HomeMy WebLinkAbout038-1080-50-010
-0
Q o C)
Co
3 0
N O va
v
N 0
O I
Q N
a
o 6 cu
r- E :1
N O N
N U)
e N
a °c N 2
•Y` a ° t w co
v a o- Y
c E N O
CU ° c `
Y C R N O
N
r m ~ a
O N O N O
C .C U fN O
N N _
O O (n
C C n C
N 3 ~ N .
N O O co cu
O L
•6 Z a
co (1) m c U O 0
Li c `o E cm r y'
o v ~ mC
N c d U o Ol H H
a L f6
(n 0
C C L-. f6 e-~ Cd O
~
Q - ~
a a w
0
> d' M •4-J C W
> > z N
w E X V) CO
O
O W 1-i W
P~ O
z d d
rn w a CO a) 3 0
H z o w M o
N Z H H 0 o
o z v 0 OI uo
M
c> Z ~ c - I
fn P r 'o ~1 I~LJ
N
N J
° oo d
c
a~ °o 0 1
N ~i
~ z
N in N
•N ° L cn a
N
o Q Q O U r~ ~.D in C
0 z z a
N w ~
c O ~3:
n
LO E U ^ r1 N
a a ',a w m
H « y Q m
b
N Nooa 8~ --f
N "I P4
w 0 'T cn F co m ° ::j
Z
~G S-+
a
O O s Hw' C4 c0
O ~n
•►v a a a
FL
N LO LO
3 O fn
cn J U ° co 00 z°
(O O M
(D (D
N N N
Q O O 0c) E
.O -O O n
L CO c d a)
LO N O O O O n
`1~~ • oN Q z U) Q
O M 7 a~+
D 0 3 aMO w e
O o Q H p ° , o 0) N c;
M
0 O
O M U 0 0
LO M a N S
>O N f6 (O ~ ' - ° N N N N
0 O '(p > C m m C O n lO
00
N
~ O d _O V N ~ 'fl "O ~ a op r ~ I~
Ir M (0 O 2 2 L
• O cn (,To O z N 2 2 cn
r :-7
a
• ee a 'a L a
tr`I~V ` c a;
_1 Ca ciao oinci
08/17/2006 11:10 AM
Parcel 038-1080-50-000 PAGE 1 OF 1
Alt. Parcel 19.31.18.333 038 - TOWN OF STAR PRAIRIE
ST. CROIX COUNTY, WISCONSIN
Current X
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 - RIVARD, WAYNE J & COLLEEN B
WAYNE J & COLLEEN B RIVARD
833 205TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property. Address(es): Primary
Type Dist # Description " 833 205TH AVE
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 19 T31 N R1 8W NE SW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
19-31 N-18W
Doc # Vol/Page Type
Notes: T07/2 tory:
7 850/450
7 670/533
7 442/321
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Last Changed: 10/05/2005
Valuations:
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 25,000 151,500 176,500 NO
AGRICULTURAL G4 38.000 5,800 0 5,800 NO
UNDEVELOPED G5 1.000 100 0 100 NO
Totals for 2006:
General Property 40.000 30,9000 151,500 182,4000
Woodland 0.000
Totals for 2005:
General Property 40.000 30,900 151,500 182,4000
Woodland 0.000 0
Lottery Credit: Batch 223
Claim Count: 1 Certification Date:
Specials:
Category Amount
User Special Code
Special Assessments Special Charges Delinquent Charges
00
0.00 0.00
Total
5
o
7, 33
Soo
j y
ST. CROIX COUNTY
n WISCONSIN
i"r~ ZONING OFFICE
5~ rx f.Yt+.;v d 4 ~ L~~t•,~~~. 796-2239 (HAMMOND)
r: - P91 - 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
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR _AFE 11 Y & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI `53707
❑CONVENTIONAL ALTERNATIVE State- Number
111 ass,qigwii
Holding Tank ❑ In-Ground Pressure k_kMound 8502569
NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER: INSPECTION DATE ;
Wayne J. Rivard R. R. 1, Box 169A, Somerset, WI
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REF. PL ELEV.
NE SW, Section 19, T31N-R18W, Town of Star Prairie
Name of Plumber. JMCounty Sanitary Perron Number
Bruce Plomski 5849 St. Croix 64904
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELE V.. PROVIIDEDLABEL PL KING ROVIDED OVER
EYES ENO EYES ENO
BEDDING'. VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD. PROPERTY WELL. BUILDING. VENT FRESH
ALARM. LINE. AIR INLET
FEET FROM
EYES ENO EYES ON0 NEAR
DOSING CHAMBER:
(MANUFACTURER BEDDING LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
EYES ENO EYES ENO DYES ENO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING (VENT TO FRESH
LINE AIR INLET.
(DIFFERENCE BETWEEN FEET FROM
PUMP ON AND OFF) EYES ENO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture atthedept11 lowin NG1H DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM: unulo
WIDTH. LENGTH NO. OF DISTR. PIPE SPACING. COVER INSIDE DIA =PITS. DEPTH.
BED/TRENCH TRENCHES MATERIAL: PIT
DIMENSIONS
GRAVEL DFPTII FILL DEPTH IDIST H. PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTH. NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESI,~
JBELOW PIPES ABOVE COVER ELEV. INLF f ELEV. END PIPES LINE AIR INLET. i
FEET FROM
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.
EYES ENO
" PERMANENT MARKERS OBSERVATION WELLS
SOIL COVER TEXTURE
DYES ENO DYES ENO
DEPTH OVER TRENCH: BED DEPTH OVER TRENCH: BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES
EYES ENO EYES ENO EYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
ELEV.. ELEV.. DIA.. ELEV.' PIPES DIA.'.
ELEVATION AND
DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS
EYES NO EYES ENO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING.
COMMENTS: FEET FROM LINE:
EYES ENO EYES ENO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side. SIGNATURE. TT TLE:
DILHR SBD 6710 (R. 01/82)
E7~-,scons,n APPLICATION FOR SANITARY PERMIT
D m IH R COUNTY
Enof
(PLB 67) UNIFORM SANITARY PERMIT #
InoUSTRV• LABOR 6 HUTRn RELRTIOnS z -
-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
PRC9RTY OWNER MAILING ADDRESS
P OPERT LOCATION / CTry:
lt~ 1/4/4, S TN, R J (or)OWN - s'~~
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, 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:
?C 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 ❑ Seepage 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 -
El 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:
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 Z C_
Manufacturer:
PERCOLATION RATE ABSO PTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signa u e: / MP/MPRSW No.: Phone Number:
Plumber's Ad ress: Na ,rf D/es~ig er:
i ' rG
>
--COUNTY/ DEPARTMENT USE ONLY
Signatur of Issuing Agent: Fee: Date: ❑ Disapproved
~t ~t ` ❑ Owner Given Initial
lV (~1tiCX~~ 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 COFVIPLETING 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.
E7=z:= PLAN APPROVAL Safety and Buildings Division
D I L H R Bureau of Plumbing
z, , . ,,,W ,..,.,mo,. o1 , ~I-'
P.O Box 7%9
7
❑ General Plumbing Plans` Madison, WI 53707
❑ Private Sewage Plans .;Telephone: (608)266-3815
OFFICE USE ONLY
Plan Identification No.
Gallons Per Day
PRIORITY PLAN REVIEW ONLY
Plan Review
Petition For Modification
$
Project Name Project Location - Street No. or Legal Description
El City 1:1 Village 11 Town of:
Z6~
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
E. County ❑ Local PI ❑ Facilities Need Analysis Secti, a
❑ UW-SSWMP ❑ Plumber ❑ Department of Agricultur'
DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other
L ~ Bureau o'...umbing
LA ek AL
P.O Box 7969
_ ❑ . General Plumbing Plans Madison, WI 53707
Prn*-gate Sewage Plazas Telephom!: (608)266-3615
OFFICE USE ONLY
! Plan Identification No.
Gallons Per Day
PRIORITY PLAN REVIEW ONLY
Plan Review
Petition For Modification
Project Name Project Location - Street No. or Legal Description
W County
El City 11 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
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 A 'proved• V-
Contact
cc: OWS ❑ DPS ❑ H&R & Rec. San. Section
County ❑ Local PI ❑ Facilities Need Analysis See_.
❑ UW-SSWMP ❑ Plumber ❑ Department of Agricultu,
DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other
Page _
Perforated Pipe Detail
Perforated
End Cop)) `e PVC Pjpe
1.
"Was Located OP bottom,
Are E *w v Svo c 9 a
p PVC Pip" me*
f~ From Pw*
P PVC
tdeNfotd Pipe
DiStri lion Alternate P*Ntot Cr Pi Force Man f+oa ►w"
e
Lost Hole Should Be
Next To End Cop
End Cop Distribution Pipe Layout P lr `
R ,
S
X J c
Signed: Hole Diameter y h
Lateral ~ ch(e~
License Number:
Manifold Inches
Date: Force Main 3 Inche_,
i
W
dim
D
k, I
.
D -Wo" I ,I
Q Lo( lit Ills
SPF A~ I'
r, 1
e~ b I I
t In III' I
•~a III
O
IC, M,1 _ I
C:
1 1 1 1
i 1 1 ( e
1 8502569
99 RECEIVED
~,u; IAY 291985
PLUMBING SECTION
, Y P Y.
Z;j
~ It"
.r
1
1
~ 'OFD ` f .`W Z
06
k
rvj !)I
D N ' ~ r. lytl
f l
71
a C C X1'1 r~.
_(D i t
m
c C7
r+
ch
-50.25 6r
DECEIVED .
w t .
JAY 9 ~5
BING SECTION
r [7 P~. .l1m
e~
r
O
c
~i
_ rte=
2: s
tL _ _ _ -
.r.w...., It
r
k y 4 t
111 c e
y; 85025
n s
"aclaveo
~h A~° f - 195
*,,UMBING SECTiO"
""+..r+^~..`. 'Ti'^~'_ Y•»__Y`~ 4 t 'F' L,
.
.-.tom.-.~-.. _ ~...+.Y..... •
r
PAW;
PUMP CHAMBER CKOSS SECTION SPEC IFICATIOW
VEAlT CAP R .
A►PROVED LOCK"
y` C.i. VEMT PIPE WEATHER PROOF fAAMHOLE COYER
JUkJCT10N BOX
F RCM D1t*mIU. ( t
WIMr,C)W OK FRESH
Alst INITAKI
GRADE ' 40 Maj.
18' MIN.
COWOUIT 1
16"MINI.
PROM&
INII I r AIRTI&NT 69
APPROVED JoiNT1
qtj W/c•=, PIPE
I
AYPROYE D JolruT j EXTEUD11114 3'
ALARM dJTO SOLID SOIL'
W/C.I. PIPE 1 o+
EXTENDIUCI 3 1
ouTO soL-ID 401L
ow
~Pg° o I I ' N
P~~M~N IOU AP Off
VV
GOUCRETE BLOCK
RISER EXIT PEKrAlITED OWL4 IF TANK 9AAWUPACTURER HAS SUGN 11PPitO~rp~~ ~N~ G
goE C.I F I.AT14N$._ 1
E p T I C AWE) (It i NI R, or DostPER DAV
uSE TA_k1K5 MAIJUFACTURER;~~S ME: >~y GALLOI.Ib
TAWK SIZE GA4t-oW5 Dose \10W
~GrALLObJS
cA►~a1T►t>;: A~ s1..-IUC-►+~s opt . j~.yY.-,-`'~-
~','Y GALLOtJS
p LARM MAIJUFACTURER: ,_IUCHES OR
MODEL MUMBER: 0~ 1tt"1-.•-yGAL1.0WS
E s lA1CNES ORS
.:.::-•L~LLOIJS
SWITCH TYPE: r pIIJLNESOR
I., IN,r MAANIFAr r 1IilL R:
a PAI TALLEOAON 6EPARATE CiRCU ITS
k
TYPE: _ / i... lf~~FX ~,1 ~ti~
,~WIIf.H
PUM►' DISC.HAR(.E. RATE G PM
L_._._ FEET
VF..KTICAL DIFFERENCE DETWEEU PUMP OFF At1J0 DISTRIpUT10W PIPE.. . FEET 66,41? J~„-42.6 + MIMIKUM NETWORK SUPPI. i PRESSURE. . . • . • • • • • .
{S_ FEET OF FORCE MAIN X F/looixFRIGTIOIJ iACTOR.• `,J~J /EET 9
~I-OTAL. pyhJAMI(. HEAD FLET
4- a
.,2 = A~, tom'' TH
ILITERIJAL DIMEWSIOWS OP TA►JK:~.L.EIJCs
~LICELiSE 1JUI+10ER:
SIGNS D-
t.1R{,~
k d 1 TMRe7W7'iRMy~ Y{+ 5h '171°% 21~t ~y~ M
4' 4
HEAD CAPACITY CURVE
TDH
W
H
W
TOTAL DYNAM 1EA01'CAPAMY PEt1 WORM
30 EFFLUENT AND DEY MTEMW
SERIES 53 SS 57-Sf i7 137-139 1t9 t{S
M LTRS LTRS LTRS LTRS LTRS
28 1 52 163 248 394 231 231
EFFLUENT AND DEWATERING 3.05 129 216 300 231 231
11 4 57 72 163 242 227 227-
26 ~ _ - _ - _
SEWAGE AND DEWATERING 110 ,04 ,ytt ?7 223
\ 162 96 216 8. 229
\ 914 206 220
` 9 - - 172 206
-
24
\1524 125 191_-
18.29 57 161
21.34 114 _
22 24.38 - - 53
M O D E L MODEL Lock vr1 e: 19' 24.5 ?8' 86' 87
20 163 - 165 TOTAL DYNAMIC HEADMAPACITY PER MINUTE
S[WAO[ AND DEWAT[RIND
[[RI[S t07T ~2N 2S2 2S4 2q
M LTRS LTRS LTRS LTRS LTRS
18
% 1 52 408 366 492 861 -
` 105 227 273 360 598
16 ` 4.57 76 163 238 511
6.10 30 125 401
7 62 288
9.14 163 292
`
14 1067 227
12 9 174
1
~ 1 13 72 - I OB
12
O EL LookVNve.. Is,..,. 21' 2b'... 36'f- 53'
10 ~ ~ ~ ~ 293
MODELS I
8 137 t39
6 MODEL
` 284
4 MODEL M 2 DELI
268
2 MODELS
53, 55, MODEL 7MO%DEL
57,59 97 267
LITERS 80 160 240 320 400 480 58o Vx,94W 650
FLOW PER MINUTE , 2 9195
w
3280 Old Millers Lane Manufacturers of .
A911 Box 1
Louisville, Kentucky 10216
O.
(502) 778-2731 Q1114"r /G AAM XMf Ifff
8
APPLICATION FOR SANITARY PERMIT
S T C - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor,("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property
Location of Property E 5 V I4, Section Z T3/ N- R W
Township
Mailing Address'
Subdivision Name
Lot Number
Previous Owner of Property
Total Size of Parcel CUIU✓~1.Q-
e
Date Parcel was Created
Are all corners and lot lines identifiable?_ Yes No
Is this property being developed for resale (spec house) ? Yes A No
Volume and Page Number 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) ee ti6y that af.2 s-tatemente on .thi.b 6onm are .true to the bat o6 my (our)
knowledge; that 1 (we) am (are) the owner (s) o6 the pnopen ty des cA bed in thiA
in6o,unatti.on 6onm, by viAtue o6 a wmAa.nty deed %ecokded in the 066ice o6 the
County Reg-i.d,teh o6 Deeds a.e Document No. ~I - v~& ; and that I (we)
phesentty own the proposed 6 to bon the sewage podydte►n (on 1 (we) have
obtained an easement, to h.un with the above ducAibed p4openty, bon the
con-6t&ucti.on o6 said system, and the same had been duty tecoxded in the 066iee
06 the County Reg-i.d-ten o6 Deeds, as Document No. J.
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
H
Cfl
H
y
ST C- 105 r
ti
SEPTIC TANK MAINTENANCE AGREEMENT H
St. Croix County z
d
9
OWNER/BUYER-
ROUTE/BOX NUMBER ~-Ld /j f/q Fire Number
CITY/STATE Z IP S~Q
PROPERTY LOCATION:1VT ~4, -!~7btf Section 9 T 3/ N, R / W,
Town of St. Croix County,
Subdivision Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix.County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. H
0
E
I/WE, the undersigned, have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- v
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED
DATE ~f.C~~~, 1~8s
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.
> 0 .C cn
E -6
\ U O CTJ L L U p C G
cC L 7 n
C N i p O O O c U m
C O O U` fn T C O O U)
V U) L- N p C L
a) ca 0) >1 6 0 m
W ocNVVcci 30-0
.=3=0~0 vEc O
O co N U L` 0 c cz
NOCV)S._. 00U)
F' = NcU.0 CN (D cn
a)c m
U v)"~op YcD In
LC a) ca)C E c
U) 0 a)
~30M
W 0 v ca
a U) 3v)-0 LN
c0 C C U O a) N L -0 tv
cc M O L p _ L co - v a
W ~UL3 0 Ewa)
U (D
F y c t U .p. a) a) C
C ~ H Co N ~ L ca
Q Z cn M: " 4) cn a vi 0 h
a= c 0)
O 0 (D cli L-
3
v 0 a L 0 o
= - C.) p
U U 7
V _ O Q ) U O N O
p O L N C
L 7 a) 'ct
CL CL co co W
C
C -0 0 - a N ) c~
C O _ N L
O
U) C~ cc Q)
c 3 c v) Z
0-0 0 E 5 0 E
o 0 c c rn Y c c
o ca 0 a) 0
0) `
0) c°aa)) 0 -0 5E`°)
y r r C U Co - .C
0 N N a) L a m _
_ -M-0 (D p
W a) a)3a) d
C 0 CO U
--0 c
t- 5a
(n :3
0 O p a) o O w O n o~ c
1!~j WW
13 N m U) p 7 O L L
CO L L` a E 0 O N
C p U U O)-1.1c p 3 O
C O ` L a) C t cti to m 0
(NJ in in U)
R
w ' C
t
•d
ST. CROI X COUNTY
A y}a W I S C O N S I N
X r
ZONING OFFICE
- - 796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
HAMMOND, WI 54015
May 7, 1985
Division of Safety and Building
Bureau of Plumbing
P. 0. Box 7969
Madison, WI 53707
Dear Sir:
An on site investigation for the Wayne J. Rivard property located
in the NE4 of the SW4 of Section 19, T31N-R18W, Town of Star Prairie,
St. Croix County, revealed suitable soils at a depth of 2.6 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,
Thomas C. Nelson
Assistant Zoning Administrator
TCN : mj
• STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING
P.O. BOX 7969 - MADISON, WI, 53707
APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM
Location: Townshipft=017=M:
NE ;41 SW 14 S 1 T 31 NCR 18 § W Star Prairie St. Croix
Street Address: Subdivision: County:
Landowners Name: Mailing Address:
,Wayne J. Rivard RR#1, Box 169A, Somerset, WI 54025
I (We), the undersigned, hereby make application for an alternative system on
the above-described premises. I recognize that the above premises are not
suited for a conventional private sewage system. If approval is granted, I
agree to have the system installed in conformance with the Bureau's approval
of plans and specifications.
I further understand that an alternative system is more complex in nature than
a conventional private sewage system and as such will require detailed
inspection during construction and monitoring after the system is put into
use. I agree to permit both county officials charged with administering county
sanitary ordinances and Bureau employes or other authorized persons to have
access to the above described premises at any reasonable time for the purpose
of inspection the construction of or monitoring of the system. I further agree
to either personally or by my agent contact the proper county official to
arrange the time and date to begin construction of the system.
I understand that this application does not permit me (the applicant) or my
agent (the contractor) to begin installation. If the system is approved, the
Bureau will send the applicant a letter of approval which authorizes
construction of the alternative system after all necessary permits have been
obtained.
I agree to give notice to any subsequent buyer that an application for an
alternative system has been made and if installed, that the premises are served
by an alternative system and further agree to give the buyer a copy of this
application.
The Bureau accepts this application subject to this understanding and subject
to all the conditions and obligations set out in this application.
Signature of Applicant Date
STATE OF WISCONSIN Subscribed and sworn to before me
SS.
COUNTY OF This day of 19
Notary Public, State of Wisconsin
DILHR-SBD-6413 (N. 05/81) My Commission Expires:
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 NE 1/4, SW 1/4, Sec. 19 T 31 N, R 18 XWM) W
Town Star Prairie Street Address
Lot No. Block Subdivision
Landowner's Name: Wayne J. Rivard
The application for this site is for:
x] new construction use.
❑ replacement system use.
If this is NEW CONSTRUCTION USE, the alternative private sewage system is:
Il to have one of the first five approvals guaranteed for this year. This is
number 59 - 05 - 6 of those applications. (Use one of the first five
quota num ers sueUto you.)
[ ]one of the applications needing a quota number. The quota number assigned to
this application is - -
D for one additional homesite on a farm to be occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
L ]for an individual lot for which a sanitary permit was issued but was later
ruled unsuitable due to new or changed soil criteria established by the
department.
[Afor an application on file prior to February 1, 1980.
U for a lot that meets the criteria for a conventional private sewage system.
If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is
replacing:
❑ a failing conventional soil absorption system.
0 a holding tank that was installed and in use prior to February 1, 1980.
❑ a privy that was installed and in use prior to February 1, 1980.
If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a
conventional private sewage system, check here
I certify that the above information is true and accurate to the best of my
knowledge.
Name Thomas C. Nelson Si ure
County Official
Title Assistant Zoning Administrator Date May 7, 1985
DILHR-SBD-6158 (R 12/82)
MW
INDUSTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
N
LABOR AND , PERCOLATION TESTS (115) P.O. BOX 7969
HUMANr.'iELATIONS 1 / MADISON, WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
/asw~/a l9 /T31 N/R /8 E (or A)h N
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
S . C oI WA n/I:7 JT. I I VARD 1 d3oK l 9A s ERSET w~ SS~o~S
USE
DATES OBSERVATIONS MADE
LKesidence NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DERIPTINew ❑Replace C,sf ~s~ro
~V /I 7
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING T~fAIINK: RECOMMENDE SSYSTEM:(optional)
❑S ~u xS Du ❑S XU ❑S u ❑S ILJ,u MOVwJ Slowt• BERM. s0/~
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: IVA Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXT"
NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
v. D+< 6y Q„ S ,r.3 - 1.9'11111; an s y-3 a 5n 4< W o ear
B- y7~ 9 8. Nonl~ y, y s
3»?-'f 9 13n !S w Secures o ar~rf S,
L 0- V 4K 6yQn5/. l-/.Z, Bft J.6'2.1 4n jlf-COA,
B- 98.2 O AJ,ff '1.6 2, 6,~ r
S! w ceb, .2. 6- 3 R Bit
rs v s! w cln~ fans
B 3 - 3.7' R as 5 w ~a ti< Cob, 3.7 - 6n dli S.4 _s
B,tdid n.S 5.2.-S.y'R an is
B 003, o ~2 / 03 13n ~t. S/ w/ r,~co6, /-.3-s.S R13~+
S- T3 stew r b 3.2-3, 7' /s
B +d,r yS w Gob ; / s/ . A Aft _,k
B- A/afe: Pif B-2 1,e open
A/eitr S ar ,o r .6e /o u) y G PERCOLATION TESTS 1*4 y8r, color Co_( brf` i er
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES r ? f 6~~
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. RATE MINUTES
No NE. PE; IOD 1 PE310D 2 PE310D 3 PER INCH
P p D
P- I _ k0,VF_ 30 3 3
P- ' O
P
kPP__
PLOT PLAN: Show locations of percolation tests, soil borings a Cil dikensi suitable
s- j areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their Iota ' on the p Show, t surface elevation at all borings and the direction and percent
of land slope.
f~FF1 Cf~ 5ySte;n e4,*Ie4Yiak if
w6e
SYSTEM ELEVATION $ls
See q/1#ac,4 ed s 4,ea : f or ~,(p
~I
/U~,/~_ ear e o SE s~~e a ~e rtc. SG re c'C a (
f{RP ~ on S. S~t~e o
80
) ~~jj
n
. A
R,l /P _!s Gt raw( across 1'oh /7Q✓Sa~ /Q~.~l"/i~~tUeL _k!l y~
' e e o+a Al. Sip o 1`0 and' _ is v.,.ed d r
o~
A / E 1,vew, o~ S. -$'1
ASSum.0 ei e_41-_te,%,%, /UO.O
A/o e: ? back_ Qe ~,~f wer Q6$erve 11E/ySw~5-II?
Go- r► d2,?.(O r, . '.S}% f Psl.. rDr? e
dA
0
r w as _.Svr__.)la k~L~ m ~ rav
L W. a-~ a~ SlTIowevQr__3w,r era' . c p, ~e
` Per to r+ 1f 5 fS j ~r~v
1~e a- r e 0. 1- 0 '#j 4t f,
I, 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 WE E COMP ETED ON:
Ate b LAI I .c le_ s y g r
ADDRESS-
CERTIF ATION UMBER: PHONE NUMBER (optional):
BALSAM BoX 4AKE 4VZ 5-~ D 3 3 4/ 8 S-3-369
3
CST SIGNAT E:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) -OVER -
v-r r _Fi,3 ~E~
E.:
i3.1
t
r 3_
71 aI ,i1 )e i4;a n f,
i
,r° r~ .t, ~22?~ e,r, ~ i s e.-t r >>)t~e. ~ r 'F, cad CC}z.ar, :c d ;"E ?r'xc t
-c 2 ig[i ai
i1 0-
j ~.=tEFa a'~ 3 ;
.,c-
Sl Si
f
i
E E
tPf 1
d 31-i
t,v
sr , ~
4
Do TillJ0 ~','!-Iy 0-1
e} ~ F lE,l1
<<:!it, _
n
o
Wa>,ne ~J_ /~i ✓oZ, c~ t-~~~a~r-f l~f ~ ,fix/GflA So s~e~se W
NE ~ S
y y Sec 19 % 3 J A/
3N STAR P4AIle1 F-
, d
4-4
F 4 G o, ~o hr~ '
~ ~ O S tl, A VE _
l2Gf!'~c ServrcPPo/.el Road D%/c~ i1/
CO)
.2/0Of
I~ a
5 emir
7 o
4 Q - ~
lop eS
u i 9v
r, ~3510
~FjW i j4+ I~ 1
~ saf- .7 III J
-Fleva7rarn'~ I~ [
I (lAiprox.)
~L
I ,
J j ~
6