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O ❑ O (D p CD = N o (D O a = O y A i Vl O a a Ik o0 m 0 (v o 1 O * o y ° 2 °o ~ o Parcel 030-1094-95'5-001 ~6 C 6' 03/01/2005 11:15 AM PAGE 1 OF 1 Alt. Parcel 32.30.19.344H IWV 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Applicati # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner * MONROE, ROBERT L ROBERT L MONROE 450 CTY RD E HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description * 450 CTY RD E SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.490 Plat: N/A-NOT AVAILABLE SEC 32 T30N R19W NW NE & NE NW LOT 1 OF Block/Condo Bldg: CSM 5/1479 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 32-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 09/10/1998 586864 1356/243 WD 07/23/1997 707/129 2004 SUMMARY Bill Fair Market Value: Assessed with: 5587 239,600 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.490 81,500 154,200 235,700 NO Totals for 2004: General Property 3.490 81,500 154,200 235,700 Woodland 0.000 0 0 Totals for 2003: General Property 3.490 47,900 121,200 169,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 131 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 030-1094-955-001 02/25/2005 10:35 AM PAGE 1 OF 1 Alt. Parcel 32.30.19.344H 030 - TOWN OF SAINT JOSEPH ST. CROIX COUNTY, WISCONSIN Current X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner MONROE, ROBERT L ROBERT L MONROE 450 CTY RD E HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 450 CTY RD E SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.490 Plat: N/A-NOT AVAILABLE SEC 32 T30N R19W NW NE & NE NW LOT 1 OF Block/Condo Bldg: CSM 5/1479 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 32-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 09/10/1998 586864 1356/243 WD 07/23/1997 707/129 2004 SUMMARY Bill Fair Market Value: Assessed with: 5587 239,600 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.490 81,500 154,200 235,700 NO Totals for 2004: General Property 3.490 81,500 154,200 235,7000 Woodland 0.000 0 Totals for 2003: General Property 3.490 47,900 121,200 169,1000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 131 Specials: User Special Code Category Amount Special Assessments Special Charges 00 Delinquent Charges 00 Total 0.00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT SEC-, T 3 N-R~W -LL OWNER% TOWNSHIP ADDRESS ST. CROIX COUNTY, WISCONSIN Y LOT LOT SIZE SUBDIVISION t{ ~I VIEPM J V C .12e/ PLAN Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM v i r k - cc) - I ~ 1 ~ )t+ ~ t~~ .~2 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 4 Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: /-4j Tank Inlet Elevation: J Tank Outlet Elevation: /("(/o ~Zz::l feet Number of feet from nearest Road: Front 0 Side 0 Rear, feet , > > O From nearest property line Front Side Rear Number of feet from: well , building: SEE REVERSE SIDE septic tank) (Include this information of the above plot plan)( 2 reference dimensions r PUMP CHAMBER Manufacturer: Liquid Capaclt/ _ y: Pump Model: Pump/Siphon nuf cturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elev ion: Gallons per cycle: Alarm Manufa rer: Alarm Switch Type: Number f feet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: 7~ Number of feet from building: i (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: ~idth: Leng'th:~ fj Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front i OSide, ~Rear, Op't 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 Bui Has eit r a drop box O or distribution box O been used on any of the above soil ab btion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlety/ i Number of feet from nearest property line: Front, O Side, Rear, O 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: _ Dated:- - Plumber on jb: ~rr License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O'BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707, ® CONVENTIONAL ❑ ALTERNATIVE State Plan I D Number: ~1f ass ip ned) ❑ Holding Tank E In-Ground Pressure ❑ Mound ________f NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER, INSPECTION DATE. Peter Kocik Route 1, Box 180, Hudson, WI e 0 BENCH MARK (Permanent reference Point) DESCRIBE IF DIFFERENT FROM PLAN REF. IT. ELEV.: CST REF. PT. ELEV NE-', NW4 Section 32, T30N-R19W, Town of St. Joseph Nam of Plumber_ MP, MPRSW N,~ Cnunly Sanitary Permit Number. Gar L. Steel 3254 St. Croix _ 69623 SEPTIC TANK/HOLDING TANK: MANUF ACT UR ER. LIQUID CAPACITY. TAN ET ELE ' TANK OUTLET FFF,,,,,,VVV WARNING; LABEL LOCKING COVER PROVIDED PROVIDED- ~j DYES LINO EYES ONCE BEDDING'. VENT DIA VEN 11 HI(,H WATER NUMBER OF TROAD PROPERTY WELL BUILDI ALARM FEET FROM LI AIR INLET DYES NO - IJYES [-ENO NEAREST ~IENTT1111S7 DOSING CHAMBER: IMANUFACTURFH BEDDING LIOUII) ('APA(:I T Y iUMP M(~I)F I i',f ~.1P til Plt[)N 11.,N(l1 Al:7LrHFH WARNING LABEL LOCKING COVER PROVIDED PROVIDED DYES LINO ` - _'YES LINO DYES LINO GALLONS PER CYCLE: PUMP ANDCQNTROLSQPERATIONAI i j NU BE OF HoPFHrV wEL L aenLDING VENT TO FRESH (DIFFERENCE BETWEEN FE T,IFROM "F R INLET PUMP ON AND OFF) EYES NO N REST-=*► SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing f+ - A%1F fF 1t J %+ATI RIAL AND MAHKINr, or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) [7FORCE IN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH I FNGTH IN O nF - v17F a wl to SSIUE r,In LIQUID t r 9E ti.y+F S r.tAr ;r DEPTH DIMENSIONS C --y PIT GF? DEPTH FDEPTH I11Slli PIP[ DISTH PIP UE DISTR. PIPE MATERIAL NO 1) H NUMBER OF PROPER 7V WELL BUILDING VENT TO FRESH HF LOW PIPE S EI f V INI k ELYN h PIPF S LI~] AIR INET97 q/ i 1 J 2 `t NEAR_ESTO MOUND SYSTEM: L 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 LI NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE Pi ItMANFNT MAHKF<v OHSFHVATIONwFL IS ❑YES NO DYES NO JDEPTH 1111EH TRENCH BED DEPTH OVFH THEN(H HE U CENTER DEPTH ()f T1)P1(IIL ~ ti( )Uf l) SF DF;T MULCHED EDGES AYES NO ❑YES ONO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF L RAI. SPACING 04AVEL DEPTH BELOW PIP' FILL DEPTH ABOVE COVEH BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFm D DISTH PIPE MANIFOLD MATERIAL O DISTH DISTH PIPE DISTRIBUTION PIPE MATEHIAL& MARKING ELEV ELEV DIA ELEV PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLS D COHHEI I L Y COVER MATEHIAL VEHTICAt L IFT CORRESPONDS TO APPROVED PL APIS ❑YES LINO LYES LINO COMMENTS: PERMANENT MARKERS OBSERVATION WELLS. ~NNUMBER OF PROPERTY WELL. BUILDING FFET FROM "E ❑YES 1-1 NO DYES ❑N Sketch System on l Retain i , c unty file for audit. Reverse Side. S I G N ~TURET I T L E ~Z ~1 DILHR SBD 6710 (R. 01/82) 4 wlsconsln APPLICATION FOR SANITARY PERMIT / '~ID I L H R ~b Z L COUNTY InOUS T Y,LRof (PLB 67) UNIFO MVANITARY PERMIT # - 'InOUSTq V, LR60R 6 HUTRn 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 PROPE Y O NER MAILING ADDRESS PROPERTY LOCATION CfT' . 1/4 k)/4, S , T)'o, N, R ~j (or) W TOWN OF: xdi-s~w ~j LOT NUMBER BLOCK NUMBER JSUBUIVISIPN NAME NEARES ROA LA OR LANDMARK STATE PLAN I.D. NUMBER N Zl,~ Ql L-L TYPE OF BUILDIN OR USE SERVED ~GQ~G~` cJ GV lQg~--~J/ 0~-1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: r2' New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ 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 (L Vault Pri y ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit ~1 ~ 11 - issued (,113/ 1 d An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Gallons Total #of Prefab. Site Steel Fiberglass Plastic Tanks Concrete Constructed Septic Tank Capacity e0-6, L Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: c IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mou rid ❑ In-Ground Pressure Total # of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 6 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Nam f Plumber (Print): Signature: ) PRSW No.: 1Phone Number: Plum -er's Ad ress: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved -vr 5i I❑ Owner Given Initial / 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 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 dimensio 13. Horizontal and vertical elevation reference points that are permanent and clearly _i.cvn. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line frorn 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. v p to x ~ o CO) 0 CCD m ID A, 'CD co c O 0-03 'CO 01 w W w c° D t-7 c CD C a m m O O 4a N m Q 0 p w p m= cD m jw0~ m~CDCLW m n -t `c R CD CD - --3 --T cD _a ° m co ti ° CD - cp W co=wocQ x w o o -T o ° C O c`G Q'm a00 ' C ? Ul 1 CD w w ~ Al O ° a D 0 D CN w 00 , <mcn Q.mc~0 cn 'N O0 cn o D c -N o ° 0 0' m o O co Cc aw -r 0 --o~a `CSm o ca ~aQ~ w O m ° ai M m° w^ w vi c co m ~cQ z D 0 =NCD CDCD0-x ~ z mCD0 3`N CD CD a cn=a omF~03' D SU OL 0) ? ° ~ p m W CD _-x iw w 0 CL CD f ~ C3 D 0 a c 0 m V1 ~ v ~ v,wm ~ le D oa=m=~ w :3 CD CD " cn I oo.cn ~3gww n 60 0 CD CA 0 - cc ~3~ CD commm a ao~ aicc°cf O w m w m CL 0) o m m CO v' nod °a~a . N Q ° o c co m (D 0a mCD 3 v, 0 ao~ °~a 0W ~°mo d o ° c w m -I m c m CL 3 0 m o o wa3' aCD 003 m CD N a o CD 3 o o DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 HUMAN RELATIONS N, WI 3707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNS HIP/MUftltttRA-t#TY: LOT 'F_0_ NO.: SUBDIVISION NAME: C 11/4 01/4 1T3v N/R J9 Vor) W = h l Q- ~v 14 COUNTY: WNER'5 BUYER'S NAME: AILING ADDRESS: 5A- 'f `vt t O Y ' f r~S W `fC~ Z S USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: ~PRQFILE DESCRIPTIONS: PERCOLATION TESTS: Residence ~ ~w ❑Replace < c~ J RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: FOE IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ® S DU U S ❑U I ❑ S U❑ SJU If Percolation Tests are NOT required DESIGN RAT 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 DjP+H, N, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) o'9 -73' wl._~.k, ~ a B- 2- ~kx B- ~J 1 ~ 5'.~ 7 ~ a~ ~7 (off z P,r~r ~1, b S. Ail, - B- B- B- ~S«tA l PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER RtCTTES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- _3w 3 3 P 2 sy >d o 3 P- 7 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 hori- 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. a SYSTEM ELEVATION Ca o p , 3_4 A PE f N 1 3 E E E E E , _ 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): O TESTS WERE COMPLETED ON: Z ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGN DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) --OVER - Whyte log, MAX aW12 irL?"tihu of bud sours or manna a.a. s ,a'ow Is this a navy or replAunment syshnn: x:-'~i~€jFi mac; d Elj-se ;i3. tzrafing .F }"e SIi..... IS d-.._Tl, i..i - c F 1 3 x WAVE s the waEgafviiatic1 , shown hera tea " inn xi)F e cles °I ptua 1a am! LoY2 plet ig the plot pin! I. EG_ . d?awclrn ai:r s.kt`cae. dy locia": .lid y'i tie vest :ocsZf..L3roi i.0 SE:iatt, is p...3lE,`t"t'af' , MOM shoot may in wool if G&W; s sc.a t..a and J_ li_ ? i n obn , .f a,unce g . jr" cl .ate', in-o orp , t _ e's 3 , it as YXY is ,,.e.5i„ r j_ S' N,- ar, t': sew'' BR - Bt! s ,.,aa t' 10"i SS at*r C s,ia . aet' LS - L n c G sarid 11 " Cox so So 16 Pero FQA to! it; e oW W F we sw~o - a Loamy Somi Sc.'Ny or, Le, Bn B", SwPW c € V10" Sve L o£x , Ql [ NCO, S,a'Lf of .~3E7 , CA", s e (A Many, tar u3 , D pay; ti-nc z #?a,= j cipaes t A e, r '6 S ki A pnr . a i as r so LOU- A- s' z . v, 9 r ST C- 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d y ti r~ OWNER/BUYER ROUTE/BOX NUMBER Fire Number R CITY/STATE ZIP PROPERTY LOCATION: 4, 4, Section T N, R W, Town of St. Croix County, Subdivision Lot number 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 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 N three year expiration. E I/WE, the undersigned, have read the above requirements and agree Cn to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. ST. CROIX COUNTY WISCONSIN r~ ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 August 5, 1985 State of Wisconsin, DILHR Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Attn: Carolyn Haag Dear Carolyn: Permit#64905, issued on June 3, 1985 has been rescinded due to the change in location of the system. Permit#69623, issued on August 1, 1985 replaces previous permit. Attached please find new paperwork. Should you have any question regarding this subject, please feel free to contact this office. Sincerely, Mary Mnkins, Secretary St. Croix County Zoning Office z 0 0 C U) o g C z ao A V \ Z M M 0 m M OD 00 r m ~o N 0 cooi x m m ~n Its 0o v)° - l t► Now 0 iN Z 0 m _ 0 0 o C o p c x C C Z z < c~ 0 r- o v' C7 M --I z aim" C/j -n Ti Fe 0 z m C m H_ z z D O' o; m = m rn H me mf `Da 3' aN mm i'u n r m ° o a - 7 3? m B o c = ° ~m o m-<d o o 0 o a- .3'o D 3 ~Fr 3..- o m rn t 70 S3 °3m~ c° o- m cu ~ °3 dd v7 ~a'm3 M n co~ c 3' Q.- all= 0 ° , ro say < S p 7 m 0 mm and ca o cp 3' W =r - :rLI all :TCD o o 3 3.a to ~.3 m m mmo a n 7 m 3 Z o onoN tG N C K ,dy H D a d a ofD H' o Z H ° " d a d o a z 7 o H S r D 1 d k of > 1© m mho 3~ C f v 3 2' 0 > 10 c c IN ° co 3 a 3 - D 30 M 01 0 CO N N F H fD N O DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING • XXCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Numbe,. Holding Tank ❑ In-Ground Pressure ufass9nedr ❑ Mound I i Meter ORMIT 1ADDR rINSPE CT& Joanne Kocik RR#I, Box 180, Hudson, WI BENCH MARK (Permanent reference f~ point) DESCRIBE IF DIFFERENT FROM PLAN NE-114 NW4, Section 32, T30N-R19W, Town of St. Joseph, Lot#1 REP. PT. ELEV. DST HEF F1 ELEV Name ,f Plu,n her. MP/MPH SW No County Gary L. Steel a "a"bet 3254 St. Croix 5 'EPTIC TANK/HOLDING TANK: IANUFA CT URER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL PROVIDED- LOCKING COVER PROVIDED 'BEDDING: VENT CIA.. ❑YES ❑NO ALARM ❑YES ❑VENT MATL.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING. ❑YES ❑NO FEET FROM LINE LAIR INLET DOSING CHAMBER: ❑YES ❑NO NEAREST MANUFACTURER BEDDING . LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER ❑YES ❑NO PROVIDED PROVIDED GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL ❑YES ❑NO ❑YES ❑NO 1(DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BUILDING IVE NT TO FRESH PUMP ON AND OFF) FEET FROM LINE AIR INLET EYES SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ❑ NO NEAREST 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: BED/TRENCH WIDTH. LENGTH NI OF DISTR. PIPE SPACIN(~ COVER TRENCHES MATERIAL' INSIDE DIA H-EL LIQUID DIMENSIONS PIT DEPTH GRAVEL DEPTH FILL UEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATER AAL. NO. DIST H R E LOW PIPES VE CO VER EL EV. INLEF ELEV. ENO NUMBER OF PROPERTY DING.VE ABOVE NT TO FRESH I PIPES FEET FROM LINE AIR INLET. -s MOUND SYSTEM: NEAREST Mound site plowed perpendicular to slope and furrows thrown upslope: Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS. OBSERVATION WELLS DEPTH OVER TRENCH.' BED DEPTH OVER TRENCH,BED ❑YES ❑NO ❑YES ❑NO CENTER EDGES DEPTH OF TOPSOIL SODDED SEEDED IMELCHED ❑YES ❑NO ❑YES jN_O EYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE DIMENSIONS TRENCHES: FILL DEPTH ABOVE COVER. I MANIFOLD PUMP ELEV MANIFOLD DISTR. PIPE MANIFOLD MATERIA ELEV CIA L ELEVATION AND ELEV . NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. . PIPES DIA DISTRIBUTION I IN FORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS COMMENTS: ❑YES ❑NO ❑YES ❑NO tERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING FEET FROM LINE: ❑YES ❑'NO ❑YES ❑NO _ NEAREST 7- _1 Sketch System on Reverse Side. Retain in county file for audit. SIGNATURE TITLE. DILHR SBD 6710 (R. 01/82) wisconsin APPLICATION FOR SANITARY PERMIT D I L H R COUNTY DEPRRTTT1EnT OF ) InOUSTR EnTR6:HLImRnRELRTIOns UNIFORM SANITARY PERMIT # E_ y 9a5 -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 P E TY OWNER MAILING ADDRESS PROPERTY LOCA N ~ C-ff,r VllF/u~1 /41U01 /4, S3z , T30 N, R (or) W TOWN LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER ILI 14 0 g- 14114 TYPE OF BUILDING OR USE SERVED X 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: k New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ 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: c 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): PROPOSED (Square Feet): ' ) Q0 K Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation the private sewage system shown on the attached plans. Name o mber (Print): Signature: SAP/MPRSW No.: [P~hone Number: P 2 Plum is Add ess: C ~y~ r Name of Designer: COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee- Date: ❑ Disapproved ❑ Owner Given Initial !vv 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 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 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequaoies 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 Location of Property 1;. It Section , T N _ R W Township t--- / 'r Mailing Address C~ ,s L-4. -S C V Subdivision Name i x - / J±r' t } Lot Number V&L r'te' Previous Owner of Property t) L( C E Z Total Size of Parcel ' - `A Iko1Z 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. PROPERTY OWNER CERTIFICATION I (We) ee&U6y that att 6.tatemente on this 6on.m an.e .true to the but o6 my (ouA) hnowtedge; that I (we) am (are) the owner (6) o6 the pnopeA ty deb cA i-bed in .thiA in6o4mation 6o&m, by viAtue o6 a wavcu.nty deed Aeeonded in the 066.iee o6 the County Regi6.ten o6 Deed-6 a6 Document No. f and that I (we) p4e6 entty own the p4opo6 ed 6.i to bon the 6 ewage R po6 6 y6.tem (on 1 (we) have obtained an ea6ement, to n.un with the above ducAibed p4open ty, bon the eonzt4ucti.on o6 6a.id 6y6.tem, and the Game ha6 been duty teco4ded in the 066.iee o6 the County Reg.i6.ten o6 Deed6, a6 Document No, U-~ SIGNATURE OF OWNER S NATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ' H H a STC - 105 r r a SEPTIC TANK MAINTENANCE AGREEMENT H 0 St. Croix County z OWNER/BUYER ~ti/1 6 ROUTE/BOX NUMBER (()L'741_ Fire Number CITY/STATE c.ti-`xCylll~ ZIP PROPERTY LOCATION: A., I° Section T 7C N, R I -W, Town of 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- I 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 I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x 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. SIGNEDL~yck~L i D A T E 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. 0 I" y Z y 0 m N Ali ? ? -:4 o W N O a 3 7C" (p n n CD O Z7 ~ ~ S W ~ IILL_~ J__C'JJ 2 S lip j c C W) Al W 0 Cc (D 0 Z7 Q CD CD ° O= ~ I c ° =a p c7 ' o ° C, f 00 :E m o ~ o - cD O (p CD I CD A) 0 CD cOn a (n c0 A CD - O =r o n s D = - 0 CD co ui ~ CO 0 ' a) ° ca o w 0 3 c AA) o w nZi c°a ao o c co CD N O N o o m 3. = cD , CL CD p) Co ~ ~ -0 D < CD V) Cr - lD c " o CD C,) c Cl) ~r0 - o n ° D~ --CCD 1 Cs* -0 9x 0 m-1 p- a cD O f (gym O(nm ~ Q 0 0) 0 I m o (a ~j ° v w cn C CDw c*0Z CO) s ° Co (DD m Z aCD0 3c mm CD ca CL (n CD C: a) y cu a CD 0 a o w m -C v ~CDo N°~m~ In o a m N O P, COC oo=~~_ 1 ~3a m~`OoN`~ CL 0aF, ~c O aw O ~ m naa O OL N R1 CL ° z = v 3 F °o 17=c %<co ~-mN. o c CO cDCD~3 v, a m O co o C1 ° N." n CD O m O c a o m -I CD C C n 0 (D o 0 tn' a o< 3 o - CD o DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, LABOR AND P.O. BOX 7969 PERCOLATION TESTS ( / 115l DIVISION HUMAN RELATIONS 707 3707 (H63.090) & Chapter 145.045) ` / MADISON, WI 53 LOCATION: j SECTION: I E'14 1 TOWNSHIP/Poltffdt~tpA~f~ y: LOT NO.: BLK. NO.: SUBDIVISION NAME: W/a /Tx:N/Rly&(or)W t~5C`'7' /U/-~ COUNTY- OiP~PdER'S/BUYER'S NAME: MAILIN ADDRESS: 11 AL I _54 6r, USE NO, BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE LK Residence PROFILE DESCRIPTIONS: PERCOLATION TESTS: ~i ®New ❑Replace t, RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SSTEM-IN-FILLHO~LpING TANK: RECOMMENDED SYSTEM:(optional) S ❑ U ®S ❑ S U YS 00 S U 7[ I7~c >dCU.% If Percolation Tests are NOT required DESIGN RATE: under s,H63.09(5)(b), indicate: If any portion of the tested area is in the /Q Floodplain, indicate Floodplain elevation: S ° PROFILE DESCRIPTIONS BORING tTOTAL ELEVATI DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THI KNESS, COLOR, TEXTURE, AND DEPTH NUMBER ON 70 SERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B Z L-10 7Z I? B- C, it" 106 7- Th 1117. sw B - 3 (2 If k 13 rz /V Q A) t.3i. l gin. :~,S.,t.• 2, B- E PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES NUMBER +Pb6µ~ AFTERSWELLING INTERVAL-MIN. RATE MINUTES PERIOD 1 PERIOD 3 PER INCH sf,, J PER(IOD 2 P J G { '3 P- '3 141 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 hori- 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 P-4 54-;1_1 _ E LAI , St~;3z . 8 It ` t Ihr 4 r ~ Q - . E E- a» X10 , 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: ADDRESS: Z ~j ~ °J CERTIFICATIONNUMBER: PHONE NUMBER (optional): CST SIGN T RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D! I- HR-SRD-6395 (R. 02/82) - OVEN =c rid, sc~ CW, #)er o 1- 1.95 It t~ 4 f i ~a ~ as ct, ~.tt-.. ~_3 ("al . €-'t) L 4 S (k no vi C s E 3, ~ ~ tt ar ~ r l~ t r.j[ t a , S t 2€ t tL Ocl~ , to t,3r a5n tFal'.~, ,,E.t-,cdt t 4, t V . c, e . s E.a; der_ 1a3 „~1 i'3- 10", SS -F ~j ..49YT sea;9_.- x.` ~U~~t r35~ .;-t Gv - t~'r stf 9 1.: ;t --3 _ t S Y r:'=~~' Leo p r 5 10 1 pph rash-` t -30 6 -3 ~ 04, Q - Z ~ Fitf pl, Ire V Joe 5