HomeMy WebLinkAbout012-1045-40-000
St. Croix County Planning and Zoning
Friday, December 21, 2007 at 1:23:35 PM
Detail Sanitary Information Page 1 of I
Computer 012-1045.40-000 Sub/Plat: NA Section: 19
Parcel 19.30.17.3000 Lot: 2 TN/RNG: T30N R17W
Municipality: Erin Prairie, Town of CSM: Vol. 04 Pg. 1084 1/41/4: SE 1/4 SE 1/4
Owner: Griffith, Frank 1588 140th Ave. New Richmond, WI 54017
State Permit: 79197 Issued: 06/17/1986 POWTS Dispersal: Non-Pressurized In-ground Permit: Replacement
County Permit: 0 Installed: 06118/1986 POWTS Detail: Bed - Seepage Bedrooms: 3 WI Fund:
POWTS Pretreatment: NA
issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed
Harold Barber Yes Schmitt, Donavin this house is just west of lot 1 from same CSM - $0.00
Harold Barber Signed Off: Yes deed attached to paperwork. 1000 gal. Weeks
tank to 18'x 36' bed 300' effluent pipe from tank,
under driveway.
Scheduled Pump Date Pumped
6/1812007
GRIFP -2H, FRANK~'k& " SE SE, Se on 19
Rt. 2 T3 17W
Hudson, WI 54016 Town of Erin Prairie
I
San.Permit#79197 6-17-86 D. Schmitt
Conventional, Re _acement,
INSTALLED - 6718-86
St. Croix County Planning and Zoning r Friday, February 02, 2007 at 4:54:11 PM
Page 1 of I
Detail Sanitary Information
Computer#: 012-1045-30-M Sub/Plat: NA Section: 19
Parcel 19.30.17.3008 Lot: 1 TNIRNG: T30N R17W
Municipality: Erin Prairie, Town of CSM: Vol. g. 1084 114114: SE 114 SE 114
Owner: Griffith, Frank 1402 160th Street New chmond, WI 54017
State Permit: 79197 Issued: 0611711986 POWTS Dispersal: Non-Pressurized In-ground Permit: Replacement
County Permit: 0 Installed: 0611811986 POWTS Detail: Bed - Seepage Bedrooms: 3 WI Fund:
POWTS Pretreatment: NA
Notes
Issuer/inspector As Built Plumber Other Requirements Additional Notes Money
Harold Barber Yes Schmitt, Donavin notecard data $0.00
Tom Nelson Signed Off: No
Maintenance
Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification
6/1812006
- - - - - - - - - - - - - - - - - - - - - - - - - - -
Parcel 012-1045-40-000 12/21/2007 08:01 AM
PAGE 1 OF 1
Alt. Parcel 19.30.17.3000 012 - TOWN OF ERIN PRAIRIE
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
RICHARD J STAFSHOLT O - STAFSHOLT, RICHARD J
1582 130TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1588 140TH AVE
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Des i tion: Ac 5.040 Plat: N/A-NOT AVAILABLE
SEC 1 30N R1 7W 5.04 A IN SE SE LOT 2 Block/Condo Bldg:
OF M V 4/1084
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
19-30N-17W
Note Parcel History:
Date Doc # Vol/Page Type
07/23/1997 995/382 PR
07/23/1997 679/282
2007 SUMMARY Bill M Fair Market Value: Assessed with:
207878 118,600
Valuations: Last Changed: 11/07/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.040 53,100 60,900 114,000 NO
Totals for 2007:
General Property 5.040 53,100 60,900 114,000
Woodland 0.000 0 0
Totals for 2006:
General Property 5.040 53,100 60,900 114,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
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 ( R,,,ccITN TOWNSHIP SEC. T N-R W
ADDRESS ST. CROIX COUNTY, WISCONSIN
//0'0-T 0 A
LOT LOT SIZE 4cl2
SUBDIVISION
PLAN VIEW
Distances and dimensions to meet requirements of I•ZHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
C
nr Y
l3 41'fT ~s r O
op r° rN5
fi gg- 4Rk~N
ioa,d c~'r
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Qv~,ol
~J
40
qlt I ~ f K
' 3 ao -
iy
I ~ dtSd ` L
~b
y'
VIE
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used G~ e/yT 9/_,+B A(,&/-T r
f3 12 M
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: /6), Y8 Tank Outlet Elevation: 107,2 9'
Number of feet from nearest Road: Front 10 Side J0 Rear, O d ! feet
From nearest property line Front 10 Side,O Rear, 0 0 feet
Number of feet from: well ~Q f building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
nufacturer: Liquid Capacity:
Pump Mo Pump/Siphon Manufacturer: p Size
Elevation of in t: Bottom of tank elev on:
Pump off switch elevat Gal s per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest roperty Front, O Side, O Rear
Ft.
0
N er of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: f Length : Number of Lines:-- Area Built:. Za !Z
W Fill depth to top of pipe:
Number of feet from nearest property line: Front, M Side, O Rear,O pt.~v
Q Number of feet from well:
,.3D
V Number of feet from building:
(Include distances on plot plan).
EEPAGE PIT
ize: Number of pits: Diameter:
Liqu depth: Bottom of seepage pit elevation:
Area Buil
Has either a drop bo or distribution box O been used on any of t above soil
absorbtion sytems? (Chec one).
HOLDING TANK
Manufacturer: Capaci
Number of rings used: Ele ti of bottom of tank:
Elevation of inlet:
Number of feet from neares property line: ont, O Side, O Rear, 0Ft.
N er of feet from well:
umber of feet from building:
Number of feet from nearest road:
arm Manufacturer:
/ Inspector:
Dated: (6 zZtaX Plumber on job: "
License Number : 3~Q S
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS
P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS
DIVISION
MAIDISON, WI 53707 BUREAU OF PLUMBING
KXCONVENTIONAL ❑ALTERNATIVE n!77
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER:
INSPECTION DATE:
'lli p/
Frank Griffith Rt. 2, Hudson, WI 54016 , w jAR,11' A Q
BENCH MARK (Permanent reference polntl DESCRIBE IF DIFFERENT FROM PLAN:
REF. PT. ELEV.: CST REF. PT. ELEV.:
SE SE, Section 19, T30N-R17W, Town of Erin Prairie
Name of Plumber: MP/MPRSW No. County
Sanitary Permit Number:
Donavin Schmitt 3205 St. Croix 79197
SEPTIC TANK/HOLDING TANK: D
MANUFACTURER:
LIOUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. IWARNINGLABEL LOCKING COVER
~ U PROVIDED: PgOVIDED:
BEDDING: VENT DIA.: VENT MAT! HIGH WA ER ~ YES ❑NO ❑YES ❑NO
/j ALARM NUMBER OF ROAD. PROPERTY WELL. BUILDING: VENT TO FRESH
FEET FRAM LINE AIR INLET:
YES ❑NO ❑YES ❑NO NEAREST p2Q ~Q s'
DOSING CHAMBER:
MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MP MODEL PUMP;SIPHON MANUI M:TU HEH
WARNING LABEL LOCKING COVER
❑YES ❑NO PROVIDED: PROVIDED:
GALLONS PER CYCLE: PUMP AND CONTROLS oPERAnoNAL ❑YES ❑NO ❑YES ❑NO
NUMBER OF PROPERTY WELL BUILDING V NT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
PUMP ON AND OFF) ❑YES ❑NO NEAREST-)r
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing Nf, I H uinME rER MATERIAL AND MARK wG
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:
BED/TRENCH WIDTH LENGTH NO. OF DISTR PIPE SPACINIi COVER INSIDE DIA -PITS LIOUID
TRENCH / fWQ~# IA PIT DEPTH:
DIMENSIONS/(~_ /
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR PIPE DISTR. PIPE MATERIAL NO DIST i NUMBER OF
BE LOW PIPES ABOVECOVER ELEV.I LEI ELEV. END PROPERTY WELL. BUILDING: V NT TO FRESH
/.Z 7 94 PIPES FEET FROM LINE AIR INLET:
NEAREST P. 2 Q
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-
❑ YES NO meets the criteria for medium sand. TIONS MEASURED.
❑
SOIL COVER TEXTURE
7 rTA N I N1 MAHKE HS OIiSEHVATION WELLS
DEPTH OVER TRENCH BED D-TRENCH DEPTH OF TUPSfnL SODUfD ❑YES ISEIDID NO ❑YES ❑NO
CENTER EDGES MULCHED
❑YES. ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.: ELEV.. CIA. ELEV. PIPES DIA
ELEVATION
AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
YES ❑NO
❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER
LOF PROPERTY WELL: BUILDING:
FEET INE:
FROM
❑YES ❑NO ❑YES ❑I\ NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
S NA RE: TITLE.
DILHR SBD 6710 (R. 01/82) r
i..~ wisconsin APPLICATION FOR SANITARY PERMIT
®OUNTY
' (PLB 67)
DEPRRTR'EnT OF UNIFORM SANITARY PERMIT #
InDUSTRV, LRBOR 6 HUMRn RELRTI0 r
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
X - T Ila/9 S, CAI m
PROPERTY LOCATION CITY:
X114 F 1/4, S , TN, R /7 E (or~ OWN OF•
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME AREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
1V' AIA 7 ZYO rte AzI
TYPE OF BUILDING OR USE SERVED
i 1 or 2 Family Number of Bedrooms. 3 ❑ Public (Specify):
THIS PERMIT IS FOR A:
❑ New System D4 Tank Replacement ❑ Repair
Replacement Soil Absorption System ❑ Revision ❑ Privy
Alternate System ❑ Reconnection ❑ Petition for Modification
IF ~THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
IpJ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
L~ System-ln-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued -
El An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity Atd O Ald
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: ' - APO ctL . 5 6 IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tan Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
LIA
Aiz' f • E' Private ❑ Joint ❑ Public
1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signatur MPR Phone Number:
i
45-1
Plumber's Address: Name of Designer:
-I Dow
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee:
Date: ❑ Disapproved
(p -17 Approved ❑ Owner Given Initial
14 Adverse Determination
Reason for Di pr al
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County; One Copy To; Bureau of Plumbing, Owner, Plumber
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.) ;
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
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 develppment be intended for resale by owner/contrac WT,("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
Location of Property' Section, 'T~ N - R W
Township Zajv -
Mailing Address
Subdivision Name (410 1
Lot Number
Previous Owner of Property ES G
Total Size of Parcel
Date Parcel Was Created ?L3
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes - X No
Volume 7 _ and Page Number as:recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3. Other recordings'filed with the Register of Deeds Office
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 the Certified Survey 'Map shall also be required.
PROPERTY OWNER CERTIFICATION
I (We) centi•j y that aU .6 tatement6 on tiaz jonm ane .thue to the but o6 my (oun )
knowledge; that I (we) am (ane). the owneAW ob the pnope4ty debc4ibed in thi,6
in6onmation jonm, by vi tue .o6 a wa4Aanty deed %econded in the 06jice o6 the
County Regi6 ten o6 Deed6 as Document No. 3.~'Q O 3 ; and that I (we)
p4e6entby own the pnopozed site boh the 6ewa9edyAtem (cn I (we) have
obtained an euement, to nun with the above duc4ibed pnopenty, Jon the
con6t4uction o6 eaid 6yztem, and the aame ha4 been duty seconded in the 066.ice
of the County Regi4 ten o6 Deed6, ab. Document No. 3 &0 f3 l .
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED LAi% gIGNED
r
H
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H
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ST C- 105 r"
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SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
t7
/ a
OWNER/BUYER A/ 7_//
ROUTE/BOX NUMBER Fire Number
.CITY/STATE f~U0TOAi ZIP -5 4716
PROPERTY LOCATION: sz ' 14, Section, T 30 N, R_Z2 W,
Town of St. Croix County,
Subdivision Lot number
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,
if needed, by a licensed septic tank pumper. What you put into
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 607 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
three year expiration.
0
• E
I/WE, the undersigned, have read the above requirements and agree z
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- ro
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. j'
SIGNED
DATE lD ' /iS ' ~G
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.
r
77 LLNSCCWVjmn SANITARY PERMIT
Coun
DILH
R
.WUS.W4.UQSMr.HLffrV4,GROUNDWATER SURCHARGE
Sanitary PermHnNo.
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com-
monly 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 included the creation of
surcharges (fees) for a number of regulated practices which can effect groundwater. The
surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to
the groundwater through your soil absorption 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-
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
Ground:.
Signature of Issuing ent: Groundwater Pee: Dale: WISco in`a
buried ~81lI#iff8
DILHR SBD 28 N. 184)
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND P.O. BOX 76
HUMAN RELATIONS
PERCOLATION TESTS (115) MADISON WI 53707
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/ FW Ok TY: OT NO.:BLK. NO. SUBDIVISION NAME:
Sc W T30 H/1pp 1/7)Kr) W " PO." 7 6 A/f /(J
COUNT NE 'S UYER'S NAM MAILING DDRESS:
A/ J
tS / .
- 10a
USE DATES OBSER ATIONS MADE
NO. BEDRM=COMMERCIAL DESCRIPTION: PROF L DE SCI TIONS: 'OLATION TESTS:
Residence ~ ❑ New ~8eplace
RATING: S= Site suitable for system U= Site unsuitable for system
UNVhN I ZONAL: MOUND: IN-G ROUND PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
sou 0S au ; s ❑u os,®.u os Ru
If Percolation Tests are NOT required DESIGN RAT : [Floodplain, any portion of the tested area is in the
under s.H63.09(5)(b), indicate: indicate Floodplain elevation:
I)Assv /!7A / PROFILE DESCRIPTIONS
I BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COL , TEXTURE, AND DEPTH
NUMBER N, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
Z?o k7 j.5'0 AV do
21 _fY
B-J A)
B-
B-
B-
I/~aSir/l~q PERCOLATION TESTS
TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER +NeMrS AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P PER INCH
P- 1 6 O -7O !7/19 3 !
P- 2 3 7' O X30 Y41 0
4
P- .3 0 B 3
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 ?J. C40-A
I'd i_e
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i
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TN
•
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40
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I, the undersigned, hereby certify that the soil tests reported on th m
a with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of t sts ar ct t e be my knowledge and belief.
NAME (print TESTS WERE COMPLETED ON:
ADDRES CERTIFICATION NUMBER: PHONE NUMBER (optional):
6 2 9,0 71.:
~~~•6
CST SIGNATURE
DISTRIBUTION: Original and one copy` to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 a
To be a complete and accurate soil test, your report must include:
t
1. Complete legal description;
2. The use section must clearly indicate whether this is a residence or commercial project;
1 MAXIMUM number of bedrooms or commercial use planned;
4. Is this a new or replacement system;
5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet may be used if desired;
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;
10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Sign the form and place your current address and your certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st - Stone (over 10") BR - Bedrock
cob - Cobble (3 - 10") SS - Sandstone
gr - Gravel (under 3") LS - Limestone
*s - Sand HGW - High Groundwater
cs Coarse Sand Perc Percolation Rate
med s - Medium Sand W - Well
fs - Fine Sand Bldg - Building
Is - Loamy Sand > - Greater Thar)
*sl - Sandy Loam < - Less Than
*1 - Loam Bn - Brown
*sil - Silt Loan) Bl Black
si - Silt Gy - Gray
*cl - Clay Loan) Y - Yellow
scl - Sandy Clay Loam R - Red
sicl - Silty Clay Loam mot - Mottles
sc - Sanely Clay w; with
sic - Silty Clay fff - few, fine, faint
*c Clay. cc: - common, coarse
pt Peat rnm - Many, medium
m - Muck ' d - distinct
` p - prominent
HWL - High water level,
*'Six general soil textures surface water
for liquid waste disposal BM - Bench Mark
VRP - Vertical Reference Point
M
TO THE OWNER:
This soil test report is the first step it) securing a sanitary permit. The county or the Department may request
verification of this soil test it) 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 postec# pA for to the start of any construction.
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Parcel 012-1045-30-000 02/02/2007 04:49 PM
PAGE 1 OF 1
Alt. Parcel 19.30.17.300B 012 - TOWN OF ERIN 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
ROBERT & COLLEEN STAFSHOLT O - STAFSHOLT, ROBERT & COLLEEN
1402 160TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1402 160TH ST
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 3.710 Plat: N/A-NOT AVAILABLE
SEC 19 T30N R17W 3.71 AC IN SE SE LOT 1 Block/Condo Bldg:
OF CSM V 4/1084
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
19-30N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/18/2002 694642 2014/623 QC
12/30/1998 594768 1391/396 WD
07/10/1998 582758 1339/244 SD
07/23/1997 1211/473 Ap
2006 SUMMARY Bill Fair Market Value: Assessed with:
155998 274,100
Valuations: Last Changed: 11107/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.710 47,800 220,500 268,300 NO
Totals for 2006:
General Property 3.710 47,800 220,500 268,300
Woodland 0.000 0 0
Totals for 2005:
General Property 3.710 47,800 220,500 268,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 545
Specials:
User Special Code Category Amount
Total Special Assessments Special Chargees0 Delinquent Chare00
0.00 6
Gi
FORM NO. 985-A
7 9 C-...1 .,.w~
CERTIFIED SURVEY N0. 1081:
Part of the Southeast 1/4 of the Southeast 1/4 of Section 19, Town 30 North, Range 17 West,
Town of Erin Prairie, County of St. Croix, State of Wisconsin as described in Volume 11
of Certified Survey Maps, page 109), as Certified Survey No. 1001
_11-171893
BRG. REF TO THE EAST
LINE OF THE SE 1/4 OF
SEC. 19, T30N, R17W.
ASSUMED BRG. N00021'
COF
APPROVED 29"E. -E V4
' SCALE 1" 200' SEC. 19,
19,
T30N,
O ,i 01981 13 R17W
JU~ ~ ~ ~ ~ • -3/4"X 30" ROUND IRON BAR
Y WEIGHING 1.502 LB./L.F.
SY. CX0IX COUNTY ~I L -41-- 2" IRON PIPE WITH ptESE COMA1~ Zoe
PC0MM1uEE 1NG & t i alp ALUMINUM CAP U)
m Of K401
ad DaWodc (.0
q UNPLATTED LANDS
r 25.20' w
rt~~~~ log
S C~~~sa Q N89°38'31a W _340.34' P
S/ 315.13' ~o N
06
+ oti e9 0
161,613SQ.FT. Z
LEON R. a71 Ac.:
e HERRICK KRAD WITH RQAQ O
S-1303 187,897 SQ. FT MENOMONIE, 4.31 AC, Q
WIS. LOT 1 0
a)
" ••••4u..a[ ` EXISTING
gIVO SURVE~0 RM > B DG. 0
IL.'.~!NGS w Z
237,123 SQ. T. _ 5.44 AC.= , v o O
M t7
UNPLATTED LANDS `r o 't v o ~
Z
M i~00
00
Q oz
N ova
eg 53523'7 a, 311.61'
Lr)
N89610'03':W S89°1003 E " 846.84
2629.38 880.06'
3V4 COR. SEC. 19, TOWN ROAD SE Cc
r3ON, RI7 W SEC. If
'T30N
SURVEYOR'S CERTIFICATE •R17W
I, LEON R. HERRICK, Registered Land Surveyor, hereby certify that I have sur-
veyed, divided and mapped a part of the SE4 of the SW, of Section 19, T30N, R17W, ,
Town of Erin Prairie, County of St. Croix, State of Wisconsin, more particularly
described as follows:
Commencing at the Southeast Corner of Section 19; the point of beginning;
Thence N. 000 21' 20" E., 550.26 feet;
Thence N. 890 38' 31" W., 25.20 feet;
Thence continuing N. 89038' 31" W., 315.13 feet;
Thence S. 690 44' 20" 14., 569.25 feet:
Thence S. 010 35' 41 !i., ,09.56 feet;
Thence S. 000 21' 29" E., 33.01 feet;
Thence S. 890 10' 03" E., 880.06 feet, to the point of beginning.
Said parcel contains 381,074 square feet, more or less (8.75 acres, plus or minus).
That I have made such survey, land division and plat by the direction of Warren
Smallidge. That such plat.is a correct representation of all exterior boundaries of the
land surveyed and the subdivision thereof made. That I have fully complied with the
provisions of Chapter 236 of the Wisconsin Statutes and the subdivision regulations of
the Town of Erin Prairie and the County of St. Croix in surveying, dividing and mapping
the same.
DATED THISy 7* /W OF 1981.
Revised this 2nd day of u e, 1981. ON R. HER' K, e istered Land Surveyor
Subject to easements, ro wa s and restrictions of record.
x ~vr~~ / ~8 f
N R. HERRIC