The URL can be used to link to this page

Home My WebLink About038-1036-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578979 -6- GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Chevalier, Martin Star Prairie, Town of 038-1036-20-000 CST BM Elev: Insp. BM Elev: BM Description: Sectionfrown/Range/Map No: 5-7. N~ JZQ 4,451416 08.31.18.158D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark P -1•L 1 •ko 95'~l 9S3 . yy Dosing Alt. BM Aeration Bldg. Sewer y gD 1So 0 Holding St/Ht Inlet F G 000 F9 Zy St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding uD f Z $ Tl~l Bot. System l Final Grade PUMP/SIPHON INFORMATION Ma facturer Deman St Cover GPM Model Num TDH Lift F ' oss System Head T Ft Forc n Length Dia. PT_e I SOIL ABSORPTION SYSTEM BED/TRENCH Width Length . Of Trenches IT DIMENSIONS No. Of Pits Inside Dia. Li ' Depth SIONS SETBACK S M P/L BLDG WELL LAKE/S M L Manufacturer: INFORMATION AMBER OR e Of Syste . Model Number DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes 0 No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2214 Cabin Lane SOMERSET, WI 54025 (SE 1/4 SE 1/4 8 T31N R18W) metes & bounds Lot Parcel No: 08.31.18.158D 1.) Alt BM Description = ` TO B'E t Z' ouEe- W of TANK 2.) Bldg sewer length = Z$ ` Q btf L Dj ij & .S~kfee %'(p" jCf 0►h HI gjL C-*SIA14 - amount of cover = f2' S-1,5 Plan revision Required? ® Yes No f~ Use other side for additional information. F7Tz, ~ 5:-] F 4 am&c4 ~ /z (0l9 l SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. county C' T-- a? 15*afe and Buildings Division 162 Sanitary Permit Number (to be filled in by Co.) i., `l 201 W. Washington- v~ e.,-PLO. Box 7 x TY Madison, W! 53707-7162 74 OPMENT ^QM State Trarsadion umber Sanitary Permit Application in accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate governmental trait is required prior to obtaining a sanitary permit. Note: Application forms for state owned POWTS are submitted to Project Address (if different than trailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary piggposes in accordance with the Privacy Law, s. 15.04(1 Km), Stats. L Application Information - Please Print All Information ! C- Property Owner's Name Parcel # ' r~Zv o~g_ 6-2,n--&rv Property Owner's Mailing Ad l s Property Location I ovt Lot C Zip Code Phone N ber_ Y~, Section City S 0 irc c p I 7' V~ T J 1 N; R t n lBo W EL Type of Building (check all that apply) Lot 2 Family Dwelling -Number of Bedrooms Subdivision Name *31 i Block # ❑ Public/Commercial - Describe Use 1~L 2-'"e ❑ City of ❑ Village of~j_® ❑ State Owned - Describe Use CSM Number Town ofti/ III. Type of Permit: (Check my one box on line A. Complete line B if applicable) A. ❑ New System System 11 Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Owner j Before Expiration IV. Type of POWTS S ste-m/Com onent/Device: Check all that a 1 1n Ground 11 Pressurized 1n-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in- of suitable soil olding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) is rsa rea It Information:Design Plow (gpd) l Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VL Tank Info Capacity in Total # of Manufacturer F o Gallons Gallons Units U -Z New Tanks Existing Tanks u o :3 2 A U C73 v: s G c Septic or Holding Tank, j AIZA x Dosing Chamber VII. Responsibility Statement- I, the up4ersigned, ass r ponsibility for installation of the PORTS shown on the attached plans. Plumber's Name (Print) Plum s azure MP/MPRS Number Business Phone N her , I, I z V , Plumber's Address (Street, City, tart, Zip VIII. ounty/De artment Use Only Approved tsapprov Permit Fee Date Issued Issuing Agent Signature 656?' 6 9 ~5 Given Reason for Dertal DL Conditions of ApprovaVReasons for Disapproval Old s sd~,,ti 1~ ;I, &A ` Attach to compieu plans for the system and submit to the County only on paper not less than 8117 111 inches in size SBD-6398 (R. 11/11) -7 ( 10 13 J R,e Ce o b-~- L Gt00Jiu lEr.cL~~av ` / ~lcvafivv~ 70 ~OGdIiQvt Lf" ,!e ~ CU[nVey /p Al"')AW t.,//V / (~*%fP'l4~/h - _y~ Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/15/15 Owner: Marty Chevalier Location: S E 1 A S E 1 A S8 T31 N,R18W 2214 Cabin Lane Star Prarie System type: Holding Tank Manuals Used: Holding Tank Component Manual Version 1.0 Page# 1. Cover Page 2. Holding Tank Plot Plan 3. Holding Tank Cross Section 4. Maintance and C tingency Plan 5. Holding Tank anc ring sheet Signature License nu r 226900 PLOT PLAN PROJECT Martv Chevalier ADDRESS 937 Ctv RD H New Richmond Wi 54017 SE 114 SE 1/4s 8 /T 31 N/R 18 W TOWN Star Prarie COUNTY ST. CROIX SYSTEM ELEVATION TBD 5/12/15 DATE BEDROOM 3 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK XXX MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 2000 gallon LOAD RATE ABSORPTION AREA # of chambers BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter B Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark Squaw Lake Scat _ 1 4° = 10' B-1 5, Scale is 1" = 40' 25' unless otherwise 25' 25' 40' 60, noted Existing 3 25' bedroom cabin 09 All piping shall be ASTM SDR 30/34, within Privy B.M.* 15' 10' of tank, piping shall be ASTM F891 10' 6' 30' well Service _~_A Building sewer is to be >8' from well, Access >25' ~P °F ` e'u- Holding tank is to be >25' from well, e1GV -per-r6 holding tank is to be within 25' of TN g~451service road - HT 70' B-2 Existing septic tank is under cabin, location of drainfield Driveway/Cabin Lane unknown! Property Line to 100th St. Property Line Area not suitable for systems due to irregular slopes 100th ST. Single Holding Tank Cross Section and Plan View Plan View S' S' S' } } > y S Y } y } S y Y } } } , > Y J Y } } } } S } S ; { i i ; { { { ; { i { < J } < > J J t { f 'i i < S T i t > Y>> S y>> Y J Y J Y J Y} Y 5 5 5 Y Y S S S Y 3 7}}> J S Y> Y Y Y> S S S> Y},> y i YL < S t t{{< 2 S{<< i i i< t{ t t< t< t t t i< i<{ i i t i t i } } } } } } } } 5 Y J J Y } J } } i Y s } > } 5 } } L S S S i t t< S S f f S S S S S<<< i{< f i S<< S<<<<;{{ } Y } s} y J}}}} Y y y Y y Y2S S S f K< S <}t S -t Tether Tank Manufacturer: Weight 1 ~ < > Tank Capacity: Gallons ; K y `y Tank Maximum Depth of Bury: Ft < } } Alarm - > i Switch i Depth of Soil Cover Over Tank Z t t; On Ft. , f i < K Alarm Switch Type: ❑ Mercury echanical Y{ }S}SYL}LyL}{y{yLy<ytyty{}{ySyi}SYS'S'LSSSSY{JSJt}SSS yS}SyS yiy Sy{yS}S}L5{JSySySYi}t}S}S JSyiyf'iy{?LS ==7z, L'S{ } GENERAL INSTALLATION: The tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Manhole covers below grade are sealed watertight. Piping at the inlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. Electrical is as per the National Electrical Code and applicable Wisconsin standards.. Electrical is as per the National Electrical Code and applicable Wisconsin standards. 03/05lgj Page of HOLI:it}~s TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to Comm 83, Wis_ Admin. Code, the Holding Tank Component Manual 0577 1-P 611111999), and the ~:5±. rfn N-- County Sanitary Ordinance. 1. This POWTS is designed to accomrnbdate an estimated domestic wastewater flow of gpd_ 2. The owner of this POWTS is responsible for system operation and maintenance, including ail provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the second tank reaches a level of 12" below the inlet invert (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis_ Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and Comm 83 and 84 WIS.- Adm. Code, 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch_ 281, Wis. Statutes. The discharge of wastes from this holding tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction Orders or a citation by the county or state. 7_ No one should enter a holding tank for .without being in full compliance with OSHA standards for entering a confined space. l`t a atmosph rwithin these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. _ 8. In the event that this POWTS fails and cannot be repaired, a code compliant feplacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Connection to municipal services would also be considered at this time if they are deemed available to the property. 9, If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with Comm 83.33 Wis. Adm. Code. 10. If there is a problem with7 or question about this installation, the flowing persons should be contacted: a installer Phone: 7f'.,%'-12 b. Service Provider %o M- r-0 X dl- Phone: ~ --L7 y~ -5j. c. County Zoning or Health Dept Phone: 71r-- 3~~~tJ 11. Project: Transaction. Number: sbird@frontiernet.net - Frontier-Yahoo Mail 5/14/15, 12:41 PM Septic Tank Dimensions & Weights Septic Tank size Dimensions Weight (lb.) Anchor Weight (Its) Soil Cover Nn) gal 204"L x 9CWW x 93"11 47,400 3u.850 24 'J gat 165"7_ x 92'V x /6"H 26,300 23,320 2~ 262 5'gat 147"L x 9U-, V1, 73"H if? .100 20,625 2000 gal 162"Lx78"Wx64"H 6, ion 15,615 aal 145",L x 78"W x 61"H 14.060 11,270 1r. 261) c?al 111"Lx 78"W x 61"H 11,460 9,532 ? COO , L114 Profile 1L z fi I"W x 57"H 9.500 8,705 P _.ivt1 ya, Heavy Duty 96"L x 78"W x 61"H 9,200 8,945 1.9 800gaI 96"Lx67"Wx57"H 6, oOn ...,6,560 16 600 ge18"L x 56"W x 60"H 6,600 3,819 14 1600;1aai cal 174L x 90"W x 73"H 23,000 22,4`.+12 22 I .Of750 gal hZ°± x 78"W x 64"H 16,400 15,725 14 IOOC COU gal 45'1 x 7C'==W x 61"H 14.700 12,705 https://us-mg6.maiI.yahoo-com/neo/launch?.partner=ftr&.rand=9rCnfpk4lj3ut#maiI Page 1 of 1 S .~G 0 1 2011 Wisconsin Depa ent of Commerce SOIL EVALUATION R Page S of Division of Safety nd guil'd' ~uUNTY PLI' `~h1~ ~„~®Nipi( Q~~ t A ce with Comm 85, Wis. Adm. Code / Attach complete site Ian on County 5 p paper not less than 8 1/2 x 11 inches in size. Plan must ~ include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q -39 Please print all information. as/y 4.o,viewe Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.0(1) Property Owner Property Location Govt. Lot 114 _ 1/4 S T N R E (o W Pr~ope i Mailing Address Lot # Block # Subd. Name or CSM# / /91/ city State Zip Code Phone Number ❑ City ❑ Village Town Meares Road . ~ fJ Sr c ~a) a - y~ ~ G~ ~~>1~ ❑ New Construction Us Residential /Number of bedrooms ' Code derived design flow rate GPD Replacement ❑ is or co mercial - Describe: Parent material 7C~ Flood Plain elevation if applicable ✓f/~} ft. General cornrnertts 7 e Q'GLC' -}'f~eGL~ and recommendations: I q70~ I f ! L System Type System Elevation C~YL(~iGK- wi- -7 b2 Boring # Boring Pit Ground surface elev. -ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 B-~ /ti- Z-~ Boring # Boring 9 19Pit Ground surface elev.!, ~2, Depth to limiting factor in. Soil Applicati on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF n in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 14- Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Blame (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 r ~ i Property Owner _ Parcel ID # Page of ❑ a Boring # Boring in. ❑ Pit Ground surface elev. ft. Depth to limiting factor Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-I Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ pit Soil ication Rate Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots .E GPDtffEff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Effluent #1 = BODS > 30 < 220 mglL and TSS >30 1150 mg/L ' Effluent #2 = BODS < 30 rrg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. 5868330 (8.6/00) Soil Test Plot Plan Project Name Viginia Schumacher and Family Shaun B' Address 1791 Stanford Ave St. Paul Mn 55105 f CST #226900 Lot Subdivision Date 7/ Y 1 SE 1/4 SE 1/4S 8 T 31 N/R18 W Township StarPrairie Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of siding System Elevation TBD *HRpSameasBenchmark Squaw Lake B-1 , Scale is 1" = 40' 25 ' unless otherwise 25' 25' 40'~ 60, noted Existino) 0, 25' bedroom cabin vy B.M.* 15 10' 6' Well Driveway/Cabin Lane 70' Property Lme W, Property ~n'!CE, ti R< y , J Line to ~ 100th St. C'. Y 4..- y Area not suitable for systems due to irregular slopes 100th ST. 5d o-6 S q36 f#f 's61sE% 1020.9 154C-1 G Dr1~ Q L•+ 1 GS / 894.91 541/409 154C-2 Pi 1084.81 ff 154C3 0 . i. 1013.73 I t isr ~!~z(. 158 A. 3 Z, 541 ~tJC~G 1.58 B w ,mo o, --0 / ~~-Zoe VVD ZZI I~ 158 G~ 1 . _ 4 157 A - 7s' 4 \ 158 D 4 2- 158~vE ~k t - - - ~~1d56`r` 158 F , ' ?Z ° I~ ~clSvdsO'' 158 G \ f; Aln Ca6l 158 H 158 N TOD-13 q 15 8 I _ iS-v x 5 zS ~ ~ , - I 158 j _ 20 z m cA x-///,/ 6" K Goo 1 2`~~ 158 L m 158 M koUS~e- - Ln ° 0 3 C), O Vy y C ci a 0 tl C h ~ 'r N O I L I N N N .N a m y°o C a o LL x.am u, v y b a> d ~ f0 O L ~ y m 3 I ay c 0 f ~ N ~wmo rn 0 3 yo j 0 09 Z 0 M .W O O LL c U ` N :C L O N U 3 5~~~~ 3 M v l z 0~ ° ~ H Q ~ O co W i+ O 2 O N O O- LL Y Z ! 0 4) LLJ I, a m A> w 3 m co 0 o 0 v w 0 -0 r 0 O Z a c v « N . Gs Z y N N c N N 9) a' (D m E C L o E (n CL 0 N a ; H Q Ut E 0atS N y N C ~S a' N OX a L 3 E 0v O 0 IT ,n 0 a) 0 Z co Z C) N 0 a u) 0 otf fV d _ CC) E V/ d ° a Y O a LO o o a` m `~+LJ E H a O O O a a a a U) 0 o v~ y U jI O rn rn 0 ^v 4) " j r ZZ4 = O _ a c m c LL rn _ II U o Q Z U) CJ O 7 a~ O C N N C N O O O V O N U N d rn v r \ N ~2 CCU N O -e 'C C a O O O V N N N M O C. 0 C co y C C"i r- d y 'O N n0. f0 co \N ►1 M 7 p a0.+ 7 O C N • O O fn LL Z U 2 Z fn O ar - E U - L (L • a d u `N o ,`v 3 A U(L o Out 0 Wisconsin Department of Health and Social Services lbo;,#b7 3/70 Division of Health SEPTIC TANK PERMIT APPLICATION y TYPE or USE BLACK INK A. MNER OF PROPERTY Name Address (Strest,.City, Zip de) L 3 7A ~_/L B• LOCATION OF PROPERTY WTSRE SYSTEM WILL BE CONSTRUCTED, ALTEREr OR EXTENDED COUNTY Check One: CITY VILLAGE LEGAL DESCRIPTION TOWNSHIP C C. IS LOCAL PERM VREQUIRED FOR THIS WORK? YES NO PERMIT NUMBER D. SEPTIC TANK CAPACITY / / C1 Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALS: Prefab Concrete Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLEDs E. TYPE OF OCCUPANCY Check Ones One or Two Family Residence Commercial Industrial Other Specify) Number of Persons to be Accommodated 4- Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES NO Dishwasher YES- NO Automatic Potato Peeler YES NO Other (Specify) G. MASTER PLUMBER MAKING INSTALLATION Name: i 7 ! r rL-. C Addrasss '-'License Numbers Signature of Applicants MP RSW Address: H. (?o a Compieted by Issuing Agent) Date of Application / 7 D Fee Paid # T Permit Issued (date ` a Permit Number Agent (Name) t. -Cyi- Town, Village, City, County, etc. (Specify) Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $1.00 for each septio texuc and the third copy of the permit (canary) to the Division of Health. Checks ano money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY . 1. DATE RECEIVED -7 ACCEPTED BY RETURNED (Initials) (Date) See Corres.) FEE RECEIVED VALID. No. PERMIT NO. (Yes or No. REVIEWED BY APPROVED DATE (Initials) Yes or No COMPLETE OTHER SIDE: EEPTIiC TANK PERMIT NO. _ REPORT ON SOIL PSRC0LATI09 TYST AND SOIL BORINGS TO DIVISION OF HEALTH - PLUMBING SXCTI1* P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code P= R C 0 L A T I 0 N T Z S T Test Depth Character of Soil Hours Water Test Time . Drop in Water Level Iaohes Minutes Number Inches Thiokness.in Inches Since Hole in Hole Interval Second to Next to Last To Fall let Wetted Overssi in Minutes Iast Period Last Period Period One, Inch Example P - 0 36" To Soil 10" Cla- 26" 25 Yea or No 30 1 2 2 2 1 60 q `Z t F 1,r c 42 3 ` - ~J ~ . C /10 RECORD DATA FROM MINIMUM OF 3 TEST HOLES v Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. S O I L B O R I N G S- Minimum 36" Below Pro osed Absorption System Boring Total Depth. Depth to Groundwater Depth to Bedrock Number Inohes Observed Estimated Observed Estimated Character of Soil with Thickness in Inches Example Black To Soil 12" CLaY Level Sand 18"• Gravel 24' H - 0 72" 72" . -71 RECORD DATA FROM MINIMUM OF 3 BORE HOLES P€ OF OCCUPANCYs Number of Persons RESIDKHCEs Number of Bedrooms ~'S _ OTHERS (Specify) FOOD WASTE GRINDERS Yes No , Dishwashers Yes No _ Automatic Clothes Washers Yes No FFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLAN Tile Size No.Lin.Feet Trench Width _ Depth Number of Lines Seepage Beds Length Width Depth Tile Size No. Lines ~ Seepage Pits Inside Diameter; Liquid Depth_C It the undersigned, hereby cert'ty that the percolation tests reported on this form were made by me or under m•• super vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and that the data recorded aad location of test holes are correct to the best of my knowledge and belief. NAME I G P TITLE Type or Print ''or -MASTER . PLUMBER LICENSE NO. REGISTRATION NO. i ADDRESS SIGNATURE DATE i' P W 154A NE-SE I ~T+ - 620/ 99 1020.9 154C-1 hAh r+ ,,zPG LA 1 GS 10, 894.91 V/ - 154C-2 A ~ 541/409 1084.61 154C3 - 1013.73 VV D ~-wk - I 1584 1.58 B 1240,0, ti gay V = PR VT) - 221 u +t 13 o 158 Ghf 157 A - f Sao, 7s ? 22 l f q r~ ` YcUb ~d 1/rr, e lc.~ VON P 158 D I - I 1A ro I t, c 40- 8 F a-hI58 G Ca6~~ 158 H 158 N w a- 3 JC 1 58 I l /-v x5- zs-' 158 J Z2a6 r,~/y/v ~ 20 z co - - - n _ 0 158 L Q~)~6,, 158 M 32Z (W✓~ 0 c~~ ` 1-(DU LO Parcel 038-1036-20-000 08/09/2011 08:02 AM PAGE 1 OF 1 Alt. Parcel M 08.31.18.158D 038 - TOWN OF STAR PRAIRIE ST. CROIX COUNTY, WISCONSIN X~ Current Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - SCHUMACHER, VIRGINIA L VIRGINIA L SCHUMACHER C - FOURRE, THOMAS D CONSTANCE M ZIMNEY,ET AL C - LALLY, CATHERINE 1791 STANFORD AVE C - FOURRE, MARGARET A ST PAUL MN 55105-2043 C - FOURRE, MARK W C - ZIMNEY, CONSTANCE M more... Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description V31, SC 3962 SCH DIST NEW RICHMOND tj 20 o SP 8050 SQUAW LAKE RHAB & MANAGE 12 SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 8 T31 N R1 8W N 150FT OF S 975 FT OF Block/Condo Bldg: 6 r~~ SE SE u~. i / 7~-' ~_-__,_j;- Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 'i J' Ulif°U {NIA-tom ~G~c ¢.QS Vh S~ 08-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 10/29/2007 863172 QC ~ 12/07/2006 840201 QC MU 08/10/1987 428950 787/56 PR 2011 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 116,900 35,500 152,400 NO Totals for 2011: General Property 0.000 116,900 35,500 152,400 Woodland 0.000 0 0 Totals for 2010: General Property 0.000 116,900 35,500 152,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I ~Y p I ' a~i o° I N O ors C o v ~ I a) m N ~j 'porn= ao j m y oo (A m "a CL 7 CO j LL X _ ~ C 4) m N t ~ I ha3 ~0CD t N w c cn W- E v z oos I lL c U N N amOUN 3 m 0 am Q ECLw0 3 Cl) ° I Z Ul a> m 00 E w o fn r O QONY € o cLL m z o o c rn oo FM- d m +c 3 c N O O N 2 U L O Z 't c c co) w. y CD Z v o w o d m U) H mE mE 'O N w O. 47 V 4) E N O 7 > E M (D w n of E 0 N O N X N 2 N N C 3 N a = 3 E-a c a O 0.0 w w 2 O o m Q N ZmZ o a m I c - E ~ E }}yy m - ~i NO C O hh,~~?ooa` .a - `J f2 a~ X333 R waaa a N ~ w 0 g j J C) O O N V 0 rn 0) Z N 04 CN - O E c o - co c rn N U o Q z in 16 C O c N y O 3o N N c co F- a) a) cn V a O N C N C ~y O O O U N M W f0 I. C M N N W ~ - CO N c M N 'a "a a07. -O (O ap N pp - j O O C N O co c LL O Z N 2 Z Sw (n w Q d a a w v c c a; _ O I 3 00 (-n C.) CILO 0 U) H z IT. WIF ^~n D - c- ~j ~ Gco ~ GL r J-- { I E 7- o C o v m C f7 w x C LL = Z c E E 0 v m d c x U° 10c m m L _a ° OW Of m v m w v Lj L C1 O m a a R 3 U d y L' S m pc a it Q U IL O C3 W ILLL J y_ U N N O J 0' J fA U O_' 2' 2' of 0 T k C~ N t~ a t w Ny!u~ Q~T ~ Q • Y , } {1 Y w 0 a a~~ Q N N ~ Q rye 9 _ 4 ~RtYI t~3 ~ 440 ~ e",r r"rte r `-t!r ao mar= "ry r rry i Stf t+5 ~b kM cw c~ ~ cv o g e4s a o d c,,~rr ~ ~,ao d 4 .,w q'+h5' gr co ~!e„'- `'>tw w o'er 9b r r t°~ ~ pp O r ~ C'Y ~ O c3 ~ S"9 r oD r C? 0 4 A W Q6 z i ! SEPTIC or HOLDING TAN K SERVICING CONTRACT Ct Cate f j > This contract is rnsc.i-, betwti _en true I Tank Owner(s) Name(s) and Pumper's Name J-11 Ne acknomcdae the nstaliauon of (a) septicfholding ,ank:son t°.,e fo li.),r, Ong property: `?rov~de legal c'ts:,~ia:i::}. 1. The o« n : agrees to file a copy of this contract w !.::hc i:, al s ; r_m«,~.~I u ri, Croix Chun= '13IIii 11!x " ZoningT, Departm-niL, C^ Ci(3GtiIT18IIt Tti3:p+°flaa:t 1 i t1~C7 S~"~ti't; S:'. 1:. ~Il~ {J ~l;;i :FiG7r as E ic.cl:;ircd i:: Comm 83.`2(,qc):'.' iu., Adm. onmon-w } S 2. T"n- wa %i-er agr",~ to :,flV t}. sep. L Tarlf v C . ,x JI ~l51 11G p`,iui cr and guarantees to i he pump-- to ac..ess ar;d oFservicing the septic'tw6lin t'hc c,~~il r riicc~s tc) tt:aint is ,ti_ a ro J yr n c, ~u ghat tide pi.mpercan service t„:.,cp' c h~ildin? :,rl_ts) t~ i-,h ilie r~ n~pia . ;:ci ilpment Ti,. ~~ts [u. ~h r °r K, racv the punip.-r for all I11., ,,s ; u7::ct1 it, upo:t iiy the oWncr el)ti purlp ar. 3, 7'l1e pu1;1 - a~. E5 to _U JI?11t t0 u t5 L;L(Jt C; OIL. i7C:I1tV1 a l Qrt IGI Ltil: ti rl't CLT ~i' the sehtlc_'i7nl,tu - ton c;.;) nu a ,llontllly basis. Th tit ~.r:- t a i,n agrees to include the followt-ing in the monthly report: a. The nan.c and .auttre- o-tt, i,-)r >truicing the septic! holding tank; ~ h. The na )oof :ac o~rner u:. srp i <.r;i, i t=.:.: . c. T'ib . , ,v.ativ:; t,i I t p:crp~:r,_, ou %N .u~~r°: installed; d. T=l.' sani.an p;.,llit null ci r~ th n~,l ii;1= (i"known); e. The d,,,t_ on iJh th; :c'ilOidtr.'~ i3 l t ~ ~C l f. The volume in gallons f t!ra ♦,-iments pum;,;;d irom the septic/holding tank for each servicing; g. The disposal sites to which the contents from the septicilioiding tank were delivered. 4. -11)"s t iuent will ren&.f ? in cffect lm.r -h,,:, owncr or Pl.n.n,1, t_:rr77,r~atc this crini act. 5', th_ e cr,? o"a a:. c ut this contract, til~, wv:I t 2i LO1t V 1.1} 10 s:.~ i.. ori~ra t or a cop% G'a ne',k' rv~ce cuntraCt 'l l; :;:e to ax ~ro% X111 i;arn.: within t , t,;!..' 4Sinas~ 3..; ~ from the da~r n1 to this service ~cmtract. Owner(s) Name{s) (Print) Owner's Signature(s) Subscribed and sworn to me on this date: P~R'~ `ty~A-ik l o ay's Date P s Name (Print) per's Signature Nota Public Signature f„ PurrtilMr's R,;y stration Number. Commission Expiration