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HomeMy WebLinkAbout038-1165-50-000 C c o 0 p a vo a) rl n a � I C� o I N O v I �i r!' I C � I I O Z � I a Z C _ LL c LL d � � I Q I I O � � I Z w co w E U) I' o I o .E L z a m o Z o I c C7 - 0 2 v c � p I d 2 c 0 0 N N O a a) ) of N U) fn 1 • N � n U .0 ° U cu 0 o Q ~ Z H Z o N 0 Z d N cd O a) - E Q y A L U d U 3 N Q l0 w (O (0 D a O C °- 0 00 0 N > O O O . , a� O O O Z O O •N m �', `� a a a a E o ai in rn rn a N U 0 rn r- N ^YJ J \ N p N O O _ `J E - 7 1 , :3 Z m In 2 �j • . � °�-' Q } i.., � � i � o � I ° � c ++ 0 0 0 a E N LO O o � ~ 0 0 v o ° Lb � H cn E N N N Lb 00 C to w � .@ I '. C M CL 0 • '� (`') O @ t �r C3 to O a) U y O CO (n (n M O z N Z Y (n O � j r.+ .r M a as EL a > • CL m .2 m r `Fv E ` ' c 0 r A Cd ci a 2' o c L ) t Wisconsin Department of Industry SOIL AND SITE EVALUATION REP Page 1 of _3 Labor end Human Relations Division of Safety &Buildings in accord with ILHR 83.05, Wis. Adm. - r" C Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must te e, but, " Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, or EL LD.� dimensioned, north arrow, and location and distance to nearest road. 038 -1 `6 50 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVEWEDB DATE -1 PROPERTY OWNER: PROPER A71E�1V' <' Terry Shilson GOVT. LO ,.. S `'Ql�,S Q'T 31 N,R 18) W PROPERTY OWNER':S MAILING ADDRESS LOT # BL D M # 949 Warner Ave. 25 na s w Addn. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE JUOWN. NEAREST ROAD St. Paul, MN. 55115 612) 426 -6093 1, Co. Rd. #C [)d New Construction Use [x ] Residential / Number of bedrooms 3 ( ] Addition to existing building L ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 4 bed, gpd/ft •5 trench, gpd /ft Absorption area required 1125 bed, ft 900 trench, ft Maximum design loading rate .4 bed, gpd /ft .5 trench, gpd/ft Recommended infiltration surface elevation(s) 93.55 ft (as referred to site plan benchmark) Additional design / site considerations alt. site teenches @98.15 3' below surface spaced to code Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK U= Unsuitable fors stem ®S ❑U ®S ❑U ®S ❑U ®S ❑U ❑S X] U ❑S :K] U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -9 10 r3 3 none sl 2m r mfr cs 2c .6 `" "' 2 9 -31 10 r4/3 none sl 2m r mvfr gw if .5 .6 Ground 3 31 -90 5 r4 4 none sl lcsbk mfr na na .4 .5 elev. 101 ft. Depth to limiting factor +90 Remarks: Boring # 1 0 -13 10 r3/3 none sl 2m r mfr gw 2c .5 .6 2 13 -36 10 r4/4 none sil lfsbk mfr gw if .2 .3 3 36 -80 7.5yr4/4 none sl lcsbk mfi na na .4 .5 Ground elev. 101 ft. Depth to limiting factor +80 Remarks: CST Name: Please Print Phone: Gary L. Steel 715 246 - 6200 Address: 1554 200th. Ve ., New Richmond, WI. 54017 m02298 Signature: 5 -20 -96 Date: CST Number: PROPERTY OWNER T. Shilson SOIL DESCRIPTION REPORT Page 2 of 34 s PARCEL I.D. # 038 - 1165 -50 , Lot #25 Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ...r..`` 1 0 -16 10 r3 3 none sl .5 .6 fM 2 16 -52 10yr4 /4 none sl 2m r mfr crw I if .5 .6 Ground 3 52 -84 7.5 r4 4 none elev. 97 ft. Depth to limiting fac% Remarks: Boring # 1 —12 10 r3 s f.N 4 2 2 -51 1 .7 .8 Ground 3 1 -80 7.5 r4/4 none sl 2msbk mfr m elev. 96 ft. Depth to limiting factor +80" Remarks: Boring # 1 —12 10 r3 3 none sl 2mar CS .< 5 2 2 -22 10 r4/4 none sil 2m r mfr Cfw if Ground 3 2 -36 7.5 r4 4 none S1 2 elev. 4 6 -80 7.5 r4 4 none sl lcsbk 96 ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to fruiting factor Remarks: SBD- 8330(8.05/92) s STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Terry Shilson New Richmond, WI 54017 MPRSW 3254 NW4SE4 S30 -T31N R18W (715) 246 -6200 town of Star Prarie lot #25- Crestview Addn. N 1 =40' Brn.= top of mid lot survey stake L el. 100' 1 O Y( 5 O� 8- v Vo jo y , S G F I 16 � t � W 03 ` Gary L. Steel 5 -20 -96 II . �10 to to �� r �. 23 2.988 AC. 0 5 f. v ? a -- �{ 25 2 34 a .L p jrrRM WAT 'ENTION •� Fi EAr a ~� `��� �7 26 s f ' 1 4 1 2 AC p� � 27 f h 1.41 2 AC. 0 �, ST. CROIX COUNTY ZONING DEPARTMENT y 19 1` • AS BUILT SANITARY REPORT � � � � �✓ Owner - y .`C.sdi, Property Address P.a ,6 o 5' S City /State —A �,o 19 r S r, Legal Description: / �ct7 � Lot 2 �"" Block Subdivision/CSM # C AA 5 - 4 A- /a i /4, Sec. , TAN -R / Town of Via.- / PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: r Tank manufacturer Size MO / Setback from: House ; g" Well P/L - 7-5 Pump manufacturer Mo fel 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: TrC -Z" Width 7> Length 6 z i Number of Trenches Setback from: House Well `S P2 Vent to fresh air intake 7 Sv' ELEVATIONS Description of benchmark To jo 114 a Ln l" S r jc P-- Elevation �d � Description of alternate benchmark T 0 2 d- 1,0 e LC Elevation r Building Sewer ST/HT Inlet 2,77 ST Outlet " - PC Inlet PC Bottom Header/Manifold ` Top of ST/PC Manhole Cover 0 0 f 2 ,1 Distribution Lines () 9 Bottom of System Final Grade () () ( ) Date of installation 110 Permit number 3 - l "el -3 State plan number Plumber's si nature License number zs .. / s`z Date g 116/ S � ' Inspector Complete plot plan i 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 JI 1 Y � r INDICATE NORTH ARROW o �� �2 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y: Safety•and Buildings Division a INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST CRO IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338943 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: SHILSON, TERRY STAR PRAIRIE _ CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: C*10 j C0 .0 :cQ (&t — �✓ _ 038-1165-50- TANK INFORMATION EL VATION DATA A9900206 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S(� Benchmark 7-i IDS. (, � I Dosi n g , G 0-�, 36 1 0 3-140 Aeration Bldg. ewer g' S ?z, q °Y. 78' Holding St/ Ht Inlet C d �' }� q . S'? TANK SETBACK INFORMATION St /Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ) 57D 3 D � 0 — NA Dt Bottom Dosing NA Header / Man. l0 • S$ S Z Aeration NA Dist. Pipe — /°• R to.go logo �o.c -a q� 90 f2.f 93•s's� Holding Bot. System ,ego 9 .so PUMP/ SIPHON INFORMATION final Grade 3 Manu and 9 /Od. Model Number GPM TDH Lift Frictio S TDH Ft Force Length Dia. FI Dist. To we SOIL ABSORPTION SYSTEM Z 3`x 6 ' -�, Q,,, p t -, A 8+69 TRENCH ) width t Length r N Of Trenches PIT No. Of Pits side Dia. Liquid Depth DIMENSIONS 3 2.5 DIMENSION SYSTEM TO P / L BLDG FWELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O ��rr � r C i Mo I Num System: lre7V�.�J . a 3 > O 0 OR UNIT ( — �C t DISTRIBUTION SYSTEM Header/Manifold (i I Distribution P e s) x Hole Size x Hole Spacing Vent To Air Intake — + r Lengt Dia- Length ia. Spacing 7 too SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only % t Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes El No El Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) { LOCATION: STAR PRAIRIE 30. 31.18.789, NW, SE 1941 RIVERVIEW LANE c ` 1( `__ �° ®as�o 1 61 sk-�. �� ► �, . _ STS= ,T3 s © bra vJ a-.4 w S`�ac.. — �— 6.4 3 �tgr � t-- ke, ` I . Plan revision required? ❑ Yes ANo Use other side for additional information.. 2 �O Y SBD -6710 (R.3/97) Date Inspector's Signature Cert No. Y Safety and Buildings Division NVIsconsin SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue ' Department of Commerce In accord with ILHR x3.05, Wis. 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. ST Gro • See reverse side for instructions for completing this application State Sanitary Permit Number 331 4 3 Personal information you provide may be used for secondary purposes Check it 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 Property Location S il . , L h )CA..114 - j 114, S — ")( - ) T at , N, R 8'E (ordo Prope Own 's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned " It Nearest Road ❑ Village Public or 2 Family Dwelling No: of bedrooms _ wn of ST P Co A? ' t C III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 3 a2J1 1 b 1 [] Apartment / Condo �— �� — .r 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 gL 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 33E '¢? Date Issued 5 - 2_ — 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 12jj34eepage Trench 22 ❑ In- Ground Pressure r 42 E] Pit Privy 13 ❑Seepage Pit �) V �Z•S 43 E] Vault Privy 14 ❑ System -In -Fill N ,�; 1. f„.� -War t elf 3I SF- - A 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 (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 00 400 �� -- 7_3 S"rFeet S'l S7'Feet i VII TANK in g allons Total # Of Prefab. Site Fiber- Plastic Exper_ INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel New Existin structed glass App. Tanks Tank e tic Thnk 7 /' (,J ` , e ❑ ❑ ❑ 1 ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ LEI 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) Plumber's Signature: (No Stamps) /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): `/ -S A.. 4� cn IX. COUNTY / DEPARTMENT USE O NLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Iss gent Signature (No Stamps) [Approved E] Owner Given Initial Surcharge Fee) Adverse Determination '71 L7�19� X. NDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Il/ rFv_� +C. �W, &,6- P($K44 ,� Ccxl�c.- cwrY fvuz-f� 6b �oW�Gr % 4 t„ CC4AA cA u 1J�,u� I9+/I(d+ �Q.✓ Gbv► CoM�� w���t al �/��iG�7/s Coz�ti SBD- 6398 (R.11/97) DI RIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber Safety and Buildings Division Vi PERMIT APPLICATION 2 01 W. Washington Avenue n In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary P ermit Num Opplication er p urposes P P ❑ Check if revision to l. Personal information you provide may be used for secondary ur P [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Property Location Sri^ L, S In v1s er h tV4 ,) /4 S C_ 1/4, S 3 c2 T , N, R PE (or) W Property Owner's Maili g Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number •e rS c 7` 4 .S 4 01 S' I ( > e r es iv.'e w Ld 11. PE F B IL NG: (check one) ❑ State Owned It� Nearest Road E] Vil age Public ff4 or 2 Family Dwelling - No_ of bedrooms _m7__ own OF S a civ III. BUILDING USE (If building type is public, check all that ap j�jPt ftv, 9cel Tax Number(s) 50- --&7t 1❑ Apartment/ Condo O 7 P- 116 J l'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. ❑ Replacement 3. Q Replacement of 4. ❑ Reconnection of 5. Q 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 E6- Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Q Seepage Trench 22 ❑ In- Ground Pressure ��' x /_ 42 Q Pit Privy 13 E] Seepage Pit UJ 43 ❑ Vault Privy 14 ❑ System -in -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) eva t ion S 6V RS S"G Y ! 3. -S _ El 3— Feet 5;43I eet VII..TANK Capacity INFORMATION in gallons Total # of Manufacturer s Name Concrete Prefab. Site Fiber- ass Plastic xppr. Gallons Tanks Con- Steel New Existin strutted Tanks T nks Septic Tari _ - '-- 7S(� <1 L./ r G.P t v ` � ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ I ❑ ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) 1 7 P RSW No.: Business Phone Number: �C'C_ 4 4 .� C . �✓ Crate �✓ 2- J-V Plumber's Address (Street, City, St te, Zip Code): Va0 sT /(d Y6 -e c✓r sve IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing g Si nature (No Stamps) Approved E] , rgereey Owner Given Initial � G Advers Determination) !O �< 01 'aw X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: • erV, 4D 0011 to "di ft o ill i f C04. alv ✓t" cdnsly've*671 (##1 #10#1 f7 4" v ��✓� S(Vl ��I�wce opt( `oca �� ''� I,�/e I T1d PK� � C� ill e s. BD- 6 (R.111 106 r n s IB lj� g�i 1 taK.�nty, n j T uiidings Division, Owner, P umber 7 / (r • 05/14/99 LION 11 -16 FAX 715 386 1686 S'1 CRX CO 'ZONING �03004 Terry Shilson NW%SE� S30-731N _R18W P� u �^ ► e tcnm of Star Frarie lot #25- Crestview Addn. Bmn. top of mid lot survey stake Lp el. 10o' �/k C ve. j h 4 7e r'Z7 - r a d ro0 7 0 �U� e o D -2 Tle 4 j l0 t r 4e �- 'i CUve," VC T7Pa�• e Terry Shilean _ NWhOth S30 -T31N R18W torn of Star prarie /j lot #25- Crestviev Addn- N 1 «=q0 Bm.= top of mid lot survey stake 0 el. 100' Sc,4 Y IUO TG vrCe dt 5 rJ h vQ h " 3Z Soy L 7 �r � 7 Tv Go �`� -• � T' �- c✓ Y�1 C C 7.5-0 y� $� 5 16r� dpi r r 3 %0 � #61-4 � fly •30' 2 6• 3 � G am' jf t 05,/24/99' MON 11:16 FAX 715 386 4686 ST CRX CO ZONING WJU05 • 4 ' NF � s�30 -13 Nl R18W £ tom of Star Prarie 2a S / ry lot *25- creetvieW AMIM- 001 pn t0* d' mid lot surv@Y stake 0 el. 100 Sc L Y U �z �hr G-.e 1.e r y v �- Gv a Ig✓ %f Ty �ac� ro c A o br r. v T: a 9 z sr 8, L :mod . • . R1�WLDIttVOrpIMI10H1Yl ...�.,r, ,UIL A[VN .711 c cv^Lum 1 IVIY noun 1 Labor and Human Relations Division of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code LINTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BAA), direction and % of slope, scale or PARCEL I.D. * dimensioned, north arrow, and location and distance to nearest road. 038-1165-50 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REV D Y DATE r ?i PROPERTY OWNER: PROPERTY LOCATION Terry Shilson GOVT. LOT NW 1/4 SE 1/4,S 30 T 31 ,N,R 18 kff) W PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM 949 Warner Ave. 25 na Crestview Addn. CITY, STATE ZIP CODE PHONE NUMBER QCITY QVILLAGE 97OWN NEAREST ROAD St. Paul, M. 55115 612) 426 -6093 Star P ar'e I Co. Rd. [ New Construction Use Jx ] Residential / Number of bedrooms 3 [ ] Addition to existing building [ J Replacement [ j Public or commercial describe Cade derived daily flow 450 gpd Recommended design loading rate .4 bed, gpd/tt .5 trench, gpd* Absorption area required 1125 bed, 11 900 trench, 111 Mardmum design loading rate .4 bed, gpd/ft .5 trench, gpddt Recommended Infiltration surface elevation(s) 93.55 ft (as referred to site plan benchmark) Additional design/ site considerations alt. site teenches @98.15', 3' below surface spaced to code Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN IL HOLDING TANK U Unsuitable for stem ®s O U ®s O U ®s ❑ U MS ❑ U ❑ S K] u ❑ S :C u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouncl3y Roots GPD /ft in. Munseil Qu. Sz. Cont. Color Gr. S2. Sh. Bed Teich 1 3�- 1 0 -9 10 r3 3 none sl 2mcir mfr cs 2c .6 2 9 - 10 r4/3 none sl 2mgr mvfr 9W if .5 .6 Ground 3 31 -90 5 r4 4 none s 1 lcsbk mfr na na .4 .5 elev. 101 ft. Depth to l imiti ng +90 Remarks: Boring # 1 1 0-13 1 r3/3 none si 2 r mfr gy 2c .5 .6 2 2 13 -36 10 r4/4 none sil lfsbk mfr if .2 .3 Ground 3 36 -80 7.5 r4/4 none s1 lcsbk mfi na na .4 =.5 elev. 101 ft Dep to limiting factor +80 Remarks: T Narns:— Please Print Ga L. Steel Phone: 715 - 246 -6200 Address: 11 m02298 1554 200th. ., New Richmond, WI. 54017 Signature: Date: CST Number: 5 -20 -96 i � _ Structure mmm momm r mmm Dominant Color Structure p o� all s!�ra�naw ems... e e r STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 'ferry Shilson New Richmond, WI 54017 MPRSW -3254 N A 4 SEh S30 -T31N R18W (715) 246 -6200 town of Star Prarie lot #25- Crestview Addn. N V Em.= top of mid lot survey stake @ el. 100' I � VQ 14 c / ' S V 1 b o tT 30 d Gary L. Steel 5 -20 -96 I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 9 0 X 1 . Property Address l y j _ ' (Verification required from Planning Department for new construction) City /State .Scam -e A-Lf "r Lk-f-; / Parcel Identification Number � LEGAL DESCRIPTION t Property Location 1 /a, ' /a, Sec. Town of -s 0/3" Subdivision C r -e S / U .e. w 17 , Lot # S Certified Survey Map # , Volume , Page # Warranty Deed # °L / , Volume �2 v . Page # 3 7 Spec house ❑ yes U no Lot lines identifiable t 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, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. S� IGNA 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 owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGN OF APPLICANT ATE * * * * ** 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 2W. PAGE`S 48 54981.8 WARRANTY DEED r . Document Number REGISTER'S OFrIGC 3�� - ST. CROIX CO., WI t�!t�f:� ' Redd for Record )\J S EP 2 3 1996 Return Address Century 21 Premier Group � '' P.O. Box 286 3 4 at lo:oo A.{�{ New Richmond, WI 54017 s Ftegtster of Deus Parcel I.D. Number: 038 - 1165 -50 Lester H. Martell conveys and warrants to Terry Shilson and Sherry Shilson, husband and wife, the following described real estate in St. Croix County, State of Wisconsin: Lot 25, Crestview Addition to the Town of Star Prairie. SIFER This is not homestead property. $ T _ — Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 20th day of September, 1996. c , �n� /�1'a"Ol (SEAL) (SEAL) Lester H. Martell ACKNOWLEDGMENT STATE OF WISCONSIN ) ss St. Croix COUNTY ) Personally came before me t 's 20th day of September , 1996, the above named Lester H. Marte me known to be a person(s) who executed the foregoing instrument and acknowledge the same. * onnie M. Gullixson Connie M. Gullixson Notary Public St. Croix County, WI Notary Public M commission e 12 -14 -97 5ta My p to of Wisc on sfn THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016 \50 J ✓ I N 4J/ CO , S 24 , N r S \ 4D M M r ' I 3.319 AC. .n t0 J " g 6 to V • (V I �' ch r ' N OD S3 56 "E o 285.04 c°I ?�, w 23 ti M 2.988 AC . OD OD �, �o W I 12'� , ap y r a ao cn J O 00 ~o S 3o 15'56E a O ; W/ p2 A 269. _ o� U M a , oo N27 15J. W 2.596 AC. 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