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038-1096-30-000
Wiscorisin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and building Division INSPECTION REPORT Sanitary Permit No: 514933 0 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: Abramson, Kurt I Star Prairie, Town of 038- 1096 -30 -000 CST BM Elev: Insp. BM Elev: _ Descriptio n^ Section/Town /Range /Map No: r 140 � l' �' 1 I L I 23.31.18.400G TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark (.,�ee�5 f zap 3. jo 3 aU Alt. Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet �•g �� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD DHr+_ -l' Septic t/� & % r - I A uning '57 r + s7 _ Header /Man. Aeration _•,._,_ Dist. Pipe Holding Bot. System �I.y3 '7� -�z Final Grade PUMP /SIPHON INFORMATION L) 1Q' •(0 97. 7� Manufacturer P Viand St CQ 1 CEO Z 1... % Model Number r7 TDH Lift Friction Loss Syste ad T DH Ft 4') 9.g Z's Forcemain Dist. to Well r �� �� t 01 1 7, 3O SOIL ABSORPTION SYSTEM p .,�1 Z " w BED/TRENCH Width J Length , No. Of Trenches PIT DIMENSIONS No. Of Pits nside ia. Liquid Depth DIMENSIONS 3 '76 Z e� 11 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: 7T� CHAMBER E OR L ► f 7� 1677- S 7 > 7 V N4- Model Number: ; DISTRIBUTION SYSTEM 19 348 Vent to Ai �- Header /Manifold ( Distribution x Hole Size Hole Spacing tak� t � Pipes) ` Z.ti A% Length T Dia Length_ Dia Spacing SOIL COVER x Pressure Systems Only x x Mound Or At - Grade Systems Only &`^ Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center L' t6.3 Bed/Trench Edges Topsoil Yes E] No ves No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2016 124th Street New Richmond, WI 54017 (SE 1/4 SW 1/4 23 T31 N R1 8W) NA Lot 4 Parcel No: 23.31.18.400G 1.) Alt BM Description = 2.) Bldg sewer length - - amount of cover = Ejf � Lj�i ny I J _ Plan revision Required? Yes No Use other side for additional informati n. )z - Date Insepctor's gnature Cert. No. SBD -6710 (R.3/97) commerce.wi.gov Safety and Buildings Division County 201 W. Washington P.O. Box 7162 St Croix Madison, 707 -7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce �� Sanitary Permit Applicatio State Transaction Num er In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the ap riate mental t ilh� unit is required prior to obtaining a sanitary permit. Note: Application forms for state -o ed POWTS are project Address (if di Brent than mailing address) submitted to the Department of Commerce. Personal information you provide may be use r secondary p urposes in accordance with the Privacy Law, s. 15.04 1 m , Stars. 15a4lh-v— I. ADiDlication Information - Please Print All Information Property Owner's Name Parcel # 038 -1096- -00 Kurt Abramson I I 06 Property Owner's Mailing Address J Property Location 2016 124 th st T. CROIX COUNTY Govt. Lot City, State Zip Code pl"O b SE -/,,SW ` /,, Section 23 New Richmond WI 54017 T31N; R18 W (circle one) II. Type of Building (check all that apply Lot # ®1 or 2 Family Dwelling - Number of Be ooms 3 Subdivision Name Block # ❑ Public /Commercial - Describe Use /1 ❑City of WA ❑ State Owned - Describe Use CSM Number / _ ❑ Village of 5/1318 �p ® Town of Star Praire III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' New System E Replacement ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) System B. ❑ Permit ❑ Permit Revision ❑ Change of ❑ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner 79137 5-5-86 Expiration IV. Type of POWTS System/Component/Device: Check all that appl Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Hold T O er Di ersal C mponent explain) El Pretreatment Device (explain) V. Dispersal/Treatment Area formation: Design Flow (gpd) Design Soil Application Rate(gpdsl) Dispersal Area Required (st) Dispersal Area Proposed f) System Elevati 450 0.60 /� 750 760 ? 7(. (� {� 93.50 T2.3 VI. Tank Info Capacity in Total # of Manufacturer w Gallons Gallons Units pp�� ` o v New Tanks Existing Tanks p " z w w w N. O 5 F H w Septic or Holding Tank 1200 1200 1 ❑ weeks Dosing Chamber ❑ ❑ ❑ VII. Responsibility Statement- I, the undersigned, ass; responsi 'lity for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumb s Si a ,' MP/MPRS Number Business Phone Number Ed Ellingson Jr 7 221904 715 Plumber's Address (Street, City, State, Zip Code) ell 2630 6 st Cumberland WI 54829 VI . Coun /De artment Use Onl Ap roved _ Disapproved Permit Fee ®V Date Issued Is mg Age ign,� 7 2 / d _ Owner Given Reason for Denial $ 4/0' Conditions of Approval/Reasons for Disapproval V / A � __ A � / t 0'rt SYSTEM OWNER: (/✓��'�� y? o 1ep icy tank, — effluent filter and f� dispersal cell must all be serviced / maintained as per management plan provided by plumber. U �° 2. All setback requirements mus as per applicable co~ Ilbgtgylans for the system and submit to t he County only on paper not s than 8 t/2 a 11 inches in size Vx1a ;ry 5f _S s �3- T31,V''e��W qoo VON .. � �St�' 1 �.a � c, •1 0 y O P q ECO Ellingson Excavating & Septic, LLC 2630 6` St. Cumberland, WI 54829 Phone: 715 -;822 -4104 Fax: 715- 822 -4291 MPRS 221904 Index Sheet Date: Property Owner Project Name j Location Z �/ S 1 / 1 /4 S v T,.�LN R A? E Municipality County Component Manual i&& - v e,, Z r Plumber lion ,4caa 7Q/3 3 aY� sir r - S'-S_A s� &AtJ CPJ u4c4,� 3d- lo q&- 3 0--ct �av6 i /v sZ3_T31,V''�pw q06 . � lot A 6 y r o � yr$o �p q r . • I `� !6• DIA LIFTVA HOOK PRESS SEAL GASKET OR EQUAL rILTER CVLf N SEALED L WRAPPED JOINT STANDARD 1W RISER (TYPICAL) y i u d � STANDARD It• RISER VITN 90 BOTTON POURED INSIDE FILTER CMTA Xof - sv�PV� �_ ?TO '1�r ,3 a D 11! x r t r, r C i" HEIS '. B Operating Instructions p 9 r..... � ElulewE � . 75 �• � • •TI1NK • TANK' IIt"1lItTEM r.,• YUIINTO 1 • •. •• G`7 rn OK r,� A 1 CAP, cw it►wewi v . T 'AMt 6 Wisconsin Department of Commerce SOI TION REPORT Page ` of Division of Safety and Buildings in accordance with Comm s. Attach complete site plan on paper not less than 81/2 x 11 inches in size. mus COun include, but not limited to: vertical and horizontal reference point BM di nd Parcel I D percent slope, scale or dimensions, north a Qa� to a road. G 3� —/Q �(�� — U d Cj Please print a info a on R ewes Date Pensonsl intormedon you provide may be used for eoondary purposes (Pr1 .. s. 1 04 (1) (m)). Property e � r � - /��1 L / P Location X `- / v A� 5 Go . Lot ✓ 1/W � 4S 1/4 S�d? T or 3 N R l� E TY �- � � Property Owner's Mailing Address ZONING OFFICE Lo Block# Subd. Name orCSM# 90 / 2 ,� s/, 0-s F cdy State Zip Code Phone Number. ❑ c1ty ❑ villa a ®Town Nearest Road ( ) s� 7" /2 "'/s - ❑ New Construction Use: V Residentlal /Number of bedrooms Code derived design flow rate �� GPD Replacement El Public or commercial - Describe: Parent material �^ Flood Plain elevation if applicable ft. General comments and recommendations: /„O X/ 4. Boring # E] Boring Pit Ground surface elev. 7 0 , ft. Depth to limiting factor / in. Soil Applicati on Rate Horizon Depth Dominant Color Redox Description Texture Structure I Consistence Boundary Roots PD in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 'Efr#2 A -?KS / Gth rAobe C P t'(o 5 Yl s "o Y S & sit - W / "7 ® Boring # E] Boring 13 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDAF in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh, 'Eff#1 'Eff#2 Y Y S 0 i )Z1 521a, - � -� 0 L41 'Effluent #1 = BOD > 30 220 mg/- and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 rg& and TSS 130 mg& CST Name (Please Print) Signature CST Number Address Da Ev ti ucted Telephone Number 1 i Property Owner /J Parcel i0 # G 1 ,, "d —� G� Page z_ z of Boring # ❑ Boring / D ,^ Pit Ground surface elev. 1 ( ft. Depth to limiting factor L in. SW lication Rate Horizon Depth Dominant Color Redox Description Texture I Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2 R] Boring # ❑ Boring (� D Pit Ground surface elev. �d ft. Depth to liming factor 12- 0 in. lic Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Muns Qu. Sz. Cont. Color Gr. Sz. Sh. -001 - E1#2 - s SC Y Ir 17 I L, F 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 GPDHF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2 ' Effluent #1 = BOD > 30 < 220 mglL and TSS >30 1150 mgA_ • Effluent #2 = BOD < 30 mg/_ 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 (807/00) 3v, e /v 5� -Sw s2. 3- 7 1,aI '' e i�a� 140 /'V 1 fl 5 iv 49C 4 1 0 ���Y i v fo f P � 01 0 7!08!08 TUE 10 :48 FAX 715 386 4086 ST CRX CO ZONING J002 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certif that I have inspected the septic tank presently serving the residence located at: -- � Y4, SGJ ' /4, Section 'Town Range J W, Town of E , 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. to - CSC, 5--/ j sig Most recent date of service J�S�" . dA Did flog back occur froni absorption system? Yes No (if no, skip next line.) , kpproximate ti --oluihe or le gth of time: gallons m mates Capacity / Constra6tiQn: Prefab Concrete Steel Other _ Manufacturer (if known). 64 S Q-" 4C Age of Tank (i f known): - -� r (Licensed Plum I ature) (Print Name) (Title) (License Number) MP/MA—�_ 7- �� 8 (Date) Form to be completed by licensed plumber (s. 1.45.06, Wisconsin Statutes) or licensed disposer (NR 113 `'Wisconsin Administrative Code) I 07/'08/08 TUE 10:47 FAX 715 386 4086 ST CRX CO ZONING Zi 001 ST. CROIX COUNTY SEP 1I(_' TANK !MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION Fortm Owrer./Buyer V" a: h Property Address (Verification required from Planning & Zoning Dtpanrriem for new construc C"tv./Statem"') Parcel IdentificallionNUI-11ber LEG' AL DLSCRII'TION Proptrty LocatiDr Sec. 0'> T / RjO41k, Town of Subdivision Plat.— Lot Certified Survey Map # voijillit TM, Page # Warranty Deed #,__ ? Z-S7 (before 2007)Volurne — 0 – Page # Spec house yes G /A Lot lines iderit;fiablc --'yes no SYSTEM MAINTENANCE AND OWINER CERTIFICATION Improper use and maintenance of YOUV septic s Could result in its prerna-aire failure to handle wastes. Fruper mnznte=.ce consists of pumping: out the septic tank every Lhl-ee years or sooner, if needed, by a licensed pumper, Whit you put into die system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance .csPcrs bijities are specified in §Comn 83. 52'1 1 j and in Chap:er 12 - St, Croix County Sanitary Ordinance. 7w property owner agrees to submit to St. Croix Ccunt� Planning & Zoning Department a Certification for ; signed by h d by a master plumbeY. jOUrneV111a!1 PIUNIOt�l. rQS(i h:.-ed plumber or licensed pumper verifying that (1) the on.-site ,v disposal systerr is in proper operating condition andlior (2) after ins and P (if necessary), th septic tan.,- is less than I! full of sLidgC. Uwe, the unden;ignel have read the above requirements and agree to maintain the privatc sewage disposal system with the Mandards set fo herein, as set by the Department of C onur - urce and th 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 plapnint & Zoning Department within 30 days Of the difeC year expiration date. I/we -,ertifv that all statements on this form are true to the best of my�our kncwledge. I/wc arn'are the owner(s) of the property described above, by virtue Of a ��an-any deed recorded in Rt - e . Cf '3 eds Office Number of bedrooms SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitar), permit being revoked by the Planning & Zonh:g Department. Include with this application a recorded warranty deed front the Register of Deed Office and a COPY Of tht certified Survey Ma it reference is made in the warranty deed. (REV. 08105) START UP For nc%v cbnstruction. prior to use of the POWTS check Irealinent tanks) for the presence, of painting products or other chemicals that ti ay impede the treatment process and/or damage lie dispersal cell(s). if high concentrations arc detected have the contents of the iank(s) rcmovcd by a scptagc servicing operator prior to use. System start up shall not occur when soil conditions arc frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and qualit\' of the wastewater stream will arrcct the performance and longevity of your POWTS. The installation of water- saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also tic brine or waste from water softeners. iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: This does not include laundry waste. showers. dishwaler. etc. This systcm is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system, Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms. cigarette bulls. dental (loss. and cotton swabs should not enter the system. Chemicals such as petroleum products, paint. disinfectants. pesticides, antibiotics. solvents. etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a rcgular steady now by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dislacrsal unit inav cause it to freeze up. Q Valves Valvcs shall be operated in the following manner Q Alarms Alarms should be tested on a regular basis by the home owner. Iran alarm sounds, contact an individual licensed to service POWTS. There is normally a I day reserve under regular operating conditions.. however water should be conserved until am problems with the systcm arc corrected to prevent back -up of sewage into the dwc1ling or surfacing. iNPECTiONS Inspection shall be madc by an individual carrying one of the following licenses or certifications: Master Plumber. Master Plumber Restricted Sewer. POWTS Maintainer or Seplage Scrvicing Operator (per the attached Maintenance Schedule). cptic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be scaled and/or locked upon completion of service. Any j defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective hacking device to prcvenl accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) or more of the tank volume. tlae entire contents I of the tank shall be rcmovcd by a Septage Servicing Operator and disposed of in accordance with Chapter NR 113. Wisconsin Adminisimlivc Codc The outlet filters) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions arc to be made to retain solids in the tank. Filter claming may be necessary it more frcqucnt intervals than stated in the nlaintenance schedule to keep the system operating. j ❑ Pump Chambcr/ T'reatmcnl Tanks Component The inspection must include a test of all electrical equipment such as pumps. alarms and floats. A visual check must be j made for leaks. backups, surfacing, missing or broken security devices and other hardware and the condition of am filters. Any service needs or repairs shall be pronaplly taken care of ,P'Kn- Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding. if zany in the observation tubes and a visual inspection foram evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulator% authority. Ponding at depths greater than 73% or the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page of f I _ s + Mounts, At4 ado, In- Ground Pressure The inspection shall Include recording the levels of ponding, It any In the observadon tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surbee must be promptl reported to the regulatory authority. Pending greater than 7$% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The presmm distribution system Is provided with an opening at once every three C3) y the end of each lateral to be used for fluslif The laterals should be flushed at least years, Pressure of systems with multiple laterals should be done lo ensure that equal distribution of effluent Is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of seivIce the following steps shall be taken to ensure that the system is property and safely abandoned In compliance with Ch. COIN 83.33, Wisconsin Administrative Code. All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, graNel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the Hiles in effect at that time. O A suitable replacement area Is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a east resort to replace the failed POWTS. The site has not been evaluated to Identify.& suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable ieplacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. O Mound and al-grade soil absorption systems may be reconstructed In place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS POWTS INSTAL E POWTS MAINTAINER Name v— Name Phone 4 - io [ Phone SE PTAGE SERV ICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name A e �, t,.,�p� 20 901v— g Phone Phone KAWFUTA%Err%TOWTS OWNER'S MANUAL/et Page of ki i �� -- pC.`UMENT INO- STATE .BA OF WISCONSIN - FORM 1 � 1 88 !i Tti16 a_ PAGC RESERVlO:� ►OR RlCORO1N O 0 DATA �( WARRANTY HEED ii OVL. Ouv PAw ST. CROIX CO , W1 This Deed, mad between - LOrn ri P r acht and___ Reza for Re 7.., .__._ d `.. .k Lynda LOiI NL frlltj 1SUSe a_ ^_d cgife, ------------ ------------ ----- -- ---- -- ---- ---------- ---------------------------- ---- - - igAh 7. 4 'ovdd ---- ---- ------- -- ----- ---- ---- -- - -- ---- ---•------ ----- ------- --- . - -- Grantor, and ... __ -land .. ...... Ot 9:30 A ly► - . h x�ksar -' aril sN� fP as sury marital--- - -. 1?rD- P0rty! ---------------------------- ----- - --• -- --- - ip� ............. - - - - --- ------------------------_-- - -- -- ... .... - -- Grantee, 8ogistor of Oo*ds _.: itnesseth, That the said Grantor, for a valuable consideration_._... conveys to Grantee the following described real estate in ------- $. ------ aeT`ast To County, State of Wisconsin: t ^apt Parcel No. ^ -----------------'-- ----- -----. ( Lot Four (4) the Certified Survey Map filed in Volume 5 of Certified Survey s on P 1338 as Document No. 386636, being a part of the Southeast quart the Southwest quarter (SE 1/4 of SW" I /4) of Section Twenty -three "+ (23), Township Thirty -one (31) North. Range Eighteen (18) West, including the perpetual easements for ingress and egress of said Lot: 1. Non- exclusive perpetual easement over designated roadway, as shown e on the -above - Certified Survey Map recorded , in Y..9lume 5 of " s Certified Survey Maps Page 1318 as Document 63 'No.- 3866. t - 2. Non- exclusive perpetual easement over the West 66 feet of the it l tsa Certified Survey Map recordeA m Volume c of eriiF;tsu uv+ �', J ' " ^ ~' app on Page 494 as Document No. 344110. I rn a �.vrcalc : to snare - - ul l.,ac: ,,,oe,,,v..,....,,, . »--•- -_--►- -- . --- �, abov.,e .easements on 'a pro-rata - basis 'with all otfier lot owners who use i ; �,. «easements. i� This 1 S -. .- - - --- ---`-_ homestead property. 11 <is) (is not) �€ T � Together - with- all-and -sin lar the'hereditaments and s l � gu ap purtenances thereunto belonging; !I. [r wvarra�lts thst the title is -good, indefeasible: m fee simple -:and free and clear of encumbrances2fte wC f, tu11L warrant and the same Dated this ------------------------------------------------ day of - -- - --- TIs31CCb..__ ................. ......_......... r G --------- ..... -�� ---• (SEAL) S,EALj � �. Lora D Pracht L da Lou Pracht i} _.a - I .. (SEAL) ........ ............. (SEAL) = = -- ------ .. ....... ._.. ..... ._ i AVTHSN'SICATIOPI ACHNOWT 1ZDG WENT ff Signatures) .. Ai _ -rQT3 - -j?- P;Cj1--------- ---- -- .STATE OF WISCONSIN LL1� and Lynda Lou Pracht $a rr -------------------------------------------- --------------- - - ---- ....County authen ' ate his _ /__p__day of_________ March ___, lg ---- R$ Personally came before me this --- -- -- Say of . _ r! • 10 -------- the above named L- ____•_______ __ ____ _ _ _ ------------------------ Ker�netharuba - - ---------- - - - - -- -•---••--•------•------------------------------ - - - - -- .......................... TITLE 'XMIC BSRZ ACI[ffiZ1tR iSDi�ffii ----------------•---------------------.-._.------------------------°•---------- - -- Notary _Public authorized by § 706.06, Wis. Stets.) to me known to be the person . ----------- who executed tee QJMTCLSS7Ori eXpZYE?S: 5/14/$9 foregoing instrument and acknowledge the same, THIS INSTRUMENT WAS DRAFTED BY ----------------------------------------------------------•-•----------•-------- 1200 Heritage D rive ' -------- .................. .... ................. ....................... ...... -- . ...... , - L��r R�. chmorrd l�I �rt+337------ ----- --- --- ----- Nota --y Public -- ........._............ * .,;. (Signatures may be authenticated or acknowledged. Both Mc Commission is permanent. (iC not, state expir, -1 are not necessary.) date: I3.........) -14— of persona signing in any capacity should be typed or printed brb.w thoir signati;r— WARRANTY DEED WrATD: RAR OF WISCONSIN tt'i.n Ze M Ell—k Co. Inc. FORM No. 1 — 1982 DESCRIPTION I, Arthur L. Wegerer, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions cf the St.Croix County Subdivision Ordinance and under the direction of Lorn Pracht, owner of said land, I have surveyed, divided, and mapped said parcel of land, that such plat ccrrectly represents all exterior boundaries and the subdivision of the land surveyed; and that this land is located in the SE4 of the SWk of Section 23, T31N, R18W, Town of Star Prairie, St.Croix County, Wisconsin, to -wit: Commencing at the Sk corner of Section 23; Thence NO'02 *54 11 W (Rec. as N0 along the N -S Quarter Section Line of said section 466.70 to the point of beginning. Thence S89'57 *OO "w along the north line of the Certified Survey Map recorded in Vol. 2 of Certified Surveys, page 494, and the Certified Survey Map recorded in Vol. 2 of Certified Surveys, page 398, a distance of 527.39 thence NO "E 844.39* to a point on the north line of the SEk of the SWt of said section; thence N89'48 "E along the north line of said forty 526.61* to the NE corner of said forty; thence SO "E along the N -S Quarter Section Line of said section 845.65* to the point of beginning. Contains 10.22 Acres. Dated this Z day of P:7tsT37e_Q'+IZY , 1983. Arthur L. Wegerer' S Kozel, Wegerer and Assoc.,Inc. River Falls, WI WIL I � � wr�ame O Volume 5 Pare 1318 APPROVED AUG 02 1983 ST. CROI COUNTY °j n �E rO1 PAWS T rtANitNNS co CERTIFIED SURVEY MAP ��do LOCATED IN THE SE I/4 OF THE SW 1/4 SEC.23, 8 T31N, RI8W, TOWN OF STAR PRAIRIE, ST. �ROIX CO. OWNED BY: LORN PRACHT , RT. 2 , NEW RICHMOND,WI. DESCRIPTION ON REVERSE CURVE DATA TABLE CURV R. W RADIUS CHORD CHORD CENTRAL ARC TANGENT N . E.W. LENGTH LENGTH BEARING ANGLE LENGTH BEARINGS I - f 00.00' 68.40' N 19 °57'00 "E 40 °00'00 69.81' N O °03'00 "W AT I •• EAST 67.00' 45.83' " 46.77' N39 °57'00 "E AT2 WEST 133.00' 90 -98' " 92.85' NO °03 00 "W AT' 39 °57'00 "E AT2 2-3 351.58' 315.01' N13 °20'07 "E 53 °13'46" 326.63' N39 °5700 E AT2. N13 °1 '46 "W 4T3 1. EAST 384.58' 344.58' " 357.29' N39 °! A T3 WEST 318.58' 265.44' 295 Q7' N39 5700E 4T2_ N 13 °16'46 "W AT3 4-5 320.00' +81.77' N3 °13'14 "E 33 °00'00" 184.3f' 46 W N19 °43' ATS EAST 287.00' 163 -02' 165.30' N 13 °16 4 " 6 W AT4. N / 9 °43 E AT5 WEST 353 -00' 200 -51' " 203.31' N 13 16 46 W A N 19 °43'14 "E AT5 5-6 352. 18' 121.76' N9 °45'49 "E 19 °54'30" 122.37' N 19 14 E A _ N O 1 1' 1 6 "W AT 6 " EAST 385.18' 133.16' (33.84' N 19 3 14 E AT5 N O ° 1 1'16 "W AT6 ° . " WEST 3$9.18 1!0.35 N 19 43 ' 170.90' 11'1 4 E 475 N O ° 6 "W ATB U NPLATTE D LAND ............... ........ S . : NORTH LINE SE114 -SW174 N89 ° 48'44 "E 526.61' i NE COR. SE 174 -SW1I4 247.81 278.80' 214.87 �/. 245.80' 33.00"1 33 1 :/ TEMPORARY CUL- 80'R40IUS�t•; :1.Y' DE-SAC. To BE N -5 OVARTER SECTION 'I DISCONTINUED LINE. UPON ROADWAY a -' W O O11cz� y m ° n G) n ExrENSrON. o_n y C LOT I 1; LOT 2 N :C APPR �D a �' O b 2 m Z a 95 aso C. F0. : 1 127 081 SO FT. ni "' • Z a ao 11, � 2 n A - -r- O C 1.87AC. R.O.WI : 1: 2.59 AC. R.O -W. a- y 4 2 a C , 0 'r C 81,337SO.FT.1: S 112,845 OFT. O max �mw .,an D o __ - �, r AUG U 983 r a � f, O w vi .D -1 o m A n a a c .iX NTY m of < (TI N89 °57b0$ 245. \ N89 °5T00'1E 281.42' = HENSIVE A !'�ANI41tiQ a s ' y n = m AND ZONING G m 2 y 3 O 'Q 211.66 33.90' 247.52 .fl�� my3 Cy�rniZ o -' O o , ,J I- A y m Cl 2� H .r A r Ol rna��i�nc�D Z `D_N LOT 4 ° I LOT 3 [iii C m n a 0 a N 2.29 AC. 7 2.82 AC. N T a 99,642SO.F7';, / I ) I23,030SO.FT.wm SCALE ! = 200' '� - 7.86 AC. R.O. W' 2.48AC.R.O.W. , m a m a 81,122 SO.FT.• ! 108,r95 SO. Fr. .D O i00 200 400 �D 2 or NOTE: BEARINGS REFERENCED ;(,_66'WIDE ROADWAY .Z TO THE SOUTH LINE OF THE SW .� d/ RIGHT - - WAY. •Q 1/4 OF SEC. 23. ( ASSUMED BEARING 'N N89 0 57'00 "E) 332.59' 60' 365.59 S89 °57'W'W 527.39' z � O - SET 1 "X 24 "IRON PIPE WEIGHING 1.1 3 L8S. PER L 1 MEAL FOOT. � O i•G.^<' ;F 1 1) S. I,'-.�'✓='/ n N • =1" IRON PIPE FOUND. _�.. : J VOL 2 , C . 398. I :vl 1R C. 1:.L. _ ?_ , a A 1n O A k661 11 66'W1DE ACCESS A 91 � O EASEMENT. SW COR. SEC. 23 S 114 COR- SEC. 23, SE COR. SEC. 23, T3IN, R18W. T3 1N, R18W. T3fN, R18W. (I'�l.P. FOUND) (1 "1. P. FOUND) - R w w N8 9 1 5 7 E 2655. S89 0 5700 W 2655.65 V02wrna 5 Pa � -310 SOUTH LINE SEC. 23. ` 82 -174 THIS INSTRUMENT DRAFTED By ncnp', 3 -0 n r� m O I 3� f 3 �T7! CA 1 r: It co 'S rn Z O V - 0 N O :r Ct O N O t0 0 j 14 Oo yr CD B. `Z fD ID W FBI « 11 N a Z L N V 3 CD 0 = N . pp CO O O n N O 0 0 f3 O Ql O N p L) 7 N 13 j O C. N N y C O (n D n _A CD m w CL CD W S CD 3 a m w f �► I �• � 3 z CA 00 ti ° c 3 I I 0 0 0 o � o (n o a C A Z ca N co) D CD — cr ovv— o o N o a _0 v rr I N Z ° z-�z 0 O D 0 CD cn co • m c CD •O N _ �f CD C W (C C. CD Z N Cp -� N y m a ? z o a. Cl) j W CL z c A O cn y z A CD a a I a � o — I m = o a I � N I I ° a i A I b �o a ti ° o ON A O CD DQ ti A 69 0 ti w ° o CL �' ST CROIX COUNTY Planning & zoning Fax Memo Date: To: Code Administratz� 715 -386 -4680 Fax Number: Land Information & ell Planning Y From: 715- 386 -4674 Fax Number: 715 - 386 -4686 Real ;:1 rty Phone Number: �l,^ 3 —�� 715 4677 ReA cling z 5- 386 -4675 Number of pages, including cover sheet: Re: w 4" 3 St.Croix County Government Center mi Carmichael Road, Hudson, Wi 54oi6 715- 386 -4686 Fax pz@co.saint-croix.wi.us www.co.saint- croix.wi.us APPROVED AUG 02 1983 n02 4- ST. CROIX COUNTY 4 C'OAFREHENSIVE PARES PLANNING 20N11•IG CO"T F4 CERTIFIED SURVEY MAP �' ra. LOCATED IN THESE 1/4 OF THE SW 1/4, SEC.23, g T31N, R18W, TOWN OF STAR PRAIRIE, ST. CROIX CO. OWNED BY: LORN PRACHT , RT. 2, NEW RICHMOND,WI. DESCRIPTION ON REVERSE �1 } CURVE DATA TABLE -CUR N0 R.O.W RADIUS CHORD CHORD CENTRAL ARC TANGENT NOE. OR W. LENGTH LENGTH BEARING ANGLE LENGTH BEARINGS AT I. 100.00' 68.40' NI9 °57'00 "E 40 0 00'00" 69.81' ° O „ W E EAST 67.00' 45.83' " 46.77 N39° 57'00 "E AT2 NO W AT2 WEST 133.00' 90.98' " 92.85' N39 ° 57'00 "E AT2 - 3 9 2-3 351.58' 315.01' N13 0 20'07 "E 53 °13'46" 326.63' N016'00" 'E AT2, N1 13 3 46 "W AT3 EAST 384.58' 344.58' 357.29' N39-57.00 E AT2, " N13°1646'W AT " 295 97' N390 00 E AT2 WEST 318.58' 285.44' N 13 16'46 "W A73 4-5 320.00' 181.77' N3 0 13'14 "E 33 0 00'00" 184.31' N13 ° 16 46 W AT4 N19 43'14 "E AT5 EAST 28 7. 00' 163.02 165.30' N1316 46 W AT4 N 1 9 0 43 : 14 "E AT5 WEST 353.00' 200.51' 20.3.31 N 13 AT4 N 19 14 "E AT5 5 -6 352.18' 121 .76' N 9 ° 45'49 "E 19 °54'30" 122.37' N 19° 3: 14 E AT5 N O ! I '16 "W AT6' EAST 385.18' 133.16' 133.84' N 0 1 / 14 E AT5 N O O 1 1' 1 6 "W A76 N19 ;3'14"E A75 WEST 3f 9. 18 Il0.35' 110.90' N O 11'16 "W AT6 U NPLATTE D LANDS NORTH LINE SEI 14 -SWI 14 N89 "E 5 26. 61 NE E 114 247.81' �✓ 278.80' 214.81 /"1 33.00' 245.80' 33.00 1 I TEMPORARY CUL- 80' RADIUS�;j : i .� ' DE-SAC. TO BE DISCONTINUED LINE. SECTION CN ?,N� ,�- �/ UPON ROADWAY c co ° n °n - T o t • + /, EXTENSION. X i n rn l ED 0mm -I .0 N a i °nn� N LOT , 2 :C A PR mA < -0aN�m= N 2.19AC 1. � LOT 2.92AC. W .z o m m o � � m Z o 95; 560 S0. FT{ . f ; 127, 081 S0. FT. iv O nom�F'2 O 1.87 AC.R.O.wI: I. 2.59 AC. R.O. W. `! o c m 0 -4 ° D r O ° 8I,337SO.F7,: 112,845 SO. FT. N) r A U G O 983 3 "�� : D Wzz�a�M {n °:� O -� ° �N a -i p m b b . -I ~ •�- m ..::�X NTY X z 1 j a ? - � (n (TI m N89°57'00'E 245. 1 N89 °57'00 "E 281.42' ° htNSIVE P R' PLANN(kC, = 4 rn A ND ZONING C MMITTEE rn z :0 y 1 a 0 Q 211.66 33.90' 247.52 Q z _ m n� 33.9 V, mobo o o O oN4 o n o r q . I t� � I w cn - �Z °nn�D2 a�\ w I ; I cn E i�rnybaima D w m b o n z t0 w LOT 4 I OT 3 N m y m a_6 v °, Q N 2.29 AC. 1 2.82 AC. N SCALE 1= 200' n n a u 99,642 SO.FT; 1 123,030 SOFT y n, -1 �• D O N b- - 1.8 6 A C. R.O.W.,' 2.4 8 A C. R.O.W. - 81,122 SQ.Fr. C �� 108,195 SO. FT. r 0 100 200 400 atn Zor •D / NOTE: BEARINGS REFERENCED )t,66'WIDE ROADWAY Z TO THE'SOUTH LINE OF THE SW RIGHT-OF-WAY. 'Q 114 OF SEC. 23. (ASSUMED BEARING '0 N89 0 57'00 "E) 128.80' L 1 l.' 332.59' 161.80 365.59 S89 ° 57$0 ° W I 527.39' � O O= SET 1"X24 "IRON PfPEWE1GHING 0 1. 13 LBS. PER L I NEAL FOOT. ll!Fic'� Jl;!?' ✓E( ��� /� i'c.i.� cC? Sa�2' ✓`( m No 10 °1 „ 1RONPlPEFOUND. o RE0. !N VOL. 2 ; PC4.39 .. . I VII A p REC. !^J ` /vL. 2, n �' o a �6s� ° m m rn 66'WIDE ACCESS v EASEMENT. �` O SW COR. SEC. 23 I S 114 COR. SEC. 23, SE COR. SEC. 23, T31N,R18W. T31N,R18W. T31N R18W. (I 1. P. FOUND) - _ _ (I 1. P. 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Parcel #: 23.31.18.400G 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 KURT E & LAURA M ABRAMSON 0: - ABRAMSON, KURT E & LAURA M 2016 124TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 2016 124TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.860 Plat: N/A -NOT AVAILABLE SEC 23 T31 N R1 8W PT SE W LOT 4 OF CSM Block/Condo Bldg: 5/1318 EXC THAT PT CON EYED FOR RD PURPOSES IN 973/399 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 23 -31 N-1 8W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 QC 07/23/1997 n/8 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.860 31,000 182,000 213,000 NO Totals for 2006: General Property 1.860 31,000 182,000 213,000 Woodland 0.000 0 0 Totals for 2005 General Property 1.860 31,000 182,000 213,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 306 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form -STC - 104 AS BUILT SANITARY SYSTO REPORT OWNER &, 0 V rj P T TOWNSHIP S 12�aZL e-, SEC . '; 3 T�ZLN - /W ADDRESS ,'Z ST CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE f z PLAN VIEW Distances and dimensions to meet requirements''of II—HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i rr^^ Vry� F � L i i t INMCATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference oint: r p �� Proposed slope at site: � �p SEPTIC TANK: Manufacturer: Liquid Capacity: J� �0_ Number - of rings used: �_ Tank manhole cover elevation: '9 7 Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from :nearest' Road.: Front, Side ,Q Rear, Q fer From' property. line Front 1 0SideQRear� f Number of feet from: well , building: (Include this information of the/Above plot plan)( 2 reference dimensions to septa SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Cap ty: Pump Model: Pump /Siphon Ma acturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation* Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of fe 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: = �j Length: Number of Lines: 2 — Area Built Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, O P't.CK Number of feet from well: 4 -4 Number of feet from building: (Q 41 (Include dis: Nun_04r ces on plot pl SEEPAGE PIT Size: of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a op box O or distribution box een used on any of the above soil absorbtio sytems? (Check one). HOLDI TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet om nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: 2– Plumber on job: License Number: ���,/S(�cJ �� s 3/84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BQX 7969 BUREAU OF PLUMBING MADISON, WI 53707 1 0 CONVENTIONAL ❑ALTERNATIVE Stale Plan l.D.Number: (If assigned) El Holding Tank El In-Ground Pressure 1:1 Mound NAME OF PERMIT HOLDER:' ADDRESS OF PERMIT HOLDER INSPECTION DATE'. Lorn Pracht Rt . 2, New Richmond, WI 54017 0 2-4 ;' 7_ `'AC '?% -7 �J BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF, PT, ELEV, . SE SW, Section 23, T31N —R18W, Town of Star Prairie, Lot #4 Name of Plumber MP /M PRSW No. County Sanitary Permit Number: Gary L. Steel 3254 St. Croix 79137 SEPTIC TANK /HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNI G LABEL LOCKING COVER J PR ED PROVIDED. (J YES ONO OYES BEDDING. VENT DIA.: VENT MATT HIGH WATER r UM OF ROAD. PROPERTY WELL: BUILDING: (VENT T F ESH ALARM EE T FROM LIN AIR ❑YES ❑NO ❑YES ❑NO EAREST DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL. PU MP; SIPHON MANUI ACTUHER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ONO ❑YES ONO DYES ONO GALLONS PER CYCLE: PUMPAND CONTROLS OPERATIONAL,, (EMBER OF PHOPENTY WELL BUILDING VENTTOFRESH (DIFFERENCE BETWEEN El FROM LINE AIR INLET. PUMP ON AND OFF) L1 YES NEAREST -1« SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowln I E NI,T II 1 111AMI TEN MATT VIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease untl FORGE the soil is dry enough to continue.) MAIN'' CONVENTIONAL SYSTEM: WIDTH LENGTH J NO.OF UISTN PIPE SPACIN(, COV + JINSIDE UTA -PITS LIQUID BED/TRENCH TRENC Es M ERIAL PIT DEPTH t31MENSIONS C GRAVE DEPTH - - FILL DEP H UIST H. PIPE UISTN PIPE DISTR PIPE MA ERIAL NO D R NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES �. ABOVE COVER E V INLf f E V. END. I ^ .� PIPE FEET FROM LINE /,, l Al. LE ` L J N EAREST - -- - •�.�1►�, l0'� �— 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- OYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE J PI HMANI NT 11ANKE IS 1 1111SERVATION WELLS EYES ONO El YES F-1 NO DEPTH OVER TRENCH BED DEPTH OVFH TRENCH R TOPSOIL I SODD[ I) SEEDED MULCHED CENTER EDGES ❑YES. ❑N ❑YE NO OYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED /TRENCH WIDTH LENGTH TRE ES LATERAL SPACING [HAVE L DEPTH HE LOW PI F EPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL UISTN C /I R. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ?'. ELEV.. ELEV. DIA. ELEV. PES . EL EVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT LY J COVIR M TEHIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ONO OY ES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF I PROPERTY IWELL, BUILDING: FEET ?M LINE. DYES 0 N OYES 1:1 NO NEAREST. _ Qr�� q ` Sketch System on eta in C unty file for audit. Reverse Side. SIGNATURE TITLE DILHR SBD 6710 (R. 01/82) wlscDnsln APPLICATION FOR SANITARY PERMIT ) (PLB 67) D'LHR / --_C OUNTY �� DeaRRTmEnTOF UNIFORM SANITARY PERMIT # InDUSTRV, LABOR 6 HurnRn RELRTions I { /N/ �? — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /zx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPE TY OWNER MAILING ADDRESS , ov� Y-1 k7t t�z 0 0 6 a) KLA a PROPERTY LOCATION CITY: S C 11 45 01/4, S Tol N, R I e )Wo CW VIL N OF LO UM ER I BL0 K NUMBER J SUBDIVISIQN NAME REST ROAD, L KE OR TATS ZPN .D. NUMBER v4- Pg- -3�' Ttn,o6F BUILDING OR USE SERVED LET O 1H or 2 Family Number of Bedrooms: 3 Public (Specify): Csrn S /ail' g64�1 THIS PERMIT IS FOR A: 'E* %ew System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ' �eepage Trench ❑ Seepage Pit ❑ Holding Tank El 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): a q 7 60 Q ,Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installati n of the private sewage system shown on the attached plans. Nam f Plumber (Print): Signature: 7, PRSW No.: Phone Number: Plumber's Addrefs : Name of Designer: COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial �(r+ Approved Adverse Determination Reas6f for ap val,. Alternate course(s) of Action Available: 'i DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in 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). 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 Location of Property _ k X 1 4, Section ' , T 3_ N - R W Township -6 ik/ k't !. Mailing Address rt- � i , V Subdivision Name 41 1 � A Lot Number Previous Owner of Property r (� &-y4 C2 AFL C grd j� Total Size of Parcel T Date Parcel was Created :2 g Are all corners and lot lines identifiable? C/" Yes No Is this property being developed for resale (spec house) ? Yes �--� No Volume 3 and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. -------------------------------------------- PROPERTY OWNER CERTIFICATION I (We) eenti.6y that a t statements on this 6onm a&e tkue to the best o6 my (ou10 hnowtCedge; that I (we) am (ane) the owner (s) o 6 the pho peh.ty des cA i.bed in .this in6o4mati,on 6onm, by viAtue o6 a wauanty deed %corded in the 066ice o6 the County Reg.i s #eA o6 Deeds eA Document No. an and that I (we) pnes entty own the pnopod ed 6 to bon the sewage dizpozaz a ystem (on I (we) have obtained an easement, to nun with t above d e4cAi. bed pnopenty, bon the condthucti.on o6 s aid d ys .tem , and the same had been duty tecokded in the 066ice o6 the County Re ' .ten o6 Deeds, ad Document No. ) . SIGNATUA OF 0 ER SIGNATURE OF CO -OWNER (IF APPLICABLE) DAT SIGN DATE SIGNED L DdCUMENT NO. DIED STATE OF WISCONSIN FARM 4 T= SMACK R VI D FOR RIPCORDIIIG DATA 1 0143 9 REGISTERS OFFICE" Tins INDENTIJR>lc, Made by Wi1� and Anderson and Patrici DT. CROIX Co.. W IS. AriUr.P A hUab .nd and 'wife and Fl a,rvin A, A.Iaderson Recd for Record this - 2kth_ A xcA alndersan. husband and wife day of„ "1-Wi- 19_7 ty9n �.� of S t . C r o X County, W hereb coavays and warrants a- --- ---�`; M. gran yy to Lrn �• Yracht "alacl Tclds Lou I'raclat, husband a 4 fyy { Ke o� 1( x SS F grantee - RET$U TO sin, , of S Cr County, Wiscon for the soma of 'w+anty two thousand and no/ dollars the foflawiag tract of land in St. C r i x county, ate of Wisconsin, ' �t` So t13 Ulf Q "..5oaartlawe t quarter {S 1 SW-' and the Northwest quarter' of ` Southwi�st quarter {NW SW -J of,, Section 23, TownAhip 31 North, Range 18 4f ;mod they South 2 rods of tlr w+ ost - 36, a reds of the;. Sotlthwa t quarter, It�rhwes quartear.SaT N''�' of Section 23, Ton 11 Noxth, lane w ,} 1 8 4 ox kl _ rMNS E.ft nn r � , r ' i r � 3 ( y. a � a l l j ti � yr �p4y' +!nR Li � wM,, ^"'. y ryV .. 4 , .. +Cpn _ •.v. ...� mow. , .. • 1 „�,,,.� , ., y 1 N C T s v t 4 IN %TrNUS WHEREOF, the said grantor -_ ha y E, hereunto sat t h al r hands . _ and seal a this 8 clay of .TAI , A. D., 19 70 Vi Rt SEAL IN I'R ENCE OF {SEAL? • f; W illard Anderson (SKA y W. Ward,L And ers on nd s k ft k v � i - n � A Anderson. 'Anderson frms ON' WISCONSIN, ' s x' o l X county. came' baforaApa, this' 8 day bf Jul , A..I3., 19 2. ' " .�— . '; the hover "wed Wi11 rd Axaderson and Patricia, Anders on huslaand 'arid wire: r , — ,� k '` : Al�ide�rs a arar� A,l e Anderson husband. eTid wi:� ea { to nor a to the person:;�E... teouted'the f * ' ru ncl mcknoal e. t m s � n 4 r W m. W. Ward This instrure ant drafted by ^ . Notary Public " *" t • ' d County, Win. Ne w R c m' n 'ermanerit Rag t (Weetb�n so-51 (1} twt' the Wbuvatutn gotates provides that aq hn#traments to be naacded:sbaii bars pm4ft` " wl a Rlpewdtten tbervoea tile, sion o at ttia Arentor4 Rraa oa `rri a and is ex). '. wDAuRRAN2 �r DEED OF VJI8Ct} BIN, FOAM NQ, 9 r C. w ore m o.. a�►w n+�t _ z cn H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z v a OWNER BUYER b 0 YI I c� i ROUTE /BOX NUMBER — P Fire Number CITY /STATE I ZIP PROPERTY LOCATION: Se, 1 L, S Section 3 , T N, R _.�&_ W, Town of � Q 9 St. Croix County, Subdivision 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 put 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- essary), 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 cn to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart - ►u 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'�) DATE ]L 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. I i 03 50 i cog T o N r m x � x m m w �cn cn rv3 p v N ("p O O 7C O A n (D 7 CD d � S N — �o ° (O Q° C o w w r .c c ° 3 ° ° m ° a . , * cl w 0 m : I n N O m ( D CD CD co�wm ?oo r A3a. 0 Cc m nw > > =r co 3 o 2 C c '< `_cwo� �= ��E = *= .» .. w _ w w j w m g a� � < t�D A � Q O A < G N N O D C_ .� BOA to A C? O p a O CL r _y Z D w a� m o 3 r.Ncc CA a o °_' a= CD �_. > fD (p (D O N y Al W m C m m C ? CL O 7 fD N O N - � lA n N CD a c cr o w m� °�y0 m ao v� ° =r c cn = , camC mcD M. co O G7 co O `� N A cD O _ Q O 7 O co a C Co M S a o.0 a �c m w 0o O � O o • a ° o� \3 a < w 7 O CD -w 2 ,� , ; 0 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, GG DIVISION LABOR HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON W BOX 53707 (H63.090) & Chapter 145.045) LOCATION: J C SECTION: jj I P IV4weff Rt T-Y: LOT NO.: BLK. NO.: SUBD VISION NAME �/4 0/ j N/R /(�or) W I TOWNSH j l CO N Y: WNE 'S YER'S NA MAILING ADDRESS: 12 n USE DAT S OBSERVATIONS MADE NO, BEDRMS.: COMMERCIA DESCRIPTION: ray PROFILE DESCRIPTIONS: PER OLA ION TESTS: I Residence 3 } A ICJ New ❑ Replace RATING: S= Site suitable for system U= Site unsuitable for system I I G�Ca CONVENTIONAL: M OUND IN- G�ND --ta URE: SYSTEM- IILLHO�LDING TANK: RECOMM D D SYSTEM: (optional) If Percolation Tests are NOT required DESIGN .� If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevatio I PROFILE DESCRIPTIONS Z Gl Z BORINGI TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, CO OR, TEXTURE, AND DEPTH NUMBER IMZxFgTlq ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) All 3 3f7 7 l `'--z I 1 9, � J B- o 4 E �J 1. �!'1 •c i /, . -5.4 . B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P_ I Z / P- '- CO F— 3 / -: �. L P- 3 4C2 3 Z - s z 3 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. SYSTEM_ ELEVATION J �'`�4 w _ , _ . ...w . _ _ _._ _ _._. , f . ....._... _ 6 i , , : L � [ ' 1 1 _.. ✓ .. _� fly`- ( V[ Q - f . _ 4 _ 3 � E f _ , M Fr { M f : _. s E i 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: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNAT DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SRC} - 5395 To be a complete and accurate soil test, your report must include; 1. Complete legal description; 23 The use section must clearly indicate whether this is a residence or commercial project; 3, MAXIMUM number of bedrooms or comraaeicial use planners; 4. is this a new or replacement system; S. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A H LDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6, PLEASE use the abbreviations shown here for writing profile descriptions aril completing the plot plan; 1. MAKE A LEGIBLE cliagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 83 Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; . Complete all appropriate boxes as to dates, narnes, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10, If the information (stich as flood plain, elevation) does riot apply, place N,A, in the appropriate box; 11. Sic;n the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. A813ReVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols s Stork (over 10 ") BR -- Bedrock cob - Cobble (3 - 10 ") SS - Sandstone yr - Gravel {under 3 ") LS Limestone *s - Sand NGW Nigh Groundwater cs - Coarse Sand Pere; - Percolation Rage rned s - Medium Sand W Well f - Fine Sand Bldg _ Building is - Loarrry Sand > - Greater Than �I - Sandy Loarn < Less Than I - Loam Bra Brown sir - Silt Loam BI Black Sill G _ Gray cl - Clay Loam Y __ Yello;v scl Swidy Clay Loarn R - Red sici -- Silty Clay Loam [riot Mottles sc, - Sandy Clay vv( -- with sic, - Silty CI «y f3` - foul, fin{v, faint y t; ._ -.. [.;i<'ay cc Common} i -.ar3p V-',! - Pew's nto - Many, mfg , dgum m Muck d -- distinct p - prornintnt I VV L - High l,v atoi €eve,l, Six general soil textures su.rfare VV,3101 fc>r liquid waster disposal BM - Bench Marl, VRP -- Vertical Re erence Point TO THE OWNER: T his soil test report is the first step in securing a sanitary pee rrit. The county or the Depart nre:rit ray reque verification of 3 °leis s oil test ill the field prior to permit issuwwe� A cornplew set of plans for the private sew=age system and a permil applir:ati;>n must be submitted to the local authority in on er to o tam a permit. The sanitary permit must be obtainer' and posted pi for to ihr� start of any cc >nstr'rsction. � 5 - 1 y�r 1 ,q 12v�i� to fled Z -'<7z