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Home My WebLink About038-1065-30-000 V f n cn z t7 o w t~ n cn p C) cn p F: v c) d ®1 (D ~d H L 3 (D CD rt tjj n ? -A Ci T •a Fl- CD ~ c C _0 W ~ rte' e ~ ~ ~ ~ ~-y 00 • --1 2 u, z o rn p z 2 cn Z ° p o 'i Sil ~C O W~ fi j~ • 4 l0 Y' I fy O a C O - (D CIO H H \ o m co a o m 0 cyc 1 (D :7- 77 1L•%~ CD W 5 n m W!3 n v. w O N a N U N H j O CO 0 a W k r r-I Fv R C CD C p~ W CD Ul y y O. N v N O. :3 :3 0 € N d I r m(D ON co D a (n z D m i? e V- U-1 Imo - N w co (D CD N U, n h o o n ° ° ° O O 1I F- H H !4 j o o o hr O W A 21 £ r s j !si ~ cfl co ~ Z co (,n C) r Ul cD Oo 00 p CO I N Ut CJl Ul Q ai !V F-h rZ.' F- d o 0 cn E N o Co Co 3 o {o o ' 0 rt (7 rt -n 'p G < (D 7l "D C O O ps N N E 0 -4 --1 Fl- (a (n (n cn cc cn cn (n (D o' v O v . 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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 BILLY W & MICHELE A STANTON O - STANTON, BILLY W & MICHELE A 2187 100TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 2187 100TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 18.850 Plat: N/A-NOT AVAILABLE SEC 16 T31M R19W 18.85AC W 1/2 NW NW EXC Block/Condo Bldg: THAT PART OF CSM 5/1337 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 02/10/1986 409109 732/11 WD 05/23/1985 402169 712/495 LC 713/274 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 119108 263,200 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 25,000 144,400 169,400 NO PRODUCTIVE FORST LANDS G6 17.850 89,300 0 89,300 NO Totals for 2005: General Property 18.850 114,300 144,400 258,700 Woodland 0.000 0 0 Totals for 2004: General Property 18.850 114,300 144,400 258,700 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 n N O m v n d c v 4 3 fD O M .o CD v xt c 'D m 3 3 = U) z 3 N ° 00 (D 00 (D :03 g F, (D C° Z N W n N C (D N pD O) Q _CC n N -0 O l < O N W O off; v ~Wb 3 3 0 ° 7 N N) = O 0 ~1 N c !r y O co O w Cl) G D a A m :3 o o N W 3 CL c o o V 0 U) O - N C co ~ CD co co p O c 3 ~..rr z 0 0 0 5 " • z o r'3= -4 -1 -1 ~ , 3 m N - - N O O Cil CD cn O d , 07 -0 N Q0 ~y CD (n Q z d ' O r 3 Q c D D o 0 C: O :0 o' 5 a tr. (D W N a 3 Z O A ? n O O C _ W ~ C W Q1 a i N Z O Z O cc) W z A CD N O to N D I :3 CD 3 Q I o 3- 1 -n c °rn°c v oo0Qz a 0 ~v a U N O o N rn y z a x m 4~ a z 77 S ` 7 OO C CL N O O~ N I A O~ t, OQ V O ffl 0 N V C~ CD ~ CD ti Parcel 038-1065-30-000 01/03/2006 03:16 PM PAGE 1 OF 1 Alt. Parcel 16.31.18.2828 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 O - STANTON, BILLY W & MICHELE A BILLY W & MICHELE A STANTON 2187 100TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 2187 100TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 18.850 Plat: N/A-NOT AVAILABLE SEC 16 T31 M R1 9W 18.85AC W 1/2 NW NW EXC Block/Condo Bldg: THAT PART OF CSM 5/1337 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 02/10/1986 409109 732/11 WD 05/23/1985 402169 712/495 LC 713/274 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 119108 263,200 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 25,000 144,400 169,400 NO PRODUCTIVE FORST LANDS G6 17.850 89,300 0 89,300 NO Totals for 2005: General Property 18.850 114,300 144,400 258,700 Woodland 0.000 0 0 Totals for 2004: General Property 18.850 114,300 144,400 258,700 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 038-1065-70-000 01/03/2006 03:17 PM PAGE 1 OF 1 Alt. Parcel 16.31.18.2836 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 O - STANTON, BILLY W & MICHELE A BILLY W & MICHELE A STANTON 2187 100TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 1.100 Plat: N/A-NOT AVAILABLE SEC 16 T31 IN R1 8W W 1/2 SW NW EXC S 1130 Block/Condo Bldg: FT & EXC CSM 5/ 1337 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 732/11 07/23/1997 712/495 2005 SUMMARY Bill Fair Market Value: Assessed with: 119111 6,400 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.100 6,300 0 6,300 NO Totals for 2005: General Property 1.100 6,300 0 6,300 Woodland 0.000 0 0 Totals for 2004: General Property 1.100 6,300 0 6,300 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 038-1065-60-000 01/03/2006 03:17 PM PAGE 1 OF 1 Alt. Parcel 16.31.18.283A 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 O - MANTE, NORMAN E & JOYCE NORMAN E & JOYCE MANTE 1041 220TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 16 T31 N R1 8W E 1/2 SW NW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 119110 Use Value Assessment Valuations: Last Changed: 10/05/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 20.000 2,300 0 2,300 NO 10 Totals for 2005: General Property 20.000 2,300 0 2,300 Woodland 0.000 0 0 Totals for 2004: General Property 20.000 2,400 0 2,400 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 AS BUILT SANITARY SYSTEM REPORT . ) OWNER ~I-KJ 8_ f t-1 j~ TOWNSRRIR ' SEC -/Gy T?/ N-RI~W ADDRI,SS ST. CROIX COUNTY, WISCONSIN. o" tdi SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 _F+VFMTHING WITHIN 100 FEET OF SYSTEM - T-L ' I d i n e o th A ro SCkLL JI 13ENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: /60 Slope at site : r < SEPTIC TANK: Manufacturer:_ jt ,c~ (1/-S, Liquid Capacity: Number of rings on cover. : Tank manhole cover elevation: 'l'ank Inlet Elevation; Tank Outlet Elevation: PUMP CHAMBER Manufacturer)1 _ Number of gallons Nurnt)er of gal. pump set for a cyc e ~ gallons; tota capacity o distribution lines z gallon: size or pump head; p,al:l.on per minute horsepower bran name of pump ;trnd model number 't'ype of warning device HOL1):f.NG ANK: Manufacturer, Number of gallons _ E ~ation of manhole cover ypef warning device _ SEEPA(_,;i~ ;:'IT SIZE: - `--Number o pits feet diameter f< t liquid d''pt~i - seepage pit in eft pipe-elevation hgttom of seepage --pTT. t E.. evation feet. S 'AC . BED SIZE: number cif lines width _leitgth the depth Si. ' tot l'RE'NCH: width lengtll_ I:'l--:RCOLATION RATE _ 71~EQUT D ~ ;axi ~t RLA AS t3U LT sue."LLB INSPECTOR DATED PLUMBER ON J y~j~c~% _ x~ LICENSE NUMBER DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL 11 ALTERNATIVE State Plan LD. Number (If ass gn, 1 ❑ Holding Tank ❑ In-Ground Pressure ® Mound ;.Yp~/ NAME OF PERMIT HOLDER'. JADDRESS OF PERMIT HOLDER: INSPECTION DATE'. William Derrick RR#1, New Richmond, WI -"'?)Isre . BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.: SW NW, Section 16, T31N-R18W, Town of Star Prairie Nam,, of Plumber MP/MPRSW No. Cnunty Sanitary Permit Number: Gary Steel 3254 St. Croix 38543 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED PROVIDE ~~GG~~ ~il~'• VYES LINO ES LINO BEDDING'. VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD PROPE RTV WELL. BUILDING. (VENT TO FRESH _ ALARM - FEET FROM LINE: AIR INLET. DYES LINO DYE ~O NEAREST DOSING CHAMBER: MANUFACTURER BE DOING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER ,^p PROVIDED: PROVIDED: 1 r l~-y~" I[.1"i DYES LIT10 UU 3b r6r2,1 7YES LINO Us ES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. JNUMBER OF PH OPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN ) lrLI q 3 FEET FROM LINE AIR INSET PUMP ON AND OFF) ES LINO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ]LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN Z CONVENTIONAL SYSTEM: WIDTH. LENGTH NO. OF DISTR. PIPES ACING COVER [INSIDE CIA UPITS LIQUID BED/TRENCH TRENCHES MATEHIAU PIT _ DEPTH DIMENSIONS - GRAVFL DEPTH FILI_ DEPTH JDPIPF DISTRPIPE M ERIALNODISTR NUMBER OF PROPERTY WELLUILDINGVENT TO FRESH BELOW PIPES AOVE COVER EEV.INLET ELEV. END PIPES FEET FROM LINE'. I AIR INLET: 1 Z f NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ES ❑ NO SOIL COVER EX URE PERMANENT MARKERS OBSERVATION WELLS YES LINO YES NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH; BED DEPTH OF TOPSOIL SODDED SE EDED MULCHED CENTER EDGES. , ❑ YES U NO YES 1:1 NO YES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES. DIMENSIONS cv.to ryCr ~ ~ f I/ MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR ELEVATION AND . DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING EL EV.. ELEV CIA ELE... PIPES. DIA: DISTRIBUTION ! 7 2 "1 / INFORMATION HOLE SIZE H LE SPACING DRILLED CORK ECTLV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED /f/~j Z ~~s„1.,.r.=. PLANS v YES NO -YES LINO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: ✓ NUMBER OF PROPERTY WBUILDINGFEET FROM LI"~' YES ❑ NO ES ❑ NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TIT LE. .rF DILHR SBD 6710 (R. 01/82) 1 i I DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PL13 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: ~ ~ 1 yn-o-~ - al~l , 04 1 All g Property Location: i y, ge or Townshi County`: k3 N4 /NUNS /6 /T._3 / N/ R E (or) W Z;~ 1747-9"~ wT r ~ L :rStfa.t, 6 v Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: Plan I.D. Number: sig~e _ TY PE OF BUILDING LL'~~ Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. `Z TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER 6- L/ MANUFACTURER: C~ EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit SO 91 Alternative (specify) &20 a d E] Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation the private sewage system shown on the attached plans. Name o tuber: Signature: /MPRSW No.: Phone Number: Plumber's Address. Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing ent: tAA) ee: Date: APPROVED Sanitary Permit Number: 'r fs3 /tO ® b'~7` ❑ DISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (R.07/81) J , ra^~eNT - I ADO' i°C~i f ~ l ~ ~E~EIVED 12,1983 a fi x+ i s ..J J f fi z + r ~ s`'/. ;,AF ?4 ~f,.J "4 ~ ,~j .,r''~ - s'~ ~ +1,~'"+~ r+ ^w`• y r`~ i ~ STATE OF WISCONSIN DILHR DIVISION OF SAFETY & REAU OF PLUMBING BUILDINGS 0 LHR PRIVATE SEWAGE SYSTEMS BU -••.w - 201 E. Washington Avenue, Rm 178 PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707 608-2663815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The back side of this form describes required plan information. Plumbing codes can be purchased from the Department of Administration, 202 South Thornton Ave., Madison, Wisconsin 53703, Telephone (608) 266-3358. Document Sales, 1. PROJECT INFORMATION (Type or print clearly) Name of bmitting Party (Plans return d to same) Pr i ({ffff t Street & No. Project Location - Str et & No. or Legal Description , tA~ 4- H. 9P) L? A City ` State Zip Code ❑ City / County ~ ❑ Village / ' i , j'f I ~~f~,"~ ! ~ X 't"-~J ~ Town /1 f~ esigner Telephone No. (Include Area Code) 2. THIS APPLICATION IS FOR A: New Mound System (3) ❑ Holding Tank (2) ❑ New Pressurized System on site not suitable ❑ Petition For Modification (6) for conventional (3) ❑ Replacement Mound (4) ❑ Replacement Pressurized System on site not ❑ System in Fill (1) suitable for conventional (4) ❑ System in Flood Fringe (1 ) ❑ Pressurized System on site suitable for ❑ Groundwater Monitoring (7) conventional (1) ❑ Conventional System - Public Building (1) czFGEw~~ 3. FEE COMPUTATIONS (Include existing tanks) 4. FEE SUBMITTED UG 1w~ FOR OFFICE USE 3a. 750- 1,500 gallon septic tank - 30.00 4a. B`NG B~g~~U 3b. 1,501 - 2,500 gallon septic tank - 40.00 4b. ~M 3c. 2,501 4,000 gallon septic tank - 55.00 4c. 3d. 4,001 8,000 gallon septic tank - 70.00 4d. 3e. 8,001 12,000 gallon septic tank - 85.00 4e. 3f. Over 12,000 gallon septic tank - 100.00 4f. 3g. 500- 1,000 gallon pump chamber - 30.00 4g. `-!n nn 3h. 1,001 - 2,000 gallon pump chamber - 35.00 4h. _ - - - 3i. 2,001 4,000 gallon pump chamber - 50.00 4i. - - 3j. 4,001 8,000 gallon pump chamber 65.00 4j. 3k. 8,001 12,000 gallon pump chamber - 80.00 4k. 31. Over 12,000 gallon pump chamber - 95.00 41. 3m. 500 - 5,000 gallon holding tank - 30.00 4m. 3n. 5,001 - 10,000 gallon holding tank - 40.00 4n. 3o. Over 10,000 gallon holding tank - 50.00 4o. 3p. Groundwater Monitoring - 32.00 4p. - Subtotal i~ 3q. Priority plan review: (walk through) 4q. Submittal of plans in person, by appointment, with double fee 3r. Petition for Modification Setback - 20.00 4r. - Site evaluation - 50.00 Total Fee ~2 C3 -+~C) COMMENTS: DILHR SBDfi748(R. 5/82) - -OVER- 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: To wnsh ip /MNff F KKF4: SW-41 NW ~41S 16 IT 31 N/R 18 >KO*3W Star. Prairie St.Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: William Derrick RR#I, New Richmond, WI 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 aY"&V&P by an alternative system and further agree to give the buyer a copy of.this ~~a3 application. ~i?~ ~ The Bureau accepts this application subject to this understanding and s ,lgG to all the conditions and obligations set out in this application. , C2 Z-e.- - -,ei Signature of App icant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY 0 This day of 197 10M HOP, Notary Public State of Viisconsin iYblic, Stat of Wisconsin My Commission Expires a*~O/, DILHR-SBD-6413 (N. 05/81) ~ ST. CROI X COUNTY 4 WI SC O N S I N ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 July 29, 1983 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear sir: An on site investigation for the William Derrick property located at the SW-4 of the NW-4 of Section 16, T31N-R18W, Township of Star Prairie, in St. Croix County, revealed suitable soils at a depth of 2.58 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Yours truly, Thomas C. Nelson ' Assistant Zoning Administrator TCN:mj ~llG 12~ 193 ~l,?-rl- 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, NW 1/4, Sec. 16 T 31 N, R 18 &)410 W Town or 'SXTWA%# Star Prairie Street Address Lot No. , Block Subdivision Landowner's Name: William Derrick The application for this site is for: Q new construction use. replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: .Ix]to have one of the first five approvals guaranteed for this year. This is number 59 - 08 - 4 of those applications. (Use one of the first five quota num ers issue d to you.) one of the applications needing a quota number. The quota number assigned to this application is - - [_]for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. Ifor 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. I ]for an application on file prior to February 1, 1980. L.]for a lot that meets the criteria for a conventional private sewage .system. If this is a REPLACEMENT SYSTEM USE, the alternative private system is replacing: F3F []a failing conventional soil absorption system. Au G 1 1383 [_]a holding tank that was installed and in use prior OpOifbr~y` 980. LJ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check here .F] I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Signature a V1,,,a l'_, County Official Title Assistant Zoning Administrator Date July 29, 1983 DILHR-SBD-6158 (R 12182) n) "ARTMCNT OF REPORT ON SOIL BORINGS AND SAFETY tk BUILDINGS INDUSTRY, C DIVISION ABOR AND PERCOLATION TESTS (115) MADIS N BOX 370 HUMAN RFLA-FIONS (H63.09(1) & Chapter 145.045) - - t OCATION SEZTI~N TOWN HIP/ PAt 1TY: - LOT NO BLK NO SUBDIVISION NAME Vj vj1/4 /13-1 N/R~ F E (~i1W~ f~ N ~6)ONT'y OWNLR ~IHUYE'H ;AME MA LING ADDRESS. I , a _~~11 0 ' ~~lYt__~1 r ► f~_~ _1? ~-0_ 1 A?_k~ )SL DATES OBSERVATIONS MADE ~ PROFILE DF`.i(HIPTIONS {'FRZ`.(5l ATION TFSTS NO. BH)RNL. ff L COMMFRC`IAI DFSCRIPFION I Retiulenre ),{New I _JItr lice l _5 _93 i4A71NG: S- Site suitable for system U- Site unsuitable for system .ONVE Nl IONA1 MOUND IN-GHOUNI>'PilFSSURE; SYSTEM IN-F-I I L BOLDING TANK. kECOMMENDED °YSTEM (optional) 1-1 S [AU l it L citofanun icsis eie NOT ieyuiied DESIGN RATE: If any portion of the tested area is in the ' nilei s.1-163.0915) (b)indicate I Floodplain, indicate Floodplain elevation. - _ - L~.----_._7__. - _ PROFILE DESCRIPTIONS lii)filN(; TOTAL PTH TO GROUNDWATER INCHES CHARACTER OF SOIL_ WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER Ut"'KtN, ELEVATION OBSERVED_ ES I HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B -I zs 03 /1a Z8 t~ L93 , ~3 83 . s. cJ 9 t- cis 5 z 00 B-, S8 X11. S. n . S. ,L . n . 5, ~z . I<J !~o - B- B- BUG 12 19 t ,IM ) PERCOLATION TESTS TFST DEPTH WATER IN HOLE TEST TIME _ DROP IN WATER LEV L-IN ES RATE MINUTES NUMBER 4N+;44ES AFTERSWELL.ING INTERVAL-MIN. PLR L4_D _ P PER INCH 10 1.L1 P :'LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances: Describe what are the hon untal 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 ,I la''d slope, SYSTEM ELEVATION rT; 8M. =)00 7a Y'n Ar+ ~ E r p, pt 3.7 4 3.5. Acr£S o tIr 13 -3 fi C i P-3 SIC- I i, ihn undr.rsn~neel, hereby certify that the -'Soil tests reported on This lofnt ware made by me m accord with the piocodures and methods apeelfied in tilt. Wisconsui i.linuustrattve Code, and that the data racurded and the location of the tiisls aie cooed to the best of niy knowledge and belief. 'i!•Mf (pruu) ILSTSM-10: OMPIETI_DOW ADDRESS ~ CERTIFICATION NUMBER: PHONE NUMBER(opuonil). CST SIGNAT H iISTRIBUI ION. Ot,ginal,ini one copy io Lur,J Authiiiity, 11,opelty Ownei .inl Soll Itstei IR O2,'tS71 tiVFH S OPTIONAL WORKSHEET '7 11. IN-GROUND PRESSURE SYSTEM-Continued- 1. MOUND SYSTEM F: k L", 10. Force Main: l•; m. 1. Wastewater Load, Total Daily Flow = gal' Minimum Dosing Rate gp = Use section H 63.15 (3) (c), Wis. Diameter = - - in. Adm. Code and PROVIDE A DETAILED 11, Total Dynamic Head: LIST OF SIZING ON PLANS. 5~ = D 2.5 ft. t. _S Ja i ft. 2. Depth to Limiting Factor = JC_ f System Head Vertical Lift 3. Landslope = % t ft. Friction loss 4. Distance from Dose Chamber to I ft. -J! ft. TDH = Distribution System = 12. Pump Selection: 5. Elevation Difference Between = ft. Pump will discharge at least gpm Pump and Distribution System at~.~- 1 ft. total dynamic head. 6. Absorption Area Sizing: h~~ Pump model and anufacturer: c=' - Area Required = -Z ~-sq. ft. r- Bed or Trench Length (B) = ft. y~ ft. 13. Dose Volume: Bed or Trench Width (A) = 10 Times Void Volume of Trench Spacing (C) _ ft P0gal. Distribution Lines = 7 Mound Height: Daily Wastewater Volume I ill Depth (D) _ ft. gal. ft. 4 Doses in 24 hrs. Fill Depth Downslope (E) = r., Backflow = jn, gal. Bed or Trench Depth (F) ft gal. 1 ft. Minimum Dose = Cap and Topsoil Depth (G) = 14. Dose Chamber: Cap and Topsoil Depth (H) _ ft. gal. Volume = 8. Mound Length: End Slope (K) ft. P ft. I11. 'ONVENTIONAL PRIVATE SEWAGE SYSTEM Total Mound Length (L) = ll• 1, Wastewater Load, Total Daily Flow = 9. Mound Width: Qi5 Use section H'63.1'5 (3) (c), Wis. Upslope Correction Factor = din. Code and PROVIDE DETAILED Upslope Width (J) _ ft. 1, /d LI OF SIZING ON PLANS. Downslope Correction Factor = gal. 2. Require eptic Tank Capacity = Downslope Width (1) ft. 3• Percolation to = min./in. Total Mound Width (W) ft. 4. Absorption Ar Sizing: 10. Basal Area: Refer to Table in chapter H 63 Infiltrative Capacity of ►7[~ and PROVIDE A TAILED TOE Natural Soil gal./sq.ft./day i sq. ft. SIZING ON PLANS. Basal Area Required = Required Area sq' 1t' Basal Area Available = sq. ft. ft. Length - 1 I. If Standard Tables from Chapter Width = ft. H 63 are Used, Indicate Table No. Number of Trenc s = 12. For the Distribution Network, Use Numbers 5-14 in Section IL Trench Spacin ft. 5. Distribution Sy m: it. It[-GROUND PRESSURE SYSTEM Lateral Le gth = ft. 1 . De"~1th4q•l imiting Factor = - = ft Q Late 1' o~Numbe of Laterals = 2. Landslope Later Spacin9- Percolation in. 3. Rate rnin./in. 1g D' ance from Sidewall to Pipe = in. 4. Pro fem Elevation ft. V}~ stem Elevation = - Wastewater Load, -total Daily Flow: _ gal, N ~c• v Usa section it h3J'; (1) Wis. SYSIEM-IN-FILL Adm. Code and PROVIDE A DETAILED Fill in All Items from Section 111 LIST OF SIZING ON PLANS. Required Septic Tank Capacity gal' V. SEPTIC TANK 6. Absorption Area Sizing: C( gal. Percolation Rate o = min./in. 1. Capacity Area Required = 5c) sq. ft. 2. Manufacturer: y System length ft• 3. Show Site Constructed Tank Details on Plan System Width - ft. VI. DOSING LANK r 7. Distribution Pipe Sizing: Q - gal. Hole Site = in. 1. Capacity = t~ ~`F s Holc Spacing ft. 2. Manufacturer: It, I. Pump Manulaclurcr: Lalcral Lcnglhr:'(-~~ 1 I_,rleral Siic in. Pump Model: Operating Hcad== LL•~~. tt. I ,ilcral Spacing I 5, Opc l•~ = gpm. Ui,I,rncc lrrnu Sidcw.ill lu I'ipc 1.1+-- in• b. Ilow Rate= 8. Distribution Pipe Discharge Ralc: 7. Show Site Constructed Tank Details on Plans Number of I loles Per Pipe To - NK I low Per Pipe gpm. VII. µ~~~ING I A z 9. Manifold Sizing: J^ I . Capacity -gal. 2. Mallul-Curer: I ype (auucr or end) Length = ft. 3. !jpyl. 'tcCnfi trucled Tank Details on Plans Diameter = - in. -SHOW ALL INFORMATION ON PLANS- -123- HR SBD-6761 (R.03/82)~ C- dIJ ~l All 0 1, x 2 N ! ITT r r Page - Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand _ H G Topsoil F D 3 E 8 % Slope Bed Of 2"_ 2 %Z Force Main Plowed Aggregate From Pump Layer D Ft. E Ft. ~ Cross Section Of A Mound System Using - Ft. F , 15 A Bed For The Absorption Area G Ft. ♦ A Ft. H Ft. 4 ( ~ Signed: 6 z Ft. License Number: Z 6- K ~Q Ft. 0 -ID Date: J 8_ Ft. AUK' 1,?, Alternate Position Ft. its=''``" of W Ft. Force Main - L 71- Observation Pipe--,, J B K -.74 A -71- Force Main _ Distribution Bed Of 2 - 2 2 Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area -114- Page _ Of Perforated Pipe Detail 0 End View i j ~Perforoted End Cap) j PVC Pipe ' f . - ooze , ,40(` Holes Located On Bottom, Are Equally Spaced S r.. PVC Force Main P PVC rG ~Elv~~ Manifold Pipe J Alternate PasN~ GOP Distribution Force Main Pipe Lost Hole Should Be_ Next To End Cap End Cap Distribution Pipe Layout P z rJ Ft. R 3 S X 20 Inc.hPS' Y Inches Hole Diameter / Inch Signed: Lateral / Inch(es) License Number: PZ. Manifold Inches Date:' Force Main Inches #of holes/pipe ° r# Invert Elevation of Laterals-Y= Ft. -116- PAGE OF I' PUMP CHAMBER CROSS SECTION AkJD SPECIFICATIONS VEAJT CAP 11"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIAIG 1UNCTIOIJ BOX MANHOLE COVER ?-5' FROM DOOR, WINDOW OR FRESH 12'MIU. I 1ovvp , tt AIR INTAKE I u ~wr GRADE 4" MIN. IB"MI~1. CONDUIT K JAJLET PROVIDE I AIRTIGHT SEAL APPROVED JOINT A I i I APPROVED JOINTS W/C.Z. PIPE I I (I W/C.=. PIPE w I EXTENOfNG 3' II ALARM EXTENDING 3' ONTO SOLID SOILONTO SOLID SOIL B .A R,rq-~sar G~ 4 I I ON C ( ELEV. FT. PUMP - OFF ~ ~ 121983 r D CONCRETE BLOCK:` RISER EXIT PERMITTED GIJLH IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E 5PC CIFICATIDUS DOSE TANKS MANUFACTURER " ` Nl1MBER OF DOSES: PER DAy TANK :,IZE h' GALLONS D05E VOLUME Y ALARM MANUFACTURER: IAICLUDIMG BACKFLOW: -LO? GALLONS MODEL NUMBER: CAPACITIES: A= )-0 INCHES OR 44 ? GALLOU5 B =~i le~ GALLOKI$ SWITCH TYPE: INCHES OR PUMP MANUFACTURER: C = IIJCHES OR///, 4' GALLONS MDDEL NUMBER: c" ~ 2 W r a, D = -I_ IKICHES 0P GALLONS SWITCH TJPE: MOTE: PUMP AMD ALARM ARE TO BE INSTALLED ON SEPARATE CIRCUITS MIA.IIMUM DISCHARGE RATE i GPM VERTICAL DIFFERENCE BETWEEAJ PUMP OFF AND DISTRIBUTION PIPE.. S FEET + MINIMUM NETWORK SUPPLY PRESSURE , , , , , , , , . 2.5 FEET Z a , } I , FEET OF FORCE MAIN X G' F o Ft FRICTION FACTOR. ~ O FEET -1-r>< R LX 13 TOTAL DYNAMIC HEAD = FEET INTERNAL. DIMEIJSIONS OF TANK: ~H ;WIDTH ;LIQUID DEPTH C c n c n , ICEUSE _NUMBFR: sf L DATE: Y/ Model 3870 Submersible Effluent Pumps 140 120 ~A 's A 100 0 LL { 80 ~Yp E ~lS 1'r, c H, p ° wp'y~o c 60 rhp rVpN %hp 40 wp~o5, r: /y p y WPM03, 1h N.P. ~cE,v 20 WP003, vH.P AEG 121ga3 r v`•~- P 0 20 40 60 1 80 100 120 Capacity - Gallons Per Minute 1 Max. wt. j / H.P. Order No. Volts Phase Amps RPM "kb Vb$-) WPO311E 175 94 4 ? 9) WP 312E E 1750 56 WP02E WPM0312E 230 im 4 7 WPHO511 E 115 .-460' WPH0512E 230 8,0 WPH0532E 208/230 3.4 60 WPHO534E 460 3m 17 WPH0712E 230 10 90 WPH0732E 208/230 5.4 WPH0734E 460 3m 27 70 WPH1012E 230 10 11.6 3450 1 WPH1032E 208/230 6.4 30 WPH1034E 460 3.2 WPH1512E 230 t0 133 W PH 1532E 208/230 92 WPH1534E 460 30 4,6 80 ih WPHH1512E 230 10 13.3 { I WPHH1532E 208/230 J 3m 9 WPHH1534E 460 2 46 SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. 3 gtgl 1' ST. CROI X COUNTY i1 M. WI SC0 N S I N ZONING OFFICE 796-2239 (HAMMOND) 425 8363 (RIVER FALLS) HAMMOND, WI 54015 July 29, 1983 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, Wl 53707 Dear sir: An on site investigation for the William Derrick property located at the SW~ of the NWT of Section 16, T31N-R18W, Township of Star Prairie, in St. Croix County, revealed suitable soils at a depth of 2.58 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Yours truly, 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 AlternatiN-e Private Sewage System In the County of St. Croix Location SW 1/4, NW 1/4, Sec. 16 T 31 N, R 18 EFX)6 i`) W Town or KIM4 WX,~ Star Prairie Street Address Lot No. , Block Subdivision Landowner's Name: William Derrick The application for this site is for: 0 new --onstruction use. ❑ repl 3cement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: 1XIto Dave one of the first five approvals guaranteed for this year. This is numl-er 59 - OB - 4 of those applications. (Use one of the first five quota nl m5ers ssueoto You.) I lone of the applications needing a quota number. The quota number assigned to ttlis application is L_]for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. Ifo• 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. L_]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: L_]a failing conventional soil absorption system. L la holding tank that was installed and in use prior to February 1, 1980. D a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check here. L1 I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Signature _ l".._, County Official Title Assistant Zoning Administrator Date July 29, 1983 DILHR-SBD-6158 (R 12182) STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING F- P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Towns hip /MdAkcA_A6 A XF4: SW'- 41 14 S 16 T 31 N/R 18 K(b&3W Star Prairie St.Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: William Derrick RR#I, New Richmond, WI 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 My Commission Expires: DLLHR-SBD-6413 (N. 05/81) Department of Industry, Labor & Human Relations Wisconsin Division of Safety & Bldgs. State of l Bureau of Plumbing Platting & Fire Protection P.O. Box7969 Madison WI. 53707 2~ V Tel. 608-266-3815 f~y~~~ X983 ~ Ict IN AL L CORRESPONDENCE REFER TO PLAN IDENTIFICATION NO. jf NAME OF PROJECT 1 TYPE OF APPROVAL STREET AND NO. CITY OR TOWN UNTY STATE ZIP OWNER Gentlemen: Examination of plumbing plans and specifications for the above-mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. to the event installation of the plumbing improvements or system-.has not commenced within two years from this date, this approval shall. become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. Sincerely, / For Private Sewage Systems ORIY: This approval is valid for two years or it will be valid until the expiration date of the initial sanitary permit. James Sargent-Bureau Director PLANS REVIEWED BY: DATE: cc: DPS-OWS Owner DI LHR Local PI Plumber H & R (2) County Mfg. Rep. Bur. of Health Fac. & Services DILHR SBD-6099 (N. 06/80) Rec. & Env. Services 1'o rm - S T C 100 Owner of Property WIwi4M G.K- ~2. Location of Property W =4 1AW Section etc T -61 N R (B W Township ~'j C- ya2AtIRA6 Mailing Address NreW V-44 4 NA00b, \A/1 Subdivision Name l`l~d► Lot Number N A Previous Owner of Property I-4W"W-e- L.AZS0i4 Total Size of Parcel Z.?j QLmS Date Parcel Was Created ~E ss. I-Orls ^ Are all corners identifiable? x yes No Include with this application one of the following; .Certified Survey Map .Deed .Land Contract, or .Other I:egal Documeut which describes the property I PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 76'11 010 ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. C;A SIUNATURE OF OWNER 51GNATURE OF CO~OWNER (IF APPLICABLE) A -A L-% t,S-r ~Z, ~4a3 DATE SIGNED DATE SIGNED