S.T. # and other information obtained from (owner/builder). Plumber's Signature 14-) MP/MPRSW# le 572 Phone 400- Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). Do Not Write in Space Below FOR DEPARTMENT USE ONLY / Date of Application % Fees Paid: State 0.0 County O-d Date Permit Issued/Rojeeted (date) W_-Issuing Agent Name Inspection Yes_,[_No Valid* Date Rec'd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1/76 EH 115 R.,,-9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES (o n P.O. BOX 309, MADISON, WISCONSIN 53701 9A~~!C, LOCATIONA~ /Y 6 1%, Section 23 ,T3_0 N,R.L_~?E (or) W, Township or Municipality j Lot No., Block No. Z347 . 9'< County n ame Owner's/Buyers Name: e Mailing Address:- L/®/~ t TYPE OF OCCUPANCY: Residence No. of Bedrooms -3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS !Z-14 / SOIL MAP SHEET 7 NAME OF SOIL MAP UNIT PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- i J7 r. .rj 'C P- 2 s lyy 'Alftlc :Z P- 3 P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- 7-7 O e > ~7.2 1.'r' (D J B- •P r rro / B- 5L - 3 4 'S B- .5 PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and squa feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy G IPS" dicate scale or distances. Give horizontal and vertical reference points. Indicate slope. rT OM3 ~JbY4411,__Si - E , i , F , s N M' L 4~7 77 -mom _ 1, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. / Name (print) e_1 VV 1-14422 'S Certificatio No. / 3 Address l ti 1 .Name of installer if known Copy A -Local Authority CST Signature l i . '13194 REPORT ON INSPECTION OF SANITARY PERMIT # cl Cl' 7~ 1 N me and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection ame, Address, icense NO. OT ns a in P umber Time of Inspection (3)INSTALLATIOIN C SISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepa a Bed ❑ Holding Tank ❑ Fill System ermanen reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: M DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO 8 HOLDING TANK: Manufacturer o gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ N0; Wired? ❑ YES ❑ NO; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR-SBD-6095 N.05/80 Signature of Inspector: