HomeMy WebLinkAbout038-1031-80-000
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Parcel 038-1031-80-000 02/03/2006 08:02 AM
PAGE 1 OF 1
Alt. Parcel M 8.31.18.144C 038 - TOWN OF STAR PRAIRIE
Current X' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
THOMAS C & CHARLENE A PETERSON O - PETERSON, THOMAS C & CHARLENE A
2257 95TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 2257 95TH ST
SC 3962 NEW RICHMOND
SP 8050 SQUAW LAKE RHAB & MANAGE
SP 1700 WITC
Legal Description: Acres: 6.180 Plat: N/A-NOT AVAILABLE
SEC 8 T31 N R18W 6.180A IN SW NE LOT 4 OF Block/Condo Bldg:
CSM IN VOL I PAGE 150 ALSO INCLUDES
INTEREST IN 144E AS DESC IN 514/589-591 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
08-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
03/24/1999 599963 1413/99 WD
07/23/1997 1154/75 WD
07/23/1997 1136/544 WD
07/23/1997 1088/196 QC
2005 SUMMARY Bill Fair Market Value: Assessed with:
118783 292,600
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 6.180 97,400 190,200 287,600 NO
Totals for 2005:
General Property 6.180 97,400 190,200 287,600
Woodland 0.000 0 0
Totals for 2004:
General Property 6.180 97,400 190,200 287,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 133
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
-Parcel 038-1032-10-100 02/03/2006 08:03 AM
PAGE 1OF1
Alt. Parcel 8.31.18.144E 038 - TOWN OF STAR PRAIRIE
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
ROAD O - ROAD
X
X 00000
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE
SEC 8 T31 N R18W W1/2 NE1/4 & E1/2 OF Block/Condo Bldg:
SW1/4 THE PRIVATE ROAD WAY AS DESC IN
VOL 640/ 544 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
08-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed:
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
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 XMLTERNATIVE State Plan I.D. Number:
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If 8 ass nee)
8b-08827
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER:
INSPECTIO ATE:
Terry Tuma Rt. 1, Somerset, WI 54025 (p`a
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN:
REF. PT. ELEV.: CST REF. PT. ELEV.:
SW NE, Section 8, T31N-R18W, Town of Star Prairie
Name of Plumber: MP/MPRSW No.:
County: Sanitary Permit Number:
Gar Steel 3254 St. Croix 88451
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL
~xy PROVIDED: LOCKINGCOVER
O , 9, PROVIDED:
BEDDING: VENT DIA.: VENTMATL.HIGH WATER ~ WYES ❑NO 1~4YES ❑NO
ALARM: UMBER OF ROAD: PROPERTY WELL: BUILDING. Y ❑ YS
EETFROM IAIR INLET
❑ NO NEAREST p~,~ ~ 3U ~ ~ 5 ~ Z ~ f
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID/C\)APACITY. PUMP MODEL: iL PUM SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER _
❑YES ❑NO v~ W~D~I ~'1 M (I PROVIDED: PROVIDED:
GALLONS PER CYCLE: P P ND CONTROLS OPERATIONAL: (J(A~~7+ ❑YES ❑NO ❑YES ❑NO
(DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BUILDING VENTTOFRESH
PUMP ON AND OFF) FEET FROM LINE AIR INLET
❑YES ❑NO NEAREST ?6 rs 5' E '
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH JDIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until
FORCE
I
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO.OF DISTR. PIPE SPACING COVER
TRENCHES. MATERIAL: A&FjLDING LIQUID
DIMENSIONS DEPTH
GRAVEL DEPTH FILL DEPTH UISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NODISTR.
BELOW PIPESABOVE COVERELEVINLETELEV. END: ILDING. V NT TO FRESH
PIPESAIR INLET.
MOUNDSYSTEM:
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.
SOIL COVER TEXTURE.
PERMANENT MARKERS. OBSERVATION WELLS
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED ❑YES ❑NO ❑YES ❑NO
CENTER. EDGES: DEPTH OF TOPSOIL. SODDED SEEDED
MULCHED
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE
TRENCHES: FILL DEPTH ABOVE COVER.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE UISTHIBU TION PIPE MATERIAL & MARKING
ELEV.: ELEV.: DIA.. ELEV..
ELEVATION AND PIPES DIA.:
[INFORMATION STRIBUTION
HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL
VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
COMMENTS: ❑YES ❑NO ❑YES ❑NO
PERMANENT MARKERS: OBSERVATION WELLS:
NUMBER OF PROPERTY WELL: BUILDING:
❑YES ❑NO FEET FROM LINE:
❑YES ❑NO NEAREST
w
.mot .
y
Sketch System on
Reverse Side. Retain in county file for audit.
SIGNATURE: TITLE:
DILHR SBD 6710 IR. 01/82)
ILHR SANITARY PERMIT APPLICATION COUNTY `
In accord with ILHR 83.05, Wis. Adm. Code -,L.4,
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than S
8% X 11 inches in size. STATE
PLANLD. NUMBER
-See reverse side for instructions for completing this application. Z
1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. PETITION
PROPER. Y OWNER FOR VARIANCE ❑ YES ~NO
PROPERTY LOCATION
0 4 1~~-~'/a, S T , N, R1 (q f(or) W
PROPERTY OWNER'S AILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
1~`1
CITY, STATE ZIP CODE PHONE NUMB R CITY
(_59 VILLAGE . N1`H` NEARES OAD A R ANDMARK
II. TYPE OF BUILDING OR USE SERVED: ao
Number of Bedrooms if 1 or 2 Family OR Public (Specify):
Ill. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable)
1. al "w 15.0 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. RAlternative c. 1:1 Experimental
2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy el&Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. See a e Bed b. ❑ seepage Trench c. ❑ Seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY:
(Mines er inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ZY
.7 3 7,5 101-7 VI. TANK) CAPACITY Feet Private ❑ Joint ❑ Public
INFORMATION in allons Total # of Prefab. Site
New xisting Gallons Tanks Manufacturer's Name Con- Steel Fiberglass- plastic Ap
Tanks Tanks Concrete structed pp.
-Septic Tank or Holding Tank G/ f a ❑ ❑ ❑ ❑ ❑
Lift Pump Tank/Si hon Chamber l ) / ❑ ❑ ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for instal 'on of the private sewage system shown on the attached plans.
Plumber's Name (Print): Plumb 's i ature: (No S ps)
/MPRSW No.: Business Phone Number:
- pn A.,.a 3.-? i~ r-7 4
Plu s Addr s (Street, City, State, Zip ode): De /5
Name of Designer:
VIII. SOIL TEST INFORMATION
Certified Soil Tester (CST) Name
CST # ao
CST's ADDRESS (Street, City, t te, C de)
Phone Number:
IX. COUNTY/DEPARTMENT USE ONLY
X ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps)
Approved ❑ Owner Given initial y charge Fee Adverse Determination
X. COMMENTS/REASONS FOR DISAPPROVAL:
BD-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 'whengver necessary, usually every 2 to 3 years;
6. If you have questions concerning your private sewaga syste ontact 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 s to be
installed;
ll. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 39 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
Ill. 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 81/2 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
result of over 2 years of steady nego`ation and public debate. The groundwater bill Groundwater -
included the creation of surcharges (tees) for a number of regulated practices which Wisconsin'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 a~ system or the disposal site used by your holding tank pumper.
jrc argas are credited to the groundwater tend adrn.nis-
The rnon'es .ollec,ted throug` these
tered by the Department of hiatur i R -ources. These funds are used for monitoring graurd- t
water, groundwater contamination ir;.•-astiga.tions and establishment of standards. Craund~vata
it's worth protecting.
SBD-6398 (8.03/86)
Fo rm - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER y, , TOWNSHIP a~~
,qtr t~_ SEC. T N-R ~ W
ADDRESS= ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of ILHR, 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
X07'
DICATE NORTH ARROW
~r~v ,ate z fIL~ .
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: f
Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings used: Tank manhole cover elevation:-
Tank Inlet Elevation: d Tank Outlet Elevation:9
J
Number of feet from nearest Road: Front ,0 Side10 Rear, ~ feet
From nearest property line : Front,0 Side, Rear, O feet
Number of feet from: well `
building: 2-
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER 1 Q
~I S Liquid Capacity: (J
Manufacturer:
Pump Model: WS. Pump/Siphon Manufacturer: (1 Pump Size`
Elevation of inlet: 9 Bottom of tank elevation: 7
ej)
Pump off switch elevation: 2 Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
r
Number of feet from nearest property line: Front, O Side, Rear, 0 Ft.
i
Number of feet from well:
Numberof feet from building:
IY7
r
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM_
Bed: Trench:
Width: ,_12 t --7 Length: Number of Lines: -~Area Built:
r~
Fill depth to top of pipe: - Z--"-
Number of feet from nearest property line: Front, O Side, &Rear, Ft
Number of feet from well: Number of feet from building: ~r
_ (Include distances on plot plan).
SEEPAGE PIT
Size: Number pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either drop box O or distribution box O been used on any of the above soil
absorb on sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of riftgs used- Elevation of bottom of tank:
Elevation of in t:
Number of f t from nearest property line: Front, O Side, O Rear, O Ft.
Number 4 feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated:/,/ 6 d7 Plumber on jo /
S GC~ `j
License Number:
3/84:mj
PUMP CHAMBER
Manufacturer:
Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Id Pump Sie
z
Elevation of inlet: 9
Bottom of tank elevation:
Pump off switch elevation: ,
_Z17?Gallons per cycle: -7
Alarm Manufacturer: ((-A Alarm Switch Type: ~Y 1 Vic.
Number of feet from nearest property line: Front, O Side, Rear,
Ft.
0
Number of feet from well:
Number of feet from building: / 417
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed:
Trench:
-7
Width: Length: Z Number of Lines:
"---y-_ ~
Area Built
i~
Fill depth to top of pipe:
i
Number of feet from nearest property line: Front, O Side, &Rear, Ft
Number of feet from well:
Number of feet from building: 00 I-J-
(Include 4istances on plot plan).
SEEPAGE PIT
Size: Number A.f'pits: Diameter:
Liquid depth: /Bottom of seepage pit elevation:
Area Built:
Has either drop box O or distribution box O been used on any of the above soil
absorb on sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number o;ofin used- Elevation of bottom of tank:
Elevatiot:
Number o rom nearest property line: Front, O Side, O Rear, ~Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on ' o
License Number:
~~f~~%75
3/84:mj
NDUS DEPARTMENT OF SAFETY& BUILDINGS
NDUS INDUSTRY,
REPORT ON SOIL BORINGS AND
LABOR AND P.O. BOX 7969
PERCOLATION TESTS ( / 115l DIVISION
HUMAN RELATIONS (H63.090) & Chapter 145.045) ` MADISON, WI 53707
LOCATION: SECTION: W TOWN, P
~ ~~/a /T3) H/R (or) n.,I OT O.: BLK. NO.: SUBDI ISION NAME:
CO NTY: OW ER'StBHR S NAME: 14r
MAILING ADDRESS:
` V _ a
USE A, a~ -11 So Ynf,,(, SEA s Z
NO. BEDRMS : COMMERAL DESCRIPTION: DATES OBSERVATIONS MADE
Residence PF SCRIPTIONS: ER OLATION TESTS:
13 10 q-c9&
RATING: S= Site suitable for system U= Site unsuitable for system GJ
CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
❑S mu ®,S ❑U E ~ EIS 2# 0S A nw~~
If Percolation Tests are NOT required DESIGN ATE:
under s.H63.09( Tests
indicate: If any portion of the tested area is in the
Floodplain, indicate Floodplain elevation:
At, PROFILE DESCRIPTIONS mc?-
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 5 ~
04, S,
9-3
B- 5- 0 0,E S, I
0 r-74
B- -
LEI
B- 1
E,C►YInA ' PERCOLATION TESTS ~,p
I
161
TEST DEPTH, WATER IN HOLE TEST TIME
NUMBER S AFTER SWELLING INTERVAL-MIN. DROP IN WAT VEL-INCHES RATE MINUTES
P I zoo PERIOD 1 PER D PE r 3 PER INCH AO n o) Hin
P_ 2- ~ 0 A) IF 13 Q rP
- -3 N 8
Z
P
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 7
_P -
t
s
E
._f
10
-31
i
E
a _ ~ R 3 i
1, the 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
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print l:
TESTS WERE COMPLETED
/ R 6
ADDRES® /0 CERTIFICATION NUMBER: PHONE NUMBER optional):
CST SIGNA
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
L HR-SBD-6395 (R. 02/82) - OVER -
INSTRUCTIONS FOR COMPL_ a . ORIVI 115 - SRI -
To be a complete and a ail test, your report MU
1. Complete legal description,
2. The use sectic ':e wh-thc- or commercial project;
3. M.V111I111 1 r• cofi. I
4 Is ; a
5r , SITE IS SL. _T OR T-- C- Y x `_L
J . . P-
0 1 to BP'--D 0"
f r_
6. PLEASE u
sE ate shoe'
it;
c r e boxes
as flood ox;
11. IV current a
tribute as s vast JITH THE
1. ,
L x riiN 30 DA,
St
Col'.`
gr }
GS
¢Srl'
Ca Y
Y
rn R
v Loam Mf
jr,
1 -
;rr -ce Point
T(
TV ?st
iction
I
~DA5SS
* ~ ~ ~lolol~ ~~4`~l ph .~owr lQl-,~c~r ra~lll v~ ~,r~/$-ff!'Y~
Ai
117 Poo r Hl ~ h ~~-f
&,Vo .
ss SE e.~ a n
l0~►o.t, 5 ~ ~ b E ~
PRIVATE SEWAGE SYSTEMS 'TOro:aiio'F~`.AFM A SU"1010
7DILHR m u Aa~».R.;,.,
PLAN APPROVAL APPLICATION P.O. see YOM Medleen. wf $3707
.STRtfCnow meow an in all applicable data and submit this form with plans. Plans will not be reviewed until all foes are received. The
back side of Vft lore describes required plan information. Plumbing codes can be purchased from the Department of Administration
Document Sales. 202 South Thornton Ave.. P.O. Box 76W. Madison, Wisconsin $3707, Telephone (SOS) 26644.
1. PROJECT INFORMATION (Type or print dearly) Revision To Plan Number.
$vv
Non" M+0 any (Flom returned a same) ProjectNarne
t6
No. or Ural Route - Progot Location . street l No. or Legal Oesoription
5 w `r /0 ,
INY"or.vifiage, 31 A-) Y2
state tip city
Coenllr Q) I Village OF: I
U3 A 6 544 l Town riq~n
slgpnoee No. (Inewde area Code)
.J5 , Z~to
Rim , Telephone No. (Inclu" area code) Name Telephone No. (Include area code)
-_9 I v v u. 'Z/5-Z4-7-
Woof& No.
ta
ty or I lage
ZIP
(z 25
TION:FOR: New Mound System (3a) Groundwater Monitorinig (7)
Conventional System - Public Building (1) Replacement Mound (4a) Holding Tank (2)
Replacement Pressurized System (4b) System in Fill (1) Petition For Variance (6)
New Pressurized System (3b) System in Flood Fringe (1) Other Alternatives (5)
FlES COMPUTATION8 (MWu" existing tanks) 4. FEE SUBMITTED FOR OFFICE USE
tUAKE ALL CHECKS PAYABLE TO DILHR
3s" 750 • 1.500 Gallon septic tank -50.00 4a. 4
30. 1.501- 2.500 gallon septic tank - 60.00 4b.
3Q' 2.501- 5.000 gallon septic tank - 60.00 4c.
3d. 5.001. 0.000 gallon septic tank -100.00 4d.
3e. 9.001-15.000 gallon septle tank - 150.00 4e.
X. Over 15.000 gallon septic tank -250.00 411.
5W- 1.000 gallon dose chamber - 30.00 49. 30--
XL,, '1,001. 2,000 gallon dose chamber - 50.0 4h.
91 2.001. 4.000 gallon dose chamber - 70.00 41.
4„001. 6.000 gallon dose chamber - 90.00 41.
4.001-12.000 gallon dose chamber -110.00 4k.
Over 12.000 gallon dose chamber -150.00 41.
3m. SW - 5.000 gallon holding tank 30.00 4m.
3n. 5.001 - 10.000 gallon holding tank - $5.00 4n.
3o."; Over 10.000 gallon h"ng tank -100.00 40.
3p• ;1111"Wons - 20.00 4p.
34:- Ofoundwater Monhoring Per Lot - 32.00 4q.
(other than a proposed subd"lon) Subtotal pin -
3r. Priority plan review: walk Mrough 4r.
dubmittal of plano'ln person,
by appointment with double tee
3s. Petition for variance
Setback - 25.00 4s.
Site evacuation -50.00 ~
Total Fee
NOTR: Fe" Pursue" w wte. Ada . Co" CMpter bd, M
attft~aare a~asl n+s►MerUss141eMneoaa>sUWir
0
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/, WX
SW ;4 NE 14 S 8 T 31 N/R 18 ZHLVd W Star Prairie St. Croix
Street Address: Subdivision: County:
Landowners Name: Mailing Address:
Terry Tuma Rt. 1, Somerset, WI 54025
I (We), the undersigned, hereby make application for an alt ake sytatem n
Z
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.
10/25/$
Signatur o Applicant Date
STATE OF WISCONSIN Subscribed and sworn to before me
SS.
COUNTY OF St. Croix Th s h d of October 19 $.6
l c, tate o isconsin
Paul 0.,. Swenby
DILHR-SBD-6413 (N. 05/81) My Commission Expires. 10/1$9
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
798-2239 (HAMMOND)
425-8383 (RIVER FALLS)
HAMMOND, V4154015
October 24, 1986
Division of Safety and Building
Bureau of Plumbing
P. 0. Box 7969
Madison, WI 53707 .
Dear.Sir:
An on site investigation for the Terry Tuma property, located at
the SW1/4 of the NE1/4 of Section 8, T3114-1118W, Town of Star
Prairie, revealed suitable soils at a depth of 2.34 feet, below
which seasonable high groundwater was noted.
This site-should be suitable for a mound system.
Should you have any questions, please feel free to contact this
office.
Sincerely,.
ell
Thomas C. Nelson
Assistant Zoning Administrator
TCN/mj
w
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, NE 1/4, Seca 8 T 31 N, R 18 MRW
Town l~xxt___M12 lj Star Prairie Street Address
Lot No. , Block , Subdivision
Landowner's Name: Terry Tuma
The application for this site is for:
® new construction use. ~f r
w~..
0replacement system use.
If this is NEW CONSTRUCTION USE, the alternative private sewage system is:
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 nTers-issueayou.)
one of the applications needing a quota number. The quota num 'rYa ision"
this application is 59 18 - 7
❑ for one additional homesite on a farm to be occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
O 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:
❑ a failing conventional soil absorption system.
0 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
ounty c a
Title Assistant Zoning Administrator Date October 24, 1986
DILHR-SBO-6158 (R 12/82) ' G
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3rI8' O' PLUMBING
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(.,oncfitionall
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APPROVED
DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS
DIVISION OF SAFETY AND BUILDINGS
SE:E ~ ,'EC
''OPTIONAL WORKSHEET
L MOUNO SYSTEM IL INIOROUNO PRESSURE SYSTEMtsmdwjo -
1. NtUN- AM LOW, Tstd Oak fbw• ~D f+l IL Sam Mains
qN s. MM 93.15 (3) (c) MUlawmoaaftRMa• 37%7
AM. C O and PROVIDE A DETAILED OMiwww - ~
11. P~ Naa/s
K
LOT OF SIZING-ON M ANL T
3, Law4Na • Vwded Lift •
OIwom" SV Mm K TOM Liu • , `
S. EkvlMlast OiNMw Ntwt IL Puwy Sdtatbwt WE dbdwP F WP S1rM9w • ~ K ahit R MW~ffrmawit Z on
ANi Ra~srAN • M K romp me"
N1 «Tv" A Lands (a) • K
NilritTtiwdr~l/M (A) • K 1S. Oar VNuram
Tt~awaA SiaawS ~1' ' K 1 L1~1 ~ 2 • O
Dkofts" f►" ww~ ~W1Att
/IN OaPMt ILM ~ K OMU MaMawaw Vidrma 4~
f, N OW& Owww /a (E) K f Daala Mt >N hta • YAB
¢w> OM.M TwsMA OINM ~ ~ K RsetAw •
Cq ad T"1M OMM IGIL's
K Miwiwssrm Oaaa •
ZEUS
Cap art/ Too" 0spo I") * K if. Ow C m*M Q,,w
L Mo wM L,w4dw Voj w L.
4
• ' T" Mond (IQ
L6a60 (L) • 2 to. 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM. r
L Mwwr wl " 1. Wa m%"W Laval.TNM IPW ►kw •
UPMNCaxw~tMwrmw ' WR 0. ILHA $3.13 3S (cEU Nis.
NMIMa SMM► (1) • ' K ASm. C66 aw PRO ID9 Al
D trnraelart 1agM - LIST OP SIZING ON PLANS. ,
OEM M1MIM p) • . K S. RawMM Sspk Tw* Clpwft •
Told Mwwf wink (NI) • K S. PW&ftd a UU • .mmmm:omom.
10. ~aql Ataat 4. AbtmMfae AtwSM M
IwfNvww Ca1>Mt s Aoior to Table 2 to I= 03
- Na1rd to • WN.R.Nafr a" PROVIDE A OET OF
Npl Am RMwNaM • w K SIZING ON PLANE.
♦MM Ada Arab" • aN. K Roqu1rM Ana • : `
•
11 'It sgu*m Taws Hwm comm +3 Lora*
~ ~ •fl►wM- • ; '
• .11wsd, 'zndioateTab3+N
It pw of OM1rIMueMts Mbtwuk, Ur NuwiM 15.14 M SNMM 11. ~ . NuwiMr N T • ~ '
IN4ROIN102. S. OZ.: LawM~* ` G lt •
Iti.rwf St► EMwrtMtt ••r~ waN M PJM •
f.. ; 1i iA)t 83.16 Pt3) (o) , N s. Swww
M t.CNa aw/ PROVIDE A DETAILED Iv. YSTEM•INdILL
e=
L STOP SIZING ON ftANS. ►NI Iw AN 100 arw Sod"*,
RMwAM Sy1M ToM taPatlt,► - O a~O OL
hoo
Atq RMrMf • M. K Maiwfamm"
S"am Left* • K L Show She CwntawtN To* Doo t em Phs
sys"m SI M • n.
T. Dkwbvftn PIN Skho VL DOSING TANK ftC
y ~ M.r sa. • a. 1. C*ad" - 8 p Ile
11aN s►aeMwt n. L Mawifedwrn
Lawd LLAMA - n. PrwwP Marwl
;T° 1.atwd Sla • Mw PwwP
L."41 S' OJIMMIM /0 1
11M.wa ftwM liMitwaNNr Mpt Mw li:'fibtr Ralr+►
DI~ttlMuiinw ►M+ OYdwPt Rank 7. SMw m CwstlrYala/ Tank Dmb mftm
No" iK IMka Pw Piw
a - 1 Mtw PMr PIPS • .~a f.Lis MM• VIL IMMANN01ANK" 'w..._
1x' MaWoM Si w 1 Cap"If •
T"W (wow w son - > , w,nwaetw.rs
Law~sA It. Tawk DwNt aw man
Oiaswtw • s.. Ma
MANS-
maim Affiffiam t rw
Page., Of
Straw, Marsh Hoy, Or
Synthetic Covering
Distribution Pipe
Medium Sond
Topsoil e
~ f
3 E F
Slope
Bed Of Force main Plowed
Aggregate Layer
' Ft.
Cross Section-Of A Mound System Using E --=3 Ft.
A Bed For The. Absorption Area F = Ft.
6 I , Ft.
Signed: A Ft. H .3 Ft.
'xj-'q"
B 4 Z Ft.
Licenst A tuber. K ,,[o It.
Dale: Q L 7 - GC, L .~r_.7 ' Ft.
Ft.-
I • I Z Ft.
I W :29 Ft.
L
Dbservotion Pipe
B K
A
---------------J-------------------- Force Main
Distribution Bed Of
Pipe PLUMI
/ Aggregate ;
Conditi.1-t
Observat n i t Markers
OWN
R UEFIARTMENT-UF INDUSTRY, L OR AND H RELATIONS
DIVISION OF SAFETY AND BUILDINGS
Plan View 0 uung W618 N reo
1
i
Page - Of
Perforated Pipe Detail
0
nd View
)Perforow
End Cop PVC Pipe
,o
pla~~ Holes Located On Bottom,
~s Are Eque*l %ocod
LOU Hole Should Be
Neat To End Cop '
Distribution Pip* Layout P Ft.
S 3.
X InchPS
Y Inches
Signed- Hole Diameter Inch
Lateral
Inch(es)
yz_
License Number: \Mq)V?-&u) 'Z Manifold " 2 Inches
Date: 0 9 G Force Main " 2.. Inches
# of holes/pipe 140
PLUMBING Invert Elevation of Laterals Ia8 Ft.
ri I ov
PR N ` RELATIONS
DEPARTMENT 0,'r: INDUS OF SAFETY AND BUILDINGS
DIVISI /J,
EEC' FES ONOEN
PAGE: CF
" PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
VEAIT CAP
IPC APPROVED LOCKING
M(C.S. VEAIT P WCATHER~ PROOF
JUNCTION SOX MANHOLE COVEp
ASS FROM DOOR . w`~Ytr~~ ~r►IoLI ~i~
VAUDOW OR FR.CSH IC141U.
Allt INTAKE. I BS
GRADE
I y' MIIJ.
IAILET PROVIDE I AIRTIGHT SEAL v I W E E -
ail Ho1E v
APPROVED JOINT A nuMBiNQ I I WPC ROVED J01
i
MI/C.L 111E
EXTENOINb a• ~t~ 1 II AWtM cxrcuolaG a
Clam SOLID SOIL s o i Omm SOLID
I'
. N RELA~ION~ I OW .
C ~AgGR AND NU INGS
P TRY , 6kj
[LCK.:~.L~ T. ~,RTMENT OF IN'DUDF SAFETY ANo
bvt ► orr
NCE r
0
g~E URF$~SPo
CONCRETE BLOCK
RISCR EXIT PEKMI'R'ED OULV . it TAUK MAIJUPACTURCK HAS SUCH APPROVAL
SPEGIFI'GATIOAlS
BEtTiC
ooSC l.~ F E t~ S'
SAS MANUFACTURER: UJIM6ER OF DOSES: PER t"
TAIJK SIZE: 9'00 CALLOUS DOSE VOLUME ~3 71 L
ALA M.AAWFACTURCK: IMCLUOIN& BACK FLOW: GALLO
AODCL UUMOER: CAPACITIES: As,...MICNES OR CALLOW
SWITCH TAPE: 6 sA INCHES OR ~ 8~~~ W►LLO
PUMP AMUVACTURCR: A Cm -7 IUCHES OR 13 GALLO
MODEL UUMOCR: "5 J/ On INGHU OR 7 7 GALLO
SWITCH Twpic: ~fLlOne UOTC: PUMP AND ALARM ARC TO SE
MIUIMUM DISCHARGE KATE _ 37, 14 INSTALLED ON SEPARATE CIRCUITS
11ERTlCAi. D1rrCREWCc DETWEEU PUMP OFF AM DISTRIBUTION PIPe..FELT 12 MIUIMUM NETWORK SUPPLY PRtSSURE 8 FCET Z'Z9'~SA~-~
} . FEET or roRcc MAIN x°?' ~ OS mmicTwu FAcYm &6-0 rECT / X e-Z d
TOTAL ciia IC. HEAD s J3r'JLLQ_ FEET p ~Tgq
INTCRIJAL. DIMCIJ US Or TAUK.: LEAIQrTN $WIDTH ~L..;LIQUID OCPTH
I . . . - A _n~.
>~QrIJED L.ICEI►ISE 1JUMDERsY'...'.Cl'JlrrZ.~.OATE~o~'~7~
~ , ~
I
i
. Rerformance Submersible Effluent
Curves Pumps
MODEL 3886
SIZE 3/4" Solid
70
so
40
}
a
10
0 0
0 to : w 40 In 90 T?O 90 90 100 110 1B ow
"LDS PUMPpS INC.,`'
NWA W" WN10K OW,
a p-
z ; a MODEL 3885
36 SIZE a/4" Wid
30 too •
.00
,40
u 00
.
,t
•8
109E
6.1
0
50 90 TO 90 90 100 110 190 am
90 40
0 /0 7D.
10 '0 iOIA'Ir1
0 QAPOAM
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ST C- 105 r"
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SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
t7
a
OWNER/BUYER H
ROUTE/BOX NUMBER. Fire Number
CITY/STATE oD'bYl~;rS~~d ZIP J~-'62_S
PROPERTY LOCATION:_& , '4 , Section O T_~N RW
Town of_cA~~ 4P r6 , 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. H
0
I/WE, the undersigned, have read the above requirements and agree CA
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- v
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.
S I G N E D Z--o...tJC.y
DATE 1.2
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.
EPARTTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
JDUSTRY, DIVISION BOX 7969'
UMA AND PERCOLATION TESTS (115) MADISON W1 3707
UMAN RELATIONS (H63.09(1) & Chapter 145.045)
.
W W fw-p 1
t~ H/ /T31 N R 1 cdN► w
C VM
DATE= OBSERVA ON5 MADE
MMIRRYL ]DESCRIPTION] OR Le 011SCRIVI I IFERCOLATION TESTS
^ New ❑ Replace
MIdMMIf
ATINat S- SM makable for system U- Slte woult" for system
_ KXJND~ - : RECOMMENDED SYSTEM:(optional)
'ou CIS
Povolation Too" we NOT roctuired IDEStOU TE* If any portion of the tested area is in the
ndrr`t1,H03.00I511b►, indicate: Floodplain, Indicate Floodplain elevation:
PROFILE DESCRIPTIONS 3 4M C Z.
U N DEPTH
U ffeL CHARACTER OF -SOIL WITH THICKNESS COLOR, ,
ELEVATION OBSERVED .l F OBSERVED EE ASBRV.ON BACK.)
.S L. Ste o~.s
I- Z Sgt D 0 dal a 'lye
c,;? 3 . 1, 1
too 0L S. L. C=V ?tie 0 ---ma 41
1.
PERCOLATION TESTS
t
ER IN HOLE TEST TIME DROP IN WATER LEVEL-IN RATE MINUTES
V7. AFTE SWELLING VAL-MIN. PERIOD 1 002 1P PER INCH
Go 'gin
.*2- gain 10f. YA
PLANt Show locations of percolation tub. ail borings and the dimensions of suitable soil areas. Indicate male or distances. Describe what are the hori-
OT
,tal aid vertical ohnotion reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
land slope. 14
YSTEM ELEVATION D '1
.4
.
l
-
I I r
! f_ ..t OsTV
o
Ald
f ,C - 1
i
the and d, hereby certify that tha soil test reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin`
IministamWo Code, and that the data redi0fda 1 and the location of the tats are correct to the best of my knowledge and belief.
%Mll (print). • ~ TESTS WERE COMPEETIB ON:
CERTIFICATION NUMBER: PHONE NUMBER optik4 ft
onal' -Z
STRIOUTION: Orlon l and one copy to Local Authority, Property Owner and Soil Tester.
LHR48041= (R. 021421 OVER -
i 5
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
Location of Property 5 (A 1 G k, Section TjN-R~- W
Township
Mailing Address
Address of Site
Subdivision Name A)
Lot Number
Previous Owner of Property 'ti,
Total Size of Parcel
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No /
Is this property being developed for resale (spec house) ? Yes No
Volume- and Page Number 13 r 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) eeAti6y that a.Q,Q. statemenu on thi.6 for te trcue to the best o6 my (ouA)
knowtedg e; that 1 (we) am (ahe) the owner k the pnopW y des eh i.bed in tW
.in6o4mation 6oAm, by vi tue o6 a waA anty deed recorded in the 066.ice o6 the
County Reg.cdten o6 Veed6as Document No. 35&5 V ; and that I (we) phedentty
own the phopoded 6ito bon the dewage di.apoz b yes em (on I (we) have obtained an
eabement, to nun with the above deachibed pnopehty, bon the eonatnucttion o6 said
eybtem, and the .dame had been duty recorded in the 066.ice o6 the County Regi-6teA o6
' Deede, ad Document No.
SIGNATURE /OIL OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
t
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
~yY. ` ' 796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
= HAMMOND, WI 54015
October 24, 1986
Division of Safety and Building
Bureau of Plumbing
P. 0. Box 7969
Madison, WI 53707
Dear Sir:
An on site investigation for the Terry Tuma property, located at
the SW1/4 of the NEl/4 of Section 8, T31N-R18W, Town of Star
Prairie, revealed suitable soils at a depth of 2.34 feet, below
which seasonable high groundwater 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
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, NE 1/4, Sec. 8 , T 31 N, R 18 XL*M)K W
Town 1 XXNWAV I 1j Star Prairie Street Address
Lot No. Block Subdivision
Landowner's Name: Terry Tuma
The application for this site is for:
S new construction use.
❑ replacement system use.
If this is NEW CONSTRUCTION USE, the alternative private sewage system is:
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 n-mTiers-issueTlo-you
one of the applications needing a quota number. The quota number assigned to
this application is 59 - 18 - 7 .
❑ for one additional homesite on a farm to be occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
F ]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.
1J for an application nn 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.
0a 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 .E]
I certify that the above information is true and accurate to the best of my
knowledge.
Name Thomas C. Nelson Sigoat
re
County Official
Title Assistant Zoning Administrator Date October 24, 1986
DILHR-SBD-6158 (R 12IR91'
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/2H#QdX
SW NE 141S 8 T 31 N/R 18 WK~ W Star Prairie St. Croix
Street Address: Subdivision: County:
Landowners Name: Mailing Address:
Terry Tuma Rt. 1, Somerset, WI 54025
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: