HomeMy WebLinkAbout038-1176-20-000
o ~o
a o°
M a O
H
O
O
N -
O C
ti O
O
O
N
U)
U
w
0
M
I
O
= Co
N p
O
p Z - C
7
LL ~ 3 m
3 0
a w~
3 ~
o
0o w 0
~ 4.; 0
0: as d
v z a m
0
U
O Z
V
d Z :t c °
U) H - N E
O Z
N N
C N N
y
N
N c
d (n O
O O N Q
Z m z p
N Z
w~ ' c ~
~a
\i E E N
~ d Y
c ~ -
P N d N C O O
a r`
m G G d E o m c~
m U) U) :3 L) Q
55 °-O
Z
• ~ c a a IL N
if °
C N U co Co N
~i t~ J U ~ rn rn ~
CD (D
Z M N y ° O
= N
O co co a
>
_ c y c
~1 z v -
~ O N N ~
N
c U to c
co y
O O r I-- V n- Qj
N 000 N a c -p
t6
6 (0 CD E
C~ h 0 N O 0 0 O N
N U t a0+ -O co
~ r y a r N F- C N
• M O O N E O U
w
col O 6 ~ O Z c~ ~U)
O ~
r \ .w r
a
V E
• e~ o m .2 `m a c
E c
r A vat 0
' sconsinDepartmentofIndus", SOIL AND SITE EVALUATION REPORT Page 1 of 3
L boor 4-V Human Relations
Division 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 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (ECM); djrecti6rrand % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to'hearest road.,, \ U~j ndi ~
\ REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE PRINT ALL,I,RFQRMkTION l]
PROPERTY OWNER: PROPERTY LOCATION
Al Lunde t OVT. LOT SE 1/4 NE 114,S 4 T 31 N,R 18 )ffdor) W
PROPERTY OWNER':S MA!IING ADDRESS SLOT # BLOCK # SUED. NAME OR CSM #
Box 686 3 na csm pending
CITY, STATE ZIP CODE: ' HO UMBER ❑CITY ❑VILLAGE JgOWN NEAREST ROAD
St. Croix Falls, WI. 54024.E 3- Star Prarie Canary Rd.
[x] New Construction Use [ Residential / Num fie s 3 ( ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate . 7 bed, 9 pd/ft2 .8 trench, gpd/ft2
Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate . 7 _bed, gpd/ft2 .8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 99.55 _ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material stream terrace Flood plain elevation, if applicable na ft
S = Suitable for system CONVEMIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for svstem I #9S ❑ U 113 S ❑ U 148 S0 U IS ❑ U ❑ S 1 U ❑ S [BU-
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture I Gr. Sz. Sh. Consistence Boundary Roots Bed !Trench
1 0-14 7.5yr4/4 none sl 2msbk mfr gw if .5 .6
1
2 14-26 7.5yr4/6 none is Osg mvfr gw if .7 .8
Ground 3 26-80 7.5yr5/4 none S Osg ml na na .7 .8
elev.
102.05 ft,
Depth to
limiting
factor
+80"
Remarks:
Boring #
1 0-10 10yr4/3 none sl 2mgr mvfr 9w if 1.5 .6
2 ~ 2 10-18 7.5yr4/6 none is Osg mvfr gw na . 7 .8
3 18-88 7.5yr4/6 none S Osg ml na na .7 11.8
Ground
103. 160 ft
Depth to
limiting
factory
+8811
Remarks:
CST Name:-Please Print Gary L. Steel Phone. 715-246-6200
Address: 1554 2 0th. ave., yew Richmond, WI. 54017
Signature: Date: CST Number:
5-10-95 cstm 02298
PROPERTY OWNER A. Lunde SOIL DESCRIPTION REPORT Pagr2 • of 3
PARCEL I.D. # Pending
Boring # Horizon) Depth Dominant Color Mottles (Texture Structure IConsistencei8wxi3y I
Roots Bed DTft2
in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh.
`
1 0-10 10yr4/3 none 1 2msbk mfr 2f .5 .6
2 10-38 7.5yr4/4 none sl lmsbk mfr gw if .4 .5
Ground 3 38-90 7.5yr4/6 none is Osg mvfr na na .7 .8
elev.
103.4 ft.
Depth to
limiting
factor
+90"
Remarks:
Boring # 1 0-10 ).Oyr4/3 none 1 2msbk mfr I gw 2f .5 .6
4 2 10-18 10yr4/4 none sil lmsbk mfr gw if .2 .3
3 18-32 7.5yr4/4 none scl lmsbk mfr gw na .2 .3
Ground
elev. 4 32-80 7.5yr4/6 none is Osg mvfr na na .7 .8
103.2 ft.
Depth to
limiting
factor
+80"
Remarks:
Boring # 1 0-10 10yr4/3 none sl 2msbk mfr gw if .5 !.6
5 2 10-32 10yr4/4 none sl 2msb> mfr gw if .5 .6
3 32-90 7.5 r4/6 none is Os mvfr na na .7 .8
Ground
105 elt ft.
Depth to
limiting
factor
+90"
Remarks:
Boring #
Ground
elev.
ft. f
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
r
STEEL'S SOIL SERVICE
Gary L. Steel Al Lunde 1554 200th Ave.
CSTM2298 SE4NE4 S4-T31N-R18W New Richmond, WI 54017
MPRSW 3254 town of Star Prarie (715) 246-6200
lot #3
N
1"=40'
BM.= top of 1" steel pipe at el. 100' by se lot corner
Alt. BM. = top of 11, steel pipe @ el. 103.00'
1
190
` Gary L. Steel
5-10-95
v+38- 117 -C-) -0od 7 ArA,
~ t ,g 1U
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER J NN
ADDRESS , ).Pv
SUBDIVISION / CSM# crl~ LOT
SECTION _T~N-R W, Town of
ST. CROIX COUNTY, ISCONSIN
PLAN I
SHOW EVE YTHING WITHIN 0 FEET OF SYSTEM
l %Ya scr/n
ss'
INDICATE NORTH ARR
Go tas_
Provide setback and elevatio inform tion on reverse of this form.
Provide 2 dimensions to ce ter of septic tank manhole cover.
i
BENCHMARK :
ALTERNATE BM:
/`h
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:S Liquid Capacity:
Setback from: Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width:_ Length Z4_ Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House-Z/ r Other
ELEVATIONS
Building Sewer ST Inlet., ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system leo '7_
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR: _
3/93:jt
Ank
9 f4
STC - 104
AS BUILT SANITARY SYSTEM REPORT Z 6 11996
r Coufq Y
OWNER ZONING OFFISE
ADDRESS z
SUBDIVISION / CSMJLOT
SECTION _T~ 3 / N-R ,Zg W, Town of_'~ZL
ST. CROIX COUNTY, ISCONSIN j~PLAN I
SHOW EVERYTHING WITHI 0 FEET OF SYSTEM
i
INDICATE NORTH AR
Go tws-
Provide setback and elevatio inform tion on reverse of this form.
Provide 2 dimensions to ce ter of septic tank manhole cover.
N/isconsin'DepartmentofIndustry, PRIVATE SEWAGE SYSTEM County:
Labor and Human -Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
262477
P r Voldet': ❑ City ❑ Village Town of: State Plan ID No.:
STAR PRAIRIE
CST BM El v.J1: Insp. BM Elev.: BM Description: Parcel Tax No.:
i
A96001 37
TANK INFORMATION ELEVATION DATA 9 sd,~96
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
c1 Z'u ,/S lily, cY~
Aerati Bldg. Sewer ~Glo
Molding St/ Inlet
371
TANK SETBACK INFORMATION St/0t Outlet Z z
~ TANK TO P / L WELL BLDG. Ventto Air Intake ROAD Dt Inlet
Septic >S0/ NA Dt Bottom
Dosing - NA Header s - 7 "ply'
Aeration NA Dist. Pipe 7, 6`11 ZO f <:; '
Hol g Bot. System /DU, 7D
PUMP/ SIPHON INFORMATION Final Grade
?r
Manufacturer Demand
I'F/fodel-Nu rLlber ~Y3PM
t
TDH Li Fric I tem r)H
Loss e
FgrCemain Length Did. Dist. To Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches ,SIT No. Of Pits Liquid Depth
DIMENSIONS /__2 / DTMEN I N
Manufacturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE / STR -LEACHING
INFORMATION Typeo h>~ v, _ CHAMIMR ~elNumber:
System: 6.F d Sl CJ -,go 4 ' S/J OR UNIT
DISTRIBUTION SYSTEM
Header /.AA Distribution Pipe(s) ,r x Hole Size x Hole Spacing Vent To Air Intake
Length 61_ Dia- Length f_z~ Dia_ Spacing Cp ° '
SOIL COVER x Pressure Systems Only xx Mound Or At-Gr y nl
Depth Over Depth Over . xx Depth Of xx Seeded/ Sodded xx MulcheTC
Bed /Trench Center 4) Bed/ Trench Edges ~/'v Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: TAR PRAIRIE.4.31.18W, NE NE, CANARY DR
Plan revision required? ❑ Yes LS'rvo
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert . No.
Safety and Buildings Division
~~■c.,=r,t SANITARY PERMIT APPLICATION Bureau of Building 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 8112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency programs ❑ Chec ic f rdv( n t`o previous ap lica~h'
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Prope Owner Name Property Location
1/4 1/4,S T , N, R 12 rElorQ.y'
All
Property Owner's M ling Address Lot Number Block Numb r
Ci y, Stat Zip Code (hone ;umber Subdivision N e or CSM umbe
~ are Road
II. YPE F BUILDING: (check one) ❑ State Owned ❑ it Ne
❑ VII age
Public 1 or 2 Family Dwelling - No. of bedrooms rjA Town O
,E
<~~z
Ill. 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 on line A. Check box on line B, if applicable)
A) 1. jg New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
-----System --------System Tank Only-------------- Existing System Exi-----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 [9 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./ nch) Elevation
Feet Feet
VII. TANK Capacity acits Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existing structed
Tanks Tanks
Septic Tank or Holding Tank 0 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for in all tion pjtqe onsite sewage system shown on the attached plans.
Plumb 's Na e: ) Plum is ' nat e- am s) MP/MPRSW No.: Business Phone Number:
I tuber' Address (Str, Cit , State, Zip de):
S s' Ft IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved anitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
/ A
Approved ❑ Owner Given Initial Surcharge Fee) 1/7
(Jx(/
Adverse Determination
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SOD-63913 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety IN Ruildings Division, Owner, Plumber
INSTRUCTIONS
I
I- A sanitary permit is valid for two (2) years.
i
2. Your sanitary perriit may be renevved before tT+r:~ exl-airatior, date, and at a time of renewal any ne- Criteria in the
' lisconsin Administrative Code will be appli( able.
i
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) t.) 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 administrato_ 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 numb=--r(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 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.
J,4 /Ixi / y
o~'i~'~,~ f,~.c~ j°,~s} - ~ Rio ~ \
~O crr~
z
a
8
~~r-3
CHECK LIST FOR PERMITS
OWN-L" --UJ-LD-E-R
Z PERC TEST OF SOIL PROFILE
vl' BLUEPRINT OF HOUSE
s+ c, , ~f ,~T WARRANTY DEED WITH SEAL; DOCUMENT NUMBER;
VOLUME & PAGE NUMBER
L/ TAX NUMBER OF LAND 03 10 L 0 0 3 00
CERTIFIED SURVEY MAP (IF AVAILABLE)
L COUNTY FORMS * STC 100 STC 105 FILLED OUT
AND SIGNED
NAME * ADDRESS * PHONE NUMBER* IF
NOT ON
PERC TEST ,So vf\eS + 1y\-e ,J:"s cj m c -q-
s~ Pra~r'~ W'T syo
PLUMBER
ALL OF THE ABOVE
PLB 67
PLOT PLAN
CROSS SECTION
CHECK FOR PERMITS
Wisgohsin Department of Industry, SOIL AND SITE EVALUATION
i.abor and Human Relations Page of
'Division of Safety and Buildings in accordance with 9, Wis.
• Attach complete site plan on paper not less than 8 1/2 x 11 inches in s' S must rl my
include, but not limited to: vertical and horizontal reference point (B , di tion ana- f el j f ~k
percent slope, scale or dimensions, north arrow, and location and di Man to rijt~ rc D. #
APPLICANT INFORMATION - Please print all infor n. Filtefd by Date
Personal information you provide maybe used for secondary purposes (Privac La s. 15.04 (1) (m)):?,yr. %V
Property Owner f y ,1.j S O Pr0~ri, on
V ( f qvt. Lot , 4 V.614 S 7 T 3 N,R i8 E (or) W
Property Owner's Mailing Address # ,B Subd. Name or CSM#
ell 5_7 47&A~)
city y State Zip Code Phone Number 15fA *,,'e Nearest Road
I 3~ S/ AY a (7/S) Y8.3 -3 ❑ city village Town add .
New Construction Use: Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 4 gpd Recommended design loading rate trbed, gpd/ft2 • G trench, gpd/ft2
Absorption area required Az2100 bed, 0~10 trench, ft2 Maximum design loading rate bed, gpd/W ranch, gpd/ft2
Recommended Infiltration surface elevation(s) a,0- ft (as referred to site plan benchmark) Fepl d c en,,rAdditional design/site considerations /3-30 -ri
Parent material Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system S❑ U N] S ❑ U as ❑ U Ns ❑ U ❑ S X[U ❑ S DK 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
-tj
13 a i 7510e Jib& v 7tr 7 . s
Ground L 8 !J '7, ~ 9 ,q s-7 ' i
elev. .
Depth to ,
limiting
factor
Remarks:
Boring # -j- V
13 J n 7J ft
y 7. S%11 8
Ground S/ $ - • 8
elev. 9
Depth to
limiting
factor
J &in. Remarks:
CST Na (Please Print) ` a;zu:~:= , Telephone No.
Addresd' 61 .~h Date CST Numb r
141 s a 6 o ~ c sy-19T J o~ /e j 99r & d
2l SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground
1 S! ~j/~ ✓ r n_?
; a
elev. 2,1
Depth to
limiting
fact
Remarks:
Boring #
c-T
Ground 9 4 .Sj S G' f'i o <
elev. ,
/GJ ~o ft.
Depth to
limiting
factor
9 p 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 #
Ground 2-1
7
.Sy~
9 elm (v CPS :5~
s ✓T , ' ~!P N
Depth to
limiting
factor
min. Remarks:
Boring # o_
/o ~m Lj Y/ ;
42 M X/ AMJAt -J IV 70e
a- yam/ ri.~ r~'6/c cJ •Z •3
Ground 7- J Y~ Y z PZJV 'Se/ ( ~n ~Sb~ G`1 p ; ~✓/o
lev.
Depth to
limiting
factor
c.')~in. Remarks:
SBDW-8330 (R. 08/95)
,PROPERTY OWNER SOIL DESCRIPTION REPORT
Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G~pjft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
7
Ground /OYw
elev. J ~Sl . / / T~ 56.~ 7~r a S , lL~ ;
Depth to Z ~^-s~.e~ i is,•~ V - _ P I✓
limiting
factor
aZ in.
Remarks:
Boring #
Ground
elev.
n. '
Depth to
limiting
factor
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 #
Ground
elev.
ft.
Depth to ,
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08/95)
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations Page of
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all information. Review by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Locatio/114 Govt. Lot 1/4,S T N,R E (or) W
Property Owner's Mailing A dre Lot # Blo # Subd. Name or CSM#
City Stat Zip Code Phone um ❑ ity illage ❑ Town Nearest Road
❑ New Construction Use: ❑ Residential / Number of bedroom Addition to exi ing building
❑ Replacement ❑ Public or commercial - Describ .
Code derived daily flow pd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2
Absorption area required bed, ft 2 trenc , ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2
Recommended Infiltration surface ele tion(s) ft (as referred site plan benchmark)
Additional design/site considerations
Parent material Flood plain elevation, f applicable ft
S = Suitable for system Conv tional /Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S U ❑ S ❑ U El S El U ❑ S ❑ U ❑ S ❑ U ED S ❑ U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant C for Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell 11u. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
A
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Boring # , E3 Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
CST Name (Please Print) Signature Telephone No.
Address Date CST Number
a
Yr
.74
J o
M
Z
7-.31 Sfax 4 ~ 7
- - z u
71
fh ~ ~
0.3
~S S f/fv. e ~l C`
y
~s.
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNERIBUYER 1 M PS K • OA v
MAILING ADDRESS t P Wt?, aY a i v P
PROPERTY ADDRESS L.O M A ► hl S✓roc~s d i s) ~w ~3tlJ~
i (location of septic system) Please obtain from the Planning Dept.
l-.DT 3 GSM X, It 3v1y 3- lags , voL. to c,)4 o2q.Sd` AOL At s3 o8 3
CITY/STATE N e,,~ L-1
PROPERTY LOCATION #IVV E 1/4, fit/ E 1/4, Section T 3 1 N-R I g W
'OWN OF S+g r Pa, ir'j -e- ST. CROIX COUNTY, WI
SUBDIVISION _ Ma jjcwc ku/ V LOT NUMBER 3
CERTIFIED SURVEY MAP3Jky5~lyyS,VOLUMELO~PACE A9S0,LOTNUMBER
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 expiration date.
SIGNED: cZ2, ~1 c~
DATE: S- Z 3 9 6
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
i. S 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 a-Am eS 9• Ma-1-
V tion of property N&- 1/4 NF- 1/4, Section LlT3-N-R W
SS &2
Township S4a,~ Araifi f- Mailing addres 0 LCinra.y ,Or; ►-t
Y in r~ cr w l'
b0 N en,,, Q
ddress of site LoT GSiv% JLJI y~
' ssc 87 3
Subdivision name Pka ital') _ Lot no. _
Other homes on property? Yes NO
Previous owner of property fp,j L,J Z
Total size of property
Total size of parcel 4'o
Date parcel was created JvL l lky4~
Are all corners and lot lines identifiable? -->~-Yes _ No
Is this property being developed for (spec house)? Yes \-__No
volume )Q_ and Page Number 1q~0 as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A 14ARRANTY 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. 30 8? 3 , 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.
30823
VV\
Si nature of Applicant Co-Applicant:
-a3 -13
[)atc of Signature Date of Signature
t FORM NO. 985•A
• KC 171U1ar
Stock No. 26273
530873 y FILED
KATHLEEN H. WALSH
ST. CROIX COUNTY CERTIFIED SURVEY MAP NO. % Register ofDeeft
LOCATED IN THE NE 114-NE 1/4 AND THE SE 1/4-NE 1/4, SLCroNCo,WI
SECTION 4, T.31 N., R.18 W., TOWN OF STAR PRAIRIE, ST. CROIX CO., WI..
r., cJ
UNPLAT7-ED LANDS BY OWNER
N.90000BOO 781.40 SCALE / 200
APPROVE 0' /00, 200' 300• 400'
LEGEND
;~~N \1 II DENOTES 314 "x 24 IRON PIPE SET,
JUL V51' WE/ GHI NG /./J LOS•/L N• FT.
rl) DENOTES ST. C.RO/X CO. SURVEYORS
MONU. FOUND
POND ~l o DENOTES / "IRON PIPE FOUND.
1 ST. CROIX COUNTY
Comprehensive Planni C
Zoning and
~i Parks Committee
tb
Kl"4e if not recorded C) within 30 days of O ~
Ufa ovadate p La r0shag ba NE - NE `Qh n
I ~s`3o o F/I'T / 696 /3F'~ SE ° NE r!j1~ y
r
i~ 3Ok 0 (POND X11 /5.
98 AC. S s r~
w i
T
IpC+ ` 4 aLOG ' * CARL W. ,
Ir, z I z , HETFELD
Z °o o I"'wo ice: = S-1544 = C~
p °w o w BLD ;ST. CROIX FALLS:
w w~~ w io WIS. Q'. y
(Zi
10
v POND
O W I X66'
I~ N N Ql~ ~~Iy
UI ~T G0 DR/vEwar
w Aso ~y A~ 29
3 80°47'34 W.
0 subject
347,756 S0. FT NOTE: The parcels shown on this map are subject
798 Aa to State, County, and Township laws, rules, and
290,32430.FT. regulations (i.e. wetlands, minimum lot size,
ROADEASMENT access to parcel, etc.). Before purchasing or
(D9 66 developing any parcel, contact the St. Croix
County Zoning Office and the appropriate I
Z Qo Town Board for advice.
0 'w Z o I
87.9 m ~ ~ Q •D
5 NGN O
50 O
61006 - I
5•
41 1.0 ` N `D" UNPLATTED LANDS
10T 9 , . - - - - - - l
.
WARRANTY DEED
54413 VOL 1179P
A,E507
Document Number F REGISTER'S OFFICE
ST. CROIX CO., WI
Recd for Record
MAY 2 3 1996
Return Address'-" at 11:00 ` a. M
Register Qf Deeds t
Parcel I.D. Number: 038-1020-60-300
Allen L. Lunde and Pamela E. Lunde, husband and wife, conveys and warrants to James R. Moe and
Melissa M. Moe, husband and wife, the following described real estate in St. Croix County, State of
Wisconsin:
Part of NEIA of NE1/4 and part of SE1/4 of NE1/4 of Section 4-31-18 described as follows: Lot 3 of
Certified Survey Map filed July 5, 1995, in Vol. "10", Page 2950, Doc. No. 530873.
This is not homestead property.
Exception to warranties: Easements, restrictions and rights-of-way of record, if any.
Dated this 171 vVvd- day of May, 1996.
I
(SEAL) (SEAL)
A len L. Lunde amela E. Lunde
AUTHENTICATION TR ER
Signature(s) Allen L. Lunde and Pamela E. Lunde
husband and wife, authenticated this 274114~- day of
May, 1996.
Kristina Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN
THIS INSTRUMENT WAS DRAFTED BY:
Attorney Kristina Ogland
Hudson, WI 54016