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Home My WebLink About038-1075-30-000 0. 0 ' ~ ° I a~i °o• 6F# 0 ° I M a, o I o I o I I N ~ Y ~ I I I A I i 1 CL N I ° ° a a - z z a c U. c L ti co E $ I 3 M N M I z ~ t Z = O _ O O z d d `m m 0o M w d co d co r z I o I C v C o Z c c E u~ 'o N I o ~ o I m z (D (c) z F- E E c E v M N NN C N 0) .c N 0) CL :3 Lo CD 4) 0 •~l I~D r _ a a 01 0 z co z z m z w N I z I 4) c V M OS E > ca a Y N I rn 0- d U N C i LO CL CD M NO H d ry N G C a p C U) ca G CC IL E rr rr 0 U) V) U) =3 2 9 !E a s I a o z I • Naaa ~aaa IL CD E LO LO o vii o 00 N cn rn rn 4N) I co 00 U) -i U CD G) 0) LO co cy) 0) _ CV ITV c aO > N N t N N co E .O m Q O) N 00 I t •0 m N O C) !I fV 9 d QI 1' fn fV d Q z co m 04 cl 0) w w 000 a y O~ O co to C ` V) H c CD ° O ` •c 0 c 00 co O C L) 1- N c N 0) C N 0 4) D 0) CD d p) O m CL c ~ N _3 wo -2 V7 0) N 0) E E t4 O N M it M OMO, C I d rn w v z aci ur N v H c m 0° co 00 c6 m E c, .2 S) -2 E 0 (n cc N 2 F- J N O Z z • ,y' O fn I U' N O Z O = t ~ ~ I s a 4) € a 4) ~t a d v d a 4 m a r 0 CL tt`i~fti o i 3 '.3 'o c ° ~1 A c~a~ o v) 0 o3H0 ) Parcel 038-1075-30-000 12/18/2006 03:26 PM PAGE 1 OF 1 Alt. Parcel 18.31.18.309C 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 PAUL J QUIE O - QUIE, PAUL J BROWN AMY M C -BROWN AMY M 889 220TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 889 220TH AVE SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 5.001 Plat: 3534-CSM 13/3534 SEC 18 T31N R1 8W NE NE BEING LOT 1 CSM Block/Condo Bldg: LOT 1 13/3534 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 10/25/1999 612627 1465/439 WD 07/23/1997 1127/368 WD 07/23/1997 1126/153 WD 07/23/1997 762/153 more 2006 SUMMARY Bill Fair Market Value: Assessed with: 175241 215,000 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.001 47,000 143,000 190,000 NO Totals for 2006: General Property 5.001 47,000 143,000 190,000 Woodland 0.000 0 0 Totals for 2005: General Property 5.001 47,000 143,000 190,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 038-1075-30-100 12/18/2006 03:26 PM PAGE 1 OF 1 Alt. Parcel 18.31.18.309C-10 038 - TOWN OF STAR PRAIRIE Current I XJ 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 - SOPER, GERALD C GERALD C SOPER 885 220TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 885 220TH AVE SC 3962 NEW RICHMOND SP 1700 WITC ^ 000 Legal Description: Acres: 7.992 Plat: 3534-CSM 13/3534 SEC 18 T31N RI 8W NE NE BEING LOT 2 CSM Block/Condo Bldg: LOT 2 13/3534 EZ-UT-1509/511 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 11/16/1999 613960 1471/356 WD 2006 SUMMARY Bill Fair Market Value: Assessed with: 175242 417,900 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 7.992 62,000 307,300 369,300 NO Totals for 2006: General Property 7.992 62,000 307,300 369,300 Woodland 0.000 0 0 Totals for 2005: General Property 7.992 62,000 307,300 369,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 568 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 030-2047-60-000 12/18/2006 02:59 PM PAGE 1 OF 1 ' Alt. Parcel 27.30.20.510J-2 030 - TOWN OF SAINT JOSEPH 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 0 - LAVENTURE, HOWARD A & LENORE E TR HOWARD A & LENORE E TR LAVENTURE 1423 MAIN ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.400 Plat: N/A-NOT AVAILABLE SEC 27 T30N R20W 1.4 AC IN GL 2 LOT 2 OF Block/Condo Bldg: CSM IN VOL I PAGE 250 ORD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 27-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/22/2004 769493 2621/638 EZ 05/31/2000 623933 1514/636 QC 2006 SUMMARY Bill M Fair Market Value: Assessed with: 169882 44,300 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.400 38,400 0 38,400 NO Totals for 2006: General Property 1.400 38,400 0 38,400 Woodland 0.000 0 0 Totals for 2005: General Property 1.400 38,400 0 38,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 FILED 0 d C Z O C T 1 4 1998 ► KATHLEEN H. WALSH RegisterofDews 27 ~~.JO~ 889"~8 8t.croixCo.,WI 9 ti~ o ST. CROIX COUNTY SURVEYOR' RECORD CERTIFIED SURVEYMAP Located in the NE K of the NE K of Section 18, T3 IN, RI 8W, Town of Star Prairie, St. Croix County, Wisconsin; being that lot as shown on Certified Survey Map filed in Volume 4, Page 1136 in the St. Croix County Register of Deeds. OWNER/SUBDIVIDERS Bearings referenced to the North line of JASON & WENDY ERICKSON the NE 1/4 of Section 18, assumed to be 889 220m Avenue and recorded as S90°00'00"W ( West Somerset, WL 54025 UNPLATTED LANDS North line of the NE1/4 NE Comer Section 18 (R WEST 782.81') (Alum cap. fnd.) (R WEST) - - 1 ,J-,s990W00"w 220TH N 90° oo~ oo" a 782.70 _AV_ENUE w 1850.891 591.55 w 8 0 184. - - - - 565.26 - - - - N1/4 Comer c"n N 90- W 00" 749.70 33'33' Section~18, T31N, R18W' N (R 49.81) ~I N Ip oI~I (1 I.p. fnd. ) 1.00 LOT 4.... ault_D1NC..... 940 ° I W o 217 836 square a .001 acres) o N including R.-O.-W. . m 192 square feet (4.416 acres) N garage exducing R.-O.-W° : D ' I o Co i b) co M Z 1---3 I o~ iZ t-I ch c~rn o I °z ~ C,; ~ rn rn o septic vent I W I W I C14 I CO CO ti dwelling well ° 55 g16: o c°'-' C 1 Ltb ~I CC, M LO ° 0531 ~ I m O i Lj 1 o ? septic vent X159 m m -4 w '1' a) ° N ' ...LL to z ib o I y tz) I co ,r ~ y N 1 1 x ~-,1 I*, 348,144 square ee .992 acres) W 1 ~I . • n z C„)1 including R.-O.-W. m 10 325,028 square feet ( 7.462 acres) Iy ! '9 exduding R.-O.-W. :r p 110 Z ~m v 750.04 :m i . I w I y r:• . . ( R 744.73') rrgi;ry(1 rY•ryiilk, ire. 'lif:. • 5.66 ° 744.38 '::,,,,;•it'r N 89° 59'04" W 783.05 c.r rs~~► ( R NUP5901"E 783.35 ) 1 - to •,s~wr n I o CERTIFIED SURVEY MAP '`1:4 gl+,l .,00 VOLUME 5, PADS 1237. w SCALE IN FEET I"= 150' m _o E1/4 Comer Section 18 0' 75' 300' 450' (O (Alum. cap fnd.) ? LEGEND The parcels shown hereon are subject - indicates section corner monument to utility easement as described in r` ( ON. as noted) Vol. 641, Pg 57-58 in the St. Croix 1i\5*C ' h • - indicates 1 1/4 " iron pipe found County Register of Deeds. • o - ' JOSEPH W. . Indicates 1" X 24" iron pipe GRANF.IERG weighing 1.13 lbs. / lin. Ft set. S- V~ - - Indicates fence Ni fti" r P I M , R I - Indicates previously recorded information GRANBERG SURVEYING IV - O 1239 C.T.H- "E" °5 New Richmond, WI. 54017 Phone ( 715 ) 246-7529 This instrument drafted by. Joseph W. Granberg Job No. 98-034 SHEET 1 OF 2 Vol. 13 Page 3534 ~a 1133HS 9El l abed V *LOA ee®®OOOOnIa ~`4% rans pNb ~s ~ S!M '3Nd'I tib'3l0 ' H1008 'Cl aHVHOIU a 18-hi 'ON 20-C ,6'~ ~ eee 1U 'NI I P9 "I El'/ :1-M .LAS 'Ad(d NObI "-hll I = O 4 NAD31 oo no £ o9v i"r 700009 s ~ I .i. ' w •I ' ~ b o~ ~WX3 n2dnS LLNnoo -135 ' W -rD -b/, av ~N1`I '~3s NMOl ~ D ~~,-50 01 s m v cn 99I SdWb -1 d31IE1ld I I T ~ ~ I m 00 -n ~k 30-65068N aZm ` cn mZ 1°~` do m p X68 v z I I'o o, 2 _Ln rJD -0 0 M/y 'OX3 53V:)d bb-11 T -4-4 *bs ob -h*e F.',e es v m ~r w o I M/d '9NI S qv oO i ~0'EI I I~, ;:J d 'bS 00.OB °~99S I~ ' to I b 1 ,o0'EF- s gto -E0 0/ S f 8'bfiL _ w I'a .L Sym _~cr N%ff 9° d 4~J NMO.L. I ,99 ~ 0NISNOJSIM 'A.LNr)oJ xiov o :Ls '3IW Ibdd aIVJ-S 30 NMO.L M 81' 1- N /8_L 81 D3S 'fi/t 3N --hh 3N - 2 3 d vw omens Q 3/2f1.V.3D "go #0 imm"s lww 18618030 ~1. 0 01311 I ~ r AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP,<~g,e &/,fa/,E SEC .I,? ADDRESS ST. CROIX COUNTY, WISCONSIN. AL jC~ino~f.d J Z SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 hA THING WI IN 100 FEET OF SYSTEM I di} a e o th Arrow I' H+ = SC LE : ~--r`1mu,:~~.~•,~~ o f h~usi BENCHMARK: (Permanent reference Point) Describe: -Elevation of vertical reference point: A00 aSlope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: .014 Number of rings on cover Tank manhole cover elevate : YBS~' Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer; Number of gallons Number of gal. pump set or a cycle gallons; total capacity o distribution lines gallon: size of pump head; gallon per minute horsepower ran name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number o pits eet diameter feet liquid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines width length o-e dep t SEEPAGE TRENCH: width len length PERCOLATION RATE ~ A REQUMD_] RE AS BU LT INSPECTOR DATED - - PLUMBER ON JOB Wow LICENSE NUMBER ~se-1 I REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM i Sanitary Permit State Septic 09 NAME TOWNSHIP St. Croix County LOCATION G. Section/fLot # Subdivision SEPTIC TANK Size t, V gallons Number of compartments Distance from: Welly.Z%"+::1 Building 12% slope Highwater PUMPING CHAMBER Size gallons Pump.Manufacturer Model Number BOLDING TANK Size gallows Number of Compartments Pumper Alarm System Distance from: Well Building 12% slope Highwater ABSORPTION SITE Bed Tr nch Distance from: Well„ Building 126 slope Highwater ABSORPTION SITE DIMENSIONS Width of trench ft Required area ~ Ift. Length of each' line ft Depth of rock below the f in. Number' of lines ~r Depth of rock over tile in. Total length bf lines ft Depth of tile below grade ,3L` in. Distance between lines C` ft Slope of trench in. per 100 ft. Total absortptton area ft Type of Cover: PIT DIMENSIONS U' Number of pits !ravel around pits yes no Outside diameter ft Depth below inlet ft Total absarption area ft Area required r s • wr- : . " INSPECTED,-BY- TITLE ~ - APPROVED DATE 19 REJECTED DATE ( 198 REASON FOR REJECTION C DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PL13 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: Pr party L ation: City, Village r Townshi : County: '/4 J_c '/4S iT N/R (or) VV Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY Joan X HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental [A Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench F%WWa_t_er Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signatur MP/MPRSW No.: Phone Number: Plum er's Address: Nam of Designer: 441L gaiza COUNTY/DEPARTMENT USE ONLY `Sign t of Iss ing gent: Fee: Date: APPROVED Sanitary Permit Number: I- If 0 / ❑ DISAPPROVED Q eason for Disapprov : Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber v DILHR-SBD-6398 (N.03/81) ~~7Q~ ~ur~,aexr • 10 o~ ro~,✓ X0.9,0 av/ r ~ r \ ~ r 4984 Soho ~Y is% X996'" DEPARTMEENT Y, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDING INDJU9TFiY DIVISION BOX P.O. 7969 LABOR AID - PERCOLATION TESTS (115) N, HUMAN RELATIONS WI 53707 3707 LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: 1VISI0 %W/4 /T H/R (or) w C UNTY: OWNER'S BUYER', NAME: MAILING ADDRESS* _ tLix USE DATES OBSER ONS NO. BEDRMS.: ICOMMERCIAL DES RIPTION: ESTS: Residence New ❑Replace FN R - 32 RATING: S= Site suitable for system U= Site unsuitable for system 10,4,ax 114 CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-I - ILL HOLD NGTANK: RECOMMENDED SYSTEM:(optional) ®S ❑U ❑s ❑u ❑S ❑u ❑S ❑u ❑S ❑u If Percolation Tests are NOT required DESIGN RATE: S T M ELEVI I If any portion of the lot is in the under s.H63.09(5)(b), indicate: `I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED E T. I HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 7 s- , B-,s- > 72 Le~, Z & 7,2 Le ye~,, s- Al~l o 9,- 30L 5"Q PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PER OD 1 PERIOD 2 PERIOD3 PER INCH P_ o J/ P- L - 3 1l / Aza 211) y, I -I P- 6 N s° s P-. P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. a6 SYSTEM ELEVATION o E Brer/Qa~- >~N./~k 0/0 Q poi/.,L~~i,+~s ` , _ ~ ; a i F y i { z yf µ 7, F- i x L~ a y! tea. A- i , { _ 34' . y I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME ( print : TESTS WERE COMPLETED ON: 0-VJJAI - IN-2 -191 ADDR SS: CERTIFICATION NUMBER: PHONE NUMBER optional): 171,5- CST~SI T ' DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~ f ADDRESS SUBDIVISION LOT # SECTION /,9 T N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK; ~4~9 ALTERNATE BM: EPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufa~urer: j'~" Liquid capacity: / Setback from: Well House 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:_ 5-5- House Other ELEVATIONS Building Sewer ST Inlet ; ST outlet Z PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade ~ 5-~-- DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: r 3/93:jt Wisconsih Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Htuman Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI AU? LEAVENS, DENNIS X Prairie CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: I/A ~ 69 7, TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 40.41 Dosing C42 Aeration , Bldg. Sewer Holding St/,Wf Inlet s (v, Cc C TANK SETBACK INFORMATION St/ Outlet /C 97 Rc,/ Verit TANK TO P/ L WELL BLDG. A irirIto ntake ROAD Dt Inlet . A / i Septic SipD X00 / NA Dt Bottom_ Dosing NA Header arr. Aeration !N:A:T Dist. Pipe Hol Bot. System ? PUMP/ SIPHON INFORMATION Final Grade Ma turer e Model Number GPM TDH Lift Fri ' n S stem TDH Forcemain tength Dia. Dist. Towel SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of jrenches PIT No. Of Pits In ia. Liq epth DIMENSION S /Y / DIMEN SYSTEM TO P / L BLDG WELL LAKE/ STREAM ~L"Mjq manufacturer: SETBACK AMBER INFORMATION T~pe O OR UNIT Moe u System: 44 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 System Depth Over Depth Over xx Depth Of eeded / Sodded xx Mulched Bed /Try-Tenter Bed / T -Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Sta;7 fPnraiie.18.31.18W, NE, NE, 22 h Avenue ✓ .rr RJ`~<.,.,i~.~`rx.~f9C' % ~S2tr._ ~a ~ f E~~c~/,.~-C //.,11~/.t? C-~5~_-.,v` 2~_.;r.F~` r J / / ZZ2 Plan revision required? ❑ Yes ❑,tdo Use other side for additional information. o? SBD-6710 (R 05/91) Date Inspector's Signature Cert No- L ADDITIONAL COMMENTS AND SKETCH . ' SANITARY PERMIT NUMBER: ~ I I I SANITARY PERMIT APPLICATION Bureau o oand ff Buil Safety BuildiinWatengWater System., ri 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 12916 77-^-2 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 Property Owner Name Property Location 1/4 1/4, S T__? , N, R e(o0S Propert Owner's Mailing AcTdWss Lot Number Block Number i-lr Cit to Zip Code Phone Number Subdivi ion Name or CSM Number II. TYPE O BUILDING: (check one) ❑ State Owned ❑ CitY Nearest Road ❑ age r xl9b E] Public 1 or 2 Family Dwellin To - No. of bedrooms -S Town of ' 1jr III. 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. ❑ New 2. IS 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 11 fA Seepage Bed 21 ❑ Mound 30E] 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. Pate 6. System Elev. 7_ Final Grade Required (s . ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./i ch) 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. Tanks Tanks Septic Tank or Holding Tank 1 Z,222 Z= - ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for inst lation oft the onsite sewage system shown on the attached plans. Plumbe 'sNam (Pr Plumber' Si e: 5 m } MP/MPRSW No.: Business Phone Number: t 7 Plumber's ddress (Street, ty, Sta Zip Co -TfVR IX. C OLIN TY / DEPARTMENT USE ONLY ❑ Disapproved Sa tary Permit Fee (includes Groundwater Date Issue Issuing Ag t Signature (No S mps Approved El Owner Given Initial 7V Surcharge Fee) t0 / Adverse Determination /O -a X. CONDITIONS OF APPROVAL /RE O S FOR DISAPPRO L: SBD-6398 (R. 05/94) DISTRIBUTION: original to Coumy, 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- 11 _ Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all ;eptic, pump/siphon and holding tanks for t his 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. Cur )u ete plans arid s1pe ifications not smaller than 8 1/2 x 11 inches must be sub!_iitted to the :c,inty. The plans must e the fok)v%ir. - A pwt Ilan, drawn to scale or with complete dimension<, locaLi .l of 10,ding tank(s), septic .,t? er tr a bl lu!ing sewers; wells Ovate r iairs/vv ,t; ce, .tre.i! > . j lakes; pump or siphon tc?rite; systems; re'placeme^ i,,yStii't r; ihC the building Served; r1C)'+, ; . .t .~..i 00 ,~ference points, C) corn !.-i.e "Pel d for t:ur,f?> ,Il+ "ontrols; dose volume; elevalioi i 4rictlon loss, pump performance curve; pumps mo..lel a!,c UmF) rl-,t"Lit_ C l_ rer; D) crosssectlon of the soil absorption system if required by the county; E) soil lest data on a 1 i orm, and F) ai', 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. ZEn Sac /~jrG3 /✓3y 1Jdkis,t" ~ , SCT ?o1v°~ , 4 wr ' ~SD ~ ~ o~ 10~%.✓ 0.9,0 4c4 4, p , `r l , f r r r pC'C ~ r Q4 s r r • y7 G ' ° r isV ° ' B/~I nak Aug ~ AS BUILT SANITARY SYSTEM REPORT TOWNSHIPSge &/,Pi,E SEC. ~T-&-RjfW ADDRESS ST. CROIX COUNTY, WISCONSIN. h/1211- ~ JZ SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet re irements of H63 11kf qmn THING WI IN 100 FE T OF SYSTEM I di a e o th Arrow -1 I SC L BENCHMARK: (Permanent reference Point) Describe: /3.fsea+,w.~T Flue e Elevation of vertical reference point:/Q® a,i Slope at site: ZO Xs~ SEPTIC TANK: Manufacturer:&i. 61,ziIJfLiquid Capacity Number of rings on cover - Tank manhole cover elevate : y8;s` Tank Inlet Elevation: 97' I Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cyc e gallons; total capacity o distribution lines gallon: size of pump head; gallon per minute horsepower ran name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device_ SEEPAGE PIT SIZE: Number o pits feet iameter feet liquid depth seepage pit in et pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines- width __length&.~/tile depth SEEPAGE TRENCH:. - wdth length PERCOLATION RATE A REQUIRED 42&.RE S BUILT INSPECTOR DATED - - / PLUMBER ON JOB LICENSE NUMBER ~SL~ I /DEPARITMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS t;N.rUSTRY, DIVISION LABOR-AN HUMAN REDLATIONS PERCOLATION TESTS (115) P.O. BOX 7969 \ N, WI 53707 LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT N .:BLK. NO.: DIVISIO COUNTY: OWNER'S BU ER'' NAME: LI ADDRESS: _ jO ' 41j USE DATES OBSER LIONS ~7l NO. BEDRMS.: COMMERCIAL DESCRIPTION: OFILE DES(; 71TIONS: ERCOLATION STS: U~ Residence New ❑ Replace - C: RATING: S= Site suitable for system U= Site unsuitable for system )0,49-111 4. IQ CONVENTIONAL: MOUND: IN-GROUND-PRESSU E: S S EM-IN- ILL HOLD NG TANK: RECOMME NI` ED SYSTEM:(optional) ®s❑❑s❑u ❑s❑u ❑s❑u ❑s❑u If Percolation Tests are NOT re uired DE SIGN RATE: Q If any portion of the lot is in the under s.H63.09(5)(b), indicate: lsy'Tm7, I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL PTH TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIG HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B > B 7 B- ? S 'z PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P R D 1 PERM ID P R100 3 PER INCH P P- Q - P- 6 S s P- P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. C! 6 SYSTEM ELE"TION ~ sa`ro r ,,.,w . JrI%e so o , t N X 34' 70 ~ I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: J ADDR SS: CERTIFICATION NUMBER: PHONE NUMBER optional): CST S I T DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) L 08/04/95 FRI 09:03 FAX 1 715 268 7207 NW` SAVINGS BANK NEW RICHMOND Z002 State Bar of Wisconsin Form 2 198_ > _ - 530482 WARRANTY DEEDQp DOCUMENT NO. -q 11,27 PAGE 368 v-. - ..vn I FJ~1yY.y~'IJIW LI ~,J L J1 1 11"X3.."t! {Ji f iJa.. i Lawrence B. Gumbert, a/k/a Lawrence Gumbert, JUN 2 S 1995 anis R. Gum ert, a c a ois M. A.. Gumbert, husband a wl a ad `joint tenants, _ a$ 11:30 A.y.j conveys and warrants to -Dennis J. Leavens and Tiffany A. Leavens, husband and wife, _ THI5 SPACE RESEPVED FOR necoRDING DATA - - - NAME AND f4ETUAN ADDRESS the following described real estate in St. Croix NNW W VW W mom County, State of Wisconsin: , ~ 67 (Parcel Identification Number) Part of NE1/4 of NE1/4 of Section 18-31-18 described as follows: Certified Survey Map filed December 8, 1981, in Vol. "4", page 1136. g This 1S homestead properly. (is) Q Exception to warranties: Easements, restrictions and rights-of-way of record, if any. 3 r~ Dated this da y of -LAP 1985_. (SEAL) lee (SEAL) -Lawrence. B Gumbert, a/k/.ALie=e Gumb t (SEAL) t IL (SEAL) -Lois; M_ G mtbPrt, a/lcla Tni c..M.-A-Gumber AUTHENTICATION ACKNOWLEDGMENT IICt3 = mlb s a/1c/a Lawrence STATE OF WISCONSIN • :Lois M. Guttbert, a/k/a ss - - _ - County, ay of __--„jurte Ig__q'?_ Personally came before me this _ day of S 19 the above named :land j1gRXR.ST' ATE BAR OF WISCONSIN • ( ttat, _ _ _ _ _ _ authorized by §706,06, Wis. Stats.) - to the known to be the person . who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Kristina 0gland - Attorney at Law Notary Public - County. Wis. (Signatures may be authenticated or acknowledged. Both arc not My commission is permanent. (If not, state expiration date: necessary.) STC-105 SEPTIC TANK MAINTENANCE AGREEMENT n St. Croix County C I ~Pn n r cl T F Frn y«I `^e "Cr S MAILING ADDRESS _ ~~9 a~ Svme~S~T~ t~z ~YD PROPERTY ADDRESS 52. (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION k) E 1/4, 1/4, Section `2~ T 3 N-R 1 W TOWN OF _ Srar pf-Ki rye. ST. CROIX COUNTY, WI SUBDIVISION -'Sr LOT NUMBER CERTIFIED SURVEY MAP 3-?g13`I , VOLUME _9_, PAGE 11 3~, 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 (I) 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. UWe, 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 maintai d must be completed an returned to the St. Croix County Zoning Officer within 30 days of the three year ~piration date. SIGNED: DATE: /57- St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 6 1 U U • 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 norm should be retained and completed when the property i sold and submitted to this office with the appropriate deed recording. Owner of property 4- T' - Location of property fA _1/4 1/4, Section 'I'_3) -N-4_q W Township 7eA Mail-in< .addres~, 7h < ANSI Address of site - 50me- 5 - 1v_'' - - Subdiv.i.sion name Lot-, no. other domes on property? Ye x No Previous owner oaf property Total sire of property 2 re5 Total. size of parcel S- urk,u7 Date parcel was created --~~G r- }9~-- - - - - - - - Are all corners and lot Lines ident:i_I i.ablc X Ye 310 I:s th property being developed for (spec: house)? No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICAT I:ON THM FOLInW1NG : A WARRANTY DEED which includes a DOCUMENT NUMPER, VOLUME AND PAGE Nl1h1l)1?lt AND 1111: SEAL OF THE RFGJ S'1El,' OF DU DS . J n Z.add i-t:i can, a certi-Ii.ed survey, if available, would be helpful so as to avoid Bela}'s of the reviewing proces s. If t.lae dead de_scr.iptian references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I we cer CO- that all statements on this form are true to the beat of my ) knowledge that I (wc ,am Ire t1jc ownr~r(~ of the pro1)(~rty c3.bed in t h.i.s information :orm, by virtue of a wara:ant.y deed recorded in the office of the County Register of Deeds as Document No. 30 AS and that I f presently own the proposed site for the sewale disposal system or. I we obtained an easement, to run the above described property, for t e construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds; cis Document No. ';lyna -urc of l oppl-icnnt_ Co-Applicant, w o M Signature flat r.. of. >ignatur- Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _L 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 J 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 PROPE TY OWNER: PROPERTY LOCATION GOVT. LOT )JZ 1/4 - 1/4,S T N,R Or I9 ROP RTY NER':S MAILING ADDRESS LOT# LOCK# SUBD. ME OR CSM # T A /V A, IA- CI STATE ZIP CODE PHONE NUMBER CITY VIL E 57OWN NEAREST ROAD 1A ).r l ) -it I I I '4-e [ ] New Construction Use Residential / Number of bedrooms -sue [ ] Addition to existing building (A Replacement [ ] Public or commercial describe Code derived daily flow _ gpd Recommended design loading rate bed, gpd/ft2 . trench, gpd/ft2 Absorption area required 5 bed, ft2 - 9m trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) y5' 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 PS ❑ U R S ❑ U ❑ S ❑ U OS ❑ U ❑ S U ❑ 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 Trer>ch Ground elev. Depth to limiting factor Remarks: Boring # v G v Ground r elev. *'Xot. Depth to limiting factor Remarks: CST Name:-Please Print Phone: Address: Signature: Date: CST Number: _ i ~ J PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. # Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourrry Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends \•'tii Ground elev. ft. Depth to limiting factor Remarks: Boring # 4\i 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) 149, ~G 7/6atsc / a7~ ell a ` ~o 41 FILED DEC g 1981 JA✓~ES O CO 4N 109131w of Doody S 6 Crou Cowty, CERT 1F/ E D SURVEY MAP z NE V4- NE 1/4 SEC. 18 T3/ N. R.19 W. TOWN OF STAR PRAIRIE, ST CROIX COUNTY, WISCONSIN, TOWN RD- P.o6. C.I.M. - - - - - - - - - - N.E. COR. 10 - ~--x- wrs T ;i oe or -4 ~ c. i. M. ego 749.81~ ~a S 03- Oaf S6 S 33.00' & qo ~I 5-66,a80.00 Sq. FT± a~ ~I 13,00 ACRES ING. R/W m I uc Q R is o cr- o Saa,3 au-. 90 Sq. FT t w~ c' co ``1 11.99 ACRES EXC. RIW M. I rri o 0 o o- c•4 0 ~ ~ ~ O I ~9 o Lu0_ a a o~ ~°~os 3 .6' V ~~•o iµ4.73' 2 Z Q N 89` 59 - 01 E -783.39' LL ou _w in I I or o PLATTED I- ANDS 66 cr w U m (n TOwNf~ CEC. LINE, RD EC.I.M. SEF COUNTY SURVEYOR FOR C.I. M. TIES goo' oo' 300' t+00' LEGEN D Q = 1'/4" 1RON PIPI^ SET LO1y~ WT. I.13 1.4./ 1-)N. FT ®oe 0,y~ -3-0 B N 0. 14 81 ,b RICHARD D. BOOTH S-1413 I CLEAR LAKE, WIS, j r 'Q, S U R~ ~mw ,~d39 ~ 0 D S ®®6s~'~3 Vol. 4 Page 1136 c~Ic~T / nF~ ppppppp db m m n° ~ 199 Sd Nd ~1 a ~11H7d o° i U) OD I -A I ~m I b~'~8L' ` D Z m 3 IO - 65 o68 N M Z Ul) I_ n S L t~ ~ ~ ~•a °b 3 o V . 9~a e b i Ln ..O O O O W WW Mf2l 'oX~ 53~1~b bblF `''_W 4 ~n -