HomeMy WebLinkAbout038-1012-80-000
FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
1 f~ _TOWNSHIP
SECTION- T_,V_N-R~W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION 101, LOT LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
~ ~42
c~
too k '0
--P
INDICATE NORTH ARROW
BENCHMARK:Elevation and description:
Alternate benchmark
SEPTIC TANK: Manufacturer: S Liquid Cap.
Rings used: !Manhole cover elev:jj~~/Final grade elev: 1
Tank inlet elev.: Tank outlet elev.: 9h~c/
No. of feet from nearest road:Front , Side , Rear t1it. Qf?~
From nearest prop. line:Front , Side , Rear Ft
No. of feet from: Well a 3". , Building: t0 l
P
(include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
z
PULP CHAMBER
Manufacturer: L4.~~ S Liquid Capacity:
Pump Model: Pump/Siphon Manufact. : Pump Size,,Yq.
b
Elevation of inlet: Bottom of tank elevation l%
Pump on elev.:-dump off elev.:Gallons/cycle: 4 2
Alarm: Man.:,cti ~N Switch Type: Location
Distance from nearest prop. line: Front
side_, Rear_ t.
Distance from: Well Z,9 J Building 5zU
SOIL ABSORPTION SYSTEM
Bed: Trench: Seepag Pit:
Width: Length Number of Lines: Area Built
Exist. Grade Elev. Proposed Final Grade Elev.
Fill depth to top of pipe:
No. feet from nearest prop. line:Front , Side , Rear Ft.
No. feet from well: No. feet from building
HOLDING TANK
Manufacturer: 'ty:
No. of rings used: Elevat' bottom tank:
Elevation of inlet:
No. feet from near t prop. line:Front , Side , Rear Ft.
No. feet fro • Well , building , nearest road
Alarm ufacturer:
INSPECTOR:
DATE: PLUMBER ON JOB:
LICENSE NUMBER: J})P~, zS
6/90:cj
• DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR &HUMAN RELATIONS U 01V DIVISION
' P.O 4OX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON W1 35, 07 18W State Plan I.D. Number:
C CONVENTIONAL ❑ ALTERATIVE (If assigned)
Town of Star Prai e
1 1 Dr. Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE.
1 V ~ 0
l
Warren Wood RT. 2 Box 109 New Richmond WI 54)17
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV..: CST REF. PT. ELEV.:
4) k
L Name of lumbe i, /s MP/MPRSW No.: County: Sanitary Permit Number:
Gar Steel 3254 St. Croix 149033
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
4 r d PROM ES 71 NO P❑ YES O
BEDDING: VENT IA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
9 ALARM: FEET FROM LINE: AIR INLET:
„IF
O 4 u YES F-1 NO NEAREST lo, ~U
[__1 YES CZN ❑
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
' I PROVIDED: P~ROVI~DED:
WC ~C. ❑ YES O U `n , r fle'~ ( Y- Ia'YYES ❑ NO YES ❑ NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN -7 r / FEET FROM LINE: AIR INLET:
PUMP ON AND OFF I ~JZ- QYES ❑ NO NEAREST l 6 ~U g-C)
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID
BED/TRENCH TRENCHES: MATERIAL: PIT DEPTH:
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET:
NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: N0. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
ELEVATION AND
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑ YES ❑ NO ❑ YES ❑ NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
COMMENTS: FEET FROM LINE:
❑pa YES ❑ NO ❑ YES ❑ NO NEAREST
1 A
'j , S~ : ;t -
3 ~
Retain in county file for audit.
Sketch System on
Reverse Side. SIGN TURE: i TITLE:
-tip~,~ Zoning Administrator
SBD-6710 (R. 06/88)
LOCATION: STAR PRARIE 3.31.18.33H NE NW CARDINAL DR.
Wisconsin Department of Industry, PRIVATE' SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 149033
Permit Holder's Name: ❑ City ❑ Village [',Town of: State Plan ID No.:
WOOD, WARREN W STAR PRAIRIE
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
038-1012-80-000
TANK INFORMATION ELEVATION DATA A9200367
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Loss ead
Forcemain Length Dia. Fi Dist.Towell
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIM N I N
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER Mode Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: STAR PRARIE 3.31.18.33H,NE,NW,CARDINAL DR.
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
1
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: s
i
~HR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
St. Croix
t..
=aa"
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 1419a 3
8% X 11 inches in size. Check if revision to pre us 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
Warren W. Wood NE '/4 NW Y4, S 3 T 31 , N, R 18 f4or) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
R.R.#2, Box 109 n/a n/a
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
New Richmond, Wi. 154017 1(715 2467300 n/a
CITY NEAREST ROAD
11. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE :
Cardinal Dr.
❑ Public 9 1 or 2 Fam. Dwellin of bedrooms 4 PARCEL AX NUMBER(S)
111. 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 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. El New 2. El Replacement 3.1E I Replacement of 4.0 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 E2 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
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
Feet Feet
VII. TANK CAPACITY Site
in gallons Total # of Prefab. Fiber- Exper.
INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Se tic Tank or Holdin Tank x 1200 1 Weeks C . P .
Lift Pump Tank/Si hon Chamber x 800 1 Weeks C . P .
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installati n f the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's S' n re: (No S ) /MPRSW No.: Business Phone Number:
Gary L. Steel r3254 715 246-6200
Plumber's Address (Street, City, State, Zip Cod
IX. CO TY/DEPARTMENT USE ONLY
Ing Ag nt Signature (No Stamps)
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue ssui
Surcharge Fee) /
Approved ❑ Owner Given Initial Sur
Advers Determin do
X. CONDITIONS OF APPROVAL/REASONS F 6R DISAPPROVAL: 4
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
w Ar t
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
• APPLICATION FOR sANITARY PERMIT
• 9TC-100
This oppllcation form Is to be conplatod In full and signed by the owner(s) of
the pcopetty being developed. Any lnadoquacles will only result In delays of
the pztmlt issuanco. -Should this development be Intended for result by
owner/contractot,(spac houaa), thcn a second form should be retained and
completed when the property 1s sold and submitted to this office with the
appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _ - - - - - - - - _ - _ _ - - -
OYntr•of property Warren W. Wood
Location of property 1/4 NW /4t Section 3 T 3• 1 ~_R 18 V
Township Star Prarie
Mailing address R.R.#2, Box 109
New Richmond, Wi. 54017
• Address of alts _ R.R.U. Box 109, New Richmond, Wi. 54017
/ubdivlslon nave n/a '
Lot number _ n/a
Previous owner of pcopetty Marvin A. Hodgin
Total ai:e of parcel acre
c Date parcel was created 4-6-91
Are all cornets and lot lines Identifiable? -_Yas _ it0
Is this property being developed for resale (aptc house)? Yes x
Volnne 898 and Page Number 138 as raco:ded with the Register of Deeds.
INCLUDE V1TH THIR APPLICATION T1111 FOLLOVINCt
A VAARANTT DRIED which Includes a DOCUHINT NUMBQR, VOLUMI AND PAOt RLrMiiiR, and
the Bit AL or Tilt R9019TER OF DRKD9. In addition, a certified sutvey, If
available, would be helptul so as to avoid delays of the tevievlnq process. it
the detd description teterences to a Cettlllad survey Nap, the Cattltled Survey
Map shall also be required.
PROPERTY OVNER CERTIFICATIOH
1(ve) certify that all statements on this form are true to the best of .y (out)
kmowltdgel that I (we) am (ate) the ownet(s) of the property described in
this Intotmatlon term, by vlttus of a warranty deed recorded In the ottice of
! e County Register of Deeds as Document No. 468133 j and that t (vel
tesently own the proposed site for the sewage disposal system (cc I two) have
obtained an teat ent to to with the above described property, [oc the
cnn cuctlnn of s )d ste , d the same has been duly recorded In the ottice
of h. nyn y no at o , as Document No.
Signet f ecSignature of Co-owner (11 Applicable)
7~~c Giow
D•t. of signature Date of Signature
• I
DOCUMENT NO. WARRANTY DEED TNSU •IAC[ RRRRRVIO "a RfCORO1NY "TA
y STATE BAR OF WISCONSIN FORM 2-1 982
I
REGISTER'S OFFICE
ST. CROIX Me VI
Marvin A. Hodgin and Clara A. Hodgin, Recd for Record
.......husband and wife, APR
111991
of 8:30 A. M
conveys and warrants to Warren W. Wood a sin le
g man.
RegiitetofDeed~'
RETURN TO
the following described real estate in ro.....y .
St C ..................County,
State of Wisconsin:
Tax Parcel No:..........
Part of Government Lot One (1), Section Three (3), Township Thirty-one
(31) North, Range Eighteen (18) West, more fully described as follows:
Commencing at an iron pipe which is set 1957.58 feet East and 451.14
feet South of the Northwest corner of said Section Three (3) as the
Point of Beginning for a parcel to be described; thence proceed South
86016' East, a distance of 200.91 feet to an iron pipe set on a meander
line of Cedar Lake; thence proceed North 14045' East along said meander
line, a distance of 100 feet to an iron pipe; thence proceed North
86016' West, a distance of 210.02 feet to an iron pipe; thence proceed
South 9033' West, a distance of 98.67 feet to the Point of Beginning.
CRAIvSF~
This is. not homestead property. 's' 3 MOL
(is) (is not) Fff
Exception to warranties:
Dated this Crl - day of : 19.1Z
(SEAL) - (SEAL)
Marvin A. Hodgin Clara A. Hodgin
(SEAL) (SEAL)
• •
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN .
St- Croix.------------ County. as.
h
authenticated this 6
........day of 19...... Personally came before me this ................day of
pii l 19-011--- the above named
_ M.......................... rn„ A•.... Hodin-.and Clara..A
`I~uaanr,r~caro~.
14 . Hodgin-
TITLE: MEMBER STATE BAR OF WISC _
(If not,
authorized.. by $ .706.06, Wis. Stata.l'' `A..
r p known `to be th erson who uted the
. n re inst ment nd Mackledge
THIS INSTRUMENT WAS DRAFTED BY i~ f F~
.......WARREN.....:...WOOD, LTD. R ~
I
- ~r; W* 1 c id aF,y r2 . !~'lo.~-c L
New Richmond, WI 5401 w L K - v
- rotary Public S._...... County, Wis. I
aa
(Signatures may be authenticated or acknowled~dCp~g~rype Mp Commission is permanent.( If not, state expiration
are not necessary.) r Z
date: L
18..~~.....)
eNams of persons signing in any capacity should be typed or printed below their signatures.
J_ji
STATE BAR OF WISCONSIN
'~AA?
ryIsa.. }Ark Nn _ 1-
i ur _ Eng.. '
~ r
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
/BUYER Warren W. Wood
ROUTE/BOX NUMBER R.R.#2, Box 109 FIRE NO.
CITY/STATE New Richmond, Wi. 54017 ZIP
Gov ` CD i
PROPERTY LOCATION: NE 1/4 1/4, Section 3 , T 31 N, R 18 W,
Town of Star Prarie , St. Croix County,
n/a
Subdivision n/a , Lot No.
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
$3000 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
systems properly maintained.
The property owner agrees to submit to St. Croix County Zoning a certification
form, signed by the owner and by a master 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. Certification form will be sent approximately 30 days prior to
three year expiration.
I/WE, the undersigned, have read the above requirements and agree to maintain
the private sewage disposal system in accordance,with the standard set forth,
herein, as set by the Wisconsin Department of Nat ral Resources. ertificati
form must be completed and returned to the St Cr ix ounty onin Off' a wit '
30 days of the three year expiration date.
SIGNE /
DATE 3~
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016 r
(715) 386-4680
Sign, Date, and Return to above address
i
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY; , c DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76
N WI 3707
HUMAN R~LArTI,ONS
(H63.09(1) & Chapter 145.045)
LOCATION: TOWNSHIP/ Y: [570--rB-LK NO.: SUBDIVISION NAME:
11 f W 1/4 3 /T 31 N/R 186(or) w Star Prarie n/a n/a n/a
COUNTY: WN E'S B A E: MA IN ADDR SS:
t. Croix Warren W. Wood IR.R.#2, Box 109, New Richmond Wi. 54017
USE DATES OBSERVATIONS MADE
NO DRMLS.: COMMERCIAL DESCRIPTION: 00 1PROFILE 10 S: PERCOLATION T ~m 1 Residence 3 n/a ❑New eplace 5-18-90 n/a
RATING: S- Site suitable for system U- Site unsuitable for system
ONVENTI NAL: MOUND: IN-GROUN T M-IN---FILL OLDING TTAA1N'K: RECOMMENDED SYSTEM: Ioptional)
QS ❑U QS ❑U ®S ❑U ❑S GA EIS QU n /a
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: Tl/a
decimal' PROFILE DESCRIPTIONS
BORING TOTAL DEPTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTHXK ELEVATION OBSERVED S HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B. 1 13.59 103.45 none 13.59 .50bl.1. 1.42bn.&bl. fills.l. 1.83bn.s.sil.
.
B-
B-
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP-IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p I p I PER INCH
P-
P- a
P-
P-
P-
P-
PLOT PLAN: 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 slope, bottom of
SYSTEM ELEVATION exsisting system 95.35
t I I i I ~
~ r f
F I i
1
1 I !
t--- -i---
TN
r
1+ t I
y
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 the location of the tests are correct to the best of my knowledge and belief.
NAME print : TESTS WERE COMPLETED ON:
ry L. Steel 5-18-90
ADDR : CERTIFICATI NUMBER: PHONE NUMBERloptional):
88 N. Shore Dr. New Richmond Wi. 54017 2298 715-A6-6200
CST SIGN E:
CI-
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
I
J
STEEL'S SOIL SERVICE
Gary L. Steel 988 N. Shore Drive
C.S.T. 2298 New Richmond, WI 54017
MPRSW-3254 Warren W. Wood (715) 246-6200
NEkNW4 S.3-T31N-R18W
town of Star Prarie
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Gary L. Steel
' PAC F OF
PUMP CHAMBER CRO55 SECTIOU AI\ID SPECIFICA-riokis
VEIJT CAP
4"C.I. VEMT PIPE WEATHER PROOF APPROVED LOCKIAIG
JUUCTIOIJ BOX MANHOLE 1 COVER
'
2-5' FROM DOOR, vilV)A'^'^~'~{n!4~4(
WIUDOW OR FRESH 12"MIU. I
AIR INTAKE
GRADE I 4" MIM.
I
MI M.
COWDUIT
\ ~d
T PROVIDE
INILE I
AIRTIGHT SEAL i i I 1 ti t J~
I I I i Y APPROVED JOINTS
APPROVED JOINT A I I11 W/C.I. PIPE
W/C.I. PIPE I I') I ALARM EXTEWDIU(. 3'
EXTENDING 3 ONTO SOLID SOIL
ONTO SOLID SOIL I
B 1 I
I
ow
C
ELEV. 94.0 FT.
PUMP OFF
D
CONCRETE BLOCK
RISER EXIT PERMITTED OIJL4 IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC E SPEC,IF I'CATIOAIS
DOSE Weeks C.P. IJUMBER OF DOSES: 4 PER DAM
TANKS MAMUFACTURER:
TANK SIZE: 800 GALLOIJS DOSE VOLUME
tank alert INCLUDING BACKFLOW: 152 GALLONS
ALARM MAIJUFACTURER:
MODEL HUMBER: rx/a CAPACITIES: A= 21'1 INCHES OR 400 GALLONS
SWITCH TYPE' . mercury g INCHES OR _38- GALLONS
PUMP MANUFACTURER: Gould 19ga1/iin.c=~-INCHES OR 52, - GALLO►JS
MODEL NUMBER: WE03 Ds 9.9 INCHES OR 210 GALLONS
SWITCH TYPE: mercury NOTE: PUMP AND ALARM ARE TO BE
INSTALLED OW SEPARATE CIRCUITS
GPM
i MINIMUM DISCHARGE KATIE- 35
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 4.00 FEET
. . W-EN FEET
-I- MIIl11MUM NETWORK SUPPLY PRESSURTE/.. .
} 50 FEET OF FORCE MAIN X 2.05 F/ p ft FRICTION FACTOR.. FEET
I - TOTAL Dy JAMIC HEAD = 5'02 FEET
IIJTERNAL DIMEIJ ONZ OF TA K. LEMGTH 49 ;WIDTH 7 ;LIQUID DEPTH 41
I
mprsw 3254 5-3-91
l-fl IJUMBER: DATE:
91GUE D. ' LICE
;DPARTMf NT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
"LABOR R VUM;AN RELATIONS DIVISION
P.O. FsOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON, WI 53707 State Plan I.D. Number:
NE 4, NW 4, Sec . 3 , T31-R18 El CONVENTIONAL El ALTERATIVE (If assigned)
Town of Star Prai e ❑
Holding Tank El In-Ground Pressure mound
A O PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT ROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ❑ YES El NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM: FEET FROM LINE: AIR INLET:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVDED:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF ❑ YES ❑ NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID
BED/TRENCH TRENCHES: MATERIAL: PIT DEPTH:
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET:
I I NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: TPERMA7NENT MARKERS: OBSERVATION WELLS;
YES El NO ❑ YES El NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
El YES ❑ NO ❑ YES E] NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: tGRAVELDE W PIPE: FILL DEPTH. ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFISTR. DISTR. PIPE DISTRIBUTION PIPE MAT ERIAL & MARKING:
ELEV.: ELEV.: DIA.: ELEV.: : DIA.:
ELEVATION AND
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: AL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑ YES ❑ NO ❑ YES ❑ NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
COMMENTS: FEET FROM LINE:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
4rrv\rC Vaud - n.eA-J PA-r t:10.~rN -to ~t S.
u-~ ~lP tNh S .
Retain in county file for audit.
Sketch System on
Reverse Side. SIGNATURE: TITLE:
SBD-6710 (R. 06/88)
SANITARY PERMIT APPLICATION
t1~I.HR In accord with ILHR 83.05, Wis. Adm. Code COUNTY
St • Croix
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than f .?5-5 3
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
Warren W. Wood NE % NW Y4, S 3 T 31 , N, R 18 f(or) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
R.R.#2, Box 109 n/a n/a
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
Hew Richmond Wi. 4017 715 246-7300 n/a
CITY NEAREST ROAD
L:I
II. TYPE OF BUILDING: (Check one)
❑ State Owned ❑ VILLAGE Star Cardinal Dr.
❑ Public 91 or 2 Fam. Dwelling-#~ of bedrooms 3 PARCEL TAX . UM ER
Ill. BUILDING USE: (If building type is public, check all that apply) 038-1012-40
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 80 Mobile Home Park 120 Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. R 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 99 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
140 System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
Feet Feet
Vill. TANK CAPACITY Site
in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New istin Gallons Tanks Concrete structed glass App.
Tanks Tanks
Se tic Tank or Holding Tank ICY, 1UUU 11T11CnoWn F] I
Lift Pump Tank/Si hon Chamber ----_E1 I El El I El El
Vllil. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's i ature: (No mp MPRSW No.: Business Phone Number:
-ary L. Steel 3254 715 246-6200
Plumber's Address (Street, City, State, Zip Cddef
88 N. Shore Dr., New Richmond, Wi. 5401-7
IX. COUNTY/DEPARTMENT USE ONLY 42
❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued issuing gent Signature (No Stam
Surcharge Fee)
Approved ❑ OwnerGiveninitial j & /I
Adverse Determination
X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) 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) 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 2 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.
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 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; distributi(m boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-8398 (R.11/88)
i
APPLICATION FOR SANITARY PERMIT
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 Warren W. Wood
Location of property NE 1/4 NW 1/4, Section 3 , T 31 N-R1 8 W
Township Star Prarie
Mailing address Box 109
New Richomond, Wi. 54017
Address of site Box 109, New Richmond, Wi. 54017
Subdivision name n/a
Lot number n / a
Previous owner of property Lambert M. Meidinger jr.
Total size of parcel 135 x 460 1
Date parcel was created 11-17-84
Are all corners and lot lines identifiable? x Yes No
Is this property being developed for resale (spec house)? Yes x No
793 573
Volume 776 and Page Number 75 as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and
the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified Survey Map, the Certified Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in
this information form, by virtue of a warrant y31deed 09 7recorded in the Office of
the County Register of Deeds as Document No. 44 • and that I (We)
presently own the proposed site for the sewagelsystem (or I (we) have
obtained an easement, to run with the above described property, for the
co tr ction of said s st m, rument ame has been duly recorded in the Office
o th No.
Signature of Ow er Signature of Co-Owner (If Applicable)
z/
Date of Signature Date of Signature
a•..
f -DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA
WARRANTY DEED
ROOK "v P e
5._~ STERS OFEICh
This Deed, made between Leonard E. Pepin ST. CPCj Co, WI$.
nd.__Juletta••E.---Pepin,_•-husband and wife,'!. ','Or Record 01Iis14th
Grantor, f~+g`r 0
USLL- --A'D. 987
'
and Warren WoQd.,-_.a_.sin- le- man.. 11:00 A
ra -
RMNtr M per,
j - Grantee, I~
Witnesseth, That the said Grantor, for a valuable consideration--_
. Crol I
conveys to Grantee the following described real estate in S-___t_•-_____..------X RETURN TO
County, State of Wisconsin:
i
Tax Parcel No:
See attached description Parcel "A"
I
F
This is_..no_t:--------- homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And......... grantor................................
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
and will warrant and defend the same.
Dated this 9th day of OCtOb--r-- 19_-8
+-.-(SEAL).--f _G-- _._(SEAL)
Leonard E. P pin Juletta E. Pepin
-----------•---•-----------(SEAL)• Q----(SEAL)
A Julletta E. Pepin
OFFICIAL SEAL
AUTHENTICATION ACBNOW T WMy0.~
IXARY rtl~.lc-
Signature(s) STATE OF x!3&6 SAM DECO
s, My Comm. Expires Aopst ,1"I
San Die o
authenticated this day of___________________________ 19______ Personally came before me this ____.Ith..... day of
October__________________________ 19 8 7 the above named
eonard E_._• Pepin and Juletta
-V
E Pepin-_AKA_ Julletta__E.__ --Pe *
TITLE: MEMBER STATE BAR OF WISCONSIN Proved__to--me__lapon•_the_•basis_ of
(If not- --•-Satisfactory -e_v_idence----------------------------------
authorized by § 706.06, Wis. Stats.) *-,Zj)7k to ~ Vt be a person _ S _
who executed the
foregoing i trT'~ all 'ckno dge the same.
THIS INSTRUMENT WAS DRAFTED BY BA KKE__ , NORMAN & SCHUMACHER, S. C . - ~ ex
* Melody- Kin I,
1200 Heritage Drive
meat--l-iehmGnd•,---W1...54.0.17-------------------- Notary Public ----San--Diego---- ---------County, .IWW C
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration
are not necessary.) date: ----August 16 19___91._.)
j
*Names of persons signing in any capacity should be typed or printed below their signatures. t ,
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc.
FORM No. 1 -1982 ) Tjl vnnF.ee, Wis.
01% Section Three (36
BPI"
tl=) Nest. Town of Star
Try.- da"ibed` as follows: Commencing at a
Prairift point erh3pM► 7S- (c" &mth and 1,W.30 feet East of the Northwest
corner of said 4ection Three (3). said point- being a one inch iron pipe and the
point of beginning for parcel to be described; thence proceed South 86016'
East a distance of 200 feet to an iron pipe set on a meander line on Cedar
Lake; thence proceed South 10°09' West along said meander line a distance of
50 feet; thence proceed North 86016' West a distance of 200 feet; thence
proceed North 10°09' East a distance of 50 feet to the point of beginning.
Said parcel containing .23 acres, more or less. Land located between meander
line and lake within side lines extended is also a part of this parcel.
r
i
A parcel of land located in Government Lot One (1), Section Three (3),
Township Thirty-onc (31) North, Range Eighteen (18) West, Town of Star
Prairie, more fully describcd as follows: Commencing at a point which is
1955.94 feet . East and 460.87 feet south of the Northwest corner of said
Section Three (3) as the point of beginning; thence South 86016'East a rj
distance of 200 feet to an iron pipe set on a mcanderline on Cedar Lake;
thence South 11°54' West along said meander line a distance of 75 feet; thence
North 86116' West a distance of 200 feet; thence North 111054' East a distance
of 75 feet to the point of beginning, together with an access and ingress road
1 rod in width from the existing Town Road in the Northeast quarter of the
Northwest quarter (NE 1/4 of NW 1/4) of Section Three (3), Township Thirty-
one (31) North, Range Eighteen (18) West, over and across Lots 8, 7, 6, 5 to
Lot Four 4 as said access road now exists. i
A parcel of land located in Government O Lot One l, Section Three O3
,
Township Thirty-onc (31) North, Range Eighteen (18) West, Town of Star
Prairie, more fully described as follows: Commencing at an iron pipe which is
sct 1955.94 feet East and 460.87 feet South of the Northwest corner of said
Scction Thrcc (3) as the point of beginning for parcel to be described; thence (j
procced South 86°16' East a distance of 200 fcci to an iron pipe set on a
meander line of Cedar Lake; thence proceed North 14145' East along said
meander line a distance of 10 feet to an iron pipe; thence proceed North
86°16' \1'cst a distance of 200.91 feet to an iron pipe; thence proceed South
9033' West a distance of 9.87 feet to the point of beginning.
A parcel of land located in part of Government Lot "1", Section Three (3),
Township Thirty-one (31) North, Range Eighteen (18) West, Town of Star
Prairie, St. Croix County, more fully described as follows: Commencing at a
point which is 533.75 feet South and 1,940.50 feet East of the Northwest
corner of said Section Three (3), said point being a one inch iron pipe and the _
point of beginning for parcel to be described; thence proceed South 86016' D
East a distance of 200 feet to an iron pipe set on a meander line on Cedar
Lake; thence proceed South 10°09' West along said meander line a distance of
50 feet; thence proceed North 86016' West a distance of 200 feet; thence
proceed North 10009' East a distance of 50 feet to the point of beginning.
Said parcel containing .23 acres, more or less. Land located between meander
line and lake within side lines extended is also a part of this parcel.
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/Ex Warren W. Wood
ROUTE/BOX NUMBER Box 109 FIRE NO.
CITY/STATE New Richmond, Wi. 54017 ZIP
PROPERTY LOCATION: NE 1/4 NW 1/4, Section 3 , T 31 N, R18 W,
Town of Star Prarie , St. Croix County,
Subdivision n/a , Lot No. n/a
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
$3000 of the cost of replacement of a failing system, which was in operation
prior to July 1, 1978. St. Croix County accepted this program in August of
1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their
systems properly maintained.
The property owner agrees to submit to St. Croix County Zoning a certification
form, signed by the owner and by a master plumber, journeyman plumber,
restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and (2) after
inspection and pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification form will be sent approximately 30 days prior to
three year expiration.
I/WE, the undersigned, have read the above requirements and agree to maintain
the private sewage disposal system in accordance ith the standards set forth,
herein, as set by the Wisconsin Department of N ural Resources. C rtification
form must be completed and returned to the St. ro' County Zoni g ffi a wi in
30 days of the three year expiration date.
SIGNE
DATE G
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386-4680
Sign, Date, and Return to above address
DEPABTM~NT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
INDUSTRY, ,
L~ABOFi ARID - r , ' P.O. BOX 7969
Hl>"MA~I RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/ Y: OT OT..-BK. NO.: SUBDIVISION NAME:
11$W 3 /j 31 N/R 18igor) w Star Prarie n/a n/a n/a
COUNTY: WN E'S B AME: MAI IN ADDR SS:
St. Croix Warren W. Wood IR.R.#2, Box 109, New Richmond Wi. 54017
USE DATES OBSERVATIONS MADE
ESTS:
NO. DRMS.: COMMERCIAL DESCRIPTION: PROFILE 00 I DESCRIPTIONS: ERCOLATION
Residence 3 n/a ONew eplace 5-18-90 n/a
RATING: S- Site suitable for system U- Site unsuitable for system
ONVENT NAL: MOUND: IN-GROUN E: S STEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: Ioptional)
QS ❑U 12S ❑U ®S ❑U ❑S CSI ❑S QU n /a
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: n/a I Floodplain, indicate Floodplain elevation: n/a
decimal l PROFILE DESCRIPTIONS
BORING TOTAL DEPTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTHxX ELEVATION OBSERVED EST. 1 HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B_ 1 13.59 103.45 none 13.59 .50bl.1. 1.42bn.&bl. fills.l. 1.83bn.s.sil.
B-
B-
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p RI -PERIOD 2- PERIOD 3 PER INCH
P-
P- a
P-
P-.
P_
PLOT PLAN: 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 slope. bottom of
SYSTEM ELEVATION exsisting system 95.38
i
r
r ! !
-
60 fi_ 1 r
i
}
15
r_.}
{
r ;
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 the location of the tests are correct to the best of my knowledge and belief.
NAME print : TESTS WERE COMPLETED ON:
ry L. Steel 5-18-90
JADDRESS: CERTIFICATI NUMBER: PHONE NUMBER (optional):
N. Shore Dr. New Richmond Wi. 54017 2298 715- 6-6200
CST SIZL~
RIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
R-SBD-6395 (R. 02/82) - OVER -
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260
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