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HomeMy WebLinkAbout030-2027-90-000 \ o ) 0 §j & * to , \ 0 Sn tn 220 k k 20 o=amp �3= ©< § -°$ 0)2 ; \ /kE 2o0 2.0 0au .0 $® 0 U) %"t . 2_ >cj $ 5CD.2U) 0 (D —@ -© z 6 2-a :2 � m �5§22fo _ % cc s0� o o'D .2 D 0U) i < =or_ o� ( I § ° � z C'4 \ ® k � _ k q / \ IL w . � \ 2 :T 2 t $ § 2 w ® 0 E E % M CD CL . @ ' o 2 / E ' f $ f 7 § z / z 0 0 k «C) c G N # § a 6 \ C e k k kT 2 » _ £ § a a = @ O p p 2 t z C, > 0 ■ » ■ CL ® 0 2 2 2 IL \ . k k zz z = S § 2 V a d \ w© 0 0 0 0 @ 2 = \ E / q / 2 \ / k CD @ § \ 2 % k < ƒ f 2 0 04 , 2 S 8 # / £ 0 E 9 u ° ® © � - 2 0 « e % C C a $ 8 3 3 3 k k ® E E E a rz e e % $ o � o s ¥ £ o o c 3 m U § 0 2 R § w & 6 f 2 § 7 a a a _ cl -� § q / \ 0 z $ i i / ■ � § (L % - a # \ E k 2 § c U C 0 2 � Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 3 of 3 Labimand Kaman Relations Division of Safety & 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 St. Croix 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. 03o_, ~0c~-go-6 6~ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REy48WE`6~ DATE 2-x- 7 PROPERTY OWNER: PROPERTY LOCATION Robert Nelg Boege • l6yylv~o GOVT. LOT NN 1/4 SW 1/4,S 22 130 N,R20 XF(or) W PROPERTY OWNER':S MALLUG-ADDIIESS T BLOCK # SUBD. NAME OR CSM # 0 Rice Creek Paris ta-Z- LO I n/a n/a 10T C5✓y a CITY, STATE lp COpE PHONE NUMBER ❑CI ❑VILLAGE 99OWN NEAREST ROAD Prl-dlev NN.543Z ( ~i/a „t. Joseph HY. 435-64 :]Repla0eament w Copstructi Use[ ] Residential/ Number of bedrooms 4-5 At= on to ~cisting building [ ] Public or commercial describe/ -n r~ aily flow 600-IVd Recommended design loading rate • 7 bed, gpd/ft2 trench, gpd/ft2 Absorption area required857+ bed, ft2 750+ trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 94.74 (as referre to ite plan benchmark) Additional design / site considerations Parent material oi,twash Flood plain elevation, if ap cable n/a ft d Ir [ct S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem tg S ❑ U @)6 ❑ U AR S ❑ U US ❑ U ❑ S faU ❑ S au SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tre & 1 0-8 10 r3 none sl. 1/m/gr. mvfr c/s 2/m .4 .5 2 8-26 7.5yr4/4 none sl 1/m/gr mvfr c/s 1/m .4 .5 Ground 3 26-86 7 5yr3/4 none Is. 01sg ml n/a n/a .7 .8 elev. 98.50 ft. / Depth to 4 Q Q d crC~cfQ, limiting factor _~&ft Remarks: Boring # 1 0-9 10yr3/3 none ST. 1/m/gr mvf_r c/s 2/m .4 .5 7 2 9-27 7.5yr4/4 none S1. 1/m/gr mvfr c/s 1/m .4 .5 Ground: 3 27-80 7.5 r3/4 none Is. O.sg ml t y a .7 .8 elev. 97. 74ft. Depth to r / limiting z factor 180 m. Remarks: CST Name: Please Print P~r 5 e' -246-"6Z(lt? Address: 1554 20 . Ave. New i.chmond, WI. 54017 Signature` Date: T Number: 1. -4-92. 22W PROPERTY OWNER SOIL DESCRIPTION REPORT Page Hof PARCEL I.D. # ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxiay Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends Ground elev. ft. Depth to limiting factor I --T Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) c fi 10 0OZ9-9t,Z (9W t,9ZE-MS8dW LLOb9 IM `Puouay3Ia MON 96ZZ '1'S'0 anlaa aao4S 'N 996 laaIS '7 djbJ 3JIAH9S "IIOS St.1991S X'3m TF Iw eC4, S,6 U- C-5_,-(1 < o / Nrr ru s'y S7>* ti ccJ c'ov s T,~° v c 7 ro.✓ ~ Safety Buiturngs Division Wisconsin Urpartment of Industry, SOIL DESLMPTION REPORT P. o. dot o 7969 Labor ano tiurltan Relati" (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Madison, WI 53707 JCS Page of ustOmer Name i Evaluation Dail _Currant Lan Use or Vegetative Cover Parent Mataru Is sr ~tiE~ P » v RoBCAeTf Mph y /s y z -flood ' u►tomer ass sumac a owat roc watts a!n tva►wn 2.90 z > 1rb T s _ . `pO e n „ A J' oyoty as Np system Lo• my a rn • one Ptr q. t.. r Day k toe less tsu,pUOn xO 7GWiw! 0 ysttm eantuy an Depth 2- ~ ~u 0 a , e.4 S k NC Sw, SILG • -a.z Tao a . R sr XVS PH" Horizon Depth .Dominant Color Mottles Structure Remarks: clayskins Loading In. M nsell u. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Bounds ores 1~ i, and other GPDJh.= 01-1- Is Y4 3/.7- t Cs - 19. /j-;.o 7, S' Ve 21~1 2e 214 to/ W Structure `V Remarks: clayskins loading Horizon Depth Domirpnt Color Mottles In. Mun ell u. Sr. Cont. Color Texture Gr. St. Sh. Consistence Roots Bounder ores Hand other GPO/h.) 7.S 41n_e j I2 /uf G S ' Y f3` o-~S 7S t/ 31 C ~Sy00 JS ,Q~ 4 / ~ 1 I t s I s. s 3 1Y • k, . _ , Loading Horizon Depth Dominant Color Mottles - - - Structure Remarks: clayskins In. Mu ell u. St. Cont. Color Texture Gr. St. Sit. Consistence Roots Bounds pores, pH, and other GPDlh.2 r3 7-32- 7 sy,~ J/ s/ ~ft ae 0 Z,e- r , i 9 eel 0'er. (0 Is test ite APPROVED f r a QnVent nal septic sys ern, Horizon Depth Dominant Color Mottles - - Structure v- - Remarks: clayskins Loading In. M nsell u. St. Cont. Color r/51- Gr. St. Sh. Consistence Roots Bounds ores H and other _GPD110 o- 7sye 34~ 2 z 4-s e-oexey 01 3 7sye 3/y , ~rz 2 0-5, 7-s, ye I/Ay D 135, _ nanteolor MDWes Structure - Remarks: clayskins ! Loading N Horizon Defiljlo_m Innsell u. Sr. Cont. Color Texture Gr. St. Sh. Consistence Roots Boundary ores liand other GPO/ft.z ' ( a I HOM[SIX SEPTIC PLUMBING CO. 651 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULDRIGHT e s 7- , JIS. MASTS P 41ER LIC. NO. 3307 APA6. I moo' ~ , s/ 51 13.n~ ri ti CIO -7ffo-7-40 7- 4o r- Z w IS, o ,Y r ~j (9 1 i 1 t ~t ` "1 07/13/2007 09:01 AM ParceI#• 030-2027-80-000 PAGE 10F1 Alt. Parcel 22.30.20.439K 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 - COLOMBO, BRIAN D BRIAN D COLOMBO 1424 MAIN ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1424 HWY 35/64 SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.840 Plat: N/A-NOT AVAILABLE SEC 22 T30N R20W PT GL 3 BEING LOT 1 OF Block/Condo Bldg: CSM 9/2550 ALSO THAT PT OF LOT 2 CSM 9/2550 DESC AS COM SE COR LOT 1 CSM Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 9/2552; TH N 88 DEG W 87.5'-POB TH S 45 22-30N-20W DEG E 58.43'; TH N 88 DEG W 89.39'; TH N 79 DEG W 94.4'; TH N 02 DEG W 24.51'; TH more... Notes: Parcel History: Date Doc # Vol/Page Type 03/12/2001 640258 1600/30 QC 03/12/2001 640257 1600/28 WD 12/26/1997 570392 1284/531 LC 12/26/1997 570391 1284/529 QC more... 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.840 261,600 131,200 392,800 NO Totals for 2007: General Property 2.840 261,600 131,200 392,800 Woodland 0.000 0 0 Totals for 2006: General Property 2.840 261,600 131,200 392,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 030-2027-90-000 06/20/2005 11:57 AM PAGE 1 OF 1 Alt. Parcel 22.30.20.439L 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 * DOVE, TIMOTHY & JUDITH A TIMOTHY & JUDITH A DOVE 1422 MAIN ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ` 1422 HWY 35/64 SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 4.000 Plat: N/A-NOT AVAILABLE SEC 22 T30N R20W PT GL 3&4 BEING LOT 2 Block/Condo Bldg: OF CSM 9/2550 EXC PT TO PARCEL DESC IN 1014/59 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 11/08/2000 633277 1557/540 WD 07/23/1997 WD 07123/1997 975/631 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/09/2004 Description Class Acres Land mprove Total State Reason RESIDENTIAL G1 4.000 384,400 563,100 947,500 NO Totals for 2005: General Property 4.000 384,400 563,100 947,500 Woodland 0.000 0 0 Totals for 2004: General Property 4.000 384,400 563,100 947,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 543 Specials: User Special Code Category Amount I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 /o/Pi E'r1 L _ _ _ cs~► LoT C',t1D:~,tTio.v ~'Z ~S?~T~ ~U~'~i~S~ ~ PE•v0~,~~ TEsT >or}~'E/ a✓`"~lu sys r~ ~ rv£ w ~o,~ s T~ ~ c ~ao,~ Buhuings Division Wisconsin Department of Industry, SOIL DESILKIPTION REPORT Safe, y 6ox 7969 Labor and Human Relatiprts Madison, 96 53707 (Attach Soil Profile Location Ma- To Scala e - On A Separate, Signed Sheet) / /3 Y -;K 11 ~C S 3'3 GP - ",10F/ ,D 7- Page of Z _ - wtomer Name Soil vo cation ate urrent lan Use or Vegetative over Parent Matena s S 00 7'&/,4 S /yfJ D yPAveA-7- RiTTtO HOEGZ-- 1"my !S - 2- 984AIDD 4 Estimated a Shallowest rou water P am evatron u m~Q r~/ GE CiP if' /W%S fiel Ple' /~1N . $S y3 2 V. 7- an ara ystem loa my tom a ns Per q. Ft., Per ay I county NO. P .9 Z - 02- l-Uff,Oy~ 0/= yu em eometry a Di ti0 a Tocu,,. l6 Lotlega Descnpuon ' M s ,S~v, SQC . z 2 T 3 6 A) , F 24 cv . vT Jos"hF- ,5 X'P- Horizon Depth Dominant Color Mottles Structure Remarks: clayskins Loading In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots I Bounda ~o~ GPD`n 24 C D' cl(i to ye G~ - S d C~ S / / co S ,7J/ 14 ~p ~ ~ 6 ~ ZptJ S , ~ S / Structure Remarks: clayskins Loa rng Horizon Depth Dominant color Mottles In. Munsell u. Sz. Co I. Color Texture Gr. Sz. Sh. Consistence Roots Bounda ores Hand other GPD/ft.2 C /0 Yoe w/l d 0 q Q- s / o,Ve 6, S , c S c E- s. - - Horizon Depth Dominant Color Mottles Structure Remarks: clayskins Loading ry] ores pH_ and other GPD/ft.2 In. Munsell u. Sz. Cons Color Texture Gr. Sz. Sh. Consistence Roots Bounda ~3 io io C /i ~Qo /o y/t ' 6 A/ S D C, S -10 - i ce~~ s ~y y t' 1 7- Li /E1/,4 jia.v 1✓~`-30 ' r _ Horizon dnp Dominant Color Mottles Structure Remarks: clayskins Loading Munsell u Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary ores H and other GPD2 s 0'e i o Horizon Depth Dominant Color Mottles Structure Y Remarks: clayskins Loading In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary ores H and other GPD/ft.2 516 S C~ c C - yp / 10 Y14 HOMESITE SEPTIC PLUMBING CO. 855 O'NEIL RD., HUDSON, WIS. 54016 _ ROBERT ULBRIGHT ,!G. MASTER PLUMBER LIC. NO. 3307 M.P.ft f i.NN. iMSTALLE i & DESIGNER LIC. NO,. 0080 Addltitin,~l Remarks: enc o,!E~4 4~- sysr~ „ort>~ o~€ y foe CDO O~3TiZ°r cTi o 5 Other Site Features: P6& e~ %4 M6 VS j Limiting Factors/Depth: CST Signature Date Signed Telephone No. WD-8330N 01190) 1 , ~NDA2~ /90SS141E fvTO/PE ~S•`r LoT- L/ U D 57c"4t,.--. 30' 3 - ~ /EUs}Tia,vs t ~ SYSTEM lO d 13 qD 3 y /3 3 0 Pepel A T- 6-5 RvcK, Vve ~g xf 4'f L (V//) - ~ A19k) 5191 /0o, o i ORIGINAL I':??" a oy N SySi~ 1;e~- v"fl /ovs o o~ o IW4 fi 31-f~ 1- (3 o ~ t (35_r33_Qy- f~~Q poly 3a oti a - - - - - - - - - w u w sv,wc yd/~' 's / T o,~ ~~1:-,; ~ rv'0)14 FILED ~ ,207 e) OCT 0 71992so- 2..z ;f7 7~.t, JAMES O'CONNELL / Register cf I)OedS SL Croix Co., WI Q G~ G O 2 4 `~3QrJ, yl 489591 X -11- /mss CER T I F.I ED S UR V EY MAP Located in parts of Government Lots 3 and 4 of Section 22, T30N, R20W, Town of St. Joseph, St. Croix County, Wisconsin. M LEGEND ~o St. Croix County Section corner. O 1"X24" Iron pipe weighing 1.68 lbs ~Za p~PO 0 per lin. ft. set. 1" Iron pipe foundl 0) ti ti9 A Jr 3/4" Iron rod found. ~1~ O~ rZa' . Pao ~ ~I wmnam Bluff line. rr • Off. vti~~ 1 C> ~7j oI ~hed ' WI o) p) i to P 11 w F I v r+ ~I cnl 18 , 993 Sq. Ft. N a1 z I .155 A c . ) a 0 rnm ~m om al Q W 00 u~7 CO N M I cr) co N r- -1 00 E-4 U) CN r. co AlI m o w ~.®1T 1 3 Z a I DI m C 00 0 %J. Sq. Ft. Wl Ln (2.677 Ac.) 2 I Z F24 2 ''''•r,, H N S aI -0 4-4 0 0 N N Z6, ai a)i 3 44 2s r~ 2 ` ra O ^O N E Cr -P -P ~4 to `t -P N 3-! C . 0 • N C' 4 O1 , z c0 O ra 'Q \ 3 F- 0 044 u. Owned by: e\ ~ _ U) 4 Z / I 9 00 times P. & Arlyce a) -P (a W Lillegaard. ,`~~N~►N ~4 VPC to ° ~i' U) 74 {4 -I 1~r HARVEY Q U ° ----------_~j~ - JOHNSONI S DSO F VOLUME 9 PAGE 2550 `HUDSON • Z WIS -tp `ee 9 Sheet 1 of 2 This instrument drafted by: ~1~~,`,,~;# ,~d' 492-2067 AS BUILT SANITARY SYSTEM REPORT OWNER 4(-/! TOWNSHIP SECTION T D N- ( W ADDRESS ~Yi~'L FLU"~ '?S - el ST. CROIX COUNTY, WISCONSIN aC" el A( SUBDIVISION LOT_g,. _LOT SIZE f PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM A .M 4ft l j Hu SE 19X5 k INDICATE NORTH ARROW BENCHMARK: Elevation and description: 7,da z.l-lr 44-A13 AcK A Alternate benchmark ~T~T P,17- Tbr,~rnv ~sc+~ ~r,= Aoeis SEPTIC TANK:Manufacturer: ILJf =S °°/t Liquid Cap. 5~ Rings.used:-Q-Manhole cover elev:Final grade elev: Q_ Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front-4-, Side , Rear Ft.~f From nearest prop. line:Front , Side, Rear Ft. / r No. of feet from: Well Building: C9 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE • 1 PUMP CE AMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pum ze Elevation of inlet: Bottom of tank a ion Pump on elev.:_pump off elev.: Gallons/cycle: Alarm: Man.: witch Type: Location Distance from est prop. line: Front_, Side,_, Rear_Ft. Dis a from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Al"A Width:-Length `i Number of Lines: .Area Built Exist. Grade Elev.--22--2'-.q,-Proposed Final Grade Elev. Fill depth to top of pipe:_ 44-' A No. feet from nearest prop. line:Front Side'..,, Rear Ft.JLO" No. feet from well: No. feet from building y0' HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom to Elevation of inlet: No. feet from neared op. line:Front Side,, Rear Ft. No. feet : Wellbuilding-., nearest road arm Manufacturer: INSPECTOR: DATE:_ PLUMBER ON JOB: LICENSE NUMBER:e;V S' 6/90:cj "dvYSttfrTS;raftmrit 8f Is§PH 22.30 .QIJIi,,}~P~,F1~,F,,M LOT W, Bwv- County: Labor and Human Relations `Safety and Buildings Division 'r'KK INSPECTION "b,REPORT C ST. QRQTX GENERALNFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 196507 Perm itHolder's Name: ❑ City ❑ Village ❑xTown of: State Plan ID No.: ST. JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: L a_", 030-2027-90- TANK INFORMATION ELEVATION DATA A9200391 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Z Z Aeration Bldg. Sewer 711 J-3 [Holding St/I*t Inlet I TANK SETBACK INFORMATION St /'outlet Vent TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Septic 41 NA Dt Bottom Dos NA HeaderIA 4an. Aeration NA Dist. Pipe Holding Bot. System Z 5Z J ' PUMP/ SIPHON INFORMATION Final Grade Man curer Demand ~~rP c'C 5 ! s- r•~-hc Jr Model Number GPM TDH Lift Friction System F oss Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~.3 DIMEN I N - SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Ma SETBACK cturer: INFORMATION Type CHAMBER Mo el Num e System: ?`v OR UNIT DISTRIBUTION SYSTEM "m Headerl-AAaa feed ~r Distribut Pipe(s) x Hole size x Hole Spacing Vent To Air Intake Length /Z/ Dia. Length ~U Dia. ~ Spacing LL I SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over S ~r Depth Over / „ xx Depth Of xx Seeded/Sodded xx Mulched Bed /Trench Center Bed /Trench Edges (p _ - I -t Topsoil ❑ Yes ❑ No E] Yes E] No 1121;p COMMENTS: (Include code discrepancies, persons present, etc.) 17z7 4- 1 LOCATION: ST. JOSEPH 22.30.20.439L.440A,NE,SW, L~ W, HWY. 35 717 r `J c~ G%lY CL ca + fir'? Plan revision required? ❑ Yes ` o / Use other side for additional information. IZZ SBD-6710 (R 05/91) Date Inspector's Signature Cert- No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: li ff" L R SANITARY PERMIT APPLICATION I In accord with ILHR 83.05, Wis. Adm Code Co STATE SANI PY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1>:c 8% x 11 inches in size. 1:1 Cn revlsi to~ew us 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 '/4 '/4, S T Q, N, R D E (or PROPERTY OWNER'S MAILING ADDRESS OT # BLOCK # RHO KL- L CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ,LLLU TLs :50 II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned VILLAGE TE 6 ❑ Public 1 or 2 Fam. Dwelling-# of bedrooms -5- AR x . NUMBER(b) Q D III. BUILDING USE: (If building type is public, check all that apply) 0 30 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. 1~ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 NA Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 130 Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 76'41 . 12es /t*r&w- S" Feet Feet VII. TANK CAPACITY Site INFORMATION in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. New xistin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank 00 Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on attached plans. Plumber's Name (Print): Plu s Signature: (No Stamps M /MPRSW No.: Business Phone Number: 7 7- Plumber's Address (Street, City, State, Zip Code : ` Q IVY( b IX. COUNTY/DEPART NT USE ONLY ) ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ' Agent Sign=S Approved ❑ Owner Given Initial Surcharge Fee) - V6 e- 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. 1 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 (SIB') 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 'jy a, licensed pumper whenever necessary, usually every 2 to :I 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: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if 'anks received experimental product approval from DILHR. 1 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 8Yz x 11 inches must be submitted to th.- county. The plans must include the following: A) plot plan, drawl to scale or with complete dimensions, ocation of holding fP.nk(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; replac:emiert 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 absorf•tior system if required by the county; E) soil test data on a 115 form; and F) all sizing information. - - GROUNDWATER SURCHARGE 1983 Alisconsin Ac: 410 included the creation of surcharges (fees) for a number of regulated practice:; which can elect groundwater. Thr ll ni;+ nie~s collected through thc-ic surcharges an- ased for monitoring gro ndwater, ground- water contamination investigations end establishment of standards. SBD-6398 (8.11/88) r ' n 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-------------------------------------------------- Owner of property -J2- Q L.. F nfn fi, ~t~CCJ i Tl'l~ LC1e' d 4 sv L) Location of property 1/4 3L6~/4, Sect'on, T~N-RW D T I E'T. uavim. MAp ~ ~ €)c -r, ? i `s`lam lJo4 t Township USA. L7flf Mailing address 1} ti L=TL XV Address of site )(?C X X wv t ~ccI- i-r",v 4j Subdivision name Lot no. Other homes on property? es No Previous owner of property :-S-Am ~ +XD ~ RL cv~"' ft,e D Total size of parcel Z S y c--- Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume 2-6 and Page Number L 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 ~V,(we) certify that all statements on this form are true to the best of (our) knowledge that X (we) K (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.9(~ , and that X (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. Signature ofa licant ~f p o-applicant Date of Signature Date of Signature I~ DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA ~I STATE BAR OF WISCONSIN FORM 2-1982 4~® 09 VOL 975 PAGE 631 pc :;1 5 OFFICE James P. Lillegaard and Arlyce J. Lillegaard, I~G,... - h u s • ban - - d - a - n-d w i f e - 5T WI Red for Record OCT 191992 conveys and warrants to ..Rollf..A...Widlund• and..Jud.1_th.A...-.Widlund., P. M -husband-ate wi:fe__ate--;viv4ar-ship......... Gt 2:35 marital-- rr>perty........................... ~ of Deeds RETURN WO the following described real estate in County, State of Wisconsin: Tax Parcel No: ~I I See attached description I~ I Also, described as Lots 1, 2 and 3 of Certified Survey Map filed October 7, 1992 in Vol. 9, page 2550, Doc. No. 489591. I I I' ~ ys~( .a4 i s ;F0.70 I~ I ~I I' This ......1S------------------ homestead property. (is) (is not) Exception to warranties: Subject to easements, reservations and restrictions of record. Dated this ---7---------------- day of Ai?.ra._1..--- 19..9 ! (SEAL) e~G . . (SEAL) I. JAMES P. LILL G ARD -----------••---(SEAL) .(SEAL) * ARLYCE LILLEG ARP ii I AUTHENTICATION ACKNOWLEDGMENT W N E .O*T Signature(s) STATE OF U~kKiki N &'rpfj ss. _ .County. 7 da authenticated this day of 19 Personally came before me this y of _-.Agri.l---------------------------- 19..91. the above named Jamea__2_._._.Li_L1.e.gasrA ..a-n1---------------------- * ---Ar_Ly. -e---J-•---Li.11.eg.aar.d-------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) to me known to be the person _5 who executed the foregoing instrument a acknowledge the same. I THIS INSTRUMENT WAS DRAFTED BY STEPHEN J. DUNLAP Hudson, Wisconsin R•S G """"""y~" " Notar w ..rw unt (Signatures may be authenticated or acknowledged. Both My n is WJ0NNM stat expiration are not necessary.) NOTARY PUBLIC-MINNESOTA date: VIASHIfiIti['u" ~4 1f 19 ) anireg Mav 15 106 *Names of persons signing in any capacity should be typed or printed below their sign r-.-,y w...~~••~.•~,u.~,..• WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. P4X)FtCEL A VOL 975PAGE 632 That certain parcel of land or tract of real estate located' in Government Lots 3 and 4 of Section 22, Township 30 North, Range 20 West, Town of St. Joseph, St. Croix County, Wisconsin more fully described as follows: BEGINNING at a point lying on the west right-of-way line of S.T.H. 35, said point being 150.0 feet south of the south line of said Government Lot 3; thence N89°57'W a distance of 422.0 feet; thence N39°57'W a distance of 724.0 feet; thence N85°48'E a distance of 430.9 feet; thence easterly 500 feet, more or less to the east line of said Government Lot 3; thence south with said east line of Government Lot 3 to the intersection with said west right- of-way line of S.T.H. 35; thence with same southwestward to point of beginning. Above parcel is subject to an easement for travel over the south 33 feet of parcel. PARCEL B A parcel of land located in Government Lots 3 and 4, in the NE 1/4 of the SW 1/4 of Section 22, Township 30 North, Range 20 West, Town of St. Joseph, further described as follows: From a point on the W right-of-way line of S.T.H. 113511, a distance of 117.0 feet S of the S line of Government Lot 3 to the point of beginning for the parcel to be herein conveyed; thence N89°57'W a distance of 406.5 feet; thence N39°57'W a distance of 707.9 feet; thence S85048 1W a distance of 279.8 feet to the shore of the St. Croix River; thence Sally along the meander line of said St. Croix River a distance of approximately 618.4 feet to a point which is 150.0 feet S of the South line of said Government Lot 3; thence S89°57' E a distance of 1422.0 feet to a point on the W1Y right-of-way line of said S.T.H. 1135"• thence N a distance of 33.0 feet to the point of beginning; excepting from the above described parcel, the South 250 feet, the S line of the parcel herein conveyed being parallel to and 250.0 feet N of a line bearing course N89057'W beginning at a point on the W right-of-way line of S.T.H. 113511, 150.0 feet S of the S line of Government Lot 3. Grantor herein conveys an easement for road purposes over the Ely 60 feet of the parcel herein conveyed, and further conveys his interest in the road easements described in the deed to Morton Berland and Shirley E. Berland, dated November 21, 1952, and recorded February 6, 1953, in 1130811, Page 395, in the Office of the Register of Deeds, St. Croix County, Wisconsin, which deed was corrected between the same parties dated March 23, 1954 and recorded March 29, 1954 in Volume 1132011, at Page 6 in the Office of the Register of Deeds in and for said St. Croix County and granting unto the grantees an easement for roadway purposes over a strip of land 60 feet wide, said strip being a SEly extension of the easement herein conveyed by the grantor along the Ely line of the parcel, and extending SEly to the point of intersection with a line bearing N89°57'W and beginning 150.0 feet S of the S line of Government Lot 3 on the W right-of-way line of S.T.H. 1135"; also an easement for road purposes over the following; a strip of land 33.0 feet in width lying immediately adjacent to and N of a line bearing N89°57'W beginning at a point on the W right-of-way line of S.T.H. 113511, 150.0 feet S of said S line of Government Lot 3, and running Westward 406.5 feet. SUBJECT to easement to Morton Berland and Shirley E. Berland, dated November 21, 1951 and recorded February 6, 1953 in Volume 1130811, Page 395 in the Office of the Register of Deeds in and for St. Croix County including the easements therein from said Morton and Shirley E. Berland, said document being corrected by deed between the same parties dated March 23, 1954 and recorded March 29, 1954 in Volume 1132011, at Page 6, in the office of the Register of Deeds in and for said St. Croix County. PARCEL C A parcel of land located in Government Lots 3 and 4, in the NE 1/4 of the SW 1/4 of Section 22, Township 30 North, Range 20 West, Town of St. Joseph further described as follows: From a point on the W right-of-way line of S.T.H. 1135" a distance of 117.0 feet S of the S line of Government Lot 3 to the point of beginning for the parcel to be herein conveyed; thence N89°57'W a distance of 406.5 feet; thence N39°57'W a distance of 707.9 feet; . thence S850481W a distance of 279.8 feet to the shore of the St. Croix River, thence SWly along the meander line of said St. Croix River a distance of approximately 618.4 feet to a point which is 150.0 feet S of the South line of said Government Lot 3, thence S89o571E a distance of 1422.0 feet to a point on the Wly right-of-way line of said S.T.H. 1135"; thence N a distance of 33.0 feet to the point of beginning; excepting from the above described parcel, that land lying parallel North of a line to and 250.0 feet N of a line bearing N89°57'W beginning at a point on W right-of-way line of S.T.H. 113511, 150.0 feet S of the S line of Government Lot 3. Subject to easement to Morton Berland and Shirley E. Berland, dated November 21, 1952 and recorded February 6, 1953 in Volume 1130811, page 395 in the office of the Register of Deeds in and for said St. Croix County, and including the easements therein from said Morton Berland and Shirley E. Berland and the deed correcting said deed between the same parties dated March 23, 1954 and recorded March 29, 1954 in Volume 1132011, at Page 6, in the Office of the Register of Deeds in and for said St. Croix County. SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ei 0LF /-t A r~~ b ct b i ra q 11 XXXX lf'tuy ~~~/!ay ADDRESS: ~r'~t~etL 7-t, : Lx,.) i 4- D S> a FIRE NO: , c LOCATION: / n v~ 1/41 f5 tk' 1/4, SEC. r T - Cy N-R _ W ~ -iL TOWN OF: T SE% p t4 ST. CROIX COU~iT SUBDIVISION: LOT NO. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system: St. Croix County residents may be eligible to receive a grant to help with the cost of the replacement of a failing system, which was in operation prior to July 1, 1978. St Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification from will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system-in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGN all At,~ j DATE: St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 . ~ 6- leclfL s5rf7F / aeeA is'E GS~i LoT' c.PE-~ Tio.v ,VE7iu srY A~ &74) G'o v s?,eP c7/o~ : Wisconsin Impartment of Industry, SOIL DESILKIPTION REPORT PSa.Otetyy & Bui~urngs Division . Box 7969 Labor and Human Relations Madison, WI 53707 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Page / of Z- jjvy s : • 5C-5 3 3 E - - - ustomer Name va uatwn ate Current Lan use or Vegetative over anent Matena s l9UT 4J.4 - 2 P~'rPram ~v RoB ~Tr te/A ~a M,tY is - evatron ust90r ,Gstoim,P ate srShallowest Groundwater i? rqa 2 L > ,Lb ' N ' System Loa mg tom a ons Pei q. Ft., Per ay County 5774 C f z5'1X arar co TrST Awelcl 906: F~ X TZf•v GGL S lot Lea psscryRron 2 D 7Afv✓ 0 Ystem eomttry an Dept o an Aspect P/~- ?ZEO as - o -w-QST, TR~ti~ f Nt Sly, sec. z , Tao t ST. ToS4 Z P Yee- Horizon Depth Dominant Color Mottles Structure Remarks: clayskins Loading M. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots -Boundary pores, H and other GPD/ft.2 Vle 21 .5 Slit 315- s o,~*, 9~ ,►„-Q Z~ C s - 0 13. /j -zo s 7, ~G Structure Remarks: clayskins Loading Horizon Depth Dominant Color MoNes In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence 2-Al" Boundary ores pH ,_and other GPD/h.2 14 L'l d 7s !R 3/Z y2 ,w,,C e -S ` fj o-)5 7S t/,P 3/ f,sd,- &,af2 /uf CS e Swo ~sYQ gl - s Horizon Depth Dominant Color Mottles structure` Remarks: clayskins Loading In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary ores H and other GPD/ft.2 (j 7- 3i 7 s y/13/ she /,w f4 Zf cs - P-e- f,P.f 57 ' is t site APPROVED or con entlon septic sys e , Dominant Color Mottles Structure Remarks: clayskins Loading Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary ores H and other GPD/ft.2 m, ~ 7, sye 31Y /s ,s2 Horizon A~4/ ~s Ye I 13 l'/zrU~T/o,u 101,62-1 _ Horizon Depth Dominant Color Mottles Structure Remarks: clayskins Loading In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary res H and other GPO/h.2 Lnv~ o-li- -7,s y2 13 MY z-F GS co,B/3/y leofie n /S C llN-e- / / PE¢ Ger/~y s JG'/o 7,Sy/2 ~-I! HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 # y8Z ROBERT ULBRIGH7 ' I ;CIS. MASTER PLUMBER LIC. NO. 3307 M.'PFM ` !',NN. INSTALLEI & DESIGNER LIC. ND: 000 ditional Remarks: Other Site Features: Limiting factors/Depth: CST Signature Date Signed Telephone No. CST snon3~o(N ot~o) m 21 m ~ J u) LO a rwlj 4 C-n 1 V) c^~ ~ I p o O -7 1 0~ 041 o 0 0 IARICI ? J v RO%vC7 X00 A ~l s Goz ' loo, L,APP ~OvOD cov~2 ~~<< p^ r I8r J 5 ysTcr/ f . yy, C i n~ gyn. aTJ- TOP of ,5w c:CrfT n _ SLh~ A .1aPE1t %1,/ T //try I pr 13S AST, I i sit- B b Q /500 6L, o S. T TIYEkg R RE NO ~f1'UPOSED U1EU-13 lVi ro1w 60 r ~{rS ACRES U~ALL OF 5ePP4 Syrre/y. PRA(vlAt& Far /o -~Z-~~ 1~ Acu,~rG I3 y ,yl E/O L 4,rE Et /%a az ~/O. `il l> U~+c L ~-y v i ~tU Tip, 5- -7y- 3 6 rtPPR~uc~ couE/Z 31 Cie b$o RA- ~o c e.- 6, s x57-&/"7 EL. C/y~y DoG I~CN/11 ~ L r P O PDT 31-46, xD. GOT L/eltC II a~5 p 0, elk -641 8 G~2~UC- ~ i I v~3 L7 ) i 150 0 c.c s,? f-{OU5e Fou von lio,v 99 9 a /"1 EZ, 7-0 OF l8 k y 3 B6 J se~~~l3c~ ^lo S GAt C i412~ NO Wezz-$ Lug eft//V 50' of SEl9ric Sys7E/-7. D~AcviG ~U2: l07 -8-9dZ D~acvi~~ C~GF GP1 / O L ~;(Nt~ p g /f GUY 35-6 7- /~Oc~ c Tort GfJ/' . S~o~~ Sa7~7~ 2s~ GVt` . Syo~ s ~.3~D 5 REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1 12/18/92 10:40 REQUESTS FOR INSPECTION WORD SHEETS FOR: 12/18/92 AREA: JT Activity: A9200391 12/18/92 Type: CONVSEPT Status: PENDING Constr: Address: ST. JOSEPH 22.30.20.439L.440A,NE,SW, LOT W, HWY. 35 Parcel: 030-2027-90-000 Occ: Use: Description: 186507 Applicant: WIDLUND, ROLF Phone: Owner: WIDLUND, ROLF Phone: Contractor: SCHMITT, DONIVAN Phone: 568-4948 Inspection Request Information..... Requestor: SCHMITT, DON Phone: Req Time: 09:12 Comments:qL3a Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION