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ST. CROIX COUNTY CERTIFIED SURVEY MAP LOCATED IN PART
OF THE NE 1/4 OF THE SW 1 /4, SECTION 2, T 31 N, R IS W, TOWN OF STAR PRAIRIE, ST.
CROIX COUNTY, WISCONSIN; ALSO BEING PART OF LOT 3 AS DESCRIBED IN VOLUME
4, PAGE 1130 OF CERTIFIED SURVEY MAPS, ST. CROIX COUNTY, WISCONSIN
S
OWNER 8 PLATTER I -1 p N. 89 14' 06" W. N. 89 14' 06" W.
ROSETTA' M. WILSON 400.0'0' NORTH L /NE OF
ROUTE 2 �" SE QUARTER
NEW RICHMOND, WISC
54017 A'� CENTER OF
SECT /ON 2 - 31 - 18
PST 5 0 O E 11- CORNER
TR 366 / ° SECT /ON 2 - X - 18
i
y mp A3 � N
ROP
v � 6 92' 6PR %PTE � LOT 7
0 �
E x1 iNG� '� a o A
/ 18, 708 SO. FT. q
LOT s IZZZ
o 10
'n o T o
0 ° 5
18, 708 SQ. FT. \O W E
o LOT 5
I N
rn a S
O
LOT 4 q Q3 c� 36 6$ 2 SCALE: ONE INCH EQUALS SIXTY FEET
I� 16, 629 SQ. FT.
I�
11,718 SO. FT. GE 0 50' IOU 200'
I� E• q, PP
2 0 V9'�'UM�
I 0 92. N 6 MAP- L EGEND
m o A P
! o yURV l� 0 1" X 24" IRON PIPE SET
I� E
6`53 R�IFi�p WEIGHING 1.68 LBS. / LIN. FT.
" • 1" IRON PIPE FOUND
Q 1 -3/8" IRON PIPE FOUND
i 0 2" IRON PIPE FOUND
THE NORTH LINE OF THE SE 1/4 OF
SECTION 2 - 31 - 18 IS ASSUMED TO
BEAR N. 89 14' 06" W.
wr��,M►?!e f �,
r ALLEN C . �.� NOTE ALL LOTS ARE RESTRICTED TO
:j NYHAGEN SALE TO THEIR RESPECTIVE ADJOINING
S'I'. CROIX COUN'T'Y ZONING DEP 1 '"
AS BUILT SANITARY RE1
�ti \.
Owner �� ; , a RECEIVED
Address
4
City /State X59 !;
ST CROIX
zaVNGOOF ICE
Legal Description: A \ti/
Lot �_ Block Subdivision/CSM
Sec. - -2 , TAN -RAW, Town of PIN # – V$ - -out
SEPTIC TANK — DOSE CHAMBER — FOLDING TANK INFORMATION:
Tank manufacturer L Size ST/PC, Setback from: House _� Well -� 77
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: 6,z-4> Width —,LP— Length - 3g Number of T+enehes ,,24
Setback from: House _g Well -v,.2 P/L 9 Vent to fresh air intake
ELEVATIONS
Description of benchmark '� tA>< �e ,�„ Elevation
Description of alternate benchmark P Elevation
Building Sewer ST/HT Inlet ST Outlet 2g Z, PC Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover 9? �S
Distribution Lines ( ) _- ( ) ( )
Bottom of System ( ) 2��3__ () ( )
Final Grade
Date of installation P rmit n ibcr State plan number
Plumber's signature License number � Date g" /
Inspector
('omplctc plot plan •�
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division ST . CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: ❑ City ❑Villa e Town of: State Plan ID No.:
LAND, RICHARD STAR PRA E
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel o
b— .: 1008 -20 -000
10D 10 _
TANK INFORMATION LEVATION DATA A9800440
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic S Benchmark
Dosing
Aeration Bldg. Sewer 17 62'
� 3
Holding St/ Ht Inlet 7• z / -.3
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Vent to ROAD Dt Inlet
Air Intake
Septic y - , 5 NA Dt Bottom
Dosing NA Header/ Man.
t
Aeration NA Dist. Pipe
Holding Bot. System 1 -A
PUMP/ SIPHON INFORMATION Final Grade '<_; A 7, a'
>" 6
Manufacturer Demand 9,
Model Number GPM
TDH I Lift L Iction System TDH Ft
H ead
Forcemai Length Dia. Dist. To weu
SOIL ABSORPTION SYSTEM _ BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS A2 P 3 1 1 1 1 DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE / SCM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type O model Number:
System: { " :,a., / OR UNIT
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 L �� Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: STAR PRARIE 2.31.18.22I,NE,SW 1248 S. CEDAR DRIVE
y
Plan revision required? ❑ Yes VNo
Use other side for additional information. 1 95 1 C n 0
SBD -6710 (R.3/97) Date nsflecio 's Signature Cert. No
SANITARY PERMIT APPLICATION 201eE Washn
V sconsin In acco r d w ith ILHR 83 05, i Wis. Adm. Code P.O. Box 7969
Department of Commerce Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 81/2 x 11 inches in size. , Y
• See reverse side for instructions for completing this application State Sanitar Permit Number
242
The information you provide may be used by other government agency programs ❑ 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 RMATI N
PropeV Owner Name Property Location
v4 1/4, S T , N, Rlg 1(orS
Property Owner's Mailing Address Lot Number Block Num r
.S
City ate Zip Code Phone Number Subdivision Name or CSM umber
( )
11. TYPE OF BUILDING: (check one) ❑ State Owned 0 Cit Nearest Roa
Public 1 or 2 Family Dwelling - No. of bedrooms ❑ of Town OF ,� ��
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo O 3$ _'00 8 — ?10 Ow
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 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 (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft_) (Min . /inch) Elevation
L Feet Feet
aclt
VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper-
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App
New Existin structed
Tanks Tanks
Septic Tank or Holding Tank ^— ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ I ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the Vpdersigned, assume responsibility for inst2114tion of th onsite sewage system shown on the attached plans.
Plumb r' am (Print) ' nat o ) MP /MPRSW No.: Business Phone Number:
Plu ber's AddressTItreet ity, Sta Zip Code)
O
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate I ssued Issuing Agent Signature (No Stamps)
t
Approved [ Given Initial sk Surcharge Fee) _(f
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R 11196) DISTRIBUTION: Original to county, One copy To: Safety S timid ngs Divisiaw onan er, fhsaber
i
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Wiscpn�.in Department of Commerce
' b ivislon of Safety and Buildings SOIL AND SITE EVALUATION
Bureau of Integrated Services in accordance wit Page of
t 63 Q9, Wis. Adm. Code
�'Ll r
Attach complete site plan on paper not less than 8 1/2 x 11 i s Plarnust ffH�vjewed
include, but not limited to: vertical and horizontal reference poi �( dirQf� {�
percent slope, scale or dimensions, north arrow, and locationid d�stance�tjpar road
F
APPLICANT INFORMATION - Please print all in;loati�llf.' Date
Personal information
you provide may be used for secondary purposes ( Law, S. 15��ii
Props er rty Location
�,. Govt Lot ; - 1/4 1 /4,S T ,N.R (or�
Property Owner s Mai mg Address l-ot # Block Subd. Name or CSM#
City Stat Zip Code Phone Number ❑ City ❑ illage 0 Town Nearest Road
r_
❑ New Construction Use: ® Residential / Number of bedrooms _ c::,�- Addition to existing building
Replacement ❑ Public or commercial - Describe:
Code derived daily flow „� gpd Recommended design loading rate — —bed, gp WF � trench, gpd2
Absorption area required —Y,?- 9 — bed, ft .� trench, ft2 g g ��
— — Maximum design loading rate , gpd/f gp d*
Recommended infiltration surface elevation(s) _ �7 �} ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material „2�44 c / Flood plain elevation, if applicable 92 7l
Suitable for system Conventional Mound In Ground Pressure AT -Grade System in Fill Holding Tank
LU T Unsu itable for system ® S ❑ U J� s ❑ u 0 s ❑ u Los ❑ U ❑ s 0 u ❑ s BI u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure
in. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots G. Trench
Gr. Sz. Sh. Bed Trench
Ground
elev. - 1
_
laZo.
Depth to
limiting
factor
2 in.
Remarks:
Boring #
;F
N
Ground
elev.
Depth to
limiting
factor
->Z&-in- marks:
CST Na Vleas Signature Telephone No.
D
Address Date CST Number
3
„�( ,l �.c°� �r�✓ a� /`me� ��oJk T�,z - � /f�0
so-
9' OR
43
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 7K"4e'3
Mailing Address
Property Address
(Verification required from Planning Department for new construction)
City/State Parcel Identification Number
LEGAL DESCRIPTION
Property Location /,, _ S� '/4, Sec. , T_, _Zf _ W, Town of i
Subdivision , Lot # �.
Certified Survey Map # , Volume , Page # aa�
Warranty Deed # 1 = '/ F3 , Volume /D , Page #
Spec house ❑ yes X no Lot lines identifiable [9 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 the three year expiration date.
SIGNATURE 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.
SI 'NATURE 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
LQ F. rXOJWXPVE s..wr. • s.w�•��.e.. !wo
• Sxrueyorr `�� "� R.R. No. 6
Menomonie, Wis. 34731
PLAT OF SURVEY
CLIENTS NAME: Mr. Richard Arcand
ADDRESS: 3671 Highway 61
White Bear Lake, Minn. 55110
LAND DESCRIPTION: Part of Northeast One Quarter (NE;) of Sagt One
(BW }) and part of Government Lot hwest
Quarter
2 of 3 00 t Oft Two (2) Thraship
Thirty m ( North, I;k1Wbe�n �.: c D
Slt•e>� (18 j `West on Cedar Lake
doing 4t SB corner of Northwest G
OUS Quarter (Nwt) Section Two (2)
T� p Thirty -one (31) North,
Elght"n (18) 'Weet; thnce i p ^te
450 Peet to place of e
beginning;
tae West 25 South_,_. 104 -35 lb
feet; thence North to Cedar Lake; - -
thence Northeasterly along the
Shoreline of Cedar Lake to a �
Point North of place of
beginning; thence South to M.C.
beginning. Copied from
4000ription furnished by
client.
„r
' I A ,
7
A
SCALE OF MAP — 4.'
I = FEET •
O-
r_
County.
Of'
I►Lee 1:
Villeneuve, repist6red Wisconsin Land Surveyor, do hereby certify that on /
surveyed the above described and mapped prop o
g official �� 8 T y
correctly dimensioned representation to scale of ethe boundaries,thatt allbui dingsrand improvements wholjy within the
bou ndary lines, and that no encroachments by adjoining owners a Pa Y y map K a
appear from said survey other than at r, # 4 j
=!
AB STRACT F TITLE
. �
Vo the following described 'keal Estate situated in
i
ST. CROIX COUNTY, WISCONSIN
Part r� Of l of S:' -1 and
Lot 2 N. or. said 1�E' part of Covernr;ient
2 -10 on �:. Ceda , a oI ' ae -1 ri
r f
.te, clesela-- heel : , .'u1lo� ,
Cornmer7c; r
.i�
at SF corner o'
thence ��'�. 400 ft�r�- i �
the Sec. 2 �1 -1�•
20 tI U Pl - '
me �� la o
�5 S. r]44 - - �ae'itlniic�
Cedar La'_ e. thenc I�Tj o
, - ` - �.�:�n�, 1, r
Lake ly alon.r shone o''
thence�S noo ;be 1 `' of place
inning .
PREPARED FO R v -
f
ST. CROIX CO
LINTY ABSTRACT CO.
Hudson, Wisconsin
M