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030-1092-50-000
o 0 0 (D z LU z Z5 -a ■ 0 0 E —0_2 go 0 0) co CO 0 0. (D 0 U) z W C L F 0 E 0rD 3o E = o D Co LLJ (1) E 0 Cl) IL co .0 :!t 0 z � kf 2 E c Y, CD CL CD cu ON 0 (L) z co z z c 00 C141 C) E C,4 C) CL 0 (D co o Q IL C%J 04 < 0 U) U) P a 6 1 Z E> E z C) CD 0 0 0 0 w M M IL CL 0 U) .0 .0 w tE C CD C\l N a 0 E .0 ; moo :3 a) r_ CL U) (D CY) cy) 0 0 E 9 co cq 0 0 i (D a. 0 0) L9 CO a) c c 0 0 0) -0 N 0 0 r- 0 0 oi r 41.1 0) (D :: -S '5 z - A 4 r- o 17 (n 0 0 0 z z �2 a) 0 LO :3 / k\co *i= cj 0 (n c 1 LU cz CD z 0 0 L: IL 0 0 0 o 0 IL 0 U) 0 PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: _ �j Leng"'th: % Number of Lines: --3 Area Built:. Fill depth to top of pipe: - Number of feet from nearest property line: Front, O Side, O Rear,0 Ft . Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT � Size: /00 Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box 0 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: S Plumber on job: i c License Number: 1'�'�"ex X _ 3/84:mj Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT . . OWNER ` _ � � tiy� % �,�'� ?�f TOWNSHIP SEC. .2 / T b N-R W ADDRESS L ST. CROIX COUNTY, WISCONSIN T SUBDIVISION !'v LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Ok i r 2h INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: �— Proposed slope at site: 2� .i51 " � - SEPTIC TANK: Manufact er: (,vlQ�G� Liquid Capacity: Number of rings used: >' Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,O Rear, O feet From nearest property line Front 10 Side,O Rear,O feet Number of feet from: well building: (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 71469 BUREAU OF PLUMBING MEsDISON,1*I 53707 SW%,SE%,S31 ,T30N-R19W PCONVENTIONAL ❑ALTERNATIVE State Planl.D.Number: (if assigned) Town of St. Joseph ❑Holding Tank ❑In-Ground Pressure ❑Mound McKinley Road NAME OF PERMIT HOLDER: DRESS OF PERMIT HOLDER: INSPECTION DATE: 71622 Steve Erickson McKinley Drive, Hudson, WI 54016 41'30-8;7 //• BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.E L E V. Name of Plumber: MP/MPRSW N. County: [Sanitary Permit Number: Roger Timm 3224 St. Croix 92512 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: ITANKOUTLET ELEV.'. WARNIED`ABL PROVIDED: ❑YES 1:1 NO ❑YES ❑NO BEDDING: VENT DIA.: V T M TL.: HIGH WATE NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH A LINE: AIR INLET. FEET FROM DYES ❑NO Y S NO NEAREST DOSING CHAMBER: MANUFACTURER: [7 ING. IQUID CAPACITY: 1PU ODEL PUMP/SIPHON MANUFACTURER. ROVIDEDLABEL PROVIDED OVER❑NO EYES ❑NO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING. V NT TO FRESH LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) DYES ❑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 the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF DISTR.PIPE SPACING. COVER INSIUE DIA. SPITS LIQUID BED/TRENCH S- -� TRENC MAT IAL: PIT DEPTH DIMENSIONS r GRAVEL DEPTH FILL D P H DISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL NO.CIS NUMBER OF PROPERTY WELL. BUILDING: V NT TO FRESH BELOW PI P,,ES. ARO R: ELEV.INLET ELEV.END. ,—•� 2 C, PIPES. FEET FROM LINE. j� AIR INLET. l/J� NEAREST—► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM 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 ONO PERMANE NT MARKERS OBSERVATION WELLS SOIL COVER ITEXTURE ❑YES ONO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES. ❑YES ❑NO OYES ONO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE IMANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV.. CIA.: ELEV.. PIPES ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY. COVER MATERIAL. PLANS. ❑YES ONO REYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LINE ERTV L: BUILDING: FEET FROM �5 ❑YES El NO ❑YES 0 N NEAREST ( U Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. Zoning Administrator DILHR SBD 6710(R.01/82) INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION 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; A. 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 licensed pumper-,Whenever necessary, usually'every2 to 3years; 6. If you have questions concerning your private sewage syste i, 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 owners nanrne and mailing address. Provide the legal description where the system is to be installed; Il. 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; Ill. 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; 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 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 ;eve: 2 years of steady negotiation and public debate. The groundwater bill Ground AtBt included the creation of surcharges (tees) for a number of regulated practices which Wisco in.'s can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasurs is used in yo:.ar building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. a The 'non es olle cted through these surcharges are credited to the groundwater fLind adrn nis- ° here' by he `Jepartment of Natural Resources. These funds are used for monitoring ground- f water, groundwater contamination inv �n estigations and establishment of standards Crodvorater, ti it worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COUNTY (� DILHR In accord with ILHR 83.05,Wis.Adm.Code 7 e . ....—.�..o.. ST SANITARY PERMIT# • - �s-ia —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.Q.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION rvi 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES InJ No PROPERTY OWNER PROPERTY LOCATION _5i�e Cr/ 'r4J '/aSe %, S 3/ T Y4) , N, R :!� (or s PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUIABER SUBDIVI I N NAME CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAp,LAKE OR LANDMARK "// !r 5.040 14p VILLAGE TOI 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family —� OR Public(Spec ifA:___. --- III. PURPOSE OF APPLICAAT((ION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b.�I 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. 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. ❑ seepage Bed b. See a e Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14, ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): 70 5�0 I Ric 5�17 Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons 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 i ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ 1 ❑ 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) MP/MP�yW Business Phone Number: Plumb rj�Address(Street,City,St e,Zip Code): Name of Des' ner: / " VIII. SOIL TEST INFORMATION Certifircl,oil Tester(CST)Name CST# h alk-le-- a y�z CST's ADD RESS(Street,City,State,Zip Code) S Phone Number: T 6 ' 71a. X/ I O l x. 94 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) ®Approved ❑ Owner Given Initial S rcharge Fee ([ y Q Adverse Determination /�,A)6,06 �� Q ' �/ v X. COMMENTS/ EASONS FOR DISAPPROVAL: plea, iQwcl by 7'A61k7exs C_ 1► eIsdli SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - r - - - - - - - - - - - - - - - Owner of Property �'`��e /'rC lb<n 1 Location of Property . ..`� J , Section , T 3d N-R _ W Township ; �r Mailing Address 61 Z Z c / Address of Site •�� is Subdivision Name r rrr.r�r r Lot Number E Previous Owner of Property LJ •� Total Size of Parcel _ Date Parcel was Created Are all corners and lot lines identifiable? ." Yes No Is this property being developed for resale (spec house) ? Yes No volume _7!? and Page Number D 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. - - - - - - - r - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) eehti6y that a t btatementa on th�.a ahe thue to the but o6 my (oun) knowledge; that I (we) aM (vAe) the owners(.a for the phopehty dew i.bed in this s .in6ouwti.on 6o4m, by vi- tue 06 a wahnanty deed neeohded in the 06 ice o6 the u Co ,qty Regieten o6 Deeda as 'Document No. 0. ; and that I fWe) puAewtey own the phopobed e.ite 6oh the sewage diapod .aye em (oh I (we) have obtained an eaaement, to nun with the above deaehibed pnopehty, bon the conbthucti.on o6 chid dyetem, and the same has be n dut hecmded in the 066.ice o6 the County Reg.iaten o6 Veeda, as 17oeum No. ` ' ► . SIGNA 01 OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED 1� 7, _,?Ats OWX R9144TY Y V T, 0 'neet fort: own VT1 8, GRY 7� son and S:qmv4," ricltsop F i�b**And. wif i 'a's, 4 g� 44 X. wy. Tax Paveal No. ... ....... T 0 -f thar, Southwest Quarter of the Southeast Quarter ,of -a oh 3 Township 30 Noith, ,Range 19, West, and -part of t,1*1 of the Northeast Quarter of Sect.ion 6, west, QuaLrter "-;4Mwaship -North,, Rangp ,,;9 at, being shown and', d' cri and _t P,�of Cer jtlf isd Survey Map dated May 20, 1977� r of beed for -St. C i1i the Of f ice, of, Wgiste A- 9 junw� 17,,: 1977 in Vol. 020, page 0 ETHER ft-TH. a hon,-,jxclusiv*` right f way- over* i 'pA ri of, t4i,,Vorth 4 rodvi.,bf said Wrthwest rQuart,*r o i 411 �w4 he'ast duark*r- of-.Section 6,, Township `219 North,, Rango 19. th t fethe '"Wool- onveyed heroinj and ove r: e, lyinot-Wod :,o P's -c - he Bast halt of the ..Nokthwost Quarter -of -:2 rods',o f -,t isbip"�*,North#-,'tRange 19 West, both of:whi0h --. ' t 64 FITOW I�m ys of the -r*hts 'oZ way grantors believe4re publ.ic 'highwo 16seph. ttALSO TOGETHERVITH, on 6 -non-*,Xc Iust*Wi-,4 hi4fiwaistp easement& and o subject' to any' other ii,*"tki6i�s of, recdrd., `4 j is ell, dt 7> TOGZ?"R-XITH and SUBJECT TOiany 4, res0tvations or i�*strictions of record, i f' anyt,t .4 -;X, d�tb exttd :such otther recorded enbumbranc"�. 14 by, w- therefor. June 24th Charles D. Wahlbet 2 44, Reba A. Wahlber, ti ACKNOWLEDGIC52 k,A U T k E 14 T1 C A T tO N V%g ()F WIS 'I N NS IR/A St. Croix 11,:,�:,i� Can't. June Charles V. Wahlbq :1L AJ rg #V' Reba�,.A. Wahlbe V 1-4--1 414*1_1_i�A 1.6 F'�%*l s N t; z j�_ !�1�A !t�111, _44 MAP, W" 'A' 4� 4 H z H 9 STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT H St . Croix County z d a OWNER/BUYER° /G.���-1, ROUTE/BOX NUMBER 4ze_42 6120, /1,417AW/15 Fire Number CITY/STATE 1'd�-� �C ed ZIP f►�d�� PROPERTY LOCATION : ', S f' 14, Section ! T .3d N, R ' W, Town of ��� � h St . Croix County, Subdivision j / 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. H 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- ro ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Off ce w in 30 days of the three year expiration date . , SIGNED DATE St . Croix County Zoning Office P.O. Box 96- Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above address . r INSTRUCTIONS FOR COMPLETING; FORM 115 - SBD - 6395 To be,a complete and accurate soil test,your report,mrsst Include: 1. Complete legal description; _ 2. The. use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete 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 locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; S. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names,addresses,floors plain data, percolation test exemp- tion, if appropriate; 10, If the information (such as flood plain,elevation)does not apply, place N.A.in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3- 10") SS - Sandstone gr -- Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater cs Coarse Sand Perc - Percolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is - Loamy Sand > - Greater Than *sl Sandy Loam < - Less Than *! - Loam Bn - Brown *sil - Silt Loam BI - Black si.- Silt, Gy - Gray *cl - Clay Loam Y Yellow sc.l - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint *c Clay cc - common, coarse pt -- Peat mrn - Many, medium m - Muck d - distinct p - prominent HWL - High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP - Vertical Reference Point TO THE OWNER: This:.oil test report is the first step in securing a sanitary permit. The county or the Department may request r;r';hc,ation of this sail test in tl�e ficid prsor w ;permit issuance, A c°ornplete scat of glans for the private seo..°age system and a permit applicati'l-m mint he -,uhmitted to the appropriate local authority in order to ohoaati a ) r;T7rt. The�Prilt iy permit mwA ho oihtzd,"eed and posted prior to the start of any construction, I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115 P.°. BOX 7969 ) HUMAN RELATIONS 1 / MADISON,WI 53707 (H63.090)& Chapter 145.045) LO ATION. SECTION: TOWNSHIP/MbNtetI`tifiY: LOT NO.:BLK.NO.: SUBDIVISION NAME: scv 1/ 1/ 3/ /T 3oN/R/9 E ( )W sT To.sfA 7*--- COUNTY: OWNER'S*Bb-rI!R'S NAME: MAILING ADDRESS: sf ego ix D.P. h'�O.ro,v 4�•s USE DATES OBSERVATIONS MADE NO.BEDRMS.:ICOMMERCIAL DESCRIPTION: [PR,,OFILE ES RIP NS: R ATION TESTS: Residence j �/,� ❑New —��I�7 �� a RATING:S=Site suitable for system U=Site unsuitable for system / ��'�T/,r�D `s�VV/ CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-1 N-FILLHOLDING TANK:��EOM�MENDE S ST L:(optional) &P a s ❑u ©s ❑u ®s ❑u ❑s au ❑s �u •�� r - .pox . S,019 s If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: C`/¢SS Floodplain, indicate Floodplain elevation: 30 C7- 4444- �1.1` A49 PAA - PROFILE DESCRIPTIONS f--F �. BORING TOTAL D PTH TO GROUNDWATER-IN2MES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEQPTHJ#,•ELEVATIO,N OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) r /. �J'7 B- / o / „8� /� > O ' S �/:NC xA4,0_ Sit'. % 2 S •p i' I' DeM -Fr/I -i�7 it/ /0 ` v. S/ B- (p.S' b h1 .=R AR , p , v ck-ET o 3,0- B- .0 / 90 3� > •33'4,05 fr�l /.S ' a 351 RAek S oC-ettI- ' o+ JA3. S / B- /0 o s $a. S, a .B-3 7 to io 'O fi B- II PERCOLATION TESTS � TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERT D 1 PERT D 2 ER PER INCH P- P_ P- , 7 I N P-_ P- I I� PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate sc&or distances. Describe what are the hori. HA zontal and vertical elevation reference points and show their location on the plot plan. Show the i0I all borings and the direction and percent of land slope. + a•/ " SYSTEM ELEVATION 93' 'MIS test gtte septic sySte"" cam, onal AH � - 2 lx f E o, JH tN x. x . x x t use s 3. x I E E i - - - w 3 � J, ' wti I,the undersigned, hereby certify that the soil tests reported on this form remade b /��a 9.46 with--t procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests orrect 21st of my knj ledge and belief. DAP/CE NAME (print): HOMESIiE SEPTIC PLUMWftCO 4l TESIS WERE COMPLETED ON: RT.3 O'NEIL RD.,HUDSON,WIS.54016 r-i�� Z 2 /f.02 ADDRESS: WIS MASTER PLUMBER LIC.NO. 3307 M,P.R� CERTIFIC TION NUMBER: PHONE NUMBER(optionap: MINN. y�L OOW CST SIGNATURE- DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — r INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 6395 To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete 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 locating 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; 0. Complete all appropriate boxes as to dates, names,addresses,flood plain data, percolation test exemp- tion, if appropriate; 10� If the information (such as flood plain, elevation)does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIES} SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3- 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW - Nigh Groundwater es - Coarse Sand Perc - Percolation Rate med s - Medium Sand W - Well I's - Fine Sand Bldg - Building Is - Loamy Sand > - Greater Than *sl Sandy Loam < - Less Than *i - Loam Bn - Brown *sil - Silt Loarn BI -_ Black si - Silt Gy - Gray *cl - Clay Loam Y -- Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc Sandy Clay wl - with sic - Silty Clay fff - few, fine,faint *c Clay cc - common, coarse of -_ Peat mm - Many,medium m - Murk d - distinct p - prominent HWL - Nigh water level, * Six general soil I.extures surface water for liquid waste disposal BM - Bench Mark VRP - Vertical Reference Point TO THE OWNER: This sot rent report is the first step in securing a sanitary permit. The county or the Department may request v.,ilicat,on of dais soil test in the field prior rr permi# ssuance. A complete s:,,t of plans for -the private sr age system am d a pef . it anplicalion must be submitted to the appropriate local authority in order to z)."t;tli`a.}tyvC!"'€:€t. ?it�; �aE �s:r yd p""r rni-' 'n dt i,w J;3 !,wer„'rind posted.� ?IC?r to the start of any Construction. DEPARTI�VIENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RgLATIONS \ 1 MADISON,WI 53707 (H63.09(1)& Chapter 145.045) LOCATION. SECTION: TOWNSHIP/�1Alifdit'tP LOTNO.:BLK AME: yw �/ �/ 3/ /T,?o N/R�"E c r1 ST Jos�p�! ' COUNTY: OWNER' 'S NAME. LING ADDRESS: S1 401X S7Oe X e%C4MAJ �2Z tiIG USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: I)kRsidence New RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) ❑$ ®U ❑S ©U ❑S OU ❑S U ❑S ©U zlf;/z� ,g,�D�l.�,_ '�r►- If Percolation Tests are NOT required DESIGN RA I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) ��S • ,�&-6-y. s';1, .7S' 6y fl,, X33 ���d, . 47- 3 �"� Si' —/4F2 - er • Pi's T bR"G /to Ar - � 6 7 ' pu we r— '.aex^;,e- Qa . B- �� pr as •-�.y. s, , a,o $>, , 5 y. s, , w 1'�, B- .75 JAY-go-') SA3 _!ff �.o /Y 5V /0 SY. B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PER IOD 2 PERIOD3 PER PER INCH P- P- P- 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 ori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION I 'AP" r or —, € { for 1rei • j d.26; r i t CrTJ - E z it I 1 _... k_ -•..............v .................{..._...{,,.. .... ._ __ �....... f .L.... ;_ _mss.. ._...... '^�I--•.— } �mm ........... _�.�..,...;,.,.,. I jE 1 i i _.__ ___ _ _I_.. 1_ _t_ 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: c HOMESITE SEPTIC PLUMBING CO. 'L 2 / l ADDRESS: ROBERT ULBRICHT CERTIFICATTI N NUMBER: PHONE NUMBER(optional): •91S.MASTER PLUMBER LIC.NO.3307 M.P.0 Z/ I.— d 6 /A NN.{N3 ALL CST SIGNATURE: b��e� DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — REPORT ON SOIL BORINGS & PERCOLATION TESTS 115 PLOT PLAN Project I.D. MOMESITE Saw rLUMMNG CO, LEGEND IT 9 WNEIL NO.,MUMN,VS&ONM "SENT ULB"T • Ba c kh o e Pits MA&MASTER PLUMBER LIC.Na 3W M.PItg MINN.4NOTALLER i OEWJ*n W,No.OW X Perc Locations C.S.T. 2482 Q = Existing Well = Vertical Reference Point of W11 C,ffl4l(' Elevation of Vertical Reference Point �d �•� Lot Line Tfitif60 aft APPROVED N P ` for a conventional septic system. SCALE: o f old- s y s . o �o sI sal r I 4 ' �AIa I I D I (P �--- I , i i Sy pvll�f / G� Of w 1g �y Timm X06 �(Oe Frrc �SCSl1 SHEET NO. OF Z Excavating Co. CALCULATED BY ' 'fin"^ DATE �R I, Box 192, Wilson, WI 54027 3zyr� CHECKED BY DAEE-- I SCALE A. ' I I iI . ._........... . Af ,el I �' , CGS�rGVa ✓ i I ... Iw 1A- 31411 JOB `�r� �nGK$a Timm 61,- /1_ SHEET NO. of/f iP 1� ZI r 1 1I Yh DATE - 7-2-62 ' � • � Excavating Co. CALCULATED BY JL R , Box 192, Wilson, WI 54027 CHECKED BY DST{_ SCALE uCKr a��np,�eLR�►Y . ran ,w .... me G'a",M-QW1 a o N ° v � I o � N N � I I I I � I Z lL C O a I I it � w E a m I M o E 0 v O Z c w Z o o E a� 9 y aai N a� C • n.. 0 I ^O\ O a> Q v= Z m Z Z N Z N N t0 AA A a+ U O coIL ai N O • � aaa N a � I g 2 c m r-- ao } to J U O rn rn C \ O U e- O ] O 7 co y C _ y a)>- (4 O ..+ O 9 d Q a3 O OI y C O ���pyyy O O U d C tl �. CO 11\ �y co M L -0 y M f� M 2 v O CO y0 OE O y 'C Z C pp O d p CO• yin O M (n v co Z N S H rd (/) O rte.+ c .r E 63 V � Ed I a CL d • e� CL d d c E c c �1 A c°� a � I:. o3aic0 1-4 0 > 4) 0 N i � CO —0 4) (con) 0 z C= -F, r LL. .0- M 0 4) z U) 0 E M z co IL co U) 0 0 z 'a cc 0 z / /A E CD z Cl) N tM cc 4) CL c 0 zC ca o 4) <z 0) co E-i C*41 Cl) 0 2 M m CL c w CD 0 C*4 U) 04 ! .9 *4 d Q co U) E cL 4) m CL E NC3 *6 v Z 0 0 0 0 0 m w CL CL IL 0 U) L� r.— co 4) tt-- 0 4) r_ U) U) cc ■ 0) U) U) 0 CO 0 4") aD Cl) 0 U) M 0 CN CL m 4) 0) 4) c 17 4) C, —2 z E co<D co r co E ce) 00 CD z u Cl) CL EL L: IL 0 Cq CL 0 E 0 m ; 0 9z o 1 IL Parcel #: 030-1092-50-000 12/13/2006 09:58 AM PAGE 1 OF 1 Alt.Parcel#: 31.30.19.338C 030-TOWN OF SAINT JOSEPH Current j XJ 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 KIM D ERICKSON O-ERICKSON, KIM D 1199 MCKINLEY DR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1199 MCKINLEY DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 14.240 Plat: N/A-NOT AVAILABLE SEC 31 T30N R1 9W SW SE&SEC 6 T29N R1 9W Block/Condo Bldg: IN NW NE BEING LOT 1 OF CSM 2/389 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 31-30N-19W Notes: Parcel History: Date Doc# Vol/Page Type 06/30/2005 799062 2833/494 QC 07/23/1997 717/400 2006 SUMMARY Bill M Fair Market Value: Assessed with: 169320 320,900 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 14.240 156,300 122,100 278,400 NO Totals for 2006: General Property 14.240 156,300 122,100 278,400 Woodland 0.000 0 0 Totals for 2005: General Property 14.240 156,300 122,100 278,400 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 #: 030-1021-30-000 12/13/2006 09:58 AM PAGE 1 OF 1 Alt.Parcel#: 06.29.19.91A 030-TOWN OF SAINT JOSEPH Current 11 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 KIM D ERICKSON O-ERICKSON, KIM D 1199 MCKINLEY DR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1199 MCKINLEY DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 21.780 Plat: N/A-NOT AVAILABLE SEC 6 T29N R19W FRL NW NE EXC N 4 RDS& Block/Condo Bldg: EXC CSM 2/587 AND EXC PARCEL AS DESC IN 668/216 ALSO THAT PARCEL LYING N OF LOT Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 3 AND S OF LOT 2 OF C.S.M.2/587&EXC 06-29N-19W CSM 7/2025 Notes: Parcel History: Date Doc# Vol/Page Type 06/30/2005 799062 2833/494 QC 07/23/1997 821/478 07/23/1997 764/74 07/23/1997 753/383 2006 SUMMARY Bill M Fair Market Value: Assessed with: 168644 Use Value Assessment Valuations: Last Changed: 05/31/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 18.780 2,800 0 2,800 NO OTHER G7 3.000 26,200 26,700 52,900 NO Totals for 2006: General Property 21.780 29,000 26,700 55,700 Woodland 0.000 0 0 Totals for 2005: General Property 21.780 29,000 26,700 55,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r. F7 1 bill GOt'PTY 34089 CERTIFIED SURVEY MAP APPROVED S. W. 1/4 - S.E. 1/4 SEC. 31, T 30 N, R 19 W JUN 15 1977 N. W. I /A - N. E. 1/4 SEC 6 , T 29N, R19 W ST. CROIX COUNTY COMPREHENSIVE PARK$ PLANNWO APPROVAL OF THIS MINOR SUBDIVISION►. 442. AND ZONING COMMITTU 1�� � DOES NOT MEAN APPROVAL FOR SEFIBC, 440'59 SYSTEM. REFER TO H62.20 S 89-461-38' W Affjiavit- Vol. 603-05 N 200, 100, 5d .0' 100, I "= , � SCALE I = 200 0 __ BEARING ARE ASSUMEI lb 'b. ' pry N 89=46-38E ON THE 0=1 X 24' IRON PIPE SET °j ��^O o - SOUTH LINE OF THE WT. 1.68 LB./FT. ^�� °j LOT- I 0 1 ' 0 S.E. 1/4 OF SEC. 31 15.0 ACRES °o z OD �0` / $� CO. MON. c S.E SECT. COR. N.89-46-38E SECT. 31 (STING T30N- R19W 357. 96 : RESIDENCE --- — N RD_ - ---- ---- --- - ---1007.75' --- -,133.0 ----- 66.0' y" N 89 t 46'-38 E N 00-45-02I to W S 3 a58-39 W 340899 (SUBJECT TO N.S. P. i,�lR�yga;�� J� DEED VOL.149- PAGE497 CO. MON. S 1/4 COP. SECT. 31 ��� ,�G0 Ot j�r'�'PA�� THIS INSTRUMENT DRAFTED BY �A WBd�, A.C. NYHAGEN i +* GENE C. JOB NO, 77-24 .., FILED E SHAFFER JUN 17 1977 0i HUDSON o, AA" 01 CONNELL , WiS. 7 II so I # 60'w. C)► W- 86 s < a CERTIFICATE OF TOWN OF ST. JOSEPH I, Carolyn Barrette, being the duly elected, qualified and acting Town Clerk of the Town of St. Joseph, do hereby certify that this Certified Survey Map has bee approved by the Town Board of the Town of St. J eph this day of -_ 1977. Carolyn Yarrette, Town Clerk V" W 0 SEE REVERSE SIDE FOR SURVEYORtS VOL. 2 PAGE 389 CERTIFICATE .•.. CERTIFIED SURVEY MAPS ST. CROIX COUNTY, WI. AS BUILT SANITARY SYSTEM REPORT '"7NER f TOWNSHIP(6f SEC. 7� 1 T N, R W .0. ADDRESS_ ^ , ST. CROIX COUNTY, WISCONSIN. t;BDIVISION LOT LOT SIZE PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM PTIC TANK(S) 134!j�D MFGR. 5 ele S CONCRETE/C STEEL NO. of rings on cover / Depth DRY WELL '.ENCHES NO. of width length area ; D no.. of lines width "length� area��� dept to top of p g_e ' "GREGATE / �5 �� /l/�iio c , ;3RK RATE __23 AREA REQUIRE]) /'Z O AREA AS BUILT_�Z�Q sciaimer: The inspection of this system by St. Croix County does not imply complete ampliance with State Administrative Codes. There are other areas that it is not possible - inspect at this point of consttuction. St. Croix County assumes no liability for 'stem operation. However, if failure is noted the County will make every effort to ,termine cause of failure. ;EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. ~INSP, R DATED O PLUMBER ON JOB LICENSE NUMBER REPORT OF ITTSPECTION--IRDIVIDUAL SEI,IAGE DISPOSAL SYSTEM Sanitar y emit P State Septic •'A;>E tab* TOTRISHIp . t. Croix ou SF:°TIC TA'?K Si ze _ gallons. 4umber of Compartments Distance From: Well Z ft. 127 or greater slope ft. ' Building ft. Wetlands ' f. I�ighwater - ft. DISPOSAL SYSTL7 Tile Field or Seepage Pit(s) Distance From: dell ) ft. 12% .or greater slope ft 7 t Building ft. Wetlands f FiI4,LD Hifhwater ft. Total length of lines ft. !Number of lines Length of each line Z—ft. Distance between lines ft. Width of the trenc�6 ft. Total absorption area sq. ft. Depth r of rock below tile -7 'min.. Depth of rock over the Z, in. Cover ,over rock; k-1 Depth of tile below gradein. Slope of trench in per 100 ft. Depth tp Bedrock ft. Depth to Around water ft. PITS , Number of pits Outside diameter ft. Depth below inlet ft. Gravel around pit : ___y s 1 , o. :Total absorption area sq.—ft. c~ Square feet of seepage trench bottom area required Square feet of see r a required Inspected b* . Approved 7-c� �J , . Date 197 6 . Rejected Date 197 vh r I r� Ogg oil I Oil fill toe All I 7 Y1 ' ° 4 4 e„ 4 j ¢ R � 1 out e _ k jw oil S t A i I a c K 4: All QUA (" tk- i All `'k i I - - 7 t aE u + # •,G.x�,,.t..-- ,-a°v; �. �p ji t n {[ ma�°z �� � y � IR kit ioi 1 bq 1 1 t $ R II III State and C ounty State Pe rmit PLB� 7 Permit Application Coun t Permit 'A GJ am{ for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: t_5W'/4 g Section J4, T,-LO N, R-0 IG (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE F CC NCY: Commercial *Industrial *Other (specify) *Variance Single fam y X Duplex No. of Bedrooms nt No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder_YES �C NO # of Bathrooms Automatic Washer RYES NO Other (specify) E. SEPTIC TANK CAPACITY—/:3 -5-0 Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement_ Prefab Concrete *Poured in Place Steel Other (specify) 1Z 0C) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) ,Z3 2)__j(,-3) Total Absorb Area New Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length f�'Width Depth Tile Depth No. of Lines _ Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land I e fi—�- Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Cqrtifiecl Soil Tester, NAME �- - C.S.T. # and other information obtained from (owner/builder). Plumber's Signature P/MP SW# C Phone Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). °_ .4L, 4V 1 00 _ Al Nu , Do Not Write in Spac to FOR DEPARTMENT USE �-IONLY Date of Application �� Fees Paid: State /a, (/C) Coun y, Date f Permit Issued/.R (date) _Issuing Agent Name !f -° ° Inspection Yes_XNo Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/11/76 p � C� ddC� St CROIX COUNTY SURVEYOR'S RECORD 34 C}cs3L3 CERTI FIED SURVEY MAP APPROVED S. W. 1/4 - S.E. 1/4 SEC. 31, T 30 N, R 19 W JUN 15 1977 f� N. W. 1 /4 - N. E. I/4 SEC 6 T 29N, R19 W q/ 1 I�� ST. CROIX COUNTY r✓I,t — (j' V yUU L/ COMPREHENSIVE PARKS PIANNINO APPROVAL OF THIS MINOR SUSDIVISIONr 2.l��i I AND ZONING COMMITiq Ia1� DOES NOT MEAN APPROVAL FOR SEW 440.-5 5-' ' ' SYSTEM. REFER TO H62.20 S 89-46-38 W Aff#davit- Vol. 603-05 N 200' 100' 5d -0' 100, W SCALE I "= 200- BEAR ING ARE ASSUMEI j N 89=46-38E ON THE m 0 SOUTH LINE OF THE 0-1X 24' IRON PIPE SET h�0 �j i S.E. I/4 OF SEC. 31 o n WT. 1.68 LB./FT. ,0 LOT- I 15.0 ACRES O p CO z CO. MON. r S.E. SECT. COR. N 89-46-38E SECT. 31 EXIS FNG T30N- R19W 357. 96' -- . �FFESIDENCE 66 TOWN RD. �`---- ---- - -- - ---1007.75' --- -X33.0' ----- 66.Oo / N 89t 46*-38 E N 00-45-02 W S3o58-39W 340899 (SUBJECT TO N.S. P. CO. MON. ,�t�499� .;rxwVaP� DEED VOL.149- PAGE 497 S 1/4 COR. SECT. 31 �� ��JG j� THIS INSTRUMENT DRAFTED BY ,2 W.0, A.C. NYHAGEN 4 JOB NO, 77-24 +' GENE C. FILED S SHAFFER JUN 17 1977 g HUDSON o, AA" o'CoNu wIS. 7 *f•r of !sw@ v► �d O 8 �ttttt CERTIFICATE OF TOWN OF ST. JOSEPH I, Carolyn Barrette, being the duly elected, qualified and acting Town Clerk of the Town of St. Joseph, do hereby certify that this Certified Survey Map has bee approved by the Town Board of the Town of St. Jeph this day of 1977. Carolyn Yarrette, Town Clerk 6 1� N , SEE REVERSE SIDE FOR SURVEYORS VOL. 2 PAGE 389 CERTIFICATE ••... CERTIFIED SURVEY MAPS ST. CROIX COUNTY, WI.