HomeMy WebLinkAbout038-1192-50-000 1isconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count :
Safe and Buildings Division S Croix
Safety INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanit3> 41r7 i No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)I.
Permit Holder's Name: ty Cl Village Town of: State Plan ID No.:
❑Ci
B erg, Mark Star Prairie Townshi
CST BM Elev.:• Insp. BM Elev.: BM Description: Parcel Tax No.:
h Z -' 038 - 1192 -50 -000
TANK INFORMATION EL ATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic l6 Benchmark y — o c /o c7
Dosing Alt. BM r.3 lOZ,BJ
Aeration Bldg. Sewer 5773 °f 8. 2
Holding St/ Ht Inlet Sj ,L L 3
TANK SETBACK INFORMATION /, 6 ,, f St Ht Outlet
TANKTO P/L WE L BLDG. Air Int ake ROAD Dt Inlet
Septic f(7 / (/ NA Dt Bottom
Dosing NA Header/ Man.
q y.
Aeration Dist. Pipe -1. pc
Holding Bot. System z /0---b J j
g
PUMP/ SIPHON INFORMATION Final Grade
St C over
Manufadur De nil
Mod Number GPM
TDH ift Friction System TDH Ft
Loss H ead
Forcemain Leng la. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width 3 1 Length ! �� No. C1f Trenches PIT No. Pits Inside Dia. Liquid Depth
D IMEN S IONS 6 I ENI N
LEACHING Manu adurer.
SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM ( , A -S
Mo a
INFORMATION Type r CHAMBER Nyym er-,
syst t y OR UNIT N` A 7 �• - /`f - l0
DISTRIBUTION SYSTEM 27-
Header / Manifold Distribution PiFpe�� x Hole S x Hole S�pa�ing Vent To Air Intake
Length 1V Dia. � Length � � Dia. Spacing 7 �0
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over c Depth Over jxx D epth Of �� xx Seeded / Sodded xx Mulched
/ No [] Yes ❑ No
Bed /Trench Center Bed / Trench Edges psoil (0 1� ❑
/ COMMENTS: (Include code discrepancies, persons present, et .sec I // o; / Inspection #2: /
Location: 1298 220th Avenue, Star Prairie, _ 026 (SE 1/4 NE 1/411 T31N R18W) -113 1$993
Huntington Meadows -Lot 9 z a.,.. "0 w .Ha�iv s , raaJ S
of V-
1.) Alt BM Description
2.) Bldg sewer length
- amount of cover
Wei f*
Ian revision required' Yes No '7
Use other side for additional inform tion. c� LOJ
/
SBD -6710 (R.3/97) Date Inspe s Signature Cert No.
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Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W Wa shington PO Box 7302
lViscons See reverse side for instructions for completing this application
Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce (Submit completed form to county if not
[Privacy Law, s. 15.04(I)(m)] state owned.)
Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 1 I inches in size.
County � State Sanitary Permit upt Check if revision to previous application State P lan I. D. Number
I. Application Information - Please Print all Information Location:
Property Owner Name Property Location
Ze
Property Owner's Mail' Address Lot Number Bl ck Number
City, State Zip Code Phone Number Sub ivision Name or CSM Number
II. Type of Building: (check one) r ❑ cit
I or 2 Family Dwelling - No. of Bedrooms ❑ Village
❑Public /Commercial (describe use):_ own of
cc� /
❑ State -Owned d7
Neare ,
Parcel T ber 71l b O�
III. Type of rmit: (Check only one box on line A. Check box on line B if applicable) — — 000
A) 1. ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only -3 g . q f3 Existing System
B) Permit Number Date Issued
A Sanitary Permit was previously issued I 3 1+1 Mp„t ( 2X
I Type of POWT System: (Check all that apply). — IM
n- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ✓ l ❑ Aerobic Treatment U ' ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. Syston Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. R.) (Min. /inch) OS 9 Elevation
�3 3 Z
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel ter- Plastic
Information Gallons Gallons Tanks Con- Con- Sls J
New Existing crete structed
Tanks Tanks
❑ ❑ ❑ ❑
� b b
VIII. Responsibility Statement
I, the undersigned, assume res onsibility for instalj4on of the POWTS shown on the attached plans.
Plumber's N e (print) Plumber's i r no stamps): MP/MPRS No. / Business Phone Number
Plumbers Address (Street, City, State, Zip o
gib.
I.X. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
�.Approved ❑ Owner Given Initial Adverse Surch ge Fee
Determination 5V • ZC0
X. Conditions of Approval /Reasons for Disappro al:
"f S S ` �t� t�N S t -fib ' m '7`�Q_ � S a i kes a -t,2ct
SBD -6398 (R. 07/00)
PLOT PLAN
PPOJECT Mark Bera ADDRESS 2209 135th St. New Richmond Wi 540
SE 1/4 SE 1/4S 11 /T 1 18 W TOWN Star Prairie COUNTY ST. CROIX
4/19/01 BEDROOM 3
MPRS Shaun Bird 226900 DATE
CONVENTIONAL X01C IN -G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22
IL BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 95.0/94.0
Alt. BM Top of 2" Pipe @ 99.6'
220th Ave
J ent
Sidewinder High Plans Designed Using
Capacity Leaching Conventional Powts
Chamber Manual Version 2.0
Grade at System Elevation
34
130' 35' _4 _ 3
Vents Vents Pro 3
Be"- 20' H.guse �n
70
0 70' B -1 _ 20 i - � ? u
t ;
B.M. %'`
`� C? �
0 0, Alt Slope `
` /!
U M.
w �.
2 -3' X 69' Cells with >3' Spacing
• x C"
1
J
PLOT PLAN
PF,.0JECT Mark Bera ADDRESS 2209 135th St. New Richmond Wi 54017
SE 1/4 SE 1/4S 1 1 /T `1 18 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 r DATE4 /19/01 BEDROOM 3
CONVENTIONAL XXX IN -G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22
BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION loo' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 95.0/94.0
Alt. BM Top of 2" Pipe @ 99.6'
220th Ave
Vent
ALong 6"
Sidewinder High Plans Designed Using
Capacity Leaching Conventional Powts
Chamber Manual Version 2.0
34" Grade at System Elevation
130' 35' B -3
Poo
Vents Pro 3
Vents
20' Be
H �; l.,af� ,j•4
70' `'
20' 7�
94 70' B -1 p" u �x
B.M: %
slope
v 0 9 Alt. ZOO
M
2 -3' X 69' Cells with >3' Spacing
C,
1
Wisconsin Department of Commence SOIL. EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis, Adm. Code
Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must County �� ^x
Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. R iewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)), 3 f 260'
Property Owner Property Location
M 0 x 1, Q, J Govt. Lot. S F— 1 /4� ja--1 /4 S 11 T 3) N R I � (or
Property Owner's Mailing Address Lot # 1 Block # I Subd Name or CSM#
,;20 07 S 4 . ----
UW State Zip Code Phone Number ❑ City ❑ Village KTown Nearest Road
New Construction Use. Residential /Number of bedrooms Code derived design flow rate S�_ GPD
❑ Replacement n Public or commerdal - Describe°
Parent malaria! . — 0 jA. ✓Cz -4-4. r Flood Plain elevation if applicable � _ ^ ft.
General comments
and recommendations: -5y �} e r� e, "p- '7 / S 0
Boring # [' Boring
[j] ®, (� // ,,
pit Ground surface elev. / _ ft. Depth to limiting factor 6 in.
Sol! Applicaflon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. i - EfN#1 'Etf#2
I 0 - 1 7 - , 3 1Z 0 -r 1 �s
1-5 /r i✓ i N/»9 T Z
3. Z
® Boring # Boring L� }�
Pit Ground surface elev. V ; R. Depth to limiting facto �,�,— In.
Soil A
AMcatlm Rabe
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/IP
In. Munsell Qu. Sz. Cont. Color Or. Sz. Sh. 'Eff#1 'Eff#2
SO L
D
" e 7t 47 S Ni I Z
o(. Z , L-
Effluent #I SOD > 30 5 220 mg1L and TS$ >30 < 150 mg/L " Effluent #2 = BOD 30 mg/L and TSS 1 30 mglL
C,�T /Jame (Please _ CST Nul
*, Aqac\. l - 4�4 & ()gja(
Address V Date Evahlabon Conducted Telephone Number
Property Owner Parcel ID # _ Page of
0 Being # ❑ Bonne
Pit Ground surface elev. llzi, t. Depth to limiting factor In.
Sod loation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Eff#2
1 9-7W c, VA L , -,
Z
3 - s
✓ h/
-" 0� . Z
F Bodng # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in,
Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/IF
In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eft#2
Boring F-1 # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ow
in. Munsek Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
Effluent #1 = BOD > 30 1 220 m#L and TSS >30 1150 mg/L • Effluent #2 = BOD mg/L and TSS 130 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777.
sec.6330 (R.6/0)
Soil Test Plot Plan,.'
Project Name Mark Berg Sha
Address 2209 135th St.
New Richmond Wi 54017 8 TM #226900
Lot ----- Subdivision ------- Date 4/19/01
SE 1/4 SE 1/4S 11 T 31 N/R 1 8 W Township Star Prairie
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 2" Pipe
System Elevation 9 5.0/94.0 *HRp Same as Benchmark
Alt. BM Top of 2" Pipe @ 99.6'
220th Ave
101'
130' S' 73 100'
99' Pro 3
Bedroom
98 ' House
U 70'
° B- 97'
�. 10' B.M. 0 0
Alt.
° 0'
U M.
vft0°n9jn Depadment of commerce PRIVATE SEWAGE SYSTEM
Sdkfy
WW CDs OhAsion County:
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sa nitary Permit
No.:
Pemond irdoonadon you provioe may be used for seoondary purposes [Privacy Law. 8.15.04 (1)(m)) 38 4171
mK Holder's Name: Ctty Vi age Town of: State Plan ID No.:
Insp. BM E v.: BM Oescnption: Pane Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Alt RM
Aeration Bldg. Sewer
Holding St /Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosing NA Header /Man.
Ablation NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand —St GeveF
Model Number GPM
TDH I Lift Friction S tem TDH Ft
LOSS oo=ain Length Dia. Dist.Towell
SOIL ABSORPTION SYSTEM
SED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENS DIMENSI
SYSTEM TO P / L BLDG WELL LAKE / STREA LEACHING Man adurer:
SETBACK CHAMBER
INFORMATION Type M e Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil Q Yes ❑ No I ❑ Yes ❑ �No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1: / / Inspection #2:
Location: 1298 220th Avenue, Star Prairie, Wl 54026 (SE 1/4 NE 1/4 11 T31N R18W) - 113118993
Huntington Meadows -Lot 9
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SOD -6710 (RW7) Date Inspector's Signature Cert. No.
1Z 9 720 E Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
NV Iscons i n Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce [Privacy Law (Submit completed form to county if not
/ ' state owned.)
Attach complete plans (to the county copy c syst , o not less than 8 -12 x 11 inches in size.
State Sgi ( P2pitNumb Check' ision tog ,i ,s application State Plan . D. Number
Connt7i� ?� 1 `�
I.
Application Information - Please Print all Inform Location:
Property Owner Name s Property Location
I I
anL - , 'i U �-r i " 1/4 14, S / T ,N, R /J(m&
Property e s Mail ing Address �� Lot Num r Bloc Num r
ZpNINGOFFiCE °� 7
City, State Zip Code
x q :/7,T5
' Subdhiision Name or CSM Number
14 "72
II Type of Building: (check one) E3 City
or 2 Family Dwelling - No. of Bedrooms : 13 Village
❑ Public/Commercial (describe use) :_ OI'own of
❑ State -Owned S P(--
Nearest Road
III. Type of Permit: (Check only one box on line A. Check box on line B if applicable)
A) I. w 2. El Replacement 3. Replacement of 4. S. 6, Addition to
System System Tank Only Existing System
B} Permit Num r Date Issued
13 A Sanitary Permit was previously issued
IV pe of POWT System: (Check all that apply) –10'D
n- pressurized In- ground ❑ Mound ❑ Sand Filter 0 Constructed Wetland
❑ Pressurized In -ground ❑ Holding Tank ❑ Single Pass 1] Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) Dispersal Area 1 3, Dispersal Area 4. Soil Application S. Percolation Raw 6. System Elevation 7. Final Grade
S r
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation
3 18 o
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
❑ ❑ 1 ❑ ❑ ❑
VIII. Responsibility Statement
rNi undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
rs ame pent um r' r ature no stamps): MP o.
usiness one um er
r's A s (Street, ity, State, Zip
i�a i9z l� s°� - 7
IX. County/Department Use Only
Disapproved Sanitary Permit Fee Includes Groundwater Date Issued
)LApproved 13 Owner Given Initial Adverse Surch Fee) so ng Agen t afore (No stamps)
Determination ZZS
X. Conditions of Approval /Reasons for Disapproval:
SBD -6398 (R. 07 /00)
P O PLAN
PROJECT Mark Bem DRESS 2209 135th St. New Richmond Wi 54017
SE 1/4 SE 1/4S 11 /T 31 18 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 3/11/01 BEDROOM 3
CONVENTIONAL )= IN-GROVND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22
IL BENCHMARK V.R.P. Top of Wood Stake ASSUME ELEVATION 100° Filte Zabel A -10
❑ BOREHOLE O WELL sH.R.P Same as Benchmark
B.M.
* 10+ SYSTEM ELEVATION 94.3
321' Prop Line
10'
15' 5' B 4
B -1
Plans Designed Using
2 -3' X 69' Cells with >3' spacing Conventional Powts
80' 40' Manual Version 2.0
u
B- 0'
Pro 3
Bedroom
a House
50' 30'
N
N B -5
^ -�
�i U
A4
0
U
Vent
>12" Sidewinder High
of Cover Capacity Leaching
Chamber
'Long 16"
34" Grade at System Elevation
220' P.L. /220th Ave
PILOTAPLAN
PROJECT Mark Bera DRESS 2209 135th St. New Richmond Wi 54017
SE 1/4 SE 1/4S 11 /T 31 18 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 ,r J DATE3 /11/01 BEDROOM 3
CONVENTIONAL X00C IN -GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22
BENCHMARK V.R.P. Top of Wood Stake ASSUME ELEVATION 100° Filte Zabel A -10
❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark
B.M.
* l0 SYSTEM ELEVATION 94.3
321' Property Line
10'
15' 15' B-4
B -1
Plans Designed Using
2 -3' X 69' Cells with >3' spacing Conventional Powts
80 40' Manual Version 2.0
a�
B- 0'
a Pro 3
> Bedroom
Q House
° 50' T 30'
N
N B -5
tx
0
U
Vent
> 12" Sidewinder High
of Cover Capacity Leaching
Chamber
6' Long 16'
34" Grade at System Elevation
220' P.L. /220th Ave
Wisconsin Department of Commerce SOIL AND SITE EVALUATION
"Divisior; of Safety and Buildings Page of
Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inchesin size: Plan must County 1
include, but not limited to: vertical and horizontal reference poingBM), dire6tion'arfd c— Y
percent slope, scale or dimensions, north arrow, and location and distance tR,,nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all ir(FOrmation. " Reviewed by Date
Personal information you provide may be used for secondary purposes ( aay Law, s. 15.04{1) (m)). I - _
Property Owner Prgpion tacation'
! Govt. Lot ' 1/4�"9/4,S T N,R K - E (o
Property Owner's Mailind Address �4 (_ot # . ; Bt k# Subd. Name o CS
Ci i State Zip Code Phone Number City ❑ Village ,Town Nearest Road v
i i 220 CC- '
i.New Construction Use: Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow r� gpd Recommended design loading rate ; bed, gpd/ft trench, gpd/ft
Absorption area required bed, ft ft Maximum design loading rate f-. � bed, gpd /ft gpd /ft
t
Recommended infiltration surface elevation(s) ' p / ft (as referred to site plan benchmark) M
Additional design /site considerations
Parent material cfJG Flood plain elevation, if applicable ,.��/..1� ft
S = Suitable for system Conventional Mound In Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system 2f El U ; ❑ U � ❑ U 1,5iK ❑ U ❑ S .KU ❑ S .2'U
SOIL DESCRIPTION REPORT QW 'L66fl
Boring Horizon Depth Dominant Color Mottles Structure GPD /ft
9 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench
./ -- � 5
Ground
elev
�ft.
Depth to r
limiting to
factor
�in. '
Remarks:
Boring #
e ll
Grou
/ "—ft'
5 0
Depth to
limiting
facto
-e 6M in. Remarks:
CST Nam (Please Print) Signature Telephone No.
Address f Date CST Number
O SOIL DESCRIPTION REPORT
PROPERTY OWNER ` Page Cif
PARCEL I.D.#
Boring Horizon Depth Dominant Color Mottles Structure 2
9 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground
i �i ft• ,
Depth to
limiting
factor
ti Remarks:
Boring #
Ground
elev.
Depth to 3fZ 12
limiting
factor
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boren #
Ground to
w�
Depth to s� 0
limiting
factor
5112in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
SBD -8330 (R.9/98)
- oil Test Plot Plan
. Project Name �� � Byron Bird Jr.
Address `
Lot _ Subdivision f luxDat��
�1 /41 /4SZT N /RW - Township -�jr
7I3erinb O Well PL' Property Line County r�i/'D� `
BM or VRP Assume Elevation 100 ft:
, S st Elevation
fry
i
03
Jam•
GoA
•
7
"-
Scale I/4 — 10 Ft. When Dimensions aren' stated
ST CROEK COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
,
Owner/Buyer Q'V z ` f 3
Mailing Address d C ( 1 3 S ) �v � 1 , c hm 12
Property Address a � e-A /
(Verification required from Planning Department for new construction
city/State Parcel Identification Nurnber 0 3 � "-
LE DZMQBRMN
Property Location i /�, Sec. T N - R L D W, Town of - �a r Frcx�iw� .
Subdivision Lot # 9
Certllled Survey Map # e� . Volume _ _ - ,, Page # 7
Warranty Deed # _ j J- Volume 1 Page # 22 ,,,Z
Spec house 0 yevG Lot lines identifiab - es CI no
Imps use and maiat aaceaf your septic system could result in its premature failure to ba dlo wastes. Proper maintenance
consists of pcmapiag out the septic took every dove years or sooner, if needed by a licensed psn qw. What you put into the system
can affect the Auwdos► of the septic tank as. a annual stage in the waste disposal system.
IU property await agrees to submit to St. Croix Zoning Department a certification. form, signed by the owner and by a
master Plumber. JotzmeYm= plumber; rest ricttedplumber or a licaased pumper verifying that (1) the =41to wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less thaw 1/3 full of sludge.
E/we, the undetsigned have read the above rvquiramew and agree to maintain the private sewage disposal system with the standards
set forth, herein, as sat by the Department of Cearmetee and the Deparmeent of Natural Rasaurces, State of W isconsin. Certification
stating that your septic systasn has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the throe your expiration date.
1- ' j!4 6( . LL C�
SIGNATURE OF APPLIOINT
DATE
OWNER .CERT�'IC�ON
I (we) cettif)r that all stateuteats on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(&) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Tfiaj a, 0
SIGNATURE OF APPLICANT DATE
*s * * ** Any information that is min - vptaseated may result in the sanitary permit being revoked by the Zoning DBp%Mwn%. ••ss «s
•* Include with this appllestlon: a stamped warranty deed from the Register of Doody offico
a copy of the certified survey reap if reference is made in the warranty deed
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once eve 3
P P p rY ears. Y
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
Contingency Plan
1. If system fails, determine cause of failure, use alternate area and install new system or
install system at a lower elevation.
2. Replace any other failing components as needed.
Shaun Bird - `/ 6 - Y S / t , G/ 6111-
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STATE BAR OF WISCONSIN FORM 2 - 1999 �T 3655$
WARRANTY DEED REGISTER OF DEEDS
Document Number I ST. CROIX CO., WI
This Deed, made between Clay A. Edin RECEIVED FOR RECORD
01 -10 -2001 10:30 AM
— WARRANTY DEED
- -- -- - - -- -- EXEMPT B
Grantor, and Mark A. Berg, a single person, _ CERT COPY FEE:
COPY FEE:
- -- - — TRANSFER FEE: 80.70
- - -- - - - -- RECORDING FEE: 10.00
PAGES: I
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croi County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
Lot 9, Plat of Huntington Meadows in the Town of Star Prairie, Name and Rcturn Address
St. Croix County, Wisconsin. First National Bank of New Richmond
PO Box 89
New Richmond, WI 54017
038- 1192 -50 _
Parcel Identification Number (PIN)
This is not homestead property.
04) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of Janua 2001
• Clay A. Ed'
w
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Clay A. Edi STATE OF WISCONSIN )
) ss.
County )
authenticated this day of January _ 2001 Personally came before me this day of
_ the above named
+ Kri stina Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, -_ instrument and acknowledged the same.
authorized by § 706.06. Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY _ --
A ttorne y Kristina Oglan Notary Public, State of Wisconsin
H udson, W 1 540 16_ My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.)
• Names of persons signing in any capacity must be typed or printed below their signature. iMormatim Profession-(5 Co Pwi,, rood du Lk. wt
STATE BAR OF WISCONSIN e00- 656-2021
WARRANTY DEED FORM No. 2 -1999
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