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Home My WebLink About038-1088-60-000 n t/) O' 0 0 g d c d c °.: c > > e 3 0 A C ` 1 c g C_ Z z o w -i 2 Z -� - n fn � o • n p O O Yo O O C ( O N Yi'i O Co N 'l w �. O c w 3 p c �." v p OD p n 4) 9 0* CD 7 n N CD oo Cp n, .�• fn fD y � - Z a N c j O M _ a g m W a n — Oft o pp 1 10 N N Qa CD n sy N N a O N N (D A, d 'm c o f m n v o A� O f0 n 0 O O N j O O O O III 1v c Q �1 C N I p ry cnzD (D a� (n�D !D rn a fD (a D N a p Ca CD N a N 3 n ^' COO O CJ�I fD O O CD F CL O C � N N p O COJC i OD A N (D CD g O Z 000 000 CA eD - 0 tD • • m O1 cr 7 ,CV„ .• N = w N c 3 m 3 I � co • • I a � y � ` ` 1 Duo > 0 O o — a m O O 0 CD o y CD y �• CD CD l►1 ? �. m ca �. 5 m S CD C) w a a n 3 v 3 _ Z (D y m -i N N O N O j A Z f7 0 z 0 a o. A j C N j CL o z O :* O ► Z C 0 v w � 50 -0 a CD mcyv a m v N _. CT 0 aw r _ o co N o o T a a;o n CL QO d c n� a � m c v yea a m o_ ', C C D v o 0 O N F N w 9) CD �• O N CD CD CD co C c O W (DD N ,�� y O N r N d= Co 'NO C O N. •O O C`7 co n d 01 co CD CD r ? o c Cr C CD = CD Cn `G A CD O CD 3 ( D 'O C 00 a) y N N I (D 1000 o n b � m � n d F va 3 m'o' m o �C 3 — ,. _a CD D gNO (D r:m c o n= �0 r o nc t jai < 2) � CD Co o°o 4- CD N ! 0) N r co N o 3 CD 'ni ap °a N O N A o o b CD CD w rflO �. Q g o ° off °oi. " b I Parcel #: 038 - 1088 -60 -000 12/08/2006 01:02 PM PAGE 1 OF 1 Alt. Parcel M 21.31.18.363D 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 MATTHEW J TRENT O - TRENT, MATTHEW J 2066 COOK DR SOMERSET WI 54025 Districts: SC = School SP = Special J*�2066 operty Address(e : * = Primary Type Dist # Description COOK DR SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.000 Plat: N/A -NOT AVAILABLE SEC 21 T31N R18W 1A IN SW NW N 200 FT OF Block/Condo Bldg: S 633 FT OF W 217.8 FT OF SW NW Tract(s): (Sec- Twn -Rng 401/4 1601/4) 21-31N-18W Notes: I B �� P cel History: �A D e Doc # Vol /Page Type 1 /03/2003 745549 2448/208 QC /16/2001 645688 1640/569 QC ,p 1/07/1999 595252 1393/507 WD 12/17/1998 593992 1388/51 ..019 2006 SUMMARY Bill #: air Market Value: Assessed with: 175398 183,300 Valuations Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 25,000 137,000 162,000 NO Totals for 2006: General Property 1.000 25,000 137,000 162,000 Woodland 0.000 0 0 Totals for 2005: General Property 1.000 25,000 137,000 162,000 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 533 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 1 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT .OWNER t „�� ti s� TOWNSHIP 5�q� //��i. SEC .��T -� W ADDRES ,�rS�- ST. CROIX COUNTY, WISCONSIN. e SUBDIVISION ( oS LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 OW-EVERY WITHIN 100 .FEET OF SYSTEM iv YN I di a o th Arrow � ' SC L . BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: (Sl ope at site: D SEPTIC TANK: Manufacturer: !?? e Liquid Capacity: �e q P Number of rings on cover : f ._ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: -� PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cyc e gallons; total capacity o distribution lines gallon: size of pump head; gallon per minute horsepower brand name of pump and model number Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device 'SEEPAGE PIT SIZE: Number of pits feet diameter feet liquid depth seepage pit in et pipe- elevation bottom of ' seepage pit e'.]_evation feet. SEEPAGE BED SIZE: number cf lines _ width ' length�tile dept SEEPAGE TRENCH: width length PERCOLATION RATE_ -- AREA REQUIRED C / r REA AS BUILT INSPECTOR DATED LICENSE NUMBER G� 1.'3 0 REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM • •, Sanitary Permit _ State Septic' NAME �/�� OWNSHIP t. Croix County LOCATION && — Section2Lot # Subdivision SEPTIC TANK Size �� gallons Number of compartments Distance from: Well y ` Building 12% slope E -,� — Highwater I PUMPING CHAMB Size ,gallons Pump Manufacturer Model Number H OLDING TANK Size gallons Number of Compartments Pumper Alarm System Distance from: Well Building 12% slope Highwater ABSORPTION SITE Bed Trench Distance from: Well Building 12% slope Highwater ABSORP SITE DIMENSIONS Width of trench ft Requir d area; 11 ft. Length of each line 14 6 ft Depth f rock below tile _ in. Number of lines Depth f rock over tile__` _in. Total length of lines �- ft Depth f tile below grade in. Distance between lines Slope f trench in. per 100 ft. Total absortption area t ft Type o Cover: PIT DIMENSIONS Number of pits G el around pits yes_ no Outside diameter t Depth elow inlet _ft Total absorption ar a t Area require / 'ft INSP Y..- TITLE - DATE--- 198 -� REJECTED. DATE _198_ REASON FOR REJECTION _ State and County State Permit P 67 Perm Permit Application County Perm ' for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: es w Y4 Y4, Section 2�, T_2/ R__Lgq (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# �° Village Towns S7'4/' lai r l lC C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family I Duplex No. of Bedrooms No. of Person D- SEPTIC TANK CAPACITY Total gallons No. of tanks n-- HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured -in -Place Steel 1 5 - 4 -' . Fiberglass Other (specify) New Installation Replacement L---� Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E, EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement tom Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: Length S2 � Width 1 Depth 2VE Tile depth (top) No. of Line Seepage Pit: Inside diameter Liquid Depth N o. of Seepage Pits Percent slope of land pia Distance from critical slope WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other th pre owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified Soil Tester, NAME 41 c: � urz� 1,41 _/�j� n e f� � lam! , C.S.T. # /'el _'3 and other information obtained from (owner /builder). Plumber's Sign MP /MPRSW# 7� 9 Phone # , ; , /S - y 5,41 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. t ..... E i � 4 I w. m' n s.� l 7 ��: # ... -,.$ { .«. Ems' o w� r I i F �^ e I ., e., m m ., „ „� ,...,. -m . 3 ..... ,. , -., ......,- ...... e.... .... .. ...... .e,:. .. Psm............. .. .. ._.. _ ... _ ,,. .. ...,,... # F 3 I i € 3 d � p F t E 7 v. 3 t j t Do Not Write in Space Below FOR COU Y AND STATE DEPARTMENT USE ONLY Date of Application Fees id: State County Date Permit Issued /Rejected (date) Issuing Agent Name Inspection Ye No tate Valid# D Recd 1. county ,(white copy) 3. owner (green copy DIVISI LTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7 /1/78 l � INDUS T MENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION LABOR AND - PERCOLATION TESTS (11.5 IJUM`AN- RELATIONS ,`? _. 8 MADISON WI 53707 LOCATION: SECTION: B A / DI N NAME: ,5W '14A' /T3P N /W9 V(or) I TOWNSHIP/MUNICAL1,TY:4 �- C OWNER'S BUYER'S NAME: MAILING ADDR SS: O USE GATES O VATION E NO. BEDRMS.: COMM ER AL DESCRIPTION: ESTS: ��Residence �7 7 ❑New ' Zoeplace �J RATING: S= Site su itable for system U= Sit unsuitable for system �^ M 11 Tn AL: MOUND: IN- GROUND - PRESSURE: S STEM4UN PILL OLDING T NK: RECOMMENDED SYSTEM . (optional u a s ❑u a s ❑u I DS ❑u ❑ s ❑u If Percolation Tests are NOT required DESIGN RATE: S STEM 4 I If any portion of the lot is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED E ST. Hl TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- P- S P- 3 G G P_ PLAN VIEW: 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 slop. y � e ` SYSTEM ELEVATION /� q7." 7" ... 1� 7t= e_ V f V -r - I ....a__ .. __ ....__ _ . n i f � .... __. ,- -e� xxx E i . e x i s , x E 8 r — 7 7-7 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative 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: 4 7 -- -;z.2 - -'e/ ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): !ry / G J / ' / 3 *— s� w �ypt c CS IGNA URE: , DISTRIBUTION: Original -Local Authority, 2nd page- Bureau of Plumbing, 3rd page - Property Owner, 4th page -Soil Tester. `R -SBD -6395 (N. 03/81) IV y� / g? r a 0 J : # ; R 2 M 7 � 0ƒ 0 7 o m a \§ w ® k } ± m \ \ \ k Q c o $ D. 00 \ CL } \ § § # g = $ / § 6 f4. 8 & co « z . ƒ e >� e c! \ 2 0 0 3 o - _ 0 2 ! i� Q o ® 00 ®3; QN CD ! ! / 2 2 CD E � E \� 0 § 000 o A[ 2 3 3 m' 2 0 JM �� ƒ ..•; E • E E § E I & [ / I z 5 :3 o \ 7 \ 0 \ 0 c I f N \ � 2 JI wm 4 k § 0 CL E R 2 7 a � e 2 \ .. m ! �f 'I 2$®m@2�> k I :E :9 90 §\ o,w_,E �J,E= «m > -E c §1�2R%'z % 7� ®77 ( >Ec ±■ EE9$�& =mom -® / §0 �Efa� § �» » k8ƒ §0 9 : ](f,] 12 222 2] j \ ��0H w 0 C/) CD m`oM j CD § CD cn «$_- 0 � § � ) 0 : e r _ ' ° 2 ; 3 J % 7! 6 r k M ■ 2 E \ A Q! § z 0 \ W o Z °� S # Q 7 _ X22 \(� �k @ / \ - & i & t � ° ; [ ¥ S o 2 o - E k o Q E . / Z CL ( /I£ ¢ o 3 ca � 2 \ S B Cl. ® \ / § \ CO 0 r § "WA : \ Oro 000 co ( ; / 3 [ m (A CA § / 2 E f 7 m ° ` § ;D CD # C- • [ ! E , I . � .. � § o z \ =r ¢ § / . I \ 2 f N / } E E . 3 - E CD 0 § 2 z CO) _ n ca 0 �k� ƒ CD 2 ;j CD \ g k / 2 o z CA) _ > § j ƒ � § k § CD \ ; m\ ƒ % w;z // 7 _ � �� J/ 9 /i k-4 2 � 0 (D § \ § . D � 2 —` Safety & Buildings Division Z I ( $ 13 c f Sanitary Permit Application 201 W. Washington Ave. In accord with Comm 83.21, Wis. Adm. Code pp Box 7302 Madison, O &C ' On-Sin See reverse side for instructions for coin 1 this application WI 53707 -7302 lam» Personal information you provide ma used for sgc�d�y purposes (Submit completed form to county if not Department of commerce (Privacy Law �p15.04(1)(m)] ( �, state owned.) Attach complete plans t copy only)_ f -the syst aper f; than 8 -1/2 x 11 inches in size. qjpa ou S an xe it Numb 13' heck i revious'app i ation State Plan 1. D. Number C_ I K 77 , Application Information - P ase Print all Infor do ± �V ? Location: roperty Owner Name Cy Property Location S `rvy11`f J /\ 1 .J2'1/4/& , 04, S l.3 T J ,N, R�7�E roperty Ownerr's Mailing Address / Lot Num� Block Number / - � ,` P D ity , S Zip Code Phon Subdivision Name or CSM Number 1. Type of Building: (check one) ❑ city " 1 or 2 Family Dwelling - No. of B �aw.J^r ❑ Village 7 Public /Commercial (describe use):_ .kjL* n J` i TOWn of edrooms r r 3 State -Owned S 0— a . Qs ✓ Nearest Road Parcel Tax Number(s III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) l • 1 $ . O a A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV Type of POWT System: (Check all that apply) Ion pressurized In ground ❑ Mound 11 Sand Filter ❑ Constructed Wetland • Pressurized In•ground ❑ Holding Tank [3 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. 7. Final Grade Soil Application 5. Percolation Rate 6�stem Elevation Required Proposed Rate (GalsJday /sq. fQ (Min.rnch) �� _ / .. 91 J Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tan Tanks ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber' Name (print) Plumb igna"(nostamps): MP/MPRS No. Business Phone Number Plu is Address (Street, City, STate, Zip Cod I.X. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Sur ge Fee) Determination M X. Conditions o pprova /Reasons for Disapproval: 1 n < L '� is $ S S 3 ' �2 �nrti9++� reS9•�G2 . ►�'1 t ►�CD� 2 ..�.w '��S l5 (Ir G— V �o«� Jet- -- SBD -6398 (R. 07/6)) #5- 311 3 1 [3 f Sanitary Permit Application Safety & Buildings Division 4i sCOnSln In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 Personal information you provide may be used forseconftary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.01(( (Submit completed form to county if not state owned.) Attach complete pl nly) for tV Wstem, on pa not less than 8 -1/2 x 11 inches in size. County to i P it Number ❑ Ch i evision plication , State Plan I. D. Number �o r - � ��' L Appl ication Information - P ase Print all Informati ocation: Property Owner Name < U OUI Property Location ST CAOIX / .G .! CC�IJNTY _ 11 /4, S I T ,N, R( Property Owner's Mailing Address f=ist Lot Number Block Number �h � � 02 City, State Zip o e Phone Nu Subdivision Name or CSM Number II. Type of Building: (check one) — us t oj h� S. o ❑ City L, 1 or 2 Family Dwelling - No. of Bedrooms : [_,� -^ e, �_ �.�� ❑ Village ❑ Public /Commercial (describe use):_ ill Q own of ❑ State -Owned ^e � Nearest Road 1 3 f / /Z5�_ Parcel Tax Number(s) D 3 III. Type of Permit: ( Check only one b ox on line A. Check box on line B if applicable) 13- 0 o "t A) 1. ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tan Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) -0 Non-pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At -grade 2 r (. 8 r ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: 3 x • �S �►.Q. u�.c V . Dispersal/Treatm Area Infor mation: 1•2 c,,, 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 (Gals. /day /sq. ft.) (Min. /inch) T'� ^ y 9p Elevation iS d 7 '� 7s� ' q 7 r0 -7. 2 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 // G X eva Lvc efi`5 J�r ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no stam s): MP/MPRS No. Business Phone Number Plum Ws Address (Street, City, State, Zip Cod IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I sung Agent Signa (No stamps) A Approved 0 Owner Given Initial Adverse Surcharge Fee) Determination I UN Z zS, 23, 2ft r X. Conditions of A kov 1 /Reasons for Disappro al: dZ�Qc`ftb•�.� ► n oars l' -zs k5 C. s� C- s�5 {ems^^ 5 " 4. 3- �ae�r°o*^ r6 e. tc . l4 K kedl Y w- M J J J oLccatcQ�t.�q C is -AA" . s► �n �`'`��` �� iS GQen�►acQ� k 3BD -6398 (R. 07/00) Wisconsin Departmomt of Commerce PRIVATE SEWAGE SYSTEM Count IX Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar Personal information you provice may be used for secondary purposes [Privacy Lawx 15.04 (1)(m)]. PFF%AtiojdgftName: ❑city ❑ V r r�Qo OWr1S Ip State Plan ID No.: CST BM Elev. Insp. BM Elev.: BM Description: Parcel d TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark G p YO Alt RD4 D Aer n Bldg. Sewer Holding St / Ht inlet , 0 - S� TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. ventto ROAD D Air Intake Septic yZ 1 r NA D f S NA Header / Man. ration N Dist. Pipe Holding Bot. System L PUMP/ SIPHON INFORMATION turer emand Model Nu er G 5 3. ?-o T131� Lift Friction Sys TDH Ft Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM if 5 BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME SIONS IONS DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEA Man facturer: SETBACK C A ER INFORMATION Type Of // Mode Number: System: CtY� i �10� Q S DISTRIBUTION SYSTEM > .SD r eX;s�Fr / Header/ Manifold Distribution Pipe(s) t x Hole Size x Hole Spacing vent To Air intake Length t� Dia. 7 Length &Ey� 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 Mulcted Bed/ Trench Center Bed/ Trench Edges Topsoil lnS ecti0 ft Yes / []/No InAp gatiet No / LGg MMFNTS' (( Incl de code discr ancies, er n res n etc.) 2�' o % Location: X066 Gook Drive, S�gmerse , V1 540255 � � W 1/4 NW 1/4 21 T31 R1 W) - 213118363D 1.) Alt BM Description = aft a o(oor s;` �.) :s ., r,Peds �� p W' 2.) Bldg sewer length =} Z a G,� „ew W t t o 6 A a, - amount of cover = > /�,� � s�;,.� ra� // ic fe*wnved . in a e hew , es /pC (� No Plan �e�iision re -- d Use other side for additional informdtlon. p I SBD -6710 (R.3/97) Date Inspector's S ature Cert No. I f L c-poi-cc- _ 5 n. 1. /t e . 9 3 S6 4 Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 ®�s ,►®nSin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)j state owned.) Attach complete plans (to the county copy only) for the t I0 papef n6t -less than 8 -1/2 x 11 inches in size. Countj G � State Sanitary Permit Number ❑ Ch 'ion to previous application State Plan 1. D. Number I. Application Information - Please Print all Information Location: Property Owner Name Property Location � /4Location iion 1 /VsK/1 / pZ T N, k 'E (o S Property Owner's Mailing Address d; , `PO Lot Number Block Number City, State Zip Code 1t Amber Subdivision Name or CSM Number V/rL� ✓' S C� G II. Type of Building: (check one) , s ❑ city ,ja\ 1 or 2 Family Dwelling - No. of Bedrooms : ❑Village • Public /Commercial (describe use):_ �� (� Town of • State - Owned Nearest Road. L b/ a Parcel Tax Numbers) III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) I. 7 1. 77, 3 63 A) 1. ❑ New 2. UMeplacement 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) - /1U Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade 2 3 , t ❑ A�,tobic Treatment Unit ❑ Recirculating El Other: 6 S 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 (Gals. /day /sq. ft.) (Min. /inch) ��, / —/ Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks I Tanks Ar ❑ ❑ ❑ ❑ Se t x w ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibili for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber' ignature (no stamps): MP/MPRS No. Business Phone Number P is Address (Street, City, State, Zip Co e IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ss ' gent Signature (No s) Approved ❑ Owner Given Initial Adverse Sur! ge Fee) JL At, Determination 225. AM - d.2,co / ". ' °V X. Conditions of Approval /Reasons for Disapproval: t� y. - �`rt��✓ ^/ S t � p s . - , Ursa lr � nR.S tC� r ( t atv" � a," . c.-3 cue , (30 'AdIs ' � i 1 :,. , u s e) Qox � �. ]r�u E b� WIXLZ ao r SBD -6398 (R. 07/00) N �o I J s � s-- s LOT PLAN PROJECT ADDRESS 2066 Cook Rd Som erset Wi. 5 4025 SW 1/4 NW 1/4S 21 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX � 4 -12 -01 MPRS Byron Bird Jr. 220527 1\ DATE BEDROOM 3 O CONVENTIONAL XXX t - Grade CONVENTIONAL L1FT HLDING TANK MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE a LOAD RATE 1.2 ABSORPTION AREA 375 # of chambers 22 IL BENCHMARK V.R.P top Of Tel ped ASSUME ELEVATION 100' ❑ BOREHOLE O WELL 1H.R.P same as BM #Alt. BMbase of tel ped97.4 LVent SYSTEM ELEVATION T -1 =93.1 T -2 =93.9 S High of f pacity Leaching_ Cove amber with 17.2 2 per chamber Grade at System Long 34 Elevation # Alt BM 200' PL BM 60 25' Zable filter A 100 0 3' ex. 18'x ' Ob i 8. Pro 6 B drainf eld 3bed house 49 59 10' alve 3 B2 15 t 25 garage DRiveway 200' Trailer Ex r !�j 7 r�� ._ 7fLOT PLAN PROJECT /�'�" 7 �j�� ADDRESS 2066 Cook Rd Somerset Wi. 54025 SW 1/4 NW 1/45 21 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Byron Bird Jr . 220527 DATE 4 -12 -01 BEDROOM 3 CONVENTIONAL XXX At - Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1 000 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE 1.2 ABSORPTION AREA 375 # of chambers 22 IL BENCHMARK V.R.P top Of Tel ped ASSUME ELEVATION 100' ❑ BOREHOLE O WELL 1H.R.P. same as BM #Alt. BMbase of tel ped97.4 Vent SYSTEM ELEVATION T -1 =93.1 T -2 =93.9 >12" Sidewinder High of Capacity Leaching Cove Chamber with 17.2 4 6 t ^2 per chamber 34" Grade at System Long Elevation # Alt BM 200' PL BM 2 5' Zable filter A100 0 3' ex. 18'x O' Ob i 8. ' Pro 6 B drainfield 3bed house , 10' alve 3 B2 15' t 25 garage DRiveway Trailer Ex 200' Vil— Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County �,- Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must v include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q "�- ��` 7 L / — Please print all information Re iewe d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2 I Property Owner Property Location ` Govt. Lot �L7 1 / Sl T ,S� N R l�j E Property Owner's Mailing Address Lot # I Block # I Subd. Name or CSM# �r- City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road y� New Construction Use: 5r Residential /Number of bedrooms Code`derived design flow rate �S GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material , /il per �i Flood, /Pla_in elevati0 'AUle _ ft. General comments r and recommendations: 37 CR01X a QOUNTY ` Z ON040 OFFICE Boring # Boring F -1 3 10 Pit Ground surface elev. �� ft. Depth to limitin�' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 o I q3. I if q U1 Boring Boring # rn Q 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 .2 411 (o3fO ,r,D� * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST e (Please Prin / Signature CST Number AW&ss Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) Property Owner �//!'/ �l�e5�! Parcel ID # Page of F --31 Boring # ❑ Boring Pit Ground surface elev. —yLy 't. Depth to limiting factoI in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 A ,-z---G_ J� r G • 3 X nJ + 9z. 9 �3• � SN ❑ 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. El Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft 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 material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) Soil Test Plot Plan Project Name John Trent 4CM Bird Jr. Address 2056 Cook Dr. O=Q , - ' �z Somerset Wi. 54025 #220527 Lot ------ Subdivision ---- ----- Date 5/12/0 SW 1 /4 NW 1/4S T 31 N /R W Township Prairie Boring Q Well PL Property Line County ST. CROIX ,BM or VRP Assume Elevation 100 ft top of tele ped System Elevation T -1 =93. T -2 =92.9 H.R.P. same asBM #A B o f T.P. 97.4 # Alt BM 200 PL BM 60' 25' B1 0 35 ex. 18'x 0' Pro B drainfield house 35 10' B2 15' garage 60' Driveway 1 Trailer Ex 200' I _ Nteintenance and Contingency Plan for a Septic System _ Maintenance Plan 1. _Septic Tank Is to be pumped once every 3 years. 2. Effluent filter is to be cleaned ones a year. Please note: larger filter Is big Iny X V order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected pia the i S ions 1: 11 1 3080 the cells. 4. Owner agrees to Imit greases, garbage, and water conditioner disc hat'ge irk S. The owner agrees to save this plan. VAL 6. Do not plant trees nor park nor drive over system. Contingency Wan 1. if system falls, determine Cause of failure, use altemate , { and instal new a install system at a lower elevation. 2. Replace any other failing components as needed. Y 4C N w y •c . )G� g { A '( fir t is' ?} Yi � x 7 M AN- . s t a2 x, vi 4 r x- �C r S �4 3 f ga. Ps ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND y� ! OWNERSHIP CERTIFICATION FORM Owner/Buyer ��4 %t Mailing Address f Property Address - — (Verification required from Planning Department for new construction)_ City /State e 615 �1' 1 Parcel Identification Number v — /d 1<1(= GO LE GAL DESCRIPTION Property Location .S'Gfe' /,, '/,, Sec. ,2-4, T�N -R /9 W Town of Subdivision , Lot # Certified Survey Map # — , Volume Page # �--- Warranty Deed # y � g Volume ® Pa e # � . Spec house yes ❑ no Lot lines identifiable j-yes ❑ no SYSTEM MAINTENANCE 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 ou put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. y p y The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) 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 Zoning Office within 30 days of the three year expiration SIGNATURE OF APPLICANT DATE i OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I we am are the owners of the property described above, b e of a warranty deed recorded in Register of Deeds Office. owner( s) SIGNATURE F 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 warrant deed from P y the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed VOL 1640PAc 569 STATE BAR OF WISCONSIN FORM 3 - 1998 QUIT CLAIM DEED REGISTER OF DEEDS Document Number ST CROIX CO ., WI This Deed, made between John W. Trent and Linda K. Trent, RECEIVED FOR RECORD husband and wife, 05 -16 -2001 10:00 AM QUIT CLAIM DEED Grantor, and Matthew J. Trent and Jennifer L. Nerby, as joint tenants and EXEMPT # CERT COPY FEE: not as tenants in common,' ..COPY FEE: TRANSFER FEE: 57.60 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, quit claims to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recordinst Area Name and Return Address BENSON LAW OFFICE P.O. BOX 370 SIREN, WI 54872 038 - 1088 -60 Parcel Identification Number (PIN) This is not homestead property. (4) (is not) The North 200 feet of the South 633 feet of the West 217.80 feet of the Southwest Quarter of the Northwest Quarter (SW 1/4 NW 1/4) of Section Twenty-one (21), Township Thirty-one (3 1) North, Range Eighteen (18) West, St. Croix County, Wisconsin. 1 0 ctit� oKA x d� Ai-- 4r1 1-�A(. r , 01999 Cloud Canographws. for. St. Cloud. MN 56301 Pom Coulrrr y = N $ r POLK / ST CROIXRD y M STAR °9y PRAIRIE uri �y 99 i 6 5 s 4 2 z DR 1 a ky Z F z O N " Huntington " � =o y h OLD MILL RD 1 12 8 9 x I = i k 1 0 220TH AV 221 ST AV z $ AY S�� 720TH AV 0 N N t cc . r GOOSE AW DP # 'a o 18 °° 16 212TH AV 15 14 C 214TH AV 13 � z1a N sTgRO�sa + AV ID i � 210TH $ S AV C 210TH AV R< ti Johannesburg cc O _ a zDSTH AV °R 1 5 22 23 24 20 Stand / r P Lake 1 N a = S N � N y t� $ �e 200TH AV ° i 65 N BRISTOL RIDGE 198TH AV 0 y GOLF COURSE 30 DR N 195TH g` r S a 28 Hatfield ¢ 192ND A ° Lake $ x N � i- r k 0 g 190TH 64 AV N c R y cc NEW RICHMOND 32 33 ,95„1 AV K LTD 64 1 A z o G EN 1 � NEW RICHMOND 9 V GOLF COURSE 65 9 ° , • L� p z P m , • O 3 64 180TH AV �\ K b K 1300 14� eoo SEE P AGE 61 900 + 1000 1100 1200 SEE PAGE 47 Thomas Warner's Dock Inc. 928 North Knowles Ave. N it of New Richmond New Richmond, WI 54017 Since 1975 0 888 -222 -DOCK 1 We'll Pull For You WE PROMISE DELIVERY ON TIME Complete Line of Marine Products • Evinrude /Johnson Outboards • Javelin Boats Common & Contract Carrier • Spartan Trailers • Alumacraft Boats Livestock • F eed • Grain • Dry Van Loads = �' •Simplicity Lawn Equipment Locally Owned Keith SALES — SERVICE �; & Managed (715) 248 -3570 Thomas - _ STORAGE 61 `