Loading...
HomeMy WebLinkAbout030-2083-70-000 0 3 c) a o op ~ ~ I rO I. N I ~ I ~ I I ~ I m ~ I I I ~ I v z c LL c C ~ O ~ a a I'' y M I ~ N W E 00 E p z l a m o M US o o z d c o m 2 d c z '2 .a ~ M I N N N i~ O O O ' p m O j o a z CO z N N co z ~°0 d co ° `6 E N 0. r w Y c O O N, N O O O N LO G G a j c N fn fR ;9 N z o 0 CL IL CL E ° N N N N 7 o m 11a v~ U } a, rn L) 0 E o CL ° M m d N (n N a) ° NN N N r.+ O O N N C C ~O O p 0 F- 0 N C y U d 00 O M 0) CL N a) E (AS N_ N 0) 0 CO 0) r_ a) r M N O O C LO 0 N 'O a) 2 H G ~ . M CO ao ° y ° E ° ►~1 O M N CO o co in o z_ z= cn O R I E £ L m °ixt I EL a a • c d .2 d c E i c c o C~/1~ cr ° ca :3 ; m O ~ D U a 0 in 0 05/16/2007 08:16 AM Parcel 030-2083-70-000 PAGE 1 OF 1 Alt. Parcel M 36.30.20.710 030 - 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 - WAGNER, ROBERT J & DIANA ROBERT J & DIANA WAGNER 247 RED PINE CIR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 247 RED PINE CIR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.990 Plat: 2323-PINE TREE MEADOWS SEC 36 T30N R20W PINE TREE MEADOWS LOT 7 Block/Condo Bldg: LOT 7 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 36-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 537/403 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 i Valuations: Last Changed: 07/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.990 75,400 128,700 204,100 NO Totals for 2007: General Property 2.990 75,400 128,700 204,100 Woodland 0.000 0 0 Totals for 2006: General Property 2.990 75,400 128,700 204,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 212 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Industry, "bor ark Human Relation SOIL AND SITE EVALUATION REPORT Page of 3 s Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but -S-T C& I not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PAR L I. D. # dimensioned, north arrow, and location and distance to nearest road. 0 3' 7&-Cot) APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY O ER: PROPERTY LOCATION 1 'n Q 8 _T ~d -CiAV~6T 5&J 1/4 S~ 1/4,Sj 30 N,R E (or) W PROPERTY 0 NE,':S ILING ADDRESS # BLOCK # SUBD. NAME OR # Z-rirqc t ke- '"-0 CITY, MUL;M)lj E I Zip CODE PHONE NUMBER ITY ❑VILLAGE MOWN NEAREST ROAD N c ) 5, JoSC'6J4 Is S -r 14 3S ew onstruc Use Residential / Number of bedrooms [ ]Addition to existing building Replacement [ ] Public or commercial describe C derived daily flo Sa gpd Recommended design loading rate 0 • S bed, gpd/ft2 _Q& trench, gpd/ft2 Absorption are wired bed, ft2 trench, ft2 Maximum design loading rate CO-bed, gpd$O 1 trench, gpd/ft2 Recommended infiltration surface elevation(s) 9 1, -7 O It (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT- RADE SYSTEM IN FILL HOLDING T K U= Unsuitable fors stem 0S ❑ U l~] S❑ U S0 U S❑ U 14S ❑ U El S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bourtda~y Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch Kk' [ 'x z' /o 3 1 - S j L 1 m a 6>~ rti 1 C Z 4.2 •3 $ Z 4z iovte4 6 -c~,~ 1 I oa o.$ Ground Z -R9 /OYR 4/4 X15 A, Ct elev. q(,.66 ft. MS O.S Depth to $ -r~ ~n T $Z L~ y limiting factor Remarks: Boring # 168 9 10 S; L I ab >~t 1~r l 4.2 0.3 41. 1 0. 7 61 z $ ~o' o >Q 3 Ground B~. 6,14e m 3 r ~ C o.~ 110% 0, ci> bvke ft. 96,3t; Depth to . limiting ° Zn$p © (3. factor > 5s.1 ND)m OS 166A4 S T~ifsoU6No g' Lavk-2 Remarks: CST Name:-Please Print / dQy yJ6grjsa"j Phone: -3-a 6 _ 4o&-6 Address: il p5a." VJ1 -S40 f 6 Signature: Date: 'I 9 CST Number: 0 CI) r PROPERT1f.OWNER ~a$F2TW'A~N SOIL DESCRIPTION REPORT Page 'Z of 3 PARCEL I.D. # Boring # Hodion Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer& Mp:.i::•: r . ? 6 s l c~ 0.7 62T Ground elev. ,6f ft. Sir- Q Q.S O•~ Depth to -i'{1 ~2bc~ N UT l+dY~ limiting factor >L Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # • Div m{v'4'i{ti•::•:: Ground elev. ft. Depth to ' limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) { I ~OgE.~' lJ~i14N1~`R II P~~t 3 0V 3 w 2 T M ~~.FO~If Ca~)ST ~C1cTlOv~/ 'N M Boa $AAKu M>4,kIL -To,P 6^t fDW~k ~6 STbl. \ t y N a [J►J Ldp L 1 nJ L . ~ A -2 J O ^^^^AA'C_ t ff~ A ANdILABLc IN N~EQ , \ \ n SC/4Lr-' 20V DD \ 1i ~ v Ap- A c►15. oa f. Wisco in Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 3 s Labord Human Relations Divisiodof Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but -S`T' t not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY 79&kT R : W d PROPERTY LOCATION U -88 4-L T 5W 1/4 5l~ 1/4,S?6 T 30 N,R I /OE (or) W PROPERTY O NEF':S 4AI LING ADDRESS LOT BLOCK # SUBD. NAME OR CSM # , CITY, ST TE ZI CODE PHONE NUMBER [3CITY EIVILLAGE XtOWN NEAREST ROAD ction Use W] Residential / Number of bedrooms 3 [ ] Addition to existing building PXA Replacement [ J Public or commercial describe IAJ Co aily 04-50_ gpd Recommended design loading rate Q. S bed, gpd/ft2 a•6 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate gpd/ft20 1 trench, gpd/ft2 Recommended infiltration surface elevation(s) 9/.-70 ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable It S = Suitable for system CO VENTIONAL MOUND IN-GROUND PRESSURE AT-,GRADE SYSTEM IN FILL HOLDING T K U= Unsuitable fors stem S O U co S❑ U 1~r S ❑ U S❑ U J~ S O U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerch S y L I rrf a b>; r►~ ~ C 4.2 • zz /o l 3 I Z 3 z' 4Z la >e4 6 In, q,) 01 03 Ground 12" /OYQ b 15 Q 4•~ 0•~ elev. eft. hZ"$a /d +,3 Z MS n, Y- p.S fl Depth to limiting factor > g .zS' A moo Remarks: Boring # A n-jb" /68 1 0-7 10 $ fo~-Z3 0 >e 3 . JOY4 0, $5 el, Ground pp elev. D 2= /b` _ MS CP- ln-~ 1 O: fJ, . 93L ft. Depth to . limiting -Zh$A b` Z Ms factor > X12 Nun us $a>,I S `~;>'ou~No r g Lavin 2 Remarks: CST Name:-Please Pont 144'e V y36+4"1sa►-j Phone: _ 4oFs-6 Address: Jtom/, `;go16 o Signature: Date:'I 119 CST Number: JPROPEICOWNER f~a$F~'rW'~`~NL SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D. # G Boring # Horiion Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots P D/ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Tn ~3 3 - S L I 4 bK n, C z p.z .3 OL 0.7 A Ground e, 61 ft. o s A Depth to "I'~1~2Oc~V N UT L~dYI+ limiting factor >7 33 Remarks: Boring # iQ nAv:.; h:. nA~4 ' Ground elev. ft. Depth to limiting factor Remarks: Boring # v : r Ground elev. ft. Depth to ' limiting factor Remarks: Boring # n g Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) ti ,j KOgE.~' ~A4Nl~R PAGt 3 og c.l W T t°.d M g~Fa~lf ~NST t,(.fcTlOv~l `N M $ uMalkL--T&P \ Q pS foW~~ T"~a66STWl. ` O r f L. q J G~►J LoT L I V j F-LEJATI6t.1= rdo,OC~" w St \ \ ~n = J J ~ Q V` 2 V AVAILABLE !N N&A. V Sc.ALC I 20' r' \ a1 \ Y-r, J vi 6Ak,A Y' 3 IYQC&TXQ#;rtrrr$T'tof IjQ4PH 36.30.?W V1&,SEWAbt SYSTEM RED PI Count Y Labor and Human Relations INSPECTION REPORT Safety and~uildings Division ST. CROIX (ATTACH TO PERMIT) SanitaryPermitNo.: GENERALwNFORMATION 86525 Permit Holder's Name: ❑ City ❑ Village ❑xTown of: State Plan ID No.: JOSEPH P Insp. BM Elev.: BM Description: Parcel Tax No.: 030-2083-70- TANK INFORMATION ELEVATION DATA A9200409 / 9 Z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. SepticC-x, Benchmark 0 "y I/ Dosi ng Aeration Bldg. Sewer [Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet tto TANK TO P / L WELL BLDG. gein take ROAD Dt Inlet 91,171 Septic NA Dt Bottom / Dosing NA Header H64a"- ~7 Aerati NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade , 21 Manufacturer Ga-1, dJ Demand Model Number GPM TDH Lift Friction Syestem TDH Ft Forcemain Length Dia. FDist.Towell > r SOIL ABSORPTION SYSTEM BED /TRENCH Width Length ? No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS s) S0 DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O , CHAMBER Mode Number: System:, /l6 , 2-~~ OR UNIT DISTRIBUTION SYSTEM Header / 11Aa ei4elcl r Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing -4- SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center $ Bed /Trench Edges S ' Topsoil ❑ Yes ❑ N ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 36.30. 0.710,SW,SrE, LOT 7, RED PINE TRAIL ' © f 4-,'' r~ t~ - -ems ee- -aJ;`15 c~-~ 0o Plan revision required? es No Use other side for additional information. g2 \ y ly f 9 SBD-6710 (R 05/91) Date Inspector's Signature ll, Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: • SANITARY PERMIT APPLICATION couNTY DILHR In accord with ILHR 83.05, Wis. Adm. Code I...e....~.4( 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. Ch rreti-to~pr v a, 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 e p- <1W Y4, S 3 T.3d, N, R /91 E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBD SIQN NAM R fd N11 11. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ❑ State Owned O VI ;QWN VILLAGE ~eS'~ gad ar c f e 7N-/ o-, ❑ Public 19 1 or 2 Fam. Dwelling-#~ of bedrooms ~ PARCEL TAX . NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) Q 3-0 ~ ;?d F3 , '76- 1 m ❑ 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. El 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 Q Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3, ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE ~r REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Main.//inch) V ELEVATION 5 v Dd Feet S'•2- Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION -New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank F1 Q F1 Lift Pump Tank/Si hon Chamber El I El F1 VIB. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system sho on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP PRSW No.: Business Phone Number: GJe M "a *r. S 3 ~s' -3d / a Plumber's Address (Street, City, State, Zip Code: ~ a IX. COUNTY/DEPARTMENT U ,%E ONLY ❑ Disapproved Sanitary Permit Fee (Include, Groundwater Date Issued Issuing Agent Sign No Stamps) Approved ❑ Owner Given Initial _ Surcharge Fee) LIN Adverse Determination 1 11-16 "Gil X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/86) DISTRIBUTION: Original to County, One Copy To: Safety 8, 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 s 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 sewage system, contact your local code administrator or the State of=-Wlsconsjn,_8~fety & Buildings D)v siRn,;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. 111. 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 informatioh. 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'f 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. GRO1.1114 WATE bURCHARGE 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 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 ' G✓o Location of property s~ -CC1/4, , Section -Ye, T d4 N-R W Township S7` Mailing address r Z=Z-P 1-,-A ge ~Vaw fJ/~ Address of site Subdivision name .ri Lot no. Other homes on property? yes No Previous owner of property ff ,c3 A, 4~7r/r` cs 7`e Total size of parcel r-'? Z e- e "--e s Date parcel was created Are all corners and lot lines identifiable? K Yes No Is this property being developed for (spec house)? Yes ~No Volumed 37 and Page Number 43 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. , 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. 333 i!7 1 Cl Signature of applicant Co-applicant -9Z Date of Signature Date of Signature I II 1 • r IT, " t ' _ . ~ rt.~'~`°6`.w"~i~F t~ ._.,+~,3~F!'c"•9S+'~'1nIfA~`F ! 'i' mew, lk a ~ ~ ~ ~ -}sue w _ 40 t ArNo. . z s 40 oar w. •Wws~p. .yew ~'4,. _4 rM vJ SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County n OWNER/BUYER ROUTE/BOX NUMBER Number d l ZIP a C? S fD CITY/ STATE PROPERTY LOCATION k Section, T-9d N. R_ Town of St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Proper maintenance con- sists of pumping out the septic tank every three years sooner, if needed, by a licensed''s'e' tic tank um per. What you put into the system can affect the function of t567-septic tank 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 60% of the cost.of replacement of a failing system, i whic was in operation prior to-July 1, 1978. St. Croix County that accepted this program in August ree to keep their system properly owners of all new systems g 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- less than 1/3 essary), the sepc~~iikbe is Certification form three year-expiration. y 0 I/WE, the undersigned have read the above requirements and agree 0 to maintain the private sewage disposal system in accordance with the standards set forth, herein, as.set by the Wisconsin Depart- ment Natural oStCeCroixeCountyaZoningoOfficetwithinm30edays and returned Co the of the three year expiration date. SIGNED i LLc Z,64 ~ - - DATE ~ St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. 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 d2.46.er zdaotwy-;-- residence located at: SGJ' 1/4,1/4, Sec. 3G' T_~?d N, R_1rW, Town of ST~osc Upon inspection, I certify that I have found the tank and bafflee, '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: l00-/- gallons minutes Capacity: Construction: Prefab Concrete-2~_-Steel Other Manufacurer (if known) : ,(/DL Age of Tank ( ifknown) : /Byrc•YS (Signature) J~ (Name) Please Print (Title) (Li dense 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/1lll`6c~,t .S'c~iaa:~yir Signature_ MPRS 5/88 C Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 3 Labor and Human Relations Division of Safety i Buildings in accord with ILHR 83.05, Wis. Adm. Code ' COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but -S-' ceol~ not Itmited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY 0 ER: f ~ PROPERTY LOCATION 19 -T WI -89++8T 5W 1/4 Sj~ 1/4,S?6 T 30 N,R E (or) W PROPERTY O NE5':S,AAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 2.0 'A' f i t P-c CITY, MUL_T6'1r,j E ZCODE PHONE NUMBER ❑CITY []VILLAGE VOWN NEAREST ROAD, t~ ( ) '5T _lOSZIPrd 5-; ~a 3S [ J New Construction Use ~J Residential / Number of bedrooms [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow Sv gpd Recommended design loading rate O • bed, gpd/ft2 0.6 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 3 . bed, gpd/00 trench, gpd/ft2 Recommended infiltration surface elevation(s) 7~, ?b ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CO VENTIONAL MOUND IN-GROUND PRESSURE AT- DE SYSTEM IN FILL HOLDING T K S❑ U ~ S El U SBA❑ U f~ S❑ U ❑ S U U=Unsuitable forsystem S O U Co SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tret'& tit4. \4' Ground Z"-~ /ayyQ ~►5 G 4.? 0.~ In . w) elev. d r p.S 9 6ft -2"$a /o ~3 Z MS Depth to s Tti >Z~ a T D~ ~-j° limiting factor >~,zs Remarks: Boring # 1 0. 7 163 B~ 42° O Y4 314 MS 0,$5 rh C I O.? 0% Ground elev. 2'- byko 1A d: o. 9LA ft. Depth to limiting '-z"SA /b` I~ Z !h5 yA r factor n ~ =-7 NUM U$ $-AQ S `n4eouGNO t >b' LA e Remarks: CST Name:-Please Print Phone: _ ^o g-6 Address: V ~gol6 Signature: Date: /I A0 CST Number: ~`C O T PROPERTYOWNER ~o$TW'~``N SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D. # Boring # Depth Dominant Color Mottles Texture Structure Consistence Baxxfary Roots GPD/ft HBriion in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench W--,-> -7 4 0' J hK n, C z 0.2 .3 /6y?l 0. CM .0,7 Ground elev. S CK'6 ft. 2'~° y~e Z s r 0~ o o• Depth to -VA X2606 N UT limiting factor >7 33 Remarks: Boring # -No Ground elev. ft. Depth to limiting factor Remarks: Boring # k Ground elev. ft. Depth to ' limiting factor Remarks: Boring # IM'-, SWIM'-, Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) Roger l~Ac,NK`R PA4t 3 og 3 w T 40 Cv- . *1 g~~l~ ~~ST ~L1cT10►~1 mop $L-,Ku MAR L -T&P a CAS row~~ T"6~STwL ~ ` ~y N r 1 c►J L -T L I n1 L. q 2 lobo AVd1LA8LC S~dLe 1 Zo' Y-t `V1 ~ \ O of N J V \1 vi Ile TFP/~ jG0 fro t✓ X6-0 01 Ba- t Iii I 7e r REPT131 st. joseph ST. CROIX COUNTY ZONING PAGE 1 11/19/92 10:21 REQUESTS FOR INSPECTION WORK SHEETS FOR: 11/19/92 AREA: JT Activity: A9200409 11/19/92 Type: CONVSEPT Status: PENDING Constr: ,Addrbss: ST. JOSEPH 36.30.20.710,SW,SE, LOT 7, RED PINE TRAIL Parcel: 030-2083-70-000 Occ: Use: Description: 186525 Applicant: WAGNER, ROBERT J & DIANA Phone: Owner: WAGNER, ROBERT J & DIANA Phone: Contractor: SCHUMACHER WILLIAM C. Phone: 386-3121 Inspection Request Information..... Requestor: wm. schumaker Phone: Req Time: 09:11 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Itpcn: 00012 FINAL INSPECTION