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Parcel 038-1129-90-050 07/26/2006 12:02 PM
PAGE 1 OF 1
Alt. Parcel 31.31.18.529A-10 038 - TOWN OF STAR PRAIRIE
Current ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
04/01/2004 06/19/2006 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - ALICE INC
ALICE INC
PO BOX 6
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * RALEIGH RD
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE
SEC 31 T31 N RI 8W SW SE EXC S 31 RIDS OF E Block/Condo Bldg:
1/2 EXC PT TO HWY PROJ 1559-08-22 (PARC
27) AWARD OF DAMAGES 2539/407 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
31-31N-18W SW SE
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 714/243
i
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/27/2006
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 26.860 156,200 428,100 584,300 NO 05
Totals for 2006:
General Property 26.860 156,200 428,100 584,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
June 13, 1985
Bureau of Plumbing
201 East Washington Avenue
P.O. Box 7969
Madison, WI 53707
Mr. Bill Raleigh
St. Croix Valley Sports Club
Highway 64
Somerset, WI 54025
Plan Identification No. 85-00754
Gallons Per Day 15,000
Re: St. Croix Valley Sports Club/Campground
SW 1/4, SE 1/4, T31N, R18W
Town of Star Prairie, St Croix County, WI
Examination of plumbing plans and specifications for this project has been
completed. In accord with chapter 145, and specifications are approved Wisconsin
Administrative Code, the plumbing plans
contingent upon compliance with any conditions shown on the plans oralas
indicated in this letter. Failure to meet the conditions of approv will
void this approval.
omonthlf the
1. This approval is conditioned upon semi-annual
reports to this office: daily wastewater
readings), monthly ponding levels, monthly groundwater elevations,
semi-annual groundwater quality analyses, annual system andare
periodic septic tank cleaning. Groundwater quality parameters
to be analyzed include organic m1tfeg al,stammonia reptococci, oPseudomonase and
nitrite nitrogen, fecal colifor ,
aeruginosa, total dissolved solids, BOD5, chlorides, sulfate, pH,
alkalinity and hardness. This monitoring is require in accord with the
department's responsibilities under section 160.27,
reported
of background samples and analyses must
prior to placing the system iperation and July of each year the system
by the owner or their agent by February,
remains in use. The department reserves the right to require
installation and monitoring of additional groundwater wells in the future.
2. The licensed plumber responsible for thisinstallationbshall keep at the
construction site one set of plans
department's stamp of approval. That plumber shall provide a minimum of
24 hours notice to the county of when the system will be ready for the
inspections required by rule or in the conditions of approval.
DILHR-SBD-6423 (N.04/8'1)
State of Wisconsin \ Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
Mr. Bill Raleigh
Page 2
June 13, 1935
3. This approval allows connection to four comfort stations serving 142
campsites and one dump station that collectively generate no more than
15,000 gallons per day. Loading of the system with more than 15,000
gallons per day would automatically void this approval. Any proposals
for changes in the wastewater sources identified shall be approved by the
department.
This approval is based on Wisconsin Administrative Code requirements. It is
also necessary to obtain and fulfill the sanitary permit requirements of the
county in which this installation is to be made. It may also be necessary to
obtain a Wisconsin Pollution Discharge Elimination System permit from the
Department of Natural Resources. Failure to comply with state and local
permit requirements will automatically void this approval.
In granting this approval, the Division of Safety and Buildings does not hold
itself liable for any defects in plans or specifications, plan omissions or
examination oversight, and reserves the right to order changes or additions if
necessary.
This approval is valid for two years, except that after issuance of the
sanitary permit, it will remain valid until the initial expiration date of
that permit.
By:
'dames Sar
Director
JS:DR:0969v
cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls
Harold C. Barber, Zoning Administrator - St. Croix County
Thomas Noyes, Designer
Bureau of Environmental Health
Charles Burney, DNR
D I L F~ R-S B D-6423 (N. 04/81
t? j l9*Tgryr,r'r 77
•K'r,A:F y v. .1n ct411Ss •t'• +2LftMX14CYrYn•.:i. ti,.:
)EPARTMENT OF p
Q
'NDUSTRY r~EO! ~(p~T ON SOIL.' BORINGSQ. ND SAFETY & BUILDINGS
-ABOR AND?
4 r', DIVISION
IUMELATIONS PERCOLATIQ =TESTS
1 ) P.O. BOX 7969
115
t MADISON, WI 53707
(H63.09(1).& Chapter45.045}
LOCATION. SECTIO
r' 'S,~:,. , TOW SHIP/
l;,ta . 11S JVQ.: SUED VIS 0 AM
51q - E
/T3 N/R I$ -ii w COUNTY E
;t t fV rY + .
t
)SE
NO "i DATES OBSERVATIONS MADE
Residence' " t O i. R T O rb~
Oft
r ~3';ftlllfrr#i:1,} 'i~:~;1!, t ri i:+{,. t7
IATING S- Site iultable for system j.U. Site unsuitable for system . • a
'ONVENT NA MOUND IN GR Q t "
a~ QU DU S +1 L 0 DI G TANK: RECQ ENDED SYS EM:(optional►
< J J 1~1 U S U Ir,
I f Percolation Tests 4f! NOT ro9u r t i, ,
under s.H63.09M jb) ! Q„ 4ESIGlV RfE aOY portion of the Se ed area is in the
Jndlcete: 7.4 Floodplaln, Indicate Floodplain elevation:
1. " k y1 Oe-4 A • scat 4- W',;'•S' I
• 4 "Y'PROFILE DESCRIPTIONS 2
Vl1MBER DEP9~i tN ELEVATION BS RVE
lORING TOTAL- T R UNDWATER-1 C ARACTER O . SOIL ITH HICKNESS, CO OR, TEXTURE, AND DEPTH
E TO BEDROCK IF OBSERVED SEE ABBRV.ON BACK.)
B' I f 9~ _ A 4 1. ^ 3f S1Ct,''i' f.': ; t1r?
y-Y, S 13n5/
B-3 !~i~: ~.76Isl~ r7-2, 'Cinsl~ 2.5-3.o Be,
9-~QMTL
3 ul!;if r:C1,.•!.7
• s D o 2
WW
rv f;L
14i.-,3.s,.~ is tG s.1-8~, i
b~ ,fir~f 9~r. 6 } $ a 0 7 g/ 7
PERCOLATION TESTS t Vol ' P 4
x.,fa, 4
DEPTH ALE TEST TIME '
Nl1MeER INCHES, W W AF ERSWELL TER TER IN N HO HO INTERVAL-MIN: RO AT R RATE M
-IN-UT E ES
p.. 0*S Q '?S}1i )d uflr t ~+j:r.. r / PER INCH
P. 0
P + rtTl{, 1 / '
P'~"erftY KIY-f r _ tf _ + t
P :t +sr tom' 1•>s+y,ct' t+S•.:5 $ - :.'ES'L,.
%Y_
~OLPLAN Show locations oLggrroI tion'tetu;,=oll borings and the dimensions of suitable soil areas. Indicate scale of distances. Desuibe what are the hori•
+rita( artdwertical elevation relerinq ir/ ts and show their location on the plot plan Show. the surface elevation at all borings and the direction and percent
'•~trX'-/., i} .y ,c'^,t ,'J ! ~Kl~ ~f. i ;X+;wt ,7
SYSTEM "ELEVAT ie
ION _~Ld . r>e,°~
. x« Rt~Gre ret g!7
lid
a$ ik: + \ O st1~~~t
< I
_7 _7
K•~
si' ' y t 1 <
115 t5 W
b• ~
T
41r, TWKN
. , j
s
he'pnders reed hereby certify that the toll tests Yepcrted n this farr wet mactiI acbord with ha Procedures and methods specified in the Witconsio
dminlstrativeCod }andtha~ths~d<~a rd0rs~11h locatio of a.tettt r
4
r i• +t~ tract toSha best of m
tf,s " ~ir ft#~~ "1 R ` C Y kh 'lodge and belief. r
rtC, +o l, -1 a
Il r# 13 N f . { r, ' lit,. r- k+
f~MXwi ~wf1~ t~f 2`Cel#R~`~{Fyrr h ,j TESTS {HERE COMPLETED ON:
ERTIFICATION NUMBER: PHONE NUMBER. oponal):
` `Lr` ] t .F•s- 1 ' i~ r'+, }
MIN•t ;!'y^ UR _ YX?.. a. r ; ~1
- WR
IV -
' 'TON Original and one copy o Local Aut;hpo~rity, Propar)y OwrLer and Soil Tester, z
IUr021m$;),' l~`r' ! ro + r ~+tGt p t~r~ Y t Y jut t
ikE
,~a~ b~'.F~•`~~`~~~ xlr'i r' ` ~ ` '~k.N;1L'`"'` : f
...t...r. in\k. ~..r~. ::.fir
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ST C- 105 r
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County Z
d
9
OWNER/BUYER Alice, Inc. / St. Croix Valley Sports Club, INc.
ROUTE/BOX NUMBER 67 Fire Number
CITY/STATE Somerset, Wisconsin 'LIP 54025
PROPERTY LOCATION: SW 14, SE 14, Section 31 T 3 N, R 18-W,
Town of Star Prairie St. Croix County,
Subdivision n/a Lot number n/a
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. Wtiat you put into I`
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
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- v
ment of Natural Resources. Certification form must e completed
and returned to the St. Croix County Zonin Office'wi in 30 days
of the three year expiration date.
SIGNED
Willi J Raleigh
DATE June 4, 1985
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.
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 Alice, Inc./ St. Croix Valley Sports Club, Inc.
Location of Property SW SE It. Section 31 , T 13 N - R 18 W
Township Star Prairie See Attached
Mailing Address Box 67
Somers'l-~t, Wisconsin 54025
Subdivision Name N/A
Lot Number N/A `
Previous Owner of Property Pearl Olson
Total Size of Parcel Thirty acres approximate
Date Parcel was Created
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for resale (spec house) ? Yes X 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.
PROPERTV OWNER CERTIFICATION
1 (We) cuLti.6y that aU statements on .this 6o4m aAe -tAu.e to the but o6 my (ouM
know.-edge; that 1 (we) am (aAe) the owneA(s) o6 the ptopeAty descAibed in ,this
in6oAmation 6o4m, by vi4tue o6 a wak&anty deed teco4ded in the 066ice o6 the
County RegiA teA o4 Deeds as Document No. ; and that I (we)
pAesente.y own the proposed 4 to bon the sewage d spoil bystem (on I (we) have
obtained an easement, to Aun with the above de.6cA bed pnopeA.ty, bon the
cons-tlructi,on 06 s 'd system, and the same has been duty neco4ded in the 066ice
06 th County R .teA o6 Deeds, as Document No. ) .
SIGNAT OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
.r„ni ?2 /A 1 R5
DATE SIGNED DATE SIGNED
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State of Wisconsin Department
of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
{ c C I f
APR a0 1987
4 _ zohyll6
OFFICE
DILHR-SBD-6423 (N. 04/81) 1'i '
SBD 6678 (R. 08/83) (Plb 100a) (Wis Stats. S. 145.02)
Detach And Return Upper ~
STATE OF WISCONSIN DILHR
Portion Of This Form With DIVISION OF SAFETY & BUILDINGS
Any Return Correspondence BUREAU OF PLUMBING
201 E. WASHINGTON AVE. RM 141
P.O. BOX 7969
DATE: MADISON, WI 53707
x 608-266-3815
ICEIVED
FEB 25
[PLAN ROJECT:
ZONING
OFFICE S1r, .
J:'uth ird
ID. #
- DETACH HERE
PROJECT NAME
This is to acknowledge receipt of your plans and specifications N ID #
Preliminary review indicates the required fee is $ s for the above-indicated project.
❑ Plan accepted for review.
El Plans being returned. Fee Received is $
❑ Underpayment- Please submit additional fee. Plans will be held in abeyance.
❑ Additional information required. SEE BELOW. ❑ Overpayment- Refund forthcoming.
❑ No fee has been remitted. Plans will be held in abeyance.
I. Plan Submission
❑ Additional information shall be submitted in duplicate unless
❑ Soil boring and percolation test data on 115 completed
specifically noted. by Certified Soil Tester. (1 copy)
❑ Plans not clear, legible or permanent. ❑ Petition For Modification signed by county, owner and
❑ All information submitted shall be signed, dated and sealed or
notarized. (1 copy)
El stamped in accord with Section ILHR 83.08 2 Complete data relative to anticipated use of building.
Administrative Code. El Affidavit enclosed. (a) Wisconsin El Deed restriction required. (1 copy)
El Plot plan showing location of land parcel (distance from
nearest road intersection, etc.), lot size and all distances fr El Condominium declaration. (1 copy)
private sewage system to buildings, lot lines, well, water-, IV. Holding Tanks
course, swimming pools, water service i in ❑ Holding tank profile showing vent, manhole, alarm,
vice road, etc. Show benchmark with e pm ing, all e weather ser- and manufacturer if state approved. Complete eation. ll. Pressure Distribution Systems (Mound or Inground
Pressure) construction details if site constructed.
❑ Application for Use of Systems
Alternative System signed b ❑ Holding tank agreement signed owner and local
unit of government (sample enclosed).
and notarized. (1 copy) by owner El Reason for installing holding tank. Statement from
El County onsite required. (1 copy) El Design calculations. county or soil boring and percolation test data on
El Soil boring and percolation test data on 115 completed s.
115 completed by CST, showing that a soil absorption system
Certified Soil Tester. (1 copy) cannot be installed on the land parcel.
El Cross section of system. El Pipe lateral layout. ❑ Affidavit for all-weather service road (enclosed).
❑ Plan view of system.
Verification to Exception Status Form by county. V. Dosing Information
El (1 copy) ❑
Calculations for total dynamic head and gallons
III. Private Sewage Systems
❑ Ground slope with 2' contours in entire area of soil absorption pumped per cycle.
❑ Size, length and depth of force main.
system extending 25' minimum on all sides. ❑ Detail and model of pump or automatic siphon, including
❑ Location e area suitable for replacement system - size, pump curves, drawdown, and average flow rate GP
data. provide soil El Cross section of dosing tank showin ( M).
El Construction details of septic, holding or dose tank if site 9 pump(s) or siphon (s)-
constructed, or tank manufacturer if state a VI. Systems in Fill (Fill must be placed prior to plan submission.)
❑ Construction details and cross section pprovedabsorption
❑ Total area filled (fill to extend 20' beyond edge
system. Of so
of trench before side slopes begin.)
❑ Depth and type of fill.
❑ Copy of signed onsite report by county or district staff.
SBD 6678 (R. 08/83) (Plb 100a) (Wis Slats. S. 145.02) ~
Detach And Return Upper STATE OF WISCONSIN DILHR
Portion Of This Form With DIVISION OF SAFETY & BUILDINGS
BUREAU OF PLUMBING
Any Return Correspondence 201 E. WASHINGTON AVE. RM 141
P.O. BOX 7969
MADISON, WI 53707
608-266-3815
DATE:
PROJECT:
RECEIVE[1:.
FEB 1,~ 1
ZONING
OFFICE Star Pral
South 3rE i+`~txt,ac.,,~;
PLAN ID. #
DETACH HERE
- - - - - - - - - - - - - - - - - - - - - - - - -
PROJECT NAME
This is to acknowledge receipt of your plans and specifications for the above-indicated project.
Preliminary review indicates the required fee is $
❑ Plan accepted for review. Fee Received is $
❑ Underpayment- Please submit additional fee. Plans will be held in abeyance.
❑ Plans being returned.
El Additional information required. SEE BELOW. ❑ No fee has been Rremitted. rPlanos will be held in abeyance.
1. Plan Submission
❑ Additional information shall be submitted in duplicate unless ❑ Soil boring and percolation test data on 115 completed
specifically noted. by Certified Soil Tester. (1 copy)
❑ Petition For Modification signed by county, owner and
❑ Plans not clear, legible or permanent.
❑ All information submitted shall be signed, dated and sealed or notarized. (1 copy)
stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin El ❑ Deed Complete data relative d. anticipated use of building.
Administrative Code. restriction required. (1 copy)
❑ Affidavit enclosed. ❑ Condominium declaration. (1 copy)
❑ Plot plan showing location of land parcel (distance from
nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks
private sewage system to buildings, lot lines, well, water-
course, swimmin ❑ Holding tank profile showing vent, manhole, alarm,
g pools, water service piping, all weather ser-
vice road, etc. Show benchmark with permanent elevation. and manufacturer if state approved. Complete
construction details if site constructed.
II. Pressure Distribution Systems (Mound or Inground Pressure El Holding tank agreement signed by owner and local
❑ Application for Use of an Alternative System signed by owner unit of government (sample enclosed).
and notarized. (1 copy) ❑ Reason for installing holding tank. Statement from
county or soil boring and percolation test data on
County onsite required. (1 copy) ❑ Design calculations.
El Soil boring and percolation test data on 115 completed by 115 completed by CST, showing that a soil absorption system
Certified Soil Tester. (1 copy) cannot be installed on the land parcel.
❑ Affidavit for all-weather service road (enclosed).
❑ Cross section of system. ❑ Pipe lateral layout.
❑ Plan view of system.
❑ Verification fo Exception Status Form by county. (1 copy) V. Dosing information
Calculations for total dynamic head and gallons
III. Private Sewage Systems pumped per cycle.
El Ground slope with 2' contours in entire area of soil absorption Size, length and depth of force main.
❑ Detail and model of pump or automatic siphon, including
system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM).
❑ Location of area suitable for replacement system -provide soil
El data. Cross section of dosing tank showing pump(s) or siphon(s).
❑ Construction details of septic, holding or dose tank if site
constructed, or tank manufacturer if state VI. Systems in Fill (Fill must be placed prior to plan submission.)
approved. ❑ Total area filled (fill to extend 20' beyond edge
❑ Construction details and cross section of soil absorption of trench before side slopes begin.)
system.
❑ Depth and type of fill.
❑ Copy of signed onsite report by county or district staff.
DEPARTMENT OF INDUSTRY,
~ R~7,U~MAt'J RELATIONS
LA INSPECTION REPORT FOR SAFETY & BUILDINGS
P.O. a _S PRIVATE SEWAGE SYSTEMS DIVISION
MADISON, WI 53707 BUREAU OF PLUMBING
ACONVENTIONAL EALTERNATIVE State PlanLD Number
❑ Holding Tank E In-Ground Pressure ❑ Mound asysn
NAM PERMITHOLD ER.
f _ DD ESS OF PERMIT HOLDER:
INSPECTION DATE:
ENCH MARK (Perm nt ference point) DESCRIBE IF DIEF ERENT F
PLAN:
Is 2/ REF. PT. ELEV.: CST REF. PT. ELEV
Name of Pl,mber i
MP/MPHSVy o.. County: Saint Pe mit Num er ~1 41
_ IF
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. (j
LIQUID CAPACITY: =V TANK OUTLET ELEV. WARNING LABEL
LOCKING COVER
/i ,N ` PROVIDED PROVIDED.
BEDDING. VENT DIA.. JVH-- _ EYES NO EYES ENO
V
ALAHM NUMBER OF ROAD. PHO PERTY WELL BU III LDING . JVENTTOFRESH
OYES ENO FEET FROM NE AIR INLET,
EYES ENO NEAREST
DOSING CHAMBER: -
MANUFACTURER BEDDING. LIOUIO CAPACITY PUMP MODEL
PUMP/SIPHON MANUFACTURER WARNING LABEL
LOCKING COVER
EYES ENO PROVIDED: PROVIDED:
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL OYES ENO EYES ENO
(DIFFERENCE BETWEEN NUMBER OF P-OPERTY WELL BUILDING ~VENT TO FRESH
PUMP ON AND OFF) FEET FROM I INE AIR INLET
DYES El No ABSORPTION SYSTEM. Check the soil moisture at the d depth of plowIngg NEAREST- AMI TER MATERIAL AND MARKING N', I
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enouqh to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH 1111TH! LENGTH NOOF OlsrR PIPE SPACING coVEN
TRENCHES. MATERIAL'. INSIDE DIA xPITS LIQUID
DIMENSIONS I-PIT DEPTH.
BFLL() CL 1) II FILL DEPTH UISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR
BE OW P I P ES ABOVE COVER El EV. INLET ELEV-END PIPES NUMBER OF PROPERTY WELL. BUILDING- VENT TO FRESH
FEET FROM LINE
AIR INLET.
-
MOUND SYSTEM: N-EA-R--EST- ---s.
Mound site plowed perpendicular to slope
and furrows thrown
Upslope: rpendi Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
EYES E NO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE
PERMANENT MARKERS. OBSERVATION WELLS
I)FPTH OVEH TRENCH BED DEPTH OVER TRENCH; BED EYES ENO OYES ONO
CENTER EDGES DEPTH OF TOPSOIL SODDED SEEDED.
MULCHED
EYES ENO EYES C~NO EYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH -IOTH. LENGTH NO. OF LATE H A L SPACIN G'. GRAVEL DEPTH BELOW PIPF.
TRENCHES: FILL DEPTH ABOVE COVER
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL NO DISTR. DISTR. PIPE .
ELEVATION AND ELEV.. ELEV. DIA. ELEV_ PIPES. DIA; DISTRIBU TION PIPE MATERIAL& MARKING
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY
COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED
PLA NS.
COMMENTS: PERMANENT MARKERS EYES ENO EYES ENO
: OBSERVATION WELLS: -
NUMBER OF JPROPERTV WELL euILOwG
FEET FROM LINE
YES NO OYES NO NEAREST--,,.L
X41.3
Sketch System on
Reverse Side. Retain in county file for audit.
SIGNATURE TITLE. -
DILHR SBD 6710 (R. 01/82)
0
DEPARTMENT OF APPLICATION
lN1J ~ SAFETY & BUILDINGS
LABOR AN, FOR SANITARY DIVISION
PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67)
MADISON, WI 53707
!attach plans for the system on paper not less than 81/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
J vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
33, 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
Imber, 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 Oy,ner:
Mailing Address:
Property Location:
ra4ilaye o ownship: Countyjtfa
5W 1/4$ ^ '/aS 3/ iT N/R / (or) W Sf'
Lot Numb r: Blk No.: Subdivision Name:
TN,Nearest Road, Lake or Landmark: t
~r N
e Plan I.D. Number:
A- (if a§iqned)
TYPE O BUILDIN
Public* E:1 Variance* El Other (specify)* Number of
❑ 1 or 2 Famil *State A Bedrooms:
Y pproval Required.
TOTAL NUMBER PREFAB POURED-IN
GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS INSTALLATION R M ENT E- (Specify)
SEPTIC TANK CAPACITY
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: p
EFFLUENT DISPOSAL SYSTEM W%LV\ M "O"L
PERCOLATION RATE ABSORPTION AREA
(Minutes per inchPROPOSED (Square feet): ❑ New Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
Alternative (specify)
7~ key-, a .5S Lt ❑ Seepage Trench
NCPrrpply: Owner's Name as Listed on oil Test Report (If other than present owner):
ivate ❑ Joint ❑ Public'
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber Signature:
MP/MPRSW No.: Phone Number:
Plumber's Address:
Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Peeasonforr tu of Issuing Agent: Fee:
Date: Sanitary Permit Number
APPROVED
Disapproval: DISAPPROVED
Alternate coursels) 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)
DEPARTMENT OF REPORT ON SOIL BORINGS AND
SAFETY & BUILDINGS
(NUUSHUMAN RELATIONS PERCOLATION TESTS (115 DIVISION
LABOR AND P.O. BOX 7969
~
MADISON, WI 53707
LOCj=CCO_Ji SECTION: u p
~ ~Tj N~R` (o r) W TOWNSHP/MUN Zl~ IPALITY.: LOT,NO.:BLKNO.: SUBDIVISION NAME:
YOWNER'S BUYER'S NAME: u I rl t
MrLl G ADDRESS:
!`,Cruz USEc~'1+~2 > z 1
NO. BE RMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE
❑Residence R T ONS: ER LA ION TESTS:
L ! V S c N ti y El New Replace
y- 7-
RATING: S= Site suitable for system U= Site unsuitable for
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FIL .HOLDING TANK: RECOM NpED SYST~: ptional)
If Percolation Tests are NOT required DESIG~ R TE: SYSTEM EL V.
under s.H63.09(5)(b►, indicate: /I If any portion of the lot is in the
VVV +~j~ Floodplain, indicate Floodplain elevation: l~
PROFILE DESCRIPTIONS
BORING TOTAL 111;;!ii~PTH TO
NUMBER DEPTH IN, ELEVATION GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B C~ C DK
.B-
B_
TESTS
TEST DEPTH WATER IN HOLE
"DUMBER INCHES AFTERSWELLING INTERVALnMIN. DROP IN WATER LEVEL-INCHES
P_ PERIOD 1 PERIOD 2 RATE MINUTES
PERIOD 3 PER INCH
P
P-
P_
PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
of land slop.
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
SYSTEM ELEVATION 95
' _I S1~ i'i~e,1c E 1 zJ 1 ry
Ta
~ t
A%
I, the undersign hereby certify that the sail tests reported on this form were made by me in accord the
Admimistfative ode, and that the data recorded and the location of the tests are correct to the best of my k o'wI dge and bell fs methods specified in the Wisconsin
NAME (p int):
~CtJ~ = T-1 WERE COMPLETED ON:
ADDRi ~lr -7"-I S S~
{y~~' CERTIFICATION NUMBER: PHONE NUMBER optional):
CSTNATURE- r
kiE~,
1
-,a Authori±y, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
State of Wisconsin ` Department of Industry, Labor um ons
' Ple jyRI,
SAF - i.& B1$
1 Burea turn
P.O. Bo 9
I
Madison, 7
m.~ ffm~Plan Identification Number
Re:
PRIVATE SEWAGE SYSTEM ONLY-
The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private
sewage system to be installed at the above-mentioned location. The plans and specifications were prepared by
and received for
approval on
The soil and site evaluation was conducted by
The site meets the soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of
The proposed system is for a
Wastes from the building will discharge to a -gallon capacity septic tank which will discharge to a -gallon capacity
pump chamber from which a pump having a capacity of gallons per minute against a total dynamic head of feet will
discharge through a.inch diameter pipe to the soil absorption system.
It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of
approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation
of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this
approval and shall follow the directions or orders issued by the appropriate local or state authorities.
In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance 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 one set of plans bearing the stamp of approval of this department at
the construction site. If the installation of this system has not commenced within two years from the date of this letter, 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 oversight,
construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions
arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the
permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void
this acceptance.
cc: OWS
County By.
Other T
Enclosures
DILHR-SBD-6159 (R. 7/81) mes Sargent, B erector
;r
State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
<-iurr- au ta'i'- P iuviui t~,,
'Jl E. Wasnirtgturt Av ti.uc
P.0. Box 71u'
3 i gliway Gli
~~:ars i:r' ci :b.
i l ternat i ve Systeiv
=t,S£,31,51, ttsb
; :aura of Star Prairie, St. Croix Louoty,
i S~Aojec•, Petition for Nodificatwn of sectlGi L ;i
~ Iscunsin Aaministrative Cote was considered on April Q1'1, 1982. It
~:pproved.
}_a•v rule requires tnau a pupp coa!, ),r fi--ve e~ _
ire high crater a lam,
. ti cc .
! ne pe-titiol request, 2 . s !
"kid of the data and statewen-ts suoniitted in behalf of the petitiu r;s
considered. This approval is specifi.- to the suoj(rc V pe-0 ,100 { t t.:..t
used for any additional
S i rtcere iy,
/J ume Koepp, Cn i of +
ectiors of Private
i;::rolu C. barber, ZA - St. Croix
i 4, 0i"'os E. Nu;ves, P.E.
Pi:/isior, r. ~7i! { Vi ° Z i
D I L H R-S B D-6423 (N. 04!8 1
btsu6678 (9/81) (Plb 100a)
Qetach And Return U
peer STATE OF WISCONSIN DILHR
Portion Of This Form With DIVISION OF SAFETY & BUILDINGS
Any Return Correspondence BUREAU OF PLUMBING
201 E. WASHINGTON AVE. RM 178
P.O. BOX 7969
MADISON, WI 53707
DATE:
608-266-3815
,SE,31,31, _ p,
[PLAN OJECT:
S?fC t~tc7s
ID. # L> It FFh'NS 1982
DETACH HERE 1S'
PROJECT NAME \ 4
PLAN ID. # I z
This is to acknowledge receipt of your plans and specifications for the above-indicated project.
Preliminary review indicates the required fee is $
Underpayment -Please submit the additional fee. Fee Received is $
El Plan accepted for review. ❑ Overpayment -Refund forthcoming.
Plans being returned.
El El No fee has been remitted. Plans submitted with no fees will be El
held in abeyance. ❑ Additional information required. SEE BELOV./
1. Plan Submission
❑ Additional information shall be submitted in duplicate un- ❑ Complete data relative to anticipated use of bldg.
less specifically noted. ❑ 2 copies of PLB 60 enclosed.
❑ Plans not clear, legible or permanent. ❑ Deed restriction required (1 copy).
❑ All information submitted shall be signed, dated and sealed Condominium declaration. (1 copy)
or stamped in accord with Section H 63.08(2)(x) Wisconsin
Administrative Code. ❑ Affidavit enclosed. IV. Holding Tanks
II. Pressurize Distribution Systems (Mound or In Ground Pressure) ❑ Profile of holding tank showing vent, manhole alarm and
manufacturer if precast. Complete construction details if
❑ Application for use of an alternative system signed by owner site constructed.
and notarized. (1 copy) El Holding tank agreement signed by owner and local unit of
❑ County onsite required (1 copy), ❑ Design calculations
government sample enclosed).
for pressurize distribution.
Soil boring & percolation El Reason for installing holding tank. Soil test or statement
test data, from county (1 copy).
❑ Cross section of system. ❑ pipe lateral layout. ❑ Plot plan showing location of holding tank with lateral dist-
❑ Plan view of system. ❑ Plot plan. ances to any buildin wells, water service piping, water
y• (1 copy) course, lot lines, swimming pools, all weather service road,
Etc. Provide benchmark with elevation reference point.
III. Private Sewage Disposal Systems
El Ground slope with 2' contours in entire area of soil absorp- V. Lift Pump
tion system extending 25' on all sides. ❑ Calculations for total lift pump discharge, head and gallons
❑ Elevation of permanent reference point (benchmark). Pumped per cycle.
❑ Size, length & depth of force main. Location of area suitable for replacement system -provide
n.
soil data. ❑ Detail & model of pump
plan showing lot size and all lateral distances from or automatic siphons including
sewage disposal system to buildings, lot lines, well, water size, pump curves, drawdown and average flow rate GPM.
❑ Plot ❑ Cross section of lift pump mp tank showing pump(s) or
course, swimming pools, water service piping, Etc. siphon(s).
❑ Construction detail of septic, holding or lift pump tank if
site constructed or tank manufacturer if precast.
1:1 Construction detail and cross-section of soil absorption
VI. SYStt In Fill (Fill must be placed prior plan submission)
system. El Total area filled (fill to extend 20' beyond edge of trench
El Soil boring and percolation test on 115 completed by cer- before side slope begin).
tified soil tester (1 Copy)- El Depth and type of fill.
❑ Copy of onsite report by county or district staff.
S13p4678 (*/81) (Plb 100a) ~ STATE OF WISCONSIN DILHR
Detach And Return Upper DIVISION OF SAFETY & BUILDINGS
Portion Of This Form With BUREAU OF PLUMBING
201 E. WASHINGTON AVE. RM 178
Any Return Correspondence P.O. BOX 7969
MADISON, WI 53707
608-266-3815
DATE:
PROJECT:
S'E,31 31, I 4s
Aar Pra i r 7
MPR p~\NQ~
S5 West'H1gitway CP
PLAN ID.
DETACH HERE
PROJECT NAME PLAN ID. #
This is to acknowledge receipt of your plans and specifications for the above-indicated project.
Preliminary review indicates the required fee is $ Fee Received is $
❑ Underpayment - Please submit the additional fee. ❑ Overpayment - Refund forthcoming.
❑ Plan accepted for review. ❑ Plans being returned.
❑ No fee has been remitted. Plans submitted with no fees will be ❑ Additional information required. SEE BELOW.
held in abeyance.
1. Plan Submission ❑ Complete data relative to anticipated use of bldg.
❑ Additional information shall be submitted in duplicate un- ❑ 2 copies of PLB 60 enclosed.
less specifically noted. ❑ Deed restriction required (1 copy).
❑ Plans not clear, legible or permanent. ❑ Condominium declaration. (1 copy)
] All information submitted shall be signed, dated and sealed
or stamped in accord with Section H 63.08(2) (a) Wisconsin
Administrative Code. ❑Affidavit enclosed. IV. Holding Tanks
❑ Profile of holding tank showing vent, manhole alarm and
manufacturer if precast. Complete construction details if
11. Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed.
❑ Application for use of an alternative system signed by owner ❑ Holding tank agreement signed by owner and local unit of
and notarized. (1 copy)
government (sample enclosed).
❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statement
for pressurize distribution. M Soil boring & percolation from county (1 copy).
test data.
❑ Plot plan showing location of holding tank with lateral dist-
❑ Cross section of system. ❑ Pipe lateral layout. ances to any building, wells, water service piping, water
❑ Plan view of system. ❑ Plot plan. course, lot lines, swimming pools, all weather service road,
Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point.
Ill. Private Sewage Disposal Systems V. Lift Pump
❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge, head and gallons
tion system extending 25' on all sides. pumped per cycle.
❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main.
❑ Location of area suitable for replacement system - provide ❑ Detail & model of pump or automatic siphons including
soil data. size, pump curves, drawdown and average flow rate GPM.
❑ Plot plan showing lot size and all lateral distances from Cross section of lift pump tank showing pump(s) or
sewage disposal system to buildings, lot lines, well, water siphon(s).
course, swimming pools, water service piping, Etc.
❑ Construction detail of septic, holding or lift pump tank if
site constructed or tank manufacturer if precast. VI. Systems In Fill (Fill must be placed prior to plan submission)
❑ Construction detail and cross-section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench
system. before side slope begin).
❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill.
tified soil tester (1 Copy). ❑ Copy of onsite report by county or district staff.
SBD 6678 (9/81) (Plb 100a)
Detach And Return Upper
STATE OF WISCONSIN DILHR
Portion Of This Form With DIVISION OF SAFETY & BUILDING
BUREAU OF PLUMBING
Any Return Correspondence , "20VE._WASHINGTON AVE. RM 178
P.O. BOX 7969
MADISON, WI 53707
DATE: 608-266-3815
PROJ
J1.,
rt Star
5 West Hi9PWdy
PLAN ID. #
DETACH HERE
PROJECT NAME
PLAN ID. #
This is to acknowledge receipt of your plans and specifications for the above-indicated project.
Preliminary review indicates the required fee is $
Fee Received is
Underpayment -Please submit the additional fee.
❑ Plan accepted for review. ❑ Overpayment u Refund forthcoming.
No fee has been remitted. Plans submitted with no fees will be ❑ Plans being returned.
El held in abeyance. ❑ Additional information required. SEE BELOW.
I. Plan Submission
❑ Additional information shall be submitted in duplicate un- ❑ Complete data relative to anticipated use of bldg.
less specifically noted. ❑ 2 copies of PLB 60 enclosed.
El Plans not clear, legible or permanent. El Deed restriction required (1 copy).
El All information submitted shall be signed, dated and sealed El Condominium declaration. (1 copy)
or stamped in accord with Section H 63.08(2)(a) Wisconsin
Administrative Code. ❑ Affidavit enclosed. IV. Holding Tanks
I I. Pressurize Distribution Systems (Mound or In Ground Pressure) El Profile of holding tank showing vent, manhole alarm and
manufacturer if precast. Complete construction details if
El Application for use of an alternative system signed by owner site constructed.
and notarized. (1 copy) ❑ Holding tank agreement signed by owner and local unit of
El County onsite required (1 copy). ❑ Design calculations government (sample enclosed).
for pressurize distribution. ❑ Soil boring & percolation El Reason for installing holding tank. Soil test or statement
test data. from county (1 copy).
❑ Cross section of system. El Pipe lateral layout. El Plot plan showing location of holding tank with lateral dist-
❑ Plan view of system. ❑ Plot plan. ances to any building, wells, water service
❑ Verification of Exception Status Form by Count course, lot lines, swimming piping, water
Y• 11 copy) Etc. Provide benchmark with elevataolnv vic
reference point road,
I If. Private Sewage Disposal Systems
El Ground slope with 2' contours in entire area of soil absorp- V. Lift Pump
ti system extending 25' on all sides. El Calculations for total lift
❑ Elevation of permanent reference point (benchmark). pump discharge, head and gallons
pumped per cycle.
El Location of area suitable for replacement system -provide ❑ Size, length & depth of force main.
soil data. El Detail & model of pump or automatic siphons including
❑ Plot plan showing lot size and all lateral distances from size, pump curves, drawdown and average flow rate GPM.
sewage disposal system to buildings, lot lines, well, water El Cross section of lift pump tank showin
course, swimmin siphon(s). 9 pump(s) or
g pools, water service piping, Etc.
❑ Construction detail of septic, holding or lift pump tank if
site constructed or tank manufacturer if precast. VI. Systems In Fill (Fill must be placed prior to plan submission)
❑ Construction detail and cross-section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench
system.
❑ Soil boring and percolation test on 115 completed by cer- before side slope begin).
tified soil tester (1 Copy), ❑ Depth and type of fill.
❑ Copy of onsite report by county or district staff.