HomeMy WebLinkAbout030-2092-30-000St. Croix County Planning and Zonin Friday, April 01,2005ar11:56:06AM
Detail Sanitary Information Page 1 V 1
Computerill:
030-2092-30-OW
Sub/Plat: Bass Lake South
Section:
26
Parcel #:
26.30.19.774
Lot: 13
TNIRNG:
T30N R19W
Municipality:
St. Joseph, Town of
CSM:
1/4 1/4:
NW 114 SE 1/4
Owner. Stout, Richard 1353 Awatukee Trail Hudson, WI 54016
State Permit: 18052 Issued: 10/19/1978 POWTS Dispersal: Non -Pressurized In -ground Permit: New
County Permit: 351 Installed: 10/24/1979 POWTS Detail: Bed - Seepage Bedrooms: 4 WI Fund:
POWTS Pretreatment: NA
Notes
Inspector As Built Plumber Other Reauirements Additional Notes Money Owed
Tom Nelson Yes Schmitt, Donavin transferred from Roger Evanson to Schmitt; wasn't $0.00
Signed Off: Yes lot 13 at original system Installation. 1200 gal.
Weeks tank to 18' x 46 bed on south side of
house, which shows up on plat for subdivision.
Will file this with replacement permit
Owner. Stout, Richard 1353 Awatukee Trail Hudson, WI 54016
State Permit: 240754 Issued: 0&1111995 POWTS Dispersal: Non -Pressurized In -ground Permit: Replacement
County Permit: 0 Installed: 08/17/1995 POWTS Detail: Bed- Seepage Bedrooms: 4 WI Fund:
POWTS Pretreatment: NA
Notes
Inspector
As Built
Jim Thompson
Yes
Signed Off. Yes
Maintenance
Scheduled Pumo
Date Pumped
8/1612005
8/17/1998
8/16/1995
t
Plumber Other Reauirements
Schumaker, William
1 st Notification 2nd Notification 3rd Notification
Additional Notes Money Owed
UGltz stin Ilon septic tank with $0.00
certification as oumniog on 8116MP. See original
p2Ma us 1200 nA Tanlc_
Changed application from trenches to bed
configuration. May have left connection to original
bed system, but no valve is recorded to indicate
systems are being alternated
• Parcel #: 030-2092-30-000 04/01/2005 11:51 AM
PAGE 1 OF 1
Alt. Parcel #: 26.30.19.774 030 - 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
RICHARD & JANET STOUT
' STOUT, RICHARD & JANET
1353 AWATUKEE TR
HUDSON WI 54016
Districts: SC = School SP = Special
Property Address(es): • = Primary
Type Dist # Description
' 1353 AWATUKEE TR
SC 5432 SCH D OF SOMERSET
SP 8040 BASS LAKE REHAB DIST
SP 1700 WITC
Legal Description: Acres: 8.770
Plat: 0078-BASS LAKE SOUTH
SEC 26 T30N R19W LOT 13 BASS LAKE SOUTH
Block/Condo Bldg: LOT 13
8.77 ACRES
Trect(s): (Sec-Twn-Rng 401/4 1601/4)
26-30N-19W
Notes:
Parcel History:
Date Doc # Vol/Page Type
2004 SUMMARY Bill #:
Fair Market Value:
Assessed with:
6482
569,600
Valuations:
Last Changed:
07/12/2004
Description Class
Acres
Land
Improve
Total State
Reason
RESIDENTIAL G1
8.770
330,600
229.800
560,400 NO
Totals for 2004:
General Property
8.770
330,600
229.800
560,400
Woodland
0.000
0
0
Totals for 2003:
General Property
8.770
238,300
171.500
409.800
Woodland
0.000
0
0
Lottery Credit: Claim Count: 1
Certification Date:
Batch M 131
Specials:
User Special Code
Category
Amount
040-OTHER ASSMT
SPECIAL
ASSESSMENT
754.75
Special Assessments Special Char?aass Delinquent Cherg00
Total 754,75 0 U
• AS BUILT SANITARY SYSTEM REPORT
PMR fle -A' /� ; . ! , TOWNSHIPS SEC. 2(0 T 30 N, R�N
.O.,ADDRESS ST. CROIX COUNTY, WISCONSIN.
:3DIti!ISIOii , ��'„ 7 .5._ .: , LOT T SIZ
PLAN VIEW
-Distances 6 dimensions to meet requirements of H62.20
EPTIC TANK(S)_/;,'� MFCR. CONCRETE_ STEEL
0. of rings on cover :2 Depth ,,0 DRY WELL
ANCHES NO. of width length area
no. of lines ; width j.Y lengthy area ,( Y
a6REGATE depth to top of pipe
?�lC RATE AREA REQUIRED AREA AS BUILT .a "
IACIaimer: The inspection of this system by St. Croix County does not imply complete
.appliance with State Administrative Codes. There are other areas that it is not possible
oe inspect at this point of construction. St. Croix County assumes no liability for
Stem operation. However, if failure is noted the County will make every effort to
;termine cause of failure.
.TEASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
iNSPECT'OR
DATED �i C ' :� `/ . % PLUIMER ON JOB
LICENSE NUMBER
� 7 30, 2 0. 55 7
RfiPOP.T OF I11SPECTIO11--INDIVIDUAL 50E6IAGE DISPOsiv, SYST 1.
Sanitary Pe i� /
Atu
r, Cate Septic r� O �
.+�1E
TOWNSHIP UZI
• 03.Jx Ubunty
SEPTIC U.1101
Size i
_ - e /
-
gallons. ber of
.
Cor�parta�ents .
Distance From:
!-jell £t.
12% or greater slope
ft
Building /G ft,
Wetlands
Highwater ft.
DISPOSAL SYST i
Tile Field
or Seepage Pit(s)
Distance From:
i
well ft.
12% or greater slope
ft
Building Lft,
Wetlands _
f ;.
FIELD
Bighwater ft.
Total length of
lines .7,L ft. number of lines - Length of
each line ft. Distance between lines _ft. Width of the
trench ft.
Total absorption area el- sq. ft. Depth
of rock below file Z-L—in. Depth of
rock over tile — in. Cover
_ -Over . xo ck, Depth of file
below grade _'IL_in. Siope of
trenoh — in per
100 ft. Depth to
Bedrock — ft. Depth to
ground water
eft,
PITS
Number of pits Outsid iameter ft. Depth below inlet
ft. Gravel aro pit: __yes no. .Total absorption area
__sq. ft.
Square feet of seep 'e tren�h bottom area required
Square feet of se page pit a ea required
Inspected bY� `^ Title:. _
Approved J ,.Date �i 197�
.__.
Rejected Date 197
I
Z.
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
w • •
San.itaxy Pexm.it ��/
State Septic D Z
NAME iownah.ip St. Cxo.ix County
LocattoK / �C Section to _
SEPTIC TANK 0 .
Size /vafl gattona. Numbers o6 Compaxtmente I
a.i.etance Fnom: Wett 121 on gxeatex Atoper 6t
Bu.itd.ing .-,? 0, 6t. Wetlands _6t.
H.ighwatex 6t.
DISPOSAL SYSTEM
D.i.atance Fnom: Well lfaf 6t. 12% ox gxeatex elope 6t.
Bu.itd.ing 6t. W ettanda Ft.
• H.ighwatex 6t.
FIELD DIMENSIONS:
Width o6' txench lV 6t. Depth o6 %ock below .Cite / L in.
Length o6 each tine �� 6t. Depth o6 xock oven ti.te .in.
Humbex o6 Linea .3 Depth o6 t.ite below gxade.�;L.in.
xotat length o6 Linea /L G 6t. Slope o6 txench .in pen 100 6t.
D.i.atance between Linea Depth to bedxock
Total abaoxbt.ion axes G 'bt2 Depth to gxoundwatex - 6t.
.. Requ.ixed axea it Type o6 Covet: "P,apex ox Stxaw
PIT DIMENSIONS:
Numibex o6 p.ite Gxavet axound p.ite yee no
Outb.ide d.iamete t Depth below .inlet 6t.
2
Total abaoxb n e 6t r
a
Aitea xequi ct' - 1 6t2 r
rn
INSPECTED 8�_ -�,4ITLE i
APPROV EP ,DATE o 19 7/.
REJECTED ,DATE 197.
fly' 4i� •
o
On
-- -
pGilMljr"r C 11AN61-�
State Permit # es!;V,
Sanitary #
County Per /
Sanitary Permit Transfer Date Original Permit Issuance Date
A. Property Location: (�y.3sL_'/., SectionI t"a", , TAC- N.R_i 9 .E (or)o Lot # City
Subdivision Name, Nearest Road, Lake or Landmark BILK # Village
a. 1 T rt or occupancy: Gommercial Industrial _ Other (Specify)
Single Family X Duplex No. of Bedrooms
Variance
C. SEPTIC TANK CAPACITY _/�y Total gallons
HOLDING TANK CAPACITY Total gallons
Prefab Concrete X_ poured -in -place Steel
New Installation
Replacement
No. of tanks
No. of tanks
Fiberglass Other(Specify)
LIFT PUMP TANK/SIPHON CHAMBER Total gallons Prefab Concrete Poured -in -place —Other (Specify)
D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 3 -- 3 — ? Total Absorb Area Suf% sq. ft.
New X Replacement Alternate(Specify)
Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top)No. Trenches
Seepage Bed: X Length y�zf Width_/P' Depth4�w
Tile Depth(top) No. of Lines
Seepage Pit: Inside o+ameter Liquid Depth No. Seepage Pits
Percent slope of land JeM Distance from critical slope /.S2 r
E. WATER SUPPLY: CC Private ❑Joint ❑Community ❑ Municipal
Present Sanitary Permit Holder Phone No. Sanitary Permit ransferred To: Phone No.
Name (Ve +,4 n S T t.,-r Name
Address Address
Zip Zip
I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with
section H 62.20, Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared
by the Certified Soil Te ter and/or any additional
il tests that may have been required.
Plumber's Signaturej.r-.-" St...�rr MP/MPRSW# 31.v.y Phone
Plumber's Address %LT2 SOS os.-r—
Information obtained from
TRANSFER FORM
SANITARY PERMIT
r agent)
PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord
with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh-
bor's property. If well has not heen druiart Qi • / I !•V ""
V
Signature of Issuing Agent
44
1. County (Yellow copy) 3. Owner (Pink copy) I5✓. DIVISION OF HEALTH
2. State (White copy) 4. Plumber (Green copy) v P.O. BOX 309, MADISON WI 53701
EH'115
LOCATION:
Lot No.
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
' DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
N
., REPORT ON SOIL BORINGS AND PERCOLATION TESTS Section", T�� R,[VOlor)aownship or Municipality—,, JJT6S'QQ�
—, Block No._, CountyT. �rd "'A
Owner'r
s Name:
%� . _ L 1 $ubdwlslon Name
Mailing Address: Rif 0/ BDx e, /
'//.
TYPE OF OCCUPANCY: Residence -- k No, of Bedrooms
Other
EFFLUENT DISPOSAL SYSTEM: NEW X, ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS d;O —/' - ZF PERCOLATION TESTS /O 14' 7�
SOIL MAP SHEET // SOIL TYPE �7 D- of R�(LJ. Go — pr�y..��,a So• �S
PFRrnI erinu
TEST NUM
DEPTH
INCHES
CHARACTER OF SOIL
THICKNESS IN INCHES
HOURS
SINCE HOLE
WATER IN
HOLE AFTER
TEST TIME
INTERVAL
DROP IN WATER LEVEL, INCHE RATE
BER
1ST WETTED
SWELLING
IN MINUTES
PERIOD 1
PERIOD 2
PERIOD 3
MINIIN
S se
/1/0
/0
3'
31z
3/L
3
P z
See_ Pore AA4
02
Nb
/0
3y
3
3
P 3
r
A4
/O
/ L
/L
l/L
7
SOIL BORING TESTS
TEST
NUMBER
TOTAL DEPTH
INCHES
DEPTH TO GROUNDWATER,
INCHES
CHARACTER OF SOIL WITH THICKNESS, INCHES
(DEPTH TO BEDROCK IF OBSERVED)
OBSERVED
ESTIMATED HIGHEST
B_
96"
arty
>qG ,
, /6 •� s� �. 7, Y'' S
y
,
B- 3
pp .,
!6
7
y6A
Ya
7 0-6 , , 7�r' S
r
.Llo Qi
� � ••
. � ,, r�G •, S
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square et of suitable areas. Indicate nu er f square feet of absorption area
needed for building type and occupancy. " 6' .Z_ c7 �.yoJ Si j'O Indicate scale
•.•••W. W11La109NU rel LIGl lelerence
Um
�Jrsrrr.►�� Re,,011reo6v
G
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 andkelief. /
Name (print)
Name of installer if known
Certification No.
COPY A —LOCAL AUTHORITY CST Signature
tN
PL-867 State and County
Permit Application
for Private Domestic Sewage Systems
State Permit #/ O
County Per k#
County
'DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required
State Plan ID. #
A. OWNER OF PROPERTY Mailing Addr
B. LOCATION: /�l�% SE '/., Section �fi, T N, R�dj) (or)
Subdivision Name, nearest road, lake or landmark Blk#
Lot# City
Village
Township
C. TYPE OF OCCUPANCY: Commercial Industrial Other (specify) Variance
Single family X, Duplex No. of Bedrooms X/ No. of Persons�3
D. TYPE OF APPLIANCES: Dishwasher K YES NO Food Waste Grinder _ YES)C. NO # of Bathrooms i—
Automatic Washer _j YES NO Other (specify)
E. SEPTIC TANK CAPACITY/Z00 Total gallons No. of tanks
Holding tank capacity Total gallons No. of tanks
New Installation iC Addition Replacement Prefab Concrete X
'Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3 3) _Total Absorb Area Z sq. "ft.
Newer Addition Replacement 'Fill System 820�' e(iu•yrca
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length Width f Depth " Tile Depth No. of Lines 3
Seepage Pit: Inside diameter. Li id Depth Tile Size
Percent slope of landl0 O 570&d X /V riV Distance from critical slope
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Ce ified Soil Test r
NAME r C.S.T. and other information
obtained from , owner w r
Plumber's Signature MP/MPRSW# -Phone *;*Pr_ M-Z4"U
Plumber's Address
PLAN VIEW:
•
Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
�tfo SC.iI� ^/
CA&A e F
t
11
' z
I CA
/-eke
Do Not Write in Sp Belo F R DEPARTMENT USE ONLY
Date of Application f
L)— ea s Palid: StateaC
Permit Issued/Flat ted (date) /0— — Issuing Agent Name
Inspection Yes__?(No Valid#
1. county (white copy) 3. owner (preen copy)
2. state (pink copy) 4, plumber (canary copy)
DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
Revised Date 6/1 /76
• �.. �.
'-
�_...
A
5007'499 BASS LAKE
LOCATED IN PART OF THE SWI/4 OF THE NWI/4, IN PART OF THE I
LOTS 6 AND 7, ALL IN SECTION 26, T30N, R19W, TOWN OF ST. ,
u
0
on
W
M
b
m1kL=-xURwn
■o pole or buried cables are to be placed such that the
installation Mould disturb Soy survq Stake. or obstruct vLslon
along any lot line or street liae.
The disturbance of a survey stake by anyone is a vLolation o!
Section 236.32 of Miscoasin statutes. Utility Casements as
hereto set forth are for the use Of public bodies and private
public utilities Aavisg the right to serve the ares.
J /
CERTIFIED MMY MAP ygLUME f t �SrE 1523
ML N0. 191926
LOT
LOT 2 \ \\
I s�
'2. t
_ CERTIFIED SURVEY MAP \ �;
VOLUME 8, RAGE 2325 A
LOT I \ VA
sd
•' �F \ )V,
SM
LOT 13e.TT ACRESa 3el.ese SO. FT.RICLUOINA LAND
NEANOERONE AM MATER'S CODE. 1
fI i \
OWNER
u67 MT�tt TRAM
NIOSW, M. Se014
.i
Isle' Y 1`+2�
Ito -
LOT I
Q�.
LUEN
MORUKNT `pAIOT sE C TION
• I' IROR ►1K FOUND
0 a' R 30' 'NOR PIPE SET. WEIGHING 3.65 Las. PER LINEAR FOOT
MOTE ALL OTRER LOT CORNER! MOMUMENTEO MAN I'A W
MOM ME. MENIeNG 1.40 LOS PER LINEAR FOOT.
�- ---- It. WIDE UTILITY EASEMENT
'• aconsmDepartmentofIndust'y SOIL AND SITE EVALUATION REPORT
Labor and Human Relations
fhvrsior?of Safety a Buildinm :- ----.�
Page 1 of 3
____._ .......-....
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
St. Croix
PARCEL I.D. It
not limited to vertical and horizontal reference point (BM), direction and `Yo of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION —PLEASE PRINT ALL INFORMATION
REVIEWED BY DATE
PROPERTY OWNER:
PROPERTY LOCATION
Richard Stout
GO Ntd 1/41 1/4,S 76 T 30 N,R 19 1E (or) W
-V96PERTY OWNERS IMAIING AD SS
353 Awatukee Tr. S-Q� �f7L
LOT t I
13
PLOCK If
Vn1a
I SUBD. NAME OR CSM #
I Bass .lake South �-
CITY STATE ZIP CODE PHONE NUMBER
016 n
CI ILLAGE MOWN
NEAREST ROAD
( )a
St. 'ose h
132nd. Ave.
[*New Construction Use M Residential / Number of bedrooms 3 [ ] Addition to existing building to r a
[ ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate. 5 bed, 9pd/ft2 •6 trench, gpd/ft2
Absorption area required 900 bed, 0 750 trench, ft2 Maximum design loading rate . 5 bed, gpd/lt2 .6 trench, gpd/ft2
Recommended infiltration surface elevation(s) 95.10 ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material outwash Flood plain elevation, if applicable n/a ft
S = Suitable for System
CONVENTIONAL
MOUND
IN -GROUND PRESSURE
AT -GRADE
SYSTEM IN RLL
HOLDING TANK
U - Unsuitable fors stem
®CS ❑ U
®CS ❑ U
®CS ❑ U
M 1-1U
❑ S M
❑ S [0 U
:ma::'
Ground
elev.
97.95 tt
Depth to
limiting
factor
>80
Boring #
.2
Ground
elev.
9 7-2LI It.
Depth to
limiting
factor
�2
SOIL DESCRIPTION REPORT
Horizon
Depth
in.
Dominant Color
Munsell
Mottles
Qu. Sz. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
BoLrdary
Roots
GPD/ft
Bed
Trench
1
0-6
1 4/3
none
I,.
2/m/sbk
nifr
c/s
2/f
.5
.6
2
6-20
10yr5/4
none
sil.
1/fshk
mfr
g/w
1/f
.2
.3
3
20-80
10yr5/4
none
s/
o/sp,
ml
n/a
n/a
.7
.8
Remarks:
1
0-20
10yr4/3
none
L.
2./m/sbk
mfr
c/w
2./f
.5
.6
2
20-45
10yr4/4
none
sil-.
1/f/sbk
mfr
g/w
1/f
.2
.3
3
45-82
1.0yr5/4
none
f s
0/s),
mvfr
n/a
n/a
.5
.6
6
9
No
j
Remarks:
T Name: —Please Print Gary L. Steel Plane. 715-246-62.00
Address: 1554 th. AVe. N Richmond, Id .
Signature: n{-5-qTate: 2299 CST Number:
� V
,
PROPERTYOWNER Richard Stout SOIL DESCRIPTION REPORT
PARCEL I.D. #
Page 2 of 3 _
r
Boring #
113
Ground,
9837, ft
No to
limiting
fact
> 3
Boring #
4
Ground
elev.
9s.65 ft.
Depth to
limiting
factor
>>2
Boring #
5
Ground
elev.
()(0.10 ff.
Depth to
limiting
factor
>F4
Boring #
On
C
Ground
elev.
It.
Depth to
limiting
factor
Horizon
Depth
in.
Dominant Color
Munsell
Motes
Clu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Corr
Boundary
Roots
GPD/ft
BiF
Trench
1
0-12
10yr4/3
none
L.
2./m/shk
mfr
c/w
2/f
.5
2
12-38
10yr4/4
none
sil..
1/f/sbk
mfr
g/w
1/f
.2
.3
3
38-42
7.5yr4/4
none
Is.
0./sg
ml
g/w
n/a
.7
.8
4
42-83
10yr5/4
none
f s
0/sg
mvfr
n/.a
n/a
.5
.6
Remarks:
1
0-9
1-0yr4/3
none
L.
?/m/shl;
mfr
c/s
2/f
.5 € .6
2
0-22
10yr4/4
none
sil.
1/f/sbk
mfr
g/w
1/f
.2 .3
3
22.-40
10yr5/4
none
Is.
ml
g/w
1/f.
.7 F.
4
40-82
10yr5/4.
none
S.
0/sg
ml
n/a
/a
7 .F
Remarks:
1
0-7
10yr4/3
none
L.
2/m/sbk
mfr
c/w
2/f
.5 .6
2
7-19
10yr4/4
none
Is.
0/so
ml
g/w
1/f
.7 .8
3
19-84
10yr5/4
noen
S.
0/sg
m1
n/a
n/a
.7 .8
Remarks:
Remarks:
SBD-8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout
C.S.T. 2298 Bass hake South New Richmond, WI 54017
MPRSW-3254 MA -SW% S26-T30N-R19W (715) 246-6200
St. Joseph, township
lot. #13
X
N
STC - 10 4 19,
AS BUILT SANITARY SYSTEM R ^ T R VEi%
/ -C' .,v� � �a �- ^
OWNERJU ,yg5
ADDRESS a-S.7 .$/✓.Vg.ke
SUBDIVISION / CSM# �a a 7 ` - 7 LOT #
SECTION__2C_T.yd N-R Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW
EVERYTHING
WITHIN 100
FEET OF SYSTEM
i
d'
Q
�[
r
Z
.M
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: san
ALTERNATE BM:
0
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:- /,�_ y
Liquid Capacity:
Setback from: Well
House aJ- Other
Pump: Manufacturer
Model__ Size
Float seperation
—_ Gallons/cycle:_
Alarm Location
SOIL ABSORPTION SYSTEM
Width:_ / LengthX
Number of trenches
Distance & Direction to nearest prop. line r _
Setback from: well:.,
�-�- House�� - Other
ELEVATIONS
Building Sewer_ ST Inlet.--. ST outlet _
PC inlet_ PC bottom
Pump Off _
Header/Manifold— Bottom of system_
Existing Grade
Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB: t_;
LICENSE NUMBER: 7
INSPECTOR: _ 777:�
3/93:jt
Wiscopsin Department of Industry,
Labor andHuman Relations
Safety and Buildings Division
GENERAL INFORMATION
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
PeSTOUrmit oT, RICHARD [I City ❑Village Town of:
CST BM Elev.: Insp BM Elev.; BM Description:
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
C
Aeration
-'--- --_
o ding
TANK SETBACK INFORMATION
TANK TO
P / L
WELL
BLDG.
vent to
Air Intake
ROAD
Septic
>
> Sp
— ,;25
NA
Dosing
NA
Aeration
Hold
PUMP / SIPHON INFORMATION
Manufaci De d
Model Number M
TDH Lift ,elfossriction S stem TDH Ft
L mead
For In Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
ELEVATION DATA
County:
ST. CROIX
Sanitary Permit No
State P
Parcel Tax No.:
STATION
BS
HI
FS
ELEV.
Benchmark
Bldg. Sewer
,
St/.Hf Inlet
St/Fjt Outlet—
Dt Inlet
Dt Bottom
)` '
Header/#daa.
Z71
Dist. Pipe
Bot. System
Final Grade
0
BED / TRENCH
DIMENSIONS
Width
Length-/ y
No. Of Trenches
I
PIT
DI
No. Of Pits
Insid
Liquid Depth-,.
SETBACK
SYSTEM TO
P/ L
BLDG
WELL
LAKE /STR #
LEACH
Manufacture(;
INFORMATION
C
yPe _
40
���
.
Mo a Num er:
System: • Ui L
T
R UNIT
DISTRIBUTION SYSTEM
Header! M/ani d (/
Distribution Pipes
x Hoe Size
x Hoe Spacing
Vent To Air Intake
Length / Dma 7
Length YL Dia Spacing �
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems
Depth Over C�7lJ „
Depth Over
/�
xx Depth Of
xx S d/Sodded
xx Mulched
Bed Trench Cen er
Bed / Trench Eees -
Topsoil
❑ Yes ❑ No
❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) -fit
LOCATION: St. Joseph.26.30.19W, NW, SE, Lots 6 & 7, Awatukee Trail
P n,( isionr�equlredes ? o�
se other side for additional information.
SBD-6710(R 05191)_ Date Inspector's Signature Cent No
►J
u
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
4 Safety and Buildings Division
EMIR SANITARY PERMIT APPLICATION Bureau of Building Water System•
201 E. Washington Ave.
In accord with ILHR 83 05. Wis. Adm Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less
Cot,
rg
than 8112 x 11 inches in size.
• See reverse side for instructions for completing this application
state Sanit y Permit Number
The information you provide may be used by other government agency programs
oW
p Check itrevisioln to p�Stem appkcalien
[Privacy Law, s. 15.04 (1) (m)I.
State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N
Property Owner Name
Property Location
a�7-
114T_fQ N,R#V E(or)
Property Owner's Mailing Address
Lot Num r
Block Number
City, State
Zip Code
Phone Number
Subdiv rCSM umber
: (check one) ❑ State Owned
t
51
Nearest Road
Public 1 or 2 FamilyDwelling-No. of bedrooms
13rllowan OF
t7` � e
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Numbers)
030 — 0-0 f 0 — 30
1 ❑Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel / Motel 9 ❑ Office / Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1, ❑ New 2. ja Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an
...... SZrstem________System_____ __ ---- Tank Only _.........ExistinQSystem________ExistingSystem
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non -Pressurized Distribution Pressurized Distribution Experimental Other
11 []Seepage Bed 21 []Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ® Seepage Trench 22 ❑ In -Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 17. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
C� d7-1-do $'O r .C/ac- .7- Feet , Feet —
VII• TANK
Ca clt
INFORMATION
in ga Ions
Total
Gallons
# of
Tanks
Manufacturer's Name
Prefab
Concrete
t
Site
steel
Fiber-
glass
plastic
Exper
APp
New
Existin
structed
T nak
T nk
Septic Tank or HoldingTank
r
®
❑
❑
❑
❑
❑
t ift Pump Tank /Si hon Chamber
❑
❑
❑
❑
❑
❑
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print)
Plumber's Signature: o Stamps)
PRSW No :
Business Phone Number:
%
Plumber's Address (Street, City, State, Zip Code):
lid 7 e
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved
Sa itary Permit Fee 11ncludef Grourdwaier
ate Issued
Issu ng Agent Signature (No Stamps)
Approved
[]Owner Given Initial
S—f—geree)
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
San•63961H. OSM) MSTRIRUTIUN. Clngi,ul m County, nor tupy To'. Safety a Rwldnup nrvn,on, Itwnrr. Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3- All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed
II. Type of building being served Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III Building use If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material Complete for all septic, pump/siphon and
holding tanks for this system Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII Responsibility statement Installing plumber is to fill in name, license number with appropriate prefix (e.g MP, etc ),
address and phone number Plumber must sign application form.
IX County / Department Use Only
X. County / Department Use Only
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks, building sewers; wells; water mains/water service, streams and lakes, pump or siphon
tanks, distribution boxes; soil absorption systems; replacement system areas; and the location of the building served,
B) horizontal and vertical elevation reference points, C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 1 15 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards
.S 7`4r4., AE F Sa
n
v\� At/
rl
okA e,
Ar�o�
TO ds �A+a�f�d FiCr t
o r abardatl
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently serving
the cL��.l st.,., f— residence located at: 6�J h, S,F �,
Sec. �(�, T_?d N, R1?W, Town of 5St. Croix
County, Wisconsin. Upon inspection, I certify that I have found the tank and
baffles to be in good condition, and it appears to be functioning properly.
Last time serviced
Did flow back occur from absorption system? Yes_ Now (if no, skip next
line.
Approximate volume or length of time: gallons minutes
Capacity:
Construction: Prefab Concrete j( Steel
Manufacturer (if known):
Age of Tank ( if known) : 1
Other
(Signature) (Name) Please Print
47e1- Mj2 IOJR--2—
tle) (Licen a Number)
4zli
(Dat )
Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or
licensed disposer (NR 113 Wisconsin Administrative Code) 1
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank condition, I
certify that the tank, to the best of my knowledge, will conform to the
requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over
outlet baffle).
01
Name /J,�/,a +�r� , ,x r� b Signature
MP/MPRS r -�_
�uor^o;,dDpaasr""Reeuo�Osby. SOIL AND SITE EVALUATION REPORT
p� 1 of 3
- - - in au:uIU wnn i nn oo.V
COUNTY
S t . Croix
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but
PARCEL LD. N
not limited to vertical and horizontal reference point (B a i fi5 of slope, scale or
dimensioned, north arrow, and location and di sta ;`/�
263019774
REVIEWED BY DATE
APPLICANT INFORMATION —PLEASE PR L INFO TI
PROPERTY OWNER:
/�
RTY LOCATION
Richard Stout s: `�LOT
NW /a gig aN,R 19 xf(ar)W
PROPERTY OWNERS MAII.ING ADDRESS
BLOCK x
SUBD. NAME OR CSM #
1353 Awatukee Trl. �}* yy,
lot 6—
na
CITY, STATE ZIP CODE N ER
❑VILLAGE MOWN NEAREST ROAD
Hudson, WI. 54016 —673
St. Joseph Awatukee Trl.
[ ] New Construction UseTxJ Residential /Number 4 [ I Addition to existing building
$$ Replacement [ I Public or commercial desch
Code derived dairy flow 600 gpd Recommended design loading rate —,7---bed. gpdt►2—_Ltrench. gpdM2
Absorption area required 8 5 8 bed, ft2 7 5 0 trench, 112 Maximum design loading rate .7 bed, gpdttt2 -.8 trench, gpdMt2
Recommended infiltration surface elevation(s) 9 2 .4 5 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material outwash Flood plain elevation. if applicable na R
S : Suitable for system CONVENTIONAL
IN S ❑ U
MOLIND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDNG TANK
I cm ❑ U ®S ❑ U I� S ❑ U ❑ S 011 O S la1.1
-U Unsuitable for system
Boring #
Ground
elev.
96.4 ft.
Depth to
limiting
fac ro
11
Boring #
2
Ground
95.44k
fo
limiting
%W
+80"
SOIL DESCRIPTION REPORT
Horizon)
Depth
in.
DominantColorMom
Munsell
Clu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
(Consistence
Bandary
Roots
GPD/ft
Bed
ITmrch
1
-10 I
10yr4/3
none
sl
2m r
MFR
GW
12f
.5
.6
2
0-22
10yr4/4
none
is
Osg
mvfr
gw
if
.7
.8
3
2-90
7.5yr4/6
none
S
Osg
ml
na
na
.7
.8
nemaras:
CST Name: —Please Print Gary L. Steel Phone: 715 — 2 4 6— 6 2 0 0
Address:
1554 OOth. avp., Aew Richmond, W
Spnawrr. Data: CST Number:
5-1-95 cstm 02298
PROPERTY OWNER R. Stout
PARCEL I.D.# 263019774
SOIL DESCRIPTION REPORT
Page`_of _3
Boring #
e,
3
Ground
elev.
95.55
Depth to
limiting
factor
+80.0
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Boring #
Ground
elev.
it.
Depth to
limiting
factor
Horizon
Depth
in.
I Dominant Color I Mottles Texture Structure
Munsell 1 Qu. Sz. Cont Color IGr. Sz. Sh.
Consistence iBounciar v GPD/ft 2
. i Roots
Bed sTmnch
0-101
10yr4/3
none
S1
2mgr
mfr
gw
11f
.5 .6
2
10-1�
10yr4/4
none
Is
OS9
mvfr
gw
if
.7' .8
3
17-81
7.5yr4/6
none
S
Osg
oril
na
na
.7 .8
Remarks:
Remarks:
Remarks:
Remarks:
SBD-8330(R.05192)
STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout
CSTM2298 NWhSEh S26-T30N-R19W
MPRSW-3254 town of St. Joseph
t-
N
1"=40'
B5.= top of cement base of power transformer @ el. 100'
Gary L. Steel
5-1-95
1554 200th Ave.
New Richmond, WI 54017
(715) 246-6200
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
T
MAILING ADDRESS
PROPERTY ADDRESS / 3 53 T✓'
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE /yam ds A"I Lzi ff
PROPERTY LOCATION .g-g1j4)_ 1/4, -5'E 114, Section ;:C , T Y J N-R—_may
TOWN OF s""�,1 os �,b� ST. CROIX COUNTY, WI
SUBDMSION
LOT NUMBER G',-�?
CERTIFIED SURVEY MAP , VOLUME—, PAGE , LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment 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 system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (l )
the on -site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year
� �expiration date.
SIGNED: 1 ` � +-'�`'� 0 C
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016
11/93
8 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 ofproperty
�/�,c�Q„�(
Location of propertyA/&_1/4 5,t 1/4, Section a ,T,�N-R_,:�.�W
Township Mailingaddress /3 S.3
1��i�f4Lf� x d k �laat scu Gd SYG� 6
Address of site 15a k*--c a9 14 afl-e
Subdivision name sss ,Lo sl.4- S.eF-t -I Lot no. !3
Other homes on property? Yes�No
Previous owner of property F rre 7^ �e 7`erS .,✓
Total size of property mac- Q cr =
Total size of parcel 414
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes _, `No
Volume S-0 and Page Number 417G as recorded with the Register
of Deeds.
-------------------------------------------------------------------
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. 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 Certified Survey Map
shall also be required.
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 (are) 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. , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run 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.
3S Irr2
&A' AA (� .1 JD4
Signature of Applicant
Date of Si nature
Co -Applicant
Date of Signature
:8-16-1985 9:31AM
FROM GARY
L STEEL 715+246+6200
P.1
�tlMlSl11 a1U�116 ' � V V Y L
fNNffGGllLL11 AICI�
SOIL DESCRIPTION REPORT
p 2 d 3
263019774
Soring # Horizon Depth
I
Dominant Color
Munsell
AAoaps I
Texture I
Structure
I Co GPDitt
du C f
or. Sz. Sh.
S*Mnce igut�ry Roots
I
1 0-10
3 x
10yr4/3
none al
2mgr
Bed iT"
mfr gw if
2 10-1
1Oyr4/4
none is
Osg
.5 .6
mvfr qw if .7� .8
Gtou� 3 I7-8
ew
7.5yr4/6
none S
Osg
ml na na .71 .8
95.55 R
Deplh b
6"Wrig
facto
+80"
Remarks:
Boring 11
1 0-17 10yr3/4
zi
w, q
17-42 10yr4/6
Ground
3 42-86 7.5yr4/6
f<
Depollo
i11101q
4idor
Remarks:
Eloring �
ew.
fl
DOM to
W"
lam
Boring #
none
sl
2mgr
mfr
nona
sil
fsbk
mfr
none
1 fs
ag
mvfr
8-16-19% 9:33AM FROM GARY L STEEL 715+246+6200 P-1
STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout
CSTM2298 NWZSA S26-T30N-R19W
MPRSW-3254 town of St. Joseph
t
N
1"=40'
HMI.= top of cement base of power transformer 1f el. 100
40
r
Gary L. Steel
5-1-95
1554 200th Ave.
New Richmond, WI 54017
(715) 24"200
a-16-1-CG 9:3GAM FROM GARY L STEEL 715+2d6+6200
P. 1
STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout 1554 200th Ave.
CSTM2298 2S4 tNownSEofSSt-TJo�seph9w New Richmond, WI 54017
MPRS� (715) 246-6200
N
1"=40,
EM.a top of cement base of power transformer 0 el. 100
Vol
B-4 for future use of exsisting system, with valve
for siternating use with new system
��o��xs►s�-,�s sus+-�• M �,(.
Gary L. Steel
5-1-95