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HomeMy WebLinkAbout030-1073-80-000 1 o r m O -0 0 N <D -0 O A~ • r A ^ i _ X A~ \ W O C) M cn N) o C' 0) c`n cD O cDC7N ~ Q 9 N ° O , A ID D O O C 11 & , 0 o a '0 w N a ~ NO ? ccn W 3 O CD 0 O O N CD O -n O cn 7 O j N CD 7 O Q N O U) D U) a D cwn D co D C Q C cn 0 :1 L CD CD co co O C N cn A Q 0 d "WA • O o O o 0 O O 3 !V~ a o cn~ CD ° w D ~ to UJ fA - m 7c ~ '9 O ~ ~ o o N~ ~ m m w d Tl N _ ~ A O DI N O J S 3 m - w N Dl CD N N Cl o z OD O O n 7 D o m o m CD CD • 7 n .O N (D N C CD CND co CL (D 7 -4 U) Z O p Z cD rn c ;u n Q A Z 7 O N cD CCD O O m Z a °O co 3 g N Z N W I CO CD Q N N N cn _ r 3 cD N O T v d C 7 N d cL N ? U) °O0 0 o cc0 2 W N ~v-0 c O -c C a < CD p A N O VC O _ N 7 CD j O p~ 0 W 77 0 A . j Er ~ 00 Z0D_7 N CD X O W O W " A O b ~ two a~ Parcel 030-1073-80-000 02/18/2005 04:56 PM PAGE 1 OF 1 Alt. Parcel 26.30.192-%6F 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 - SHER, PHYLLIS PHYLLIS SHER SWAIMAN KENNETH SWAIMAN KENNETH 1821 UNIVERSITY W #N188 ST PAUL MN 55104 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1335 AWATUKEE TR SC 5432 SCH D OF SOMERSET SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 26 T30N R19W GL 7 LOT 3 OF CSM 3/738 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 702/601 2004 SUMMARY Bill Fair Market Value: Assessed with: 5355 525,600 Valuations: Last Changed: 07/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 241,600 275,500 517,100 NO Totals for 2004: General Property 5.000 241,600 275,500 517,100 Woodland 0.000 0 0 Totals for 2003: General Property 5.000 145,100 208,500 353,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 718.10 Special Assessments Special Charges Delinquent Charges Total 718.10 0.00 0.00 n cn O 3 v n C7 `*1 o d c m O ce 3 - (D 0 (o v m i4- CD v Cn N) C:) o o co co 3 C N c- W ?'S c\ c` ro n ro m o 0 0 O n m z m v N ° -ti lA :3 (D \ O O CD 7 a W 1 (D t) N N S N O (o = 0 :D O (D CD co T~ CO -0 5, M O ro N n Q co O T O a o U m =3 °0 0 ro (n (A (o b W H U) Z D a w 1` z co A (D (n D N a p -0 D c• ~4 ~ o j C 9~ lot ro lz CD Oc~ N MME rn . 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(D _d a =3 3 7 Z O O Z fD 0 p ~ A Z v m a O S O w rn W II 0 0 CL Z 0 3 C Co 3 -4 Co N z O CA) m poQ~ = D :3 a S N CL n - . cn v cn cDr-3 mN o C =5 O 77 8 D (D CD v C an z o 00000 p c cc = co N w o 0 - -a 0- C: 5 C a Q N D ICD S O A N cn 7 C K N ~ O O N 3 co A O 77 ? ti v O O (ZD X 'll O N ~ A p b O O O O tW v a o Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER yTOWNSHIP SEC. T 30 N-R-LY-W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISIO LOT - L LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I i I i 7S' I x INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Gy(~ Elevation of vertical reference point: 1490 Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: ~fse~ C5) Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,o Rear, 0 feet From nearest property line Front,0 Side,0 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: Length: Number of Lines: Area Built: Fill depth to top of pipe: 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). 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: License Number: 3/84:mj 'DEP^RTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HI)MAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 RUONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: ❑ Holding Tank ❑ In-Ground Pressure El Mound (If assigned) NAME OF PERMIT HOLDER . ADDRESS OF PERMIT HOLDER: INSPECTION DATE Dr. Ken Swaiman 380 Delaware SE, Minneapolis, MN /Yt~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. ELEV. NW SE, Section 26, T30N-R19W, Town of St. Joseph, Govt. Lot T, Lot 3 Name of Plumber. Y MP/MPRSW No.. County Sanitary Permit Number Richard Hopkins 1059 St. Croix 58897-T SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED PROVIDED J ' ❑YES ❑NO ❑YES ❑NO BEDDING. VENT DIA.. VENT MATE. HIGH WATER NUMBER OF ROAD: ' PROPERTY WELL: BUI LDING. I VE NT TO FRESH ALARM FEET FROM LINEAIR INLET ❑YES ❑NO ❑YES ❑NO NEAREST 1 DOSING CHAMBER: MANUFACTURER . BEDDING. LIQUID CAPACITY PUMP MODEL. 1PUMP/ SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO ❑YES ❑N0 ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NO BER F' PROPERTY WELL BUILDING I(DIFFERENCE BETWEEN F~ T F M LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO E RE fi SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing i FNa H ! D AMETEK 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 rN0 OF DISTR PIPE SPACING COVER SIUE DIA SPITS LIQUID ENCHES MATERIAL: T PIT DEPTH. DIMENSIONS J GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER ELEV. INLEr ELEV. END:. - r / PIPES FEET FROM LINE: AIR INLET.. ^ NEAREST-s j I 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- ❑ YES ❑ meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER TEXTURE JPERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH RED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED. CENTER EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE IMANIIII-DIMATERIAL. NO. DISTR. ID:1TRPIPE DISTRIBUTION PIPE MATERIAL & MARKINGELEVELEVDIAELEV.PIPESDA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY JWELL: BUILDING. FEET FROM uNE. ❑YES ❑NO ❑YES ❑NO NEAREST f f Sketch System on, Retain in county file for audit. Reverse Side. SIGNA7UREr" TITLE. DILHR SBD 6710 (R. 01/82) wrsC-onsin APPLICATION FOR SANITARY PERMIT ` (PLB 67) COUNTY ~DILHR ®,~EPFIRTTEr1T OF UNIFORM SANITARY PERMIT # Ir1OU5TR4t LABOR 6 HUTFirI RELf7TlOn5 -7 7- -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS n if PROPERTY LOCATION CITY: VILLAGE: MW1/4, 1/4,S T,N,R E(or)W' wNo LOT NUMBER B OCK NUMBER SUBQIVISIO NAME NEAREST ROAD, 'AKE R LANDMARK STATE PL N I D. NUMBER r' TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): ) THIS PERMIT IS FOR A: 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 / Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: [ 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: (Minutesrper inch): REQUIRED (Square Feet): PROPOSED (Square Feet): '13 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: PRSW No.: Phone Number: 01/ Plumb is Address: a e 9f Desigger: COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved 7t /y 9 fiT ❑ Owner Given Initial ye ((~f ~`e~~ fJ z7 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. SANITARY PERMIT COUNTY ®ILHR TRANSFER/RENEWAL UNIFORM PERMIT # (PLB 67-T) y,? 7 T PERMIT RENEWAL DATE: PERMIT TRANSFER DATE: ORIGINAL PERMIT ISSUANCE DATE: STATE PLAN I.D. NUMBER: PROPERT LOCATION: CITY: ` 4 t VILLAGE: Sri: /4,S w;T kF N,R E (or) W TOWN OF. LOT NUMBER: JBLOCK NUMBER: SUBDIVISION, NAME: NEAREST ROAD,,,LAKE OR LANDMARK: PREVIOUS SANITARY PERMIT HOLDER (IF CHANGED): SANITARY PERMIT TRANSFERRED TO: NAME: SIGNATURE: NAME _ f _ _ PHONE NUMBER: D -C- ADDRESS: PHONE NUMBER: JADDRESS: I I the undersigned, hereby assume responsibility for installation of the private sewage system that has previously been approved for this property. PLUMBER'S SIGNATUR / PREY US L.UM ER'S ME. 1F CHA>GEpI: A-ell PLUMB R'S ADDRESS: I / PREV, US PLUMBER'S DR S : r" "AF M#RVOTMPRSVV NUMBER: 71 P ONE NUMBER: MP/MPRSW NUMBER: PHONE NUMB,FR: SIGNATURE OF ISSUING AGENT: DATE APPROVED: DISTRIBUTION: Original - County / l Copy Bureau of Plumbing - - Copy - Owner DILHR SBD-6399 !R. 5/82) Copy -Plumber O O E F9o cw ~ 3 w ° CE '8 00 05 c a a LO ¢o ~E E 5 0 w U C H ` N c c E c E m y ° a o QI Q 3 a o ° Q cm c C Z $ 4 _ m°> m F- c cy _ O j y .D Q Z U - O - C O E N aU -c mmw UO E 'Cal a a t m 3 U L.L N a s w E~ E E w e ~ r O > m am m` C O a O In W C C >,2 7 O O. 7 N m to M y O C O 11 c CU - Lim -0 c ~U a Ecwm o pm Ed cu w O E H a0 c ~o ~ _L ° E ° O F- d a m ` n c v CL > o v w- y W J E E ° c ° O W r t r -Cm mE c~ d~ >a° w He Hcu w2 V~ cr ~o a F- W m F- C5 w -7 ° c c - Q 2 y`~ - E C) Z Z a o E ° o` _ N W D - a w ~ Z Z O U p o 9 U) -0 w z U 3 U' 0 C) max LMIMJ } w Ir x C) c/) Ci~ C/) C!) ck: -3 0 Q z w cr CLO _ O W U .a Q 1) > I _Z O 'I) U < F- oC J ~ 4 c~ gm 0 Q LL LLJ U cn m W -SI W (n O > x F- w 2c ~ t C0003 ~ ° ~ w w co co O m cr 00 W O w co z o vD ° O z = 0 w F- Q f- ..p B, L, 6 PLOT R, 0 S1,; c.; FCT1~ PROJECT 13 LU.M _ E ' E LOCATION r.: _ L.I.. ENS E,T ATE_- .g ---_P L C' T M. A _ WO\ ~ . ~ot~ Nul SyRV'1) oR,t r IOT~~ I k G1 1 _ ~ I .1 FRESH AIR INLETS AND OBSERVATION PIPE CROSS SECTION Approved Vent Cap Minimum 12" Above j ! t-t I 4" Cast Iron Above Pipe G- - Vent Pipe To Final G r a d cr- Marsh Hay Or Synthetic Coven: ng Min. 2" 11,q_g1ecj'aue Over Pipe Distribution, t E Tee Pipe Aggregate Perforated Pipe B_.low Beneath Pipe 4 Coupling Terminating At V Bottom of Svstem DEPA..RTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BOX 7969 MADISON BUREAU OF PLUMBING MADISON WI WI 53707 EVCONVENTIONAL ❑ALTERNATIVE State Plan 1. D. Number. Holding Tank ❑ In-Ground Pressure 1:1 Mound Ilr assigned) NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER . INSPECTION DATE. etc. Ken Swainam 380 het acwcvice SE, MpZs. , MN BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV NW!,- SP%, Section 26, T30N-R19(.U, Lat#3, Town a4 St. Jozeph Name of Plumber. MP/MPRSW No. C'-" y Sanitary Permit Number: RGbeAt Utbtricht 3307 St. cuix 58897 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL j CKING COVER PROV IDED. OV IDED. ❑YES LINO ❑YES LINO BEDDING. VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING. (VENT TO FRESH ALARM . FEET FROM LINE AIR INLEr. ❑YES LINO ❑YES LINO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PU MPi SIPHON MANUFACTHHEH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES LINO ❑YES LINO ❑YES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY JWELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE I .-LET PUMP ON AND OFF) ❑YES LINO _ NEAREST SOIL ABSORPTION SYSTEM. Check thesoil moistureat the depth of plowing LF77 );AMETEK 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.) FM AIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE SPACING CO INSIDE DIA ZfPITS LIQUID DIMENSIONS TRENCHES MAVTE ER RIAL: PIT DEPTH GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BFLOW PIPES ABOVE COVER. ELEV-INLET ELEV. END I PIPES. LINE. AIR INLET: FEET FROM 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- meets the criteria for medium sand. TIONS MEASURED. ❑YES LINO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES LINO ❑YES LINO DEPTH OVER TRENCH; BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL. SODDED SEEDED CENTER EDGES MULCHED ❑YES LINO ❑YES LINO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: W BED/TRENCH IDTH LENGTH NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. JNODISTR JD~STRPIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV. ELEVDIA ELEVPIPES DA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES LINO ❑YES LINO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROP ERTV WELL: BUILDING. FEET FROM LINE' ❑YES NO ❑YES LINO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710 (R. 01/82) S~ - wlsconsln APPLICATION FOR SANITARY PERMIT COUNTY (PLB 67) OEPRRTfT 1EnT OF UNIFORM SANITARY PERMIT # In OUSTRY, LRBOR 6 HUR1Rn RELRTIOnS /f~''~X/~ LL f 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 PROP12 TY OWNER SW_4/ M eA,/ MJec) ADDRESS PROPERTY LOCATION -'tTF': N u)1/4 SC1/4, S 2(0 , T?~N, R) E (or W TOWN ~ F: S' ` l~ 9_12~ aK~ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, tAKE OR EA STATE PLAN I.D. NUMBER 3 S1_1 ve 3 /~art~o N N7f TYPE OF BUILDING OR USE SERVED K1 or 2 Family Number of Bedrooms. - ❑ Public (Specify): THIS PERMIT IS FOR A: A 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 Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: l(jg=1er 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 / J v/5- 6 Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private age system shown on the attached plans. Name of Plumber (Print): Signature: MP/MPRSW No.: Phone Number: HOMESITE SEPTIC PLUMBING Co. X30 (r1S 1 ~PC i&001. Plumber's b N, WIS. 54016 Na e of Designer: MAST ROBERT ULBRICHT WIS. P11IMBF 09. NO. 3307 M,RR.S7. "jh I& C. 3 COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ~v J i1 /}_C El 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 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 PERMT S'1' C- 100 This application form is to be completed in full and signed by the owner(s) of the property u~.iub developed. Ai-,y .i iladuC{L1aCles will Olll.y result in delays of the permit issuance. Should this development'be intended for resale by owner/contractql~,("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 I tly/y~ ~U/AI111A I-or 9 y G-c V' Lo7" 7 t4/ Location of Property ~4 ~4, Section 'r 3U N - R I _-W, Township 5~7-- JOSL Eft _ Mailing Address $0 uJs9At- S' { Ira Z-/,S Subdivision Name Lot Number 3 Previous Owner of Property U L 7-7 Total. Size of Parcel ,3~ S ! _ Date Parcel was Created Are all corners and lot lines identifiable? Yes No is this property being developed for resale (spec house) ? _ Yes y No 3 1 ~ Volume s8 and Page Number 3 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 7 ((;lei `er F Gil that mow.-^OP ti f +nennvit ,y( t~ L'S ;!La'Li 4."' , f~il i vSt C~ m (v v~j ..,~"t" U hnowtedge; .ghat I (we) aln (an.e') the ownuL(h) o6 the pnope&ty dc.6ni.bed in taws in6wmat%on i6onm, by v.vutue o6 a watvLLu't-ty deed &ec_oltded in t1Le 066ice 06 the County Regi, ten- o6 Deeds as Document No. 337 and that I (we) pneeentty oan the pnopoeed zite bon the. acwage L C~osa~ 6y-5 em (on 1 (we) have obtained an e"emeri,t, to nun with the. above desuubed pnopmty, bon the const~Luctior, o6 4atd dy,5.tem, and the aanie~ has beeit duly neconded tin the 066ice o6 -th2 County Regi,5-ten. o6 Deed6, as Doewnent No. ) /IGNATUR~ CSI OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED 7SP In w 1 ~v try d ~J H v~ y S T C - 105 r~ y SEPTIC `.LANK MAINTENANCE AGREEMENT Sr. Croix County 0 t4 c7 OWNER/BUYER' E}`t`L=*B 0 X NUMBER r ~ 4;42 S Fire N u m b e r CI'T'Y/STATE 4Z41Y_-Af C aT 3 Ga T L D7" PROPERTY LOCATION: i4, I41 Section 11'I, IZ W, 't'own of ST )bSC)P 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 l.icense_d septic tank pumLer. What you put into the system can affect the [unction of the septic tank as a treat- ment stake in the waste disposal system. St. Croix County residents maw be eligible to receive a grant for a maxi-alum of 60% of the cost of replacement of a failing; System, which was in operation prior Co July 1, 197ti. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keen their systems properly maintained 'file property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a piaster 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 Lange is less than 1/3 full of siudge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 I/WE, the undersigned, have read the above requirements and agree 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. SIGNED DATE St. Croix C.,unty Zoning; Office P.O. Eox 98 Hammond, WI 54015 715-NO-2239 or 715-425-8363 Sign, date and return to above, address. R w . ~ m x ~ x m to w~cc^'30 v m N w~~ O O 0 v (D A A o 0 a3 .o x c° o~0-O c z ' =O~(D Hamm°''o N cc v c w N CD F N N R 0 CD :E°v~ °~o'~ w A w w a r CD ID Co i d c 0~~~ CO 0 CD >>s cc w o 3' z t° or- c ~ Cr w CA 0 Co 0 - m -C oo~vv , (a cr < (D CC" ccr co u, o D c CD CD CA `s ai-1~ ~~05D con v a C_, Z CD -4 C,) CD ID DD S aC A 3WNOEa a D (D °A~ m ~On ..w~cwO 0, (n0. O CD vi ?a a co g (0) V vi w a c A (D C m v 3CD° vw~~O? 0 (D co elm m°.wcp = -1 Sa v,oc .«c~~(DV; CDC :CRc'_ w m 0. G) aof Nc°ccawo m w 7 w a a C W CO) aa- aOCD Q~f =U) cr C N c `<c° w a CD 3 co n ~vo G~co7 u';c-D cDO g ID o o co ° c -i ((DD CD (3SC O a ? C = w " A v~ c m 0 10 a a CD 0 QCJ CD CD ' 0 Z • a * - 0 I I I c_> L 11.00 ydk>~ PLOT and Il FIANS soil 7~~5~•y s~('stEr~ n ~ tS' Aft, ~S U li( 20 iI? ~ G 3(0t \ (3~ sS Gac.~ Hof -93 Cr0 L o _1.+ I•IOMESITE SEPTIC PLUMBING CO. ~O # RT. 3 OVA RC., HUDSON, WIS. 54016 ROBERT II BRIPHT WIS. t-JASTER PLUMBER LIC. NO. 3307 MARA M INN. INSTALLER & DESIGNER LIC. NO. 00663 Fresh Air Inlets And Observation Pipe so►L 7e5rt>J5 By WOMES1TE TESI•NG 1-6. lr~ Approved Vent Cap HUDSON, WIS. '-Ili4:46 Minimum 12" Above v~ Final Grade l~L Above Pipe -4" Cast Iron Vent Pipe lo Final Grade Marsh Nay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee S pal pipe _ 0 0 0 0 0 57- Aggregate o Perforated Pipe Below 7 Beneath Pipe 0 Coupling Terminating At J~, Bottom Of System SOIL BORINGS AND SAFETY & BUILDINGS D REPORT ON DIVISION IDUSTR , OF P.O. BOX 7969 ` LAABOBOR•TRANY,D PERCOLATION TESTS (115) MADISON, WI 53707 ~ HUMAN RELATIONS (H63.09(1) & Chapter 145.045) (+S~ /Jde • J P (j- 7 S~ TOWNSHIP/ rioni iT LOT NO. BLK. NO.: SUBGDIUVISION NAME: LOCATION: FEC 3 00 7`- 7 ti,J /4 T 3oN/R 1 f E (o 1 : MAILING A DDRESS Y: r BI4FEf~S'NAME: L CQk1 'T iy P~' DATES OBSERVATIONS MADE USE PROFjLE DESCRIPTIONS: ~TION TESTS' NO. EDRMS.: ]COMM ERCIAL DESCRIPTION: New eplace S j 'P I Residence 3 r ING: S= Site suitable for system U= Site unsuitable for system RAT r W-O!Off, L: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:loptional) S ❑U NS ❑U ❑ S CCU ❑ S E]Q DESIGN RATE: If any portion of the tested area is in the If Percolation Tests are NOT required Floodplain, indicate Floodplain elevation: under s.H63.09(5)(b), indicate: PROFILE DESCRIPTIONS 1Aj ~JeC%M~ OBSERV ED OUND EST. HIGHEST TO BEDROCK IF OBSERVED (SEE IABBRV. ON OBACK j EX T URE, AND DEPTH l D ELEVATI DEPTH O ' . s~ iss Q ' ~ 3 NUMBER ORING DEPTH L N B 0 ' j alms B- .0 B-L S~ 106 ,00 ? ~s~ n p s/ o,P- a .d 11 A), ofM ~.6 G r i B- 3 13- f S. 1' /if r/ f72 c S B /off.'/0•D r cs 42 B - PERCOLATION TESTS RATE MINUTES DROP IN WATER LEVEL-ffNCHES PER INCH TEST DEPTH WATER IN HOLE TEST TIME PERIOD 2 NUMER AFTER SWELLING INTRVAL-MIN. PERIOD t P- ~ v e S P_ L G Z ~ , P- P- c. p_ y P PLOT PLAN: Show locations slndope. vertical elevation r at all boingseand the'di ectionaand pe cent eference points and showtheir glocatlon otllthenp of plan.Show the surface elevation dethe zontal of land and F7- SYSTEM s of lan ELEVATION Irboop, - SvRV E y ~ _ ^ I s~ O J • r ~3i¢ Cam/ e~ E / 75e /Its0 r ( aN r I sj4et 4c, R N Pt. 20 , /O 4 . p FT L far 'y - - - L 5y ~3 I i- 7- (3 35 ertif that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin I, the undersigned, hereby c y Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. TENTS WERE COMPLETED ON: NAME (print): SEPTIC 54016 ROBERT ULBRICH CERTIFICATION NUMBER. PHONE NUMBER (optional): ADDRESS: S -Z~ 1- ~f 2-- WIP, ASTER PLUMBER LIC. N0. -6 3307 N M.P.R.S. CsT SIGNATURE: MINN. INSTALLE DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. - OVER DILHR-SBD-6395 (R. 02/82) ti 1AXII~'MAI nurn r ? Me sm a c l r r l C R' E 3 E r AS [d i iri ~_t'~ r a sa'Ci¢ Ct ?2 C ~Ct ~.('a1 i~ C. ,1C; C.f t..Pi.37.i s and t avi A ! EGM CPi i a 6 td s-CRAtf ~.r( s~ti 7 a vow ta4?. (E?c an `sns, {~.P as U~~ Meet qT V cars usf",~ 1. ~f.UC }ae a~rrrsr°P"E<s'3< <IrECi ~i,;~ ~1+ ' 3 ;I€? at itt r' })fia 3i rt F clear [ ` I[A ol-,(€ate 1tC" 'E _3 is c E 3"1G;C a s oai;C~t a r+ n } er s, So, i C E; r it fwr '3, z -m! ID q'"xEss C3, C... ty=" a, a F x, .it r f , ~i"aia ~ji*rt v 1#i Sod test 'n i tar"'t Sr kat s'vst~?,tii 1 it t _ R3t3 ~ tai, o- ~ a` r i 1I 0 , 1 FORM NO. 985•A Y IL:o NOV 7 ~~#o 0 moo, 1978 co 35351 SUR EYO S RECORD 8 CERTIFIED SURVEY MAP GOVT LOT 7 -SEC. 26, T 30 N, R 19 W s W 1/4 CORNER 430 OF SEC. 26 S 89°-29'-57" E IS -1► 36 6. 2945.85' /S00, S 43436 56" E \ F w ~P~ • 240,95' LEGEND w Q~P. N o- I" X 24' IRON PIPE SET ~ Q~P 0y I 5g3 60. O WEIGHING 1.68 LBS./LIN. FT. 6„ E w w Z cn I" X 30" IRON PIPE SET ~~~p N -75°-25- 1 9\.75\ WEIGHING 1.68 S 82°_ 0 , 2g S 21°-21'-01" E LBS./ LIN. FT. 23 -24" E © 502' 117.09' w 3 0- 2" X 24" IRON PIPE SET 166'91 LOT I 25' o 3 N WEIGHING 3.65 9- (33~ 3.0 ACRES coo LBS./ LIN. FT. 01 Iti 3 '-21" E N J 79°-01 `t ti ~i,r ® ® /33 482.15' 550.00' 3 0 PLO _ 10, S 82°- 23'- 2 " s a ul) a 10 109.43' 80 E 77 .77 51 ' A° I M ~ci ' tb 67. 1 _ o N ~ 85 LOT 2 I Z N J~e~P 0~ .e ro 3~0 s A9° 4l_ 0 T 3 ~6.0~ 3.0 ACRES o0 of ct) 66? 3.0 ACF2ES S 28°-38'-I I" E ,0 S.W. CORNER `09 151.77' cy DF SEC. 26 0• ' p t 92.02 4 FOUND I" I.P. 59.75 50.00 / 15 - co ` ~SO /s:39.23' 126 N ° LOT 4 '4 3.0 ACRES 100 S 700-36'-25" W BEARINGS ARE 2 .0 32'1 I? 175.50' REFERENCED TO ( 466,44') S 87°-22'-28"W BASS THE WEST LINE OF N 89°-51'-27" W • 17 THE S.W. 1/4 OF 283.13' 31' 13 6.22 - ~s S 43q-5l'-36" W LAKE SEC. 26 S 13°-48-54" W 189.23' (ASSUMED TO BE tip N 00°-00'-17" W) 182.28' O-!~ 1~1 Q~p G) Go N 000-08'-30" E® 66' ® S 000-08'-30" W 71.07' 71.07' ~i GENE C. ' - - R W - 200 100 0 100 S SHAFFER N 890-5l'-27' W - , • S-1325 qJ 6 6.0 0' - 66' ROAD - _ _ It HWSO[y ( BOARDMAN ROAD) R/W SCALE IN FEET ~r W($. CURVE DATA TABLE y CURVE LOT RADIUS CHORD CHORD CENTRAL TANGENT <gND $UR~ ~~g1gtN NO. NO. LENGTH LENGTH BEARING ANGLE BEARING i 1-2 - 200.00' 47.61' S 06°-58'-42" W 13°-40'-24" S 13°-48'-54"W 3-4 266.00' 63.32' N06°-58'-42" E 13°-40'-24" N 00°-08'-30"E 5-6 - 30.00' 40.07 N 55°-42-45" E 83°-47-42" N 13°-48'-54"E 3'- 2 4" E APPROVAL OF THIS MINOR SUBDIVISI 7-8 - 35.75' 34.91' S 53°-09'-44" E 58°-27'- 18" S 82°-;- OES NOT t~EAN APPROVAL I - 58" E 580- 27'- 18" S 829-23'- 24" E` UIL DING S,T~- OR SEPTIC SYSTEM. 9-10 - 35.75' 34.91' N 68(122' EFER TO H62.20. 8-10 - 80.00' 100.09' N 07'-36'-36" E 282°-33'-07" N 31°-06'-50"W - 1 80.00' 1,16,.41' S35°-42'-23"E 93°-22'-03" - APPROVE' 2 80.00' 66.00' S 35°-20'-22" W 48°-43'-28" - NOV 17 1978 ~J 3 80.00' 112.33' N75°-42'-21"W 89°-11'-04" - ST. CRO x - COwi6TRFISfV.i. ;;ViJ ;r 5~ 10- 11 - 80.00' 69:23' N 710- 58'- 19 E 510-16'-32" MAN ZO pNG COAAi Y., i Volume 3 Page 738 THIS INSTRUMENT WAS DRAFTED BY R.M.W. ,JOB N0. 78-52