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HomeMy WebLinkAbout030-2005-10-000 00 ~ p O e» oq v m 0. o c M ° a _ x O UNarO N C E p N O j (9 a) C N -O 07 a a) N O N O 1 N O C C x ° U N O (O (6 N 'O N Co 0) Q N E w Q N E C O c 2 _ CIO > a iq N L W N C > N ca c 0- N 16 ? 3 O O am o pw~ Z aNY E ° Z 5 SO -o C N C C w e 75 (0 LL c C1 U. 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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner WARD, PATRICK & MARILYN PATRICK & MARILYN WARD 597 125TH LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 597 125TH LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 4.988 Plat: N/A-NOT AVAILABLE SEC 33 T30N R19W NE SE LOT 1 OF CSM Block/Condo Bldg: 1/210 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2004 SUMMARY Bill Fair Market Value: Assessed with: 5708 336,700 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.990 129,000 202,200 331,200 NO Totals for 2004: General Property 4.990 129,000 202,200 331,200 Woodland 0.000 0 0 Totals for 2003: General Property 4.990 76,000 139,100 215,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 222 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 t AS BUILT SANITARY SYSTEM REPORT OWNER l R\f-:)(A4' )AID-L?1N WAND TOWNSHIP S~ ~USe P~ SECTION -33 T a d N-R---LW ADDRESS ST., CROIX COUNTY, WISCONSIN SUBDIVISION LOT, NA LOT SIZE 1 y~ PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF.SYSTEM f3 u11 ,lo d .10) vP1we 3 Qeor~vor~ Sk~~s New" q~) 3S y13,41) IZ~,u V~~ve Ic►o' v7l~y n~ red ayxyq &0 INDICATE NORTH ARROW BENCHMARK: Elevation and description: (Q-0 'fU p U~ Alternate benchmark f/\ SEPTIC TANK: Manufacturer: W)P2~ bI l AMLquid Cap. `00o Rings used:-LManhole cover elev: liiFinal grade elev: a T~` Tank inlet elev.: fV Tank outlet elev.: I No. of feet from nearest road:Front Side , Rear Ft. QyefZ- ~ From nearest, prop. line:Front Side , Rear ~ Ft. (a3 1 ,No. of feet from: Well , Building: a (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE ~ `mss 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 ho 5. Nepuetc i~d . ?Y - a.~y iou ob SOIL ABS RPTION SYSTEM 4 a z s . `V _ ~a O Hs] Bed: Trench:] Seepage Pit: Width: -l - Length l ~ Number of Lines:-Area Built 5 Y' Exist. Grade Elev. 8,8 Proposed Final Grade Elev.` Fill depth to top of pipe: No. feet from nearest ProP• line:Front Side x , Rea 3s' , Rear Ft.3s' No. feet from well: No. feet from building 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: Q Q Q DATE:, 7 I I ~ PLUMBER ON JOB : -c~- V LICENSE NUMBER : - 7 U 6/90:cj t2f1539rtfofTndu4EPH 33.30. PRIVATE SWAGE SfST M LOT 1' 125TIF LANE County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENE^L INFORMATION 175675 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: WARD, PATRICK & MARILYN ST. JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: c4 , 030-2005-10-000 TANK INFORMATION ELEVATION DATA A9200334 9~a f~ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark DosiAg- Aeration Bldg Sewer C CK64LK2 Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Outlet p / TANK TO P/ L WELL BLDG. Vent to ROAD Air Intake Septic >Sa~ >-170 ' NA NA Header/MaR. Z (Q/ Aeration NA Dist. Pipe 112,60" Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade 99,0-/ Ma Demand Model Number GPM TDH Lift Friction stem TDH Ft oss Forcemain Length Dia. TD::, s is. SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches P Pits Insi Dia. Liquid Depth ~7` DIMEN 1 N DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHI Manufacturer: SETBACK INFORMATION Type O Cart . I CHAMBER OR UNIT Number: System: DISTRIBUTION SYSTEM Header /~1Aaf , Distribution Pipe(s) , x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length __~Z_Z Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over® Depth Over (~D xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMME S: (Include code discrepancies, persol"resent, etc.) ~ ~C Dl~l ge, Plan revision required? ❑ Yes No / Use other side for additional information. 02 51--- SBD-6710 (R 05/91) Date Inspector's Signat a Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: =::qEH SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code couNTY , U STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than El 7~ 8% x 11 inches in size. Check rf r Sion to pre ous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPE O ER I ~ \A ).4 PROPERTY LOCATION L Mfm, D '/..S f' '/a, S T , N, R E (or) W PROPE TY OWNER'S MAILIAD RE LOT # ) BLOCK # ±5 " I I I NA i CI , ST T ZIP CODE PHO MBER SUBDIVISION I wCSM NUMBER b b fJ W 5 . ® .2/49 y p II. TYPE OF BUILDING: (Check one) F1 State Owned ❑ VILLLLAGE Sq, a NEAR ROiD_ 41 ❑ Public [%or 2 Fam. Dwelling-# of bedrooms 3- A Ax MB J III. BUILDING USE: (If building type is public, check Z11 that apply) 030CQ 00 S / O 00 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. ,Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] 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 ❑ Specity 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) £ QELEVATION 1 S® ' 0 16S G _14? ~ 3.7 1 I JFeet d Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concre a Con- Steel glass Plastic App Tanks Tanks ) c& structed Septic Tank or Holding Tank r jot o LZ I =PR~ F] Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Sign lure: (No Stamps MP/MPRSW No.: 1~Business Phone Number: ICU D Plum er s Address (Street, City, State, Zip Code) 110 t e N ~dJ o~ ~.S C- Q IX. CO /DEPARTMENT USE ONLY S Date Issue E uiZAnt lure No ❑ Disapproved S'tary Permit Fee (Includes Groundwater I L Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SB7 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_ansite..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. 11. 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. Vlll. 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, 'ocation of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/Hater 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. Owner of property a~~ ~ Location of propertyjt~Ll/4 S 1/4, Section, TN-Rj_j W Township Mailing address S:=~ Address of site Subdivision name G'IA Lot no. Other homes on property? yes No Previous owner of property b Total size of parcel ~9 Date parcel was created Are all corners and lot lines identifiable? bL- Yes No Is this property being developed for (spec house)? Yes Z,._No Volume ~a7Zand Page Number J,2 13 as recorded. with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, ;would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the 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 . 3894)96 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No. 38(-a 9,0 Signat e o a icant Co-applicant 4 Gf U Dat of Signature Dat of S'gnature ? r ti ,p X r- r ~ ~t• ,,s6~~ ~ _ 5 t -f i 4 py~y~ t } 4 'Trays ' .~t w.. ~y`,,~r ,.,fie,. ..~r,.j„~ • t ~ ' . t - tL •C•i. Z- 'Al tt «~'P1A • '!.7•IR.Yi~ 3~. .....ti 4. ^I r•'Mn M~{.r.._ ,y~,~,._. .L ,.:f _ w1Q kt~°iSJ► t~l~ # ..t a ~f7t1~MRNT,WA~-~iMAf'T~(7 BY ~ 4y 48~1m~~*ny~,~ ►c~,~~a: ~-.xF G„+N~iasiod :F~~~. 04t > a$-'.' "BC-_, ,;~+r' n'Yv„O^'S ~ :y. ..~i.-- pt. n y4. A'' SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER BUYER - v d~ ^c=yY GK~ ~ ADDRESS • 7 - ~07 FIRE NO: LOCATION: ~V 1/4, 5 1/4, SEC. TAN-R 1 1 W, TOWN OF: ST. CROIX COUNTY SUBDIVISION: NA LOT NO.~ Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system: St. Croix County residents may be eligible to receive a grant to help with the cost of the replacement of a failing system, which was in operation prior to July 1, 1978. St Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification from will be sent approximately 30 days prior to three year expiration. i I/WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system,in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: d I I DATE: I St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS • INDUSTRY, , DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISO N WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: OWN HIP NICIP LITY: LOT :BL SU"BSI S[ON NAME: 01 Y1014 -33/T-3-D N/R/9#(or 91- COUNTY: ER'S BUYER'S NAME: MAILING ADDRESS: Or TO 8 rte/ ) 1 ICJ Zee ~p,Jkk OS~/ USE DATES OB ER ATIONS MADE NO. BEDRMS.: COMM R L DESCRIPTION: PROF L D RIPTIONS: PER O ATI N TESTS: ep la/ 2, Z g [~~Residence ❑New ~~c ~3 RATING: S= Site suitable for system U= Site unsuitable for system C'EM S ❑NAL: IMOUNSD: ❑U IN'Xv PF-111 SYSTEM-1N FILLHO❑LDING~ANK: RECOM~ MEND SYSjiE tional) MU S If Percolation Tests are NOT required DESIGN RATE: 1 S' If any portion of the tested area is in the _71 under s. ILHR 83.09(5)(b), indicate: / ,3. 71 Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS R-Z' TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH DEPTHI*.. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ~~3 SS' 83 . k 3 5-A AJ-5 2,'~S .67 2s'es sjv'g...('rl4 V 5r , aS ~49 S" 3' s . LX gls/ 2. B-3 ,as , D > as B- B- B- PERCOLATION TESTS TEST DEPTH ATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 1481 E8 AFTERS WELLING INTERVAL-MIN. PER OD 1 PERIOD 2 PERLOV PER INCH P_ 3 4010- ~r 3p /s s s P_ Z r~ /y 2/~ l rp' 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 i 3 e s 7 , E I ' P 7 i.~.~.. € 1, t N 14 9'qt"o-.4 v'o b ~ 35 9,m i- '70 E E y- Q ~p ' rQ If¢' ~o~ '~oG Mag~ _j_tthe_jn lersigned, 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. NAMOErit,: J J TESTS WIRE/COMPLETED vr R COMPLETED ON: G/r ~2 HONE NUMBER (optional): ADDRESS: CER FI ATION NUMBER: 070 6dp 7 P3!~ e-3i CST S N T IjE, DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - .IONS FO O6' PLET"a`r FORM 115- SRI - " . To 1 a cc t.e So Yrau: repor inciode, 2. Ti se src,a indi< lei, " siderrce or carnmerc.ial project; 3, M ' I MU orrr erc Tined; 4. . 5, SITE IF '\BL.E FOR A HOI...DIN T NLY IF ALL 0' T BASED CAN '-1 L CONDITIONS; r. PLEASE use re re for writir j Profile descriptions and completing the plot plan; 7, MAKE A LE -'IF, y locating your test locations. Drawing to scale is preferred. A sr"e -at:e shy, 'T- 8, end aevation reference point are dearly shown, and are permanent; 9, r-i t, boxes to dates, names, addresses, flood plain data, percolation test exernp- ti 10, if the (such as flood elevation) does riot w place N.A. in the appropriate box; 11_ Sign ti I ice your Cr . ss and your cer 'i( :-ion dumber; 12. Make leg=1 rpies and distribu- required. ALL SOIL TESTS MUST BE FILED kPVITH THE LOCAL AUTHORITY WITHIN 3 DAMS OF COMPLETION, ~xEt/IATIONS FOR CERTIFIED SOIL TESTERS Soil S and Textures yrr bols sl - over 10") d 3edrock -1011) SS - &rndstone ;der 3") Lirnestoi - High r ter d - pe.-col, c W Well d - C gars ,sr°i Sl d GV Gray c y Ye l l ovi! R Red JO C;I 1 L Tricot - Mottles, sc - S<' ciy I ry vv/ Frith sic Silty Clay ff f' - few, fine faint c M cOmn°""p! min Many, m r rrr - ck d - distinct: p promine IA f'I! High traxtutes surlt sposol Ber"C' VP Veit, ~ (erence pornt 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. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the fp~P~,(, ~ rgACC 114N kJ residence located at: Iv 1/4, 1/4, Sec.-33_ , T30 N, R_I_LW, Town of SI ~OSf pit 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 Did flow back occur from absorption system? Yes_,No (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacurer (if known) : Wl y'R iz Age of Tank (if known) : V! J~~~J 117G / (Si ature) (Name) lease Print M A sfv rL P h u L 2 3yo (Title) (License Number) L(. -at -eForm 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). -11 -d Name J MVO M~ ~ Signature P/MPRS 3YO 5/88 . n B. L... 6 7 P L Cif N : i 0 SS S EC _f~ .~.~.1\1 N A, M i IV_I,_.MM ~~,.R C> az TT_ PLO - - - - o S eloi,'a 4"L •;MIA 'h ou_ s e Well } 5b' - rom sep~ ic, i $l✓~ -fop c~'✓e1Nt Cato E! = /oO.o © ore ko ie S i te5 ' )C P~~C hole S i •~e 5 Q J ~ 13 Al i n 70 -from V 6 C d __?S IL- k of ffie f,•A/e o-E si~ /Ue 5 ps4tw 15 ~_rom old sr km f r - ! -to meef max C._vvel^ re u,U.,n /.v 'of- ex,Cta rorik m,s De added- Lwder O f Sys v areas Bev d~ ^iusf be eL ADWIJ " _ \1P', r c3 VI~ ~ ___,_FRESH AIf INLETS AND OBSERVATION PIPE IRA Approved Vent Cap Minimum 12" Above Final ,r;gde \ 1-- 4" Cast Iron Above Pipe Vent Pipe To Final Grady Marsh tlay Or Synthetic Covering Min. 2" Aggregl-11 o _ Over Pipe Distribut-io~~ Tee Pipe Ell Aggregate Perforated Pipe Celow . Beneath Pipe -e Coupling Terminating r Bottom of System REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1 09/10792 07:56 REQUESTS FOR INSPECTION WORK SHEETS FOR: 9/10/92 AREA: MJ Activity: A9200334 9/10/92 Type: CONVSEPT Status: PENDING Constr: Address: ST. JOSEPH 33.30.19.368B1, NE,SE, LOT 1, 125TH LANE Parcel: 030-2005-10-000 Occ: Use: Description: 175675 Applicant: WARD, PATRICK & MARILYN Phone: LYN Phone: Owner: WARD, PATRICK & MARI Contractor: BOUMEESTER, JIM Phone: 386-9020 Inspection Request Information..... Requestor: BOUMEESTER, JIM q.,jd Phone: Req Time: 09:09 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION AS BUILT SANITARY SYSTEM REPORT f W OWNEF, (4 01- e, /t/ TOWNSHIP SEC. S T 0 N R P,0 ARESS ST. CROIX COUNTY, WISCOTN. U ~aT j '3 tit SUBDIVISION LOT LOT SIZE PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM { uu S E OeOIA~ R } , q q i { SEPTIC TANK(S)MFGR. l4e K 5.. CONCRETE STEEL u NO. of rings on cover Depth DRY WELL 3 TRENCHES NO. of width length area BED no. of lines fl, width length area dept to top of pipe 1011 AGGREGATE CX PERK RATE AREA REQUIRED AREA AS BUILT Disclaimer: The inspection of this system by St. Croix County does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction: St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to + determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. _'INSPECTO DATED - PLUMBER ON JOB LICENSE NUMBER i 1 . {_REPORT OF IT1SI!rCTIO'1--Ii1DIJ1PUAL SE14AGE DISPOSM., SYSTEM - - h o Sanitary Permit r State Septic "A:IE TOW11SHIP t. Croix County SEPTIC TA"K. :size r)-t,rn gallons. `lumber of Coripartments Distance From: Well ;P(ft.g 12% or greater slope r Building _Lft{ Wetlands f- Righwater r-- ft. DISPOSAL SYSTL:1 Tile Field or Seepage Pit(s) Distance From: 'Tell ft. 12% or greater slope ----ft 2 ` Building -t. Wetlands 31- f FIELD / `rllighwater ft. Total length of lines /C d ft. Number of lines Length of each line d7ft. Distance between lines ft. Width of the trench ft. Total absorption area e) sq, ft. Depth of rock below tile in. Dp-pth of rock over tile Z~ in. Cover ..,over.rock, Depth of tile below grade in. Slope of trench -in per 100 ft. Depth to Bedrock ft. Depth to .,round water ft. PITS Number of pits Vd.; dle diameter ft. Depth below inlet ft. Gravel a-r_yes no. Total absorption area sq. ft. Square feet of seepage trench bottom area required ::guars feet of ~seepa ar quired Inspected biy • Title*: Approved l~ Date G 197„. Rejected Date 197. • l z= EH-5 '11'1 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH • P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS- LOCATION Section N, R, (or W wnship or Municipality Lot No. Block No. ~d County Subdivision Name Owner's Name: ` s-0/-W Mailing Address: gA4 TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ~x ADDITION REPLACEMENT _7 PERCOLATION TESTS DATES OBSERVATIONS MADE: SOILBORINGS 6 O - e ~d SOIL MAP SHEET SOIL TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE 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- tZI 1 Sea ~ ~ ~ 14 27 P Ct~y & er ~ R 7 !~O ~O l~ I ~a 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) y~.. "`4L- x'40' 6 ~Pe 7-5, SiX 6c- y Ak.14a- _16er r-r/ S 3-C - ~76 r4 B- Y_ 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 n mb o quare feet of absorption area needed for building type and occupancy. 12,1 0 d>J < Zncate scalor distances. Give horizontal and vertical referent oin o slope. Ale vlc~ 00, l k,. / G 117 Z000" IN 0 e ~ ~S 17 oLZ ri t O t D ~ 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 location of test holes are correct to the best of my knowledge and be ief. Certification No. ~J 7 e pv istaller if known 1 LOCAL AUTHORITY CST Sigr r + ~ ae . Y s ~ ~~~a ~ ~ ~ 7 . ~ - T l _ ~ - ~ } ? ~ -J ~ ~ ~ ~ ~ ~ ~ I ~ ~ ~ _ - ~ i ~ 4: d f ~ ~ ~ - . t _ ._a _ ~ ~ - - ~ s • State and County State Permit # Q PLB67 Permit Application County Permi 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: ar ry uds 40/k S)oW46 B. LOCATION: Y4 '/a, Section T _30N, R f JP (or) ot# City _ Subdivision Name, nearest road, lake or landmark Blk# Village Township , C. TYPE OF OCCUPANCY: Commercial Industrial Other (specify) *Variance Single family X Duplex No. of Bedrooms No. of Persons Z D. TYPE OF APPLIANCES: Dishwasher _X_ YES NO Food Waste Grinder YESCNO # of Bathrooms-,2.e- Automatic Washer _/1,_YES NO Other (specify) E. SEPTIC TANK CAPACITY /00c!3 Total gallons No. of tanks / *Holding tank capacity Total gallons No. of tanks New Installation x Addition- Replacement- Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1)."2)_/v3) _QTotal Absorb Area 2 s, f . Newx Addition Replacement *Fill System i Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length 4Or7-# Width z , Depth Tile Depth 6" No. of Lines _V y„ Seepage Pit: Inside diam ter Liquid Depth Tile Size Percent slope of land 0 e- &/.400 °C_ Dis ance from critical s pe S~~ A.. a .r 'co Apr 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 C ified Soil ester NAME ,i& ti1'~ba. C.S.T. and other information obtained from owner Plumber's Signature MP/MPRSW# Phone #gla - ZS(~ Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). +f-- t4 A-ep D y ~ _ 1 \~tt~,`~eraf Do Not Write in Sp3(cla *e) FOR DEPARTMENT USE ONLY Date of Application QFee Paid: State G'iQ C u t a~` to~~ ~o Permit Issued/mod l C~ 8 Issuing Agent Name Inspection Yes No Valid* Date Recd 1. county (w 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 t i ~ ~ . r ~ -'3 r, .,,t ~ . ~ i l -.,..tea. . _ ! i ~ t v' - f 1 ~ ~ • ~ _ - p 'ter T ~ a t s.~ ~ .I ~ _ y ' 1. L _ _ . ~ ~ i1 :1 ! . , s _ _ _ . _ _ . _ - I Parcel 030-2005-10-000 03/24/2005 09:19 AM PAGE 1 OF 1 Alt. Parcel M 33.30.19.36861 030 - TOWN OF SAINT JOSEPH Current XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * WARD, PATRICK & MARILYN PATRICK & MARILYN WARD 597 125TH LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 597 125TH LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 4.988 Plat: N/A-NOT AVAILABLE SEC 33 T30N R19W NE SE LOT 1 OF CSM Block/Condo Bldg: 1/210 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2004 SUMMARY Bill Fair Market Value: Assessed with: 5708 336,700 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.990 129,000 202,200 331,200 NO Totals for 2004: General Property 4.990 129,000 202,200 331,2000 Woodland 0.000 0 Totals for 2003: General Property 4.990 76,000 139,100 215,1000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 222 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges 00 Total 0.00 0.00 33124 71 LRO SURVEY'331214 CERTIFIED SURVEY MAP I, Arthur L. Wegerer, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St.Croix County U Subdivision Ordinanee and under the direction of Floyd Nestrud, 0 0- owner of said land, I have surveyed, divided, and mapped said parcel Lu of land, that such plat correctly represents all exterior boundaries 8 N and the subdivision of the land surveyed; and that this land is 0 located in the NE4 of the SE4 of Section 33, T 30 N, R 19 W, Town J of St.Joseph, St.Croix County, Wisconsin, to-wit: 0 > o Commencing at the Southeast corner of Section 33; thence 0 c"! N 1°31134" E along the Section line 1327.851.; thence N 87°19'39" W -5 a°`. 10 41.26, to the point of beginning; thence continuing N 87°1913911 W to Q = 426.521 (recorded as West 426.121); thence N 0°36113" W 1203.051 0 (recorded as Northerly 1233.91);to the Southerly line of the Town <t Road; thence Southeasterly 868.631 along the arc of a 768.511 radius 5 `E Lu curve which is concave Southwesterly and whose long chord bears 0 S 30°32143" E 823.121; thence S 8802812611 E-8.751; thence j 0 S 01°3113411 W 513.93' to the point of beginning. • w Contains 9.976 acres of land. Dated this 20th. day of November, 1975. yo Arthur L. Weg rer CSC . ~ ' • Wis. R.L.S. No. S-963 0 IVS~ ,o`' i *0 to N ' C ARTHUR L ? z 3Z WEOGQER w ]0 • • CURVE DATA y ELLSWORTH o S `a'cJ- 2 = 64045'36 WIS. W v> LO It R = 768.51' 0'•. ~o•••......••'Q v 9691 SUR`11y,, y< ~ t9 M0 ARC= 868.63 TAN = 487.34 tl. 0 r N T • Um U 2 LOT I 4.988 ACRES 4 • S 88°28'26" E 8.75' ?i S 89-48'14" E 331214 I , 425.118 y~Z OP M M N ~ j 0 ~ I a3 M 50': F+ D SCALE. I"= 200E L9 0 171 O = I" X 24" IRON PIPE JAN 2219" Z , ^,T, 2 ,0 o,t WEIGHING 1.13 LBS. L~.ILJ ; y w e o, PER LINEAL FOOT • 4.8 ACRES M .0 • ~1 Who"i~ 0= FOUND IRON PIPE rn6 e o 00 s~, ' N 87019'39" W 426.52' ~3 N 41.26' N 87° 1939° W • QI -*:-N 1°31'34° E 1327.85' t COUNTY SURVEYOR'S MONUMENT Volume 1 Page 210 SET AT SE CORNER OF SEC. 33, T 30 N, R19 W