HomeMy WebLinkAbout038-1079-95-200 r S 9, I ST. CRO IX COUNTY ZONING DEPARTMEN.4 AS BUILT SANJTARY REPORT ECEIVED 3 0 � Owner , Jn,� ���Ti l T 1 CROiX
998 Address '�' ��, ;
City /State � -� ZONINGOFFIM
Legal D cription
Lot Block � Subdivision/CSM #
'/. A L/5 %, A/g�', Sec. 1, TAN -R.Zg W, Town - PIN #
SEPTIC TANK -- DOSE CHAMBER -- TANK INFORMATION
Tank manufacturer - Size ST/PC z4nQ ITw Setback from: House _Z� Well P/L r /aa
Pump manufacturer. Model �)�'Q S-��/,/
Alarm location ,,o
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: 4a Width _�_ Length ��_ Number of Trenches
Setback from: Mouse Well P/L s �/ Vent to fresh air intake
ELEVATIONS
Description of benchmark /X� f Elevation /.
Description of alternate benchmark : / Elevation , s
Building Sewer ST/HT Inlet 9�. 9 y ST Outlet 9e, 7 PC Inlet % /_s'/
PC Bottom Header/Manifold ,i �,Q. Top of ST/PC Manhole Cover
Distribution Lines ( ) , f o/ O ( )
Bottom of System( ir,7 ; D () ( )
Final Grade () ,Z-�22 2c3�_ O ( )
Date of installation / / P rmit number 31) 779 , State plan number 9D/672�
Plumber's signature License number Date
Inspector �u
Complete plot plan �+
f �
Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Coun'9T . CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitajf7701537
Personal information you provice may be used for secondary purpoges [Privacy law, s.15.04 (1)(m)].
L!Mjft�f, N E*AR4 I town of: State Plan ID No.:
CST BM Elev.: JtJ Insp. BM Elev.: aal
BM Description: ParcelQe.1079 -95 -200
TANK INFORMATION ELEVATION DATA A9800178 �� _�-.;
o xf
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark a /
r,e i D ,3 �Z
Dosing f' '� q, 93
Aeration _.__ _ Bldg. Sewer A S
Holding- St /014 Inlet �3 7� �C47'
TANK SETBACK INFORMATION St/ I0 Outlet lSCa3 9G-
TANKTO P/L WELL BLDG. Aenttake ROAD D t I nlet 22—
Septic � NA Dt Bottom
Dosing 25 S g y ��!� NA H / Man.
Aeration < - — NA Dist. Pipe
Holding -- Bot. System y ` /a 7 76
PUMPIINFORMATION Final Grade
Manufacturer F -� Demand
Model Number r GPM
TDH Lift Friction System TDH Ft
oss Forcemai n Length Dia. H ead
^ " Dist. To
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. iclut Depth
DIMENSIONS DIMEN I
SYSTEM TO P/L BLDG WELL LAKE /STREAM HIN anufacturer:
SETBACK HA INFORMATION Typeo
System: /Hr/u.� d " /Do , f� O NIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
r �+
Length Dia., Length �,6 Dia. L 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 f f []Yes ❑ No ❑ Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.)
LOCATIO STAR PRARIE 19.31.18.328F,NE,NE 2078 90TH STREET
�7 l �.�i"n ���-� 6��� �► -,off' ,a-� �-� 2 :°�`�
L% .Y/ .eU" ". � � Vlf �[ l�,e..C„f(. � �' '-'-^� L -" °"'" ' (�'� /f !. -:.��✓ � '�/ i
Plan revision required. ❑ Yes dNo -
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert No.
V ismis i n , SANITARY PERMIT APPLICATION 2 01 E ety w shingtonAve
P.O. Box 7969
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 vi x 11 inches in size.
-:5:" " I
• See reverse side for instructions for completing this application State Sanitary Permit Number
7:3 77qjC,
The information you provide may be used by other government agency programs E] Check if revision to previous app (cation
(Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
t. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION /
Prope Owner a Property Location
1/4 - 1 /a, S T� , N, R �(or)
Property Owner's Mailing A es Lot Number Block Number
Cit , State 1 Zip Code _ Phone Number Subdivision Name or Q5A&Alum ber
2� a - I ( )
. TYPE F BUILDING: (check one) ❑ State Owned it� r earest Road
Public 1 or 2 Family Dwelling - No. of bedrooms ❑ vll age jj�
OF
Town
III. BUILDING USE (If building type is public, check all that apply) 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 E] Replacement 3 E] Replacementof 4_ E] Reconnection o E] f 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 [AMound 30 ❑ Specify Type 41 E] 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. ate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min./ ch) Elevation
7S' 7 Feet Feet
VII. TANK Cap acit in altos Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App
New Existin strutted
Tanks Tanks
Septic ED El 11 El 11 ❑
Pump nk a er — A m I t2 j 1C _'4eT ❑ 1 ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, thq undersigned, assume responsibility for in allation of a onsite sewage system shown on the attached plans.
Plum s Nam : ( In Plum is gn r o a s) MP /MPRSW No.: Business Phone Number: Plumber Ac dress (Streefcity ate, Zip e).
_e /.�
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (((inncludesGroundwater [� - te issued Issu g gen Signature (No Stamps)
App roved C% V �./ �/ � rge Fee)
//] \. pp ❑ Owner Given Initial l/ /7�� /g��'
Adverse Determination
X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL:
SBD -6398 (R 11196) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, plumber
' Safety and Buildings
15837 USH 63
HAYWARD WI 54843 -8107
�sconsin Tommy G. Thompson, Governor
Department of Commerce William J. McCoshen, Secretary
May 12, 1998
CUST ID No.224263
KIM A O'CONNELL
504 3RD AVE
OSCEOLA WI 54020 PAW
RE: CONDITIONAL APPROVAL Transaction ID No. 80150 Condido,
APPROVAL EXPIRES: 05/12/2000 APPRO
SITE: DEPARTMENT OF I
Site ID: 8019 DIVISION F S�AFET
ST CROIX County, Town of STAR PRAIRIE
NE 1/4, NE1/4, S19, T3 IN, RI 8W
JOE CLOUTIER SEE CORRESP
FOR:
Description: NEW MOUND
Object Type: POWT System Regulated Object ID No.: 19859
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
This plan approval is for a 450gpd mound.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• This plan action is subject to designer comments on the plan
• Correspondence Note:
• Maintain well setbacks per Comm. 83.15(4) & 83.10(1).
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead. When making an inquiry or submitting additional information, please refer to Transaction ID
No. in the regarding line.
Sincerely,
DATE RECEIVED 05/07/1998
FEE REQUIRED $ 180.00
TOM BRAUN, PLAN REVIEWER FEE RECEIVED $ 180.00
Integrated Services BALANCE DUE $ 0.00
(715)634-3026, M -F 7:45 AM - 4:30 PM
TBRAUN @COMMERCE. STATE. WI.US
RESIDENTIAL MOUND DESIGN
INDEX AND TITLE SHEET
Project JOE CLOUTIER •`�
sally
Owner JOE CLOUTIER VED
Address P.O. BOX 338 afAlitE110E
NO tWLDNIG;
SOMERSET WI 54025
:)NDENCE
Legal Description NE/NE- 19- T31 -R18W
Township SOMERSET County ST. CROIX
Subdivision Name CSM 5452 Lot No. 4
Parcel ID Number 38- 10799 -5200
Plan ID Number 80150
INDEX SHEET PAGE ONE
MOUND CALCULATIONS PAGE TWO
MOUND DRAWINGS PAGE THREE
PRES. DIST. CALCS. & LATERALS PAGE FOUR
PUMP TANK DRAWINGS PAGE FIVE
PUMP CURVE PAGE SIX
PLOT PLAN PAGE SEVEN
Designer KIM A "NELL � License Number
Signatur Phone No. 715- 755 -3145
Date 5 -4-98
Notice: Tampering with this file by unauthorized persons is prohibited.
Deliberate modification wail result in disciplinary action under s. 145.10, VIA& Stats.
SBD- 10462 -E (R.04P97) P 1 of 7
RESIDENTIAL MOUND DESIGN
Eight Bedroom Maximum
Complete information in red framed boxes as necessary.
(y or n) n Is the system over creviced bedrock?
Slope 5 %
Number of bedrooms 3
Wastewater flow rate 450 gpd 11703.3 1 Lpd
Depth to limiting factor 26 in 1 66.0 1cm
In situ soil infiltration rate (code) 1 0.5 gpd/ft 20.4 Um
Contour line below the upslope edge of absorption cell 106.6 ft 32.49 m
Use standard fill depths? 1� OR Designer speed depth in L 1cm
Place X in box to use standard depths (!Z 24, A+4 inclusive) OR specify design 1111 depth.
Center or end manifold a (core) Estimated hole space 4 ft Not a final calculation.
Lateral spacing 3 ft Minimum dose >= 10 times void volume
Use a 0 lateral spacing for trenches. Pump tank elevation 90.6 ft Outside bottom of tank
Number of laterals F Force main diameter 2 in
Force main length Force main actual dia. 1 2.067 lin
SYSTEM SOLUTIONS Inch- pounds Metric Cell media "x" one only.
Estimated daily flow ®gpd 1703 Lpd x ] Chamber Aggregate and pipe
and pipe
Absorption cep
Design load rate & area 1.2 gpd/fe 375.0 ft' 34.84 m
Linear load rate 7.1 gpd/ft 88.0 Lpd /m
Design width (A) 6 ft 1.83 m
Cell length (B) 63.0 ft 19.20 m
Depth of cell (F) 9.9 in 25.1 cm
Sand filter
Upslope fill depth (D) in 30.5 cm
Downslope fill depth (E) in 39.6 cm
Basal area required (gpd/infiltration rate) [Efl? 83.61 m
Supporting components
Topsoil depth 6.0 in 15.2 cm
Subsoil depth at center 12.0 in 30.4 cm
Subsoil depth at cell wall 6.0 in 15.2 cm
End slope toe length (K) 10.4 ft 3.17 m
Upslope toe length (J) 7.4 ft 2.26 m
Downslope toe length (1) 11.0 ft 3.35 m
Total mound length (L) 83.8 ft 25.54 m
Total mound width (W) 24.4 ft 7.44 m
Project: ; OOE CLOUTIER
Plan LD, W150 Page 2 of 7
MOUND PLAN VIEW
observation pipes (typical)
E ; � B W= 24.4 ft A A= 6.Oft 1.83m
7.44 m B= 63ft 19.2m
K J= 7.4ft 2.26m
I = 11.O ft 3.35m
K = 10.4 ft 1 3.17 m
L = 83.8 ft
25.5 m typ. obs. pipe
A X B refers to absorption cell width and length (anchored securely)
J = upslope width
I = downslope width
K = end slope dimension 6' (150 mm)
T
MOUND CROSS SECTION
topsoil subsoil cap D = 12.0 in 30.5 cm
lateral t G H E = 15.6 in 39.6 cm
invert 108.1 ft F = 9.9 in 25.1 cm
elev. 132.95 m see note TF G = 12.0 in 30.4 cm
D
H= 18.Oin, 45.6 cm
E ASTM C3 i
sys. 107,6 ft Sand Fill
elev. 32.80 m 106.6 ft contour 5 %
132.49 m slope
/-Z Note: Absorption cell media will
D = upslope fill depth plowed layer consist of aggregate and pipe
E = downslope fill depth or leaching chambers and pipe
F = absorption cell depth as specified eAggregate
G = subsoil + topsoil depth at cell wall at right. Chamber
H = subsoil + topsoil depth at cell center
Designer notes:
If aggregate is used, it is covered with code compliant material.
Project: JOE CLOUTIER
Plan I. D. ### Page 3 of 7
PRESSURE DISTRIBUTION CALCULATIONS
Absorption cell Inch - pounds Metric
Width (A) 6 ft 1 1.83 Im
Length (B) 63.0 ft 19.2 m
Lateral specifications
Number laterals 2
Holes/lateral 16 holes
Lateral length 60.0 ft 18.3 m
Perforation dia. 0.25 in 6.4 mm
Lat. dis. rate 18.64 gpm 1.2 Us
Sys. dis. rate 37.28 gpm 2.4 Us
Hole spacing 48 in 121.9 cm
Lateral diameter Pipe diameter Design options Design choke
Designer must 1 in125 mm Place X in red
'X" one choice 1 1 /4in/32 mm box of chosen
from the options 1 12in /4o mm X x diameter.
provided 2in/50 mm X
3in/75 mm X
Manifold diameter Pipe diameter Design options Design choice
Designer must 1 in25 mm
'X" one choice 1 1 fdin/32 mm Place X in red
from the options 1 iizn /4o mm X box of chosen
provided. 2inW mm X - x diameter
3in/75 mm X
4in /100 mm X
Distribution system contains 2 lateral(s).
LATERAL DIAGRAM - END CONNECTION
Place correct lateral degram by clicking in one of the drawings at right and dragging the degram into this area.
Laterals center edover & Last hole drilled next to end cap l cal )
F P
All laterals areid"Mcal t<-X----)1 HOft kil"Oft the bon m of the lateral s
sp-ed
Force main cornection via tee of crass to mx &M at any point. Laterals & fore* main of PVC Sch 40
• = permarwt erns marker (per COMM Table 84.30 -5)
Inch - pounds Metric
Lateral length (P) 60.0 ft 18.29 m
Lateral spacing (S) 3 ft 0.91 m
Manifold length 3 ft 0.91 m
Hole diameter 0.25 in 6.35 mm
Lateral diameter 1.5 in 40 mm
Number of holes per pipe 16
Invert elevation of laterals 108.1 Ift 32.84 m
Project: JOE CLOUTIER
Plan I.D. 80150 Page 4 of 7
Total dynamic head
System head = M5.33 EL1.62 m
Vertical lift = m Are l atera ls the highest point in the
Friction loss = m system? Yes W here. Total dynamic head = m If no, what i s the highest elevation
Dose Volume downstream of pump?
Lateral void volume = 12.7 gal 48.1 L Force main drain
Minimum dose = 127.0 gal 480.7 L back to tank? ('u' one)
Drain back = 40.1 gal 151.8 L x Yes
Dose volume = 167.1 gal 632.5 L No
Typical Pump Chamber Layout
In combination with state approved treatment tank Tank construction as per Comm 83.20(3) WAC.
approved manhole cover
T weather proof wAvaming label and padlock
grade levels junction box —�
grade levels
quick disconec
alternate �
4' vent pipe electric as per NEC 300 and E— outlet
Comm 1628 WAC location 18" (46 cm) min.
wall of pump �— approved L
chamber or outlet
combination joint
A 1W weep Grade levels
tank
alarm on hole as pump tank manhole = 4' min. above finished grade
pump on B necessary pumptw* man. =100 mm min above firished grade
C vent = 12' min. above finished grade
pump 91.5 ft vent = 3W mm min. above firmed grade
off elev. 27.9 m
D
3 " 75 mm) of bedding under tank and anchor tank as necessary 90.6 It Pump tank elevation
27.6 Irn bottom of tank
Tank specifications: WEEKS
Pump tank = 19.04 gal/in
Pump tank volume = 800 gal Capacities: Inches Gallons
A= 23.2 442.5
Pump manufacturer: IGOULDS B = 2 38.1
Pump model number: WE0511 H C = 8.8 167.1
D = 8 152.3
JOE CLOUTIER
elan I.D. 80150 Page 5 of 7
i eaorniance y
Curves Pump
MgURS FEET
- - —'— MODEL 3885
is -- SIZE 1 /4" Solids
WE15H -
70 --�—
20 WE10H - - - --} - -- -
60 -
f;
WEO5H I -
- - - -
WEOJL -- - -- - -- - -�-
---
S —
10
0 10 20 30 40 50 60 70 60 90 100 110 120 GPM
I I L.
0 10 20 30 m'm
CAPACITY
Z* �; �, : •r '4" .1,�v,' r 5' GOULD5 PUMPS, INC.
`J ScnEu �•Y.S rtly r�iw j.�.
METERS FEET
120 MODEL 3885
— - - - r — SIZE 3 /4 " Solids
110 W EISMH -
- -- - -t- -
100 -
30
90
25
70
20 -
0 I -\-- -f - - T_
0
WE05HH
1 5 50 - _ J
40 -} - -
1p 30
20
5 -
10 -
0 10 20 30 40 50 60 70 w w I W 110 I:b GPM
0 10 •0 30 m'A►
CAPACITY
•1"6 OwIW Pum, &. Inc. .Iua, I
C)JAI
x?/ Gy'
- - --� �� IA
C
nJ ^ T
i
4
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Wisconsin Department Industry
4lxat ard'Auman Relations 9 l 3 SOIL AND SITE EVALUATION REP P of
Division of Safety 8= Buildings in accord with ILHR 83.05, Wi f~ -�
�s
cou
Attach compl ete site plan on paper not less than 8 1/2 x 11 inches in size: � . Croix
Plan mde, ._ - not limited to vertical and horizontal reference point (BM), direction and % of slop or RCEL . dimensioned, north arrow, and location and distance
to nearest road. pe ing
APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION
WED DATE
I NJ
.ir CA
PROPERTY OWNER: PROP C W11 NFY
Toe: 'Cloutier GOVT. L 31 N =R 18 xFx(or) W
PROPERTY OWNERS MAILING ADDRESS LOT # B # ME CSM #
318:;Suhrisei Dr. 4 na endin
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE nOWN NEAREST ROAD
Somerset, WI. 54025 (71$ 247 -5602 1 Star Prairie 90th.` _1St.
[x] New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building
(] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd /ft2 - 6 trench, gpd /ft
Absorption area required 375 bed, ft 375 trench, ft Maximum design loading rate -5 bed, gpd /ft - 6 trench, gpd /ft
Recommended infiltration surface elevation(s) 107.60 ft (as referred to site plan benchmark)
Additional design / site considerations system el. based on contour line of el. 106.60'
Parent material glacial drift Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ❑ S O U QCS ❑ U I ❑ S ® U ❑ S CRU ❑ S t] U ❑ S -T] 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
l l 1 0 -9 10yr4 /2 none sl 2m r mfr cs 2f .5 .6
2 9 -28 10 r4/4 none is os mvfr crw if, .7 .8
Ground 3 28 -41 10yr4 /4 c2p7.5yr5/6 is lcsbk mvfr gw if .5 .6
elev.
1 4 41 -80 7.5yr4/6 c2p7.5yr sil lcsbk mfr na na .2 : : .3
Depth to
limiting
factor
28 "
Remarks:
Boring #
1 -8 10yr4 /2 none sl 2m r mvfr cs 2f .5 : :.6
2 -26 10yr4 /4 none is osg mvfr gw if .7.8
3 6 -48 7.5yr4/4 c2p7.5yr5/6 sicl lfsbk mfr na na .2.3
Ground
elev.
1
Depth to
limiting
factor
26"
Remarks:
CST Name: Please Print Gary . Steel Phone:
rY 715 - 246 - 6200
Address:
1554 200tiQ New Richmond, WI. 54017
Signature: e: CST Number:
4 -23 —�� cstm 02298
STEEL'S SOIL SERVICE
Gary L. Steel Joe Cloutier 1554 200th Ave.
CSTM2298 NE4NE4 S19- T31N -R18w New Richmond, WI 54017
MPRSW 3254 town of star Prarie (715) 246 -6200
f lot #4 -csm
1 " =40'
BM.= nail in corner post C el. 100'
Alt. Bm.= top of corner post C el. 104.5'
b
y �3
�
N .
loo i
l� CY
Gary L. Steel
4 -23 -96
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer _ Q J LC L ej 0 GU !-
Mailing Addres
Property Address
(Verification required from Planning Department for new construction)
City /State So me i e - Parcel Identification Number 0 3 1 7R '
LE GAL DESCRIPTION �r l
Property Location - )Vl — ' /4, I /,, Sec. __LL, T -- L N -R_j_�_W, Town of
Subdivision , Lot
Certified Survey Map # 5 y 5 Z3 3 , Volume I , Page #
Warranty Deed # S� , Volume / U , Page #
Spec house ❑ yeso no Lot lines identifiable �p 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
d s of the three year expiration date.
ATURE 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
;GNATU" operty described above, by virtue of a warranty deed recorded in Register of Deeds Office.
13 b
A PPLICANT 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
1
�..�'
FI L�
�,. -
JUG'! 1 6 1996 10
5 45233 MTiiLEEI`I H.VJAISIi 1�
RLQistel of Deeds
C SURV mAp ti ��/
Located in Part of the Northeast Quarter of the Northeast Quarter and part of the Southeast Quarter
of the Northeast Quarter all in Section 19, Township 31 North, Range 18 West, Town of Star Prairie,
St. Croix County, Wisconsin.
LEGEND ® Set 1 '1/4" x 24" Iron Pipe weighing
{ County Section Corder Monument a minlmum of 1.13 pounds per
® Set 1" x 24" Iron Pipe weighing
linear foot.
a - minimum of 1.13 pounds per s Set 3/4" x 24" Iron Pipe weighing
linear foot. - a minimum of 1.13 pounds per
O Found iron Pipe linear foot.
• ' ' • • • • • • Denotes 100' Building Setback. Line —x — Denotes Fer.ce
NORTH 1/4 CORNER SEC. 19 R = Recorded as If 0VFn
(ESTABLISHED FROM TIES) 210_TH AVENUE E NE CORNER SEC. 19
_ _ U
_ _ — _ . _ (BERNTSEN CAP)
E 2671'- T
S 89'23'28" - - - -- 5.2 � JUN 11 y%
Uj
_L _
_�._.. \� ��In
NORTH LINE 011 THE NE 1/4 SEC 119 -- /
� •:ROIX COUNTY
LOT - 2 1 UNPLATTED LANDS i J30 Plarxlir
- -- — - - -- --- - - - - -- -- -
z
I
1 - - — V_ -- _8__ ---- 1 r` � w P- Acks�Coaunittav
R >S 99'32'17' E
�Y 1 - - -- I `t
V_
S 89 E I 1336.02 - -- - -,. �; I ° I not racofdad
z x -- x -- X---+-- - - -- 906.18' - -- v I tom' r,,;tiin 30 days of
429.84' - -' - - - 870.63' -- -N j ��' J :.ppioval date
. 8 I I. x)rovai'si' A b*
LOT 1 <
li x s `v o S 89'24'37" E �� „
° `" -- 585 .y - -' -
CN w nk!
(n I r) r7 - 548.
0 co _LOT 2 9 33 ~- ' `_�'9' N
F— Z I I \\ N WELL - M
a Q I I 1 z `- 1 f�ous£ o
w N 321.05' - -- ``' 3 : r r�9 a
r� D Q S 89'24'37" E - c c) r= I SLED cV IN 13, u1
_ 11 (V I CV M N ( M Ito I L I
ORDINARY HIGH WATER LINE �i I
1 f3AR� c • L4 w
SET- 'K N GARAGE +_� I 1 41
V �I 3
tS 546. Z' .
13' co E- rll I _I n
p L�C�f DU I -
.
IN 4.1996 A
4-
ST. Olx COUNTY JUN 1 3 1996
545233 SURVEYOR'S RECORD MmEm11 10
SLCMIXCo
CERTIFIED SURVEY MAP
Located in Part of the Northeast Quarter of the Northeast Quarter and part of the Southeast Quarter
of the Northeast Quarter all in Section 19, Township 31 North, Range 18 West, Town of Star Prairie,
St. Croix County, Wisconsin.
LEGEND • Set 1 1/4" x 24" Iron Pipe weighing
-0' County Section Corner Monument a minimum of 1.13 pounds per
• Set 1" x 24" Iron Pipe weighing linear foot.
a- minimum of 1.13 pounds per • Set 3/4" x 24" Iron Pipe weighing .
linear foot. a minimum of 1.13 pounds per
O Found Iron Pipe linear foot.
• • • • • • • • • Denotes 100' Building Setback Line —x— Denotes Fence p
NORTH 1/4 CORNER SEC. 19 R = Recorded as'� ^ � Y G`/c
�
(ESTABLISHED FROM TIES) 210TH AVENUE NE CORNER SEC. 19
---------- ------- (BERNTSEN CAP) 1 5
- - -- S 89'23'28" E 2675.21' - - -- - � JUN 1 90
NORTH LINE. 0� THE NE 1/4 SEC I 19 i �_ ;;FIpIX COUNTY
°' I LOT_1 I LOT _2_ I UN_PLATTED LANDS Ljxywehensiv* Pwv*
C. - VOL.I 8 PG. _2362 I c:;,) 09 �'� erk
Ps Co�unitt«r
R =S 9'32'17' E I I U-
S 89124'37 E I 1336.02 - -- - �' I c 's.not reicordod
w x— x--- x - - -- 906.18' - -- I
x — - z wirh 3640" Of
w / 429.84' - -' �� ' 35'55 in -� , :.r A'f�flr
-- 870.63 a : -o ��
3 (� v i.. rrov3l? Misr bo
9' o LOT 1 S 89'24'37" E rn �I w La u; w rAd
O N Ni
Cf) !� N
, _•_ N
I— �I I \ O I` N
CO ` LOT 2 9 wE LL 33' I /l
I ;�,,
Q Q� ' Z HOUSE o
w N �- 321.05' "� 3 r a Cn
w S 89'24'37" E co r- a 0
sHEO cV IcV
S WI II N N M r 17 Itr wl
ORDINARY HIGH WATER LINE I" BARN °� j
�� 3 ►— 75' SETBACK N 546.11 2GARAGE I I yya� �WyI pp
r-
zi ? -7 - 58 I V
S 89'24 37 E r� CO Irn I N z
w LOT 4 Y� �, ��
N LO � '� N IN I �1 W
5' ACK f �! 1; 5 "1. 76' 8, ? :� N I 0 Q Z N
Z I
V b� I t _ j 0 �`� , I� J - 585.14' � CSI � W M M
ORDINARY HIGH WATER LINE ?S 89' 21'20" E ! I I •a X a- C O
to
— .. —.�. —.. in ' .. M _ S. LINE OF F THE NE 1 /4 �: rM I� N a
�""..+r" �-M 11- 66' 1 U m
Z1 �I W O
Q� w!S - - -- 1330.63' N 8 22'35" W - - -- x W o
���, LO �R =s ss3z'17 E 5 ' �� : I ?,� z v
aQ _ coy LOT 3 '
DOUGLASJ. 0 LOT 2 X V) N
co ZAHLER = I - I 00 I - � i a W a
N
5-2145 * C.S.M_ VOL. 16 r� I PG_ 1526 Ki f� ° N
HUDSON, - -- - I - i I - o z _6
t' Wi s. �. ca � : � a •-
- �5 \1 '� �i I �I mzs
Prepared for and at the request of I
Vernnn Rnrst ni I F 1/4 CORNER SEC. 19�