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HomeMy WebLinkAbout038-1129-60-200 o O ova O °� o a I00 a� Q) o C, Y o c �O c)E .� U C ° N Co V 0) N CL Co Q)L O 2 N C E O N a) O N ^� m a w 3 0) CO. i L C o w E �L N -a co N M U m CL U a L N00 rn�' arm QE ° c N () `) N CLj �O N p O O N O. p N 0 0 X0 0 C Z N E c 0 a) O Q a) LL LL O m 1, N C j 0 3 '� > C rp U 0 3 ba) 3 :1 m Q � lL Q m mLL cin jl M > m W Z N Z N E co E = O !+ 0 W U) O £ O Z M a m a m co I Z c Q c 0 c O z d•Z 'I c c _ V U O 0 Z d `O o) c 2 c Z E E '2 O ' M a) a) a) .O N_ N_ m O O O CL N N N N N Q) N C N N a) a) CL O U U O a) Q O N Q 1�V0 Z ) Z Z m Z ,0 _ \ "06 O N c 00 c (V r > IL U) o 'wo U LO a R .. o N N N N N d i C) 13 G a C O a CO is E j l H H H O p c FfA FN- o �Ny d d O d m 0 �i E 0 0 0 E 0 0 0 Z Caaa N CL 4i o fA J U -. N r- 0 000 000 Z rn rn Z Z rn rn O ►„v a N �: @ r oo � a) o m o `o o � Of Lo w 3 E -�� 0 0 o) m m 0 a Y ..T�. N U O .� '6 U c N ?) Q Z N Q U1 Q O 0 0 O co OC) N C Cl) N C cl r:+ N N p O 'O O E to 0 TT o ED - a) c c d o 0 L 0 U N m 4) L N N 00 N O W (0 c m „O„ O y.y N 0 - Z Z ca ;H c- Cl) LL i N .ems. O , 7 `- N O y m O p C7 cn p p U • L O 0) O N m Z O z rn H H = E L E L •III ma a`, a #t a a w a w tw0 c� C d V a) 0 N y = t A 0CL OinU OinU • I Parcel #: 038-1129-60-100 05/18/2006 12:13 PM PAGE 1 OF 1 Alt. Parcel M 31.31.18.528A-10 038-TOWN OF STAR PRAIRIE Current ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner O-JENSEN, LINDALOU M LINDALOU M JENSEN C-VAILLANCOURT, PHILLIP B PHILLIP B VAILLANCOURT 1835 RALEIGH RD NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1835 RALEIGH RD SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 33.110 Plat: N/A-NOT AVAILABLE SEC 31 T31 N R1 8W NW SE EXC COM NW COR, S Block/Condo Bldg: 375 FT, NELY TO PT 200 FT W OF POB,W 200 FT TO POB&EXC CSM IN VOL III P 807 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) BUT INCL.WLY PT CSM VOL III P 780 EXC 31-31N-18W PT TO HWY PROJECT 1559-08-22 Notes: Parcel History: Date Doc# Vol/Page Type 05/13/2005 794891 2802/166 QC 10/10/2001 658666 1735/46 WD 07/23/1997 1187/214 GD 07/23/1997 903/616 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 37,000 203,400 240,400 NO UNDEVELOPED G5 30.110 42,700 0 42,700 NO Totals for 2006: General Property 33.110 79,700 203,400 283,100 Woodland 0.000 0 0 Totals for 2005: General Property 33.110 79,700 203,400 283,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 146 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 YZ o _f C /� ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLIICATI P.O.BOX 7969 ON MADISON,WI 53707 State Plan I.D.Number: Mq4, 4,S31,T31N-R1&4 CONVENTIONAL El ALTERATIVE (If assigned) Town of Star Prairie ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound • I R: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: John O. York Route 4 Box 181 New R.ichnond 'JI 5401 e, BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV R: CST F.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Byron Bird Jr. 3318 St. Croix 119469 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.: 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: P PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑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---11110' 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: 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 TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCW6ED­_]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: NO 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�N ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑YES ❑NO ❑NO NEAREST---11111" k ` Sketch System on h etain in county file for audit. Reverse Side �" SI TURF: TITLE: Zoning Administrator SBD-6710(R.06/88) SANITARY PERMIT APPLICATION 7DILHR In accord with ILHR 83.05,Wis.Adm.Code cou� /r0 �ro�,,.KUaswnwrwv� v STATE SANITARY PERMIT# -Attach complete plans(to the county copy only)for the system,on paper not less than y(p°J 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 I. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. PROPERTY OWNER,.-, PROPERTY LOCATION i Y. , _ E or S T N R/ �4 �4 , , a Qr � , PROPERTY OWNER'S MAILING ADDRESS n LOT# BLOCK# © CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER { 1(7/6 II. TYPE OF BUILDING: (Check one) ❑State Owned VILLLLAGE: NEA T R AD Gt!' - G J ❑ Public 1 or 2 Fam.Dwelling-#of bedrooms R EL AX NUMB R( ) III. BUILDING USE: (If building type is public,check T11 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. 9 New 2. El 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 El Mound 30 [__1 SpecifyType 41 El 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 12.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 �'D 6� �,� ,,,2eet eet VII. THINK CAPACITY Site in allons Total #of Prefab. Fiber- Expp. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdina Tank Lift Pump Tank/SI)hon Chamber i Vlll. 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) r MP/MPRSW No.: Business Phone Number: "� r Plu dress(Stree,City,State,Zip C de). CXIK IX. LINTY/DEPART ENT USE ONLY ❑ Disapproved San tary Permit Fee(includes Groundwater pa e ;su e Issuing Agent Signature(No tamps) Surcharge Fee) Approved ❑ Owner Given Initial �dv rs De rmin tin l X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber 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 numbers) 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.11188) 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. 9 Owner of property Location of property /o`l ## � 1/9, Section f , T aI N-R/9 W Township Mailing address Z30-sl f5 `� l� /Y.�-� o t �.� 5.�o 1 Address of site Subdivision name Lot number r Previous owner of property Total size of parcel 7C 6-41� Date parcel was created I Q Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes No Volume s / ( and Page Number . la tp 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 ec rded in the Office of the County Register of Deeds as Document No. 6 / ; 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. — ) . Signa re of Ou&r Signature of Co-Owner (If plicable) Peg Date of gignature Date of Signature DOCUMENT 110. STATE BAR OF WISCONSIN-FORM 3 1 QUIT CLAIM DEED THIS SPACE RESERVED FOR RECORDING DATA 6V TM DIED. John U. York I.vl . �� _ Grantor quit•classsto __Joi1n D York and 'Qcilia _11. Yoikt A.D. i9 7b husban(i and wi fe, .is 'oint tenants M. 1-- Grantee. for a valuable consideration the following described real estate in St. C ro i X County. State of Wisconsin: RETURN TO REI'JSTRA & V11,J DYK, S.C. _few Richmond, 1.71 54017 �('A 'ialf of the Southeast ouar.ter of Section Thirty-cane ( 31) , Tax Key .irty-one ( 31 ) :4orth, of Range Th is is homestead propwty. Eighteen (18)iJest. The purpose of this door: iy to create a joint. tonanc.y. i.,. ♦ 1 I Executed at .'-new Richmond, Wisconsin 9th August 78 - --- thin - _._ - day of --- --- _ 1 9 SIGNED AND SE kLED IN PRESENCE OF „S( —=-T' -(SEAL) John D. York 1 , (UAL) (SE AL) I Signatures of I _ — t tuthenticated this _ 311 __.. dry of ... _.'1UC�l1St, .---. 14 Scott 'R. Neeclhi3r Title: Member State Bar of Wiseons erOflltsr-pim 1tvtlralrtseitvtdei �: �.Df�eis. STATE OF WISCONSIN -- - _. County. ss. __-.-..---------- - 111 Personally came before me, this _________ ___. .._._.. day of tht above named to me known to be the person - who executed the foregoing instrument and acknowledged the seals. This instrument was drafted by REI__jS'rviii &_ VA_J—LYt_t__ _C___ Notary Public cowR>.,Via New .Richmond, JI 54017 The use of witne3ses is optionaL My Commission(Eaows)(Is)_ apes of persons signing in any capacity should be typed at printed below their signatures. •eagle.a,aTUia a..are SLAWL so QUIT CLAIM DECD-STATE BAR OF WISCONSINr, FORM NO. J - 1171 L i STC 10.5 i SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUY ROUTE/BOX NUMBER s/ /x /P FIRE NO l e 3 � CITY/STATE 2zzfc �9 ,,�,�.d ZIP 7 PROPERTY LOCATION: /V�9 1/4 S L 1/4, Section /_, T / N, R W, Town of _!{-L_ St. Croix County, Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failfire 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. I SIGNED 1 rj2C !'>, DATE r 1 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, DIVISION LABOR AND PERCOLATION TESTS (115) P.O.MADISON WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: _.aTOWNStLVMUN ICIPALITY: LOT'/ NO.:BLK.NO.: SUBDIVISION NAME: cJ'/ ' /T3/N/Ro (� — COUNNTY: ,{ MAILING ADDRESS: �/ ;,A D 1 r �f- d Ile ' J d USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFIL ;: PERCOLATIO'N'TESTS: IRIFIesidence .--^ $New ❑Replace —/j/ 7 f L � 3 D RATING:S=Site suitable for system U=Site unsuitable for system �� �,a CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDI G TANK:RECOMMENDED SYSTEM: (optional) ®S ❑U S ❑U S ❑U ❑S A ❑SZU If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: b PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIGHEST—TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) � 6 B- B- .e. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I AFTERSWELLING INTERVAL-MIN. P RIOD 1 PERIOD 2 PER PERINCH P- P- �v P- o ' .�� G 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 ELEVATIONS _ _ U E "A ' E ------ ------- _ - IN e I I T Ie E = E , L� I z __ � 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): ITESTS WERE COMPLETED ON: ron � �^• ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): o - o a CST SIG ATURE: �- DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) –OVER – INSTRUCTIONS FOR COMPLETING FORM 115- SB0 - 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 Separates 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 fs — Fine Sand Bldg — Building Is— Loamy Sand > — Greater Than 'sl — Loamy Sand 'c — Less Than 'I — Loam Bn — Brown 'sil — 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 v- -AN t PROJECT To bg g. Vert ADDRESS d 114,55 1/4/S�//T N/R/ W TOWN < COUNTY MPRS Byron Bird Jr. 37t8 DATE BEDROOM CLASS PERC � G L�CONVENTIONA IN- OUND PR URE CONVENTIONAL LIFT N — M OU U—HOL ING TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE __�r—BED SIZE _ /azl�h�eZ/" 1116 Benchmark V.R.P. Assum6 Elevation 100' Location of Benchmark Z7,6 x�, * H.R.P. D Borehole Q Well Scale = Feet 0 Perc Hole System Elevation - Uent Grade 12" TYPAR COVERING 2" 12" 3' O 6' O 3' 6' Sewer Rock 12' a ut� ir �_1-17L r ,�o Wisconsin Department of Health and Social Services 3/70 Division of Health SEPTIC TANK PERMIT APPLICATION ?YPIC or USE BLACK INK A. OWNER OF PROPERTY Name Address (Street, City, tip Code) B., tMATION OF PROPERTY-- ,.a RE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY Check One% J ` EITY -"` VI LLAGE LEGAL DESCRII;TI03� .,. l TOWNS F{IF 6 � _� / 11 1 C. IS LOCAL PERMIT REQUIRF,D FOR THIS WORK? YES NO C-i- ===--- PERMIT NUMBER D. SEPTIC TANK CAPACITY C� Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALS: Prefab Concrete Poured i Place s Ste>1 Other . NUMBER OF TANKS TO BE I NZTALLED: E. TYPE OF OCCUPANCY -Check One: One or Two Family Residence � Commercial Industrial other Spe(,ify) Number of Persons to to Accommodated 14� Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer /AYES NO Dishnasher YES z/ NO Automatic Potato Peeler YES�Y/NG I Other . (Specify) f G. MASTER PLUMS I MAKING IyST TFON y �,/ ��f ,/ License Number: Names � �-' -v>.��-p,��L>>'-^ Address: i�%-, 1 / HP Signature of Applicantt_—el MP RSW Address: H. (T P be C pleted by Issuing Agent) Date of Application Fee Paid ; ' 0- Permit Issued (dat 0 7o Permit Number Agent (Name) L . For: " (� L Town, Village, City, County, etc. (Specify) Note: The application cannot be eonside^4d for filing until all of the above questions are ansr4ered and the fes paid. Agents wil' forward application, the fee of $I.OU .'or each septic tanic and the third copy of the permit (canary) to the Division of Health. Checks and money orders should be made payable to the'Division of Health. Do not writs in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED ACCEPTED BY � RETURNED i (Initials) (Date) Seg Core FEE RECEIVED VALID. No. PERMIT NO. es or No REVIEWED BY APPROVED DATE (Initials) Yes or No) COMPLETE OTHER SIDE -- SEPTIC TANK PERMIT N0. R Z P C R T 0 K S O I L P t R C 0 L A T I O N T Z S T AND E OIL 'B ORI NGS TO DIVISION OF HEALTH —PLUMBING SECTI& P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code P Z R C O L A T I 0 N T Z S T Test Depth Character cf Soil hours Water Test Time Drop in Water Level Inches anutes Number Inches Thickness in L-aosie3 Since Hole in Hole Interval Second to Next to I Last To Fall 1st Wetted Overnijq in Minutes Last Period Last Period Period One, Inch s Exewple P - 0 36n Top Soil 1011 Clay 261, 25 Yes or No 30 1 2 tj k2A1 60 RECORD DATA FROM MINIMUM OF 3 TEST HQ?.E, g�g i Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. F S O I L B O R I N G S - Minimum 361 Below Propised Absorption Systom Boring Total Depth De th to Ground Water Depth to Bedrook Number Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches ExamDIe B 0 7210 7200 Black Top Soil 12" C1a 18111 Sand 1811• Gravel 241 7, .,, - / ;� 7 4/ ,, l 9 lL� Y ,Z ll 21 y r RECORD DATA FROM MINIMUU OF 3 BORE HOLES YPE OF OCCUPANCY: RESIDENCE: Number of Bedrooms OTHER: (Specify) Number of Persons , � F FOOD WASTE GRL'IDER: Yes No X, Dishwashers Yea No Astometio Clothes Washer: Yes No EFFLUENT DISPOSAL SYSTEM NEW EXTENSION ADDITION REP ACF]IENT Tile Size No.Lin.Feet /®� Trench Width k✓ Depth Number of Lines Seepage Bed: Length Width; Depth 'file Size No. Lines Seepage Pits Inside Diameter _ i Liquid Dep=-, _ r Is the urdersigneds hereby certify that the percolation tests reported ore this form were made by me or under my super`- vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and that the da�Fecor�Ad and_locatir of test holes are eorreat to the best,,-of my knowledge and belief. NAME G r`J / TITLE Type or Print REGISTRATION NO. / or MASTER PLUMBER LICENSE NO. P ^ f` ADDRESS Ica DATE SIGNATURE i STAR PRAIRIE T 31 N:-R• 18 W. 55 J POLK COUNTY sb` ` �¢./ �� e• \� ®\" C • you / s l c abeam I Ed i• CEDAR V 'C� .S/rohb<crz >3.Z ©✓i//e C) a�' . h'1 \ arrai�. .. °j' � � 0 cy°n( !/ems � �e¢e ,PeF/ izo ® �UeC,� Qd� h; s•C S�,°C sQ��6 , hi. as.� b �p\ �.0 •. 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QyP_�8 9 f � � a� o/e ev aboi ap Pe¢ son � e iPah�76 ©fog e h • n °oo , v fo .80 so di s • �8, Q WHANNESBU ,Ba/s/ /s✓ � ems-� E/ <,r/o� �f • � l` '+ri s/e,�i f/e�,. 9/c c Vi F va o. 4i U vv� � c Bo • /��s9s /u�d ,Exos G�¢r- T¢/ 9e Ci�p� s..�y �o• �meiso� ��0 y°` �h y C C h /60 / �e o% U6Q Po6e f Po r /3 9/6 BD c'oo/r O/so2� C" /fo S RA1 .F r Y E h \ By / ii � L. �� v�� •Noh�� J � ���' aaso .SOU/so!7 n � • • Rath 5 / d�lCj iTohn,cTr �3r h n .`4.v /so mac/ ,Bernd Ba Max,ne /✓o� //Q/vex r/oe• /moo / � Dorn z o i a/ r�e Ppb f �v Lynda L. Pou/ Elmer fLucy /S� Bo So 3B 4 Qfh � ? //url"is Bo y Ci to kc HsP/nd ��^� Pi'achf Lot/-so�• "/ s. Cho•--. ®o � Bo a � /!00 • 7d6 � / 3 9i oa 'Po6e�f C =a o yss o,�ry�1. a Ma.fe//F °.•o • KeTth C Tai° as, /`�/¢,;��e¢iJ• s Ua �h�O ao •�� a��� ,9u o ��¢�c°ois 9i eta/• ' 3 'T • f/ohnekiz �a a � l � Q a m Rchinv�d Co- � �ggg Y�• .Bea. a.S/ales'� z6o �O moii • � z°a�f •f ._ 9�` � �� i /'o✓ �sso �� � 6s CCd yo �0 ¢s /zo frb�o%r . �yv� •� � ae c" c 0 C U ° � :::: C l'V <1` F`9 �i/r✓i tl ° /moo rasa¢:9 y/gym J h/7 �4• A r1¢/,;/ • iie �� F/o�d/c,¢ ��ry /moo aa�- Ma,.y � � 3/0 .Be�d b .• �'�� �� �i✓o�-d ao s 37 j � 0 <� �c 6� � •� � /3a �i q k /tea rah eFra ��3 K ...............:::::: n/- 0\. � T hn 4� Firr�us f �/�a 3 �.0 5• " \d 0::. Q� �..t!.�.::: LQw /9 1• • +� /fB 3 © d �. 64 rp� r-- SEE Fi1GE SEE N PAGE 43 J Sf C�o,x Coisnty 64 I PLAT BOOK COMMITTEE EXECUTIVE COMMITTEE Mr. David Afdahl Mr. Ray Mitchell, Jr. Mr. Robert Draxler Mrs. Eldred Moe Mrs. Arthur Feyereisen Mrs. Robert Pitschneider Mr. Richard Heebink Mr. Talley 9 Ro uette Mr. Richard Kruschke I Mrs. Harlan Tiber Mr. Eugene McPhetres Mrs. Robert Zwald I ` Cont'd on page 59 �5bi13 . - CERTIFIED SURVEY MAP 70 Being the Northwest 1/4 of the Southeast 1/4 and the Northeast 1/4 of the Southeast 1/4 of Section 31 , Town 31 North, Range 18 West, Town of Star Prairie, County of St. Croix, State of Wisconsin, described in Volume of Certified Survey Maps, page 780 as Certified Survey No. 780 W N Z N ® p f if o m a N01 °04'51�' W n c... — -q WEST LINE 131 I. 36' z rn OF S.E 1/4 M in O �p oW o x= m � 6 0 /� CD = o W Z ,'o Z wz vo p g = A, ti� v o r o r' I rn Go r z v rn $ r 0 z b 149.65' 279,34 d TJ O r� n Js Gs ao M m rn o S `' 'go .92' co r O rn a 20 rn o� O rn r v - Sal z N " ~ \ ._ N O D D u > n r z If r- W r rn O C m r Z 00 N - (3) O ° N ° N N A N G) n A W 00 _ W v OD 11 o c m OR 6 1979 O SX�U$ O'CONNELL O �1 wbfer of DOG& 8K Croix C-Gty, z D �uWOfID �, r m oN zrn 0 c nt m rn rn G) — v _v 4 rn 4� is• z n O Lill G) 0 rn + 1303.39' n � EAST LINE OF .E I/4 to W zM S01° 06 m 11„E M rn n .o O {' 1 M o rn ,ER C) 00 a,. SHEET 1 of 2 Vo7.ume 3 Page 780 CERTIFIED SURVEY MAP 807 • 35`"x®65 Part of the Northwest 1/4 of the Southeast 1/4 of Section 31 , Town 31 North, Range 18 West, Town of Star Prairie, County of St. Croix, State of Wisconsin, described in Volume 3 of Cert' d Survey Maps, page 807 as g 9 Certified Survey No. 807 7P/1 FILED k" daa►es-'CON �. S(S;i�lt:Ur'V� Wpbter of D,,do ` e COUNTY 54 St Crolx Caob, • `"'p"°®^^�- R'S RE�r�Rp UNPLATTEO^..... ...... . �° Z CENTER SEC 31 NORTH LINE OF SE 1/4 SEC.34 rL S89°49.17"� / ;• N 8 9 °,4 9 17 W N 89°49 174 208.61 66 1888.47 • / //10 525.00• LN Su 3 • 3 —n °O f l of 3':' h ti LOT I _ o :—I o; BUILDABLE N o :� 134,251 SQ. FT ± Z o3.08 ACRES ± 30 33 e a g' Sa,, .co /2g o'b� 510.06' • S)0° 8 9 `yy rJ 8 5°24' 1 8 E 04� F .UNPI;ATTED,,LANDS, LEGEND = LEdti yEflRtCr• O 3/4' x 24' ROUND IRON ROD WEIGHING 1. 502 LBS/ LF. v w /0 BEARING REF TO THE EAST C.INE SE V4,. 31 : ��� ��: t•��d�,, SCALE ASN 01§06�1111�RWN.G I$. = 100' 100 50 0 I 0 I, LEON R. HERRICK, Registered Land Surveyor, hereby certify that I have surveyed, divided and mapped a part of the Northwest 1/4 of the Southeast 1/4 of Section 31 , T31N, R18W, Town of Star Prairie, County of St. Croix, State of Wisconsin, more particularly described as follows: Commencing at the East 1/4 corner of said Section 31 ; Thence N. 890 49' 17" W. , 1 ,888.47 feet, the point of beginning-.— Thence continuing N. 89° 49' 17" W. , 525.00 feet; Thence S. 250 05' 20" W. , 231 .48 feet; Thence S. 700 09' 47" E. , 126.18 feet; Thence N. 850 24' 18" E. , 510.06 feet; Thence N. 010 04' 52" W. , 210.00 feet, to the point of beginning Said parcel contains 3.08 acres, more or less, 134,251 square feet, plus or minus. That I have made such survey, land division and plat by the direction of Larry Chadwick. That such plat is a correct representation of all exterior boundaries of the land surveyed and the subdivision thereof made. That I have fully complied with the provisions of Chapter 236 of the Wisconsin / . r Statutes and the subdivision regulations of the Town of Star Prairie and the County of St. Croix in surveying, dividing and mapping the same. DATED THIS 3/ DAY OFg&A.gj/ , 1979. W APPROVED LEON R. HE RI' , Registered and Surveyor j APPROVAL OF THIS MINOR SUBDIVISION MAY 17 1979 DOES NOT MEAN APPROVAL FOR pp BUILDING SITE OR SEPTIC SYcJEM. ST. C OIX COUNTY PAFER TO H62.204 Volume .� Page 807