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HomeMy WebLinkAbout038-1034-80-000 > 0 i i \ � c 0 z E 0 0 � � \ \ � I co w 4.: z w a- ca z 1 1 E 0 z C'0 k / 7 C 2 .4 z E -2 N 0 CL (D § ) 0 C z 0 (D z 0) < 0 z C C*41 cb 0 C IL LO CL 2 0 0 C14 64 24 IL .0 4) >,0 < E z CL m *6 0 0 z P%6 0. CL CL E © co W cn, j 0 0 0 �?co co CO — — t ID :3 0 E 0 co co M 0 G ƒ CN 0 § k E 6 CD co 0 0- 0 4 ce) CO 40. �? -7 20 ■ U) Z a CD C6 1� 04 E E 0 co co 0 0 la (- I Mo cd { IL cl CL .2 0 E c Sc 2z u o IL i U) o 0 Parcel #: 038-1034-80-000 1ti1ai2oos F 1 PAGE E I OF 1 Alt.Parcel#: 8.31.18.154C-1 038-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-TICHENOR, EDWARD J EDWARD J TICHENOR 2236 100TH ST SOMERSET WI 54025 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description 2236 100TH ST SC 3962 NEW RICHMOND SP 8050 SQUAW LAKE RHAB&MANAGE SP 1700 WITC Legal Description: Acres: 10.400 Plat: N/A-NOT AVAILABLE SEC 8 T31 R1 8W 10AAC S 1/2 NE SE LOT 1 Block/Condo Bldg: CSM 2/414 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 08-31 N-1 8W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 996/580 QC 07/23/1997 /114 / 07/23/1997 77 07/23/1997 710/390 1 2006 SUMMARY Bill M Fair Market Value: Assessed w 174846 527,500 Valuations: Last Changed: 10/05/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.400 177,000 289,200 466,200 NO Totals for 2006: General Property 10.400 177,000 289,200 466,200 Woodland 0.000 0 0 Totals for 2005: General Property 10.400 177,000 289,200 466,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 132 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST CROIX COUNTY February 26, 2008 Y Edward Tichenor 2236 100th Street Somerset, WI 54025 h Code Adminzstrat+ RE: Remodeling/addition to existing house, Town of Star Prairie 715-386-4680 Parcel#038-1034-80-000 (8.31.18.154C-1) Land Information Planning Dear Mr. Tichenor: 715-386-4674 AA The Zoning Office has reviewed our remodeling �% Y g project for compliance with the Real Property state sanitary code (COMM 83). When remodeling or adding onto a dwelling you 715-3$,.4677 are required to examine whether or not the planned modifications involve an Re cling increase in design wastewater flows to the existing Private On-site Wastewater X386-4675 Treatment System (POWTS). According to your house plans, the project involves removing an existing deck from the rear of the house and construction of an addition to living areas over the same footprint. On 2/25/08, 1 verified the location of Squaw Lake's Ordinary High Water Mark @ 940.69' and determined that the exterior edge of the existing deck is 85' from that elevation. This project will disturb less than 2,000 square feet (grading/filling) on slopes <12% within 300' of the OHWM, so you will not be required to obtain a Land Use permit (per Shoreland Zoning Chapter 17.29(2)(a)). The original septic system was designed and installed based on design wastewater flow (DWF) for three (3) bedrooms (450 gallons/day) with a maximum occupancy of six (6) persons. The proposed plans will not add bedrooms and m occupancy remains unchanged, therefore the project will not exceed the design wastewater flow. The original system was installed in 1988 by Byron Bird, Jr. using a 1000 gallon capacity septic tank to an 18' x 54' bed-type POWTS. It was inspected by zoning staff after installation and was found to be code compliant at that time. A word of caution; after calculating the elevations recorded on the inspection report, it appears that the elevation from the septic tank outlet to the upper end of distribution pipes is nearly level. When the drainfield eventually becomes saturated and ponds wastewater, a backup into the septic tank would occur. Make sure that when the tank is pumped (last maintenance was October 2006) the drainfield observation pipe is also inspected for signs of ponding or failure! Inspection report, as-built, and sanitary permit documents are on file in the zoning department archives. ST.CROIX COUNTY GOVERNMENT CENTER PZ000 SA/NT CR IX.W/.US 1 101 CARMICHAEL ROAD, HUDSON, W/ 54016 715-386-4686 FAX O W W_W_._CO_SAINT-CROIX_WI.US To prolog"the"life e`Pm tesae epic° npumpo `il ry three yrs or when the tank becomes 1/3 full of sludge and scum. Other efforts to extend the lifesparjof the system include: water conservation measures such as repair/replace leaking plumbing fixtures, r oderate shower time, running the dish washer only when it's full, avoid using a garbage disposal, -ng a wash machine with a suds saver feature, etc. The projected lifespan of your POWTS is A' ndent upon proper maintenance of the system. If this PO should fail at any time in the future, the system will be need to be inspected by a licensed pf er or POWTS maintainer to determine if it must be replaced according to state code requirement"`' effect at that time. The propos`` `. remodeling project must comply with all applicable building codes. Please contact the B ding Inspector for the town of Star Prairie to obtain a building permit. Should y have any questions, please contact this office. Si , amela Quinn Za Ong Specialist a Cc: B n Wert, Building Inspector Jny Shillcox, Zoning Specialist rrie Stoltz, WDNR-Water Regulations onitary permit file ST CRO/X COUNTY GOVERNMENT CENTER 1 10 1 CARMICHAEL ROAD, HUDSON, W/ 54016 715-386-4686 FAX PZCCO.SA/NTCRO/X W/us WWW.COSAINTCROIX WIUS G- c � (/ J UQ' jWfi �'l-0{L� s 14 i iA 9 � v V• [- � x Thom ql-ls113 ' L3 lull. aw/ 4-tny Of (J" '74 ej e- cddoe i Irk 3,-73 0 n Cl) 0 3 ' n d O fa E Con 3 3 m a c :r 3 3 w m � (D 3 - `•� � 0 0 o o �O N poo ow C • 3 3 c -- o rn Q M Z Z 0 -4 '', � o CD w UT CD 0 0 G 0 7 7 CD fD p O Co CA c3 O 3 � A 3 O y O O .. a (D w ! o CD «. m N a O c N W O rn 3 m rn =r O CD O p co co 3 N O G OD O O O �' �• n 3 (Al N a N CO v v v A 0 N D ° D �1 N O U .d. .7 y y A C3D A N ZwZ 0 � v� o D a 3 C, ter 0 CD CD CL cn CD E 'a N N MA CD O C CD CD V y 0 3 N Oy CD Cf� n N O A Z O w ° C) a O o o 0 Z -1 00 (D o 0., z rn x R 3 a N C :: Cl)o 3 m CO O UI Z (D A . w � I O N CD Cv a o RE. � -0 aa)i �_ -. 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CROIX COUNTY, WISCONSIN SUBDIVISION ?--- LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM G � � ( jr- Joy V� f J vet INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /oo Proposed slope at site:t SEPTIC TANK: Manufacturer: eat Aj Liquid Capacity: Number of rings used: -AL15 Tank manhole cover elevation: 5;�.ir,aj�" 2.z`�� Tank Inlet Elevation:___ - I7 Tank Outlet Elevation: Number of feet from nearest Road: Front 10 Side ,o Rear, / o J / feet From nearest property line Front,O Side,O Rear,O /;� O feet Number of feet from: well Jot / building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) RRR RR.VRRRR RTflF 1 .2 Lo N FILED JUL 22 1977 ° w "- G7{ J"ES O'coiimeLL Z O _ bolder of .Qa, v► � O � � � z & Croix ,h,, m 6' wLamd. pJ z m z OZ n O 8 G c o m O D z D m --I SQUAW N. LAKE g m = 34.94' C) N vo � / � O n N/ /� P0 Z\p 90 O 01 .4 0040 r O O v N ' a m O n? 3 F I.0 AC. o T�-yi Y z p N 0°00'48"E �' x <N CO 20_0.50___ , z O ' 0� o 3 p0.85°�r`Orno 2< Q r O� U7 w D Z 1po C� O �! tV z i =r ao CAD a° z 2?2°4 mlCjp > n q n n>.4 / <O czn p o m o mm X23' m 3 c v o o z 0 o° 430 725" \ 3 e ZZy � M OD Z 4_ w 268 023'35"'c� m Z -C ~ O O FO Ln p iv O O v' _ N G� CD OD_ O Z �; 0 ♦ 'A Si = Q OD W /_ r. O rp:m m N n W - I 1 Z m ) o o a V) p m pp N (a w N V N ... v T Q z A .1 --1 CD m O (/� O — 11 0v z DD Co Q am 10 0 -� `n D + n w W N 0 3:8 -r D (�ii cn z O �' D c`n C) p OD O� K m n m z 3C(� w !�r\1 r-- r0 m D Z o X n m /lJ rn O0 O �? O� p m = -n Z D K D `? p rm r m D 0 D M w 9J m *�rn m ti Oo lac I00f04 194. G 334.61 --- - SOUTH 676.3 pn .v SOUTH m 74 p M w W -i o b 629. p m D b_ APP CENTERLINE c C) cn o TOWN ROAD OF ROAD SURFACE Z ={ --j -I O c1p -C Z f C ' D K CO O O z z m m z %mum I Volume 2 Pagre 414 Parcel #: 038-1034-80-000 02/12/2008 09:12 AM PAGE 1 OF 1 Alt. Parcel#: 08.31.18.154C-1 038-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 EDWARD J TICHENOR 0-TICHENOR, EDWARD J 2236 100TH ST SOMERSET WI 54025 Districts: SC= School SP=Special Property Address(es): '=Primary Type Dist# Description 2236 100TH ST SC 3962 NEW RICHMOND SP 8050 SQUAW LAKE RHAB& MANAGE SP 1700 WITC Legal Description: Acres: 10.400 Plat: N/A-NOT AVAILABLE SEC 8 T31 RI 8W 10AAC S 1/2 NE SE LOT 1 Block/Condo Bldg: CSM 2/414 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-31 N-1 8W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 996/580 QC 07/23/1997 924/114 07/23/1997 776/154 07/23/1997 710/390 2008 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/05/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.400 177,000 289,200 466,200 NO Totals for 2008: General Property 10.400 177,000 289,200 466,200 Woodland 0.000 0 0 Totals for 2007: General Property 10.400 177,000 289,200 466,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 132 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 0-299\231-009\C.dci\231-009.dwg, 3/29/2006 9:17:41 A' 1140 r1l go > --j M m x 0 ro vb" mom r m 946- < V(II 0 If IT --j EX/S CAB I r-F r- > N 1 -U =0 lo 00 CO d MP U) im m o m 0 U) r.(ct I] m m < (n al 0 OD 0 . m X -u (.0 0 C: X ;u Z _q m 0 // / �' co M>o C? Ul > <M >0 f x U) m 1. ........... _--960--o /------ ...... -0 --------------- -T Aj c4, /V jo-f- A14 ,E-Z-, V.2 co /Of/ v 31 AOtm lot ui G. -rockenor /00Y-4 N&+ 5. r S 7-fit// S-) sy,7-4 f- sIq Parcel #: 038-1034-90-000 02/12/2008 09:11 AM PAGE 1 OF 1 Alt. Parcel#: 08.31.18.154C-2 038-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-JACKLIN, ELAINE H ELAINE H JACKLIN 265 GREATON RD NEW RICHMOND WI 54017 Districts: SC= School SP=Special Property Address(es): *=Primary Type Dist# Description *2236 100TH ST SC 3962 NEW RICHMOND SP 8050 SQUAW LAKE RHAB&MANAGE SP 1700 WITC Legal Description: Acres: 4.700 Plat: N/A-NOT AVAILABLE SEC 8 T31 N R1 8W 4.7AC IN NE SE LOT 2 OF Block/Condo Bldg: CSM IN VOL 1/414 ALSO PARCEL SURROUNDED ON 3 SIDES BY SD CSM & DESC IN VOL Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 541/409 08-31N-18W Notes: Parcel History: Date Doc# Vol/Page Type 06/27/2006 828312 EZ-U 08/07/2002 686287 1943/99 WD 07/23/1997 1021/601 WD 2008 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/05/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.700 69,400 20,600 90,000 NO Totals for 2008: General Property 4.700 69,400 20,600 90,000 Woodland 0.000 0 0 Totals for 2007: General Property 4.700 69,400 20,600 90,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: 132 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �Ierl,-7,7an LA�;(c1u C/ TOWNSHIP �c�( / 1J Y���^, SEC. T 3_�N-R�W ADDRESS �� ���/O2 �T ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE _ PLAN VIEW Distances and dimensions to meet requirements of IT.HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM re S / Jac, 3 V� o or INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /bo Proposed slope at site: SEPTIC TANK: Manufacturer: A) "a A Liquid Capacity: ��� � Number of rings used: Tank manhole cover elevation: y Tank Inlet Elevation: g Tank Outlet Elevation: �Fi ✓� Number of feet from nearest Road: Front 10 Side 10 Rear, feet From neare8t property line Front 10 Side 10 Rear,0 T D feet / g l Number of feet from: well J' 02- , building: el (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 1 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: x Trench: Width: _ Length:., Number of Lines: Area Built: Fill depth to top of pipe: '2':V Number of feet from nearest property line: Front, O Side, O Rear, Ft . _ Number of feet from well: f Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom .of seepage pit elevation: Area Built: Has either a drop box O 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, O Side, O Rear, O Ft. Number of feet from well: Number.of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• Dated: v T v"J4 Plumber on job: / License Number: 3/84:mj s Lr u- ..,.......... 3 1 d'b 7 1 � N FILED _ ° JUL 22 1977 �_ 0 p� JAMES O'CONNELL � Rollie. of Deeds Vl fTI 8% Croix Canty, z m z ZO n 6' w ,.r 9 0 0 D o z D m SQUAW o-N: LAKE gm = I z N 3 O n. O O DNS c�° %p40 o0z - 2F3Oy� A C1i GSA r �� rv_ G I I \ ro I.0 Z A I�C z o d 0, 74 X N s 0= N O°0q48 z O n <- - 200.50___ m o 9 p0 o I m Z m r C L ti >t t� 7p w / z r ao Co�' a zp X22°44'23„ISm- O R 0 p ��•'J1 p O tr o m �m \ 3v+ C Ca n° 7d� ro O� A m p0 43°/72 i v z -.1 rn z� .4 w 268°23'35" 5„ z v G2 N � o m O: G� t� NO �cJn aG'o OW c°n ° Nm O c { N S o l J O T b �fc).m � m W N- I ' I 1 6D U,- N 0o4 (j)z O Om f� 0 0 A n U �GOi 8 (v m D Q M v_ CA p r �' -' z _ 0 0 m z C� co N co n D 0 p N M "I Q ^ Ul O Ii w D (Jl c 08 L A m O0 rn" m z � C Z cn NAW —I w D m ,9 o D� � D 41 o U o DOQ nw ( � 00 : m w cn n ° n � m ~ <0 -4 ao Z C T N 'C _N w -+ P -1 00 z = -n �n rn O O -� O p m p z Dm D m m °m O mm ^\Y l�rn m CO � 0 /60 I s - - ---- - _ s,, 10 .04 194_�G� 334.G1 - SOUTH 676 0 -N w L, SOUTH �,, _ n o m Z u) w -� - rn D 40 G29. w O b 0 o n cn � - o APP CENTERLINE � C D N R AD OF ROAD SURFACE -i n o TOWN 0 D E: C O O z z z c m an m z -I Voluse 2 Pare 411 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS .Q.BO&HUMAN RELATIONS t PRIVATE SEWAGE SYSTEMS DIVISION MAD1ISS ON,,W WI 53707 P.Q. X BUREAU OF PLUMBING SZ,NE%,SE4,S8,T31N—R18W TN CONVENTIONAL E]ALTERNATIVE State Planl.D.Number: (lf assigned) Town of Star Prairie ❑Holding Tank ❑ In-Ground Pressure ❑Mound S(ivaw Lake NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE Herman Oswald Route 1, Box 129H, Somerse t, WI 54025 ,'N_ 8g BEM ARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN REF.PT.ELEV.: CST REF.PT.ELEV.: 0L16 04 hk&_ Name of PI ber: MP/MPRSW No.: County: Sanitary Permit Number: Byron Bird Jr. 3318 St. Croix 112671 SEPTIC TANK/HOLDING TANK: Q Va- bhs -- MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER �W\ h O ,S PROVIDED: PROVIDED. BEDDING: ri VENT MAT L.. HIGH WATER V j1_ ES ❑NO DYES NO ALARM: NUMBEi3 F ROAD: PROPERTY WELL: BUILDING: VE TO ESH BEET FIR ` INE: ��AIR INLET OYES O DYES O NEARES"1 r— DOSING CHAMBER: MANUFACTURER. Bj ING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: YES ❑NO ❑YES ONO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. GAF PROPERTY WELL BUILDING.IVENTTOFRESH (DIFFERENCE BETWEEN F °T FROM LINE AIR INLET: PUMP ON AND OFF) ❑YES ❑NO SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until ' ` the soil is dry enough to continue.) MhAIl CONVENTIONAL SYSTEM: WIDTH: LENGTH INO.OF DISTR.RAPE SPACING: COVER '.JINSIDE DIA.. #PITS: LIQUID �E /) I TRENCHES. A TERIAL: PIT DEPT GRAVEL DEPTH FILL DEPTH R.PIPF IS PIPE )ISTFL PIPE MATERIAL. NO. R I" ' ,­',T ROPERTY WELL: BUILDING: VENT TO FRESH BELOW PI ES: ABO E COVER: ELEV.INLET ELEV.ENDS. PIPE INE AIR INLET: MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES 1-1 NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES 1:1 NO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED: CENTER: EDGES: 1:1 YES ONO 1:1 YES ONO ❑YES 0 N PRESSURIZED DISTRIBUTION SYSTEM: I w WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVERT Fa. TRENCHES: dT t d MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO-DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: at 'ELEV.: ELEV.: DIA.. ELEV.: PIPES: DIA.: HOLE SIZE HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: DYES L1 NO 1:1 YES 1-1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: o'e PROPERTY WELL: BUILDING: LINE: I ❑YE Noll OYES ❑NO III T6P ofe'p-e. Sketch System on �11� Retain in county file for audit. Reverse Side. ' �1 V D SIGNAT E TITLE: DILHR SBD 6710(R.01/821) p jjjZ?ning Administrator SANITARY PERMIT APPLICATION COUNTY�� Gro °°. _...�. In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT¢# y/ —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 ®NO PROPERTY OW ER PROPERTY LOCATION �/ wA Q s / —%a S T , N, R E (o PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBE SUBDIVISION NAME "_/!0� /a x �-- CITY,STATE ZIP'ClODE PHONE NUMBER CITY NEAR ST R E R LANDMARK ,C f` T D f S .� �_ O VILLAGE:TOWN OR II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): Ill. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. New 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. %Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Di seepage Bed b. ❑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): L r-2 7 Feet P41rivate ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic A Tanks Tanks structed App. Septic Tank or Holding Tank A-H .G Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): / Plumber's Signature:(No Stamps) w MP/MPRSW No.: Business Phone Number: l n n � IY•� � ty a6''�7es'l Plumber' ddress(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil T ter(CST)Name CST## 17 5;1 CST's ADD (Street, �',ittyv,State,Zip Cod ) Phone Number: IX. COUNTY/D PARTMENT USE ONLY rK ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial f1 IS charge Fee Adverse Determination 2 U, C� q. X. COMMENTS/REASONS FOR DISAPPROVAL: 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 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 question concerning your p6vat. sewage syster,;, contact your local code aclministra`or or the State of Wisconsin, Bureau of Plumbing, 608-266-381-3. To be compk,:te and accurate this sanitary permit application must include: 1 Property awner's nar:,,e and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public 13 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 8'/z 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; 13) 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 at9r included the creation of surcharges (fees} for a number of regulated practices which Wisco ln,6 can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rec`sujry 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. a 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 ,,!atey, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(803/86) " APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owners) 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 Z��IfX911911 0 5 &,J A 4- Location of property, 1/9 1/4, Section TU_N-R A? W Township /fi'l'e Mailing address Address of site Subdivision name Lot number Previous owner of property / c flAffb /- U C #5 Total size of parcel fQ , 6". Date parcel was created Are all corners and lot lines identifiable? Z_Yes No Is this property being developed for resale (spec house)? Yes No Volume OC and Page Number -�Q34 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 gleed glee recorded in the Office of the County Register of Deeds as Document No. "-A_ S'U ; 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 Regis of De s, s Document No. ) , 0j, r ignature of Owner Signature of Co-Owner (If Applicable) �3 Date of Signature Date of Signature DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2—1982 1.. Y�! 77&Ia,� �� REGISTERS OFFICE l j ST. CROIX CO., WIS.. ...---- Rec'd. D.Rich x ------------ uchs--and__-Dorothy___M,___Fuchs �' for Record this 24th ... nd._wife_-as-__j.oint___tenants, I; day Ap.. _aD ---- 1i 1987 -------------- ---------------------------------------•--------------------------------------•------•............ _ © 8:30 conveys and warrants to ........ ............................. -••..............................•---•--•-•-----•------•-----------•----------••--------------------------------- ---- ----------•----------------------- ------ -•--- •----•.............•---------•-----•---------•--•---•-----..------ •---•----•--•----•-----------------•---------- I; ....__ _.... _...�. r ............._.-......_-.-..._...._.-._....._........--..-._..-......-....._....._...-.-..-.......-.............. RETURN TO ............................................_.._-.--._-.--.--_-._...._...._..--.-...---I.......--................ L ... _�- � - ---------- ----• ---------------------------•- ---•---- -------- ----------------. County, i the following described real estate in .--------. -5..t.-,-CrOlX__ __ State of Wisconsin: Tax Parcel No: ------------------------------ Lot 1, Certified Survey Map filed July 22 , 1977 , in Volume 2, Certified Survey Maps, page 414, as Document #341787 , I� being located in Section 8-31-18, Town of Star Prairie, St. Croix County, Wisconsin. I This Deed is given in satisfaction of that certain land contract dated January 25, 1983 and recorded at the Register of Deeds office for St. Croix County, Wisconsin on January 26 , 1983 in Volume 658 , Page 319 , as Document Number 382339. i I i TEANSFM PE F i This _.---i S__not______-_ homestead property. (is) (is not) i Exception to warranties: Subject to ease men ts, reservations and restrictions of record. Dated this ------------c21_3--- .---------•-------- day of ----A F r.11----------------------------------------------------- 19....8.7.. ---r�.�-1 1--`ft-.�rSEAL) .-------- ---•--------------•----•------- --•-----•-----..-_.------(SEAL) _ �`- -�`�-�--� = � I * RICHARD_P- FUChS -- ...... �! ---------------- -------------- r � ----- -- ---------------------------------------------.-.-(SEAL) �` '/X.... . l_ , (SEAL) I' * -.DOROT M. FUCE:S - I�. AUTHENTICATION ACKNOWLEDGMENT Signatures) __of__Richard P.___Fuos____________ STATE OF WISCONSIN ---------•---- and__ucrathy___` .-_-Fuchs ss. --------------------------------------County. aut t this ._ ..._day of... --- ril _______, __87 Personally came before me this ................day of . 'G�' -----------------------------------•----• 119........ the above named ---------------•---------------------------------------------------------------- s_ STEPHEN J. DUNLAP --------------------- -------------------------- --------------------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN ------------------------------------------•--------------------------- ( �d+ ------------------------------------------------------------ ------------------------------ ------------------------------------------------- at }I'oife�d�b��$�l�fj!(j6� �/�9t�It�S� to me known to be the person ------------ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ............................... -----------5TEIPt N._J:_._.I)I _IZ-1?---------------------------- .............................................Hdon .V isosin-----------------•----...... Notary Public -----_------- ........County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration are not necessary.) date- ------------•--•-•--------------•-----------•---------- 19------...) 'I *Names of persons signing in any capacity should be typed or printed below their signatures. i KC.MillerGonp" STATE ORM No. 2— 1982 SI Stock No. 1 3002 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ,ERIyI��I.� /(, , CAS [.c_AA b ROUTE/BOX NUMBERAor / 14 FIRE NO. ' 3SG' CITY/STAT&., CQ mzrsz'7- z'Jf I ZIP C, PROPERTY LOCATION: 1/4 1/4, Section , TN, R�W, Town ofe_� St. Croix County, Subdivision , Lot No. 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. S I E � 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, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: NSHI UNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: 5' / 1/ /T N/R (or �u -- COUNTY: OW E 'S/ U ER'S NAME: MAILING ADDRESS: . eliro � e nevap 4L< USE DATES OBSERVATIONS MADE NO.BEDRMS.:ICOMMERE�L DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence g New fflReplace RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) OS ❑u Vs ❑u s ❑u a s ❑s �u If Percolation Tests are NOT required re DESIGN RATE- If any y portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: e I Floodplain,indicate Floodplain elevation: G /s 55 IIZ 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 OBSERVE (SEE ABBRV.ON BACK.) B- G.lo oti< 7 4!U B- S�� ��- '1' - B-3 0 f e i _ y 6/ B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER @44§hW AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- . .7 0 c 3o P- . 7 0 eL< p P- 47 d tie_ 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 - 5_ o /- Q. Ou. F . o c � I,flw_.undersignecl, hereby certify t at t e sot tests rte 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(pr ` TESTS WERE COMPLETED ON: Al", h Jr -- - ADDRESS: CERTIFICATION NUMB R: PHONE NUMBER(optional): .3 5e 7 CST SIGNAT E: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) —OVER — i 1 i INSTRUCTIONS FOR COMPLETING FORM 115 - SBO -6395 To be a complete a nd accurate soil test,your report must include- 1. complete legal description; 2. The use sectio€l must€:l€:.arty indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms o€-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 'F ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; B. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagrarn accurately locating your test locations. Drawing to scale is preferred, A separate sheet may be used if desired; S_ Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates,names,addresses,flood plain data,percolation test exemp- tion, if appropriate; 103 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 your certification nurnber; 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 — Saone (over 10"} BR Bedrock cot) - Cobble (3- 10") SS — Sandstone gr — Gravel (under 3") LS - Limestone s Sand HGW — High Groundwater cs — Coarse Sand Pere — Percolation Date med s Medium Sand W — Well fs - Fine Sand Bldg -- Building Is — Loamy Sand > Greater Than sl Sandy Loam < -- Less Than *I — Loam Bn — Brown *sil Silt Loam BI Black si — Silt Gy — Gray McI _- Clay Loam Y _ Yellow scl -. Sandy Clay Loam R Red Jcl — Silly Clay I_oarn mot - Mottles sc Sandy Clay vv/ — with sic Silty Clay fff -... few, fine, faint *c Clay cc common, coarse= pt: Peat mm Many, medium m €duck d - distinct p — prominent HWL - High water level, Six general soil textures surface water for liquid waste disposal BM Beach dark 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. NGS I.VORrA 41 ON ; 0 A PE T ( : y; triWlAN{�ECA TONS t M7 LQQATIO fi• t MU iCIPALiTY: T iv I,�r (,NI 1 I iorl " A A �0 DATES tER�tl0. � USE - Residencej' New O Replace 6- c ' .r�..'`ss is f RATlMG:'S�Sits4ultable for system. U=Site unsuitable for system x a L: IN L LDiNG A K:RECOMMENf3Et3SY , S C� 1 S ❑U $ S, A �E 6 es DESIGN ATE.SYSTEM ELEV.1f•iolatidn.Tts are NOT-required / if any portidn of the Jot is in the under 5}( ),indicate: / ✓� . ` 1=loodptain,indicate Floodpiairt'etavation ° 5 PROFILE C? ,.�� 3.,.. „ SORI NG IN E,EV IOhI is Y B OCK IF(> IL E© E A8S r n z r r ' s•�.r (y r f t . i a * { PEROOI TION TESTS fir; " Ay -DR. IN WATER ES` . hlO h TEST TI _y ;-. - A INTERVAL MI PERIOD t T tions of perpiatioa'tests; soil borings land the dimensions of lAble soil areas. Indicate`sCele or. i "_` M e}83�►ttcrr� e&,points and show their location`bn the plot plan. Show the surface e{evatio'n-�all borit0i " *W # slop. ;> ti."� � �.. fry - t I IF J A, € j S I'.. a un ,_hereby;oertlfy that,the soil testa repor* on this form were made by me in sword with the procedum in ° A"mistratiw-Code;and that the data`recorded and the location of the tests are correct to the best of my kndwiedge-and belief. i print r, TESTW R L 4 y EAT FICATi W_, WURE: ttj40d row' 6f Plumbitvg.3tdpage 4gnrtrOwrilr.4thoioi�$011 R-SB - b:.i. ryt�te #n�J.">•r"* }41kit";7 Well yyq 9n Y^+u C ATI© 1l RT1#1ED' 1L 'f NW, i .,{,�' � y .x � "per . 't,�,, ,�-•+ ��'w " - 3� �' -..r.,, x AA -'Cobbf 43- 1 � { [ •per y Fc 1 Pr 0:A 1ftrC ... . — 'Meth WD Well F ., `t x y fines kiblWtA M IS (parity SM -- SQSra A wo ei d r , Well b *t' 'S..• Loam �, °v .. SIVBI[ t Silt Lo _ -Bldg. Silt ' `' -Clay L ,.5,: �:.�CI~. clay Lct8trt � k' "� .x,•_ a�.�:eCa" � �� _� ;Y w,�.. �•' iGz ..�..y a ..:.._. Sandy gray `.•'w�`-ctp --. .:-.. ,..�, -,.�,.Ma` .a7i * �. .ry. "4eys�,, By $ � 168 ±�,f$ € p,.A ♦ +7- �t�"�ptt,^yxK,�"b'°" wi r c 14 T - �"' Al °7 w p��` • �d e Hig h water ta�fef OW is x� r t" rub'. a � , � x fi a 44r' k MC �y y5. I ii, yyJ� r uS Mi- Zr't '` N'-'Y 'C >-s ', --gym -, ' t'<. "' •• II" M _ .1 ; ...iw. v^ail.rter� P`;' :''r_4�- �,m••'�a� e� €'' - e. ,xE .i* •`-}e 4e �• '?i•;w` ,q y n°.,}y PLOT PLAN .PROJECT-4i 0,,117 ADDRESS /j/ 1/4 Jl-,jF- 1/4/S$ /T3/ N/R;�W TOWN �a ri �� COUNTY ,6m r 5 5 MPRS Byron Bird Jr. 3318 DATE BEDROOM_ 5CLASS PERC_,g CONVENTIONAL IN-GROUND ESSURE CONVENTIONAL LIFT_ MOUND_HOLDING TANK SEPTIC TANK SIZE e LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE G5R7 BED SIZE Benchmark V.R.P. 4ssu6 Elevation 100' Location of Benchmark o o Lc) -�/�/,, H.R.P. 13 Borehole Q Well Scale Feet O Perc Hole System Elevation 85� Uent 12" Grade TYPAR COVERING 2 i 12" 3' 4 6' O 3- 3' 4O 3' %¢j(, �DCJe h5 I 6" Sewer ock 18 1 I -'9 Pe- 12' ' 49, g_ /o h � f a y�� �o t �a A n / , p �- U �i 3