Loading...
HomeMy WebLinkAbout030-2001-80-000 c 3 0 3 C) O O e» b tv; ~ C fY+ 0. I..,, ° S C ' t/1 c Y N G 0 > T O a m° C LL.. m co N N (D 4) w CO 'C: M u N a) C w-0 U NL'6 N~~~ a a> w Q C E co) C N a C Q_ Y U= L p CL V O N Y L) U) LL 7 y n ~ OD -1 0 N NFL. NcFU-;6 fn co L) -0 E N N OM E Q-) (CD a N C aE" E Y N a~ 3 p O rn ° a3iFO- E c. N a> L a"i cu ° °a E. c m > m a~ Lac o Lo°(n CL UU) D 0UE°m U co c c a o o c a 3 m r " 0 0.0 0 X co m a O)o E 0- m a. ac io m 0O 3: m c ° °o n y ~Z y 3''° ° U' a aNi `n Tm~ • ami E•-° N E N O T O N O- N N M C •0O m Y N 0) 0 0 0 N ~'C W'6 L. .2 F- n. -o Lo c m NOp 0.00 M m o as ° o m 4) O ° C Z N~ C N L N EO N N C Z Z a m p CO p° V a T '0 C 3 m .L.. O -C N a C Lo ° a N LL C N O 0> Co L N N C w N LL p 0~ m° C~ x~ 0 toil a) I O 3 m E' V 0)t t N j N a~ oa t6 mew c aL c a N E a~ m~ E 3 oY -6 0, 0_ a y> Q) n N O (D a t w m i° N O N C Q a~ m :E ° m 3 ac E Q F- w N U aZ..~ ED E U M N v ~ a a~ Z ii Z C = o v £ 0 Z ~ a m d d Cl) M M F- U C z a C O Z ~ C O 0 Z O C O C [Y r O N I O ~ ' VJ P ~ c m m 70 10 0) m m a c rn m m N Q to L LL L L_. m N ►V Cl) d ' Q C C w c a 0 O a) Q 0 Q) Z m z Z Z Z O ~N N C "O y -a 0 V E co ca m E N d y- d LL' N- i 0. ra to a m ~ C45 1 (0 T v U) o G G a` °w D D a` c t= LO N U) U) E 0 rn m to ti E H~~ d w N a= ' • ; X000 •°000= a a a a a a N w a N N 7 O V1 a O ! m0 p p N U) U w x a) - N tb a> 00 N N = M T E 0 0 O O O T O U O d m N N a a) ) cu ° '0 Q y Q } Q ~ U m a> > a Iii ° LO N N J to U) cl O O t- C'4 N C N s E to r- 0 Q O c IL•' O O O W O rn O ® F- _N a c a~ to a B a) o r) _ a ( \ L M a N Co N F- E E U; OJ i VJ p O C C 0] p - O O Cj N 0 -0 ❑ O O N ° a Z O~ O F- F- N : CO LO cn E E ~I • o M? o a°o N m o m yy O co (n M co - 2 F- J O -a O . 21- ti ~ ~ E v E N f m ~a a a a w L a • a m .2 N c m m c con m c nTIgN• ST. J~SEPH 33.30.19 PRIVATE SEVI~AG~SYCO. STEM E y SW NW bnsin epartment of In ustr , Count : Jor and Human Relations INSPECTION REPORT ST. CROIX afety and BVildings Division (ATTACH TO PERMIT) Sanitary Permit No.: FF GENERAL INFORMATION 175659 Permit Holder's Name: ❑ City ❑ Village [XTown of: State Plan ID No.: LARSON, TIMOTHY L & KATHERINE ST. JOSEPH CST BM Elev.: Insp.`BM Elev.: IBM Description: Parcel Tax No.: /C J, G Gl1' ~ e6,7- 030-2001-80-000 TANK INFORMATION ELEVATION DATA A9200318 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic _ j K Benchmark a), Dosing Ek. ~ Aeration_ Bldg. Sewer Holding St/ Ht Inlet , TANK SETBACK INFORMATION St/ Ht Outlet) If TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic >s~p 60 (o ~ NA Dt Bottom Dosi NA Header / Man. Aeration N Dist. Pipe 1 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Man Demand Model Number GPM TDH Lift Friction System TDH Ft Jd- I PIZ oss Forcemain Length Dia. Head .4:~ Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PDIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS CO LEACHING u acturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM - INFORMATION Type O Cm. V-• / CHAMBER Model NO System: ~ r 3 Zsv S >SZ7 OR UNIT DISTRIBUTION SYSTEM Header /AAaai4 it Distribution Pipe(s) x Hole size x Hole Spacing Vent To Air Intake Length / Dia. Length Dia. Spacing L 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 $ed/Trench Center Z~ 3~ RadJ Trench Edges 2( ~3~ Topsoil C] Yes ❑ No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) , T $ IF' //7 60 0(f_op box l , 13, 3 Plan revision required? ❑ Yes Brvo Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , 7 DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY / STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ~J ,Fu-►(J'/ 8% x 11 inches in size. ❑ chf~f re~iision to 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 -r) M l& eso o, S L") % A/PY., S 3 3 T _30N, R E (or) W.. PROP ~NER' C~-,, XT I MAILING A SS LOT ~ ~ ~ h A BLOCK # Cry S ATE ZIP COD PHONE NUMBER SUBDIVISION NAME OR C M UMB /(:?f f~s~ S C~ ~zf O q-~nD7 C S II. TYPE OF BUILDING: (Check one) CITY ,5e NEAREST ROA n ❑ State Owned VILLAGE * u G d/ ❑ Public A, or 2 Fam. Dwelling-# of bedrooms - A cEL AX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) Q3~ r ~59 OIL.) 1 El Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Ch Kknlyonein line A. Check line B if applicable) A) 1. ❑ New 2. eplacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System ystem 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 K:Seepage Bed 21 El Mound 30 ❑ Specify Type 41 El Holding Tank 12 eepage Trench 22 El 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 ELPV. 7. FINAL GRADE REQUIRED (sq., ft.) PROPOSEp (sq. ft.) (Gals/day/sq. ft.) (Min./i ch) vo. Iq, ° WATION 5-- V )e !off L a 3 . 3-83 + Feet 7,'+ Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank ® ~O Lift Pump Tank/Si hon Chamber , i . El-i El EL_ n iL± 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 re: (No Stam MP/ PRSW No.: Business Phone Number: AEG S. 11 7~• /~rP 74 y~ lol X3`1 % Plumber's Address (Street, City, State, Zip Code w~ SG 6 0 / 3 6 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee (includes round water ate ssu issuing nt u o a (No Ap 81 tail Surcharge Approved ❑ Owner Given Initial f~Qa~~ 9C Adverse Determination QQ " 7_ X. CONDITIONS OF APPROV UREASONS FO DISAPPROVAL. G SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety,& Buildings Division, Owner, Plumber INSTRUCTIONS 4,.. -A sanitary permit is valid for two (2) years. 2: 'You`r 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 b properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, uAany every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the . State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I., 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) 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. - ~7 0_10 7~/ % .clv Owner of property h Location of pproperty-SL~/1/4 ,r ~ /V W 1/4, Section , Tad N-R_Z2W Township L/ QSP,J Mailing address drool t1k/ v~ Address of site Si Nl A&J1V_e_ Subdivision name AL-/" 14~2o G Lot no. C _ Other homes on property? yes_ No Previous owner of property I~~y Trion /KL4 k1i mfr Total size of parcel Date parcel-was created PLIO. Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes /7No Volume9Y--~ and Page Number-5-0 r7as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map j 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 i e o 4 ce of the County Register of Deeds as Document No. 41 , and that I (we) presently own the proposed site or the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No: Signature o applicant Co-applicant Date of Signature Date of Signature # ' a yt~ k WFA vwq~ V 000 -77 p lyt1~M~/yRQn Mtn .>..Na~sgliM.. a7 A...itdVA~Ailghg........... ~i C~ ~ a;. 5 Oar - • .aii.r w U~1 . 3:30 p„r am wiesa s fie LE$ . ~.A iS~ 4Rl d. ♦ x k 7..IU WWukL tid.. wif P-r................ 'Zr iYi+ZLit -'pi4j>teY; Ly :..t,,~:.~:. ' .....r. •...X...v p0.$et ►3~ VICOL t ~ wc.v Falk Loy iMerMi Mal estate In ....Sit.....CroiX ....................County ~ 51l'k'I~MrNSao fi .aa~ Tas Parcel No:...................::....,.- the Southwest Quarter of the Northwest Quarter (SW 1/4 of NW 1/4 tLcM Thirt~~rr-three (33), Township Thirty (30), Range Nineteen (19) ~ -,~ll follo+is: ikt 4outhwest corner of said Section 33s thence hest along y , , tion Thirty-two (32) , Township Thirty (30), l , 41 < W!) 57:61 feet thence North 628.97 feet( thence North 87 q,. -1 S.. **to thence North 44. 48' East 444.26 feats thence 1 "Bast 1091.23 feet o thence North 10° 42' East 1205.62 fasts f. ~EastY°288.73 feet to the point of beginnings thence East 351.0 Xorth 00 14' 45" West 302.0 feet to the centerline of Covent "E "I thence North 78. 22' West along said centerline 306.1 "feet i"theaiilefSouth 07' 48' 20" West 367.13 feet to point of beginning. - BUBJWT T13'*e=isting County Trunk Highway "E" Right-of-Way over the ? Northerly line thereof. FURTBBR SUBJECT TO all reservostions, restrictions and easements apparent or of record. pro This homestead property. i A Exemption to varraatis is I a, t' 4 ~ . D.ad this . day of . . . June 1Y ...86.. (SEAL) (SEAL) II I :A I Ri nd.8 ooks K I~ r simmer • . . C { s ........(SEAL) (SEAL) i Carol E. Kummer I, { • • AVTaiIfTIOATIOM ACHNOWLEDGMBNT `e) STATE OF MONTANA uGB............................ County. day of 19...... Personally came before me this d .-s. .dsy of ~ _ June....-- 1946... the above named liAX1"~O D..BR04K -K.`.II R--II j CAROB, E . KUMMER• Tn%Z: IIEIIBER STATE BAR OF WISCONSIN ' b ~oeoe. Wh►. sate.) . ' to me known to be the person 5.......... who executed the I 1 } ~V foregoing instrument and acknowledge the same. I J {,~~~t►+tyM411)IAe DRAFTED er il...~.P.. ~4:ineY ' P864 r Notary Public I _ 'Corny ( 1I•a isatieated or acknowledged. M.• Commission is ah 417 Both permanent. (if- not, sate expiration" date:.... ,4G~.,..:.J 19.tl tI s16on st Mwar sbuft Is aaf .aPwkr .hOUM be r-p..i or printed heiow their signature.. •ARR"" STATn D" or WMCONatY Wheomin 1a al Wank Ca I YOM No. f - 1"s MAwaNM., 1a. w S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 1 lit r5C'i ADDRESS Sa C'~ x/ 01 FIRE NUMBER CITY/STATE_ lyLeAo~'I ~l `>L ZIP_ S`/O/6 PROPERTY LOCATION:-2L-tZ1/4,Z:4GL/4, SECTION=, T-3(2N-R_/j W TOWN OF St. Croix County, SUBDIVISION C S /~A' LOT NUMBER40 36d. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1918. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning officer within 30 days of the three year expiration date SIGNED:- DATE: St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 °AA TRTMENT RY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS TRY, DIVISION BOR AND P.O. BOX 7969 PERCOLATION TESTS (115) MADISON, WI 53707 saves f MAN 1-0 TEST> RELATIONS ~Ovo/T/aws -F 0 30y5' 7-- (1LHR 83.0911) & Chapter 145) LOCATION: SECTION: OWNSHIP/""_ UX4G P~~EI''Y: OT NO.' BLK NO.: SUBDIVISION NAME: so -1/ Nom' V/ 3 3 MO N/R If E (o , ST TOSS p 1~ COUNTY: MAILING ADDRESS: y-1`~Ro~X ~i•~j G~iPs~~ sis may. E, s~ ;osepf►-, 40,s. syaPZ USE g ~(00 7 2 Gv (0/2 - ¢ 3 y- 7y O DATES OBSERVATIONS MADE NO. BEDFIMS.: COMM R IAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION S. %Residence S ❑New Replace RATING: S= Site suitable for system U= Site unsuitable for system S~ (2 ONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL OLDIN :RECOMMENDED SYSTEM: (optional) E S []U ®s ❑u ©s ❑u ❑ s Zu ❑ s ou s'°~/1FVl/° ~,f Ste- aT~ fir/ ~'zti~s ~ D (30 ~f'STRiBuT,o.J 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: G (,As S =7- Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED HE TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) B-J oi 7to > CS 'fe B_3 ion 97: o(D ' i6~ --kl 19' "1 Z, .2011 E- o,- '$N - cs jR . B- B- B- PERCOLATION TESTS 1 v CS .S7,(:W4 S t' EST DEPTH f WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES' AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD PER INCH P- P_ Z .yam Z P_ 72- P_ 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 i of land slope. None)% 7,e£U SYSTEM ELEVATION. DO /4,/Q ' .K.__. M 4u el ke 0~ E-! "Wi IA. I G- 12 A' ~1 17_ Jr v 4) t N t 1 0 d L 40 : t TI - - _ -6 A - . L i 1, 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): HOMI ESITE - - PtUMBING GO. 655 O'NEIL RQ., HUDSON, WIS. 54016 TESTS^WERE COMPLETED ON: ADDRESS: CnRF8 7 111 RRIGHT '.v45. MASTER PLUMBER LIC. NO. 3307 M.P CERTIFICATION NUMBER: PHONE NUMB (optional): .R.3. & DESIGNER LIC. NO. 00663 Z F Z ~~-P4 s CST SIGNATURE DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SB08395 (R. 10/83) - OVER - L P 736DR" f7 OA 05, Ex~sr/.vh PP~iitST ~o..,~~-c S'~Ti t T-f•aaK / putipEV A300.30 1 Qi18 - fe'voogtD plyK~' S S+F"nj T!G SfpU/CE ~G'~c<<.t uv \ 5y ~!l v v 'i T 1$ O O 54._Q.1 -I 13hFFLC5 eXq,41Nt v HoH4--s e-r& SEpTrc oN zec. FoLA.5a ~ ~aTr1c7- ~ r wD ~ y 4 ~ .z . , tip,,. • _ - _ hf ~J ~ovaD o ✓ vE~'r to _ , ~ ~3 O ~ Z r~ CIA s s y sTE'y 5 s Y sT~~ 8g.so f-~ I~ ZS pow o f ~!'aE T Rees + f~SS~~refl !5w A-0 T I'~_ 3 d SC A It r xtip~ IocrtTiaaS N 0-Te ' ~oRI: # 3 HOMESITE SEPTIC PLUMBING CO. aA) 655 O'NEIL RD., HUDSON, WIS. 54016 W'f S / ROBERT ULBRIGHT C$1` 1M rl e j tTE` ,vIS. MASTER PLUMBER LIC. NO. 3307 M.P.R. ~OJ4C4 T 7 p MINN. INSTALLER & DESIGNER LIC. NO. 0060 s 7a£ S y EklsT jA) 6-- Sc~~TA~iL~ r~I V ~I SO iLS Itiia &o;,o G- o ke,NA 46y, 0612 SySif^~ T v1eE ViA- Ut"Ver Dle Del CdNNPC 7D f~T ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT n FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the 11WL 4etv5c residence located at: S&t" 1/4, .10' 1/4, Sec._ T_0 N, R/'~ W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced 0- Did flow back occur from absorption system? Yes NolZ/'1/(if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: 15-0c, GS Construction: Prefab Concrete- -Steel Other Manufacurer (if known): Age of Tank (if known): (Signature) (Name) Please Print (Title) (License Number) (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name EY~~ ~Yv/S Signature _3/~ MP/MPRS 5/88 SNN I ~4 ~a +C~ Co.ic~.'r~~ ~l, ;z, .i:4~~',T,i"~( .►C?~ti 4' Prr'~v~• ,d rvG. SiA ~T~1QiI 3L 4 ji.r✓t-~ae.. 9~~'L 34- L-F ~y~~ll1 tl if 30 `a SY~ K•t C1p~cty.'I .4 41 CP &I 5 ' X 3J 57 sy.~. On,~k r-elol ale, e W, Ri THrtre -TrLa e 4.3 l~ d VS m S' x ds' - 395'.s:. At. 975r of~ I s7 s"~- S" e y 6 /b 69►•dL / S~ JoSr/I ~i 7aw x ll %v~ sl` ~/oj( ~'y~ S' ~J rYro:ti /iGvus C. yr, jv y Gt r ~'a~l~ . J /y +0 oixt ~3riy~ ~4- S. t,T y ~yJ S: 33 i. 30, O~3 rv fin ,1/" Sc/C. y0 C. Z a'T ~ ~P g3Ci ~2 ,4. ~''G►1 ~i"'t /G1 p A'- 7 o' ~Vr<YY.s ✓L . C.7 # + / 4'_ v I s ~ clus a 5,y l1AX l1'OLS7, Q "W), 136TH ST R 430-1101' -~0 4j . ® S- (3rd►~vrt.. ~1e;s'~~ks Pr~c'o~T !okeroP'~,_ j~odSG -'4K / by /Sao 6, It. ~ NL h Y p .Y %kg ' o Ali X/ , (qV~}iQ, I~ Off' rx~f hS. 4.o,_ &I sO ~ ,s a Y }S' 1~ ~ Eck a 6 6 o a ~ 4' ,+S5, t<,.cc~ wcgt~ Lod LiKv 30, ~Pi" ~1 6 ra Pia X _ L lw c. a s C-3) )N t .L Cer,t✓ SKk yR~fi` ~r~yr, LiJ l~lJ 'G 14M fvv~✓ / ' X_ v_ vL r E"'_o! ~ti tvvc✓ ~ sra c ~ D ~~f Dt•tv<✓ /~e~ ~ C) Is" x 'Alt s'X !n s"' 0 6 Lk1 A,av L QIr4~h fl't d ®`a ~yis N.~ '[rt►•t Nc5 V Y65 =3;T, x 3 = ~7ss/F4. REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1 11/17/92 13:56 REQUESTS FOR INSPECTION WORK SHEETS FOR: 11/18/92 AREA: JT Activity:~A9200318 11/18/92 Type: CONVSEPT Status: PENDING Constr: Address: ST. JOSEPH 33.30.19.362A,SW,NW, CO. RD. E Parcel: 030-2001-80-000 Occ: Use: Description: 175659 Applicant: LARSON, TIMOTHY L & KATHERINE Phone: Owner: LARSON, TIMOTHY L & KATHERINE Phone: Contractor: HOLST, JEFF Phone: 612-439-1101 Inspection Request Information..... Requestor: HOIST, JEFF Phone: Req Time: 15:11 Comments: 3 ; 4s Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION I l Parcel 030-2001-80-000 03/24/2005 09:02 AM PAGE 1 OF 1 Alt. Parcel M 33.30.19.362A 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 * LARSON, TIMOTHY LEE TIMOTHY LEE LARSON 525 CTY RD E HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 525 CTY RD E SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.530 Plat: N/A-NOT AVAILABLE SEC 33 T30N R19W SW NW COM SW COR SEC 33 Block/Condo Bldg: W 57.61 FT N 628.97 FT, N 87DEG E 120.15 FT N 44DEG E 444.26 FT N 1 DEG E 1091.23 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) FT N 10DEG E 1205.62 FT E 288.73 FT ZQ„ 33-30N-19W P FT N 78 DEG W 306.12 FT S 7DEG W 367.13 Notes: Parcel History: MISSED PT OF LEGAL ON DEED. FOUR Date Doc # Vol/Page Type SEASONS WILL FIX. NOTES ON DEED. 08/24/2004 772481 2643/09 QC 08/27/1997 1260/255 QC 07/23/1997 745/507 07/23/1997 690/364 2004 SUMMARY Bill Fair Market Value: Assessed with: 5672 252,100 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.530 69,800 178,200 248,000 NO Totals for 2004: General Property 2.530 69,800 178,200 248,000 Woodland 0.000 0 0 Totals for 2003: General Property 2.530 41,000 138,500 179,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 502 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 T r b Z i f~ r UZI Sr. CROD(cowry = _ RVEyOR' RECORD VO'I N ,1 W 11 Z 45-0 i a Y5 f3~'` V I FW- I;L ~ OD N s ~ Lod" WEST 639.73 33.58' ST 619.74 f ^ 36 a T O . t M r L 3~~ A a U O to WEST702.54 t ON's mop N~a o 554.21 O G J e WEST 760.13' i i 1 _QQ ~ S 0 WEST 818.11, ' 38740 430.71 'rn 1 N 3 33 U')N O 418.70' d' o U-) O 0 o Lo Z LO • AS BUILT SANITARY SYSTEM REPORT WNER , TOWNSHIP SEC. 7. N, R /Cj T .0. ADDD#4S , ST. CROIX COUNTY, WISCONSIN. '0&a 'UBDI,j1AON LOT % LOT SIZE 1 PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~w earaL~r house 306 ' . .III 1d~' LOP41 ]PTIC TANK(S)MFGR. CONCRETE 13 NO. of rings on cover ef Depth 3& 6 DRY WELL ENCHES NO. of width length area--' :D no. of lines width length gr ? areas- depth to top of pipe M Z 3GREGATE -2,4 d RK RATE Q AREA REQUIRED fit,!5 Z AREA AS BUILT c77 2 zf'yl. Z sclaimer: The inspection of this system by St. Croix County does not imply complete ::mplfance_with State Administrative Codes. There are other areas that it is not possible/ inspect at this point of construction. St. Croix County assumes no liability for ,stem operation. However, if failure is noted the County will make every of ort to ~termine cause of failure. :EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYST i 1 lee '-INSPECTOR DATED PLUMBER ON B Lira LICENSE ER • i { t REPORT OF I11SPECTIO?1--174DIJIDUAL SEHAGE DISPOSAL SYSTEM Sanitary Pernit State Septic j .lX,1E TOWNSHIP St. Croi~/c oun y SFDTIC TA711; sW. 33 .~xze gallons. 'umber of Conoartments . Distance From: Well ft. 12% or greater slope `L Building' ft. Wetlands f Highwater ft. DISPOSAL SYSTE:1 Tile Field or Seepage Pit(s) Distance From: Well. ft. 12%_or greater slope- ft Building ft. Wetland FIELD HiFhwater ft. , Total length of lines ft. Number of lines Length of each line ft. Distance between lines ft. Width of the trench ft. Total absorption area sq. ft. Depth of to c% below tile in. Depth of rock over tile in.. Cover aver .rock., Depth of tile below grade in. Slope of trench in ner 100 ft. Depth to Bedrock ft. Depth to ground water ft. PITS - :lumber of pits Outside diar:eter ft. Depth below inlet ft. Gravel around pit: ___yes no. .Total absorption area sq. ft. Square feet of seepage trench bottom area required Square feet of seepage nit area required - - Inspected by: Title: Approved Date 197 Rejected Date 197. EH 115 s WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 t MADISON, WISCONSIN 53701 o REPORT ON SOIL BORINGS AND PERCOLATION TEST /tl 3.3 d ®(or wnshi 14M nici a it S Section T•3nf I, R g' p y LOCATION:/a, I f4c Lot No. Block No. T 6)IL M 4.4r ounty S" C•~d~ Owne'r's Name: ~rQ1e,(e Subdivision Name _/'~,L~~a,✓ Mailing Address: s1'11W0A0' A'!A ~ TYPE OF OCCUPANCY: Residence X No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW }L ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS -A -.2/- 7y PERCOLATION TESTS Ax-ACW -521IK 4102"' SOILMAPSHEET SOILTYPE 67 PERCOLATION TESTS TEST DEPTH SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE CHARACTER OF NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- I see ,ire //o /0 x/_ /'Id 9 P 2. ZO N ler- ,BorL D lO P -_S ( See Arm .2a SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) I -M 4 Z., Z- V31, 7 ~4, " 75r ,Z " S4 w 'g X 6r OF4 , 17 N 4F -4 7-S B- -3 AAAge- , y AAutz- 7 sb"sV B- >p6`r 7u7S, 20 " 27" S4 `f3" SING.., 117s, Z 46 X4 S I( PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate num er fisquare feet of absorption area needed for building type and occupancy. CUd°' .S'"k /t '00-44 Indi to scale or distances. Give horizontal and vertical reference nts nd' slope. r' r j<'YS' d-- P,yt LI► d MOWN l~ i N a 0 °I a ' t I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my nowledge and ief. Name (print) t Certification No. Ss=/,Sr/ / Address Name of installer if known CST Signa z~~~~~~ COPY A -LOCAL AUTHORITY s i I -z r t s P1 ~ ~ ~ ~ State and County State Permit Permit Application County Per ' for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: .s '/4 AZRo~ Section T3 ON, RZ9 W (or) Lot* City _ Subdivision Name, nearest road, lake or landmark Blk# Village 1 M Township ~s f ' z. ~ ,L~ 1~ ~e~ PeyQ•s ro~ C. TYPE 0 OC PANCY: *Commercial -Industrial *Other (specify) *Variance Single family X Duplex No. of Bedrooms --3 No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES A NO # of Bathrooms Automatic Washer K YES NO Other (specify) E. SEPTIC TANK CAPACITY am0 Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation X Addition Replacement- Prefab Concrete X *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) 70 Total Absorb Area sq. ft. New_& Addition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches No. of Lines 3 Seepage Bed: Length sr- Width F ' Depth " Tile Depth 36 6, Seepage Pit: Inside diameter Liquid Depth Tile Size's Percent slope of land 7 2Q F~v Distance from critical slope ~JA- I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Ce 'fled Soil Te r, ff NAME KIw~ Gri C.S.T. and other information obtained from owner 51d--e Plumber's Signature MP/MPRSW# Phone Plumber's Address w M PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H6220, including , well). -14 c> e *-F Awl EL. = /0d' t~4 04"~' _ 904 E.C. t ~e 3S Do Not Write in Spa a Belo FOR DEPARTMENT USE ONLY - ` Date of Application Fees Paid: State ~o' County Date Permit Issued/Reje ted (date) =,e -Issuing Agent Name ` Inspection Yes No Valid* Date Recd 1. county (whi a copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1 /76 1 t k s ~ Y • - 'ti _ T { ` . ~ a-y t ~i t-.-~ .r Q . _ - . r `"s Y ? TRANSFER FORM SANITARY PERMIT B 67 - PLT State Permit # /~O 'JrIO Sanitary Permit # 3~ County -.S)4 C c= / OL Sanitary Permit Transfer Date 7/Z a /79 Original Permit Issuance Date f0 e-1-7 A A. Property Location: _S:+J '/a MW ''/4, Section, T-3D N, R /4 -E-(er4 W Lot # City Subdivision Name, Nearest Road, Lake or Landmark BLK # Village _ t~ a~ h[]~- Township B. TYPE of Occupancy:. Commercial Industrial Other (Specify) Single Family ✓ Duplex No. of Bedrooms 3 Variance C. SEPTIC TANK CAPACITY /dam © Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks N ,Prefab Concrete Sol Poured-in-place Steel Fiberglass Other(Specify) New Installation ✓ -Replacement LIFT PUMP TANK/SIPHON CHAMBER /S Total gallons Prefab Concrete Poured-in-place Other(Specify) D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Z~-Cd 'Total Absorb Area 47"VZ- sq. ft. New. ✓ Replacement Alternate (Specify) 945 fJF Seepage Trench: No.Lineal Ft. - Width Depth Tile Depth(top) No.'Trenches Seepage Bed: ✓ Length Width Depth !:~VTile Depth(top) ZZ No. of Lines Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits Percent slope of land ? Distance from critical slope y E. WATER SUPPLY: Private ❑ Joint ❑ Community ❑ Municipal Present Sanitary Permit Holder Phone No. ` Z Sanitary Permit Transferred To: Phone No. Name a of Name ~..L~ , - SiA Kd ~JLi Address Address Z 15A, I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with section H 62.20., Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared by the Certified Soil Tester and or a y additional soil tests that may have been required. Plumber's Signature -W/MPRSW # Phone 1(9 Plumber's Address $ ' }Z r- Information obtained from (..--t.- C8%, (owner or agent) =jam per" PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh- bor's ro pert y. If well h not b 4F T, kQ- as l e e __4 T ~T, i Signature of Issuing Agent 1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH 2. State (White copy) 4. Plumber (Green copy) P.O. BOX 309, MADISON WI 53701 TRANSFER FORM SANITARY PERMIT ~P L B 67-T State Permit it Sanitary Permit # County Sanitary Permit Transfer Date Original Permit Issuance Date A. Property Location: '/4, Section , T N, R E (or) W Lot # _City Subdivision Name, Nearest Road, Lake or Landmark BLK # Village Township B. TYPE of Occupancy: Commercial Industrial Other (Specify) Single Family Duplex No. of Bedrooms Variance C. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks 'Prefab Concrete Poured-in-place Steel Fiberglass Other(Specify) New Installation Replacement LIFT PUMP TANK/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place Other(Specify) D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 'Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) No.'Trenches Seepage Bed: Length Width Depth Tile Depth(top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits Percent slope of land Distance from critical slope E. WATER SUPPLY: ❑ Private ❑ Joint ❑ Community ❑ Municipal Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No. Name Name Address Address Zip Zip I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with section H 62.20-, Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared by the Certified Soil Tester and/or any additional soil tests that may have been required. Plumber's Signature MP/MPRSW # Phone Plumber's Address Information obtained from (owner or agent) PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh- bor's ro ert . If well has of been 'I -TT - - - Signature of Issuing Agent 1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH 2. State (White copy) 4. Plumber (Green copy) P.O. BOX 309, MADISON WI 53701 Aku TRANSFER FORM SANITARY PERMIT PLB, ~6=7 T State Permit.-* 1A e) Sanitary Permit # 3 County Sanitary Permit Transfer Date . 2"f Original Permit Issuance Date a~ A. Property Location: '/a_:~ '/3, Section ___:.L T N,R r' E.(orl W Lot # d City Subdivision Name, Nearest Road, Lake or Landmark BLK # Village p Township S,.Z -u44 j f B. TYPE of Occupancy:.Commerci;I - Industrial Other (Specify) Single FamilyDuplex No. of Bedrooms Variance C. SEPTIC TANK CAPACITY „ Total gallons No. of tanks HOLDING TANK-CAPACITY - Total gallons No. of tanks Prefab Concrete Poured-in-place Steel Fiberglass Other (Specifyl New Installation Replacement LIFT PUMP TANK/SIPHON CHAMBER-L.:,.- Total gallons Prefab Concrete Poured-in-place Other(Specify) " D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate :.1 Total Absorb Area 7t sq. ft. New Replacement - Alternate (Specify) Seepage .Trench: - No.Lineal Ft. Width Depth Tile Depth(top) No.'Trenches Seepage Bed: Length t -/Width "`5 ' DepthTile Depth(top) = `J No. of Lines Seepage Pit: - Inside d,ameter Liquid Depth No. Seepage Pits Percent slope of land Distance from.critical slope E. WATER SUPPLY: GYPrivate ❑ Joint ❑ Community ❑ Municipal Present Sanitary Permit Holder Phone No a 4ZL , ; Sanitary Permit Transferred To: Phone No. Name .1074,1 Name r s . E .L' Address Address lip Zip r` 1, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are'in accord with' section H62.20., Wisconsin Administrative Code.and that I have sized the effluent disposal system according to'the`1EN 41IS prepared by the Certified Soil .Tester and/or any additional soil tests that may have been required. Plumber's. Signature' F , IV4R/MPRSW Phonek Plumber's Address Information obtained from s (owner or agent) n{•; , PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include directiomof slope and aH dista•nces in accord ' with. H 62.20. Well. location shall be included on the sketch. Indicate or dimension location of all wells, on the property `or,'neigh bor's ro ert . If well has not been r, r c S i fl } 14111 L;_j } I a•} . •'L'1C, i _ L Z i ' i Signature of Issuing Agent _ , . . _ . , DIVISION IOPMEALTH County" State'-JWh (Yettellow copy) -copy). 34'. . OwnerPlumber(G(Pinkreen.copy) 1 - N VVI 51701 - 1copy} A Q:: 309; M DISO