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HomeMy WebLinkAbout030-2003-80-000 Q o N ° p °r of ~ I o O c ~ I 0 ~ I b ~ I I j O a z c 7 t6 LL c O Q M Z O NI o ~ v Z > m a°i Cl) (M 7 a m m F- U) c o j o z :1' c v y Z v ° o c ~ -p I v M '0 0) N U) N -~7 C O c O o d w N ZF-Z I z . w~ y c Z4 E' co N is a co C o D w m c `O 'o c a ` °O °O U ~ N N V) (n E Z H F- H v w~ N 3: IL (n c 0 0 0 Z o o l 0 CL CL IL a 4j Cl) Cl) N O N 2- 1 ~ N J f6~ ° } O) LO o rn V N M N • m N CL M ~ 'O y N cs1 O li 7 l0 O ° ~ m N H I 0 3: f9 N C CC O Q O U O N C E (V W 2~ O C Q 's d. O O L. M O. C E N N O r M C N O O M In ~E N L 2 O h m -o c m Cl) • ,.a M M E C p~ O V) O E to U O L. O co N Q O Z In Z= In CQ v C~ it a m a L CL CL 4) tt~~ w C A ci n. g O in 00 4 07/16/2007 10:52 AM Parcel 030-2003-80-000 PAGE 1 OF 1 Alt. Parcel 33.30.19.365A 030 - TOWN OF SAINT JOSEPH ST. CROIX COUNTY, WISCONSIN Current X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - ANDERSON, MICHAEL D MICHAEL D ANDERSON 513 BIRCH LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 513 BIRCH LA SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 5.356 Plat: N/A-NOT AVAILABLE SEC 33 T30N R19W W 1/2 SW 1/4 COM SW COR Block/Condo Bldg: SEC 33, TH W 57.61 FT, N 628.97 FT, N 87 DEG E 120.15 FT, TH N 44DEG E 444.26 FT, Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) N 1 DEG E 251.23 FT TO POB CONT N 510 FT 33-30N-19W E 449.08 FT, TH S 509.78 FT, TH W 466.26 FT TO POB Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 973/173 07/23/1997 824/292 07/23/1997 519/35 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.360 101,500 184,300 285,800 NO Totals for 2007: General Property 5.360 101,500 184,300 285,8000 Woodland 0.000 0 Totals for 2006: General Property 5.360 101,500 184,300 285,8000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 134 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges 00 Total 0.00 0.00 f t STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER JI C~~ L~ L I ~I /C. S~fAl ADDRESS SUBDIVISION / CSM# LOT # SECTIONT~30 N-R_49 W, Town of S T[1~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM CAA fjp~S~ - S X ~7 1 l~ ew' I Opp INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. • r BENCHMARK: _Zoe ©t= ST . s= r Z-2/1/a-7 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING.TANK INFORMATION Manufacturer: 1JJtr Liquid capaci:ty:_ Setback from: Well House Other Pump: Manufacturer NA Model# Size Float seperation AL/ Gallons/cycle: Alarm Location &A :SOIL ABSORPTION SYSTEM Width: Length_ Y2 Number of trenches Distance & Direction to nearest prop. line: E.4sr p ' Setback from: well: House Other ELEVATIONS Building Sewer O 2) ST Inlet. (jam ST outlet PC inlet PC bottom Pump Off Header/Manifold "7 Bottom of systemTV~yd Existin Grade 90 g y Final grade iW,L' y DATE OF INSTALLATIO • PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93 : jt ounty: Iv~'W art4X,5fI49,§ 'PH 33.30.IWIVj► hj0Abj~SYSTEM , 52ND S Labor and Human Relations INSPECTION REPORT Safety and Buildings Division Sanitary PeST- CROTX rmit No.: GENERAL INFORMATION (ATTACH TO PERMIT) - 193434 Permit Holder's Name: El City Village ❑xTown of: State Plan ID No.: eT O P ST-J BM Eev.: Insp BM Elev.: BM Description: Parcel Tax No.: l 0 -2003-80-000 TANK INFORMATION ELEVATION DATA A9300094 4 f 3©/R'z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark % K/ ~CG', Irk x Dosing l L.~,CyT ~lo~2~ Aeration Bldg. Sewer Holding St/ 0Y Inlet / 162 G TANK SETBACK INFORMATION St/ Ij* Outlet 1 177 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic l , NA Dt Bottom Dosing---- NA Header /bra. r - Aeration NA Dist. Pipe Holding Bot. System E a7_233 cf(o'7G PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Loss Fi a Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of T nches PIT_. No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN EACHI Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM L CHAMBER Model Nu INFORMATION Type O /l eu~ i OR UNIT System: ~L✓??C DISTRIBUTION SYSTEM Header LMa~ Distribution Pip~e(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 2 Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center - t.; g~}YTrench Edges J, Topsoil ❑ Yes ❑ No C] Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 33.30.19.365A,SW,SW, LOOT 7, 52ND ST. Plan revision required? ❑ Yes [pNo Q 9 Use other side for additional information. Date Inspectors Signature Cert. No. SBD-6710 (R 05/91) ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: LHR SANITARY PERMIT APPLICATION . In accord with ILHR 83.05, Wis. Adm. Code COUN ~.o..~.,..,..,. STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ® /9.~? y 7 8% x 11 inches in size. Check if revisi n to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION /G e WY4. %,S 33 T 64N,R tl -QOQ W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # TN CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY NE EST ROAD ❑ State Owned 0 VILLAGE RLTOWNQF ❑ Public X 1 or 2 Fam. Dwelling-# of bedrooms a PAR ELT NU ERIS) III. BUILDING USE: (If building type is public, check all that apply) 6 Rd, 0,? 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 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. rv 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 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (s q. ft.) (Gals/day/sq. ft.) (Min./inch) 961 ~y ELEVATION 11,5_0 57o 40 ?0 . Feet 98 ~/Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. ew glass Plastic App INFORMATION N istin Gallons Tanks Manufacturer's Name Concrete Con- Steel Tanks Tanks structed Se tic Tank or Holdin Tank 3 tie) P` 1 L] _X~ 0 1 Fj Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu is Signature: (No Sta s) M P Business Phone Number: ber's Address (Street, City, State, Zip God Plum 6S6 OALLEr- Olelw 7-If IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature stamps) Surcharge Fee) Approved ❑ Owner Given Initial , Adverse Determination w X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-8398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 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. Itt( _ 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement.-Installing plumber is to fill 'in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. - SBD-6398 (R.11/88) II i S 64: 914 Fo f9 s 16 R N T N PA - C3 I 3 w Fo c ` h p- s r vo I a) R po I o - te, \1-1100T I-TT J f F_ r ' u G oo~ i r i l I i _ s I t5 - ~ l i l i t I r , . : _ coo 2 0 i /t j I it G ; p I ' I I , I I i I c~ I it- t , , f ~ f T , t. I I p I j t ~ I_ -~'Q - - - - t- I I 11 If i ~ r I ~ I t + o I : f „ : I ~ I { ; I ~ r _ r I 1 II r I - I - - I _1 i S' T Tp i I _ ' I i I ~ i + I 1 I- I ; i 1 j I I i I 5"1-3 cis 44,oo$ ~ - } I ~ { ~ ~ ~ I I; I j { I I _ ~ j ~ - - i j ~ ~ i - - I j ' _ ~ ! ~ i _ _ - _ _ i f i. ~ ~ i i ~ ~ i ~ i I i . i i ~ { ~ ~ ~ r i , ~ J j : i ~ l j ! ' ~ ~ ~ i ~ I j ! i j 1 - ~ I - I _ i -r I i ~ ~ I _ ~ _ ~ i . T ~ _ _I ~ _ L _ _ _ - - ~ - V i . ~ j i i ~ - i ~ ' 1. _ i ~ 1 ' ~1590'ann De nt of ndHumanR lations use' SOIL AND SITE EVALUATION REPORT Page of Division of,Safety 8 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 St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 30'~ U "Uza6 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Vi-chael Anclerson GOVT. LOT S1,7 1/4 Sjj 1/4,S 33 T 30 ,N,R 19 Rijor) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOC K# D. NAME OR M ()T ez~U Q 5026 4th. St. 7 n/a Rex Meyers f~L ~y l'iiBSTon TJI. 5401h ZIP CODE PHONE NUMBER []CITY ❑VILLAGE ~f0 AREST ROAD (715)386-8356 St. Jose h Pirch 1-n. [ *New Construction Use [4 Residential / Number of bedrooms 3 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 • f trench, gpd/ft2 Recommended infiltration surface elevation(s) 96.74-94.90 ft (as referred to site plan benchmark) Additional design / site considerations step trench systerai Parent material outwash Flood plain elevation, if applicable n/a ft S = Suitable for system CONVENTIONAL MOUND 71N-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for s stem S❑ U L❑ U ❑ U C❑ U ❑ SU ❑ SU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BouxJary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-11 10yr3/3 none L. 2/m/gr rlvfr g/w 2/f .5 .6 2 11-40 10yr4/4 none scl 2/m/shlk mfr C)-/W 1/f .5 Ground 3 40-84 7.5yr4/4 none S. 0/sg inl n/a n/a .7 .8 elev. 100.1#x, Depth to limiting factor 2 Remarks: Boring # 1 0-9 10yr3/3 none I,. 12/m/pr mfr Ow 2/f .5 .6 n% 2 9-24 10yr4/3 none sc_l 2/m/tr mfr g/w 1/f .4 .5 3 24-34 7.5yr4/4 none s_l. 2/rn/shlc mfr g/w 1/f .5 .6 Ground elev. 4 34-82, 10yr5/4 none ,a. S. 0/s; ml. na/ n/a .7 .8 100. 24 ft. Depth to limiting jj factor X82" cam:. Remarks: CST Name:-Please Print CarY L. steel_ Phone: 715- . . Address: 155- 4 200 Ave . , P w chmond , Wi. 54017 'cam v Signature: Date: CS 6-15-93 cstm Tl~.e PROPERTYOWNER Michael Anderson SOIL DESCRIPTION REPORT Page of,L_ ! PARCEL I.D. # Boring # Horizon in. Depth Dominant Munsell Color Qu. Sz. Mottles Cont. Color Texture GrStr SuctuShre Consistence Boundary Roots G Bed TrePD/ft . Trench 0-6 10yr3/3 none L. mgr my r g/w 2/f .5 .6 2 h-20 10yr4/4 none scl 2./m/gr mfr g/w 1/.f. .4 .5 Ground 3 20-84 10yr4/4 none Co. S 0/sg ml n/a a/ .7 .8 elev. 98.40 ft. Depth to limiting factor >84" Remarks: Boring # .5 6 1 -9 10yr3/3 none L. 2/rn/gr mfr r, ml g/w 1 f 4€ 2 9-26 10yr4/4 none S. 0/s,-, 3 26-80 10yr5/4 none Co. S. 0/sg ml n/a na/ .7 .8 Ground elev. 96.74 ft. Depth to limiting factor X8011 Remarks: Boring # .-::;::1 0-10 1(~r3/3 none L. 7./m/pr mvfr g/w 2/f .5 2 10-2.0 10yr4/4 none scl 2/m/gr mvfr g/w 1/f .5 3 120-31 10yr4/4 none TES 0/sg mvfr g/w 1/f .7 .8 Ground elev. 4 131-82 10yr5/4 none Co. S. 0/.sg ml n/a n/a .7 .8 95.50 ft. Depth to limiting factor >82" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05192) PnOPFOY OWNER M i c laae. _ l_ -AfOe _ rso _ aa 2 3 _ SOIL DESCRIPTION REPORT Page of PARCEL I.D. tt Poring I lorizora Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench l 0-6 10yr3/3 none mgr my r g/w 2/.f 5 7. 6-2.0 10yr4/4 none scl 2/m/gr mfr g/w 1/.f. .4 .5 Ground 3 20-84 10yr4/4 none Co. S 0/sg ml n/a a/ .7 .8 elev. 98.40 tt. Depth to limiting - factor i >i34" - Remarks: Boring # 1 0-9 10yr3/3 none L. 2/fn/gr mfr g/w 2/f .5 .6 4 2 9-26 10yr4/4 none S. 0/sg fat p 7w f 3 26-80 10yr5/4 none Co. S. 0/sg ml n/a na/ .7 .8 Ground - - - elev. 96.74 ft. - - Depth to - limiting factor > t 30" Remarks: Boring # 1-10 10yr3/3 none L. 2/m/gr mvfr p/w 2/f . 5 12.6 2 10-20 I.0yr4/4 none scl 2/m/gr mvfr g/w t/f .4 E.5 3 20-31 10yr4/4 none TES 0/sg nrvfr g,/w 1/f .7 .8 Ground - elev. 4 31-52 1_0yr5/4 none Co. S. 0/.sg nLl n/a n/a .7 .8 95.50 ft. Depth to limiting factor - >f;2„ Remarks: Boring # Ground - - - elev. it. - Depth to - - limiting factor - - fiernark~: _ snn essotft o/sat 1 STEEL'S SOIL SERVICE 155 200th- Ave, Gary L. Steel; C.S.T. 2298 New Richmond, WI 54017 MPRSW-3254 Michael Anderson (715) 246-6200 STJ S~]% -T30N-MW 933 town of St. Joseph 1_ot #7, Rex Meyers addn/ r .Y ti..r. 51.7, l 2 2- ~ 3 ~ 50` ~l -~1 ~0~ Ezz. , N SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SA ITARRMIT -Attach complete plans (to the county copy only) for the system, on paper not less than L/ 8% x 11 inches in size. ❑ Ctl~Ck f revisio16. n pre ions application wee reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Mt 0, Id A '/a, S T30, N, R W) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 711 S , CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER t - jg S II. TYPE OF BUILDING: (Check one) El State Owned O VI LAGE ' NEAREST ROAD EXI ❑ Public VX1 or 2 Fam. Dwelling-# of bedrooms - P AR EL X NUMBS ) III. BUILDING USE: (If building type is public, check all that apply) Q IQ -.2 603 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 4 ❑ Church/School 8 ❑ Mobile Home Park 120 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 5.0 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 N 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 5-63 6_ is 70 s e DM Feet Feet VII. TANK CAPACITY Site in alions Total # of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New istin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Hoidin Tank i _11_d~l Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu is Signature: (No S m s) MP PRSW N Business Phone Number: 1 Plumbers Address (Street, City, State, Zip Code 5c16 (2AZijqX &Arw 7T_ S~ O 9 IX. C LINTY/DEPAR ENT USE ONLY ❑ Disapproved S nitary Permit Fee (Includes Groundwater Date Issued Issuing Ag nt si atur No m F-1 Owner Given Initial Surcharge Fee) Approved Adverse Determination Q(~ d--- 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 sbnitarX_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, 6W266-3815. 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 serded- Checkonly one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% X 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; *elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a-115 form; and F) all'sizing information. GROUNDWATER' SURCHARGE 1983 Wisconsin Act 410 included the creation, of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigationrand establishment of'standards. e. SBD-6398 (R.11/88) . SAFETY & BUILDINGS INDUSTRY, OF REPORT ON SOIL BORINGS AND INDUSTRY, DIVISION P.O. BOX 76 HUMAN RELATIONS ,H.UMA ANa PERCOLATION TESTS (115) MADISON W153707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP FPRi~T'}° LOT NO.:BLK. NO.: SU IVISION NAME: rrx x/45 w a 1 /T_ ) N/R/ 9 E4 u St .J p s e s COUNTY: 0V1f fFZ'E/BUYER'S NAME: MAILING ADDRESS: roi "J USE DATES OBSERVATIONS MADE rr~ NO. BEDRMS.: COMMERCIAL DESCRIPTION: r~ I PROFILE DESCRIPTIONS: ER CATION TESTS: 25Residence Z]New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system 041 2 _5~ C a CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) CAS ❑U E ❑U QS ❑U ❑S EU ❑S ©U Ire OT required DESIGN RATE: If an y portion of the tested area is in the 5)(b), in dicate: 'ill in /`t Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL LEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN,E OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ` , C~ /c ly J4. n, cr/s cr 7-0 B- 03 1 B- ~ 02 36 y . 7 J2 Z; o ~ B- 102 fir',. J7 1/D2 G'crs Y< 5; 1, 7. A 9 0 AF/1 CV:, B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER PER INCH P- P- P- WP 3A eu1 S /C,M Irr / i LIU e/P .20 i C,~ -~f Q 5 P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 7, ol Sc - / D 7 ,0s r~ e W , E I, the undersigned, 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 the location of the tests are correct to the best of my knowledge and belief. NAME (prinTESTS WERE COMPLETED ON: ADDRESS: CERTI IC TIO NUMBER: PHONE NUMBER (optiona-0: CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - L IN 'T "-AS FOR COS4 PLEPNG l 115 - RD To be a core test, your report r l' ~ Carnple,e' s is t3 Fss 4,r cornwe' c>al >rc ject; 2. The use 3_ INIAXl` U1, use l 4. Is f his a ALL z Co > SU i 'X 6, PL-N) f. A y ' 10, 11 12a M._` ILL- "I"HE LQC - F COMPL_ F ° "T[ _n Textures asats cot t 3.,1 I ; SC a t TO THE OWNER: This soil test report is the l first step in securing a sanitary permit. The coui i; or the Department may request verification of this soil test in the field pric t.- rnit issuance. A cot . of plans for the private sewage system and a pert-nit application r t 1 _.ithority in order to obtain a permit. The sanitary permit must ! . of any construction. S T C - 105 . SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER_ ADDRESS __I 3 !!7: Ia h P FIRE NUMBER- Ir S/3 CITY/STATE Au SUrt LtJ~SL~ ZIP_ S~I~L,~, PROPERTY LOCATION: W 1/g,, ~l 1/4, SECTION TOWN OF S- cc_-/)~ , St. Croix County, SUBDIVISION -16)c /`9CYk23 , LOT NUMBER 7 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 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/Iqe, 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 Co. Zoning officer within 30 days of the three year expiration date. SIGNED: (k_- DATE:-- St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 STC-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 Ia 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 ///rci rA ~ ,J"p-r'spn Location of property C. 1/r 57,W 1/4, Section 33, T -30 N-R~9 W Township Mailing address `Z e-10 " St NOC4so el 6JI15;S l1 Address of site ~Ji c_S-L{ot,4 Subdivision name Lot no. Other homes on property? yesNo Previous owner of property _ JC'LvyiES ~y,►-?7~~; ~nnSS Total size of parcel 57. 3S-6 o c aj7g_-c Date parcel -was created /!j 9 'Are all corners and lot lines identifiable? ___X__Yes No Is this property being developed for (spec house)? Yes -X_No Volume. 13_~3 and.Page Number 11 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 & 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. _!MS's-14 , 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 County Register of deeds as Document No. signature of applicant Co-applicant Z ~ C( Date of Signature Date of Signature t DOCUMENT NO. WARRANTY DEED' THIS srAC[ RESERVED FOR RECOROlk* DATA r STATE BAR OF WISCONSIN FORM 2-196! 489556, r - v0t REt ,3i"~#NS OFFICE- James E. Janssen and Cynthia L. Janssen . J........-... husband' and wife, OCT06199 - conveys and warrants to ...?~?!41~I T1,•_-~t~dPsoi}~--_a single-.person at 10:00 k M t. 1 F 1 j Y how r..: _ ' Y R[TURN TO . K .fir .the following described real estate in Stt[-aoix.CoDnty' state Of Wisconsin „ ' w yrn t ,dt r,K.. a Tax Parcel No M s r r' rrRv v :try.' .r Yr R .t Paitior.: V2, of SPT`~/.4, og Section; 33 Townshi 30 Nkorth Ran a 19 West Sty Croix EJout1 isconsitr: described' as follows; Coanencing . at the South 1,_ scornof*,32;thence West along the South-line of Section 32 i R x sance ot'57 61a feebp thence North 628,97-feet.- thence N87o55'00"B.'` ~f 120.15 feethence,N44°48.00-E 444.26 feety thence N1041''00"E 251.23 feet r k to the int of be inni ° 3 Bo q ngl thence continuing N1 41100"E,510.00 feet;.thence -i East- 449.08'feetx,-thence SOo14'45-E 509.7$ feet; thence West 466,26 feet. ..N to, the point of beginning, ~ t . 1. Y i 2 A j~q !tiC iNtlVJr 'a. .a} 7e S ; ` I`J1 Zn\ 3(0SA f k ~ , - Vii- ~ 'i'•i -~s.~ .y "''+i3~,. r is not- w This homestead property:` ,nn [r iak (it not), ' Exceptioa to wasrantiea Subject to easements, reservations and restrictions of'record a October: Dated thla it, _ .7 day of i : 9 ' --.--...(SEAL) ` (SEAL) _ JAMS S: ------!I.SSEPI a w .1. _ _ _ (SEAL) (SEAL) M _ o...... CybjTFITa I.~_JANSSEAI. AUTHMNTI CATIOhi AC SNOWLSD(i>1[SNT - - ?±rz Signstnre (a STATE OF WISCONSIN Croix St - - - authenticated this nn _.day of 19 Personally came before me' this . day t...._.__ - as - October 19-92 the above named - - - - - - - - " ° James E. Janssen and Cynthia L. Janssen = - M; e. - - - TITLE: MEMBER - STATE - BAR OF WISCONSIN y t" (If not, authorized by i 706 06. Wis. Stats) - to e .k _ i . ho executed the f e sa e. p• THIS INSTRUMENT WAS DRAFTED BY . STEPHEN J. DUNL_AP . ' - °-Iiudson~..Wisconsin - l a - Nota' Pqi _ - _ •Q ' ,r. ....County, may be authenticated or acknowledged. Both MY I . - are not necessary.) 1 t, state expira date: Wis date: !r eNaar at Demons signing In say capacity should be typed or printed below their sicnatnre.~ '•i- -F' 1 , 1,t . F'w WARRANTY DIED STATE RAIL Of WISCONSIN • Wisconsin Leflal Blank Co., Inc. FORM No. 2 - 1082 uu...•.~... L ;S;;Qk; rtgeTritof`~i kyPH Labor and Human Relations 3 3 3 Q Safety and Buildings Division [ S~ A(j~ S'WWEM• 52ND S GENERAL INFORMATION INSPECTION REPORT ounty: Permit Holder's Name: (ATTACH TO PERMIT) Sanitary Permit No.: ev.. El City El village [k Town of: State Plan ID No.: Insp. BM Elev.: BM Description: TANK INFORMATION Parcel Tax No.: TYPE MANUFACTURER ELEVATION DATA A9300094 Septic CAPACITY STATION BS HI FS Dosing Benchmark ELEV. Aeration Holding Bldg. Sewer TANK SETBACK INFORMATION St/ Ht Inlet TANKTO P/L WELL BLDG. ventto St/Ht Outlet Air intake ROAD Septic Dt Inlet Dosing NA Dt Bottom Aeration NA Header / Man. Holding NA Dist. Pipe PUMP /SIPHON INFORMATION Bot. System Manufacturer Final Grade Model Number Demand TDH Lift Friction GPM Forcemain System TDH Ft H Length Dia. a SOIL ABSORPTION SYSTEM Dist. To Well BED/TRENCH Width DIMEN I N Length No. Of Trenches PIT No. Of Pits SETBACK SYSTEM TO DIMEN I N Inside Dia. Liquid Depth INFORMATION T ype O P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: System: CHAMBER DISTRIBUTION SYSTEM OR UNIT Model Num er: Header /Manifold Length Distribution Pipe(s) Dia. Length x Hole Size SOIL COVER Dia. Spacing x Hole Spacing Vent To Air Intake x Pressure Systems Only xx Mound Or At-Grade Systems Only Bed /Trench Center Depth Over Bed /Trench Edges xx Depth of xx Seeded/ Sodded COMMENTS: (Include code discrepancies, Topsoil xx Mulched ❑ Yes ❑ No ❑ Yes ❑ No LOCATION. persons present, etc.) ST. JOSEPH 33.30.19.365A,SW,8W, LOT 7, 52ND ST. Plan revision required? Use other side for additional infYes orm no SBD-6710(R 05/91) EITI Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I ' I I I I yt Cr ~ _ I , I I I I I I I I _ I - _ I I I , I I I I I I I , 0 I I I ' r I / I i I , r I I I ~ I I~ I I i I I I , t ~~R ~ II I I _ II I j_~ ! T A b I ; I F° C I " ' t ~ I I iI I I o j I I ~ I I I i i i T` 4 ~ ~ R Pos' I I I I I r$e I I I I ens I j i I i I I ~ _ I I j I I I I i l ~ I I I I I I I I I I I .IY i t ~ I a I II I j i o i o I I ~ ~i f ~ I I i 1 I ~I I I I ! I I I I I I I_ LI I'._ rtit FI 1 1_f F I._1.1 t a i _ Z ~ L iTl i-, 7. - ~~_11 I. a..T _l. _I; 1`I ~ i i I I_I +,II i 4 i I - --i i I I 'I-1 - - 1. _I_rl. I i I~- I ~r I {I ~'T S) ~h lane f Q f i E I • ~c~crya e'. t~ ~ T hc~s~ i i i -e s f i e 4, f7 N. 366 C. i