The URL can be used to link to this page

Home My WebLink About020-1342-10-030 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(ni Permit Holder's Name: Township City Village David Bi TOWN OF HUDSON CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA CAPACITY TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction L'Oskr stem Head TDH Ft Forcemain Length Dia. Mist. to Well SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/i Inlet St/i Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO ji B D WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer: Type Of System: Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipets) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xz Seeded/Sodded xx Mulched Bed/Trench Center Bedlirench Edges Topsoil O Yes A No ® Yes No COMMENTS: (Include code discrepencies, persons pres nt, etc.) Inspection #1: �an� j�nL2- Inspection #2: flQ Location: 673 COTTAGE LN S) SB r t� � Si f 1.) Alt BM Description = /P� Q��yu�,�,�jgr W�L� O ('� y�j,i7r ka�•1.6.2 2.) Bldg sewer length = �l P� EnsC. relix dZ �p'er • �� amount of cover = r- / n !1 �t S4 t £ tl �.1r� Yt.t. GT �i QDrO/ '+'t-ice r 1 Plan revi ton Requir dVYeC Use other side for additional informa on. _ � l I t Cate n Inse ors Signatj�S [TL 1(J411^.R�31�(gx7_')IT" 'QN1.1►1�- �` c Carl. No. In jam, tS cc. �1�+�41 S .T• i 5 Ma. �n�, b! - 11 ! M. �v ��\f.f �� sFy y. � i• eh g` _. yr{>� �� ( J,d''t-�a Ha �,(X . WWI bull p F b • {- 4.. �Ld+1.- i•^' u �... f ` ram$ - v �(( tY r i i • T+ a • t � l � f ••C4. 4,,v� •. 'fit: aFy, r J�� r•Y v � 1 f' T r t Yr rtx �s w i ,� • r t �K,, E,r �. rrv. a n t2 TeC" ' J AWAF 41 1. ny IWA e _ Syr R`1'�fll,FdMM!". ` 0. '%(_` si► ° ��t 'r Y,�,� e '.. �N a• .y�r,' _ x� t ,. :K � Fhe +,17 /v ` .�G, 2f 1 q. _ e.�a e > "pi+`1- r i /' ° �...x 'M M L„r • r y rtt�+:. � } A ? . . , � _.� ti � • ...� ., v � � -➢t t°/ � � ff � t I IV � ` ,fiA ,C n. e�'i�` L .a ..��v�5?` ..... :r+' TM�;: b.`. ...M �rd+�de::, `wY , ,h`Sk� •Iri _'i4'S`'�'' i`. ."�.,� •2=. r tYa _''_ xi'c{1LeY,`"uF �r E:�a ��N ?d�_�p - rs16 Sanitary Permit Application ST. CROIX COUNTY WSCONSIN accord with Chapter 12 St. Croix County Sanitary Ordinance COMMUNITY DEVELOPMENT DEPARTMENT FCounty rs nal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER sGnsaa [Privacy Law. S. 15.04(1)(m)] f`�\ 1101 Carmichael Road �� Vt 1 2Q22 000777 Hudson, WI 54016-7710 I I Q `� (715)388-4880 Fax (715)245-4250 Atta complete plans for the system on paper not I 2 x 11 inches in size. St. CraX Bey fish Permit # ❑ Check if n o previous application „nits e omm I. Application Information - Please Print all information Location: Property Owner Name rw 1 r„� 1/4 pint/4, Sec Z T .Z `? N, Rr f i Z. I Property Owner's Mailing Address Lot Number Block Number 7 L 1 3 City, State Zip Code Phone Number Subdivision Name or CSM Number Win w.r- WIND5m2 W-s (ni`tTS II ype of Building: (check one) ❑City ❑ Village $Town of or 2 Family Dwelling - No. of Bedrooms: I ❑ Public/Commercial (describe use): J / N Nearest Road 1 I C is tick kb i—Av ❑ State-owned box A. heck box B if If. Type of Permit: (Check only one online online applicable) Parcel Tax Number(s) 10 Repair R)connectJon 3L] Non -plumbing 4.❑ Rejuvenation A) ozD LLIL Sanitation Permit Number Date Issued B) c� G State Sanitary Permit was previously issued zoo � IV,Type of POW System: (Check all that apply) on -pressurized In -ground ❑ Mound a 24 in. suitable soil ❑ Mound 5 24 in. suitable soil ❑ Mound A+0 and Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating V. DispersaUTreatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required roposed (Gals. /day/sq,fL) (Min./inch) Elevation (0OD fTlr VI. Tank Information Capacity in Gallons Total o Manufacturer Prefab i Site Con Steel Fiber- Plastic Gallons Tanks Concrete strutted glass New Existing Tanks Tanks ❑ ❑U ❑ ❑ VII. Responsibility Statement 1, the undersigned, assume sibility for repair/reconnection/rejuvenationrrnstallation of non -plumbing for the POWTS shown on the attached plans. A license is not require r terrali ai or the installation of non -plumbing sanitation system. Plumber's Name (p nt) lumbees Signature (no stamps): MP/MPRS No. Business Phone Number R 3164o - O �1�- �? -588 Plumber's Address (Street, City, State, Zip Code Al'?05_3COULNg R rim a (ek (.tJ Vlll. County Use Only Disapproved itiai Adverse SanaryPermlt Fee Date Issued �! Issuing Agent Signature Ps) r Approved � 5—D -7 �ZZ 7 Determination IX. f eF13) AA �{ &" A w. Ds PS -i�R_ ` �� ep is an at n°�sfarDt> dispersal cell must be servleed / ma]nttlinad 'N J,. z p AA� as per management plan provided by plumber.Ly 2.All setback requirements must be maintained, `{ �A Per:-{n i " ')SIN 382. 32�I��Pfi� Z S ltcr as per applicable code/ordinances. - _ s ��r ,b,�,� or�✓pv�� `�I1 f'2t&KA&C7W-lan_'fa 15 S n_ Ram.. d 1 e-AN . -_-) e.�) -1 — k�L County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN accord with Chapter 12 St. Croix County Sanitary Ordinance information be for COMMUNITY DEVELOPMENT DEPARTMENT ST. CROIX COUNTY GOVERNMENT CENTER S rs nal you provide may used secondary purposes .„„r [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road 1 2022 Hudson, 0 16-7710 Q 1 (715)3 86-4680 Fax (7 5)245-4250 Alta h complete plans for the system on paper not 2 x 11 inches in size. 5t. CrOO( SaH Permit # ❑ Check if Pe*19117F previous application om munity e — 20'2.'Z— 1 s% I. Applicatlon Information - Please Print all Information Location: Property Owner Name yd 1/4 f 67'1 /4, Sec 3 Z _ C I I 7-1 T 2 `) N, / Rr Property Owner's Mailing Address Lot Number Block Number 7 f ZAAvE 3 City, State Zip Code Phone Number Subdivision Name or CSM Number 4in �✓ s�� — b wfN05se- ► 1.16, tTS II Type of Building: (check one ❑City ❑ Village_S$Town of or 2 Family Dwelling - of Bedrooms: ❑ PubiiGCommercal (describe e use): / N Nearest Road . I C tMlk" LJv ❑ State-owned Il. Type of Permit: (Check only one box online A. heck box online B 0 applicable) -C Parcel Tax Numbers) ir R nnection 30 Non -plumbing 4.0 Rejuvenation o20 �f. Sanitation i!3T2—)1)_030 Permit Number LB) Date Issued Sanitary Permit was previously issued �% ii - /Z- - z� IV. Type of POWs System: (Check all that apply) on -pressurized In -ground ❑ Mound t 24 in. suitable soil ❑ Mound 5 24 in. suitable soil ❑ Mound A+0 Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required rop (Gals. /day/sq.ft.) (Min.Anch) Elevation 600 VI. Tank Information Capacity in Gallons Total o Manufacturer Prefab Site Con Steel Fiber- Plastic Gallons Tanks Concrete structed glass New Existing Tanks Tanks 250 ❑ ❑ ❑ ❑ ❑ ❑ ❑ El ❑ ❑ VII. Responsibility Statement 1, the undersigned, assume sibility for repair/reconnection rejuvenation/installation of non -plumbing for the POWTS shown on the attached plans. A license is not require r teral' al or the installation of non -plumbing sanitation system. Plumber's Name (p nt) lumber's Signature (no stamps): MP/MPRS No. Business Phone Number I Z Bz6r40 d �1F' Plumber's Address (Street, City, State, Zip Code w t,✓4� Vill. County Use Only Disapproved San' ry Permit Fee ?P Date Issued Issuing Agent Signature Ps) Approved ilia/ Adverse %Z/ ( 7 V r Determination IX. v s-fvrfrssq�pror 3) AU �.� & S �v DS P5 'f�2 ep is an , tar n --b'��l^er dispersal cell must b�serviced / ' in®d Jo r, �,�,r p� a 1. as per management plan provided by plumber. 2.All setback requirements must be maintained 4)A U"k i " ') ( 5M 3R2. 301W z L't S-Ad'"`" CAke .as per applicable code/ordinances. - I ��T�a-aSC r e dey fkK t EA RetWm /B { S(3 L6VlYl�'rJ�7jV� t ¢ # �R5 s_ �f.`li't;t`� -, k 1 Z .L3isiOa�!e . e � rh , Towk 45Ek 3urry 3s6�o�,6t`t� ierc� Pl�wl�;�y +N C ME 0 D,Iro ROY15 2c5. b73 Lol4ote Lahr . 14%dSntn wr, 5-AO16 May 31, 2022 Plan Review: PWTS-052200012-PV David Edward Buye 673 Cottage Lane HUDSON WI 54016 APPROVAL OF PETITION FOR VARIANCE Contact Name: David Edward Buye Contact Address: 673 Cottage Lane Hudson, WI. 54016 SITE: David Edward Buye Address: 673 Cottage Lane Hudson, WI. 54016 Total Amount: $600.00 FOR: Petition for Variance SPS 383.43(8)(i), Wis. Adm. Code DIVISION OF INDUSTRY SERVICES 2850 MIDWEST DR STE 104 ONALASKA WI 54650 Contact Through Relay http:iidsps.wi.gov/programs/Defauft.aspx www.vAsconsin.gov Tony Evers - Governor Dawn Crim - Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES �10 7 r SEE CORRESPONDENCE The submittal described above has been reviewed for equivalency to applicable Wisconsin Administrative Codes and compliance with Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED The owner, as defined in section 101.01(10), Wisconsin Statutes, is responsible for compliance with all conditions of this petition approval. The code section petitioned requires that POWTS treatment, holding and dispersal components shall be located so as to provide the minimum horizontal setback distances as outlined in Table 383.43-1 as safety factors for public health, waters of the state and structures in the event of component failure as per SPS 383.43(8)(i), Wis. Adm. Code. The variance requested is to allow a corner of a proposed pool building with facilities to be constructed no closer than 2 feet from a septic tank. The corner of the building will also encroach 10" over where the existing sewer line from the home to the tank is located. The intent of the code section petitioned is to provide the minimum horizontal setback distances as outlined in Table 383.43-1 as extra safety factors for public health, waters of the state and structures during construction and in the event of component failure. The petitioner submitted the SB-9890 application form including several pages of supporting documents and photos. Reviewer's Comments: • Kevin Grabau, St. Croix County Land Use & Conservation Specialist does not object to the variance request made by David Buye. • The proposed pool service building will be placed upon round column concrete footings at all 4 corners. This should minimize any force put upon the existing septic tank. • The variance approval procedure is an acceptable and cost-effective way to satisfy this code requirement. • Based on the precedent established by the previous petitions, this petition for variance is being processed as permitted by Wisconsin Statute s. 101.02(6)(g), and SPS 303, Wis. Adm. Code. Departmental Action: CONDITIONAL APPROVAL Reviewer's Conditions of Approval: • The warning label in missing from the lid of the existing septic tank. This shall be replaced with a permanent label attached to the cover per SPS 384.25(8), Wis. Adm. Code. • The existing septic tank shall be fully protected from being damaged during construction of the pool service building and installation of the footings. 9deed restriction per SPS 382.30(11)(a)2, Wis. Adm. Code shall be recorded with the Register of Deeds office no later than 90 days after the building is completed. The document shall indicate the pool building encroaches 10" over where the sewer line is located. • Per St. Croix County comments, there shall be adequate area surrounding the tank for all required maintenance purposes. All of the petitioner's statements of fact or intent included on the variance application form, any other documents submitted to the Department shall be carried out. This variance is specific to the subject petition and cannot be used for any additional modifications. This decision will become final unless the department within 30 days from the date of this letter receives a written request for a hearing. A request for hearing should be sent to the address shown on this letterhead. A copy of this letter must be included with the request for a hearing. The request for hearing should state the reasons for objecting to the department's decision. A request for hearing may be denied if it does not present a significant question in fact, law or policy. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. We look forward to working with you to make this code -compliant construction. Sincerely, r I Gerard M. Swim POWTS Plan Reviewer WI DSPS — Div. of Industry Services Bureau of Field Services 608-789-7892 jerry.swim@wi.gov cc: Kevin Grabau, St. Croix County Land Use & Conservation Specialist 5/31/22 correction of error - GMS STATE OF WISCONSIN Application for Review, Petition for EP =1 -Complete all pages- E c Department of Safety and Professional Services Variance Industry Services Division Use this page for fax appointments (fax 877-840-9172) NOTE: Personal Information you provide may be used for or email to: dsossbolanscheduleC_wl.00v secondary purposes [Privacy Law s. 1504(1) (m), Stats.) Indicate date plans will be in Industry Services office fl 1 wish to suhmit nians via SharePnint. SharePoint UserName: 1. Facility Information Complete for confirmed appointments*: Transaction ID: Facility (Building) Name: '""" NOma 540 16 Number and Street C o }+4ky f-a r,f Zip: Previous Related Trans. to; BPS Site Number (if known): Assigned Reviewer: Jo r ry S wi m Legal Description: Assigned Office: County of: S '}. C e o I X C ou i+y Review Start Date*: ❑ City ❑ Village 19 Town of: 'Submittal must be received in the office of the appointment no later —H-%Ld s an than two working days before the confirmed appointment. 2. Owner Information Customer it _ 3. Designer Conditionally — Name: Company Designer. APPROVED —DEPT. OF SAFETY AND PROFESSIONAL E r,N QN Q Name: L!tt Yid g iAy¢ f % SERVICES Design Firm DIVISION OF INDUSTRY SERVICES Number and Street:_6 73 Cc+tCj L.Ane Number and L ^ City, Slate, Zip Code: PIAJ tell W T ; S G1b City, State, � Contact Person: Do, g ,, ,z `y�yQ`11.\,<-Q� Contact Pon SEE CORRESPONDENCE (012 79y-�oq rjnvtd et�,ti, h Telephone Number. Email Address: Telephone Number: Email Address: 4. Plan Review Status Plan previously review by�please enclose a copy of review letter) [I Plan submitted with petition ❑ Slate ❑ Municipality Approved ❑ Held ❑ Denied ❑ Plan review not required Code Being Petitioned: ❑ Commercial Bldg ❑ HVAC ® Plumbing ❑ Plan will be submitted after petition determination ❑ Private Sewage System ❑ Swimming Pool ❑ Electrical ❑ Boilers ❑ Amusement Rides ❑ Uniform Dwelling Code ❑ Requesting revision ❑ Other ❑ Elevators ❑ Gas Systems ❑ Refrigeration ❑ Camping Unit BPS Transaction Number L1 Other 5. State the code section being petitioned AND the specific condition or Issue you are requesting be covered under this petition for variance. —SPS 383.43(8)(i), WAC, The code section petitioned requires that POWTS treatment, holding and dispersal components shall be located so as to provide the minimum horizontal setback distances as outlined in Table 383.43-1 as safety factors for public health, waters of the state and structures in the event of component failure. ®Reason why compliance with the code cannot be attained without the variance (Attach additional sheets, if necessary) _ 84sCJ oh Sef --ic -h,,.k lace.4-;vh, +),a Cikj)*, e4- +tie 54r} c 1,'ke 4-e mtr 1^cult. And 91.e Se-4- mask rett.ureA /-rpm lood 4-o Shea( ', we lime v, line i�e� lacn�icn 4-o pkce }lie Stied, /}s drscµssedj -l- s- voirJOhcf is re9a�dh9 acce)Olai++ce o.F a 2 �bv+ SeJ ba<•jc I`nSk"A d4 5 fop}� SaP}t't }c,hk ed'e }d Stitd edja. AlSo., S ,cli flank /tic SPpit"c lines rNnS ctr,deti rll�v rotAshly las} 10 intliss vF �11e g)ied Gerhah, State your proposed means and rationale of providing equivalent degree of health, safety, or welfare as addressed by the code section petitioned. Rojaad(ntr ad0tiA(A-e 0.cc.e19 4-c n,c+ii4cvi, +c syl)h 4tlhk +1rd,e will ral"clen rlo ob Siau 1�_ ne,a)- 't)� i6hi= QiY-rp„ T-{- Wi ll remain derv,"•gbla 4-t if -has be -eh, /Js f-or land 7'ernl �D a.r�er n^aaae, p� pia S'rp�-Pt: sy etri is Iaehce by �e hew S,a +o r� N�c riYk o-F-Freezel tlirw e><ptn,ts�aftcrus eve Are ttsin� cyli.ldtr- �cil,a Slc �oe+�a�s is Clisr^ectE fiorccS Y�igl(� a� }hc GvrnarS Ihskec\A O�- k-06A rec4AnS1t %oo+lMI> cnloh9 -�Lo, PQr'irhz'%er, l 8n, List attachments to be considered as part of the petitioner's statements (i.e., model code sections, test reports, research articles, expert opinion, previously approved variances, pictures, plans, sketches, etc.). — — Cots wl-er dretwi'0�1 0+ IryVI+ f)1v e;s o-f 1aiyt9o+ mec•ketl v�p msl'h) markiriv oh f1,2 jretih. SBD-9890X (115/18) Page t of 4 Explanation for recommendation including any conflicts with local rules and regulations and 6Su-re- ❑ Department of Agriculture, Trade & Consumer Protection (DATCP) ❑ Department of Health Services (DHS) ❑ Department of Natural Resources (DNR) Other. 5. (4i7C Gw4 Name of nee (type or.p lnt) /J iL19j $A-" est ��Itlµnt er re ^ row"-4� e..►� �..,ar a,.�G�a,.ir-t► e"lo°.r�F�ao Petition for Variance Information and Instructions SPS 303 In instances where exact compliance with a particular code requirement cannot be met or alternative designs are desired, the division has a petition for variance process in which It reviews and considers acceptance of alternatives which are not in strict conformance with the letter of the code, but which meet the intent of the code. A variance Is not a waiver from a code requirement. The petitioner must provide an equivalency which meets the Intent of the code section petitioned to obtain a variance. Documentation of the rationale for the equivalency is required. Failure to provide adequate information may delay a decision on the petition. Pictures, sketches, and plans may be submitted to support equivalency. If the proposed equivalency does not adequately safeguard the health, safety, and welfare of building occupants, frequenters, firefighters, etc., the variance request will be denied. NOTE: A SEPARATE PETITION IS REQUIRED FOR EACH BUILDING AND EACH CODE ISSUE PETITIONED (i.e., window issue cannot be processed on the same petition as stair issue). It should be noted that a petition for variance does not take the place of any required plan review submittal. The division is unable to process petitions for variance that are not properly completed. Before submitting the application, the following items should be checked for completeness In order to avoid delays: • Petitioner's name (typed or printed) • Petitioners signature • The application must be signed by the owner of the building or system unless a Power of Attorney is submitted. • Analysis to establish equivalency, including any pictures, illustrations or sketches of the existing and proposed conditions to clearly convey your proposal to the reviewer. • Proper fee • Any required position statements by fire chief or municipal official A position statement from the chief of the local fire department is required for fire or life -safety Issues. No fire department position statement is required for topics such as plumbing, private onsite sewage systems, or energy conservation. Submit a municipal building Inspection department position for SPS 316 electrical petitions, or if SPS 361-366 commercial building plan review Is by the municipality or orders are written on the building under construction. (Submit a copy of the orders.) For rules relating to one- and two-family dwellings, a position statement Is required only if the local municipality is the enforcing body. A position statement from the county sanitary permit issuing agent is required for petitions to SPS 383 and 385. A position statement from the Department of Agriculture, Trade and Consumer Protection (DATCP) is required for life -safety issues for public swimming pools requested from SPS 390. Position statements must be completed and signed by the appropriate fire chief, local government enforcement official or state agency designee. Signatures or seals on all documents must be originals. Photocopies are not acceptable. SBD-989OX (R5/I8) PaRc 3 of 4 This shows the patio area just behind the house and a portion of the pool in addition to the yellow pool house / shed which will be built soon, so the contractors would like to tie into the septic ASAP and get footings poured. The dark orange circle is the septic tank and the orange / yellow lines are shown from the house to the tank and fromthetank to the drain field. To get everything in the desired location to fit, the resulting distance from the septic tank underground edge to the shed edge is roughly 2 feet and S inches, then the shed edge to the pool is just over 7 feet and lastly the septic line running from the house to the tank would run under the shed corner roughly 10 inches. • See subsequent 4 pages for reference photos. i Y � i1� •� � l � � ' ♦ 7 t � rI' rr Y � JJ'• `ri. f � S i K ..��i ` — y `y ✓ tT L d {y,r � G , :fcK- �.�rn� �sy:'.o'1! �'� �� y✓ � r:�L� .x'r � 1 .r+� ��`G d Ny�i.h.l! �' �jwsr�'�R'1f �F�w�`r. ��\iK��.a�t":'i rC '�4s t'',q�r.• .f, Jam' �/ '� pUiy �j w �.r Aib •� �eVt J fyF M -Lcn tun5oVetP �1�1me jev4n a-. ji y'"✓� _. ,�Nyr i `'y�� - a M �{�I,,�yh�Yh� �. � � � ��s.%�. y.- � , ec - is 1 .k ° •v.l \�ll. M � IM vfiXF 41 ee .,bed e dg 8, eft Nil 4-4 *Q lt A4. MOM ` R s ft At 1' y. rl totk./T� !'• ..l , ,t . _ of ..�' , • J'i.� �!{( I � i Ugh1V SeQICXCX% of o{ shed �O(�ec e4.' 1p.o Q" Ora, GoLiry p ierc� [icehSE �-I - )o04A M isbi�� +0 Tip. cl ��r wasTt �ihe iv,�o 4t� �vi[d', Tke a , -'o L O'xd Would C ov-S i O F O h. e Wi�.� c � IoSeT 44 6ke lavA-Poly, 'fie hee toto� Sep�I c i�K, Tketc Gv, �I gc c�9 c l ear v v r i `d2 uew S*ve-fvre, e Ta,�K �;StR IN;11 .Ve� fo be-elevet+4 pve Tke SyS7'etir �i�ea�s Tp �e �vK�-��nN�� ade va�L. ak�t Straw! tzo V, � � � ' rjvt� v aoge44%o-- E A variance was obtained May 2022 from the state of WI and St Croix County for setbacks relative to septic tank and septic line �1�> f Septic tank edge dark orange, lid is gray circle Septic line it orange z Cu66isS I 32''-h 3'f/I 54tee) cleat- �o' /KAYLe Cal);hj Kj6f/pAn 5L C eyn}er Nt Pybe Eoev,is Ou 6" Medium FiA3,e I I S+ael 28" COD �� Po�kcr d uor OU}lei' Cold water ink 31 / °nli 6, wide w,hJ.w , — w i th f'I " P OP°h lid 4-o SxFo54 "Cev,n�ev -- --. Y! ON+ t.a� gbeve c wn4e r ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) In"7� Aa.o �AAIE located at: N-0 ''/4, '/4, Section 3Z , Town__ai_N, RangeI_L_W, Town of tk*o , , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? (if no, skip next line.) Approximate volume or length of time: Tank Capacity: Construction: Prefab Concrete Steel Manufacturer (if known): Age of Tank (if known): Permit number (if known) F.�" (Licensed Plumber Signature) (Title) �-I - N�-D, (Date) Yes No gallons _ Other BAR V 3SAAAE 1?t (Print Name) minutes gXb70 (License Number) MP/MPRS Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 ST. V,NTY SANITARY SYSTEM File#: OWNERSHIP/ADDRESS FORM Office Use ly Created /2021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer bom.4L Mailing Address (973 t bo4c,� L 6 to City/State/Zip Ov&O Phone Number (required) Email Address (required) d9vJhUVe&tW4 n'1(/7� Parcel Identification Number .a.Q 119. ! R/9 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location _A(LV'/4 , #W t/4 , Sec. _3a, T 2TN Rj_q__W, Town of V 44814 Subdivision Plat: Iji-t ar Belltlai? , Lot# . Certified Survey Map # Volume Page # o Warranty Deed # �t Dq (before 2006)Volume Page # Number of bedrooms Spec house O yes O no Lot lines identifiable 0 yes 0 no New Property Address OFFICE USE ONLY (Verification of new address reg(Ljired from Community Development Department for new construction.) (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwioov Wisconsin Departmentcf Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary Durposes IPdvacv Law. s.15.04 (1 lfm)l. Permit Holders Name: city village X Township Kin sborou h Ho es I Hudson Township CST BM Elevv, Insp. BM Eleevii:�� SM DDescription 100-pGv, rw.,,X.eXJW6frsM at TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic lv_ l� 30 r �• Dosing Aeration Holding PUMP/SIPHON INFORMATION TDH Lift ction Loss System Head For an Length I . Dist. to Well SOIL ABSORPTION SYSTEM 13, t;, l e.... ' -9Eaf(RENCHJ Width r Length No. fTrenches D I M E N 91 NS SETBACK SYSTEM TO P/L JBIfDG INFORMATION Type Of System: r r co-,vv. I o + -•- IZ6 DISTRIBUTION SYSTEM r=1111ATIAaLai 2PLaC1 County: St. Croix Sanitary Permit No: 399569 0 State Plan ID No: Parcel Tax No: 020-1342-10-030 1 io.-49 di I/dl95-+e 6K1c�*•1eI9'A TATI N s BS HI FS ELEV. Bench rk J \ Z.o'} liz•v im-se' Alt. BM Bldg. Sewer ' '/+ jolt 1 to. 2, t if SUHt Inlet �1 1/214 .O �17.1 1 SUHt Outlet , / b 1 Dt Inlet Dt Bottom Header/Man. q Dist. Pipe 1 13•o qq•&� Bat. System (7 • r Final rade 21 " � •� IQ.%st �11-•yt -1 • /0D.8D stCo r • 42' f: lo. Of Pits CHAMBER OR UNIT Model Nu -z) Header/Manifold y Distribution Leng(h) x Hole Size acing Vent to Air Intake 21.} t Length Dia Length la Spacing SUIL GUVtK Drncmirn Cvetnme Al I1 vv MnunA rlr At-Mmrfa Svstams Onty Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched BedrFrench Center Bed/Trench Edges To soil p � Yes A No [-M] Yes [I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: l 5 / Ob / -02-- Inspection #2 -4----7 Location: 673 Cottage Lane Hudson, WI 54016 ((_N,W 11/4_N!W 1/4 32 T29N1R19W) Windsor Heights L Parcel No: 32.29.19.1819 1.) Alt BM Description = �•� 'T N"�"` �'� ` �°iie ��J �}`' ct` w--�` 2.) Bldg sewer length = 3` J l3.01 1 `r Z • t -amount of cover.(? - J �o � o.op�, • S. ision 6quir �bf�Ygerfs�yQry N�o cidpfgjadiitt%Da!—if�•dC14-V 0� e� Pc g Date Inse tors Si nature Cert. No. Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington PO Box Ave. seonsin See reverse side for instructions for completing this application Madison, WI 53707-730' Department of Commerce Personal information you provide may be used for secondan• purposes (Privacy Law. s. 15.04(I)(m)] (Submit completed form to county if r state owne( Attach complete plans (to the count), copy only) for the system. on paper not less than 8-1/2 x I I inches in size. County - S1<,( :Y State Sanitary Permit Number ❑ Check if revision to previous application State Plan 1. D. Number N I. Application Information - Please Print all Information Location: Property Owner Name Property Location I y rc L L C Gt�t/4 �/..d/4, S � T�` or 71 /✓ 7N. RAE Property Owner's Mailing Address Lot Number Block Number k 7 S t> City, State Zip Code Phone N Subdivision Name or CSM Number LG`/i=ix �/✓.-e•� )— S—C�iC ; �T : --)"l" `M1O�r f�f II Type of Building: (check one) t en is l or 2 Family Dwelling - No. of Bedrooms: p=A- City ❑ Vil RC�E�VLU -ff Town of ❑ Public/Commercial (describe use): ❑ State-owned III Type of Permit: (Check only one box on line A. Check lip app a Nearest Road J1 A) 1. JR New System 2. ❑ Replacement 3. ❑ Ret of T� tto/rto�" X ax 1Jumbcr(s) S stem Tank 2 ' xtstin $ $) Permit No r ^�E's Date Issued ❑ A SanitaryPermit was previouslyissued W. Type of POWT System: 6p9eck all that apply) dr20-- 13(6? do -O 36) ANon-pressurized In -ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In -ground ❑ Holding Tank /1 ❑ Single Pass ❑ Drip Line ❑ At ❑ Aerobic Treatment ❑ Recirculating ❑ Other: -grade nit W V Dispersal/Treatment Area Information: (. Design Flow (gpd) 2. DispersalAma 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required a Proposed b a , (O Rate (Gals./day/sq. ft.) Min./inch) ` Elevation VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete strutted Tanks Tanks // ev 10 1 Al p ❑ ❑ ❑ ❑ VII Responsibility Statement the undersigned, assume resmonsibili for installation of the POWTS shown on the attached plans. Plumbcrs Name (print) Plumber's SSiign�aturee((��): MP/MPRS No. Business Phone Number 7 9 7/3 Iumbees/Address (Street, City, State`,, Zip/ ode) VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued AgenTSiture (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) oe )tcp t t- t 7 -c9 Determination IX. Conditions of Approval /Reasons for Disapproval: t4vr 6co 4 - f1w 0 .2vn+e "Cy TlfF- I''DKeOw► pz-'IPo A-;,9P3L- c 90 W- � r� ,1\rr0o#� Pr-�-cW .� PorJT3191)K4�,1,ivo_picLNMWVIRAciut l 5PCA %V-«r,-tLtMs- °�tic wFlt t,.t(S� 13(3 �Mru tzs-%�rFws�..'ttPon7�TPtA�(E�dpN-lr1 ��#C Footr�-f�sS a,aQD, o, J SBD-6398 (R. 07/00) e of Survey for: KINGSBORO UGH HOMES House Address: 673 Cottaze Lane N1'i ' „ 13.04 jF x DRAINAGE AND t "�b CL = 30' 4 vacant I U�, EASEMENT ASEMENT 22.56 T — — — S02h! 6O'W -----.o! \ 1 95.13 \e IT 1 - 1—a I I 1 1 I I 1 I I 1 17 I- 1 I I I I I 1 1 I 1 1 I 1 I 1 1 )J �2n 't0 1 1 I 1 1 I I I 1 1 I 1 1 1 I 1 I I, to^�3` Nate'• �clelc� Gdj�i� bldo� \ 4ACb elegy,. pQr So.15 c„d O�a.n ^0 / 2 1 , 'rap aP P1p� A, EL 2 vacant ^~ J Ouse J;LAGEN16n/r %DER cw^)6,z ' --. 95 6.4 ST, CROLX COUNTY No. srcW(_tu+z-1sb SANITARYPERMIT, REPAIR ❑ RECbNNECTION NON -PLUMBING ❑ SANITATION REJUVENATION ❑ &uYl (a) The purpose of the sanitary p uto allow repair, reconnection, y��OWNERrejuvenation, or Installation of non-pllumbinmbing sanitation as described in the application for permit. (b) The approval of the santlary permit Is based on regulations In force on PLUMBER SAP& &&AD&I E LIC. # 4W&20 the date of Issue. (c) The sanitary permit Is valid for 2 years from original date of Issuance and may be renewed for similar periods thereafter. Application for renewal shall be TOWN OF LOCATED made through the county and shall comply with regulations in effect at the time. Sw� (d) Changed regulations will not Impair the validity of a sanita • /� (��' E C T Z / the time of renewal. sanitary Permit until -� N;R 9 �l (e) Renewal of the sanitary permit will be based on regulations In force at the time renewal Is sought. Changed regulations may Impede renewal. AND/OR LOT BLOCK �� (fl The sanitarypermit is transferable. A sanitary P permit transfer shall be obtained from the St. Croix County Zoning Department. If you wish to renew the penult, or transfer ownership of the permit, SUBDIVISION lease contact the St. Croix County Zoning Department. t AUTHORIZED ISSUING OFFICER -DATE THIS PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE TWO YEARS FROM ORIGIRAL DA OF IIISUANCE OST _IN LAIN V1 W VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION