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Parcel #: 030-1087-90-000 08/19/2005 09:08 AM
PAGE 1 OF 1
Alt. Parcel#: 30.30.19.315E 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
0-SCHEID,JUAN P
JUAN P SCHEID
332 CTY RD E
HOULTON WI 54082
Districts: SC=School SP=Special Property Address(es): "=Primary
Type Dist# Description "332 CTY RD E
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 5.100 Plat: N/A-NOT AVAILABLE
SEC 30 T30N R19W PT SE NW NOW KNOWN AS Block/Condo Bldg:
LOT 1 CSM VOL 7 PAGE 2052
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
30-30N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
09/25/2002 691701 1988/476 TI
07/23/1997 503/80
438780 814/579
2005 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.100 100,300 151,200 251,500 NO
Totals for 2005:
General Property 5.100 100,300 151,200 251,500
Woodland 0.000 0 0
Totals for 2004:
General Property 5.100 100,300 151,200 251,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 303
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Vz
Form — S T C — 104 . ':
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP C�s�° SEC. T _N—RW
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I•IHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
F .k
A33
i
-7 S
/f
/06
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used ��J�rzC
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer
Liquid Capacity: Jlldea'Az
Number of rings used: Tank manhole cover elevation: —?l
` Tank Inlet Elevation: Tank Outlet Elevation: ;
- _�- /TC
Number of feet from nearest Road:
Front, Side, Rear, 9� feet
From nearest property line Front 10 Side,0 Rear,O �r ,feet
Number of feet from: well building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank),
SEE 1,LEVERSE SIDE
1
PUMP CHAMBER
Manufacturer: zz Liquid Capacity: 1-I
Pump Model: Pump/Siphon Manufacturer: Pump Size y
Elevation of inlet: _ Jar Bottom of tank elevation: 7C—
Pump off switch elevation: �8 `Q� Gallons per cycle:
Alarm Manufacturer: ILJ, " ..jC Alarm Switch Type: t �[o �j a
r' �
J �
Number of feet from nearest property line: Fr on , O Side, Rear, Ft. _
Number of feet from well:
Number of feet from building: '
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM IIlOUA14
*ed: Trench:
Width: Length: , Number. of Lines: Area Built:
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, Rear,O Pt .�
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built: '
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one) .
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
r.
Inspector:
Dated: Plumber on job: itii T O',j'rZs
License Number:
3/84:mj - ,,
S 30, T„s�a.!/'A01?
AAI
fJ ._
Si
N
91% ,
err,
Pitt `
/4Q
3 lcej d SC
ea
Strove, Marsh Hay, Or W',W, l
Synthetic 'Covering
Medium Sand Distribution Pipe
T H �
1 opsoil iSSSaar xTiiisit��t^ :z7sa ci:r�.�-wus+s'zt
3 E _ D
M Force Main
Xs $t0¢e Trench Of r. Z Plowed
-Aggregate ` , layer
(Undisturbed D _L Ft.
Sail E Ft.
x#' ` Cross; Section Of A Mound System Using F ,fr''3 Ft.
t2jrenches For The Absorption Area
A Ft. H Ft.
S .-
B _(.�. , Ft.
Signed:
C1,3 t
License Number: q_2� K ,[Q�,; Ft.
Date: `-/_ (w L 3,6 Ft.
J Ft.
Alternate Position of Force Main I L9,:Z Ft.
L 1
J i
K
A -M - - -_=
C
Force''
W Obseryd4ioin Permanent Main
x Fi ... Markers
Distribution Trench Of 2 - 2 -j
Y
Pipe
Aggregate
Mound Using 3 Trenches For Absorption Area
tj,
` PAO
y
P*cfArplaA Pip• Quail
RN
PVC foras Mow 5
Of or* ■r
�� �_ ��.,, ��;a: MANs>;a.•�an���+tlpl '� �i{
.,�� � �'q a an caw�r� oe•rl. ,� ,� r
> i I
F
1,�1#i! r4�o11
Alto
rfgie NOW pa of
force Mile 4 #
'. �II1t,111► ' � * •!S �3 , ,�.' i �: � . 't
' t
Layout
R
S P
,. x,. '
Y Jnches;
Sigfsed: - �, Mole Qiametor Inch*
Lateral " Inch0s)
License Number: Manifold " 3,y Inches `
Date: — Force Main ' Incho3
of holes/pi poi �a
Invert Elevation of Lteral
Ft.
S
1
b
m
o
ro
rr
to
LQ
w
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•
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PAGE
PAP CHAMBER CR255 SECTION AND SPECIFICATIGAIS ,
VCWT CAP
4'C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING
23' FROM DOOR, _T JUNCTIOW 80X MANHOLE COVER
WINDOW OR FRESH I2"MIIJ.
AIR INTAKE
GRADE
18 M,
CONDUIT
10"P11AJ. IV �\
IAI1..E T PGF.`S�S�`
PROVIDE
AIRTIyHTSEA4.
edpPROVEq DINT � oNs`��SEw I�a` I I I� APPROVED JOINTS J I I'I
W/C.2. PIPE,' W/C•I.,PIPE
EXTENDIAIC, 3' ALARM EXTENDING 3'
OuTO $01.10 Sc::. D � ONTO SOLID SOIL
ON
I
PUMP OF F
1� p
k �
CONCRETE QLOiCK
RISER EXIT PERMI?TED OMLA MIF TANK MANUFACTURER HAS SUCH APPROVAL.
SPE CIFICATIOK.IS
..SEPTIC AND fJ / 1 7 /
00&j TANKS MAWUFAC;TURER/: „� '�c`.� n 1CCI�x�� s ►LUMBER OF DOSES: PER DAB
TANK :,1ZC : 1 _..GAL.LOWI D054 VOLUME
ALAR MANUFACTURER' �+- INCLUV!`!;. :;:C'!iLOW: _GALLONS
MODEL LILIMBER: __,,lA !1 CAPACITIES: A= �lD� IkICHE5OR GALLONS
3WITCH TYPE: /�%' ar�,:�� :fl, r ,�i ��f,( B=--„�.--. INCHES OR ^ 9 GALLOAI3
PUMP MANUFACTURER: C- LI,IEICHES OR J/ki? _GALLONS
MODEL ►DUMBER: --� �� `f D-INCHES OR .. GALLOWS
SWITCH TYPE: MOTE: PUMP AMD ALARM ARE TO BE
PUMP DISCHARVE RATE 6PM
INSTALLED. ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE OECAJ PUMP OFF AND DISTRIBUTION PIPE.. 7 FEET
+ MINIMUM NETWORK SUPPLY PRESSURTTE . . . . . . �•5 FEET
+ . FEET OF FORCE MAIN X �F/f1OoFT.FRICTioIJ FACTOR.. FEET
TOTAL OyNAMIC. HEAD .L.G._ FEET
INTERMAL. QiMEWSIGWC TANK.: L.EAIGTH ;WIDTH _;LIQUID DEPTH
91G�IED: ry LICEMSE NUMBER: DATE:,Z:. SL
'M' del 3870 Submersible Effluent Pump..
140 1 S"10
s
1100 tiA a
sL
A 80
� WAhJ
E
► o X70
? 60 'hp
40 wpMOS i?H P
WP'M03,IA H.P.
20 WPO3,v,N.P.
20 40 60 a 80 100 120
0 Capacity—Gallons WMIM110
,r
( _ Max.
M.P. 0MW No, Vgllll IM►r41 AIM
WPO311E 115 94
WPM0311E 1750
WP0312E ?�
10 47
WPM0112E
wFaHOr>1i1:
r�
WPH0512E
• n WPH0532E 2061230 34
` 30 --
Wf'NQS34E 4A0 _.
WPH0712E 230 10 _-
WPH0732E 2WZ30 30 54
WPH0734E 460 27
WPHt01ZE 2a0 ja x_16 3450 w..
1 WPHIrMr, 3!06/230 84
WPH103E 460 3.2
WPH1512F 230 1# 13.3
WPH 1532E 206/230 92
WPH1534E 160
30 46
8 WPHH11112E 230 10 13.3
WPHH1532E 2061232 30 92
WPHH1634E 460 4.6
SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE,
c
DEPART °F - REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS
(H63.090)& Chapter 145.045)
LOCATION:,/ SECTION:T� u �}
�TO HIP/MUNICI ALITY: LOT O.:BLK. O.: SUBDI ISION NAME:
COUNTY: NAME: AILIN ADDRESS:
"' n� I
wac" W\00.44
USE DATES OBSERVATIONS MADE
NO,BEDR .: COM ER IAL ESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
®Residence New ❑Replace �� � ? �
RATING:S=Site suitable for system U=Site unsuitable for system (j ff d
r. ENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional)
r1S U CIS DU [IS ®U ❑S �U El ®U
If Percolation Tests are NOT require DESIGN RATE: [Floodplain any portion of the tested area is in the
under s.H63.09(5)(b),indicate: ,i ndicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING
NUMBER DEPTH-W, ELEVATION
DEPTH TO TER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AN DEPTH
OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B-
9 A:3
B- /
ZA11-1 4r
B- 3
B-
B-2
B-
T PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER LNGkibS AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH
P- 7
P- 6V2' Zfq
J
P- l
P-_
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil are s. Indicate scale or distances. Des ribe what are the hori
zontal and vertical elevation reference points and show their location on the plot plan. Show the sur ace elevation at all borings and th direction and percent
of land slope.
SYSTEM ELEVATION
—/118�rab
1 17-1 09M
. I
I
! l
I
E
1 j (
J`
- _
l
r
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 rint) TESTS WERE COMPLETED ON:
OR
ADDR r CERTIFICATION NUMBER: PHONE NUMBER(optional):
1
CST N UR
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
T s �
INSTRUCTIONS FOR COMPLETING FORM 116 - SBD - 6396
To be a complete and accurate soil test,yous' report must include:
1. Compete legal description;
2 The use section must clearly indicate whether this is a riesidence or commercial project;
S. MAXIMUM number of bedrooms or commoi cial use planned;
4. Is this a new or replacement system;
5. Con-jplete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locatirrg your test locations. Drawing to scale is preferred. A
separate sheet may be used if desired;
8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
9- Complete all app}oPriate boxes as to (fates, names,addresses,flood plain data, percolation test exemp-
bwlr if appropaiate;
10. if ti=c information (such as flood plain, elevation)does riot apply, place N,A.in the appropriate box;
11, Sio , the form and place.,your current address and your certification number;
12.. Make legi ie Copies a"d distribute as rctfrrired. ALL SOIL TESTS MUST BE FILED WITH THE
LOCCAL AUTHORITY yV`ITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Sepae°aces and Textures Other Symbols
sr; _.. Stone lover 10") BR Bedrock
Cob Cohble ;3- 10") SS Sandstone
gi, Gravel (under ") LS Lirnesto€se
Svrad FdGVV - High Groundwater
s -
coarse, Sand Fe,c; -- Porcolation Rate
m€d s .,._ t1f d; art S„end try Vv
.s Fmc,Sand BIdr .._ Building
is Loamy Sand ) Greater Than
sl Sandy Loarn < - Less Than
Lcaarn Br, ._. B€-ovvn
eii (Silt Loarra BI .._ Black
si -- wilt Gy° - Cray
c; - Islay L_oars?
°t ._ Ye i I crty
sc.l Sandy Clay L.c=am l i Red
sic; — Silty flay Loarrn nkot - Mottles
sc Sandy rl,y vill "vith
silty Clay f f f - fety, Tine, falnt
G1<"§y CC ,,r>mrnoi=, e O'Me
Peat ,n in - Many, medium
I _.. f0luck d -- distinct
p -- prominent
HtVL - High water level,
Six general soil textures Surface water
for liquid ssaste disposai BM - Bench Mark
VRP - Vertical Reference PC ink
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit.The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete sett of plans for the private
seilra,e symen) and a permit applicatican mast be submitted to the appropriate local authority in order to
obtain a per€snit. The sanitary Hermit mast Eae obta ned and posted prior to the start of any construction.
rsg
s
60ARTMENT OF-% REPORT ON SOIL BORINGS AND SAFETY"&BUILDIWS
�>GNIv*f-AY. ■. yDIVISION
LASER AND
HUMAN RELATIONS
PERCOLATION TESTS 115) MADISON,WI 63707
'
(1-163.0911)&Chapter 145.045)
��� 1' H� E for T L IiIP/MUNTUITY; O.:IItK. a:151,10 1 I ION NAME:
O'U1V Y: ER• NAME: MAILING ADDRESS.
DATES OBSERVATIONS MADE
� 15II CRCs- flo`n�: _.. yu:. ,. a "PROF V5E§CF1IPTI15R9 P t"6IXTIOQ TE
eince New ❑ReplacOR e ' r�� J� `/f / U►� l
RATING.S•Site sultdble for system U*Site unsuitable for system
r� _]1)EN�TUN-C: UND: IN GRQUND. ESSSURE ILL TOLD N TG ANK:RECOMMENDED SYST EM:(optional)
f#Percolation
its are NOT require IDESIGN RATE: If any portion of the tested area is in the
UntNpr s,HB i.ttR(blfhl,I"die"trr ) Flnnelplain, Irntirate FlnnelpinFn nInvetinw j
PROFILE DESCRIPTIONS
EIOR. OB R n . I ;� 7
M -110014 J4 J(
Dofn T
V AE • TEXTURE, A EP
betim w. EI'EVATION TO BEDROCK IF O SERVE ( EE ABBRV�ON
BACK.1
a - 9, 9
- r
A.
.r
I 9
fPERCOLATION TESTS
DEPTH WATER IN HOLE TE T TIME DROP IN WATER V -I H RATE P INCH
ES
R AFTER SW_EL IN INTERVAL-MIN. 1
fr> s
r
P.
PLOT PLAN: Show locations of percolation tests,soil borings and the dimensions of suitable soil are s. Indicate scale or distances. Des4 ril)e what are the hori
zonal and vertical elevation reference points and show their location on the plot plan. Show the sur ace elevati n at all borings and th P direction and percent
'i of land slope.
' SYSTEM ELEVATION
R �
yy i _
i
Y
1,the undersigned,hereby certify that the soil testl reported on this form were made by me in accord with the procedures and methods specified in the Wiscot in
Administrative Code,and that the date recorded an the location of the tests ere tract to'the best of my knowledge an belief, ;
NAME not K97 W ON:IAI
A CERTIFICATION NUMBER: PHONE NUMB ER(optioto)t
/ w
CST N ATIJ R
DISTrlID.lI ION:01 i!p,W c,)I)v to 1 — ,i Ajoht1rily,P..Ii Iv OwnKr flat#S,)il Togw,r,
DILI III SBU 6395 IR.u2/81 OVEft
ST. CROIX COUNTY
x{ }� WISCONSIN
r ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON,W154016
�..+� (715)386.4680
S'eptembeh 6, 1988
Div soon o6 Sa6e,.ty and Bu Zdi.ng
} 5uneau o4 Ptumbing
P.D. Box 7969
Madtiaon., Wl 53707
Dean Si,%
An an zite invatigati.on 4ok the Lowell Scheid pxopenty, Located at the
SEA o6 the NG!% og Section 30, T30N-R19W, Town o4 St. Jo4eph, St. Cno-ix
County, ne.veated 4ui ab.Qe 4oZb at a depth. a(j 4 6eet:, bek.ow which
4ea6onabte high ground water wa.a noted.
Th.i.e bite shoutd be su.i,.tabee. 4on a mound b y4tem.
Shou,Ed you have any quati.ons, pteaze 4eet ghee to contact this 064.ice.
Sincere e y,
r.!�M
Thom" C. Nebon
Zon, n.g Admin-i.6tAatton
TCN/ju
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX 7969 � URR�� F LUMBING
MADISON,WI 53707
SF� NWi S30 T3ON-R19G1 9CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number:
4, 4) ) ❑ (If assigned)
Town U{ A. Joseph Holding Tank ❑ In-Ground Pressure ❑Mound
91 lt /1- /y - 16 y
NAME OF RMIT HOLDER: ADDRESS OF PERMIT HOLDER. INSPECTION DATE
Ldwe,Qt Scheid R. R. Hud6 an, W1 54016 //— 3—W S! 'Jo
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF,PT.ELEV..
Name of Plumber: MP/MPRSW Nr�. C�umy. Sanitary Permit Number:
Catvin Poweu Jac. 1563 St. C&Oix 112807
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
❑YES ❑NO ❑YES ONO
BEDDING - VENT DIA.. VENT MATT HIGH WATER I�IOIMIBER OF ROAD: 1PROPERTY WELL. BUILUING: TO FRESH
ALARM FEET FROM LINE IVENT
AIR INLET:
❑YES ❑NO ❑YES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MOUEL JPUVI SIPHON MnNUE AC 11111111 WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED:
❑YES ❑NO ❑YES ONO I ❑YES ONO
GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET.
PUMP ON AND OFF) OYES NO 101 1
SOIL ABSORPTION SYSTEM.Check thesoil moisture at the depth of lowln 1ENC,TH JDIAMF MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire,construction shall cease until FORGE
the soil is dry enough to continue. MAIN+
CONVENTIONAL SYSTEM:
WIDTH JLINGTH I NO.OF IDIS111 PIPE SPACINI, COVER :INSIDE DIA -PITS LIQUID
BED/TRENCH THE NC HFS MATERIAL PIT DEPTH
DIMENSIONS, ;.
GRAVEL D PTH FILL DEPTH UIST if PIPE DISTR PIPF. DISTR.PIPE MATERIAL NO DISTH NLIME3ER OF 'd PROPERTY WELL BUILDING. VENT TO FRESH
BELOW PIPES ABOVE COVER EI EV INLfI ELEV END PIPES -LINE. AIR INLET.
FEET FROM
NEAREST-
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-
❑YES ❑
meets the criteria for medium sand. TIONS MEASURED.
NO
SOIL COVER TEXTURE PI,HMANI NT MARKERS JOIISIIIVATION WELLS
_
DYES ❑NO _❑YES ONO
DEPTH OVER TRENCH BED DEPTH OVFH TRENCH BEU DEPTH OF TOPSOIL SOUDFD SFEUFU MULCHED
CENTER EDGES
DYES. ONO OYES F-1 110 OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH NO.OF LATERAL SPACING IGHAVII DEPTH HE LOW PIPF FILL DEPTH ABOVE COVER
BEDITRENCH TRENCHES
oimeNSIONS__:__:'
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO UISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING
ELEVATION AND ELEV.'ELEV.. ELEV. DIA. ELEV. PIPES DIA..
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT t.Y COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
EYES 0 N OYES 1:1 NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. INUMBER,10F ROPERTY P WELL: BUILDING:
FEET FRAM M;, LINE
DYES 1-1 NO OYES 1:1 NO NEAREST- , =
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE TITLE.
DILHR SBD 6710(R.01/82) Zoning Admini6ttatot
e _
�ILHR SANITARY PERMIT APPLICATION COUNTY
3�,,� Q' � In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT#/
//,22,0,7
—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. 3o03_0(4 2 $$
—See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES C2(NO
PROPERTY OWN E PROPERTY LOCATION
'/4 '/4, S T , N, R E(or
PROP Y OWNER'S MAILING ADDRESS LOT NU KErE R BLOCK MBER SUBDIVI NAME
CI STATE ZIP CODE PHONE NUMBER 0 CITY NEAREST TI AD,LA RhANDMA
E3 VILLAGE:
II. TYPE OF BUILDING OR USE SERVED: C)30 "- fd 7— ��Q
Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): 1711,4
III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable)
1. a.X New b. ❑ 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. El Conventional b.�Alternative c. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.El Pit Privy d. ❑ Vault Privy e.N Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. El Seepage Bed b.,X Seepage Trench c. ❑ seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Sure Feet): l�1
J�••�i Feet ( Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in allons Total ##of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
structed
Tanks 1 Tanks
Septic Tank or Holding Tank — ❑ ❑ El
I Li
Lift Pump Tank/Siphon Chamber ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the v e sewage system shown on the attached plans.
Plum er's Pame(Pri PI nature: o S ps) MP/MPRSW No.: Business Phone Number:
umber' ddress(S re ,City,St ,Zip Code): Name of Designer:
Vlll. SOIL TEST INFORMATION
Cert i' d So' Tester T)Name CST##
CST's RESS(St et,City, ate,Zip ode) Phone Number:
IX. COUNTYInPDARYMENT USE ONLY
Disapproved S itary Permit Fee Groundwater ate I suing Agent Signature(No Stamps)
A roved Owner Given Initial S arge Fee
mil. ❑
PP � ( h I�
Adverse Determination '""' ��O D�
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
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION
TO THE APPLICANT:
1. This sanitary permit is valid for two 2 ears;
YP OY ,
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 perm it 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 a licensee+'
pumper whenever necessary, usually every 2 to 3 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;
II. 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 a//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;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; 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 —Gro-und Ater
included the creation of surcharges (fees) for a number of regulated practices which Wisco IWS:
a
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasurR
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:
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- t
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
SBD-6398(R.03/86)
APPLICATION FOR SANITARY PERMIT
STC - 100
his application form is to be completed in full and signed by the owner(s) of the
roperty being developed. Any inadequacies will only result in delays of the permit
ssuence. Should this development be intended for resale by owner/contractor, ("spec
ouse"), then a second form should be retained and completed when the property is
old and submitted to this office with the appropriate deed recording.
er of Property 2i6�,
Location of Property nk 11A) � Section F( , T-I?JQ-- N-R9 W
Township
Hailing Address
Address of Site
Subdivision Base
t
lLot Number
Previous Amer of Property _L414,61 LA..rwl
( Total Site of Parcel
Date Parcel was Created
Are all corners and lot lines identifiable? _ Yes No
GIs this property being developed for resale (spec house) ? Yes _ No
Volume AW and Page Number as recorded with the Register of_ .Deeds
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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 (tool cvA i6y that att etatement�s on tlws ohm ahe tJcue to the best 06 my (ouh)
hnmtedge; that 1 (we) am (ahel Vie owneh(e� o6 the pnopehty d"chi.bed in th,i,A
tnAonmation 6ohm, by v.ihtue 06 a waAAanty deed hecohded in the 06 ice 06 the
Co„n.tyy Regi.4teh 06 Deede " Document No. ; and that I (we) phezentty
c.un I p�toposed Bite bon .the eewatne di�5p0.6 aye em (oh I (we) have obtained an
fdAtmtn.t, to hun with .the above deAcAi.bed phope&ty, Koh the conethuction o6 Aaid
Ayetem, and the Awn¢ ha.A been duty Recohded .in the 066tee o6 the County Reg•i,Ateh o6
VttdA, aA Uoement No. ) .
I�
SIGNATURE O OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED'
1 .
DOCUMEN-1 NO. 1PIA saTY k3ED
THIS SPAF:'F k+'J+v;M'n VED FOR Ri'.
438780 STA3'E BAR, OF 4 i SCONSIN F01-01 4—1982
�a 9th 814 5 V
tAu"E
R�c�i '��R'� +�
Edward A. Brown and Jane A. Browny husband and wifeT� �
- -- -
- -- ----------- - ---------
coneys and warrants to Lowell-Z. ---li i€. YiC�-. 1,i il.. l.., .1 1 ,>r_. ! '
4IAN A I
husb and.__and.-wi-ia.as.._aritai-.p.�.�p��fiY.wi.t.h_.�?.�h�._R�_.-.._. �2 �..��' P: '
survivorsh-11-------- ---- ----- ------ • ------- --- .. _..... -....
_.
-------------- -
... ...... . ......------------------------------------ -- .- .._.------._.-.. T TO ..._... -._ ., _..
.... .. .... .... ._ .. -----. .._..- ._- .. ..... ..---.....--------------..__ ..
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the following described real estate in ...5t••_.Croix ,,County, r
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State of Wisconsin: i
Part of the Southeast Quarter of the Northwest Q uakter of Tax f'arcei No, .............
Section 30, Township 30 North, Range 19 West,' described as follows: Belinning
point on the South line of the Northwest Quarter of said ,Section 30, 906 feet .
of the East line thereof; thence North parallel with said East {line 73i. feet;
West parallel with said South line 300 feet; thence South parallel wi '. :said
730 feet; thence East along said South line 300 feet to the POINT OF E�G'INNIN,
",'TR A N S PFF2
IP1
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is not
Phis - homestead property.
( j (is not)
Exception to warranties: easements and protective Covenants or Ilrestrictions of
record, if any.
I
Dated this ------ -- -- ------ -74day of ---.-June -- ..-.. - 19.8-8. -.
_._.(SEAL) - / '.1 -_-(SEAL)
- . - - --. ----- --. . -- .,,Da and A. Brow
.. . - _....(SEAL) L�- --.-(SEAL)
Jane A...Bxo.wan.__
AUTHENTICATION`�NN ACKNOWLEDGMENT
Signature(s) ------.---------------------------------------------------- STATE OF WISCONSIN
SS.
St. Croix
.......... .......... ---------County-,--.
authenticated this da y of ....__.--._., 19...... Personally carne before me h ' rk f}
�_.day of
7t1A@.....•.........................t iott.�.04Q vesiia'med
....-----••...................•I.........•••........... ...... ..... ---......... �.- ... ---TITLE: MEMBER STATE BAR OF WISCONSIN < w1
--------------_ -•-.........--- -.
(If not, ----•-----------------
suthorized by § 706.06, Wis. Stats.) to me known to be the person S.___'.c.�� who ��cil$d the
foregoing instrument and acknowledglt theTs�rtie.' "
THIS INSTRUMENT WAS DRAFTED BY
Lois A. Murray, HEYWOOD, CARI & MURRAY
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P.O. Box 229, Hudson, WI 54016 *--__k,:i. 'L�"-_��1 - �j(,LF?�d l I/U�� a
----------------------••.......••-•---•-••-•••--- Notary Public -----S-t----frA1X.._. -----------County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration
are not necessary.) date:
*Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STA`fR BAR DV WILOP NOtM y�tjsANpp.m i,rty�{ lyiy}nit bait• ti+�,
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SEPTIC TANK MAINTENANCE AGREEMENT o
St . Croix County z
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OWNER/BUYER Q17wC119 M
ROUTE/BOX NUMBER I& Fire Number
CITY/STATE ZIP
PROPERTY LOCATION : , �Z, Sections, T N , RW,
Town of _ St . Croix Coun y ,
Subdivision , Lot number 4p, 4K
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 , I
if needed , by a licensed septic tank pumper . What you put into I!
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. Ho
E
I/WE, the undersigned , have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with x
H
the standards set forth , herein , as set by the Wisconsin Depart- b
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
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 .
I --
ST. CROIX COUNTY
, M WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
` Y 911 FOURTH STREET • HUDSON,WI 54016
- (715)386-4680
Sepzembetc 6, 1988
Divizion ob Satiety and Bud eding
Bureau o6 Ptu.mbing
P.O. Box 7969
Madizon, Wl 53707
An on .bite investigation Jot the Lowett Scheid pupenty, tocated at the
SE4 ob the NG!% ob Section 30, T30N-R19W, Town ob St. Joseph, St. Cuix
County, neveated .su.itabte dohs at a depth ob 4 beet, below which
4ea6onabZe high gtcound watetc ways noted.
Thi6 .6 to 6houed be .6u,itabte bon a mound 6y.6tem.
Shooed you have any que.6tions, pteaze beer? bnee to contact th.i6 obbice.
SinceneZy.,
Thomas C. NeZ6on
Zoning Admin"ttcatotc
TCN/jAz
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