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Parcel #: 038 - 1200 -20 -000 03/04/2010 04:46 PM
PAGE 1 OF 1
Alt. Parcel M 18.31.18.1056 038 - TOWN OF STAR PRAIRIE
Current 0 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
O - BENSON, SARA
SARA BENSON C - HAASE, JARED
JARED HAASE
2107 80TH
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): " = Primary
Type Dist # Description 2107 80TH ST
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 2.111 Plat: 07- 099 - ROLLING OAKS
SEC 18 T31 N R1 8W SW SW FRL LOT 5 ROLLING Block/Condo Bldg: LOT 5
OAKS EZ -UT- 1666/06
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
18-31N-18W SW SW
Notes: Parcel History:
Date Doc # Vol /Page Type
10/29/2007 863197 WD
02/26/2007 845402 SD
06/16/2004 766016 2596/593 EZ -U
08/26/2002 688122 1958/176 WD
more...
2009 SUMMARY Bill M Fair Market Value: Assessed with:
54865 199,300
Valuations: Last Changed: 10/05/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.111 32,600 171,600 204,200 NO
Totals for 2009:
General Property 2.111 32,600 171,600 204,200
Woodland 0.000 0 0
Totals for 2008:
General Property 2.111 32,600 171,600 204,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 304
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
wismoir' d am ' PRIVATE SEWAGE SYSTEM
Saft
and A Division County:
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) SanrtaryPermitNo
Persond k4ortnafim you ptovlos may be used for secondary purposes (Privacy Law. x.15.04 (1 xmp.
mrt s Name: 0 city 0 village Q Town o : State Plan ID No.:
v.: P Insp. BM E ev.: BM Desch i n so Parcel Tax No.: �Q V C. 0384200-
qi� 4-3 4Y ,� l ��
z
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic �� Benchmark .3 ld p 7
Alf- RM
Z
Hera ' Bldg. Sewer
ding Ht Inlet I S O 93-
TANK SETBACK INFORMATION Ai Ht Outlet Z
TANKTO P/L WELL BLDG. Air intake
ROAD 04 ink-t_
Septic s / NA
NA Header / Man.
T /D Z -
Aeration A Dist. Pipe 0 Z
ding Sot. System +Ir 9. y0 �� 6
EE
PUMP/ SIPHON INFORMATION Final Grade If
facturer Demand
—4t eeyeF
Model Number
TDH Li Friction m TDH ft
ain Length Dia. Disc. To II
SOIL AB PTION SYSTEM
BED/= width L h No. Trenches PIT DIMENS No. Of Pits Inside Dia. Liquid Depth
Dime SYSTEM TO P / L BLDG I WELL LAKE / STREA L SETBACK r
INFORMATION T M um r:
System: u Z -�� r
' A jo j DISTRIBUTION SYSTEM e�pra�C. W � a ra '"1°yl
Header/Manifold f� Distribution Pipe(s )7 x Hole Size x Hole Spacing Vent To Air / ntake
Length Q Dia. Length 7Jpia. A& Spacing 4-3
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 C No Q Yes Q No
COMMENTS: (include code discrepancies, persons present, etc.)
Inspection #1: / b/ O /inspection #2:
Location: 2107 80th Street, Star Prairie, WI 54026 SW 1/4 SW 1/4 18 T31N R 8W 8 118 056 Rollin
g
Oaks -Lot 5 3 obse v,%�Z&K )- 1
1.) Alt BM Description (owe Sjcl: q •� Ko we If a+ `"
2.) Bldg sewer length
- amount of cover = rv.'It X. 4
Plan revision required? []Yes CO No
Use other side for additional information. 3 ,yam G
S80-6710 (R"7) Oat Inspector' 'nature cent. No.
� 4 ":
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� �.�� � �
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# 210 Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
lVi sconsin Personal information ou p rovide may Madison, WI 53707 - 7302
y p d y be used for secondary purposes
Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not
state owned.)
Attach complete plans (to the county copy only) for the system; on paper..Eot less than 8 -1/2 x 11 inches in size.
Coun n� K Stat
St Permit Number ❑ Chec
rev jo.)?r vibes implication State Plan I. D. Number
I. Application Information - Please Print all Information Location:
Property Owner Name i, Property Location
//i�
/V / L U- �/1/' /it/ E f o f 1/4 y4V1 /4, S 1A T 3 N, R (or&
Property Owner's Mailing Address C .- ; 1UUl x • Lot Number Block Number
ST CROIX
COUNTY
Y `J
C ity, State Zip Code \ fi ne y Subdivision Name or CSM Number
G(QSOAI :'� ) P ' OLc /nr 04 r S
II. Type of Building: (check one) _ _ ❑ City
1 or 2 Family Dwelling - No. of Bedrooms: 3 ❑ Village
Public /Commercial (describe use):_ 181' Town of
❑ State -Owned E
Nearest Road r �
2 3�X g� , 2 S ,�,�� (� �) 3 ` K S -} .! 2.v�t�� Parcel Tax Number(s) DO O
III. Type of Permit: (Check only one bo on line A. Chec box on line B if applicable) / g. 3 �, 0 5
A) 1. 9 New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
$) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply) —1 a'O
K Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (G ?'- ':.. ft.) (Min. /inch) Elevation
ys0 Q&
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
IR ❑ ❑ ❑ ❑
& 0 0l7 E — r ❑ ❑ ❑ 11
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) Plu r' Signature (no stamps : M RS Business Phone Number
Plumber's Address (Street, City, State, Zip Code)
I/Arazi - s -a —
IX. County/Departmen se Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Is ing Agent Signature (No stamps)
Approved ❑ Owner Given Initial Adverse Surchar� f Feee) (
Determination �]+�(' L�
X. Conditions of Approval /Reasons for Dis _{— I e t t o
Yom"^ 15 /�Q.0�2DV Cam .,` - �-�,/yJC SN&Cv 1 4' [T`S cl-j
Ana, t� E at�edC CW I Ak IMl> a-r tnlitS S .
SBD -6398 (R. 07/00)
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Wisconsin • Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of 3
Bureau of Integrated Services in accordance with Cqoik&B fl� „Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in s^ "Plari must �,' ounty
include but not limited to: vertical ert cal and horizontal ref r
refer point B ~d'ifie' ' ti
on on d
,
percent slope, scale or dimensions, north arrow, and location and d jgtanLe to nearest road. Parcel'.I.D. #
j
APPLICANT INFORMATION - Please print all information. Revia . d y Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 20 (
Property Owner ^ tCl
'^ -I f�rtlp�rtLooation ; e
lV rU 31OL4 Govt. Lot j4 SIV1/4,S1 T 3 t ,N,R �- E (or) IV
Property Owner's Mailing Address t # Block #r Subd. Name or CSM#
135 c u4ukeee 7r. w ._..... e611 in C�o�kS
rt St ate Zip Code Phone Number ❑ City ❑Village] Town Nearest Road
d5o (tai s�4UIla JT�r� t ; ��
New Construction Use: Residential / Number of bedrooms 3 - y Addition to existing building
Replacement ❑ Public or commercial - Describe:
Code derived daily flow 4 00 gpd Recommended design loading rate 5 bed, gpd /ft trench, gpd/ft
Absorption area required /ZOO bed, ft 42 trench, ft Maximum design loading rate
g g gi bed, gpd/fK trench, gpd/ft
Recommended infiltration surface elevation(s) �� �, ft (as referred to site plan benchmark)
Additional design /site considerations ✓T 4- 'e l-e y ' O' 7G
Parent material ~ � 1 Flood plain elevation, if applicable
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U Unsuitable for system S❑ U WS ❑ U O S ❑ U P als ❑ U EIS O U ❑ S 12PO
SOIL DESCRIPTION REPORT O,) Cb& I Z�ev a
Boring Horizon Depth Dominant Color Mottles Structure GPD /ft2 !L.
9 Texture Consistence Boundary Roots
'..... :,
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
I o -8 Ib r 31 z- SL Itm b m �r cS Iv y 5 t `f
g -2-( S14 — LAS 2 CL 1<' C 5 s'
Ground .3 2( -85 16y 1 41 to LS I mab V C.5 .�-
elev.
Depth to
limiting a -{- q�.se) C& p �}
factor
Zi in.
Remarks:
Boring # 'n _(o v r 31Z SL t rr5 b rQ� r L S 1 y
K
S `�
-- Z
Z a -L (O /`� LAS �m4bl( �� cs S (n •5
y -3 22 -`)f ld vrdU LAS I MCA Mn '
. to
Ground
elev.
9 20 ft.
Depth to
limiting
f at or
/ in. Remarks:
CST Name (Please Print) ignature � Telephone No.
/- darn
Address Date CST Number
2 _ 11 S S +. Svmer e� . ) oz I -(2 -coo Z S3 305
SOIL DESCRIPTION REPORT 2
PROPERTY OWNER �� Page Z - of .Y
PARCEL I.D.#
Boring Horizon Depth Dominant Color Mottles Structure 2
g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed ,Trench
5L 1 rY r c 5 l v � 4 4 '. 5
Z 8-2 t L-P 5 (yiUbk rn
•r
Ground 3 2y -9D I 'flu b�S Imc� m�'� c5 S
elev.
4 M ft.
Depth to
limiting 3(,e / :: V 7 -
factor
90 in.
I
Remarks:
Boring #
6 -9 Icy r31 L 1ry+5 r cS IVY `-� . •`�
5) `— J5 2anc,bk roc C"S 5 �p • s
3 2y -4 l q1(P LAS kmub n LS • 5
Ground
elev.
— & 0 ft .
Depth to
limiting
factor
8 9 in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring # 0 -10 L6\. S/Z L llm5blt kr- e-
l�� `� •`�
`J z r) -Z 3 !D 5 L� S 2 tYl� c
3 Z3 Z c H IL L S 1 mabk C-5
Ground
elev.
Depth to
limiting
factor
9 2 ' " Remarks:
Boring #
x
Ground
elev.
ft. ,
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R.9/98)
4
PAGE_3_OF
NAME LOT# J LEGAL DESCRIPTIONS u/' / <Std,S(c -T ::�1,N,R lg� (oCW�
/�SCALE: I"= l�
BM 1 ELEVATION /OU ' 6
BM 1 DESCRIPTION
BM 2 ELEVATION 9`�• 3
1 "
BM 2 DESCRIPTION
SYSTEM ELEVATION
ALTERNATE ELEVATION
CONTOUR ELEVATION 4
I �
j O�
g$ f • t3^ 3� •
SIGNATURE DATE G —�/
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number
Number of Bedrooms
Design Flow - Peak (gpd)
Estimated Flow - Average (gpd)
Septic Tank Capacity (gal) p A v
Soil Absorption Component Size (ft2) z -
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absor tion Component
Design Flow - Peak (gpd) &51 z — aS le
Maximum Influent Particle Size (in) 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the se tic tan nd outlet filter shall be assessed at least
once every 3 years by inspection. Th outlet filter hall be cleaned as necessary to ensure
proper operation. The filter cartridge shou not be remove un ess provisions are made to
retain solids in he tank that may slough off the filter when removed from its enclosure. If the
` Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole risers access risers and covers should be inspected for water tightness and
p
9
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound, defective, or subject to failure must
be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNE-RS141P CERTIFICATION FORM
Owner/Buyer �> W C, Y` \\A_ �ei msA
Mailing Address
Property Address C 11 ?R,
(Verification required from Planning Department for new construction)
Ci ty/S tate 4 ZA Parcel Identification Number - 1 01- 06 210 fi)to
LEGAL DESCRIPTION
Property Location S W ' /4, Su) '/4, Sec. I , T - R__&_(p Town of 51plf R�s\ "A
Subdivision Q LAT o-� aLLjwG 0 R " , Lot #
Certified Survey Map # - - _, Volume , Page #
Warranty Deed # 6 39q� - ,Volume Page # 5`6 3
Spec house )k yes ❑ no Lot lines identifiable J4 yes ❑ no
SYSTEM MAINTENANCF ,.
Improper use an d'maintenanccof your septic system could result in its premature failure to fiandle 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.
The property owner agrees to submit to St. Croix Zoning Department a certification forth, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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 retumed to the St. Croix County Zoning Office within 30
days of the three year expiration date.
tvx k R_ - 1 �. � ). - 3 r
/ /O)
SIG ATURE O PPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) ant (are) the owner(s) of
the pro rty described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIG TUBE OA APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.
Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
ii);. 10`9 1 PAG 583 o
STATE BAR OF WISCONSIN FORM 2 -- 1998 639955
WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
Document Number ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between _ _
- __I CHARD 0 _ S IT
T OT and JANE 4
T , P _ Tni1T, Oe03 10:00 AM
.R
_ hu sband and wife, . WARRANTY DEED
Grantor, EXE -4PT #
— - - - - -- -- -- CERT COPY FEE:
and
ccP•; FEE:
TRANSFER FEE: 111.60
REMRM413 FEE: 10.00
Grantee. PAGES: 1
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate in St- Croix ___ County, Slate of Wisconsin:
Lot Plat of Rolling Oaks, Town of Star
'F r r — airie, St. C roix Coun y, Wisconsin. Name and Return Address
mILNAtL 6trmltlr�
I
Q4R_1900 -20 -000
Parcel Identification Number (PIN)
This iS n0t homestead property.
(is) (is not)
I
Exceptions to warranties: easements, restrictions, rights -of -way and covenants
of record.
Dated this 2 nd ((� F2 - h } r - - Vary , 2001 A'
\� �>1•S \��'S (SEAL) - /J�_ (SEAL)
i, '
Richard 0. Stout a Janet P. Stout
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
State of Wisconsin,
55.
St. Croix County.
authenucated this day of Personally came before me this 2 2nd day of
February 2001 , the above named
Richard O Stout and Janet P
- R117Ont
TITLE: MEMBER STATE BAR OF WISCONSIN - - _ to
(If not, me known to be the person S who executed the foregoing
authorized by §706.06. Wis. Slats.) - -^"'^"""""" instrument and acknowledge the same
CHERYL JACOGSE
Notary Public
THIS INSTRUMENT WAS DRAFTED BY Et of Wisconsin —
Janet P. Stout ( /
1353 Awatukee Tr. _ _.
Hudson, WI 54016 NotaryPubltc, IeafW'c a n sls)n
My commission Is permanent. (If at. state expir date:
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
Names or Persons signing in any capacity must be typed or printed below their signat'l
STATE BAR OF WISCONSIN W-on- Legal Blank Co., Inc.
WARRANTY DEED FORM No. 2 - 1998 Milwaukee, Wis.
_ ` wv r+vrli.p
S 8W3W5W K $75.44' re
53.00' X07 +•.--
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1.800 ACRES.
1.677 ACRES r 78,786 00 FT
68.705 90 FT /
BgpS41' s8ss
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U 66.004 Sa Fr
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° j \l EE
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• 1.408 ACRES V GGAW4 80 FT
61,117 80 Fr I
N 00'33'10' W 700.76'
DEDICATED TC
t3MENT Z -- SOUTH LINE OF THE SWI /4 N 89 W 145
= 70.06 +
U.S.Q.S. DATUM of ,058 L 21 oTM . AVE
4AEEENr DPAFTW BY M C AEI F VCsZ i Joa NO. W 179 DATE: B-1 4-00 U N P L A T T E D`, L Ali D S, -0