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Home My WebLink About038-1183-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No 538807 0 GENERAL MFORMATION (ATTACH TO PERMIT) State Plan ID No: Personar information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Heintz, Thomas I Star Prairie, Town of 038- 1183 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: /dam VYl 1 cST' 21.31.18.925 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER �5 CAPACITY STATION BS HI FS ELEV. i Septic J Z"ti Benchmark _P? ? gi q� 9 0 Dosing 6 Alt.. - k Z. 7 ;11ra... Aeration Bldg. Sewer 7 9,3.5' Holding St/Ht Inlet �.� LL TANK SET ACK INFORMATION St/Ht Outlet TANK TO O P /�` WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic T7 J .� Dt Bottom Dosing r r Header /Man. /Z Aeration Dist. Pipe 9Z . L Holding Bot. System 7-6 91 4 Final Grade PUMP /SIPHON INFORMATION 3. . • l Manufacturer Demand St Cov r q GPM �� r / _ Mod mber T Lift Friction Loss Syste TDHl Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of T rench es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1 Z rems SETBACK SYSTEM TO Y/ P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer INFORMATION Type Of System: CHAMBER E OR �� . -,(� - (a, G L A' � A }►� Model Number d DISTRIBUTION SYSTEM sf ` b Header /Ma ifoId/ Distribution x Hole Size x Hole Sp ia�ng Vent to Air Int Pipe(s) e �n E S Length `�' Dia Length_ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over Fxx th of xx Seeded /Sodded xx Mulched Bed/Trench Center �. �[ / Bed/Trench Edges l ��r es No es [ No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2115 Cook Driv So e�rset, WI /54002,5 (SE 1/4 NW 1/4 21 T31 N R1 8W) Circle "C" Lot 8 Parcel No: 21.31.18.925 1.) Alt BM Description = ' j L'"� C, 4-- �'b�S a ✓� 2.) Bldg sewer length =27 - amount of cover = � Z• �J o r Plan revision Required? ❑ Yes o Use other side for additional informati Date InsepctoXignature Cert . No SBD -6710 (R.3/97) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix � Safety and Building Division Sanitary Permit No: INSPECTION REPORT 538807 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Heintz, Thomas I Star Prairie, Town of 038- 1183 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 21.31.18.925 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length T. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 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 j xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [Q No ❑ Yes E`' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2115 Cook Drive Somerset, WI 54025 (SE 114 NW 1/4 21 T31 R1 8W) Circle "C" Lot 8 Parcel No: 21.31.18.925 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes ❑ No Use other side for additional information. Date Insepctor s Signature ce t No SBD -6710 (R.3/97) Commer4e. YVi Safety and Buildings Division County t. C ED 20 Washington Ave., P.O. Box 7162 Madison, WI 537 1 Sanit Permit Number to +e filled in b Co It i ' s pa co s in 1 � ( y rtmerrt Com MM e S nil nr1''t' t A plieation S tateTransactio Number In accordance with s. Comm. 3F. ubmis n of this form to the appropriate governmental unit is required prior to obtain 0&W. plication forms for state -owned POWTS are Project Ad ress (if different : ban mailing address) submitted to the Department of Commerce. Person r tion you provide may be used for secondary / e p urposes in accordance with the Privacy Law, s. 15.04(1 )(m), Stats. I. Application Information - Please Print JOKnformation Property er's Name / parcel # Property Owner's Mailing Address Property Location �z 21 �z - f 0, Govt. Lot City, State t 4ZipCode Phone Number -A 1/4 Se.tion, irc le on T R E W II. f Building e o u ldin check all that apply) Lot # P g ( PP y) l./ r 2 Family Dwelling - Number of Bedroom Subdivision Name Block # El Public /Commercial - Describe Use 6X F - 0 - ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of _ III. Type f Permit: (Check onlylone box on line A. Complete line B if applicable) A ' ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Exist ing System (explain) B. El Permit Renewal El Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number : nd Date Issued Before Expiration Owner IV of POWTS S stem /Com onent/Devic t o . t Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil STs ❑ Holding Tank ❑Other Dispersal Component (explain) ❑Pretreatment Device (explain) P� 03 V. Dispersalffreatqfent Area Information./ .- I>s ip Flow (gpd) Design Soil Application te(gpdsf) nDialArea Required f) Dispe Area Pro d s yttem / e a r ati nt / VI. Tank Info Capacity in Total # of Manufacturer , Gallons Gallons Units o New Tacks Existing Tanks n t � � o y 1 Septic or Holding Tank Dosing Chamber VII. Responsibility Statement I, the undersigned, assum onsibility for installation of the POWTS shown on the attached plans. Plumber' ame (Print) Plumber' ature MP /MFRS Number Business Phone Number / Plumber's Address (Street, City, State, Zip Code + VIII.0ountyffiepartment est Onl Approved is a d Pennn Fee Date 1 sued Issuing a Signature Given Reaso Denial $ ! 75 . / Z 1'SfEM O�1%AER: pp IX. Condi . easons for Disapproval +� r 3 a 14( 1. Septic tank, effluent frfter and � dispersal cell must all be services l maintained e4A* as per management plan provided by plumber. 2. All setback regtrirements mustbe. maliftned as Attach to complete plans for the system and submit to the County only on paper not less than 8 to x 11 inches in size SBD -6398 (R_ 02/09) PLOT PLAN PROJECT Tom Heintz ADDRESS 2140 Ctv Rd C Lot 43 New Richmond Wi 54017 SE 1/4 NW 1/4S 21 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/25/11 BEDROOM 3 CONVENTIONAL )00( IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 IL BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all setbacks required by SYSTEM ELEVATION 93.0/92.9' 3' below qrade WDNR Property Line 1 V ent 0' Plans Designed Using ji Leaching Chamber Vents Quick4 Standard -W 20 Conventional Powts ' Manual Version 2.0 with 20.0 ft2 of Area B -2 Scale is 1 = 4�' 5.8ft ^2 /pair of end caps Grade at System Elevation 75' unless otherwise 34 noted 0% Slope B -3 2 -3' X 66' cells with >3' spacing Well is to meet all setbacks found 40 ' 80' in Comm. 83 25' ST 15' Pro 3 25' 30' Bedroom B -1 House �� Property Line Q Cook Drive Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 7/25/11 Owner: Tom Heintz Location: SE1 /4 NW1 /4 S21 T31 N,R18W Lot 8 Circle C Star Prairie System type: In- ground absorbtion system(conventional) Manuals Used: In- ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4 -5. Maintanance and Contingency Plan 6. Filter Specifications Sh e Signature License number #2 0 PLOT PLAN PROJECT Tom Heintz ADDRESS 2140 Ctv Rd C Lot 43 New Richmond Wi 54017 SE 1 /4 NW 1/4s 21 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/25/11 BEDROOM 3 CONVENTIONAL )00( IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 IL BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100 Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark Well is to meet all setbacks required by SYSTEM ELEVATION 93-0/92.9'3' below qrade WDNR Property Line 10' V ent Plans Designed Using >6 Quick4 Standard -W 20' Conventional Powts �� Leaching Chamber Manual Version 2.0 of Cover with 20.0 Ch of Area Vents B -2 Scale is 1" = 40' 4' 'Long 5.8ft^2 /pair of end caps unless otherwise 34" Grade at System Elevation 75 noted 0% Slope B -3 2 -3' X 66' cells with >3' spacing Well is to meet all setbacks found 40' 80' in Comm. 83 25' ST 15' Pro 3 25' 30' Bedroom B -1 House Property Line Cook Drive Cross Section of Quick 4 Standard -W Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard -W Leaching Chamber with 20.0 ft2 of Area per Chamber 5.8ft ^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 96.0' Vent Ae l Grade 4' 4" AV= X30/34 Septic Tank 4 Long i 1f 5 ' f) 3 4" Grade at System Elevation 3 4" Grade at System Elevation Spacing 5' 2 -3' X 66' Cells Observation tubeNent Same on other end Located at ends of Cell A B 16 chambers per cell System elevations: A__93.0 B 92.9 Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Eff luent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. arge into system is not exceed those required as per Comm. 83 C-C ting ncy Plan ption # . If system fails, determine cause of failure, use alternate area and install new t n tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 ST. CROIX COUNTY SEPTIC TANK MAIQMNANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number A-:� 3 r Z-Z LL -tea —r2 I DESCRIPTION Property Location V. A)W Z V. , Sea::�?/ , T LN R _W, Town of`5i,— c Subdivision � 1C� L/ , Lot # Certified Survey Map # '-- JJ , Volume , Page # Warranty Deed # e2 0 Volume , Page # I Spec house y no Lot lines identifiab yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper main bcnance 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 syst= Owner mainfionance responsibilities arc specified in §Comm. $3.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 wastewater disposal system ism proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 frill of sludge. Uwe, the undersigned have road 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 bean maintained must be completed and returned to the St. Croix County Planning & Zoning Departin within 30 days of the three year expiration date. Uwe certify that all statements on this form an true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a Warranty deed recorded in Register of Deeds Office. Number of b ms" WO I IVI SIGMA (S) ATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** 1whlde with this application a recorded werranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed ME'V. 08/05) LLJ o "i - oC I.. co cl, �oac, LLI cn LIL LL. u w 12 U - LAJ 4i�0 LL - 14 - IIII � N ...... -------- - ._...._. - - cd p�p y � y fA ril �w -.r RECEIVED 1 PA ID Wisconsin Department of Commerce SOIL EVALU MON RE f3T Page of Division of Safety and Buildings in ccorda t*[wdR Wis. m. Code r County Attach complete site plan on paper not lessithan 8 e. Pia must s' include, but not limited to: vertical and hori r tld �� p�i(;3i and Parcel I.D. percent slope, scale or dimensions, north a earest road. 67 S - Ag Z— B — mo Please print all information. Revi ed by Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). Z/ Property Owner Property Location Govt. Lot N R E Property Owner's Mailing Address Lot # Block # Subd. Na or M# 0 U of y� 6 , - C City State- Zip Code Phone Number ❑ city ❑Village Town Nearest Road New Construction Use Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public commercial - Describe: Z G � Parent material 4 r c� Flood Plain elevation if applicable /-40K ft. General comments 3 and recornmendations: System Type ��Ii[� /4 System Elevation ❑ F /9 Bon # Boring Pit Ground surface elev. ' 0 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 D _ 7 �JJ Boring # Boring Pit Ground surface elev. O ft. Depth to limiting factor tn. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff#2 Z ee l ,t ►t b Effluent #1 = BOD > 30 < 220 mg/L and T >30 < 150 • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Ham (Please Prino — _ lure CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, W 4017 / 715- 246 -4516 Property Owner _ Parcel ID # Page of 15 - Boring # F1 Boring qr ) pit Ground surface elev. I �'' - ft. Depth to limiting factor ! in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I 'Eff#2 - 1VW K0 ' _57 t c t �I ko F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1, 'Eff#2 Boring # ❑ Boring F ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate. Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -9330 (Rb/00) Soil Test Plot Plan Project Name Tom Heintz Shau d Address 2140 Cty Rd C Lot 43 New Richmond Wi 54017 M #226900 Lot 8 Subdivision Circle C D t 7/21 /11 SE 1/4 N W 1/4S 21 T 31 N /R18 W Township StarPrairie Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of steel fence post System Elevation TBD 3' below grade *HRpSame as Benchmark Property Line 01 20' Scale is 1" = 40' unless otherwise B -2 noted 0% Slope 75 B -3 80' 40' 25' Pro 3 30' Bedroom House B -1 Property Line Cook Drive A'J 945.54' h - All L 16 ' 9 I v t M f! A L. n 5 ca � 6 / • , t, 1.23 ACRE rrt 1.51 ACRE S ua 65,77Fa SQ. F7. : art 5404 1�e y 1,51 ACRES �Wa t� 7 5 � 4 �� e° o 65,774 ,Q. FT. Wr z ' 1.51 ACRES ' 65,77' SQ, FT w•a e� cr NO BUILDING BELOW H.W.I., (r. r 176,06' 1 75,,9 �y�c, 3Ifs.15' S 89 *10 7" E 834.79' t E iii�i 6 iii� ii�ii 0 4 viii ii STATE BAR OF WISCONSIN FORM 3 - 1998 86760 1� KATHLEEN r [ H. WALSH REGISTER OF DEEDS Annette F. Heintz, quit- claims to Thomas M. Heintz, the following described ST. CROIX CO., WI real estate in St. Croix County, State of Wisconsin: RECEIVED FOR RECORD 01/23/2008 11:45AM Part of the SE 1/4 of the /4 of Section 21, T31N, R18W, Town of Star QUIT CLAIM DEED Prairie being described as ws: Lot 1 of Certified Survey Map Filed EXEMPT t BM December 12, 1990 in Volu e 8 Page 2301 as Document N 464863. REC FEE: 11 e PAGES: 1 AND Lot 8, Circle "C" Addition in the Town of Star Prairie, St. Croix County, Wisconsin. Recordin g Area Name and Return Address Krishna E. O'Boyle t7� VAN DYK, O'BOYLE & SILER, S-C. 201 South Knowles Avenue New Richmond, WI 54017 038 -1089- 30-110 and 038 - 1183 -80 -000 Parcel Identification Number (PIN) This is not homestead property. This conveyance is given pursuant to divorce judgment granted in St. Croix County, Wisconsin, Case No. 07 FA 337, on December 3, 2007. The purpose of this deed is for Annette F. Heintz to transfer her interest, if any, in the above described properties. Dated this 2r day of 2007. (a& *Annette F. Heintz AUTHENTICA ACKNOWLEDGMENT Signature(s) e F /gip/ STATE OF WISCONSIN ) )ss. ,,--'' aa II-- County ) authenticated this�day of c' ,�,, �Y iep - 2007. Personally came before me this day of 2007 the above named to me known to be the person(s) who executed the foregoing TITLE: MEMBER STATE BAR Or—WISCONSIN instrument and acknowledge the same. (If not, authorized by § 706.06, W is. Stats. ) THIS INSTRUMENT WAS DRAFTED BY Kristina E. O'Boyle Notary Public , State of Wisconsin VAN DYK, O'BOYLE & SILER, S -C. My Commission is permanent. (If not, state expiration 201 S. Knowles Ave -, New Richmond, WI 54017 date: 20_.) (Signatures may be authenticated or acknowledge. Both are not necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures 1 of 1 QUIT CLAIM DKED STATE BAIT OF WISCONSIN FORM Nu. 3. lPJ8 INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI 800 - 855 -2091 i i I z j I - I I I I � I I 1 � 7U LL 4 7 LA ILI r 0 17.-- -Mot �" ' � � m ti �n v b n � N E rn Z � 7 Wisconsin Department of Commerce On''' AN SITE EVALUATION division of Safety and Buildings Page of I % - %0i eau of hitegrated Services i crs�d ,& ice with s. HR 83.09, Wis. Adm. Code Attach complete site plan on paper not less tha .� x 11 i Plaq,m t County include, but not limited to: vertical and horizon I reference poi f B , Irectio ark , percent slope, scale or dimensions, north arro r �r dl loq,4i p and distance to ne road. Parcel I.D. # r E a 1997 ti C9 3 p- // �'3 Q —0CJ6 APPLICANT INFORMATION - Pleas ebit all 1 Revie b Date Personal information you provide may be used for secon a �rpe�Es. 1 ( (m)). G 1 ;w-7— Property Owner f i— ioperty Location �� ` Govt. Lot 1/4 i 1 /4,S T N,R (or& Property Owner's Mailing Address ! d �� Lo Block Subd. Name or SM# _ City State Zip Code Phone N ber ❑ City VIII ge ® Town (- Nearest Road — iJ J ) S zk, �aa ® New Construction Use: [ Residential / Number of bedrooms Addition to existing b 'Iding ❑ Replacement Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate ._,_ -bed, gpd/ft gpd/ft Absorption area required f_3 bed, ft 2 _5�___? trench, ft Maximum design loading rate __ bed, gpd/ft gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations Parent material eq-5�_ a �� «'�%�� /�� °;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 for system S E1 ® S ❑ U [S ❑ U (� S ❑ U EIS U El S •� 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 S s — Ground elev. , �Qft. Depth to limiting factor Remarks:' ` Boring # Al 3 bu3ii Ground elev. Depth to limiting factor �i�in. Remarks: CST Name leas rin ignVVe JZ Telephone No. Address Date / CST Number Jf 27 SOIL DESCRIPTION REPORT PROPERTY OWNER � Page ,�:2- of 'PARCEL I.D.# o Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed , Trench 13 2 20 Al r r L ' 4e5 — Ground elev. Depth to limiting factor Remarks: Boring # Je Al 4Y S 13 a2 s �R 3 s — ' Ground — elev. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Boring # / lal! .1 - s 3 Ground el n Depth to limiting factor }&Lin. Remarks: Boring # L Ground elev. ft Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) n s — r AZI �sc�r�i I kJ Parcel #: 038 - 1183 -80 -000 07/02/2007 11:13 AM PAGE 1 OF 1 Alt. Parcel #: 21.31.18.925 038 - TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner THOMAS M HEINTZ O - HEINTZ, THOMAS M 2140 CTY RD C NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 2115 COOK DR SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.510 Plat: 0174 - CIRCLE "C" ADDITION -98 SEC 21 T31 R1 8W SW NW LOT 8 CIRCLE "C" Block/Condo Bldg: LOT 8 ADDITION Tract(s): (Sec- Twn -Rng 401/4 1601/4) 21 -31 N-1 8W Notes: Parcel History: Date Doc # Vol /Page Type 05/09/2002 678515 1887/359 WD 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.510 28,600 0 28,600 NO Totals for 2007: General Property 1.510 28,600 0 28,600 Woodland 0.000 0 0 Totals for 2006: General Property 1.510 28,600 0 28,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00