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CROIX COUNTY y, t.~ _ WISCONSIN ~S`' ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 January 13, 1986 L Bruce Plomski Luck, WI 54853 Dear Bruce: We have been holding the Sanitary Inspection Sheet for the following system (s) Wayne J. Rivard - Town of Star Prairie Jack A. Brust - Town of Star Prairie Please turn the As-Built into this office as soon as possible, so that we may complete our file. Until such time as all As-Builts are received by the Zoning Office., no further permits will be issued, or inspections made. If you have any questions, please feel free to contact "nis ut icc.. Sincerely, Thomas C. Nelson Assistant Zoning Administrator mj :1/86 Parcel 038-1065-95-000 01/24/2006 10:10 AM PAGE 1 OF 1 Alt. Parcel 16.31.18.283E 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 JACK A & DEBRAH R BRUST O - BRUST, JACK A & DEBRAH R 2155 100TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 2155 100TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 4.140 Plat: N/A-NOT AVAILABLE SEC 16 T31 N R18W 4.14A IN SW NW LOT 3 OF Block/Condo Bldg: CSM VOL III PAGE 730 ALSO KNOWN AS LOT 3 OF CSM 5/1314 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 16-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 119114 286,400 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.140 42,700 238,800 281,500 NO Totals for 2005: General Property 4.140 42,700 238,800 281,500 Woodland 0.000 0 0 Totals for 2004: General Property 4.140 42,700 238,800 281,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 306 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 AFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING ,IADIS" )N, WI 03707 Ell CONVENTIONAL InLTERNATIVE I,ld1e~h~l0 vameef 1 (1f assp~w71 _1 Holding Tank ❑ In-Ground Pressure k7- Mound 8502446 .:DAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER'. INSPECTION DATE. I Jack A. Brust I R. R. 1, Box 215 C, Dresser, WI /7-1? 1 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.. CST REF. PT ELEV. ISW NW, Section 16, T31N-R18W, Town of Star Prairie N,~me of Plumber MP;MPRSW No. Cou>>y eSanita , Pe.mi; Number !Bruce Plomski 5849 St. Croix ! 64903 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ENO EYES ENO BEDDING: VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: PR OPERTV WELL. BUILDING. JAIR VENTTO FRESH ALARM (FEET FROM LINEINLET. DYES ENO DYES ENO_IEAREST- DOSING CHAMBER: MANUFACTURER BEDDING'. LIOUI I CAPACITY PUMP MODEL =NLIIACTIIHIH WARNING LABEL LOCKING COVER PROVIDED PROVIDED: DYES ENO DYES ENO DYES ENO tGAN PER CYCLE: PUMP A ND CONTROLS OPERATIONALNUMBER OF ROPERTY WELL BUILDING VENT TO FRESH NCE BETWEEN FEET FROM NE AIR INLET AND OFF) DYES ENO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LING rH DIAMETEH 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 CONVENTIONAL SYSTEM: WIDTH LENGTH NO. OF DISTR. PIPE SPACINC_I. COVER INSIDE DIA =PITS LIQUID BED/TRENCH TRENCHES MATERIAL. ( PIT DEPTH. DIMENSIONS GHAVFL DEPTH iIFILL DEPTH DISTR PIPE DISTR PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BFLOW PIPES ABOVE COVER. ELEV. INLFT ELEV. END' PIPES FEET FROM LINE. AIR INLET. NEAREST- ► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ENO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ENO DYES ENO . DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL. SODDED SEEDED JM CENTER EDGES DYES NO DYES ENO DYES ENO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES I DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING E LEV.. ELEV. DIA. ELEV.' PIPES DIA.'. ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS DYES ENO DYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROF ERTV WELL. J BUILDING: DYES NO DYES ENO NFEE FR EARESOM - Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. [ITLE. DILHR SBD 6710 (R. 07/82) Wisconsin APPLICATION FOR SANITARY PERMIT ~~DILHR (PLB 67) -7 UNIFORM SANITARY PERMIT # i inOUSTRY,LAROR HUMRnRELRT1or1 J & 1V 9 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROP MAILING ADDRESS _jRTY OVVNEF3 4J( /I PROPERTY LOCATION Sl~j 1/4 1/4,S T3 /N, R 1'~Ft (or) Vill _A -TOVVN OTt-- 1 LOT NUMBER JBILOCK NUMBER ISUBDIVISION NAME RESTROAD,LAKEOR ANDMARK STATE PLAN I.D. NUMBER 7 /6 6 -tk, si;~ I ap.,~-C,2 Wll~,~ TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. Public (Specify): THIS PERMIT IS FOR A: New System Ll Tank Replacement Repair Replacement Soil Absorption System Revision Privy Alternate System Ll Reconnection Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. 0 Seepage Bed D Seepage Trench Seepage Pit EJ Holding Tank EJ Systern-In-Fill 0 In-Ground Pressure Vault Privy El 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 /6 C, IS A Lift Pump Tank/Siphon Chamber 6() C1 X Holding Tank capacity manufacturer: AA ob t- /-Z'4 IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: Mound F-1 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): 99 7/jo'- 3-,7d- J( Private L:1 Joint El Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): _-T,,71natur MP/MPRSVV No.: Phone Number: '-4 fe A, _mbe_r~ Address: NWf e. ,,,zer- -7~ 61 COUNTY/DEPARTMENT USE ONLY SignatVre of Issuing Agent: Fee: jDate: El Disapproved Owner Given Initial co Approved Adverse Determination Reason for Disapproval: 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. 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 - ~e~irc7 fem., k-' Location of Property SGtJ Jt 12 6ti k, Section T j N - R W Township Mailing Address V Subdivision Name Lot Number Previous Owner of Property ric %s - Total Size of Parcel Date Parcel was Created ,~2 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes_ No Volume ( - and Page Number rS' 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) eeAti 6y that att s tatement6 on this 6o4m ane true to the be.6-t o6 my (oun) knowledge; that I (we) am (ahe) the owne&k) o6 the pnopehty de6CAbed in ,thiA in6o4mati,on 6o4m, by vi&tue o6 a wa"anty deed heeonded in the Oj6ice o6 the County Reg-iAten o j Deeds " Document No. -s ; and that I (we) pneb entt-y own the ptopoa ed 6 to bon the a ewage poa a y6.tem (ox I (we) have obtained an mement, to n.un with the above ducAi.bed pnopexty, bon the conat&uCtti.on o6 said 6y,6tem, and the name has been duty ucon.ded in the Oj6ice o6 the County RegiA teh o6 Deed6, ab Document No. ? 716 ~2L- Z SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H C!1 H y ST C- 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d j H OWNER/BUYER ✓c~ L ji ✓C2r~ / S <y ROUTE/BOX NUMBER f 2Z !5 Fire Number CITY/STATE Dl-~ C 5 ZIP ) yc)<> j PROPERTY LOCATION: , 14, Section_ T j N, R_/,~__W, Town of 6tZ>~ rl St. Croix County Subdivision Lot number I 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 E 'L 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 Depart- 'b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED- DATE a~j f 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. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON WI 7969 HUMA►~~'LA'bONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHI MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: s►,J/"',~/ 16 /T31 N/RISE (or s wmalE COUNTY: OWNER'S BUYER'S NAME: MAILI G DDRESS: C ~X j/ C 5 w' S 0 USE DATES OBSERVATIONS MADE NO. 1EDRMS.: COMMERCIAL DESCRIPTION: PROF D P ONS: AT ON T ESC Fb~ Residence 4 New ❑Replace t/ p5~ 34;~ RATING: S= Site suitable for system U= Site unsuitable for system 7 Ai 9 d CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) W~11cR Ds MU NS ❑U ❑S U OS U EIS ZU mouAjz If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: /V,4 ~Floodplain, indicate Floodplain elevation: u j do PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) 0-.9 VaKGyDn. it- r /.1 2),t A, L.S w,9r, .2- r B- 7• S 9S ~.9 See ,2. y ' I B !s 3.o R.Dn S~ 8r,Ille w Gmct s/rl3n ~ yR a+ef RRn '61 63, e), Gi'Sn )S rq , re ,W Cm Ao seep B- y/-yS Aan by /-c~ gwna~. p p_ . V. ox xy / / .9 - ..3, a--h s 2.3 -3,S/ RB„ ltrJ - B- .Z 3•~ 7 7 Q 0 AAE >a • 3 I -.S,S~I? Lin Sfrj, lend S/ br,Yle w o►, moTf i' Go r ' B 3 98.E /VoNF ~•oZ,p~ 0 -.7 Y. 4k cyQjj S / .7-/. 5' Gxa„ -a„ s/,A5_-?.6Bn- 964 V - C ! S ,d ~t t WI )NA B- 3.0 ~y2- a ~E 0-.8 Voa cyB„ /-5-1 ,.8-/.s Gyeh ,/.sh"y5 / cl logy 7~. iolW 0 a~ o r rl BS uT.o ~9•~ /VU~II~ }50~ 0-.78/ 1,.7 ~On/s- s/ /•9-2.6'kDn"°' M%0( 31-K V 'Y 6 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD PERIOD PER INCH P- E 3o a U, V / 12.71 P- o J c 9 01 IF P- ~9'~J d k E 13 r .2 P- P- P~ h!e s~~ ~i 7~ - 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 percertt of land slope. SySfe'n oel ew'lan rs / ~ ~tppt/`, Tj(C 25~/rgq~P~ SYSTEM ELEVATION 49.0 IfnoY -457 6 e zYa~'°" d/ . l f h t' asp ;o~ tyl n ; m ~,~'ve i"_ rn~ ,w~r:,~ i f I [ I Ifu~ola a.ol• I~~~~ a f S/d,x rvar,ke Go rn ~r d f 4raJ y Sf,~ce /S Vi~+.KI• I /57 SF Gnr~ drt v3 1_ W O a ~aT SS Iv An eGf 2I - ~7 I i a 11 CL L7 tr a c, _ 01 I IN ~uI °L~ )aU r I . ~ I'I ~I a.re_Cr~ . ~ I ~ ~ ~ I ~ ~ I ~~°c I i I- fy of / C_ 01 ~!l r~ IleS ` ["eL,~I Arc ' Cr ! _ ,o ' I i h , f Ir! 2.~I91(I70~ h~, S sl IY121 l'h• _ ewer at-1 0 e~ ! I C ~h~JeS et`e Usl er`' 1 l LJ I n r r n 71 r ';6j, U ( 5 le /255 Wit l1? . . I 7 r, I r4-c r CS wort s/otAj et" aS wo~Cer /e✓e s Jragaj (~a.stneJ,j,1 ~ o r p of~ I, the undersigned, hereby certify that the soil tests reported on this form were made me in cord with the cedures and ~ds r~irt.N ' consir} 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 WER COMPLETED O / Z _74 ADDRESS: CERTIFI ATION NUMBER: PHONE NUMBER (optional): 1 V9.6- 33,69 CST SIGNATURE! l DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - M O w L r Q > O 0 C u1 Ea o • E 0 c- 3 a 4 O p L O j= j U cif O w C W%,% (D 'C C U) V i O -0 0) 0 C O O 4 o a i cn C C O U m 0 (n Ln, c Co c M o vi o -10 cc - W M cCU W = 3 00Z 3 °c to 70 E in c 0) j - j ` a (D (D U > O O~ O EJ C c0 0),o C U N N i N O O U) C W ►-cc~occaN Vai 00) o CL 3030= 6 .,"r- O'D c v M C C U O O N a W o L 0 L ca ~C Q N C N 0 v~ a~ O Q O L L U E U F- O N O C O cc IL Z Q 0) F- C (b O cu y Z (1) m- C O cn O~ C m (n - cua ~c .0 v m c o w CU O 3 0 o o a L~ U C O D U RS L U 0 C7 '-a' o ..cn M p a 0) U) O(n a) 0 L- D O U (a cr 'i L N C Q aaL- 0 cn C c C O O O L- 0 7 C O C .C U~0E~0 ~Z- Cnzm C=)--3 00E o c c r- m o m o 0) - c c Ci 0)0) m o 00 N N 0 U 70 E U d 0) ~C c ~ .L U i to ~ to 0 i o Co o aro cv Y o aD 3 c c M e C v 00 cU i 0 '0 C 0 O N 3 cn 3 o cn O a y " ~r C- N O C Q O L C- O~ >'Y 0) ~ 0 E OC ~L C Z 13 =3 m L- cu cc O L y D O a> fiS L L E ` ao c le OEcj cncn ~ Via`) m cn tm O ST. CROIX COUNTY WISCONSIN 's ~ • ZONING OFFICE ..t fig`s ns° 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 January 13, 1986 Bruce Plomski Luck, WI 54853 Dear Bruce: We have been holding the Sanitary Inspection Sheet for the following system (s) : Wayne J. Rivard - Town of Star Prairie Jack A. Brust - Town of Star Prairie Please turn the As-Built into this office as soon as possible, so that we may complete our file. Until such time as all As-Builts are received by the Zoning Office, no further permits will be issued, or inspections made. If you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Assistant Zoning Administrator mj:1/86 r umbin LAIN Af e i L~.. R VKQ Bureau o.. g VAL g P.O Box 7969 General Plumbers Plans Madison, WI 53707 Private Sewage Playas Telephone: (608)266-3815 OFFICE USE ONLY Plan Identification No. L.i ;~W z-1 Gallons Per Day sLA PRIORITY PLAN REVIEW ONLY Plan Review $ 16-o' Petition For Modification Project Name Project Location - Street No. or Legal Description County El City El Village Town of: C The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan X approval must be obtained. FOR PRIVATE SEWAGE PLANS: C\ C~ This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: C,_ ~ James Sargent Bureau Director i If Questions Plans Approved By: Date prove. Contact cc: ❑ OWS ❑ DPS ❑ H&R & Rec. San. Section ❑ County ❑ Local PI ❑ Facilities Need Analysis Sec' ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculit- DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other n ~ -o i~b- ; , c y r J ~ O 4 O P O S rill F►- c a v± .esp. \j s { T 7' Q t ten, s, T ~ 3~T ~ 45 W N~j Page Of - Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand, G Topsoil F E D 3 ~ % Slope Bed Of 1-2- Force Main f` ~r Aggregate From Pump Layer 1 K x. i s .:I dross Section Of A Mound System Using E . A Bed For The Absorption Area F ; G Signed: B t Ft. License Number: I I -7 Ft. Date: J ? Ft. - K 11 Ft. Alternate Position L Ft. of Force Main W r3. Ft. Observation Pipe g K A I~--------------------- - Force Main W ° - - -From Pump Distribution Bed Of 2«- 2 2« Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area 'i Page Perforated PIN Detott Ee4~ End Cop Perforetel y PVC Pipe a~ "a*$ L"W" ow ON," Are Comm boee ,L K tor A- t PVG i Y` , I } +Yf felt t494 ~ ~ s• MW~ sk"d 9e Nest To End Gap Ead G* ~ttrirpNi~ .ripe ~.lhwMt 9 P~qs ~ ~ar r W fA Signed: NO License Number: inch(es) Date: .0 I0ehes Inches y. sj MAY .2 PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS f VEIJT CAP y"C. Z. VENT PIPE APPROVEp LOCKING WEATHER PROOF JUNCTIOKJ BOX MANHOLE COVER 25' FRCM DGGR, WINDOW OR FRESH I2 MID. AIR IAITAKE I GRADE 4" MIU. 18"MIN. COtJDU1T 18"MIN. ~\N~\\ PROVIDE AIRTIGHT SEAL I I i' INLET -T I APPROVED JOINT A I I APPROVED JOINTS W/C.I. PIPE Q~V~~ I I W/C.I. PIPE EXTENDING 3' ! I II ALARM EXTENDING 3' QNTO SOLID 50!1... ONTO SOLID SOIL is Q S I I Y~y1p(1 I ON L.k P OF F CONCRETE BLOCK RISER EXIT PERMITTED GIJL'd IF TANK MANUFACTURER HAS SUCH APPROVAL 6PEC,IFICATIWJS 8 5 0 24 4 6 SEPTIC ANq /f tll(7% ~ DOSE TANKS MAtJUFACTURERao: V II~~ i ~-~-~I t'~~.FfG# NUMBER OF DOSES: PER DAB TANK IZE : 1 ~~t GALLOIJ~IS DOSE VOLUME: GALLONS ALARMMANUFACTURER: yim•r~ KC CAPACITIES: A= I r WCHES OR.34 L41 CALLOUS MODEL IJUMBER. Pi B= INCHES OR s~ ALLOUS ~IZN (c l w L - C= l1~~~ INCHES OR GALLONS SWITCH TYPE: / PlAmr, MANUFACTURER: D=.i(-J _WCHES OR( ALLOQS MUnt_L NUMBEK: NOTE: PUMP AND ALARM ARE TO BE ;3WIlCFI TJPE: Cr, Fl f' ,Q~ INSTALLED ON SEPARATE CIRCUITS ! 1.~.L ~ JL PUMP DISC HARGF. RATE--lc! GPM _ RLCEivpu VEKTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE_.~ FEET -F MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . 2.. 5 FEET MAY 2 3 1985 + FEET OF FORCE MAIN X ~l FjOFT.FRICTION FACTOR.. (L i_ FEET PLUMBING SI CTIO d TOTAL D! IUAMIC. HEAD FEET .QL~. IIJTERNAI_ DIMENSIOIJS OF TANK: LENGTH ;WIDTH --;LIQUID DEPTH SIGNED: LICENSE DUMBER: y DATE:-~'-~ H L) EA cc w w . 30 TOTAL DYNAMIC HEAD 'CAPACITY PER MINUTE EFF11. ENT AND DE WATERING _ ~ _ SERIES..i 53 55 57 SgT 1' f Rs 28 - M LTG RS L7 RS .y' 7 EFFLUENT AND DEWATERING 394 _ 6r 77 305 12v 300 61;'~ 1 . A 26 4.57 72 SEWAGE AND DEWATERING 6 10 4 '36 762 24 ' 80 + t I}- 9 14 1 g~ I I I 12 19 -1 524 ' ' St \ 18 29 22 - 4;s 21 34 24.38 14 t , M O D E L MODEL Lock Valve: 19 , 4 > 26 `a l 65 163 \ 165 TOTAL DYNAMIC HEAD/CAPACITY PER MINU TEi +f+ \ SEWAGE AND DEWATERING I - \ SERIES 267 266 292 264 293 \ \ M LTRS LTRS ITRS~A..--- \ \ 1.52 408 386 492 6.• - 3.05 227 273 360v 16-1 r ' " 4 57 76 63 238 6 10 - 30 125- + - 14 7 62 r, 9.14 1.., ; t .i; \ 1 10.67 ' 1 - \ 12.19 Io" 12 - 13 72 - x ; 15.24 1 MODEL Lock Valve 8 21 26 35 1p.' \ 293 f3 MODELS 1 137 139: 6 t . = MODEL 284 MODEL 1 MODEL 10.. 268 1 282 2 a- MODELS \ 5 53, 55, MODEL MODEL 57,59 97 267 LITERS _ 80 1 60 240 320 400 480 560 640 655 FLOW PER MINUTE 3280 Old Millen; Lane Manufacturers at PO. Box 16347 Louisville, Kentu entucky 40216 (502) 778-2731 Qaaurr PUMPS S,vcE 8 Safety and Buildings Division DILHR PLAN APPROV 7 8 Bureau of Plumbing P.O Box 7%9 ❑ General Plumbing P v Y Madison, WI 53707 El Private Sewage Pla Telephone: (608)266-3815 6s OFFICE USE ONLY Plan Identification No. ~ I d _ Gallons Per Day PRIORITY PLAN REVIEW ONLY Plan Review Petition For Modification Project Name Project Location - Street No. or Legal Description County ❑ City El Village ❑ Town of: The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. ❑ FOR PRIVATE SEWAGE PLANS: This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact cc: ❑ OWS ❑ DPS ❑ H&R & Rec. San. Section ❑ County ❑ Local PI ❑ Facilities Need Analysis Sectior, ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other a ,JK ST. CROI X COUNTY rt r WI SC0 N S I N ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, W1 54015 May 3, 1985 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Jack Brust property located at the SW'-4 of the NW4 of Section 16, T31N-R18W, Town of Star Prairie, St. Croix County revealed suitable soils at a depth of 2.0 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, 0 Thomas C. Nelson Assistant Zoning Administrator TCN:mj Id 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 P LTO W Town Star Prairie Street Address Lot No. Block Subdivision Landowner's Name: Jack Brust The application for this site is for: -I 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 59 - 04 - 6 of those applications. (Use one of the first five quota numbers sue 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. 1for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. I.]for an application on file prior to February 1, 1980. I__1for 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. Fla 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 S1 ure County Official Title Assistant Zoning Administrator Date May 3, 1985 DILHR-SBD-6158 (R 12/82) STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Towns hipAbUpd(9JMkkRX: SW % NW S 16 T 31 N/R 18 E(or)W Star Prairie St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Jack Brust R. R. 1, Box 215C, Dresser WI 54009 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: DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION 796 LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON WI 53707 HUMAN RELA FIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHI MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: s~.j 1/N,)/ 16 /T31 N/Rl8Efor sT COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: c Box J/ -c ES F/~ Pf l- S co USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI E DESC IPTIONS: PERC LATION TESTS: WResidence 1 A JA New ❑ Replace i/ 5r y q 3 p RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) W41E~ 4` ❑ S U S ❑U ❑ S 'I ❑ S Nil F IS ZU mo v/v,D w / If Percolation Tests are NOT required DESIGN RATE: If an portion of the tested area is in the under s.H63.09(5)(b), indicate: AM Floodplain, indicate Floodplain elevation: Q A PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBR. ON BACK.) 0-.9 y vu cr On. ~ • _ /J DK Bm G . S /r-, ._,2 l B 1 7• S 9S ~0 3,g $eeP .Z. y C3 IS 3.0 /R SI 6rrlf~r W GM~L 5• r /3n ~YAtnof 3.0-34 Rl3„ sl Co.;vo/3.?-y./ Gr3~+ ,5 ra , .e ~wc.s7 r~rho seep Aan hr l-cl blzt,d. i p-~ 0_ - V, oaGY .2,3, R-+t s , 2.3 -J.V ks" Jtv, - j B z .S.s 7 Q D/()E oE >Z • 3 -.3,5~1~ IIn Sfr re~ SI -I bril`f~E w a/n e 111o r In Ga r-e' StnM 10 0 - • 7 Y. c~k (;,-6h S . 7 - S• 6y an - a" s l 1. S 2. /o En- R6,) B- 3 S. S' 98.41 N0 V ~`a.0 v - cl G -.5-45 ' a V]14/401' mofk i o-.8 ✓oK cyB" I-s?,.~,4-/.s Gydh ,/.s-~.SDn{yJ~yS l- .'cl lo~ty~ B 3.0 77•` d J , ic~W M act v - ral~ I st' BS So 1~9~1 uF } S.0' 0-.78/ 7--/.Q'Onfs•/J s%, /y-2•GkDn"'" ~r 1-) 114n PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- ~1E 30 a 3 /3 a' P- J -3 .20 P- . U P- P- P-1-1 J_J 1% 2 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. mow. Sysfew, P-/,oV~, a,7 /S "&-ve f ~i~/rgq~PA SYSTEM ELEVATION 99.0 * ~r°~" ela►a~'°" tom- RNs/°P~ '"~G"``' It"' 78 1 'j /~i>l! ( n 0..i' 1-5 d: 10 J, JR,,[ l~`~d .}S 1 h YYJ a~az~C' C / 1. rn~t WAS ~t2 ' (4 j..2 rr ~o ! 1t,l©0 P0 0 ltif!77 1V.' of Sake hoarr~Cer ct)~ c rs /~/d~o11ve ,o tGorti~F o ggrG S7c.!<e ~.'~l~xlh~2~y /sr c~ S~ fr~~'r u 6 LWo Q /a?. Yl`ai -i - I P-frc ~1on e s a s{,a ~;e5 I - SW% AIWA eG l E v~ r Svr r+H~ ni0Or'll urea. ;Y f O ~ o , • 1' <I ''7t, s II ~1S orgy. Ir ~bw e rati~ o~/Pe,e i ;A i h~leS eI e j usl /A rr~ol~ 255 ~rn~ /lratJ~~ 1 rlc~. ~r ~ ea-"c r,e5 w4 re ,Sl jjower a f Wo(er lt✓QS dr a~~~~C• ~a frCo l ~ I, the undersigned, hereby certify that the soil tests reported on this form were made me in a cord with the cedures and r C~Ovc s e~Yf''e irt,oerv_Ws onsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. u, NAME (print): TESTS WER COMPLETED O ADDRESS: CERTIFI ATION NUMBER: PHONE NUMBER (optional): 33 CST SI NATURE/: / DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - ~'~o (~~as~ or JC.-- l~ruYraP42r r' aa~cY~ess R7_ QvX ?-/S~'. Sw %y Nwiy SeG 16 T31AJ /8w Sfa~l'r-a~rg fw~o br-e55er- tvZ 3`~GG~ r/ IQ 5 fJUi~ Use P-1 f 6"~ °a a g1,o)p•3 21 v n Ki, 'ICY ~ y~