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038-1114-60-200
c O' cNO c 'o 0 d r� c A `�1 3 r+ C cD fD 7 N a 'fl M n .6 M M 01 M vj A 3 Cn - 1 z cn z O N w 7 x N z A Cn N O � �• O O !n G1 O O 0 G: N .+^i COO O O co c V C ro E:. _. 3 O N C j H.r a Z ro o N o a CD w O^ CD O O ro ro _ O> .... C O (7 O O O, 1 O C {y 7 S . CD W O-0 0 N Co CD � ro O c Q O 0OD €D CD O 7 C C C O Z 0 O N CL O O O O - (� :E 0 ^' 0) '.3 N N CA CO co . CAD y co ! O ry -< D 6 a 9 F Ct, Z D CD c. z co CD n fD N C cc CD cn" D C ce U - � � £ I CL w N N -, CD C ° ° o° m n 0 cn ( N N n C/) CT rn O O cr a 3 3 m oZ OOO z OOOy N co o o o� N ro v v - C- a - u v v °O O C O ro CD .tro. N y cn O rn o q v oA d oA D cn . N UI N CL I n A z z N ZWZ z °_ Z p n T ' o. � n D w O - b m O j m (D o ? o � ro N N C/) N CD w ° CD p c c CD m -o c F m w m a w CD �' x a a n 3 3 0 Z C6 Z En cn '' cn C O c y c n a z o CL v o N a f' O 7 0 o c 3 o c 3 A o " ' o " z rn m 'A CD Q T D - 00 D 3 C> lc c a CD n. ro (a 3 - o yro a' W -0 CD v boo z a ro z a CD 0 = o o (vo m CD ° m N SD N ? N ` CD CD i � C ro ro I O ] O - CD N 3 n A i AO ro A Cr a CA n O. 6 a N W ro 0 O CD CD U a O 7 CD A 0 0 n C CD ,. A W ft 4k o 0 0 0 p � ! L .rya Wiscomin Dep frtmE-O)t of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety aii ;e tiuiiding Division INSPECTION REPORT Sanitary Permit No: 0 499243 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: Moulton, Brian I Star Prairie, Town of 038 - 1114 -60 -200 CST BM Elev: Insp. BM Elev BM Description: Section/Town /Range /Map No: /o /. 3 1 /• 8 'ST, 29,31.18.485D10 TANK INFORMATION ELEVATION DATA TYPE MAN R CAPACITY STATION BS HI FS ELET S Septic ` l Bench I rk 'S , � to 3 &= O /+ K Dosing / Alt. BM ih7 jf 21. Aeration jl�- Bldg. Sewer Holding V St/Ht Inlet D /od 3 3 SUHt Outlet TANK SETBACK INF TION �„f �► /00. I TANK TO P/L WEL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Zo Dosing e ll] Header /Man. SDI Aeration Dist. Pipe Holding Bot. System 7 7 � Final Grade not PUMP /SIPHON INFORMATION'S 5 0 �J Manufacturer Demand St Cov P er /b 5 � Model Number 4 2• TDH Lift rich Loss System Head H Ft ✓ Forcemain Length Dia. Dist. to Well O SOIL ABSORPTION SYSTE 17-/l Z. (l , 960 TREN9W Width Leng I No. Z Trenches PIT DIMENSIONS No. Of Pits inside Dia. Liquid Depth DIM S t k SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufact r / INFORMATION CHAMBER OR `D Type Of System: v , �� 2 Z l UM `�I Model er: - DIST T SYSTEM ead r nifol ��Ps�tribution x Hole Size x Hole Spacing Vent to Air Intake I Length Dia Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over �. Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center / Bed /Trench Edges Topsoil Yes No Yes ]No COM E TS' ncl e code cr encies, ers s present, etc.) Inspection #1:�i�/ Inspection #2: Loca s-� �` to`n: 1 8 Night awk Drive Somerset�5 (SW 1/4 NE 1/4 29 T31N R18W) NA Lot 1 Parcel No: 29.31.18.485D10 1.) Alt BM Description 2.) Bldg sewer length = 20 - amount of cover = ,d2.Q C S s.� L' (P-0 Use other l side for additional in Yes . 2 o6y Re formation. Date Insepctor's Si ure Cert. No. SBD -6710 (R.3/97) r Safety and Buildings Division County a 201 W. Washington Ave., P.O. Box 7162 Madison, �/'� on, W1 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) t��r�.`ari�sin 608 266 -3151 >1 Department of Commerce ( ) ` 2 Sanitary Permit Application State Plan LD. Ncanberr In accord with Comm 8321, Wis. Adm. Cade, pe se tat information you puyide _ may be used for secondary purposes Privacy Law, s15.04(lxm) Project Address (if diSaat titian mailing ) address) I. Application Information — Please Print In formation S Property r-- en's Name Parcel # Lot # Blodr # R I AEI - Iwo 03� -iii -�6• Property Owner's O 1� er's Mailing Address Property Location 1 l9 / 64 r 'A WK ST. CROIX COUNTY SVtf Sextion 2 9 y, �., City, State I S ,� ` Zip Plane + S D IJ�,� Kla YV T 3 1 N R �B e H. Type of Banding (check all that apply) al or2Faml subdivision Name CSM Number yDwdling— NumberofBedrooms I4 ❑ PubliclConmercial — Deacnbe Use ❑ State Owned — Describo Usc 3 & , f 4- /Z �- 1 Z e �s Vii! Ov Rt ip III. Type of Permit: (Check only one bar on line A. Complete line B if applicable) A. ❑ New System �jieplaaxraernt System ❑ TmahoontMolding Tank Replacement Only ❑ Other Modificati® to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑Change of ❑ Permit Transfer to New list Previws Permit Number and Date hawed Before Expiration Plumber Owner ZJ 2 9 IV. Type of POW TS S Cbeek all that a pply) 0Non Pressurized k -Gmwid ❑ Motmd >_ 24 ia. 'table ml ❑ Maud <24 of suitable soil ❑ At -Grade ❑ Single Pala Sand F1uer ❑ Constructed Welland Ptessairiaed ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Una ❑ Recirculaft Sand Filter ❑ Recirculating Synthetic Media Finer ngCha;uW ODripUn. ❑ el- Pipe ❑ (explain) V. Dispersalfrreatment Ares Information: Desigtu Flow Design Soil Application Rate(mAsf) I Dispersal Amer Required (so Dispersal, mo o' bob , 7 85$ f 87S 3�N� 6 9G - cI 4 VL Tank Info capacity in Total Number ManufmA mr Situ Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Tub T� J r A/ Septic orHakhog Tank Aerobic Treatment Urait Doting Chumber VII. Responsibility Statement - undersignA assume respojhibWdy for " the POWTS shows on the attached pram. Plumber's Name (Print) fmuber's ber Business,Phoae Number F �x zZ3Z9 Z 71S -7 SS - Z I l PiumixesAddmss (Street, City, State zip ) P. 8bx S � CC . (i/ 1 `� 0 use Approved ❑ Sanitary Permit Fee (meitalas Groundwater 776 Issuing S' (No Surcharge Fee) ❑ Reason for Daniel �� 7 I L Conditions of ApprovaMRasores for Disapproval @fit TN OWN#R'; 1. Septic tank, efflu&N flit@( and dispersal cell must all be services / maintained \ ( 1 as per management plan provided by plumber. V eJ 2. All setback requirements must be maintained U / as per applicable code / ordinances. AtbA eomplets plans (to the Coungr a*) for ebe @stem an paper not lea fl um 8W x 11 inebes in site /, I SBD -6398 (R. 01/03) ��t� t340An! AAOu L �1 s wt l � NE' 1A 1�1b� IV IC�th f/ IK &, S 2g 7'3I N k 18 K/ m Ps 223ZI uoKYA ----� 3 7 'eEtL"/� v✓/?� 3s \ h � ��cIS�' MCI 3S a� W EXt3T1106 low 6AL TAUr- i �r n1E 26t GAL - rtIO K t7 139,nWAt c _ maxis sys7E� . 165O Mai b AIL 8�ti9GS SCALC 1 6 A J IUI th' fffilKl�C �vj l 1 A ,S 2g - T3 ! /J 2 18 11-/ , ai M PC 223212 f©/ flKC 3S �tlHnrlBEEi�S \ ti Exts W 6 l ow 6AL - Tfl k1 K n1Ev 26l GAL 7tll) k d AIL 8OR / CGS Wn�or,sinD%,InentofIndustry SOIL AND SITE EVALUATION REPORT Page of mor ark Muman Relations 'g".on of Safety &Buildings in accord with ILHR 83.05, Wis. Adm. Code • COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OW PROPERTY LOCATION k GOVT. LOT �j4c1 /4 1/4,S T N,R E PROPERTY bWNM ADD ES 1 LOT # I BLOCK # I SUBD. NAME OR Ig 75 �l �`"_ CITY STATE -ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE fi�P'OWN NEAREST ROAD <5 L, j New Construction Usey Residential / Number of bedrooms [ ] Addition to existing building Replacement [ ] Public or commercial describe U Code derived daily flow Recommended design loading rate , 7 bed, gpd/ft d trench, gpolft Absorption area required 4''Y3 bed, ft2 S,63 trench, ft ximum design loading rate bed, gpd /ft gpd/ft Recommended infiltration surface elevation( r�'F� 1 r� ft (as referred to site plan benchmark) Additional design /site considerations �P�R - Y � • Y Parent material Flood plain elevation, if applicable 440q ft S = Suitable for system CONVENTIONAL I MO ND IN ROUND PRESSURE AT- RADE SYSTEM IN FILL HOLDING T NK U= Unsuitable fors stem S❑ U S❑ U ES ❑ U S❑ U El U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Botxldary Roots Bed Trench 0 lz2 16J 3? Ground — /41'r ,� .�' ` el /t ft. Depth to 1p limiting 3.5 Remarks: Boring # 541 -e--. 051, / J� L - 7 : Ground e g ft. Depth to limiting J Remarks: CST Name:— Please Print Phone: Address: IA O Signature: Date: _ CSTber: PROPERTYOWNER 2C�' vtr'C z2 D0 - ' ?MOIL DESCRIPTION REPORT Page._ — of ' r PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Y Bed Trends z s m Ground 7Z Q 0 Iv I( Depth to limiting f c�toc, 7 2 � Z f Remarks: Boring # D _ /I / 1 ✓ L 1/b ... o- �s Ground s !4 I ft. R (� Depth to � limiting V f or y..s� Remarks: f Boring # 14 444 12 .:: Ground / z� W a e ( / ft. q 1 Depth to limiting f� �! Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) PROPERTY OWNER rr�/ Ou FOIL DESCRIPTION REPORT Pa e _of PARCEL I.D. # Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench I. 3 -Y 5 I Ground 3 j! 72 D v � ft. Depth to It limiting t u Remarks: Boring # / :: .t!S Ground ✓ s ® > b 4 7 3 ft. Depth to y� limiting J . y. s Remarks: Boring # In — V 3 �` „ti~ � 5 Ground ze I' q ft. q Depth to ` limitinngg� Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) Soil Test Plot Plan Project Name Richard Moult Byro ird Jr. Address 1970 Nighthawk Drive ` �! So Wi 54025 M #3479 Lot ----- Subdivision -- - --- Date 5/13/95 SW 1/4 NE 1/4S T 31 N /13 W Township S t a r Prairie Boring O Well PL Property Line County S T. CROIX BM or VRP Assume Elevation 100 ft o f White Stake Red Ribbon System Elevation 96.8 * H R P Same as Benchmark M. 0' 140' B -5 15 ' B -4 � 19% Rep A � Slope 60' Driveway to go -3 40' o 3 North to Nighthawk Bedroom Drive — � House 14% 60' Slope Pri A B -2 15' B -1 300' to P.L. 4 East Property Line POWTS OWNER'S AAMUAL & �;fi 14AGE�T `#?}. _ pa - of (W (VI(YUL7MIQ sew :rank Capacit Septic Tactic Nlaltufaceurer W �� O ' NA PARALIETER.S Effluent Filter iMlam*achnw s ❑ NA r of Balmoam O NA ' ° Effluent Fkw hle del O' NA r of - Public FacMW d)nits L V NA Pump Tank Capacity gal ed flow (ave>rZage) �lj® q W d a Pump Tank faiasufas:turec 5( NA flow (peak), (Es�l x 7.55) p &0 aVday pump Manufactuver 0 NA PaMation Rate gaud 1W Pump Model _ o raa M WW* +fie' P- Unit 0 NA ' Fats, oil & Grease F06) 530 mg/L O SwWGravel Fitter 0 Pest Titer dtW*id Oxygen Demand (BOD X20 mg/L - 0 NA 0 Mechanic i-Aeradon E3 Wetland _ Total Suspended Solids USS) - :91 a0 mg/L 0 D:s erfe ction- - EI aC Other: - ted Effluent Qu�l - " - IN average D'l Cep ( s) ' O INA herntcal Oxygen - Demand {BOG _<30 nig/L- �0 M- Gnxsnd (gr4vitY) 0 W (Pressurized) Total Suspender of is tT9S) „i0 mg/L O NA II At- Grade. O Mound Fecal. Col fban (geometric ineaa) Si W efu/'l0OrW 0- Drip -Line II:Othe r uns Effluent Particle Size Ys in did. E3 NA Ot7en L'3 NA Q NA Other. 0 NA for domes ric � and septic tank eflie=t. Othec . - DNA NANCE SCHEDULE. .5ervir:e Enact Service Fiicy condition .of tank(s) At least -once every. II sstorrt}i{s) y ears} am s} iA�dRnum 3 Fit contents of.tankfs) When cornbkwd sludge-and scum wpsds onet" (Xt of tank volume 0 qGpersal een(s) At'least once every: 0 montfifs) faun 3 years} L1 ILIA ` m sfflue nt filter At least once every: ..1 © morithis) D NA Pump pump controls & alarm At least once eve3rp- 0-month(s) p AiA 13 y�ts) nerals pressrire test At leash once every: 0 }:>aurd's {s) 0 NA 0 yearts) At feast once a veay: [III year(s) 0 -mss, 0 NA NANCE_iNSTRUC'tKQNS !ions of tanks and dispersal cis shed be- made by an bui"nridual carrying one of the - fal[r Wi lg licenses or certifications: 'Plumber; Master Plumbs 'Restricted Sewer; POWYS Inspector; P MrrS Mavrtainim, Se ptage Servicing Operator. Tank ['sorts must include a visual inspecitiort of •the tmMsl to identify any missing ng cu broken hardware, identi#y any ma cks or leaks, re the volume of combined sludge and scum and to check for any back up or pondirlg of effluent nt rnt the ground surfam sersal eattfs) shag be visually inspected to check the effluent levels in-the observatiOn and to check for any potftg sent on the ground surface- The porKfi ng of effKWM on the ground surface may builcam a faWtg eondytion and requires the idle notification of the local reguWWry authority. the comb tsed accxumulabasi of - sludge and -scum in -any tank_ a quaffs one -third (X) or more of the tank volume. the entire Rs of the tank shall be rema►vW by a 5eptage Se�nft�hg Operator and &Wosed of- in acc:mdsnce mirth chapter- - NR 113, [sin Adrtsirsist wve Code. - j er swrvices. including but nut rmited to the servicing of effluent fitters. mechanical or pressudzed components, pretreatment mod any servicing at intervals S12 -shall be pwrormed by a certified POWYS Mar. nAner_ ice - report shalt be Provided the aocal regutatory autlsocity within 10 Clays of cornplvdo� ail any service event. C4AW a t AND OPERAT —Z—If 1WW construction prror to use of .the the f ,.�,__ _ ,of ng) Ae• -ll8nivge or Qom" the - by 8 - Sep�e - pcwrm two detect d hgve -the. ASS Systern start tip shaft not 'occur when -Sol conditions are trozesi at the asffivative surfa ika ng -power outages,purnp'anks rrray to above.naaal iirgawater levels. When � to the dispersal - jR one � dose. Power is wed the excess wa�" will be afflue To avoid this sifumon have the contents 'rat in the b "or Cfiqchwge.ef Power to tine effluent PurrrR or a Pkanber or POWT'S Mainz to g Opp Pnw to 9 rare noetrat•leaels within the rr Y- - •die. t� Tom- °� s to Do -trot drive Cr Park over tares and drspn;d ceps. Do not drive or widen 15 feet.down slope of any nmund or at grade soil ?bSaptiow area. ° • or ° . the area _ Raducdon or elisrmiaAiai of -the f from the wastewater strearn �v irsapxoare and fo� datrori baby mss: b C°tb°° swabs; degra� denial floss & the &€e of the as s water *W and v"etabie .p fat: Peres; sari �;. riieao[ stxaps; t; �"� rtaiy napi6res: tampons; and water: softener trite. ABANDONMENT When the POWTS fails and/or is penned/. •mlcen out of service the -631lo itV szepa shall be abe taken m iasure that the cxioned in compliance Corn 83.33, Wmxwtsin Adminestrapve Code. is AN P*ai9 to teaks and fiefs shall be disconriected and the abandoned . Pipe - sealed. • The aaiteam of.alt-tanks and pis shall be rar+anred,and PrapedY disposed of by a SepTage Servicing Operator. e After PumPinc, all tanks and pits shall be excavated and nwnoved or their covers removed and the void �. del. or another inert solid Ytsa� space filled with C%ONTINGLB tCY PLAN If. the -POWTS 'faits and cannot, e repawed � �. b 9 meeauvs have been, or.must be taken, to provide a code comp - MxVPW0WJent ova s slioerld proms frsxn be utT¢ed for the loc al of a % a WW c:cu n and shaxdd r+Qt bs 1e'4sm'ed frufn -� and proposed sorucawe, lot Snes and wells. Fad m znfraiged upon by absorption result in the steed ort for a new s and site the � area will ev on m i a �rt' ae& Replacw*mt sysiecas must comply with the ndes in effect at 'that *ne_ E3 A. sLiudge, repWcmnem area is not available -due to setback and/; sop ins_ Mwin9 advanices- in POWTS � Y a 9 t ink rrraY be wed as a last resort to o seplacx the fased. povn s- �3 The site has not been. evaktatecP to :rdesrtify a suitable ISP area. Upon 'faalrxe of the POWTS a "sal avid site evacuation must be Performed to locate a rePLacanWM area. If no wit area is available a hog tank MW be installed as 'a• last resat to rePlacethe •failed. POWTS_ O Mound and at -grade sad absorption system may be recorisbvcted :in place fopo g ressioval of the bioriiat at tine eve zlniFace_ OC>strasctioNSS of such systerrss must c ornpiy with the rules in efl ect at that tine. -C <WAAMNe >> SIEPM. PEMW AND OTC TREATMENT TANKS MAY CONTAIN DO LETdiAL S'ES AND/OR � OXYE�11_ NOT BITER A SEPM, PUMP OR OTHER TREA TNT TANK [iND� ANY t�� 6AS ANCES_ DEATH PERSON FROM THE 1NTIUOR OF A TANK MAY - tE DU:RWLT OR WpOSS� MAY RESULT_ �1E OF A ADCCIIONAL COMMENTS -POWYS EMSTALLER POYYIS MANTAB R Name � _ Norris . Phone _ 5 -: j Lit SEF`IAb'E SE?"MG OPEfEATOR ONNAPM LOCAL F&SUIATM X"013" name Na - Pliorie u N-- � 0 61 u cry ?� N iN 6 .Phone ; 7 (5 3, 6 4 68 — n& was dratted in cornets =e wah d>epftr. Co— 83.2213d9ilitHdt6 O ands Nov 07 06,09:53a Brian Moulton 6513513074 P.1 Nov 07 06 07:362 JEFF FOX �iJ.auux+ ri -�,s RECEIVED ST•'ROIX COMW Tft+r � SEFM TAM MAWrEW AGREEMEar AND NOV 0 6 2006 OWNED W CMIRCATION FORM ST. CROIX Ce8►6A a �f,�, �L'� Matlwg A ddness 1 J�1t��lT � W 1C L7 a�Y1£r� "T" 1/tll 'il - rs402 5 p roPa t y Address f (v ° �cd P�8 Z , tent txw c70nctractian•) [:tty tote bX1E�Sd'T w r Parcel Identification Number LDF • �Y1f y, ! ,Sac. °1 , T 3 I N'R ..1 S W- Town of �IlR 2i f�J�I proparty Lacxt ion .. �.� Lot Subdivision Cerdfied SarYW Map # Valtnaaue , Page # _ 'vojutne _ , Paw ## Warr ly d # no Spw hoate Yw to_ iiaes ide to Yes i SVS TEM MAINTEN C AND �VNp.IL CER'I'I iCATIOL�T could mvit is its p f=KW to haadie wastes. Prow an o wk Avery am yew ow so==, if needed, by a tiaesod pMUper. � Ya'o pot 140 g out tbsgo � die $yatm} cm affect to fumdon of to WPUc tank so a Ueat:r+eat stake is the waste system �� nasidw�x 83. 1 aad in 12 - St. Ckc& C40UMY 3mit�► Orbs' iXi Gam®. 37d } are i � a cet�fication foam. signed by tbt The pmpay owner fees m n*..at t. St. amix C+ou: w Phmiag Zones that (i� vo3* ow= tatd by a masaer plumber, l�Ym P resn�cted plasnbes or a liaenaed p Ong �e tsttk is waalevr+stet etfisposal s3'sa+°° is is proper opetadgg oem&am andlor (2) after i W=tkm and VAMPE9 (� 9)' ° teas tl>m ir3 fiall of sludge. the w" pe db pwd gY�m with th e ve =4 the above reWWvw ones sad agree m ma�mlai�d e ha State of Vrxwonsin. Ilwee the e eadsaet�d of Gooamia�� still tJye Dt�� of RasotaCes, Cerd6cmdon smft that yow septic syjwm � n0a1°m� m°at be °oaf and raa�raod ua &G 3t. Cow p � 744= Dcp&duXw witch 30 dsyte of the tit " Yes tatpn'oti = daw• Uwe aettib that an AMMUO on 'dm foam are trap to the best of mylonr bwwleelgo. Lwe anVom the owna( of the pn Taty deaanl)od abave, by virma of a wwputy deed nowde in der afDeeds Office Nu mber of bedrooms /LZ- CI.c.. ---► � C <S} -'r DATE I L3YtE OF A ANT S G valmd the Pbnamg & Zaett DMww t- ...p �p�p$otn that is a�isx'eps�ftd mw result is the samtarY Permit betag n b3' ,Wig& wi& tms won a reaoeded vammtY deed from the Register of Deeds Office: and a copy of cite Certified attr+ay >mp if ere is math in th�- ww==vty doe & (RZv. tls" ArclMS Viewer Page 1 of 1 m VOL BPO l r; 8�2 W1 so giB % tan La" V tan 83C -m ®p ®E tan 0 L WZB NIGHTHAWK Y t. GEA u ass, LWD•1G B® 2 SW -NEB �• SE -NE _ TN STAR PRAIRIE 29 caiis�s ,: 4Y3 YNJYI 3 � M 600 �c - f i L48 Fl� SGa d d "C) L , , A-Q http: //72.21. 230. 178/ website /LRPortal /ARCIMS /MapFrame.asp ?PIN= 11/9/2006 ag 0 n o, o• � \ l — _= ___ - -- �N �� ��� n� - . - - m r o / - _ it ° Ila .fl •_ �i - ' Q/ ti _ Lam. J�" / _ �� 1 �r , ' ( � �� il ly III �- s . �ll - � �� - rQ of d ice. L I' 0 CO FP' r o ° A to I C S I l 1 o � &OS p U� dl ii I 1 0 1,\7 ) 3 h U O o D9 'S /MI Ol 71 P Z O 1 loo o w O LL M � O to V Cl) CO) O 3 - 0 n .. m p d ID 0 > > 3 � d A r c o l m o O o d m ° w `c • CU 3 f( m - c i �' *0 00 00 z N 7 O O d. O� N C- 7 O W FD* A i"'0! O Ln O CA O 3 ro 7 p 2 N K 7 N C O O CA to co v v> fD CD a? CD C N W to CD c 3 CL O 07 O N � CD �+ Q (� to Ul COT CD ( N w C O 3 9 m z OOO °� r c 3:: o D a4 W C = N fG Cn p� N N 3 Can C A CL z N z w z O D ° CD 0 �r l�l o' = !V CD CA CD N N C 7 C CD CCD W (D Cl a 3 7 z m (6 O C p A Z n B CL A Z o , G) .. i cn j m T CL z a ? ;o ° o z 3 m !�! z W C A O Q O Q < N N C C o CD _x o y N X � A CD n CL W ti N O O A w O O CD OQ V fp O * ti 0 CD V 0 CL Parcel #: 038- 1114- 60-200 03/31/2005 10:15 AM PAGE 1 OF 1 Alt. Oarcel #: 29.31.18.485D -10 038 - 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): * = Current Owner * BRIAN H & JULIE A MOULTON MOULTON, BRIAN H & JULIE A 1968 NIGHTHAWK DR SOMERSET Wl 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1968 NIGHTHAWK DR SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 7.200 Plat: N/A -NOT AVAILABLE SEC 29 T31 R1 8W PT SW NE BEING LOT 1 Block/Condo Bldg: CSM 10/2954 ALSO ALL THAT PT SE NE DESC AS COM AT A POINT ON W LN 673.1'S OF NW Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) COR;TH S 26 DEG E 726.8';TH W ON LN 29 -31 N-1 8W PARALLEL TO S LN 318.7';TH N 653.4'POB Notes: Parcel History: Date Doc # Vol /Page Type 09/17/2001 656685 1719/330 QC 2004 SUMMARY Bill M Fair Market Value: Assessed with: 30565 298,000 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 7.200 105,000 206,200 311,200 NO Totals for 2004: General Property 7.200 105,000 206,200 311,200 Woodland 0.000 0 0 Totals for 2003: General Property 7.200 51,400 157,900 209,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 157 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ,Wisconsin DepartmE -)t of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety an Building Division INSPECTION REPORT Sanitary Permit No: ` 499243 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: Moulton, Brian Star Prairie, Town of 038 - 1114 -60 -200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: TANK INFORMATION ELEVATION DATA 29.31.18.485D10 TYPE MA N _gC_ CAPACITY STATION BS HI FS ELEV. Septic Benchmark c t oaa .5 o/. S3 Dosing Alt. BM Aeration 2J. i I Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 2_0' Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade p PUMP /SIPHON INFORMATION Manufacturer Demand " St Cover r�� �• S �' GPM fv!odel Number / - ' CKI 2 TDH Lift IL ric tl Loss System Head H Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTE IZ IZ / I Ak, RENC Width t Leng No Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM S SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufact r' INFORMATION CHAMBER OR Type Of System: I t t UNIT Model @r: v. >� 2i 5 1� , DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil / Yes No Yes No COM E ! e code cr encies, ers s present, etc.) Ins pection #1:��b Inspection #2: W Locatio w Drive Sorset, WI (SW 1/4 NE 1/4 29 T31 N R18W NA Lot 1 Parcel No: 29.31.18.485D10 1.) Alt BM Description = •� 2.) Bldg sewer length = - amount of cover = (p•a ✓ � Plan revision Required? Yes i I No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert . No. Safety and Buildings Division County Me 201 W_ Washington Ave., P.O. Box 7162 5 i dz L ����� Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) "h De partment of Commerce (608) 266 -3151 Nvi 4 1 1 z u mberr Sanitary Permit Application State Plan LD. N N In accord with Comm 8321, Wis. Adm_ Code, personal information you 0mvide may be used for secondary purposes Privacy law, s15.04(Ixm) Project Address (if diffemt than mailing address) L Application Information - Please Print M formation J A KW Properly r Name Parcel # Lot # Block it R AN * AVID U L I b 0 Kirw it -66 Properly / w � n ,Q o's Mail . mg Address I� Properly Location I / `r,V � 164 } r AVJV_ b 1R1 � ST. CROIX COUNTY S t/ij � , 2 G j city, State Zip plane N y ' ��' X101 S onn r__fZ -�T V1/ I S , 3 N, R IB IL Type of Building (check all that apply) 191 or 2 Family Dwel ling - Number of Bedrooms 4 Subdivision Name CSM Number ❑ Public/Commercial - Descnbe Use nn ❑SmtcOwned Dm=bOUse 3 f.1+ It J Z IZ 2(5 OCity ❑Yiilau®e fervuanshiEn _ ST�i� ���A77Ir� III. Type of Permit; (Check only one box en line A. Complete line B if applicabl ) A. ❑ New System Rkpeplacement System ❑ TreatmentMolding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to NOW List Previous Permit Number and hate Ltwed Before Expiration Plumber Owner Z'1 6 7 2 0 Z 9 IV. Type of POWTS S Check all that a pply) JdNos -Pressu nod 1n -Ground ❑ Mosmd > 24 im. of stutable soil ❑ Moasd <24 in. of suitable soul ❑ At m& ❑ Single Pass Sand Filter ❑ Constructed Wetland Pressurized In- Ground ❑ Holding Tank ❑ Peat FAter ❑ Aerobic Treatment Unit ❑ Rexdreu lating Sand Fr7ber ❑ R=u wg Synth *c MediaFilter ❑ Leaclong Chamber ❑ Drip Line ❑ GraveHess Pipe ❑ Other (explain) V. DispersalfIrreatnuat Area Information: Design Flow Design Seal Application Rat Mxbf) I Dispersal Area Required (sf) Dispersal Alin system Elevation 000 , _7 VL Tank Info Capscity in Total Number Manuf cturer Site Steel Fiber Plastic Gallons Gallons ofUnits Concrete Glass TWO T� rill r ti. 6 es - , Septic orHoWingT=k Aerobic Tam Unit Doming Ckmbw VII. Respousibility St atement - I, the undersllpn4 aaaame respajislil0ty for the POWTS shown on the attached plans. Plumber's Name (Print) emnbees ber I Busimesli.Phone Number &C I 2 Z3 Z1 Z 715 -7 SS - Z -1 W Plumbees (Shoed, City, Stabs, Zip ) Po. 8tk SAS �Ws5Ec . W 1 51 o n rtaaent use Appmed ❑ Sanitary Permit Fee (includes Groundwater Date Issuing Si (No Surchaw F-) ❑ Reason forDernial D , ap 11 q a DL Conditions of, for Disapproval MTN 4WNIM � 1. Septic tank, effluent filtef and 3> ' `j � 0 ew dispersal cell must all be services / maintained I as per management plan provided by plumber. 2. All setback requirements must be maintained as per apple code / ordinances. Attm6 cede ptaos (to the Cep rob) for at q w m paper not leas thm girt x ii mchea in site SBD -6398 (R. 01103) 116A lv l6lffl/lwz lbk Svj /y W 5 2q - J - �3 1 AJ1k )8 MKS 22Z` Z- �0 3 ARC, 3S �'tfHlY1��S 0, F-xia O6 /Ow 6AL ?f1k)V- 26t GAL - rtlO k t7 B�itx'lU�l ' �XI� ?��G SyS �E� �L b 53L 5CAW ST. CROIX COUNTY WISCONSIN ZONING OFFICE r r x r r x r x■ �,,.� ST. CROIX COUNTY GOVERNMENT CENTER , 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 September 11, 1995 Hartman Homes P.O. Box 326 Somerset, WI 54025 Attn: Becky RE: Septic Inspection for Brian Moulton Address: 1968 Nighthawk Drive, Somerset, WI 54025 Dear Becky: An inspection of the septic system serving the Brian Moulton residence located at 1968 Nighthawk Drive, Somerset, Wisconsin, was conducted on August 8, 1995. This property is located in the SW 1/4 of the NE 1/4 of Section 29, T31N -R18W, Town of Star Prairie, St. Croix County, Wisconsin. At the time of inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions with regard to the above, please give our office a call. Sincerely, Thomas C. Nelson Zoning Administrator St. Croix County Zoning Office db STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSM# LOT # SECTION -R 1Y W, Town of ST. CROIX COUNTY, WISCONSI A f PIAN VIEW 2&p� SHOW EVERYTH NG WITHIN 100 FEET OF SYS EM ✓tZ� S /u INDI ATE NORTH ARROW Provide setback and elevation information on rev rse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: 0 PTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATIO / N � Manufac urer: Liquid Capacity: Div Setback from: Well ? 5 House fa Other Pump: Manufacturer Model # Size Float seperation Gallons /cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: Length !• Number of trenches Distance & Direction to nearest prop. line: . 5 -7 i Setback from: well: / Hous Other ELEVATIONS Building Sewer ST Inlet; ST outlet / PC inlet PC bottom Pump Off Header /Manifol Bottom of system Existing Grade Final grade�,��� DATE OF INSTALLATI PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 75ry,,� 3/93:jt Wisconsin Depailmentof Industry, PRIVATE SEWAGE SYSTEM County: , Cabo( - al id Human Relations ST. CROIX Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: Permit Holder's Name: ❑ City ❑ Village aa Town of: State Plan o.: MOULTON, BRIAN X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic lao d Benchmark Dosi ng � 7 1 - q " Aeration /V 1v Bldg. Sewer Holding St / Ht Inlet 90 162 el TANK SETBACK INFORMATION St/ Ht Outlet 2B /U/ 8S TANK TO P/ L WELL BLDG. Air ir I ntake ROAD Dt Inlet Septic /00f A//f NA Dt Bottom L Dosing NA Header/ Man. S OG �SU.S Aeration NA Dist. Pipe g LS �1 95 Holding Bot. System 9 9� 8 PUMP/ SIPHON INFORMATION Final Grade 0 9 1 9 Manufacturer Demand 5".5 Model Number GPM TDH I Lift Friction System TDH Ft Forcemain Length Dia. H Dist. Towel SOIL ABSORPTION SYSTEM BED/TRENCH Width Len t / No Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION � DIMEN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION TypeO CHAMBER So ZS �//�— OR UNIT Mod Number: System: DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Star Prairie.29.31.18W, SW, NE, Nighthawk Drive Plan revision required? ❑ Yes ❑ No Use other side for additional information. a S L I S SBD- 6710(R 05/91) Date Inspector's Signature Cert.No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Buildin water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. f X • See reverse side for instructions for completing this application State Sanitary er it Number o p�2v The information you provide may be used by other government agency programs El Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name r Property cation , y i 1/4,S� T ,N,Rj�E( Wn rty Owner's Mailing Address of Number Block Number Cn )Kc 11 e</ at if ip Code Phone N her Subdivision Name or CSM Number C1 64".4 ( . TYPE OF UILDING: (check one) ❑ State Owned ❑ City , N eare Road E] Public 1 or 2 Family Dwelling - No. of bedrooms own of �r �O'�rrr r 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) / 1 F1 Apartment/ Condo l l ( 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Ilecreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1.V New 2. ❑ Replacement 3 E] Replacement of 4_ ❑ Reconnection of 5 E] Repair of an System System Tank Only Existing System Existing System ----------------------------------------------------------------------------------------------- B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 4seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade _ Required (s a- ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation o �{ .7 `Feet Feet Capacity VII. TANK in Ca gallo s Total # of Prefab. Site Fiber- Exper- INFORMATION Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank �!/�+✓ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I I ❑ I ❑ I ❑ I ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb ame: (Print) I Plumber's ature: (No Stam ) , MP /MPRSW No.: Business Phone Number: b s Address (St City, State, Zip Cede): _ 6 � IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (IncI d sGroundwater D ate Issued Issuing Agent Si s) Approved [:]Owner Given Initial Adverse Determi on . CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD -6398 (R. OS /94) DISTRIBUTION: original to County, One copy To: Safety & Buildings Diw.ion, Owner, Plumber INSTRUCTIONS — r 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed-pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary p application permit a lication must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, inc icate prefab or site constructed and tank material Cecnplete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP; etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. ompleie plarr,s an sf ecifications not smaller 'hon 8 1/2 x ' :nc.h.es must be sii -ed to tr)e county. The plans must nr_iude. �.iie foilowing A; plot plan, drawn to scale or wl r, complete dimer ,. location : holding tank(s), septic -00her treo',r�Ie.nt tanks, building sefit- well,. i,. ac -e rrrainslwater r ice; strear. sand lakes; pump or siphon I y ; w I the locar on cf g a:� s;ribution ho :es; soil a�.�or �t;on s �� r�7 repl.:t - �����. ,� stem area. -, a� � the building served; Sri ror r ,1 and Ter c1 elevation referer ts, c _ e spcc fit >t on for pumo_ and controls; dose volume; < +U• differences; friction to >s; pump Inc ��,�mp model a �r' ;ump ma�rufacturer, D) cross section elev of ,lhe sun absorption system if required �e datt, n a ° 1 form, an�_3 =) ,III sizing in Formation. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. PLOT PLAN PROJECT Brian Moulton ADDRESS Apt 119 1687 Century Circle Woodbury Mn 55125 SW 1/4 NE 1/4S 29 /T 3 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MFRS BYRON BIRD JR. 3318 - ` - DATE 5 BEDROOM 3 CONVENTIONAL XXX IN -GR D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE O HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 648 BED SIZE 12'X54' IL BENCHMARK V.R.P. Base of White Stake Red Ribbon ASSUME ELEVATION 100' ❑ BOREHOLE O WELL •H.R.P. Same as Benchmark VENT SYSTEM ELEVATION 96.8 12" GRADE " VERING 12" i K .M. 0 ' 140' B -5 15 ' B -4 ,b 19% Rep A b Slope 60' 25' Driveway to go ' T o 3 North to Nighthawk B -3 15Bedroom Drive House 14% Slope 12'X54'Bed Vent \ `` B -2 15 B -1 300' to P.L. East Property Line STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County L OW1%9 BUYER MAILING ADDRESS J1 4 PROPERTY ADDRESS (location of septi.A;mtem) Please twin from the Planning Dept. CITY /STATE PROPERTY LOCATION -� 114, 1/4, Section �T 'T�N R W TOWN OF / �� •� r �— ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER i CERTIFIED SURVEY MAP VOLUME C&, PAGE LOT NUMBE 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment 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 system properly maintained. "Wbw,- , The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted,plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with ' the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that. your septic has been maintainer} must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: ZLtti/'ij .,. DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 54016 11/93 r 8 T C 100 •TIAs 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 g ^i Location of property /4�� - 1/4, Section ,T� -R l W Township Mailing address Address of site �� �• Subdivision name Lot no. Other homes on property? Yes Previous owner of property t is /ia 117 r Total size of property 6 5 7� . Total size of parcel �24 �� 4 5 -Z,,," � i Date parcel was created <Tc- /P- �c Are all corners and lot lines identifiable? _ Yes No Is this property being developed for (spec house)? Yes _>� No Volume & mi l/ and Page Number o L as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 31 1 7 7 and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the off' of the County Register of Deeds as Document No. 7�17 Signature of Applicant Co- Applicant Date of Signature Date of Signature r DOCUMENT NO. i1STATE BAR OF WISCONSIN FORM 3 -1982 ( i THI SPACE R ESERVED FOR RECORDING DATA QUIT CLAIM DEED,.:'"+4 531.4`3 __ - - -- VOL 1 131PAGE 30 4 j Richard T. Moulton and Ramona M. ;! I Nioultori - . __hus7barid --- aria:: wife •---------- ------•--------- •------------------ - - - - -- .��� ���J -I 8.00 A.1 --------------------------- ------------------------ n cE� .1 quit- claims to ---- Brian Moulton __Motn - nd - a_ - Julie A,____ - -- j Moulton, husband and wife as survivorship I� �s�c�rts 4l rs marital__property --- - - - - -- - - - - - -- -- _ -------- - - - - -- --------------------------- •-•- •• - - - -- ---- - --- -- --------- - - - - -- - ------------------------------------------------ ----------------------------------------------------- County, D U !! the following described real estate in ................ . .St. C y D / State of Wisconsin: R TURN To li Tax Parcel No: ---- ----- • - ---_- ......... II A parcel located in part of the Southwest Quarter of the I I Northeast Quarter of Section 29, Township 31 North, Range 18 West, described as follows: Lot 1 of Certified Survey Map filed July 6, 1995 in Volume 10 at page 2954 as Document No. 530938. FEE �XE1vLPT ,I li I This ------ ls ----- _--------- homestead property. (is) (is not) Dated this 18 th---- --- -- - - -- -- - -- --- day of - ------ -------- -- - --- Jul - ---- --- -- ----- _--- ----- --- - - -- - - --, 19.95._. I! - - - ------ ----------- --- - - - - -- (SEAL) - -- - ---- - - - - -- (SEAL) I -------------------------------------- - - - - -- -------------- - - - - -- -- RICHARD T. MOULTON-----------------•- • i ------------------• ---------------------------------------------- _ (SEAL) .c ......... (SEAL) * RAMONA M. MOULTON I I, AUTHENTICATION ACKNOWLEDGMENT Signature (s) ------------------------------------------------------ - - - - -- STATE OF WISCONSIN ss. -------------------------------------------------------------------------- - - - -•- ST. CROIX ---- -- --- ------ -- -- - - ---- -------County. authenticated this -------- day of_____________ ______ __ ______ 19______ Personally came before me this ___.1 ------ -•--- ------- ----- - - -- -- -- ------- ---- -- - - - - -- ---- ____.__ ._____ __. _ , 19__95_ the above nam d - Ri and Moulton and ----- - - - - -- ---'---•------------------------ - --------------- - - - - -- -- * ------------ •-------- - - - - -- Ramona M' Moulton, husband and TITLE: MEMBER STATE BAR OF WISCONSIN wife - ------- •--- --------- --- •--- - - - --- ----- - - - --- (If not, -------------•------------------------•---------------------------------------- authorized by § 706.06, Wis. Stats.) to me known to be the person ___s___.___ who executed the j foregoing instrumen and ack wledge the s y , CY R y� N THIS INSTRUMENT WAS DRAFTED BY - • 'F"dw0Q(?fl REMINGTON LAW OFFICES - Nancy R. Feh Juditb A . R min ton ' rman ------ - - - - -- - - - - -- ----- - - - - -- New__ Richmon -- _ W 5 4 017 Notary Public ------ - -- - - -- t . Croix ___. --- County, Wis. I (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) � date: -------- -- - - / -- 1- -- -•-- ---- - - -- 19 - - --- ) QUIT CLAIM DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FOR \T No. :1 -- 1982 bfilwauk,�e, Wis. FILED JUL X61955 10 1"iiiyam r 8 oiDr:eeir 530938 SL�1�w •� • ` r This instrument drafted by Ed Flanum Job No. 95 -56 Y rJ3 P_AT )F C )LINTpY LIVING L OT I LOT i :_ - J — - - - -- r i ?IIGHTHAWK DRIVE M 0 VOL. S 0 a w N89 0 35 1 42 11 W aj N w 154.56' � I o N I �, 1L r* H C� �� f Q d r 01 I J 3 m� 7 0 z 1r- N M U3 w u+ I Co °�, ID z a W tzi r ° `r �� - G I cr�c ' rt P co (0 v II , i E S c 0 - 00 IU — �Ct 0 Mo CD Irl - o� OD 00 cn a ° Iy fD o W - 1 0 It S 7 • J o I0 t O� 0 T O 10 7 N L OT I g D 0 I Ln m ;o II to rn U1 rn 1 1 IM W 4.81 Acres //^^��y; O 0 O 209,725 Sq. Ft. '" dR V V ED m W m O - m i 0 t� o _ N Area excludes all land lying {� M between meander l i n e and water's �VE 6 '�3; N C Ct G1 � ;;0 c o v ro >' Edge. a C7 � N ®f19�1p H _<< c o o o ��`� C e. ��ix COUN w ° o ' �o wn ig and o -v 0. a _ ° F p v H�Oi: / LOAlrYtt�>@,i 0 _ / o 0 C :E 0 0° _ HtlDS 11l, t w ¢ts 30-Says of ` a :3 3 We, Wis. ✓ ✓ n- �: ap Val daft N 0 > ; �, '9N .o..w�•••' �0 �.� ;�rav shah V9 O old rt %D CL -r N ��a�� £t` � �p"-� �., & v �• O 00 M to O o S I <i�+ rh o w In �0 IU Ib (0 Irn N89 °20' 45 "E S So \ - -n 1[,n Ir IU N . 56.89' 1� n I In �. CORNER \/) /✓ . \ • Z.9, I('1 iC7 SECTION 29 �.0 z N01 0 39'52 "E w Ln 0. 2633.29' Ln >S V LN88027146"W orner E1 /4 Corner O - See County Surveyor for Section ao n 29 m Section 29 0 Section Corner Ties �1 N 8 ° 27'46 "W N0I 039'52 "E 3946.38' 2601.55' 1313.18' ` SW CORNER, SEC. 29 EAST -WEST 1'/4 LINE, SECTION 29 t_ VOL. 10 PAGE 2954 *756Z HOW 01 'ZOA •OOTAp9 ao3 pzEog,uMoy 94eTadoadd aoT33p BuTuoZ 1C4unoo xToaa -4S aq4 4o94uoo Taoaed Aue Bu ao BuTsga pond aao3ag - (•O4a 'Taoaed og ssaooe 'azTs 4oT mnmTUTm 'spupT49M 1 •9 - 1) suoT4eTn6aa pue saTna 'sAvj dTgsuAos pup Alunoo '9194S o4 4oa Cgns sT (4ptci) dem sTg4 uo uMogs Taoaed go9$ -am BuTddpm pue Bu TA9Aans uT xtoaD - 4S 3o A4unoo ago 3 aouputpap uoTSTA.pern P�'I ag4 pue s94n494S wrsuoosTly ago 3o v£'9EZ a94d9go 30 suoTSTAoad 4uaaano ago g4TzA paTTdmoO kTTn3 eAeq i 4eg4 :pagTaosep pue padaeans Aaepunoq aoTa94x9 aL4 3o aTeos o4 uoT4e4ueseadea 4oaaaoo p sT deW AaeanS pBT3T4aao 9T44 4pg4 A3T4a90 0919 ' - paooea 3o s4uamespe TT9 o4 4oelgns sT Taaa9d pagtaOsap anogV •96pa s,aaggA pup auTT aapupam uaaM4aq BuTAT pueT BuTpntoxa (•4g •bS SZL'60Z) saaoV 18 suT94uoo Taoapd paq - BUTT aapueam 3O pua pies mOa3 Mu8T,LSOTOS BuTapaq BUTT p 3o uotsua4xa Bg4 pup auTT aapueam 3o BuTuuTBeq pTes moa3 Mu8T,LSOTOS BuTaeaq BUTT a 30 UOTsu94xa ago uaaAgeq BUTAT a9ATg atddv ag4 3o aBpa s,aa4em eq4 pue BUTT a9pueam pagTaosep anoge ago u99M49q BuTAj spueT TT9 BuTpnTOu2 aq4 pug auzT aapueem pTes 3o pua aq4 BuTaq aBpa s,aageA eqg o4 ssaT ao aaom 4aa3 OE BuTaq 4uTod a o4 4993 61 •6EE 'auTT a9pueem pies BuoTe '$u00ASEOSSS OD ua44 :aBpa s,aa4eA 9 44 moa3 9 89T ao aaom 4 aa3 OE BUTaq 4uTod a o4 4983 68 'PUTT..aapueam pTes BuoTp 'g„9fi3OZo68X 90uag4 :aaATa p Tes BuoTp auTT aapupaw p 3o BuTUU ago BuTaq ae - d aTddy ago 3o a6pa s,aa4em aq4 moa3 ssaT ao aaom 4993 OE BuTaq 4UTod a o4 4993 TL'Z6T 'Mu8T.LSOTOS 80uag4 =4993 EZ'S6V 'Mu8T,8T 90S BOUag4 :4993 9S'vST 'AeA- 3o -4g5Ta pTes BuoTp 'MuZV&S£068K 9ou9g4 WueBue4 3o 4uTod 944 o4 4893 E8'EOT 'AeA- 3 - 4g6 Ta pTes pug aeanO pTes 30 o ae 9 44 BuOTe 'ATaeg4aoH 9Ou9g4 :4993 VT'96 seanseem pue MuSSILSOOSN saeaq paogo asogM '„:,EST2c� seanseem aTBue Teaqueo asogA 'ATaa�s9Aq� nos 9A9ouoo '9ATaQ xMe4g4%TH 3o AvA- 3 - 4gBTa ATaag4nos a go BuTaq aAano snTpea 4003 00 -LL a 3o anano uo 4uTod a o4 4 9a3 T9'SZ:p 'Su8T,LSoTON aOUa :4993 LE'69T 'MuZ:i,ZOOTZN 90uag4 :4893 SE'VEZ 'auTT 4seO P T - es BuOT* 'El 81&LSOTOx BuTnuT4u6o aouag4 944 o4 3983 WISE 'BUTT gsea pTes BuoTp '$u8T,LSOTON 9ou9 !V /IHN 9 144 30 VANS 9 3 BUT 4sea ago o4 4993 8T' ET£T 'UoT4oas pTes 3o auTT V/T ISOA - 4sea ago BuOTe 'Mu 9V - LZ088N 9ou9g4 '6Z uOT4o9S 30 aauaO, VAH 9q4 49 BuTOuaum OD :sAoTTo3 se pagTaOsep aag4an3 :uTsuoosTM 'A4unoZ) xToao '4S 'a-rx pad aeIS 3 UAO.L 'M8 'NTES '6Z uoT439S 3o V /T$H aq4 3o v /TMS aqg 3o 4aed uT p94eOOT pueT 3O Taoaed V :sAOTTo3 se pagTaosap sT paddem pug paAaeans Zaoaed pu ago 3o Aa aOTa84x8 ago geg4 !dew AananS p9T3T4a9O sTg4 Aq pa4uaseadaa sT goTgA Taoaed pueT aq4 pagTaosep pue paddpm 'paAaeans anew I 'uo4Tnow papgoT-d 30 uOT4oaaTp ago Aq 4eg4 AMa90 Agaaag 'aoAaAanS pueq utsuoosTM p9a94sT69a 'ua6egAN •o u 'I AIM SE068H M1801OZ0ZTH 10 i61'96 AiSSiLSOOSH stEiSTOLL 00'LL Z Z-T 9NIHYSE 9HIHYfiH EL60 RlDla4 9HIHYSS 8`lMHY HZ9H84 ON ON ZH89HYZ I MHYS OHY OHOHO OHOHO iYum SIlIQYH ioq anno vv DOGUYENT NO WARRANTY DEED n,,s •S VA [ Rf. ERVE0 , OR RL':� C N' DATA STATE BAR t,F WISCONSIN FORM '1 -1982 483215 rr,, VOL .��QPASE /J REGISTER'S OFFICE Beatrice Moulton a /k /a Beatrice R. ST.CROIXCo.,WI Moulton, an unremarried widow 4 Reed for R ec ord MAY 1 21992 ronvr >- an.l •.%arrant.: to . Richard T. Moulton and Ct 8:30 A. M Ramona M. Moulton, husband and wife as survivorship marital property Re9ister of Deeds the fr,!lu%cit.g real —'.ate i;: at. Croix State of Wi;eon.sin: All that part of SW 1/4 of NE 1/4 and SE 1/4 of Tax t1 ^CoINo: _. NW 1/4 of Section 29 -31 -18 lying Easterly and Northerly of the Apple River, EXCEPT Commencing at a point on the East line thereof 16 1/2 feet South of the Northeast corner of the SW 1/4 of the NE 1/4 of Section 29- 31 -18; thence South 656.6 feet; thence North 26° West 169.4 feet to a point; thence North on a line parallel to the East line of said tract 500 feet; thence East on a line parallel to the North line of said tract 74.25 feet to the place of beginning, including the island located within the limits of the Apple River. Also, All that part of the SE 1/4 of the NE 1/4 of Section 29 -31 -18 bounded and described as follows: Commencing at a point on the West line of said tract of lard 673.1 feet South of the Northwest corner thereof; thence South 26 East 726.8 feet to a point; thence West on a line parallel to the South line of said tract 318.7 feet to a point on the West line of said tract; thence North 653.4 feet to the place of beginning. r . is not , municipal and zoning ordinances, easements and restrictions of record. .92 Beatrice Moulton AUTHEiY \ rIo:V ACK r FLORIDA M .OFFICIAL SE/ Judith A. Ri TLL rig ton KAQtN L. SMITH REMINU:ON LP OFF ICE ' •r COMMA ;5610N IXPI :fE'w Rlc.h.mon<�, Wi U01 o. cMntN O>I. 199a ..... xxFL 1� Iq 2 /0 .2 -z/ y'" t b l B3 ° u • S.0� Boa !o`1•S3 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _ of _Lab_,..f -and Human Relations G` "Divisfq� ,.Safety & Buildings y in accord with ILHR 53.05, Wis. Adm. Code X f COUNTY Attach complete site plan on paper, not less than 81/2 x 11 inches in size. Plan must include, but not limited I..a vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION– PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OW : PROPERTY LOCATION , GOVT. LOT 54c, '1/4 1 /4,S T ,N,R E PROPERTY W E -. S MAILIN ADD E f LOT # BLOCK # SUBD. NAME 0 CS # !>` _ CITY STATE *'ZIP CODE PHONE NUMBER []CI []VILLAGE . OWN NEAREST ROAD Dr ' New Construction Use] Residential I Number of bedrooms [ J Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd 'Recommended design loading rate . 7 bed, gpd/ft trench, gp d/ ft 2 2 2 2 Absorption area required 40 bed, ft 6 trench, ft xlmum design loading rate . bed, gpd /ft trench, gpd/ft 2 Recommended Infiltration surface elevation — ft (as referred to site plan benchmark) Additional design / site considerations PEA °l 6 • V - Parent material 19,1 1 S 4 Flood plain elevation, if applicable _ � ft S = Suitable for system CO VENTIONAL MO ND IN.pROUND PRESSURE I A, Tom- GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem S ❑ U ®S ❑ U ®S ❑ UJ S ❑ U 11 SU O S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bwidafy Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Ttend't 0 —14 3 z o Ground A 1 10 l J, ft. Depth to limiting _3.5 Remarks: Boring # L, s -Y E - .01 Ad Ground 9 tl ft. Depth to limiting f Remarks: CST Name:—Please Print } Phone: d A ddress: Signature: Date: CST umber. C� off M EMPIM R M.. lon. ME M.M MAAMEMON mmm mm ���=�Mmmm A MOI 9 MZ M Mh M 4 Mw, ff. M M' iii ro a m CD Soil Test Plot Plan Project Name Richard Moulton Byro ird Jr. Address 1970 Nighthawk Drive Somerset Wi 54025 M #3479 Lot _ Subdivision ------ Date 5/13/95 SW 1/4 NE 1/4S29 T 31 N /1318 W Township Star P r a irie Boring O Well ' PL property Line County ST. CROIX BM or vRP Assume Elevation 100 ft.Base of White Stake Red Ribbon System Elevation 96.8 * fip Same as Benchmark 0 ' 140' B -5 15' B -4 b 19% Rep A E Slope 60' Pro 3 Driveway to go B -3 40' North to Nighthawk edroo Drive ouse 14% 60' Slope Ri A B -2 15 B -1 300' to P.L. i East Property Lune w I a � y S . .� � / Z �� �� �� � � � '�