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Parcel 038-1103-10-000 01/31/2007 10:15 AM
PAGE 1 OF 1
Alt. Parcel 25.31.18.433E 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 - MOE, GREGORY A,& DEBRA A CONE
GREGORY A,& DEBRA A CONE MOE
1950 140TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1950 140TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.300 Plat: N/A-NOT AVAILABLE
SEC 25 T31 N R1 8W 1.3A IN NE SE LOT 1 OF Block/Condo Bldg:
CSM IN VOL II PAGE 438
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
25-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1110/427 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
175540 220,800
Valuations: Last Changed: 10/14/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.300 27,100 168,000 195,100 NO
Totals for 2006:
General Property 1.300 27,100 168,000 195,100
Woodland 0.000 0 0
Totals for 2005:
General Property 1.300 27,100 168,000 195,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 502
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 - TOWNSHIP ~4 SEC. T _N-R i W
i
ADDRESS ) ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
i
i
I~
-
INDICATE NORTH ARROW
f,
BENCHMARK: Describe the vertical reference point used I ~r
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 Tank Outlet Elevation
Number of feet from nearest Road: Front,0 Side, y/ Rear 0 feet
From nearest property line : Front,0 Side,(D Rear, O feat
Number of feet from: well building:
,ice
.._iuce of rhe above c1_-
M
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, GSide, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
T
Width: X Length: Number of Lines: _ Area Built:
Fill depth to top of pipe: 7
Number of feet from nearest property line: Front, Y) Side, O Rear, O Ft
Number of feet from well: .-6 Yl~
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:
i
f j
Dated: Plumber on j ob
ti
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 796"9 BUREAU OF PLUMBING
MADtSON, WI 53707
LARCONVENTIONAL ❑ALTERNATIVE State Plan 1,D . Number'.
Ilf assigned
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER'. INSPECTION DATE
Robert Goodlad R. R. 3, New Richmond, WI go-,31-911
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. BEE. PT. ELEV.: CST REF. PL ELEV
NE SE, Section 25, T31N-R18W, Town of Star Prairie
Name of Plumber_ MP/MPRSW No.. County Sanitary Permit Number'.
Cal Powers 1563 St. Croix 54986
SEPTIC TA K/HOLDING TANK:
MANUFACAJff ER. LIOUI TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
9, , 2 PROVIDED. PROVIDED:
/ YES ENO EYES ENO
BEDDING: VEN DIA.. VENT MAIL. HIGH WAT R NUMBER F R JPROPERTY_ JWELLBUILDING VENT TO FREALARM FEET FROM ~
V LIN& LAIR INLET.
YES ENO tv, DYES ENO NEAREST +Jf
DOSING CHAMBER:
MANUFACTURER BEDDING. LlOlllD CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED'.
EYES ENO EYES ENO DYES ENO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING (VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) EYES ENO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ILENt,TlI 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.) ,p MAIN
CONVENTIONAL SYSTEM: 14
BED/TRENCH WIDTH LENGTH IN O OF DISTR PIPE SPACING COVER JINSIDE DIA -PITS JLIQUID
TRENC.~IZ / MATERIAL PIT DEPTH:
DIMENSIONS
GRAVEL DEPTH FILL DEPTH
J 7k,,~_ DISTR PIPE DISTR. PIPE DISTR. PI E MATERIAL'. NO. TR NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH
BELOW PI/P~S_ ABOVE COVER EL V I LFi ELE E,jND 4 / PIP FEET FROM LINE AIRpIN-~L-E/T
d~ 3 L'/ 1 NEAREST
/~C1~ ~r~ t7 5
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-
EYES NO meets the criteria for medium sand. TIONS MEASURED.
E
SOIL COVER TEXTURE PIOIDE RMANENT MARKERS OBSERVATION WELLS
EYES ENO EYES ENO
DEPTH OVER TRENCHBED DEPTH OVER TRENCH;BFD DEPTH OF TOPSOIL SEEDEDMULCHED
CENTER EDGES
ENO DYES ENO EYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL'. INO DISTR. JG~ITRPIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEVELEVCIAELEV.PIPES DA.'.
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
EYES NO EYES ENO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF P INE RTV WELL'. BUILDING.
FEET FROM LNE'
EYES ENO EYES ENO NEAREST
1 tt- 0
Sketch System on VV: Retain in county file for audit.
Reverse Side.
SIGNA RE TITLE.
DILHR SBD 6710 (R. 01/82) f6lla
_ f
Wisconsin APPLICATION FOR SANITARY PERMIT
~ ~ I LH COUNTY
M oEPRR=EnrOF (PLB 67) UNIFORM SANITARY PERMIT #
MM= InOUSTRV, LABOR 6 RUMRn RELRTIOns
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROP RTY OWNER MAKING ADDRESS
P OPERTY LOCATION CTTY:
11~- 1/4`., /4,S T N, R (or) W TOWN OF:
11% / 4'1
LOT NUMBER BLOCK NUMBER ISUBDIVISIO NAME NEAREST ROAD, LAKE OR 'LANDMARK
STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms: - j ❑ Public (Specify):
THIS PERMIT IS FOR A:
E New System [ Tank Replacement ❑ Repair
L7 Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
Z Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
J 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):
l Private El Joint E] Public
I, the undersigned, hereby assume responsibility for installation o he pr' at sewage system shown on the attached plans.
Name of Plumber (PrinO: Si at MP/MPRSW No.: Phone Number:
Plumber's Address: / Name of Designer:
,r{
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
❑ Disapproved
❑ Owner Given Initial
0, Approved Adverse Determination
Reason for Disapproval: .1 for
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
C - 100
This app!ication form is to he completed in lull and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner(contractor,("Spec,
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Own e r of Property L) . [
Location of Property j -_-14 It,, Section, T t- N - R l W
TownslIIP l hk
Mailing Address
i ~
Subdivision Name
hot Number
Previous Owner of Property 1 i-
Total Size of Parcel
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume ; 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. Tf the deed description references to a Certified Survey
Map, the the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
7 ((ale) eeAtil y that At statemenS on ,this loom ace true to the beat of my (out)
knowtudge; that T (we) am (ate) the owners (A) of the ptopetxy de6axibed in tkiQ
Qonmation loam, by viktue of a wattan-ty deed neeoaded in ,the. Office of the
County Rugloteh of Deeds aS Document No. and that I (we)
ptie A en tt y own- .the poo poA ed Ate lot the 6 ewag e d s pay at 6 p te.m (on 1 (we) have
obtained an eaAement, to man with. the above de6csibed propetrty, {soh- .the-
conAtsucti,on of Aa,i.d AyAtem, and the flame hay been duty ne.colded in the Office
of the County Regi6ten of Deeds, aS voeument No.
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
-
DATE 'SIGNRI) DA'F'T. SIGNED
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SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
OWNER/BUYER
ROUTE/BOX NUMBER Fire Number___
CITY/STATE LIP_
PROPERTY LOCAT ION : rl / Section 2S " 1-- / N' K1 1 -W,
Town of St. Croiy. County,
_ J
Subdivision Lot number
Improper use dad 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 se)tic tank pumpc~r. 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 maw 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-
lying 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. yo
E
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- "u
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
1) ATE f t
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
715-796-22:;?9 or 715-425-8363
Sign, date and return to above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, c DIVISION
P.O. BOX 76
LABOR
HUMAN R 4ATIONS PERCOLATION TESTS (115) MADISON WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT -NQ-.- [B NO.: SUBDIVISION NAME:
/T , (or) W
OUNTY: W ER'S/BUYER',S NAME: MAI LI G ADDRESS: r
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence ❑New OReplace
RATING: S= Site suitable for system U= Site unsuitable for system
-xff
CONNVEn\NTIONAL: MOUND: 'I IN-GROUND-PRESSURE: SYSTEM-IN;FILLHOLDIING TANK: RECOMMENDED SYSTEM:(optional)
US ❑U NC V ❑V 'fir S ❑u [:IS EU ❑S [zu
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: \ I Floodplain, indicate Floodplain elevation: t r/. r
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 OBSERVED (SEE ABBRV. ON BACK.)
r i r
i
B-
B-
g-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER iNEt°t:ES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PERINCH
i ,
P-
P- .1 i
P_
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
- 7
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F_
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): = TESTS WERE COMPLETED ON:
ADD~ESS: / CERTIFICATION NU R: H NE NUMBER(optional):
CS N URE-
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
FY! _HR-SBD-6395 (R. 02/82) - OVER -
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Fresh Air iniele And Obcervatlon Pipe
Approved Vent Cap
Minimum 12" Above
Final Grade
20- 42" Above Pipe _ 4" Cost Iron
To Final Grade Vent Pipe
Marsh Hoy Or Synthetic Covering -
win 2" Aggregate
Over Pipe
Olstrlbullon
Pipe 0 0 0 0 0 - Tee -
6" Aggregate
Beneath Plp• o Perforated Pipe Below
o Cowpiing Terminating At
Bouom of System
~I <
Pru~o1~ D
4.litJ..~ tort j
SOIL FILL
DISTKIBLITIOIJ PIPE
APPP.OVED S4WTHETIC COVER
OR qOp STRAW
2- OFAGGREGATE OR /AARSN HA,J
LEV. O~' - AGGREGATE X08
F, I , FEET
DIS"-RIa ;TI:~1) PIPE T(-) BE AT LEAST ( IIJCHES BELOW ORIGIIJAL GRADE
AQU AT LEAST20 IIJCHE-'~ BUT 1.10 MORE THAtJ 92, IKICHES DLLOW FILIAL GRADE
l
MAXIMUM DkPT1i OF EXCAVATicio FXoM OKI&VtAL 6KADF- WILL BE / INCHES
MINIMUM WrH OF EXCAVATION FROM. 01611aAL 6RApf- WILL BE L INCHES
SIGIJED:
LICEUSE AJUMBER:
DATE: Rio
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