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HomeMy WebLinkAbout038-1167-60-000 ~0 11 STC - 10 4 EQ AS BUILT SANITARY SYSTEM REPORT 3, j,,996 OWNER F ADDRESS 1279 SUBDIVISION / CSM_,~s LOT SECTION,,229_T21 N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM .a 14' 3 ~ a ay R ~ Busk ~ ~4.0-( 6i9 / =x,20 Sc e INDICATE NORTH ARROW ~ i 171E Lr}J~- Provide setba k and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: ~g J SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model Size Float seperation Gallons/cycle: Alarm Location -.SOIL ABSORPTION SYSTEM ~K Width: j-:v Length Number of trenches Distance & Direction to nearest prop, line: Setback from: well: House__ Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt i Wisconsin (jepartmentof industry, PRIVATE SEWAGE SYSTEM County: LTbor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 962466 PerFWgEK, N %L' E ❑ City ❑ Village Cl Town of: State Plan ID No.: CST BM Elev.: UA Insp. BM Elev.: BM Description: ~C Parcel Tax No-: TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic O Benchmark iv3,y5 Ic~a: Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air intake Septic Q NA Dt Bottom Dosing NA Header / Man. ' Aeration NA Dist. Pipe (,,-2a' 77,0 ,)3 Holding Bot. System 9(' ' PUMP/ SIPHON INFORMATION Final Grade 7- Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Head Forcemain Len Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /,-q- { DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type O ,a r CHAMBER Model Number. OR UNIT System: 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRAIRIE.28.31.18W, SW, NW, 104TH ST, LOT 15 71/ 1 n /dr " an evlslon required? ❑ Yes ( X10 Use other side for additional information. SBD-6710 (R 05/91) Date nspector's Signature Cert. No. a 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. y( IV' • See reverse side for instructions for completing this application State Sanitary Permit Nui~~ ber The information you provide may be used by other government agency programs [ teck if revision to pr7e"viioouuss application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Prope O ner Narr~~gg P operty Location `'la' _ x,91/4 1/4, 5 T , N, R E (or Propert Owner's ailing Addre Lot Number Block Numb Cit State Zip Code Phone Number Subdivisio ame or M Number ( ) - r*. Ti. TYPE F BUILDING: (check one) E] State Owned ~ City Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 11U1 7-- ~Q~DO 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. M New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------System System TankOnly______________ Exlsting 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,LSeepage 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.) Wig/ Inch) Elevation Feet Feet VII. TANK Capacity aclts Site Total # of Prefab. Fiber Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank EJ ❑ El 1:1 1:1 Lift Pump Tank /Siphon Chamber ❑ +E1 10 1 1:1 1 11 1 El VIII. RESPONSIBILITY STATE-MENT 1, th)e undersigned, assume responsibility for instal ti n oft o site sewage system shown on the attached plans. Plu b s Na : ( In Plumber' Signa re' ps) MP/MPRSW No.: Business Phone Number: i ' 1„ - .I P Plum er s Address (51p t, C' y, State, Zi de): L IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate slue ssuing A ent Si nature (N t ps) Surcharge Fee) Approved ❑Owner Given Initial Adverse Determination X. ONDITIONS OF APPRO L/ REASO FOR DIS ROYAL: ice SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber lb- INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewer before the expiration date, and at a time of renewal ar,v i:riterla 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 submmitted 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. 3e Pl 31 11 i~V /ice/c7 > S y 0 o,-e S~ ,t/ti1%yf XIS6J ~,~jsir~/t ~~c)oasr~ - >C gip.»v~x= ,6? •,j~®,.-. v ~ 1121 V-41o6 "W '11Y,I-9 SCE- /,;t ~71°~ScJ ~S ~ STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS T SUBDIVISION / CSMfLOT SECTION,,-~ T N-R~ W, Town of s ~ ,F ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM @r /S- "5e it, INDICATE P10RTH AR OW Provide setback and elevation information on reverse of this f rm. Provide 2 dimensions to center of septic tank manhole cover- z _ BENCHMARK ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer ModelW Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length - Number of trenches i Distance & Direction to nearest prop. line: Setback from: well:_ House Other ELEVATIONS Building Sewer. ST Inlet. gs- ST outlet aiiee. PC inlet PC bottom Pump Off Header/Manifold Bottom of system ~~•a Existing Grade Final grade I DATE OF INSTALLATION: C? PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt L abor i d [department of Industry, Labor and Human Relations PRIVATE SEWAGE SYSTEM County: Safety and Bu;dings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI FRASER, DALE X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 1(D,~ l~d_ , ~c •x'12 QVr ®`C~ri- IL(/ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic SCy Benchmark' Dosing 3, ~ 3 ~ 7 A01. e,1' Aeration Bldg. Sewer 99 &~:7/ q H St/M>rf Inlet 5 ' gw' TANK SETBACK INFORMATION St/.#t Outlet yC5/' 9~ TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 22%2 NA Dt Bottom 0 7T_ Do ' A Header/-N*F - glv ' Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Many r De nd Model Number GPM L -4 riction System t TDH Lift F F in Length Dia. Dist. To wen SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Tr nches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS m DIMENSIONS SYSTEM TO P/ L :B LDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O tj ~ v'' / CHAMBER Mode Number: System: of 3 OR UNIT DISTRIBUTION SYSTEM Header / Manifold (r Distribution Pipe(s) , x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing ~D SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ry ,r Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center 31 Bed / Trench Edges Topsoil E] Yes ❑ No El Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Star Pra rie.28.31. 8W SW NW Lot 15, 104th Street Plan revision required? ❑ Yes 8 No A11A Use other side for additional information. o? D8` 9d SBD-6710 (R 05/91) Date Inspector's Sig an ture Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY o -Attach complete plans (to the county copy only) for the system, on paper not less than 11 VV j' 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP TY NER PROPERTY LOCATION '/4 %4, S T , N, R E (or)dp PROPERTY OWNER'S AILIADDRESS LOT # BLOCK # jr- CITY, STATE ZIP CODE PHONE NUMBER SUBDIVI ON NA OR CSM NUMBER 11. TYPE OF BUILDING: (Check one) ❑ State Owned E3 CITY VILLAGE NEAREST ROAD / =w OR: ❑ Public 1 or 2 Fam. Dwelling4 of bedroom PARCEL TAX NUMBER( S) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.9 New 2. ❑ Replacement 3. 0 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 Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 A Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 430 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 99, el Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank - Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installa n of thelon • sewage system shown on the attached plans. Plumber' ame rint).k Plu er's 8111 t ( St ps) rMP/MPRSW No.: Business Phone Number: u ber's dres (Street, ity, Sta e, Zip C IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved nitary Permit Fee (Includes Groundwater ate Issued ng Agent sign re o Star rift Approved ❑ Owner Given Lini!ial Surcharg e Fee) Adve e Deten AD X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety 8 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 the 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 & 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new ,and/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% 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 i 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 41 few i 1119 /fa uS~ 1 PAC-C or its r,A Ali Ieleh A04 OA/4lt4lloe PIS ' • e t ue"PIS 4* C•.1 1#04 1~ /b•1'a/•~• ~Vom rife 141 Olt age# PIP, olN/u.l~ f4• 1 • • ~•M•1~ II~• • /wlw•1•• PIP, YNwI • C•rll~/ iwnl••Ilot AI , i•n•. OJ iJ/l•w ' ,fI ' • ~ ~ is 9 r.% ' COIL Fill,' ©13TKIBUT101.1 plrC APPRObIrp S•I7J(1aCTIC COVC 2"~ A~GK>:6J11~ 11ATRR14 OR I' OF 57NN OK MAK4.6 ►'Ay I:I.EV. OF-~LFELT, OUG Clio ~i-t'~i AGGRCGgTC ell, WSYRIAUTiou PIPt •TV DC AT 4UU AT. 4CAi7 IWCNF:3 BCLOW ORiWWAI. t.CAfT;O IIJC.KL8 OUT 1.10 MORC THj-,W 4% IuCKC6 CCLOW rINAI. r, ^pC t%uctrtuM pIPT.H OF EXc yAT►,0u FXom OK16wA.L 6Rw w1t.G. BE 1'11N1J1V1l pEP1l1 of C Av IIJCHCS ATION f0 l"% C~I4114gL GRAPE Wlt.t.• BC INCHC S SIGwC . LICCUSC LIUMBC11: Wiscgnsin D:partment of Industry, SOIL AND SITE EVALUATION REPORT page,-/ of Latio~ 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.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY 0 ER: PROPERTY LOCATION GOVT. LOT 1/4 J(~ J 1/4,S. T N,R(oW PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SU NAM CSM # ~ ~ CI STATE ZIP CODE PHONE NUMBER CITY VIL=13OWN NEARi2L 5-- ( ) - ( New Construction Use [~Q Residential / Number of bedrooms [ ] . Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 5 li gpd Recommended design loading rate gibed, gpd/ft2__-.g trench, gpd/ft2 Absorption area required bed, ft2,2.7 trench, ft2 Maximum design loading rate gybed, gpd/ft2__,&_trench, gpd/112 Recommended infiltration surface elevation(s ft (as referred to site plan benchmark) Additional design/ site nsiderations ' - Parent material 19y_2 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 l~ S❑ U Z S ❑ U 0S ❑ U 59 S❑ U ❑ S I& ❑ S ER 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 1)k 2,dl- S Ground elev. / W ft. "'o 2ZZ1 V Depth to limiting factor Remarks: Boring # s I c~ 52 ~~2 4Z - b 1 Ground J elev. W -/ft. Depth to limiting factor isi Remarks: CST Name:-Please Print Phone: Address: z Signature: Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page-of, PARCEL I.D. # Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour lay Roots GPD/ft in. Munsell Qu. 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) l s ~ ga s ~ J7Bur.E to STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER___Jgj~C_ ',4 0 MAILING ADDRESS /P/ l h /fir j j~yy~~o ~ PROPERTY ADDRESS (location of sept sys "2 Please obtain from the Planning Dept. CITY/STATE Q.2 c~ l1 i C'iGl /"&w d PROPERTY LOCATION t; ° 1/4 / , kAJ 1/4, Section T_N-RW TOWN OF ST. CROIX COUNTY, WI SUBDIVISION 2- a o LOT NUMBER --1 • 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 expiration date. SIGNED: DATE: Iy 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 ,Q V- Location of property, y~~1/4~ Section, I N-R~-W Township e Mailing address <nha-~ _ Address of site Subdivision name Lot no. / other homes on property? Yes_ No Previous owner of property Total size of property Total size of parcel o~ Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes _ No Volume j)03 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 ?,(o a0 , 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. Signature of Applicant Co--Applicant 2 2- 9 G ~-9 9 Date of Signature Date of Signature RED P.IN,E IN THE SW I/4 OF THE NW I/4 , PART OF THE SE1/A SECTION 28, T31N , R18W , TOWN GF STAR PRA, UNPLATTE NORTH LINE OF S 88° 47 '00"W ro- 280.00' 60.00 440.00 80,00, 6~0 500.00, 0 14 ~T 15 X3% 93,179 SO. FT. r 4 90, 139 SO.' FT. 2.14 ACRES uh 13 .2.07 ACRES ry 2 88,368 SO. FT. 2.03 ACRES r1 , - VV P , ` \ 3e ' 60 .0 C30 00 00 3a 000 1 '00. 1 O 22 2 y J 0 ?q. 2 23 ~+u►0 ~f`. Q~. 96, 70,715 SO. FT. ~iPO na, 2.2 a►, , 1.62 ACRES 24 r ' 92,869- $O. FT: 2-5 SO. N 9.13 ACRES: ACRES s _ "i J- i' } ✓ A - :1 DOCUMENT No. WARRANTY DEED THIS 3►AC[ R65lRV= FOR RLCORDINO DATA FQRM 2-198 STATE BAR ,,..UJPiEi~N" 523620 REGISTER'S OFFICE Daq McCulloch, a/k/a Daniel McCulloch ST. CROIX CO., W1 RAa'd for Record ( NOV 2 ~11994 4 conveys and warrants to $~.~S..R .._FrBtSPY_•tind DAr Ene A. So30 "tt. M ' ...Fxa;a.el<.,...Ilugbar~.d.:and. IleOepfdDNds RCTURN TO Dale & Darleae Fraser . 114 Sunrise Drive the following described real estate in St. Cro .i.. x County, ...W1 54075 . State of Wisconsin: Tax Parcel No: .6 Lot 15, Red Pine Estates in the Town of Star Prairie. MAvM-b //17 0 Dad D FED T i s n O t . This homestead property. UK (is not) Exception to warranties: Easements, restrict hts-of-way of record, if an, Dated this !M-11........................ day of 19.. ~4.. ....................................................................(SEAL' ~ SEAL) _ _ \ } ' 1, v AUTHENTICATION signature(s) aathenticated this ........day of ..........................119 day of .e. the above named .IIa. 4a..Ilanial......... .M.C14. TITLE: MEMBER STATE BAIT OF WISCONSIN (If not. authorized by 1 706.06, Wu. State.) . 11 11 to me known t~~Q eq`;K~~i;.,;Yezee he foreeoiba inet onid k?aois edEtl! i fi I I Y00 HO 60 660' 6e6.9i 14 10 16 07 806 bhn 13 I 803 802 S "D 805 17 EE _ EST S s(9LeD 114 - NW !/4 4 -NW 4 zs \ ' pabr 815 8 4 9 24 9 801 o / 25 t 816 z53 \ 800 E 7 810 1 817 0 SOLD eA \ ems, n.a a 814 \ 450 7e616' . 22 SOLD I 19' 81 I 21 20 813 \ 812 SOLD OLD 474 B 5 ! .I . »zv / w SOLD 799 3 798 795f .n^ FEATURES N +114-s ~P~Es LOT # ACRES PRICE TAXES - 1992, 2 794 5 s. 1 3.5 SOLD 797 606.74 2 3.2 SOLD b~ 4 , 3 3.9 SOLD 796 I 793 4 2.4 $11,500 $147.72 94' , 5 3.1 $12,500 $161.57 c . S* M. 3= VOL. I PgGE 115 b 4.9 SOLD Lo 4~ 10 SOLD I 'I SOLD s Sd>J 7 2.5 $12,900 $240.06 DoT 2 8 2.5 $12,500 $173.11 J j 107 a LOT .4 9 8.1 SOLD - - _~ti_ - - roa va 10 5.6 SOLD 11 3.3 $15,900 $205.43 12 2.2 SOLD 13 2.0 $13,900 $175.42 14 2.1 $13,900 $177.73 15 2.0 $15,500 $200.82 16 2.9 SOLD 17 2.4 SOLD 18 1.4 $17,900 $166.19 19 2.4 SOLD 20 3.3 SOLD 21 6.11 SOLD 22 3.7 SOLD 23 1.6 $14,900 $152.34 24 2.1 $14,900 $177.73 25 1.9 $14,900 $168.49 . I MAJ. • 3s asl ton 1sTAR!. A o ~T r~dt c 4 PRAIRIE z - - ..i New Somerset Richmond 0 777 3S C~~. ` .G !~r1 A ( G RE I) PINE ESTATES "A Peac-etul lZural Subdivision" PRESENTED BY: RE/MAX team 1 realty New Richmond: (715) 246-7125 Somerset: (715) 247-5900 Scott Zahnow chi Jim Moe *20°'o Down Tennis Available *Wildl.ila~ *Building Contr !"Aors Welcome *Near Apple River *Electrical & "Feie.plione Installed *No Assessments J Roads *Somerset Schools DIRECTIONS: From Somerset: IINvy. 64 East to ] 00th St. North to }.02nd Ave. Fast to 104th St. North. RF/MlKteaml realty ~.o...,.. 103 Main St., Box 68 Somerset, Wisconsin 54025 Mss 708 Somerset Rd. New Richmond, Wisconsin 54017 each office independently owned and operated f REID IN,E SWIM OF THE NW I/4 , PART OF THE SE1/ 4 OF THE i 281 T3IN , R18W , TOWN 4F STAR PRAIRIE , ST. UNPLATTED LANDS NORTH LINE OF S1/2 OF THE NWI/4 S 88° 4700"W 60.00 440.00' 80400' 0 500.00' 0 ~i- 14 s 93,179 SO. FT. QS~, FT. 'u►~N~iP 2.14 ACRES v`~-- S 13 88,368 SO. FT. 2.03 ACRES Aa .3A4 OO V~`G . 00 0 2 23 °o , 12 96,947 SO. FT. w 70,715 SO. FT. ~JO a ~6~~~• 2.23 ACRES d? = 1.62 ACRES 8 r YJ ~ ~ 24 \ r ,oa 92.869 SO. FT, a 5 9?A63 o G 2.13 ACRES ~ro 4 N ~2 ~ • 1. 'Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 4 of Labor arr,~c~ lirar an Relations bivisiA/bf 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 S~ I Z not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distanc APPLICANT INFORMATION-PLEASE P It, REVIEWED BY DATE PROPER 0 NER: VAT ~ROPERTY LOCATION z° T. LOT 1/4 1/4 S T~ N,R J(orM1l PROPERTY WNER':S MAILING ADDRESS , w # BLOC # UBD AME 0 SM # CITY TATE ZIP CODE PHi~Af , ,fiABE ry TY _Q LLAG OWN NEAREST ROA p(J New Construction Use M Residential/ Numbeiuf tae10omrti~ ( ] Addition to existing building [ ] Replacement [ ] Public or commercraFdes i Code derived daily flow- :ZID-Z gpd Recommended design loading rate ed, 9pd/ft2_,e -trench, gpd/ft2 Absorption area required /;!5 bed, ft2 . rs' trench, ft2 Maximum design loading rate ~~bed, gpd/ft2_. R trench, gpd/ft2 Recommended infiltration surface elevation(s) ~1~L ft (as referred to site plan benchmark) Additional design / site considerations 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 fors stem ®S ❑ U ®S ❑ U WS ❑ U ® S ❑ U ❑ S Z U ❑ S Nil SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Pont Color Gr. Sz. Sh. tBe Tmr& zzsz Ground elev. 0 ft. - % - _ Depth to 14' - Q-2 ~el X - - limiting factor >9,~2 Remarks: Boring # Al Z; ^3~ Ground / elev. ft. Depth to - / / limiting factor -C* Remarks: CST Name: Please Print Phone: Address: J . Signature: - Date: _ CST Numbe : 'ILL PROPERTY OWNER SOIL DESCRIPTION REPORT Pageg PARCEL I.D. # w ` Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. nt Color Gr. Sz. Sh. Bed Trench ~•titi ~ ,~iti _ n}: :may - A, 141 7 9 Ground elev. &L ft. Depth to limiting factor > 22 Remarks: Boring # /J Ground elev. Depth to limiting ?c Remarks: Boring # 17 Ig Ground ' elev. ,Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) . l 7 /AI, ~ L✓ ~i9G~ ~O/' , ~X . /6 1 9y 4''JAt ~4a~~iJ e s ,y 40, S7 ism ~p f ~J i' ST. CROIX COUNTY WISCONSIN l~ t ZONING OFFICE won" ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road w- Hudson, WI 54016-7710 (715) 386-4680 January 30, 1995 Hartman Homes P.O. Box 26 Somerset, WI 54025 RE: Septic Inspection for Dale and Darlene Fraser To Whom It May Concern: An inspection of the septic system for Dale and Darlene Fraser property was conducted on December 8, 1994. This property is located in the SW k of the NW h of Section 28, T31N-R18W, Lot 15, Subdivison Red Pine Estates, Town of Star Prairie, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions with regard to the above, please do not hesitate in contacting our office. ince -~ely, J es Thompson ..•.-I;ssistant Zoning Administrator 7s q R tr