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Parcel 030-2028-70-000 01/11/2006 02:58 PM
PAGE 1 OF 1
Alt. Parcel 22.30.20.440F3 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
WILLIAM HOUSTON O - HOUSTON, WILLIAM
1406 HILLTOP RIDGE
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1406 HILLTOP RIDGE
SC 2611 SCH D OF HUDSON
SP 1700 • WITC
Legal Description: Acres: 3.800 Plat: 1766-CSM 06/1766
SEC 22 T30N R20W GL 4 THAT PART OF LOT 3 Block/Condo Bldg: LOT 06
OF CSM 3/822 NOW KNOWN AS LOT 6 OF CSM
6/1766 Tract(s): (Sec-Twn-Rng 401/4 1601/4)
Notes: Parcel History:
Date Doc # Vol/Page Type
06/09/2005 797235 2820/001 WD
06/28/2001 649772 1670/578 WD
06118/1999 605265 1435/335 PR
07/23/1997 977/180 PR
2005 SUMMARY Bill M Fair Market Value: Assessed with:
84340 321,200
Valuations: Last Changed: 07/09/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.800 220,000 72,100 292,100 NO
Totals for 2005:
General Property 3.800 220,000 72,100 292,100
Woodland 0.000 0 0
Totals for 2004:
General Property 3.800 220,000 72,100 292,100
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
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• Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNERorZG~ IjLcTOWNSHIP p5Z~ 14 SEC. 22 T
_ Q_N_RZ0W
ADDRESS ST. CROIX COUNTY, WISCONSIN
i AT ~ it 001AJ , ~JV A- L-6
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
9=
1~►
t
_ I
INDICATE NORTH ARROW
No ca le
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: / Proposed slope at site:
SEPTIC TANK: Manufacturer: ~l<-w Liquid Capacity: Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: //L; 7 Tank Outlet Elevation:
Number of feet from nearest Road: Front, Side 0 Rear, O
feet
.From nearest property line Front 10 Side,aear, O - feet
Number of feet from: well 'L
f , building:I~,''
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
s
PUMP CHAMBER
rr
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, 0 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: Length: Number of Lines: Area Built: >
Fill depth to top of pipe:
Number of feet from nearest property line: Front, CrSide, O Rear,0 ht
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 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:
Side, O Rear, 0Ft.
Number of feet from nearest property line: Front, O
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job:
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR
LABOR & HUMAsq RELATIONS SAFETY & BUILDINGS
P.O. BOY 7969 PRIVATE SEWAGE SYSTEMS DIVISION
MADISON, WI 53707 BUREAU OF PLUMBING
XX CONVENTIONAL ❑ ALTERNATIVE State Plan I.D. Number:
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If assigned)
NAME OF PERMIT HOLDER: FAD~ESS OF PERMIT HOLDER:
INSPECT N AT
George Holcomb t. Stillwater, MN 55082 ® D~ i1
BENCH MARK (Permanent reference pomt) DESCRIBE IF DIFFERENT FROM PLAN. 0 v 1`l
RE. PT. ELEV.: CST REF.PT.ELEV -
SE SW, Section 22, T30N-R20W, Town of St. Joseph,Lot#3
Name of Plumber: MP/MPRSW Nn. County
Sanitary Permit Number:
Gary 2appa 3300 St. Croix 79154
SEPTIC TANK/HOLDING TANK:
MANUFACTURER.
/0(
LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV WARNING LABEL LOCKING COVER
~'L PROVIDED. PROVIDED
.
BEDDING: VENT DIA.: VENT MAT! HI(iHWATER < YES ENO EYES NO
( I JALARM NUMBER OF ROAD: PROPERTY WELL: BUILDIN TO FRESH
L FEET FROM LINE. IVENT
gIR INLET
S-fy NO EYES C~~Vp NEAREST -LS-
DOSING CHAMBER:
MANUFACTURER'. BEDDING'. LIQUID CAPACITY PUMP MODEL PUMP; SIPHON IANIJI AC iIIHEH
WARNING LABEL LOCKING COVER
EYES ENO PROVIDED. PROVIDED:
GALLONS PER CYCLE: PUMP AND covrgo soPERgTIONAL EYES ENO EYES ENO
(DIFFERENCE BETWEEN NUMBER OF PROPERTY wELL BUILDING (VENT TO FRESH
FEET FROM NE AIR INLET.
PUMP ON AND OFF) EYES ❑NO_ NEAREST-1
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ulnMF TER M1tATE HiAE 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:
BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE SPACINI; COVER ]INSIDE UTA
/t/Y TRENCHES I / M~TEHIA L: PIT =PITS DpTp
DIMENSIONS
C; RA VLL ULI'T{ FILL DEPTH DISTH. PIPE DISTH PIPE DISTR. PIPE MATERIAL NO U -TH
BELOW PIPES ABOVE COVER ELEV. INLFI ELEV END F
NUMBE EET FROM PROPERTY WELL. BUILDING. VENT TFRESH
tt 7 C, PIPES FEET FROM LINE AIR INLET
J
3 0 2 / Z / I NEAREST--,
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-
EYES ENO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PEHMANF NT MAHKI CIS OBSEHVATION WELLS
DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEU DEPTH OF TOPSOIL j OIIUFU EYES ENO EYES ENO
CENTER EDGES 11E EDED
MULCHED
EYES. ENO DYES ONO EYES NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIOTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIP[ FILL DEPTH ABOVE COVER
TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD M7E O DISTH DISTR. PIPE UISTHIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV. ELEV DIA ELEV PES DIA
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHECILY CIAL
VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
YES ENO - EYES ENO
COMMENTS: PERMANENT MARKERS OBSERVATION WENUMBER OF PROPERTY WELL: BUILDING:
LINE
FEET FROM
EYES ENO EYES O NEAR EST=
9
Un Le,
Sketch System on
Retain in county file for audit.
Reverse Side.
SIGNATURES. I TITLE
DI LHR SBD 6710 (R. 01 /82) - /I
•.7.. wisconsin APPLICATION FOR SANITARY PERMIT
COUNTY
• DILHR (PLg 7
-
)
EWMMW~ OEPRRTTTIEnT OF 6 UNIFORM SANITARY PERMIT #
InOUSTRV, LRBOR 6 HLJMRn RELRTIOnS
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PR~Cd- ERTY OWNER MAILING ADDRESS
i L.
f -
~C'D•`'t f • l S~%//fit/~ P~v ~~w~ .
PROPERTY LOCATION ,f: /
SC 1/4 Sw 1/4,S- , T3ON, R :)'OE (or W TOWN OF 57 SEED 1r7L
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, L K STATE PLAN I.D. NUMBER
3 IV- •s"y • /a~ 3 12- w 3 N
TYPE OF BUILDING OR USE SERVED 0 - W10 U-Y
1 or 2 Family Number of Bedrooms: ❑ ublecify):
THIS PERMIT IS FOR A:
❑ New System ❑ Tank Replacement ❑ Repair
1>Q Replacement Soil Absorption System ❑ Revision ❑ Privy
El Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: AVIESIE~q O 44Ie-r C Q /
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROP ED (Square Feet):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signature: /MPRSW No.: Phone Number:
C R A 3300 (7/5'dj'd'.2 d'
Plumber's Address: Name of Designer:
1 f co . 3 S o~Q ~ f~l~~ /S .
COUNTY/DEPARTMENT USE ONLY
Signat re of Issuing Agent: IF eDate:
Disapproved
-7-10 E] Owner Given Initial
F~ Approved Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
e
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 '
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
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/contractpr,("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
Location of Property S ' W 1%. Section 2_Z T 3~ 0 _
N - R Z. 0 W
Township
Mailing Address
Subdivision Name AA
Lot Number ,
Previous Owner of Property
Total Size of Parcel dAlul-L
Date Parcel was Created ZM
Are all corners and lot lines identifiable? Yes No ,
Is this property being developed for resale (spec house) ? Yes No
Volume and Page Number as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. -,Warranty Deed
2. Land Contract
3.• Other recordings filed with the Register of Deeds Office
In addition, a certified survey, if available, would be helpful so as to avoid delays
of the reviewing process. If the deed description references to a Certified Survey
Map, the the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
I (We) eenti-6y that aU axatementa on .tW 6onm aite tAu.e to the be,b# 06 my (our)
knowte dge; that I (we) am ( are) the owner 1 a) o6 the pnopen ty dea cAibed in ,th.c a
in6onmati,on 6onm, by vi tue o6 a waAAanty deed %econded in the 066ice o6 the
County Reg.ca,teA o6 Deede as Document No, W60 ; and that I (we)
pnea en.tly own the pnopoa ed 4ite bon the a ewage diapo,&at a ya.tem (oA I (we) have
obtained an eaeement, to Aun w.c,th the above deaehibed pnopen-ty, bon the
conatnu.cti.on o6 aaid ayatem, and the aame has been duty tecoAded in the 066.iee
o6 the County Reg.cateA o6 Deeda, as Document No. ~-r b6 )
b
;q NOR Ic
SIGNATU OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
I ~ 7
DATE SIGNED DATE SIGNED .
H
H
a
ST C- 105 r"
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a
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
t7
a
OWNER/BUYER ,9_01,'Cg5 C~~ H
to
ROUTE/BOX NUMBER X ab Fire Number
.CITY/STATE ZIP
PROPERTY LOCATION: 14, Section 2-L T 3C) N, R a W,
Town of_ 5 . St. Croix County,
Subdivision Lot number 1
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 z
to maintain the private sewage disposal system in accordance with x
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.
SICNEDA"[_
DATE_16? 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.
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P
ND
US RY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
UST DIVISION
U AND
I PERCOLATION TESTS (115) P.O. BOX 7969
UMA MAN RELATIONS \ /
5 1' r4/~ ' (1-163.090) & Chapter 145.045) MADISON, WI 53707
~Cgq,TION: SECTION: TOWNSHIP/
1~• v7 LOT NO.: BLK. NO.: SUBDIVISIO NA E:
/-a7- t/4 1/4 22 /T 3o NIR20 E (or) W Sr ilos~>o~/ 3 _ cE,pr. uVFy
COUNTY: OWNER'S18UYER'S NAME: MAILING ADDRESS: y 2 lee 4-e
Sr. neo,X Sv f e //az ee /"c4 STiLLI~/.Q T E.F'
JSE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMER IAL DESCRIPTION: ❑New ~vReplace I I~f PROFILE DES RI TIONS: ER OLATION TESTS:
Residence 3 IV 14 8/ZZ/,~~ ~J 1
IATING: S= Site suitable for system U= Site unsuitable for system 7 /
NVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: F~COON~N~DE
I Zq
~
. ~ TE(~/I:(op ~I~~D
Ns au ❑s ~.u Ms []U []S Zu os u
i 8rcolation Tests are NOT required DESIGN RATE: [41oodplain, n
n / n any portion of the tested area is in the
nder s.H63.09(5)(b), indicate: indicate Floodplain elevation: " / x
33 ~in/~ ~ PROFILE DESCRIPTIONS
30RING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
vUMBER DEPTH IN, OBSERVED EST- HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B Ne NE
..t'-~ •dn Ga.
B- 2 12 6 91. f' NO N E > /2 6 30 30 a,,
-e zo,4
B- NO AAA 7 /C4-O 12 gJ ! 6- ra-7 e
/ ~ 34 .Qri G2
B A/E B-
B-
PERCOLATION TESTS ezx S s
EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
d-_dBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
P. 2 62 O S Z. 2 / I/V
.
P- 60 O 5. 2 2 .
P-
P-
PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
intal 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
f land slope.
;YSTEM ELEVATION 9S4
82 s'P/h' EI a:v ~ I ~ - , a
o ~~/APO w
A N
D _L a cA Tid y
s
__PEIle? eZA 77;1,0 4/ T f7"
/od•a b v
x Nurr~ B~.e ~ Lo c¢_~'ioy
-sue t.
F
1,47
I
I '
' ( I s
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
Aministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
IAME (print): TESTS W RE CO PLETED ON:
( ~~f'I
G~/,q `r--,C ~ a.Py -I
ADDRESS: CERTIFICATION NU BER: PHONE NUMBER(optional):
/2 E . EL /yj S'T, E",P FALL s~ Cti// S~dZZ .S
cs~r'SIGNATUR
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Fresh Air Inlets And Observation Pipe
Approved Vent Cap
Minimum 12" Above
Final Grade
M cove 9y603
yl Above Pipe 4 Cast Iron NoTE".
1 .3 Vent Pipe ~Pp~oXi~.~rF~Y
To Final Grade
F-/. o ~ 40pSoi/
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ggregate
Over Pipe
Distribution
Pipe - 0 0 0 0 o Tee
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f o Beneath Pipe Perforated Pipe Below
o Coupling Terminating At
FT. Bottom Of System
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