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HomeMy WebLinkAbout038-1059-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499221 0 GENERAL IN'OORMATION (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: Ulrich, Steve I Star Prairie, Town of 038 - 1059 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/ Range /Map No (� ,p' looz CST tsMA )C 14.31.18.258 TANK INFOR TION VELEVAfIdN DATA TYPE o MA6NUFACTURER CAPACITY STATION BS HI FS ELEV. 47 j Septic Benchmark Dosing Alt. BM � . Aeration Bldg. Sewer l • 1 ZV g2Z ' Holding St/Ht Inlet s, n g.V E SUHt TANK SETBACK INFORMATION Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dosing > / / Dt Bottom Header /Man. Aeration Dist. Pipe / Holding Bot. System •20 .ZO p ,00 Final Grade PUMP /SIPHON INFORMATION au Manufacturer Demand St Cover GPM Model Nu ber I TD H Lift Fric Loss System Head DH Ft Forcemain L SOIL ABSORPTION SYSTEM Z BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth II l DIMENSIONS /�w ' 2 6 G`L SETBACK SYSTEM TO /L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: 5Z / UNIT Model Number G � CoAV 7 DISTRIBUTION SYSTEM 2 _ Header /Manifold Distribute n x Hole Size ole Spacing Vent to Air Intake Pipe(s) length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx ound Or At - Grade Systems Only Depth Over Depth Over Ixx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoli Yes No Yes No oIJN nclude ode discr p�e�r��i persons present, etc.) inspection #1:h� Inspection #2: - - T ---r° cation: 1262 Count> d tlUnknown (Sy 1/4 SE 1/4 14 T31N R18W) NA Lot 4 Parce No: 14.31.18.258 f 1.) Alt BM Description = QC rivet a �� 2.) Bldg sewer length = / 3.9'J amount of cover = $ " t k — s 3) l� ! � / iffl:4 CR+- Plan revision Required? Yes XNo wFOU- z9 �,*/ 5� Use other side for additional information. `_ _ Date ignature Cert No SBD -6710 (R.3/97) 4 O ,may -ma ,r 17 i Safety and Buildings Division County ` Cisconsin 201 W. Washington Ave., P.O. Box 7162 S Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 1 (608) 266 -31 417? 2z Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal information y ovide / V may be used for secondary purposes Privacy Law, sl 5.04(1)(m) oject Address (if different than maili dress) I. Application Information — Please PH t All Informati 1Z w2• C�'7r R C Property Owner's Name f Parcel # Lot # L4 Block # V 038 - lob _ o -oov Property Owner's Mailing Address Property Location 90 X 7 ST. CRUX COUNTY Siv • 5 /y ;;, Scc :ion City, State Zip Code Phone Number p Z � cle T 1 N; R (c E ore) ( , ii. Type of Building (check all flini apply) j p/C c• p I 5 J4 e ❑ I or 2 Family Dwelling — Number of Bedrooms ` Subdivision Name CSM Number ❑ Public /Commercial —Describe Use El State Owned — DescribeUse Z ('o 1j, LJ Z4 t Z1 61A.4 e(� ❑City ❑Vi a e wnshipof III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. tZ New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑Permit Renewal ❑Permit Revision El Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl ❑ Non — Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit a94 Filter yam El Recirculating Synthetic Media Filter Leaching Chamber El Line ❑ Gravel -less Pipe ❑ Other (explain 7 11 (�_[, �' V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (so Dispersal Area Pro sod (sf) System Elevation yS0 ✓ ✓ 900 917 �'`7 Z VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Existin New Tanks Tanks Septic Holding Tank f 6 m /00U t4 Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for instal of the POWTS shown on the attached plans. Plumber's Name (Print) P d, s Si umber Business Phone Number osnn 1 4 C.; /�i e Z2/�/7! 7i� =.?68� f 4,T7 Plumber's Address (Street, City, State, Zip Code) -?5 Z ,/ fa ST &/1 S'r/oo VIII. Coun /De artment Use Onl Approved El Di pp Sanitary Permit Fee (includes Groundwater Date Issued Is tam Surcharge Fe e) �/ ❑ Oven iven Reason rial / w bb �d zI �O IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must all be servicesbe services /�hltai as per management plan provided by plumber. 2. All setback requirements must be maintained as per sppOwbie code / ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) A*j to y V 1„ , N 1 COPY r 49 to 40 LA- 4 V . v` y�r ' 1. a Wisconsin Department of Commerce . EVALUATION REPORT Page ! of Division of Safety and Buildings in ordanpp wifii Comm 85, Wis. Adm. Code .�` County Attach complete site plan on paper l an 8 1 /2 ches in size. Plan must include, but not limited to: vertical an orizontal nce point (BM), direction and Parcel I.D percent slope, scale or dimensions, nort , and location and distance to nearest road. 3 1 0 59 - a o-aio r9 Please print all information. Review d by Date Personal information you provide may Privac Law, s. 15.04 (1) (m)). Id Z (o d d--;� Property0 ner 0 % ?! Property Location c Govt. Lot S 1/4 fir, 1/4 S Al T_? / N R rI E (ortf) Propelty Owner's Mailing Address UL, I b Lot # Block # Subd. Name or CSM# ffcrg /7 City r State Zip qode o ffN um r ❑ ity Village ® Town Nearest Road eo c New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public r commercial - Describe: Parent material - Flood Plain elevation if applicable rte ft. General comments D _ and recommendations: Q 4.e 0%� t �� �, �j �✓ Z E] Boring Q � r Boring # rat !D .Z , U Pit Ground surface elev. � ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 *Eff#2 a Z 7SY�3f S[ la�'sl hw aW hc , y . 7 7 1-4o KID ?N-543 4L 4 v I y�, Z Boring # ❑ Boring Qom, El Pit Ground surface elev. • ' 1 ft. Depth to limiting factor 7 in. Soil Application 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 I *Eff#2 o• 2 �r e3 /Z- Av ,6SOr C?W IF r y 7� 1 As 0- r S l. 3 P C, 7- �yQPAR I f Sz YIS1 N'1- . FS 40, 4C f 1 i , * Effluent #1 = BOD > 30 < 220 mg /L and T84 >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L C c& T Name ( Print) S' CST Number 0 4 Address Date Evaluation Conducted Telephone Number C`/Go /m -s- aE 7it>7?G Y �G 3-7 l Property Owner � Parcel ID # Page of 1-31 Boring # Boring Pit ® Ground surface elev. 1&,/ — ft. Depth to limiting factor 7 �Z in. Soil Application 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 p, Zc► 7,S' 3/3 ''' sL I ots��C' -3 s t 7O S/z 014 ¢S F-1 Boring # ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sl *Eff#1 *Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil A lication 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 * Effluent #1 = BOP, > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 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. SBD -8330 (R.07 /00) 1 r Property Owner YqL, Parcel ID # Page of 1-31 Boring # ❑ Boring - 0 pit Ground surface elev. ft. Depth to limiting factor 7 in. Soil A "bon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Diff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2 v 7 3 � zaf a !� , '7 .Z- D :3 jryl sY 0 14 � . �7 I, Co F-1 Boring # Boring ❑ ❑ Pit Ground surface elev. ft. Depth to limiting factor in. - S — oflAppliGation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 *Eff#2 F] Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F F1 Pit [ Soil Application 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 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need p material in an alternate format lease contact the department at 608- 266 -3151 or TTY 608 - 2648777. SBD- 8330(R.07100) - `sws� s i 'V-r3 i WON/ s*4" `. Al % / /0 Ap yRP,�m ®Ih,'oa t�Sf S lf PO�S.�a f �.91 LCey [:)LT9Zi aSoUAhr,, 7 :f3 �,'�.�z�:��tLc't�,...� .3:'tt:r..t��° ' llrt�t�. uf5111'IJ.c "J "t[tt1 Vol. JjrA.':'c:i.( i� cAYc L lYt'rsGl'i :r,'911.1� Gttlu�fl� VCClI:Llul. y �V zritr:rtZ� r•L �Y � . —f__ �z ..�'�_ - -___. c ,1 .3 ') ".'r'rkr4:r� � ...� �,.lrla�:rsrr.�c °el �� ,� ^/ .•_�______.._...___ w _- .__.._.._..............._,.W_ ._....... -.�_.. _.... _._...... .. :P:ic;rJ�u•1:f�fe a'��"fye;�:+�c��'na� 7 �} ` 17 '•' ft%&Nr IV ,:l o- of batIv:ri o.tris :E•5?'(l�r ' V4 r i4.1•�{ Iry i V .l=') < :'P:t�� ..L�F� }:f t7:t Cl 5' �:�t�r:�•�•i. t�e:ll. (s) �.M , .l.)ist�7c;�c'tt�i .�c�,;:f �f�' r��::r• €:�t,c�,����I.�;� G JY. duadbelz ••�• +�+f Va .rY41fF•I �.V % %p k %Jfu For now con.rstrtacyti ©Il, prl t ea I 1'Q'tJtl i'S a he(lk •tra atn'ia nt; tankirs) 'far ttlea prOse"We 'if Writing prodtta;t:aa or other rllrsanlar:Ilts of the) unk { Mat may Jrrs�aearlry tttra tr+�eitr114rit: f-Vocaiss arurt.jur daarrtage Ale dispersErl ce,lt {s}„ if 11brg, ::orrrarltrat :irarl>x fire +c #rrtrrctad havrl tltra tniri IU i dv) raal arJ l)y a tsapt:a ge racirtrtcsing o{�c3rrstar prior tat ars;ca. l y t;� r rr aEarrx trle sly>rSt rtrr oof.Grr Where &oil cronah:lans a,r« fr t�, ?. ),, ot: ttte #eft }t rr3rtva9 r:urFraca�. During fyely er crt,rttt<tges pu 1py t anks rxaeay 1111 ab OW-11'iwrntAal bighaaa War Join. la, 11. airs Islxtrvea° Is raastxrretd rilta cayt008w vuri atcrtnrrtrerr will h diet harrgarl - ru the diasna}r:aaa# crelli ,} 11" one lori7e day a, rsverloerding Zho call(s) F, nd fanny resefit #n th u backilp ar• sm•f�ac discha rgo Or ri <;rfl'tatcsrrt„ 2'o ravaiat rhi.a siUlastlain have the norra:a nul of Tht'l M11111R tunk re,riovod Jaay ca sept"Go a erviaing Operator Prior to rlrituring isalwor to #10 affILICI rt; purnp or c:nnt;:rct as Number or POEM'' , Maalrttxafher to aursist: if" n°lant.rsal[y cylaetratfnn 'Cher I�tttrrra r r >rrfriats tt� 1'slrtoro,no�arial levels vrrltltin the pump lrYrttr. 1 -hi not drive or park veyhicle$ over 'Canks; mid rdisperael calls. 130 not drlvcs Or praric over, or atharwise a�?iattrrb or curnpsart, tlrra a,.,,tsr vtr.irlttrt 'L #i fef"R dOwn 91cs}rer of any in atini or alt.= grrula call asbrtrrnllnn amsa_ 11crGltiloJiairl wr aritrrttnation of T hey ftllJOWJnl .j frorn t:}laa wEaaiawRtcur strs.rrni rna3y ia_nPravh VII iJt3rl'`04nalice nrid Prolong t w iflfe. of t,ltci 1'I]1/1J'Ilxe arla;Ibiatia s; baby vv`Jpolu; c1prrattu btitts, oasrldr,�yrrts; Wilton swabs; degrOusera derytel flags dlrttyorrrN cif t'l +rNltrsl'atrttt�; fray; I'�:iasnaJarttpra d:rex}rl ir,�tlrnp }rt.ulypl Waaler; frtdl: end vog0l:610 p £parsoflha; grans; fierb`rotdes; most straps;; rner#iaatfton;s; lr.alarl1nq produni..w: [iestlaide s, sanit:etry ,napkin fsnlrrnrnn; and akraa'trer softe rlor bring. ALIAND©Nltt EN'l' W7ifsn the J faalla and /or is pennanuntly 'halter, alit of s ervitaao Cho faiir:,vtrtng stepis shall has t4drart to Insure that tha syst;nrrl is laruparly and ..ai'erly vbandone d in e- 017tpliance with Chapter COMM 33: 'Wilda ansin ,adininla rative irlot1a . All tai „alrtg to 'tanks and pits, s t itrrill be disoontie YtaLl a nd • abandoned pipe a p anings Se alled. ! 11te astaryt:n l,s a#' till tank.. and p71ts, shall be removed and Property r a•.1•f by At Serlatut;tca'.3ar,rx'e:Jng Qpe at.or. • Af ta9r p;Itaitll,Sn 7, rill 'rairtks ,arid pitta 0a ll he eaaat mintte,d and rcnnimrad or thullr covert, rernovaed and that ,role# .sp accl 'killed with rrayli, gravel Or aanathtir tricsrt trrrllrJ rnFat.�lriarl, (;ONTIAIGlJiNt~Y PIl -A4M tf t:lu� POW TS falls tmcl cannot: be rarrallled the folloinring rrionsures lave boron, or n'ltnstt be takcan, I :o prrivido as ,wade oompligant: rcrlrlayacaMBI'd eirrt:ror'n: .. 1:3 A r ttit:.libl s rey}lktccar ISITt area has been evaalz,tated and rn ay bo utilized for the looation of a reptaanntont Still a bsorlrtion sys tern. 'the replan erna nt; nTVv ST'lould be prtatalu ed i"rorn r.listurbaaF,ue and asazinpand1rrrt and: butilri not bra lrttrirtga3t3 tapYrYn by requIrad setbar=kat from existing and proposed strurjtu+ o, lot ilnass fund wells. F'c.,illIM tu Protect the reply ceanteant; area mill, result irl the r usaad for n r -laser soil and alto evaluation to a.st'abllssll ,tit suitable areplrarmunint area._ fteplanca tirlernt Wstotrrs njuut r.c+mply with the ri:rlor, In f.9f {act: sat that tIMP. A at,tll:ables ruplaacernonj. area Is not avraillublrs due -to ewrbriolc andlar soil HIM tratta ns. Rorrirag ad}ri:YRuos Ir? PoWl "mil t: arcl'iree,Jn.gg a 1101 ding tank arraty bra InStaiir✓ad A-29 a 1itaat rasort: to repleas they felled POW - i:+. YJ The eatun #mist not been eavailuated To lrlanti'fy at sultable re• ioernerzt nitsa.. Upon faallure of thv POINTS at sail mid adieu ervaltiaatio n must: big perforrals d to [,stain' a Suitable replriacarrierst ar'Haz. If no ropllaname nt: eirefi is avyAt able a Itolding tatnk rna:ay b,� Ir,staallaed as as last miss rt; to rep%re t110 fallaad dr'L:AM TS. I" Malt ric.i -oud at.-grade said aallsairptlan systainas ,rimy he rrruonstruotod In plaaco following rernuval of the i lawat: at the in•111 ives surl'aica, Re rten,,iPruatlnras at sr:rclt sysstryms rnust comply vvrt j t'lsa: rukaas In aa110rt art: that tirrie. SL»la'I C, -PUMP AND E1'I'I ER TREAT`IIRENT `I"ANKS [MAY CONTAIN LETHAL GASSIM ANIC1tfOR #NSILIFFICISNT OXYGEN. N. 130 NOT f tV`1'M A SEPTIC, PUMP ttii: G'I`I'14ER TREATMtSWI' TANK UNDER AWY WROUIVISTAN WES. MATH H I4AAY RESULT. I< ;MMIE OF A PERSON FROM THE [i1 ERIOR OF A, TANK ISR,I Y 1IFi l)LtrFLOWLT On IMPoSSIRI.Sa. MI TIGNAL COMMENTS TS _.,._.......,_...____....._ .._.....-__- .__- ...._._•_.._._. _..._.._....w_.___._..�._. „.. „..,• _ �..�__._._,. _. __. ,___._._._., .. _.., ...__.__.___......_.__.__._.. ...- _........._............. __ _--------- _.......... 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J # Ji Il 1l }� {f and 13.. ,, �S't l ,].; � � srtrC , } . i # },'+�i r ,,In Arlm }nls•l:ra,tl3no Ca,tie • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFOR TION SYSTEM SPECIFICATIONS E Septic Tank Capacity 0�3 O gal ❑ NA # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer © NA Number of Bedrooms 3 ❑ NA Effluent Filter Modeler s ❑ NA Number of Public Facility Units J9 NA Pump Tank Capacity ga l ❑ NA O D Estimated flow (average) gal /day Pum p Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) tyro gal /day Pump Manufacturer ❑`NA Soil Application Rate gal /day /ft' Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) _ <30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Eff[uent_, ua1lty Monthly average _. Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg/.L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) <10 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: 0 NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third W of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 ears) O NA 3 0 year(s) y Clean effluent filter At least once every: /0 El m 17 year(s) a ) 11 NA ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) Flush laterals and pressure test At least once every: El month(s) ❑ NA ❑ year(s) Other: El month(s) ❑ NA At least once every: 13 year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. Ail other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the. local regulatory authority within 1.0 days of completion of any .service event. 0 n � � IE ii � U CIA ( 1 ♦ •. V � 3 ' i. ' r If II EI CA od ri tTl rA b 10/19/2006 07:56 7152687080 GILL.E TRUa<ING PAGE 01/01 ST CROIX COUNTI' SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CLRTIFICATIO" •1 FORM Ownermuy^er .. Mailing Address P Cp� t 1 w ��': c (n .� ^ J (�; S `f c t `7 Property Address (Verification required from Planni Department for new. +,otntruction) City /State Parcel Identification Nui, aber LEGAL DESCRIPTION Property Location 5L '/.; yi, Sec ?�y . T 7 / N -R t , W, Town of Subdivision f , Lot N 4 Certified Survey Map # ] 4+ L+ Ci , Volume 9 , Page # 04 11 Warranty Dad # 9 `f tP 55 , vol _, . Page !� Spec house ❑ yeg)4 no Lot lines identiJ. i.able ❑ yes ❑ no SXB= MMMAKE Improm me and maintenance of your septic system could result in its pr, mature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooans, if needed bj a licensed punnper. What you put into the system can affect the function of the septic tank as a treatmept stage in the waste dispa 41 system. Thu property owner agrees to submit to St. Croix Zoning Department - ► certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensed pumper veri Vying that (1) the on -site wastowaterdisposal system U m proper operating cooditioa and/or (2) after inspection and pumping (if aces iary), the septic tank is less flan 1/3 fall of sludge. Uwe, the undersigned have read the above requirements and agree to maintain du private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of N [atrial Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and mturh A to the St. Croix County Zoning Office within 30 days _of d* three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CER'T'IFICATION I (are) certify that all statements on this Norm are true to the best of my (our) knowledge. I (we) am (arc) the owner(s) of the propt'ty described above, by virtue of a warranty deed recorded in Register of Deeds Office. NATURE OF APPLICANT D "" "" "" Any information that is mis- repraaented may result in the sanitary permil being revoked by the Zoning Department. baelade witb this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if refereno ! is nude in the warranty deed .r i c1 This instrument drafted by Fran Bleskacek Proj. No. 91 -08 474491 CERTIFIED SURVEY MAP Located in the SW'h of the SE4 of Section 14, T31N, R18W, Town of Star Prairie, St. Croix County, Wisconsin. N t LEGEND H Aluminum County Section Monument Found o N N A 0 1 x 24 Iron Pipe Set, weighing 1.68 lbs, per linear foot s " " Existing Fenceline +. o Building Setback Line A.IPR VED v LL+ ° N 0 0 T il 9 1991 ° c G`NWACHRIJ&VE Poi ou 1 ; N_. txvdR ° OWNER c o .o i to " Allen Peterson U N P L AT T E D LANDS 411 W. 4th Street IN FEET - -- New Richmond, MI 54016 0 0 100 200 300 North line of the SW} of the SE} " N89 38f 1323.71' 14' Joint Drive Easement Detail �rJ� 4 LOT 4 ;:4 LIT 3 LIT 2 0_ 20'„ 20 913,305 Sq. Ft. Inc. R/W o 20.97 Acres ° _,. 910,588 Sq. Ft. Exe. R/W H �I C.T " C " Acres a, V)I C)I – ;' m C:)l JI i -,. o JI N89 597.06' N89 27 661.83' 9 ' g pl 298.53 298.53 m WI 00 QI C) < _ '" o I 0 o zl LOT 1 zl � 431,179 Sq. Ft. Inc. R/W �l LOT 3 LOT 2 50 m s 9.90 Acres Inc. R /W: o Inc. R /W: i° ° 400,761 Sq. Ft Exc. R/W m 194,310 Sq. Ft. 194,310 Sq. Ft: o = : 0 9.20 Acres CD .°moo :o . 4.46 Acres m tO 4.46 Acres e o 0 p Exc. R /W: o Exc. R /W: o o E3 I 183,880 Sq. Ft.a 182,728 Sq. Ft. a o 4.22 Acres 4.19 Acres Buildings a z Z 0 °° - : Septie Well ....... ... ... . ... - ... o o ° r T" — N89o091571fE w 1326.16 — g � _ 1 29 298.5 66.0 _ 663.02 I a _�— 98. 3' _ 298.53' —_ - i N89 54'27 "E - 1326.12' S} Corner of South line of the SE} _f N89o5412711E C.T.H. 11 w 1326.12 Section 14 — — UNPLATTED LANDS _T SE Corner of VOLU14H 9 PAGE 2411 Section 14 � Z800 P 592 - 794655 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., MI Document Number Document Name RECEIVED FOR RECORD 05/11/2005 10:00AI1 WARRANTY DEED THIS DEED, made between Jeffrey A. Tarman and Laurie J. Tarman, husband and EXEIIT # wife ( "Grantor," whether one or more), REC FEE: 11.00 and Steven Ulrich and Nancy Ulrich, husband and wife TRANS FEE: 510.00 ( "Grantee," whether one or more). COPY FEE: CC FEE: PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): That part of SW % SE '/. Sec. 14- T31N -R18W described as follows: Lot 4 of — Certified Survey Map recorded in Vol. 9 of Certified Survey Maps, page 2411 as Estreen $ Ogland W Doc. No. 474491. St. Croix County, Wisconsin. 304 Locust StrW Hudson, W 54016 038 - 1059 -30 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated '21 0 S (SEAL) lg (SEAL) Ta man (SEAL)'' (SEAL) * * Laurie J. Tarman AUTHENTICATION ACKNOWLEDGMENT Signature(s) Jeffrey A. Tarman and Laurie J. Tarman, husband and wife STATE OF ) authenti ate O ) ss. COUNTY ) *Kristina Ogland Personally came before me on , TITLE: MEMBEk STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Oland Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: 1 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO -PROTM Legal Forms 800 - 655 -2021 www.intoproforms.com q1D r _n n m � n r > < `� m Co a T o r« r CD O C1 1100 M 0000 00000 ! vZ1L Q. �T2 C�_n?io _� cno �cno BCD rnCD < o� 41 2 3 o v m v * ;� N � o O. r' �D n '' ? �- �v v ��° '' -4 3 X 0) _ rn o CD En G) �>', rn ^`z *O co n � O cn • < � CD te + < `[ � (D W :2 A �cuma o *oo0) �v Cl)� O O O(Q :3 2 O cn � n a o`er ° O to � ,. �� (a m 0 —I JJ O 1 ( n O 1 m o C r ED O < n cn n cD ic ° N > Z o n 0 p X . c 0 Z O � C o O r -4M(n O c n 0 C-) v =3 N O fD � O CA •P 4 O S:\Land Projects 2005\0465\dwg \0465 BOUNDRV.dwg, Layoutl, 7/22/2004 3:02:34 PM, jwest, 1:2 C. O � � r1 n --------- - - - - -- } I I �• I I I I I I o I W n A W I I N CO i n I o W v N W v N C tn A N rN N -P) n f 1 7 O I � I s 4 +, 1 00 co ° o C ` r o 03 p V` z Ln N rF fU 0D T r "m h I o m ro ;4 A �- n) � - N !+ _ T °gym r E5 r� r z -� E. , ° € N CD o ° A o �o �1 3 z� tn tn (� {U .3 Il p C. O Ln (11 V Q W Q � co N LA p fU . A V Y A to V n� fv —� O L- O C-) c7 rn " h z m --i r z 0 C) X m -n CTt C \ � F; Z M o m v G �C J " �, 4 e5/MAY, 19. 20041: 9:05PM71569EDINA RFALTY HUDSON ED DONNA WOLLACK NO. 0503 FP. 2 eiiel 3 • pg199 4 r This instrument drafted by Fran Bleskacek Pro9, No. 91 -Ofi O 1 , rCNSb�L 1 4 CERTIFIED SURVEY MAP �_.. Located in the SWk of the SEh of Section 14, T31N, R18W, 'Town of Star Prairie, St. Croix County, Wisconsin. LEGEND G Aluminum County. Section Monument Found b o G�` 0 1' x 24" Iron Pipe Set, weighing 1.66 lbs. per linear foot 21�' S Y - Existing Fenceline ' , � e Z ••.••. - -- Building Setback Line A PPROVED oc oG OQ L 4 Y1 ° .. OCT 09 1991 SL =IX COU AM C ME I v Y S •• OWNER b p r Allen Paterson N s UNPLATT�p 411 W 4th Street c SCAT, T>` F EET – _____ . LANDS New Richmond, WI $4016 :I100 200 300 North line of the SN} of the SE} a "' 7 N89 0 32 1 38"W 1323.71' Id' IL' �L1e i9R7� Jo1 Drive Easement Detail ALL N��' 407 a LOT 4. . H11pS0l1 f '•. i (— 1 .�' G T 3 L qT 2 ', Wis. ,r� W n 20' 20' I 913,305 Sq. ft. 100. A/N t �'69 N0 SUt' % J 20.97 Acres l 96e663,� - 910,586'9q. Ft. 5xo. R/W 20.90 Acres r (ni Uil - -- - - -- W U)I �I w h zi ZI ° Qi v H M jI JI .4 pl 15' N0905b 597.06' N89 "E '681.63 ° dl WI W 298.53' 298.53' m l�I F --I,_ aa- o - W z dl zl _ LOT 1 � DI 431,179 34. Ft. Inc. A/W LOT 3 LOT 2 e0' : 9.90 Acre@ N _ Inc. R /W: S o -Inc. R /W: i IS w ° 400,761 Sq. Ft Exe. R/N m o W 194,310 Sq, Ft.� 194,310 Sq, Ft s o 9.20 Acres o : 46 Acres c © 4.46 Acres ° c c e Exc. A/W: o Exc. R /W: o a ❑�� 183,880 Sq. Ft, 182,729 Sq. Ft: c o 4,22 Acres 4.19 Acres - Buildings ......., ..,. ............ y :� u; Snptie• Well M1 S I i ...- 009o091'57j1E o ��z9e.66! __14 5,'27 "E -- 1326.12' ---T N99054'27 N99054127111 -~ , H. �I_�� South tine of :he SE} 1926.12 s} Cor+rr of C T C UNPLATY� J LANDS SE Corner of Section 14 r Section 14 d a l �j VOLUME PAGE . 2411 t R n� � 7 l p�f, �. I PLAT T -31 -N • R -18 -1 Pori co. U u l' 04 See Page 112 For Additional Names. 0 5 20 X RD 1000 1100 CA DINAL DR 1200 1500 1400 Adeak PC t o sr Randall & L Dou as caAR STAR Mary o Rivard c tr CEgAR Phy q R7 } Demullin o �� PRAIRIE 261 2 CL7AR TON DR 2 1 200 Go c o ° 3 !3RN 3I ey 0o eo .-,3 Riv ard b b 'a � sa p >F R a 5 U s �tS d o J p u 6 ' Vincent & G +� 128 . [� ua � � 8 " Doreen tr V a M 95th U D c c w '" Wilson 80 8 3' 1 Sand- Z aaa �_ A H SN 9'�_ — >� john Susan 2 TON Gall Meeds is 00 aS " o Abra- a "' �' u H � Alfred & 38 JZ 60 39 '3 I.,Allse :.:;:,.: N tr tr a o Normal � H oa U u $ Larson DL 8 N 80 r �o �� 121 ct o _ G &I e.m sn T & S 20 Fern i & R zo OLD Mi I 13 7 tr "B" t Sias o � P J eatson s a u oo Parnell Me as - M RD Daniel F ta+ale R & c 20 Estate 0 Gu Ahlness 40 v7 N Ea r° z Trust �� 40 40 "111\ s ET 15 34 v P amela Jess O w N � u C 24 20 � q L owell tr j &C 15 nt ►+ v +n+ 31laaa �iS �+� 0 Y¢ s N tr Edin �i ° Emer- voB tr L A U C9 0 id �a,Ke C'3 J etux Pq r� son 40 37 tr Z ° 3s Ch„ 117 _40LC40 14 ss a R& s o Gar. D&P 3 Sandor & ' S Patricia 1 en CC M ,.14 N o Janet 1 Anderson Crisdhome 120 Norman `"°° ° a Nemeth 77 3 H LE 82 Farm L s & Joyce quid E Inc g Mante „ ^^ a „ Scott Richard I Harlan C tr 109 a is Counte8 stout t za\J�Q,Vehrs 158 RV 13 1 JL &c C) Robert a Matthew 15 Q c Wallrieh � In Patric & 10 L & Patsy opher d '" Estates Gremwrood Thomas Brenda °"�" o Larson s '" ° i' Ine_< 77 Enterprises s6 Lee 40 Rivard & R 10 j & D 20 B David 1 t k tamct 26 CC 42 3 Crichton Cook A ronson E A M 20 w RM j &L " 60 13 &i tr ( 80 135 Gs son i pre c to o R o s 5 tlea 2 s 2 - ` Neil Mar 3 210th NE O Keith, Hen Emerson & Gene « wore tz & 1 S 17 Talmage Hemen- Bruce ao Wayne �� i o s rotrler 4s 38 t 39 Mary way 40 40 75 0 1 Thomas O e., G&c FD 5 B &I ;°. Robe atrida Jones 2U 9 Steven & 4 T, , P& 60 Z 6 F s s 5 Ci w T a 37 80 E 20 Cxlsty c '.S Z i� G a 00 Gejrtnaln As an 127 AN Glaser Wicken- 79 _ Roger & ` her 2 zs 25 i&M � & Ralph & L 20 is N —. & Ma nderny 00 t David Neu volkeit tthys °L, &Mary Mondor D i Railsback mann A&s 140 Curt & s Rosene/ 99 Stewart 78 Ri rd 0 II Trust 91 s i s Mary T&I AnderlW 2 p o Robe Volkert D Bonestroo 1� - Robert, 1tl ' ... CC 1B Fritz k 4 T, & Violet 6 156 3 _ _ 75 14 Asplund 80 a U 4 102 " tr 40 tr (` DIRK Gerald & L �� 1 200th AVE Gary 42 F_ Ste n I & Bonn B& Marcella u) uh"� "� & C ris Dam Baillargeon R li tr Backes L 34 �� tr Wig ' Genevieve Cas ' Trust S hausel Francois M L bard ac D 31 Hm & �°,�; at Do 100 'R 56 D9 0 1 &" eH t 220 T Us 4 °hO 3 160 195th AVE 217 zt 97 i p n B S 20 tr °n 10 CI of Gene Daniel& r 2 e on ri vieve Ad a w B1s d Nla�. a 40 Casey 9 ae ranwis I � man P w tr Rkb- 40 ss a A r $ o eze 8U mono 40 s St Croix �Ielene -- ss� tr tr 192nd AVE TS N o Victor „^ t s 3 County Farm Houle B& j & L 22 w Myers III 103 11 W o & N 40 _8_0 120 72 & 20 VV Z oix un O lames & t eAUnter 000 0 tY '7i N r.... (n i Tnol #, e1� rs n. w TRC major plat checklist TRC meeting date 0 Lf Submittal type r�,o Project name Location Zoning y ,s ETZ Floodzone W Submittal checklist items OCT -08 -2004 01:01 PM DOUGLRS RIVRRD 715 248 3739 P.01 Douglas Rivard 2286 100 Street New Richmond, WI 54017 Fax No: 715 -248 -3739 Ph No: 715 -248 -3741 FAX To: St. Croix Zoning Department Fax No. 715- 386 -4686 From: Doug Rivard, Town of Star Prairie Chairman Subject: Tarman Concept Map Pages: 1 plus cover Comments: 1 talked to the County Highway Department about their Revised Tarman Concept Map and agree that this is a better way to go. Emerson property to the east had a limited access along the County Trunk Highway corridor. OCT -08 -2004 01:01 PM DOUGLAS RIVARD 715 248 3759 P.02 OUT- 0B -ZE84 37.06 PM 16ICIA GERNRIN 10%08/2004 FRI 10:46 F_4X 716 7912339 ST MII COMP Pi MR �002100Z Pft )rjlL "view It1 crs 0.nc y * a eS A cc 0s3 , Imo - los t � OL dpw (w Q Im 104� ✓ �f M, 9 L LT t L 1 2114 � t. �: I j II I tv C-(A Se I ii f, I j j i I! i j i, i II j III Ii j�l • • i �I P.O. Box 108 1150 Davis Street. J71 S) 796 -2227 Hammond, Wisconsin 54015 Fax (715) 796 -2339 ST. CROIX COUNTY WI SCO N SI N HIGHWAY DEPARTMENT FAX QMR SHUT DATE: TO: h ATTENTION: �l4 yvN FROM: at St- Croix County Highway Dept. PAGES: This is one of pages. MEMO':' -- 77A; Ar— /gAy S Gi a1.. } er Lo '2 o iL 4-r C J44. tl S�ev e- Md, A D S ADU IA b 1 o V'�,% 1 1 ' fief i K K ova VV G b C, 4 elcic '� r Lj 'l Z00 /TOq DNINOZ DOS OFF IdN AU EX100 11080 IS HN 96L 3% IYd O1:6 Mll tOOMO /OT o n 3.5.. o N Z00(� DKINOZ 33S ZddQ All AJMOO XIOHO IS HN 96L STL IVd 01:6 RU MULO /01 TOWN OF STAR PRAIR sr C z 2004 2034 COUNTY ROAD C 2on,NG co j erk SONERS]ET, W1. 54025 October 7, 2004 Zoning Administrator St. Croix County Zoning Department 1101 Carmichael Road Hudson, WI. 54016 Attn: Zoning Re: Jeff Tarman (9 lot Subdiv.) Dear Debbie, Mr. Jeff Tarman approached the Town Board for approval of his 9 lot subdivision located oft of County Road C. Mr. Tarmans home -is on lot 2 of the CSM. He would like to have his drive way come off on to the new road that the subdivision will use. The concern is that there miaht not be enough room for him to have his driveway off of the new road because of where his septic is located. The Town Board has no objection to Mr. Tarmans 9 lot Subdivision, with the stipulation, that if he can not get his drive way to service his lot from the new road he will have to go back to sharing the drive way with lot 3. The Town Board also took in consideration Statutes 91.77. Sincerely, OA Felicia Germain, Clerk h&hh, ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT 1. t I M you • n ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 Phone: (715)386 -4680 Fax (715)386 -4686 r aspy _ October 6, 2004 TEC Design 5828 Arndt Ln. Eau Claire, WI 54701 RE: Tarman Conceptual Plat —Town of Star Prairie Dear TEC Design: On October 6, 2004, the Technical Review Committee reviewed the above plat. The following comments were made: 1. Potential road connections to the East, and Northwest to Harlan Vehrs property & Wallrich Estates. 2. Extraterritorial plat approval from the Village of Star Prairie. When the above items are addressed, a preliminary plat may be submitted for review. If you have any questions or concerns, please feel free to contact our office. Sincerely, Alex Blackburn Zoning Specialist /ml cc: Owner — Jeff Tarman, 1260 Cty Rd. C, New Richmond, WI 54017 Buyer — Hank Fogelberg, White Pine Inc., PO Box 504, Hudson, WI 54016 Buyer — Ed & Donna Wollack, 2816 90 Ave., Woodville, WI 54028 Town of Star Prairie File