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HomeMy WebLinkAbout038-1113-70-010 O o d . y o a g E a`) N a t N 3 I i a~ y j ? 11 U co C ~ N N N O C Z a LL c 0 O U) 3 N C 'O (D 'a I E Q O 8 1 co ry I w y 1 co w E °o a E Z a m 03 N H O Z a a U O to d Z c (n F- r C E v I N N ~ N CL w - c (D (0 (D N N O O O O O •1V a D R f6 N L_ N N U U C 'ON Q 4:. N N N © O a+ o Z [0 Z 0 Z o o 0 N L N _w E R E C" g CL O Z rL Y W d d O j Cl o Z E E Q 0 N fn fn U) U . Z N > o o 0 a N ►.v c n. a a N m 0 (D } N co -j U o rn- CO 6l N 0 Z Z: C) 0 d' " O O Cn O 0 U O N N N 0 0 co N a N N N c LO 00 d' N N N w 'o N Q CT) is (mil O 3 N O o 3 uyi c o N O C c O N O N 0 o U l c p d o rn o 0 00 a ] N N o N U - O -0 p1 O O O L p N E E CL r_ N N N N 0 CL C [7 ro U V o o 7 N N N N 17 C 0. y y a~ H e °D = u~ v 00 C'b (n C') cu 1 O N E E N v O N v~ (D O Z Vl =5 L Cn I V1 m ~ ~ o°'. 1 CL • ~ a m d c r~~ E i C C r 3 o CL 0 (n 00 Parcel 038-1113-70-010 06i29i2007 03:05 PAGE 1 OF 1 F 1 Alt. Parcel 28.31.18.481C 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 - SPENCER, THERESA L THERESA L SPENCER 1069 192ND AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1069 192ND AVE SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 10.690 Plat: N/A-NOT AVAILABLE SEC 28 T31 N R1 8W PT SW SE BEING LOT 2 OF Block/Condo Bldg: CSM 9/2592 10.69 ACRES Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 28-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1192/340 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.690 75,500 153,100 228,600 NO Totals for 2007: General Property 10.690 75,500 153,100 228,600 Woodland 0.000 0 0 Totals for 2006: General Property 10.690 75,500 153,100 228,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 127 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 % a-W 7N x•.1.9-~-~''r,~ ~,~?5` Ya /~2 ~ ~ ~Q ~ (J CAS/rr l~'/'.~b•r1.".-' iyFEB z o 1993 r✓,(" ' ' r''1 //l 7 ~y J.'f~'' I 1 JAM i 7; -8 0'r r 9 o s 6 Se9lster of trcods CERTIFIED SURVEY MAP Located in part of the SW k of the SE 4 and in part of the SE 34, of the SE -4, all in Section 28, T31N, R18W, Town of Star Prairie, St. Croix County, Wisconsin. UNPLATTED LANDS LOT i LOT2 LOT3 OLOT1 ACRES INC. RIW 2.00 10.69 2.00 SO:. FT INC. R/W 87,120 465,698 86 95. 2 slDMAL`• L ACRES EXC, R/W 1.80 10.36 2.19 1.92 T! 1 A`+t SO, FT. EXC. R/W. 78,290 4b1,350 96,380 83,757 192N° AV E. NORTH LINE OF THE SW1/4 OF THE SE'/4- 48.41 48,36' O T N89. 13 30'!E 545.-0-0' 296 5. s \ M r 182.55 10 N89o13'47" E 5.00' M Ili `JO N 182,55' 48.38' 296.45' 66!0 v cn w O C_ BARN WELL OUSE a S N. p N 7 A ,~1, C °n SHED 0m N SHED ❑ SE TIC O ~ O D r ~ M IT CU CD -1 'o O r H o D \ w a p z . rt n 1k < w m O o fi v O• "ti 0'v0 m rn O v l11 T •7 M M O N CORN A° W m m m .P CRIB y N i~F+ f1 W r , CJ f=Y' co O O. Q IC y J 'per IC d O A IZ IZ r n rr I~ ZO S89°'30°IV N rrnn ago rt S a O 192.55' N Ir s o rn o- ~~n-~,.. rn In. H Sx w C I-~ ;m r- i~ APPR % OVED VW" 0 c J y Il, p N Note: o Lo 17 I ~ZCJ' Lot 2 cannot be subdivide jyy~}~ o mow' f /y,I ID Co ID 1f (tj~ N until remaining land is 1z o a developed to south or a o IZ cul-de-sac is in place. w U) 10 CROIX COUNTY ran J w o I(f) , ehensive Planning O zoning and I r I L Ras Com"ttee J,1' WNER L w WMt recorded Scott Counter %wAlh;gp days of 1911 Riverview Lane eApltfvsldate Somerset, Wi, 54025 N88°41'45"E 523.08 Ln 1A00,►0~%'ifva *hall be Gee` ^ *14 void !t • '8`~ SOe43'53"E 3" z 6' IRON PIPE FOUND CJ - Ln H 3.38 O N N88°41'45"E O• 3 N I S88°41'46"W 1 w A 54 5.03 --r- S1/4 CORNER 779.17' .x788041' 4511 W 611. 03'' 66.00' 1258.20' SE CORNER OF SECTION 28 ~n SOUTH LINE OF THE SEYq OF SECTION 28 UNPLATTED LEGEND LANDS Aluminum County Section Monument Found Q 11' x 2411 Iron Pipe Set, weighing 1.68 lbs. SCALE IN FEET per linear foot' 1001 Roadway Setback 0 100 200 400---« Existing Fenceline It VOLUME 9 PAGE 2592 I Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 t.rbor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Sr - C-MG t,IC Attach complete site plan on paper not less than 81/2 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. p-1113-70 -Ql0 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION $c -T T- CDuNTIFR GOVT. LOT S w 1/4 551S~ 1/4,S 7,8 T 31 N,R E (0 111 PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SUED. NAME OR CSM # a7S~ 2 Lt S t el S -r tr. 5T. - ~T" 10. u 9evp c s wf CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE WTOWN NEAREST ROA 1J 1 _k I eH"ok)b W I '311017 01S)-2114- S u y ~ s7-P~F2 ~"k r tGZ 1 °j Z v` , [ New Constr. 'on Use [Xj Residential / Number of bedrooms zl [ j Additign to existing building [ ] Public or commercial describe ally flow, b~O gpd Recommended design loading rate o-y bed, gpd/ft2 a, s trench, gPdtft2 Absorption area required \ SOIL bed, ft2 1Z,b0 trench, ft2 Maximum design loading rate o• 4 bed, gpd/ft2 0. 5 trench, gpd/ft2 Recommended infiltration surface elevation(s) 016.0 ft (as referred to site plan benchmark) Additional design / site considerations Z 4 `X 671' IBM bv! ~ywb p (Z~epr~ ►'1 D Parent material ouiwRS 1i Flood plain elevation, if applicable I~1 11 • It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for stem OS ❑ U ®S ❑ U IRS ❑ U OS ❑ U ®S ❑ U ❑ S W II SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure consistence Bound3y Roots GPD/ftin. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tench " -ll ~v`'LR 313 S1~ Z FSb a-5 o-S >s.6 µ tit-ZZ 7 S Y y V- 3/ - G►- S I 1 e sUk ►n c S 0-V 0-S Ground 3 zZ-7 y -7. S y p- 3/ ° 0, elev. 8 . t ft. Depth to limiting factor ~y, Remarks: Boring # o-1Z ~bH2 313 sl \0- SUk m~~v. cs o S t Z Z lZ-Sz 1tojV \CSbVI mu~~ cS n S a.L Ground SZlb -Sy¢ 31 10 S I \ csb1~ m~~„ o.q a,S elev. )\Zi1-S ft Depth to Fot- ling f Remarks: TName.-Please Print Arthur L. We erer Phone. 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: &< if 9z_ z-o 3 Dtv-~ t1, 1442 M00576 PROPERTY OWNER G~SS - CUy~1TEZZ SOIL DESCRIPTION REPORT Page Z olr-z- ' PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxiary Roots GPD/ft . in. Munsell ()u. Sz. Cont. Color Gr. Sz. Sh. Bed Trench n . S 0,6 k<> r~>>:::<::< Z 17 -5 2 -Sys 3 Ay c S ,bk x y ~h S • V S Ground 3 S Z-$ 3 2 3/ 6 S a Y~ ` 0.7 0. S elev. qq, } ft Depth to limiting factor y ~3 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ~ A 1 Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) 4y V WISCONSIN ~l y +ti},',:, ZONING OFFICE ST. CROIX COUNTY COURTHOUSE Y.,. 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 December 22, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: Four onsite soil investigations of the Melroy Gess / Scott Counter property, located in the SW1/4 of the SE1/4, Sec.28, & NE1/4 NE1/4, Sec 33, T31N, R18W, Town of Star Prarie, St. Croix County, WI., have been conducted with the assistance of Art Wegerer, CST# 576. These onsites revealed suitable soil for onsite sewage disposal to a minimum depth of 28" at each of the four locations while meeting the requirements of the A + 4" rule. This site should be suitable for new construction utilizing a mound septic system having 12" of sand fill. Should you have any questions, please feel free to contact me at this office. SSince ely, es K. Thompson Assistant Zoning Administrator cc: file . % ~ ~l~/. ~ L~ C~ e,~., 7 `1 ~,a,l~~.~ r Cif' YQ •~~2 ~ f 4;1 yl r'' IB u p 'I 10 FILER.! r~ FEB 10 C 1993• AMIS < c 93 s~c f Oc dsCl 6 Cp Co., M 4= 4 ' ' / r- Xwr CERTIFIED SURVEY MAP Located in part of the SWa of the SE4 and in part of the SEa of the SEo, all in Section 28, T31N, R18W, Town of Star Prairie, St. Croix County, Wisconsin. l JNPLATIED LANDS LOT I LOT2 LOT 3 SLOT 1 ACRES INQ R/W 2.00 10.69 2.00 SO:. FT. INC. R/W 87,120 465,696 - 86,952. TM ALL ACRES EXC. R/W 1.80 10.36 2.19 1.92 ~AY~ SO. FT. EXC.R/W 78,290 451,350 95,390 83,757 192ND AVE. NORTH LINE OF THE SW/4 OF THE SE 1/4 ' ~ r,• 48.36 ~~48.41 trJ. o t N89°13'30''E -1545.-010 \ M /`N , N N69°13'47" E 5.00' M 162.55' 46.38' 296.45' 66f0 r'ti• ` r,. . OUSE Q o BARN WELL N) W m o ~ rt ~ - N T oQ o 12 c `r S ED 0m ut SHED ❑ SE TIC ? c7 y A N N OJ G O 1 ~r+ - • T 0 Q N 0 '(D o < W M A (~1 c0 m ro m m m v , CORN ~o W = c (q M ti > CRIB W ; - 000 0 O. I C J r v pp W 'per I C rt o -n o 4 1z 1z z W. `D O 182.55' N m m is 0 I r Q N • it 2 J~x A,,- ,p o iD APPROVED r ~ v Note: a - o Z0 1 D Lot 2 cannot be subdivide V 00 o'. 1Z o m until. remaining land i 1D s ~ 1, i/~ h S 1 1 0 developed to south or a o ~z ~ n / I0 - cul-de-sac is in place. a° IO CROiXCOUNTY " u+ o V) 'cWnWehensive Planning l , . ll~ln~ a m p Zoning and fir ~t ~~~ll: W Peas''Corn"ttee ~~I, WNER w e Scott Counter whbt recorded 1911 Riverview Lane W+it 11-30 days of Somerset, Wi. 54025 AW*valdate NBB°41'45"E 523.08' Ln M0 ` AftvaJ;6hau be G~ 2 r4w"A void • ~9~ S00'43'53"E 3° x 6' IRON PIPE FOUND - .38 o+o O, N, N88 41'45"E I 1 w rf-- 5.03' I_ S88°41'45"W 54 SI/4 CORNER 7T9.17' S88041-45"W 61];.03 66.00' 1258.20' SE CORNER OF SECTION 28 v~ SOUTH LINE OF THE SEk4 OF SECTION 28 UN_PLATTED LEGEND LANDS & Aluminum County Section Monument Found Q 111 x 2411 Iron Pipe Set, weighing 1.68 lbs. SCALE IN FEET per linear foot 1001 Roadway Setback y 0 100 200 400 0 Existing Fenceline VOLUME 9 PAGE 25,02 PLOT PLAN Page 3 of 3 SCALE 1"= 3p ' a'r 0.3 m i lv 0,m ST. 3soC'NwT '4 sCAL~) C.~R~J ettt t3 ' II p~>r : auS;k~ vd►C'1.1. t=X~5T1lvG S4S11-J^9 ! S ~Pp, `IOU N01Z`C?} OF $3 . Fu'ruX X Ltr 1. we s R~ 'W;Ez NT L" ST S' t-R9H s i s't3t , 3 u.. 0 t ~a 1 r LL. 4c1 9 L,.. tW- oN 3114 ~C P~Pt w/~k'M Ur su ~T'~C3 LE \-TV Cat a Do't mm oP 8 7-4 , t''L, TO 0E 416.o' N4. IDES 9Z-z'73 l[, 199 Z (715 ) 42~ -n1 6-; M00576 CST Signature Date Signe Telephone No. CST Wisconsin Depzrtment of Industry, SOIL AND SITE EVALUATION REPORT Page N of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY S- r. (Z'[7_0 IX Attach complete site plan on paper not less than 81/2 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 OWNER: PROPERTY LOCATION 1-- Lk_ Cov"uZ-'_-R GOVT. LOT S w 1/4 -Z 1/4,S ZS T 3 N,R k b E (mCWD PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # Lt S Z C . S 'cam 5T. - - \-TL4P0 s~sP csr-1 CITY, STATE ZIP CODE PHONE NUMBER [3CITY ❑VILLAGE ®fOWN NEAREST ROAD tJ(~9K3 _kZ)CAJ"otiib WI S14 01-) 01S)Z1/t- SbY6 sY*'CR. \ n' 2hlRtt, lgzv`.C ?rue, [ ] New Construction Use (X) Residential / Number of bedrooms LI [ ] Addition to existing. building Replacement [ ] Public or commercial describe Code derived daily flow 6tz~o gpd Recommended design loading rate o.4 bed, gpd/fl? a, s trench, gpcW Absorption area required ~ SQ t0 bed, ft2 %Z.00 trench, ft2 Matdmum design loading rate o • 4 bed, gpd/ft2 0. 5 trench, gpdM2 Recommended infiltration surface elevation(s) a 6 • o ft (as referred to site plan benchmark) Additional design / site considerations Z y ' X 6 3' D STD! p R ~iC or~I M1 t D ~D Parent material c1uTWNS ti _Flood plain elevation, 'rf applicable fv f.1. ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL. HOLDING TANK U = Unsuitable for stem ®S ❑ U OS ❑ U ®S ❑ U ®S ❑ U ®S ❑ U ❑ S W U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consiste Ice Bw-dary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed iench I 0-~l ~\34~L 13 50 7, ~SA1~ a-S D-S e.6 PON, Z tt-zz sY(Z 3~y - G►. s I 1 e sUv< h1~>^ cs ° o• s Ground 3 ZZ _7 y S y 2 31 - S elev. fig. t ft. Depth to limiting facto 7q Remarks: Boring # s o-~Z ~oy2 3J3 S~ \cSbk Yhu~ti. CS o.~! o.S n S s n. L CZ- Z tZ-S Z 1 D7f~ 316 - `FS \ cs b~ rh v ~t^ c.S 3 SZ-It 7.SVtZ 31 g S I 1 csbk m~`V, aq :O,s Ground elev. tit-S ft N Depth to ..a limiting facto 710 " ...1.~ 'n y cD Remarks: ICU CST Name,---Please Print Arthur L. We e r / L t Phone. 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Numba: a?__ z-t 3 ~zc 1 111991 M00576 PROPERTY OWNER GeS S - CUQKX SOIL DESCRIPTION REPORT Page L of •Z PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourdary Roots GPD/ft in. Munsell Qu. Sz. Cone Color Gr. Sz. Sh. Bed Ttendh ' r> o-~Z ~oK 313 st'1 ~~Fsbk rhf►~ ~-S n.S o,6 r...;.: Z ~z_sz -syQ 3/ s 1 1~sbk )hvf h s o•`l o•s Ground SL-$ 3 L tZ 1/ 6 S D 9 M o."f o. a elev. 09.1 ft. ; Depth to limiting factor 7 ~3 Remarks: Boring # i Ground elev. ' ft. Depth to limiting factor Remarks: Boring # i r.;'~x.;;vkvi.3 Ground elev. ft. ` i Depth to limiting factor e Remarks: Boring # s , w, l;t Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PLOT PLAN Page 3 of 3 SCALE 1"= 30 ' 0 o .3 >n i 1'0 ~ 1 O ~ ST• 3 50~ C N0~ 1O 9 C.Jt(.E*~ C.uCt~ ctL~p ►~ot~; l ou5 ~ w~,L exvs'r)Q G s4ST1 1s PrvbP. `-loL3' Notz-`D) OF $3 . Fv tv tLu- I.OT l_ 1`v e s 'Ti 'It%IZ )NT L" ST S' t'1m H s'i s Teq . 3 U. 0 t 0 r, jFL aq - zy' 5's f,. LW. oN 31,4 ~vG P~Pk' -l"em l~ S U tT~''C`t~ LE" \'C'Q~j r 63 r ~.3 a SwTIMY1 OP 6 e7 eL., To l3E c) 16 &L, lobs 9Z-z~3 lt, 199Z ( 715 ) 425-01bs M00576 CST Signature Date Signe Telephone No. CST # j + ,t,WW,,gWIE 28.31 ~~~E J9?ND ST_ County: Safety and Human Relations INSPECTION REPORT ♦ Safet fety and Buildings Division T (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 186544 Permit Holder's Name: ❑ City ❑ Village ❑xTown of: State Plan ID No.: STAR pRAIRI$ lev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 038-1113-70-001 TANK INFORMATION ELEVATION DATA A930000 20 3-bid TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3 cN Dosing Aerati Bldg. Sewer Holding St/ Inlet g51 p,ZZ d~' TANK SETBACK INFORMATION St/ Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake d3 ! Septic >10~~ r ® ' 44- NA Dt Bottom Dosing ti NA Header/.raW. Q 7X3 Aerat NA Dist. Pipe Holding Bot. System PUMP/ INFORMATION Final Grade Manufacturer De and ETpo °F $.7' (w,?{ Model Number ~j7M TDH Lift 1~PFriction, Sysatem TDH Ft 1: a t~ Loss Forcemain Length~j! Dia. Dist. ToWell> SOIL ABSORPTION SYSTEM BED/TRENCH Width Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS o~ 3 DIME=1N LEAC Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM Mo e INFORMATION Type O 6~e- E CHAMBER System: kV '1 / OR UNIT DISTRIBUTION SYSTEM Header/Manifold Dis ri tion 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 ❑ ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.)154S LOCATION: TAR PRARI~E 28 31.481B,SW,SE, 192ND T. 1c~Ca~j Iq? Ave- - N A. Plan revision required? ❑ Yes No / p Use other side for additional information. T SBD-6710 (R 05191) Date Inspector's Signatu a Cert No. ADDFTIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: QILHR SANITARY PERMIT APPLICATION c r In accord with ILHR 83.05, Wis. Adm. Code ~.o.,~..P.....,..,,~,,,o. STAT SANITAR PERMIT# -Attach complete plans (to the county copy only) for the system, on paper not less than yy 8% x 11 in ches in size. 1 rev svious 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 &eS d Sco 77 in-e z, gv y, 5411 '14.5 '/4,Sa T l,N,RE(or PRziz R'S MAILING ADDRESS LOT # BLOCK # 67 s CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Q - /3 4/G'- Q e 11. TYPE OF BUILDING: Check one CI NEAREST ROAD ( ) 11 State Owned tt,,// ❑ VILLAGE : //y le- ❑ Public k1 or 2 Fam. Dwelling- # of bedrooms L AR ELTAx N B R( 7 Pr `i 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo V G / 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 El merchandise: sales/Repairs 11 El 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 in line A. Check line B if applicable) A) 1. ❑ New 2. RReplacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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 EQ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ 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 f) REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION ~w /S:5110 Qel) SAO r4-• a Feet Feet VII. TANK CAPACITY Site in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks oncret glass App. Tanks Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber 14~ AW c Vlll. RESPONSIBILITY STATEMENT 7-SW 1, the undersigned, assume responsibility for installation of the onsite sewage system sho n the attached plans. Plumber's Name (Print):/ Plumber's Signature: (No Stamps) MP ~ r~PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): /o2a 'sca= 46"4 l, c O W. IX. COUNTY/DEPARTMENT U ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date 11ue Is Agent Sign No Stamps) Approved E] Owner Given Initial I- 'X Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber - MsIrMCTIONS 1. saflitarr:pjermit is valid for two (2) years. 2.'odr santtalypermit 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 wflorg.the, System `isjo b+e installed: If. 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 marufacturer'sname. 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 tanks), 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 grbundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) STC-100 This application form is to be completed in full and signed by .the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. ,Should this development be intended for resale by owner/contractor,(spec house), then►a second form should'be retained and completed when the property' is sold and submitted to this office with the appropriate deed recording. owner of property 7,-Z- (",)Z/, Location ofproperty 1/4 ;u1/4, Section , T N-R W Township _ S'T,41P p,IX 9/L" Mailing address Ae Address of site /l1 1r, /9~7hq/ C,%JOP eO, eW g~ / 7 Subdivision name Lot no. other homes on property? yes 54 No ~rs~sTi~✓E fJc~a~ = NiEOs rV~ Sf~STcs~1 Previous owner of property /lc / Uoal Total size of parcel Date parcel was created 'Are all corners and lot lines identifiable? X Yes c.-W- No Is this property ¢eing developed for (spec house)? Yes „9 No volume- hand Page Number gVZ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICA'T'ION 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 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 the office of the County Register of Deeds as Document No. ~ Z-7 , 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 County Register of deeds as Document No.- 2-7 Si 4ure f appl cant Co-applicant Date of Signature Date of Signature i STATE 13AR OF WISCONSIN FORM 1 - 1982 THIS $PAC[ PILScavscD rOR MCCDODiND DATA DOCUMENT NO. WARRANTY DEED 483927 Y 952PAV REGISTERS OFFICE This Deeci, m ul.• Isdtweesl James R. McLeod and ST CROIX CO., WI lavunniu M. McLeod, husband and wife as Ioint tenants Reed for Record MAY 281992 Grantor of 11:10 A. M uu,t 'telroy F. (;es.,; and Scott I. Counter as tenants in common Crsustec' Register of Deeds Witnesseth, That o said Grantos, for it \slual.le consideration Nl 'NII .n SL. Croix ruM'e~, to Grunted the following drecrlhed real wstate ul CountN. State of Wi:cnsisul: Tax Vao-vl No: 4 The Northwest Quarter of the Northwest Quarter (NW 1/4 of NW 1/4) of Section Thirty Four (34), Township Thirty One (31) North, Range l~ighteen (18) West; the Northeast Quarter of the Northeast Quarter (NE /4 Rof NE an e 1/4) of Section Thirty Three (33), Township 'thirty One (31) North, g Eighteen (18) West, except the North 66 feet of the West 660 feet thereof: the East 545 feet of the Southwest Quarter of the Southeast Quarter (SW 1/4 of SE 1/4) of Section Twenty Eight (28), 't'ownship 't'hirty One (31) North, Range Eighteen (18) West; a perpetual easement for tra%el between the .bove described parcels over the South 66 feet of the West 66 feet of the Southeast Quarter of the Southeast Quarter (SE 1/4 of St? 1/4) of Section Twenty Eight, and the West 66 feet of the North 66 feet of the Northeast Quarter of the Northeast Quarter (NE 1/4 of NE 1/4) of Section 'Ilurty Three (33), all in Township 'shirty One (31) North, Range Eighteen (18) West. is n0L lexr s- notl I.v'.tL.s wJl. all un•i SIl'V •1al. ttr,• L~r. l,' n l .\i„1 .~.ut..ut that the title 1. (;oral, •rl,lr',.,,IL•, In rl.. 27 . \ s' I. ti P ;r s• ?l l \ ; A n it t: N I I i (W%, n!. n I i 1E .a, 3 i S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS 9 Aw FIRE NUMBER--ZQ&Q__ CITY/STATE ZIP PROPERTY LOCATION: SECTION-.qL, T,3,/ N_R-LL_W TOWN OF_ 55M Rd's 11CIC , St. Croix County, SUBDIVISION , 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 a 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/Ile, 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 Wis nsin DNR. Certification stating that your septic has been maint ed must be completed and returned to the St. Croix o. Zoning O cer within 30 days of the three year expiration SIGNED: DATE: St. Croix co. Zoning office 911 4th St. Hudson, WI 54016 r %WsinDepartmentof indusUy, SOIL AND SITE EVALUATION REPORT Pie of 3 -Laoor and Human Reiations `Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ` ST- Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION I~t~-QU`1 G ES SC_ t'T• CovnJZ-tER GOVT. LOT S w 114 3G~ 1/4,S Z8 T -1 N,R E (010W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SUBD. NAME OR CSM # Ll S 2. E . S ` ST- - - [zz-o~u s~~ swr CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE DOWN NEAREST ROAD 1J~►til ZIc41"Dwl7 WI 13t/01-7 (7tS)Zy~_ Suy6 Sy-pV P2RlRtI l°LZv,Cll true. [ j New Construction Use pQ Residential / Number of bedrooms AdditiQn to existing. building L4 Replacement [ j Public or commercial describe Code derived daily now 61-° gpd Recommended design loading rate o•4 bed, gpolft2 a. s trench, gpolft2 Absorption area required \SOb bed, ft2 NZbn trench, ft2 Maximum design loading rate q,-14 bed, gpd$ 0, 5 trench, gpd/ft2 Recommended infiltration surface elevation(s) a 6 • o ft (as referred to site plan benchmark) D l ~~+^-t p t~ bn'r i"1 eau D Additional design / site considerations Z 4 r X &V Parent material QIJIWNs h flood plain elevation, if applicable t a • 1+1 • ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM N FU HOLDING TANK U=Unsuitable for tem ®S ❑U ®S ❑U ®S ❑U ®S ❑U ®S ❑U ❑S Vail SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rttd uv ) ~ -l l 1,10`'I~ 313 5 L ~ Z S1~ M 'F 1. 11-ZZ 7-5 3! - 6u. S) ~CSbk MFi- cS Ground 3 Z2_`t y • S L/ fZ - S C] S elev. ft. Depth to limiting factor ~y" Remarks: Boring # ' o - tz v0 X12 313 _ s 1 \ as bk Y" %3 c s o• t( o. S ~1^ cS n S Z Z l2-SZ lb-1v 3/6 - S CSbK m\j 3 SZ-lo ~_Sy2 31 _ S [ ~ cSb~c m`~~„ o.~{ a,s Ground elev. 1~1-5 ft Depth to limiting factor Remarks: T Name:-Please Print Phone. 715-425-0165 Arthur L. We erer Address: Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Signature: Date: CST Number: e~ 10, qZ_ z~ 3 tli 1442 M00576 PROPERTY OWNER GAS S - C-UyQQ TE SOIL DESCRIPTION REPORT Page -*f Z 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 Tmnch 3 wX o_~Z ~oK 313 si 1 sbvt CA-IS n.s o.6 )-5v1Z 3/ - s l lcsbk r,vf~h cs o•~! o S Ground 3 SZ-g3 LoIfR 0 9 1~ 0.7 0.8 elev. q9 1 ft. Depth to limiting ` factor y ~3 Remarks: Boring # - I Ground elev. ft. Depth to limiting factor i Remarks: Boring # um . 4 Yin Ground elev. ft. Depth to ` limiting factor i `s Remarks: Boring # nt4i.. , >^~w`a+ ` Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PLOT PLAN Page 3 of 3 SCALE 1"= 'SO' 0 V, 3 so C 'NOT `m S CkLee WRIV e.~Ll(3 ~p`~T;oug~ WC'l,l► ~lS~IVG S~SZL^1 IS tYpP• ypv~ NO1L~} OF B3 . Fu~v\2l3 "T Lipues 'V,:~ '%IZ ►'~-T LOST S# FjmH siis`1 l . i 3 U. a H t cD i r qq - Zy` 8.3 ~•~'BVl- t~ • ~ W ON -V(4 t~vC P1Pr W/~k'M Ur S V ~`T'fi3l..E \'CR.C~A ~ 63 r a O~'t•~'pW) OF $ ~5 Zy eL, To [3E 46-0' 8.2 L'I. 10 S qz-Z~3 ~+t air ll, 199 z (715 ) 425-0165 M00576 CST Signature Date Signed Telephone No. CST # A $6 s7 OIL/ cfaxel-/eY S Y~YQiyJ'B - . J l ~v J 30 ~ NI O A\ 0 ~li ow f, Fd -re sr ell s tk- ~X S I', :vs ve---- 141 G' PAGE OF PUMP CHAMBER CRO55 SECTION AND SPECIFICATIONS VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUAJCTION BOX ~MAUHOLE COVER 25 FROM DOOR. WINDOW OR FRESH AIR INTAKE GRADE I y.. MIN. 16'M IIJ. CONDUIT I8"MIN. f~JL.F= 1" PROVIDE I AIRTIGHT SEAL I I I V I III APPROVED JOINT A I III APPROVED JOIMTS W/C.l. PIPE. I III W/C.I. PIPE EXTENDIAJC. 3' I II ALARM EXTEUDIAJG 3' OQT0 SOLID SCI:. I I ONTO SOLID SOIL fa I I ON C I I I PUMP +q~ OFF D 3 CONCRETE BLOCK RISER EXIT PERMITTED UIJLd IF TANK MANUFACTURER HAS SUCH APPROVAL SPCC.IFICATIQKJS SEPTIC AND DOSE TANKS MANUFACTURER: m",2'aJe,97_p`!' v Go57` NUMBER OF DOSES: PER DAy TANK ; IZE : 2-5-0 GALLONS DOSE VOLUME ALARM MANUFACTURER: -scr INCLUDING BACKFLOW: 7G•-S_ GALLONS MODEL NUMBER: Z"// CAPACITIES: A= r IUCHES OR _l_/_-7-'GALLOM5 SWITCH TYPE.: B =2-y INCHES OR L GA'_L01JS PUMP MANUFACTURER: ZO~ Y C= IMCHES OR 14"r GA_LOUS MODEL NUMBER: ,GS D-lii2z INCHESOR-205-" GALLONS SWITCH TYPE: NOTE: PUMP AND ALARM ARE TO BE PUMP DISCHA.RVE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE B'11'WEEAJ PUMP OFF AND DfSTRIBUTION PIPE..Z~'-FEET -F MII,MII~MUM NETWORK SUPPLY PRESSURE . . . . . . . . . 2.5 FEET FEET OF FORCE MAIN X _fL,!~e_FYoFr.FR1CTIOU FACTOR.. FEET TOTAL Dt0JAMIC. HEAD = 24 " FEET INTERNAL DIMEWSIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH SIGNED: LICENSE NUMBER:DATE:7T -117-