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038-1147-95-000
o O O fa c 0 o I o I h 7 a LL O ~ N N N f y ~E y h l~ 7 t(D . 0 e'I f, d r-. 'D N co j a m E c 2 x $Y v NMa B ti m c C to 3 v w o mcoc`oo i o o my Z c C Z 000 U) N LL c LL C: N a 3 'v E Q ni co O Q 2 ~ w I Cl) m d Z Y1 Z co Z O L' O O O` Z 0 ~coai am am I o I o z g c ~ ~ I N I Q Y o I v c E m I N N 3 C cc a) y a~ o • N L U) a O ~ c O c ° w 0 U Z Z Z m Z o N co z co 'C I m N N 0 E T R E m o 3 N ,c 'c o CL G G a m N C-4 rn o C, N N N v) otS U) to Co rn N O O a u O O a Z o 4i a a a a a a v, N a Id ~a N o v E o E o) o) z }y 0 _0 Z C p -p C O O 7 Q N Q mI C CL .0 2 ii (n n L 'd m Q 1- (n N O m Q Z ( O r - CO Y ° y O o 3 v to O y c 5 E C~ N N O N O rn c_ rn a n o r Lw c f0 € E 16 q? co v O cc U `o u~ U o o y = d co >w o m mH c a°i~ ly~~) r> co o N o o N E .E 1, 2 Cl) • ^i co) U) in N O Z S Z m N o Z C rL (A O I - i ('L ca a V r/~ d A a€ m a L: a L: a • co a d m d c m e c c 3 Co~ A v a 2 0 to V 4Wiswntiin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and Buildings in acco ILHR 83.09, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1( 'iQ inches in ' ' e. Plan , include, but not limited to: vertical and horizontal r e poi lion aPd l~-r percent slope, scale or dimensions, north arrow, ation a near$s~ d. Parcel I.D. # ►ot►t _ dig-1111' -95 1d'l a c>3~-11 y - S -IoiaC~o+ta APPLICANT INFORMATION - Please all in jP9? Reviewed by Date Personal information you provide may be used for second ses (P~ s. 15.04 ( . Property Owner 1 o Location rd 1.(~r i $ f" 2 Lot Se 1/4 kjE 1/4,S 1 -1 T 3 I N,R 1 g E (or)( Property GAfner's Mailing Address Lot # Block# Subd. Name or CSM# 3~b -7 to" I1+ I a C VJ'~ \'3. a. Yn Shr7 r c City r State Zip Code% Phone Number / El Nearest Road G c ° G'{ s N 5'r,1 p7 ( City El Village r ~ To ~ $ MQC bf - X72. New Construction Use: ® Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow SO gpd Recommended design loading rate gibed, gpd/ft2- Aa-trench, gpd/fit Absorption area required 9bo bed, ft2 '7 50 trench, ft2 Maximum design loading rate • S bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) I~ a 4 3 ( c/ 8.13) 5 4 fe 1. , S 1)\ft (as referred to site plan benchmark) Additional design/site considerations ConJan~ n wL ~P + y ri 9 g.5l~I ) 4 S t C r t OTtC „r o.. S. v-P MoVh Parent material a I a c.: c. L 1" • Flood plain elevation, if applicable d ft 1 Mound In-Ground Pressure AT-Grade F System in Fill Holding Tank S = Suitable for system Conventional U = Unsuitable for system S ❑ U ~ S ❑ U ® S ❑ U S ❑ U ❑ S U ❑ S ( U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 in. Munsel► Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench o-Ib Ioy2`~1 1.5 bk MjVe R S aF a !!!-:3s 0 . y! L C7 - S M L- c- I F .1 . ~ und 3 3 -L 7.S 5/ b L G W f- . 7 elev. J Q~ 38ft. R 41 S a - iM >w _ .7 .8 Depth to limiting factor 95 in. Remarks: Boring # 0-9 I D yl <S oZFSb1t vFr R 5 ~F 1 3 al-~'I yR~~N a - ran L Gw ~J F .S3 Ground 7-y5 7. S y2'41y L r, <S b k t-\V r w I V F S , b el Iv. c~~fjl -1.S` RLIj9 i r1 ~1-q5 5'10)q 6L e. Depth to ; limiting factor -5 in. Remarks: CST Name (Please Print) Signature Telephone No. r1-8 I` 5tQY" K ' ` 71S- ZL49-35V$ Address Date CST Number a-I ra,\ f ; r - a4 - 9 -7 L4 0 I 64 D~lp p SOIL DESCRIPTION REPORT PROPERTY OWNER C r a'1 a + L o r '1 y! vlay Page of PARCELLD.# (O31-95>!,a/x'11 ~d3~-1ly~-g5--►o0~ 11q7- Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots - in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench -3 1 0-9 ,o y► LS QF5bK m~ ~ gs aF ; C R-16 I0YRy/ Sc.L- aMSbw- rn ~r G w_ .y ' . 5 Ground 3 /li-3,x ~ISYRy~4 S L V'^ S ~C M FP' U.i 1 q f elev. Depth to ya 5 Y (Z y/ 5 p _ ,i,,, L , 17 limiting factor (OS in. Remarks: Boring # 0-`3 Ityp ~S aF k vfr aF 1 / ; 1 -IA ID'49q)y SL amsbK Mir G w F .5 Ifo la-Il, dy R q1 F ~.S `~{L51 S L a,M fr 1~= .5 ' . b Ground T ISYRyI cl GIs Y2-'I4 S~- a>r k vHFt- W / 5 .6 elev. 102.2 ft. 8y3 -7,SYp4J c10kh.SjR,/N SL ern 1L rr~r Gw~ 1~~ _.5 ,Lo Depth to S p q) y F 3 't, 5 YR V/ 5 L -~m S b IC t~ f'r G w 1 S'~ lv limiting b- s y yl 1fM1 L~ factor JS5 in. 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# p.9 ID`{~U +LS aF tC rr~F~ S dF ~7 S 9-18 Ry~y L dft bK r,-.5-*r Gw a~ ,S la-3 ~ISKRUI F1F7.15 SL w- t-, 1 F , 5 ,b Ground .y 7►SY(ZyI G 5'f 2?~ ~L 1 F 9 eAAft. -S SYp- 3 1,5K 5~- r,-, )ofir I e. w 5 : ,1. Depth to LL limiting factor 20 in. Remarks: Boring # b- I u Ryj aFS 1C MVFr Is xc- - SL 9N►sbk MF agja 7.Syt y/ S 1- r~/+~M SbK. 1th f r- w 1 5 Ground 7 as Y(~`~l, _ V tv1 L V-0 I / V elev. ft. SSA - S L a~ 1 1 Depth to limiting factor SO in. Remarks: SBDW-8330 (R. 08/95) ~v 0o + ~ 1 to a•3 l t r a lo I 0 k 10 to ' o 1 1 B 1 c ~.O t r .t! Lw AL A4 C A i - - 1 i ~ i' Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 LaW 4snd Human Relations F Orticion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less than.8,,y,-2Ard lan must include, but PARCEL I.D. # not limited to vertical and horizontal reference Q<sir~t'(slope, scale or dimensioned, north arrow, and location and,disfance 038-1147-95 EVIEWED BY DATE APPLICANT INFORMATION-PLEASEPRINT PROPERTY OWNER: LGOVT. LOCATION NE1/4 Se 1/4,S17 T 31 N,R 18 j&or) W Eugene Burke PROPERTY OWNER':S MAILING ADDRESS SUBD. NAME OR CSM # 4657 Charland Rd. C Xiqwam Shores CITY, STATE ZIP CODE PHONE NUMBER VILLAGE OWN NEAREST ROAD 100th, St. Shoreview MN. 55126 (61A 484-096e New Construction Use [ Residential / Number of bedrooms 2-3 [ j Addition to existing building j j Replacement (j Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • _5 bed, gpd/ft2 .6 trench, gpd/ft2 Absorption area required 375 bed, ft2 375 trench, 112 Maximum design loading rate • 5 bed, gpd/ft2 •6 trench, gpdjft2 Recommended infiltration surface elevation(s) 105.87 ft (as referred to site plan benchmark) Additional design / site considern*cns na Parent material glacial till Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S ®U I 7 S ❑ U ❑ S ®U ❑ S ® U I S $ L] U ❑ S [21.1 SOIL DESCRIPTION REPORT Depth Dominant Color Motues Texture Structure CortsistencelBourdary Roots GPD/ft Boring # Horizon in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Tter>d 1 0-10 7.5 r4 6 none sl 2m r mvfr crw 2f .5 1.6 1 2 10-27 7.5yr4/6 none is Osg mvfr gw if .7 .8 Ground 3 27-60 7.5yr4/6 f2p 2.5yr4/4 sil M na na na p •2 elev. 104.87ft. Depth to limiting factor 27" Remarks: Boring # 2f .5 .6 1 1 0-7 7./5yr4/4 none sl 2m r mfr C[W 2j 2 17-22 7.5yr4/4 none sl 2msbk mfr gw if .5 .6 3 22-46 7.5yr4/6 none sl 2msbk mfr gw na .5 .6 Ground elev. 4 46-75 10yr4/3 none lfs Osg mvfr na na .5 .6 104. 8-4t. ands of 5yr 4 sil throughout h-4 Depth to limiting factor +75" Remarks: CST Name _Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 2 ,t . Ave., New Richmond, WI. 54017 Si nature: 0% T Number: 9 7-1-~4 cstm 02298 PROPERTY OWNER SOIL DESCRIPTION REPORT Pags 2 Of 3 _ PARCEL I.D. # Boring # Horizon Depth DominantColor I Mottles Texture I I Structure Consistence I II Roots GPD/ft _ in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed iTmr& v\\tiiiii:: 3 1 0-7 10 r4 3 none sl m mfr crw 2f .5 ! .6 i 7-20 7.5yr4/4 none sl 2mgr mfr if .5 .6 Ground 3 20-27 7.5yr4/4 none sil 2fpl mfr gw if np i.3 elev. 104.27ft. 4 27-60 7.5yr4/4 c p5yr4/6 sil 2msbk mfi na na .5 .6 Depth to limiting fact~7 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. I Depth to limiting factor i Remarks: SBD-8330(R.05192) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 NE4SE4 S17-R31N-R18W New Richmond, WI 54017 MPRSW 3254 town of Star Prarie (715) 246-6200 lot #11-block C- Wigwam Shores N 1"=20' BM= top of NE lot stake at el. 100' 07o &3 , ~Y 4t- 8- lo' 55-~-AKE" Gary L. Steel 7-1-94 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUhit§b?_1q[WY: LOT N0.1131-K. NO.: SUBDIVISION NAME: SE 1/1/4 17 /T31 N/R18 E (or) W Star Prarie 11 n/a Wigwam Shores COUNTY: UYER'S NAME: MAILING ADDRESS: St. Croix Warren Knudson Countryview Ct., #27, Somerset, Wi. 54025 DATES OBSERVATIONS MADE USE NO. BEDRMS.: COMMER IAL DESCRIPTION: (PROFILE DE CR PTIONS: ER OLATION TESTS: ~esidence 3 n/a [bQew ❑Replace 2_7_92 3-20-92 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSUREYSTEM-IN-FIL 1:1i;: LDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑ U ®S ❑ U , 9S ❑ U : S❑ S ®U ❑ S DU conventional trench If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: n/a Floodplain indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 11 AnC2 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTj_DM, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 7.42 105.50 none >7,42 .5810yr4/3 l.s., 3.4210yr4/4m.s. .7510yr4/41.s. 2.671 4/4m.s. .7510yr4/3s.1., 1.0010yr4/31.s., 3.0010yr4/4m.s. B 2 7.08 105.70 none >7.08 .831 4/4 l.s. 1.501 r4/4 m.s. 37B_ 105.90 none >7•25 .5010yr4/3s.1., 1.2510yr4/41.s. 2.2510yr4/4 m.s. B- 3.5OlQyr4/4 1 s 1. 01 4 4co.s. 4 6.67 104.50 none >6.67 .501 4 31.s., 3.251 4 m.s. B- 21 r 41 s 2.001 r4/4 m.s. 5 6.50 104.90 none >6.50 .6710yr4/3 s.l., 3.8310yr4/4 m.s., B- B- PERCOLATION TESTS deciaml' TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAPER INCH NUTES NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER P_ 1 3.30 none 10 3% 3 3 3 P_ 2 3.50 none 10 4 3 2 31- 3 7_3 3.70 none 10 22 2y 2' P-_ P- P- _ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 102.20 i s J ~ I I 4~L ~ i I I t ! 1 ( 1 t E ~ 1 t g ~ ~ E 1 E 1 ~ ~ 0 ~ 1 ~ i ~ Ai, 1 3 INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6336 To be a complete and accurate soil test, your report must incluc#e; 3. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A crate sheep may be used if desired; z your benchmark and vertical elevation reference point are clearly shown, 11armanent; 9. all appropriate boxes as to dates, names, addresses, flood plain data, percc st exemp- tic ~propt iate; 10. If th, i. ormation (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Sail Separates and Textures Other Symbols st - Stone (over 10") BR - Bf-lrock cob Cobble (3 - 10") SS - ~ stone gr - Gravel (under 3") LS - Li iestone "s - Sand HGW - H i Groundwater cs Coarse Sand Perc P, on Rate med s Medium Sand W We fs Fine Sand Bldg - Bi ing Is - Loarny Sand > Greater Than sl - Sandy Loam < _ L Than *l - Loam Bn - B m sil - Silt Loam BI - BI :~:k si - Sill Gy G- , cl - Clay Loam Y - Yellow scl Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc Sandy Clay w% ~flfith sic - w Clay fff - few, fine, faint c cc; common, coarse pt mm - Many, medium rn d - distinct p - prominent HWL - :High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP Vertical Reference Point _ r- INDUSTR'ih, a~r-r vr•a vre vvr~ P.O.BOX7969 LA13OR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS (1-163.090) & Chapter 145.045) LOCATION; ECTION: TOWNSHIP! LOT NO.: BLK. NO.: SUBDIVISION NAME: SW '/NE 1/4 17 A N/R or) W Star Prarie 12 D Wi Wam Shores COUNTY: 'S BUYERS AME: A L D R SS: St. Croix Warren Knudson Somerset Wi. 54025 R.R.31 Lot #27 USE DATES OBSERVATIONS MADE RCI A DES PT 0 : R 0 S: A TESTS: NO. BEDR COMM Residence 3 n/a E~3vew Replace A7 Qn n~i3 RATING: S= Site suitable for system U= Site unsuitable for system 1 :11 If MS TANK: RECOMMENDED SYSTEM: (optional) r ONVENT NAL: MOUND: IN-GROUND ESSU S M- -FILT!I- as]U CAS DU DS ~U OS ®U ®u mound Percolation Tests are NOT required DESIGN RATE: [F' any portion of the tested area is in the n/a under s.H63.09(5)(b), indicate: n/a loodplain, indicate Fioodplain elevation: decimal' ; PROFILE DESCRIPTIONS a e 11AnC2 BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH I ELEVATION OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1.42bn.sil n/a none 2.00 •67bl.1. 1.33bn.s.l. 1.33bn.mot. sil. 1 7.42 .67bn.mot. s.l. 2.00bn.l.s. .58bl.1. 1.58bn.s.1. .83bn.mot. s.l. .92bn.l.s. B-2 5.91 n/a none 2.16 n/a none 2,83 •00bl.l. 1.83bn.s.l. .83bn.mot.s.1. B.3 5.24 .58bn.s 1. 1.00bn.mot.s.l. 4 12.33 n/a none 2.16 .33bl.1. 1.83bn.s.l. 1.17bn.mot. sil. 3.oobn.s.1. 6.0 bn m B B.5 11.58 n/a none 2.16 83bl.1. 1.33bn.s.l. 1.67 bn.mot.s.l. B- PERCOLATION TESTS TEST DEPTH . WATER IN HOLE TEST TIME DRO IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PER INCH P- P- P- P P- P- _ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori. zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM_ ELEVATION n/a for information only n, i t__ ut app.,_t could be site uitable_lforl moron o4 y in re e t__ n ,iti 1 ` I s pp ud ~av t b cut o determine this. §si le to ob ain convent oTun 1 e t h w ve lot 4- I _ fa on si -e `va►u. ion must be One I y t.. Croix Co. this ;report is uded fo1 on. - - 1 Zoning ffice for v ri icati I - I TN ~er~• 1 - 8 9 STC - 104 AS BUILT SANITARY SYSTEM REPORT RECEIVED OWNER _ f SEP 2 3 1997 ti ADDRESS 3 90 s 7- sr COMW ZON . ~ ~ ►NdOFFICE M-N, S~a7~ Z SUBDIVISION / CSM# LOT SECTION T_N-R~W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM `j M S n v INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE DM: 7v SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer- #L&044~~ Liquid Capacity: /ODO 16"00 Setback from: Well0 House p)0 Other Pump: Manufacturer Z~ Modell Size it Float seperation Gallons/cycle: Alarm Location J o-~,rG•.~s~ SOIL ABSORPTION SYSTEM Width: / Length 3S f Number of trenches Distance & Direction to nearest prop. line: 3~ r r i Setback from: well House 75- Other ELEVATIONS Building Sewer Os ST Inlet: ST outlet: PC inlet ,7 PC bottom ,C D Pump Off Q / Header/Manifold y 9 Bottom of system ~ r Existing Grade Final grade DATE OF INSTALLATION: - l - ~ 7 PLUMBER ON JOB: / LICENSE NUMBER: f j(d INSPECTOR: T 3/93:jt 1 Wisconsin pepartmentof Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST . CROIX Safety and Buildings Division (ATTACH TO PERMIT) 5anitaN9049 GENERAL INFORMATION o L Permit Holder's Name: $TAR PiIRA~ E Wn of: State Plan ID No.: BRULEY, CRAIG CST BM Elev.: Insp. BM Elev.: BM Description: Parcel ~a~c No-1147-95-000 TANK INFORMATION ELEVATION DATA A9700366 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark It Dosing QPe,c„„.8•m. Aeration Bldg. Sewer y'•OS~ Holding St/ V( Inlet p. (a5/ TANK SETBACK INFORMATION St/ Outlet Vent TANK TO P/ L WELL BLDG. Airitontake ROAD Dt Inlet Ar Septic NA Dt Bott,4 a~ n>+ tato i Dosing NA Header- Aeration NA Dist. Pipe 5,59 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand s-~ ;l--rm. S.01- 9-Model Number GPM PCB $ TDH Lift Friction System TDH Ft Loss FHead Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer. SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION TypeO CHAMBER Mode Number: OR UNIT System: DISTRIBUTION SYSTEM [Heagdeirr / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake th 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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 4 ,4 S 6 P - X LOCATION: STAR PRARIE 17.31.18.634-6~5, J1,109,2140 SHORE DRIVE LT 11/12 co C%, e. Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH s SANITARY PERMIT NUMBER: t Ais~onsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. In accord with ILHR 83.05, 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 8 1/2 x 11 inches in size. T. C I-h-JA' • See reverse side for instructions for completing this application State Sanitary Permit Number 'OR g17J,0 L 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 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION y Owner Dame Property Location Propert S J T 3 , N, R / *orX& C A, &A Property Owne 's ailing A r y Lct~umberr Block Number "f5 T, ll~.✓( City, State ip Code Phone Number Subdivision,Name or CSM Number S 7~ 1(6j_) cJ Ill. TYPE F BUILDING: (check one) ❑ State Owned ❑ ityge Nearest Road Villa Public 1 or 2 Family Dwelling - No_ of bedrooms 3_11 ❑ Town OF III. BUILDING USE: (if building type is public, check all that apply) Parcel Tax Number(s) ©3S-`1 y? _y5 1 ❑ Apartment/ Condo O 3 On 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. KNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an -______ystem 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 oZy X3 S 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. 17. Final Grade Required (sq. ft.) Propo ed sq. ft.) (Gals/da /s q. ft.) (Min./inch Elevation Q o s Feet Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank lloind 44c ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu e' ri t) Plum s $ignat : (No S a s) /MPRSW No.: Business Phone Number: f s ' Plumber'M s (Street, Cit tate, Zip Code QC] IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved San- ary Permit Fee (includes Groundwater ate Issued Issuing A ent Sign ture (No St ps) Surcharge fee) Approved ❑ Owner Given initial d2 90 - 7 Adverse Determination X~ CONDITIONS OF A PROVAL~n REASONS FOR IS P ~V,~-l SBD-6398 (8.11/96) DISTRIBUTION: original to county. One copy To: safety a BuBclogs niyisioo. owner, Pluerber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit: Transfer/ Renewal.Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained- The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed- 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.); address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete-dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surchargeV(fees) for a number of regulated practices which can effect groundwater. - The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. 7 -7-3 70, /3 6-6 per ii ~-y 6- a ~ are =lam ~ r~~G~ ,Oiscorisin Department of Industry, SOIL AND SITE:EVALUATION Labor and Human Relations Page of Division of Safety and Buildings in acco r (LhIQ 83.09, Wis. Adm.,Code t, T Attach complete site plan on paper not less than 8 1 `y inches in e PI R. County include, but not limited to: vertical and horizontal r e lion S"f f~ percent slope, scale or dimensions, north arrow, ation a near st d, Parcel I.D. # ►o+1f APPLICANT INFORMATION - Please all ini 9r Reviewed by Date Personal information you provide may be used for seco ses (Prs. 15.04 ( . Property Owner S o Location 19 Lot 5~ 1/4 uE 1/4,S 1-7 T 3) N,R 16 E (or)® Property Ookner's Mailing Address Lot # Block# Subd. Name or CSM# 3qb C& -7 IoT% W avh ~p r r- Z3~ State Zip Code Phone Number El City g Nearest Road G r t, S El Village Town 7b n ssd~ c 6r~~ysr_ 9(a 0.r \ Bro b i je. New Construction Use: ® Residential / Number of bedrooms 3 Addition to existing building Replacement ❑ Public or commercial Describe: Code derived daily flow SU gpd Recommended design loading rate _ bed, gpdfft2__,_(a_trench, gpd/ft2 Absorption area required 9bo bed, ft2 '7 SO trench, ft2_ Maximum design loading rate • -S bed, gpd/ft2--L-(o trench, gpd/ft2 Recommended infiltration surface elevation(s) 1, 2 4 3 C 9 8.13 3k, 5 i c. [ 9 ft (as referred to site plan benchmark) Additional design/site considerations __C.°r, don't or` wt. + y If. 91), q,S f 6 e_ 01~t.,&, } 5. Parent material A~ QC.-% c, L I" • I f Flood plain elevation, if applicable M 0 t~ r~~~ ft IEUE:Sunsuitable uitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank for system S ❑ U rj~ S ❑ U ®S ❑ U [AS ❑ U ❑ S C5? U ❑ S 0 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench 0-10 1wip-44 KS 2f 56K MJ -q 5 a lo- 5 C ,\f C se, I M1... cw 1F ,1 Ground 3 3- sl a L C w IJ r 7 elev. Q~ 3gft• 5 Q s Q - Wl L. .7 6 Depth to limiting factor 9S in. Remarks: Boring # ~y~ LS aFsbx vFY' AS .g a a Q-fit Y~W~ p,5 r.,t... cw f P ; r~ 3 al-A`! 2 r^ L L w I J P , S3 Ground 7-ys 7 , S yR y1 L rv, k t-\ f= r W I f .5 . 6 el1vX1 1 Q yo, 19 ®-S thL Lw 51-4 ~RNf L .0 ,5j k. rh~~ rS , b Depth to limiting factor __%5 in. Remarks: CST Name (Please Print) Signature Telephone No. ry.\ 5-~-ar K CIS- X49-3S$N Address Date CST Number an \0 Z) no 5~, ~+CL Pro.;, ; ~ kA ) 5gO24' _7 -Q4-9-7 volt PROPERTY OWNER . C ('0.`. a + LD r yt SOIL DESCRIPTJON REPORT v BC ~Lpf'1I (d 3 -'~fly7~gS-I'DO> 1-0'~ ►a Page~of~L PARCEL LDI CD 3 - 11q7- 9 S> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench LS a FSbK m~ F~ 4 5 a F .7 .~3 4 q-Ib IOYRy/ c~- b?rq\.5bw- rn ~-r c, w Ground 3 7, SYf,yI4`_' S L a Wn s `k M Fr 1 v 5, tp elev. - .L3n. 3.2-4 .5 Y R yJy S 5 L c w 1 F , '7 , Depth to S 7a-~o S Y (t 141.. limiting factor (PS in. Remarks: Boring # 0_% eyly vfr aF tq\ 4•I~ 1Dy2414 SL aMSbK MFr C w F 5 ~b m 1a-11, DJAV) F -7.S`I10, 515L am ~r ,a tt= .5 ' . e Ground IL-~ ,SYf'Ly/ CI 5 YfZ~/K Sf-- oZrn k SFr W IvF . 5 , 6 elev. Ioa.a n• 8 y3 7~SY2y/ c~dh.SY2'Iy SL inn "5 Depth to S R q h F 3" -1. S YR 6/ SL 4 m S b K tv%f G w _ S limiting b. $ Y y f ©-S W1 L. ..r 7 . $ . factor L± it in. Remarks:. Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ~ p -9 / D f KU q L g a F u. M I+~ S a F "7 ' , a 9-18 R q1y L am 16K tf~.~r cw 6L F: , S ; .6 3 18-3 -7.SKR'~J FIF7.,5 Ground 7►SVK i/ C -1 SYR7I SL rh b rn fr 1 f: •5 elev. 9 on 0-5 Depth to - S y/ S • S M L limiting factor 530 in. Remarks: Boring # b- 1 DYRgl ~.S aF5 k MVFr q 2f- a 15- q)q 5L aMshti t"F ~F ,b 7.S`fKq/ SL olrhsbx- r~f~ w 1~F Ground 4 b -5 r~ L w elev. ► 98~1n. SS~o O-S L ~"1 ,Q Depth to limiting factor in. Remarks: - SBOW-8330 (R. 08/95) 00, PA 4- VAN, %V Z; C? A04 00 t d fa t ~hc, ~ - ' 1 102t•3 t r A G I 0 r 01 ~ ° 51 pa J Ile" s 0 rC L, P 01 1601. 11' 4, L t` J ~ r g•p 1 a cut: -A let r t ~ &ALM i i. t 7.7-7 7 • VOL 1~7~1 562095 STATE BAR OF WISCONSIN FORM 1 - 1952 WARRANTY DEED DOCUMENT NO. - - ri:i. i Y...1 This Deed, made between John A. Luger Tr .istee I....~~- John A. Luger Trust rJUL 8 11:00 A "4 and Laurie Bruley and Craig Alan Brulev. as ; '0 J►~,- {f 4 .t... ~ joint tenants 1it,r, 1Deo 'i Ctaeae+e. - Witnesseth, That the said Grantor, for a valuable oonsidera^^^ +1 S t. C r o i X it THIS SPACE RESERVED FOR RECORDING DATA conveys to Grantee the following described real estate in County, State of Wisconsin: Lot 12 Block C Wigwam Shores I NAME AND RE-row AOOWSS in the Town of Star Prairie, according to the Laurie Big B y_ plat thereof on file at Register of Deeds T(t-C-1- Office for St. Croix County. O~9 ~/t(~ l f 3 'e6s 038-1147-95-100 PARCEI. IDENTIFICATION NUMBER I TRa FER 'I i~ This is not homestead property (is) (is not) Together with all and singular the hereditaments and appurtenances there unLa belonging; And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except I I i I 'I and will warrant and defend the same. iI 'In 1937-• Dated this /7 day of (SEAL) (SEAL) • John A. Lu er trustee John A. Luger Trust (SEAL) 'I (SEAL) l i AUTHENTICATION ACKNOWLEDGMENT State of VlUeomitK Minneso a i Signature(s) ss. I Ramsay County authenticated this day of '19- Pctmx&Ay came before me this dry of June 19-2-7, the above named John A Luger, trustee JoFn A Linger Tru~* TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Scats.) io me bmawa to be the person who executed the foregoing ilnlst and acknowledge the same. ` ' I~ y -3 7/96 1/4 PP+6E l7 4F } BEAD CAPACITY C MODEL "98" 4 5/8 i 25 6 O 4 3/16 15 tl 4 „ 10 t 1/2-11 1/2 t4Pt 2 5 0 CJILLONS 10 2 30 40 SO 60 70 80 so 160 2410 O FLOW PER MINUTE c K11Y OVMMW ""AS \aa P" sonum V~~N4eAT NrP ppIW1Tlleap CAPACi1Y 12 14EAO uMrt+ww fE[i Yt71:q t7AL.e 1i11>t . s 1,32 n 273 t0 105 et 231 is 4,57 ss 170 3 S/ 11i 70 & to 25 >b tors!. VaM 23' CONSULT FACTORY FOR SPECIAL APPLICATIONS is w a etnators. to duplex systems. are available and o Mercury float switches are available for controlling single and .,ji,ed with an alarm. thtee phaz..tl sys(ems. IA-owi I,cal afle(nalors, for duplex systems. artb available with or a Double piggyt)pck mercury fk3al switches are avallat.le for it .ut didrm SMIC1185. variable level long cycle controls. SELLC710H GuiOE 1. lilt Wdi Woo opaakld 2 polo rnet:ltenic-M swrich. no e4 vsui w..u.,t Avy wow, Stanc;erd all models - Weight 39 lbs. - 'h N.P. VM pVWback nterCsoy Goat sww*ordob6o 9yyt,",,,,,,,,L,,,y. ukw, _ 2 Sw va Senes Gun4o1 Seiecllon WWI. RNM W FM0477. .~i vdts-VA Mode Sia.~1MA tkA~ras a Mw;nan" ahem a-r 109072 at 100075 $15 1 AN4o 9 0 1 a t a_7 4 G" FM0712. ku coned R10dai d Lktuicat Aherrteutr. "6P.d.. 113_ 1 0%01 a « 31d4§- S Mwcwy 6www boat w^AL* 1041M used ea a canrol acUvst4:r• 11Mciy 7U 1 Auto 4.5 1 a t L 7 - duplse (3) of (4) bloat syslan• 6. t out (4) hokt -J-Pak". psrtct n box. to walatftyllt corurawn (m a iod is, win W 1 lit) t Fiol1 4.3 2 w 2 4'. O 3 at 4► 3 plea a dupW opelebm 109002 7. Two (d) hole "J•Pak la weLA1igM aotutecoon a spkca CAU110N .I -nr.an On 02*110 sly loebr P/atlucti Aster b cAmk%4n Coebutubm blow, FMM14; An ipeieeeYee Nt wnt. ete, ptAett en 4v.ALee MW -..ne ehouW p,a a.... PY ..1N.t, a ..e.c..ry S..elcl.ee, FMe+77: Lbeco" AawA.e FMOUa: Wedypiy AI1Mne1m, lod lace so" e4dr.c..n AN ellooft cet end eele" c-d.e at-.1d N t..e....eo -",d n_ ItMM.e YeaAApe, lti4il~1; ttee{tlsaag7e WierM► FW4a); ape oetAPMe Card htR Np the .woet ..cwd Nelle..et LAOMM Lo" (NLL) and the Uc.upe.wr.A b.1eq and 1 11eeeA sta ( wuq. RESERVE POWERED DESIGN F(x tutus" conditions a reserve safety factor is engineered into the design of every Zoeller pump. tirni~ ro: r.o: ©arc 7a7d7 M47 tarl4r.. xv ~0?50Q147 Marwl~;,turrrs c)1 714g-/ X_,q rX7 "^'~o~•R UXOSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE 8 ? 25' FROM DOOR, WINDOW OR WITHER PROOF FRESH AIR INTAKE JUNCTION 80X APPROVED FINISHED GRADE 4" Cl RISER WITH CONDUIT MANHOLE W/ PADLOt 6" MIN. WARNING I ABOVE G ADE 19" IN. - v" MIr b" MAX. INLET WATER TIGHT SEALS GAS- 4 fTIGHT A SEAL ~ CI PIPE BAFFLE -j- APPROVED 3' ONTO B I I ALM JOINTS W/ SOLID -I-- ± ON PIPE 3' 0 SOIL C SOLID SOI PUMP OFF ELEV. FT. OFF RISER D PERMITTED IF TANX MANUFACTU? 3" APPROVED BEDDING UNDER TANK HAS APPRO. SPECIFICATIONS CONCRETE PAD EPTIC / DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY: TANK SI2£S: SEPTIC je~on GAL. ~ - DOSE GAL. DOSE VOLUME INCLUDING FLOWBACK: Z G ALARM MANUFACTURER: ' MODEL NUMBER: CAPACITIES: A = 11CHES . , SWITCH TYPE: C B s ~2 INCHES = 0?98kl PUMP MANUFACTURER: MODEL NUMBER : C = Z~_V&CHES <C SWITCH TYPE; D INCHES REQUIRED DISCHARGE RATE Q GpM PUMP S ALARM WIRING AS PER I LHR_ 16. 23 VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . t MI~N/IMUM NETWORK SUPPLY PRESSURE FEET * _..1 X2L FEET FORCEMAIN X s 7 FT/ 100 ~FT..FRICTION FACT ""FEET TOTAL DYNAMIC HEAD FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ~~~QQFel i WIDTH DIAMETER LIQUID DEPTH IGNED: -14 LICENSE NUMBER: 'WisconsinDepartment ofCommerce PRIVATE SEWAGE SYSTEM County: Safety aril Buildings Division INSPECTION REPORT ST . CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar~IsntNQ.: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. 2S5 ~y 33 SS BRULHolder' CRAIG & LAURIE TLR'^'n of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel U s t5-:114 95-000 TAN FORMATION ELEVATION DATA A97 189 TYPE MANUFACTURER CAPACITY STATION BS I FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inl TANK SETBACK INFORMAT N St/ H utlet TANKTO P/L WELL BLD Ventto ROAD Inlet Air Intake Septic NA Dt Bottom Dosing N Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction ystem TDH Ft Forcemain Length ia. H Dist.Towell SOIL ABSORPTION S STEM BED/TRENCH Widt Length No. Of Trenches PIT N Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA ING Manufacturer: SETBACK CRAM R INFORMATIO TypeO Moe Number: System: OR UNIT DISTRIB ION SYSTEM Header / M ifold Distribution Pipe(s) x Hole Size x Hole S cing Vent To Air Intake Length Dia. Length Dia. Spacing SO COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Ved thOver Depth Over xx Depth Of xx Seeded / Sodded xx Iched /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Y ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRARIE 17.31.18.634-635,NE,SE 2140 SHORE DRIVE LOT 11 Plan revision required? ❑ Yes ❑ No Use other side for additional information. I F77 I FF1 IJ SBD-6710 (R.3/97) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r t..ro Safety and Buildings Division v~■I`Itnr,t SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County f than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number a9713 7,5 The information you provide may be used by other government agency programs ❑ Check it revision to previous application lPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name 0_ Property Location Or P , &~4~ A I E ' 1/4 1/4,5 T , N, R /Q (0 Property Own 's Mailing Address Lot Number Block Number 8 - 6 T~ Cit , State Zip Code Phone Number Subdivision Name or CSM/Number ZY Nr - 76o (&1 X II. TYPE OF B ILDING: (check one ❑ State Owned City / Nearest Road Village ❑ Public 1 or 2 Family Dwellin No. of bedrooms _ Town OF 111. BUILDING SE: (If building type is public\F'Iity y) Parcel Tax LT; q5 1 ❑ Apartment/Condo - ) Iq7- q 2 E] Assembly Hall 6 E] Meursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ M e/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church / School 8 ❑ Mo12 ❑ Service Station Car Wash 5 ❑ Hotel / Motel 9 ❑ Of13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. C ck box n line B, if applicable) A) 1. New 2. ❑ Replacement 3_ ❑ Repla me /t of 4. ❑ Reconnection of 5. ❑ Repair of an _ FvistingSystem Existing System - -----System System Tank O_ _ B) ❑ A Sanitary Permit was previously issued. Permit N er a V. TYPE OF SYSTEM: (Check only one) Other Non-Pressurized Distribution Pressurized Distrib tion Experim to N:~.O 11 ❑ Seepage Bed 21,&Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12E] Seepage Trench 22E] In-Grown ressure 42E] Pit Privy 13E] Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Abs p. Area 4. Loading Rate 5. \Perate 6. System Elev. 7. Final Grade Required (sq. ft Pro o d (sq. ft.) (Gals/day/sq. ft.) (MElevation 460 Feet Feet VII. TANK Caacit in all0 S T al # of Prefab. Site Fiber- Exper. INFORMATION g G Ions Tanks Manufacturer's Name Concrete con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank ® 161, ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 6M I-/ 6 J ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibi ity for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) PI s Sig t"'. IM -Ztg P PRSW No.: Business Phone Number: Plu ber's A dr s (Str t, Cif, t te, Zip C-Qde): © A P 1114, IX. C//v'OUN Y / DEPARTMENT USE ONVY f k~f, 54)1 ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Si Surcharge fee) Approved F1 Owner Given Initial Adverse Determination 02, X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divi,ion, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The-septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6- If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815_ p To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide.the legal description and parcel tax number(s) of where the system is to be installed. II_ Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorptigj ,system informatione,,Provide all information requested for numbers 1 through 7. VII. Tank imko{f 1 in the capac ty of every new/or existing tank, list the total gallons, number of tanks and manufacftrr~¢in i te'prab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for isysck experimental approval only if tanks received experimental product approval from DILHR. -%%.W* I Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. RESIDENTIAL MOUND DESIGN INDEX AND TITLE SHEET C f PRIVATE SEWAGE SYSTEM Project EUGENE RKE Owner EUGENE BURKE vto Address 4657 CHARLAND RD. firrnu Lp710N8 MY 11UMAN SHOREVIEW, MN. 55126 DEPT. DIVISION OF S AND 8U1 68 E Legal Description NE 114 SE 1/4,S 17 T 31 N,R 18 W Township STAR PRARIE County ST. CROIX Subdivision Name WIGWAM SHORES Lot No. 11 Parcel ID Number 038-1147-95 Plan ID Number S97-20250 INDEX SHEET PAGE ONE MOUND CALCULATIONS PAGE TWO MOUND DRAWINGS PAGE TREE PRES. DIST. CALCS. S LATERALS PAGE FOUR PUMP TANK DRAWINGS PAGE FIVE PUMP SPECIFICATIONS PAGE SIX SITE PLAN PAGE SEVEN Designer BRADY TGARD License Number MP 7456 Signature Phone No. 715.266-6995 Date 05/01/97 NMI. TO"Pwft with this tMe by urmWwrbed persons Is prop bated. Wfber to mod 6cWm wle re=* M dlsc*dne y wam ,N,der s. is.-w, wt& stet. S813-10482.E (N.0506) Page 1 of 7 RECEIVED MAY 14 1997 S 9'7 2 0 2 5 0 SAFETY a BLWS- DIV. RESIDENTIAL MOUND DESIGN Eight Bedroom Maximum Complete infamal5i7xn in nd trained boxes as necessary. (y or n) n Is the system constructed over creviced bedrock? Slope 2 % Number of bedrooms 3 Wastewater flow rate 450 gpd 1703.3 Lpd Depth to limiting factor 27 in 68.6 cxrr In situ soil infiltration rate (code) 0.6 g 20.4 Um` Contour line below the uIsloPe elge of absorption cell 400 ft 30.48m Use standard fill depths? x OR Designer speed depth 1 0 in 1cm PHce X In box to use sbnda d depths (1Z 24 A+4 rnckmWe) OR specMy deslQa rrn dep&. Center or end manifold o a q Estimated hole space 3 ft Not a *W cad ubdom Lateral spacing 3 ft Minimum dose 10 times void volume use a 0 WNW speekt rw car chee. Pump tank elevation 90 ft ourswe bosom. Force main length 75 ft Force main diameter 2 in Force main actual dia. 2.067 in SYSTEM SOLUTIONS Inch-pounds Metric Coil mea8a Oe one only. Estimated daily flow 450 00 1703 Lpd x rChisi regate and pipe mbe r and pipe Absorption ceH Design load rate 8 area 1.Z pd 375.0 fe 34.84 rn ~Unear load rate 9.6 gpd/ft 119.0 Lpd/m Design width (A) 8 ft 2.44 m Cell length (8) 47.0 ft 14.33 m Depth of cell (F) 9.7 in 24.6 cm Sand filter Upsiope frill depth (D) 12.0 in 30.5 cm Downslope fill depth (E) 13.9 in 35.3 cm Basal area rsQuired (gpd/infiltration rate) 900 ftz 83.61 m2 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) 10.2 ft 3.11 m Upslope toe length (J) 7.9 ft 2.41 m Downslope toe length (1) 11.1 ft 3.38 m Includes basal edjusbrwW Total mound length (L) 67.4 ft 20.54 m Total mound width (W) 27.0 ft 8.23 m Project: EUGENE BURKE Plan I.D. S97-20250 Page 2 of 7 MOUND PLAN VIEW obewabM pipes nYp1000 27 ft AA A= 8.0 ft 2.44m w= 8.23 m 10 8= 47 ft 14.33 m B K J= 7.9 ft 2.41 m I I = 11.1 ft 3.38 m K = 10.2 ft 3.1m Ila 87.4 ft 20.5 m typ• obs. pipe A X B refers to absorption cell width and length (Wghcred ww") J = upslope width I = downslope width K = end slope dimension W OSOMm) MOUND CROSS SECTION subsoil cap D = 12.0 in 30.5 cm lateral topsoil r N E = 13.9 in 35.3 cm invert 101.5 ft F = 9.7 in 24.8 cm elegy 30.94 m see note F G= 12.0 in 30.4 cm H = Min 45.8 Cm D E ASTM C33 Sys 101 A ft Sand FM elev. 50-77-81m 100.0 ft contour 2% 30.48 m slope Note: Absorption call media will D = upslope fill depth plowed layer consist of aggregate and pipe E = downs" fill depth or leaching chambers and pipe Aggregate F = absorption cell depth as specified FqChamber G = subsoil + topsoil depth at cell wall at right. H - subsoil + topsoil depth at cell center Designer notes: If SRMQ!!e is used, it is covered with code comoWd material. Project: EUGENE BURKE Plan E.D. S97-20250 Page 3 of 7 PRESSURE DISTRIBUTION CALCULATIONS absorption cell Inch -pounds Metric Width (A) a ft 2.44 m Length (B) 47.0 ft 14.33 m lateral specifications Number laterals 4 Holes/lateral 8 holes Lateral length 21.9 ft Iflern Perforation dia. 0.25 in Lat. dis. rate 9.32 gpm Us Sys. dis. rate 37.28 gpm Us Hole spacing 35 In Lateral diannter Poe d w ew o« n opft o..en • Designer must t W25 mm X Place X in red '7(" one choice i 1mww mm x X box of chosen from the options 1 1rAm mm x ~ provided. 2KW mm x arv15 mm X Manifold diameter pipe d o ew D..ipa options o..O anoio. Designer must 1 hV25 tnm ')C' one choice 1 imno w mm x Place X in red from the options t trAv4o mm x box of chosen provided 2WAo mm x x dkvneter 3rWM mm X *ow mm x LATERAL DIAGRAM - CENTER CONNECTION Place correct iaterat diagram by licking in one of the drawings at right and dragging the diagram into this area. Faroe "w& 0awwookin YH too or Goss to at QV Pam • W afs ih i/endeai typical S P end cap S • IE X-- *IF af2 r~ latKais & fords main Far PVC Sch 40 last hall drMd nett to and cap (per COW Tob 94.30-6) Molls &Ibd on the bottom of the lanai. • , p9mumm and marker #*mh spaood Inch -pounds Metric Lateral length (P) 21.9 ft 6.68 m Lateral spacing (S) 3 ff; 0.91 m Hole spacing (X) 35.0 A% 88.9 cm Hole diameter 0.25 lin 6.35 mm Lateral diameter 1.25 in 32 mm Number of holes per pipe a invert elevaWn of laterals 101.5 ft 30.84 m Project: EUGENE BURKE Plan J.D. S97-20250 Page 4 of 7 Total dynamic head System head = 3.25 ft 0.99 m Vertical lift = 10.80 ft 3.29 m Are laterals the highest pant in the Friction loss = 1.74 ft 0.53 m system? Yes "X" here. Total dynamic head = 15.79 4.81 m If no, what is the highest elevation Dose Volume downstream of pump? Lateral void volume = 6.8 gal 25.7 L Force main drain Minimum dose = 112.5 gal 425.9 L back to tank? ("x" one) Drain back = 13.1 gal 49.6 L x Yes Dose volume = 125.6 al 475.4 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 weather proof w1wamirtp label and padlock grade levels junction box J grade gels quick disconect aftemate 4" vent pipe electric as per NEC 300 and outlet COMM 16.20 WAC location 18" (46 cm) min. h-wall mp ~ - approved chamber or outlet combination ,l joint tank A 114" weep tirade levels alarm on hole as pump tank manhole = 4" min. above finished grade pump on B rwo"sary pump tank man. =100 mm min above finished grade C vent = 17' min. above finished grade pump 90.7 ft vent = 300 mm min. above finished grade off elev. 27.6 m D ly -J 3" 75 mm of bedding under tank and anchor tank as necessary 90.0 ft Pump tank elevation 27.4 m bottom of tank Tank specifications: HUFFCUTT Pump tank = 14.92 gal/in Pump tank volume = 600 gal Capacities; Inches Gallons A= 24.8 370.0 Pump manufacturer. ZOLLER B = 2 29.8 Pump model number. N98 EE3 C = 8.4 125.6 D = 5 74.6 Project: EUGENE BURKE Plan I.D. S97-20250 Page 5 of 7 7 HEAL) CAPACITY CURVE 1 71,q - b 20 MODEL `198" g f~ I I 3 S/8 ~1~ I I 4, U 1 J i 15 10 0 I c 3/ 1 s O U.S. GALLONS r0 30 4o so 80 io go j - - ! - fc 1 240 0 FLOW PER #INNUTE I r - - I` = TOTAL OrMMat MEAOf ow no myuirE _ FfTtuENT CAPACOY 12 MEAL uwrrsam FEET "ETEA3 Gros iTttlt 5 1 52 72 273 1 I T 10 305 61 23T I 1 Is 457 AS 170 - 20 a to 25 95 3! F l -_.r Lock valve 23. , CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical altemators. for duplex systems, are available and • Variable level float switches are available for controller Sirl~e supplied with an alarm. and three phase systems. • Mechanical altemators, for duplex systems, are available with or • Double piggyback variable level float switches are available for Without alarm switches. variable level long cycle controls- SELECTtOM OLNOF Standard alt models - Weight 39 Ibs_ - 'A H.P. 1 integral Most operated 2 polo msrhanical Switch. no e=ternal control required. 9i>flAt>t 2- Single piggyback vanabio level float swdch or dou0te piggyback variable level. Catbol KdO^ Goal swfth Retof to FM0477 v6ft-ft Du Yodl1 WO sin 3. Mechanical alternator 10.0072 of 10.-0075. M95 Its t Auto 9.4 1 or t tt 7 - 4. See FM0712. for -me, nodal of Electrical Alternator. 'E-Pak'. N98 115 1 Non 4 2 or 6 14&5 S Con" sift" 10.0225 used as a 00ntr01 activator. speutq duplex (3) or (4) Ova 230 1 Auto 4_7 1 or 1 d 7 - float system ESS 230 1 Non 4.7 b. 2 or 2 Four (4) hole -J-Pak-, iunebon boll. (Or waterlight connection or wasdyn d 6 3 a< i 5 SRlptex Of dLn test am. ion 10.0002. 7 Two (2) hole -J-Pak-, for watertight correction or splice. for maonnason on additional ZoNker prod6ot:4s re(r to catalog On Comtlwutmm Sta"a. 9MOS1a_ All installation of cdrtlrOls. CAUTION Ngyaadc vansble LavN SnittAes, rAW477. Eladncat Atlenw, r, FAS0es6_ ectric an e.wees cd wirhy undue se 4oed by a ding : the e tr, ftA0495, Aerta lP NtadmracalAkama- rieensed e?eQri~,an. All efctnw snd sarHyco ees s"OUtdM followed including t 101 F102 -kasa X13. ~nwSe~mayseus+ns.t=ssp4d7 aridS.rnDNacontrolsom. most recent Nations? Electric Code (NECI and tht Occupational Safety and Health Act tOSMAI- RESERVE POWERED DESIGN For unusual conditions a reserve Safety factor is engineered into the design of every Zoeller pump. MAIL TO. P.0 SOX lifiXf Loukii s, xN 402W-M? 1►fatkdac4nsrsd 0 ~ SW WJ2W Old M# m Law Pl1MP !D. f Z97427J~ t (dMW&PLAP V~/Tr Pi,~IP .~i4tCE J~T w 7-cl e~ A)E 5-17-7-31-~18~ r 143 i 4 M ~ r 1 74 J43 4o-k 75 STEEL'S SOIL SERVICE Gary L. Steel NE4 1SE4 1 S17-T31N-R18W 1554 200th Ave. CSTM2298 town of Star Prarie New Richmond, WI 54017 MPRSW 3254 lot #11-block C-Wigwam Shores (715) 246-6200 1 N 1"=40' BM.= top of NE lot stake C el. 100' a c~a n Q,3 Ala C"' i 4 r~ Gary L. Steel 7-1-94 6-16-97 cMrsan or.ysery a nua,ngs in 3=11d With ILHR 83.05. Wis. Aram. Code Attach complete site plan on paper not lass than 8 1t2 z 11 inches in site. Flan must mtkuoa, but [PARCEL, OUv not hMed to vertical and hori;ontai referenCe point (13K. direction and' of slope, scale or .O. A dimonsiorwd, north arrow,, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION EVIEWD BY DATE PROPERTY OlNAW PROPERTY LOCATION Eugene BUrke GOVT. LOT NE 114 Se 1i4.s17 T 31 .N.R 18 xOda)w PROPERTY OWNEtr-.S MNUNG ADDRESS LOT s BLOCK s SUSD. NAME OR CSM x 4657 Charland Rd. 11 C Wigwam Shores QTY. STATE Zip CODE PFI NUIMEER L]CrTy L]VILLAGE OWN NEAREST ROAD Shoreview MN. 5 126 (61A 484-0962 a *4 New C,=V action use Res her vial / Number of bedrwIms 2_3 ( ) Addition to exisfiN Wilding i 1 Repwoerl" Pubk or oommercW describe Code derived daily lbw 450 gib ROWWWWW Cesign l)adirto rate - 5 bed. 9A - 6_Irenck gpd*2 Absoroon area re"red 375 bW' n2 375 trench, tit Miaximum design loading we ' S bed, gpem2 - 6 trench. gpM12 Remmmended intimation surlaoe elevation(s) 105.87 ft las referred to site plan bencnmarki Additional design ! Site canons na Parent material glacial till Rood plain elevation, if applicable na ft U U tors tem 0 ®u fl O U ON S o u `sp'ar: Cl! ++aE U SS V uL` I HOLD ING, TAW SOIL DESCRIPTION REPORT Boring tY Horizon Depth Dominant Color AAma Texture Structure f j A~ GP/it4 inMunsell Qu, Sz. Corti Color Gr. Sz. Sh. ! Be0 (Tralc !~rxy:ase'. :;-+COi~IwwM:~: 1 0-10 7 none Si I 2mgr mvfr CTW 2f .5 6 1 R 2 10-27 7.5yr4/6 none f is Osg mvfr 9W if .7 .8 Ground 3 27-60 7.5yr4/6 f 2p 2 . Syr4/4 s i M na na na 1.2 elev. 104.87tt, Deph to gtm5ng taclor 2711 I f Remarks: Boring r~ 1 ~0-7 7./5yr4/4 none si 2mgr mfr 2f .5 .6 2 2 7-22 7.5yr4/4 none sl 2msbk mfr gw if .5 .6 a,. 3 22-46 7.5yr4/6 none si 2msbk mfr gw na .5 .6 Ground e►e,r. 4 46-75 10yr4/3 none Ifs Osg mvfr na na .5 .6 104.8. ds of 5yr 4 ail through f h-4 Depth to WrAng +75" i Remarks: CST Name: Plesse Pnnt Gary L. Steel 715-246-6200 AQ6ress: 1554 2 t . Avg., New Richmond, WT. 54017 CST N=W: Sgruuxe: ? 7-1~4 cstm 02298 L "d OOZ9+9VZ+S L L -1331S -1 MVQ WOdJ t'ldZ t :E: S66 t -EZ-O l 9oanQ Homon'l 0!' ~ Dorninam COW Moldes Texture ! Structure } Co~moe 6 rn>lry, ( Roots Ned offs in. 1 Murtseli Ou Sz. Coot Caton ! Gr. Sz. Sh. I ( bed ITZM 3 1 0-7 1 4 3 none al 2mor Mfr Ow 12f 1.5 2 7-20 7.5yr4/4 none sl 2ngr mfr if .5 ~.5 Grotmd 3 20-27 7.5yr4/4 none siZ 2f 1 mfr 9w if np .3 elev. 104-27% 4 27-60 7.5yr4/4 C P 5yr4/6 sil 2msbk mfi na na .5 .6 Depth to Wong tol Remarks: Boring U + . k! Ground elev. tt Depth to tam r Remarks: Boring it i•`~ 3 Ground elev. tt. w Depth %Mor f ~ Remarks: Boring e I 1 I i Gro" AM I` tt, limiting 'a`x ! ! I I I i ! Remarks: ssae330tR.oS92t Z,d 0029+9vz+9 l L -031S 1 , bvO w0bj Wdc t ° £ 566 l -£Z-01 STEEL'S SOIL SERVICE Gary L. Steel N13kSA S17-T31N-R18W 1554 200th Ave. CSTM2298 town of Star Prarie New Richmond, W154017 MPRSW 3254 lot #11-block C-Wigwam Shores (715) 246-6200 1 N 1"=40' BM.= top of NE lot stake @ el. 100, 7` ~r- r r 400 (0 n s ~2 v 1 ' s \g-,n lJ g 1 i S i /YlaUriYJ 8-i 01 f. Gary L. Steel 7-1-94 6-16-97 STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT S Croix Count X OWNER/BUYE12 / r d E ULE~ x MAILING ADDRESS _3 gob / [p'-h _-TZ. /4 AI J PROPERTY ADDRESS 1/UT.` I I k,C a y~ s (71 a ion of septic system) Please obtain from Ilse P tinning Dept. CITY/STATE c PROPERTY LOCATION 114, SC- 114, Section _ T~I!-Rj -W TOWN OF ST. CROIX COUNTY, Wt SUBDIVISION LOT NUMMER - CERTIFI DS VEYMAP VOLUME 3 ,PAGE~7-VSL.OTNUMBER_ 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system- St. Croix County residents may be eligible to receive a grant for a maximum of 60ye of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St- Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) tltc on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge and scum. i/We, the undersigned have read the above requirements and agree to maintain the private scivage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Cenification stating that your septic has been maintained must be completed and returned to the St Croix County Zoning Officer within 30 days of the three year piration date SIGNED DA-T[. St Croy (:otinty Zoning Office Goverrimcm clatter 1 101 t,. arrtildiad (toad 8 T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. r Owner of property Location of property N 1/4 S~ 1/4, Section ~l ,T~N-R /00 W _ Township /~.lML-L Mailing address 9 S 76 x A v Address of site o~ 1 y~ ~`"T Subdivision name Lot no. Other homes on property? Yes__k-' .No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? ~_Yes No Is this property being developed for (spec house)? Yes )K-No Volume ,j~~and Page Number 3 6,5-as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY Ow"It CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the of c of the County Register of Deeds as Document No. S and that I (we) presently own the proposed site for the sewage disposal system or I (we) Obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in th* office of the County Register of Deeds as Document No. Align I4-o re A ppli t C pplicant t' r , , .till. . ' , a y . : • , }"4c~:<•~. ~ » 4 e'°fii=, d4/' aA t6iR -~a,'MIR ~3: .tc Q1.IM~► ~i 4 I State Bar of Wisconsin Form 2 - it 532545 WARRANTY DEED _ DOCUMENT NO. r c 6 'JAI (r-- PAGs CT _bgene M. Bwke and Thomas G. Burke, AUG 1 G 1996 as tenants-in common, 9:00 A. conveys and waaaota to Craig Alan Bruley and Laurie Bruley, husband and wife i! 1 • THIS SPACE RESERVED FOR RECORDING DATA ' NAME AND RETURN ADDRESS I 11 EQUITY TITLE 3ERVIM the following descrilmd real estate a St. Croix 400 SOU rh SECOND I County. State of Witeonaw. HUDSON. VA 54016 L 4 2 tl i (Parcel Identification Number) ~l Lot 11, Block C Wigwam Shores Star Prairie Township according to the plat thereof on file at the Register of Deeds office for St. Croix Comty, Wisconsin, jj located in the SE1/4 of Sec.. 17, T31N, R18W. Together with a non-exclusive easement over that pert of the private toed shown as Teepee Trail on the plat F i' of Wigwam Shores, move fully described as follows: Beginning at the North-South Town Road, lying Easterly of said plat, thence Westerly on Brave Drive to Teepee Trail, theme Northerly along said Teepee Trail to an Easterly extension of the North line of said Lot 11, the point of termination of said easement. ll , i , h I~ 11 Thin is not bomesteW property. ~ 1010i11is not) Exceptiox to warrantiex Easements, restrictions and rights-of-way of record, if any. I~ it 4 Dated thin day August 1995 i~ li Il (SEAL) (SEAL) j f, • ~l M. Burke (SEAL) (SEAL) Thomas G. Burke II ii AUTHENTICATION ACKNOWLEDGMENT (a) STATE.OF WISCONSIN 36. Pis St. Croix Cou ey. authenGaued Nis day of . 19 rkkosoonany came before ate this day of August 19 the g o named ! Emene M. Burke and Tflaoas G. Boma 1 TITLE MEMBER STATE BAR OF WISCONSIN I~ (If not, h authorized by;706.06. Wis. Stab.) as sae Down to be the person S wbo executed the basquil3 instrument and acbnowletip the now ! TY• IYQTOI IVCYT W.Q nO.rTln av w .