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HomeMy WebLinkAbout038-1141-80-110 Q ~ > tv N C ~ I t~ X VV N O C N I y L C rn z LO N M N N \ 0 Z C Q \ U. E N d M oz~ M z y co E U) Y 00 Z N d w a m m H Z o I O Z d c o w a> Z C CO F- m m Z C E 'a N O N CL 7 • N N O O O O N d Z co z O Z N a) j = c £ N N ~ 0) CD 0 IL V N_ N C O O CO d O O O `o G G a o A N N (n U) ~ w O O Z N >0 I (n F- U) N N d O I -6 3 3 3 Z O O E a. a. a. a -ro- cr- 0 0 o N rn rn O to V 3 rn rn Z N N CO N > Lo Lo N Q O O ,-y 7 CO W j d ~ ~ th N O LL'1 ~ h•i a a d ui co w d t0 l~l O M 7 _O O N C O E v O 0) F- _a) r \ 00 U O O O O C 'p N N N LO ) V W C N N C 4 m rn 0 O o OD OD M 1: Z Z LO LO co M ~p L O E E L ILO r ik w I, E V d ~o £ a 3 #t a L: IL rw• a u m 0 t c Q 0 a 2 0 in u `Parcel 038-1141-80-110 11/14/2006 10:50 AM PAGE 1 OF 1 Alt. Parcel 35.31.18.579D-10 038 - 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 - RICE, WANDA K WANDA K RICE 1239 185TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1239 185TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.110 Plat: N/A-NOT AVAILABLE SEC 35 T31N R1 8W PT NE SW 1.11AC LOT 2 Block/Condo Bldg: CSM 8/2194 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 11/26/1997 569071 1279/229 QC 07/23/1997 871/61 07/23/1997 868/279 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.110 25,800 134,100 159,900 NO Totals for 2006: General Property 1.110 25,800 134,100 159,900 Woodland 0.000 0 0 Totals for 2005: General Property 1.110 25,800 134,100 159,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 122 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 Dozp_ State Plan I.D. Number: N0%, Spl%, 35, 31, 18W FX CONVENTIONAL ❑ ALTERATIVE (If assigned) Town o6 Stag. Pttat4ie ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound L M 5 PER T H ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Gten Johnson 40 Petelcson StAeet, Houtton, W1 54082 ; BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. E-LEV., CST REF. PT. ELEV.: - 11 Name of Plumber: MP/MPRSW No.: gCounty Sanitary Permit Number: John P. S Fiona 111 3212 SEPTIC TANK/H8hB . -10 ~ Wta,- kot, - MANUFACTURER[:~ LIQUID CAPACIT T ANKOI~k~T ELEV. WARNING LABEL LOCKING COVER e PROVIDED: PROVIDED: 9 Y. 7 YES ❑ NO ❑ YES NO BEDDING: DIA.: VEr# MATL.: HIGH WATER NUMBEPRPBUILDING: VENT ESH • C . ALARM: FEELINAIR INLET: ❑ YES NO C F '"G ❑ YES NO NEA DOSING CHAMBER: MANUFACTURER: BEDDING: LIOUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURE*RAO ING LABELOCKNG COVER IDEDPROVIDED: w ❑YES ~NO C ~ ES ❑ NO YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OWELL: BUILDI G: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM AIR INLETPUMP ON AND OFF YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: ERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: N0.OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID ~5r Is- TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS a2J GRAVEL DEPTH FILL DEPTH DISTEPIPEjulb TR. PIPE DISTR . P PE MAT IALNO. I TR. NUMBERTY WELL;BUILDING: VENT TO FRESH BELOW PIP S: ABOV CO ER: ELEELEV. END: Ef !Fj ~1) j i) PIP : AIR INLET: ci~D~o~ 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 BE LOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST ~ ~n~LI..I~'1. ~-Y I'Yl GC,''s/'.i~. 7L.[Xl V~-'.n'~ .E.{,~~ f,~ i},{ 1Ga/"✓-`. ~ X~C/ . Sketch System on in in county file for audit. S~ Reverse Side. SIGNATU TITLE: A S5 is SBD-6710 (R. 06/88) } ZOnin A miniztn h DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUN STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than /S 8% X 11 inches in size. ❑Check re sion o 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 G /e..t 36 ~K Q-6,4 I)F_ Y4 S(t Y4, S SS T 34 , N, R /18 E (o W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # ~Ao s~. CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 32 77/ ' -"05' :Z9 O G 2 II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE NEAREST ROAD ❑ Public I4 1 or 2 Fam. Dwelling-# of bedrooms PARCEL AX NUMBER( S) III. BUILDING USE: (If building type is public, check all that apply) 679 0-/0 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. New 2.E1 Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.E1 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 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 SC7 76-0 -7.570 Cv { 7 q`/ feet 96"11' Feet VII. 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 Septic Tank or Holdin Tank 0(~ Did S Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) M MPRSW No.. Business Phone Number: I%L Plumber's Address (Stredt, City, State, Zip Code) Z 75- B/W c, ~ 4 7Z IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued issuing Agent Signature (No Stamps) U Surcharge Fee) Approved ❑ Owner Given Initial ,e/ / S . 6 0 S ' 9 _ 9d Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-8398 (formerly Plb-87) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber o INSTRUCTIONS f 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. Vlll. 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 fortn; 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 8TC-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 le-', 7A Location of property N~ 1/4 1/9, Section LS W Township r t'ra~ 'r'S~ Mailing address `~Up,rs Jc-~ _ Address of site ,)EcJ roc-I_~l~~l Subdivision name Lot number Z Previous owner of property Lj Gi i4L .-e If/ J~ca eo_ Total size of parcel cg-Q~ Date parcel was created ; H _ t7 19 Are all corners and lot lines identifiable? es No Is this property being developed for resale (spec house)?-X„_Yes No Volume _and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, 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 warranty deed recorded in the Office of the County Register of Deeds as Document No. 4EY c 7y l;~) ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been du y recorded in the Office of the unty Regis r of Deeds, as Document No. Signature 6r-Owner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature J • awR frl~AOIOOIMIS nrss ,S• hoop Aoi>•rt M~ xrwlst Brian ~1 ~!,c«"~3.s~-w~ lbuttia,~- as Dew AMIS .a>~~n +M'.weaaa. r u. Sa£ricia''1~1. 00 8:30 ~ i 1l~...» roperty d , P.:»~tlK.#its..A...At.7t08~txlP.R 81s~Mr~f~li' y ,~/'!klw .'.Y'.w«~«»».........»....-_..«...._...•_»»--..--».«_..»..............».....-» « « . - 9.r `.i...l.. «.......»....«...w..«»»..«......... 2%z Food Not .i St the Met, goar< M (MD COM r of Section 7hirty-five (35), WWAU6* fdCtr- i 1 , RMP Ei*A&M (18) Mast; theio South 88. 46' 37" East, a1aa8 the Let E = bec line, 1,991.54 feet to the Point of Begi:us j thmoe aaltimdnq 8oath X6''31" Let 41ow add quarter line, 40.00 fiett thenos South 020 40' 07" Mot, j thme Mwth 880 461 37" hest, •40.00 feety thence Mocth 020 40' 07" East, 3aet to the Point of Hegiii>tlin . meaning to =r ey the want 40.00 feet of tct °t7rtctifiied Survey Mep filed Mntcch 17, 1990, in Volume 08" of Certified survey NKS, 229y, as Dm11 mt No. 456928. d ~ k ti ' 1 W (is no w: y s. r I .....~s6 ryr of ews„i„j{,•••••/.... 1R.. 11 (SEAL) :t~. T ..SEAL) • M'.. 1' I' M . ~3er e .l..«.... : AQl1;~aTTIOATI I1 ACKNOWL■DO>tlBUT STATS OF WISCONSIN « St. Croix MMWi ........iq oi..._. U...... taw bdoeo mina thi,..16th ...a" of w«.w«................................. .........-&=U 19.9.0.. too abm mod ~ ..iJ~effrny...S....0ahnstsan+...8abert..~r,~....... ».»--._...,.w.w....««.........» 'P1TL~a XMKM STATS "It OF WISCONSIN Y suft.e~ ' by KKK Will, ::,Iah~a~tan-.and..,lames..ht_: to mo known to be the I , .a......... who e~.eatod jhe h to inotrument adcnowladp the _ nun wanRuss=uT wws oowIRrso or " t rA&..YA11..Dxk.»"..-N10.C 3~=&...S,.~. 201 South Knowles Avenue, Box 127 •...Hatb...A.....aQ on. » MbNdMilli wy be . Notary Public S.t.....CXa~7C A wtboatk~d or ' Both Id aet<~tod. Y Commission is - PerWanentIf os~ lion cos ~ date: ...12/.231.90 ) r ~ awns eisolso M W 011010814 rwld M UP" of Prihtod Mow their sis•eturee. a?ATO OAR e. MI N , IOW N•. I - Isla It,i l r; f~OCIjMEF!'T NO. WARRANTY DEED I THIS s►ACC REKRVED Fl"t RECOa01Ma1 DATA STATE BAR OF WISCONSIN FORD[ 2-iD1M 458219 w; Ssy rAsr. 539 REGISTER'S OF E ~ I ST. CROIX 00., WI I! Reed for Reid aingie person........ $ Q WIA 10 551A. _M j ~ seq....... i conveys and warrants to Glen..E...-Johnson -and Patricia.M.. 610111 ofDuh ..Johosoxk#..buaband..and...wi.fe, as marital.. property with..rights...of..survivorship..... II . ' PL-Tl1PN TO TT i` . Ow following described real estate in -St Croix County. j state of Wisconsin : + Tax Parcel No: Part of the Northeast Quarter of the Southwest Quarter ;j (NEVI of SA) of Section Thirty-five (35), Township Thirty-one (31) North, of Range Eighteen (18) Ilest, y described as follows: Lot One (1) of Certified Survey flap, filed January 17, 1984, in Vol. "5" of Certified Survey Maps, page 1393, as Document No. 390624. I; {p This conveyance is given in satisfaction of that certain land contract between the parties, dated July 11, 1989, recorded August 22, 1989 in Volume "849", page 168, as Document No. 450769. WE This f $...not homestead property. (is) (is not) Exception to warranties: Dated this . I!p_.... day of April Iy 90 , (SEALi .Wayne R. Vargo . (SEA[.) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE. OF %YK-X~,8XX , NFVAn County. authenticated this ........day of 19 ['1•rsonally came before me ti:is day of April Itf 90. the uix,vo namt4i _ _ Wayne R.. Vargo TITLE: MEMBER STATE BAR OF WISCONSIN (It not,... authorized by 4 706.06, Wis. State.) to MP 6n•Ilcn to he the Ilcr-on %tlIo execated the f1Ir1•_rlin, in truullnt :Ind ar~nmtih•I^t• the :came. THIS INSTRUMENT WAS DRAFTED BY / Reinstra,... Van..nyk. :leedham, ~ . C . j 201 South Knowles Avenue, Box 127 New---R-ichriond-i W1--- 54-017 N,,t., illl T. • -,I ,1.4• .1.1.. !•nunty. %YdxNevada 11 I' t ' t.11 • 1 r: (3ignaturea may be authenticated or acknl~•~led;•1•d. I:~.tt 1 Iwt•i ~~;1 ~,~ili'Xiti'~•N~ t esI' 1tiu.t are not necessary.) date: I / ti • . I I 1• i . 19 .1 1-----------------~ eNARNA or persons ri[nina in Ally Capacity ~i.••:.:d L: or. f ..r .1 1, i.. I• I.T i «..ww..w.w w.~ww -ATV VIA" I1% U'1:/'ll\•'i~; U ......1 1.:....~ , 1. L- STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER UYER reef,, ~Lj4 ' !.I ROUTE/BOX NUMBER T P_.V" s sb j ~t FIRE NO. CITY/STATE f6 ZIP S® 62- PROPERTY LOCATION: 1/4 SLR 1/4, Section T - R _W, Town of ri2tdd'ne__ , St. Croix County, Subdivision C, 5,~!~5_(o9ZB , Lot No. Z 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 $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE ~/z7 Z961 St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,' c DIVISION LABOR AN P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 3707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: WNSHIP UNICIPALITY: T NO BLK NO.: SUBDIVISION NAME: V sLd /T3i H/Ri$ E( r) W t - COUNTY: MAI LING ADDRESS: 89 z Q_ t4 N t Gr USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCIAL DE RI S LIkResidence A' J PTION: KNew ❑Replace /I/rCep RATING: S= Site suitable for system U= Site unsuitable for system C ONVENTIONAL: MOUND: IN $ -GROUNDPRESSURE: S STEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) C []U NS $ ❑11 ❑ $ ®U ❑ $ ®U "?zv%rk If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: Jv~i PROFILE DESCRIPTIONS ; gac BORING TOTAL PTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, XTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B B4 qse CM j , - Qr~ f sT s/ - 6., S j 3;-L- - R c IF LP / Q0_ sf S.i 1 z,6` e- /S:, Z4''- 3Z" B- $p V a4 B' S/ /V S B ii .3 ; 9. S ~ 1 v r` ~v A 0- to, B-4 87 X7'4/, Ir Z Si -5► as"J s//errs It Sy 5 7to 11 rJ H 7' ©`1- g yi 171 r "~u sQ wl~K B- y . .r B- PERCOLATION TESTS } EST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES F NUMBER INCHES AFTER SWELLING INTERVAL-MIN. P RI D 1 PERIOD 2 PERIOD3 PER INCH P- / J P_ _1> ig IN 4.4-,p P- P_ P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their locyaU on on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. -5c rt /y •o a ZZ SYSTEM ELEVATION. _?A/1 !'r :j FZ? 7il ' I 40 % iki~ ~I / t 1 _ P y 10 4 0,6 L. -l TH 7 T__ - - ON _J` i 3 eca I 1 ' _L_~ I, the undersigned, hereby, certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: G,.,,► P. n it ADDRESS: 22 CERTIFICATION NUMBER: PHONE NUMBER (optional): z ~Z'7 /S Z- 0 do Y~ u.ula~P' G-4774:tf CS IGNAT E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD£395 (R. 10/83) -OVER - DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS JNDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: OWNSHI MUNI IPALITY: OT NO.:Ba NO.: SUBDIVISION NAME: N~ /45(41/4 /T 31 N/R/$ E (o stizl!' 0)Q_ ,s.N1. A166 9zF3 COUN//T~~Y::_ /I MAILING ADDRESS: .Si. l~ro(Y, Gl" 'ToII~K v1 TV Yt.y e-,r-S~ JJatL«Ovl ~4r USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: 7ROFILE A TESTS: ,KResidence /ZL QK New ❑Replace 1~Q~ 1 w D l$) ! ~1 Q4 l ho RATING: S= Site suitable for system U= Site unsuitable for system MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) EIS DU El! ❑U :IS E:Iu EIS ❑u F IS DU If Percolation Tests are NOT required D ESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGWE--ST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ) B-2 B- 3 B- B- rr ~l - PERCOLATION TESTS ~'dcr S a >i. ~e.lQc~ } TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER L V L-INHES RATE MINUTES f NUMBER INCHES) AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER 100 3 PER INCH P- P- 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. SYSTEM ELEVATION. ~~r~s buy l 1 I t E i I s I } I E _ ~ tiro ~ -m _ ~ E F ( 3 ~ ~ I Q I, 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: < 91,0 ADDR CERTIFICATION NUMBER: PHONE NUMBER (optional): '7~ as 7 `3 Z 1-71,T 5A- 49 A CST GNATU DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - J INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Soperatas and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well Is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than '1 - Loam Bn - Brown Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. L -pf VA -a> E .JE~ Lo -'s *s(yz~j _ s G C~ PM g~ PILO p'~ ` E tllllsLl kof G6su~'~ Cold lof Gb~"c►e,"> As.s 9- P , oo!! p~.~. -AY- to (,Q- I ~ Po a cuu-e-&~, I I , V -5, i VAIN 2~ 3oAf ~a Sid N F. Dose Tank 1. Manufacturer. 2. Dose, holding capacity. 3. Siphon, elevation difference. G. Required Paperwork 1. Verification form, quota numbers. 2. Application for Use of an Alternative System. 3. On-site form from county or state. VII. Systems-In-Fill A. Soil Test Report 1. Monitoring requirement, topsoil. 2. Benchmark, system elevation. B. Plot Plan 1. Setbacks, SIF specific. 2. Tank placement. C. System Cross-Section 1. Actual limiting depth. 2. System elevation. D. Plan View 1. Trenches, observation pipes. 2. Fill perimeter. E. Required Paperwork 1. On-Site Investigation Forms. VIII. Sanitary Permit Application (Plb-67) A. Overall Format B. Attached Plans -6- Form -S?C-104 ► AS BUILT SANITARY SYSTEM REPORT OWNER" ~~i. 1 p I,wA 5~ ~1 TOWNSHIP A '0.a+!' I( a__ 'Jr T 31 N-RW ADDRESS OesS A ST. CR61X COUNTY, WISCONSIN 1. _ . ' SUBDIVISION f • L0T LOT SIZE _ ~z cam' PLAN VIEW f Distances and dimensions to meet requirements of ItWta`83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM jL. _ I ..i ..t. L.. J o,~ s.2 :j. INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used d Elevation of vertical reference point: it Proposed slope at site: Oz-a /o SEPTIC TANKS Manufacturer: Liquid Capacity: 1060 2-t '•'••i•Number of rings useds!~ ' Tank man over elevation: 4'S op .y- ins. ~2~.~• • Tank Inlet Elevation: ank outlet Elevationt Number of feet from nearest Road: Front,W Side Rear, O feet From nearest-property line s • Front O ,QSide,©Rear, feet Number of feet from:' Well building: (Include this information of.-the above plot plan)( 2 reference dimensions to septic tank) SEE, REVERSE SIDE 5 PUMP CHAFER Manufacturer: (4~e.9-L S _ Liquid Capacity: ~C' Pump Model: j~a Pump/Siphon Manufacturer: Jr6 ua_-ki c- Pump Sise ` Ito kh. Elevation of inlet: SLL - //q~i Bottom of tank elevation: L6 6-z Pump off switch elevation: -15 Gallons per cycle: , 00 ckxl, Alarm Manufacturer:S: I ~`Le~aS- Alarm Switch Type: •Number of feet from; nearest property line:'. • Fronts O Sides Rears © pt A4 4) 'Number of feet from well: /00, Number of feet from building: c (Include diatances.on plot plan). SOIL ABSORPTION-SYSTEM: Bdd:- Trench: V Width: • tt , Length: - .••Number 'of Lines: Area Built:7 6'6 Fill depth to top of pipe:fl Number of feet f~'m nearest property line: Fronts /O Sides 0 RearsO Tt.2 .Number of feet from well: Z~... . . ' N 'bar of feat from building:_ (Include di tancas on plot plan). SEEPAGE PIT nf~ Size: Number of pits: Diametart Liquid depth: Bottom of seepage pit elevation: Area Built: r Has either a drop box O or dint-ibution box O been used on any of the above soil absorbtion sytemsl (C~eck one). HOLDING TANK Manufacturers Capacity: Number of'.rings used:- Elevation of bottom of tank: Elevation of inlet: Number of feet from.nearest property line: Fronts O Sides O Rears 0Ft._ Number of feet from well: Number of feet from building: Number of feet from nearest roads Alarm Manufacturer: Inspector:. Dateds Plumber .on job: ~L" t License Number:~ 3/84:m j ' ~.4 pro,.- e- _ ~ lam, s4 n ~ be~@v~~~ Inowc, PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 4"C.I. VENT PIPE T WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER ~ 25' FROM DOOR, 12"MIU. WINDOW OR FRESH AIR-INTAKE GRADE i 4" MIN I. CONDUIT-- PROVIDE I INLET AIRTIGHT SEAL I I i -7 I III APPROVED JOINT A ( I I APPROVED JOINTS I I W/C.I. PIPE W/C.l. PIPE I III ALARM EXTENDING 3' EXTENDING 3' I 11 ONTO SOLID SOIL ONTO SOLID SOIL B I I i I ON C I I I LLEV. FT. PUMP OFF D CONCRETE BLOCK APPROVED RISER EXIT PERMITTED OIJLy IF TANK MANUFACTURER HAS SUCH APPROVAL B6.00 INQ SPEC IFICATIOKIS SE TIC DOS.E~ 40 uiek`5 Cam, M kA NUMBER OF DOSES: JIA"TIS PER DAy ANKS MANUFACTURER: TANK SIZE: ,GrrALLOMSjSDOSE VOLUME INCLUDING BACKFLOW: GALLONS ALARM MANUFACTURER MODEL NUMBER: CAPACITIES: A=1 -7 - INCNESOR ~-~GALLONS SWITCH TYPE: B -INCHES OR 3"LLB GALLONS PUMP MANUFACTURER:.'~'..`'S~! C INCHES OR ~z- GALLONS MODEL NUMBER: "~Q + D=INC14 ES 0R > s:=Z GALLONS SWITCH TYPE: NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE- --GPM INSTALLED ON SEPARATE CIRCUITS / VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE..-2= FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . ~/2.5 FEET + FEET OF FORCE MAIN X FYOFTFRICTION FACTOR..LIZl& FEET _ TOTAL DYNAMIC HEAD = Z/f FEET rr ✓d u. INTERNAL. DIME.WSIONS OF TANK: LEIJGTH ;WM" .;LIQUID DEPTH LICENSE IJUMBER:►°1P3'2i Z DATE SIGNED: SP40 4MO HP _&W. SOLOS 1%" SPHERE -1750 RPM 28 Oil-filled ball bearing motor 24 incorporates automatic reset thermal overload. 20 ' Non-clog two-vane sewage-type impeller. LL • Reliable diaphragm switch with 16 piggyback plug-in. _ • 2" NPT discharge. o t2 • Stainless steel shaft. • Completely field serviceable. b L AMPS AT 19115V. 4 9,41 AT 23( 14-7 0 0 20 40 90 80 100. 120 - - U.& "LLON• PER MINUTE 1 SP50 1/2 Hp- MAX.. SOLIDS 1%". SPHERE -1750 RPM 28 Oil-tilled, heavy-duty ball _ t ! bearing motor 24 ` Enclosed, two-vane sewage type impeller. m Oil-isolated level control diaphragm switch. • Mechanical shaft, seal with f carbon and ceramic faces. < 12 2" discharge (3" flange optional). - • Completely field serviceable. 4 { FuLLsLOAD 4 ,zaiaz3w.m - 0 0 40 ep ,A 140 160 SEW/SED50 • Heavy-duty, oil-filled, 1/2 HF ' HP-MAX. SOLIDS 13/4" SPHERE-3000 RPM motor with built-in thermal overload protection. 24 1 20 • Heavy-duty, cast Iron motor housing. 1s Non-corrosive ABS volute. , Automatic feature wide-angle Q 12 FLU ' switch with piggyback plug E'' A1,F6 AT i. (SEWSOAI) or diaphragm „`"."7,26 I H pressure switch with piggyback 4 ' plug (SED50Al). 20 40 a° ao 00 Manual model (SEW50M 0 also IN GPM available. z V 456928 CERTIFIED SURVEY MAP Located in part of the NEJ of the SW} of Section 35, T31N R18W, ~ Town of Star Prairie, St. Croix County, Wisconsin; S includes Lot 1 of Certified Survey Map volume 5, page 1393. FILED LEGEND OVINER MAR27 19900- Aluminum Cap set in concrete Glen Johnson JAMES O'CONNELL Q 40 Peterson Road Register of Deeds • found 1" Iron Pipe Houlton, Wi. 54082 St. Croix Co.,W! set 1" x 2411 Iron Pipe weighing ° 1.68 LBS/linear foot. SCALE IN FEET -,F---x- existing fenceline 100 50 0 100 AREA OF LOT 1 - 52,692 sq. ft. (1.21 ac.) INCLUDING ROAD R/W - 43,784 sq. ft. (1.01 ac.) EXCLUDING R/W' AREA OF LOT 2 - 48,390 sq. ft. (1.11 ac.) INCLUDING ROAD R/W - 43,703 sq. ft. (1.00 ac.) EXCLUDING R/W Wi corner Section 35-31-18 Q corner - '~j - - Section 35-31-18 I C.T.H. "KII w S8804613711E 365.56' East West } line S88°46'3711E i 175.001 h 190.56' - g 3002.521 1981.54' - - a --c --.mod f% N I Z7 1 7 CT G'`'1 [D OC/) 1 v CD M Z I 1 W S N co O I rt N N 1 A> 'm ~ I rt O O l rt 'n Im 4- t Irr z rt O I Q- O M CO t0 i. ~ y`~ 1 W 0 r y<.." V I~ F• m N y-~ .,c~J ~y~, I O I CO 7 n m N o existing f J M)K H c r o house ;"i v cC • I N I O c0 r 1= 4-' co hi I x 5R CV 1i y 11~ I a v C7O - V 1 7 • JL I Cr LOT 2 - m LOT 1 0 IIc m o. o ° I Id stone o d o foundation \ „ s V N 175.00' a m 40.001 135.00' •190.561 o N 0 W1 i rt N88046'3711W '365.561 -•••t unplatted lands owned by others ^•$'iW ley i.A'. LINE BEARING & D I STANCE TABLE a - i N0204010711E 26.441 c - h N02°40107"E 27.141 + l- -EN a - b S88°3214611E 40.001 c - d S8803214611E 43.64' a - c S88032146"E 174.98' d - e S0102711411W 25.001 b - c S8803214611E 134.981 e - f S88032146'lE 146.38' - f S0204010711W 52.92' a - d S8803214611E 258.62' itb r:^ ~1. ova this instrument was drafted by Douglas Zahler job no. 83-58-190 .11vo WlrC"J y+Wy VOLUME 8 PAGER 2194