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Parcel 030-1032-60-000 01/04/2006 12:54 PM
PAGE 1 OF 1
Alt. Parcel 08.29.19.112H 030 - TOWN OF SAINT JOSEPH
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - SCHETTLE, RONALD O & MARY L
RONALD O & MARY L SCHETTLE
504 NELSON FARM LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 504 NELSON FARM LA
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE
SEC 8 T29N R1 9W NE NE LOT 15 OF CSM Block/Condo Bldg:
5/1266
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
08-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 662/203
i
2005 SUMMARY Bill Fair Market Value: Assessed with:
83387 271,400
Valuations: Last Changed: 07/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 91,200 155,600 246,800 NO
Totals for 2005:
General Property 3.000 91,200 155,600 246,800
Woodland 0.000 0 0
Totals for 2004:
General Property 3.000 91,200 155,600 246,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 107
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANI'T'ARY SYSTEM REPORT
OWNER- 0(!Y~e4i TOWNSHIP c'79~ SEC. TaN-R W
ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUB1) IV I S I0 NSgy~,C~►1. LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requ-irements of H63
SHOW EVERYTHING WITHIN 100 FFE`i' OF SYSTEM
I.
J~
I
0-- NOW-
I di at N :)r h rr w
BENCHMARK: (Permanent reference Point) Describe: ~•ko 4-A ke
%d
Elevation of vertical reference point: Slope at site:
SEPTIC TANK: Manufacturer: c- Liquid Capacity: 0(7,
Number of rings on cover L Tank manhole cover elevation:
Tank Inlet Elevation: `!'auk Outlet Elevation:
PUMP CHAMBER
Manufacturer- Number of gallons
Number of. al. pump set for a cycle gallons; Total capacity of
distri tion lines gallon: size of pump _ head;
gal n per minute _ horsepower ;brand name of pump
a d model number ;
ype of warning device-
HOLDING K: Manufacturer Number of 4~ s -
E anon of manhole cover- n
ype of warning device_
SEEPAGE. T SIZE; Number of pits- feet diameter
e liquid depth- seepage pit inlet pipe-elevation _
f
ottom m of seepage pit elevation feet.
!EEPAGBED SIZE: number of lines width length --tile dept
SEEPAGE TRENCHC2-)width _ _ length s~~~
PERCOLATION RATE-- J AREA REQUIRED_ 54'` AREA AS BUILT_,,,2~0j~tn=_
INSPECTOR
DATEll - ^t15` PLUMBER ON .TO
LICENSE NUMBER
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
.LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7069 BUREAU OF PLUMBING
MADISON, WI 53707
E~CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number
~ (lf assign ed)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
CA&
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION [ATJ
Ronatd U. Sehettee 306-6 St. N, Hudson, W1 54016 1 3
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. Lot 15, N l FoF,m REF. PT. EL CST REF. PT. ELEV.
NE NE, Section 8, T29N-R19W, Town o6 St. Joseph Rd. ,4ddn.
Name of Plumber IMP/MPRSW No.. CSanitary Permit NumberGahy Steet 3254 t. ctoix 43728
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
c~2/J 0 /r/ 1. `j~ /j3,05 15-YES ENO OYES NO
BEDDING: VENT Of A.: VENT MAT L. HIGH WATER NUMBER OF ROAD. PROPER WELL. BUILDING. VENT TO FRESH
ALARM FEET FROM LIN+- J f AIR INLET.
DYES ENO ❑YE~ NEAREST /°2~ 0
DOSING CHAMBER:
MANUFACTURER BE DDING. LIQUID CAPACITY PUMf MODEL P77" FRER WARNING LABEL LOCKING COVER
A PROVIDED. PROVIDED.
DYES ENO DYES ENO EYES ENO
GALLONS PER CYCLE: PUMP AND CONTROLS oPr 7N NUMBER OF PR OPYIRTY WELL BU ILDING VENT TO FRESH 110 (DIFFERENCE BETWEEN FEET FROM NE AIR INLET
PUMP ON AND OFF) YES NEAREST
SOIL ABSORPTION SYSTEM. Check the sooisture at the depth f plowing ['11,T11 DIAMETERIAL AND MARKING;
or excavation. (If soil can be rolled into a wire, construction shall cease until ORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH LEN TH NO. OF DISTR. PIPE SPACING COVE
BED/TRENCH TR_F,yc S I M RIAL. PIT 11111DIIIA =PITS pOUID
DIMENSIONS Z
GRAVEL DEPTH FILL PJJJJJH IDISTR. PIPE DISTR PIPE DISTR. PIPE MATERIAL: NO. DI R NUMBER OF (PROPERTY WELL BUILDING. VENT TO FRESH
BELOW P PFS AH rLVER EELLEEV. INLE r ELEV. END PIPES FEET FROM LINES AIR/N T
/ j /b3. ~9 L Z NEAREST--►
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of th ill m terial for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound.. tems to e cer in that i ON REVERSE SIDE. SHOW ELEVA-
me~t, e iteria fo medium an TIONS MEASURED.
DYES ENO
SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION WELLS
DYES ENO DYES ENO
DEPTH OVER TRENCH'BED DEPTH OVER TRENCH;BED 17H OFT P L SODDED SEEDED MULCHED
CENTER EDGES.
DYES ENO EYES ENO DYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
VEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
WIDTH. LENGTH N F L TERAL 77
BED/TRENCH T NCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PI E MANIFOLD MATERIAL. JNPIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVELEVDIAELEVPI PA.:
ELEVATION AND
DISTRIBUTION
INFORMATION DOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES ENO DYES ENO
PROPERTY WELL: BUILDING:
COMMENTS: PERMANENT MARKERS: VATIO WEL~S NUMBER OF LINE
FEET FROM .
EYES ALAO OERA' ENO NEAREST
Oil~ A.)
4.01
of°` 8`IG
~o I AI
C
S ketch System on 1 __-$&t ty file for audit.
Reverse Side.
SlGtaiR7 - - - ~r . TITLE
DILHR SBD 6710 (R. 01/82)
I - -
uJitconssn ' APPLICATION FOR SANITARY PERMIT /
~ 1:3 ILHR °"'"'t" C~VIX COUNTY
- o of (PLB 67) UNIFORM SANITARY PERMIT #
~ N In OUSTn- V, LRBOR 6 FiUMRn RELRTIOn5
t
-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
PROrTY OWNER MAILING ADDRESS
~JJ L / 4' ;y
PROPERTY LOCATION CtTY-.
1/4 ''L 1A S T N, R (or) W TOWN OF:
LOT NUMBER BLOCK NUMBER SUBDIVISION ME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED 3
70&,,7-
[A. 1 or 2 Family Number of Bedrooms. j Public (Specify):
THIS PERMIT IS FOR A:
-,New System ❑ Tank Replacement ❑ Repair
-1 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 Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
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 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):
` /,2 _,-5-c C, 44 ~ P~4 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: j MP/MPRSW No.: Phone Number:
Plumber's Address: Name of Designer:
l 1 COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
❑ Disapproved
~+'1 / _ ❑ Owner Given Initial 'IFY
eJ 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.
Form - S T C
t
Owner of kjrpp4rtY lynna1 o 7A
Location of Property Section^ ; TAN R W
Township
Mailing Address 1✓(-~ , l i! So 17 LAD ~ S 6 Subdivision Name_ /11~ 1ST nrrr, Ac~~,
Lot Number k2
Previous Owner of Property
Total Size of Parcel ~.ar., . vet
Date Parcel Was Created 3 ; 3
Are all corners identifiable? Yes No
Include with this application one of the following:
.Certified Survey Map
.Deed
.Land Contract, or
.Other regal Document which describes the property
PROPERTY OWNER CERTIFICATION
I (We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am tare) the owner(s) of the property described in this
information form, by virtue of a warranty deed recorded in the Office of the
County Register of Deeds as Document No.--f ~3 ; and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No.
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED "
IN
DUS_ MEI~T'OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DUSTriY, DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS 1 / MADISON, WI 53707
• (H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/I4611`+etPat-rrY: LOT NO.: BLK. NO.:SUBDIVISION NAME:
T
N/R (or) W as ~ r~ 5 -
E'/a'e~/a I
COUNTY: OWNER'S/BUYER'S N ME: AILING ADDRESS:
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence New ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVEcNTION'AIL: MOnUNcD: II IN-GROUNcD-PRESSURE: SYSTEcM-INn-FILLHOLDIcNG TnANK: RECOMMENDED SYSTEM:(optional)
If Percolation Tests are NOT required DESIGN RATE: 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 Deef"4N, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
17
~i 1
s/u r) /U 7S c ;3 / ct c
73i'k (3
~_3,3 O 3 } 33 L7 cip 0 (e7
B- C ? Z t fG? GC' /3 ! ✓ / 2, C . S . % aC) S
-AC:S i Al A PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER+NG4S AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PERINCH
P- 3
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 An Z ss
1'7 1
A,6' f z'
49 _Ap
,
3
t
i'
- N
t3
__4
,
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:
r V
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST SIGN UR; . n
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) F"FP
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