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Home My WebLink About038-1047-80-000 o 0 ° 0 h y 4) O O O O ~ ~ I c I 0o m EL ryi o o 0 o ENw a Y ao 0 ~ i c ~ LL I r m a~ c I o ° c co i rn w N I N N C I N 7 0a. N Vl z I Z > LL c y LL G N U _ O _ O U 7 0 f0 C c 4) cD I Cl) M N I N E 3 z I z co I Z o o N ` V ~FMUWi am I am o I o I o z c I co z ~ N Z$ o 4N 0 1 0 o U) Z Z c E '2 c v M M I v ` O 4) 7 O N m CD cc Ix • -N 4) O N 4) O I co N a 0 n co r 'a Q zco z zca z w N z z m c y c R Y N A Y cV l~1 ° c coi v°i ` d v G C IL O c to6 o N (D c o .0 c N IL .0 c Q r U to U) Ur) E 0 n fr N co E 0 w Z o$ 3 n. O z o 1 0 3 3 a O z •N Laaa y ILaOaa d _U _U I I a w co co LO 3 O V1 tnJV 4) z° z° acv ~M~ ~ '0 Ira _I O E O E = o o CD d O V m) o o co Q o O N 7 a~ I N 7 \j O N C N c ` 1V ° o E I o v E O c c 0) LO tt= c 0 CL aUi a a c rn° (D a o. c c a l a°o o y V 0 :c = E E E y a~~i a y m FL- FL d m H v c 0-4, M m m LO o can E E as v m o E o v • O fn U N O Z N L5 ~i 2 U U N O Z_:-s z g fn O .y a.i V #k = E € y 'a a € a • ad 2 4) c ma m d ~1 A c°~ a 0 (`n u l 0 U) ci 1 10 A. STC - 10 4 AS BUILT SANITARY SYSTEM REPORT n f V2t.,w= 37 OWNER COUNTY 7r NiNG OFFICE: ADDRESS SD s ~ r, ~ IQ SUBDIVISION / CSM# LOT # SECTION T,7/ N_R_W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 Z-4111 Gq[f16f` v? /moo yys AA/ft X.1-E INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank, manhole cover. BENCHMARK: ~ C 2 ~-tG ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:Liquid Capacity: Setback from: Well House 5-' 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: Setback from: well: House, S- Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold 917 Bottom of system_ 5✓/~ Existing Grade C' Final grade j~ DATE OF INSTALLATION: - _ C PLUMBER ON JOB: LICENSE NUMBER:S l~ INSPECTOR: 3/93:jt Parcel 038-1047-80-000 07/03/2006 10:53 AM PAGE 1 OF 1 Alt. Parcel M 11.31.18.201A 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): O = Current Owner, C = Current Co-Owner O - FRAWLEY, CHARLES J & JANICE L CHARLES J & JANICE L FRAWLEY 1226 OLD MILL RD NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description 1226 OLD MILL RD SC 3962 NEW RICHMOND SP 1700 WITC I Legal Description: Acres: 9.470 Plat: N/A-NOT AVAILABLE SEC 11 T31 N R18W PT SE NW BEING LOT 1 Block/Condo Bldg: CSM 11/3003 9.47 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 11-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 09/16/1998 587176 1357/396 WD 07/23/1997 1146/90 WD 07/23/1997 1122/635 WD 07/2311997 811/260 LC more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 9.470 79,900 225,900 305,800 NO Totals for 2006: General Property 9.470 79,900 225,900 305,800 Woodland 0.000 0 0 Totals for 2005: General Property 9.470 79,900 225,900 305,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 156 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and E~uildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Per`q~t F_,lQ sJVam~~~.,/ ' ~ r E~~` ❑ 4 City C] Village ❑ Town State PI AMY U P'` ~ x 5 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A om 6 y(, TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic GC) eG y~ ~OI~d Benchmark Dosing Aeration Bldg. Sewer ! (P' 9~ -:y Holdin St/~ff inlet g s0 TANK SETBACK INFORMATION StTkft Outlet 7f`' 9~51 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 1;4 NA Dt Bottom Dosing NA Header.._ Aeration NA Dist. Pipes Holding- Bot. System A2- S&~ PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Lriction TDH Ft 19 ead Forcemin Length Dia. Dist. To Well SOI ABSORPTION SYSTEM BED/TRENCH Width Length i No. Of Trenches No. Of Pits Liquid Depth DIMENSIONS 1.2 56, DIMEN I Manufacturer: NG- SYSTEM TO P/ L BLDG WELL LAKE / STREAM L HI SETBACK CHAMBER INFORMATION Type O 17x-,, (3~,K i / Model Num er _ System: 6xl_& OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) / x Hole Size x pacing Vent To A take Length Dia. Length Dia. Spacing C~ ` SOIL COVER x Pressure Systems Only xx Mound Or Atrade Sys Only Depth Over 'I Depth Over C~ y\ << xx Depth Of xx Seeded/ Sodded ulche = Bed /Trench Center `i Bed /Trench Edges V Topsoil E] Yes C] No E] Yes ❑`No COMMENTS: (Include code discrepancies, persons resent, etc.) Cwt ✓Q~ ~.~i~ 41;1. ~d':`rStar- Pel 18W SE r NW ; Lot 1. Old Mill Road Plan revision required? ❑ Yes 0 Use other side for additional information. 1,0 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: t I I I I i v~='■ "n SANITARY PERMIT APPLICATION Safety Building WaterlSystem! 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 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit N tuber a~9 Z/ The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prope Owner Na Property Location 114 AIA) 1/4, S T , N, R(orN Property Owner's'gailirlb Addres Lot Number Block Number City, S to [Zip Code Phone Number Subdivision Name or CSM Uum.faer II. TYPE F ILDING: (check one) ❑ State Owned ❑ !ty Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms -3- Town OF Q 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 on line A. Check box on line B, if applicable) A) 1- jy New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 11Seepage 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 Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel Plastic p New Existing strutted glass App. T nks Tanks Septic Tank or Holding Tank - ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins Ilatioq a onsite sewage system shown on the attached plans. Plumber' Nam . (Print) ~ Pumbe 's Sig t rta s) MP/MPRSW No.: Business Phone Number: Pumber'sA dres (Street,City'St 'Zip Co r IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signa (No Stamps) XApproved E] Surcharge Fee)~~ , Owner Given Initial Adverse Determination 'Au"Alllfl X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) - DISTRIBUTION: original to Counly. 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 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. 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 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. / U" scr~ ~ r 3 ~,r~c~: ✓16usc _30' 1 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of '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 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.. # dimensioned, north arrow, and location and distance to nearest road. a -71e APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROP RTY OWNER J _ PROPERTY LOCATION GOVT. LOT 114 114,S T f N,R E(or)IGV' P OPERTY OWNER':S ILING DRE IE21 C # SUED. NAME OR CSI. 1 CI±YTAI E IPCODE PHONE NUMBER LAG ®fOWN NEAR BY ROAD [j New Construction Use ~Q Residential / Number of bedrooms [ J Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate ~ 7 ed, gpd/ft2-,,e -jench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate i~bed, gpd/ft2_,ftrench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site con ider ions Parent material 0 ,4~,l Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem INS ❑U EMS ❑U MS ❑U ZIS ❑U ❑S fyU [Is ~U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. C t. Color Gr. Sz. Sh. Bed Trench } 4+i 444 v - Ground elev. ft. Depth to limiting factor Remarks: Boring # :•%t v 21 Ground elev. ~ ft. Depth to limiting factor Remarks: CST Name:-Please Print Phone: Address: Signature: Date: CST Number: PROPERTYOWNERL-)& SOIL DESCRIPTION REPORT Pag~of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary GPDBoundary Roots in. Munsell Qu. Sz. Co Color Gr. Sz. Sh. Bed Trench Ground elev. /aft. 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) aka ,r ~o i 5 3s o~3~ 'xw 9S CERTIFIED SURVEY ` l.ooated in Part of the Southeast MAP Quarter of the Northwest Quarter Section 11, Township 31 N Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin, o 0v WIS NORTH 1/4 CORNER SEC. 11 0 Proparad for and at the request of pO~►GI•ASJ, N 40 Merrill Campeau ca ZAHLER 1245 Old MJIJ Road 7~• 0,2146 I Star Prairie. M 53705 kUp$pN, Drafted by. James m. Brault UNP~ATTJANpS WIS.. Q N. LINE OF THE SE 1/4 OF 'HE NW 1/4 SEC. 11 S 8939'18" 11 1 • . _ , , _ 653.34'-_ ~ ~ • ~ ~ ~ w _rT W. LINE OF THE Ne 1/4 OF 71.1E 100' SETBACK I I II rh I I y J SE 1/4 OF THE NW 1/4 FROM R O.W UNE J J z ~ LOT 3 r J J AREA J I 9• do / ~ UyPLATTED~AN N X974 s Q~ ; h ^ D, 9B Beres ~ ~ O ca, AREA 10MLOONO R. O. W J 3 z 1 414357 sq.n. J 1 l ! N. LINE OF THE SW 1/4 OF NE 90 oawr 1 Ik BE 1/4 OF THE NW 1/4 CENTERLINE OF I y , J Nmp~1'r . hr S 89'23'23" E OLD MILL ROAD i I^ o 31 JI ~ -`650.33-, 1 s 89~3'z3 1 can ICNO (n LOT 1 ' LOT 2 n CENTERLINE 0 ~j y,I AREA OLD MILL ROAD I ^ o I ! 01,,00 s9,fr AREA 11 , ~l O N O 9.47 does A I I 957,903 sq. fe, l l 7 f AREA I 8.22 acres I l M _r1ra 0NC R. a W N K AREA l! I/ I Qr 1 Le) N! o i i 3 9<s oe ; r. g EXCtLIDWO R.O,W. FENS 9' EAST I y w 1 eM ~SO OR PROPERTY CENTERLINE OF I i~ '1 I I OLD MILL ROAD 100' SETBACK LINE 1 1 1 (SEE NOTE 'A') FROM R.O.W. ~~'Pto~ ~ 1 I j I1 33 R.O.w.~ ~y ! p / I I I'.; t. i 947.8$' N 801443111 I W I 44'36 W r r' I /r 280.22' 69' R.O.W. " t I 927.41 N N 88'44'38" W-' ~ . OLD MILL ROAD • ~ - - SOUTH LINE OF THE NW 1/4 ~ SEC. 11 ~ I UNP A ; 1 7,~ANDS CENTER 1/4 CORNER OF SEC. 11; r-e I ALL QUARTER QUARTER LINES wER4 ESTABLISHED PER STATE N I T STATUTE 39.62. UR t° / AD US LO A-6 120D, LENC RD SEA N DELTA Q i A-C 00 84.16 64.16 SO 30.5 3'03 49 1' to , _OT 1 8 85 397.02 -C 00.00 -E 280. 3.8 S1 8 "58 4 2 F-0 B S. S 48 0 5 06 LO •00 66.70 250.23 N 56'0 e I- 1167.00 3 4 08 ,~i { .01 S 12"54 26 10'51 36 SOUTH 1/4 CORNER S6C. 11 .00 387.69 396.10 5 11`1 55 19'02 38 J-1 1167, 64. 4.84 SURVtYORS REPORT; S4otlon 11-31-18 Mea Wded S 0373 0 W 1 0 In Oert, 40 acre parcel■ per ■tote statute 39.82. LEGEND AlI•n C, Nyho Roplaitersd Land Surveyyopr, had ~ County Section Corner Monument Me nr once 8euthweet Comer of Section 2-31-18, Of Record r' L1 1989 r,,hGatlAetl Surrey Mop recorded In Val- n o.. a,.. _ _ 4. . STC-toy SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER - CA L)/2 02 MAILING ADDRESS l y q Q I c~ M I I 1/Z~R • (6~ e I~~r1 f 1 PROPERTY ADDRESS l aLf~ 01 Gz (location of septic system) Please obtain from the Planning Dept. CITY/STATE 1 nJL. PROPERTY LOCATION Sty 1/4, 1/4, Section 1 T_ 3 / N-R_ /j_W TOWN OF __--)_-ta e I~rz urz, ST. CROIX COUNTY, WI SUBDIVISION LOT NUM 3ER _ CERTIFIEDSURVEYMAP VOLUME1 PAGE340,LOT NUMBER awi. No. S3~.1.30 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: 6 DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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 - / ~ ~ h F,tlw Location of property Se 1/4_/V{) 1/4, Section T_31 N-R_~_w Township STAot NKAJRi c Mailing address yy old /22i// I2,/. A) EE J K,rAmvinA O 51101'7 Address of site Old /Yell Subdivision name Lot no. / other homes on property? Yes/ No Previous owner of property _.~,QI// ~1.►r»n~rL✓ Total size of property q. if 7 QCreA Total size of parcel q.4'~GtCr~ T.~~'G.fy1Q0 4ClN# JVkj Date parcel was created 10 -,P3-j;1r Are all corners and lot lines identifiable? ✓Yes No Is this property being developed for (spec house) ? Yes L.- o Volume / (a 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. ,5: 5!Zq/ 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. Siy C t e of Applicant Co-Applicant Date of S'gnat re - Date of Signature e 535441 STATE BAR OF WISCONSIN FORM 1 - 1982 WARRANTY DEED DOCUMENT NO. ~O FREGISTER'S OFFICE T. CROIX CO., WI Reed for Record .Thl Deed, made between Merrill J. Campeau, OCT 2 6 1995 a singe person, - at 2:00 Pm Grantor, 6APA.'1. t-axvK. and Jeffery A. Campeau, a single person, Registar of Deeds , Grantee, w the Seth, That the said Grantor, for a valuable consideration Of THIS SPACE RESERVED FOR RECORDING DATA one dollar and other valuable consideration ~I~•~ Td. NAME AND RETURN ADDRESS conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: ' ~a~4tiPd, Part of the Southeast Quarter of the Northwest Quarter o Section 11, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin described as follows: Lot 1 of (Parcel Identification Number) Certified Survey Map filed October 23, 1995 in Volume 11, page 3003, as document number 535230. F E EXEMPT This homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Merrill J ._.Campeau warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants, and restrictions of record, if any, and will warrant and defend the same. t, Dated this 7 day of OC 19 9 5 (SEAL) (SEAL) Merri 1 J. Campeau (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St. Croix County. Wig epartmentofIndustry, PRIVATE SEWAGE SYSTEM County: Lar HurganRelations ST. CROIX SafetyaY auildingsDivision INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: PerAMHolder's PEAU Name: ❑ City E] Village QA o : State Plan 1 VP , JEFF x CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVA TA IL X TYPE MANUFACTURER CAPACITY ATI J At HI FS ELEV. Septic • n ark Dosing Aeration Bldg. Se r Holding St/ Ht 1 t TANK SETBACK INFORMATION • S / et TANK TO P/ L WELL BLDG. ventto Intake ROAD et it Septic NA 07 Bottom Dosing NA Header / M Aeration NA Dist. 1 Holding B e PUMP/ SIPHO FO TION 4P I I de Manufacturer De Model Number 447Y fflvff~* TDH Lift Lriction SYs TDH t Forcemain Lengt Fi ist. To Well SOIL ABSO O IRWM BED/ TRENCH Wi Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS TEMTO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO CHAMBER 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 C] Yes C] No C] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Star Prairie.11.31.18W, SE, NW, Lot 1, Old Mill Road 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 SANITARY PERMIT NUMBER: v , Y f d : _ i Safety and Buildings Division 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 than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number y ❑ Check if revision to previous application The information you provide may be used by other government agency programs d77" [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property caner Na Property Location 1/4 1/4,S fBIck N, R (oil Property Owner's Mailin ddress Lot Number Number Cit tate Zip Code Phone Number Subdivision Name or CSM Number II. TYPE O BUILDING: (check one) ❑ State Owned ❑ Cit~ Nearest RID ❑ VII age ❑ Public fif 1 or 2 Family Dwelling - No. of bedrooms Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) l~~) 1 ❑ Apartment/ Condo S-'~~~ ~b1 `1 Uv 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 online 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 ~f 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 .h ch) Elevation Feet Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank f ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, th undersigned, assume responsibility for inst Ilation of the nsite sewage system shown on the attached plans. Plu b s Name: (Print Plumber' Sig ur ;to ps MP/MPRSW No.: Business Phone Number: P ber's Address (Street ity, St t Zip 7d) : IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (IncludesGroundwa[er ate Issue issuing ent Sig ature ( Stam Surcharge Fee) Approved ❑ Owner Given Initial / pil Q h Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to Couniy, One copy To: Safety & Buildings Division, Owner, Plumber _ INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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 IicEnsed 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. 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 num':Ier(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 Dvv,(dling. 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, re,_onnection, 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, nurnhE r of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for aJ .?atic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experiment: product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropri )1. )refix (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 t'rr ~nty. The plans must include the r'oUouvir;g: A) plot plan, drawn to scale or vvith complete dimensions locati 3 . (ding tank(s), septic tanl<ls) or other +rexment tanks, building sewers; wells; water mains/vrater sera-e; stream lakes; pump or siphon (ankdi!)u i --j"00 'i i ,);:es; soil ai>sorption systems; replacerent system area,, ar;;. 'lie lo:at,: r -f the building served; ~rizc ~~_al f=r c; v_~rtical elwa_ti~~n reference pcints; C) complete speciticatior-, or pare,..,; i :)ntrols; dose volume; elevation differences; friction loss; pump performance curve, pump model and _'Amp m:3-i t .r - er; D) cross section of t.'ie soil Jbsor ptic_? system if required by the iounu, 1.) soil test data on a 1 15 . -)rrn, arnt. - sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated pr-.-,t_. c: which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contaminato'i investigations and establishment of standards. 1 -.54X Z"m 3/n -4 A, c so' . j C is All Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Divis.on.cf Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 11 s ize. Plan must include, but St. Croix %2 of slope, scale or PARCEL I.D. # not limited to vertical and horizontal reference 11 dimensioned, north arrow, and location and t ;to near t roa 038-1048-40 APPLICANT INFORMATION-PLEAS NT ,L IAT REVIEWED BY DATE ' PROPERTY OWNER: ~FPOPERTY LOCATION 4 c' OVT. LOT 1/4 1/4,S T AR or W Jeff Campeau rf SE NW 11 31 18O PROPERTY OWNERS MAILING ADDRESS r 'f A S` OT # BLOCK # SUBD. NAME OR CSM # 1245 Old Mill Rd. na na csm endin CITY, STATE ZIP CODE E NWBER []CITY []VILLAGE SOWN NEAREST ROAD New Richmond, WI 54017 1&;48=3248~ Star Prarie Old Mill Rd. tc* New Construction Used] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] 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 900 bed, ft2 750 trench, ft2 Maximum design loading rate -.1.5 bed, gpd/ft2_. 6 trench, and/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 CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK 12 )0 )(Z S❑ U S C3 U I S ❑ U 06 ❑ U ❑ S ®U ❑ S ® U U= Unsuitable for svstem 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 Treat 1 0-7 10yr4/3 none L 2mgr mfr gw if .5 .6 1 2 7-22 10yr4/6 none sil 2msbk mfr gw if .5 .6 Ground 3 22-42 10yr4/4 none sil lfsbk mfr gw na .2 .3 elev. 4 42-96 7.5yr4/4 none is Osg mvfr na na .7:.8 99.35 ft. Depth to limiting factor +96" Remarks: Boring # 1 0-12 10yr4/3 none L 2mgr mfr gw if .5 .6 2 2 12-25 10yr4/4 none sil 2msbk mfr gw if .5 € .6 3 25-84 7.5yr4/4 none L fs Osg mvfr na na .5 .6 Ground elev. 99.15ft, Depth to limiting factor +84" Remarks: CST Name:-Please Print Phone: Gary T_ REPt=1 715- Address: 1554 00th. A.ve., New Richmond, WI. 54017 Signature: Date: CST Number: 5-22-95 cstm 02298 PROPERTY OWNER Jeff Campeau SOIL DESCRIPTION REPORT Paget _rff 3 PARCELI.D.# 038-1048-40 ' Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft Boring # Horizon in. I Munsell I Qu. Sz. Cont Color I Gr. Sz. Sh. I I Bed iTrerch 3°' € 1 0-8 10yr4/3 none L 2cpl mfr gw l f np .2 2 8-16 10yr4/4 none sil 2cpl mfr gw if np .2 Ground 3 16-8 7.5yr4/4 none sl 2msbk mfr na na .5 .6 9 gle . ft. Depth to limiting factor +82" Remarks: Boring # i 1 0-10 10yr4/3 none L 2mgr mfr gw if .5 .6 4 2 10-5 7.5yr4/4 none is Osg mvfr gw if .7 .8 3 55-5 7.5yr4/4 none sl 2msbk mfr gw na .5 .6 Ground elev 4 9-78 7.5yr4/6 none co s Osg ml na na .7 .8 . 97.8% Depth to limiting factor +78" Remarks: Boring# 1 10-8 10yr4/3 none L 2mgr mfr gw if .5 .6 5 2 8-20 10yr4/4 none sil 2msbk mfr gw if .5 .6 3 20-8 7.5yr4/4 none sl 2msbk mfr na na .5 .6 Ground elev. 97. f{ Depth to limiting factor +80" Remarks: Boring # Ground elev. ft. i Depth to limiting factor I Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Jeff Campeau 1554 200th Ave. CSTM2298 SE 4NW a S 11-T31 N-R 18w New Richmond, WI 54017 MPRSW 3254 town of Star Prarie (715) 246-6200 1 N 1"=40' BM.= top of 1" steel pipe @ el. 100' Alt. BM.= top of 1" steel pipe C el. 99.25' lot 10 acres 100 6-5 ~s•weo~NCX2- O M ; I l IZCI Gary L. Steel 5-22-95