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CROIX COUNTY, WISCONSIN SUBDIVISION A) LOT A)l 4- LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILIiR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f7 f 0 i S3 ` Flo ~ s INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: / !Ad~ -94" Proposed slope at site: ~ SEPTIC TANK: Manufacturer: W `Liquid Capacity: z. ~ w- 1 Number of rings used: y Tank manhole cover elevation: C7 g Tank Inlet Elevation: Tank Outlet Elevation: /Q Number of feet from nearest Road: Front, &Side 0 Rear, O feet From nearest property line Front,0 Side,RRear, O f feet Number of feet from: well j building: ~a I (Include this information of the above plot plan)( 2 reference dimensions to septic tank) RRR RP.URRRP RTnV • PUMP CHAMBER Manufacturer: Liquid C city: Pump Model: Pump/Sipho nufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elev on: Gallons per cycle: Alarm Manufac er: Alarm Switch Type: Number feet from nearest property line: Front, O Side, a Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM / V Bed: Trench: Width:j _ Length:11hd to Number of Lines: Z Area Built: c Fill depth to top of pipe: 22 6 Number of feet from nearest property line: Front, O Side Rear,0 ift Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Nu er of 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 absorbti sytems? (Check one). HOLD G TANK Manufacturer: Capacity: Number of rings sed: Elevation of bottom of tank: Elevation o inlet: Number feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: fp Plumber on job: Dated : License Number : - 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR &.HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING Mit,DISON, WI 53707 T CONVENTIONAL ❑ALTERNATIVE State Plan LD.Numbec assigned) El Holding Tank ❑ In-Ground Pressure El Mound r NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE: Marshall Boumeester Star Prairie, WI 54026 O 46 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PL ELEV NW NE, Section 12, T31N-R18W, Town of Star Prairie Name of Plumber-. MP/MPRSW No. Counry Sanitary Permit Number Gary Steel 3254 St. Croix 79171 SEPTIC TANK/HOLDING TANK: f MANUFACTURER. LIQUID CA ACITY. TANK INLE ELEV.. TANK OUTLET ELEV WARNING LABEL LOCKING COVER 10, PROVIDED PROVIDED t~~YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.. VENT MATT JHIGH WATER NU ER OF ROAD: !PRCFPERTr- WELL- B OILD ING: JVENTTOFRESH ALARM FEET FROM / LINE. _ AIR INLET. YES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP:SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PH OP EH TY WELL JBUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM uNE AIR INLET' PUMP ON AND OFF) ❑YES ❑NO NEAREST- 0 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing InAMF TEH atATE RInE AND MAHKIN or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH'. LEND 7;:fN OF UISTH PIPE SPACING COVER DIA =PITS LIQUID ENCE IALPIDEPTHDIMENSIONS G A +a R+': EL LLPTtI FILL DfTH UI PI ' S pT}E DISTRPIPE MATERL NO ISTHNUMBER OF PROPERTY WELLBUILDING: VENT TO FRESH BELOW PIPES ABO R EtIN(/F ELEj ,a PIPE LIN T_ FEET FROM NEAREST 11- MOUND SYSTEM: /2, 7 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 PE HM A N I NT MAH KF HS 013 S EH V A T ION WELLS DEPTH OVER TRENCH eED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL ❑ YES ❑ N 0 ❑YES SO UDFD SMULCHED ❑NO CENTER EDGES ❑YES. ❑NO ❑YES 1:1 NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING GRAVEL DEPTH -BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD =DTR ELEV E IPE MANIFOLD MATERIAL NO CISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING LEV.' CIA. PIPES CI A.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT(-Y COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SI A _ //~~//J TITLE. DI LHR SBD 6710 (R. 01 /82) ll//l/ 6 , wtsconsin APPLICATION FOR SANITARY PERMIT COUNTY (PLB 67) OEPFIRTTEnT OF UNIFORM SANITARY PERMIT # - In0U5TR4, IFIBOR 6 HUTRn FIELFiT10n5 U -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PRMTY OWNER MAILI G ADDRE 11 rr ,L1T_Vts (5 Z PROPERTY LOCATION C (A/4 91/4, S Z, T31, N, R *-(or) W LAGS: ` LOT N MBER BLOCK NUMBER SUBDIVI ON NAME NEAREST AD AKE OR L NDMARK STATE PLAN I.D. NUMBER 6: A, TYPE OF BUILDING OR USE SERVED X 1 or 2 Family Number of Bedrooms: 13 ❑ Public (Specify): THIS PERMIT IS FOR A: .New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed kZeepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: Leg. 5 IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ in-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): I ~ Q Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installat' of the private sewage system shown on the attached plans. Na Plumber rintl: Signatur t~ PAiDIMPRSW No.: Phone Number: Plumber's A ress: Name of Designer: tej ti COUNTY/DEPARTMENT USE ONLY Signature of Issuing Ant/ Fee: Date: ❑ Disapproved ~-0 (i6 El Owner Given Initial f r0 A Approved Adverse Determination Reason or a Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 " To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary (permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. ci o ~ >0 ~c N E w nom. 0 0 o a> > c° v ses 75 cc L- :03 'D C i w v O -p tm O r- 0 m V yw d w cU o w'~ w c 3 c n ~oui 0 cwa~c W >.0 j g oc t3 cE0 cc ya).cO~ Op`w Q a) « v w O o CC~ = c~0 0 U.S ( y l~ G V t w 0'a O t j a) W Q. ~ ~ ~ L w a) ~ O N C C_ U a) w p W c 0 O 3 L `o c= awi 0 0) EQ- 3 ~Ea) a~E 0~~ a~~ c ? a) o M ci Q ~3aiCc > w~c 0 Z i co a) (D vi O V) > w - ~ a ~c 0) v O 3:.o p N p O t` rn 7 o Ow- o`a O o Cl) 0.0 cm 4) > QL- 7~v~ oa[c as 0)- w c r- :3 cocoTo o c 3 c.0 >.:3 L c O O 0 ~j O C C L L C C M CM :3 4) o co 4) 0 U O 4) ~ U 6- a) c 'C C O Q T -0 4) ca w a) - CD cc - n. ccf pip (d c0 Y O O U C) C (D 00 M i V O o ` T 3 w w~ 3 0 w o a 113 ,i 0»- y 0c 6- ~t o a c c O z >.~c w v~v>> ? o M >'~LL "CL E.0 L- O co C O a" " M C O N °3 3 `O Pi c0 w p :3 M O EN w w£:~ F- 4? 3 ~ y 01 ~ N G ST. cRO c OUNTY ZONING OFFICE yt5 St Croix County Courthouse LG, JU, T911 4th Street .Hudson, WI 54016, Telephone - (715)386- 4680 L The St.' Croix County Zoning Office offers the ice of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Comnletion j2f this form I& essential, aQ that thg pro erty can Dg located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received., WATER TESTING----------------------- a -FEE: $ 35.00 J D • 0- (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOCIS) SEPTIC SYSTEM INSPECTION FEE:. $25.00 (Determines if system is properly functioning at ;time of inspection) PROPERTY OWNER'S NAME: J PROP. ADDRESS: CITY gal Des ription 1/4 of th 1/4 of Section. , i 3 _N-R Town of Lot Numb r72 ubdivision. Color of hou a Realty sign by house? If so, list firm: L -A ~ Z' PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires--a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER .TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the -home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: _z Telephone Number C i z- C/ / L v d REPORT TO BE SENT TO: (p,E,r, CLOSING DATE: signature EDINA 9A~Ty INC. CORPORATE RELOCATION SERVICE'S 1400 S HIGHWAY 100, SUITE 200 1141 NNEAPOUS. MN 65410 f ~ i N 0 A a N w; c N H '17 ro v (D <:r 0 rt o N O :P. m n r I~ Z, OQ 0 c t G C~ H Q rt a g (-t K wm ono rt c K k P. H- co 0 O a c~ C w m 0 = ~ ~ 0 • to 1 -J O y FS S y s 0 CT Ir CT I-h r, w ti 0 `C (D K (D Q c CY V fl) (D H H H ~f~p) I -b r t h .3 s: t ACs co to cOt Cri M 47 3 A. N w, N- N 5 rf t=d .'3 N ~I O K O~ rr M (D J gy En 0 a Y `v fD n 1- 0 rb N L4 K t- O M rt , a (D r. m v (n C) N0 N n'F3.8 O 9 3 O (D H PO 9x 0 y M ~r (D to rt M O_ A H iA x 0 cn o < HH r° Vl (D (D H Q s O X D, p~ m y ~n 0 00 a. a 3 r Z~ 1 D m (7 Q 0 0) CD to to r OD (D ~ ? W zrti;:: (A W w .w FJ i • ST. CROIX COUNTY WISCONSIN ray ' ` . ZONING OFFICE S ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 November 19, 1992 Mary Brausen Corporate Relocation Services 1400 South Hwy. 100, Suite 200 Minneapolis, MN 55416 Dear Ms. Brausen: An inspection of the septic system on conducted e opro n perty1loc tee at 407 Hill Ave., Star Prairie, WI was At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface chemical said.sysAccordingtem, and em not not involve any excavating o there is the. possibility d def ects in the not in any way twarrant discoverable by this inspection. operation of this or guarantee the continued proper functioning or op once system. It is recommdattheeprsystem olongedhlife of thisesystem every three years. Therefore, may be dependent upon proper maintenance of the system. Scly, i ere , Mary J. Jenkins Assistant Zoning Administrator cj NOTE: This home has not been lived in for an undetermined amount of time. Edina Realty,,.. FROM THE DESK OF Mary Brausen Lac. ~ , n. ~ Wit' Edina Rya Mary Brausen Assistant Account Representative Corporate Relocation Services 1400 South Lilac Drive Minneapolis, MN 55416 Bus. (612) 591-6427 ST. CROIX COUNTY d " } a WISCONSIN ` > . ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 December 4, 1992 Edina Realty Inc. Corporate Relocation Services 1400 S. Highway 100 - Suit 200 Minneapolis, WI 55416 To Whom It May Concern: You informed our office that you did not want a water test done on the property located at 407 Hill Ave., Star Prairie, WI. Enclosed you will find a refund check of $35.00. If you have any questions, please feel free to call our office. Sincerely, Jackie Stohlberg Secretary enclosure DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATJONS \ / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LO AT ON• SECTION: TOWNSHI / NI ALIT LOT NO.: BILK. NO.: SUBDI ISION NAME: e Z1 lot) T VN/R or) W i T NER'S UYER'S NAM MA Li N A RESS. ' ! ~ ~ ^i u ` USE DATES OBSERVATIONS MADE NO.BEDRMS.: ICOMMERCIA~ DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS: ~idence ~ g Pi%ew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system ( V c'7 ° Z9 CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTE :(options 1 CAS❑U ~S❑U ~S❑U ❑SM ❑Sill z°~l1 If Percolation Tests are NOT required DESIGN ATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: Ilk PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH , MBER D~P~FH'ffd ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 97- o aG ? a I.s, n .s. ,L. S 17 -y' Z fpg~ 1oli qr / S PIZ B-3 X67 PIE > (o t" 6 ZS '11, et 4/73 B- oil B-e CIO ~~Sln?4` I PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER +h"t"f-B AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- 1 ° o < 3 P- Z a 3 tp & 4 3 P_ NO 3 i/'* A/41 P-_ GtS o 3 /e 3 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 ELE"T 97 OsA C3 to ~ t 3 Jj fdj _v E h tea'- t004 6A- ►-z E Z r s E 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)- TESTS WERE COMPLETED ON: I Z., C!; )4 5. z9, °96 ADDRESS-CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGN T DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D I LH R-SB D-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SR - 6395 -Y To be a accurate sail test, your report must include: 1. Cc ; 2. Th y indicate whethe silence or commercial project; 3, MA) or ccam nned; 4. Is . wn; 5. Co as. A SITE t1 ~RI_E F:OR TANK ONLY IF ALL. 0-11 L ) OUT BAS C Be PL town here fc t 7. surat, ' Ic A u re v rr neat; 9. C fixes as to dates, t I exernp_ t 1B. " plain, e° u ) r?x>' 11. , -t adc, a < r r - w F as re(ILi- BE FIL TH THE 1 C I. 30 DAYS OF _E . ~ A l REVIATI lmo t II I SOIL. TEST . s )Is Is i sI *I p_ HWL I * B1 VBP i T{ c t may request f~3r the private - der for uz wj Ae 1000 1Y V/I - AO, 7~1 y -9 7 ~~rs,GJ .3a 5 ~ ST. CROIX COUNTY WISCONSIN ZONING OFFICE 798-2239 (HAMMOND) y .1 425-8383 (RIVER FALLS) ~j HAMMOND, WI 54015 June 2, 1986 Carolyn Haag Permit Division Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Carolyn: Attached please find permit#75040, issued in the name of Marshall Boumeester. This permit has been res&inded due to the change in location of the system. Pemit X179171 was issued to replace #75040. Should you have any questions, please feel free to contact this office. Sincerely, Mary J. Jenkins St. Croix County Zoning Office w < « m M oo O F--- E N N c c c a « E ~ o Q N LAJ ~ cE c co Z c Q z H mw NN1O Z oa N N8« a~ a > Cc w 0 E- N « N aM O a~ ~M to ~C 'E BOO c c c N W •C~ ~ = ~ N 7 ~ L•Y Ec~°/ c EL ~Y «'o o„ CL Lc aE $ 0 O and IM N~ w a cT c~ c ~m~~ d of ;u w Q aN U! E Nm ~o E c V d3 dt y~w~ ME c~ tD >d LLJ W ~ a ~ N ~ c ~ u c c U« CC 16 0 _ v -o LUUJ uNiOm ~j a:.r~: -N • a .4 -O z z w °r z O D Z ~ (jj z F- O O O O Mac U) Q z Z LL Cc U > 5) D F- LAJ mmmi U) U) m Q Q Z CC D w 00 o O Z N m U l ~ ~ o = O ~ J Q Y 1-- Z C) N U Q O ~ Z) _j 0 J O ~ co LL.. w . J U co i C/) w uwj cry U) °-C > C h w ~ O E- N J ~ m u- oC oC M ~w~ O w co w Z O a- Z 2 CLM CD Mac U) ° y A1,0002 3: Q F- ° 0 CL F- 1~ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS DIVISION LABOR 8i HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O. BOX 7969 MADISONIWI 53,707 CONVENTIONAL ❑ALTERNATIVE state pla +D Number. asslg eol O Holding Tank D In-Ground Pressure ❑ Mound INSPECTION DATE: NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: Marshall Boumeester Star Prairie, WI RFF. PT. ELEV. : CST REF. PT. ELEV BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. NW NE, Section 12, T31N-R18W, Town of Star Prairie Name of Plumber: SantaryPer Number MP/MPRSW No. County 75 Q, Gary L. Steel 3254 St. Croix SEPTIC TANK/HOLDING TANK: LIQUID CAPACITY: TANK INLET EL ANK OUTLET ELEV.: IWA ING LABEL LOCKING COVER MANUFACTURER: IP VIDED: PROVIDED. 'YES ONO DYES ❑NO BEDDING: AT L. NUMBER O ROAD: PROPERTY WELL: BUILDING: ~VENTTOFRESH LARM LINE AIR INLET. VENT OIA.: VENT M. HIGH WATER A' FEET FR DYES ❑NO NEARES DYES ON DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPAC Y. PUMP MODEL U SIPHON MANUFACTURER. RWAR OVIID DLgBEL PLOCKING ROVIDED COVER DYES ❑NO f "YES DNO OYES ONO UMPAN CONTROLSOPE ATI AL NUMBER OF PROPERTY WELL BUILDING. AIR ENT N OTRESH GALLONS PER CYCLE: FEET FROM LINE (DIFFERENCE BETWEEN ES Nn NEAREST PUMP ON AND OFF) - LFN(~~TR. DIAM ETER MATERIAL AND MARKING SOIL ABSORPTION SYSTEM. Check the soil moistu a he dep of o ing FORCE or excavation. (If soil can be rolled into a wire, co ction shal ea ntil MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: LlnuiD WIDTH: LENGTH: NO OF D( R. PIPE G. MATERIAL: PIT INSIUE DIA. #PITS: DEPTH BED/TRENCH TRENCH DIMENSIONS G PROPERTY WELL: BUILDING: VENT TO FRESH LINE: AIR INLET: RAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL NO. DISTR. NUMBER OF BELOW PIPES: ABOVE COVER. ELEV. INLET ELEV. END- PIPES. FEET FROM I NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. LC ERMANENT MARKERS OBSERVATION WELL LS DYES ONO P SOIVER TEXTURE. DYES ONO DYES ONO SODDED: 15t:EDED: MULCHED: DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: CENTER EDGES. DYES ❑NO DYES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE COVER: BED/TRENC H NIDTH LENGTH: TRNO.EOFNCHES LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: : DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: V PESISTR. DDiSATR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.: ELEV.. DIA.. ELEV.: ELEVATION AND DISTRIBUTION COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED (INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY: PLANS. DYES ONO _ DYES ❑NO L~- NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: LINE: FEET FROM DYES ❑No DYES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) wlsconSln APPLICATION FOR SANITARY PERMIT , _ Awnnw~ DILHR (PLB 67) UNIFORM SANITARY PERMIT # - DEPfiQT 1E11T OF InDUSTRV, LH9- 6 HUMRn RELRTIOnS ✓ L~ -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPE TY OWNER N 14 P OPE T L,QCATION ILLAGE. 1/4 1/4, S , T3/ N, R /9)E (or) W LOT NUMBER BLOCK NUMBER SUBDIVISION N ME NEAREST ROA D , LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ Repair b"ew System ❑ Tank Replacement El Privy El Replacement Soil Absorption System ❑ Revision Reconnection El Petition for Modification ❑ ❑ Alternate System IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. El Seepage Bed El Holding Tank Seepage Trench ❑ Seepage Pit El Pit Privy El In-Ground Pressure El Vault Privy System In Fill issued ❑ Existing, For Which A Previous Permit Is On File, Permit # ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity U Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installa of the private sewage system shown on the attached plans. MPRSW No.: Phone Number: Name o lumber (Print): Signatur ~~S - (7 S ►z~. arm Name of Designer: Plumber's Ad ess COUNTY/DEPARTMENT USE ONLY Fee: Date: ❑ Disapproved Signature of Issuing Agent: ❑ Owner Given Initial Approved Adverse Determination Reason for Disapproval: Alternate coursels) of Action Available: DILHR-SBD-5398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber L INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit:, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.) ; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. . T APPLICATION FOR SANITARY PERMIT ST 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. - R- Owner of Property/0"5 C -L 7 Location of Property W 14 Section , T3/ N - R / b W Taw strtp 01,11ag Pa (r ie Mailing Address e- Icl~ f y Subdivision Name , Lot Number Previous Owner of Property J, o n sen Total Size of Parcel :3 • 44- acre s Date Parcel was Created Are all corners and lot lines identifiable? 7~-- Yes No Is this property being developed for resale (spec house) ? Yes No Volume ,I- and Page Number 4-4-as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eeht%6y that att statements on this 604m ane tn.ue to the best o6 my (oun) hnow.tedge; that 1 (we) am (ane) the owneA.(s) o6 the pkopen ty des c i,bed in th.i.a kn6onmati.on 6onm, by viAtue o6 a wannanty de neeon.ded in the 066ice o6 the County RegiAteA o6 Deeds as Document No. 2~g ; and that I (we) pn.eaentty own the ptoposed d.c to bok the .sewage pob system (o& (we) have obtained an easement, to hun with the above desen.i.bed pnopenty, 6o& the constnucti.on o6 said system, and the came has been duty neeon.ded in the 066.iee 06 a County Reg<.sten o6 Deeds, as Document No. 1. SIGNATU OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 4- Mo DATE SIGNED DATE SIGNED y • r ST C- 105 r v , y H . SEP'T'IC TANK MAINTENANCE AGREEMENT z St. Croix County 0 H OWNER/BUYER &efiA&L h CT] Fire Number ROUTE/BOX NUMBER p CITY/STATE CCU I r& 10 161, ZIP !V ! _4, Section-!2- , T~N, R~ , PROPERTY LOCATION: liv -W, of. ~f~rlr~ St. Croix county, UC(l a 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 pLimLer. 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 maj 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 t L progrn. "r of 1980, with the requirement that heir systems properly owners of all new sYStelAS agree to 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 H three year expiration. o E z I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Dep+rt- "b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED k& ~WW96~ DATE St. Croix County Zoning Office P.O. ~ox 93 Hammoid, W 54015 715-7'a6-2239 or 715-425-8363 Sign, date and return to above address. 2 N r - s N cn N 70 O W co o q O cD ro mc~ H o Qo cww~,~< .,cow > 3 or-coco O ~ A ° a cD cron ° N Z S O zr CD, C CD cn ro o -m ~ Q ° m o g ro CD 'c ro a vi' R 0 -0 _ m -t cnroho ~ororow Oro O O O < C- c n O Cc a O -0' 3 C: w Z (D c Q O ~ ~ w::r 1 ro w w w r- u) - c " - CD =3 C ° 1 O a o ro = w v, -ono-t~Z3 r. CD :3 :10 ro cr o' o c y c - CD G) ccnn p~ O- w c, n o = C: o ~ nom~o* V w n o -~aQCcwn c to 11 a CD (D D s-0 w _ (~7f O ro w En Z N N ro CD 0 CD =3 N ro CCD D a aro cn 9 Ica °o~o wp' c D CCD U) zr a c=n w (n a (D f11 n w a c c) * e CD _0 CD :3 ::r. 1 a cn ro « c (D o cn o cn o oc = c cn ° uroi u' ~":3 CD w W3CL ccnc~°nwo a 0 ro- ro N 7 acid CL - G7 a 0 Q :3 w 3 ro 3 (A o l< (a m 0 c a ° ro m CL O 7 O (ID ro- •e W CD w w n ce a c 0 CL "Af a- aro c o 3 CD N LO ° o LDINGS REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DEPARTMENT OF P.O. BOX 7969 INDUSTRY, PERCOLATION TESTS (115) MADISON, WI 53707 . =AND HUMAN RELAT-IONS (H63.090) & Chapter 145.045) TOWNSHI MUNICiPALIT LOT N .:BLK. O.: SUBDI SION NAME: LOCATION: SECTION- RU kor) n '%V~4 MA I G A DRESS: COU TY• WNER' YER' ME: ~f DATES OBSERVATIONS MADE USE PROFILE DESCRIPTIONS: PERCOLATION TESTS: NO.BEDRMS.: COMMERCIA DESCRIPTION: ~•New Replace Residence 3 X New S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUNT ( IN-GR1OUN15-PRESSURE: SYSTEM-IN-FILLHOL~DING TANK: RECOM NDED YSTEM(optior) 11) S EI U 0 I U EA. S S X1 U DESIGN A 4 E: If any portion of the tested area is in the If Percolation Tests are NOT required Floodplain, indicate Floodplain elevation: under s.H63.09(5)(b►, indicate: PROFILE DESCRIPTIONS W/ F SO r~~s.5~/1'►a~ CHARACTER OLOR, BORING TOTAL ELEVATION DEPTH GROUND EST.HIGHESTS TO BEDROCK IF OBSI RSV~ED (S EI ABBRV. ON BACK jEXTURE, AND DEPTH NUMBER ®EFf+i'tRk OBSER RVED C S 5 v 8~ 9t sv ? ®3 ~ 8? 7 B- 3 Z, /110 ~ fo ,~l . S.~G /ice T 7.5 6L, Z-7 A610 (L /..s-,1.. OC1~w ~f~ • 1317• '7 20- Z 5 ALA B- 6 1 .4, PERCOLATION TESTS DROP IN WATER LEVEL-INCHES RATE MINUTES PE ~D 3 TEST DEPTH, WATER IN HOLE TEST TIME PER INCH NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P- 3 A) 0 v 3 3 V l 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 ELEVATION1~ 99 3 . , 7 ; F I , I 1_70' TIL IOa TN x , d~ j i ` E I E - - E } I C(D'~1-~.~ A E • E , i lio , 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. \ tTT S WERE C OMPLETED ON: NAME (Print 8 06 TIFICATION NUM E : PHONE NUMBER(optional): Q/ J ADDRF,S~YY S URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - ' T RUCTION FOR COMPLETING M 116 - S BD - 6396 .J c=r-ate soil test, your resort must incluc:le: to w hell rhifi is -r commercial project; r 1, . >UITAB" 'z- TA_ = ALL k in; 1, A 2t; Xemp- 'e box; ti 12 L )IL TE: THE D ®ID Is xs rs si x e TT t - he county ° r i t rnav request ~~tsvate • Lei ~ I- 1 3 v C~;rY/6>7 6~~~~ 3~ I t a8 r be 8- S, fo ° L.i L C fT~ ~eJ Q / (Qt J g S~~ 72-71