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CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT - - Owner Property Addres City /State I Legal Description: Lot Block Subdivision - 7 Nr�t , ' /a ' /a, Sec T U N- RZ W, Town of SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFO N Tank manufacturer ',M-c Size ST/PC 14w / Setback from: House -3�1) 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: 'w Width Length _ _ Number of Trenches Setback from: House Well er P/L ,,29 , Vent to fresh air intake 1, f ELEVATIONS Description of benchmark L,3,L Elevation IeA n Description of alternate benchmark Elevation Building Sewer ST/HT Inlet ST Outlet Y-/1.9 PC Inlet PC Bottom Header/Manifold 9/, ,?R Top of ST/PC Manhole Cover Distribution Lines ( ) 9/, 9/ () ( ) Bottom of System () �2 2� () ( ) Final Grade ( ) 9s, - 5 ( ) ( ) Date of installation /9g Permit number State plan number �— Plumber's signature License number �� ?�75/�� Date / Inspector °��,� f_s�in g +�✓ Complete plot plan Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT y ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) SanitarR�it.: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. PermitHold RLiX ![i1 t n of: State Plan ID No.: CST BM Elev.: M Insp. BM Elev.: BM Description': TAK' YKPi Parcel lynta- ;1119 -50 -100 1 �0 T TANK INFORMATION U ELEVATION DATA A9800517 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic Bench rk o , c4 ;L- /VV4, Dosing Aeratio B dg. Sewer Holding Inlet .S 5 'F s TANK SETBACK INFORMATION Outlet 5 qq TANK P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing A Header / Man. Ae ion NA Dist. Pipe Holding Bot. System 9Q �S PUMP/ SIPHON INFORMATION Final Grade °737 a13.� Manufacturer De d y•D4 14- Model Number GPM TDH L rictI - Ft Forcema Len th Dist. To Well SOIL ABSORPTION SYSTEM B M N RENC H Width Length C � No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth J DIMENSION SETBACK SYSTEM TO P/ L I BLDG WELL LAKE/STREAM LEA NG Manuf acturer: INFORMATION Type �� �� --�'— OR UNIT CHAMBE Moe Sys m.'0 DISTRIBUTION SYSTEM Header if Manifold H Distribution Pipe(s) i a x Hole Size x Hole Spacing Vent To Air Intake Length AV Dia. Length � Dia. Spacing AS 272+01 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 /TrenchCenter Bed /Trench Edges Topsoil Yes [] No Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) �a LOCATION: STAR PRARIE 29.31.18.493C,SW,SW 1901 90TH STREE LOT 1 Plan revisio�uired ? es " Co Q ❑ Use other side for additional information. t SBD -6710 (R.3197) Date Inspector's ignature Cert. No. Safety and Buildings Division ,- - SANITARY PERMIT APPLICATION 201 W. Washington Avenue ♦� ■ ��ons►n t o 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 Permit information you provide may be used for secondary purposes ❑ Check if revision to previous appsiiMoon [Privacy Law, s. 15.04 (t) (m)]. r State Plan I.D. Number I. APPLICATION INFORMATION PLEASE PRINT ALL INF RMATI N Property wner N e Property Location _ 1 1 1a, S T , N, R E (or go Property Owner's Mailing Add r ss Lot Numbe Block Numb City tate Zip Code Phone Number Subdivision Name SM Num II. TYPE BUILDING: (check one) ❑ State Owned Cit earesl ftoa�t Public 1 or 2 Family Dwelling- No. of bedrooms s2 s2r To w a n OF III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) o3g `t l� _S O — to o 1 ❑ Apartment/Condo � 3 I. c g • I­4q3 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 Onl�r______________ Existinr�System _________ - �Syste - 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 Ej Seepage Bed 21 ❑ Mound 30 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 E] / Seepage Pit i 1p X _ �� �_ 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. date 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /y+'ich) Elevation Feet Feet Capacit VII. NFORMATION in gallo Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. New Exist in Gallons Tanks concrete structed glass App. Tanks Tank Septic Tank ISM — $ 13 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the u dersigned, assume responsibility for i allation of the onsite sewage system shown on the attached plans. Plumb is ame: ri t} Plum rs Si n : (N ps MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, Ci , State, Zi Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved I Sanitary Permit Fee (includes Groundwater Groundwater ate I ssued , Issuing Age gnature (No Stamps) ® pp []Owner Given Initial A roved Surcharge Fee) /dj� pp � Adverse Determination I t . CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: s 19AEM 4 bee ai6c,, e- f)ew- God:° SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber 6 1 '04 1scatsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page E of Bums of Integrated services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches i z k must County include, but not limited to: vertical and horizontal reference point bifection ate, �� percent slope, scale or dimensions, north arrow, and location di to ( sf road. Parcel I.D. # a . ; 8- s- Xav APPLICANT INFORMATION - Please print all in rnabt frr,'lo Re by Data pw Personal information you provide may be used for secondar poses (P ' law, S t► (Olk Prop Owner location 1 . / r R 'C e Ai Govt Lot s 1/4s /4,S .2 T 3 / ,N,R /8 E (or)© P Owners Mailin Ar)dress ` ;fot # YbQW Subd. Name ©� h -i�, Cn i� 3 State Zip Code Phone Number ❑ City Cj Village ® Town NbanW Road T eivn � Al io W/ S l , 7 (71S zv7 S37d She i py - a)'r , e, 1 qo i� Sri, ❑ New Construction Use: ® Residential / Number of bedrooms Addition to existing building ® Replacement ❑ Public or commercial - Describe: Code derived daily flow ys0 gpd Recommended design loading rate ' bed, gpd/H ' 8 trench, WVtt Absorption area require bad, ft 2 5d_? trench, ft2 e M aximum design loading rate bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevatio(s) / �• v ft (as referred to site plan benchmark) Additional designtsite considerations ,( Parent material d �+as y lac %� 7� /'Y L 0'.." / ,n Y fan Flood plain elevation, if applicable 1 ,* ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S❑ U ® S 1 U ® S ❑ u I © S❑ u I [Is El U ❑ S 9 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench E l - 12 /0 � � S/_ IM5hl� mv c w 2 c 2 1240 7, 5 Y s/y 07 -5 0 a.- C W 2 C- Ground Yl 6 M4 M5 O S /77 L �"'� � �' P - 7 ,. 8 `IiSft. ; Depth to limiting factor T - in. }o" Remarks: Boring # i 0-6 o y;� IV4 s ms k MW / - C 6V 2 M. 3 - AYR 111,4 m5dL6r © 5 M 4. Ground g jley sft Depth to limiting fact in. Remarks: CST Name (Please Print) Signature Telephone No. Ad dress f3r,'4 � 7 Arne fl 6& -- f� - 7/s - Z� 3Za� 98 / 2 �, p Somp��,�� ,� z s- �o - 98 2 3 131 Y , a 3 q!pI `9b r ; I I BYn o O k i 3 If yoj , I I I r %L*_4 I i I o r pirl 3 0 r - -- - -- - -_- - -- y___- � --�-_ jf - -_ I __� mot,. -_ t.__- •l- __,_�__- -�, -__ _ -_ _ ; __+- -_ 1_ .�.__ �_ rt-__ —. - - -'t - - - -- I ' I ; 1 �_... _ T , f ! , i 1 I r t I , i I i ! I , ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address 1 (Verification required from Planning Department for new construction) City /State Parcel Identification Number _ . LE GAL DESCRIPTION Property Location ' /a, _�> t /4, Sec. ;,7G , T _ N - R _ W, Town of Subdivision , Lot # Certified Survey Map # �/�7,`i' , Volume , Page # > 7!!3 Warranty Deed # Volume - , Page # Z Spec house ❑ yes [Z 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. 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 ye r expiration date. NATURE 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 describe abov by virtue a warranty deed recorded in Register of Deeds Office. S ATURE 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 419224 t 1 ML CERTIFIED SURVEY MAP NOV 131986 LOCATED IN PART OF THE SW} OF THE SW} OF SECTION 29, T31N, R18W, &4" 0 �pY� oef D�1 " TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN. 64 aois cm1f, WYsosi LEGEND SCALE IN FEET O Set I" x 24 iron pipe weighing 1.68 pounds 100 50 0 100 per linear foot. N unplatted lands owned by-platter � 1 7 92 O 7 1 � 4. •'1'. 10 6 61 S89 317.861 o s d a f 288.45 CD W ` �.- 29.41 CD Ln 4 o y co I O ►+ ,`, N 10 0 1 L • �O n fe 43,842 sq. ft. (1.01 ac.) o o I I 48,369 sq. ft. (1.11 ac.) INC. R/W ' ° I 3J8.62 o n ' s N89 29 a o H 288.451 w s 30.17 - o _ r I o w N 3 = OWNER c I m c 43,842 sq. ft. (1.01 ac.) Ln I °' i r; GLEN H. WIESE 48,485 sq. ft. (1.11 ac.) INC. R/W ° o i� RT. 3 3 9.3 1 - i RIVER FALLS, WI. 54022 _ N89 2912611E i a CD 288.45 NOTE: Position of the Town Road 30.92 ° m „ does not agree w`itthh position y !IN 2 N =� shown ft Y C6, P9. 1295. o M ° CR i v ° - 43,642 sq. ft. (1.01 ac.) `" - is 48,600 sq. ft. (1.12 ac.) INC. R/W !� NOV 13 1986 I 37d0.131 I 1 o N89 2912611E ST. CROIX COUNTY H COMPREHENSIVE PARKS PLANWAG 3168' AND ZONING COMMITTEE . I existing house ° r I w 1 and out buildings CURVE DATA FOR LOT 1 a, R - 164.00 N I w _I 62,680 sq. ft (1.44 ac.) : Q - 15 " °oo CB - S06 I 68,207 sq. ft. 1.57 ac.) INC. R/W 33 331 N C 43.08 I N o L - 43.20 I 1 26.8 m 1st TAN - S0100611311E ST. CROIX COUNTY WISCONSIN ZONING OFFICE "p ■ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road _ Hudson, WI 54016-7710 (715) 386 -4680 November 16, 1998 Mr, and Mrs. Jim Reed 1901 90th Street New Richmond, WI 54017 RE: Septic Inspection for Jim Reed located at 1901 90th Street, Town of Star Prairie, St. Croix County, Wisconsin Dear Mr. and Mrs. Reed: A septic inspection of the above referenced property was conducted on October 26 19 This property is located in the SW% of the SW' /a of Section 29, T31N -R18W, Town of Star Prairie, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sincerely, Rod Eslinger Assistant Zoning Administrator Am