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HomeMy WebLinkAbout030-2078-80-000 o y o u, o 2 0 G1 C f O 61 f O fD 0" :3 v m = T _0 3 3 m C/ ^ 3 z Cf) a 0 O O O v n v O tOn O O c0 p=j ~ co W ~C • c7 ~ CD d IN ep, 0 cD N 0 C- W O ~ (n ° =r CD O o m o D a) cn 3 G7 oN ° o O =r m C90' 't :3 0 CD cn C N O (O O cn O O 13 C) N cn cn F C N_ C y -4 O O O W O C D C c n m (D D a W CC a m N a cD O N T cco O Q _ o ° c a \o O f' CO ~ ~ O o cD N o , r w = ! ° co z CD ° 03 N me o co = N r°r. c n v cn n a ° o 'a 'D M O O O o O O O CD C* 3 D P7 cn (D V) 0) :3 v v M (D G_ .~,n ~ ~ G1 N 7 3 > 3 d CD CD z N ~ z z W a ° D D co z O a ° n a (D CD CD "O Q Q N (D 7 N N O N C N. O N W O_ 7 D_ z (D (n .n O O ~in O A Z M 7 c a 7 A Z O N CL C 7 CD m 07 T m o co CD CD 0 3 z r- o O Y m cD N z vii Z CD m a m o aD D N a X _G c +i T c FP c 3 C - - o- Z Q cr z m a O 'D CL 0 ° o ° o 0 0 p' 4 7 O A CL ~ z NN N ` O A O_ 7 N (D O ~ O A O N O O CD O v+ O ft O O O O C' O 7 y 'r ~l Parcel 030-2078-80-000 03/04/2005 12:44 PM PAGE 1 OF 1 Alt. Parcel M 33.30.19.665 030 - 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 " HAWORTH, GREGORY J & MARGARET GREGORY J & MARGARET HAWORTH 579 BURR OAK LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 579 BURR OAK LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.580 Plat: 2234-OAK KNOLL ADD SEC 33 T30N R19W OAK KNOLL ADD LOT 8 Block/Condo Bldg: LOT 8 (EZ-U-1150/140) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 712/631 2004 SUMMARY Bill Fair Market Value: Assessed with: 6375 225,500 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.580 61,900 159,900 221,800 NO Totals for 2004: General Property 1.580 61,900 159,900 221,800 Woodland 0.000 0 0 Totals for 2003: General Property 1.580 36,400 130,600 167,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 120 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Fo rm - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. T ADDRESS ST. CROIX COUNTY, WISCONSIN Fi~s'i•~f'rS C~ ~ j G 3' o)-0-7 SUBDIVISION f LOT LOT SIZE (o(y~ PLAN VIEW Distances and dimensions to meet requirements of ILIIR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM &77 G' INDICATE NORTH ARROW l~ BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: j.: iquid Capacity: Number of rings used: .-2 Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,0 Side 10 Rear, O f 7 feet From nearest property line Front,O Side,r Rear, O feet Number of feet from: well ,i~r , building: (Include this information of tho above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE A . 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: Length: L Number of Lines Area Built Fill depth to top of pipe: -o~ Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft Number of feet from well: 1~5 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, Q Rear, 0 Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Plumber on job: Dated: License Number: 3/84:mj i DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR I,ABORAF HUMAN RELATIONS SAFETY & BUILDINGS .P.O. BOX 7969 - PRIVATE SEWAGE SYSTEMS DIVISION MADISON, W1'53707 BUREAU OF PLUMBING L7CONVENTIONAL DALTERNATIVE Sate Plan LD Number Holding Tank D In-Ground Pressure ❑ Mound IIf assigned) 71ME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER. INSPEC'ION DATE. 1 . 15111:7 Greg Haworth Box 209, Roberts, WI 54023 '.3FNCH MARK (Perman,- reference P-m,) DESCRIBE IF DIFFERENT FROM PLAN y~/'~ y SE SE, Section 33, T30N-R19W, Town of St. Joseph, Lot#8, Oak Knoll REF PT ELEV. CST VALE PT ELEV Nainc of Plu I- MP/MPRSW Nu C"""' Sanitary Pe,mit Number. Cal Powers 1563 St. Croix 69666 SEPTIC TANK/HOLDING TANK: EG TURER. I LIQUID CAPACITY ~NK INLF7 ELFV TANK OUTLET ELLV WARNING LABEL IIII LOCKING COVER / ) PROVIDED PROVIDED VENT VFIN MATDYES ONO DYES ONO [NUMBE F ~OADPROPERTY WELLJ JB''_1ILDING VENT RESH NO / FEET FROM / urv f r l!rt LAIR INLET ~_~YES LNO NEAREST- / DOSING CHAMBER: - IMANUFACTURER BEDDING LIOUID CAPACI AV POMP M(IDEI P.,ttP SIPI~W, %',,NCl :~CTUHI WARNING LABEL LOCKING COVER DYES ONO PROVIDED PROVIDED . GALLONS PER CYCLE: PuMPANDCONrROrsoPERAnDNAL DYES LJNO DYES ONO (DIFFERENCE BETWEEN NUMBER OF PHOPEHTY WELL BUILDING VENT TO FRESH PUMP ON AND OFF) FEET FROM AIR INLET SOIL ABSORPTION SYSTEM. Check the soil moisture at th depth of plowing NO NEAREST-> or excavation. (If soil can be rolled into a wire, construction shall cease until nMF TEH ~`'ATLFVInI A"° ^~AHKiNG FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH NO OF _ BED/TRENCH i>ISTH PIP[ SPncI~ a>v 1r - -,F 7I THEENCHES 41A r[FIAI =PITS LIQUID DIMENSIONS / Z r' PIT DEPTH CRAVE I DFPTI, FILL DEPTH UIST" PIPF DISTH PIPF DISTR. PIPE MATERIAL NO UI' H~ 'F LCiW PIPES % ABO E COVER EI E V IN! F i ELEV END r~ xx NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH PIPF S FEET FROM L INE AIR INLET NEAREST--► (I MOUND SYSTEM: - Land ound site plowed perpendicular to slope 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 meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER TEXTURE Pf RM11 A'~f NT MAHKf fis 013SEHVA IIHN WF I.LS DEPnfOVERTHENa3eED DEPTHavrHTHFNCHBED _ DYES ONO EYES ONO ENTER EDGES Df PiH OF iOPS(IiI S(11)DFI) JFE IJ[I] MULCHED C OYES LINO DYES ONO DYES NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH q~' NO. OF LA rE RAJ SPACING GRAVEL DEPTH BE LOL'V PIPF FILL DEPTH ABOVE COVE R TRENCHES DIMENSIONS MANIFOLD DISTR. PIPE MANIFOLD MATEHIAL NO LJISTH UISTH PIPE UISTRIBUiION PIPE MATEHIAL& MARKING ELEVATION AND DIA ELEV PIPES DIA DISTRIBUTION INFORMATION CINC, D1;IUEDCOHH[cuY COVFH MA I EHIAL1CAL LIFT CORRESPONDS TO APPROVED PLANS COMMENTS: NrMARKERS❑YES ONO _ DYES ONO J OBSERVATION WELLS NUMBER OF PROPERTY ~VVELL BUILDING. FEET FROM LINEDYES 0L_L DYES ONO NEAREST--_ Sketch System on Reverse Side. Retain in county file for audit. SIGNATURE - TITLE DILHR SBD 6710 (R. 01/82) Wisconsin APPLICATION FOR SANITARY PERMIT (PLB 67) J/ 1~4 COUNTY DILHR E~7 Y,LR UNIFORM SANITARY PERMIT # InOUSTq LRBOR6NUTRn RELRTIOnS )/~j -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 PROPERTY OWNER/ MAILING ADDRESS PROPERTY LOCATION CITY: / V14_-~ E: J11i 1 1/4s 1/4, , N, R El (Dr) TOWN OF: N LOT NUMBER BLOC NUMBER SUBDIVISION NAME NEAREST ROAD, E OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED CI'- uo"~v c~UZ6 Z 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: LX New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System L Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X 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 q 2,-3/l o p~ _ ❑ 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 i Manufacturer: > - f IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ 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): L-2 S: X Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation o e private sewage system shown on the attached plans. N/a/f/~}//'of Plumber (Pri Signature: MP/MPRSW No.: Phone Number: Plumber's Address: Name of Designer: J COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved 40 i' T~ ❑ 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 l 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. o m O ° o o CD 0CD r 4c 0 oo'o cowwv,~~g ? ? 3 ccocn o ° ~ c c ~ m ~ o ~ ~ 0 ~ 0 00 10 OLM ~m0 CD 0 '0 CD < Mo. n 0 O o ~D m ppw o ~ :3 ~ on 10 3 :3 -Y on c w0o 0c~v -"c O 3 o a0 Z(a w C cr Om w~ 1 m ~w c°an- wwu~ j w m am ° -CD oo~v~ D <C't VOi 10, 'AcoQO ^ (D (A D C m L to o n n o - m : N(n v=, c w w N Z co =r CD o aCD0 3mmC?a D D (1) o E; 0 m as w ° w c ~~'m mvca(~ to V viva ac°~m C fTt a m CD =r CD m " F. m 00 3 (vw = ~4 O ao o to D --I cn c • « C ~p 7 m W O m, n N w L/ aof (AA c00.0 R1 w CCL 0. CD CA 00~ Cr ~m ~comm3 C, n C f0 O N m m 0 7 C Q O a C co Ci ((D - m c m m =r 0) 0 CD 0'03 • cm o v a3 0? a a O CD 3 o CL . : N 3 CD (a z gr ' p 0 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ✓Lp;~, r 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 September 19, 1985 State of Wisconsin, DILHR Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Attn: Carolyn Haag Dear Carolyn: Permit#69645, issued on 8-23-85 in the name of Greg Haworth has been rescinded due to the fact that the drainfield had to be moved to a different spot. Permit#69666, issued September 19, 1985 replaces above permit, and the necessary paperwork for that permit is attached. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary J. J kins, Secretary St. Croix County Zoning Office Attachment DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, ,LABOR AND P.O. BOX 7969 PERCOLATION TESTS ( / 115l DIVISION HUMAN RELATIONS (H63.09(1) & Chapter 145.045) ` MADISON, WI 53707 LOCATION: SECTION: TOWNS HIP/M)4N.IG-Ff-A-M_ry: LOTNO.:BLK.NO.: SUBDIVISION , NAME: I (or) W CO NTY: OW R'S/BUYER'0 NAME: AILIN ADDRESS: USE NO. BEDRMS.: COMME Cl L DESCRIPTION: DATES OBSERVATIONS MADE Residence PROFILE DESCRIPTIONS: PERCOLATION TESTS: ILK L New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-G ROUND-PRESSURETOu YST-- HOLDING TNK: RECOMMENDED $YSTEM:(optional) ZS OU QS F]V ®S oU ri EIS G , 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 ~ Floodplain, indicate Floodplain elevation: - ~ PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH t[tl ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B : RIO f 71 B- 0 VA,1c -3 1 B- B- B- PERCOLATION TESTS NUM ER INCHES AFTER SWELLING INTERVA MIN. DROP IN WATER LEVEL-INCHES RATE MINUTES PERIO 1 PERIOD 2 PE IOD 3 PER INCH ..3 1 PP 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. X79 4 r SYSTEM ELEVATION F, CA v c. ~IBr/,CyT ) /I/ 41e i. 3 P 3 / , a uSC E I, the undersigned, hereby certify that the soil tests reported on this form were made by rrle,in ac4ord 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. NAM (pri / TESTS WERE COMPLETED ON: A S: / Q S CERTIFICATION NUMBER: PHONE NUMBER (optional): CST ' NA R DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER av" j anplutu 7 9f~ ' ~f mlrni-wr of "',C 3 S 1t1 +r+f€4 1 pr r i ! E ailt., i', ,Et.,t. ,j!-(' S.a_cofl,j.7tw 3 i1 ~{e' ,xI ` S c' Sl yt,u- t„",l, ie"3'1e!t:on'- Dd;:l'ing l SC:; :.`k '.al"C, t,l ::.7. r . lav 7 cta s i csif i, xt s~ ~iA" . I)d k , ri} "k ~v io r..7 ('1Q t r; point re c1 d o t it i cl ;CP p i-larlenI; N 11- &-m-s, n add .as,i llood p,akl +.i o-i?, i,l i.,C?'1 test k s f l t~ .2€~t"S E flevcrtlf~,i, 4,C -s C r 3~a~b s.~ S -Inc 10 BR B~~(fit, ..2w g i t~.. 3 E pC~ clay t. f , y u x .t i 1 k CF. {t for "al Lv ,k PAGE OF I ' N1~ Cr~SS Sze iL) 1, o'~ Fr*eh Air InI616 ^And Obcarvotlon Pipe Approved Vent Cap 12" Above rade 20 ve Plp• _ 4" Cost Iron Trade Vent Pipe Moran Hay Or overing min 2" gregate ]Agg,ogats DIe1rlDul iUn Pipe 0 0 0 Tae Pipe Perloraled PIPa Below Plpe ° o -Coupling Term inating At botlom Of Sy►tem tin-l C~rc.c1t , - ti rL~cJ•-~ ton ~j~./ SOIL FILL DISTRIBUTIOVI PIPE APPROVED S'JMT1-IETIC COVER ° MATER~►~t OR 9" OF STRAW 2"OFhGGREWE OR MAPSN HAy ° oOFAGGREGATE LLEV. OF&Z4FEET.-.,. r 7 .a DIS-Rlp}JTIO11 PIPE TO BE AT LEAST _~lJ IUCHES BELOW ORIGI"AL GRADE AF1L AT LLASTZO IULHE-- BOT un MORF_ THAK. HL IMCHES BELOW FINIAL GP.ADE MAXIMUM ®EPTH OF EXCAVATIDO FKOM OKiGrNALb 9AoF- WILL BE IHC-HES MINIMUM ®EPr'H OF EACAVATPmN FROM 1*116114AL F3RAPE WILL BE I NCHF- r i; SIG►.IEO: ~ L.IGEU5E QLIMBER: 1l~ DATE- S Rio i 1 r ~A yr i i = , Ear, DEPARTMENT OF INDUSTRY N LABOR Br"HUMAN RELATIONS INSPECTION REPORT FOR .10- Box 7969 MAD PRIVATE SEWAGE SYSTEMS ISON, WI •53707 SAFETY & BUILDINGS ~~y~~V, DIVISION NVENTIONAL BUREAU OF PLUMBING 0 Holding Tank O ALTERNATI VE ❑ In-Ground Pressure State Plan I.D. Number NAME OF PERM 0 Mound (it assigned) - IT HOLDER Gtr ADDRESS O2F PEgM1T HOLDER BENCH MA (PermC1W0 rete~Ce point) DESCRIBE IF DIFFERENT F M PLAN , cry Rd. TT, Rabet-~, N1 54023 INSPECTION DATE: SF SEf Sec-tion 33, T Z Name of Plumber f 30N-R 191U, Town 0 6 St Joy e ~ .Lo t# REF PL LE V.: 9 Oak Knoa F PT ELEV Cry ~ ')Towe„fvS, Jt~,. MP/MPRSW No. w~ f c~~~tv „ SEPTIC TANK/HOLDING TANK: 7563 St. Cna-e San Pe e MANUFACTURER. : x 6 n LIQUID CAPACITY, TANK INLET ELEV.. .r BEDDING: TANK OUTLET ELEV WARNING LABEL VENT DIq.. VENT MgTL PROVIDED: LOCKING COVER JHIGH WATER PROV ID ED. YES ONO ALARM NUMBER OF ROAD: OYES ONO DYES FEET FROM PROPERTY WELL ONO DOSING CHAMBER: OYES ONO NEAREST LINE AIR INLET euILDINC R INLE MA NUFgCTURER BEDDING JVENTTOIRISII T LIQUID CAPACITY PUMP MODEL PUMP/S(PHON MANUFACTURER GALLONSPERCYCLOEYEJ ONO WARNING LABEL IFFER LOCKING COVER PU (DENCE BETWEEN PUMP AND CONTRO LS OPERATIONAL PROVIDED-. PROVIDED: MP ON AND OFF) NUMBER OF PROPERTY DYES ONO OYES WELL BUILDING VENT TTnFOsH SOIL ABSORPTION SYSTEM. Check the soil moisture at th~ pEh of plowing ❑NO FEET FROM LINE O or excavation. (lf soil can be rolled into a NEAREST IAIR INLET the soil is dry enough to continue.) Fire, construction shall ceas I-ENGTH e until CONVENTIONAL SYSTEM: FORCE DIAMETER MATERIAL AND MARKING MAIN BED/TRENCH WIDTH' LENCrH DIMENSIONS NO TRENCHES DISTR PIPE SPACwc DOVER GRAVEL DEPTH MATERIAL' INSIDE CIA BELOW PIPES FILL DEPTH DISTR. PIPE PET ttPITS ABOVE COVER ELEV. INLET DISTR. PIPE LIQUID J ELEV. END DISTR. PIPE MATERIAL. NO. DISTR DEPTH. PIPES NUMBER OF PROPERTY MOUND SYSTEM: FEET FROM I LINE WELL BUILDING: VENT TO FRESH AIR INLET: Mound site plowed perpendicular to slope NEAREST---_i, and furrows thrown upslope: Check the texture of the fill material for mound systems to PROVIDE A DIAGRAM OFSYSTEM ❑ YES meets the criteria for medium make esandthat it ❑NO ON REVERSE SIDE. SH SOIL COVER rexruRE TIONS MEASURED. OWELEVA- DEPTH PERMANENT MARKERS : OVER THENCH.'BED OBSERVATION WELLS CENTER DEPTH OVER THENCH;BED EDGES. DEPTH OF TOPSOIL sooDEO DYES ONO DYES ❑NO SEEDED PRESSURIZED DISTRIBUTIONYESE SYSTEM: YES ❑NO BED/TRENCH LENCrH OYES :OD D DIMENSIONS TRNO.EOFNCHES LATERAL SPACING GRAVEL DEPTH BELOW pipp ONO : MANIFOLD FILL DEPTH ABOVE COVER ELEVATION AND FLEV EL PUEMVP MANIFOLD D DISTR PIPE IA ELEV.: MANIFOLD MATERIAL . No. DISTR. DISTRIBUTION DISTR. PIPE TIIATERIAL & MARKING INFORMATION HOLE slzE HOLE SPq CING DRILLED CORRECTLY PIPES D l n DISTRIBU ON P PE M COVER MATERIAL: COMMENTS: DYES VERTICAL LIFT CORRESPONDS TO APPROVED PERMANENT MARKERS: NO PLANS OBSERVATION WELLS: O YES ❑ YES ONO ❑ YES NO NFEET UMB FROM [PROPERTY ONO WELL BUILDING: ❑ NEAREST Sketch System on Reverse Side. Retain in county file for audit. DILHR SBD SIGNATURE 6710 (R_ 01/82) TITLE wlsconsln APPLICATION FOR SANITARY PERMIT _ DILHR (PCB 67) COUNTY 0 ~ oEaRRTmenT of UNIFORM SANITARY PERMIT # In OUSTRV, LRBOR 6 HUMRn 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 PROPERTY/LOCATION 0/4 S "'1/4, S , TI- 10 N, R (or) W TOWN OF j CSC- LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, L~4if STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED i 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): ~ f~- THIS PERMIT IS FOR A: ,X 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. ,~Seepaye 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 r o c) p Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: r`_,. 777- IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #01 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): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of e private sewage system shown on the attached plans. Name of Plumber (Priru~: Sig re: i /MPRSW No.: Phone Number: -VIC 4rS2 ri/~T I(TS Plumber's Address: r r Name of Designer: e-) J1 2LCJ,) /hUIACV, C1(_1 k C_ COUNTY/ DEPARTMENT USE ONLY Signat re of Issuing Agent: Fee: Date: Disapproved r'!ti' N + t y ~r~- Approved Owner Given Initial 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 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 (-L--, f' Location of Property ~jj~ 14 Section T ? C) N - R W Township J 71 Mailing Address j'~ G X 2 L~j y C i4 0 u,r3 c 5Y G L _3 Subdivision Name L.ot Number Previous Owner of Property 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 and Page Number -f- 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 cif the reviewing process. Tf the deed description references to a Certified Survey Map, the the Certified Survey Map shall- also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFRTV OWNER CERTIFICATION I (we) eeAti6y that a X 5.tatement,5 on -this ~onm ahe Phue to the befit o4 my (ours) knowledge; that I (we) am (arse) the owners (,5) o{ the, pnopen ty demos eti i.bed in -th L5 i.n.Konmation Koh.m, by v.vrtue o4 a wa&4anty deed neeonded in the 04()gee oA the. County Reg,us.teA o{ Deeds as Document No. ' l L 2 L-~p-o~- and that I (we) pAuentky own the pnopo6ed bite {yon the aewage. ~y~s,tem (on I (we) have obtained an ea6ement, to nun with the above de6cAibed pnopmty, 4on the con,5t,Luct%.on o6 6aid /system, and the Same h" been duty neeonded in the O~4ice o() ,the. County Re.g,i,s.ten ob Deeds, as Document No. ) . - -Y'~- r.~ STGNATUR OF WNER , DATE SIGNED DATE S I GIN I?li ~.32V3h2 L DAR] QU~ ~ ' •t ST CROIX COUNTY i ; LOCATED IN THE NW 1/4 OF THE SE 1/4; NE 1/4. OF THE SE 1/4, SE i4 OF THE SE 1/4 AND THE SW 1/4 OF THE SE 1/4, ALL IN SECTION 33, T 30 N, R 19 W. R DATA TABLE UNPLATTEO FORTH CURVE LOT RAL,;US "CHORD 1 CHORD :EN,;44 . ' ' ' • . ' ' ' NO. NO LENGTH LENGTH BEARIh3 ANGLE y 1•2 -r 2009.86' 104905' 534't049'E~50•.3'42 G PLAT REAR Nc', EFrkFr,-~ "-.92.08' 522'27 28 E 05'2e 4u 'HE .4 .c f• uJ4 1'f / 2 - .23343' S28'3i33*E ^G6.3930' A' " _ 4f C `_`f :.r:,•l4 'J dr' 4 179.41 •574.24' 47.,E ~C5" 58' • 0. 9860, 534.48 11 1 05• :9 50 ' •0c - 6 +25730- 546'1818E 0 "2024- ~ ' ~p I S-4 X80.00Y 66.n S36'10 30•w 31r16 32 1-16 a O. SCA,E IN F! ET 5 87 61' 'S86'15'43"E 66'24'G6 . 6 8Y 58 St9'00'43 E fd•0550- 4~ or) 74 57' '•542.4400"W _ 53'23 40" w~ ; ` 8 + +39.52' N4e'S2 42 *w 121.22 56' * S89°1242" W NOTE : A-L L.vE :G MEAS~kEMENTS r AVE BEEN MA.F e'6 ~80 00' 66 00 ~N02'56 30 E 311.16 32' 3T37~ TO'HE NEARS ,T U\F HUNOREO TH CFA FOOT, ALL ~ - o - 2 ANGULAR LASUkEMENTS RAVE BEEN NAOE 'O THE - 1 104!5' S6d'0642~M 81.3656" - r NEARES' MINU'r :.40 CAM' C TOSF12 93.20'_N35.2T+S w 71. 15 10• 1'4 p \°~4 fj3 \ 13 ~9932 LM38`32'35"E 76.44'30 14 10462 SG2.1512'E 81.39'_6- 6- \ - -7-_-. - 7-9 ' 80.00'_ 66 00' N00'C 20 *E 1311* 16'32" oa \ 15 } 70.62' SSG'4327'w~52*22 46- 16 125 44' N51-2`25'w 103'15 30' \ 17 99 32' N38'32'357E 76-44'X- 0 y3, a 17 \ j 18 1+ 64' 563.38 +T E 73' S3 46- 324. ib? \ 4H'•w~ *L'E-r v^ .,a LOCATION SKETCH 4340- E \ ` ;CON \ _ _ \ .LANDS { ✓ NwI/4-sF. 1/4 4's. 54 \ f % j w`c uo O j hELct-s. OAK z + KNOLL SE ~ •'y~~ 4+T S+s=.~ to ± ~ , < 47~+ a \ e TO*N OF ST JOSEPH LEGEND 10 , ar O-l ■.k' 4GM t,oE. of Gw,MG a 55.4' <1 6 ALL 0'-ER `CT EQS STA.EC -ir. ' S ,4,57 y c `3z4 3p~ co O: ' 1 I 1 r.: I w~' - • U N P LA T T E D F j" a Larvos 77 s z U) S T C - 10 5 r' r a H SEPTIC TANK MAINTENANCE AGREEMENT H 0 St. Croix County z 1 d 1 a OWNER/BUYER C ROUTE/BOX NUMBER ,~Uq G ~ '1CC d TT Fire Number CITY/STATE ; beric, f, ['5 ZIP PROPERTY LOCATION:J_~` 14, Section', T J6 N, Rt W, Town of 05 St. Croix County, Subdivision C 9 L Lot number S~ 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 o•- 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 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- 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. Y 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. 0 > O C to 4? U c - C C i O > of C a O O;- N 7L C q O 0 i)~ O)O c 0'a :3 ~o 0 0) N y c0 O N L- 0 Ul E U) C) m u) o .6 C U) c (a 0 0 •a c=3 N (o O •0 0 3 0 :3 m (D 0 co Q ow o V N cn m t o a) ,°10 nccc0.0 o o~ - " t a N 3 0 -0 cn 0 'a <C C C U O O O cU c 0 = a-• CC W NrnNr`o a) Q ~ m~ m 4) -C 0 CD a) M Q G w3m~3N cn~c Q 3o~~0= s~~ Gw cc C) U U co = i U 0 r' N• 7 Q O j N 0 O > 0 (n V CL a 0~0 f~ U C y[8I _c _O 'a 0 0 O 0 i fn tU r L. c -C co c 3 LZ.c Lc°-»>°, p0co 3: L 0) 0 = a) o co 0 0 0 U~ a L) o) rn c v c y 0 to N CD M a ro V O CD ~ a) 3 ~ d _ co rn c O O cti O'o -0 a r a w 0° 3 a`) cn a) < o ~t c O aN CD O N 0 a c Z 0) c: E E -0 13 m w M 0 :3 0 a) C a) U U ~,C O 3 C n C O H O C O N D 0ENU)ccnr~ fL-a) J N C DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS •INDUSTRY, DIVISION LABOR I` ,ND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: 5WT OWNSHIP/Pdiefp~{}TY: LOT NO.:BLK. NO.: SUBDIVISION NAME: 5 £ 1/ /a 33 /T30N/R !9 E (o ST 7.01 ft-- 04& ,(-,vo/l COUNTY: OJPJP~€bi~S/BUYER'S NAME: MAILING ADDRESS: s ~ioix G~PEG~e~i y*v,iP- aox 2Oy C 7<~ s7f~o.Z3 USE DATES OBSERVATIONS MADE NO. BEDRMI 1COMIlRCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence ItI. p p 3 New ❑Replace R;ff ~.s _ ~9, -5 ~ /(r IfQf RATING: S= Site suitable for system U= Site unsuitable for system J Cf 2 .5_ .5 rr~E S~- r fv~ fjlTi9 CONVENTIONAL: MOUND: IN-GROUND PR -ESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) / ES ❑u ©S ❑u ES ❑u ES au oS ©u (*0,,,t1L-A.)7 11 X(S o,?,cP If Percolation Tests are NOT required DESIGN RATE: T I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: G G~f SS Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-IN CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVE (SEE ABBRV. ON BACK.) r H G~. O orl i 1. N• B-/ 7.o' yo 7o S~ r Ed p, c f B- 2 g,D 9 G~ 7'1rr d Hots •G7',l~u. 's s,.N~, 3.0 Q - , B- P I > ~.0 aiC . S~ ~7' T)J•v CS wjlG. few SH*N S~ pocKtTS ",;ty AAJ 7. 003 B- F 7 si >O o r o f ~~a . s~, ~w1, 'TI X12 Ssf ~t0~ a.~, RrJ • .+.5 B-S Y•v 97 (p~ i > Qa 7. 5- B > D ' . s Ai- 3,001 . br«s/1-1'C aN• RAve~, .3'3 %'1N eOxY ~s Grk 11off Si ,x r4oC&P7~f4 ,'t fT f/nr~►r~e/~i /S Sc,«p~oEp o F PERCOLATION TtSTS 1OW4- pou.>.v S6o~Lr TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIO~D/2 PERIOD 3 PER INCH P- x . O P- P- L 3 P_ r Aol irv v TES P- 1 P- PLOT PLAN: Show locations of percolation tests, soil borings and the di nsions 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. P, SYSTEM ELEVATION TEO ~L r P 'N P~ r3 x s" flN f/ f~lEa _ 3&1 3~ • 133 17r 27 r To ~Vl~VAVA G AcrERN. w crr/ •1,V.SX t{E' /'A, ' All /33 -13S.- BG /~O rE BUST GrE Mo F v This test s t APPRIL Il zs /~it~o ti 7e sr 4Wr #or a convention sepue syst 1! wr -1410-10,c- ,rte L x,ai4cf,6 -eTS U177 70I' s ~S `z 19 604-r 13o4 C'/1 uT/o~v . G W E,P L~~U~ /PUNS 7~~f'oUb - /3D.PE` e S. 1-~E _w~fs 7 C07 OaXiNJ - 501Z- TEST ,l I, the u r ' ere that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Admi ive Codejd tha ata recorded and the location of the tests are correct to the best of my knowledge and belief. Lo NA print): TESTS WERE COMPLETED ON: lip, OMESITE SEPTIC PLUMBING CO.~ AD SS: S ROBERT ULBRICHT CERJJFICATtON NUMBER: PHONE NUMBER (optional): ASTER PLUMBER LIC. NO. 3307 MARS. f s ' ~L lie ~l~~s---'-- N. INSTALLER & DESIGN R L . CS SIGNATURE DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - t y ind as~ c: _ tat' u} ; C' :7€ S ,z~f)S3"I (_i3{t~ ti{ i:a .K1 ;i's'i. ii Y APE ..~,1L Pl") (..a .3 G.a'tL i- ° 10 e (Iiss0 €;)P. -or rE 9 , Id re ~ 3t t€ ralrc { o, al r!y tit vr„ ali d are t f trii:9nrs "'a 1 Pi oPI rcc~i. ~ . °?Cz! 5 a 'r{3 Dates, name's, addl . ,,`:fir Hood p,a~ n e,( oa, p Fcola.€on "esi .9~h is`tik.` e Itl,€l, f l,.,,~ o ) rk c's t1.,. € lac the „3 1, ,3Fb t1:2~ 13 10") \ st. .i."s,P ert=. t4. TB 3 ; v - E, Y x e~ii'~ y 'G i i € yb, t *,a ifi y ;)Cii Y CC:k,..~, U_t",-i <a vac <09✓ obeff5,, u-ts $c(G2.3 PAGE OF Yy -&o~ 33 T 3G61 ST.~O,3, C) I-) y 0-11 Fresh Ai( Inlo,e And Obfittirvallon Pips LJ Approved Vent Cop Minimum 12" Above Final Grade LO - 42" Above Pipe _ 4" Cost Iron To Final Grade Vent Pipe Monb Moy Or SyniM11C Covering Min 2° Aggregote Orer Pipe Distribution Pipe 0 0 0 0 0 - Too P e Be 0 perloroled Pipe Below Beneath Pipe 0 -Coupling Terminating At Bottom 01 Syslem Pr v N e n 1~ c~ t ~ICJ•.} SOIL FILL DISTRIl3UTiO1.1 PIPE APPROt~VEO ~~~JTI-IETIC COVER ° MAT~ItI/~t C'P 9OF STRAW 2"oFAGGREGAIE OR MARSH HAy r "SZp (F ? 2 AC-,GR E GATE v ALE V. of : L FEAT DIS-1'RIR'JTI,--)IJ pIFE TC) BE AT LEAST UCHE5 BELOW 0RIGIIJAL GRADE At`IL AT LLASTZO 11JCHE_ RUT I, 10 MORE -1-HA11 IZ If-IcHES 6LLOW FIAIAL GRADE I'MIMUM DkPf i OF F-XcAVAT1(D0 rKoM dWvvu 6KADF- WILL BE WCHES MIK)MUM OCT" OF FACAVATIOM FROM 1*161WAL (3R49f- WILL '?,E ~ IKICHE5 SIG►JEO: LIG I-KI50 UUMBE R: S } DAVE ZZ ~S~ JC „o