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HomeMy WebLinkAbout030-1015-50-100 ~ ~ oo ~ oo I M p p N O ~-0 III N N O p~ o 0 C N T F. U O N E ty N N a ~ I T > II v ° L I ~ co U t 'C O 'C a3 E s 3 N F. a N c U) N N CO N ° N O L -p z c : ' z -p c E°U c c a~ Y L m Y. o c c0 C ~ LL O N i o cc Q a 0 v-" 3 `0 3 ch Z z Ivi H E rn w 0 ° z d £ ° ° z (N U) I, d m G. m oI i0- c C7 I c O z c .2 V H r z co N N N N C N • aU N a) O ) (n L FV L_ I i CL a o a-°i Q O U o N Q O Q z co z o z co z N z `n c tic y a N W E E N W _ m Y I ~ is Y CL CD 0 0. M O O W N S C 0 0 N N i c 0 0 0 G a .0 c N Z; G C a a c ~7q Z•->I' 1 Ln U) U) U) L) LJ C) Lo :3 X333 ° o N 33.1~ a 0 Z o • 0 0a a s o a a a cts a v, in o m o N = rn rn U' = Cal) !n J U m rn a Z ~i way,, O O ~ m > O cn N 0.. O co N N Q} a3 N 'p N Q z LO 4, 1r1~ O c N N N N C o _o 3 H e o c c E to rn l o c O ° p Q F- 61 pUj en N CJ Q- 0) o (U N C S ri LO t! a~ a E c c~ ° E v ~n a°i c o o o c c o _ a> rn v N H c m m co H v • > M a' co ca E E U o. v ss N E o o o U) ! u) o z_ o z ti Z 0 ~ ~ E a v~ 4) E a a m #t a a L a w `N am.L ° m c d E S o A C.) a 2 0 co u 0 vn 0 DEPMITME~T RY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR BOX HUMAN NDLATIONS PERCOLATION TESTS (115) MADISON WI 7969 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/CITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: SE 1/4 Nw/4 4 /T29 019Lor) W St. Joseph n/a n/a n/a COUNTY: OWNER'S/B3AWbWAME: MAILING ADDRESS: St. Croix Kenneth Bauer 530 River Rd. Hudson,wi. 54016 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILED CRIPTIONS: P R ATION TESTS: ~esidence 3 n/a 53fiew ❑Replace 2-7-92 2-7-92 RATING: S= Site suitable for system U= Site unsuitable for system ot CONVENTIONAL: MOUND: IN-GROUNDPRESSUR_E:SYSTEM-IN-FILLHOLDINGTANK:RECOMMENDEDSYSTEM: (optional) QJ S ❑U ®S ❑U S ❑U ❑ S ®U ❑ S EU conventioanl If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 50 OnC2 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH CIW ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 7.25 99.7 none >7.25 .75bl.1. .83bn.sil., 1.50bn.l.s., 4.92bn.c.s. B- 2 7.42 101.2 none >7.42 .42bl.1., .50bn.s.1., 1.00bn.s. 5.50bn.c.s. B- 3 7.00 99.3 none >7.00 .58bl.1. .83bn.sil. .75bn.l.s., 4.83bn.c.s. B 4 6.92 98.2 none >6.92 .83bl.1. 1.00bn.sil., .75bn.l.s., 4.33bn.c.s. B_ 5 6.67 98.7 none >6.67 1.00bl.1., .67bn.s.sil. .67bn.l.s. 4.33 bn.c.s. B- decime 1' TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER DES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P-1 2.70 none 3 6 6 6 <3 P-2 4,20 none 3 6 6 6 <3 P-3 2.30 none 3 6 6 6 <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 97.00 ,~(I P ado` r o a a e i t , [ t { I E 1 1 r a -j I, the undersigned, hereby certify that the soil tests report o CCvyer a y me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location h t ty `rgpr~to the best of my knowledge and belief. NAME (print : TESTS WERE COMPLETED ON: . Gary L. Steel 297-92 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. aVe. New Richmond wi. 54017 2298 15- 46-6200 CST SIGN E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - r t t ~ r INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Coml. ;;:iI descriptton; 2. The u~ ; ction must clearly indicatQ whether this is a residence or commercial project; 1 MAX('. M number of bedrooms or commercial use planned; 4. Is this or replacement system; 6- Coat,.. suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL. OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for vitriting profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A sE:Pa _,__y be used if desired; 8, M _rr 1 enchmark and vertical elevation if point are clearly shown, and are permanent; 9. Cpl Fr appropriate boxes as to dates, nan >,,s, flood plain data, percolation test exemp- tion, if>te; 10. If the intorn ;c (such as flood plain, elevation) does not apply, pl N.A. in the appropriate box; 1 1 . Sign the f -i Mace your current address and your certification n_.nL -r; 12. Make legible >ies and e as re(Juired, ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAPS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Sol- ; and Textures Other mbols st - ...,r 10") BR - I Coh C 3, 10") SS - 3r gr - r l (under 3") LS - Lim= ne *s _ H( I - I o, :water cs fined s - fir' f n -d is - F ,td Is L . rny Sand - Than sl dy Loam < I s T! an E -arn Bn *sil - 5 t Loam BI - :k si Silt Gy - y Clay Loarn Y - yellow Sandy Clay Loam F - Fd Silty Clay Loam mot - r.;*les Sandy Clay wr r sic - Silty Clay fit - •w, nt 'Ic Clay cc commor pi Peat corn - Many, rn - Muck d - distinct p prorninr. HVdL - High wa level, Six genera( soil textures Sur` for liquid waste disposal BM - Bench VRP - Vertical F lerenee Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request `icatio n of this soil test in the field prior to permit issuance A complete set of plans for the private . a _ system and a permit application must be submitted to the appropriate local authority in order to < permit. The sanitary permit must be obtained and posted prior to the start of any construction. r i W,tionvADeoPir^erlOf lndulity, WIL UtyLI%lrIIV't 111.1 Vrrl : U 9nt Labor and human RelJhant • `(Attach Soil Prolile Location Map • To Scale • On A Separate, Signed Sheet) U.Adrlon, 41 5 0 - Page .r twtta~a.IrA~ IMIVAL.OAT eureerrllroUW"QGwtrl eAnerr►wr nvA elOevfp§~~ Kenneth. Bauer 2-7-9~L pasture utwasfi N-550 River Rd., Hudson, Wl. X54016 erArt CO1rtSt. Croix ' lae.reweg4~{ IAa► n.w.~trt IOCAtcN DORM SE 14 NW 29 U 1911 1 St. osephl a , . CsllJl wtw _ rrertate sUBVIVIS1oN LOT, BLOCK _'n /a rt a B.1 Norton Death. Dominant Color Mottles Structure Limllinq faaeu LoeongGPO,sp it. In Muntell u. St. Cont. Color Texture Gr. St. Sh. Consistence Rooll Boundary Depth Trench god 1 0-9 10yr3`/3 none l /m/sbk mfi 1/f C none .3 .2. Elcv n ..2 9-1 10yr4/4 none sil. /f/sbk mfi 1/f C none .0 .0 3 0-2 75yr4/4 none l.s. 1/f/sg ml 1/f G none .8 .7 99 7 ..,•1 ~.8 .7 8-8 7.5yr5/4 none C.S. /f/sg ml' 1/f n/a none Hellion Depth Dominant Color Motllet Structure Urrntln0 Factory LoAOnq.GP0/0 n. u St. Cont. Color Texture GI. St. Sh. Conte Aooll Boundar Ogth Wench Bed G In.t~nsell tense 1 -5+-' 10yr3/3 none' 1. /m/sbk mfi 1/f C none .3 .2 Ekv it -11' 10yr4/4 none s.l. 2/m/sb mfr 1/f C none .5 .4 101. :'~..3 1-23 75yr5/4 none s. /f/sg ml 1/f G none .8 .7 4 3=89 7.5yr5/4 none' C.S. 0/f/sg ml 1/f n/a none .8 .7 X4;1, i tt; Hellion Depth Dominant Color Mottles Slructur! Urntllnq ITatlsr/ LeadingaPOed h. In Mun ell u. St. Cant. Color Texture Gr. St. h. n I ten • Root Bounds Depth Trench Bed 0=7 ` 10yr3 /3 none 1. . 2 /m/ sb mf_i 1/f C none .3 • . 2 Eil:v ea°, -2 r_17, 10yr4/4 none l' sil. 2/m/sbl mfi 1/f C none .0 .0 9. 72 .5yr, none. l.s. 0/f/sg ml i 1/f G none .8 .7 + 4 6-84 7.5yr,5/4 none C.S. 0/f/sg ml 1/f n/a none .8 7 IHOrtoh Depth Dominant Color Moults 'Structw• Lhrilllnq Factor/ laanyQPpta.a. e .1+ to M n ell u. Se Cont. Color Texlur Gr. t h. Contlitencif Root Boundar Depth trench Bed = l0vr3j4 none 1. 2/m/sb mfi 1/f C none .3 .2 Elev m ,2 p-22 10yr4/4 none sil. 2/m/sbl mfi 1/f C none .0 .0 98'21 `3 2-31 7:5 r4/4 none l.s. 0/f4sg- ml 1/f G none .8 .7 4 1=83 7.5 5/4 none C.S. 0%f/sg ml 1/f n/a none .8 .7 5 Norton Death Dominant Color Mottles Structure Umhinq Factor) LeadingoPOtq.n. In. Muntell u. St, Cont. Color Texturt Gr. St. Sh. Con ntence Root Boundar Oep.h trench Bed 0-12 1 3 3 none' 1. 2/m/sb mfi 1/f C none. .3 .2 Elev + . 2 - 1Ovr4/4 none s.si'-2/m/gr mfr 1/f C none .3 .2 20-2 1 r3 A none l.s. 0/f/sg ml 1/f G none .8 .7 ~'4 8-80 10yr4/4 none c.s.. 0/f/sg ml 1/f n/a none .8 .7 Additional Remarks: 1 RE-COMMENDED SYSTEM TY page 450 Soil series On02 ' lot ` on back" lot 2.33 acres 9? ~Ckc YA- pG'qS I_Q Other Site Features: . . i ' •97.2 2-7-92 1715 1246-6200 2298 Syetcm Elevation Date Signed elephoneNo. 01 a Gary L. Steel, 1554 200th. Acve., New Richmond, Wi. 54017 CSt Neme (Prim) City Stale Zip • a 7o 3 0 4 6 30 ,S ~ ~ p3 b r ,a ~hC ~t} -1 L, ! co ,~p, a~ Flo ""JJ y .a o~ rv- '7 9L W,ttonlonDeoa'rr^pntof Industry. ~Wlt.Utyll%lrIWof 1% 1-1 vet Latlor and human Relations U 901 d (Attach Soil Profile Location Map • To Scale • On A Separate, Signed Sheet) Madison, 41 51:x' > Page Itvc K°►tlAVttT R°OOrWrI! tutmatnrwi Sm@VAL, Ar CURB,rlNO UW V[O co'" [~-Wmroi Kenneth. Bauer 2-7-9L pasture il N-5% a 11 Rd., Hudson, Wi. `54016 true CstCx '^"°'°"00'°" 530 R er 450 tAtl►AAC ►4Mt11 l SE ~O114 NW 114 29 tiln 19 r St o eph n/a C9M/ Lot BLOCK n /a sueDlvlsloa n /a Y•, haw neeLAct (3.1 Mattoon Death Dominant Color Mottlet Structure UrNUng Facrm/ Leaangt3P0•94.R. In Munsell u. St. Cont. Col Texture Gr. St. Sh. Consistence Roots Boundar Depth trench Bad 1 0-9 10yr3/3 none 1 /m/sbk mfi 1/f C none .3 .2 Elev = 2 9-1 10yr4/4 none sil. /f/sbk mfi 1/f C none .0 .'0 99.7 3 0-2 7.5yr4/4 none l.s. 1/f/sg ml 1/f G none .8 .7 4 8-8 7:5yr5/4 none C.S. /f/sg ml 1/f n/a none .8 7 ~.2 Manton Depth Dominant Color Mottlet Structure Looming Facrerl L°Abnq.t]PDaa n. In. unstil u St. Cont. Color Texture Gr. Sc. Sh. Consistence Roots Boundary Depth Trench Bed 1 -5 10yr3/3 none 1. /m/sbk mfi 1/f C none .3 .2 Elev a► 2 =11 10yr4/4 none s.l. 2/m/sb mfr 1/f C none .5 .4 101. 3 1-23 7.5yr5/4 none s. /f/sg ml 1/f G none .8 .7 4 3-89 7.5yr5/4 none C.S. 0/f/sg ml 1/f n/a none .8 .7 Mattoon Depth Dominant Color Mottles Structure llmldng Facteu Leadtrg,0110 ta. 3 In Mutt ell u. St. Cons. Color Texture Gr. S:. Sh, Consistent t Rootf Bounds Depth Trench Bed 1 0-7 10yr3/3 none 1. 2/m/sb mfi' 1/f C none .3 .2 Elev 22 2 -17 10yr4/4 none sil. 2/m/sb mfi 1/f C none .0 .0 9.3 3 -26.5yr; none l.s. 0/f/sg ml 1/f G none .8 .7 4 6-84 7.5yr5/4 none C.S. 0/f/sg ml 1/f n/a none .8 .3 POW 4 -IMoto ton Depth Dominant Color Mottles 'Structure Urroling Factor) Leaang.WDsoo h. In. M n ell u. St. Cont. Color Tertur Gr. t Sh. Consistence Roos Bounds Depth Tench Bed 0=1 10 "3 4 none 1. 2/m/sb mfi 1/f C none .3 .2 Elev too 2 0-22 10yr4/4 none sil. 2/m/sb mfi 1/f C none .0 .0 98.2 3 2-31 7:5 4/4 none l.s. 0/f/-sg . ml 1/f G none .8 7 4 1-83 7.5 r5/4 none C.S. O%f/sg ml 1/f n/a none .8 .7 i i (j. 5 Mattoon Depth OomonantColor Mottles Structure Llmlung Facl°rl L°adingaPdW.h. In, Munsell u. St Con t. Color Texture Gr. St. Sh. Consistence Roots Boundary Depth Treneh sod 1 0-12 10yr 3 3 none' 1. 2/m/sb mfi 1/f C none.3 :2 Elev a - 4 4 none s.sil2/m/gr mfr' 1/f C none .3 .2 8.7 20-2 g10vr4j/4 none l.s. 0/f/sg ml` 1/f G none .8 .7 4 8-80 none c.s. 0/f/sg ml 1/f n/a none .8 .7 Additional Remarks: RECOMMENDED SYSTEM TYPE: trenc page 450 Soil series OnC2 $ 9 lot ` on back, ` ..n lot 2.33 acres N rn ~ ca co r^ n sf -t, ~ z i~c} © rV n„ N Other See features: 97.2 2-7-92 1715 124 - 2298 Systcm Elcvation ` L"17 7-7-CII 'gnat" oast Signed itltphoneNO. C • Gary L. ~-zteel, 1554 200th. Acve., New Richmond, Wi. 54017 CST Name (Print) City S1ai1e Zip e2 7c' 3 .~@ I o lco s i - 92- r AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP ja S SECTION- T N-R-~W ADDRESS D 7 Ric} s ST. CROIX COUNTY, WISCONSIN u~~~,) ~L) r_ _s~ / % SUBDIVISION LOT LOT SIZE PLAN VIEW T~ Q / ; yd Scr/n- /oa da ~ it+FP~~ INDI ATE NORTH ARROW BENCHMARK:Elevation and description: , r-rQ) 4'4 11A~-' Alternate benchmarko ~SEPTIC TANK:Manufacturer:Liquid Cap. Rings used:-~'Manhole cover elev: Final grade elev: 1&2.:,;? Tank inlet elev.: Tank outlet elev.: I No. of feet from nearest road:Front , Side,, Rear Ft./ ?l From nearest prop. line:Front Side , Rear Y Ft. No. of feet from: Well Building:---2gV (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front-, Side_, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length Number of Lines:_,-,.2 Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: Zrk No. feet from nearest rop. line:Front , Side, Rear Ft.~~ No. feet from well: No. feet from building 7~&/ HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front Side Rear Ft. No. feet from: Well building nearest road Alarm Manufacturer: INSPECTOR: DATE: C~ `✓S - q~~ PLUMBER ON JOB LICENSE NUMBER:S 6/90:cj LOCATION: ST. JOSEPH 4.29.I9.65A E~~'~jWW ~TH AVE. Wisconsin Department of Industry, PRIVAYE ~EWAGrE SI F I County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division .4- (ATTACH TO PERMIT) Sanitary ermit o.: .14 GENERAL INFORMATION Permit Holder's Name: ❑ City [I Village [Town of: State Plan I R o.: JEFF SPANGENBERG ST. JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: - - TANK INFORMATION ELEVATION DATA A9200220 c~~j5~9Z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark O~ s dv,~ D Aeration Bldg. Sewer Holding St/rtrt Inlet S (o 9S, 26- (o ' TANK SETBACK INFORMATION St/ ICE Outlet Vent TANKTO P/L WELL BLDG. Ai,ito ntake ROAD Dt Inlet ir Septic NA Dt Bottom p NA Headed. k 9 O Aeration NA Dist. Pipe Holding Bot. System 7' PUMP/ SIPHON INFORMATION Final Grade nufacturer Demand 99 Model Number GPM TDH Lift Friction System H Ft oss Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of T enches PIT Of Pits Inside Dia. Liquid Depth DIMENSIONS DIM I N LEACHING anu adurer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION TypeO e~ CHAMBER Mo a ber: System: C( /o, OR UNIT DISTRIBUTION SYSTEM Header kMVn4e4* Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length SZ Dia. Spacing 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 Bed /Trench Center Bed /Trench Edges Topsoil E] Yes [I No El Yes [I No COMMENTS: (Include code discrepancies, persons present, etc.) VZ b", Z ~ v I,,~`''tr..~.UF'~.._y~.l~ r Plan 'revision required? ❑ Yes to Q Use other side for additional information. SBD-6710(R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: A f DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITA PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than / q5-5-- 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. PR792Ee RTY OWNER PROPERTY LOCATION ,N,R E(or PROPERTY OWNER'S MAILING ADDR SS LOT # BLOCK # CITY TATE ZIP CODE PHONE NUMBER SUBDIV SION NAME OR CSM NUMBER L1 <v j CITY NEAREST ROnq II. TYPE OF BUILDING: Check one ( ) State Owned ❑ VILLAGE : tv F QF- ❑ Public [41 or 2 Fam. Dwelling-# of bedrooms ~ PARCEL AX NU ER() w 111. BUILDING USE: (If building type is public, check all that apply) 020/0 /-5S-0/00 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. TY~P7EI OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. IL~J New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 511 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. 'rich) ELEVATION Feet Feet CAPACITY VII. TANK Site in allons Total # of Manufacturer's Name Prefab. Con Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks Concrete strutted glass App' Tanks Tanks Septic Tank or Holdin Tank On Lift Pump Tank/Si hon Chamber Ej r-1 F] F-1 L1 I L1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installa on of the onsite sewage system shown on the attached plans. Plumbe 's Name (PrinV: Plumb 's gna re- S MP/MPRSW No.: Business Phone Number: 9 57 I , j 1~)~A & 1 & ? P um is Address rset, City, State, Zi C e): t'l A"o X- '4~y~ &Ae- ,,e J C IX. COUNTY/DEPARTMENT USE ONLY W❑ Disapproved Sanita Permit Fee (Includes Groundwater a e Issued Issuing A nt Sign ure (No Sta ) Approved ❑ Owner Given Initial Surcharge Fee) AS-1 Adverse Determination X. CONDITIONS OF 4PPROV/~L/RE SO S FOR DIS PROVAL: I -e=Lie ,-gyp I ,~0-t~ C~ cal 3 v_~~ SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County. One Copy To: Safety & Buildings Division Owner. Plumber r INSTRUCTIONS 1 -A sanitary permit is valid for two (2) years. 2 'Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems. must be properly'mainta"ined. 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) soiLtest 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 ancrestablishment of standards. SBD-6398 (R.11188) e • 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 a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Location of property 1/4 X1/41 Section , T N-R~LW Township - L,~ Mailing address Address of site g Z'/ Z J Subdivision name Lot no. Other homes on property? yes No Previous owner of property'' Total size of parcel (:_Cre Date parcel was created G, - `IO Are all corners and lot lines identifiable? a"Yes No Is this property being developed for (spec house)? Yes No Volume, WV 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 the est of my (our) knowledge that I (we) am (are) the owner(s) of b property described in this information form, by virtue of a warranty deed recorded i the office of the County Register of Deeds as Document No. . C , and that I we own the ( ) presently 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. a _g; ur of pal' can co-applicant r Date of Signature Date of signature J t • • i DOCUMENT` NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA ~ 48295 WARRANTY DEED ~I VOL 949PAGE171 REGISTER'S OFFICE - ST. CROIX CO., WI KENNETH J. U E R Recd-for Record This Deed, made between - ~ j Rt. 2, Box 530, River Road, Hudson, 4L - . - W is c o--- s---n---54016 II~AY s 1992 - + Grantor, G~ and----~-E F:F I~E,Y---H-' ---a n-d K---I-S-- M ' P A N G E N_6 E_ R - 8:45 A. M 7-.0;. N_o r t h___E i.g h t h_•:S t .n e eu.d s o n-,••__________________________ - "husband and wife as survivorship marital propertyGrantee, Register of Deeds WitneSseth, That the said Grantor, for a valuable consideration 0 f - - one dollar and other valuable co nsati. - .i. . d..e.•~r-_.-._-._o-_. n_ RETURN TO conveys to Grantee the following described real estate in __S.t.,...C Y'-0 1-X....------ County, State of Wisconsin: A parcel of land located in part of the SE k of the NW i of Section 4, T 2 9 N, R 19 W, Town Tax Parcel No: of St. Joseph, St. Croix County, Wisconsin; being Lot 1 of Certified Survey Map recorded in Volume 9, Page 2445 at the St. Croix County Register of Deeds office; further described as follows: Commencing at the W k corner of said Section 4; thence S 89013'29" E, along east-west line of said section, 2016.62 feet to point of beginning; thence N 05010'01" E, along the easterly line of said Certified Survey Map recorded in Volume 9, Page 2445, 268.39 feet to the southern line of Lot 2 in said Certified Survey Map recorded in Volume 9, Page 2445; thence west along the southern line of Lot 2 in said Certified Survey Map recorded in Volume 9, Page 2445, S 890 267.00 feet 05-08" E 1, S 000541 52 W, ; hence south, 3.0.33 feet t thence s 8913'29" E, 369.49 feet to the.point of beginning. Grantee is hereby given an express easement of use to 66 feet of the private road adjacent to Lot 1; abutting said lot on the eastern side of the lot. This S..--- 0 t.-.-..-.-_- homestead property. (is) (is not) ~t} Together with all and singular the hereditaments and appurtenances thereunto belonging; J. Bauer And Kenneth - - • warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances *Xe)bx FEE, whatsoever and will warrant and defend the same. Dated this day of May 19 92 --..----(SEAL) _(SEAL) KENNETH J. BAUER 4JEFFk~ Y H. SPANGENBERG ---------(SEAL) `1-----•----------(SEAL) * KRIS M. SPANGENBERG AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ STATE OF WISCONSIN ss. vs 4~r~I Y-------------County. $-7~' authenticated this day of...................... 19______ Personally came before me this ___-____________day of 19.1__ the above named Kenrfeth J. Bauer and Jeffrey H. Spangenberg * and Kris M. S an enber TITLE : MEMBER STATE BAR OF WISCONSIN y--~saaniii--- (If not, - authorized by § 706.06, Wis. Stats.) to me known to be ~Aole'an., at *ho executed the foregoing in alit-a ' ack4pwle •~'lle:same. 1 7 = • L THIS INSTRUMENT WAS DRAFTED BY Robert R. Raehsler 1 - K nneth L: Attorney at Law G Notary Public ~S._County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission i'str., t. vav, tate expiration are not necessary.) d~ x STN 93 19 date c ---_-----t-...... -Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 1 - 1982 Mil--kee, Wis. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~~r~?.1,° ROUTE/BOX 'NUMBER FIRE NO. CITY/STATE__ 'z4-" ) I 1 ZIP PROPERTY LOCATION: 5., 1/4 A6111/9, Section J , AN, R__z2_W1 Town of St. Croix County, Subdivision , Lot No. 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 $3000 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE - St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 59016 (715) 386-9680 , Sign, Date, and Return to above address f tVyfOnllnOtoa•Ir••rrtofIrdullty. 5~111t)t:)t-l%lrIIV'4llt.t Vr11 Labor and►runlan M11110816 r~ L , : 1 ~(At{ach Soil Profile Location Map • To Scale • On A Separate, Signed Sheet) Mad'son.:•' S):~ P,qe t1IRAtANM~ •al evAL. 0A1 CVN'9AlY0UW YtO tOYN ~twa'mSt 1K ppalAV•ci n.p»nlr/lt Kenneth. Bauer 2-7-91L pasture N5n/a 530River Rd . , Hudson, Wi . tF4016 stale . Croix o•a e•or s 450 IMAM" OaMN 1411 tt►Ar.Gt11 SE 114 NW ` 29 U 19 ISt.Yos I a DORM ~ ce r r1e+r .ncAee Lot 9-LOCK n /a sueolvlaloN n /a B-1 No►iten Death Dornmant Color mottles Structure llmrun0 taeron lsench Bed n _ In Munllll u. St. Cont. Color future Gr. St. Sh. Con111lenct Roots loundar Depth 11•^c^ 9•e 1 0-9 10yr313 none 1 /m/sbk mfi 1/f C none .3 .2 I:Icv to .2 9-1 10yr4/4 none sil. /f/sbk mfi 1/f C none .0 .0 99.7 3 0-2 7.5yr4/4 none l.s. 1/f/sg ml 1/f G none .8 .7 4 8-8 7.5yr5/4 none c.s. /f/sg ml 1/f n/a none .8 .7 U•2 ltelrien Depth OomrnanlColor Mollltl Structure Urn-ling Facle,# L"ong.orDin n. t-•ncrl 9.e In. Muntell qtr St. Cont. Color Texture G►, St. Sh. Contrtlence Aootl Boundary 0991h 1 )-5- 10yt3/3 none 1. /m/sbk mfi 1/f C none .3 .2 Clev >d 2 -11 10yr4/4 none s.l. 2/m/sb mfr 1/f C none .5 .4 101. 3 1-23 7.5yr5/4 none s. )/fl/sg ml 1/f G none .8 .7 4 3-89 7.5yr5/4 none' c.s. 0/f/sg ml 1/f n/a none .8 .7 ) Structure limrylne taster/ <I► n. Horrten Depth Oorrllnanl Color Mottle Trench bad 3 ` I In Muntell 9u. St. Cont. Color texture Gr St. Sh C n Its n t 80011 Boundary Dror^ tr•rltn .e =.'1 0-7 10yr3/3 none 1. 2/m/sbl mfi 1/f C none .3 -r2 Elev . 2 -17 -iOyr4/4 none, sil.. 2/m/sb mfi 1/f C none .0 .0 9.3 3 7-2 .-5yr, none I.S. 0/f/sg ml 1/f G none .8 .7 4 6-84 7.5yr5/4 none c.s. 0/f/sg ml 1/f n/a none .8 •7 t Limiting fseteU le•ant,aPd•o n. 4 HorUOn (),01h OominanlColo► Moltlet Zltutlur Depth In Munltll U. St. Cont. Color Ttxtur Gr. t. Sh Contl ten Roo 1 boundary stench e.e =3: 1 3 4 none 1. 2/m/sbl mfi 1/f C none .3 .2 Elev ° 2 0-22 10yr4/4 none sil. 2'/m/sb mfi 1/f C none .0 .0 98'2 3 2-31 7:5yr4/4 none I.S. 0/f/sg . ml 1/f G none .8 .7 4 1-83 7:5 r5/4 none c.s. 0/f/sg ml 1/f n/a none .8 .7 U~ 5 Notllbn Dt01h Dominant Color MOtlltl SI1 Vt1Ufe llmllln0 raelor/ lonc In, Muntell u. St. Con . Color Texture G►. St. Sh, Conlrtttnte (loots loundary Oroth ti•neh Bad 1 0-12 1 r3 3 none 1. 2/m/sb mfi 1/f C _ none .3 .2 Elev b 2 2- ~yr4/4 none s.si--2/m/gr mfr 1/f C none •3 •2 8.7 " 20-2 10 i3 ,4 none l.s. 0/f/sg ml 1/f G none .8 .7 •'`'4 8-80 1 r4/4 none C.S. 0/f/sg ml 1/f n;a none .8 .7 Additional Mma►kl RECOMMENDED SYSTEM TYPE: trench ' page 4150 Soil series OnO plot' on back' 'lot 2.33 acres Other Srtt 11SIU111: 97.2 2-7-92 1715 1246-6"LUU 2298 QQ~ ~41LIZ26C / - ,ynatuto alt lgne ettphont No Mr 5ytlcm Rlcvation ' Gary L. Steel, 1554 200th. Acve., New Richmond, Wi. 54017 c8t Nnm• (mints City .~iule bp O a 7c' o1 1G~ OY • ,5 v E'L. 100 a- , gL 1f ' ,CERTIFIED SURVEY MAP Located in part of the SE= or the NW} of Section 4, T29N, RIM Town of St. Joseph, St. Croix County, Wisconsin. OWNER Kenneth Bauer AREA OF LOT 1 530 River Road 101,669 sq. ft4~(2.33 ac.) EXCLUDING ROAD R/W Hudson, Wi. 54018 108,684 sq. ft. (2.45 ac.) INCLUDING ROAD R/W ' I i I unplatted lands owned by others north line of the SE of the NW 33'i N8901410611W 752.70' 32'i r 0 IV o a • -•1 re, C rt ic 11-4 -nn ' m n , CL. M ! N m Co ^ 1 ~O P r+ N O ' N .r O h y. o io r. to 1c S es cn I^ IA N LOT 2 Ito~n o, 1.9 .T 653,201 sq. ft. (15.00 ac.) w a s s N89022130"W I. r• n s 5.50' (p -c rre 32 m y i~~„ +i• Rec. as 7.0' /~C~%r1 by v a > > w v ' S8901213911E n i~ ' to 330.09' Hote: o, Ic.i is 1 1 Icn h Any additional•.lot•aroun4 10., CL ' I existing house must a _ - _ rr ~OD I CERTIFIED_SURVEY _MAP w O minimum of 3.67 acres t°ni~I M• : 2 of.. I v_oluae_2i_eage_534 H In size. 1 o ia~ If" I o L" Ion J= o #.A In existing house N r„lC A 1m I i : V to I.-c r. Ito W" 1 I .r S89005' 0811E Ir - to la two . r Icn 1a 20 00 0 200 390.331 - ( 1~ • 1 V N 1 h.h } 03 C" C" N o LOT 1 i ~C2 , 1 A SA9329E 1647,13 L\- - - 0 1 n 1 _ N88059103"W 370.43' 1 east E west one-quarter section line a S890131291iE 369.49' 3216.09' W} cor er - Section 4-29-19 , E} corner .115th Avenue - . Section 4-29-19 ,~C11Q954dfft.;' LEGEND „~*Q~yt'"~$lt,~ 19 Found Aluminum Cap in concrete. 6 Ip. c~• f, y r • Found In Iron Pipe. It FIAC1.1. o Set 1" x 2411 Iron Pipe weighing 1.68 LBS/linear foot. I{,~ ' t existing fenceline 1'itji.►?Ci.°1, this Instrument was drafted by Douglas Zahler job no. 89-39 f ` Surveyor's Certificate I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, do hereby certify that by the direction of Kenneth Bauer, I have surveyed, described and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located i.n part of the SE4 of the NA of Section 4, T29N, R19W, Town of St. Joseph, St. Croix County, Wisconsin, further described as follows; Commencing at the Wed corner of said Section 4; thence S89013129"E 1647.13 feet along the east & west one-quarter line to the point of beginning of this description; thence continuing S89013'29"E 369.49 feet; thence N05010101"E 884.99 feet along the westerly right-of- way of a 66 foot wide Private Road; thence N89022'30"W 5.50 feet along 0he south line of Certified Survey Map volume 1, page 198; thence NORTH 438.42 feet along the west line of said Certified Survey Map; thence N89014106"W 752.70 along the north line of said SL's of the N%A; thence S00054152"W 660.75 feet along the west line of said SE4 of the NWh; thence S89012'39"E 330.09 feet along the north line of Certified Survey Map volume 2, page 534; thence.S00054'52"W 659.79 feet along the east line of said Certified Survey Map to the point of beginning. Subject to right-of-way for the Town Road as shown on this map and all other easements of record. Together with an easement for ingress and egress over the 66 foot wide Private Road shown on Certified Survey Maps volume 1, page 198, volume 2, page 535, and volume 2, page 405. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of he Coun y of I St. Croix in surveying and mapping same. TUV;,, 'S, a ~IYHA~~9 ~ t,1nSON. ~ • . ~sasavve~~qt Npr-9No a►sr Note: The roadway shown on this map is a Private Roadway. All maintenance costs of the Private Roadway, after its approval by the Zoning Administrator as a standard road, shall be shared pro-rata by the adjoining owners. If the Private Roadway is taken over by a municipality as a Public Road maintenance costs thereafter would be a public expense. V7 8' SS 1413 ,O,E,o S/z.E - /a•!'S"7 `s 107/ , ~ '1 9q3 ,is ' L ~ I \ PAGE OF CroSS S~cc~lol, cl ~~r1~ S~en-~ p f _ j . ~ ~~7 S~~S'~• ~~t ~ fraM Ak IMele AAO OC~~►valloe Plpa 'I APPlov:• Veal COP v Wwow12' Aaotio I Final Good* j 20. 12' Above Plop 4• Coal Ikea To ►lool Geode Veal Pipe Wren lar of Syn1A4fle Cove) lAY auo 2' Ayyrogele Oael Plot • Oleulblloa tiro o -Too a i~ A1Vreo•lo • , look .11 Ilre Pe~lorelae Plra below o ~CCOIAll Tern11441149 As iulow. 01 i►elee / _ SOIL FILL. • OISTKIBUTIO►.) PIPE • APPR01/EG S'IIJ•TIICTIC COVE 2" OF 1l6GRE6A1E ~'"'"l1ATEIt1At- OR 9" of STRAk Oil MARai• N,Ay ELEV. O / ~ 1."OPp- AGGRCGATC F FELT DISYR15UTIOM PIPE To DC AT LEAST INCHES BELOW ORiGIWAI. •:,rlwOE AUV AT LCAST;O INCHES BUT MO MOKC THAW 42. IWCIIES CICLOW FINAL. r ikAOC MAXIMUM DEPTH OF E-ACAVATIOP )fKOM OKI6Wg1. 69A)F WILL aE INCHES rJf(IMVM ©Cf ni OF EXCAVATION rAO^ c+IkIGIt1At_ GRAPE WILL. 5C 1:~ INCHES SIGIJCO: LICCNSC WUMBEII: DATE: T T o _ LOCATION: ST. JOSEPH 4.29.19.65A,SE,NW,115TH AVE. Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and HumanRelations INSPECTION REPORT ST. CROIX 'Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 149329 Permit Holder's Name: ❑ City ❑ Villages] Town of: State Plan ID No.: SPANGENBERG, JEFF ST.JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 030101550000 ELEVATION DATA A9200176 TANK INFORMATION TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV- Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Head Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trench PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS !L DIMENSIONS- LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION TypeO CHAMBER Model Number: OR UNIT System DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole 7pacing Vent To Air Intake Length Dia. Length Dia. Spacing 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 Bed /Trench Center Bed /Trench Edges Topsoil C] Yes No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Plan revision required? ❑ Yes ❑ No Use other side for additional information. I SBD-6710(R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 4 t I SANITARY PERMIT APPLICATION DILHR 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 Vwa Q 8% x 11 inches in size. ❑ chec if to a f- jpplication -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 '/a '/4, S , N, R 1,9 It (Or) PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK --,4 CITY, TATE ZIP CODE PHONE NUMBER SUBDI ION NAME OR CSM NUMBER CITY NEAREST RO D 0 40 : II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE r ION Q~ RCEL T AX NMER(S) . U B ❑ Public M 1 or 2 Fam. Dwelling-# of bedrooms 3 III. BUILDING USE: (If building type is public, check all that apply) /0 S'S°'aiOr7 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 1130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2.E1 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E1 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ® Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min. nch) ELEVATION Feet 8 7 j/,~ Feet AAJ VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 16y&~ 0 . 1:1 El F] 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. Plum is Name (Print): Plumber's Si nature: (No Sta s) MP/MPRSW No.: A Business Phone Number: 104)z& 91 ~ j 4 /2, m r s Address (Street, City, State, Zip Coder IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sani ry Permit Fee (Includes Groundwater ate Issued I ing Agent Signature,( Stamps) %Approved ❑ Owner Given Initial Surcharge Fee) 41 Adverse Determination UU X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ovine,ship or plumber requires a Sanitary Permit Transfer'Renewal Form (SED 63991 to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be purr,p>_d by a licensed purnper 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 manufaciurer; 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) REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1 06/15/92 11:13 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/15/92 AREA: JT Activity: A9200220. 6/15/92 Type: CONVSEPT Status: PENDING Constr: Address: ST. JOSEPH 4.29.19.65A, SE,NW, 115TH AVE. Parcel: 030-1015-50-000 Occ: Use: Description: 171455 Applicant: JEFF SPANGENBERG Phone: Owner: JEFF SPANGENBERG Phone: Contractor: O'CONNELL, KIM A. Phone: Inspection Request Information..... Requestor: KIM O'CONNELL Phone: Req Time: 15:06 Comments: Items requested to be Inspected... Action Comments Time Excp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION Labor bor and nd hum Dnham Relations IydutvY• EVIL Utbinlr i Ivtt nw vrt t ' M erons V jet. (Attach Soil Profile Location Map • To Scale • On A Separate, Signed Sheet) r.tadtton, :.r Page curma raga tOh 1VK.0u1 C uW NOtOVM ►yMfarl W11MK YOYYr1lf r1o00 l1 "°wse t:rtr P I1ar'1 ,o► SIGIUM J Iesrtaho.ro o.o» a tOC.IOn tOMrMW .K I~a.MCIl141~t11 - Boaaro I CSMI LOT BLOCK SUBDIVISION ~waw _alrtaol 13. Mouton Depth Dominant Color Molllet Structure Umlttne Faclorr laanOGPO so n. In Munsell t. Cont Color vesture Gr. t. h, Conti 1l n e '11110 l n at Oaoth iron/en Bed C l e v e r ~.~L C/ / , S' A.S All, 3? 1,7 D Morison Depth Dominant Color Mottles Structure t,rmrttne Factory lat6^9 0POt4 n _ I In Muntell u t, Cont. Color T 1 r Gr. St. h. C ntl tent Roots to ndat Oaolh Trench 9•d Elev ■ 1 D Mouton Depth Dominant Color Mottles Structure Umrtlno Factor/ laonQGPOW n. • In Munull St. Con t! Color Texture Gt. t h, Conjiltintir Roots Boundary Depth Trench sod Elev a Mouton Depth pomrnentColor Mottles Ztruclure Unitttne Factory LaanpGPdw n. In. Mun ell . St. Cont. Color Tf*ture Gr. . 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