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lyp~PAT,Tjr itATT XdV IE 30. 31~ IVi4TE1SEW~►GE' SYSTEM 7' RIVE County:
-Labor and Human Relations INSPECTION REPORT
. Safety and Buildings Divisi n ST. C OIX
91 ~-J L"" • (ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFO MATION 186527
Permit Holder's Name: ❑ City ❑ Village Elyown of: State Plan ID No.:
TRUCTION STAR PRAIRIE
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
r
038-1164-70-000
TANK INFORMATION ELEVATION DATA A9200411 1/0&
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic AJ ")e_ Benchmark
g r
Dos U / %/%Z 03.
Aeration Bldg. Sewer
Holding St/jiiPE Inlet 99/S
TANK SETBACK INFORMATION StIA Outlet 8. -77
TANKTO P/L WELL BLDG. Ventto ROAD Dt I
Air Intake
4~1 ..a.-
Septic >6V 0' NA
Do NA Header1,Aan. X13
Aeration NA Dist. Pipe g' ' 2-5-
Holding Bot. System j
PUMP/ SIPHON INFORMATION Final Grade 7 L 9B. o , 8
Ma r Demand
Model Number GPM
TDH Lift Friction 5yestem TDH Ft
Forcemain Length Dia. Ilia Dist. To wen
SOIL ABSORPTION SYSTEM
BED/TRENCH width l Length / No. Of Trenches PIT Inside Dia. Liquid Depth
DIMENSIONS 3 EN I N
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Man cturer.
SETBACK
INFORMATION Type O /I &.6 CHAMBER mod el Number.
System:-r,-c,,,4. R ~ OR UNIT
DISTRIBUTION SYSTEM
Header/-%4eft4oW !Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length _a~~ Dia Length I Dia. 1`- Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over 1 xx Depth Of xx Seeded/ Sodded xx Mulched
&@61 Trench Center 13 -sot Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: STAR PRARIE 30.31.18.7 SW,S/E~, LOT 17, RIVER VIEW
(n a,v 'tM ;0 L G-,~ ,,t, l . f C✓ r_ ? r q/ E1L / Z I ,
-,~.~~-cam!
Plan revision required. ❑ Yes []-N'o~
Use other side for additional. information. G(~ ~a~--
SBD-6710 (R 05/91) Date Inspector's Signature Cert No.
,
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
SANITARY PERMIT APPLICATION . COUNTY
LHR In accord with ILHR 83.05, Wis. Adm. Code
I wt.
ON
STATE SANITA PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ S
8
% x 11 inches in size. rev sion to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
e '/a, S ~a T21, N, R E (or)
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
11. TYPE OF BUILDING: Check one) CITY NEAREST ROAD
( ❑ State Owned VILLAGE y + I ,f ' C u/
❑ Public [1 or 2 Fam. Dwelling-# of bedrooms S AR AX NU R( )
III. BUILDING USE: (If building type is public, check all that apply) O P~ G ?O
1 ❑ Apt/Condo .J a
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash
5 El Hotel/Motel 9 1-1 Off ice/Factory 13 El Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ® New 2.❑ Replacement 3. El Replacement of 4.E] Reconnection of 5. El Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 300 Specify Type 41 ❑ Holding Tank
12 9 Seepage Trench 22 ❑ In-Ground 420 Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5 PERC. RATE 6 SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) G ELEVA ION
-5-e :mod t 2 Q' f tielz_Q • Feet 91.31 Feet
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holdin Tank ~S2il1 l :~i✓L$?"
=El=l =E
ift Pump Tank/Si hon Chamber
L
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) (VP MPRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sa 'tary Permit Fee (includerg roeej Water ate Issued Iss int Signature (No Stamps)
Surch pproved El Owner Given Initial
E/ _
~ P t
Adverse Determination
/
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber
INSTRUCTIONS s
1. A sanitary permit is valid for two (2) years. r
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
VIII Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; (lose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
- -
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
S `I, C - 10 0
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
douse), 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
7~,c/
Location of property _1/4 1/4, Section , T N-R W
Township !,qL~/~ _
Mailing address
Address of site
Subdivision name__C__I?C-Is le--tv p> do _Lot no.
7
Other homes on property? es
Previous owner of property
Total size of parcel ~ 6 F% ,CSC
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes X No
Volume and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER & THE SEAL OF THE REGISTER OF DEEDS. 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 Certified Survey Map
shall also be required.
PROPERTY OWNF..R Cf.''R':PIFI.CATION
I(we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) 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... and that I (we
own the proposed site for the sewage disposal system or I (we) ~
obtained, an easement, to run the above described property, for
the construction of said system, and the same has been duly
recorded in 'the office of County Register of deeds as Document
No 'ell
Signature of applicant co-applicant
Date of Signature Date of Signature
7777 7-7w
THIS MAC& l7
Own"" am
STAT3 U OF WISCONSIN FORM s-i/MI
i sr. aMa~,..
RsC~ !m Mond P
f 108 330
seas sad warrants to A#L+Rrat IxQpltltastll...11.,I11itCQAa1A _ 0
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RCTURN TO Century 21 SoGwVt
Box 416
W rise, iAed rw in .St.--UniX ...........County, Somerset WI
WRi~ewNis:
'at
Tax Parcel Nos
a;
Lot# 7 AM Was -Crostvi w AddlOon in the Town of Star Prairie
3 J~ v
1
d proprtY.
777- 4
.ate . der of November , 19.Z
.....:._.......'~S3EAL)-
.Lester H.-Martell.
jilBCAT201~ ACSNOWLEDOUBUT
` STATE OF WISCONSIN 1"1
St.- C;oix......- County. n..
Personally came before me this
:
. Novetib~........... 19.92•-. the a" ■u ~
x .H Le~>wer H. Martell
me knowa to bit the person
. . wlw ijieet~
forego instrument and acknowle4p the nuns.
Gar
y... ai 1 l arSeor! .
r.... Notary Pub 8. Croce r'.
1tyl............
iperms E. (It
wet; t
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I, r1 i'.a13n:. date:
019 - ~".y x, dF.ti u'1~~ atlq'ah
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.ate..... _ ._i~.. ~ C~^.:
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER BUYER W7-F,es-,)IL) 42 0 &74 T/ `J
ADDRESS] FIRE NUMBER
CITY/STATE "k) FILA e, ZIP .jezl4/7
1DROPERTY LOCATION: 1/4, 1/4, SECTION , T N-R W
TOWN OFi St. Croix County,
SUBDIVISION&ESTU/&~J LOT NUMBERX7%
Improper use and maintenance of your septic system could
result in its premature failure to handle wastes. Proper
ma.intenanc~,2 consists of pumping cut 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 tr'eatinent stage in the waste d_i.sposal 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
system properly maintained.
The, property owner agrees to submit to St. Croix Zoning a
certification form, signed by the owner and by a mater plumber,
journeyman plumber, restricted plumber or a licensed pumper
verifying that (1) the on-site wastewater disposal system is in
proper operating condition and (2) aFter inspection and pumping (if
necessary),, the septic tank is less than 1/3 full of sludge and
scum.
I/We, the undersigned have read the above requirements and
agree to maintain the private sewage disposal system in accordance
with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be
completed and returned to the St. Croix Co. Zoning Officer within
30 days of, the three year expiration date.
SIGNED:
1ZsyL
DATE: I/ /oZ _
St. Croix co. Zoning Office
911 4th' St.
Hudson,] WI 54016
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WiSco~,in Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor arxf Human Relations
Diviswn of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
St. Croix
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D. #
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
PROPERTY OWNER: PROPERTY LOCATION
Peterson Const . GOVT. LOT SW 1/a SE vas 30 T 31 N,R 18 xTor) w
P1MF3R~ O%rER':jMMAAIILI~IVeDDRESS LOT # BLOCK # SUBD. NAME OR CSM #
17 n/a Crestview
CITY, STATE . ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD
New Richmond, WI. 54017 (715 246-5650 Star Prarie Riverview Rd.
[xMew Construction Use [a Residential 1 Number of bedrooms 5 [ j Addition to existing building
[ j Replacement [ j Public or commercial describe
Code derived daily flow 750 gpd Recommended design loading rate • 5 bed, gpd$ - 6 trench, gpd/ft2
Absorption area required 1500 bed, ft21250 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 •6 trench, gpd/ft2
Recommended infiltration surface elevation(s) 96 78 orig 100.78 alt . ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material outwash Flood plain elevation, if applicable n/a ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT•GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem x® S ❑ U EEB ❑ U fS ❑ U [Rb6 ❑ U O S 3a U ❑ S )E U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Bour~lay Roots GPD/ft t
Boring # Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends
1 0-12 1 4 4 none gr mvfr c/s 2/f .4 .5
n / sl. 1/f/
~f 1
2 12-28 10yr4/4 none sl. 2/m/sbk mvfr G/w 1/f .5 .6
3 28-10 10 r5/4 none Ifs. 0/sg mvfr n/a n/a .5 .6
Ground y
elev.
10~~7~i
Depth to
limiting
factor
> 00
Remarks:
Boring #
1 0-12 10yr4/4 none sl. 1/f/sbk mvfr c/s 2/f .4 .5
2~ 2 12-3 10yr4/4 none sl. 2/m/sbk mvfr g/w 1/f .5 .6
3 32-7 10yr4/4 none sl. 2/m/sbk mvfr P,/w 1/f .5 .6
Ground
elev. 4 72-10 10yr5/6 none lfs. 0/sg mfr n/a n/a .5 .6
104.5
Depth to
limiting
facia
>102
Remarks:
T Name. -Please Printl
715P~M-6200
AddjL ~OUtti. P~°E=o.`TE'T7 n~rt;rQ ~'7T. s!+01.7
.PROPERTY OWNER Peterson Const. SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D.1.
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Bourd3y Roots Bed Trerxh
1 0-10yr4/4 none sl. 1/f/ r. mvfr c/s 2/f .4 .5
E-13 .
2 12-1266 10yr4/4 none Us. 0/sg mvfr g/w 1/f .5 .6
Ground 3 66-8 10yr4/4 none ifs., 2/m/sbk mfr n/a n/a .5 .6
elev.
1~=l~
Depth to
limiting
factor
>80
Remarks:
Boring #
1 0-12 10yr4/4 none sl. 1/f/gr. mvfr c/s 2/f .4 €.5
55~4. 2 12-9 10yr4/4 none lfs. 0/s mvfr n/a 1/f .5 1.6
Ground
elev.
100.2$
Depth to
limiting
fgr
Remarks:
Boring #
„.tom 1 0-15 10yr3/3 none sl. 1/f/sg mvfr Is 2/f .4 .5
5 2 15-43 10yr4/4 none ifs. 0/sg mvfr g/w 1/f .5 .6
3 43-86 7.5yr4/6 none 1s. 0/sg mvfr n/a n/a .7 .8
Ground
elev.
9 9,43t.
Depth to
limiting
>8tior
Remarks:
Boring #
1 0-12 10yr3/3 none sl. 1/f/gr mvfr c/s /f .4 .5
6 2 12-45 10yr4/4 none Ifs. 0/sg mvfr g/w 1/f .5 .6
3 45-86 7.5yr4/6 none is. 0/s mvfr n/a n/a .7 .8
Ground
elev.
1QO-,7f8
Depth to
limiting
factor
>86
f
STEEL'S SOIL SERVICE
Gary L. Steel 988 N. Shore Drive
C.S.T. 2298 New Richmond, WI 54017
MPRSW-3254 Peterson Const. (715) 246-6200
SW4SE4 S.30-T31-R1814
Star Prarie, township
lot. #17
PCC 10c)
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REPT131 STAR PRAIRIE ST. CROIX COUNTY ZONING PAGE 1
01/06/93 10:09 REQUESTS FOR INSPECTION WORK SHEETS FOR: 1/ 6/93 AREA: JT
Activity: A9200411 1/ 6/93 Type: CONVSEPT Status: PENDING Constr:
Address: STAR PRARIE 30.31.18.781,SW,SE, LOT 17, RIVER VIEW
Parcel: 038-1164-70-000 Occ: Use:
Description: 186527
Applicant: PETERSON CONSTRUCTION Phone:
Owner: PETERSON CONSTRUCTION Phone:
Contractor: SCHUMACHER WILLIAM C. Phone: 386-3121
Inspection Request Information.....
Requestor: SCHUMAKER, BILL Phone:
Req Time: 11:01 Comments:
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION