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Home My WebLink About038-1150-90-000 4 o m o I C)p I 0 6o 0 00 o°'p 4) I 4) a 0. ° I c e (D o ~ ~LTc N as av~3 O y Y 0 y N C I C y O 0,0 «d N C N N U C C O A C L CD O C O C' O Z O a0. N N I c E O . N LL I N 0 a) y C > w .0 O p (D F y U N U y N G'r-) CL N O C N C 7 C Z t-o w o E C Z U C C,0 O 0 C N C y w _ L N 7 c C LO U C O O y N C I U. CO f0 f0 y N 3 Ts CL .2 o 3 ~5 N 3 D Q c~ c Q °c« vOi m c 3 Cl) U Cl) Z O O Z ~ ~ m I `m d I ccl am I am I _o I c c o z ~ c I c w U) z a~i z a o I o o c v M '0 ~ w (D m a~ cc 4) cc CL ix c • W O Q a z°mz I z°mz 1 N I z E C14 Q - - y In d g r ` Q Lo C (D N y 4) it N N o d O T O O N O Q G d .n LO CD G 0 0. .D 'C N m ca co co CL to U) 2 U I~ N ? O Z p N a. LL •N ~;aaa ~;aaa ~ CL C N E o) n E a~i y fn J U U) rn rn z 0 ch rn rn O O U7 1~l C I C N Z O O J O O J f~ _ p' E M O O O 20 5 (D OI U m 0 c N y O y fn Q Z Fn I C/) 9 d Q A U) co O ! n 7 a~+ n 7 a~+ O C ~ H C 0) N CD c 3 'ed °o O c o v o v E O ♦fO 0 cu N C I D C C V d 00 p l \ fr O U7 ' (n m ' y C m N co co v ,v~1O Ul) ~2 (`0 C ` in co CD I O C N d N N CV) y v c n v d y U y y i aci d o • ~ Cl) c°~ cn = aN- N Z N m z cn co 0 Z N Z 2 2 U) I ~ at • • E I E E `L v~ `m •m € a I d a EL L: IL L: IL r A 0 a2 0 ai0 0 vaV ► . z jREPORT OF ZNSPEF,.TION_INDIVIDUAL SEWAGE SYSTEM San.izaxy Pexm.i-t _ 7` ` State SPptic~/ a NAME rownbhip Ckoix County Location Ct_) , >zl Section _ SEPTIC TANK Size gattond. Number o6 Compax.tmenxb I D.cA tance Fnom: We.L.i it. 12$ o& gxeatex s.iope 6t Bu.itd.ing it. Wextand.6 ~ . DISPOSAL SYSTEM Highwaxex V.i.atance Fnom: Wett it. .121 of gxeatex Mope it. Bu.i.Cd.ing St. W et.Landd Ft. H.ighwatex it. FIELD DIMENSIONS: Width o6' zxench it. Depth of kock be.Low x.i.Ce .in. Length of each tine it. Depth o6 tock ovex .t.i.Le in. Numb ex o 5 t in ea Depth o6 at.ite b etow gxade in. Tozat. teng.th o6 t inea 6t. Stope o6 txench in pen 100 it. Di4tance between tinea_.. it. Depth to bedxock ~ . Totai abaoAbtion area 6t2 Depth to gxoundwatex i ..Requited axea it2 Type of Covet: Papers ox Stxaw PIT DIMENSIONS: Numbex of p.itd Gxavet. axound p.it.e yea no Ouza.ide d.iametex Depth Oetow .inlet it. Tozat abaoxbtion axea it2 z Area Aequixed it2 rn INSPECTED BY TITLE APPROVED ,DATE 191 . _ REJECTED DATE 197 S&er. 30 14 1~~.u %f~i'NSQN Ga% C/PES % V `u A !~D T i ti AJ* r 30 ofQ ,~5 IDV'o + L Y 115 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCO ATION TESTS 3 WISCONSIN DEPARTMENT OF HEALTH AND OCTAL SERVICES P.O. BOX 309, MADISON, WISCONSI 53701 _ LOCATION: Section jV TA N,R AE (or) W, Township or Municipality r,4~ r/WV1_7~~~ E Lot No. BI fdc No, A 00e T/ON County 5'-f. «O/ X (i u ivision Name Owner'siBuyers Name: A ySeN Mailing Address:- RT L /17 UPSCdAJ W/S• ,syd TYPE OF OCCUPANCY: Residence- No. of Bedrooms _CO MERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: OIL BORINGS 05r• I I 111 PERCOLATION TESTS OCT` I I ? 7 9 SOIL MAP SHEET 5t S y~ NAME OF SOIL MAP ~JNIT Bje 13 I30Qk HA ROr PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER I TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFT INTERVAL MIN/IN BER ae 1ST WETTED SWELLIN IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- 3l~ 1113m Is 14"l- •QN ( Z 2 P-)- 24 L V 15 14, Bm 15 S" .GS t ly b ly 4 1%G P-3 ra..' /5 12" w RN 0-C5 P- P- n ; ` 1 P- . SOIL ING TEAS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES i _ fO ER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES RE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST SERVED IN INCHES B- 78 /vowF 78 y a BN 1 s 16" t flN A i yie . 53 CS 3 B- z 71 NONE 72 /0„ BN • S ) "Lt w 5 d 5R. y of 0. CS B- 3 7 N046 > 7b' "e5 3 R " av /s 17 "MFD. 5 38" CS i R . B- S' 71 NOVAE ~ 71 1Y RN /s 1 "~1 W v /S " o . ~s s R . B- 7L NONE > 72 13 aN A '[1I (1W /S / "')"ED • S 30" 0 - CS ! R B- 6 go MONE ) eo " 13N s z ct. &V A L/ 2. 0, C S; i PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate n the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupa cy 61 S FOR BED Indicate scale or distances. Give horizonta and vertical reference points. Indicate slope. ~/1'~"7 1 N no 4` 14 O~ i• a (!_-12~ 4-!----f r : i Cfl RY Szi-;~'fi or 94 e u i CL_„ Q 1 V ~ N . jam. E £ f E 104 PLS 6 7 State and County State Permit # yr Permit Application County Permit, # for Private Domestic Sewage Systems County T *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: A N q, S c "t' V UN w is'~ r B. LOCATION: Y, ty, Section q&yr _L8 , T N, R E (or) W Lot# City Subdivision Names SE nearest road, lake or landmark Blk# Village i~ I IL~ ~it7iG <e5e!~ Township C. TYPE OF OCCUPANCY. *Commercial *Industnal *Other (specify) *Variance Single family _"A Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY 1 000 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber _ Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUE T DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Linea Ft. Width r)pnth Tile depth (to) No. of Trenches Seepage Bed: Length- Depth Tile depth (top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Ce ified Soil Tester, NAME Q r3 e'4r (Z 1G) r C.S.T. # jnd other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# Phone #,3&- Z f Q Plumber's Address e PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. ~I 3 E , 7 4 Wisconsin Department Industry, SOIL AND SITE EVALUATION REPORT Page rL~bo~ and Human Relations ~ Of Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 038-1150-90 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION John GOVT. LOT SE 1/4 S 1/4,S3 0 T 11 ,N,R ft(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1927 Sicard Ln. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE GOWN NEAREST ROAD Somerset WI. 54025 ( ) „ „ [ ] New Construction Use ( ] Residential / Number of bedrooms 4 k ] Addition to existing building L ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate - 7 bed, gpd/ft2'_trench, gpd/ft2 Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate -_7_bed, gpd/ft2--8_trench, gpd/ft2 Recommended infiltration surface elevation(s) PXC; Ming=93 4o ft (as referred to site plan benchmark) Additional design / site considerations water @ el. 90.90, Parent material stream rra 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 ®S ❑U ®S ❑U (a ❑U CAS ❑U ❑S :7U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Ttendi 1 - 2 17-34 10 r4 6 none lfs os mvfr c[W 1m .5 .6 Ground 3 34-94 7.5 r4 6 none cos os mvfr C1W na .7 .8 elev. 97.90 ft. 4 94-11 7.5 r4 4 water fs mvfr .3 .5 Depth to limiting factor 9 Remarks: Boring # Ground elev. ft. ST ROIX ka - - Depth to limiting S' OpRC ZOO RIG factor A" A Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. e New Richrngad, WI 54017 Signature: Date: 5-26-97 CST Number: m02298 - PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Bourxlary Roots GPD/ft Boring # Horizon in Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed Tw& Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev, ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 John & Denise Siggins SE4SE4 S30-T31N-R18W New Richmond, WI 54017 MPRSW 3254 (715) 246-6200 town of star Prarie l lot #11-Carries Apple River Adda N 1"=40' BM.= cormer pf sodewa;l C el. 100' I ono'-r ir Gary L. Steel 5-26-97 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 1 0 ADDRESS 19,2 7 57 "-""7 Z. 1,9 SUBDIVISION / . CSM$_ ~rr; t.ol fir. LOOT f SECTION 3a T 3/ N-R1~W, Town of ST. CROIX COUNTY,_WISCONSIN _ PLAN. VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM s,7: .I I pal IV PWMINNG DATE: ~.•.•:~.i;!~,.Z JOB PT: Joe SP: INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. e ')3ENCHMARK: //oar ('dy/c e fP ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: roe Setback from: Well >d -,g House 1-0 ' Other - Pump: Manufacturer Mode Size Float seperationGallo cle: Alarm Location SOIL ABSORPTION SYSTEM Width: ngth Numbe f trenches Distance & Direction to n est p, line: Setback from: well: Ouse Other ELEVATIONS Building Sewer ST Inlet:_ fyST outlet: PC inlet Z=v Off Header/Manifold Bottom of systQw,.q. r y"3 1 Existing Grade - Final grad.0 'T DATE OF INSTALLATION: s~ PLUMBER ON JOB: / LICENSE NUMBER! //-,P / INSPECTOR: 3/93:jt ,Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count SY'T. CROIX Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita12WT4tJV-: Personal information you provice may be used for secondary purposes [Privacy L%v, s.15.04 (1)(m)). N9 TN & DENISE C$qqKI7 q"Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tp31150-90-000 s TANK INFORMATION ELEVATION DATA A9700237 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Q ,v' 3.Vl Off f Dosi ng Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent irIto ntake ROAD Dt Inlet TANKTO P/L WELL BLDG. A Air Septic T - 1 NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Lrict' System TDH Ft Head Forcemain Len Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width Length o. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION DIMENSIONS SYSTEM TO /L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type Of Moe Number: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake 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 xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes 11 No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRARIE 30.31.18.682,SE,SE 1927 SICARD LANE LOT 11 rJ % e_. e_ ice' C~~~?iY[.e~~.~ ~ -~/'~r'_✓~li~~ 71~2eJ -(!i~v~~ ,l~c.~ do& c{&l-y-~ AL.JL Plan revision required? ❑ Yes dNo Use other side for additional information. -7 LF 19711 (j & `,IV.~, SBD-6710 (R.3/97) Date ns ' or's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH ` SANITARY PERMIT NUMBER: v~iLAn SANITARY PERMIT APPLICATION Bureau o oand B ff Buiui Safety i ngWater ldiin Water System! 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 than 81/2 x 11 inches in size. m • See reverse side for instructions for completing this application State Sanitary Permit Number ~d / 49W 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 INFORMATION Pr erty Owner Name Property Location e if% n E 1/4 1/4,S l o T , N, R E (or Property Owner' ailing Address Lot Number Block Number Z'7 ` f City ate Zip Code Phone Number Subdivision Name or C-91VI Il inter, a 11 r c~ i.X_$ I(Zq7 Y `s c 90tA/ i t II. TYPE F BUILDING: (check one) ❑ State Owned ❑ itr Nearest Road ❑ rit ❑ Public 1 or 2 Family Dwelling - No. of bedrooms VIIa ownge of 1/z' c7y AV L III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo 3 0' 31' OT 6 3Y- / d 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. 0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 110 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.) (Min./inch) Elevation Feet Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or4-k Id ~/l pW ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of a onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: No Sta ps) I*WAWRSW No.: Business Phone Number: P;t z) ff . /-aA' i t X a- Z Y.0 -_74 -nr Plu is Address (Street, City, State, Z Code): d r 0.;.3 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue ISi a re (N a ps) Surcharge fee) Approved ❑ Owner Given Initial 44 Adverse Determination X. CONDITIONS OF APPROVAL / R SONS FOR EfiS P O L: SOD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, 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 nevv 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 Permi t 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 y y 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. 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 forth is 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 8 112 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. DAVE WOMY PLiNI Lk SOW N ROBE~KT~ Rid _ Phone y49.3656 ~~n ~ fllli \ p gym- i 33 r l I pRn~oSEJ~ /UGuI I FA-1 O w6LL O = ; ood ,4L, s.T ~ XI = ~~y s7•~sts's S. ~•f j dorer'NG I lire ~ I q~ ry ✓ - h Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _1 of 3 labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 038-1150-90 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT S 114 114, T N,R jt(or) W PROPERTY OWNER, -S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 1927 Sicard L n. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY DVILLAGE MOWN NEAREST RO D Somerset WI. 54025 ( ) or%_ WV_ -foil [ J New Construction Use [ J Residential I Number of bedrooms 4 k J Addition to existing building j J Replacement [ J Public or commercial describe Code derived daily How 600 gpd Recommended design loading rate __7-bed, gpd/ft2_.g_trench, gpd* Absorption area required 900 bed, f12 750 trench, ft2 Maximum design loading rate ,,Lbed, gpolh2_ a --trench, gpdift2 Recommended infiltration surface elevation(s) -1 =j--93 • gp ft (as referred to site plan benchmark) Additional design / site considerations water @ el. 90.90, Parent material stream terrace 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 12S ❑U IRS ❑u ®S ❑U [RS ❑U [ij S [IU ❑S ]U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bourdtaly Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerlctl ..1. - 2 17-34 10 r4 6 none lfs o mvfr lm .5 .6 Ground 3 34-94 7.5 r4 6 none Cos os mvfr na .7 .8 elev. 97,9Q It. 4 94- I 1 7.5 r4 4 water f S tttvf r Depth to limiting factor 94„ Remarks: Boring # ~Y ti+i vk;. Ground elev. ft. Depth to limiting factor Remarks: CST Name:--Please Print Gar L. Steel Phone: 715-246-6200 Address: 1554 200th. Aft., New Richm WI 54017 Signature: C Date: 5-26-97 CST Number: m02298 STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Jahn & Denise siggis New Richmond, W! 54017 MPRSW 3254 SEkSEk S30-T31N-R18W (715) 246-6200 town of star Prarie lot #11-Carries Apple River Adda N 1"=40' BM.= cormer pf sodewa;l @ el. 1001 f A livo S64- JZ 49WIA f I, tno`.r 30' I~VLON ~~tign(Lo~ to ~~i~.C Tv~~K ~yj / IV Gary L. Steel 5-26-97 ST. CROIX COUNTY y WISCONSIN ' f i;{. ,~~fi~' ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 rf: - _ , (715) 386-4680 EXISTING SEPTIC SYSTEM AFFIDAVIT The existing septic system which serves the dwelling being added on to must be inspected by a licensed soil tester for compliance with high ground water and/or bedrock seperation requirements as set forth in s. ILHR Chapter 83.10(2) WI. ADM. CODE. The results of that inspection must be made available to this office. If the existing septic system meets these minimum requirements, and is properly functioning, an addition may be added to the dwelling without updating that system. This addition must not, however, encroach upon the required septic system setbacks as setforth in s. ILHR Chapter 83.10(1). Property owner (s) ~ C 4Q S G C ►.1 c Property Mailing Address: /4 a2 Property Legal Description: Lotj1L CSM/Subdivision Rr ucVt- ✓y-?iorr-a - c~l/41/4, Sec. 'lb , T._N. , R.W. , Tn. of Srigrt I-i2Arrciz- I, as the owner of the above described property, hereby affirm that the septic system serving this dwelling meets the above referenced state private sewage system codes. I realize that this addition may cause the existing septic system to become undersized for a dwelling of the resulting size, and I will make this information available to any future parties interested in purchasing this property. Notary Public Subscribed and sworn to S7's-~-_ before me on this date: Signed: V John E. & Denise R. Siggens 6-19-97 , Date: commission expires: ~9y!"ar County Approval: Date: 07/09/1997 16145 FROM Fe9erty P1b4./P.T. Inc. TO 17152467762 P.02 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the JOHN E SIGGENS residence located at., SE SE Section S30, T 31 N, R___18 W, Town of STAR PRAIRIE Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: MAY 1997 Did flow back occur from absorption system? Yes X_ No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: 1,000 GALS Construction: Prefab Concrete X Steel Other Manufacturer: (If known): Aqe of T k if known): CHRISTOPHER HOPPE (Si atur ) (Name?) Please print SEPTIC PUMPER `(J:~;ZG (Title) (License Number) 7-10-97 Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm Code (except for inspection opening over outlet.baffle). Name signature/ 9 TOTAL P.02 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 cj4k-) Location of property SQ 1/4 SL 1/4, section S3~' TAN-R 1~ W Township ! rPgK Pkjy-4rr~'~ Mailing address i jZ"1 Siy~✓zr_~ ,.r,= Address of site -J4(2 ~~IOZL- Subdivision name( r~r < i!'l,r P}~,L C-e" Lot no. (I Other homes on property? Yes_ X, No Previous owner of property ~'►1 r~ 1,.~ lTrz cr4 w' > Total size of property I ~ ' • 07 X- 122 Total size of parcel Date parcel was created Are all corners and lot lines identifiable? t-''Yes No Is this property being developed for (spec house)? Yes 1,-~No Volume -7 ?S- 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.' 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. y3/ dz ~ < ) `"Sig ature of AAplicant Co-Applicant" 11 'l' I 1 i --1 Date Si ature Date of Siqnature i. STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER )Li h~ ~ O -h; Lam= QQ- 10 e MAILING ADDRESS 1 q 2,) S f t Cr~a- PROPERTY ADDRESS Q ao C f c_✓i~ L~ ~ (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION L- 1/4,. K(,E 1/4, Section T_I~N-R_L3_W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER I CERTIFIED SURVEY MAP , 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 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 60% 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) 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. I/We, 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 expimtipn date. SIGNED: DATE: Jl v 1 ~l I St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 • DOCUMENT NO STATE BAR OF WISCONSIN FORM S IS" .HIS s►A'.l •[sAAVrr' FOR e•COnD'NG OAVA ~ PERSONAL REPRESENTATIII E'S DEED 43182n a". 'I-JUM631 RWWM oFM ST. sax (me Scott Wetterland ftedfarlbond - Nov. , 1987 WOOD Per~p ! Renrent tive of the e_ta:e A M Mark L. Wetterland aAnpa Mar f ee 10: 00 Wetterland ("Decendent'"e. for a valuable consideration conveys, without warranty-. to John E. __iggens...and. Aez~ie-.R...-S_iggens,..-husband. and- /vJ wi.f.e.,.....as..s.urvivarship..rtar-itaI ProPe_rtY.._ . _ . _ , Grantee. P[TU r0 ~ t.-.. -.Croix FlYSt Bic cf NEW Rld'IIl7T1 the following described real estate in . _Coaatp. 1~ E 2rd St $3?CC C State of Wisconsin (hereinafter called the "Property") : MW Iidwcnd, WI 54017 Lot Eleven (11) , Carrie's Apple River Addition Tax Parcel No to the Town of Star Prairie. WPM " Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedent's death, and all of the elute and interest in the Property which the Personal Representative has since acquired. 19.87... Dated this r{i-------- day of October ----------------(SEAL) - e- - ----(SEAL) - - Scott Wetterland ' Penonal Representative Penonal Repr_mentative AUTHENTICATION ACKNOWLEDGMENT Signature(s) .....pf Scott Wetterland STATE OF WISCONSIN . ss. authenticated this .Tday of.-,.__ October 19 87 Personally came beft.re me this day of , 19 the above named Gerald F. liarvieux 1(EF1L0~IKA¢1?,24yWtI~'f?(1x TITLE: (If not, Notary - ~~L~F -HAFRV1EUX - - - - _ - - - - - authorized by § - - 706.06, Wis. S$"ry pUbliC to me known to be the person who executed the Stall Of YYh00ns foregoing ins•rument and acknowledge the same. THIS INSTRUMENT WA J BAKKE, NORMAN &-SCHUMACHER,_--S. C. L tom- r. . s ' r f e ttt 2 iZ E QO t * r • 'S N LAND SURVEYING • HUDSON , WISCONSIN 54016 (715) 386-2007 Nome First National Bank of New Richmond Address 109 East Second Street New Richmond, Wi. 54017 Description Lot 11, Carrie's Apple River Addition, Town of Star Prairie, St. Croix County, Wi. John Siggens PLAT DRAWING N This is not a complete Land Survey i._ W E 3~c Q 11610 c S D v ~ 1oS. I19,F ,0 0 h .10 O A -1 0 4> tib try i D hb ~ 0 4z, F s U 1L~. ' 50 'o APPLE RIVER 48,