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Parcel 030-2078-95-000 04/01/2005 09:32 AM
PAGE 1 OF 1
Alt. Parcel 33.30.19.667 030 - TOWN OF SAINT JOSEPH
Current X_', ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* CALLENDER, LOWELL A
LOWELL A CALLENDER
1209 RED OAK RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1209 RED OAK RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.750 Plat: 2234-OAK KNOLL ADD
SEC 33 T30N R1 9W OAK KNOLL ADD LOT 10 Block/Condo Bldg: LOT 10
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
33-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/13/2004 771601 2637/507 WD
07/23/1997 909/245
07/23/1997 739/551
2004 SUMMARY Bill Fair Market Value: Assessed with:
6377 140,100
Valuations: Last Changed: 09/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.750 59,500 78,300 137,800 NO
Totals for 2004:
General Property 1.750 59,500 78,300 137,800
Woodland 0.000 0 0
Totals for 2003:
General Property 1.750 34,800 83,900 118,700
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
6?
S T C 104
AS BUILT SANITARY SYSTEM REP pj~yf,`9'Oor
OWNER
r o(~ TOWNSHIP dg SEC T N-R& W
ADDRESS
OTC ST. CROIX COUNTY, WISCONSIN
SUBDIVISION S J LOT LOT SIZE or ~c
PLAN VIEW
Distances and dimensions to meet requirements of I1HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
v~
~e,
cP o
-tic 155 /1
tc' 5z~ 66a' f~Pp-
ol~
Y
bask S►~ t ~ y
DIC NORTH ARROW
BENCHMARK: Describe the vertical reference point used 1
Elevation of vertical reference point:
8D Proposed slope at site: / 0
SEPTIC TANK: Manufacturer: -Liquid Capacity:
Number of rings used:
Tank manhole cover elevation: .d#
Tank Inlet Elevation:
Tank Outlet Elevation: ZC)ff
Number of feet from nearest Road: Front,o Side, Rear, Q
feet
From nearest property line Front,0 Side,O Rear, O
feet
Number of feet from: well d /
, building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SrnF
` M
,AID- `
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: /r
Len `h: Number of Lines: G.- Area Built:
Width: j 9t
Fill depth to top of pipe:
/t
Number of feet from nearest property line: Front, Side, Rear, ht.
Number of feet from.well:
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT 9VA,
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:
O O.
Number of feet from nearest property line: Front, Side, Rear,
Number of feet from well:
NNumber of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
u~ / y Sc~
Inspector:
Dated: Plumber on job:
~ •
License Number:
i
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOFI & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 5?707
UCONVENTIONAL ❑ALTERNATIVE State PlanLD.Number.
Uf assigned)
Ll Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER! JADDRESS OF PERMIT HOLDER INSPECTION DATE.
Alfred Schmidt Rt. 2, Box 306A, Hudson, WI 54016 ~R
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV. CST' REF. PT. ELEV..
SW SE, Section 33, T30N-R19W, Town of St. Joseph, Lot#10, Oak Knoll
Name of Plumber: IMP/MPRSW No.. JEnu Sanitary Permit Number:
John Sykora III 3212 St. Croix 79167
SEPTIC TANK/HOLDING TANK:
MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.: WARNING LABEL ILOCKING COVER
I / PROVIDED. PROVIDED
rrt`°•^,'+~114Y"-~• _ VYES ENO DYES NO
BEDDING: VENT DIA.: VENT MAT( HIGH WATER - NUMBER OF ROAD: PROPERTY WELL- BUILDING. r' ALARM FEET FROM LI E JVENTTOFRESH
AIR I,NLET'.
DYES NO DYES DNO INEAREST~~
DOSING CHAMBER: '
MANUFACTURER 7YIN G LIQUID CAPACITY PUMP MUUEL PUMP NMANUE A1;Tl1HER WARNING LABEL LOCKING COVER
PROV IDEDPROVIDED:
ES ENO DYES ENO DYES ENO
GALLONS PER CYCLE: ND PUMP ONTES4 O ERATIONAL NUMBER OF 1HOPER11 WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM `1NE AIR INLET
PUMP ON AND OFF) LI NO NEAREST_-~
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of p owing 11,1AMI TEH 111ATIRIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall ceas until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH. LENGTH NO. OF ID11T. PIPE SPACING COV EH INSIDE OIA SPITS LIQUID
~THENCHES 6 M HIAL (_1
PIT DEPTH
DIMENSIONS 5T/1 UR.11' LL ULPTII FILL DEPTH UISTR. PIPE DISTH PIPE DISTR PIPE MATERIAL NO DI H NUMBER OF PROPERTY WELL BUILDING: IV ENT TO FRESH
BELOW PIPES, /l ` ABOVE COVER E(EV INLET EL v. FND 7 PIPES N ET FROM PRO AIR
~'EAREST-s !~f/^
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 syste s to make Art* that it ON REVERSE SIDE. SHOW ELEVA
meets the cri ria for mediuTIONS MEASURED.
DYES ENO
SOIL COVER TEXTURE ti - PER hIVFNT MAHKF HS OBSERVATION WELLS
DYES ENO DYES ENO
DEPTH OVER TRENCH BED JIPTH OVER TRENCH BEU DEPTH OF l PSOIL /[)[)I D ' SEE DF1) MULCHED
CENTER DGES
DYES ENO EYES ENO DYES DNO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH NIOTH. LENGTH NR EONCH ES. LATERAL SP IN (TRAVEL DEPTH H LOW PIPF FILL DEPTH ABOVE COVER
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH DISTR. PIPE DISTHIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV.. ELEV. DIA ELEV. PIPES DIA
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES NO DYES NO
'COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: IaUILDING:
FEET FROM LINE.
DYES ENO DYES ❑NEAREST
Sketch System on Retai i county file for audit.
Reverse Side.
SIGNATURE: TITLE:
t
DILHR SBD 6710 (R. 01/82)+ f,.
ulisconsin APPLICATION FOR SANITARY PERMIT
DILHR
(PLB 67) COUNTY
- ~EPRgTfT1EnT OF
inpusTRY.LRBOR&HumgnRELRT1ons UNIFORM SANITARY PERMIT #
qi6
-Attach Complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER
MAILING ADDRESS
AIS v~cd tiit ,d+ Z 96K 306A tfudro~ u1;. s~o~~
PROPERTY LOCATION CITY:
SW1/45E1/4, S 33 TAD, N, R E (a W VIwN o : 51t. se
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
ES TTM Al OR LANDMARK STATE PLAN I.D. NUMBER
O IcH p ~l r
~A NsA
TYPE OF BUILDING OR USE SERVED w`
1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): /V /A
THIS PERMIT IS FOR A:
K New System ❑ Tank Replacement ❑ Re air
El Replacement Soil Absorption System p
❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection
❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit
Ell System-In-Fill El Holding Tank
❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit #
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions, issued
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity O
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: S C Gd
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound 1:1 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
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY:
3 &iS 6z~
K 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:
M PRSW N Phone Number:
S o xx 3z I Z (715)569•y?f-S
Plumber's Address:
Z ISO X W B ~OD Name of Designer:
k~ P.ir Lill. S~ZZ'
COUNTY/DEPARTMENT USE ONLY
Signatu a of Issuing Agen F
Date:
''7] )pw~ ❑ Disapproved
/pC« /'~~j ❑ Owner Given Initial
Reason for Di pr al: Approved Adverse Determination
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
s
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/contractor,("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property t D j L 6 TA 4' n ti,,, 4] /lm /,JT
Location of Property S ~4, Section 3T 3n N- R C
Township C S p
Mailing Address
Subdivision Name
f\~
Lot Number U
Previous Owner of Property A E IV 0 , F. L l Eft ~
Total Size of Parcel Cle
Date Parcel was Created 5~ h~ f ?
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes ` y No
Volume '2, 19 and Page Number S-r/ as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. War
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) eeAt i6 y that at statements on thi,6 6on.m cute tAue to the but o6 ivy (oun )
hnow.bedge; that-1 (we) 6w (an.e) the owneh(b) o6 the pAopehty deg c ibed in this
injo4mation bonm, by viAtue ab a wa4Aanty deed neconded in the 046.ice o6 the
County Registeh o6 Deeds as Document No. l ~~3 ; and that -F (we)
phesentty own the puposed site bon the sewage posat syztem (on I (-we) have
obtained an easement, to nun with the above de6c ibed ptope&ty, {ok the
eonz thuc Lion o6 said system, and the same has been duty neeonded in the 066.iee
o. the County Regi6ten o6 Deeds, as Document No. ) .
SIGNATURE/ OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
H
c z
y
a
STC-105 r
a
y
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
d
a
OWNER/BUYER kA'Xr-_D C.. SCi~M i D
ROUTE/BOX NUMBER Q~x 30(,/~ Fire Number
CITY/ STATE DS n t ~ i i , Z I P
PROPERTY LOCATION:5 14, SW 14, Section, T_ 3,6 N, R 2 W,
Town of OSE{~ti St. Croix County,
Subdivision C,,4j , Lot number / Cb
_ I
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. y
0
E
I/WE, the undersigned, have read the above requirements and agree W
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.
a
SIGNED
DATE S / R -'9
St. Croix County Zoning Office
P.O. Box 9&,
Hammond, WI 54015 '
715-796-2239 or 715-425-8363
Sign, date and return to above address.
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DEPARTMENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS \ J MADISON, WI 53707
(H63.090) & Chapter 145.045)
LPCATI ____6_N_:7- SECTION: TOWNSHIP/fdb4+ 4P.A"TY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
_444 1/ 1/ 33 /T.3o N/R-• E
-To st,d/~- 4~4~`•vo
OUNTY: OWNER'S &HAOC-i'S NAME: MAILING ADDRESS:
5><•C'~°oix ~f/ S~~,y/fit ',QT Z o,~~ ~ o!/ ~v~1'ov (.v~•S .
USE DATES OBSERVATIONS MADE
NO. BEDRMR.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER OLATION TESTS:
1 X Residence IV.4 XNew ❑ Replace A41 A0 1/~,r ~6
Soil •S -9-t-7v OK ~••.,4> T . 5/%Otw S. ns scs 0-'12 Su pe tR1~ P'~~ -s f 7,0,f7* a
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM- (optio al)
zS0U1E1~FA_1Uj 0S ❑u oS au EIS KA ow N*R*0xu /1'X,5 L
a fs
If Percolation Tests are NOT required DESIGN RATE: [Floodplain, an
y portion of the tested area is in the
under s.H63.09(5)(b), indicate: indicate Floodplain elevation:
le-
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.)
B- i r //✓13z, > O 7S' V.4, . S, ,.is • v . ,s, V . a e 7~fA., UtA y e
s 7~~
B-3 116.7Ge ;7j;7- p,' B` . s, 33 s . /G %#4./ u*u as
jW, 174V 19_~ as
B-y C9 /rf. l~ ~ia-- 0
B-5 /0J >/o•S X P 3,V, S, ~v St 7o' xfx, vA~r C
B- This test site APPROVED
PERCOLATION TES
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER L RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
P- / .3i' ca s
P_ S
P- L • 1 2- 1
P < L
P _ r0
PLOT PLAN: Show locations f~ colation Ots, soil b ngs and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori
zontal and vertical elevation nce p s'i~ sh~u location on the plot plan. ~S/how the surface elevation at all borings and the direction and percent
of land slope.
'AIN
112-0 S i
SYSTEM ELEV "OIVW,°0 9
57,ye
Ij 4$
O SM~. I id
:
~ E LOT l
c S~
20 x
r j
,r
flit s
3. T~ WNF•
_ zaLc 1~iT - art Tok si~~ to
iS
E
74
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:
IA l bR ~c T'" /0
dY /o
ADDRESS: CERTIFIC TION NUMBER: PHON NUMBER (optional):
3 O'~e i 019SOA) l.~iS $ y0/ z~Fi 3 (-eie
CST SIGNATUR
r LL
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ~p ~y UT /}T .41'
S/~
DILHR-SBD-6395 (R. 02/82) -OVER - -1E ~~M - L
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