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030-1092-40-050
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"0 0 3 C N C C N C . r.+ m o > O N O E > 00 co \ Y M L O Y O (n N C C N 0 Q1 C,4 C'i 0- v _O C C N C C V°7 y t N\ O N 0 0) 0 C) N L" Z N 11 N N O O N u) N i+ Z Z ~7 n N M o co ~ Z E Q E E o N f0 o m U) W o N 2 F°- W o s H V) a L a m ° a ti a 3 cid rrte~, r1 Ca uCL 0 ONCE C` ,.-.tea .e+q 4 _ I l AS BUILT SANITARY SYSTEM REPORT T ~-j OWNER- Stz r ` S U!j . TOWNSHIP SECTION T-30 N-R W ~ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOTLOT SIZE tic G { PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM UAk/u G f } 13, 6 7 k yo <k INDICATE NORTH ARROW BENCHMARK: Elevation and description: Tf,R-'zS ~ ~ 0~ ! 1c7D (Z ON Alternate benchmark IOU.V SEPTIC TANK: Manufacturer: 3 Liquid Cap.-. rl4 Rings used:a-Manhole cover elev: (-AFinal grade elev:~ Tank inlet elev.: , a5 Tank outlet elev.: 95-9(p No. of feet from nearest road:Front , Side , Rear Ft.'1'75.' From nearest prop. 1 ine : Front , Side , Rear Ft . U<J { No. of feet from: Well Building: e (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 AB RPTION SYSTEM f~Q Bed. Trench: Seepage Pit: l~ Width: Length 0Number of Lines:_-~__Area Built 971 Exist. Grade Elev. -~~-pProposed Final Grade Elev. 3a Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side , Rear Ft.MOP '~?60 No. feet from well: No. feet from building S 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: PLUMBER ON JOB: t.~~~'-.`•Sw`~ ~ ;V- LICENSE NUMBER' 3`(JV 6/90:cj 4,Co TlgepartmeTt of IJu EPH 31.30 .19.3 3$C SW SE MCKINLEY DR. PRIVATE SEWAGVSYSTEM County: Labor and Hyman Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: 171450 Permit Holder's Name: ❑ City ❑ Village [Town o : State Plan ID No.: ERICKSON STEVEN E & KIM D ST. JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 030-1092-50-000 TANK INFORMATION ELEVATION DATA A9200215 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark o D .Go Dosing Aeration Bldg. Sewer Holding St/Ht Inlet SAS TANK SETBACK INFORMATION St/ Ht Outlet 9 Vent TANK TO P/ L WELL BLDG. Airito ntake ROAD Dt Inlet Air Septic jppij AM- ~ NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe y 7 ,G f Holding Bot. System -e t3~G PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM 3. - q7 G TDH Lift Lrictio S tem TDH Ft Forcemain Length Did. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengt No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING manufacturer: SETBACK INFORMATION Type O ~O~ &,-0- OR UNIT CHAMBER Moe Number: System: DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. S gzl_ SOIL COVER x Pressure Systems 0 t-Grade Systems Only Depth Over Depth Over 1161 1 xx 134 6 Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Plan revision required? ❑ Yes ❑ No Use other side for additional information. 7 SBD-6710 (R 05191) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: LI~.HR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code 4, C G^ STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. C Ui revs onto revious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNE PROPERTY LOCATION . ~~2 Q x)C'~5a)J SL, '/as S T~ N,R E(or PROPERTY OWNER'S MAILIN ADDR LOT # BLOCK # m L 1 J2 IL,,14 A 1 V Cl STATE P CODE PHON NUMBER SUBDIVISION NAME OR CSM N BER ~ ~ S i . s v a) o CL e- iLk 21 II. TYPE OF BUILDING: (Check one) ❑ State Owned O VILLAGE: NEARESTJkOA ) I e Dik ❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms - PIRARCEL TAX ) 1 K 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 120 Service Station/ ar Was 5 ❑ Hotel/Motel 90 Office/Factory 13 ~NrOther: Specify o Se IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. Vl 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 120 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 430 Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min /inch) ELEVATION ('j * 7.10 W IJFeet 7 J Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete Tanks Tanks structed glass App' Septic Tank or Holding Tank - -t t Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Sign lure: (No Stam s) MP/MPRSW No.: Business Phone Number: Q Jlr~ ~e~r,rneSt2 M. !~O ~1J 35(0 Plumber's Address (Street City , S te, Zip Code): 11 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved SapitaryPermit Fee (Includes Groundwater Date ssue gent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Zaj~L Adverse Determination 14 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 7/7 - S 60 INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitsry permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If yo(r 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 !ine 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 informat on 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:/,vater 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; (Jose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115:form; and F) all sizing information: GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are use, for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) . APPLICATION FOR SANITARY PERMIT S T C - 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 S it1 1/9 x_1/4, Section, T_3D_N-R_L_~ W Township / Mailing address J Address of site _ I Subdivision name_ A J A Lot number A Previous owner of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for resale (spec house)? Yes ✓ No Volume 311 and Page Number k 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, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. f~O 3 993 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construct' ion of em, and the same has been duly recorded in the Office of the Co ty egi er Deeds, as Document No. n Zignature of Owner Signature of Co-Owner (If Applicable) a 7AAJE Date of Signature Date of Signature r x= fib ' C as7,es D. Wahlberg &ad ft" A. Wahlberg Mc" tfik, h and rife and each in their own IWO& *r Wit,;;-4 Oki ?I: right coneys and a::cranes to StOVeII. E.: Erickson and _.kin Q. Erickson, husband and: wife as_ ALO& ~q joie tenants ""Cow; 4, the foil-)wing described real a+tate in - St.. CrQIX. _ C runty. ' State n: Wisconsin: Tax Parcel No:...... Part of the Southwest Quarter of the Southeast Quarter of Section 31, Township 30 North, Range 19 West, and.part of the Northwest Quarter of the Northeast Quarter of Section 6, Township 29 North, Range 19 West, being shown and described as Lot 1 of Certified Survey Map dated May 20, 1977, and zj. filed in the Office of the Register of Deeds for St. Croix County,.on June 17, 1977 in Vol. 020, page 389, Document 'i #3404", TOGETHER WITH a non-exclusive right of way over that part of the North 4 rods of said Northwest Quarter, of Northeast Quarter of Section 6, Township 29 North, Range 19 West, lying West of the parcel conveyed herein, and over the, East 2 rods of the East half of the Northwest Quarter of Section 6, Township 29 North, Range 19 West, both of which rights of way grantors believe are public highways of the Town of.St. Joseph. ALSO TOGETHER WITH, on a non-exclusive : basis, and subject to any other highways, easements and other restrictions of record. Thu is nn.,:rt~,,! ran r•, t, Wiirrant;es: TOGETHER WITH and SUBJECT TO any other easem~ Covenants, reservations or restrictions of record, if any, but this- not be deemed to extend any such other recorded enbumbrances beyond tba term established by law therefor. u.~t~,l t!::_ 24th June ~:+85 x 1 %1.I z ill ! LLB ~IL~VG (SEAL) Ft' Charles D. Wahlberga , T„" .t 1. r. c_ f` </i~ (SEAL) p Reba A. Wahlberg ra. z AUTHENTICATION ACKNOWLEDGMENT Signature(s) I '."1'F: r~I \1"l~ ~r\rl\ _ N/A St. Croix Gs. authenticated this da.: of l , c t: b • r, r• me t},is 24th y p June 11.0 85. - the alwve'nawed Charles D. Wahlberg and N/A Reba A. Wahlberg I t TITLE: if ElilsEl: iTITE HAR 40, '•c1. CARI"L (U not, authorized by S ()C.06, ~V H+O ! t u •r un $ ICJ, info ggu •i~ii -rt i• {r lji~ t~l~ ><att 'r+'nJaSWL GWIN & GWIN_ Cftol tZ;mer t 430 2nd St., Hudson, WI 54016 St. Croix o„tv (Signatureet way hr• as'f or,tsr• eir ~n;.., or not. •tatt, e~h Y ~ ~r ' s are not necessary., ~ r 1M~~1 to ~~.~E - - -r ».;qM of #+wns eianiAR ir•. n..Y a.,a`+.y 1, b 7A1L 8R, VCt xA SEPTIC TANK MAINTENANCE AGREEIIE14T w Sc. Croix Count w OWNER/BUYER o Fire 11umber / 22 / - ROUTE/BOX NUMBER d Y/STATE `t 0 CZT 1 4_izIP PROPERTY LOCATION:' _ _ Section , T _IQ N, R_2 W. Town of St:. Croix County, Lot dumber 1. Subdivision /V ___A- Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Prover maintenance con- sists of pumping out the septic tank every three years ar sooner, if needed, by a licensed' *se t'ic tank pumper. What you put into the system can aF ect t e unct on o t e•septic :ank as a treat- ment'stage in the waste disposal system. St. Croix County residents'maY be eligible to recieve a grant for a maximum of 604 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 'sys•t'ems agree to keep their system properly maintained. The property owner agrees to. submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or..a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and .(2)•after inspection and pumping (if nec- essary), 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. y 0 I/WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance ith N the standards set forth, herein, as set by the Wisconsin n par ment of Natural Resources. Certification form must m leted b and returned to the St. Croix County Zonin Offic wi in 0 days of the three year expiration. date. SIGNED DAT St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. I, f I I State: of* Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 BOUMEESTER & SONS EXC. Owner: STEVE ERICKSON JAMES W BOUMEESTER 1070 HWY 35N 1221 MCKINLEY DRIVE HUDSON WI 54016 HUDSON WI 54016 RE: Plan Number: S92-01622 Date Approved: May 27, 1992 Gallons Per Day: 80 Date Received: May 26, 1992 Project Name: ERICKSON, STEVE Location: SW,SE,31,30,19W Town of ST JOSEPH County: ST CROIX Fees Received (Priority Review): 100.00 The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionaliv approved' This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation f shall keep one set of plans with the department's approval stamp at the construction sie. The installer shall notify the appropriate inspector when inspections can be made. This approval will cxplfre two years from the date approved or if a sanitary permit is obtained, ii: will expire the day the initial sanitary permit expires. The Sectiot a¢' Private Sewage has reviewed these plans for private sewage system code requirements only. These ps3nc have not been reviewed for the code requirements set forth i!. Sect;o-= I' 1.1k for t. neral plumbing or in Chapters 50-64 of the Wi scor7`, i P !!un + t' A >E'. cade. T, is f-o" the followili; components only: - NFW CONVENTIONAL I i; Ef fl •ble'i N. UI M7 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,r DIVISION LABOR AND P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: OWNSHIP/~1~1: LOT NP.: BLK. O.: SUBDIVI ON NAME: 1/ 561/ 31 /T3vN/Ri91(or 5; f z N N1~_ COUNTY: OWNER'S BUYErrR'S NAME: M~ L ADDRESS: D '1usl~D~J DI 54-6-000 Ste- fiF--;ekSay. ,2 USE DATES O SERV IONS MADE NO.BEDRMS : CO MER IA DESCRIPTION: PROF DES IPTIONS: PER TI / - O TESTS: ❑Residencelew ❑Replace Z~ RATING: S= Site suitable for system U= Site unsuitable for system CSTIDU INAL: MS. ❑U JIN-GPd ROUND-Pou RE: SYSTEM-ILHO~LDING TANK: RECOMMENDED SYSTEM: (optional) DAs S ✓ ' If Percolation Tests are NOT required DESIGN RATE: M, ~,(kt5 If any portion of the tested area is is in the under s. ILHR 83.09(5) (b), indicate: 4 Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH I LEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) / ' J~O Q~S, , s Qn .SO Bra S B- / S ,l5° ors 5 B- Z 411 (43~ .,98,1./s a~ B- > S7-0 OF, 7 7, VY'r 4 7 , , sg '6' Sr Z S 6n S B- y 5( 93 sp > 7-<- B- s 3 , 15• ~s ' ' .33 n S/ , O B~, S gv 5 / $ [sus. , 08 ex, 5,9 q, PERCOLATION TESTS TEST DEPTH "'WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I AFTER SWELLING INTERVAL-MIN. PERI 1 PER 2 PER INCH __U 10D 3 P_ i , S O 6 3, V 172 p 20 : L 711, P ° 3 ~o y ~'g s 3 -7 NV 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 ~ f i 2 n_ ~'n I ~Qt~ f i E l [ i t~ E I ~I I ,I•~a: i f 3 _ i r0frh E it S m... _ __F_ q, o - p ~ ~teI, the undersigned, hereby certify that the soil tests reported on this form Svere made by me in rd ith ~~procedures and methods spe cFisf onsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAMXc~ nt TEST ERE MPLETED ON: 79'~- ADDI'4ESS: CER IFICA ON NUMBER: PHONE NUMBER (optional): 23Y s~►., ~~o ~o 3 g'L f./ CST SI E: 441 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. a ILHR-SBD-6395 (R. 10/83) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SRO - 6395 To be a r - Id accurate soil test, yoa.€r report Mcrst include: 1. Complete lef t Elescriptic 2. The use section must c~- idicate tit,' this is a wsidence or commercial project; 3. MAXI I' number of - : c ns or cor use planned; 4. is this a m repl system; 5. Corn ' t s ; rating boxes. A Sl- 1S SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER ` Y RULE- -VT BASED ON SOIL CONDITIONS; 6. PLEASE viat:ions s e for tt'ritir cdesrriptions and completing the plot plan, 7. BAKE aaagrarn locating your t:es' ' ms. Drawing to.scale is preferred. A sr..par :;y be used if & Make saa~ i -hraark ar evation refere a re clearly shown, and are p6manent; 9- Complete" «rrariate boxes ; dates, names, zar flood plain data, percolation test exemp- tion, if appr(I 10? #f the inforrnatic flood plain, elevation I does not --Iv, place N.A. °n file appropriate box; 11 . ~ form and pl - ur curremt adds ess and your c _,ion nurrabr 1:. kjble copies ~d distribute as requires:. ALL. !L TESTS MIJ, " BL' FILED WITH THE L ';UTNORITY WITHIN 30 DAMS OF C£}TEMPLE"; ARRREVIATI _E FOR CERTIFIED SOIL TESTERS Soil Sr,=- and Textures f ',/mbols st:- stoi 16°`) BR a=<t cob Col 1011) SS ``;ton(? gr Gr- r der 3") LS _ tone - Sai l- GW Groundvvater - Perc a~.:ion Rate s - F ; € E1 Ed as ~ zer T,`aa n .s I s f a77 . ~s€l BI s: Gy ay y s_c v Lc?arn R . sic! L. ;m mot sc sir fff fir€e, faint c cc nnaon, coarse p€ nar;a Iny, mecdiur7a d r 'nct p arninent. 1-ter ;eve!, Si" xtures :ce water for hqt sposal BM I Mark VRP Rf=re€e€,ce Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. Pkr E OF ~r^U`>> Secll0Cl O A -Sel) Sy5tCn1 + Froth Air Inlets And ODse(volion Pipe t ^ Approved Vent Cap Minimum 12' ADova -~C.".• ,A Final Grade d ~S r a C 20'- ♦2' Ab~o~ve/~~ rrPipe _ ♦"Cott Iron • To FlArtii i~i71a~ Vent Pipe Mortn No r,5 n1Mtk Covering - W2 2, 1 2" Aggragot* 9 2 or Pipa . ri 4 r k R 1p .t l"• 0 0 o 0 0 - Too SEE CC; - Aggregat e o Perloroled Pipe Below Be Beneath Plpe o -Coping Terminating At Bottom Of Syttem r 1 Prupo C'(ac~l / ~~tt.Jr.~ ton SOIL FILL D!S-'"k18UT10lk.1 PIPE APPROVED S4MTrNETIC COVCP N%,2KLfrc-- IF K i --MATERIAL OR 9" OF j~RAV1 Z OFAGGRCCAIE OR MARSH WAy la OF -2t/2 AG ~°GREGATE E SLEW. o' 123 ~a - -3r?; RI , f'rIf')I'S 04 C Pr AT LEAST (e IUC•4ES BELOW ORIGIWAL GRADE 4'r i_ckS-40 ItJCtI -oUT kit) MORE -rPAIJ X12 IkICNES BELOW FINAL rePAIDE IAIZ"11,~ g,7, cy .•s=fir>: -iv,-kT14DO FRor? ORI&wrA4 bR'ADR w!LL BE ~ !F.It_►1e.,~i o",,As lc`s ` A',fA.TJ N IRON! L*1410AkL_ (jR49E WILL BU -INIGWES f r c , r . .r 1 - c3 , G r. i S L ! L' N. 8 r F? _ 1 I K 5 ^_.(_V 1 /1Q. i ' \ 30' X'I4 ~xt S~) tJ e OKK J Dr I W (A 71z f G y S [3e n so t ( r I-- lei D I ly as Rs 3 i t 1 ,i i i r ~ i i s i ~ ~ sfiern P ~ l f!~~~: '~ie<< iS kAO~ ht R AN 75ft I 4 Sp pt ► C S~ Stc m r e A- a M.-Thp,t5 4 O~ 40ORO►J Pule eAPN C~- ~~.eh~l~ Saes: holt sites { 1 i 1 1 i f 7 1- Steve f~;~ kSoN ~NoRse •~3q~r~r ~Tr, Bot t rn~ ?She r'1 P K If a JU 1 c CO) O e ~ ` I c c M m ^ U) z c, m 3 3 O o. -I = 0 N N O =r =r N V C O O v O U) O H; CD 9 3 N -0 N W O O 111 O O t.+ O_ O n D -I CO o N O O 3 m F W O O O O I O y ~ N li ~ ~ t~~` m O CD N cn p, a N ci O 3 - O O O N N N C) W z O to o m N° c c cr ~r °a O O O O 0 ch ~y~ 0 - t% N- D OQ N d la a G A 3 -u o c°n N ui o d m rn N N 0 D co O o Z C N (D 41 ro c C N N CD ca ~ n 3 F J O N a A z m 9~ CL C) ri) * W O~ v o CL CD z c 3 o" cn~ y M Z (D U) F CL D 07 a I 3 m T II c O O a CD I a N I I N O O V A O C ti CD c,Nn En O C) M o Q v c viO gID c v1 m f ~ ~ m m v A+ H to 0 o h m! o -1 z z o v o • 3 c zg, A 0 O CD Z CD m cn cn o j O CD N I N A ro Q NO 3 m O 3 "O pO+ ` 11 Cn S fLf~ W O co COn 7 CD C7 G O O 3 Q o m lV o !a C) ~y m C D y v a o CD N CD O i O p Cn o o 0 r, O c N N N N rr a 3 o T M 10 p • a o O O O t~l _ co o o °c c N N a D 3 CL z ° zco z 0 D o. 0 d O :3 CD , a C N co CD cn 10 ED c m C. W @ a a 3 J z CD O N O ~ Z n n A z 3 0 w ~o CL z I ° 3 p ~ O cn 3 m o y z CD ? i W l< Cl. 41 Q CD 3 0 o v ~ o o 0 0 I y m CD N I ~ 3 c (D N O lV °o A o ti rv CD a o ~O ~ v 0 CD *t ° ! FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER -~S7-2-vlg 14 1~ Kso.~ TOWNSHIP Sr J6)P~ SECTION 31 T_-30 N-R_Z-2~-W 122-1 Akc-Kc;K~ ) ~Y+41A-dSCr1 ADDRESS c „v ST. CROIX COUNTY, WISCONSIN CSYn 3Y9 SUBDIVISION /✓A LOT AAA LOT SIZE A14 . 30. 19 • 33~ PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM NoT~; l'/2-o oost~ n cJEtc Ac~.~ P~cJOd~'`t/ ~/NL`5A C~✓EQ yn( 3t7U' rCwA-Y ' I~S~~c~cL lay 15G, PECK S,On( 3S J h PpS~ D ~An~K G~rT~ /c~ A•r Tim IT ~v G~vP Vq B~NQ A A-r Dui 1. ~Cl SP, xor /,v - c I J~_ VeN~ INDICtXTE NORT ARROW I~IO ScAcE BENCHMARK: Elevation and description: SATE /x/ i-g" Alternate benchmark S-K,2 SriilE t=«-✓ SEPTIC TANK:Manufacturer: 1../lesLiquid cap. la <-a Rings used: _Manhole cover elev: g3• iS 11 Final grade elev: TS. Tank inlet elev.: 7~. y0 ' Tank outlet elev.: ~9.0!~- No. of feet from nearest road:Front , Side J Rear Ft. Yooo ' From nearest prop. line:Front , Side , Rear 4"-Ft. 300 No. of feet from: Well lo?O" , Building: iS9" (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE f 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:EeV ,1,9.9o1rrench: Seepage Pit: Width: /a' Length Number of Lines:_,,Z_Area Built g? g Exist. Grade Elev. W.s-V ' Proposed Final Grade Elev. 23. ~S` Fill depth to top of pipe: No. feet from nearest prop. line:Front Side , Rear Wit. 30o' No. feet from well: SSG No. feet from building Ste" 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 : 3 l7 PLUMBER ON JOB: /L,~ _ LICENSE NUMBER: 0,e- c' 6/90:cj i 0 cno 3vn C `r1 o m c 3 0, 'D v' ^ cn O m o o r,- O n o o q O M 0) w < • (D c m oN3 O IV ° 1-CD 0 N C_ @ Z Z O (D_ O M N ~ M CD (D 0 817 N N 0 0° j> s co 1 CD Cf) 010 co rl) ICD G) AD 3 _ 00 p d ~ { (A i A N (,-n N IN N a n N M 00 3 cl N 00 CD O O a (n "Nit c A z O W co (D 0 r, OD C N O C a 3 a 0 - O A O _ N CA CO~ Z D N 3 N CO OA 0 O v v o C) 0 -4 o d a rn m (D - CD N N O N a cn Z . ° zouz O = D O 5D a lY ::3 CD CD "*A y x 'D (D N N MA c CD CD V~ a (D y C6 $ Z (D n O Z O A' CL G Z N O W (D < (O e- a . Z O A TJ O \ V, z to y z m ~ p a ~ N - N 7 N _ 1 571) N n N G C N2.p~ 7 N N O d O'6 O O N (00 cn q~~\ CT 0 N y O C 3 N A rn (D K m I O C e, ay cz cn o in (D rn tv O 3 N O O O 3 N O a 4 ti O ZJ 7 \ (D o O o O N O • ti Parcel 0 - 92-50- 05/10/2007 02:37 PM PAGE 1 OF 1 Alt. Parcel 31.30.19.3380 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation D Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - ERICKSON, KIM D KIM D ERICKSON 1199 MCKINLEY DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 1199 MCKINLEY DR Q SC 2611 HUDSON C -7 SP 1700 WITC al Description: Acres: 14.240 Plat: N/A-NOT AVAILABLE SEC 31 T30N R19W SW SE & SEC 6 T29N R19W Block/Condo Bldg: IN NW NE BEING LOT 1 OF CSM 2/389 Tract(s): (Sec-Twn-Rng 401/4 1601/4) ha~~ ol- ~5rn 31-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/30/2005 799062 2833/494 QC 07/23/1997 717/400 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/08/2004 Description Class Acres Land rove Total State Reason RESIDENTIAL G1 14.240 156,300 122,100 278,400 NO Totals for 2007: General Property 14.240 156,300 122,100 278,400 Woodland 0.000 0 0 Totals for 2006: General Property 14.240 156,300 122,100 278,400 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 Parcel 030-1021-30-000 05/10/2007 02:30 PM PAGE 1OF1 Alt. Parcel 06.29.19.91A 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 - ERICKSON, KIM D KIM D ERICKSON 9600 KESWICK AVE N STILLWATER MN 55082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 1199 MCKINLEY DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 21.780 Plat: N/A-NOT AVAILABLE SEC 6 T29N R19W FRL NW NE EXC N 4 RDS & Block/Condo Bldg: EXC CSM 2/587 AND EXC PARCEL AS DESC IN 668/216 ALSO THAT PARCEL LYING N OF LOT Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 3 AND S OF LOT 2 OF C.S.M. 2/587 & EXC 06-29N-19W CSM 7/2025 Notes: Parcel History: Date Doc # Vol/Page Type 06/30/2005 799062 2833/494 QC 07/23/1997 821/478 07/23/1997 764/74 07/23/1997 753/383 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: j Last Changed: 04/16/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 18.780 2,900 0 2,900 NO OTHER G7 3.000 26,200 26,700 52,900 NO Totals for 2007: General Property 21.780 29,100 26,700 55,800 Woodland 0.000 0 0 Totals for 2006: General Property 21.780 29,000 26,700 55,700 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 I ~ L,~IQA I JIX 01WITY V11 r CERTIFIED SURVEY MAP APPROVED S. W. 1 /4 - S. E. 1 /4 SEC. 31, T 30 N, R 19 W JUN 15 1977 N. W. 1/4-N. E. 1/4 SEC 6 , T 29N,R19 W ST. CROIX COUNTY COMPREHENSIVE PARKS PLANNING APPROVAL OF THIS MINOR SUBDIVISION. 442-48, AND ZONING COMMITTH DOES NOT MEAN APPROVAL FOR SEE 440-55 SYSTEM. REFER TO H62.20 S 89*-46'-38 w Affflavit- Vol. 603-05 N 200' 100' 5d _O' 100' W SCALE In= 200- BEARING = ARE ASSUMEI 1b p.~L - N 89-46-38E ON THE 00 O.I' X 24' IRON PIPE SET o h ^O' - ' SOUTH LINE OF THE WT. 1.68 LB./FT. °j LOT- I of S. E. I/4 OF SEC. 31 15.0 ACRES °o p z \\Cl CO. MON. S.E. SECT. COR. N 89 46-38 E SECT. 31 (STING T30N- R19W 357.96 C~RESIDENCE N RD. - ---1007.75' - 66.0 s~33.0' / N89=46-38E v~ N00 45-02W 78.0' o (SUBJECT TO N.S. P. S31 - 586-3911W 340899 ,«1C~i,rrr~~,fa DEED VOL. 149 - PAGE 497 CO. MON. G~~ S I/4 COR. SECT. 31 s_a,~J +ray Aj~ THIS INSTRUMENT DRAFTED BY s' A. C. NYHAGEN GENE C. „ JOB NO, 77-24 F E SHAFFER ~ JUN 17 1977 HUDSONn' AA" O' CONNELL i WIS. v Q j~ 7 o„r.. ie a 8 ~ 1'1i~~► CERTIFICATE OF TOWN OF ST. JOSEPH I, Carolyn Barrette, being the duly elected, qualified and acting Town Clerk of the Town of St. Joseph, do hereby certify that this Certified Survey Map has beep} approved by the Town Board of the Town of St. J eph thisday of 1977. ell? Carolyn arrette, Town Clerk V" ~r r~ W 0 SEE REVERSE SIDE FOR SURVEYOR'S VOL. 2 PAGE 389 CERTIFICATE "Nano CERTIFIED SURVEY MAPS ST. CROIX COUNTY, WI. l A DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING DIVISION LABOR & HUMAN RELATIONS P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION [State an I.D. Number: MADISON, WI 53707 ned) NT,,1.;,, S 4f T30-R19 ❑ CONVENTIONAL ❑ ALTERATIVE Town of St. Josenhu r- ❑ Mound r Holding Tank ❑ In-Ground Pressure NAME OF PERM HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: PT. ELEV.: oil ')r- HUdSQn, WI BENCH MARK (Permanent reference•point) DESCRIBE IF DIFFE ENT FROM PLAN: REF. PT. ELEV.: 7 = Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING OVER PROVIDED: PR ED, ❑ YES ❑ NO ❑ YES ❑ NO UILDING: VENT LE FRESH TO IB BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WEL ALARM: FEET FROM LINE: J AIR INLET: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARM G LAE 3EL pROKING Co' ER PROVIDED: OVDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL, BUILDING: VENT TO FRESH GALLONS PER CYCLE: FEET FROM LINE: AIR INLET: (DIFFERENCE BETWEEN ❑ YES ❑ NO NEAREST PUMP ON AND OFF LENGTH: DIAMETER: MATERIAL AND MARKING: SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LE TH NO. OF DISTR. PIPE SPACING: EGOVER INSIDE DIA.: # PITS LIQUID BED/TRENCH TRENCHES: IAL: PI T DEPTH: DIMENSIONS r .GRAVEL DEPTH FILL DEPTH DISTR. PI E DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIP : ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: J AIR INLET: NEAREST MOUN15 SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARFKERS: OBSERVATION WELLS; ❑ YES ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: D: MULCHE D: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST - .111 / 141 #30 If,(,- .yl Retain in county file for audit. Sketch System on p L Reverse Side. SIGNATURE: TITLE: SBD-6710 (R. 06/88) O EM:_ac SA NITARY PERMIT APPLICATION ILHR In accord with ILHR 83.05, Wis. Adm. Code 7M. STATE SANITARY PER IT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ se-Ia. 7 8% x 11 inches in size. Chad if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION S vE'u is 5o.t/ Y4 5-/ Y4, S 3 / T N, R E (O PROPERTY OWN R'S MAILING ADDRESS LOT # BLOCK # e LC CITY STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ~O QN G✓~ '~o~G II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned O VILLAGE . 51 os4-10s/ ❑ Public or 2 Fam. Dwelling- # of bedrooms PAR L TAX NUMB R( ) Ill. BUILDING USE: (if building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 1.0 ❑ 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 F IV. PE O ER MIT: (Check only one in line A. Check line B if applicable) A) aNew 2.0 Replacement 3.E] Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an Syste System Tank Only Existing System Existing System B) anitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: - 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 'C, 0 ~ A.. Ira iris . • t?o? g 4"1- Feet r, Y Y- Feet 4~ 00 VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. Plastic App INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass structed Tanks Tanks Septic Tank or Holdin Tank / SO / SO £ Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumb s Si nature: o Stamps) MP/MPRSW No.: Business Phone Number: 339' ~e s 38~-a~So Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuing Agent Signature (No Stamps) Surcharge Fee) Approved E3 Owner Given Initial / C2-/3-~~ Adverse Determination Z X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber L, J 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 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 seviage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 4r O O a 0. ~ I °o I N 7° ~ N c o Its c a N N N rO z c o LL o E i ~ N V) Q ~j I co Z 1/1 rn W (n O 0 ° C m 0 c I O z :!t c d~ y Z~ c a I cn F- ~ c' ~ -o I _0 ` N O a m N CO cu O N Q w p Zco Z - 'rJ N V `\Tc` y E tJ ` - R N O. 'l0 w ` N O CO cn m w o °o o a E m N Q v cn cn cn o z fl 00 Z o • a a a N w a N _ ° N N N } cn -1 0) 0) 0 'T T 0 0 co N R O 3 r+ U) vl~ O c ` 00 > N O 'O rC to W p Q~ ~ c c~i a m °o v N oi O CL V) a) VII 0 C O N V) 0 CD 01 0 U) LO N c_ m ° `h 0 U) 0 o r O I 1 t~ ~ dt r = ~ I d a xt a I • ~ ~ d d d c i `I~~v E 3 rr c APPLICATION FOR SANITARY PERMIT 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 ` $W of J~.JNL / N Location of property QU 1/4 5 E.j /4, Section , T.X~ N-R~W Township, -T 05-> Mailing address ~U~s~ ~f, 5 yo L~ Address of site 7 , Subdivision name-_ ~e A Lot number Previous owner of property ,Z, IA1c6Af ~ Cf~`=e- Total size of parcel Date parcel was created J Are all corners and lot lines identifiable? ✓ Yes No / Is this property being developed for resale (spec house)? Yes No Volume ce5- and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. `!5%; /,3~ ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of ~t.e C domhty i e p Deeds, as Document No. IV ~ ignature of Owner Signature of Co-Owner (If pplicable) j/J ~ v 113 Id9l) Date of Signatur Date of Signature L_ I r-~ ,VC! 853 PAGE THIS SPACE RESERVED FOR RECORDING DATA ' DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 - ~ • ' WARRANTY DEED 45213` REGISTER'S OFFICE This Deed, made between ...Dale__L._ Morrlll__ard__Margar~t ST. CROIX CO., WI J._ Morrill,. husband and _wife.__as__survivorship__maritai..... Recd for Record .property--------------------------- G l i G 51989 + , Grantor, of 8:30 A.M and-..__$tR-YOSI--F....Fr1 Cka0t1- and..Kim..D._..Er_iakaon,___husband..and. wife--as._suryiyorshiP--marital..proper_ty------------------ Register of Deeds Grantee, witnesSeth, That the said Grantor, for a valuable consideration...... { - conveys - - the - following described real estate in St RETURN TO - to - Grantee _ 4rQ-X LAUX & CAMERON, S X. County, State of Wisconsin: P.O. Box 456 Oseenla,__ WI,__ .54020 Tax Parcel No: A parcel of land located in the SW~ of the SE4 and the NW' of the SEA of Section 31, T30N, R19W, Town'.-of St. Joseph, St. Croix County, Wisconsin, described as follows: Beginning at the S' corner of Section 31; thence N0°40'56"E (bearings referenced to the North-South 4 section line, assumed N004015611E) 1827.51' along said North- South 1 section line; thence N45D57'41"E 627.83'; thence S89°43'46"E 150.00';' thence I S33°11'03"E 132.111: thence S0040'5611W 101.67'; thence S3505515311W 900.521; thence i. S23°24'06"W 217.481; thence S0040'5611W 1122.53'; to the south line of the SE4; thence N89042'3311W 66.001•along said South line to the Point of Beginning, containing 435,597; square feet (10.000 acres) more or less. ~I j' MANS $ boo FEE This is_ 210t____• homestead property. 1 OW (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; Grantor And ( warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and ordinances of record II and will warrant and defend the same. , I~ Dated this 27th day of S E' ber (SEAL) E~j"~f (SEAL) Dale L. Morrill * * G?G~: cs~C--- AL) * * .-Nlar et J-•--P!Iorr................. AUTHENTICATION ACKNOWLEDGMENT li Signature (s) STATE OF WISCONSIN ss. l POLK .Count authenticated this -.......day of-------------------------- 119 Personally came before me this .-J 7_..._.day of 41.( _ 19-19- the above named „ Dale L. l_i-_Margaret•_ J _ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, - `l •th'. authorized by § 706.06, Wis. Stata.) to me known to be the person SL d e• F~ V fore oing instrument and acknowled th ~ ~ THIS INSTRUMENT WAS DRAFTED BY y °i~~01'Aa LAi~X..&._CAT!1 .rucade_.St..,.. ~ n P.O. Box Qia.,.._ Polk P. Q h1 ...5?±A~O Notary Public g. w. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, p are not necessary.) date: -------V-9 19 •Names of persons signing in any capacity should be typed or printed below their signatures. II WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 1 - 1982 Milwaukee, Wis. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County e_ ~K- BUYER l i, J - IS C IG7_ OWNE / ROUTE/BOX NUMBER_Ldy N'C I f ~ IW 1J FIRE NO. CITY/STATE Z I P D j`~ (ICJ ~i S~,;ry 5~ r~Nfl PROPERTY LOCATION: LAW 1/4 _1/4, Section, T 36 N, R Town of~CP , St. Croix County, Subdivision t~~- , 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 Of within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS 1NDUSTiRY; C DIVISION P.O. BOX HLABOR UMAN NDLATIONS PERCOLATION TESTS (115) MADISON WI 539069 (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHI OT NO.•BLK. NO.: SUBDIVISION NAME: riJ14 sE 1/ 31 /T3oH/R/9 (o W S,- -\C-)S tt P" COUNTY: MAILING ADDRESS: 'ST Ceo IX 7544,41E ERICICScW 199 MC K1 N tEy D~ r, pSo~ 1,(~) S 4 0l 6 USE DATES OBSERVATIONS MADE Residence NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: I PER CO *Re lace Q S. t4 New ❑P . 4Ak>Avltx 30, 90 ,01L:5 )e 4 41 ScCZ S4,~ l A1,6 RATING: S= Site suitable for system U= Site unsuitable for system ~Iu An b-z A~r- ey CONVENTI NAL: M UND: IN-GROUND-PRESSURE: S STEM-IN-FILL OLDING A T E]S COMMENDED SYSTEM:(option 1) DU S ❑U ZS ❑U gt ❑U ❑ S Co►vvfti fo es If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: C LASS ~ Floodplain, indicate Floodplain elevation: K14 r__ i PROFILE DESCRIPTIONS BORING TOTAL DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH4X. ELEVATION OBSERVED EST7Tr HET TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B' 1,~7 9,0.47 14dN~ > ! 6"-FG+c .4"2o$u,,FS 52" 8a$C.s ~coh arv►h5 B- ? 9.6-1 7q 69 NONE 7 ~.61 IJ $LLTSlV"RQ~5,19"Y8QN5r 2 "2deQ•vS'/ ut 33 9e,,1r/1`Is Z7 " Lr $e. e OS c re RrDBQN A1S B' NO f7 Z `&-crs WgRNSIL S2~R4$QIvSt 40= p N 39, Lr9ANCST(,t J~.~3 71.0 I;' ~ 1I3~ l3'BLC. !3"'B32S8RN ~~GBRNMS 84..I^+ CS B- ON B_ ~ ,$3 ~0-~1 3 9~BLL-{ i3~y6KNS/C. /9r>~n$~~/ )L 5"; ~o ge~.r>•s o N 9.~ 22 earl -r-- B- PERCOLATION TESTS } TEST DEPTH WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATE MINUTES r NUMBER S AFTERSWELLING INTERVAL-MIN. PERIOD t P RI D PER INCH P- s► NO&ILf 11 4 ,So 10 r 4 ' 8 P- Z 6, 4 N Ng ",So O 7Z ?2 >2 Z P- 3 .)O aS 77-tO 10 > Z >2 >Z lZ P- P F_L[4;iT IW J AT RG. 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 plat plan. Show the surface elevation at all borings and the direction and percent of land slope. / I ~oR1;k ~ SYSTEM ELEVATION. 69.70 -fl) I I I _ 1 I i r - - ) - - I r 1 ~ I Ira F 46- - G !mod . ~ ~ ~ J i r vT fou 8 \ ' l ~T16 r t. Lt t - Y - - __T 7T T_ 1, the undersigned, hereby certify that the soil tests reported on this form were ma3e 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: NAIYEY Jo114116av So N~sa>u SL)+~vp_\/ 114 IN C- Spa- (J-AA y 3 / /99 0 ADDRESS: CERTIFICATI N NUMBER: PHONE NUMBERIoptibnall: 4D7 S End S-7 r~ /JcJ4so~ r ~I c>1 34g~- ~E6- CST SIGNATURE: r DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - D vg, Soo s~~ ~,Ey ~ZooosEp ~6s` G DoE PLB 67 PLOT & CROSS SECTION PLANS ZAPPA BROS. EXCAVATING INC PLUMBING UNIT -40,00 SED /~ES "~~NC PROJECT fit~Tic,7,vi}t Aj~ f -f- / a mwv 5c ~yi7 ~v~© y CL. sEwE~~/NE ST G rv ;~A.FT Duds G `./f ST ~.C R~~ CAd-AAYdUT STIFC t' C.J 1'~IF p A 82 AA°iPvVP/~ AieT~TE ~,tuG a Al SOS -3S f~f~c.~tz.~ L,~.vF yo ~ ~s /t B3 ' !V NO Jf SCALE FRESH AIR INLET AND OBSERVATION PIPE C APPROVED VENT CAP MAXIMUM 12' ABOVE FINAL GRADE 4' CAST IRON VENT PIPE MAXIMUM OF 42' ABOVE ~ A46 oS _ ~.Wc . PIPE TO FINAL GRADE SIGNED: MARSH HAY OR SYNTHETIC COVERING LICENSE: eL f s 33 9S MINIMO ER PIGPEREGATE DATE: DISTRIBUTION PIPE TEE SOIL TESTING BY: C ELEVATION BED W AGGREGATE • f BOTTOM PER SOIL BENEATH PIPE PERFORATED PIPE BELOW TESTIS COUPLING TERMINATING 90 ' FT• AT BOTTOM OF SYSTEM lk rcel 030-1092-40-050 05/10/2007 02:52 PM Pa PAGE 1 OF 1 Alt. Parcel 31.30.19.338B-10 030 - TOWN OF SAINT JOSEPH ST. CROIX COUNTY, WISCONSIN Current X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 02/25/2005 00 0 Owner(s): O = Current Owner, C = Current Co-Owner Tax Address: O - ERICKSON, STEVEN E STEVEN E ERICKSON 1221 MCKINLEY DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.190 Plat: N/A-NOT AVAILABLE SEC 31 T30N R1 9W PT SW SE COM SW COR SW Block/Condo Bldg: SE, TH N TO NW COR, E 150 FT SWLY TO A PT 200 FT S OF N LN & 66 FT E OF W LN, S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TO S LN, W 66 FT TO POB & INC PT NW SE 31-30N-19W AS DESC IN 2755/253 Notes: Parcel History: Date Doc # Vol/Page Type 08/17/2005 803748 2869/202 QC 07/23/1997 1032/135 LC 07/23/1997 853/97 07/23/1997 815/396 more... 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/26/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 91,200 777,200 868,400 NO PRODUCTIVE FORST LANDS G6 9.190 95,000 0 95,000 NO Totals for 2007: General Property 12.190 186,200 777,200 963,4000 Woodland 0.000 0 Totals for 2006: General Property 12.190 186,200 777,200 963,400 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 s , Parcel 030-1092-40-000 05/10/2007 02:27 PM PAGE 1 OF 1 Alt. Parcel 31.30.19.338B 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 02/25/2005 00 5 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner RETIRED ERICKSON 0 - ERICKSON, RETIRED Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.190 Plat: N/A-NOT AVAILABLE SEC 31 T30N R1 9W PT SW SE COM SW COR SW Block/Condo Bldg: SE, TH N TO NW COR, E 150 FT SWLY TO A PT 200 FT S OF N LN & 66 FT E OF W LN, S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TO S LN, W 66 FT TO POB 31-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/17/2005 803748 2869/202 QC 07/23/1997 1032/135 LC 07/23/1997 853/97 07/23/1997 815/396 more... 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/03/2006 Description Class Acres Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: 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 K 05/10/2007 02:53 PM Parcel 030-1092-20-05'50 PAGE 1 OF 1 Alt. Parcel 31.30.19.337A 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 02/25/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - ERICKSON, KIM D KIM D ERICKSON 1221 MCKINLEY DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1221 MCKINLEY DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 30.000 Plat: N/A-NOT AVAILABLE SEC 31 T30N R19W NW SE EXC PT DESC IN Block/Condo Bldg: 2755/253 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 31-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/17/2005 803748 2869/202 QC 02/25/2005 788263 2755/253 QC 05/13/1998 579065 1323/230 WD 07/23/1997 1142/320 more 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/26/2006 Description Class Acres Land Improve Total State Reason MFL BEFORE'05 CLOSED W8 30.000 122,800 0 122,800 NO Totals for 2007: 0 General Property 0.000 0 0 122,800 Woodland 30.000 122,800 Totals for 2006: 0 General Property 0.000 0 0 122,800 Woodland 30.000 122,800 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