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HomeMy WebLinkAbout038-1120-30-300 $ 0 2 / 7 j & oco Q . i 2= E % / cc b � d / L- . ƒ \\ c co ! 7c # co 8 [2a s «2 LL \ )/ / . 0 E § ) ) Ea 7@227 » m - z ; \ \ 4i § m } CL c q � ) z k 2 \ ce k / k C: z $ E 2 k & � M � -� � / ) S / Q z m z ` .. ) \ � � 2 / lot '3 @ ƒ 7E % k \ \ a 2 a 2 ) & \ ƒ n \ / k k -� k5 2 2 2 CL 0 U $ 2 j u z _§ CO } DR w \ « § § = o § § ° \ j 7 a 16 j # } / ƒ . / / _ } § 0 ( _ co Q } ` ° @ 6 $ r- 2 © 2 CN oo j = o o c - - , 2 \ / \ / E f \ § \ a k § a o m , § 5 o m ; u - o z 2 I R ■ E / J 2 � k { I � L: CL \ E �) ka § c 0 2 2 0 $ J gEPARTMtNT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION M` !IB4"$�9',b LN-RI 8W State ass Plan I.D.Number: Town of Star Prairie ® CONVENTIONAL El ALTERATIVE 100th Street ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Ilayne Larson 650 North 4th Street New Richawnd, WI 4017 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Byron Bird Jr. 3318 St. Croix 119477 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: 7VENTATL.: HIGH WATER 1AREST MBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: ET FROM LINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: P PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑YES El NO I I I El YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY I WELL: BUILDING:I 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: I 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: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID 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 I 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 I MANIFOLD MATERIAL: NO DISTR. I DISTR.PIPE DISTRIBUTION PIPE MATERIAL 8 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 E-1 YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: FFEET MBER OF PROPERTY WELL: BUILDING: FROM LINE. DYES ❑NO DYES ❑NO ARES! Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: T ITLE: SBD-6710(R.06/88) =Z7ff(!L�nHA SAN ITARY PERMIT APPLICATION In accord with ILHR 83.05,Wis.Adm.Code COUNTY . Gbolo STATE SANITARY PERMIT# –Attach complete plans(to the county copy only)for the system,on paper not less than /.J-7, 7 7 8%x 11 inches in size. ❑ Check if revision to previous application –See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION % _15"%,S,� T7Z, N, R E(o PROPERTY OWNER' AILING,ADDR LOT# 3 BLOCK# CITY,STATE ` /✓,1/ ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER I. TYPE OF BUILDING: Check one CITY NEAREST ROAD I ( ) State Owned VILLAGE 1:1 Public 41 or 2 Fam.Dwelling—#of bedrooms, R( ) T III. 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.X New 2. ❑ Replacement 3. ❑Replacement of 4. ❑ Reconnection of 5.❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit# — Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 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 /Y 50V REQUIRED(sq.ft.) PROPOSED sq.ft.) (Gals/day/sq.ft.) (Min./inch) ELEVATION /0,115—Feet !0T eet VII. TANK CAPACITY I Site Manufacturer' Con- Steel INFORMATION in allons Total #of Prefab. Fiber- Exper. New !sting Gallons Tanks s Name Concrete glass Plastic A Tanks Tanks structed pp' Septic Tank or Holdino Tank IOfJ�t� Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Si nature:(No Stamps) MP/MPRSW No.: Business Phone Number: 4&40n P is Address(Street,City�te,Zip de): IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(Includes Groundwater Date Issued Is g Agent Signature(No Sta ps) 4Approved ❑ Owner Given Initial ( ` Surcharge Fee) /4 O Adverse Determination / 00 O— M. 6r• X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-63M(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety 6 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 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: I. 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. 111. 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) 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 d U Location of property cJ [ 1/4 S C 1/4, Section O� , T �'J�N-R W Township C 5m VI) ( (F'�7. l d : T Mailing address Cam'1 VN&VI(A4 UJT Address of site Zq1k / CJ(J N Subdivision name Lot number Previous owner of property ) Total size of parcel ,13 Date parcel was created a&jj 13 Are all corners and lot lines identifiable? _Yes No Is this property being developed for resale (spec house)? es No Volume �� and Page Number o5 /, 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 deed recorded in the Office of the County Register of Deeds as Document No. ; 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 duly recorded in the Office of the County Register of Deeds, as Document No. ) . 0 Signature of Owner Signature of Co-Owner (If Applicable) 6- /1 - k? Date of Signature Date of Signature ----------------- DOCUMENT NO. 4, WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA OF WISCONSIN Ob P'O STATE BAR OF WISCONSIN FORM 2-1982 SO MOWN% Opp CE 8T. CROIX 00.1 W1 P4,04 for Reewd . '.... husband___and wife ... . • .......•.•.•... .. ......... . ....... APR IS IM 01 11:30 Am ..................................................................... ..................................... conveys and warrants to Wayne.. .. .... ------Tars-on,...husband--.and­w­ife,.._as...mari-ta-1-pIxoper.ty ......with..riglits---Of.-S-urvivor-ShIp.......................................... 0"* ........................................................................7........................................ ................................................................................................................. RETURN TO ................................................................................................................. ........................................................ ................................................ .. the following described real estate in .........5.t (.r ................. State of Wisconsin: County, Tax Parcel No: Lot Three (3) of Certified Survey Man, filed April 13, 1988 in Volume "7" of Certified Survey Maps , page 1954, Document No. 436160, being a part of, the Southeast Quarter of the Southeast Quarter (SEh Of SEh) of Section Twenty-nine (29) , Township Thirty-one (31) North, Of Range Eighteen (18) West. 0 This ----iZ--not---------- homestead property. (is) (is not) Exception to warranties: Dated this .............. ..................... ------ day of ..........Apr ............................................. .•.•....•.....•.....••.•.....•..•.•.••.....•...... ..................(SEAL) ... .. ..... •.........•.•..•.• ... ...... -------_----------(SEAL) ......•.•.•.....•..............••.... ............................ .. .......................... .....................................................................(SEAL) .... (SEAL) ------------------------------------------------------------------ Pauline__Fa.g ................................ AUTHENTICATION ACKNOWLEDGMENT Signature(s) ...__----•------•------___-__•••............................ STATE OF WISCONSIN ------------------------------------------------------- St. Croi:!S ss. authenticated this --------day of........................... 19..._.. .................. ----------------County I Personally came before me this ....13th of ApX'2.. ................................................................................ ........ _I ........................ the above named Ra -Y ------------------------------------------------------------------------ inaud...Fagnan---and_P-alJ1ine__.Fagn an TITLE: MEMBER STATE BAR OF WISCONSIN ----------------------------------------------------- ........1.4,;j......... (If not- -------------------------------------------- .................................................. authorized by ----------- --------------------------------------------- 34 ----- ------'1'_.':--, 4 to me known to be the person ------ c the foreg instru � . y ack o le !n THIS INSTRUMENT WAS DRAFTED By ReirSf-ra, Van Dyk & Needham, S. C. ....... ----------- ................................ ... ......... ... . ........ 201 South Knowles Avenue, 0------------------- Hendrik W. Van Dv Box 127 "N1_' Ne '__Rj_c_hraond-r---wl------5-40-1-7------------------------- --- ------ ---------- (Signatures Notary Public ---- ----------------County, Wis. res may be authenticated or acknowledged. Both MY Commission is permanent.(If not, state expiration are not necessary.) date: ------------ ............................................ 19......... -Names of Persons signing in any capacity should be typed or printed below their signatures. ................ KC.Md1*rConwwiy STATE BAR OF WISCONSIN FORM No. 2— 1982 Stock No. 13002 ST'C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER W d q� Q_ a. D&W_AaA_��� ROUTE/BOX NUMBER S 7 FIRE NO. CITY/STATE ZIP q01 PROPERTY LOCATION:G 1/4 1/4, Section 0( 1 , T_aLN, R_L�W, � Q(�,� v Town of fi0� r TT�t 1 r'1-�J , St. Croix County, Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failGre 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 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 AND PERCOLATION TESTS (115) MADISON W HUMAN RELATIONS I 5377077 HUMAN (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: HI /MUNICIPALITY: ILOT NO.:BLK.NO.: SUBDIVISION NAME: COUNTY: W ER'S BUYER'S NAME: ivtiaiLiii� vRIC SS. Gros u xd P� s� USE V DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PR FIL N PERCOLATION ES Residence New 1:1 Replace f RATING:S=Site suitable for system U=Site unsuitable for system rONVENTIONAL: MOUND: IN_ -GROUN�`D-PRESiS'URE: SYSTEQM-IN-FILLHOLDIING TTANK:RECOMMENDED SYSTEM:(optional) ®S OU ®S E1� J 0Y El S ®� D S ZU 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: 10 PROFILE DESCRIPTIONS BORINGI TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER IDEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) r A/! 51.10 e7 A' 502 7—31'dOi7 13- /0775 i S °;{ � > �- � B- /07,t B- 3 1.9 B- �'y o� �`✓ 1Q �- 7 4, f r� r/a d, ,�'� S//0 36i-f$ 3d ��s I3- Viµ; f e PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IdMOVS3 AFTER WELLING INTERVAL-MIN. PERIOD 1 PERI D2 PER INCH P oZ G P �- P- P — t P- — A 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. i 'I SYSTEM ELEVATION 3 cP 5y 5%e,,- j-ry. a 9L ✓ ¢5 �po IPA , sb0 lot a • //A t N / ♦• / � I I i 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: __ /— ADDRESS: 7— CERTIFICATION NUMBER: PHONE NUMBER(optional): ` c_ 6 CST SIG ATURE. DISTRIBUTION: Original and'one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R. 10/83) —OVER — '` FLU I PLAN PROJECT 0-5� ADDRESS AC:1/4� f/4/S-9 /T N/R/ W TOWN ar i'a�.•, ',L COUNTY JAG^o,.� MPRS Byron Bird S( 318 DATE BEDROOM_ CLASS PERCH_CONVENTIONAL N- ROUND PRESSURE ION CONVENTAL LIFT MOUND_HOL NG TANK SEPTIC TANK SIZE ® LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA a- PERC RATE ­ L ,3 BED SIZE I\ Benchmark V.R.P. Assume Elevation 100' Location of Benchmark d -- X/O 4/- * H.R.P. C] Borehole Q Well Scale = Feet O Perc Hole System Elevation _ `ell Sr Uent 12" Grndp TYPAR COVERING 2" 12" 3- 4 6' 4O 3, 1 6- Sewer Rock 12' �L r ' o a 40 Ell 3� 7p Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT ` q p OWNER G d TOWNSHIP SEC. o� 1 T ?Jl N-R,� D W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION CS , " 7 S LOT -3 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I a 4 � f 7011 NV ra ' INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: !--� Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: lea o . Number of rings used: -Tank manhole c� o ele�n: /97 ys Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,(--,ASide,O Rear, O po v feet From nearest- property line O Front,OSide,0Rear,O feet Number of feet from: well /y , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: g Trench: Width: Length:_,!57.2 Number of Lines: Area Built:w2v Fill depth to top of pipe: 52CR P< 3 d Number of feet from nearest property line: Front, O Side, O Rear,0 It w� Number of feet from well: ooze 4.""c Number of feet from building: z g�' e (Include dices on plot plan). SEEPAGE PIT l D c{,.oZ ��Cx Size: Number of pits: Diameter: ,. Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box 0 or distribution box O been used on any of the above soil , absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, 0 Side, 0 0 Rear, Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: ��°� Plumber on job: License Number:/S 3/84:mj Parcel #: 038-1120-30-300 02/13/2006 10:26 AM PAGE 1 OF 1 Alt. Parcel#: 29.31.18.498D 038-TOWN OF STAR PRAIRIE Current [Xi 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 WAYNE A&DIANE M CARSON O- LARSON,WAYNE A& DIANE M 1918 100TH ST NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1918 100TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.351 Plat: N/A-NOT AVAILABLE SEC 29 T31 N R1 8W SE SE 3.351 ACRES LOT 3 Block/Condo Bldg: CSM 7/1954 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-31N-18W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 808/22 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 119696 230,400 Valuations: Last Changed: 10/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.030 39,200 187,200 226,400 NO Totals for 2005: General Property 3.030 39,200 187,200 226,400 Woodland 0.000 0 0 Totals for 2004: General Property 3.030 39,200 187,200 226,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 310 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 � 30 -3tb 3 !rl 92v 43GIGO CERTIFIED SURVEY MAP LOCATED IN THE SE1/4 OF THE SE1/4 OF SECTION 29, T31N, R18W, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN OWNER & SUBDIVIDER RAY FAGNAN R.R. #4 NEW RICHMOND, WISCONSIN 54017 FILED APR 13 JM JAMES OJCONNELL E1/4 CORNER C0. LOT 1 ( SECTION 29 S lm T31N, R18W 1 VOL. 6 - r _ $ PAGE_1534 I LOT 2 DOC.#402649 I CERTIFIED SURVEY MAP 1111 — 1111 — - - - - - I Ln VOLUME 7 PAGE 1865 —— ---� --------L------1865 N89°42'19"W :.•417.00' 133' 33' POINT OF 375.81' 1.1 ' i BEGINNING I 6' Al °o LOT 3 I �1 zl 0 3.351 AC.t Being 145,950 S.F.t of I AI: Ln -.41 Cnn Including Town Road c zl a1 3.030 AC.t Being 131,997 S.F.t MI �I Excluding Town Road WI ai AI N W I O r O ICI Ln wi ^ MI O 'I wl HI o O '.. p l M o H H 1 di .Cn �nl ZI HI d, al ( I dl � P41 al W zI ( ( -0 041 00 zl x C :=)I Ei 2f FENCE I I 378.46' 1138.55, :2 ( o S89 042'19"'E 417.00' 61 I j I 2 UN'PLATTED LAND S ( 3333'� H W z H Pd SCALE IN FEET p� SE CORNER SECTION. 29 LEGEND 0 x;100 200 T31N, R18W SECTION CORNER MONUMENT, FOUND (BERNTSEN CAP) . 0 1"x24" IRON PIPE, WEIGHING 1.68#/LINEAL FOOT, SET. 111• IRON PIPE, FOUND. This instrument drafted by James T. Swanson A WVED Vol.' 7 Page 1954 APR 12 198 ST COW COUNN AND