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HomeMy WebLinkAbout030-2002-80-000 C) I H ^ 03 y v'O, tl c I NO. o ao N m 00 O •- � y c I N BO y CO N Cp r C N N y a c•- o i o pv°Z Z v d Co M Y 7 f6 O C O C LL O ` O.N .�. O C j O C 'O E >L O N V O N E Q N w D) M 'ail N E Z = o v z (D � Cl) H uwi a m c C7 I O Z 4) Z c C N N O � N N N N O N •N C. � L O Z m Z J N _ c N C d III O G O 06 j > CL w N jI G o a a O FL N 0 0 0 •IvIi, a a a = a N 3 � : , J N rn rn o Z p w M CO O O O � Q 0 z N N N N E c0 Lo Lo M N IL V m O N N .�- N L' $ <w 4) .0 w d - o c E IA C -p O O a O V y d j O w O N M_ V E co M F' N C C U a 0 0 0 0 0 ) i.i M L a € N 'O N N N N N rw 0 N CO .,p. N O N M N G N O O N O Z C N O r co O c� 7 N .a ►� it ': Cd € a i! L: CL E ` '2 c �1 A ua � ll, 0U)iu ST. CROIX COUNTY WISCONSIN ZONING OFFICE I IN oil"N x■ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 May 23 , 1994 6 Mr. Kernon Bast l l0 Edina Realty 700 Second Street Hudson, Wisconsin 54016 RE: Water Inspection for Jerry/Phylis Anderson Address: 548 county Road E, Hudson, Wisconsin Dear Mr. Bast: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for a water inspection of the above property. If you have any questions with regard to said report, please let me know. ncere y, e T$o ps nr Assistant Zoning Administrator mz Enclosure I P . COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 ST. CROIX COUNTY ZONING OFFICE REPORT NO.1 6:429/01 PAGE 1 ST.CROIX CTY GOV.CTR REPORT DATE*# 5/19/94 11031 CARMICHAEL ROAD BATE RECEIVED** 5/13/94 HUDSON, WI 54016 ATTNS THOMAS C. 14ELSO;4 OWNERS Jerome PhYtis An<terson LOCATIONS 148 Co. Rd. Efi Hudson COLLECTORS jim Thompson � DATE COLLECTED** 5-11-94 TIME COLLEiCTEDi 12S15pm SOURCE OF SAMPLES Kitchen 'faucet DATE ANALYZED:5-1 3-942 , TIME ANALYZEDS11100am 9 COLIFORM,MFCCS 0 /100 Gal. r `,, r`1'dG C� �C1> INTERPRETATION# SAFE s �01� NITRATE-NS C ,' pPm Abmaa 10 ppm exceeds the recommended Public Dri*, ing Water Standard. Cotiform Bacteria/100 ml. Nitrate-Nitrogen, mg/L LAB TECHNICIANS Pam Gaue WI Approved Lab No. 19 0 4 C Means "LESS THAN" Detectable Level Approved by,' PROFESSIONAL LABORATORY SERVICES SINCE 1952 5q-$ ST. CROIX COUNTY WISCONSIN ZONING, OFFICE r N r N N N N■ - Slum ST. CRON COUNTY 30� NMENT CENTER 1101 Carmich,I- ad Hddsof , WI 5 10 (715) 386-4 r SEPTIC INSPECTION / WATER TE4,T�. ,REOUEST "!iF'O Please specify desired test(s) & rem i C� p`" ��T ee with application. Outside water lines are o ri.ajt f during winter months, making access to the home ne ` Please make arrangements with this office to insure that entry can be gained. 0 Water (VOC's) $185. 00 )< Septic $50. 00 Water (Nitrate & Bacteria) 45. 00 0 Nitrate & Bacteria retest Q $15. 00 Owner:� Q �tS S�7 Requested by:offM4 0 BSS? Address: ej;V address: S% • ZIP- / i0n0 / ZIP Telephone N4: ( ) S' l Telephone N°: Property address J(�i�e N° & Stret) Grp , /PQ Location. „ (�L� , , Sec. 3 N, R W, Town of 57« Realty firm: -aLA Lock Box Combo: IfZ-8 Closing Date: Sr! TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH. OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: T rA Is the dwelling currently occupied C,Yes ❑ No If vacant, date last occupied: ;0114 Age of septic system: Septic tank last pumped by: 4rtl A_lv Date: "y' Previous Owner's Name(s) : LOA Have any of the following been observed? ❑Y V Slow drainage from house. OY 96 Sewage Back-up into dwelling. ❑Y 6 Sewage discharge to ground surface or road ditch. ❑Y Lf1 Foul odors. Other omm DUi�7 la ive to system operation: A; S is A �� I cert ify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE: �S 1/94 OWNERS DRAWING OF HOUSE & E LOCATION IN a TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system: ❑Below grd ❑At-Grd ❑Mound Approx. size �I X 5.2T— ❑Gravity ❑Dose ❑Pressurized Ft. ' ❑Bed ❑Trench ❑Dry Well Molding Tank ' ❑Outfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbac s: ❑House&,—<E]Well d7el❑Prop. lined7<00ther Dose tank Setba ks: ❑House ❑Well ❑Prop. line ❑Other ❑Locking cover ❑Warning label ❑Pump/Floats ❑Alarm ❑Elec. wiring Soil Absorption System Setbacks: ❑House Well ❑Prop. line❑Other ❑Ponding: ACS ❑Discharge: General commen s• [�N INSPECTORS SKETCH OF SYSTEM LOCATION 1 spfo et itlor �/ A V ST. CROIX COUNTY WISCONSIN ZONING OFFICE r r r r"r r■■ �, ST. CROIX COUNTY GOVERNMENT CENTER �+.. 1101 Carmichael Road N Hudson, WI 54016-7710 (715) 386-4680 May 13, 1994 Mr. Kernon Bast Edina Realty 700 2nd St. Hudson, WI 54016 Dear Mr. Bast: An inspection of the septic system serving the Jerome and Phylis Anderson home, located at 548 Co. Hwy. e, was conducted on May 12, 1994 . This inspection was based upon a surface inspection of said system and did not involve any excavating or chemical analysis. Accordingly there may be hidden defects in the system not discoverable by this inspection. Most septic systems consist of a septic tank which traps the solids and greases from the sewage stream and then allows the remaining sewage effluent (liquid) to drain into a subsurface drainage area. Once the liquid reaches this point it seeps away by percolating through the soil surrounding the system. Failure results when the soil surrounding the system becomes plugged with microscopic bacteria and sludge, which form a clogging mat. As time goes on, this clogging mat becomes progressively thicker, allowing less and less liquid to seep away from the system. When this clogging becomes severe enough, liquid sewage is trapped in the drainage area, a condition known as ponding, and results in backup of sewage into the structure or the discharge of sewage to the ground surface. At the time of inspection, your system appeared to be functioning, but not at full capacity. I noted that there was approximately 41/2" of sewage effluent ponded within the drainfield. This indicates that the lower portion of the system has begun to clog and has reduced the ability of the sewage effluent to drain away from the system. Because the failure of a septic system is a progressive process, I cannot predict how advanced this clogging is, and therefor how long this system will continue to dispose of sewage effluent. Neither can I predict how soon the system will fail completely. I want to stress that I cannot guarantee or warrant that this system will continue to function properly in the future. In an effort to prolong the system's life, I recommend that steps be taken to minimize the wastewater flow from the house which enters the system. For example, repair any leaking water fixtures and/or replace them with water conserving fixtures, reduce time spent in the shower, wash clothes and dishes only when there is a C(op'y full load, use a washing machine with a suds saver feature, etc. I would also recommend that the septic tank be pumped at a minimum of once every three years. Please feel free to share this report with anyone who may have an interest in its findings. Should there be any questions or concerns that I can clarify I can be reached at this office between 8: 00 am.- 5: 00 pm. , Monday - Friday. Si erely, - James K. Thompson Assistant Zoning Administrator cc: file r, ' Form - S T- C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ��%�i � �EI�� NSHIP SEC. 33 T�LQ N-R �W T ° ADDRESS ST. CROIX COUNTY, WISCONSIN �/� ,� SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•T.HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM SYS1L/t•'/ OP 7Y' � y 5 i A e�r ,�L./r1G'o�• INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point usedc.S a 7 IN Q Elevation of vertical reference point: Proposed slope at site: TANK: Manufacturer: Liquid Capacity: Number of rin sed: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet E1 on: Number of feet from neares Fro Side,O Rear, O :F:rom ne property line Front,O Side, r,O N r of feet from: well , building: lot plan) ( referen (Include this information of the above p SEE R VER f Y R J • /- . . .. . . . �. � . j k . . ¥ 0 . k § &D ( 22) 7 �ƒ§ � Nc c . ono o22fE ) Z 72 J LOL 0 LD=2 ; \ D eE ;� � ; E 7 /)2/ § n « ) / � § - o z 7 Cl) / \ a ■ $ \ z # 2 0 k / k \ k S E (D \ Cl) W . CO / ; E # o Q zmz / .. z ! W c 2 £ > , ca � § 3 ; ! ° & 0 2 ® « 0 . E k k k -� i § a a a } IL o B \ § OD CO o m u z § § � � co k ƒ / i % S & ( 2 E : Q C:, � ) ° ± § \2 9 m£ . § c k \ ) ƒ 8 I § 7 / ) / , 2 / R ] k } / E f \ § * Cl) CO) # � 4 @ 0 z f / 2 \ l .. Cd CL® i E $ c \ , c k 3 a o U) u Parcel #: 030-2002-80-000 02/14/2005 03:57 PM PAGE 1 OF 1 Alt. Parcel#: 33.30.19.363B 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 *FREDRICKSON, GARY L&KELLEY C GARY L&KELLEY C FREDRICKSON 548 CTY RD E HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description *548 CTY RD E SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.320 Plat: N/A-NOT AVAILABLE SEC 33 T30N R19W PARCEL IN SE NW COM NE Block/Condo Bldg: COR,TH S 525 FT TO POB:W 250 FT,S 191 FT TO CEN LN OF RD, E ALG RD 264 FT, N Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 269 FT TO POB 33-30N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1079/566 WD 07/23/1997 412/424 2004 SUMMARY Bill M Fair Market Value: Assessed with: 5682 259,900 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.320 87,700 168,000 255,700 NO Totals for 2004: General Property 1.320 87,700 168,000 255,700 Woodland 0.000 0 0 Totals for 2003: General Property 1.320 55,800 137,000 192,8000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 128 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges 00 Total 0.00 0.00 PUMP CHAMBER Manufacturer: Liquid Capacity: Pum del: Pump/Siphon Manufacturer: Pump Size , Elevation of Bottom of tank ation: Pump off switch elevatio n. ons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nea property line: O Side, O Rear,© Ft. umber of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width:- �_ Len the Number of Lines: L_ Area Built: L Fill depth to top of pipe: 6g 01' Number of feet from nearest property line: Front, O Side, Rear,0 Ft . Number of feet from well: 9l? ` Number of feet from building: (Include distances on plot plan). SEEPAGE PIT ze: Number of pits: Diameter: Liquid h: Bottom of seepage pit elevation: Area Built: Has either a drop box O or stribution box O been used on a of the above soil absorbtion sytems? (Check one) . HOLDING TANK Manufacturer: city: Number of rings used: E1 ation of bot of tank: Elevation of inlet: Number of feet from ne est property line: Front, O Si Rear, 0Ft. umber of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector Dated: �L' 0� Plumber on job: License Number: 3/84:mj Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �����J/�,�� ✓!�/'/�� JL �NSHIP S'/r !J' SEC. J T` N-RW ADDRESS CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM .f w 5 y L`L'X/S7/iv 6 y 5'TAp '�L` r ��r INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used &Zl' ,gyp i .57A Elevation of vertical reference point: Proposed slope at site: 5EP TANK: Manufacturer: Liquid Capacity: Number of rin sed: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet E1 on: Number of feet from nearest Fro Side,O Rear, O feet From ne property line - Front,0 Side, r,O feet N r of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE ;r i j I - f I r j { i - - -� - RR l T L i - — IK f r 2 rf j i4 f��f c?�E _ fl' - - - r i I - - - - 5- ` - - - - - i I ' I DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O BOX 4969 BUREAU OF PLUMBING MADISON,WI 53707 SEk, NWh, S33,T30N—R19W ))J Y'YI CONVENTIONAL E]ALTERNATIVE (if State Plan I.D.Number: Town of St. Joseph ❑Holding Tank El In-Ground Pressure ❑Mound CTY HWY E NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Jerome Anderson Route 2, Hudson, WI 54016 /Q.�f/-c4'7 OCR BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber MP/MPRSW No.. County Sanitary Permit Number: Donavin Schmitt 3205 St. Croix 99117 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO DYES FIND BEDDING: I VENT MAIL. HIGH WATER NUMBER ROAD: PROPERTY WE BUILDING: (VENT TO FRESH ALARM-. FEET FRO LINE: AIR INLET: DYES ON ❑YES ❑NO INEAIRESTF—� DOS ING CHAMB MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO DYES ❑NO I ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PR OPERTV WELL. BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES F-1 NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (if soil can be rolled into a wire,construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: 1 F't�NICH WIDTH: LENGTH: NO OF IDISTR PIPE SPAGING COVER INSIDE DIA. #PITS LIQUID TRENCHES. / M ERIAL: PIT DEPTH: pIMEA S10NS 3 U GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO. TR NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIP S i ABOVE COVER. ELEV.INLET ELEV.END. S PIPES. FEET FROM LINE: AIR INLET: L a 2)2 NEAREST ----0► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ❑NO SOIL COVER ITEXTURE FE]YES ANENT MARKERS OBSERVATION WELLS ❑NO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED MULCHED: CENTER. EDGES. ❑YES ❑NO DYES 1:1 NO [—]YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BEOT.REfeIGH WIDTH LENGTH LATERAL SPACING GRAVEL DEPTH BELOW PIPE TRENCHES: FILL DEPTH ABOVE COVER E?iME�SIflNS ! MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV.: ELEV: DIA.: ELEV.. PIPES. DIA'.. E#;EVATION AND DISTRIUTION'i HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICALLIFTCORRESPONDSTOAPPROVED NFt}RMATIt3N PLANS DYES ❑NO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LINE: ERTV WELL: BUILDING: FEET FROM El YES ❑NO ❑YES ❑NO A1Ea4RESr �4 Sketch System on Retain ihdUky file for audit. Reverse Side. TITLE: SIGNATURE: Zoning Administrator DILHR SBD 6710 (R.01/82) INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT__ APPLICATION E TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained.,,The septic tank(s) should be pumped by alicensed, pumper whenever necessary, usually bvery !`tb%p years; - 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. - To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; ll. Type of building or use served: If-public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms'if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; k VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; 4 X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8Yz 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; dosing or pumping chambers; 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. --------------------------=----------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground Aw— included the creation of surcharges (fees) for a number of regulated practices which Wisco ila can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure! is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. 0 The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COU T DILHR In accord with ILHR 83.05,Wis.Adm. Code '" 2i�, STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES N NO PROPERTY OWNER PROPERTY LOCATION va f � S Z— t/4 '/4, S T30 , N, R 12 E (or OW PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME !7 l gA CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK VILLAGE: ��. r T t/ �7 /T II. TYPE OF BUILDING OR USE SERVED: � 036—460cP- Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. El New b. VM Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. X Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. X seepage Bed b. ❑seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): 6 f� y� � Feet X Private ❑Joint ❑ Public VI. TANK CAPACITY Site in aa ons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank QQ� Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) _ M MPRSW No.. Business Phone Number: Plumber's Address(Street,City,State,Zip Code j. Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# i 5 7,-t. ,=•L CST's ADDRESS(SAreet,City,State,Zip Code) Phone N�ummber: Y IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa tary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial j /1 S�jharge Fee �l Adverse Determination (,/ _"Q rJ~' d + lk;� X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber f F . APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be' retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property r/ k,6_1 s-4- Pl , S z:_ s- o Location of Property_ __AL4, Section 33 , T_34) N-R� W Township Mailing Address _P1 ja 1Z �Gj�j'ia,� �, ;; �f0el Address of Site Rio A(fj eA,, �.2 Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created /g� Are all corners and lot lines identifiable? (' Yes No Is this property being developed for resale (spec house) ? Yes X No Volume and Page Number _,-Y,-V--q as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 (We) ceht i6 y that a t S tatement6 on th i.6 6onm ane true to the beat o6 my (ouk) knowledge; that I (we) am (au) the ownen(s) o6 the pnopenty ducAibed to this .in6onmation 6onm, by viAtue o6 a waA.anty deed necohded in the 066.ice o6 the County Re9iAten o6 Deeds as Vocument No. ; and that I (We) pneaently own the pnopos ed bite bon the sewage pod b yb em (on I (we) have obtained an easement, to nun with the above de, chibed pnopehty, bon the conatnuctti.on o6 6ai.d -- s ystem, and the dame ha,a been duty neco)tded in the 0661 ce o6 the County Regizten o6 Deede ae Doemen t No. 2 7 Y 4�_ ) GNATURE OIL OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED a DOCUMENT NO. VOL 412 PA�E44 WARRANTY NEEN STATE OF WffiCONSIN-FORM 9 279846 TEU PACK RMV®M UMBIAO DATA THIS INDENTURE,Made by REGISTERS OFFIC,—E Tttnm&_ W Seim and Tlnnna ARa Seim husband aT. CROIX CO., Wis. and wi fa as j - ___ of Route ? uttdann wi Acnnsin Reed for Record this- s.of St.Cro iX County,Wisconsin,hereby conveys and warrants d*Of--April-_-_A.D 19.65 to Ot Station, --ti H dd0n WiS00I18�n _ R kt r Deeds Of grantee - RETURN TO $t• Q�'0�7f County,Wisconsin,for the sum of nra nni,e,. nn Est—othervalRable c4A9�-d®-raticlns the following tract of land in Cr n i County,State of Wisconsin; A parcel of land in the Southeast one quarter of the Northwest one quarter (S',Ei-NWJ-) of Section 33,Township 30 North, Range 19 West described as follows: Commencing at the Northeast corner of the SFj-NW4 of said Section 33, thence South on the East line of the SE4-NWJ for 525 feet which place or point is herein after known as the Place of Beginning, thence West for 250 feet, thence South for 191 feet to the center of the black topped road, thence Easterly along the center of said road for 264 feet more or less to a point in the center of the road which is on the East line of the SEJ-NWJ of said Section 33 and 269 feet South of the Place of Beginning, thence North on the East line of said SE9-NW4 for 269 feet to the Place of Beginning. Containing approximately 1.19 acreXs. This is a correction deed and supercedes deed recorded in Vol. 401 Page 188 I i IN WITNESS WHEREOF,the said grantors—ha ge hereunto set the i r hand_and sealg this day of ,A.D., 19 65 . SI ED AND SEALED IN PRESENCE OF �� �.��r,.� (SEAL) �e7yrt.Y ,_ l�tyn (SEAL) (SEAL) (SEAL) STATE OF WISCONSIN, St.�Crnix County.}� Personally came before me,this 1) day of 'zcX A. D., 19 . the above named Thomas W. Seim and Donna Mae Seim, his wife, to me known to be the person-R-who executed the foregoing,',. ffij%and acknowledged the same, This instrument drafted by i • 3VotarypubUc � �� 4 ,Z (.-✓ County,Wis. y ••.• O NIy Commission(Expires) (Is) (Seceloa 69.61 (1)of the Wisconsin Statutes provld�s,thet IWI Art 1ps t.eore.e-OuM hare pWae7 printed a ewAtten thereon the names o[the arsntan,grantees.witnesses and notaq). 's, WARRANTY DEED-STATE OF WISCONSIN,FORM NO,9 --- w,e,eiutr CO.,etLelltttt H • z CA H a ST C - 105 r r • a H SEPTIC TANK MAINTENANCE AGREEMENT H St . Croix County z d a OWNER/BUYER %' '4� ROUTE/BOX NUMBER Fire Number $ CITY/STATE �j/�.t GI S o W, ZIP S Y v / G PROPERTY LOCATION : _ , � � Section 33 , T 30 N , R1_W, 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 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 treat- ment stage in the waste disposal system. St . Croix . County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 E I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED DATE 1`7 St . Croix County Zoning Office P. O. Box 98• Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above address . ,DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS DIVISION INDUSTRY, P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON,W1 53707 HUMAN RELATIONS �..,0 (H63.090)&Chapter 145.045) LOCATION: SECTIOW TOWNSHIP Y: LO NO.: SUBDIVISION NAME: � � 33 /T N R (or)W St: Jose h /a n/a COUNTY: OWNER S B E: MA L ADDRESS: St. Croix Jerome Anderson R.R.#2 Co.Rd. #E, Hudson, Wi. 54016 USE DATES OBSERVATIONS MADE ER Residence B DRMS.: COMM E R TIO R N A N TES ERResidence ; 3 n/a MNew ®Replace 19-16-87 -16-87 RATING:S-Site suitable for system U-Site unsuitable for system CONVEN I NAL: MOUND: IN-GROUN R U :rYSTEM.-ICNF JL LHOLDING TANK:RECOMMENDED SYSTEM:(optional) ®S ❑V ®S ❑U a S ❑U S U EIS ©U I conventional If Percolation Tests are NOT required DE SIGN RATE: I If any portion of the tested area is in the I.1 1 n/a under s.H63.09(5)(b),indicate: n/a Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS 2 SHC2 BORING TOTAL DEPTH TO GROUIN DWATER-INCHES CHARACTER OF SOIL ITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIZTH_EST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 7.84 102.19 none >7.84 .92bl.1. 1.00bn.sil. 1.00bn.l.s. 4.92bn.c.s.&gr. B- 2 7.84 102.76 none >7.84 .42bl.1. 23.92bn.sil. 3.50bn.c.s.&gr. B- 3 17.83 102.35 none >7.83 1.17bl.1. 2.33bn.sil. .50bn.l.s. 3.83bn.c.s.&gr. B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLI,NG INTERVAL-MIN. PERIOD t -PER 10 PERIOD PER INCH P- 1 i P- 1 P- 1 P-_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori• zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 98.18 ; s I ' j TN S 3 i ..............- I I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. _ NAME(print : TESTS WERE COMPLETED ON: Gary L. Steel 9-16-87 ADDRESS: CERTIFICATION NUMBER: M5-246-6200 ONE NUMBER(optional): 988 N. Shore Dr. New Richmond Wi. 54017 2298 CST SI URE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R.02/82) —OVER — iI � ,ill I lily Dili i � ' jfl � � f y ilkl i 1-I 1 } 1 G E VIII � lal III � IIII 'i l NEI MOM MOM No NONE loom MINE mom ON mom m IMMENOMM mom NNE Elm ilia M MINN I. ON ME