HomeMy WebLinkAbout038-1010-80-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 597369
GENERAL INFORMATION State Plan ID No,
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]
Permit Holder's Name: City Village Township Parcel Tax No.
ARTHUR & ROXANN SAWYER TOWN OF STAR PRAIRIE 038-1010-80-000
CST BM Elev: Insp. BM Ele : IBM Description: QQ Section/Town/Range/Map No:
3' o D 8'd a ki 02.31.18.31 C
TANK INFORMATION ELEVATION ATA
TYPE MANUFACTURER ; CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
LJ 1- F: 4A".. Z 3, o 03 . / a~
Alt. BMA
°M," Aa
u, o k...
4#z
Aeration BIa fewer f 41b Holding St/Ht Inlet
-7-t69 95, 3
TANK SETBACK INFORMATION St/Ht Outlet O -Q /7 a
TANK TO P/L WELL BLDG. ent t Air Intake ROAD Dt Inlet
Septic / Z I AIL Dt Bottom
Dosing Header/Man.
Aeration Dist. Pipe
--rte" i b , b `l 3 a~
Holding Bot. System H-0 4ctz.
PUMP/SIPHON INFORMATION Final Grade , / 9 4
Manufacturer Demand St Cover 3'bVL q~,
Model Number 7
TDH Li Friction Loss System H DH Ft
well
Forcemai n t a. --"ell
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Lengt No. Of Trenches PIT DIME SIGNS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ` ( A
SETBACK SYSTEM TO P/L BLDG / WELL LAKE/STREAM LEACHING Manu ur
INFORMATION CHAMBER OR
Type Of System: n UNIT Model Nu
DISTRIBUTION SYSTEM b 44(0 c~ v5
Header/ManifcP If I Distribution Ix Hole Size ix Hole Spacing VAir Intake
•u1 Pipe(s)``
Length Dia4 Length Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Degth of jxx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edge Topsoir" a Yes No Yes 7N
o
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1251 CTY RD H (3L J
1.) Alt BM Description ~ s
2.) Bldg sewer length = - { c -Z GO V ,f~ C--~ 4-r,5L.
- amount of cover
Plan revision Required? ❑ Yes o
Use other side for additional informat n. -A
L4777 J D `
SBD-6710 (R.3/97) Date Insepctor's S ature Cert. No.
I~NV
Safet„ - County
j L~
2C' r.~: IT6x 7162 Sanitary Permit Number (to be filled in by Co.)
P ~UN Vl/I 53707-7162
S, I
5q 7
lX COUNTY nSRWLI) State Tran on Number
~t►uN ary ermit Application
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
/ ^ n
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(1)(m , Slats.
1. Application Information - Please Print All Information
Property Owner's Name j Parcel
Property Owner's Mailing Address Property Location o-)
3 i = S i L,
j 'L _ Govt. Lot
City, State Zip Code Phone Number 6L.J Y,, 6- Y. Section
rcle one
T~N; R Eo/w 1
II. Type of Building (check all that apply) flock f #
Subdivision Name
0 1 or 2 Family Dwelling - Number of Bedrooms r
_ .A #
El Public/Commercial - Describe Use e.►~.I~i
❑ City of
❑ State O ed - Describe Use CSM Number ❑ Village of
c / J : Te-wn of
III. Type of Permit: (Check only one box n line A. Complete line B if applicable)
A' ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
ange of Plumber List Previous Permit Number and Date Issued
B. El Permit Renewal El Permit Revision El o 11 Permit Transfer to New
Before Expiration Owner
IV VT e of POWTS System/Component/Device: Check all that apply)
Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soiP46 Holding Tank Ei ispersal Component
(explain) ❑ Pr reatment Device (explain) V.
Dis ersal/Trea ent Area Information:
Design Flow (gpd) Design Soil Application Rate(gpd Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units 010
New Tanks Existing Tanks / y o a~ y M as
W a U n;; n w C7 a
Septic or Holding Tank -
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume respons' ty for installation of the POWTS shown on the attached plans.
Plumbe S Name ring Plumber's lgna MP/MPRS Number Business Phone Number
i /
Plumber's Address (Street, i , State, Zip C e)
VIII• oun /De ai•tment Use Onl
proved Permit Feej Dat/;~ d Is suing nt Sgnatur
p
X
77
❑ Owner . ' en Reason r Denial $ ~ o (J ' /
IX. Condit ea~.q~f +i Disapproval r t ~ d
u Ss_,er::sn cell r: *401 ec ~~jj nn
-as per mair.3g~nert! plaet P: t~[00~1f
v
2. AN t6 lc'dcl~~ n+~. 'I E 1 as pK pKitlbla cc* / adlu. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I I inches
in size
SBD-6398 (R. 11/11)
r
O
=1* s ~
a~
r -
- `j 0py
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:;
Owner's Name:,
Owner's Address: /
Legal Description: Z/-
Township:
County:
Subdivision Name:
Lot Number:
Parcel ID Number.
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachmen$s: Soil Test & House Plans
Designer/Plumber: License Number.
Date: Phone Number
Signature j`Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
Know >((~Inonzv
Ilia ;fOximmo 14" ~N&7
~ ~tttrrG
t
0~6 -s#.a. on r- oa04on
• t ft
Grade
4°SdwdtdE4
PVG Vent Pipe ~i rsst
Vent iaia
leaching ~C{fi
Chamber sysmm Elevaflon
3i is
e;~ii ~~IS~PR'~SQ1't ~iaet ~est~
it
~ W"1 _ Lear.~ing 3'rer~ch ~
?t Vent Or Obsenraiian Pipe chambers
e pia.
0.1
Trench 2 Header
hi Ch2mber
Manufacturer And Model T, ~r ` / rbv~vi?
EISPI Rating Sq it p, i 18t}3ber Soil Applicaon Rate z r gt~~ it
Sail App on Rate EISA = Cttamhers
~
ggd i3esign Flow :
saws of mess each.
page _ OY
N
PL-5255 EFFLUENT FILTER
Polylok, Inc is pleased to add its
new commercial filter to its existing
line of duality effluent filters. The
PL-525 is rated for over 10,000 GPD Alarm _ I r ..It Accepts PVC
(gallons per days making it one of a accessibility extension handle
the largest commercial filters in its
class. It has 525 linear feet of 1/16° h~filtration slots. Like the Polylok P
PL 122, the new Polylok PL-525 has
f " R
an automatic shut off ball installed 525 linear feet
with every filter. When the filter is of 1/16" 16 ~ a
removed for cleaning, the ball will filtration slots Rated for over
10,000 GPD
float up and temporarily shut off
the system so the effluent won't
leave the tank. No other filter on k y
the market can mane that daimf Accepts 4' & G'
SCHD. 40 Pipe . e 3
The PL-525 Effluent Filter should
operate efficiently for several years 3
under normal conditions before
requiring cleaning. It is recom-
mended that the filter be cleaned
every time the tank is pumped or
at least every three years. If the
installed filter contains an optional f
alarm, the owner will be notified
by an alarm when the filter needs
servicing. Servicing should be . Gas deflector
done by a certified septic tank ' Automatic shut-off
pumper or installer. _ ball when filter
is removed
1. Locate the outlet of the u.s. Patent No# 6.415,483
septic tank. 5,8;1,sac;
2. Remove tank cover and pump
tank if necessary. _Ar _ 1. Locate the outlet of the
3. Do not use plumbing when septic tank. P- L52S filter is removed. Ideal for residential and com- 2. Remove the tank cover and
4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary.
5. Hose off filter over the septic 10,000 Gallons Per Day (GPD), 3. Glue the filter housing to the
4" or 6" outlet pipe. If the
tank. Make sure all solids fall filter is not centered under the
bade into septic tank, access opening use a Polylok
6. Insert the filter cartridge back Extend & Lok or piece of pipe
into the housing making sure to center filter,
the filter is properly aligned and 4. Insert the PL-525 filter into
completely inserted. its housing.
7. Replace septic tank cover. 5. Replace the septic tank cover.
1~°
of
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Tank Manufacturer: 1C fr~r`C ❑ NA
Permit # ❑ Septic ❑ Dose ❑ Holding Volume: (gal)
DESIGN PARAMETERS Tank Manufacturer: 1J` NA
Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal)
Number of Public Facility Units: J19 NA Vertical Distance Tank Bottom(s) to Service Pad: (ft)
Estimated (average) Flow: „ (gal/day) Horizontal Distance Tank(s) to Service Pad: (ft)
Specific servicing mechanics must be provided if vertical is >15 feet or
Design (peak) Flow = (estimated x 1.5): (gal/day) if horizontal is >150 feet. Specific instruction to be provided on back.
In Situ Soil Application Rate: 7 (gal/day/ft) Effluent Filter Manufacturer: 1 cy o
~ ❑ NA
Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model:
Fats, Oil & Grease (FOG) _530 mg/L Pump Manufacturer:
Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA J!~_NA
Total Suspended Solids (TSS) 5150 mg/L Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer:
(BOD5) >220 mg/L NA JZ[ NA
(TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter
❑ Disinfection ❑ Wetland
Pretreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other:
(BOD5) 530 mg/L Soil Absorption System
(TSS) 5_30 mg/L NA
Fecal Coliform (geometric mean) 5_104 115In-Ground (gravity) ❑ In-Ground (pressure) ❑ NA
Maximum Effluent Particle Size in dia. ❑ NA El At-Grade ❑ Mound
❑ Drip-Line ❑ Other:
Other: ❑ NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) 0 When combined sludge and scum equals one-third (%3) of tank volume
❑ When the high water alarm is activated
Inspect condition of tank(s) At least once every: (l month(s) (Maximum 3 years) El NA
Inspect dispersal cell(s) At least once every: , g month(s) (Maximum 3 years) ❑ NA
Jd year(s)
Clean effluent filter At least once every: ❑ onth(s) ❑ NA
Jf year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
❑ year(s)
Flush laterals and pressure test At least once every: 10 month(s) ANA
❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil
absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent
on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment tank equals one-third (%3) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of 5_12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
GMW-005 (02105)
Page 4~ of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are
detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use.
Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these
conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber
or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the
area within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment
tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper).
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by required
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in
effect at the time of their permit issuance.
❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.
( The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a
last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INST LER POWTS MAINTAINER
Name LNa e
Pho ne S _ tee) . e
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
-1 Z
Phone Phone
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections
Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
Page Z of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are
detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use.
Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these
conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber
nt levels are restored with tank.
or P in the
'normal effluent pump OWTS Maintainer to assist in manually operating the pump controls until
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the
area within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment
tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper).
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by required
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in
effect at the time of their permit issuance.
❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.
The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a
last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INST LER POWTS MAINTAINER
Name Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone `
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections
Comm 83.22(2)(b)(1)(d)&(0 and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK. MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
QwnerBuyer
Mailing Address -
Property Address
(Verification required from Planning & Zoning Department for new construction.)
Parcel Identification Number h~
City/State
LEGAL DESCRTP'TION
1/4 Sec. T } LN RTown of
_ J -
Property Locatlon l
Lot #
Subdivision Plat:
Volume Page #
Certified Survey MaP #
(before 2007)Volume , Page #
Warranty Deed #
n
Lot lines identifiable 0 yes G no
Spec house Q yes +no
~I
S'YSTEIVI ENA.NCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
What you put into
the s out the septic tank every three years or sooner, if needed, by a licensed pumper.
maintenance consists of pumping the system
tem can affect the function of the septic tank as a treatment stage to the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance-
- a g The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 113 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on thk form are true to the best of my/our knowledge: I/we am/are the owner(s) of the
property described above, by virtue of a i ty deed recorded in Register of Deeds Office.
Number of bedrooms_
a ;
SIGNATURE OF API' CANT(S) DATE
* misrepresented may result in the sanitary permit being revoked by the Planning& Zoning Department_
~`Any information that is include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
T 1TST A.l lf'71
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Parcel 038-1010-80-000 Valid as of 05/1 3/201 7 08:47 AM
Alt. Parcel 02.31.18.31 C TOWN OF STAR PRAIRIE
ST. CROIX COUNTY,
WISCONSIN
Owner and Mailing Address: Co-Owner(s):
ARTHUR J & ROXANN P SAWYER
1251 CTY RD H Physical Property
NEW RICHMOND WI 54017 Address(es):
* 1251 CTY RD H
Districts:
Dist# Description Parcel History:
3962 SCH DIST NEW RICHMOND Date Doc # Vol/Page Type
1700 WITC 04/17/2012 954578 ! QC
12/02/2011 946601 / DM LTTR
Legal Description: Acres: 0.090 12/02/2011 946602 / PR
SEC 2 T31 N R1 8W PT SW SE BEGIN 705 FT N OF 12/30/1987 433344 800/83 PR
SW COR SE 1/4 SEC 2, TH N 104.2 FT, E 359 FT more...
TO CEN LN OF HWY TH SELY ALG HWY... more...
Plat Tract (S-T-R 401/4 1601/4 GL) Block/Condo Bldg
* N/A-NOT AVAILABLE 02-31 N-1 8W SW SE
2017 Valuations: Values Last Changed on
09/13/2011
Class and Description Acres Land Improvement Total
G1-RESIDENTIAL 0.090 18,000.00 59,400.00 77,400.00
Totals for 2017
General Property 0.090 18,000.00 59,400.00 77,400.00
Woodland 0.000 0.00 0.00 0.00
Totals for 2016
General Property 0.090 18,000.00 59,400.00 77,400.00
Woodland 0.000 0.00 0.00 0.00
2017 Taxes
Taxes have not yet been calculated.
Key * -
Primary
' RECEIVED -r=a G I- - 0 9a
Wis. Dept. of Safety and~i~'LV rr =~~RT Page /I of
Division of Safety and Su'
ST, CROIX COUIQTCordanee _ur L uue
rr~~pptt,,,,ttFF~~
Attach comptetg~i1ll County
4R rWda§ 1'3(r'81/2 x 11 inches in size. Plan must - 7, 2' X
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please Print all information. Re wed by Dat
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Govt Lot J 1/4 114 S T N R E (or/
Property Owner's Malang Address Lot # 8104 Subd. Name or M#
City State Tip Code Phone Number 0 City ❑ V Rage ®Town Nearest Road
( j a T 2L /7/
❑ New Construction Use:O Residential I Number of bedrooms Code derived design flow rate GPD
tD Replacement ❑ Public or commercial - Describe:
Parent materials Flood Plain elevation if applicable ; < ft.
General comments /
''°~~~r'
and recommendations:
Boring # Boring
® pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft 2
in. Munsett Qu. Sz Cont. Color Gr. Sz. Sh. ff#1 fi#2
-
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27 ZZ
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Boring # ❑ Boring
pit Ground surface elev. 4 . ft. Depth to limiting factor Z-.,71, in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure sistence undary Roots GPD/ft z
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh_ ' ff#1 102
7
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_2 Z-2 16
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* E "t #1 = BOD > 30:5 220 mgiL and TSS >30 < 50 * Effluent #2 = SOD < 30 mg/- and TSS < 30 mg/L
CST Nam VeP ntjE , L e L CST Number
Address Date Evaluation Conducted Telephone Number
SBD-8330 (RI 1/11)
Property Owner ~ Parcel ID # Page of
❑ Boring
~ Boring #
Depth to limiting factor in. Soil Application Rate
Pit Ground surface elev. &r ft
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft s
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ff#1 ` ff#2
[j Boring
Boring #
❑ pit Ground surface elev. it, Depth to limiting factor in. Soil 6catuon Rate
Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft 1
in. Munselt Qu. Sz. Cont Color Gr. Sz. Sh. ftY# ( fW
E Boring # El Boring Ground surface elev. R Depth to Nmiting factor in.
❑ Pit Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots ff#1 GPDz
in. Munsell Qu. Sz. Cant Color Gr. Sz. Sh.
Effluent #1 = BOD c > 30:_< 220 mg& and TSS >30 < 150 mg/L " Effluent #2 = BOD a < 30 mg/L and TSS 30 mg/L
The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay.
M-8330 (RI 1/11)
Property Owner Parcel ID # _Z-) 2422 -Fill/ Page c~ of
Boring
Boring # Ground surface elev. ft Depth to limiting factor
Pit n. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPDfft 2
in. Munsell Qu. Sz. Conti Color Gr. Sz. Sh. ff#1 * ff#2
S r
9- AIIX
-~l r
L
tc~ Q 4
Boring # ❑ Boring
❑ Pit Ground surface elev. fL Depth to limiting factor in.
Soil A 6cation Rate
Horizon Depth Dominant Color Redox Description Texture structure nsistence oundary Roots GPD/ft 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 il#2
wF
Boring* E' Bolin, Ground surface elev. ft Depth to limiting factor in. t.
111~~~JJ~ ❑ pit Soil Application Rate
14ortzon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPDfft 2
*
in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. * t i if #2
I
* Effluent #1 = BOD 6 > 3():5 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD , < 30 mg/L and TSS 30 mg/L
The Dept, of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay.
31ID-030 (RI 1/11)
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