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012-1065-60-100
St. Croix County Planning and Zonin Monday, October 03, 2005 at 7:52:21 AM Detail Sanitary Information page 1 oft Computer 012.106560.100 Sub/Plat: NA Section: 30 Parcel 30.30.17.4621310 Lot: 1 TNIRNG: T30N R17W Municipality: Erin Prairie, Town of CSM: Vol. 14 Pg. 3935 114114: SW 114 SE 114 Owner: Moore, Patricia 1562130th Avenue New Richmond, WI 54017 State Permit: 83867 Issued: 09/16/1986 POWTS Dispersal: Mound Permit: Replacement County Permit: 0 Installed: 0712511986 POWTS Detail: NA Bedrooms: 3 WI Fund: yes POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Requirements Additional Notes Tom Nelson Yes Money Owed Powers, Calvin 2-trench mound system with 1000 gal. Powers $0.00 Signed Off: Yes septic tank to 610 gal. Powers dose tank to 15' x 63' bed with 2 3ft. Cells inside. attach notecard to file Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7(2511989 04/01/2005 F Step 7. DISTRIBUTION SYSTEM 7A) SIZE DISTRIBUTION SYSTEM 1) Hole size = in. 2) Hole spacing = in. 3) Distribution pipe length -iftd-~J` 4) Distribution pipe diameter =a.V in, 5) Spacing between distribution pipes = ia`T 6) Distance from sidewall to distribution pipe i ins 7B) DISTRIBUTION PIPE DISCHARGE RATE 1) Number of holes per pipe 2) Flow per pipe = ZR GPM 7C) SIZE MANIFOLD 1) Manifold is central,/ end 2) Manifold length ft. 3) Number of distribution lines = 4) Manifold diameter = in. zT4 7D) SIZE FORCE MAIN ~ vN ~.J~',c''s,~ 1) Minimum dosing rate = ~ GPM 2) Force main diameter = in, 3) Friction loss 7E) TOTAL'DYNAMIC HEAD 1) Vertical lift = S ft. 2) Friction loss = ,;eft. ~ 6• 3) System head 2.5 ft. ft. 4) Total dynamic head 1, t. REUtivcL AUG 12199 PLUMBING sECI}IOIo Cf 7F) PUMP SELECTION 1) Pump selected will discharge GPM at ft. total dynamic head. 2) Pump model and manufacturer 7G) DOSE VOLUME 1) 10 times void vo/l~u/ry)~Rpy., of distribution lines ~ gal./cycl( 2) Daily wastewater volume 4 doses/24 hrs. _ rrgal./cycl, 3) Minimum dose volume z_ gal./cycle i 7H) DOSE CHAMBER 1) Minimum capacity required gal. /044 d,rr, rV ~ 0 B AUG 12 19863 PLUMBING SEtlsItllUn - 1 1 r~ ~V 14.4 • I )V 3 pV WAG [lortaff, ~ OAr~- SV N~ OF.1e~DU5l FC - A~0 >~v , p~PARZME p1~~S10~10F ON~ENCY✓ ~~gP • 06.106 7o Cfas"t k.t ti O-V- 0 REGtivu~ AUG 121986 PLUMBING SECTION Page a r Straw, Marsh Hay, Or 1 Synthetic Covering Medium Sand Distribution Pipe Topsoil H - c 3 E ..1f 0 p Force Main % Slope Trench Of 21" Plowed -Aggregate Layer Undisturbed D Ft. Soil E Ft. Cross Section Of A Mound System Using F Ft. x 2;Trenches For The Absorption Area G'Ft. A_Ft. H Ft. B 3 Ft. Signed: C Ft. 7 License Number: K /Q.- 6 Date: Ft. Alternate Position of Force Main I _ jje~ Ft. W Ft. L J ~ A - - - - e- - - - - - - K C Forcer W Observation PLUMBING Permanent.: . Main Pipes Morkers N DEPARTMENT Y L~ u~R l 7A61 Gh {0t 1 DIVI WOF SAFETY AN BU. LDINC~Ag gate SEE C FiESPOND_"i, ('ttlrti v C.t. Mound Using Trenches For Absorption AUG 21986 4 OWNING sa;ll w ~,rGSS seetiwr vi Yte~sute 5~,;~~,,, 4~ 1 i fi T ~j1✓?Jf l W a / _ Finial grade_ vent - ffie 'O'rftE''. 'y 4" cast 1 ZN f/,f,'JArr 1^ iron L zrr Q ~c.i I It Drain back to tank + c.0 O CC) ; ej G~2 septic tank I 2r pump station I a FS r ~ ~ Si i I 1 F Ln~: L , ~11 F Sign I:iscense Nu: Dote: i Pogo - ' Perforated Pipe Dotal[ End View )Perforated End Cap PVC Pipe de~ot`s'e Moles Located On Bottorn, ' s Are Equally Spaced 0 Q PVC Force Main .7 ~ Q PVC Monifold Pipe ~,pltsrnote Position Of Distrib-0ion Force Main Pipe Lost Hole Should 8e Most To End Cop End Cap Distribution Pipe Layout P c'Ft. S X Inches Y Inches Signed: /7 Hole Diameter Inch t Lateral " Inch(es) License Number: Manifold " Inchws r'.~F . tine ` PLU N4 ~ Force Main ' Inch-is o d one y # of holes/pipe A f Invert Elevation of Laterals•?,Z Ft. 0 "4 A P P OF IN[lUSTRY, LABOR ~;Rpp~~~.] . TIONS i r'JIS10N Of SAFE } TY AND 4~ I~ !6 r 6®,,~ ' RESPOi T E C \ 10 Vjrp'w w ~•~~C~~ y~ PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS PAGE VENT CAP 'i'~C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER /~~c i 25 FROM DOOR, waf+wr~q J WIU00\4 OR -FRESH I2"MILL. J AIR IrjTAKE 1 GRADE I I `I" MIN. • I 150 AIM. CONDUIT-- IB"MIN. fAJI_.k I' PROVIDE vtG AIRTIGHT SEAL I III ` APPROVEC JOINT/ A I I I I APPROVED JOINTS W/C.I. PIPE. LtbO 10 I 11 W C I. PIPE EXTENOINIG 3 ~O ~~~\ONS. I III ALARM EXTENDING 3' ONTO 501.10 Sr1 1 B I I ONTO SOLID SOIL I \,~yGS I C j 1 L 1ti \3\~~~ I I ON Xlk 1 ~EQ P~~ME D\N\S~NO~ PUMP OFF SES CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MAAJUFACTURI<R HAS SUCH APPROVAL SPECIEICATIOUS SEPTIC .AND f~"~ DOSE TANKS MAWUFACTLJRER: 7 264-:4 Jay IJUMBEK Of DOSES: PER DA-4 TAMK :,IZE GALLOIJS DOSE VOLUME ALARM MANUFACTURER: INCLUDING BACKFLOW: GALLONS MODEL NUMBER: ; CAPACITIES: A=_c21 , INCHES OR 3-Y®Q ALLOWS y t- SWITCH TYPE; . ' " B L_INCHES OR GALLONS PUMP MANUFACTURER: C IMGHES OR GALLONS MODEL NUMBER: - - • - Ic?> -,lj~j p. INCHES oRL GALLONS SWITCH TyPc• MOTE: PUMP AND ALARM ARE TO DE PUMP DISCHARVE RATE GPM INSTALLED ON SERRATE CIRCUITS VERTICAL DIFFEKENCIE 6t1 WCEAI PUMP OFF AND DISTRIBUTION PIPE., .2FEET + MINIMUM NETWORK SUPPLY PRESSURE , , , , , . , , , . _ Z.5 FEET r+40 + FEET OF FORCE MAIN X ~F~ Q IooFTFRICTION FACTOR.,,•/Z.L:FEET L oil TOTAL DyAJAMIC HEAD c ,4Z.7 FEET INTERNAL DIMENSIO F TAkJK: LENGTH p _;WIOTH LIQUID DEPTH _..JLL.~ fl~l,rta V CL/ 51GQED: LICENSE NUMBER: - _L L a DATE: '21= ~C luou -117- _ p i Model 3879 Submersible Effluent Pumps 140 "Wx 120 yy 's 3 100 'SrA 0 ~ aL i v 80 d u ~Ay7s C h/P 60 7y~o /Y. 40 wPHos hP _WPM03, 1/3 H.P. 20 WP03, 'h H.P. i 0 20 4C 60 41 80 100 120 Capacity -Gallons PerMlnute r S60,540 HP. Order No. Volts 3L wt PAN A+^Ve RPM Solld& (tbs.) WPQ3TIE Y, WP 03 11$ 9A WP031?E 1750 y6 WPM0312E 230 1m t 7 WPHC II ! WPHM12E 230 7 h 8.0 WPH0532E 208/230 34 60 30 - WPHO534E~460 1.7 WPHO712E 230 10 9.0 WPH0732E 208/230 5.4 30 WPH0734E 460 2.7 WPH1012E 230 im 11.6 315Q k•• 70, 1 WPH1032E 208/230 6.t - WPH1512E 460 3 WPH1512E .2 10 ~ 10 13.3 p~~Vt~ V ck. WPH 1532E 208/230 8 11 30 4.2 lYi WPMt53gE 460 4.6 W11Ht51YE 230 10 13.3 9.2 r 1!1 AUG 121986 WPHP, SPECIPoCATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PLUMBING SEGIIUn 3 IEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS NDUSTR,Y, DIVISION P.O. BOX 7969 UMAN! ANA RELATIONS I PERCOLATION TESTS (115) MADISON WI 3 07 UMAN (1-163.090)* Chapter 145.045) SECTION: T p TOWNSHIP/Mlii~1+6FctITY: OT NO.:BLK. O.: SUBDIVI ION NAME: } /1 " N/11 (or ,OUNTY-z BU 'S NA MA~HNG AD RESS: DATES OBSERVATIONS MADE Na REDRMS., C M IAL DESCRIPTION X4esidence New .Replace I 7 IATING:$- Si+til suitable for system U- Site unsuitable for system PAe-a ROkJND-PR ,OI.J ~ . MS. oU IN GQ S Mu .E: ❑ ~ IBYSTEfW-IN- UL O~DI TANK: RECOMMENDED SYSTEM: (optional) -SI f Percolation Test are NOT requir D SIGN FATE: If any portion of the tested sea is in the inftr %1463.09(5),(b), indicate: Floodplain, indicate Floodplaln elevation: PROFILE DESCRIPTIONS IpRI T AL H fl ATE -INCH CHARACTER F SOIL WITH C NE , GO TEXTURE, 'A AND DEPTH IUMBER EPrH ELEVATION - OBS V D H TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) 3- 3- 3. AUG 1 PERCOLATION TESTS PLUMBING SEC110b DEPTH WATER IN LE TEST TIME DROP IN WATER LEVEL-1 RA tN A ER SWELLING tNTERVAL-MIN. PER INWES P 47 A&Q&eZ .DT PLAN: Show locations of percolation tests, soil borings and the .4tnensions of suitable soli areas. Indicts scats or distances. Describe what are the hori- ntal wW vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent Fland slope. State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE 4'k Wh (`.`DVOL SAFETY & BUILDINGS DIVISION ~ 1gy~~•~FQ o , C.a,l.'.?.,~ ?.iDt~l;.l~;._ I: ~~6' itiL. ~~r !i' ~'.;-3i.G P -N .,G„ ~:?.t.t,i':rl,;,'.k.t, pr tL~T •W~,! ~ s S :r.,.:n! z o'}r - '.I. ~ `t, t i r' t,.r.G.'~ t. 4: t .4: t _ +.i?,_ i. L'... i' ! ! l t~ t w ~ ,`.t .i <<~ ''.3!'• r.?1;~(;'. :r~ :rtlt it i .s , { A ! 'q "A ....i _ t ! r ! s arxrl i 1"_ i. F:,'ctilJ t.i L..f, .J tli ~ "1 lr - f r Alit ~a , . • r Cl s. r <a i• i. I'd f::, .f r ( c. r;~ i t~, F.)1' t!%$~ i~r;,{~. . s ...}Lva:t"-l r,e~a ,1: ._i'~ ..1 qiA Fc 1 1:t ,i. L,. i,:Ji1., e, } :."ii'!(., v ( i ~ llait. 1, d t .%[V re ES~,'e~.i 1'iaw R C~F'i NR-SBD-6423 (N. 04/81) _ ST. CROIX COUNTY WISCONSIN ZONING OFFICE R'"$ a 796-2239 (HAMMOND) r ~ rya', . r F 425-8363 (RIVER FALLS) HAMMOND, WI 54015 July 29, 1986 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Pat Moore property, located at the SW1/4 of the SE1/4 of Section 30, T30N-R317W, Town of Erin Prairie, revealed suitable soils at a depth of 18 inches, 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 ' 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 ( N1111P SW ;4 SE34 S 30 T 30 N/R 17 ZW W Erin Prairie St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Pat Moore Rt. 1, Box 181, 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 agree 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: r WISCONSIN DEPARTMENT OF INDUSTRY9 LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location SW 1/4, SE 1/4, Sec. 30 T 3o N, R 17 #x W Town xr~t om i rac111 Erin Prairie Street Address Lot No. , Block Subdivision Landowner's Name:, Pat Moore The application for this site is for: ❑ new construction use. 0 replacement 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 year. This is number - - of those applications. (Use one of the first five quota num3ers issueU-Fo you.) 1. 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. L for an application on file prior to February 1, 1980. (_]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: ® 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 geff re (County Official) Title Assistant Zoning Administrator Date July 29, 1986 DILHR-SBD-6158 (R 12/82) Parcel 012-1065-60-100 09/28/2005 04:50 PM PAGE 1 OF 1 Alt. Parcel 30.30.17.4628-10 012 - 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 O - MCCARTY, MICHAEL & JENNIFER L MICHAEL & JENNIFER L MCCARTY 1562 130TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1562 130TH AVE SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 3.544 Plat: 3985-CSM 14/3985 SEC 30 T30N R1 7W PT SW SE BEING CSM Block/Condo Bldg: LOT 1 14/3985 LOT 1 3.544AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 30-30N-17W SW SE Notes: Parcel History: Date Doc # Vol/Page Type 09/23/2002 691508 1987/294 WD 03/01/2001 639484 1593/531 WD 11/23/1999 614391 1473/398 WD 07/23/1997 1157/363D 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/08/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.544 9,500 103,900 113,400 NO Totals for 2005: General Property 3.544 9,500 103,900 113,400 Woodland 0.000 0 0 Totals for 2004: General Property 3.544 9,500 103,900 113,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 554 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 MOORE, `PAT ~SW SE,~ ec ion 0~6 ~ Rr.. 1 T 30N-R17W New Richmond, WI 54017 Town of Erin Prairie San.Permit#83867 - 9-16-86 C. Powers Mound, Replacement nstalled: 7-25-86 Lori CA ►u~~~ - 3 1 5 ISNOV URVEYO R°S RECORD 63~SG'~ CERTIFIED SURVEY MAP Derick and Julie White Located in part of the Southwest %4 of the Southeast Y4 of Section 30, Township 30 North, Range 17 West, Town of Erin Prairie, St. Croix County, Wisconsin. OWNERS ADDRESS p 2 1562130th AVENUE OCR _ NEW RICHMOND, W/ 54017 LEGEND 1i THE N SOUTH ~G~~o T 1 0 1" x 24" IRON PIPE SET SECTION 30, T 30 N, R 17 W, (MIN. WT. -1.13 LBJ NV. FT.) ASSUAEDAS S 90'00'00" E. o SOIL BORINGS (PROPOSED SEPTIC SYSTEM) SECTION CORNER MONUMENT (AS NOTED) SCALE IN FEET 1' m 200' 160 50 160 20 30 40 I g,g Q~ Z; ZI UNPLATTED _ LANDS yl y' ~l 90000'00" C LOT I e 35os J - OT 154,368 SQ. FT 026A R 3.544 AC. a LOT 2 a~ (140,525 SQ. FT. OR 3 2C EXCLUDING $ 129,026 SQ. FT. OR ch TOWN ROAD RIGHT OF WA10 _ (117,456 SQ. FT OR S; w $ GARAGEQ EXCLi 0 WWN~-ftu 13 8U SETBACK LDW g DNELLING rt DRIVEWAY SOU TH 114 CORNER SECTION30, SE CORNER SECTION30, T 30 N, R 17 W (CORNER Z -N 90.00'00" 770.09'- T 3D N, R 17 W (FOUND RE-ESTABLOED FROM TIES BER OSEN ALUMMU x419.48' 350.61' Nh AS 90VOIDO'E 572.38' ?o 33.00' 419.48' 350.61' 1342.47 -N 90°00'00" 770.09' + AVENUE s 9oroo~oo• E - _ , ` SOUTHWW 1130M AVENUE - - - - - - - - - - - - - -SW W0'E 2684.94' UNPLAITED LANDS 3 REVISED THIS 19TH DAY APPROVED O ST.CROIXCOUNTY OF OCTOBER, 2000. Planning Zoninq and Parks Committee ()CT 3 0 2000 w THIS INSTRUMENT DRAFTED BYJERALD L CARSON a not recorded within 30 days of SHEET 10F 2 approval date approval shall be null and void Vol. 14 Page 3985 Parcel 012-1065-60-000 10/03/2005 07:56 AM PAGE 1 OF 1 Alt. Parcel 30.30.17.462B 012 - TOWN OF ERIN PRAIRIE Current K 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 - WHITE, DERICK J & JULIE M DERICK J & JULIE M WHITE 1562 130TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 6.500 Plat: N/A-NOT AVAILABLE SEC 30 T30N R1 7W 6.5 AC E 770 FT OF S Block/Condo Bldg: 368 FT OF SW SE NKA CSM 14/3985 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 30-30N-17W SW SE Notes: Parcel History: Date Doc # Vol/Page Type 11/23/1999 614391 1473/398 WD 07/23/1997 1157/363 WD 07/23/1997 727/103 07/23/1997 468/302 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/06/2000 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 012-1065-60-100 10/03/2005 07:56 AM PAGE 1 OF 1 Alt. Parcel 30.30.17.4628-10 012 - 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 O - MCCARTY, MICHAEL & JENNIFER L MICHAEL & JENNIFER L MCCARTY 1562 130TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1562 130TH AVE SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 3.544 Plat: 3985-CSM 14/3985 SEC 30 T30N R17W PT SW SE BEING CSM Block/Condo Bldg: LOT 1 14/3985 LOT 1 3.544AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 30-30N-17W SW SE Notes: Parcel History: Date Doc # Vol/Page Type 09/23/2002 691508 1987/294 WD 03/01/2001 639484 1593/531 WD 11/23/1999 614391 1473/398 WD 07/23/1997 1157/363 ..D 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/08/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.544 9,500 103,900 113,400 NO Totals for 2005: General Property 3.544 9,500 103,900 113,400 Woodland 0.000 0 0 Totals for 2004: General Property 3.544 9,500 103,900 113,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 554 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 SEC. T N-R4W ADDRESS ~0j ST. CROIX COUNTY, WISCONSIN -704 44=0 x,117 SUBDIVISION v Z, LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM WA44 3r;G' a, ~ /rlauaA icy `V BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: fi~P2D ` Proposed slope at site: " SEPTIC TANK: Manufacturer: -Liquid Capacity: A / Number of rings used: _,s Tank manhole cover elevation: 93 5' Tank Inlet Elevation: Tank Outlet Elevations Number of feet from nearest Road: Front 10 Side M Rear, O LS~ feet From nearest property line Front, 0 Side, Rear, o /ag feet Number of feet from: well building:_ (Include this information of the above plot plan)( 2 reference dimensions to se7:A' SEE REVERSE SIDE r. PUMP CHAMBER ' Liquid Capacity: Gl1Manufacturer:~ Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: ,lZ Alarm Manufacturer: <Z_1 I, 4 Alarm Switch Type: ~~~°--~~Y~'`✓~~ / Number of feet from nearest property line: Front, O Side, Rear, 0 Ft. Number of feet from well:y/Number of feet from building: y (.Include distances on plot plan). 0 SOIL ABSORPTION SYSTEM /WOaO Bed: Trench: Width: Length: Number of Lines:-l- Area Built:. Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, ® Rear,0 Pt.l Number of feet from well: 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, 0Ft. 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 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR a HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7989 MADISON, WI 53707 BUREAU OF PLUMBING ❑CONVENTIONAL R ALTERNATIVE Z86 n I.D. Number: ed) Holding Tank ❑ In-Ground Pressure 93Mound 106 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION D T : Pat Moore Rt. it New Richmond, WI 54017 -')'s.--- BENCHMARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV. SW SE, Section 30, T30N-R17W, Town of Erin Prairie Name of Plumber MP/MPRSW No. Cou.ny. Sanitary Permit Number: Cal Powers 1563 St. Croix 83867 SEPTIC TANK/HOLDING TANK: [MANU A LIOUIO CAPACITY TANK INLET ELEVT ELEVWARNING LAB L LOCK ING COVER ^ PROVIDEDPROVIDED /00 1 /IV/ ;XXES ONO DYES ONO DDING: VENT DIA. IVENTMATI HIGH WATER IN W ROAD. PROPERTY' ELL BUILDINGVENT TO F ALARM H INE W AIR INLET YES ONO YES ONO EAREST D470 C' < , OSING CHAMBER: MA ACT URER BEOUING JLIOUIO CAPACI Iv PI1MP MOUE l PUMP. SIPHON MANUI AC IIIHE WARNING LABEL LOCKING COVER PROVIDED PROVIDED MYES ONO (7U2- OYES ONO DYES ONO GALLONS PER CYULt: PUMP AND CONTROLS OPERATIONAL NUMBER OF 1 LE PROPE Hry WELL BUILOt N<i V NT TO FRESH (DIFFERENCE BETWEEN / FEET FROM LINE/ / AIR PUMP ON AND OFF) /75, EVES ONO NEAREST---~ ` 6 (a ✓ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing L FORCE I t N( T" UTAR9F TE H INIATI HIAL AND MAHKIN(1 Or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) MAIN SS "7` CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF UISIR PIPE SPA(:W(, COVFH INSII:L I)IA =PITS LIOUID DIMENSIONS TRENCHES MATERIAL PIT DEPTH AV EL FILL DEPTH UlSllt PIPF rS1 iH PIPE DISTR. PIPE MATERIAL NO DISTR :NUMBER OF PROPERTY WELL BUILDING V NT TO FRESH PTH BE LOW PIPES ABOVE COVEI V EN U vIPfS L INE RE I FV I NL1 AIR INLET FEET FROM NEAREST--im. 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 NO meets the criteria for medium sand. TIONS MEASURED. O IL COVER T xTURF PI RMANI NI MAHKr IIS JIMSEE4VATION WELLS YES ONO .=YES NO DEPTH OVER THE NCI/ BED DEPTH OVER THENCE/ BEU ]1,111111111 1(/PSO S(IUDI I) Sf I D1O MULCHED CENTER /I EOfiES f DYES. NO YES 11 No YES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGT/I NO OF LATERAL SPACING (;RAVEL DEPTH III LOW PIPE FILL DEPTH ABOVE COVER 3 J TRENCHES / DIMENSIONS /(..O 3 s / / 1"1,5 MANIFOLD Pump MANIT OLO DISTR. PIPE MANIFOLD MAT TRIAL NO UISTR UISTR PIPE UISTHIBUI ION PIPE MATERIAL&MARKING ELEVATION AN E v9 ELIy T DA ( P S DIA DISTRIBUTION / INFORMATION >HOLE SIZE HOLE SPACING URILLEUCOHHFCILY 1COVIRMATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED 2 ' L PLANS 7 YES ONO EWES ONO` COMMENTS: PERMANENT MARKERS OBSERVATION WELLS. NUMBER OF PROPERTY WELL BUILDING FEET FROM / YES ONO EWES ONO NEAREST LI Sketch System on Retain i county file for audit. Reverse Side. SIGNATURE: ~ TITLE DILHR SBD 6710 (R. 01/82) 7 DILHR SANITARY PERMIT APPLICATION COUNT In accord with ILHR 83.05, Wis. Adm. Code no~t STATE SANITARY PERMIT # 93Y46 7 -Attach complete plans to the coup co only) for the system, on not less than ( county PY paper STATE PLAN I.D. NUMBER 8%x 11 inches in size. 1o--6510G S -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ NO PRO TY OWNER PROPERTY LOCATION '/4,S T ,N,R 17 E(or PR TY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME Cl ST TE ZIP CODE PHONE NUMBER CITY NEAREST 13nAn LAKE OR LANDMARK L2- _,!VeA 'rr%%AIKI n VILLAGE : rS/ II. TYPE OF BUILDING OR USE SERVED: Q La - !O C~~` Number of Bedrooms if 1 or 2 Family _ OR Public (Specify): 111. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. ❑ New b. CK Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing 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. 9 Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. ® seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 96 Feet 19Private ❑ Joint ❑ Public CAPACITY VI. TANK Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete structed glass App. Tanks Tanks Se tic Tank or Holding Tank )00,0 El Lift Pump Tank/Si hon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. n2b Plu er's Name (Print): Plumber's Si re: Stamps) MP/MPRSW No.: Business Phone Number: dl-La~j Plum s Address Street, City tale, Zip Code): ame of Designee VIII. SOIL TEST INFORMATION CerY d Soi Tester (C Name CST # CST' D RE S (Str et, City, St Zip Code) Phone Number: /-5 IX. COUNTY DEPART ENT USE ONLY X❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature o Stamps) Approved ❑ Owner Given Initial Surcharge Fee q14. 0 Adverse Determination 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 wheC'ever.necesSary; usually very to 3 years; 6. 1f you have questions concerning your private sewage systern, 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 owners 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; 111. 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; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'h 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 result of over 2 years of steady negotiation and public debate. The groundwater bill Crourtdwater included the creation of surcharges (fees) for a number of regulated practices which wiscor4in's a an effect grr_.un(leater. The surcharge took effect on July 1, 1984 All of the w,~ter tha buried ~reasu're used in your build ng is returned to the groundwater through your soil ct sorption system or the disposal site used by j6ur holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adn- inis- t.rec by the Department of Natural Rasources. These funds are used for monitoring c o,1nd- ~ meter, groundwater contamination in estigations and establishment of standards. Grcurduvater, mirth protecting. 'R.03/86) DEPARTMENT ° REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (H63.09(1) & Chapter 145.046) T WNSHiPlML*4G+FLALITy: OT NO.: BLK O.: ION NAME: E; /T N/R llor MA/ C TY ER A A N A SS: r ` DATES OBSERVATIONS MADE NO. BE OMM IAL E P IO k, DES R: JPROFFLE PROFILE C IPTIONS S esidence New Replace _ Al 1P RA NG; S Sits suitable for system U- Site u►xuitable fqr aystam l EN' AL: MOLND: IN-GROUND-PRESS : S S - N-FILL Q ! TANK: RECOMMEND SY$TEM:(optional) SU (~1S ❑U ❑S CCU . DS f~]U QS U If Per.:olation Tests are NOT require DESI N RAT If any portion of the tested area is in the under s.H63.09(5) (b) , indicate: ' Floodplain, indicate Floodplain elevation: i PROFILE DESCRIPTIONS NG TOTAL LEVATION T ROUND T R- HES ARACTER OF SOIL WITH THI K SS, COO R, X . RE; AND DEPTH i DEPTH p4, f OI3SERV D jlkiKEST TO BEDROCK IF OBSER EQK(SEE ABBRV•,ON BACK.} "k PERCOLATION TESTS 1 P H WATER N HOLE TEST TIME H AFTER MELLIN INT RVAL-MIN. PE 0 1 R PER INCH P. z 'a A,7 J~ -F t t 72. PLANS, Show tlocations of percolation testa, soil borings and the dimensions of, suitable soil areas. file or distances. Describe vet ar¢ t(ae - and vertical ellhtation reference points and show their location oR the plot plan. Show the surfa W of all borings and the direAon arJd" air 31009. Y -11~k'I T M ELEVATION ll 'f IT- ( f7 3` I l a ' --T IW4 ~ ~y l i r I~ i F I r { J I «w I I v 4 { WI s I '---d.......... _ _ _ _ ..f T 1 f { 4 ~ - _ ILI 1, tOe undersigned, hereby certify that the soil tests reported on this form were made by me In accord with,the procedures and methods specified in the Wisconsin Adtxiinistrative Code, and that the data recorded and the location of the tests are correct to the best of my kn6wiedge and belief. E rin TEST ERE MPi.E, O ON: R ER fICATIAN NIMABER: PHONE N R( G `IBI,II)ON: Original and one copy to Local Authority, Property Owner and Soil Tester. 38136355 (0.0212) OVER 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - i rn^ Owner of Property Q J/ Location of Property -LO It ' Section 6 T 3 o N-R/7 W Township (Jw~%.. a ,c~-"z Mailing Address ( Address of Site F Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel ~q A CAA-t-4--i Date Parcel was Created Are all corners and lot lines identifiable? ~Q 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 APPLICAT HE FOLLOWING: A Warranty Deed w ich includesia'Document number, olume and page number, and the Seal o e egister of Deeds. In 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) eenti 4y that att statements on this 4orcm cute tAue to the beat o6 my (ou,%) knowledge; that I (we) am (ahe) the owneA (.6) o4 the pno pW y des c i,b ed in this .i.ngohmati,on 6,otm, by viAtue o4 a waAAanty deed neconded in the 044ice o4 the County RegisteA o6 Deeds as Document No. 36-35aS ; and that I (We) pnesentty own the pnopos ed site bon the sewage d igs po.s d ys em (on I (we) have obtained an easement, to nun with the above des n bed pnopeh ty, 4an the constnuc ti.on o6 said .syetem, and the same has been duty neconded in the 046ice o6 the County RegisteA o6 Deeds, as Document No. r . ` ~/6 SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)' DATE SIGNED DATE SIGNED ° r-~ Z ro H a STC - 105 r' r a SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County Z Z d OWNER/BUYER -.(9-,csvti.e y ROUTE/BOX NUMBER k( J~ X t / Fire Number -E /0'72- .CITY/STATE Z I P 5'(/o 17 PROPERTY LOCATION: W , S E Section 3 O T 90 N, R 17 W, C0.s A Town of GI!L 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- 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. 0 E I/WE, the undersigned, have read the above requirements and agree N 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. SIGN E 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. State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL SAFETY & BUILDINGS DIVISION Bureau of Plumbing 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 CALVIN POWERS, JR. RE: Plan Number: 86-05106-S ROUTE 3 Gallons Per Day: 450 NEW RICHMOND Date Approved: August 19, 1986 WT 54017 - Date Received: 8/12/86 Project Name: MOORE, PAT - RESIDENCE Location: SW,SE,30,30,17W Town of ERIN PRAIRIE County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - REPL MOUND Inquiries concerning this approval may be made by calling (608) 266-9374. Sincerely, I• ANTHONY T. FEDIERSPILL Bureau of Plumbing Safety and Buildings Division PPP022/0009w/32 cc: Private Sewage Consultant County UW-SSWMP Plumbing Consultant Owner Plumber Environmental Health I LHR-SBD-6423 (N. 04/81) STATE OF WISCONSIN D1LHR 4Ro PRIVATE SEWAGE SYSTEMS DIVISION OF SAFETY BUILDINGS ."~C9YRIL BUREAU OF PLUMBING G 201 E. Washington Avenue, Rm 141 PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707 608.266-3815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The bark side of this form describes required plan information. Plumbing codes can be purchased from the Department of Administration, Document Sales, 202 South Thornton Ave., Madison, Wisconsin 53703, Telephone (608) 266-3358. CT INFOR A TI ON Type or print clearly) Revision To Plan Number. 60 5 -1 Sabmittiny P ty (Plans returned to same) Projec ame Stre & No. or Rural Route Project Location !Street & No. or Legal Description City or Village State zip city 0 % county Village O OF: 1 J Town 09 llephone No. (Inclu area code) Designer Telephone No. (include area code) Own Name Telephone No. (Include area eiwM1 SbeetI No. Stree No. eft or Vi State zip City or 'Village , r rate zip hlwt AU- -146/ Z t APPLICATION FOR; ❑ New Mound System (3a) a Groundwater Monitoring (7) © Conventional System - Public Buildinq (1) ® Replacement Mound (4a) ❑ Holding Tank (2) .0 Replacement Pressurized System (4b) ❑ System in Fill (1) - ❑ Petition For Modification (6) New Pressurized System (3b) Cl System in Flood Fringe (1) ❑ Other Alternatives (6) 3 fEE COMPUTATIONS (Include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO DILHR 3a. 750 - 1,500 gallon septic tank -r Q 4a -5~ 3b. 1,501 2,500 gallon septic tank - 60.00 4b. , 3c. 2,501 5,000 gallon septic tank - 80.00 4c. 3d. 5,001 9,000 gallon septic tank 100.00 4d. 3e. 9,001 - 10,000 gallon s ,ptic tank. r - 150.00 4e. 3f. Over 15,000 gallon sep:.ic tank -250.00 4f. 3g• 500 - 1,000 gallon dose chamber 49 Sh. 1,001 2,000 gallon dose chamber - 50.00 4h. 3i. 2,001 - 4,000 gallon dose ' chamber - 70.00 4i. -3j. 4,001 - 8,000 gallon dose chamber - 90.00 4j. .3k. 8,001 12,000 gallon dose chamber -110.00 4k. 31. Over 12,000 gallon dose chamber -150.00 41. 3m. 500 . 5,OQ0 gallon holding tank - 30.00 4m. 3n. 5,001 - 10,000 gallon holding tank - 55.00 4n. 3a. Over 10,000 gallon holding tank 100.00 4o. 3p. Revisions - 20.00 4p. 3q. Groundwater Monitoring Per Lot - 32.00 4q. (other thanra proposed subdivision) Subtotal nc. 3r. Priority plan review: walk through) 4r. R Submittal of plans in person, AUG ± by appointment, with double fee 1~ , 1996 3s. Petition for Variance Setback - 25.00 4s. PLUMBING, SEA; toiv t Site evaluation - 50.00 Total Fee 8o Note: Fees pursuant to Wis. Adm. Code, Chapter Ind. 69 DILHRSHD$748 (R. 03/84)- may be subject to change annually Effective July 1, 1984 -OVER STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS y DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township XJWU919X1V#1 SW 141. SE 14 S 30 T 30 N/R 17 M WW Erin Prairie St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Pat-Moore Rt. 1, Box 181, 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 re to have the system installed in conformance with_the >kureauis approval of plans and specifications. I further understand that an alternative system is more complex in nature than 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. RE(;ti Vt:u The Bureau accepts this application subject to this understanding and su ~~ppttt to all the conditions and obligations set out in this application. 12 1986 R X10510 3tumBifti swion G1 ^Y- C 7- 3 t Xy Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF St. Croix This 31st day of July 19 SfL Notary Public, State of Wisconsin DILHR-SBD-6413 (N. 05/$1) My Commission Expires: 5/20/89 ST. CR'OIX COUNTY WISCONSIN ' ZONING OFFICE 798-2239 (HAMMOND) 426-8383 (FOYER FALLS) HAMMOND, WI 64016 July 29 1986 Division of Safety and Building Bureau of Plumbing P 0, Box 7969 Madison> WI 53707 Dear Sir: 1 An on-site investigation for the Pat Moore property, located at the SW1/4 of the SE1/4 of Section 30, T30N-R317W, 'town of 8rin Prairie, revealed suitable soils at a depth of 18 inches, below which-seasonable high ground water was noted. This site should be suitable for a mound system. Should you have ariy questions, please feel free to-con,tact this office. Sincerely, r- Thomas C. Nelson Assistant, Zoning Adm~nistratoz TCN/mj 86061 06 RE~twcu I AUG 12 *6 PLUMBING SECI10 WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location sw 1/4, SE 1/4, Sec. 30 T 3o N, R 17 W Townx~ Erin Prairie Street Address Lot No. Block Subdivision Landowner's Name: Pat Moore The 46011eation for this site is for: a. Q new construction use. [~]replaceflent system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: L 1 to have one of the first five approvals guaranteed for this year. This is a number - - of those applications. (Use one of the first five quota num ers7ssueTT5 you. ) lone of the applications needing a quota number. The quota number assigned to 3 this application is - - ❑ for one additiorral homesite on a farm to he occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. [.1for 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. [A 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 ~J 05,E ®>a failing conventional soil absorption system. 06 0 a holding tank that was installed and in use prior to February 19 198 WEGtIVGv 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 ANG12 196 conventional private sewage system, check here. 0 PLUMBIhS SECTIOh- I certify that the above information is true and accurate to the best of my, knowledge. Nave Thomas C. Nelson Sigmt re (County Official) Title Assistant Zoning Administrator Date July 29, 1986 DILHR-SBD-6158 (R 12/82) WORKSHEET - MOUND SYSTEM DESIGN N ~ c.f/i»aa,o hi„~Sf~oiJ PROBLEM: Oe$,#94 a mound system for a The site characteristics are Depth to groundwater or bedrock _ in. Landsl ope ~x Percolation rate _R6 min./in. Distance from dose chAmbe`r to distribution system, Elevation difference between pump and .distrib~ systa'm Am& Step 1. WASTEWATER LOADp Step»2. SIZE THE ABSORPTION AREA 1 A) 1fea required •D,~; .f4Ir I M sq• ft. B) Bed or trench. length (B) C) Bled or trench width (A) D) Trench spacing (C) g Wastewater ad .24 gal/ft2/day g renc Z, 9.0 Step 3.. MOUND 'HEIGHT ✓ 6Q, A) Fill depth (D) B) Fill depth (E) s 0 + % slope ()Ps) ► ~ ft. ) Bed or-trench depth (F) ft tly ~ /SG3 D) Cap and topsoil depth (G) a *t, ft. a' b~G E) Cap and topsoil depth (H) _ ra I ft. P1.U Step 4. MOUND LENGTH A) End slope (K) = D+E'\+F+H X3= B) Total mound length (L)✓= B + 2(K = J f ~ ~ ~~~aGGft ft • 5 3 Step 5. MOUND WIDTH ~~~✓j Al) Upslope correction factor = A2) Upslope width (J) = (D + F + G)(3)(factor) q ft. BI) Downslope correct o~ 9T~ i factor B2)'Downsl ''aidth`(I) - (E + F + G)(3)(factor) Cl) Total mound .width (W) for bed = J + A + I = ^w foe '4z14 ft. ATA~#/,W4 P~ C2) Total mound width (W) for trenches = J + A + (no. trenches -1)(c) + A + I Step 6• BASAL AREA A) Infiltrative capacity of natural soi gal./ft3/day B) Basal area required it wastewater flow dfA) AOo) 1S natural soil infiltrativ capacity s. ft. Cl) Basal area available for bed for sloping sites = ? B x A s9. ft. C2) Basa area avail le for trench for sloping sites BX h1 4_/ +A) 9 = CC3 ) Basal area available for trench or bed for level ftutsites = B x w = sq. ft. AUG 1219 160 PLUMBING ~,<'.5,~ t~ St. Croix County Planning and Zoning Tuesday, October 09, 2007 at 8:34:41 AM Detail Sanitary Information Page 1 of l Computer 012-1065-60-100 Sub/Plat: NA Section: 30 Parcel 30.30.17.4621310 Lot: 1 TN/RNG: T30N R17W Municipality: Erin Prairie, Town of CSM: Vol. 14 Pg. 3935 1/41/4: SW 1/4 SE 1/4 Owner: Moore, Patricia M. 1562130th Avenue New Richmond, WI 54017 State Permit: 83867 Issued: 09/16/1986 POWTS Dispersal: Mound less than 24" suitable s Permit: Replacement County Permit: 0 Installed: 07/25/1986 POWTS Detail: NA Bedrooms: 3 WI Fund: yes POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Mary Jenkins Yes Powers, Calvin find permit paperwork in archives 2-trench mound system with 1000 gal. Powers $0.00 Tom Nelson " ' f: Yes septic tank to 610 gal. Powers dose tank to 2 - aft. X 73' Cells inside. Attached notecard to file - permit missing from original folder, which has data on it from inspection. WI fund file had complete copy of permit and record of $3000 award Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/25/1989 11/6/2005 04/01/2005 11/6/2008 A Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ,4jj..f- TOWNSHIP c SEC. T CZ_ Q N_RZ;7_W ADDRESS ST. CROIX COUNTY, WISCONSIN ;,7 SUBDIVISION LOT LOT SIZE , PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 01f14 3 db w~~ tlof PAC -mil 4 BENCHMARK; Describe the vertical reference point used Elevation of vertical reference point: Iny"y ` Proposed slope at site: SEPTIC TANK; Manufacturer: dQ /_Liquid Capacity: / Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: y q - Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side M Rear O _ feet From nearest property line Front Side kV/VN -3P1 feet Number of feet from: well building: (Include this information of the above plot plan)( ~ 2 reference dimencinna to cant' PUMP' CHAMBER Manufacturer: - a.,27:L-Is Liquid Capacity: A - Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: 27 ,31.1 Bottom of tank elevation: "./00 Pump off switch elevation: Gallons per cycle: Z Alarm Manufacturer: 'y~~ c~,Alarm Switch Type: Number of feet from nearest property line: Front, O Side, Rear, 0 Ft. Number of feet from well:/ Number of feet from building: 1 (Include distances on plot plan). SOIL ABSOVYTION SYSTEM AVO"6 Bed: Trench: Width: Length: Number of Lines: Area Built: ? 7$~- i Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear,0 Pt.LLUL Number of feet from well: _ ~ _ 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: ~D2 ="V" =1Z License Number : 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR -LABOR & HUMAN RELATIONS SAFETY III BUILDINGS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 63707 BUREAU OF PLUMBING ❑CONVENTIONAL ERALTERNATIVE 7.6. P Holding fisrtk ❑ In•Ground PreSture Mound ,dl 106 NAME :13F PERMIT HOLDER: ADDRESS Of PERMIT HOLDER: Pat Moore INSPECTION DATE: Rt. 1, New Richmond, WI 54017 CH MARK IPeratanml relerenee point) DESCRIBE ~11.IFFIF~RliilT FROM PLAN SW SE, Section 30, T30N-R17W, Town of Erin Prairie :REF. PT. ELEV.: STREI, PT.ELEV Name n( Plumbe. MP/MPRSW Nn co-ty Cal Powers Ss bury Pe.m.1 Number: 1563 St. Croix 83867 SEPTIC TANK/HOLDING TANK: MANUFACTU U O CAPACITY TANK INLET ELEV TANKOUTLEI ELEV WARNING LAB PROVIDED LOCKINGCOVER 7 11 ^ PROVIDED , DDING. VENT DIA VENT MATT HI(i11 WA H / ' al /K YES ❑NQ ❑YES ❑INQ 1 j AIARM NUMBER OF ROAD PROPERTY WELL UILOING VENT TOFq N YES ❑NO rr-(t FEET FROM LINE AIR INLET t,[~YES ❑NO NEAREST DOSING CHAMBER: MA / ACTURFn BEOUING 1-101111, (:APA(a IY PUMP MrIUf 1 PUMP. S1PDoN MANUI A(5 1 lilt p n WARNING LABEL LOCKING COVER f YES ❑NO ~Y 9 v PROVIDED PROVIDED GALLONS PER CYC PUMP AND CONTROLSOPERATIONAL ❑YES ❑NO ❑YES ❑NO (DIFFERENCE BETWEEN / NUMBER OF PHOPE H/TV WELL BUILDING 1 N roF E 11 PUMP ON AND OFF) FEET FROM LINE t✓ AIR 1 LEJ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth ofplowing❑NO NI I N6 Ill EAREST-MIA 1E1! MAIfH1AIgNUMgNKINE. or excavation. (If soil can be rolled into a wire, Construction shall cease until FORCE the soil is dry enough to continue.) MAIN NVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO Of UISTH -Vt SPA(.INt. COV H DIMENSIONS T14FNC14S MATLHIAIt JS1Ul In4 spIIS LIOUID IT DEPTH ^VFL H ILLCE TH IIISIH P11•f DISTH PIPE BELOW PIPES BUVE COVER II IV IN(f 1 ELEV I.NU OISTq. PI MAT RIAL Nn DIS I11 NUMBER OF PHOPE TV WELL BUILDING V NT TO FRESH v1Pt S FEET FROM LINE AIR INLET NEAREST UND SYSTEM: - - Mound site plowed perpendicular to slope and furrows thrown upslope: Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- YES ❑NO meets the criteria for medium sand. TIONS MEASURED. 1 COVER TEXTURE PI HNAN1 N 1 111A1IK 1 HS OUSf 11 V A 111 IN WE LlS PTH OVER TRENCH RFD DEPTH OVIH TH NCII HF1) YES ❑NO 2JYES ❑NO ENTER S EDGES UI {•Tn fit TIU•SE ryy ti(,UIHO SFIUFn S M,U~ILC//ME O PRESSURIZED DISTRIBUTION SYSTEM: I ❑YES. NO YES ❑NO Ld7YE5 ❑NO BED/TRENCH WIDTH Ft N(.iH HOOF LATE{IAI SPACING (,HAVfI UfPUI HF (/-Tiw VIP(-- DIMENSIONS 3 3 TRENCHES FILL DEPTH ABOVE COV H MANYOLD PUMP / v • ' ~y MANIF O7LU UISiR PIPE MANIE UID MATE. H1Al N1 blSllt 1,1.1111 PIV / ELEVATION AN E V FLQ~ DIA S E DIA/~ Ilisi HIHI/ ION PIPE MATERIAL 6 MARKING 9 L DISTRIBUTION INFORMATION HOLEsize NOLESPACINE. )Fi1L1tocg,11fCI(Y 1 COVER AA tEH1AL VERTIf.AI OF CORRE SPONDS TO APPgUYEO 2 PLANS COMMENTS: ERMANENTMARK RS YES ❑ OBSERVATION WELLS NUMBER OF PROOPERTY WELL eU1LGO11NG YES ❑NO CTC'ES [JNO NFEET EAREST TM L2 so Sketch System on Reverse Side. Retain i county file for audit. SIGNATURE TITIf OILHR SBO 6710 (R. 01/82) 1