Loading...
HomeMy WebLinkAbout030-1079-50-110 70 0 ^4, o p - v o N Oi h Qv O c e, 3 0 Cb ° c ~ N Cl) o•Ec ~ ~ ca v e cm co a n if) O w C •Q 0) N (n 0) t i C ~ I ~ 76 a a w C Z CO 7 (0 M w LL o o~ E a F- C) 3 M v! (D _ Z y 0) W G O Of U) Z r C', LU ° a m 0 c C7 co O z Z o o (D to F- N Z m N N 01 N_ N N N C • ~y a U) _o U rZ`i O m © O N Q w Z [n z o N C C Z C ~ N N co (6 E N N N V1 (O N O - w 0 00 p N a O (n a a 1a N Q to N to > F- F- u ~ o ~y Z - > (D ° o ~i. 0 0 0 0 z •rv m a a (L a ' o N o 0) rn aNi V1 U N rn rn 'V u> 0) } a) o N 4 O O m `t m E J O O a W 0 N N U I o CD r~ 0 0 0 3 w e < O C OU N N O O cO m a) C C a 01 O ]l^ ' . N Q J N C C N N V r~r n N U G N N N U U') (O aO C? o _ N O N N m • y?,~' O N U) W O to UJ ~ O N O 3 O E ~ O A U aM O N 0 DEP'ARTWNT OF REPORT ON SCE SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATI r115) MADISOP.O. BOX 76 HUMAN RELATIONS N W 53707 (H63.090 apteF1445) LOCATION: SECTION: TOWNSHIP/MAY: LOT NO.:BLK. NO.: SUBDIVISION NAME: SE 1%E 1/4 28 /T30 7N/R[ 9xE (or) W St. Joseph n/a n/a n/a COUNTY: OWNER'S AME: MAILING ADDRESS: St. Croix Pane Paolocci 539 Nordic Lr., 1€udson, Wi. 54016 386-7078 USE DATES OBSERVATIONS MADE L35haesidence NO. BEDRMS.: COMMERCIAL DESCRIPTION: )(New PROFILE DE RIPTIONS: PER O ATION T3 n/a LReplace I4-7-92 4-7-92 RATING: S= Site suitable for system U= Site unsuitable for syr_- ` CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) L S ❑U ❑ S BS ❑U ❑ S ❑ S HU conventional 18x40 bed If Percolation Tests are NOT required DESIGN RATE: I 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 42 RxD2 BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTF3';1!61, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 8.00 99.65 none >8.00 .50,10yr2/1,s.1., .67,7.5yr4/4,1.s.,6.83,7.5yr5/4 o.s. B_ 2 7.91 101.40 none >7.91 •50,10yr2/1,s.l., '200,10yr4/3, l.s.- 5:33 1 4 4 CO.s. B_ 3 9.70 103.30 none .50,10yr2/1, s.l., 3.00,10yr4/3, l.s.- -70 6.20 1 4/4 co.s. B- 4 7.92 108.00 none >7,92 .67,10yr2/1,s.1., 1.25, 7.5yr4/4,1.s.,- B- 5 18.50 108.50 none >8.50 •50,10yr2/1, s.l., 4.00,10yr4/4, l.s.- 4.00 1 4 3 l.-.. B- d.ecirlal' PERCOLATION TESTS TEST DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER )MOM AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI002 PERIOD PER INCH P_ 1 3.00 none 3 6 6 6 P- 2 4.75 none 3 6 6 6 <3 P- 3 6.65 none 3 6 6 6 <3 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 96.65 t surface A~re~ to' he chit, o_ 61,10.65 v~" 0 { r_ l n i 00 _ e_ 14r i F E [ t ~ _.Pr 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and me cified in the W' Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print : TESTS WERE COMPLETED ON: Gary L. Steel 4-7-92 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. Ave., New Richmond., Wi. 54017 2298 15- 46 200 CST SIGN DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INS'i . ~k MMMPP 4s FORM 115 - SBD - 6395 To be a complete and acc~ tet, your report must include. 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or conmercial use planned; 4. Is a new or repla( -nent system; _ 5. Ci e the suit ig boxes. A SITE-kSUITABLE FOR A HOLDING TANK ONLY IF ALL u R SYSTEM- )LED OUT BASEL? ON Q ,r D IT IONS; 6. P1 ..ASE use the r ons shown here for writing profile -.scriptions and completing the plot plan; 7. MAKE A LEGIBLE ' am accurately locating your test locations. Drawing to scale is preferred. A separate sheet may A if desired; 8. Make sure your h mark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all at date boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if approl e; 10. If the inform< (such as fl( I plain, elevation) does not apply, place N.A. in the appropriate box; 1 1 . Sign the for place your rent address and your certification numt:)^-; 12. Make legibi° and dis 'Rite as required. ALL SOIL TESTS M' - F BE FILED WITH THE LOCAL AU~ - ITY WITH N 30 DAYS OF COMPLETION. ABBR NATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures C Symbols st - 10") Bpi - Bedrock cot) - C 1011) SS Sandstone gr G 3") L'; - Limestone *s Sat I * - High Gro, r cs - Cos Pere - Percolation " e roved s ~ ^ f W - Wel l fs F:. _ Bldg - Building Is - Loamy 3 id > - Greater Than sI - Sandy Loam < - Less Than "l - Loam Bn - Brovin `sil - Silt Loam BI Black si - Silt Gy Gray *cl - Clay Loam Y Yellow set - Sandy Clay Loam R - Red siel - Silty Clay Loam mot - Mottles se Sandy Clay vv'/ ti" sic - Silty Clay fff fire, faint "c Clay :3 cc - in , yon, course pt - Peat rnrn - uy, med;um rn - Muck cl ,,nct p - orninent HWL - High water level, * Six general.soil textures..- surface vv~ for liquid waste disposal Blot - Bench M-''-' VRP - Vertical _ 1( Point a , TO THE OWNER: i This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this so test in the field prior to permit issuance. A complete set of plans for the private: ar-i --nit application must be submitted to the appropriate local authority in order to it. 1 ry permit must be obtained and posted prior to the. start of any construction. I Parcel 030-1079-50-110 02/17/2005 10:19 AM PAGE 1 OF 1 ` Alt. Parcel 28.30.19.287A-10 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner " PHILLIPPO, RONALD A & BETTY S RONALD A & BETTY S PHILLIPPO 576 PERCH LAKE RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 576 PERCH LAKE RD SC 5432 SCH D OF SOMERSET SP 1700 WITC I I Legal Description: Acres: 5.640 Plat: N/A-NOT AVAILABLE SEC 28 T30N R19W PT SE SE LOT 1 CSM Block/Condo Bldg: 8/2232 EXC AS DESC 1167/457 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1167/459 WD 07/23/1997 1167/457 QC 07/23/1997 945/192 07/23/1997 875/265 2004 SUMMARY Bill Fair Market Value: Assessed with: 5429 427,500 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENfIAL G1 5.640 106,800 313,800 420,600 NO Totals for 2004: General Property 5.640 106,800 313,800 420,600 Woodland 0.000 0 0 Totals for 2003: General Property 5.640 62,700 239,300 302,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 117 Specials: User Special Code Category Amount Delinquent Charges Special Assessments Special Charges Total 0.00 0.00 0.00 Parcel 030-1079-50-000 02/17/2005 10:16 AM PAGE 1 OF 1 Alt. Parcel 28.30.19.287A 030 - TOWN OF SAINT JOSEPH Current IX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * ERICKSMITH INC ERICKSMITH INC NKA PLAT OF BIRCH PO 00000 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 18.410 Plat: N/A-NOT AVAILABLE SEC 28 T30N R1 9W SE SE EXC P287B (LOT 1 Block/Condo Bldg: CSM 6/1643) & EXC CSM 8/2232 & EXC CSM 8/2357 & EXC PARCEL DESC IN 899/128 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) N/K/A PLAT OF BIRCH POINT 28-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 995/109 WD 07/23/1997 899/128 07/23/1997 871/398 07/23/1997 845/519 2004 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/27/1995 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 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 Wla2- S t %y s: 6'. Z. V AJ `%u,? to % O CERTIFIED SURVEY MAP LOCATED IN PART OF THE SEJ OF THE SEJ OF SECTION 28, T30N, R19W, ,•pg9~1'd3f,~~ TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. LEGEND ,y ~rt~..r-,a C.~ Y~, rs~ • .:ra tR & St. Croix County Section corner monument- aluminum cap in concrete. x; 1 -a7 a a 0 1" iron pipe found H JOS0 e'1, WIS. ,e`' O set 1" x 2411 iron weighing 1.68 Pounds , ' pipe per linear foot. ..;,..00 , , 11 ~ !1 v u"n ~ J L1 r ~~jv~ N SCALE IN FEET OWNER 0 150 300 450 Ericksmith Inc. P.O. Box 201 Bearings are referenced to the south line of the SEk assumed Lakeland, Mn.. 550.43 to bear N89°04'58"W. FILED a unplatted_lands S8900415811E 617.001 JUN 2 5 1990u*- 9 Z JAMES O'CONNELL Register of Deeds St. Croix Co., WI ° LOT 1 iN N / 1 O 1C O 1 c = 435,652 Sq. ft.) W ' o' m o° )INCLUDING ROAD R/W 10.00 acres I rt rs ' ~ Itp CD 406,275 sq. ft,) o+ :E N 9.33 acres )EXCLUDING ROAD R/W co 1 O) 13 O, o0 1 1 a v I W 1 01 O N A - APP J U N 2 2 1990 41 TO1/ ROAD 130th Avenue 66' right-of-way (-k1~i2K~~P~M I N8905511IYE SEE D TAIL AND ZONINC-, 183.561 S88°23'45"E 397.788E W 1396.481 N89 ° 0 ' 4 58 1V ' " 583.15 _ 633.85' S4 corner 1 _ -.Uth_11ne_4f the.SE Section 28-30-19 SE corner CSf-1 vol. 5, pg. 1381 Section 28-30-19 1 ~ CSh1 vol. 6, pg._1700 I DETAIL NO SCALE S88°23145"E 397.781 _.0...,_4.-U1 S$Z_°4~'1 this instrument drafted by Douglas Zahler job no. 89-29-190 VOLUW 8 PAGE 2232 583.151 633.85' N890041581111 FEB 18 1998 ST C S RECORD C) < CD Z C-) ~0 BEARINGS ARE REFERENCED TO THE If SOUTH LINE OF THE SE1/4 OF SECTION CD rri 28, ASSUMED TO BEAR S89'04'58'E z kP I• ,I- _9 I i. 10 °c M j ~ T4P 1. I I~ I ID I- ~ I iZ In 0, CD m - I~ I~ IC rn 4E I I I ( I I Z Mtn CIO w ICS Or CD CD l O r -~-I S00'45'34"W~ ~r ~o 1306.08' I I~ 1 -44 v~ 3 D r 66 z -i a --I z o v- rn 00 o r9 y z m C-4 -4 i' 1c: x 0 rT, D I tm ~z co lz C-) m i~ c t1m N m 46 -1 3 I -P ly z o rv -D-I i-I z n -I G 50 _ S00'32'56"W 755.53' ~o M m ° m rv r= 0" 0clz--In = m -I o mm m x brg) Z: v m C\ m OW~o p -N Zm-Zi4N 9N -4 m %D w I*I UI r,,) 1(-400 Op O tJ C O 1-1 0, 3. d~ eye '-4 d a o :I r- zo --I m Comm" 1121.39' 'm*I m 04W70 00 N00'45'34"E 1201.76 IT! `v Zo m / r- Q m m z 0 ro A o D CT1 / ro 0 z ; • 0 0 Ir i0 ~ r 00 - 10 E3 I~ m M ro ° m 0 ? m r N co x~ z 3 G') I-P In O G) z -0 -u d` vWi~: z z 0 i c~£ \ ~ IT H H --I 3 m -n ;o r p M .I-. -0 O d -i ` IZ z -I C~ Z p C I~ m m M d a Dm d to d -q N ~m ~ C m r- C3 0 ; r Z frl ~1 O dC z G Z A m ?o 0-0 z ;o z zm m ~ ~_m ~ C7 Lnr* om 0 ~I:jm ~ J VOLUME 12 PAGE 3394 FEB I Dec 1 569771 KATNLfE 199 ST. CROIX COUNTY Registero pis 1 SURVEYOR'S RECORD \ S[ CroixCO., y~ z 0' BEARINGS ARE REFERENCED TO THE c a ` SOUTH LINE OF THE SE1/4 OF SECTION 28, ASSUMED TO BEAR S89'04'58' i C) m ~4r n a ;zo z m -I co ru 7d O v m LOT 1 _OF_C_S_M__IN VOL. __9,_ PG._ 241_3 - ~N y 1 o cn g r*1 ry '0oi~nlm I -v'kio c~~ • L., I S00'45'34"W 1 306.08 1z 31,46 , CCESS EASEMEN 662.04' N N00.45'34'E 554.86' c °1 5Nr 1 co I a, I0D l~1 as cn n 33 3 ~;o =I ro £ 3 a r i cn 1 I 0D I I `D -i V -I z o r~ m m 1 l i ( r*' w L -1 i 1rp I iD I ° D o m vo Z rr, ~-4 n d im I 0 429,92' 44.94 n X C3 ~ D i~Z S00'45' 4'W 474.86' Z 2 n C Z N I p -P I I ID ~ N cn ~ r' C C 0 "0 cn l r U7 1 io cn o+ m -u o z -1 O a m l it 00 co o LA ►y "0 UI fTl z (7 n LOD C-) I O fTl cA 1T1 rn w v 00 ty 50 _ m m CD, c') ;a Q E3 1 G7 ~ N Fit- W c Flo o 0 ~ 0 X Z~ m wn <m CJ W a) w ~ 14 ~N Ln y; Il ~OC M H IN N ~I w na) V UI I °D N ko w M(A 4 c w O ago, ;o w z .P 0 m ~-i0~ z o do£ d m imm 8r~37 p o- o z z N w O ty Z<~~ Z 10 I (7, C3 d~ e~ '4 34 ~m ~,=a C cn r- ~ I. I' m=~ Nm 2d1.76 d o C3 0) Co N "o zo m it O 3.r1= M ~ OINT DRIVE (J1 10 m m Z w Nti,_ z - - - N00'47'12'W 726.32' L, - - . 46 i~ ap m 1 v 'o iv co; c I w Z, 463.72' \ 01 ° Op 'CT1 I *1 m TI ~ ~ < 10 `0- Ln R- 4 LA w r) 348.23' 262.60' Lal Gl 0 ~ R- ow 610.83 m~-+ m a' N °D 676.83' X"w 2 w N00'20'20"E m z pl, f'l % n N (7 as rU N r m . S ytnD N o° r- r 132.01 w ~Z a D ZI (U .Z~J X coo) C-) JO .p .66i0170... a O c'686c'~~ o x0~j I Ir 9$' Z y D 0~( of _iI( O m o I w z TI z 0l j~ • o• r 'Tl Z I-D I~ ?33 ww d -PI~I-~ C3 -I c 01 CD 1^ F N, E OD 10 m-Xm I C i l ' 38 I~ N ° . . 3a r as Q r- M -q O M N 100 F'~SF 86 910 ° °D X Z 3 C) ~ 0 o o ; MFNT ir'~ Z ° Wp, zm z Z > -pt 00 r- Ln I< 10-0 tj z c ° m CC) oo ~OiO 2 o a -0;0 In ~oo CD m lr I 2U1L o l I m< Z M 0p TI i• yom z ° 'M ~-0 o d~ m Z = m h 10 I1- D o-v rri 1p Z z -o Z do m ~l O rC a m 1 x ~ m t=l clo) 1 =d ;o iz (4 ° 0 n ~~m l TI HED 1~I~10 ADM z 0 C3 z 11 fTl IN I• m o~ n M m o Z as --q Cl C3 u oDa IC,4~• pm z z m 0 0 0 0 IN ; Z m d VOLUME 12 PAGE 3394 AS BUILT SANITARY SYSTEM REPORT OWNER L ANZ PALL L, 0 CC /l TOWNSHIP -SW SECTION-,X 6 T_110 N-R f 9 W ADDRESS ERCA C-AX' ~t ® ST. CROIX COUNTY, WISCONSIN l~(0soy y Chi: syo/6 2 3 v SUBDIVISION I """rK Vj'-7 LOT LOT SIZE s PLAN VIEW (O f am Cy 3 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM a ~ l I 1,419'0 10040 C-41- !9& pAe X15' ' ~ p .~a12c14 - INDICATE NORTH ARROW BENCHMARK:Elevation and description: ~Alternate benchmark_jrp V /3N MT 1VAL SEPTIC TANK: Manufacturer: Wj5,& AC'S Liquid Cap. 144 Rings.used:_Manhole cover elev:i~~,//Final grade elev: I Tank inlet elev.: Tank outlet elev.: a,?.3 No. of feet from nearest road:Front_~L, Side , Rear Ft.-j(2920-+ From nearest prop. line:Front , Side,, Rear Ft. gtV'7' No. of feet from: Well , Building:^I.s- (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacit Pump Model: Pump/Siphon Manuf act Pump Size Elevation of inlet: Bott f tank elevation Pump on elev.:_______Pump elev.:-----Gallons/cycle: Alarm: Man.: Switch Type: Location Distance om nearest prop. line: Front,_,_, Side, Rear_Ft. ance from: Well Building SOIL ABSORPTION SYSTEK Bed: Trench: Seepage Pit: Width:-A_Length Number of Lines: Area Built 261D Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe:tIJ " No. feet from nearest prop. line:Front Side', Rear Ft.24Q f No. feet from well: No. feet from buildingg HOLDING TANK Manufacturer: Capaci - No. of rings used: Elevation ottom tank: Elevation of inlet: No. feet from rest prop. line:Front , Side-, Rear Ft. No. fe from: Well , building , nearest road larm Manufacturer: INSPECTOR: DATE: PLUMBER ON JOB: LICENSE NUMBER:- F.2-0 6/90:cj LOCATION: ST. JOSEPH 28.30.19.287A,28,SE,SE, PERCH LAKE RD. Wi4 oA7 in Department of Industry, PRIVATE SEWAGE SYSTEM County: ' Labor and Human Relations • Safety and Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 149305 Permit Holder's Name: ❑ City ❑ Village] Town of: State Plan ID No.: PAOLOCCI LANE ST. JOSEPH CST BM Elev.: Insp BM Elev.: ]iBMDeescription: Parcel Tax No.: o 030107950000 TANK INFORMATION L I TA A9200 4 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Ntj,_ r" Benchmark p.p /,7~ 1,_7L /00,() Dosing Aeration Bldg. Sewer Holding St/Ht Inlet ~,7 9 > TANK SETBACK INFORMATION St / Ht Outlet w ~l q y,8 -.2- TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic >30~~ / NA Dt Bottom 61jL Dosing NA Header/Man. -7, q-7, 5(, Aeration NA Dist. Pipe $ p 6 Holding Bot. System ~j 96 6 Z PUMP/ SIPHON INFORMATION Final Grade 4 5 /o a 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 Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 6 / DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION Type of 7 / CHAMBER Moe Number: System: Q ~a a.5- 1A_ OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipq(s) x Hole Size x Hole Spacing Vent To Air Intake Length (o Dia. Lengt?I- Dia. ~u 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 ul` Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENT9: (Include code discrepancies, persons present, etc.) w ~ UJY' 9 ~ F Plan revision required? ❑ Yes ❑ No C/ 0 Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH t SANITARY PERMIT NUMBER: i 7DILHR SANITARY PERMIT APPLICATION COUNTY ~v In accord with ILHR 83.05, Wis. Adm. Code STATE SANITA ERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 I 8'f1 x 11 inches in size. Check y1revqsi0to prevwus 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 ~'/a S T3 ,N,R E(0 W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # n ` 23 ,5 4 I A b CITY, STATE ZIP CODE PHONE NUMBER SUBD ON NAME OR CSM NUMBER UO iGU~ .5yo/~ 111- ) .-7 7 Il. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD L1 State Owned VILLAGE : ❑ Public LA 1 or 2 Fam. Dwelling-#of bedrooms 3 AR EL AX N UMBER(b) 111. BUILDING USE: (If building type is public, check all that apply) .2 l / C ;Z _ a 1 El Apt/Condo O 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 2.0 Replacement 3.E] Replacement of 4. ❑ 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 El Mound 30 El Specify Type 41 El Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 130 Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 116-0 7 r 6 s 3 6/.Feet OZ Feet VII. TANK CAPACITY Prefabj Site Fiber- Exper. in allons Total # of Manufacturer's Name refabe Con- Steel glass Plastic App INFORMATION New istin Gallons Tanks Concre structed Tanks Tanks Se tic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber I OR n 0 p El Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown ached plans. Plumber's Name (Print): Plumb s Signature: (No Sta _ M Business Phone Number: u itT iI- sy9x'63 Ile Plumber's Address (Street, City, State, Zip Code):- ! S T r S~1O .5-,96 IX. COUNTY/DEPARTMENT USE ONLY Sa itary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) ❑ Disapproved Surcharge Fee) Approved ❑ Owner Given Initial CQ~WZV Adv rse Determinate n X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SF3D 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 lode administrator or the State of Wisconsin, Safety & Buildings Division, E08-266-3815. 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 fil' 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, locaticn of holding tank(s), septic tank(s) or other treatment tarks; building sewers; wells; water male 1water 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 refere,lce points; C) complete specifications for pumps and controls; dose volume; elevation differences, friction loss; pump performance curve; pump model and pump manufacturer; i3) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) ali sizing information. - - - - - - - - - - - - - - - GROUNDWATER SURCHARGE 1!?3L Wisconsin Act 410 included the creation of surcharges (fees) far a r~r tiv r of regulated practices which can effect groundwater. The fF 3Ptft 5 collected through thcso surcharges are LISeC f-)3 rnort;toring grouocivv'mer, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) APPLICATION' FOR SANITARY PERMIT 9TC-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 tesult In delays of the petmit Issuance. -Should thin development be intended lot resale by owner/contcsctoc,(spec house), then a second form should be tetalned and completed when the property Is sold and submitted to this oltics with the appropriate deed recording. Owner of property „L ~rv M. 'S~anncek k- e CO ' j q • Location of pcope:ty 1/4 /4" Sectlon T 3-(- j RAY Township ,yet C> 2.~y I~ ri r Lcz~ k.(_V5 t.c~' f Melling address Address of site 5 I L- r'u*C_. r4 . 1,4 5 Cd. L1 Subdivision nasty Lot number previous owner of property Total else of parcel - Date parcel was created 99c, Ate all cotnecs and lot lines Identifiable? -=Yes o is this property being developed lot resale (,spec houselTYes No Volume and Page Number LZI as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION TITS FOLLOWING: A WARRANTY DENO which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMa[R, and the SEAL OF THE REOiSTER OF DEEDS. In addition, a cectlfled survey, It avallable, would be helpful so as to avoid delays of the reviewing process. it the deed description tolerances to a Ceititled Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) cattily that all statements on this form are true to the best of my (out) Rnowledgej that I (we) am (ace) the owner(s) of the property described In this Information form, by vlttue oL a warranty At J/ `recorded In the Office of the County Register of Deeds as Document No. Cj ) and that t (We) presently own the proposed alto for the sewage disposal system (at I (we) have obtained an easement, to run with the above described property, tot the construction of sold system, and the same has been duly recorded In the Office of the Count-,)Reglstar/b-; Deeds,, as Document N irnature of owner lft4riiaturg of Co-Ownet (it Applicable) '1 1•~ ~~i'li ~ Data of gnaluca Data of Signature ~lJ~7 ~S 38 CERTIFIED SURVEY MAP' LOCATED IN PART OF THE SE} OF THE SE} Of SECTION 28, T30N, ,R19W, ♦,t4~,0°~ f TOWN OF ST. JOSEPH, $T. CROIX COUNTY, WISCONSIN. +w''•'"~ ~'rf LEGEND %Ap AL C. 1-4 rtl~ .14 x.. County Section corner monument- aluminum cap in concrete St. Croix 1 ~t • FILID 34M, '♦~lh• • 111 iron pipe found f ♦ O sot 1" x 2411 iron pipo weighing 1.68 pounds per linear foot. Q! N 1 N SCALE IN FEET OWNER 0 150 300 450 Ericksmith Inc. P.O. Box 201 Bearings are referenced to the south line of the SE} assumed Lakeland, Kn. 55043 to bear N89°04'58"W. FILED unplatted JUNE 51990P- S8900415811E 617.00' JAMS O'CONNELL "I of coos SL CMh a. a o ' LOT 1 ~ N 10 hf C, ~ ~ N 435,652 sq. ft.) 14 r:, )INCLUDING ROAD R/W i~ T 10.00 acres n 406,275 sq, ft.) I a EXCLUDING ROAD R/W I - 9.33 acres ) ~w 1 N ca e APPI JUN 2 2 1990 TOWN ROAD 130th Avenue $7, CROiX4l1t'}N s- 68' right-o~-way_-.--- Mi4m PdVK%QP+ P~MPiVdC SEE DETAIL ATV it)I 44 COHANa IE~? (N89°55'11"C BELOW- - I 183.55! ,.,o-_ S88023145"E_397.781 1396.48' N89°D4'S8"1V 583,15' 6 ~8 ' _ Uth-Une At the SE S, c Irner ,A SE corner Section 28-30-19 i CSi_1-vol. 5,Cg:-1381 Section 28-30-19 - I CSN vol. 6, pg. 1700 DETAIL NOT SCALE $88°23'45'E 397.78' ~ this instrument drafted by Douglas Zahler v, job no. 09-29-190 8 PAGE 2232 583.15' ~ 633.65' vOLdR 1189004 58"11 J QOCUMENT NO. WARRANTY DEED-By Corporation STATE OF WISCONSIN-DORM 2 THIS SPACE RESERVED FOR RECORDING DATA • ~ ~ 481946 LIBER 945PAGE 192 . REGISTER'S OFFICE THIS INDENTURE, Made this .....9t11............ day of........ Apr $T CROIX CO., W~ A. D., 19..92.., between .........ERICKSMITH....... INC Recd For Record a Corporation APR 141992 duly organized and existing under and by virtue of the laws of the State of Wisconsin, located M at ..........C~.IfiaX............................... Wisconsin, party of the first part and Ct 10: 30 A ane•.M.----Paolocci----and.__.Shannon_ K......Paolocci~.................. husband---and-- wife--•- Cary, , Deeds part ..;:fC..Sof the second part, RETURN TO W f t n e a a e t h, That the said party of the first part, for and in consideration of the sum of....One,•_ Do l.lar -.-and--- other---va l uab 1e________________________________________ ...cQn;qldexatlom...................................................................................................................... -...to it paid by the said part --iaS-of the second part, the receipt whereof is hereby confessed and acknowledged, has given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents does give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said partieB.of the second parthelLeirs and assigns forever, the following described real estate situated in the County of........S.t...Ii Q . .................and State of Wisconsin, to-wit: Lot 1, Volume 8 of St. Croix County Certified Survey Maps, Page 2232, Document Number 459863. Being a part of the SE4 of the SE'! of Section 28, T30N, R19W. ._./D ? 04 (IF NECESSARY, CONTINUE DESCRIPTION ON REVERSE SIDE) Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate right, title, interest, claim or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To Have and To Hold the said premises as above described with the hereditaments and appurtenances, unto the said partl.Q S...of the second part, and tothei-TZ .heirs and assigns FOREVER. And the said .E RICRS21I.T.1is----S.NJC..............................................---...................---.................---............---........-•--------...................... party of the first part, for itself and its successors, does covenant, grant, bargain and agree to and with the said partlea.of the second part their........ heirs and assigns, that at the time of the ensealing and delivery of these presents it is well seized of the premises above described, as of a good, sure,, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever and that the above bargained premises in the quiet and peaceable possession of the said part-i.e,S.of the second partkhe.iZeirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, it will forever WARRANT AND DEFEND. In Witness Whereof, the said ERICKSMITH...._..INC. ...W......Frlck.so.H.:_......._................. its President, and party of the first part, has caused these presents to be signed by Dennis. countersigned by its Secretary, at.................... ---HlldSon....----.................... ..Wisconsin, and its corporate seal to be hereunto affixed, this 9-th_-..day of....Apr.il A. D., 19...9.2... SIGNED AND SEALED IN PRESENCE OF .,poste Name President Dennis W. Erickson COUNTERSIGNED: Secretary ST OF ~'1'ISCONSIN, AT C'✓U % x ss. ...........................County. Personally came before me, this .......q. s..... day of.. AP..Ki1 A. D„ 19....9 2, s....W.......Er.i.ckson......_ President, and.... , Secretary of the above named Corporation, to me known to be the persons who executed the foregoing instrument,.ar d to e known to be such _President and Secretary of said Corporation, and acknowledged that they '*e -ted th foregoing instrument as such officers as the deed of said Corporation, by its authority. NOTARY SEAL This instrument drafted by Notary Public Corny, Wis. Dennis W. Erickson 9s My Commission (Expires) (Is)........... (Section 59.51 (1) of the Wisconsin Statues provides that all instruments to be recorded shall have plainly printed or typewritten thereon the names of the grantors, grantees, witnesses and notary). WARRANTY DEED-STATE OF WISCONSIN, FORM NO. 2 N. C. MILLER CO., MILWAUKEE I SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County ~J OWNER/BUYER L11 CA ADDRESS: Y' r7 FIRE NO c ~ L ~ lj ~1 LOCATION: J 1/4, S~ 1/4, SEC. Z T 3C N-RW, TOWN OF: C 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 to help with the cost of the replacement of a failing system, which was in operation prior to July 1, 1978. St Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification from will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE : St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 I I I I!/~ I ~ I ~ ~ I I 716, I i I g I 60 0 Alm, 1 °o sP i I I i - S I I I ~ i II ~ I ~ v u PEN i I I I ~ p ~J f S• ! i ! ! t y E / J * .SATE C i i i ! ' I _ l4A L7 / O _ / _ A 3 Z-i I ! r ] t II 'II ~iII ~ III jI ~I C` t I 'i i I` tr I~~ ~ i+ it it ~ ~ ~ _ _ ~ ~ i ~ - T 't i G ~ , t r- f ' 1 j Ii- l~ 1, T~ 1! }I ~ ~ - i T ' ~ ~ ~ v 15 too j DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS "INDUSTRY, DIVISION LABOR P.O. BOX HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/Ml]Y: LOT NO.: BLK. NO.: SUBDIVISION NAME: SE ',fE 1/4 28 /T30 N/R(.9xE (or) W St. Joseph n/a n/a n/a COUNTY: OWNER'S , AME: MAILING ADDRESS: St. Croix Lane Paolocci 539 Nordic Ln., Hudson, Wi. 54016 386-7078 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Fb~esidence 3 n/a )mew ❑Replace I4-7-92 4-7-92 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL,HOLDING TANK: RECOMMENDED SYSTEM: (optional) EIS ❑U ❑ S We MS ❑U ❑ S 9Q ❑ S HU conventional 18x40 bed If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: n/a I( Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 42 Bxn2 BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTRM. OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 8.00 99.65 none >8400 .50,10yr2/l,s.l., .67,7.5yr4/4,1.s.,6.83,7.5yr5/4 o.s B_ 2 7.91 101.40 none >7,91 .50,10yr2/l,s.l., '2;6010yr4/3, l.s.- 5.33 10 r4 4 co.s.~ B_ 3 9.70 103.30 .50,10yr2/1, s.l., 3.00,10yrlt/3, l.s.- .70 none >8.50 6,20 10 r4/4 co.s. B 4 7.9?. 108.00 none >7.92 .67,10vr2/l,s.l., 1.25, 7.5yr4/4,1.s.,- 108.50 .50,10yr2/1, s.l., 4.00,10yr4/4, l.s.- B- 5 8.50 none >8.5fl 4,00 10 r4 3 1.6.. B- d.ecimal.' PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER XNMM AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- 1 3.00 none 3 6 6 6 3 P_ 2 4.75 none 3 6 6 6 3 P- 3 6.65 none 3 6 6 6 <3 P- PP -4 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 96.65 it ce Are tt) _ J_b c su T. ut to 61.E 9g. 65 1 0.65 1 ~i I 1 i I 1 1 . , r , f ^ l'/Y 1 G Y'' r I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print : TESTS WERE COMPLETED ON: Cary L. Steel 4-7-92 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. Ave., New Richmond., Wi. 54017 2298 15 6-6200 CST SIG E: r DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. nILHR-SRD-6395 (R. 02!82) O\/FR REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1 06/9,q/9Z 09:23 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/ 9/92 AREA: MJ Activity: A9200146 6/ 9/92 Type: CONVSEPT Status: PENDING Constr: Address: ST. JOSEPH 28.30.19.287A,28,SE,SE, PERCH LAKE RD. Use• Parcel: 030-1079-50-000 Occ: . Description: 149305 Applicant: PAOLOCCI, LANE Phone: Owner: PAOLOCCI, LANE Phone: Contractor: SCHMITT, DONIVAN Phone: 568-4948 Inspection Request Information..... Requestor: DON SCHMITT Phone: Req Time: 09:06 Comments: Time Exp Items requested to be Inspected... Action Comments o?S~i~ 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION