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HomeMy WebLinkAbout182-1016-40-200 (2) I �I oc O ti a) a �Y o w � o o N 00 ^Ni 0 j� O It w U O o Co n a)s zt a� 0 U) � z a) a? a LL LL c a E m 4 w> I Cl) N z y Z O O LL V z a m 0 O z c in CD z c E 'p 2 Cl) m N o a o cD y o •� d L O a) Q it O Z OD Z m N z y N C a�A7 O La � J C v a b G w y m C7 0 0oa E v Z •N r "' aaa R y c N o oo co cA J U rn rn z ti CL r r O CD o _ E 4)' 00 Q) a C L 7 r °o a � w c O N O U y d j 0 C N y T Cn �O O C N to V `Q a0 O U) M c O O d O FN O M l9 - I` ay. � E C N O 0 00 = p O U O p U • o > '', Y cA O � I # .E i d rr`1w�1 E ` 'c c :: _1 A tia � f'. ov� c°� Parcel #: 182-1016-40-200 01/12/2006 04:11 PM PAGE 1 OF 1 Alt. Parcel#: 311801-24-03-00-00-000 182-VILLAGE 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 SCOTT A&SHERRY L KITTEL O-KITTEL,SCOTT A&SHERRY L 505 5TH ST STAR PRAIRIE WI 54026 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description "505 5TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 3.245 Plat: N/A-NOT AVAILABLE SEC 1 T31 R18W SE NW 3.25AC COM N1/4 Block/Condo Bldg: COR SEC 1 S 2028.22 FT TO POB S 250.78' S 89 DEG W 563.72'N 250.78'N 89 DEG E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 563.72'-POB FKA PARCEL 163E 01-31N-18W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 790/375 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 139206 289,000 Valuations: Last Changed: 09/08/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.245 20,000 233,500 253,500 NO Totals for 2005: General Property 3.245 20,000 233,500 253,500 Woodland 0.000 0 0 Totals for 2004: General Property 3.245 20,000 233,500 253,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 133 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 prForm - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER @ 4 TOWN9HfF a~j p SEC. T N-R —W ADDRESS /�[ ,3 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE � S PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 2 S' A, INDICATE fl� � INDICATE NORTH ARROW / I BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: / Proposed slope at site: �p i, SEPTIC TANK: Manufacturer: lam, � Liquid Capacity: . jQdc Number of rings used: O Tank manhole cover elevation: Tank Inlet Elevation: �J 3 Tank Outlet Elevation: Number of feet from nearest Road: Front,o Side 0 Rear, O / feet From nearest property line Front,0 Side,&Rear,O CVCQ feet Number of feet from: well 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: p/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch evation: Gallons per cycle: Alarm Manufa urer: Alarm Switch Type: Number o feet from nearest property line: Front, O Side, O Rear,O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: L/ � (2)Width: Length:_ Number of Lines: 2 Area Built: Fill depth to top of pipe: Z 8 Number of feet from nearest property line: Front, O Side, �j��`Rear,O Ft .�_ Number of feet from well: J Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Num r of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a rop box O or distribution box O been used on any of the above soil absorbti sytems? (Check one). HOL G TANK Manufacturer: Capacity: Number of rings ed: Elevation of bottom of tank: Elevation o inlet: Number feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: 'A? B� Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MAD►60N,VA 53707 SE4jNW4iS1,T31N—R18W JRCONVENTIONAL 1:1 ALTER Slate Planll)D.Number: Town of Star Prairie El Holding Tank ❑ In-Ground Pressure F-1 Mound Co. Road "H" NAME OF PERMIT HOLDER: DDRESS OF PERMIT HOLDER: INSPECTION DATE: 7Route Scott Kittel 3, New Richmond, Wr 54017 16- C) BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF,PT.ELEV .- Name of Plumber: MP/MPRSW Nn.. County. Sanitary Permit Number: Gar L. Steel 3254 St. Croix 106073 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED'. DYES ❑NO ❑YES ❑NO BEDDING'. VENT DIA.'. VENT MATT HIGH WATER NUMBER OF ROAD'. PROPERTY IWELL: BUILDING: VENT TO FRESH ALARM LINE AIR INLET: FEET FROM ❑YES ❑NO DYES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING'. LIQUID CAPACITY 1pumi,MoOEL IPUMP'SIPHON MANUI ACTUHEH WARNING LABEL LOCKING COVER PROVIDED PROVIDED. DYES ❑NO ❑YES ❑NO I DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER dF JPHOPEHTY WELL BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM NE AIR INLET. PUMP ON AND OFF) DYES 1:1 NO NEAREST—�3► SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing Nanl IIAMf TI 11 IIIATI HIAf AND MARKING or excavation. (if soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH IN O.OF 7P'SPAf.I Nt� COVER INSIDE DIA -PITS LIQUID BED/TRENCH THE NC HES MATERIAL: PIT DEPTH DIMENSIONS �Z GRAVEL DEPTH -- PILL DEPTH DISTIL PIPF DISTH PIPE DISTR PIPF. MATERIAL NO DI$TH NUMBER OF PgOPE RTV WELL. BUILDING'. VENT TO FRESH BELOWPIPES ABOVE COVER EI EV. NIL ELEV.END PIPES FEET FROM LINE. AIR INLET: NEAR EST'.----- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES 1:1 NO SOIL COVER ITEXTURE E111111ANINT MAHKIHS OBSERVATION WELLS [:1 YES 1:1 NO DYES ONO DEPTH OVER TRENCH BED DEPTH OVER TRENCH HEU :r)l T()PSI)IL ISOLDf I) SEEDED MULCHED CENTER EDGES Ell YES ED NO 1:1 YES ONO [DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: I'.'':'.WIDTH. LENGTH NO.OF LATERAL SPACING IGHAVIL DEPTH HELOW PIPF FILL DEPTH ABOVE COVER BEDITRENCH TRENCHES. DIMENSIONS 4 MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO UIS7H [STR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV. ELEV. DIA. ELEV. PIPES A LEV ATION AND DISTRIBUTION �NFfy�INA-1•IO1�I HOLE SIZE HOLE SPACING DRILLED COHHECiLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED V ❑YES NO DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF'. L NE PROPERI WELL: BUILDING'. f FEET FROM /Z/q� Qlj I L1 YES 1:1 NO ❑YES ❑NO NEAREST LA Vj f d C7 o• j 2 lot l Sketch System on / , Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. Zoning Administrator DILHR SBD 6710 (R.01/82) DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code z:)t. Croix .a.:.�......�.. STATE SANITARY PERMIT�# Aj&d�3 —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES nd NO PROPERTY OWNER PROPERTY LOCATION Scott Kittel SE '/4NW '/4, S 1 T 21 , N, R 18 for)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME R.R.##3, New Richmond, Wi. 54017 n/a n/a n/a CITY,STATE ZIP CODE PHONE NUMBER Ej CITY NEAREST ROAD,LAKE OR LANDMARK New Richmond Wi. 54017 715 246-5609 VILLAGE:Star Prarie Co. Rd. ##H II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a.QcNew b.❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. Ekonventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b.iGJ seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): 94.92 upper n class 1 495 500 94.32 lowtot rivate ❑Joint ❑ Public CAPACITY VI. TANK Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xis Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank X 1000 1 Weeks Concrete Lift Pump Tank/Siphon Chamber --- -- ❑ ❑ -HILL] VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installati n of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber' ' nature:( o am ) N WMPRSW No.: Business Phone Number: Gary L. Steel ei 3254 715 46-6200 Plumber's Address(Street,City,State,Zip Name of Designer: 988 N. Shore Dr. , New Richmond, Wi. 54017 VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## Gary L. Steel 2298 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 988 N. shore Dr. , New Richmond, Wi. 54017 715 246-6200 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issue Agent Signature(No Stamps) 12 Approved ❑ Owner Given Initial rcharge Fee Adverse Determination f20,oc) aS� X. CO MENTS/REASONS FOR DISAPPROVAL: �to►� f i�.l.�c� � � ,�-e F. ct� SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION } y TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 81/2 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground 8f4#r included the creation of surcharges (fees) for a number of regulated practices which disco in: ° can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried r>na'iS.,B' is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) 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 so Location of Property SE_ 0 Section L , T N-R�_ W Township }-� 1 Mailing Address Address of Site Subdivision Name . Lot Number Previous Owner of Property Total Size of Parcel 3 Z S Date Parcel was Created °/ . ®7 Are all corners and lot lines identifiable? C-� Yes No Is this property being developed for resale (spec house) ? Yes 4----No Volume .25PO and Page Number-37-5'— 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) ce4.ti6y that att Atatementa on thi.6 anm ane true to the bat o6 my (oun) know.tedge; that I (we) am (ane) the owneA(.6 0 6 the pnopen ty dez cnibed in thin in6onmati,on 6onm, by vixtue o6 a wamanty deed necoaded in the 066.ice o6 the County RegiAteA o6 Deeds ass Document No. ; and that I (We) puzenttey own the pnopobed .bite bon the bewage dibpoz -yb em (on I (we) have obtained an easement, to nun with the above deacAibed pnopehty, bon the con6.thucti.on o6 said system, and the same hae been duty eeakded in the 0 'c y .ceo the County Re .i.d 66 .ten o Deed&, a& Voeument No. 6 y 9 6 1 . SIGNATURE OIL OWNER SIG AT 0 CO-OWN (IF APPLICABLE) 19e 7 DATE SIGNED DATE SIGNED ►, a oocuMENr No. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA ' WARRANTY DEED B K FA^ 790 , c �E,1 i,• REGISTERS OFFICE I' This Deed, made between __DUWdYneJ, _Larson j and..Sylyina__Larson sty GIarOrx Co., wls. I, -----------------------•--------- Reed.------------------------------------•---------•----------•--...-------- 6 Record this 4th ............................................... day of Sept. Grantor, .,_,_A.D. 19$7 and---.Scott_•A. Kittel and Sherry L. Kittel husban 3: 15 P and wife, as surviorshi marital property - - - - - --- - - - - - -.......................................... Grantee' ":'.,.,1 f Witnesseth, That the said Grantor, for a valuable consideration_._._. - —�i conveys to Grantee the following described real estate in St• CroiX RETURN TO ......... .............•..... County, State of Wisconsin: A parcel of land located in the SEA of the NW A of Section 1 , T31N, R18W, Village of Of Star Prairie, St.Croix County,Wisconsin, more ax Parcel No: ._1.82;;101_�-!.Q•-.•_-- fully described as follows: I Commening at the NJ corner of Section 1 T31N R18W; Thence S0108 ' i 22" E along the North-South Quarter Section line a distance of 2028. 221 j to the point of beginning: Thence continuing SO°08 ' 22"E along said line' a distance of250. 781 ; Thence S89 051 ' 38"W 563. 72 ' ;Thence No°08 ' 22 11W II 250. 781 ; Thence N89 051 ' 38"E 563. 72 ' to the point of beginning. Contains 3. 25 acres subject to existing road right-of-way over the Easterly 3 ' thereof. �I !I FA This --------------iS- ------- homestead I property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And-.---- --DuWayne._-J_.-._Larson-.and-..S}t_lvina_.L�rs.on---------------- .......warrants that the title Is good, indefeasible in fee simple and free and clear of encumbrances except any and all easements and right--of-ways of record. i and will warrant and defend the same. 2nd ll this .._._.----••-• -•-•••-••-•----•--. ------ day of .• September i J _.....--•-••. 19..$.7... i - -- - --__• _�L�'�---...(SEAL ) -- , i . •-----e �-- ...............(SEAL) DuWa ne" Larson • •- •-- - - -• Scott A. K ' tt 1 'Z� YLs .-.(SEAL) - - ----- - AL) • -__•..y_lvina__Larson Sher ry L'--.Kittel........ j AUTHENNT A ION ACKNOWLEDGMENT Signature(s)ep 7%/Iuidote,_ STATE OF WISCONSIN Jos eJr. F�.• ss. authenticated this '•••-'•..°........................••.County. ---•-day of-- �7�51!! -..,_, 19. � / Personally came before me this . ..day of .............................................. .......................................... 19........ the above named ------------------------•...._.•.•........_........--•--•............--•---..... TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ----------------------.......................................................... authorized by § 7W-66'. Wis. Stats.) - --- to me known to be the person ------------ who executed the THIS INSTRUMENT WAS DRAFTED BV foregoing instrument and acknowledge the same. Joseph• P.•..Guidote POBox 69 -----...-•--------------------------------- -- ---•--•----••------•--•----------•-•--••-•...........................•-••-- New---Richmond----W1 are not necessary.) ------- Notary Public ----------- ••--- -•••-----• (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration ,...County, Wis. date: .... ..................... .............................. 19......... _ Xame., of _ persons sinning in any capacity should be typed or -- — - -- i printed below their signatures. i ARRANTY DEED STATE ]JAR OF WISCONSIN FORM No. 1—1982 Wisconsin Leval Blank Co. Inc. H N H a r ST C - 105 9 H SEPTIC TANK MAINTENANCE AGREEMENT 0 St . Croix County z d OWNER/BbY`ER SCE�`t ROUTE/BOX NUMBER Fire Number CITY/STATE PV C0 I LJ ZIP jj / ,7 PROPERTY LOCATION : ,5,:!�__ Section / T3 / N , R J9 W, v�7fvf5rr of � JYppitg l t!� St . Croix County, Subdivision �) Iry Lot number. I Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , I if needed , by a licensed septic tank pumper . What you put into {I the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% 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 veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to H three year expiration. 0 z I/WE, the undersigned , have read the above requirements and agree v, to maintain the private sewage disposal system in accordance with H the standards set forth , herein, as set by the Wisconsin Depart- 'b ment 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 P . O. Box 98- Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above address . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, GG DIVISION BOX LABOR HUMAN RLDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.09(1)& Chapter 145.045) LOCATION: SECT-ION. T� 1 UNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: 1 1 /T N/R (or)W Star Prarie In/a n i n a COUNTY: GPDUOCS BUYER'S NAME: MAILING ADDRESS: St. Croix Scott Kittel 1R.R.3 , New Richmond, Wi. 54017 USE DATES OBSERVATIONS MADE NO.BEDRMS.:ICOMMERCIALDESCRIPTION: PROFILE DESCRIPTIONS: OLATION TESTS: LRResidence 3 n/a New ❑Replace 14-11-87 n/a RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSUR : S STEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) ❑x S ❑U ©S ❑U x❑S ❑U ❑S 0 [:]S FL]UI step down trench If Percolation Tests are NOT requif3cESIGN RATE: I If any portion of the tested area is in the 71 under s.1-163.09(5)(b),indicate: lass 1 Floodplain,indicate Floodplain elevation: n/a PROFILE DESCRIPTIONS page 4 AOB BORING TOTAL P H T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED ES HES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) .58bl.1. 1.92bn.l.s. .50bn.s.1. .42bn.l.s. B- 1 7.25 98.57 none >7.25 .33bn.s.l. 5.58bn.c.s.& . B_ 96.80 .58 bl.l. 2.00bn.l.s. .92bn. s.l. 3.17bn.c.s.&gr. 2 6.67 none >6.67 97.82 .67bl.1. 1.75bn.l.s. .50bn.s.1. .83bn.m.s. B- 3 7.66 none >7.66 67bl.1. .50bn.s.1. 1.83bn.sil. B. 4 7.50 96.02 none >7.50 • B- 4 98.42 b .c. gr' B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH P- P-' P- sea design rate 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. upper trench=94.92 SYSTEM ELEVATION lower trench=94.32 i ( I i o0 8 r !i 11 i V 1 i i ,J I Y` a I � , I _r ff I ; TS I < i , i ` O j L vti 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: Gary L. Steel 4-11-87 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 988 N. shore Dr. New Richmond Wi 54017 2 - - CST SIGN E: T/ DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — Scott Kittel SFr4VI S1T31N. R18W village of Star Prarie AM use � � �•z _ � - - �' `ls�of —� -�° SJ6 rn'Q6-4s w t 49 ro Zd ` +._( 12ocK Gary L. Steel 988 N. Shore Dr. New Richmond, Wi. 54017 MPRSW 3254