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Parcel 038-1156-60-OOLO 02/10/2006 12:03 PM
PAGE 1OF1
'Alt. Parcel 22.31.18.726 038 - 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 - BECKSTROM, JON L & KATRINA D
JON L & KATRINA D BECKSTROM
2081 ASPLUND RD
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description 2081 ASPLUND RD
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 1.490 Plat: 2230-NORTHWOOD
SEC 22 T31 N R1 8W PLAT OF NORTHWOOD LOT 6 Block/Condo Bldg: LOT 06
EXC PT TO HWY DESC 993/458,459
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
22-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
09/20/1999 610648 1457/473 WD
07/23/1997 993/458 WD
07/23/1997 697/624
2005 SUMMARY Bill Fair Market Value: Assessed with:
119974 168,800
Valuations: Last Changed: 10/12/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.490 28,400 137,500 165,900 NO
Totals for 2005: 'i
General Property 1.490 28,400 137,500 165,900
Woodland 0.000 0 0
Totals for 2004: i
General Property 1.490 28,400 137,500 165,900
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
V
AS BUILT SANITARY SYSTEM REPORT
TOWNSHIP,,.-4~✓ SEC.TN-RW
OWNER
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
L
-a
Ir.
9X
I di at N r h rr w
r,
BENCHMARK: (Permanent reference Point) Describe: %x='f
Elevation of vertical reference point:Slope at site:
SEPTIC TANK: Manufacturer:~~~ Liquid Capacity: Number of rings on cover : Tank manhole cover el evat on:
Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER
Manufacturer:---- _ _ Number of gallons_
Number of gal pump set for a cycle___ gallons; Total capacity of
distribution lines_ gallon: size of pump head;
gallon per minute horsepower ;brand name of pump
and model number _
Type of warning device-- _
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover ;
Type of warning device
SEEPAGE PIT SIZE; Number of pits feet diameter
feet liquid depth seepage pit inlet pipe-elevation
bottom of seepage pit elevation feet.
il
SEEPAGE BED SIZE: number of lines width length;y2 tile depth
SEEPAGE TRENCH: width` length
PERCOLATION RATE 7 AREA REQUIRED_ C/' AREA AS BUILT
INSPECTOR
DATED _ PLUMBER ON JOB
LICENSE NUMBER I
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BQ.( 7909 BUREAU OF PLUMBING
MADISON, WI 53707
®CONVENTIONAL ❑ALTERNATIVE state Plan I.D. Number.
El Holding Tank El In-Ground Pressure El Mound [If assigned)
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE'.
Larry Hanson New Richmond WI
11 -~..~3
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.'. CST REF. PT. ELEV..
NW, NW, Sec.22,T31N-R18W,Lot 6, Northwood,Town of St.Prairie
Names of Plumber'. MP/MPRSW No.. ro~7sanitary Permii NumberCal Powers 1563 t. Croix 43658
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. / (U OUTLET ELE V.. WAR NING LABEL JLOCK G VER
LIQUID CAPACITY L, TANK INLET ELEV TANK
h~ G~ S 1,(,7 i/ ' ' JJ ` J PR VIDED'. PRO
OYES LINO YES LINO
BEDDING. VENT CIA VENT MATL. HIGH WATER NUMBER-OF ROAD'. PROPERTY WELL'. BUILDING. VENT TO FRESH
Z ALARM FEET FROM uN / AIR INLET:
❑YES LINO ❑YES LINO NEAREST<i~7 "U 1 (p0 ~2-
DOSING CHAMBER:
MANUFACTURER 7YIN G LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURERWARNING LABEL LOCKING COVER
PROVIDEDPROVIDEDES LINO ❑YES LINO ❑YES LINO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE I AIR INLET
PUMP ON AND OFF) ❑YES LINO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LE.NC,TH 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.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH_Z NO OF DISTR PIPE SPACING CO~ NSIDE DIA =PITS JLIQUID
am.-- TRENCHES. MATERIAL' ~ PIT DEPTH.
DIMENSIONS ,
GRAVEL DEPTH FILL DEPTH UISTH. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. N DI NUMBER OF PROPERTY WELL. BUILDING'. VENT TO FRESH
BELOW PIPES ABOVE COVER. ELEV. NLET ELEV. END PI PP S
LINE] AIR INLET;
FEET F
~ 2- C~ - NEARESTO--► (!i
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-
❑ YES LINO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES LINO ❑YES LINO
DEPTH OVER TREND H; BED DEPTH OVER TRENCH RED DEPTH OF TOPSOIL SODDED SEEDED MULCHED.
CENTER EDGES
❑YES LINO ❑YES LINO ❑YES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
WI DTH. LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV.. ELEV.. DIA.. ELEV.. PIPES. DIA.:
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES LINO ❑YES LINO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE
C, ❑YES LINO ❑YES LINO NEAREST
9 I v~~ " ~I U~ ~l
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01
Sketch System on n county file for audit.
Reverse Side.
A TITLE
DILHR SBD 6710 (R. 01/82)-_~
E7E- wisconsn 1EnT OF APPLICATION FOR SANITARY PERMIT
D I L H ROUNTY
(PLB 67) UNIFORM SANITARY PERMIT #
InOUSTR V,LRBOR6HUTRn RELRTIOnS 3 /
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT,
PROPERTY OWNER MAIL-LNG ADDRE S
-.~j
PROPER" CATION etTY:
/4,$ , T' , N, R (Dr 1n{ v~~~aGE:
TOWN OF:
, Ile-
LOT NUMBER JBLOCK NUMBER SUB91V SION NAME NEAREST ROAD` LAKE OR LANDMARK STATE PLyrN I.D. NUMBER
e
TYPE OF BUILDING OR USE SERVED j
1 or 2 Family Number of Bedrooms. ❑ Public (Specify):
THIS PERMIT IS FOR A:
5 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.
a Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holdiny Tank
❑ System-In-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
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
r /
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):
/
-i~7;f! j':❑ Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print Sig.ajure; j MP/MPRSW No.: Phone Number:
- J is f ~(k. L'~.i.-yf~. a~ : i--- = 7 (7/ ~ ) ~ Jam-
Plumber's Address: Name of Designer:
J _
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
❑ Owner Given Initial
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
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.
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V urIII - S T C 100
Owner Of Property
Location of Property ~ectiun~- , i 1---N It %i; W
Townahlp-1*~rt/ C
Mailing Address
i'
- r,~ ~ .
Subdivialon Nawd-JL X/ 1'f : j
Lot Nuwber
Previous Owner of Property
Total Size of Parcel y
Date Parcel Waa Created Y
Are 411 corners ideutlfiaula: Ye.: No
Include with thib application One or the followillp:
.Certified Survey Map
.Deed
.Land Contract. Or
Other Legal DOCUwent which describes the property
PROPERTY OWNER CERTIFICATION
(We) certify that all srtaturnents on this form are true to the best of my (our)
knowledge; that I (we) am (ara) the owner(s) of the property described in this
information form, by virtue of a warranty deed recorded in the Office of the
County Register of Deeds as Document No. _2L ; 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 Register of D e as Document No.
SIGNATURE OWNER SIGNATURE OF CO-OWNER (IF APPLICAULL)
OAT SIGN PATE SIGNED
DEPARTMENT OF REPORT ON SOIL BORINGS AND :SA Y & BUILDINGS
INUSTR~, DIVISION
LABOR ANID 7969
D'i WI BOX 53707
PERCOLATION TESTS (115)
HUMAN RELATIONS ~'p,
3707
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOTNO.:B ISUB01VISION ME
N
'/nY4 -2-1 /T_-3r N/R PYJ (off r , , off
Z
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRE
c~
USE DATES OBSER Mb M
NO. BEDRMS.: COMMERCI L DESCRIPTION: R R T PERCOLATION TESTS:
N~rResiclence ^ ,f New ❑Replace Z -zs
V /T I- Z S- I
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: . MOUND: ❑U IN-G""S ❑u RE: SY0STEM-IElILL HOLDING TANK: RECsQMM ND ED Y TEM:(opti nal)
r9If Percolation Tests are NOT required DESIGIN ATE: SYSTEQII EL V. If any portion of the lot is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: i
P/ROFILE DESCRIPTIONS i~ I y ,v.hc:~
BORING TOTAL ELEVATION D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED E61. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
BZ YY lc~" r,~ z
-3 S"
B- y
f ~ .
B- - ion
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIODt PERT D2 PERIODS PER INCH
p_ i
t
P `
P
PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or nce&/4.4cr rr arzontal and vertical elevation reference
points and show their location on the plot plan. Show the surface elevation at all In gs and bhe dire~tr'~aof land slop. I,.U
Np..n'l
SYSTEM ELEVATIONS office
Jf► rc:h cc~
t' 5t.
.
-
n.n S' 'rb
J
I, the undersigned, hereby certify that the soil tests reported on this f rm were made by me in accord with the procedures methods specified in the Wisconsin
Admimistrative 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:
LvrV1 oU_' V"
7 - z
SS: CERTIFICATION NUMBER: PHONE NUMBER optional):
r - ~ ft.'- (.u 5 S` _l 7 S - 1.3" i..
,GNATU
CSI ev
I Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
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