HomeMy WebLinkAbout030-2006-60-000 (2)
n cn p K T 0 r~
o rD j
m ' o 3 nA
(D M -0 w
0) CD
n
O W O
Ll 00
0 C-
it A o C) r)
(n o
N
C- (D CD
03 c
T W
91
o O
C7
Ch co
p CO CD
N
7 N ~ O
to to ~ ~ o p
C O p
M -u
D (D O. G
O r
l~ o cD a)
I.n
CD a
CD 0 r- C/)
N ~ ~ 2 Ul O C
C a
(n
N
O O O
U
N
fn fn (n CT O D
m A
o m m ~
7
N O
CA
z - Cl)
z
N
D co OZ O
_ IO °
(D N !V
CD N
N
O N
C CD CD
W C1
C1 7
z _ CO -1 N
O O p Z CD
C Z1
n A Z
G)
O CC W 'O
< O A
Cl M z
3 a
O z CO
3 j
z
N
CD A
W
C1 O Z Cll W
CD 0 O CL O
00-2 =g- cL S c-
;4 Ey CD
N CD' O O CO
O n = Cl) a) T
N 07 O j 7
C) p~ cn!1 n'
N d w co
(D T. i~
CD N 7 N N !n
CU < CD
C n O O
7 ~ d (D
O C O O O O
f/1 O- N ~ CD P
C ~ a
(D CD = Cn
Cp O N O
c' 0 O O
00 0 O 3 C O A
<< W
dQ
7 W -0 c?
Cn X ti
00 Co
O C1
ti
O W O CCDD O
:(7 a ~
A
Ck
ti
O
DEPARTNiENT OF APPLICATION SAFETY & BUILDINGS
INDUSTRY, FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be
included.
Property Owner: Mailing Address:
Ric t, a v^ i~4 Z 8o ➢C 3#0 Q 4)1', 5'4161(,4
Property Location: City, Village or Township; County:
*W% AoLt aS 3 ! T -30 N / R _ S* -C---).,- C. ✓'0 4
ZL,
7-0 _S41 IM4
Lot Number: Blk No.: SubdivisiotfName: Nearest Roa , Lake or Landmark: State Plan I.D. Number:
I I - / 1. 1 s pf(~~ C / 11 Z (If assigned)
TYPE OF BUILDING "A/ tl` 0 1• S! S VrvUriG~ L ol- I
Number of
❑ Public* ❑ Variance* ❑ Other Bedrooms:
5d 1 or 2 Family *State Approval Required. Z
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY
%OILJ
HOLDING TANK CAPACITY N
LIFT PUMP TANK/SIPHON CHAMBER W-A
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA V New per inch): PROPOSED (Square feet): L`~ NeW ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit
2,5+ 6 3~ ❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
"Private ❑ Joint ❑ Public R, St
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signature: /MPRSW No.: Phone Number:
J S J p 3?_ 2- (71S ),116-049
Plumber's Address: Name of Designer:
, to . , ,
COUNTY/DEPARTMENT USE ONLY
ign to of Issuing A nt: Fee: Date: APPROVED Sanitary Permit Nu ber:
❑ DISAPPROVED
eason for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (N.03/81)
2
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC ~ Tg%-R /?W
ST. CROIX COUNTY, WISCONSIN.
ADDRESS L
SUBDIVISION " - '1 LOT LOT SIZE 7 ct L
PLAN VIEW
Distances and dimelions to meet requirements of H63
THING WITHIN 100,FEET OF SYSTEM
R
5r
r p
r
Idiae tlo~thj Arrow
SC L .
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference oint u
p Slope at site `L/n
SEPTIC TANK: Manufacturer: $AAW J~v ,wZj5'` Liquid Capacity: e-)06
Number of rings on cover Tank-manhole cover ele ation :9z 4-t'r
Tank Inlet Elevation: ~►y Tank Outlet Elevation:
PUMP CHAMBtR
Manufacturer': S14 Number of gallons
Number of gal. pump set or a cycle gallons; total capacity o
distribution lines gallon: size o pump head;
gallon per minute horsepower ran name of pump
and model number ;
Type of warning device
HOLDING TANK: Manufacturer Number of gallons
.Elevation' of manhole cover
Type of warning device„
SEEPAGE PIT SIZE: _ Number o pits feet diameter
feet liquid dept~i~ seepage pit in eipe-elevation
bottom of seepage pFit o. e on feet.
SEEPAGE BED SIZE: number of lines_wi. t 7_lerigthtile depth,,ZO"/
SEEPAGE TRENCH: width length
PERCOLATION RATE e AREA REQUI D RE S BU LT
INSPECTOR />O- ~~?w
n
DATED LO PLUMBER ON JOB
LICENSE NUMBER
NOIS,ozr3u Xod NOSV3~!
861-- -SyHa aayoar3'
;86T RIVC1 QSAOIIdd`
• _ 8'IyI y xS QSyOSdSN
= IV
13 azTnbaz eazy
-33 eaze uoTjdzosge TeIoy
13 19TuT mOTaq g1daQ 13 zaiameTp apTslno
ou 9a1, s]Td punoze TaAezO slTd 3o zagmnN
SNOISNaNIQ IT,:
:zaAoO 3o ad4l 13 .0/ eaze uojldlzosge TeIoy
'13 OOT zad •uT,,2 gouazl 3o adoTS I3 sauTT uaemlaq aouelsTa
•uTapez8 taoTaq 9TT1 3o g1daQ 13 nsauTT 3o gl$uaT TeIoy
•uT `.z aTT1 zano IiJooz 30 g-adea sauTT 3o zagmnN
•uT---Z-/"-aTT1 mOTaq xaoz 3o q-1daQ -a 3 -Os- auTT gaea 30 gl2ual
•13 eaze pazTnbag 13 gouazl 30 g1PTM
SNOISNBWIa SyIS NOIyd2i0SB`.
. - za~eMuSTH /1
adoTs %ZT L -$uTPTTng TTaM :moz3 aourls
gouazy'f1 y!rp ag A
SyI S NOI lasos 9
za]em ggTH
adoTs %ZT SuTPTTnq TTaM :moz3 aauelsT,
malsAS mzeTV zadmnd
sluamlzedmoo 3o zagmnN suoTTeS azTS
xNVI 9NI Q•IO
zagmnN TapoW z9znioe3nueyl dmnd suoTTeS azTS
2i~EWHH~ 9NIdW
za~eMgSTH
-aCl-adoTs %ZT ~2uTPTTnB TTaM :moz3 aausas
squamlzedmoo 3o zagmnN suoTTeS~azTS
uoTsTATpgnS 301-P oT339S NOIyHO
dIHSNMOy awl
A-juno0 xTozO •1S
T"m
- oT1daS a1e1S
ITmzad AJPITuES
y ,
WSIS)~S R9HM3S 'IHnQIAIQNI - NOIyOSdSNI 30 INURE
l~"G
REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
Sanitary Permit / -z
y State Septic "0/*or
\ME TOWNSHIP St. Croix County
CATION Sectioz4e- Lot #Subdivision
'PTIC TANK jeyr-y-\ ~•7/P. w~~ -0 3-71065
Size-)00 n gallons Number of compartments
:stance from: Well Building / 12% slope L~
Highwater I/Zd
-MPING r.HAMBER
Size gallons Pump Manufacturer Model Number
OLDING TANK
Size gallons Number of Compartments
Pumper Alarm System
-istance from: Well Building 12% slope
Highwater
BSORPTION SITE
Be ,,/✓~/r/eTrench
stance from: Well Building 1Z Z 12% slope
r
Highwater
3 If
,BSORPTION SITE DIMENSIONS l
Width of trench / ft Required area C) ft.
Length of each line ft Depth of rock below tile in.
Number of lines 3 Depth of rock over tile in.
Total length of lines - ft Depth of tile below grade in.
Distance between lines ft Slope of trench e47- -in. per 100 ft.
Total absortption area ft Type of Cover:
'IT DIMENSIONS
Number of pits Gravel around pits yes no
Outside diameter ft Depth below inlet ft
Total absorption area ft
Area require ft
INSPECTED BY TITLE
\PPROVED DATE_ 1982
EJECTED DATE _-198__
lEASON FOR REJECTION
EH 115 Rev. 9/78
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION~1- Section N,R-11r (or)CTownship or Municipality S ty S ~r°~
Lot No. , Block No. S ~4 q, S. / ✓ County S C Yo i ~t
~u6aivislo Name
Owner's Name: _ k v Cr ~ -~0 s
Mailing Address: I_ D u dSO t3 (~j a
TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM _ OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS yZ~}8 8~ PERCOLATION TESTS
SOIL MAP SHEET u~ _T_ SGG
NAME OF SOIL MAP UNIT
PERCOLATION TESTS
TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
NUM- DES CHARACTER SOIL SINCE HOLE HOLE AFTER INTERVAL RATE
MIN/IN
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P-3 3~" sew G - z ti1a 30 1IGo ylr~ z
P- Ll 3~'' Sic L3 - L/ o 3a i 17/1 l 14~ ! rho Z
P- Z yC, 1 311 Y/1 z5
P-
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK
/ p 8 OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES /
B- / (n )oe Ia" Z' a. 5'S.G ou SL J- :3~" Sc..d IZ l~
B- Z i` /lpo 8 Iz" s.. ll"~I 1 Z3`'sI I
z"~ f GG6c
B- 3 ~Uo-ri C! -7 83" l(d"_-.c , 1L) ~Si
B- 8 \ " k) G n C.. 1 "3a S I Ica 5 N« C.4,
113-
1-
e3 3 _r 77, 4ouBPLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy c1 LI .Indicate scale gr distances.
Give horizontal and vertical reference points. Indicate slope. LDS r~A eo
~~;~n 1Zu y0~. L (p
'v4r~ s
1 * l t` . ,o ! A4 q~
F
4o
4
+ I _
4", Cf N
'gyp
I
N1 -
i
Nr r
I a.
m _
i i c s
r__,.._
z
1.__ ...__i.~... I
I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedure nd methods
specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my
knowledge and belief.
Name (print) /4 ~ IP YJ j Certification No. 6
Address to 8 Vja( nu+ 5 dl -'Do \ej Ij y~:, I I
Name of installer if known
(J/ .
Copy A -Local Authority CST Signature
T
.rwr~. 1 i
if A
1
21
~i ~v .U / r .1 rj ` ro \
LJ
ra.l
\ '7 r f
r
fop,
r
1
i
COMMERCIAL TESTING LABORATORY, INC.
51A Main Street, P.O. Box 526
Colfax, Wisconsin 54730 Cj[:A;w
715-962-3121
800 - 962 - 5227
A# CROIX COUNTY h'EPORI' DATE; 3/03/92
COURTHOUSE RATE RECEIVEDS 2/28/92
-IUDSICIN, 431 54016
`JWNERt Everett Short
i
ATIONS 669 Perch Lake Rd., Hudson
SECTOR: M. Jenkins
F COLLECTED. 2-26-92
'L COLLECTED: 2.34pm
--RCE OF SAMPLE: Kitchen faucet
'rE ANALYZED22-28-92
ANALYZED.I1.00am
TFORMi 0 3 U sr
=RPRETATIONt Bacte-;o[
ove
r.
~ a 9 1
O
to
N
LAB TECHNICIAN: Pam Ga,,re
OF.\NDEPEA1,
`o W1 Approved Lab No. 19 3
a y .
Means "LESS THAN" Detectable Levei Approved by`
PROFESSIONAL LABORATORY SERVICES SINCE 1952
02/03/12 16:15 ^p715 386 4628 S.C. CO CR'I'110US1', Z002
7 o2 i -
SIA'
ST. CROIX COUNTY ZONING OFFICE
911 4th Street
Hudson, WI 54016
J ;
Telephone
- (715)386-4680
The St. Croix Co. Zoning office offers the'tervice of se tic and
water inspection to Lending Institution, Realty Firms, and
private individuals.
COMPLETION OF THIS FORH IS SO THAT THE PROPERTY CAN BE
ESSENTIAL
LOCATED.
Please provide the following information, enclose appropriate fee
;jade paydble to ST. CRoIX Co. ZONING, and mail, along with form
to the above address. Testing will be done as soon as possible
after fee and form are received.
WATER TESTING --------------------------------=-FEE:$'25.00
(For nitrates and coliform bacteria)
WATER TESTING------------------------ FEE:$175.00
(VOC'S)
SEPTIC SYSTEH INSPECTION FEE:$;25.00
PROPERTY OWNERS NAME: I
PROPERTY OWNERS ADDRESS: CITY:_'
L
Town egal oDescription/.-:, 1/4, 1/4, Sec. r ' ! T N-R_ W,
Subd'vi's ion
FIRE NO_
LACK HOX NO.': ~
Color of house-,;- Realty sign? Firm:
1 -77
PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP, i.e., COPY OF PLAT
BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that'is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. if
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services:i
Telephone No.
REPORT TO BE SENT TO:
CLOSING DATE:
Signature:
FEE 3 '92 16:21 715 386 4628 PAGE.0E12
`T4.. ST. CROIX COUNTY
WISCONSIN 10
ZONING OFFICE
7ST. CROIX COUNTY COURTHOUSE
irl 911 FOURTH STREET • HUDSON, W154016
(715) 386-4680
Feb. 26, 1992
Joanne Regan
Real Estate Support services
7825 Washington Ave. S, Suite 900
Minneapolis, MN 55439
Dear Ms. Regan:
An inspection of the septic system on the property of Evertt
Short, located at 669 Perch Lake Rd., Hudson, WI was conducted on
Feb. 26, 1992. At the same time a water sample was obtained for
testing. The results of that testing will be sent to you as soon
as we receive them back from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and
did not involve any excavating or chemical analysis.
Accordingly, there is the possibility of hidden defects in the
system not discoverable by this inspection. This does not in
any way warrant or guarantee the continued proper functioning or
operation of this system. It is recommended that the system
should be pumped once every three years. Therefore, the
prolonged life of this system may be dependent upon proper
maintenance of the system.
Tar ins
Assi stant Zoning Administrator
cj
1
_ C-. z
m <
o
n, C-
z n -
O.ZO
U)
m
O
.z Z
O
< rn
m
z
O Y m
O
C
yl !
C-
m
s,.. D
rn
a
r" m
r'l C
r
n O
m
o N
13
o
n z _
cr
N
r1 Z
.1 0
~t
O
C
m ~
N
-o O
O m
P z
>y
V
I
CQMMURCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730 C Aw
715-962-3121
800 - 962 - 5227
l
Cni) X, COUNTY REPUkT i.A Ee 2/220/91-
;
OURTHOUSE DATE RECE.TI rD!
UDSON, WI`
7S 'TO wNE:k: Prudential R*eIocators
L GLLLit , i Ell: 6-!?
id4E COLLECTED' 2S30
'0MCE OF SAMPLU
ATE ANALYZED'S-1E
fME ANALYZED: 22(C)r
,0LIFORM2 0
W ppm exceeds the recommended Pub is is
i nk i ng (dater Standard,
:.,oform k;actevlai100 mi
+:a#a-Ns#~°oaer\, malt..
C lp
Z~C,9 ~ O
WI Approved Lab No. 19 p f,
9m
O p
g ( Means "LESS THAN" Detectable Level Approved b4'
dJ, S
PROFESSIONAL LABORATORY SERVICES SINCE 1952
ST. CROIX COUNTY ZONING OFFICE
911 4th Street
Hudson, WI 54016
Telephone - (715)386-4680
l e St. Croix Co. Zoning Office offers the service of septic and
water inspection to Lending Institution, Realty Firms, and
private individuals.
COMPLETION OF THIS FORK IS ESSENTIAL SO THAT THE PROPERTY CAN BE
LOCATED.
Please provide the following information, enclose appropriate fee
made payable to ST. CROIX CO. ZONING, and mail, along with form
to the above address. Testing will be done as soon as possible
after fee and form are received.
c
WATER TESTING FEE: $ 35.00
(For nitrates and coliform bacteria)
WATER TESTING FEE:$185.00
(VOC'S)
SEPTIC SYSTEM INSPECTION FEE:$ 25.00_--AL-
PROPERTY OWNERS NAME: (f,7)- V . q y R P u Q~
PROPERTY OWNERS ADDRESS : ~G I ?4 CA f J- L 44:
Legal Description /V L 11A4 E 1/ Sec.,3y , lk-J30 N-R W,
Town of 11k. Q Lot No. Subdivision NQ 4
FIRE NO. LOCK BOX NO~" v`` ` 63~ 3~i•~ 4'
Color of house_ a,,
'J Realty sign?_Vc~_Firm: _ G(l
PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP, i.e., COPY OF PLAT
BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. -If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual reque ting services:
Telephone No. 2 3
°
REPORT TO BE SENT TO: U
orb
CLOSING DATE: a y
Signature•
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
ry, 'YTI 911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
Aug. 18, 1992
Shirley Nelson
Edina Realty
700 - 2nd St.
Hudson, WI 54016
Dear Ms. Nelson:
An inspection of the septic system on the property of Prudential
Relocation located at 669 Perch Lake Rd., St. Joseph, WI was
conducted on Aug. 18, 1992. At the same time a water sample was
obtained for testing. The results of that testing will be sent to
you as soon as we receive them back the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and did
not involve any excavating or chemical analysis. Accordingly,
there is the possibility of hidden defects in the system not
discoverable by this inspection. This does not in any way warrant
or guarantee the continued proper functioning or operation of this
system. It is recommended that the system should be pumped once
every three years. Therefore, the prolonged life of this system
may be dependent upon proper maintenance of the system.
Sincerely,
Mary J. Jenkins
Assistant Zoning Administrator
c7
LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE TOWN OF SAINT JOSEPH
COMPUTER NUMBER 030-2006-60-000 Parcel Number 34.30.19.373B
OWNER NAME: First LEONARD S JR & DEBORAH L Last KODLUBOY
PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment
669 PERCH LAKE RD
SECTION 34 TOWN 30N RANGE 19W '/4160 1/40
Line Description Line Description
TOTAL ACREAGE 3.880 PLAT LOT BLK
01 SEC 34 T30N R1 9W NW NE LOT 15
02 2 OF CSM 4/1063 16
03 17
04 18
05 19
06 20
07 21
08 22
09 23
10 24
11 25
12 26
13 27
14 28
F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit