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' Parcel 012-1022-60-000 09/06/2006 05:00 PM
PAGE 1 OF 1
Alt. Parcel 08.30.17.119D- 012 - TOWN OF ERIN PRAIRIE
Current XI, 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 - FOWLER, DAVID L & REBECCA
DAVID L & REBECCA FOWLER
1614 160TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1614 160TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST G /
SP 1700 WITC
Legal Description: Acres: 1.890 Plat: N/A-NOT AVAILABLE
SEC 08 T30N R1 7W 1.89 AC SW SW LOT 1 OF Block/Condo Bldg:
CSM V 4/1133
Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
08-30N-17W
Notes: Parcel History:
~y Date Doc # Vol/Paged Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 11/07/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.890 28,400 174,700 203,100 NO
Totals for 2006:
General Property 1.890 28,400 174,700 203,100
Woodland 0.000 0 0
Totals for 2005:
General Property 1.890 28,400 174,700 203,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 122
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Y TOWNSHIP Er►YN ~E SEC. T zj N-R~W
ADDRESS rZ~~ ST. CROIX COUNTY, WISCONSIN
T
SUBDIVISION LOT LOT SIZE j'L1
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I
i
i
i
9k
1
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: 16 0 L Proposed slope at site:
SEPTIC TANK: Manufacturer: 1-J t s_ Liquid Capacity: ,
Number of rings used: Tank manhole cover elevation: /02
a
Tank Inlet Elevation:.Tank Outlet Elevation: rQ®
Number of feet from nearest Road: 0Front, Side Q , Rear, 9 feet
~a
From nearest property line Front 10 Side,O Rear ,,O --5--' feet
Number of feet from: well building: -51/ t
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
L SEE REVERSE SIDE
i
PUMP CHAMBER j
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevati Gallons per cycle:
Alarm Manufacturer* Alarm Switch Type:
Number of fee from nearest property line: Front, O Side, Rear Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: Length: Number of Lines: Area Built: Z-~gO^
Fill depth to top of pipe: ~~Z n
Number of feet from nearest property line: Front, O Side, O Rear 10 Vt
Number of feet from well:
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, Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector
Dated: ' -C' Plumber on job:
License Number: 3/84:mj
DEPARTMENT OF FNDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN 'RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 75_69 BUREAU OF PLUMBING
MADISON, WI 53707
) CONVENTIONAL OALTERNATIVE State PIan I.D. Number:
(
❑ Holding Tank 1:1 In-Ground Pressure 1:1 Mound If assigned)
A M0011
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTIO
N ATE:
David L. Fowler R. R. 1 New Richmond WI 54017 -5, 9
BENCHMARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: 7F . PT. ELEV.:
SW SW, Section 8, T30N-R17W, Town of Erin Prairie
Name of Plumber. MP/MPRSW No, jC,"my: Sanitary Permit Number:
Gar L. Steel 3254 St. Croix 64876,
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: p LIQUID CAPACITY: TANK INLET ELE V.. TANK OUTLET ELEV.: WARNING LABEL JLOCKING COV
PROVIDED: PROVID D.
!~~,lAr `tf✓.j'..`.'; YES ONO ❑ NO
BEDDING: VENT DIA.: VENT MATE. HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDIN ~VEN T FRESH
ALARM FEET FROM LI" C/ AI
OYES ONO OYES ONO INEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY JPUMP MODEL: 1PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
OYES ONO OYES ONO OYES ONO
GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING: I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET'
PUMP ON AND OFF) OYES ONO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing rJ14TH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIM
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH: LENGTH O.OF DISTR PIPE SP LING: COVER
7 INRE N CH MAT RIALJINSIDE DIA LIQUID
5 PIT DEPTH
DIMENSIONS
GRAVEL DEP IH FILL DEPTH DISTR. PIPE DISTR PIPE DISTR. PIPE MATER` L. TINEAREST
(NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH
BELOW PIPES: ABOVE CQV9R. ELEV. INLET.. ELEV END FEET FROM LINE30 1 AIR INLET:
1
V
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture o~ the fill aterial for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make cert in that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for m dium s nd. TIONS MEASURED.
DYES NO
SOIL COVER TEXTURE ERMAN ENT MARKERS: OBSERVATION WELLS.
OYES ONO [DYES ONO
DEPTH OVER TRENCH!BED FE VER TRENCH/BED DEPTH OFTOSOILSODDE : SEEDEDMULCHEDCENTER ❑ E ONO DYES ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH: TRENCHES LATERAL SPACING GRAVEL DEP H BELOW PIPE: FILL DEPTH ABOVE COVER.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERI L: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.: DIA.: ELEV.: * PIPE&. DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY: COVER ATERIAL: VERTICAL LIFT CORRESPON DS TO APPROVED
PLANS.
OYES ONO _ DYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WEL LS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
OYES ONO DYES NO NEAREST
Sketch System on etain in county file for audit.
Reverse Side.
SIGNATU TITLE:
DILHR SBD 6710 (R. 01/82)
MMMM". wls`or%sln APPLICATION FOR SANITARY PERMIT S
1~iDILHR COUNTY
(PLB 67) UNIFORM SANITARY PERMIT #
OEPRRTTEr1T OF
~ IrIOUSTRV, LRBOR 6 HUMRn RELRTIOnS ,~yy /J
SL/ A 7
-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
PROPE OWNER
/ MAI ING D
4, vocg-r . ~ A) ~ ~/X/XOV7 cyle
PROPERTY LOCATION -t'tTy:
=5 k) 1/4 501/4, S 8 , N, R /7 E) (or) W To'Tw oE: 1^
LOT NUMBER BLOCK UMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE LAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED /LO ,
X 1 or 2 Family Number of Bedrooms: 2 Public (Specify):
THIS PERMIT IS FOR A:
New System ❑ Tank Replacement ❑ Repair
Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
❑ Seepage Bed X Seepage Trench ❑ Seepage Pit ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ 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
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks 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):
/2- ~b ~Q Private ❑ Joint ❑ Public
1, the undersigned, hereby assume responsibility for installatio f the private sewage system shown on the attached plans.
Name f Plumber (Print): Signature: MPRSW No.: Phone Number:
3~ s1~ r7/S )z fZ6 ! z~m
Plumber's A dress: Name of Designer:
N •~r
re,
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
❑ Disapproved
❑ Owner Given Initial
/ eJ Approved Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
r e
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
S T C - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractAr•,("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 -pa uJ
Location of Property 5 iJ 14 Sid 14, Section ~ T 3 b N - RNo~ 1. W
Township r r) T a t{ t -e-
Mailing Address 1, ( 4(e w/ 3~ ~v.. ati 1 l.~ t S` p 1
T
y
Subdivision Name
Lot Number '
Previous Owner of Property 0j1T o n ~0- e T S o T_
Total Size of Parcel C~P Q c
Date Parcel was Created
Are all corners and lot lines identifiable? ~Lr~ Yes No
Is this property being developed for resale (spec house) ? Yes_ No
Volume W/ q~pl and Page Number / 9 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) ceAti6y that att statements on this Johm aAe true to the but o6 my (oun)
knowP..edge; that 1 (we) am (are) the owner (a) o6 the pnopeh ty des CAibed in thiA
in6o4mation bon.m, by viAtue ob a wama.nty deed necon&ded in the 066ice o6 the
County Reg.i.eten o j Deeds as Document No. 9 -7 0 3 P' ; and that I (we)
phesentty own the puposed site bon the sewage pas system (on. I (we) have
obtained an easement, to Aun with the above deacAibed pnopenty, bon the
constn.uatLon o6 said system, and the same has been duty %ecacded in the 06jice
of the County Reg-isten o6 Deeds, as Document No. ) .
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
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SEPTIC TANK MAINTENANCE AGREEMENT H
St. Croix County z
t7
/ a
OWNER/RUT-ER}-j/,
ROUTE/BOX NUMBER / Fire Number
s
CITY/STATE ZIP '5Q/7
PROPERTY LOCATION:,, [W k, s !4, Section T 73d N, R 'fkW, /7
Town ofrrt.'11 - 7'rAITI t_ St. Croix County,
Subdivision jA))4- Lot number/070.
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 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. Ho
E
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- •d
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED a~a.--~--
DATE ~J S
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.
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTAY, - CC DIVISION
LABbR
BOX HUMAN REDLtATIONS PERCOLATION TESTS (11J) MADISON WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: e- SECTION: TOWNS HIP/NVJAMQRA--ITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
c5 U) 1/4 V/4 8 /T3oN/R>7,&or►W I n~a
COUNT : OWNER'S~B.#€,T=S NAME: MAILING ADDRESS:
t) I
USE DATES OBSERVATIONS MADE
IIC~II NO. BEDRMS.: COMMERCIAL DESCRIPTIO (PROFILE DESCRIPTIONS: PERCOLATION TESTS:
p Residence 1-15 N: 544ew ❑Replace Z ^g~ '~S
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GR~OUNND-PRESSURE: SYSTEcM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
S ~U CAS IL JV7 ~U J [KU FIS o4
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
Gcsj~~/ PROFILE DESCRIPTIONS < 47 V?
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
7Z ag 7 A3 'f a /7
B- Z, 8°¢ ooh oo i / "5;1. 190- ez'
B- 3 17 oo zes 0 A) '7 B- G 0- `a0 ?L 'ea N 60-
3
B "V-
A10 A)
B-
j~~/ / PERCOLATION TESTS
LNUMBER DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
I4GIt9S' AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
D
Z,
Z_-
_
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
3 3 3 _
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-
33
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1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST SIGNAT E•
C~o
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DI LH R-SBD-6395 (R. 02/82) - OVER -
INST UCTT NS FOR °"TN_-T -ORM 115 - S BD - 5395
To a complete l to <clude.
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