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HomeMy WebLinkAbout030-2063-70-004 v I 0 o as 4 o I ~ i b I O N ~ .a N I a d CD I x ~ I a~'i c I m c ° Li c v O N a ~ 1 I 3 Cl) ~ I z " E 1 o C'4 0 M O C. m M F- C7 o I O Z :!t c d z ° c o U) I- y Z c O E -o I N co N a N O C d U CD O ~ C O Q z z I N 16 z 4 1 B N 3 R ~ ~ I Its O O CL W Y c 06 y co N d N C O y 0 0 C. 'al U (0 w ° E v vri v~ rn ~E',1 `n 3 3 Z 1 • aaa y CL 0 cr) ! S rn rn I N J Z) Lo - a Cl) AV co Ncn O N O . N 0 0 m W C d co f O y d l N w ,r, m ~ Q Cl) o I ° 0 3 N O o Y O 00 U N GO d j CO I'- G~ O 0) M N C 0 U 4. p Qj 1 r Fi N :z I V ~ M 0 CL ~ C ~ E m N I- 0) CH O M N CD ° d (O CD .2 N C5 'o m LO ICI M Y V F- C L ULo O W O E ca O M U) J O Z z: CU/)l V E € v~ `y M C m vt EL ! a I • a m .2 d tt`Iw~i E c c .d. _1 A 0CL 0 U)0 s -STC 10 4 AS BUILT SANITARY SYSTEM REPORT 11~TL) OWNER , ADDRESS- 22/r~ LTE.eJ lt!/'$'. s~(S/~o ss /2.773 few y. heCo v 1-7E,~ Cv i s. SYo~ SUBDIVISION / CSM# LOT # SECTION. T30 N-R 2 W, Town of STD S p ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ORIGIN INDICATE NORTH.ARROW Provide setback and elevation informAtion on reverse of this-form. Provide 2 dimensions to center of septic tank manhole cover. C 57- p 4 T Go T BENCHMARK- ALTERNATE BM : Td/d 6~ /f Ova ~~OUtiJ~ L G C~El~ coazt_~ C-3 if'i v (s 7i 1 - /0 3 Z G l SEPTIC TANK / PUMP CHAMBER / IiOLDING..TANK INFORMATION Manufacturer: Lv1!5~7x-5 e:~,VAOC ro . S s Liquid Capacity: 160 Setback from: .Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location ':SOIL ABSORPTION SYSTEM Width: Length 5100 i Z f" 6d Number of trenches Distance & Direction to nearest prop. line: r NO . Lo •t' L Setback from: well: I IS House SD ' o , to Other N T • T61OF Lo G/Ci,v 4s Ue-e C3 /Pi,re5P ~i.vGsJ /O 3.2 6 i ELEVATIONS Building Sewer ~b6' d ST Inlet; 6 ~y S~ • ~7 ST outlet. PC inlet PC bottom Pump Off He e / 1411d c/' y 4 Bottom of system dpO Ex is i g Final grade O DATE OF INSTALLATION: 14 ~f y I Q j / PLUMBER ON JOB: T R-ERT 2W t,/3(r-Lc LICENSE NUMBER: ~?~J~S 3 3 D INSPECTOR: _ µ 3/93:jt • s--,TT-gE' 0" 3 S 5 1 21y wE(~ • ly, . 4o Luc/vv T OF N£ Lo Y1 T-A 3 QEDQr~ . o 7,2 ~y. (3 a x PRO? NS ~o 5' 5 8 _ 5 y STEM INSET Td ZRop 2z g' 'i 1Re oa. ..+°1 feeDS Ft RSA'. rf e a (3 csT'S R~ . E AS T' L-0 T c., • o -r e P a 'F S TR£aC.C~. specs vQ~ ~y~o12'5 & " WAS t+t'D 3 pz 6:rtrE N. E. Lo T- for -Ele. 'b i s T. P i p e 46 CO ►2 N E 2. • AS 5 G,~'rE P po'rlrctz ?Y PA 12 .0 o ~hQp- , I oP of pl pE T6 p 6f Pi Sys' BMX CA30 Ue-151- e-m A Tel q 5- 64 s ~y - C ALt . s ~ 30 Wisconsin Department Industry, Labor and Human Relations. SOIL AND SITE EVALUATION REPORT P~ / of 3 ' - Division of Safety & Buildngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. o.3o 2-0 63 -70 DO APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE C PROPERTY OWNER: I 1 J PROPERTY LOCATION SO L Uet,.-- GOVT. LOT lVtd 1 /4 1/4,S T 3 N,R 20 E (or) W PROP2E, RTY NE L MAILINN~G ADDRESS LOT # BLOCK # SUED. NAME 0 CSM # CITY, STA((TE IP CODE PHONE NUMBER ❑CITY ❑VILLAGE WN NEAREST ROAD "D U t,TU~ tO 1. 5 q61' G (SW') '6fP(-- s T • gas t= tf- Y. 3 S ~I [ ew Construction Use [ q--Residential / Number of bedrooms .3 [ J Addition to existing building j J Replacement [ J Public or commercial describe Code derived daily flow. gpd Recommended design loading rate bed, gpolft2 ' trench, gpolfl2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2=trench, gpoltt2 Recommended infiltration surface elevation(s) ~y 000 ft (as referred to site plan benchmark) Additional design / site considerations ?CSE T/~'t'~f Parent material 4C5 d1 ~frr~,4 Flood plain elevation, if applicable NA- h S = Suitable for system C~ONV TIONAL MOUND - / INN--GRO ND PRESSURE TAT GRADE S~YSTEM~N ILL HOLDING TANK U = Unsuitable fors stem Ct~'S ❑ U ❑ S L~0 CW ❑ U ❑ S G{3' ❑ U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BMNX, y Roots GPD/ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed tench 1 0-k lo v o- 5/7 Z A.A 5,0re s S % Ao` , S . G z V- l? /b Yee 312-- s~ z~► Pee eeti Q 5 /M., MP tip Ground 3 117-31 /o L6 .Si 17-- SAX M,-F t • C S • y . S elev c17. i fL /0 ''.s. a~ s elf . 7 i . Depth to limiting factor I fy" Remarks: Boring # 4?ft G7`D t • 3 /o 51-1 It dull 2S' 3-F ~u = ti 2 z,,~,, 13 -/rte io Ye 5 A s~ o , Ground elev. jff, - ft. Depth to limiting factor Remarks: ~j CST Name:-Please Print Phone: Address: &ss O' Am c f>So.~ 4J S. S ilo -1 C sT~r z ~d' Signature: Date: CST Number: PROPERTY OWNER J0127 L GA yQ^"~ - SOIL DESCRIPTION REPORT Page Z of - PARCEL I.D. #t Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerxh 131 a/Z c c7-6 7 I -F SiT p Q S Zr -7.s yR ds cs s . D 7 Ground v 4 /f s ~ S. elev. Depth to limiting factor Remarks: Boring # 13 Ground elev. ft Depth to limiting factor Remarks: Boring # 13 Ground elev. ft Depth to limiting factor Remarks: Boring # 13 Ground elev. it Depth to limiting factor Remarks: con 0,2q^/0 AC inn% l - III III , o scc..4~ Poe- w/ou T ° N~Ew yy~ TAatc 3 t3 EORr~ . Zz n , v /y, -X 59' lb Y 57,EA4 ~N~~T To zRop 2z g' C3oX 9G. yo` ~I - X30•- TReAJ s .35 q q. go ' 43 ' S' x 0 -t a ~r.G.. •,A fe~05 Ft Rs•r. 't e e (3 csT's Rx . TR£~l~... S Fc 5 Sv Qo t yo 12,5 p_ w^S t+, -D 31~e +$j pz- GrtrE N.E. Lo T` 21aPE1 'b i S T• P i p e lz( • Gp►2 N E Q tFS 5 to r/ r-r~ P p-o`r~c,-T-EO t d't• TY PA ' E l Evh T 1'0 0 - oo •d -pop of P► PE' 76 p °f P►ht Sy ST: B &A £.5D u ea i e_D 5, Tel 1? 5.6,60' gyro 5c,4 LE . = 3 d M eW 6441CA&C- • " Soi'~ ~0.'T S LOCATION: ST. JOSEPH 34.30.20.559K (HWY 35) Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor-and Human Relations Safety INSPECTION REPORT ST. CROIX and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: G-ENERAL INFORMATION 193536 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: VENTURE, JOEL ST. JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 104 030-2063-74-004 TANK INFORMATION ELEVATION DATA S TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /lf1.CIJ Dosing Aeration Bldg. Sewer Holdirntj- St/ Inlet 0q TANK SETBACK INFORMATION St/ Outlet 9 0~~ TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header/Man. Aeration Dist. Pipeg ' (Q$~ Holding Bot. System 9 f~~oz PUMP/ SIPHON INFORMATION Final Grade Demand - 9 76- 910. 5~'• Manufacturer /-r 165~' 0(✓0,0 6 Model Number M sLr' o 24/ 43, 55- TDH Lift Friction System TDH Ft Forcemain Length Dia. If ea I Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches PIT Of Pits Inside Dia. Liquid Depth DIMENSIONS 0 141_ I DIMENSIONS SETBACK SYSTEM TO P/L BLDG WF ELL LAKE/STREAM LEACHING :5 1 INFORMATION Type O 4cLo COOK CH System: _r-e-"eL OR UNIT DISTRIBUTION SYSTEM Header Distribution Pipe(s) ,i x Hole size x Hole Spacing Ven e Length Z~ Dia. ` Length Dia. Spacing 1+~~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syste ly Depth Over v I Depth Over xx Depth Of x ed / Sodded xx Mulched No HeiTrench Center -Trench Edges ( - 39" 1 Topsni ❑ Yes ❑ No ❑ Yes El ,Bedri COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 34.30.20.559K (HWY 35) - 6"?j,e.'.) 4/ -4, 6 7-~ ' a e-n,r Ii3, tlf. ',o,0 711 C l~Q' y r r a c ~d"' O Zn fSc~ y~ L c~ 01 Plan"r~vlslon required?`' ❑ Yes Eo tion Use other side for additional inforation.. 1/9 SBD-6710 (R 0,5/91) /Daate Inss ector'ssig~na~t, rree~ Cert. No. ~~5-~ L/.r'.F~It" ~C/L~.G~k` !'a-t~ ~...~%+s";~ ~ /✓x//-at'~?C.l~ ~ ~.~°L.l; ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: ' ~ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATES ITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ /8%x 11 inches in size.application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 44.4-- PROPERTY OWNER PROPERTY LOCATION ~f JOeZ 4A Ve-A1 Y-o/e E-" 4 )01,, Alkl% S T N, R 2-0 E (or) W PROPERTY OWN 'S MAILING ADDRIESS _ LOT # BLOCK ZZ- / •1^/*)" Ad ,4- f'~'Ei tom- - 4-A ,vim CITY, urA70~ ZIP CODE PHONE NUMBER SUBDIVISION NAME PR CSM NUMBER IL TYPE OF BUILDING: (Check one 1(3,j/f)&fS16 CITY NEAREST ROAD ❑ State Owned ❑ IM =N W: VILLAGE : 5J •TaSQh 5 ❑ Public M1 or 2 Fam. Dwelling- # of bedrooms PARCEL TAX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) 3 C- L 0 Vr 3 70 00 y 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 f 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. K 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 Z - rg FAj c4 e--5 4^A66,%- 3- 7 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 (s q. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION Feet Gd • Z Feet VII. TANK CAPACITY Site INFORMATION in allons Total # of Manufacturer's Prefab. Fiber- Exper. New istin Gallons Tanks Name Concrete Con- Steel glass Plastic App Tanks Tanks structed /avV Septic Tank or Holdin Tank Lift Pump TanIVSI 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): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Roe&-R r ' lf4 I?117_ luz,-'i 3307 71,x' 36P6 Plum ber's Address (Street, City, State, Zip Code): / " " 65S _ IX. COUNTY/DEPARTMENT USE ONLY 1/1 ❑ Disapproved Sanjtary Permit Fee (Include geroee Water Date Issued Issuing Agent Signatur No Stamps) Approved ❑ Owner Given Initial Q'71 f~" Advers Determination Q V 15/ 7 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 Wi sco~~sin 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 : rPr*sfer/Renewal Form ;513x7 6399) to be submitted to the county prior to instaliat;rri. 5. Or+ °t :.tiev,age -,ystems must be properly maintained. The <l±~ tank(s) must be Furr,.,ed 11,y a licensed purr+per whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage syster i, 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. 111. 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, reconrection, or repair. V. Type of ~;y~stem. Check appropriate box depending on system type. VI. Absorption system information. Provide all information request:-) in ##1.7. VII. Tank wt•_trriation. Fill in the capacity of ory new and/or exrs :ik, list the total gr. 1... number of tanks and n.gnufacturer's name. Indira prefab or site construe%%, -.i ar,c tank material for all - septic, pur:rpl siphon and holding tanks for this system. Check c ~ ~~tal approva; c { `t tanks received experimi>r tal iaroduct approval from 311-f RI, Vlll. Fesponsibiiity ° tatement. installing plurnk,-r is to fill in narne, I+rr -!mber with ap rop6ate prefix (e.g. NAP, etc.), addres., and phone number. Plumber must sign ap ti:)n ;orm. IX. County!Department Use Only. X. Cour:ty/r,. apartment Use Only. Complete ,11ans and soocificatiom::ict srnaller than 81/z must he za~~ r+;ttaci to. the county. The plans rrii!_ tG ';wl'lg is?l0i plan, drawn tU 1('atlOn of holm ac , .8r,k s) or ~'tf1 F' treatment tanks, erg,, wil" vvater service; sirear114 or siph-- ip-k'-, `.listribution 3:+*.• .•.I ~.~+SG`;?tf lt± ~~'4 rr;c;< t e.;erTtent system areas; and °._rc : r=-1 of the bwi:ng < ~-d 33) horizot ~.:rticai :!le: points; C) complete spec.... ,.:ara for pw}.p_< r.,id controls, close vo ur.:._. savatlon L: ?it frfcL,Yn loss; pump performance curve, purrp model and pump manufacturer, O) s.s .rss section of the soli ah,-orption system if required by the county, E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsiri !pct 410 included the creatiun tli °,,urcharoes (fears) `or a number c:f regulath pr='.-If'!(':e5 V/f r'.'t? roan effect grounllvv to. The rncn es collected through these surcharye~::r .,serf for rrionJorwg gro_,r!dVVater, grr,un.:- water contamination investigaiions am estabRi i,r.,f>,„ }f standards. SBD-6398 (R.11/88) /7w 3s- s ~ i W rn ~u\ L i jz . 9 m N N 9 y kA o -0 1 O $m `c its 5 ~ k N~oc=~ i m ~ _ - Iw W OD W 1 e„A y,,3~ dl d 9 -VW-V a °c ~J 0 G ~ I O ~ rn ~ ~l y n o c rh o ~0 0~ . ~ p 0 Fresn ioor C)J G l ' Approved Vent Cap Minimum 12" Above Fi~ol Gr r de O 4 Cost Iron 3Co Above Pipe Vent 'Pipe' 'ro Final Grads W ►Synthetic Covering min. 2" Aggregate Over Pipe Tee Distribution Pipe o 0 0 0 o J 6 1 Aggregate o Perforated Pipe Below • Beneath Pips o Coupling Terminating At . . Bottom Of System S S7Z~1 '7 3 Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12 Above Final Grade Raw 4" Cast Iron 3 & Above Pipe f Vent Pipe -ro Final Grade Synthetic Covering Min. 2" Aggregate Over Pipe Distribution - Tee Pipe 0 0 0 0 0 " Aggregate 0 Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At Bottom Of System ' 3 • ~O L } 4 ,i • 0 . 'fir < ' -5-CALE IN FEET-- I so' t'" R4 N4 IRON _P1PE F4UN1) . .0 FENCE ra.. A P&V* l 4 iaa Gave armse nt Lot 1. SecU*a 34 , T 30N , R Z O W d p, ~d ae as f4l.*w$: -4om;nwwiag at the f ` I+ 6ttm¢ 1 thence 31 42 E Mons • e of Crellvoa~gl~s>e 1; thonc e " . 1 i 1 4y t 1 f7rslw# s"A of way line of premoat Stag J'* 071t of benul ""4 'or ` '~6Nx . Let 1 r AMA 34 . T301 r ~ ZQw , $t . + d9 t t• 1t1Ml d 1~#~ $nws: at this 'NE corner tl.X&st line of Government i OWN" i 9$`t. ;`i I'V # wi~ tote North - ITO' 0 G j at of ' i r. a„ Fx yr r. ~ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND- PERCOLATION TESTS (115) P.O. BOX WI 7969 HUMAN RELATION (H63.09(1) & Chapter 145.045) MADISON, LOCATION: SE T N: OWN~~ N !Vr ff'i': L ~ .:BL~Kj;O.: SUB I 1SION NAME: _e PA tv w 1/4Nt~~ a -36 /T / N 112otor / ,I COUNTY: OW ER'S BUYER'S NAME: MA IN ADORE S. s~ c►~,,v oeo No(eom6 f ©se h &~~~PC- USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMER IAL DESCRIPTION: ~t PROF LED RIP IONS: PERCC)LATIC~N TESTS: JXResidence L~New ❑Replace I l7 ~ Q7 2 '7 RATING: S= Site suitable for system U= Site unsuitable for system ~Y/~' o C NVENTI❑u . MX"OUND: I IN-G~iOUN URE: SYSTEM-1 N-FI LHEISG TANK]RECOMMENDED SYSTEM: b I,_( (optional) SS JC~Jj SS 0U S❑U J~a~~.}'JV~ X 52i If Percolation Tests are NOT required DESIGN IRATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: 3 Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H T ROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHX ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.~O~N`B/ACK.) f ' ! 17 ND~ , / , .ZS~4~a5~ ~~/~~!$~~~r,~~~ QhCI~. 7'O'Q~•~$' sJY B- 33 Q Sl ~ivs~s~-~.tSQh 3 9r~ .L3'BnS yr~,b ~BnCS 9r 7/ VU B- r., 9i / U ~i / 7 . S g'Bn s 3 21' S VP ~ S rl7k 6n Av 2. a' kh > B-3 > ?17~ / ! / / n S 1 r~ 713n G $ 13,1 e ley ~ V17' -,-'Y 9 3 y B-~ ~.d7' > es, ,i eh ,;~7SB„~/,szsBr~fi9r i sc-~ B "k go, / t DMr d 5q W/o A141 C a s -,t1;4 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I#6#E AFTER WELLING INTERVAL-MIN. PERIOD 1 P RIOD2 PERIOD3 PER INCH P- 1 ~t yz 3 3 P- a' 6 G 4, P- 5. S ' 2 7, iL 3 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 c ?3, 73 ( T 2 i_ I A ti, t 4, f... _ _ 1 n/ 1Y 'E - But We r- I I r } s c~ ~ 3 S t ,l~ ~ r, ~ f I I i ~ r T~ Mi 6' , 5 ~I )I- - - 4 I, the undersigned, hereby certify that the soil tests reported on this form weVmade 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 rin TESTS ERE OMPLETED ON: i Ike Zd ADD SS: CERT FIC ION NUMBER: PHONE NUMBER (optional): CST SI AT DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - y~ iu o ~ ~ r S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER J OE L GA ADDRESS jL il-tll Ilee " FIRE NUMBER CITY/STATE U L ~'y (0/S ZIP SY~/ PROPERTY LOCATION : N&)1/4 , /Ul()114 , SECTION , T j e N-R Ld W TOWN OF St. Croix County, SUBDIVISION` , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by 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, 1918. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration a e h SIGNED: DATE: i 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 Td~ L A Locatirih of* property /UW 1/4 *Aj 1/4,, Section, T 3~ _N -R 2'0W Township J~ OSlep ff- Mailing address Address of site _Z.T _R S_ S40 I Subdivision name Lot no.. other homes on property? es No Previous owner of property Total size of parcel 2 G~-l S Date parcel was created Are all corners and lot lines identifiable? !l_,Yes No Is this property being developed for (spec house)?____Yes 4No Volume/-PI-5 _and Page Number /G7~ ~ , 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 best of my (our) knowledge that I am are true to the (we) (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. 500G yf , and that I (we) presently own the proposed site for the sewage disposal system or I obtained (we) an easement to run the above described the construct property, for ion of said system, and the same has been duly " recorded in t he office of County Register of deeds s Document No. . Signa re of applicant -app cant 1 Date of Signature Dat of signa e y . II ~I DUM ENT. f10. STATE BAR OF WISCONSIN -FORM 2 WAPILkh" ! DBBD THIS SPACE RESERVED FOR RECORDING DATA 15 00* VOL 10~.FAc1:9g ; - REGISTERS OFFICE ST. CROIX CO. WI SIANLEY__D_..HANKS........................... ~ Rec'd for Record I. JUN 14 1993 conveys and warrants to NEL---- LAYENIURE................................. a 330 ~ at ~•nr•~rCli. M 'i R rotO w • RETURN TO . l! j the following described real estate in ......_~ST,._ pj ......................county, ~ State of Wisconsin: - - - Tax Key No. 34 30 20, 599k . A parcel of land in Govt. Lot "1 Section 34, Township 30 north,Range 20 West. St. Croix County, Wisc. described as follows: Commencing at the j NE corner ofGovt. Lot "1"; thence S1'42'E 85.00 feet along the East line of Govt. Lot "1" to the point of beginning; thence S1'42'E 501.03 feet along East line Govt. Lot "1"; thence N51` 28'W 589.44 feet along NEly right of way line of present State Trunk Highway "35"; thence N73 20'E 465.92 feet to the pint of beginning. o MANS F This iS.-D-Ot homestead property. (is) (is not) Exception to warranties: All. unrecorded easements, Govt. rules and regulations ~i all zoning laws, Dated this t .4............. day of alU 19-93---• I I ii ..........(SEAL) . EAL) ' S.tsnl .A.-_119MUS----------------------- (SEAL) (SEAL) I; i AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN 119 ss. St._ Croix County. P sonally came before me, this ....._LQ........ day of . bYtti. the above named . TITLE: MEMBER STATE BAR OF WISCONSIN Stanley Han s_..__.--..•_--_....• (If not, authorized by § 706.06, Wis. Stats.) . . THIS INSTRUMENT WAS DRAFTED BY to me known rson who executed the foregoing in - ut'•eln44cknowledge the same. . ...............Stan]etc..Kanks•---••-------.---_--.-------•--•----- • . r. I (Signatures may be authenticated or acknowledged. Both N ry c _ .County, Wis. are not necessary.) Comm;s ipn is pernianenti ,.If not, state expiration date exaumM of persons signing in any capacity should be typed or printed below their signatur.. ~ ~l ~+3 t, 7?* ntr.Rp STATE BAR OF WTBCONL9I14 '.p~Iirnna.in T easl A1nnL- Co. Inc. Parcel 030-2063-70-004 01/18/2006 11:14 AM ~ PAGE 1 OF 1 Alt. Parcel 34.30.20.599K 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): O = Current Owner, C = Current Co-Owner O - NELSON, KEITH B & PEGGY L KEITH B & PEGGY L NELSON 1275 HWY 35 N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1275 HWY 35 SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.400 Plat: N/A-NOT AVAILABLE SEC 34 T30 R20 THAT PARCEL IN GOV LOT 1 Block/Condo Bldg: DESC AS COMM NE COR GL 1; TH S 1 DEG E 85' ALG E LN GL 1 TO POB; TH S 1 DEG E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 501.03; TH N 51 DEG W 589.44; TH N 73 34-30N-20W DEG E 465.92' TO POB Notes: Parcel History: Date Doc # Vol/Page Type 06/08/2004 765231 2591/238 WD 07/23/1997 1015/199 WD 07/23/1997 954/282 2005 SUMMARY Bill M Fair Market Value: Assessed with: 84633 282,600 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.400 68,200 188,800 257,000 NO Totals for 2005: General Property 2.400 68,200 188,800 257,000 Woodland 0.000 0 0 Totals for 2004: General Property 2.400 68,200 188,800 257,000 Woodland 0.000 0 0 i Lottery Credit: Claim Count: 1 Certification Date: Batch M 124 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 v Parcel 030-2063-70-000 01/18/2006 11:14 AM PAGE 1 OF 1 Alt. Parcel M 34.30.20.599G 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: Owners : O = Current Owner, C = Current Co-Owner O - SOMMERHAUSER, JEROME C JEROME C SOMMERHAUSER 2586 PARKVIEW DR WHITE BEAR LAKE MN 55110 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.450 Plat: N/A-NOT AVAILABLE SEC 34 T30N R20W PT GL 1 LYING SWLY ST Block/Condo Bldg: HWY 35 COM NE COR SEC 34 S 88DEG W 1376.47 FT -POB S 88DEG W 552.54 FT S 41 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) DEG E 265 FT N 60DEG E 432.98 FT TO POB 34-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 639/301 2005 SUMMARY Bill M Fair Market Value: Assessed with: 84630 14,400 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.450 13,100 0 13,100 NO Totals for 2005: General Property 1.450 13,100 0 13,100 Woodland 0.000 0 0 Totals for 2004: General Property 1.450 13,100 0 13,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00