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HomeMy WebLinkAbout038-1115-70-120 I m n Z� Z U) K) CY) _' :3 ° C ° W = w C?o 0-4 N C W 7 O 0 '' C N N p- _ (D SD co W c /p N O l� n: 7 H O Z O O to A to O b M m A a a N O CD fl d N 3 O ° W cn A C O C ` N cn co \ \\ a m 3 c N CL �+ i' Oz CD 000 f o W O M d j IQ v v O o = m ID N m o C> = m D = o CL N �. 0 z m o v Z O CL w+ m s CD w 3 CT CD O v� co m m w m m a ° m (D = -� Z = _ -1 N p y O c .a .. j c CD Z to n 00 m W CO CD M "O �' A X =r C ^! Z O y Z O CD A cn Q CD CD n j N C N 0 CL N o I I v d I COD x CD a I � ti W ti W O � O CT O 0 b CD Op N I � w A O O C O 00 a Parcel #: 038- 1115 -70 -120 01/24/2007 03:35 PM PAGE 1 OF 1 Alt. Parcel #: 29.31.18.4871 -20 038 - 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 O - LANGE, JOSEPH A JOSEPH A LANGE 1992 NIGHTHAWK DR SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 2.500 Plat: N/A -NOT AVAILABLE SEC 29 T31 R1 8W PT NE NW & PT NW NE Block/Condo Bldg: BEING LOT 3 OF CSM 8/2248 2.5 AC LOT 3 INCLUDES A STRIP 10.84' ALG WLY R/W Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) NIGHTHAWK DR (BEING IN NW NE) 29- 31N -18W Notes: Parcel History: Date Doc # Vol /Page Type 1212811999 616109 14801327 WD 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 175661 427,900 Valuations: Last Changed: 10/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.500 34,500 343,700 378,200 NO Totals for 2006: General Property 2.500 34,500 343,700 378,200 Woodland 0.000 0 0 Totals for 2005: General Property 2.500 34,500 343,700 378,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce Count PRIVATE SE SYSTE y: WAGE SM Safety'and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 363810 Permit Holder's Name: ❑ City ❑ Village ❑ 3bwn of: State Plan ID No.: Lan , Joe I Star Prairie Township CST BM Elev.: Insp. BM Elev.: BM Descripti n: Parcel Tax No.: 038- 1115 -70 -120 TANK INFORMATION ELEVATION DATA `' y 3 j n ) ' ' `7 / TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic l 0 0 p Benchmark 2_ -0 - S__ 1,oz.o 166 Alt. BM �S— Aer Bldg. Sewer . Z 9 Holding & Ht Inlet 5 S TANK SETBACK INFORMATION St / Ht Outlet �� �d /^� 2 TANKTO P/L WELL BLDG. Ventto ROAD Air Intake Septic NA rnb/J� NA Header / Man. d A on NA Dist. Pipe / , .0 9l O Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade We-wA acturer Demand St cover Z.cp Model Nu GPM T�FI Lift Friction stem TDH t Forcemain Length Dia. Dis . well L ABSORPTION SYSTEM BED TRENCH Width ' Length No. Of T en FF hes PIT No. Of Pits Inside Dia Liquid Depth ION 3 �J� r D SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA Manufacturer: SETBACK INFORMATION Type of AMBER Model r: System: j' S Z / 3 OR UNIT DISTRIBUTION SYSTEM Header /Manifold // Pipe(s) x Hole Size x Hole Spacing L Vent To Air Intake // Length Z / Dia. Length Dia. Spacing Z 2- 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 COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: ! / I >/ 0 Inspection #2: Location: 1992 Nighthawk Drive, Sg WI 54025 (NE 1/4 NW 1/4 29 T3 1N R1 8W) - 29.31.18.487I20 -Lot 3 1.) Alt BM Description = e �k vie/ e� r!ir- s Y f �c u,Qs ���� /��� — �4 ► « I ou«,- 2.) Bldg sewer length = - amount of cover = >yo #i :3 wo we (� a,�- ��� � )�•sPec J � , Setil, ,3 j . Plan revision required? ❑ Yes No Use other side for additional information. for (c s SBD -6710 (R.3/97) �4 •'�.s /�2L 4Y U� /I pectgr'sSignature Cert. No ( o6 ) ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' S ri. m ` � � F .. t t a c z E ....... x s i v j ii 3 E a t s f EE E e .......... .„�,.,.. { _.....� a _�... .., , a. .. ..,.. E ...., .. .. .. _ ..... .... .... ., t sm t 1 e. ,,. > .. ...a a,,.. E .,..e.; ....��. ..m.e� .... ... .:......m ... � .. .._. .,... e e... ,, m., ... .. .. ,0. . ..... j.�. i9 e ,.,.,._ _ ....... ...... „.._. ..q_.,.,, ..s ,,.. ........... , _.,mow .. .. _s.... —.__._ ... ,. _. . ... .. .. ._.. ... ..... __ E _ I j F € r l t g j �F. a � 3 a s � t S u..a.. ma 1 .. ,.....e E E S � I j M. m. m.. ..2..... -_' w x a s x a e � A ftconsin (�' /�1 G�thctwl� Dr'� Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 Department of Commerce In accord with Comm 83. m Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for thee" (stem on aper n ot less County than 81/2 x 11 inches in size. • See reverse side for instructions for completing this Yticatioki_ L' L- State Sanitary Permit Number 3 (P-3S)D Personal information ou provide may be used for seconds ps t revision to previous application Y P Y secondary pur o�,�s Check it �.. [Privacy Law, s. 15.04 (1) (m)]. c " ST ;0g0i}: a` State Plan I.D. Numbe I. APPLI ATION INF RM ON - PLEASE PRIN `' I ON 4 ]A Property 0 ner Name 4 roperty! occatiion 1 ' ; r "i /a, S T „ R f'(or� Property Owner's Mailing Ad res of N¢° Block Number City, State Zip Code Phone Number Subdivision Nam or SM mb ( > q(0 0 ZZ II. YPE F B LDING: (check one) ❑ State Owned ❑ It Neare Roa Public 1 or 2 Family Dwelling - No. of bedrooms ❑ gr Town OF:!5� 111 BUILDIN USE: (If building type is public, check all that apply 7[\ Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational 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. ®' New 2. ❑ Replacement 3. ❑ Replacement of 4 ❑ Reconnection of 5. ❑ 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 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 [:]Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure f / 42 ❑ Pit Privy 13 ❑ Seepage Pit X s7 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: rAo le 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /' ch) Elevation Feet Feet Capacit VII TANK in gallo Total # of Prefab. Site Fiber- ass Plastic EAxppepr. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel New Existin strutted Tanks Tanks tic Tank ng Tank — 1:1 1:1 El El El I ump Tank /Siphon Chamber ❑ 1 ❑ ❑ I ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the u ersigned, assume responsibility for instgtlation of the onsite sewage system shown on the attached plans. Plumb ame: i ^ Plumbe ' S to trS MP /MPRSW No.: Business Phone Number: Plumber's dress Street, C "t� y, Stat ip Code IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing A nt Si �atre (No Stamps) Surcharge fee) Approved 1­1 Owner Given Initial � -� Adverse Determination / X. XON CWRW�l DITIONS OF APPROVAL/ FEE SONS FOR ISAPPROVAL: �r S BD -6398 (R. 4 9) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber ' ' + b NSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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 (SB 9) to be submitted to the county prior to installation S. Onsite sewage systems'MUst be properly maintained. The septic tank(s) must be pumped by a li4erhsed 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 �Buildi ngs Division ,•608- 266 -3T51. - To be complete and accurate tl�is sanitary permit application-must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system isto be installed. 11. 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, indicate prefab or site constructed and tank material. Complete 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_:Plamber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must 'include the following: A) plot plan, drawn to scale or with complete dimensions, locatid66f holding tank(s),'septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences, friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- 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. �U,LiJC✓/ Q � �/fy�it�q�� �`u� ar � /OS� �,,�r; Cw� // ,shp�"E �C,.1�v� / 1 OL a a Wisconsin Department of Commerce SOIL AND SITE EVALUATION co Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. ft APPLICANT INFORMATION - Please print all information. Revi d b f Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 11 Aa � Property ner Property Location r Govt. Lot 1/4 1/4,S T N,Ro Prope wner's Mailing Address Lot # Block# Subd. Name orp,pS Q# i State Zip Code Phone Number City Vi Near t Ro ❑ ❑ Ill g e ,® Town lf'q �— New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate. bed, gpd/ft gpd/ft Absorption area required _ /-5�3 bed, ft 12z trench, ft 2 Maximum design loading rate . 7 bed, gpd/ft gpd/ft? Recommended infiltration surface elevation(s) ,�j ft (as referred to site plan benchmark) Additional design /site considerations Parent material _" Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S El U �o s ❑ U ®S ❑ U ® S El U ❑ S ®U ❑ S '21 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz, Cont. Color Texture Structure Sz, Sh. Consistence Boundary Roots Bed , Trenc Ground _ elev. el , ee 7 ft. Depth to limiting factor Remarks: Boring # / IV 13 .3 Ground I q l q elev. Depth to limiting factor > Remark CST Name (PI se P nt) Signature f Telephone No. Address Date CST Number PROPERTY OWNER SOIL DESCRIPTION REPORT Pag 2 of 3 PARCEL I.D.# _D Boring # Horizon Depth Dominant Color Mottles Structure z In. Munsell Qu. Sz. Cont, Color Texture Gr, Sz. Sh. Consistence Boundary Roots Bed Trench: Ground a e ev. �ft• ` Depth to limiting" factor Remarks: Boring # Ground elev. o u Depth to -q limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground i elev. 3 Depth to ��• /f limiting ( °3 r3R factor > Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (8,9/98) W4 �, �,F„ac�,i �� -�,�/ � �o�o e� to fi. �..1�+',c • ,F- 11DG� vo gg r o � y�Y� � 7"/ �J ������ � s�� ,, 1 �c�yp/ /� ,` ,. �.— ��5� �� � 3 /��� j I �� nn 1L= �� �.� �� �� -� r �`� ,` � 9` ` � �` �. �d'��RG � �e __ - __ `' � y � � � (p �� � � � �,� ,� �, s. -� �, �� � ' � � ,s ,s ��,, �/� � I Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page —L of 3 Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. APPLICANT INFORMATION - Please print all information. Revi d b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ") 2 Property Lner Property Location Govt. Lot 1/4 1/4,S T N,RoV Prope Owner's Mn Address Lo-t# Jbi66k# I Subd. Name or pV# I/ I lar - _�? - , R State Zip Code Phone Number ❑ City El Vill ge Town Near t Ro New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement Public or commercial - Describe: Code derived daily flow 9Pd Recommended design loading rate _ bed, gpd/ft 9Pd/ft Absorption area required - r�& bed, ft . trench, ft Maximum design loading rate _,gy bed, gpd /fie trench, 91�d/ft Recommended infiltration surface elevation(s) - ft (as referred to site plan benchmark) Additional design /site considerations Parent material _ " - Go - c Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system s U XS ❑ U ® S ❑ U ®S ❑ U ❑ S 1Z U ❑ S -9 U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD/ft g in. Munseil Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots g Bed ,Trench Ground p elev. Depth to limiting - factor Remarks: Boring # / i3 �7- e 3 - Ground elev. Depth to limiting factor » in. Remark CST Name (PI e P nt) Signature r Telephone No. Address Date CST Number PROPERTY OWNER SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. Depth to limiting factor Remarks: Boring # <'K o Ground elev. Depth to k limiting l2 t factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Boring # Ground �elev. 7 d / ft• ' Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R.9/98) ro ©D 1 o -� I I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, CC DIVISION LABOR H'IJMAN RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP / ITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: NE 1 44W 1 /4 29 / T31 N/rt8xE (or) w Star Prarie 1 3 n a n/a COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St - Croix Orville & Jeanette Rivard 1 1980 Nighthawk Dr., Somerset, Wi. 54025 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCR PTION: IP OFILEDESCRIPTIONS: R ATIONTESTS: lisesidence 3 n/a 6bNew ❑Replace Il 7 -17 -90 7 -17 -90 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM- IN- FILLHOLDINGTANK: RECOMMENDED SYSTEM: (optional) �S ❑U ® S ❑U �S ❑U ❑ S EIS U conventional If Percolation Tests are NOT re uired DESIGN RATE: Q if any portion of the tested area is in the under s.H63.09(5)(b), indicate: n/a Floodplain, ind icate Fl elevation: n/a decimal' PROFILE DESCRIPTIONS pag 19 BrB BORING TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH =ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B -1 7.33 100.32 none >7.33 .83bl.1. .75bn.sil. 5.75bn.c.s. &gr. B 2 7.42 99.55 none >7.42 .67bl.1. .75bn.sil. 6.00bn.c.s. &gr. B 3 7.01 99.55 none >7.01 .92bl.1. .67bn.sil. 5.42bn.c.s. &gr. B 4 7.17 100.48 none >7.17 1.00bl.1. .67bn.sil. 5.5Obn.c.s. &gr. B-5 7.09 99.08 none >7.09 .67bl.1. .50bn.sil. 5.92bn.c.s. &gr. B- deciaml' PERCOLATION TESTS TEST WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER R AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PER1003 PER INCH P _ 1 .02 none P _ none P _ T none P 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 96.30 _ ( _._ 0 i E ­ _j I ( t 1 _ 3 i E E r 5 - I , I a S L E 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: Gary L. S teel 7 -17 -90 ADDRESS: CERTIFICATION NUMBER: I PHONE NUMBER (optional): 1554 200th. Ave., New Richmond, Wi. 54017 2298 715 -246 -6200 CST SIGN RE: 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 - SR - 6395 To be a complete and accurate soil test, your report must include; 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. IMAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or rcplacetnent system; 5= Cornplete the suitability rating boxes. A SITE IS SUITABLE F A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6, PLEASE usf the abbreviations shown here for vvriting profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram €accurately locating your test locations. Drawing to scale is preferred, A separate shcot may be used if desired; S. MLjke stare your benchmark and vertical elevation reference point are clearly shown, arrd are permanent; . Complete all apfaropt "sate boxes as to dates, flames, addresses, flood plain data, percolation test exernp- tron, if appropriate, 10. If the information (sUCh as flood Main, elevation) does riot apply, place N.A. in the appropriate box; 1 1 . Shin the farm and Glace: your current address and your certification nUrnI:wr; "t?, Make lec ;ib e copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE L OCAL AUfiHDRITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS S oil :separates and Textures Other Symbols s, I, - Stony (over 10 ") BR — Bedrock cob -- Crmble (3 - 10 ") SS — Sandstone gr - Gravol (under 3 ") LS -- Limestone 's — Said HGW High Groundwater cs Coarse Sand Perc — Percolation Fate rned s Medirsnn Sarrd W _- We! Ls _- Fir=e Sarad Bldg — Building Is — Loamy Sand -- Greater Than � sl Sandy Eoarn Less Than 'I — Liam Bn -- Brown sil — Silt Loam BI Black Si - Silt Cry — Cray cl - Clay Loam Y - Yellow scl — &m dy Clay Loam R — Red sicl — Silty Clay Learn root — Monies se Samly Clay Lryy -- tn, itlt sic — Silty Clair fff fev,', Tine, faint c _._ Clay,{ C€i - -- common, coarse pi - Peat mm — Many, medium ro Muck d — distinct . p prominent HWL — High water level, Six "cieneral soil textures surface water for Iiccrid waste disposal BM Bench Mark VRP — Vertical Reference Point 7 y TO THE OWNER: This rtoil iFSt ref }t>r1_ is the first crap ira sceurinft a sanitary permit. The county or the Department may request ticati�nr= n* this soil te, in the fic'Id prior io permit issuance. A coml;lete set of plans for the private . age sysle.M anc r, ;ae11ri9_ application artist 1w subntittcd w =far. appriTr ioc;aai authority in order to xJr't.wn a p riml. Ti san - al 'y mP ttrilt must be u!ilx liii and posted oiiot" to Ii", st,Iri, O arSv CflnStfi'UCt30n. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND , OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address ( etI cation required from Planning Department for new construction) City /State J "' / , cz�arcel Identification Number EP- / //s - :�01-,62ej LE GAL DESCRIPTION Property Location '/4, ,� 'A, Sec. T�N -R_2Z_W, Town of L5 Subdivision , Lot # Certified Survey Map # OAS/ � , Volume � , Page # _2-2 Warranty Deed # ,Volume _l U— , Page Spec house O yes X no Lot lines identifiable / E9, yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumberor a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da of a three year expi I ratiQ$2ate, SIONATIRE OF pptit T DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the op rty described above, by irtue of a warranty deed recorded in Register of Deeds Office. I IATURFOFAh DATE * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed vol. j480PAGE327 F,1b109 STATE BAR OF WISCONSIN FORM 2 -1998 REGISTER OF DEEDS pal; ment Number WARRANTY DRF.,n 5T. CROIX CO., WI This Deed, made between Orville J. Rivard and Jeannette A. RECEIVED FOR RECORD Rivard husband and wife 12 -2E -1999 9:30 AN YARRANTY DEED Grantor, conveys and warrants to EXEMPT it CERT COPY FEE: Joseph A Lance a single nerson COPY FEE: TRAN5FER FEE: 46.00 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Recording Area Na Return Address Wisconsin (The "Property "): " 1,; TINA GGLAND 7 i 1,; 1- screen & pg1 f'.f ?, 1 ;0x 359 and ffudson, Wf 54016 038- 1115 - 70.110 Parcel Identification Number (PIN) This is not homestead property. Part of the NE1 /4 of NWl /4 and pan of NWI /4 of NE1 /4 Sec. 29 -31 -18 described as follows: t 3 of ertifted Survey Map filed July 26, 1990, in Vol. 8, page 2248, Doc. No. 460815, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this �. day of December, 1999. * Orville J. Rivar „ eannette A. Rivard AUTHENTICATION Signature(s) Orville J Rivard and Jeannette A. ACKNOWLEDGMENT Rivard husband and wif STATE OF WISCONSIN ) authenticated this 5V day of December, 1999. ) as. County ) ' Kristin. Ogland I Personally came before me this_ day of TITLE: MEMBER STATE BAR OF WISCONSIN 1999, the above named (If not, to me known to be the person(s) who executed authorized by § 706.06, W is. Scats.) the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland , Hudson, WI 54016 Notary Public, State of Wisconsin My Commission is permanent. (If rot, state expiration date: (Signatures may he authenticated or acknowledged. Both are not _ ) necessary.) -Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 .1993 INFORMATION PROFESSIONALS COMPANY FOND OU tAC. WI 800-655-2021 f N t FiL F-D a JUL2 61990 JAMES n'r(N` WELL 5 pegister or ucw,".s 460815 SL CroixCO.,W1 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NEI OF THE NW} AND IN PART OF THE NWj OF THE NEI ALL IN SECTION 29; T34N, R1QW,,. TOWN OF STAR PRAIRIE , ST. CROIX COUNTY, WISCONSIN. #�:t. OWNERS LEGEND Orville C Jeanette Rivard St. Croix County Section Corner Monument - Atuminum Cap•-set` } 1980 Nighthawk Drive in concrete found. Somerset, Wi. 54025 1 • 2 iron pipe found. - Denotes d " - •• —��.- enot drainage course. try `� 1 iron pipe found. NW corner o 1 0 1 x 24 iron pipe weighing 1.68 LBS per linear * foot set. Sec. 29 -31 -18 1 � N 66 1 unplatted lands 810.081 Sec. 29 -3 - .9 north line of the NW} D N89 0 14 1 5 799.24' 1842.36' iv A PRIVATE B < F G ROAD ' I N I r cn 3 I• I—i H / N89 0 14 I rrr I I 22'± ' �' ///--- /// 5911W 4 w ,I 456.30' n � � Z y I o C N 3 m a cn I 0 a o rr — 2 O 7 I 12 I't7 I � -n W i� m I - 49j ,o is z I 1, U N89 0 14 1 59 11 W co 0 M - 4 L 456.30' , rr I m 22 1+ m 1 aD r o cn rr I a v s I 6 I cn ° I� : M C O I T �• I� I s co o I l7 z ,* House ❑ o 4 ' 1 "; 66 ° I Q Outbuildings 4 1+ 0 681.58' I P N89 °54' 19 914.73' Q 2' iron pipe and 1 unplatted -lands 1 iron pipe ;I found. LINE BEARING DISTANCE LINE BEARING DISTANCE A -B N89 °14 "W 10.84' north line of the NEI N -0 N89 129.01' I A -C it 456.30' 0 -P 11 104.14' B -C 11 445.46' Q -R N00 400.00' C -D ° 285.68' R -S if 238.75' C -E " 353.78' S -A 11 " D -E " 68.10' U -T it " G -F " It . T -C n It E - F S13 50.00 recorded as S12 0 01 09 11 E S} corner D - n u n It n Sec. 29 F -H S29 126.72' recorded as S27052157 SCALE IN FEET H -I S37 129.48' recorded as S38 I -J N89 78.50' r,"orded as N87 200 t 0*,�� �^ `��� 200 J -K SO4 176.44' K -L S64 ° 51' 15 190.14'' L -M S70 226.51' � M WE c' L -U N82 0 50 1 22 11 E 286.40' , a •P7 M -N S08 299.88' I A -E N89 ° 14' 59 810.08' �� �lY, G {;3, r HUDSOM, r VOWME 8 PAGE 2248 to ORVI; E _,"_ iN.NETTE R. 7 Real Estate STATE OF WISCONSIN S9q1.jS-nC9 No, 0 1 271 1 B No. 00()7550 PROPERTY TAX BILL FOR TOWN OF STAR PRAIRIE Correspo should refer to W number. r-' ST. CR0I.X COUNTY Sea reverse side for Imponw Information 1 7 Computer- # 038-1115-7()-120 .,e mpwamsnrs PAC#�9-71' R7 701W Assessed Val* A". AWN. ROW EN. Fair w Langi EN, Far W *VomMer" T. 1.. 1. Mta - Z - 1301 w" bw mum urparr OPWYM I . I 1, 1 00 74.60% 14. 900 14, 900 0 M 1996 19 Nei Prop" Tax 161 CS Est State Aids Est. State Aids 1996 1 997 %Tax Allocated Tax Dist. Allocated Tax Dist. Not Tax Not Tax Change 2,80 2.?2 4 88134 91575 67.07 66. -G.8% 1 150897 8.66 20. 57 T 894405. 950011 111.06 r 115.65 4.17. H0 : 46269 47 76 22.78 2 -11 3% 1175061.00 1239855 '.00j 2 1'2. 37 228.16 7. 47. Lottery Credit -67 0 6 101111 0,111 FOR FULL PAYMENT . Net Property Tax 7 1 ^ X7 1 1 f C, '7 4 PAY BY JANUARY 31 i 9 9 8 Not Assessed Value Rate — Z6 . 12 1, (Do NOT r~ Icawy Breda) 16 C 1 n 1 r Warning: H not paid by due dates, installment Option is ,ion covers your property. This 0 2 0 r, 5 5 _1 6 10 and total tax is delinquent subject to interest al a y and may not be a full legal description. BILL NO, applicable. penalty. (See reverse) IL . 500A Or Pay 1st Installment And Pay 2nd Installment ORVILLE 6 -JEANNETTE PT NE NW P I VARD $ 47 .00 $ 11 08 "OT 3 OF 9 9 B ey JULY 31 1 9 5 '& AC LOT 3 10 E 7 6H ST UN.'( 7 21) Spacial ey JANUARY 31 rp;r-at 84 NEW RICHMOND W! Charge Pad Tax Paid DR (BEING 5 7 —0000 Special Total Amount Assessment Paid Paid ol� P'O';:y Balance Tax d Due Palo by Q Reed by Date /I T r 1 t 1 �� �� � / I \ ' i i y _ _._. i ��, j ----- ___ --____ _ i �► _, 0