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Parcel 030-2091-10-000 02/10/2005 11:20 AM
PAGE 1 OF 1
Alt. Parcel 26.30.19.762 030 - 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
* LIPPMAN, TODD R & CHERYL M
TODD R & CHERYL M LIPPMAN
1393 AWATUKEE TR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): • = Primary
Type Dist # Description * 1393 AWATUKEE TR
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.000 Plat: 0078-BASS LAKE SOUTH
SEC 26 T30N R19W LOT 1 BASS LAKE SOUTH 3 Block/Condo Bldg: LOT 1
ACRES
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
26-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1094/613 WD
07/23/1997 1089/289 LC
2004 SUMMARY Bill Fair Market Value: Assessed with:
6469 248,900
Valuations: Last Changed: 07/12/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 60,200 184,700 244,900 NO
Totals for 2004:
General Property 3.000 60,200 184,700 244,900
Woodland 0.000 0 0
Totals for 2003:
General Property 3.000 46,100 153,900 200,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 117
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
` 2(o. 30• ~`1. -1(02-
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER LGt^o~ ~'~w
T nn
ADDRESS ~~s3 ,~4Jst~,f, ~ 13~ ~WA- 4WUt- U►J~
of o::~2 w/ oaf r U-d~rn
SUBDIVISION / CSM# LOT #
SECTION 2`P TsON-RW, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
-jr
NIX 5
4
tic,
5
VOW
I
T-A INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
r
B'ENCHMARK•
ALTERNATE BM:
i
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: ~c~C• cc9% Liquid capacity: Setback from: Well 3-?p_ House Other
Pump: Manufacturer Model# Size
Float seperation Gallo (/Cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: S Length 5-7 Number of trenches
Distance & Direction to nearest prop. line: IS-,
Setback from: well: 001- House ,2,OA- 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:
Owl
PLUMBER ON JOB: 1k ig!
LICENSE NUMBER:
1~
INSPECTOR:
3/93:jt
LQ9A` ;Q#lpartAAXtof4Q , H. 26.30.
Labor and Human Relations IVATE SEW GE SYSTEM UTH County:
Safety and Buildings Division INSPECTION REPORT ST- nROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 199918
Permit Holder's Name: ❑ City ❑ Village IR Town of: State Plan ID No.:
S B ev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA A9300322 G0
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic f Benchmark
Dosing , _2 00' /0~1,1Sl
Aeration Bldg. Sewer
Holding St/~41 Inlet
TANK SETBACK INFORMATION St/ Outlet D '
TANK TO P/ L WELL BLDG. Airinta to ke ROAD Dt Inlet
rl
Septic ~/,0' U NA Dt Bottom
Dosin NA Headerlchd=
Aeration A Dist. Pipe zo
Holding Bot. System 7 ~S
PUMP/ HON INFORMATION Final Grade
Manu Demand o/-/DDS'
322
Model Number
TDH Lift Fric System Ft
H ea
Forceman Length
Did. Dist. To Well
I I - IF T
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length o No. Of Trenches P No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 5 7 DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING nufa
SETBACK CHAMB
INFORMATION Type O fia~l ; Model Numbe .
System: r~•~`b. " c?SD O IT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) „ x Hole Size x Hole Spacing it Intake
Length 1ZL Dia Length :5~_ Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syst Only
Depth Over Depth Over xx Depth Of. xx Seeded / Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges i Topsoil ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) -v-AS 13o J { r cu-(,W1/1 I/A/
LOCATION: STS. JOSEPH.26.30.19 LOT 1 BASS LAKE OUTH
Lt/V,/r-. Oj/, .!',P-••,L'1/d~"'!.._ ~~'~.t~, l.(^-/t.-~.~ •c
Plan revision required? ❑ Yes 1
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
ZETIF31LHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code CON D/
STATE! I ITARj #
-Attach complete plans (to the county copy only) for the system, on paper not less than
8% x 11 inches in size. ❑ Check if re ision to prdvfous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
:T W%4 .SGd'/4, S Q,ig TSO, N, R Q E (or)(9
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
[
17/ - , SS
il. TYPE OF BUILDING: Check one CITY NEAREST ROAD
( ) State Owned / ❑ VILLAGE ? 11,,4, e_
❑ Public f I 4 or 2 Fam. Dwelling- # of bedrooms ✓ PAR ELTAX NUMBER( )
III. BUILDING USE: (If building type is public, check all that apply) 030 - old 9/ ' ld
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 100 Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 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 12. 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) ' 5SS.. ELEVATION
G 5-7a IL410 Feet MtO~Feet
VII. TANK CAPACITY Site
in gallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New istin Gallons Tanks Concrete structed glass App.
Tanks Tanks
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber Ej F1 I F1 Fj F1 F1
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system show on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) j@FJMPRSW No.: Business Phone Number:
I'll, G r~G, a •x ~ ~/s 3~G -,3t2 ~
Plumber's Address (Street, City, State, Zip Code):
4~ r
0&:270 -'se A05
IX. C0jM /DEPARTMENT USE ONLY
❑ Disapproved Sa ry Permit Fee (Includes Groundwater Date Issued issuing A nt i N tamps)
Approved ❑ Owner Given Initial M Surcharge Fee)
Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) 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 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection., or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are usEod for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
U~
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'Wisconsin Department oIndustry, f SOIL AND SITE EVALUATION REPORT Page I of 3
LaW-r and Human Relat ons
Division of S ety & Building accord with ILHR 83.05, Wis. Adm. Code
COUNFY
&4&4~ /4&u/'7 tvol/fa St. croi.x
Attach complete site plan. 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. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Richard Stoitt 4r-liary GOVT. LOT TA-1 1/4 SUd 1/4,S 2.6 T 30 N,R 19 R1or) W
PROPERTY OWNER':S MAILING ADDRESS BLOCK # SUED. NAME OR CSM #
1353 Awatukee Tr. n./a Bass Take South
CITY, STATE ZIP CODE PHONE NUMBER ❑VILLAGE MOWN NEAREST ROAD
T3udson 54016 ( ) n/a. St. Joseph 132nd. Ave.
# New Construction Use [x_* Residential I Number of bedrooms 3 ( ) Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 R trench, gpd/ft2
Absorption area required 043 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2
Recommended infiltration surface elevation(s) g7.40 ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material otitwash _ Flood plain elevation, if applicable n/a ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem qN, S ❑ U DS ❑ U BS ❑ U A~d S ❑ U ❑ S ) U ❑ S Q
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Bowdary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color GY. Sz. Sh. Bed Trench
1 -9 l0 r4/2 none L. 2 /m/sbk mfr c/s 2/f .5 .6
9-29 10yr5/4 none sil. 1/f/shk mfr g/w l/f .2 •3
Ground 3 29-40 7.5yr4/4 none Is. 0/sg ml g/w n/a .7 .8
elev.
100, 4 40-82 1.f?yr5/4 none co. S. O/sg P11 n/a n/a .7 .8
~0 ft.
Depth to
limiting
factor
Remarks:
Boring # /s 2/f n .3
1 0-1.1. 1OvrZi 2 none L. 1/f /p1 nvfr c /s
U2 11-20 10yr5/4 none sil. 1/f/sbk mfr g/w 1/f .2 .3
3 20-31 7.5yr4/4 none ls. O./sg m1 g/w 1/f .7 .R
Ground
elev. 4 31-8 10vr5/4 none S 0/sg ml n/a n/a .7 .g
1, 01.MI. -
Depth to
limiting
factor
2,
Remarks: -
CST Name:-Please Print Gary L. Steel Phone: 715-246-6200
Address: 1554 200th. AV.e, T,Iew P,ichmond, Wi 54017
Signature: i Date: 9?r)TiNumber
PROPERTY OWNER Pickard Stout SOIL DESCRIPTION REPORT Page - of - _
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Bcxjxiary Roots GPDlft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trertcft
10yr_4/2 none mfr c/s 7/f .5 .6
2 o-22 10yr5/4 none s~J_. 1_/f/shl; mfr P/w 1/f .2 .3
Ground 3 ?.2-2 7.5yr.4/l, none 1_. 2/tTt/sbk mvfr 1/f .5 .h
elev.
1()0.40 ft. 4 2P,,-}0 10yr5/4 none co.s. 0/sf tn1 n/a n/a. .7 .f~
Depth to
limiting
factor
Remarks:
Boring #
1 0-9 10yr4/2 none L. 2/f/pJ_ mfr c/s 2/f np 3
7 .7. .3
(?-tit 10 r.4/4 none si1.. 1/f/shk mfr /w 1/f
3 22-29 7.5yr4/4 none ].s. 0/sr, ml
Ground
n/a .7 .f;
00 .1Cev. ft. 4 2.9-80 10 r5 4 none co.s. sg ml D
.
Depth to
limiting
factor
>f;0
Remarks:
Boring #
0-12 10yr4/2 none L. 2/m/shk mfr c/s 2 /17 _ .5 .h
' 2 1.2,-7..1 1.0 r4 4 none si).. 1_/f/sh'a rnfr P/w l../.f_ .2. .3
3 21-33 1.Oyr4l4 none ls. 0/sg m1 f;/w .7 .<3
Ground
, /a n/a. .7
elev. 4 33-SO 10yr5/4 noon co..~. 0/sf ml_ TI
(M. 10 ft.
Depth to
limiting
factor
>80
Remarks:-
Boring #
Ground
elev.
ft.
Depth to
limiting
factor - -
Remarks
,.;BD 0330(6.05/92)
STEEL'S SOIL SERVICE
+ 2.00th. Ave.
Gary L. Steel Richard Stout *k)8bareAMw,
C.S.T. 2298 Bass Lake South. New Richmond, Wt 54017
MPRSW-3254 NTJ<%SIJI S26-'r3nr?-R1QTJ (715) 246-6200
St. Joseph, to-mislAp
lot #12.
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SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER f"C'42."J 7-
ADDRESS:- 4y -S2 k-2 Ze' FIRE NO: LOCATION:,(141 1/4, x_41 1/4, SEC. 02 C T_* N-R
TOWN OF:~?_,~d~e,/~J~i / ST. CROIX COUNTY
SUBDIVISION: o S ~i ~-2 dam LOT NO. l
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 a 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 to
help with the cost of the 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 the St. Croix County
Zoning a certification form, signed by the owner and by a master
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. Certification from will be sent approximately
30 days prior to three year expiration.
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 form must be completed and returned to the St.
Croix County Zoning Officer within 30 days of the three year
expiration date.
1~.
SIGNED:
DATE : 1 I b' 3
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
• APPLICATION FOR 8A11ITART PUMIT
• 9TC-100
This application form In to be conplntod In full and signed by the ownttta) of
the property being developed. luny Inadoquacles will only result In delays of
the pit rrlt Issuance. -Should thle development be Intended tot ttaalt by
owner/contractot,(spsc houae), thou a second form should be totatned and
completed when the property is sold and submitted to this office with the
appropriate deed tecordlnq.
---------------------------------w-w----------------------
Ovrntc of property ~~`Glr~ ~ztAGQ ~~~WT
Location of ptopttty/UL 114 ,i 1/4, Section -'2
Township .S'T SOS,tJ~
Halling address /X S' 3 , e.,A
Address of site 132~~U a,,> s 4 e 4r i'Zi
8ubdlvlalon naM_ ,t~css 1,n~~,o
Lot number
Previous owner of pcopetty ~'d•.~~~ 4 e 4d''C-lr3
Total 5116 of parcel - ~7 ot(:2 cv-ems
Data parcel was created ,UsU 2~. /9 P'S'
All all cotnsts and lot lints ldentlflablsl ~_,Yes _ No
Is this property being developed for resale (spec house)?- on _No
Volume end Page Number - 5-7 as recorded with the Reglstee of Diode.
INCLUDK WITH THIS APPLICATION THE FOLLOWIM
A vAARANTY D¢tD which Includes r DOCUHIINT HUNBIIR, VOLVNlt AND PAOR Rvxlz;t, and 7
the GXKL Or 7112 RROISTHR Or D9ZD8. In addition, a cettitled sutvey, It-
available, would be helptul so as to avoid delays of the reviewing process. if
the deed detcrlptlon tolerances to a Cettlfled eucvey Hsp, the Cattlfled Survey
Hap shall also be required.
A
PROPERTY OWNER CERTIrICAT10H
I(ve) certify that all statements on this form are true to the best of my (our)
k novItdgeI that t (we) am (are) the owner(s) of the property described In
thIa Intotmatlon form, by virtue of a warranty deed recorded in the office of
the county Regltter of Deeds 85 Document Ho. 1 and that I (ve)
presently own the proposed alto tot the flowage disposal system (or I (wt) have
obtained an easement, to run with the above described property, tar the
conettuctlon of said "yatem, and the same has been duly recorded In the Oft►ce
o the Coynty Register of Deeds, ON Document Ho.
Signature of Ow ec elgnatuce of Co-Owner (it Applicable)
(a ( q3
Date of llvm4turs Data of Signature