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Home My WebLink About038-1114-10-400 ~ o 3 0 H ~ ° v o U') O X N (V V O N Y L C V, V Y y 0 r N `c (s. O o 5 N N O ~ O) O c Z 0 4) C z +L-' p, y L r N 7 LL CO w W _ C U) 'O N CD Q 6 -O a w 3 ~ v d > Z N co >WWII E w O Z Z d N Q, w a m N F Z 0 O C z p O Z U ~ c - 0 Z O N c p 16 fn F ~ rn ~ Z S E -o N CD C M N d y C •WV a ~ r _p o (D m z 16 O Z z N p V O d N ~l N y E ~ Y a Ln CL O o y d L C w Q o (A CO) v> > 0 Zv- > Z 0 •N yaaa a f/J US o U) J U L) CD aoi rn } 1 o O E - co c n I D y (n N O a) <1 U) O H N o E O o 3 y c a to LU (D 25 C:) O O M ~ ~ d V a 0 0 ' T. N C OI C 'p N N 0) V O co 'm y c j 0) N Cpy O U co V) LU -0 iz~ 2 CC) • c) O m o", O c 0 M C O O N In N O Z- U) v CC C/] GI R d 7 a d • CL d d rr`1w~j E C C .d. 7 _1 A 0IL ~~inU Parcel 038-1114-10-400 04/20/2005 09:32 AM PAGE 1 OF 1 Alt. Parcel 29.31.18.483E 038 - TOWN OF STAR PRAIRIE Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * MAITREJEAN, TIMOTHY R TIMOTHY R MAITREJEAN GEENEN LINDA S GEENEN LINDA S BOX 245 SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1990 100TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 4.145 Plat: N/A-NOT AVAILABLE SEC 29 T31N R1 8W PT NE NE BEING LOT 4 OF Block/Condo Bldg: CSM 9/2607 4.145 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 03/31/1994 514797 1071/514 WD 2004 SUMMARY Bill M Fair Market Value: Assessed with: 30561 420,000 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.145 113,900 324,700 438,600 NO Totals for 2004: General Property 4.145 113,900 324,700 438,600 Woodland 0.000 0 0 Totals for 2003: General Property 4.145 58,300 235,000 293,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 145 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ' -2~~-~ 12511) Ps CERTIFIED SURVEY MAP LOCATED IN THE NE V4 OF THE NE 1/4 of Section 29, T31N, R18W, Town OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN. LEGEND BEARINGS ARE REFERENCED TO ST. CROIX CO. SECTION CORNER MONI~'ENT THE EAST LINE OF THE NE 1/4 • FOUND 2" IRON PIPE ASSUMED TO BEAR SOO•22'27"W, V ~~_NOO*12'27"E O SET I" X 24" IRON PIPE-14QV`I~V I.6BLBS/LIN. FT, SCALE 1150• 41, 97' 5 0 9 15 0 m tymD / m m1v UNPLATTED LANDS o~ m - - -:628.73' - - - - - - - n:' .Ir.d N00° 12'27'IE 562.72' 66, 0 m o,z 496.72 66.00 1 mco WEST LINE OF THE NE 1/4 OF THE NE 1/4 t;~crls C zm 61 I~ Ir ;u qFD J ✓1 1~ I= m Im ITT~ N 1 ! n O ~1 C W ~l~0 UI s n A O N 1 Ln I~ z OIL m O m c~ rn m rn CD rn O o m itmin o W m o a I~ w -j rn m Itn < m i \ 3 N O Z momma z wom I O) 1 r i 0 N00° 12'27"E- 560. 72 66.00' p cD - - - - 626.72' - - w - - - - - - - - \ O \ r r I tT Oi 'K N ~ 1 i m0 ' I Z< _ A N fo `L1 W U 11 0 W A A FD W zrr+, ~ rt 4- N o W_ i. w W w r NOII I Zm fD H C Ut f Zy-4 n o m O I Tmw IC N P" F • o my 0H Dolt AcD IZ (D CD IZ mm (D N 1O n ~o m° cn o Im y rr ,7 > m i i N O 4' (jl 17 I D N m ° -1 -I 11 uV'i •J I D m I-I Im I O m I m ~0 c = I N00°17'27''E 493.81' N 17 -I 112.02' 1 361.79' , w A ID O 1D = 1 o IZ I~ N 10 m a ° rt I p y -4 h T1 Z e _ w v „ \ I W m Z. -4 IT 'D _ m o m N O 01 Z n "I W . mU, o z i f J M ° A- 0 m cIJ m o o a - W tTJ ' rn w y n N `1 `1I 616' 1< O - I -4 r A . -..1 'Z' O m N G p m I N o h r r r w 10 In, I' y I(Tl --1 , 1 < w I anhro I~ Z o I-D I 1-0004 m G O I N00°2227"E 556.58' C m P. (A 130.94 '1 o CT ,y W 425.64' rt CD rf CL r+ r 1 _ I `I r O M P. m 0 ? I I / w n o O 0 N O W N ~I " co x o? x' I ,r• N• m DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 HUMAN RELATIONS N WI 53707 I''"'ILHR 83.09(1) & Chapter 145) LOCATION: SE ION: C4TOWNS U~iNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: C '/a•fv /UVN/" COUNTY: MAILING ADDRESS: r.5 Y~ 17_ 7 USE DATES OBSERVATIONS MAD Q ej6 NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: esidence New ❑ Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) IS ❑U os ❑U SOU ❑S yU ❑S ZU If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST-. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 02.3 00- B- PERCOLATION TESTS t TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- J? P. L-, P- G -3 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 t--~7 z 3 ~ _ s ie. _ 7/ N 1 so ~6 I i 1401 411 u _ INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction 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 scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate: 10. If the information (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 yur 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-SM-TESTERS r' Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under W) LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than '1 - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - , Vertical Reference Point Y r , STC - 104 r AS BUILT SANITARY SYSTEM REPORT J ~F fc`,D i.. OWNER ADDRESS l~D /.9r~/ J~ sr cpo, `tic r °A I(~NJIIO "Ns SUBDIVISION / CSM G C/17 LOT S ECTION~_TZ_N-R, f W, Town o f - P/J`, ST. CROIX COUNTY, WISCONSIN 0;1K,j11 H - j 0 -+a 3i . l8. y-g3~ PLAN VIEW SHOW EVERYTHING WITHIN 100 EET OF SYSTEM .~s S I INDICAT NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: _ a9 Setback from: well: House _5 ~ Other ELEVATIONS Building Sewer _sg ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold ~~2.Z/ Bottom of system Y17 Existing Grade Final grade DATE OF INSTALLATION: , 2-- C PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: n 3/93:jt r , V1scorsin Department of Commerce PRIVATE SEWAGE SYSTEM County: SAfery and Buildings Division INSPECTION REPORT 51. G/o i T GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Z411 Permit Holder's Name: ❑ City ❑ Village ® Town of: State Plan ID No.: Tim c" s1~a~v /G ' " - CST BM Elev.: rinsr. BM Elev.: BM Description: Parcel Tax No.: o too' To off'r~/ ~►csT~ o - - o - v TANK INFORMATION ELEVATION DATA ~Q97oo3~0~ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic C S `Zp~ Benchm k ' p !0~ .pO Dosing A/f, B/A 31 97-11 Aeration Bldg. Sewer I&/. Irv Holding Cs2>,IW Inlet TANK SETBACK INFORMATION Outlet (o$ j gi/.l~y TANK TO P/ L WELL BLDG. AAir ntake ROAD Dt Inlet epti 5o' yla, s' NA Dt Bottom Dosing NA Header/ Man. cmlt/ Aerati NA Dist. Pipe $,(oy 9Z~3S Holding Bot. System x},83 ql-)7 PUMP/ SIPHON INFORMATION Final Grade 6.7 ' .7 0.z Manufacturer Demand Y&O ,5:2/ 9S Mod er GPM TDH Lift Lrlction System TDH Forcemain Length Dia. H Dist.Towell SOIL ABSORPTION SYSTEM nWm~XRENCH Width Length No. Of ;tenehes PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ' r 7.5-DIMENSION EACHING factu SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM INFORMATION Type Of r Model Numbe . syste 3: ~ W OR UNIT DISTRIBUTION SYSTEM Header/Manifold ~L N Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length ?D ~ Dia. Spacing ~ AS-rM Sk_/1' Z77c1 7 S~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Oxx Depth Seeded / Sodded xx Mulched Bed/ Trench Center Bed /T s~S o i l ❑ Yes o ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) P --top 167 "44~ 44W4,'- 61011~ - Plan revision required? ❑ Yes IN No Use other side for additional information. ~L 211 ~ F 7 S SBD-6710 (R.3/97) Date Inspector's Signa re rt. No. ADDITIONAL COMMENTS AND SKETCH T SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION Safety and Builds nADivision Was. Visconsin P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. ' • See reverse side for instructions for completing this application State Sanitary Permit N tuber t~Q9o~ 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 Property Owner ame Property Location Zee f v4 1/4, S T , N, R K(or~ Propert nOwner's Mailing Address Lot Number Block Nu er 7 Cit State Zip Code Phone Number Subdivision Name or CSMMI ym er o ( ) II. PE F B ILDING: (check one) ❑ State Owned !t~ Nearest Roa Public 1 or 2 Family Dwellin - No. of bedrooms 0 roan of :S:L1 /,n~ 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box online A. Check box on line B, if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5 ❑ Repair of an ------System System Tank OnlyExisting 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 R Seepage Bed 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. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft_) (MinZ/*nch) Elevation Feet eet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel Plastic p New -Existing structed glass App. Tanks Tanks Septic Tank or Holding Tank 2 ❑ ❑ ❑ ❑ El Lift Pump Tank /Siphon Chamber ❑ El ❑ ~ 1:1 E3 VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins Ilation of the onsite sewage system shown on the attached plans. Plumbe s Na e: (Print) Plumb 's S. r d a ps MP/MPRSW No.: Business Phone Number: r Plumber's c dress (Street, City, tate, Zip Code): JCp IX. COUNTY/ DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) pproved . ❑Owner Given Initial ! -f~ Surcharge Fee) A 5r pp Adverse Determination OD X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, Plumber r~ 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. 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. 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 isto 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. S®,~~ . yes s m&k)x Sci1- 9 7 i ! cy n~, J7". 7e ,Je 7/duFiG ~ i V ~ ~ I i ~ r~ '4'' ( I ill Widconsin Department of Commerce SOIL AND SITE EVALUATION Divigion of Safety and Buildings Page of Bureau of Integrated Services oggr lance q ' h s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less /2 1 ir4es size Pled must County include, but not limited to: vertical and hod o refere 0A), direclioh and ' percent slope, scale or dimensions, north and location and distance to nerest road. Parcel I.D. # i j F P 2 1997 ~ eye-' APPLICANT INFORMATION - P/ as print *i0ftwation.,- . Reviewed by Date Personal information you provide may be used for ry pu w, 1:0 (1) (m)). Property er Property Location Govt. Lot 114 . 1/4,S T N,R Property Owne s Mailing Address Lot # B oc Subd. Name or CS / J 2 2S --s I City Stat Zip Code Phone Number 91~C%y ❑ V'Ilage ID Town Nearest Road'/ j T ( 7-' ❑ New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate -.7-bed, gpd*-,-o'-Vench, gpd/1t2 Absorption area required AS bed, ft2~_trench, ft2 Maximum design loading rate 1~bed, gpd/(t2_L? ._trench, 9pd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional designtsite considerations Parent material - Flood plain elevation, if applicable *~S~ ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ® S ❑ U 4 S ❑ U C o s ❑ U [21s❑ u ❑ S RU ❑ s Cz~ 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 Ground 8 s / 7 jley ,~j.~ T ~27iTZ 'e eh Depth to limiting factor ~in. . Remarks: Boring # ~ezk s ~s Ground Ce~lle-v~./ /J~7Sff. Depth to limiting factor -~"W_Jn. Remarks: CST Name Pleas ~rin Signature Telephone No. L Ad ress p to CST Number Z SOIL DESCRIPTION REPORT PROPERTY OWNER <r' Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Gep/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench s Ground / - le-vv.. /S- ft. Depth to limiting factor in. Remarks: Boring # Ground elev. tt. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) Ilk,s 0 ~7 97 ~sr~~3yy A , ~C 90' a/.r w Zoly 0 1 3 ~ N m TRY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR P.O. BOX HUMAN NDLATIONS PERCOLATION TESTS (115) MADISON WI 7969 (H63.090) & Chapter 145.045) LOCATION: SECTION: WNSH UNICIPALITY: LOT NO.:BLK.1\10 SUBDIVISION NAME: ~'/~tiJ/4 45j^1T A1R14E Ave/ COUNTY; OWNER'S B YER'S NA . MAILING ADDRESS. / Grog d S//'Dsy► / D l~ Cam/ ,,,,o OT O/ 7 USE DATES OBSERVATIONS MADE f _ NO. BEDRMS.: COMMERCIAL DESCRIPTION: PR FI DESCRIPTIONS: R A ON TESTS: Residence New ❑Replace ~!.'~a•.5~ RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING fil RECOMMENDED SYSTEM: (optional) S au s au sou a s Or 0 s Zao ,e- 101 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: J` O PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST: I HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ~o p 7, S ° ~3rs _ 9u ~S B- Z 76 to A. B- 3 02 6- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER R*81W AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERT 2 P R PER INCH P. 1 2. 4-.rL 6 41 L P ? L P_ All, P- I 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 Z, f i i o i 1 I m I a I 10 1~ I 49'7224 CERTIFIED SURVEY MAP LOCATED IN THE NE V4 OF THE NE 1/4 of Section 29, T31N, R18W, Town OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN. LEGEND BEARINGS ARE REFERENCED TO ST. CROIX CO. SECTION CORNER MON NT THE EAST LINE OF THE NE 1/4 FOUND 2" IRON PIPE ASSUMED TO BEAR SOO°22'27"W. NOO°12'27"E O SET I" X 24" IRON PIPP•111I (&gg11.68LBS/LIN. FT. SCALE 1° = 156' 41.97' 1' J 50 150 D~rn UN PLATTED LANDS cnmN - - .::iatt►NTY - rn cn ml'o ~c'6 alr4we PtannLng W z wire -,628.73 - - - - - - - - - %wriand - NO0° 12'27'IE 562.72 - Izna:~t' m TZ 66.00 72' 66.00 z ~o WEST LINE OF THE NE I/4 OF THE NE 1/4 1 ~o lz m v1et>rd \ ICI. ~m ~rk° m [ I m i~ N n o~i w o N "r'i'rf~• O ID Zc)o a0 0Cn mo 0 -1 q m y ry, X107 to 0 OD m I~ m 1 IJ m Z Z Wo CO i ° 1 NOO012'27"E 560.72" 66.0_0 J \ - - - - - - 626.72 - - - - - - - - - - - - - w 0 ~ r ~ W w 0. m- ,W wa r 0 i w O cn I m 'C cn f z O cDi °o C n oo I o C CO (3) Iz G) CID o I-O m w aa• w° m o y(A w U) N I 0 Cn Ir :t R+ it W m ;i i : JO .'11 to 1 y ID ID •N m z _ _ 1 m I-I $ C1 I-i 1 m 1 m W ~-1 I-j Im o m m Io 1 ah m to cn o : I N00° 17'27"E 493.81' Ir N rn Ir• --4 112.02-1 381.79' , w m N ' ID u1 bD ID = . I to 1Z O r 1 0 Ip 1`1 - rt IN 0 m m z ° I W I 01) o r m_Wt+ mcA "'w .0. O W m y - o N 1 U1 m_ cn oz- ~J W _ z I~ -40 m Im p m p I gg m w m rn v w Gel I O a. fD N• I` 0 m i ^1 A i • 71 I D O I W I a' ro P. ea Im rn l \--l 1 0 1 c~►,no z n to 0 x to CD es':I NOO0222fE 556.58' OD Ir- O 0 N ~ 130.94'. , ~ .0 i wC ' C 0 m ` 425.64 rtart tr r„ wo of / I q! w 1070 2 xl o m of 1< M Cr rt P. r y, W O I 0 W t3' O ra '/A a 0 m~ W 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. Owner of property Location of property 1/4 XE 1/4, Section ,T_,~,LN-R_ZF_W Township ,y Mailing address,,-~ Address of site Subdivision name o?~-o 7 Lot no. Other homes on property? Yes No Previous owner of property ~p/,nc 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 No Volume -/d 7 and Page Number 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 OWNER 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 office of the County Register of Deeds as Document No. , 1-2'z , 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 the office of the County Register of Deeds as Document No. a Signature of plicant 4c-aApp-jillicant d? - ?2 q/~I,q 7 Date of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION, 1/4, AIZ 1/4, Sectiun~, T ~ N-R_ )g W ST. CROIX COUNTY, WI TOWN OF SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAZ-VOLUME PAGE, LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out (lie 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 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Cruix 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 inter plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I ) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Me, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification 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 c.• R .ration da~,c. SIGNED: DATE,: _ 17 St. Croix County Zoning Office Government Center 1101 Carmichael Road 11/93 Hudson, W1 54016 • T"13 SPACE NESCPYED FOR REGOPCIM~. DA'A DOCUMENT NO. WARRAMY MEF-fl ' STATE BAR OF WI3CtU=' FORDS 2-1982, :jN 514797 10 7 'ICE r-k'S Ur ST. CROA Mo VA Charles H. Bor°strom and Dolores BOrgstr s a . -/k/a P.add tarFaoot9 husband Aria wi -es - - . - Dolores Borgsc'r°~, . - MAR 3 1 1994 - i~ 12;15 Y I. - - M I IA conveys and warrants to _ ii itrejan - - . I~- . ; 1 1 7 ~I - ibed real estate In ....-St.-..Cr~OiX the following dexr State of Wisconsin: Tax Parcel No- I 1 1 Part of the NE1/4 of NE1/4 of Section 29, Township 31 North, Range -18 West, St. Croix Cax]ty, Wisconsin described as* follows: Lot 4 of Certified Survey ~I No. 497224. Map filed April 9, 1993, in Vol. 9~', pew 2607 as Doc' II 'i 1 ; ! This is. noc homestead property. j . li (is not) f rights-of-way of records to warranties: Easements, restri-G tions and j if any. j 1 ^-,4 - ]994. 1 L~ Al- Dated this day of / (SEAL)! _......(SEAL) ` ___Charles H. Borgstrom SEAL) -------------(SEAL) - _ _ . I Dolor~s..Borgstrarn.___ a/k/a Dolores S. Borgstrum - ~j ACHNOWLBDOMENT I + AUTHENTICATION STATE OF WISCONSIN signature(a) -_(~arles_ H._,Borgs~rom,__--______-- ss. I Dolores Bor strum afV Dolores S. County. BOA StrOITI" Personally cams before me this •---------------may of authen ted this day of_-_--•-- ]9-------- the a}9Pt naafi kj-(, - 1SClria 1 - TITLE: MEMBER STATE BAR OF W SCONSI - - ' (Ii not, anthorixed by $ 70b.08, Was. Stata•) to me known to be the person who executed :he 11 foregoing instrument and acknowledge the Same- 1 INSTRUMENT WAS DRAFTED BY iI ..~suc;xcH, a2KnP~sl,yr 2tO -~i `a we lGl~"!E 2 U_FS.Q dSN1tKEYM hi16?n35L4 .i4T RY3S 1 x+l ~~>iur:$:e5r+lc,~sut.ss~/~p •cai~ieaf!* _"g Fn,pd ao 'I N PM"' 4yeaeAO [vim uF lu~ufks rsos~Q jo pmtjj~ sa a :asap vvsaaau ;ou as 61 ouxas io nv Slaw saa vuBI %log wAlrj;dxa "4vv '40u lI)'3uauvuizad sy uo,lsfcuwoo ax - II '3.utloj------- ,Iq q.,rT-.-_ ispx"/t~f{~