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Parcel 038-1103-90-000 05/11/2006 04:58 PM
PAGE 1 OF 1
Alt. Parcel M 25.31.18.436E 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 - COX, BRIAN A & PAMELA S
BRIAN A & PAMELA S COX
1400 HWY 64
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 430 S KNOWLES AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 0.230 Plat: N/A-NOT AVAILABLE
SEC 25 T31N R1 8W PARCEL IN SE SE COM Block/Condo Bldg:
402.24'W & 7.43'N OF SE COR ON CEN LN
TN RD, TH N 143', N 82 DEG W 71.4', S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
151' TO CEN LN TN RD, E 71 FT TO POB 25-31 N-1 8W
ANNEXED TO CITY OF NEW RICHMOND
(1246/344-#561171)
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1151/191 WD
07/23/1997 1U WD
07/23/1997 (-9 39/410
07/23/1997 3
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 02/27/1998
Description Class Acres Land Improve Total State Reason
Totals for 2006:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2005:
General Property 0.000 0 0 0
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
AS BUILT SANITARY SYSTEM REPORT
I
OWNER ~~~~~s•, TOWNSHIP ~i SEC TAN-R,' W
ADDRESS ST. CROIX COUNTY, WISCONSIN.
)eZ4. /44- 41
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
j 4-
e ,
7 A
Y
9
I di at N r 1h rr w
BENCHMARK: (Permanent reference Point) Describe:..,,!
Elevation of vertical reference point: "I"11'') -Slope at site:
SEPTIC TANK: Manufacturer./. , Liquid Capacity Number of rings on cover Tank manhole cover elevat n:
Tank Inlet Elevation: jy Tank Outlet Elevation: 1~ y
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.
SEEPAGE BED SIZE: number of lines- width lengths/ )'the depth
SEEPAGE CRENCH: width length
~i~
PERCOLATION RATE- AREA REQUIRED AREA AS BUILT
INSPECTOR
DATED PLUMBER ON JOB ;~s
LICENSE NUMBER _
® wlsconsln APPLICATION FOR SANITARY PERMIT
®(PLB 67) COUNTY
OEPRRTI"nEnT OF UNIFORM SANITARY PERMIT #
InDUSTRV, LRBOR 6 HUMAn RELRTIOnS - / 2 70
-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
PROPERTY OWNER, MAILING ADDRESS
PROPERTY LOCATION GIT-Y:
j ` V-I LUAG E :
1/4.;~ 1/4, , , TJ, N, R E (or) W TOWN OF: - LOT NIYMBER BLOCK NUMBER JSNAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
4C~ 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): `
THIS PERMIT IS FOR A:
❑ New System Tank Replacement ❑ Repair
Replacement Soil Absorption System ❑ Revision ❑ Privy
J Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
Z. Seepage Bed ❑ 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: r S
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):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of th p ~ ate sewage system shown on the attached plans.
Name of Plumber (Prin)): Signa re MP/MPRSW No.: Phone Number:
r,~ -c if-- I Z.,
Plumber's Address: Name_of Designer:
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
I
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.
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
FN CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number
(If assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound it,
NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER: INSPECTION DATE. a
Mike.Kbucher R. R. 3, New Richmond, WI 9 -fg
BENCH MARK (Permanent reference point) DESCH(BE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.
SE SE, Section 25, T31N-R18W, Town of Star Prairie
Na- of Plumber. IMP,MPRSW No. County. Sanitary Permit Number.
Cal Powers 1563 St. Croix 43670
SEPTIC TANK/HOLDING T NK:
MANUFACTURER. LIQUID CAP ACITV. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING C
? G PR VIDED PiI--~I E
1 5.33 • SYES LINO LJYES '_DNO
BEDDING: VET DIA.. VENT MAT L. HIGH WATER NUMBER OF ROAD. PROPERTY WELL BUILDING: VENT TO FRESH
ALARM FEET FROM r{'~~ I AIR 1~11 64
❑YES LINO ❑YES LINO NEAREST
DOSING CHAMBER:
MANUFACTURER BED Y G. LIQUID CAPACITY PUMP MODEL 1PUMPISIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED PROVIDED'.
❑YES LINO ❑YES LINO ❑YES LINO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES NO 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
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH. ILENW NO. OF DINSIDE DIALIQUIDBED/TRENCH TRENCHES RIALPIT DEPTHDIMENSIONS
GRAVEL DEPT FIL DEPTH J I UISr PF DISTR PPIP TER IA L'. O. DI NUMBER OF PROPERTY WELL BUI DIN VENT O F ES
BELOW P PFS AHOY COVER E IV INf I ELEV ENDq PIPE FEET FROM LIN AIR T
~j3.$~" t NEAREST
MOUND YSTEM:
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-
meets the criteria for medium sand. TIONS MEASURED.
❑YES LINO
SOIL COVER TEXTURE PERMANENT M ARKERS OBSERVATION WELLS
❑YE . LINO ❑YES NO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH,BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES.
❑YES ❑ O ❑YES NO ❑YES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH. NO. OF LATERAL SPACING. GRAVE DEPTH BELOW PIPF4 FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. IN O DI TR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV. ELEV.. DIA.. ELEV.. PIPES DIA.'.
ELEVATION AND
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
❑YES LINO ❑YES LINO NEAREST
S~
Sketch System on R t Ile r audit. 7
Reverse Side.
IGNATuRE:' , TITLE:
DILHR SBD 6710 (R. 01/82) a
Form - S T C 100
Owner of Property f1
Location of Property _.51F 4 5F Section 1' N RW
Town ship C-.4-
Mailing Address
Subdivision Name
Lot Number
Previous Owner of. Property
Total Size of Parcel
Date Parcel Was Created
Are all corners identifiable? _ -Yes No
Include witty this a1Ll i_cat_ion one of the foll.owi.ny':
Certified Survey Map
.Deed
.Land Contract, or
Other Legal Document which describes the property
PROPERTY OWNER CERTIFICATION
I (We) certify that all statements on this form are true to the best of my (our)
knowledge, that I (we) arr► (are) the owner(s) of the property described in this
information form, by virtue of a warranty d x in the Office of the
County Register of Deeds as Document N ;and that I (we)
presently own the proposed site for the sewage ystern (or I (we) have
obtained an Oasement, to run with the above described property, for the
construction of said system, and the sarrie has been duly recorded in the Office
of the County egister of Deeds, as Document No.
SIGNATURE O OW~yNEN SIGNAIUNE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE Su:NED
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS
.INDUSTR•Y, DIVISION
LABOR AND, PERCOLATION TESTS (115) MADISP.O. BOX 7969
HUMAN RELATIONS
ON WI 53707
(H63.09(1) & Chapter 145.045)
LOCH ION: SECTION TOWNSHIP/MUNICIPALITY: LOTNO.:BLK.NO.: SUBDIVISION NAME:
N/R (or) W C'
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
'
USE DATES OBSERVATIONS MADE '
NO. BEDRMS.: COMMERCIA/L DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
OResidence ❑New Replace
RATING: S= Site suitable for system U_= Site unsuitable for system
j(,% / i
CONVEccNTIONIA''L: MOOUUN(D: IN-GROUNND-PRESSURE: SYSTEcM-IN-FII'LLHOLDiN TA'NIK: RECOMMENDED SYSTEM:(optional)
11 I If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
r
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL EPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, EOBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B B - c
711, /k,
B-
B-
6-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P- L/ 4 4
i
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
,YS
3
P
f D. .
I
r z ,
7
41, `
E
r
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:
ADDRE~ / CERTIFICATION NUMBER: PHONE NUMBER (optional):
~T
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