HomeMy WebLinkAbout030-2079-20-000
0
~ °o 0
3 O 3: c>
p E9
d Sc cu w
M C O 0
C E O
r, m
CL c
O -0 c6 c0
N c'n iN -co C
r m CU) O m m N
N c X(1) N C
L O
C C N LL
.Q U p r- ` O 00 m
z- co co 4 C
Q w cu co to O O c
:i N CO N O C N d
° a
n c o m (D p
-02Q)
cN0 E 02 m'
(D Ln L) a) -Fo .0 cn
F. N E E c m c
U) au
cci y
n 3cn co
y3
Z 1 0-6 'p b c Y c
c c LL y c O c D p
m
7 B N
O O m
7 m C O_ -
LL -0 = m - 3 U. c m O N
co O 07 _ .~w0--. N L
S2 C:, Q) '6 E a 0 7 c 'C7 N> C
'B O a 0 0 0) N 'O O
a H co (n CL E a U~>
U
Cl) O M
V
> Z N 01
O > E E
_ O
2 t £ OL E O
z a m a m
M 0M >
0 2 d c
U a o N o N
Z d C
N N F- O' p O
c
c E E
y
'0 _
~y7 f a~ m
N M N C J
N O LL N
U Cl) N
O c C O
z°mz z° t F- z
O
N ~ d
FQ E
U) £ > H is C
n1 y _ ` C~ y ` Q
O O. . (D CL CO
C ) 0 (0 N y Vi d i
-
Y o'oca °oea ~.E
ID LO :3 0 L)
§
O O O ~I ~ O O O
• rv c a a a o a n. a
m 00 00 I T- a) 0)
fA J U r } N O-
O } M to 00
IM~~ O N ! OO M N O O m
a N N
'd 00 00 m 0 C) M_ N
0 r-
CL 0)
m) N
O n N -p
r .-4) a)
4) ol
O M 7 e+ MO 7 w
C) c N
c N C I C+
O 3 ON 0)
O O Oi c c c CO c0 00
4 o o r I o yi w° ) Oo 00 0) 00
C: a CL
} N O O E E A N N: N
V N
O N N m c c O O c 6) M O N 1: M wr
❑ Cc o o E y c: 0
p Z N H FL c E2 CO - m - m E M v E E U
• y„' co co cn Y W In = Fp- W - 0 n cn
ik w I E
V~ 4) m a a
5 EL L: L: (D
• a m N m C
C tpia5 ONV 0UC)
1
ti I
R' O N O
N ~ 0
d
h c
op
O
O
N
l~ I L
o I '3
oii d
.o w
v
O coo
U
/ t0
I C
0 N E
Z o ~
o a
z m
m E
aO I o m~ C~
o
3
o a
E
U
(0 M
d a
N
O z = O
z
N W d m
z
C
0
O z a c
Q~ o w
a0i N
z °
U) r•- li rn a z
m E '2
U E M
N
•IV `p O
L_
76
O z C z
N z
w° y E c
N i l6 ~ ~ N
.5D CL 0 c
0 0 a` m o
E E
M C-4 _w
•N Iaaa. z
N
IL
7 O fA 0 0) (D
y
~y U) J CU -c rn m }
V :1
= O M O
N
LO 0 O 0 E N
J O O j -0 = M
a N
.he
` m W C O
Ica a O d Q <n N
Cl) 0
O O ~ y C
N co to
O C cc
V 0 0 0
rO op ~p ~o 0 O C -0 N N N
W ! O y M N o W w O N N
-0 a) CO
~ O V) N O N C to 0
• rl N~
• L M O Vt p t6 v
O = H cn 0 z ccc rL (n
.fir I w
V
sk a m CL
L:
_ - 0 a
'
M ,v
• ~ m m y c
_
E c c
y
r A U as 2 j 0 N U
AS BUILT SANITARY SYSTEM REPORT
OWNLtR kL-1 l 1~?s~', , TOVNSHIP ~ SEC. T l)N, R_jjj
.Q. ADDRESSLr,,~r~f~~'a,;,,/ , ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE t 8
PLAN VIEW'
-Distances dimensions to meet requirements of H62.20 f
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
4
7
SEPTIC TANK(S)MFGR. CONCRETE STEEL
NO. of rings on cover Depth " DRY WELL
TRENCHES NO. of width length area
BED no. of lines ,2 _ width , length area `
,depth to top of pipe'
AGGREGATE
PERK RATE AREA REQUIRED 6 AREA AS BUILT
ley
Disclaimer: The inspection of this system by St. Croix County does not imply complete
s compliance with State Administrative Codes. There are other areas that it is not possible
to inspect at this point of construction. St. Croix County assumes no liability for
system operation. However, if failure is noted the County will make every effort to
determine cause of failure.
k GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
.,INSPE / /~-4-
,Y PLUMBER ON JOB
DATED
LICENSE NUMBER /5i`~
REPORT Or ITTSPECTION--I14DIJIDUAL SET,4AGE DISPOSAL SYSTEM
Sanitary Permit
~j - State Septic JS~
f L G i l l ~:C~ It ~~`i
TOWNSHIP
• t Croi- County
SKPTIC TA'T1:
Size '1-61G LG-
gallons. 'umber of Compartments
Distance From: Well ~ ft. 12% or greater slope r~ft.
Building' 2 ft . Wetlands f
11ighw3ter /V /ht,
DISPOSAL, SYSTEH Tile Field or Seepage Pit(s) 79- Distance Fr m: Well - J70 f ft, 12% or greater slope A ft
Building ft. Wetlands
FIELD 4
4~ Highwa ter
.
ft.
0
Total length of lines ! ft, Humber of lines Length of
each line 2 ft, Distance between lines ft. Width of the
trench - _ft. Total absorption area 2- sq, ft. Depth
of rock below the n. Dp-pth of rock over tile Z_ in.. Cover
_ ..over.. rock , Depth of tile below grade in. Slope of
trench ~ rnnner 100 ft. Depth t;o Bedrock
ft. Depth to
ground water ft.
PITS
Number of nits Ou s' ~ ianeter ft. Depth below inlet
ft. Gravel around ' t yes no. Total absorption area
sq. ft.
Square feet of seepage tree ottom area required
40
:square feet of see ge nit r uired
Inspected by:
Title:.
Approve Date 1971
Rejected Date 197 .
EH 1, 15
r WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON/SOIL BORINGS AND PERCOLATION TESTS
LOCATION: Section T~N, R 1 *(or) W, Township or unicipality
-33
l~
Lot No. Block No. County
ubdivision Name
Owner's Name:
y Al-
Mailing Address: l
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS 2 7 7 PE C LATI N TESTS
SOIL MAP SHEETSOIL TYPE
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 AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P-z. ~o << Jud S s s
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B-> 7 54
As- Q~ 6- - SL -!P
B_ 4-4m-%Zfr & - -?G s
S
B- f Fs G S L fr -7 C S
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet o suitable eas. Indicate number of square feet of absorption area
needed for building type and occupancy. Indicate scale
or distances. Give horizontal and vertical reference pp As. ts. Indicateslope. AM
4
61 f-,
~N
i
i
O i
O
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 location of test holes are correct
to the best of my knowledge and belief.
Name (print) l} P-101ii.&J L ii- Certification No. 3 f
Address
Name of installer if known
CST Signature _e:e~
COPY A -LOCAL AUTHORITY - - -
..a iounty State Permit #
_ County Permit
Permit Application
Y ` for Private Domestic Sewage Systems County -Jr
TATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: 4j '/o, Section 3, T36 N, R / E (or) W ot# Cit
Subdivision Name, nearest road, lake or landmark Blk# V' lage
Township
C. TYPE OF OCCUP WNCY:Commercial Industrial *Other (specify) Variance
Single family- Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES NO Foo aste Grinder YES # of Bathrooms
Automatic Washer AYES NO Other (specify)
E. SEPTIC TANK CAPACITY Total gallons No. of tanks
"Holding tank capacity Total gallons No. of tanks
New Installation Addition Replacement _ Prefab Concrete
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) ..7 2) 3),_5 Total Absorb Area 4~S sq. ft.
New Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth _ Tile Depth No. of Trenches
Seepage Bed: Length Width- Depth Tile Depth No. of Lines 1
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land /-2-m 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 Cued Soil Test
NAME _ C.S.T. and other information
obtained from (owner/builder).
Plumber's Signature MP/MPRSW#~-Phone
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 U E ONLY p
Date of Application 2 Vees Paid: State Q o Co nt ate. y o
Permit Issued/ rN (date) uin9 Agent Name
s
Inspection Yes o Valid# Date Recd
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
I
a3liVIdNri
Z6'6ZZ 1 M,,SS,ZSo68 N
,02,909
~oop6 ~ ~ co ~ t+
z pc
/ c5 ca 4
m
w ~ o
O
O
O ~ Z Z
O
p O Q• 90
c,n ~,p O Z b tra
rri
z
Q
,01'OSS 4
3 ,OV,6bo68 S
l
i
Z
O
O
0
W
£i °
0 W
O O
O O c
O rn
' C
:Z
(D • C°
W' ,S9'9~S
o.
ti
1
Wib'fg;~nsidn Human Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
La Rel ations
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 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. wo-f
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVI E
OPER PROPERTY LOCATION
John Everson GOVT. LOT SW 1/4 SW 1/4,433 T 30 IR 19 i°f) W
PROPERTY OWNERS MAILING DRESS LOT # BLOCK # SUBD. NAME OR CSM #
1203 Red Oak Rd. n/a n/a n/a
Hudosn E 016 ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MWWN NEAREST ROAD
( ) n/a Joseph Red Oak Rd. _j St. [ ] New Construction Use: ] Residential / Number of bedrooms 3 [ ] Addition to existing building
jx] 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 .2 bed, gpd/ft2 .3 trench, gpd/ft2
Recommended infiltration surface elevation(s) 96.92 ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material outwash Flood plain elevation, if applicable n/a ft
S = Suitable for system CONVENTIONAL MOUND 7IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem RiS ❑ U US ❑ U US El U Eks ❑ U ❑ S 6JU El S 42 U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BoLUxfty Roots GPD/ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr&
1 0-14 10 3 2 none L. /m/sbk mvfr c/w 2/f .5 .6
4~ 1
2 14-33 10yr5/4 none sil. /f/sbk mfi a/w 1/f .2 .3
Ground 3 33-94 10yr5/4 none S. Wsg ml n/a 1/f .7 .8
elev.
10 _5 7ft.
Depth to
limiting
factor
>94
Remarks:
Boring #
1 0-12 10yr3/2 none L. 2/m/sbk mvfr c/w 2/f .5 .6
.
2. 12-32 10yr5/4 none sil. 1/f/sbk mfi a/w 1/f .2 3
3 32-94 10yr5/4 none S. O.sg ml /f .7 .8
Ground
elev.
Depth to ' 0 5 limiting
factor
X94 y ,y
e v
Remarks:
CST Name:-Please Print Phone:
-246-6200
Address:
1554 2 Richmond, Wi .54017
Signature: Date: CST Number:
10-24-92 2298
f
PROPERTY OWNER John Everson SOIL DESCRIPTION REPORT Page? ..4 3_
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw&
n 2/f .5 6
3
2 -34 10yr5/4 none sil. 1/f.sbk mfi a/w 1/f .2 .3
Ground 3 4-84 10yr5/4 none co.s. 0/sg ml n./a 1/f .7 .8
elev.
99.92 ft.
Depth to
limiting
factor
Remarks:
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 T--T
Remarks:
SBD-8330(8.05/92)
I
STEEL'S SOIL SERVICE
Gary L. Steel 1 ~4 th. Ave-.
C.S.T. 2298 John Everson New Richmond, WI 54017
MPRSW-3254 SW4SW4 S33-T30N-R19W (715) 246-6200
St. Joseph, township
/oD '
gilt-
~1 .
e~
QC
T
I I 1z0 r k
S,.\ ~oe ~ofl~~
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS
SUBDIVISION / CSM#f'-,a JCS LOT # I,2-
SECTION__33 T-30 N-R~_W, Town of 57, Zy rUff
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
1) Ptvc
oD
f
Cx117/N(r
f
V e)vc#e~ t 1~
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: aAlL QUTA~ Liquid Capacity: /Qa__)
Setback from: Well House Other
Pump: Manufacturer /((A Model# Size
Float seperation &,4 Gallons/cycle:
Alarm Location_ NA
;SOIL ABSORPTION SYSTEM
Width: Length 5-9 Number of trenches f
Distance & Direction to nearest prop. line: SOUZ-/y a °
Setback from: well: House /L10 Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet &A - PC bottom A ("A Pump Off /I_
Header/Manifold '7,7, 21Bottom of system
Existing Grade fQD,5~Z Final grade Id 0 _g
DATE OF INSTALLATIO
PLUMBER ON JOB:
LICENSE NUMBER: 61
INSPECTOR:
3/93:jt
LsE~rc s;rtnSieTntof'I9WH 3 3.3 Q O111 2
75157)-c-'
• Labra d Human Relations 3PgqS% ROAD, L
INSPECTION REPORT
Safety and Buildings Division
No.:
CTx
GENERAL INFORMATION (ATTACH TO PERMIT) sanitary 193427
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
CST BM E ev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
C~ ~rJ G .1 Y~.v F a S ) a
c,
030
- - -
TANK INFORMATION ELEVATION DATA A9300086 61AR0193 = 9prr-
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 7' Cv'
,
Dosing
Aeratio Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Airinta to ke ROAD Dt Inlet
rl
Septic >/GZ, -f)o, 4: NA Dt Bottom
Dosing NA Headere W 9 g7,
Aeration NA Dist. Pipe 9. S3 97
Holding Bot. System 7
y
PUMP / SIPHON INFORMATION Final Grade
Manufactur Demand
Model Number GPM
TDH Lift I Friction System T Ft
Loss Hea
Forcemain Length Did. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width r Length / No. Of Trenches P T No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 57 DIMENSIONS
SETBACK
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING aINFORMATION Type O CHAMBER Mode Nu
System. ny,~ ,~,/Ct~) ~i' OR UNIT
DISTRIBUTION SYSTEM
Header/ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length < Dia. Spacing -ILL
SOIL COVER__ x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over „ Depth Over xx Depth Of xx Seeded /Sodded xx Mulched
„
Re~aTrench Center 94e.4 /Trench Edges ~3 Topsoil E] Yes E] No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: ST. JOSEPH 33.30.19.669,SW,SW,RED OAK ROAD,LOT #12
1
SBD-6710(R y _CPlz nX isireq " red? Yes D, NO
Use`6ther side for additional information. ~O 05/91) Date Inspector's Signature Cert No.
a-
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
T
{
e,
. SANITARY PERMIT APPLICATION
V 01LHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than /t?S U a
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.
PROPERTY OWNER PROPERTY LOCATION
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
L9,03 'D O e 07
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME O SM 7~~_
UJ/ • G
11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD
❑ State Owned VILLAGE : ,v- EO euf< O
❑ Public VVN1 or 2 Fam. Dwelling-## of bedrooms -1 PARCEL A NUMBER( S)
111. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo 40-30 -.2,017 9
a
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. ❑ New 2. Z 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) O ELEVATION
YO 563 590 9G. Feet /0 Feet
VII. TANK CAPACITY Site
in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New xistin Gallons Tanks oncrete structed glass App.
Tanks Tanks
Septic Tank or Holdin Tank
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): Plum r' Signature: (No Stamps) MP/ RSW No Business Phone Number:
DWAVIAr C~,1_A1?,1;17_ -32 6- -66
Plumber's Address (Street, City, State, Zip Code):
r`
IX. CO NTY/DEPAR ENT USE ONLY
❑ Disapproved San ry Permit Spe (Includes Groundwater Date Issued Issuing pent signat
Surcharge Fee)
Approved ❑ Owner Given Initial
~W ( 00,
,A? Adverse Determination
/W4 _5/03
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. r. A sgit~ry 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.
Ill. 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.
Vlll. Responsibilitystatement. Installing plumber'is fo fhl 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)
i
I
} I ,E T d- ~ItcSi' i Alm j
c r
I ' ~
f
TT
,
~ ~ 0 6 6 Rg o w -
f -
:
57 If
-i-dr,-r-~
I ,
I C I ~ I; i I! E~ j
.
, 1 1
I 1
1 I
- - j
:
u.
~ I o
i
I_.
'
,
I t
R eocAlIZ I
T
l
,
I -
'
~ I I i ! ~ i i { i ~ ( ~ I I
I
f I
1
qe~
3 !
stegL
Irk
17* mil'.
r - /0 A ! 4f f } C S1~{'6 !Jr4 / ~v T _
j
,i l
I i
S~~z 41
: I i 1 I
_ _ _
~ ~ ~
: ~
i ;
:
i
r I
j I j ~ ~ _ _ _ ; . - -
1 ~ ~ _
:
1,; ;t
~ ~
: ~ I r
_ I { ~
1 I ~ I i
r ~
i
~ ~ ~ ,
. -
I
i ~ I ~ ~ ~1 I i I I
I
~
~ _ _
' - ~
i i j :
_ _
J i
i
i - - -
: ~ _ _
~ i ' ;
i i _
~ ~ -
_ . -
:
r t _ - -
- t- - _ _ ,
1 ~ ; _
i
.Y ~ 1,
x xis ~vtY~+d
i
Zo'
S 89°49'40" E ; 4
_ ,x k
536.65'
s'" GSM{
' y
,
-A, luk W.
1 1
• ~ ref..., k,
x?1~ s4
Y
S:..89 4 40 E.;
5 5 0 t.4'
• f _:_../.~r-~~4 fir,,
~ •C
CY Z M .G;<- Y
k r
14
,
00
`a. vi -r~ N 89?-52`~~~51,lW. 1 229,92 PLATTED
w `Z
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
=Human Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
St. Croix
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. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
John Everson GOVT. LOT SW 1/4 SW 1/4,S 33 T 30 N,R 19 )EAa) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
1203 Red Oak Rd. n/a n/a n/a
CITY STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [SOWN NEAREST ROAD
Hudosn, Wi. 54016 ( ) n/a Red Oak Rd.
[ J New Construction Use k J Residential / Number of bedrooms 3 [ J Addition to existing building
(xJ Replacement [ J Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd$ • -8 trench, gpd/ft2
Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate .2 bed, gpd/ft2 .3 trench, gpd/ft2
Recommended infiltration surface elevation(s) 96.92 ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material outwash Flood plain elevation, if applicable n/a It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK
U Unsuitable fors stem EiS ❑ U aS ❑ U as ❑ U RkS ❑ U ❑ S tl ❑ S x7 U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour-day Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend
011 1 0-14 1 3 2 none L. /m/sbk mvfr c/w 2/f .5 .6
2 14-33 10yr5/4 none sil. /f/sbk mfi a/w 1/f .2 .3
Ground 3 33-94 10yr5/4 none S. 0/sg ml n/a 1/f .7 .8
elev.
101 S2ft.
Depth to
limiting
factor
>94
Remarks:
Boring #
1 0-12 10yr3/2 none L. 2/m/sbk mvfr c/w 2/f .5 '.6
>tl
? 2 12-32 10yr5/4 none sil. 1/f/sbk mfi a/w 1/f .2 .3
3 32-94 10yr5/4 none S. O.sg ml n/a 1/f .7 .8
Ground
elev.
UU- 511
Depth to
limiting
factor
114
Remarks:
CST Name _Please Print Phone:
Qary L. Steel 715-246-6200
Address: i 4017
Signature: 1 Date: CST Number:
10-24-92 2298
r
PROPERTYDWNER John Everson SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
-
3 y
r
2 -34 10yr5/4 none sit. 1/f.sbk mfi a/w 1/f .2 .3
Ground 3 4-84 10yr5/4 none co.s. 0/sg ml n./a 1/f .7 .8
elev.
99.922 ft.
Depth to
limiting
factor
Remarks:
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)
I
I3 J^
1
(307 -10,"'1 /3 4 C K AL-AAl 6:-2
'TAIv At
,,A(K_
T ,,f
N ,ti
~k
Y
• J ~
a
s
STEEL'S SOIL SERVICE
Gary L. Steel 1~~4 th. e^
C.S.T. 2298 John Everson New Richmond, WI 54017
MPRSW-3254 SWbSW4 S33-T30N-R19W (715) 246-6200
St. Joseph, township
e~
` d~
r ~ Is
-40` 0 \oo`k
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
A
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
serving the cT qAt 'ELC s'0A[/ residence located at:
,S CY-) 1/4,~5U)-1/4, Sec. 33 T_,LLN, R-LZ-W, Town of
~Si, dO~ Pfaff Upon inspection, I certify that I have found the
tank and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced c7AN 2
Did flow back occur from absorption system? Yes_.&_No (if no, skip
next line)
Approximate volume or length of time: gallons minutes
Capacity:
Construction: Prefab Concrete Steel Other
Manufacurer (if known) : W'75C-4
Ag f Tank (if kn wn) : APPAOA
06,,VA(JIv scz /lyi'( f
(Signature) (Name) Please Print
it 92- 13E2 X3.20 5
(Title) / (License Number)
7- ~3
(Date)
Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes)
or Licensed Disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR-83, Wis. Adm. Code (except for
inspection opening over outlet baffle)
Name►N40/nI &#-11,117% Signature Y MP MP 3 r/
5/88
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER Ja ky\ 4 ~AXke_ Ev 1r no n
ADDRESS __L2(~1 7 R-_(A C JO, L CAA FIRE NUMBER
CITY/STATE _ t~1ucts0n Lk1 [ ZIP
PROPERTY LOCATION: 1/4 , 1/4 , SECTION .5Z , T_7j ZN-R_L7'_W
TOWN OF-S-+. ~C)S Q t
~ N , St. Croix County, % SUBDIVISION (`7Gt k. kY\ Dl I , LOT NUMBER 17-
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/Ile, 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:'- - (1
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), thenta 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 V0VNIA a
Location of•properl\ty 1/4 1/4, Section, T 3N-R~_W
Township _si. S ) L a Yl
Mailing address R c (`)0- Q
Ll Ac c) Lk~ - 5-(4 4 RD
Address of site R a no_ Rd
Subdivision name__ Cc K r~ n I I Lot no.
Other homes on property? yes_++ X No
Previous owner of property 3c~v in h Yti~ 4' . 01~ I ~l l'Gil►
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? --.s-Yes No
Is this property being developed for (spec house)? Yes „),No
'O'S 33
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 & 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. 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.
ry
gnature of applicant Co-applicant
Date of Signature Date of Signature
DOCUMENT NO STATE BAR OF W15CONsINL FORM t
A"~~) WARRANT! DEED'
J 366745 , VOL 618 PA%14 -335 THIS 8►AtE RESCPVCD FOR REGORGING DATA
tr r JJJ
' l
' r
ThiS Dged made between .-John L Cramer an$ REGISTERS OFFICE
' a --mela P.
.__Cramerj.._his wife, ST. CROtX CO., WIS.
r
Recd. for Record Ifik
' --Grantor
> . . S. Everson and- Julie- A,•.A erson,_._........ day of Oct• _~b. 19gp
husband and fife..as.--i' oint•.tenant:s----------------- at 3:30 P--aft
.
i .........................•---.._...............-•--•-----•-....-•-•--..--.........---........Grantee, 3amps , oohlr o D«d t
Witnesseth, That the said Grantor, for a valuable consideration
i ~ epqtY
' conveys to Grantee the following described read estate is ,fit-.---CrOXX..... RETURN TO
County, State of Wisconsin:
Lot 12 of Oak Knoll Addition to Section 33, Tax Hey No
f Township 30 North, Range 19 West, Township
of St. Joseph.
i Tg~iSFER
~De p~
This 1s homestead property.
itlilijX f [>1C1fdCK
Together with all and singular the hereditaments and appurtenances thereunto belonging;
the said And -------•---.._.__g-------------•-•---------------------------- -
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements of record.
and will warrant and defend the same.
Dated this 1--------------- day of Oct.,----- • 19AQ...
-----------(SEAL) =Yl~-!..............(SEAL)
' L CRAMER
(SEAL) Z2!LC.... (SEAL)
PAt LA C~~t......--•-----•-----
AUTHENTICATION ACKNOWLEDGMENT
s
Signatures authenticated this day of STATE OF WISCONSIN
• 19....... sa.
St. Croix County.
Personally came before me, this _..1$t..----- day of
9Cr.t.a--------- 1980 the above named
TITLE: MEMBER STATE BAR OF WISCONSIN _.....JOhn.-L....Cramer..and_.Pamela..P-t-.-_..
(If not, Cramer---------
authorized by § 706.06, Wis. Stats.) t~!!.
CJ; N y i-------.----------
TH,S INSTRUMENT WAS DRAFTED BY
w to me known to 'rat who executed the
HEYWOOD-, CARL-.&, .,MUR-RAY foregoing instrumetytaa~~Kvd~e-!)tsame.
Samuel R Car.T
'
, ;
Hudson....................
Hudson, WI 54016
- -
lit
Notary Public x-~ CrQl County, is.
(Signatures may be authenticated or acknowledged. Both
are not necessary.) My Commission is permanent:(If not, state expiration
date: --July .2 4,
t
•NAMea of persons signing in any capacity sholild be typed or printed blow their signatures.
WARRANT! DEED STATE BAS CF WISCONSIN Wisconsin Legal Blank Co. Inc.
FORM No 1 - 1677 Milwaukee, Wis. (Jobu16E )