HomeMy WebLinkAbout038-1155-10-000
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER e ✓'/N! C~ t/~ Lt,
ADDRESS
11/Gt~7~, C'i/t ~'1Z01/►( W Sf1ol
SUBDIVISION / CSM# ~~iai^•C~.c/1~~ LOT #
SECTION 13 T~~N-R/W, Town of C.;
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WI HIN 100 FEET OF SYSTEM
\~Jo ~
1
alp
n
Jr
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form-
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
,Q ~~~J-L+~Lty Cje
ALTERNATE BM:
C2 EPTIC TAN / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity: ll
Setback from: Well- House Other Ya D~~.
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches/
----Distance &--Direction- -to-nea-r-est pro
- p .--1-ine _l. - -
v
i3a 5
Setback from: well: lp House Other ELEVATIONS
Building Sewer ST Inlet: - ST outlet fa a . D
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system 2 7.
Existing Grade Id f a2 Final grade 7
DATE OF INSTALLATION
PLUMBER ON JOt:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION
P HULSEY , NfiffRMAN B . ❑ City ❑ Village Town of: State Plan o.:
CST BM Elev.: Insp. BM Elev.: BM Description: ~S Parcel Tax No.: starprairie TANK INFORMATION ELEVATION DATA 71p 7
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic C S < C Benchmark G, /F
Dosing - ; 1 ~c_•.r~,
r Q 'f~(f
k;ic
Aeration 5✓ ' Bldg. Sewer
c" o
Holding St/0 Inlet r~
TANK SETBACK INFORMATION St/ot Outlet
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic -,,~SO _Z-7 - NA Dt Bottom ,
Dosing NA Header f Nkrrv-. / ~r r
Aeration Dist. Pipe
~v3' 9~ rS {
H Bot. System Sl q a3
PUMP/ SIPHON INFORMATION Final Grade
Mapufacturer_,.. _ Demand
Model Number
TDH Lift Fric ' System TDH Ft
_LWSs F In Length Dia. I-f Dist. To wen
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length - , No. Of Tr ches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMEN I N
SYSTEM TO / L BLDG F WELL LAKE/STREAM LEA M fadurer:
SETBACK CHAMB Mo el Num
er:
INFORMATION Type O p
OR T
System:
DISTRIBUTION SYSTEM
Header / Distribution Pipe(s) x Iuole S+ze - _ x Hole Spacing Vent To Air Intake
Length _Z Dia. Length 1 Dia. Z Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems O
xx
Depth Over „ r Depth Over 11 „ xx Depth Of xx Seede oddecl
Bed /Trench Center e2:S - 7 Bed /Trench Edges 25 - 37 Topsoil _Qre's ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATI N: Star Prairie.13.31.18W, NW,.NW, Lot 11, 132nd Street 11
09 / 05- n
Plan revision required? ❑ Yes N3"No
Use other side for additional information.
SBD-6 10 (R 5 ) ? Date Inspector's Si natu a CertNo
~ X~_i~ OS? ~~'.~'~=~-f!~ ~J ,`=1~0 ~if -t'1-r'~~->'~ ,~-~/~'2~/~7'' h"C~-Cri'./.1.~ ~~l-_? a
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
I
w SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY ^rO
STATE T N Ph i #
-Attach complete plans (to the county copy only) for the system, on paper not less than `~7)
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.
PROPERTY OWNER PROPERTY LOCATION
%4 (d %4, S T N, R E (or
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
z l
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
II. TYPE OF BUILDING: Check one CITY c NEAREST ROAD
( ) ❑ State Owned
-El
Ed TOW N 0 VILLAGE :J
T cc
❑ Public IFA-C 1 or 2 Fam. Dwelling- # of bedrooms 3- PARCEL TAX NUMBER(S)
Ill. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/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 120 Service Station/Car Wash
50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ❑ New 2. ~ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 Q Seepage Bed 21 ❑ Mound 300 Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 220 In-Ground 420 Pit Privy
13 ❑ Seepage Pit Pressure 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
~O REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Of ELEVATION
/ 5'• O Feet Feet
VII. TANK . CAPACITY Site ,
in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New xistin Gallons Tanks Concrete structed glass App.
Tanks Tanks
Septic Tank or Holding Tank f F] F] 0
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumbe ' Signature: (No Stamps) MP/MPRSW No.: Business Phone Number:
33/8 7" ),4VS - ~6/
I beer'ss Adddre s (Street, City, State, Zip Code)!',
4/6 YG e6Lex-t
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps)
Approved ❑ Owner Given initial 611A Surcharge Fee) V \
YYY~~\ Adverse Determination v
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: U-u
SBD-6398(R.08/93) DISTRIBUTION: Original to County, 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 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) tmbe
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
1983 Wisconsin Act 410 included the creation of surcharges (fees) fora 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)
PLOT PLAN
PROJECT Herman Hulsey ADDRESS 132 St. 2181 New Richmond Wi 54017
NW 1 / 4 NW 1/4S 13 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX
MFRS BYRON BIRD JR. 3318 S= f2 DATE 5/21194 BEDROOM 3
CONVENTIONAL XXXX IN- UND PRESSURE CONVENTIONAL LIFT HOLDING TANK
1000 Gallons LIFT TANK SIZE DOSE TANK SIZE
MOUND SEPTIC TANK SIZE
HOLDING TANK SIZE LOAD RATE.7 ABSORPTION AREA648ft^2 BED SIZE 18' X 36"
BENCHMARK V.R.P.Top of Electric Box ASSUME ELEVATION 100'
❑ BOREHOLE (DWELL «H.R.P. Same as Benchmark
V1Nr SYSTEM ELEVATION 95.0
12" GRADE
4 TYPAR COVERING
2'
12" 6' (D3' 3' ® 3'
SEWER R K
12' 18'
15' Property Line >200'
15' B-1 15' 40'
i - - - - Drainfield 18'X 36'
36' - - - 20 25' 54' 24' 18'
20 enB-2 20, a 15'
B-3 54' Well
3
T
a Existing Septic Tank Hour eo
w
N
G7
120'
Garage
.M.
15' Property Line >200
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _ of
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but sf, G - a
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. f~3 ^/~6s 'ao
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER- PROPERTY LOCATION
rm~n G GOVT. LOT pJ0 1/4 L31/4,S,~ T N,R/ E
PROPERTY 0 N R':S MAILING ADDRESS / LOT # BLOCK # SUBD AME OR CSM #
f ar✓~~_' de
LCIYTYATE IP ODE PHONE NUMBER []CIVILLAGE OWN NEAREST ROAD
W r r ( 5f$ 7jZ a r a r
[ ] New Construction Use [x] Residential / Number of bedrooms [ ] Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow lV gpd 5,63 Recommended design loading rate -7 bed, gpd/ft2 ~lsr trench, gpd/ft2
Absorption area requireAZ: bed, ftk Tench, ft2 Maximum design loading rate bed, gpd/ft2 o trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as r ferred to site plan benchmark)
Additional design / site considerations t
Parent material 01 =A-rc 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 a S ❑ U RS ❑ U RS ❑ U ❑ S JU ❑ S atry
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Bouxbry Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Ground
elev.
ft.
Depth to
limiting
fact
y~
Remarks:
Boring # D -512
~s rjT 5 b
a .
4k r /
5 ) 7T ' V
Ground
ff lev.
Depth to
limiting
tacwr
Remarks:
CST Name:-Please Print r Phone:
Address:
t/'e r
Signature: Date: T umber:
PROPERTYOWNER lSOIL 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 Trend A0 U 11
\:::::y
-
Ground 3 O 5 6
S- &2<7a hV/ k, f? vv , -7
.01
/ ft.
Depth to
limiting
factor
7gD
y
Remarks:
Boring #
~:}ti::::•i:?:^:?iii
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)
Soil Test Plot Plan
Project Name Herman B. Hutsey Byro Bird Jr.
Address 132 St. 2181
New Richmond Wi 54017 W3479
Lot 11 Subdivision Date 6/25/94
NW 1 /4 NW 1/4S1 3 T 31 N/1318 W Township Star Prairie
❑ Boring ()Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Electric Box
System Elevation 95.0 * H 13 p Same asBencmark
>200'
4 15' B-1 40' 15'
4 0'
36' 25' 54' 24' 18'
O
20' B-2 20' a 15'
B-3 Well
3
c; T Bedroom
a House
w
N
C/i
120' Garage
SP.M.
15' Property Line >200
Scale 1/4" = 10 Ft/ When dimensions aren't stated
I`
r,-
f
0
r' o
Al
Z'
d•
OIQI IA I1 -,BO-000 S
,00 sLI ,OO'sLI ,00'SLI '00 SLI ,00'Z(
so LLZI
W
W 2 W W
W m o7
aD -o O CID
M O M O O
M a M O O Q O 0 -
n oo M p 0 N (0 p n - ro n
' M M O N • M • M1 o M
W M (n OD
y 0] Cn ( N
N
Lb LLZI
---00'sI1- - - 00'sLI- - -OO'sLI - - - - 00'sLI- - - /00,911
,sb'6£01 M I -,80-000 S ,0.08
M„ZZ-,£I-ObZN~~
ad08 s,838VH -
,OH'Ob01 3.2 1-,80 -000 N
0V
- - - - - '66661_ -,66'661 - - -,99"OOZ - - - - -
,Lb LLZI
Q
to
40 p U
N M M W Q
°D = _ } U)
(O W N w
to W
Q r CD Q ~
Q OD M OD 0 O J
Q M M
OD w 0 re)
w an 0 co
gU
o
ON m fn to W
rn - o I-
r- OD am
O O
N s
o ,
(0 OD O
V OD
N
- N b6'Obl
~ o
. e
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
serving the ke.residence located at:
V✓ 1/9, Sec., T3 N, RW, Town of
Upon inspection, I certify that I have found the
tank and baffles to be in good condition, and it appears to be
functioning properly. ,D J /f
Last time serviced-7- 6- 9T
Did flow back occur from absorption system? Yes NoK(if no, skip
next line)
Approximate volume or length of time: gallons minutes
Capacity:
Construction: Prefab Concrete Steel Other
Manufacurer (if known) :/D6W(5,-
Age of Ta (if known):
(Sign e) (Name Please Print
(Title) (License Number
/-a
(Date)
Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes)
or Licensed Disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR-83, Wis. Adm. Code (except for
inspection opening over outlet baffle).
NameByf-6n g~ed%jr Signature MP/MPRS 33~~
&V ov
5/88
s
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
MAILING ADDRESS II
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE A1'2'4') VA . CO h W 1 5__// y
PROPERTY LOCATION N11, J 1/4, A~ 1/4, Section l 3 ' T 3 I N-R W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION P y~tr P -e- Cc/f, Ad fX LOT NUMBER
CERTIFIED SURVEY MAP J, VOLUME S'71, 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 Wiskonsin DN-R.
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. r
SIGNED: k-, % V
~~~9
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
I
STC-100
This application form is to be completed in full and si ned
fthe owner(s) of the property being,developed. Any inadequacies
wall only result p, delays
d of the permit igsuanc evelopment be intended for resale by owner/con-tr chtould this
house), thenla 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 140_y-~ n%, 4 / C, 10
1
Location of property_81!~L/l/4Z%1/4, Section
~ T_fLN-R_L&'W
Township
Mailing address CP <7)
- o o
Address of site
Subdivision name %Y-tt?1YIC.~.
Lot no.
Other homes on property? es
Previous owner of property Ala
Total size of parcel Q
Date parcel-was created 41 p'
'Are all corners and lot lines identifiable?
-Yes No
Is this property being developed for (spec house)?-Yes
S __X No
volume 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 & 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 th
best of my (our) knowledge that z we am e
the property described in this information form tb a owner(s) of
warranty deed recorded in the office of the County Register 'of
Deeds as Document No. S'p
own the proposed site for the sewage' disposal t system) rr e e(we)
obtained an easement, to run the above described e)
the construction ,of said system, and the•same hasopbeen,duly
record d the. office of County Register of deeds as Document
No._ S 7
ignature of applican `
Co-applicant
-f-
Date of i*nt'u neDate if
Vgngnature.
OJCUMENT NO. 579 Q --_rATE BAR OF WISCONSIN-FORM 2
' i. V m• 10 V~ WARRANTY DEED
VOL 350778 THIS SPACE RESERVED FOR RECORDING DATA jl DuWayne L. Harer and Doris E. Harer, REG)~TERS OFFICE
ST. Cr-)IX CO., WIS.
husband and wife, as joint tenants
Recd. for Record this 10
day of tiuv 1B A.D. 1918
conveys and warrants to Herman B. Hulsey and Sandra K. at A°30 A >
Hulsey, husband and wife, as joint tenants
i i _ Reybter ol~eed.
RETURN TO
the following described real estate in 5 t. Croix County,
t` II
State of Wisconsin: it
ii
~ I I
I
Tax Key No. Ij
Lot Eleven (11) of Prairie Rich Subdivision of
the Town of Star Prairie
u I~ I
TR"NSFER
PEE
k I~
This is not homestead property.
JIM (is not) j
Exception to warranties:
i
Dated this 'nth day of August 19 78 .
(SEAL) t/e GL ~G~ SEAL)
Du a ne L. Harer
p (SEAL) /10LS.1Lc/ (SEAL) y
6 _ Doris E. Harer
G
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated this 7th ay of STATE OF WISCONSIN
August 1978 1 s5.
~ St Croix County. )
Personally came hrfore this h
day of
At-, gus.J 1978 the abov.. named _
TITLE: W..MSER-W*IPE-B*R OFiVf3e0NS N- _ Aiwayne L. and Doris E. Harer
(If not,
authorized by § 706.06, Wis. Slats.)
This instrument was drafted by
DOAR, DRILL, NORMAN, BAKKE, to me known to be per n wt ecuted the fore-
BELL & SKOW going instr at ackl w)E ame.
New Richmond, Wisconsin 54017 y,
(Signatures may be authenticated or acknowledged. Both a Wt3sler'_' "'~S11e.`_:
are not necessary.) Notary Public - 3t'T„ipiq(_ County, Wis.
My Commission is-pgrmatent. (If not, state expiration
date: Tleraml.g a'jn.. 1978.)
WARRANTY DRIED-sTATa BAR OF WISCONSIN. FORM NO. 2-1977
I
I
I
I
e
0 3 n d
0 0
I a= 7 2 3
n
*It
su. Z4 cp 0-4
co C. 3 z m j y !G M `A\
N a O 07 to ! r~ 1
0 (D
3 H = oo p
j
v cn ~ ID a ~
cfl y v, a W
CD W o o
co OD a V
3 O c :1
< co co o r N
N v v
v, OD oD Z 3 C
0
d x N N CO) a d.
A CD
m
~ d
N m 3 n
a n J
7 o
r
= O
O D CL T
c~ •
o CD
= t,~~l
CD
CD v `i ~1
C
I w ~ a
Z CD -1 N
= A Z 0
a O
7
Z
N W j w
CL z
oo
y z
CD
C.0 f A
I.
I
I a
a ~
0
w C
z C.
CD
I
A
I
b
I ~
m
3
o•
I e
I ti
0
a
A
o
CD
o O o
I °0
~ ~
Parcel 038-1155-10-000 12/01/2006 11:26 AM
PAGE 1 OF 1
Alt. Parcel 13.31.18.715 038 - 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): 0 = Current Owner, C = Current Co-Owner
0 - GRIFFIN, PATRICK E & KELLY J
PATRICK E & KELLY J GRIFFIN
2181 132ND ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 2181 132ND ST
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 1.306 Plat: 2348-PRAIRIE RICH ADD
SEC 13 T31 N R1 8W 1.306A PRAIRIE RICH ADD Block/Condo Bldg: LOT 11
LOT 11 A 1/1 5TH INT IN OL 1 HAS BEEN
ADDED TO THIS PARCEL 736/585 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
13-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/02/1998 576280 1311/178 WD
07/23/1997 736/585
1223/160 QC
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/12/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.306 27,900 144,800 172,700 NO
Totals for 2006:
General Property 1.306 27,900 144,800 172,700
Woodland 0.000 0 0
Totals for 2005:
General Property 1.306 27,900 144,800 172,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 208
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
- a ov --v/ - yes t 525.00'
183.65' o p4.37'
00
G9 6 6' 8a "o
o~
O
4 in
P.- in
15
1.306 A.
0 4 ° 5
¢ o O
1.267 A. o 0 O
z I .269 A. I
S 890-07'-38"E
325.00'
11!' 15'
i
5~ 1 O O
O~ r1 O
~ ' 14 n
2rO 183.65' 183.65' i -i 1.306 A. r-
S 89°-07'-38" E 367.30'
S 890-07'-38" E
p I I 325.00'
p O~► 1
O 6 Of Q i
O
N 1.685 A.
O O
O
13
r ( in I 1.306 A.
S 89°-07'- 38" E R1 p~
366.83' v o_
325.00'
O
O P-- O to ( M
to o
O 7 r ao to P.
N 1.683 A. a m ui o v
I M o, 0 ti' ~ If1
N 12 r~
OD (n 0 1.306 A. a
S 890- 07'- 38"E O
O ` S 890-07'- 38" E
d 366.35' I z C 325.00'
900_52 .02690'07 _9\ ( Q O
I
07,-51"w = o O
0 0
64.0 5' co o
co ri
9 0 II ti
1. 480 A. N I 1.306 A.
0
v
N I S 89°-07'-38"E
S 89°-07'-51 E Mo I 325.00'
301.8 2' 1 0 0D
N 0
TEMPORARY z vi
- 1 0
CUL-DE-SAC I 10 cIC!
v
\ I 11.182 A. N
0 ` I 6~ 0 1
S7 °
M 6 N 3g>. S2, f
x M OUTLOT
ti
I o 0
a
PRIVATE PARK ~ w a
z 2.604 A. I N 9
m 3
1.820 A.
I15~ M15'I ~
o ,
O O
O 6 6' O I O
2 o N
O
O
09 X90 I I A3 ''S6 ~9c /S
O
300.92' `07, 6 6.00' 90 ' 325.00'
OF .
N 89°- 07'- 51" W 691.92'
SNP . ~PNO .
'."r 'ER 1t1 ~t.I.S - , TOUNSHIP_S{,r f~ttr-t . SEC. T- N, R ~~W
,0. DRESS ST. CROIX COUNTY, WISCONSIN.
'3DIVISION LOT LOT SIZE ! .
PLAN VIEW
-Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
or3
-'TIC TANK(S) MFGR. CONCRETE STEEL
NO. of rings on cover Depth " DRY WELL
INCHES N.O. of width length area
J no. of lines width 12 , length,, f . area Y.T~
depth to top of pipe ;9 cf "
3REGATE "
E~-
K RATE AREA REQUIRED A' AREA AS BUILT h22,7,01
,claimer: The inspection of this system by St. Croix County does not imply complete j
_pliance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
tem operation. However, if failure is noted the County will make every effort to
-ermine cause of failure.
:ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
'-INSPECTOR
DATED_ PLUMBER ON JO
LICENSE NUMB R '
k
t
Z
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
San.itatcy Penm.itz.7 l4es
State Septic 7,5W
NAME owns hip_ St.- Cno.ix County
_ Locat.iona641 Section /3T31N,R A
SEPTIC TANK
Size gattonA. Numb en a6 Compatetmentz
Distance Pram: Wett 12% on greaten stope bt
f
Buitd.ing it. Wettands
H.ighwatetc it.
DISPOSAL SYSTEM
Distance Fxom: Wett it. 12% on greaten slope
Bu.itd.ing it. Wettande Ft.
H.ighwaten 6t.
FIELD DIMENSIONS:
Width aj tAeneh'),At. Depth ab rock below t.ite Lin.
in. o6 each tine_ 102- it. Depth ob tcock oven tite Numb en ,aj tines Depth o ti.le b e.low gtrade in.
f Total .length of tines Stope o$ trench .in pen 100 it.
Distance between t ines____~jt. Depth to b edna cFz
Totat absanbt.ion area ,O jt2 Depth to groundwater St.
2
R e q uite e d ate e a,~ ;a it
PIT DIMENSIONS: Numbers o6 pits ~ Gxavet anaund pits ye.a no
Depth betow inlet it.
Outaide d.iamete it.
2
Totat absotcbt,ion area ~t Az
2
Axea tequ.vice.d ~t rn
r
INSPECTED 8y: TT E APPROVED ; .g., SATE 191
REJECTED , DATE 197.
EH 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: N-E114,~'/a, Section , T~71N, R ff E (or) W, Township or id~wisi~ality c / I
Lot No. Block o. County
ubdivision Name
Owner's Name: C ` V
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms - Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS 7 C PERCOLATION TESTS SOIL MAP SHEET SOIL TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
1
P- 7- 3V /Vo- 3
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
ii
B- f 72" 'e, 7 z J. ",.a 7,151- 6 34
-72 " T, 7 Z-,r 3711 i,
R- .3 72140
72.. 7 Zil
46 Z,
ri ( 7 72 PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas. Indicate numbgf square fe t of absorption area
needed for building type and occupancy. 6/c 0,1 .30k ~J~ Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
N,
tN
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures
and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct
to the best of my kno ledge and belief.
Name (print) C i 'catio No. '07 2-p- 91019"
Address
Name of installer if known
CST Signature c2!~ Ce
COPY A - LOCAL AUTHORITY
t
State and County State Permit
PLB67
Permit Application County Permit #
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
116, 1~ lS CV t1A //if 1.0 AIJA.,
B. LOCATION: JV K) Se tion J3 , T,;51 N, R_lg!r (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township ~
4__v;N-t,-r & y,
C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance
Single family L~ Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher ✓YES NO Food Waste Grinder YES_A---IqU # of Bathrooms)
Automatic Washer ✓VtS NO Other (specify)
E. SEPTIC TANK CAPACITY- Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation Addition Replacement- Prefab Concrete -
*Poured in Place -Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) , 2)~,~3) Total Absorb Area 6i~ sq. ft.
NewReplacement *Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches _
Seepage Bed: Length f' Width Depth 3 Tile Depth Z No. of Lines "Z-
Seepage Pit: Inside diameter Liquid Depth Tile Size lo~ 4'
Percent slope of land Distance from critical slope
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certi ' Soil Tester,
NAME 05 C.S.T. # m'2- ~/S and other information
obtained from wn builder).
Plumber's Signature T Z~ Phone yP/MPRSW#
Plumber's Address
07 -7
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
t1~1, /2c~1.
o
Do Not Write in Space Below FOR DEPARTMENT USE ONLY
y., 171
Date
Date of Application - Fees Pa d: State Count
Permit Issued/FI'rjeeted-(date) - Issuing Agent Name
Inspection Yes -X-IN o Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON,
2. state (pink copy) 4. plumber (canary copy) Revised D
L
Parcel 038-1154-95-000 12/01/2006 11:26 AM
PAGE 1 OF 1
Alt. Parcel 13.31.18.714 038 - TOWN OF STAR PRAIRIE
Current X' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - NELSON, BRIAN J
BRIAN J NELSON C - LLOYD JEANNIE M
LLOYD JEANNIE M
2179 132ND ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 2179 132ND ST
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 1.182 Plat: 2348-PRAIRIE RICH ADD
SEC 13 T31N R18W 1.182AC PRAIRIE RICH Block/Condo Bldg: LOT 10
ADD LOT 10 A 1/1 5TH INT IN OL 1 HAS BEEN
ADDED TO THIS PARCEL 722/352 762/629 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
13-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page q~ I Type
08/02/1999 607839 1446/68 l l WD
05/06/1999 602676 1424/481 QC
11/20/1997 568775 8/58 WD
07/23/1997 762762-9 more...
2006 SUMMARY Bill Fair Market Value: Assessed with: r
ylsey h`4~
Valuations: Last Changed: 10/12/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.182 31,400 135,400 166,800 NO
Totals for 2006:
General Property 1.182 31,400 135,400 166,800
Woodland 0.000 0 0
Totals for 2005:
General Property 1.182 31,400 135,400 166,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 211
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00