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Home My WebLink About182-1021-60-100 COMMENT FORM FOR FILE DATE: I n l V l e� Lu OWNER NAME: PROJECT NAME: !J LAf s A4 A e � E ADDRESS: COMPUTER #: PARCEL #: vjl f' D i k� B er- INFORMATION: 411-7/ `y ak ro c1x -Vv c11 draw- CL G o✓vie✓• d ra ikfid d I • ~ S 'I'- CROIX COUN'T'Y ZONING DEPAR "I'MWT AS BUILT SANITARY RLI'OR'I' Owner Address Sy, 1 � . City /State ` c"o,X� Legal Description: Lot Ij;lock (2 Subdivision/CSM 11 t� '/• '/, k� , Sect, TJIN -R W, Tow d SEPTIC TANK — DOSE CHAMBER — HOLDING TANI{ INFORMATION: Tank manufacturer n > Size ST/PC / Setback from: House Well P/L Pump manufacturer _ –� �/? Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: _ . S Width / —_s� Length .�`� Number of Trenches Setback from: "House Well ',',2 P/L Vent to fresh air intake ELEVATIONS Description of benchmark Description of alternate benchmark Elevation r Elevation Building Sewer ST/HT Inlet �7 71 - ST Outlet 9 PC Inlet PC Bottom �� Header/Manifold ��/ Top of ST/PC Manhole Cover . D Distribution Lines Bottom of System O Final Grade Date of installation /Z Pcrmit number State plan number 0 p Plumber's signatur ' License number 1O- rL -`--�– Date / ST 0 Inspector D r Complete plot Alan + 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 rf*c- ge5" / , / , -5X ' P fl' ‘' ` Tx 2S--, `�'��'`'� °s ff v-.GJ �+ -L7 t \ N t Sip, , c t n) gk. k INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Coun Safety and Buildings Division k CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitlyyffillo.: Personal information you provice may be used for secondary purposes [Privacy w, s.15.04 (1)(m)]. Permit Holder's Name: ❑ Vil own of: State Plan ID No.: EEBE, DWIGHT & LUCINDA , YRAI TE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /V o I 1 0Z> l U- TANK INFORMATION ELEVATION DATA A9800451 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �G 1Zo6 Benchm ,.I L 1004 1>7c� Dosi ng , j , Aeration Bldg. Sewer Holding St/ Ht Inlet /� of 12,-37 ? 7-7 5-- TANK SETBACK INFORMATION St/ Ht Outlet a0 v 12. 5V .Te TANK TO P/ L WELL BLDG. Air I to ntake ROAD Dt Inlet Air Septic 'Z 1 NA Dt Bottom Dosing NA Header / Man. „ 13.17 Aerat' n A Dist. Pipe 13L 13-41 Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Dem d , �y( Model N er GPM TDH L Friction System T H Ft Fie Forcemain I Lengt la. Dist. To Well SOIL ABSORPTION SYSTEM Bq jJXENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth _UFM ENSIONS (g S DIMENSIONS l SYSTEM To P/L BLDG WELL LAKE /STREAM LEAC G - manufacturer: SETBACK CHA ER Sy INFORMATION TY O (.� G.. OR UNI M a N um er: DISTRIBUTION SYSTEM Header/Manifold ,. Distribution Pi e(s� x Hole Size x Hole Spacing Vent To Air Intake Length tl Dia. H Length b Dia. Spacing 0 it4 A tM Z7 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: VILLAGE OF STAR PRAIRIE 6.31.17,NE,NW 2 0 4 • -C.(bm 0 0YIe,f 4IV46(01 go ose— dtvlG veff w f �Dyts�ry lG7� ik L i xc-I"es ( - 0e_*- b low P ipe. Plan revision required? eYes W<N0 t Use other side for additional information. t EN SBD -6710 (R.3/97) Date Inspe or's Signature rt. o. Safety and Buildings Division . SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue Viscons I n 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. 5 , • See reverse side for instructions for completing this application State Sanitar Pe mit N Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)). State Pla I. D. N umber I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Pr ert y Owner Name ) ' property Lo ation 7 c1 /a t /a, S (� T J , N, R /' Fes) Prope y Owner's Mailing Address Lot Number Block Number 1,1 State Zip ode Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned ity Nearest Road � Village Public 21 1 or 2 Family Dwelling - No. of bedrooms n Town 0P_, III BUILDING USE (If building type is public, check all that apply) Parcel Tax N umber(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. gLNew 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 gSeepage Bed 21 ❑ Mound 30 ❑Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure i 42 ❑ Pit Privy 13 ❑ Seepage Pit Z 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.) Pro osed sq. ft.) (Gals/da /sq. ft.) (Min. /inch) (� Elevation Q p (f a "— 1J -� 7 Feet Feet VII. TANK Capacit gall Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existing structed Tanks Tanks eptic Tank an ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber El El El 1:1 El ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on a aUached plans. Plumber's Name: (Print) Plum er' ' nature:( MP/ MPRSW No.: hone Number: Plumbe s Address (Street, Gty, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONL ❑ Disapproved Sanitary Pe mit Fe (Includes Groundwater ate ssue Issuing A ent Sig ure (No Stamps) rOVed (j� �harge Fee) )gApp ❑ Owner Given Initial 0 � L �d Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber BA PLUMBING =~ .=.A.nNw, INC. �7 Lloyd Pahlow, Master Plumber DATE . ................ ......... ... ............. ............ ....................................... .... . . ........... .............. ............. .............. . .......... . .. ... .......... .................... ... ......... ............ f j ILY Wisconsin Department of Industry SOIL AND SITE E V A L U A T 1 O N_- E P O R T P age Labor and Human Relations g _ Of Division of Safety & Buildings in accord with ILHR 83.05, VY Adm. Code i . COUNTY X. Attach complete site plan on paper not less than 8 1/2 x 11 inches in sizes/ Plarf mus t D / not limited to vertical and horizontal reference point (BM), direction and Tp' of/slope, i. L, EICEL I.D. # dimensioned, north arrow, and location and distance to nearest road. cc5 j l l g2 - VV —� D p[t APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATI� �, E RE I ED BY DATE --A ST CTROIX / 2� PROPERTY O,WiNER: J ` OP t , 4� 74'1�C�'l 1/4,S �p T N R l ��`J PRO ERTY OWNER':S MAILING ADDRESS � NAME OR CSM # U F Sp CA_ f�' S� �E 7 — I�J�S7 -- � � SU ' CITY, STATE ZIP CODE PHONE NUMBER ❑CITY (AVILLAGE ❑TOWN NEAREST ROAD VA7 F:: (7%S'I rA r C C'Occ ,L iNr A t/E. New Construction Use Residential / Number of bedrooms [ J Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow (200 gpd Recommended design loading rate bed, gpd /ft 0 � trench, gpd/ft Absorption area required bed, ft grate-7 gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s •7 ft (as re d to site plan benchmark) Additional design / site considerations Parent material K Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑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 Tnench 2 —/ Ground _ el v. _ Depth to limiting fa a, Remarks: Boring # Nom. �1 ZL Ground elev. - p t S Depth to - `' M limiting factor 9? Remarks: CST Name: — Please Print one: /1 Ph LCJ Gr/ S _ l� Address: Q S — Signature: � Date: V T CST Numb n �" -30 - JJ PROPERTY OWNER rX ESL? SOIL DESCRIPTION REPORT gage :'+of : PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles ' Texture Structure GPD/ft2 Consistence Boundary Roots in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench _3 / 0-9 70 VA /) - 2- t Ire e -1 ! ( Ni p .._....... ... Z ?i7 7„5- , - ' t( xi.4- //f/c 5 V- Pj 2 a 0 .5- , 6 Ground /721 f y 7e- 7 - Cr 10/ ) (5'6 141./ (4 0 ' -7 . t> ,5',/:_, ft. ('1 2- '-'3'7i 7'.11/e.=,- /1 t( ;') ---, '-:.- ,,--- Depthto .3y'-fL/O/1 4-V r. f (��'�f �✓1 C 0 7 limiting 1i: fact f �y Remarks: Boring# ( U 9 / 4/A '-'` /i ') / 2� /ft-, 2 47, r' 1 e -( / Cam, / f ti`i Ground 7/-Z}1 ,( - V ei 141, 60- -�j 11/1." C -' o . 7 eg> elev. ft. 2 ,'.3-,/, a /!'-51 LI r ( hr�,a.J �% /J� kYa �� - 0 0 7 ,�Y Depth to -?7--&/K. 6---V. -/ ' ' (.FI (} 1'i1 0 ,7 • ? limiting factor ,i � y Remarks: Boring # / a- i /6 y/z N b A/�--- ., - i'+, . /..v-- ni e�% " C-4.- 2 ' P r /1° 2- 9_/.7 .7 j-yR y_ I mo- o , - Ground 3 . /7-7_ S i1e V )14 0- 7 , )14.-0-,i gal \yd? Lfl . .0 . 2 . P 90 ft. Depth to .3 33-?J° y12 -Y L/ h"lam'-) (3 )" 0 -7 . P limiting factor €, Remarks: Boring # .................. Ground • elev. ft. Depth to limiting factor Remarks: SBD-833o(R.o5/92) BARRON PLUMBING & HEATING, INC. JOEL E19- S Lloyd Pahlow, Master Plumber BARRON, WIS. 54812 V S. �, - 7 - 31 A) (2/ 1-t- (715) 537-3448 V1U-AC-7C / /2-/ - D 0 ........... .......... 11111111 .. ... ......... . . . ........ .............. .............. ....................... ..... ....... . ............. �rA f-'- ............. .............. . .......... ... ......... ..... .............. .............. .............. ..................... .... .. ........... ........ .. . ............ ....... . ... ............... .............. ............. .. ........ .......... .......... ................ ... ...... ................ .... .. . ..... .. .............. .............. ... . .................... . ..... . . ........ ................. ............... . ... ......... .. .. .... ...................... . . .......... .......... . ........ .......... ....... . - - .. . ....... ......... . ... .. ... ........ ... .............. .... ............. ............ ............ . .. . ............. . ............ .... ........ .............. ............. ........ .... ........ ..... ... .......... ....... ...... ............ .. ...... ... ................. ............................. .............. ... ... - ..... .................................. lot, . ......... . ......... .. ............... .......... ......................... ..... ........ . ... ........... . . ........ .... .. ..... . ........... .. .... .. .. . ............. ........ . . .... .............. .............. .............. ............. ............. .......... .............. ............ .............. ...... . ......... ........... ............. .............. ... ........ . . . ...... .. .. . ..... ..... ............. .............. ........... .............. .................... ....... ......................... . ...... .............. .............. ..... .... .. . .. ......... ............ .... ....... .......... ........ .......... . ......... ............. . ......... ........... . ... ...... .............. ............. .... ............... ............. ............... . .......... ............ .......... ........... .............. .......... .................... .......... ........... ............. ..... ........ ............... ............ ........... ............. ............. ; ............. .............. .............. ... ........... .............. ........................ ........... ................... ............ .......... ............ .............. .......... .......... .............. ......... ... .... . ............. .............. .............. .......... .......................... ............. .............. ............. . ............. ........................... ............. ............. .... ........ . .. .. ........... .............. .............. ........... .................. .............. ........... ........... ............. . ............. .............. ............... ........... .... . .... . .......... . .. .......... .......... ........... ....... ...... .............. .............. ............... .............. ............. .......... .............. ...... ....... ........... ........... ........... ........................... .................. ............ ............. ......... .. ........... ............. ............. ............. ........... .............. .............. ........... . .............. ............................................. ............. .......................... ............. .............. .............. .............. ............. ............ .............. ............ ........... ........................ ........... ................... . . .............. .... . ...... ------------- .......... ................ - PRWW 2D4-1 J� IM, &Qtxt MM 01471. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND I� OWNERSHIP CERTIFICATION FORM Owner/Buyer W 1 ' 1� C� Lu � I C Mailing Address �SOc�- S - fei, Property Address (Verification required from Planning Department for new construction) nn City /State �)- ar gal r 1 C' ' Ll parcel Identification Number — J LEGAL DESCRIPTION Property Location N C ' /,, �' / <, Sec. -ZW, Tow of Sz r Pl�alr Subdivision , Lot # Certified Survey Map # , Volume , Page # 3 3 7 Warranty Deed # 5 [") 55 2. , Volume Z G Page # 3 Spec house ❑ yes ❑ no Lot lines identifiable [Tyes ❑ 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 da f the three ear expiration date SIGNATURE I 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 rry described above, b virtue of a warranty deed recorded in Register of Deeds Office. pe -f H161 -�A - lr--) SIGNATURE O 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 .v( Er i C_�.- Ri> °� 1dit-d_ Ct ^LF -t E. AUG corve s and vy_i, do s io Cwt } (_S fit ' - d l.d l t1�1f i i ,.. t..'.be -, M ( t R14 the !0 described real es*le in ._ _ -.___- S t. ,._ . ,. Croix _ - -- C''<CN Staff$ of NJSC(?r'.SiP.: Tax Farrel No: x/182- 1021_50 Part cf NE 1/4 of NW 1/4 of Section 6- 31 -17, Village of Star Prairie, described as follows: LOT 2 of Certified Survey Map filed November 13, 1997 in Vol. "12 ", Page 3379, St. Croix County, Wisc risin. F_ This _ -_.._ i S n _ no .,esteaii property. Xix) (is not) Exception to warraniies: Easer:ents, restrictions and rights of way of record, if any. Dated thi - -- _ 18th Auju -- -- _ • Eric L. Russell ` Doreen E. R se11____-- -___ -- - -- — - -- - - - - -- -- - — (SEAL) — — - - -- -- - -- (SEAL) ALITHF"NTICATION ACK;1rJWt_FDGF -M.FtiT Eric L. Russel T_ Siynature(s) - - -- - STh, DF ss. & Oo E. t E. Riff, ,e11 _ST_ lt�.'X_- - -__ County. Pie yo aify came be} ^(e me this __ _ - - .../$__ day of autt,a .iiCa}r c U is 1 gt �iay of _ Augu _ 19 9_._ ' 19 the above named L _ .. -- ----- - - -- -- — . _ - -.— -- — — - - -- —._`r_ ��_..- -a 2 ia - i — -- TITLE: WE_I`,'HFP.3LATE6AR Or ___.- _____.__ _-__._,-- �.- _ -___- to rrter I - , Son ! - who ,X�cuted ; ,e a! +I o r zed by § 706.06, Sta"a) me:,t and acknowledge the Same THIS INS T R; IMEN VY 1S DPAF I'LO BY c 1) 568534 CERTIFIED SURVEY MAP The Fractional Northeast Quarter of the Northwest Quarter of Section 6, Township 31 North, Range 17 West, Village of Star Prairie, St. Croix County, Wisconsin. Prepared for and at the request of: Gary Russell 703 Jewell Star Prairie, WI 54026 OWNER: UNPLATTED LANDS Eric and Doreen Russell - -- - - - -- - IF COUNTY LINE AVE ST. C_R__O I X ROAD NORTH LINE OF THE FRACTIONAL _ NE 1/4 OF THE NW 1/4 NORTH 114 CORNER -- -------- S89'33'27 "E 2780.52'-- - - - - -- --- 6 -31 -17 � --- - - - - -S 8_9'3_3'2_7" E 1 3 14 . 67 '-- - - - - - (SURVEY NAIL) �. — — — — _ — - — - -- 673.69'- ------ - -Z! T 306.26 �'i 6 08 301.35 � 0 , GC7 34.17' , i �,t S89'33'27 "IE i / tt � 303 Ln i / t °// / o S89 27 E Uj o / l L1- R.O.W. ,''O I I c i 1 M t Q to /2oJ97 r i i 1 ' i i' co 1 I I 1; RONALD f. 0 1 Ni JOHNSON co 'LOT 2 IM 8- „86 W I L O T 1 I I AMERY. e o I I 1 WIS. j • I 1 O I I I f • E^R I I in I I O I I I < a Q ms`s SU R�� ,► 1N .. !0. I _ 1 O O I• � 11M�� ° 3 M� O .. d I J I ao r �,, ° r . 1� 3 i CID 1 en Cz C: O1 i ^.y I I 1 v I I 1 i wain °6V)I I 1 1 w In tw in W I I I I a pr y O d ,n I I I I W ° �I I 1 0 L Ow N La 1 I 1 , IQ tAU W M UI i I m X tr I I I J to 4m 1 a to L) W r, U I I I C3 I Q Ui r , I 1 J O Q C-1 a 1 1 ^p O W ^n b in N ta7 Q N �1 I I N N Q N try ► 1 I I \ V); 1 0 in I k1 Z I 00^ I Z g1 to to N 89'54'32” W t tl I ►� N 89'54'32 W 3 N .. I w N o 25759' 34995 �1 ■ r 3 I = P Q1 O[� M 1 �I I IM k ZI J D I 1 O N w Oi w 0 1 I 2 I O W Z t o ZI LOT 3 �M ~� I to I l.Z I N O I i C31 i ,OO Z w GARAGE J i 1 O N N i i •/ WELL I i I Q tU c y v O O I I d HOUSE SEPTIC m : ° ®�, �� ♦ TOTAL AREA i i a_ Z �� I 545,246 SQ. FT. v c� 12.52 ACRES t�'� �CZ' I o- J I I c , 3 AREA EXCLUD. R.O.W. �J� 0� i i :. o W ° Ito 1 1 543,065 SO. FT. �, O� I I 04 E .: z w 12.47 ACRES `��' Q I I N ` x E o �d�E 0