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HomeMy WebLinkAbout038-1085-50-100 70 CD o o a p ° % o to ~ 0 0. o ~ I 0 o N i I ~ II I ~ I z° 7 co U. C o Q co d' N Z w E U o ~ v E Z a l N F- cl) O O Z c V r O= _ co Z r) N - °1 I y a •IV 0_ to ~ - c -0 z° co z N z 04 I 04 C) E N r m a c,4 O. M o y o o D D a ~ a~ Q 0 U) U) U) as 6 Z M > o N 0 0 0 z ~aaa IL i° o o N (o (o N U) J Q > a) 0) } ~l 0 za: ~Y5 a Y ro rn o o -a = m c 0 t •a v, Q m p Q Z u) ~ ~ Z vii H ~ 0 0 3 °o o O U N o m CD LO `o m v 0- m oo r 1o ai o a c v O ago ao m 0? o o co 1 L: Cf) c,4 Q 0) w -o m co N E U • ~ M O -tea N COO O N O o N U) ! co N 0 Z ci U7 ~t EL • a y .2 y r 3 0 IL U) U Parcel 038-1085-50-100 03/18/2005 10:04 AM PAGE 10F1 Alt. Parcel 20.31.18.355C 038 - TOWN OF STAR PRAIRIE Current I X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * GOOSSEN, SALLY SALLY GOOSSEN 2001 NIGHTHAWK DR SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2001 NIGHTHAWK DR SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 5.330 Plat: N/A-NOT AVAILABLE SEC 20 T31 N R18W PT SW SE BEING LOT 3 Block/Condo Bldg: CSM 11/3022 Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 20-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 09/22/2000 630391 1544/626 WD 07/23/1997 1191/569 WD 2004 SUMMARY Bill Fair Market Value: Assessed with: 30278 189,100 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.330 48,700 148,800 197,500 NO Totals for 2004: General Property 5.330 48,700 148,800 197,500 Woodland 0.000 0 0 Totals for 2003: General Property 5.330 24,200 109,100 133,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 306 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER .S TAB, ADDRESS- 5 r ha.,.,~• C. A SUBDIVISION / CSMJ IAT ....3 SECTION as T 5) / N-R /S-W, Town of ST.~X COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ I t r 0 w i vJ r 1~ ~y INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to rent-,,, - BENCHMARK: ~[JJ C3'a ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well A) House Other Pump: Manufacturer AJA Model Size IVA Float seperation Gallons/cycle Alarm Location :SOIL ABSORPTION SYSTEM Width: ~ 2.,,, Length Number of trenches Distance & Direction to nearest prop, line: 01 Setback from: well: _M, House_ Other ELEVATIONS Building Sewer ST Inlet: 6,ST outlet 96. PC inlet PC bottom Pump Off Header/Manifold ?yo Z Bottom of system S.3 Existing Grade Final grade DATE OF INSTALLATION : PLUMBER ON JOB: LICENSE NUMBER: J5 (a INSPECTOR: 3/93:jt Wisconsin GQpartment of Industry, PRIVATE SEWAGE SYSTEM County: Labor andHuman Rela Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary 6Permit No.: 8592 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: BERG, STEVEN STAR PRAIRIE CST BM El v.: Insp. BM Elev.: , BM Description: Parcel Tax No.: ~o~- Qs C Ply.-- TANK INFORMATION ELEVATION DATA A9600294 91151k TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic _T Benchmark Dosi Aeration Bldg. Sewer Holdin St/ Inlet 97' NK SETBACK INFORMATION Stl)W Outlet f 31la,S9 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic (3- NA Dt Bottom Dosin NA Header tf» Aeration NA Dist. Pipe's ( H Ing Bot. System PUMP/ SIPHON INFORMATION Final Grade M Demand ¢C v9 `5 98; 96 Model Number PM TDH Li Friction System TDH Ft Loss Head For emain Length Dia. Dist. To Well 71 F SOIL ABSORPTION SYSTEM BED /TRENCH Width,~ Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS D nuf -CHWk SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LE MaINFORMATION TypeO Xx,-,, r CHA Iwo ~ SysGIB` UNIT DISTRIBUTION SYSTEM HeaderaMOll Distribution Pipe(s) x Hole Size x Vent To Air Intake Length Dia Length Sa Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or -Grade Syste my Depth Over Depth Over xx Depth O xx Seeded /Sodded Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRA IE.20.31.18W, SW SE, CTY RD C Plan revision required? ❑ Yes QAo Use other side for additional information. e- SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 4 d Safety and Buildings Division ~•pZ~~n 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 8 1/2 x 11 inches in size_ S'i , Q, • See reverse side for instructions for completing this application state sanitary_ 7 N~nt r The information you provide may be used by other government agency programs ❑ Check if revision ttoo pre5viouss application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Propert Owner Name C Pr; Bert Location S -Q0 T N R Q^ Li) e^ . W 1/4, r ~p W Property Owners Mailing Address Lot Number Block Number S A C State Zip Code Phone Numb Subdivision Name or CSM Number 9a---C_U (7is) 7 9- 3~a~ C- 11. TYPE F BUILDING: (check one) ❑ State Owned ❑ itNearest Road ❑ Village t t Public 1 or 2 Family Dwelling - No. of bedrooms Town of r ft III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo ® a% to 100 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 S ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box online A., Check box online 8, if applicable) A) 1.,j6 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------System ___System_____________TankOnly______________ Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 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 S. Perc. Rate 6. System Elev. 7. Final Grade a Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft_) (Min./inch) Elevation 7 eft 7 - 7.~, _3 Feet Feet TANK Capacity VII. in altoTotal # Of Prefab. Site Fiber- Exper. INFORMATION g Tanks Manufacturer's Name Concrete Con- Steel Plastic New Existing Gallons structed glass App Tanks Tanks Septic Tank or Holding Tank ~~1y ^ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 11 El El El ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Name: Print) Plumber'sSignaP": l5 1 C ( S to ° t Plumber's Address (Street, City, StatZip Co o t ILC_l 09 CO 811-1-1 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing A nt Sig re (No S ps pproved El Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: ell SBD-6398 (R. 05194) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ; E 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 licensed pumper whenever necessary, usually every 2 to 3 years. f 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 Dwel'ing. 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 E3 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 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. VIIL 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. , I I f , I i I• 15~ I I ~ I' I I I I 157rc.1?PJY'~ ~Pi i I , ~ "f ~ f~/~'•..r, ;,J ~.1~ S ~ D i~~ I , I - J i ~W i ( l i I , I ' I I I i 1 I ; I I I I I ' I 1 ; -4 '000000~ All, I - t- - j I { -111 I - - -Al - t I ' f I I i ~ Al - I ( 1 1 I 1_ ' ~ ~ E ~ r ' ' ' I i I - I I r I i I I I I I ~ I i I i I ~ ~ ~ ~ I ' ~ ' I I I j I I I ~ j I I I i I 11 i I I ; I I _ I I - 4 { - - - -j r - - f I I I ~ _ 7 , 1 C I , ( I ` I I ~ ~ i I I I ; I t I I ' f- ( I I I I I-- , , I I I I I I I I I I I I I ; I I I I , i I 4 4 i , I I ! I~ , I i I I + i 1 , I r i I i , I I I , I I , ~ I I I I I i i -I_. , 4 i I - i- I I I i I I I D I I I I I I I I I 1 1. I ~ I a I I i l l~~ i I I( I I i I ~ ! - r- - r -T , I I I i , I - f t I 1 J i ~ J 1 I I , - } i I I ! 1 ~ I I i I I ~ I , r , I I I I I 14 I I I I I - + I I i L j - a _ _ - ! - - 4 0 L - - - ' - I - I -I ~ I t 1 P4. fi ' ~ I II I ' i I I ; I 1 l I I I~ i I I 4. J: lZi +4A ' r i i . + _ I I I T-1. - t r 1 L: W -f i-t-rid Yj K 1 K 4 FT -I J11,11 I r I I I i ~ ~ ~ 1 I i l I ~ I ' I I w to, i- - -i- - ' III I - i I I d A 4 I ' I ' !I ~ ,I i I i - - 1_4 I I ~ I i I I I_~ ~ 'i q 1 i 1- 1. t - -i- i I t I + -1 I i I I I I I I i I i t i t I : I K 1- 17 tp I_ JI: L ' I i I !q- l I - - I ~ I i I I i I 1- i I r I J 1-4-4 _ * - -1 __..1 - - --j--- - - j - - - - ? -I t-- l PAGE OF Cr~SS Sec~IOn p~ Sys~e~a-~ I • Fresh Air InISIS And Observation Pipe n Approved Van$ Cap v 411ntmum 12" Above Final Grade 10~~ 1 , sl~ (7 d~ 20- 42' Above Pipe _ 4' Coen Iron To Final Grade Venl Pipe s ~ YK _S JC Q^ Marsh Hoy Or Synthetic Covering 3 (N 1.O Yln. 2e AgQreg'als . t over Pipe Sf. ~~~n~ ~a,a,,~SKlilrlbullon s Pipe 0 0 0 0 -Tee Bte a Beneath Pipe Perloroled Pide Below o Capling Terminating At Bottom Of System Pr~~oSeD ~Inkl: 19r. ~.(cJ .lion SOIL• FILL. • OISTKIBUTIOEJ PIPE APPROVED S~J, PETIC COVER qx Op 2" OF A6GRl;GA'TE o OR MARISN NAy „ OF STRAW a (o.OF~2-21/2 AGGREGATE ELEV. OF S3:EEY~,,. • DISTR19'JTIO►J PIPE TO BE AT LEAST IIJCHES BELOW ORIGIfJAL GRADE AQU AT LEAST 20 INCHES BUT .1.10 MO E THAI) 42 HICKS BELOW FINAL GRADE MMIMUM DSPTIi OF FXCAVAT100 FK011 .ORI&NA'L 69AK WILL BE INCHES MINIMUM AEPT-H of EXCAVATION f.ROM..0~1419AjL CIR49 WILL BE INCHES SIGlJEO: LICEUSE DUMBER: A DATE: a !2 1 (e 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 81/2 x 11 inches in size. Plan must include, but C r 0 i 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. 0 39 - - O-- J APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT .5143 1/4 50 1/4,S o~~ N,R 1e f(or) W 111C h PROPERTY OWNERS MAILING ADD SS LOT BLOCK # SUBD. NAME OR CSM # &Vtk CITY, ATE ZIP CODE PHONE NUMBER ❑CITY ❑VI GE FKjfOWN NEAREST ROAD W-T 3-PR-3 -,2 f5r 0 S"fttw t "f wf & C.' K New Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 'So gpd Recommended design loading rate ed, gpd/ft2 i trench, gpd/ft2 Absorption area required 6%2 bed, ft2 '54,3 trench, ft2 Maximum design loading rate r L bed, gpd/ft2 . trench, gpd/ft2 Recommended infiltration surface elevation(s) 4`Ae-3 ft (as referred to site plan benchmark) Additional design / site considerations Parent material3 c~ os 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 K S ❑ U ~S ❑ U &S ❑ U WS ❑ U ❑ S gU ❑ S , w SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundaly Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench -)7 es '8 Ground 17- B# 16)1 OS I elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. 221 ft. Depth to limiting factor Remarks: CST Name:-Please Print /j a to 0 ~ r~ Phone: Address: 1 ! J Signature: r! Date: CST Number: 'P J0 PROPERTYOWNER 5t-UC.," 13-0- `4 SOIL DESCRIPTION REPORT Page _G2 of L-3 PARCEL I.D. # Q'3&- / 0 8'S - :SO r-f0J Depth Dominant Color Mottles Texture Structure Consistence GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bourclary Roots Bed Tw& imi Ground AVR S lrt^~ ( 7 62,5 elev. ~~t• Depth to limiting factor _ Remarks: Boring # h41:iii~•: • Ground elev. ft. Depth to limiting factor Remarks: Boring # •\;•v :iii: Ground elev. ft. Depth to limiting factor Remarks: Boring # pti':: ihvx tiii Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) I t Y r ~ I I I 040 I~ r ~D j w~J~ -t- - t - i I ~ I I I i I I ' 1 ' ' I ~ I I j ( - - r, , I r ~ I I I _I ~ I I ; - -j- - - l -r - now 709 _ J - - - - - - - I I I , l - { , I fi I - I I -I- I I t - - - - - - r , t - } r } ! _ I- - - - _ 1 1 1 1 i - I i r t T t I , , I 1 I ~ i I T f I - _t r- I I I ' ~ 1 I .f-_ - - 1 I - ...v t ~ j 1 -1 ! ~ ~ I I i _ I 4A 1 I - - was 1 1_1 4 -I - - i - - - j I - - I. } - - } I - I - r- ~ t f 1 ~ i ~ I T - ; _ - I I I I ~ ' I i II i I 1 ~ ~ I Z - ~ I i f - I t I I TT- i - I I I - 1 i - I I ~ ~ I i ; i ' 1 , I ~ t I Al t I I~ ' j I 1 I ' i I I I i _ ~ I I ~ _ L _ Y- , - i . - - _ i 1 . - ~ - ~ ~ I i ~ ~ ~ i h- ~ - i 1 i I i ~ I ~ I i ! ~ - 1 t i - 4 i r ~ - ~ ' ---I ~ ~ ~ ~ a_ I - 1 - ~ ~ i ~ I r ~ - - r ~ ' - - - - i ~ i i ~ ~ 'I I i ~ - ~ i . I t ~ - ~ L ~ t ! j- i i ~ l I i ~ ~ I ~ i -a ~ ~ ~ _ _ _ - - F i i ~ i i ~ --j , --F-- - - ~ _ - ~ _ - ~ - - ~ ~ i ~ ~ _ I ~ ~ i ~ ~ - ---C- } ~ _ ~ ~ i r - ' _ _ - 4 - - ~ J _ - ~ r _ - - i ~ ~ -r- - - _ I i ~ + i ~ - ' ~ i I ~ ~ ~ _ ~ _ _ ~ _ ~ - L ~I-- -1 _ ~ ~ I _ - - ' - ~ , i i 1 I i ~ i i i ' - - ~ i _ ~ i i i _ . ~ _ t - - i _ - ~ ~ ~ + E-__~ j I ` ~ - ~ I I i I ~ I I- i f i ~ I - . _ - ~ _ t - ~ I i j _ ' i ~ i ~ r -r I ~ _ ~ j I i ~ i ~ ~ ~ I 1 -___i ~ i ~ a-_- r __.I __.i 1 t . ~ I -_IIr_ _J_ .I___._ _i _ -r_ F- ~ r ~ ' I I ' i _ 1 ~ ~ ~ i 1 ~ _ _ ~ I - - - i _ _ ~ - i i i ~ - ~ ~ I , _ r I i ~ ' _ _ _ ~ ~ t ~ - I I ~ ~ ! ~ r- ~ i 1.--- i - ~ - - ~ - ~ ~ 1.-___L_ t I - ' I I - -~I_ ' t t T- ~ r - - ~ _ I ' - i i i I ~ ~ ~ - ~ - j _ ~ L - ~ Ili F ~ I ~ L__ ~ t ~ - ~ ~ ~ ~ i ; i t- ~ ._.___r ~ ~ __t- p_.. ~ ~ ~ ~ ~ ~ ~ L i C ~ - - - _ ? - r- -i 1 I I - i i ' ~ ~ ~ i _ ~ - ~ i l a I ~ - ~ I i-- i ~ - - t - ~ ' r - - + _ _ _ _ I- _ 1__ _ ~ i ~ - I ~ ~ _ ' i i j i ~ - .i-- _ ~ r _ I I ~ i iii. - --1-- f__ _ ' _ - . _ i _ i - y - - 7 - ~ ~ - - j ~ T ~ ~ ~ ~ ~ ~ ; i ~ i I ~ i I I I - ' ~ i - I i- i ~ I i - ~ ~ ~ - - _ _ i ~ ~ ! ~ I I ~ _ , r-- i l i i r ~ ~ i - - ' ~ - - i ~ I r - - - _ ~ i ~ ~ ~ I i ~ ~ ~ - ~ - - r y_ ' - - a ~ - _ ~ - ~ r- ~ ~ ~ r i- -i'_ ~ - ~ _ 1 i ~ - - ~ _ ~ ~ E ~ - a a- ~ I - I ~ ~ ~ - ~ ~ ~ ~ ~ i ~ I i ~ - ~ - i - - ~ ~ i ~ ~ i I - ~ ~ , ~ - -r ~ - ~ - ' - 1 r ' - - ~ - i T - ~ i i - - I i i ~ i ~ i _ ~ i I ~ f 7 _ I ~ ~ i i I - ~ _ - - - - - - i - - 1 ~ I ~ i ~ ~ ~ ~ ' ~ i l i - - I ~ ~ ~ f ~ i I i f-~ - - -r-- ~ ~ ~ ~ I ~ i i r _ i i f t ~ ~ ~ ~ - -i - t- , ~ ~ ~ - - i i--~ r - , ± ~ ! i ~ - ~ ~ r ' - ~ ~ ~ I i i ~ t__ - i-- i ~ ~ ~ ~ I ~ _ ~ , ~ 1 ~ , ~ - - - - i i i i i ' ~ ~ i i I i , i I } - - rt - - _ Wi9coasin Department of l ndustry, SOIL AND SITE EVALUATION REPORT Page _ of Laboftnd Human Relations Division of Safety & Buildings in accord with ILHR 83.05 ~Jdm.,'Code COUNTY J1 '7 rd Attach complete site plan on paper not less than 81/2 x 11 inchesa¢`ut PARCEL I.D. # not limited to vertical and horizontal reference point (BM), directi % Of slope, scale dimensioned, north arrow, and location and distance to neares rn@ .e 1 REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INF J4~IQN PROPERTYOWNER: ` PROP RT`FEOCATI>Df!I~ " =OVTtT Sjj5,:7 1/4,SO'20 T3 N,R,)K E (or y- 8 ✓r y , '_f LOT # ` BLO r b .f ;'SUB. NAAME O SM # e00 PROPERTY OWNER':S MAILIN ADDRESS i C' CITY STATE ZIP CODE PHONE NUMBER C V_ GE OWN NEAREST ROAD n/ U) i )5,4 All .S5 - Li (3 15 6 1~ '5'1 i C' ['New Construction Use [o Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow L50 gpd Recommended design loading rate _,7 bed, gpd/ft 2 - 'qtrench, gpd1ft2 Absorption area required 6 ~ bed, ft2 trench, ft2 Maximum deZft loading rate ? bed, gpd/ft2 c trench, gpd/ft2 Recommended infiltration surface elevation(s) 0 (as referred to site plan benchmark) Additional design / site considerations - ' ' Parent material 1n~z Flood plain elevation, if applicable ft S = Suitable for system CO ENTIONAL MO D IN ROUND PRESSURE AT-,GRADE/ SYSTEM IN LL HOLDING T K U= Unsuitable fors stem S❑ U S❑ U ❑ U S )IQ U ❑ S „p S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Botxxtary Roots GPD/ft Boring # Horizon in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends Ground elev. tC~-fit. Depth to limiting oC'V Remarks: nn 'fY ~'i5 5 ! Boring 2 U~ Mop- k 5 S ~S ✓ 1(1-a Ilk ew' 44 "o- 'Okf Ground elev. Depth to limiting factor„ ~ Remarks: CST Name:-Please Print Phone: I S ~2 6 -1 -6 5kCj_L-y\ rc~ Address: ~ 6 0 I 5 `4 6 Signature: Date: ~O CST Number: 10 PROPERTY OWNER /C Z~ S AIL DESCRIPTION REPORT Page _.of' PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground 3 ~5 N N I v. 1 ft. Depth to limiting fa r 7 Remarks: Boring # © ! n / 5 s C-5 Ground elev. ~ft. - Depth to limiting favor 7n j~S Remarks: Boring # q Q } S H L s 7 I-) I- f 0 Ground elev~ Depth to limiting fac or Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) Soil Test Plot Plan Project Name Charles Borgstrom Shaun i - Address 2033 Co. Rd. C Somerset Wi 54025 CSTM #3922 Lot 3 Subdivision Date 10/20/95 SW 1/4 SE 1/4S20 T 31 N/1318 W Township Star Prairie Boring ()Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft.Base of White Stake Red Ribbon System Elevation 97.8 * H R P Same as Benchmark 103' Night Hawk Drive AL 4 30' 835' Property Line B-4 30' B-2 10- Rep A Pri A B-3 60' 0, 00 30' 0 3 Bedroom % Slope House c 5' 5' 60' B-5 B-1 c~ 344' Property Line Ltiis~g-;,inDeaartmentofIndustry, SOIL AND SITE EVALUATION REPORT Page of labor and Human Relations DiNd'sion of Sgfety & Buildings in accord with ILHR 83.0 ~ • ,Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inche h a`~ an mus u `'lout not limited to vertical and horizontal reference point (BM), directi % of slope, scale of,1 PARCEL I.D. # dimensioned, north arrow, and location and distance to neares0ro APPLICANT INFORMATION-PLEASE PRINT ALL INF~IA5-10 REVIEWED BY DATE PROPERTY OWNER: ZPAOPERTYtOCATIQN. l 1 ' t 5 0 °rt i tiv'k -~iOV1c QT i •To:Se7 1/4,S026 T~ N,R fYj E (or PROPERTY OWNER':S,MAILI ADDRESS LOTS BLOCi( SUBD. NAME OR CSM # ff 1/O/ /D d 00 C w, 770 CITY STATE ZIP CODE PHONE NUMBER ,171 V1Lb4GE OWN NEAREST ROAD C'l~v,16- -f- [ New Construction Use Residential / Number of bedrooms Addition to existing building j j Replacement / Public or commercial describe Code derived daily flow gpd Recommended design loading rate 7 bed, gpd/ft2 - trench, gpd/ft2 Absorption area required '6Y-3 bed,:fi' S 43trench, ft2 Maximum design loading rate -2 bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) T? "t Pr a fl- ft (as referred to site plan bendhmark) Additional design / site considerations ' Parent material= Flood plain elevation, if applicable I. It S = Suitable for system COWENTIONAL M 0 IN- RQUND PRESSURE AT- RAPE SYSTEM IN LL HOLDING TANK U= Unsuitable fors stem s O U S❑ U ❑ U S U O S S U 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 Trench Ground / _5 0-5 elev. Depth to limiting J c21-6 f\ Remarks: Boring # t INKS y 411 1 Ground elev. k Depth to ' limiting factor Remarks: CST Name:-Please Print !I r'hone: f S 5kc2- L- Y\ r CX Address: 0 ✓ e~ l'}l Cj s t( 6 5gnature: Date: - CST Number: .r RdPEhT-YGWNER /L ~Z►~--g.S L DESCRIPTION REPORT Page_ of PARCEL I.D. If Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botncay Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed mrxh 1 2 2 n~- CS a V- ,b Ground 3 $ ~l DS N [ p, N ► p, ' 11 1 v. i ► ft. Depth to limiting fa 7 Remarks: Boring # c^ ( n / 614 wQ C~ - Ground ~S N/ Nl ? ~elev. - (d.>sL ft. Depth to limiting 2-T I C2 -2 Remarks: Boring # 4- Ground O- , 1 m- 0 elev. d~~ ft Depth to limiting factor Ly Remarks: Boring # X Ground elev. ft. Depth to limiting factor Remarks: y Soil Test Plot Plan Project Name Charles Borgstrom Shaun i Address 2033 Co. Rd. C Somerset Wi 54025 CSTM #3922 Lot 3 Subdivision Date 10/20/95 SW 1/4 SE 1/4S20 T 31 N/1318 W Township Star Prairie F] Boring O Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft.Base of White Stake Red Ribbon System Elevation 97.8 *H 13 p Same as Benchmark 103' Night Hawk Drive 30' 835' Property Line * 30' B-4 30' B-2 10 Rep A Pri A B-3 sy 60' 0' % Slope 30' o 3 Bedroom House 5' 15' 60' B-5 B-1 344' Property Line -7 Z to~ 3 ~ Ud ~ ~ ~ N FILED 11 DEC 4 1995 ► 5 ENH. 53` 100 KT1st rof DeedsH p\ St Croix Co., W1 P- O rn n 0 v,NO~0 O••~ 00 0) w a) W-3 :J fD cyoocoA W ~ y ~ N > 0 a o v - t=i f K a o cn X L4zz~ 0 0. 0 -0, 4-0.0 cNn0((A < CID 0 -0 -0 0 O o N °i o o h cNr n °o A a 0. 0 C y cry 3 rD Nll- Z o S / d F•h o- 111--_IPa~V~:_CRIVC-~-~ rt ~ y m cr sol'39$3"W t 102.83r O e; cr Q C7 -I ' ~G~ rt m LP S I -i I co 000 Z rs~ < 00 0 IC7 10 0 0 0 S~ N m vi I \,A O Irl I- - C 0 i-Z-I 11 W rn N I N rn w v' r- w O m H to 'n 9~ W C c C) z m 1< y N cn io v I;r 1w z - v 0 I--~ 3 0 0 cn rn 00 D--. N ' ~ H w £ O I-h 344.50' 488.25' rn N0103915311E 832.75' ~i I ro I'= I-S O ~ I~ Qr n o Iw-~ ICS P N STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OVVNERBUYER y-~. .o ;ru MAILING ADDRESS S 7V~an PROPERTY ADDRESS d © V 1 c ►"16- -0 +f~ 10, ` o_1 (location of septic system) lease obtain from the Planning Dept. CITY/STATE Ro A S t ; O a-3 PROPERTY LOCATION S W 1/4, S"V_ 1/4, Section T 3 P N-R~W TOWN OF S~Ac,"r` ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER J CERTIFIEDSURVEY MAPS 3 10 o VOLUME, PAGE 3 Oa OT 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%0 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: ' (72 -"%-t/ r-11 Y DATE: 42 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 , S T C - loo 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 R'k r-q Location of propertyS W 1/4 S 1/4, Section , c(D , T_3 j_N-R 13_W Township e a',e+~ Mailing address riola se's to s y o a3 Address of site Qt3 ' aW ` Subdivision name A~ Lot no. Other homes on property? Yes X No Previous owner of propertylikA s et, e1r S~ ro rlti Total size of property 3 C I 0 Total size of parcel Date parcel was created Q A. Q-- ~ ~ Q 4 S Are all corners and lot lines identifiable? Yes No Is this property being developed for ('spec house) ? Yes No Volume IS I_ and Page Number s(09 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. S 4 7A n ~o , 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 construgtion of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Si n t re o Applic t Co-Applicant ~~/9,/, Date of Signature Date of Signature WARRANTY DEED 5473OG Document Number VOL 1191 pACE~~9 REEGi` i BRS OFFICE ST. CROIX CTY., Wi Reed br R----d Return Address J U L 2 5 ?-.96 2:45 P. M -a I'Uk. s is rr e; Deeds Parcel LD,_Number: 038-.1085-50-100 Charles H. Borgstrom and Dolores S. Borgstrom, husband and wife, conveys and warrants to Steven T. Berg and Lynn J. Berg, husband and wife, the following described real estate in St. Croix County, State of Wisconsin: Part of SW1/4 of SEl/4 of Section 20, Township 31 North, Range 18 West, St. Croix County, Wisconsin, described as follows: Lot 3 of Certified Survey Map filed December 4, 1995, in Vol. 111 Page 3022, Doc. No. 537100. This is not homestead property. Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this day of July, 1996. R~ o§FER FEE' 1- (SEAL) + ) Charles H. Borgstrom Dolores S. Borgstrom AUTHENTICATION Signature(s) Charles H. Borgstrom and Dolores S. Borgstrom, husband and wife, authenticated this 7~n day of July, 1996. Krisdna Ogl d TITLE: MEMBER STATE BAR OF WISCONSIN THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016