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Parcel 038-1104-10-000 05/11/2006 04:57 PM
PAGE 1 OF 2
Alt. Parcel 25.31.18.436G 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
BRIAN A & PAMELA S COX O - COX, BRIAN A & PAMELA S
1400 HWY 64
NEW RICHMOND WI 54028
~I
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: 0.500 Plat: N/A-NOT AVAILABLE
SEC 25 T31 N R1 8W PT SE SE BEGIN 473.22 Block/Condo Bldg:
FT W & 9.04 FT N OF SE COR-SEC-25' TFrW
61 1/2 FT; N 1 DEG E 99 FT; N 88 DEG W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
95 FT; N 1 DEG E40 FT TH S 88 DEG E95 25-31 N-1 8W
FT N 80 DEG E 62.66 FT; TH S 1 DEGW151
FT TO POB AS IN VOL 605 PAGE 255 ANNEXED
more...
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1234/157 W ID
07/23/1997 51 193 WD
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
Parcel 038-1104-10-000 05/11/2006 04:57 PM
PAGE 2OF2
Legal Description: cont.
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AS BUILT SANITARY SYSTEM REPORT
OWNER el/7 / `TOWNSHIP SEC.,t6_T2N-R_&W
ADDRESS_,e2 _ ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT z 1 LOT SIZE 4,
PLAN VIEW
Distances and dimensions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
i"
IAI
j
Indicate N Dr h rr w
BENCHMARK: (Permane t reference Poi t) Describe: /(4J i
1 reference poi t: ` Slope at site: ;E
Elevation of vertic
i P I
SEPTIC TANK: Manufacturer:/Liquid Capacity:-," .
Number of rings on cover Tank manhole cover elevation: %C~S 7
'l'ank Inlet Elevation: -Tank Outlet Elevation: 9~s
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set for a cycle_ -gallons; Total capacity of
distribution lines- gallon: size of pllmp_ 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-ji width length" -A'tile depth
-7 .1"
SEEPAGE TRENCH: wi th length
PERCOLATION RATEy AREA REQUIRED AREA AS BUILT
-r^T" INSPECTOR
DATED PLUMBER ON JOB 74-'
LICENSE NUMBER
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR,& HUMAN RELATIONS DIVISION
t'VP.O. BOX 7969 PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING
M,;,DISON, WI 53707 X
EJ CONVENTIONAL ❑ALTERNATIVE State Plan ll.D. N„mber:
(If assign ed
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Paul Rickard New Richmond, WI 14o-- -H
BENCH MARK (Permanent reference porot) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PTE V.
SE SE, Section 25, T31N-R18W, Town of Star Prairie
Narne of Plumber. ltviP/MPRSW No. County. Sanitary Permit Number.
Cal Powers 1563 St. Croix 43671
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAP ACITV. TANK INLET E1L V TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROV I DED- PROVIDED,' -
~ - YES LINO EYES LINO
BEDDING: VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD'. PROPERTY' WELL: BUILDING: VENT TO FRESH
A LARM. FEET FROM LINE _ ( J J AIR INLET.
EYES LINO EYES ENO NEAREST
DOSING CHAMBER:
MANUFACTURER DI NG. LIQUID CAPACITY PUMP MODEL JPUMP/SIPHON MANUFACTURERWARNING LAB LOCKING COVER
PROVIDED_ PROVIDEDYES ENO ,~3 YE.8 NO EYES ENO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPER, LL BUILDING. I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINF AIR INLET
PUMP ON AND OFF) EYES ENO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH IDIAM ERf MATERI L AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE w
MAIN
the soil is dry enough to continue.) ,
CONVENTIONAL SYSTEM:
WIDTH LEN t5 NO. OF DISTR. PIPE SPACING. COVER INSIDE DIA 1 PITS LIQUID
BED/TRENCH TRENCHES MAT DEPTH
,
DIMENSIONS e/, 5 / - I ~ a PIT
GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE M`-ARTERIAL. NO. DI NUMBER OF PROPERTY WELL: BUILDING. VENT TO FRESH
BELOW PIPF$ ABOVE COVER ELEV INLET ELEV EN PIPES LINE.' FEET F AIR INLET.
~1~.~~ h FROM a
NEAREST-
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-
E meets the criteria for medium sand. TIONS MEASURED.
YES NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
EYES ENO EYES ENO
DEPTH OVER TRENCHBED DEPTH OVFR TRENCHBED DEPTH OF TOPSOIL SODDED SEE ED] MULCHED
CENTER EDGES.
EYES ENO EYES ENO EYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO, OOCH ES LATERAL SPACING GRAVEL DEPTH BEL PIPE J FILL DEPTH ABOVE COVER
TREN
DIMENSIONS I
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR; DIST PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.. ELEV. DIA. ELEV. PIPES
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL' PLANS CAL LIFT CORRESPONDS TO APPROVED
EYES NO EYES ENO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING.
FEET FROM LINE
I ❑ YES ❑ NO ❑ YES ❑ NO NEAREST
o,
0
Sketch System on Retain in county file for audit.
Reverse Side. C7
j SIGNA E. TITLE: .
DILHR SBD 6710 (R. 01/82)
g
~ wls~onsln APPLICATION FOR SANITARY PERMIT
`~I DILHRS16A~~k' COUNTY
(PLB 67)
oERRRTmEnr of UNIFORM SANITARY PERMIT #
~
InOU5TRY, LRBOR 5 HUMRn RELRTIOnS
1i
-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 MAIIfING ADDR SS
14 0
PROPERTY LOCATION CITY:
VILLAGE:
1/4': 1/4, S N, R (o0 W TOWN OF: - L
LOT NUMBER BLOCK NUMBER JSUBDIVISI94N NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
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
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
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: i ,
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 the private sewage system shown on the attached plans.
Name of Plumber (Print): Signature: MP/MPRSw No.: Phone Number.
1-J
Plumber's I Ad dress: Name of Designer:
~ i~ ~ iii ~ i `i /,r :rte"
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
'~j~ 7 ❑ Owner Given Initial
/ ` `J 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.
l
I'u rm - S '1' C 100
I/Ownur of Property Paul H. and Jean M. Rickard
Location of Property ' SE Section 25 ,'1'31 N R18 W
Township of Star Prairie
Mailing Address Route 3, Box 107
Ne'w Richmond, WI 54017
Subdivision Name
Lot Number
V_ Previous Owner of Property Russell Moberg, Personal Representative
of the estate of John anT ora au son.
Total Size of Parcel. less than one_ acre
Date Parcel as Created
W 1_0Q tober .1OL197^9
Are all corners identifiable?
x Yes No
Include with this application one of the follow_in:
.Certified Survey Map
.Deed
.Land Contract, or
.Other Legal Document which describes tike property
PROPERTY OWNER CERTIFICATION
I (We) certify that all statements on this form rle`teue to the-twst of my (our)
knowledge; that I (we) am (are) the owne s) of the property dl~scribed in this
information form, by virtue of a warran . deed recorded in the ffice of the
County Hegister of Deeds as Docurn 36.1 526 ; an that I (we)
presently own the proposed site for the se 'ge disposal system (or I (we) have
obtained an easement, to run with the above wnbed'peOperty, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No.
SIUNATURE OF OWNER SIGNATURE OF CO-OWNLR (IF APPLICABLE)
DAYS SIGNED DATE SIGNED
SURVEY MAP
FOR
PAU►_, ►s.z.~ x~,~~u
'~1it ~s oO.E 62. b6
ATT. Q;r'.4f?A Cw- 4E:
ST
r"
V
hY.E'.5 T 47"9.2.2 '
DESCR I T''! I ON t
A paref>l of land located in the Southeast 1/4 of the Southeast 1/4, Section 25, T j1 No
It il'i "W, Town of :ita r, Iva lrie, :at. GroJx County, W.I scolistrr, rruore t'ully doeoribod as tollowal
Copmencing at s point which is 4'(3.22' I&Iest rand 9.041 North of Uie southeast comer of
said ::e tion 25, which }joint Is can the centorline of the `l'awn floaad' e.nd thO POINT OF P-WIv-
N X~NG
thPxlce tJ 88e 421 00" W (A .'jt'7' l
thence N 01° 18' 00" E 99.00';
them e N W* 421 00" W 91).001s
thoncez N 010 16, ' CMG" E )io.00';
thence .S 88* 42' 00" E 95.00' R
thence N F550° 16' 00" F, 62.66' ,
thence S 010 16, 00" W 151 .00' ;
to the A) 1,14T 0V llt~i{."aPvt.ldtx, I;zolrly otat+jent Ua c^nnolrront; ovor tiara w,;Oot_,.ti+ riy ttvvroo.r rov
Town tIoaxcl Irtar. lx,r r ;a .
State of Wiconsin)
Ss
County of Pierce )
1, James L. Murphy, do hereby certify that by direction of the Owner I hove surveyed the above
described property according to official records and that the above map, is a true and
correct representation thereof showing the correct dimensions and location of the property,
all structures, apparent easements and encroachments thereon.
This certification is for the express use of the Owner oe Ns designate ioe mortgage or
title transfer purposes and shall continue for one year from the date of survey
unless changes occur to sold property thereby nullifying this certification,
*Denotes Iron pipe found,
4 Denotes iron pipe set. Wise olsin Reg. No. S• 1442
DATE !c7 /Q 'i cnOrrrnr~~~~~
FLD SURVEYS /M` VAMGS L. MV/Tl~/7 ! `N,
-os,•' S
SCALE
DRAWN PROFESSIONAL ENGINEER 'nIr 0 4 2
JD ER
~.v
REVISED
_
REGISTERED LAND SURVEYOR
LOCATION,'
RIVER FALLS, WISCONSIN
JOB NO 7;3 -.516
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABCIR AND PERCOLATION TESTS (115) P.O. BOX 76
HUMAN RELATIONS
(H63.09(1) & Chapter 145.045) MADISON, WI 53907
LOCATION: J SECTION: TOWNSHIP/MCINIC9PALITY: LOT,NO.:BLK. O.: SUBDIVISION NAME:
•y /T N/R~, , (or) W
/ IF
CQUNOWNER'S/BUYER'S NAME: M ILING ADDRFSS:
L Z,
USE DATES OBSERVATIONS MADE
:1NO. BEDRMS.: COMMERCIAL`DESCRIPTION: !PROFILE DESCRIPTIONS: PERCOLATION TESTS:
OResidence ❑New Replace ll r. _r a
J
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: M-G OUSYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
DS ❑u ❑U DS []u ES E]U ❑S ]U
If Percolation Tests are NOT required ;r DESIGN RATE: I
L y portion of the tested area is in the
under s.H63.09(5)(b), indicate: If an
Floodplain, indicate Floodplain elevation: r
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B~
B-~ -
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD,t PERIOD2 PERIOD 3 PER INCH
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
I
° teL: _7-Srs_ .
f. J
c
3
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e
7`-
I l
-
~f 7 4,41Z
/C
,
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i
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.
NAMEAprint): TESTS WERE COMPLETED ON:
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