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Home My WebLink About012-1024-50-100'ermit Holder's Name: City Village X Township Fast, Ed Erin Prairie, Town of .ST BM Elev: Insp. BM Elev: BM Description: Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT (ATTACH TO PERMIT) GENERAL INFORMATION Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ J~~~ 5'.~}- Dosing O~~ G. pcr~4in~l. ~~ ~. /~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ / ~ / ~~~ ~T i -~_ Dosing 33 0 ~ ~ / ~,` ~ T t ~~ Aeration Holding PUMP/SIPHON INFORMATION .~. `~ Manufacturer ~~~ le ( GP and Model Number ~ w ~ c ~ `. / ~ J ~J~ [ • TDH Lift S ^ Fricti ~n Loss ~, , m Head Sys te ~ TD~ ~ ~ Forcemain Length a Dia. 7/ Dist. to well ~ Cnll AQCl1DDT1llAl CVCTGM ELEVATION DATA county: St. Croix Sanitary Permit No: 479405 0 State Plan ID No: Parcel Tax No: 012-1024-50-100 Sectionlrown/Range/Map No: 09.30.17.130B10 STATION BS HI FS ELEV. Benchmark ~(~ -, s ~, ~j T ~CZ ~ ~ M ~v ` `~ Alt. BM ~ ~, ~ ~ '~ Bldg. Sewer ~1` ~ ~,~ ^ ~ St/Htlnlet 'L,~ ~~,q ~ St/Ht Outlet ~ ..~ Dt Inlet ~ ~ Dt Bottom `~ ~ ~S Header/Man. 7 ~ Q~) q ~`I' • J Dist. Pipe Bot. System : 3 ~ ~ q Final Grade ~ '7. St Cover ~. `'~~ ~ ~ ~ /3 (p, ~,a - ~ Q ~ BED/TRENCH Width / ° Length ~ No. Of Trenches ~ PIT DIMENSIONS No. Of Pits ~'""'-~ Inside Dia. ~~_ Liquid Depth ~ DIMENSIONS ~ ~ ~ ~ -~---.. - ,. SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer. , ~ ~ INFORMATION Type Of System: ~ i '~Z / Z~] ~ 51 ~ UNIT Model Number: ~ ,~~t-f a a nrc•Tnro~rTlnsl CVCTCIIA ic~-rin ,f- m -- ,«~ Header/Manifold ~I Distribution Pipe(s) ~ ~ x Hole Size \ x Hole S aciR ng \\ Vent to Air Intake C Length ~ Z Dia ~ Spacing Length ~ Dia cnu nnv~n _ .,_-_---__ ~.._._.__ .,_~.. .... ~e,.....a n. a+-r_.~.~o s.^crnmc nnrv ^ Depth Over Bed/Trench Center ~ Depth Over BedlTrench Edges 1 xx Depth of Topsoil \ xx Seeded/Sodded [J No Y xx Mulc d No es ~ ;`~ ~ ~ es , COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 1715 170th Avenue New Richmond, WI 54017 (NW 1/4 NW 1/4 9 TT°3 N R17W) NA Lot 2 i~ 1.)AItBMDescription= ~~\~ G~~~~" c~~1,ti, `~- La~2S 2.) Bldg sewer length = ~~~ ~ /$ / ~~ _ 1 I -amount of cover = y I CCCCCC777/// 1.17~Z` -mac , Plan revision Re uired. I : Yes ,_ No ~ e- ZZ ~J j Q ~ ~ D ~~ Use other side for additional information. '~-~ Date SBD-6710 (R.3/97) Inspection #2: / /_ Parcel No: 09.30.17.130610 O t/~. d }~ __ Cert. No. Safety and Builds gs ' ts' County ~ ~ l 201 W. Washington Ave., ~71~ /~j) /~ I S~~II SIII Madison, WI 53707 - 2 </ ~ Sanitary Permit Number (to be filled in by CoJ (608) 266-3151 ~ 1 5,l Department of Commerce stet Plan LD. Num r Sanitary Permit Applicati ~~~~~~ In accord with Comm 83.21, Wis. Adm. Code, personal informat n you may be used for secondary purposes Privacy Law, s15.0 1)(m) Proj t Address (if different than mailing address ~ i7~.~ / 7d d-l^. I. Application Information -Please Print All Information 3 r4.~~ Property Owner's Name ~T. CROIX COUN Parc # „1-ot # Blo # ~y~ ZONING OFFICE G ~~. ~'~ Property Owner's Mailing Address /~ roperty Location ~C/ ~~~ -(J(J ~ ~a~~~~Section City, State Zip Code Phone Number r~v II. ype of Building (check all that apply) `~i~ ~_ Subdivision Name CSM Number 1 or 2 Family Dwelling -Number of Bedrooms ~ ~ ~~ /j ~~~J ^ Public/Commercial -Describe Use 3 ~ ~-. Ce-1.x.5 .,,., ..~ is ~-~o f i0 ^City_^Villa ~, ~ ip of ^ State Owned -Describe Use i III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Z - Z ~ b ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System List Previous Permit Number and Date Issued ^ Change of ^ Permit Transfer to New Plumber Owner a t IV. T e of POWTS 5 stem: Check all that a 1 ^ on -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter Constntcted Wetland ^ Pressurized In- round ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recir /lating Sand Filter ^ Recirculating Synthetic Media Filte hing Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaUTreatment Ar Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevat' n Ca acs in Total Number Manufacturer Prefab Site feel Fibe Plastic VI. Tank Info Gal]ons Gallons of Units Concrete Constructed Glass New Existing ~.. t ~~ Tanks Tanks _ Septic or Holding Tank ,~ Aerobic Treatment Unit Dosing Chamber ~~v VII. Responsibility Statement- I, the undersig assume responsibility for installation of the POWTS own on the attached plans. Plumbe ' t afore MP/IvI%PRS Number Business Phone Number~ / J PJ ber's`N~ e (Printa~% ~ ~ ~ `~~ l ~fr'~ ~ -~ % J L ~~ ~/rnJ (/ 1~/~ Plumber's Address (Street, City, State, ode) y~/~ ~ ~L G~ y~ ~ VIII. C n /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date ssue Issuin gent Signatu e o tamps pproved ^ D~ Surcharge Fee) ~~ , t:~ /~ ~~ ^ r eason for D IX. Conditions of ApprovaUReasons for Disapproval I SYSTEM OWNER: ~ ~ b.~--; c~j~-(~Q~Z~"`-' O C` ~" 1. $eptic tank, effluent filter and dispersal cell must all be services I maintained as per management plan provided by plumber. ~-t~ 2 qM s~bsck requirerrbnts must be maMtained ~ per alppilc~IbN t:dd~ / ardirnna~s. Attach complete plans (to the County only) for the system on paper not less than 81f1 x 11 inches in siu A• t eplacement System B. ^ Permit Renewal ^ Permit Revision Before Expiration - SBD-6398 (R. 01/03) PROJECT Ed Fast P PLAN DDRESS 1715 170th Ave New Richmond Wi 54017 NW 1/4 NW ' 1/4S 9 /T 30 / 17 W TOWN Erin Prairie COUNTY ST. CROIX ~-- MPRS Shaun Bird 226900 8/11 /05 3 DATE BEDROOM CONVENTIONAL IN-GROUND P SSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. Top of Well ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL * H, R. P . Same as Benchmark SYSTEM ELEVATION 96.6/95.6/94.6 3' below grade 170th Ave Scale iS 1" = 40' 493' Property Well is to meet all unless otherwise Plans Designed Using Line setbacks required by noted Conventional Powts WDNR Manual Version 2.0 Tanks are to be ~g, O pumped and buried •operty D W ne ST Existing 3 Bedroom 60' House Huffcutt A1t.B.M Bottom of Combo Tank 20' Siding @ 101.0' 35' B.M. 50' 11% Slope B- 20' 55' 15' L~P~1..~- Vent 0, ~ ~ ~~ B-3 > ~ Standard Biodiffuser X5.5' Vents of Cover I-eaching Chamber 97.5' with 31.1 ft2 of Area 45' 6' Long 1 1 " 99.5' 3 4" Grade at System Elevation P PLAN PROJECT Ed Fast DDRESS 1715 170th Ave New Richmond Wi 54017 NW 1 /4 NW ~ 1/4S 9 /T 30 / 17 W TOWN Erin Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 8/11 /05 3 DATE BEDROOM CONVENTIONAL IN-GROUND P SSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30 ,BENCHMARK V.R.P. Top of Well ASSUME ELEVATION 100' Filter 7abe1 A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark 170th Ave Well is to meet all setbacks required by WDNR 78' 'roperty D W ,ine ST 60' Huffcutt Combo Tank 50' 11% Slope ~ B- 15' 0' 5' Vents 97.5' 45 99.5' SYSTEM ELEVATION 96.6/95.6/94.6 3' below grade Scale iS 1" = 40' 493' Property Line unless otherwise Plans Designed Using noted Conventional Powts Manual Version 2.0 Tanks are to be pumped and buried Existing 3 Bedroom House A1t.B.M Bottom of 20' Siding C 101.0' 5' *B 55' ~ ~3 ~6~J ~'P~1.~- Vent of Cover 6' Long111 " Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area at System Elevation ... ~ ~ J V ~~~ss ~ ^~~~~ X W Q' V V a V O 2 ` ~ ~ ~~ s ~~ s l i i i i i i i i ~ ~ » R r » s»= l i t i t i l i i ~ ~ ~~ ~ ~? » i l i l l i i i l t~ N ^~ $ ~»Y x»i- fii ifi i ii~ g g ~ ~ n .~ ~3 ~~ s i i i l i i i i i ^'~ ~ x s ~ s i i f i i i i i i M M~~ ~ N x~ i I I I i i i i i I I C ~~ ^~ ~ ,~~ ~ a ~ so '~'~~~ ~^~~~ ~~ ~ ~_~~~~ r.^ ~~ R~ X~ i i i i i i i i i i i~ ^~~$~ ~~~ i i i i i i f i i i i i ~~~~~ i i i l i i l i i i i i~ ~~$ M=~ i i i t i i i i i i i i~ ~ S 3 5t = i i i i i i i i i i i i N~ Y ~» i i i i i i i t i i i i i a ~ Z J NN ~ UOW d O p ~~ ~ J QZ N O J ~ ~ ~ ~ W ~ 2 N Y :~ ~ n H .n o R 4 m ~ ~. e ~ ~ ~ N N N O b ~~ ~~ ~1~1 R ~~ 1' N ~~ ..~ Ntfl SF£CI~ICR p TIaNS S£PTZC TANK 8£R CRflSS ~ FtJMP C~;hM , S£CTiaN ~tEATHEitP~t00F y== GI SENT PIPE IZ'* MIN_ ABODE GRADE ~ Ji12~CTZflN $DX AFFROV£D COVE~t ~ ~~j` FROli D40R. 4dINI?0~1 (1R WITH CflI+iI3Ui2 MA~iNOLE W / PAD Li)CK ~ FRES~* .~ IR ;NTAKE „~ ~ ~ r ~' ~ ' r~ yiARN;NG iABEL PIl3~ ~"t~ GRADE -o ,rv 9 ! ilp ~ ~ ~ ~,~..,,,4'= MIN. ~~ t f %..... ~ _ .x, a. `_ ~ u ZS M1N• •*pp Tf~ SV" ii-• - - _ a _ ` :. _ . iniAT£R TIGHT SEALS ~"' C,AS- ~ , TIGHT j ~pp~lEO ~ SEFsL. ! ~OI1yT51~IT1i ~f LT ER ~ < i ALM APPROYW PIPE APPi~VED ~ B -;-- = - i~ 3 0 ~ St~i.IQ SOIL PIPE 3` c r _ (fit} SQLTD FT t?FF SOIL p~#f~P {yFF EL£V -EL=-~°_ ' ~ ~"`__ TAI+~IC ~ ~'~ APPROVED BEDDZHG UNDER ,~~ _ OISiCRETE PAU =.CIFICATIONS ~ l J y'~~~tr-Q S P.. ~/ v`-~-t-~ hlUi'fB£~ ROSES ?£R BAY = SEPTIC f DOSE Tl+,ISK MANUFACTURER' ~ _ I305E VO*_~7ME z15iCIJt1DING C/~'~ ~ GAL- _ GAi.. g ~,pj„iBAC K TANK SIZES = DpSEZe ~ GAL. = 3~~- ~AL- ~~~ INGHE5 ~.- CAFACITI£S: #+, GAL. ALARi~t MRNUF~tCTS3RER;a _ 8 = ~ ~ Ii~fCHES = q~ ~-- MODEL i,KiKB£R = Grua- ~- ` ! ~~ ~ GAL. $y~x'!`CH TYP£: (~ ,C = ~ ' '~ INCHES .___~_..~- pl?HP MAi~i€JFI~CT~JR£K: ~~ II = ~ ;HCF~ES = ~GAL- KQDEL NUl48ER = ~ ~~ CL. ~~ Z5.23 wxc ~;TCii TYPE= `-' ~ !SP ~ ALARH j,TIRZ iJG AS PER I L~fR GPM w~EET REt~IRED DISCHARGE RATE _~_____ E:ET VERTICAL I3IFFERENCE ygET~rTEEK PUMP O£F ANB DZST#tIBUTI(3N PIF£` . + MINIrit3l~i NET~,TORK SiJPP~~ XR S~~FT/ ZO Q ~ gT, ~ FR;CT~~I~p-~T~ ' _ ~ / ~---FEET + Q FEAT FORC ~ TflTAL DY '' D I AM ETA ,____..- I,£NGTFT [ ~ ~ WIDTH FNT~iNAL DIMENSI~ -~~ ~ ~'9d~ gR~£= LfCENS£ i~iIMB£R= S FGPtED: if&8 ~. Wisconsin Department of Commerce Division of Safety and Buildings _ Qp - ALUATION REPORT ....~., ...uti r•..~_ o Page of Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County > ~; ~ " indude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. . . d~Z -~(J - S n .-/'~ Please print all information. Revie by Da e Personal iMormation you provide may be used ror secondary purposes (Privacy Law, s. 15.04 (1) (m)). $ / ! ~ s r Property Owner L ~ ~.c./~ ~ ~2 ~'yC. Property Location Govt. Lot ~ 1/4,~~~ /4 S ~ T n/~ N R ~E (o W Property Owner's Mailing Address ~ r~ ~ ~ ~~- ~' Lot # ~ Block # --- Subd. Name or CSM# ~n i ~ a.3 Cily State Zip Code Phone Number 2 ` i ' ^ City ^ Village Town a rest Road ~ ~/e~ S Dl ( ~ ~ , ~ ~~~ti~ ~tew Construction Use• esidential /Number of bedrooms ~'S Code derived design flow rate _~,s-?7 GPD Replacement ^ Public or com erda~l -Describe: ________ ___ _____ ___ __ ___ Parent material C7 c.~~LC/c:e'~ Plain elevation if applicable /t//~- ft. General oorrnnerrts and recommendations: ~~ • ~ ~ j -, ~> ~Lf` Borifig ~ ~ ~ Boring # Pit Ground surface elev. ft. Depth to limiting factor ~ U (/ in. Soil lication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. MunseB Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 O -1 3/ ~ ~- ~S/ ~ ~ -- ~ ~ , ~ Z -a~ / s =c ~ ~ , v ng Boring _ y~ Bon # ~ pit Ground surface elev. J r i/ ft. Depth to limiting factor ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Z / Gr~ ~ S L ~ S /~ l~ •^ O G i l/ ~"~ ~ / / t - r=muen[ si = tsvu ~ su ~ [tu mgiu ano i ~ >3u < 15p mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 nxyL CST Name (Please Prints - _ Si '_ CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 8-- ~~J J 715-246-4516 Property Owner Parcel ID # Page of 3 Ong # ~ Boring L pit Ground surface elev. ~ ft. Depth to limiting factor ~~ in• Soil lig6on Rate cri tion D R d Texture Structure Consistence Boundary Roots GPDIff Horizon Depth in. Dominant Color Munsell p es ox e Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ L ~ ~ ~ 2 ~ ~---- ~ o~ Yn ~~` ~ ~' ~/ ~ ~ 3 ~ ~6~ ~•~yl ~ .S 0J ~I ~~ ~ ~ a Boring # ~ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor )n• Soil lication Rate t Cd i Redox Description Texture Structure Consistence Boundary Roots GPD/ig Horizon Depth in. or Dom nan Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Effif2 o ~rin9 Bonng # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil ication Rate i tion D d R Texture Structure Consistence Boundary Roots GP D/ff Horizon Depth in. Dominant Cdor Munsell p . escr ox e Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BOD; > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 =GODS < 30 rnglL and TSS < 30 mg/l_ The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8)30 (8.6/00) Property Owner _ Parcel ID # ng Bori / h l - Page of ~~ ~ ~• _. _ _.._ __..___ _._. ~ v~...~ w ~w~ w•.aan ~ n~. Sal ICBtron Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft? in. Munsell Qu. Sz. Cont: Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z- 3 ~ Z-~ ~ ~ 6 ~ . s a ~ yI _-----~ ~ ~S s6 0 ~ ,n I ~ ~ ~ D ~ ~ I I Boring # ~ Boring I n _ ..~.._~ _...~--- -,- Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/if in. Munsell Qu. Sz. Cont.-Color Gr. Sz. Sh. •Eff#1 •Eff#2 a Ong # ~ Boring Pit Ground surtace elev. ft. Depth to limiting factor in. Soil icatron Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • Effluent #f = BODa > 30 < 220 mg/L and TSS >30 < 150 mgll • Effluent #2 =BODE < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seo-e»o (R.~) Soil Test Plot Plan Project Name Edward Fast Shaun Bi Address 1715 170th Ave New Richmond Wi 54017 _ #226900 Lot 2 Subdivision -------- Date ~/05 N W 1/4 N W 1/4S 9 T 30 N/R17 W Township Erin Prairie Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Well System Elevation 96.6/95.6/94.6 *HRpSame as Benchmark 170th Ave Scale is 1" = 40' unless otherwise noted 7s' O ~ roperty D W .ine ST 20'. I ` 35' •1 55' 0' B-3 97.5' 45' 99.5' Existing 3 Bedroom House AIt.B.M Bottom of ~ Siding C 101 ^* I \B.M. 20' 493' Property Line ST CROIX COUNTY SEPTIC TANK bsA1NTg~NANCE AGREEMENT AND OWNEgSH~P CERTIFICATION FORM pwnerBuyer Mailing Address ..! 1L-`~ ~~,A~e-_ ~ ,Y" property Address -SQ ~^'`~'~ {Verification required from Planning Department for new censtruction) Parcel Identification TIurnber CitylState GAL ~~CgIp'r10N q ,r -~ C~N-Rl2w~ Town of .~ ~ , ~ / j,,pGatlOn y~C.~~a, /v Lt/ ~~a, SeC / ~~ ~oP~3' .Lot # Subdivision Certified Survey Map # ~~ Page # ~ ~~ ~ Volume Volume ,Page # Rrarranty Deed # p no Lot lines ident~fiabl~e•;~`- SYSTEM 112AIN'I`ENANCE retnature failure to handle wastes. Proper maintenance Hance of your septic system could result in its p `Rlhat you put into the system Improper use and mainte ears or sooner, if needed by a licensed pumper. ~ ~p~pmg out the septic tank every three y the waste disposal ~n'- can affe~ the function of the septic tank as a treatment stage in b ~ owner and by a to submit to St. Croix Zoning De~~t a certification form, signed water disposal system lumber or a liceasedpumPeT verifying that {l) the on site waste 1C3 ~ of sludge. .~ pre~ty owner agrees is less than masterPlumber, Io~eymanplumber, restrictedp on and pumping {if necessary), the septic tank is is proper operating condition and/or {2) after inspects with the ~~~ ~ ~ agree to maintain the private sewage ~m ~~"ication I~ ,~ undersigned have read the above requireme nt of Natural Resource. State of Wisco O ~ ~~ 30 set forth, herein, ~ set by the Depar~nt of Commerce and the Departure ~ the St. -Croix ~~ zoo maintained must be completed and returned stating that your septic system has been days of the three Year' expiration date. ~-'~ ~_}~ ~• ~ DATE SIGI~IAT(JItE OF APPLICANT Spec house ^ Y~AO O.w~, R CERTIFICATION our ]mowledge. I (we) certify that all statements on this formdeed~recorded ~ Registmer of Deeds Office. the property described above, by virtue of a warranty z- ~- _ I (we) am (are) the owner(s) °i' ~ /~~ ~~~~ DA'T'E SIGNA'l~E OF APPLICANT ent. "*~*~ bon that is mss-represented may result in the sanitary pernut being revoked by the Zoning lkPartm ststss j,~y informs lication: a stamped warranty deed from the Register of Deeds office ~• Include with this app a cePy of the certified survey reap if reference is made in the warranty decd Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 C cy Plan ption #1. Ifs tem fails, determine cause of failure, use alternate area and install new ' ested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 DOCUMENT NO. `~ 9T:\TN: hAR OF ~~'[tiC 1Y51Y FORii 3-1982 48218 uu~T c~ M DEED • ......Edward._B._.Fast and,Ar-gene R._Fa-$t,,.husbanc_ .-... ._4nd..wife, as marital prgparty with.ri~i!ts.q.f ._. . _.survivgr~hp... _._. _. __ .. .. .-.. n,~it-claims co _-.--Greggry_A, -Demulliny-..and,.D-iane. -L_..- -.Demulli.n ~ - g,.hushand and wi e,. as marital property, with. .. C'i_ghts of..survivorship.- the !gl!rn,~in de~crihed real estate. in ... St ..Croix... --------------- -county, State of ~Vi.conain: TNIb SMC[ R[3[RV[D -pR R[CORDINO DATA ' REGISTER'S OFFICE ST CROIX CO., WI Recd for Record APR 1 ? 1992 ct 11:00 A, M Reg(ster d 0~ 1'ux Parcel No: A parcel of lanr' lcx-atPCi in part of. t}~e *Iorthwe~t Quarter of t'ie N~rt-!wpst Quarter fNFI} of NW}) of Section Nire (9) , Towns'~ip Thirty (30) *North, Range SAVPnteen (17) West, Tam of Erin Prairie, St, Croix Count~~, Wi^consin; being part: of C^rtifie~': Survey Map recorcieca in Volume "8", pzge 2343 at t'ie St. Croix County R~giGter of Deeds Office, further descrih~ as follctrrs: Corr.>r~ncinq at the WPSt Quarter (W~) corner of Laic' ^ection Nine (3) ; thArce North ' 00° 36' 34" West, a'.onq tha WA ,t lire of the 1'dort'~wN~t Quarter fl`7y'l~) of Gain' Section, 1324.79 feet to the Sout'naest corner of sai~' CFrtifiea ^urvev Map; thence continuing North 00° 36' 34" Ih'ElGt, al~nq sai~? West linC', 3.49 fit; t'~enc-e NoY+:~+ R7° 1R' 09" East, 704,15 feet' t'~c~nc~ Ncirth ~8° 1?' ?.8" F,~~st, 03.7 font to tha point of beginning of this description; thanrn ~r:ntinuinq No'±`~ RR° l?.' , R F.~nnt, 50,00 feet; thence North 02° 22' 04" 6;~s*_~ alnnc? t~ ~~ East ling ~~ ~:ai~' ~c~rt.i~i~' ,uroc~v ~+ap, ~1fi6,C,2 feet; thence Sc,uth 67°'24' 0"' FJ~+~t, <t'onq t'~? nort~,e~-~v 'ins or n31,i Certifies' Survey Map, 128.07 feet; tt~nnrA S~~~tti 0si° 3R' ?~" F'<~Gt, 2?1,~2 `~t• t`rence South 12° 39' 4R" iro'E,~t, 1F4,?q feet to t`~~~ point of t~Yrir.r.irq, Parse' is t~ he r?e~~~ tr, ;,r ,~-^inin7 ~x.T~~ ,,-~,~ ;.~.,~-,;nom 1. icr~~• ^~~r.-~i ~~ .,~;_n GtL~",~F~r~t to tcx~m ,-r:,-_~, ,-i~7-•t-n:'-w,~; (!"n-' n~•r•n,,_i ~,1, ~. crr~ . r.~. is not ,,,...-,;,a ; ~;~, i,:rt, -~ : ~%~~, J.r, r ~h:.\L! I ;. \. ~3GTEiFN'TICATI0:7 ~ier.arr~r•~Isl ~r <<~~r:~~. ~ _ ~•. ;;.plc ,,. ~,c ,~~ "FI~;STRA, VAi, DY(:. r, ~iEF_DHAf'., S.C. ZC;r ~- Knowles +e.•; t i r_h,r,und , (~!i scons i n ~4'l l ~^>~.. i ' ». .~ ~~.~ alarefr - i~' • - 92 . ; .+ i~F::\L~ Edward L. Fast - - - f _ ~ Arlen? R. Fast ACKNOW t.LDG;VIENT 5"GATE: ,)(~ 5t"I~iu\~I`; , Edward E. Nast ar.d Arlene R. Fast SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify that.by the direction of Edward Fast, I have surveyed, described and mapped the land parcel which is represented by this Certified Survey t4ap; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in the NW of the NW;d of Section 9, T30N, R17W, Town of Erin Prairie, St, Croix County, Wisconsin; further described as follows: Commencing at the NW corner of said Section 9; thence SOOo36'34"E, along the west line of the PdiV'~ of said section, 1024.20 feet to the point of beginning of this description; thence continuing SOOo36'34"E, along said west line, 300.59 feet; thence N87o37'S6"E, along the south line of NW's of the NW~d of said section, 858.00 feet; thence N02°22'04"W, 492.6'L feet to the centerline of the town road (170th Avenue); thence S67°24'p7"W, along said centerline, 167.93 feet; thence S74o27'31"W, along said centerline, 172.58 feet; thence S77o21'51"W, along said centerline, 531.68 feet to the point of beginning. Above described parcel is subject to right-of-way for town road (170th Avenue) as shown on this map and subject to all easements o€ record. I also certify that this Certified Survey Map is a correct representa- tion to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. ~"+y°- s ~:'~ ~~~ ~ n~ ~ ~~ ~~ ,~ 1':::i ..1 i~ VOLUME 8 PAGE 23A3 ~PJ ~.q '~~a,..v^"~~-i~~t vy '`~,~~. `N4 .S t1 Fa ~ F. ~~~ .~SSedG%'htrw~%''~ .s Z ~~ ~ ~, 9 f'?'7'35 APR O 1'~"~~ a ~ • ~.._. ~ ;'' rn : «.. r w ... w ,... r o, a o~ m o Y -n o w o -' d w rn° O ~? ~ ~" -~ r a n i n m ~ v edi ° a~ ~ m ,N„ IT) O a s a s H a m a ~ ~- m~ ~ :° ° ~~-. 'aD v x ^i y a c= s rt N c7 e.> c-~ n s ~; oo x p T ~ ~ m '~ ' o C/7 +" r r ~ d S O O O C '~ a0 N A C' `~C ~ 4l1 ~ ~ _N ~' L O = O h Z t K ~~ ~v ~ ^ o. s x s ee rn n = ~ O = = E fC ~ N ~ N• S ~' b A A O ~ ~ ~ O eY Z 1 • !{.. • .p Unplatted Lands .- ~' o ~+ N ~~ y X A 40 if C'f 1-h O / C O~ > > Mest line of the NW} of Section 9 °' STREET ~ ~, o. S04°3b'34"E 170TH S00°36'34"E 300.59' _ ~ -" SOOo36'34"E H ~- - ~r ~ ^ e~ 132k. 74' ~- ~ a' ~ 266.85' 33.7 ~- 1 1024.20' ~_~ x N ~ s ~~ o -oi ~ ~° ,33 +J3', o ~ b 7 > > -Oya A , , , ~o rs 0 nl J J_ .t (-~ • ~ I- W O 01 0 ~.-T w ~ `~ ~! o ~ '~ N tT ~~ ~ c.f~ .+ '~ ~, w ~ ~ ~~ o m ~ ~ 1'O O m i v' ~ v 1 , ' fi .' '- i n ~~ rn N02o22' 04"W 377.76' ~ s ~~ r = H i c o~ `~ 6' ~'~ 344.22' 33.54'-r .n ~yt ~i o- a A O G l V' N I W eT N S l ~' l f'~ N 'f j d N ~ d ~ ~ 1 G ~ Y ~ p=j.. rt ~ O ^ o ~ ~ w ~ ~ d rt 0 r r~ ~ o m S = r' o ~\ N 2 N ry ~ O J ~ r ° S = N 2 H ~' j G) ~ CP_ O N A 0 0 ~~ d 3 a n y ~ t C ~ ~. N ~~~ an n. o r w « r a+ r\ r o\ G'ta0 ~ f .=o ~° J,~ O'er ~ O~s Bt N ~ °~ ~ ' ° a 'r'°. ° Z 1_ s' 457.45' 85. 17~ y ~ \ k b, •~. `~ ~i `~ ~ _ N02°22'04"W 492.62' ~ ~ 6~ ;a ` ~ q ~ ~ ~ ~~ ~ ~ a H ~ o ~ t~ i :L ~~ r. ° A-PPROVEa Unplatted Lands v,_`~y. ~ `f ~. i.3 ~ `'a.:~~ a :. 'r. .. ..~..E~j ~L- SEP ~ 7 1990 VOLUME 8 PAGE 2343 ` . , ._; .;~~:^~' N ° oo ~°c .: ~. Parcel #: 012-1024-50-100 os/1s/2oo5 09:46 AM Alt. Parcel # 9.30.17.130810 PAGE 1 OF 1 Current X 012 -TOWN OF ERIN PRAIRIE ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Per it # 00 m Permit Type 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-owner EDWARD B & ARLENE R FAST O -FAST, EDWARD B &ARLENE R 1715 170TH AVE NEW RICHMOND Wf 54017 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 1715 170TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.010 Plat: N/A-NOT AVAILABLE SEC 9 T30N R17W PT NW NW BEING LOT 2 CSM 8/ Block/Condo Bldg: 2343 3.01 ACRES EXC PARCEL DESC 918/101 &EXC PARCEL DESC IN 946/39 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 09-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 946/39 07/23/1997 918/101 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/15/2004 Description Class Acres RESIDENTIAL G1 Land Improve Total State Reason 2.010 8,000 139,200 147,200 NO Totals for 2005: General Property Woodland 2.010 0 000 8,000 139,200 147,200 . 0 0 Totals for 2004: General Property Woodland 2.010 0 000 8,000 139,200 147,200 . 0 0 Lottery Credit: Claim Count: 1 Certification Date: Specials: User Special Code Special Assessments Total 0.00 Batch #: 110 Category Special Charges 0.00 Amount Delinquent Charges 0.00 ~~ Plb,. x}67` 10/69 A. OWNER OF PROPERTY Name Lid+- ~ .., ~( ~TION OF PA(~PFi Wisoonsin Depart,nent of Health and Sooial Servioes Division of Health PEf;i•IIT APPLICATION i' for ~> b PRIVATE D~STIC SEWAGE SYSTEMS O/ ~ - /O 2~j .J~ ~ U TYPE OR USE BLACK INK Add~rCess (Streets City Zi~od ) RE SYSTEM WILL BE CONSTRUCTED ALTERED :,R TENDED County ~.+vun ones CITY' TILLAGE LEGAL DESCRIPTIONS ~~~ ~4~` `'~~ ~ r ~ TOWNSHIP /,,'t~ ' • ~~/ BC~ /• <<, ~ ~~/ ~i: ~ ~ ~/ ~ ~~ ~~ , C. IS LOCAL PEFd2IT REQUIRED FOR THZS kO RK? ^~ yES NO PERMIT NUMEER D. SEPTIC TANK. CAPACITY ~ ~-(~ Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALS; Prefab Concrete ~ poured in place Steel Qther ~- DIUMBER OF TANKS TO HE I1'iSTALLEDt /~~»-LQ • E. TYPE OF OCCUPANCY Cheak One; One or Two Family Residence /~ Commercial Industrial Other ~-7 Number of Persons to be Acaortunodated '`~ 1Speaify Number of Bedrooms F. AppLIANCES, ETCj .Food Waste Grinder .~ YES NO Automatic Clothes.Washer Dishwasher ~ YES NO YES NO Automatic Potato peeler YES ~- NO Other (Specify) G. EFFLUENT DISPOSAL SYSTEM NEW ~ EXTENSION ADDITION -- Tile Size ~ . REPLACEMENT No.Lin.Feet~_ Trench Width ~~~ Depth_ _ Number of Lines`_ Seepage Bads Length Width Depth _ Tils Size No. Lines / Seepage Pit= Inside diameter''- Liquid Dept. P Y R C O L A T I O N TES T est Depth Character of Soil Hours. Water Test Time Dr~in Water Level Inches Minutes umber Inches Thickness in Inohes Since Hole Sn Hols Interval Second to Next to Last To Fall s~.._•_ ~ .1St W@tted Qvw..nivl.+ ~.. n...`.~.__ '- _ _ ~ ~~ - rv ~c=1 l0~' Cla 26" * 25 es or no 30 1 2 1 2 1 2 6p ~ ~ ,. ~, ,. ~.1 `~ / '' Q i.7 Y /U ~ ~, A~7 ., •. /G~ ,i 7lJ RECORD DATA FROM MINIMUM OF 3 TEST HOLES ompute size of absorption are.. in accord wit h H 62 20 W1 . 9. Admini stra„ive Cods. orLZg S OIL BORINGS -Minimum 36" Belon pro osed Abso tion S atom Total Dspth Depth to Ground Wat umber xampls er Inohes Observed Estimated Depth to Bedrock Observed Estimated Character of Soil with Thickness i I h - p 72" 72n n nc es I .- Black To Snil 12"• Cla 18"• Sand 18"• Gravel 24" '; 3 ~ ~ +~ ~~ ,+ / ' ~ ~ ~ t RECOAD DATA FROM MINIMUM OF 3 BORE E#OLES _OMPt ATE OTftCR crn~ Y f , I, the undersigned, hereby certify that the peroolation tests reported on this form were made by me or under by supervision in aooord with +,he procedures and method specified in Chapter H 62.20 (3), Wisoonsin Administrative Code, and that the data recorded and location of test holes are correct to the best of may knowledge and belief. n NAME ~~,..~ 1 ~ L -~ C~.1 f` ~ .~ r+~IC TITLE (Type or Print) REGISTRATION N0. or MASTER PL[1MBER LICENSE No. .S C ~~ ADDRESS ~ ~ GCS / G %~~~~ ~ ~(L~ ~) DATE _ ~ -- / -- ~ ~ SIGNATURE rT1 MAS'PER PLUk'G3~'R MAKING APPLICATION 1 MP Signatures ~~ Lioensa Numbers ~~~ ~., MP RSW (To be Completed by Issuing Agent) / ~S Date of Application _--- i ~ -I~ ~~~ Fee Paid $ / ~~ ~~(! Permit Issued (date) ~ ~ ~~_ permit Number ~.~' l/ .~ Agent (name) '' 3. For• j" ~.~ Town, Vil age, City, County, eta. (Speoify) Notes .The application oannot be considered for filing until all of the above questions are answered and the fee paid. Agents x111 forward application, the fee of $10.00 and Copy (b) oP the Permit (yellow Dopy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not xrite in space below ~ FOR DEPARTMENT USE ONLY DATE RECEIVED / ~- ~ U ACCEPTED HY ~'~'~ RETJRNED (Initials) (Date) SGee Coryreps. FEE RECEIVED t-~ VALID. N0. ~~ ¢i~0 PERMIT N0. / J~// .. (Yes or No) REVIEWED BY APPROVED DATE (Initials) Yes or No) COMMENTS : ~' //~~ , a . .~ / ~L!/ ,,,~ , 9 - d~,o - i 7 Pf ,L y. ,IrU.J ~liir~ /.~~ti i ~ o /Jj ~/,1~'~3 .' ~ 3r/~~ APR 01,~~~ - JAMES ~ . . '- w :~. r ~-. r- w r-. w ... r- i~~.. d a+ O N m o p -~ w r o r+ W O) ~-1 ~ x a m 'ff '"r W W cn H t ~O = D_ ° cn t1 i~ o n~ Cf OD v r. ~-. A O1 t1 Ol . ~ 0 0 z ~ i ~~w a ~ ' ~ y f1 rrr ~ ~ A N f• N A N (p N ~GiJ S W Cf ~~~ N~ N d N d N .C~ CrJ H O X a ~ O ; ,o K x m .. .+ d n Cn 7 N m ~ N N OD X H O t~ '71 f'! C7 t l C'7 S N ~~ rt In d ' ~' S C C C C ~ 1C N r - B N M Z .'- r. N o 0 o v ~ r o f D ~ ~ ~ a z °' A v i d rt ~ o o ~ o v ~• 0 0 0 ° • a a a a ~ ''"' ~ . . o 0 0 0 0 > ~ ~ >~ c ° O ~ a ~ ~ m ro m ~ ' S aE S S ~ Vf 9 e ~ ~ rt O ° 0 0 rt i o w rt z i o ~ ~ Un latted Land ~~ T ~ g p s --..-..---- --_.-- ~,., 7 7 a lG __- ~~ ~- ~ STR EET West line of the NW} of Section 9 ~, -- - ' 170TH S00°3 6' 34"E - S00°36' 34"E 300.59' __ __ - ' S00°36' 34'~E ^ ` ~ - - V~ ~ - ~' 266.85' `~ ,~ ,~. 1324.79' ~ 4 '- 33.74 ~ , 1024.20 x ~ rt C'f N . n _~ ? f a3~ 3~ / ~ ~ r ~ ° ~ o > > io ~ ~ ° o ~ ~o ~ ~ ° 1 0 1 A ~ 1~ fi c. is d IN o° Cn n o H z o H 0 /V b O ~. o OzD C V rt o ~- w r v~ V1 ~ ~ A m o -f1 O T ~ S O x - +~ 0 -* S x 0 -+s N rt ~~ O 0 w -r r w o o ~ z sv rt ~ d v ~~ s ~ ~1 d O ~ t rt 7 O O ~.f '+f r+ m ~ ~ x ~ ~ n, o ? • -•, .-• rt A T N Vf 2 rt = .w n o ~ -n 0 y X N A (7 R ° 1+. C ° rt ~ ~o r ° ~' m ~ J ~ ~ Q rn O ' N ~ ^' W w N. ~ , .. ~ v N ~ o ~ ~ ,• °' / s'~ _ w , ti~ ~ ~ .~, ~ ~ o ~ ~ \ - ;~ ° m - )f I ~ 1 / ~ r 1 ~ 1 n A rt ;J` 11N r A O• N02°22'04"W 377.76' ~°` ~ ~ ,r a ~ : e' Q 344..22' 33.54' ~ p J ~y 1 ~G ' a 'IN d N N '7 1~ ro ..I ~ 1 G H -n d ~J ~, ~r'1 N A d 'f ~. ~ K ~ o ~ '` ~ ~ o. Q N ~ ~ d rt r s o O r~ ° ~ o s o . ~- ~ ~ e.-~-" cam', w °: `~' = rn r`o ~ ~ - ~ ~ w rt r m o c sw -~ i' t,~~' `: f 35.17'== ~ ~~ s 457.45' / ~' s ~ ~ ~ N02°22' 04"W 492.6j' ~, ~ 66` ` C ~ •` b ~ .~ ~ ~: ', .Y ,`n .ti Unplatted Lands ~~, ~• ti .e" 'r~~:= l: .sq SEP 17 1990 VOLUME 8 PACE 2343 ' '~ :. ~~.,;,,.~~,""'' Sl'. Cl~ODC COUNTY COMPR~it'NCl1+~ PARKS PLANNING; AND ZONfNG COM-vNTTEE f-7 m T m d C rn 3 -L7 s~i• `~ _ti i `1 . ~ `j t •_ ~J . ,~ ,n Y ~, a s '~'