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Parcel 030-2061-80-000 11/17/2006 11:30 AM
PAGE 1 OF 1
Alt. Parcel 27.30.20.593B 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 - VERTIN PROPERTIES LLC, MARY
MARY VERTIN PROPERTIES LLC
135 HERITAGE TRL
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 49 CTY RD E
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.960 Plat: 2111-HOULTON
SAEC 27 T30N R20W LOT' 7 BLK 8 EXC E 38 Block/Condo Bldg: 8 LOT 7
FT VIL HOULTON
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
27-30N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
09/01/2004 773170 2647/447 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 09/07/2004
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 1.960 257,700 7,300 265,000 NO
Totals for 2006:
General Property 1.960 257,700 7,300 265,000
Woodland 0.000 0 0
Totals for 2005:
General Property 1.960 257,700 7,300 265,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT Sy iTARY SYSTEM REPORT
l TOWNSHIP SEC. T N, R W
ADDRESS , ST. CROIX COUNTY, WISCONSIN.
3DIVISION , LOT
L~T
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
1 IridicaCe North' Arraw j
---t - t - - - -t - f --t - - _
1 I I L S CALF :
yPTIC TA1,T,(S) MFGR. CONCRETE STEEL
NO. of rings on cover_ _ Depth DRY WELL
ANCHES NO. of width length area
j no. of lines width_ length_ area
depth to top of pipe
tGREGATE _
p+g": RATE AREA REQUIP.E D AREA AS BUILT
'~,Sciaimer: The inspection of this system by St. Croix County does not imply complete
o~-Pliance with State Administrative Codes. There are other areas that it is not possible
3 inspect at this point of construction. St. Croix County assumes no liability for
vStem operation. However, if failure is noted the County will make e,rery effort to
1~~ermine cause of failure.
'EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
0000,
`'INSP R`
DATED_ PLUMBER ON JOB
LICENSE NUMBER
I .
' r t
z REPO•?T Or INSPECTION INDIVIDUAL SEWAGE SYSTEM
San,itatcy Petsm.i,t .
• State Septic
`
NAME=~~ ?{~rutn6 hi p St. Croix County a.
Location Section
SEPTIC TANK
I
Size ~hfl gattoms. Number o6 Compatctmentt6 I
D.itstanee Ftcom: W e Z 12% ote gtseaten stope.t
Bu.itd,ing6t.23 Wettands ~ •
Highwatetc .
DISPOSAL SYSTEM
D.idtanee Ftsom: Wet / 6t. 12% on gneatetc stope_
BuiZd.ing 76 E fit. Wettands -_Ft.
~S H.ighwatietc
FIELD DIMENSIONS:
W id•th o6 ttseneh 6t. D th o6 ock below Cite in.
Length o6 each tine 6t. epth ock oven tite in.
Numbers o6 2ine~s Dep o~ti2e• 6eEow g,~eade in.
TotaZ .e.ength o6 tine .t. S ope o trench in pets 100 6t.
D.ustance between Zines it. epth ' o bedtcocfz 6t•
Totat abtsoAbtion area 6t2 Dept to gtcoundwatetc 6t.
Requited atsea 6t 2 Type o6 Covets: Pape t ots Straw
-
PIT DIMENSIONS:
Numbetc o6 pit3 Z, Gtsavet around pits yes no
Outside diametetc6t. Depth betow ,inlet 6t.
2
Total ablsoAbt.ion a 100 6t A
Area tsequ " ed bt2 n'
INSPECTED BY L T TLE a
C- r- j
APPROVED DATE 197_
REJECTED DATE -197-
ti`s
r
PLB 67 State and County State Permit #
uf: Permit Application County Per t/#
~G
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
Q.~2
B. LOCATION: % &(4---%, Section .47, T2 N, Ra20 E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township G 7
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex _ o. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY Q 0 d Total gallons No. of tanks L_
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber-- Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLU T DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft.
Nev. Replacement -Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length -Width Depth Tile depth (top) No. of Lines
Seepage Pit: X_Inside diameters Liquid DepthNo. of Seepage Pits-
Percent slope of land Distance from critical slope
WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑
Owners name as listed on H 115 if other than present owner:
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Adgin' trative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the CertiSol Te ter, , - /5a~,2_
. -"`IFand other information
NAME C.S.T. # C/
obtained from -2.- (owner/builder). Phone #
Plumber's Sign Sure L''L'~' P/MPRSW#
Plumber's Addres Z " /
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
i
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3 ,
1
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Do Not Write in Space F PR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application ~f lel Fees Paid: State C'- oun Dat
i
Permit Issued/RetMMM (late) ~T Issuing Agent Name t2=t etc
Inspection Yes No State Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy)
Revised Date 7/1 /78
t DEPART~MENT.OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH
State of Wisconsin SECTION OF PLUMBING AND FIRE PROTECTION
P.O. BOX 309
MADISON, WISCONSIN 53701
TEL. 608-266-3815
INALL CORRESPONDENCE
REFER TO PLAN
IDENTIFICATION NO.
NAME OF PROJECT ,
TYPE OF APPROVAL
STREET AND NO. \
CITY OR TOWN COUNTY FS TATE ZIP ` l~~
OWNER~
Gentlemen:
Examination of plumbing plans and specifications for the above-mentioned project has been completed. In accord with Chapter
145, Wisconsin Statutes, and Chapter H 62, Wisconsin Administrative Code, the plumbing plans and specifications are approved
contingent upon compliance with the stipulations indicated on the plans. Please review your code for the requirements of each code
section noted.
The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of
plans bearing the stamp of approval of the department.
In the event installation of the plumbing improvements or system has not commenced with in two years from this date, this
approval shall become void and new application shall be made for approval of these plans before work may commence.
In granting this approval, the Division of Health does not hold itself liable for any defects in plans or specifications, plan omissions,
examination and reserves the right to order changes or additions should conditions arise making this necessary.
This approval is based on Chapter H 62, Wisconsin Administrative Code, requirements. It shall be necessary to obtain and fulfill the
permit requirements of the city, village, township or county in which this installation is to be constructed. Failure to obtain local
permits will automatically void this acceptance.
Sincerely,
James Sargent - Chief
PLANS REVIEWED BY: DATE:
cc: DPS-OWS Owner DI LHR
Local PI Plumber H & R (2)
County Mfg. Rep. Bur. of Health Fac. & Services
Sec. of Plat., Rec. & Env. Services
Pl@ 100a 1?08 ; ♦ •
State And Return Upper of Wisconsin
DIVISON OF HEALTH
Portion Of This Form With SECTION OF PLUMBING
AND FIRE PROTECTION SYSTEMS
Any Return Correspondence MAIL ADDRESS: P.O. BOX 309
MADISON, WISCONSIN 53701
608-266-3815
DATE: PROJECT:
PLAN ID. #
DETACH HERE
PROJECT NAME PLAN ID. #
This is to acknowledge receipt of your plans and specifications for the above-indicated project.
Preliminary review indicates the plan review fee required is $
❑ Plan accepted for review. Fee received is $
Fee is being returned because of ❑ Overpayment ❑ Underpayment.
Providing one of the two catagories above is checked, remit correct fee in one payment.
❑ No fee has been remitted. Plans submitted with no fees will be held in abeyance.
❑ Plans being returned.
❑ Additional information required. SEE BELOW.
1. Plan Submission
❑ Additional information shall be submitted in triplicate unless specifically noted.
❑ Plans not clear, legible or permanent.
❑ All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2)(a) Wisconsin Administrative Code.
❑ Affidavit enclosed.
11. Alternate sewage Disposal Systems (Mound Systems)
❑ PLB 108 (Application for use of an alternate system).
❑ County onsite required (1 copy). ❑ Design calculations for pressurized distribution
❑ Cross section of mound. ❑ Pipe lateral layout. ❑ Plan view of alternate.
111. Private Sewage Disposal Systems
❑ Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides.
❑ Elevation of permanent reference point (benchmark).
❑ Location of area suitable for replacement system - provide soil test data.
❑ Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank to bldgs, lot lines, well, watercourse, etc.
❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast.
❑ Construction detail and cross-section of soil absorption system.
❑ Soil boring and percolation test on EH 115 completed by certified soil tester (1 copy).
❑ Complete data relative to anticipated use of bldg. ❑ 3 copies of PLB 60 enclosed.
❑ Deed restriction required (1 copy).
IV. Holding Tanks
❑ Profile of holding tank.
❑ Holding tank agreement signed by owner and local unit of government (sample enclosed).
❑ Reason for installing holding tank soil test or statement from county (1 copy).
V. Lift Pump
❑ Calculations for total lift pump discharge, head and gallons pumped per cycle.
❑ Size, length & depth of force main.
❑ Detail & model of pump or automatic siphons including size, pump curves, drawdown and average flow rate GPM.
❑ Cross section of lift pump tank showing pump(s) or siphon(s).
VI. Systems In Fill (Fill must be placed prior to plan submission)
❑ Total area filled (fill to extend 20' beyond edge of trench before side slope begin).
❑ Depth and type of fill.
❑ Copy of onsite report by county or district plumbing supervisor.
❑ Length of time fill has been in place.
t • )5 ' PRoPOSCp (CG -
,S s -roc A,1
1 RECEIVED
MAY 9 1979
PLUMBING SECTION
P
Ta 6~a `
1666 LA L
SR''TIC TAMK
NoI.iS
0 tsaAOt
s
J
MAINV 13jQ0 GAL
1306 V A L S' s`o A,~E
SOON, at
P it
lrU AiN p ! !/s t•► otk AIeoVN4 PiTS
FhAMINED and reported upon by the Section of
Plumbing and Fire Protection Systems, Bureau
of Environmental Health, Division of Health,
Department of Health and Social Services.
I JAM,,ES A. SARGE T, Chief
of I'ium.,bing & Fire Protection
Section
Dept. f
APPROVED by the Division of i-eclth, con o
Health and Social to conditions
sot forth in the letter of approval.
Verification i
Plb. # 60
1 /7t
PROJECT DETAIL DATA SHEET
NAME OF BUSINESS
LEGAL DESCRIPTION 6 -7-:3Z71, If 2e)
_All
"-7
OWNER ~ ArkiC C) Nor MAILING ADDRESS (Jd
ZIP
ARCHITECT, ENGINEER, ff7l ADDRESS 722 -~7~ E
PLUMBER OR DESIGNER
o A/ Z I P
TELEPHONE NUMBER 3s-
1. Check appropriate building usage(s) and fill in the information requested opposite
each usage listed. Please consult Section H 62.20.
Existing building New building Addition
( ) Apartments and condominiums . . . . Number of bedrooms
( ) Assembly hall . . . . . . . . . . . Seating capacity
( ) Bar . . . . . . . . . . . . . . . . Seating capacity # of meals served ( ) Bowling alley . . . . .
. . . . . . Number of lanes ( ) With bar R•FF~~
( ) Campground and camping resorts . . . Number of sewered sites
Number of unsewered sites AY 9
Total number of sites
( ) Camps . . . . . . . . . . . . . . . ( ) Day use only Number of persons hP,!~1L'i SeCT1014
( ) Day and night Number of persons
( ) Catchbas i n . . . . . . . . . . . . . Number
( ) Church . . . . . . . . . . . . . . . ( ) No kitchen Number of persons
( ) With kitchen Number of persons
( ) Dance hall . . . . . . . . . . . . . Number of persons
( ) Dining hall . . . . . . . . . . . . Number of meals served daily
( ) Dog kennels . . . . . . . . . . . . Number of enclosures
( ) Drive-in restaurant . . . . . . . . Inside seating capacity
Car-service Number of car spaces
( ) Dump station . . . . . . . . . . . . Number of dump stations
j~C) Employees ( total of all shifts) Number of employees
( ) Hotel ( ) Motel ( ) Cottages . . . . Number of units with 2 persons per unit
Number of units with 4 persons per unit
( } Medical and dental office bldas. Number of doctors, nurses, medical staff
Number of office personnel
Number of patients
( ) Mobile home parks . . . . . . Number of sites
( ) Nursing homes . . . . . . . . . . . Number of beds
( ) Parks . . . . . . . . . . . . . . . Number of persons ( ) Toilets ( ) Showers
( ) Restaurant . . . . . . . . . . . . . Seating capacity
( ) Dishwasher and/or disposal?
( ) 24-Hour service
( ) Retail store . . . . . . . . . . Total number of customers
( ) Schools . . . . . . . . . . . . Number of classrooms Meals ( ) Showers
( ) Self service laundry . . . . . . . . Total number of machines
( ) Service station . . . . . . . . . . Number of cars served daily
( ) Swimming pool bathhouse . . . . . . Number of persons
( ) OTHER . . . (Specify) . . . . . . .
COMPLETE OTHER SIDE
Z. Indicate whether the following facilities are present.
Floor drain yes no Number of drains
Food waste grinder yes no
Dishwasher yes no
Automatic clothes washer yes no Number of clothes washers
3. Septic tank capacity 1()()() 4 _
Holding tank capacity
Septic or holding tank manufacturer
4. SEEPAGE TRENCHES: total square feet _ width of trenches
length of trenches depth
number of trenches
SEEPAGE BEDS: total square feet width
length of bed depth
SEEPAGE PITS: total square feet outside diameter
depth below inlet
total depth from top to bottom of pit
Signatur of person completing form: FOR DEPARTMENTAL USE ONLY
~fJ
Address 22 r 41
Zip/
Tel ephone Numbe
Date ` G
i XANEINED and reported upon by the Section of
~Ilun bins and Fire Pr^t~ctior! Systems, Bureau
c of Environmental r ^c ltd, Division cf Health,
Department of Hac.lth c nd vociccl Services.
C-N cT ` r
JAPv1CS A. Sd.:.c~~~~~, ~.h
Soctoon of Pl;,r;;t,ir & t=ire Protection
APPROVED by the Division of Heath, Dept. of
Health and SockA 'Prvic,_-'s, to conditions
set forth in the letter f approval.
Y
E14.115 161-
WISCONSMEPARTMENT OF HEALTH AND SOCIAL VICES
DIVISION HEALTH, BUREAU OF ENVIRONMENTA `ALTH ilkG.t:ar/lbia
P.O. BOX 309
MADISON, WISCONSIN 53701 MAY 9 1979
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: Y4, Section , T' N, R _ E (or) W, T r Municipality PLUMBING SECT'
Lot No. Block No. F` County
Subdivision Name
Owner's Name: ' t'Yf L i. r: > N t_ ,j i-t .
Mailing Address: it f. W- a.C'- "Ito 1~ " ` f
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
;tllLMAPSHEET----------,, C SOIL TYPE !rI } ~I ( 1,ti c r'
PERCOLATION TESTS
_TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
CHARACTER OF SOIL
THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
IVUM- INCHES
SER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
, Is
P- 7
i f I ~~G- / l
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
J
G L
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the locationand square feet of suitable areas. Indicate number of square feet of absorption area
needed for building type and occupancy. Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
r j ;
P 1
~ I I ~ f
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 location of test holes are correct
to the best of my knowledge and belief.
Name (print) /rl 1t-Y' j Certification No.
Address
Name of installer if known
CST Signature
COPY A -LOCAL AIATEORiTY ~
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