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HomeMy WebLinkAbout012-1030-30-051 St. Croix County Planning and Zoning Tuesday, January 31, 2006 at 4:52:12 PM Page I of 1 Detail Sanitary Information Computer 012-103030-000 Submat: 40 acres Section: 12 Parcel 12.30.17.173 Lot TNRNG: T30N R17W 114114: NE 114 NE 114 Municipality: Erin Prairie, Town of CSM: - Owner: Whiteford, Howard 1684 Hwy 63 New Richmond, WI 54017 Permit: Replacement State Permit: 88411 issued: 1012011986 POWTS Dispersal: Mound Bedrooms: 2 WI Fund: County Permit: 0 Installed: 0511311987 POWTS Detail: POWTS Pretreatment: NA Notes Additional Notes Money Owed k9920022= As Built Plumt~er other Requirements file in 1986 archives, Erin Prairie. $0.00 Mary Jenkins Yes Steel, Gary L. Tom Nelson Signed Off: Yes Maintenance Scheduled Puma Date Pumced 1st Notification 2nd Notification 3rd Notification 811011999 811012002 0410112005 811012006 - - - - - - - - - - - - - - - - - - - - - - - - - - - NE NE, Section 12 WHITEFORD, HOWARD Rt. 1 T 30N-R17W New Richmond, WI 54017 Town of Erin-Prairie San.Permit#88411 10-20-86 G. Steel Mound, Replac ent J3-87 J. r\.5tex i Parcel 012-1030-30-000 01/31/2006 04:51 PM PAGE 1 OF 1 Alt. Parcel 12.30.17.173 012 - TOWN OF ERIN 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 LATON N & RANAE J HENDERSON O - HENDERSON, LATON N & RANAE J 1790 220TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1684 HWY 63 SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 12 T30N R17W 40A NE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1114/083 QC 07/23/1997 1102/365 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 104777 Use Value Assessment Valuations: Last Changed: 11/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 45,000 115,600 160,600 NO AGRICULTURAL G4 36.000 5,900 0 5,900 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2005: General Property 40.000 51,000 115,600 166,600 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 13,100 76,600 89,700 Woodland 0.000 0 0 I 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 Form- STC-104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP f. SEC. `Z T r _j;ZaN-R 7 W ADDRESS f l ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Soo Sa% 0u--,P \ 9, 4, e~'~,bc., vo©~+ i 38~ ~ ass /so/ INDICATE ORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: 2 Proposed slope at site: SEPTIC TANK: Manufacturer: L,C- J/ Liquid Capacity: /6F00 e- Number of zings used: - I ~-Tank manhole cover elevation: Tank Inlet Elevation: i Tank Outlet Elevation: _ e 7Z t"N Number of feet from nearest Road: Front, W Side o Rear, O feet From nearest-property line Front,~3ide,O Rear, O 89'1 feet Number of feet from: well ' ~ building. S'' (Include this information of the above plot plan)( 2 reference dimensions to septic tank) PUMP CHAMBER Liquid Capacity: Smn- I.- Manufacturer: 2~ pump Model:. 0 3 Pump/won Manufacturer: Pump ze y / 9 S Elevation of inlet: Bottom of tank elevation:, pump off switch elevation: _ T Gallons per cycle: Alarm Manufacturer: ►4~- Alarm Switch Type: i Number of feet from nearest property line: Front, 9 Side, O Rear, 0 Ft-2 Number of feet from well: e) D Number of feet from building:_ / ' (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Z- . Number of Lines:~ _ Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, O Rear, It . r•.F Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT umber of pits: Diameter: Bottom of seepage pit elevation: Ze bove soil Has sor distribution box O been used on any of the a absor eck one). HOLDING TANK Manufacturer: Capacity: Number of/fings used: Elevation of bottom of tank: Elev ion of inlet: ber of feet from nearest property line: Front, O Side, O Rear, OFt. 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 : 42 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING ❑CONVENTIONAL C$VALTERNATIVE State Plan I.D. Number: ❑ Holding Tank ❑ In-Ground Pressure XX Mound (If assignee) 86-43- NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION A BENCH MARK (Permanent referencepo Rt • 1 New Richmond WI 54017 ; U int) DESCRIBE IF DIFFERENT FgOM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: NE NE Section 12 T30N-R17W Town of Erin Prairie Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Ga Steel 3254 St. Croix 88411 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ' oo LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LA 98J7 P OV OED: LOCKING COVER ~ I } PROVIDED: BEDDING: VENTDIA.: VENTMATL.: HIGHW V vLJ L19YES ❑NO ❑YES NO r ALARM: NUMBER OF ROAD: LROPERTY WELL: BUILDING: VENT 70 FRESH ❑YES NO ❑YES FEET FROM ~r 1 AIR INLET: NO NEAREST -1 I O p1 3 ~g DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL PUMP/SIPHON MANUFACT ER W" Sao ~ ^ `Sl/O 1 6 Q ~ 1 ~ WARNING LABEL LOCKING COVER ❑YES NO (7 V PROVIDED: PROV DED: GALLONS PER CYCLE: PUMP AND CONTROL OPERATIONAL: YES ❑NO YES FIND (DIFFERENCE BETWEEN h G NUMBER OF PROPERTY WELL BUILDING V Nr o RE PUMP ON AND OFF) U I FEET FROM LINEQ AIR INLET SOIL ABSORPTION SYSTEM. Check the soil moisture at the depEh of plowing NO NEAREST 1 O O q f 111 1 or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE DIAMETER MATERIAL AND MARKING the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH. LENGTH: NO.OF DISTR. PIPE SPACING COV DIMENSIONS I TRENCHES MATERIAL: INSIDE CIA *PITS LIQUID PIT DEPTH V L O P H FILL DEPTH DISTR. PIPE DISTR. PIPE ISTR. PI E MA RIAL: NO. DISTR. BELOW PIPES: ABOVE COVER: ELEV. INLET. ELEV. END: PIPES, NUMB OF PRO E TV WELL: BUILDING: V NT TO FRESH A : FEET FROM LINE d~ AIR INLET: 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- ❑YES FIND meets the criteria for medium sand. TIONS MEASURED. IL OVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: YES ❑NO ❑YES ❑NO CENTER: EDGES: SODDED. SEEDED: MULCHED. ❑ PRESSURIZED DISTRIBUTION SYSTEM: YES FIND ❑ YES ❑ NO ❑YES ❑NO BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. TRENCHES: FILL DEPTH ABOVE COVER DIMENSIONS 1 2 3 O I t PIPE MANIFOLD PUM MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR. DISTR. IPE DISTRIBUTION ATERIAL & MARKING ELEVATION AND EL / 0 0.7S EV' , DIA.I I ELEV.: PIPE DIA. DISTRIBUTION LE Z rv , q 1 L) INFORMATION HOLE SIZE HOLES ACING: DRILLED CORREC LV I 1 / COVER MAT IAL VERTICAL LIFT CORRESPONDS TO APPROVED / PLANS COMMENTS: YES ❑NO YES ❑NO PERMANENT MARKE OBSERVATION WELLS: NUMBER OF vqo ERTY WELL: BUILDING: YES FIND FEET FROM LIN YES ❑ NO NEAREST Q J J77 '1 / 00 Sketch System on Reverse Side. in county file for audit. SIG / TITLE.. DILHR SBD 6710 (R. 01/82) 20 r Lt w DILHR SANITARY PERMIT APPLICATION COUN In accord with ILHR 83.05, Wis. Adm. Code STAT SANNIITARY PERMIT # -Attach complete plans (to the county copy onO;) for the system, on paper not less than STATE PLAN y 8% x 11 inches in size. N I.D. NUMBER -See reverse side for instructions for completing this application. 'N - 3 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION PR RTY OWNER FOR VARIANCE bn~LyES ❑ NO PROPERTY LOCATION %4, S T30, N, R 1 11.7 Y(or) W PROPERTY OWNER'S MAILING ADDRESS OT NUMBER BLOC NUMBER SUBDI ISION NAME 1_ 1-0 ' Cl Y, A ZIP CODE PHONE NUMBER CI I/IM1 ❑ NEARE~ OA E OR LANDMARK l .2~GS1 VILLAGE: z5 I6A C _-Z OA&ZItoe I. TYPE OF BUILDING OR USE SERVED: .100 Jr- 4;if0::;5n Number of Bedrooms if 1 or 2 Family OR Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. ❑ New,. b. -eplacement c. ❑ Replacement of d. E1 Reconnection of e. El Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑.A Sanitar Permit was previously issued. Permit # Date Issued 3. ❑ An Exist'ng System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. ❑ Conventional b. Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e.*5?,Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. l See a e Bed b. ❑ See a e Trench c. ❑ See a e Pit 2. PERCOLATION RATE 13. ABSORPTION AREA 14. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): o C2.5-0 asd ~ On TANK CAPACITY 6 Feetrivate ❑ Joint ❑ Public INFORMATION in allons Total # of Prefab. Site New xistin Gallons Tanks Manufacturer's Name Con- Steel Fiber- pp. Plastic A Tanks Tanks oncrete glass A structed p Se tic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber ~pa VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for instal 'on of the private sewage gystem shown on the attached plans. Plu er's Name (PrintPlumb s / gnature: (No S m P/MPRSW No. Business Phone Number: N is% In Plunlb-er'sA ress (Stree , City, State, Zi de): ~fD - t~jT CJ~ tj R, Name of Designer: VIII. SOIL TEST INFORMATION 1 Certifie Soil Tester (CST) Name CST # CST's AB)D S (St et, City, State, Zip C de) \ um Z AA) Phone Number: 47 4y &kb,-F- (DI CA 0 IX. COUNTY/DEPARTMENT US ONLY ~l ❑ Disapproved Sanitary Permit Fee Groundwater ,V El Approved urchar a Fee ate Issuing Agent Signature (No Stamps) -T Owner Given Initial n D (J Adverse Determination d ~ X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every'2to 3 years; 6. If you have questions concerning your private sewage systerri, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; Vi. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/ Department Use Only; application is disapproved. X. Comment area for use by county or resaon given when app Complete plans and specifications not smaller than 8'/2 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; dosing or pumping chambers; 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; dose 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more. commonly known as the groundwater protection law. This change in statutes was the l result of over 2 years of steady negotiation and public debate. The groundwater bill Ground> ater o included the creation of surcharges (fees) for a number of regulated practices which Wiscorfsin's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in, your building is returned to the groundwater through your soil absorption. " system or the disposal site used byyour holding tank pumper. The €-nonies collected through these surcharges are credited to the groundwater fund adrrinis- te,red by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) r / b V2 I'S h b~ ~s 711 8604233. DECEIVED PLUMBING BUREAU ~j- 7 1,7 R PRIVATE SEWAGE SYSTEMS STATE Of ISCONSIN BUREAU Of PLUMBING INGS PLAN APPROVAL APPLICATION M L Waddngion Avenue, Rm 141 P.O. Box 71111110, Madison, WI 53M x-2"15 INSTRUCTIONS; Please,fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The back side d this form describes required plan Information. Plumbing codes can be purchased from the Department of Administration, Document Sales, 202 South Thornton Ave., P.O. Box 7840, Madison, Wisconsin 53707, Telephone (608) 266-3358. 1. PROJECT INFORMATK)N (Type or print clearly) Revision To Plan Number: 51U0423,41 Name of Subraltting Party (Plans returned tc same) SProject Name r 0I Street $ No. or Rural oute Pro eCt Location -Street & No. or Legal Description City or Village f I State Zip uJ City County Village OF: Telephone No. (Includs area code) C) 0 Designer Telephone No. (Include area cods) Owners ame - Telephone No. (Include area code) Street 8 No. Street & No, City or Villag State ZIP City or Village Slats G') t Zip 2. APPLICATION FOR: < 4L0 ❑ Conventional System -Public Building 1 New Mound System (3a) Groundwater Monitorinig (7) g Replacement Mound (4a) Holding Tank (2) ❑ Replacement Pressurized System (4b) ED New Pressurized System (3b) H System in Fill (1) ❑ Petition For Variance (6) System in Flood Fringe (1) ❑ Other Alternatives (5) 3. FEE COMPUTATIONS (Include existing tanks) 4. FEE SUBMITTED MAKE ALL CHECKS PAYABLE TO DILHR FOR OFFICE USE 3a. 750 - 1,500 gallon septic tank 3b. 1,501- 2,500 gallon septic tank - 60.00 4a. 3c. 2,501- 5,000 gallon septic tank - 4b. 3d. 5,001- 9,000 gallon septic tank - 00 00 4d. 3e. 9,001-15,000 gallon septic tank -150 00 4e• 3f. Over 15,000 gallon septic tank 00 4e. -250.00 4f. 3g• 500- 1,000 gallon dose chamber - 30,00 3h. 1,001- 2,000 gallon dose chamber 4h. - 70'00 4. 31. 2,001- 4,000 gallon dose chamber _ 70'00 41i. 3j. 4,001- 8,000 gallon dose chamber _ 3k. 8,001- 12,000 gallon dose chamber 1000 4j 31. Over 12,000 gallon dose chamber -110.00 4 -150.00 41. 1. 3m. 500 - 5,000 gallon holding tank - 30.00 3n. 5,001 -10,000 gallon holding tank - 55.00 4n. - 3o. Over 10,000 gallon holding tank -100-00 4o. A '424 3p. Revisions - 20.00 4p. 3q. Groundwater Monitoring Per Lot - 32.00 (other than a proposed subdivision) Subtotal 3r. Priority plan review: walk through Submittal of plans in person, 4r. by appointment, with double: fee 39. Petition for variance Setback - 25.00 4s. Site evaluation - 50.00 Total Fee NO?E: Pees pursuant b Wis. Aden, Code, Chapller NMI. 09 SSOad74e (R. eras) may M errejssll to dwupe anrrwgy t~soeve Jrrly 1,1N4 -OVER PETITION FOR VARIANCE WISCONSIN DEPARTMENT OF OF'A RULE IN THE INDUSTRY, LABOR AND HUMAN RELATIONS OFFICE USE ONLY WISCONSIN ADMINISTRATIVE CODE DIVISION OF SAFETY de BUILDINGS Petition No. P.O. BOX 7969, MADISON, WI 53707 - um r. N of Olwne► 001/ f 1 Building o► Parry vG/ - /6 AYent. Architeet or Enpi ing Firm Tenant Name, if any Stmt 8 No. ir»t 8 111111 Building Location, Street at No. City • e ~ Zip 8tat 8 Zip /rill City County one 1 f 7 one Plan Numberls CP ZUG ~a IF KNOWN Nam of Contact Perron 1. Rule ~~e3. 3 (1 ~ i'a ~ of the Wisconsin Adminstrative code cannot be entirely satisfied because: 2. In Iieu of complying exactly with the rule, the following alternative Is degree of safety: proposed as a means of providing an equivalent 3. S~u/pppoo Ing arguments are: 2--q~~Zt~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - - - - - - - - - - - - - - VERIFICATION BY OWNER - PETITION IS VALID ONLY IF NOTARIZED For Fee Information See ILHR 69.15 or Contact The Department at (608).267.7843 NOTE: Petitioner must be building owner. Tenants, agents, designers, contractors, attorneys, etc, may not sin of Attorney is submitted with the Petition. g petition unless a Power (NAME of PETITIONER Please type/print) being duly sworn, I stele as petitio~~ W read the foregoing petition, that h I believe it to be true and I have significant ownerift rights in the subject building. J U l 1 R 11985 OFFICnON $+o~.eur. AL owns o-~i this date; Date Rm Ript No. County, Wisconsin oPaid . apart.~ My 0"miaitiit`estpi'rp;/ Office of The Secretary oats as In. 11IN4I STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P:O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township mum NE ~b NE ;41s 12 T 30 N/R 17 Street Ad ress: W Erin Prairie St. Croix Subdivision: County: Landowners Name: Mailing Address: Howard Whiteford Rt. New Richmond, WI 54017 I (we), the undersigned, hereby make application for an alterJtl'DAd0z the above-described premises. I recognize that the above suited for a conventional private sewage system. If a prises are not agree to have the system installed in conformance with ptheaBureau's nap pr I of plans and specifications. oval I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not agent (the contractor) to begin installation. Iftthe me (the system pisiapproved or my Bureau will send the applicant a letter of approval pr, the construction of the alternative system after allnecessar authorizes obtained. Y Permits have been I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. RECEIVED ' JUL 1 R I~>g;; S N~ture of App ica t STATE OF WISCONSIN Subscribed $nd sworn to before me SS. COUNTY OF This dai► of vc V 19n. tPubli Notary:c, State e of scons DILBR-SBD•-6413 (N. 05/81) MY Commission Expires: WV 000" ST. CROIX COUNTY WISCONSIN ZONING OFFICE 798-2239 (HAMMOND) 425-8383 (RIVER FALLS) HAMMOND. WI 54018 July'7, 1986 Division of Safety and Building Bureau of Plumbing P- 0. Box 7969 604,98,9 Madison, WI 53707 Dear Sir: Anion site investigation f5r the Howard Whiteford property, located at the NEh of the Nit of Section 12, T30N-R17W Town of ri Prairie St. Croix County, revealed suitable soils at a~dep h of 180 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions , please feel free to contact this office. Sincerely, Thomas C. Nelson Assistant Zoning Administrator TCN/mj RECEIVED J U L ? R ,n8:5 PLUMBING 13UREAU WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY 6 BUILDINGS, BUREAU OF PLUMBING P.O. BOX 79691, MADISON, WISCONSIN 53707 'Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location 1/49 NE 1/4, Sec. 12 T.._ _N, R 17_x W Town Erin Prairie Street Address Lot No. , Block , Subdivision Landowner's Name: Howard Whiteford The aPplication for this site is for: 0 new construction use. '360 423 (Bre.Placement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ~.1 to have one of the first five approvals guaranteed for this e number - of those applications. Y ar. This is quota nB er`s-1'Ssue~o you-) (Use one of the first five 1. lone of the applications needing a quota number. The this application is _ quota number assigned to ❑ for one additional homesite on a farm to be occupied by a parent ch grandchild, sibling, niece, nephew, or first cousin. ild, Clfor an individual lot for which a sanitary permit was issued but was ruled unsuitable due to new or changed soil criteria established bytheter department. Ufor an RECEIVED application on file prior to'February 1, 1980. Ufor a lot that meets the criteria for a conventional private sewag If. this: a REPLACEMENT SYSTEM USE, the alternative private sew st~~ BUREAU replacing; age system is [x a failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February l 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here. 0 I certify that the above information is true and accurate to the best of mY knowledge. Name Thomas C. Nelson oun . Y c a Si re Title Assistant Zonin Administrator • Date July 7. 1986 DILNR-SOO-6158 (R 12/82) PARTMENT OF SAFETY& BUILDINGS 3USTRY, REPORT ON SOIL BORINGS AND .BOR AND P.O. BOX 7969 IMAN RELATIONS PERCOLATION TESTS (115) DIVISION (1,163.090) & Chapter 145.045) MADISON, WI 53707 4 3~/n 171 TOWNSHIP TY; O. BOI S lU T (orl W I V7 IL ` DATES OBSERVATIONS MADE ~Residanq /v ❑New IRReptaca ~1 ~ 2 6 ~9 6 - e3a TI 0: III Site suitable for system U• Bite unsuitable for system S u Ou 0s oU O~DS TANK: RECOMMENDED SYSTEM (optional) V 'ercolation Tests an NOT required 0 S AT : der olatio 09 eats ar indicate If any portion of the tested area is in the Floodplain, Indicate Floodplain elevation: F.SIa)A I PROFILE DESCRIPTIONS ~6E .3.0 M8 8 RING R ELEVATION V R-INCH 1. WITH H IMTOR. TUR , AN DEPTH T BEDROCK IF O SERVED (SEE ABBRV. ON BACK.) (oil 0 0-- RECEIVED JUL 1 R `09 PERCOLATION TESTS PLUMBING BUREAU D H OMER a WATER11M LE S RO IN WATER RATE MIN AFIERS LLIN iNT RVAL-MIN. PER IN H 8 c C;? O IT PLAN: Show locations of percolation tilts, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. D*wN* whet an the hori- -U-w their location on the plot plan. Show the surface elevation at all borings and the direction and percent 5~5 v f12 ~yyt i 1-851 #3O3 3 hZ a scQ~ ~ RECEIVED n j Wt«tZ 1 J UL C MBING BUREAU p~U~81~G p P PRF ~ DDbu's .OPTIONAL WORKSHEET 1. MOUNQ SYSTEM 11. IN-GROUND PRESSURE SYSTEM-Continued. 1. Wastewater Load, Total Daily Flown vQ pl• 10. Fora Main: 3=e• Ube li. ;LHR 83.15 (3) (c) Minimum Dosing Rate ■ a Adm. Cogand PROVIDE A DETAILED Diameter a Lift OF SIZING ON PLANS. ~O 11. Total Dynamic Head: 2. Depth to Lbnitbts Factor • It. System Wad ■ ft. 3. Landslope ■ % Vertical Lift ■ ft 4. Distance from Dew Chamber to Friction Lou • IL Distribution System • j 4 ft. TDH • /t, S. Elevation Difference Mtwaen 12. Pump Selection: Pump and Distribution Synlam • G~:~ ft Pump will discharge at bust 91 AS. pm 6. Absorption Area Siting: at 161 a ~ It. total dynamic head. Area Required a p. IL ►umpindel ut q~p • bed or Trench length (8) a ~ g1N~ E3.0 U7 BO2 L. Bed or Trench Width (A) a L Trench Spacing (C) ■ e 13. Dose Volume: 7. 10 Times Vold Volume of Mound Height: 20 letributbn lines ■ W, .3 Fill Depth (D) '-ater S hrs.Velume J.r• .Fill Depth Downslope (E) • i h' y'}~ IM II all Bed W Trench Depth (F • • Cap and Topsoil Depth •"`•z 41t r 8 w■ p O uS imum Don ■ &d. Cap and Topsoil Depth (H) ■ Ch 6. Mound Length: aSM~ t. • DEp~ unto a End Slope (K) ago to. TOW Mound Length (L) ■ 'in!~t ONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: 1. Wastewater Lead, ToW Daily Flow • USal. psiops Correction Factor ' Use s. ILHR 83. 15 (3) (e) , Wi Upsiope Width (1) • h. Adm. Code and PROVIDE DETAILED Downslope Correction Factor a LIST OF SIZING ON PLANS. Downstope Width (1) ■ ft. 2. Required Septic Tank Capacity • gal, Total Mound Width (W) • ft. 3. Percolation Rate ■ minjin. 10. Basal Area: 4. Absorption Area Slike: Infiltradw capacity of Refer to Table 2 in ILHR 83 ual Soil e ' gai./sq.ftjday and PROVIDE A DETAIL LIST OF basal Area Required • sq. h. SIZING ON PLANS. Basal Area Available a sq./L Required Area ■ p, ft. 1 I. It Standard Tables from Chapter ILHR 83 *O / 2 idth a f . ale: use ed, indicate Table ble # ~ R. 12. For the Distribution Network, Use Numbers S•14 In Section It. Number of T tins ■ 11. IN-GROUND PRESSURE SYSTEM Trench S n6 ■ f. 9d S. Distribut ystem: 1. Depth to Limiting Factor • Later Length a ft. 2. Landslope a N bar of Laterals. 3. Percolation Rate • minjin, atotal Spacing ■ lot. 4. Proposed System Elevation a = ft. Distance from Sidewall ~~ICN~)VED in. S. Wastewater Load Total Daley Flow: gat. System Elevation ■ O- Use S. IL93i 83. 15 (3) (c) , Wis. Adm. Code and PROVIDE A DETAILED IV SYSTEM4N-FILL I LIST OF SIZING ON-PLANS. Fill in All Items from Section 111 R Required Septic Tank Capacity ■ 000 I1126 6. Absorption Area Sitk4: V. SEPTIC TANK PLUMBING SURE Percolation Rate • min./in. 1. Capacity a (5 IW Area Required a sq. ft 2. Manufacturer: -Wef k-S L°DrtLyr'P System Length ■ tL 3. Show Site Constructed Tank DeWls en Plan System Width a R. 7. DlstrlMtion Pipe Siting: VI. DOSING TANK Hole Sire ■ lo. 1. Capacity Sal. Hole Spacing ■ ~ fl. 2. Manufacturer. Lateral Length • ft. 3. Pump Manufacturer: Lateral Sloe • In. 4. Pump Moulel: Laterallp*cbtg fl. S. Operating Header ft. ,Iixl,wtte from sm"agert Pier 6. Flow Rate: ' !i~• It. Distrdoulion Pipe Discharge Rate: 7. Show Site Constructed Tank Details on Plans Number tot 1 Noes Per Pipe 1 low Per raw' gpttt. VII. HOI.UING TANK 4. Manifold Siring: '1.. Capacity ■ .type (center or end) 2. Manufacturer; Length a It. 3. rutted Tank Details on Plans Diameter ■ in. -SHOW ALL INFORMATION ON PLANS- DIIN fit IR.~3lt21 . ~Q k ' • Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Mediwn Sand Topsoil a ✓L~,~ Of - 2 Force Main Plowed Sw~,'~A Aggregate Layer st~lce~~ GF ~ - ~,~R~ n ~ ~ ~►O ~~~AR 1 U, (•L~~e~ G .L~= Ft. Cross Section Of A Mound System Using E Ft. A Bed For The Absorption Area F Ft. G / Ft. A Ft. H S Ft. Signed: o-a4 B 442-. Ft. License Nurser:~'.f~3.~J~ K ~Ft. Date: L Ft. 8 6 0 4 2 3 3 J I Ft. I Ft. - _ W &74:; Ft. Observation Pipe 8 K ----_MW . - A I Force Main Distribution Bed Of~- 2 Pipe 'I Aggregate Observation Pipe Permanent Markers waft JUL 1.819. Ptah NNW Of Mowed Using A *ad For The Absorption Area r. Y PNh.etsd Pipe Often • And V Rat cap Fs.t~rfke PVC moo Itsl~s i~gtN Ow NitM, • ~d ~n tew~yr Mesa " PLUMBING 31% AW& . AF Q DEPARTMENT OF D Y; LA RAN H AAN :ATIGN,S DIOj ' 5AF' AN IN a,*-- Ell 67 14; SEL NDORSESPO E9 CE +ew~ °r~• .N 8604233 _a.t•rorti." Pipe leyf~rt Ft. Y liol~` Way _ ' TKh Stud: Latsr~l _Inch(es) L1conso Nwbor: `FYI .Scc.) 3 5 _ HrMfold In&AS Oats: ' 1 BG Forco IACMs--Z- Invert Elevation of Laterels~~ Ft. - ~JUL 1.8 i v PAGE CF PUMP CHAMDER CROSS SECTIOW Akio SPECIFICArlOkJS VCAJT CAP 4'C.Z. VtWT PIPE WCATHER PROOF APPROVED LOCKILIJ~l AS' FROM DOOR, JUNCTIOAI BOX, MANHOLE COVER WINDOW OR FRESH It•MIU. AIR INTAKE 'ALI GRADE I i y MIAJ. 00 . ~ le• rnu. COUDUIT IAILCT uBtN(~ PROVIDE I p~- QURTI&NT SEAL I I I iiQ 1 I I y~ l APPROVED JOINT W/Ca. PIPE ~0 I III 1~ APPROVED JOINTS a I I W/C.I. PIPE EXTCNOIU6 3' r;F't~~ ~U',J I III ALARM EXTEUDIM& 3' ONTO SOLID iOlf,. a, k,l' G, I ONTO SOLID SOIL S~ ~Y 6G~ I I %spAASM~~a~ ' pF lYl I I OLI , ELEV. 0 PUMP 0 ~ CONCRETE BLOCK ~CEIVeD RISER EXIT PERMITED OIJL9 IF TANK MAUUFACTURCK HAS SUCH APPR96tL tEII UJ DOSC~~ .i~ PWA48ING EU , EAV TANKS MAUUFACTURtIt: LLMBER OF DOSES: PER DAM TAAJK SIZE: - GALLONS DOSE VOLUME ALARM MM►WFACTURER:. + IUCLUOIM6 /ACKFLOW: &ALLONS MODEL IJUMIOER CAPACITIES: An MICRES OR . CALLOUS ds IU@WZS OR -LLLCLLOUS PUMP MANUFACTUREiWITCM Ty►E: R: c: INCHES OR fiALLOUs MODEL AIUNIBER: J, Ds Z- INCHES OR GALLOUi SWITCH TYPE: tA~ : PUMP AMID ALARM ARE TO OE NUNIMUA DISCHARGE RATE GPM IIN((STTALLED ON SEPARATE CIRCUITS -3 170 - 17 VERTICAL DOFF 9REW -9 oETWEEU PUNY OFF AAIO OISTRIWT10U PIPE.* -L ~ FECT ♦ MINIMUM NETWORK SUPPLY PRt%SURE • , . 2-5 FEET 'Za,Z9G IRA ♦ FEET OF FORCC MMN X, 9?1 =F 1i•2O FEET ~lx ~ -~dl / p0 KFRICTIOIJ PACTOR..~,~~ TOTAL DYNAMIC. MEAD s~ ' I FEET INTERQIAL DIM[ MOMS OF TANK: LEAI&TH ;WIDTH jLIQUID DCPYN i Performance Submersible Effluent Curves Pumps METERC FEET 25 MODEL 3885 SIZE 3/4" Solid wE, 70 20 WE10H so w~ 15 50 40- 10 30 -T -1 TLLW1 5 f 10 0 0 0 10 20 30 40 50 eo 70 80 90 100 110 120 Gm A Ch 0 10 30 WA CAPACITY GOULDS PUMPS. INC. PJ:ET SMWA RA" New MW owe ~Ils 120 MODEL 3885 110 SIZE 3/4" Solids W- TE 1-5 30 100 9o 2S 70 20 -T- ,S 50 40 10 30 20 5 10 0 0 EIVEp 0 10 20 30 Q w so 7o so 90 100 110 1 . 0 10 20 B1NM • H!6 t#o1,kN P1, Ino. CAPACITYEA U swot».A~ 1w ' H z y a STC - 105 r r a SEPTIC TANK MAINTENANCE AGREEMENT rHr St. Croix County o x tv a OWNER/BUYER -p M Ile c=f ROUTE/BOX NUMBERFire Number .CITY/STATE e C,~ ma"7c G(/~ ZIP ,!5- D/7 PROPERTY LOCATION:AQ IF, h, Section 4z , T,71) N, R W, Town ofkri-4 fora ICI'"/,e St. Croix County, Subdivision , Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- s ists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you pit 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. y 0 I/WE, the undersigned, have read the above requirements and agree E x to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b 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. 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. i APPLICATION FOR SANITARY PERMIT STC-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 do AI)alr Q, / le- 41,01 - vh Location of Property ] -'k - it, Section T36 N-R~ W Township Mailing Address Address of Site `?7 c. Subdivision Name All .4 Lot Number Previous Owner of property m 5& es 4" Q l o Total Size of Parcel ~Q jJ/'Q x ! A6 reS Date Parcel was Created Z f512 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _ No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warrant Deed which includes a Document number, volume and page number, and 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) cvLti6y that aZt atatementa on thin 6o4m ane true to the beat o6 my (oun) knowtedge; that I (we) am (are) the owner (.a) o6 the pnopW y ded ch i.bed in thia injonmation 6onm, by viAtue o5 a wamanty'deed teco&ded in the 066ice o6 the County RegisteA o6 Deeda as Document No. ; and that I (We) pneaentty own the pnopoa ed .6ite bon the d ewage du po.a a yb em (on I (we) have obtained an easement, to nun with the above deaehibed property, bo,% the eonatnucti.on o6 said aybtem, and the .name had been duty neconded in the 046ice o6 the County Reg-isten o6 Veedb, ab Document No. SIGNATURE Olt OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED w ' ti _ ST. CROIX COUNTY WISCONSIN ZONING OFFICE r. ~i 796-2239 (HAMMOND) ` 425-8363 (RIVER FALLS) HAMMOND, WI 54015 July'7, 1986 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: Anon site investigation fbr the Howard Whiteford property, located at the NEk of the NEk of Section 12, T30N-R17W, Town of Erin Prairie, St. Croix County, revealed suitable soils at a depth of 1.80 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. /SSin'cerely, V ~ T Thomas C. Nelson Assistant Zoning Administrator TCN/mj WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 79699 MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location NE 1/4, NE1/4, Sec. 12 T 30 N, R 17 XVUM W Town XQL1M 04WfiWJW Erin Prairie Street Address Lot No. Block , Subdivision Landowner's Name: Howard Whiteford The application for this site is for ❑ new construction use. Careplacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ~..1to have one of the first five approvals guaranteed for this year. This is number - of those applications. (Use one of the first five quota num ers issued_fo you.) ]one of the applications needing a quota number. The quota number assigned to this application is - - . ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. [D for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. (.for an application on file prior to February 1, 1980. U for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: Q a failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here .0 I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Si re (County Official) Title Assistant Zoning Administrator Date July 7. 1986 DILHR-SBD-6158 (R 12/82) STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township1Xi~X NE 4 NE 14S 12 T 30 N/R 17 $W Erin Prairie St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Howard Whiteford Rt. 1, New Richmond, WI 54017 I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I a ree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DILHR-SBD-6413 (N. 05/81) My Commission Expires: