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CROIX COUNTY, WISCONSIN O~ 7 JJ2 SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM: CQ t s.,, INDICATE NORTH ARROW /r BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: 19 , Li uid Capacity: .z-_ q Number of rings used: 2 Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,0 Side, Rear, ~ ,Z fir feet From nearest property line Front,0 Side Rear, O _2 a©O feet Number of feet from: well - ~11 2' building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE RFVFRSF. STDF 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, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Y Trench: Width: Length:-~'~-~- Number of Lines: Area Built:/6 Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side Rear,O Ft Number of feet from well: A~ 1 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: Dated: Plumber on job: License Number: 3/84:mj w DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, V 53707 CONVENTIONAL D ALTERNATIVE State Plan I.D. Number: I (If assigned) ` ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION D TE-. Chris Neuman New Richmond, WI 54017 12 ? 8~0 ~7 a ~t~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REI'. PT. ELEV.: TT(:I)I,11. PT,. ELE VNW SW, Section 33, T31N-R18W, Town of Star Prairie C~.O Name of Plumber MPIMPRSW No County: Sanita,y Permit Number Cal Powers, Jr. 1563 St. Croix pz SEPTIC TANK/HOLDING TANK: _ MANUFACTURER: LIOUID CAPACITY: TANK INLET ELEV.. TANK OUTLEET ELEV.: PROVIID E DLABEL PLOCKING ROVIDED COVER Q go to S.- &6 NYES ENO EYES NO BEDDING: VENT DIA.: VENT MATI_: HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING: VENT TO FRESH ALARM' FEET FROM LINE Q -S Z AIR INLET EYESINO EYES O NEAREST ~u V _I OJT ~v DOSING CHAMBER: MANUFACTURER. BEDDING: I_IOUID CAPACITY. PUMP MODEL PUMP/SIP ANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ENO EYES ENO DYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPER N NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH _ FEET FROM LINE AIR INLET'. (DIFFERENCE BETWEEN PUMP ON AND OFF) I- YES ENO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 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 TRENCHES DISTR PIPE SPACING MATERIAL: INSIDE DIA 1t PITS D PTHD DIMENSIONS I a PIT GRAVEL UEPTH FILL DEPTH DISTH. PIPE DISTR PIPE DISTR. PIPE MATERIAL: NO. DI R. NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPES. ABOVE COVER. ELEV. INLET ELEV. ENDQ p ~g PIPES FEET FROM LINE: 1 ' AI'INLET: (i .I 30 11 ~Op~.7 / Z-7 6 NEAREST--► ~v0 VV 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- meets the criteria for medium sand. TIONS MEASURED. EYES ENO SOIL COVER TEXTURE PERMANENT MARKERS. OBSERVATION WELLS OYES ENO EYES ENO DEPTH OVER TRENC HEED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL. SODDED. 16EIDED. MULCHED C ENTER. EDGES. DYES ONO EYES ONO OYES 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: NO. DISTR. ID ISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV.: DIA.. ELEV.. PIPES. DX: ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS: EYES ENO EYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑ YES ❑ NO EYES ONO NEAREST 10 Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE'. DILHR SBD 6710 (R. 01/82) wiscons,n APPLICATION FOR SANITARY PERMIT ffj COUNTY DILHR (PLB 67) UNIFORM SANITARY PERMIT # i OEPRRTTT1Er1T OF - InOuSTRV, LRBOR 6 HUR1Rn RELRT%OnS M n y - -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS a t vv tc~rll 5 O/ : PROPERTY LOCATION Of+11- x,31/4 1/4, S3 , T„3 , N, R IF (or) W rowN oF: v I 1 E LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER 22 f w G t /v /V 44 TYPE OF BUILDING OR USE SERVED, :3 1 L 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS. PERMIT IS FOR A: LJ 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. >L 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 06 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: pcj? 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): / 2-` S 12 L/ 5- Z / V U '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): Signa re: /MPRSW No.: Phone Number: a l/ w ~i 3 rt5--e. ( / -1 Z yG 75-13 Plumber's Address: Name of Designer: Lt co l ILL COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved V J Od ❑ Owner Given Initial /.2 S J A~~roved 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 r w 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. v r:. VJ S m c _ _ _ p (D =r -MO w N" w c c 3 O K) a ~ m Q m ~ C1 n m? 7 (o , Z C =r ~Q j ~ N W N I "C E =r m. 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Fresh Air Inlay And Obcervallon Pipe YV U-j y`l i S V1,/J~'/J~, 5,~3 1 (8w r Approved Vent Cagy it 1 a-I r I.e-, Minimum 12 Above Final Grade 20 - 42" Above Pipe _ 4" Coat Iron To Final Grade Vent Pipe IAOr eh Noy Or Synlhellc Covering min 2" Aggregate Over Pipe Dielrlbulion pipe _f 0 0 0 0 0 -Tee 6" Aggregate 0 Perforated Pipe Below Beneath Pipe o _ Coupling Terminotlna At Bottom Of Syslem ~~~Jn1 ton SOIL FILL DISTRIBUTIO►.1 PIPE APPROVED S4M-THETIC COVER ° '~-IyIAT~ltll~~ OP, 9'1 OF STRAW Z"oF/~6GR~GATE OR MARSH HAS (o OF 12-2/2 AGGREGATE t,L E V. OF /0 FEET, Dil, RiR!jm.-)" PIPE TO BE AT LEAST _ Q_ I U C H E 5 BELOW ORIGIQAL GRADE AML AT LEAST20 ILICHE- BUT AIO MORE THAJ H2 WCHES BELOW FI►~JAL GRADE MAXIMUM Mrvi OF E)VAVATiao FKOM oKi& VAS bKAaF- WILL BE Sj'j WCHES MIK MUM OCT "tt OF E'XCAVATIOW FRoM 111611 SAL GR49E WILL BE INCHE S LIC_ EIJSE WOMBER: DATE: 110 DEPARTMENT OF -REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND BOX HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 7969 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUftl+2tfAtITY: LOT NO.:BLK. N SUBDIVISION NAME:• '/4 /T-31/ N/R F (or - N OUNTY: OWNER'S/BUYE 'S NAME: MAILING ADDRESS: / l USE DATES OBSERVATIONS MADE I NO. BEDRMS.: COMMERCIAL ESCRIPTION: IPROFI E DESCRIPTIONS: ERCOLATION TESTS: Residence ~ New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: r -GROUNDPRESSURE:SYSTE -IN-FILL HOLDING TANK:R COMMENDED SYSTEM:(optona-) LOS EIU ®S ❑U CAS E]U OS [ZU ~S [Z U1 od"i'4 RATE- If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b1, indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ft ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- } E -l B- y -Jlqk,-Z /A - B- G,S- ~3~~.~ Fs 11,3 > B- B- > - - B- / - j PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 14UCWZS AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D 3 PER INCH P-t./ .310 P- / P- y P-_ P- P- PLOT PLAN: Show locations of percolati n tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference poi is and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. f~ oe~ SYSTEM ELEVATION Al IJ4 F jA~ L A f / i ' 3 I E _ i a € . V r I i IN r i € F E E 3 : ( ~ 1 t } r" _I I /~S To.,Coy.Cr.Jt I, the undersigned, hereby certify that the it tests re orted on this form were made by me in accord with the procedures and m thods specified in the Wisconsin Administrative Code, and that the data reco ed and th location of the tests are correct to the best of my knowledge and belief. \ ~/~0 ~~~BJO NAM (print): TESTS WERE COMPLETED `ON: 7ADD ES CERTIFICATION NUMBER: PHONE NUMBER (optional): CST -N UR I DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - l INSTRUCTIONS FOR COMPLETING FI- .M 115 - SBD - 6395 To her rr- ete and accurate soil test, your report mus 1, cc) ,Kscription; 2, Th n' List clearly indit to is is a residence or commercial project; 1 MAXIIVICI, na of a ms cial use planned; 4. Is this • 5, C°orrr' A QITI; "z .1.11TABLF FOR A HOLDING TANK ONLY IF ALL Cpl OIL CONDITIONS; 6- .1 _ profile de ptions and completing the plot plan; 7, wing to scale is preferred. A _ wn, and are permanent; l ata, percolation test exe€rrp- A, in the appropriate box; r; L JST SR FILED WITH THE " I TION FOrl C "FIED SOIL, TESTERS Textures F` L Y L R not W?' fff 4c cc Pi Mm - art ni cl p HWL-I to es posal n" point T' T1 fi, t r ' 1 The r gay re(tuest va A he private y 7 order to r t --tion. APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Ch ~ 15 )p Li Y;-2 q- k-1 Location of Property w 4, Section 3T_ N - R W Township C~~(la; Mailing Address IRL C-4 K;n a tnce/ Subdivision Name Lot Number Previous Owner of Property r "j-f &Ly n ,e_5- 12. 4U 40 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 Z 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. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTy-OWNER CERTIFICATION I (We) ce4ti6y that aU statemen.t/s on this bonm are tAue to the but o6 my (our) knowledge; that I (we) am (are) the owner(s) o6 the pnopenty de~scAibed in .thu6 in6otcmation bonm, by viAtue ob a womanly deedd Aeeorcded in the 06bice ob the County RegizteA o4 Deeds a6 Document No. L~ 1 / ; and that I (we) pnvsentY.y own the proposed .site boA the sewage dizpoaaL'aystem (oh I (we) have obtained an easement, to nun with the above dese/Libed pnopeAty, bon the con t ucti.on ob chid .system, and the same hays been du.-y aeco&ded in the 0b6ice o6 the County Regis teh, o j Deed6, ass Document No. ) . SIG~JV TU OV OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) (0 DATE SI NED DATE. SIGNED . • H z y a STC - 105 r r a I H SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z tl ((~!r a OWNER/BUYERG fV~CI c~ ROUTE/BOX NUMBER Fire Number CITY/ST ATEC(,-- ZIP ~11o/ PROPERTY LOCATION: UA, Scv Z, Section, T N, R W, Town of 5 Qe_ St. Croix County, Subdivision Lot number • I Improper use and 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 septic tank pumper. 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 may 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- fying 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. H I/WE, the undersigned, have read the above requirements and agree vi to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- d 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. 'CV"►' SIGNED DATE St. Croix County Zoning Office P.O. Box 98; Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. Parcel 038-1136-40-110 o2io7i2oo7 09:23 AM PAGE 1OF 1 Alt. Parcel 33.31.18.556C 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 - BROWN, DONALD H DONALD H BROWN 1839 100TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1839 100TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 33 T31N R1 8W PT NW SW BEING LOT 1 OF Block/Condo Bldg: CSM 10/2726 5 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 12/29/2004 783693 2723/037 AFF 09/03/2004 773353 2649/126 WD 07/23/1997 1063/119 WD 07/23/1997 732/19 more... 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 47,000 255,900 302,900 NO Totals for 2007: General Property 5.000 47,000 255,900 302,900 Woodland 0.000 0 0 Totals for 2006: General Property 5.000 47,000 255,900 302,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 118 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 -Q NEWMAN CHRIS NW SW, Section 33 New Richmond, WI 77__- T31`14-R18W Town of Star Prairie San.Permit#75029 3-21-86 C. Powers Conventional, New Installed 7-7-86