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Parcel 030-2081-30-000 05/27/2005 08:29 AM
PAGE 1 OF 1
Alt. Parcel 25.30.20.690 030 - 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
MARK J & JODY L KELLER "KELLER, MARK J & JODY L
1369 PINE VIEW TR
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1369 PINE VIEW TR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.770 Plat: 2644-WOODLAND HILLS
SEC 25 T30N R20W WOODLAND HILLS LOT 13 Block/Condo Bldg: LOT 13
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
25-30N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/12/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.770 86,800 144,400 231,200 NO
Totals for 2005:
General Property 2.770 86,800 144,400 231,200
Woodland 0.000 0 0
Totals for 2004:
General Property 2.770 86,800 144,400 231,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 105
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC. T N-R W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of ILH.R 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
jj
\ 4,6
1 r
iv'i _
'C 41
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used i
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,0 Side,o Rear, feet
From nearest property line Front,0 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
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: Lenith: Number of Lines: Area Built:',
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, O Rear Ft . "
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:
Inspector:
Dated: Plumber on job: 1
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & 69 RELATIONS
P.O. BGti 79969 PRIVATE SEWAGE SYSTEMS
DIVISION
•MADISCN, WI 53707 BUREAU OF PLUMBING
CONVENTIONAL DALTERNATIVE State Plan lD.Number
❑ Holding Tank ❑ In-Ground Pressure D Mound (If assigned)
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER'.
INSPECTI N DATE.
pS~~ ~C~
Mark Keller R. R. 1, St. Joseph, WI o "6'
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: (O
REF. PT. ELEV.: CST REF. PT. ELEV
SE NE, Section 25, T30N-R20W, Town of St.Joseph,Lot#13,Woodland Hills
Name of Plumber
MP/MPRSW No.. Coumy. SannaryPermit Number:
Donavin Schmitt 3205 St. Croix 64866 j
SEPTIC TANK/HOLDING TANK: I'
MANUFACTURER'.
LIQUID CAPACITY. TANK ]OF ET ELEV. . TANK OUTLET ELE V.. WARNING LABEL LOCKIN OV
O Y P V DE) PROVI
YES ENO NO
BEDDING: VENT DIA. VENT MATL HIGH WATER NUMBER ROADPROPERWEL BUILDINGVFEET FR7 LINE IL AIR DYES ENO DYES ENO NEAREST J a
DOSING CHAMBER:
MANUFACTURER BEDDING'. LIQUIDCAPACITY PUMP MODEL. UMP/SIPH MAN FACTURER
WARNING LABEL LOCKING COVER
PROVIDED'. PROVIDED:
DYES ENO EYES ENO DYES ENO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERAT NA UMBER OF PROPERTY WELL BUILDING VENTTO FRESH
(DIFFERENCE BETWEEN FEET FROM INE IAIR INLET
PUMP ON AND OFF) DYES ❑N NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plo ing FN(;TH 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
BED/TRENCH TRENCHES ° NSIDE DIA rrPlrs LIQUID
DIMENSIONS t °D Q i " ERIAU PIT DEPTH
w
(]RAVEL DEPTH FILL DEPTH DISTH PI PF UISTH, PIPE DISTR. PIPE MATERIAL: NO. ISTR NUMBER OF PROPS RTV WELL. BUILDING. VENT TO FRESH
BE LOW PIPF( Aljjy OVER ELEV INLET ELEV. END q PIPES LINEG
T
7 33 A'Rf
1}vw ddCC C~~ 2 FEET FROM
L
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-
DYES E NO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
DYES ENO DYES ENO
DEPTH OVER TRENCH: BED DEPTH OVER TRENCH,BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDG ES.
DYES ENO DYES ENO DYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTHIBU T.- PIPE MATERIAL & MARKING
V. . PIPES DIA
ELEVATION AND ELEV ELEV CIA ELE
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING; DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLAN
1
S
DYES LINO DYES ENO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY W
.
FEET FROM LINE'
DYES ENO DYES ENO NEAREST
Sketch System on / etain in county file for audit.
Reverse Side.
SIGNATURE. TITLE:
DILHR SBD 6710 (R. 01/82)
wisconsm APPLICATION FOR SANITARY PERMIT
(~I DILHR COUNTY
a_~ OEPRRTTEnT (PLB 67)
.1 UNIFORM SANITARY PERMIT #
~i InOUSTRV,LRBOR5HumRn RELRTIOnS
-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
r 5 - ,cr
PROPERTY LOCATION CITY:
1/4 /4, S T. a N, R E (Dr IJIf TOWN OF / t
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
13
TYPE OF BUILDING OR USE SERVED C-r 0W - ,o7_
L Tor 2 Family Number of Bedrooms. 3 ❑ Public (Specify)A,* a~
/of W-rL -
THIS PERMIT IS FOR A:
New System ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System Ll Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
11 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 Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF T NATIVE SYSTErJI COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel ss Plastic
Tanks Concrete Constructe
Septic Tank Capacity
Lift Pump/Siphon Chamber =777i7~~ /t
Manuf
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (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): Signatu M PRSW Ngr: Phone Number:
T (7%.i~ try
Plumber's Address: Name of Designer:
`T lrvr' y~ 5 r ~ COUNTY/ DEPARTMENT USE ONLY
Signatu / re of Issuing Agent: FEe: Date:
El Disapproved
C/e1C ❑ Owner Given Initial
1„C s ; 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
1
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.
' l
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
Location of Property i ' Section T_ N - R W
Township
T
Mailing Address
y
Subdivision Name V~
~ Z
Lot Number `
Previous Owner of Property
Total Size of Parcel 22 `
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 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.
PROPERTV OWNER CERTIFICATION
I (We) eeAti.6y that aPt atatementa on this 4o4m ane tAu.e to the beat o6 my (oun)
knowledge; that I (we) am ( cute) the owner (a) o6 the pAopenty des cAi.bed in .this
.in6oAmation 6onm, by viAtue o6 a wahAanty deed keeonded in the 066.ice o6 the
County Reg-ia.ten o6 Deeds as Document No.~~ S ; and that I (we)
pneaente.y own the proposed 6.1te bon the sewage di.apod bya-tem (on I (we) have
obtained an eaeement, to tun with the above ducAibed pnopenty, bon the
con6t&uction o6 da.id 6y.6tem, and the tame has been duty recorded in the 066.ice
o6 the County Reg.c.s.ten o6 Deeds, as Document No. ) .
i
I~
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_
SIGNATURE OF OWNER SIGN,AT E ESC -OWNER (I APPLICABLE)
DATE SIGNED DATE SIGNED
~L L6 9D'GLZ b f6 19 LO BZZ CO OOf M1•r~ PC Mf
09 fL4 96 607
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SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
0
OWNER/BUYER
ROUTE/BOX NUMBER Fire Number
CITY/STATE ZIP
PROPERTY LOCATION:, Section T N, R W,
Town of St. Croix County,
Subdivision Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into 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.
0
E
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- 'v
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED-
DATE
/:J
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.O. BOX 7959
;I_LATIGi,s 53707
(H53 0 )M & C;hnpter 145.045)
ATfM iN: =t I ION' 1~1f.~ UNIr l?At I TY. - O 31_K_ NO
SU3DI V!S') J lA`it
.'}NI 4
j N7Y: O'~JNrR $;BUYER:S NANIE: v1AILING /\L DHLSa
Ltcc _ DATES OBSERVATIONS MADE
N0.8cDRNr-,: COrvwM R IAL 0ESCRPTION: , PFli~rl~r D rSC`~IPfI~NS: ~L jDJ 7cSTS:
'Residence / 1\ ~1;"w ❑Rnplace
41 RATING: S= Site suitable for system U- Site unsuitable for system
(IV 'ENTIONAL: MC)I I^J IN-GROUNfyPRFS;URE SYSTEM IN-FILL ROLOiNG TANK RECOMMENDED SYSTE%I Ioption+l)
--U1 1EASEA1111SU-J
Ali F'--, cola,ion Tests are NOT required DESIGN HATE:
If any portion of the tested area is in the
--ier s.1-163.0if5)(b), indicate: ( Flocioplain, indicate Floodpl-in elevation: ~1, 7-`^
PROFILE DESCRIPTIONS
Pi NGj TOTAL QPPTH TO C HOUNCIb^JA (ER + v 4i=S CHARA( TEFR OF SOIL b+iTH TMCKNESS, COLOR, -(EXTURE, AND DEPTH
_1E.q EPTH.ELEVATION pF3SERVtCl -EST. Hi( n ~TO BEOf t)CK IF Cdr AVER (Si-t_ r'WESHV.ON E ;Cis )
I ,
r / / ~^--1' ~,t~~ ,,.~_~'~•C~_. ~ ~ , ,1~, ~ a'] 4~N L alt//
O,~U 3L~J7-5V 3nJj;L~rrjo' !~~.5 f^~ C.
< ~r a
T PERCOLATION TESTS -
F- f T,
I DEPTH daATER IN HOLE TESTTiMF DROP IN t%Ai- ER LEVEL i ,CiIcS RATE MINUTES
T.BER j••:GMtFS Af ER SNItLLiNG INTERVAL-MIN F_-qj ~p 1 P_RI0D 2 FPER INCH -
'LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
=antal 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 :and slope,
YSTEM - ELEVATION fz~ ~ cis, pLE~ ~N -r' !q
,
i~
1 ! ! I ' I } r ! O E-~CGtL ATtA/+j f ST Q,
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I ' I i _ i +t 7 1 ' 21oa 4 8)
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9; 7 ; 20 r I a°
,e undersigned, hereby certify that the soil tests reported on this form v%-~re made by we rt accord with the pFncedure.s and method, specified in the Vi,sconsin
-;;ri;trative Code, and that the data recorded and the location of the tests are correet to the best of my knowiadt;e ai,d-belief.
;1 (print): - TFSTS `I=RE CO-wIPLETFD ON:
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