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034-1031-97-000
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CROIX COUNTY ZONING DEPARTME N ' g AS BUILT SANITARY REPORT �� ©f A y � Owner Property Address ,VV,/ cc f ? tx 1ggg � � �.� City /State � �: �(/ G o c/ �' 4 , Atd i Legal Description: Lot — Block Subdivision/CSM # S '/4 �2:L t /4, Sec. 4, TAN -R EW, Town of ST %N /= /La( PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Mi dey es �"g / YSize ST/PC Setback from: House Well O P/L l�v- Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air ' Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: �d /Y veNt /o/m av idth Length 9 -5 — Number of Trenches 2_ Setback from: House Well P/L Vent to fresh air intake j/� ELEVATIONS Description of benchmark tap a' � � � A? 0 Elevation Description of alternate benchmark IYiO� /L - / /�� "�i %� 6kr re_, 1VW I' & & eElevation . 2 i :top o f Al go —/ode 81 Building Sewer D` ST/HT Inlet ST Outlet _I �JL' PC Inlet PC Bottom Header/Manifold P. _ Top of ST/PC Manhole Cover Distribution Lines (z) Bottom of System (I) ! 0 (a) ( ) Final Grade Date of installation b lAli Permit number 8 8 State plan number Plumber's signature eJ GC/�� -r icense number c;? Date b k201 99 t Inspector Complete plot plan � NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW 1v pRB,vo e d �4 71 Se, I '1.4H K 1 o At INDICATE NORTH OW Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary 33897 8 Permit IX Personal information you provice may be used for secondary purposes [Privacy La 2 s.15.04 (1)(m)j. Perr t W9 e: TONY El rn11t1vvLV� Cit /�ll�gQ S.avb of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description if FLU Parcel Tldl_1031 -95 -000 I orb 11'D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic �.� U� re c&,4— Benchmark 1106401 boa Dosing Q.G 100. Aeration Bldg. Sewer.�� Holding 6) HS64� � 3 `j o ,7, o 7 - TANK SETBACK INFORMATION bl F+_&Uttet �G 2 /a TANK TO P/ L WELL BLDG. Ventto ROAD Dt-Miet� , Air Intake Septic v NA •Dt Bottom Dos � A Header / Man. ..rP `�G•S8� . Aeration NA Dist. Pipe �t g y� 5 f•9y Q6. �' H Wdrn g Bot. System (o• 88 pr. 6 0 PUMP/ SIPHON INFORMATION Final Grade s ?I -S Manufacturer Demand Model Number GPM TDH Lift Lrictio System Ft H ea Forcemain ngth Dia. Dist. To well SOIL ABS RPTION SYSTEM BED QRENCH j Width / Length _ / No. f Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER / r Model Number: System: 4 02 7 — OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length A_ 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 COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SPRINGFIELD 14.29.15.224A,SE SE 3176 CTY RD E 6) AP - &A r 4 a "VVI C21,4. O V PVW y &-(* ) Plan revision required? ❑ Yes ❑ No I Z 6 Use other side for additional information. I (e qOL va-x . SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division 2 01 W. Washington Avenue Vi scons i n SANITARY PERMIT APPLICATION to Wi P O Box 7302 Department of Commerce accord with ILHR 83.05, s. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. d Re • See reverse side for instructions for completing this application State sanitary Permit Number _---- 3 Personal information you provide may be used for secondary purposes E] 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 Prope y Owner Name 01 Propert Location � v4 �' 1/4, S T .,'i; , N, R /3hbr) W Property Own is Mailing Address Lot Number Block Number R io ,L / Cit ,State L(J V Zip Code Phone Number S bdiv Sion Name or CSM Number (71 2 , II. PE OF BUILDING: check one) ❑ State Owned cit Nearest Road C] Village /� Public 1 or 2 Family Dwelling - No. of bedrooms i , Town OF ii o III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) V 14.2n 1 5. 22-`+ A 1 Apartment/ Condo a �D �i• O O O 2 F] 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____ _________TankOnly______________ Existing System -- - ----- --------- - ---------- -- B) 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 X Seepage Trench 22 In- Ground Pressure Pit Priv ❑ !X� 42 ❑ 13 ❑Seepage Pit o� 43 Vault Priv y 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 . ft.) Pro osed (s . ft.) (Gals/da /s . ft.) (Min. /inch) Elevation q q q Y q ,SD 7 D �SO 9.5 =.f' Feet Feet VII. Capacity TANK in gallon Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel - glass Plastic App New Existin structed Tanks T nks 4M2 Mid &mx tew& Q6 ❑ I ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume respons ibility for installation of the onsite sewage system shown on the atta plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP /Atl@NWNo.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): G o / Lv l d IX. COUNTY/ DEPARTMENT IJS1E ONLY ❑ Disapproved Sanitary Permit Fee (IncludesGroundwater ate I ssued Issuing A tSignature (No Stamps) El Owner Given Initial �� Surcharge Fee) J n l Adverse Determination A n I X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, plumber , INSTRUCTIONS ' 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, 60 8 - 3151: ` To be complete and accurate this sanitary permit application must include: 1. 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. Vt. 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. Plumber mustsign application form. IX. County/ Department . Use Only. Y p Y 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, location of 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 requieed the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- " I 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. _ i - --1-- I- _� _ -- - -- -- - - - - _ X s i- - -- -- 1 i - -- -- - - - - - -- -; -1 -- !— - -- I -- — ; - . - --+ i _ IF -- -- - t- - -- - 1 I - — -- - - - - aft-R__ -- N - �_ - -�— Fl I l e — - - Wisconsin Department of Industry SOIL AND SITE EVALUATION / Labor and Human Relations Page / of 3 fbivision of Safety and Buildings in accordance 8 .09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches i� Ian mu Y County include, but not limited to: vertical and horizontal reference point r directi4, -n frr'1 e ro / percent slope, scale or dimensions, north arrow, and location an s nce to n'eaYes : r'6 p p �- � Pardel I. D. # 6 p, 0 3 /0-3 9S- APPLICANT INFORMATION - Please print all inf m",Ition. Sr ;e c►�c�x , Reviewed by Date _ Personal information you provide may be used for secondary purposes (Priv cy& �yW, S. 15.01CQW ' Property Owner ytr: �" t�, Prope L \�✓` areas YD. m e- 009P KinYle / : ;GGYt• ; ,, 1/4 _<qF 1 /4,S T .Z. ' N,R 1110*a4 W Pro erty Owner's Mailing Address 3t # � k# Subd. Name or CSM# /� �e . o rs zs-� 91/ A -0Scal -5 C' cwt City State Zip Code Phone Number Nearest Road l e' 1 � 40. 5 ( ) El city ED viii o 0 . . ew Construction Use: si ential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow _ 50 gpd Recommended design loading rate O• S bed, gpd/ft 40. G trench, gpd /ft Absorption area required POO bed, ft Zso trench, It Maximum design loading rate 0.5 bed, gpd/ft ©•` trench, gpd /ft i Recommended infiltration surface elevation(s) �l.S. It (as referred to site plan benchmark) Additional design /site considerations-r-ns'6&JW E► ", !t: e ' i L�s.�+ /'e ' . { u5Q Parent material 94 99� 4 Flood plain elevation, if applicable n 3ftt. ft S U TUnsuitable Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank for system ag ❑ U �❑ U 1?9�0 U 2 U ❑ S 9 t ❑ S SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots ,:•;, - : in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed '. Trench X / W S a 2 O. 0.6 2 1- 36 0 X re 4 5 Ground 3 - 61 O. tr O. e ev. s s j/ i?on.e 5 0:5.q m I as 10.7 0. Depth to S S / Jk5 f 0.5" O.6 limiting factor Remarks: Boring # 6 -/0 /0 a rn r - 0.3.2 �0 6 mir Rs /f' s 3 - 7 s Vf VIV none- 5 2rK! C; ac — O•S J Ground 51/ ( /j ob S fll rvl I Q LA.) — 0.7 , 0. &'- cP /1 one 5 1 wL 6ke ►+a F i Depth to a limiting -� factor ? t/_ in. Remarks: CST Name (Please Print) ignature Telephone No. a to _ Cri5 - ).2- Ve- 3 2- 71 Address Date CST Number Af • 3(p0Z 3 ) LAI SCkj L Cam_ e /. syOZO & 3 1 777 SOIL DESCRIPTION REPORT F PROPERTY OWNER -�' "'`rY Page �- of ' PARCEL 1.1131 Boring 9S- Boring # Horizon Depth Dominant Color Mottles Structure 2 Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots in. Gr. Sz. Sh. Bed ,Trench /0 iP ne"' S1 1.( C-r M�'/ a Q. O. 9 /O ye &One S! 2 f" 51# r W d' O• S";p. 4 Ground _� T g S/ -(..( 2 M G� . (� elev. k T cs M SO ✓ r o. S (o Depth to limiting -75. factor > 120 in. t� •Z Remarks: Boring # n ow- 2.4 ed- e- as -2'dr ©.s ; 0.(0 i Q 3 azX InvR4 Of > S Ground _ Q/ 5 v �f� t't✓l "_ — . 3 ; & elev. /C Depth to limiting factor tin. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # 0_/0 /Q z 51 24' W. C w/� �/�" 5 ,z o. o /lent. 5i( �, r+t r C� _9 0.- o• 4 Ground 7iZ 7. M6 0 4 0 ' � S Q G $ (lffa �/� i r • 3 'O. elev. y ft. Depth to limiting factor .Lin. Remarks: Boring # ,1 FF Ground elev. ft. , Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) G B u t�c►ut �rce Lev = 892's, . b -2 � 5�i1 obS¢Na�:m.,pt� N P 9 p N iv %b P art 122 "a64K � Q owri e('' A rrles !? rf/ "eard B s' �_ Sy Loc.a --6'oy7 5EY-(SE1'g See. /S; 7-4*, _ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owncr/B"bT r Mailing Address Properly Address (Verification required from Plnning Department for new construction) Qt3atate ia c ation Number 0 �D — ,S = D D y D 3/ 9 LEGAL DESCRIPTION Property Location %, y,, Sec, 1 _ T2N R Town of T P Subdivision _ Lot # Certified SmTey Map # D Volume Wage # Warranty Deed # At _ ® Volume Z& A page # Spec house ❑ yes ❑ no Lot Imes identifiable. ❑ yes ❑. no SYSTEM- �1�IAINTENANCE m cmd ofy' oarseptwsyd =couldremkiaitsp tui+cfa =tohaadtewaa=Proper consists of pa�mpiog out the septic tame every tinoe yearx � scones; if ieoeded by a iiceasod pampa; What you pat.iato tfu system can affect.&& function of the septic taalcas.a ta=ftneats4v is &c w:ste sd . The pwpcxty a8roes to submit Croix Zoning Deparrmenti =ffi xtion farm, dgaed by the •owner andby a - p =tidodplumbcrori lio=odpmmpa vcrwyiog aw (l) &c oa�siw ' -- disposd sysomh is is proper operating condition and/or (2) after kVoctioa and pmgft.(if may). the mpd tank.is iess .than i/3 full of sludge. Ywc„ 8rc undetsigood have read the above wquirmnents and agree to ma;-b;- the pdvate sewage disposal system with the standards set forth, herein. as set by the Department of Commence and the Department of Natural Rasoac+oes;'State of Wisconsin.. Catificatioa statingthat septic system has been maintained mast be completed and retuned to the SL Ctoix.Couaty Zoning OTT within 30 of the e year expiation date. J OF APPLICANT DATE OWNER CERTIIz'IC MON I (we) oatify that all statements on this form are tine to the best of my (our) knowledge, I (we) am (are) the owaa(s) of �e city cn'bcd above, by virtue of a wananty deed seconded in Register of Deeds Office. OF APPLICANT DATE ssssss Any information that is min- rcpresentedmay result in the sanituypennit being revoked by the Zoning Department. 40S0Ss ss Include with tuts appticatfon: 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 Y01. . 1430 PAGE 401 / STATE BAR OF WISCONSIN FORM 1 -1998 604130 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between, Grantors James P. McCarthy and Carol A. McCarthy, 06- 02-1999 10:00 AM husband and wife, and Grantee Tony Ninneman. Grantor, for a valuable consideration conveys to Grantee the following described WARRANTY DEED real estate in St. Croix County, State of Wisconsin: EXEMPT I CERT COPY FEE: �Parce I COPY FEE: A pe>c;,of land located in the Southeast quarter of the Southeast quarter of Section TRANSFER FEE: 37.50 14, Township 29 North, Range 15 West, Town of Springfield, St. Croix County, RECORDING FEE: 10.00 Wisconsin, further described as: Lot 1 of the Certified Survey Map filed of record PAGES: 1 May 3, 1999 as Document No. 602422, with the St. Croix County Register of Deeds. Area Tony Ninneman 3133 Campground Lane Glenwood City, WI 54013 Parcel Iden ification Number (PIN) 0 '4&4 I 0 31 " q-7 This is not homestead property. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements and encumbrances of record. Dated this let day of June, 1999. 1 AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN) COUNTY OF ST. CROIX) authenticated this day of James P. McCarthy and Carol A. McCarthy Personally came before me this 1st day of June 1999, the above named to me known to be the person(s) who executed the foteg0m$VW erlt and acknowledge the same. ��``�•l`, W IZ)O, TITLE: MEMBER STATE BAR OF WISCONSIN _' CJ••�� '`�. ••�,% (If not, _ 7k . * • authorized by §706.06, Wis. Stats.) Notvly Public, State of Wisconsin . • issio I= 2 -23 -2603 ' THIS INSTRUMENT WAS DRAFTED BY P i��iJ1� • • "D` , � ; •e������ James IL Krave PF WISG4? P.O. Box 304 ��rrutnl� +t Glenwood City, WI 54013 (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of person+ signing N &M capacity should be typed or printed below thew 54rAuaes WARRANTY DEED STATE RAR OF WLSCONSO4 FORM Nw I - IM FILED {� MAY 0 31999 ► U KRHMIMUM 602422. j v 1 CERTIFIED SURVEY MAP Located in the Southeast quarter of the Southeast quarter of Section 14, Township 2 9 North, Ra ss a 15 West, Town of Springfield, St. Croix County, . Wisconsin. Owned by: James & Carol McCarthy Surveyed for: Tony Ninneman Glenwood City, Wisconsin 328 Maple Glenwood City, Wi. UNPLATT_ED LANDS r S 89..'08'24 "E 4-17.42' 3 z'1aY 0 3 '99 Comprene cw, i ....uu„ Zoning an!+ ParKS COmm:n.e (j); 217,800 Square feet (5.00 acres) 11 motrecc'mw r ilin 9O days of Includin Z , $ g ht -of -way _ liproval0ale _ 204,025 Square feet (4.684 acres) shall be Qi m Excluding right -of -way. m ON andvoa Jl N _ N Ln - 9 1 "mw to m 03 O o H .. v O O r (U 1 CU O LUi Lo h �1 LU I— QI O ti OQI JI O W O JI � � o Q- I 2 W N 21 Z, ? Sfl LINE �1 t 1 y W 3 100' SOUXN LINE OF THE SE - SE. - z _ S 89_08'24•E 417_42' -- 900.99 N89 COUNTY HIGHWAY e N89•0e24 "w 'O 1 N 89'08'24 "W 417.42' a SE Corner S1/4 Cor. I M Sec.14- 29 -I'S . — — — — — — ` — — — — — — — — — Sec.14 -29 -15 (square bar i UNPLATTED LANDS (PK nail found.) found). --- - - - - -- - - - - - --- Legend 1 �� • denotes 1 "X24" Iron pipe weighing 1.16 cn� Of pounds per lin. foot set. r��N� ° ► /p V, O, Bearings referenced to the South line of "#!"" SGo�l$� � �1 the Southeast quarter of Section 14- 29 -150 �`�� 4 N NI assumed to,be4r Na9 °08!94 "W . HARVEY JOHNSON S -1099 HUDSON SCALE IN FEET %'= /00, yam! < WIS ...+ �� s 0 �� N� SURJ o /oo z �e This instrument drafted by 4992632 Vol.13 Page 3637 L£9£ 96ed EL i S t1f ►+ g ... 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CROIX COUNTY ZONING DEPARTMEN g >> AS BUILT SANITARY REPORT Owner Property Address i^ ,.�v / (� 51 owX� City /State FfIGE ` Legal Description: �- Lot Block Subdivision/CSM # = ' /�' /4, Sec. , T 4N- W, Town of a '"a ^� �-- PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer AAC Size ST/PC Setback from: House Well P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake -Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: y'tn Width Length 5 Number of Trenches Setback from: House Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark Elevation Description of alternate benchmark Elevation �f Building Sewer 4 / ST/HT Inlet _ ��FAAr ST Outlet �/7d� Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines Bottom of System Final Grade (7) �) '✓ ( ) Date of installation I ' Permit number State plan number Plumber's signature s License number y Date l� /f Inspector 0,111 Complete plot plan f u� NOTICE Please provide the following: 1 • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. r PLAN VIEW Ib o� L fl U INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT IX GENERAL INFORMATION (ATTACH TO PERMIT) SanitarY338�912 Personal information you provice may be used for secondary purposes [Privacy La 1 s.15.04 (1)(m)]. Perrlbi,'"eCW72R' GARY ❑ Ci1y JWT State Plan ID No.: CST B�M Insp. B v.: BMG scri - p a tio � Parcel Tlch: 1049 -55 -100 TANK INFORMATION `. ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic otrD Benchmark 3. . N? job 0 Dosing .D r Aeration Bldg. Sewer Holding 41M Inlet TANK SETBACK INFORMATION t i. Outlet TANKTO P/L WELL BLDG. Ventto ROAD -DtrtTltet Air Intake Septic SSE) 3 p ' NA Dt Bottom Dosing NA Header / Man. }Z 9 v Aeration NA Dist. Pipe . 0 0 ,O Holding Bot. System 3, 9 PUMP/ SIPHON INFORMATION Final Grade F2_ JS, LY Manufactu Demand / .S. Q .( Model Number GPM TDH Lift L oss on Syste TDH Ft ead Forcemai n Length Dia. H Dist. To well SOIL ABSORPTION SYSTEM 2) ' X67 REN Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S' 9L DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING M r' e�y` INFORMATION Type Of �� r CHAMBER M el Numb l System: C��J - ( O r OR UNIT DISTRIBUTION SYSTEM Header / Manifold W Distribution Pipe(s) ` / x Hole Size x Hole Spacing Vent To Air Intake Length l 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 COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRAIRIE 11.31.18.209C,SE,SE 2211 127TH STREET — LOT 2 V fil � gM = �6v-aJA? et Ian revision require? ❑ Yes ❑ No /f �S 5- 6 Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division *6consin SANITARY PERMIT APPLICATION 201 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 - 7302 • Attach complete plans (to the county copy only) for the system, on paper not less County t than 8 112 x 11 inches in size. �j • See reverse side for instructions for completing this application State Sanita Permit Number - 3 - 3 1!�l ti- Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Pro erty Loc bon s-. /a .1 /4, S T , N, R �o Property Owner's Mailing Ad ss I Lot Number Block Number L// , Cit tate t Zip Code Phone Number Su vision Nam r C M N m r ( -6 DC. o . 11 p 3)1 (. TYPE OF BUILDING: (check one) ❑ State Owned ❑ !t� Neare oad VII age Public 1 or 2 Family Dwelling - No. of bedrooms Town OF s Ir/ / III BUILDING USE (if building type is public, check all that apply) Parcel Tax Number(s) 4L�� LS- '209 L 1 El Apartment/ Condo �� D _ l �� `�r'"�O 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. E] Replacement 3. [:1 Replacement of 4. E] Reconnection of 5_ ❑ Repair of an - ___ ------ __System _______ Tank Only __ Existing System ________ Existfn 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 E] Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 r Trench 22 ❑ In- Ground Pressure \ Z5 42 ❑ Pit Privy 13 ❑ Seepage Pit J 43 ❑ Vault Privy 14 E] System -In -Fill / �G / d0 ks ( �� '3(. Q, VI. ABSORPTION SYSTEKA INFORKIATIOW r 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Requir (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min. /inch) Elevation J_ • "'b � Feet 7 Feet VII TANK Ca acct g in g allons Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existing structed Tanks' Tanks Septic ' T a BC�O ¢-� El 1:1 1:1 1:1 Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print / Plum Signature: (No Stamps MP /MPRSW No.: Business Phone Number. PI rs Address (Street, City, State, Zip Code): /^ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater F e Issued Issuing nt ignature (No Stamps) [Approved ❑ Owner Given Initial 6O Surcharge Fee) P Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety a Buildings Division, Owner, Plumber rev i h'LAN d.,2e � �1��' �. i�/ PROJECT v� aur�� ADDRESS S 1 /4 1 /4 /S!/ /T� /N /R / :W ' TOWN �" COUNTY MPRS Byron Bird Jr. 3318 DATE BEDROOM CLASS PERC -GROU PRESSURE CONVENTIONAL LIFT MOUND HOLDING TANK SEPTIC TANK SIZE ,/� LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE BED SIZE o2 , 3 XS 5' IL Benchmark V.R.P. Assume Elevation 100' Location of, Benchmark * H. R. P. 0 Borehole Q Well Scale Feet — 0 Per Hole System Elevation 3 jVo IL �s y-0 Wisconsin Department of Industry, SOIL AND SITE EVALUATION -Labor and Human Relations Page of Civisiokof Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 81/2 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 Review by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)): Property Owner Property Location ♦ ela- t.�- Govt Lot � 9 1/4 M 1 /4,S ❑ T3 t ,N,R E ( Property 9 Pro P a Owner's Mailing 'Address Lot # Block# Subd. Name or CSM# ® 42 77 City State Zip Code Phone Number Nearest R r 6 ! ( ) El city ❑ ' I `ge Town Q� New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 'y V gpd r Recommended design loading rate — J—bed, gpdO ' trench, gpd* Absorption area required ��' bed, ft ✓ trench, ft Maximum d si bed, 9Pd/ n oading rate ft = trench, gPf Recommended infiltration surface elevation(s) _A 9.S.J AA ft (as referred to site plan benchmark) Additional design/site considerations Parent material a a Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT Grade System in Fill Holding T k U= Unsuitable for system S❑ U S❑ U`] S U S ❑ U M S U ❑ S aU SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 0 -i2 Ground / � le Depth to limiting �� L fa in. Remarks: Boring # Ground � Depth to f limiting / Remarks: " 11 ST 11ame (Please Print) Signa ... Telephone Np o Address � � Date FA ' M l .:.:..::. : Color Gr. Sz. Sh. 0 Dominant Color Mottles Structure �M , M JMEM&Mr MIMa Falb M MOMM TAM- FRM- .. " PRA -M r�Mn�, WWI MEN so rOMFFM M M� M I vM, I rim .. MM MM • . . c . Dominant Color • • • • ® ® ®® - • . ti o .0 • , 1 1. a WA �. �� :� Soil Test Plot Plan Project Name Clay Edin — y B r Bird Jr. Address 2220 127th St. New Richmond Wi 54017 #3 #3479 Lot 2 Subdivision ---- Date 5/4/96 SE ' 1/4 SE 1/4S11 T 31 N /13 W Township Star Prairie M Boring ()Well PL Property Line County S T. CROIX lk BM or VRP Assume Elevation 100 ft SE Property Stake System Elevation 95.1/95:1 *HRP as Benchmark 2 - 7 4,1 312' P.L. B-2 40" B-5 N J b 80' 1% l B -3 20 + !i a3to4 Bedroom House Pri A Rep A 30' 25' • B -1 B -4 40' .. .M.a 12' P.L. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address _ s vDi7 Property Address 1? ✓�5/��— ��l /��' �� (Verification required from Planning Department for new construction) City /State Parcel Identification Number D LE GAL DESCRIPTION Property Location Sec. �, T N -RZ!� Town of Subdivision S , Lot # Certified Survey Map # S L/� /7�, Volume / , Page # 4 Warranty Deed # ,Volume ,Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of he three year iration date. SIGNA E OF APPLICANT 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 owncr(s) of the pr rty described above rtue of a warranty g deed recorded in Register of Deeds Office. 3 1 10 1 9 SIGNAT OF APPLICANT DATE * * * * * * Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ' GU 2 4PAGE187 State Bar of Wisconsin Form I - 1982 602574 KATHLEEN H. WALSH WARKANT'Y DEED REGISTER OF DEEDS DOC ST. CROIX CO., WI RECEIVED FOR RECORD '1111S DEED, made between Clay. A. Edin, a single person , . 05- 04 -1999 1:15 PH ............................... .. ............................... ............... WARRANTY DEED EXEMPT I ............ .... CERT COPY FEE: COPY FEE: ..... , Grantor, TRANSFER FEE: 47.70 and , _ .Gary I. RECORDING FEE: 10.00 Gsterbauer and Mae I. Osterbauer, PAGES 1 husband and wife as survivorship marital property THIS SPACE nESERVE FOR RECORDING DATA Gfalllee, NAME AND RETURN ADDRESS: - -_ -- WITNESSE "1'11, That the said Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix EAGLE VALLEY BANK, N.A. County, State of Wisconsin: 1301 Coulee Rd., Unit 2 Hudson, WI 54016 0_3 1049 -55 -110 PARCEL IDENTIFICATION NUMBER Part of the Southeast Quarter of the Southeast Quarter (SEJ of SEJ) of Section 11, Township 31 North, Range 18 West, described as follows: Lot 2 of Certified Survey Map filed June 12, 1996 in Vol. 11, Page 3113, Doc. No. 545175. This is not .. .. homestead property. (is) (is 1100 Together with all and singular the bereditamews and appurtenances thereunto belonging: And Grantor .... .. ............. warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except . ............................... easements, roadways and restrictions of record and will warrant and defend tPIRsarite. Dated this`1 day of A ril ....... . P 19 99. . (SEAL) — (SEAL) �__C_ay__A._ Edin_. ____ - - _ (SEAL) (SEAL) ............ ............................... ...................... ............................. AUTHEN'TICA'TION ACKNOWL-E�G �N v `� Signatures) STATE OF WISCONSIN ? '� 3 S. St..Cr.oix.. .... .County. .. authewicated this day of 19 Personally came before me this a Jay of 19 9.9 the above ranted ...Clay. A.. Edin ......................... . TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Section 706.06, Wisconsin Statutes) to me known to be the person .. .. ..... who executed the foreg i11 instrument aii ckjle a the same. THIS INSTRUMENT WAS DRAFTED BY ° � . ............ Michael H . Forecki, Attorney * Kathleen R. Videen Eau Claire, Wisconsin .................... Notary Public . ...... Polk ........ County, Wis. (Signatures may be authenticated or acknowledged. Both are not necessary) My commission is permanent. (If not, state expiration date: ' Names of persons signing in any capacity should be typed or printed below their signatures. June 24 M200 . t F►L,Ep a APPROVED 2 1996 ► %istai of wn & 5451'75 JUN 1.2 '9b' SL � & � _ a CERTIFIED SURVEY MAP ST. CROIX COUNTY ocated in Part of the Southeast Quarter of the Southeast Quarter of Sectio JIPWCV . Plannu Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. OF W1S, Zoning znd g Committee Prepared for and at the request of: Clay Edin 4 DOUGLAS I 11;6o recorded 2220 - 127th Street to ZAHLER New Richmond, WI 54017 Drafted by. James M. Braul * S-2145 i days of HUDSON, ap val date EAST 1/4 CORNER SEC. 11 WlS. at shah be (1 IRON PIPE) UNPLATTED - LANDS / '4� A & vr)id - - -- 2624.52' S 00'51'13" W EAST LINE OF THE SE 1/4 V. 1_ ■H. * C * R.O.W. LINE / \� S NER SEC. 11 _ — — — �� (COUNTY MONUMENT) - - -- 656.13' - - -- ° - 1968 'i " 46 o r l� --r ��--- - - - - -- 0 r 1� LOT 1 AREA — 653,380 sq.ft. o r 1 1 ` r 1 1 / 15.00 acres s I 11 R.O.W. LINE S 00 W 604.37 " AS,SS � r I l / c' • , , s�.��•� 1 1/ AREA EXCLUDING R. 0. W. T i C - ++ ... ........................... 0 O C o o , ss, (i 583, 610 sq. ft. a o / I I 1.3 40 acres C o .x / 1 6 6' I O r N o NI Y I I LOT 2 AREA o . N Qi a 68,133 sq. ft. C) ° -jI m I 1.56 acres AREA EXCLUDING R. 0. W. m 65,340 sq. ft. N 0 ° U QI 0- c -> a I i -' _ 00 I ' I 1.50 acres O Z I t0 O N n I I E U a0 F5 2 � � rn Co I i _z LOT 3 AREA .E U `v M rn O I 1 3 J 68,119 sq. ft. a� E ,, ° W i i J 3 I I o 0 1.56 acres `o v cm I , O 0 _ ° ° , N I I o AREA EXCLUDING R. 0. W. a° CID ° ; o^ o I N I rn 65,340 sq. ft. " c °' ° E 3 a� z a M ;� I 1 1.50 acres o a> < N O) Z 1 I W I o, O 0-\ o z I j I Q LOT 4 AREA c �v a o� W I 0. ° o° a m� I I Z 77, 328 sq. ft. 3 •- °+ ° I I �I 1.78 acres �- 0 w = o N° O p Q AREA EXCLUDING I R. W. W o,L z� rn r a� ° ° _, o , / I 65,340 sq. ft. u c �� r/ I, I I 1.50 acres L- o ° z N �i� - -- S 00'55'12" W 655.89' - =- -_�I 1 � m o i �r- 209.17' - 1�- - i� r T ° o 209.17 - / 208.48,- G < N a� I o ,,, 1 I-- m w i ;' i 23 29 b�'`r� i I M i z <i 3 N M* �t ; ' I ° I q CM I I o� O° ( !0 O n t n- n- w `� N `� I �I W W Z N N 17 n O a c O D ,,, O 0 M N I`F o I I F-I z - N J a� .- J a ui cV O O IL IU. �j cV t�M 00 C4 r7 N '" �NIM !nM'� O oZo .............: ......... I a .. Z in . M I N , MNOO'55'12 "E N N"'I I �I � Uj a_ m in -- 628.21' -� ) ^ -- I I I I o = z n ` 209.17'- i r- 209.17 / ! - 209.87' = ,\ / c� ~ 0 z 0 R. O.W. LINE— CENTERLINE 209.17 - 209.17 - ' - �� 41 N v ° m 237.47'' z z CENTERLINE OF 127TH ST. � —` i� -' `� ° R.O.W. LINE — — �\ — — ''I z U- w z ~ 655.82' N 00'54'03" E r o F W TREET _ r oW ulNN 127TH S �� < WEST LINE OF THE SE 1/4 OF THE SE 1/4 O! o 0 o rn 2 z U NPLATTED LANDS 0 _ a �o m� LEGEND A & E LAND SURVEYING County Section Corner Monument. Z PHONE # (715) 246 -4319 of Record GRAPHIC SCALE P.O. BOX 325 Set 1" x 24" Iron Pipe weighing 0 50 100 200 300 400 109 EAST 3RD STREET a minimum of 1.13 pounds per NEW RICHMOND, WI 54017 linear foot. IN FEET 1 inch 200 ft. Sheet 1 of 2 VOLUME 11 PAGE 3113