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HomeMy WebLinkAbout038-1155-50-000 TOWN OF STAR PRAIRIE 2034 COUNTY ROAD C SOMERSET, WI 54025 April 4, 2001 "t. Croix Count Government r County nment Cente� 1101 Carmichael Road Hudson, WI. 54016 Attn: Zonina Re: Douglas Olson (Temporary trailer on land) Dear Mary, Mr 0 Son a a — roached the T-To- Board for approval of ^lacrn- a tia °i ^ his 11 r, rr� 4acre lot Temporarily. His intentions are to tear down the house on this land and build a new house. There was a trailer on this property 8 years ago, so there is a well and sewer on this parcel. The Town board has no objection to Mr. Olson placing a trailer on his 4 acres temporarily. The Town Board also took in consideration Statutes 91.77. Sincerely, Felicia Germain, Clerk TC) v'4 : , OF STAR PRAIRIE 2034 COUNTY ROAD C SOMERSET, VI 54025 St. Croix Count- Government Center 1.101 Canxtichael Road Hudson, M 54016 Attn: Zoning Ise: 'Vh•, Russ Flandrick putting a trailer on property. The Toxm of Star Prairie has no objection to 1r. Flanchick putting a trailer Douse oiI his property to live in. With the stipulation, that when he moves out of the trailer he will ha,-e to move it of his property. Sincerelv, Felicia Germain, Clerk ST MNTY 1 ,5 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 143 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Beestman, James D. I Star Prairie, Town of 038 - 1155 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: SectionlrowNRange /Map No: 13.31.18.719 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. t Septic Benchmark eel / Dosing Alt. BM Aeration Bldg. er Se �'et,� 5 gs •55 r Holding St/Ht Inlet St/Ht Outlet T TANK SETBACK INFORMATION TANK TO P/ WELL BLDG. Vent to Air take ROAD Dt Inlet 0 5 Septic 7 � / � � `b / Dt Bottom Dosing Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number o V1b TDH Lift Friction Loss System He TD Ft Forcemain Length la. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH WidthLength No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO 5 B G WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: //�'� 30 / 5 7 �� UNIT Model Number: C 014�P t n RQ — !� DISTRIBUTION SYSTEM „�--- Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 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 El Yes [] No 0 Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1323 220th Ave. New Richmond, WI 54017 (NW 1/4 NW 1/4 13 T31 N R1 8W) Prairie Rich Addition Lot 15 Parcel No: 13.31.18.719 1.) Alt BM Description = ! 14wL �4 Lve <4 tCq,fw 2.) Bldg sewer length = �1 - amount of cover // r Co�.c., bu P. e.d� � = to iJ ��~' kJ Plan revision Required? Yes ` No Use other side for additional information. O // Date Insepct ignatyy Cert. No. SBD -6710 (R.3/97) P A D P� County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN G p In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT �O�fb Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER G (Privacy Law. S. 15.04(1)(m)) 1101 Carmichael Road Hudson, WI 54016 -7710 (715)386 -4680 Fax(715)386 -4686 Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. County Sanitary Permit # Check if revision to previous application � 5 _x vsy 0 / V %§ R r 8 rctxn=n I. Application Information - Please Print all Information Location: Property Owner Name A q n - Q E �f / H-.O •-, G Q 5 LOQa N 4 ��R4/ r E (or Property Owner's Mailing Address PL g 0 , ZONING OFFICE [Parcel Num Block Number f y 1.2- cT.� al 4 0 77.2 1 s — City, State Zip Code Phone Numer ' ' ' e or CSM Numb i Type of Building: (check one) � � ily ❑ Village [Kown of �-1 or 2 Family Dwelling - No. of Bedrooms: � [1 Public /Commercial (describe use): �s' rj ; 11 State-owned Nearest Road 11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) 2_2.0 � A4 Tax Number(s) A) 1. ❑Repair [.,Df—Reconnection 3. ❑Non - plumbing 4. ❑Rejuvenation Sanitation S ^ a B) Permit Number Date Issued ❑ State Sanitary Permit was previously issued 7 f2 O IV. Type of POWT System: (Check all that apply) Rl" pressurized in- ground ❑ Mound z 24 in. suitable soil ❑ Mound 5 24 in. suitable soil ❑ Mound A +0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min. /inch) Elevation s 62y I. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks >-r- �C ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement I, the undersigned, assume responsibility for repair /reconnenction /rejuvenation /installation of non - plumbing for the POWTS shown on the attached plans. A l icense is not required for terralift repair or the installation of non-plumbing sanitation system. Plumber's Name (print) Plumber's Signature (no stamps): I &/MPRS No Business Phone Number wf , c I k-z4, z zs -r i L G Plumber's Address (Street, City, State, Zip Code) _0. 0. W ....e.- v,V 1^ y ova VIII. County Use Onl Disa Sanitary Permit Fee Date Issued issuin gent Sign ure o star ) Approved Ow en Irn verse 4 -7 1Z $ �q Determination lI IX. Conditions of Approval /Reasons for Disapproval: ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM /Buyer r'w yes 7y. ac, Mailing Address / yy,2 GTy R� �� L� T n/e �� c,J� -x%0 /7 Property Address /:s Z ,S Zoo (Verification required from Planning & Zoning Department for new construction.) City /State yv ,2. `l, d wz Parcel Identification Number 038' - / /sue- s'a - y vu LEGAL DESCRIPTION Property Location 4/c,,) '/4, IV '/4, Sec. !,7 T :3 / N R 1 W, Town of 37 P e a r'rr.'-- Subdivision Plat: PrCi I'rI'.f- ",'�.� , Lot # Sr Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ! yes no Lot lines identifiable Kyes , ! no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that ( I ) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 /0 /0 SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) r z - Zzo r *, located at: w4j /4, W,-, /4, Section 13 , Town Range r W, Town of r w ('r , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. I Most recent date of inspection or service Did flow back occur from absorption system? Yes No � y � (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: / go v Construction: Prefab Concrete _ Steel Other Manufacturer (if known): e / s Age of Tank (if known): Permit number (if known) (Licensed Plumber Signature) (Print Name) (Title) (License Number /MPRS 7 Z 2- � o (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 i o � f �a r o -, 2 o , -. r-ID � i � a � c� r * � 1 p it i 3 d p C m m !, �• 3 �1. gc :: 0 m M( O ° v y w ° w O • ro o o c A o w 4° 0.4 1 C 0. 0. N a Z j 3 c m A 2 Q m m n y L :3. � ;n ° o CD (D v ° Q 0 rn ° o ° 3 m o p c w p _ w v� < D a fD t= N W CL N D CD Q IS I co 00 Z c�rN CD �i N rn rn� 3» Q lv lo t 0 00001 "' �r• a s Orq �5 W Q Moog', a CD CD .. N ° N d v Q n r. 0 Z O z m z 0 =� D p � b CD N y CD C �. N w C. z ? cp - � N CL ? 7 7 aov ���' C � z 0 P .Z1 3 r: zZ C � y z C < N A w Ll 0 N � o a CD U) j �lk b o- I 0 O CD 0 o o � o Parcel #: 038 - 1155 -50 -000 12/04/2006 01:02 PM PAGE 1 OF 1 Alt. Parcel M 13.31.18.719 038 - TOWN OF STAR PRAIRIE 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 - 1323 220TH AVE RESIDENTIAL LAND TRUST 1323 220TH AVE RESIDENTIAL LAND TRUST PO BOX 70 SPRING VALLEY WI 54767 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 1323 220TH AVE SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.306 Plat: 2348 - PRAIRIE RICH ADD SEC 13 T31 N R18W 1.306AC PRAIRIE RICH Block/Condo Bldg: LOT 15 ADD LOT 15 A 1/15TH INT IN OL 1 HAS BEEN ADDED TO THIS PARCEL 722/352 727/220 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 13 -31 N-1 8W Notes: Parcel History: Date Doc # Vol /Page Type 08/09/2004 771133 2634/377 LC 04/16/2001 642931 1619/90 WD 07/23/1997 727/220 07/23/1997 722/352 m0re... 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/1212004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.306 27,900 158,300 186,200 NO Totals for 2006: General Property 1.306 27,900 158,300 186,200 Woodland 0.000 0 0 Totals for 2005: General Property 1.306 27,900 158,300 186,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 219 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 X rq O „J X _0 C D G m� Z r m • v " Flo y �.. 9 A O w CO. HIGHWAY ,_ "C wo wz X W D o NORTH 333.50' �0e SEC. LINE a m T ni 22 N00 ° - 14' - 45 "E N ,� • „__ Or v m Ol oq 0 - j� - 4 33' 33' Z z a) •'� m - I u z u I er m I r r b 30' • �� ' NORTH O ;a �! 300.50' i -0 Z.r.. N I w z o r N O i V C� O � D � O �Z � O OD �0 �o NORTH VI •� u 300.50' w ZOO m � T{ y N J w ° W y I 0 m , C o D o NORTH m 460.14' w = 1 mz 200.00' �� 300.50' CD m rn N o W ~ a NORTH o m o u M m 300.50' I � m u m 30' x CD a w w m ae m ;O o W 01 UI Jf > 0 i. -_ -- -300.48' -- .00+ - - 199.99' - - - - •-- - iti 1040.30' m ROAD a 1039.45' _ _.175.00'_- - - - I 7S.00'__� - -_ --- 195.00' m L w n 4 i f - = w ao co in 33' 33 _ o W- N O - 0 N 0 0 (71 0 O 0 W 00 , 0 w Y m o W I 0 i m � ' 4. D • ' .0 i 0 y � 175.00 175.00' 175.00 , 5' i Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER S Gt' 5g11er TOWNSHIP /« � A fee- SEC. T & N -R Y W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•I.HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �v �r 1 r I INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 461,1c_ Elevation of vertical reference point: 1/4 Proposed slope at site: d SEPTIC TANK: Manufacturer: -of le & Liquid Capacity: d a__ Number of rings used: U Tank manhole cover elevation: J/4 Tank Inlet Elevation: • q,5 Tank Outlet Elevation: Number of feet from nearest Road: Front 1 0 Side,o Rear, O Zc ' �: feet From nearest property line Front 1 0 Side , Rear, O j) feet � Number of feet from: well 6 , building: / 1 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE l PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: 4-AX Lenith:_ / Number of�L ni es: _ Area Built: &,:;2V Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, Vt . / Number of feet from well: Number of feet from building: (Include distances on plot plan). ll SEEPAGE PIT I Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). I HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector- Dated: Plumber on job: ' License Number: /SS 3/84:mj I DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABQR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 XX XONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: (If assigned) El Holding Tank El In-Ground Pressure El Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Same Lund Box 121, Statc PnaiAie, W1 54026 7 —/7 - -a o2 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. NW NW, Section 13, T31N- R1$(0, Town o4 StaA PtcaiAie, Lot 15, PAaitie "ch Name of Plumber: IMP/MPRSW No Counly Sanitary Permit Number: Byron B.vcd, it 3318 S Croix 79208 SEPTIC TANK /HOLDING TANK: S MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER �? PROVIDED PROVIDED � d�rS� L YES ❑NO DYES ONO BEDDING: VENT DIA.. ! VENT MAT[ HIGH WATER NUMBER OF ROAD. PROPERTY WELL BUILDING: VENT TO FRESH I ALARM LINE. AIR IN T'. FEET FROM YES ONO ❑YES ONO NEAREST— ?IQ DOSING CHAMBER: MANUFACTURER REDOING- L10U 10 CA P ACI TV PUMP MODEL PUMP;SIPEION MANLIF ACTLIRE FI WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO I DYES ONO DYES ONO GALLONS PER CYCLE: PUMPAND CONTROLS OPERATIONAL NUMBER OF PHOPFHTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ENO I NEAREST ; —} SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1 F N(1 TH 1 0JAMF TER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORGE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH I ND OF DISTH PIPE SPACI / COVEH J IDSIDI UTA =PITS LIQUID BED /TRENCH ^ THEN IAL PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR PIPF DISTH PIPE DISTR, P ATERIAL NO TFt NUMBER OF PROPERTY WELL BUILDING: A VENT TO FRESH BELOW PIPES ABOVE COVER E[ V LE ELEV E D PI LINE IR IN ET FI ET FROM D� �' •� ,•i t� fy i •� � I N EAREST —i ► / ! MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- 1:1 YES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PEHNIANINI MAHKEHS OBSERVATION WELLS DYES ❑NO _ DYES ONO DEPTH OVER TRENCH BED I DEPOVER 11111 H TRENCH DEPTH OF iOPSf )IL SODI)1 D 1 1EIDED MULCHED CENTER EDGES DYES, ❑NO ❑YES NO OYES 1:1 NO PRESS URIZED DISTRIBUTION SYSTEM: BEO /TR'ENCH WIDTH LENGTH TRENCHES LATEHAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH DISTR. PIPE ELEVATION AND DISTRIBUTION PIPE MATERIAL &MARKING ELEV.. ELEV. CIA. ELEV. PIPES DIA ' DISTRIBUTION INF ORMA TI ON HOLE SIZE HOLE SPACING DRILLED CORRECT L COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INF ORMA TI ON 1:1 YES El NO 1:1 Y ES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE. ❑YES F-1 NO ❑YES L NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. S NA U �ITLE . - /\ DILHR SBD 6710 (R. 01/82) ( /�(/J�• • r...r� umsconsln APPLICATION FOR SANITARY PERMIT t COUNTY DILHR (PLB C 67) UNIFORM SANITARY ERMIT # - In�U5TR4, 1ii60R 6MUTCin REILiTIOns 9�oF — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /2x 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATION CI T , N, R E (or)&V < ow OT NUM ER IBLOCT<NLIMBER SUBDIVISION NAME NE REST ROAD, LAKE OR LANDMARK ISTATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair L� Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed El Seepage Trench F-1 Seepage Pit E] Holding Tank ❑ System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump /Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): G Lid Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): , �- Signa MP /MPRSW No.: Phone Number: �3 F -'K I �7 /S'T 76 Plu Address: Name 94 Designer: COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved h ,_ r��� (�/ ❑ Owner Given Initial C Approved Adverse Determination 09 Reas for Di p al: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber i INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 . To be complete and accurate the permit application must include: Pr owner's name and complete legal description, lease circle the appropriate munici al government unit whether this is in 1. Property o s p g p p p g ( p Y a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). Y � 9 P 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PERMIT STC - 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 of Property _SQtnael L/ &erlund &AjA �Sa `f+erluad Location of Property _� - �, Section _ /� , T - R - W Township STQ r 6Wrie- Mailing Address 6 o x )o9 5 o c 6 (' - ; a W1 Address of Site L-6 / o R ich Rd 4. 22L 5- iCh mo/la� liU Subdivision Name ( ri C Lot Number J� Previous Owner of Property Fic, �Qf 3 n k - Leg,) gjC�mOj1rl Total Size of Parcel /.-3 a cca Date Parcel was Created O ct r; n l � q g 5 Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes -- No Volume l_ a and Page Number o?a 0 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATIO I (We) cent%by that att statements on thin bonm cute true to the beat ob my (our) k.nowtedge; that I (we) am (ate) the owner (,$) o the pnopetct y dea ch ibed in this .inboxmation bonm, by vi tue ob a waAAa.nty deed seconded in the Obbice ob the County Register o b Veeda Document No. t4 - 7 3 •7 ; and that I (We) ptuentey own the p ed .6 to bon the a ewage dia pod .a ys •em (on I (we) have obtained an easement, to nun with the above ducni.bed pnopenty, bon the construction ob .said eybtem, and the .same has been duty neconded in the Obb.ice ob the County Reg.caten ob Veede, as Docment No. ) . SIGNATURE OIL OWNER SIGNATURE OF CO- WNER (IF APPLICABLE) DATE SIGNED DATE SIGNED / DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2 —1962 i �`•7s370 s� t� (' � f17 PIKE r 2 REGISTERS OFFICE 1' C ST. CROIX CO., WI& I First National Bank of New Richmond Wisconsi ROC'd. fer Pe . - cord thi 25th 11 Nov. .................................................... 8:30 A - w• ®r 1 ....................... . .. ..... ._ conveys and warrants to ...Samuel__J._ and_ -- Donna.. J , .._S.atterlund.,._.hushanr3.., nd. wife_..as ............. •••- j.oint -- tenants i b9M�r OeNl ..--•-------------------------- •----- ......-- •............. II ------------------------------------•-----•-••------ •-- •------- .....- •---- ... - - - - -- - _ First National Bank ' ` RETURN TO 109 E 2nd St Box C .................................................... _ New Richmond, W 54 the following described real estate in ..... at•. CrOlX._..... •County, State of Wisconsin: Tax Parcel No: .............................. Lot Fifteen (15) Prairie Rich in the Town of Star Prairie. I I I This ..... -5-- AQ:t ........ homestead property. (is) (is not) Exception to warranties: I i Dated this .... ......... 21 st ........ ........................... day of ........... November , FIRO RATIONAL B K OF EW RICHMOND it i - -- • --- - - •••. - - • - •-- - - - - -- - - - -- - - - - - - - - - - (SEAL) .........._ ............................... (SEAL) B James - - F. Sheraelc,_ e._?resident * __ __.____•_ i = �I EAL) .............................................. ..................... (SEAL) *: James G. H e ink, Vice President * .... •-•--•-- ••-- •---------- ---- ---- •• -• - -•- �I AUTHENTICATION ACKNOWLEDGMENT Signature(s) ............................................. STATE OF WISCONSIN ----•----------------------------------------•-------- •------------------- - - - - -• St. Croix ss. - - - -• -• - •- • - - - -• ......County authenticated this ........ day of ........................... 19 ...... • Personally came before me this ................day of -------- - November ............... 19 _ 8 5 Above mli p , named -----------------•------ •--------------------- - - - - -- . • ----•--------------- •-- •-- ••-- ••• - -•• -• -• ----- • -• - - -• _.Hp-Hp to..lne_.knq TITLE: MEMBER STATE BAR OF WISCONSIN O E eS 7.S�PT3tS_.12f_..t ey Ya-t..Ii iiels hal. (If n - - -• ..Sank-- ol-- ReW_._Ri on` authorized by § 706.06, Wis. Stats.) ' l to me known to be the er a`` -------- !7**b0jQpxecuted the j foreg ' g instrument and ikk THIS INSTRUMENT WAS DRAFTED BY Reinstra, Van Dyk & Needham, S.C. .__... .. ........... -- •• -••. ------- - - - - -- \Y Attorne s at� - 1,aw ---------------------- - - - - -• , •� I etta.na w.ens_c ::::------------- - - - - -- II Np --- Ri- c *"- hm0r4d Wi scransa.n- ....54D_11- 012 7 Notary Public ........ �t ..;..L'f01X. ----------- County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: ........... 4 - -86 �! ................. ••---- •• - -...) I I *Names of persons signing in any capacity should be typed or printed below their signatures. . 19 • H.GMNI *rColnpvv ryI STATE BAR OF WISCONSIN 1111.1—h- WI-1. ® FORM No. $ — 1982 Stock No. 13002 — H z H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a OWNER /BUYER SQm Sa fk rlund M ROUTE /BOX NUMBER Box Fire Number .CITY /STATE S+ r # rc , 1AIZ ZIP ,rjl/Qa� PROPERTY LOCATION: _�L, ±LW &4, Section 13 T _� I N, R _I_Z__ W, Town of Sfar Pr'Qlri� St. Croix County, Subdivision 0 /Ric Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you pdt into the system can affect the function of the septic tank as a treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essar Y ), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart - 10 ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. //)) SIGNED /_S ;7za DATE ( / St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715- 796 -2239 or 715- 425 -8363 Sign, date and return to above address. C N � m 'o ^! (D ° a N (D N 7C m (1 0 ( D a J a °1 �O ..m� 3cmmo=�, S d CD (D - O O 0 O w OD A - ' w � CD (D N `< CD " ( : D * " co : m ? n O (D (D CO c -. m o _2 SD O `- c w N 3 ° 0 oo. c3o C Z m a' c m a w v c a i w � � -, w .. - 0 g 0 0. m a a N a . gy m � mco m Q sf c ° c = c? v o o O c mew -'"a CD aw ^l� o N CD ' S° w w N Z L l g ai N N_ :E n '� C Z m w U)CD w �mm ?a a s ¢ m om 3� N CD, c m CL ° w o co m -� Cr w CD m y =r C rm N •p - m CL ac C 171 �� o �CD m CDc� o°(p�NN C) IC 7 N (D Cl) 7 fD Q w — ° N. O (D � CA O c -. c m m N N a m "�0 iy O ': oc�awo R1 (D = = (D N 3 a a a =r U) CD c G a j.- <(D m m 3 d o :2 N O G)m a O N '� n N� c 0 c - a -� - (D m CD E a = 0 a =r c (D =! O ° A CL 3 O a ° 3 ° 3 w vi �°` o< «� m m o m c DEPARTMENT OF RE PORT ON SOIL BORINGS AN D SAFETY & BUILDINGS INDUSTRY, ___ _ DIVISION LABOR AND PERCOLATION TESTS (115 P.O. MADISON WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) L OCATION: SECTION: TOWNSHIP /MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: jV �/ 1 / /T.E N/ E (or F C OUNTY: - O NER'S BUYER'S NAME: MAILING ADDRESS: Al 11 1,21 51 4 , l inx t � 42 a USE DATES OBSERVATIONS MADE I ND. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PE DILATION TESTS: Residence 3 New 1:1 Replace 1 20 — perk- � RATING: S= Site suitable for system U Site unsuitable f or system O ONVENTIONAL: MOUND: IN- GROUND SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTE :( ptional) s ❑u s ou sou EIS u EIS u 6 - If Percolation Tests are NOT required DESIGN RATE- If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS 9,% 7 BORING TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLQA OxTuRE " NUMBER'DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON C O -.Z dr 0/7 /S -2 -A Av $ 13- pao'e o - oZ /S d 2 - B- 3 7 7 B _ . ao r 19 /746 0 -,3�-/' B- 5' y6` / "�,�., 'V 69 /" 74, BS S 13- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD1 PERIOD 2 PER D PERINCH P - I . P- P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent`` , of land, Slope. SYST ELEVATION 9' 1. y� f O;6 ©�.�3rG_ j} E c 0. 4 ff F E E E z 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 the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: r r — q A SS: CERTIFICATION NUMBER: PHONE NUMBER (optional): - G S / 4 3 �is-- CST SIGN TURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R, 10/83) —OVER — 1 .. � IINSTFR�!CT\QNS FORCUK8PLE.7\N(.1, FORM 115 SCO '6395 � ' Tn boaoom�waandaouu�emj|usz,your mnor m�� �ndudy� � I, Comp|oto |oga| dmsoiption� 2, Tl, cse —0 COO ioioa this )uw mmi'!enonor uommoroiai po4cot� 3. MAX K3UNI numoe,ofbodmnm»nruommo p|anned� 4, bthb� o now or m�|o�ament oyauam� it Ca boo "s. As In SU�T4BLE FOR;, wQii-Qi& TA0KUCKY IF ALL 0 THE R SYSTENiS ARE RULED OUT BASED 00 I L C O SC) CO0D|T\ON�� � 5. PLEASE use W auuroviorions ohum^ here to vrihng pro fQo douoip^imnz and unmn\'thng chev|ctn|an; 7. MAKE A LEG|BLE diyG,em amu�euiy {ocahng you, t— to «ca/* {a pmfered, 'A oa�arara uh�n may be uVd if deoi/od� 8, K8nkooura you,bonmxnmrk and ve,tioo| o|eation yrvnce non amo|ewdyAhow^ vonnanont� B, Oumpo,�'-o aU apprupriat* boma ao zcdaveS' wjdmaeO Mnod piuh test vxmnp- cion.�fopprop 1O. |fthe inforn�tion aud` mm NOW PAN, o|ev* ion>dua nucapply. p|oce N°A in thoapp box: 1l iovmamd Paz yourcunnntadnnmcmndyourmud+katmnnundam� �2 K8ake |egib\a oonie mnd disoibuze as mnuimol ALL SOIL TESTS KAUST BE FILED VV|TH THE LOCAL &UTHOR\TvVVi'TH!03O DAYS OF C0K8PLET}ON. ABBBE\/|/kT|O[VS FOR QERTlF|2D SOIL TES 8oi| Souma Toxrums 0zharSymbo|b�, s — Sxone(ovo,lO'') OR — Bedrock cob — (Wb|* M' lU^) 83 — Sondaonu � g, — G,avo| (wider 3") LS — Limomonv 3mnd H0 VV — HighGmu"�uma, ON — Q^an*S�nd Pao — Perco|ationRae modo — Me, dium8und VV — 0eU � — Fino8mnd 8ldg — BvUding |s — Loamy Sand — Gmatm, Than 8andyLoam � — LmmThun Lo*n` & — Brmmn °y/| — Si|� Loam B| — 8|ack Gv — G,av ~d — C3mvLuam Y — YeUow ed — ��ndyC|ay Lo em R — Rod dc| — Si|ry Coy Loam ma/ — N"Io� "iex ^o — 5wndvC|oy v"i�h 0c — @i|ry C|ny tf — h:w fine fnin! ~ — C1aV u — nomnnon.nmumo P1 — pw,� " mm — PIwn*' modium m — KXuck d — dii'not p — p,ominonu I L — High |me| ° Six my em| "oi| tex,umo mur�uemmm, fo, liquid diopoxe| 8M — 8enoh Wk VRP — Vetoa} RvfNonce Poinz ` To THE OWNER: This soil test report is the firm step in snudriq a sanitary pormit. The cmmry on f Dcpaqmera may request verification of this mnU test in the field prior to permit issuance. A 000p!ete oet of Plans for the p,ivote omwayp system and a permit application mu�t be submitted to tho', appnmmrion* |ocal authority in order to Wain a permit. Thoenirary permit mum be ohta\naJand pugmj IRK tm the uunmfany construction, J PROJECT i u �� ` Cj• �r un ADDRESS 17 1 AI41& 1 1/4/S/ . �/T31 N1W �� TOWN , r - f COUNTY 7 C /X, BEDROOM,3 CLASS PERC / CONVENTIONAL)( CONVENTIONAL LIFT_ MOUND_ HOLDING TANK IN-GROUND PRESSURE_ SEPTIC TANK SIZE 6 /LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE � BED SIZE - 5;-a PLUMBER LISCENSE NO. :3 /j( DATE BM Assume elevation 100' ��� f � o VC 5'7` Location of Benchmark 5�,y - Q Borehole Q Well Perc Hole System Elevation �< TYPAR COVERING 2 . 2 .. 2 .. 2 .. 12.. \� C4 3 4 ") 6" Sewer Rock i 12 ft. 18 ft. 24 ft. `\ �.�� T D v e� c � ar • s Qr ° �' , � b .3 r YL Iv , o � 6 � Parcel #: 038 - 1155 -50 -000 08/05/2009 04:56 PM PAGE 1 OF 1 Alt. Parcel #: 13.31.18.719 038 - TOWN OF STAR PRAIRIE Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner 0 - BEESTMAN, JAMES D JAMES D BEESTMAN 1442 CTY RD K LOT 21 NEW RICHMOND Wl 54017 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description 1323 220TH AVE SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.306 Plat: 04 -044- PRAIRIE RICH ADDN 038 -1978 SEC 13 T31 R1 8W 1.306AC PRAIRIE RICH Block/Condo Bldg: LOT 15 ADD LOT 15 A 1/15TH INT IN OL 1 HAS BEEN ADDED TO THIS PARCEL 722/352 727/220 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 13-31N-18W Notes: Parcel History: Date Doc # Vol /Page Type 11/25/2008 884727 TD 11/25/2008 884726 CT TR 11/25/2008 884725 WD 08/09/2004 771133 2634/377 LC more... 2009 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/15/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.306 27,900 24,000 51,900 NO 02 Totals for 2009: General Property 1.306 27,900 24,000 51,900 Woodland 0.000 0 0 Totals for 2008: General Property 1.306 27,900 9,000 36,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 219 Specials: User Special Code Category Amount SS`s" 14 6.50 Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00